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010-1033-80-020
~ 0 3 c I 3 o I m o I ~., ~ O ~» I p v~ I O o~ I 0 00 ~ I I ti o ~ I d, ~ % p c c .., g I ~ I ~ I ~ ~ I I I ~ I I N N I I ~€ I I I a 1 ~ I c I ovi I I I N I A y ~ ~ S ~ d I I C 3 I 0 h ~ E I ~ I 3 I _7 tll y I _a ~ I ~ a~ I aNi C I O o c Z I~ o 'o Z I 'a Z~ I ~ lL C U ~ ~ {L C LL C U 3 `o o I ~t ~ ~ I 3 v c I 0 0`~ I N M I ~ 3~ I N N ~ O p i. Z ~ •o ~ 'o E v M~ a m I d d I ~ d a~i I ~F-tn j I am I l am I c I I. I _o I «- o Z a ~ ~ N ~ I c X11 ~)~ a°i Z~ ° ° o I o ~ ~ ~,-;, o w I to F- ~ 4' a=i m Z 4' aci -' ` rn aci ~ y ~ ~ ~ I c~ E ~\ ~, ~ ~ E I _~V r~ E ~ c~ M I ~ E ~ ~ T\ ~ ~ y ~ ~ I w U ~ a t = ° ~ ~ a~ d ~ u`, I c° O c m I a ~ ~ I d ~ O I O Z J Z 'o I Z J Z Z J Z ~,; Z I ~ I ~,,~ I N :: `°° .. ~ c I ~ •. d I o I ~ ~ d N ~ ~ f6 ~ ~ (p ~ I N d ~ N J O W ~ ~ d •O N 41 ~ N ~"~ O G a .n ~ I M O G a -p ~ I m G G d -o ~ I bap zN>° ~~~~ a~ ~ I~~~~ ~-LL ~~~~ aLL w ~ o 0 o z I 'N a ~ a a a ~ I~ a a a I ~ a a a I rya ~ +r ~ ~ ~ co co ~ co I t v I ~i 7 p fn N fn ..i U i E N N Z I~ °o Z ~ oo Z _` I W ~ N O_ ~ N a N O O Y .~ ~ M O - ~ I '~' O O ._ ~ E I ~ M ~ ~ ~ fV .,.. O fq ~ y ~ ~ ° g ~ ~ ~ ~ N _~ m Q ~ ~ I= ~_ m Q ~ I ~ ~ m Q ~ I ~n ~ ?~ Q Z v) o I N d~ Q Z in I ~ 'a d Q Z cn I ~l .~i N O I~ fey/! C ` C ~ ~Yy! C C N C ` lOV ~ o m ~ I o o Ern ~ o o v m o v ~' \ °p cow lo- ~ °~ ~ a c a° I coo y m c I m ~~ c I v ~ c%~ ~ N'E c~ m'°N c .o ~' ~ p ~ U O_ N ~} C r '~ O U O N om} N Y M y ~~ N ~..~ M NI 'C ay+ C C N •C O d N C •O U N 01 N C 'fl • ~, G rn p N >• m ~ I a~ ao o w >, o I .c cc o N~ o I O o W j 2 v o Z N~ Y~ c~ 2 v o Z '? ~ Z c~ c o Z '? Y Z ~ f I I V ~ ~ ~ € E I E Y'dt a l € a I ~a I €a I • '~ ad;v ! m ~ ~' I da ~' I a ~ r`iv ~ E ~ c c •• c :: c c ;; c r A Val ~Omtpi IONV Otov I A Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building f~ivision * • '' INSPECTION REPORT GENERAI~rNFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 'ermit Holder's Name: ~ City Village X Township Hetrick, Matt Emerald, Town of ;ST BM Elev: Insp. BM Elev: BM Description: ~ •a ~ ~O . c7 ~ CST g tM.~' 1 a d.sf ° ~o.ao. Stils~~„ TANK INFnRMATI(~N ELEVATI DATA TYPE MANUFACTURER /ft. ~-(d0 CAPACITY Septic l,~ l ~17a / (~ Dosing t ~ C$~~ . n-! tl Aeratio Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ $ a / D(o / ~ e ~~~ Dosing ~ ~ ,~, f~ ~ ~ / Aeration Holding County: St. Croix Sanitary Permit No: 499103 0 State Plan ID No: Parcel Tax No: 010-1033-80-020 Section/Town/Range/Map No: 14.30.16.2066 STATION BS HI FS ELEV. Benchmark 5 .l S (oS.~S ~ ~. ~ Alt. B ~w ) r / qsa Bldg. Sewer 1z~`13 r 9Z_22 SUHt Inlet ~ 3 • ~ O ~ Q , 2~ ~ / SVHt Outlet ~ Dt Inlet ~' Dt Bottom '~~~ ~~ ~_I Header/Man. ~ ~~, ~/ / Dist. Pipe / Bot. System ,b fi • ~} ~ Q~ /~ / , Final Grade ~~ ' w. S / St Cove 1 ~~~~ ~'~S t~Q~...~' ~ „ ~ i3.~e ~j~. 3 ~ Pl1MQ'/SIPHON INFORMATION .Jr'-- x,10• ,/ Manufacturer L Demand 1~ GPM odel Number 7 ti ~ DH Lif ~,,L Friction Loss System Head TDH Ft ~• ''CC''~~ i.31 tr•~s Forcemai L ngth~ i Dia /r Dist. to Well ~ / ~ / ~ Cull ARi/1RPT1(1N CVCTFM / ITT\/'/l w__ a..a.~ /~1-~twLL ENCH DIMENSIONS Width / 3 Length V /- ~( / ~ No. Of Trenches Z) PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 24• !~v ll J SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING ER OR Man t e~/ 1 Ctrt~B~~ INFORMATION Type Of System: v • ~ t . J I "' 2 ~ I~ 1 ~ CHAMB UNIT Model Nu ber: IIICTDIRI ITI/'1N CVCTRM Header/Manifold t~ Distribution x Hole Size x Hole Spacing Vent to Air Intake ~Ge" Pipe(s) in h Di S Dia Length g pac a Lengt Cull P`!~\/CD .. n-___..__ ~.,..~....... n.. i.. .... ~n.....,a nr e4_(Ar„In Sve4amc nnly Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes No Yes No C MI~I~TS: (Includ~,code dis r nc s, persons present, etc.) Inspection ##1: ~~ ~~ Inspectiur~ rr2 ocation: (/1573 2r50th~SS eet Emerald W1~540 3 (SW 1/4 NW 1/4 14 T30N R16W) NA Lot 2 Parcel No: 14.30.16.2068 1.) Alt BM Description - ~ 2.) Bldg sewer length = ~ 1 A - amount of cover = ~Z fi Plan revision Required? i Yes , No ~['~ I Use other side for additional informs If'on. __ ~~} '__ I~~~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division 201 W. Washington Ave., P O Box ~ 102 ~SC~~S~n Madison, WI 53707 - ? 1 De artment of Commerce (~8) 31 Sanitary Permit Application In accord with Comm 83.21. Wis. Adm. Code, personal infortnan u provt c ~~r may be used for secondary purpbscs Privacy Law, s15.tyi(l)(m) I. Application Information -Please Print All Information L _~ r_E~V County! ~ ~~ Sanitar~y~Permh //Number (to be filleC m by Co) I State Plan 1. D. Number _._-- Projec~ Address (i(diffcrcnt than mailing address) I -~ /5 ~3 25ts +~-. ~- . Property Owner's Na me Parcel p Block X I Property Owner's M ailing Address TY ~~`~ Property Location i r/ 5 2.50 f~ ~' f S~ - ~RO~x ~ ~ ~w u , Gy '.c , Secnon City, State o/de Number Ziep C (circle one) J10 G( 7, ~/'f~G.~/l~!'~-!/ GeJ~ ~ J'~G~ ~fs~7g~~~f2.~ ,~ . 1 R~E or~ T 3~ N II. Type of Building (check all that apply) O ~ v~e.r~ // ~ k ~~ ~` I . CSM Number, Subdivision Namc ~~,, ld~l or 2 Family Dwelling -Number of Bedrooms ~~jylq~ 1(C.d[ ~orJ~SL_ ~ ~a.~. Q ,/ i ~ ~~ / U r ^ Publtc/Commercial -Describe Use _____ r ~ T _~~a'~~3`$a' 6~ ^ State Owned -Describe Use sb~"' ~ w ~7'f' ~ ~Cip_'^~~Ilage ~ownship of ~wICICAe}e;,~~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ^ Replacement Systtm ^ TratrnendHoldin Tank Rc lacemeni Oc g p .y ~ Other Modification to Extsun S stem 8 Y '; B. ~ Permn Renewal Permit Rcvislon ~ ~hange of ^ Permu Transfer o ' i.tst Previous Permn Number and Date Issued I ~e~~ Before Expiration Plumber Owner .~#' -3231 ~ i_ fV. Type of POWTS System: (Check all ,that apply) ____ _ - I Non -Pressurized In-Ground ^ Mound >.24 in. of suitable soil ^ Mound < 2a :n of swtarlc so.. ^ At-Grade ~ Single Pass Sand Ftlter _~ Coruwcted Wetland J Pressurized In-Ground U Holding Tank ^ Peat Filter _ ,\e :sic : -eatment tJnu _- Recir laung Sand Filter ' 1` u Rearculaung Synthetic Media Filter ^ Leaching Chamber ^ Dri Line ^ Gravel-iess P,iK ~ Other (explain) ~ ~ _y 1~ V Tlicnnreal/T'rnatmant Arra Tnfnrma[innc Design Flo (gpd) Design Soil Application Rate(gpdtf) ' System Elevation' (sf) I Di~rsal Area oposed~~1~ Dispersal Area uired 1 ~ VI. Tank Info Capacity In Total Number Manufacturrr Prefab ~ Site i Steel I Fiber Plastlt: ~ Gallotu Gallons of Units ~ oncrete Corutructed Glass ' Teinks Txinksng //{{~~,~ ~ ~ ~r/CJ __ _._ -- -- - Septic or Holding Tank ~~~ ~ GvPG-S~.C Gl'~+'rG~ ~_ __~~ nerobic Treatment Unit i Dosing Chamber _ / Gam.. tP ~~ ' VI1. Responsibility Statement- I, the undersigned, assume responsibility for installanon ~~( the f'Os~_fS shos~n on the attached plans. Plumber's ties me (Pn t) P m s Si gna r MP/MPRS ~'urntx: Business Phone Number ~ /~.f. ~~~.5 ~ 2 2 -~~/7 ?~5-~ ~3-a52~1 j Plumber's Addre ss (Street, Ciry, State. Zip e) ~ r 55~ ~ ~A•fG- /L~ ~'4~~,~a ~c~tliccC, cc, ~ 5~7?S '^ VII1. County/De artment Use Onl __ __ Approved Sanitary Permit Fee (,in/cludes Groundualrr :)ale Issu ! Issuing nt Signa e ( S ~ i '' Surcharge Fee) X 75 . ~/N ~ ~ ~ ~ O Given Reason r Denial ~j / `~J __ IX. Conditions of A rov~1/Reasons for Disapproval , , sYSTHIA~MeR: 3~ /~Js~'-- ('ew,.u,...._. J~D ~ t-fo,,~ !~f-Lr~ ~ ~'~o.-i- i 1. 8dptic tank, e/fluer~ tUNf amd ~ dktpersei teeN must aA es par management plan Provided ~ plumber. 2. AN seQ~ack roquiremertts must be Tralinteirtsd I as pef appicab4e code / ordirwlCes. Attseh complete plans (to the Coueq od)) for the sTstem oo paper not less than 81 2 z l l inches in size 3~ SBD-6398 (R. 01/03) E f2t a f-~ ~~-~~ cK SI~4 ~"30~ IZ lG w ~~EK..pt,~ ~w St ~`~= ~~~ ca~N ~ y F ~~~ V_ ~ ' ?~ (bt. = ~v r , o ~~ ~ Afi ?ns~ e F s-r~. ~'ff-KE gru ~2 ~ /ao.o ' ic%~c fin/ !e r' g~,rcrf ~,~-~. BI _ /oa.v 82. laa.o' v~3-99./~ S Cf~C.E ~~r' ~~ 1 ~~ ~~ ~ ~ ~'Gt a f-/ /~ ~i2a cK Sw'/~. ~(w'/.~ SI~4 7"3orf IZ lG w ~~EK.Ht~ '~`.,~ SI ~~ e~x c%N -~ y ~~~ V_~ .~ a hl. . /v~, c AYE Afi ?etst ~~ s~r~. ~ KE g-u ~2 ~ /ac . a ' g~ - /OO.O ~ 8Z. laa. d $3=~y,~~ S uKE / ~ r= ~~ ' Wisconsin Department of Commerce Division of Safety and Buildings ~RIG~1~A~ SOIL EVALUATION REPORT in arenrrlaneP with (:nmm R5 Wic Aram Cnrla 1841 Page 1 of 3 Certified Soil Testing County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must i l t li d b t it d t i l d h ri l f Croix St. nc u e, u no m e o: vert ca an o zonta re erence point (BM), direction and _ _ percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 7.145 A CSM Pending Please print ~founattara... _ , _~,_....,, 1 R iewed By Date Personal intorma6on you provide may be us for secoh~al~`p~u~po5~(Ptivypt.~W, s. 15. (1) (m)). ~ Oz Property Owner Property Location Jungwirth & Manke, Charles & Rose1 ~~!i ~ :7 G 't. dot SW 1/4 NW 1/4 S 14 T 30 N R 16 W Property Owner's Mailing Addre~ y Lo~ # Block # Subd. Name or CSM# 1551 250th St. i § 2 Pending City State ZirxCod,~Phoft~,;J~~~.b~j _ City ~ Village ~ Town Nearest Road Emerald ~ WI 54012 715-265-4811 Emerald 250Th St. _-_ _/ New Construction Use: /' Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement _; Public orcommercial -Describe: Parent material sandy/loamy outwash Flood plain elevation, if applicable NA General comments and recommendations: install 643 sq ft leaching chamber trench @ system elevation of 96.5 for 3 br (assumed) a Boring # Boring ~• 2.~ r ` Pit Ground Surface elev. 100.0 ft. Depth to limiting factor ~ 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' 1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 _ 'Eff#2 1 0-7 7.5YR 3/2 - sl 2 m gr ds gs ! 1f/m .5 .9 _ (p 2 7-40 7.5YR 4/4 - Is 1 f-m sbk ds gs 1 m/c 7 1.2 y2 3 40-80 7.5YR 4/4 - s 0 sg dl - 1 m .7 1.2 -- -~ a74 ~~•Ol tr --- -------- r 3~ ~ Z - - ----- - occasional gr/cob/st 0-80"; 1 m to 60" ^ Boring # Boring Pit Ground Surface elev. 100.0 ft. Depth to limiting factor ~ 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-4 7.5YR 3/2 - sl 2 m gr ds cs 1f/m 5 .9 2 4-28 7.5YR 4/4 - Is 1 f-m sbk ds gs 1m 7 1.2 3 28-48 7.5YR 4/4 - Is 1 f-m sbk mvfr gs 1 m .7 1.2 4 48-80 7.5YR 4/6 - s 0 sg ml - - .7 1.2 ee,~- ~1 - ~ 56 ~ --- - ,~,~ / occasional gr/coblst 0-80"; horizon 3 is occasionally ml ' Effluent #1 = BODS> 30 < 220 mg/Land TSS >30 _< 150 mg/L 'Effluent #2 = D < 30 mg/L and TSS _< 30 mgr CST Name (Please Print) Sign to CST Number Henry F. Grote `- 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 8/18/2003 715-233-0398 .(p .'~ . ~. ,~ Property Owner Jungwirth & Manke, Charles & parcel ID # 7.145 A CSM Pendi Page 2 of_3_ a Boring # `_J Boring " /~; Pit Ground Surface elev. 99.1 ft. Depth to limiting factor > 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0-5 7.5YR 3/2 - sl 2 m gr ds cs 1f/m .5 j 9 2 3 5-21 21-30 10YR 4/3 10YR 4/4 - - sl sl 2 m sbk 2 f-m sbk dsh dh gs gs 1 m 1 m .5 ~ .5-~i! .9 --.9 4 30-36 7.5YR 4/4 - sl 1 m sbk dh cs 1 m .4 .6 5 36-48 7.5YR 3/4 - s 0 sg dl gs 1 m .7 ~ 1.2 6 48-80 7.5YR 4/6 - s 0 sg dl - - .7 i 1.2 -- I i ^ Boring # _ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots / ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -- i I --~- - - I -- ~ --- Boring # ---''~~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _ "Eff#1 "Eff#2 -- -~---- i - - ~ i, ' - - -- -- - i I ---- ~ -- "Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <_ 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3 I51 or TTY 608-264-8777. .~ (r . (p . '- f .~ . ~- SBD-8330 (R.07/o0) Certified Soil Testing Property Owner Jungwirth & Manke, Charles & parcel ID # 7.145 A CSM Pending Page 2 ,of 3 Boring # Boring 1 - I Pit Ground Surface elev. 99.1 ft. Depth to limiting factor > 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P : in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-5 7.5YR 3/2 _ sl 2 m gr ds cs 1flm .5 .9 2 5=21 10YR 4/3 _ sl 2 m sbk dsh gs 1 m .5 .9 3 21-30 10YR 4/4 _ sl 2 f-m sbk dh gs 1m .5 .9 4 30-36 7.5YR 4/4 _ sl 1 m sbk dh cs 1 m .4 .6 5 36-48 7.5YR 3/4 _ s 0 sg dl gs 1 m .7 1.2 6 48-80 7.5YR 4/6 - s 0 sg dl - - .7 1.2 . ~o . (r • (P . '-~ .~ . ~- ^ Boring # `-- Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2 __ I ~ _ i -- ----- T r - ---- - i - i I - - ^ Boring # ' ~ Boring _~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i i . ---- - 'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L s- - The Department of Commerce is an equal opportunity service provider and employer. If }'ou need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Certified Soil Testing .` ,i ., _-- a J a 4- c d 1 ~~ ~~ ~~~ f d ' ~1 Y 0 C d 3 s 1 1~ J a d 0~ ' ~ !3~ V, D M ~~~ (_~ ~) ~ o c~'" m ~ g~° ~ a ~ ~~ ~r"; ~ ~ ~ ~~. - ~ _A ~I S ~ r V '~ i .,.J ~ ~ ,~ ~ ..S° 0 ~ +A ` ~~ ~x ~ ~ ~ ~ ~ ~ ~ ~ N 3 Dd= ..-._~~ o ~~~~~~Z r /^' f ~ +1 / p M ~ s '~ ,%, ~ ' ~ ~ o ~ 3 I O Y ~ ~ F ~.~ G- ` ?, 3 4 g J U / C PA VJ~ W ~ o j -; ... ~ ~ ~ 1 -~r s f ti~ ~[ o ~, ~ `' _. `n f - -- ~ / ? p s ~, \ `~ r~ ~ ~~ g ~_~ a '=-£~~~ ~a~a~ :7n Tl(t~~ ~~~m~T ~~T~,^,. -=>n>~ .^.OQ~O~ `» > `» > ,„," ._ ~ ,~ 9EH SERIES SUMP/EFFLUENT PUMP Specifications. RNIDEL CAL SOLIDS SIZE RUNNING PERFORRUNCE (sPN Q NEAD- SHUTOFF PTYA. CRD. FLEIONF OIAN]LSIONS N0. pg, LIS11N6 NP VOLTS P.S.L Nh• lo.) AMPSIMAFTS 5' 1M 15' 21' Ihl 1Ft- (l6s•) IH x L x VO 9EH-qM 509330 UIICSA 4110 .115 314 13.0 1000 70 64 55 41 32 13.6 20' 24 9.11 x 11.64 x 6.94 9EH-CIM 509340 UI/CSA 4110 230 3/4 6.5 1000 10 64 55 41 32 13.6 20' 24 9.11 x 11.fi4 x 6.94 9EH-CIA-AFS 509350 UUCSA 4/10 115 3/4 13.0 1000 70 64 55 41 32 13.6 20' 27 9.11 x 11.64 x 6.94 9EH-CIA-flF6 509360 UUCSA 4/10 230 3l4 6.5 _1006 70 64 55 41 32 13.6 20' 27 9.11 x 11.64 x 6.94 Continuous Duty Rated-"LNtle Giant Wastewaterpumps are rated continuous duty as long as they are run withlnthe published ratings forthese pumps." FLOW- LITERS/HOUR 0 1000 2000 3000 I VIII, 30 w zc W ~~... - 1C u cu 4U bU dU FLOW- GALLONS/MINUTE PUMP PERFORMANCE CURVE I15V 60HZ www. LittleC><iantPump.com to ~.s W W a -~ x z.s 0 Construction Motor Housing Epoxy Coated Cast Iron Impeller Material Poly Carbonate Im eller T e Closed Vane Volute ABS Power Cord SJTW-A N,J,e,~ ""11 ~~// ~nical Shaft Seal ~- ~hS : h Nitrile with carbon and ceramic faces Fasteners Stainless Steel Shaft Stainless Steel Bearings Upper Sleeve and Lower Ball Bearings ~r `i lI~ l `~arR4 a•` °j C(7u~ 'S~ ~ x Little C><iant Pump Co. PO Box 12010.Oklahoma City, OK 73157 Phone: 405.947.2511 • Fax: 405.228.1550 E-mail: customerservice@littlegiant.com Form 995235 - 07/03 y s 4 • Page 1 of 4 ~ ~ ~ ~ ~ ~Y~TEM S I N C Envirnnmental C?nste 4Unsttwv/ttrar 5afutians °" Leaching Chamber Design Spreadsheet Project Name: Hetrick-Conventional Owner's Name Matt Hetrick Owners Address / 5? 3 2 5 0 f~ s "t EYLt.EKAi~ it w / $'FO l2 Legal Description sw • y4, Nw~ /4 Sec 14 T 30 N, R 16 w , ~ Township Emerald County ~ Saint Croix ~__- -- - - Subdivision Pending Lot# 2 Parcel ID# 7.145 A CSM Pending Table of Contents pg• 1 Cover page 2 Calculations and Drawings 3 Management and Contingency Plan 4 Plot Map total # of pages: 4 Designer Name: License #: Date: Ph. #: Signature: Lyle J. Myers 77AR17 L/V/VV 716-643-2520 Design Methods Used "IN-GROUND SOIL ABSORPTION COMPONENT MANUAL FOR PRIVATE ONSITE WASTEWATER TREATMENT SYSTEMS" (Version 1.0) SBD-10705-P (R.6/99) svsrenns No Infiltrator and the Infiltrator logo are trademarks of Infiltrator Systems, Inc. .,,:,,~~"n„~,,,.,.~,.,M,~ Spreadsheet provided under license to Inriltator Systems, Inc by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 ~.. ~ , *. SYSTEMS INC Calculations and Drawings Page 2 of 0 Site Conditions Infiltration Elevations Site Type: Private ~ ~ %Slope 4.5 # of Bedrooms 3 Depth to limiting factor 80 inches Soil Application Rate: 0.5 gal/ft^~ Effluent Quality erg #1 ~, • Design Flow: 450 gal/day Max BOD 220 mg/I Max TSS 150 mg/I Septic Tank Cross Section of Septic Tank 12" Min Trench #1 Trench #2 Trench #3 100.00 99.50 0.00 96.50 96.50 0.00 Ft II Ft 93.33 92.83 N/A 3.17 3.67 N/A 0 0 N/A In 100.00 99.50 N/A Distribution Cell Choose chamber type: Infiltrator Quick 4 Standard- I - I # of trenches: I ~ ! ~ ~ Chamber Length: 4.00 Ft Chamber EISA: 19.1 Ft2 ', Endcap EISA: 5.8 Ft2 3 Required Infiltrative Area: 9~.0 Ft2 (oµ G~ . Actual Infiltrative Area: 9'9$.3 Ft2 to Total # of Chambers: ~4 ~~ Total # of Endcaps: ~' ZCSG~ Combined Length of Cells: 12,0 Ft i 131 Cross Section of Cell 18" Min Cover Material Observation Pipe (if required) _ -Final Grade Alljoint to ~ -~~ e Wate tight D3034 or Ground Effluent Sch40 Contour Filter Pipe Leaching System Chamber Elevation 3" Bedding Under Tank ~J ~bsef#~r1 IerwaUctl 1~~d'i l+bf~l ~~ l~lp~ I'~re ~r ~~ I'VC p Infiltrator and the Infiltrator logo are trademarks of Infiltrator Systems, Inc. Spreadsheet provided under license to Infiltator Systems, Inc by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Contour Elev: Infiltration Elev: Limiting Factor Elev: Treatment and Dispersal Zone: Cover Material Required: Finished Grade Over Cell: Manufacturer: ~,uiESF.ie, Gatc Volume Chosen: o00 5o c.Y Effluent Filter Selected: Zabel A100 Note: Access opening of sufficient size to be provided to allow removal of filter. Opening to terminate at or above grade. Page 3 of 4 In-Ground System Management Plan pursuant to Comm 83.54 W. A. C. Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludgelscum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with IVR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Absorbtion Cell The absorbtion component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank or other components therein (including floats, alarms, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the absorbtion component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by removing the clogged bacterial mat, aggregate/leaching chamber cell, and distribution piping within the cell and replacing failing components in order to return system to proper working order as required. If repair is not feasible, a new system is to be constructed in a designated replacement area ,, State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Number ~~ Document Name THIS DEED, made between Daniel R. Shackleton and Nicole L. Shackelton, husband and wife ("Grantor," whether one or more), and Jody Wittmer and Matt Hetrick ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St.Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): That part of the Southwest Quarter of the Northwest Quarter (SW 1/4 NW 1/4) of Section Fourteen (14), Township Thirty (30) North, Range Sixteen (l6) West, described as follows: Lot Two (2) of Certified Survey Map recorded in Vol. 18 of C.S.M., pg. 4656, as Doc. No. 747510. SUBJECT TO a joint driveway easement as shown on said Certified Survey Map. Exceptions to warranties: easements, restrictions, covenants, and rights-of-way of record, if any. 8 1 859 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 02/13/2006 11:40AIf YARRANTY DEED E)<EI~T # REC FEE: 11.@0 TRANS FEE: 184.50 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Retum Address St. Croix County Abstract & Title 252 South Knowles Ave New Richmond, WI 54017 010-1033-80-020 Parcel Identification Number (PIN) This homestead property. (is) (is not) Dated February 9, 2006 ,, i GG~ ~ (SEAL) ` A ) * Daniel R Shackleton * Nicole L. Shackleton SEAL) (SEAL) * Signature(s) AUTHENTICATION authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (lf not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Wertheimer and Associates Hudson, WI 54016 ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. . CL V-C% l k C011NTY 1 Personally came before me on February 9, 2006 the above-named Daniel R. Shackleton and Nicole L. Shackleton husband and wife to me known to be the person(s) who executed [he foregoing instrument and acknowledged the same. 1.,,.'. /'~.~~4'P' lea', L~ Notary Public, State of Wisconsin My Commission (is permanent) (expires: ~ - (S - ~ L>L' (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Typc name below signatures. 818509 1 of 1 Parcel #: 010-1 b33-80-020 osio7i2oos 08:23 AM PAGE 1 OF 1 AI't. Parcel #: 14.30.16.2068 010 -TOWN OF EMERALD Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O O D E JODY WITTMER - HETR C K, MA T T C MATT HETRICK 910 1ST GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description * 1573 250TH ST SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 7.145 Plat: 4656-CSM 18-4656 010-03 SEC 14 T30N R16W PT SW NW CSM 18-4656 Block/Condo Bldg: LOT 02 LOT 2 (7.145 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 14-30N-16W SW NW Notes: Parcel History: Date Doc # Vol/Page Type 02/13/2006 818509 WD 11/22/2004 780562 2700/200 WD 11/25/2003 747510 18/4656 CSM .07/24/2000 626904 1528/589 GD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/19/2004 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 7.100 49,000 0 49,000 NO Totals for 2006: General Property 7.100 49,000 0 49,000 Woodland 0.000 0 0 Totals for 2005: General Property 7.100 49,000 0 49,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ,,,.rte"" ~ Safely nail ioi w. w~b~t.. ,~., P_o. s ~nua m = /SC~I~S~/~ ~ ~ t ®$ 2~ ~ u I rrvo~c~ee~ea m eyco.} ;~.y De artment of Commerce A~ 3 ~JIJ t Z Sanitary Per-mit Applic~t . cR ~ cc LD. Naa~er In accord vvffit Caaml x3.21, ~ Adn Code, petanod ~- ,~, ~ ~ ~ > ~ , a15. Ep lhoject Addaeai caTd~t ~slt address) L Apptiatioa Ietasmatioa - Please PriaR A~ Id'wwadioa T ' ~ ' 7 s . s 73 Fropmty tawna's Name Papa s tot • Block # _ -~ ~ Gv ST. CROIX COUNTY ~ YO-OZG 2 ^- Propaty Owner's t PmPetty Locatim a ~ ~`~ .i T ~ se~i°° emu! y ~l lL City, State 2~-Cade PboaeNuaaber s. l. _ ~~ rJ ~3 ~~ (~ ~) 8 or W ~7 N; !t~ T IL 7~pe ulNo7diax t alt t)rac apps} ~ _ ~ ok Q.s s ~ b r, : CSMN d i i d or2ram~7yDwdtigg-Nmaberafl3ea~oae~t ~ /~fAa) _~,ta.. oa ~er iv s ooliame S~ _._---- _._ l ^ Pu61i~Comaoereiat-Deacnlre(he _ ._ ^ state owned- tkaaibc ()se ^cicr_^vil~e ~'1`owaship ar~~,rca~d >n Type of Pam C~~ ax baa..lre~. Cspleie iateB dam} ~ C - I ~: `+. fl~rlew system ------- ^ lte~lacmaent System ^ Tack Rgdacaavaat Only ^ o8,v Modification m 13ostiAg 5ystenn B. 0~tamit Reuetval ^ Pamit Rsr:sim ^ CbaoBe of ' '6aoafer bNex List Pieaiaoa lkmlitNaaaber nail Date tssned . F>tmaba ~ 2 Az ly. T of POW15 C'l.edc s/ flint t+J Non -Pressurised Iu-Gromid ^ Mamd> 24 is of sdtable sal ^ Memd <24 0. ~a~ so7 ^ At-(1~ade ^ Sis~le Pats Sa®d Filoer ^ Card Wetland ^ Fred ia-Caavad ^ F~i~ Tack ^ P~ FitBrr ^ Aerobic TratmeaetUait ^ Recaa~g Sand Fitter ^ Merin F~ ^ Leacb~ Cisuiror o Drip tine ~ ^ >~ipe ^ o~ t - ~ -5/5 V. area Ieferasalioax ~ -- 3 ~. c ~ct~ ~ son ~a lte9u~ es~ Area g, ~ ~ system °"c i ~,~d / / s ~ ,~ VL ank Info ~ Capacity in Total Number MauaSadua~ Pm~b Site Steil Fiber Plastic t3a11oos Mons ofUQits Caacrete Coaextv~ed GEass Near Tale Tats tDL ~a~ Aasdiic TWmmt I}ad ~6 arai6tr W. Responsibility S"Eatess~eat-1, tke a~3ar~d, awe rij !or iesfaWtisa ort4e PORRS ahmn w tie pleas. Plmubrr'a Nsme (Print) Fiamber's Sig.lme ii~/Mf?'R.S Number > Pioae Number /,~ ® ~ o ~ hs- move Plumber's Address (SUeet, City, tip z~.zPF t'- tlTv- v>m. >~e ^ _ ~; Fee (ate Date o ) '~j • °0 3 9 ^ iteatan for ><x. Conaitioae ol'Y~lppravaUitasoes forDis+grpt..al ~/ /tea ~a~- , w ~T a,~~o~,~e ~~ ~ct: f i. ~ t J ~ ~ ~rt ~' ~ 6 f ( ~ ~i ~ ~ , tr e at~ ~ mast t pers . • as per management p~ t b'f-1 _ 2. AN aelbaclt regttirerrlerlts must be lr+airdaMed es per Mode ! cldirtallces. AHai !~ (m aklJe~afry ~P) ear Ole ~ a paper mews ®~ ws: a awaio ~a see ~~ SBD-6398 (R. 01/03) ~ ~~~~~~ Fogerty Plumbing ,~_ ,---- r~2211$0 2~32~?3 P.9cKenzie Rd. Sp~ars~r, Wt 54801 (715) 635-9609 ~ Combination Tank Component Crass Section ~3 ` Approved Manhole Covers With Warning Labels and LockingDevice / 4'" Min. Above Final Grade 4" 5ch. 40 Vent >or=m 12" Above Final Grade ~ ~ ' Inlet ~ _ Bffiueat Filter < or= to 1/8" Ba~i~ Particle Size A Weather Proof Junction Box Electric per NEC 300 8c COlvflVi. 16.28 WAC ~.. ~1 B C Tank Mfr. w,~rs~c ,~'.~do D Alternate outlet Location W/Approved 4" Sleeve _ Force Main Diam. _ " ~ - x~ Hole or Anti Siphon_~evice Pomp OffElev. Dose Tank Elev. _ Veztical Duce Between Pump Offend Distn'bution Pipe = ~°_ " PST. ofMaia a ~ 2 Fnct,<on~ Facbar/100FT.... _ ~, ~- Total Dynamic Head .................... _ //, z- ~ - Number of Doses ... _~ Per Day Gil. PerDay/ #ofDoses = ~3aGa1. ` Volume of Bad~ow ....:./.&.~! .~.. X~ ...................................... = 7. gip' Gal. Total Dace Vol~e .................................... ................................. =,/~1 pump Tank Opacity 7 7 3 Gallons . Dimensions Inches Gallons Pmonp Tank Vohme . t GaUlnch A 3/, s Sp3• s9 B 3 YY.3G ' Pump Mii 6-a~uL /~ C 9.7G ~~3 Pump Model ~~ a ~/ D ~_ ~' I~um Discharge Rate = ~' .GPM . AlamuMfr. ~- i ~~~ Tota1= Y~ 77~1L Alarm Model ~ro l -o! ff Bed Tank per COMM. 83.45(5) Anchor Tank as aeoessary to nepte lxwyant forces Per COMM_ 83.43(BMgJ_ . ~.~anr-., . Up to 40 GPM Discharge size 1'/°'NPT :~' Solids: ~~ maximum Motor `~ Single phase:115V Materials of Co~>IStruction Brass/thermop~istic Features and Benefits •Top suction eliminates impeller clogging. • Corrosion resistant construction. • Float actuated switch. METERS FEET 25 ~ MODEL DUP03 O 5 ~ a = 5 v 15 a 4 3 10 6 2 FFi 5 1 0 00 5 +0 15 20 25 30 35 40 U.S.GPM 0 2 ~4 5 8 10f03AH CAPACITY °/+o and'/z HP • EP04 impeller- semi-open design Up to 60 GPM with pump out vanes to protect Maximum head to 32' mechanical seal. Discharge size 1'/:" NPT • EP05 impeller -enclosed design Solids:'/•" maximum for improved performance. Motor • Rugged glass-filled thermoplastic All motors feature ball casing and base design provides bearing construction. superior strength and corrosion Single phase:115V resistance. , Materials of Construction 'Cast iron motor housing for efficient heat transfer, strength, Cast iron Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. - • CSA listed models available: All Models are designed for continuous operation and feature stainless steel hardware. Wisconsin Department of Comme~rcL PRIVATE SEWAGE SYSTEM Safety and Building Division ~ ~` INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Hetrick, Matt Emerald, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFOIZ4AATION TANK SETBACK INFORMATION \ PUMP/SIPHON INFORMATION /' ~ anu ac urer eman GPM o e um er i nc ion oss ys em ea or emai ng a. JVIL A13.7VK1"' I IVIV .7 T.71 GIVI J ELEVATION DATA county: St. Croix Sanitary Permit No: 488092 0 State Plan ID No: Parcel Tax No: 01 3-80-020 Section/Town/Ran ap No: 14.30.16.2066 ,.~'' STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. ewer t/ t nlet t t t et 0 om ea er an. is . ipe o . ys em ma ra e over COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection ~~: i i Location: 1573 250th Street Emerald, WI 54013 (SW 1/4 NW 1/4 14 T30N R16W) NA Lot 2 Parcel No: 14.30.16.2068 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = _ - - -- Plan revision Required? Yes ~ ~ No I II ~ Use other side for additional information. ~ ~ J -- - ~- -------in --- -___ -Cerf N~ _. _ _ . _ SBD-6710 (R.3/97) Bed/Trench Center Bed/Trench Edges Topsoil i Yes '' No ! es No I ~+ ~ Safedy a~ Bnildiags Divisi~ ' 201 W. Warrington Ave., P:O. Box 7162 ^~~~~~~ Madison, WI 53707 - 7162 Sanitary Permit Number (to 6e filled in by CoJ ( 26Cr3151 ~/$ Z De artment of Commerce Sanitary Permit Applica state Plan LD. Nwnber In accord with Corrm- 83.21, Wis. Adm. Cody petsoaal ' may be toed for secondary purposes Privacy La , s15. E ® Projax Addrtss (if differatt than mailing address) I. Application Information -Please Print AQ i[nfotmation ~ T ~ 73 ~ .S Property Owner's Name Parcel ~ Lot # Block # -~ D GtJ ~ ST. CROIX COUNTY _ p -fro-p2 2 ^- Properly Owner's Mailing ~P~Y I-ocati°n v ~ lF ~ Yy Section ~%~ City, State Zip Code Phone Number _ . ' ~K/Gf/~® C S' p ~f 3 =~S = ~ (cattle orte) T 1~ N; R~E or W ~!J l ) ( all that a f Buildin II T pp y g pe o . // O fC 2S 5 ~ b r~ : ~' ~ ~ Subdivision Name CSM Number .. `fog) Sp l ~ or 2 Family Dwelling - Nttmber of Bedrooms 7 ~- D ib U ^ P bli /C i l se ommert escr e u c a - ^ State Owned-Describe Use ^Caty ^Village township of~i ~jj III. Type of Permit: (Cheek only one boz en Tine A. Compl~e 6mc B if applieabk) A' (L~New System -~ ^ Replacement Systeart ^ TrtUHoldang Tack Replacea>eatt Oely ^ Other Modification to Existing System B. L~f Yermit Renewal ^ Permit Revision ^ Change ~' ' Transfer to New List Previous Permit Ntmtber and Date Issued Before Expiration ~_. Plumber ~` 2 ~L IV. T of POW'I'S S Check a0 that a l7 Non -Pressurized In-Cuotmd ^ Mound>_ 24 in. of suitable soil ^ Motmd < 24 is of snitabk soil ^ At-Grade ^ Sirgle Pass Sand Films ^ tri Filter ^ a Constntaexl Wetland ^ P'ressuriaed In-Grom-d ^ Hold'mg Tank ^ Peat Filter ^ Aerobic Ticeunatt Utut ^ Recirculating S ' / Recirculating Media Filter ^ Leaching Chamber ^ Drip Lice ^ Grave!-lens Pipe ^ OUter explain) '~` 5 V. 1D' rsal/l'r~catmentAresInformatioa: ` ~ ^ 3 ~. 'C n Dispersal Area Required (st) Design Flow (gpd) Design Soil Applicatio Arta sF) Dispersal g 7(. ~ ~ J Sy~ern Elevation ~ / ~7.d ~ / ,/ / S ~ ~- VI. ank Info Capacity in Total Nttmber Manttfacptrer Prefab Site d Steel Fiber ~ Plastic Gallons Gallons ofUni~ Concr~e Constructe ~ New Tesler Tanta OG F Septic m v^'~~°-'...- Aeroluc Tn~dnent Unit Dosing C7rnrLer VII. Responsibility Statement-1, the ontlcrsigaal, assrrak txaportslbtltty for utstallatioo of the POWTS shown oa the attached plans Pltmtber's Name (Print) Phutiber's Signadue ~IvIP/it~RS Number Bttsiness Phone Number Plumber's Address (Stieex, City, Zip ) .Z~.z~F ,ic o t- ti!Tv- VIII. Coon /D tlment Use On S~~Y Permit Fee (includes Groundwater Date Issrt' Si to o S ) pproved ^ isappro ~~ S'ntharge Fee) ~{ 75 00 3 9 ^ ~ t Reason fce •(.~ IX. Conditions of ApprovaUReasoos for Disapproval ~a ~o~- ~~w pToJ c~,~~owe ~~ ~Q•~ gy>tTpAOMMER: J - t. Septic: ttmk, taffhlerd fNter tttrd ~ 6 r l t i ~~ l / ---~ it> s es (/ ~ dispersal cell must all be services / mt as per management plan provided by plumbtar. -~-s----------,_ 2. Au setback requirements must be maintained ss per aPPNca-bk tide /ordinances. Athelt eempeoe pair lm tae a:oaaty ~9'1,~ ~ s~~ w rH,~• •~• •°~ •••~• °°~ SBD-6398 (R. 01/03) Y NI ~ «~~ ~ _o _ O ~ ~ N~~ ~ . ~ ~ 0 \ a 2 ~ ,~ C dN ~~~ A ` ~ ~ ` *N p _ ~ 1f#N Cn ~ V ti ~ a N N i J :~~1 , 1 l~ /` h j ~ J H ~ ~ a 3~ ~~~ \ ~. I~ W N lg ti ~l N M k ~~ \~ \M\ J -` Q ~ a ~ 0 0 ~ ~ p ~ ~ ~ J ~I N ~ ~ 3 ii ~j l~ V~ !~ V` ~ ~ `~~ W J M h ~ ~ ~ ~ -~_ s p +: C 3 ° ~~ ~ ~ a ~~ ,i Q a x 31 ~ a '!.~ ~Zi W a of ,ry o p. v a v J w `~ ~o ~ ~° 1 V s ~ V oP'~ Tl r[~ ~© v ~ c ~o~ ~ u ~~ ~~~ ~ \ o.N v~~ ~ ~ ~N .~'N cam'' y.~ n iv\ ~ ~ ~ m~~ o~ 'g v ~ ~ p,v N ~ t J / 'I\ ~ R ~~~ ; ~~ ~~ a ~~ c v `- 3 a ~~ v;kl a v \ \ ~ a ~ ~p ~ ~ W 4t ~ v_ ~ J S 0 \ ~ ~ \ ~ J ` h ~ Q~ ,Q '~ U Q ~ ~ ~ ~ ~ W n ~ n ~ ~ ~ ~ ~ ~ r ~ - '" ~ ~ '~ '' ti ki ~ M ~ 0 N. v ~ ~ ~ ~ H l~ ~ _ ~ ~ ,, a x z~ S• ~--~ a ~ J v 4l _ 1 .~ ~ ,~ v ~ ~ ~ V 1 4~ v 3 11~ y~ ii- .~r- 0 J o. a ~' :~ ~, 0 ~~ d s d s d 7 d 0 .~ t .3 1"~ ~' O ~ 3 ~ ~ ~' 4 ~ ~~ ~ ~ ~ o~ ~ ~ ~~~~ r ~; r ~ ~ Y ~ ~ NY l ~ ~ ~o~ ~= w ~ ~, ~ J a .~ 1 d Z ~_~ F *~~c~.: =c:A ='F 4" ;' ae~;T_, f F,n__, _~~~ ~= ...= ~i25;xv: I YYY:Y; ~~1~i _ q c a~ Y ~, ~-~°° .~ ~ ~~ '~ ~ o~ ~ ~~ ~ ... J 1i-~Y~° ~~ ,~ -- '~ d i ~ ~ ~ ~ ~ Z IJ r -~° ~ ~~~ 0q ~q~ ~. ~ ~: v 'f ~ ~ ;~ H ~ ~ ^ ~ ~ V 'I `_' o S 3 0 r ~ 3 °~ ~ ~ r ; ~' ~' / .~ S >r~ ~~ ~ i~ o • 3 ~ ~ d ~ ) { ~ ~ ~ a- ~~ r~ ~ .~ ~ /,/~ 1n f `.! 1 i V ~ o cc[[ ~ /~ -. ~ / i; ~ M ~ _ ~ ~ \~ / s ~ .~~ ~ ,_ ~:~ ~ ~' nn i I .._ c ~ O C1 .~ N~~. ~ ~ ~ ~ ~ a.-~~~m U r~`+..{{~~ L ` 'f~ d ~ oNO Q'v N ~ 3 r~ V ~ o ~~ ~U ''' an F~-i CC3 ~ ~ ~ V! AUK T~v~/./~ Vl ~Q V ~' a a a ~y {~ N 0 ~ i V i II II ~ ~ ~ b ~ t ~ ~ y V C~ O (3~ r f ~ V ~ II ~!, S bA O ~ ^ ~ ~ } ; `` ; C i ``~ ,;~ ( _ ~~ ~`~ p'~ v a 1 `~~; i~ ~'' R _' 1 1 ~ ? 1 ~ 1; ~~ ~ ~ t' \` I II ` b 1 R~+ t v T~'1 ~,/ ~ I ~ ti. t 1~ O ~ 'r J Q ~ ~; ~~ .~ _~ Q ~ _. .._t -:---- ,~~ - ~ ~ ' ~ •~ ~` \ _ _ •: _ _ ~ v _ •~ ;• •.• •. Nt r• ~ f' , ! -fir- • a . ~ •~ ._ ~: v _~~ ~t ••b ~ ~ ~• N ~ - •1 • ~- ~ _ _ __ _ •~ `• •_- ~- i ~ ~ \ j• ~~ •R-~ ~ ~ i ~+t • • __ 1 '- .' - .- __~ - _a . t '3~_ '_ s ~•. °~ : 4 II .~ 0 a 0 H II p. .~ a~ O 4-c d] C~ "d 3 R3 U b y V y .~ N. R3 0 $_ s ' ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 `FILE INFORMATION Owner ~N N IGf{c~LL- ~~ Permit # ~ 2 3 ~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units A Estimated flow (average) U~ gal/day Design flow (peak), (Estimated x 1.5) p~ al/da Soil Application Rate d -~' gal/day/ft2 Standard Influent/Effluent Quality Monthly average` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 5104 cfu/100m1 Maximum Effluent Particle Size YB in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity 2 ~ al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~ - ~ a'U ^ NA Pump Tank Capacity al A Pump Tank Manufacturer A Pump Manufacturer A Pump Model ~ ~A Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~A Dispersal Cell(s) ~n-Ground (gravity) At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ~NA Other: q Other: A eeeru~r~ue~urrc srrucn~ n c Service Event Service Frequency Inspect condition of tankls) At least once every: ^ monthls) (Maximum 3 years) earls) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: 3 ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: ^ monthls) ~ yearls) ^ NA ^ monthls- ~A Inspect pump, pump controls & alarm At least once every: ^yearls) ' ^monthls) A Flush laterals and pressure test At least once every: ^yearls) ~ Other: At least once every: ^ month(s) ^yearls) A Other. A MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page' ~ of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the celllsl and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: ~j A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T alua ' a o ing ank ~~ e ai e ~ nom, ~i2 /~/~/ CaNS'T72ll~t~~ b Ra+~lB ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~~r ~L_lt,wlg/ N Phone ~~ ?~ S, 9 (o D POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ~ Phone Name ST, C ( CCU 7D~f~ Phone ~ l S- 3 g(~_ (O (~ This document drafted in compliance with chapter Comm 83.22(2)Ib11f lld-&(fl and 83.54111, (2) & (31, Wisconsin Administrative Code. Page Z of 2 START UP AND OPERATION ' Fqr nHw construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have ~e contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages: pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the celllsl and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing. Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~~ T alua ' a o ing ark b e ai a ~fZUf-1181'T>/'I~ Y-~D~2- !~/~ ~NS`T72(J4TL p~ ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~~~ ~~-~.t,N'lg/ tJ Phone S-~ ?~ S. 9 ~ ~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ~ Phone Name ST. CR.OI dU ZD~IIl~tJ Phone '71~- 3g(P_ (p ('~ This document rafted in compliance with chapter Comm 83.22(211b)(1)(d)&Ifl and 83.54111, (21 & (31, Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner~- Mailing Address q ~p / SF ST ~,s/tag~®1j c,CI-G~ «,~ ,s yo~~ ~ ' Property Address zsD ~ SJr required from Planning & Zoning Department for new construction.) City/State ~L.~~~v ~ Parcel Identification Number p/o .... jf~33-- ~t3- D~ LEGAL DESCRIPTION Property Locationsw '/4 ,mid '/4 ,Sec. Lam, T 3 o N R~~W, Town of ,~~~i~-L!~ Subdivision =~ ,Lot # _~_. Certified Survey Map # -""- ,Volume ,Page # Warranty Deed # ~/ y SDSp ~ ,Volume ,Page # Spec house yes ~i Lot lines identifiable ~ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) /~/~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) #i /~ State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Number 11 Document Name THIS DEED, made between Daniel R. Shackleton and Nicole L. Shackelton, husband and wife ("Grantor,' whether one or more), and Jody Wittmer and Matt Hetrick ("Grantee," whether one or rnore). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St.Croix County, State of W isconsin ("Property") (if more space is needed, please attach addendum): That part of the Southwest Quarter of the Northwest Quarter (SW 114 NW 1/4) of Section Fourteen (14), Township Thirty (30) North, Range Sixteen (16) West, described as follows: Lot Two (2) of Certified Survey Map recorded in Vol. 18 of C.S.M., pg. 4656, as Doc. No. 747510. 8 1 8509 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 02/13/2006 11:40AM MARRANTY DEED EXEUPT 1 REC FEE: 11.00 TRANS FEE: 184.50 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address St. Croix County Abstract & Title 252 South Knowles Ave New Richmond, WI 54017 SUBJECT TO a joint driveway easement as shown on said Certified Survey Map. 010-1033-80-020 Parcel Identification Number (PM) This homestead propcrty. (is) (is not) Daniel R Shackleton * Nicole L. Shackleton ~' ' (SEA1,) (SEAL) * : Signature(s) AUTHENTICATION authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (]f not, authorized by Wis. Stet. § 706.06) THIS INSTRUMENT DRAFTED BY: Wertheimer and Associates Hudson, WI 54016 ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. , . C t/' ( 1 Jc _ COUNTY ) Personally came before me on February 9, 2006 , the above-named Daniel R. Shackleton and Nicole L. Shackleton, husband and wife to me known to be the person(s) who executed the foregoing instrju~ment and acknowledged the same. ~" I /l Y llL.i-C~ ~ ~; ~~ Notary Public, Statr3 of Wisconsin My Commission (is permanent) (expires: :~- - (S - ~ LG' (Siguatares may be autbentiated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM N0.2-2003 Type name below signatures. 818509 1 of 1 Exceptions to warranties: easements, restrictions, covenants, and rights-of--way of record, if any. 3 CERTIFIED SURVEY MAP Charles .Xungwirt6 and Rosemarie Manke The Southwest '/, of the Northwest '/, of Section 14, T 30 N, R 16 W, Town of Emerald, St. Croix County, Wisconsin APp~tov~n ~„~, s'~'• c~xoac couNTr eaNnp and Parire ^~rr»,t+•.,q ~~ V 8 $ 2003 It SECTION 4 TR 16 W p3' ~"-'-4~ ~MaR _.. 13~• _. _. ~ouNn'PK' NAU) ; -' ~~., "'"'""i1"UIVPL4TTFD ~ "~ %~1',rit9r ,,,,, JOINT DRIVEWAY -------------- LANDS OF FENCE TO EAST 00 ~~ N Z' s~ ~ s` Z~ ~• -~'~ 691283' • ~Q,. ~ LOT 1 7t.TC0 R ;! OttWMj • 7,14'3 ~~ ~ :H3 0 l1oAq~ SQ. F7; ~ ~~ . FT ~1~ ; ~ 5.876 ACRE ~94 Cn ~ •,~ ~~7f2 p/y~ SQ. FY. ,p, BENCfID[ARIC ~ •~ /f/ T +~ ~l itWA S>'1KE Q4 10.OAK - ~. -r , y . ~ s,1 723.Q7' e.EV. a 73.63 ~ ~ c ~...,... ~_ pia cENT~u.trrrE . FtJ'CURE 4!Z'59"W !323,87'--- 59 4 C0 ~ ~~ ' • 1 ~ s ~ ' ~ . (OHWM) ~ ~~ t3RtvEw AY 13.274ACAESOR57s,6i2 ~ ~ $~C ~ p~$i (SF8 NOTE ON SE~B'r 2) (j~~ 128841I~~$ ~ ~ ~ ~. FT, BENCHMARK ELEV 8323' `~ ~ ' (OHWM) ,[ 4t! ~ ~ ~ vE>vrs ~`-~+~ 13.144 ACRES t7R 574,750 SQ. FT. • , ~9 ~ ELE VF 100.eD~O BIIJCFIlIN ~K (E~(Q ~ ~ ~. ~: ~ 3~; tAf°"°"~1 ~srnora+IO•oAx ~ "~ ~,.,.. ELEV.=9~.8Z' ~-' ' `sr 76.4 CONTO °{,~-~, ~ i~'- cotiwM~ ""~- ,~l ~' 4? S9" W 1319.91' WEST QUARTER CORNER µ~.g~'~ D - - - NBJ°4(23y' {y ~811.R7' - - - SECTI 14 T 30 N, R i6 W (FO ~et~1TSEN Atu,~+,tNUM MoNUx1ENT~ UNPIATIEp ~N.2~ Ordinary High Water Mark of Wetlands N e:tabiishea by st. croi: County Zoning Specialist on JnFy 29, 2003. LEGEND E O Indicates 1 "O.D. = 18" Iron Pipe Set (Min. Wt. -1.131bsAin.11t.) 0 Section Corner Monument (a1 noted) 5 --- x -•- Indicates Fence _ _ 75' Setbaek Line from Ordinary 300 200 100 0 300 ~ c High Water Mark of Navigable WeNand Bearings are referenced to the West line of the OHWM Ordina H Water Mark rlw ita of Section la, assumed bearing NORTH. ry ~ This Instrument Drafted by Mark W. Peavey • Indicates Soi! Boring LoeaHon 7 4 75 1 t2f VOL 18 I,AGE 4656 KATALESA H. M7iLSA~- REGISTER OF DEEDS 5T. CROIX CO. MI RECEIVED FOR ~tECORD 11!25/2003 10:45AM CERTIFIED SiIRVEY 11AP REC FEE: 13.00 COPY FEE: 3.00 PAGES : 2 OWNERS'ADDRESS ISSI ?SOtAr St Enwrap WI. St413 st•ncE w ~z• oAx ELEV.' 61.59 ~~ ~` Z" ~: v ~i ti ~ d,~ 8 ~ ~•' y h EASr QUARTER CORI~R SECTI 14, T 30 N, R 16 W (FOUND 2" IRON PIPE) pON~q[ • LAUR MU 13 • LOENVILLE= ~ LAND 8 AUGUST 1, 2003 SHEET 1 OF 2 Vol 18 Page 465b Wisconsin Department of Commerce. PRIVATE SEWAGE SYSTEM Safety and Building t)ivision INSPECTION REPORT GENERALi1NFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Shackleton, Dan & Nicole Emerald Townshi ;ST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to wen SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 463231 0 State Plan ID No: Parcel Tax No: 010-1033-80-020 Section/Town/Range/Map No: 14.30.16.2066 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Fi rade S Cov BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: I N CHAMBER OR INFORMAT O Type Of System: UNIT Model Number: DISTRIgLITION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER v Praccnra Svcfams Only YY Mnuntl Or At-Grade $VStemS Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedRrench Edges Topsoil I ~ Yes ~ .;] No I _~ Yes ?I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 250th Street Emerald, WI 54013 (SW 1/4 NW 1/4 14 T30N R16W) NA Lot 2 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Inspection #2: / /_ Parcel No: 14.30.16.2066 Plan revision Required? ` ] Yes ~J No ~ ~ il~ ~ i Use other side for additional information. ~_ - __L_J L ___ - !-- Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) • Safety and Buildings Division C~4' 201 W. Washington Ave., P.O. Box 7162 ~' ,~ ~~~~~,~ Madison, WI 53707 - 7162 Sanitary Permit Nnmber (to be filled in by Co.) Department of Commerce (~) 2663151 .32- .3 Sanitary Permit Application Sm~ ~' I.~-'` In accord with Comm 83.21. Wes. Adm. Code, ~ you may be used for secondary pwposes Privacy .04(Ixm ECErV (if different than mailing address) I. Applit~tion Information - Plt~ Print AII I~ornuatian ~ O ~~-C O ~ ~~~~ Property" Owner's Na me T CRGIX C Lot # Block f QU il/ yt''c~f-pC.~ .e1=T1~/lJ ZOIVIN Z ~.; Property O 's M ailing Address n Prope Locatio ~ ~) City, State Zip Code Phone Number .S~ DO S" • y7~~ (circle ) E a~ T 3 o N: R~ pq (check all that apply) e of Bttii ' -S II T _ ~ g . yp e~,c 1 Subdivision Name CSM Number ®'1 or 2 Family Dwelling -Number of Bedrooms S . ^ PublicJCommercial -Describe Use ~ ~S'~ / L~7Sl ~ ^ State Owned - Descn'be Use -- -- ^City ^Village Township of G III. Type of Permit: (Cberk only aloe btt~ on lit>~ A. Complete line B if applicable) ~ -. p - - p 2 O . ZO(, A' I~'New System ^ Replacement System ^ Treatmera/Hokling Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List ~~~ Permit Nnmber a~ Date Issued Before Expiration Plumber Owner IV. T of POWTS (C6eck all that ) 19~NOn -Pressurized In-Gratnd ^ Mound > 24 in. of suitable soil ^ Matnd < 24 in. of suitable soil ^ At-Grade ^ Siagle Pass Sand Filter ^ Constructed Wetlant! ^ Pressurized Ia-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating synthetic Media Fdter Qtamber ^ Drip Line ^ Gravelaess Pipe ^ Other ( .r.T/~ll.Ci)r V. Dis reatment Area Information: t.G ~ ~- X ~ + - 3 L S- /r!~ s Design Flow (gpd) Design Sots Application Rat fl Dispersal Area Regt»red (sf) Dispersal Area System F.levatiort f ~/ ~7 0 ~D , 7 d~ s7, r ~S'9 ~ ~ "~ c- i ~ , o , VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastic Galkue Gallons of Ul~s ~~_~ ~,~, . Concrete Constructed Glass T1 nl¢ Ta . .rG ~ ivd Septic or ittt~Yilg'Fattk 2 5O / C/Fs,~t S Aerobic Treatment Unit Dosing Chamber - VII. Responsibility Statement- I, the'imdied, asstitnt: "for iaifallatiwt of the POWTS shown on the attxhed plans. PIum4ler's Na me (Print) _ Plumber's Si gctature ^AH~/MPRS Number Business Phone Number _ Fogerty Plumbing r''~- --~ .z~ / T/.i - 3 - 9Lo Pm°tbe~ic~et~F ~F`tt~' ~ 7/S-L.~.S = s 1 ~G ~X Spooner, Wt 5480k 6S~- ol- vd Approved ^ ell Yom.--^ ~3' ~t Fee (' Groundwater Dm Lssued Signaarre (No 3tampa) ^ne` liven Reason for D Slrrcbarge Fee) ~ r'-~- . ~ 2 < IIf. Conditions of ApprovaUReasans for Disapproval SYSTEM OWNER: ~~ ~ I~t _ ~~ ~ ~ o~ iC ~at~ow ~~ v~a~vw2t~ aSl~< ~Q ~ ~ e . 1 Septic tank, effluent filter and ~~~ 'T^~-~ ~~S dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to Use Comty only) for the system on paper not less than 8111 x 11 inches in size Nov 18 04 02:05p Nov 1-.7 04' 1'1:498 - ,. - iMark Molding LLC FOGCRI'Y PLUMBING [7151698-3150 17156355286 p.2 p.l ~ST CRO1X COUNTY SEPTIC TAI~IC MAINTENANCE AGREEMENT ~ ~ _ 7,v -G ?~'~ 3/ ~ AND OWNERSHIP CERTIFICATION FORM OwnedBuyer~ .~- - c' Lr NlsilinS Address ~~ diiT ~,~zr~~ L.t~ ~~~r . `yQ~~,_,_ .~: ~ t ! u ` . ~i Property Addte~s (Veriliutiaa regncsd tiro~n Playo+a6 Depuonmt for mar eaocerueuan) City/State pat-ce1 IdeMiGcation Number - - O /o -/0 3 3 - ~° "~-° I..EGAL DE5CR1PTi0 (. 20~ ~ ) Property I,ocation~_ '/., ~/i ~ '/., Sx. /y _. 'f,.r~,-N-~--~~ Town of ~'s•,F.eA~4D , - ~._ ___.. _ _ __ __ - , )rot # ~ r_ Subdivision ~~, Page # ~ Certified Survey Map # J1l d Volewne Warranty heed # 7~ ~`Z . Volturxe ~7~ -Page # ~-~ Spec house U yes 19'rro T:ot lints idcnxif~ablc t~yes ~ no S;~STEM MAIN'1'ENAN iia~ropause aad ed.'yaQSePlicsysoemroaY~t~ tespat>mattue:la~meto Laa~ac vraries. Rvprrmaioowaue wosists of pompwig oat tha stptit tank esety 11>ree lass of somri'. if aud<d by a lice~od P~ Wlr~ 7'q° ~ ludo ~ >~ ca a0ect tLe 6ucaiaa d' ~e septic tadt as a heataaent ~ m tLe wasoe dill sYsbea~ The propettY owaQ mess b salt to SI. (~oct Tim bepa~aot a oati6alti~ fiouoV si6Jsod ~ 1be ow~r and b7' a enaskrpluobe~L jaaltsttas+sp~, te~t~dplrmberara~edpgaapQ~~n ~~.~~~ratcrdiaposal rys1~ .s iu' ~~ aP~6 ea~w ~«~ ~ ioaa ~ p~ C~~7~ ~ ~ taut is Irsi mau l l3 full of sladBG Tlerc, the mdeasi~ed tears ~ 6a aldoe.eq~me:o~ts ad ~ m da pm+~ se.~e di~osal ~ evit4 ~e ataedtads ~t W,d~. law. as ad 6r tie Dq~atmo~o[Ce_ emaoa amd duo De~~eutof 1~d Resowooe~. S~ af'aliio. Catifinaoa staE~g ~ mo'd' >~ y~q ~ 6eA as16t be eadaplt0e+i and admeid p ~ C~aot CeMUty ~ Ogee v;thia 30 ~~. ~ _ STGNATURF. OF AP i.TC,RIdx DATE O'~VlVE1t CER'lIF1CA.TTON T (ere) eet6ilr Wt aU adtaneats an tLis form aee tnie to ehc best of my (our) Imortvdga 1(wc) tum (are) the ovrpei(s) of ~ ~ .-ictt-e a eraawry deed rcouided is Register o! OtEcc. l (~/ `~ 'r \ ~~~ 1 ~` /IDlV Sl NA'T'URE 0 APPI,TC„fl1~T DATE _ _ swssss ADy i~ot'aaoation Wert is ~tegesm[ednaay resnk is lie saaibery permit being tsw~lc~edby the Zoniu6 Depa~rtne.. nl, ••s.i. •• Include w'il6 f6it Appllcntion: a stamped wanartry, deed tlap tln Registu of Dcats utTi~x a copy of tde eelified surrey roap if reference is triode in die warranty decd .~; Z7fl~ ~ ~~~ .,,~, _ • STATE BAR OF WISCONSIN FORM 2 - 1999 N ,. ~ 8 ~ ~ 6 ~ WARRANTY DEED KATHLEEN H. MALSH Document Number REGISTER QF DEE DS ST C . ROIX Cp, MI This Dced, [Wade between Charles J. Junt=_vvirth and Rosemarie M. , RECEI YED E'CIR RECORD Menke Grantor, and Dtuiie! R. Shackieton and Nicole 1L. Shackleton. 11/22/Z004 1@:08Aif _ Grantee. NARRANTY DEED Grantor, for a valuable cansideratian, conveys and warrants. to Grantee EXERT ~ the following described real estate in t. Cro' County, State of Wisconsin RBC FfiE (if more space is needed, please attach addendum): ll ~t R16W d ib d f 14T30N 4 NW 1 f SW 4 S : TRAI+IS FEE: 157.5@ COPY F ows: escr e as o - ec 11 1 That part o Efi: f Certit5ed Survey Map recorded in Vol. 18 of Certllled Survey Maps, CC FEE: PAGES: i page 4656 as Doc. No. 747510. St. Croix County, Wisconsin. Recotding Area Name and Renutt Address WESTconsin Credit Union 860 Char ST PO Box 136 Baldwin, WI 54002 Part oP 010-1033-80-000 ~ Parcel Identification Number (PINj ~ ' This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. ', Dated this 5tt1 day of November , 20{14 ' ~~ * * es J. u h * • Rosemarie M. Macke AUTHENTICATION ACKNOWLEDGMENT Signature(s) ....---• ........................----.....------------------_._-_-------...---•------ STATE OF Y.+1].;~32s5~,n.......-•--•---_... ) . ) ss. St Croix County ) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN {If not, _____ authorized by § 7t)6.t16, Wis. Stets.) ' ---- Personally came before me this 5tr1_ day of Nov , 2004 the above named ~- _ ~-~~ii~yirth and Rosemarie M. Menke, - * o e ~ • e _ wn t be,erson(s) who executed the foregoing A _~~. y4.~ d .tt~um nt am~~g~ledged the same. • ~ -aQs~ .~J~S THIS INSTRUMENT WAS DRAFTED BY °., iFT 1~ `r~~~ ._.___-...---.-------.._..___..~~ Attom_ey Kristine Ogiaitd `__ _ __ ~ i - to~_ _ H_u_ds_on, WI 5.4016 __ _ Notary u ic, State of } j j~«~~<<}~ _. - ~ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or aclmowledged. Both are not necessary.) -- --~~-V-~_2t~..__-_~`-`-_-_ , .~~~ •) * Nantes of persons signing in any capacity must be typed or printed below their signature. [nfortnation Professionals Co., Fottt du Lac, w1 STATE BAR OF WISCONSIN 800.655-2021 WARRANTY DEED FORM No. 2 -1999 1~