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HomeMy WebLinkAbout034-1064-70-075 Wisconsin Department of Commerce ' PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 463373 0 GENERAL INFORMATION 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: Moor, Jesse & Ann I Springfield, Town of / CST BM Elev: Insp. BM Elev: BM Description: Section/ Town /Range/Map No: / / �T 29.29.15. J TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic !o Benchmark /Z66 a M Z . C --T I 7 16 1 ,4 7 /Or:> Dosing Alt. BM Bldg. Sewer 1ld 3 7- 9 Holding St/Ht Inlet I7.4 q 10 . 53 TANK SETBACK INFORMATION St/Ht Outlet ANK TO P/L / WELL BLDG. Vent to Air Intake ROAD Dt Inlet `- L Septic / '9 (T7 / Dt Bottom 2 0 3 /B Dosing & / 7 I q 7 ! Header /Man. Z. N /0 / S Aeration bZ Dist. Pipe Z,17 /al. 57 Holding Bot. System -Z Final Grade !�Z S/ c PUMP /SIPHON INFORMATION I, l / Manufacturer // Demand St Cover l�� J 5 GPM !d • 5`�1 9 3. l S Model Number P C-) Z3 , TDH Lift Friction Loss System Head TDH Ft Forcemain Len th q i Dia. , Dist. to Well d Z- SOIL ABSORPTION SYSTEM BED /TRENCH Width e Length No. Of renc PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS <V 7:5 �-- �- SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: ` INFORMATION CHAMBER OR Type Of Sys J � ! ! ��� / ,� J /) UNIT � Model Number, ICY \ �� `. �. DISTRIBUTION SYSTEM xjoop, Header /Manifold 1 i! Distribution C ( I I �/ I x Hole Size I I x Hole Spacing Ve� J Air Intake l pc) 3 31 { I Lengt Dia /4 Length 3V ` Dia 1 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 3 Bed/Trench Edges Topsoil 1 I 1>�y s No4es No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: O / 1 d5 Inspection #2:_ / / Location: Wilson, WI 5 27 (SW 1/4 1/4 9 T 9N RI 5W) NA Lot 2 , _ A ` parcel No: 29.29.15. �d n� b 10( 3 11 - 1 106 6b C r. L,_ 1.) Alt BM Description = / J 2.) Bldg sewer length = G -7 , \ - amount of cover = w /Signal� Plan revision Re q cared? No 75 Use other side for additional informatio Date Insepct Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County t m 201 W. Washington Ave., P.O. Box 7162 ��v� ` �5�0nsirn Maats(6 E IVE D San ry Permit Number (to be filled in by Co.) (b0 26b- 4 Department of Commerce S Plan I.D. Number Sanitar ermit A H a on In accord with Comm 83 y Wis. Adm. Code, p a1 ►n on yo 0 4 2005 D may be used for secondary purposes Privacy Lai, sf gi (I xm Pro t ddress (if t Brent than mailing address) ST. CROIX COUNTY 1. Application Information — Please Print All Information Property Owner's Name 9 arce l # Lot Block # J e5 e >7„ �1�ro r 27333 S y� A heti,< �vj� N Property Owner's Mailing Address roperty c� v %J v %., Section City, State Zip Code Phone Number (circle one) ll f v T N, RE or W II. Type of Building (check all that apply) n. CSM Number �1 or 2 Family Dwelling — Number of Bedrooms ❑ Public/Commercial — Describe Use sMA S ' ❑ State Owned — Describe Use ❑City_ ❑VillagePTownship of t t" III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A • X New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner 1 "d � I it IV. Type of POWTS System: Check all that appl ❑ Non — Pressurized In -Ground W Mound > 24 in. of suitable soil ound < 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 Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaVfrestment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed ( System Elevati-, 600 1 QD ()©- -� Vi. Tank Info Capacity in Total Number Manufacturer 11 Prefab Site Steel Fiber Plastic Gallons Gallons of Units �10D J Concrete Constructed Glass New Existing . Tanks Tanks Septic cc Holding Tank ( (] Aerobic Treatment Unit r VV Dosing Chamber VII. Responsibility Statement- 1 the undersigned, assume responsibility for installation of the POW17S shown on the attached plans. Plumber's Name (Print) Plum 's Signature MP /MPRS Number Business Phone Number Plumber's Add As (Street, City, State, Zip Code) 6� d C lz CI W)111 W0 y� 1 VIII. Coun /De artment Use Onl Sanitary Permit F (includes Groundwater Date Issued lssuin Agent Signatur (No Stamps) Approved ❑ D's oved Surcharge Fee) ❑ O en n for Denial'` IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced 1 maintained) maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) FORM NO 985 -A l'ler a.... �__,...__._ .. 7 8 EN Z--� - 7 4 Stock No. 26273 VOL 19 PAGE 4939 KATHLEEN H. WALSH REGISTER OF DEEDS RECEIVED FOR 02/25/2005 10:45AM CERTIFIED SURVEY MAP NO . CERTIFIED SURVEY MAP RE�FEE : 13.00 VOLUME 19 9 PAGE 4939 * CCOPY FEE: 3.00 PAGES: 2 PART OF THE SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER, SECTION 29, TOWNSHIP 29 NORTH, RANGE 15 WEST, TOWN OF SPRINGFIELD, ST. CROIX COUNTY, WISCONSIN 453.1 O' \'ri i : ov PREPARED FOR: N89 "E 1W 'w W NORMAN NELSON o 2812 HIWAY 12 0 WILSON, WI 54027 U_N V c I 14 LANDS P938SO A NOTE: o No additional access will be permitted from these rn lands to US 12. Any further development will require access from an alternate public road. Access restrictions are stated in Covenant recorded in Vol.2318. Pg.80. N ti SOIL TEST TEST 00 .` `L w SURVEYOR: 302.34 tx� JOEL A. BRANDT N84'13' "E JB SURVEYING LLC 966 Rustic Rd 3 Z Glenwood City, WI LOT 2 N W 871,200 Sq.ft. West 1/4 Corner 29 -29 -1S 20.00 acres I'd Alum. Monument N 89'45' 36 "E 46.52' centerline of o 66' wide w I �inc�ress /egress easement serve unplatted lands ^• Z a ° 66.t2' * a�wsgT UNPLATTED '�' °p° I 89 - W 111-111111103 LANDS O 66' easement recorded .1 * C in CSM 4546 � I — t0 •_— �� � alrY� 0 OD t N R W S rn rn LoI Vol'17 i ,, ° building setback line 41 rn P9_4546 .I 41� - N 33.00' 556.73' S89'45'36 "W °- 771.22' i N89'45'36 "E P.O.B. US _12" Southwest Corner - -- ---------------- - - - - -- Section 29 -29 -15 WISDOI driveway Found Berntsen Noil permit # 55- 0002 -05 UNPLATTED LANDS /• The parcel shown on this map is subject to State. County and Township laws. rules and regulations(i.e. wetlands• minumum lot size, access to a parcel etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the appropriate Town Board for advice YV � LEGEND .........Government Corner (as noted) SCALE: 1" = 200' North is referenced to the i...........Found 3/4" iron rebar West Line of the Southwest A ........ _Found 1 iron i e Quarter of Sec. 29- 29 -15. P P 0' 200' 400' which bears N00 °05'39"W o..- ----- Set 3/4" x 24" Iron rebar (St. Croix County Grid System) weighing 1.502 lbs. /lineal ft. Vol 19 Page 4939 Page 1 of 2 f P age o �� oun ans --0- --fie -� 0 z elan �� a�nbaoae ■ 6 P A 4 Q O ■ House Are D am-am -am A a. > goP Q C ) C:) f z �o 2 A G\- 0335 12,cc lb CO l ESER PPP GauIB�NKr /oN TA�JK 42 upslW mr"ctlon 0.89 4 L. dwnslaps correctAon 114 Vold volurie 1 1/4 void volurx >Y Frktlon Loss O c l r r Safety and Buildings 4003 N KINNEY COULEE RD commerce .Wl.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 It � sco n s i n 111 (// ` l www•commer isco sin.go / epartment of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 18, 2005 CUST ID No.220499 ATTN.• POWTS Inspector BRUCE ALLEN WEBSTER ZONING OFFICE WEBSTER PLUMBING & ELECTRIC ST CROIX COUNTY SPIA N3659 CTY RD C 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/18/2007 Identification Numbers Transaction ID No. 1120281 SITE: Site ID No. 695967 Jessie Moor Please refer to both identification numbers, Hwy 12 above, in all correspondence with the agency. Town of Springfield St Croix County StA /4, SV1/4, S29, T29N, R15W FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1008966 Maintenance required; 600 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.0 1 /0 1), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter 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 approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.01 /01). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)". • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • 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. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Coll it °,. wllal y APp - -- - r BRUCE ALLEN WEBSTER Page 2 3/18/2005 • Comm 83.22(7) - 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. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - 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. 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. 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. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswirn@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Mound Plans for Jessie & Ann Moor 27333 540th Ave Austin Minnesota 55912 Located in SE of SE sec 29 T 29 N R 15 W Town of Springfield St, Croix County Parcel Com # Page 1 Title Page Page 2 Plot Plan Page 3 Plot Plan Page 4 Cross Section & Plan View Page 5 Dist Pipe Detail Page 6 Tank Detail Page 7 Pump Curve Page 8 Symtex Filter Detail Page 9 Maintenece Plan Page 10 Maintenence Plan Page 11 Pump Chamber %am murnrn "'''., Design Criteria °S4 � %; Pressure Dist Manual Ni -1 4 0 •: Version2,0" SBD- 10760- P(N.01 /01) Mound Comp Manual E�"�" Version 2.0 " ....... - - 1 PCN, '. ••.�•••" '• .. SBD 1069 01/0 1) „!!! /t /fi(iltlltl „ RECEIVED MAR 17 200 (t�cE FP . uF SAFETY AND BUILDINGS SAFETY & BUILDINGS SEE CORRES DENCE I I ' _d n w 4 CT - n o s (4 U CC) O N O3 U � Q o w OD CU 4- O CU U C5 o) d Q� T C £ in S �� 0 -i >a V1 3 � L w z ED Q , z U(Um 3w I r P age c - F our arcs ry z 4, 57 House Area PR O A s� i• � G + JSK p 0P m� Q 3 � O ❑ Q O N :3 N f •/� Q N (✓Q h 'S � �C � 2 A X35 W i ESER PPP . 0M&jMAr/0A1 TrM)K 4X upslope c vctlon 0.89 4X domstope correctlon 1.14 2' Void volume 1 1/4 void volume 2' Frlctlem Loss Cross section H Page 4 of 11 Cb 0 G t ele 101.38 � Of Mounol or at 1Q�` j A re ate F D 3 E Mound S °hd P�oWed Layer F Turnups at end hr4jh c of laterals with 4 7. Slope threaded n plug Plan i U ew of Mound L B A O For e Main o I o o i `� a ko +� I ~� n o a 0Q� n= O D— 0 5 Note PNT w to PNT Y is 75' 8 f 1 � / PNT X May move downhill B — _ E = U :L4 . �� up to 7,5' to reach same 75 elevation as PNT's W & Y _ E 0 8 Mound Bed Shall �? • CXNVEX K — 7 Proportionally L= 89 G= 0,5 J= 5,5 H= 1,0 A �(Q Min Supply Pressure I Backflow 200 )K 0,163 = 32,6 W = Max Dose 600/5 + 32,6 = 152,6 I Page 5 o-F 11 O N O d i O O O C r a S a m Q 4 ` a � � Maur ,re S ►� X x 2 Last Hole Near Turnup P = 36' 3" 54 hoes X = 51" P 0,41 gpm per h O � e Hole Diameter 1/8" 22,14 m i n dose Lateral Diameter 1 1/4" rate r e q Manif old Diameter 1 1/4" Void Volume Laterals 36,25 )K6 = 217,5 Force Main 2 217.5' X 0.064 = 1392 Holes er Lateral 9 13,92 %K 5 = 69,6 p 69 .6 gal Min Dose Invert Ele Laterals 101,38 Page 6 of 11 Co m bo 1200 Septic Approved Locking manhole cover with warning label req BOO g a d Pump min 4' above ground Cover within 6' �+ of grade+ warning label req Q E QJ N 4- 4 Q � 4- C5 d A 0 B 1200 gal septic o O Q pump off elev 100 84,00 n block Manufacturer Wieser Doses /Day 5.35 Size 12001800 Combo Gallons /Dose 144,56 Alarm Manufacturer Level Arm Backf low 32.6 Model # DLV Total Dose 11996 Switch Type Steel Ball Pump Manufacturer Gould Model # EP05 A =21 = 467,04 gal Min GPM = 22.14 + 16 = 23,74 B =2 = 44.48 gal Verticle Lift 17.38 C =6.5 = 144,56 gal Min Supply Pressure 7.0 D =6.5 = 144,56 gal Friction Loss 1,1612';= 2.32 Tot 36" 800.64 gal Total Dynamic Head 26.68 Force Main Dia 2 Manufacture Tank Specks included in Plans r [q * GOULDS PUMPS Submersible Effluent Pump MODEL 3871 EPO4 EP05 � Series APPLICATIONS • Full submerged in high ■ EP05 Impeller. Thermop;a5- ■ Bearings_ Upper and lower grade turbine oil for tic enclosed design for heavy duty bail bearing Specifically designed for the lubrication and efficient Improved performance. cunhbuction. following uses: heat transfer. • Effluent systems ■Casing and Base: Rugged automatic and thermoplastic design provides AGENCY LISTING • Names Available for atomat • Harms manual era Au superior strength and corrosion C ana di an Stand resistance. File # LR38549 • Heavy duty sump matic models include • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron Goulds Pub is LSO 9001 Registered. • Dewatering assembled and preset at the for efficient heat transfer, factory strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 'la' maximum. ■ EPO4 Impeller: Thermoplas- s Power Cable: Severe duty • Capacities: up to 60 GPM. tic semi -open design with rated oil and water resistant. • Total heads: up to 31 feet pump out vanes for mechanical • Discharge size: 1 NPT. seal protection. • Mechanical seal: carbon - rotarylceramic- stationary, BUNA -N elastomers. - Temperature: 1041E (4010) continuous METERS FEET ..... __ 1401E (6010) intermittent. 10 r • Fasteners: 300 series i stainless steel. s 30 - Capable of running dry without damage to s components. 25 .... . Motor: _ • EPO4 Single phase: 0.4 HP, c zo 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with o 15.. automatic reset. c 4 EPOS • EP05 Single phase: 0.5 HP, i? 115 V or 230V, 611 Hi. 1550 a - 10 RPM, built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot s standard langth, 1613 1 SJ with grounding t Optional 20 0 10 20 30 4 p 0 0 0 Stl GPM foot length,1613 S1TW with dime prong grounding plug 0 11 10 12 mllh (standard on EP05), CAPACITY Goulds Pumps t 2003 GoAA Pumps ITT Industries Effective July, 2003 83871 • e Fop i2 • Pa9 . R.75 • 28 32.75 ' 15. 315 IIUV II I - -- - - -, GAG SIMARH FILTIR WSW IURIUII UAY IM:III RU UUYIIC CITY, 1•II 4911 I-000-999-32JU FAX 1-231-502-7324 SIIVIEU1 FIVER ASS'Y UCIAII PAIE 5OU5152 J IMP I STF -100 112711 GARY WICSKEY UYIIT UNG (X12 j a v V44 Management P(an Page 9 of 11 Owner Jessie Ann Moor Permit # _ Z-4(Q3 3T_3 Parcel # _ _ _ System Specs Tax ID # _ �� _ Septic Capacity 1200 gal Design Parameters Manufacturer Wieser Pump Tank Cap 800 gal # of bedrooms 4 Manufacturer Wieser Estimated Flow 400 gal /dy Effluent Filter Simtex Peak Flow 600 gal /day Model 100 Soil Application Rate Pump Manufacturer 1.0 gal /ft /dy Model # Gould EP05 Ef luent Quality BOD>30 <220mg /L Max Particle Size 1/8" Start Up Prior to use of POWTS check treatment tanks for presence of paint or chemicals that may Design Criteria damage olispercement cell Pressure Dist Manual If high concentrations Version2,0" are detected have tank SBD - 10760- P(N,01 /01) pumped prior to use. Mound Comp Manual Version 2.0" SBD- 10691- P(N,01 /01) Maintenance Monitoring Schedule Inspect Tanks Every 3 Years Pump Tanks when sludge = 1/3 tank Inspect dispercement cells every 3 years Clean Symtex Filter every 13 months Inspect pumps controls & alarm every 3 years Flush laterals every 3 years .Management Phan Page 10 of 11 Operations The property owner is responsible for the operations and maintenenceof the POWTS and submissions of required reports,The quantity and quality of the wastewater stream affect the performance and longevity of your POWTS, The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volumn, The brine or waste from water softenners and other water treatment devicesshould discharge to ground surface whenever possible Thissystem is designed to handle domestic strength wastewater, food grease and oil discharging into this system should be kept to a minimum or avoided. Non biodegradable product such as tampons, cigareete butts dental f loss,sanitary napkins should not be disposed of into the POWTS, Toilet paper is the only paper that should be disposed into any POWTS, Inspections Should be conducted by a licensed plumber, POWTS maintaner, or Septic system service operater, Tank inspections include visual inspection of tank and system for leaks or surface discharge. When sludge fills 1/3 of the septic it shall be removed by a licensed pumper, The effluent filter should be cleaned twice yearly, Contingency plan, Mounds and at - grade may be reconstructed by removal of biomat at the infiltration area. POWTS INSTALLER Bruce Webster phone 594 -3080 Septic Pumper Johnson Sanitation Ellsworth POWTS Maintaner Johnson sanitation Ellsworth Regulating Authority St,Croix County Zoning 0 53" 39" 96° O c r m K� I I D C C � 44" U O r r r, m 4 S < z �► CC) C) D�F 4 � m 3" 6' Ni r C D m < z m m S 0 z �Oz r � m D 41" n c U c D N _ Z m U p c r r 4 p m m D Z p �r M r =�C�OJ 2` (-n Z z� C� n mD Y�`Z m�,��zmDOODG In m m m C CO m ' S p� Z _ _ 70 O I _' z m U p �0O r = 0 �(A IA J r C7 m - m - O r m D- w r V N rn z O U p C ^ c D� CD C C /�� C -0 m c% p c 0 U -D Lo p / O D U� Z m m r C C p m�� D Dr D DG 0 x Z N C� m D c Z Z p W O O \ 'O O o D O C? U� co �m r �� ' n" ul y PE � C K m G I � EA N OU O CD o m M-4 t �n z rl 0 1 m o mm � F c Dz, c c O C a f� m 00 T J m a c 0 0 4 l � 1 E' 1 d e e .. A f r 3 ++w /� s x C W 1 � 1 i w z l I r 1 ` r N tV S lit - •i� --K' -. it Y . E. i • r M 4 i Y F" s r Iv 6 1 S q t Va CD J t a 4 wqn d.. �MN'1yy�o'MtR aw. � ' ' jf t t. � r- t ^.. w ...... �� r ..r N�[lfA:'w�wuvMla. ^'Wi`L�wr Jh: Vn✓ rM.yr'wK aSewtira•V'�ti+OVwm I l r 1 1 U 2 7 5 8 P 3 4 6 - 7 88 - 7 Q) 6 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. YALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. MI Document Number Document Name RECEIVED FOR RECORD 03/03/2005 10:00AN THIS DEED, made between Norman L. Nelson and Arlene L. Nelson, husband WARRANTY DEED EXEMPT It and wife REC FEE • 13.00 TRANS FEE: 260.70 ( "Grantor," whether one or more), and Jesse Moor and Ann Moor, husband and COPY FEE: wife CC FEE: PAGES: 2 ( "Grantee," whether one or more). Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more Name and Return Address space is needed, please attach addendum): See Exhibit A attached hereto and made a part hereof. 034 - 1064 -70 -025 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements and restrictions of record. Dated (SEAL) (SEAL) • • rman L (S EAL) - � (SEAL) * • Arlene L. Nelson AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) _ ) ss. authenticated on ST. CROIX COUNTY) c� Personally came before me on / �/Ql' - A 0-1. a the above -named Norman L. Nelson anal pe 4. weo TITLE: MEMBER STATE BAR OF WISCONSIN r' ` (If not, to me known to be the person(s) , ruing authorized by Wis. Stat. § 706.06) instrume d acknowledg a THIS INSTRUMENT DRAFTED BY: * T2 lOr4lS ;'a : °►; b. Thomas A. McCormack Notary Public, State of WISCONSIN T A Y• Baldwin WI 54002 My commission (is permanent) (Signatures may be authenticated or acknowledged. Both are not necenary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED STATE BAR OF WISCONSIN FORM NO. 2-2003 'Type name below signatures. 0 State Bar of Waconsin 2003 INFO - PRO"' Legal Forms • (800)655.2021 • irhopraorms oom U. 2758P 3`!7 of 2 Certified Survey Map recorded in Vol. 1 9, Pa a 493 as Doc. No. 788274: located in part of the '/e of SW % of Section 29, Township 29 North, Range 15 Wes�`Tow o Springfield, St. Croix County, Wisconsin. Together With and Subject To a 66 foot wide ingress and egress easement as shown on said Certified Survey Map as recorded in Vol. 19, Page 4939 and on Certified Survey Map as recorded in Vol. 17, Page 4546 as Doc. No. 726602. r �E'"c DQcf N rl v T R IX COUNTY � S .0 O W L �ryNS Q E AGREEMENT SEPTIC TANK IVSAIl�ITENANC AND OWNERSHIP CERTIFICATION FORM Owner/Buyer iJ 2 5 S CU d (:�o r'' t� u Mailing Address A 7 33 3 J 1 o t� hl)-e- A 5 'A /' / M lhweigh LEVI Z Property Address 91q 4W tj 1 (Verification required fr&h Planning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Properly Location '/ , SV , T N R )f W, Town of Subdivision , Lot # Certified Survey Map # 7 , Volume Page # Warranty Deed # U I J U I 3V b , Volume , Page #, Spec house yes no ?6' 70o 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. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County 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 Department within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I/we certi that all statements on this form are true to the best of e. m /our lmowled Uwe am/are the owner(s) of the fy Y g property described above, by virtue of a warranty deed recorded in Register of Deeds Office SIGNATURE OF APPLICANT DATE * * * * ** Any information 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 and a copy of the certified survey map if reference is made in the warranty deed. 4 n Vifisoordn Departrnent of Conrna= SOIL EVALUATION REPORT p 1_ of -3 MAsion of safety and Buldxcis in accordance with come 85, tlifis. Adn code corky . G R b I >C Attach complete site plan on paper not teas than a v2 x 11 inches in size. Ran must 5 kWude. but not lifted to vertical and horizontal mWerice potrk (BM), t&ecbon and Parod I.D. U O GnO v percent slope. scalsordirnensions. north arrow, and locadon and distance to nearest road. — 6 1 34 – ,06q - p D- S Please pdnt all InformafwL L Date Paeoi IZ-� (� Pmpwwowner F �� Property) orr 5� G 4 110 jJ btj y. Govt. Lot 5 E 114 A 1l4 S Zq T Zcj N R 15 E Prcpertyownees meav Addrms Lot # Block # subd. Name or W 1 � 2-:7 cJ y� -r +► v ,y ally Sf� Code Phan, ❑City ❑Village ® Town N Road MN 91; 1A 77 ( I 1 2-11 S�Wr� �t E�--D tn�Y I"Z New Construction Use P ResidenN / Number of bedroorns � Code derived design flow rate (D O O GM ❑ Replacernert ❑ Pulft or con - Descilm parentmded+si flood Ptairn elevation ifvplla": ft Gsrnenat corrnerft Area ?1- Spot Tested suitable for a MOUND Sy STS M mound (RO.W.T.S.) system using Cp sand fill. -7' ® Pit mound surface dev. 1 00. ft. Depth m factor 3 - 7 h Rate Hwim Depth Dominant Cokx Rsdoc Desaipdon Tom" corwatience Boundary Rods GPM in. & mow CkL Sz. Co Cdor Sz. Sh. 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