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HomeMy WebLinkAbout032-2145-40-000 Wisconsin Dep ,ment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: r 420784 0 GFINERAL 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: Hin er, Pat I Somerset Township 032 - 2145 -40 -000 CST BM Elev: Insp. BM Elev: BM Descriptiop ' Section/Town /Range /Map No: (�Q` d o 13.30.19.1266 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark bo Dosing G W A Alt. BM !�'T J q1-33 Aeration Bldg. Sewer i Holding St/Ht Inlet SCE( TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 1 / Dt Bottom Dosing u Hea Man. In Aeration Dist. Pipe l Holding Bot. System Final Grade PUMP /SIPHON INFORMATION t'` Manufacturer Demand St Cover GPM Model Numb TDH Lift ' t' oss System Head T Ft Forcemain Length DI Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Le h) �� No. Of Trenche� PIT DIMENSIO No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L BLDG WEL L, LAKE /STREAM LEACHING Man ufa re . INFORMATION Ty p Of System: e CHA UBER O I I I >20 \ / f ` del Number: DISTRIBUTION SYSTEM / "tJ HeaderlManifold Distributior 2 :� I x Hole Size x Hole Spacing Vent t it In ak' /110 h Pipes) (Q 3 Length Dia )Kgth Dia _ 'spacing 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 �� Bed/Trench Edges Topsoil Yes, No Yes No t COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / � / G Inspection #2: Location: 867 156th Ave New Richmond, WI 54017 (W 1/2 NE 1/4 T30N R1 9W) Nathan Hills Lot 4 Parcel No: 13.30.19.1266 1.) Alt BM Description = ST (- � ,, O , v 2.) Bldg sewer length = N� � ( Sk� Vt4 jjL SM,ds - amount of cover = Zs/ � I � f It 4e �� a ✓ 3 , S' �� -31 03 ; - -- - ana ure Use revision de for in Yes 1o?'No 0 formation. Date Insepctor's S Cert. No. SBD -6710 (R.3/97) 3 M Q +� b� �_ � S� ��� Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7082 lv miconsin Madison, WI 53707 — 7082 Sanitary it (608) u ber t �5 filled in b Co.) Dep artment of Commerce (608) 261 b546 � y Sanitary Permit App ' a tl on State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, person info rovide maybe used for secondary purposes Privacy w, s i .ilr} i - 7 7777 , Project Address (if different than mailing address) 1. Application Information — Please Print All Informatio / /�/ -f r 6 (, Property is Name ,jj� Parcel # Lot # Block # (�6 L. (/ Property Owner's Address w (j� -;C Property Location T ` ` 5 W d A/, k) � - Section 7 City, tate / Zip Code Phone Number 1 " L t� - q�c t o� II. of Building (check all that apply) T N; R / � 1 ❑ i or 2 Family Dwelling — Number of Bedrooms Subdivision Name -CSM- Number ❑ Public/Commercial — Describe Use fd &J ❑ State Owned — Describe Use ❑City ❑Village �rownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) - A ' ew System ys ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B List Previous Permit Number and Date Issued ❑ Permit Renewal )( Revision 11 Change of ❑Permit Transfer to New Before Expiration Plumber Owner 0" IV. Type of POWTS System: Check all that apply) *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 VLaching Chamber QDripLine Gravel -less ipe QQi&r (explain) V. Dispersal/Treatment Area In m ration: / "p� Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sfJ Dis r System Elevation (Z 0 98t5 VI. Tank Info Capacity in Total Number Mamufactu Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) Plumber's Signature MP/MR&6-Number Business Phone Number ��L - A 22 b �CQ 7 Z Plumber's Address (Street, City, State, Zip Code) VIII. n /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee �!ncludes Groundwater Date Issued ssuing Ag Signature ps) Surcharge Fee) QT < ❑ Owner Given Reason for Denial ���"`Ilf /J Z IX. Conditions of Approval/Reasons for Disapproval 07 '74 ytp 4e6l�GL G</'cl-X.- � 7 lU `lid o it Comic vh &A kf Attack complete plans (to the County only) for the less on paWblot less than gltl x 11 sachet In size SBD -6398 (R. 08/02) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of - 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code S j Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County �2v 1 X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 03 Z —2 L qS — 4 U-000 Please print all information. Reviewed by Date Personal information you provide may be us cy Law s. 15.04 (1) (m)). Property Owner Property Location 6eyE:- " S w IM M6 S 3 T 3 (� N R q E (o' 1/ j Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# �� C - U NT Y — 1 L. City State Zip Code Pho�N}g8FFICE ❑ City ❑ Village [3 Town Nearest Road -S O M E;1Z SE 7— I \ S ` fw � EL New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate y S y GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G S—�l Q U _S H Flood Plain elevation if applicable General comments and recommendations: CE, LS. 3 '- >o G w/ t1 v�t k rv/ - 7 U ti, F I Boring # ❑ Boring ® pit Ground surface elev. C 1 ft. Depth to limiting factor } B3 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 S Z4 ) 0`-t• CL 316 wy 'f 1,- C "') 3 -y ,S Cw 3 �.�` � S U S9 — .� 1• Z ❑ Boring # ❑ Boring ® pit Ground surface elev. C) ) • S ft. Depth to limiting factor }�' Z 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 I -S 1o'-- P- zlz - L Z r �n v - a.S �� _s - 8 10 `��3�6 — L Z`Fsb k hn. 3 2.1-30 s 1a-sS ir- 'mv`v- Z 1•Z ' 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 (Please Print) Sign tun: CST Number Arthur L 'Wegerer oy ' � -- �Z 220254 Address W e g e r e r Soil T e s t i n g & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, 11I 54022 �f Z9 —LU3 715 -425 -0165 I Property Owner \- f l YQ 6e) Parcel ID # O - Z `l s - 4 0 —w3 a Page z of 3 5 Boring # ❑ Boring ® Pit Ground surface eiev. C) 1- ft. Depth to limiting factor 7 8 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 l o -S tb- ;-,/ - L _ z'`�) S -g Z S -1 S 1 y 12 3/ 6 — L Z Sbk )vt 1- C W 3 1g 30 - ).S Y2 31Y � S 1 s M vfv e I-5 - - Y, Z U - c-i P- v1 — S D S9 M F] Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor 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 ff#2 Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor 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 Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L ' 17ie Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department. at 608 -266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6/00) PLOT PLAN Page of 3 Scale 1' I i �M� P ��w W e , ors w. BUT L) jj V-3 Q D �7 $ Yh 0) 0 7 tS�r� 6g ls , � r \ l�Lg i , 6g s e I I t -t-- S 1`VF- { i - 3-M � 1 Lz_, i f3 0 .0 f', a j fu 3 I "bI A Pve pI P wltA-�j1, -29-03 715- 425 -0165 220254 03 - 6 Z CST Signature Date Telephone No. CST No. Job NO. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7082 C t`X �sconsin Madison,' WI 53707 - 7082 Site Address r Department of Commerce '— Sanitary Permit Application Sanitary L, �[., r In accord with Comm 83.21, Wis. Adm. Code, personal information you provide [I CheC,k�tfARevision may be used for secondary purposes Privacy Law, s15.04(l)(m) I. Applicatio formation - Please Print All Information State Plan I.D. Number G Property Owner's Na me 1 Parcel Number Wr ' , ( — fOAJ v Z 4ed _ 0 0 Property Owner's M ailing Address Property Location X1;.(4 (o ST. CROIX COUNTY IAJ o 6, y; S T N, R [ MI City, State Zip Code Lot Num er Block umber Subdivision Name CSM Number II. Type of Building (Check all that apply.) LNeares 3 1 or 2 Family Dwelling - Number of Bedrooms ❑ Public /Co ercial _De " scrihe ITg �e , � ❑ State Owne � p�t L t -7i .�N oad CA > tAkkS ) s .- III. Type of Permit: (Check only one box on line A. Numbering is r Internal use.) (Complete line B, if applicable.) A. 1� New 3 ❑ Replacement of 6 ❑ Addition to 2 ❑Replacement System For County use S stem Tank Only Existing System 1 — 1 B. ❑Check if Sanitary Permit Previously Issued Permit Number 7Datesued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) 44„* Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland �- 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line S 45 ❑ At -Grade 46 ❑Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate PSystem Elevation Final Grade Required Proposed tom` Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume esponsibiHty for installation of the PO shown o n the attached plans. PluT Na me (Print) Plumber's Si gna re MP Number Business Phone Number lC �6 Wed 2 2,6 q Plumber's Addre ss (Street, City, State, Zip de) W �. VIII. County Department Use Onl ❑ Disapproved Date Issued Iss ing Agent Signature ( Stamps) ❑ Sanitary Permit Fee (includes Groundwater * 9 Approved Owner Given Initial Adverse Surcharge Fee) eft D etermination 1 79 0,3 IX. Conditions of A proval /Real " for Disapproval �. mAgA tL O. z $e aXo 1 V t J. - J 3 z Y a Attach complete plans (to t e County only for the system on pa not less than 81/2 x 1 k inches in lize VA 04 fVott tkak C64-0.4 SBD 6398 (R. OS O1) P L f e � _ .,aIJ Rc S� 5� e� = �t • � � Ne e CST- Q �►�` Z- o a� ,.`1 i h wb; IWOP 4L�-9t ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Dfvlslgh of Safety and Buildings' in accordance with Comm 85, Wis. Adm. Code �� County .7�' .- Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must ✓ ! include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. & Please print all Information d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z o3 Property Owner Property Location I F) C 1. Nj�k k _j c Govt. Lot VQ ) t" ''1/4 S > T j N R E(or 6W Property Owner's lVibiling A Lot # Black #! I Subd. Name or CSM# gar City tatQ Zip Code Phone Number City [3 Village Town Nearest Road I R: ff4® New Construction Usel&Residential / Number of bedrooms Code derived desig el GPO (] eplacement /❑ Pubi) or commercial -Describe-, Parent material te11 dCi Flood Plain etevatio t licabi ft General comments -,, WWI', and recommendations: G 0.t,0 e ry A/ elh vl — C f cR rvr — F-11 Boring # ❑ Boring �� i "� �%�rvt d?JLt/L Pit Ground surface elev. ft. Depth to limiting factor in 5oi1 Applicatllon 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 'Efl#2 1-_4k cs a dS 3 ,6 X� 5 q 0 Boring # ❑ Boring spit Ground surface elev. �` ' ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftx in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 e v GJ o-o - 7 4 Z ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >3V . 0 m L ' Effluent #2 = BOO < 30 mg/L and TSS < 30 mg/L CST Name (Pleese Print) lure CST IVumbec, 6 / Address Date Evaluation Conducted Telephone Number �9a. sL ' s- -d� ls"� /Jr SBD -8330 (R07 /00) r=roperty Owner Parcel ID # 2 _ goring # goring Page � of `_ -- Pit Ground surface elev. _ ft. Depth to limiting factor tdorizcn Depth Dontinent Color Soil Rale React Daoription Texture Stnx�re Consistence 13Zrodary Roots GPD/tf in. Mw"11 flu. Sz. Cont. Color Gr. 5z 5h. •Efflltl •EfN2 d -1 3 12 � is sy1 ti L a goring # ❑ ❑ Pit Ground surface elev. R. Depth to limiting factor in. l4elison apt . Domktartt Redox Desc iption Texture Structure l con Rate kt. Munsep Ou. SL Cont. Color COn�ewe Rots P pm Car. Sz. Sh. , Ear awne # ❑ � Cl Pit G1'ound surface elev, _ ft. Depth to limiting factor in. Sol Hwten Depth Do ninant Redox Desa( Rate pttpn Texture structure Consistence Boundary Roots Murtaeil Ski. Sz. Cont. Color Gr. Sz. Sh. •EMM •E W w d 01 ■ SOD s 30 S 220 mgll. and TSS 2 = iso mg& ' Effluent 02 = SOD 130 nVL and TES 130 mpll, The Depammept of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or heed material in an alternate format, please contact the department at 608 -266 -3151 or 'TTY 608_264.8777. lsoD•ttH {awou� Soil Test Plot Plan Project Name Brian Boardman Shaun Bir Address 824 East 11th St. 1 New Richmond Wi 54017 C TM # Lot 4 Subdivision Nathan Hills Date /13/01 W 1/2 NE 1/4S 13 T 30 N /R W Township Somerset Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Nail in Oak Tree System Elevation 89.6 *HRP 1n"s -Sensh a Alt. BM Top of nail in Poplar Tree @ 96.8' Pro Town Road 175' Soil Test was done to 97 , 96'95' fullfill zoning 94' requirement, test may not be suitable for desired building location 40' B 2 100' 10' B. • 10% 35' Slope 2 B -3 -1 lt .M. a� a 0 �/ /ice lfWfmrI!r - ....I "' -�� I my iii I e 2" 14 IPMA 'a • FA AM /���♦ � e► //� iii ��' / x:00♦ ♦ ♦♦t►♦i►*.. j►1�►i�i� • ♦i ♦1 � � ►� �i� �"� / / / / /�i11 //, ��D .�i��♦�1�1��111�G j/ jMIE .� ,.y X111 ♦ ♦ I_I - �/ i /I %rii. 1y� r i Iq .11/1/111,/ VA �/�� .�i.. �.t��. ?• ♦:♦i `i?�i/LL�� � • CIA :sr�iw`y�yy`i Al ol / II /' /// ♦ ♦♦ ♦• W / � / y..•.•. �� /' I ....��ir 1111 ♦ � .. / I -ii iii � ♦♦ ♦I 5� 5� e� = �t •�o � Le tw "�sc °" s = 7 f+ csT : g �► Z = roe a �. , �k� +.`�►•� c �Ql.,r -fie - 9 p V p p n I � L, c. a LU r S I r < D v & �? O 6 _ p Q � U X � z � e (� O , o y- C CIO Z C'') C4 a .... 4 C Y 0 cq a b c Q a Q) a z N :� w l a` 0 O (QQ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number O Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) `&V Soil Absorption Component Size (ft') Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) lecocl. 04 Maximum Influent Particle Size (in) U 1/ Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years b inspection. The outlet filter hall be cleaned as necessary to e� p roper operatio The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during inter months. The compaction ompaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. PLif_ T Pi� - 7Cs - x - 73 CO T� S r •� 7� �` • z 73 6 7 3 01/09/1995 04:36 7152737753 NELSON PLUMBI43 FAGE 01 ST CROIX COUNTY SrPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM (_ wner,Suyer Mailing address Property Address — (Verification required from planning Department for new construction) City/State ParceleI'tcation Number__ -�- ` O80 � ��i. b •�GRi' Property Location `/� G /4, Sec. �, T 2_ N-FL—W, Town of 5 4 Subdivision ( L & , Lot#. Certified Survey Map # , VOiwMe _ , Page Y Warranty Deed # – —�1 Z� I � , Volume � ��� --- Page # Spec house O yes R -no Lot lines identifiable Dyes 0 no MK5= MAiNTE Improper use and mainttnaneeof your septic system could result io its premature failLre to handle wastrm preper maintenanc Consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. %Vhat you put into the syster can affect the function of the septic tank as a treatment:taga in the waste disposal system.. The property owner agrees to submit to St. Croix Zoning Department a certifrcatiou fors., signed b', the owner and by master plumber, journeyman plumber, restricted plumber or a licensed pumper verifyiag that (1) the on -site wastewater dispc sal s ystet is in proper operatirig condition and/or (2) after inspection and pumping (if necessary), the septic tank is less titan 1/3 full of sludge 144, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the st3twarc set forth, herein, as set by the Department of Commerce aad the Department of Natural Resources, State of Wisconsin. Cerdlicatic slatisrg that your septic system has been maintained roust be completed and returned to the St. Croix County Zenirrg Off-cc within ' days of the three year expiration date. ! r SIGNATURE OF APPLICANT DATE OWNER CER11FICA`x'ION I (we) certify that all statements on this form are true to dic hest of my (our) knowledge. I (wc) am (arc) tl;e owners) the pr erty described above, by virtue of a warranty decd recorde(I in Register of Deeds Office, ATE SIGNATURE OF kPPLICAN1 44 ° ° ° ° °• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Deparim --it . 00. Include with this application: a stamped warranty deed frotrs the Register of Deeds office a copy of the certified survey map if reference is made in the warranty dted 1 794P 47 ,+ STATE BAR OF WISCONSIN FORM 2 - 1998 665617 Vr THL EEN H. iWALSH WARRANTY DEED REGISTER OF DEEDS Document Number C.ROIX CO., WI This Deed, made between Nathaniel Stephen Enterprises, LLC, a RECEIVED FOR RECORD Wisconsin L imited Lia bility Company, ?2- 19-2001 5:25 AN - - -- - - 6flRkflNTY DEE EXEMPT N Grantor, and Patrick Matt Hinger and Amy Jo Mager, husband and wife, CERT COPY FEE: ur FEE: TRANSFER FEE. 187.50 RECORDING FEE: 11.00 PAGES: i Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area Name and Return Address The First National Bank of Hudson G ) lat of Nathan H ills in the Town of Somerset. At tn: Pat PO Box 187 Hudson WI 54016 032 - 2145 -40 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: municipal and zoning ordinances and easements of record. Dated this 13th day of December 2001 N,QTHANIEi,, S E ENTE RPRISES, LLC + v By: Brian K. Boardman, Memb AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) ) Ss. Signature(s) _ __ ST. CROIX County.) Personally came before me this 73 bk day of authenticated this day of December ' 2001 the above named Brian K. Boardman, as Member of Nathaniel Stephen Enterprises, LLC TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the forlegoing (If not, instrument and acknowledge the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY �— .... Judith A. Remington, Remington Law Offices + P.O. Box 17 New Richmond, WI 54017 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. not, state expiration ate: necessary.) J 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800. 655.2021 �1 J _ do O AV ° / Re ZMA . � ,. 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