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HomeMy WebLinkAbout036-1062-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538888 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: Bethke, Christian & Loretta Stanton, Town of 036-1062-50-000 CST BM Elev: Insp. BM Elev: BM Descriptiof~ Section/Town/Range/Map No: / bD I~ M os-r 26.31.17.401 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic j, Benchmark 7-32-1676L 166 Dosing 3 Alt. AM 5 66J4., 2.31 ~5, a ! a Bldg. Sewer ej/. ZZ Holding St/Ht Inlet &I ' Z W. TANK SETBACK INFORMATION St/Ht Outlet TANK TO LP/ WELL BLDG. nt to Air Intake ROAD Dt Inlet Septic ! 4 Dt Bottom (ob 7/66 9 76 .3/ <d 7. t~ Dosing H0141A. ? , Dz . 6 [H0I eration Dist. Pipe 10- /d fT to, sly I ob . 77 d ing Bot. System Z N /00 11 7 9 ~ S7 PUMP/SIPHON INFORMATION Final Grade 13, z, f T j f~ T• Manufacturer Demand St Cover GPM i Model Number TDH Li 5~ D I Friction L~s System Head A-- TDY4 7 7 Lencth Diaz / Dist. to well Forcemain 1 t6 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z - 4g ~ /I SETBACK SYSTEM TO Y+ P/L cQBLDG WELL LAKE/STREAM LEACHING Manufacturer7. f CY INFORMATION CHAMBER OR T r Type Of System: • I~ UNIT Model Number: / L, (yt G.~l~ &S DISTRIBUTION SYSTEM 1`7 70 A4 a Header/Manifold/ Distribution x Hole Size x Hole Spacing Vent to Air Intake 5 Dia T Pipe(s) LLDia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ 2- Bed/Trench Edges Topsoil t ` ` Yes 0 No Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1938 190th Stc~et New Richmond, WI 54017 (NE 1/4 SE 1/4 26 T31N R1 7W) 40 acres Lot Parcel No: 26.31.17.401 ~I 1.) Alt BM Description = 66deA, _ 2.) Bldg sewer length = /O GQJe,- amount of cover = if 1, Plan revision Required? Yes 14 No ' I Q 1 I J - 1 - - uu ( i~(p Use other side for additional information. 6 SBD-6710 (R.3/97) Date Insep is Si ature Cert. No. C rcoml.QOv Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 MV Is Madison, WI 53707-7162 Sanitary Permits Number (to be filled la Co.) U Sanitary Permit Applieati State Transaction umber In accordance with s. Comm. 8321(2), Wis. Adm. Code, submission of this form Ttel~rpropriates,4 ental unit is required prior to obtaining a sanitary permit Note: Application forms fors ed POWTS are Project Address (if different than mail' address) submitted to the Department of Commerce. Personal information you provide used for condary purposes in accordance with the Privacy Law, s. 15.04(1)(mStats. - 11 ` PK• 1. Application Information ~-`Please PH AI formation Propert C % N , e 'G /fr ;-P Parcel # O D~"~~ ProperttyC0,A7mer's Mailing Address (po Property Location / ZJA c1h)O~\C1E Govt. Lot C City, State Zip Code Phon Section ..Z ~o T31 circle one) y Sx`G 1'7 '1(o - S Z -7 ( II. Type of Building (check all that apply) Lot # N; R f 7 Ell or 2 Family Dwelling - Number of Bedroom 3 Subdivision Name ❑ Public/Commercial -Describe Use 4~~We4j- Block # ❑ City of "Cle ❑ State Owned - Describe Use CSM Number ❑ Village of _ _ L I C..~ Town of "04 / C),q III. Type of Permit: (Check only ne box on line A. Complete line B if applicable) A. New System 63 Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) System B. Permit Permit Revision Change of Permit Transfer to List Previous Permit Num r and Date Issued Renewal Before Plumber New Owner Expiration . V/ /N IV. Type of POWTS System/Con onentfDevice: Check all that apply) Non-Pressurized In-Ground Pressurized In-Ground At-Grade Mound > 24 in. of suitable soil Mound < 24 in. of t Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area Information: +fAkhril Design Flow (gpd) Design Soil Application Rate( f) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation yso , 7 61/3 660 to le) Z, a /a i s' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 2 ~ v U N New Tanks Existing Tanks / j o0.j O pip or Holding Tank `h O C9 O W El 1 1:1 Li I Li Dosing Chamber &00 4- Li Li VIL Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. PIuiDber's Nam (Print) Plum t re MP/MPRS Number Business Phone Number 01-el',/J ,l//-c 2Z/v >!Y'a~8-G(J7 Plumber's Address (Street, City, State, Zip Code) ~~Z /Sr6 5 Thf Lv y©o~ VIII. ern /De artment Use Only X1P proved _ Dis Permit Fee Date 71sed/ suing t Signature enial $ DL Condi%4M Reasons for Disapproval 2~ t 4f~ le a 1. $epGc tank, effluent filter and dispersal cell must all be services !maintained as per management plan provided by plumber. ' 2. All setback requp'ements must be. maintained as Code / ordinatt + Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 Neches in size (R. 01/07) Valid thru 01/10 : o ,s! /00 i AV) I L C ~ i I i I ~ ~ i I i , r I pro r p', U p C~~` ~ Citc✓y° 7 } ~ T ya /az o • ? ,~o%T4at a1 .Si C~czs.etc /k,a_c /oo - - Q Q• rn Qcuo-cad'. ~c~ >(xx goo - - - I i _1\ : : i I . i l I : i so Y _ . , W~ Wisconsin Department OfCommerce EVALUATION REPORT Page of Division of safety and Buildings essthanxll 85, Wis. Alm. Code County, r Attach complete site plan on paper nos in must include, but not limit ed to: vertical and action and percent slope, scale or dimensions, north arrow, and locatio stance rest road. Parcel I.D. Please print all information. Review by Di// Personal information you provide may be used for secondary purposes oacy Law, j 14 P ropeuyOwner gA G $ g rtyLocation 4;✓ t~ Govt. Lot AIIIII 1/4 S1/4 S J'4 T ~7 ! N R ~ E (or)o N\N Property Owner's Mailing Address Lot # Block # Subd. Name or M# g' /`1d S7' City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road Lkv 6e 4-,- chd tvr 4NO /7 (:kr aY -S o 7 01 J9 ,rA S 1 ❑ New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe: Parent material I Flood Plain elevation if applicable - g General comments / and recommendations- Boring Boring # El Boring / U q Pit Ground surface etev/ ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fE in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 6 7, SY/17.)'lJ- Sjx lk"rj • e Also Giw lv~c > y ~o 2 -l Sys /3 STL l-`SQ.t' /yivFi~ ,3 We3ll 14 D-- I Boring Boring . 1 tYy Pit Ground surface elev. ft. D 167 epth to limiting factor in. Soil -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 'Eff#2 if ;`4z/ CZ 4j 17, U.,e fA -v L . Effluent #1 = BOD > 30 < 220 mg ;W TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST N Pfeasq Print) CST Number /?n-ls (':IIt Zz/vyr Address Date Evaluation Conducted Telephone Number 3,5-2 f/o 7- tcl Property Owner Parcel ID # Page of [37 Boring # ~ Boring Pit "Ground surfAe elev. 03i ft. Depth to limiting factor in. Soil Ap lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In., Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eft#1 `Eff#2 lfl~,~ G S i s Z -f o rG ArSeK 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/ff 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 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 'Eff#2 Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L -E Muent #2 =BODE < 30 rrtg/L and TSS < 30 rnglL y 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 608-2648777. SBD4330 (RA7/" - 0 r Property Owner Parcel ID # Page of FYI Boring # ❑ Boring pit Ground surface elev. D 3, ft. Depth to limiting factor in. Soil 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#i 'Eff#2 iP ,V ,L a 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 Boring # ❑ Boring F-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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 Effluent #1 = BOD6 > 30 < 220 mg/1- and TSS >30 < 150 mg/L ' Effluent #2 = BOD6 < 30 nig4: and TSS < 30 mgfL - - - The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or, ry , need material in an alternate format, please contact the department'at 608-266-3151 or TTY 608-264-8777: seD-nw(rtmwo. w lJ I r l,.T 16T f ~Gl ~ -rAVI Id /a 2, O / 0 / S' ! 4G,~tao d~Vl l ` r Ot arx~.A ,e~) x x x X X k x sa ~ x x k k aC yC t 4oTlih-t 0"'-' /00, Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer 1 Pump Manufacturer Za c //t i` Tank Model Number A0 Oa 6 0 0 Pump Model Number Total Tank Capacity 0 0 Alarm Manufacturer Z-avi Max. Bury Depth Alarm Model Number 011Z Switch Type Filter Manufacturer rs Total Dynamic Head (TDH) - Feet Filter Model Number 10 Elevation Head /Z Distal Pressure Network Loss Minimum Pump Performanc Required Force Main Loss , -7 GPM @ Ft-TD-H] Total Y'l Outlet Manhole Min. 4" Above Grade With 2 • Z. Locking Device. Inlet Manhole Manhole Min. 4" ve e < 6" Below Grade Sealed Watertight Securely Mounted With Locking D ce Weather-proof 1 7 Junction Box Finished Grade + Depth of /~U !!a 1 Vent Min. 12" Cover Disconnect Ft Above Grade Means With Vent Cap 3. F ' Outlet < Outlet Filter Inlet Inlet Baffle a<a s > a<r < > 31 31 a< . a < < A < a~a Switch Settings and Reserve Capacity y4» Tank Volume = GPI Weep a<} <r< a<a Dimension Inches Volume Gal. B ,i Hole a<a -C t (reserve) A , 4 S a > (alarm) B 2 $ Off Elevation C a' (dose) C <,t Ft ,t Bottom (dead) D Jo a< <a< D '>i Elevation ata Total f/4,3 00 <<<<<<<t 0 Ft a as a a s a a a a a a s a s a► a a a a a a a a a a s> a < t<< e s t t t t<< t< t<: t< e t t t t t t t t t a<<< e< t t t t< t t t<< t< e e< t t e t t< <'< a a> s a a a a> a a>> a a a s a s a s a a a a a a s a> >.a s a s> a a a a t a a> a a s a s a a a a a> a a a GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. 02/05 LJ Page of Y TOTAL DYNAMIC HEADIFLOW PUMP PERFORMANCE CURVE PER MINUTE MODEL 14014140 EFFLUENTANDDEWATERING - 3M seats s /s to MODEL 140/4140 eo Feel Mohw eeL hers 5 1.S Ee 326 3 45- 1 ___L to 3.0 60 303 15 4.e 73 276 0 40 20 6.1 G6 250 25 7.6 59 223 , >a• n to art 35 140, 4140 30 9.1 49 165 35 10.7 36 144 x 40 112 26 106 45 13 7 17 64 s 25 010610 SmA o0 Heed: 501flUrn o s r e 70 171261 tb 4 10 I fill 2 SK1a24A 5 0 ,a 20 30 Ia W 00 70 e0 !q r , • ; r s oluots • wim o eo tee 210 no t1AWPBIM114M - 77a~ elm CONSULT FACTORY FOR SPECIAL APPLICATIONS Sam • Electrical alternators, for duplex systems, are available and supplied with an + _L alarm. • Mechanical alternators, for duplex systems, are available with or without alarms. • Control alarm systems are available for1phase pumps used insimplex system. See FM0732, • Variable level control switches are available for controlling single phase sys- tems. • Double piggyback variable level float switches are available for variable level long cycle controls. • Sealed Wk-Box available for outdoor installations. See FM1420. • Refer to FM0806 for applications above 130°F (54eC). alp, -r 9K1S7AB SELECTION GUIDE 14014140 MODELS Control Selection 1. For automatic use single piggyback variable level Moat switch or Model Model Volts-Ph Mode Amps Simplex Duple double piggyback variable level float switch. Refer to FM0477. 2. See FM1228 for correct model of simplex control panel. N140 N4140 115 1 Non 12.0 1 or 2 3 3. See FM0712 for correct model of duplex control panel. E140 E4140 230 1 Non 6.0 1 or 2 3 BN140 BN4140 115 1 Auto 12.0 a cA+moN All installation at controls, protection devil as and wiring should be done by a qua06ed LBE140 6E4140 230 1 Auto 6.0 Reamed oleadclan. All electrical and sa" codes should be followed Includbtq the most recent Natlonol Electric Code (NEC) and the Dccupa0onal Safety and Health Act (OSHA). 'Single piggyback switch included. RESERVE POWERED DESIGN For unusual conditiors a reserve safety factor is engineered into the design of every Zo4311er pump. iatlAt~e, KY 40736.0317 Z 979p 7a 9649 Cabe /iLn Rord L'snufacWe7s d.. PUMP !O. z/wIry'amiaw slAw IYJ7 WWW..zo.u.~ a om /tNf (30~ 771JQI4 0 Copyright 2006 ZoeUar Co. A0 rights MUrvea. f--^-- i Soil Absorption System Cross Section ft a' Schedule ao Final Grade PVC Vent Pipe 1,00, Si With Vent Cap o/ d ft Leaching --0,. Chamber /OZ. ft /6 S! System Elevation ft ft Soil Absorption System Plan View Coe, ft { ft I ft Leaching Trench 1 Vent Or Observation Pipe r Chambers 4' Dia. (v ~e Trench 2 Header Leaching Chamber Specifications Manufacturer And Model EISA Rating 0 sq ft per chamber Soil Application Rate 7 gpd/sq ft yT gpd Design Flow : Soil Application Rate ,i?d EISA =..3 Chambers 2 rows of chambers each. Page of U4/U4/2001 10:07 FAX 7155378847 BARRON CO ZONING 001 SYSTEM SPECIFICATIONS In-ground Soil Absorption Component SBD - Project Name: gi7Z --e Distribution Cell Type Septic Tank Aggregate ❑ Leaching chambersZ Min. Septic Tank \101' a :11: ! d o gal. Wastewater Quality _ septic T.irnk Volume gal. Treated ❑ Untreated K Manufacturer! _ Number of Bedrooms Effluent Filter Design Loading Rate PLR) 7 Manufacturer (Maximum Soil Application Race) - Model Combined wastewater, - Number of bedrooms Pump Tank gal/day/bedroom x SO Manufacturer Daily Wastewater Flow (DWF) = ' S G Volume U' O gal. Clear and graywater only. Number of bedrooms - Divertet valve ❑yes Ono gal/day/bedroom( Manufacture Daily Wastewater Flow (DWI _ Model _ Blackwater Norc : The use of a dive ur valve shall be indicued on Lhe management plan irnj ir.tir% how and when the valve Number of bedrooms shall be used- gal/day/bedroom x 60 Daily Wast:ewiter Flow (DWF) Distribution Cell Sizing (Aggregate) DWF / DLR ft2 Distribution Cell Sizing (leaching chambers) Leaching Chamber Manufac e Model Adjusted Design Loading lZate_! gpd/ft' Chamber size, bottom area 2(~ fr System siting = D%VF / ADLR / Chamhcr si2N 17~b do =33 (1»'7 (Ap1,R) (sq.ft.) # of chambers Number of chambers co be used = Page of vl~l. INGROUND SOIL ABSORPTION MANAGEMENT PLAN PURSUANT TO COMM. 83.54, WIS. ADM. CODE General This system shall be operated in accordance with Comm.82-84 Wis Adm. Code and shall be maintained in accordance with its component manual [ln-ground Absorption Component Nl in.ual 1,)r pOWfS Version 2.0 SBD-10705-P (n.01/01) and SSWNIP publication 9.6 (01/81) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic tank or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm. 83.33, Wis Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed and watertight upon the completion of service. Any opening deemed unsound ,defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis Adm Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of the triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maxium scum and sludge accumulation in the tank The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Dept of Commerce. Pump Tank The pump tank shall be inspected at once every 3 years. All switches, alarms and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Soil Absorption System No trees or shrubs should be planted on the absorption area. Plantings may be made away from the all's perimeter, and the area shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration, Tragic (other than foot or for vegetative maintenance) on the area is not recommended since soil compaction may hinder aeration of the infiltrative surface within the system and snow compaction in the winter will promote frost penetration. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired of replaced with a component of the same or equal performance. If the dispersal area fails to acxept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Replacement in a suitable area nearby is also an option at which point a diversion valve will be installed between the old and new systems to allow dispersal cell rotation at a schedule to be determined at the time of cell replacement 4, Y 1. r 1. G! UA y_ N J ~ ,-use a. 0 L ~ L- N O~ d O IS Ln w 1~ m c o € 3 nQ Um .~w C~ N E N V O Y 2 N Q - p 0] Z 6 to o GJ E W w °'p d3_ ~N s C O C 141 No,c W 3ov~v~ 464 u - Q: m vow Y m © mi ) 2= '24 O Lqm M C v4ceAEZ ~ w W V 2 opo V w Ol 51 u N (a u 07 M O C. Y" y A . w m O C 0 O ~l N V T d a Z L C N °3 9 4i • dt wa a V E a= au, as A L d R ~ K~ /C6 pGj - fV d w 3v © °m E L `H• A O C a~~ N L C Q Q A V N q a4C W h q 3 t 00 %u • IG . a ~ C G v 120- q a -0 O a .2 a.2- o•a 1,0 acs N I I G 4n m o m t~ y au) Jz~ 2:5 w 3mo3 ®m da 3,~p _a 1 OV ~ yV.. ~ N d ~ ti Y"a~+ Y . LL ~ ~ v ~Q V~ L- C 4U q 1 w` n'1 p d O L N d 3. 61 .-3 d Y 1 vi~jOCN3oo ' ptc~~ 1 ar, 1 4-4 E 1 M=_ ad~ 1' 1 1° gem ~ ~ `m ao•°Y off, 1 ~ ~ 1 •~..~~aQ~A" 1 wa 1 p,~ o plc ~ ~ 1 €~M 1 W OL - - O A i YA ~ N a v r+ w G 1 u E7 • E w V O W g W_ 1 j V V - d p• ? E 1 ~ 1 mud ~uuu tj 0:2 ! 1 1 .~..i owo Q~d t~ 1 H aL-.-+ w N w V tOi4 ~ 1 - ~~>s Oe~~ r 4D ;2 foe ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L, A S e -P Are Mailing Address L Property Address / g / q / C 1'-"' 0.', I-)'- (Verification required from Planning & Zoning Department for new construction.) City/State I Parcel Identification Number LEGAL DESCRIPTION Z_W, Town of e? g /a /~i Property Location A/1~ '/a ~ '/a , Sec.--4 , T31 NR/ Subdivision Plat: Lot # Certified Survey Map Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house U yes U no Lot lines identifiable U yes LJ 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 1/3 full of sludge. I/we, the undersigned have read the above requirements and agre,6 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this fo are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warran deed recorded in Register of Deeds Office. Number of edrooms --3 ley 'O~ Z-&r~~e SIGNA RE O APPLICANT(S) DATE ***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. 09/07) VOL 1.837PA;I 5 2-3 6- STATE BAR OF WISCONSIN FORM 3 - 1998 KATHLEEN H. WALSFI REGISTER OF DEEDS l3ocument Number CORRECTIVE QUIT CLAIM DEED ST. CROIX CO., WI RECEIVED FOR RECORD Christian A. Bethke and Loretta Bethke, a/k/a Loretta D. Bethke, husband 02-18-2002 3:30 AM and wife, quit-claims to Christian A. Bethke and Loretta D. Bethke, husband and wife as survivorship marital property, the following described real estate OllIT CLAIM DEED in St. Croix County, State of Wisconsin: -YEMPT # 3 CERT COPY FEE: COPY FEE: N 1/2 of NE 1/4 EXCEPT the East 396 feet of NE 1/4 of NE 1/4; SE 1/4 of NE 1/4 TRANSFER FEE: lying West of Willow River; N 1/2 of NW 1/4 EXCEPT South 340 feet of West RCCORDING FEE: 11.00 512 1/2 feet of NW 1/4 of NW 1/4 and EXCEPT North 364 feet of West 339 feet SAGES: 1 of NW 1/4 of NW 1/4; S 1/2 of NW 1/4 of Section 25; NE 1/4 of SE 1/4 of Section 26, All in 31-17. Recording Area Name and Return Address Ronald L. Siler VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 118 New Richmond, WI 54017 036-1058-30-000;036-1058-20-000; 036-1058-50-000;036-1058-70-000;. 036-1058-80-000;036-1059-10-000; 036-1059-20-000;036-1059-30-000; 036-1059-40-000 and 036-1062-50-000 Parcel Identification Number (PIN) This is not homestead property. The purpose of this Corrective Quit Claim Deed is to correct the legal description in that Quit Claim Deed dated October 31, 2001 and recorded November 8, 2001 in Vol 1758, Page 66, as Document Number 661528. Dated this day of Feb • -2002. r ~ lu is lan A. Bethke ' `"Vow * oretta Bethke AUTHENTICATION ACKNOWLEDGMENT Signature(s) C kri$ 47a-,. STATE OF WISCONSIN ) Lo re ><f-r (3e 44 Y, )ss- County ) authenticat d this /`I~day of s~P~o r.0-;f 2002. ' O Personally came before this day of Z 2002 the above named to me known to be the person(s) who TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing instrument and acknowledge the same. (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY „ Ronald L. Slier Notary Public , State of Wisconsin VAN DYK, O'BOYLE & SILER, S.C. My Commission is permanent. (If not, state expiration date: P.O. Box 118, New Richmond, WI 54017 20_.) (Signatures may be authenticated or acknowledge. Both are not necessary.) 'Names o r persons signing in any capacity should be typed or printed below their signatures QUIT CLAIM DEED STATE MAR OF WISCONSIN FORM No. 3 - 1995 INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800-855-2021