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PRIVATE ONSITE WASTE TREATMENT SYSTEMS County Visconsin (POWTS) Department of Commerce INSPECTION REPORT ST'•C� lSC Safety and Buildings Division ATTACH TO PERMIT Sanitary Permit No: GENERAL INFORMATION L R4 3S Personal information you provide may be used for secondary pu ses [ Privacy Law, s. 15.04 (1)(m) ] Permit Holder's Name: U City Village ATown of: State Plan Transaction ID#: 'fi N 0 A %-L CST BM Elev: Insp BM Elev: BM Description: Parcel Tax No: co . oo . ' lie ai! (,, 018 1099- 4 N- 00 TANK INFORMATION ELEVATION D G 8S TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic t k , , cm l fo 30 � Benchmark T .:�D Dosing Q +' Aeration Bldg. Sewer 12. p' 9 A Holding St / Ht Inlet J `{• 00 f 9 3 • o' TANK SETBACK INFORMATION St / Ht outlet TANK TO P/L WELL BLDG VENTTO ROAD Dt Inlet AIR INTAKE Septic �� + 'k �3' NA Dt Bottom I--•3o 1 0 • cro ` Dosing NA Installation 3 t� Contour 3'Sf0 3. D 13,. o • 30 Aeration NA Header / Man. Holding Dist. Pipe T S OS. 9S PUMP/ SlPlibN INFORMATION Infiltrative Surface 2"40 10 S o a ! Manufacturer Demand Final Grade / del Number 4 3 r J 53 GPM l�s 3• `f ° �j 3 • J °� 3d + TDH t-!Lift Friction Loss 3, 1 System Head 4.to TDH ZS- t $� ►,,.„,) D q }O r Forcemain I Length Ito I Dia 21 Dist. To Well DISPERSAL CELL INFORMATION DIMENSIONS Width Length No of ,) l &4, - ( Type of System Manufacturer: I �^ SETBACK P 14� Bldg Well OHWM of Nav N n ER INFORMATION Waters 1 "l Model Number: CELL TO I 10 DISTRIBUTION SYSTEM X Pressure Systems Only Header / Manifold I Distribution Pi e(s) I '+ , X Hole Size X Hole Observation Pipes Length (,:, Dia C I Length 2 ea ) Dia I /� Spac 3•0 5 32- Spacing ❑ Yes ❑ No SOIL COVER Depth Over Depth Over Depth of Seeded /Sodded Mulched Cell Center Cell Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) P&.-) eo.. Plan revision required? ❑Yes 1K No 1 5&ft . 2 tcn Z Use other side for additional information Date POWTS Inspector's Signature Cert No Bureau of Field Operations, PO Box 7302, Madison, WI 53701 -7302 SBD -6710 (R.3/01) o Safety and Buildings Division unty Box (. N 2 W Washington Ave., P.O 7162 Sanitary Permit N to be filled in by Co.) son, W1 53707 - 7162 Number (3�� Isco /SI ) 26 - T q I Department o f Commerce u Pl LD.Numb- Sanitary Permit A cati0 -37 o Brent than mailing ation provi a� 2 )� dress (if di address) In accord with Comm 83.21, Wis. Adm. Code P ersonal w, s1 5.04(l)( ) may be used for secondary purposes Privacy La ST. CROVX I. Application Information - Please Print All Information ZONING Of Parcel # Lot# Block # Property Owner's Name I /I GJC G Property Location Property Owner's Mailing Address Section /� Phone Number Zip Code e as�l one) City, State — -� N; � E r W �=� - r oZ � �� Su is Name CS�vl Number II. Type o Building (check all that apply) , u or 2 Family Dwelling - Number of Bedrooms : 4 ' `-"�� �' []City ❑VIII Towns 11 Public/Commercial - Describe Use ❑ State Owned - Describe Use _) p9� ., Qr� III. Type of rmit: (Check only one box on line A. Complete line B if applicabllee) Only C Other Modification to Existing Sysixm Replacement System ❑ Treatment(Holdmg Tank Rep and Date Sued A. S stem 0 Rep vious Permit Num y List Pre owner e mit Revision Change of ❑ Permit Transfer to New / /� 3 L( r r )3_ ❑Permit Renewal. l Plumber � Before Expiration Ch k all that s 1 X s e D Single Pass Sand Filter 0 TV. T' e of POWTS S ste At -Grad Cl - Pressurized In- Ground ound ? 24 in. of sui le soil ❑ Mound < 24 in O Aer bi Treatment Unit ❑ Recirculating Sand Filter Constmcted Wetland C] Pressurized In- Ground ❑ Holding Tank El Peat Filter a Filter ❑ Leaching Chamber ❑ Drip Line ❑ Grave] -less Pipe C] o (explain) Synthetic Media Dispersal Area proposed (sf) System Elevation Recirculating Yn V. Dis ersaLlTreatment Area Information= Dispersal Area Required (sf) i s Jr, l Design Soil n Rate( r G/ Design Flow (gpd} Application �yr� Sh Steel Fiber Plastic o Pre Constructed fab Gi� 7 Nlanufacturar one Capacity in Total Number VI. Tank Info Gallons Gallons of Units New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Cbamber / shows on the attached plans. es onsibility for installation of the POW rs Business Phone Number VII. Responsibility statement - 1, the undersigned, p MP,jfPRS Number r Plumber's Si Plumber's Name (Print) Plumber's Address ( treat, City, Stare, Z � / D C � ~ A` issuing Agent Signature (No Stamps) VIII. Coun /Deartmeut Use OIIl Sanitary Permit Fee (i lodes Grou Approved 1 ZS Surcharge Fee)Lj ew w 1 Z s ❑ DisapP ❑ Own easo enial — �ra1 a Conditions SYSTEM OWNER: ` � a 1 Septic tank, effluent filter and /1 dispersal cell must all be serviced I llumbea. dl as per management plan provided by p q� J� 1 2. All setback requirements must be maintained �) / as per applicable code /ord inances. (7o Ar C Se Sf fete PiaDS (to the County only) for the sys rem on paper not less than 8111 x 11 inches in size Attach comp � SBD -6348 (R. 01 /03) PLOT PLAN • PROJECT Ted Tindall ADD 994 E. Drake ke Dr. TemQe AZ 85283 NE 1 / a SW 1/4S 9 /T 29 N/R 17 w TowN Hammond COUNTY ST. CROIX ,SYSTEM ELEVATION 105.3' BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none lk BENCHMARK V.R.P. Top of Look out foundation ASSUME ELEVATION 100' Filter label A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Property Line Scale = 1/4" =10' 150' Grading is to be done to divert run -off away from system Tank is to be B -2 properly bedded and B-1 provided with lockdown covers 105' with approved warning labels 104.3' Huffcutt Combo Tank 104' 6% Slope B-3 103' Area 15' below system is 102' B.M. * to remain undisturbed Property Line Pro 3 Bedroom Well is to meet all (not to scale) House setbacks found in Comm. 83 174th St. Safety and Buildings " 4003 N KINNEY COULEE RD Cots merce.Wl.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.m(isconsin.gov m(isco ov Department of Commerce wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary September 14, 2005 CUST ID No. 226900 A77N: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/14/2007 Identification Numbers' Transaction ID No. 1193704 SITE: Site ID No. 704490 Ted Tindall Please refer to both identification numbers, 1037 174TH Street above;, in 411 correspondence with the 'agenc Town of Hammond St Croix County NEIA, SW1 /4, S9, T29N, R17W Lot: 44, Subdivision: Pheasant Ridge FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1039531 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual -Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. L'Om 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: DER RTMEh OF AAA Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORK "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD - 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 /01). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • • SHAUN R BIRD Page 2 9/14/2005 • Comm 83.22(7) 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. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 Safety & Buildings 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 . • 3 a Cover Page g Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 9/6/05 Owner:Ted Tindall Location:NE1 /4 SW1 /4 S9 T29 N,R17 W Lot 44 Pheasant Ridge Hammond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 01/31 Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section -vt?ij 6. Pump Curve 7 -8. Maintance and Contigency plan AN u, s 9 -11. Soil test ' „SC Shaun Bird Signature License number 00 F E1VED R .0 � p R 2005 �, P GS f • PLOT PLAN • PROJECT Ted Tindall ADDRESS 994 E. Drake Dr. Tempe AZ 85283 NE 1 /4 ,SW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX ,SYSTEM ELEVATION 105.3' BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1 000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none IL BENCHMARK V.R.P. Top of Look out foundation ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Property Line Scale = 114" =10' 150 Grading is to be done to divert run -off away from system B -2 Tank is to be properly bedded and B-1 provided with 105' lockdown covers with approved 104.3' warning labels Huffcutt Combo Tank 104' 6% Slope g -3 103' Area 15' below system is 102' B.M. * to remain undisturbed Property Line Pro 3 (not to scale) Bedroom Well is to meet all House setbacks found in Comm. 83 174th St. i Page _ Of - Synt Covering �Sfy, -C33 Distribution , Pipe Sand Topsail E << p 3 � % Slope t C� f Bed Of 2 "_ 2 %Z `,,,Force Main Plowed Aggregate From Pump Layer D �F.t . Cross Section Of A Mound System Using E -I Ft./ 6 F' - `- Ft . A Bed For The Absorption Area Ft. A Ft. H Ft, Signed: g j Ft. 1_i cense Number: K 7 Ft. ct . c �.� jFt. Z /J.O Ft. Observation Pipe —, K .} 6 � -- - -- - A I---------------- - - - - -- - -- --- �---� - - - - -- - - -- t Force. Main io Distribution Bed Of 2 -� 2 2 Pipe Aggregate 6cpe' Observation Pipe /f Permanent Markers c e!/ Plan View Of Mound Using A For The Absorption Area Partoratea Gipe Qetaii ;'- ERQ Yeew Pertororea PVG P-pe �e Mgtsis LOaOtsd Oa t;oltam, Are 1109001 SPOte6 Ch u� P . 1v X o n�' D t PVC Forcc Main F I rt9T rtat riaxT t e Ge,nnee * Oz PVC Molutotd Pipe 0 Osstr�w+�,an Pipe Qisirributio Pip L' t� P Ft. R R. X Inches. Y _,,....,.. Inches Signed: Hole Diameter ' 3_ Lateral Inch(es) License Number Manifold i Inches Date: Force Main " Ii1 C h E8 # of holes /pipe 2 Invert Elevation of Laterals, -alt," i �'osS S EC AND S pEL f IGATIDNS SEPTIC TANK VUMp CHAMB£.R WrA�ItpoOF AF ED A gOV£ GRADE ��NCTIO MANHOLE C01TEit r, .VENT WIPE WITH CONDUIT W 1 PADLOCK r k G WINDOW 4K y �D. £ ROlS O4QR • � y,�pRliING LASE �.ZA ;�tTAi�E !'fit �'f �� - r'4" 14IN FREaI� E fo � f �" � Cs"D �� z Y u _ Y• a' ;8 fMl1i• r a ( ' a i GAS' s ED INLET TIGHT , -�-- i , jtiLNTS kI7H W ATER TIGHT SEALS A SEAL + ALM APPR4Y� PIPE --+�- _ __ 3' DNI;� fILT£.R P ; R SeowLID SOIL AFP20VED PIPE 3' - (f i T- wo O p ppP ELEU - -- D SOIL p T O� BEDDT.NG UNDER TA NY GDN/C ETE PAD 31 AP�'R W4 SprGTFICATIONS i D+pS ES ?� DAY = N� H P'ER C LU SEPTIC DOSE VOLUME �� GAL TANK hAllUfP'CW GA i�DS£ GAL GAL SEPTIC GAL THCB.ES TANK gZ2 2 YNC DOSE � GApACITZ£S' �' _ i t —G AL, HES = - GAL - ?- p St�Z'tC FACTOR£R a D I LHg 15. 23 WA PUMP MOD j '� IoG AS PVt M� ; T�'tp�E. . ---- w�� punF £ � Awn W C .FEET GPM , Ti ON EET DIgT}ZI� FTP£ � r REV13ZR£D DISCR!►KGE BATE _ . . _ Y FEET g£TirfEEN pU�4P Os F ANI3 FACTOR .% FEET VERTICAL RIFF Q "C uppLy PR •' ^ RE TOT ZDYNAM MEAD = '— M r"u Z 1 .. ' F f 1Q Q • FT + � � itET�i RCF•� X � FEET FO , JIgTx 4F MP TANK' �,LZ+i. E"SI O �r� LIR�ID F N T£KNA L D iM LICENS il�� i TOTAL OY{dAMIC rEA0 /CAPACITY • PER Mil E NT AND DE WATERING EFFLUE r .., • HEAD CAPACIn CURVE EFFLUE 153 N MODEL 152/153 MODEL 152 Gol. Liters Uj Feet i Meters Gai. lifers 77 291 ti 50 5 1.5 69 261 231 A ti 1 70 265 I 153 �' 10 3.1 , 4.6 53 201 61 231 0 12 40 152 2•�' � � ` i 20 6.1 ` 44 167 �� 159 7.6 34 129 1 30 30 9.1 23 1 87 33 1 125 Q 8 �— 10.E -- — 22 11 i 42 i 85 90 I 40 12.2 I I -- i i 4 F t. (13.4m) a zS,O ; (11.6 _!J o Lock VGIve: 014500 4 10 � 1 80 100 0 20 40 60 GALLONS ')40 32 0 _ 3 27/32 I 4 5/8-1 LITERS 0 80 160 _ I I 3 27J32 FLOW PER MINUTE ACTORY FOR SPECIAL APPLICATIONS CONSULT F r 3 27f32 <• � • Timed dosing panels available. r -- --I • Electrical alternators, for duplex systems, are available and supp lied with ; ! an alarm• hase • Variable level control switches are available for controlling single p systems . available for variable 1 , • Double piggyback variable level floa t switches are r I level long and short cycle controls. See FM1420 1 • Sealed Qwik-Box available foroutdoor installations. . s pecial quotation required. I • Over 130 °F. (54 °C.) P 12 11 /8 I 15Xi53 Series control Selection 1521153 MODELS Du lez 1 Model ' VoltS•Ph Mode Am s Sim lex 2 or 3 1 ---1 6K2064 N752 115 1 Non 8.5 included 2 or 3 i I 8NI52 115 1 Aura 8.5 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2oi3 SELECTION GUIDE N153 115 1 Nor, 10.5 1 2 or 3 double pi Auto variable level float 10.5 Included I z or 3 1. Single piggyback variable level float switch or g9Y aN153 115 1 5.3 1 E153 230 1 Non 5 3 Included ' 2 or 3 switch. Refer to FM0477. eF153 230 1 Ai10 2. See FM0712 for correct model of Electrical Alemator E-Pak dup 3 o CAUTION ualifled 3. Variable level control switch 100225 used as a control activator• specify p ( ) be done by a 4 wi ring should Ali Installation of controls, protection devices a au d be followed including the Most or (4) float system. licensed electrician. All electrical and safety and Health Act (OSHA). recent National Electric Code (NEC) and the Occupational Safety RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. kWLTO: P.o. BOX 16347 Louisville, KY 40266 -0347 ManuFdchuarsof. " S HIP ro: 3649 Cane Run Road nvcE /939 o� s it r Q Louisville, KY 40211-1961 : !ldL.f TYPE Q a (502) 778 -2731. 1(800) 928 -PUMP e PUM` MO FAX (502) 774 -3624 hup.- 1A~- zoeller.com © Copyright 2000 Zoeller Co. All rights reserved. Page of T PAN . �E�'S MANUAL $ MANAG F IFICATtOAIs 90VVTS Ow SYSTEM al 0 NA Septic T111111 1K CaPadtY NA INi^ORMATiOt'r! tic Tank Mar► .-� �+ 0 NA Owner Effluent Filter [ulanufa� � 0 NA P�nit#- al 0 NA " d NA Effluen �� Mod )ES1GK P S PumA.Tank CapadtiY N,rnber of Beds nits aVda Pump Tank Manoturer Number Comm pump. Manufai 0 flow ��? alld - Est n fla�►(P� • ( d X -� atrda /f9t� Pump f+�►od nt unit _ r Dew pre L3 p Peat Floe SoggPplegoon Raw Monthly average` L7 Sandt n 0 Wedand uerrt Quality G) a m9A- 0 Mechanical AeraW p Other. inn Oil li Grease (Fo 5229 rnglL p Disinfec lon nnieal Oxygen Demand (BOSS e /L Manufacturer 5150 m Dispersal Celts} .gro Biod und (pressunzed) le eded Solids (T n averag Total Monthly 0 In -ground (gravflY) ound iuent Gluafihr �i0 mg/L Q At -grade p O er_ p en Demand (8005} : 530 mg/L p Off the wastewat" MW B'1ochemic Susp en ded Solids (tS 510` cfutf oornl Total (non "7e mean) vahms tyPr� for doh Fecal Conform (9eOr"etric y inch diameter yaYP Yuen retread er. P Size values trP� W M Effluent uencY Service Freq m ar(s) 3 yrs' r(s) (Maxi ) NMCE SCHEDULE i months MAINTE Ice Event every oats an - ird () of tank votunae Sere At least once Maxtfnunt r yrs•) dined sludge and scum o ar(s) inspect condition of tank(s) When com ,� 0 month out contents of tanks) At least once every r(s) Pump [ 3 months cell(s) At least once every "� the s ) p NA inspect disPe p mon s) O NA Clean nt filter At least once every p months efflue umP controls S alarm At least once eye r S 0 year(s) 0 �` Inspect pump, P ❑ months Flush laterals and pressure test At yeast once every 0 months 1 year 0 NA 01 At feast one every omen one of the following license or rrying Maintainer SePMe C)NS f cells shalt be made by an ind i v idual v ca r, POVVTfs lnsPe�Or. PC fs any miming or broken NSTRUC u MAINI�NANCE I� ti and dispersa Plumber Restri on of the tanK(s) to d to die fnr any els P Inspe Master Plumber: Master m u st i a vcsuat inspecti sludge and scu the effluent lev moons'. Mas ins pections to the volume of oomixn visrralty inspecte to check the fluent on the Orator. Tank measure rme C l shall be The ponding Servicl"g any �dcs or teaks. The dispe round surface- r�l- hardware• . round nding of effluent on date notification of the loc ra � autho k lumg• �e or ponding of effluent on the 9 for any Po d wires the Immediate more pi and to check ird ( � ch. NR in the Obse ground surface may indreate a failing Condition and tank equals one -fh sed of in accorda of sludge and, in any Operator and disPo when the combined acCumulation moved by a Septag Servicing and any k shall be re ent caornpone "�' iner. entire oDrtt ntS Of th tan one�rmed bY as of pOVVTS Mainta in AdmirirstraN+e Code- POWYS come 1t3, Wtsoon mechanical or pressurized Ce event The servidn9 of effluent filters, at intervals of jZ months or less shall be , . of c orn of any serer ainienance o r monitoring 1 reg au#ho in 1 rity within days . other to pro vided to the IoCa nting p roduc ts or other A W r A* report shalt be Pro fesence g p� are the P if high CQ"�� STARTUP AND OPERAnON a POWYS check treatrnen# tank(s) arsdl COW' nStNtiOn, prior to use of s and/or damage the lisp For new 00 . atrnent Armes b s septage servicing operator p rior to u5e cheer that may ImP�e the k s) removed Y dt�t+eete�d have the contents of the tan Page of. ve surface- - conditiOns are frozen at the infiltrative Pow is restored the excess system start u p small not occur "hen sot above normal highwa le vels. sand may result in the may a dose. oved'ing the a�( ) q ps pump tanks �t(s) in one large doa Gimp tank removed by a During �r be discharged to the dish id this si6uation have the contents of the p PObVTS Maintainer to �e�ratervvn�t die of a puent. To avoid W the effluent pump or contact a Plumber badwP or surtace rlor t� restoring p is within the pump tank.. stage , operaboc' the PUMP cones to restore n ormal lave over, or othetwlse disiutb or oornpad, assist in manually open_ an diSMSW Celts. Do not drive or pa Do not dine or park ' slope of G mound or at -grade soil absorption area and prOW9 the fife the area within 15 feet m the vvasterrater stream may irrlpmve the performance of the following fro collar swbs; degrea a �• deter : - Reduction or-erirnination d�ttee butts; condoms; efings; gasoEine; gt�eatser herbiades; meat tttibio6ds: bab9► swnF Pip) water, fruit and vegetable Pe of the POWTS: e and wafer softener brine. drsinfeit►; fout� dtailt { des; sanitary napkins: Campo motions; oti; painting p PeSbc' _ scraps, motions; shalt tie taken to insure that the A13ANDOMWENT fail andlor is [�errnanteritlY taKen out of service a following step Add Code.: When the POWTS ed in compliance with ctn_ Comm 83.33, pipe open system and sadon b discorinecePipe openings sealed- is p roperly fely aban _ td and the abandoned of b'Y a SePta9e Servicing Operator. Ail Piping to tanks and pits shall -be be removed and properly disposed and the void space The contents of an tanks and pits s removed um in , a t tanks and piss shall be excavated and removed or their covers After p . P g I filled With Soil, grave( or another inert solid material - CotMr4GENCY PLAN the following measures have been, ar must be taken, to provide a code if the POVYTS fails and cannot be reP ant system be u tilized for the location of a realm and( s hould not comptiant cernen: ea should be p has been evaluated and may ice and cornea p A suitable reP1a replacement arrotected from t lines and wefts. Fa disturba suvdvre, lot to absorption s(stem• The rep ired from e)dsting and proposed e s ta blish a suitable be infringed upon lay requ ,,p si t d vrill result in the need for a new soft an site 'eval as t hat tire protect the replacement area systems must comply with the rules in effect advances in POWTS replacement area Replacement is not ayaitabie due to setbcK an a d/or soil limitatio �Sng installed as a last resort to replace the failed +l.and 0 A suitable r eptacemetank may be insta U n failure of the POVYTS a so technology a holding a su replacement area Po t area is available a luat t identify ed o tify - the site has not been eva locate a suitable replacement to area_S f no repla cement jj site evaluation must be pef< � ast n g remov of the biomat at as a l resort to replace the failed POD holding tank may be install be reconstructed in place followi Mound and at�9mde absorption systems may with the rules in effect at that time - cons of such systems must comply e infiltrative surface Reovn� INTERIOR <cYYARNIN©� TiIEtE{+iT TANKS MAY GO LETHAL GAS SE S AN1310R INSUF DEA i 4 O?C1'GEr�t SEPTIC, PUMP AND OTHER. TRF� TMENT TANK UNDER ANY GiRGUMSTAI•iCES. DEATH MAY , PUMP OR QTMER TRI=A RESCUE OF A PERSON FROM THE OF A TAt+iK MAY BE DIFFrCULT OR 1MPOS RESULT.. SIB DO NOT ENTER A SE0MC ADDMONAL COMMENTS pOWTS MAINTAIN( R PO16Ts 114STALLER Name < Zl" 1/ Name /i ck-a Phone ' Phone 7 2 7 `� LOCAL REGULATORY AUTHOR" SEPTAGE SERVICING OPERATOR PUMPS Name r''� Peons j -- � �y. ��..�p/� t ffoets 1 ��is dlJ�.ua.n'.. Ptwne l �J / g SanffatiOn a9en afthe Glean take, rytarquette and Waushara County Zanln and Cede_ Use of this doeument does not Ttas d,=,eat was dratted b'Y Ow staffs t arA 83.Kl ). (2 & (3). Wisconsin A6rninLstrativB (W (7101! m rr,,mum mquuements of ctL Cmnm 83 2zl�tbl{ xd}d{f7 guarantee 0* Wormanm of the ppV1rTS- Wrsconsin Department of Commer ' gg''�PfI ORT Page of Division of Safety and Buildings an Com;distance Vbf �AdiTRe County C ` Attach complete site plan on papef�te he ' e. Plan niust � include, but not limited to: vertical and horizontal reference int irerwtiofa andl, ` parcel I.D. percent slope, scale or dimensions, north arrow, and locati n and to nearest road. Please print all informal n. S CROIX COUNTY awed by Date Personal information you provide may be used for secondary pu jE s�T , 2 Z� Property Owner Property Location f . J � n (' Govt. Lot 114 -4j A S T � N E ( W Property er's Mailing Address � � S Lot # , Block # me or CSM# � L � �'ry r N l f� 7 &z S City State Zip Code Phone Number ❑ City ❑ Village own Nearest R_ o 1 '`. -7 New Construction Us , esidential I Number of bedrooms Code derived design flow rate J GPD ❑ Replacement Pu A or commercial - Describe: Parent material Flood Plain elevation if applicable General an recommendations: Boring # ` Bonng 'CA it Ground surface elev. I Yft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ovel el Orr ® Bori ng # Boring � `� it Ground surface elev. V ` ✓ ft. Depth to limiting factor in . �— Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef / f#1 •Eff#2 �� ,, y Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 ` Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg& CST Name (Please Print) S' CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address fy Date Evaluation Conducted Telephone Number 1 1008 192nd Ave, New Richmond, WI 5401 ��' � -�--�� 715 - 246 -4516 4 Property Owner _ Parcel ID # Page of Boring # j Boring Pit Ground surface elev. /� 4 Depth to limiting factor irC Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. S Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 Z -1 1j�Z ` — l U ` 4 i F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I `Eff#2 E Boring # ❑ Boring C3 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 I 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/l_ ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (8.6/00) ' Soil Test Plo;ate P n Prdject Name Ted Tindall aun ird Address 994 E. Drake Dr. Tempe AZ 85283 CSTM #226900 Lot 44 Subdivision Pheasant Ridge NE 1/4 S W 1/4S 9 T 2 9 N /R W Township Hammond Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Look out foundation System Elevation 105.3' *HRpSameasBenchmark Property Me Scale = 1/4" =10' Scale is 1" = 40' unless otherwise noted 150, B. 105 104.3' O 6-3 104' 6% Slope 103' * 102' B. M. Property Line Pro 3 ( not to scale) Bed roo m House 174th ST. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479354 0 GENERAL JNFORMATION (ATTACH TO PERMIT) State Plan ID No: PersorAl 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: Tindall, Ted Hammond, Town of 018 - 1099 -44 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 09.29.17.854 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 Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM uid Depth BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T DIMENSIONS SETBACK SYSTEM TO l P/L JBLDG 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 1 77�odded xx Mulched Bed/Trench Center Bed(rrench Edges Topsoil Yes ] No [ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1037 174th Street Hammond, WI 54015 (NE 1/4 SW 1/4 9 T29N R1 7W) Pheasant Ridge 1st Lot 44 Parcel No: 09.29.17.854 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = � .: � - -- - - -- — Plan revision Required? [� Yes ❑ No Use other side for additional information. Date Insepctor's Signature Carl. No. SBD -6710 (R.3/97) Safety and Buildings Division 201 W. Washington AVe•, P•O. Box 7162 Sanity Permit Ntunber (to be n1led m by Co.) Madison, W1 53707 - 7162 }q 3 S isconsi (60$) 266 - 3151 �► State Plan I.D. Number Department of Commerce R- E CEIV Sanitary Permit inf you�provde Pro; wddress (if different than mai dress) with Comm 83.21, Wis_ Adm. Codc, P'--x w j ]n accord purposes Privacy may be used f La , or secondary pure D r oration Yor a 5 3� Print All Info Block # L Applicationlni -anon- Please COUNTY # Lot ZONING OFFICE Property sName operty Logtion Prop y O 'ling Address l- , f %, Section Zip Code Y66 phhoone Number cl ne) City, State a ��- T N; R �-t - W 6 i N e CSM N bar S� check that apply) �� ° 5 3 II. ype of ilding ( ._ J .�� �p�D• I 2 Family Dwelling- ]'lamb Bedrooms ❑Vil ip of []City In ❑ Public(Commercial - Describe Use Q State Owned - Describe Use 8 — Comp lete line B if applicable) 11 xyp one x on line A. Comp Only [3 Other Modification m Existing SY' e o exmit: (Check only Treatrnent/Holding Tank Replace W System R stem List Previous Permit N Date Issued ❑ permit fef to New El Change of Owner B. ❑Permit Renewal ❑ Permit Revision Plumber Before Expiration El IV. 'p of POWTS S stem: (Check ail that a le �� ❑Moan 24 �. of suitable soi At Grade � Si e filter ❑ ngl Pass nd ❑ Mound >_ 24 in. of s r ent Unit ❑ Recirculatml* S F on- Pressurized ]n- Grou d - Tank EI p filter ° (] Pressurize In ound ❑ Hoid ( ai Constructed Wetland Chamber thing �p Li ❑Gravel- Pip Elevati Recirculating Synthetic Media Fiat ispersal S reatment A Information: Di Area Required (sf) p V. Dis erssV/r Soil A plication Ratc(.°P r Pr site Design Design ow (gpd) � s Site S lass J--v Capacity in Total Numb e Manufacturer n Constructed VI. Tank Info dons Gallons ofU New Existing Tanks Tanks $optic or Bolding T2n11 perobrc Treatment Unit Dosing Chamber f 10W IS own on the attached plans. e responsibility for ins b be Bu � Phone Number VII_ Responsibility Statement - I, the under ne Mp S N J / f? Plumber' a (Print � ) Pl is lam ewes Address (Street, City, State, Zip ) Date ]slued Issu g Agent Signature (No Stamps) Coun /De rtment Use sanitary Permit Fee (includes Groundwater 'VIII. S Lary ❑ r Surcharge Fee) _ . D'� � VV II � � Reason s Denial 1 3 S s VL Conditions of rov es R: u.t� �- \ S ` SYSTEM OW �(5 k --- tt� 1 Septic t effluent filter and p ���2 •'— disper cell must all be serviced !maintained , as p anagement plan provided by plumber. 2. All s back requirements must be maintained `� t as per applicable code /ordinances. Attach comldete p>aas (to the County only) for the system on P$1'� not less than $12 X 11 inches in lux SBD -6398 (R.. 01 /03) PLOT PLAN PROJECT Ted Tindall A D ESS 994 E. Drake Dr. Tempe AZ 85283 NE 114 SW 1 /4S 9 /T 29 N/R W T N Hammond COUNTY ST. CROIX r 7/29/05 BEDROOM 3 MPRS Shaun Bird 226900 1 DATE CONVENTIONAL W IN- GROUND PR SU CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambers 39 IL BENCHMARK V.R.P. Top of 1/4" steel rod ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 96.0/95.8/95.6 3' below qrade l 1 is to meet all Plans Designed Using set ks required by Conventional Powts D Manual Version 2.0 tE Stand Biodiffuser Leaching amber with 31.1 f f Area / 3 4 Grade at Sy stem vation Pro 3 Bedroo House 20' ST 3 o Slope Please note: This soil t is suitable ' 4 _r for sanitary permi 30 t p. oses only! 1 V It is to be field ver' ed prior to installation! 40' t. 3 -3' X 83' Cells with >3' M. #2 174th St. 1 367' Property Lin / 150' L, Q, S�� I PLOT PLAN PROJECT Ted Tindall A D ESS 994 E. Drake Dr. Tempe AZ 85283 NI: 1/4 SW 1 /4S 9 /T 29 N/R W T N Hammond COUNTY ST. CROIX 7/29/05 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN- GROUND PR E44 CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambers 39 IL BENCHMARK V.R.P. Top of 1/4" steel rod ASSUME ELEVATION 100° Filter ZabelA - 100 ❑ BOREHOLE O WELL * H. R. P . Same as Benchmark SYSTEM ELEVATION 96.0/95.8/95.6 3 elow grad J � � f Well is to meet all Plans Ids d U ' g etbacks required by Con n na o s Vent N R M 1 Versi 2.0 l >6 „ ndard Biodiffuser of Cover Lea ing Chamber with 1 ft2 of Area J / 6 Long 11„ / 34" Grade at S em Elevation Pro 3 droo House 2 ST 3 o Slope Please note: This it test is suitable Ve�n�ts� for sanitary pe it purposes only! 30 40 It is to be fiel erified prior to 40' installation I , 3 -3' X 83' Cells with >3' .M. #2 174th St. 1 367' Property L e 150', I of Vxueorr3.re Department ofCommerce SOIL EVALUATION REPORT Page_ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County n � C 1 • Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. viewed y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). U 3 Property Owner (� a -_, .Pmptfrty Location tQ 9 M i I { f Govdi -ot � _ 1/ 114 S T 2 - 1 N R i'j E (or Property Owners Mailing Address Lot #. Block # Subd. Name or CSM# I 70 cl i2id &- T 11 City State Zip Code hone Number El i El Village S[Town Neares oad f J New Construction Use: qP Residential I Number of bedr oms � � ** " 1_� Code derived design flow rate _! s��1t Q —__ GPD ❑ Replacement r ❑ Public or commercial - Describe: Parent material L �( _ Flood Plain elevation if applicable �� General comments and recommendations ,G0 E33 .!V- c -.z� , So ,ate 44t&d PAx- `•I AA.: rte` Lx- Boring Boring # �p / / © ® pit Ground surface elev. _ I O ft. Depth to limiting factor _ % in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 S 1Z — '-Sd 2 c -C . 5 Z IZ -y2 1 1 3 — 5' cl 2rn5 c y2 4 ' C ,21 L 5 c 2 �( 1 0 F L� Boring # 0 Boring Q ,` 9 EA pit Ground surface elev. �19 •• 1-6 ft. Depth to limiting factor U± _— in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDO in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 6- S; I 2►-,a r, � c � I4 / 1p 5 2 o ' I ri Z bk c 4-1 3 Sc-t 2rn q _ – . cl =2 13 • Z Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) gnature CST Number ZS Address Date Evaluation Conducted Telephone Number 2 113 T►, �• q-)l 4<)Z s C 71 — ) 2�F� -�Ua Property Owner U LtCl !�? lly_IY Parcel ID #______________ Page _ of�-- - IN Boring # ❑ Boring ®"Pit Ground surface elev. ` - 7- ZV _ ft. Depth to limiting factor _ V _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efl#1 'Eff#2 I p -12 I si 2 a �r C 3 4 9 -�b (U r 31co — Sc F-1 Boring # F] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Boring Boring # Ground surface elev. ________ ft. Depth to limiting factor ___`� in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i ' Effluent #1 = BOD > 30 220 mg/L and TSS >30:S 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, lease contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) r v � Property Owner l_�tr��l�i _(YU Parcel 10 # Page _ of Boring # ❑ Boring J Q -7 �'P Ground surface eiev. - 20 _ ft. Depth to limiting factor Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 o -12 10 r'3l r-_' S ---, S► I a -r C5 (v S 12- -iJ 11ilir 415 Sr" C4 y 3 9 - �U !U r /cP — Scl F-1 Boring # El Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 F] Boring Boring # Ground surface eiev. _ ^_____ ft. Depth to limiting factor , in. 1:1 pit Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff #2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS <_ 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) PAGE_OF 3 AM U i Yyv # " H % V4 g T z 9%tLR / SCALE: 1"= yG' BM 1 ELEVATION /4Q O BM 1 DESCRIPTION BM 2 ELEVATION y� BM 2 DESCRIPTION 4o j 2 i " _51e e l SYSTEM ELEVATION `Is 30 1 SYSTEM TYPE e Urn •f "c,no, / r -- CONTOUR ELEVATION Cl r SIGNATURE Y DATE r PAGE2_OF 3 NAME U Vha C LOT# y LEGAL DESCRIPTION, 4/F Sw i4 ,S q T z 9,N,R, 1 E(or SCALE: 1"= yU BM 1 ELEVATION 100 0 BM 1 DESCRIPTION Irk c %y Sao l 2 o cQ BM 2 ELEVATION y�- BM 2 DESCRIPTION k� o iN S�e lo d s PC ' SYSTEM ELEVATION SYSTEM TYPE -{— CONTOUR ELEVATION 9 , a v tb' t r SIGNATURE DATE 1093.2 ..� `�� , i • 1093.8 x S �( to (1.50 , ... . _ o Zy � 8 L OT 83 3 i • 1.82 ACRES 2 8! 1097 ' . 1.68 ACRES M r � r , :s ♦ / ° w o L OT 84 . 33' r , ® 1 a 1.38 ACRES , OT 8 ®' ' ' 1. 3 ACRES M a "• ° ?6 _ .J. 30 ACRE t O � r TWR, ' r ADV t 110.4 ' M ' a 1200 FORM � M 3 •33 �1f8pa38. „ l • 68' i co O 1. 52 ACRES I ° O � , N N OT 81 : °r °• 1.68 ACRES N r r j i o S8Qo51 ON 3 It ency Plan for a Septic System Maintenance and Conting Maintenance Plan ed once every 3 years. 1. Septic Tank is to be pump 2. Effluent filter is to be clea once a year• please note: a larger filter is being installed in � order to extend the maintenance interval of the f liter. via the i pipes at the ends of 3 . every 3 years, cells are to be inspected the cells. ' . limit g reases, garbage, and water conditioner discharge into the system. 4.Ow ner a 9 rees to 9 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. stem is not exceed those required as per Comm. 83 s 8. DischgMe into y g `y Plan of and install new system fails, determine cause of failure, use mate . sted replacement area. nstall sy stem at a lower elevation, by removing chambers, removing biomat, ew system. d uate area is suitable for replacement area, and system elevation Option#3. No a eq cannont be lowered. install holding tank as last resort. 3. Replace any other falling components as need Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715-386 Pumper Tom Mondor 715- 246-5 Shaun Bird #226900 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT 5 AND FO i J ,� ? 0 OWNERSHIP CER ICATION FO i�iA o rc �� l � / p ���-- "- f1C/ �'. /C ,�2 Mailing Address / property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number AL DESCRIPTION Location /v � '* /•, .50/•, Sec. TON' W, Town of Property Jj` Subdivision ��� . Lot # -'--- Page # Certified Survey Map # Volume 054 Warranty Deed # �° (to , Volume , 22g41 Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SSS'+ M 11'SA premature failure to handle wastes. Proper maintance Improper use and maintenance of Your septic system could resulte� bm en if y a licensed pumper. What you put into the system consists of pumping out the septic tank every three years or sooner, can affect the function of the septic tank as a treatment stage in the waste disposal system Departm a certification form, signed by the owner and by a verifying that (1) the on -site wastewater disposal system meg=plumber,��yman. p l u mber, Th property owner agrees to submit to St. Croix Zoning restrictodplumberora licensedlwniPa � tic tank is less than 113 full of sludge. is in proper operatrug condition and/or (2) of er inspection and pumping (if nocessatry), �P the pr i va te sewage disposal system with the standards I/we, the undersigned have read the above requirements and agree to maintain Pn State of Wisconsin.. Certification ent of Commerce and the Department of Natural Resources, Offi within 30 set forth, herein, as set by the Departm leted and returned to the St- Croix County Zoning stating that your septic system has been maintained must be comp days of the three car expiration date. DATE S GNATURE OF APPLICANT OWNER CER'T'IFICATION knowledge. I (we) am (are) the OWU -qs) of ( c I ) e that all statements on this form are true to the best of my (our ) Office. the pro d above, v f a warranty deed recorded in Register of Deeds �O DATE SIGNATURE OF APPLICANT t Any information that is _represented may result in the sanitary permit being revoked by the Zoning Department 0. 0004 . warranty deed from the Register of Deeds office •• Include with this application: a copy stam if reference is made in the warranty decd a copy of the certified survey map 1� 2841P 057 • State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WAL5H REGISTER OF DEEDS • ' WARRANTY DEED ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 07/12/2005 09:00AK WARRANTY DEED EXEMPT 4 THIS DEED, made between Brett C. Jenkin ( "Grantor," whether one or more), REC FEE: 11.00 and Theodore Tindall TRANS FEE: 250.50 COPY FEE: ( "Grantee," whether one or more). CC FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space f E � is ed, please attach addendum): Name and Return Address Fe �NJ _ ,44 heasant Ridge I" Addition, St. Croix County, Wisconsin. TIMBERLAND TITLE, LLC 40F& WINGTON AVENUE, SUITE "D ARDEN HILLS, MN VF 6.610A r O18- 1049 -44 -000 Parcel Identification Number (PM) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. j Dated _i (SEAL) (SEAL) * *Brett C. Jenkin (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF ) ) ss. COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on 05 , (If not, the above-named Brett C. Jenkin authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the for�ot j'QjA ' • S �,� THIS INSTRUMENT DRAFTED BY: instrument and acknowledged the same. � - t 1 9� •. Attorney Kristina Ogland Hudson, WI 54016 * y % y • , V81 - � • • • Notary Pub�� State o My Commission (is permanent) (expires: ) I - U? N - 1 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO .PROTM Legal Forms 800.855 -2021 www.hfoprolorms.00m 9 0 ° o. 000 00000 00: SE_ I 1 4 - __N W l, - - - -- °� NE / i4 SW 1 i4 L OT 41;, •.G ' 2.43 ACRES 2� 105,993 S0. FT. f. O •• oc ti tip` � •..:yy N L OT 42 � \ � 1.88 ACRES k 81, 890 S0. FT. i ® \; s �� ® ® °� Z o 11' 0 V 1 c � CD L OT 43 1.75 ACRES O 76, 143 S0. FT. ' 1 331 ` 33' --------- �-- LOT 4 .O --�-:� •,:; �, k -' j' `•� 74,372 SO. FT. 0 N89' ��•\ _ ®_ , ; 1 ' • 1 .T -- .31 - - - - -- �N L OT 53 LR` �.. 1.52 ACRES B O v -... 017 so. Fr. ' 1 -P 1' W 316• T ss ' 0 314 o N8 I ° 25' .... ... ... ...1.... > >3, 3,g • E 346. 7 ' 1 ; ` . r • 1 x LOT 45 1 6! ' 6 a 1.65 ACRES 1 co 71, 796 S0. FT.