Loading...
HomeMy WebLinkAbout026-1173-39-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ` INSPECTION REPORT Sanitary Permit No: 463163 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: Waldroff, David Richmond Townshi CST BM Elev: Insp. BM Elev: BM Description: nn Sect nlrown /Range/ p No: 1 — G D� m 1 T 21.30.18. TANK INFORMATION ELEVATION DATA ( �Li TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark e�w I ( 0/y \ 1 4 104 'Idis Q>asipg 4 Alt. BM 1 `tom 3 1do , k� Aeration Bldg. Sewe C1` S Holding St/Ht Inlet / ' S 9_7 9 St/Ht Outlet TANK SETBACK INFORMATION 9 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Z i A) A- s /'5 Dt Bottom ` Dosing Header/Man. % Aeration Dist. Pipe 1 Holding Bot. System C Z ! q , " Final Grade 1 ' PUMP /SIPHON INFORMATION 5 (8 . 5 Manufacturer G emand St Cover � � led, Model Numb TDH Lift Friction Loss Syste d DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z ( CZ� Z "� _C SETBACK SYSTEM TO V P/L JBLDG IWELL LAKE /STREAM LEACH G Manufacturer. - /( �� ,1 INFORMATION CHAMBER O t ✓`� C �l Type Of System: G / ! A) i7 Model Number: 1 DISTRIBUTION SYSTEM hh- Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake_ f 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 A 7 Bed/Trench Edges \ Topsoil � Yes [] No ^I Yes L No COMMENTS: (include discrepencies, persons present, etc.) Inspection #1j /()q Inspection #2: / / Location: New Richmon WI 54017 (NW 1/4 SW 1/4 21 T30N R1 8W) Waldroff Meadows IV Lot 39 Parcel No: 21.30.18. // 1.) Aft BM Description = JT C610Z �� Soh-` 2.) Bldg sewer length = Z7 I - amount of cover Plan revision Required? ,yes No Use other side for additional information. SBD -6710 (R.3197) Date Insepctor's ignature Cert. No. Safety and Buildings Division — -� County AM ' 201 W. Washington Ave. oxE62 ' Y n�!C' _--� ,sO�S,� Madison, WI 537 7 - 7 tary Permit Number (to be filled in by Co. j Department of Commerce (fig) 266- 51 �V Sanitary Permi U(`1 S�� PI I.D. Number T— In accord with Comm 83.21, Wis. Adm. Code, person t provide 1 2 ©� may be used for secondary purposes Privacy Law, s15.0 ) ST. CROIX Project ddress if different than mailing address) - -- OONT` I. Application Information - Please Print All Information IC QitA Property Owner's Na me _ Par ei # of # Block # I Property Owner's M ailing Address Property ocation _ ^� City, State Zip Code Phone Number � I - circle o II. Type of Building (cheek all that apply) � T. N; R 1 � E o �erS vwr im l or 2 Family Dwelling - Number of Bedrooms Subdivision Name ^ CSM Number Public /Commercial - Describe Use _ ( � "4 L Slate Owned - Describe Use i `TY`V ❑City_ ❑Village 9-6ownship of� _ III. Type of Permit: (Check only one box on line A Complete line B if applicable) A. New System 4 ❑ Replacement System ❑ Treatmenttliolding Tank Replacement Only ❑ Other Modification to Existing System 13. ❑ Permit Renewal I ❑ Permit Revision ! ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ! IV. Tyke of POWTS System: (Check all that a 1) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < in of suitable soil ❑ At -Grade ❑ Single Pass and Filter { ❑ Constructed Wetland ❑ Pressurized in- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit D Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter &eaching Chamber ❑ Drip Line ❑ Gravel -less Pipe L 1 Other (exp lain) Y. DisIx wsallTreat ment Area Information: 0 Design Flow (gpd) I Design Soil Application Rate(gpdsf) Dispersal .Area Required (sf1 I Dispersal Area Pr sed stem non VI. Tank Info Capacity in Total Number Manufacturer r Site_,_.__.._ Steel Piber plastic Gallons Gallons of Units !! Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank f ., Aerobic Treatment Unit Dosing Chamber 1 VIL ResportsibiHty Statement- I, the undersigned, assume responsibility fur imilallatio of the POW TS shown on th attached pl ans. Plumber's Na me (Print) Plumber's Si gnature MP . PRS Number Business Phone Number :��L6 . zi Inn ak� Z4� i ax 7 - Z F".-- y��l + Plumber's Addre ss (Street, City, State, Zip Code)) VIII. County/Department Use Only_ Approved I ❑ sappy Sartitary Permit Fee (includes Groundwater Date issued -- sui Agent Signa a (No Stamps) Surcharge Fee) z��.�_ ❑Owner Given Reas or Denial 2- T _ IX. Conditions prov /R o val SYSTEM OWNER; 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach Complete plaits (to the County only) for the system on paper not less than 81/2 x 11 inches in size •• 1 .. . . .. .......... . . .. .. . .. .. . . .. O ld O OPT'' �'� ° 5 � �^ r V IZI � o z i Wisconsin Department of commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and PSI I.D. Pending percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Y Revi d b Date please p all Personal information you provide may be ed for secondary purposea'(Prlvacy Law, s. 15.04 (1) (m)). p fl Property Owner Property Location David W drof Govt. Lot NW 1/4 SW 114 S 21 T 30 N R 18 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 398 Rive d ZONING OFF!' 39 - WaldroffMeadows IV city State Zip Code Phone u ° -- -- ihr []Vllage ■ Town Nearest Road Hudson WI 1 54016 ( 715 - 549 - 6601 144th Avenue a New Construction Used Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement 11 Public or commercial - Describe: Parent material Loess over outwash sands Flood Plain elevation if applicable ft. General comments and recommendations: Ong # 11 Boring Q Pit Ground surface elev. 103.10 ft. Depth to limiting factor >94 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff##2 1 0 -7 10yr3 /2 - sil 2msbk dsh as 2f .6 .8 2 7 -13 1 1 4/4 - is O ds cw if .7 1.6 3 13 -21 7.5yr4/4 s Osg dl cw - • 7 1.6 4 21 -34 5yr4/6 cos Osg dl cw - .7 1.6 5 34 -94 7.5yr4/4 s Osg dl - - 7 1.6 ❑ 2 Boring # 11 Boring 105.35 >94 Q 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/fP �^ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -12 10yr3 /2 sil 2msbk dsh as 2f .6 .8 2 12 -22 1 4/4 sil lmsbk dsh cw if 4 .6,�„ 3 22 -32 1Oyr4 /4 is Osg ds cw - .7 1.6 4 32 -36 7.5yr4/4 s Osg dl cw - .7 1.6 5 36-46 5yr4/6 S Osg dl cw - .7 1.6 6 46 -94 7.5yr4/4 s Osg dl - - .7 1.6 * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BO %:S 30 mg& and TSS < 30 mWL CST Name (Please Print) Signature � CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI September 8, 2004 715- 246 -2454 i Meadows ff N Pending Properly Owner Waldro Parcel ID # Page 2 of 3 F 3 Borin # Boring g Q pit Ground surface elev. 99.90 ft Depth to limiting factor 92 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -12 10yr3 /2 - sil 2msbk dsh as 2f 6 .8 2 12 -19 1 4/4 - sil lmsbk dh cw if .4 .6 3 19 -32 7.5yr4/4 - Is Osg ds cw _ . 7 1.6 4 32 -9 7.5yr4/4 - s Osg dl - - . 7 1.6 E --- T 1-1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 17 Boring # 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 GPQtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '01#2 ' Effluent #1 = BOD > 30:5 220 mg/L and TSS >30:5 150 mgA- " Effluent #2 = BOD < 30 mglL and TSS _5 30 mg1L 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 - 2648777. SBD- 9330TCA (R.07/00) f Meadows 'Waldro IV f Lot 39 N 01 X04 t31 f lol' jo�� SE ldl boo Cdane�. S 1' = 40' Z� op of iron pipe 1 00.00' . 0p of iron pipe 105.50' B1103.10' ---� 82105.35' B3 99.90' Thomas Nelson 7 227387 S%PTrc 'S PUM y�-�r"�� cR455:C"C) Mrv �YL�lri�nllu.� u" CI' VENT PIPE '12 PION: 'ABOV GRADE WEATHERPROOF >_ 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK I j FINISHED GRADE WARNING LABEL 41, C I RISER MIN- 18" IN. 6" MAX. sat NLET WATER TIGHT SEALS GAS - 7- TTGHTi VED A SEAL JOINTS WITH PPROVED ..� ; ALM APPROVED PIPE I P 3' -- ON 3 ONTO It SOLID sort 4TO SOLID r OIL PUMP OFF ELEV . FT. --- ! OFF Pa RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED_ BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: a NUMBER LOSES PER DAY: TANK SIZES SEPTIC GAL. DOSE VOWHE INCLUDING DOSE GAL. FLOWBACK: GAL. CAPACITIES: A INCHES = _„ GAL. ALARM MANUFACTURER: ) MODEL NUMBER: � v_,_,,,�..... S 2 INCHES 2 32 GAL. SWITCH TYPE: - �--- C INCHES =GAL. POMP MANUFACTURER: MODEL NUMBER: o D w ..SG._ INCHES = SWITCH TYPE: /;Pfl �"� REQUIRED DISCHARGE RATE _ GPM PUMP B ALARM WIRING AS PER ILHR 16.23 WAC ,� F£E VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE FE£T + FEET FORCEMAIN X FT /19D FTOTAL DYNAMIC EAD + x . ?,S -FEET DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: LIQUID ISEP�A w ,. • �C..�!�. / LICENSE NUMBER: g..2..? Qa0 DATE' -y ,C. • SIGNED: ..�..... ---- Ic PUMPS [I GOULDS Submersible Effluent Pump EPO4 4 f 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing Pe Y 9 lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion �� • Farms manual operation. Auto- resistance. • Heavy duty sump matic models include U Motor Housing. Cast iron (CSA listed model numbers end • Water transfer Mechanical Float Switch in "F" or "C ".) • Dewatering assembled and preset at the for efficient heat transfer, factory strength, and durability. SPECIFICATIONS ■ Motor Cover Thermoplastic Goulds Pww is iso 9001 Re*wed- FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. '/•" maximum. ■ EPO4 Impeller: Thermoplas- N 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. I Ili" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104 (40rQ continuous METERS FEET 140OF (60°C) intermittent. 10 • Fasteners: 300 series stainless steel. s 30'x--- „- —► �- s GPM • Capable of running FT dry without damage to e ; zs components. 25` 2 _ Motor: • EPO4 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 s RPM, built in overload with _. automatic reset. q EPOS • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, 3 t o - - -- __ _ built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot s 1 . standard length, 16/3 SJTOW with three prong _ _ GPM grounding plug. Optional 20 ° 0 0 10 20 3 40 SO foot length, 1613 SJTW with three prong grounding plug o 2 - a 6 8 10 12 ml/h (standard on EP05). CAPACITY Goulds Pumps ITT Industries C) 2000 Goulds Pumps <�> Effective February, 2000 838 71 = uick4 STANDARD CHAMBER -- — Quick4 Standard Chamber I - - ---- ---- 48„ ----- - - - - ~ - i (EFFECTIVE LENGTH) "'a t t I r f t � I I 1 4 2 " I 1 1g _111 107 OW at— SIDE VIEW SECTION VIEW MultiPort End Cap - -—___ r - -�— 34' — -- SIDE VIEW TOP ViEW FRONT VIEW >.,. '., �? Quick4 Standard, Chamber Nominal Specifications" �k` } 1� f , , Multipart End Cap Nominal Specifications .:, Size (W x L`x H) _ 34 x 5 2 " x 12" Size W x L'x H) " " 34" x 16" x 12" Effective Length 48' Invert Height 8" or 1.25" Invert H 8" INFI LTRATOR SYSTEM INC. STANDARD IN WARRAN (a) The geuclurai inlNity of each chami'ler, end plate, wecig0 and other acoass[,ry mlrnufac o td tN'nfitrator (`t -'nitE f. when ir :N Id ofrralRd iris IrnChrield of an 0nsde saptic 6ySiP.in ,n arcordince with Infillralor S i � >(ruC140rrs, rs warra,He[1 tc. iha nrigihal o.n:i sal ('1-t0lder'1 aeainsl , hHacl'rve e,nte alp and workmanship for one YEW Irom lha date, that lhf. sept, permit,", Issued for the sertic system C <xltairtli It*, Uhirs; Provded, Yn ar, that it a seplic permit is rxlt w4uired by applicobla taw, the wh'raniy penrtil w04 begin uprnn IN) date that insts4atlon of the s®pLe system wn;men095. lr; ovowAse its wamanly fights POIr m must notik sifitlrator in wdl N at its C rporale Haarktu,u!ers in Old Saybrook, Cz nirmfinut n,lnin frosesr, i f 5) L oll ] days of the all[x1ed delimJt. lr taw will supply teoLr.- B+nE"d Units ten \Snits determined nit nfiCratlor to be covared by ;his Limited Wananly InN rat.'s haheuy •,p.,olic W eYCkdes the cest M (em-1 and or mstailatnar of the UnRa. , Tit Ir Llffl l F, W4 LIDNG I ANn REA l =C"ES IN Sin, CW MFR( HAT i JTA 4RC [ Y OR f 1 N S E I+ZRE. nf.6 tvO J7tlan WNa Wrirl RESPECT �` l � I I(J I HF Una N +�LUD h3 NO iMFLILL HbARRANIIE� OF FNr.,fIJL IN pn F n ky1HrIC UL/U? f'JftPC I', Y (rl Th s L r t l tit Wam Ady h .0 be v nic3 t " y pad Of tt ,`iaetbe system is , ml Jlactumd by 1M GM ether Iha l l fl ,nor Ting L"pitlyt W.ananty Mss r nvj nor 0 x 100'.rn t_ . r,(b. Jr�JQJe flat IleL ,x ndreCl t!amatps, Infolrnc IN not b0 able • f0, penalte , iqu n,mapo1 includ E/Q(� enta' f �wte w/n`1mww so'uthwie pr:xltl 10 d Pmf tS. Iakrx and 1 a:P tats, Jvgd"`ad `*$" "04"01 IQSS08 to exit' - 17-11 i ncl "md by the Molder 01 any Ih"d pally Spleclilcally rxnludo f 'r .n Lim a S Warranty l IX uP age are dsnvyge to the Units due to ordinary wear am ! lear, alteration aceidgnr rnlsusg abuse or neglaCl of n untq ti n uril 6e P subj ecte1110 qr, IF trallic 0r other condillon v s which We no t oermed Iry the installation insmlM ons, laikrs to maintain the 6 Business Park Road • P,O, SOX 768 inimrm around cover sof forth , the insladlaticln instrue'lions; if*, effacement of OPrtSPet Mil* Bits into lie sysem corllafri the Unae lai re o of iha Unit; o the septic system due tr, improper siting or hnitmper sizing, excessive water It 90, Impmper gret ie disposal, or impropc opereticr;; nr Ofd Saybrook, CT 06475 any other avenl not caused by In11h alo Ignited r, This Warranty shall be void if the Holder fails to crmply with al! 01 the terms sat for," rn tt�rs Landed Warranty. 860- 577 -7000 •FAX 860- 577 -7001 medrier, i n no event shafl In!iltram, txt rtly7rnaibl9 t0r any loss or darlsge to the Helder, the Units. or bay th"d party ms fling from instaila!t0n �x ship. p]� /�I� /�'c airy pxcducA iiaS>aity Gains 0f Holder ry any Ihhd Party for Ihis Limited lVamanly 10 app the inks must be installed '1n a,xordyl0o 8t)i� -2,2 �4 V win, all wile non(fil!one raelu;rat 6y state and Ili cods-: A oiler applicattlq laws; and 1.6f installallon instrpolvnn9 id) No rrlore5en"ti�G of tnfllitalm has the aldh.lilY to ahcnge or exlend this Li,nited ylramanly No waranty APPNea 10 em Pony onmr than the wtgr hill Hoiden. Pttt above mtlNeW[x , the, Standard Limited Wahanly oBererl by InfiAralOr A linwlal number 01 slates end Cwnlias Nave different warranty rep im- moms. Any Purchaser of U"Rs should oontacl h Corporate Heodquarters in Old Saybrook, COnnectCUI, prior to such Cemharf., to obtain a OnPy of Iha applicable warranty, and should Carstuhy read the; warranty prior to the Purrha',e 01 Units. US. Patents: 4,759,661; 5.017,041 :5.156,488; 5.336,017; 5,401,116; 5A,,1,459; 5,511.903; 5,716.163; 5 „588,778; 5,839,844 Canadian Patents: 1.329,959; 2.004.564 Other paloiits pending. Infiltrator. Ecttialji and Sid W trademarks of are registered trad of Irtf&a a Systems M, i7flibot0f is a regisieracl trademark in France. Ir,141ralcrr Systems Inc. is a registered tra• "ernark in A4exiCO Contcwr, CorNOiir Swivel Connpcl M:ri:Lenct „n,a ❑01yTuff, $rkapLcck, Cham6e, Spacer. PosiL(X1k, QuickGUf. GAHekPlay MEGMeOPAPER and Quick4 are tads narks of Infiitralor Systems Ind Q 2003 !ntiIIrator 5y &!ems Inc. Pmted in U,S A, I Y POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page i— of 2— FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ga l E) NA b Permit # ? 3 Septic Tank Manufacturer G►Se r ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 6 e. © NA Number of Bedrooms 3 ❑ NA Effluent Filter Model I4 4'Q ❑ NA Number of Public Facility Units ❑ NA Pump Tank Ca pacity G gal O NA Estimated flow (average) f?0 Ilda Pump Tank Manufacturer fe D NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA Soil Application Rate al /da /ftl Pump Model O NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit ; NA Fats, Oil & Grease (FOG! <30 mg /L D Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection O Other: Pretreated Effluent (duality Monthly average Dispersal Cell(s) O NA Biochemical Oxygen Demand (BOD : 530 mg /L P'Jn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /1OOml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ® NA Other: A Other: ❑ NA Other: PA "Values typical for domestic wastewater and septic tank effluent. Other' NA MAINTENANCE SCHEDULE Service Frequency Service Event Ij monthls) (Maximum 3 years) p NA Inspect condition of tank(s) At least once every: 3 ear(s) Pump out contents of tankls) When combined sludge and scum equals one -third (Ys) of tank volume O NA Inspect dispersal cell(s) E3 month(s) (Maximum 3 years) 0 NA, (s} At least once every: Of year(s) monthls) ❑ NA Clean effluent filter At least once every: I Mvear(s) O month(s) © NA Inspect pump, pump controls & alarm At least once every: ❑ years} ❑ monthls} ❑ NA Flush laterals and pressure test At least once every: ^— p ear(s) ❑ month(s) ❑ NA Other: At least once every: ❑ yearls) ❑ NA Other: MAINTENANCE INSTRUCTIONS individual carrying inspections of tanks and dispersal cells shall be made by an ying one of the following ftcenses or certifications: Inspector; POW Maintainer; Septage Servicing Operator. Tank Master Plumber; Master Plumber Restricted Sewer; POWTS 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 celi(s) shall be visually inspected to check the effluent levels in the observation pipes n d 10 check tion for aequ red th of effluent on the ground surface. The ponding of effluent on the ground surface may indicate 8 immediate notification of the local regulatory authority. re of the tank volume, the entire When the combined accumulation of sludge and scum in any tank equals one -third (Y,) or more contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. mechanical or Ma ed to months, the ahail a f effluent filters, by a certified POWTS pressurized ntainercomponents, pretreatment All other services, including but not limit units, and any servicing at intervals of 5 days of completion of any service event. A service report shall be provided to the local regulatory authority within 10 r r •apoo 8A!leJls!u!wpV u!suoas!M '1£3'S {Z) '1 tlti9'£8 two l ;J'8{pN lHq!{ZIZZ'£8 wwoa iaide4a 4V* eoue!ldwoo ul P8349,11) ssn� lueurn0op S1 n0 a Q r J � BUOt� , euo4d /(V6� 1(Y rlgD 7C! ftD eweN eweN F AlllIOH1nV AaO1V1l103ti 1V0O1 ia3dmn volVa3d0 ONIOIA313s 3t)V1d3S 9uoyd 9 u 0 4d eweN ,'I ?, 9uieN 93NIVINIVW SJ.MOd 9311VISNI S1MOd S1N3WWOO 1VN0WGGV '318ISSOdWI SO m313dld 38 AVW XNVl V d0 VOWUNI 3Hl WOW NOSH3d V d0 3n3S3V '11f1S3N AVW HIV30 '33ONV1SWt om ANV OCINn XNV11N3 IMA ISH10 VO dwnd '011d3S V HUN3 10N 00 'N39AXO 1N313lddnSN1 1:10 /aNV 33SSVO WHIM N1VINOO AVW SSNVI 1N3W1V31i1 113H10 ON < <Wnd 'Of 3S •awti 1e41 le Joe ; ;e u! solni eyi 41!m Aldwoo isnw swaisAs Lions ;o suoiioni •eoe}ins entieill! ;Uj a4l ie iewo!q 944 W Inowei ButMollo; scold ui polonusuom eq Am swelsAs uotidiosge pos opeiB -le pue punoW ❑ e jUei el!s 9,q.L ❑ ol!s pU S1MOd p011e; 941 eoeldei of iios9i 1901 0 se pelleisu! eq Aew )fuel Bufploy a ABolou40e3, S1MOd. ul saouenpg Butiieg •suo1191lw I!OS io /pus iloeglas of enp elgel!ene 1ou at e9ie iueweaeldei olgel!ns V ❑ •ow!1 1e41 le ioo;;e ut solni ayi 41!M Aldwoo isnw sweisAs luGwooeldet eoie iuew90eldei elgellns 9 4stigelsa o1 uo!lenlene alts pue 1!09 Meu a io; poem 9141 ut llnsai ]Jinn e 9i e lu aweaeldoi 941 i oeioid of e •s119m pue sautl 101 'ain lonils posodoid pue 'Butislxe woe; sjoegles p9itnbei Aq uodn pa8uti ;u! aq iou pinoys pue uo!10edwoo pue eoueginistp woi; paiooloid aq pino4s e9ie ivaweoeidel ayi, •weleAs aq soy 8818 iueweaeldai ef4e uo!idaosge 110s lueweoeidea a ;o uotleool 041 Jo; pezlltin eq Aew pue peienJena u9 s V :weisAs 4 usuieaeid9i lueildwoo apoo a ep!Aoid of 'uplei aq lsnw'io 'uoog ene14 sainseaw 5u!nno11o; ayi peiledei aq iouueo pue si!g; S.L/IAOd 0 41 it NV1d ADN30NIINOO •letieiew p!los 1i 9U1 1ey10Ue io JeneiB 'I!os 411M p8l14 aoeds ptOA 941 pue paA0w9i si9AOa i1e41 io panowai pue pe leneaxa aq Beys slid pue sjuel }le 'Bu!dwnd 1814V • •ioieiado Bu!o! obe ;deg a Aq ;o pesods!p Apedoid pue paAOwai aq Keys si!d pue s3uei pe ;o slueiu0a 941 • pelges sButuedo edld peuopuege ayi pue pal0auuo0slp aq Heys sl!d pue sluel o1 Bu!d!d 1IV e :apoo eA!leilsturwpV utsu002tM '££'£S wwo0 iaide4o 4i!m 9oue!ldwoo u! peuopuege Ale ;es pug Aliedoid ,t walsAs ayi 1e41 ei nsu► o ua�sl eq 1104 sdals B ulMollo; ayi aot ;o ino do l el Allueuewied s! io/pme 9 11 8 ; S1MOd 043 Ue4M 1N3WNOONVSV •9wiq i9u9i ;0s ia1 pue :suodwel :sut�Jdeu Aie i!ues Nepiopsad :sion Buliu!ed :]!o :suo!1e0!paw :sdeias ieaw :sep10!gie4 :ese6is :gullose6 :sButlead algel98aA pue i!ni; :i9i Id dwns) uleip U0 1 lepu no; :lei aiuei0e ;uts!p aiede!p S SOI; leivap :sieseaiBep !sgenns uolloo :swopuoo aunq altaie8t0 aadtM Ageq aotlolq!iUe S 1MOd 841 ;o ON a41 Buoloid pue eouewio�ed aq1 enoidwi Aew weeps ia1emaisem 9141 w oi; Bu!MOl]o; 841 ;o uo!ieutwlla io m0!10npea •eeie uo!ldiosge I!os apeiB - 1e io punow Aue ;o adols u lee; g l u!43!M eaie 94i 'ioedwoo io ginis!p es! io 'igA :lied io entip 1ou 00 •sllao Iesiods!p pue s)tuel iano SOJO149A )lied io 9A!ip iou 00 - jue1 dwnd ayi u!41!M 519AGI JeUJiau 9103891 o1 slaiimoa dwnd ayi Bu!leiado Allenuew ul 1s o1 ieutelu10W S1MOd io iagwnld a 10eiuoa io dwnd iuenl ; ;e 9 41 of i9M Butioisoi of iotid ioleiodp Buto! ebeldeS a Aq penowei duel dwnd ayi ;o sivaluoo 941 9Aey uoilemis styl p!0Ae o1 'W911114 ;o e8ie4os!p eaepns io d oeq 94 u! l lnsei Am pue (s)1100 941 8u!pe0l 'asop eBiel 9 uo u! (s)pao le sio dstp 94 of PGBJ940SIP eq 11!M iaienneiseM ss90xa ey paio st ieMod ueyM •slenel ielenny814 ]ewiou enoge 11!; Aew s:luei dwnd se8eino ieMod Butina •eoe ;ins aA!leul!lul 041 le uazoi; eie suo!i!puoo pos ua14M inaoo IOU Heys do B ois wa1sAS •esn o1 ioud ioleiedo Bu!o!Aies e6eldes a Aq penowei MMLIel 0 41 1 slu9lm00 941 9Ae4 pelaelep 9ie suatieAU"Lloo Ott ;I •(s)pea tesiedstp 041 eBewep Jo /pue sseooid luewieail vy1 apedwt Am le41 sleotwe40 19 i0 913npOid BUliuled ;0 9ouessi 9141 i0; (s):Jue1 lmawleeii X10040 S1MOd eyi ;O esn O iclu 'uo!lonilauo0 Meu iO� Nomvv3d0 am d111l;V1S ;0 aged i ST CROIX COUN'T'Y SEPTIC TANK MAINTENANCE AQREBMENT . AND OWNERSHIP CERTIFICATION FORM Owaer/Buyor Mailing Address `G �d g S Property Address (Verification required from Planning Department for new construction) Cit3atate Parcel Identification Number LEGAL DESCRIPTION Pr+Operty L*MdOn V S y Sec. -1 1 . T � N R, ,.W, Town of ) -4 kw Subdivision /J)./Zro ,, E CG D WS" . Lot # -3 CertltMed Survey Map # . Volume ­ . , . Page # Warranty Deed # _ - t�h; 7Z 3 . Volume 1Y- 7 . Page # 2l Spec house Cl yes k no Lot lines identifiable 0� yes O no HAMRUM Improper we and maintenanoc of your septic system could result in its premature failure to handle wastes. leer maintenance cowirta of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can slyest die tiraation 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 maatoepltmrber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -situ 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 bave read the above requirements and agree to maintain the private sewage disposal system with the stsudards set forth, Herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Cerdfieation dating chat your septic system has bean maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the throe year expiration date. SIGNATURE OF AP CANT DATE OWNER 0 CA7' N I (we) certify that all statements on this form arc true to the best of my (our) knowiedge. I (we) am (are) the owner(s) of the prope�t described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNAMW OF MPLICANT DATE «•s «MS Any information that is rnis- represented may result in the sanitary permit being revoked by the Zoning Department- •e include with tWs application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey asap if reference is trade in the warranty deed /v F' 14 210 6:31 - Y.ATOLEEN H. WALSH REGIS DS OF DEEDS ST. CROIX CD., WI RECEIVED FOR RECORD This Deed, made between Edward Merkt a/k/a Edward J. Merkt, a single 12- 2x1999 10:00 AM man, Grantor, and David J. Waldroff and Julie A. Waldroff, husband and WARRANT( DEED wife, Grantee. EXEMPT N Witnesseth, That the said Grantor, for a valuable consideration conveys CERT COPY FEE: to Grantee the following described real estate in St. Croix County, State COPY FEE: of Wisconsin: TRANSFER FEE: 645.60 RECORDING FEE: 12.00 PAGES: 2 Recordin Area Name and Return Address BAKKE NORMAN, S.C. P.O. BOX 50 NEW RICHMOND, WI 54017 (see attached list) (Parcel Identificatlon Number) SEE ATTACHED SCHEDULE A. EXCEPT Lot 1 of Certified Survey Map recorded in Volume 8 on page 2299 as Document No. 464655, which was previously deeded to Grantees by Warranty Deed dated December 26, 1990 and recorded on December 28, 1990, in Volume 889 of Records on page 435 as Document No. 465220. This deed is given in satisfaction of the Land Contract dated December 4, 1990, and recorded on December 5, 1990, in Volume 887 of Records on page 615 as Document No. 464663. This is not homestead property. Together with all and singular hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, highways, utility rights and reservations of record, and will warrant and defend the same. Dated this _ ( day October, 1999.. 'Edward Merkt a/k/a Edward Merkt AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE of WISCONSIN ST. CROIX COUNTY Personally came before me this L*5 day of October, 1999 the above named Edward Merkt a /k/a Edward J. Merkt to me authenticated this day of known to be the person(s) who executed the foregoing jps jfument and ackno le�dge the same. signature signature type or print name type or tir ame H� TITLE: MEMBER STATE BAR OF WISCONSIN �� roix County. Wisconsin. (If not, rA5 ermanen not, state expiration date: authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Names�i "iin ' 1 g in any capacity should be typed or Timothy J. Scott rio�d tTBjo)y�t�tei 'g ures. BAKKE NORMAN, S.C. 1J ��,1 V . (Signatures may be authenticated or acknowledged. Both are not pi necessary.) Information Professionals Company Fond du lac. W soonsin 800 -655 -2021 q?AgE 211 SCHEDULE "A" Real Estate Description St. Croix County, .'� (All property located in the Town of Richmond, Township 30 North, Range 18 West) 1, The Southeast 1/4 of Section 17. , North 2, A11 that part of the Northwest 1/4 of the Northw f s iheOmaha Railway known and Vilest of the abandoned railroad right of way Hereinafter railroad tight as the Chicago and Northwestern Transportation Company of way). 3. The Northwest 1/4 of the Southwest 1/4 of Section 21. 4, The North 1/2 of the Southeast 1/4 of Section 20 EXCEPT that part located Northwest of the abandoned railroad right of way. 5 The Northwest 1/4 of the Northeast 1/4 of Section 20. EXCEPT that part located 6, The East 1/2 of the Northeast 1/4 of Section 20 Southeast of the abandoned railroad right of way. 1/4 o f Section p arcel 7. The Southwest 1/4 of the Northeasen Bader and Shirley BadeEinthe warranty described in the conveyance to Warr egister of Deeds Of deed recorded in the St. Croix County R fice in Volume 768 0 Records on Page 594 as Document No. 422339. g, ned railro *d All that portion of the abando right of way describedinEtdWa conveya erkt N from the Chicago and orthwestern Transport e »t No. 383796. ation Company o recorded in Volume 662 of Records on Page 349 as Docum parcel Identification Numbers: Section 17 026 - 1050 -40 -000 Section 21 0 026- 1050 -50 -000 26- 1064 -40 -000 026 - 1050 -60 -000 026- 1050 -70 -000 Section 20 026 - 1060 -20 -000 026 - 1060 -30 -000 026-1060-30-110 026 - 1060 -40 -000 026 -1 062 -70 -000 026- 1062 -60 -000 026- 1060 -60 -000 026-1060-60-110 T M G? Lj R'3 . �h io Z11 - r�3 Q ' �a r�i o ol.,•"7 ( i R Mp - ;� ^i0 ao N op n c o e4 w ri t?± ,�c3, -na�cV fiin ;rrNCnaC$ci d006 P4 -. uiM;tiodni... 'ri $�a 'oitn�dNodcti000 ��nwNnaRrfN# of d © ° r.'oo a d I (� a0 �YNNIV NIDNq►� :O • �1 It, J tppsla W 33a:�3W� � 0 a W W �� it Wp ~ ii gg N N Yj = � W wwwuiwac �p _gyp ■ s • � • = *6 + yi , p lu7Nr d NN ppqq��GO Nd XRQ�f, OD � m 1�OfC0!a • NEQ T f � CAJ{ �� V *1 C �v? + �' Nr In M NOO4 1h 4OK]C7_N �p ��ONfM�tOF�' OIQ►01Q`Q�Q�000 oai�Taco: into Yl Q� Q *►��7PKsr�r�MSapr�;�l;on+;•s;��n� 1 = n 4"14a ° d1�� W �Faf M�t�MJ�71�0Y0►CI�OOIp� � 'J, i(�,� W ozzz z i rnnilvS�ni�nzi° xav,nsv"'iinzzzzag c 1 �r CYM7 P�NM� orN r r N in .•1 N r7 d u� �O h aD 0 r � 2 M � irn a) N V) V� Vk Vl �n to V) tt� V1 1n � -7 7 ' � 7 3 7 � 5 1 _.--- __— ....._...—...__- -. _— _- - -..- —.� 1 1 r TS$£ 'mod - pT "ZOA ru ITS t iOz IMP . � • iL ' (sz'ats M..�staQVS? � � ,9�' BLS 3N99•BZo0p5 1 U- o �n •.. a 42 -� o k F in m Cn d \_ F„ to Ad- N , \ • • !r- i W O a r7 r I to \ \ 1 ,� I :•• *- as o C 9 r ! • a 1 �� � f. 1 �� �,� •,•mot � ;pfY i c)n j SUM 30 salsiDad LW M 5iL YVd 40:91 NON WSW /OT asekwsata , < -., _. ..... sak.0 <.,: -.' .. • •.,.. . , >tc <r., exc.NLilrt.kfr.:... :... .. .... ,. .. ,.. , ...... ,. ,. „t .>'1kt�tacf�1•s... `i•wr........e!zv���{. _ G, _.d�, �:;. rALY6 SNDILrOp3301gISV7y ro- 9t19w. I.w 8m�aeM REM IMPS sa��aosse� 1`d - 1b'NIJ i•0 —YfL9 ezy all s:o -.cw mw " � e -m-+tu a NA ''00 X10210 as 'ONOWMOIN .40 NMOl 'MOTS 'NOQ U $ OZ NOLL03S WOW m" un- nL -nL1a AA08(]IVM 3AVC1 sN non n •wMe InlN n •I•••. S ;k. =mcl Al SMOOV3W A.JO80�`dM srr u.lLrwo >�ei'n �n WNW" .00.99 •�..i1,� -,i a.99,caoos 1r 7Nn GL +v,m HORN 20 jt jniyW,•�,1,yy�1yW, ki;•. t'•. � d Ot ,t,t Ji �I0.1 OI �lal F1 i f� Cil MIR lyqls*o 101 Lij .9L'IL91Y.99.tZ.00t I °1 I J, NI \ \ bL NDOA7t A ♦/W 7NL�71f U \ Am 7NL OA 0ommom 7w SONNM - 10A TV S� \ f lag 1 .a aid � \\ \ \ �� Z 10l R g •� 0 4.1 2 000.1 YL RI .9 a.99,cabos ONVILVA 31SYMYN NON I i ii 1 St /us — • }95a � tt � I .LYTLfI �34r fl2 b 7Nfl 1M Di ii g9 SUN Wd Rigi ILA _R I I I i � Q� CLI . 19 tneo Q o� Ut I t \ \ \ I a MIMI IN oil g '\ WOM41 3".9r. \ \ k — �'♦ b 41 \ � rr 4 "LW •''� �. \ A1.M i si t ......... •.�. I N s n \ b \ .LE'B09 N4.f C.f tAON S \ \ ��� ' \ \ 6 ¢ t �e� A 7161 AUR ---- -- f 101 r :, I oi �I