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HomeMy WebLinkAbout040-1278-00-000 County: St. Croix .~consin Department of Commerce PRIVATE SEWAGE SYSTEM c°u" Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574390 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)]. Parcel Tax No: 1V7 Permit Holder's Name: City Village X Township 040- 8-00-000 Marek, Matthew & Shannon Troy., Town of Section/Town/Range/Map No: CST BM Elev: Insp. BM Elev: BM Description: qyz . 47 14-- /9',10 16.28.19.1552 TANK INFORMATION ELEVATION DATA STATION BS HI FS ELEV. TYPE MANUFACTURER j CAPACITY FAlt hmark ~y4 q y Z . Septic 5 W t' e sw. F't 1.~.. Z. M a9 fit Devil; Bldg. Sewer Aeration Holding St/Ht Inlet 3c~ Z St/Ht Outlet c Z TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent SAir Intake ROAD Dt Inlet D Septic /,.5,/ _ t Bottom `T AA I1 J g, g' g Header/Man. Dosing Dist. Pipe 94$. Aeration /o , / 47 o Bot. System 9' 9 Holding !1 ' I S `7 Final Grade 5. L5 5 Z PUMP/SIPHON INFORMATION M' Manufacturer Demand St Cover/ / C/o l Z °lSS GPM ~u . Model Num TD Lift Friction Loss System H TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM Inside Dia. _ Liquid Depth PIT DIMENSIONS No. Of Pit.L BEDITRENCH Width / Length No. Of Trenches nn DIMENSIONS Z ,(A 3 c J SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER OR Manufacturer: P3 11 INFORMATION Type Of System: n A J UNIT Model Numbey 4 5~4 61 DISTRIBUTION SYSTEM ko (J-(- Z -7 4-- Z-- 5 x Hole Size---x Hole Spacing Vent to Air I Header/Manifold it Distribution E it G Pipe(s) Length Length Dia ntake l0 Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At Grade Systems Only xx Mulched Depth Over xx Depth of xx Seeded/Sodded Depth Over To soil Yes No es No Bed(Trench Center Bedrrrench Edges \ p Inspection #2: / / COMMENTS: (Include code discrepencies, persons present, etc.) Inspection Parcel No: 16.28.19.1552 Location: 397 Cedar Court tiudJ$on, WI //5._4016 (NW 1/4 NW 1/4 1~6t~28N R19IW) Eagle Bluff Lot 20 dy` 1.) Alt BM Description a ws rrrr = -Te ~-[c S M 2.) Bldg sewer length 50, - amount of cover = > $ o F: t Plan revision Required? Yes No Z 7 1 ~f Use other side for additional informatidfi. Alinnseepctors 4gnature J Cert. No. SBD-6710 (R.3/97) Date ~~-1 S 1 6 7 ZF M R ~1r~'TT' n'1Fl{~ Lol -rr~ w/ ivt 6- t 1 RL" S~-fC I~ -5H', 2 x x)- CG d?L~~d~~1 L0 CL ~ L c, .410 0, too" and Btu DlwWcomfy 4 ` 00, (j 2i w wwNou W sa~r Pan* Numba (to be Mod in by Co.) Q " ' S7y39o 441, Awtay Petmlt -A p 4 stftT - In accordance whin sP5 lira. Adel cvdt n offitis fomte Sae eIpg p SweensumsWunk a nxlu'sedpaior to a shy pem t. Ndm A farm forte pOWIS we to Pio jax A (i€datll~a~ ) ft I of saf y and Pal Savies. Peoaml ia&wmfiw you provide nary be and for secanda[y PURIMMS ina=ardawxwit *c laaa;s. is SwL 3Gj 7 0 EJ)11?- L A - i, s-PlowPrbtARhOrnatien Pmpetty Oasads rye I- -d56V1n0V%- L" Pamdf ,Fad AQ.E OLIO ' 1 Z76 -,W Ptoperw owads M Addax I' ap"F lncafian J 11 Govt Lot G a,~ 7apCO& PSaooerhenTt~ Niel w,11lei V, Swfim llo kasoo W11 one) T 2-6 It R E II. Type of BadMing (dmick attthat appty) Lot a 1h or 2 FaDAp Dwellag-Naaaber ofd Niame ak BID&S E F,6 Lc 3LU F F a;4 W01E, ❑ ' -De=ibeUw ❑ city VIMW ❑ SM Owwd--nesac vs~ c9mil 3 ~ ~b~ G c rs cam. - III. Type ofFawallb (Check oiffy oar box on tare A. Campiefe Me B Ka ppUcaW) o A SOM ❑ R S-V!A= D T T=kRepla 0* D 0&WMo&ftwfiMfoR&b%SykW1 (00=0 B. ❑ Pa»t xsaewat ©F~moaa R+tv~aa ❑ amw of Pla®bar ❑ Ploonlt rra ao Nznr p pp~asitl~mber and Daete &*M apnation Owner IV. T of PO'4V7'S Check an flat wpw ❑ IIoa-Psi D k-~ ❑ A&Ch ade ❑ lomd>24 m efsoilmble sod ❑ Mwud <2s m of s~ ❑ HoWMT=k D Ds~ t:on taq>1 ) D (S I AMC V. r Area 7afannxd9a: DcsignFtaw(tM nesign son Dkp=lAreaRe~r1 Area (so sum lemon D~ Q6 5~ 1 (~72 > 1072 D~0 ' 9 VL Tank info (may in TOW Oaf Mir _ at' - Cs>UM Gallons Units a `g L NwrTaalcs ~TuNks A Sgwc or 7mk - i565 65 nosiagCbmab- VELResponsi6itityStsbe>eea`..Lde ,assume r tyfair off ePOWIS attacilled rl~ummber l~mnbaa'sNexae(Priat) - V, 1-* 1 L j~ zZ32 IZ 15 7 SS-Zybl Plaaa~-s Aadr (stns <cJtr= Saw'Zipce&) S6S I>RaSrK. VV I S116617 caa$ UM peanit Fee ao aft fie. a. ~-v alesel' . coa 3) 6rl 1 Sept"~c tank, effluent f'tter ar►d ` / A dispersal cell must all be services 1 maintained at, per management plan provided by plumber. rj'y+$~ of ~~"`~a'~ r" fC( 2. Ali s & requirements must be` maintained J t ( J as Par applicable cods'/ ordnaricg V"l~Lr` ~i4~,}'-P tan <M,J ~ ° j'~'~ mosa9te0epbnsfa Me5_II 22d=W&asfleC01011Y aWRIS PRWSKkS OWN +Us In$be 4a 0<4- 0--7 SBD-6398 (R• 11111) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: ff\, IT- -i :541 QI~O U ~ K Owner's Name: Owner's Address:I N 51►►~ 4A \j imb w s'tia l!~ Legal Description: _ 111 kr V`/ IVW jXy S Ib -r Z6 K1 P.,1 a 1r1/ Township: ~~yy County: -i( Cpl X Subdivision Name: 9 KLU LB LU FT- Lot Number. I Parcel ID Number: b~-10 11 ZB 60- 6Q0 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: -::E FF Tb )Q License Number: Mt~eS 22 3 Zy Z Date: C11/81/L/ Phone Number 1 v S- 755- ZN LI Signatur Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 ~C I(~ t~ ld~. 1 1SP-' gz~ f~>L`tils~~uZIC 7 Soil Absorption System Cross Section ft lob ft 4" Schedule 40 Final Grade PVC Vent Pipe p , ft With Vent Caa Leaching Chamber ft System Elevation ft L ft ft Soil Absorption System Plan View 7Y ft --N\ 3 ft { ft Leaching Trench 1 Chambers IN F- k\ 4" Dia. Trench 2 Header Vent Or Observation Pipe 111117-- Trench 3 Leaching Chamber Specifications Manufacturer And Model T7 ) Fil-l L 0k EISA Rating ZL sq ft per chamber Soil Application Rate 1-7 gpd/sq ft -76 gpd Design Flow 7 Soil Application Rate - 7-0 EISA = Sy Chambers 3 rows of chambers each. Page of Installation and Maintenance Instructions Installation Step 1 Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under the access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added) Step 2 If utilizing the additional single side support and the two bottom supports: While the case is still dry fit to the outlet pipe, measure and cut 1"schedule 40 pvc pipe to the length needed to extend from the hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the hubs that are pre-molded onto the case. Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the cartridge until it locks into place at the bottom of case. Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter. Press straight down until it locks into place Maintenance 1) Remove the access lid of the tank. Note: To ensure undesirable solids do not exit the tank and into the drain field, the tank should be pumped out until the level of effluent is below the outlet level of the tank. 2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging it from the case. (if utilizing a vertical read switch, removal of switch is optional) 3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed. 4) Place the filter cartridge back into the-filter case pressing down on the cartridge until it locks into place. S) Place the access lid back onto the tank ensuring it is secure. Lifetime filter has a lifetime limited warranty: Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use for the period of time the original purchaser owns the product. Lifetime filter will provide a replacement filter in the event that the original filter was not damaged during the installation or maintenance process. Damage to this product caused by accident, misuse or abuse will not be covered under this warranty. Improper care or malfunctions resulting from product not being installed, operated or maintained properly will void this warranty. Lifetime filter assumes no responsibility for labor charges, removal charges, installation or other incidental or consequential costs. Contact: mikePlifetimefilterllc.com Phone: 502-724-2231 POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION It 01 SYSTEM SPECIFICATIONS Owner Septic Tank Ca aci al p NA Permit # Septic Tank Manufacturer VU R- p NA DESIGN PARAMETERS Effluent Filter Manufacturer L I Ff, ❑ NA Number of Bedrooms 100 gp - Pump d/bedroom p NA Effluent Filter Model ❑ NA Number of Commercial UnitsQ Tank Capacity al NA Pump Pf Estimated flow (average)* c50 O al/da Tank Manufacturer NA Design flow (peak), estimated x 1.5* O aUda P Manufacturer NA Soil Application Rate al/day -7Model LtNA Influent/Effluent Pretreatment Unit NA Quality (NA❑) Monthly Average*s ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) 30 mg/L [I Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (HODS) :5 Total Suspended Solids (TSS) 220 mglL ❑ Disinfection [I Other: 5 250 m L Manufacturer: Model: Pretreated Effluent Quality Dispersal Cell(s) ❑ Monthly Average In- ound Biochemical Oxygen Demand (HODS) < 30 mg/L (gravity) ❑ In ground (pressurized) Total Suspended Solids (TSS) ❑ At-grade ❑ Mound Fecal Coliform (geometric mean) 5 30 mg/L ❑ Drip-line Other: <10 cfu/100m1 ❑ Leaching Chamber Manufacturer f )UFiL-r2NTt R Maximum Effluent Particle Size 1/8 inch diameter Model ( 1ek 11 Laying Length/Chamber L r *Wastewater Flow Verification and Calculations: Soil Application Rate__a_gpd/f 2 Area Req. /()14 ft2 (Other than bedroom based) Infiltrative Surface/Chamber-ESIA Ra ' g Z o f 2 Minimum Number of Chambers $ ❑ Aggregate Design Flow/Loading Rate= ft2 min Values typical for domestic (non-commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ***Values typical for retreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At-grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 'Design of Conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/1-80-012 October 1980 ❑ SBD - 10570P (8.6/99) "At-Grade Component Manual Using Pressure Distribution" ❑ SBD -10567 P (8.6/99) "In Ground Absorption Component Manual" ❑ SBD - 10705-P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD - 10628-P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD - 10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572-P (R.6/99) "Mound Component Manual" p SBD - 10691=P (N.01101) "Mound Component Manual" Version 2.0 p SBD - 10595-P (8.6/99) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657-P (8.6/99) "Drip-line Effluent Disposal Component Manual" ❑ SBD - 10573-P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706-P (N.01101) "Pressure Distribution Component Manual" Version 2.0 p Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ❑ months btyear(s) (Maximum 3 s. Pump out contents of tank(s) When combined sludge and scum equals one-third 1/3) of tank volume Inspect dispersal cells At least once every ❑ months ears um 3 Clean effluent filter At least once eve p months year(s) Inspect pump, pump controls & alarm At least once eve ❑ months ❑ year(s) NA Flush laterals and pressure test At least once eve ❑ months ❑ year(s) NA Valves At least once eve ❑ Months ❑ year(s) NA START UP z 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 treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ Valves Valves shall be operated in the following manner: ❑ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). ❑ Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When 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 tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ❑ Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of. ❑ In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75%.of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of ❑ Mound, At-Grade, In-Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, 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. 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 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 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. «WARNiNG>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN 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 ;ZOV F 6 t- Name Phone (5 - -715S7 - Phone SEPTAG SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency I s+ f : Phone Phone 71:5- 10/2006 K:IWPDATAtEH\POWTS OWNER'S MANUAL.doc Page of SOIL EVALUATION REPORT Page of Wisconsin Department of Commerce Division of Safety.and Buildings in accordance with Comm 85, Wis. Adm. Code County 0120 \X Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must D -7 ~I 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. a1- / W Please print all information. R sewed b ad, Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1.) (m)). Property Owner Property Location Gevt:-tivt'- N t~j :1/4 11 )6 7-r N R 19 C 5. COOK Property Owners Mailing Address Lot # Block # Subd. Name or # ~SO 17 o t 17 00 A6efZbEeM ST, ME 5L1 ITE ►oo ZO EA ,L F, 5L.uFr city State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road g1 PrIA3t_ AAM 44 ( 63 ) -757--75(o8 `fiRD Tc wSV~~ _ 0 GPD New Construction Use: M Residential / Number of bedrooms ~ Code derived design flow rate ❑ Replacement ❑ Public or commercial - Describe: Parent material 5AM D5TbWE Flood Plain elevation if applicable General comments Z Tt2EwGttss t r17! and recommendations: :-,y Ss LeWri-t nl r G~_ d !cam. ' ZONI W4 -ry Boring ryy ❑ Boring # Soil A _ i to Ground surface ele . Q4 y, 2- Z ft. Depth to limiting factor Pit Horizon Depth Dominant Color Redox Des Texture Siructure Consistence Boundary •Eff#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sl 1 -b z - SI - rnI ab 3v - S ,q 0.~ I.Z Z (7_12 (ovQ2/i S 0 t u b 3-1 3 12 -11 1, 0v 31y - s m I 3f-L-n o.-7 I,Z 4 I -2Q 10\1 0314 Is sb ds ni-co -112- a- LlZ' I0V 3 - I -m0. ask Q5 m 0,(0 4/6 l CS rn a,-7 1,2. ~ -55 IoyO - S 0 rn 7 55-1I)104es/L 5 OS rnI B,"7 I17- Boring ®goring # 7 10 0 in. Soil A Iication Rate Pit Ground surface elev q 4q, 3-~ ft• Dep 'o limiting factor . Horizon Depth Dominant Color Redox De Texture Structure Consistence Boundary Roots -Eff#l GPD/ Eff#2 In. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. 0- 41 - 1S Ir-r\ sbIC m1 0.b 3V' O 1.Z 2- ~'-Ilo q13 IS Zrnsb M I CS 3Jf-- 0, trZ 3 Ib-3► ova 15 Im sb J15 Cs 3~-eD 0.11 I. Z 15 1< h 5 2m 01-1 I. Z S 5b-10D d 1 - I rh 0.'1 1.2 = Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L Effluent #2 BOD < 30 mg/L and TSS 130 mg/L CST Number CST Name (Please Print) Sio lure 22 q Date Evaluation Conducted Telephone Number Address w-V 9{022 10- 0-IDO (:"1IS)y2,-1-7-7S W 75 IoQ~Au f✓, tz\q FAI-cs L-0- r2_0 PrcelID# Page Z of Property Owner COOK S Boring Boring # pit Grou Depth to limiting factor > 1 D(-( in. Soll A lication Rate Ground surface elegCont.Color ft •E ffff#l Eff#2 Horizon Depth Dominant Color Redox Texture Structure Consistence Boundary Roots f in. Munsell Qu. Sz. Gr. Sz. Sh. Z 10 I I 0-lb l0 2~ is r rnl a 3~f-rn 0.7 1 z S p I -co 7 z -L 10 M zIz y S 5 ?~-co 0 i Z 3 25- . ' J 5 im 2- 35-10 0 `I y E' . . . ❑ Boring Boring # ft. Depth to limiting factor In. Application Rate . El E] Pit Ground surface elev in. FZon Depth Dominant Color Redox Description Texture G~rSzu8h. Consistence Boundary Roots .E GPD/ff°Eff#2 In. Munsell Qu. Sz. Cont. Color Boring . in. E Boring # Ground surface elev. ft. Depth to limiting factor soil licatlon Rate ❑ Pit GPD/FP Horizon Depth Dominant Color Redox Description Texture Gr. Structure Consistence Boundary Roots *Eff#1 •Etf#2 In. Munsell Qu. Sz. Cont. Color Effluent #1 = BOD5 > 30:S 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-9330 (R.6=) C RLES I:CGCNn, y Pt;OPPp1Y OWN~P, L o.K C~+A LECK V~5CFZIPIIQN: Lb 2 EAGLE luF-F 13M° 041--MP OF AI 1 -ME T lzrA C . on 4* ly 2- OF CPt tt1E Al W` oF-rrle Nw uN su 1. T2 IAW WA) 0 TYLO 1" VC91 E lo" IOUAD SURFACE. T can Esc IJ ❑-5011, POONG W/ 13PCKNM NO COMM 65 %fPACK PROLUM5 P.F #2 Cl Bza~ EL 942. 221 Ns L~ ~ C3 >3z(:)C. / f✓1,948.~9' (Tl~lVV/ate) A-qq134 CI tti206 EL 9y 9,3~' ZO ClJU'R-T x `5r S \W4 A _ 516W C5f ZZy~3Z SEC AO UAiE: 10-30-00 . ~NCe 4 a~ 4 C4OTOIAK WAS FOK LOTS Ili GA"I UAFF SWSD• r 9! 6 f.!! ~6d.3 f l X ~ ~ r i PAr.e y O y CO►.Mk K LINES FOR LOTS - IN eAC,t,E (SLIT SUZJD. r go' -94 EEL 0 C- B-208 \ \ .,51.8 ~ h ~ 96Gt..3 ` I I ~ I >I I I' ST. CROIX COUNTY S"TIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Matt and Shannon Marek " Orv Wftyer G Mailing Address 1 Kinsman Hudson WI Property Addretts 397 Cedar Court (Verification required from Planning & zoning t1a"mon' for naw construction.) CiWState Hudson W1 Parcel Identification Number LEGAL DESCRIPTION Property Location Al K/ ' • • v A, Sec. _LL, T dS N RL~LW, Town of ( PQy Subdivision Plat: 4AE lE ELuj-F- , Lot # a~ Certifled Survey Map # , Volume , Page # Warranty Deed # ai 52Z (before 2047)Volunu . Page # Spec hones 0yesclo Lot lines identifiable Q yesono SYSTEM MAINTENANCE AND OWNER C R'1MCATION improper and maintenance of yawn septic system could result in its premature 5iturc m handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed punk per. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner mailer ws reaper:ibilitics are specified in f9P3. 383.52(1) and in Chapter 12 • St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning R Zoning Department a certificatiorn foam, signed by me owner and by a master plumber, Journeymen plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) afkar inspection and pumping (if necessary), the septic tank is ka than 113 Ail of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with *a standards to forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Rewurces, State of Wisconsin. Certification stating that your septic system has been maintained roust be completed and returned to the St. Croix County Planning do Zoning Department within 30 days of the three you expiration date. Uwe daft that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(a) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bad 1~5~ L//~ 4~ I A F APPLIC (S) DATE ***Any kfornnstion that Is misrepresented sented may mutt in n the sanitary permit bed revoked by the Plowing x Zoning Dapaxtrrant. Include with thb application a receded warranty deed from &a Register of Deeds Office and a copy of the certified survey snap if reference is merle in the warranty eksd. MV. Un2) 1~ 995322 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM 1 - 2000 RECEIVED FOR RECORD 04/30/2014 08:46 AM WARRANTY DEED EXEMPT # NA Document Number REC FEE: 30.00 THIS DEED, made between Darcy Jerome, a married person, Grantor, TRANS FEE` 405.00 and Matthew W. Marek and Shannon M. Marek, husband and wife as PAGES` 2 survivorship marital property, Grantee. "The above recording information verifies that this document has Grantor, for a valuable consideration, conveys to Grantee the following be turned to 'the submittdr described real estate in St. Croix County, State of Wisconsin (the "Property"): SEE ATTACHED EXHIBIT A Recording Area Name and Retu Address: Title One W5 File 41 ~ i V Edna Realty We Together with all appurtenant rights, title and interests. 040-1278-00-000 Edina MN 55435 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements and Restrictions of Records Dated this 23rd y of April, 2014. * * Darcy Jerom * AUTHENTICATION ACKNOWLEDGMENT ) Signature(s) STATE OF WISCONSIN ST CROIX COUNTY. ) ss. authenticated this 23rd day of April, 2014 Personally came before me this 23rd day of April, 2014 the above named Darcy Jerome, a married person to me known to *-cry c.s~,~ tjie person(s) who executed the foregoing instrument and 'ac)£~c3~vledg a sam . TITLE: MEMBER STATE BAR OF WISCONSIN : NOTARY (If not, PUBt_ authorized by § 706.06, Wis. Slats.)•. C chE i THIS INSTRUMENT WAS DRAFTED BY •'9 DFW► Pube of consm -try commissio permanent. (If not, state expiration date: 7/1/2017 ) Michael H Forecki, Attorney (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature St. Croix County 995322 Page 1 of 2 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000 d EXHIBIT A Lot 20, Plat of Eagle Bluff in the Town of Troy, St. Croix County, Wisconsin. St. Croix County 995322 Page 2 of 2 N 1 /4 CORNER 'TED L AND SEC TK` N 16 T2 t LINE OF THE NW 1J4 880590 00#1 E 2616,30' 53 IM Umwmmmmwww am -00 130& 15' DEDICATED TO T PUBLIC FOR PARK 0.4W ASS 2017.411 2.546 ACRES ;o r r r $«,T % Boo { < 46,1 ZYll I - [ I LA 20' 21 6. . ~ j ? 94.48 5 S.F. Parcel 040-1276-80-000 04/09/2008 11:16 AM PAGE 1 OF 1 Alt. Parcel 17.28.19.1540 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - KOLLITZ, JOHN A & JANE A JOHN A & JANE A KOLLITZ 8802 SPRINGWOOD ALCOVE WOODBURY MN 55125 Districts: SC = School aSp = Special Property Address(es): = Primary Type Dist # Description 395 EAGLE BLUFF CT SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: } 1.470 Plat: 08-037-EA LE BLUFF LOTS 1/43 040-01 SEC 17 T28N R19W NE NE LOT 8 EAGLE BLUFF Block/Condo BI LOT 08 \ Tract(s): ( ec-Twn-Rng 401/4 1601/4) 17-28N-19W E NE Notes: XOO tory: Doc # Vol/Page Type 2 676067 1871/209 TD 2 675897 1870/26 WD 2 008 SUMMARY Bill Fa Market Val : Assessed with: 0 Valuations: Last Changed: 09/09/2003 Description Class Ac4s Land Imp ve Total State Reason RESIDENTIAL G1 1`.470 229,900 229,900 NO Totals for 2008: General Property" 1.470 229,900 0 229,900 WoodlantA 0.000 0 0 Totals for 2007: General Property 1.470 229,900 0 229,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1278-00-000 04/09/2008 11:24 AM PAGE 1 OF 1 Alt. Parcel 16.28.19.1552 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - JEROME, DARCY D DARCY D JEROME 804 SPRUCE DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 397 CEDAR CT SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.546 Plat: 08-037-EAGLE BLUFF LOTS 1/43 040-01 SEC 16 T28N R19W NW NW LOT 20 EAGLE Block/Condo Bldg: LOT 20 BLUFF Tract(s): (Sec-Twn-Rng 401/4 1601/4) 16-28N-19W NW NW Notes: Parcel History: Date Doc # Vol/Page Type 10/20/2006 837042 WD 07/26/2006 83586 WD 10/23/2001 659807 1743/199 WD 10/23/2001 659806 1743/198 TD 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.546 132,000 0 132,000 NO Totals for 2008: General Property 2.546 132,000 0 132,000 Woodland 0.000 0 0 Totals for 2007: General Property 2.546 132,000 0 132,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 b 9loVS IM 'uospnb '4ano7 uDPa7 L69 5 a a - a mumm Q 19aoW uouuDu✓"4 14pW o U10021 GUIMDJQ S UIDI h< ~ R R S e o U ° o nog a~uaav~n o o C O ma ° ~ p U ~ O w Z ~ N N> I Z a O K N K N V I ~1 ~ m8 ass bg~ ~ J Ii ~ ❑ N O zU z ~~=o (.D p F~°~n r Q o8w== N~ ~ * ' ^ E:j~ C) O 2 O 2 N O Nd ❑ CD 11 iu 'v 3 a r v w ~ -7I z r ~I _ Q - J w w 1 J I ~ NI , O Zp f Z> Q W w J p J L Zz~w O U Oz~z U~~\ o - > I] W V J W - W W U c~ - ~ _L_- I II.J ~ CQ J A LL- I N S - ~ f i j I 1 ~i IMP ~ I I`f I J__._~_ N U Z p w 2 ° 1 u4 ~OQUt I" ~I 3 I.~ ~ ~ oOaJbm C g ~inw ( _ I I I cpioN~ ~~=~m~ E N oL+ u ~ E II o ~m ~o ~ I ~~I ~oo~ vo u~ ~aR w❑ N~o io 3 N N I 11 ( I l =,4 v n n E u I s ~ ~ ~ ~ O Try _ ! 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