HomeMy WebLinkAbout032-1065-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
395283
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:
Krueger, Bordette I Somerset Township 032 - 1065 -90 -000
CST BM Elev: Insp. BM Elev: BM Description:
UU
TANK INFORMATION I ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
2. 2, s
Dosing Z / Alt. BM
Aeration (� Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION Ht Outlet S3
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
,GZ 9.33
Septic � � � i � Z � r � Dt Bottom
Dosing Header /Man.
g >yZ' ,6 -a 1G, 9G
Aeration Dist. Pipe -
C �✓ 9
Holdin Bot. System L `�, Y6
L ,y
k
PUMP /SIPHON inal Grade ON INFORMATION 7 . U 91.
turer Demand St Cover
-- --
Model Number
TDH Friction Loss Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenc es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS / ./ Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LE G Manufac
INFORMATION C OR ;
Type Of System: '_7 / 91T Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
/�
Pipe(s) Dia Spacing �� �� �— y ZS
Length Dia % L
SO IL 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 [W No
COMMENTS: (Include code discrepancies persons present, etc.) Inspection #1:_16 / 4 Inspection #2:
Location: 726 72nd Street Somerset, WI 54025 (NE 1/4 SW 1/4 24 T31 N R19W) NA Lot NA- / Parcel No: 24.31.19.327C
1.) Alt BM Description
2.) Bldg sewer length
3�JJ� mount of cover =
lCYdL+ A
an i,� Plan revision Req ? - ] Ye s No
-4 ��
Use other side for additional information. 3
Date InsepctArs Signature Cert. No.
SBD -6710 (R.W97)
Safety and Buildings Division County
An W
201 W. Washington Aye., P.Q Box 7162 ST C� /X
iseonsirn Madison, W1 53707 - 7162 Site Address
_Department of Commerce `'726 72K10 S T
Sanitary Permit Application Sanitary Permit Number
In accord with Comm 8321, pis. xdm.. Code, personal informatiop..you- provci& a cb k if. t,,nfon
ma be used for sect purposes Privacy Law, sp-, � my z
I. Application Information- Please Print All Information Vii. , ' State Plan I.D. Number
Property Owner's Nam ^ �.� Parcel Number
ED&
Property Owner's Mailing Address o '. �i .. Property Location
- 72 (a J -5'W S ZVT .3I N. R 19 City, State Zip Code Phone N r' Lot Number Block Number
T.
T` Subdivision Name CSM Number
��a&CT htj S o25 � iE -
a b
II. Type of Building (check all that apply) o0
❑City �!y!. 7
Al or 2 Family Dwelling - Number of Bedrooms ❑VIIlage
C1 Pubhc/Commercial - Describe Use
❑ State Owned Nearest Road
l
III- Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A' For County use
1 11 New Replacement System 3 ❑Replacement o f 6 ❑Addition to tY
stem Tank Only Ezistin system
B. n rat. P"mit Previou ' Permi Number Date Issge¢-
.J
IV• Non P t: (Check all that ayl a�,t -- nbering scheme is for internal use)
44 Mt:
In-Ground 2113 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedand
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line l�7-f
45 ❑ At -Grade 46 ❑Aerobic Treatment Unit 49 El Recirculating 30 ❑Other Z r 9 3 • 7S t
V. Dispersal/Treatment Area wormation: T PLfi 0AP SJDCkit 1V f/Z ! /' /L7 L' C
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required spp <,CC Proposeq Rate(Gals. ays/Sq.FL) (Min.11wh) Elevation
160, I&OL efil - so, , S /. �l A IL. Z /DOS
S �
VL Tank Info Capacity in Total Number Manufacturer Prefab site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New E:is 4
Tub Tanks
or Ho Tank
Dosing Ct+smber 2_ b 1 C 2U G a� [ [ qA ?aN
VII• Respo nsibility Statement- I, the undersigned, respowfboity for installation of the POWTS shown on the attached plans.
Plumber's Nate (Print) s Si roue /� umber Business Phone Number
�bx �L l 2222yZ - 71S z9�1 -
Plumber's Address (Street, City, State, Zip Code) PF
VIII. qjSY/Department Use Onl
Approved 0 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
S
❑ initial Adverse
III. Conditions of Approvalf%wons for Disapproval
1. Effluent filter to be installed and maintained per manufacturer's recommendations.
2. This approval is for a 3 -bdrm structure. Any increase in wastewater loads (added bedrooms) may result in a non - compliant septic system, and the
system may have to be modified to meet current codes.
3. All setbacks to system and residential structure must meet applicable code requirements.
4. Property is zoned Ag- residential - only one principal dwelling is allowed on this property.
5. Floodplain mapping = Zone "C"
I
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,*sconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County St. Croix
Attach complete site plan on paper not less than 8 1 /2_x - tfnchesJn size. Plan must
include, but not limited to: vertical and horizontal raferenci point,(BWtr• irection and Parcel I.D.
percent slope, scale or dimensions, north arr ; and tocatrdri and disfattc o nearest road. 032 - 1065 - 90 - 000
� ��•' Re iewed by Date
Please print ►'l�laf
Personal information you provide may be usQ�for secon AM P rivacy Law, s. 1' 04 (1) (m)). /
T
Property Owner VIV Pr rty Location
Burdette Krueger ��r � } Govt. Lot 1/4 SW 1/4 S 24 T 31 N R 19 MR(or) W
S
I
P B o ck # ubd .Name or C SM #
7
Property Owner's Mailing Address ., ,, g A pr✓
C7� ' na na
City State Zip Code Phone Nu Na � L- 1 City ❑ Village IN Town Nearest Road
Somerset WI 54025 1 (7 , 5 7 5T, 411 Somerset 72nd. ST.
I r
❑ New Construction Use: (Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
[IReplacement , ❑ Public or commercial - Describe:
Parent material = 1 f-ted - glacya] dzut Flood Plain elevation if applicable na ft.
General comments
and recommendations: /
trenches @ el. 96.20, spaced to code 4.00' below grade
F pit Ground surface elev. BoHn # Boring
g 100 ft. Depth to limiting factor 120 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0 -10 10 3 3 none L 2msbk mfr qw 2f .5 .8
2 10 -15 7.5yr4/4 none sicl 2msbk mfr qw if .4 .6
3 15-301 7.5yr4/4 none grms 0 mvfr l qw if 7
4 30-981 7.5yr4/6 none ms Osq ml QW na 4 P W
5 98 -11 5yr4/6 none sl 2msbk mfr
6 110-120 75.yr4/ none -- ms Ogg mvfr na na
Boring # Boring 100.60 100
F 2 Pit Ground su ace elev. ft. Depth to limiting factor in. Soil Application Rate
i
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
1 0 -12 10yr3/3 none sl 2msbk mfr qw 2c .5 9
2 12 -32 75.yr4/6 none sl 2c sbk mfr qw 1m 5
sl /ms 2msabk mvfr na na 5 9
x
> < L and TSS >30 < 150 m IL ffluent #2 = B D < 30 mg/L and TSS < 30 mg/L
Effluent #1 BOD 30 _ 220 mg/ a _ g
CST Name (Please Print) Signature . CST Number
Gary L. Steel 02298
Address Date EvaluatiorrConducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 7 -31 -2001 715 - 246 -6200
i
Property owner BU ft Krueger Parcel ID # 032 - 1065 -90 -000 Page 2 of 3
Bo ring g
#
3
❑ Boring 98.60
[� 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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0 -7 10yr3/3 none L 2msbk mfr •
2 7 -24 1 7.5 4/ none sic l mfr gw 1f .4 .6
3 24 -38 .5yr4/4 none grins Osg mvfr 9W na .7 1.2 --
4 8 -100 7.5yr4/6 none sl /fs 2msbk mfr
g.x1f .�
❑ Boring
4 g
❑ eorin # )E] pit Ground surface etev, 20 ft. Depth to limiting factor 1 00 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
1 0 -12 10yr3/3 none L 2msbk mfr 2c .5 .8
2 12 -36 7.5yr4/4 none sl 2msbk mfr CFW 1M .5 •9
3 36-101 7.5rY4/4 none 1 /ms 2msbk mvfr na
a
F-1 Boring # Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication 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 I 'Eff#2
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD E 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.6 /00)
' STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
�4
CSTM2298 � T S24- T31N -R19W New Richmond, WI 54017
MPRSW -3254 town of Someraset (715) 246 -6200
/ /
N
BM. of NE corner of con to slab @ el. 100.00' (/
alt. BM.= top of SE rner of n ete slab @ el. 100.10'"
ALP
r
r
� _ a
V
k.
� jDq
�y
Gary L. Steel
7 -31 -2001
i
POWTS OWNER'S MANUAL at MANAGEMENT PLAN rage __X of y am_
l FILE INFORMATION SYSTEM SPECIFICATIONS # 250 w
Owner B Y r Septic Tank Capacity /wo gal ❑ NA
Permit # 73
Septic Tank Manufacturer I ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer t [3 NA
Number of Bedrooms [3 NA. Effluent Filter Model 0 p � ❑ NA
Number of Commercial Units Pump Tank Capacity gal NA
Estimated flow (average) y gal /day Pump Tank Manufacturer QNA
Design flow (peak), (Estimate x 1. . DC) gal /day Pump Manufacturer X NA
Soil Application Rate gal/day/ft' Pump Model e XNA
Monthly average
Influent/Effluent Quality Y * Pretreatment Unit NA
❑ Sand /Gravel Filter ❑ Peat Filter
Fats, Oil ez Grease (FOG) :530 mg/L ❑ Mechanical Aeration ❑ Wetland
Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Disinfection ❑ Other:
Total Suspended Solids ( TSS) <_ 150 mg /L Manufacturer
Pretreated Effluent Quality ❑ NA Monthly average* * Dispersal Cell(s)
Biochemical Oxygen Demand (BODs) :530 mg/L �R In- ground (gravity) ❑ In- ground (pressurized)
Total Suspended Solids (TSS) :530 mg/L 0 At-grade 0 Mound
Fecal Coliform (geometric mean) :510 cfu /100mi 1 ❑ Drip -line ❑ Other:
Maximum Effluent Particle Size A inch diameter Values typical for domestic (non - commercial) wastewater and septic
tank effluent.
* * values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every ❑months CP�ear(s) (Maximum 3 yrs.)
Pump out contents of tank(s) When combined sludge and scum equals one -third (A) of tank volume
Inspect dispersal cell(s) At least once every ❑ months 2 (Maximum 3 yrs.)
Clean effluent filter At least once every ❑ months P year(s) Qlot416 a.
Inspect pump, pump controls ez.alarm At least once every ❑ months ❑ year(s) MYNA
Flush laterals and pressure test At least once every ❑ months ❑ year(s) ONA
Other: At least once every ❑ months ❑ year(s) ANA
Other: At least once every ❑ months ❑ year(s) 2NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Mast
Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspection
must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or Leaks, measure tt
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 (Ys) 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 ch. NR 113, Wiscons
Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other
ed b
maintenance or monitoring at Intervals of 12 months or less shall be performed Y a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemic
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conter
nF rho ranlrm romovPd b i tentage 5ervidng opera prior to use.
.
page r3 of CD--
'Sys tem `stark up shall not occur when soil conditions are froten at the Infiltrative surface.
During power outages pump tanks may All 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) acid may result In the badup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servking Operator prior to restorini;
power to the effluent pump or contact a Plumber or POWTS Malntalner to assist In manually operating the pump controls to
restore ncrmal levels within the pump tank.
Do not drive or park vehicles over unks and dispersal cells. Do not drive or park over, or otherwise dlswrb or compact, the area
vAthin 15 feet down slope of any mound or at -grade sod absorption area.
Reduction or elimination of the following from the wastewater Weam may improve the performance and prolong the lift of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental Ross; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting croducts: oesticldes: sanitary napkins: tamoonsi ind water softener brine.
ABANDONEMENT
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 ch. 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 property 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 oiled with
soil, gravel or another Inert solid material.
CONTINGENCY PLAN
If the POWTS faits and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement 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 strvcwre, lot (Ina 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 advancts in POWTS technology
holding tank may be installed as a last resort to replace the failed POWTS.
W' The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a loll and site
evaluadon must be performed to locate a suitable replaceia►ent arta. if no replacement area Is available a holding tank may
be Installed as a last resort w replace the failed POWTS.
D Mound and at -grade soil absorption systems may tot reconstructed in place following removal of the biomat at the
inflitradve surface. lkeeonswctiorts of such systems nwst.colnply 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 TKE INTERIOR OF A TANK MAY 6E DIFFICULT OR
IMPMURI F.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Na me
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL R>rGULATORY AUTHORITY
Name Agency Lr'p v Z
Phone h n �?
t oci r Vvia vi, o 4t,
-
Plrivat6 Onsite Wastewater Treatment System Management Plan onent
`Septic Tank And Gravity in- Ground Soil Absorption Comp
• Pursuant to Comm 83.54 Wis. Adm. Code each Private onsite Wastewater Treatment
procedures for maintaining the system within
and
System (POWYS) shall include information p
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or govemmentai 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.6199).
'fable 1: System Design Specifications
Sanitary Permit Number
Number of Bedrooms 3
Design Flaw - Peak (gpd) 300
Estimated Flow - Average ( pd) If 5D
Septic Tank Capacity (al) 1000
Soil Absorption Co 30 e-H
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) LIED ySD
Maximum Influent Particle Size (in) 118
Maximum BOD. (m ) - 220
Maximum TSS (m L) 150
Table 3: Main&imnce Schedule
Septic Tank Inspect and/or service once every 3 years
Outlet Titer Inspect once a year and dean at least once eve
Soil ry 3 years
Absorption Component Inspect once every 3 years
5eotic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Slats. 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 by inspection. The outlet filter shall be cieaned as necessary to ensure
Proper operation. The rlter 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
1
95 -9 1 - 99
16:32
RECEIVED FaCM :715 386 4686
P -92
Manager r f
sir:i Sc%;IlAbsorption Component
filter is equipped with a - ' - ,';h - ali he if U!'e alarm is activated continuously.
rmittent filter allarr.-u- irr�j)i�r ding continuous alarm. The
septic tank shall have i's o
whir, - .nevolurne of scum and sludge in tie tank
exceeds 113 the liquid volume c-1 th tank. If the contents of the tank are not removed at the \
• Inte'
time of an assessment, maintenance personnel shall advise the owner of when the next service
needi to be performed to rnaii %!-iin i.. inan maximum scum and sludge accumulation in the
tank.
Manhole risers, c-we should be inspected for water tightness and
soundness. Access and assessment shall be sealed watertight upon
the completion of servics. c% c-pAnirgdeemed uisound, defective, or subject to failure must
be replaced. Exposed acck,-�s -- '1 8- inches in diameter shlall.be secured by
an effective locking de.- :r_: or unauthorized entry into the tank.
No one sharji*c; .n ; or olher trearment or holding tank for
any reason withratV being in full compliance with OSHA standards for
entering a cats rl r. space. The atmosphere within Me septic or other
treatment of holefinc tank may contain lethal gases, and rescue of a
person frici - n € ` E :r
.-i:rn- FVie fan,C rimy be difficult or impossible.
Tank in. n%c;;ordartcen-*ah Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a liz
Sc Abrcrptian Component
The soil absorption corr pot sent santing this structure is designed to accept domestic
wastewater from a residential facility. The Urnits of operation of this component are shown in
Table 2.
The longevity ci'a sc. coinponert depends greatly on proper and timely
maintenance, and system u•5 3 or below the limits of reliable operation. Good water
conservation practices by all cc-,!.iparits and theinsTallation of water conserving plumbing
fixtures are key factors in eylendrig ttie useful life of this component.
The soil absorption c-., - T;. - - - - jr er, z':, cDtiration mist be assessed by Inspection at least
once every three years. The in;c-acdon shaisl include recording the levels of ponding, if any, in
the observation pipes, and a, is a 31'nspeciion for any evidence of surface seepage or discharge
from the component. On sh sites, areas of erosion should be identified and
reported to the owner tor rep3ir Tiio surface discharge of domestic wastewater or sewage
from the system is prohibRe- a human health hazard.
Traffic around or ovef i6=7 soii absorption component should be avoided particularly
during winter months. The carom ..);ioloil or removal of snow cover over the component may lead
to hydraulic failure by freezing. 'inic. type of failure is usually temporary, but is difficult or
impossible to repair until weaUhe:.- :ndi' ions improve. In general, soil compaction over this
component will reduce dit Iffu n -yg,n in 'o the soil and dispersal cell, which may lead to
more intense, and earlier, or.! of Piecc:1.
2
3 4 FiFz.�r:IVEV F11OK-.715 3B6 4586 P•83
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address - 2 1W L C'
Property Address 7 („ - '? ;t---aO _ o�, ,� , , SiJ Z S
(Verification required from Planning Department for new construction)
City/State -d 4 'd T u c,_ Parcel Identification Number O 32- / 4�, 90� Oa 8
LEGAL DESCRIPTION
Property Location �'�" l �, ' /4, Sec. . T N -R W, Town of
Subdivision Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # 3 2,q Volume , Page #
Spec house ❑ yes ❑ no 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.
The property owner agrees to submit to St. Croix 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, 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 Office within 30
days of the three year expiration date.
SIGNATURE APPLICANT DATE
OWNER CERTIFICATION
L(wo) 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 property d /l escribed above, by virtue of a warranty deed recorded in Register of Deeds Office. `
STUREPLICANT DATE
* * * * ** Any information that is mis- represented 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
DOCUMENT N0, STATE BAR OF WISCONSIN -FORM 2
WARRANTY DEED
THIS SPACE RESERVED FOR RECORDING DATA
REGISTERS OFFICE
IaY:TIVIS DEED, William E. Aai 1 1;%rgepn and. T. t - 11a
ST. CROIX CO., WIS.
_- Baillargeo.n, husband and - wi-fa-
Read for Record this-
day of_ o -tober .A.D.19..7 ,
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tltOfCIinoey*sad w turan ta to Bur dett e D. Kr ueger and Max ielle 0 A.
KYUecTer, husband and wife, as joint At-- lug -_ M. Y
s .,.. -. tenants
k Riebtor of Weds
Grantee_...
1 it ilAdbl s consideration Rnu To
`AJ4 6Jfi9 dliertbad n.I estate in St Croix County, State of Wisconsin:
k' Tax Key N
This is not homestead property.
.. 'A part of the North Half (A) of the Southwest Quarter (SW4) of t
�� "'Section Twenty -four (24) Township Thirty - one (31) North, Range
Nineteen (19) West described as follows: Commencing at a point on
the North line of said eighty a distance of 968 feet West of the
Northeast corner thereof. Thence West along the North line of
said eighty a distance of 403 feet: Thence South parallel with
> It'he East line of said eighty a distance of 112 feet to the North
edge of the private roadway as now laid out and traveled and ex-
tending generally East and West across said eighty: Thence in a
Southerly and Easterly direction along the North edge of said
private road to a point which is 357 feet South of the point of
, beginning: Thence North parallel with the East line of said eighty
a distance of 357 feet to the point of beginning, together with a
' non exclusive easement to use the private roadway described above for
ingress and egress.
` TRI
Ext:eptloa'to warranties: � -F--i-
E&
w ` 'Ixthmted at New Richmond. Wisconsin — this da of 4c rd , 19-74—
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�D AND SEALED IN PRESENCE OF I r (SEAL)
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(SEAL)
Il y F.
(SEAL)
(SEAL)
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- E_ .Sai tar eon nd T. i {110 ai 1 arrr n
irMttt�M �! ' —William — Q 8 l��e._21
Z# day of 42jG AZ
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Q. E. Norman --
Tltler °lfeshor State- 13ar of Wisconsin .
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Coret� J
tMsae..e. ( n+ts ..,+..' 1, tlsl_ , _ rr- day. of
1l�:Ferson. r— who exftuted the foregoing asUNI Miaf "d- Icknew1odipg! "O same { . + a �
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