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HomeMy WebLinkAbout026-1133-01-000 (2) 0® 0 m m 0 _ k m \ / k ) / « (D \ £ » _ r m . k% °® J 2 T© \ $ 9@ 8 ® i m \ \ E / / ƒ 7 . / / / \ / / ^ 7 \ � CA) % B \ \ } ( } / / 2 2 2 0 o y» c o , ® ° a 0 k ro ! / / > ± ¢ e / - E . 2 � - a Z / § f / ) ) Z a o c CD T M 10 0 0 0 / > - $ j j j } D r -3 7 7 \ \ } � % \ ƒ : 7 to 2 m c > 0 / / CD CD \ N g °$ < . . � § CD , \ } j \ 0 2 m / / / « 0 f { { k \ \ z CD CD ,(A > :_ �_ /f § 2 2 § \ cacao c ; & zzz c \ - pmR _ 25 0 * e el. % c \ 0 -0 r 0 < / \ \C, } / } \ @&2- a 5Q. \ 2 � � / 0 C 7 00 00"0 00 lelol sa6aeya ;uenbu!laa sa6ae40 leloadS s;uawssassy leloadS ;unowy Ajo6a ;ea apoa leloadS jasa :sleioadS ZL5 :# y3le8 :a ;e(3 uo!;eoippoa 6 :;unoa w!ela :ppa lo /(181101 0 0 0000 puelpooM 009176Z OOL`Z9Z 006' Lb 08Z'Z Alaadoad Ieaaual) :90OZ ao; slelol 0 0 000'0 pUelpooM 009176Z OOL'Z9Z 006'6t 08Z'Z A:podoad IeMOD 400Z ao; sle ;ol ON 009176Z 00L'Z9Z 006'6b 08Z'Z LJ IVIIN3aIS9H uoseeN a;elS Ie;ol anoadwl pue sa.ay ssela uo!;d!aosea bOOZ / O£ / 90 :pa6ueya ;se : suoljen WA 0 :y ;!nn passassy :amen WlJeW a1ed :# II!9 AuvwwnS LOOZ lb'ld 69/8 ££L9b9 LOOZ /6Z/90 (IM 9ZZ /Z99L £9ZLb9 LOOZ /b0 /90 (IM L99/b696 b9 L£99 600Z/L0180 (IM 9££ /860Z 68£bOL £00Z /ZO /LO odAl abed /1 # 30 0 ale(] :iGo ;s!H Iaoaed :sa;oN MS 3S M86 NO£ - 90 (b /6 096 b/L Ob 6u�J- unnl -096) :(s)loeal Od08Z'Z L 101 WRIV 60101 :Bp19 opuoaploola A311b'A 3NId MS 3S id M8L2] NO£1 9 03S M LL/L Nodb' 1.311b'A 3NId :)Bid 08Z'Z :sajod :uo! ;d!aosaa le6a1 011M OOL L dS 1S1(] OVH3�1 M01 213ddn OZo8 dS aNOWHOIH M3N Z96£ 06 3Ad aNZLL Ob6 uo!;d!aosa(] # ;sla adAl Ajeunad = , :(sa)ssajppy A:pedoad leloadS = dS IooyoS = OS :s ;ola ls!(] LLOb9 IM aNOWHOI?J M3N 3Ad aNZL L Ob6 J ObJVN '311VH - O aaumo oo ;uaiano = 0 'jaumo juaaano = p :(s)aaumo :ssaappy xel 0 00 adAl;!waad #;!waad # uo!;eo!lddy easy sales # deW ale(] leouo;s!H a ;ea uo! ;eaaa NISNOOSIM '.11Nnoo XIO?jO '1S X ;uaajna aNOAHDI2J 30 NMOl - 9ZO bL6'8L'0£'9 :# Iaoaed III l j0 L 3E)Vd Nd 90 :90 LOOZ /K /L L 000 60 4 la3aed I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divisiddl . - INSPECTION REPORT sanitary Permit No: 20318 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: Halle Builders Inc. I Richmond Township 026- 1133 -01 -000 CST BM Elev: ! Insp. BM Elev: BM Desch p'on: i ` t TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATIO BS HI FS ELEV. Septic Benchmark � ! Z o . 1100 . Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet �, c� a�• !L� TANK SETBACK INFORMATION St/Ht outlet 3.9 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic C Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade • PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Numb TDH Lift fiction Loss System Head DH Ft Forcemain rngth Dia. l Dist.toWell SOIL A ORPTION SYSTEM Z$ BED/TREINCH Width Length No f Trenc es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENS S SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Ma ct V ` JJ INFORMATION CHAMBER OR ! J �L' Type Of System: ! v , UNIT � O Model Number: /2 l! . DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake k Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil �] Yes ® No Yes I] No COMMENTS: (Inclu - coglgyli crepepcies, persons present, etc.) Inspection #1:!/ I �fl� Inspection #2: �- ---� -- ocation: 940 172nd Ave New Richmond, WI 540 1/4 SW 1/4 6 T30N 11111 8W) Pine Valley Lot 1 Parcel No 06.30.18.914 1.) Alt BM Description = S•`(� wo a'" S� h�"`� � r�¢ �L �p,,,,�uv5 2.) Bldg sewer length - amount of cover = > 3rP << C tftt l G ► 9/• 02 C. J Plan revision Required? Ye N { � Use other side for additiona rm I - SBD -6710 (R.3/97) L Date Ins ct is Si n ture Cart. No. ,rcc,c +ti,e N +� • Z i .�� tl♦I.... fl•..Ifl� r, .. � �, . ;• r s �, • 1 . � •� �. �. ._ � �, � Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7082 f . SCO�SI n Madison, WI 53707 - 7082 Site Address Department of Commerce -07. p 3 76 ` f t fd tit F�JC Sanitary Permit Application Sanitary Pe 3 In accord with Comm 83.2 1, Wis. Adm. Code, personal information you p rovide Check if Revision may be used for secondary purposes Privacy Law, s15.04(1)(m) I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number Property Owner's Mailing Address A ,OV Property Location 7 p. 12 VAC/ 14; S lD T30 N, R/ / E City, State Zip Code Lot Numbe t Block Number ` Subdivision Name CSM Number lres�r �ea /7 II. Type of Building (Check all that apply.) ❑ City 0 1 or 2 Family Dwelling - Number of Bedrooms ❑Villa e • Public /Commercial - Describe Use g RT • State Owned Nearest Road cAo",ets 44a III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. � New 3 ❑ Replacement of 6 ❑ Addition to System 2 ❑Replacement System Tank Only Existing System For County use B. Check if Sanitary Permit Previously Issued Permit Number 2c) 2 ( 9 Date Issued 4 V;% 7ftZ IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) , 44,Q�Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation S/sz " �IDb 0 : 107,0 ,IN — 9/- Sl*' 9s-, VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks puc r Holding Tank X00 O Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for ins f the POWTS shown on the attached plans. Plumber's Name (Print) PluMbrr s Signature umber Business Phone Number Plumber's Address (Street, City, State, Zip Code) 37 Z_ 190 7' s - r - Am -e A V S7 Vo o 1 VIII. Count /De artment Use Onl Disapproved Sanitary Permit Fee cludes Groundwater u' Agent Signa a (No Stamps) Approved E O wner Date Issued n Initial Adverse Determination Surcharge Fee) d IX. Conditions of Approval/Reasons for Disapproval ov a- °Chi- mt,ox ` Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD -6398 (R. 05101) Tad Hk i T Iv ' y6 3 : :zZS, lP a e�b a < ?2 r I ! i I l �E L i t I I ! I I -- - - - � : r I i I i. i j ! j. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 VN Iso6nsin Madison, WI 53707 - 7162 Site Address V De artment of Commerce ��S' - T-- © f03 f � 9 0 IT?— Sanitary Permit Application Sanitary Permit Number Q' In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ��� �' V ❑ Check if Revision MX be used for secondary mrpms Privac Law, s15. 1 m I. Appileadon Information - Please Print All Information State Plan I.D. Number Prope is Na! m � O L Yl ---� Parcel Number 02l0 � I - wkL , C.91 Property Owner's Mailing Address P , Property Location Sk W'A; S T30 N City, State Zip Code Lot Num Block Number d ZO, (i 'Dtl 41*j &,A,- Sudivis n ame S"S/ / 7 It 4 II, Type of Building (check all that apply) ev ❑City or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public /Commercial - Describe Use ❑Towns ' ❑ State Owned t Road ( -3 V3 I X(07,0 U&S 4� /72-, a M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete Iine B if applicable A I New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use S stem Tank Only Existing System B. ❑Check 3 Permit Number Date Issued IV. Type of Pei �iv1N1 (S [ng scheme is for internal use). OQ MOD . 4Non -Prev 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized S l Q.S mk 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At-Grade t � , e eatment Unit 49 ❑ Recirculating 30 ❑ Other V, DisRqrsal T Design Flow (gP� t lea Soil Application Percolation Rate System Elevation Final Grade tl� P Rate(GaIs./Days/Sq.Ft.) (Min./Inch) Elevation Sa . 700 � `t 3.3 � � �� �- 9y Z Ana.. C) VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass Now Existing Tanks Tanks or Holding Tank Dosing Chamber VII. !LmE nsibfilty Statement- I, the undersigned, assume responsibility for the POWTS shown on the attached plans. Plumber's Name (Print) 's Sigma Q2ftdF8S Business Phone Number Plumber's Address (Street, City, State, Zip Code) 37 fh AL drrT S°yaa VIII. Co un me artment Use Onl KApproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse I S Z 9 Determination W IX. Conditions of Approval/Reasons for Disappro 1 � 1, AIM Attach complete plans (to the County only) for the system on paper not kss than 81/2 x 11 inches In size SBD -6398 (R. 05101) i , : . 1 : ZIA -, j i AWN 1 - - - - _ 1 Jl J I I � JJ I I 1 � I _ J : 1 : , rhT � , � 3 0 I i I i 4 S � b ls? 1 I c 4 � I I r d ' I r I I i II i I I t l i I I ' i � I I I _ I ' I I i COO I I I i y I 0 iDo II - �I /7Z `" a �� � �� f ;_ —— — i i, ` , i i i I i � ! � I I � � �� � I _ I i � i� J _ � � � _- � - -- - r � - - i - I i �� I! _, i � � I I i �_ I I � ! � � �- � , -- � -— � -- I � � � � � ��. � �� _ . _ _ —_ _ _ f — i i i i ' I � ,.. __ ,. .� __ _ , _ I � _. r. _ _ _ _ _ _ __ -_ �� _ i I I � 1__� _ ! �__r � !_ I _ L- _;� } I � �, i I i �— � _ �, � � �, �� �, � � �, i -- __ _ _ � _ �, —— ��( -� � , � � � —,, —' � ��� � - � - � -- -- , - - �- - r----- r -�-t - ! -, 1 I � ,, I i j C � �� � i � � i _ � i i � - i � ! � j I_ _ i — _�_ � _ —r —� -- - - - —; — I � i � � - � i - -- _ � � + 'i !_ �� ' � � l i �� i j � ', ! i � � � � i � � I I � I i i i � —, — — -- � � � i i � i , _ _ s — - -- — -- — — — -- — I �.. � �. —� — � i i � � � i I I i � �_ ` � — i- - I - I � F - _� ' - � _ , E � � I } , I i � i i �' — -- ��; ! � � — � �� — — � — — — r _ � i f � i � � I �— —�- -� � —� -- — i— i i - I ,_- r _ - __ .-_ ' 1 I i i ; I I � .L I i i !� ' r -- I� — - -- — — -- �, _ � _ � r_ r t _. i i , i � , i �� r ,' I I 1 j '� l � __ � _�_ - -- -- - -- � � � � ' ii ' I i i i i i � i � — 1 � � — �� � — — i — �� — � � — —� -- �i _ �, � � , i � i ,I l _ -- — -- i i � � I I � i I � � � i � -- -- I � � � f i � t i s ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code S7r- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County Cef include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. ev' wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Q d Z Property Qwner Property Location Govt. Lot S 1/z&4f 1/4 S (, T 30 J R /r E (or)(0 Propert wner's Mailin Address Lot # Block # Subd. Natne or CS14# ,� /�A t QG✓ A/� City • So to Zip Code Phone Number ❑ City Villa a 'gown �Neare#[ Road New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Publi r mmercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations: IT 1 Boring # ❑ Boring r pit Ground surface elev. ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 y 3 /z- Z M01, Cis 2, V-Ai,7,TV Wq Z :2 irt mr)e Ck/ G rt LS - �►vGlt? Ctv 7 /. 2 - • /� q 4s• r.sz 2�- 6 3 ❑ Boring # ❑ Boring / ❑ pit Ground surface elev. ft. Depth to limiting factor > /Z d in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 o 20 7. Cup g CA/ * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signalure CST Number S Z / Address R Date Evaluation Conducted Telephone Number Z q0 ST 14,,-ek w� rx /(� 2 oz �{ �.269�6e SBD -8330 (R07 /00) I Property Owner Parcel ID # Page of Boring # ❑ Boring p. / ❑ Pit Ground surface elev. ! ft. Depth to limiting factor ] ? in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I g lciv,�3�z war F-1 Boring # F1 Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring El Pit Ground surface elev. ft. .Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 L: Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) aL �i l�P! -� � A, i I I ( f r I i I I i i I I I j I I s I I i I I � I _ r L ; r i i I a_ � I ; I I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with C ^ 85, Wis Adm.. Code l County Cra I X Attach complete site plan on paper not less than 8 1/2 x 1 insties'in size. Play� must include, but not limited to: vertical and horizontal referen poiftt (BM), d{k-rAi*and Parcel I.D. percent slope, scale or dimensions, north arrow, and to ttcaond distance /tdtf�Z�;�t road.. _ �.. Please print all inform Lion. r Reviewed by Date Personal information you provide may be used for secondary =ts (Privagg� s. I$Ukt (m)). Z Property Owner i nterty Location) L a d.. �' S h r- amp Lot. f 1 /4 1/4 S V T30 N R ) E (o W Property ner's Mailing Address c - i ck # Subd. Name or CSM# P, . )0100 �, Aj e s N► tiva Nv City State Zip Code Phone Number ❑ City ❑ Village Town Nefarest Road k of L A 51 ( ) - Qq 49 17a New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate ( GPD ❑ Replacement ` ❑ Public or commercial - Describe: Parent material Q IQC141 6 - F + Flood Plain elevation if applicable ft. General comments '1 �` - :5 V e S't / a h F, tre, '+ *V S and recommendations: n ) S5 " � _ � °t .S T 1Q ��� -�'' � � �'� c.wtA b.c- se-f ff'-4 94.a3 F—) I Boring # Boring �t ® Pit Ground surface elev. 00 7 ft. Depth to limiting factor J ao in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 / o -g - 10' 40 /a - L aF R mF R Cas a F .5 . $ -Iq 25W - " arcs - m .S .G 3 -a X15YRq GL —� - '11A 0,S y R L l 11 &S 116 The soil test report for lot 3 was discovered to be inaccurate during the septic inspection on Nov 2, Boring 2001. The soil horizon reported as single grain Fa-1 Boring # pit Ground surface elev. p 9. a+3 ft. loamy sand was actually massive loamy sand with ® % occasional pockets of sandy loam. Therefore the Horizon Depth Dominant Color Redox Description Texture loading rate must be .5/.7 and not .7/1.2. If this in. Munsell Qu. Sz. Cont. Color error is discovered on any other lot, additional 0--7 I L borings /soil investigations will need to be performed for the rest of the subdivision. The plumber should 5 make note of the potential for error and prepare for ? - aq j0q C L the possibility of increasing the size of the drainfield. a%.yg 101K q16 F 1 1, 5 A 6 1% SCL -o s a5 °o Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L CST Name (Please Print) Signal re Address a Aoo +� S+ I Property Owner hQ h �P- 5 + Parcel ID # Page _�;L of _3 F3-1 ❑ Boring Pit Ground surface elev. Boring # ft. Depth to limiting factor in. ® OG � p g � as ' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Muhsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l 0 -11 M 361 -- - L. QF&R m rg a s aF .8 )1 -lq j8qR 5 y L- 'RF S8K MFR cw 1 111 .5 .8 3 - 1q-31 )OYR ` J q m s a Y, rnFR C VJ LVE * 6 31 - 3$ 7 , 5 VR ql S aFSeK FR tti) — • S 3 16 YR'Ylq LS 0 -Sq m V F -- — . 1.a S ` d5 % ' 9 (x F Boring # F1 Boring IN Pit Ground surface elev. /0D.61 ft. Depth to limiting factor 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0-11 1 oy R L RF&R MPR as F ►S .8 t:R 1 I low, 3 14 L. W 56 ' M C W I F • S . S .3 g -30 10 R `�I3 L a FSQK MER e I VE S - q 30 - 10 R * C L 0 M ER C W q , 1_jS -61 - 7,5 R SL R P56K m CW — , 5 ,9 bl - 7. YR qjq LS -5 miF °— –° . 7 I oZ .1Z l2 ott ❑ Boring # F1 Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07/00) SE X f, SW 'l y ' QC.. 4, ,'t3bP, Rt �t�yt n A� go P re i k J , k• S _ f i All) r e ferrnl. e s ( $rn POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATLO SYSTEM SPECIFICATIONS Owner Septic Tank Capacity O al 101 NA Permit # ZO Septic Tank Manufacturer (3 NA Effluent Filter Manufacturer DNA DESIGN PARAMETERS ❑ NA M11 3 Number of Bedrooms ❑ NA Effluent Filter Model bd Number of Public Facility Units -� ❑ NA Pump Tank Capacity al Cl NA Estimated flow {average) 300 al /da Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) j allda Pump Manufacturer ❑ NA - 0; Soil Application Rate al /da /ft Pump Model ❑ NA [J Month) average* Pretreatment Unit NA Standard Influent /Effluent Quality Y Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ in- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510" cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: earls} Pump out contents of tanks) When combined sludge and scum equals one -third (Ys) of tank volume ❑ NA E3 month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: •� year(s) 13 month(s) ❑ NA Clean effluent filter At least once every: ear(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) ❑ month(s) ❑ NA Other: 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 cellls) 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 (Y 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. Ail 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 shalt be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4101) s . Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) 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 bee n or must be taken to P rovide 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 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 POWTS INST LER POWTS MAINTAINER Name Name Phone ?1S_- 6i"_ 1637 1 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORI Y Name Name S ?, Z6.41 Phone Phone 71s S rc ( N This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ,tt OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 1 l 3 L LtA� Property Address J - P - ri Aily 42 • (Verification required from Planning Department for new construction) City/State NLW K� C h -d Parcel Identification Number b24P- �b2� 'ZO -t902 LEGAL DESCRIPTION Property Location -S& '/ .51) '/ 4, Sec. ( , T 3 N - R f e W, Town of �r�n w%." Subdivision 71 no'- Vaa hem , Lot # Certified Survey Map # , Volume , Page # Warran ty Deed # u55154 , Volume Page # Spec house ❑ yes 12 no Lot lines identifiable ❑ 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. irem and agree to maintain the Uwe, the undersigned have read the above requirements gr private sewage disposal system with the standards P 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 yearhxpiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all stateme on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property describe bo by vi a warranty deed recorded in Register of Deeds Office. Y SIGNATURE OF APPLICANT DATE * « * *** An y information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. «« 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 VOL tfAJPAGr 567 ' STATE BAR OF WISCd�SIN FORM 2 . 1999 THL EN 1 rJ' KATHLEEN H. WAL SH Document Numbe WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Hillvale Development Limite a RECEIVED FOR RECORD Minnesota Li Liability P artnership, 08- 07-2001 9:30 AM WARRANTY DEED -- — — EXEMPT N Grantor, and Halle Builde Inc. CERT COPY FEE: � - - -- COPY FEE: TRANSFER FEE: 252.00 — —__ —_- RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in S Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lo10l 7 and 17, Pine Valley Addition, Town of Richmond, St. Croix Name and Return Address County, Wisconsin. KRISTINA OGLpIND ESTREEN & OGLAND 304 Locust HiAson. W1 1 026 -20 -000 _ Parcel Identification Number (PIN) This is not homestead property. 04) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of july 2001 Hillvale Development Limited ey: Ric S. Nelson AUTHENTICATION ACKNOWLEDGMENT Signature(s) Hillv De velopm ent Limited, a Minnesota STATE OF WISCONSIN ) Limite Liabil Partnership, by Richard S. Nelson _ _ ) ss' - -- County ) authenti led ti q day of July 2001 - a � — Personally came before me this _ day of p : - the above named - —' - -- t� �$.1G}EMIOR,S ATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. aut�'f&66'by § 706.06, Wis, Stars.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogl Notary Public, State of Wisconsin Hud WI 54016 _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) • Names orpersons signing in any capacity must be typed or printed below their signature. aMOrmar o P area one eom0enr, rya au tee wl eaoss5- W WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 I DEVELOPER /FUTURE OWNER: OWNER OF RECORD: HILLVALE DEVELOPMENT C.S.M. VOL 11 PAGE 3229 EARL k MARY ANDERSEN $ CONTACT. RICHARD NELSON 347 W. RIVER DR. P.O. BOX 10622 WEW RICHMOND. MA 54017 WHITE BEAR LAKE. MN 55110 ' bl PHONE: (651) 748 -0448 1 8 7 1 FAX: (651) 746 -044= � 1c -' ; u ASSUMED BEARINGS REFERENCED TO THE WEST LINE OF THE SW 1/4 OF SECTION 6, TOWNSHIP 30 N., RANGE 18 W., ASSUMED TO BEAR N00'25'01 "E. ( g NORTH GRAPHIC SCALE j 1314/001 xn o so m goo �- UNPLATTED LAND I ( DI FEET) I 1 2 I NORTH LINE OF THE S 1/2 OF THE SW 1/4 -- 1 inch - 100 It I I I •`1 33 33 j !0'55'11 2596.63' oo . „•� .Op 1 .00 32. 200.00 R sa 200.00 o m4.1e 16. sEUa+T 1 21LL _ aa_�Y I Z a � 96,648 SgFti \' \ W � -w 261 -72 BUILDING SETBACK UNE J / a _ 2.22 As* r• rra Jo 88,184 SgFI* c I W 2.02 Aces* ° a a* I E 16 3, r 8� 6G \" i' n .gt* !? Z 87857 SF �• v 2.02 Acres* + 87,920 SgFt3 [$� • . N R `\ g 202 Aces* z ��• C z z 99.396 SgFt* h !g \ 2.28 Aces* M Cs �` \ o 33 3311 z / 17 \ �� ��� i? 12' UnuTY EA NT I o 117 o Ac \" `hF �� tiy" �� c23 154.66' - -- - 2oaoo' ' - -- zz7.00' - -- t o n J - - - - N89'21'40'E 581.66' I� b _ -_ 765.22' 615.14' 8 t ur n N89'21'40 1693.12' j I o I I I 33 I N LAND I W LOT 1 I a 1 o I w CURVE TABLE C.S.M. VOL 11 PAGE 3031 I I �•I I n To Out Cu- Lot Tangent In Chord Chord Arc Tangent Out Delta Radius Odta h Longth Bearing Number Number Bearing Bearing Length Lenalh Bearing r? < Y 361.06' 31`00'55' N59'24'06'E 18 16 457.00' N6478'40'E N86'0840'E 334.98' 34297 43'00'00" S72'21'20 "E LEGEND: 6' 193.44' 787700" N73'48'01'E 19 5 428.00' 572'21'20 "E S6343'20 "E 128.49' 128.98' 17'16'00" S55 `05'20 "E 8' 167.62' 14'23'55" N59'24'06'E 20 17 362.00' S72'21'20 "E S6343'20'E 108.68' 109.09' 17'16'00" S55`05'20'E Denotes County Surveyor's 6' 3%.79' 31'00'55' N59'24'06 "E 21 3 -4 279.00' 555'05'20 "E S7251'50 'E 170.35' 173.11' 3573'00" N89'21'40 "E Monument (unless noted) I I Lf- '5' 262.25' 2019'57" N69'55'04'E 22 4 279.00' 555`05'20 "E S68 '12'31 "E 126.66' 127.77' 26 '14'22" S81 19'42 "E Denotes 1' Won Pipe Found Y 66.02' 5'09'38' N64'45'26 "E 23 3 279.00' 581'19'42 "E 585'59'01 "E 45.29' 45.34' 9 '18'38" N89'21'40 'E (unless noted) I 3' 68.52' 5'21'20' N5924 06 24 17 345.00' S55`05'20'E S7251'50 "E 210.64' 214.06' 3573'00' N89'21'40 "E 1 I 0' 12257' 13'10'32" N7274'38"E 25 14 283.00' S22'39'45'E S1322'17'E 91.38' 91.78' 18 504`04'49 "E 0 Denotes 2' Aron Pipe Set I 5' 107.39' 13 '10'32' N7274'38 "E 26 10 217.00' S2279'45'E S13'22'17E 70.07' 70.38' 1874'56' SO4'04'49 -E Walghing 3465 Ibs /ft. I I, 1' 64.66' 7'55 `0 58" N64 - E 27 14 80.00' SO44'49'E 52676'54 "E 61.32' 6293' 45`04'10" 549.08'59 "E C22 Denotes Curve Number I I M s' 73.80' 755'58' N6478'40 - E 28 10 80.00' 504`04'49 "E 518'2716 - W 61.32' 62.93' 45'04'10' 54059 - W (see curve table) LJ '6' 392.51' 43-WOO S72'21'20 "E 29 10 -14 80.00' 549'08'59 "E S8555'1 1"W 113.00' 377.18' 270 `08'20" N40'59'21 "E I I I Q 6' 183.80' 21708'09' N84'46'49 "E 30 14 80.00' S49 `08'59 "E S33'05'48.5'E 44.24' 44.83' 32'06'21" S17 `02'38 "E - - - - - Denotes Utility Easement 1 D_ ;2' 208.71' 2251'51' 572'27'20 "E 31 13 80.00' S1 7 `02'38 "E 509 '16'55'W 70.96' 73.51' 52 S357 (12 feet M width unless noted) 6'28'W I 1 32 12 80.00' 53576'28 "W S79'38'38-5'W 111.22' 122.97' 88`04'21" N56 '19'11 "W -- Denotes Building Setback Line 1 ,3 N I 33 11 80.00' N56 '1 9'11'W N30 '11'52 "W 70.45' 72.95' S2 '14'38' N04`04'33 "W I .Y .-I 34 10 80.00' N04`04'33'W N78'27k4'E 61.31' 62.92' 45 `03'54" N4059'21 "E 87.857 aZt Denotes Total Lot Area 0 vartkd Datum Is U.S.G. 1929 Adpstment I Ig I NI Other Lot Comers Are Monumented With I I Ito 1' X 24' kon Pipe Weighing 7.73 Ibs /fL I I U Distances are computed to the nearest 1 04 0.001' and measured to the naorest 0.01' j I F- LOT 3 Angles we computed to the nearest OO UO'00.5 . j 1 Todd M. Hendershott, RLS 2362 and measured to the newest 00`00`05' I Registered Wisconsin Land Surveyor 1 331 3S 597 Doted this _ da of 20_ I - -- SOUTH LINE OF THE SW 1/4 - - 1 L _ _ N89'21'40 "E - - 1957.90 -. - .- .- .- .- .- .- .- .- ._.- .- . -. -. -. .- .- . -._. -. _. RR 166 SEC 6 NTH VA ENUE _ _ _ S P IKE - - - - - - - - - - PREPARED BY. The followin note is to be Pla an deeds for future lot buyers: Subject to notes, restictions and any easements, covenants and right of i but not limited to those for drainage, w VALLEY ADDITION water r rettention, paneliondi g and ng, and o ututilities e as shown an the Plat of PINE SURVEYOR: 1��/ "R O with recorded n ded Volume _ Poge St.Goix County, !ranoga and Wisconsin. Todd M. Hesdsrahott A to bulding Metro Lond Survcying k Engineering ny pond 412 County Rood 'D' �� �7��yp�y�� arts, Dorms or Lot owners should be odvised that there are Forms in the surrounding area Little Canada. MN 55117 I.AL \L s7 JRVL MG and that this subdivision may be subject to poesible Form An" sounds �(�` �'�. and smdls. Todd M. Hender9hott Sheet 1 of 2