Loading...
HomeMy WebLinkAbout026-1142-46-000 Nisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division% Sanitary Permit No: INSPECTION REPORT 463153 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 I Richmond Township 026 - 1142 -46 -000 CST BM Elev: Insp. BM Elev: Description: Section/Town /Range/Map No: BM _ J66) B ff 1 G S k 25.30.18.1030 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 3 Benchmark LbCj 5 ►ot, . 1 Job Dosing ` y Alt. BM� � 103. 'FS Z Aawfin Bldg. Sewer Al �� .� � I O Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet V TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 9 / Z , ` r Z4 / Dt Bottom ( 3 , l q3 • L Dosing 7 5I r Header /Man. . G5 / Aeration Dist. Pipe 5. /ts /, I � Holding Bot. System IG ^ Final Grade PUMP /SIPHON INFORMATION Z j Manufacturer G nd N C St Cover j - /' � /61. Model Number 49 -Z i, TDH Lift Friction Loss 1 System HQad TDH Fit �� J Forcemain Len Dia. r/ Dist. to Well dad SOIL ABSORPTION SYSTEM BEDITRENCH Width 1 Length No. OfTrenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ' --�. �` ------ �1 SETBACK SYSTEM TO P/L BLDG WELL / LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of stem: 2 1 UNIT Model Number: �1 CV DISTRIBUTION SYSTEM Header /Mani li Distribu��ti��on( Cy- , Ir / x Hole Size x Hole Spacing Vent to Air Intake Z J Pi /z \ r 1 r Length Dia Length Dia Spacing _ ' 5+ J �• EU C r-k SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges \ Topsoil 1 (�I r , ark 1) <.. g No es i f No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: - 7 /5/ Inspection #2: / / Location: 1437 136th Avenue New Richmond, WI 54017 (SE 1/4 NW 1/4 25 T30N R18W) Red Pine c P1 k- d t Parcel No: 25.30.18.1030 1.) Alt BM Description JWL_ 2.) Bldg sewer length = 3r_ - amount of cover = c / Use other de for additional in Yes No � L -� - 0- �— formation. / `U ` SBD -6710 (R.3/97) Date Insepctor' gnatur Cart. No. Safety and Buildings Division , County - -- ar 201 W. Washington Ave., P.O. Box 7 S fi C ✓� iJIC I sco / in Madison, Wl 537 G� tary Permit Number (to be filled ill by Cl-.; -.—. Department of Commerce 6 G 43/53 Sanitary Permit Applic tion c� s K1 D..Num2ber Ln accord with Comm 83.21, Wis. Aden Code o ti on yo �jidelu � > =7,!4+115. Q.# may be used for secondary p D s va La 15. 4(Ixm 1XC ��N�Y Address (if different than mailing add::w 7 i. Application Information -Please (at K1 0 on ZONING X,•�4 7 P -opcny Owner's Name Parcel M Lot N Bloc, P -operry Owner's Mailing Address Property Locatio'n. / SE % hW r Cit , State �, h, Section ZS Y Zip Code Phone Number 7 7r T 3 N; R �I or 2 Family Dwelling - Number of Bedrooms 11. Type of Building (check all that apply) hh �+ S +mod'eej foss ft. ��a Subdivision Name CSM b _ � p ❑ Public/commercial - Describe se / P Q-S P tea- tt�o �n a ( A p •� 'u State Owed - Describe Use e4fl S a'9G ( ✓e, 99, 2 G ❑City_❑village0roswship of 111. Type of Pcrm1L• (Check only one box on llne A. Complete line B if applicable) 0 2fa _ 142- - /030 A New Sys Lem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System I b Cl mi Pert Renewal ❑ Permit Revision C1 Change of ❑ Permit Tram fer to New Vst Previous Permit Number and Date Is;uca Before Expiration Plumber Owner I v. Type of PO'A7S System: (Check all that apply) ❑ Non - Pressurized In- Ground 9 Mound > 24 in. of suitable soil 1) Mound < 24 in. of suitable soil ❑ At -Onde ❑ Single Pass Sand Filter L. Coastnued Wctlaad ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit 9 R it ecirculating Sand Filter ❑ w V ,Saw j MAN, F.x culating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Chavel -less Pipe ❑ Other (explain) D = Q�O rG V . Dis ersalt7reutment Area Information: Lks gn Flow (gpd) -f-Design Soil plication Rate(gpdsn Dispersal Aica uirod S sf) Dispeml Area Proposed (sf) System Elevauou qr /�Z s yso �0 0,20 -- 1 1. Tank into Capac ty in Total Number Manufacturer Prefab Site Steel Fiber Gallons Gallons of Units ZA ME- 14 1010 Concrete Constructed Glas; Ncw Pxiiting F Tema Tanks i.. S:ptic or Holding Tank !._rub�c Tmvmctu Unit 71 W Ca ng Chamber X -- 11. Res porisIbUlty Statement- 4 the under red, asswu res onslbtllt for LnsUlladon of the POWrS shown on the attached plans. Plumber's Name (Print) I Plumber's Signature MP/MPRS Number Business Phone Number M (k� D0 NF-1 G tz/� z z sa 3 �iZ -S6f 2 Z - -- PlLx-6a's Address (Street, City, State, tip Code) oho �i�• -T� iP•QG &46 0 iv air ILL County/ eartment UseOnl _ Approved C3 Disapproved Sanitary Permit Fee (includes Groundwater Date Issuo Issuing gent Sipratur (Nu S 23.9s; Surcharge Fee) 3 c ❑ Owner Given Reason for Denial � IX. Conditions of ApprovaUReasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. 'Attach complete plans (to the County only) for the rystem on paper not Less thin 31/2 a 11 laches In site SBD -6398 (R. 01/03) �, Exi�ncy grade i e l e ✓a Ei 136 '9, 4,ve . A Lt— 6.,'YL . 6a �e 0 r ra--;4 ✓y37 Iw = 91.90, v c ' 3 loos)' S3 \\ �J Q� �.�e.K ` Pro�ostd pi'o�Oa�se.d wrescr \ s wL -/ le pc—p �� 3 bcdre�pn.� Gann bal �arct�C �� re5 ;4�ie2 �t 5! „S voAd. n o h o o f ba %d,nq newel / "P, d. G. l o,�a . Assumed c/ e lev, = JdO. co. a OF Safety and Buildings commerce.Wi.gov 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 ,tic ■ TDD #: (608) 264 -8777 sco n s' www.commerce.state.wi.us /sb epartment of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary September 11, 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: 09/11/2005 Identification Numbers Transaction ID No. 904813 SITE: Site ID No. 664402 Sam Miller Please refer to both identification numbers, 1437 136TH Ave above in all correspondence ndence with the agency. Town of Richmond St Croix County SE1 /4, NW1 /4, S25, T30N, R18W Lot: 46, Subdivision: Red Pine Corner FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 918884 The submittal described above has been reviewed for conformance with applicable pp a Wisconsin Administrative Codes 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: General Approval Requirements: • 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 "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0 - SBD 10706 -P (N.01101). • 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. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Cora • The well must be a minimum of 25 feet from an POWT y Stank, and a minimum of 50 feet from the absorption API area. chs. NR 811 & 812c DE ARTMEN • A Sanitary Permit must be obtained from the county where this project is located in accordance with the N OF requirements of See. 145.135 and 14 5.19, Wis. Stats. SEE CORK • 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 III MICHAEL P MC DONELL Page 2 9/11/03 • 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. 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@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 Hudson, WI 54016 Pcl. Add.: 1437 136th Ave. Legal Description: SE1 /4NW1/4, Sec. 25, T.30N., R.18W. i Township: Richmond County: St. Croix Subdivision Name: Red Pine Comer Lot Number: 46 Block Number: na Parcel I.D. Number: 026- 1142 -46 -000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry I1 E C E VE {J Page 3 Mound drawings oF CONN E Page 4 Lateral and dose tank ` d °HAS AUG 2 1 2003 Page 5 System maintenance specifications spo Page 6 Management and contingency plan OEN SAFETY & BLDGS p �}� Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report I Designer: Mike Mc Donell License Number: 225036 Date: 08/12/03 Phone Number: 715 -386 -8692 Signature: �fif y ally 0 VD Designed Pursuant to the r E Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and TEY C OMMERCE SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01 /81)�CD `�SnONDENC Version 3.0 03/01/01 P 1 of 9 ( ) 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -443 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of <= 36 inches. 450.00 Design Flow (gpd) 6.00 Site Slope ( %) 99.70 Contour Line Elevation (ft) 42.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 90.001 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 higF'Y" nt in the distribution 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) 2.50 Estimated Orifice Spacing (ft) = 6.25 ft /orifice 2.00 Forcemain Diameter (in) 35.00 Forcemain Length (ft) Does the forcemain drain back? Y 93.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 5.71 Forcemain Drainback (gal) 6.70 Vertical Lift (ft) 81.25 5x Void Volume (gal) 0.66 Friction Loss (ft) 86.96 Minimum Dose Volume (gal) 13.86 Total Dynamic Head (ft) 29.66 System Demand (gpm) Lateral Diameter Selection Manifold Diame 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 760.50 Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) 37.50 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 20.28 gal /in (enter result in cell B49) Dose Tank Information Effluent Fi lter Infor mation 760.50 Dose Tank Capacity (gal) Zabel Filter Manufacturer 20.28 Dose Tank Volume (gal /in) JAII 00 Filter Model Number Wieser Concrete IManufacturer Project: Sam Miller 3 bedroom residential mound system Page 2 of 9 Mound Plan View : l Observation Pipe — FK ' ... :. B . : : : :'.'. :' :': : : ... . .....'. : : : " .... . . ... " . .... .. " : .'... . ..: . . L Mound Component Dimensions A 5.00 ft E 9.60 in H 1.00 ft K 7.33 ft B 90.00 ft F 9.50 in z 7.65 ft L 104.65 ft D 6.00 in G 0.50 ft J 4.56 ft W 17.21 ft 450.00 (ft 2 ) Dispersal Cell Area 1 1138.72 (ft Basal Area Available 5.00 (gpd /ft) Linear Loading Rate 1 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.99 (ft) —► ,rrrrirrf... G * H � .rirrrrrrr 2 • j . rrrrrrrr :frrrrfTJ�rrrrrrrrrrrrfr�., F Dispersal Ceu 100.70 (ft) Lateral 100.20 (ft)-1 Invert Dispersal Cell Elevation E D ..:::.: 1 J`4 ` `! w 4 A +,+. ,+•. {•:{. i .4,. : _.i ti i . ,1 . A .4.._.i,A j _ , A, A. 4 i. �. J. _,k ' { ,{ }� + _l :i.i - .i_ � 4 ' �'li - i ~ i '� %A. i A 'i -�'l :+.i.- .i. ?, t.A s •.,,x.: 4. -� + '� i i {�:i.:i.. {`.?,` 99.70 (ft) Contour Elevation 6.0 % Site Slope Geotextile Fabric Cover Shading Key n. Dispersal Cell See lateral details on 1❑ ® Topsoil Cap o °- 1.5 ft Page 4 for number, L .�. © rrrrr Subsoil Cap �' .o :4=1 (Y size, and spacing of © .. R, ASTM C33 Sand � � � °" F laterals. Laterals are 0.5 ft Typicai Lateral FA] `i. _x• Tilled Layer c h equally spaced from 05 Aggregate o _ the distribution cell's * — A * centerline in the distribution cell (AxB). Project: Sam Miller 3 bedroom residential mound system Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cro5s to manifold at any point_ Laterals are identical I � P 5 •- Turn -up we ball valve or IE X-- +, xl2 I x1231 Laterals & force main of PVC Sch 40 cleanoutplug per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 44.28 ft Orifices per Lateral 18 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ft /orifice Lateral Flow Rhte 7.41 gpm Manifold Length 2.50 ft System Flow Rate 29.66 gpm Manifold Diameter 1.50 in Total Dynamic Head 13.86 ft Forcemain Velocity 3.03 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect _ Tank component is properly vented F— Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 760.50 Gallons Volume 20.28 gal /inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.01 385.44 C B 2.00 40.56 P ump off elevation (ft) C 4.49 91.14 94.00 D 12.00 243.36 D Total 1 37.501 760.50 Dose se tank elevation (ft) 3" Bedding under tank. 1 93.00 Alarm Manuafacturer ILe velArm Alarm Model Number I DLV Pump Manufacturer JZoeller. Pump Model Number 198 Pump Must Deliver 1 29.66 gpm at 13.86 ft TDH Project: Sam Miller 3 bedroom residential mound system Page 4 of 9 Mound System Maintenance and O eration Specifications Y p A Service Provider's Name Jim Thompson #30021 d Phone 715- 248 -7767 POWTS Regulator's Name St. Croix County Zoning Dep't. 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 ft' Maximum FOG 30 mg /L Type of Wastewater 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 monthly 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 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 0 • Threaded Cleanout Sprinkler Valve Box : • Plug 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 um tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as pump 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 finer when removed from its enclosure. If the fitter 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 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 . aN �i ynan��c Hea apac�fy r , AV HEAD l .? T � RVE. w EF FLJ'_N , 'C 2 10 -±- �- - - =Ac AUTION Model 185 /4185shojld! I not be sub'ected to less than 30 feet TJH I ., I it ;; � - r - - -� -� - - -- -- - -- _---- - - - - -- -.. _. 1 }5 L - ' a0 itJO i- - 38 125 l t� 36 4 110 - i � 32 ti 1 D5 j�--- t--- �_- : -�i_- 30 -y 1 ' ii 1 186. 26 -I 88 4188 I ::4 -{ 80 165. 416 75- - a 70 - A N1 a 20� 65 •_ t .- t'� -1-- . a 8 60 4165 169. ! rt - i - r - _ altl9 1 + 50 r Tyr - 4 I 12 40- 798 1aG, ap I at I 18d ' 35- ! - JI 30 1 -- 0 I� 8-1 25 137 a185 61, - - loll 5 - y - - t -- h - - t T - 1 53.57 I 96 0 1 i s GALLONS l0 20 m 10 60 9U ICG 110 120 13U la) 15L '60 uTERS 8C 160 240 120 400 -0 56p o 0 F'_U'W aEK M�NU1_ (6 z9. q.D I1 in,'rYlurv/ TOTAL DYNAMIC NEAC /CAPAClrY PER MINUTE C111.1011 "" DE'WATERING - - - Model 53/57 98 137 14D/4140 16 163/4163 1 16`/4165 135i4185 11, 8 ^� ^13tl '89/4189 19 FL Meters Gal, Llrs, 0.1 1 Llrs. Gal -1- Gal. Lt, . i;v Ltrs Cal. ._Ire. Gal. Lbs rs_C.I Llrs. Cal. L!rs . Cal L s 5 1.5 43 163 72 273 93 352 91 344 100 379 61 231 61 231 � �- t 220 - 45 149 145 549 i 45 1' IC 3.1 }4 129 61 79 d4 93 61 til - - -t - ~ - _ - Ia0 74C t 45 PO J2 'I 231 299 }19 1 352 231 231 76 ~ 2% 530 5.0 1 _ 15 4,6 l9 45 170 64 1 242 76 283 BS 322 60 227 61 2 31 �E 22) :: '.3< S07 !35 511 45 1',' ! 20 6.1 25 95 36 136 68 257 - 79 299 59 223 60 227 j 5E 1 2.0 '29 454 131 496 45 170 1, 25 7.6 8 30 59 223 70 265 57 -�- - -r - f - 1 216 ' S9 2.3 _7E 220 22 462 !25 473 ! 45 17 1 -.� _ 30 9.1 49 185 62 235 55 206 SB 220 85 7� E !2'] 1 16 4 }9 120 45; a5 I 0 40 12.2 21 79 a5 170 46 172 55 206 70 265 ! 7t 7 2 1 ) 1 394 1J9 415 45 1 0 50 15.2 - Tr -- . 1: � 1 1 . 90 _ _ 367 45 20 76 33 125 SU tB9 SI 193 i6 . 1 90 341 37 60 I 18.3 1 I 15 57 39 1 a8 3'2 58 - �_ 19 22 0 71 269 d5 322 a5 t 7J 70 21.3 i 23 87 5 34 / � 193 09 261 a5 10� 80 24.4 '0 38 � - 1 170J 28 106 it 193 a5 1'J I 90 27.4 j - - - -T S1 2 8 34 129 a5 1 :) 00 30 - 17 64 { a? 110 32.0 - -- --- -- - -- - -- - --+- I ' 20 36.6 130 }9.6 -� - Latk value. 19.3 11. (5.9m) 23 IL (7m) 2fi f1. (7.9m) 46 It (tam) 156 11. (17 66 Il (20 . 1 rn)166 -5 11 (26 -ant) 73 t. (223, ) i � 1l._ 3, .7 91 It (.77m) 1 'J It 13351Y137 11 (at. ;n� 7 MEM6ER® � . _ � D ia ANa SEWauE I 'a = , . " ql t:.i:. b L �' J'�J7`9t`a&.r t`,1�,.� -a 5c ++• -: i © Copyright 1998 Zoeller Co. All rights reserved. i �. ExiS�� �rccde C/va .L • I ,E '/o / I 136 ' . _- Se o �' e✓ lec. Tra„54 iy3� lev = 91.90. � U 98.0 , 99.v� 3 iao,cv' Q earn o"r � 5`�� 83 �fL5.rt.3039'P•J,c. ewluto 6 /ire" • X, IAA a4e o Prop ascd P�o/�osed Wrest•r wLP7s - ntQ P` ,. p Ctta M bet �aret�C \� res denee t3 5l ✓.C. n � 7o °� bu %drn� sew' / "Pd.C. �o, jac. �4ssur�ed e lev! = id0. cu. •ti Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St CroiX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. P endl fi g 1 Reviewed by Date 7 Please print all ' 4� a'(ror{, f ;• Personal Information you provide may be used f e ry purposes (Privacy w, .15.04 (1) (m)). Property Owner L` RECEI, r r 0 P�perty Location 0 kw d V[ Go . Lot SE 1/4 NW 1/4 S 2 5 T 3 0 N R 18 (or) w a ck # Subd. Name or CSM# Pro a Owners Mailin Address —� Lgj Blo 1 HY.. 10 Mr f 3 2001 i- na Red Pine Corner [ �� S i� pr — ing State Zip Coder'•. Phone TM ity ❑ Village [36own Nearest Road �\ hm Lak Pa k MN5 Q: 6>sr8w� Ric o nd I 140th. St Ek New Construction Use: ® Residential / tJ' ti 6ec�ro G Code derived design flow rate 600 GPD 9 E] Replacement ❑ Public or commerc ia - Parent material C11 a C i a 1 dr i f t Flood Plain elevation if applicable Pa ft. General comments and recommendations: mound @'el. 1002.0 +', b ased on contour line el. of 99.70' a Boring # n ] Boring 100.10 ` U pit Ground surface elev. ft. Depth to limiting factor 4 5 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 -9 10 r3/3 none L 2msbk 2f .5 .8 2 - 7.5yr4/1 none sicl 2msbk mfr w if .4 .6 3 21 -45 7.5yr4/4 none sl 2msbk mfr qw 1f sl M na .3 .5 5 0 -90 10yr6/6 c2p 7.5yr5/6 lime tone residuum na na n ❑ Boring # El Boring 2 ® pit Ground surface elev. 1 00.1 0 ft Depth to limiting factor 42 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •EGPD/ Eff #2 in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. 1 -8 10yr3/3 none L 2msbk 2 -19 7.5 4/4 none sicl 3 9 -42 7.5 4/4 none sl 4 2 -58 7.5 4 4 f1f 7.5 5 6 1 5 8 -72 10yr6/6 c2p 7.5yr5/6 lime tone residuum na na n n ip Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L flluent #2 = BO < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature 41DL r T Numbe 02298 Gar L. Steel Address Date valuation Cdndu Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8 -3 -2001 715 - 246 -6200 1 Property Owner Oakwood Land De v. Parcel ID # pendicgrl Page 1 of 3 a Boring # F] Boring h ® pit Ground surface elev. 97.80 ft. Depth to limiting factor 52 in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'EfT2 1 0 -9 10yr3 /3 none L 2msbk mfr 2 9 -16 7.5yr4/i none sicl 2msbk mf 3 16 -52 7.5yr4/4 none sl 2csbk mfr 4 2 -85 10 6 6 c2p 7.5 r - V5/8 T- 7 Boring # Boring Ground surface elev. ft. Depth to limiting factor in Soil Application Rate a ' ❑ Pit p 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 F] 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 .Effffl *Eff#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Effluent #1 = BOD > 30 < 220 mg1L 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. SBU4330 (R.6/00) STEEL'S SOIL SERVICE Gary L. Steel Oakwood Land Dev. 1554 200th Ave. CSTM2298 SE4NW4 S25- t30N - R18W New Richmond, WI 54011 MPRSW -3254 town Richmo f nd (715) 246 -6200 o lot #46 -Red Pine corner I 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 1" pvc pipe @.el. 100.00' alt. BM.= base of elec. trans. @ el. 91.90' � � b 2 1 7 b4 A , E N t Gary L. Steel 8 -3 -2001 L Wisconsin DepartmentofCommerce SOIL EVALUATION REPORT Page _of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must t X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and locattio an d distance to nearest road. pend i g g Please print all��r a�(ro, , Re 'ewed by Date Personal information you provide may be used ry purposes (Privacy w, . 15.04 (1) (m)). ZM Property Owner �� pp �1 " y P perty Location R �`�/ FC EiVEO , . Lot SE 1/4 Nw 1/4 s 2 5 T 3 0 N R 18 )E (or) W Oakwood Land Property Owner's Mailin Address , Lg( Block # Subd. Name or CSM# 1 HY.. #110 NE. A.0 j`. na Red Pine Corner City State Zip Cod Phone ity ❑Village ❑$own Nearest Road Spring Lak Pa ilk MN55� 5, �8CE4 Richmond 140th. St [�} New Construction Use: 12 Residential / Nt}rrt�b@r 9f G Code derived design flow rate 600 GPD El aT Replacement ❑ Public or commerci�e Parent material tl a c i a l d r i f t Flood Plain elevation if applicable ft• General comments and recommendations: mound @ el. 1002.0 + b ased on contour line el. of 99.70' as F1_1 Boring # r Pit Ground �—I Boring 1 4 5 . U s urface elev. ft. Depth to limiting factor T in. Soil Application Rate �1 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 -9 10 r3/3 none L--2msbk 2f .5 .8 .� 2 9 -21 7.5yr4/1 none sicl 2msbk mfr gw if .4 .6 3 1 -45 7.5yr4/4 none sl 2msbk mfr 1f (O sl M na aw na .3 .5 _ 5 0 -90 10yr6/6 c2p 7.5yr5/6 lime tone residuum na na n 2 F Boring # ❑ Boring ® Pit Ground surface elev. 1 00.1 0 ft. Depth to limiting factor 4 _ 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 I 'Eff#2 1 -8 10yr3/3 none L 2msbk mfr' 2 -19 7.5 4/4 none sicl k mfr CU if 4 6 `( 3 9 -42 7.5 4/4 none sl 4 2 -58 7.5 4 4 f1f 7.5yr5/6 sl M na 9W nA ` 5 8 -72 10yr6/6 c2p 7. 5yr5/6 limestone residuum na na no n ` Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg /L (fluent #2 = B0 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature . CST Number Gary L. Steel 02298 Address Date ffvaluation CAnducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8 -3 -2001 715 - 246 -6200 1 r Property Owner Oakwood Land DeV' Parcel ID # pendign Page 1 of 3 ❑ Boring 3 Boring # ® Pit Ground surface elev. 97 . 80 ft. Depth to limiting factor �2— _ in. J Soil Application Rate E 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 -9 10yr3/3 none L 2msbk mfr 2 9 -16 7.5yr4/4 none sicl 2msbk I mfr•`/ 3 16 -52 7.5yr4/4 none sl 2csbk mfr •(a 4 2 -85 10 6 6 c2lD 7 5 RP F-1 Boring # F] 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 GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F] Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. 1:1 pit Soil A 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 N Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6100) STEEL'S SOIL SERVICE Gary L. Steel Oakwood Land Dev. 1554.200th Ave. CSTM2298 SE4Nra4 S25- t30N -R18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #46 -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 an pes�+mnextt lot lines mere rat established at the time the test Was conducted. �N 1 " =40' top of 1" pvc pipe @ el. 100.00 base of elec. trans. @ e 91.90' ern h p Gary L. Steel 8 -3 -2001 • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ? 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner 'S'04 fil n1 /I L 4"R Septic Tank Capacity /O o o al ❑ NA Permit 11 3 /S3 Septic Tank Manufacturer (.UF-(SER ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z� 8 �L ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A — 1400 ❑ NA Number of Public Facility Units NA Pump Tank Capacity 7 :!� al ❑ NA Estimated flow (average) 300 g al/daL Pump Tank Manufacturer W e Is E ft ❑ NA Design flow (peak), (Estimated x 1.5) �� g al/day Pump Manufacturer Z p I ( GlZ ❑ NA Soil Application Rate al /da /ft2 Pump Model 43 � g ❑ 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 (SOD,) 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized), Total Suspended Solids (TSS) 530 mg /L XNA ❑ At -Grade 4 Mound Fecal Coliform (geometric mean) 510' cfu /100ml ❑ 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: A X year(s) month (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: 3 ❑ month(s) (Maximum 3 years) ❑ NA JW year(s) Clean effluent fitter At least once every: ❑ month(s) n NA i �<year(s) Inspect pump, pump controls &alarm At least once every: ❑ month(s) 0 year(s) ❑ N~ ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other. At least once every: ❑ monthW ❑ 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 certificatlo ^s. Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tane, 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 disposed of in accordance with chapter NR 113. Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of S12 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. .A Up AND OPERATION Page o f 7/ 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; 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 . �r technology a holding tank may be installed as a last resort to replace the failed POWTS. Iv� T alua n� Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the nfiltrative 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 Name / lk6 �VI "'00A/ CL POWTS MAINTAINER Name Phone ( Z . g'� 5'_ C L 7 Phone - El 1::::_ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S C ( b Phone Phone This document was drafted in compliance with Chapter Comm 83 .22(2)(b)(11)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code, ST CROW COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address 3 7 /3h f,4 (Verification required from PI N ul arming Department for new construction) P City/State N,6 [N , 4101 v1 o N Parcel Identification Number LEGAL DESCRIPTION Properly Location S '/4, 4J ' /., Sec. Z S. T 32 N -R r 8 own of f2 M D Subdivision R ;t� P ( N E CG R hl - r - _ R . Lot # � Certified Survey Map # icy 2 2 - 3 . Volume 4 . Page # z13 Warranty Deed # 73 �' S Volume 2 3 3 Z . Page # Spec house IX yes ❑ no Lot lines identifiable 9 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The 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 wastewater disposal system i s sludge. is less than 1/3 full of s the tic tank � e. proper operating condition and/or (2) after inspection and pumping (if necessary), septic I *% 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 three year expiration date. • / D / !S / oy ATURE O P ICANT DATE OWNER CERTIFICATION I (we) certify certi that all statements on this form are true to the best of my (our) knowled e g . I (we) am (are) the owner(s) of the property des 'bed above by virtue of a warranty deed recorded in Register of Deeds Office. ii All.O APPLICANT DATE « * «•s« 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 � J J 2332P 465 732165 ' STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST, CROIX CO., NI I Document Number RECEIVED FOR RECORD This Deed, made between I � ment. In 07/28/2003 08:30AN Corporation ; Grantor, a Sam . Mill r al person Grantee. Grantor, for a valuable consi a veys to Grantee the following WARRANTY DEED described real estate in St. Croix County State of EXEMPT M Wisconsin (the "Property"): REC FEEL 11.00 TRANS FEE; 508.50 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address Sam E. Miller 1408138th Avenue New Richmond, WI 54017 026 1130113 0061026 1130 28 000 Parcel Identificatlon Number (PIN I� 0� ss- o a b This Is not homestead property. (Is) (is not) Lots 16, 28, 40, Red Pine Corner and Lot 46 nd 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 JC4 day of f . (SEAL) (SEAL) Ae Oakwood eveTopmBTit-Inc. (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County authenticated this ! day of Personally came b f e me this QC, day of _ the above named Greaory J, Pe on. as Vice President to me known • to be the person _ Q _ who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN instrument and acknowledge the same. (If not, authorized by §706.06, Wis. Stats) --- THIS INSTRUMENT WAS DRAFTED BY ` P 1 Public, St of ,;R. , '' Coidwell Banker Burnet ' t sconsin 1301 Coulee Road ycmission is permanent. (If not, state expiration date: Hudson, WI 54016 _ -< 2 -41063 (Signatures may be authenticated or acknowledgjd.B( /C Both are not necessary.) tiniu Names of persons sig ning in an capacity must be type or nnted below their sl nature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. [ WARRANTY DEED FORM No. 1 -1998 Milwaukee, Wis. ? \ LOT S 750 � ;. 64 � � `�� $4 441 So �r 50 ACRES 0, I '\ l O \ 1 LOT I sS LOT I f7 o co LOT 48 N •v , , N 113,9' LOT 57 , °- 09 LOT 47 047 X / LO T 35 \�\ _ N W �� X3'7 _ 1� 33 33•, � O �� f J Oj 66, w LOT � f I LOT 45