Loading...
HomeMy WebLinkAbout040-1072-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 1 = 420635 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: Erdman, June Troy Township 040- 1072 -10 -000 CST BM Elev: Insp. BM Elev: I BM Description: � -- ' - 2$ q , 275 M 6a . a r t� . a CS`� J TANK INFORMATION LEVATIO AT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark � 12. SE) • 4 ICA • Dosing 0 Alt. BM Aeration Bldg. Sewer 1 N Holding St/Ht Inlet St/Ht Outlet / TANK SETBACK INFORMATION S. Z Z ���{•�$� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' ' l � � z 8 , / �,. Dt Bottom a Dosing Header /Man. �, Zo Aeration Dist. Pipe _.. p. Holding Bot. System 11-Z 9 Y6 PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover S . 3 } t GPM O� ` Model Number TDH Lift Fri Loss System Head DH Ft Forcemain ngth Dia. SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengt� No. Of Tenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 0 SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacpr INFORMATION CHAMBER OR Type Of System: t . Z5 + �� 8 UNIT M el IJumber: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Pipe(s) ` lDia Length Dia SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed/Trench Center Bed/Trench Ed es To soil g p Yes No [] Yes n No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 Inspection #2: ­ 4 Location: 362 Deer Valley Dr River Falls, WI 54022 (SE 1/4 NE 1/4 18 T28N R1 9W) Deer Valley Lot 25 1 _ Parcel No: 18.28.19.275a 1.) Alt BM Description = k.S+Q.. S•T• 2.) Bldg sewer length = Z 8 - amount of cover = �g V N 4- _10 Ems Y e s t revision Required? L_i No Use other side for additional information. U _ SBD -6710 (R.3/97) Date Insepctor's Signa ure Cart. No. �., .n. uv.ati rAA (10 san 4060 9T CRA CO ZONING 1�1p01 l �7'snd tisilsitt� Qirillea C+�we1 � � �� t 201 W. Wub ftftb Arc,, Fa 8M 70 2 M"NS. WI 53707 - M2 NwAw (pr be MW in w Coc) trtstmt of c ommW eW (� 2f1a6316 3 Sanitary Permit M.wrnl wi0 C.esse saa I. IIN! Ad. t _ ltiei�E uayl.treliesaee..dMypa� .i3.6M(iKwy l' w1eaMAna(�dtdf'a.�tdMS:trY�e�M1 L AppNe afte h t•1M "Hes - h/als. Flw L j��s`� I 3Co hapwq� f7nraed't ihste T.toN s t.at s t 1 TII: s I W IL i�! of (idtedr s1t IItN sue) 4or ]llssi�Diwpi�_tlnMsads�.dr.lws tone cs" l•+iidCwawrnlclN- Dsrcn3e Urs DOW I L st F+.reeib asdy otte hs *6 lira A. it A' s7 0 1l"M w-m sy.— D 7W..MAfts-r-* am'.." O* O od. al.disraeo. a RowiDs sy— s. 0 soew.l tarwc Rwiaoe D L+rt tr..�oea a'ertar AMa1er s.0 s.at. � Ttsestrel. rs..r . IV. of Fowls C%wk 11 ow now WW ta4WWA d &SWAM? 20 W af= tW $*H 0 MSWd c Ir WL of =W*k $W ❑ wt-fttade ❑ &: Pan. slas later ❑ rwdwa Q ►rs».uad MAke.d ❑ uga r rG a pat F D Aseslk Tftw= w LM © weir* ablkq Sad FAW 0 s�aer�ea�.lt.t>Neer D CbM&W DD M LMe c...&kq 00*er ) Y. I Am Flv� bard) Maim soi dspiM Arm Rage�ed . Tragosed M s yd — r S VI. Took In i c in TOW Halal sAe Swd FAw Flank 08%M tidba! oftwu C..eeat. Coe.a.eeld dear = I rw. IN o VII. StNtalnli- 1 rt Nigfl led, Ar tic tOWiS ebneo N q. aw w ! saai. a rbow HtaaOw O -S3 T(& Q S' /as S In O VUL QsioftMg use © sw�wy ►txar►r � . +0laratArlr► o.te worst lu.ies ) � 0 o..e.c. Room %, Doom A 6 IX. Cftoft is f r "rs al _ o A Dk _ � Ao..b +t�•e►e «+e►aaAcew.. »pprtwr..>r..Nal1 t.s� - SBD -6398 (R. 08/02) t N \1 Vv�4 � VCS \\ E Z 12 03H iT T•Ttf fitrrr♦ o ` fT TrOr �-c ' r1i .. � t.. - t • ttti ry +, f f it ♦. - t ^ f1f .tf 4.625" wV : •tt i it r♦ Vr f r, Vi 7 112 Ci ••i �T•• i7 e • f1••T••iTi; 1� •ii, • •rr, 24 #1 V 36 'r lte I2 -I/2" DbI . (typ tieia c oe#T[cre A gWepW afiv" at Sl, ;fir., 0.1), ofd^ §w w r{ Arla ihve �, 4425 ��' !� void -I-- -I-- e S'dtwatl f2 s�aUs #Q EL •twin r2 ' o.aa ya. tin O. a. of .0"'. s R.S t3ottnm rrnoGa tft Vow voles i:t aWett. ofrarnmrr eYiandM: 12 i+�et i.rs m �= Totai Safi 1wtK 3.00 ertin - (a.zs tare qra + O.U. o foyCSWr t2 sir ' -57a. 4I2 re SQ 1 vord volum m naitide 3_! l IZprti j *.574.. 90, f}' Pro3Kted T rese(i Area Sidew 'Void rol ail Height � 12 � tom �k'een cylira�rs 24ie Z � 2.00 Sq.Fl. f (� _ 8ottpm ti2inrfi l2wr �-�.r�? —�"_� l( 5 ft. in. = 3 - OOSq_Ft_ ' � v ot�c at oao� �ot� t t tzia, ft !� Profeet � its trY 17 + Ta t v ° f void vo lume berwsrr c6 Area � t 11 oid volume - 0. ! 0,422 S Ag Sq.Pt +O.Qp1 � `'l`in'�t0..lS.: -0 108 k' I Ga1fu t.763 0 .2iS . 0. 109 0 r+rbu 8 s As p er R' X7.413. , ¢t? (t t!3- s`8� E'S Aggregate Trench SYs t ern EZ12p3H R''nil AnduStri0l Group flame 65 tndtlakiGl P Oakland. TN °rk Rd. ! 38060 j j j Sift ad >irr�s D�iir t�rris► 301 N. wadAleum Am. t.Q fra 710 of Cie 3 UJL Per .� ,..,f..,.. irain7► !twat Mrriar In Namd rft Cinn UM. WiL AdwL Csik pwi=W k#wwMW7w W,4& c"at a RAVW a S bras oa.aaa a aa. E t V E D �• L..al.. O sE x NF % -s 1 r ' N x l ow 2* cob rM CSM akmdA syo sr al�iis #ra.et ai Mwt a� +ar 2 Rnib Ou+is - WMMhw d Yeas 1 A41 n 4 3 3 o C mo m Veit. err a fCbK& MW WW bWw . ja.. aiia.aitar waaaaal waNy. t1ai.�r. . t 4L Mbw 2 Q ft* =w rt *ftn 3 Q a n..wc d l a 0 baft 1Olk RAWN s- Q Eiw! r M4 vtmm t n low* r MM l it Mahar Dur Mao n Ti ..r �laarit l�ClMett r ae�►btiir•iM� adwas it •r iia w"d wo ' .. "M - ll�i./ lO me 230 .�. 47 o in. POW 59 CJ..,wa..r.a1�d G� 1213 pono foe b4kwmd a D aluk itat 4! ❑ $W* tan St D ary uw� 43 E) ASOMb 460AW*k 40 02NMdMft M Q MW Sim I ra IMAM A..a wa�.we naw SWAOPMMdft ! am OMMft TL Took Sdb � r i►.r rs M s !It ftd ! Or1as Olson 4977 is osnaar C)MOM ad ohm �.. a►Ir�t r � tea.!- r Qr .rraa 2OOO2rla�s..►rae.M.raM Orator !!aw Maalar s pis 535 "NOW% MUM Oft* CW%M~W. t g Soh v , .o r on ci. Co a D [I � OaArry 1lurrk !te + mb" awwa mw Dart %MW �raae 0 Own OMr b&M wilr.ras � M � f 0 C1aa�i1lYs ar err ° 3 l� -``� �i'bV Sa -hest -b & 0 s�rr e t e �r�t�ur- � � ► c ' +^^ C 1,2�k �o�h a-F - 1 -�'r►� o � �a,�r2fiv�, <(.ed . � e P:171 Fov 011 Aa1rA+a�+�a �A�raOw� air ash.. alrrava �earie __ p e� � � 3 n,cacae nt matt i 6 � S q - /, , f j [ qkAJ J ol Ueli , I ' I � Al! l! g _ "T q ' � I a` 4 I ;al Nk I I - i I 111 J -L- - - I { I • ' I 1 , I 1_ �d 4 } I i t I I I 1 I I ' I : : PI P \ , a VII ,Ii vi E Yy S; I s 7. 1 ' 1 I C [ c ( - 1� 0 0 cam . Rd e� v�ti� LOT aS �- I e:Q o Fl ip a r c'3, 7 O &0 sde- n, -'r Ian u A A�� _ = 0 - Ail t _ �( l ii lx __ __ .� __ �_ __ __ - - - _ _ -- __ _ _ _ _ Ue Nay _ Us ft Unita: i � a X76 ` e OmWkkag or Whadow a hoc anal c . PrOWdes the xiir � �► tb unJU&S'�d fye te °gym t to pr0"d space- Its e ed art si villa -- ��1 o to al l 09w botto�'�8n nmas# M n d r'}' a ct efi`lu on in a ent to ow ev ed b via ��/ It r °'mbinin ons. s o„ us* ° with ,� g the traditional ...._.. Pipes E series of lou . ope ....76- Low � t l # al�� Hers a long the sides w h.._....... ... 34- ... ....7s- Ic�ggtiy8ht ..... . 14' Wiah - ......34° s "'°'rup;�t,ct a Bch she. The larve� _.._._.........9" '� H ht.,_.... .11° r�1`1ll while r . -Pass into the ' Mvre+f ...._...... &.5. to umber rp"D,,,,� Of 12' or ra, 7"' Mdtitst h- i Q d opft r fACivrs Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor Prib Human Relations Di4sion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/ size. Plan must include, but St. Croix not limited to vertical and horizontal reference po' {� �i _46n d °(o of slope, scale or PARCEL I.D. # V--*' dimensioned, north arrow, and location and di c 0 nearest road.' 'ti, 040- 1072 -10 APPLICANT INFORMATION PLEASE, RI,NT ALI, j MATION R VIEWED BY DATE ` : PROPERTY OWNER: '�; P OPERTY LOCATION �y� �2 D ud` d' F 6 �ki VT. LOT SE 1/4 114,5 T N,R 1�(or) W Derrick Construction Inc. 18 PROPERTY OWNER':S MAILING ADDRESS X LOT # BLOCK # SUBD. NAME OR CSM # , 1505 H 65 e CITY, STATE ZIP CODE HONE N % CITY ❑VILLAGE [XrOWN NEAREST ROAD New Richmond WI. 54017 7 Troy E. Cove Rd. [X] New Construction Use JK ] Residential / Number o Tooms 4 [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum deslg loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 99 It (as referred to site plan benchmark) Additional design / site considerations na �n b�� dal (S Sim �dUve►'S i yt 2 S� Parent material outwash Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S El nS El ® S El ® S 11 U ® S ❑ U ❑ S (NU SOIL DESCRIPTION REPORT ° f t v 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 0 -18 10 r 2/2 none 1 lcsbk m .4 .5 2 18 -34 10 r 4/4 none sil lcsbk mfr crw if .2 .3 Ground 3 34 84 7.5 r 4/4 none cos osa ml Ena na .7 .8 elev. 1 02 . l ft. Depth to 1 3 f , . limiting factor +84 9 ' 0 � 34 34 1 2 34, de cucQ -�-v s s Remarks: 5 r CbQit,Qe S d SQi+>� W rue �Ary� r H Boring # 1 0 -20 10yr 2/2 none 1 lcsbk mfr cs 2f .4 `:.5 2 " 2 20 - 33 10 r 4/4 none sil lcsbk mfr if .2 � .3 3 33 84 7.5yr 4/4 none cos os ml na na .7 .8 Ground elev. 1 02. O ft. Depth to limiting factor +84" 3s ►b�/.1 b Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200 e. New Rich and WI 54017 Signature: Date: 5 -28 -99 CST Number: m02298 I 1. PROPERTYOWNER Derrick Construction SOIL DESCRIPTION REPORT Page L -of PARCEL I.D. # 040 - 1072 - 10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence �.* Roots GPDIft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ..._3 1 0 -16 10 r 2/2 none 1 lmsbk mfr cs 2f .4 .5 ................. 2 16 -29 10 r 4/ none sil lmsbk mfr gw if .2 .3 Ground 3 29 -38 10vr 4 4 none sl 2msbk mfr .w if .5 .6 elev. 1 4 38 -86 7. 5yr 4/4 none cos osa m1 na na .7' .8 Depth to limiting factor 86 ' 5 �b Remarks: Boring # 1 0 -18 10 r 2/2 none 1 lcsbk mfr QW 2f .4 .5 4 2 18 -33 10 r 4/4 none sil lcsbk mfr if .2 .3 Ground 3 33 -88 7.5 r 4 4 none cos osq ml na na .7 .8 elev. 103.q —_ Depth to -- limiting factor +88" Remarks: Boring # — T — 1 0 -9 10 r 2/2 none 1 lmsbk mfr cs 2f .4 .5 2 9 -20 10 r 4/4 none sil lmsbk mfr gw if .2 .3 Ground 3 20 -26 10 r 4/4 none sl 2msbk mfr gw if .5 .6 elev. 4 26 -88 7.5yr 4/4 none cos osg ml na na .7 .8 10 ft. Depth to limiting facto p +8 " Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SE4NE4 S18- T28N - x 19w New Richmond, WI 54017 MPRSW -3254 town of Troy (715) 246 -6200 lot #25 -Deer Valley 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. L =4 0 top of mid -lot survey stake C el. 100.00' Alt. BM.= top of 1" pvc pipe C 101.70 40 -A #� Gary L. Steel 5 -28 -99 I POWTS 4VMM'S MANUAL & MANAGEMENT PLAN � of FM.E MINVINN SYSTEM Sl6fiCAT10NS Owner Septic Tank Capacity 0 NA Pbrmrt i d 3 S Septic Tank Manufacturer ✓S 0 NA 06 MINI PARAMETBIS Effluartt Falter Manufacturer NA Number O of Bedro 0 NA Effluent Fiber Model 0 NA Number of bfic facility Unfs O NA N Pu Pump Tank Capacity ga l 0 NA Estimated flow (average) p C) Pump Tank Manufacturer 0 NA Design flow (peak), !Estimated x 1.5) Pump Manufacturer 0 NA Soil Application Rate `7 Pump Model 0 NA Standard (ryfkuent/Effluent Quality Monthly average Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg/l. 0 Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand 1801:} 5220 mg/L 0 NA 0 Mechanical Aeration 0 Wedand Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection 0 Other. Ptietreated Effluent Quality Monthly ars Dispersal Cents) 0 NA Biochemical Oxygen [)emend 1800 530 rrhg/L f,,J, n -Grand (gravity) 0 In- Ground (pressurized) Todd Suspended Solids (TSS) 530 mg/L 0 NA �0 At -Grad& 0 Mound Face( Coliform ig&orniMic meam) 510` cfu/100m1 0 Drip-Line 0 Other: Maximum Effluent Particle Size Y, in dia. 0 NA Other 0 NA Other 0 NA Other 0 NA 'lrakwo typical for donwestic wsstswgtw and septic tank efiknnt. Q��er. 0 NA SCHEDULE Service Event Service Firewency Inspect rtndition of tank(s) At least once every: rrnonf�is ( 3 yaws) 0 NA Pump out contents of tankls) When combined slydge and scum equals one -third ()y) of tank volume 0 NA Inspect dispersal ced(s) At least once every: 0 rrhorhtfn(a) iMaudwwn 3 Yaers1 0 NA k r"ds) Gear effluent fter At least once 0 monthis) �v- Y�sl 0 NA inspect pump, pump controls & alarm At least once every: 0 month(s) 0 NA 0 s) Fkash laterals and pressure test At least once every: 0 Yew h s1 0 NA other_ At least once 0 month(s) eveery: 0 yew(*) 0 NA Other. 0 NA MAMM'T!ElMANCE WSTAUCTOW Inspections of tanks and dispersal ce t shall be made by an ardwidual carrying one of the following licenses or certifications: Masten' Pkrrnber. Master plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. Tank ➢nspoctions must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the Influent levels in the observation pipes and to check for any ponding of effluent are the ground surface. The pondurg of effluent on the ground surface may indicate s 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 (Y or more of the teak 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 components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4 /01) r Z'"W UP AND OPERATION !'Rpm of FOr than e now eonstnede �on- Prior to ties of the POW TS shack treatment tm*fsl for the presence of pain Y rrnp the � P and /or damage tt* dopersal ceWs). If tng irodticts or otfnsr chemical of the tankW removed by a � operator prier to use. hid► aupnrasn anions are detected have the content System start up shall not occur when soil corditigns are 11"Wen at the infiltrative surface. During Power outages Pump tanks may fill above normal highwawter level, When disdWirged to the dal ceNts) in one WW dose, ov Power Is restored the excess wastewater wild b effluent. To avoid this situation have the P ding the cel(s) and Wray result in the backup or surface discharge o c ontents of the pump tank rangved restore normal level within the Pump tank. Plumber or POWTS Maintainer to assist rrtar lY �per$bng P P contr ols t( Do not drive or parts vehicles over tanks and dispersai salts. Do not drive a within 15 feet down slo Park °' otherwise disturb or compact, the ghat �' +d` any nntwrd or at -grade toll absorption area. Reduction or elimination of the # POINTS: entibiotics; ba f ollowing from the wastewater stream may improve the Performan and Prolong the life of the foundation drain Isurttp w�; a9arette butts; = cotton swabs; dW6ft rs: dental foots; diapers; disinfectants; fat; Pump) water; fAW and Vegetable Painting Products; Pesticides; sanitary napkins; tampons; and er soften' brine. Wane herbicides; treat saris: medications; oil; ASMOONMEW When the POWTS fail and /or is permanen* taken out of service the Properly and safely abandoned in with follo pow• ensure that th system is t#ua�pter Cornrn 83.33. N►eetmnsitt Adrniru' • All Piping to tanks and Pits shad be disconnected an d the abandoned pipe openings seated. • The contents of an tanks and pits shall be removed and Property disposed o f by a septage Servicing Operator. • After pumping, all tanks and Pits shad be excavated and rartwved or their covers removed and the void $od. gravel or another inert solid material, id space filled with CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been. or must be taken, to provide a crude comppant replacement system: A suitable replacement area has been evaluated a may be utilized for the location of a replacement soil system. The replacems"t area should be protected from disturbance and setbacks from c�Pamioru and should not be infringed upon by euei sot and site a val structure resu . lot lines and waft. Failws to protect the repiacwrant area will h in the need for new tetra and evaluation to establish a suitable replacement area. Replacement systems must comply with the riders in affect at than time. ❑ A suitable replacement area is not available due to setback and /or sod limitations. i3arrit:g advances in POWTS a holding tank may be installed a s a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be perfomned to locate a suitable r0plecerneent area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Motmd and at -grade sots absorption system may be reconstructed at place follow infiltrative 'surface. Reconstructions of such em9 removal of the biomat at the Systems must Y with the rubs oo effect at that tirrne. < < WAf MNG > > SEPTIC, PUMAP AND OTHER TREATMB" TANKS MAY CONTAIN LETHAL GASSES AND/OR ITT OXYGEN. DO NOT EMIER A SEPTIC. PUMP OR OTHER TREATMENT TANK( UNDER ANY SAN CES. DEATH MAY RESULT. RESCUE OF A PAN FRfRR THE IM1 W40R OF A TANK MAY 6E D�ULT OR WpOSME. ADDITIONAL CMAMM" TS POWTS MIM'iTALLER POWTS MAINTAi11Efl Name , ,S Name One S1 Phone SWAGE SERYICMW OPERATOR WlIMPERI LQCJLL REGULATORY AUTHORITY Name Phone Name 1 5 � S This doctsresr. was drafted in comhpsence with chapter Conme 83.22t2ub11114dj&M end 83.5411). 12t dr 131. WWconsin A trativa Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND . OWNERSHIP CERTIFICATION FORM � A � M E � � Owner/Buyer er J U Mailing Address �� 60 VIE PO/A -A A //uUS 0 � �CI�' ..S' S10 1( Property Address VA t_t.. L� 6 eZ (Verification required from Planning Department for new construction) CD City /State #u - ° 4 - � Parcel Identification Number © 4 1 1 0 - 7 O 0 �3 LEGAL DESCRIPTION Property Location '5C V4, i4f V4, Sec. / 9 ___ j T 21- N -R �g W, Town of rz-o � Subdivision ��'��- �� �- �- c Lot # ZS . Certified Survey Map # , Volume _ Page # Warranty Deed # � . Volume 3 . Page # Spec house Wqes ❑ no Lot lines identifiableXyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification foam, signed by the owner and' by a master lumber, journeyman 1' on- site ,) yman p timber, restricted plumber or a licensed pumper 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. 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 S ; K eee year expiration date. OF TURE APPLICANT 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 th rop described ab ve, by virtue of a warranty deed recorded in Register of Deeds Office. ATURE OF APPLICANT 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 WARRANTY DEED (Fanner Srntutory Form). � STATF. OF %V1Se.ON3IN Mlller•Davi.4 Co" Minnenta,6a, Aann. Form No. D W. 2 59154 Whis Inbenturr, rlhulc by Archie J. Waxon and Lois Waxon, his wife, J grantors , of St. Croix County, Wisconsin, hereby convey and warrant tu' Jack J. Erdman and June M. Erdman, husband and wife as joint tenants erardett, , of St. Croix County, Il''isconsin, for the suns o f One dollar and other good and valuable consideration the followings tract of land in St. Croix County, State of II isconsintr Northeast quarter of Section Eighteen (18), Township Twenty -eight (28) North, Range Nineteen (19) West, (NEI 18- 28 -19). i REGI%THR.S OFFICE 3T. CROIX CO.. WIS. Kec'd fof Hocord thii-_ -17th dey of__ _Aut I _59 ),IV d Hope Deputy In Ulitnrua Wflrrraf, 7'he swirl 1 s haVchc,•cnt„to srt the it h,110 s,Ir,l „l s chi„ 14th rl „y of August .1. !�. 1!i 59 SIGNED AND SEALED IN PRESENCE Of I. I ? - - -` cl 'e J,_�s H `r1 Givin r Lois Waxon �iarold !Yalbrandt Otutr of Wwronuiit, St. Croix ('ou,rlryj Personally cu»ic brforr• nie, this 14th'. - (MY of August .4. D. 19 59 the oborc natnrtl Archie J. Waxon and Lois Waxon, his wife, to n,c kvu„rw. to be the lovrson it c.trcutrtl fit forc�Voiny instruntent (Intl acknowledged the •.w It) e. r ”- Iiligll- _ J .Notary Public;_------ �t�_�IIiX_ _ Cotcnty, Iris. t'I+IJ Coln tirission e.rpirc.s_S -2 , .1, 1). 19 60 *Typewrite Name under each Signature ' P��K 360 r. "E 631 .I j y )r, 7 � L ca RD F o CA z — CO) O O � t0 o a a � . O q�iW A O �' W W N �� A A o c A a eh i 6 A O " �" N 0 to fa FO 13. rn P,a A o 0 ry C� I r J J.a 1 f 4 L V 1 q . l.t�