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sconsirs Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514921 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: S mes, Jeffrey J. I Rush River, Town of 028 - 1014 -90 -500 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /C�p �j Z" 11.28.17.788 TANK INFORMATION lot ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION S HI FS ELEV. Septic � 1 Benchmark t,, , cam_ /QOv 1 • /61,4qj ba Alt. BM SZ Bldg. Sewer a (.� �e5 --•- 75�; `�,3 17, /'Std St/Ht Inlet 3 TANK SETBACK INFORMATI , St/Ht Outlet 7A ': 7 3. O TANK TO P/\ WELL BLDG. Vent to Air Intake ROAD Dt Inlet 9. 7 (/ Septic t 7Z / 11 if ` 7 Dt Bottom (icw�.17D �. Dosing 4 -is() 7 /66 Z J , z Header /Man. 1 � 96 'f Aeration Dist. Pipe ` / 96- Holding Bot. System 5 . Final Grade / 955 ,7S /, S PUMP /SIPHON INFORMATION �. c l 7. 3 Z Manufacturer mand St C ver �dg S GPM Q !7 Model Number TDH Lif 9Z Friction L,os� System H ad L TDH� . l� LO 7 Forcemain Lena Dia Dist. to Well 1 " / SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length / No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 56 —\ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of, ystem: , I 37 �' 7 UNIT Model Number: �LJ1TT°- � DISTRIBUTION SYSTEM E Header /Manifol Distribupe {s) ion / x Hole Size x Hole Spacing V t o Air Intake �/ Pi �j /� 1 Len g t WLj _J Dia Length O� Dia �� Spacing Z'� �,7D J / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx ulched Bed /Trench Center 1.55 Bed/Trench Edges ` Topsoil ( �, es ❑ No 0 No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 7 / Z1 1 Inspection #2: / / Location: 1950 Cty. Rd. N Bal win, WI 54002 (SW 1/4 SE 1/4 11 T28N R18W) NA Lot 1 ' "� �''' ParcefNo- 1.28.17.786 1.) Alt BM Description 2.) Bldg sewer length - amount of cover= �� -' 3 P� ��' w'a.. �o� 4Z. ..� Use other side for additional information. Plan revision Required? Yes o J SBD -6710 (R.3/97) Date Insepc is Sign re Cert. No. ' La CE iU i �- CorYttT ero@.wi.g+ov Safety and Buildings Division County � • 201 W. Washington A e. P.O. Box 7162 -, C' 'sco n j n Madison, WI 5 - Sanitary Permit Number (to be filled in y Co.) department of Commerce s/ J /9Z Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 153 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS re Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information yo � econd ry p urposes in accordance with the Privacy Law, s. 15.04 1 m), Slats. I. Application Information - Please Print All Information / 9 9 C lla A l Property Owner's Name �� Parcel # C- �' .-� e J 0 7 2008 0 9 -!p /Y- 7U - 590 Property Owner's Mailing Address Property Location CROIX NTY C !�(�Q NG ICE r Govt. Lot_ City, State Zip Code PhopfNum6er , S(,t7 1, / <, Section 2_ �� 1ti/ LLL���^^^[[V// T � N; R � circle o E ot� II. Type of Building (checkAll that apply) Lot # 1 or 2 Family Dwelling - Number of Bedrooms 1 I Subdivision Name Block # 1 V ❑ Pub] ic/Commercial - Describe Use 1!'� / � / / /�A ❑ City of ❑ State Owed - Describe Use CSM Number El Village of 5 � 9a i J �3 Dr Town of � % III. Type of Permit: (Check only one box online A. Complete line !B if applica A. ❑ New System Re lacement System y p y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) ❑ Permit Transfer to New $• [I Permit Renewal El Permit Revision ❑Change of Plumber List Previous Permit Number and Date Issued , Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that appl ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal//Treat ent Area Information: 1 Design Flow (gpd) Design Soil Applicatio ate(gpdsf) Dispersal Area Required Dispersal Area Propos s System Elevation VI. Tank Info Capacity in Total of Manufacturer Gallons Gallons Units New Tanks Existing Tanks /-2 Septic or Holding Tank Qn �a > > �• Dosing Chetnber l L/ (J' 0 J Y VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) 1 PZ �Zf;- ' e MP/M IRS Number Business Phone Number q ,46, . ,.�� Plumber's Address (Street, City, State, Zip Code) V11I. Count /De artment Use Onl pproved Disapprove $ e>�t Fee Date I ued O � Issuing ent Signature u r �7 I n Reason for 1 / IX. ConditttW"0 " *easons for Disapproval 1 effluent 3 / / t r ffl rf� . Septic tank, euent filter and ' �' ao -!S ti dispersal cell must all be services'/ main hied t 1 IF E� as per management plan provided by plumber. �c-b- "'`'¢� — 2. Al seffiack tagtkWents must be maintained d I r lam` 9 �� Attach to complete plans�for the system and sub t to the on�less than 8 1/2 x I1 inches in size c / G ` SBD -6398 (R. 01/07) Valid thru 01/09 ca/ie.' E,Yi /� EYi 3�i' �S t/S4/ �e/' #v2 et // w�eG .TCIrrey-i7 Shrines �°r�P, /ot/ 1 d �:l e s rK �/P1.23, ��, sy yc jccJYySE/y CP/ /ardaars sec. 1� 7...tB0' P.i7uJ. T o � E,ris�iu� �rey,v4,Eer d :s� j� e ��.3z`iY,q O )Posk W,'V , St. CV.,r 2%cp- u.�clSw,�ce.Tr,J�erioy CO // rJ /G.7-527creJ /�c% °E OzB- iois/ -9s -zm he aba. cd: c v ; e—;Cr Concre4t 3bdr.,�• WLjl, &cotr;ple L.. eh` /uyt,t✓�f�� lei �z S.7- PY.C. C�.a+ybr� y'Sc1.4�0 d fish - E - re e � SPrkCe - �•ees '� � � ; `� �,. 3 to be 5av � b rl gfl�or"-Y. /oca.6 S o�CSecl /Y(archda-� 12.s✓a' /oy . __ ``' /Cc W. er,,&cc� a �� eo {�radePee // = 4i�J�4L 7y loaa raoc 9y sD.' TK.k� (� dJS ti: Area i - S /.��ua./s a. � /i�;r SB• sS' �,� � C �c+,..(,�4 � c, l� 5 y e'Y' � 5pi ce ,2 . S &V6,t 6 G"46- 'l,i (4c1 py P. e a' 9 �' — Rar4g2 .SOS /8(/QlLCCCO�✓/��� • � E,riJEinq e /td¢'�ion cale f/ �rsa .�; f FX�st/ cc .?c�F-f Sy,nespro ?., /ot/ e S 23� ��. sy 90 jcJYySE/y C e�la�do�rs T. AkC� , P. /7,J, T . a F EX%S �� � r'ey rt�rvEerdsc.�to.�¢ �7' /32 0 �at�i W1 ✓t!, St. C.ro fogr Sur,Cczee. X;p6ertvr Co / %p�ld IG.7facrtS, �! �oz8 /oif/ -9s - z� �o /wmbin ED a /�a /cd To Sven i CXi vsr� �i'Yf ub- fe/ b u," Jd; Seuxi d e a c*�• � y " GTJCi 5f; n� b u; ldi. q t A ) ; tS¢r Co ncre{� 36drr.�• wLF�J&6vtr;p1e be a Sldvn pa Le e� Bu�J��FR 9 2 sd, 4s s,T d f{,sti�ree � SprkCttrces ��' `a � y e+D bf 5av a o 0 f \ lu w n - ok J � j ogeSec/ Mou„ d a-6 2,2- 5(k 10y..j4 9y sD.' 7'.,)0 des 6"% 6"' ` /,�t�eialsa�li" 5ys�e+r� Area .2 88• SS'�� } B avyf.'i'CCS �r cedaE .2 . s.3.' i i i Peo-�9 Safety and Buildings 3824 N CREEKSIDE LA CommerCe.Wl.gov HOLMEN WI 54636 TDD #: (608) 264 -8777 i scO s' www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary June 26, 2008 CUST ID No. 220853 ATTN.- POWTS Inspector DALE E HUDSON BOLDT'S PLUMBING & HEATING, INC. ZONING OFFICE 820 MAIN ST ST CROIX COUNTY SPIA PO BOX 78 1101 CARMICHAEL RD BALDWIN WI 54002 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/26/2010 Identification Numbers Transaction ID No. 1553494 SITE: Site ID No. 739002 Jeff Symes Please refer to both identification numbers, 1964 Co Hwy N above, in all correspondence with the agency. Town of Rush River St Croix County SWI /4, SE1 /4, S11, T28N, R17W FOR: Description: Three Bedroom Mound System ! Replacement construction / 7.5% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1187986 Maintenance required; 450 GPD Flow rate; 21 in Soil minimum depth to limiting factorfrom original grade; System(s): Mound Component Manual- Version 2.0, SBD- 10691 -P (N.01/0 1), Pressure Distribution Component Manual- Version 2.0, SBD - 10706 -P (N.01/01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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 woik 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: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • 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 P.O.W.T.S, Conditionally APPROVED DEPARTMENT OF COMMERCE DALE E HUDSON Page 2 6/26/2008 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.Comm 83.54(1). i • 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. • The owner is responsible for submitting a maintenance verification report acceptabb to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildingsreserves 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 to the owner and any others who are reponsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Jeff Symes 3- bedroom residential mound Owner's Name: Jeffrey J. Symes Owner's Address: 1964 Co. Hwy N Baldwin, WI 54002 Site Address: 1950 Co. Hwy N Legal Description: SW1 /4 SE/4, Sec.11, T.28N., R.17W. Township: Rush River County: St. Croix Subdivision Name: CSM Vol. 23, Pg. 5490 Lot Number: " 1 Block Number: Na Parcel I.D. Number: 028 - 1014 -90 -500 Plan Transaction No.: 1553494 Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached Soil Evaluation Report Designer: Dale Hudson License Number: 220853 Date: 06/22/08 / Phone Number: (715) 684 -3378 Signatu afro Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. D6/06) Page 1 of 9 DIVISi6N OF SAFELY ANU bU��,,,,.,,,, i � C-E ORRE ONDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) RI Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of <= 36 inches. 450.00 Design Flow (gpd) 7.50 Site Slope ( %) 94.50 Contour Line Elevation (ft) 21.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd/fi Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fl?) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) a Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. Z __ r 0.125 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 6.25 fe /orifice 2.00 Forcemain Diameter (in) 85.00 Forcemain Length (ft) Does the forcemain drain back? Y 89.00 Pump Tank Elevation (fit) Enter Y or N `L✓� 6.50 System Head (ft) x 1.3 13.86 Forcemain Drainback (gal) /„ I 6.38 Vertical Lift (ft) 81.25 5x Void Volume (gal) `�C 1.61 Friction Loss (ft) 95.11 Minimum Dose Volume (gal) / 0.50 In -Vine Filter Loss (ft) 29.66 System Demand (gpm) 1 � 14.99 Total Dynamic Head (ft) 3 Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x i 3.04 x Gallons/inch Calculator (optional) Treatment Tank Information 608.00 Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) 00 Total Working Liquid Depth (in) Wieser Concrete I Manufacturer 16.89 gal/in (enter result in cell B49) Do Tank Information E ent filter Information 608.00 Dose Tank Capacity (gal) Lok Filter Manufacturer 16.89 Dose Tank Volume (gal/in) P 5 Filter Model Number Wieser C oncrete I Manufacturer Project: Jeff Symes 3- bedroom residential mound Page 2 of 9 I Mound Plan and Cross Section Views T 1/10 B : :O: J : 1 _ Observation Pipe K. • .a�L�ti•L :LPL• . . . .ELK• . .•L•L••.••.••.••.• .•L •5�� .�'••' • : : . I L Mound Component Dimensions A A15-00 ft E 19. 50 in H 1.00 ft K Aft ft B ft F 9.50 in 1 11.29 ft L ft Q in G 0.50 ft J 6.22 ft W 450.00 (fe) Dispersal Cell Area 1466.13 (fe) Basal Area Available 5.00 (gpd/ft) Linear Loading Rate 1 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 97.54 (ft) - - --- . rrirrrr r r r rrr,+ .. F Dispersal cell 96.25 (ft) Lateral 95.75 (ft)—► Invert Dispersal Cell p Elevation E ' 4 Sou+ � + • + +, i.? t/k J \ < {�+ a, 1l ? �,,?.•� {. ' r��i { !, a. + 94.50 (ft) Contour Elevation 7.5 % Site Slope Geotextile Fabric Cover Shading Key Dispersal Cell See lateral details on 10 — Topsoil Cap c a 1.5 ft Page 4 for number, size, rirrr Subsoil Cap 0 5 r. •. •.L ''f�,, and spacing of laterals. ASTM C33 Sand n ' ��•�.�:�'r'�� F Laterals are equally r; " + Tilled Layer c 0.5 ft spaced from the v -' .r:, :.•: •• f ti : • ;•;.• `5 distribution cell's Aggregate ��•' �' �' �' �' �' � centerline in the A distribution cell (AxB). Project: Jeff Symes 3- bedroom residential mound Page 3 of 9 i End Connection Lateral Layout Diagram Laterals centered over the A & B olrrwnslon 0aTurn- upwlball valve oroleanoutplug .I rForo P erals are identical I<- X � I Holes drilled on the bottom of the lateral equally spaced main connection via tee or cross to manifold at any point. Laterals & Force main of PVC Soh 40 (per COMM Table 84.30 -5) Number of Latera)s 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 88.55 ft Orifices per Lateral 36 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ft /orifice Lateral Flow Rate 14.83 gpm Manifold Length 2.50 ft System Flow Rate 29.66 gpm Manifold Diameter 1.50 in Total Dynamic Head 14.99 ft Forcemain Velocity 3.03 fttsec Dose Tank Information Locking cover with waming label and locking device and sealed watertight Electrical as per NEC 300 and -- 10 Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented E-- ARemate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Cap acityl 608.00 Gallons Volume 16.89 gal/inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 17.8 301.76 B 2.00 33.78 C Pump off elevation (ft) C 5.63 95.11 89.88 D 10.50 177.351 D Total 36.00 608.00 Do se tank elevation (ft) 3" Bedding un er tank. 89.00 Alarm Manuafacturer SJE Rhombus Alarm Model Number Tank Alert SJE1011421 Pump Manufacturer Goulds Pump Model Number 'EPO4 Pump Must Deliver 1 29.66 gpm at 14.99 ft TDH Project: Jeff Symes 3- bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Dale Hudson Phone (715) 684 -3378 POWTS Regulator's Name St. Croix County Zoning Dep't. Phone (715) 386 -4680 System 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 Frequency 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 month! Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards �I 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 mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 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 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Jeff Symes 3- bedroom residential mound Page 5 of 9 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 [SBD- 10691 -P (N,01 /01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10708 -P (N. 01/01)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced, Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. 32otjc Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet 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 filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter 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 sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial 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 shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution 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 prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather Installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg/L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg/L BOD 30 mg /L TSS, 10 mg/L FOG, and 10 cfu 1100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shalt be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective components) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically 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 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Pa 6 of 9 J 9E - X GOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 AIto APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. • Effluent systems ■Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion resistance. SP' Canadian Standards Association • Heavy duty sump matic models include ■ Motor Housing: Cast iron • Water transfer Mechanical Float Switch Goulds Pumps is ISO 9001 Registered • Dewatering assembled and preset at the for efficient heat transfer, strength, and durability factory. . SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. maximum. ■ EPO4 Impeller: Thermoplas- ■ Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1'/z" NPT, seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104 (40`C) continuous 140 - F (60'C) Intermittent. METERS FEET • Fasteners. 300 series stainless steel. 9 30 5 GPM • Capable of running dry without damage to s �� F components. 25 Q 7 Motor: i • EPO4 Single phase: 0.4 HP, 6 20 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with automatic reset, • EP05 Single phase: 0.5 HP, 0 4 EPOS 115 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot 5 standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 ° ° 0 10 20 0 40 50 GPM foot length, 16/3 SJTW with ,�.1 / " al three prong grounding plug o z 4 6 1 s 10 12 nn Vh (standard on E'P05). CAPACITY G Pumps 2002 Goulds Pumps ITT Industries z iiective September, 2002 �(�. '0 'r 7 Q 83871 (/ I - 2122 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil 8 Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and -- -- - - " percent slope, scale or dimemsbns, north arrow, and location and distance to nearest road. Parcel I.D. _ 02_8 1014 -9 0 -500_ Please print all information. Reviewed By ~ Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Jeffrey J. Symes G ovt. L ot SW 1/ SE 1/4 S I 1 T 28 _NR 17 - - W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1 964 C o. Hwy N 1 � CSM Vol. 23, Pg. 5490 City State Zip Code Phone Number I City j Village V, Town Nearest Road Baldwin WI i 54002 (715) 688 - 2836 Rush River Co. Hwy N ✓ New Construction Use: ✓; Residential / Number of bedrooms 3 Code derived design flow rate 450 _GPD Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable General comments and recommendations: Site suitable for mound with 15" of sand fill placed on 94.50' contour. FT] Boring # J Boring e Pit Ground Surface elev. 93.26 ft. Depth to limiting factor 36° in. Soil Application Rate Horizon Depth ! Dominant Color Redox Description Texture Structure Consistence I Boundary Roots GPOW n. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. I 'Eff#1 'Effft2 1 0-16 1Oyr3/3' none sil 2fsbk ds cs 2fmc 0.6 0.8 2 16-25 j 1 Oyr4 /4 none sil 2fsbk ds cw 1 fm I 0.6 T 0.8 3 25 -36 7.5yr4/4 none sl 2fsbk mvfr gw I 1 vf,f. 0.6 1.0 4 36-47 7.5yr4/4 f2f 7.5yr5/8 Its /sl mix Osg /lcsbk ml /mvfr 1vf 0.4 0.7 I i Horizon #4 consists of an unsorted mix of 7.5yr4/6 Osg Is and 7.5yr4/4 lcsbk sl. Redox. concentrations appear in coarser textured Is. Boring # J Boring be Pit Ground Surface elev. 93. 59 v ft. Depth to limiting factor 21 ,in. Soil Application Rate Honzon Depth Dominant Color Redox DescdpWn Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0 -6 j 1 Oyr3 /2 none sil 2fsbk mvfr cs 2f,1 m 0.6 0.8 2 6 -11 10yr3/3 none sil 2fsbk mvfr cs 2vf,f 0.6 0.8 3 11 -21 t 10 r4/4 none {- sil 2fsbk mfr cw 1 V 0.6 0.8 4 21 -30 7.5yr4/4 f2f 7.5yr5/8 scl 2fsbk ml cw 1 of .4 0.6 0.4 0.6 5 30 -41 7.5yr4/6 f2d 7.5yr5l I /sl mix I Osg /mvfr ml /mvfr I 0.4 0.7 Horizon #5 consists of an u ed ml f 7.5yr4/6 Osg Is and 7.5yr4/4 lcsblc sl. Redox. concentrations appear in coarser textured ls. Effluent #1 = BOD 30 < 22 mg /L and TS >30 < 150 mg /L 'Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) ignature: CST Number James K. Thompson s ---- -- 3602 - Address A.C.E. Soil 8 Site Evaluat' Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 5/30/2008 715- 248 -7767 .. . ^. .. ^ ` pmportyCwne ����� Parcel |o# paQc 'Z m } n Bvnng# / Boring oopo to limiting factor ' in. n Rate , iorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots none HorLzon #4 consists of an unsorted mix of 7.5yr4/6 Osg Is and 7.5yr4/4 1csbk sl. Redox. concentrations appear in coarser textured Is Scl peds in | ( Boring -�o»«nQ | | Depth to limi-ting facto in So,I Appfication Rate orizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots | | Boring # Boring Depth to limiting facto in norizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft� Emuent #1 ~BOD and TSS'»O< 150 my/L Effluent #2 gOc\�-»omg/LandTSS< SVmg The Depummont n/'Cvmmeme ban uqou| opportunity service pmvidcruod employer. |[yov need ,u,btuocc to access -wrnu, or need material inun alternate format, please contact the department oto08'2h6'3|5|v,lTYh08'2o+8777 c —5 OW /uaz� 6 ��i�tin9 e /C ✓�cficn OO C a/e e:�ll 361 Ce / %i�/�1GG 1P /eyJ SYntesi� %off. cc di3 < C S rK ✓0 .23 �O�.�`y9 ' o ScuYySt/y ee/ /ardoors sec. �� 77,ZA ." -• i7ui• E,ri3 � i ey �cvEe rd sc l� a.�e �7i Y;9 A W,• ✓el St. Cro .+ o to cyra�e.ticf Su r{.a ce. T- ,�,Eer� v>^ GO / /op� /G.fSezc�eJ Pel. ` �o /✓ 9s • z c p/" be a To d e aba , crl • "� � it � 3 b d r,n • � .� 1 �'i'sfi•.,c�bcvldi (1✓ Or 97 �!J �yl 6 � ✓ 4���ree Q Sprkee-�ites ��' b � 6 4'1 rA �P p goy, . /o c �i• cn o �'6 u..,'ct7/ l w' t� /e��ont /i'ne, �o be 'V.('� - - • - ` C ti B} -93 on o( lzr 4/ i�k� 7�i7�Ktcyr. � lope - t1.raK CSC. Fu.�CC �'c.l� 5 Arta � i 85Z7't tb Ctni-cylJine rt ? 2122 Wisconsin Department of Commerce SOIL EVALUATION REPORT P age I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper root less than 8'% x 11 Indies in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and distWe to nearest road. Parcel I.D. 0 101490 -500 . 7g � Please print all informs R E V Date Personal iManration you acy law, s. ? (,�'�I/1 E Property Owner Location Jeffrey J. S mes Govt. Lot SW 1A SE 1/4 S i t T 28 N R 17 W Property Owner's Mailing Ad ress JUN Lot # Bi # Subd. Name or CSM# 1964 Co. Hwy N 1 CSM Vol. 23, Pg. 5490 City St.D�Obtl�fl Num r City J Village �/ Nearest Road Baldwin OFFI 2836 Rush River Co. Hwy N { New Construction Use: V1 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Site suitable for mound with 15" of sand fill placed on 94.50' contour. s� U Boring # J Boring 1 Pit Ground Surface elev. 93.26 ft. Depth to limiting factor 36 " in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Stnx wre Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E 1 0-16 10yr3/3 none sil 2%bk ds cs 2fmc 0.6 0.8 2 16-25 1Oyr4/4 none sil 2fsbk ds CW 1fm 0.6 0.8 3 25 -36 7.5yr4/4 none sl 2fsbk mvfr gw 1vf,f 0.6 1.0 4 36-47 7.5yr4/4 12f 7.5yr5/8 is/sl mix Osg/1 csbk mUmvfr - 1 of 0.4 0.7 Horizon #4 consists of an unsorted mix of 7.5yr4/6 Osg Is and .5yr4/4 lcsbk at. Redox. concentrations appear in coarser textu El Boring # I Boring e Pit Ground Surface elev. 93.59 ft. Depth to limiting factor 21 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Mureell Qu. Sz. Cord. Color Gr. Sz. Sh. *Eff#1 *E 1 0-6 1 Oyr3 /2 none sil 2fsbk mvfr cs 2f, l m 0.6 0.8 2 6-11 1Oyr3/3 none sil 2fsbk mvfr cs 2vf,f 0.6 0.8 3 11 -21 1Oyr4/4 none sil 2fsbk mfr cw 1vf 0.6 0.8 4 21 -30 7.5yr4/4 f2f 7.5yr5/8 scl 2fsbk ml cW 1 of 0.4 0.6 5 30-41 7.5yr4/6 f2d 7.5yr5/8 Is/sl mix Osg /mvfr mUmvfr - - 0.4 0.7 Hodwn #5 consists of an u m f 7.5yr4/6 0sg is and 7.5yr4141 csbk si. Redox. concentrations appear in coarser textured Is. * Effluent #1 = BOD? 30 < 22 mg/L and T4>30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson 5-- 3602 Address A.C.E. Soil & Site Evaluatot Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, Wl 54020 5/30/2008 715 248 - 7767 Property Owner Jeffrey I Symes Parcel ID # 028 - 1014 -90-500 Page 2 of 3 a Boring # I Boring Pit Ground Surface elev. 95.09 ft. Depth to limiting factor 21 11 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#i *Eff#2 1 0-5 1Oyr312 none sit 2fsbk ds a 2fmc 0.6 0.8 2 5-9 10yr313 none sit 2fsbk ds cw 1fm 0.6 0.8 3 9-21 7.5yr4/4 none sl 2msbk mvfr gw 1vf,f 0.6 1.0 4 21 -27 7.5yr4/6 f2d 7.5yr5/8 Is /sl mix Osg/1csbk mVmvfr di 1vf 0.4 0.7 5 27-42 7.5yr4/6 f2d 7.5yr5/8 act 2csbk mfr - - 0.4 0.7 Horizon 04 consists of an unsorted mix of 7.5yr4/6 Osg Is and 7.5yr4/4 lcsbk sl. Redox. concentrations appear in coarser textured Is. Scl peds in H#5 are covered with 10yr612 fs. F-I Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 F—I Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1= BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mgA. 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. SM4330 (8.07/00) A.C.E. W & SAe EYalY81UM ' 4arggR � � E,riJ�'n9 G /Gd4�ion 9 ca/e. Ci c(,%3 cc!/ w�iu .Te�+"r<y.7 Sy,nes prop., /ot/ di3 a< c3n( ,/a� �3 * .o9.sy9 0 ju�YySEjg; 1 Stc. //, T- A*-f .C. /7cJ. T, of �rey�va.#ardscl�"e Cel /ardanrs ��.s�iYlt7_ O AOmfAAvee, st. CV-'A Le. cJ< togr wzclSu- r�te¢.T�,bcriv>^ Co / /gp tcres, �1. �oXB- io /f/ -9s -2m �%� �►, 6i%►� bo Ae a /d aicd fp o� ct; vw� Frey �`*.� -6 b u; a; su.av 1 361Pm• �� ,,v 5,'c+.;r�, Assu•ne,drlw!,�c�.cii —�' J �i piny SlcvGr ,\�`._�� �► V e l4,'V- z 97 , �rt. d� ,� f ; Al ILI 3 r{sk�rte � SpruCtz`r'ces � , b tabc 5A 6 3 gP�oraX. /0ca.�6 ot'hu - el'd� ( B � /4 '1 r - 93 4/ Itkr! yys �O»� loo`.e4 5 P 3a F3 RECEIVE. ' ! llflfl l�lll lllf i lilif liiii !illl llli flfll! 11lI iIN JAS - 2 865661 KATHLEEN H. WALSH ST. CF0X COUNTY REGISTER OF DEEDS *Aftyo 'S Mr.0111) ST. CROIX CO., WI RECEIVED FOR RECORD CERTIFIED SURVEY MAP 12/14/2007 10:45AM CERTIFIED SURVEY MAP PART OF THE SW 1 \4 OF THE SE 1/4, AND VOL: 23 PAGE: 5490 PART OF THE NW 1 \4 OF THE SE 1 \4, REC FEE: 13.00 COPY FEE: 3.00 SECTION 11, TOWNSHIP 28 NORTH, RANGE 17 WEST PAGES: 2 TOWN OF RUSH RIVER, ST. CROIX COUNTY,WISCONSIN. DRAFTED BY: North 1 \4 Joel A Brandt Section 11 -28 -17 JB SURVEYING LLC Found "PK" Nail 4 e Z, UNPLATTED �g co lys $o w LANDS Ln .% , F I UNPLATTED N89 01'54 "E 660.00' . y LANDS LOT 1 ' o II 729,538 sq.ft. north -south a quarter line 16.75 acres Incl. r -o -w rn �. - -- NW C 719,411 sq.ft. _ 16.52 acres _ _ ��NW/SE -- form excl. r -o -w U SW /SE eee//J qqq bui:dings n "- z n 353.18' LJ S88'S6'46 "W � r 183.81' 169.37' iv � � I to well I N � � w houseg. , rn o cot I UNPLATTED O �i h� n -I LANDS North is referenced to the UNPLATTE N O South line of the Southeast LArrDs °- Quarter of Section 11 - 28 - 17 /(� ,,, ~l� PREPARED FOR: which bears S88 °56'46 "W �, ° Jeffrey J. Symes (St. Croix County Grid System) W a at 1964 CTY RD N Baldwin, WI 54002 C) m Cn i LEGEND ' 6D.........Government Corner (as noted) w o__......Set 3 \4" x 18" Iron Rebar weighing a DWY `" Southeast Corner minimum of 1.50 lbs. per lineal foot building R se'bock ne i Section 11 -28 -17 _ ......._Found 3 \4" Iron Rebar 33.00' L- - "`� - 33.00' - - -- ( Found "PK" Nail L1 -_ 2 3_0 .80 South 1 \4 POs 2615.93' centerline SCALE: 1" = 300' Section 11 -28 -17 Found "PK" Nail UNPLATTED 0' 300' 600' _ L ANDS — Line Data dump NOTE= FL11 588 i 306.61' A possible violation of the St. Croix County Zoning Ordinance L2 SOO'58'o6 "E 73.1x' I will be created if the existing structure, located 200' from the property line; OR 150' from the ublic road right-of-way v P g y, a er houses livestock or anlmat units. N Note: Each parcel on this map is subject to State and County laws, rules and regulations 1 (i.e, wetlands minimum lot size, access to parcel, etc.). Before purchasing or developing Vy parcel, co ntact the St. Croix County Zoning Office and Town Board for advice. Sheet 1 of 2 �r I V"I _ 23 Pacgc 5490 I CERTIFIED SURVEY PART OF THE SW 1\4 OF THE SE 1 /4, AND PART OF THE NW 1\4 OF THE SE 1\4, SECTION 11, TOWNSHIP 28 NORTH, RANGE 17 WEST, TOWN OF RUSH RIVER, ST. CROIX COUNTY,WISCONSIN. DESCRIPTION A parcel of land located in part of the Southwest quarter of Southeast quarter, and part of the Northwest quarter of the Southeast quarter, of Section 11, Township 28 North, Range 17 West, Town of Rush River, St. Croix County, Wisconsin, more particularly described as follows= Commencing at the South quarter corner of said Section 11, as the point of beginning of the parcel herein described: Thence N00 °09'49"W, along the north -south quarter line, a distance of 1728.00 feet; Thence N89 °01'54 "E, a distance of 660.00 feet; Thence S00 °09'49" E, a distance of 579.57 feet; Thence S88 °56'46 "W, a distance of 353.18 feet; Thence S00 °58'06 "E, a distance of 73.16 feet Thence S01 °34'05"W, a distance of 380.92 feet; Thence S01 °03'14 "E, a distance of 693.63 feet Thence S88 °56'46 "W, a distance of 307.13 feet, to the point of beginning. The described parcel contains 729.538 square feet 116.75 acres), and is subject to easements of record. SURVEYOR'S CERTIFICATE I, Joel A. Brandt, Registered Land Surveyor, hereby certify: That I have Surveyed, Divided, and Mapped the above described parcel of land in full compliance with the provisions of Chapter 236.34 of the Wisconsin State Statutes, along with the provisions of St. Croix County in surveying, dividing and mapping the same. That such map is a correct representation of the exterior boundaries of the land surveyed and the subdivision thereof made. Said survey was done under the direction of Jeffrey J. Symes, owner. Dated this 2 c ? day of 0V 10&r , 2007. X81 a4j A • . ww�o T Joel A.03randt, R.L.S. S -2603 JB SURVEYING LLC ':arE++rr000c,Tr.,• • Z CERTIFICATE OF COUNTY TREASURER STATE OF WISCONSIN ) COUN OF ST. CROIX ) SS I ' I, & , the duly elected, qualified and acting treasurer of the county 6f St. Croix, do hereby certify that the records in my office show no unredeemed tax sales and no unpaid taxes or special assessments as of )a /� affecting a ands of t is Certified Survey Map. D a e T r e a s u r T. CROIX COCK Y +o + DEC 14 2007 Approved this of 2007 4I t 7L fS f � A "" + h H nOt Moor to approval a0 hall o1 a pproval dates approval shalt be St. Croix County Zoning Representative ^sA and vold 2of2 Sheet 2 of 2 r , Vol. 23 Page 5490 �Y' Parcel #: 028 - 1014 -90 -500 06/12/2008 03:18 PM PAGE 1 O F 1 Alt. Parcel #: 11.28.17.78B 028 - TOWN OF RUSH RIVER Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12114/2007 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - SYMES, JEFFREY J JEFFREY J SYMES 1964 CTY RD N BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 1950 CTY RD N SC 0231 BALDWIN - WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 16.750 Plat: 5490 -CSM 23 -5490 028 -07 SEC 11 T28N R1 7W PT NW SE & PT SW SE Block/Condo Bldg: LOT 01 BEING LOT 1 CSM 23 -5490 Tract(s): (Sec- Twn -Rng 401!4 1601/4) 11- 28N -17W SW SE 11- 28N -17W NW SE Notes: Parcel History: Date Doc # Vol /Page Type 12/14/2007 865661 23/5490 CSM 2008 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations Last Changed: 04/11/2008 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 10.500 2,000 0 2,000 NO 00 UNDEVELOPED G5 0.250 100 0 100 NO 00 OTHER G7 6.000 24,000 100,900 124,900 NO 00 Totals for 2008: General Property 16.750 26,100 100,900 127,000 Woodland 0.000 0 0 Lo tter y Credit Batch #: O � Claim Count: 0 Certification Date: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address �• W /V Property Address (Verification required from Planning & Mning Department for new construction.) ' �/ p o -5av City /State �1I n 1 Parcel Identification Number (9, - — ��� "/ LEGAL DESCRIPTION Proper Location S p y ) 1 /4 ,'/4 ,Sec. , T N RjW, Town of c/S ZA&Y Subdivision / , Lot # I . Certified Survey Map # Volume , Page # Warranty Deed # f O(oq 9 , Volume l q lS , # , Page # K I Spec house yes no Lot lines identifiable & no 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 §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 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. I/we, 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms r A F PLICANT(S) DATE * * *An information that is misrepresented may result in the sanitary permit being revoked b the Planning & Zoning Department. * ** Y P Y �'Y P g Y g g P 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. 08/05) I U 2 9 18 P 0 9 1 8 1 to E6 4 9 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 3 — 2000 �' REGISTER OF DEEDS QUIT CLAIM DEED ST. CROIK CO., MI Docu ment Nu mber _ RECEIVED FOR RECORD This Deed, made between _ Cynthia SMes 10/28/2005 04:00PM QUIT CLAIM DEED EXEMPT N 8M Grantor, REC FEE: 11.00 and Jeffrey Syrles TRANSFFEE: CC FEE: _— — — PAGES: 1 Grantee. i Grantor quit claims to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Name and Return Address Southwest Quarter of Northeast Quarter f' Donald J. Fast (SW,- of NE,) of Section 11, Township 28 Doar, Drill & Skow, S.C. North, Range 17 West, Town of Rush River, P.O. Box 460 Baldwin, WI 54002 028 - 1013 -50 -000 i. Parcel Identification Number (PIN) This 1 �_ �O t�_ homestead property. } (is not) t Together with all appurtenant rights, title and interests. Dated this / O S day of 4V e-_ 2005 (SEAL) (SEAL) * C THIA 4S T�� (SEAL) _ (SEAL) o nDeq AUTHENTICATION ,•, ACKNOWLEDGMENT Signature(s) State of Wisconsin, ' - pRY authenticated this day of a ;�7� T`L County. p S B�` p Personally came before me this day of ' ''••. •`' C' r DC ?/1 2 _ Q 0 0 5 the above named f W+ ° � y s� o C nthia S es TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person who executed the foregoing authorized by §706.06, Wis. StatsJ instrument and acknowledge Same THIS INSTRUMENT WAS DRAFTED BY * is DONALD J. FAST, DOAR, DRILL & SKOW, S.C. No ary Public State of Wisconsin BALDWIN, WI 54002 My commission is permanent. (If not, state expiratio date: (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. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. 1, QUIT CLAIM DEED FORM No. 3 — 2000 Milwaukee, Wis, 1 I � J c it CERTIFIED. SURVEY MAP PART OF THE SW 1 \4 OF THE SE 1/4, AND PART OF THE NW 1 \4 OF THE SE 1 \4, ..SECTION 11, TOWNSHIP 28.N0RTH, RANGE 17 WEST, TOWN OF RUSH RIVER, ST. CROIX COUNT YASCONSIN. DESCRIPTION A parcel of land located in Oart of the Southwest quarter of Southeast quarter, and part of the Northwest quarter of the Southeast quarter, of Section 11, Township 28 North, Range 17 West, Town of Rush River, St. Croix County, Wisconsin, more particularly described as follows: Commencing at the South quarter corner of said Section 11, as the point of beginning of the parcel herein described: Thence N00 °09'49"W, along the north -south quarter line, a distance of 1728.00 feet; Thence N89 °01'54 "E, a distance of 660.00 feet; Thence S00 °09'49"E, a distance of 579.57 feet; Thence S88 °56'46 "W, a distance of 353.18 feet; Thence S00 °58'06 "E, a distance of 73.16 feet Thence S01 °34'05 "W, a distance of 380.92 feet, Thence S01 0 03'14 "E, a distance of 693.63 feet; Thence S88 0 56'46 "W, a distance of 307.13 feet, to the point of beginning. ' The described parcel contains 729;538 square feet 116.75 acres), and is•subject to easements of record. SURVEYOR'S CERTIFICATE: I, Joel A. Brandt, Registered Land Surveyor, hereby certify: That I have Surveyed, Divided, and Mapped the above described parcel of land in full compliance with the provisions of Chapter 236.34 of the Wisconsin State Statutes, along with the provisions of St. Croix County in surveying, dividing and mapping the same. That such map is a correct representation of the exterior boundaries of the land surveyed and the subdivision thereof made. Said survey was done under the direction of Jeffrey J. Symes, owner. Dated this 2c day of 0V mb&r , 2007. .00... '� • * ? MbWpT yt Joel A. randt, R.L.S. S -2603 i S�b43 JB SUR EYING LLC :,GIBM WCITY,' Im O� CERTIFICATE OF COUNTY TREASURER STATE OF WISCONSIN ) COUNT OF 5T. tROIX ) SS' I, , the duly elected, qualified and acting treasurer of the county 6f St. Croix, do hereby certify that the recor in my office show no unredeemeq tax sales and no unpaid taxes or special assessments as of LAIa , affecting a ands of t• is Certified Survey Map. Lwj - A Date T re asu r ST. Cf>,ont cotgm Nowiling a zodnp DEC 14 2001 , 0 Approved this�day of , 2007. far- kL h it not ncorodd within 30 days of M date approval ahalt to St. Croix County Zoning Representative rull and Vold 2of2 Sheet 2 of 2 Vol. 23 Page 5,490 1 111111 I�III �fif �Iffi fNll 111111 111111!1 865661 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., W1 j RECEIVED FOR RECORD CERTIFIED SURVEY MAP 12/14/2007 SURVEY AN PART OF THE SW 1\4 OF THE SE 114, AND VOL 23 PAGE: 5490 REC FEE: 13.00 PART OF THE NW 1\4 -OF. THE SE M, COPY FEE: 3.00 SECTION 11, TOWNSHIP 28 NORTH, RANGE 17 WEST PAGES: 2 TOWN OF RUSH RIVER, ST. CROIX COUNTY,WISCONSIN. DRAFTED BY: North 1 \4 " Joel A. Brandt Section 11 -28 -17 18 SURVEYING LLC Found "PK" Nail ib a UNPLATTED ° l c a I w LANDS KWO T : *' g I v, b400S N89'01'54 "E 660.00' C[rY UNPLATTED (_'• !N1 LANDS T ! I o w o 729,538 sq. f t. north- south / 16.75 acres A quorter line t° Incl. r -o -w �+ 719.411 sq.ft. NW corner _ _ _16.52 o2reg_ �_NW 1 L \ -Z c of sw /sE form excl, r - o - w - N sw /sE buildings "t z 353.18' $ 0 ❑ S88'56'46 "W N 183.81' 1 169.37' Ln o ell o house ?C, o c �l I UNPLATTED r 201 I LANDS O 'k North is referenced to the UNPLATTE o i South tine of the Southeast _ LANDS ° Quarter of Section 11 -28 -17 l PREPARED FOR: which bears S88 °56'46 "W ° HI I Jeffrey J. Symes (St. Croix County Grid System) �` a of i 1964 CTY RD N $ A I Baldwin, Wl 54002 Cn m LEGEND ! l ®......... Government - Corner (as noted) w o ....... ..Set 3 \4" x 18" Iron Rebar weighing a owY W Southeast Corner minimum of 1.50 tbs. per lineal foot „ building I Section 11 - 28 - 17 ' 33.00 "!!ock line 33.00 " ..........,Found 3 \4" Iron Rebar ' t !b ' -------�'_ � Found PK' Nail „ CTI-i 2 3_Q8.80N - 0 88'.56 46 W South 1 \4 Poll 2615.93' centerline SCALE: 1" = 300' Section 11 -28 -17 Found 'W" Nail i I I Jbn5 -wn rop uMO1 pue al1il0 buluoZ .ey)Jnd A4uno3 xloJD •4S a44 4Je4uo) 'la)Jed Ig aJO)ag •�')4a 'laDJed o4 ssa»e 'azis col wnwwiw 'spuelaaM l a � .alnJ ',Mel .t4uno3 pue a4e4S 0 4)afgns sl dew siy4 uo laiJed 4)e3 :a4oN Jana `AeM o- 6l� eoi >i nd a iun Je Jlue Jo > 304Sanrl sasnoy �y P )9 yJ d ,OSL b0 , au)l *taJado.id ayf wOJ3,OOZ Pajelol'a.m4)nJ4s 6ul4slxa aq4 Jl paaeau) aq lllM ..Cos Z7 a)ueuipio 6uiuoZ A4uno3 xloi3 {S ay{ jo uoi4eloin algissod b ,ss.ess t1 310N eQ auil saHdz aiivzaHn 00 00E ,o [qGOULDS PUMPS Submersible Effluent Pump MODEL 388 WE Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion - resistant, Single phase (60 Hz): can be operated continuously stainless steel. Threaded • Capacitor start motors for without damage when fully Specifically designed for the design. Locknut on all models maximum starting torque. submerged. following uses: to guard against component • Built -in overload with ■ Bearings: U er and • • Farms damage on accidental reverse automatic reset. lower heavy du ball bearing •Trailer courts rotation. • STTOW or STOW severe duty construction. power •Motels ■Fasteners: 300 series oil and water resistant P ■Power Cable: Severe duty • Schools stainless steel. cords. • ' /3 and' /z HP models have rated, oil and water resistant. • Hospitals ■ Capable of running dry Epoxy seal on motor end • Industry without damage to NEMA three prong provides secondary moisture • Effluent systems components. • � grounding plugs. barrier incase of outer jacket 14 HP and larger units have damage and to prevent oil ■ Designed for continuous bare lead cord ends. wicking. 9 Standard cord is 20'. Three phase Hz): SPECIFICATIONS operation when fully submerged. P ( Optional lengths are available. Pump Class 10 overload protection P ■ 0 -ring: Assures positive • Solids handling capabilities: MOTORS must be provided in sealing against contaminants 3 /4" maximum. separately ordered starter • Discharge size: 2" NPT. ■Fully submerged in high unit. and oil leakage. • Capacities: up to 140 GPM. grade turbine oil for lubrication • STOW power cords all have AGENCY LISTINGS • Total heads: u to 128 feet and efficient heat transfer. bare lead cord ends. P Tested to UL 778 and TDH. ■ Class B insulation on ■ Designed for Continuous ® CSA 22.2108 Standards • Temperature: 1 /3 -1 1 /2 HP models. Operation: Pump ratings are By Canadian Standards 104TF (40TC) continuous ■ Class F insulation on 2 HP within the motor manufacturers c us Files Association 140TF (60TC) intermittent. models. recommended working limits, Goulds Pumps is ISO 9001 Registered. • See order numbers on reverse side for specific HP METERS FEET voltage, phase and RPM's A 130 - SERIES: WE available. EtSH SIZE: 1 14' SOLIDS 120 - } fi 35 d - — RPM 3500 & 110- ??moo __ sGPM } FEATURES w f2 4 " 30 100 5 Fr , ■ Impeller: Cast iron semi 90 1 -- - — l _ I l open, non -clog with pump -out Q 25 80 _.. vanes for mechanical seal protection. Balanced for g 20 70F f0 " smooth operation. Silicon 60, bronze impeller available as 15 50 _.= .. WEO Eo H an option. 0 40 ■ Casing: Cast iron volute type 1 0 - 30 1 who for maximum efficiency. 2" NPT discharge. 5 20 .woos l_ € F i ■ Mechanical Seal: SILICON 10. CARBIDE VS. SILICON ° 0 0 10` 20 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM CARBIDE sealing faces. L_ , , , _ J , , , _ , _�__ Stainless steel metal parts, 0 5 10 15 20 25 30 35 m BUNA -N elastomers. CAPAC11Y Goulds Pumps © 2003 Goulds Pumps Effective July, 2003 www.goulds.com ITT Industries