Loading...
HomeMy WebLinkAbout020-1395-56-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORII~ATION (ATTACH TO PERMIT) ,: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Carria a Homes Inc. Hudson Townshi SST BM Elev: Insp. BM Elev: BM De ription: la ~ ~ ~ a ~ . a ~~ rte.. =~4..~.~ - cST- ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / / /~`~ J (/(-/ / Dosing Aeration Holding - TANK SETBACK INFORMATION TANK TO "" ~~P/L /v~rl~t, ELL BLDG. Vent Air Intake ROAD Septic i / Dosing Aeration Holding PUMP/SIPHON INFORMATION Head SOIL ABSORPTION SYSTEM ~ 17 -~}~ C-G1 iy,,,,,,~ county: St. Croix Sanitary Permit No: 420566 0 State Plan ID No: Parcel Tax No: 020-1395-56-000 ELEVATION DATA STATION BS HI FS ELEV. Benchmark 17.6 /Da.a ~on./s Alt. /O ,D Z,S , ~-/ IAS. `~X Bldg. S ~ r3, 3 ,/ o T' , ~ /D ~j 3- TQ St/Ht Inlet~~~t-p ~ O . ~/ ~/ I, 7d SUHt Outlet ? oI- Dt Inlet ~S ~ ~~ / Dt Bottom .~ v,o eader/ anf a,~~ I a . S ~~ Dis ipe a~~n lei s' 3 (, b ' Bot. S stem ~ '2 ' ~ f 7 g . ~ S Final Grade ~j ~ -"-- M J-~` Jo ~,3s / 3 s Z ~d5~~ ~ /~. . O l 0~ 1. 0 99_ J BED/TRENCH Width ^ ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pifs Inside Dia. Liquid Depth DIMENSIONS J/ ~ J 3 ~ , SETBACK SYSTEM TO P/L BLDG WE KE/STREAM LEACHIN Manufacturer: INFORMATION T Of S t CHAMBER R yp ys em: > ~ ~ 11 ,, T'"I (/U UNI Model Number: DISTRIBUTION SYSTEM ~~- ~ Z O -'ft0 ~a-S~ ~hd C~1~'h ~~'" Header/Manifold J I Lengt ,~ y~Dia ~~ Distribution i p () r Length ~~ Dia "1 k ~''S~a-cing~ / x Hole Size / x Hole Spacing ~' Vent to Air Intake SOIL COVER ~ x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ,'/ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ ~, Bed/Trench Edges Topsoil (~ Yes ~ No ~ Yes [] No i 7=6` 1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~4 / ~~ Inspection #2: / / Location: 875 Highlander Tr/~a~il~~Hrrudson, WI 54016 (SE 1/4 NW 11'4' 25 T2'9_NLR19W) Scenic Hills L'ot Parcel/N-o/: 25.'29.19.2450 1.) Alt BM Description = ~TLW~ ~~ I(Z~ ~ _ ~~v ~GI~~ h~G~L~-~ ~~~''' 2.) Bldg sewer length =//p" / ~Q /fyl _~e_ (/4~,~G -- ~ I'~ j~~t~ ~~~/~ l~ ~ta~/l _ _ t - amount of cover / ~ ~ //~ /, ('~~/(p ~ -~ ,~-.(N'fi+~c~ G,~,~~eo-r.~J 10 7 1. , ' ~ti'~ GL~ 0 Plan revision Required? ] Yes No Pn~ ~ ~ Use other side for additional information. ~ V ~ ~` __ __ ~~~~ ~ ~ b SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No. Safety and Buildings Division C~tY ,~,....~ r ~ ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~/ ~S~~~Sj~ Madison, WI 53707 - 7162 Siu ddress De artment of Commerce -LV dJZ .') f ~j/~ /"~ Sanitary Permit Application ~~ Permtt N /Ir ~'~"~ S~ 1~ In accord with Comm 83.21, Wis. Adm. Cade, personal information you provide ^ Check if Revision ma be used for seco ses Privac Law, s15. 1 m I. Application Information -Please Print All Information Stau Plan I.D. Number Property Owner's Name Parcel Number ~ ~ ~- ` e -t 2 `fso~ D2o - 1395- 57 ( ~ ~ ~~ ~ ,, ~ ~ ~ . v ho , Property Owner's Address /~ f S~ Properly Location ~ ~ ~ ` ^// j~~- C~ i"'' L- ,~ S ~ 3f~~ Sk; S ,~S T oZ~ N. R City, Statc, Zip Code r i:i_ Lot Nt~pber Block Number ~~~~~~~ Subdivision Name CAM Number ~_ : / rv II. Type of Building (check all that apply) As ~ 5..~oN.•~ Oeiry 1 or 2 Family Dwelling -Number of Bedrooms ^Village ^ PublicJCommercial -Describe Use owtuhip D~ ^ State Owned -d~ 6 r Barest Road .2_s .~ 3 K III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A' 1~New 2 ^ Replacement System 3 ^ Replacemem of 6 ^ Addition to For County use I' ~~ Tank Onl Ezis ' stow B • ^ Check if Sanitary Permit Previously Issued Permit Number Dau Issued "" IV. Type of Permit: (Check all that apply)(numbering scheme is for internal us •~ 14-`LSO ~'~ C 44~Non -Pressurized In-Ground 21^ Mound 47 ^ Sam Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 4b ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. D' rsal/'heatment Area Informati on: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate stem Ele 'on Final Grade Reqtured Proposed c~~ ~ Rate(Gals./Days/Sq.Ft.) (Min.lInch) ~ , / ~ ~~ ~G-~ ~~~ ~~~ . 7 ,tea. ~~ ~d ~3,~~ VI. Tank Info Capacity in Total Number Manufacturer Pr b Suel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanits Septic or Holding Tank _ ~ l ~ VII. Responsibility Statement- I, the undersigned, assume responslbDity for tion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature (Iv[PRS Number Business Phone Number Plumber's Address (Street, City, Srau, Zip Code) VIII. Coup /De artment Use Onl Approved ^ Disapproved ~~' Pervnit Fee (includes Groundwater Dau Issued Issu' Agem Signature (No Stamps) Surcharge Fee) ^ Owner Given Initial Adverse ~} ~~ p ~ q~v2- Determination ~1D 1X. Conditions of ApprovaUReaso fnfs for D11is~__approval I ,~./ .~. `_ ~ A ~ /y~ I `^0..1 l S t ~2P X 9 -- M9-ot_ -h '~1MIt~ ~ . ~t7•L'~ ~1 a-~ p /d t~Q 6+~5t~~ L l 2 tt V ,,, . ~. ~~ ~~ ' n . ,~Q ~ / 1 - ~ e< ~ta.i'tCLOI. ~ -~~- ' ~0.~C 71o a cQQ•A,t~~"~P~l ."' ~Q2 - . syS~..~~ ~.. ~ , a -~ ~ t ,~ ,~ ;,, ~ ~.. 5.~. o s~ ->E- B+~Q~9tss~hiGf- „~ax~ ~ vRS+~ ~ -~ -` °°',d.~°t~~`•E-OwC~ ~`C~t~C`~ tk~l~ ~ tM8.0.,u..'~. ~L: ~ ~ i ~ I v ~~ ~, V ~ ~ ~\ `~ ,~ V ~~ 1 V ~~ ~~ Q ~ ~l d ~1 V ~ .~ ,~ V` ~~ V ~ ~~~1 `~Y~ W ~~ VO 1 v 7 ~~ nu~~ ~' 1 ~. ^\ a ,~ ~~ ~~ . z ~~ ~ ,, ~ , ~ ~~ 0 wr"sconsinDepartrnerrtofCommerce - SOIL EVALUATION REPORT page I of~ Division of Safety and Buildings in aocordarrce with Comm 85, Wis. Adm. Code Attach complete site plan on paper not lei than 81/2 x 11 Indies in sae. Plan must ~ ~• C- r0 l ~ inducts, but not limited to: vertical and horaorrtat reference paint (BM), dinedion and parcel I.D. percent sbpe, scale or dimensions, north arrow, and n to nearest road. Please print all f ' n. `° ~ ` ; by D?~ . ~'• - [I~p Personal Niformation you provide may be used for pu l~~Y Law. s. -104 (1) (m)).. (• 1 ~~ Z. Propergr Owner ~ Prop~_ ty location . ~, GovE S - 1/4 W 1l4 S Z S'T Z ~' N R (~( E (or~ Property Owner's Mai~rig Address - , : L Bbdc # Subd. Name or CSMIf ._- CD ~ Z• ~ S~ i ~ ~ Wa- ST ~AOIX S G ~ ; . City StaUe Zrp Code NaAibRtG OFFlc;E , ~® ^ Vfllage ~ Town Nearest Road <S7 i' I t wa.~-cr Vet v~.. fS'0 XZ. ( •F' - Z.~!-~ v s ,• ,• ~P ® New Construction Use: ® Residential / Number of y ' `l~ Code derived design flow n3te ~Sd ~(o O O GPD ^ Replacement ^ Public or oommeraal - Describ e: Parent material O v f c~J0.S (~ Flood Plain elevation if applicable 9 4 3 • S-O R General comments S~S~rvl e.le.Jc~f.b/~ - tvP ~q~lD Gaw-ei g ~•/v ~' o and recanrnendations: ~, (..~ e„ I e.J a.'~-•`cU ~ - tv p ff 7 ou Go w-~ r ~s - t # r~~i B°nng \ ~g ~ Pit Ground surface elev. 93• q0 R Depth to limiting factor ~ L' ~ in. Sod icxition Rate Horaon Depth Dominant Cob Redox Description Texture Stn>dure Conssstence Boundary Roots GP D/fP , in. Munsell QU. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 v-12 fD r312 Si ~ Zrr~Lk >Yi~r- ~ S 3L ~ 5 . 2 i z-~ Ip y(y '- S~ c.l 2rn5bK m c 5 Z~~ ~ `~ ~ -JVf IQ ~yl1n ~-- m 5 LSD ~~ i -- 1 ? /. Z 9. ~ t dS'. Z Boring # ^ Bonrrg ~~ ®Pit Ground surface elev. 9s ~ y ft. Depth tiD limiting factor 1 ~~3 in. ~ Rats Horizon Depth Dominant Cob Redox Description Texture Stnrc~un; Consistence Boundary Roots GP D/fP in. Munsefl Gtu. Sz. Cont. Cobr Gr. Sz Sh. 'EtT#1 'Eff#2 2 il_i~ ~~~ ~ ~~) - sick b ~ ~r ~. ~ ~ ~ ~i•/~~ ~. , 2 * Effluent #1 = BOD_ > 30 < 220 a TSS >30 1 50 mall ' F~tluent #2 = BOD< < 30 ~, and TSS < 30 m9lL __ CST Name (Please Prir»t) ature CST Ncari~er e.r ~ ; .. - 2s 3 3a9 Address Date Evaluation Conduced Tele~rorre Number 2U3 gd7~ 5-~- ~'v,~-~e~ .e-~-~ ~1 ~ S ~ - ~ ~'l-O / (7~s) 2~-17-~Foc~~ Property Owner Q.r k~ l Parcel ID # . Page • z of a Boring # U Boring ® Pit Ground surface elev. q0 ' ~ U ft. Depth to limiting factor ~ ~ ~ in. Soil ication Rate D ti mina t Cobr D Redox Description Texture Structure Consistence Boundary Roots GP DItt? Horizon ep ~ in. o n Mansell flu. Sz. Cont Cobr Gr. Sz Sh: "Eff#1 *Eff#2 i ~-g i~~ ~ ~I _ - -~, ~ Z ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. ~~ ic~tion ~~ Horizon th De Dominant Cobr Redox Description Texture Sbvctune Consistence Boundary Roots GP D/P~ p in. Mansell Qu. Sz. Cont Color Gr. Sz Sh. `Eff#t `Eff#2 Bonng # ^ Bonng ^ Pit Ground surface elev. _,,,__ft. Depth m limiting factor in. Sal lication Rate Horizon Depth Dominant Cobr Redox Desaiptbn Texture .Structure Consistence Boundary Roofs GP D/fr? in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. `Eff#9 `Eff#2 * Effluent #1 =. BODS > 30 < 220 mglL and TSS >30 <_ 150 mglL * Effluent #2 = GODS < 30 mglL and. TSS _< 30 mglt. The Departrnent 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 departmerrt at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07/00) ~ ~ I PAGE ~ OF_~ NAME Y` -e- LOT# 5• LEGAL DESCRIPTIONS E `/.Nw'~4 S Zs TZ q N R I q E or ~ CONTOUR ELEVATION X0.0 y SCALE: I = BM 1 ELEVATION ~oo• a BM I DESCRII'TION y~~.; ~ ~ ~ (~ y y0.k BM 2 ELEVATION QUO • o BM 2 DESCRIPTION Yla; ~ ~• r $ ~• ask SYSTEM ELEVATION ~ P $ q• l CJ L~ w ~ r ~ $•/ ~ ALTERNATE ELEVATION }~ ~, $ 7•~° L.ow t r• ?S (~• o ~' C~ (o . p v i (J~'~~~ascd: Rcl. ~ ~ ~~ as.o~ // a~.W~/ q2• X1,0 av SIGNATURE ~~--~ - ~~/~ ~ DATE G ~ - b / n ChAMBi~R CRbSS SECT%~''~ SP~.CIFICATiCNS SE.pTYC 'TANK ~ :UMP wEATNERPROtIF AppgOVED ~~~ CI VENT PIPE IWINDOW• O bflVE GRADE ~ JUNCTION BOX MANHOLE CCVER ~ 25' FROM DOOR, WITH CONDUIT W/ PADLOCK ~ FRESH AIR INTAKE WARNING LABEL FINISHED GRADE ~,,F CI RISER -- ~..._-~-'~..~-u" MzN ~ ,ti ~~ i6" IN • 6" N:AX • ~' ~ L ,t Vi,ET ~ GAS- ~ ~, WATER TIGHT SEALS ~ TIGHT i ~ ~ApPROVED A ,SEAL ~ 30if~TS WISH ~, , ~ ALM APPROVED PIPE B , ON 3' 0411'0 'PROVED --~-~- ' , , 50LIi~ SOIL tPE 3' ~ ~ ` OFF ~s" RISER EXIT BYO Sf}LID FT • PERMITTED ONLY SIL PUMP OFF ELEV . D MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE NUMBER FiOSES PER DAY : _,_~__....._ TANK MAN~3FACTURER: ~.1,~sc,- CAL. DOSE VOLUME INC LUDING TANK S~,~~ ~ ~O~EIC °~ GAL. ~~ 2 INCHES = _~~~-,---GAL CAPACI TIE5 : A = .~-._ ALARM MANUFACTURER: ~~k~k''='` ----- y2 GAL. MODEL NUMBER : B = 2 INCHES = _,_„_.,_...._. SWITCH TYPE: Yc C = _~_ INCHES = /____~, CAL. PUMP MANUFACTURER : l>oc~l~ = ~ INCHES = !l,2~ GAL ` -" MODEL NUMBER : ,^,~=~~ ' ---- D SWITCH TYPE: jne~ 16,23 WAC ,~ GPM PUMP ~ ALARM WIRING AS PER I LHR REQUIRED DISCHARGE RATE ~ ,.~,. ~~~ FEET • ~-~--- m ~--~_ ~ FEE 1 TICAL DIFFERENCE gETWgEHrPUMP GFF .AND ,DISTRIBUTI ON P ' _" -_ 'FEET + MIN MUM NETWORK 5UPPLY PR..SSUR£ ~ FFET ~!~ FEET FORCEMAIN X ~-DSFTl104 FT. FRICTION FACTOR ._• * ~~~ T.flTAL DYNAMIC MEAD L---~ +r1IDTH_,•„„„_,~~ DIAMETER _______ INTERNAL DIMENSIONS OF PUMP TANK: LENGTH LIQUID ~ 3 ~~ ~l.~l ~~Y ! `` ~~~ ~ z~ LICENSE h*JMSER : ~~ 7~ v DATE ; ~ ~ S IGIvED : 1/R9 -+ 10/15/20@2 .~ r AtPUCAT10115 Specifically designed for the followrnQ uses: • Effluent systems * Homes • Parn18 • Heavy duty sump • Water transfer • Dewater9ng saPf~lr~anou>s rump: EP04 • Solids handling capability: s/e" maximum. ,~ • Ceper~fee: up to 65 GPM. ~ • Toot heads: up to za feet. + Discharge sine:!'/i NPT. • Mechanical seal: carbon- . rotary/ceramio-st2ti4naN, BUNA-N elastomers. • Ternperatuns: 104°F (40°C}continuous 140°F {60°C} intermittent. • Fasteners: 30Q serlas sratniess steel. + Capable of running dry without damage to components. Pump: EP05 • Sdids trundling capab~ity: ~" nraadmum. • (~apacitiea: up to ii0 GPM. + Total heads: up to 3t feet. • Discharge 5ire:134' NPT. • Mechanical seal: rarbon- rotarylceramiC•shattonary, OUNA-N elasbomers. + 104+P {°°f4o°cj corranuaus 140°F {sp°C) irtie~rmitient. • FasterrerS: 300 series stsirrless steel. • Capable of running dry without damage to components. Mater. • F.P'ly4 Single phase: 0.4 HP, 115 or 230 V, 60 H=, 1550 RIM, !wilt in ovartosd with automatic reset • EP05 $inQb phase: 0.5 HP, 115 V, BO Hz,1S50 RPM, built in overload with automatic reset. • Pourer cord: l0 foot standard length,18~3 SJTO with three prong grounding plug. Optional 20 foot fengtl~, ii313 SJTW with three prong grounding plug (standard on EP05}. ~u~AS ~ 10~ a WEGERER SOIL TESTING PP,GE 09 Goulds ~~ ~ °~ ~ Submersible Effluent Pump 3p~ I EP05 • Fully submerged in high grade turbine o1 for lubrication and efficient heat transfer. Availefrle !ar eulomatjo and manual eMretlao. Arrtomsfie models ledeie Meehanieel Plant SrrllCd esarrrbled sad preset at the fardOryr. FF.ATIIII>aS ^ EPat Yepefler. Thermo- plastlc Semi~pen design with pump out vsrres for mecharrku! Beal protection. ^ EP06 hapeiler. Therma- phgtiC Ieoleeeddesign for improved perfomrance. ^ Casing end Sea: Rugged thermoptastii; design provides superior strergtft and corrosion res'stance. ^ Molar Heaslnp: Cast iron for efficient heat trauufer, stren~h, and durability. ^ Melor Cover: Thermoplas• tic cover witll integral handle and float switch attachment points. ^ Power Cable: Severe duty rated og and water resistant ~^ Beartn~: Upper and lower haavy duty ball b~nng cons~uotion. AHElIt:Y fJ1iTINf3 ~• Cam tirde~ Apoehtloa {CSA listed modN numbers end in "f or "AC".} Gl i ~ I i I ' ac I ~ 1 - 1 25 ~ GWr „,~,. ~ -r I i ao r.4 ~- ~ ! 15 i ~J ,~ ~ 5 °0 1 0 2 0 3 0 4 o G a~ 0 a 4 6 B 10 12 ret'lh CAPACRY • 1005 Giad4a F'~neps, be. Eereuv~ May, t945 W57t Private Gnsite Wastewater Treatment System Managemenonent Septic Tank And Gravity ln-Ground So>Il Absorption Comp Pursuant to Comm 83.54 Wis. Adm. Code a educes foe maintaining the syst m withint System (POWYS) shall include information and proc royal by the department, agent, the parameters of Comm 83 and 84, and the conditions of app or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the ln-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Sail Absorption Component inspect once Sep#Ic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, State. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filte shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Table 3: Maintenance Saheduie Se tic Tank Inspect and/or service once every 3 ears Outlet Filter Inspect once a year and clean at least once every 3 years -...., Mena 8ttlettt Plan fo- 8 Septic Ta^K df'd :76i; Aasorptian CotTtaas~en3 a alter is a uipped with ar9 a~arm, the filter shad de garvtre~i if the ale ~tinuaus alat"tn ~ Th+s ~~iy. tntesmlaent tilt~r alums may lr-d#q~te govt when tree vo ~~-~~ s~ and studpe In the tank septic tank shoo 4~ave its oonter~tt rem ~ ~ the tank are riot rsmovsd st the e~aeeds 'I!3 the l#qutd vo#ume of the tank. tithe oortto ~ Oi men ~ ~'rvsce tlm~i of en aeeeeemont, malrttenence Asmon max~mlu and ~ accumulation to the node to be performer to metntetn left the ttH'-k. Manhoto rivers, eoGesf ritsrs and covers should be inspected for water tl~httt8et end n s used for feNlce and aisseei~nt fh>~il be Peeled ~Srti3ht open soundness. Ao~ ~ ~ the torr~ptotl~an of ~isrv#ae• ~Y oRen#ng deemed tansaund, defect#dv~ ~r shell be ~ ed by be replaced. ,Exposed aocees vpeninge greeter than 3.Itiartss i~ the tank. mn vf!'rcdtve looWnQ device to prevent aoe~dental or ur~eutl~rtated sr~Y 1Vo or,e should Mlet' ! sspNC o-' o~ra° ~~t ~g~ kIr ~,y reaaan without betrr~ In !Wl eoepl~noe In the ~' at'~ar rrns~rln~ a contJmd spao~t. tie ~trttospher~ 3~d r+eeat~t of s ~slti~r;t of ~~ ~r of !hi ~ntc meydJll~o~uft m't~p~tbir. person tro:» thi• fn~+' o Tank abandonment shall be lr! aooordena with Cornet 33.33, Wtt, Adm. Cods when the tank is r,o lor~gsr used as • POWTS aomppnsM, ~~ ~~ The soil absorption ctifiponent gNln~ thtis stet Flo the oompone~ar~t sl~own~n wastewater from a restdrntlal fac-133ty- 't'l'+e ltmtts of trp+rrt Tahiti 3. The larcgevity at a toll ebtorptlon oompor~snt depends greatly on proper and tim~-y rr~intenanoe, er>d :ystsm use within or tastaw the rim#tt of reliable oprratlan, ©ood water Goritervation practicer by t#t ppq,taar~tf ar~d t!'~e #nstellstlon of w~ ~nsarvlrs~ plurnbinp flxturss are key feclorf in e~cbendlns the uselut life of thtt camps The toll at~sorpdon aomponent`e apetatjor~ m nt~ dS ~r gels of pondlnp t>~ enY~ `n qns~ awry three yeah. The Itnpectton :heft tn~atude 8 or discharge the obosrvatlon ply, and ~- vliUa's lnspec~ion fOc e a ~ erosion shoo d b 1~1en~l~ d and from the oompons~nt. On ftNpiy =loping ettef- +~ a of domesttG wastewater or sewage rs~ported to- the owrssr for repefr. The surfos d~tcnsry from tl'te syt#et~n h prottiblted and considered a human health t+axord~ 1 orient should be avoided pertt~lrar y read Traffic around or over the so11 absorpt on comp during winter rrtCrlthf. The oom~tcdon Or nmavel i tJtru~tly temp~'y' budltpcult or to hydreuttc failure by frseatng. This ty~ ~ failure lrr~possibls ~ repair until weather eondltlons improve. !n d die el, s I ~ ~ ~o~`y eadl to component wltt reduce di~ustor~tG colxo'Ygen l of the sollil an i~ more irtt3nge, and eerller, arpa 4~s~ x Management Ptah for a Septic Tank and $oil Absorption Component Plantings of deep-rooted iroes and shrubs dtrsctty over of within ten feet cf the component should be avoided since root Intrualon tnto the component may obstruct wastewater flow. Contingency Plan In thsr event of system failure, a new system could tie installed fn an altsmate area. With the Installation of s diverter valve, the existing system could also be reused after a period of three to four years. (t is the property owners responetbtiity to maintain the aitsmate area tree from any planting of trees, shrubs, etc. In tees oi' fall~uresorfrted anrigtheaal yma a arei~ths ~I have to be re sued at any tress, shrubs, etc, have bee pl pr~rty owners expense. H attemate arse is destraysd, there are other altemativs systems that can be used, in which, oouid result in added expense to the property owner. Any tank abandonment shall be done in accordance with Wisc. Cade 83.33, Any -~~ regarding this code, please contact your local Zoning Office or contact the metalling plumber. .ZcS N ~ N q ~~y ~Cl. ~~ ~J~ J.3 $ ~p "' 1.~ b$ ~ n. ~` u,e,r+ Ira; Ny t Z iS~ 3 ~ to ~ 3 ~ a 1 5 ~.~,.M ~k*~. a t t,icutx wu~~ ~ ! SEPTIC TANK MAINTENANCE AGP,EEMENT AND OWNERSHIP CERTIFICATION f'ORM Ou-ncr/Buyer ~ «', Mailing Address Property Address ~ ~' ~ (Verification required f om Planning Department for new construction) ~ty/s~u ~ -~~~_ Parcel Identification Ntunbcx ~,F,GAL DESCRIP'>t~ON , Properly Location ,~~%, ,~4r~ ~/~, Scc. ~~ To2~ N-R~..(~W, Town of ~~S'~''Y Subdivision Lot # .~ . Certified Survey Map # ~ . Volume r Page # r" Warz~nty Deed # , ~ ~l~?'~~l `~ , Volame 1~G2 , Pagc # 28~ Spx h~anse D ycs~'no I.ot Lines ideutifiable~yes D no ~'~ S'~STEM MAINTEi~IANCE Imlx+oper use sad tnamteaaaoe of yoar septic system could resBlt im its pr~utfa~uce to handle wssLcs. Proper aramtcaan~ce of poo=ping oat the eeptic ta~alc every thiee years or sooner, if weeded by a lion-ud pamper. Wfrat Yov Put into the rystem . eaa affxt the firactioa of the eeptie tank as a >reatmrst stage is the ~sx dispasal tysaeai. Tl~ pcvpcrty owner sgtzes to submit to St Croix Zaaiag Dcpactiaccat i eertifi~oa form. signed by t1~e own=s and by a p~.lP~~4 resocictod plumber or:li,oensodpumper veafyiag that (1) the on-site wastcwatrrdisposal system is is ptnper operating eonditioa and/or (2) situ iaspoction and puurpiug.(tf accessary), =tie scptiataak is less than 113 full of sludge. Uru~c„ the madersigcsod h:v+e read the above r+oquirem,eats and agree tp azaiut:in the private sewage disposal systeas wig the standards eet fvcth, ha~eiu, ss act by du of Commerce and the Dcgartmeat of IQatural Rcsour+ces; State of Wisooasin. Cctti~catioa stating that yoar septic tysteoR lets boon taaiataiaed must be carnplded and returned to the St t:roix t;ounty Z,oaiag Office °~ 30 days of the throe year expittiioa date. SIGrIAT'URE OF APPI,ZCANT DATE OWNER CERT1i~CATTON I (ae) rectify statements oa this form :re true to the best of my (owr) knowledge. 1(we) am (arc) the owner(s) of the , by virtue of a wam~aty deed rococded in ~cgister of Deeds Office, r //r /~ SI APPT:ICANT DATE . «s«««« ~, information that it ta'ss tod may rextrlt in the sanitary permit being revoked by the Zoning Department """ •• Iadudt r-ith this application: a stn warranty decd from the Register of Deeds office a copy of flu certified survey map if reference is trade in the waaaaty deed ~-- tip" ~UU~PAGt289 - 1>aamem Number' ~L W o~ r r-wn-4~ ~cc~ -.. }:.. , 6486Q4 KATHLEEN H. WALSH REGISTER Of' DEEDS i ST. 4ROIX CO., WI RECEIUED FDR RECORD 06-18-2001 12:5 PM WAkRANTY DEED EXEMPT N CERT COPY FEE: COPY FEE: TRANSfEk FEE: 9900.00 RECORDING FEE: 1~.Dp PAGES: 3 Rxoediaa A~u ~~ Hama and Raman Add:zra _ --_~ t..a,.1 T; -} le, l.. ~ . X900 ~'il.,~c Ltike ~~ Ne,~, ~t'tp"ion ~ MN SS/1 Z C7Z0- 1D(,q-']'p -Oop Parcel IdeotiSaaSan NmaLer 0'~ c~zo-ld~Y-~p--vcip pz o - 1 X65 -~d - vov C? Zc~ - l07D - t.~o - Camp 020- 1070 `~v'-nvp v 2 c~ ~-) v -7b - z. o ~ ~ "THIS PAGE IS PART OF T$ZS LEGAL DOCOHE[iT - DO NOT REMOVE^ 7L'u uifotorlioa aa.R3a oomplercd by enbm~tter; ~*a~o~ title err the ~rnndat alaaree, kcal drrMpyp~, ea4 tuane [ nwrn addnu- and ~ ~yn4'~k CMlirr Jyanoetott fuel. dOC1O1OK ~ ~ oJtiir Barr mQr ~ P~~ on tb4~trar pose oJda Aaaaaanr or war ~ P~ on addldawi pater oJtbe PaK addr one pate re rou' Cae+ana.r and 52.017 w de reeer~ - `-- W~+~on.in Swomcs. J-.S17. 14RDA 1Ad '; , ,DOCUMENT NO. I. , ~. WARM1YTy DfifiD / F) '22~~a~(~. 67ATE OF W14CONt1IN-FORM 61 ~CII .i V V-`~rlllff TMI~ ~rAC[ Ra^EtIVE[I FOR R[COIte INO DATA 'THIS fNDENTTJR]? Made b RICHARD N• PEARSON and JEAN M. PEARSON h ................................................._.........., ,,,,,,,,,,,,,,,,,,,,,-• usband and i£e, grantor_s_-of..._St-..Croix.....--- ............................................Countyy Wisconsin, hpreb conveys and warFants to-.._~~IA~ HOMFS XXI, INC., a Minn~sota rnrporation, ...................._.............__......._._....---........... ; ashing~on.._.._....._ ...............•---••-----•-•-----....-•--•--...... rantee-----... of'. - County, or the sum of 9!?~ Qollar.,and-•nof100-..(,1.00), ana-•other--good-and-valuable-•-!~„Er,,,,N,oL~~„_,~f T:f/t ~~S1d~F~tion ,ESfo3yt[3 /~jL`C Sr I ~ ri lttl(e (7r.~. ......... ._... Sf 1c~C the following tact of land in...._St,.._Ct'oi?f ...............................................Countyty--~~~ r~~F.``~~'rt J`(~-ow~s~Z Wisconsin: .11~~...4>..~h~..Northwg~,k Q41ar1rer-..iNW;~, and-.(dor~h__Half (N~) of the Southwest Quarter (SW~} of Section Twenty-Five (25), Township Twenty-Nine (29) North, Range Nineteen (19) West, St. Croix County, Wisconsin, except Lot One of Certified Survey Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register of Deeds, as Document No. 518444. See Attached Exhibit A Parcel Identification Number This is not homestead property In Witness Whereof the said grantor.s__ haVe__.... hereunto set......__.their hands... and seals.... this . ....._..__ clay of.._~aY ....................................• . ............ ___.._._._. _. .. A. D., iC~C..2Q0]. 616NED AND SHALI3D IN PREeENGE OF of the above named ..............................._... ~ ... .....~ .°-.........-.........(SEAL) ,. ;' .................................................. . (SEAL ) Personally came before me, this.~~:.!~:-_ day of.. ~r.~ ............... A. D., ._?Q,Ol __.--____-OIV--and JEAN M. PEARSON, husband and wife. to me nown to be the personS__.. who executed the foregoing instrument and acknowledged the same. TNIB INSTRUMENT Aii DRAFT D pY OUNTAIN Richat•d J. Ga~r>el, (32864 _ - •-- 880 Sibley Memorial Hwy. #114 NsEALT Nota[y Public, . ~•,~' NOTARYPUBUC _MINNESOTA COUnt Wis. M,andol-, . m,; • tia• ti cc v _1736 My Comm. Explreg Jen. 31, 2005 y' Dty mtnttlission (tit ' ••--, - ^ ~- (Section 59.31 (1 J of the V7iscoruie Statute Drovidn that all inatrvments ro be recorded sfull have plainly printed or e acmes of the Branton, grantees, vitnmses and notory. 5ation 39.513 simiiarl rypcaritten thereon [tunW agency vrhtch, dq(ted loch imttument, shall Ise printed, r teque¢n that the name of the Jxraon yho, or govan• WARRANTY DEED typevri!ten, vamped rincn thereon in a legihl< manna.) STATE OF WISCONSIN wtxonaln r.ogat Hlanx oomoavy FORaf No, 3 Mlitvsukee, WI^, (Job 3Jg 31 ) • _ ~ r VQ! .1662pAC~ 291 EXHIBIT A Parcel Identification Numbers 020-1069-70-000 020-1069-80-000 020-1069-90-000 020-1070-00-000 020-1070-10-000 020-1070-20-000 ~. .22 N _21 . 1 10S.a33`SC~ FT `~! 129,631 SQ FT 2.492 ACRES m 2.976 ACRES i ~i s. H.W.L= 979.7 ~ `~' ~F ~ ~` .~ • / \ ~I ~ ~ ~ 50' ~ .70' ~ ~ g i .. ~ ~ ~ ~ CENFEA w c $ ~~- ~ ~ / / N67°44~Q9"W 88.54' ~_ cr~ F • 1$ 50_ _7 0 0 ~ •. / G /mar ~ ~ _.. ~. a4?t - -- ~• .. /,~ ~~ ,~ ,~ i 89,233 S ' ~''"~ ~% ,~~ _eh ~j H.w ~, = ss~.s ~) 2.049 ACRES / '~ ~ • ~ ~ ~ • ~ r• ~ % vim, `~ ~ • ~ -J ~ ~ / .~ Z ~~ o' ~~ _~~ ~~ .55 o~ 119,137 SQ FT (~ ~ 2:735 ACRES i _ ,~ ~ ~~~.~r I I d ^ I.