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020-1374-22-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 563827 0 GENERAL INFORMATION 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: Peterson, David F. Hudson, Town of 020-1374-22-000 CST BM Elev: Insp. BM Elev: BM Description: /3 Section/Town/Range/Map No: 77. b / 12.29.20.2255 ~P TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1%J /,e s-t, _ J zi5~ Benchmark • 7 /Dl .~-T 5;7. d glM Dosing s Alt n~o ' 6T_ o~% ~ 131 Afifatier" Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet g.5`f g3. 3 TANK TO P/ WELL G. Vent to Air Intake ROAD Dt Inlet 5oJ 00-r-, g. / ~z. 0 Septic 75 / JZ Dt Bottom Z. 5 36 Z Dosing 7~ Header/Man. G'44 Aeration Dist. Pipe v/ (el 9C /7~ Holding Bot. System 71 58 PUMP/SIPHON INFORMATION Final Grade 'f 3.7 7, -141 Manufacturer Demand St Cover t GPM t t') 1z 17. S Model Number 6 _5 116 _ 4,A_ a~ S , L. TDH Li / / Fricti 6LZs System Head PA- TDH6'. 4t Forcemain LenguJ~ Di a. Dist. to Well SOIL ABSORP%_TIION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -5b 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~J C INFORMATION CHAMBER OR ~Z O 1-i V Type Of System: UNIT Model Nur ber:. J :d 7 n ZS 1' e'_ L._ DISTRIBUTION SYSTEM !d') Z ~ Header/Manifold Distribution x Hole Size \ x Hole Spacing Vent to Air Intake 71 Pipe(s) \ \ Length Dia 1 Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over G Depth Over xx Depth of xx Seeded/Soddded xx Mu hed Bed/Trench Center 3 . ` I Bed/Trench Edges Topsoil \_1 `K Yes FM-] No Yes FW] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection Location: 217 Starrwood Hudson, WI 54016 NE 1/ 1/4 12 T2 W Starr od Lot 22 , icel No: 12.29.20.2255 1.) Alt BM Description = `I 2.) Bldg sewer length - amount of cover = " ^ ~f Plan revision Required? Fal Yes No ~n Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No. I Safety and Buildings Division Cott T, ceo1 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) 'Madison, WI 53707-7162 \ilk Sanitary Permit Application State T Fp In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sani it. Note: Application forms for state-owned POWTS are submitted to Project AdVi6s 55 e jtran mailing address) the Department of Safety and P e Servies. Personal information you provide may be used for secondary L U f u ses in accordance wi e Law, s. 15.04(1)(m , Stats. JtSY►C~IX -7/'7 L Application Inf k rint All Information Property Owner's Na Parcel # I ✓J _ ©,v l4lu9J 134FIK) d A TIE L T A Ozo - /3741 , ZZ- cYx, Property Owner's Yffiling Address Property Location Govt. Lot City, State Zip Code Phone Number ~ `Z Section ",o SO /(J / 6 6 trcle one) T ~7 N; RZE) EorW R. Type of Building (check all that apply) Li Lot # iW 1 or 2 Family Dwelling - Number of Bedr om 7 Subdivision Name Block ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 10 Town of 1/ c4 6 5 OJU III. Type of Permit: (Check only one boa on line A. Complete line B if applicable) A, ❑ New System 9 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B- ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner _ ~c3` / 200 I IV. Type of POWTS S stem/Com nent/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized in-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Yther Dispersal Component (explain) El Pretreatment Device (explain) G z QA L" J V. Dis rsal7frea ent Area Information: Design Flow (gpd) Design Soil Application Rate(g Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation DQ O's- v d /zoo y- z 5 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units r' c b New Tanks Existing Tanks _ ✓ c g Septic or Holding Tank I Z5-Lo 12-5-0 ylll E s k Dosing Chamber 7 J d 173-01 1 «S E VIL Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's re MP/MPRS Number Business Phone Number ot4 Iv Sc 4,#Y1 c ell` Gr ( y Z 3 7(o 0 ;?/S 7(p 0 ~OY ,6 Plumber's Address (Street, City, State, Zip Code) 61 16 /5-(D 7-H 14L) :5 o J/q e fe5 e / WT _s- (v, © J~ VIII. Coun /De artment Use Only /7 pproved Permit Fee Date Issued Issuing nt Signature X1 plm~~ iven Reason for ial $ IX. Cond' ns for Disapproval 1. aep66,tahk, ejhUbxitfillet and dispersal cell must all bg,ekes f maintained as per management plan provided by plum; Aq slw sck requjfsmrrtts,ir lA be maintain" a PK "Voc itiia COCK / of*lalloaa, Attach to complete plans for the system and submit to the County only on paper not leas than s to : I t inches In size SBD-6398 (R. 11/11) PLOT PLAN N Eron & Robbin Hutchinson Legal Description: NE 1/4, SW1/4, S12,T29N,R20W P.I.D: 020-1374-22-100 Subdivision Name: Plat of Starrwood Lot 22 Township: HUDSON Parcel Size: 1.501 Acres County: ST. CROIX SCALE: = ao~ System Elevation: T1=94.25' 4 inch Sch 40 -ASTM D2665 Slope: 3% T2=94.25' 4 inch 3034 - ASTM D3034 A BM1 Elevation: 103.59 Garage Floor T3=94.25 © BM2 Elevation: 97.06 To of septic tank manhole cover ■ Backhoe Pits: Hand Dug Soil Boring: ~f &W_JLwtKG~,-~~~ Flw~ 143. V' 1K 66 Je 0~ S r~.~odd v~,l,e 1 1 V2t4iNi=~ Lp ,i~ 750' 1 _J Y i ' d 6! S - vaivf- -J Ex/3 Y~ I Ce,7C Se obz, •2•,K-/ - - h o-~) P,/ I t- e {~c/tun 383.1p 3 -3 X 'SD l~. Tp o,~s. T CC)P Y In,,.,hote ~vu E/e, ~ 97 cl~' CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 217 Starrwood 4-Bedroom Septic System q Owners Name: David Peterson & Brenda Tjelta f Owner's Address 217 Starrwood Drive Hudson, WI 54016 Legal Description: NE1/4, SW1/4, S12, T29N, R20W Township Hudson County: St. Croix Subdivision Name: Starr Wood Lot Number: 22 Block Number Parcel I.D. Number 020-1374-22-000 Plan Transaction No. Page 1 Index and Title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Septic Tank Specifications Page 5 Effluent Filter Information Page 6 Dose Tank Specifications Page 7 Dose Tank Cross Section Page 8 & 9 Pump Curve and Specifications Page 10 Bull Run Valve Page 11 EZ Flow Information Page 12 & 13 Management and Contingency Plan Page 14 Septic Tank Maintenance Agreement Page 15 Warranty Deed Page 16 CSM or Map Page 17 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 7/1/2013 Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) PLOT PLAN N Eron & Robbin Hutchinson Legal Description: NE 1/4 SW1/4 S12 T29N R20W P.I.D: 020-137422-100 Subdivision Name: Plat of Starrwood Lot 22 Township: HUDSON Parcel Size: 1.501 Acres SCALE: 1"=40' County: ST. CROIX System Elevation: T1=94.25' 4 inch Sch 40 -ASTM D2665 Slope: 3% T2=94.25' 4 inch 3034 - ASTM D3034 A BM1 Elevation: 103.59 Garage Floor T3=94.25' BM2 Elevation: 97.06 To of septic tank manhole cover ■ Backhoe Pits: ■ Hand Dug Soil Boring: 31WAL Zip 1 qs°' t7l/ 5 t 7 N 5~ j~~ by Sfbt+' cJ Odd UQ I~- is. / ' ✓Q ~c. 1 yt D2AiNi=rELID 1% It a wl. ~1 1 3 j „J va EJG~E~ TSo PC. Melt 1 a1Ve i Cenu•~fx sepb~+K"'l Poly l~ r e /wn 383,74, new 3 4x 80 E2 ~ rt . T p o>r s. T M,, hole E'le~ 97G'' SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: David Peterson & Brenda Tjelta 3 No. of Cells 8 Per Cell 3 ft Cell Width 24 Total No of 1203H ft Cell Length 400 sq ft EISA Per Cell 3 ft Cell Spacing 1200 sq ft Total EISA Manufacturer Model Laying Length EISA Rating infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: to Infiltator Gravelless Leaching Unit Model: 1203H Typical Cross Section Finished Grade 97 ft Observation Pipe with approved cap or vent . ■ ■ Soil Backfill 24 in ■ • Geotextile Fabric 94.25 ft Infiltrative Surface 12 in 7 I 91.13 ft Limiting Factor M r >36 in Slotted and Anchored Vent/ Observation Pipe with Cap Plumber/Designer Signature: License MPRS 223760 Date: 1-Jul-13 D (A 72r 86" m 53" D z z m C ~ D N m p rT7P 52" -4 1 4" CAS M > I 3" 47" I 4" m x I D m m In m D UP 49" r (A ~m v 4" cas 0 E i N v V-)0 g 0 -u z 50" 10 r- D 0 > z c -ml KDr N m co -n Z4 pmD D A0 U) ~Vx0 D m r x~ c7 x D z 0 m c c0 DO r x C z z Z z D °r c m m m D D g o v z z CoDg xro CD ~cn ~N X~ rn D Z -4-' ~ 0 nG0 0 0 z > vZ cr-V zmD° °r0 Cp Ox -0 z OrW 0 i~ rFj-+ - 5~ n0 (n0 C)-010~=~ z = m ymD D mOp mDp ~0~ N u1~ m0 =1 CD 4 cn~'~ n m - r--1z 0 xz [n r- N z 25 LA \ c r z Om''- NFJ ~ i F C Fri vr^~a~i~•~ ~xN~ N CA z m Vl X D O -4.F: m D D m N ~ A N N rn O -1 p m 'V D -r N O s _ co D N ~w 0 O \ s g~ D r O D° m v D v o o v D r~ rz*1 o c~~ rn NmD ->r m ~vO0~_ z0 -TI p m n U N p o N C O mm Dr N it O0 Off'` M m oo to m ~ zl z Jm D mDm m0 O Q~ s D O m z Ow c A o D (A 0 r OFD >O n -Di v H ~v z A ° z D 00 m p N 0 O m Z '4 r O ~ D D° 0 x -'1 0 Z lz~ -n ;a O N m ~ 20 i4 r C D O O0 z ° O 3 v x N A-4 O 0 mr m 10 jA r D H 0 O r Z m z F \ m W1250-MR MHER C®~CRETE DRAWN BY. SME R 1/4'=l'-O' -POUR: ° -4 SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 DATE:. POST-POUR: `O REVISED JAN. 2010 800-325-8456 FILE: 111I4SI-0 p~L qK INSTALLATION INSTRUCTIONS Innovations in Precast DrainagaI Zabel' & Wastewater P L-525/ P L-625 FILTER & Products A A DM NM of Polybk hr- INSTALLATION INSTRUCTIONS Center filter with opening C1 1-N J=1 X _ Mddwnal pipe or Polylok F_xtend 8 Lok° Glue for centering. M Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS 1 1 ,r a Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back F- -I if necessary. into the the housing making sure • NOT USE PLUMBING (B) Pull the filter out of the housing. the filter is properly alighed REMOVED L WHEN FILTER IS (C) Hose off the filter over the septic tank. and completely inserted. USE RUBBER GLOVES Make sure all solids fall back into the (B) Replace septic tank cover WHEN CLEANING FILTER septic tank. D Z X N D m z 61" 84" c D 42" z r O AN m~m f*i ~ UP 41" / to n 4 CAS _ m ° IV 3" 37" 4" r D m I UP 39" 71 o D ;v (n c) 4" CAS \ D / I N E1 V -v ~ C m K n ° 0 -u r. C 'Q. rFJ p<O D O> Z m D r OmD n 1,10 > ?D;u0 r mA x n;u S D Z 0 m C O D D Z = r Z Z 0 r~* x -i v v _c m m p m O~ K~ (A D D gZ 0 ODZ v D -4 -4 G)~D A,E mg mDOODWo --I - X CO c) np XX -0 Z v r-0 v rl~-4 ->U ~CN)v WOO =p0~ F2w D C v =1 OD m mi. D D m0 D ~v 740N N Z (n ~ D - =rte 0 ~Zr= -4WC mzm mN z° = cn r~* Z °D.. w2 r-1 A 1 , ~mvv.. ~w\ c M a m D N C -aN Z Or v >0 CD mD N >N-4 > 1 -4 or~r. ~m~ N Cn r v D v D v An -vA O ~mCD ~I Fm m w Pm n z r-4 C) W;v o R' o c O N N O ONO mmD DrD- U) oOV m (J1 r v m z W O ~O <`-4 Z m-4 y my M0 'p 0Or*~1~~ °D o° m m 023 M f~1 O a vO ~ =r z r0 ~ CA-O)m 0 < o ~o H m z 0 ~v D Z O v 0 O =N D 1l r, O ;u 2 ° D Om 4 bo N N c v z r °Q` 0 0 0 3 rn ~ = O cn a 'v 0 Z D A z rl ° m r rrn W H 2 ° > X o ~ A z M Z m \ cn W750-MR r=at DRAWN BY: SME SCALE: 1 4"=1'-O" -POUR: ° -4 SEPTIC MANUAL W3716 NBER US HWY 10 MAIDEN ROCK, W C®ICRETE 54750 DATE: JANUARY 2010 I REV. DATE:. POST-POUR: \ Z ° REVISED JAN. 2010 800-325-8456 FlLE: VIPM-W DOSE TANK DETAIL Owner's Name: David Peterson & Brenda Tjelta 99.24 ft Inlet Elevation Weatherproof Manhole with Locking Device Junction and Warning Label ....¢uick disconnect fitting n I ~~-Alternate forcemain outlet co j Sim/Tech Filter re (a) Dimensions Itches Gallons La alarm on 19 413.44 se ara n (b) p 2 43.52 dose vol a (c) 4 87.04 pump on 12 261.12 37 805.12 imp Off d (d) 95.5 Intake Elevation Tank Manufacturer Wieser Concrete Pump Manufacturer Zoeller Tank Model WLP760 Pump Model 53 Tank Capacity 750 gal Alarm Manufacturer SJE Rhombus Tank Volume 20.28 gal / in Alarm Model Tank Alert AB Filter Manufacturer Polylok Filter Model 525 DOSE VOLUME CALCULATIONS TOTAL DYNAMIC HEAD CALCULATIONS Design Flow (DWF) 600 gal / day Min Network Supply NA ft Number of Doses 5 / day Passive Vertical Lift 6 ft - (Header/D.Box elev. - Pump intake elev.) - (Forcemain Length x Friction Loss Max. Dose Volume 80 gal Friction Loss 0.26 ft Factor)/100 + Filter Friction Loss Drain Back 1.63 gal Total Dynamic Head 6.26 ft Design Dose Volume 81.63 gal Min Discharge Rate 35 gpm NOTE: Pump and alarm are to be installed on separate circuits. INTERNAL DIMENSIONS OF TANK Diameter 79 in Liquid Depth 37 in Plumber/Designer Signature: License 223760 Date: 1-Jul-13 p SECTION: 2.20.010 Q64L/TYPUMPB S1iYCE FM0493 0311 ® O Product information presented Supersedes ® 0810 here reflects conditions at PUMP !O_ time of publication. Consult factory regarding discrepan- cies or inconsistencies. MAIL TO. P. O. BOX 16347 • Louisv01e, KY 402560347 Visit our web site: SHP TO.- 3649 Cane Run Road • Lwisv*, KY 40211-1961 www.Zoeller.COm (502) 778-2731.1(800) 928-PUMP • FAX (502) 774-3624 COMPARE THESE FEATURES 53 - 57 Cast Iron Series - Nat-Clogging vortex impeller • Float operated, submersible (NEMA 6) 2-pole mechanical 55 - 59 Bronze Series switch & variable level long cycle systems available • UL Listed 3-wire cord plug: 9 ft. standard for automatic, 15 ft, standard for nonautomatic (For Pump Prefix ldentIrAwoon see News & Views 0052) • Corrosion resistant powder coated epoxy finish • No sheet metal parts to rust or corrode i ' M I G H TY-MATE" • Stainless steel screws, switch arm, guard and handle • No screens to clog SUBMERSIBLE PUMP • Watertight neoprene "0" ring between motor and pump FOR housing U SUMP • Solid buoyant polypropylene float Tesfedfo L& DEWATERING • Moto - 60 Hz, 1550 RPM, oil-Bled, hermetically sealed, d L11-778. OR automatic reset thermal overload protected EFFLUENT (SEPTIC TANK SYSTEMS) • Upper and lower sleeve bearings running in bath of oil • Entire unit pressure tested after assembly c CID us PASSES '/2" SOLIDS _ I • Carbon and ceramic shaft seal (TeSWtoUL778bd 1'/z' NPT DISCHARGE ~ • Maximum temperature fa effluent or Csnzz 2108 sa+,Uds) dewatering-130*F (54°C) AUTOMATIC • Passes 1/2" inch spherical solids • MODEL 1'W NPT Discharge. ; • On point-7Y," - Off part-3" a i! • Major width-10 3/32" - Height-101/16" SPECIAL MODEL FEATURES: MODEL 53 MODEL 55 Cast iron switch case, motor & Bronze switch case, motor & pump housing pump housing Engineered thermoplastic base Engineered thermoplastic base Engineered, glass-Bled, plastic Engineered, glass-filled, plastic VORTEX TYPE impeller with metal insert impeller with metal insert IMPELLER Stainless steel guard & handle Stainless steel guard & handle Bearing - lower & upper oil fed Bearing - lower & upper oil fed cast iron bronze MODEL 57 MODEL 59 All cast iron construction All bronze construction Stainless steel guard & handle • Stainless steel guard & handle Bearing - lower & upper oil fed Bearing - lower & upper oil fed castiron bronze Cast iron impeller Bronze impeller ALL MODELS ARE COMPLETELY SUBMERSIBLE POWDER BN MODEL HERMETICALLY SEALED COATED Tou6NN Watertight - dust tight. Permanently oiled bearings. MODELS AVAILABLE VARIABLE LEVEL CONTROL Automatic or Nonautomatic SYSTEMS AVAILABLE "53 - 57" - .3 HP,115V or 230V '55 - 59" -.3 HR 115V or 230V Note: The sizing of effkient systems normally requires variable level BE531BE57 & BN53IM7 available packaged float(s) controls and properly sized basins to achieve required with Piggyback Variable Level Float Switch pumping cycles or dosing timers with nonautomatic pumps. 0 Copyright 2011 Zoeller Co. All rights reserved. TOTAL DYNAMIC HEAD/FLOW PER MINUTE g W PUMP PERFO NCE CURVE EFFLUENT AND DEWATERING MODEL 53/ 5/57/59 MODEL 53/55/57/59 6 20 Feet meters Gal. Liters = 5 1.5 43 163 15 10 3.0 34 129 4 15 4.6 19 72 o Shut-off Head: 19.25 fL(5.9m) a 10 0 2 00' 3716 sins 5 -t7-745A 11/24118 IPT ~\X 3716 0- 10 20 30 40 50 ' i GALLONS , LITERS 0 80 160 FLOW PER MINUTE i i CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level float switches available • Variable level long cycle systems available • Available with special cord lengths of 15', 25', 35', (50'230V only) 1LFZ i • Alarm systems available • 33! Duplex systems available !2 i ~ salsa SELECTION GUIDE 1. Integral float operated mechanical switch, no external control requited. 2. Single piggyback variable level float switch or doable piggyback variable level float switch. Refer to FM0477. 3. Mechanical alternator "M-Pak" 10.0072 or 10.0075. 4. See FW712 for correct model of Electrical Alternator. "Easy assembW 5. Variable level control switch 10-0225 used as a control activator, with (t)" & wee pipe Electrical Alternator (3) or (4) float system. not irrdrrded.) Sral control selection CSA ul Model Volts Pi;;; Mode Mips M53155 & M57/59 115 1 Auto 93 1 Y Y N53155 -&N57159 115 1 Non 9,7 2 3 or 4& 5 Y Y BN53 115 1 Aldo 93 Y Y BN57 115 1 Auto 97 y Y 230 1 Auto 4.8 OPTIONAL PUMP STAND PIN 10-2421 BE53/57 D53155 & D57/59 230 1 Aldo 4.8 LEL y y Reduces potential clogging by debris E53155 & E57/59 230 1 Non 43 or 4 & 5 Y Y Replaces rocks or bricks under the pump Single piggyback sM,,h included. • Made of durable, noncorrosive ABS • Raises pump 2" off bottom of basin All installation of controls, protection devices and wiring should be done by a qualified Provides the ability to raise iintake by adding stns of 1'h" licensed electrician. All electrical and safety codes should be followed including the piping most recent National Electrical Code (NEC) and the Occupational Safety and Health or 2Attaches Attaches PVC pSpiping to pump Act (OSHA). Accommodates sump, dewatering and effluent applications For information on additional Zoeller products refer catalog on Piggyback Variable Level NOTE: Make sure float is free from obstruction. FloatSwirtclres, FM0477; 477; Efedrie~Aterroducnator, FM0486; MecharriccalAlternator, FM0495; Sump! Sewage Basins, FM0487; and Sargle Phase Simplex Pump ControVAlarm Systems, FM0732, RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 0 Copyright 2011 Zoeller Co. All rights reserved. American Manufacturing Company Bull Run Valve Page 1 of 3 w 11 ::11 Order Info Training Videos Contact Data Center Home About Site Map Drip Systems WaWlWastewater Controls Products Downloads Design Guidance THE BULL RUN TM VALVE -VYATER-TIOFff ACCESS CAP i RISER CAP ADAPTER RISER TUBE VALVE DIRECTION VANDL E The Bull Run Valve TM is designed to split flows to septic +V OVIF PORT fields or systems. In addition to the advantages of longer life and easier installation it is the most public C OUT PORT health safe alternating device available for wastewater disposal applications. The use has absolutely no contact with wastewater due to the valve's leak-proof and external operating characteristics. The change over from 4` IN PORT one drainage field to another can be accomplished in less than a minute by simply turning the valve without The Bull Run Valve is available in 4" sch 40 pvc digging or contact with wastewater. and is suitable wherever septic disposal systems are used - in commercial, industrial, and residential applications. OPERATING THE VALVE The direction control handle should be rotated periodically to direct effluent to one or the other No. I No.2 Noof two septic fields. After removing the screw Field Field FiQValve cap at the top of the riser tube, the valve handle can be turned with the valve key furnished. valve valve Positioned ed BULL RUN VALVE onNo1 . 2 Complete Valve Kit dunng dww Contains Odd Years Septic Septic Even Years Tank Tank 1. Bull Run Valve body 2. 28" Valve Key 3. Riser Cap Adapter ITEM DESCRIPTION 4. Watertight Access Cap BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE & KEY ONLY BRVCIRISER BULL RUN VALVE RISER W/ CAST COVER BRVCIRISER - 4" BRVKEY28 BULL RUN VALVE KEY 28" ADJUSTABLE TO 28" BRVKEY36 BULL RUN VALVE KEY 36" HIGH POLY RISER Wisconsin Department of Commerce, Safety and Buildings Division, 5. The Absorption area (SF) necessary for a given site shall be has reviewed the specifications and/or plans for this product and sized based on maximum daily sewage flow (GPD) and the determined it to be in compliance with chapters Comm 82 through Permeability for the site. If certain criteria is met, the EISA 84, Wisconsin Admin. Code, and Chapters 145 and 160, Wisconsin sizing can be used in Wisconsin, resulting in a 40% smaller Statutes. All sites must meet the Site & Soil Conditions & Jg0bg-n-g drainfield. & I I ation distances as noted in local regulations. The approved products are 1203H (3-12" bundles with pipe in cen- 6. Place UWbw bundle(s) in the EZ)'lmv configuration approved ter bundle in 5' or 10' lengths) and 1203HP (3-12" bundles with pipe by system design permit specified for the particular site. The in each bundle in 5' or 10' lengths. top or center-most bundles containing pipe are joined end to end with an internal pipe coupler. Any additional aggregate A single pipe bundle contains a four inch perforated pipe surround- only bundles that may be required, should be butted against ed by EPS aggregate and is held together with polyehtylene net- other aggregate-only bundles and do not require any ting, A single aggregate bundle contains aggregate only and is held the together with polyethylene netting. type of connection. Materials and Equipment Needed 7. The top of each GEO cylinder contains a filterfabric pre-manu- • Wow@ Bundles factured in between the netting and aggregate. The fabric • EZJIow Geotextile Fabric is inserted to prevent soil intrusion. The installer shall make • E 41ow Internal Pipe Couplers sure the the GEO is positioned upward and is in contact with • Pipe for Header and Inlet the fabric contained in the adjacent cylinder before backfill- • Backhoe/Excavator ing• Installation Instructions 8. The EZJ1ow Drainfield Systems should be installed in a level The instructions for installation of EZ,JIow® products are given be- trench in all directions (both across and along the trench low. This product must be installed in accordance with state rules bottom) and should follow the contour of the ground surface defined in chapters Comm 82 through 84, Wisconsin Administrative elevation (uniform depth), with all continuous adjoining Code, and Chapters 145 and 160, Wisconsin Statutes, as well as the 10-foot cylindrical bundles placed end to end, with central local health department's current design manual. bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 1. After the local health department has determined sizing, con- figuration, and layout for the EZjlow systems, stake or mark 9. The trench top shall be graded such that water will not pond. with paint the location of trenches and lines. Be careful to set Backfill should be seeded or sodded immediately after correct tank, invert pipe, header line or distribution box and completion to reduce erosion. trench bottom elevations before installation of pipe bundles. 10. EZjlow EPS bundles are flexible and can fit in curved trenches 2. Remove plastic EZjlow shipping bags prior to placing bundles as may be necessary to avoid trees, boulders, or other in the trench(es). Remove any plastic bags in the trench be- obstacles. fore system is covered. 11. EPS aggregate is lighter than water, therefore, it might be 3. This product must have geotextile fabric that meets require- expected that natural buoyancy forces would tend to cause ments of s. Comm 84.30 (b) (g), Wis. Adm. Code, installed ETflow assemblies to float out of ground when ponding oc- directly on top of the product and extending down along the curs. Field experience has shown, however, that this is not a sides of the product to a point at least six inches from the problem when systems have a minimum of b" of soil cover as bottom of product. recommended by manufacturer. 1203H-GEO GeotextiIe 4. When installed in a trench, the trench should be dug to a width of 36 inches. This not only saves labor in excavation, Barrier Material but also provides better load-bearing capacity after backfill- ing is complete. 'r WERNAL tflU1111F8 VIIN w7FY wa rvF,sx;nm+c 38' r,y 00 E w Ring Industrial Group P: 1-800-649-0253 30 Industrial Park PERFORMANCE. DOES IT.* F: 1-866-279-9203 Oakland, TN 38060 Ringlndustrial.com 1044101008 0 2006 Ring Industrial Group, LP POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Dave Peterson & Brenda Tjelta Tank Manufacturer: Wieser Concrete F NA Permit # E Septic C: Dose Holding Volume: 1250 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete F NA Number of Bedrooms: 4 r NA E Septic E Dose Holding Volume: 750 al Number of Public Facility Units: I✓ NA Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 400 gal/day Horizontal Distance Tank(s) to Serivce Pad: ft Design (peak) Flow = estimated x 1.5: 600 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.5 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Polylok F NA Fats, Oils & Grease (FOG) 530 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand (BOD5) 5220mg/L r NA Pump Manufacturer: Zoeller r NA Total Suspended Solids (TSS) 5150mg/L Pump Model: 53 High Strength InfluenVEffluent Monthly average Pretreatment Unit Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L r7o NA r mechanical Aeration r Peat Filter r NA Total Suspended Solids (TSS) 5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r sand/Gravel Filter r other. Biochemical Oxygen Demand (BOD5) :530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L ro NA r- In-Ground (gravity) r In-Ground (pressure) r NA Fecal Coliform (geometric mean) 5104Cfu/100m1 r At-Grade r mound Maximum Effluent Particle Size: % in dia. r N r Drip-Line r other: Other: F Other: r NA MAINTENANCE SCHEDULE Service Event Service Frequent When combined with sludge and scum equals one-third of tank volume Pump out contents of tank(s) When the high water alarm is activated mn"s) Inspect condition of tank(s) At least once eve : 3 r rear(s) Maximum 3 ears) r NA Inspect dispersal cells At least once eve : 3 r Year(s) (Maximum 3 ears r NA r morwxs) Clean effluent filter At least once eve : 1.5 r rear(s) r NA Inspect pump, pump controls & alarm At least once eve : 1.5 r rear(s) r mory" Flush laterals and pressure test At least once eve : r rear(s) r NA moreig Other: At least once eve : r rear(s) r NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notfcation of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary permit for a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-780-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Owners Choice Name: St Croix County Zoning Phone: Phase: 715-386-4660 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev. 2/05) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~0.Vrcl h GZv,G~ nJG L Mailing Address Property Address 217 Starrwood (Verification required from Planning & Zoning Department for new construction.) City/State Hudson, W1 Parcel Identification Number LEGAL DESCRIPTION Hudson Property Location N E '/4 , SW '/4 , Sec. 12 , T 29 N R 20 W, Town of Subdivision. Plat: Starr Wood , Lot # 22 Certified Survey Map # Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑yesEho Lot lines identifiable Oyesono SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in 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 you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(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 form, 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 and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are t to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed re rded in Register of Deeds Office. Number of bedrooms 4 -/34_3 SIGNATU OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) lE~ ,•J _ ~-364.47" Fes 364.07 \ \ C8 66524 SQ FT 1.527 ACRES 23 Y 75907 SO FT 043 ACRES ;;51" I S13•TS'~ AG EXC. E9AT.~ ~ wS67' al' ~e"' • pfpVAtE ROAD 25 w 393.97• L-01-S 24 Y 13. t pcG ES~iT) 3 $r 9 01 2266609 SO FT - 1,529 ACRES 65562 SO FT Ul c 1.505 ACRES ME -NOTE B) 7- , 17 E S89.52150"V 32836' 11 3 CD 60607 SO FT 16.51 1.391 ACRES N~ X59 (SEE NOTE B) : 2•~~' ;Z 1' Slit 1 EE S SHEET .1 OF, 3 SHEETS, 20 f. L AdNn0S7&o vs 2316 L Z Nnr SOIL EVALUATION REPORT Wi~hsin Department of Com Page 1 of 3 x 'Division of Safety and Buildi in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations • Attach complete site pia WW% x 11 inches in size. Plan must County St. Croix include, but not limited W. horizontal reference point (BM), direction and Parcel I. percent slope, scale or dimemsions, north arrow, and location and distance to nearest mad. 020-1 74 Please print all information, Re Personal inforomfim you provide may be used for secondary purposes (Privacy Law, s.15.04 (1) (m)). ' BY !Z7 Z1 L -4-9-2, V== Property Owner Property Location Eron & Robbin Hutchinson PA Govt. Lot NE 19 SW S 12 T 29 N R 20 W Property Owners Mailing Address Lot # Bbck # Subd. Na or CSM# 217 Starwood Dr. 22 Plat Of Starwood City State Zip Code Phone Number J City _J Village e Town Nearest Road Hudson WI 54016 Hudson Starwood Drive New Construction Use: W1 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement _J Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable NA General comments and recommendations: Site suitable for in-ground POWTS. System elevation to be 94.25' in primary system area. System elevation to be 94.25 in aftermnate system area. ~K ✓ v U Boring # J Boring W1 Pit Ground Surface elev. 95.47 ft. Depth to limiting factor 52" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots DIRT in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E 1 0-6 10yr3/3 none I 2fgr mvfr cs 2fm1c 0.6 0.8 2 6-30 1Oyr4/4 none ft Osg ml cs 2fmc 0.5 1.0 3 30-52 1Oyr4/6 none ~ft grfs Osg d1 aw 2fm1c 0.5 1.0 4 52-61 10yr5/6 f2d 7.5yr5/8 ft Osg dl cw VIM 0.5 1.0 5 61-69 1 Oyr4/4 f2f 7.5yr4/6 MIS Om dh aw I ft 0.4 0.6 6 69-119 10yr4/3 none fsAfs/fsl Osg/Osg/Om dUdUdh - if 0~ 0.5 H#6 consists of irregular, discontinuous stratified horizons Osg fs, Icemen )ifs and lenses of m fsl. y, a Boring # I Boring e Pit Ground Surface elev. 96.11 ft. 64° in. Sol Depth to limiting factor Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *E 1 « 1 0-5 1Oyr3/3 none I 2f9r mvfr Cs 2fm1c 0.6 0.8 2 5-32 1Oyr4/4 none Ifs 0sg ml a 2fmc 0.5 1.0 3 32-46 7.5yr4/6 none r Ifs Osg dl aw 2fm1c 0.5 1.0 4 46.63 1Oyr5/6 none ft Osg dl cw 1fm 0.5 1.0 5 6469 1Oyr4/4 f2f 7.5yr4/6 Ifs Om dh - 1fm 0.5 1.0 H#4 5 consist o r, discontinuous strat le horizons of Osg fs, Ifs and lenses o 10yr4/4 al. ' Effluent #1 = SOD? 30 220 mg and TSS >30 150 mg/L ' Effluent #2 = BOD X30 mg/L and TSS <_30 mg/L M: CST Number A 2~ CST Name (Please Print) James K. Thompson s--__ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane Osceola, WI 54020 6120/2013 715-248-7767 Property Owner Eron & Robbin Hutchinson Parcel ID # 020-1374-22-000 Page 2 of 3 16 Boring $ Boring# Pit Ground Surface elev. 98.02 ft. Depth to limiting factor >82" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD1r In. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 `Eff#2 1 0-4 10yr3/3 none I 2fgr mvfr cs 2fm1c 0.6 0.8 2 4-30 10yr4/4 none Ifs Osg ml cs 2fmc 0.5 1.0 3 30-42 7.5yr4/6 none gr ft Osg ml aw 2fm1c 0.5 1.0 4 42-50 10y175/6 JP U none gr Is & s Osg MI Cw 1fm 0.5 1.0 5 50-82 10yr4/4 none Ifs Om mfr - Urn 0.5 1.0 H# 5 consists of irregular, discontinuous stratified horizons of Osg fs, Ifs & Irregular, discontinuous bands of 10yr4/4 sl. ❑ Boring # - I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rood GFOJr in. Munsell CNu. Sz. Cord. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ❑ Boring # J Boring J Pit Ground Surface ebv. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stnx#ure Consistence Boundary Roots GPD& In. Munsell Ou. Sz. Cott Color Gr. Sz. Sh. 'Eff#1 `Eff1Q " Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD5 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 (R07/00) A-C.E SON & SRO Evdluidim • Sa% a✓a p;t 6yQS~nso~ x v • ,[,o~y ~~re~ptr'~ 3~2~ A EX~sx~l~xt ~'rnde eleckc •6n . U ca/c: 'e Eros 166A;,7 f/ic nso~ xi7 66-4-rv00 d 4~ Q r[,lcc a~sQr; cJ/. 5-41014, /,0.622, Iola 6 a s~w'z 176*3WA, SIC, is, 7--29/I.,e20u7., T, oz/4cd- i, 56. Oro;Y C'e., u0/. PCJ. -it -0,20 -/37f'-;z2-OCO 3~B ' rgCK ~~GUr ~F 6eneAW(W)k': ale ,A la • , 1^ • e 1~a stagy-~ oad (7r; ue -a' ~~i~ 1 • aSp~Lt d,~,~ pfOpdui ` ~Jjp QNo~accn~en~ 1 ~ ~ 1 0da . , lr 1 Wet( co ; rryi ms`s Ly - 4 ~i i o ~ d'~ gar i I l / ~ ~ i ~ i / E1GJ~• 1,.2.571 ` . c~Scr - C@r1U•C seo'.I. -AmWAIRcoe Llpcc/ 6 - i r~. • Top o,~s. T. /1?4y,hde e4ow. Elegy = 97c~" 981876 STATE BAR OF WISCONSIN FORM 1 - 1998 BETH PABST WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD Document Number 07/09/2013 08:02 AM This Deed, made between Eron L. Hutchison and Robbin C. EXEMPT* N/A Hutchison, husband and wife Grantor, and David Fulton Peterson REC FEE: 30.00 and Brenda L Tielta husband and wife as survivorship marital property TRANS FEE: 178S.00 Grantee. Grantor, for a valuable consideration conveys to Grantee the following PAGES: 1 described real estate in St. Croix County State of Wisconsin (the "Property°): ""The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address Return to: Burnet Title 5151 Edina Industrial Blvd. #500 Edina, MN 55439 Attn: Post Closing 020137422000 Parcel Identification Number (PIN) This homestead property. (is (is not) Lot 22, Starr Wood, in the Town of Hudson, St. Croix County, Wisconsin Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this O[ o day of tt-2e- _,2013. (SEAL) (SEAL) Eron L. Hutchison Robbin C. Hutchison (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ~(r©( X County } ss. authenticated this day of Pe~,~o~ally came before me this ~ day of -1 (,LtiL , 2013 the above named Eron L. Hutchison and Robbin C. Hutchison. husband and wife to me known to be the person who TITLE: MEMBER STATE BAR OF WISCONSIN ex a ted the foregoing instrument and acknowledge the (if not, s authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Burnet Title-Scott Tranby Notary Public, State of Wisconsin 5151 Edina Industrial Blvd, #500 Edina, MN 55439 My commission is permanent. (if not, state expiration date: 13-05853 LINDA KRAEMER ) (Signatures may be authenticated or acknowledged. NOTARY PUBLIC Both are not necessary.) STATE OF V!IISCOId IN 1 " Names of persons signing in any capacity must be typed or printed below their signature" STATE BAR OF WISCONSIN r Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 - 1998 Milwaukee, Wis. 1 of 1 Q o a~i ° I N ~ O v> 0 0 N N c t tl I Q'~ Z N o ~ ~ I ~ M I Y N m a Z ,°O C CIJ L f6 LL 0 i Oy Q > I 3 ~ z N o = C 0 z a? N N W a m a 0 r H z O Z :T c 0 w y E y a0i Z ° E u1 F- r I c' 0 (~i m E a~ co N O 0.- fa = V1 c H O E ~ 0 O O d N a L R m N CL c O y V O O C Q 'w O N OAT z- z O z O N Z LO Z.; 0 !0d 'a CL 2 G ` C a a CL E CL !n N I- 1- H co f2 a N •PW4 3 a a a a w I 3 C N fn r N cn U n 00 00 aD N N } (O O r N N Q O O r-. 0 0 0 0 0 0 C~ O p ~ 4\j M V N N I L m co Of N O N Y y N (n is r ~j Cp, o g c O Q LO c L 0 = to O N V m L N~ 7 C x 0 0 0 0 0 0 N N 0 0 = N N c 0 r 'O N N N N N N n N C 'p O , C C 7 c 7 r N LO Cl) . ~ N - N 0 r O y C N 0 (n C N r I~ O N • ry^C)l N 7 O 0 c R r t, O 2 O M O Z 0 cc d .r8 fn v O# C d u ~i~l 3 C C a0. c i 2316 Wisconsin Department of Com SOIL EVALUATION REPORT page 1 of 2 Division of Safety and Build' ngs A ance with Comm dl' , Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site pffin q=aca@l4@ff f%ffV5x 11 inches in size. Plan must St. Croix include, but not limited to. vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distancA Parcel 1. Z S S a13 020-1374-22-000 .2 Please print all information. Revi By Date Personal information you provide may be used for secondary purposes (Privacy l~ e ~3 Property Owner Property L tion Eron & Robbin Hutchinson Govt. Lot NE 19 SW I S 12 T 24 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM# 217 Starwood Dr. 22 Plat Of Starwood City State Zip Code Phone Number City Village a Town Nearest Road Hudson WI 54016 Hudson Starwood Drive J New Construction Use: y► Residential / Number of bedrooms 4 n Code derived design flow rate 600 GPD 01 Replacement I Public or commercial - Describe: f- - 41- 31at 1 W40- ZCW Parent material Outwash Flood plain elevation, if applicable NA General comments and recommendations: Site suitable for in-ground POWTS at 0.5 gpd loading rate. System elevation to o be = 94.25' P('e C k 4i r V a n( rt~t d 0 1W0 r% R D Boring # J Boring ('w ; nct~di[ M~•~ bt, P e ~e , Pit Ground Surface elev. 95.47 ft. Depth to limiting facto 52" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDIft= in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 `E 1 0-6 1Oyr3/3 none I 2fgr mvfr cs 2fm1c 0.6 0.8 2 6-30 1Oyr4/4 none Ifs Osg ml cs 2fmc 0.5 1.0 3 30-52 10yr4/6 none gr fs Osg dl aw 2fml c 0.5 1.0 4 52-61 1Oyr5/6 f2d 7.5yr5/8 fs Osg dl Cw 1fm 0.5 1.0 5 61-69 1Oyr4/4 f2f 7.5yr4/6 Ivfs Om dh aw 1fm 0.4 0.6 none fs/Ifsffsl 0sg/0sg/0m dl/dl/dh - if 0.3 0.5 6 69-119 10yr4/3 I H#6 consists of irregular, discontinuous stratified horizons of Osg , um (cemented) Its and lenses of Om fsl, Effluent #1 = 60D 5> 30 220 mg/L a TSS >30 150 mg/L ' Effluent #2 = BOD !E.30 mg/L and TSS < 30 mg/_ CST Name (Please Print) Signat re: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Once WI 54020 2/28/2013 715-248-7767 0 sal eVa.. "o; t 6 y ?b k 1 so 12 • LrocaLLEtd~oi-c~~ji s~a~ • ~,Y/S~J/k1 G~l"Qr~l° el¢d2'~i'6r) CCs/e : f ' E/ron o~ ~W;q W c dl aw 'J". 5-voi6 f22,IolaEot,s&a wcod, o~ f.lt~CdkYl, bE.. C'rroi}r ee. IBC/. -A 0,20 -/3751-;U -OCC r File v ■ , ~ ~ Stn,-~,J orb t~~,'ve Q ~i d 1 t 5 aSpkal d 1 1 ! EX~~J,~ O Ski Melt c/ 1 It ~ i ■ , hd ..J I It `-f b oz ilk ~ (lisp d~ IV ~ 97.E 960i con EiYiJ'~+~j, 1, cencr~fx Syo6zK143/ 6t/A igw e(,F~ira, Mao ho(e Gwu: 97 c4~, i ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT RECEIVED Owner ..1 `rpow~ MAY 0 2 2002 T.F,P/1 wove Property Address 4/"7 City/State 1-46l o-J ST. CROIX COUNTY ZONING OFFICE Legal Description: Lot Block - Subdivision/CSM # w w N f 1/a 1/a, See. , TgN-Pa 0 W, Town of / +45 oN PIN # /3 2 28 - 00 a SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC/,L5 Setback from: House Well ( P/L 7lo'wcsr Pump manufacturer Model AA Alarm location /NJ A (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: 1:'l 1, 77PA7,ne Type of system: "rl?d ► C µ Width Length G~- SO' Number of Trenches 3 Setback from: House 3' Well P2/o',,j Vent to fresh air intake 113" ELEVATIONS: Description of benchmark Djl+« /y~~O~C TAE Elevation Description of alternate benchmark f.>>sN fzar-v /NG4-?,Ge Elevation o3- ' Building Sewer 93.3 i • ST/HT Inlet3 °1' • ST Outlet PC Inlet A )A PC Bottom IJA Header/Manifold f/• 2rd ' Top of ST/PC Manhole Cover 3b' Distribution Lines (A) _~;7/• jr_/(B) Bottom of System • o, f Final Grade ' ~D 9~ • K) Date of installation S /1 /02 Permit n tuber 399 o State plan number Plumber's signature C~ ~4z~ License number Ve7/2~27 Date Inspector ~Qti✓L LA V\_ Complete plot plan Q 1 NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. i • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PL VIEW Ao2o ~r oPErI +3' ~tNF ~{oi~ moo- JA-5&jti 3T j /.u 6 J - - ~jvEtClw. /d7 Yo 'Jr 1 Ijr, rn.Ero?/S~DEca~.ud~aP L~fimg~s io ~£e ~~~cK , Y3'\~ gtv c la irl.arRtf Iloit+P~G~ /4pq _ /A 10-04k'%-QLF ~ice~~ - - - - - - ~ JCL Ae,u LOIATIOA t /S, y eco-, \ N®r l~t~iDrra~t f QOArRTY' /250 ~.c~ Lv~~sE? S'cPT'c T.u• wrTf( '~'QVc So/~.~G EFT~c~ouT ti,~E INDICATE NORTH ARROW 4o !5cA1.E Z I t Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building t;ivision INSPECTION REPORT Sanitary Permit No: 399640 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: 1 7 O'Dowd, Hugh M. $ Kathleen A. Hudson Township 020.1-30-Y2-000 CST BM Elev: g,I Insp. BM Elev: BM Description: yrrl , 30' r eap ei 5- . TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic V! { / Benchma rn,rz o,; / 3 ru~j Dosing Alt. Aeration Bid er Holding t/ t inlet TANK SETBACK INFORMATION CH Outlet t/ ,3 , TANK TO P/L WELL BLDG. Vent to Ai Intake ROAD Dt I `I C- Jai Septic / / Dt Bo Dosing Header/Man. C2- .1 c Z t 'aJea s-r?/WJ X, 3 . Aeration Dist. Pi 1i Sd ~I Holding Bot. System r ~ is-, Final Gra y PUMP/SIPHON INFORMATION ~.s Manufacturer emand St ver Model Number TDH Lift Fr on Loss System Head TD Ft e a. a. Force main ngth Di SOIL ORPTION SYSTEM . Of Trenches ONS No. Of Pits Inside Dia. Liquid Depth B C Width Length No PITDIMEN DIM S SETBACK SYSTEM TO P/Lwj..S LDG WELLAKE/STREAM LEACHIN Ma a r . INFORMATION ,CHAMBER OR' h Fd✓ ~ Type Of System: Model Number: t DISTRIBUTION SYSTEM h ; lp el Distribution ! /Y✓'1i1~ / 'role Size x Hole Spacing V nt to r Intake Header/Manifo)d Length Dia t Length Dia_~~iacing I 3/, t >i SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over -7T Depth of J xx Seeded/Sodded xx Mulched Bed/Trench Center > Bed/Trench Edges psoil Yes ® No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: Location: 217 Starrwood Hudson, WI 54016 (NE 1/4 SW 1/412 T29N R20W) Starr Wood Lot 22 Parcel No: 12.29.20.2255 1.) Alt BM Description 2.) Bldg sewer length = 4 C ` - amount of cover a Plan revision Required? Yes No D- 1~4 trots i n tu~re Use other side for additional information. e No. Date P 9 SBD-6710 (R.3/97) Q~ -J svA U ? x n~ I L(:La jr C w&-3 Sanitary Permit Application Safety & Buildings Division t In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 VisconSftt Personal information you provide may be used for secondary purposes Madison, W [ 53707-7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned. Attach complete plans to the coup co only) for the s r1_ t s 8-1/2 x I I inches in size. County State Sanitary Permit Number 11 Check if vision ro previous app ,t7 State Plan I. D. Number d 1. Application information - Please Print all Information I. cation: Property Owner Name pi; Location 114E 1/4, S/; T e ,N I.oE or Property ees Mailing Address Sr _ gC71 Lot umber Block Number 0A71 City, State Zip Code PhohR Number $irbdivision Name or CSM Number r - II. Type of uilding: (check one) U city IN I or 2 Family Dwelling - No. of Bedrooms : v ~5 pc r r~~V, ❑ Village s s 0 Town of ❑ Public/Commercial (describe use):_ ❑ State-Owned N 'rest Road OP Parcel Tax Number(s) III. T e of Permit: Check only one box on line A. Check box on line B if a licable 2 • Z . z .2 zSS- A) 1. IN New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System 13) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Sand Filter ❑ Constructed Wetland IN Non-pressurized In-ground ❑ Mound ❑ Single Pass ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: ]l! i V. Dispersal/Treatment Area Information: ( 1. Design Flow (gpd) .2. Dispersal Area 3. Dispersal Area It. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (GatsJday/sq. fo (MinJinch) Elevation ~o o ✓ cS`aa ..-w spy. xe> - fr cv 9/ n 9~•oc~ VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ® ❑ ❑ ❑ ❑ ~00 ~ 0 0- r _l " VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached laps. Business phone Number Plumber's Name (print) Plumbers ignature (no stamps): -hw/MPRS No. ~so Plumbe Ad((d~~ress (Sheet, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination 4 Z Z5~-, 0 o Z A4 - X. Conditions of Approval /Reasons for Disapproval: 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. The 66 ft. access easement shall be treated as a property line - system must be >5 ft. from easement. ✓ 38' per Gd^f oppa p d . 'PLOT & CRO66 •BCT" PLANE ZAPPA 9ROC EXCAVA7M W 58 PRAJECT /0` (AQ' I• 13j"P~n~s ~'D 6,J J ~0 ns oN ~ ~ . L _j Slp r,c T~k wirN - yDr Z.r,3L~ /`E ,geo G~+ tET ~j~~.1 ~N ry1 ~t2K - K~ ~N . vhl fer~rt yp<~/~~s<<~ a~J = i00 00' . 1Aj IPdS /QE~~ ~~JJLttl~ir►~t~ S~/,~E /O"OiE~t'~G~ r-r /Y, Sv//air/ 4e , `7 /~La?cx~o7 ~GS , Oc.✓cfr Goo ~oG' SP P7 o0? CALM Y,,-,o or ~tbopo Azle -7 ~1'tt~Erl~cQ C7,~iS~1i'V,A`t,~N L',fV UCENSE' GATE: y' Ate !5', M Yo P,PF ; ROIL TEST" 8Y: To ~n,tSH ~a4rtGE p~/?a(7~~ Side View ££E~gTia.J ~E Jc H Ba iro..•. A£4 So,c 'rfA,r End View T t6' ` X15° 1 S,aFc...►,.~o~R ~,GN ~APAci-rY /vlvOec 38' per ..p . PLOT 41 CROG6 SECTION PLANS ZAPPA 8ROC EXCAVA7]Nfi INC PWMBINO UNT 9s - PROJECT rz /4 X, A hi5 1/0' --D G/fit~'//S~ts lAl 3TPV\X Cv lgN'rY /~So G•t~, c~~fs~2 ` Z,gy~c rf /4 i $OD arT <E~ ~.t 6g AJ Of iy/ AR9 Kif -'AJ /G Of 7e ~Pold s ° ~ ~ = /00.00' o as ~ iN E ~dS iDa~~ . -64~~. = ss.s7 N ~l &DI? ids , V"L co lro0 Coo SQ r-r 301eiar-0 /e, 21_ /17 oi? 6CALB FQ?NmE 1 /01 eW DATE: , OILTE6T INqBY. V' Ate Sc f yo P pf Z49ud ~ ~OI~sUSavJ _ To fN~SH GfAcw- a~2? 715"7 Side View &VA•r'42A 44,14 60Trc, T£Q <0,c -rLST End View 16 ' ` I X15° 0 ar F f _ 7r 34' J S'r aF c..,~ ~ ©~R ~ ~G H ~~PA c iT'Y MO AE L Wiscottsio Department of Commerce SOIL AND SITE EVALUATION 3 Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County -ST eQ include, but not limited to: vertical and horizontal reference point (BM), direction and C j ! x percent slope, scale or dimensions, north arrow, an and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - print_l in~~rmatlgn. Revi we by Date Personal information you provide maybe us d fdr econd _ "I tfFR -'1 1 rivacy law, 15.04 (1) (m)). z Property Owner Property Location Govt. Lot r4E. 1/4 5W1/4,S f Z T Z~ N,R 76 E (or) W O Property Owner's Mailing Address ST UROX Lot # Block# Subd. Name or CSM# {XCLJNTY ZZ ~TQ,e~2t.~dz~fl City state Zip de''~ Phone Numbe Nearest Road ❑ City ~/zillage Town D 5o+~ $ TP s~ New Construction Use: ® Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow l00 gpd Recommended design loading rate b,7 bed, gpd/ft2Qitrench, gpd/ft2 Absorption area required bed, ft2 7,r trench, ft2 Maximum design loading rate 0,7 bed, gpd/ft2_p,_Jl trench, gpd fft2 Recommended infiltration surface elevation(s) 92. ft (as referred to site plan benchmark) Additional design considerations ~V~ L CJ 4 rf 6~ bp Q E T-6 Ar 4 pppoy'd c ' Parent m ZL,4C_1AC aterial T1 LL Flood plain elevation, if applicable ft Eu = Suitable for system Conventional rMoound In-Ground Pressure AT-Grade S stem in Fill Holding T k = Unsuitable for system S El U IQjS ❑ U S ❑ U S ❑ U S ❑ U ❑ SU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 i~C W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trenchc 4- !A . d-1 6\1k'3 ~ encr ni <5 Zm ~ 7 ~ ~ air P, 4/4 S4 Ms /h 6,76,% Ground I ft. Depth to Z G limiting Q a' f tr RK in. Remarks: Boring # m ~ Qg / • R4 ~ - `fiL G t I S Cr nn-,, 1 r eC S ! Z- m 6Y A0 4 4 ms Ground elev. ft. Depth to q 5 R limiting factgr t > 16 A -in. Remarks: CST Name (Please Print) Sign Tull% Telephone No. U4,Nky ~JNSZrk/ - 46,R6 AdcitA~s 86x 91 s6 ~ Date CST Number `t SO 72 Z7s7 SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Borin # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots (qi1) in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ~aP 16 R 3 - L. 1 m er r-h -I~ 3 3 - 5L sbK Al 1 CS Zr, 6, Ground 4-4 vR 4 Sc, 7:63 I 41 ft. /moo/ s' 6 56 Depth to limiting t-Acto r in. Remarks: Boring # lei' - !d 4 4 s~ r~ls >v, cs o,-? :6.1 &U--U I&IR4 3 - m ¢s rh Ground P413 M5 Depth to limiting , Y factor 7 lIZ in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 2 L. w~ c r' rri r' C `J /M 8, - s? 16YR2 41a - s~ n,s r►,1 Cs /Yv, , o, X24 A S rn s 1 c S - o$ Ground B - 6&vP, r 6A _J6 ISJ7 0- Depth to limiting factor > JO~jjn' Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) I i PAZ, C i f a to i Q m U~ N 17 J 2 N 1 )-a 4~1 00 X07 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND - OWNERSHIP CERTIFICATION FORM Owner/Buyer Oybu--t' 4,)6N /r), ~j-r,►G~ A. - - Mailing Address o7RV Z IS j ?d A& Property Address -nrrrq4"'~ _ / 7 ~7a "Jo oct% (Verification required from Planning Department for new construction) City/State 4LA& SDw i, Parcel Identification Number DoZo - /375/ - - LEGAL DESCRIPTION Property-Location Ali %4, S w '/4, Sec. T - ~ N-R?0 W, Town of Subdivision Lot Certified Survey Map # , Volume , Page # Warranty Deed # 62615'91 . Volume /,•S`7 . Page # Z11~93 Spec house ❑ yes 0 no Lot lines identifiable J@ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in 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 you put into the system can affect 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year ex iration date /7 J 11201 L IGNATURE OF APPLICANT DATE 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 pro erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. 17 ,701e) SIG ATURE OF PPLICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.****** M Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of o` FILE INFORMATION SYSTEM SPECIFICATIONS ❑ NA Owner Septic Tank Capacity ZkVC1V ow /,2S-0 7 al Permit # Septic Tank Manufacturer _ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model IS NA Number of Public Facility Units ® NA Pump Tank Capacity al M NA Estimated flow (average) -5100 al/day Pump Tank Manufacturer 18 NA Design flow (peak), (Estimated x 1.5) 0 U al/day Pump Manufacturer IN NA Soil Application Rate al/day/ft2 Pump Model IN NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit M NA Fats, Oil & Grease (FOG) :530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) _:150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODr,) 530 mg/L IN In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ® NA Other: ® NA Other: ® NA *Values typical for domestic wastewater and septic tank effluent. Other: ® NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ~7 ❑ month(s) (Maximum 3 years) ❑ NA A ® ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ® NA Inspect dispersal cell(s) At least once every: ® monk )(s) (Maximum 3 years) ❑ NA / Clean effluent filter At least once every: ❑ month(s) ❑ NA ® year(s) Inspect pump, pump controls & alarm At least once every: p Yeast j(s) ® NA Flush laterals and pressure test At least once even' ❑ month(s) ® NA ❑ year(s) Other: ❑ month(s) 10 NA At least once every: ❑ year(s) Other: ® NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) r • Page '9- of ST)%RT UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: IN A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS OWTS INSTALLER POWTS MAINTAINER P Name Name Phone Phone 2dp SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name _ Name 0 Phone _ Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&M and 83.54(1), (2) & (3), Wisconsin Administrative Code. l • voi, 1 75 ( PAGE 603 WARRANTY DEED 6S 495 Document Number 15FlTi-!LEEN H. WpLSH REGISTER OF DEEDS This Deed, made between LANDSTED HOMES, INC. ST. Mix co., wI RECEIVED FOR RECORD a Wisconsin corporation 11-08-2001 8:25 AM Grantor, NTY AND HUGH M O'DOWD and KATHLEEN A O'DOWD EXEMPT # DEED CERT COPY FEE: COPY FEE: husband and wife, as survivorship marital property Grantee, TRANSFER FEE: 375.00 RECORDING FEE: 11.00 Witnesseth, That the said Grantor, for a valuable consideration of one PAGES: 1 dollar and other valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: ReEtc! Area This is not homestead property. Retum Address Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, ~.1-,F-36 indefeasible in fee simple and free and clear of all encumbrances except easements, covenants, and restrictions of record, and will warrant and defend the same. LOT 22, PLAT OF STARR WOOD IN THE TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. (Parcel Identification Number) 020-1374-22 Subject to the Private Road Access Easement for Lots 24 and 25 as shown on the Plat of Starr Wood. L (Da~ttedd,this day of~~C 20 ~i mark M. Erickson, President AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN COUNTY OF ST. CROIX Personally came before is this 4' day or*`-- 20-/ authenticated this _ day of the above named Mar~C M. Erickson, President to to be the person s) who executed the foregoing signature strument nd.adcnowl 1te am type or print name aturo 1 sign TITLE: MEMBER STATE BAR OF WISCONSIN type or prim name ! ~r~3a r.: (If not, authorized by §706.06, Wis. Slats.) Notary Public ST. CROIX County, PaV,i.psw-Knutson My com issio is per 'anent. (If not, state expiration date: DRAFTED By d ) Robert F. WgiarY Pu IC State of VVisconsin 'Names of persons signing in any capacity should be typed or printed below their signatures. _TL 3 ! \ C8 \ 66524 SO FT 1.527 ACRES 23 4. 75907 SO FT 1,743 ACRES Fk~ ,kG EXG ESIAT.) pfoYA17E RDAD wSa r ` i w 3937' ^NG LOTS 24 A (~i~ G EXC. ESiiT•) ! v X33 ;D' 66609 SQ FT - 1.529 ACRES 65562 SQ FT 1.505 ACRES o (SEE NOTE B) C7' 17 23,x, S88.52'50"N 328.36' . IQ! 60607 SQ FT 16 5~ 1.391 ACRES N13(SEE NOTE B) jj ,r C x S SHEET I OF. 3 S,,"fEETS.. 20