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HomeMy WebLinkAbout026-1099-60-200 Wisconsin Departmept of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453014 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Gefeke, John I Richmond Township &I 2_o' CST BM Elev: Insp. BM Elev: BM Description: Section ( rown /Range /Map No uc.. 6_ •.* A - Z- 35.30.18. TANK INFORMATION ELEVATION DATA Z� TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 6 a v - 3-3 o (a 3b 3-5 �' 1 Qr_ Dosing Alt. BM 5 - /V•' �y Z 109 q9 .r Aeration Bldg. Sewer Holding SUHt inlet Or St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic r Y�Jt� i a/ DtBottom rr•\ tca Dosing HeaderlMan. Aeration Dist. Pipe �. y.3 $ 4 Zfl 94 /Ze, 'f i Holding Bot. System PUMP /S PHON INFORMATION Final Grade 3-o 3v Manufacturer Deman - St Cover GPM (j 3 Model Number _4� TDH J IM Friction r Loss System Head TDH L !b'0 /.U q Forcemain Length Dia. Dist. to Well .? ,:- 1 Z' "T � SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 31 4 l o ql 3 SETBACK SYSTEM TO P/L JBLDG IWE LL LAKE /STREAM LEACHING Manufacturer �^ INFORMATION CHAMBER OR � , 'fit Type Of System: t 'v L-- UNIT Model Number: _. k c DISTRIBUTION SYSTEM &.A -C6 e,jS Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Length J Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center j Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 5 1 Inspection #2: / ! Location: 1264 140th Street New Richmond, WI 54017 (SE 1/4 NE 1/4 35 T30N R1 8W) NA Lot 2 Parcel No: 35.30.18. 1 1.) Alt BM Description = Ier cG 2.) Bldg sewer length - amount of cover Plan revision Required? Yes No Use other side for additional information. Da ._ - +BD -6710 (R.3/97) Date Insepctor's Signature Cert. No. t Safety and Build' n O Y r 201 W. Wash' 62 ` N Visconsin Madiso , WI — 7162 S Hilary Permit Number (to be til d in by Co.) ( 8)266 -3151 �Opk A15_3 ©1 Department of Commerce Sta Plan I.D. Number Sanitary Permit Applica 'on In accord with Comm 83.21, Wis. Adm. Code, personal informs "on you o�rOIX LFFI�E i ° n may be used for secondary purposes Privacy Law, s15.0 (000, Q�ANG 0 Prgject Address (i different than mailing address) 1. Application I nformation —Please Print All Information Property Owner's Name Parcel f; L Block p - 0 Property Owner's Mailing Add ss /� P perty Locaatti) 7 - � Y., jVE 1 14, Section .3.� City, State Zip Code Phone w er circle one) ��11r WT T R EorW I1. Type of Building (check all that apply) Subdivision Name CSM Number K I or 2 Family Dwelling - Number of Bedrooms A) 7C.1 7 L15 El Public /Commercial - Describe Use ❑ State Owned -Describe Use .3 PLS1' (S fil 6, 4- 7 City_ Vill IJ 10 ship of 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. k New System ❑ Replacement System g P Y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑Permit Renewal El Permit Revision El Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of PORTS S stem: Check all that apply) - /Do 9 Non - Pressurized In- Ground ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber Line G vel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Des' n Flow (gpd) Design Soil Application ate(gpdsf) Dis ersal Area Required (sf) Dispersal Area Proposed (sf) bvstem . �1 rIS.9?c _t 3 8 VI. Tank Into Capacity m Total Number ManuI turgr / Prefab Site Neel rroer Plastic Gallons Gallons of Units „ J� Q (� Concrete Constructed Glass New Existing Tanks Tanks / Septic or Holding Tani: o6 Aerobic Treahnen( Unit Dosing Chamber C)O VII. Responsibility Statement- I, the undersigned, assume responsibility for in Ration of the POWTS sh on the attached plans. Plumber's Natw (Print) �� Plumb Si ature MPRS Number Business Phone Number p j J ) ao 3s Phunber's Address (Stree CnyAtateXZipe) /� 10 A (r __4: - :7 Y11 . County /Dc artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued tumg t Sigt a htr o tamps) Surcharge Fee) El Owner Given Reason for Denial • IX. Conditions of Approval /Reasons for Disapproval YSTEM OWNER:.t� 71 AV�A ep 1c tank, effluent filter and � s_,g," l dispersal cell must all be serviced / maintained 1 as er mans ment p lan provided by plumber. ov 5ys�� _M. CC is 2. II setback requirements must a malntalne �g' as per app ' ble code /ordi nces. „ i�" LZ� S s ach co let a (to the County only) for the system on paper not less th n 8112 x I1 in es in size 91 - > _ -.4� SBD -6 -)98 (R. 01/03) wuj L� I ca d CT ~ INA / O n b r ;L O V \ 1 � OC1 I n d \ o I ZJ 4k 4 a J � W o d o �a • r,jf LMOSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MiN. ABOVE GRADE E WEATHER PROOF > 2S' FROM DOOR. MINDOW OR FRESH AIR INTAKE JUKCTtON BOX APPROVED WITH CONDUIT MANHOLE t FINISHED GRADE 4• CI RISER W/ PAOLO( 6" MIN. WARNING 1 ---- ABOVE G ADE —1 _v" MIt is" IN. 6" MAX. INLET WATER TIGHT SEALS GAS_ 4" TIGHTS Cl PIPE BAFFLE A SEAL APPROVED 3' ONTO B LM JOINTS W/ SOLID — i — ON PIPE 3' 0 SOIL C � SOLID SOI PUMP OFF ELLV . FT, � '�'"' OFF * * RISER D PERMITTED IF TANK MANUFACTU) 3" APPROVED BEDDING UNDER TANK HAS APPRa SPECIFICATIONS CONCRETE PAD "EPTIC / DOSE _ -- - - - ........_ ........ . TANK MANUFACTURER: _,t,� -- NUMBER DOSES PEtt DAY: TAN SI ZZS : SEPTIC SOD GAL. DOSE GAL. DOSE VOLUME INCLUDING F LOirBAC K : -120 GAL. ALARM MANUFACTURER: CAPACITZES: A : HODEL NUMBER: INCHES SWITCH TYPE: 2 INCHES = r Q O t LUMP MANUFACTURER: , C MODEL NUMBER: = INCHES = SWITCH TYPE: n,�,� D = � INCHES REOUIRED DISCHARGE RATE i GPM PUMP C ALARM WIRING AS PER ILHR 16.23 VERTICAL DIFFERCNCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • • MINTKUH NETWORK SUPPLY PRESS / yRE _ _ & FEET • D FEET FORCEMAIN X UFT/ 100 FT. • FRICTION FACTOR . FEET TOTAL DYNAMIC EET IC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH ; DIAMETER LIQUID DEPTH :IGNED: ,D LZCEli3E NU?!tlQt : Submersible Effluent Pump ii e 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor manual operation. Automatic 'and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- * Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING 3 14' maximum. • Power cord: 10 foot with pump out vanes for —� • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Go- Canaan StandardsAssocia6on . •Total heads: up to 24 feet. with three prong grounding _ • Discharge size: 1 1 /2" NPT. plug. Optional 20 foot ■ EP05 Impeller Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".) rotary/ceramic - stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 i s • Capable of running dry without damage to 9 30 6� t , components. � —'-- - -;-- -.� � �'- "� fir. • ¢ � —1 Pump: EP05 _- • Solids handling capability: c 7 25 i 3 / maximum. w _ ! — � — _ -- • Capacities: up to 60 GPM. 6 20 • Total heads: up to 31 feet. � i L • Discharge size: 1V NPT. z s • Mechanical seal: carbon- } rotary/ceramic - stationary, 4 15 BUNA -N elastomers. — E, — E , 5 • Temperature: 3 10 i 104 °F (40 °C) continuous - 1 61 y — 140 °F (60 °C) intermittent. 2 ! ! 5 . i 0- 0 0 , 10 20 30 40 50 GPM L -L L 0 2 4 6 8 10 12 m °/h CAPACITY 41995 Goulds Pumps, Inc. Effective May, 1995 83871 7451 z6 VOL XAT 17 PAG 464 REGISTER OF DEEDS ST. CROIX CO. NI RECEIVED FOR WORD 10/29/2003 11:00AM C E R TIFIED SURVEY MAP NG : —ice. COPY FEE: 3.00 CERTIFIED SURVEY MAP PAGES: 2 LOCATED IN THE SE 114 OF THE NE 114 OF SECTION 35, T30N, R1BW, TOWN OF RICHMOND, ST, CROIX COUNTY, WISCONSIN. PREPARED FOR RON BONTE NE CORNER OF SECTION 35. (FOUND 3 /4'REBAR�_ NOTE i BEARINGS ARE REFERENCED TO THE EAST LINE NOTE NO ADDITIONAL PLATTED LOTS M4Y OF THE NE 1/4, (ASSUMED TAKE ACCESS THROUGH THE 66' WIDE BEARING BASED ON GLOBAL PORTION OF LOT 2 UNLESS ALL POSITIONING OBSERVATIONS). STRUCTURES CONFORM TO APPLI y O .T. , .4 SETBACKS AND COUNTY ROAD STANDARDS APPROVED ARE ACHIEVED. o'g ST. CROIX COUNTY fk Pb6ft 2onino and Parks CommMse UNPLATTED,.LANOS m l" "" .. Q " OCT 2 9 2003 {.:....... _ EAST L INE OF THE NE 114 If Aot recorded within 30 days of I 133' approval date sppro:'M shall be S88' 49' WE .968.81' 59 7.5 7' 371.24' 3 564.57' 33.00' a L OT I N 3.00 ACRES T: ci 130, 716 SO. F T, sQs: 100' 8, M. TOP OF P 1 PE 46 O N 2 123, 07 SO.FT.� n �w! I ....1000.60' 0 .......... to LOT 2 2 LBO-993. 0' :33. 564. 48' S N69 ° 53' 09 "W 597.48': I. •.• ;C 2 m 226, 930 S0. FT. S89 09 "E 597. 45:66. o 2 8 w 5.16 AC. EXC. RiW 3 :33. O 'ro • 224, 752 SO. FT. 564. 45' ro ;n W , LBO-988. 0' 'w b LOT 3 N N $I c .y u, 3.00 ACRES m: ml<o ro U m m se . Oi 130,894 SO. FT. 2.84 AC. EXC. RIW y: 123,664 SO. FT. h' O LB0.9s9. a X. 0 m� : A 372. 19' 564.37' w r l a w v �•3 *, S89 ° 53' 09" E' - - 969.56' 597. 37' ' I LDT w DRAINAGE LOT WAY Q 4 ww (0 7.48 ACRES ` \ sF4 � F m orn m l � ~ 325,823 SO. FT. ` Ns •� \yT b + m ' 7.23 AC. EXC. R ,, W 1o,. \ 314,736 SO. FT, er ` 1 6 3 \ : 100 L80.991.0' �3;. 33.00' ° 4261.38' 937.06' 4t X34. i ....................... 589.53' 08 1 7 N89' 53' 08' W 970. 06' E -W QUARTER LINE E li4 CORNER OF W 1. CORNER OF SECTION 35. (FOUND SECTION 35. (SET :Q CONCRETE NAIL) Y NP4. ATTFA.kAN0$ SURVEY NAIL). B. M. 998. 00' 1 NOTE NO OWNER OF RESIDENT SHALL DO ANYTHING WHICH WOULD INTERFERE WITH OR CHANGE THE WATER DRAINAGE EASEMENT. THIS INCLUDES BUT IS NOT LIMITED TO BUILDING UPON, OBSTRUCTING, Sco 8�ti ALTER FILLING, GRADING, EXCAVATING, OR BERM/ NG. JAMES M. O • SET P O. D. X 18' IRON PIPE WEBER WE IGHING i. 13LBS PER L (NEAR FOOT. 6.1004 ® PROPOSED DRIVEWAY LOCATION ( wl Q' O 1 "•200' �Q SHEET 1 Of 2 JAMES M. 604 0 100 200 400 LANDMARK SURVEYING, INC. 2003071A THIS INSTRUMENT DRAFTED BY JIM WEBER DATED RE��s� q- 1b -o�j Vol 17 Page 4640 'ORIGINAL I)o Nor Ae5 s n, ,- 3 j L � '►�� SOIL EVALUATION REPORT (�G � . S� D� 3 Wisconsin Department of Commerce Pag 1 of 3 0-d Q Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 5 A7 acre CSM pending Please print all information. �evie ed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Bonte, Ron Govt. Lot SE 1/4 NE 1/4 Property Owner's Mailing Address Lot # Block # Subd. ame or SM# 1011 170th St. 2 >' 6 7 Pending 'Jot. City State Zip Code Phone Number �1 City A Village 16 Town arest�" 1 6 2003 Hammond WI 1 54015 1 715 - 796 - 5240 Richmo - 140Th St. New Construction Use: 16 Residential / Number of bedrooms 3 Code derived design flo rate ZONINOOFFICE GPD Replacement j Public or commercial - Describe Parent material loess over till / „ _ p' �Flood'la in e}evation, if applicable -- NA General comments M V fi 5 � C / L E VE sy�'l 1'n t1 / ��N �- and recommendations: install shallow conventional trench system w/ system elevation 1.5' below surface contours 6 4 gpd /�q ft loading M1 �(,c.Z , &a--c !c- X00 FT] Boring # ---, Boring Pit Ground Surface elev. 99.5 ft. Depth to limiting factor 54 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10YR 2/2 - sil 2 m gr dsh cs 1f /m .5 .8 2 6 -16 10YR 2/2 - sil 2 f -m sbk dh cs 1m .5 .8 3 16 -54 10YR 4/4 - sil 2 m sbk dh cw 1m .5 .8 4 54 -60 F 10YR 4/4 c2p 7.5YR 5/8,5/3 sil 2 m sbk dh - 1m .5 .8 variable horizons: 3' to E of horizon 4 on N wall => 34 -64" 10YR 4/4 s (0, sg, dl) & 1' E of this is sil (2 m sbk, dsh) @ 34 -40 w/ no redoximorphic features then 40 -64 5YR 4/4 sl (0, m, mfr) also w/ no redoximorphic features! F2]Boring# �i Boring i Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 61 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisteripe Boundary Roots GPDIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10YR 2/2 - sil 2 m gr dsh gs 1f /m .5 .8 i 2 1 8 -15 10YR 212 - sil 2 f -m sbk dh cs 1 m .5 .8 3 15 -20 10YR 4/4 - sil 2 m sbk dh cw 1M .5 .8 4 20 -3 7.5YR 3/4 - sl 1 m sbk dh gs 1f .4 .6 5 30 - 5YR 414 - sl 0 m dh cw 1 m .3 .5 6 61 -66 LSBR 9 8 a LSBR by general resistance to penetration w/ > 50% LS gr /cob /st > > * Effluent #1 = BOD '1 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mgr CST Name (Please Print) Sign to e: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, Wl 54751 9113/2003 715- 233 -0398 Property Owner Bonie Ron _ Parcel ID ; g 5.57 acre CSM pending Page 2 of 3 a Boring # �j Boring 't", Pit Ground Surface elev. 98.8 ft. Depth to limiting factor > 70 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GROW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -4 10YR 2/2 - sil 2 m g dsh g 1f /m .5 .8 2 4 -10 10YR 2/2 - sil 2 f -m sbk dh cs 1m .5 .8 3 10 -23 5YR 4/4 - sl 1 m sbk dh gs 1 m .4 .6 4 23 -44 5YR 4/4 - sl 0 m dh Cw 1 m .3 .5 5 44 -60 7.5YR 414 - Is 0 s dl cs 1M .7 1.2 6 60 -70 5YR 4/4 - sl 0 lr mfr - - .3 .5 horizon 5 has some stratifie s (0, sg, dl) ❑ Boring # _j Boring I Pit Ground Surface elev. ft. Depth to limiting factor Soil Application Rate in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. SFr. 'Eff#1 'Eff#2 i i I I I I ❑ 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 GPDIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I t I I � I * Eff luent #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 OWN) Certified Soil Testing J N I 9 ,r o } 9 � OS IZ 4 ca r Jv s 1 � 1 � � i b � g o w � S , 9 o � s nZ J \ tq ST. CROIX COUNTY F/ SEPTIC TANK MAINTENANCE AGREEMENT V� AND �`��' s © �9 OWNERSHIP CERTIFICATION FORM Z c ,?0 l A Owner/Buyer ►U � Mailing Address 7qg 51 -M R P- dN AyC Property Address 12 `A ST. / ( erification required from Panning Department for new construction.) City /State I P_W hZV& JV,6 , Parcel Identification Number LEGAL DESCRIPTION WAA 1 ' �4� 026 3 Property Location SE %4 , Il C V. , Sec. 3 5 , T 3o N R J � W, Town of P ►C u410/-J - b Subdivision , Lot # a Certified Survey Map # 71/ 5 / 24 , Volume / , Page # 2 /6 yb Warranty Deed # 7 S3 9 53 , Volume Z S U Page # 3 - 7 3 Spec house yes no Lot lines identifiable (!t) 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. 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 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. i/we, die ui dersign h ave read the a reTairements and a to mainta-L^. the private EeNvaQg 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 Department within 30 days of the three year expiration date. � n /9/6 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION f e to the best of m /our knowledge. Uwe am/are the owner(s) of the Uwe certify that all statements on this form are true e. y g pro erty described ve by virtue f a warranty deed recorded in Register of Deeds Office STC1rWATURTf OF APPLICANT DATE * * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** j /I 2 nclude with this application a stamped warranty deed from the Re ister of Dee Office and a copy of the certified survey map if reference is made in the warranty deed. I _C &t G� � r- Pi�� �� � ����J � ��. , �C��:a/y -��v� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -4 A-) Mailing Address 7 `f 9 SC v •j A - L 2, C b- I/L2 a,,j 6 Gt/ Property Address es -- 5: - /L �v 12 i +�'� G N� > (Verification required from Planning Department for new construction.) City /State Parcel Identification Number d a —/ 9 -6 0 -60 0 LEGAL DESCRIPTION Property Location SE '/4 , �V & " /4 , Sec. 3S, T 30 N R W, Town of k c- 14 A^ o N b Subdivision , Lot # 02 Certified Survey Map # 7 y �� Z� , Volume 1 , Page # 4 /6 �0 Warranty Deed # 75 -� S S 3 , Volume age # Spec house yes C.J Lot lines identifiable 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. 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 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 Zoning Department within 30 days of the three year expiration date, C- �� 1 :A n a o� SIGNATURE W APPLICANT DATE OWNER CERTIFICATION 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 prope de ribed abov , y irtu of a warranty deed recorded in Register of Deeds Office SIGNATURAW APPLICANT fX DATE * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. CO23 97085749 Yoi.1552PAGE 226 22. Release. Upon payment of all sutras secured by this Security Instrument, Lender shall release this Security Instrument without charge to Borrower. Borrower shall pay any recordation costs. 23. Accelerated Redemption Periods. If (a) the Property is 20 acres or less in size, (b) Lender in an action to foreclose this Security Instrument waives all right to a judgment for deficiency and (c) Lender consents to Borrower's remaining in possession of the Property, then the sale of the Property may be 6 months from the date the judgment is entered if the Property is owner - occupied at the time of the commencement of the foreclosure action. If conditions (b) and (c) above are met and the Property is not owner-occupied at the time of the commencement of the foreclosure action, then the sale of the Property may be 3 months from the date the judgment is entered. In any event, if the Property has been abandoned, then the sale of the Property may be 2 months from the date the judgment is entered. 24. Attorneys' Fees. If this Security Instrument is subject to Chapter 428 of the Wisconsin Statutes, "reasonable attorneys' fees" shall mean only those attorneys' fees allowed by that Chapter, 25. Riders to this Security Instrument. If one or more riders are executed by Borrower and recorded together With this Security Insmvnnent, the covenants and agreements of each such rider shall be incorporated into and shall amend and supplement the covenants and agreements of this Security Instrument as if the rider(s) were a part of this Security Instrument. [Check applicable box(es)] Adjustable Rate Rider ❑ Condominium Rider 1.4 Family Rider ❑ Graduated Payment Rider ❑ Planted Unit Development Rider Q Biweekly Payment Rider [] Balloon Rider ❑ Rate Improvement Rider Second Home Rider 0 VA Rider Q Other(s) [specify] BY SIGNING BELOW, Borrower accepts and agrees to the terms and -tbisSecurity Instrument and in any rider(s) executed by Borrower and recorded with it. Witnesses: ~� 0g 6 t N �, P IQ (Seal) , aefeke -B ower (seal) Borrower (S eke wer (Seal) (Seal) - Borrower - Borrower STATE OF WISCONSIN, St Croix County as: The foregoing instrument was acknowledged before me this October 17, 2000 by Rebecca S.P. Gefeke aad John ta. Oefeke (date) (person acknowkd 'rag) My Commission Expires: 10/20/02 P 3wc J cy�, r k Notary Public, State of Wisconsin Marlene R. Schmidt (Seal) �r Q o - 2 } �pQ' This instrument was prepared by Marlene R. Sebmidt . , First Federal Savings Bank .!�TE� La Crosse - madison �NJhh11N 90 ^ ,�,rBtt(Wt) (90081 Paps a d 8 Forrn 9050 9 U 1943P 383 BY SIGNING BELOW, Borrower accepts and agrees to the terms and covenants in this Security Instrument and in any Rider executed by Borrower and recorded with it. Witnesses: OFIN N GEFEKE -Borrower L �l rlr)� (Seal) REBECCA S.P. GEFE - Borrower (Seal) (Seal) - Borrower - Borrower (Seal) (Seal) - Borrower - Borrower (Seal) (Seal) - Borrower - Borrower (sk"ll (0005) rap. 14 m 15 Form 3050 1101 U 2506P 373 7�36 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIK CO., WI This Deed, made between Hombuilders. LLC RECEIVED FOR RECORD Grantor, 02/10/2004 09:30AN and John N Gefeke and Rebecca S F Gefeke husband and wife WARRANTY DEED Grantee. EXENK # Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 TRANS FEE: 186.00 (if more space is needed, please attach addendum): COPY FEE That part of SE r /4 NE' /. Sec. 35- T30N -R18W describeds follows: Lot 2 CC FEE: o` ertified Surve Map recorded in Vol. 17 of Certified Survey Maps, PAGES: 1 page as Doc. No. 745128. Recording Area Name and Return Address Estreen & dgtand 304 Locust Street Hudson, WI 54016 426- 1099!60 —M Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any. Dated this `A 'P- day of January , 2004 HomBuilders, LLC Y: b r " AUTHENTICATION ACKNOWLEDGMENT Signature(s) HotnBuilders, LLC By: STATE OF ) ) ss. County ) authenticated this day of January , 2004 a va , Personally came before me this _ day of the above named * Kristina Oland —..._ 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 Attor Krishna Og[a Hudson, WI 5 4016 Notary Public, State of _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) L i * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800 -655 -2021 WARRANTY DEED FORM No. 2 .1999 POWTS OWNER'S MANUAL & MANAtatMtN I I•L.AN Page I of - FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al O NA Permit 53 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms L4 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity Q a l ❑ NA Estimated flow (average) QO g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.51 al /da Pump Manufacturer (f( 13 NA Soil A Rate t gal/day/f;2 Pump Model ❑ NA Standard lnfiuen ffluent Quality Monthly average* Pretreatment Unit )k�A ats, 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 ❑ O ther: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg/L A in- Ground (gravvi ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. C3 NA Other. ❑ NA Other. 13 NA Other- ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: earls) 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 n� (s) (Maximum 3 years) ❑ NA , / [3 months) ❑ NA Clean effluent filter Al N�� least once every: jilr ar(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ months) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other At least once every: 13 year(s) NA Ocher: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and 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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. ... _ . - - Paga -2— , of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) 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 repl nit system* A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T o ing tank W alua ' �,¢ !�/ Ca�N S7Rdcat o b e ai �'f10}ll8 Tim ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone '� _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name � , i!' ( 2plt�l�(1 Phone Phone -1 /S-- 3 R" - 0 This document was drafted in compliance with chapter Comm 83.22(2)(bl(1)(d) &M and 83-54(l). & 131. Wisconsin Administrative Code. 745128 AT P I WALZU REGISTER OF DEEDS ST. CROIX CO. vi RECEIVED FOR EC WD 18/29/2003 11 :00AN CERTIFI SURVEY MAP R£6 --sue.- - COPY FEEt 3.00 CERTIFIED SURVE MAP PAGES t 2 LOCATED IN THE SE 1,14 OF THE NE 114 OF SECT 35, T30N, RISK TOWN OF RI CHMOND, ST.CROIX COUNTY, WISCONSIN. ,PREPARED FOR: RON 90NTE NE CORNER OF SECTION 35. ( FOUND 3/4' REBAR� NOTE: BEARINGS ARE REFERENCED TO THE EAST LINE NOTE NO ADDITIONAL PLATTED LOTS MAY OF THE NE 114. (ASSUMED TAKE ACCESS THROUGH THE 66' WIDE BEARING BASED ON GLOBAL PORTION OF LOT 2 UNLESS ALL POSITIONING OBSERVAT STRUCTURES CONFORM TO APPLICABLE y I QT...4 SETBACKS AND COUNTY ROAD STANDARDS Q APPROVED ARE ACHIEVED. m "l, ol ST. CROIX COUNTY (4 Pboft z0*19 end Po ft Con wet �� m OCT 2 9 2003 {1 MP 4A T7E0 , 4A. I {:' EAST L 1 NE OF THE NE 114 I 1 ( If sot recorded within 30 days of t 33 *Aw0 ' al date aWmW than be S88 15' E 968.81' 597.5T ` 371.24' 3 564. 57' 33. DO' � � T.-3 o LOT I N 3.00 ACRES x: o�ao . 130, 716 SO. FT. 1 DO a � B. ML TOP OF PIPE ep N 2.84 AC. EXC. RV o�lw J000. So O 123, 507 SO. FT. �; - I ....................... cn LOT 2 x LBO.993.0' 33. 564.48' Q 5.21 ACRES . � ....................... N89 53' 09 W 597. 45 48 : 2 226, 930 S0. F T, S89 OWE 597. 66. 'C vom 5. 16 AC. EXC. R/W 3 564. 45' :� • 224,752 50. FT. 33.0 ro Leo•988. o' o LOT 3 N N 81 ;y w ~ ` q� 3.00 ACRES w :� v �sBS, O of 130, 894 SO. FT. A m '•� �'��'!t• $ N 2.84 AC. EXC. RiW 123 654 S0. FT. �: O ....................... ? Lr#o -989. o' X33.0 372.19 . °Io os . 564.37' w 'y w N om% S89 09' 9 r 69. 56 :� ` � 597.3 7 y " �. a I .OT ..2 DRAINAGE WA � -��` ` • � `o W • I � \�� Ct � r : tr w p w LOT 4 5 ° •�•`� �' F �,�.��. x +N I � ..... co 7.48 ACRES \4sF4 23 F +n, of `! 325, 823 SO. FT. 7.23 AC. EXC. R/W � \,, `. `� , 1*.QT ...( 314, 736 SO. FT. Q>: \ \ ; I00� 4261.39' LBO 881. 0' `�3� 33. 00' '' I 937. 06 4• E 3 4. 52' 589.53' N89 08' W 970.06' E -W QUARTER L INE W 1/4 CORNER OF E 1/4 CORNER OF SECTION 35. (SET SECTION 35. ( FOUND :0 CONCRETE NAIL SURVEY NAIL). i (i 8. M. 998.0 NOTE 0' NO OMER OF RESIDENT SHALL DO ANYTHING WHICH WOULD INTERFERE WITH OR CHANGE THE WATER DRAI EASEMENT. TH • INCLUDES BUT IS NOT LIMITED TO BUILDING UPON, OBSTRUCTING, AL TERING, FILLING, GRADING, EXCAVATING, OR BERMI NG. G O try JAMES M. O • SET 1' O. D. X 18' IRON PIPE W EBER WEIGHING 1. 13LBS PER LINEAR FOOT. 8-1804 ® - PROPOSED DRIVEWAY LOCATION �9 tiPRrr0 EY. 1..200, mmmom SHEET I OF 2 JAMES M. 804 0 100 200 400 LANDMARK SURVEYING, INC. 2003071A THIS INSTRUMENT DRAFTED BY JIM WEBER DATED q " 0% 4'd Vol 17 Page 4640 i� 1 . 0 ?. r 2 0 / � � $ � � / f -0 � "W o � / e 2 3 z& 2/ q �. CD O % $ \ ¥ § f CL \ ^ / ® E f N) a : o a » § 3 ; 0 � � ) i � 2� { o o E 0 > CL $ \ 0 co S Cl) CL 9 k § a Itz Q z; CD C) k % § o c fT 7 �- . g T T 3 \ z o 0 0 o> * 2 % % \ < z / g § C (a *1 % > { \ E v g -4 I \ « a ; E m e 9 ~i A & A A z .. E E z 7 0 \ § S / \ ƒ r \ ~ . i [ « E 3 / / — m § M a Q a F z $ � ƒ � .. w � \) m 0 i $ 2 9 : . \ ± \ E& § CD E c ] 0 % i 7 < \ con I ! � f � � \ � 2 � 2 . � K 0 o m � } /a �\ LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF RICHMOND COMPUTER NUMBER 026- 1099 -60 -200 Parcel Number 35.30.18.539A -20 OWNER NAME: First JOHN N & REBECCA S F Last GEFEKE PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 1264 140TH ST SECTION 35 TOWN 30N RANGE 18W 1 /4160 NE 1 /440 SE Line Description Line Description TOTAL ACREAGE 5.210 PLAT CSM 17 -4640 026/03 LOT02 BLK 01 SEC 35 T30N R18W PT SE NE 15 02 EZ- U- 1390/035 16 03 NKA CSM 17 -4640 LOT 2 17 04 (5.210AC) 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit