HomeMy WebLinkAbout026-1130-35-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 463127 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:
Miller, Sam E I Richmond Township 026- 1130 -35 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range /Map No:
X60 byv- \ GS i 25.30.18.895
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
/P go /// • $6 At
Septic W { r Benchmark / / 166
Did /ODD
Dosing Alt. BM
, a 1 3-1 /Q (P. q
{4eFebierr Bldg. Sewer
5 •` 115-V
Holding St/Ht Inlet 7
TANK SETBACK INFORMATION t VZ 103 .57
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ♦ g Dt Bottom
Dosing ! �� T O + Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION S -6$ IN .7
Manufacturer GP and St Cover ` 2- 16 7. 7
Model Number
Z4�7Z. C r 5.74 16 Zco
TDH Lift Friction Loss System Head H t
5 .s 1 5b TD 1 z 5�
Forcemain Length / Dia. r1 Dist. to Well !
Z 8
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length 0 No. Of nche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION Type Of Syst J / / Z /v A CHAMBER OR
UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifo }d ` I� Distribution �� t. , � ! x Hole Size /� rle Spacing Ve t to Air Intake
�+� 1 Pi 7. 1 % C �tJ G
Length 3 Dia \ �' Length Dia / Z Spacing 'Z Jz
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 , Z4—, L� ❑
� es No as No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / 7 / i55 Inspection #2: / /
Location: 1434 136th Ave. New Richmond, WI 54017 SW 1/4 NW 1/4 25 T30N R1 8W) Red Pine Comer Lot 35 Parcel No: 2 .30 .1 895
1.) Alt BM Description = t4le �� ��♦ � ��� �Ot J �[� 105
2.) Bldg sewer length
- amount of cover = o d
—
r
-
Plan revision Required? Yes No
7
Use other side for additional information. l
SBD -6710 (R.3/97) --
Date Insepcto nature Cart. No.
el ev - cm' ey
63 �v r
0
i
=ropo-� ntounda f4.s� BQ.93
cz
.74
I6 , q' Z (� W X 0 3. y3'� s� l o p e
- 7 J . 7 116
� �coPoSCd l.J� e.Sc.r' CrrtCrz,� � _
L-P , doo/ ('s0 - /t Ca»Kbo
�60 S.T�,oC. �7i, 'Istibt(
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i
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Safety and Buildings Division : County
N *i sconsin 201 W. Washington Ave., P.O. Box 7162
Madison, WI 53707-7162 Sanitary Permit N�ug� (to be filled m by C:: ,
De artment of Commerce (608)266 -3151 _ LL 2
Sanitary Permit Applie tio s le Plan LD. Number T
In accord with Comm 83.2 1, Wis. Adnt. COde,•personal info lion you pro e �✓ ��
my be used for secondary purposes Privacy Law, s 01(lX (; 2004 Pr 'ect Address (if different than mailing add: _;s
I. Application lnformadon - Please Print All Information
V___ST- CROIX COUNTY w a; a k a" 014 fj W
P -operty Owne7's Name Z el N Lot q Bloc'.
3S
Property Owner's Mailing Address Property Location n
o '# /S S y N w %, Swiod- 21 S/
City, Stan Zip Code Phone Number
7. : o2o -lt3v ,
syo/ 27eeg o c'cleo t
of checkaUthata l T,,,�N; RE
11. Type
*9 y Pe g ( a p p ly ) y) ��, � •s w d -4 14O. "- PAS..., Subdivi /n�Name CSM \umt
I or 2 Family Dwelling — Number of Bedrooms p x;
2 Publ UComns=ial - Describe.Use - r Pmt' f : of a.- cm r A e � /�
El Sute Owned - Describe Use �ea%♦ I C. o.l ".40yrt� 2(0 ❑City_ ❑village Township of 2 sG k jk osr,J(
I11. Type of Permit: (Check only one box on line A. Complete Line B if applicable) O ZG //30� jy open
A
YNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
i
f ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Pemut Transfer to New list Previous Permit Nuosbcr and Date is >ucu
Before Expiration Plumber Owner
I V. Type of POWTS System: (Check all that apply)
❑ Noo - Pressurized In- Ground O(M�ound- 24 in. o suit soil ❑ Mound <24 in. of suitable soil ❑ At -Orade Cl Single Pass Sand Filter L_i
Coastructed Wetland ❑ Presstu' Ind Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Rx rculadng Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ (ravel -less Pipe ❑ Other (explain) 41 �-1 /�a.
V. Dispersal/Treatment Area Information: _
jl L Flow (DA) Design Soil Appli tion Rate(gpdsf) Dispersal Area uired (so Dispersal Area roposed (sq Sy tens Elevatiou
yse
1. Tank Lafo Capacity in Total Number Manufacturer Prefab Sik S el t
Gallons Gallons of Units Concrete Constructed Glass
New Bxiating
Tanks Tanks _
o, Holding Tank
A. .'robin Tmaimctu Unit
Cs�ng Chambct
V11. Responsibility Statement - L the undersigned, assume responsibi.Lity for Lnstallation of the POWTS shown on Use attached plain. _
Plumber's Name (Print) I Plumber's Signature MP/MPRS Number Busiuess Phone Number
&ZkA VIA. 5% Z 2 j b 3 C, 1 44- �f 1 �/ 2.7
Niumber's Address (Strut State, Zip Co (( / - --
Col C, H&O- T &r k ek (4w � s 0� � ( S �O b
\11L our /Dc artment Use Only_
Approved ❑Disapproved
Sanitary F Groundwater Date Issu;¢_ : wing Age Signs ue (: eras;
Surcharge Fee) 35� (7v Q
❑ owner Given Reason for Denial U !9 0 it
A. Conditions of Approval/Reasons for Disapproval
��cu� w�duCoee Q hcz / .E2G� f�'�Lt/� U%�
( !I :S e STEM OWNER' �- C jr 3 T L
ti effluent filter and ^
Ispersal cell must all be serviced /maintained �/ 3 fit Lei'
as per manse
2. setback requirements must be maintained
as per a licable code /ordinances.
Atucb complete plans (to the County oaly) for the syltemoorwitolpss t as 8M s 11 Inobwalue
SBD -639 1/03) /.S-/,
1. �b.rt.: Toro of
w,�h n'lar,�' Toe o
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Pro po�-e.4 r+louu wt tQ.s� x 8� $3
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to..�c.ra,Cs of �yi'z 36. G9' KY ra " rn^ , i�•ca�s 6Z ® • B c3 0� ; �j
6,042 ccd aEZ.s.3: ;
/423 y Slope t0 � l �
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Pro posed W, aer carp erime
wVA coo /l - M -Q Cov,�l�o
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a'.65-r. outtct.
proposcal
3 btdroon,
a residence.
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Safety and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
I \
Visconsin www. comm erc .wis s emi.
Department of Commerce _ www.wisconin.gov
Jim Doyle, Governor
Cory L. Nettles, Secretary
November 06, 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 A~� 1 & 3
PLAN APPROVAL EXPIRES: 11/06/2005 Identification Numbers
Transaction ID No. 937767
SITE: Site ID No. 667682
Sam Miller Residential Please refer to both identification numbers,
1434 136TH Ave above, in all correspondence with the agency.
Town of Richmond
St Croix County
SW1 /4,NW1 /4, S25, T30N, R18W
Lot: 35, Subdivision: Red Pine Corner
FOR:
Description: Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 928648
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes L dh
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. AP
The following conditions shall be met during construction or installation and prior to occupancy or use:
DEPARTMENT
OF
General Approval Requirements:
SEE CORRE
• 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 /01)
and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (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
• 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
r
MICHAEL P MC DONELL Page 2 11/6/03
W
O ner 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@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
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
Pcl. Add.: 1434 136th Ave.
Legal Description: SW1 /4NW1/4, Sec. 25, T.30N., R.18W.
Township: Richmond
County: St. Croix
Subdivision Name: R d Pine Corner
Lot Number: ( �3 )_ Block Number: na
Parcel I.D. Number: 026 - 1130 -35 -000
Plan Transaction No.:
'011171 y
Page 1 Index and title O
Page 2 Data entry
Page 3 Mound drawings :)F C OMMERCE
RECEIVED Page 4 Lateral and dose tank �d DINGS
Page 5 System maintenance specifications
Page 6 Management and contingency plan
OCT 2 2 2003 SPONpENC
Page 7 Pump curve and specifications
Page 8 Site Plan
SAFETY & BLOGS DWa ge 9 Soil Evaluation Report
Designer: Mike Mc Donell License Number: 225036
Date: 10/15/03 Phone Number. 715- 386 -8692
Signature: DR 'I 91&
Designed Pursuant to the
Mound Component Manual for POWTS Version 2.0 SDB- 10591 -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
NOV -06 -2003 08:01 AM A.C.E. Soil & Site Eval. 715 248 7764 P.02
Mound and Pressure Distribution Component Design
Design Worksheet
81% Information
(r or c) R Residential or Commercial Design Not*. Bond fill (D) oslo hub •scum• e
300.00 Estimated Wastewater Flow (gpd) Table es if irm of <• soil hub for *W 1.50 Peaking Factor (e.g. 1.5 = 150%) of
450.00 Design Flow (gpd)
104.26 Contour Line Elevation (ft)
3, e a or
0.40 In -situ Soil Application Rate (gpd/ff)
,-bl tbutlon Call Information
✓ 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft)
1.00 Dispersal Cell Design Loading Rate (gpd/e)
1 Influent Wastewater Quality (1 or 2) Are the laterals the highest olnt
In the distribution Y �]
Pressure Disribution Information network? Enter Y or N
(c or e) c Center or End Manifold
3.00 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)
2.50 Estimated Orifice Spacing (ft) 7.50 ft /orifice
A 2.00 Forcemaln Diameter (in)
40.00 Forcemaln Length (ft) Does the foroemain drain back?
98.57 Pump Tank Elevation (ft) Enter Y or N
6.50 System Head (ft) x 1.3 8.52 Forcemain Drainback (gal)
5.69 Vertical Lift (ft) 67.32 Sx Void Volume (gal)
0.54 Friction Loss (ft) 73.84 Minimum Dose Volume (gel)
12.73 Total Dynamic Head (ft) 24.72 System Demand (gpm)
Lateral Diameter Selection Manifold Diameter Selection
In. dia. options choice in. dia. options choice
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 n38.0 Total Tank Capacity (gal)
1000.00
Se pt ic T ank Capacity (gal) Total Working Liquid Depth (in)
Weser Concrete Manufacturer gal/in (enter result In cell B49)
Dose Tank Information Effluent f=ilter Information
W.001 Oose Tank Capacity (gal) JZabel Filter Manufacturer
17.001 Dose Tank Volume (gal/in) JA100 Fitter Model Number
Wieser Concrete Manufacturer
Project: Sam Miller 3 bedroom residential mound system Page 2 of 9
N -0 6 -2003 08:01 AM A.C.E. Soil & Site Eval. 715 248 7764 P.03
Mound Plan View
1/10 B ot�servaMon P�. J
K ti } •.. ti. ,.,. �.•ti••...,. ,.,. ti r
} }.}; } r r }.r r r r r• }•.;r.r r ' ~ {• }• ' A
�, '••tip 7' �. { + 5 � {. { } }rr;r " r;�} } r
' r� "• ?r r. .}. }.�.r r r . .r. .r:x; + ». .,•r•r• •r. }.i.r }r r r. ..r. —
I
LI
Mound Component Dimensions
Down sio a toe extension made.
A 6.00 ft E 10.32 in H 1.00 ft K ft
B F 9.50 In z 9.00 ft 89.83 ft
D 8.00 in G 0.50 ft J 4.56 ft 19.56 ft
450.00 Dispersal Cell Area F 1125.00 (ft) Basal Area Available
6.00 (gpd /ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 108.55 (ft)
✓i G * H
✓ ✓ri ✓rii 2 ✓ ✓rill✓ l
1 nisi ✓i .
t F a ae+i 105.29 (ft) Lateral
104.76 (ft) —► Invert
Dispersal Cell r
El evati on E D
...........
4
104.26 (ft) Contour Elevation
6.0 % Site Slope Geotextile Fabric Cover
Shading Key $ Dispersal Cell See lateral details on
0 _ Topsoil Cap .L 1.5 ft • 6 ..,. 1 ��.,r, f,r { �� f�� Page 4 for number,
�� ✓�� Subsoil Cap .,,,. ,,.ti size, and spacing of
r•r• r• r rw• r•r +r
ASTM C33 Sand — ,4�"� .. . ti','�., },�,.1 F laterals. Laterals are
Tilled Layer = 0.5 ft f; s 11►rJ!ca Lete►a� equally spaced from
/'� •�� =r -r•r r•r•r r•r »r
u 1~f~1~ Ai/gregate o : + 'ti.ti•y.4.4.'. ••. �S+ti•�+ `j.
v . •r•r•• "•s•r•r ».;r. the distribution cell's
A -* centerline in the
distribution cell (AxB).
Project: Sam Miller 3 bedroom residential mound system Page 3 of 9
NOV -06 -2003 08:02 AM A.C.E. Soil & Site Eval. 715 248 7764 P.04
Center Connection Lateral Layout Daigrarn
Fora main ow'O otlon via tee or cross to rnufald at ang point. Laarata an Identb rW
. S
d/ ■ TunwP rf batl w Ivr. a �E X !I! -wlZ al'Y �I Laterals fk FOOe main of PVC Soh 40
olrranoutplug per COMM TAW 94.30.5
H s WNd an the bottom of the lateral.
Number of Laterals 4 Orifice Diameter 0.125 In
Lateral Diameter 1.50 In Orifice Spacing QQ 2.53 ft
Lateral Length (f) 36.69 ft Ortfices per Lateral 15
Lateral Spacing (S) 3.00 ft Orifice Density 7.50 if /orifice
Lateral Flow Rate gpm Manifold Length 3.00 ft
System Flow Rate gprn Manifold Diameter 1.50 in
Total Dynamic Head EAft Forcemain Velocity 2.52 ft/sec
Dose Tank Information Locking cover with woming
label and looking device and
aesiad watettlght
Elacbical as per NEC 300 and ---♦►
Comm 16.28 WAC �iacanned 4 in. min.
Tank component Is properhl vented Alternate outlet
location
Forumaln diameter
Wieser Concrete Manufacturer 2 in.
Capacltyj 648.00 Gallons -
Volume 17.00 gal /inch A
Weep hot* or anN-
Dimenslon Inches Gallons siphon device
A 18.63 315.70 C
B 2.00 34.00 1 Pump ofT a kwatbn R
C 5.37 91.30 T A8.57
D
12.00 204.00 D
Tatai 38.00 648.00
Dan lank elevation ft
3" Bedding uniTer tank. 1 98.57
Alarm Manuafacturer LevelArm�
Alarm Model Number I DLV
Pump Manufacturer Zoeller
Pump Model Number 190
Pump Must Deliver 24.72 gpm at 12.73 ft TDH
Projed: Sam Miller 3 bedroom residential mound system Page 4 of 9
Mound System Maintenance and Operation Specifications
Service Provider's Name _ Jim Thompson #30021 Phone 715- 248 -7767
POWTS Regulator's Name �St. Croix County Zoning Dept. Phone 715 - 3864680
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 ft Maximum FOG 30 mg /L
Type of Wastewaterl Domestic Maximum Fecal Coliform >10E4 cfu /100 mL
Service Frequency
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 month)
Pressure System Laterals should be flushed and pressure tested every 1.5 years
Mound Inspect for pondingand seepa once eve 3 years
Other
Miscellaneous Construction 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 piping 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 \ ; •
6 -8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Lateral
1 �► 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 9.5 (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, Stats. 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 fitter 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 fitter when removed from its enclosure. If the filter is equipped with an alarm, the fitter
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 113 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 then 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 vvather 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.
Continaency 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 6 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: Sam Miller 3 bedroom residential mound system Page 6 of 9
HEAD /CAPACITY CURVE
N H
2 W
r LL HEAD CAPACITY CURVE
EFFLUENT MODELS
y4 TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE
- --
1 10 EFFLUENT AND DEWATERING
32 10 1
SERIES
00 6744 97 99 137.139 161 i 166 466 18E
18a 8D
7T. L{, Od ylbl Gal.jLtrs, Gat LVS G.I. n Gd Le6.:. l3n L Ve Gal Lh. Od i Lta' Od Lh . Od Lbt Gal lYS.
30 - _
95- b 1,52; q 160 56 !212 72 :273 104 34;4;'. 106 401': 91 201 61 231. sa 220 156 :687 166 , Sd7
28 10 536 34 .129 48 11.74 61 231 79 30 100 379: 61
90 2 .1: 61 �i'' 69 :22J 1N 66V 151 677
16 4.57 19 72 36 1153 46 170. 64 242 61 Stu 60 ,ZU 60 227.: lab b19
26 - 85 - 20 410 15 I 67 25 96 x 136 92 510 69 ?:3 :` 60 227'. 69 720 136 -. 816 140 tJ0
74 280 67 216;i 69 223.: 68 22G 129 Oat 133 661
24 - BO 30 { V4
I 66 240 66 2E6 68 229:' 90 340 68 : ?2t 121 - .166 127 "1
75 b 1219 ;I 46 174 /6 17 2`:' 66 206!: 76 297 68- -220 106 ':597 114 431
22 166 60 1624 21 60 0J 1?6: 61 iF'. Ed .21D 68 :. 2E0 90: - Jdl 100. 37D
70 bo
t6 1 67; 43 161 36 136 W ':.220 71 269 66 J2:
0 70 3/ 1 30 114 10 38 62 - :197 61 ::I OJ 70 256
T 65 21 165 _
60 90 i 24� 9B 11 F7 45 170 26 LU
5 -T- - ;T - 2743 106 64 2 ._
_ 32 121 2 1 37 140
55 too 'I30.48 19 68
21 79
110;3200 7
50 V.N. 1 ao
I ; 19.26' 2376' 23' - .
28' b6' 75• 116' .. 112'
14 5 61'
_.
;2 40 - EFFLUENT & DEWATERING
° 35 165 Warning: Model 185 should not be subjected to less
than 30 feet TDH.
a 25 log
Note: For Head Capacity on Model 112, industrial
6 20 - - column - explosion proof pump, see FM 219.
7 ,3 5
Td, lea
lo-
5- 96
5 5, 7,59 SEWAGE & DEWATERING
GALLONS t ,
° 201 30 40 S 60 70 80 90 100 1110 120 1130 140 1150 160 WARNING: Model 293 should not be subjected
LITERS 80 160 240 J20 400 490 560 640
° to less than 15 feet TDH.
N ,
.1/7.3 M . ,
W J_
eS CA
W
4
24 60 - -..-. --
TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE
75 _
SEWAGE AND DEWATERING
22 -
70 -
SER 262 266 2 266_ 282 284 292 293 294 295
FT. _M Gal, Ll s. Gal. Ltrs. G Llre. Gal. L!re _ Gel U rs. G al. LIr6. Gal Urs. Gal. Lln. Gal. I" Ga! Urs.
20 5 1.52 >70 341 129 4B4 1 4B4 128 481 130 192 4 691 '.40 530 196,712 225 652
65 10 3.05 60 227 89 331 89 337 8 337 95 360 1 598 '.24 469 181 685 205 776
15 4.57 22.5 65 50 189 50 169 S 189 63 238 135 511 •06 401 130 492 165 6?5 165 700
18 60 - 20 8.10 10 ]8 10 38 '0 ]8 ]3 125 106 401 88 33J 119 450 i50 568 1f>d 6 36
25 7.62
30 9.14 _' -.- -- - -- ;6 288 g8 257 _ 106 101 1J6 515 tS d 2 _ -'
S5- -_- -_ 43 163 47 178 90 340 121 458 140 530
16 d0 42.49 _ 5 19 SO IB9 94 356 It, 4J5
50 15.24 -.
50 j 60 -18.29 58 220 85 337
14 70 21.34 -- - - - -- _-_-
] /9 SS 223
_ 25
/S Lock Velv 8' 21.5' 2 ?1.5' 95 28' 3G /2 SD 62' 7
12 40 -_
i
35 _
10 - -- -
30
293 _ --
25
15
4 282 --
10 -- -
292
2
S _ _
_ - 262 266, 267, 268 284 194 285
0
GALLONS 10 20 30 40 SO 60 I 70 BO T� II 90 100 110 120 1 130 140 1 150 160 170 180 190 200 210 220 230
I -� -- --- }- - -- - - i
LITERS 0 60 160 240 320 400 48U 560 640 720 800 660
7 0� 9
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mow
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1732
VI/tsconsin Deparhent of Commerce SOIL EVALUATION REPORT p age 1 of 2
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County
include, but rat limited to: vertical and horizontal reference pant (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.
026- 1130 -35 -000
Please 4:Wvnp e y Date Personal mf ormaAiar you provide mor 15.04 (1) (m)). O b
Sam Miller OCT 2 �,,, ot Location SW 1/4 NW 1/4 S 25 T 30 N R 18 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSNW
P.O. Box 151 ST. CROIX 35 Plat Of Red Pine Comer
ZQNIN( OFFICE
City State J City ,J Village V1 Town Nearest Road
Hudson WI 1 54016 1 (715) 386 - 2769 Richmond 1 1434 140Th Ave.
New Construction Use: ✓J Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
J Replacement J Public or commercial - Describe:
Parent material Glacial till Flood plain elevation, if applicable na
General comments
and recommendations: Evaluation competed to move contour to overcome deflection problems in originally identified system area.
Install mound system at elev. 104.76' at 6' above 104.26' contour.
Boring # _j Boring
N Pit Ground Surface elev. 105.03 ft. Depth to limiting factor 42 in. Soil Application 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
1 0-12 10yr3/3 none sil 2fsbk mvfr as 2f,1m 0.5 0.8
2 12 -19 10yr4/6 none sicl 2msbk mfr cs 2f,1m 0.4 0.6
3 19 -27 7.5yr4/6 none sl 2msbk dsh cW 1f,vf 0.5 0.9
4 yr Wsl 2msbk dsh cW - 0.5 0.9
5 42-68 7.5yr4/6 f2d 7.5yr5/8 Is/sl
D m
sbk dsh - - 0.5 0.9
• Effluent #1 = BOD 30 < 220 mg/L and TSS 30 < 150 mg/L = BOD . 30 mg/L and TSS < mg/L
CST Name (Please Print) Si tune: CST Number
James K. Thompson 3602
Address A.C.E. Soil & Site Evaluations nducted Telephone Number
340 Paulson Lake Lane, Osceola, WI. 20 10/132003 715 - 248 -7767
• ,4 &L. ,6.,,1. ; T,o o.F
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3.73`
A
ON REPORT Page of
Co mmerce SOIL E V ALUATIO N �_ �_
Wisconsin Department of Co 9
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County St. Cr oix
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 rQfer&i - ci poinl`(BM), and Parcel I.D.
percent slope, scale or dimensions, north arrow; aRfd location and distafte to nearest road. A -- peindin g
Revie
Please print �11��t�rma Date
ti
Personal information you provide may be use ¢fp�sfConda Wti�acy Lak, 8 -.1A04 (1) (m)). L t7 L c
Property Owner "t L � 4' P Locat
Oakwood Land DeVelO �'. - DEC 1 ZU tOovt .;Lot SW 1/4 NW 1/4 S 2 T 3 N R Ador) W
Property Owner's Mailing Address ST CF(Clx o _ Block # Subd. Name or CSM#
1611 Hwy #10 N.E. ":, couNT`r 3 na Red Pine Corner
City State Zip Code ne City ❑ Village ® Town Nearest Road
5p Pakk J
MM 55
y
® New Construction Use: ® Residential /Number of b`edird`oms 4 Code derived design flow rate r- A A GPD
❑ Replacement . ❑ Public or commercial - Describe:
Parent material ql ar•i a 1 drift Flood Plain elevation if applicable „ ft•
General comments
and recommendations:
mound @ el. 103.00', based on contour line of el. 102.00'
F Boring # F] Boring 102.30 45
1 ® 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
1
mfr 9W if .4 .6
3 22 -45 7.5yr 4/6 none sl 2msbk mvfr law na 5 9
4 45 -75 5vr 4/4 none scl M na Ina na 0 0
Boring Boring
2 g ® Pit Ground surface elev 1 02. 30 ft. Depth to limiting factor 33 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
1 0 -7 10 2/2 none L 2msbk mfr qw 2f 5
2 7 -18 10 4/4 none sicl 2msbk mfr 9W if .4 .6
3 18 -33 5vr 4/4 - 2msbk mfr 4
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L (fluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature . CST Number
Gary L. Steel 02298
Address Date Ltvaluati6n Conducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 715 - 246 -6200
Pro Owner Oakwood la Dev eo t Parcel i0 # �_ of _ 1 _
Pe�Y Ok d l
Pn►en �nc� nq Page
F- Boring # ❑ Boring
3 ® Pit Ground surface elev. 1 .50 ft Depth to limiting factor 50 in.
Soil Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. I 'Eff#1 I •Eff#2
k mfr aw 2f .5 .8
_ if 4 6
2msbk mvfr crw na .5 .9
5 0-75 - 4 4 2d7.5 5/6 scl M M na na .0 .0
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F F1 pit Soil lication 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
i
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg& and TSS _< 30 mg/L
I
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)
i
r
STEEL'S SOIL SERVICE
Gary L. Steel Oakwood Land Development 1554 200th Ave.
CSTM2298 SW4NW4 S25- T30N - New Richmond, WI 54017
MPRSW -3254 'Town of Richmond 715 246 -6200
lot #35 -Red Pine Corner
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1 =40' - -
BM.= top of SW lot s e @ el: 100.00'
Alt. BM.= top of NW to stake @ el. 102.20'
d 1a�13/o3
Gary L. Steel
11 -14 -2000
- -J
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
Septic Tank Capacity I00D SO g al ❑ NA
Permit # Septic Tank Manufacturer • ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer za b ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model .4-10.0 ❑ NA
Number of Public Facility Units A Pump Tank Capacity g al ❑ NA
Estimated flow (average) Wb g al/day Pump Tank Manufacturer l�2i ❑ NA
Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer Zd fl ot ,— ❑ NA
Soil Application Rate gal/day/ft' Pump Model 1 6 Y ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade />v Mound
Fecal Coliform (geometric mean) 510' cfu /loom ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: , / 0 m onth(s) (Maximum 3 years) ❑ NA
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: . 0 mont )(s) (Maximum 3 years) ❑ NA
year
❑ month(s) ❑ NA
Clean effluent fitter At least once every: A / GZyear(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ 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. Tank
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 ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and dispoged of in accordance with chapter NR 113,
Wisconsin Administrative Code. ;,•:
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.
START UP AND OPERATION Page Z of
F, '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; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant
replacement system:
❑ 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
A technology a holding tank may be installed as a last resort to replace the failed POWTS.
T
alua ' a o mg ank
bf �o �/�✓
Mound and at grade soil absorption systems may be reconstructed in place following removal of the biomat at th
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
«W >
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 4L A -:�: 0 N¢r Name
Phone �/2 —�� 5 X 92 7 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name S C
t d 20,4!l
Phone Phone
- 1 3S'Co- (V 0
This document was drafted in compliance with Chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer S A W R j
Mailing Address f 0 /-s /f V Ws — u.) -
/ L
Property Address 3 el / 3 6 Tb nhl )
(Verification required from Planning Department for ne construction)
C i t y / S t a t e fir. C w / Parcel Identification Number ° 2 6 ^ 3 ° ' 3 - o a r ,
LEGAL DESCRIPTION ` g
Property Location S W %4, Ill `-y '/4, Sec. Z S . T 3 ° N -R $ own o f R % wt o -k c�
Subdivision Anal i� : aL— Ca r N - v . Lot # 3 l—
Certified Survey Map # �' t ' ( Z 3 r . Volume . .Page # 3
Warranty Deed # -7 3 8 8 V 9 , Volume Z y ° , Page # 52 3
Spec house ',QT yes ❑ no Lot lines identifiable ® yes ❑ no
NANCE
SYSTEM �
S
TE
Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
mastorplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
!:fg� Ttl� L / � 0
SIGMA 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 owners) of
the property descr above, by virtue of a warranty deed recorded in Register of Deeds Office.
4 �p�� ILLQa"X ta/
gidgATURE OF APPLICANT 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�
U 2 4 0 0 P 5 2 3 736849
KATHLEEN H. WALSH
STATE BAR OF WISCONSIN FORM 1 — 1998 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX Co., WI
RECEIVED FOR RECORD
Document Number 09/04/2003 02:30PH
This Deed, made between Oakwood Land Develooment. Inc.. a
Corporation , Grantor, and Sam E. Miller, a single person Grantee. WARRANTY DEED
Grantor, for a valuable consideration conveys to Grantee the following EXIDPT N
described real estate in St. Croix County State of REC FEE: 11.00
Wisconsin (the "Property "): TRANSFPER: 607.20
COPY CC FEE:
PAGES: 1
Recordin Area
Name end Return Address
�a(� fl3Q —31 cno Sam E. Miller
wl 45 40 44L-
C) a(Q - 11 3cz -- 3� - "" d emu,. S'io, cv - ►(�
134 _ 3y too
Parcel Identltication Number (PIN)
This Is not homestead property.
(is) (is not)
Lots 31,32, 33, 34 and 35 Red Pine Corner.
Lot 54, 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 I day of , Z003
(SEAL) (SEAL)
C
O wood Land Inc.
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT w
Signature(s) State Wisconsin,
} ss.
St. Croix County
authenticated this day of
5 Personally came before me this day of
P 2003 the above named
re n the vice president of Oakwood Lan
2he to me known to be
TITLE: MEMBER STATE BAR OF WISCONSIN p on who executed the foregoing "instrument
(If not, ckn dg e the same.
authorized by §706.06, Wis. Slats)
„ A
THIS INSTRUMENT WAS DRAFTED BY�Q� �.. t? u e 1�4�/�7 7 ' 7 � 9 i y��
Coldwell Banker Burnet • , .• lath fy Public, State of—Wisconsin
1301 Coulee Road f ARA K, t i
Hudson, WI 54016 TAMRgST �Immission is permanent. If not, state expiration date:
2 -41070 Ln HE 0 }
(Signatures may be authenticated or ackn d. _ ■4-T - - '
Both are not necessary.) �h�rtrA. OF c � G
Names of persons si nin in an capacity must be Z or anted below their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc.
WARRANTY DEED FORM No. 1 — 1998 Milwaukee, Wis.
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