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016-1004-95-050
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538709 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: Andrews, Conrad Glenwood, Town of 016 - 1004 -95 -050 CST BM Elev: Insp. BM Elev: BM Description: ?? �, v,�i Section/Town /Range/Map No: / 51) -0 / bD - 0 �Sj�'�C / 4 (AAL ce-(,rtzt, 03.30.15.42B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J / Benchm�r}c ,,, / c olaao Dosing <S L' /�"' Alt. BM G ,L__ ° 5 ��. ' g /0 Aeration � 2 '/ B ldg ewPr �`'� 7 �' �-�- / 6 3 /040, $ Holding St/Ht Inlet 1 3 V ,a6 ----- P✓c 5Q' O /U ,17 7.° -- 7- , V St/Ht Outlet TANK SETBACK INFORMATION i TANK TO PIL / WELL BLDG. vent to Air Intake ROAD Dt Inlet c-----"-- Septic MAI > ' w ''''' Dt Bottom Dosing it h a 5 /CO- ' - Aeration 11=1-� Dist. Pipe S Holding _- Bot. System 4"•32 ✓.- WIIt Final Grade PUMP /SIPHON INFORMATIONivr.•c-t,tr,. .s d /e, >r7; .¢, / Manufacturer Demand St Cover 1 �GP .--"'_3 Ceh1CAQ V15-g" „StO /0 / - V Model Number 3 -/ // 20.z, b rnr 7,1 73),---b. 73),---b. TDH Lift 1 Frictio oss System Hea TDH Ft ( 7 (3 3.2 /ti - 3 krktis m-, i-t.'soi-s Forcemain Length Dia. D/ , Dist. to W� kit) SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length , No. Of Trenches / PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS // SETBACK SYSTEM TO P/ S BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHA OR Tye f System: , l � 1 / � D / } t t ` 1 ,. / UNIT Model Nu n k fr DISTRI ION SYSTEM A� rf O : � s Head /M anifo Distribution 1 of/ Siz Fr i x Hole Spacing V Intake 2Z Pipes) 4 �/ Length Dia /' Len / %' 7 Dia � ' Spacing �'T�'d SOIL COVER x Pressure Systems Only xx • and Or At - Grade S stems On / u. ' _ ,,,.yzO F Depth Over Depth Over 1 . r -pth oL `� 1 xx Seeded /S .e Mul 'ed• Bed/Trench Center / Bed/Trench Edges �` opsoil I, 60 es No s No f .. ../ --- / u�j�2- c p COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 0 / f I. / / 1 Inspection #2: / / / Location: 1770 310th Street lenw000d City, WI 54013 (SE 1/4 NE 1/4 3 T3ON R15W) 5 acr s 1q. P, I No: 3.30.15.42B 1.) Alt BM Description = F 0- 5i6l ( N 6,2d 2.) Bldg sewer length = 4(I / - amountofcover = > q / `! f / re Plan revision Required? Yes �0 I ! /!, ff ,6 i Use other side for additional information. 1 ( - -- V - -J / A , SBD -6710 (R.3/97) Date Insepctor's Signatur- Cert. No. eommerce.wi.gov Safety and Buildings Division County i • 201 W. Washington Ave., P.O. Box 7162 a • i sco n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 53 g 702 Sanitary Permit Application PA j D State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to th opnate governmental /SG 2/ 4 unit is required prior to obtaining a sanitary permit. Note: Application forms for s ate -e. .aJ POWTO -., Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for second.. w / 77/\ purposes in accordance with the Privac La , s. 15.04(1)(m), Stats. 3/044. I. Application Inform n - Please riot Al formation � \�3��, („J • mummer Propert ner's Name p / ' Parcel # ��'�v �) S��/ N I - i01(1 t ago- /� 1 - F5- 656 Property Owne ? Mailin g Address OG� f �� Property Location City State I (l(V1I 0 Ht� Zip Code .)-J- ST• CR ON OFFICE ovt. Lot 6' i e - 4- &) LiLi 6t e. N RAM I ,i / <, Section ) 1 i le one II. Type of Building (check all that apply) L Lot # T 3�7 N; R I E or W 1 or 2 Family Dwelling - Number of Bedrooms 6 _ 6dd Nd 4-/ _ I Subdivision Name tIr6 - p �_ Block # �O ❑ Public /Commercial - Describe Use / ❑ City of ❑ State Owned - Describe Use / CSM Number ❑ Village of c_. n 6 4 7 0 gl Town of lL _' III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) a of Plumber List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Chan Before Expiration Change 0 Transfer to New Owner / IV. Type of POWTS System /Component/Device: (Check all that appl , • ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At-Grade � /, .,� • r �it' .�1L L , . ound < 24 in. of suitable soil '/ • ❑ Holding Tank ❑Other Dispersal Component (explain) 0 , t N Pretreatment Device (explain) !/� -- /Q V. Dispersal /Treat ent Area Information: # / Design Flow (gpd) Design Soil Application Rate dsf) Dispersal Area d Require rr ' Dispersal Area Pro os 1160 ./ r � / 9 1 � p � P y�(St Sys Elevation levation `o / � ` /�l/ J � / i ✓ 1C� I '` . O� V VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units • c New Tanks S Existing Tanks Al V H 44i l"' �a` U° ::1 in t7 a Septic or Holding Tank — Dosing Chamber X . ��'� �° 6...)/ a(,� VII. Responsibility Statement- I, the undersigned < su espons' for installation of the POWTS shown on the attached plans. Plumb is Name (Print) Plumb`r's Sign. • � re i MP/MPRS Number Business Phone Number Plumber's Addres treet, City, State, Zip Code) :"-- _tea ea›..., /4' 6 M.dubikIe3,v /vl 5 ti 757 301 -2173 unty /Department Use Only VIII. ppro ved • • isapprove, Permit Fee Date Is ued Issuing nt Signature Own en Reason fora ial $ 62 • / /87/6 IX. ConditiverptStemegiffeeasons for Disapproval l r t n 1. Septic tank,. effluent filter and ' J Co.i..4 f f S I... tD✓G,.a� 1. dispersal cell must all be servk ! maintal ate.. „� e _ / e 1 .4" as per management plan provided by plumber. d ...V s fle4A • 2: All *back requirements must be.maintained as per applicable Code / ordklences. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 02/09) Valid thru 02/1 l 3 / .....__ y___ eficiAis _ f ( / \ ) I A 1 \ ! . _ 1 ( 3P Z) 5 r ' "' 1 i 1 0'• jr- g (\_\,- le 4- 8 ° (-- ?A r k- 0 I 1 (4O , —, Wg itkiC10- 1 \ oz FF) . S , gAP w 7 ° A iko NI ......., , , _ IQ POIG co itA■KA4, ti ---,IA . .„,-- - .-, f.-..-::;.,-;,,,,:;04?7,--.-x--1,,•,' - „ .. , ' - a....,....._ : L'.." ":-.3.' ":70...V/4'1".'-', - 4,,/ • t —7 , ' . -s: - I. ''' ''' ,-• -',/;" „ , 923 ..-:-.7.-----_:sz- --;‘''':: 5 -,,,...,..-,:<,,„:•:,--;',.:.., , . - • ; 77) e k ------9 8.5 ... . , . .. . .. --_-_, ii gz ,....____ ....„_____. ------- <1(4.5 - -1 • copy r.......... aA 2s 3611C Safety and Buildings 10541N RANCH ROAD commerce.wi.gov HAYWARD WI 54843 I s c O n s i n Contact Through Relay www.commerce.wi.govlsb! Department of Commerce www.wisconsin.gov Jim Doyle, Governor Aaron Olver, Secretary October 08, 2010 CUST ID No. 253976 ATTN: POWTS Inspector LEWIS C BJORK ZONING OFFICE LEWIS BJORK LLC ST CROIX COUNTY SPIA E7818 CTY RD E 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/08/2012 Identification Numbers Transaction ID No. 1862143 SITE: Site ID No. 760703 Chip Andrews Please refer to both identification numbers, 310TH St above, in all correspondence with the agency. Town of Glenwood St Croix County SE1 /4, NW1 /4, S3, T3ON, R15W FOR: Q ,C Description: Mound, 3 bedroom residence C0nd Object Type: POWTS Component Manual Regulated Object ID No.: 1283162 Maintenance required; 450 GPD Flow rate; 17 in Soil minimum depth to limiting factor from original grade; System( Ezflow Mound Component Manual, (R. 8/07), SSWMP Pub. 9.6; Effluent Filter coop,RT �Nj a 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. SEE C 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: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • Care must be taken to preserve the bench mark during construction or establish a new bench mark with the elevation set to relate to the original bench mark. • The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and COMM 83 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. LEWIS C BJORK Page 2 10/8/2040 + , Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. • Insulate building sewer per COMM 82.30(11)(c). 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. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter 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 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Revi er, Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634 -5150 , M -fr 8:00 - 4 :45 pat.shandorf@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828 -5902 , Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi.Q ov/ SB/ SB- BuildingContractorProeram.html LEWIS C BJORK Page 2 10/8/2010 Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour er COMM 83.44(6)(a)2. P • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. • Insulate building sewer per COMM 82.30(11)(c). 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. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter 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 Fee Received $ 250.00 Balance Due $ 0.00 i Patricia L Shandorf POWTS Plan Revl er , Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634 -5150 , M -fr 8:00 - 4:45 pat.shandorf@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828 -5902 , Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi. gov/ SB/ SB- BuildingContractorProgram.html • EZFLOW MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Chip Andrews _ New Mound Owner's Name: Chip Andrews Owner's Address: 8715 Aiverno Ave. West Inver Grove Heights Mn 55077 715 - 452-0271 Legal Description: SE NW S3 30 150WEST Township: Glenwood County: St. Croix Subdivision Name: na Lot Number: na Block Number. na W'T'S� 11 itiOna y Parcel 1.D. Number 016-1004-95-000 ROV Et) Plan Transaction No.: BEM OF C•'' VICE SAFETt Page 1 Index and title � � Page 2 Data entry 3RRESPOD� Page 3 EZFIow mound drawings r g - Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Plot Plan Page 10 Septic and Dose Tank Page 11 Effluent Filter Page 12 Soil Report Designer: Lewis c Bjork License Number 253976 Date: 09 /29 /10 Phone Number. 715- 231 -7375 Signature: Designed Pursuant to the EZFIow Mound Component Manual (N. 06/03), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) EZFIow Mound Version 1.2 (R. 02/04) Page 1 of 12 • EZFIow Mound and Pressure Distribution Component Design Site Information r Residential or Commercial Design Note: Sand fill (0) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ soil treatment for fecal coliform of <= 36 inches. 1.50 Peaking Factor (e.g. 1.5 = 150 %) 450.001 Design Flow (gpd) 6.00 Site Slope ( %) 98.50 installation Contour Line Elevation (ft) 120.00 Contour Length Available (ft) 17.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 6.00 CeII Width (ft) 1 75.001 = Dispersal Cell Length (ft) 1.00 Dispersal CeII Design Loading Rate (gpd/ft P 9 9 (9 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? c Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 3.75 Orifice Spacing (ft) = 1 11.25Ift /orifice 1 2.00 Forcemain Diameter (in) 10 l k � 30.00 Forcemain Length (ft) Does the forcemain drain back? Y 92.50 Inside Pump Tank Elevation (ft) 3.25 System Head (ft) x 1.3 4.89 Forcemain Drainback (gal) 7.42 Vertical Lift (ft) 67.47 5x Void Volume (gal) 0.45 Friction Loss (ft) 72.36 Minimum Dose Volume (gal) 11.12 Total Dynamic Head (ft) 26.21 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection I in. dia. options 1 choice I in. dia. options 1 choice 0.75 1.25 x 1.00 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer 1 1 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity (gal) polylock Filter Manufacturer 15.90 Dose Tank Volume (gal /in) PL 525 Filter Model Number Wieser Manufacturer Project: Chip Andrews _ New Mound Page 2 of 12 • Mound Plan View t J Observation Pipe :: --) O © A WI. -. - 1' " . • " . • . • • .. " • • • • • " • • • " • • • • • • • "" • • • • " • • .......................... ........................ ............................ • . • • • .............................................................................................................. .................,............................................................................................. 2 . . . ....................................................... .. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • L • Mound Component Dimensions A 6.00 ft E 23.32 in H 1.00 ft K 11.29 ft B 75.00 ft F 12.00 in 1 12.60 ft L 97.58 ft D 19.00 in G 0.50 ft J 7.84 ft W 26.44 ft 450.00 (ft Dispersal Cell Area 1394.82 (ft Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.08 (ft) —♦ ..,//,,,,, . . H I F n . • • . • • • : Dispersal Cell 100.58 (ft) Lateral 100.08 (ft) - * 6" Invert Elevation Dispersal Cell Elevation ; 5[ •:::.:;:i:;:;::.. :.. ;.:.:::.:.:.;::.:.;::::::.::•:•:.:•:•:.:•: •—•.•—•.••••• • • -4- © 0 4 98.50 (ft) Contour Elevation 6.0 % Site Slope Typical Dispersal Cell Shading Key m n See Page 5 0 1 1 Topsoil Cap o c Geotextile Fabric cover ,,.,.,,, El Subsoil Cap a o 2.0 ft 2 as ASTM C33 Sand ___ O Y J is i'_ I ( Tilled Layer d i ® © F © r` ; :1 EZFIow Media v o 11 0 ♦ 5 ft 1 — A —( See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: Chip Andrews _ New Mound Page 3 of Center Connection Lateral Layout Diagram I ..t .. to,:r.l.Vr,O.• , at.y. vl1n 4.t.l., :fir., 1V r:, It.tol.f ,it ,ngp,..lnt t ,n.: ,I: I n.ol.•nta :11 .. - III. v, IAN: It ti;!, t: .:r t t: V .? y 5th ..,1 le pant :. ti::,vv:r tu: iit<nft.,Iie S _.. • - Turn -up vo baihrai,.., ..t L: x _._-. it' ,,l•-• I a2 .( ._ JIV:41.- •: 1.3c.: Ge zn,iar: Of FTC. SO, 40 c1.2.anout Ow: p•:: C2 tv1F:i T it.I 4 pi.ti Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.87 ft Lateral Length (P) 36.77 ft Orifices per Lateral 10 Lateral End (Z) NA ft Orifice Density 11.25 ft /orifice Lateral Spacing (S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 6.55 gpm Manifold Diameter 1.50 in System Flow Rate 26.21 gpm Forcemain Velocity 2.68,ft/sec Dose Tank Information Locking cover with waming label and locking device, and sealed watertight Electrical as per NEC 300 and —► Comm 16.300 WAC �^ ; Disconnect 4 in. min- Tank component is properly vented \------ Moll III ,:: *-- Alternate outlet location 1 1 Forcemain diameter Wieser Manufacturer _ ■■: ,_ 1 2 in. Capacity 650.00 Gallons Volume 15.90 gal /inch A Weep hole or anti - Dimension Inches Gallons i B c l siphon device A 26.33 418.64 B 2.00 31.80 C d 4 Pump off elevation (ft) C 4.55 72.36 1 93.171 D _ 8.00 127.20 D Total 1 40.881 650.00 Dose tank elevation (ft) Min. 3" Bedding under tank. 1 92.501 Alarm Manufacturer Vector Alarm Model Number DHL Pump Manufacturer Zoeller j - ---•\ Pump Model Number 151 rV Pump Must Deliver , 26.21 lgpm at 11.12 ft TDH Project: Chip Andrews _ New Mound Page 4 of 12 EZFIow Distribution Cell Media Layout I 6.00 Cell Width (ft) 4 1.50 (Sidewall to Lateral (ft) Distribution Cell Cross -section Arrangements �iiititi : i� s iii ;r. i i iti � Wit tit* 6 ft Wide � I 11111 W1 11111.111 W it X it* `►1ti1' 1111' •IPW 1111' ` ltV Vti1 •• Component Legend 6" EZFIow Bundle - EZ0601A, 5 or 10 Foot Lengths ► •ti1111 12" EZFIow Bundle - EZ1203H, 5 or 10 Foot Lengths A. • +A N11' 12" EZFIow Bundle - EZ1203HP, 5 or 10 Ft Lengths 4" Distribution Pipe With Pressure Lateral Inside • Tumup Enclosure — — — — Lateral Distribution Cell Plan View Layout - Typical I 6.00 'Cell Width - A (ft) ( 75.00 'Cell Length - B (ft) Force Main 6 Center ftWide - -- Manifold Project: Chip Andrews _- New Mound Page 5 of 12 • • Mound System Maintenance and Operation Specifications Service Provider's Name Lewis Bjork LLC Phone 715 - 231 -7375 POWTS Regulator's Name St.Croix County Phone 715 - 386 -4680 Svstem Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Freauencv Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Call Lewis for Pumping 715 -231 -7375 Miscellaneous Construction and iris Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the EZFIbw mound component manual. 2. Dispersal cell media conforms to EZFkwv products approved for use with the EZFIow Mound Component Manual approved 6/3/03. EZFIow media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, 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 Grade v1 6 -8" Diameter Lawn . . ......... Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where ..... • •..... ....... • • • • • • Variable Length Cleanout Begins Long Sweep 90 or Two ►11 *.. • • .. ,r 45 Degree Bends Same '► i EZFIow Media y�tititl;',tt»V'ptititittiti Diameter as Lateral AI* ti`11111111111N.,~ 1.24 Feet • 1 Distribution Lateral —► Lateral Cleanout Project: Chip Andrews _ New Mound Page 6 of 12 Mound System Management Plan • Pursuant to Comm 83.54, Wis. Adm. Code • General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [EZFIow Mound Component manual 6/3/03 and SSWMP Publication 9.6 (01/81)] 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 shalt be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POINTS 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 shag 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. Saaosllc Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stars. 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 filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The liter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed front its enclosure. if the finer is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of she and scum in the tank exceeds 113 the squid volume date tank. If the contents of the tank are not removed at the time of a trienniet assessment, maintenance personnel shall 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 shaft be approved for septic tank use by the Department of Commerce. Puma 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 effuer t filter is bled rritimin the tank ht shall be inspected and serviced as necessary. Mound and Pressure Distribution System 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 preverk erosion and to provide some protection tram lest pion. Ti affic (oeier than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the irmtiltraMee 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 ehrceed 224E mg& BON, 160 mg& TSS, and 30 mge_ FOG for septic tank albeit or 30 m9/L i3OD 30 mg/L TSS, 10 mg/L FOG, and 10' 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_ Wien a granule teat is performed it should be compared to the mill teat when the system was installed to determine if orifice clogging has occurred and ff orifice cleaning is required to maintain equal rfistnbrtion within the dispersal cell. Observation pipes within the dispersal Dell shall be checked for effluent pon ding. Ponding levels shag be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, ropes frequent monitoring. Continnencv 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. ff the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) stall 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 bioiogicaily clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. r L—L_C For sabot yaw (l Ire- cs4715 -131 -1315 I ., Project: Rod Webb - Replacement Mound Design Page 7 of 12 • .EFFLUENT . KEY CODES FOR ZOELLEE PUMPS ..ter..; p —® • MPS BN = w/ Float in Box i .- PU MPS M = Auto Float Attached (vertical) 1 1 i 4 • N =Non -Auto (manual) - ' 'P,(/P lD E = 230V Non -Auto (manual) :4y.y.rrP,u as. Swcr "Sy" "FLOW-MATE" 98 , e y es , ka ' a cap., ....a.:�u.. -.. „,`.0..:z,., , ,. 4,‘,..:,,,, _r.._ a __. .. _. _ _.._r:= s...- ._..e: *�.er_ • 1a x e , ��"'�” `fie ra F ....:i<�r ` .. -w � . � ::___ ......` �. ZBN98 BN98 1/2 HP 115/1 Automatic Cast Iron 1 /? Solids, 1 -1/2" Disc. Tethered Float (15') 358.95 ZN98 N98 1/2 HP 115/1 Manual Cast Iron 1/2" Solids, 1 -1/2" Disc. 319.45 FEATURES: t - BN98 The "Flow- Mate" is constructed 2 H MODEL ~98 1/2 CURVE P of durable cast iron, carbon 90 , ceramic seals and a non- clogging vortex impeller. 15' Cord . APPLICATIONS: 15 - The "Flow -Mate" is ideal for 4 .. 0, septic tanks, dosing, low 70 pressure pipes, large mounds and step systems 5 0 - 1 0 10 20 30 40 50 50 70 e0 "DOSE- MATE" 151,152,158 , c k a a w 4 " ,,t---,,,_:71, a � � . kky3 .. `d + •v ..'- ,-, - 4 ..t , "' ,,- vtr,Mc .,# ^a Ys,�... '#�, •c �' Yr ,, S. t , s. t ,... _. : _. ._.. .. , a '�. �� ..,.,..r -s i_., G°�v ..,. �.m. : s.....�. ... .. . � . _. w � nw � ZBN151 BN151 1/3 HP 115/1 Automatic Cast Iron 1/2" Solids, 1 -1/2" Disc. Tethered Float (201 322.08 ZN151 N151 1/3 HP 115/1 Manual Cast Iron 1/2" Solids, 1 -1/2" Disc. 281.16 ZBN152 BN152 4/10 HP 115/1 Automatic Cast Iron 3/4° Solids, 1 -1/2" Disc. Tethered Float (20) 355.08 ZN152 N152 4/10 HP 115/1 Manual Cast Iron 3/4" Solids, 1 -1/2° Disc. 314.16 ZBN153 BN153 1/2 HP 115/1 Automatic Cast Iron 3/4° Solids, 1 -1/2" Disc. Tethered Float (20') 49 &95 ZN153 N153 1/2 HP 115/1 Manual Cast iron 3/4" Solids, 1 -1/2" Disc. 462.00 2E153 E153 1/2 HP 230/1 Manual Cast Iron 3/4° Solids, 1 -1/2" Disc. 462 _ FEATURES: FEATURES: j a' PUMP PERFORMANCE CURVE • The "Dose - Mate" is constructed of MODB.151n52t153 BN152 durable cast iron, carbon ceramic 14 1111111111111■■■■■■ seals and anon- dogging vortex ,,. ®.■■., _ impeller. 20' Cord iiIEVON111111111111111 „ APPLICATIONS: 1 etne1fiNIUUR The "Dose- Mate" is ideal for septic g " ,. rE311■`11111111111111 : ° tanuntldosing, � pressure pipes, . IS �.ta�e��IN I I, li„Ui 10 20 70 PO 9D ® 70 b SO X0 UM A • 120 tee 240 221 FUNIP9fYE11E 014000A 3 - -. 14 -2 ///,' �w P/°f_ /-)),,,,- 5_ �w ���� (7 �G� s A Om = too A oP of VC-. Pt"- N or1-1A .b g Lot � %I:6 z:), 5 3 ►1 \\ 6 c.f*, t. 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Z U i_� 0 ,_ 0 • • a 0 _ -- W UJ °m 0 y 0_ W R O � w0� I— (n 'X J Q 1 CA .s _ I .617 ( 1 ) • ---- u u � M z Z 9� „ZL v „L5 Effluent Filters .: Polylok Inc. roc 1 Lit Y INK:tit:de in glue >L1.S+A. Poisiok Inc. 3 Fairfield Blvd. laaffingfert, CT 06102 tall Tall Fro 898 - 7984566 Enna potyiok eom _ Yon ate Here: Home > Products List 4 EFFLUENT FILTERS 3 m Ate Raising the bar in filter technology About Polylok New Promotions New Pronurt, Resources Crdersnq Contact Us - �Ri6w w0cmaa- _ PL-68 Efftaent Filter POLE Effluent Mere PL-68 is much more than just an effluent filter. The housing can also be used as an inlet baffle ( tee) or outlet baffle. The housing Is designed to accept Polyloles snap In gas deflector to Ext.nd & Loki" ... _w deflect gas bubbles away from the tee and to keep the solids in the tank Risers Riser Covers Dla dbution Boxes and Accessories Pumps, Basins, Pump Stations and Stop Systems Seals / Gaskets Bdfss, Sanitary Tees & Gas PL -122 Effluent Filter 1 Deo actors Reber Spacers The PL -122 was the Test filter developed by Poylok. The biggest advantage of this filter is that it has an automatic shut off ban bunt into every filter. When the triter is removed for regular Handles and Receivers deaning, the bait will float up and temporarily shut off the system so the effluent won't leave the tank. To this day, no other manufacturer can make that daim. It is also rated for 1,500 GPD Signs (Gallons Per Day) and is NSF approved. Lane f Drainage Products Jz : Forms & clamps L . • 7- Butyl Sealants Concrete Accessories . `:.. � .. Pressruns filters Odor CrarNrol Products Rsbar-LOk and CMU Accessories PL-525 Effluent Titer Reber Wet and ID Caps Polylok. Inc is pleased to add its new commercial filter to its existing One of quafity effluent titers. Dive Landscape Stones The PL-525 is rated for over 10.000 GPD (Gallons Per Day) making it one of the largest commercial filers in its lass. it has 525 linear feet of 1/16" filtration slots. Like the Polylok PL- Technical Specifications 122, the new Polylok PL-525 has an automatic shut off bat installed with every filter. When the later is removed for deaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. No other filter on the market can make that daim! CD PL-625 Effluent Filter The PL ideal for grease trap applications. The 1/32" filtration has been shown to reduce fats, oils, and grease ( FOG) by as much as 60% to 98 %! The Star may be used in onsite wastewater systems that require a finer level of TSS removal. Whatever the application, Polylok has the titter for you/ http://www.polylok.com/products list.asp?prod subcat= Eflluent%20Filters 5/9/2010 , • .1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance wit Com 85, . Adm. Code _ Attach complete site plan on paper not less than es in size. must include, but not limited to: vertical and horizontal r ence point cti County , (r �� /i{� � on and parcel I.D. 0/6 /e0/11, percent slope, scale or dimensions, north arrow, and loc ' distance to nearest road. f AO-5 d ' e by -('ka Male vu. s Please print all information. R ev ` PersonI formatio you provide may be used for secondRr Er(J€ I w, S. 1!.04 (1) (m)). . f � ' Date � I 5A/ Pro ertyOwner p n _ Property L. - Ionk-- // � ( r 0 . c n dI re W S (' • 1108 Govt. Lot ` "' f uu) 4 S _3 T 30 N R I S E (o4 Property Owner's Mailing Address Lot # Bloc' -. 1ameeor C,SM // rI _ /D Ar)74 - g 7/ s 4/(ier-Jiv 4u �-� s CROIX COUNTY — — , ♦,, wr 1� I moo ,/-4 City State Zip Code Phone/ OFFICE City ❑ Village l 1 wn earest Road Vlvet -61b flfs. 1MALItsS I (-31 ) S 5: .7/ 6 /eft t.,9 epoel 3/0 -74 574 / t/ E'New Construction Use: ❑ Residential / Number of bedrooms Y Code derived design flow rate ‘ 0 GPD ❑ Replacement ❑ Public or commercial - Describe: �l Parent material n -s s �UPi— 1 // Flood Plain elevation if applicable ft. General comments � e w ev� 5 e c Ce ll / �Pp T'/ and recommendations: u SE- / 9 va �I r n c o 4 C o •fo u V 9'e% S dela- 75 g7 / g j 1\10c,tln,ct - sys���, 5/ &. /00.08 Boring Boring # ,v Ground surface elev. 9,r, a ft. Depth to limiting factor / 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure I � Consistence Boundary Roots GPD /ft A-i- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 /� i _. ql. k /_ Inn n>) /0.-1 to s/4 IM < a - , r q VJ ; ( U (" .' 6, • .3 / - e C _ -c .5`I . '(L c shk r 10 * � , 3 Boring # 0 Boring I L _ I G h'it Ground surface elev. ' ( ft. Depth to limiting factor / 7 in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 *Eff#1 *Eff#2 r1 / / 0 — 110 `ll 3 y 3 , i.5 1— a SI 14/1 et_UO , �-. ' �S 1~ a9-1 to `IdZ 4 —P sf L Q wt,S ) 1 1 G GL) r iv � • (j • g • 3 / 7-3 8 I O ybe r 5 cal) 7. Y % . I - � ( 1 ( i)k wr •r r V , 1 L 4 - • , 3 * Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Pn 1'e f Signa ce , I.- CST Number h h I -P CC l e S 0 �� � U a % � Address Date E a luation Conducted Telephone Number .0( 7 77014 4 - ;or/o U0l / W.F y .30 of 7? - 3.2,7 ' $-(/767 , L . • 4 Property Owner Co h rack !'tncXh�uSS Tv' - Parcef iii, #. Page of 3 Boring # Boring E p t Ground surface elev. 97, ( ft. Depth to limiting factor ‹a in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / 6 /oy2 3 `-- $rL _9 sk iv) •F(-- r ihA - e , 8 .),)-D8 ID yf2 $3c 7. s'iR c L a c s 61c c1 rl 9 (.0 , - `4 , 1- / �8 - f g /0 `(i'z (3D 7 5 YR JCL f C 4 uvrri / J I: . 3 B oring # r Boring t Y E Pit Ground surface elev. 9Y,S� ft. Depth to limiting factor / (' in. Soil Application Rate . Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 1 1 ft iv in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / D /b 10 y62 S/L a sbk 0 1 ( v et-u- i..1 . 6' . 8 . , I(.).-1 rov tu p 'z sv2 -B C 1 trvi sbk 1' T,) 1.4 f)4 ,') . 3 3 , / - /oy122 f'vPD 7- `s`112 i SCL l c kn -ii-- goF , , 3 0 Boring / Boring # L`� Ground surface elev. _ ft. Depth to limiting factor (O in. tl it Soil Application Rate i f k 0 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 b -� , r oy► ' � -- IL ,p �s bi - CO.)- ; I r . (,, , 8 a c,-/(„ co •12 y - 3 c.n 75-YR-c (- ► w- 6 I k f - 1 i . a . 3 .3 / /,,9 lo•IK. Un3 D - 7. sY2 Sc L l c 5i,k w`C I0'f- . D • - * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = 1300 < 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 (F..07 /00) , Property Owner 65 n rQ,c� Al \av- -. t V' - Parce 1 , h ' •,:, Page cp of , '"� Boring # ❑Boring g p t Ground surface elev. 97 / ft. Depth to limiting actor p c a in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture , Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. j *Eff#1 *Eff#2 / 6 I o YR � r L � I.4k fyi (- rR LA) � � ( t g - -)) /0 V. 3 -- s / i- , bic 5 ,,J if /04. . G, . g 3 - -,)s ID Yf? ?3D 7, 5- Y2 C .s4k w r 8 co _ ( , q , f- ,DR - g /o YCz «D - I, vK k , SCL 1 < 6A (rwri / 3 �/ Boring # ❑� Boring j I; Pit Ground surface elev. 9y,s ft. Depth to limiting factor / (l in. Soil Application Rate p t! Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft� �' � 1 / `T in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 K C� (‘-'P / , 0 - 1b )o 5/1.. -_ cD 51,k onry 6-0) . 4, . 8 I► --, 1• e -. t .. i~ s 6 if 0 £ i.,r 3 -./ -3(/ to y k t'l?D 7- 5 `it( 5( ( C C b(c lAt 'i— 10 F , , 3 111 5 Boring Boring # Pit Ground surface elev. () ft. Depth to limiting factor in. ll Soil Application Rate U Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fh in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff #1 *Eff#2 / b —� Oki K.3--- S /2_ 4-sbk 041_ c ,„ c . , 8 a 6_ / (6 3 c..DO 7 5 YR C — t wt. 6 tk 1t - , 1 ,,.) It ..) , 3 3 ,I - I0`IK. % 03 7.s `in —t SCL, 1 c si.i< vvI_C"I tv� . D 3 . , * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (8.07/00) 14 P5 Picot. 9 ` 6 f rce'1 d' '. COri f c d ILAire,..J C ►', (S.T. 'mil- � . e .:. c-D9'..4 --I- . I. — V y 4 e;ppi-9c 10‘.% 30 ' BS 8 0 4( s 1 / 7 (ro/ kr Coc«t -7 N [ woo re, w (Aslt c . 1 p 5E z o r /Uto y Se e . 3 f..27v.UR/S� Sc_.,I t''_ to' ,LX C e p4 /is S `! o css k. rex• t-• if t W of f ro pc6' s ' 6 e C 3 / 5 -` Top o-f t-1/4" P1C P,p.e AA � Vo s lope _roo.S �l�a3 �I`� 3i u a B3 a—,_ - l r ec Slo� .......,__________ iTT, . _____ �11 r Oct-15-2010 07: AM St. Croix County Plan /Zoning 715 =386 =4686 1/1 ST. CROIX COUNTY SEPTIC TANK MAMNTI NANCE AOREEMRNT 6 401a AND O WNERSHIP CERTIFICATION FORM , L1 6. 4 Owner/Bum k , ' 1 -, Mailing Address _Si Q0 4- 3f- 0 r , C al 1 j A L( hero 111L e Property Address ., ®� 3 4' C`L.ry w C7c 4 / 7 7 o 3( D 44 C 54 ( 4 pp, Verification required from ?leaning & Zoning Dot fir new construction.) City /State 6 k Parcel Identification Number (DIG - OCy`1 95 — COO LEGAL DESCRIPTION I - o� Property Locator E- V4 , `� 1, See. 3 , T &D N r S W, Town of l ��o w .. . Subdivision Plat: , Lot # Certified Survey Map # _ ; Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house yes eta Lot lines Identifiable ° yin no f Ms: i!_ AN : s = A it i - imoof.,ce use and maintenance of your Sep& system could result in its prermture figure to handle wastes. Proper msintenence consists of pumping out the septic tank every three years or soo46t, if needed, by a licensed pumper. What you put into the system san affect the tbnction of the septic tank es a treatment stage In the waste dismal system. Owner maintenance responsibilities ewe :petrified in *Comm. 83.52(1) and in Chapter 12 = St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification fonts, signed by the owner and by a master plumber. journeyman plumber. restricted plumber or a Licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition andlor (2) after inspection and pumping of uucessaryk the septic tuck is less than 1/3 full of sludge. Uwe, the undersigned have read the above requireteats and agree to maintain the private sewage disposal system with the standards !6t fit. herein, as set by the Department of Commerce and the Department of Natural Remiss, Stato of Wlscomin. Certtflcation mating gnat been =Waked mast be completed end returned to the St: Croix Cannily Planning & Zoning Department witiYm 3%0 days of the throe y ` I ; irajari date. Uwe certify that all statements on this form arc trte " the beat of tntyfour knowledge. Vtt►e anttare the owners) aft* ty described above, by virtue of a warranty deed ..., s Resistor of Deeds Office. Number of bedrooms 3 IONA /I' OF APPLICANT(S) DATE ny intertwine that is misrepresented may result its itaey permit being revolted by the Planning & Zoning DerstrtrnsnL *•e Include with dt 'on a , .,. , . dead from the Register of Deeds Office std a copy of the certified survey temp if reference is laude in the warranty deed. (REV, il$/Os) 4.1r— . 1111111111111111 IIIN 111111111111111111 INI 1111 • * 8 7 5 0 9 4 1* 875094 STATE BAR OF WISCONSIN FORM 2- 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI THIS DEED, made between Thomas P. Majerus, a married person, RECEIVED FOR RECORD 05/19/2008 02:15PM Grantor, and Conrad Andrews Jr, a single person, Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT # the following described real estate in St. Croix County, State of Wisconsin: REC FEE: 11 .00 Government Lot Six (6) and Government Lot Seven (7), all in Section Three TRANS FEE: 594.00 (3), Township Thirty (30) North, Range Fifteen (15) West, St. Croix PAGES: 1 County, Wisconsin. Recording Area Na a and Return Address: Edin eaity Title, Inc. RETURNED I6` a IEMO LEQAL. SERVICES, Na 400 S. St. — Suite 115 Exceptions to warranties: Hudson, 4016 330500TH SECCODINENUESOUR SIq'IEM MN Easements, restrictions and rights -of -way of record, if any. 867081 MINNEAPOLIS, 554012217 016- 1004 -95- 000... 016 - 1005 -10 -000 Parcel Identification Number (PIN) This is not homestead property. Metro Legal Services Dated this 9th day of May, 2008. EDIRET 867081 A 878488 WD 475531 4 m "v � E 4 M* •�1 * Thomas P. Majerus AUTHENTICATION , °y1I ACKNOWLEDGMENT Signature(s) 0\ \ . STATE OF WISCONSIN iC1S ST. CROIX COUNTY. ) ss. • authenticated this 9th day of May, 2008 } C) personally came before me this May 9, 2008 the above * named Thomas P. Majerus, a married person to me known to be the • erson(s) who executed the foregoing instrument and TITLE: MEMBER STATE BAR OF WISCONSIN ackno • • led the e. (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY * Che : rown Notary Public, State of Wisconsin Peterson, Fram & Bergman — Steven H. Bruns My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 55101 2/27/2011 ) (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 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 • • t.. l ie N ' s. \ \ N N N N X ROOM • OPEN TO BELOW X 14 0 Z LCONT ADOVE - RAL & 8ALU6TER 13ALCONY h a T1 ir 14' 6" X 4' 4" BEDROOM ;(17 5, 10' 5' X 10 9' t... WALK-IN CLOSET Z — b F ico"xlio" L _ ,' MEZZANINE '3 , 72 X 20' 8" - 2' 6" N \ t, I • 5 \ MASTER BEDROOM CD , LINEN 14' 6" X 20'0" --- 24 NO -, ..A.- - Z _ DEPROOM k ..... ) a, MASTER BATH 10 8 X 10 3 ; , .. 10'0"X 9' 4" 2 ' 0 " / ' \ CERAMIC ,, WHIRLPOOL TUB TILE 6 0' X 4 0" --,1 • -I 44 X 4/3 [.J , \ x X IA VI VI X X X 6 // 6 4/"--- 3 -7// 14� /// / 6' / 26 / 10 8 4 4 8 Andrews/Magnus Residence 310th Street, Glenwood City St. Croix County, WI Chip Andrews (651) 248-9708 candrew500@msn.com 0 5 10 PAWING SCALE - ' 1118 0Ir NoRTH It 6 .. / V 38'2" N : • OPEN TO BELOW , L_ . HOIST STATION • I i- RAIL k Oh LISIER F E 4 BALCONY a 14'6 "X4'4" N LK - IN CLOSET 1 10' 0" X 11' 0" 1 Q s i M m - ' 2' 0" N I MASTER BEDROOM (/(f�)J N LINEN 14'6 "X 20' 0" T \ --- 24 �1 O 60 N om/ v 0' BATH 1O 10' " X X9' 2' \ J CERAM _ OOL 1u9 - I.E % 4' O ' :4 N J / 44 "X48 \ \ X 6• /� 3' 7 // 14'6" /// 8" 26 ' / / 3B 10" Andrews /Magnus Residence 310th Street, Glenwood City St. Croix County, WI Chip Andrews (651) 248 -9708 candrew500 @msn.com 0 g 10 I111111nILJlul■illllullllnl DRAWING SCALE NORTH