HomeMy WebLinkAbout038-1207-20-000 / Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
f 395249
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:
Ewlen Properties I Star Prairie Township 038- 1207 -20 -000
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV.
Septic Benchmark
(� o, q 1�.4 lob.
Dosing Alt. BM ( p. 3 1 b l 3o '
Aeration Bldg. Sewer 0 (q .SD'
Holding SUHt Inlet f
TANK SETBACK INFORMATION SUHtOutlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Q3 1 C Dt Bottom
Dosing 4�, Header /Man. 66 2 .
Aeration Dist. Pipe `. o Z C F 33
fo
Holding Bot. System - 4 . 12 3.23
Final Grade
PUMP /SIPHON INFORMATION
Manufacture Demand St Cover t • `a p 4 2 � r
GPM l 7
Model Number
TDH Lift tion Loss System Head T Ft
Forcemai Length Dia. Dist. to Well
S91L Ag3 SYSTEM
t1FfZ ENCH Ddth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMEN u a S G?)
SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Man�ifacjprer.
INFORMATION CHAMBER OR • 4 r
Type Of System: 11 45, f I 1 �_ UNIT Mode[ f�umber:
Ca2a r tiC C �c •`
DISTRIBUTION SYSTEM Sa, ,,,�,
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
I L
Pipe(s)
S Z
Length Dia [ Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of j xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes [1 No ❑Yes [] ]N,
COMMENTS: (Include code discrepancies persons present, etc.) Inspection #1: 1 ID / g / G Inspection #2: T 7
Location: 2148 126th Street Star Prairie, WI 54026 (SW 1/4 NE 1/4 14 T31 R18W) Prairie View Es Parcel No: 14.31.18.1117
1.) Alt BM Description =� p C C �o. �U pCSIrJ �i
2.) Bldg sewer length
- amount of cover
3) pit n' f - t "CR
Plan revision Required? D Yes No 0 I Z
e othe de for additional inf r a% �_ �. A -i
L W c aw. d ` gy p r r Insepctor's Signature Cert. No.
2 �C,
r Safety and Build'utgs Diyrspon County
201 W. Wavlhington;Ave., P.Q,_!�dz 7162 ,
�,i �a���n Madison, `GVI. 53707 - 7162 Site Address
De artment of Commerce V l 2.6,1 - -
Sanitary Permit Applicat Sanitary Permit Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide t71 Check if Revision 3 9 S ?°
tna be used for sec Privae Law a15. 1 m ;
I. Application Information - Please Print All Information r x State Plan I.D. Number
Property Owner's Name Parcel Number
,..,JY ry r- j Dag - 12-6 20 - V
Property Owner's Mailing Address Property Location
(�
34, 'A it S I T5 N. R
City, State Zip Code Phone Number Lot Tiler Block Number
�/
Subdivision Name s r
✓. f Vj
H. Type of Building (check all that aPP1Y) Q
❑City
, '2& - O ' t2 Family Dwelling - Number of Bedrooms ❑Village
❑ PubliclCommercial - Describe Use wnahi S � f f .
❑ State Owned Nearest Road
L2 3 `x (� 8 •� �� ads
M. Type of Permit; (Check only one boa on line A (numbering scheme for internal use). Complete line B if applicable)
A ' w 2 11 Re Replacement system 3 ❑ For County use
P Y Replacement of d ❑ Addition to
stem Tank Only l3 ks syste m
B. ❑ Check if Sanitary Permit Previously issued Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(mtmbering scheme is for internal use) 4C - [cT0
!t;@ an - Prossutized In- Ground 21❑ Mound 47 0 Said Filter 50 ❑ Constructed Wedand
22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass • 51 ❑ Drip Line
45 0 At -Grade 46 Aerobic Treatment Unit 49 ❑ Recircaia ft 30 ❑ Other
V. DIRWxw1rhyatment Area Information:
Design Plow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate 3ystcm Elevation Pinar Grade
Required Proposed Rate(Gals. /Days/Sq.Ft.) (Min. /Inch) 8levation
3 - �5 - �.7 1 - � X?,
VI. Tank Info Capacity in I Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks Septic or Holding Tack _
Dosing Chamber
VII. Statemtent I, ehe tmdmAped, responsib iliti for hutallatlon of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's S MP/haw Number Business Phone Number
)3r
Plutnber'S Address (Street, City, state. Code)
VIII. Court /De partinent Use O nly
X Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
11 Sarchalt Fee)
Owtur Given Initial Adverse . --
Determination so ftah S f - &-A Ce C.) 10 f i 0
IX. Conditions of A ns for Disappro 1
Attach complete p%m (to fife Conety onty) for the system ao paper not less tww 81/2 x 11 laelm in sire
SBD -6398 (R. 05101)
P LDRE S S
PROJECT Ewlen Prooerties 649 East 3r d New Richmond Wi 54017
SW 1 / 4 NE 1 / 4 S 14 /T 31 TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9/15/01 BEDROOM 3
CONVENTIONAL XX)C IN-GR06td PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1 000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
IL BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100° Filter Zabel A -100
❑ BOREHOLE O WELL -H. R. P. Same as Benchmark
SYSTEM ELEVATION 93.3
Alt. BM Top of 2" Pipe @ 100'
Plans Designed Using
Vent Conventional Powts
Manual Version 2.0 ?
> 12" Sidewinder High
of Cover Capacity Leaching
Chamber
6' Long 16"
3 4" Grade at System Elevation
Pro 3
Bedroom
House
'0'
2 -3' X 69' Cells w' >3' Spacing T
B -2 0' B -1
,s
Vents
en
ts
2% B -3 5
Slope 35'
10' * Alt.
M.
25'
Property Line 125';
` PLO PLAN
PROJECT Ewlen Properties DRESS 649 East 3rd New Richmond Wi 54017
SW 1/4 NE 1 /4S 14 /T 31 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9 BEDROOM 3
CONVENTIONAL XX)C IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 93.3
Alt. BM Top of 2 Pipe @ 100
Plans Designed Using
Vent Conventional Powts
Manual Version 2.0 07
> 12" Sidewinder High
of Cover Capacity Leaching
Chamber
6' Long
16"
34" Grade at System Elevation
Pro 3
Bedroom
House
10'
2 -3' X 69' Cells with >3' Spacing T
B -2 70' 10 B -1
Vents It Vents
5 '
2% B -3
Slope 5'
10' * Alt.
M.
25'
Property Line 125';
• �cQ � � ' l'] - o I
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
s Division of Safety and Buildings
In accordance with Comm 85, Wis. Adm. Code
County . /J
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must (.-
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Re awed by Date
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
I 2ra Govt. Lot �� 114A OZ� 114 S�/ T5 N R O ( W
Property Owner's Mailing Address V Lot # Block # Sub�Name or CSM#
CRY ' V J
e p Code Phone Number [] City ❑ Village Town Nearest Road
New Construction Use!: Residential /Number of bedrooms _ Code derived design flow rate GPD
❑ Replacement ❑ Public or mmercial - Describe: �`
Parent material �� cZ.c�� Flood Plain elevation If applicable e ft.
General comments
and recommendations;�t1
ST
a
❑ Boring •'
D Boring # `%- ;
5� Pit Ground surface elev. �ft, Depth to limiting factor in.
Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftl
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
j - 1-3/z �� a Z 'j-- 04- , �-
, 3
3
fi �3•�ai
a Boring # ❑ Boring
❑ ❑Pit Ground surface elev/ ft. Depth to limiting factor / ` Z
in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2
rS s vZ 3
i
I
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Na (Please Print) Signature CST Number
Address Date Evaluation Conducted Telephone Number
SBD -8330 (R07 /00)
Property Owner Parcel ID # Page of
Boring # ❑ Boring Q
;� Pit Ground surface elev, U► ft. Depth to limiting factor �"In,
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 I - Eff#2
- / .s
Baring # ❑ Boring
❑ 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/W
(n. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2
❑ Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Applicatim Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 I 'Eff#2
Effluent #1 = BOD > 30 c 220 mg& and TSS >30 < 150 mVL ' 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.07 100)
Soil Test Plot Plan
Project Name Ewlen Properties Sha
Address 649 East 3rd
New Richmond Wi 54017 CRTM #226900
Lot 22 Subdivision Prairie View Date 9115/01
SW 1/4 NE 1/4S 14 T 31 N /R18 W Township Star Prairie
R Boring ()Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 2" Pipe
System Elevation 93.3 *HRpSame as Benchmark
Alt. BM Top of 2" Pipe @ 100'
Pro 3
100' Bedroom
House
99'
25'
' B -1
98'
5'
2% B-
Slope 1 3 Alt.
M.
25'
Property Line 125'; IIH
I
+ ifety and &iiidirlgs Division County _
201 W. Washington Ave., P.O. Box 7162
Madison, WI $3707 - 7162 Site Address
De
art ant of Commerce 21cfg -�
Sanitary Permit Application Perrm[it Number
In accord with Camera 83.21, Wh. Ain. Code, pem W inlblmuion you provide 315 fg
MAY W gaud Cheat if Ravigion
Fri Law s13, t 0
L Applicad n Idwowdon - Pieria Print All Information Sacs Plan I.D. Number
Property Owner' Parcel Number
Property Owner's Malift Address OL()
property Loaetion
City, State Zip Code Lob Numttat Brock Number N.
;2 E
bdivbton Niiii Number
IL Type of Suaft (check that Ap*): o► Q ✓
2 Fundy Dw*Htng - Naodbar
❑ Public/comm mial - Describe Use loge
0 Stets Owned Nearest Road
ou�
M. Type of Pawft (Check unity one boa can Tina A (numbering schema for internal . Complete Hag B licable)
A 2 ❑ Replscemont Sysem 3 ❑ of 6 13 Addidon to County use
Buds ' s ystem
1B, ❑ Check if Satttt q Permit Pmvicu* Usued pernl Due Issued
IV. Type of Petradh (Cbuk alt that apply)(mambaft to for int see) - loo
Nat - Ptesatdmd In-Ground 2111 Mound ❑ Filter Sri ❑ Constructed Wetland `
22 ❑ Pressurized 14-Ground 41 ❑ Rolling Tank 48 itugie Pass' 51 ❑ Drip Lim 43 ❑ 4b ❑ Aerobic Treeemem Unit 49 R 30 ❑ Other
V. Ana Info t
Design Flow (t o Diapered Area Diaperral Area Soil tication \ Percolation Rae Syabem Movadon FitW Grade
Requirod Proposed Ra Clale.iDayslSq.Ft >) (MinAlrA) Skvation
VI. Teak Ink CQU4 is Tons Numbs Manufacturer Prefab Site Steel Fiber plastic
ilatboe
New Bzisdas (lelloas of T \ Concrete Consaucted Oka
of ftb tng'Ibtlo
DOWN chnow
VII. Statsmant- 1, ties assume for taalagdlon of the POWTS ehoitw on the attached
PName mcko s MP/ivIIyitB Number Business Phone Number
flttmbees Addrou (St wk Cby. Sate, )
-
V va
❑ , S anitary _ Pee (includes Groundwater Data issued faming A,8 Qt S1p& (No Stamps)
0 Orrasr Owen bid d Adverse • F") 2� \
�.i� A t^-A- " 0C I t• W. L . 0 R--
Allub eere34 pion 06 the Coatafe **) tar tie **m aP yepa• Pot 2061 dan aura U t m*m m pea
SBD -6398 (R. 05101)
PLOT P AN
PROJECT Roaer K eoDDle D ESS 649 East 3rd St. New Richmond Wi 54017
SW 1/4 NE 1/4S 14 /'r 31 N W TOWN Star Prairie COUNTY ST. CROIX
MFRS Shaun Bird 226900 DA TE8/20 /01 BEDROOM 3
CONVENTIONAL XXX IN -GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
BENCHMARK V.R.P. Top of 1" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL sH.R.P. Same as Benchmark
B.M. SYSTEM ELEVATION 96.0
105' 10 ' 47' 53' 0' operty Line _ l
No B -1 Alt - 9 9 •`i� �! �p u P P`1�/
Vents Vents
2 -3' X 69' Cells
with >3' Spacing �- 5'
S
Pro 3
o Bedrm
4 Hesse
00
N
i
i p
Vent
/Sidewinder High
> 12 Capacity Leaching
of Cover Chamber
Plans Designed Using
6' Lon 16 Conventional Powts
g Grade at System Elevation Manual Version 2.0
34"
PLOT P AN
PROJECT Roaer Keormle DD ESS 649 East 3rd St. New Richmond Wi 54017
SW 1/4 NE 1/4S 14 /T 31 N W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE8 /20101 BEDROOM 3
CONVENTIONAL XXX IN -GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
BENCHMARK V.R.P. Top of 1" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL R P Same as Benchmark
B.M. SYSTEM ELEVATION 96.0
105' 10' 47' S3' 0' operty Line
AL
B -1 B-2 Alt
Vents Vents
2 -3' X 69' Cells 51
with >3' Spacing
S
5 '
a
a Pro 3
o Bedroom
House
o0
N
O
O
O
O
Vent
> 12" Sidewinder High
of Cover Capacity Leaching
Chamber Plans Designed Using __�
6' Long 16 Conventional Powts
Grade at System Elevation Manual Version 2.0
34"
P
wisteo Department of commerce SOIL EVALUATION REPORT Page _ of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must St Cgo
include, but not limited to: vertical and horizontal reference poinQBM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow and location and tance to nearest road. nct
Please prinVall' nformatlon. viewed by Date
Personal information you provide maybe used for second pprq nvacyJ aW, .15.04 (1) (m)).
Property Owner P►operty Location
r^ Gdvt. Lot SW 1/4 NE 1/4 S 14T N R Wor) W
AS
Property owner's ai ing dress �K L t # Block # Subd. Name or CSM#
1430 220th. Ave. c;uNTv 2 r>a Prairie View Estates
City State Zip C PhqS*hl5WFlCE i ❑ City [j Village ® Town Nearest Road
NeW Richmond I WI. 54017
j New Construction Use: Residential i Numberbf s 1 4 Code derived design flow rate 600 _ GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material MtWaSh Flood Plain elevation if applicable na ft.
General comments
and recommendations:
trenches @ el. 96.00'
Boring # E] Boring 99.80 +100
1 [][ 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 /fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
2 11 -20 7.5 4/4 none sl 2msbk mvfr 9W if .5 .9
3 20 -10 7.5yr 4/6 none ms osg ml na na .7 1.2
•0
S• b $�
Boring # E] Boring 99.40 +100
2 ® 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. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0 -11 10 2/2 none L 2msbk mfr cs 2f .5 .8
if
3 22-100 7 5 4 6 none ms 0sq ml na na .7 1.2
•tf
Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ffluent #2 = OD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature . CST Number
Gary L. Steel 02298
Address tiate EvaluationCoWdOffed Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 11 -29 -2000 715- 246 -6200
Property Owner ri (.11 0„ D repe- �; es , Ltd, . Parcel ID # pen Page 2 of 3
a Boring # El Boring 100.00 +100
® pit Ground surface elev. ft. Depth to limiting factor in.
-- ST 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 'EMQ
1 0-10 10 2/2 none L 2msbk mfr Cs if .5 .8
2 10 -25 7.5 4/4 none sC1 2msbk mfr qw if .4 .6
3 25 -10 7.5yr 4/6 none ms Osg ml na na .7 1.2
F Boring
Boring # ❑
C1 pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
F
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit 5iiNplication 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 '01102
Effluent #1 = BOD, > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD c 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.000)
f
STEELS SOIL SERVICE
Gary L. Steel Ewlen properties, Ltd. 1554 200th Ave.
CSTM2298 , , New Richmond, WI 54017
�
44 S14- T31N -R18W
MPRSW -3254 town of Stzr prairie (715) 246 -6200
lot #22- Prairie View Estates
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.
IN
�1 =40'
top of 1" pvc pipe @ el. 100.00'
Alt. BM.= top of 1" pvc pipe @ el. 99.45'
2
l'
l Z
a �{
CIO
Gary L. Steel
:11 -29 -2000
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
1. If system fails, determine cause of failure, use alternate area and install new system or
install system at a lower elevation.
2. Replace any other failing components as needed.
Plumber: S n Bird 715 - 246 -4516
Shaun Bird #226900
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Q O Pde,-
Mailing Address L z! Lc J �J S < L " "
Property Address
(Verification required from Planning Department for new construction)
Cit /S t pr o ' , v Parcel Identification Number
LEGAL DESCRIPTION � C i/� Sec. T N -R� w� Town of G�/Y�
Property Location /., �L—
Subdivision ��1 �—� _;_l
Lot # C
Certified Survey Map # , Volume , ,Page #
Warranty Deed # Volume , Page #
Spec house ❑ yes ❑ no Lot lines identifiable 0 yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenanceof 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
mastorplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on site wastewaterdisposal 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.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal syst em with the standards
set forth, herein, as set by a Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification within
that your septic to has been maintained must be completed and returned to the St. Croix County Zoning
dapy the three year on date.
APPLICANT DATE
OWNER CERTIFICATION the owners) of
&descnibed tify that all statements on this form are true to the best of m ( our ) knowled I ( we ) am (are)
th pro v by virtue of warranty deed recorded in Register of Deeds Office.
SI A LIC DATE
« « « « «« A 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 is the warranty deed
w : 1468PAGE 556 6 33�s
WALSH
c0 / STATE BAR OF WISCONSIN FORM 2. 1998 R k EGIST E H.
E R OF DEEDS
GISTEEDS
ST. CROIX CO., WI
nocumprit Number —WARRANTY DEED This Deed, [Wade between Ernest J. Dosedel and Marione 13. RECEIVED FOR RECORD
Dosedel husband and wife 11- 05-1999 10:40 AN
Grantor, conveys and YARRANT11 DEED
EXEMRT N
warrants to EIdLEN Properties Ltd Texas Limited Partnership. CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 1060.00
RECORDING FEE: 10.00
Grantee. RAGES: I
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of
Wisconsin (The "Property "):
Recording Area
i �+
i. EST.
13,. .;CUs
03g- 1057 - 50.000 & 038. 1057 - 60-000
Parcel Identification Number (PIN)
This is not homestead property.
S %2NE' /., Sec. 14- T3 IN-RI 8W except commencing at the Northeast comer of said SE' / +NE' /4,
Sec. 14- T3 IN-RI 8W; thence Westerly along the North line of said SEr /.NE' /. to the Westerly
edge of the right of way of County Trunk "C"; thence Southerly along the Westerly edge of said
County Trunk "C" right of way a distance of 608 feet to the point of beginning; thence
continuing South on the Westerly edge of County Trunk "C" right of way a distance of 208.71
feet; thence Westerly and parallel with the North line of said SE' /,NE' /o of Sec. 14- T31N -R18W
a distance of 417.42 feet; thence Northerly and parallel with the East line a distance of 208.71
feet; thence Easterly and parallel with the South line a distance of 417.42 feet more or less to the
point of beginning.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this z C -4-1 day of October, 1999.
*
� *Ernest J. D el,
* Mkjorie 0. Dosedel
AUTHENTICATION ACKNOWLEDGMENT
Si na� st J. Dosedel and Marjorie B. Dosedel STATE OF WISCONSIN
h g usbatlE�HtL) ) ss.
authenticated thi County )
da y 0 • r; t 999.' Personally came before me tttis _ day of
1999, the above named
* rtgu�Og ,land to me known to be the person(s) who executed the
y foregoing instrument and acknowledge the same.
T(tlf $ER STATE BAR OF WISCONSIN
lil
authorized by § 706.06, Wis. Stats.) +
THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin
Attorney Kristin Ogland My Commission is permanent. (If not, state expiration date:
Hudson, Wl 54016
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
*Names of persons signing in any capacity should be typed or printed below their signatures
wARRANIY DEED STATE BAR OF WISCONSIN
FORM No. 2 - 199E
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