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HomeMy WebLinkAbout018-2007-23-000 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563810 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Toen'es, Matt Hammond, Town of 018-2007-23-000 CST BM Elev: Insp. BM Elev: BM Descrip ion- ' Section/Town/Range/Map No: 100 , o Q U 05.29.17.962 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Gut, Dosing Alt. BM Aeration vtS / V Bldg. Sewer i S S fs Holding t/Ht Inl -Z r ` St/Ht Outlet TANK SETBACK INFORMATION TANK TO P W LL BLDG. Vent to Air Intake RO D Dt Inlet A A<- A& 4- ~ Septic 96 I r^ / Dt Bottom j 2 q r7 - !V & S~¢ 1. J r Dosing > RX) I eader/ an. Aeration Dist. ipe ` 6 ! Dooa, lip Holding Bot. 12-tf System T 31'L U-7' v 6 Final Grade PUMP/SIPHON INFORMATION Manufacturer r Demand St Cover X GPM ✓ `i a r Model Number ( Vt4 r ~J Q v 15- 16 '7. TDH 70, Friction Loss System Head TDH Ft~ / Q -3- , Forge n / Len Dia. 2 Dist. to Well SOIL A RPTION SYSTEM BED/TRENCH Width I Length I No. Of Trenches PIT IMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ LDG WE t LAKE/STREA CHING Manufacturer: INFORMATION HR Type~[f ~y, l UNIT Model Number: DIST ON SYSTEM 5 ar He erMt Id Distribution , x Hole Siz r I x Hole Spacing Vent to Air Intake Pipe(s) 4 Length Dia y Length Dia Spacing SOIL COVER x Pressure Systems Only Mound O At -Grade Systems Depth Over Depth Over xx Seede p6Yes] xx Mulched Bed/Trench Center d/Trench EdTopsoil 59 - g No es t No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 Inspection #2: Location: 1656 115th Av . H on , WI 54015 (SW 1/4 NE 1/4 5 T29N R17W) Farm View Ridge Lot 23 Parcel No: 05.29.17.962 1.) Alt BM Description = ` ~p r0 ro'e V, ~ b kd)t vwm)n 2.) Bldg sewer length = f/ C~ 15 - amount of cover = / 4 / cvt Plan revision Required? ~ Yes o - Use other side for additional information. ° 13 - Date Insepctor's'Signat re Cert. No. SBD-6710 (R.3197) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NE 1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 108.3' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE WELL *H.R.P. same as benchmark 226' Propert Line 107.3' 1 Scale= 1/4" = 10' 108, B-2 2 acre lot ~ 9% Slope B-1 Tank is to be properly bedded and provided with lockdown covers with approved warning labels Grading i to be done to divert ru -off away B-3 from sys 'em Huffcutt Combo Tank ~G area 15' below system is to remain undisturbed ry)j Pro 3 Bedroom h ~,1o Ho use roc s ~/w 1 Ave 655' Property Line ~dO3 0M , ; - County Industry Services Division is •1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) P.O. Box 7162 Madison, WI 53707-7162 g -.fn' :sip - State Transaction Number y ant Permit Application ~S 7 In accordance w S 38 s. Adm. Code, submission of this form to the appropriate governmental unit is required prior *1 ai mg a sanitary perrnit, Note: Application forms for state-owned POWTS are submittod to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may sed for secondary 6 ` ~ ' / rZa ur oses in accordance with the-Privacy Law, s. 15.04(I)(m), Stats. 1. A lieation Information -Please Print All Information Parcel Vv Property Owner's Name ~i-- *_-,1217 G V P roperty Location 16,2 Property Owner's Mailing rss (I //J / ` CR~lk t: _ Govt. Lot , .lam AIAI Section _ -41 2 _ Phone Number rcle o City, Zip Code Subdivision Narne II. Type of Building (checN TO that apply} Lot # or2Family Dwelling -NurnbertifBedroams - ~ , ~ Block # Publ ic/omCo. - - D City of.-_.. - ❑ mercial - Descri'e CSM Number L1 Village of _ ❑ State Owned -Describe Use - awn of 111 Type of permit: (Che(_k only one box on line A. Complete line B if applicable) L0,1e, ❑ Treatment/Holding Tank Replacement Only ation to Existing System (explain) A. w System I~ Replacement System - rmit Number ttnd Date Issued Chan e of Plumber ❑ Permit'frausfer to PB. ❑ PermitKenewal Permit Revision Chang Owner Before Expiration - r~-'7 I`-_ S Sysbe! l mponent/Deviee: -(Check all that a 1 iV. T e of NOWT ❑ Non-Pressurized In-Ground D Pressurized In-Ground D At-Grade Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil J v (/vY ❑ Pretrea~rnent Device (explain) ❑ Halding,rank D Other Dispersal Component (explain) • ---------r✓'~- V. Dis ersal/ l reatment Atea Information: sf Dis e 1 Area Rec wired (sl) Dispe sal Area Pro o d (sf) System 0 Elevtuition Desi Flow (gPd) Desigr So~ii,Application Rate(gpd) P Total # of Manufacturer U VI. "hank Info - Capacity Gallons in Gallons Units 9 New Tanks Existing Tanks a U r` C7 a Septic or Holding Tank y~ _ - f- Dosing Chamber VII. Responsibility Statement- I, the undersigned, onsibilifY for installation of the PUNTS shown on the attached fans. assn P - P/MPR Plum er Phone Nutrber Pltunbe M~ 'sName(Print) nature Plumber's Address (Street, City,'State, Zip Cody I , Vill 'punt /De vartmew: Use Only Permit Fee Date sued Is t.ng ASignao t 7 e_ Approved ❑ Disapproved $ C n Reason for Denial ❑Owner Cave - IX. (~p ► Nal/I2easous for Disapproval 1. Septic tank, effluent filter and (.~K ( 1/VL dispersal cell must be serv_iced_/maintained r ( C~~i/! Jl/~ S~~ lJt O~ as per management plan provided by plumber. Prat , 2. All setback requirements must be maintained C9 I Paper nol less than S Ift x 11 ir~clres in size 1 l-k-dp ~ 10,s for the system and submit to the County n„y on { 1 SBD-6398 (80313) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NE 1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 108.3' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK XXX 1000 gallons DOSE TANK SIZE 630 MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE WELL *H.R.P. same as benchmark i~' B.M. 226' Propert Line 10 7.3' 106' Scale= 1/4" = 10' 108' B-2 2 acre lot 9% Shope B-1 Tank is to be properly bedded and provided with lockdown covers with approved warning labels Grading i to be done to divert ru -off away B-3 from sys em Huffeutt Combo Tank Area 15' below system is to remain I~ undisturbed ~j Pro 3 Bedroom House 11 Ave 655' Property Line dO min to UNPLATTED LANDS AIL N 89-51',32" E 1316.00' i - - 330.63 - - - - _ -7:7 \ L1 E =1062.2' 653.99 N HWE =1055.0, =1064.2' / / \ \ LBO =1057.0' 20 160607 S.F. / 0~ \ 3.69 Ac. a-j \ ~v \ 15.0 0'---~ N 87°34'27" W 506.31' M 29 - \ 0' 134722 S.F. N \ \ 3.09 Ac. /"n 21 81160 S.F. 0j 1.86 Ac. 28 \ \~cP ~ N 80°09'01" 122374 S.F. ~ ( \ _W 441.58' 2.81 Ac. 15.46°_ \ \ _ 226.12' _ $M \ \ ~2 304 S.F.' ' 4 ~j cy/ , \ \ ~'L \ \ .52 Ac. Lli 27 71902 S.F. \ )ORARY to I / \ \ \ -SAC 1.65 Ac. \ IIJL- J. To "23 WEID \ \ 63 ° `0 `L 113623 S.F. N w \ ~2>> `L G -Y 2.61 Ac. ON OF Z cV \ X22 ' \ \ \69 / co % N 26 \ \ (~j~~ j \ N 87'3218 E / 81.84' 69891 S.F. ~R 1.60 Ac. 25 66514 S.F. O1/ I v /l / / 6651 1.53 Ac. O CC) C; tf) a~QARTr DIVISION OF INDUSTRY SERVICES 141 NW BARSTOW ST FL 4TH 0- C' WAUKESHA WI 53188-3789 I Contact Through Relay P S www.dsps.wi.gov/sb/ G~ www.wisconsin.gov oss101S¢*~ s Scott Walker, Governor Dave Ross, Secretary June 14, 2013 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRF,S: 06JI412015 Identification Numbers Transaction ID No. 2257403 SITE: Site ID No. 791666 Oevering Homes Please refer to both identification numbers, 1656 115TH Ave above, in all correspondence with the Town of Hammond agency. St Croix County SW1/4, NE1/4, S5, T29N, R17W Lot: 23, Subdivision: Farmview Ridge FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1432610 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment System dRs N 2.0" SBD-10706-P (N.01/01). (~~1 1VALLs APPRovEQ The building sewer and distribution network piping shall be of material listed ~~~T8Q~` 384.30-5, Wis. Adm. Code. DIYI" EESS,ODN'Ap~lof In the event this soil absorption system or any of its component parts malfunctions, so create 'a nem hazard, the property owner must follow the contingency plan as described in the apptav~d,` aris n additi a owner must comply with the operation, maintenance and monitoring duties as described i n Ithe mound component manual. A copy of this information must be given to the owner upon a project. CC All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 6/14/2013 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osbome Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Payment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 julia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. ' RECEIVED Cover Page MAY 2 9 2013 ;TRY SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 I Date: 5/ 25/13 Owner: Oevering Homes Location:SW1 /4 NE1 /4 S5 T29 N, R17 W 1656 115th Ave Hammond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-)C~ ~ Soil test 1 Filter Specificatio and cross section Shaun Bird Signature AND 'ERVIc 3 License num r 226900 Ry SR°a~; PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NE 1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 108.3' 3 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark 226' Property Line B'M'* 107.3' 106' Scale = 1/411 = 10' 108' B-2 2 acre lot 9% Slope B-1 Tank is to be properly bedded and provided with Iockdown covers with approved warning labels Grading is to be done to divert run-off away B-3 from system Huffcutt Combo Tank A rea 15' be I ow syste m is to remain undisturbed Pro 3 Bed roo m House 1 1 Ave 655' Property Line 21, 1V~OUEld SysIvI i ~:~~;~'o s' ~°c;t on and Plan 'View l t me nsiora . .!H'a et L L•t.\ L.L.L~L:ML L 1 t 1 L\ t t t ~4 l L t~ 1 tJti~t i 1,rLr 1~,~-^r di ~r~r"J J-JN NJ-i1 r•r•r•F+r r•rr\'}rr r+r rr r'rJrrr rr r++r rr r• + + 11 55L1 Lt /A~ F". F :i~}•'i:j ~jM1.'. :iK t,L.1.t.1.t.L.L.L.L.... 1.5.-.{ .L.L.4.i.',.L. . : . .r.+.r f yr N r,+. ~f. p~.}, 1 4 1,1,\{ }tii HL,W ~ljirirti{ti• Mi{yrtl{ 1{S {5. f \ { L; ..,,,5.1.${y},r.r.r. 1{Li1{ r,Ari 1{1RRI A5M 5 t r-,r.},r.F:'r..r.r. ,r,+M1%:}'F° L.t .i.j.i.y,{t r'+• z{''"'}irirL}if rirti+i-M},1~• Rr•'S F'~i,4M1.4 1 tL~ y ~.1.1.1.M1.M1,R L.t.1{R.{r.F}' 3,.r..~ ~ .F1r 1 { }1 +1~ r. 1r ~ P •f.r,+•rY•r. i-,F R,\},} tif'r1 R 11 ,ry R 1 4 Y 4{4{L~'4:~r•,'t{~+1r,1 5 1KrtRYL• • - - r I . ss~xs~eti`s~s.}~ea~i'Frky,-S S. s ts.S..aS`i.i_5 s tii`•_i'i~{._iii`iif~r~:ss~,3''sr.srs'Rti~rs. _ _ I t.p a - I l N i : ~ l< 1q f~ Ma W l Slope Ol7solll _ ASP L~~ irti}4r: t t t.'lca aggregate 4 in. sc:h. 40 pvc C a Material _ p sand fill LrL % to . % in. dia. ol)servat-ion I:)ipe Geotextile R 5 1{\ R 1y R i + °~rr r1+. . 1a1.1~ae-w?i r /0 \ /Z X F( „wed Suri"arc ~ 3 - ~.,Ot]tor~ r ~1 lope Direclao tl ORl' ERAL, CNSTA,IJ.°A,TION.- l'he mound area is st:a.ked out along; the design Contour, k;xisting vegetation is rr►uwf:,d and raked off thu site. `rhe: nuria)ad basal area { x w) is plowed with a moldboard or claisCl plow. Plowing may not proceed if° the soil is wet enottg,l-a at t:l•s( plow depth to form a'/' Inch soil wire when a sample is rolled between the patlrras of the hands. ~~~i'l'l0 33 quality laud is place immediately afier plowing. Sand is placed with a tracked unachine keeping lace l or more nlche,, of sand under the tracks or is placed overhead by a backhoe. Special care rnust: be used when placing sand of less than one I:ooi. thickness to ruin fume compaction of i he plowed surfiacc. After the topsoil cap is placed, the entire mound is seeded and rnulc;lacd to IWORIote vegetative growth, hunit crrosion and l°)rotecl from freezing. The observation pipes are slotted in the lov,e;r 6 triche;s and secured in place with rebar or a closet flange. I0/071g71 f'agc^ 3 of JI- .I_wo Lalercafis - fi=r cr: ~I-- - Threaded Clearlout ~ l .at::ral :I'tiirrr-iip ___._-A► N'Ir.il, iVIallil;old C'1 a m t 1_,alit FORX M11, ~9 wee p rt „r~ 90 ° 1.$E;irCl s - Distc ibution Netwodi 811c:c ctf iea tioris Pr a csrir-e System Canstruc.tion Lateral Diarrickm 1VI'anrlold Diarriete Lato.ra.l.s -lie constructed of Schedule 41.? PVC 3~ Orifice hccameter pipe. Oritic,es are drilled perpendicular to Soacing) ~ _ _ ~ lip, ta~rc 1111"' bvitl:r a sharp drill lri1: and face dcwuri. L (Lateral l,c a _119. ~ Vt.. Lateral tug-a-ups terminate with a larrea.ded. M (Mac061d Length) 1"t. c4eari(A t 1). tag and are enclosed is a 6-8 iia.cli -Force Main Y )iamc le i' Z diameter [i n spririkler valve boat ace4:5sible i'or.(.c Main 1 catftlr...__ 1"t, l',°ocri fiiiided grade. a w cc ar Pi'adcA cr w 0. Sprinkler Vaive F)'ox rJ Page ~ - of 03/05 ltaj It, Performane tic Punt)) 14atrtt.tiaotcarer QAL -Tank. Model Nmnbe t Pump Model'Number 't'rtal • / IX Alatnra~14aT1tltfatlGttrot ' T"7 .~~R•Y~ c ty . Max. thay Depth A lrarm Model Number - - l±ilteY 1Vla,t,rxfact~t~rer _ TO Dynatntu Head (l).ll) 1`"ert ~ 1Filte~r 1VCuc l 1 uun ear Elema•.ion Hetki l::tistatL:lrt~esadut`e > Netwrlr k.1_ oss - lVlininium Pump Pefforn antic e Required lIoroo M1ain fJosy -17 4 /'s outlet VUnhole 4"' Above Grade With Looking i[kov., hdct Manhole, Manhole Mir,.: 4Y' .Aibo vu tvr°e(ci 6" Below Or .e'Seaded Watertight ~ Sdcurof Mounted With l_Ycyckint, Device ,lttnOtio r+ BOX p'ixxt(;l,6(1 Grade ~ kaw ~ Wit mww _r.._..... ~~txt .~+t Yrx. l :7.y" 1'Iy5C()T1YIC.(;1 .A.l ovu Grade With `Vgmt Cup me etrts '"t~°tl`I'V'WY"W-'Y"Y° d-.wp^ ~.°w••L+-v~wY••v~v r,..~rv-a-rY•'w~veW -c•. bah YYY V Y Y V b Y Y E b p Y 1 Y 4 V,Y Y Y b Y JY b t Y Y,Y Y 4 6 4 Y Y,S V 4 Y I V ~06tyV J4 4~Ytl J4JY JyJVtlYJYJ dYYYdydYVVa4J4 dYY~ VY J Y Y d J Y J J Y J Q d J, d JYJ J !/,HY 4 V LY b y { Y Y Y Y Y b.V,Y ~4 6 yYY ~jVy'~.E J Y j V4 - ! b _d.:L. rrY..aA..a+.adX _ "4~.4 4 Y v V~ J Yav outlet: Filter lttlet ; j ; .e _ _ - :Inlet; Baffle i ayV YY3tl{ 4 yY4~ ,J f~Jb`, J + YYY ~yyy~'(Y!yyY .~{({py{~ yyy(~y~yya~y~Y ■a.^V-~p y A, YYb VYiLMLI I✓V~1 OUP mid iwm ve Ca :gia4 `tY (J1 `+YY _ Tank Volum v(Tl'x 'emu€p Dimension: fttcltes Volume Gal (lot( J YYY Fib (alarltt)t . - iflle~rat, U.t, t r y; _ _ YJY d,j C ~Y~V ai•;YYwYnYU~b 'yY{ Boom" > (dead) D { ~ Y~e~ I~ a ~la~rrtt~tyr, Total . . 4YY 4VJVVYYL JYYYYpVYVY b Y Y x-, Y`a -~Y i'-V i_Yri 4 V 4-L G Y-TZ~G 4`4'TY~P1-T"Y'~'4`Y~Y 6ti T'Y T 1"4"~CJCU `"Y'4' YVJV L-Y"'4-~Y'"Y'4-'L`y`-4°`1"i' 'T'""b~•'L'I""'~~` • .'Y..~Y~•.~•.' {~JbV`d"J` Yiatl J Y i J J J Y J Y d V J a Y` Y Y J Y d V J Y YVG Y b"4 4 Y Y 8 Y•p '"p Y b Y Y"l~Y YYY YYy k 1 S Y Y b V"Y b 4+4 4 4 4">d4 Ya1ap V"614YL Y"Y"iY4jbJ4 SY Yd LY4 tl4YV Y L Y Vd4"Y~YUY"VY~I~JYYY144"4dYYYb LaYayY { 1' i J V d YYOaV b i VYJ4J JAVaV~i~V tl J J ; L d V 4 J ri d YIYV yV•J Y d Y d''d d d J V d J J d d Y J V V Y V J r J+ tl Y d Y J Y J`{`dva~ b _>"L:k Y 'k Y ":aL t_~b.22..Y • ...kaY.A..iY_k.-4LI[.4:3.L.Y..4.2.A.&..A...#.Y.~..7.~L.a-.k.k2Yk»L~.{.t-Y Ns°Y.~"b: y, bdv..LMxL.t.,Y..:Y:.Y.k.k.t..Lk.Y,l..J{..i•-Y..L+A GENERAL INSTALLI yly 0N.' The septic/dose, tame. is bcddtwJ anti back filled in wcoldatltce; with the manufactntr-r's product Spptorral Vecific;ations'Maximum depth of brrr y as specified by the ittanufacturer may not be exceeded without prior Opprovatl. Manhole covets exposed to p-ad(i have art efi ;tive lookitig device (padlock.) installed. Piping at th~ Wept and outlet is of appi'Oved tnaterir,ly oonuec and to the tank with wate xtight tiltings, oriel laid oil stable soil to prevent Sottling or S&ith. The force mati#t i$ sl evA with 4y' Sch, 40 PVC to bridge the tartlc excavation atrdE the sleov ea sealed xi aotmtight. lllec;trtaal sa,,vice, e;.o pl i*.r with NFC100 and Comm 16.1;91. 02/051,1 Was-do, ~yp F 1 y,., 81..x. ~ SEW-40 Series 4/10 hp Submersible Fffluent pul gyp, 3/41 Solids Flow IYterw/mirluto 0 so •i 96 •151r 2utt 750 :too Govo1, Fpuxy!:,(;o :od vout irukj 35 l.t IVILic,+ IL, 1 hlluxy-rzrctrd-.rl irc?t 30 bu111~Ih~r IVlti.erlal Therrvioplastin Lla:alcn,utr 20 wlr,,l1'Ibr 1 ~1e r ~rtrrxy-t utlla'L' 1 cast Ytor1 ~ s IV 1ucViwi,i~iVoY,ai r Nltrilv~ lam b w yu11 tlnd ; ~c~,l !~ttr'~n'rlr; 1'EU,Hb o ;;haft 'aecll v 10 a Gu t1u Upp'(O 1,3ir)f&Qd;; pjpovq Flow - GaMona/Mituttn f n Mf►+ 3~a)4,49al l(VI, i.... 0 t ;EN-40.- Ar SM-40 SpKifications $0 WOW SEN U 5OU211 4)10 1*4 f d/3 f;llilPl Stf9ztl 811 70 60 4:1 ?rS i2 14 1C1 PU l~ '1760 by 4~~1 ,Y4~~f~3 ~.;9f9'4`k 19"`' 611,;7 ";F}> i"'? ! ',arid + ''~'frffi. ` f/61 SEN-40-AP 6py1)t013 . ~~l l r7 1 1,q ' i uo rNPT (9~J}')M bo f'U ~ 60 ~ '14 20 ?1.11; -17.50 4'. f yR~G t N 1Q'-I U 1t x~~ ~I1 y f' 1 ! .Hf'~~ =W "~M:b .A~... ky 6.: l'! i..'i'13l! S.tiil7 (1~I© WQAF.~ :~..6u 1t yE u= ~.Lt". r rt9U East Spring Street, HIL1f(t01111, IN '46714 Tel: ZtiU.itLq.Z9UU W Fax: 260.024.2909 k orrn: 099199 Y.II VOWW ~~EInYCYf.hHIBCiYit.CUYrs Page J- of Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of safety and Buildings in accordance with Comm 85, Wis. Adm. Code County / J G Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must /\/r include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. C~ o n i rest road. Reviewed Date percent slope, scale or dimensions, north arrow, and location and dis cat Please print all information. a-// c% Personal information you provide may be used for secondary purposes (Privacy w, s. 15 (1) (m)). ~y v Proptgrty Lo ion Property owner I r` D 1/4 ff 11/4 S T N R E(or W / ~1 k GovtJLot ) , ~[1~~~d/ a or CStvl# Property Maili 4SItatte"-) ss i L Block # SubdQ l - V n! -A Village Town Nearest Ro + Zip C ode hone Number ❑ ity ❑ 0 1 city flow rate GPO New Construction Us Residential I Number of bedroom s Code derived design ❑ Replacement ❑ Public or commercial - Describe: ne- , / n s Flood Plain elevation if applicable Parent material General comments 3 and recommendations: 5y,54e,- e, (e. VeA- 1 Boring Boring # Pit ft. Depth to limiting factor J, 4 in Ground Soil lication Rate ED surface elev. ' Texture Structure Consistence Boundary Roots GPD/ff Horizon Depth Dominant Color Redox Description •EfF#1 `Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~ l Iz --2 in /✓l)4 Zvi~* ' s/ ~s ~a ® Boring # Bopitnng Ground surface elev.~'1GJ+ Og. Depth to limiting factor ~x_ in. Soil cation Rate ~C~ !GEP DI if JJJ"`---""" Consistence Boundary Rooms Horizon Depth Dominant Color Redox Description Texture Structure Gr. Sz. Sh. `Eff#1 `Eff#2 in. Munselt Qu. Sz. Cont. Color Si ✓ C a • Effluent #2 = BOD 30 mg/L and TSS < 30 mg/L • Effluent #1 = BOD > 30 < 220 mglL and TSS >30:S 150 CST Number CST Name (Please Pnnt) ST N rnb 226900 Bird Plumbing, Inc. Shaun Bird Tele hone Number Date Evaluation Conducted p Address 715-246-4516 1008 192nd Ave, New Richmond, WI 54017 ~j Property Owner Parcel ID # Page 0 of 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 GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0- D 1{r"f S1 to Ip' fir- L a 4~ S C I Li ' .42 3 - d .S r VA, c --d S r `I/ S' - n, - F _rYj Boring # ❑ Bonng ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 L F-1 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit - Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft#2 Effluent #1 = BODa > 30 < 220 mgll and TSS >30 1150 mglL ' Effluent #2 = BOD, 30 mg& and TSS 130 mglL 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 608-266-3151 or TTY 608-264-8777. SOD4330(RAM) Soil Test Plot Pla Project Name P.C. Collova Bldrs. Inc. S' n Bird 'j "Address P.O. Box 489 Somerset Wi 54025 STM #226900 Lot 23 Subdivision Farm View Ridge Date 5/8/04 SW 1/4 NE 1/4S 5 T 29 N/R17 W Township Hammond Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 108.3' *HRpSameasBenchmark Altern/JatgBenchmark Top of 1/2" Pipe C 100.2' IV W 226' Property Line ~/6 ' lso' B.M. los' 30' Scale is 1" = 40' Alt. M. B-2 unless otherwise noted 30' 9% Slope B-1 10' C 30' 20' B-3 106' I Jur T'a S44Lj~: N 655' Property Pro Town Road Line ~1 IPOWTS OWNER'S LMNUAL & MA4N AGEMENT PLANtN I'Atie.`.~... caf.--__ 1`1LE iiVIFOR11M110M To e7 `r ~FC . 1q17- SYSTEM SPECiFIOATIONS ` eptir I f!nk Gapealty C1 NA i?r~rrrut # Q 3r~rrkic, l w nk Manufacturer l(, I 1 NA . JESIGH PARAMETERS I~ffluent I rtt~ar Mrarrufachurrr' I.J NA Number of I3adrouins t-1 NA Effluent i llter Model Number of Public d arility Units , A Iunrli i s,rk pacsty real 1-1 NA 1 f~ /1 ~ r ` I;stlrri ated flow (average) Pump E -1i lit Alianufac tural. _ I Design flow (peak), (Fstirriated x 1.5) aI/da l'urrip Manufacturer _ I1 NA Soil Application Rate o aiWi ~ Turn Mcldfal 11 NA ltandard Influent/Effluent Quality Monkt ly averrage* Pretreatment Unit Fats, Oil & Greaser (170(3) 510 mg/1.. ~ 1._I .sandlf.: ravel Filter L"i feat Filter Biochemical Oxygen Demand (BODr,) s220 tng/L 0 NA r'l Ilgeclam ilcfal Aeratiori [::I Wetland Total ::suspended Solidrs (1':38) 5151) rng/I t:I DialrifrvAim [I Other:. (--'retreated FlItrent Quality Allandil averil e_. Ciislaarref ell(s) _ U-1 NA-- Bioolienncal Oxygen Demand (BODs) sat) rugk 1.1 ln-Grcu"d (gravity) 111-1 In--(.ground (pressurized) Total Suspended Solids (J',88) 30 mg/L. iA r 1 At43m( e %fili mound Vocal Coliform (geonietric rnean) . 1Iol r frr/1k1()nil 11 trip-1.i a C1 01her: axirriunt l (fluent Particle Sloe hi in cfia 0010r Ili, . . _ I-) NA tI NA - - - Othrar A 11 A ''~larues typical fin dwynrostic wraslrruvater ,ariel septic tanN sffluoni:. t athrar I_,.d IVf1 IIA>,IN'i"ENAiNGE: SCHIEDUt..t rsw,..__ 4$ r rvf ww.. .M~ . W_._ t.... Service Event _..q._........»_....._...>.~....... r ' aEi FrQCtlrMinliy. llnspec;t ccarikfifrcrri of lank(s) At toast oriv a oveary 1_7 maniir(s) (lVtaxtrnunk years) [:7 NA > earl Ilsurrr a out contents of tank(s) f INlren corrrlained skrdge and ;scrrrri rrqualri one-ttrird of tank vblumer L.) NA Inspect dispemail call(s) 1, l month(s)- At least once every: "aL~l, era ~u (Maximum ;I years) 0 NA _ eian a c At least orlu e evory month(s) r month(s) ent filter 251-year(s) 1_I NA napes put lip, purnp controls & alarm At least once every. -1 NA yrear(.e Lush laterals and pressure test a > lTl month(s) /~t least rant a "very: ~ -4 1-1 NA Othor: At Isast untie every: I°l manttr(s) - IJ NA it her: D NA MAINTENANCE .v M,....~. . a . _ w. w , _ _ _ INSTRUCTIONS Irisper.-tions of tanks and dispersal scads shall be mado by an iridividsial carrying orrei of the fallowing licenses or cortifrcations: Mastrar' Ilrltrrnber; Master Plumber Restrioted Sewer; POW 'S htspector; POINTS Maintainer; Septage Servtwing Operator. Tank insl)ec.Klons must include a visual Inspection of the tank(s) to ldent for any rnissincl or brokon hardware, Identify any racks or leaks, measuro the volume sit c,ornbinod sludge and scum rand to check for ary back up or poriding of effluent ran iher ground surf'ac:e. '['lie dlspkrrsal gall(s) shall tae irisually inspected to check the effluent levels in the obsorvatlon pipes and to (..,heck rar arty pondirig of effluent on the ground Surface. The ponding of effluent on the ground surface awy indicato a failing condition and requires tho immediate notification of tlre3 local i-ragulatory authority. IMlion the combined aircurnulation (if sludge and scurn in any tank equals ono4hird (l(,) or more of the tank vulurne, the entire contents caf 1tie tank shall be removed by a Septage Servicing Operator and disposed of k-r accordance with chapter NR 113, vVisconsin Administrative Codo. All other services, including Drat not limited to the Servicing of effluent fillers, m olianic eil or pressurized components, pr•etreatmem units, ("Ind carry servicing e+t Intervals of s12 months, shell be performed by a oartified I10VVY8 Malntraincar. A service report shall tie provided to the local regulatory rautiaorilywithin 10 days of courpietion of :any service event. • i'ragee ~ _ of . , Si'ART UP AND oPF-RATi(3Nrt Vor new wristructlort, prior to use of the POW TS c:tieck treatment tank(s) for the press a: rrcaa of fsairitin;q products or other ayherrrgcals tha:li rnaay impede the treatment process and/or damage the dispersal r call(s), If high (.;oiw rntrrartlorts are detwied have tire contents of thi tank(s) removed by a septage servicing Operator prior' to rises. System start up shall not occur when stall conditions arr-r trc ZOn at thO Intiltrratlve surfara:. During power outages purrip tanks Wray fill above riorniai hlghwater levels, when cower is restored the excess wastewater, will tqa discharged to the dispersal cell(s) in nrte large doss, overloading the cell(s) and tnay r, Woult in the backup ur surface discharge of efflux-mit, fo avoid this situation have, the contents of the purvip tank removed by as Septage t-e:rvicing Operator prior to restoring power to thle ctfla.rent punga Or contact a Plumber or POVUf'S Malrrtainer to assist in rnaanually opiarating the pump controls to restore normal levels within the pump tank. Do not drive or, park vehicles ov€ar tanks and dispersal calls. Do nest drive or park ovrt or otherwise disturb or compact, the area with IVI 15 feet down slope of any mound or at-grade; soil absorptiot eirea. Deduction or ellmination of this foilowing iron the wastewater stream may improve Clio pertorrnmm;es and prolong the life of the P(:tll I:1~: antibiotics; baby wipes; cigarette butts; condones; cattail swabs; degreasors; dental floss; diapers, disinfectants; tart; foundation dralin (sump pump) water; fruit and vegetables peelings; gasoline; grease; herbicides; i neat scraps; Medications; oil; painting producljs; pesticides; sanitary napkins; tampons; and waterssoftettear hdrie, ABANDONMENT When the POWTS falls andlor is permanently taicen out of service the followintt step.a shall be taken to insurer that the syste'rvr is propel-ly and safely abandoned In compliance with chapter Gomni as t. 33, vvisconsirr Aduilnlstr.A ive (;odes: rr All piping to tanks and pits shall be disconnected and the abandoned Itipe co ilrigs sealed. a rho contents of all tanks and pits shall be rernoved and properly dlmaose5d t;f by ra Septaagei 1;ervicing operator. W After pumping, all tanks and pits shall be excavated sand removed or theii ~;overs removed and the void space tilled with scli 1, gravel or- another matt mild material. cowrINdGENrYCY PLAN If the FJOW`i'S falls and cannot bo repaired the following measures have, beoi, or roust be taken, to provide ra code c oniplialirit veplacernent systems: 1-3 A suitable replacement area has been evain ated and may he utilized tor, st , location of ra rr-grlavervrerit moil absorptiori systeirw The replacement area shrjuld be protected from disturbance and c.ornpeo,lun and should not be Infringed upon by rerluirled setbacks from existing rand proposed sstruCturirr, loi lines and wells. F ailurea tl, prated the replacerrient area will result in the ric+ed for a new soli and site evaluation to establish a suitable replaai.eme nt area. Replacement systems rrar.ist comply with the ruleeei In affect at that time, Ll A suitable replacement w,ea 15 not ava+llablea duo to notback and/or loll limitations, 1-.4n naafi advances in POWI'S technolollll ;a holding tank may be. installed as a last reacrrt to replace the failed POW e,41_ , 1-he site has riot been evaluate to Identify u suitable replaacrarrlerit amass. t l Iron failure of (lie: POW U a slyly acrid site evait anion must be performed to locate a suitable replawritent area. It no replaceitltDr 0 area is atvailiablei a holding tank may he rnstaalledl as a last assort to replaces the failed POWI`t.-. c` 1otlnd and at-!raids soil absorption systems rimy be recoristruvted in phwes following romovfal of the biomat at the infiitnalivei `surtarce. Reconstructions of such systrwiti rrrmt ccrrriply with the rules in efr'e:.r..t rat that tirilo. ,,-'WAR NIING>> SEP'T'IC, PUMP ANN OTHER "rRrWA'rMENNT TANKS MAY t;;CtNTAIN+t I.F."11-HAL UikOEU ANdlt" IOR NNWIFMCIONT Cy;'tYG&K 00 INJOl° EN, TEE A s,wric, PUMP OR O'rHER `rr7EXf M1-_"NT ` AN K tlNDEk ANY C.iRCIJNUI84ANCF8. DEATH iUNAV' RVSIJN..'r. RES( UP 0)- A PERSON FROM THE Ilrt't'ERIOR OF A TANK MAV 4PF DIFFICULT ON ItUIPOSS1113t N=. ADDITIONAL COMMENTS fyOW11'8INSTALLER pt1WfT`~MAIIrI't-AINER _...._.~w.__ _ lrticene, J J .,~,..r,.. l SEPTA4315 SERVICING ClI'EN7AT11?VP PIED t_CaGAY RIF_13'JIL.AT'0Ry A0010RI Y _ .Y NatrnA l j JC KC' .7i Narne U 77 Phone This document was drafted in ewnpliancu with rrraapter at7 ;gg. ~2{z)(b)(t)(rJ)li (fl rand 'rtiii.54;1), 8. (3), vUisi.Di4srn Adivsinistraalive Codex. F! jl i t~.l' CAR"' „t nyl hmmucrioss ~'r'lyb~ Y try Ilt't;1r~ trlraarcaratur cwirttrrre,rY tlrrdbr t'Irl ty„a oY.liYp'~ tYl 1'bu rruBlrtt Mrrpa, laa ratrtrlvu it la turdc llrr6rYWh Kitt eruklrnrorv #r$ rrw uudr+rurrt wWlt 111Th Y Alper. +ulllwr' l#rr~+rt trrYrYra pltyu arrgr,, flat t;Yyy d1lUlll'lrtlr;rr tYlprt J~p lrtrYrr tile uYrtlYaY GIV 1 W~#hyllrr ttrex c«rrrw WIN it. UP hfi~lrYtlY M1#0 1+w-deal tw lrr~e:a•I trty ~Y! Oki lifts wtttlrli' tfh+ rl ~ rrpYtUrtpl 5~'iWimilllll:tirl ' to 016 twl#it t U terry r~,rnrrt VIVO larl#(rtll Iyrul.Vlaytj tar kldta L+tuYu runt, li etdm r al wail it' aet1whotf 1'Ire Qlt Y'W1Y yirlr~rt lrrbilrg#J in ituE pkfil~t,,,l, lien: fr bid Nra a11rYrrrt wlal iasltwrrYwr;frrr«ru tiCfrJ:1141 My r~rlfultYri sYl ca1 1$r•-lttcslu W1po tud'a tlaN YiYIY Y r;iY6Y# f11tIWYrtirriwl=ldrr nt trllil;ua#tl, irrne~ud t>r rrt~ru lraurp +Vt'ita,u: li' Y~rr113 slrpy,urt rw~k#ttlrf ta, irnl sufartrr t W#dd tirq 11f8trr too uktal tll¢i, a#ttlr~t r,itiu. r r crrhY'rtrlUrr irdu than t'qA;&' NretNriitrl tiUIYUYI tltr I ttru u1sm. ! r ur# 6Yra JN6 1' a ' at zf t'~ tI ttYla liitttw lrn:ktt hater t#au 1111Y#trtt, 1 r 1#''a V#W hAtch ig tYtHk Ajuj- irr[ardl®a tutu Ctrs @' . lartcuult: 49 w1w, rWarr .rrrrl PF. yr1 i~ krctr Irq tt1Y'wirrtt r . i~Nrrl ~ly ?1k ,t. '11nd 91'ptivieft I'illkur eParlrlld hca ri-rwrtruaY tave"'V time EIraI +~+Yf~Cle; Iftnl! Ib wlmrufutrif , 1. CijYr§h I"1Yr4 uUN1et rcccusa ugtu~rtrra]t krr rtrn~rutrG LfY#r t 9. WLtYrYp ttiW we"U : ttlrri, a+attrglrtt:wtiv, rhakitf Ylr tfiYYf Nf1#YI ltly#A'tow Mo irtlktrtirrr oft'irrr twrd~ r f 11, r►Irru tdtr, viirtwlrt IttvtaM Yrmtt tlrattrr 1 w~rrrrd u ac 110 6' 1#r# lthd' le0ilbdgn bulow alltirnt Ittfrrr, 1VnrAV troll rip ojt f4iis trttuw rr:trrstlrtr to the UrYtrrt vrt tlru `,;,u r:urlr 1190 traNrr tiwy r lrrl#t. rllidnll t ills t11YY - SEldri tit" r rvif'lri raw trt, :rrrrl urtrr: ryV't#yyt a:#ruu 111#Y' ' (F. 11' Lt Vfk8 switth #artarlarrtWd Y,iu arra 41 ~MillrlYYff sbt,uld iru rrtrrourred try tvrwushttr +s►YrrrwrrJYrIJt YINtYI, tits vWf111sfr I'Y With #VrICvY' Irrrly. WSW rtitll Wid lalNifhetrl Wishe trul"o late lV*111i w i ovrtt'tFru 61tY Cdi k,'i sid'y ri:Ir'ill' Werl suttyrat iwrfr~ar ilOW41) r V trrdp, rnylrlHy atuu4 r~ YrurYu~rt~r rrll itl un,t the usiflldff,t wiklY Wirtra' ~,t N $ 10'a ur'tilll 1$i fill rLL „`r It. W Vow swptrh ly utilised w+a alWr:er, Utttl iYiYCiC IIVCu f[lia~ tank. t'rrWrllrty ,da+alrwhata Yrrt~ ~ btsliriltr it#Erl H1w~Yt' iulgti J, 116"Swee bow 014,e1celYYrtdffre b'Welt !di-11 the tlika" ltmka hotu flop Luacoutr i#a# ljr*fjq0i5rtu IlYfl6bkY' 1 u dUUurrtt#rtlY I r ~I, Ybatl n:,. l t1. l#rytriaG•m u/tr1 a+ur:urrr tltxi 1 a, UwV;tYY;tri Yllrtalffifki U14 Clio takili. t 'IW~~N►"Illll..~~illiir`t'il~lllfil~~'~11lk~tLi~rwdrY. '~'~~.,~'~rJ~"~y (~~Ila,l~r~µ~t~ Y ✓~'w r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address _ -5-6/S' (Verification re aired from Planning & Zoning De artrnent for new construction- l / rl g P ) City/State [1airyili'M_)g _ Parcel Identification Ntmibert 9) LEGAL DESCRIPTION Property Locatiort~t %a r/a ,Sec. T C.`l_N Town of Ai (Mr Subdivision 7'q V V ` yl' , Lot # 4 . Certified Survey Map # Page # V o li tme Page # Warranty Deed # Spec house yes no Lot liners dentifiable yes no SYSTEM MAINTFNANCE 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, ifueeded, 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 §G nn. 83.552(l)a and in Chapter 12 - St. Croix County Sanitary Ordinance. 3f -3 - The property owner agrees to submit to St. Croix County Planning & Zoni;rg 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 systt::m is in proper operating condition and/or (2) alter inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. T/we, the wsdersigned 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 k iowledge. [/we andare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Dews Office. NumbtSIGN.KTR =0F ANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being ravoked by the Planning & Zoning Department. Include with this application a recorded warranty deed front the Register of Deeds office and a copy of the certified survey map if reference is made in the warranty deed. (RE'V'. 08/05) M N 1 /4 CORNER, N SECTION 5, FOUND NORTH LINE OF THE SW 1 /4 OF THE FRACTIONAL NE 1 /4 o N SURVEY NAIL o - UNPLATTED LANDS In N 89'51'32" E 1316.00' _ _ _ _ 330.63' L77 L18 308.46' L14 E HWE=1062.2' 653.99' -------7 I~-- --i~ - - L12 LBO =1064.2' / / N L16 I L20 0 N \ HWE =1055.0' I ffi1055.0' 15.00 \ LBO =1057.0' HNfE 160607 S.F. N \ \ I I LBO =1057.0' 3.69 Ac. 0) 15.00 I _ N 87'34'27" W 506.31' r a 29 II II,~ 121s800S.F. 21 N / \ \ 134722 S.F. II II 2.80 Ac. 81160 S.F. 3.09 Ac. I I O I 19 O N .t 1.86 Ac. / \ \ I N 8 28 \ NII I 80' TEMPORARY 00 N O'O9'p1_w 441. / 122374 A \ ~j I II EASEMENT. U, TO I ~p 2!5.46+ 58' CO 2.® Ac. \ \ I -I BE REMOVED / 00 W UPON / 0 [ ' ?26,12, \ \ \ I I Ln EASTERLY EXTENSION OF ROADWAY. i 2~ N &304 S.F. N \3j \ Z w o I 'n 1.52 Ac. C23 S :2 0 29 -7) w to 0? (n I Q 80' TEMPORARY V - / Z L~ 7 EASEMENT, TO 71902S.F. RREEMOVED 23 ^ \ N 1.65 Ac. UPON c61~ F- WESTERLY 113623 S.F. --CIV 41 4j `L G p 6 Z EXTENSION +)F 2.61 Ac. O/ ° \ \2° \ G~i / c, / ~n 1 107 O ROADWAY. \ co / a \ \ \t'Y~2 J / G` 1 R2O3 cllv) .6 7 F 10 1 N 87'32'18" E 26 \ \ G~Gj o~~ 81.4 ' 69891 S.F. 31 N- 1.60 Ac. 82454 S.F. \ Cis \ ~ / \ \ \S3S 61 VN/ 1.89 Ac. ~ ~ ~ mac,! .0/ \ \ ~ l / / Ls- N 84'40'47" W 4195A u,\ 7~• / (gyp - - < 9 ~ \ N\ \ ~ / / \ \ J c" - - - - Lil 25 m Lo m 66514 S.F. / • , , 32 C? cc) u?\ \ OVA \ / \ N 66. 1.53 Ac. O / , 79961 S.F. o o \ O d \ \s\3. / Nj / o / p 1.84 Ac. 03 co 'r \ \ `7~ \ \ v \ X23 / po / L - N 82_21'33" yy .01 r~I ? a' \ \ / \ 6g+ 3 / - 459.01's 19 24 69641 S. F. \ O A' 72161 S.F. N/k / c~ 1.60 Ac. \ O , \ 1.66 Ac. rn/~ 33 \eQ~ \ \ ~/2 / tV \2~ 88149 S.F. / c' 2.02 Ac. i F, 6S• \ W / / / \ \ \289 27 co / / 18 X82. ~S'\ 22 F\ 3/x.66' \ c`v+ 72244 S.F. , \ / / / - - - - 1.66 Ac. 228 6 3419 66474 S.F.~ 9p- - 1.53 Ac. S 89'26'33" W I A 00 I 17 LN 75. ioN 6\ \ tK 68909 S.F. //O J`»=46- 1.58 Ac. 5 00 35 NI 46 h~ 66591 S.F. co) 75381 S.F. 1.53 Ac. I~ i i o~ 8 0 x64044632 4 STATE BAR OF WISCONSIN FORM 6-2000 I 958722 Document Number SPECIAL WARRANTY DEED BETH PABST THIS DEED, made between Contractors Capital Corporation, a Minnesota REGISTER OF DEEDS ST. CROIX CO., WI corporation, Grantor, and Matt T o e n i es, a married man ,Grantee. 06/22/2012 2:21 PM Grantor, for a valuable consideration, conveys to Grantee the following EXEMPT#• NA described real estate in St. Croix County, State of Wisconsin (the REC FEE: 30,00 "Property"): Lot 23, Farm View Ridge, St. Croix County, Wisconsin. TRANS FEE: 15.00 PAGES: 1 Recording Area Name and Return Address: Land Title Inc. File No. 379290 2200 W. Co. Rd. C, Ste 2205 Roseville, MN 55112 Together with all appurtenant rights, title and interests. 018-2007-23-000 Parcel Identification Number (PIN) This k= homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances, ansing~by, through or under Grantor, except Easements, Restrictions, Reservations, Roadways and Rights of Way, if any, of Record. Dated this 31 day of May, 2012. Contractors pital C_orpc o * e Ambrasas, President/Chief Financial Officer AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF M E OT COUNTY OF ) ss. authenticated this 31st day of May, 2012 Personally came before me this -i- day of May, 2012 the above named Kyle Ajbrasas, President/Chief Financial Officer, on behalf of Contractors Capital Corporation, a TITLE: MEMBER STATE BAR OF WISCONSIN Minnesota corporation, to me known to be the pe ) who (If not, !eMforegoiinginl me and wledg t, me. l I'll, authorized by § 706.06, Wis. StatsJ THIS INSTRUMENT WAS DRAFTED BY i3 * Notary Public, State of Minnesota My commissio HN50N) Larry S. Mountain, Attorney at Law PAULA KATHRYN !2015 (Signaturesnmybeautheniieatedoracknowlcdg~d. Both are notumessary.) 8fy Public, *Nmnes ul" persons signing in any capacity must be typed w printed belmy their signature State of Minsota t My Commission xpires r»' January 31, SPECIAL WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 6-2000 1 of 1 Parcel 018-2007-23-000 06/24/2013 03:14 PM PAGE 1 OF 1 Alt. Parcel M 05.29.17.962 018 -TOWN OF HAMMOND Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 09/02/2004 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - TOENJES, MATT MATT TOENJES 410 CHERRY LN # 3 ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description " 1656 115TH AVE SC 2422 SCH D ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.610 Plat: 10-022-FARM VIEW RIDGE 018-04 LOTS 1145 SEC 05 T29N R17W PT SW NE; BEING FARM Block/Condo Bldg: LOT 23 VIEW RIDGE ('04) LOT 23 (2.610AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-29N-17W SW NE Notes: Parcel History: Date Doc # Vol/Page Type 06/22/2012 958722 WD 03/30/2012 953439 SD 09/02/2004 773272 10/22 PLAT 2013 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/01/2011 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 2.610 600 0 600 NO Totals for 2013: General Property 2.610 600 0 600 Woodland 0.000 0 0 Totals for 2012: General Property 2.610 600 0 600 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