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026-1294-33-000
N _partment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix _.wry and Building Division INSPECTION REPORT Sanitary Permit No: 499297 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan to 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: Smith, Gerald I Richmond, Town of 026- 1294 -33 -000 CST BM Elev: ,�p—� Insp. BM Elev: BM Description: Section/Town /Range /Map No: tV ti a — d V) 28.30.18.1515 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1A) U,4,4 IM 6 Benchmark �• /O �• /O D Dosing A lt. BM �di Aeration Bldg. Sewer �S V �� Gp // x Holding St/ t Inlet 307 3 1 /• TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > / / o, Dt Bottom Dosing Header/ an. h � , ,� �• L p/_ b Aeration Dist. Pipe _I t0 a,�d 7. i�� (0 `1S•b0 Holding stem _ 0 Fin PUM /SIP HON INFORMATION b0 �{` S `7 - 7 5 6113 Manufacturer De St Cover -7 • '5- i ? •y /00. Model Number u TDH Lif� Friction oss System TD Zt 3 , - �y� � lam. Forcemain Len h �• Dia„ v Dist. to We 7 SOIL ABSORPTION SYSTEM l -7 x-17 .- BED /TRENCH Width Le th,1 No. Of Trenches "' PIT DI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS f }�( �) SETBACK SYSTEM TO PlVtj JBLDG jWtL LAKE /STREAM LEACHING Ma turer: / INFORMATION }� CHAMBER O Type f System: Jt1, �� UNIT Model Number: J1 DISTRIBUTION SYSTEM /M H /ManifpId Distribution x Hole Size x Hole Spacin� ent to it Intak I � Pipe(s) Length Dia Length V Dia Spacin I SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only 7 I Depth Over ` Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center �' Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Y Inspection #2: Location: 1156 132nd Avenue New Richmond, WI 54017 (NW 1/4 SE 1/4 28 T30N R1 8W) Richmond Acres Lot 33' Parcel No: 28.30.18.1515 1.) Alt BM Description �GfX- 2.) Bldg sewer length = , j - amount of cover �� t� .:1G(/i'10►•(! �" /�d � o1 S (33— 7 0� Plan revision Required? Yes q 0 71 Use other side for additional information. h� L__ Date Insepctor's Signature Cert. No. SBD -6710 (R.3197) �i h �cGra val�an ��rru �neyv�i� n ..f i Commerce.wl.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ' G{' t+ /+O t+ n Madison, WI 53707 -7162 . ` �3 V �7 ■ i w' anitary Permit Number (to be filled in by Co.) Department of Commerce ,/� i 9 / g z / g 7 Sanitary Permit Application teTransactio/n�N�umber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the ap opnate g mental / " unit is required prior to obtaining a sanitary permit. Note: Application forms for state -o OWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you p (A p urposes in accordance with the Privacy Law, s. 15.04(1 )(m), Stars. I. Application Information - Please Print All Information 3, ue— Property Owner's Name Parcel # FEB 2 6 2007 OZ (a - !Z 9 y - 33 - z60 Property Owner's Mailing Address h "V ST COUNTY Property Location / 5-15 // 1 60 D v� lV Gpyt i�.ot �t City, State Zip Code one ��V y & y Section aP 6 �^ �/� � le one) 3 �' ctrc G� -�el'� i "t✓t SJ T N; R Eor® II. Type of Building (check all that apply) e k ,z Lot # I or 2 Family Dwelling- Number of Bedrooms 3 Subdivision Name r . (� '506 A �:1 I� Block # R -c h Ytt C f f 5 ❑Public /Commercial - Describe Use Pica- - N o ( ❑ Ciry of ❑ State Owned - Describe Use EM Nambe, a ❑ Village of r( ' Town of Yh Crr III. Type of Permit: (Check only one box on line A. Complete line B if applicable) System ' New S y 11 Replacement System El Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that appl Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound? 24 in. of suitable soil ❑ Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate pdsf) Dispersal Area Required (sf Dispersal Area Proposed System Elevation yS0 VIR . 6 L/4 .S o Na VI. Tank Info Capacity in Total Efts Manufacturer �v Gallons Gallons B v New Tanks Existing Tanks -7 �/ /� ,/j �T c ;; ,� ca A/ _ Le /Q' c-LJ a U yr s IT. Q a Septic or 1101 >�ank O � 1 J � (, ,-(. —S V Dosing Chamber OCC0 ( � W L C VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP umber Business Phone Number 'n n P �� l CI6 7t 6 Z?-S- Plumber's Address (Street, City, State, Zip Code) /v 61�11c? s-� a an d VIII. County /De artment Use Onl pp roved =Zeri Permit Fee Date X 1 6-9 Issuin ent Signat Reason enial $ Y50 . z IX. Condits off�Approval/Reasons for Disapproval OWNW. 3) 1. Septic tank, effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per i4joujim W e system and submit to the County only on paper no l ess than 8 1t2 x I 1 inches in size /i SBD -6398 (R. 01/07) Valid thru 01/09 fit'_ hewvt�c.�lt� PIIAWC M31ZYE �riJti6.rr� yQ a' ilt; . ;i .�Q6 '.t�Q L6 qo B All s LA- r.,ey 3�35 �oo' N 9S. S. E. 9S. 0 b-- 3 ' -t- 6 > -1 3 ` �i q CYJ� J` ,r cross seCA CL o 1opo/6 °V Pd M � r wA JV L d 3 A/ i , s (3 All a A-of 5 ,el S u rrey 20 l 5,E, 9,5 o ,�' doss Se�'r�zcv� n>o Sole cu gq P 1 � Jv h 1pp0/60v Cab° ro t i L ©+ 3 / v Wisconsin Department of Commerce O EVALUATION REPORT Page � of — Z Division of Safety and Buildings ? o wi mm 85, Wis. Adm. Code th County S- U Attach complete site plan on paper not /2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal refer int BM direction and parcel I.D. percent slope, scale or dimensions, north arrow, and I tion�p►t46w t� roa . Please print all Infor Lion. C �� !!99 CC Re awed by L Date Personal information you provide maybe used for secondary urposes (Pri cy a s. 5.04 (1) (mp Property Owner Lt j P Lo foil SE. p G er a l . SM r •, T t w , 1/4Sf 1/4 SAD T N R E(or Property Owner's MailingAddrwp ZONING FIMM j Blo # Subd. Name or CSM# / 90 e • N at O F �.c m c rc City State Zip Code Phone Number c] city ❑ Village ® Town Nearest Road F-K SIN 3c I ( • � 8 6 1 Psil.h m 32' pue . [B New Construction Use: L Residential / Number of bedrooms Code derived design flow rate s __ GPD ❑ Replacement ".,�. ❑ Publi or mmercial - Describe: — - -- Parentmaterial -y_1 _IeLl A• ( �^ Y _Flood Plain elevation if applicable T _�� —_— ft General comments S v S S e $* 3 '? r t .. 4�� S (, Fo t 0,4- S G; r .� and recommendations: ' 7. 9S- g � ae 7 •3 ` tYVI L J b T. ;L 19Y.93� S ' ' - T,Y ! 114.63`) FT I Boring . Boring # Pit Ground surface elev. 9 9,08 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 oo Y R a/ A Y w a , i I ._--- - - - - -- L Ma tit n) w �= 4 Ncu vf C u� 1vF ❑ Boring # Boring a 1 Pit Ground surface elev. 00. 66 ft. Depth to limiting factor in. Soil Appli cation 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 ,15 YIP �/ - L A 5 ,Y, C LU a 1 f 6 .21 1 A R , � -- L- I k K sMr� � c t -a I F � ►� LO V 4 X11 it -I— r _ V , Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 5 30 mg/L T Name (Please P Signature CST Number qjP A d `ss a C 't Date Evaluation Conducted Telephone Number cR -7 -fig -os - 7 Is a Vs -339 S�aa Property Owner Gera ldQ S m � Parcel ID # __ Page gp_ of _ F.-31 Boring # ❑ Boring 1 f �• Pit Ground surface elev. ! - (109 ft. Depth to limiting factor I u L7 —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 . i 10 r R f L �T L Yn ;Y a a r Lo 11,a , OYk 1 q L I C w 1 , 4 LO YR SaL`I -s- 2-W t R- J 11 , Z� Boring F-1 Boring # ❑ 0 9 ❑ Pit Ground surface elev. __�__ ft. Depth to limiting factor in. F-Eff#2 on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots f In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boring # ❑ Boring a ❑ Pit Ground surface elev. _ ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 Effluent #1 = 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. M-8330 (R.60)) Property Owner Vera ldQ V. �l�'1 +�' \ Parcel ID # __ Page �_ of _ Boring # ❑ Boring 00. f F , - 3 1 �• pit Ground surface elev. l (X0 ft. Depth to limiting factor _ in. Soil 51 tIon 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 Ll ! t 4 4 a 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 a Boring # ❑ Boring — ❑ Pit Ground su rface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOO, < 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.6=) Sw' /�. 5 E 1 ' ' ` a � Sc c. 130p P-1 i� �- ,f Dan � � � - 5 O-rk 1 50, So c GCB, ( .9' r B too. 1A� - M M o .�' � 32 A ti - - __ __ __ __ _._ _. __ ______ __ _ -- __ ___ __ __ __ _ __ __ __ __ _ __ __ __ _ __ _. __ __ _ _ __ __ .........___...... .....__..... _...._ __ __ __- __ __ ... __..... _ __ _ __ __ .....__..._ ___ ............_. _. ___.__ __ __. __ .............. . __ __ ___ i HLIG- Eli'.- dU0 11:43 FROM:JEO CONSULTING GROUP 715 -3830 T0:2487839 P. 001/001 PRE'LIMI'NARY PI,AT OR RICHMOND ACRES (A C7QWM PI.A'A LWOW h asi d r`tA S"MWO,t IN a7 fff S m.ael I/« of sm(A n J4 rW4AP 17 NIVt16 Mrnp N ft" 14" or Mov1 M T P.b a e"' "'W"h 1 ♦� 1 a.a „ d i�: f�l `� i. {. 4 � rf�. c " ^ r• • _ _✓ .., �' >c % n `� ►rz v r.eo �sros 1 f � r. M.Y.1 / ' `` I rLft++Wff �'^+.�,. , �I I� I �r./G fr✓It 41 ! 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X.9$ c,c \ F 9 ogres - �. ac res gores ti: \ NB 1.8�ac v / ph 1.9 oc 977.3 N B,A 1 67' acres I T A. y. 1. �5 ogres 94 es 1. 95 crgs x \ 1.9B afire y� I 17 acl t T T _, y \ .. z I �Q 1 67. vc �s ._U 9 A 1 B2 "acres r a , acres i ; .'r � ,.. -` . \ ���.; `.,, �. � � t � ' -�/ -, ._. _ -Jo \\'� �1 J T v . ° 1 2.`20\ a6(e,s= 1 - \ $'3' Y` 8 20 ��_ - 196 J _ \ ` ��.�9 ales • \ _. 1 i , !1 ' 1 r J ` 4 r� / ! �, j -1 - 1 `1 ' ' t y \ -_ 'i �. � `. \ 1 � i _ , x �; ( (�4 r i 6, x ; , I (� 201 1 (1 19.A, ; PQQARYCUL-QE_SAC " T 1. .......... ncies 4 I i Hr (m RE - RFUOitn .1•... ; 1 ! ! I \ .....' ` I`. \:, - T _, x7 �i " - " ! >� I } I 1 y c 1 J ' tNS7AV OF ME ROAD) I \ ti .� ,. •'� � ` �� _ _ ' I .4 8 \ f I \ y `, c; C9\ �`' \\ 0; I 158' 3� 9626 i°' i acres � 1 J Cb 1 { l p i j l N.B.A.' 1 ��\ 1.;7 .acres A�B.ri. ,,1.73 acres i `\ i W 1 1 P ores _ S. c8' � -� ` i acres J t �e 97 acres I ( \ 2' 962 1 1.4 NB, 4. \ ' \ 1 2 r S x y \ N&A 1 UDC �.26.bcre8� '� \ �// / r • ~\ \ �A { J � '�\ `� , ,,�.�•( acres t 21. %67 \� - X 1 2,,65 `acres;% / 0 x iif x / i 9765 ,.s13 3 t `'�. `:\ 2♦ 12 acres a,\ \ z s acre %7.7 3 r %4s fb0 ` \ 23�' l 277 ocTes i , 11 7 .� \. N. acres B A 1. „ q %4s t\ \ \ y '1 \. _ --• .., 32 L h 2. 18 .: N.8* � 1 -- - -,. Z 1B ace l l 6 i, e� i 37 �, 30 I 35\ 2001 ff acres 1 81 acres 2.11' s ? 7z.R x 9r ' /h Z70 acres A. 961 x N B A : 'N acre J , J ,} I / .._ _J btt. B A. i 1.`B• acres 10 acres 1 BT\ ore T 2. i N.B.A. 6 '� Z acres \ y 9602 acres o�" , I 478' 11 62 acr s �F N-B-A. / x :975.6 965.8 t t 95YB J t'., -\ x 8 f j r N. B. A. i � 1.90 acres , / J 1. 2 acres 2.2.4 acre , 974.6 1 � \�Sr N.B.A. r 1 0 . 5 r J 224 acres j I 28' J I f p 7" -- - x ` i ' � 0 _ r Q 20�J' \ - `- �\j 525'r'� x a f / 17 AE_ - \ a 7,g 974b x \ &2 +7 �, I ,..\ - 21 q' 00 \ 117 ores t 1 , / i \ i - Y V j - N,f 2.17 acres N.B.A. j 973.4 / 1 411 l _ �,\ ... _. I ( � i _.. �\\ 469' � x - w w 4 7 J T %7. °eS' %9. v ; +9 acres 973.3 97at'. �- a/ t f 1 1.79 acres `, v1 83 acres x ,j 1- 74'cres N. B. A- \ \ 1.94 acres �( N.B.A. �f� V N.B.A. NBA NBA{ >.9ff vcres. NH A. 1.79 acres \ \ 1 - 1/8.f a 1.97 acres %e,9 1.74 ocr`es oO -4.94 acres 6 acre S �` ' ( 172 7 /' /' I 968.7 x 284 36' N - 263 acres L4 f j ,., %7.3 I ,�Qn 180' 0' 1 \ I 9 I /5 %! 200 x 7aenJ `� ( 4 y -I �i- . - 1. 9 acres x 965.2 -- U 970.5 �\ y,, x \ I x 1.96 acres ti of I`O udA. r ... y .4 `\ ) LOT 1 C.I x � N.B.A. p 11.89 acres x %z7 1.96 acres �....,. CERTIF IED SURVEY MAP I 436' I i 7 2()3 `. VOL 8 PC2199 ) 452 x I \ -.„ MPRONNO AU IH9BLIT; 'A1 PENDING SEC 11 T N. �B W. TOWN OF RICHMOND ?" 2 1 acres %92 " - •: ) TOWN DF RIUWONO, ST. coax COUNTY _�.,.. " \� ,�• ST. l7iq%C W� -_ -.. U O /Q 1. $5 acres ��� / � \ 2. N.B.A. 9645 I r- I PLATTED AREA IS ZONED: I N B. A. _ . •/ 21 acres Pa Ofa PRIVATE SEWAGE SYSTEM SEX AND TITLE SHEET Property Owneo{s (�; ef c>. '0 . S m , A- k Prefect Name: GI e-f- l A vv--N'1 i \ L bt - 3 R L U'\ w c m.0 Project Location: A v e_ Stroot Ad&oss /S S S �� rt 3C� t /R W scyp �O4 j � � � n L1 > ! a - 1 L� ✓mil OYtd ow or M@DdP ` J 4'otffiy' Contents: Page is k ;La 't' I e, S ke-e* Pagel Page 3: vyn S Page 4: P L M n P� �or V-Y.\ aL Page 5: �C� CJU S c>w n e S vv10. ►1 ua d / �IQ h cr �e tee' Page 4: tc Page 7: Name:. 3n� �e_ lee . Signed: '�— Credential Number: 3 I - 3 Ll C7 Date: Address: 4!� ' Phone Number: I (, a - 5� Page 3 Of,Z SEPTIC TANK E' PUMP CHAMBER CROSS SECTION' AND SPECIFICATIONS 0 4 ". Yo. 4" Cl. VENT PIPE 12 MIN. ABOVE GRADE JEA BOX APPROVED y /p" FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVERS FRESH AYR INTAKE W/ PADLOCK 6 WARNING LABEL .�_ ,4" MIN. 18" IN. k N INLET WATER TIGHT SEA - GAS- SEAL �. APPROVED f�c rtc A" JOINTS WITH APPROVED S ; AL I M , APPROVED PIPE - 3` .' . � — i 3' ONTO PIPE ON SOLID SOIL - 01170 SOLID C 1 ' RISER EXIT SOIL' PUMP OFF ELEV . _ FT • -J—. OFF D PERMITTED ONLY IF TANK-' MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE -PAD SPECIFICATIONS SEPTIC./ DOSE* �• NUMBER DOSES PER DAY: ,- TANK MANUFACTURER. LU _ r` esc _ LL.S Y�G_ _ e TANK SIZES SEPTIC �c� 0� GAL. DOSE VOLUME INCLUDING DOSE 6 0 O GAL.. FLOWBACK: /17..6 ,GAL. ALARM. MANUFACTURER: CAPACITIES: A a0 INCHES = w 3� GAL. '"':MODEL NUMBER: `SWITCH TYPE; _, B .a INCHES �36 - GAL. PU MANUFACTURER: f�u��� a �� /--= � C _2 INCHES . =. I I , 6 GAL. MODEL •NUMBER D. = INCHES = II GAL. • - SWITCH TYPE: /�'teruX . REQUIRED DISCHARGE RATE �5�, M PUMP S ALARM WIRING AS PER TLHR 16.23 WAC �VERTTCAL'DIFFERENCE BET MP OFF AND DISTRIBUTION PIPE D FEET 7 - -� + MINIMUM NETWORK -SUPPLY PRESSURE •' • _ FEET t FEET FORCEMAYN `X L.Y--FT /100 FT. FRICTION FACTOR . y // O 'FEET FEET TATAL DYNAMIC HEAll �, T INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S3" ; WIDTH ; DIAMETER LIQUID`' A, ,., HY ii AATIC HYDRONIATIC SD33 VS33 SW50 i Typical Application* Sump/Effluent pump Typical Application* Sump/Effluent pump Capacities SW /SD/VS33 - to 48 GPM (3.0 I /s) (apodes SW /SD/VS50 - to 44 GPM (2.8 Vs) Heads SW /SD/VS33 - to 26 ft. (7.9 m) Heads SW /SD/VS50 - to 24 ft. (7.3 m) Electrical SW/SD/VS33 - 115V, Io,10.0 FLA, 60 Hz Electrical SW /SD/VS50 - 115V, le, 8.0 FIA, 60 Hz Motor SW /SD/VS33 - 1/3 HP shaded pole w /thermal Motor SW/SD/VS50 -1/2 HP shaded pole w /thermal overload overload 1550 RPM 1550 RPM Minimum Recommended SO/VS33 =12" (304.8 mm) Minimum Recommended SD/VS50 =12" (304.8 mm) Sump Diameter SW33 =18 "(457 mm) - Sump Diameter SW50 =1 B" (457 mm) Automatic Operation SW = Wide -angle float switch Automatic Operation SW = Wide -angle float (manual available) SO = Diaphragm pressure switch (manual available) SO = Diaphragm pressure switches VS = Vertical float switch VS = Vertical float switch Materials of Construction Cast iron and engineered thermoplastic Materials of Construction (ast iron and engineered thermoplastic Impeller Thermoplastic vortex Impeller Thermoplastic two vane semiopen Discharge Size 1 -1/2" NPT (38.1 mm) Discharge Size 1 -1/2" NPT(3 mm) Solids Handling 3/8" (12.8 mm) Solids Handling 3/4" ( 12.8 mm) Power Cord 10', SRW,(20' optional) Power Cord 10', SJIW,(20' optional) Superior Features • Carbon/(eramic mechanical seal Superior Features • (arbon/Ceramic mechanical seal • Oil -filled motor w /automatic reset • Oil -filled motor w /automatic reset thermal overload thermal overload • Uses single row ball bearing construction • Uses single row ball bearing construction • Piggyback plug available for easy maintenance and • Piggyback plug available for easy replacement maintenance and replacement 9 30 40 SD33, 3, 33 30 SW /SD/VS50 6 � 20 °C a r i— 20 o z � 3 °10 4. � 10 u. 0 ttSJ!M tl O. 20 30 40 50 10 20 30 40 50 60 10 `likrs/Setond p , 1 2 3 GPM cra ck Switch y ,o 9 i f P r Q�� _,• off, POWTS OWNER'S MANUAL MANAGEMENT PLAN Page _7 FILE INFORMATION SYSTEM SPECIFICATIONS Owner 1 �� j,, �` Septic Tank Capacity lCt90 al C] NA Permit # Septic Tank Manufacturer W ; cs� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 0-a.be-4 ❑ NA Number of Bedrooms 100 d/bedroom 3 ❑ NA Effluent Filter Model ,- -- lao ❑ NA Number of Commercial Units NA runip Tank Capacity 6 6>-p g al ❑ NA Estimated flow (average)* 3 aVda Pump Tank Manufacturer w ; e- s� ❑ NA Design flow (peak), estimated x 1.5* g al/day Pu Manufacturer d a" •t_❑ NA Pump Model 5 w 33 ❑ NA Soil Application Rate al/da ft Pretreatment Unit ❑ NA Influent/Effluent Quality (NA [I) Monthly Average ** ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) 220 mg/L ❑ Disinfection E3 Other: Total Suspended Solids (TSS) Manufacturer: Model: <_ 250 m L Dispersal Cell (s Pretreated Effluent Quality ❑ Monthly Average * ** ,(In- ground (gravity) ❑ In- ground (pressurized) Biochemical Oxygen Demand (BODs) < 30 mg/L ❑ At -grade ❑ Mound Total Suspended Solids (TSS) :5 30 m ❑ Drip-line ❑ Other: Fecal Coliform (geometric mean) l0 + cfu/100m1 ❑Leaching Chamber Manufacturer i^ i Maximum Effluent Effluent Particle,Size 1/8 inch diameter Model Q? ,Jr_ y Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate gpd/ft Area Req. 17 ftz (Other than bedroom based) Absorption Area Credit per unit 19. 1 ft Minimum Number of Chambers ❑ Aggregate Desi Flow/Loading Rate= ft min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and a roval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and "Design Manual — Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 SBD — 10570—P (R.6/99) "At -Grade Component Manual Using Pressure Distribution" SBD — 10567 —P (R.6/99) "In Ground Absorption Component Manual" ❑ SBD — 10705 —P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD — 10628 —P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD — 10656 —P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572 —P (R.6/99) "Mound Component Manual" ❑ SBD - 10691 -P (N.01 /01) "Mound Component Manual Version 2.0 ❑ SBD. - 10595 —P (R.6/99) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657 —P (R.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 —P" (R "Pressure Distribution Component Manual" ❑ SBD - 10706 —P (N.01101) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequenc Inspect condition of tanks At least once every ❑ months —3 A year Maximum 3 s. Pump out contents of tank(s) When combined sludge and scum equals one -third 1/3 of tank volume Inspect dispersal cells At least once every ❑ months 3 0 y ear(s) Maximum 3 s. Clean effluent filter At least once every M months ❑ year (s Inspect pump um controls & alarm At least once every ❑ months year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ ea s NA Valves At least once every ❑ months ❑ ears ❑ NA Other: At least once every ❑ months ❑ ears ❑ NA START UP Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required.reports. The quantity and quality of the wastewater stream will affect the perforiiance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette :butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ Valves Valves shall be operated in the following manner: Alarms Alarms shouldbe tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to service normally POWTS, There is a 1 day reserve under regular operating conditions, however water should be conserved' until any . problems with the system are corected'to prevent back =up of sewage uito the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual .carrying: one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined and scum and to check for any backup or surfacing of effluent. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidentqij or_unagtborized entry into the tank: When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove an y accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. j Pump Chamber/Treatment Tanks Component The inspection must include a test ofall electrical equipment s uch as pumps, alarms and floats._ A visual, check.must be. — made for leaks, backups; surfacing; missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly - taken care of. I Page of START UP 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. OPERATION The Property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the.wastewater stream will affect the perforrikince and longevity of your POWTS. The installation of water- saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette :butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. 1. Compaction of snow over the dispersal unit may cause it to freeze up. O Valves Valves shall be operated in the following manner: Alarms _._ _ _ Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with" flit sysfein are c'orrected'toprevent back =up of into the dwelling or surfacing. INSPECTIONS Inspection.shall be made by an individual carrying one_ of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or surfacing of effluent. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accident4l. or unauthorized entry into the tank: When the combination of sludge and scum in any tank exceeds one -third (1/3) 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. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. t�J Pump Chamber/Treatment Tanks Component The inspection must include a test of all "electrical equipment such as pumps, alarms and floats.. A visual. check. must be made for leaks, backups, surfacing missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of J • T a esl en a an Za C o SPECIFICATIONS APPLICATIONS: Th ff e A1 is used in restdent:al and commercial septic ryatenu: lc -0 isgecetntpultifamilyhous .tental ces and evsriqu►here a►astervater has�i . ph atupet�ded solids concert:. a FLOWRA7E: 3,000 perffiter. lnataptaroocmorefilte n in a�on «ece gcu�ifold,toultieveFlowsof 6.000 apdarmore. Chec fcit details. FILTRATION: The 26 Disc Dams 0 1,116 inch provide 198 lineal feet of filtration. 2. INSTALLATION: The filter mar be installed inside the rani: or insnlled m a label Container Assembly ontiide the septic rank. SERVICE Service residential installations whenever you pump the tank. DIA O ,1,9/1G -•I �- s 3 -9/t6` p 11 1 : 'j.�• h �� : - -114W DUl Mnaw Specifications item. Cases, Lids, Reducers Rigid Vinyl PVC 87371 MAMUL 2 26 Filter dire Discs High Impact Polystyrene 3 i tber Rod, Nuts High Demiry Polyethylene '` 3 Red 5 3 Nur U.S. Patent No. 4,710,295 Call 1 -800- 221 -5742 or Fax (502) 267 -8801 for further information. - — 1 ....... ....... ....... Maintenance The interval for servicing septic tanks is set by state and local code Throughout the United. States there is a wide difference of opinion on what this interval should be, but mast regulatory agencies suggest two to five years. The Zabel"' filter, which does not increase the frequency of servicing for tha tank, should be cleaned when t septic tank is normally inspected and pumpped. However, our fitter is virtually self- cleaning. The continued a . of the anaerobic organisms on the Zabel fiiter causes lod particles -to disintegrate and fall to the bottom of the tank. If your filter contains a SmartMIter larm when '" alarm, you will. be notified by an a the filter needs servicing. To service the filter: "Servldng any zabel filter should only be done by a certified sepdc tank pumper or Installer. Locate the outlet of the Septlo�tank. Ffimly pull the filter ham. and slide the c8lrbid9� Remove the tank of the ;x and pump the • Note: A lee handle may ` necessary to b be used s ilia Mier Is any Sol below. round level to escaping to th coma zaoel ror lnro when the 4 re While. holding tFt the access ope Insert ilia I$ cartridge with'fr bade in th careful to rinse b Kz sure thou:. *Able: n h not Co. tYl level ,, . me b blo Replace �e � rna be sass Y r 04 U/ The products) shown are covered by one or more of the following patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,759,393, 5,683,577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,03 4,710,295, 5,382,357, 5,482,621 U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealand: 264824, Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1- 800 - 22.1 - 5742 • Website httpJ /www.zabel.com A1001300- 1- M,61499 i I , Maintenance The interval for servicing septic tanks is set by state and local code. Throughout the United.States there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggesttwo to five years. The Zabel"' filter, which does not increase the frequency of servicing fdr the;tank, should be cleaned when the tank is norm inspected septic ally icted and pufh ed. However, our filter Is virtually self - cleaning. The continued ac tion P ed particles dlsinte rate and fall to the bottom of the anaerobic organisms t he tank. If Y our filter co nta , on the Zabel filter causes lod g p. 9 ins a SmartFilter'" alarm, you will. be notified by an alarm when the filter needs servicing. To service the Mter: *Servidag, any zabel filter should only be done by a certified septic tank pumper or installer. Locate the dtAlet of the _. SeptFc•tank. : _ .:..: Firmly pull the filter harx a9r11d slide the cartrM96 . Remove the tank of the and pump th • Note: A tee bangle I to In be used a are tllrer is arty 5011 below A round level to escaping to th handles Zabel for Info s when the , re Boom 9 4 White, holding tFfe , t apt the access ope Insettthe �{ { cartridge wit h;fr back In ,' ' careful to rinse ail sure ttie 'll b Plie: vote: n Is nor conlpletey j a= 119V060, The kv fie be OR on are filter (M Replace ma be Y w' The product(s) shown are covered by one or more of the following patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,759,393, 5,683,577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,03 4,710,295, 5,382,357, 5,482,621 U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealand: 264824, Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1- 800 - 221 - 5742 - Website httpJ /www.zabei.com A100/300- 1- M,61499 {` Page? of In- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. ❑ Mound, At- Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may,indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS [ Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. 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 other 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 repl cement system:. , A suitable replacement area has been evaluated and may be utilized for 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 from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at- grade,soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES 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 J oln r\ e_ 1 e 5 a313N,C Name IDI Phone - )/ , S — G7a —5-a60 Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency S C r I t , co Phone Phone I 3 g L? 0 Feb 2? 07 09;599 WATERS EDGE CONSTRUCTION 7157724435 p.2 _ t �� —.... rwr•� X6.1 ' J a f ✓' r i Waters Edg® Coaskma0 a 11104 .! i t _ cnmrUn etl V 3 scute Road 123 vason, Wf 54027 Feb 23 07 09,59a WATERS EDGE CONSTRUCTION 7157724435 p.3 es+a� sorsu'xd Leos srrsu'aa > ' 6y St 1AOIBYYMD�1HOf1.A7tYFlLLI(1M .7MJNE0163tl o t 4 N v � is ii j yi I! I i E3 -; o Ac � -- 000 acao t --- ---- - - -..: Feb 22 07 10:01a WATERS EDGE CONSTRUCTION 7157724435 p.4 -iu b'606 t90664L•5lt'Hd W.;upy P+al6up' S F E < • EZ0 SIM'$WQU *A1IV70B t9ll �.� -'' mouawrx»L+on.rronvruv�w.�»tpawa .�• Z, ` M-3 3 V �Q uacq.rm u a W r 1 W Q i �s i t I E I I � 4 I s a( Yi Y _ Y i 4 � • T ICI 1 ........ ........ ..... �I + I ri sss I '� y � F :N.. •rn...,. sr.......... i f A. :y ti • r.a I Fob 23 07 10:01a I IVATERS EDGE CONSTRUCTION 7157724436 p.5 I Tgi; 1--jila \` j CZO*S IM '%J&CPU - aAV 4M ZS I IL 1 �� It I �I i . .... .......... . ...... U 2 8 1 4 P 5 3 1 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT NO. WARRANTY DEED RECEIVED FOR RECORD 06/03/2005 12 :00PIy WARRANTY DEED EXEMPT It This Deed, made between David A. Ball and Kimberly A. Ball, husband REC FEE • 13.00 and wife and Dennis F. Ball and Nancy A. Ball, husband and wife, TRANS FEE: 31$5. 40 Grantors, and Gerald J. Smith, a married person, Grantee, COPY FEE: WITNESSETH, That the said Grantors, for a valuable consideration CC FEE: convey to Grantee the following described real estate in St. Croix PAGES: 2 County, State of Wisconsin:: RETURN TO: Parcel 1: The East Half of the East Half of the Southwest Quarter Loberg Law Office (E% 359 West Main Street /E' /2 Ellsworth, WI 54011 /SW %) of Section Twenty Eight (28), Township Thirty (30) North, PID #026 - 1082 -40 -000 Range Eighteen (18) West, Town of Richmond, St. Croix County, 026 - 1082 -70 -100 Wisconsin, EXCEPT Lot One (1) of Certified Survey Map filed April 026- 1082 -95 -000 24, 1990, in Vol. 8 of C.S.M., pg. 2199, as Doc. No. 457843, being 026- 1083 -10 -000 part of the Southwest Quarter of the Southeast Quarter (SW'h/SE%) and part of the Southeast Quarter of the Southwest Quarter (SE %1SW %), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West. Parcel 2: The West Half of the Southeast Quarter (WY. /SE' /.) of Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West, Town of Richmond, St. Croix County, Wisconsin, EXCEPT the following described parcels: 1. Lot One (1) of Certified Survey Map filed April 24, 1990, in Vol. 8 of C.S.M., pg. 2199, as Doc. No. 457843, being part of the Southwest Quarter of the Southeast Quarter (SW %/SE %) and part of the Southeast Quarter of the Southwest Quarter (SE % /SW%.), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West; 2. Lot One (1) of Certified Survey Map filed August 13, 1981, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, being part of the Southwest Quarter of the Southeast Quarter (SW %/SE' /,) of Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West; 3. Commencing at the Southwest corner of Lot One (1) of Certified Survey Map filed August 13, 1981, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, for the point of beginning; thence N89 *59'15" West 20.00 feet; thence NO'01'41" East 262.00 feet; thence S89'59'15" East 224.00 feet; thence SO'01'41" West 15.00 feet; thence N89'59'15" West 209.00 feet; thence SO'01'41" West 242.00 feet to the point of beginning; 4. Commencing at the Northeast comer of the Northwest Quarter of the Southeast Quarter (NW/4/SE/4) of said Section 28; thence South 16 feet; thence Northwesterly to a point 10 feet West of the point of beginning, thence East to the point of beginning. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And grantors warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, covenants and conditions and will warrant and defend the same. U 2814P 532 Date of May. 2005. .�!"• "!Il l/� /�'`^^ (SEAL) ! SEAL) David A. Ball R / Kimberl A. B ��e� � . / /Ll� (SEAL) Q�(SEAL) Dennis F. Ball Naficy A. Bair AUTHENTICATION ACKNOWLEDGMENT Signature(s) �bshool STATE OF MINNESOTA } ) SS. authenticated this ay of COUNTY OF 20 Personally came before me this 16th day of May, 2005 the above named David A. Ball Kimberly A. Ball and Dennis F. Ball and TITLE: MEMBER STATE BAR OF WISCONSIN Nancy A. Ball to me known to be the persons (If not, who executed the foregoing instrument an authorized by §706.06, Wis. Stats.) acknoWledge the same. THIS INSTRUMENT WAS DRAFTED BY C�p'" " LOBERG LAW OFFICE Notary Public County,MN My Robert L. Lobes Commission is permanent. , _ ) (Signatures may be authenticated or acknowledged. Both are not necessary) (if not, state expiration date: 20 jb / SST1042 T }A$ w, NiE �Y Z..... tLhr Cattrn[wtm bM� � •1.1wN I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer e fo (ac Mailing Address / / / O fit` ✓e Property Address �� l 3�n� ✓� 2 j� (Veri required from Planning & Zoning Department for new construction.) City /Stat qK / y(i . Parcel Identification Number LEGAL DESCRIPTION Property Locatio Q /e+/� 6V 1 /a , YE '/a ,Seca , T 36 N I� W, Town Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house e no Lot lines identifiable 0s no SYSTEM MAINTENANCE AND OWNER CERTIFICATION C lmproper 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Numb r of bedro s a swWATur& OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05)