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HomeMy WebLinkAbout004-1043-80-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567213 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: Frye, Shawn M. Cady, Town of 004-1043-80-100 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: ,Qn B/ ^ , / T 19.28.15.296A TANK INFORMATION i ELEVATION DATA A /1. GI //4'. Z5 I''/• .57 TYPE IIMINIMIN /O�, STATION * �SZ /d?'� FS /a sR,s ■ Septic �' �,, �' 4 750 Benchmark / , ? /O/,� t a 1 O ic 525 , Alt. BM in I /ems J A !'33 1/3,T. Aeration Bldg.Sewer (/ $ 11... /01.,i3 .MII.Holding ligill1=11 St/Ht Inlet St/Ht Outlet A `j• 'fd//0 g, 7( TANK SETBACK INFORMATION TANK TO P/L ME BLD . fp o Air Intake ROAD Dt Inlet .t MO 97, 09 Septic Dt Bottom * /4,.Z.. 73. 57 � /oo Icy lb ` Dosing 7MO/ 7266 11 �� Header/Man. / ( 16/ .i A Aeration � Dist. Pipe /61. 4 Holding ®--° Bot.System /,i 5 /U6 S Final Grade `,,-,.� PUMP/SIPHON INFORMATION 0 , I Qa,/62. 7 ' .-,, Manufacturer Zb /1 e ^ Demand St Cover,,,n. J� '1 33 1/3 ( / GPM ,`� h Model Number 3Z,4 /j 77 TDH Lift Friction Loss System Head TD�� S4t / 17, 7/ /. Z`) y.SS J Forcemain Length.. / Dia.Z II Dist.to Well ' zoo SOIL ABSORPTION SYSTEM 7,45 /6Z.q S /t5a BED/TRENCH Width f Length / No.Of nch PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS G 75 Le '...a.....� ....Ns SETBACK . SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: 1 INFORMATION CHAMBER OR Type O stem: 75 / /OD/ "7 I `/14- UNIT Model Number: PIif. ,^, ,v I'r DISTRIBUTION SYSTEM (,tfe,64-- ////►►►► Header/Manifold 0r Distribution / /1 / x Hole Size x Hole Spacing / V ✓Air In e S Pipe(s) 7 C S Length '3 Dia Length /�� J Dia /� `/ Spacing 3 ��� Z a,�,.,..,,{iaAN.„ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only / -Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched ' Bed/Trench Center / ' Bed/Trench Edges a Topsoil ( Yes E No Yes E No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: // / 4, / /3 Inspection#2: / / Location: 291 270th Street Wilson,WI 54027(NW 1/4 NW 1/4 19 T28N R15W) NA Lot 1 C h� Parcel No: 1928.15.296A Fr 1.)Alt BM Description= t Gou-c„� Plot.) /14.1- 2.)Bldg sewer length= 2'3 I a,AA�� ~ 6 L.) OK amount of cover= g 1.—O c....1 z.5 O�.. n _ t I Ot tiy51"e�,w h � ,lo 4,„j•. � G- Q------- _ .—_ Plan revision Required? Yes No ( t I O1 s Use other side for additional information. `c - -- Date Insepctor'• Signet, Cert.No. SBD-6710(R.3/97) SITE PLAN I NW,NW,S19,T28N/R15W Cady township A, St. Croix county , ..t 7 `,. LI-(1-) LEGEND I IBM: 100.0" top of i . 2- PVC pipe 2BM: 104.57' top of f (6.0, //j q 9.9 „X- pits w/backhoe 41"16' 1.-' ' ' ' --'.. - - - .-/ r, ,,r- 0 \ *- grade elevations , ......-,- _- -s-- — - contour No DSPS 383 set back - — - • t--- : / problems „„ - . .. Scale 1”- 40' except -.." "-- where indicated 1„cf.f-1-,, _, --- ) ----, I , _, ------, 1 -7(),_ ..c_2 _ , ..„--- ......_,07._. / 7 - - a , _4_ Woo is 121 ) ilia- ektorcb , - A System 100.9' u,,,,p -k-TaA..' ,„„,\ >4. on contour 99.65' e :7 - . er ALI'3°I‘i ; Part of 30A.C. EyISfl Ner 1-1005 C q OL,13 s-c-pn6- ,-...„,-_,L7-).-?..:L., 2_,It,...___17 e---- Ni 9 1.720/1410L.1) 0 Attii, _z-3vt.'...., IC'01 f '--1 S, - \k- A 4 1.. {. 1 -, 1 1 1 eflji is......\ L ,o _ —7- ,,, •---- , , 7" B I project: FRYE _ page 11 of 11 PeVietute K Cdpy 1 1 J r •~S ~ County Wisconsin Safety and Buildings Division St. Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Department Safety and Madison,37-7162 ^ Professional Services ~ J'j Plan I.D. ns idNumber State Sanitary Permit Appli Stater a 3*3rjL+q (,p In accord with SPS 383.21 (2) Wis. Adm. Code submission of this form to the appropriate ve ental Project Address (if different than mailing address unit is required prior to obtaining a sanitary permit. Note application forms for state-owned P TS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the P Stats I. Application Information - Please Print All Information 4 ✓ Property Owner's Name SEP 2 4 2013 Parcel # Mr. Shawn Frye 00 [ p 3 - [Q0 Property Owner's Mailing Address Property Location / (ra th ST CROIX COUNTY Govt. Lot C 291 270 Street - City, State Zip Code Phone Number N W N W Section 19 Wilson, WI 54027 715/772-4366 T 28 N/ R 15 w II. Type of Building (check all that pp~ ly) n~ Lot # / Subdivision Name X 1 or 2 Family Dwelling - Num er of Bedrooms (~f ( Th1Jee b(~) Public/Commercial - Describe Use Block # City State Owned - Describe Use CSM ber Village of X Town of Cady V 'z p3 III. Type of Permit: (Check onneAxm on line A. Complete line B if applicable) J I A. X New System placement Syste , ! ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System lVut7u List Previou ermit Number and Date I sued B. El Permit Renewal El Permit Revision A umber of ❑ permit Tran sfer to New 1~ S s Before Expiration Plumber Owner 16 IV. Type of POWTS System: Check all that apply) Non -Pressurized In-Ground Pressurized In-Ground At-Grade Mound >24 in of suitable soil X Mound <24in of suitable soil _ Holding Tank Other Dispersal Component (explain) -Pretreatment Device (explain) ' L / . / 05./ - /,7 S/ Gtr V. Dispersal/Treatment Area Information: CM (P X /D U'yt e5--ntRVZ-- -7 7- d -171 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requir d (sf) Dispersal Area Prop ed (sf) System Elevation 450 - 0.5 / V 900.Osq.ft. y~o 1462.5sq.ft C/o 100.90' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks pCOrHolding 1000 1000 1 Weiser Concrete X Tank *oft Chamber 750 750 1 Weiser Concrete X 0 y 1 W-- 4e v ,,l VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber'~signature MP/NMPRS Number Business Phone Number Jack A. Bowman MP 22839 715/418-1349 Plumber's Address (Street, City, State, Zlprk-6de) 409`" Street, Rldgeland, W1 5476313437 VII Coun epartment Use Only Approved ❑ Disapproved Permit Fee Dte Issued I ing Agen Signatur Qf El 2 L Cl) Owner Given Reason for $ 2 / 3 Denial IX. Conditions of Approval/Reasons for Disapproval d ►(~0-hd ~ ~~S 1•►1 s'{d--~ ~ Nti ~?I~~~1 SYSTEM OWNER: W14h,t: o 1. Septic tank, effluent filter and ~Q S 5~1,4WAI D/ dispersal cell must be serviced /maintained ~ f-ra~.S~ as per management plan provided by plumber. l J Pe~WIQAI~ 2. All setback r uirements must be mainjained /"l/1 U,$r 66- 1&-Move-Dl b~OL Ils-WE~ plans (to the County only) for the system on paper not less than 81/2 x 11 inch S~ J ._)C 1 ~7Tl~6li✓CZL Ai 65tr-19,' PCIZ_ C06 ac" J?-Y -V3, 33 D/ol 5Q Tb ~~uJ~ DIVISION OF INDUSTRY SERVICES otip"xTUF,~T 3824 N CREEKSIDE LA yti~ o~ HOLMEN WI 54636 oz f . Contact Through Relay t S K www.dsps.wi.gov/sb/ P ' www.wisconsin.gov 72oA S ~~ow Scott Walker, Governor SSI014 S~ Dave Ross, Secretary September 18, 2013 CUST ID No. 224580 AM. pOWTS Inspector LORETTA LARRABEE ZONING OFFICE L AN L PERC TESTING ST CROIX COUNTY SPIA 1101 CARMICHAEL RD N2089 CTY RD Y MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/18/2015 SITE: ID No. 2304962 rabove, entification Numbers Shawn Frye 795271 270TH St to both identification numbers, Town of Cady cones ondence with the a enc . St Croix County NW1/4, NWl/4, S19, T28N, R15W FOR: Description: Three Bedroom Mound System / 10% slope Object Type: POWTS Component Manual Regulated Object IDNo.: 1448309 Maintenance required; 450 GPD Flow rate; 21 in Soil minimum dept to limiting R. 10/12ctofrom e Dg trib> one System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N. Component Manual - Ver. 2.0, SBD-10706-P (N.01101, 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. is system is to be manual(s) referenced bo ected and located in accordance with the enclosed approved plans and with any component ~ON The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code A 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, bEP7pR Ep7- 0 stats. $~O(y O The following conditions shall be met during construction or installation and prior to occupancy or use: F Reminders: A sanitary permit must be obtained from the county where this project is located in accordance with the SEE C RR requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements or inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20 2 d , Wis. Stats. A state approved effluent filter is required. 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. • The area within 15' downslope of the dispersal component shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. A co of the a roved plans, specifications and this letter shall be on-site during construction and o en to ins ection b authorized re resentatives of the De artment which ma include local inspectors. LORETTA LARRABEE Page 2 9/18/2013 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. 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 Fee Received $ 250.00 Gerard M Swim Balance Due $ 0.00 POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm 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 a and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by.4PS Chapters 360-366. Private On-Site Wastewater Treatment System (POWTS) Mound and Pressure Distribution Component Design Residential application Index and Title Sheet r;FIVED Project Name: FRYE 1WIG 3 0 2013 - cjY SERVICES Owner: Shawn Frye 270th Street Street Address NW1/4 NW1/4 S19 T28,N/R15W Legal Description Cady township St. Croix county Township/County Contents: Page 1: index and title Page 2: general information & latera2Y!W_ kt E© Y Page 3: mound drawings PROV Page 4: dose tank SAF Page 5: pump information IVqL 3 f AAfD Page age 6: septic tank detail pump tank detail ~uST RY SERV C P Page 8: filter information ES Page 9: management plan , Page 10: contingency plan IV~ENCE Page 11: site plan Attachment: soil test to state plan % Designer's name and license no: Loretta Larrabee #1872-007 Address: N2089 Cty Rd. Y IN` ' .;j►~~i~ Menomonie, WI 54751 ~A Phone: 715/664-8184 to2 Fax: 715/664-8164 NENOWME Cell: 715/505-1628 w18...,.~ e-mail: lanlperetestingng wwt.net "A OES~~~ Designer's Signature: Date: August 16, 2013 I the undersigned submitted these plans under my authority Mound component manual for POWTS Version 2.0 SBD-10691-P (N.01/01), and Pressure Distribution component manual - Version 2.0 SBD-10706-P (N.01/O1) page 1 of 11 f, ¢..r.:, r~, , xrt~~ .ease . . w' +iii~'~~~`?, ~ 414! GENERAL INFORMATION Three bedroom home, 450ga1 DWF end fed system w/2 laterals 10% slope system area dispersal cell design loading rate 1.0 0.5 soil application rate linear rate 6.00 21" limiting soil factor orifice sq/ft. 7.5 1000gal Wieser septic tank with Polylok 525 filter effluent quality #1 750gal Weiser pump tank LATERAL LAYOUT DIAGRAM (not to scale) End Fed System Number of laterals 2 orifice dia. 5/32in. (0.156) Lateral dia. 1 V2" orifice spacing (X) 30in. (2.50') Lateral length (P) 72.5ft. orifice per lateral 30 Lateral spacing (S) 3.Oft. lateral discharge rate 16.20gpm Manifold dia. 1 %2 in total system rate 32.40gpm Force main dia. 2.Oin • O turn-up end on lateral at manifold for access of lateral at both ends for servicing ♦_Valve box Pressure lug finish grade X P first orifice next to fitting X manif 1 1/ " S 3.0' (36") f.25' (15 " Orifices located on bottom of lateral ~ I I Last orifice next to fitting Force main 2" dia. project: FRYE page 2 of 11 PLAN VIEW OF MOUND (not to scale) J= 6.0' D=1.25' (15") K= 10.0' required bed 450sq.ft A= 6.0' E=1.85' (22")= 75.0' proposed bed 450sq.ft. I= 13.5' F= 0.83' (10") L= 95.0' required base] area 900.Osq.ft. = 25.5' G= 0.50' (6") proposed basel area 1462.5sq.ft. I4= 1.00' (12") observation pipe @ 15.0' Observation pipe W ° 6.0' 25.5= I x.75 o' E13.5~ L-95' Mound Cross Section View (not to scale) Finished grade elev. 102.69' t Lateral invert elev. 101.40' H Dispersal cell elev. 100.90' ".11, llllllll 4ll!lllllll/lllllllllllll dispersal cell = 2" O+--lateral D 31 - - a - Aggre ate bed 6" - - - - 3 - E l - tilled layer tilled layer contour 10% site slope elev. 99.65' Numeral Key 1 topsoil cap 2 subsoil cap 1.5ft. 3 ASTM C33 sand 4in. dia. observation pipe 4 synthetic cover over cell with 1/4in slot 5 aggregate O.Sft. Closest Flange to secure observation project: FRYE page 3 of 11 PUMP CHA/4\%LR CQOSS SECTION ARID SFCCIFICATIONS WCATHEKPROOF APFRO`IED LOCA;kl(... JUNCTION BOX MANHOLE COVER I c-r-s. 4~-i~4 ° u GRADE b" MIN. ~ L_r 18"x1 m. CONDUIT 18'/'11 N. - I 4~iscclQe INLET PROVIDE AIRTIGHT SEAL ~ p APPROVED JOIIJ7 A 4 ale APPROVED JOWU WI q0 PIPE I W/- 440 PIPE EXTENDING 3' EXTEUDIUG 3' OUTO SOLID SOIL, O)JTO SOLID SOIL t Q~ D C ELEV. L- FT_ PUMP a, 0 CONCRETE BLOCK mn K~arM Robe. on wrme c~rccxi SPECIFI'CATIOAJS OOSE- TANK. MANUFACTURER: Q 010 L7 F CIO 10 TAi W SIZE: 250 GALLONS a (010 ALARM MANUFACTURER: - ir&Qruc' l deoc. v~Q . i+ ( t+ Ct S_7 / Q'~ MODEL tiJUMBER. Yh TT l CAPACITIES: A= Q?O•S IUCRES OR •GALLOUS SWITCH TSPC: #Y1C L~±l~ni Ak B= ,cQ IIJCHES OR GALLOAIS PUMP MANUFACTURER: C =INCHES OR '9/24 GALLONS MODEL NUMBER: - D--/O tAtCHES OR a~'~• GALLONS 5WITC14 TYPE:EYL_tC-)NO 1i rte] -104-0is _Z7 Inches o,t GALLoaus MINIMUM DISCHARGE RATE 3 GPM 0mll • In VERTICAL DIFFEREUCE BETWEEN PUMP OFF ARID DISTRIBUTION PIPE_. g ~o FEET i-I + MINIMUM NETWORK SUPPLS PRESSURT,E/• w rJ~ FEET + _ 33- i'EET OF FORCE MAIN Y, s $ F/oo rtFRICT1oN FACTOR 9. 0 FEET TOTAL DSNAMIC. HEAD = 1-31 -S FEET project: FRYE page 4 of 11 W HEAD CAPACITY CURVE 3 7/8 6 1/4 MODEL "98" 4 5/8 -1 30 8 25 ~ 0 3 5/8 6 20 3 ® + + Y 1s IN. 0 o 10 4 3/16 0 2 5 1 1/2-11 1/2 NPT o - U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS 0 8o 160 240 FLOW PER MINUTE MODEL 98 60 CYCLE ZVE Feet Gallons Meters Liters 5 72 1.5 273 10 61 3.1 231 Is •5 4.6 t7o 12 20 25 6.1 95 Lock Vakre; 23'. 009971 4 3/16 5x1102 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available • Double piggyback variable level float switches are available with or without alarm switches. for variable level long cycle controls. SELECTION GUIDE Standard all models - Weight 39 lbs. -'/z H.P. 1. Integral float operated 2 pole mechanical switch, no external control required. 2. Single piggyback variable level float switch or double piggyback variable level, 98 Series Control Selection float switch. Refer to FMO477. Model Volts-Ph Mode Amps simplex Duplex 3. Mechanical alternator 10-0072 or 100075. M98 115 1 Auto 9.4 1 or 1 & 7 - 4. See FMO712, for correct model of Electrical Alternator. N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10-0225 used as a control activator, specify duplex (3) or (4) D98 230 1 Auto 4.7 1 or l &7 - float system. 6. Four (4) hole J-Pak, junction box, for watertight connection or wire" E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 100002. 7. Two (2) hole J-Pak, for watertight connection or splice. CAUTION For information on additional Zoeller products refer to catalog on Piggyback Variable Level SWitches, All installation of controls, protection devices and wiring should be done by a qualified FMO477;geWWAftarnOW FMO486;Mechanical Mernator,FMO495;SwnpSCwage8asms,FM048T licensed electrician. All electrical and safety codes should be followed including the most Single Phase Sirrp Pump Contrd, FM15WAlarm Systems, FMO732- recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AWL TO: R0. SOX 16347 LOL600, KY 4025"117 TO: 49 Care Run Road , 902 fadurersW ~ 1-1961 ~ff~i'ti No • PUMP !O. (502) 778 -2731 • f (600 928 -PUMP ~IAUTY/'UMP9 svcE z7v httpJ/www.zoel%%com FAX(502)7743624 a • z to D m 531" AS REQUIRED a 86" z c 42" Z v 0 3 i m ~ UP 4j" 4" CAS X \ n o n 1 En 0 3" 36" I I 5" I o to CO rr m I n 4" CAS F I nNi I V ~ m c ~ -0 v n z ° 39" c~ to n a I U) a r a D0 D x r Z Z O I 7Zr*1 C X D G C m Fri -n c o o z D ~N X~ mz ° nCG) n p z D*Z apmozmDO OD0 z ~-ao~ th-4 r°nv 0rrri L -4z D moo ,X ,,ng Fri Z- r C') ;a szo IDIM voN) -u v a Zy 000 OO n V P1 mm N-IVI~ oA~v~;~ n Q m ? o~7_ A o v a X 0 ~ V1-n m ina' x A a 1/1 z r N s s o O C) w ~7 Q 0 ` C r G7 f+lOm (A W 0 0 • Uu Z7 r Z~ C W 00 a Dm m0 v _ I m D G 0 H 1 nm K D Zf'Z r~ Wm ^ D m;o j2 q -0 E! GZ) 0 z zO mo N g ;U o D Sn D D ~o°Om Q i m 'n - z 0 oe P2 TA C mm m x cn tzn ~ a 00 r O W p o $ OD O m G rF* PD ID' F-1 In v rrl m A a 0 ~ N :lc ,'°°°_MR MHERBIRINETE o ~ DRAWN BY. WCP SCALE: 1 4'=1'-O" ERE-POUR: -n - SEPTIC MANUAL O W3716 US HWY 10 MAIDEN ROCK, an 54750 DATEW Do 00 OATS: • ST-POUR: 800-325-8456 nm- imm-0 Taetj t 0.3e e0~- a - Z rn r m c 54" AS REQUIRED 84" D A 42" v ~ m m m 0 UP 41" x m - 4" CAS ( r v 3" 37" 5" m r~ F- n UP 39" r O a / ° LAS I ' m ;u n 1 r~ N 1 N V ~ c m m a ~ ° 40" r a z m+Ni v~ a1 1 rn m ' i n y0 r S r Z Z ° ° Z rrl* ~y o O C r rrn m Oz ~P 0 z pyz O a -1 -f ~rCWOS~C~WgrZl1 -I n Oga C)-PCma00a- O Ro -x -0 O P(2 -4 101, ~0wa U)c-;o 0- On 0(ja AEZ z aim mm o m N mirr--Z n z p20 rn>c) ~r 0-4p-. N U) rrl -so c - Mo.. T) 4c z0 m to Z Oaf ~Zm 019 f*1 Y N Z O rn r-O a ~ a Wr-1> - - N "A.. ° -00 N rnN -4N O.. m s rrss~~ W 0:- > X O Z N c r~"A N WRiD yD =N 000 m -I °a v 7D N Z C 0.. ~ m m~ 1 r to O t~* t7 ()1 Z V y Mc a W~ L O $ oA~m a -n :E z n~ C D vo i- nra >rri z a o H D ~m -0 ~ C) Z >MO W0 0-a m Om =t) D cn r rA O r -i rn -v 0 °°z En w ;0 [A z O A m r V~ n m DH Z r rI M m v KP750-MR X DRAWN BY: WCP SCALE: 1 4'=1'-0' PRE-POUR: o m -4 SEPTIC MANUAL MIERER cullIETE Y. 00/00/00 DATE:. r-POUR: ~ \ Z W3716 US HWY 10 MAIDEN ROCK, VA 54750 DATE: ° 800-325-8456 FlLE: URM-W Prc.1e,c.{: -+ayE a -1 c~1I Filters PL-525 EFFLUENT FILTER (COMMERCIAL) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters. The Pt-525 is rated for over 10,000 GPD Alarm W' (gallons per day) making it one of accessibility excenp on Handle the largest commercial filters in its class. It has 525 linear feet of 1/16° filtration slots. Like the Polylok P6122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1116' removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No otter fitter on I the market can make that claim! Accepts 4' & 6' " SCHD. 40 Pipe PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning, It is recom- mended that the filter be cleaned j every time the tank is pumped or at least every three years. If the installed filter contains an optional , alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be Gas deflector done by a certified septic tank Automatic shut-off pumper or installer. ball when filter 1. Locate the outlet of the U.S. Patent Noe GAn5.488 is removed septic tank. 5.871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and eom- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day {GPD}. 3. Glue the filter housing to the tank. Make sure all solids fall 4' or 6' outlet pipe. If the filter is not centered under the bade into septic tank. access opening use a My= 6. Insert the filter cartridge bade Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. ?(-D~.e-a : lp,~ i~ ~M5'- 8 -S~- M Mound System Management Plan Pursuant to DSPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with DSPS 382-384 Wis. Adm. Code. and shall maintain in accordance with the component manuals and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with DSPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manholes risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8" in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slip off the filer when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personal shall advise the owner of when the next service needs to be done to maintain less than maximum scum and sludge accumulation in the tank. Puma Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings maybe made around the mound's perimeter and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since compaction may hinder aeration of the surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations dictate that the mound be heavily mulched as protection from freezing. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral and it is recommended that each lateral be flushed at least once every 18months. When a pressure test is performed is should be compared to the initial test when the system was installed to determine if orifice clogging has occurred, if clogging has occurred orifice cleaning is required to maintain equal distribution within the cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner and any levels above 6" considered impending failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or components shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank or its components become defective the defective components(s) shall be immediately repaired or replaced with a component of same or equal performance. If the mound fails to accept wastewater or discharges wastewater to the ground surface, it will be rcpainxl or ruplacod. Increasing basal area if toe leakage or by removing biologically clogged absorption and dispersal media and related piping and replacing components as deemed necessary to bring the system into proper operating condition. See page 10 of this plan for the name and telephone number of your local POWTS regulator and service provider. project: FRYE page 9 of 11 Mound System Maintenance and Operation Specifications Service Provider's Name: J.B. Hydro LLC Phone: 715/949-0099 POWTS Regulator's Name: St. Croix Zoning Phone: 715/386-4680 System Flow and Load Parameters Design Flow - Peak 450gpd Maximum Influent Particles Size 1/bin Estimated Flow - Average 300gpd Maximum BOD5 220mg/L Septic tank Capacity l 000gals Maximum TSS 150mg/L Soil absorption component Size 450bed Maximum FOG 30mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cf i/100mL Service Frequency Septic and Pump Tank ------Inspect and/or service once every 3 years Effluent Filter--------------Should inspect and clean at least once every 3 years Pump and Controls ------------Test once every 3 years Alarm--------------------------Should test monthly Pressure System ----------Laterals should be flushed and pressure tested every 1.5 years Mound ----------------------Inspect for ponding and seepage once every 3 years Other----------------------------Initially filter should be checked yearly to determine service schedule Miscellaneous Construction and Materials Standards I. Observation pipes are slotted and materials conform to Table DSPS 384.30-1, have a watertight cap and are secured as shown in the mound component manual. 2. Dispersal cell aggregate conforms to DSPS 384.30 (6XI), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in DSPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration 6. Lateral Turn-uu to finish at grade or above, enclosed in a 6-8" diameter lawn sprinkler valve box or similar product. (lateral turn-up consists of a long sweep 90 or two 45degree bends same diameter as lateral) 7. Lateral Turn-up on end of distribution laterals after the last orifice. project: FRYE page 10 of 11 SITE PLAN NW,NW,S 19,T28N/Rl 5 W Cady township St. Croix county) LEGEND 1 BM: 100.0' top of 2- PVC pips. 213M: 104.57' top of 2" PVC" pipe X- pits w/backhoe 1,5' wn I ,b5, ® - grade elevations 1q", 1 -contour - No DSPS 383 set back ~~o = problems Scale 1" - 40' except __Qs = ~ f where indicated f- 10? 2v System 100.9' I _ ~10 J , on contour 99.65' ,~,.En~e~t•n.,};. ~u/l~p 303`{ Part of 30A.C. ~ ~s°.`~`~ ~°u'~, a~ i i ~i project: FRYE page 11 of 11 `fisconsin 2_2L Y ~~~EPORT #1579 Department of Commerce . Adm. Code Page 1 of 4 Division of Safety and Buildings _ Schmitt Soil Testing, Inc. Attach complete site plan on County paper not less than 8'/z x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal ref rend paS nt 4R direction and percent slope, scale or dimension , , V C Rdfine D and stance to nearest road. Parcel I.D. Z~ 1 [.J rt of. 004-1043-80-,0 Please rint a f rrrformadon. Personal information you provide may used (Prix taw, s. 15.04 (1) (m)). Reviewed D1 Z 3 Q~ Property Owner Property Location Frye, Shawn COUNTY jGo NW1/4, NW1/4, S19, T28N, R15W Property Owner's Mailing Address ZONING OFFICE of # lock # Subd. Name or CSM# Lti/~l/S 291 270th St. 30 Acre Parcel -4 City State Zip Code Phone Number City E] Village M Town Nearest Road,*Z3/ ~y 1 3 Wilson WI 54027 715-772-4366 Cady 270Th S. 7 on Use: M Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial - Describe: Paten material Glacial till vet limesto a Hood plain elevation, if applicable NA ft. General comments - ~2~ ~C C _ "~2 _ Z2'1/.YZrC". ~~Y1 ~ ~Q~C".~' ~~d ~ and recomnrendations: Area is suitable for a mound system. System elevation is 100.90' based of centour line established at e. 99.65'. Slope is 10%. Depth to limiting factor is 21". Boring # Ground surface elev. 100.05 ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consiste Boundary Roots GPDft't2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0-7 10yr3/2 none sit 2mgr mvFr as 2f,1vf .6 .8 2 7-12 10yr4/4 none sil 2fsbk mfr gw 2vf .6 .8 3 12-19 7.5yr4/6 none scl Imsbk mfr gw .2 .3 4 19-32 7.5yr4/4 none sl om mfr gw .2 .6 5 32-40 10yr5/6 ~~6 scl Imsbk mfr cs 2 3 6 40-65 10yr6/8 Limestone bedrock I l } Boring # l_J Ground surface elev. 99.55 ft. Depth to limiting factor 27 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD1W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 0-9 10yr3/2 none sil 2mgr mvfr as 2f,2vf .6 .8 2 9-16 10yr5/3 none fsl 2fsbk mfr gw ivf .5 1.0 3 16-27 7.5yr4/4 none sl Imsbk mfr gw .4 .7 4 27-35 7.5 r416 mid 7.5yr6/6 Y 7.5yr6/i scl imsbk mfr gw .2 .3 5 35-62 7.5yr4/4 m2d 7.5yr6/6 scl Imsbk mfr 7.5yr6/2 .2 .3 " Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <30 mg/L and TSS s.30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt , /C"'"~'-~- 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Stmt New Richmond, W1 54017 8/17/2007 715-247-2941 SBD-8330 (R.07100) Property Owner Frye, Shawn Parcel ID # part of: 004-1043-80-000 Page 2 of 4 F3 ] Boring # M Ground surface elev. 97.65 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10yr3/2 none sil 2fsbk mvfr as 2vf .6 .8 2 11-19 10yr5/3 none sil 2fsbk mfr gw 2vf .6 .8 3 19-21 7.5yr5/6 none grsl 2msbk mfr gw ivf .6 1.0 4 21-32 10yr6/3 m2d 7.5yr6/6 Ifs lcsbk mvfr w 5 1.0 7.5yr6/1 9 5 32-45 7.5 r4 4 m2d 10yr6/6 y / 1 r6/1 scl icsbk mfi cs 2 3 6 45-65 10yr6/8 Limestone bedrock F ]Boring # ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Ground surface elev. k Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 *Eff#2 * 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 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Schmitt Soil Testing, Inc. Page 3 of ,4j Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: Shawn Frye Thomas I Schmitt, CST 227429 Address: 291 270th St. 1595 72nd St. City, State, Zip: Wilson, WI 54027 New Richmond, WI. 54017 Phone: 715-247-2941 Subd.Name: CSM Pending Approval S' Lot No.: .1 (30 Acre lot) Datt Legal Description: NWl/4 NWl/4 S19 T28N RI 5W ® Backhoe pit Township, County: Cady, St. Croix County A Bench Mark El. 100.00' Top of 2" pvc pipe A Alternate Bench Mark El. 104.57' Top of 2" pvc pipe Slope= 10% Contour Line El. 99.65' Contour Line Length 90' Scale 1 40' 1 7 54- /0 a3 964* awn Lj r V / / L 17/ F31 ~ _ m j7 r AtelMS Viewer Page f of f ' M5 I ,~~.t ~Y•~Ye ~ * ~Y`~• C f~t. T,i i a FiJE` NT~ 2 r G~ v~ d e~ ~ i~ I 27TH M r r r - Ntl http://72.21.230.178/website/LRPortal/ARCIMS/MapFrame.asp?PIN= 8/23/2007 CHOOM S.HOA3ASns * Amnoo xioao is RECEIN/P Rhil 11111111111111111 Will IIII IN 8002 Nv(' 8 ~ X 2 5 3 2 2 866253 CERTI FI E~ KATHLEEN H. WALSH LINTY REGISTER OF DEEDS LOCATED IN PART OF THE FRACTIONAL N ECORD ST. CROIX CO., WI THE NW1 /4 OF SECTION 19, T28N, R1 SW, TOWN RECEIVED FOR RECORD OF CADY, ST. CROIX COUNTY, WISCONSIN. 12/27/2007 03:40PM N CERTIFIED SURVEY MAP LEGEND VOL: 23 PAGE: 5493 ALUMINUM COUNTY SECTION REC FEE: 13.00 U CORNER MONUMENT FOUND COPY FEE: 3.00 g 2" IRON PIPE FOUND OWNER w Q x 1 3/4" REBAR FOUND SHAWN AND TABITHA FRYE w ¢ 291 270TH STREET cad U O I' X 18' IRON REBAR SET WEIGHING WILSON, WI 54027 Z w o 1'50 LBS. PER LINEAR FOOT SURVEYOR S °C x x EXISTING FENCE EDWIN C FLANUM m NORTHLAND SURVEYING, INC. NW CORNER P.O. BOX 14 N1/4 CORNER , 1 \ \ SECTION 19 869014'37"W 1313,69' ROBERTS WI 54023 SECTION \ 0.01:t -j \ Soo'22a.1'W'. 17.0'• ' 47 58'. . '~C7 APPROXIMATE.LOCATION.OF 12%SLOPE$, LOT 1 ' 11¢ AND GREATER 29.78 ACRES U INC. R/W z 1pN!1N7i1iQ11NM/I// 1,297,187 SO. FT. `\Scc) S`f V%~" y'\ 28.45 ACRES EXC. R/W 51 l~f i lz 0. 1,239.155 SO. FT. vS N :....i~... = f FLMIUIN a ° ~ AtiJEFtY - - D 331~ _ s SEPTIC VENT SL l M 11J @') HOUSE NSW15'15"E 606.34' 12.0's v- cg) U); I - - ® 303.17' 303.17' } W EXISTING A 93 = i BUILDING SOIL TEST (TYP.) DRIVE 1 A (0 A N C I ® WELL LOT 2 LOT 3 5.00 ACRES INC. R/W t~l 5.00 ACRES INC. R/W 217,800 SO. FT. 217,800 SO. FT. Z I n 4.81 ACRES EXC. R/W l~ SHED 4.81 ACRES EXC. RAN A 209,331 SO. FT. El - w 209.318 SO. FT. + -1 I FIELD bcc 1d DRIVE $ Yd © g ry n I 6' I z rd ~ ~ z a~ 50' BUILDING SETBACK LINE I ¢ ~ . v 68' JOINT DRIVEWAY EASEMENT N89°15'48"E 1280.99 _ O- o 1 674.65' N 303.l r N 6 5 2 _ 303.17' 711.34' 303.117' 303.17' 27.92 _.08t EXISTING CENTERLINE '1 6'e 17I 7 27TH AVENUE : to J CURVE DATA TABLE . CHORD NUMBER RADIUS ANGLEAL BEAR NG CHORD C1 458.00 20.42'10' S10'10'46'E 1164.59 LENGTH 65.4gENGTH TS20 31 51I E TANGENT I 19'WT W1/4 CORNER SECTION 19 SCALE IN FEET 1, = 200' THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON JOB NO. 07-80 DATE 7-29-07 SHEET 1 OF 2 SHEETS 200 0 200 Vol. 23 Page 5493 00'0 00'0 00'0 le;ol soBJeyO;uenbullaa soBae40 IeloadS s;uewssossd IeloadS ;unowy iGoBa;eO opoO leloadS Jas :sleloadS LINe8 :a;ea uol;e3mvea 0 :;unoa wlelO :;lpaao AJO110-1 0 0 000'0 pUelpooM 0 0 0 000'0 A:padOJd leJauaO :8002 Jo; sie;ol uoseell a;e;S le;ol anadwl pue-1 saJOV sse10 uol;dinsea 800Z/£0/ LO :paBueyO Ise-1 : SUOl;etl leA 0 :y;Inn passessv :enleA;a)lJeW Jle3 Ills J1uvwwnS 8002 e,ow OM 990/S6t7L 9E06L9 OOOZ/LO/EO aM L90/£6VL LE06L9 00OZ40/EO 00 Z L L/6Z6 L tlztlt,99 ZOOZ/LO/LO WSO E6V9/EZ E9Z998 LOOZ/LZ/ZL adAl eBed/IOA # ooa a;ea :dJO;s!H IaoJed :sa;oN MN MN M9 L-N8Z-6 L (b/L 09L t,/L Ot, 6u2:1-unnl-oaS) :(s);oeJl E6b9-CZ WSO LO iOl :Bpls opu03plool8 L iOl ON 139 MN MN id MgPJ N8Zi 6L 03S LO-1700 MG-CZ WSO-E6b9 :field 08L'6Z :saJod :uol;dlJosea leBa3 OlIM OOLL dS `d32]V 3111A000M-NIM( I`d8 LEZO OS iS HiOLZ L6Z * uol;dlJosea #;sla ads jL iJBwlad :(se)ssa,ippy A:pedOJd IeloadS = dS Ioo43S = OS :s;owsla LZOt,g IM NOS-11M iS HiOLZ L6Z 3A2J3 W NMVHS W NWHS '3WJJ - O jaumo-oo juenno = o 'jaumo juaiino = p :(s)Jaunnp :sseippV xel 0 00 LOOZ/LZ/Z L edAl;IwJad #;!wJad # uol;eollddy e9jV soleS # deW a;ea leolJO;sIH a;ea uol;eaJO NISNOOSIM 'AiNf10O XI02iO 'iS X ;uaJJnO AGVO 30 NMOi - b00 V96Z*9V9Z'6L lowed 11`d L d0 L 3JVd Wb'SL:60 8002/CZ/LO 00 V08-£ti0 Vt,00 V 183aed ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/__d_~ . Con a w cr Mailing Address k C k j 1 S L40 1:1 Property Address Z 2 -7 04" S 7-, AeLt-Q. (Verification required from Planning & Zoning Department for new nstruction. City/State WT Parcel Identification Number LEGAL DESCRIPTION Property Location N W '/4 , tj ill '/4 , Sec. i Q , T )L'6 N'R 15 W, Town of Subdivision Plat: , Lot # Certified Survey Map # 9 b b ~S , Volume Z 3 , Page # SV X W_arxauty Deed # 6 0 `7 ~7i~ (before 2007)Volume I9 2-1 Page # 11'2, X Spec house 11yes40 X Lot lines identifiable yyes❑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 §SPS. 383.52(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. I/we, 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 Safety And Professional Services 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 -3 /2~?a/ 2-0t3 SIGNATU 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. 04/12) r 11 1 9 2 f} 1 2 02. H2 tiALSH STATE BAR OF WISCONSIN FORM 3 - 2000 REGISTER OF DEEDS Document Number QUIT CLAIM DEED ST. CROIX Co., WI RECEIVED FOR RECORD This Deed, made between Nicole S. Schlosser, a single Derson 07-17-2002 3:30 PM Grantor, and Shawn M. Frye, individually Grantee. Grantor quit claims to Grantee the following described real estate in LUIT CLAIM DEED St. Croix County, State of Wisconsin (if more space is needed, please attach EXEMPT # 10 addendum): REC FEE : 11.00 Parcel #1: The Northwest Quarter of the Northwest Quarter (NW V. of TRANS FEE : NW ) of Section Nineteen (19), Township Twenty-eight (28) North, COPY FEE: Range Fifteen (15) West. CERT COPY FEE: PAGES: 1 Parcel #2: Part of the Southwest Quarter of the Northeast Quarter (SW %4 of NE of Section Eighteen (18), Township Twenty-nine (29) North, Range Fifteen (15) West, described as follows: Beginning 33 feet North of the Southwest corner of SW of NE '/4 ; thence South 33 feet; Recording Area thence East 33 feet; thence Northwesterly to point of beginning. ALSO, the South 2 rods of the East Half of the Northwest Quarter (E V. of NW ) of Section Eighteen (18), Township Twenty-nine (29) North, Range Fifteen (15) West. Thomas A. McCormack ALSO, the Northwest Quarter of the Southeast Quarter Attorney at Law (NW of SE ) of Section Eighteen (18), Township Twenty-nine (29) PO Box 2120 North, Range Fifteen (15) West. Baldwin, WI 54002 004-1043-80: 034-1041-50:0341043-80:034-1042-20 Parcel Identification Number (PIN) This 1S NOT homestead property. (is not) Together with all appurtenant rights, title and interests. Dated this &W day of June , 2002 vao'r + • Nicole S. Schl M". AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. PIERCE County. ) authenticated this day of Personally came before me this 24th day of June 2002 the above named Nicole S. Schlosser TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who exe tC' egoTOg` . authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same,: t t V % THIS INSTRUMENT WAS DRAFTED BY / /Q/t (/I rT . //2~~ Q 0 Q1 ROBERT J. RICHARDSON, Attorney at Law Mary V. Nelson SPRING VALLEY, WI 54767 Notary Public, State of Wisconsin Sb'- My Commission is permanent. (If not, state g t~-D (Signatures may be authenticated or acknowledged. Both are not necessary.) December 12 IXYOM 1 ) Names of persons signing in any capacity must be typed or printed below their signature. INFO-PRO (800)655-2021 www.infoprofbnns.com STATE BAR OF WISCONSIN QUIT CLAIM DEED FORM No. 3 - 2000 111111 I~lI' ~ Fill IIIII IIIII IIII 111111 Iill IIII 866253 KATHLEEN H. WALSH CERTIFIED SURVEY MAP REGISTER OF DEEDS LOCATED IN PART OF THE FRACTIONAL NW1/4 OF ST. CROIX CO., WI RECEIVED FOR RECORD THE NW1 /4 OF SECTION 19, T28N, R15W, TOWN 12/27/2007 03:40PH OF CADY, ST. CROIX COUNTY, WISCONSIN. CERTIFIED SURVEY MAP N LEGEND VOL: 23 PAGE: 5493 REC FEE: 13.00 o ALUMINUM COUNTY SECTION COPY FEE: 3.00 cwi CORNER MONUMENT FOUND PAPFR7 w 0 2' IRON PIPE FOUND OWNER w 10 .2 w x y ■ 1 3/4• REBAR FOUND SHAWN AND TABITHA FRYE s a 291270TH STREET WILSON, WI 54027 U Lu 0 1" X 16" IRON REBAR SET WEIGHING rn qZ 1.50 LBS. PER LINEAR FOOT SURVEYOR rn F EDWIN C FLANUM -X X EXISTING FENCE ~ NORTHLAND SURVEYING, INC. ~~]pdp~[p dp~]p~ P.O. BOX 14 N1/4 CORNER NW CORNER ROBERTS, WI 54023 SECTION 1 \ SECTION 19 889°14'37"W 1313.69' \ \ S00'22.41'W 17.0'±- \ 47.58 1 1 j, Ic1 1 m' 7 APPRQXIMATE LOCA,T,ION OF 12%SLOPES LOT I x AND GREATi R 29.78 ACRES INC. RIW 1,297.187 SO. FT. 2 ~N~IIUlfliilAxMN, 4r ``28.45 ACRES EXC. RIW Qi 1,239,155 S0. FT. v~i 3~ 44WINC _ FLAN„,. .•1~ ~i S 2487 : X ,7 33' 331 . AMERY g 10 r I M s SEPTIC VENT r I ~N~ „IIIM II~PA• N89'15'15'E 606.34' 12.0 ± W M HOUSE r n 3o3.17 303.17 ♦ r ♦ W N ' r EXISTING ♦ ♦ SOIL TEST (TYP.) J ♦ IO = i ~I DRIVE BUILDING ♦ N G N I _o ®wEU ♦ LOT 3 C o0 LOT 2 5.00 ACRES INC. R/W 0 n 0 5.00 ACRES INC. RAW 217,800 SO. FT. N N I 217,8W SO. FT. Z 6i to 4.81 ACRES EXC. RIW SHED m , 4.81 ACRES EXC. RAW n 209,331 S0. FT. ~i w 209,318 SO. FT. FIELD iv m 7d 6 DRIVE Z g 8 " a~ W : 50' BUILDING SETBACK LINE 86 JOINT DRIVEWAY _ EASEMENT i N89°15'48 .E 1280.99 . pp,, .p c" and. i, y T 874.65' co 303.1 T E N 303-1T 6.5'± 711.34' 303.1 T 303.1 T 27.92 _N"°71 " 1178' EXISTING CENTERLINE (I li I 27TH AVENUE CURVE DATA TABLE CHORD CHORD INUMBERIRADIUS I ANGLEALIB EAR NG ILENGTH IARC LENGTH ITANGENT INITANGENT OUTI C1 458,00 20'42'10' S10'1 0'46'E 164,59 165.49 S20'31'51'E S00'10'19'W W1/4 CORNER SECTION 19 SCALE IN FEET 1" = 200' THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON iia JOB NO. 07-80 DATE 7-29-07 SHEET 1 OF 2 SHEETS 200 0 200 1 of 2 Vol. 23 Page 5493 Oti8b S£Z SLL SHWOHNVD12IaNN,.Va'dDAH T, (lano'daav ss IMIX SMV-fd ao NOUVDrlana usv £toz/o£/8 sawoH ua3IJawd leaa!D SHWOHKVO>aaraviva$OaOADdHdoxaa$vsnivaa axing an I-- HWOH HXWA - -11 .[gN`JISRQ J i I II I II III 'I~~ 'I III II,I II'I IIII I U) O I Z I - I I I ~I~~I I I H r d I Z I , O t~ IIII I I i, i I ~ !IIII III I I ~ ~I tl I I I 'i i IIII'' I I ' ;I , I I I I I I I I I I I it , I II III' I,I '~I I I ~ +I II, I; z U) I r ~ ,I I~ j ii III III r ~ ~~I I E ~ it II I J~i J ;I, ' 1 III I lrll'll - u .t I I ,I I ii ill ~ l 1~ h l I i i l I I I I I i li L"~{ ~ (7 q ! w ti !1 : ~ I I I , r' I i Q .I I !ii II. ; I IIi I I I III I~ I ,lu'InU ~ i I d U~ r i. 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