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HomeMy WebLinkAbout026-1068-90-000 . ...._ _._ /k�'ic -0 o / Lo� r � § f _ / ( 0 ® 0 ° & E § a m = m + / -` § \gam �9 §» 7 / i § : I � • /;; & o § Q 3 . (D ■ 2 = z > E % \ \ CD a >} e $\ \ _= o o = H CL k \M / k / CD § E CO) # ® ■ r a "*A, j 0 0 0 2 .. / / \ CO) CO) CO) \ $ E 4E 4� k 03 a , k I E \ § @ - K \ � E \ & \ I 0 \ � � I \ § = f � / \ _ \ \ 3 § \ k k / ; 0 [ \ s: z E P 2 � 0 . 2 2 i / z ; } : z m o $ 3 z $ CD � co \\\\)� § " } :* 2: §2 §\ G\ \ § ; %m m }� •/=Em'� = »R - £2�Emn'�m ® = § ®E0 D ( w0),y -0 ±ian»E�eg E$3$§ §{ _ 3 RE / /a' iE§E I ©$S «0RcD z ®3O ; / - �( - -o CD / /%k / 3 a - @E5= aE ° k � cr0 - EE£[} \§ƒk)a§ §i \S�2 1)< $ =rF'< m�2 C < U) U) CA ,E / D te a CD ?K' $EJ /Zo3 @o ® 3cb �§ /ƒ 2 7a§ m 3 K 8 / \ ° % \ : �Cl �2 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453137 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'. Becker, Edward I Richmond Township 026- 1068 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionfrown /Range /Map No: /00 /d0' Sur I/ 23.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /Q D 0 Benchmark 1 n �( ( -� l� t ul l / 06 Dosing 1, / f` Alt. BM _l O S S Z a Aeration (J Bl d_a Sew er SChI 363 Holding _ St/Ht Inlet q2 - 73 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I.> r 1 n � i e Dt Bottom Dosing 7 G Head /Man. pP flir -� 22 Aeration Dist. Pipe p� d aAA" v q 7. Holding Bot. System / :5011 v }L Z � 'Jo I /S PUMP /SIPHON INFORMATION F inal.Lr ade �0v, `i Manufacturer Demand St Cover / GPM 2 5-e 4- V2, 3- 6 Model Number 6ZA,_ F �� r e TDH Lift Friction Loss ead r DH Ft Forcemain Lent Dia. Dist. to Well SOIL ABSORPTION SYSTEM 2 s BED/TRENCH Width 3) Length 7 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di 4� eZ D DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM EACHING an / L - INFORMATION HAMBER OR yl t - y4yer, fr Type f System: N I T f \ - (J UNIT Qodel Number: DISTRIBUTION SYSTEM d a it t G / � � �m a Z _a�U �S Header /Manifold Distribbrtion x Hole Sizd I x Hole Spacing IV ent to Ai take L Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over 1 Depth Over T Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges psoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: // Inspection #2: Location: 1315 146th Ave Unknown (S 1/2 NW 1/4 23 T30N R18W) Whitetail Meadows Lot 19 Parcel No: 23.30.18. Ck 4, r5 1.) Alt BM Description = D� �� -eSS Uja G� �x�� �� ec�s+ 4' a � 2.) Bldg sewer length =2l CUav"C S S "dY (diaw, Jwtu" joa*W Sa d - amount of cover = -e p v1C>JW".- k. r. --e-j Ce,�J &- ,Qg,4 _at 3 i d y 1a kJ (as+ 1 41 Z s� � 04 CUJ � �t,tutSf 2Gt�� Plan revision Required? Yes No - v Use other side for additional information. D L�:, - Date / Insepctor' Sfature ,� r Cent.. No. SBD 6710 (R.3/97) I „ p / f C�1 C �'IO -- (- Q�p(��7 (,1/x'1! PKV r ;q�� GcF�OVl C > ����) C / Gc� hers (mod ►� -3 ?J o �rovv�erL br I�'� 131' - 1 oo �. � .aab3s7 30 / V OTe o I f lJ r I l�0 Y L L l a d � Olt �40 or g o k a ► /h - /3 / ' - Safety and Buildings Division County 1 ` 201 W. Washington Ave., P.O. Box 7162 M adison, WI 53707 — 7162 Sanitary Permit Number (to be tilled in by Co.) eonsin (608)266 -3151 , Department of Commerce Sanitary Permit Application state Plan I.D. Number � in accord with Comm 83.21, Wis. Adm. Code, personal information o : / /A may be used for secondary purposes Privacy L �1Y D Project Addres (if different than mailing address) 1. Application Information —Please Print All Information 004 - 1114 lt V, Property Owner's Name p, r Parcel # Lot # Block # ,� r 1XC00N oao_1068 Property Owner's Mailing Address jo zO��NG Property Ucation —1, Section �_ City, State Zip Code / / Phone Number 7 /2 409 T 30 N; R ,&E9 o e) II. Type of Building (check all that apply) D Subdivision Name CSM Number I or 2 Family Dwelling —Number of Bedrooms r ❑ Public /Commercial — Describe Use ❑ State Owned= scribe Usaf T !�� / '� �� �� C � 34 ❑City VillaTownshi f i III. Type of Permit: (Check only one box on line A. Complete line B if app ' A ANew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System B. El Permit Renewal El Permit Revision El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply — /Ob 7. K Non — Pressurized In- Ground ❑ Mound >24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade El Single Pass Sand Filter 13 Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Keaching Chambe rip Line ❑ Gavel -less Pipe ❑ Other (explain) V. Dispersal/Treat ent Area Information: S =- Design Flow (gpd) Design Soi cation Rads D' ersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation D T- I z I .7a , 3 - . VI. Tank Info Cap u1 Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New I Existing Tanks Tanks Septic or Holding Tank i 6 / Aerobic Treatment Unit e Dosing Chmnber VII. Responsibility Statement- I, the undersigned, assume responsibility for i tallation of the POWTS shown on the attached plans. Plum er's Name (Print) Plum s Si ature P MPRS Number Business Phone Number t "/f I o9G?o3S 7 684 Plumber's Address (Street, Cit State, Zip Code) Cj (�, ��� .S bo VI11 'ountvl )c artment Use Onl Approved Surcharge Fee) ❑Disapproved Sanitary Permit Fee Includes Groundy ter Dq� Issue su I ge t Si n e ( ips) (J �/ L V c 7 ❑ Owner Given Reason for Denial h � la ition xoval /Reasons for Disap rov I � SYSTEM OVI�NER: �GI.000Prt, G2�%Oy 6"Y>`�i"t ep Ic an ,effluent filter and • 3• dispersal cell must all be serviced /maintained � ; ���� . "� �1Q,2 D� � � as per management plan rovided b {umber. 2. All setback requirements must be maintained 7tx-� � � ��� � � �' T as per applicable code /ordinances 9 3- 734 l G(/ Attach complete plans (to the County only) for the system on not less thM Sl 11 ' s in si KBD -6398 (R. 01/03) / G ��� CO"ri y � � 2c�ji��S• /�) f2 itz'� t'", g't�tf'�t�"�" /I ?. i3m - _ / oo 7° 0 �} m d To� a - as b 3.5 y0 r - a =30� e7 f w I 4-3 X ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT ~ ST. CROIX COUNTY GOVERNMENT CENTER °'�•' ��r�MN�11■ rrrrq 1101 Carmichael Road .� Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 Memo to File From: Pam Quinn Date. 4/27/2004 Re. Sandy loam structure misinterpretation on subdivision soil reports Recent soil on -site determinations have brought a problem to our attention. During these on- sites, bofings were excavated to confirm soil conditions where two conflicting soil reports had been submitted for zoning department review. The soil profiles, evaluated by myself, Dave Fogerty, and Dave Steel (all certified soil testers) differed from the original soil reports in that massive (structureless) sandy loams were encountered in horizons that were described as having either moderate, medium subangular blocky (2msbk) structure by Adam Schumaker or weak, medium granular structure (1 mgr) by Shaun Bird. There apparently has been a misunderstanding between "structure" caused by handling samples of the soil during texturing versus the soil characteristics in situ. The soil, when chunks were taken out of the profile to hand texture, with pressure parted into "crumbs" that appeared at first to be subangular or granular in shape. However, these were not true peds that broke apart along planes of weakness, but fragments created by handling. The soil when observed in the horizon did not have distinct units of structure and should have been reported as "massive ". Added notation: on 4/23/04 Mark Iverson (Cedar Corp. certified professional soil scientist), Shaun Bird, and myself did an evaluation of soils on Lots 6 & 9, Richmond Meadows where the original soil report described the third horizon as sandy loam, "lmgr ". On Lot 6 we checked soil profiles within a POWTS distribution cell and then excavated a test pit on Lot 9. The sandy loams in question were a weak, coarse to very coarse subangular blocky structure, where planes of weakness were just discernible when peds were parted from the profile. The peds separated with verxliaht pressure by soil tester. Sand coatings were observed on the ped faces in the Lot 9 soils, which supported the determination that some structure existed to allow water to move through the upper portion of the sandy loam horizon. However, below the weak - structured soil we found massive (structureless) sandy loams and the boundary between these horizons was irregular, which would mean a distribution cell could encounter alternating weak and massive sandy loam. Shaun said he would amend his soil reports with a memo recommending that any sandy loams he identified as "lmgr" or "2 mgr" be assigned a lower loading rate of 0.3 gpd/ft2 (see attached memo for Whitetail Meadows) to provide a larger dispersal area. Page Two — Soil Memo 4/27/04 Massive sandy loams have been assigned a soil application rate of 0.2 gpd/ft with the code changes in Comm 83.44 -2, effective as of 2/1/04. The application rates listed on the soil reports were higher due to the structure having been described as either weak or moderate, which affects the calculations for sizing of POWTS distribution cells. Obviously, one of the concerns is to make sure loading rates for the soils are not in error and allow undersized POWTS to be installed. For example, in December 2003, Lot 35 of Richmond Meadows subdivision had to have its loading rate reduced to 0.3 gpd/sq. ft. when the installer encountered massive sandy loam at the system elevation. The sandy loam horizon had been described on the soil report as "l mgr" with firm consistence. Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist, has been consulted on this situation and advised the zoning department to require on -site verifications for any lots with this potential misinterpretation on the soil reports. All soil reports with sandy loam "1 or 2 mgr" as its structure will be required to use a design based on the current code's soil application rate for massive sandy loam @ 0.2 gpd/sq. ft. unless additional soil testing proves otherwise. Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Subject: Whitetail Meadows Soil Tests To Whom it may concern: I Shaun Bird did the soil tests on this subdivision known as Whitetail Meadows in Richmond township. After a couple of installations, some of the soils were found to have a more weak structure than what was found in some of the borings. In order to protect home owners and contractors, it is my recommendation after discussing the issue with Pam Quinn from St. Croix County Zoning office th at the systems be oversized using a.3 loading r ate instead of the original .4 ra te. On the lots that were originally sized for a.5, I recommend using a.4, not the new .6 that the state has suggested. The soils are what the tests indicate but the large areas tested did not reveal some of the weaker structures that were found upon installations. If a installer can prove otherwise, that the weaker structures do not exist, then the installer should proceed with the soils that he /she believes are present. Shaun Bird CST #226900 a - ds� =Ti �o sa add 7 WisconsinOepartrrentofCommerce SOIL EVALUATION REPORT Page ! of Division of Safety and Buildings in accordancewith Comm 85, Wis. Adm. Code County 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 Parcel I.D. percent slope, scale or dimensions, north arrow, and loication and distance to nearest road. Please print all information. eviewed y Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15A4 (1) (m)). Property Owner Property Locatio ^ 3 ' A J Govt. Lot 1 /4 5�T R E( N W •�✓ ' C/ Property Owner's Mailing Address/ L�t Block # Subd. game, or CSM# 7/ Nearest Road City State Zip Code Phone Number City ❑ lllage own AR New Construction Use: Residential / Number of bedrooms Code derived design flow rate o GPD ❑ Replacement El Publiq or commercial - Describe: —_ _ - - - -- - -- - -- Parent material _s 1 „' Flood Plain elevation if applicable General comments and recommendations: /' Boring # ❑ Boring Ul Ground surface elev Soil n Rate ft Depth to limiting facto in• licatio horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2� a ,4 �1 �- yk 2 a n Boring # Boring pit Ground surfiace a v. Depth to limiting factor �— in. lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ` / L �j ✓ 5 L LU2 vn h ' '`7 7 Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 150 ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L CST Name (gym Privit) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54 7 Y — /V- _ — 715- 246 -4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring it Ground surface elev. l *. I ft. Depth to limiting factor 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 0 2 jN, 3l �L �m 2 S Ll 6� S L ,-►-, r--Y 61 1- b k- �s w 5 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring Ground surface elev, ft. Depth to limiting factor in. ❑ Pit Soil lication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- ' 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 .6/00 (R ) Soil Test Plot Plan Project' Name William Stock/Steve Dalton Sha ird Address 1748 112th St. New Richmond Wi 54017 M #226900 Lot 1 9 Subdivision Whitetail Meadows Date 8/15/03 S 1/2 N W 1/4S 23 T 30 N /13 W Township Richmond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 96.7/96.6 *HRPSame as Benchmark Alt. BM Top of 2" Pipe @a 100.2' Scale is 1" = 40' Please note: Installer must unless otherwise verify all lot lines and setbacks before installation. noted Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. Not enough B -3 slope to 45' establish Poo 1% Slope contours 30' Alt. B.M. B -1 90 B. M. 70'5' B -2 1 40 r 4 e 4 ' Property Line POWTS OWNER'S MANUAL & MANAUhMtN I rL.AN Page ' of FILE INFORMATION SYSTEM SPECIFICATIONS Owner _ Septic Tank Capacity d a l ❑ NA 1 El � A­4�� Permit Septic Tank Manufacturer c ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z ❑ NA Number of Bedrooms 3 ❑ NA Effluenj Filter Model — ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) O gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) Q gal/day Pump Manufacturer ❑ NA Soil Application Rate f al /da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average` Pretreatment Unit ❑ NA Fats, Oil & Grease (FOGI 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 (BODJ 530 mg/L )ln- Ground (gravity) 13 In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) S10 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other. ❑ NA Other. ❑ NA `Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency E3 month(s) (Maximum 3 years) 13 NA Inspect condition of tank(s) At least once every: p2 earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA In At least once every: ❑ month(s) (Maximum 3 years) 13 NA Inspect dispersal cell(s) EZyear(s) Clean effluent filter At least once every: 0 month(s) ❑ NA ❑ 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: a e Master Plumber; Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer; Sept g Servicing Operator. Tank missing or broken hardware, identify any cracks or leaks, include a visual inspection of the tank(s) to identify inspections must in p any Pact measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispoged of in accordance with chapter NR 113, Wisconsin Administrative Code. AN other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the kcal regulatory authority within 10 days of completion of any service event. Page of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: X 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. A � T Iv alua ' a o ing tank b e a� '�flDi- 11817FA �� /�/ L'ONS'772(J�?'tOr! ❑ 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 INSTALLER POWTS MAINTAINER Name Name Phone 6 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Nam � e Name , G ( 20rJl�cJ Phone Phone 1 - 71 9 5 7— 3g40- This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(fl and 83.54111. (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C;:RTIFICATION FORM Owner/Buyer 9 , 0 C Mailing Address 7V Property Address 3 V� (/ (Verification required from Planning Department for new constru tion) City/State WWW U).r Parcel Identification Number LEGAL DESCRIPTION Property Location %., L W �/., Sec. T 'h- N -R Town of Subdivision /I� Q.�tQ Lot #. Certified Survey Map # J Volume . Page # Warranty Deed # 7.2 2 L / o? Volume 2 Cf 7 , Page # 07 Spec house es ❑ no Lot lines identifiable gkws 13 no SYSTEM MAINTENANCE � NANCE 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 propertyowner 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 day the three year iti date. In NA OFIAPIACKNY DATE OWNER CEATMCATION I (we) certify that all stat ents on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of A pr describ o , by rrtue of a warranty deed recorded in Register of Deeds Office. E O P ICANT DATE ' f * * * * ** Any 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 P ty Deeds office g a copy of the certified survey map if reference is made in the warranty deed U -254 ?P 222 _7J "- `\ STATE BAR OF WISCONSIN FORM 2 - 1999 I KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., VI This Deed, made between Dalstock. LLC RECEIVED FOR RECORD and Edward J. Becker Grantor, 04/13/2084 09:45AN Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXDRT # the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.80 (if more space is needed, please attach addendum): TRANS FEE: 135.00 COPY FEE: Lot 19, White Tail Meadows. St. Croix County, Wisconsin. CC FEE: PAGES: 1 Recording Area Name an"LZABLA&V ALLEY BANK, NA 1301 Coulee Rd PO Box 70 Hudson, WI 54016 026- 1068 - 90-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this �c��rh day of April , 2004 Dalstock, LLC s * BY:.� 2)A 1�btJ * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Dalstock, LLC STATE OF k �� Ly��•t r ) B ) ss. County ) authenticated this day of April , 2004 Personally came before me this PM day of - i � the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ,`1 me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) ��� . • • , VAPstrument and acknowledged the same. Z y S. THIS INSTRUMENT WAS DRAFTIM BY Attorney Kristina Ogland _ = /'� 5 ► �'�� � �• a Public, State of Hudson, WI 54016 d Ct ry �.�� • . , . � Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both atiQ ��� a I A. , oo •) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co.. Fond du LA-:. WI STATE BAR OF WISCONSIN 800.655=2021 WARRANTY DEED FORM No. 2 -1999 a VL W g i s I_ M Qj -- — — SW -NW 6 s �N rn �s — • o q) r O i h N t '1 0 . . . . . . N /.�' SOW �� o� z G O ' . • ��' \\ — C11 3 " -Z-- 10 L9 c CA p / k ' R O CD .�. 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