The URL can be used to link to this page

Home My WebLink About038-1211-30-000 Wisconsin Depalliment ofi.ommerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 429941 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)J. Permit Holder's Name: City Village X Township Parcel Tax No: Lindus, Richard I Star Prairie Township 038 - 1211 -30 -000 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range/Map No: 91 4S' C S( - Ar(f .�►�. 13.31.18.1151 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark c...�.iS6 fZ I Qav II�SD 3.30 Dosing t Alt. BM Aeration Bldg. Sewer ,o t I (3 9/ 3 Holding St/Ht Inlet •Z3, St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I t Dt Bottom 3,0 - I—(.L. D 15:90 � •`{S Dosing Header /Man. Aeration Dist. Pipe Z�Z gS.lS Holding Bot. System TT Ily t- -Zz Fi I Grade �� •�S' PUMP /S HON INFORMATION D Manufacturer , ka� • t over 3•% If. �� ,� a gAodel Number v{ � � . ` 4, c �,�0 ch, .�S! �V PrIDH Lift • � Friction Syste ead T `,• Ft a.y� Z _._ 04 !t Forcemain Length ; Dia , « Dist. to Well yt , • SOIL ABSORPTION SYSTEM Width f Lengt ( No. Of Trenches Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI IONS SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Ma a _ INFORMATION CHAMBER OR c Type Of S stem: V UNIT Model Number: ' Z [. DISTRIBUTION SYSTEM y I F /4 Header /Manifold 0 Distribution x Hole Size x Hole Spacing Vent to Air Intake Aid, (s) 1 1-engtri�v`" , Dia 1 1-eng Dia Sp ang 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 j No Yes ; No COMM.�ITS: (Include code discrepencies, persons present, etc.) Inspection #1:� 3 1nspection #2: ` 7 - - Location 1349 212th venue New Richmond, WI �� 54 QQ 17 (NW 1/4 S 1/4 13 T31N R18W) Northgate II Lot 61 �@ rcel No: 13.31.18.115 �. S•T• %T• w.a C,swtS� "I Description S 1.) Alt BM - � 2.) Bldg sewer length = ow - amo o' cover�,,8��" * Plan revision Required? Yes No r - - � %I Use other side for additional information. !� SBD -6710 (R.3/97) Dat J sepctor's Signature Cert. No. G� Safety and Buildings Division Ounty _ �I r i 201 W. Washington Ave., P.O. Box 7162 R� ��5�� Madison, WI 53707 - 7162 Sanitary Permit Number (to be titled in by Co.) Department of Commerce (608) 266 -315'. I Sanitary Permit Application i state Plan I .D . Number . In accord with Comm 83.21, Wis..Adm. Code, personal information you provide may be used for secondary purposes Pri 7 Prwect Address (if different than mailing address) , E I. Application Information - Please Print AU Inform tion Property Owner's Na me APR 2 Parcel # Lot # Block c�k C _ A :c, y, . ( r a/ -I &, - -s ST. CROIX COU Property Owner's M ailing Address ZONING OFFICE Property Location ;220 lS r vQ.rr� .yam 'A, ,'5 - 4 u.Section City, State Zip Code Phone Number " /p (circle o II. Type of Building (check all that apply) C3 ubdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use , �71� r /LAG ) ` rat •zfc ❑ State Owned - Describe Use L2 X c lUl� $ ❑City�ovillage ownship of III. Type of Permit: (Check only one box on line A. Co mplete line B if appl icable) 039' 1 3a — OW 6 /!SI A. ! New System ❑ Replacement System ❑ Treatntent/Holding Tank Replacement Oniv ❑ Other Modification to Existing System H. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued 1 Before Expiration Plumber Owner IV. Type of PQWTS System: (Check all that appl — 60 Non - Pressurized In- Ground ❑ Mound > 24 in. of'suitable soil ❑ Mound ¢ 24 in. of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter I ❑ Constructed Wetland ❑ Pressurized In- Ground El Holding Tan.4 U Peat Filter i« Aerobic Treatment Unit ❑ Recirculating Sand Filter f ❑ Recirculating Synthetic Media Filter JXLeaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: / A A of n t Design Flow (gpd) Design Soil Application Rate(gpdst) Dis ersal Area Required (sf) Dispersal Area Proposed (sb ystem Elevation 1 VI. Tank Info Capacity in Total Number `` Manufacturer Prefab Site j Steel Fiber Plastic Gallons Gallons { of Units I Concrete Constructed I Glass I New Existing Tanks Tanks Septic or Holding Tank fed d gy p.-, e Aerobic Treatment Unit Cb6o j Dosing Chamber VII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature V IPRS Number Business Phone Number v7a 7Y9C1 7�3" - 3�' Plumber's Addre ss (Street, City, State, Zip Code) VIII. County/Department Use Q!g Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued !ss ing Agent Signature (No Stamps) Surcharge Fee) � �S nl 3 ❑ Owner Given Reason for Dertial IX. Conditions of Approval/Reasons for Disapproval U i p Attacit complete plans (to the County only) for the system on paper not lea than 81/2 x 11 inches in size SBD -6398 (R. 01/03) �i G F+ 4 �-� � �' �/L a''/ S � O �� /��lt� / L2 .lJ�- `�'E_l D /y,r� D /� ✓�� y 1�Yrs..i V> '-� E 11 �- ,' Ile I , e3 l � � b ,�Y' / Y` a� < R� /G R• / S lo �(�' �/_ fl/ G[ r�L�( �.- / d'� -��/ D / ✓ „ v r"e-- i I n rY� fe�� /�s ° � n f y NNOr' KlTCirl M iait�stiwwa auLt"'W MY O *UIL UPSCfliPTI N REPORT Page _2._ot 3 PARCEL IA. is X38- 1055 -95 r Bo�cng # Horizon Depth Dominant Color MOWN Texture Structure Cor�enoe Bosr�ry Roots GPDfft Mansell Qu: Sz. Con, Color Gr, Sz. Sh. g� 3 0 -11 10= 3 Z 3 n= bnsbk r 2 11 -27 10 r 4 sici 2msbic mfr aw if .4 .5 Ground 3 -84 .5 cos mi na na .7. .8 dw Iran X84 Remarks: Boring # 1 11 10vr. 3 3 none 1 2mSbk mfr w if .5 .6 4 2 11 - 10yr 4/4 none Ski 2msbk mfr gy if .4! .5 Gmur�d 3 .5 r .6. Horse - ccxs mi na na 7 :8 I - hrrdtin9 fBClpr Remarks: Boring # L1 2msbk mfr w if .5 .6 5•• _ ..� i bk mfr if .4 .5 Ground 26-84 .5 r 4 6 parse cos ml na na .7 .8 98�C,, fL DipM lo iirtaUrq +84 Remarks: Boring •# .i around dev, D" to C�ng Wisconsin [department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor arx!,Human Relations Q?�;ision or Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. C roix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION VIEWf D BY DATE ( C l PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterprises, Inc. GOVT. LOT NW 1 / 1 /4,S 13T 31 N,R 18 E kkr) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1416 Third St. 61 na NorthGate CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE KFOWN NEAREST ROAD Hudson WI. 54016 (71% 386 -3674 Star Prairie 212th Ave. [ New Construction Use [ ] Residential / Number of bedrooms 4 [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd /ft trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) 95.25 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U ® S El l5d S El Gas ❑ U [R S ❑ U ❑ S Eki SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 "' 1 0 -12 1 2msbk mfr CfW if .5 .6 2 12 -28 10 r 4/4 none sicl 2msbk mfr qw if .4 .5 Ground 3 .28-32 i elev. 9 9.0 ft. 4 32 -84 7.5 r 4 6 non Depth to limiting factor +84 n Remarks: Boring # 1 0 - 10 r 1 2msbk mfr 2 2 14 -30 1GYr 4 Ground 3 30 -84 7.5vr 4/6 none eons Q os m1 na elev. D .� s S + r — r 9� .0_ ft. Depth to limiting EU � L L, factor n j +84 11 r ST CROIX Remarks: COUNTY CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. AveNew RichmondW119400 Signature: Date: 11 -8 -98 CST Numb'er: r PROPERTYOWNER Greenwood Enterprise SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL 1.134 # 038 - 1055 -95 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTwich 3 1 0 -11 10 r 3 none 1 2msbk mfr qw if .5 .6 2 11 -27 10 r 4/4 none sicl 2msbk mfr qw if .4 .5 Ground 3 127-84 7.5 r 4/6 none c 0SCI ml na na .7 .8 elev. 9 8.9 ft. Depth to limiting factor Remarks: Boring # 1 0 -11 10 r 3/3 none 1 2msbk mfr gw if .5i .6 4 ' € 2 11 -25 10 r 4/4 none sicl 2msbk mfr gw if .4' .5 Ground 3 25 -84 7.5 r 4/6 none co osg ml na na .7 . 8 elev. 98.9% — Depth to limiting factor 11 Remarks: Boring # 1 0 -8 10 r 3 3 none 1 2msbk mfr w if .5 5 <> 2 8 -26 10 r 4/4 none sicl 2msbk mfr if .4 .5 Ground 3 26 -84 7.5 r 4/6 none cos osg ml na na .7 .8 elev. 9 8.6 ft. Depth to limiting Af a . At" ,Zo factor +84 Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330 (R.05 /92) r STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave. CSTM2298 Nw4SE4 S13- T31N -R18w New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #61- NorthGate This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 " =40' BM.= top of 1" pvc p ipe @ el. 100 Alt. BM.= top of 1 pvc pipe C el. 99.05 �� rJ �i Gary L. Steel 11 -8 -98 SEPTIC TANK F CH AMBER CROSS SECTION AN'� St�LCIFICATiOrSS 4" CI VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF > 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK & FINISHED GRADE WARNING LABEL 4" CI RISER _.... „ 1$" IN. 6" MAX.� INLET + ' GAS - WATER TIGHT SEALS i --- TIGHT, pR VED A SEAL ►� AP 0 ; __L__ JOINTS WITH PPROVED ALM APPROVED PIPE 1PE 3' B ' ON 3' ONTO NTO SOLID , SOLID SOIL OIL, _ *it RISER EXIT PUMP OFF ELEV . FT. t OFF D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3 " APPROVED. BEDDING UNDER TANK CONCRETE PAD c SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: TAN SIZES SEPTIC /per GAL. DOSE VOLUME INCLUDING DOSE _ 4;4 GAL. FLOWBACK: _ GAL. ALARM MANUFACTURER: �P��- CAPACITIES: A = INCHES = f. -. GAL. MODEL NUMBER: � �. y SWITCH TYPE: H = 2 INCHES = _A2 _ GAL. PUMP MANUFACTURER: 6; ac�,�d� C = S INCHES = GAL MODEL NUMBER: - _ SWITCH TYPE: rr,e:c D = (le INCHES _ GAL. _ REQUIRED DISCHARGE RATE __y GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . •2 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . FEET + � FEET FORCEMAIN X , FTJ100 FT. FRICTION FACTOR . FEET TOTAL DYNAMIC HEAD =FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH_; DIAMETER LIQUID DIP 79�G� DATE: SIGNED: J % -- tirf�� LICENSE NUMBER: .2 �.I88 • aGi.i�S P�;C,I." C� of � Submersible Effluent Pump 3871 EPO4' EP05 APPUC:ATIONS • Fasteners: 300 series • Fully submerged in high a Motor Honing: Cast iron Specifically designed for winless steel, grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durablittyy. • Effluent systems dry without damage to heat transfer, ■ eMotor Cover, Thermoplas- • Homes components. Available for automatic and to cover with Integral handle • Farms mow and float switch attachment +Heavy duty sum • EPO4 Single phase: 0.4 HP, models include Mechanical RP M, points. • Water transfer p , built in overload 230 v Erioto ad wit i5 with manual operation, Automatic Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RP preset a t the factory. rated oil and water resistant automatic resat P M, ■ Bearings: Upper and lower 115 V. SO Hz, 1550 R RP SPECIFICATIONS • 1:105 Single phase: , FEATURES heavy duty ball bearing Pump: EPO4 built in overload with construction. Impeller: Thermo- • Solids handling capability: autom EPO4 imp atic reset. plastic Semi-open I ell : design 3 /4' maximum. • Power cord: l4 foot with pump out vanes for AGENCY USTINO �,- • capacities: up so 66 GPM. standard { ength, i6/3 SJTC mechanical seal protection. tgt�nirtdgAtisoei�ticn • Total heads: up to 24 toot, with three prong grounding • Discharge size: 1 NPT, plug. Optional 20 foot ■ EP05 impeller: Thermo- • Mechanical seal: carb length, 16/3 SJTW wits, plastic encluW design for end i fisted made, 4 numbers rotary/ceramic- stationary, three prong grounding plug improved performance. end n F" or �C ,) SUNA -N elastomers. ;standard on EP05). ■ Casing and Baas: Rugged • Temperature: thermoplastic design provides 1041 (40°C) continuous superior strength and 140 °F (60°C) intermittent, corrosion - resistance. • Fasteners: 300 series MEYMRS FEET stainless steel • capable of running dry without damage to s 30 components. Pump: EP05 • Solids handling capability: 25 — 114' maximum. • Capacities: up to 60 GPM.' • Total heads: up to 31 feet.. e • Discharge siz I IN NPT. < 51 Mechanical seal: carbon. 0 15 rotarykeramic-sfationary, J 4 , % BUNA -N elasterners. • Temperature: 3 104°F (40 continuous 140°F (6K) intermittent. 2 ` `-- 5 i 0 1) 0 '1 20 30 40 50 GPM 0 4 fi 8 . 10 12 MI/h CAPACITY * 1ees &xft Pub, hm r rlkCtiv May. {895 i t POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page .L of FILE INFORMATION SYSTEM SPECIFICATIONS Septic Owner Tank Capacity d(1 d al 0 NA Permit # Septic Tank Manufacturer C y NA 0 Effluent Filter Manufacturer O NA DESIGN PARAMETERS Number of Bedrooms ,3 ❑ NA Effluent Filter Model CI CJ DNA E3 NA Number of Public Facility Units ❑ NA Pump Tank Capacity �d al Estimated flow (average) 4 /.. , S� - 6T galida Pump Tank Manufacturer y ❑ NA Design flaw (peak ), ;Estimated x 1.51 - al/da y Pump Manufacturer 6; 0 E, / ❑ NA gal/day/ft /ft1 Pump Model � d � C1 NA Soil Application Rate Q NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter C] Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L MYNA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg /L ' ❑ Disinfection ❑ Other: Pretreated Effluent Quality l onthly average Dispersal C8 d NA Biochemical Oxygen Demand 30 mg /L 0 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids 30 mg /L NA ❑ At -Grade 0 Mound Fecal Coliform (geometric 10` cfu /100m1 O Drip -Line ❑ Other: Q NA Other Maximum Effluent Particle Size Y in dia. 0 NA 0 NA Other: ❑ NA Other: Other. ❑ NA *values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency months} (Maximum 3 years) 0 NA Inspect condition of tank(s) At least once every: earls} Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA monthts) (Maximum 3 years) DNA once eve earls! least every: s At .� Y al cell( ) Inspect dispera ❑ month(s) ❑ NA filter At least once every: e Clean effluent dte ars) Inspect pump, pump controls & alarm At least once every: 3 El ear s) nth( ❑ NA 0 months) 0 NA Flush laterals and pressure test At least ones every: p years} Other At (east ones every: manthts) 0 NA D earls) ❑ NA other: MAINTENANCE INSTRUCTIONS be made by an individual carrying one of the following licenses or certifications: inspections of tanks and dispersal calls shall Inspector; POWTS Maintainer, Ssptage Servicing Operator. Tank Master Plumber; Master Plumber Restricted Sewer; POWTS inspec inspections must include a visual inspection of the and too id any back up or ponling d of eluent on the ground surface. d measure the volume of combined sludge ondin The dispersal cell(S) shall be visually inspected to check the effluent levels in the observation pipes and to check for any p g 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 %) 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized ¢omponsnts, pretreatment units, and any servicing at intervals of S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of complet'wn of any service event. Pa" . _S101 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 chemicals that may impede the treatment process and /or damage the dispersal cell(s) . If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System star; up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellis) in one large dose, overloading the call(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade so!( absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or,must be taken, to provide a code compliant replacement system: IS A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. site AIIA tank e ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name:/ � `Q !� .S �c. � ��y Name Phone �� 1.2 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 15T r C.our.TT;' �N�/J Phone Phone --(5 . 3V- - L K, This document was drafted in compliance with chapter Comm 83.22(2)(W1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. r - 04/24/2033 20:18 17156844630 ALWIN EXC INC PAGE 01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CBR IFICATION FORM Owner/Buyer / C �` r r Mailing Address '' Property Addr s 3 S� o (Vatifieation required from Planning Departm"t for new construction) City/State -57�2� �`�r e- Parcel Identification Nuintw _ C� 3 Mf 9 -S Q r Property Looation AI W ' /., Sec. _ 3 . T 3 / N -R 8 W, Town of Subdivision 1` Lot # �O Certified Survey Map # . Volume -Page Warranty Deed # Volume :2 Page it Spec house 0 yes K no Lot lines identifiable I$f yes O no Improper use and w aidft"= of your septic system could nsalt in its premawm f*ilu re to bundle wastes. Proper mamtananc. consists of pumping out the septic tank every dirm yearn or sooner.. if needed by a licensed pumper. Wbat you put into ells sysoer; can meat dw Amcdon of the septic tank as a t vatnmat stage in else waste disposal rift= Inw property owner agmes to rAmh to St. Cmix Zug Department a certification form, signed by the owner and by a masterplumber, jowmaymanplumber, restzkWplumber or a h dpum;w veti&iog that (1) the on -site wastew aterdisposal 111, eL, is in proper operating cou tion stWor (2) alter inspection and pumping (if necessary), the septic tank is Ian than 113 full of shedge. Uwe, the undersigned have read the above requirements and agree to maintain else private sewage disposal system with tbd: standar4 set forth. herein, as set by the Department of Commerce sad the Department of Natural Resources, State of Wisconsin. Certificstiou statin that your septic system has been maintained must be cozoplawd and mu ned to the St. Croix County Zoning Office within 3s' days of the three n data• iL 9 ! d SIGNA71NEi OF APPLICANT D ATE QVMR =&MC& QN I (we) certify that all statements on t4is form am true to the beat of my (our) knowledge. I (we) am (are) the owner(s) opeajlt scri ve, by virtue of a Aced recorded in Register of Deeds Office. -' - �( ,pp, o-? SIGNATURE APPLICANT DATE *""" Any information that is mis -rep tsentedswy result in the salutary permit being revoked by the Zoning Department •• "� *" Include with this appikadan: a stamped warran deed from the Register of D**& office a copy of the certified survey map if reference is made is the wtrmnty deed J 2 19 5 P 6 10 7 1 3 STATE BAR OF WISCONSIN FORM 1-1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between Greenwood Enl;�ri§e--S 04/04/2003 01:20PK r a WARRANTY DEED EXEMPT # Gr antor, and R' h ard A. LjW sii4le a REC FEE: 11.00 TRANS FEE: 78.00 COPY FEE. 2.00 CC FEE: Grantee. PAGES: I Grantor, for a valuable consideration, conveys to Grantee the following described real estate In qt-- C Count State of Wisconsin (the I + —,,On, N1, Name and Return Address ([Lt 5 of the Plat of NorthGate II, recorded in the Office of the Register of Deeds for St. Croix County, I I _p o Wisconsin on June 20, 2001, in Volume 8 of Plats, at yn G j J 7 gyo'�- L Page 55, as Document No. 648882. - 7 7 038- 1211 -30 -000 jl Parcel IdenhWation Number (PIN) This is not homestead propert (is) (is not) I. II To g ether with all appurtenant ri title and Interests. Grantor warrants that the title to the Propert is g ood. indefeasible in fee simple and free and clear of encumbrances except ease,Tlents, restrictions, and reservations, if any, of record. Dated this da of March D IS (SEAL) (SEAL) I il ._j4ffl9q E. sch. President I i (SEAL) (SEAL) • Ma r �ch sec/Treas AUTHENTICATION ACKNOWLEDGMENT Si State of Wisconsin, 5s, II St. Croix Count authenticated this da or Personall came before me this da of j March 2003 the above named .Tames V. RiiqCh, it-, Mary - R . Rllqt-h, i t s Sec/Treag TITLE: MEMBER STATE BAR OF WISCONSIN (If not. me known to be the person S authorized b §706.06, Wis. Stats.) d ac h ?I. • rumanu ' the THIS INSTRUMENT WAS DRAFTED BY Mary R. Rusch S andra Notar I'LlbliC, State Of Wisconsin S New Richmond, WI 54017 My commission is permanent. (If not, i (Si may be authenticated or acknowled Both are not I. necessar N--( p--si in an ,,.p-1 .-, be t o, printed below Their li STATE BAR OF WISCONSIN Wisconsin Le Blank Co. IM WARRANTY DEED FORM No. I - 1998 MuWaukee. Wis. I I 25 _ N 89 W — — 2 1 2139 N 89 o 07 26 N W 66.00 ° I 188.00' 125.00' 06 3 234.73- - - 245.00' 125.00' I I V) 10' DRAINO GE EASEMENT / 'Ln cu h �D C -� 5r2 CD ccuu 9ISC��s \ �� 2 / 49,451 sq. ft. <v 50 �\ / < f00, 1.135 ac. 7 . cn 65,278 sq. ft. ti _ f ° °- Gj 2��, ~O i�(' srS�f6� 2h 2 1.499 ac. c 57,014 sq. ft. \ poa �4 Z 1.309 ac. / 24 7,Sg - _ _ _ 26.4 4' , 3 - _ 0 \ O� 30.00• S 7 o - - -- \ 0 55,265 sq. ft. \ 4S 1.269 ac. , loe °o. ° \ 60 ft. v 1 N 10' DRAINAGE 8 & �� o cu UTILITY EASEMENTS 66,360 sq. ft. c tit i 61,994 ft. Z 1.523 ac. 63,859 sq. ft. tit %Ci i �1 >E 1.466 ac. 202 1.423 ac. o , b DRAINAGE EASEMENT 15 utility easement �ODQ 9fS °� 6.71'- _ - - -250.00' -- _ y05.00' _ 1 - 135.00 °' �s - - 415.00' '280.00' S 88 *5058' E (RECORDED AS SOUTH LINE OF THE I NW 1/4 OF T 7 PRAIRIE FLATS ADDITION PLATS PAGE1 "� f ee