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HomeMy WebLinkAbout018-2013-04-000~ o ~°°' ° I M ~ ~ ~ ~ ~ I o 0. c p w ~ ~ I b O N a ti w ~ i ~ I ' I I i I N I i a I ~ Z I ti c I O 3 ~ i ~ a I i 3~ I I ~ ~ n ' z ~ I ~ ~ c ( z I a m ~ ~ ~ I o I o Z ~ ~ ~ _ `~ ~ ~ ~ c ~ I awi Z ~ ° m c z ~ M ` C ~ / 1 N U N . 7 '7 ~ • J _ ~ y ~ ~ I ~, • Ai y ~ ~ O L c p ._ n. ~ ~ ~ ~ O Z ~ Z w N N rn O ~ O Z v ~ o.. d ~ ~ ~ I N O ` • ~ ~ o y C ~ . ~ ~ H d ~ a~ c ~ ~ E o' o o a ~ Q E ~ ' c~v r r r X333 a.~ 0 ~ • . Saaa z •- . . R ~ ~ ~ j ° ~' *~ , ~ ' o N ~ ~ fA J V I t i, ^ N N } ~D r CO ~ ~ N O I ~ ~ ~ y ~ ~ I a ; c ~ as Q Z !A ~1 w y 7 r m ~ O ' ~ F°- Y' I ~~ ~ rn l Gag ~ ` -p N V w r O ~ ~ ~ ~ ~ C (~ ~ ~ ~ ~ ~ ~ d ~ ( 1~ N I d I a cc e j ~ 7 C 'S C m C N .c • O 2 1 fn v O Z y Y ~ ~ (n I O ~ I . .r ~ #E ~ . E € ~ v~ r~ a ma I ~` `I~i ++ E ~ c = +: ~ r r A vat oi I ~ , nc Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Sippel, Mike & Christine Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION n. TYPE MANUFACTURER ` y ~i- Tom, l CAPACITY Septic ~ ~ Aeration Ho Ing TANK SETBACK INFORMATION en o +rnae ep Ic ~ ZS + ~ ~ ZS , ~ ~J~ r osing era +on o Ing __ PUMP/SIPHON INFORMATION anu ac urer eman GPM o e um er nc +on oss ys em a orc m eng ELtVAIIVN UAIA county: St. Croix Sanitary Permit No: 488146 0 State Plan ID No: Parcel Tax No: olB - 2or3-~ Section/Town/Range/Map No: 08.29.17. //~ STATION BS HI FS ELEV. Benchmark (o.~ y3 ~D1e~'~ /~ Alt. BM F;1~. ...... 3 ~S /aZ •S3 Bldg. ewer t t l n et 7~ 4 ~,~ ~ .~ t ut et 7 + b ~~ t ne `\ ~ 0 om ea er an. +s . Ipe 9.~`'s e,tz 5L . 5 9~0. 3r o . ys em II d e.~ ~ ma ra a 5.3~j /0/~ 0~ over ~; ~~- Co~~- 3 ~ /bZ • ~~ ~,,syr I /6 . ~( 9S. S3 l,J ~s~ ~ -~ 11. r I 9 5 . ~ .7VIL ACS.7VK1"' I IVIV .7 T.71 CIYI DIMENSIONS 2 ~ 17 ~~ / ~„9a L (`~~ ~'~ ~ __ ~ INFORMATION CHAMBER OR ~n~r'(~~~` ' A UNIT C.~pJ~tJ~ ~ ~Z, ~~7 ~ l35 ~ ~J i~ / UIJ I RIGU 1 IVIV .7 I J I GIrI 5_.,li _ Length / S Dia 4 Length Dia Spacing ~ ~ ~ ¢M, wI~ a..vvGr~ x rressure aysiems vmy xx+vwunu v~ r+PV~auc.ayawu~.~ very Bed/Trench Center / 5.710 Bed/Trench Edges \ Topsoil ~ Yes ~] No J Yes~~J, No -\ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 1014 167th Street Hammond, WI 54015 (SE 1/4 SE 1/4 8 T29N R17W) Corner Stone Ridlge~Lot 4 1.) Alt BM Description = ~ ~ ~ Cad ems' C~4` ^'~ ~ ""~'L~S 2.) Bldg sewer length = Z S +nspecuon ~c i ~ Parcel No: 08.29.17. 4 /~, ~~ Z I ~ Z~l = S~ S ~~~ Safety and Buildings Division County ~ ~ ~ S ` 201 W. Washin t / / i Madison 5 ~ S mber (to filled in b Co ) P it N it sconsin , (60 ) 266-3151 a y . ary e u 8 ~ Department of Commerce f 0 Sanitary Permit Applica on A s e Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal inform ion you provide may be used for secondary purposes Privacy Law, s15. (txtr~}T. CROIX COUNTY pr ect Address (if different than mailing address) I. Application Information -Please Print All Information Prope Owner's Name ~. arcel # t # Block # ~ ~ Property O wner's, Ma ling Ad Property Location u 7 S^ • ~ ~ eye ~ i~ ~ ~ ~~a SCCtIOn (~ Ciry, State Zip Code Phone Number , ~~ 9 ToZ ~ N; ~ Ecl ~ II. T e of Building (check all that apply) wit ~ ~ ~ S C Number bdi visio n Na m e Su ^ 1 or 2 Family Dwelling -Number of Bedrooms ~ ~ ~ ' `~~~ ^ Public/Commercial -Describe Use ~ l _ ~" _"~- '~"" """ ^ State Owned- Describe Use ^City_^Villa ~1'ownship III. Type of Permit: (Check ouly oue box on line A. Complete line B if applicable) p,~ ~ ,Q~ A' New System p y ^ Re lacement S stem g p y ^ Treatment/Holdin Tank Re lacement Onl ^ Other Modification to Existin S stem g y B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a 1 Non -Pressurized In-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/I'reatmentAren Information: Design Flow (gpd) Design Soil Application Rate(gpdsfj Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Gallons Total Gallons Number of Units Manufacturer W ~ 4'0 ~~ ~ ~ Prefab Concrete Site Constructed Steel Fiber Glass Plastic New Existing ~ . Tanks Tanks Septi or Holding Tank dV ZC6 y ••L Aerobic Treatment Unit Dosing Chamber VIL Responsibility Statement- I, the uudersigoed, assume respousibili for ius POWTS shown ou the attached plans. Plumber's Name (Print) PI 's Signature M er Business Phone Number ~ r`s ' /..~ -E~ ~-~ ~ v 7 r His= 2~~- ~G3 7 Plumber's Address (Street, City, State, Zip Code) 3 s Z iv~~ s ~-- .4~.~ ~ w .~- ya a r VIII. Coun /De artment Use Onl Approved ^ Disa d Sanitary PermitFee (i ludes Groundwater Date Issued Issuing A ent Signature (N Stamps) ^ Surcharge Fee) c wn e s or Denial 2 IX. Conditions ov SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. Ol/03) ~~?~"~'C SZ s~ ~~~ ~9N~/7w ~~~ 9s,.~ ~ ~~R~ ~ ~- /~~~T~/ ~ ~~ /=~~ Q~.~e,Id. i~J~ boo ~ 80~.~~ ~~~ -- le~~ p~ J C~ S~9 ~ Q` G~ ~6 . ~Z , ~~~ l~~ zz/y~ i s z sF~~,~~ ~~~~ t~a,~.,~ ~-~ . 9s, s f l.~-/~ ~"~ j~ F~~r ~os 7" /ocs f ~~R~ o%T,~/ i~ ~~~'~ zziy~ i - /o~~ • „Wisconsin Department of Commerce ~ a SOIL EVALUATION REPORT Division of Safety and Buildings ` in r ~nt m 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1 1~ sin _ indude, but not limited to: vertical and horizontal reference (BM}, dlrelxind µ aroel LD. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . ~ evie by Please print all informafion. 3, ; , ., 9 Pen3onat intortnation you provide may be used (or secondary purposes (Privacy Law, s. 15.04 (1) (m)). P Owner +. ^0ryty,mikltion Page of zr ~ i '~.. Date r I ~z/g/~ property Owners Mailing Address Lot Block # Subd. Name or Tt `~NR~ ~E T _ "~' r ~^ LlX~ ~ ~ Nearest Road -State - Zip Code P e Number C' ^ Village own New Construdion Use Residential /Number of bedrooms Code derived design flow rate GPD ^ Replacement ^ Public or oommer/ap(-Des/c/ribe: ------- --,-~ - Parent nlateria~f fC~ ~r ~ ~ 4' f ~Gi~ ~%/ ~/ `/ ~ Flood Plain elevabon if applicable -,~~,0;~~ ,~~~'_M-_ ft- General corrallertts ~, ~ ~; .S/~~ ~ ..~" y~~ ~~ ;E/, ~~~"'~ and recommendations: °~ / ~` Bonng Boring # ~jf~~~ pit Ground surface elev ~ ft. Depth to limiting factor l ~ in• Soil iption Rate Flarizon Depth Dominant Color Redox Description Texture Strudure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Etf#2 i o-13 3!L ---- ,- ~~ ~-~- ` ~ ~, a Z- 13-~f.~ - S.~ ~,_ ~ ~, rl ~2. ~-, n R„~.,., ~~ ~ -, .i U ~~ #~ y Ground surface elev. ~~U~ eft. Depth to limitin fador /v~ y in• Pit g Soil iication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fP `Eff#1 `Effft2 ~ - f ~3 ~ , 3/ S/ ~- ~--- S 1 e M r-rl >~r- m~r' c s w o`~ 1 ~ . ~/ ,D - (o 3 ,~ ~'/ ~- s n~ , ~ , 6 ~0 _ . _ __. ,.n _ nn n . 'a!1 mnA ~nri TCQ < 3tl riYlll_ • Effluent #1 = 80D > JU ~ t[l3 mglL arw s »v ~ ..N ~~ _...----- - - - _ - CST IVam@ {~~ Prirtt~ Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~ --~~~ ~ ~-- 715-246-4516 Property Owner Parcel ID # Page of U Boring ~~ # Ground surface elev. ~ ft. Depth to limiting factor ~ in. ~oit Soil ication Rate Horizon Depth``-'Dominant Cokx Redox Description Texture Structure Consistence Boundary Roofs GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 i t~- i ~- / , 3/Z ----- s ~ a - a ~ ~ ~~ ~. iL~`~~ /d rs/ ~~ C I . i ,i rl ~~ # ^ Bonng I ^ pit Ground surface elev. fl. Depth to limiting factor ~• Soil ication Ra Horizon Depth Dominant Cdor Redox Description Texture Stnrcture Consistence Boundary Roots GPD/fl: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Bonng # Ground surface elev. ft. Depth to limiting factor ^ Pit Horizon Depth Dominant Col Redox Description. Texture Stnx~ure Cons in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. in. Boundary Roots 'Eff#1 I •EtF#2 ' Effluent #1 = BODE > 30 < 220 mglL and TSS >30 < 150 mgll.. ' Effluent #2 = BODs < 30 nx,IlL and TSS _< 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sen-esw cR.eroo> ' ~ Soil Test Plot Plan Project Name Cornerstone Properties LLC Shaun ' Address 1025 170th Ave Hammond Wi 54015 C #226900 Lot 4 Subdivision Corner Stone Ridge Date /11 /05 S ~/2 SE 1/4S 8 T 29 N/R17 W Township Hammond [~ Barl~sg (~ Well PL Property Line County ST. CROIX gty ~. ~P Assume Elevation 100 ft. Top of Fence Post System Eilevation 95.5/95.3 * Fi R pSame as Benchmark - - ~~ " • ~ COUNTY PLAT OF: ;ORNERSTONE RIDGE LOCATED IN PART OF THE SOUTHWEST 1/4 OF THE SOUTHEAST 1/4 AND IN PART OF THE SOUTHEAST 1/4 OF THE SOUTHEAST 1/4 SECTION 8, TOWNSHIP 29 NORTH, RANGE 17 WEST, TOWN OF HA-AMOND, ST. CROIX COUNTY. WISCONSIN. RQ 2T ~~ ~~~ N x~ ~~i ~~~ ~: o so too zoo LOCATION MAP (NOT TO SCALE) SECTION 8, T29N, R17W, M K 9 >" loam •tvac PLAT LOCATION ~, 1 s ~ 'r s Win. i p;~ p' ortl~>EO tm ~ t~ LEGEND ® PROPOSED i --------- 12' UTILITY EASEMENT ® PROPOSED ----------- DRAINAGE EASEMENT LINE HWE HIGH WAIEI t.eo LowEST 8U ----------------- 68' JOINT DRIVEWAY EASEMENT K UNE - - - - - SETB COUNTY Si AC (FOUND AF SET 1 1/4 ~ PIN 1Nr. 4. -I- SET 3/4' We7GHING ' PER UNEA OTHER LO' N g4'31'OS' E '~ ..GO / Z~ /' m PiP 5pA / ~ ' ~ ' ~ . ~p3 ! ~, <J 68 // ui ~ LOT 7 87590 S.F. / "' - 2.01 Ac. yga LOT 6 `" ~ / Hwe_to3afio F, Leo=loaz6o ry ~ 78285 S.F. y ~ mqy ~6~~'4 1.80 Ac. ~ a9~ HNE_to28.t ~eo_1oa1.1 ° ~ I = ~{ s>7s 1 . y 10: : 3 b i~ ®~ ~~ ~~ ~ 3gO 2 - ,eo LOT 5 e4' , ~ ;,~ ~; 73793 S.F. ~ ~ a,~ 1.69 Ac. ~ HWE-102&00 \ ®` ~ m4r Leo-loao.oo lO N 8728'56• E 4' . 1 / 1 N ~ >Z3a5p. 1 ~~ i h W S ~ ~ \ ~ ,~[ LOT 75629 S i G6.s . A ~ ? . V i°~~ ~ /V eye LOT 4 1.74 Ac 2 '6/O' 11256 S.F. I I I I 2.58 Ac. I / ~ I HNE=1ge.so ' ~ ~ LBO-7028 50 N 81'47'39' W 483.: ' . • ~ ra>o.Ht , ~°"'~i '{~ ~ ®~ LOT ~, . 4 ro s . 63Bye. ,~; ; , 10 86,2, S.F. ~ z„ n~ LOT 3 ws~9~. / ~ ~ °~ i 1.98 Ac. 84368 S.F. soG~ ,/ i 9' 1.94 Ac. i // ,i HME=to25.o0 ;p , i ~ j i~ ~D ~ ~' b ~ N 7643'49` K, 513 g LBO=1027.00 S..g ~ i~ ,o,,~ ~ `~ s. , so. / .80. LOT it i ~ j ?8, W ~> /~h ~ ~~ ~~- ~ / 80567 S.F. .>0. ~~ E t„ <~. h s>' LOT 2 i '~O/ 1.84 Ac. tnt z°I I ~ ~ ~ s 80273 S.F. ~ / ~`~i'~1Mg~`% 835` k, 1 84 Ac ~ i ~ i~~ 2g? J . . ~ ~ .gs, o~ ^ i ~' tp HWE_to24so ~~ % 1B0_to26.so / f / ~ ' LOT 12 ~ 70672 S F N 89'35'14' E 2 1 W . . ~ / al a I 1.62 Ac. ~ c,/ i/ N 87'08' • ~ / o z LOT 14 ? N I ,~ 45 W 348.52' 0 ' I / ' • $ 70135 $.F 20 E 471.73 LOT 1 ~ 1 N 89'04 ~ 1.61 Ac. Z ~ 80481 S.F. I I I~ \4 1.85 Ac. so'I {so' LOT 13 m N ~\ HM£_1024.00 NI IZM aY 96291 $.~. '` lB0_1026.00~ ~ O 1 a0 j~3Y21 • _~.~ ~ L~ m -~ W ~~4r- ~ _- --uali_Olr - \1~, ~ ~ I I1,1 ~ 4yt~, ~ HWE=1026.25 b wI ~~n 1 {1O-~ o t..e.o.=1oza25 "~ ~T e mnyr w laor ~ - ' ' b m --1388.84'- 11ad 33 ~ 33 '° -' g~e 11AaE Vsfmlf o '-------- ~ -----'- Cu' a asenr a -'--- msw -- sw is ' _ . » N ~ ~ " 482.46' Y _____ 341.61'----- m ~ 66!00' 1r=-------------- --- 'O0°' ----- . - - - -230_72' _ - - - - S 89'04'17 ' W 1798.45' 33.04' w ----- s Bsro4'n' w ts3o.s4' - - ~- - - - - - - - - ~Iy _ _ __ I~~ - 7 SOUTH UNE OF SECT, T.29N, R.17W ~ C LOT 31 I LOT 30 LOT 9 II II I LOT 29 _ A Q~' FINAL PLAT OF PRAIRIE RUN FINAL PLAT OF PRAIRIE RUN II I ~GRiCULTURE-REST[ ~~ ~~ I ~ ~ c;~ ll tJ ~ ~ ~O fly „~ fE tE v ~ ~ ~ ,~ ~ ~ ,.o M ~ ~ ~ ~` :~ z~ ~ r~ ~~ w ~(.U`(( ..,, i ` ~j ~.~ S ~ ~ ~~ ~~ ~ ~~ ARE ~ ~ ............ I l1 ~ \, ~, ~~1,• Q a~~ ~ ~r a~ '`: ~,..~; ~ ~ as p C~ ~. ~ ~~~ .......... _~ _......._... ~ : o '~~ ~ ~ Kr I1, ` .. ,.. ; ....y ~ ~ .. c.7 F ..~ ~ ~ . ' ~ ~~^' .:~, .... Y{~ 1 7" 1 ~ ,v • „y„ ~, ~ .s~ ~ C'~ ~ ~~ :~' °~ ~~ © ~, :1~-~~~~-[sis-~.~:~. ~`~3:i1.~.f3~;~,:tr~ti[~:~. ~:,c~nz~:~[~:aZt~r~e ('::r~.t~rif7G397.G:1't'l:'1V].ii9TCt~1 `ll- ~ ~./" r"e. j ~. , r-Y.rJ~~~'t.l;e~ t~:L? l~, I~OY'1:-,~.4? t.t,',~LtC'; ~~rs~''~.s ~~ rVli~~., Ut;~(s~U,c ~"tt:tzl~ ~'Jr.,1.:r~.[~c~~ /~ m0 g~,1. J'~ti~ ~t.r...~~~~:,r~-.l~as~!~:z;:,-acr~:t:~°,rr_tt~~st~~:~.~: 5~,~c~t~.•:r~~i~r31~:~~J~:~l:~~-~. ~ /`z. o ~~r. ~~ dy ~, ~..__._. ~4.~~,a:li~~~l ~ lr:c~i~ _ .......:....._.___~._ .y ~,,,~~:Sti~Yl':rf!~.I t nta:llrtt;l~etE[s) ~,~..t.~,~;[:'tilirsA;lx3i: C,~t.~.s?:Iit:~ }..,Y,;stt:'~.i. ,.~..~~ Y..),la{:~.cs~t.a`c::CL C;r~:tsa.Isa~-tc:E~. ~car;:~r'~re~Wrt~[~~,•t•~ 1~1cu~i:l`,c~:t: +uJ: ~~~;C(li~c:'Y:P:r.~.F~ ..._,...__3__.~... L;rtl.Jei~t:~r/1:~~.rLtc~r~3,cri ::~.~:~.,~.~~.. r._,~.::..~..,. ..:7::i41. ~,~:"i;6'y`'Vi''4'C•t?~~:':i:' Ux,:Ly; ~;'~.:1/~:ls:t:y/~L~~.~t:Gi:r~i7:txt -._-_ a~~i) ._ .•-, k?•wal.. ~ '~r.tt~;t~~vYSti,i~7' Ittra.`s~nr r.'L~~u~'.la) .,... 'r'~~ixx;z:9~ira: [~:L"L:,i~r.~lx[3tx:tc~., e~ . •r .-- I~~~tt,e::~:~tsil .Cl~'C:it• ~ttil'r~~.a~l~.~,~a;ec,~;;~~t;c~ ii'y~•I.Y.~'ri .~u:~i~ :.~ 1.:~1`Gr~ ~~~ ~'~:~X~, ~_~ 1~,~~L;.l~. :M:~~~.2u.,L^~t~1:E:cr~t: :NJ'~eli:~:l :L~i~:~.il~'it~tlt•~:~~ C.i~i~x~a[:~r,.ertr~t. ,~~;~t~r:~:!}'rLl't3,~31:! .~~iC1JK. ~..~~ C~~t#:tryr .w...~.._.~.._..._._..~....._.....__.__.... :~~:~t~:z~~'z+~'r:x::t~~c:.t~ ~,.i:'USti :;G~..IiC?J7 [7~: t~l~;~_fi'~~7t:t'ht.tJY1 [:C~.~~S~ i~~.~v'~~~;it.l: ~?°~t:l~rt L .J•'~c%r~ ~~i-L[5 POWTS OWNER'S MANUAI & MANAGEMENT" PLAN Page. of 1NFORMATIQN _ SYSTEM SPECIFICATIUMS QESIGN PARAMETF~s Number of Bedrooms ^ NA Number of Public Facility Units ~g(Nq Estimated flow (average) ~~~ ga(/day Design flow (peak), (Estimated x 1.5) OG cdal/day Soil Application Rate gal/day/ftZ Standard lnfluen•tlEff[uent Quality Monthly average" Fats, Oi! & Grease (FOG} 530 rng/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS} 5150 rng/L Pretreated Effluent_QualiiY Monthly a~~eragP.... Biochemical Oxygen Demand (HODS} 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean} 5104 cfu/100m1 Maximum Effluent Particle Size %8 in die. ^ NA Other: ^ NA Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Septic Tank Capacity Z -d al 1~ NA .Septic Tank Mdanu#acturer ^ NA Effluent Filter Manufacturer ['D NA Effluent Filter Model ~ ~tp ^-NA Pump Tank Capacity P j('NA gal _ Pump Tank Manufacturer ANA Pump Manufacturer 'C4'NA Pump Model f~`NA Pretreatment Uinit ^ NA ^ SandlGravel Filter ^'Peat ;Pilfer ^ Mechanical ,4eration ^ Wetland ^ Disin•Fection ^ Other; Dispcrsal.Cell{s.) __. _ _ C]-PdA ^ In-Ground ,(gravity) ^ In-Ground (:pressurized) ^ At-Grade ^ Mound ^ Drip-Line _ ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency lnspect condition of tank(s) At least once every: 3 ^ month(s) (Maximum 3 years) year{s) ^ NA Pump out contents of tank{sl When combined sludge and scum equals one-tl-iird (Y3) of tank volume ^ NA lnspect dispersal cel!(sl At least once every: ~ ,~ 'ei m~anth(s} {Maximum 3 years} year{s} ^ NA Glean .affluent filter At least ones every: / ^ month(s) ^ NA / YSd year{s} lnspect pump, pump controls & alarm At least once every: (~ month(s) ^ NA ©year(s} Flush laterals and pressure test AAt least: once every: ©month{s} ^ NA Other: ^ ye~ai•{s) At least once every: ^ month(s) ^ year(s) ^' NA Other: M A -n ~~ ^ NA tvtHnv t ~11tHlY(:t 1lY5TRUCTIONS Inspections of tanks and dispersal cells shalt 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 effluent levels in fihe observation pipes and to check for any ponding of effluent on-the ground surface. The ponding of effluent on the ground surface may indi+sate a failing condition and-r®quires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) ar more of the tank volume, the entire "contents of the -tank shah lee removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of _<12 months, shall be performed by a certified PO'WTS Maintainer. A service report shall be provided to.the_local.regulatory authority within 1A days_of.completion of any service avant. • vys-s~ls vy +-l~rr,r Vl-L.YiN1lYVlY Far ncaw eoJrstruction, prior to use of the NOWT"S check treatment izank{sl fcr tlr6~ presi~nce cf ptrir-ting products ur other ehem)calrs ' brat stray Irrrpede the tro&trrrer-7: prUnf-sb and/or daJSrag~r tlrr~ dispersal ce1l(sy. !f Irtglr nnncentratlorrs are defeated brave the contents of fire tank{b) rerrroved by zr septage servir;irrg operator print ice use. liybtern start up shalt rrtrr nr:cur wlzcrrr soft aoriditlor-s are fro~r7n at thcr inflltraitvu surfar•~~. flurLrJg power our'rrges pump tanks may ~Fitl above ncr:rrat highwafier levels. Whorr power is restored tho exr:ess wastewater troll! be dlschargod to the dispersal cells} in orrra lar~ca dose, uvertoadinp the cellls} strut may result in th© bactcup or surfano disnhargo of efCluc~nt. Zo avoid fists situation have the conttnts of the pump tank rerrrovc~d Cry a Septagc~ Servicing Oportrtor prior to rostorh-g puwor to t}rrr effltrunt }kurrrp or ccnrac:t a I'1trJ°nbt~r ur t~CW7'~; Maintainer tc eJSbist in rnanua8y rsperating the pump cpntrnls to restor© nnr'tnal Travels within the pump tanlc. !7o not drive or park velric:leb over tanks and disperse! cells, loo not drive or- park ever, ar otherwise rlieturb or compact, fire Great within Zxs` fast dctvuJt s1ap11 of tarty 1y:nand trr at-•grs~d~x salt absrsrixtlon Brea. licrductlort or crtlirrinatIrJn of filte fU1lowing front the wastewetor rrtreaiYr stray irnprovr~ tlFro performance and preJlong tltta Life of tho I'o{~i°i"5: antrbicrfilcs; baby vvipes; cigarette buffs; condoms; cotton swabs; eie•~~7reasors; dental floss; diapers; disinfectants; fat; f~undatlon drain !sump pump) water', fruit arrd vc~getubla (]eeIIJ'1gs; gasoline; grease; 1lerblc}des; rrtc~rxt scrape; medicetionry; otl; 1Jalrrting products; pesfiitsicios; sanitary nr3plcirrs; tampons: arrd water sofl:crner in'}no. At3ANl7QNMfvN'T Wtton the t'oWTS falls arrdlor is permanorttly takers nut of servl-;o the following steplr shall bo taken to insure that the system is prCri~erly and safe>!y abanr~cJnad in c;orr:pilar~JCe vuitir chaK>tc-r Cnrnm 133.3:3, Wiscorr»Iri Adenirrlstrativo Code: + All triping to tanks arrd pats shall bc~ ct)snonnos;torl and tho abarrdnned pipe nper-Ings sealed. + `t'he entrtents of alt tarttcrti and pits shall be removed arrd property disputrJd n'( by a Srapiaya 5rrrviclrrg ©peratcr. +~ After purrrpln~}, ail tanks and pits shah be exnavatcrd arrd rerrruved cr the}r ccvn~rs rernaved and thca void apace filled with soil, gravel nr arrafiher inert sty!}d rrJaterta}. CQN'TIiltCriENGY Pl.At1t !f the NOW~"S fails and cannot be ropz3lred the fcltowing rrJOasures have bcat~n, or rrru;st ba taken, to provido a coda currrplil-rrt reptatrtartrent >>ylster'rt. A su}table raplaeerr-ent area has been evaluated and may be utitired i'crr the iocaticn of a replaaemant soft absorptieJt eysfir7rrr. `i"tta repidcernent area sittsutd ite prdtecteci frnttt disturbance Graf corrrpFrciinrt arrd should not be tnfrirrgrad upon try reciuired setb~icks frorn existl-•-g and proposed structure, tot fines and welts. ~a}lure to~ protect tht3 rriplacsment area will result irr ti-e rtcroei fur a r~-ow soil and site evaluation to estzJblish a suitable replacerr-ont area. r3eplacoment systems must carrlply w)tlr the rutos in effect at that firno. Cl ~~ rar.ritabie roptaccrment area is not available duo to setback andlcr soil lintitatinn .. Eiarrirrg advannets in NoW-rs tec:l-rrr~tugy a ircttdirrg tank may be installed >xs d Fast rersnrt to replarse th~x faitc~d PCVU"CS. C] The sits, has not bt~en ov~ttuated trJ (dtarttify ~i suitable replanerYtent area, llipnn failure of the F~oW"i"5 a sell and bits eva(uatitirr rrtust ba perforrncatt to tacate a suitaiste~ rupiaeorrrent area. if nr7 raplanement arc3zt is available a holding tank may bra irrstalted as a last resowt to replace thtx fir}led l''CJW'i'S. ~ Mound arrd afi-grade soil al~sorpfitan sysfierrts may be rocrrnstructed iJt place following rernpval of the biornat axt the irrFlltrat,Ivrs surFace. i'irrnonstructinns a•F such systems r'r-ust nornply with tiro rules 'rn effect at that time. < ~C WA13t~11NC3 ~• :y SLC'`!'1~, p'I.lMF ANl7 t3'Pblta~t 'i'Fi~A"1"tVIENT 'PAtllt(S MAY CC}i1l`i"AiI1l L~"i't~IAC. C3A:SSi~S Ariiu/OR iN'SUP~iCIEMT UXYC3~N. DO t1IE)T 1c111'i:"~t`l A Sl^.:pTtC, PUMP E)l~i O`i'NIwR 't'Fi>rATM~N'1' TANK UNpSR ANY C:IRGUM:~'I'ANCIFS~. i?EC1'1"H MAY f`tte"511LT. iFt~SCiJE b1= A t~l~l;otlt t=R4M 't"M!w lgt`t"f:~itC)Ft oC= A TLt1VK MAY 13Y± I)1TpC~UL T f1R tMPOSSISI.iE. . Al17i~lT'toillAt. CCliViMENTS' ....,.._~..~.......,...._....._..._..._......__.._..~_._......., F'tyW"CS3 tN5"I'Ail.~l3 Nanr,~ ~/? h i _...~w..._. ~...__..._w___,.__._._..~1, r~ ~ ._..~.._ _.... ~ltcrrtd 7~ s-: ~ co ~'- ~ ~ ~ PCtiV41't'S MAtIWPi;A1NEt4 lVartto .._.....•.~..._..._....~...~.._...._.._...._.._~..__.._.....__ ..._. t'hone SIrP''E°~1C~1~ S>~R'1!!L`tNl~ C1P>~KpTf1~E (Pt11ViPEFt1 l.oCAL Fi~~GtIE.pJ;i Qt~:Y AtJI'HC31!tiT~f ... ~.. _. ~. _.:... r... 1Llamcr iVarr-o ~ /r z0/1/il ~j Rhone ~~ ~ t'Flctnca / ~ 3 ~(o ' y~ '{'Iris dorunrnnt waG'drafled in rnmt-tianoe with chatster Curr~rn l33.Z21?.}(i~}(Y}id}(~({} and t33.b~I't}, (;+} & (~}, Wlstionsin Aciminist-'at)vo Code. r - •- ~.~~ ~~ OwnerBuyer ~ 1 ~ `'~' ~~ ~ f ~ i 1 Ix~ ~J~,'~ ~ E~ Mailing Address Property Address ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIiIP CERTIFICATION FORM d/~ ~~~ ~ ~~~~ (Verification required from Planning Department for City/State _~~ ~ w i Parcel Identification Number LEGAL DESCRIPTION Property Locations '/,,5~ '/,, S Subdivision ~"~'~' a ~`'OL Certified Survey Map # 'R~9 N-R~W, Town of Lot # Volume ,Page # Warranty Deed # 0 2 3 Z'zZ~ Volume _ .Page # Spec house ^ yes ®no Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterphimbcr, journeymanplumber, resttictedplumbcr or a licenscdpumperverifyingthat (1) the on-site wastowaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin, Certification stating that your septic system has boon maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. ~,17,0(~ SIGNATURE OF APPLI DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (wc) am (arc) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~f r/ r~, SIGNATURE OF APPLI DATE ««~*«s ««s««« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed HWE=1029.1 ~ C80-1031.1 ~ z ~ / sa D D ~' y° LOT 5 "84' , - - ~;~ ~~ 73793 S.F. / ' C4 ~ \ ~_ ~,~,. ~ 1.69 Ac. j~ ~ Q` h~ HWE=1o28.0o j ~ ~ L80=1030.00 ^~ .`~~/, N X2:3 - ' D t` f /r ry / oT 4 , ~ , _. ~ 11 4 2.58 Ac. ~ ~ ~ ~ I HWE=1026.50 ~ !f ~ ~ / I ~ ;~ LB0=1028.50 ~ ~ ~ ~ ,, ~, ~ a o, ~.~ ../~ ~~ N 6638~8 / ~~~ ti~ ~~ / V ~ LOT 3 ~ S19 06. / ~~ ~ ~~ , oF.~'~` 84368 S.F. f r •so~ % ~ f q2~s ~" 1.94 Ac. ~ ~ ~f ~~ ~ HWE=1025.00 ~p ~ ~ ~ / ! / O s! 64. 1.B0=102.00 ~~ ~~~j/ ~~, ~/ S . S8• / ~ f G> I 28~ k' /n ~~~ / ~ 4 / ~ % ~~' `~~' / ~`'~o~ 6'~/ r ~' cn, I LOT 2 ~i ~- ~ ~.~~ ~o /~N 6~S935y ~~ ~ 80273 s.F. , oo ~h.,, w <=1 ° ~ 0 1.84 Ac. ~ ~ ~, ~ ~ `' lu1/ ~s? 95 N i Ai uu~c~ . nom. cn ~ ~ ~ i i i _ State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Number ~~ Document Name THIS DEED, made between Cornerstone Ridge, LLC ("Grantor," whether one or more), and Michael J. Siplpel and Christine A. Sippel, ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other .appurtenant interests, in St. Croix County, State of Wisconsin ("Property").{if more space is d, please attach addendum): of 4 Cornerstone Ridge. St. Croix County, Wisconsin. 8~~252 KATH4EEN H. MALSH REGISTER OF dEEDS ST. CROIK CO. , NI RECEIVED FOR REGORd 04/20/2006 10:10AM MARRANTY DEED EIIEhPT # REC FEE: 11.00 ?RA?IS FEE: 143.70 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Retum Address Estreen & Ogland 304 Locust Street Hudson,lNl 54016 l.ul-rho Part of 018-1017-60-000 Parcel Identification Number (Pll~ This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated _ ~ Q ~ . f ~ (~ c-- * *Ron~ Borate, President {SEAL) (SEAL) * * AUTHENTICATION Signature(s) Cornerstone Ridge, LLC bv: Ron Borate President authenticated on *Kristina`O land TITLE: MEMBERS TE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: ACKNOWLEDGMENT STATE OF ` ) ss. COUNTY ) Personally came before me on the above-named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * Attorney Kristina Ogland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: 1 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TOTHIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO.2-2003 * Type name below signatures. INFO-PROT"' Legal Forms 800-655-2021 www.infoproforms.com