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030-2027-70-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 582026 Personal information you provide may be used for secondary purposes [Privacy Law, S.15.04 (1)(m)]. 2615660 Permit Holder's Name: City Village Township Parcel Tax No: John Earl TOWN OF SAINT JOSEPH 030-2027-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: goo A 1 22.30.20.439) TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. S Septic IAA ,G~ Benchmark z Z,06 3. 163. /act Dosing ,gyp Alt. BM Bldg. Sewer Holding St/Ht Inlet 45 r TANK SETBACK INFORMATION St/Ht Outlet TANK TO P` WELL BLDG. ent Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing /L Header/Man. 756 33 9T. 3 Aeration Dist. Pipe f•y ?T. Holding Bot. System L S'.5 S gam. 7Z PUMP/SIPHON INFORMATION Final Grade qy Y. ?-1QI Manufacturer / 6 OA- 11 Demand St Cover (~e-11 , dbl GPM Model Number WL&r ~Y ~ n, r Cb~uf ~ S (o TDH Friction~Los~~ System H3 dZ ~ H ' Zft rcemain IL7g #4 Dia.,j/ Dist. to well t(tf-C be, r s1a, b 3. JAI' , SOIL ABSORPTION SYSTEM BED/TRENCH MENSIONS Width T-7 ngth. No. Tre s s PIT DIM` IONS No. Of Pit=` Inside Dia. Liquid D\ D SETBACK SYSTEM TO `/R P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type stem: UNIT a1✓ 5 l 1 -7 56 Model Number: DISTRIBUTION SYSTEM Ca Header/Manifoil 10 Distribution '(to I N / x Hole Size x Hole Spacing VAir I e C Pipe(s) Length J Dia Z Length Dia A Z6 Spacing-Z-115- SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onl Depth Over Depth Over xx Depth y -7 B ed/Trench Center I~ Bed/Trench Edges Topsoil ofl 1xx Seeded/Sodded xx Mulched ❑ No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: I/ Z-1 S Inspection #2: Location: 1436 TRIANGLE D ~O l.tl d 1.) Alt BM Description = ~o 5 b^ 4-j S4 U 2.) Bldg sewer length = ~8~ LONAPdi ~It~ - amount of cover = Jr~ A p v Q Oks Plan revision Required? Fal Yes o V Use other side for additional information (O SBD-6710 (R.3/97) Date Insepctor's Si ature Cert. No. (r ~rID taGa t..tx~lC, Winrt~, nt. 4nJervv t~~,l~ .11 11 INIgn an'r"rrr r County Safety and Buildings Division j ~e r/d ~I')G ' L Washington Ave., P.Q. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 5370L-Z162 G ~-RO► COUNTY D 5 Zb Z EVELOPMENT Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit ZY/ / is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servics. Personal information you provide may be used for secondary purposes in accordance with the Priv Law, s. 15.04 1 m , Stats. t0 t rt 1. Application Information - Please Print nformation Property Owner's Name / Parcel # - o ao To C, 3 It - ,~7aa 7 - 70 Property Owners Mailing Address Property Location ~l Z Govt. Lot_ • City, state Zip Code Phone Number Section { S/0 82 , ` ! ~8 6 Sao a (circle one) -r iv T ~ N; R d E or ~ H. Type of Building (check all that apply) Lot # 3 Subdivision Name or 2 Family Dwelling -Number of Bedrooms may. B1 ❑ Public/Commercial - Describe Use t t JJ ❑ City of ❑ State Owned -Describe Use J CSM Number El village of X Town of TO S C l~/L fo o,, III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal ❑ Permit Revision & Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) $ 4 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVrreat nt Area Information: C 7 O V Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Pro sed {sf) System Elevation a0 t ~ 46 110',3 11 7. sd t/ V1. Tank Info Capacity in Total # of Manufacturer _ Gallons Gallons Units o a ° New Tanks Existing Tanks i / !O E ft/ a. U U) w r~ w C7 Gti Septic or Holding Tank / 2i„R Dosing Chamber 74~, I : Q V11. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS wn on the attached plans. Plumber's Name (Print) Plumber's Signature RS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) 4P ?GS e- o J- V VIII. un /De artment Use Only XP-Proved ❑ D Permit Fee Date Is ued Issuing ent Signature ' -65 , as 16 Z3 /5 Owner n Reason for Denia( ~ I / IX. Condi RReasons for Disapproval ~1 GO a/l'$ Aff-AA _V D✓ L H-er 1. $ept3ctank, emusthfilter and ✓ ~ ~ /H. ~ cYi5~persai call tmust all be 1% A- servlr,~s ? ~+~~n!~~hw,_a eVt-CC4_ at per managdOment plan provided by oluo zw, 2. ik s t'e lg2MWts must be mainumod as per applkabls code / ordinances. Attach to complete plans for the system and submit to the County only on r not less than 8 in x 11 inch siu SBD-6398 (R. 11/11) ~ptipAxTSrF~I DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD f , d~R HAYWARD WI 54843-6462 3 S PI Contact Through Relay S http://dsps.wi.gov/programs/industry-services www.wisconsin.gov A - 4SS70NPX, Scott Walker, Governor Dave Ross, Secretary October 09, 2015 CUST ID No. 226375 ATTN: POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMIC14AEL RD SPRING VALLEY WI 54767-9102 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/09/2017 Identification Numbers Transaction ID No. 2615660 SITE: Site ID No. 797997 John Eral Please refer to both identification numbers, 1436 Triangle Dr above, in all correspondence with the agency. Town of Saint Joseph St Croix County NE1/4, SW1/4, S22, T30N, R20W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1559665 Maintenance required; Replacement system; 600 GPD Flow rate; 18 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: Please see corrections made to the plan in red. Thanks. Reminders • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. 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. ROBERT W ULBRICHT Page 2 10/9/2015 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. 644~lff When You Receive That Invoice, Carl J Lippert Please Include a Copy With Your Wastewater Specialist , Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM WiSMART code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm 'ULBRICHT & ASSOCIATES CO. 2812 10th Ave. • Spring Valley, Wl 54767 Reg. Designers of Engineering Systems 715-772-3442 Private Sewage Consultants PROJECT INDEX Plan I.D. # _ Date SPr Z s, O l s Owner Hof f1~ RR L. Phone (051 _ o Address 1Y3~ 1''/~t~vyle, ~R• #ovc.7oN- a)i. sgo$Z ' Legal Description sw pApr VF Govr. L.or3. PIM 030•1oz7.7o • oooa N al y , X1, SEo. 7-7- )Tao N, R Zo w Town of 5T- Z'O.SE h County .5T: Gleotx. C.S.T. LAVE i:03 ERTy 2-2-11$0 Installer Local Authority/ uoervision 5r ~Roi G7 Y. zoA~ ,~4 U-- 715.3606• `1080 .PRO,JECT DESCRIPTJON REP1ACE/46_1,)~r J~1nUNp sysT~,~. THE ~1Ctsr,u~ ©~n (~-ovsE ;s To t3E' R~4z~p~RE~,oU ED 4)3D tTS F007-Q Rri,YT J4 Al &Uj 4 &EDRM . lJoAie will Bee 13wi-T• Soi L TEST w9 cwra'S R c0&3\m\ noA)14L l10 UAJD SYST. -P5/,4J & I.5 ~t ( lP 5AJ~3a Fill. 7h~ a~>7 515PTtc i hxJk Prep ANY ©ID DRyw6115 SM11 B-= PRopERC.~ /~t3~4~Da~~D ~~lz >}II coDES . ~ - Th>; fl~itry DE5i cro. Flaw i 5 690 0 ~ n I N~ ~ D o DES~ym5k .N.e~ 0AJ 5EP~. 21) aot5 h ! Fl 1q, P RE69-AME ©F So i C. TEST 6'q 5 )?W IAFu Ip15V 7-Ly rZt~MbVEli/.PE5T-R6Ye~0 TONALLY ,,~.,`5C.0Ns CB R~GTL APPROVES /Z y RE PP D D ()l t"V Top' D17-PT OF SAFETY AND F0CRT W. ~ ULOW . iT p~vM(~~I2 l ~JUSffJ/~i~f"r/o/l~ . p° jWF S tONAL SERVICES r.- :ho DIVISION OF INDUSTRY SERVICES ii1o G . SSE ~oT~s CoR,5C-_f/ o.v 5 0.J rain"m,un~,n~~~ SEECpuPESPONDENCE Pg.? PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC/TOP FILL DETAILS) P9.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN OUTS) Pg.4 DOSING CHAMBER CROSS SECTION & SPECS. Pg.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) Pg.6.OPERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE & SPECIFIC PROJECT DETAILED INFORMATION,UNIQUE TO LOCALE AND GOVERNMENTAL UNIT AREA) The attached plans and specifications are based on the following approved manuals: "Mound Component Manual For Private Onsite Wastewater Treatment Systems 11 (Version 2.0 SBD-1069,1-P(N.01/01)' and "Pressure Distribution Component Manual For Private Onsite Wastewater Treatment Systems" (version2.0) SBD-10706-P(Nol/01). sr G Ro I X R i VEp Q ~ Ri G E2 'f3 l ~ F F L~ N C o e U-A o -i D to o`3 3 ~ F At C ~ w o COP 6 M m fR v ' L "C' `ri. r fn m C) ED > oe ;-4 b n1 m zmZ zv.~. H o cv v, z 0 ~ o ny -4 to m ri ca C7 D O aca a Z!', O ---6 ° ' b- O. C 'I" coo U) C) cm 0 CD 13 U) S3 m = S 70 ,.v' d ~ vs o ~ E n$ V~7r Z~ G C`o ~CD C. d4a 3t '71 to ~ d o Z ) (P CNI L rn ca / - y a o -t) (;k'aSS SECTiOQ OF MOUAjE> w i T ti BE'LD of ° 0@ D o F ro Di STRi(3uT~oN ! ~4 Ailet`SATE' G» rkeCkod eS 3 Pip OF TOP so( L l vl TE~i~1f~fJ~L. S yS r E~M o s• \ ar ievArioz ! u _ -1 T0E- 97, 50 s!r tt H l.. L-! ,v E j j P C. f i SAmP _ 1 @ Pic,wEd Top Soi s1apE F'oRcir uN~ FORM 7 MAW t ~c~ATAda v~ [3E~{ ~►~T7 ~ (o . 0 ' c o N 'F-o v F T (1 ga) a_._. F-L E v A ri o t.15 PS& SOIL TE 5 T ' ' - Fr. x 13 • lmvERr o f f IATGRA(5 00- 0 F FT-(q- ♦ O O y T'op of Rack q?. 30 G FT. H 0 FT. °P OF I~ IATERAIS 98, jz PLAN VIEW OF MoUs-) D Wirt} BE D aN j FURc;E MAIAJ A ! Fr• Lll- - CCPVIR f3 `7 F r r / T 1Z FT ! a t k -Fr V) a IN Sev of PVC- cAPPED To J., Pl~ti R~G-y~;T" nC3SERVhrloN p ~ ~ E -S f©GA-T~ dt15 PERMA,JtwT MkRkERS ( rl*PS DT- G/, AA2 00 j S' `4-E REcqumeo BASAL AReA 7)Ai~ whST`E to (o SOIL- t0-fi lrQA-M0E ~~ff n z. C AfAci Ty . (P d 1 f f~ :gat. Fr. PROPOSEV HASH ARL-A = B I! A ti FT. Observation pipe -t -Distribution cell fill Fill I material, - Cover material (AS TH C3:3, fine wry``- aggregate) Tilled area < - Slope Force main Figure 6. Cross-section of a Mound System Water tight cap Top d" ntin. Ilia. of _ leaching Repaircoupiings char) t v r 6** min. M111. ^ Infiltrative surface\ Water Closet Collar Bar@JB" i ilia.) Figure 8 - Observation Pipes l~ t 2 Ce9141 4'f 'q!I S rV~. V( Y/ 14V1 41 t e4l ! C 4? Al LI-C rs ~ ' 114 --e IDISTRtt%juTio N ptpc LAYO uT , 3 of 6 cr~oTRfii._ ~'O R G E Nt tJ r ice. Is I ~olE , l 15T Note " I " x lei 12- P _ 31.5 r T TOTAL VOILD V()IUM E or NETuJORK 21. 5 gels. ~NckES `T'OTAL. \JOID Vol umC o F F nR cE MAN AM, 5 ~S • INVERT EI.EVATIOQ o of LATER.A1S Hole lei ptM~T ~G~► CAREFully 1:Zamooe AkI ER iNE5 • 1- RTL- RA, L In1GH~5 1-Folts 10cAYED au MAN\F(DL-n 2. 11 ING41>:5 • GoT['omp eMOLy FC')RC:E MAlk) Z SPAcr-a. ~ 00l~ s'PER I NTRAL l~ c~l~ 5 o pf'STRi13v~i o~ Ge-11 Sv.f+. SEE RE\)ER SE 510E IFOR rt>rRtytU! L % Di--thi L PER C)TIS, FOR NO 901e5 Pi 5cInRR L RATE To 13E 4 CO yNlS PER MINUTE PER Hole , s b1STP.1>30TloN Di SchAR~E RkTe. FOR EAck IATekAl 7. Z G IAV (C7 M I N • TnTl~ l P I STRi BOTIW PL56AARgr~ RRTE FOR ►JL-i-WO , y~ 9A(S1MIN C 9.5 1ltNiMVM ~eAsp .;R ay Y cr z ~,a M . _ Y' x off. w \I 1*9 13 4 114 la,E r 4 . IV SEPTIC TANK 6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 "WEATHER PROOF J LO' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED j FRESH AIR INTAKEWITH CONDUIT MANHOLE COVE c64 d W/ PADLOCK & WARNING LAB E 4 " MIN. 1 1INLET GAS- , p~Ly~pGK°-l„~,, . SEALT i9~f1~ APPROVED SCD- 40 _J, I ; ALM JOINTS W/ 1 L)c p j B ON PIPE 3' ONTO fp SOLID 3rr(0 SOLID SOIL SOIL 8~•D 3'~ EX1 PUMP OFF EI~EV. FT. 10 I OFF RI SER p►S►o~ + I - D ~ I - PERMITTED OA ~1pnR g8. 17 .83 IF TANK MANUFACTUREF ~p'C~°M f 3" APPROVED BEDDING UNDER TANK HAS APFROVAI CONCRETE PAD SPECIFICATIONS SEI~'TIC / DOSE GtJIESLcR CONGi~,2 CO• 5 '.TANK MANUFACTURER: COM(;o T'A~ k NUMBER DOSES PER DAY : LOW FROP.IE 'A 120 `T'ANK_ SIZES: SEPTIC /2" GAL. DOSE VOLUME INCLUDING 2 - DOSE GAL. I~.g. FLOWBACK: ~33 GAL. ALARM MANUFAC'T'URER: LEVY`( (1-1APM CAPACITIES: A = 19 INCHES = y0_b GA1 MODEL NUMBER: 3? 1. V~_ SWITCH TYPE: ieRT B = 2 INCHES = Y7 GA' PUMP MANUFACTURER: 70a(lep, C = (0 INCHES = X33 GA MODEL NUMBER: j37p = ~v - z Z 3 (jA- c,Kf;100T~ INCHES - GA: SWITCH TYPE: p±ggy D REQUIRED DISCHARGE: RATE q { GPM PUMP 9 ALARM WIRING AS PER ILHR 16. 23 W, VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 7-0 FEET 4- MINIMUM NE'T'WORK SUPPLY PRESSURE . . . . . . . . . . . FEET + FEET FORCEMAIN X I I FT/100 FT. FRICTION FACTOR FEET TOTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH _ WIDTH DIAMETER,--' .SEE ~EVE2S~ LIQUID DEPTH S lT)B~ r'o,Q pppopo cT SIGNED: ~ sr `rG7 LICENSE NUMBER: DATE: P/C 'SPIZcs 67,N C&, 11 It 0 f= = 2, 2 . Z SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an outlet attached approved filter device ( a0[..YLO fliter). Tank shall have an approved above ground locking manhole cover for regular (every 19 mnntbs or less) inspection & servicing by a - U A:S REQD Q- V-5 44" i Hred ~!j A ! i 4X1 ~ f71 YC ! - . m E 3a" _ E~ ` i r Cs m C'P ~ ~ s C'7 :ICY ! n m~ ~ f g ~ f s f I `Yr r ~ ~ Ste, Lt ;z} 11 314- rn 1 u~ aa~ z m rJ ern " C~ d"} 1 -4 4 `F's r 6om m tPf C? C7 .rQ -a r~ ua e s c gas g i c, ' . to 0) Cm) 0) 7. 0 In (A -q OD Q n 10 , 11Z, > C) C r > rca Z r x WLF1200/800-EAR WIESER DRAWN 0Y: WCP SCALE: 1 4°=1'-O" PRE-POUR, SEA' nc MANUAL DATE, QO ao IDAM I~osr-~cxa~: W3718 U8 HWY 10 MAIDEN R®GK, 64760 800-325-8$56 F11 E. apuo9 g p V E~' ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 0 JJ L Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer 10 jES a K ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer PoG y r O C. ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 52 5 ❑ NA Number of Public Facility Units J21NA Pump Tank Capacity 84)0 al ❑ NA Estimated flow (average) 'al/cla Pump Tank Manufacturer (,v I e ; j e ( ❑ NA Design flow (peak), (Estimated x 1.5) CO gal/day Pump Manufacturer Z O E rf E~, ❑ NA Soil Application Rate ~D al/da /ft2 Pump Model 137 YZ RF ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit , ❑ NA Fats, Oil & Grease (FOG) <30 mg/L ❑ Sand/Gravel Filter ❑ P ilai'F ter Biochemical Oxygen Demand (BODs) <220 mg/L ❑ Mechanical Aeration -fl Wetland Total Suspended Solids (TSS) <150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Mo average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand 30 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Soli JSS) _ mg/L ❑ NA ❑ At-Grade Mound Fecal Coliform (g metric mean) :5104 c%/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every" ❑ month(s) Z year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Inspect dispersal cell(s) At least once eve ❑ month(s) every: Z iff year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA I1RI year(/ Inspect pump, pump controls & alarm At least once every: ❑ month s) ❑ NA X year(q Flush laterals and pressure test At least once every: 3, A ❑ month(s) ❑ NA year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: 4 ❑ NA 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 tank(s) 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 4eff}uent lever in, the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of "effluent and the ground 'surfade may indicate a failing condition and requires the immediate notification of the local regulatory arithority When the combined accumulation of sludge and scum in any tank equals one-third (X) 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, mechanica4-or.pressurized compnpen#s,-pretreatment units, and any servicing at intervals of:512 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. I q t..• Page ~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatments process and/or damage the dispersal cell(s). If high concentrations are, Rected have °the ^tontents of the tank(s) removed by a sep(age servicing operator prior to use. System start up'sMall'1n6t4occur when soil conditions are frozen at the infiltrative surface. During poW r.wbu ege°s purno tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situat?64-h1ve 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 vikicl6s-bver tanks and dispersal cells. Do not drive or pafk over, or otherwise disturb or compact, the area within 15 feet down slope pf.any, ,moujd;or at-grade soil absorption area. Reduction or elim(n~tion of the foUnving from the wastewater stream may improve,,the performance and prolong the life of the POWTS: antibiotics; baby wipes 'jjaretter bu tts; condoms; cotton swabs; degreasers; ddMat 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 SPS 383.33, 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 tj a 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. ❑ The site has not been evaluated to identify; suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. i, Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions 4such 4stems 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 POWTS MAINTAINER Name Name Z(~~ F.l Gk f- t A$$0. (A) (t-- Phone Phone 715- 3 8(p ?a 7 7 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 'U1.139kC kr 3 R-550C - PVM (/t1 Name S 1'• 6)eOfX Zo/V tl.3 Gr- Phone '7[ 5 3~1D • b a17 / Phone -7l g • .7 6 (.P • ( 4 This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. Revised 3/29/13 SECTION: 2.20.40 /pqp FM0411 `QUALITY PUMPS SNCE /JA7iJ Z2 71 ZZ I LCA ff ZZ Q 0491 ® Supersedes Product information presented here ° 0890 reflects conditions at time of publication. Consult factory regarding MAIL TO. P.O. BOX 16347 • Louisville, KY 40256-0347 discrepancies or inconsistencies. SHIP TO: 3280 Old Millers Lane • Louisville, KY 40216 (502) 778-2731 • FAX (502) 774-3624 COMPARE THESE FEATURES • Non-clogging vortex impeller design. "137" Cast Iron Series • Float operated, submersible (NEMA 6) 2 pole mechanical switch. "139" Bronze Series • Durable cast construction. Cast switch case, motor and pump housing, base and impeller. No sheet metal parts to - rust or corrode. t=LOW MATE • Stainless steel screws, bolts, handle, guard, and arm and seal assembly. FOR SEPTIC TANK SYSTEMS • Bronze units available. • UL-listed 3-wire neoprene cord and EFFLUENT plug. 10 ft. standard for automatic. OR DEWATERING PUMP 15 ft. standard for non-automatic. • Automatic reset thermal overload SUBMERSIBLE protection. 11/2" NPT DISCHARGE • Oil filled motor-hermetically sealed. • Carbon and ceramic shaft seal.` • Maximum temperature for effluent or p dewatering-130°F. - 54°C. • 60 cycles, 1725 RPM. ;r rsrsse • Passes % inch solids (sphere). • No screens to clog. sump & sewage Pump Mfg. Assoc. • 11/2" NPT Discharge. ~I SSPMA specification • On point-93/4" Number L 137 Series SC2225 • Off point-3". 139 Series Se1115 • Major width-113/4". • Height-13". LISTED SIMPLEX AND DUPLEX SYSTEMS AVAILABLE PACKAGED SYSTEMS AVAILABLE VARIABLE LEVEL CONTROL SYSTEMS AVAILABLE DESIGNED FOR HEAVY DUTY EFFLUENT APPLICATION MAIL T0: P.O. BOX 16347 Louisville, KY40256-0347 MODELS AVAILABLE SHIP TO. 3280 Old Millers Lane e Automatic or Non-Automatic Louisville, KY40216 e 1/2 H.P., 1 Ph., 115V, 200-208V or 230V (502) 778-2731 0 FAX (502) 774-3624 0 1/2 H.P., 3 Ph., 200-208V or 230V • SP Canadian Standards Assoc. Manufacturers of Certification available o Q gp Vortex Type Impeller QUALITY PUMPS ~NCE ,7 r'T W 42/4 7% 61A cc w o 5 TOTAL HEAD CAPACITY CURVE METERSYNAMIC HEAD FEET/ CAPACITY GALLONS/LITERS 0 0 42/4 MODEL137-139 _ 30' _ CAPACITY HEAD UNITS/MIN 0 00 1'/z-11'h 8 FEET METERS GAL LTRS NPT 25' 5 1.52 104 394 513/32 0 10 3.05 79 300 o w M 15 4.57 64 242 U 20'_ 1 20 6.10 36 136 i ¢ 6 25 7.62 8 30 > 26 7.92 0 0 o J ~ 15 O 4 10' i 2 5' 122/4 I 0 U.S. 10 20 30 40 50 60 70 80 90 100 110 GALLONS 4 LITERSI 80 160 240 320 400 0 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS e Three phase pumps are available in 200/208V or 230V. a Mercury float switches are available for controlling single e Electrical alternators, for duplex systems, are available and and three phase systems. supplied with an alarm. a Double piggyback mercury float switches are available for e Mechanical alternators, for duplex systems, are available variable level long cycle controls. with or without alarm switches. a Long cords are available in lengths of 15-25-35-50 feet. e Combination starters are available. a Over 130°F. (54°C.) special quotation required. Standard All Models - Weight 47 lbs. % H.P. SELECTION GUIDE SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. 137/139 Series Control selection 2. Single piggyback mercury float switch or double piggyback mercury float Model Volts-Ph Mode Amps Simplex Duplex switch. Refer to FM0447. M137/139 115 1 Auto 10.4 1 or 1 & 8 - 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075. N137/139 115 1 Non 10.4 2 or 2 & 7 3 or 5 & 6 4. Combination Starter. Refer to FM0514. D137/139 230 1 Auto 5.2 1 or 1 & 8 - 5. See FM0712 for correct model of Electrical Alternator "E-Pak". E137/139 230 1 Non 5.2 2 or 2&7 3 or 5 & 6 6. Mercury sensor float switch 10-0225 used as a control activator, specify ^H137/139 200-208 1 Auto 8.2 1 & 8 - duplex (3) or (4) float system. `1137/139 200-208 1 Non 8.2 2&7 3 or .5 & 6 7. Four (4) hole "J-Pak", junction box, for water tight connection or wired-in "J137/139 200-208 3 Non 2.2 2&4 3 &4 or 5 &6 simplex or 2 pump operation, 10-0002. 'F137/139 230 3 Non 3.0 2&4 3 & 4 or 5 & 6 8. Two (2) hole "J-Pak", for Watertight connection or splice, 10-0003. "G137/139 460 3 Non 1.5 2&4 3& 4 or 5& 6 * No molded plug Three phase units require a control switch to operate an external magnetic or combination CAUTION starter. All Installation of controls, protection devices and wiring should be done by a qualified For information on additional Zoeller products refer to catalog on Combination starter, licensed electrician. All electrical and safety codes should be followed including the FM0514; Piggyback Mercury Float Switches, FM0477; Electrical Alternator, FM0486; most recent National Electric Code (NEC) and the Occupational Safety and Health Act Mechanical Alternator, FM0495; Alarm Package, FM0513; and Sump/Sewage Basins, (OSHA). FM0487. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Manufacturers of ZZ711-Zli-ff O. Louisville, 40256- Lane Louisville, KY 40216 (502) SHIP 778- T0: 2731 32880 0 • Old FAX Milleers rs (502) 774-3624 `QUAL/TY PL/MPS ~NCZ- lff& Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567293 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: Eral, John M. St. Joseph, Town of 030-2027-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 22.30.20.439J TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration t. Ipe Holding Bo ystem F al ade PUMP/SIPHON INFORMATION Manufacturer L Demand Cover PM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I ength No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of r7Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes ❑ No [E Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 1436 Triangle Drive Houlton, WI 54082 (Gov't Lot 3 22 T30N R20W) metes & bounds Lot Parcel No: 22.30.20.439J 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Fn] Yes [9 No Use other side for additional information. I J-1 Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) County © as' Industry Services Division Sr p 5'-{ 1400 E Washington Ave Sanitary Permit Number (to be filled in b.) ;ix+ St P.O. Box 7162 y Madison, WI 53707-7162 a ry. Permit Application State Transaction Number{ In accordance wit 383. Wis. Adm. Code, submission of this form to the a ate governmental unit 1 is required prior to fining a sanitary permit. Note: Application forms for state-own the Department of Safety and Professional Servies. Personal information you provide may be re submitted to Project Address (if different than mailing address) u ses in accordance with the Privacy Law, s. 15.04(I)(m), Slats. condary I. lication Information -Please Print All Information c~lfiy y~,L. , Property Owner's Name C r Parcel # oy,✓ o ,?o _ 07 0,7 7 - 1 o - Property Owner's Mailing Address d 000 ~NProperty Location City, State Govt. Lot Zip Code Phone Number 1461414 jd~J ~I >r/-I- ,Teo - /08 WS, %a S41 A Section o?i7 s5~a8.2 8p_ QO e II. Type of Building check all that apply) exLot #l T 30 N: R ,~O(circle~ oonf ,i ~l or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial - DescribeUse_ ~:~r'~/Yt ~ Gily eP- ' v ~ 2C~ 7 ❑ State Owned - Describe Use CSM Number m "f a Town of .:0- ZXz- III. Type of Permit: (Check o ox-6n m Complete line B if applicable) A. ❑ New System Replacement Sysic ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision Change of Plumber List Previ us Pe it Numbe a r n Date Issued ❑ ❑ Permit Transfer to New t , p,/ _ Rp Before Expiration Owner IV. T e of POWTS S stem/Com onent/Device: (Check all that a I ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil 17 7 )(Mound < 24 in. of suitable soil / .O ❑ Holding Tank ❑ Other Dispersal Component (explain) !O ❑ Pretreatment Device (explain) V. Dis ersal/I'reatment Area Information: Design Flow (gpd) Depi n Soil Applicati n Rate(gpdsf) Dispersal Area Re ired (sf) Dispersal Area Pr sed (sf) System EI ation G6o p G60 /U 26) Cog 2r-/ 97s' o,d 9~0 l VI. Tank Into . Capacity in Total # of Manufactur Lo~7ir / Gallons Gallons Units f v New Tanks Existing Tanks kkev.. ° .ia v U a U in n i% C7 a Septic or Nnidirtgj~* a7S0 a7S0 //ESE.t C O~tJG rte Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si ure MP/AE1214 $ Number Business Phone Number ~of/.✓ 6°ELxE 3Y4 C7,7-S,ZGG Plumber's Address (Street, City, State, Zip Code) C,? 9f' r, r uR •I~o lJl V11 . Coun /Department Use Onl Approved ❑ Disapproved Permit Fee Date I sued uing ign a ❑Owner Given Reason for Denial / 3 Ix. 109"" wal/Reasons for Disapproval 3 ~aAt _ 7 1. Septic tank, effluent filter and dispersal cell must be serviced /_m.aintained ~G U as per management plan provided by plumber. ® s a/ 2. All setback requirements must be maintained ris for the system and submi to t e County ly on paper not less th n 8 Ill x 11 inches in sizt \ O G~,QQ L.¢.-1't~-eG~¢ d % Sf/Sy~P ~vtS"al~c. SBD-6398 (R0313) ~~,yYy„~d 2 0! tip 9 yPAR DIVISION OF INDUSTRY SERVICES 5ti? Toy 10541 N RANCH ROAD m ' HAYWARD WI 54843 3 j D $ Contact Through Relay P k www.dsps.wi.gov/sb/ $ .Q www.wisconsin.gov G SIONAtis~ Scott Walker, Governor Dave Ross, Secretary November 25, 2013 CUST ID No. 231346 ATTN.- POWTS Inspector JOHN HERBERT PELKE ZONING OFFICE PELKE PLUMBING ST CROIX COUNTY SPIA N 6298 ST HWY 25 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/25/2015 Identification Numbers Transaction ID No. 2338496 SITE: Site ID No. 797997 Please refer to both identification numbers, John Eral 1436 Triangle Dr above, in all correspondence with the ages OOH Town of Saint Joseph C0191 ROv E® St Croix County POP I? IN? NE1/4, SW1/4, S22, T30N, R20W 1010I S~ FOR: Description: Mound, 4 bedroom residence pgo Object Type: POWTS Component Manual Regulated Object IDNo.: 1460349 N D Maintenance required; Replacement system; 600 GPD Flow rate; 18 in Soil minimum depth to l actor o original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), P es Distribution 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 Administr ode~iEE GO~~~S and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to a 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: Key Item(s) • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The bottom of the distribution cell shall be level per the Mound Component Manual. The "D" dimension shall be a minimum of 18". The maximum finished slope of the mound surface shall not have a slope ratio steeper than 3:1 per the Mound Component Manual. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. 0 Surface water drainage shall be diverted away from the system area per Mound Component Manual. JOHN HERBERT PELKE Page 2 11/25/2013 • Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code. 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 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L andorf POWTS Plan Review r , egrated Services WiSMART code: 7633 (715) 634-7810, Fax: ) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov -QQL 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 and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. J i io,e 9 Private 4nsite wastewater Treatment System IU&$ and. Trap, Page Ned Nal = ..J OHN G iC~f L - ! ~yt /1p, . ~e O tw!"S C.~~ /L.rt Xr.~r gear's Address: - ~y3G ~.~~A.r«F /.lc~v~ /,~/o toj saw !JS Sf~os.7 _ Lvov Lot .3 ' Lem Desc,on: x_oV% Voom - eity of Sr. ✓as CouIy: Sr. ox , s~1~Tame: LotNumban Bkw*Nu; Patel ID. Number: o 10-- ~aa > - ro - coa A Page 1 Page 2 f'L o 3' G ✓GA.~/ Page 3 J, Page ¢ - `l/~ 1,9T~itAt LAYour Page 5 ,SEPI/G.~,✓,e ~~w,~ ~.yA.y,~E.~ sr ~~or~or Paga 6 ~uy►,o o~E ofi9r.0.✓[~' ~uitu Page 7 ~ow3-s dt.J.tIER s i'1.~o/uy[ r/A.✓.~i~.yEar OL,v,✓ r Page 8 et a /t me Name o€Desigraar: J o s~.~ ~6~ rE Limm Nmnber: P ~~i3 yG Date: 11-11-.W613 Designed 1 ~bft Follow gPOM Componog Manual and nsP s 81-85: /~acr,~D ~o.yP6~varnr ~.✓a.~c t1f'iysi6a ?.G _ t"i2E.SSugE ll11STa/B~r!1J-o.1--~o,~r~6i.~~rd~--/-~rafuA~ rJE~iasv ~O- • ~$dt-Ia~arL wit/ o//a/,~ j'r/4C,~/iyE.J 1's ~ j o~L ~vAL uq ro,,, ~E~a~t r 4' ~o ♦p lk )II w o T w a ~i o y Z i z o V eo aIN e` I ~ o 0 1 , ti o ~0 i . R a ~ Z 'n.4 K.•~ tD 6~ 'mot n eT4e-tom Z ~ to _ O ` z H ti x .d t v to o c~ k tit m . tt H - ~ ~J o it { ~ - - - o .re• ~ 0 s o ° t zk~ pt ~ t l i l~ z~ Cam., ,'?9 R~nR~ .t t 1 7~ ~P C O x ~ i O 04 t. O 0 w k CS, ~ t ~ ~ ~ O ✓ fD ~ f~ H . t ~ yC Z O Nj O qIn ' u 3 o b oil 0 ~n Page of, 7 :SEPTIC TANK &'PUMP CHAMBER CROSS SECTION'AND SPECIFICATIONS 4 d4A 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHERPROOF /O** FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVERS 'or~o~r W/ PADLOCK S FG~gper 'y WARNING LABEL --1,4" MIN. 18 N. [NLET t' t► I' WATER TIGHT SEALS GAS- TIGHT t )APPROVED 'PROYED Fic rEti SEAL ALM JOINTS WITH [PE 3' B i i APPROVED PIPE {TO SOLID C ON S31 NTO OLID SOIL. )IL PUMP OFF ELEV. 9 s FT. t OFF' RISER EXIT : D PERMITTED ONLY, IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS EPTYC./ DOSE' ANK MANUFACTURER: l✓jEsE.t ZO.d "EsE NUMBER DOSES PER DAY: 5..2 y.37 ) ANK SIZES: SEPTIC / GAL. DOSE VOLUME INCLUDING DOSE 7S0 GAL.. FLOWBACK: /.~90 GAL. GARM MANUFACTURER: S. „7.' 6: A/orraus CAPACITIES: A = 3,0 INCHES = - y83 4 GAL. MODEL NUMBERS N.C 416tr SWITCH TYPE: B = _2~ INCHES GAL. IMP MANUFACTURER: ZoE~te-,t C = 8.0 INCHES = -GAL. MODEL NUMBER : SWITCH TYPE: = i EG~tIq.✓icAL D = " INCHES = ,T , o AL. :QUIRED DISCHARGE RATE 3f 3.Z GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC :RTICAL-DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 8.5' FEET MINIMUM NETWORK SUPPLY PRESSURE . . 3 3 FEET 80 FEET FORCEMAIN `X .S FT/100 FT. FRICTION FACTOR FEET TATAL DYNAMIC HEAD = FEET TERNAL DIMENSIONS OF PUMP TANK: LENGTH SS ; WIDTH 80 ~ ; DIAMETER LIQUID DEPTH y8" PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW MODEL 151!1521`153 PER MINUTE • ~ EFFLUENT AND DEWATERING 14 45 +53- 12 40 MODEL 151 152 153 35- Feet Meters Gal. Liters Gal. liters Gal lMxs to 752 t 5 1.5 50 189 69 261 77 291 30 10 3.0 45 170 61 231 70 265 8- 24 15t 15 4.6 38 144 53 201 6i 231 20 6.1 29 110 44 167 52 197 0a 6 20 25 7.6 16 61 34 129 42 159 30 9.1 - 23 87 33 125 t5 X 35 10.7 a 40 12.2 1 17 42 fo Shut-off Head: 30 ft. (9.1m) 3811. (11.6m) 44 ft 13.4m) 2 O,a5089 6 0 + 1 Model 151 Models 152 / 153 ,0 w 30 40 50 60 70 ,io 80 100 GALLONS LITERS i~ 67M - - 67/32 ; 0 a0 80 120 1f~ 200 240 280 320 360 3 7 a _ ; 4518 4518 PLOW PER MWUTE I` 3718 014608A i t 3716 3718 o ~ • Timed dosing panels available. 3 7!8 3il8 1 I • Electrical alternators, for duplex systems, are available and supplied with an alarm. i • Variable level control switches are available for controlling ! I 1 single phase systems. l ; • Double piggyback variable level float switches are available i I for variable level long and short cycle controls. • Sealed CNnk-Box available for outdoor installations. See 12 Ila FM1420. • Over 130°F (54°C) special quotation required. J i i 415116 5318 151H52H53 MOQELS Control Selection SK2444 SK2064 Model Volts-Ph rAuto Amps Sim lex Duplex N151 115 1 6.0 1 I 20r3 BNi51 115 1 Auto 6.b Inducted 1 2or3 E151 230 1 3.2 1 _2 or 3 SE151 230 1 3.2 Inducted or3 N152 115 1 8.5 1 2or3 "Easy assembly" BN152 115 1 Auto 8.5 induded 2 or 3 (rump & discharge pipe E152 50-T- Non 4.3 1 2 or 3 not Included.) SE152 230 1 Auto 4.3 inducted 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E159 230 1 Non 5.3 1 I 2 or 3 eE153 230 1 Auto 5.3 Included 20r3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. Reduces potential clogging by debris. 2. See FMO712 for correct model of Electrical Alternator E-Pak. Replaces rocks or bricks under the pump. 3. Variable level control switch 10-0743 used as a control activator, s Made of durable, noncorrosive ABS. peaty duplex Raises um 2" off bottom of basin. {3) or (4} float system. Provides the ability to raise intake by adding sections of 1%" o CAUTION or 2" PVC piping. Attaches securely to pump. Accommodates sump, dewatedng and effluent applications. NOTE: Make sure float is free from obstruction. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 0 Copyright 2008 Zoeller Co. Ail rights reserved. POWTS OWNER'S MANUAL AND MANAGEMENT PLAN BILE INFORMATION SYSTEM SPECIFICATIONS )weer L Septic Tank Ca aci SD l ❑ NA ermit # (p Z Septic Tank Manufacturer eojc. C3 NA )ESIGN PARAMETERS Effluent Filter Manufacturer EST' ❑ NA dumber of Bedrooms (100 d/bedroom) Effluent Filter Model GF /o ❑ NA dumber of Commercial Units Pump Tank Capacity So al ❑ NA :stimated flow (average) pp al/da Pump Tank Manufacturer DES x Lo r+c. ❑ NA >esign flow (DWF), estimated x 1.5 Coo ~jzal/dav Pump Manufacturer Zc+Ett4t ❑ NA oil Application Rate ,6 Pump Model !S/ NA ifluent/Effluent Quality (NA❑) MonthlPretreatment Unit X NA Fats. Oil & Grease OG ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Ox Demand BOG) 30 ❑ Mechanical Aeration ❑ Wetland ygen ( 5) 20 El Disinfection C] Other: Total Suspended Solids (TSS) 5 150 m Manufacturer: Model: retreated Effluent Quality 13 Monthly Average Soil Absorption Component 3iochemical Oxygen Demand (BOD5) 5 30 mg/L ❑ In-ground (gravity) E] In-ground (pressurized) Total Suspended Solids (TSS) El At-grade ,$(Mound Fecal Coliform (geometric mean) 30 mg/L ❑ Drip-line ❑ Other; 510 cfu/100m1 ❑ Dispersal Units - Manufacturer Aaximum Effluent Particle Size 1/8 inch diameter ❑ Aggregate Cell(s) Model alculations: Soil Dispersal (EISA) or DW = Application rate = Area Required = (Ae reQate Trench Width) Units or Total Length of Agaregate Trench(s) ao - i a = Goa -s- = 87 ESIGN CRITERIA ❑ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publication 9.6 (SSWMP Manual) ❑ "ICC Flowtech Mound Component Manual" Version 1.2 ❑ "EzFlow Mound Component Manual" Version 8/20/2007 ❑ SBD - 10854-P (8.1/12) "At-Grade Component Manual Using Pressure Distribution" Version 2.0 ❑ SBD - 10705-P (N.01/01) "In Ground Soil Absorption Component Manual" Version 2.0 `r SBD - 10691-P (N.01/01) "Mound Component Manual" Version 2.0 ❑ SBD - 10657-P (8.6/99) "Drip-line Effluent Disposal Component Manual" ,M SBD - 10706-P (N.01/01) "Pressure Distribution Component Manual" Version 2.0 ❑ Other - kINTENANCE MONITORING SCHEDULE - MAINTENANCE AND MANAGEMENT Service Event ~P jr Service Fre uenc n /ins ect tank s , ins ect dis real cell(s , clean filterL' At least once eve : X 13 months Z3 ears ❑ Other - ect um & um controls, alarm, pretreatment unit At least once ev : ❑ months 3 ears ❑ NA sh and pressure test laterals At least once eve : ❑ months in 3 ears ❑ NA kRT UP AND OPERATION: For new construction, prior to use of the POWTS check treatment tank(s) for the presence of Ming products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations detected have the contents of the tank(s) removed by a septage servicing operator prior to use. tem start up shall not occur when soil conditions are frozen at the infiltrative surface. property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving fiances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water .ners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface never possible. Note: this does not include laundry waste, showers, dishwater, etc. system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit s and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only ;r that should be discharged into the system. Other non-biodegradable items sucb as baby wipes, tampons, sanitary napkins lams, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, Page 7 of~ ;infectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS 3 contaminate your drinking water supply. 3intairi a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. )mpaction of snow over the dispersal unit may cause it to freeze up. 'SPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or rtifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached aintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, :ntify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ound surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings cater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. hen the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the ik shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NRl 13, Wisconsin Administrative ode. ie outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids tshed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the aintenance schedule to keep the system operating. larms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, iere is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the stem are corrected to prevent back-up of sewage into the dwelling or surfacing. BANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure at the system is properly and safely abandoned in compliance with Ch. SPS 383.33, 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 other inert solid material. ONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide 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 render it unusable. Replacement systems must comply with the rules in effect at the time of replacement. ❑ 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. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 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. <W ARNING>> EPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT )XYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. IEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR MPOSSIBLE. ►DDITIONAL COMMENTS 'OWTS INSTALLER POWTS MAINTAINER Jame .7-41-1^/ 1E,6' ^0-di / ILL Name a y,J E K hone G7,?- S.7GG Phone 7/S G7,? - Se7;EPTAGE SERVICING OPERATOR (Pumper - LOCAL REGULATORY AUTHORITY lame A enc fir- 'd 4.-x o .,/t O~fi 'hone Phone /S 38G - GAD Page 8 of 9 ►.i is t'~ w e a 5::' ss.~. 10 m rn=~ ID ~ m m m t4.9 i ` roen A ; =ate IF+ W •t _ 3 m w CFO =,a c h r nww [D NN S .1. m ~m w (D ro E O >s' ~ m cc m 'c Rr 50 RS~1 3mr~mrp N ro is Cro mw "oo~c !E ! rA c3 rt Na~~o Rc~~cc ~ 9.. w o It M m p m ? R a ^t _ L A C ..1 3 T wg N C !tl 7-3 n mS O Z' O O a m in C 3II ram C~a7 n c Ow O 7 a $ o+ 3 E..t a or o7m OMII Q O01S o O. s ~ 0.. O Q N C 2 s oro, N A > > -a r~o a~t•"y v rya i 79 i' m X33$ 2 CD o~gm N m CD ro 1 m 3 ~ ~ v+ 7D a fv -Q IS O w• wi` a u m ry ^p' ~ y a_ n COI C. ST A n "O is :9 r+ to W K ' -ac o- i 'n0 Q !'IIT~ ► _ Q N p0j 9 F m N ♦ ~ " 2. ip 1n 0 too NS xm m_ ~ -t fD o a• Q = m r to O 'fi'r x Xd % M ~ N 66 m +J Z rc T ' %0 C ` ST. CROIX COUNTY SEPTIC TANK MAID TFNANCE AGREEMENT AIND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 6 L Z3 2- Property Address S ~L (Verification required from Planning & Zoning Department for new construction.) City/Mate ~()l) v P W Parcel Identification Number , Q?OZ 7 0 too LEGAL DESCRIPTION Z. fo. 20. ~ 9 J Property Location ` ~r 3 mt< , Sec. T 30 NR 20 W, Town of SJ""~~~-rG`~°rf Subdivision~ L-~N6 GL7C_ St,-~ ZO~~ f)Lt T-Y C-0-o l , Certified Survey Map # / tj~ s /30wna~ , Volume ~j Page # Warranty Deed _ b -7-7 Z j Volume Page Spec house yes an Lot lines identifiable 4P no SI'STEM MAIiVTRNA.NCR AND OWNER CERTIFICAT'It7Iti' Improper use and namimenance 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(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zonln3 Department a certification foram, signed by the owner and bya master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition andlor (2) after inspect ,.)it and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to nmaintain 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 maiataine t mw t be completed and returned to the St. Croix County Planning & Zoning Department within 30 bays of the three year expiration Late. 1/we certify that all statements on this form are. true to the best of my/our knowledge. I/we amiare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nux0er o omS L CiNATtIRE OF APPLICAINT(S) 1 l 01 ~ l l3 DATE ***Any information that is misrepresented may result in time sanitary permit being revoked by the Planning & honing Departrnent. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey snap if I : ~ :,e is made in the warranty deed. ("Isv. 081115) Jun.18. 2013 8:59AM Anchor Real Estate No.0203 P, 1 J1~~ 4^ WlsaorWnOpmdmenlof ~ SOIL EVAL O T Page / of DMeion of Sakti end eogO ` f't b, C01nn1 e6. VW9. Adm. . Atleah aompleis Me plan an IeSS r"x II Mxhes In Am. Plan must fndude, but not Itmited la: tierbwl and No" pow m", dieCdw and Pad LD. pemontsiope,Sidleard•Rnewwome, arrow.endwCohnandmuncetonesraetread. Ore~ Uz7 ^ rp-- 40W Please pnWt aN inIbm efion. Re~e by . Dote %r;dr►~- PapawilebrmadonyaupovMlomwbel"ofers"Mmlmm-O (14 Pmpertyowner PkopakWL001k n GaK. Ld A-14 1145W 114 5.1.& T N R E ( WjW~0wWoMAWAftm 10 # Slick 9 90d Nana or CSW Aud~ "e cky ❑ vibp CRIum JNeareel Road Oivl J Z -Z New C wdQdwn use: ❑ RssidenLat / Nund al bO ms _ Cade dwWed dedgn Ik w role 7 ms OPD Replaoamenl Pubk a aomtarkerdal - Desiaibe Pamot meleklel ( Rood PkMk deY den UmpAtoble fL ~1 / ~ ~1.Y•~~1~ ! /~~!"f~~~ `'.~,~i~~if L L~~' /'i~~/ w roo mmendaumm- Wf#WJ) 004 0 S 0 PI( Gkaukkdaufeae kdelr. • 7 R pspllt to ttmlerg lador in. * Q__.. son Rate 'Halmn DO& Dmf dIW COW RedoaOe D"m Tmibew Sbuchm eoandary Roob (n Munaeb Qu. SL Qont Color or. SL Sh. •EWI ISM ' / ♦ a G Yt- Ira S v ZNCYA pJt amuwsu mwwv. ~R. DopO ID ft" factor -2 7 ik Sol Rata HarQOn D" Dom%" RedomDosa"m TO&M much" Caasmim amwwy Root GPM 'E'IfN2 h. (tluroe9 Qu. SL Cmd Cdar Or. Sc Sh. *M1 r - JL c 3 1 T t • E'Mbt~nt N1 ~ 80D ~ 90 <29p ardl. and TSS a3D c 1S0 null pl = 80D' ~ 90 ragll. and 788 < 90 ntBti Cw Now (P(aM P" i Cu Number erg ?J/pO 01.0um a. A-4n s Addreee s / Date Oortducoad Tkrlaphiorka Number Jun.18. 2013 8:59AM Anchor Real Estate No.0203 P. 3 pw of 8oiin9 S p ~ b t~ K gd an Ra4e tL , Iteols VIA C4=indmNbwaleV .3 cppe eeueu0ry Tam Samoa flaiaan D Qhr. SL Oast. Cam Gf SL Sla MINdws .0 r f _ r r pafne • aa►. f61 a a.ra a rnes Bw r FININ GPDM T s Samoa *M tiariaon t~ Ooniaal~ ~ 8h. Mund OL GL CmCollar Or. Bangr pg rL Sd liels eo~ug5 ~ PR (~egsut~eisr.l-- 8~r 1~ Sj*w Hmftn ' ~ Dales 11edoROe T who ;F.W Liit.3t M+. Qu BL Cart. Odor d 30 RWL Rd Tw 1 • EMUMO 111= qw., 30 <2M MOIL OWT>8 40 S t50 mB~t. ider>tnd cmplo!►or. If yon Dec, eSa1s15nee to acccsa sfervieea m i ,nit pgrtmena of Commerce is an equal opportunity tcrwce prov 1 !n iW 60&7b48777. . * t at need INVA&I is an aUamte r0111111111% plow COp 608 3 Jun.18. 2013 8:59AM Anchor Real Estate No-0203 P. 2 FOGERTY PLUMBING & PERK TESTING 2473 Rolling Green Rd. Ja,(N rrw Spooner, W154801 ✓ (715) 468.7000 Cell (715) 416.0000 ♦r / 7 BIZ SI'~r~ 1 j dY Nff ~f+V,.r~i ~ o 07 teat ky*- otD S'ysTEM 1 ` \ N S cwGE / " ,3s' eel fie. x r• Off Q IYr Blsr/ 7~~ a s~e~le ~N Bd/r \ f op.e fjtL~ 6e \ a s z = ,Kr. ,B~i r•~ er coucw.sr~ ~ d - ~ a~ -a. ,a -a dos) ~ t pT ~.v~ /Jl/!/~ iCi✓~ CeNLtET~ 1 p.~K 7 ~ A-i Apr) rl~rt k-t - ~ A-1 74-, 7 x,i 9rP' 'os saw a wsL x-~ ~0~, A1IN.vp I A-3 r-~ I . _ 1111111 lllll 11111 111(1 11111 1(111 ills Ilflll 1111 IIII * 8 7 7 2 3 1 2 STATE BAR OF WISCONSIN FORM 2 - 2000 877231 KATHLEEN H. WALSH Document Number W~ DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, trade between Scott Koke and Leslie Skelly, husband RECEIVED FOR RECORD and wife Grantor, and John M. Eral, Grantee., and Jennie M. Eral 06/23/2008 01:15PM Grantor, for a valuable consideration, conveys and warrants to Grantee WARRANTY DEED the following described real estate in St. Croi= County, State of Wisconsin (if EXEMPT 1 17 more space is needed, please attach addendum): REC FEE: 13.00 *Grantee, husband and wife, as survivorship marital PAGES: 2 See attached Exhibit A propert This deed is given in fulflilment of that certain Land Contract by and between the parties hereto, dated June 5, 2007, recorded March 21, 2008, as Doc. No. $71310 in the office of the St. Cron County Register of Deeds. Recording Area ,3 Name and Return Address Casterton Title At Closing Co. / 13264 Lake Blvd. z Box 746 Lindstrom, MN 55045 030-2027-70-000 Parcel Identification Number (PIN) This Is not homestead property (is not) Exceptions to warranties: - Dated this day of MX 2008 .t « S Koke i « L'"r Leslie Skelly AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF H IAIIJ A f• T A ) T1401MPM CHA ) ss. tarany -rsar~o W!I Sf4 f a G T o a County ) Wcommm an 00-01",-4 authenticated this day of Personally came before me this 9 day of May , 2008 the above named JScott Koke and Lesle Skelly, husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowled a same. THIS INSTRUMENT WAS DRAFTED BY James S. Casterton, P.A. ' C A 4 -I-14o K f S s .J Box 746, Lindstrom, MN 55045 Notary Public, State of K I A.) We t o TA My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are no necessary.) TI g 0164 it oeY 3 i 0201 o } " Names of persons signing in any capacity must be typed or printed below their signature. tNFO•PRO (800)6554021 www.infopmfoma.com STATE BAR OF WISCONSIN WARRANTY DEED FORM No.2.2000 1 of 2 EX MIT A A pared of fund located In Government Lot "3" in the Northeast 114 of Southwest 114 of Section 22-30-20 further described as follows: from the Northeast corner of said Government lot "3" go North 89 degrees 57 minutes West along the North 1100 of the said Government Lot distance of 3731 feet; thence South 0 degrees 4 minutes East a distance of 360.0 hot to point of beginning for parcel to be herein conveyed; thence North 0 degrees 4 minutes West a distance of 210.0 feel; thence South 89 degrees 56 minutes West to the St. Croix River, thence southerly along said river to a point South 89 degrees 56 minutes West of the point of beginning; thence North 89 degrees 56 minutes East to the point of beginning; together with 33 foot road easement adjacent to East line of above parcel and extending Southerly and Easterly to highway. Except the following described parcel: Commencing at the East 114 corner of said Section 22; thence South 89 degrees 59 minutes 26 seconds West, along the cast-west quarter line of said Section 22, 2,633.65 feet to The northeast corner of said Government Let 3; thence South 89 degrees 59 minutes 26 seconds West (rec. North 89 degrees 57 minutes West), along the north line of said Government Lot 3, 373.20 fed to the east But of a pared of land described in Volume 1059, page 84 at the St. Croix County Register of Deeds 0111ce; thence South 00 degrees 00 minutes 00 seconds East (see. South 0 degrees 4 miautes East), along salil east line, 150.00 feet to the northeast corner of said parcel recorded In Volume 1269, page 441 and the point of beginning; thence continuing South 00 degrees 00 minutes 00 seconds East, along the east line of said parcel. 10.24 feet; thence South 89 degrees 59 minutes 26 seconds West $64.58 feet to a point 32 feet more or less from the water's edge of the St. Croix River, said point being the beginning of a meander line along said.rlger; thence North 22 degrees 16 minutes 34 seconds East along said meander line, 10.81 feel to a point 32 feet more or less from said water's edge being the end of said meander line; thence North 89 degrees 59 minutes 26 seconds East (rec. South 89 degrees 56 minutes West), along the south line of sold parcel in volume 1059, page 84, 560AS feet to the point of beginning. Including all land lying between said meander line and said water's edge of the St. Croix River between the extension of a line bearing South 89 degrees 59 minutes 26 seconds West from the beginning of said meander lino and the extension of a line bearing South 89 degrees 59 minutes 26 seconds West from the end of said meander line. 2of2 f ~ 2013 Property Record I St Croix County, WI Assessed values not finalized until after Board of Review. Property information is valid as of NOV 13 2013 04:29AM . OWNER CO-OWNER(S) JOHN M ERAL - 1436 TRIANGLE pR HOULTON, WI 54082 1PROPERTY DESCRIPTION :SEC 22 T30N`F12OW PRT GL 3 FROM NE COA GL 3 GO N 89DEG W PROPERTY INFORMATION `373.2 FT; S ODEG E 360 FT TO POB: N ODEG-W 210 FT, S 89DEG W 'TO RVR; SLY ALG RVR TO PT S 89DEG W OF POB N 88_ DEG E TO Parcel ID: 030-207-70-000 POB LOT C.EXC AS DESC 1461/540 Alternate ID: 7 22.30.20.939) _Proper Address: School Districts: ` 1436 TRIANGLE DR SCH DIST OF HUDSON Municipality: TOWN OF SA/NT JOSEPH Other Districts: WITC DEED INFORMATION Sec' Town Range. Qtr Qtr Section.--" Qtr Section 22 . SON 20HV. Volume Page Document Lot - - 8 2 Block: _ 871310 Plat Name NOT AVAILABLE ? 375 812510 2491 48 751467 - 556 356 633022 1461 TAX INFORMATION = 540 1171 - 1450 587 609050 Net Tax Before: 1269 441 00 566722 Lottery Credit: 461 582 .00 147 180 5 535731 First Dollar Credit: 00 1 847 `9 450317 Net Tax After: - = .00 = Amt. Due Amt. Paid, Balance Tax .oo 00 oo LAND VALUATION Special Assmnt .00 .00 .00 Valuation Date: Special Chrg,- .00 .00 .00 20110511 Delinquent Chrg - ' .00 00 Code Acres Land Value 00 Improvements Total Private Forest_ 00 00 00 _ G1 2.700 176,000 90,800 266,800 Woodland Tax .00 00 .00 2.700 176,000 - 90,800 266,800 Managed Forest ° 00 _;.00 .00 Tota{ Acres: Prop: Tax Interest :00 op _ 2.700 Spec.- Tax Interest = 00 00 Assessment Ratio: _ .0000 Prop. Tax Penalty ---too 00 ill Rate 01000000000 Spec. Tax Penalty .00 •00 Fair Market Value:. 0.00 Other Charges. - - :.00 - .00 .00 TOTAL 00 = = .00 00 . over-Payment oo INSTALLMENTS Period E Date Amount PAYMENT HISTORY (POSTED PAYMENTS) ` Gerir Source T = ec Vpe A unt Tax Status Assess.`Status rater Pen _9 _Total