HomeMy WebLinkAbout002-1037-70-100Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
°' INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)].
armit Holder's Name: City Village X Township
/an Damme, Carol Baldwin, Town of
iT BM Elev: Insp. BM Elev: BM Description:
ioc7 (3 rv~ ~ G5-
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic
~; s i a~
~
Dosing ~ ~ ~ ~
eS.9-`.~ ~/ Q
J
Holding
TANK SETBACK INFORMATION
ELEVATION DATA
County: Sf. Croix
Sanitary Permit No:
506271 0
State Plan ID No:
Parcel Tax No:
002-1037-70-100
Section/Town/Range/Map No:
17.29.16.252A10
STATION BS HI FS ELEV.
Benchmark ~~ ~ ~~ 1 ~~
Alt. ~.p(1 L~ ~ J
f~'• Z • ~S ~ ~ ~7
Bldg. Sewer
~x.
d-; ~-
SUHt Inlet
~75~ aJ~ ~, ~I•S. !o
Dt Bottom ~
Header/Man. ,.~ ~
Dist. Pipe ,~~
`~ ,~ c ~~ Z cf.
Bot. System ~ ~, $ q3 . l
Final Grade $ ~ (
3.9 `TZ •,
~'
~w~,~. 1~ 5. ~5 95.55
~, l~ ~~ C ~ 5.~`i 9s ~ s3
1~a1~~. ~ ~ 5•`~~ ~s•s3
TANK TO P/L WELL. BLDG. Vent to Air Intake ROAD
Septic 7 ~5 ~ 7 SZj ~ Z ~ ~ Z ~ ~
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
GPM
Model Number
TDH Lift Friction Loss System d TDH Ft
Forcemain ia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width ~ Lengt
~ No. Of Tre-nc-hyes t ~ PIT DIMENSIONS
~ No. Of Pits Inside Dia._ Liquid Depth
DIMENSIONS jg z C' ell~~4/~,~ -
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING
CHAMBER OR Manufacturer:,.~'r~'~ 1
j ~
INFORMATION Type Of System: ` ' ~' yZ i ' SO ~ ^ - /1
' V ~f~' UNIT Model Number:
~ ~
>5 ~
a v
-.
• ---.. ~.
nICTDIRI ITIl1A1 CVCTGM
Header/Manifo~d
,~ Distribution
Pipe(s) x Hole Size
~\ x Hole Spacin
~
~ z /
Length ~ Dia_~ ~
Length ` Dia ~ Spacing ~ c~.v`
gnu /+/1VG~ __ .,____..__ c.___._.Y_ ~_i.. .,., ~e,......~ n. n~_r_.~.~o sv¢tcm¢ nnw
Depth Over / Depth Over
h Ed
es \
B
d/T xx Depth of
Topsoil xx Seeded/Sod\ded xx Mulched
No
Y
Bed/Trench Center ~~ ~ renc
g
e '^1~;es ~ No es ~~
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 2239 Cty. R. ~~ dwin, ~ 4g0~02 (NE 1/4 NW 1/4 17 T29N R16W) NA Lot 1 ~` Parcel No: 17.29.16.252A10
1.) AIt BM Description = \ G.~; ~,s ~- ~a L~J O I/~
2.) Bldg sewer length = /~ 1 S ~t
- amount of cover = C
Plan revision Required? ' ,_,I, Yes No ~ Z (~`'
Use other side for additional information.
Date
SBD-6710 (R.3/97)
~~
g Vent to Air Intake
~~~~ ~~
Cert. No.
commerce.vvi,gov Safety and Buildings Division County
~
~
4 201 W. Washington Ave., P.O. Box 7162 ~
p
~
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n ~ ~ ~ Madison, W 153707-7 be filled in by Co.)
Sanitary Permit Number (t
o
V
Department of commerce w
7
St~CQ Z ! I
Sanitary Permit Application
te S ransactiopjVumber
Nr/]l~.
tal
In accordance with s. Comm. 83.21(2). Wis. Adm. Code, submission of this form to the appropria
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-o~med POWTS ai
submitted to the Department of Commerce. Personal information you provide may be used for secondary ectAddress(ifdifferentthanmailingpCidress)
/
~
(
-
u ses in accordance with the Privac Law, s. 15.04(I)(m), Stats_ ~ ~ ~ ~ C~ /
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2
'
1. A lication Information -Please Print All Inforn
on
Property Owner's N• me ' t
~
U Parcel #
4
~, ~. D~, /031,~0~ o
Properly Owner's Mailing Address ~~ ~ ~ `/~
Property Location /+
/
,
(
Govt. Lot
Ci a, Stat Zip Code
'
floe umber ~~
Y., _~ %, Section
t ~
~D
(circle on
T ~ N; R ~ E o W
I1. Type of Building (check all that apply) Lot #
t ~r 2 Family Dwelling.- Number of Bedrooms ~-~ Subdivision Name
f_
a Block # -
^ PubliciCommercial -Describe t.!se
-- '~--~~
^ Cin• of
rilx
^ State Owned - Des
c
~ise CSM umber ^ Village of
,
/
~
/~~ -7
`` 1
Z kJ ~ ~'f' C..f: ~ ~./ ~ ! if`~ 7 / p~
~ ~®t~ O V~ ~ O r Town of tl)/~1
Ill. Type of Permit: (Check only one x on line A. Complete line B if applicable)
A.
^ New System
..Replacement System
^ TreatmentlHolding Tank Replacement Only
^ Other Modification to Existing System (explain)
B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner `L
1V. T e of POWTS S stem/Com onent/Device: Check all that a 1
Non-Pressurized In-Ground ^ Pressurized hrGround ^ At-Grade ^ Mound > 24 in. ofsuitable soil ^ Mound < 24 in. of suitable soil
^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain)
V. Dis ersal/freatatent Area Information:
Desig ~ low (gpd), Design Soil Application Rate(gpdst) Dispersal A~
e uired (st) Dispersal Area Proposed (,vFj Syste Elev~ tv
,
Vl. Tank Info Capacity in
Gallons Total
Gallons # of
Units / Manufac er
`1/
,o ~
t? v
Y
NewTank Existu
Tanks tt ~~ '~ a u
~ Y ~ i'e ~
h ~ ~
a, U ,
r
~ h
rn
u, C7 c~
u
w
Sept or Holding Tank ~ ~f S`O )^
h
Dosing Chamber
YII. Responsibility Statement- 1, the undersigned, ass responsibility (or installation o(the POWTS shown on the attached plans.
Plu tier's Name (Prin Plumbe gnature M!P~/MPRS Number Business Phone u ber~
Plum is dress (St eel, City, t ,Zip Cod r--- 1 ~
~~~ ~~
~
~ ~~
~~
1~~.
v l
Vlll. Court /De artment Use Onl
Approved ^ isapproved Permii Fee
$ ~~
~° Date Iss d
-
~
7 Issuing t Signature
^ eason fo nial , 7
6
IX. Condif,~E~Q~easons for Disapproval ~ _ ~ ~ / ~ t_p ~~ /~ ~ i~
' / l
!' ~
/ /1 ~ ~ a~~,~ ~,r ~ ~( ~O~
(
~ J [~
1. L4apt-c tank,-stltwftt flRar atttf
,
/ `~
dlspefsal cell must all be se es / mairtfaifrd -
as per management plan provided by plumtter,
2 A~ stttbacl( Itequiremertts must bm maiMainad
~'"-.dtiviTi ru c'dib~li~t~'(Srd9Tl`f>~i'the system and submit to the County only on paper not less than 8 to x t t inches in size
SBD-b398 (R. 01/07) Valid thru Ol/09
Safety and Buildings Division County 1
201 W. Washington Ave., P.O. Box 7162 .
~~~On~~~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Ca.)
(608) 266-3151
Department of Commerce
~"'
Sanitary Perm'. A ication State Plan LD. Number
In accord with Comm 83.21, }Avis. ~i~n. C" nal information you provide
ryyttrpAS~es Privacy , s15.04(lxm)
may be used for segot~da Project Add if different than mailing address)
a
#4 ,>
I. Application Information - Please Prin ormation
~. .
Property Owner's Name Pa el # Lot # Block #
Property Owner's Mailing dress Property Location
Section
'~~
~~'
City, State Zip Code Phone Number >
~
(circle one)
T N; R E or W
(check adl the apply)
e of Buildin
II
T
g
.
yp Subdivision Name CSM Number
^ 1 or 2 Family Dwelling -Number of B rooms
crib
Use
l -De
i
blidC
^ P
s
e
ommerc
a
u
^ State Owned-Describe Use ^City_^Village ^Township of
III. T ype of Permit: (Check only one box on 'ne A. Complete line B ' applicable)
A' ^ New System ^ Replacement System ^ TreatmendHol ng Tank Replacement Only ^ Other Modification to Existing System
B. ^ Permit Renewal ^ Permit Revision hange o ^ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plum r Owner
N. T e of POWTS S stem: Check all that a
^ Non -Pressurized In-Ground ^ Mound ? 24 in. of suitabl soil Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^
Conswcted Wetland ^ Pressurized In-Ground ^ Hol ' g Tank Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^
Recirculating Synthetic Media Filter ^ Leaching Cham r ^ Drip Line ^ Gravel-less Pipe ^ Other (explain)
V. Dis ersaUTreatment Area Information:
Design Flow (gpd) Resign Soil Application Rate( sf) Dispersal Area aired (st) Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity in T Number M facturer Prefab Site Steel Fiber Plastic
Gallons Ilons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement I, the undersigned, assume responsibility for in a WTS shown oa the attached plans.
Plumber's Name (Print)„ Plumber's Signature M Business Phone Numbe
A
P umber's Address (Street, Ci , S e, ip Code d } 9 L
)
/
/
~
D'
`
U t J f `
VIII. Coun / De a ent Use On
roved
^ A ^ Di pproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
pp Surcharge Fee)
^ er Given Reason for Denial
1X. Conditions of pprovaUReasons for Disapproval
~`le1 ~Vf"1 yl:l~~'~.v is
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SBD-6398 (R. 01/03)
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Wisconsin Department of Commerce SOIL EVALUATION REPORT ~~~,,,.,.~~e / of
Division of Safety and Buildings
111 GVWIVGIIt:C Wlul liUlllln 0.7, VVIS. HUIII. I..UUC
County
X
S ~/' o
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
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.. p~ ),p,
O D a, ' / d ~ 7- O ~ f p O
Please print all i rmation. Review by Date
Personal information you provide maybe used for se ndary rivacy Law, s. 15.04 (1) (m)). r0 Zip 0
Property Owner Vc erty Location
~' d M 0 , ~a h ,iQ aZ ,ha C
Govt. of ,N ~ p
1 /4 JI~1I11 /4 S '7 T ~ / N R
~D -~E-(o W
Property Owner's Mailing Address
9 20p~ Lot Block # Subd. Name or CSM# Y! ~
s
'
/ S'
z a 3 c R .~ s -- ~0~6 ~o i
c
f
/ /3
City State Zip Code Phone COU City ^ ~Ilage ~ Town Nearest Road
^ New Construction Use; Residential / Number of bedrooms .3 ~ Code derived design flow rate '~.~~ GPD
~, Replacement ^ Public or commeraal -Describe:
Parent material G ~d c ! d ~ T + /~ Flood Plain elevation if applicable N ~'1 ft.
General comments ,~' !' c ed,+, ~ e .~I ql cL. i~ C,pl cL c C .-s e•,~' ~ t"tC++~ W i ' ?'~~/ ~ hd v, 7~~i ~ 0.41
and recommendations: ~ ~ ~ ~ ~ J s ~o~/~/ cuks~ ~- f
*v q, d,s~oP. cit// c~ /. T /je ds' dard cell r
o~/edcl,•~~ e,~d.y,6e.s s'a.c~ a"r 1'h .' 7`dfrJ...~u•'cX •~ ot.• e_~cc."Y~,/eyf. ~Lcdo4.:r
cL~ d., ~ ..r s ! ~ti / ~ 6 e d7` d dePr`! ~' 7'tie 96=' ,~s 6 e/d ~. o+-. f , ;mt,/ s,~ /C . ~s`i ' .,/{/dire ? 7
Boring # ~ Boring ~O ~L ¢ f5-
,~ Pit Ground surface elev.~ft. Depth to limiting factor ~ / t4 in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff~
in. Munsell Qu. Sz. Cont. Color tic Sz. Sh: 'Eff#1 'Eff#2
/ ~~ ~ .
Boring # ~ Boring /~" t t ~ X17 !~-
Pit Ground surface elev. ~ /^~ ft. Depth to limiting factor } ~ ~ ln. Soil ligtion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffP
in. iviunseii C~u. Sz. Cont. Color Gr. Sz. Sh. `Ef(# i 'Eff#2
3 /7-1 ~af'~P 4/ `' r: .Z Qd ~ ~~ Q.s' / o• ~ d ~'
`¢ 1-7 = ~0 7 -S'i!C 6/ -- 1I s p s r., I - - ~ -7 !-
t 1
3 '
t/
~a
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mglL and T55 _< 3o mgi~
CST Name (Please Print) Signature CST Number
CG, ar-les we.~ ~ ~.~06"7.~
Address ate Evaluation Conducted Telephone Number
~s8i3' ~7f>-/GS~ t/jrvro.-fls, Cut" .~~ol~ s~s'1 ~67' 7/5.~.7.~--3~so..,..
Property Owner Cdhvl V~4 ~.2~~r G ParcellD# OD~~^~03~'7O-/mod Page °~ of
a Boring # ^ -Boring
pit Ground surface eiev. ~ 6- G ft. Depth to limiting factor T ~~~ in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Gonsistence Boundary Roots GPD/ft~
in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
D- loZ, lC~ f'i7~'l-l S ~ ~ ~ ~ a.6 /+
~ 7' v 2-s' ~ O. ~ CfJ. ~'
~ l a' /D X.~/,3 -- s,`l ~ r3 a/~ r~ r" Qs l ~-6 0- ~
4~ -~ 7 S " 6 ~- .r v r ~ - -- d . ~ / ~
-`
3
~ •l
r ~
~l
^ Boring # ^ 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/TF
in.' Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring # ^ Boring
^ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
.Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl~
in. Munsell Qu. Sz. Cont. Color Gr. Sz: Sh. 'Eff#1 'Eft#2
* Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.07/00)
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CER~'IFIED SURVEY MAP
Carol VanDamme
Part of the Northeast 1/4 of the Northwest 1 /4 of Section 17, T 29 N, R 16 W,
Town of Baldwin, St. Croix County, Wisconsin
F~L.ED
Marv 3 r 200 .
tLlTFitl:Ek N. WAt,Sy
atgi_ctEr a t~
St. Croix Co., tM
.,_r~•
'~'~ ~ _
_{ll,(P_~.A.TT_F.L7 LAND$
North Quarter comer
- - - N 89'S3'f 8" E 2642.40' - - - Section 17, T 29 N, R 16 W
- _ North line NW 114 Section 1 (Set RaikOad Spikej
~~ Centerline ~ N 89°53'18" E 626.56' ~
Northwest Corner 201 -~~ =•33-oa' $3 G _r_hl. E"_ 33.05' ~3
Section 17, T 29 N, R 16 W
(Found Bentsen "PK' Nail) ~ N 89°53'18' E 624.83'
)C
~T 1
5Z'~ 4~.
'
.
~ 5.605 acres or 244,162 sq. R (Ind. R/Uy) pj 69 ~ 1
°~
~,
Z
; ~
~ - _ - _ • ~ - _ 5.131 acres a 223,485 sq. ft. (Excl. RMI) ~
~ Existing Orivevvay BO1L331N~'SETBAi:KC1N!' . _ - ~v Cal
Zs~.
¢
Shed ffi ;,~ o
W.
$ N
event shed0
~ ~
~
~:
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Sam
"' 1O
~ ~
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dt Z w
o_ S
rlt
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N 87°26'39" W 628.88'
4~N_P_~4T_[~Q _[_.4L~L1S
OWNER'S ADDRESS South Quarter Comer
2238 C.T.N. "E" Section t 7, T 29 N, R 16 w
Baldwin, WL 6+002 (Found Bentsen "PK" NeN}
Scale in Feet 1" = 150'
50 0 50 100 150 200 250 300
Bearings are referenced to the North-South Quarter section
line of Section 17, assumed bearing S 03°051 O° E.
Trtis parcel is beirtb created for p>.uposes of farmland
consolidation.
T Fef_F1~Til
~ Indicates 1" x 24" Iron Pipe Set
(Min. Wt -1.73 Ibs.flin. it.)
Section Corner Monument
O (as noted)
x -- hldicates Fence
y`~LAUREN'E ~J
w.
4 ML~I R Y
` '~ 1 13 ~ ~
/r RIVER ~
` FALLS, eo 4~O
s` `_< wt. ~
bt~~ eo ua rso `SO
APPROVED
ST. CROIX COUNTY
Planning Zoning and Parks Committee
. iaH 3 1 zoat
If not recorded wlthln 30 days of
approval date approval shall be
M1N end VOW
This Instrument Drafted by Mark W. Peavey v3ATED: October 13, 2000 SHEET 1 OF 2
Vol. i 5 Page 4026
1
.~:
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owne uyer
Mailing Address
Property Address
(Verification re uired from Planning & Zoning Department for new construction.)
Parcel Identification Number ~ a ' ~ ' ~ ^f~~
City/State ~A ~~ ~ l 1~ r
LEGAL DESCRIPTION ~j /~ /
/4 , Sec. f l , T ~ 1 N R l ~ W, Town of ~Q 1
Property Location ~'/4 , .~r' -"Q ~1~
Subdi~~ision - ,Lot #,
ertified Surve Ma # '/b ~ _, Volum `~ ,Page # ~~
C Y P --~-
Warranty Deed # ,Volume ,Page #
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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 Planning & 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 113 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 Deparhnent 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 Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of edrooms _,~_
l.~ I.~l
SIGNA OF PLICANT(S)
/ /
TE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
~c ~~~: System HanaAement Plan
' Pub"scant to Carom 83.54, 4tis.ddm. Code
• ~ectic Tank
• The septic tank shaifbe maintained by an individual cer~fied to service septic tanks under s. 281.48, Sfats. The patents of the
septic tank shalt be disposed of in ac,:ordance with NR t i3, Wis. Adm. Code. The operating audition of the septic tank and
_ outlet fitter shalt be assessed at least once ever) 3 years by inspec'3on. Toe nutlet fii~r s~.all tie Geared as nec2ssarJ to
~'~ tamper operatlcn. The fitter rar~idge should not be removed unless provisions are made to retain solids in the tank that
may slough otf the 18ter when removed from its ensure. If the fitter is equipped with an - - ,~ the fillet s'taq be serviced if
the alarm is activated pntkurausi~,, t filer alarms
SeP~ tank shat have its patents removed when the volume ate ~e ikrirs or an ~endbrg pnclnuous alarm, The ~-
the tank !f the pnter>ts of the tank ,are not removed at the tithe ofua tdennist assessment, maul 1~ ~e liquid vctume of
' the owner of when the next service needs to be performed b maintain teas than mat6mum scan and personrtet shah advise
the tank Tire addiBon of bk ~9e e~tadaaon ~
• However, d suet bgkat or ~ ad~ves b enhance septic f4nk perfotn>enc~ is gener-.ty not required.
8s p prodv~s are used they shag be appn~ved for septic tank use by the Oepartrnent of Canunecce. Safety and
Pumo T k .
T-+~ pmnp (dosing) tank shalt be inspected at least orxre every 3 years. At swit~tes, alarms, ar>d pumps abap be tested to
. f Arop~ operatlOa ~ ~ etllueni fl<ter b ir>atated wfihin the tank k std be inspected and serviced as necassarx
At- zade Comooneat and Pressure Distribution S stem •
o.trees.or s ru s s on e p ante. or a love to grow on the component, plantings map
be made around the perimeter and the component shall be seeded and mulched as necessarq
to prevent erosion and to provide some protectiaa frass frost penetration. Traffic (other
than for vegetative maintenance) on the component is not allowed. Cold leather install-
ations require the component to be heavily mulched for frost protection.
Influent quality into the at-grade system may not a=cesd 220mg/L BODS, 130 mg/L TSS sad
30 mg/L FOG. Influent floe may not exceed the maiiminn design floe specified in the permit
far this initallatioa.
The ~ sY~m is provided w~ a
lateral be of ap;unulated somas at least once 18~rrtonths. When a ~ ~~' and fi is reproroertdgd that eats
~mn test why the system was b determine tt oxides C.airas ocP be
~ wit the disp~sat cell. canning is
Observation pipes within the dispersal cell shall be'checked for effluent pondiag.
Bonding levels should be reported to the ovaer and any levels above 4 caches considered
as as impending hydraulic failure requiring additional, more frequent monYtoring in
accordance with•Camm 83.52 (2).
General
• ~h s a`y§tem shall be operated is accordance with Comm '8Z-84 Wis.ddm.Code and shall be .
maintained in accordance with it!a coapaneat manual SBD 10570-P•(B.6/99)'aad.local and
state tales pertsiairig to system maintenance and taainteaance reporting.,
pump ~~ ~ ~ $~ ~ vdth ~ us gases nroy be present that putd ease death Septlc and .
PQWTS pngronents, 83.33, Wis. Adm. Code when the tantcs are ro ku~ger used as
o ~ ~ ~~ and savers should be inspeded fOr water tigitlness oast . Access
dive. or sut~ct ~ fatur+e roust be bs seated ~ upon the won of service. •Any apenktg deemed
~ std ~ ~ eve loddrtg device m p ~ cddentator unautho~~~$ g ~ Sys in ~nra~• stra8
• __'-~/y~ • . er~by ineo a tartlCC or comporunti
,sy~,~, ProP~ - beams defec8va the tank or proponent stta8 be repaired or repldced to keep the '
B~•~P•P~p its. aims ortelabed w~irtQ becorrtea d~erii+rs ~e detiecSve corriponertl shat ~ ..
a<napiar.ad wlat a of the same ar eQtd per6aat~ce.
If ~tk- e~rtt=_._._ .'-- p _ __.._.
the tie nom onent:-faila to accept aastewater'os b's'g3as~to`disc rge-" vastevater~to
tl;~onnd outface, it asy be necessary to install sa sesobic pre-ereataaat Wait or
-replace the component. Additional site aad~soil•gvaln:bons rosy need to be done.aad •'
add3taonal pla$s atay-' need to be prepared and approved by the Department of Cowwerce,-
Safety sad Bnildings'Divisioa. _ .
Qaestiona.ibant~~he operatioa•or ~aiateaance of•this spates should-be directed to:'
-• The Cottaty~Zanfng Office at ~ LS .. '2,~•~_ 6'?~7 1~1. ~
~`1'• ~1X 3~d~y.6~D
• the system installer at BLS- t-1.2S-- ~QSR h,~fh'h~~_
The tank manufacturer at _ $0~-3ZS_BySth VVt~ES~ •
. Zhe effluent :filter' manufacturer at ~~p - 221.. S?r,(Z, Zt'~S~t
' rr`e. ia~r,„~,A ' K _ 6 3q-.82.0-4,~.~' Gouws
v
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify th t I have inspected the septic tank presently serving the
~y~ 7 residence located at:
~~ 1/4, ~! I/4, Section , Town a N, Range~W, Town
of ~T ~,icy- , St. Croix County Wisconsin. Upon
inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly.
Most recent date of service Jc-" ,Q
Did flow back occur from absorption system? Yes No
(if no, skip next line.)
Approximate volume or length of time: gallons _
Capacity: -~Q
Construction: Prefab Concrete ~ Steel Other
Manufacturer (if known):
Age of Tank (if known):
(Licensed Plumber Signa e)
~~
(Title)
C~
(Da
minutes
4 g ~
(Print Name)
~Y
(License Number) PRS
Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes)
or licensed disposer (NR 113 Wisconsin Administrative Code)
~TATE'~AR CAF ~~'I~CL)ti5'ti Fl~[2'~1 '_ - lyti2
~50~~2 ~~ARN.~N"rY DEEU~
UOGUtitEN C NO. y~~ ~ ~n ~ PAt~[ ?~"~
John H. Wernlund and Arlene Wernlund, _ __
_ _ __. - -_
----
husband and wife, said John H. Wernlund
by his guardian, Glen Wernlund
_-_- ___ _
~t,m.~}s;t!,tl~~.l~ta„!,~,, _Douglas__M.`Van Damme_and Caro__
~__J. Van Damme_, _husband_and _wife_ _ ___ __,_____.
the Il11I11~11n~; lli~ifllh'd !t.~I Mali ill .,___ St . Cr~1X Lilil!;I1'
State rt `~1,.on,ui.
The North Half of the Northeast Quarter of
Southwest Quarter (N12 of NE4 of SW4); and
Southwest Quarter of Southeast Quarter (SW4
of SE4) of Section Eight (8); the East ~ialf
of the Northwest Quarter (E2 of NW4) of
Section Seventeen (17); all in Township
Twenty--nine (29) North, Range Sixteen (1.6) West.
1
F.. _ .~ Pdccrd
OCT 2 1996
ai I o : oo A. p,~
P ' .',' e' ~Fe'~ .
THiS SPACE N~SERVED F;~R RECORDIt,7G DATA
~~AME AND RtLIIiN ADL`RcSS
T~t~r~ ~., ~. yicCormack
~a1~'~iVlC1, ~~~15 :)~:C'~
002-1016-90 002-1017-70
002-_1037-70 _ 002-1037-95
PARCEL lOENCiFiCA(lON NUMBER
AND
Easements for right of way purposes over the East 2 rods of the South
Half of Northeast Quarter of Southwest Quarter (Sz of NE4 of SW4) and
East 2 rods of Southeast Quarter of Southwest Quarter (SE4 of SW4) of
Section Eight (8), Township Twenty-nitt` (29) North, Range Sixteen (16)
West.
This deed is given in fulfillment of that certain Land Contract between
the parties, dated December 8, 1977, and recorded December ;."., '_°77, in
Volume 566 of Records, at Page 1=,t6, as Document No. 345377, office of
the Register of Deeds for St. Croix County, Wisconsin.
T ' I~~ER
This _.____ 1 S _n0 ~ homestead ~ro~rty. ~! i
......
}~M~C its not)
Gxcepuontow•arranties. Easements and restrictions of .record and pt any
liens or encumbrances created or suffered to be created by the acts and
defaults of the grantees, their heirs, successors or assigns.
' DatcJ this _~~ day u( ~~'~,-~ ----- , A.D , ly__96
John ., Wern~rund ~
/ / .
b . ~ . ~ ;• ~ ems,., ~se~u _ ~:~ ~ ~ ,~~~- ~-
«G en Wernlund, Guardian Ar~ene Wernlund
(SEAL) -
« -
AU"CHENTICATION
~_ . tsE~
l5[A
ACKNOWLEDGMENT
State of Vb'isconsin, l