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032-2029-10-300
. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578951 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:253 I Lf sO Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. City Village X Township Parcel Tax No: Permit Holder's Name: 032-2029-10-300 Brata er, Derek & Rachael Somerset, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: C S 07.30.19.578C TANK INFORMATION ELEVATION DATA, 06 TYPE MANUFACTURER CAPACITY STATION ' BS H~~ FS IELEV. Septic i.b f Benchmark 5.4 3 W/ 14 Dosing W 1 LS Z~ It. BM ~J , to 66 a on Bldg. ewe ,63. 5 St/Ht Inlet StNi#-A~tlet ^ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. en o Air Intake ROAD DHn%T-flu Septic Dt Bottom C AlZ A f a 75. 403 Dosing 1 f Z s 7o 10/' Aeration T Dist. Pipe ~Jr I 161,17e)- Holding Bot. System Z /Q Jr 3 Final Grade ` St(! ?an UMP IPHON INFORMATION lJ urer Demand St Cover ' , 6 b2 •f odel Number GiM~~ 2.115 /163.2 TDH Lift r~ Friction Loss &1 System Head1'~~ TD .1 t Ft 6~ `~5 'J Forcemain Length 26' Dia. Z ] I Dist. to Well N , l SOIL ABSORPTION SYSTEM fib. T 5 BEDITRENCH Width i Length O, No. Of T I~/~RJrenches IL Le PIT DIMENSIONS No. Of Pits Inside Dia. ~ Liquid De DIMENSIONS Jl ✓ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: INFORMATION Type Of Syst : f 2 h~ 1 UNIT Model Number: 'Nu bbl ~ DIST ON S~YSTEM I'~ nt to Air Intake C "gader if ol Distribution I f x Hole Size Pipe(s Length ) r Dia Spacing L Dia SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only thrOver Edge ToDeplh of 1 1xx Seeded/Sodded xx Mulched J-D Be th Over C t 1 Depth rench Yes [E No Yes No i COMMENTS: (Include code discrepencies, persons present, etc.) Ie[ction 1: /Z7I/ y{~5 Inspection #2: 7 Z0/ Location: 395 165th Av Somerset, WI 54025 NE 1/4 SE 1/4 7 T30N R19W) NA Lot 1 ~ yl~J17` V \ Parcel No: 07.30.19.578C c Pibtou'ns~' I S 5 1.) Alt BM Description = 2.) Bldg sewer length = G~ea✓► OJ w~l~ o-4- in ~nsPe -amount of cover I[- d4 L r t - T Plan revision Required? ® Yes XNo Use other side for additional information. Date In epctor s Signature UUU Cert. No SBD-6710 (R.3/97) o~yaarxty~r County ftstry Services Division 51 P.O. Box 7162 -go p S S r - a E 0 E Washington Ave Sanitary Permit Number (to be filled in by Co.) ?J1 1 Vwdison, WI 53707-7162 Sa n lt M 'Ion State Transaction Number In accordance with SPS 383.21 (2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 3 St~ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Protect Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1) m , Stats. c , G 1. Application Information - Please Print All I ation ] S Property Owner's Name 6 C, , Parcel # r UA PAC~~tZ t`~ 0WOQ_ ot0 2R - / D_ 3PJp Property Owner's Mailing Address Property Location 5 7T -C- q16 IRZ 01) AV6 City, State Govt. Lot p Zip Code Phone Number j~► ~''/a, SE Section `7 W6W Fi 1t! ft111d w1 5W-7 T N R I9'(cirEcle o IL Type of Building (check all that apply) 4 Lot # & or 2 Family Dwelling - Number of Bedrooms 7- Subdivision Name ❑ Public/Commercial - Describe Use R. "Mock # ❑ State Owned - Describe Use 41 ❑ City of / CSM Number 3 7 33, ❑ Village of 16 ly l 6 J' , 1Q J e Vo ) p~. qL Town of 50 V15 PIS III. T e of Permit: Check only one box on line A. Corn late line B if a ticable b A. J&iewS tam ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B, ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner / IV. Type of POWTS System/Component/Device: Check all that "Ply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil ❑ Holdin ❑ Mound < 24 in. of sui le soil g Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatmen Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required Dispersal Area Propose sf) System Elevation (O0 , Rate(gpdsf j I 9 00 j.70) 6000 I-pDD 10/. ZS VI. Tank Info Capacity in Gallons Gallons Units Manufacturer Total # of New Tanks Existing Tanks i- ~-l c U vi ti ~n is. C7 G. Septic or Holding Tank ] /Z / ❑ ❑ ❑ ❑ Dosing Chamber ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pi igna r MP umber Business Phone Number Z 2 `715 y3y Plumber's Address (Street, City, State, Zip Code) R0 S66 DR DER "vJ Q9 VIII. un epartment Use Only Approved 9=15ven Permit Fee Daze sued Issuin ant Signature Reason for Denial $ z~ ] IX. CondigWWpReasons for Disapproval 1 Septic tank, efflt brit filter and J ~ 1 414aersal cell must all be servtoes I maintained e t.~) V tr S ~N('r"`' a3 per management plan provided by 'plumber. 2.11t'1rictt_remer>ts must be maintained 1.6 Attach to complete plans for the system and submit to the Conn onlyRn paper not less thm 81/2 x it inches in size SBD-6398 (803/14) 'C.+\✓+ i v Cw• ,r t r ~ r ~i r t d f~' i ` .y E S; t t t r.t I j q``! Cam. C • t ■ y DIVISION OF INDUSTRY SERVICES j 5~~9~4T~~ro~ 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304 D Contact Through Relay 3 S hftp://dsps.wi.gov/programs/industry-services P S w www.wisconsin.gov 92' tiG sroNScott Walker, Governor Dave Ross, Secretary May 08, 2015 CUST ID No. 223242 ATTN: POWTS Inspector JEFFERY V FOX ZONING OFFICE JEFF FOX CONTRACTING & SEPTIC INC ST CROIX COUNTY SPIA PO BOX 565 1101 CARMICHAEL RD DRESSER WI 54009 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 05/08/2017 Transaction ID No. 2539480 Site ID No. 812126 SITE: Please refer to both identification numbers, Derek & Rachel Bratager above, in all correspondence with the a enc . 395 165TH Ave Town of Somerset St Croix County NEIA, SETA, S7, T30N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1533792 Maintenance required; 600 GPD Flow rate; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: ,CONOM APPR • The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the t)EPT GP direction of the slope. pRQFESSION • As per s. SPS 383.43 (8) (i), Wis. Admn. Code, the dispersal component shall be set back from any proMWOON OF by a minimum of 5 feet. • The approved dispersal component is made of 3 lterals, spaced 3.33 feet apart in a 10 foot wide mound, ho only two laterals are displayed in the lateral layout diagram. • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. JEFFERY V FOX Page 2 5/8/2015 In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, ?achael Huempfner Please Include a Copy With Your POWTS Plan Reviewer, Division of Industry Services Payment Submittal. (920)492-7726, M-f 7:45 am To 4:30 pm WiSMART code: 7633 rachael.huempffier@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Derek & Rachael Bratager Owner's Name: same Owner's Address: 940192"d Ave New Richmond WI 54017 Legal Description: NE1/4 SE1/4 S7 T30N/R19W Township: Somerset County: St. Croix Subdivision Name: Lot Number: 2 Block Number: IALL.Y Parcel I.D. Number: 03 E CY AND Plan Transaction No.: - SERVICES TRY S VICES i Page 1 Index and title Page 2 Data entry Page 3 Mound drawings ,A Page 4 Lateral and dose tank E Page 5 System maintenance specifications ~QN Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 plot plan Page 9 soil test Designer: Jeff Fox License Number: MPRS 223242 Date: 04121/15 Phone Number: 715 755 2461 Signature Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R. 11/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) Version 7.0 (R. 11/12) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) Residential or Commercial Design Note: sand is (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ sot treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 600.00 Design Flow (gpd) 7.00 Site Slope 100.75 Contour Line Elevation (ft) 32.00 Depth to Limiting Factor (in) 0.50 In-situ Soil Application Rate (gpd1ft2) Distribution Cell Information 60.00 Dispersal Cell Length Along Contour (ft) = 10. ell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpdMF'1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) a Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation (ft) 3 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 8.33 2/orifice 2.00 Foccemain Diameter (in) 50.00 Foccemain Length (ft) Does the forcemain drain back? Y~ 93.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 8.1 Forcemain Drainback (gal) 7.84 Vertical Lift (ft) 80.40 5x Void Volume (gal) 1.56 Friction Loss (ft) 88.56 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 38.77 System Demand (gpm) 13.95 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. da. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x 1.25 2.00 x x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer _ gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) lifetime Filter Manufacturer 22724 Dose Tank Volume (gal/in) 01/08/14 Filter Model Number Wieser anufacturer Project: Derek & Rachael Bratager Page 2 of 9 Mound Plan and Cross Section Views 1/ 0"P -J 4-- K Lr A W B- 3 Mound Component Dimensions Down slope toe extension made. 10.00 E 14.40 it H 1.00 K 7.9 B 60. F 9. it z 10. L E75.85 D 6.00 in G 0. J 4.44 W 24.44 600. (ft2) Dispersal Cell Area 1200.00 (ft2) Basal Area Available 10.0 (gpd/ft) Linear Loading Rate 6.0 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.04 (ft) rir~ ` r} H G ~r F Dispersal Ceti 101.75 (ft) Lateral 101.25 (ft) - ► Invert Dispersal Cell i' Elevation E D a sr.t r a a a a a s :r, a s a' a..a a s ....a.. a. a s a 100.75 (ft) Contour Elevation 7.0 % Site Slope Geotextile Fabric Cover Shading Key 4 in. Dispersal Cell See lateral details on dia. Page 4 for number, size, 1 Topsoil Cap 1.5 ft slotte and spacing of laterals. rrrr Subsoil Cap d Laterals are equally ASTM C33 Sand obse F spaced from the Tilled Layer rvad 0.5 ft Typical Lateral distribution cell's 4 Aggregate °n centerline in the pipe distribution cell (Ax8). A Project: Derek & Rachael Bratager Page 3 of 9 End Connection Lateral Layout Diagram ater s centered over the A & B dimension • = Turn-up vdball valves or oleanout plug P LtA re identical I X -3~ Holes drilled on the bottom of the lateral equally spaced n connection via tee o1 c ross to manifold at any point. Morcemain Sch 40 PVC per SPS Table 384,30-6 Number of Laterals 3 Orifice Diameter 0.16 in Lateral Diameter 1.5 in Orifice Spacing (X) 2.54 Lateral Length (P) 58.42 Orifices per Lateral 24 Lateral Spacing (S) .33 Orifice Density 8.33 2/orifice Lateral Flow Rate gpm Manifold Length 6.671ft System Flow Rate 38.77 gpm Manifold Diameter 2.00 in Total Dynamic Head 13.95 Forcemain Velocity 3.96 sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 306 and SPS 316.300 WAC L-4 - Tank component is property v nlWL outlet location B 7 Forcemain diameter Wieser Manufacturer 2 in. Ca acit 800.00 Gallons Volume 22.24 gal/inch Weep hole or anti- imensio Inches Gallons siphon device A 19.09 424.54 B 2.00 44.48 Pump off on ft C 3.98 88.56 93.91 D 10.90 242.42 Total 3547 800.()0 Dose tank elevation (it) 3" Bedding under tank. 93.00 Alarm Manuafacturer Rhombus Note: Switches Alarm Model Number JJ Pluger containing mercury may not be used in Pump Manufacturer oeller this system. Pump Model Number BN15 a Pump Must Deliver 38.77 pm at 13.95 TDH Project: Derek 8 Rachael Bratager Page 4 of 9 Septic-Dose Tank Grass Section And Pump Performance SPecificafill McJnuffictturr Pump Tank M and WIE:5C N Tank Model Number- M/L Model Number Total Twk Capacity Alarm MnnttfaCwrer Max. Bury Depth Alarm Model Number Switch Type Filter Malrlu et ll~ Total Dynamic Head (TDH) - Feet Filter Model Number evation Head Pressure Network Loss Minimum Pp&p Perfonnaace Required Force Main Loss GPM Ft TDH Total et Manhole Min. 4" Above Grade With Manhole Min. 4" Above Q Locking Device. Inlet Manhole We WdhLocking Device <b"Below Grade sealed Watertight Weatherproof Junction Box - Finished {3ra& = Depth of Vent Min. 12" Discom Cover Above Grade, Mean Ft Witb Vent Cap • • > t 6 < ! t t < t • ! ! < t •,i t t t t 444 tat • -:411-1 Wit, at - st 011111 at Outlet Filter Inkct f..._. Inlet Bale ,t g t ~t A<' ,41 Switch Settings and Reserve ii~► Wet t Tank Volume = GPI t Hal 't Dimension Inches Volume Gal. at B a 11 406 ?t ft t sts (ali/L1{l} 77 2 - 'tt OffElevati C Yt at (dose) C I s a t ' El D D Total t: t• e t t• a : t ats a s a a s r a s r a a s s a s s a s a t a a s a, a at ttt+as+tt:ttt•tttctt+e++tt+ee+tte+t:++tsttttt!•t:tttttt+ce a s s a a s> a a a a a s> a s a a a s s a a a> s a s a a a s a a> s s a a a a a s a s a a a a s a: s a a s a s GENMAL INSTALLATION: The sq&rJdow tank is bedded and back filled is accordalbce with m;anufaetur es product approval specification& Maxirnum depth of bury as spetified by tha mama TDRY be mmeded without prior approval. Manhole covers exposed to grade have an a ecuve locking device (pedlo installed. Piping at the mkt and outlet is of approved materials aanected to the ionic with waWd&W laid an stable soil to prevent settling or saggin& The force main is sleeved with 4" Sch. 40 PVC to brake the t elccav don and the sleeve is scaled ws t. Electrical service complies with NBC 300 and Comm 1628 WAC 02105 U of Mound System Maintenance and Operation Specifications Service Provider's Name Jeff Fox- Phone 715 755 2461 POWTS Regulator's Name St. Croix Cty Zoning Phone 7153864680 System Flow and Load Parameters Design Flow - Pea 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 pd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 al Maximum TSS 150 mg/L Soil Absorption Component Size 600 s Maximum FOG 30 g/L Type of Wastewat Domestic Maximum Fecal Colifomt >10E4 u/100 mL Service Frequency Septic and Pump Tan Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 years Pump and Controls Test once every 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for onding and seepage once eve 3 ears th€'r Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished •~r~~~~~~~~s■*~~ ■~~~~~~~a~~~~~ai Grade 64" Diameter Lawn Threaded Cieanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Derek & Rachael Bratager Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals 1SBD-10691-P (N.01/01, R.11112), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2.0 SBD•10706-P (N. 01/01, R. 10112)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be In accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Seofm Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet liter shag be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shag advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution %mle r No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODs, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODY, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was Installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the detective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condfition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. ~ f yyp6t v ~ ~ - _ IMAM 41:84, PAX 731 Ru- JUMP put toUTE t PUMP s t3 ; 153 '3 . 5 0~. ire. Ohm 39~ At 42 o as 20 Won alp z s COWL _ s 3 low f t t t 7 * R CL "aw i 3 - VIV _ i i 4-.~. f V-1 1 ! L/ ~M i 20140048A i + ,rp F a ~ ~ _~\\\fyf'~ M iY: A - ~ •'~f~ ~..ir'nG.i~`P I~..: 4'^ ./'A e yi 'i Installation and Maintenance Instructions Installation Step l 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 V'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 I 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. 5) Place the access lid back onto the tank ensuring It is secure. R LE-C - lllED FED 16 2`014 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: mike@lifetimefilterlic.com Phone: 502-724-2231 r f ST. CROIX COUNTY SEPTIC TANK MAINTAINA NCE AGREEMENT AND OWNERSHIP CERTIFICATE FORM Owner/Buyer \D V-z~z Mailing Address "l qo 2ihd w w p Y~o ( 7 Property Addres 3QS ZS ( Verification regsired from Planning De afimet3t for new cmstructi(n) City/State Parcel Identif ication Number 0 3 2 - ZO ZG) - 16 3 6,5 LEGAL DESCRIPTION Property Location NE'/;, %:V4 Sec 7 T3 R19W, Town of -50 E RS61- Subdivision LOW Certified Survey NIap# , Volume Page Warranty Deed# , Volume Page Spec house yes Xno Lot lines identifiable'2 es no SYSTEM MAINTENANCE Improper use and maintenance of your•septic system could result 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 youput.inta the.system_.can affe=ct 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifyingthat (1) the on site wastewater disposdsystemis inproper.operating condition and/or (2) after inspection and pumping (ifnecessary), the septic tank is less than 1/3 full of sludge.- Uwe, the undersigaedhavereadthesbove_reguirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by th Department of Commerce and use the Department of Natural Resources, State of Wisconsin.Cedificatinn atina tit your.septic system has been maintained must be completed and returned to th t. Croix County Zoning Office within 10 days of the three year expiration date, SIG ATURE OF APPLICANT DATE #of proposed bedrooms- _ OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office: s^-~Z-cam SIGNATURE O APPLICANT DATE Any mformatim that is mwepreaented may result in thesmitary pemut being revoked by the Zcnkg Deparbned Include with this application a tamped warranty deed frnm the Register of Deeds office a copy of the certified survey map if reference is made inshe waaaoty deed. £ZOtr aced t?L'1pA n Found East 1/4 Car. CSM Vol. 6, Pg_ 1620 t0 0-4 Section 7 - - ° cap t` PK Nall 3 l { Ox p tr I ! East line of the SE 1 /4 -r_ o f u o co L O _ :3 o I ! 40th Street a o = o v~U o° _x O m I I L2 cnQI m A C1, . '0 v C> ro N Z r~ - _ ] st I` NOO'42'00"W 2613.21 TT W viO oq r, NsV t+~s c I i~--_-~- ° o Lo M Westerly R.O. W. 40th St. a w --,r7 r`1 i J - j ~s r~ ° ,n pq; ' I w e a a O I l` t~f9/i w 3 W p op } I, LU H E-4 2 Cy a.+ y I in i • I f~ dam, v x _01 On, C5 tz I YEA ° to I- I I I cv~ a c ( C (fin' O -~1 w < C4 M N ! 33.00+ U N In n o M d O I i~ 285.3 o r+i r7 a t2 Cd 5'f Z. 18.32' cO Q o U) LIJ ` ~ L~ o N W C, LAJ C) E p C) C> V) 44 FF ifIrI ii~~ c rn v rn tr _j v II c to 5 U ! rn , 'r•'p'~,^' - a_ ? _ ceiv O N C; O U v CDP C-11 <D:) C4 Lij <D Ln 38th street West line of the NE 1/4 of the SE 1/4 _ aq HMI${e a4eP lencude I r !o s+(eP (W ur vn papw9a) lQL # J o UNPLATTED LANDS LOOZ Ndr Oo I I I> M w I Q t~ l "j&WOU sil:Lg (+ue uuwoZ ULOueld n I~ ! 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CROIX CO., WI 04/01/2014 11:16 AM THIS DEED, made between Ronald Anton Johnson EXEMPT#: NA ("Grantor," whether one or more), REC FEE: 30.00 and Derek M. Bratager and Rachael A Brataaer, husband and wife TRANS FEE: 129.00 ("Grantee;' whether one or more). 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 is needed, please attach addendum): Name and Return Address That part of the NEI/4 SE114 of Sec. 7-T30N-R19W described as follows: Lot 2 of Certified Survey Map recorded in Vol. 14 of Certified Survey Maps, Page 4023 as f~T Doc. No. 637335. ~I t I i 032-2029-10-300 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Easements, restrictions and rights-of-waA*RonaldAnntoo of recordif any. Dated (SEAL) (SEAL) * hnson • (SEAL) * (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF _ CALikU(?IN ilA-) ) ss. 1at~ucO►4 COUNTY ) TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on and( 2d- ?---A (If not, the above-named Ronald Anton Johnson authorized by Wis. Stat. § 706.06) to me known to be the person() who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristina Oland ;6;~`ublicS~tateof Hudson WI 54016 C u NI, My Commission (is permanent) (expires: Zu -C4-7, in (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-PRCI ' Legal Forms 800-855.2021 www.infopmkrms.com SI JOSE VLADIMIR GALVAN v, a rU;. COMM. # 2016668 1 NOTARY PUBLIC CALIFORNIA ALAMEDA St. Croix County 994225 Page 1 of 1 COUNTY ~vyMY COMM. EXP. MARCH 30, 2017 Y Property Owner SP 6~~ F ~6e'~~r Parcel ID # p ~7 )/L G Page Z of 3 F Boring # ❑ Boring pit Ground surface elev. 01Q-13 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 - 9 ro~.Z 3 ~ z - sit z sbk r~~~ Cw 7- . s sa Z --3s loK~z ~)6 - sit Z`~sbk s~ ew 1~-' ,s 3 3S-S8 5`11Z-:N1y '1,SLITL Sj?, t o Mai - ,S ❑ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ El Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = 13013, 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.W00) Wiscrh•rsin Department of Commerce Division of Safety and Buildings SOIk,8VALUATI ON. , PORT Page 1 of 3 in accordance with rp 85, Code i f Attach complete site plan on paper not less than 8 1/2 x 11; inch s in ~►1~Ian mt~QQ un~ C-\- U LX yl include, but not limited to: vertical and horizontal referen '~of (BM),'directio andF" percent slope, scale or dimensions, north arrow, and IocaU d dista`T 4e Pit road. reel I.D. t~ Please print all informati G00' wed Date Personal information you provide may be used for secondary purpos f cy Law, s. 1 m /I- Property Owner S"P 6 0 L 1~1 cs T` ~~oPe l~ ~ ,"_'18U W1J`1f'~G<;}~{ T L 1/4 SE1/4 S T 30 N R lq E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 6016 3w ~ Q-L R-(2 Z -L - ~ ~ P o S ~'fl cs " I Lf Ufa 3 City State Zip Code Phone Number M'tt1~.1~NZU1~.llz ❑City ❑ Village J? Town ad MN SS3~3 (wL )C.Is-$o~-v Sori'1`ZSL~1' 16S`n~ RUB New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate Ll S O ❑ Replacement GPD ❑ Public or commercial -Describe: Parent material Flood Plain elevation if applicable 1V /Q\ General comments ft. and recommendations: il`'Z O~llv~~ W/ 1 U~ Xy S~ 1a(BStJ~'np k I eL*L•L- • Y`1 I lv . 6 4 OF= S p{h~p IZ LL - V tAlt y s%k eot.&tr;-ia aht- wA- 41j QC r 3 a Boring # ❑ Boring Pit Ground surface elev. K3 3 - 7 ft. Depth to limiting factor Z in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 O -9 1~`•t2 31 Z - S1 ~ Z.`~s b1-c wl'fl- L°.w Z'~ - S . 4~ Z- G-Z9 ~o`t~Z 31~ - Sit 3~Psbk rm'('►- cr," 1~ •s Zc)- )O'IR 316 1ZS10k h2`Ft- e~ - • Z 3 ~lZ-fib S`IR- L Oti,-~ vvi~! _ _ 3 . S E Boring # ❑ Boring ® Pit Ground surface elev. 1\)(3,13 fL Depth to limiting factor 3 Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eft#2 I O- b 31 Z . - S L ( z ~sb►-c M41 az4j . S Z- %--sl ~oy~ Sll3 - SiI Zk)?sb w-R- . S •9 3 32-" I~H~ 316 ~1~ ~.SLi2 s/~ si I 1 eslDk M'A- ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign cure - Arthur L. tdegerer a4d" 1 ~ CST Number : ~5~ 00-Z3~-Z 220254 Address W e g e r e r Soil T e s t i n o, & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, WI 54022 $-L')-.G0 715-425-0165 Property Owner -S1' 601F l"tP1~ 1~6 '1011` Parcel ID # PIE')'~)A J 6 Page Z of 3 a Boring # ❑ Boring Pit Ground surface elev. 1~a.O ft. Depth to limning factor in. Soil ApplicaVon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-9 toMNt`ItZ - SO Z-~sbk M-6, cw 7- -P .s Z 3S W4M 1A - S; k Z`Psbk h ew IT 3 3S--S~ 5 `iu- S 1$ L O y,,t`~ i . 3 .-S F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. SoA Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. OEM 'Eff#2 F-1 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Hate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsen Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2 ' Effluent #1 = SOD, > 30 < 220 mg& and TSS >30 < 150 mg/L ' Effluent #2 = BOD6 ~ 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. sao-uw (LMM PLOT PLAN Page Z of 3 Scale 1' = yp' I~S-N Ptu~ b ODD * lb alb Tt1 ST, ~r. `l9 - t3..3 ~-tU J ? c~ pL3Ttr~~3 ~ ,s _ Y'1~ S AcRC~R ~ v / 611) 1_`5' ~eT1tih OF C.z.L &I ~F 2 J - tj SE_h WZ q~ T Is, Flzuwl Mouwt'~ . ,L._ - t N S CS L K 3hE1 ~::LaU:o' ate, 9"~'ttGt~,_S1y~b~i1 l'UC hthE .wl~. -131.1 t+f'Z-._~. LO1.3' i K k Y pp 715-425-0165 220254 oa_z3 "4 CST Signature Date Telephone No. CST No. Job rd0. { Parcel 032-2029-10-300 03/26/2008 12:12 PM PAGE 1 OF 1 Alt. Parcel 07.30.19.578C 032 - TOWN OF SOMERSET 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 % CAROLYN JOHNSON O - J P GOLF, MANAGEMENT INC MANAGEMENT INC J P GOLF 109 BOCA DE LA PLAYA UNIT B SAN CLEMENTE CA 92672 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.541 Plat: 4023-CSM 14-4023 SEC 7 T30N R19W NE SE BEING LOT 2 CSM Block/Condo Bldg: LOT 2 14/4023 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-30N-19W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1196/252 QC 07/23/1997 1117/415 WD 07/23/1997 830/160 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.540 110,300 0 110,300 NO Totals for 2008: General Property 3.540 110,300 0 110,300 Woodland 0.000 0 0 Totals for 2007: General Property 3.540 110,300 0 110,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 4 ` t Property Owner SF' Gl)~ F 1"It'i7~ 1l~6t?`~lChJl- Parcel ID # p~ ~/U G Page of 3 F Boring # ❑ Boring pit Ground surface elev. 901.0 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 S C) - ~o~~z~~z - sil z~('sbk m~fh cw z--P z --~s ~o~~z X16 - si 1 Z~sbk s 1~ et,~ 1~F • s • ~ 3 3S-S 2 X1'1 ~Pl~ -l•S~R S/b L o t,.t`Fi - .S ❑ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 T F... -7- F-1 Boring # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD6 > 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. M4330 (R.6/00) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of 3 Division of Safety and Buildings z in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ST. include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. p 6 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location S? Go -F 1" 1'NJN-6Q;MIOj T GQW I or tvL 114 'S~E1/4 S T 30 N R 19 E (o Q Property Owner's Mailing Address 6 016 taw ~ ct, Re~~ ~ ~tvt Lot # Block # Subd. Name or CSM# -z- - 1-:1 l~l~OSt_'fl CS M City State Zip Code Phone Number ❑ City ❑ Village a Town Nearest Road 1Mt1~►r'.) ~1ilq >utty SS3Y3 (6lZ )Q-S- $o $u so>~`ZS T 16 S 7?~ RUB New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate _ L~ S O GPD ❑ Replacement • ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments ft andrecommendations: V`'10u1~t~ L.r~ O~XyS~ S SO~110i~t e.LrLL,., Y"1l)%j, 64 OF SpA.p F-7 LZ Boring # ❑ Boring Pit Ground surface elev. 10 3 --7 ft, Depth to limiting factor Z- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-9 Lt-1xz- Z - 511 Z`~s \0 k M'f ew z~ . s . a Z q-Z9 Io`1rL 316 - sit 3~Psb1c m'f1- ct,~ 1'F • s 1o7R- 316 - St 1 1L°Sb~t }n`t^t- L°LV - • Z -3 t{ ~lZ-6b SK~Z 31y fly l.3LlR SA L pr,.~ rn'Ft• _ _ 3 . S a Boring # I❑ Boring ~I Pit Ground surface elev. 1\ 313 -3 ft. Depth to limiting factor 3 Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o- ~ vo`- jt- 31-L - s L l z ~sb►z M C--t~ 1~ • S ~ ~ z z oy yr f3 - s i Z h-i s b w, ~Fi. erv -S • 8 3 3zs7 ~~~~316 ~l~-1•SLfIz s/8 si) 1 csl~k lr)'F~ - . Z .3 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = SODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign lure CST Number Arthur L. Wegerer 00-Z3\/-Z 220254 amkc Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. I'iain St. River Falls, WI 54022 L')-.p0 715-425-0165 PLOT PLAN Page Z- of 3 ` Scale 1'= y,p' O -ti. 1~oW~Z ALL S-M 316 T1v 5T, i=- *~j ~U ~pT ea►^1►~r'c~T ~•lt-l S A T~C'fl ~ X010 iy ' bt' ~~pv2. ~Tt, lpb-~S5 ~ %,h-T MK of C ZLL. LTI 101. ZS' J C-4 0 Fr 1`)-0o 715-425-0165 220254 _ 0o zay_Z CST Signature Date Telephone No. CST No. Job NO. ttY~!j~ FILED ~ a 200 • JAN 2 2 ST. CR01X COUNTY WEIORKWM SURVEYO ' p~00 0(1~ WNW Zr- coa ~tr00 1 m V) W N O Z -0 3 14 Of I y ~ rt Z Z Z Z Z Z Z Z 3 O O O OO O Oo rn W O O 00 Ut OO O ° ~ El ~ ~ 0 01 0 v WNW (0 O 3 . s G7 D m o f 07 NWOU100W O TWO P Io y ° n w O °c p I' IZ7 0 0 N-IO~00 0 p v DODO N m W POCJiOW OONOO N C7 ~1 Z+-, a O 0)t0 c0 co •P t0 O CJs t t0 O I .p I fTl o+ I I c o x s s s a - s a s s a Z f - 0.0 1 p n O N rozmo ~m mm ~~I - I Sim ~ Cc: N Z ` I I I W r ` c., o Z;r C OIO Ao . 01 1 3 2: .0 ~ c ~v O CO U ri C1~ -PCD M O W N N OD ~I I r I 0, I rt m ° ,a . gy m W PO p rnl N~.iJ ° W O 0) 0 a0 W N p p P -I I i rn) ° gT. ROIX T~UE t4•Y WO O Q, Cn ~Ln0LA8 N D D O W O- O p 0 0 0 Z v Planjgno Zornnn and +~ks CommPp m I ~ -I j( I A JAN 2 4 2001 W--~ -t- S C N V~ d 311 b'1 d -Nn ° r--w if rot recorded van in 30 days ut W approval date sW be 2 l t/t 3S 941 jo */l 3N 041 ;o cull IsaM L1 ;0 0 rn m n a n D p n~ I t f \ `S x Q ° I w Aa 0 (b 040 D A <G Z m< N I O A 14 2 O ~ 2. z a ii, 0 IC ~ ~ ~ I ~ w ~QC ~mor wA„ 19 ; N ~ ID L~ I 00 > N ~ m ° 3 a I IT c0 O rt m 0 m O 3 D D O I00 D (A Z rn ,Z£'8l o: n W W o w o / I CO 0 C: 00 ,4 x Iz N We ~O 1 ,00'££ s N a D a 1 Ell ( m I r p ch > n (A I 01 to I I0 ~ der f<~, . I ~ ° 1D EA < 0 At 0 :E En r- to ('0 0 0 x trJ c~ m i I (CD :3 --j ~ a Iy-I Ind 00 i'~s m i I v 00 00 0 -01 0 --1 v 0 0 ,Z w (i 0 3 -1 C.4 M (A V10 N IS 410ti 'M'0'i l ~(iaa}saM w - r4 - a --I • ..p 0 to • O) (n O reDo - --r `V W T~ lZ £ l9Z M„ OO,Zit.00N I N Cn a s I f I I W Z W OD O X• 0 m ~"c+0DN I I0c0 0 ~ o o m }aa.l}S u}0-b ~d ° o .t(JiP0 G 3= a W I I O moo* 3 50 m W r 3 v m b/ l 3S ay} ;o auil ;spa I ~ I IRON Ad 4WD .1 0 0 0 d u o i; 0 a S V rn OZ91'5d `9 'I0A WSO J03 j,/l, Iso3 puno3 Vol. 14 Page 4023 i 8 3 0 2 3 3 7 Tx:4248981 Document Number Document Title 1012028 St. Croix County BETH PABST REGISTER OF DEEDS Occupancy Affidavit ST. CROIX CO., WI RECEIVED FOR RECORD 05/14/2015 9:28 AM re~ rOL EXEMPT Name - (Owner) Type or printed REC FEE: 30.00 COPY FEE: 2.00 being duly sworn, states, under oath, that: PAGES: 1 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume Page - Document Number99 X1225 t. Croix County Register of Deeds Office: Recording Area Name and Return Address A parcel of land located in the IJ Ir % of the S6 of Section 7 T 36 N - R ~ w, Town of , St. Croix ~ q Zr AW County, Wisconsin, being duly described as follows (include lot no. and K/tu c'nV~.o VJTk S ~(O subdivision/CSM or detailed legal description): 6 32 „ 2-62-1 16 - 360 ~~n ) -AT I Z n ~LJ Parcel Identification Number (PIN) As owner of the above described property, I owledge that the septic system serving this residence is sized for a Al bedroom home, or a design flow of _ fa6Q gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently _.,I occupants living in this residence; $ occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. rs day of /fjA>-s Zv / 5"- * j2c-r e, Bl~~1-771~~ * AUTHENTICATION VA ANS0!1~1i, * ACKNOWLEDGMENT M•••bb Signature(s) ~#,STATE OF WISCONSIN ) ! it. )ss. AXAA authenttcated this day of + , Z fi, roix County. ) 0-4- / Personally came before me this day of 011 the above named i TITLE: MEMBER STATE BAR OF WISCONSIN ~i •NNN~ ~GO~` f authorized by § 706.06, Wis. Stats.) O Iwt,•~~`,`` Zins7trumt to me a dbe the person(s) who cnowledge the executed the foregoing not, Aide do.- O'A r k %A- A THIS INSTRUMENT WAS DRAFTED BY Cd Notary Pubic, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not my commission is permanent. If not, state expiration date: necessary.) Date: &1-Ua -.-)-o1 q "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" TNs Information must be compieted by submftter, document title. name 6 return address. and PIN (if requlra4- Other information such as the granting clauses, leagat description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. Note: Use of this cover page adds one page to your document and $2.00 to the recording fee. Wisconsin Statutes, 59.517.