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HomeMy WebLinkAbout026-1130-016-000 N 4) p O 2 w 3 V N O m m UL .. O o a c a 'O O mM •O U U m Y N +E Q � U O tp 4 n w w C U E O O N yC E C O N w ._ t E N 7 M O. O E 2: F- L N 2 ' N N M n C Y CD Lo L = (C t z 3<n �� 3 3 m w w .. m y O C LL c Eo �v �cp• v 0r- E Ecb p O� m =?v c m a C. — O. CD. N._ V I Cl) z E z '= O p ° a m c e) N F- fn N C C7 d O z d 0: N 0 z :z 3 c N H r N N O N 1 L N LO 9 0 z z O N o .; E EE Y U R .. R m - m y a C i Z N N N IL 0 0 13 0. Z o I cu CC i (D > a� I a •N �aaa FL cr 7 O 0 Cl) 0 N CD N J U ° o N N O D 'V z t a� ° o CL 0 N N N — N O CO O O) c D D � d ¢ ^ N 13 10 �j O O c 7 f_ C O p E_ O N O to m H w a i'0. - c a ° O o V O M c 6 M m c R N N L 4r � 7 O 1 Co N J U p N M -r- N Cl) N j C �• C N • O N "L V O z N Y W L fn O a 0. f a Z 'c c °' c t A U a O 0.i U CD 0 a , 6 e Go d) a 0 Cc o N a d om o a, Lyo O 0L U p d M Y cc O N n c >" O O N 4= m TO ? 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Permit Holder's Name: City _Village X Township Parcel Tax No: Miller, Sam 1 ''° Richmond Township 026- 1130 -16 -000 CST BM Elev: Insp. BM Elev: BM Descripl qrW . Section/Town /Range /Map No: 1 U v cep �(� 25.30.18.876 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark sew MOO m 1�. I c� I I I. I0 Dosing Alt. 7 � BM F rum: 41.1s- 1b(o •q Aeration _ Bldg. Sewer 7 O R, o2 Holding St/Ht Inlet 101.01 TANK SETBACK INFORMATION St/Ht Outlet v, y 100 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt inlet 1 l Septic ►ZD i Dt Bottom �` Dosing ea er an. S.y 8 79 102,39 Aeration Dist. Pipe ~ ---� -� x,72 -. a �3 Holding Bot. System 0� Final Grade„ ��. ~7�$2 1 rJ3 PUMP /SIPHON INFORMATION pd s$ Manufacturer Demand St over Model Number � GPM a� .1 � I s.�j � p `J .I ` PIR Lift Friction LQ�s ISystem HPar TC Ft Forcemain Length , Uia. Dist. to Well c +� SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. OfJrm&Ms I PIT DIMENSIONS No. Of Pits Inside Dia. DIMENSIONS c; / 0 SETBACK SYSTEM TO P /LNK✓ BLDG WELL LAKE /STREAM LEACHING Ma cturer: INFORMATION CHAMBER OR Type Of System: �7�'" �p4 �Ivl • / UNIT Model umber: DISTRIBUTION SYSTEM JJ I. _ WA I 1K042 Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 1 / / i /i / e / Length �I,S Dia Length �.a Dia I 2 Spacing r /� 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/Trenc r — Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 /_ C Inspection #2: d / Z ( / e 3 -t Z Location: 1404 138th Avenue New Richmond, WI 54017 (SW 114 NW 1/4 16 T30N R1 8W) Red Pine Corner Lot 16 Parcel No: 25.30.18.876 1.) Alt BM Description = t'b-"A� Wl` n °I Se pt C I d i, 2.) Bldg sewer length = a 3 F - amount of cover = 3 a co v 4it Plan revision Re uired? Yes V No ( Use other side for additional Information. / J — ` ____ J 1 / _ (R.3/97) Date \� Insepctor's Signature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 5T. C — N) Pisconsin Madison, Wl 53707 - 7162 Sanitary Permit Numbs (to be filled in by Co.; ent of Commer (6&6) 266 - 3151 Sanitary Permit Application RECEIV D I.D. Number Number _ In accord with Comm 83.21, Wis. Adm. Code,•penonal information yo- provide ( � ���s• may be used for secondary purposes Privacy law, s15.04(lxm Project Ad ess (if dilTerent n tnailir d: csi; S 1 J�O 1. Application Information - Please Print All Information �0 ST. CF? II G Property Owner's Name ONING OFFI E el ti Lot N Bloc', a 5 /L Property Owner's Mailing Address Property Location - -- —� - a t d' /., ffu Section Z City, State Zip Code Phone Number VU 5 o YL W f - �Se 3 94 -Z7 T 3 ©N R /�(cE le ` o n e) 11. Type of Building (check all that apply) >1 or 2 Family Dwelling - Number of aedruo� J�'� (S�ub � �division Nant CSM l x ❑ Pubtic/Cotnmetcial - Descr be Use (\ ' ` O It ❑Ci ❑ State Owned - Describe Use ❑Village foxvnsht p of R\C-1 M 111. Type of Permit: (Check only one box on line A. Complete llne if applicable) OZ,(p t Vp ow _ A' )kNew S stem y ❑ Replacctneut System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to L'x sting System B • ❑ Peanut Renewal El Permit Revision ❑ Change of C1 Permit Transfer to New list Previuus Penrt t N umber a nd Date I Before Expiration Plumber Owner l V. Type of PO WTS System: (Check all that apply) ~� ❑ Non - Pressurized In- Ground Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter i Constructed Wetland ❑ Pressurized lu- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculatung San j Recirculating Synthetic Media Filter El Leachin Chamber ❑ Dri Line ❑ Gravel -less Pi ❑ Other (explain) ( _ V. Dis ersaVfreatment Areu Information: Z i — �n� T';eE Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed S levatiou -- i� o cv r V1. Tank lufu Capacity in Total Number Manufacturer Prefab r ?I-st.c j Gallons Gallons of Units Concrete Constructed Glass New $xitaing Tanks Tama ' Septic ur Holding Tack A -'wbio Tsatmcn: Unit � '., Ucning Cliambcr — - -- —� N'll. Respousibillty Statement- 1, the undersigned, assume responsibility for Lustatlatiou of the POWTS shown on the attached plans. -- -_ Plumber's Namd (Print) Plumber's Signature MP /MP RS Number Busuness Phone Number (Lf. o nel1 is ' 2 Z S O 3 G /Z- Plumber's Address (Street, City, State, Zip Code) / to 70 t�u K']�cl' 1A m - je,4C /1-y.A , :vk k- ,-`l -- i VILL County /De artment Use Onl 'Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date lssuec(,_. is n ' gent Sibntature (N -- ::c: Surcharge Fee) 350 `� I ❑Owner Given Reason for Denial r DC Conditions of Approval/Reasons for Disapproval j SYSTEM OWNER. 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plMber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not lees than 81/2 s I I Inches in size SBD -6398 (R. 01/03) J � Soi/ Q ✓a /ua�'m -� • /oCn.�Ld pro/? Sfax A Sca /e; / "do' Q2nLh tjar,� -_ 7o' o{' /oe S -6r,4. Proposed Mound aE y15su/►'�ed 2 Q.✓; c /OO.Gt�' or��•�tS Spactc/2t �.oS; J 0 �orccwkain driveu�y Pro poscc� Oar Je I � I i � tw�.7�IO ✓C• 0 '' �JJ � I LLB, �% 7 P1fj .Sebt�r G / i i (iz� 51;4.s,>.' 3035/ �`` ras :dlg fc ^l Proposed 6W,54-P. S.T. w � '7 f Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 +" �- TDD #: (608) 264 -8777 In www.commerce.state.wi.us /sb ,sc0 s www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary September 02, 2003 CUST ID No.225036 ATTN: POWTS Inspector MICHAEL P MC DONELL ZONING OFFICE MILLER CONSTRUCTION ST CROIX COUNTY SPIA 1070 HUNTER RIDGE RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/02/2005 - Identification Numbers Transaction ID No. 900752 SITE• Site ID No. 664095 Sam Miller Please refer to both identification numbers, Town of Richmond above, in all correspondence with the agency. St Croix County SW1A, NW 1/4, S25, T3 ON, R18W Lot: 16, Subdivision: Red Pine Comer FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 917932 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes Cond and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in ���� chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: DEFARTMEN ON 0 General Approval Requirements: SEE CORK • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST (0 1/8 1) • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c e A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. I - MICHAEL P MC DONELL Page 2 9/2/03 Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II, Integrated Services WiSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz@connnerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 t t s F� MOUND AND PRESSURE DISTRIBUTION COMPONENT n(✓�i' v Residential Application INDEX AND TITLE PAGE 4 Project Name: Sam Miller 3 bedroom residential mound system Owner's Name: Sam Miller • Owner's Address: P.O. Box 151 Trout Brook Road Hudson, WI 54016 Pd. Add.: 1404138th Ave. Legal Description: SW1 /4NW1 /4, Sec. 25, T.30N., RAW Township: Richmond County: St. Croix Subdivision Name: Red Pine Comer Lot Number 16 Block Number: na Parcel I.D. Number. 026 -1130- 16-000 0! ���nlly Plan Transaction No.: 0a Page 1 Index and title OFcoMMERC� T Page 2 Data entry DING Page 3 Mound drawings Page 4 Lateral and dose tank 'SPON�ENC Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer. Mike Mc Donell License Number. 225036 Date: 08111/03 /J/� Phone Number. 715 - 386 -8692 - P4 ( Signature: i � /), ,( Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) Page 1 of 9 I� Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculatiom mane a 300.00 Estimated Wastewater Flow (gpd) TaNe 83 -44-3 in sod try for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) OOlifom of - 36 kwtm. 450.00 Design Flow (gpd) 3.00 Site Slope ( %) 101.00 Contour Line Elevation (ft) 47.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 7.50 ft /orifice f yo 2.00 Forcemain Diameter (in) 30.00 Forcemain Length (ft) Dees the forcemain drain back? Y 95.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1:3 "' -� 4.89 Forcemain Drainback (gal) 5 Gb 6.00 Vertical Lift (ft) i 81.16 5x Void Volume (gal) 0.41 Friction Loss (ft) 86.05 Minimum Dose Volume (gal) 12.91 Total Dynamic Head (ft) 24.72 System Demand (gpm) 3 � Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice L� (� 0.75 1.25 x 1.00 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information 750.00 Total Tank Capacity (gal) 1000.E Septic Tank Capacity (gal) 36.98 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 20.28 gaUn (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.00 Dose Tank Capacity (gal) JZabel Filter Manufacturer 20.28 Dose Tank Volume (gallin) JA100 Filter Model Number Wieser Concrete Manufacturer Project: Sam Miller 3 bedroom residential mound system Page 2 of 9 Mound Plan View T 1/10B: _ :.- -_-�.: observation Pie Q — �:r r•t•�•�;.••r•. r• r•r•:•r•r;r;r•r:t:t;r,��,r;�;r• r:r• r•r•r•l•r•r•r•: • r•r; r; r; r; r•t• ; •r•: • t:.`:t:l�l•l:ttr t:rjr r�t; t•rtiltir:r:r:r: t:t; . l�l •••� ' W .�............ .. .. B � I LJ• ... ... .... ............................... L Mound Component Dimensions Down slope toe extension made. A 5.00ft E 7.80 in H [ Aft ft K Al ft B 90.00 ft F 9.50 in z ft L ft D 6.00 in G 0.50 ft J W ft 450.00 (ft Dispersal Cell Area 1125.00 (ft) Basal Area Available 5.00 (gpd/ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.29 (ft) ► ..,� ♦ H I F . Di sp er sal 102.00 (ft) Lateral 101.50 (ft)—li — = . = : Invert Dispersal Cell "p Elevation E= ... ... ........ ..... .. .......... 4 4 - _ 101.00 (ft) Contour Elevation 3.0 % Site Slope Geotextife Fabric Cover Shading Key T Dispersal Cell See lateral details on 0 — Topsoil Cap c 1.5 ft L•L•ti , •L•L• •L• ".• Page 4 for number, _ t•.�•r.l•t •r•l © 11111 Subsoil Cap a c fLt . L• L ... size, and spacing of ASTM C33 Sand .:5 i H �� :ti %� -% %� %� $r F laterals. Laterals are m '. }' Typical lateral ® Titled Layer 0.5 ft L•L.ti...• .;;. . ti equally spaced from Aggregate c . L•L % L %L•L•L % ".•L••.• s ; the distribut cell's 05 f•t•r• v ••r•;•;•t;:; ;•:.: •: •; —A centerline in the distribution cell (AxB). Project. Sam Miller 3 bedroom residential mound system Page 3 of 9 i Center Connection Lateral Layout Daigram Face main corw*cWn via tee or cross to manifold at any point. Laterals are identical i P s •= Turrwp udball valve or � X- +W2 sl2i� Laterals & kx0e main of PVC Sch 40 clennoutplug per COMM Table 84.30 -5 Holes dried on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.05 ft Lateral Length (P) 44.23 ft Orifices per Lateral 15 Lateral Spacing (S) 2.50 ft Orifice Density 7.50 if /orifice Lateral Flow Rate 6.18 gpm Manifold Length 2.50 ft System Flow Rate 24.72 gpm Manifold Diameter 1.50 in Total Dynamic Head 12.91 ft Forcemain Velocity 2.52 ft/sec Dose Tank Information L oc k kV cow vWth ,, mV label and (o wv device and Electrical as per NEC 300 and -� Carrmt 16.28 WAC Oiscorereot 4 in• rrdn. y Tank cortwmeitt is properly vented Afberrrate outlet Wation ForceffeM diameter Wieser Concrete Manufacturer �_ 2 in. Capacity 750.00 Gallons Volume 20.28 gal/inch A fl --, - Weep hole or arti- Dimension Inches Gallons B siphon device A 18.50 375.10 B 2.00 40.56 C P wy off a on Qt) C 4.49 90.98 96.00 D 12.00 243.36 D Total 1 36.981 750.00 iF- J ♦ Dose to* eievad°n (ft) 3" Bedding urJer tank. 95.00 Alarm Manuafacturer LevelA Alarm Model Number DLV_ _ Pump Manufacturer JZoeller Pump Model Number 198 Pump Must Deliver 24.72 gpm at 12.91 ft TDH Project: Sam Miller 3 bedroom residential mound system Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name r Jim Thompson #30021 Phone 715 - 248 -7767 POWTS Regulator's Name St. Croix County Zoning Dept. Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 ml- Service Freuuency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthl Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Constriction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure pipin materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up (Detail Finished •.........•... ............... Grade Diameter Lawn Threaded Cleanout Sprinkler Valve Box Piug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Sam Miller 3 bedroom residential mound system Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10`cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page,B of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Scott & Angela Klancke 4 bedroom residential mound Page 6 of 9 HEAD CAPACITY CURVE EFFLUENT M ■■■■■■■■■■■ NOON ONE mom MEN C ■� \NOON■■■ .. \ ■\ \NOON■■■ : � rmo ■ \ \►1 \1 \1 ■ ■ ■O mom® 0-19 MEMO : m ►`�1 \O \1 \1 \ ■■ ®gym ■1� \NI\ IN \ IN ■Nil Mg. i! ■ ►NO \\ \NOON - - • ■oil ■ ■�, IO\ ■ ■ ■ ■0 M■■■ al j olm�� Ike \s\ ■ ■ ■�►\ �►� ■ ■■ or NO \_��� ■MEN ■\mum ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ �� ■ ■��M-IR \MORE N►m ■ ■ ■ ■ ■ ■ ■■ MEN ME Bonn�in ■■ ■NOON •��!�� ► \mem\\►\NOON■ ■ ■�����on I mmommoo-O ■ ■ MEN ■ ■-� \ \on \■ ■\o►mumo■ ■ ■ ■ ■ ■ ■■ ■ ■■ MINE ■ So,/ Q ✓a A a-6'o, -? • �oCtZ'Etc/ Oro/? Sfa�e I V 6ca /e; / - "k' i ne,h wta.r -- 7o of /o�-S-&4. Prropo- }dMo(I-nd aE 17.i13 1OY,;o' / flssu,►aed a is; _ /oo.a?' w/ 5'x ?o /eeff /a -dia, s a f 112 'X yV 2-3 ✓J d r Bi oo At/ 0- rccwtai„ d I mad drivey proposed 75 9 a.:P. Pe. Pro I ar4je 6311 i "sol. yo,o, ✓,c. , I bu, %al�;, seux✓ Prop as LJe { 1 � II 3 bcdr�t,.. (� � I p2 r,/:4•S,Tyr/ 303y' I'¢s,dlnCe. N, /; he. proposed ow ,54.P. S .T �; 4 AlE• S. � Tjoa/'/�f, "d- /off • 5e. E /eta P, 8 or 9 -- r 1 i Vt�. �conrinDepartment >rr, mcr+_ -e 501E EVALUATION REPOR Page 3 -- ,... Djv -gicn od Safely and Buildings ' in accordence with Comm 85, Ms. Adm. Coda County l St,. Croix glory( gpmprete alto 001`1 paper net loas!han B 112 x•11 inches in size. Pion must include, but not limifod to: vertical and horltcntal reference point (5M), direction and 7MURN I.O. periding percenl elope, seala or dirnarsions, north arrow, and lucetion and d1stgi to nearestmad• pl print at; Jnfermarirsn. P.oviawod by Oat *r PervonM ;rlrGnMat bn you provi de may he usetl tot eeMN;Iry purpose, (Privacy La. A, 15.01 b y (m; ), Property Owner Propery Looat wakwcnc3 Land 0evel0pM" Govt. Lot SW i /4 NW 114 s25 T 30 N R 18 a ( 1 Pr is d� ess Lot ✓ EJ!t7r k N Subd. Marna I CSMA #10 :V. . 16 na { Red pine Cnrnez I Gib Sta;e Zip Gale Phone Number city Village ® Town Nearest Read Sprinc( Lake F' �^ 6 7 2r 780 -49' 6 Ricl'rr 19 0th St. 5d Now CDnslruction Usn: [)_6 Rerid9ntial 1 Number of bedrooms ... 4 Cride derivod deslzn tow rate Ana _ - -- L7 Ropl 2Cgntani [ ] Public v comm rrdll - C+esoribe: _L3C1e3_L_ ri ft- - -- Flood Plain olevatisr if app &rnblc _ �.. — _ -_ It. Q.nerrl Cernrnon" and recemrrenCati;xir.; @ raj 102.00; based on contour line of el. 101.00' I 3oring # ❑ t3orir>p 1 Q Pit Ground zurfaoo elev 10 -50 ft- Depth to limlting fectgr Horizon Depth Dominant Go1w Redox Description Texture 5tn.i0tura Conai9t8 1co 6oundery Raatc G?0 1fF in, Munsali Qu. St. 09M Color Gr. Sz_ 5h. 'Eft'#1 WN2 1 0 -13 1 Oyr2 /2 r=e L 2msbk mfr cs 2f .5 .8 2 13 -29 10yrQ 4 none sic 2mgbk mfr gw it .9 .6 3 29_47 7.5yr4/6 none is 0sg mvfr gw na .7 14 47-70 5yr4/4 nora sc1 M na na na .0 •0 $c�ng ❑ Boring 2 101.50 _ - pit Ground .urfeco elev. _ n, Depth 18 i:r:dng factor .._�,_ In, 5oU A lili ti n Rate r _ I lorizon Depth Oam +nAnt Color Recoa Ces;rlpttoJl T C %tllrr; Structure Coneistenae Bound9ry Roolg GPDlFF In . _ _ Muraell tau. St. Cont. Color G Sz. Sh. 'Etflfi 'E 6= i 1 0 -10 1 0yr2/2 none i, 2ru9bk mfr ~ gw 2f - .5 .8 2 10-21 ' 0yr4 /4 none scil 2msbk - trfr car 1 f .4 .6 3� 21 -3 _7. 5yr4/ norM 31 2m, ,5bk rtr%lfx if .5 .9 4 l 32 -5 7. 5Yr4 /d none ~.a. 1s Os - ntvfr gw . t'ra .7 112 5 64 -81 5yr4 /4 C2d 7,SyrS /6 Sol M ha tla na .0 .0 Cfrueni #1 = BOO 30 < 220 rng1L and 'toS >30 �_ 150 m g.rL F.: cent 02 = a S 3C mglL and 'rss •: 30 rng/L CST Number CST Narre (Pleas Prini) Signature r 02298 Gar L_ Steel Address Oate Evaluation Go ndjdM Telaphons Nutrilsar 1554 20 0th. Ave., Mew Richrngnd, WI. $4017 11 4.2000 71 246 -6200 I f Proms owner Oakwood Lr and De veiopmem Party) ID # � `� ring ❑ � I 3 I Pil G Ae ar�elav - ..100.50 n, Depth to lir*Vng factor 7 2 In — Soil Ilaation Rate L.. �J Texturo Sweture Consistence Boundwy Reats GPt]!IF Horizon Depth Dominant Color Redox Description •Etr#1 "Eff#Z in. Munsell Qu. Sz. Cant; Color Gr ss. Sh. 1 0 - -16 10yr2/2 none L 7atlsbkc mfr 2 1 6-27 10yr4/4 ric�rt e sic) 2msbk* m£r c1w 1f .4 .5 3 27 -40 7.5 Yx' 4/4 none S1 2msbk mfr 9W 1f •5 . 4 40 -72 7.5 4/6 none fS 0:5q mvf .na 5 5 72 -80 S 4/4 node Sol M ❑ fiorint; Bong # -- El El pit Ground surface drv. R, Deoth to limiting factor h. Arpliwtion Rate Hortzor; Depth Dominant Colo Redox Description Texture Stivdure t;pn4isteneE Mundary Roots GPOfff' In. Mtmse4 QU, 37- Cont. Color far, SL Sh. 'Efya1 EfW ❑ 6or:ns ❑ ISO"; # pit Ground surface elay. rt. Depth to AnAng (scot - In' Sol) 6oaiian Rate Hort7on Depth Daminant Color Redox Dncrlpdon Texture Stnxh+e C statrea i3aiwdaty Rood in Munsel Cu. SL Cont. Coles i i Effluent #1 = BOD, a 30 1 220 nVrL and TSS >30 S 150 mg(L ' &Auent #2 a BOD,130 mg& and TSS 130 rn01- The Department of Commerce Is an equal opportunity service provider and employer. if you need assistance to access services or need matoriai in an Alternate format, picasc contact the department at 608. 266 -3151 or TTY 608- 264.8777. SMA330 fL&W) N1ZEUb SOIL S,l RVIUL G�r+� L. ,Steel 1554 200 #h Ave. M4+ S25 T3 BW CSTM2298 SW4 Land - lapmetYt New Pichmond, WI 5401'7 MPRSVII -3251 �� town of Richmond , (715) 246 -6230 lot #16 -Red Pine Cbrner N 1 " =40 I BM.= top of NW lot stake @ el. 100.00' Alt. BM. top of mid -lot survey stake @ el. 100.50' Al Yb � � f �b 31 �� �1 Cary L. Steel 11-4-200D 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. C:rOlX 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 refer ) direction and Parcel I.D. pending percent slope, scale or dimensions, north arrow, Ip tipnla�ld i� , e to nearest road. Please print a hfonfiatio �' , evi ed by Date Personal information you provide may be used /ora�p(indary R�� (� acy LaVt .a .04 (1) (m)). Property Owner - ` ro rty Location Oakwood Land De velopme of SW 1 /4NW 114 s25 T 30 N R 18 X (or) W Pr O is II• g dress # Block # Subd. Name or CSM# R�'j ' 6 N `E ; r - c::, na Red Pine Corner City State Zip Code ` ,Phone "W� Or City ❑Village )K] Town Nearest Road Spring Lake PfLrk, MN. 5543A'61`27 .780- 4996';,` Richmond 140th. St. ® New Construction Use: ® Residential / Number 6Tbedroo , 4 Code derived design flow rate 600 GPD ❑ Replacement , ❑ Public or commercial - Describe: Parent material ql ar•i a 1 drift Flood Plain elevation if applicable n� ft• General comments and recommendations: mound @ el. 102.00; based on contour line of el. 101.00' 1- B # Boring 11 oring ® p it Ground surface elev. 101 _50 ft. Depth to limiting factor 47 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 1 0 -13 10yr2/2 none L 2msbk mfr cs 2f .5 .8 2 13 -29 10yr4/4 none sicl 2msbk mfr gw if .4 .6 3 29 -47 7.5yr4/6 none is Osg mvfr gW na •7 1.2 4 47 -70 5yr4/4 none scl M na na na .0 .0 _ Boring # F] Boring 2 ® Pit Ground surface elev. 101 .50 ft. Depth to limiting factor 64 in Soil ADolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -10 10yr2/2 none L 2msbk mfr gW 2f .5 .8 2 10 -21 10yr4/4 none ; 2msbk mfr gw if .4 .6 3 21 -3 7.5yr4/4 none sl 2msbk mvfr gw if .5 .9 4 32-64 7.5yr4/6 none is Osg mvfr I gw na .7 1.2 5 64 -8 5yr4/4 c2d 7.5yr5/6 scl M na na na .0 .0 Effluent #1 = BOD > 30:S 220 mg/L and TSS >30:5 150 mg /L Effluent #2 = B < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gar L. Steel _ 02298 Address Date Evaluation ~ nducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 11 -4 -2000 715- 246 -6200 Property Owner Oak wood Land Dev elopmetn Parcel ID # PE-miding Page 2 of 3 31 Boring # ❑ Boring ® Pit Ground surface elev. 1 00.50 ft Depth to limiting factor 72 j, in. — �I 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 1 0 -16 10yr2/2 none L 2msbk mfr gw 2f .5 .8 2 16 -27 10yr4/4 none sicl 2msbk mfr gw if .4 .6 3 27 -40 7.5yr4/4 none sl 2msbk mfr gw if .5 .9 4 40 -72 7.5 4/6 none fs Os mvfr qw na .5 9 5 72 -80 5 4/4 none scl M na na na 0 F-I Ong # ❑ 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 GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # E] Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = SOD, > 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 (86/00) STEEV S SOIL SERVICE Gary L. Steel 1554 200th Ave. Oakwood Land Development New Richmond, W! 54017 MPRSW -3254 SW S25 T30N -R18W � � town of Richmond 715 246 -6200 lot #16 -Red Pine corner 00 'IN `1 " - 40' = top of NW lot stake @ el. 100_00' t top of mid -lot s stake @ el. 100 60', x to � urvey 2 �� f t o 'j f ^1 0 X- D J � Gary L. Steel 11 -4 -2000 II I _ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner 5,A4 m rn L /_ Septic Tank Capacity 00e a l ❑ NA Permit a o Septic Tank Manufacturer S — ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2.4 (j ` c / ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model _ X00 ❑ NA Number of Public Facility Units NA Pump Tank Capacity 7s0 al ❑ NA Estimated flow (average) V-5 Pump Tank Manufacturer wF 1 S E/L ❑ NA Design flow (peak), (Estimated x 1,5) SO gal/day Pump Manufacturer Z c> (� @ ❑ NA Soil Application Rate 4 SU gal/day/ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L 1 Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD,) 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade Ij� Mound Fecal Coliform (geometric mean) 510' cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ N Other: ❑ NA Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 2f year(s) (s) (Maximum 3 years) C] NA Clean effluent filter At least once every: ❑ m l ❑ NA /� yeaarr((ss ) ) Inspect um ❑ month(s) p p pump controls &alarm At least once every: NA ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications. Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer Septage Servicing Operator. TanN 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 cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondin -; 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 dispo$ed 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 completion of any service event. 7/ STAR r UP AND OPERATION Page 2, of 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 tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal.highwater levels, When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat: foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications: oii 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 witn 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: ❑ 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. T �f aluat a o ing anK b e of a '�fZDN(B Tl�� CDR- N>� con1577z (iG?i D� 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 < NFL Name Phone Z- `S_ 5' Z 7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. C ( b _0r�.1(�v Phone Phone "� / S— 3 W(�_ 4 1 (a YD This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S 4*1 &1 Z-1-- 6 0 , Mailing Address o X # /S 1 P roperty Address O 3 *� AJ a.. ✓ (Verification required from Planning Department for new construction) City/State W I . Parcel Identification Number Z(o 30 ' ! c oo LEGAL DESCRIPTION Property Location :r;- W ' /., � V) '/4, Sec. Z- . T,1aN -R — Town of C- N1 o -K Subdivision kal <'. o iN o.r , Lot # & Certified Survey Map # CG 2 / 2 - '� , Volume Page # Warranty Deed # 7 3 2- / 48 S , Volume � 3 3 Z . Page # � � •S Spec house ICJ yes ❑ no Lot lines identifiable � yes ❑ no SYSTEM 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 disposal can affect the function of the septic tank as a treatment stage in the waste p osal sy stem. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a ber, restricted lumber or a licensed pumper verifying that (1) the on -site wastewater disposal system um ber, journeyman hum P P master plum , J yman p P is in proper operating condition and/or () after 2 in and pumping if necessary), the septic tank is less than 1/3 full of sludge. mspe P P g ( 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 da of the year expiration date. 7 O ATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property de c 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. S ATURE F AP C DATE « ««««« 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 Deeds office a copy of the certified survey map if reference is made in the warranty deed I J 2332P 965 7321 a5 STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between Oakwood Land Develolament, Inc., a 07/28/2003 08:30AN Corporation Grantor, an am E. Miller, a sin rson , Grantee. Grantor, for a valuable cons ider `JTSfi v s o ra'ant'ee McT6Rdwing WARRANTY DEED described real estate in St. Croix County State of EXEMPT 1 Wisconsin (the "Property"): REC FEE: 11.00 TRANS FEE: 508.50 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address Sam E. Miller 1406138th Avenue New Richmond, WI 54017 026 113016 00026 1130 28 000 Parcel Identification Number (PIN) 1 - // tf a - 5T -- 0 a O This is not homestead property. (Is) (Is not) Lo 16, 8, 40, Red Pin Corner and Lots 46 and 55, Red Pine Corner First. Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this IC? day of (SEAL) (SEAL) Oakwood L eveRSpRfBfit;'Inc. (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, St. Croix County authenticated this _ day of Personally came b f e ma this IO� day of the above named Greoory J. Pe erson. as Vice President to me known • to be the person _ $, who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN instrument and acknowledge the same. (If not, authorized by §706.06, Wis. Slats) `` �u�uuu i „ • cJjliir1 r, THIS INSTRUMENT WAS DRAFTED BY Public, St& of Wisconsin Coldwe)l Banker Burnet 1301 Coulee Road _ y? mission is permanent. (if not, state expiration date: Hudson, WI 54016 2 -41063 (Signatures may be authenticated or acknowleclgpd, /C • x Both are not necessary.) ' % SCONS�� •` �`` Names of persons si nin in any ca act must be tyged or nnted below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 -1998 Milwaukee, Wis. RED FINE CORNER LCCA'F; N Y RT OF THE N �n Ak`. M AR. :f ly ti .2 }; T ,,q AR TLS A4 t '{: ML N 't 1Fl AN1E. ({ a�f G + ART HE SC T .F:4 1. A. fFH 4 NOR Y,'E.SI QLA TFR J7 PAN TM .. ;JT d T :.. J R _R „i' n e..'tOn IE VYfS h . n: ^Tr 4 A.l `. t �..C"W 1.;, .N._ dF J h 42.tL F, Wx A w"', /NN C ?li: dCN,., •,T ::RCI,< .C„N1Y, qA, .JN>:h. " MavmrxlsF� [. lK _ • ,.,, .^, ._ .... .,L sa i ,„ .. ua :•. .� ..+.t� . ' f } �� � !;1-r x ' v I �' ' y,-• ' •-t._ � [vtuY1 r .. >. •" '•: "., •. r[vus m a.st . Pn ri r�nA at¢a,s w I.Effor 7 f 7Y � LOT 11 LOT 26 OT Ii / ^ ' I ........ .... .... .. ... ij YA,V1l' Z E LOT 97 j....._ r.,r LOT G } d ... LOT 16 LOT A ... p5 X LOT 16 � i 1 .. LOT c. Y LOT 76 LOT JD LOT M � , n.cm t . LOT 3t w , p f Ajj LOT Sy _ ry 3;f' d;e3 s•1L • I 3 LOT wx.. Lorne d„ LOT tl / h. >al. LOT m .. * ��• „nut Y .1.1 I LOT qI ' LOT 1� . a.+^e.leI awry LOT as + r e £ a r ry 1 "' Nl1951 6 N s+ V 1 I tT hM 4(13- L s. i ...... LOT 20 ..... .... P: q[..}yn;j .. LCr )} L.Ci 1i LOT 2J ..... LI.T ?< LCT 25 j nT 26 SMC[ T Z OF 3 SHEET!:, 1 Ru ki-e) S- � �� r} ' L3i Cr