HomeMy WebLinkAbout034-1004-50-025 f
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
SafEay and Building Division ` ,
INSPECTION REPORT Sanitary Permit No:
488103 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:
Bazille, Dedric I Springfield, Town of 034- 1004 -50 -025
CST BM Elev: Insp. BM Elev: SM Description: Section/Town /Range /Map No:
jv / 03.29.15.37A10
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmar I
In / �" �� �
Dosing i % ,r r Alt. BM
Aeration Bldg. Sewer
j
Holding St/ Ht Inlet
S t /Ht Outlet
TANK SETBACK INFORMATION - `
en o it In ROAD Dt I
S ep - tic / c '' B ottom 7 - 21 23 osing , r I Header/Man. �• 39 79, 7t
era Ion D ist . P ipe
• 3 9� 7t
Holding Bot. System
IF Grade
PUMP /SIPHON INFORMATION ��U Od
manufacturer r - eman over, }
GPM �1 ....�,�,,,� i" •_ C.LC �Z. l (o
o e um er �•
I Ic Ion oss ys em a
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II- or c ema in p i a.
Jj_ ABS p//
DIMENSIONS
-7
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or
INFORMATION CHAM OR
J NI 11viudel 14011100.
e: 014Z ]A 1 �V. ly
t
Length Di a Length Dia Spacing -
x Pressure Systems Only xx Mound Vr At - Grade Systems Only
Bed/Trench Center Bed/Trench Edges Topsoil _ ^� p .\ Yes Yes
�
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: T / / Inspection #2:
Location: 1193 Highway 128 Wilson, WI 54027 (NE 114 NW 114 3 T29N R15W) NA Lot w Parcel No: 03.29.15.37A10
1.) Alt BM Description = ��'�"" C /1.�•�J ° ' ��''�' S `'
2.) Bldg sewer length k
- amount of cover = J
Plan revision Required? Yes 6;o _ AA �T
Use other side for additional information.
SBD -6710 (R.3/97)
Safety and Buildings Division County
201 W. Washington A In)
` C-. SSIn Madison WI 53 707 - RECEIVED6 1 Permit Number (to be filled in by Co )
�7 0 3
De artment of merce (�$) 2 3151
Sanitary Permit Application MAR 2 2 2,,,s"e I D Number
In accord with Comm 83.21. Wis. Adm. Code, personal information ou provide !ZSN3ZZ —�" /0 --�I
may be used for secondary purp6ses Privacy Law, s15.04(1) ) ST. CROIX COU Project ddress (if different than mailing address)
NTY
Q
I. Application Information - Please Print All Information � � � 17 3 12 0
f
Property Owner's Na me Parcel p Lot p Block X
/Qf2.
Property Owner's M ailing Address Property ovation
ZZ 3 C _.rek , `
City. State Zip Code Phone Number
rcic one)
R
II. Type of Bwlding (check all that apply) 0Z Xf C I
0,1 or 2 Family Dwelling - Number of Bedrooms
_1 Public /Commercial - Describe Use
1Cit _ llageXT0wn 1 of
❑State Owned - Describe Use >_
[II. Type of Permit: (Check only one box on line A. Complete line B if applicable _ Op — SD —025 (.3t ~lam
A New System ❑ Replacement System ❑ Treatment./Holding Tank Replacement 0,:y Other Modification to Existing System
ist Previous Permit Number and Date Issued
B. Permit Renewal O Permit Revision ❑ Change of ❑ Permit Trarts(er :o %c% L
Before Expiration Plumber Owner
IV. T of POWTS System: (Check all,that appl kx �D = I • 0 = I 6
Non - Pressurized (n Ground soil If Mound 24 ,n of sutra' Ie so.. ❑ At - Grade Single Pass Sand Filter
Constructed Wetland J Pressurized In- Ground J Holding Tank at Filter Ae btc eatment Unii _. Recirculating Sand Filter
Li Recirculaung Synthetic Media Filter ❑ Leaching Cha r ❑ Drip Line ❑ ravel-i2 Pr;e Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) I Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity in Total Number Manufaen rer r (ab Site Steel Fiber Plastic
Gallons Gallons of Unis Ej A - (L utr
Crete Coructed Glass
New Exisung ,
Tanks Tanks —
Septic or Holding Tank
Aerobic Treatment Unit v S ,q
C -7—
�L
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for ' afatiori of the• }'Otis_hS shossn on the attached plans.
Plumber's Na me (Print) Plu is Si gnature PRS NUMOCxr ' Business Phone Number
Plum is Addree ss try. State. p Cod
V / !,
o 7 d e T 72 S
VIII. County/Department Use Only _
Approved Dis ved / Sanitary Permit Fee (includes Groundwater 4 Gate Issued Issuing gent Signature (No S(amps)
charge Fee)
�
O � n Rcason or Stu
nW
LX. Conditions of Approv easons for Disapproval
I
SYSTEM OWNER: i
1 Septic tank, effluent filter and
dispersal cell must all be serviced / 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 oe paper not less than 81.E x 11 Inches in sue
SBD -6398 (R. 01/03)
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Safety and Buildings
commerce.wi. OV 141 NW BARSTOW ST FL 4TH
g WAUKESHA WI 53188 -3789
TDD #: (608) 264 -8777
i O �' www.commerce.wi.gov /sb/
www.wisconsin.gov
De partment of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
March 20, 2006
CUST ID No. 224617 ATTN: POWTS Inspector
LYLE J MYERS ZONING OFFICE
NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA
E1556 STATE ROAD 64 1101 CARMICHAEL RD
BOYCEVILLE WI 54725 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 03/20/2008 Identification Numbers
Transaction ID No. 1254322
SITE• Site ID No. 710581
Dedric Bazille Please refer to both identification numbers,
Highway 128 above, in all correspondence with the agency.
Town of Springfield, 54013
St Croix County
NE1 /4, NW1 /4, S3, T29N, R15W
FOR:
Description: Mound, 3 Bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1067031
Maintenance required; 450 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version
2.0, SBD - 10706 -P (N.01101)
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound
Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-
10706 -P (N.01 101).
In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the
property owner must follow the contingency plan as described in the approved plans. In addition, the owner must
comply with the operation, maintenance and monitoring duties as described in section VIII of mound component
manual. A copy of this information must be given to the owner upon completion of the project. !•
All holding/treatment tanks are to comply with Comm. 84.25(7)(a).
Maintenance information must be given to the owner of the tank explaining that periodic cleaning , the filter is
required. Access to the filter for cleaning must be provided per Comm 84 product approval conc(itfUns.
A Sanitary Perrnit must be obtained from the county where this project is located in accorda�e with the
requirements of Sec. 145.135 and 145.19 Wis. Stats.
r
LYLE J MYERS Page 2 3/20/2006
Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the
designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
utilized in the POWTS.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sin rely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Julia Lewis- Osborne
POWTS Reviewer 2 , Integrated Services WiSMART code: 7633
(262) 548 -8638, Fax: (262) 548 -8614
julia.lewis@Msconsin.gov
L
y ,
Mound System Cover Page pg 1 of 6
1 1
14 Project Name: Bazille, Dedric
Owner's Name Dedric Bazille
Owners Address 2235 Statia Lane
Hudson, WI 54016
Legal Description NE [ v %, [NW FvJ %4 Sec( T -29 N, R F1 5 = W j
Township Springfield
County Saint Croix
Subdivision N/A
Lot# N/A
ParcelID# Pending
Table of Contents
pg-
1 Cover page / z0��•
2 Mound Sizing Calculations
3 Pressure Distribution Layout and Dynamics
4 Dose Tank
5 Management and Contingency Plan
6 Plot Map
total # of pages: 6
Designer Name: Lyle J. Myers
MP /License #: 1. DI 224617
Date: 3/10/06
Ph. #: 7156432520
Signature:
Mound System Design Methods Used
per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10691 -P (N.01/01) F
per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD - 10706 -P (N 01/01)
(.<, ,,
Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715 - 643 -6068 email: 3ba @3baddi� com
Mound System Page 2 of 6
Mound Sizing Calculations
Project Name: Bazille, Dedric
Site Con ditions Design of Entire Fill
Project Typ 1 cr 2 Family Dwelling I Cell depth at u slo a edg D 14.0 in.
% Slope: P22in. % Cell depth at downslope edge (E): 23.4 in.
# of Bedrooms: Distribution cell depth (F): 9.5 in.
Depth to limiting factor: Cover thickness over edge (G): 6 in.
Absorbtion rate of fill material: 1 gal /ft /day Cover thickness over center (H): 12 in.
Absorbtion rate of in -situ soil: 0.6 gal /ft /day End slope width (K): 10.1 ft.
Effluent quality l Eff #1 • Fill length (L): 95.2 ft.
Max BOD effluent value: 220 mg /I Upslope width (J): 5.4 ft.
Max TSS effluent value: 150 mg /l Downslope width (Toe) (1): 16.0 ft.
Fill Width (W): 27.4 ft.
Design of the Distribution Cell Basal Area
System Design Flow: 450.0 gal /day Basal area required: 750 ft
Distribution cell width (A): 6.00 ft Basal area available: 1650 ft
Distribution cell length (B): 75.0 ft
Area of Distribution Cell: 450.0 ft Observation Pipes
Contour Elevation of Mound: 96.94 ft Location from end of cell (Z): 12.5 ft
System Elevation of Mound: 98.11
Final Grade of Mound: 99.90
ound Plan View
Observation Pipes
J Z--___l
y T
B F k—K
I Tilled ArealFill Material
L '
Mound Cross Section
Final Grade Observation Pipe
Synthetic Fabric � G
Distribution Celly M,
System Elevation g .
9
Cover Material fterr�l
:'�rl'a�ert is 4
Fill Material
Tilled Area
Slope �Forcemain System
Contour
Notes:
Fill material to consist of ASTM C33 Sand
Distribution cell aggregate to comply with Comm 84.30(6)(1)
Synthetic Fabric covering on cell per Comm 84.30(6)(8)
Distribution Cell to have minimum 6" aggregate below lateral and 2" above.
Mound Syst Page 3 of 6
Pressure Distribution Calculations
Project Name: Bazille, Dedric
Lateral Layout Lateral /Manifold Design
Lateral elevation: 98.6 ft Lateral diameter: VA v In.
Rows of Laterals: Lateral spacing (S): ft
Manifold type: Center . Lateral to cell edge: 1 ft
Orifice diameter: o.i25 . Lateral discharge rate: 9.06
In 9 gp m
# of Laterals: 4 System discharge rate: 36.25 gpm
Distal Pressure: 5 ft Manifold diameter: 12 I In.
� _
Lateral Length: 37 ft Manifold length: 4 ft
Orifice Spacing /Distribution Forcemain Friction Loss
Orifice spacing (X): 20.65 Inches Forcemain length: 1 60 ft 7 1
Orifices per lateral: 22 Forcemain diameter: 2 In.
Avg. ft /Orifice: 5.11 ft Friction loss in forcemain: 1.651 ft
Lateral Side View
,IC/ c�
Manifold
Lateral � Lateral
x x 7r x r x x x x x x x x x
2 2
Lateral Length Lateral Length
Lateral Plan View
Lateral Length ( Turn -up w /ball valve or cleanout plug
I S I
0 o L
Orifices on bottom of
lateral equally spaced PVC laterals and Forcemain to comply with
specifications per Comm 84.30(2)(e)
Forcemain connection via tee or cross to manifold at any point
Clean Out Detail Observation Pipes
Clean -out plug
Final Grade or ball valve
Water tight cap
or plug
Lawn
Sprinkler
Box
Slot
Note: Closet Collar
6" Minimum may be used in
Long Sweep 90 place of 318" bar
ortwo 45's 3/8" Bar
Lateral
Mound System Page 4 of 6
Septic, Pump and Dose Tank
Project: Bazille, Dedric
Tank Information Dosage Volume
Pump tank manufacturer: Wi Concrete Forcemain drains back to tank? OQ Yes O No
Pump tank size /model: " /6 -MR _ -E Lateral void volume: 15.6 gal
Pump tank gal /inch: 17 Dosage to absorbtion Cell: 78.2 gal
Actual Pump Tank Volume: 646 gal Forcemain volume: 10.5 gal
Tank bottom elevation (inside): 91.5 ft Total dosage: 88.7 gal
Septic tank size /model: W 1000 /650 -MR
Pump and Filter Total Dynamic Head
Pump Manufacturer: Little Giant Are laterals highest point? y
Pump Model: 9EH if not, enter highest elevation: 0 ft
Effluent Filter: Zabel A100 System head (distal x 1.3) 6.50 ft
Vertical Lift ( "D° to lateral) 6.44 ft
Note: Access opening of sufficient size to be provided to allow
removal of filter. Opening to terminate at or above grade. Friction loss in forcemain: 1.65 ft
Pressure loss from filter: �p ft
Total dynamic head (TDH): 14.59 ft
Pump Tank Diagram Dose Tank Levels
Watertight Locking Cover In. Gal
4 Inch With Warning Label
Minimum Finished A Reserve 22.8 387.3
Grnde B Pump off to Alarm 2.0 34.0
Alternate
Outlet C Total Dosage 5.2 88.7
Location Elect. per Comm D Effluent depth for pump 8.0 136.0
r in 16.28 and Total Capacity: 38.0 646.0
NEC 300
Weep Hole A
or Anti -
Siphon B
Device FLOW- LITERS /HOUR
C 0 1000 2000 3000
D 30 10
V!
w
— 7.5 3
, 20 w
Y
I
5 1
6 A
W Q
Pump must be capable of: C14.6 2 GPM = 10
2.5
and head pressure of: Feet
/ o 0 1111 / 0 20 40 60 80
Little Giant FLOW- GALLONS /MINUTE
9EH PUMP PERFORMANCE CURVE
115V 60HZ
Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6
Owner's Responsibility:
The component owner is responsible for the operation and maintenance of the component. The county,
department or POWTS service contractor may make periodic inspections of the components, checking for
surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary
maintenance reports to the appropriate jurisdiction and /or the department.
Septic Tank:
Septic tank(s) are to be inspected routinely and maintained by department approved individuals when
necessary in accordance with their approvals. The use of chemical /biological "treatments" is not required or
recommended. If such additives are used, make sure they are approved by Department of Commerce,
Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep
solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied
by sludge /scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be
emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved
individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified
of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely
inspected to be watertight and of good repair.
Pump /Dose Tank
If an effluent filter has been installed in the pump /dose tank, it must be removed & cleaned as
necessary, with provisions to keep solids from passing to the mound component during removal.
The pump, float switches and alarms must be inspected at least every three years for proper
operation. Pump /dose tank should be routinely inspected to be watertight and of good repair.
Mound and Lateral System
The mound system component must remain free of ponded surface water prior to pump operation. If 4
inches or more water level is detected in the observation pipes, the owner must be notified of possible
problems /failure. The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the
component. Activities OTHER than mowing /maintenance (i.e. excessive walking, pets, vehicles, etc...) could
compress the component and reduce it's absorbtion capabilities and /or possibly cause it to freeze in winter
conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points
at each end of the component to remove scum that may clog orifices.
Performance Monitoring:
Performance monitoring ust be one at least on every three ears following the installation or at the time
g d once ery y g
of a problem, complaint, or failure.
Contingency Plan:
If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc)
become defective, the defective tank or component must be replaced immediately to ensure that the system
can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the
surface, the component must be repaired or replaced in it's current location by either: extending basal toe to
provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution
piping within the mound and replacing said components in order to return system to proper working order as
required.
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sin UA ION REPORT #12
Department of Commerce clnrith Co 85 Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings Northland Plumbing, Inc.
`� '� `1�' County
Attach complete site plan on paper not les 'than 80 6 i►t�ches �, , siz : e. Pla mtlst - St. Croix
include, but not limited to: vertical and hori ntal reference point (BM) dir du
percent slope, scale or dimensions, north a ow, and I l he es r arcel I.D.
Please print all formT►NG OFFICE
Reviewed B Date
Personal information you provide may be used for condary purposes (Privacy Law, s. 15.04 (1) (m)). G,
Property Owner Property Location
Bazille, Dedric Govt. Lot NE114, N 1/4, 3, T29N, R 1 5W
Property Owner's Mailing Address Lot # Block # Subd. Name or dSM#
2235 Statia Lane
City State Zip Code Phone Number City Village ❑ Town Nearest Road
Hudson WI 1 54016 1 715 - 531 -0486 Springfield I State Hwy 128
❑ New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Glacial Till Flood plain elevation, if applicable ft.
General comments 6'x90_' mound using 96.94 contou
and recommendations:
Boring # Boring
Pit Ground surface elev. 9 4.89 ft. Depth to limiting factor 28 /i n. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure 'Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1
1 0 -9 1 0YR4 /3 sil 3sbk mvfr cs if .6 .8
2 9 -17 7.5YR5/3 sil 3sbk mvfr cs if .6 .8
3 17 -28 7.5YR4/6 Sid 2sbk mfi gs .4 .6
4 28 -60 7.5YR4/6 7.5YR6/8f1f spots sc isbk mfi cs 0.0 0.0
Boring # '
] Boring
EX, Pit Ground surface elev. 96.94 ft. Depth to limiting factor 34 ✓ in. ISoil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu. Sz. Cont. Color Gr, Sz: Sh.
1 0 -13 1 OYR3 /2 _ sil 3sbk mvfr CS 11 .6 f
2 13 -24 10YR5 /3 I sil 3sbk f mvfr cs if .6 .8
3 24 -30 10YR5 /4 Sid 2sbk mfi gs .4 .6
4 30 -34 7.5YR4/6 7.5YR6 /8fif spots sc isbk mfi gs 0.0 0.0
5 34 -52 7.5YR4/8 7.5YR6 /8fif spots sc isbk mfi cs 0.0 0.0
* Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L " Effluent #2 = BOD S30 mg /L and TSS S mg /L
CST Name (Please Print) Signature: CST Number
Michael J. Myers 267985 aj
Address Northland Plumbing, Inc. Date Evaluation Conducted Telephone Number
E 1556 State Rd 64 Boyceville, WI 54725 7/12/05
S13D.8330 (R.07 /00)
Property Owner Bazille, Dedric Parcel ID # Page 2 of c 3
3 ❑ Boring
❑ Boring # Pit Ground surface elev. 98.89 ft. Depth to limiting factor 22 / / In-.
Soil Application Rate
Horizon , Depth Dominant Color Redox Description Texture Structure Consistence Boundary; Roots GPID/W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t •EW2
1 0 -9 10YR4/3 sil 3sbk mvfr cs 2f .6 .8
2 9 -13 7.5YR5/3 sil 3sbk mvfr cs if .6 .8
3 13 -22 10YR5 /4 sicl 2sbk mfi gs .4 .6
4 22 -32 7.5YR4/6 7.5YR6 /8flf spots sc lsbk mfi gs 0.0 0.0
5 32 -61 7.5YR4/8 7.5YR6 /8flf spots sc lsbk Mill gs 0.0 0.0
' 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) Northland Plumbing, Inc.
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ST CROEK COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer cil it. %c IS kzt L t_C-
Mailing Address 2235 ST+4Ti A L��fE i���so�I cv� - s'4
#7 Q�
Property Address fl 1 2- O In I
(Verification required from Planning Department for new construction)
City/State Parcel Identification Number p34
LEGAL DESCRIPTION
Property Location A[ L ` /,, ` /., Sec. N -R (5 W, Town of SP�1�GF /EG1�
- -73 98 � Lot#
Subdivision --
Certified Survey Map # - --- . Volume Page #
Warranty Deed # Co 3L 3 Le . Volume 1 S Z-- , Page # SJ
Spec house ❑ yes X nno Lot lines identifiable ;Z yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance cif 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.
GNATURE OF / PLICANT DATE
OWNER CERTIFICATION
I (we) 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office.
1
SIG AItM OF ICANT X 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
_ _ _
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636.326
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Charles D. Kutzler _ RECEIVED FOR RECORD
_ 01 -05 -2001 10:30 AN
WARRANTY DEED
_ EW..PT N
Grantor, and Dedric K. Bazille, a single person CERT COPY FEE:
COPY FEE:
-- -- TRANSFER FEE: 270.00
RRE FEE: 10.00
Grantee. —
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
East Half of Northwest Quarter (E 1/2 of NW 1/4) of Section Three (3),
Township Twenty Nine (29) North, Range Fifteen (15) West. Recording Area
Name and Return Address
Thomas A. McCormack
EXCEPT, property described in that certain Warranty Deed to the State of 1020 10th Ave.
Wisconsin, Department of Transportation, recorded January 5, 2000, in Baldwin, WI 54002
Volume 1486, page 29, as Document No. 617354. 10
034 -1 3 50, 34- 1005 -20 C• 7 ��_
Parcel Identift ion mbar (PIN)
This is not 4 0 Gbc4omeste property.
3 q$ -t (is not
Exceptions to warranties: all easements and restrictions of reco d. 3 G4/"
Dated this __2 day of ir_ , 20_
M + Charles D. Kutzler —
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) _ STATE OF WISCONSIN _)
) ss.
- -- St. Croix County )
authenticated this day of _ �_— Personally came before me this 29th _ day of
2000- the al�R>la�naAp . d
— - -y Charles D. Kutzler ��t`[
TITLE: MEMBER STATE BAR OF WISCONSIN to me: known to be erson(s) who exec a re q injj
(If not, _ - - -- instrume ac ow edged a same: Z�tr 02 -
authorized by Q 706.06, Wis. Stets.)
--- fff
THIS INSTRUMENT WAS DRAFTED BY * Steven H. Perry - --
Thom A. McCorm _ Notary Public, State of Wisconsin
My Commission is permanent�(Tf` not, state expirfftoriaa[e
(Signatures may be authenticated or acknowledged. Both are not necessary.) ^�n 1r+ _— }
du ' Names of persons signing in any capacity must be typed or printed below their signature. trvormetbn PrdNS o ar Com pany, Fond Y
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. 2 - 1999
i
� ✓ —° 745349
d 1��� ✓�
_—r V 18 ppGE 4642
REGIS EEI< H.
(` REGISTER OF DEEDS
ST CEIVED FOR�RECORD
\ 10/31/2003 12:50PH
CERTIFIED SURVEY MAP
CERTIFIED SURVEY MAP PAGES: 2
LOCATM IN THE NEI /4 OF THE NW I/4 OF SECTION 3. T29N, RI5W,
FORK BAZILL TOWN OF SPRINGREID, Sr . CROIX COUNTY, WISCONSIN.
110 NEWELL STREET
ROBERTS. WI. 54023
NW CORNER SECTION 3 D.O.T NUMBER 55-f�s- 3819 - 3& �P '�(�",��'��
( ALUMINUM CAP FOUND ) - - -
_
- - - - - -- - -- - E 26 - - - - -~� 8 • dhQ` (��
NORTH LIME OF THE NwJ/4
wt
LANDS OWNED
UNPL TIED LANDS * r fO EN E RGY
7 546
_
� ���- -� = ` '2 THIS -DRIViWAY
TO BE
" .. REMOVED - / 0
BEARINGS REFERENCED TO THE E NORTH -SOUTH 1/4 SECTION LINE-
ASSUMED TO BEAR SOOOOO'00"E.
DWELLING -nLj
O
—N— LEGOVD / GARAGE
- INDICATES SECTION CORNR
MONL1EW ( AS NOTED ) OR ERLI OF
• - INDICATES I X 24" ( OSIOE DIAMETER ) Q
IRON PIPE WEIGHING 1.6 LBS. / LINEAR
FOOT SET.
- - - INDICATES FENCE.
•..• - INDICATES 100' ST. CRDI COUNTY SHED
SETBACK LINE FROM RIGr -OF -WAY.
- - INDICATES 50' STATE OFWISCONSIN
SETBACK LINE FROM RIGS -OF -WAY.
HPOIE
'
THE DRIVEWAYS SHOWN HEREON APPEAR Z C
TO BE CROSSING LANDS OWNED BY "MOVED � z
XCEL ENERGY. BUT THE ACCESS IS A $T. CRIX COUNTY +
PERMITTED USE ACCORDING TO THE
WARRANTY DEED FILED IN VOLUME PI1ulnlni: Zon1 ^a^d Park ~ Cam 333.138 FEET 9
149. PAGE 468 ON MAY 29. 1916 IN ^n' ( 7 47 A S ) n1
THE ST. CROIX COUNTY REGISTER ACT ; 1 2003 0
OF DEEDS OFFICE. THE DEED I
RESERVES TO THE GRANTORS. HEIRS $
AND ASSIGNS. - THE RIGHT TO USE a
WITHOUT COST TO THE GRANTEE AND If not r*00rdj within 30 da S 8
AT THE GRANTORS OWN RISK. THE approval d9QPProvel shall
PREMISES CONVEYED. WITHOUT nJnd Void II I�
PAYMENT OR RENT SO LONG AS
SAID USES DO NOT INTERFERE WITH
PRESENT OR FUTURE USES WHICH
SAID GRANTEE . SUCCESSORS t
DR ASSIGNS MA DESIRE TO MAKE
OF THE PREMISES CONVEYED.
AAD7E• �, S NS. /y .
ALL LOTS AND BLOCKS ARE HEREBY RICT " w .
SO THAT NO OWNER. POSSESSOR. USER LI � j N Rf
OR ANY OTHER PERSON MAY HAVE ANY RI T OF,�L�
DIRECT VEHICULAR INGRESS FROM OR E T ti flICHMONO °
ANY HIGHWAY LYING WITHIN THE RIGHT -OF AY
OF S .T N S.T. - 128 - . IT IS EXPRESSLY INTE W I Q Kj
THIS RESTRICTION CONSTITUTE A STRICTI
FOR THE BENEFIT OF THE PUBLIC AS PROV
RE �, �� °• •'
IN S. 236293 STATS _ AND SHALL BE ENFORCES Q ••' " "• "� � Q
BY THE DEPARTMENT OR ITS ASSIGNS. ANY $ URV r
ACCESS ALLOWED BY SPECIAL EXCEPTION SHALL �y
BE CONFIRMED AND GRANTED ONLY THROUGH Fri
THE DRIVEWAY PERMITTING PROCESS: ALL
PERMITS ARE REVOCABLE AND REVOCATION 5
IS NON-COMPENSATORY. ADDITIONAL LAND WB7 5426
DIVISIONS. CHANGE IN LAND USE. OR FUTURE 333.34'
HIGHWAY PROJECT (S) MAY REQUIRE A PUBLIC
ROAD INTERSECTION OR RELOCATION OF THE
DRIVEWAY TO AN ALTERNATIVE PUBLIC ROAD _ PLATTED LANDS
AT THE DISCRETION OF THE DEPARTMENT. TH
DEPARTMENT HAS GRANTED AN ACCESS FOR
THE THE WESTERLY DRIVEWAY SHOWN
HEREON AS WELL AS A SINGLE RESIDENTIAL
ACCESS APPROXIMATELY 400' WEST OF
THE WESTERLY DRIVEWAY SHOWN HEREON.
SCALE IN FEET 1" - 150'
rki
PREPARE) BY:
O 75 150' 300, GMINERiG S'UR12�YJ/VG
1235QTJLIV S1/4 CORNER. SECTION 3
N RICNAA0ND. WL 6/017 ( 5 /8 - STEEL RE -BAR FOUND )
THIS JOSEPH S1T�LIhENT DRAFTED BY: JOB NO � 7�
SHEET i OF 2
Vol 18 Page 4642
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