HomeMy WebLinkAbout026-1147-35-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety?nd Buyding Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 430 0
GENERAL INFORMATION 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:
Oeverin , Oranzo I Richmond Township 026- 1147 -35 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
�L.. re v' r t '•� , s .1 ±S /il , / 24.30.18.1093
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic \ r , —s / & !� ✓ Benchmark
Ui .73!
Dosing < h �� / _� Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet S'' Q T-1 Z
TANK SET St/Ht Outlet ACK INFORMATION 5. 72
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic � ^J� - 0 Dt Bottom
70 ,
Dosing eader /Man.
g 7 3 <( 3
Aeration Dist. Pipe 7. "11 7 �! 7S
Vv
7 7 3.
Holding Bot. System << . 4 7 .O S
0 "4 11 c 7v .7 ► 3
Final Grade
PUMP /SIPHON INFORMATION U
Manufacturer DP and St Cover 3 ,y� 18
F el Nu Lift Friction Loss System Head TDH Ft
emain Length Dias Dist. to Well
SOIL ABSORPTION SYSTEM
BED►TRENCH Width L j �ength,.3 . 1 1S No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 1 _5 —
DIMENSIONS
60
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: ,[[
T ��IVCa� .✓
INFORMATION yt
Type Of System: � `—��� k 1
CHAMBER OR UNIT
Model Number:
C � n V Z.. -, �. � ... S � &'3 , J - _.... � /-/ f o f � �., . i .
DISTRIBUTION SYSTEM ��
Header /Manifold Distribution x Hole Size x le Sp ing Vent to Air�itaky � �X
Length Dia �- Length Dia Spacing G
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 1:` Yes No [ Yes r, No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection # /C. / -qa Inspection #2:
/ I w/
Location: 1466 142nd Street New Richmond, WI 54017 (NE 1/4 NW 1/4 24 T30N R18W) Richmond Meadows Lot 35 Parcel No: 24.30.18.1093
p t n+.t. i c'
1.) Alt BM Description = ✓ �, �TC✓t ( 'V A'Y ""`�Q 1b:� La /� ry
J c' c. ;
2.) Bldg sewer length = I ? 3-) eGoy�� ^� {e ��• w b ,� ker.�.� we l a n S•'7�.�
- amount of cover = %-{7 ` Q „11 m • d • : � 4 .o ���. -' tl t, ✓.c_�' � y► S
+ M 4 4- e/A- 1 µ-
Plan revision Required? Yes No
i 1
Use other side for additional inform _____;
3.3 -�P Z{� bt-/e-w S, y w G e- Si g n ature L x-L, ` w . Cert. No.
SBD- 6710(R.3/97) St1S•�!� 5 r �j�p Q�? � T/ L
S e%G �, tpwd� n S role- ea i rr S'f4 l It-� ,� S r1S7t� �+-� d 3 G � /�t-='
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Safety and Buildings Division County
W. Washington Ave., P.O. Box 7162 v=
isconsin A►�o' , � V3W EIVE Permit Number be filled in by Co.)
Department of Commerce « 31) S z o
Sane Permi ♦ hCahU NOV 0 4 200 Plan I.D. D. Number
'Y PP
In accord with Comm 8321, wis. Adm. Code, p �
you p
may be used for secondary purposes Privacy Law, s15.p4( X81) ST. CROX COUNT Address (>f "&rent "an marling address)
I. Application Information - Please Print All Information
/ X11 S ST
Property Owner's Na we Part / el 0 Lot t Block I
Property Owner's M aging Address Property Location
zrp 3a-*' lr r?c GtR
city, State Zip Code Pbone Number �,� —�
11 A&W,0A1 j (circle one)
H. Type of Building (check all that apply) R — E o&
❑ 1 or 2 Family Dwelling - Number of Bedrooms .3 � S 4 .
Subdivision Name CSM Number
❑ PubliclCommercial - Describe Use
❑ State Owned - Describe Use 00ty ❑Village Wownsbip of
M. Type of Permit: (Check only one box on lice A. Complete lice B if le)
A. WNew System ❑ Replacement System ❑ TrptmwdHoldmg Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision► ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date issued
Before Expiration Plumber Owner
IV. Type of POWTS em: (Check all that ) .Z c,c4er 75'. O / CVee . —
R'Non - Premrized hi-Ground ❑ Mond > 24 in. of suiubk soil ❑ Mound < 24 in. of suitabie soil ❑ At -Grade ❑ Siogle Pass Sand Finer
❑ Constructed Wedand ❑ Pressurised h Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Symneuc Media Fitted El LeaBtmg Chamber ❑ Drip Line 0 Gravel-less Pipe ❑ Odwr (explain)
V. DiispersaVrreabnent Area Information:
Design Flow (gpd) Design Soil Application f) Dispersal Area Required (so Dispersal Area Proposed (so System Elevation C— I Qa• 3 �
/ c -3 s
Vt. Tank Info Capacity in Toni Number Manufacturer Prefab site Swel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New E xisft
Taatcs TarAm c✓ �L ^ /dU
OO eri'v cd�'J ✓
Aerobic Tmannem Unit
DoAft Comber
VII. Responsibility Statement I, the tmdersigned, assume respoosMW for installation of the PORTS shown an the attached plans. - -
Plumber's Na me (Print) MPIMPRS Number Business Phone Number
Plumber's Addre ss (Street, City. Stike. Zip Code)
Fogerty Plumbing & Ptak T eaft
6 5 - 1 – — 37 117 ZVAWV� vIII. c
p AWovc 1 sanitary Permit Fce ( Gnoandwater Dato Issued Signature (H staffs)
Sureba ,
❑ owner Given Reason for Denial ��'�- OV • /Q 2� c
I% Conditions of Approval/Reasons for Disapproval
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.
Atbwb conPift pism; 0a no couaty Daly) for to syst® on papa• sot tens than SW x 11 inches in size
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with 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 r feta7n �t - � . BM), direction and parcel I.D.
percent slope, scale or dimensions, north arrow, dnd loq qe4oxiaarest road.
pt; � e wed by Date
Please print all information. f %�
y N °V •�� 3
Personal information you provide may be used for secondary p4rppses (Privac Law , s. 15.04 ( 1 ) (m))
Property Owner rope Location ,
d Z o
Gvt. of
r 114 /4
��..
�-
Property Owner's Mailing Address / ` (`FFICE Lot #' Block # Subbdd. Name or CSM#
City State Zip Code Phone Number ❑ City ❑village Town Nearest R w oa ' d ' ,
ew CtxtsPnrc6on Us esidential / Number of b Code derived design flow rate —h J Z GPD
❑ Replacement or commercial - Describe: - - - -- - - - - -- - —
Parent material Flood Plain elevation if applicable
General comments
and recommendations:
Boring # El Boring
'� l �
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 I 'Eff#2
S
Lt, h '
Boring
Boring #
Pit Ground surface ele � 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
CL N
r 6w
a - 7
ILEMM Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 1 • Effluent #2 = BOD 130 mg/L and TSS < 30 mg1L
CST Name (Please Print) nature CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 5 017 =��—J v 715- 246 -4516
Property Owner _ Parcel ID # Page of
®Boring # ❑ .Boring
Pit Ground Surface elev. `'� ft. Depth to limiting favor in. Soil Application Rat
e
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz. Con Color Gr. Sz. Sh. 'Eff#1 'Eff#
M GS .5
Iz .3
4, 6 L
F—I Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil liption Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIlf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2
❑ Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in.
El Pit
Soil liption 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 I •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 (8.6/00)
Soil Test Plot Pla
Project Name Richard Nelson Sh Bird
Address P.O. Box 10622
White Bear Lake Mn 55110 7S-TM #226900
Lot 35 Subdivision Richmond Meadows Date 7/1/03
NE 1/4 NW 1/4S 24 T 30 N /1318 W Township Richmond
F1 Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 93.3/93.0 *HRPSame as Benchmark
Alt. BM Top of 1/2" Pipe @ 96.2'
326' Property Line
B.M.
Scale is 1" = 40' M. 1
unless otherwise
noted
80'
B -1
50'
4% Slope
B -3 30'
0' a
0
B- N
97'
96'
0
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+• Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 31- (
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. viewe y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
6&4-1� 3 v o3
Property Owner Property Location
� t d prd L Govt. Lot :5 1/4 PJ01 /4 S N T -�;O N R E (o W
Property Owner's Mail' g Address Lot # Block # Subd. Name or CSM#
1�. 1d Z z 35 IZ / n -
City State Zip Code Phone Number City Village aTown Nearest Road
l(I WOyne LL W& 00-0 9
Q New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate VSO O d GPD
❑ Replacement (` ❑ Public or commercial - Describe:
Parent material TI Flood Plain elevation if applicable
General comments SYS - W` V 9 J', t and recommendations: e o � J �l Q U r �� 3� 2 . CR01 ZONING
Boring # Boring �}
[�. pit Ground surface elev. 97 - 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
1 0 Ip 31 S,' i Zlbk m c
-4 IO rat
c3p 1.5 SL I Z rn�e
Boring At R ❑I Boring t '
pit Ground surface elev. - ft. Depth to limiting factor ( l6 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
`y ✓
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
T Name (Please Print) Signature CST Number
Z5 3309
A dress Date Evaluation Conducted Telephone Number
` - 7(S - Z� -y00(�
SRD -8330 (R07 /(x1)
Property Owner Q Isb Parcel ID # Page of
® Boring # E] Boring
t� pit Ground surface elev. V 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 I 'Eff#2
1 2rc& L
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 /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring Boring # Ground surface elev. ft. Depth to limiting factor in.
F
❑ Pit 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
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)
PAGE OF
NAME Z I SoV\ LOT# 35 LEGAL DESCRIPTION Y44w X ,SZg T ?�c N R I k E(or
SCALE: 1 "= 7 o /
BM 1 ELEVATION 16 6 O
BM 1 DESCRIPTION Ja o + J
BM 2 ELEVATION C I
BM 2 DESCRIPTION �Z,�J Cj+ O TC— - - -
SYSTEM ELEVATION �9 90 _
ALTERNATE ELEVATION tl1114 /�-
CONTOUR ELEVATION
i a j o°
3 a
v�
/ S
J
/ G
e
8 eti.
SIGNATURE y _ DATE
_ ' � / _/. .....,,.. o.. -[.v0 •. , � -.. ti � r . ..ems -
�� N�A =2.11 Acres 40 ,
oit
4 5 A - -- S � ? g•3�,
or
/ � p'p� h`►/ o i / / \ �'y�,A o,`O� �' m
I
54.0
N �•4 1 E -� - --
a 1 229.
lCo
81676 S Ft
1.88 Acres
to
NBA =1.69 .Acres
so
o / 2 ~~ ~ / 7270 6'Ft $ / _ . $N
1.67 (acres ° C .
s► / hry / �0 0� / _► NBA =1.48 Acres / / m8� �c
/ A
tr
5 84 0 22'
84553 SgFt ?�` c�� P B21B c
/ 1.94 Acres .N�. / 7 ^� /® 3v
' NBA =1.74 Acres /�o�y — L — — ' 7795S'gFt
^ � /0 1.79 acres
' 2 ry o' o NBA =x.71 Acres g
r0 •
. /A .h / / �'� g $ � ' • / � �� -Las
l
a r
it
25 SgFt /
3 Aaea / 1 /69796 SgFtf / / 416 • ,
.75 Acres / �89k / 1.60 Acrest
NBA =1.45 Acre `ryD- WV�
`ZZ / V
/
ry IX/
� / �►A � 73889 SgFtt I
/ 1.70 Arrest /
/ NBA =1.52 Acres / � p0 S�
�� •/' / / 1 / ' off I 0
/ �F / / / /000
33 of
79566 SgFt / / / ry •�o% / / / / 1
1.83 Acres 26 \
IBA =1.55 -: zres / / �% / 1 /
1 3.75 st
Acres
/ •' / � 3.75 Acres �
118A 3.60 Acres
�`� co ga / �` / . � /„p• / /
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pace of Z
'RW NV>W1111111AT10R SYSUM SP6GACAf10NS
Owner _adr.t,,al , Sac Tank Capac
O NA
g
Perrnit # ®. Septic Tack Manufacturer .Y r 13 NA
OES�III PARA� Effluent lamer Manufacturer 13 NA
Number of Bedrooms ,3 0 NA Effluent FEW Model _ !gyp 13 NA
Number of Pubic Facility Units xNA Pump Tank Capacity g o b.M
Estimated flow iaVeFage! Phrtgi Tank Mawfacdrer _
NA
Design flow (Eeakl. (Estimated x 1.51 D - NA Marrurfactuer D - NA
Sol Application Rate _ . gavolarife Pump Model �7 NA
Standard Quaky morntidy average* Pretipannner Unit O,NA
Fats, Oil & Grease (FOG) <_30 mg& (3 S d)Gravel Filter 13 Peat Filter
r
Biochemical Oxygen Demand (BODJ 5220 mg& 0 NA D Mechanwal Aeration 0 Wetland
Total Suspended Solids RSM Si50 mgll 0 D'nskWWcdan a Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s1 0 NA
Mocnemical Oxygen Demand (BODJ 530 mg& ;q hn-Groad (gravk" 13 bn-Groud (pressurized)
Total Suspended Solids iTSM 130 mg& 13 NA O At -Grade El Mond
Fecal Coifmm (geometric mean) 510 cfullOQnI 13 Drip -Line 13 Outer:
Maximum Effluent Particle Sim Y in dia. 0 NA Odw (3 NA
Other O NA Other: El NA
`'Values typical for donreslic wastewss" and septic tank effluent. Other. CI NA
MULE
Servfoe F - Service Fmmpeaey
Inspect condition of tank(s) At least awe every: 11;Z; Q sJ 3 years) O NA
Pump out contents of tank(s) When combined sledge and scum equals en*4wd (!j of tank volume El NA
n n mndMs) Alaramtuu 3 years) 0 NA
Inspect dispersal cells) At least once every: ?j >OO"
Clean effluent filter At least once every: ' — Z D � CI NA
-
JR O months)
t punp. PUMP controls & alum At least once everts 11 Y'earls) C1.NA
Flush laterals a st d pressure tea At least once every. • 0 V incinirW
esirm Q NA
Other At least once every: p month(s) a NA
Other. ELNA
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
inspuHCtians meant include a visual inspection of the tankls) to idenWy any missing OF bnolaen hardware. identify any cracks or leaks.
measure the volume of combined sludge and scum and to check for any back up or pending of effluent on the ground surface.
The dispersal cells) shag be nnsualiv inspected to check the effluent levels in the observation pipes and to check for any pondnng
of effluent on the ground surface. The pending of effluent on the ground surface may indite 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.
All 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 local regulatory authority within 10 days of corrnpketion of any service event.
Page — of Z-
iattT tH' AND OPERATION � products or other d�eriicals
trot revo construction, prior to use of the POWTS clack treatment tanldsl fa the P P detected have the coolants
that may impe the VoWnent p w'� a die °ems. if high
of the tank(s) nerrioved by a septage servicing operator plim to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks MW 0 above normal highmater kevds. WNen power a restored the eXOeSS wastewater will be
discharged to the dispersal ceNs1 in one large dose, avoloargng the ce1131 and may result in the backup or surface &=her" of
effluent. To avoid dw situation have the contents of the pump tank ren ved by a Sepcage Servidng OPeraitor Prior to restoring
power to the effkw a pimp or contact a Plumber or POWTS Msintmw *0 assist in mad uailtt operamg on Pep t to
restore normal levels within the pump tack.
Do not drone or park vehicles over tanks and dispersal
cells. Do not drive or park over. or otherwise disturb or w"acthe area
within 15 feet down slope of any ;;wand or att-9rede soil absorplion area' the performance and prolong the Me of the
Red;,". or elimination of the fo&mft from the wastewater stream may improve dental floss d . s disinfectants; fat:
POWTS: ark fiiotics: baby wipes; butts; condorW owton swabs.
roast scraps: medications; oil:
foundation drain Isump pumo water, *W and vegetable 11119060W 9
Painting products: pgsddAes 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.
CONTINCA94CY 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:
t� A suitable replacement area has been evaluated and met/ be uuMwd for the location of replacement w
system. The replacement area $1110111111d m n
d be protected fro diist urbae and compecTfin and shouild not be
required setbacks from eo atoll and proposed structuM lot Tines and wells. Faium to protect the replacement area w9
result in the need for a new soil and site evaluation to establish a udtd* 91011110cillmem area. Reptativant systems nvW
comply with the rules in effect at that tine.
O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTf
technology a holding tank may be installed as a last resort to replace the faded POWTS.
The site has not bean evaliated to identify a suitable replacement area. Upon failure of the POWTS a soil and silt
evaluation must be performed to locate a suitable replacement am._ if no replacement area is available a holding tent
may be installed as a last resort to replace the failed POWTS.
CI Mound and at-grade soil absorption systems MY be reconstructed in place following
removal of the biotnat at tfti
infiltrative surface. R of such systems must comply with the rules in effect at that tine.
< <WARNWG> >
SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR T OXYGEN.
00 N01
Hil'[Bi A SEPTIC. PUMP OR OTHER TREAT&UIIT TANK UNDER ANY CNKMWANCES. DEATH MAY RESULT. RESCUE OF I
PERSON FROM THE INTERIOR OF A TAR MAY BE DST OR .E.
*2211130
WeRom
. uw aeerft
C115} 1
POWTS INSTALLER POINTS MANT
Name I �i Name
Phone S - _ 5 �r Phone: — a
SEPTAGE SERVICING OPERATOR VtMKM LOCAL AUTHORITY
Name Name psi c"0C CowiTy
Phone phone F lfs - - 3?b
Th s docu.nent was araftea in compiance with ctuw r Caann 83.22(2 ij(ci W and 113_544 S 431. VYisoosiaii AWICK straWe Gods.
FROM :OEVERING HOMES LLC
FPX NO. :7155311292 Oct. 30 2003 10:24AM P1
flat 30 03 09:99a FOCCATY PLUMBIMG
171000GG�OO P'�
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREBMBNT ,
AND
OWNERSHIP (33RMCATION FORM
Owner/Buyer
Mt►ft Addam rig Adyi&A2{ A 446- �V✓ ..ter ��
(VerUe ano mgW ad fit Plar=V Depubnw for new �)
City/Stete Ptvee) IdWtification Nuroba e z 4;
LEGAL DESCRI
Property Location Y.. &&.1— y+ Sets ZZ--. T 3o N -R ZL-W1 Toad of
Subdivision - -•'—
CertUled Survey Map # _ , Volume — Page # —
Warraa ty Deed # Volume .2 ys . page # s' 7 `/ .�
Spec hoax D yes O'no Lot lines Wa arable Oyes O no
MMM-K
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of 11 oat ttia aepik tact aieq► Am yam w mmuK V asead b! a l'iasn" pairae• lsttM 7'N pa tale Ate fall
as afaw Aye fans'iort o[ lba aapde melt et a RHtAaeat sAa/a bt Ate carte dtereaai R7��
tod6 dsia by Ate owner and by s
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is iu proper itpeoifit� oiisd�tiai; ai ar( j Mesiageelies cad Ptrli� Cf 9� c sat is tpi Aw VA h* of a @AP
. Ate tertdeaed rasa said Ibe shore te*i4reb aed ewes to m lam e7ltoltl wilt Ate Nsedab
sdfa. �t. be+ tis. asa�tlr) ieD4stardtafC�eroseati�eDeprewrrRaftiMrw lAseosooe
statics lia pw **& efrwie bar beem x"Is iamo ie esorkai aed as wmit" Ats SL Caaot Cb>W ?wabg OlYicsw]Otta 30'
d"s 3e d
DATE
OWNER CERT CA Off]
1(*t? early ttirt ai ureeeetld � fiis bwe a� taia r As beet o[ � (eat foeoarle�tr. I (we) era (�) � °� -d�� �-
me r p ales q, 6y viMe titi weNSt� lest aewiied o >tyjwx a[ Jkede Olirioe;
oi• pZ,�CJ1Nl' DATE• --
tr.rw �, iafemeetirn Atha n�irreptaselMed eery reeak ie � etei/eq pet>wlit be�os na4lmd br dle l�eoig( Dtp�ent. rrrrri
•• bdude with Ikk eppWadi : t slMed vism j. deed Gan ft Itcsirier of Dee& office
a a*" of qty cadfed $6V&Y aM if refeTeMa is snide is d►a rrniranq decal
U 2424P 574 742029
WARRAN I'Y DEED KATHLEEN H. WALSH
REGISTER OF DEEDS DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
10/01/2003 18:30AN
This Deed, made between, WARRANTY DEED
HILLVALE DEVELOPMENT PARTNERSHIP, nwT #
A Minnesota Limited Liability Partnership REC FEE: 11.80
TRANS FEE: 752.70
GRANTOR and COPY FEE:
CC FEE:
OEVERING HOMES, INC PAGES: 1
GRANTEE THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
WITNESSETH, That the said Grantor(s), for a valuable RVAT
consideration conveys to Grantee(s) the following 03A -11000
described real estate in ST CROIX County,
State of Wisconsin:
PIN 026 1147 - 14 - 000;026 - 1147 - 16-
LOTS 14,16,43,32,33,34 t?W 6 AND 37, PLAT OF 000;026 - 1147 -43 -000 026 1147 -
RICHMOND MEADOWS TOWN OF RICHMOND, 000 1147 - 000;026 - 1147 -
ST. CROIX COUNTY, WISCONSIN.
000;026-1147-36-000
000;026 1147 - 35 - 000
This is not homestead property.
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the property is good, indefeasible in fee simple and free and clear of encumbrances except
easements and restriction so record.
Dated this 1 day of October, 2003. C ��
RICHARD NELSON v
(SEAL)
ACKNOWLEDGMENT
AUTHENTICATION State of WISCONSIN )
)SS.
Sipature(s) authenticated: County, ST. CROIX )`
Personally ca mF be me oq _October 1 , 2003
the above named
be known to be the persons) who ed the
TITLE: MEMBER STATE BAR OF WISCONSIN fo n instru en - acknowledged the same.
TIACY L. URNEK
THIS INSTRUMENT WAS DRAFTED BY: Ob tary Public,
RIVER VALLEY ABSTRACT y commi ssion is permanent. (If not, state expiration
Tracy
1200 HOSFORD STREET #201 L. Tume :12/07/03
HUDSON WI 54016 Public
Notary .
State O f Wisconsin
��. M' 33'
S7 421 $3 �L o
LO N81 49 2
/ 54.60' 22 9 '
81676 SgFt
1.88 Acres
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Co 37 I
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3S0 ll 6 + F / / / 1.67 Acres
/
42 S84'22'27 -E
/�� ? 3 63.29'
84507 SgFt
1.94 Acres
/^ 36
77957 SgFt
^ ^CF4 , `�, 1.79 Acres
C V/ 1
Q.
43 A l A' A F
84271 SgFt /
1.93 Acres
69796 SgFt
1.60 Acres /
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i / e,
34 ry
73889 SgFt
1.70 Acres
N'
h /elc p�• /, ,��
79566 SgFt
e F / 1.83 Acres /
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