HomeMy WebLinkAbout026-1160-23-000 Wisconsin Department of Commerce County:
P PRIVATE SEWAGE SYSTEM St. Croix
Saliety and Building Division
INSPECTION REPORT Sanitary Permit No:
479390 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:
LeQue Builders LLC Richmond, Town of 026- 1160 -23 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
23.30.18.1229
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding
St/Ht Inlet
ft
t/Ht ttlet j< 0OF
TANK SETBACK INFORMATIO
TANK TO P/L WELL OFBLDG. Vent to Air Intake R D nle
Septic Bott
Dosing Header/ I n.
Aeration Dist, Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORM ON
Manufacturer bemand St Cover
GPM
Model Number
TDH Lift Friction Loss stem TDH 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
SETBACK SYSTEM TO P/L BL G WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold IDistribution x Hole Size x Hole Spacing Vent to Air Intake
Pipes)
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 E] Yes ] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: i 1 Inspection #2: 1
Location: 1333 146th Avenue New Richmond, WI 54017 (S 1/2 NW 1/4 23 T30N R1 8W) Whitetail Meadows Lot 23 Parcel No: 23.30.18.1229
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ] Yes ] No
i
Use other side for additional information.
Date Insepctor's Signature Cert. No.
SBD -6710 (R.3/97)
i
Safety and Buildings Division County
N 201 W. Washington Ave., P.O. Box 7162 S y l (`
I SC�II SIII Madi 3707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) �r q l Q
Sanitary Permit Applicati,on State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, per al:informat *, You provide
may be used for secondary purposes Priva ' w, s 15.W(])(• , Project Address (if different than mailing address)
L Application Information — Please Print All Informati ZUNI iX LUU 1 J 3 3 1
ZV N l Y
Property Owner's Name Parcel # Lot # Block #
n,
Pro erty Owners ailing Address Property Location
p IS '-1 `r 0 '/., Section
City, State q� Zip Code Phone^Numb(er �j
w ` °. tis o� l T �N; R�E or ,)
I. Type of Building (check all that apply) S .,.�
Subdivision Name CSM Numbep �
or 2 Family Dwelling - Number of Bedrooms /✓
❑ Public /Commercial - Describe Use �h a 1 tcQC
❑City_ g p
State Owned- cribe ❑Villa e (�fownshi of Q
III. Type of Permit: (Check only one box on line A. Cbm plefe line B if applicable)
A. )KNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ 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 appl
K Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ravel -less Pipe ❑ Other (explain)
V. Dis ersaUTreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sl) Dispersal Area Proposed (sf) System Elevation
f OoD I L4 I I so a 08 i6` I
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New I Existing
Tanks Tanks
epic r Holding Tank , t�JC I Lu i t \ rS
Aerobic Treatment Unit JC J
Dosing Chamber
VII. Responsibility Statement- I, the undersig a responsibility for in n of the POWTS shown on the attached plans.
Plumber's Name (Pri Pl be ' Signatu MPR umber Business Phone Number
_0 aa as 6 _s 135
—_ � C Plumber's Address (Street, City, State, Zip Code)
VIII. Coun /De artment Use Onl
K Approved ❑ Di proved Sanitary Permit Fee cludes Groundwater Date Issued Issuing gent Signature (No Stamps)
Surcharge Fee) �,�g�
El Own n Reason fo Denial �y ~ . ((
IX. Conditions of
1 Sep OWNER:
i
1 Se pt i c tank, efflu ent filter and
dispersal cell must all be serviced /maintained
as per management plan provided by plumber. Std w� a 0 A
2. All setback requirements must be maintained �- N�AX �os C D ' Z )
as per applicable code /ordinances
Attach complete plans (to the County only) for the system on paper oti s than 8112 x 11 inches in size
SBD -6398 (R. 01/03) tie- cc4,iav
t � o . z �� /� s-QS /
P IO
Z -Qu ELILA Nw'
II� I
f'ti2 hC 10c, ltdr9
3 C) s e�o►�Z`���
too
f
s
re
�!� B in ac re
r.
. o
:
;L -
,
:
,
A '
i
PIO 1 Ra....
s la, N W �y S�3 3 o N IQ I Ff uj
P� t�' Ox . k i`�Va 1 aw4o u-� S Lt* a 3
Wl J`�y 0 t ck m Q 11 A S C <'�O t
-P��s2� (o ) �� loB _ q� -ooh
3 3
3 r�e he loo`
3 C s ���or- , ,s ' \,O
s Q-A. `' d
3
BTDP `/a``; �i Ion—
bYt�
I
Q
N
Post -it Fax Note 7671 Date pages
To From
Bird Plumbing Inc Co. /Dept. C C L l
1008 192nd Ave Phone # Phone # r J 15
Fax # JF JY�
New Richmond WI 54017 `� 7
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. Aftbr 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 that the systems be oversized using a .3 loading rate
Instead of the original .4 rate. 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
Z
d d61► = T i 40 5Z �dli
ST. CROIX COUNTY
WISCONSIN
r �'1 ZONING DEPARTMENT
r - ~ ST. CROIX COUNTY GOVERNMENT CENTER
��M�MM�N■ Igloo
1101 Carmichael Road
Hudson, WI 54016 -7710
Phone: (715) 386 -4680 Fax (715) 3864686
M emo 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, boiings were excavated to confirm soil conditions where two conflicting soil reports had
been submitted for zoniflA 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 (I 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, "l mgr ". 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 vga light 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 "1 mgr" 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
"lmgr" 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.
I
i
WisconsinDepurtmentc3iGommerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County _ i
. t.
Attach complete site plan on paper not less than 8 1!2 x 11 inches in size. Plan ihust
I , ; i <
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.
e . Reviewed by Date
l i
Pleas all info rmation. p
Personal information you provide may be used for secondary purposes (Privacy law, S. 15.04 (1) (m)).
Property Owner Property Location
Govt. Lot 1 A 5 ,23T N R E( W
r Maili ddress t # Block # Sutxj. hJame jorGSNW
s
P Owner's rig
�rtY
j
city State Zip Code Phone Number ❑ City ❑ ��Allage own Nearest Road
S
_
New Construction Us Residential / Number of bedrooms > Code derived design flow rate 9 0/ GPD
C3 Replacement ❑ Publip or commercial - Describe: --- - - - -- — - --
Parent material — 4VI Flood Plain elevation if applicable ✓, — ft•
General comments
and recommendations:
'ng # p Borin
s �
Ul
It Ground surface elev. Depth to limiting factor lay in. Soli Appl 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
�.
12-- A o
414
30
1
® Boring # Boring � /�
pit Ground surface elev. �/' ft. Depth to limiting facts y � 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
— Z 4 --311 5L
Z -30 5) q L - 'r
C— IF
Effluent #1 = BOD >30 < 220 nxl/L and TSS >3VJA 50 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 nVL
CST Name (Please Print) nature CST Number
iL
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 4017 715- 246 -4516
c � 3
Property Owner ` Parcel ID # Page of
a Boring # ❑ Boring �
it Ground surface elev. V v� `e ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
Fr-
Z 33�
a Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Solt Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
a Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication 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
Effluent #1 = BOD > 30 1220 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.
SBD4330 (8.6/00)
V Soil Test Plot Pla
Project Name William Stock/Steve Dalton Sh rd
Address 1748 112th St.
New Richmond Wi 54017 TM #226900
Lot 23 Subdivision Whitetail Meadows Date 8/15/03
S 1 /2 N W 1 /4S 2 3 T 30 N /R W Township Richmond
EJ Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 1 /2" Pipe
System Elevation 97.1/96.9 *HRPSame as Benchmark
Alt. BM Top of Survey Iron @ 99.0'
Scale is 1" = 40'
unless otherwise
noted
Please note: Installer must
verify all lot lines and setbacks
before installation.
433'
Property
Line
B -2
101' Please Note: Tested area
may not be suitable for
0' B -1 45 15' desired building area.
Check system location
45' 15' 100' before excavating.
50'
B -3 3%
B.M.
Slope
10' Alt. B.M.
217' Property Line
1I
14 A-y
EZ1203H
vvovoviv ��' °..':;::• \ veeevv°
'•'• _ • eresvos
°,. � ::.� . o•vee
2 12
11 eve ''i' ,: '�,.:. °.
°vv � ; , y A,.. ess
soo
4.625 v o 0
UG_J ov vvv
v vvv
ev
ovo
ove
°.� IV 1 I/2 Ciro. = 28.84
vT °va
°O a'eeee a eee
eevv ve voo�vsv000vsv ° ev °e
eoevovv eevvvosovoov� ve vvvveoW
svvvvov
0
24
Bottom
36
1 2 -1 /2 DIA. (tV.)
Void Coefficient in Aggregate given at 57.4%. oil tnt�rfacee Area
In. IQ Ers � F1
O.D. of 4" pipe - 4.625 inches Sidewall (2 Sidewal)s) 18.84in
?� =
Yoid volume per linear ft. = 3.14 • r 2.]125in \ 3.14
t` I2in /fi )Ift ° 0.117 FN Bottom lR
O•D• of ecatercylinder a T2.5 inches 2.00
Total Soil Interface Area
Void volume in aggregate of centercylinder 3.)a• 5.14 SQ.FT
s 'si" / 2.3125in 1
�I Zin 1 Ft) � 3 • i �.»"- - 1 \� ..574 - .422 fN
l I2in /ft l
t).D. of outside cylinders= I? inches
Void volume in outside cylinders= 2.3.1
( bin Projected Trench Area
12inift� 574 - .901 ft'
Sidewall Height = 12 in. •2 - 2.00 Sq.Ft.
'Void volume at bottom between cylinders = r( 24in Bottom =
36 in. = 3.00 Sq.
tl 6m 6 m lit Ft.
tlinrk' I2in /R� 3.14 � \J� yQ,215 ft' Projected Trench Area =
Ili "ift 1
Void volume at outside bottom cme I 5.00 Sq.Ft.
corners ( /2 of void volume between cylinders) 0.2 15 12 = 0.108 ft'
Total void volume = 0.1 17 +0.422 + 0.901 + 0.215 + 0.1 o8 = 1.763 cubic rt / ft
Gallons per ft = 1,763 X 7.48 = 13 2 patlons o�. a __ _
t
t/
Erg Aggregate
Trench System
EZ1203H �Z
Rin9 sfrial Group "'' O1v
65 Indus' r'01 Park Rd.
Oakiand TM 18060 }
SCA "LE NAUE. EZ1203H-,,l
S1iF3:T: 1 at t 11 -27 -Ot {
1
POWTS OWNER'S MANUAL &MANAGEMENT PLAN Page of
'
s�rs�M si�alHC�►Taas
+► o
�4ql- Tank Manufacturer t Q-S f c2 ' o Dow o Hold V ol. �
gal
Tank Manufacturer ❑ NA
DESIGN PARAMETERS p Dose Q Holding vol. gal
Number of Bedrooms 0
of Public Facility Utuits
Ef
flow . Filter M scty+ is NA
Number of
(average) lbw Effluent i Model
tSoaa (peak) (Estimated x IiA
Sel Purnp Manufacturer "A
plication Rat e Pump Mode lA
Mely - t� pretreatment Unit rd Y Filter
SandlGravel f D Peat
Fats, Oil A Grease 5 $O mg/ • C7 Wetland Biochemical Oxygen Demand 5220 m9& D Mech fecio n ❑Other:
Aeration
' O Disinfection
Suspended SOWN (MI 5160 c�-
Pretreated Effluent Quality Monthly average Celts) 0 NA
Biochemical Oxygen Demand (BODs) 530 mg/L p lo - t3ro�urd (preesu�ed)
Z Suspended So Cis CfSS) S30 ❑ NA tIn- rotrdIi } 5c1O0m1 O At O Mound
oTefcxm �gc D Other:
Maximum Effluent particle Size Y in die. ❑ NA d Drip -t i(ue DNA
Othen ❑ NA
•vim typical for domestic Wastewater
grid sept+
c limit efFiuerrt. Other` CO3 NA
TENANGE SCHEDULE Service F
Swvk* Event nwtudl(s) � 3 years) ❑ NA
Inspect Condit M of tanidsp At least once every s
`
When combined sludge and scuurn lam one third (%) of tank volume ❑ NA
[ pump out contents of tank {s} O When the high water alarm k wt iva al
tlntlt(st
(maxknurn '3 yews) ❑ NA
Irk dispersal eats) At least once every: (s)
D rrronth(vs} DNA
Clean effiuert filter At been Once every: (a)
O rruarutfuts) � NA
Inspect pump, pump controls A alarm At least one every: D s)
0 Man") �VNA
Flush laterals arc! Praesuae test At least once eve rw O year(s)
❑ m onth(s) � NA
Other: _ At least once every: tI s)
�bNA
mAwrENANCE INSTRUCTIONS one of the following licenses w certifications:
Inspections of tanks and dispersal cells shall be made by an individual carrying ng licenses
Operator (pumper)
Sewer, POWTS Inspector, POW f8 Idlairutair>er: Se:ptage
Master Plumber, Master Plumber Restricted Inspector, or broken hardware, identify any cracks or
Tank inspections must include a visual inspection of the tank(s) to identify any of effluent o the ground
leaks, measure the volume of combined sludge and scum and a for any back the a PonalnO o t
surface. The dispersal cell(*) shall be visu+a Ny � to check the � g��nn may inic falling Check and
ponding of effl lent on the ground surface. The � of effluent
requites the immediate notification of the local regulatory suthOrity
combined accumulation age ars<I scum in any vestment tank equals one -third (Y or f tan 'i
When the for crud disposed of in acco rdance
entire contents of the tank shall be removed by a Septage Servicing t) P�
Wisconsin Adrttiinistrative Code. pressurized components, pretreatmen-
All other services. including but not limited to the servicing of effluent filters. mechanical or
units, and any servicing at intervals of St 2 months, shelf be performed by a certified PQWTS mai y
service avant.
A service report be provided to the local reguWOry authority wid"n 10 days of completion Of l any
GMW (2 /02)
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals that may impede the treatment process and/or damage the sod dispersal ceUls). If high concentrations. are detected
have the contents of the tanks) removed by a septage servicing operator prior to use.
System start up shad not occur when soil conditions are frozen at the infiltrative surface.
Dung extended power outages pump tanks may fit above normal highwater levels. When power is restored the excess
wastewater will be discharged to the dispersal ceMts) in one large dose and may overload then resulting in the back-up 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 at contact a PUmsbw or POWTS Maw 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 I S feet down slope of any mound or art -grade soil absorption was.
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 floes; diapers; disinfectants; fat;
foundation drain (sump pump) discharge; fruit and vegatabia peelings; gasoline; grasses herbicides. most scraps. medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system is
property and safety abandoned in compliance with chapter Comm 83.33. WhKwisin Administrative Code:
• AN piping to tanks and pits shell be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shell be removed and property disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shad be excavated and removed or their covers removed and the void space filled with
soli, 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:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
r
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and poposed structure, lot litres and wells. Failure to protect the replacement area will
result In the need for a new sod and sits evaluation to establish a suitable replacement area. Replacement systems must
comply with the riles in effect at that tine.
❑ 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.
❑ Moused and at -grade soil absorption systems may be reconstructed in place following removal of the bio tat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that tom.
< <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
POWYS INSTALLER POWTS MAINTAINER
Name P, Name
Phone S i s S Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name t t l h
Phone Phone l j S 3&(o
This document was drafted by the staffs of the Green Lake, Marquette and Waudwra County Zoning and Sanitation age in compliance with
chapter Comm 83.2212)(b)t711d1 &M and 83.54(1). (2) & (3), Wisconsin Administrative Code.
r
S r CROIX COUNW
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNS M P CERTIFICATION FORM
Owner/Buyer
Mailing Addr= f : 0 0)
J3 33
Pmpe ny Address kh
(v m mgnlma fro p fear new )
ac R i�rrnr,�l Parcel I Ntunber
L—EGAL CRtPT'ION
Paperty Location S %110N,-N v,1 y., Sec. , T 3i:�N -R LyW, Town of
Subdivision Wail ���x��s La # �.
CerWand SurM m # volume . gages #
Warrant Did `7 �4 I S volume - a 7 Q : page # .�,.
Spec hm= Cd Ym D IIo Lot lines identifiable 0 yes 0 no
bnpcwa uw ma tmwkmxx f Jm s y - " C m MOM == k is it F=WftKo far a to Lwndle aasmc. Pcopar
c aff a do rain 0 of CUP � � � �s or snore, if aa�dcd by a licaaed j j What ym pit hM eo �
ft* as a staff is tbt "m fapmW system.
The psopefr Own= 20= to wbm* to St Craft
Z.a�ag Dqmbmeas a oeatifscatim fana, by ft mmer and by a
is in swap= apendws P pL eara &ocaescdPunva Mao) me e>� disposal system
oo�moo aad/or (2) after aapewoa said paaapnog {tf sacerssuty},�e tasuic is kas ttsta W W of'eodge.
VWC% the sat fttk end Lave resat the above sequirmuft aad W= to nuhft& the prmta wwW e#tspoW sy�n VA the
9 1! Domeoto£ tLeDe�moo�af Namrat , Sm� of 1iioos.
Odm bas beam mmihiad =a* be- =mpk� and �d to as St: Ca�aix C=My Zug t]fFce.vht3n 30
UP etas
1
c ATVRE o� l/ 05
DATE
2
eye) that alt Cm this Emm am Um to the best of my (am) I ( am (an) the OWUM(s) of
by vnrtnc of a
p deed te;ooretod in Rester of Deeds Off aG
CW APPLICANT DATE
is faismsepasexacd may resebt in ties m`_' J mint being mvolxd by the DcpwftmL �,tsas•
• Include with lbis VPUMEon: a mmFW deed S m the
Y ' of Deeds OfbOc
a copy of dw a affled mwfty map it seta is M& in &a waaaaty dead
M, 2725P 602 78416!
KATHLEEN H. WALSH
State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX CO., WI
Document Number Document Name RECEIVED FOR RECORD
01/05/2005 10:30AN
WARRANTY DEED
EXEMPT #
THIS DEED, made between Dalstock. LLC
( "Grantor," whether one or more), REC FEE: 11.00
TRANS FEE: 144.00
and LeOue Builders, LLC COPY FEE:
( "Grantee," whether one or more). CC FEE:
PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area
interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is
needed, please attach addendum): Name and Ream Address -
Lot 23, White Tail Meadows. St. Croix County, Wisconsin. _
`r
LVI 540
026- 1068-0 -000
Parcel Identification Number (PM)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated Z� 31 U ` Dalstock,
(SEAL) (SEAL)
*
*By: Bill Stock
(SEAL) X ' "( (SEAL)
* *By: Steven M. Dalton
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Dalstock, LLC
B Bill Stock and Stev M. Ekalton STATE OF )
authe ticated l I 49 ) ss.
COUNTY )
*Kristine biland Personally came before me on
TITLE: MEMBEk STATE BAR OF WISCONSIN the above -named
(If not, to me known to be the person(s) who executed the foregoing
authorized by W is. Stat. § 706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
*
Attorney Kristina Ogland Notary Public, State of
Hudson, WI 54016 My Commission (is permanent) (expires: 1
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
* Type name below signatures. INFO-PRO- Legal Forms 800 - 855 -2021 www.infoproforms.corr.
Avol
AI RUZO N
I h
►� r bbi X
A lF. N
•,433 9
Ac
1 Rf C1 Jl .— �_ r ` 1311tlS Man
st
•..
ox
all
1 0
01 031 VJAM 30 0_1 NOW
Q
' R..._.....a........... iA
11 0R ;S
tj
� tt ' ` ..cal. • ("�'
'� Al \� \ �\ 9t N air 1 v �►` a HE G�{
y • ` �
db 106, 432 ft.
Z 44 mss.
'►
a
L-o 75
Casement
MW
323,60`
` N89
. 2
`+ S$9'49'"W 343.3E
1* 2�i� - 142,40'
•� � j "�`� tXr�r+r�c�r
ft • o� ?an f
ares ' • • -M�'ca'�
. / Drvwso e
' 611 ft.
94�.�72 � ff. � � � � 89
x.17 crcrse , 1. 90 acres ^ 2-06o
_on .
r. N
CIO
C 0
z
—739.48'—
302.22' 217.26" 220.0
8 89 °49
�t --ftst 114 Line --N89 1 E 5279. 06!—
(R =M895?'54" 5279.10 7
i