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Home My WebLink About030-2141-00-031 Wisconsin Deptirtment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safly and Building Division INSPECTION REPORT Sanitary Permit No: 499138 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: Wurtzber, er, Alan & Amanda I St. Joseph, Town of 030 - 2141 -00 -031 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: cp.o, I I 0T. 0 ( *f 36.30.19.2081 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ' Dosing Alt. BM Aeration Bldg. Sewer 1 0 3 , I 'f � Holding St/Ht Inlet _ TANK SETBACK INFORMATION St/Ht Outlet ^. 'r.• DZ• 0 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 1 c / Dt Bottom Dosing -fJ Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade UMP /SIPHON INFORMATIO `` Io Manufacturer and St Cover C. O r GPM Z�i a, �Y J Model Number TDH Lift Fricti oss System Head T Ft I Force ain Length Dia. SOIL ABSORPTION SYSTEM �{S id Depth RENCH Width Lergj t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T DIME NS '2 `I$Z SETBACK SYSTEM TO P/L BLDG WELL ' /STREAM LEACHING Manuf ctur INFORMATION CHAMBER OR Type Of System: I / UNIT Model Number: Go nV. 2.1 R' " DISTRIBUTION SYSTEM Header/Manifold .' D istribution x Hole Size x Hole Spacing Vent to Air I ntake Pipe( L Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of 1 xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil Ye No Yes No C/lOMMEEnN nc_lude i cr pen ies, persons P, & esent, e c.) Inspection #1: oe vil ?.�0(o Inspection #2: Luca on: 1258 St e Richmond, W 1 T30N R19W) Natalie's Ridge Lot 31 Parcel No: 36.30.19.2081 1.) Alt BM Description = S' T' C S)5F*U, fS /n► - /n► /n� . - 0 n 2.) Bldg sewer length = , ; V�.�.�dC s amount of cover = t � Plan revision Required? X Yes "`', No Use other side for addition I atioll. i . ~�/ Date Insepctor's Signature c Cert. No. SBD -6710 (R.3/97) Safety and togs Division County �� // N *isconshn 201 W. Washin ve., O 1 � . Box 7162 � Madison, 71 Sanitary Permit Number (to be filled in by Co.) Department of Commerce ( 266 -3 ?1,3 S Sanitary Permit Application State Plan I.D. Number N/ In accord with Comm 83.21, Wis. Adm. Code, personal informati maybe used for secondary purposes Privacy w, si 3 Project Address (if different than mailing address) I. Application Information — Please Print All Info Property Owner's Name Parcel # Lot # Block # 1tN Ar0�4' l,��Rr��3 - 3/ Property Owner's Mailing Address Property Location b S 5 57.� • Z c _ :5&) / tiW Serm 19 City, State Zip Code Phone on 3 Co Number R ►V�, �� /S �v /• syozZ T N; R E o 30 11(c ird / Zo C H. Type of Building (check all that apply) e k 1 or 2 Family Dwelling - Number of Bedrooms y mo b, �,� 4� /e Subdivision Name CSM Number / ❑ Describe Use 1Ab tcvl— ❑ State Owned - Describe Use Z ❑City ❑Village JVTownship of S III. Type of Permit: (Check only one box on line A. Complete line B if applicable) i A. New System ❑ R lacement y ep System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B- ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration ' Plumber - Owner N. T of POWTS S stem Check all that s J No – Pressurized In- Grou ❑ 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 f ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. DispersaVrreatment Area Information: Design Flow (gpd) Design Soil Application gpdst} Dispersal Area Required (sf) D' I Area :P System Elevation > &00 0 ✓ 0 �� /oo. y' y. ✓ VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units - / Concrete Constructed Glass New Edsft n Tanks Tanks � k! � L 4-.,— Septic or Holding Tunic e / to Aerobic Treatment Unit l.7 C Dosing Clamber J VII. Responsibility Statement- I, the undersigned, assume respon sibility for installation of the POWTS shown on the attached plans Plumber's Name (Print) Plumber's S umber Business Phone Number R . W'13 R I zz 4e 3 s 7/5 - 77a - 3 Y/ (Z- Plumber's Address (Street, City, State, Zip Code) VIII. Corm /De artment use On Approved El =tn Sanitary Permit Fee (includes Groundwater Dates Issuin t Stgnature o S ) Surcharge Fee) / ❑ Reason Denial U fP IX. Conditions of Approval/Reasons for Disapproval ' tt rr SYSTEM OWNER: t. Septic tares, effluent finer and " U dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code / ordinances. Attach complete plans (to the County only) for the system on paper not dos than SM z 11 inches in size SBD -6398 (R. 01/03) ► NO 1,6 T G- . / 7 G or3z Lora p o 01.0 6 .r v o �► t l j _ 13,¢c 4e P rs I3rJ' S • t � o�t 3� �_ ,, �tt -roe � af= l `tit - y. J PVc 107. n t4 dC /pp. 0 -roP i `o IX 50 e j t i THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # gep Lpaper; 1327 WisconsinDepartmentofCom SOIL EVALUATION REPORT pap I of 3 Division of Safety and Building acwrc**Iwith Comm 85, Wis. Adm. Code Torn Schmitt County Attach complete site plan less than 8'% x 11 inches in ae. Plan must St. Crobc include, but not limited to: h&kbdlaF point (B) n and percent slope, scale or di n and d t `nUre�t road. Parcel I.D. Please print all infornwdon. v Revi By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Grand Properties, LP Govt. Lot SW 1/4 NW /4 S 36 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 31 Natalie's Ridge City State Zip Code Phone Number City Village ✓ Town Nearest Road Somerset WI 1 54025 1 715 - 247 -5900 St.Joseph 80Th St. ✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design Bow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a co nventional system with a 0.7 gpd/scaft rate. Possible system elevation for Area 1 is (High trench) 100. ' low trench) 99.30 Boring # Boring Pit Ground Surface elev. 105.70 ft. Depth to limiting factor 121+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF *Eff#1 *Eff#2 1 0 -9 1Oyr3/3 none sl lmpl mvfr as 2vf .6 1.0 2 9 -16 1Oyr4/4 none scl 2msbk mfr gw 1vf .4 .6 qq 3 16 -38 1 Oyr4 /6 none Is 1 csbk mvfr cs 1 of .7 1.6 ! ` 3 4 38 -48 1Oyr5/6 c1d5 r /3/8 S 2msbk mfr cs --- .6 8 � J13 5 48 -54 7.5yr5/4 none grcos Osg ml gw ----- .7 1.6 6 54 -83 1Oyr6/4 none gs Osg ml a - - - -- .7 1.6 7 83-121 1Oyr5/4 none grcos Osg ml -- -- .7 1.6 a Boring # Boring ✓ Pit Ground Surface elev. 104.67 ft. Depth to limiting factor 101+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0 -8 1Oyr4/4 none sl 2mgr mfr cs 2vf .6 1.0 2 8 -18 10yr5/6 none sl 2msbk mfr gw 1vf .6 1.0 3 18 -29 1Oyr5/4 none grcos Osg ml gw — .7 1.6 4 29 -101 1Oyr6/4 none grs Osg ml - - -- - --- .7 1.6 t' tt �ti o ` Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOO < 30 mg/L and TSS <,0 mg/L CST Name (Please Print) Si re: CST Number Thomas J. Schmitt '"O 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 4/20/05 715 - 247 -2941 Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 F3 ] Boring # Boring of Pit Ground Surface elev. 102.20 ft. Depth to limiting factor 100+ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP ' *Eff#1 *Eff#2 1 0 -8 10yr5/4 none sl 2fsbk mfr as 2vf .6 1.0 2 8 -21 10yr4/4 none sl 2msbk mfr gw 1vf .6 1.0 3 21-44 7.5yr5/6 none ms Osg ml cs - -- .7 1.6 4 44 -89 10yr5/4 none grcos Osg ml as .7 1.6 5 89 -100 10yr6/4 none ms Osg ml -- -- .7 1.6 n 3 7! 4] Boring # Boring ✓ Pit Ground Surface elev. 103.44 ft. Depth to limiting factor 98+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP *Eff#1 *Eff#2 1 0-6 10yr4 /4 none $l 2fsbk mfr as 2vf .6 1.0 2 6 -21 10yr4/6 none sl 2msbk mfr gw 1vf .6 1.0 3 21 -34 7.5yr5/4 none s Osg ml cs - -- .7 1.6 4 34 -78 10yr5/6 none grcos Osg ml cs - - -- .7 1.6 5 78 -98 10yr6/4 none grs Osg ml ---- -- -- .7 1.6 ❑ 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 *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. Page 3 of 3 ` Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: Grand Properties, LP Thomas J. Schmitt, CST 227429 Address: 712 Rivard Street 1595 72nd St. City, State, Zip: Somerset, Wl. 54025 New Richmond, Wl. 54017 Phone: 715- 247 -2941 Subd.Name: Natalies Ridge I Lot No.. 31 C- �o_ f— Legal Description: ,SqJl /4 /K4 /4 S36 T30N Rl9W Township of St. Joseph, St Coix County 111111MI Soil Boring ® Bench Mark El. 100.00' Top of� 0 Alternate Bench Mark EL e Top of Slope= j� rh / S Contour Line EL /1//� P rcrsed Ro ad / 7 Scale V= = 40' J 7r 4 ,y 7,", 160,2 c)1 l r &t d • J �9 � r 6% 7y P J This I i r n' m or ma y t be in a location suitable for so report was done to i a �o ink, req nrmeht It m ay y no our use. y Ik �� /4 � a I N19 N89'SVOS"W 704.07' Z ,yam 33' I °= DRAINAGE EA _ S£li /ENT 'N H.W.E.= 933.5 s N LOT 32 Z 3.000 ACRES ".50 �r v I ( 130.685 93 5 .5 L.O.O.= 2 �? BENCH MAR TO P �75' Im PIPE. 93.5 �'� 100' I ATION 928.3 ' 34.58 N18 •,� LOT 3 1 �s 8 !R 130.682 SO. FT. I s S89 0 58'39 "E 439.19 0 L.B.O.= 920.4. LOT 1 C.S.M. IN 3 J VOL.19 PG _ 4997 y I ----------- - - - - -- � N �Na' S89'S1'OB"E I O 2 N 0 .40' N W P I o LOT 30 LEGEND I FOUND ALUMINUM COUNTY T N SECTION CORNER N • FOUND 2 -3/8" OUTSIDE i DIAMETER IRON PIPE LINE TABLE - DRAINAGE EASEMENT - W FOUND 1" OUTSIDE j D/REC70W D/ST. / D/REC70V DVST. DIAMETER IRON PIPE NI N00V0 "E 19.07' N16 N79:T642E 7188' SET 2 - 3/8" OUTSIDE DIAMETER N2 N51 51'41 "W 160.23' N17 S0837'59E 14080' I O BY 18" LONG IRON PIPE WEIGHING N3 N3242'55 "E 62.34' NIB N8958'J9"W 41.77' 3.65 LBS. PER LINEAR FOOT N4 N25V6'45 "W 170.16' N19 N8951 "W 27dt29' N5 N8951 7 W 16454' N20 SOb173'30"W 13900' I ALL OTHER LOT CORNERS N6 N6J74'35 0 W 94.26' N21 S2740'32E 5% *$' MONUMENTED WITH 1" OUTSIDE N7 N2740'32 0 W 46.52' N22 S0229 2742' I DIAMETER BY 18" LONG IRON PIPE N8 N8951'08 "W 142.10' N23 S0279'00E 6065' NEIGHING 1.13 LOS. PER LINEAR FOOT N9 S40 48'11 "E 69.09' N24 S3152'32 "E 11760' _ DRAINAGE T AREA LINE N10 S1.3;34'55 "W 61.45' N25 52877'51 "W _W. V' ROADWAY SETBACK LINE (AS SHOWN) N11 S4674'01 "W 57.70' N26 S183147E 8429' N12 S08 -j7'59 E 99.81' N27 N7178'13E 7124 ----- ExISTING FENCE N13 S89 51 '08 "E 107 70' N28 S5151 '4f E 15R 14 ` .�. PROPOSED DRIVEWAY N14 52275 40 "E 66.26' N29 S89 1 E 2dt 74' H.W.E. =964.9 HIGH WATER ELEVATION N15 S557229 E 164.84' N30 S8951'OISE 10a 12. !`$ LOWEST BUILDING OPENING — THE ' L.B.O. = 968.9 LOWEST WINDOW OR DOOR ELEVATION. —' — 12' UTILITY EASEMENT V/w DENOTES VARIABLE WIDTH RIGHT—OF—WAY — .. —.. —v ` ULBRICHT & ASSOCIATES CO. 281210th Ave. - Spring Valley, WI 54767 Reg. Designers of Engineering Sys t ems 715- 772 -3442 Private Sewage Consultants PROJECT INDEX PLAN ID # DATE � 23 - 0 (° e OWNER / 1 /,f '�/�/�.Vl' A r.7 � - 7 , 2 PHONE ADDRESS / O S 5 ffl� LEGAL DESCRIPTION 3 ! /(//tI - f4l ` `5. w AW , S4c . 3 7 ), 2/f & TOWN OF f Sr �Os e p �(' COUNTY S 4. CR of 7 }C CSTM / lw - SC `j AI r 7 LOCAL AUTHORITY/ SUPERVISION 5r- C AN Y CT)! Zp,K) t A5 PROJECT DESCRIPTION: • y &w zVV sr204- 7 - ,CO �P AT Ulbricht & Associates Private Sewage Consultants 2812 10th dive. Spring Valley, wi 54767 Jet PR-S 4 2-_2� 3 _� s 0fdGIN-Nla ? wb ul�_ - 2- o � P9.1 INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN r P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg.4 IT IT if it it of P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS Pg.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. i The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater TrPAf:mPn1- RvRtPme_" (VprGinn 7.n) CRn- 1075 -P(NOI /01 . kA 0 � 0 c l z ? m 3 CD Ci �r v 1 m + T O m < < Oa U; m z Z� 44 �t fl 'o � 1 lA/cukArEV - 1 AV U FT 3 Iff Ile Co - CrPo SS Sic �o� ©� TiPE�u�s' C- K Y 1 1U 7 4 :1Z, 744 7 O e S u'rdyi, 1q.1 ,9IM41P469 UEti c>v �.v .,il..spEtTlov p/� - , IA/. ill 1 I / // r ,, sue. �0 9�•�f�� 103.0 G4V9! R,4rItD TIC'& .-rte y OVER: See Reverse Side for Vent/ Observation Pipe Details. r iP`ctrcei rr: i Jti-Z i4 U0 -U:i 1 yVl � 7 OF 1 `Alt. Parcel #: 36.30.19.2081 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/08/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner ALAN C & AMANDA J WURTZBERGER O - WURTZBERGER, ALAN C & AMANDA J 905 STATE ST APT #2 RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1258 82ND ST SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.000 Plat: 10 /065- NATALIE'S RIDGE LOTS 1 -32 030/05 SEC 36 T30N R19W PT SW NW NATALIE'S Block/Condo Bldg: LOT 031 RIDGE LOT 31 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 36- 30N -19W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 07/19/2005 800735 2846/017 WD 07/08/2005 799811 10/065 PLAT 06/01/2005 796404 2812/618 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 04/26/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 64,200 0 64,200 NO Totals for 2006: General Property 3.000 64,200 0 64,200 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 U 2 8 9 6 P 0 17 600735 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. NALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., VI Document Number Document Name RECEIVED FOR RECORD 07/19/2005 10:15AN THIS DEED, made between Grand Properties, LP KARRA DE ED ( "Grantor," whether one or more), REC FEE: 11.00 and Alan C Wurtzberger and Amanda J. Wurtzberger, husband and wife TRANS FEE: 290.70 COPY FEE: CC FEE: ( "Grantee," whether one or more). PAGES: 1 Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space r, N 13 tjl t < a�sa h is needed, please attach addendum): Lot 31, Plat of Natalies Ridge in the Town of St. Joseph, St. Croix County, Wisconsin. 030 - 201430- 000:030- 2014-40-000 :032- 2014 -40 -100 030 - 2014 -60- 000:030- 2015 - 20-000 _ 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 Grand Pr rties, LP (SEAL) (SEAL) * *By: Richael J. G main (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Grand Properties. LP By- Michael J. Germain STATE OF ) authenticated o G ) ss. le�� ( COUNTY ) * Kristina O land r Personally came before me on , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristina Op-land Notary Public, State of Hudson WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name belop signatures. INFO -PROTM Legal Forms 800 -655 -2021 wwwIntoprotorms.com a �7 ST. CROIX COUNTY Nve-" SEPTIC TANK MAINTENANCE AGREEMENT C1Q AND OWNERSHIP CERTIFICATION FORM � ' � ///O . ' 7 Owner/Buyer 1 41,4Al &h±V PA AIPW E 13&145 2 Mailing Address S 577 IY`h - 2 ' FiN15 rd Property Address ca (Verification required from Planning & Zoning Department for new construction.) City /State N � �� t" l �� AJ J �' I Parcel Identification Number LEGAL DESCRIPTION Property Location �J V4 , 44) 1 / 4 , Sec. 3�P , T 3U N R W, Town of T O SEP 1 " Subdivision I V f /4'G , S ---3 Lot # 3 I Certified Survey Map # , Vo ume , Page # Warranty Deed # g o o -7 3 s , Volume ? o' Page # 7 Spec house yes no Lot ideiltifiab yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted phimber 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 113 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 Plaiming & 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. Itwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SI ATURE OF ICANT(S) 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. 08t05) TO IeM Ulbricht & Associates Private Sewage g Consultants 2812 10th Ave. Spring Valley, WI 54767 t5 -7 7d; - 3 qq�_ O OWiKERes MAINTNANCE SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation and maintenance of.thi -s system. Regular periodic inspections and servicing is necessary for the safe healthy operation of system. The owner is required. by code to submit all necessary' ° maintenance /inspection reports to the controlling,authorities:. SPECIFIC CONTACT AGENTS s • C�O C 7.y . ! G.." * Governmental authority) inspectors: A9 30 • ��a * Licensed responsible for providing an operation/ maintenance.AUsers" manual: - 7 - 7A • yy z R ..� �g Pj `c G4-r M PRS . 3 °* Licensed service / inspection other than installer: T�'� - •cT� S�4rv: rg- T io,(� ` �'U�tp,� =-` �o - * Electrician,.. for pump, electric controls, v units: 6.44 'L S . ,ec • IMPORTANT Awwwo MAINTENANCE REQUIREMENTS ;• Winter traffic (sledding, shoveking, etc.) across the area shall not be permitted, or frost can /Will penetrate into the cell, freezing up the system. Di_scontinuos use in the winter_ (a v - acact -lon _ trip, resulting' no Water -use) can also lead to freeze tips. 2 • Water conservation - needs t6 lie - exercised t - Or system can be _ hydrolically overloaded and destroyed. This sv _.- designed for a o€ stem was - maximum wastewater flog - - CP�t3: gals. daily: - 3. POWTS are not desligned to disposal unit, Or anyotherCunnaturalwsourcesrOf waste a Any introduction em such waste "materials will ' overload , -a nd v destroy this system, _ . 4• If 'a power outage ar a pump fails, it way result cell, In a temporary overload of effluent being Pumped into the which may adversely impact the cell (ieak -kge). It is recommended that a licensed pumper empty the dosing tank, allowing th pump to return todosin t g the corre t our Consul - a Y installer �i - I mmediately for advice. mounts. k 5 • Neglect of the vege tat ive "cover e rosion preventive (the cells insulation traffic also ) can lead to failure. Compaction or heavy can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent In the Aystem beneath IS NOT su fficient alone to maintain a y 1 N Fovur. 6. Periodic inspections by the owner, or his a necessary. Inspection pipes and s, is t Into the system on the mound basalareave been incorporated inspecti pipe$), cleanout terminals on the' level laterals, at each tip - for flushing and clean ngsthezlater Out- The filter system in the tanks als ground cover /manhole {via a lacked above person should be )• Onl a licensed properly qualidied severe safe! Performing this work which involves health systems tr e ?talY risks. Evidence of effluent ponding ent cell, in the shall also be regularly inspected.