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HomeMy WebLinkAbout026-1098-20-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildny Division Sanitary Permit No: INSPECTION REPORT 506369 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: Sunset Ridge LLC, c/o evering Homes I Richmond, Town of 026- 1286 -11 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 6 1 f 65 34.30.18.1433 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L MOO Benchmark g 11 t, �- y, �l Dosing 10C Alt. BM X04 a rOJ�dC . 0 IO i Aefet[m Bldg. Sewer Holding St/Ht Inlet � TANK SETBACK INFORMATION St/Ht Outlet TANK TO A' P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet lvo�� -- Septic Dt Bottom o /1J►Q' 1 Z C, L Dosing Jn i �^ �Z t �L � Header /Man. Aeration Dist. Pipe Holding Bot. System ' Z .S iaz. � Final Grade a PUMP /SIPHON INFORMATION 1 6, b gY Manufacturer 4 �W /� 1 -4 J DP nd StCov Model Number LJX TDH Lift Friction Loss System Head TDH ! Ft 5'. • 'Z.a! 3.1 /S. Forcemain Leng% Dia. Dist. to We r SOIL ABSORPTION SYSTEM �V 3 • 2 BED /TRENCH Width Length ! JNo. Qf -�renc PIT DIMENSIONS No. Of Pits Inside Di Liquid Depth DIMENSIONS 7 ll ; \ �-- SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: N INFORMATION CHAMBER OR Type Of System: � � y / /4- /JA UNIT Model Number: m0a N DISTRIBUTION SYSTEM 5eo Header /Manifold `( Distribution Z x Hole Size _ x Hole Spacing, O— to Air Intake Pipe(s) l Lengt Dia 1 1-ength 7 Dia Z Spacing �T �/ � Z .�+ 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 b Bed /Trench Edges Topsoil ( �'. ><Y�s q No es No COMMENTS: (Include code discrepencies, persons present, etc.) inspection #1: A / 215 6 -7 Inspection #2: Location: 1224 121st Street New Richmond, WI 54017 (W 1/2 SW 1/4 34 T30N R18W) Sunset Ridge Lot 11 Parcel No: 34.30.18.1433 Pt 1 �.. 1.) Alt BM Description = , C�++,�. �� 0 v'� O`"� O f`.. 2.) Bldg sewer length = • P4 , a,�, - amount of cover = �" Plan revision Required? : j Yes No � c s Use other side for additional information. E Date Insepctors ignatur Cert. No. SBD -6710 (R.3/97) coffs"ermW11.90y Safety and Buildings DiAkon /. S' 201 W. Washington Ave., P.O. Box-7152 sco 1 . gto 4 tcDeparbnerd of Camnwrae 11F, 1 Madison, WI 53707162 Permit Numb ? er (to be filled in by Co.) Sanitary Permit Application rI. / nNu g m�t Q In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental /7 C� ( U unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if diflemnt than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary 1 ',lvl AA PUMP ses in accordance with the Privacy Law, a. 15. ,1 d m , Stats. '1 ,�` '� � a A � 5 `� - L Applicadon Information - Please Print All Information Property Owner's Name E i V E ® 1 # © 1& property owner's Mailing Address. �/� O CT 1 0 2 0 0 DertY Location � g S Li n ,,, P J r t. Lot—�- City. State Zip Code hoceN�p.9ROIXCOUNTY LtJ * �++ Section II. Type of Building (check all that apply) Los # Subdivision Name r 2 Family Dwelling - Number of Bedrooms i d1�. Block # / 11 Public/Commerciat? be Use ❑ City of W/ CSM Number ❑ Village of (3 State Owned - Describe Use III. Type of Permit: (Cheek only one box online A. Complete line B if applicable) A. System ❑ Replaceirterrt System ❑ Treahnent/Holding Tank Replacement Only ❑ Other Modification to Existing Systcrn (explain) B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner / 1V. a of PO'WTS S tem/Com onent/Deviee: Check all that a I ❑Nen- Pressurized In- Ground ❑Pressurized In- Ground ❑ At Grade and ? 24 io of suitable soil ❑Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (exp ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Appli ' n Ra Dispersal Area Requi (S Dispersal Area Propo (st) System Elevation 125 VI. Task Info Capacity in Total # of Man Gallons Gallons Units New Tanks Existing Tanks ,�Q�Q,iI �!" �) Septic or Holding Tank -/ Dosing Chamber / VII. Responsibility Statement - I, the undersigned, assume r Wp us ibinty for installation of the POWTS shown on the attached plain. Plumber' Name (Print) Plumber's Si MP/MPRS Number I Business Phone Number Plumber's Address (Street, City, State, Zip Code) VII oun /De artment se Onl Permit Fee Date Issued Iss ' Agent gnattm Approved ❑ Disapproved $ ❑ Owner Given Reason for Denial /0 dt�l9us ¢pproval/Renons for Disapproval ' 1 Septic tank, effluent filter and dispersal cell must all be serviced / m inta n as per management plan provided by plumber. . s maintained k r t be 2. All setback re 4 irements mu as per applicable CQiQQW6PJ6kjM6V6ns for the system and submN to the County only on paper not loss than S in x 11 Iselin to du SBD -6398 (R. 01/07) Valid dm 01/09 I PLOT PLAN .PROJECT Sunset Ridae LLC ADDRESS 838 Summer Pines Circle Hudson Wi 54016 W , 1/2 SW 1 /4S 34 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 102.3' BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none ]BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark 2 Acre Parcel �� 417' Property Line 121st. St. Scale = 1 = 40 ' Pro 3 bedroom house Tank is to be properly bedded and provided with lockdown covers Grading to be done to divert with approved run -off away from system warning labels 101.5' B -1 Huffcutt Combo Tank B -2 Well is to meet all setbacks found in Comm. 101.3' 83 100.5' 6 -3 3% Slope Area 15' below system is to remain undisturbed B. M. 236' Property Line C Safety and Buildings 4003 N KINNEY COULEE RD commerce .Wl.gov LA CROSSE WI 54601 -1831 i of C TDD #: (608) 264 -8777 t i rtment sco n s i �,.c ommerce.wi.gov /sht Depa www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary October 08, 2007 CUST ID No. 226900 ATTN. POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/08/2009 Identification Numbers Transaction ED No. 1469382 SITE: Site ID No. 731085 Sunset Ridge LLC Please refer to both identification numbers, 120 Street above, in all correspondence: with the agenc Town of Richmond St Croix County W1 /2, SW1 /4, S34, T30N, R18W Lot: 11, Subdivision: Sunset Ridge FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1155591 Maintenance required; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01/01), Pressure Distribution Component Manual -Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described. above has been reviewed for conformance with applicable 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, Condition stats. u` lqj The following conditions shall be met during construction or installation and prior to occupancy or use: t % ENT OF Cal Reminders s"'2OF'Y • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRESPON component manuals listed above. • The minimum distal pressure at the end of the distribution lateral is to meet three feet. This amount of pressure will supply a discharge of 0.72 gallons per minute through the 3/16 inch orifice. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. + SHAUN R BIRD Page 2 10/8/2007 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. 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 l� Charles L Bratz D POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. R�cEivED OCT 0 3 2007 Cover Page sAFM8 e u1wjN Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715 246 - 4516 Date: 9/ 30/07 Owner: Sunset Ridge LLC Location:W1 /2 SW1 /4 S34 T30 N,R18 W Lot 11 Sunset Ridge Richmond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curvej1 7 -8. Maintance and Co 'gency plan 9 -11. Soil test FENCE Shaun Bird Signature License numb 226900 PLOT PLAN .PROJECT' Sunset Ridae LLC ADDRESS 838 Summer Pines Circle Hudson Wi 54016 W . 1/2 SW 1/4s 34 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 102.3' 3 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 2 Acre Parcel AL �� 417' Property Line 121st. St. Scale = 1 = 40 ' Pro 3 bedroom house Tank is to be properly bedded and provided with lockdown covers Grading to be done to divert with approved run -off away from system warning labels 101.5' B - Huffcutt Combo Tank B -2 Well is to meet all setbacks found in Comm. 101.3' 8 100.5 B -3 3 Slope Area 15' below system is to remain undisturbed B. M. 236' Property Line -;,gner No Date { Noa Woven Filter Fabric 4" Observation Pipe Perforated ,Distribution Pipe Below Filter Fabric ,AM C-33 Send Topsoil 7. Stope Bed Of 2 Force Main ~ .P (owe d �2 From Pump Layer Drain Rack /. Cross Section of A W-0v tt S sttm Usin F A $ed For The Absor tion Area G.. r t'Ir A Ft. s _ Ft_ Ft. . ` )r f L 20bservatian Pipe-'! --K A -_ Force Main dWW —° - - -- ------ -- - - - -- - - -- From PumP 3 i `�. �` a Distribution Bed (}t � Z z 0 RocX Pips Drain ' 40bs jj e ff rvation Pipe •{0Ca Permanent Marker fl o ��'S p '� pC Or mods :? Plan View Ofw#Vlound tSt #n A Bed For Tie Absarplft�n Area Pe- fotctea Pit:e Detail r 0 ,J End View Per to•af #a K PVC Pepe e 04 8n1iC0. � Netes Lau tOd tt /" • lire E4" ! SOo csa t`.� v4M 1 PVC Fares to �i t gt7CgT Utah ti G+�nt�eG } wn PVC tMOnitota P:Pe • . pioe Distribution Pipe LOrOtt Q1 _ Ft. At X OL Inches Inches Signet!: Role Diameter 3.�� finch _ L ateral Inch (e License Neer: Manifold " Z Inches Date: Force Main " Inches # of holes Z Invert Elevation of Laterals jo. C -Ei�;� AND SP£C - CATION SEPTIC TRH CB£R CROSS SC Ga� �# APPROVE yjoMoLr six vw . LpE 12 onow OR Wj i1 PADLoCX 6 rR� t3 �.a r F R AIR Kill. ripIr • f a INLET --�--- G �S- ; • yfA"!'�R TIG _ Se 5'EFi £ '1E3 P'fP '. ... .. ?FlLT�,F. • ' "_"_ $ ` . _ � �;.IB Spit - plPE 13' SOIL �rtG v "rA Cfl ET T 5. DOSE IN cjj�vrwa Moor-L SWITCH .= _ ,6.23 Pump x �'- £ � ; AS SWITCH -- p f p[i pipe - 9/ E� FvST RECRjTR� pu p oi'E AND 7ZS - - olt - LET VERTICAL 3f� �� �PFLY PRESSURE • ,3 Til LEW E,ICE S£ �gBER = ^1e$ Sent By: HP LaserJet 3100; 1 715 Et 9E H SE RIES SUMP/EFFLUENT PUMP • ,,,,r.,_„�_,�._ — 11.65 o pis wa@� slate IROR wit 9l�i It018 $won �� fu fm py NAM Na K i8>Vi t• an t1Y.ia IMF � tt � 4S 82 13B 2P 2� &it sitaJAN 991M mm Lqm ysp 115 311 13E! 10f>D � � � Al 32 M v i6 411 stl5isi8i SD�m 509 0 V-6 = V 65 I= 74 � � 18B 29 7► 4h s111':1:496 k'0 115 3N f90 10(9 70 64 55 Z7 911 x11 x 22 4AS 20 9@iaAfi6 SMOG mm dt ConAlwsouiGubNMsi— 'ifale6iadW i�Cs>srssrOca sto�KDONasbDS�Oft0l ron%WWWM u0lbid�� W � :truction Cost Iron FLOW LITERS/HOW xY,. • _ ... 0 1604 2000 3M m otor Housin Impeller Matcriat e Carbost PoI Closed Y " -- _. . aD VoIuu... ABS -- --... Power Cord SJ I'W A �� Mechanical Shaft Sod Nitrile with carbon and � r ceramir. faces 5 pssteaers _ Staertless Seel' _. $LOCI - �' LO 2.5 -- - -_ — { Upper Stee�e and Lower 1 Ball Bearings 10 2.0 .0 601 eD FLAY- GALLONS/- * Lftue t ftmP PUMP PERFopt4ANCE CURVE r0 ga12A1i -nMm - CN%097315 113v 60HZ pbw. X7.2311 -Fie: 986.23USM I-saw a Fear+ 995235 — 07x13 wwwAAtt1eQiaatP'tatap -c0M i Wisconsin rtmentofcommerce S IL. EVALUATION REPORT Page of d Division of Safety and Buildings in actor omr .EiR�L I b Lc& county S_�,. r Attach complete site plan on paper not less than 8 1/2 1 in - � :ze. Plan must include, but not limited to: vertical and horizontal reference n ` f►' �Jre ion and Parcel I.D. percent slope, scale or dimensions, north arrow, and locati n aBr-e'k 0ea2cGo§ad. tint all informati n. Revi ewed b Date Please ST. CR P UIX COUNTY Personal information you provide may be used for secondary pu as (Pr `ZGlf property Owner Property Cocatiol I yy c ,r Govt. Lot IAI 1/ 1 114 S T C N R E (o W Property Owner's Mailing Address 1 Lot # Block # Name or CSM# City. state Zip Code Phone Number ❑ City ❑ Village own ,^ N est Road V r -��� f 7 c " New Construction Use: esidential / Number of bedrooms _ _�� Code derived design flow rate GPD ❑ Replacement Public or commercial - Describe: - - -- - - -- - -- -- - - - - -- - -- Parent material __ Flood Plain elevation if applicable General comments / d 41 and recommendations: 0 u Boring # Boring O I Depth to limiting factor in. it Gro Sol{ De und surface elev. _ f . P ri g Appl ication Rate � Consistence Boundary Roots GPD/ff Horizon Depth Dominant Color Redox Description - rexture Structure •Eff#1 'Eff#2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. J'' • ❑ Boring # Boring i Ground surface elev. DI ' = t. Depth to limiting factor - (2 in. soil lication Rate Pt -- Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Gnu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 .v Du e , c ' Z - l b ✓s' -- r � � LID ' Effluent #1 = BOD > 30 < 220 mglL and TSS >30:S - S r Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL -- �; CST Number CST Name (Please Print) 226900 Bird Plumbing, Inc. Shaun Bird Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, W1 54017 —,, 715-246-4516 I� 1 Property Owner _ Parcel ID # _ _ Page of 3 Boring # ❑Boring it Ground surface eiev. ffo__�_b, Del, " -t; k r iting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture r, +;c:ture Consistence Boundary Roots GPO/ft? in. Munsell Qu. Sz. Cont. Color z. >h. 'Eff#1 'Ef142 0-1 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Dept o limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture :. jcture Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color G 3z. Sh. 'Eff#1 '042 F ❑Boring Boring # round surface elev. ft. Dep! -i o li-niting factor in. Cl ❑ Pit Soil ApOication Rate Horizon Depth Dominant Color Redox Description. Texture `Ar uctjre Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color < =r. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 rtgtL and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 rngll. and TSS _< 30 nVL The Department of Commerce is an equal opportunity service provide- aid employer. If you need assistance to access services or need material in an alternate format, please contact the deparment at 608- 266 -3151 or TTY 608 -264 -8777. SBD.8330 (86/00) F - Soil Test Plot P la Project Name Sunset Ridge LLC Sha Bi Address 838 Summer Pines Circle Hudson Wi 54016 CSlffi #226900 Lot Sunset Ridge Date 4/15/05 W 1/2 S W 1/4S 3 4 T 30 N /R W Township Richmond Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Nail /Iron System Elevation b2, 3 *HRPSame as Benchmark 417' Property Line Scale is 1" = 40' unless otherwise noted B -1 10' B -2 30' 45' 101.5' 40' B -3 80 p 100.5' 3% Slope B.M. 50' 236' Property Line No PLAN Page OWNER'S MA $�EANA�E11ffENT POWTS$T'EM SPFGtFtCA►TtOh[S ai DNA septlo T� C F Owne ORMA Su- �.5� �� Sep�aTanic Martttfac�a+er / d HA a NA DEstok P,� ' d NA Eft p o NA wof � tYA PurinpTarn capadtY .'� KA Number of Carrlm Unb purmp Tank h4nufacuw NA flow (av� .Pumia� Q NA ova► (Peed• x 1.� p Pump Model Unit $02 °" RsW Monthly average Q a ,4Grgwel Far © peat Fltbsr Q Ws" & Gram (F - 430 � � M � a rt D Other. �� O� sots �ft SS) Ls M average Dpeis� s)} .. p in -ground f9 II�r�vuad (P trpated EMusnt Q o 5) S30 m9n' Q At-grade a 0 ter_ Bi SOWS fTSS) 1o0mt 0 e •� Fec311 - rrsean) vrrues in Qiametar zY� for dotal ts° :: X Ma)&num Effluent Psftide VMs W,.. tyv fb 11N�! MNC SCHF_DUi"E SsMce Frsquency 5) Imurn 3 yrs.) gent At least once every D m onth on equals squa of tank volume snspe�t wr, &Wn of tsnk(s) When combined sludge and scan+ e -third (Y� D rrt r(s) {Maximum 3 yrs.} PUMP out contents of tanks) At las once every s) +� �pe�t cetl(s) At iesst once every d tzsvttths $} p NA Clean sf uWA fitter At least once every © motes Dui con 8 alarm+ Q rnont m>§ YMWRS) Q NA lnsped P . P t� once every At least D m onths fl y$ $r{s} l3 NA Flush laf� and At least once every Q rr1onth$ f3 y ew(s) o NA on+et At least Once' every rimes or oM of the � ."NT>rl�t WCE INSTRL1GnON5 Geis shaft be made by an indivtdiral Caliyln9 p,� M Sap�O'e and d Rasitrseted Sewer- POVVTO MsP�°r or tx+°i°°n ld any book UP i� t Piumbat: �tDrm� dude a �l lnspeetton cf the tan K s%�rri and to for any SwVEC q ai,or. Tank inspeezfOks ure the v olume of Opnnbutad e t v sttige to check " eflly� tha ns crac ks or Ieslrs• rstegs b d(spers ce s shall e tscta<ly went on or a and The at el�uent on ttte 9M of the local °`y s " d ' o � to Check fOr any in the observes P nand t�eQtiues the icnmedsats tank vOlurm, the indii" a ftffmg O ,rtdw anew (V Or more Of>� 9 MW and Scum in any tank eq� drsposed of in a '"fit' dt NR When Me Mnbt and sue' of a a $ePtage Serv&� OpM . ent of the tank strati be removed � M nporlents: and MY 113, WPM Admk�►&e Code- r+e5surtzed POWs Compo P $ �� Maim of s t wt rlk".a1 or P ad by The � n0e Or m 9 m � 12 months or min 0 �Pkow any ant aflld a 10a regulatory authority A SWA* repod SW � to � UCZ Of OMer paftWM S1 ART UP AND OPERATION ,. POD d ,� �ment tan'1k(S) fOr t PM �r15 2M Ira new r iwd th �� and/or damage the dMP`amal chankals ffi*t MW &Hoed of the tanlds} removed by a Septage senrlcrng operator prior to use d�Ged tyre the ovnte� _ —_ '! � orrs are frost st the infra suda+cie system t steel up Stoll nm oCii W `WfWn yS ! �EL� �i , DWM t mw � rmnal tftattl�i leveb ��elt W . a and ttt 1rt the ,W el d to the "r 0 in ane same dose, overtoadhv � • Ta avow lift sWabon h8ve ills eonb®niss Of fm pcia* tau* tt moved by a bad cirsdrIWO ;ttior9d&J01&L power tovoetfluwtpamp oc a tam ear AOYV'T$ rto tWL amt ft �Y' Mx dw c to temm tong tev'e�s' n € ,e Puy Off. Do not elfiVe Or PA OAT- or iii dSUb tipCOti1�i� Do nd drhwcr PxkvdW=0W t Or at-grade Sol ab�ptW �- ttte arm term is feet dMM �� � psr�orag the R 10ra Wnatba cf the MaNNra ttre wa sfrzaam rrray imFrt of go p0WM *VUOWtwbywpw�d� ndoms; coWn swabs dqv derM $060; 44"M do , trs,ata�d veget t"ili dotter ASANDONORENT ralcea, out of sesrice the ft tt3 t st:a�c tats gilt the sysw tt� Pt7l w* salts d* is � Y wft ch- Cornm 88.33. � Adts� �a s3+ s abandoned I n �� 9 and the abartdorted pope opener s� R0 i to t3hft and pits sf�f be The 40C A P rift of aff tonsm and Pft shag be rerno ed and proper* &sposed of by as Open After PUIVIEW, aQ tanks knd P is s1a8 b-- W=vaLed artd mmoved3 or ouar Fors m mmW esd this read! spy l °t arm inert sofid rd3rial C0mTvjoWC•Y• P the ' • °r r uml be tallle m prpv�e a code It ttw P0wrS flan and =Lwt be reps cc,fnp fi an t WPb09MWtGYBtW= dis St evakmdetl and may be ut�i� for the #oc�n Qfa rap © A si tyttt � ne n tt'at� =e been midi o W=8= s riot absorption �- TtO n ett area should be pre�bected frarrs fsrrbar x�a be � upon by hO f m Ong and proposed � lot Orms and w� VaAff a bo �ateart?8l e� In the need for a new soil and fg;9valttsl8o�ft fD 2 �tfidttle syy is rrwst ea3trtply rsritlt the rules in enect at ow ff mrne. p#cttestt area Rat gdygtigea In POWTS II A sine fVPfaoest GMt sees is slot avaftbie•due to , M=ock and/or 3= technoiogyr a ta&pW be metalled as a last resort to replace the fm5ad P01MrS. The aft has not been evaWaged to idet&Y a sulftble i ePga�t tea- Upon cf ffta S Ia a - ovation must be Owftsaed to jocaae a" sui�xle eaplscx�cnertt erect ff tso r l fm * � be d az a Last raesdsrt replace t S saattaval a the brat at Mound and atVrade =9 ab �'�` sur PGGC r os of'such must comply with tits rules: in eldt;dx st ftta 5rna «vV I�FTAiN LE'tHAi . GASSES AMWOR IAtSt1FFTCQ�IT+OXYQM S�Cy PUIM P AND OTHER TREA TANKS Ifl1AY CC) T ANCES. MATH I BRAY Do NOT l NTM A S'�i(::6 PUMP tit cs rMM TREATWENT TANK ujvr) rR ANY SfPOSSfBLE. ResULT- _ RES=E OF A P �oW THE 3MlERiOR OF A, TANK MAY BE D�- ADDMONAL COAUUNri, P4YYf5 POWTS IKAiNTA94M Name � Name rra , f i Pltsure / Pf� .T� sEPTAGE SERYtM OPERATOR LOCAL s1ATt3RY t�t+ORITY Phone ItP:= Et 0--e ger, WS mount W W d6ftd by0 a Aftft eflbe QPM tMIX &UM%xW& aid Wausir m CW* Zorn a:sd S`az orl me m**mmft of eL domed 8&22M&XIXd= aid 8&540). (Z b M. wdsmt* AftbICUUMM Cade. I!A of ft gvacacttee the of ft POififi"5. GttW lllbtl ST. CRUIX COUN'3'Y SEPTIC TANK MADn- ENANCE AGREEMENT N OWNERSHIP CERTE9CATION FORM ow=/Buyer n ) MOing Address Property Address aired from Planning Bt Zonitsg �partraeat for new 0ons��on-) required taon . d 2 �Z�b City /State 'Iden'tif cation Number i LEGAL D�CRWnON (a7 Jl� /A /" N RL, '! own of �) Property Location — Lot # l Subdivisiou t �� Volume ; Page: Certified Survey Map # 2 (v Volume 0 (� l,' L�Q Warranty Deed # Spec house ye no Lot lines identifiable no c R CERTMCATION M AND Q WNE 9, Pro rn in its ematuretsreto wastes• per Improper use and maintenance of your septic system or ooner if needed, by a pump" 'fit you put into maintenance consists of pumping out the se ptic * every years the system can affect the function of the septic tank as a treatment stage in flat waste disposal tenanct in §Comm. 8352(1) and in Chapter 12 - St. Croix County sties are speafied property form. signed by the gt Zoning Department a certific n e p owner agraos to submit to St Croix County Planning that (i) the on-site owner and by a master plumber, lumber, restricted plumber or a licensed wm ve � tic tank is wastewater disposal system umber, proper op erat i n g plumber, and/or (2) after inspection if necessary �P i in less than 1/3 full of sludge• sewage disposal system with the �, the undersigned have read the above requirements and agree p t of the tub vats p standards set forth, eso State of Wisconsin - herein. as set by Ilse Department of Commerce to the St. Croix County Planning & Certification stating that your septic system has been maintained must be completed and returned Ironing Department within 3o days of the three year expiration date. Lwe am/are the owner(s) of the Uwe certify that all Statements on this form are true to the best of my/our r knowledge- 1 prop M SIGNA , by virtue of a warranty decd recorded in Register of Deeds Office. DATE TURE AppLICANT(S) #* ormation that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Dzpatti ML Any inf Include with thus a p pli cation a recorded warranty deed from the Register of Deeds Offu%e and a coPY the ecrti£ied survey map reference is made in the warranty deed: {RE'V'. t18J0 2 6 6 0? 3 0 5 774940 STATE BAR OF WISCONSIN FORM 1 - 1999 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIK CO-, MI This Deed, made between Herman W. Keller, Sr., Herman W. RECEIVED FOR RECORD Keller Jr. and Karen -M. Keller, husband and wife 09/21/2004 10:25AM Grantor, and Sunset Rid2e. LLC Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXOPT # the following described real estate in St. Croix County, State of Wisconsin REC FEE: 13.00 (the "Property ") (if more space is needed, please attach addendum): TRANS FEE: 1440.00 See attached Exhibit A COPY FEE: CC FEE: PAGES: 2 Recording Area Estreen & Ogland ' 304 locust Street a� Hudson, Wt 64016 Together with all appurtenant rights, title and interests. 026- 1098 -20 -000. 026 -1098- 30-000 &jvj Parcel Identification Number (PIN) This is homestead property (is) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any, o r ecord. Dated this //'T day of (/71 2004 * Herman W. Keller, Sr. * Herman W. Keller, Jr. * K ren M. Keller AUTHENTICATION ACKNOWLEDGMENT Signature(s) Herman W. Keller, Sr., Herman W. Keller, Jr. STATE OF WISCONSIN ) and Karen M. Keller, husband and wife ) ss. ST. CROIX County ) authenticated this 7 da of 2004 Personally came before me this day of 2004 the above named Herman W. Keller, Sr., Herman W. Keller, Jr. and Karen * Kristina Ogland M. Keller, husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Kristin Ogland, Estreen & Ogland 304 Locust Street, Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, W1 STATE BAR OF WISCONSIN M655 -2021 WARRANTY DEED FORM No. 1 -1999 V 2660P 30?- EXHIBIT A Located in part of the northwest quarter of the southwest quarter, and the southwest quarter of the southwest quarter of Section 34, Township 30 North, Range 18 West; Town of Richmbnd, County St. Croix, State of Wisconsin described as follows: Commencing at the southwest comer of said Section 34; Thence North 00 degrees 08 minutes 04 seconds ' East along the West line of the southwest quarter of said Section 34 a distance of 484.68 feet to the POINT OF BEGINNING; Thence contiue North 00 degrees 08 minutes 04 seconds East along said West line of the southwest quarter 2157.27 feet to the West quarter comer of said Section 34; Thence North 89 degrees 50 minutes 54 seconds East along the North line of the southwest quarter of said Section 34 a distance of 1018.75 feet; Thence South 00 degrees 08 minutes 04 seconds West on a line parallel with the West line of the southwest quarter of said Section 34 a distance of 2007.79 feet; Thence North 89 degrees 59 minutes 59 seconds West 694.55 feet; Thence South 00 degrees 08 minutes 04 seconds West along a line parallel with said West line of the southwest quarter 164.50 feet to the northeasterly corner of a Certified Survey Map recorded in Volume 5, Page 1400; Thence North 87 degrees 49 minutes 24 secons West along the northerly line of said Certified Survey Map 324.40 feet to the POINT OF BEGINNING and there terminating. St. Croix County, Wisconsin. i i FROM :OEVERING M*S LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P11 i. ._. - - -• ..� --- - - - - -- -- �.� _ a ;1t a f1� M fill a s _ ti FROM :OEVERING HOMES LLC FAX NO. :7155311282 Dec. 14 2804 10:14PM P12 - - - - - - -- ---- ap r p o � f r � N - 1 , 6 I 1 i 0 214.79 c � N N P r � W O ttii m N OD N � ock Z -- 1772.43' - - -- Z - - -- 97 = - - - -- - - -- 238.57'- - - -- - - --- 237.78' - - -- - - -- - - - -- 14 IN •y 7' —__ 16est Line of the Scuth~t Quarter P. Q' 1 �I i I �I 0 Z p o �