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Home My WebLink About032-2129-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463012 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: Boardman, Barry I Somerset Township 032 - 2129 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: 1 00 -0 1 1 1 C)o . O C51 t 13.30.19.1153 TANK INFORMATION ELEVATION DATA TYPE , MANUFACTU CAPACITY STATION BS HI FS ELEV. Septic Benchmark W � � 1�• S a-v-t? — -L . �� . (aa a D- o Dosing Alt. BM 3 -q D I f 20 r Aeration Bldg. Sewer y .ya 3.20 r Holding St/Ht Inlet s.z 2.3 TANK SETBACK INFORMATION St/Ht Outlet S. 2 .0 ' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic r� l �/ Dt Bottom Dosing Header /Man. . Aeration Dist. Pipe /0.p� -- 0 - o • S � `1 Holding Bot. System 11.2-0 7 PUMP /SIPHON INFORMATION Final Grade �s 1 5 2, 2.35" Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Los System Head T H Ft Forcemain Length a. Dist. to Well SOIL ABSORPTION SYSTEM 1 '4 BED/TRENCH Width I Lengt - No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 L) SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Man cturer: I INFORMATION Ty Of tem: CHAMBER OR `jc— yp 7�� , UNIT Model Number CJv3 D DISTRIBUTION SYSTEM Header /Manifold f � Fistribution x Hole Size x Hole Spacing Vent to Air Intake i (s) Leng Dia ang Dia Spacing i SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil - Yes No Yes r J, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1/ Z 7!"' Inspection #2: Location: 1589 89th St. New Rich nd, 14017 (NE 1/4 13 ON R19W) Boardman Estat s Lot 6 Parcel No: 13.30.19.1153 1.) Alt BM Description D � Si • . Gu291 2.) Bldg sewer length = 15 AA - amount of cover = 2 q t Plan revision Required? Yes No Use other side for additional information L L__', SB -67 0 (R.3/97) Date 4 Signature No. .� = Safety and Buildings Division `; County 1*i m1 W. Washington Avg P,Q. Box 7162 Consi ■ Madisd{t WI '�!ltl — 7162 Sanitary ermrt Number (to be filled in by Co.) Department of Commerce (4 266 -3151 1 D ?� Sanitary Permit Application stdte Plan I.D. Num be f In accord with Comm 83.2 1, Wis. Adm. Code, personal informAon you provide - N maybe used for secondary purposes Privacy Law, s 15. ftl)(m) Project Address (if difflerent than mailing address) I. Application Information — Please Print All Information / Property Owner's Name Parcel # t # V/ Block # Property O 's Mailing A dress Property Location c ity, S to ip Code Phone Number ,Y., Section (circle ) S It. Type o Building (check all that apply) /C T� N- R - o W) �` Subdivision Name C r 1 or 2 Family Dwelling — Number of Bedrooms 7 , ❑ Public /Commercial — Describe Use ❑ State Owned — Describe Use ST CELLA l �� / „ � ❑City ❑VijJage- III. Type of Permit: (Check only one box online A. Complete line B if applicable) A ' 2 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. List Previous Permit Number and Date Issued ❑ Permit Renewal ❑Permit Revision ❑Change of [I Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a pply) A 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 Drip Linp ❑ Gr el -less Pipe Other (explain) V. Dispersal/Treatment Area Information: I f R — (� Design Flow (gpd) Design Soil Application Rate(gpdsf) / Dispersal Area Requi ed (sf) Dispersal Area Pro osed (sf) System Elevation ✓ -'2 ✓ , � q z i g2 9 Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ Aerobic Treatment Unit v Dosing Chamber VII. Respg4isibility Statement- 1, the undersigned, flume responsibility for installation of the POWTS shown on the attached plans. Plum er' ame (Print) Plumb 's S re MP/MPRS Number Business Phone Number 3 � S' PI er's Address (Street, City, State, Zip e) VIII. oun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater D tq Issued Issuing AV Si tur tamps) Surcharge Fee) 00 ` /1 3 / D 11 Owner Given Reason for Denial p? CJ IX. Conditions of Approva for Disapproval , • - / r / Urns ^J��/)2�/L/G �J 7�1j X7 ' ��(STEM OWNER: 1) &d M�/� U Septic tank, effluent filter and 4,kj , r� dispersal cell must all be serviced / mai ntaine an V ded by C d 3 5 as 2. All setback requirements must be maintains as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 R 1 (. 0 /03) I X g9.5-/ �l/"•,! .sic %3 -.✓- �i9� I / /f•� il•�/�4 ' �S s'�d 17 �m�.Gse.�' I i i i i _ - - 0 9 - - - - - - - - - g8 9 I i I I I I I I i i i I I I I I i I I I I : I I I I I , ' I _ I III I I I LIP s I I i I I I I. i // 1Q6 _ lOf Ii J I � _ I l I I I i I gg'� n � - r O�tdkw5ty � \ - - -- a 3 fi i � � I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan mus County ' include, but not limited to: vertical and horizontal reference point (BM), direction and 1r arcel I.D. percent slope, scale or dimensions, north arrow, and location and dis to neares d»d. 03 2 — 2i a moo pCl� Please print all inforwafion. Re ' e by D Personal information you provide may be used for secondary purposes (PriyaGy 4w, s. 15.04 (1) (m)). �� 6 3/0 l� Property r Propert Location ((� Govt. Lot 1/4 �' 14 S /3 T �� N R / i (or)o Property Owner's N Address Lot # Block # SubcL Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road New Construction Use: ( Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement J7 ❑ Public or commercial - Describe: Parent material �i HLx (ry tG 7` G[ vJ �(a aJ Flood Plain elevation if applicable ft. General comments _5 y S few and recommendations: F-1 1 Boring # ❑ Boring r C] Pit Ground surface elev. 74 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu.S Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 S� .k�� s ,3C o 7 5�� ,�s��s z 0a (fie y J�O psi/ l¢ 5 7 C S' 6 Boring # 1❑ Boring IGS Pit Ground surface elev. /, / ft. Depth to limiting factor / 2- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 �- i�iP -�/ �-� /1�► ;G D,S '0 2 9-23 ' , Sel- 2 AU4'.' ees zc 0 , 0 7,2- Ak y y-70 r >%/l�/ �, ,> ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Pie a Print) Si urea j CST Number /G,q , Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) 1 Property Owner ' ��G�`�" '� Parcel ID # Page ;�- of '3 F-3-1 Boring # ❑ Boring ® Pit Ground surface elev. -�� ft. Depth to limiting facto 1Z G in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Z C I �� Q� lJ� S /lam �5�/� /' �S .SC c� 7 - S 1 S%� � 411k lk L �" lit -7 M 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ El Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E1142 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) OWNER Page 3 of 3 Name Brian Parnell Address '15 If CST 231314 Ae w X° L n 6 � Date A Benchmark 1 IOP .2 %�L�� ,'�� )6171, A Benchmark 2 N un 1 1R 2 " oa/C71 - ee ❑ Soil Boring i_ Suitable Area F = 40' Scale 1 , i 1 I � f y 2 S m - WisconsiA Department of Commerce SOIL AND SITE `EVALUATION division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and '( 6 /_0I x , percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please p >tfnfo � r � maboq.. Reviewed by r *r"fi Date Personal information you provide may be used for secorpos s Ptkai w, s. 15.04(1), (m)). Property Owner Property Location & 11, v 41 ± ��ytf Govt- Lot Al E 1/4 NE 1/4,S �3 T20 ,N,R � 9 & (or)o Property Owner's ailing Address Lot Block# Subd. Name or CSM# F 79 ��JJ - 60 � `t � e ' Y' l �(�arA m u n S a 7 _r City State Zip Code f' e N 91 f Ci ❑ Village 154 Town Nearest Road /►f/e� rr � h,.,�., � � Ss�d 7 ,( A� >> zy� ° ° � r� Pis � �- / �o -74 New Construction Use: ® Residential / Number of bedrooms T Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 00 gpd Recommended design loading rate ® -7 bed, gpd /fi 0 trench, gpd /ft Absorption area required - �57,� bed, ft SO trench, ft Maximum design loading rate o 7 bed, gpd /ft . trench, gpd /ft Recommended infiltration surface elevation(s) 9Ii ft (as referred to site plan benchmark) Additional design /site considerations Parent material CO y z �Q. �� fW�1 A &.V d/ Flood plain elevation, if applicable /" A ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U 0 S ❑ U ® S ❑ U ®S ❑ U ❑ S 2 U ❑ S 2 U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench /�i� ` S ` C w 3c or e 2 12 -3 9/ ltl S/: 2M hA h 7 b CCU 3C . -5 . 6 Ground 7. 6 4 M5 0 /'/L Cup 2M elev. 3,r- Depth to limiting f 1 in. Remarks: Boring # IVL C tv C Z i6 J 7 10W mi,,6 lam/ C w 36 *7:, Ground y6-IJZ 7. 5-1ooe 6� S v� �-- /A v ' e ft. ' Depth to limiting factor ��in. - Remarks: CST N e (Please Print ) Signature Telephone No. Address Date CST Number - /ZaJ y 0 2313Jy PROPERTY OWNER 13a f < I'l o' u ll SOIL DESCRIPTION REPORT Page 2 ✓ of M' PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 2 5 -ZZ �id % I A L / / � /i? .., 4 S ' 3C Ground 3 Z2 - 7- !r' A 5j Cr M-SbA L C 6-- "v ff. y 32- yy 7�� 1 41,4 ms ash Depth to S AM MS OS limiting factor � in. Remarks: Boring # `l - SIX S� I mS ^,c,- ce 3 c Y S 3 (> Y� - 75 - 9% /1/�4 Ls�y� l tn I6x M L C w Ground 9 2 - I26 7 4 I'r 0S I L' .7 ;-S elev. q ft. Depth to limiting factor ;;ILZD in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # S 2 o as /o / /�� SL lmo-v W/ yes 3c s Ground y y7 -�lD 7> �� iY mS �- t' . / 'oo Depth to limiting factor �' Q in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) OWNER, Page 3 of 3 Name Brian Parnell Address 160-fAtoa e CST 231314 U1.1 R O / ell 0 A J LAIJ7• Date 7 2 �/- oo A Benchmark I /Y�c 1'1 .0 - 1/ - 7 Fv � 4 A Benchmark 2 /t 14/, 0 ❑ Soil Boring j Suitable Area F = 40' Scale 71 Z L fw l Cc 17 'IV 1 ! f 110 17-T LL IL): 77 IT' i I 7A '331' 00 r i %�(d.tilh"t ...� /��, rt,r'�� / /� _ _ ��• ��- � � - y �{ KLS - /�� "�)) 9 � =4 EMPRRY/ -Ae, ' ? AWN ISQ F.T_ �/- - � � � '�_•/ '�� \ - �9 589' /" _ _ _/ �, --- — ra�� %PLAT -:BQU 4.87 ACRES TO BE RE'��NED BY OW .E R . POWTS OWNER'S MANUAL & MANAGEMENT PLAN Peg _,1._ of FILE INFORMATION f r SYSTEM SPECIFICATIONS owner r rEf ic Tan Capacity..: .,.,. , , i , 6.1 d NA Permit # 0 ic Tank,Manufacturer r i O NF' DESIGN PARAMETERS ent Filte r Manufacturer O NA Number of Bedrooms O NA • Effluent Filter Model O NA Number of Public Facility Units 2 NA Pump Tank Capacity a l �3'NA Estimated flow (average) al /da Pump Tank Manufacturer ANA ' Design flow (peak), (Estimated x 1.5) g al/da y Pump Manufacturer' ,� r . , '' • ° '' A ;r `•_� • 1� NA _. !, 12� NA Soil Application Rate gal/day/ft' Pump Model Standard Influent /Effluent Quality Monthly average" Pretreatment Unit t''" :'' NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter r' ❑ Peat Filter I Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection D Other: , Pretreated Effluent Quality Monthly average Dispersal Cell($) O NA Biochemical Oxygen Demand (BOD 530 mg /L Z In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L d.NA 0 At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip - Line O Other; Maximum Effluent Particle Size Y in dia. ❑ NA Other: O NA Other. 0 NA Other: ' '' ` ' a O NA "Values typical for domestic wastewater and septic tank effluent. Other. O NA MAINTENANCE SCHEDULE Service Event Service Frequency monthls m 3 y ars) 0 NA At least once eve : ( 1 14 "M"� �. Inspect condition of tank(s) every: � ,�•._� ear s �� Pump out contents of tank(s) When combined sludge and scum equals one -third Jy$) of tank volume O NA At least once every: mont (s) (Maxim 3 yews) 0 NA Inspect dispersal cell(s) ear(&) _ ❑ month(s) 0 NA Clean effluent filter At least once every. earls) Inspect pump, pump controls &alarm At least once every; 0 month(s) _Q-NA p year(s) ❑ month(al E. 4,5 , • r ANA Flush laterals and pressure test At least once every: 0 year(s) Cl earl8 (s) Other: At least once every: ANA Other. _ONA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following lioenses 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, identity_ 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:pheok fgr 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. I When the combined accumulation of sludge and scum in any tank equals one -third (Y rrt)ore of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in g000rdanoe ,with oMpter NR 113, y ;; f •'x'1' `S � �';Y� !� 1:" .. Wisconsin Administrative Code. t4 All other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized cormpononte, 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,, ny sorvi4�9 evvr OMW 14/01) Page cf START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or, 9", r, chemicals that may impede the treatment process and /or damage the dispersal cell($). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the exco" wastewater will uu discharged to the dispersal cells) in one large dose, overloading the collie) and may result in•the bookup or wHm discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing OW&tor pdw to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually_oPeratln ths'pump ontrols to restore normal levels within the pump tank, Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicide$ ;; scraps;, mmoications; 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 s 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 Rperotor� • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled wits 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,codo compliant replacement system: >„ ws.n rt.aN !i , J& 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.°- •� ❑ 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 avallablo 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 thv 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 NO•i ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTAN0E8. DEATH MAY .RESULT. RESCUE OF F PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS ,. ri�Y Srrltt �. r tf?�:x POWTS IN TALLFX POWTS MAINTAINER Name Name L Phone / _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name �. .Name , ; , Phone Phone 5 -•.�,, ,, j «,;� f.. This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Admirdstrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ��wner /Butier Mailing; Address troperty Address (Verification required from Planning Department for new construction) C'iry /state , Parcel Identification Number 05a-a1a-- a0 -d 60 I.E CAL DESCRIPTION Property Location ' /4, /_ ' I,, Scc., T2 - W, Town of Subdivision , Lot # G Certified Survey iylap # , Volume , Page # NVarrauty Deed P , Volume , Page # spec house dyes O no Lot lines identifiable 0-yes Q no Y TFM M.�INTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes, Proper ma r;;cr.ancc consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper, What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system, The property owner agrees to submit to St. Croix Zoning Departincnt a certification form, signed by the owner and 'uy a 'taster plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on - site wastewatcrdisposai 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, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the staiio"rds set forth, here"', as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St, Croix County Zoning Office within 30 days of the duce year expirati n date, S1G ATURI; OF ICANT DATE OWNF,R CERTIFICATION i (we) certify that all statements on this form are true to the best of my (our) knowledge.. I (we) am (are) the owners) of the property described abov by virtue a warranty deed recorded in Register of Deeds Office. S1GNA'rl)iZl OF APPLICANT DATE in or * * *" Any mation 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 a copy of the certified survey map if reference is made in the warranty deed M� LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SOMERSET COMPUTER NUMBER 032 - 2129 -20 -000 Parcel Number 13.30.19.1153 OWNER NAME: First BARRY Last BOARDMAN PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 1589 89TH ST SECTION 13 TOWN 30N RANGE 19W 1 /4160 NE 1 /440 NE Line Description Line Description TOTAL ACREAGE 3.000 PLAT BOARDMAN ESTATES LOTS 5/15'00 LOT06 BLK 01 SEC 13 T30N R19W NE NE 15 02 LOT 6 BOARDMAN ESTATES 16 03 17 04 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 l - z - ... VOL �acE 196 J JO; STATE BAR OF WISCONSIN FORM 3 - 1 QUIT CLAIM DEED DOCUMENT NO. "j _ Frank Keith Boardman a /k /a F Keith Bo a sin t S CRt.!X CO., W! person _ AUG 0 6 1998 quit- claims to Barry Bo ardman 9 A I R oglitar of Deeds the following described real estate in St. Croix County State of Wisconsin: - IHIS SPACE RESERVED FOR RECORDING DAtA NE 1/4 of SE 1/4, SE 1/4 of NE 1/4, and the NE 1/4 of NAME AND RETURN ADDRESS NE 1/4 EXCEPT Lots 1, 2, and 3 of Certified Survey Map filed July 7, 1997 in Vol. "12 ", page 3295 as Document PostDofficeBBoxE1L7SILER, S.C. No. 561969, all in Section 13- 30 -19. New Richmond, WI 54017 032- 2047 -80 -000, _ PI47CEL IDENTIFICATION NUMBER � 0 . S This is not homestead property. x(]�k (is not) Dated this U day of _. A D. it 98 I (SEAL) (SEAL) • Frank Keith Boardman (SEAL) - -- — AUTHENTICATION ACKNOWLEDGMENT Signatures) — rank F Keith Boardman State of Wiscons ss County 0th Adaof 1 108 Personally came before me this — day of authentica Is — 19 , the above named • Hendrik W Van Dyk TITLE: MEMBER STATE BAR OF WISCONSIN - -_ -- — (If not, - authorized by §706,06, Wis. Scats.) to uie x owTt to be the person who exe:utcd the !cicgoing msrr - ent and acknowledge the >ame. THIS INSTRUMENT WAS DRAFTED BY _- Hendrik W. Van Dyk — VAN DYK O' BOYLE & S ILER S . C. _ -_ -.___ post Office Lounty. \Is New Ri Wisconsin 54017 Not Pabhc, __ — ._— . - - - -- (Signatures may be authenticated or acknowledged Both are -tot My connmission is ,erntanaat tlf not, .late expiration .tau necessan•) - -" •Nature of 1, ers ons agning in ant'.aPa.nr. hold 5t !rFx'.!.tt pnmtd 'r :'.arw their .enaturts STATE BAR OI t61SCONS1% was. a.• , .r3n R:.,'« QC[t Cl A{ ?t DEED Form No 1 - 1082 I 0 cn p l 3 n 3 ID A A � c Z O w w to o N 0 0o w w `C � o o , or to O N 3 7 K A d' i fY' (D 7 (D -� 3 0 N H c � C L 7 0 y fD w W C N W 7 CAD M OD �:'° O Ln v A CD co z N m a w O a I� o 'I 3 N o co� CL � N O Z N N fµ O O O O O o Ili 3 lr m a z ca C 3 (A (A ch a 7 Q CD T. m N 3 y 7 W O. 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BOX 180 Date Invoice # NEW RICHMOND, WI 54017 0712112111 4347 Bill To BIRD PLUMBING 1008 192ND AVENUE NEW RICHMOND, WI 54017 Terms DUE ON RECEIPT Serviced Description Amount 07/24/2008 PUMP SEPTIC AT 1589 89TH STREET, NEW RICHMOND 160.00 2-1 ZJ - Zo -- 2 pwnt/ Total 5160.00 6'd e8Z:O6 ZO LZ 100 C � K o ■ -0 n c � @ � � § ° k � % q 0 2 . � § / g 0ƒ 7 o & E 0» S § k / f / § g . 9 ) po ec; Q0 ®B - / � \ / N k 8 2; c _ o e ~ o 7 t / \ 0 ° C > in ¢ � ƒ \ / K) § § CL F3 § z 2 § a ° 2 2 {I .. :a Z u z . 0 0 0 =r * G * S 2 « co / n ` in c m 0 o ( ] A \ & § ■ § m r-i § w & � / 0 .. . /_ o \ \� j 0 A £ 2 § n � C4 = g 0 E & ) 2 g E z _ a w co a \ } § § a. / a a 2 / § R 0 . CD w i } 7 § F K / z \ � 0 . � > � k ■ � � 0 � 0 A W � � § � � � § � J 7 � \ ƒ 2 G -o �§ /CL � #