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HomeMy WebLinkAbout004-1046-90-025Wisconsin 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)]. Permit Holder's Name: City Village X Township Ta lin, Barr Cad ,Town of CST BM Elev: Insp. BM Elev: BM Description: f g9 . Z ~ b~V1 Z TANK INFORMATION „ TYPE MANUFACTURER ~°~S CAPACITY Septic Y z, F~ i~1,.~.. 3 ~ /bOh V Dosing ~b Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 /~/ ~~ gy s g L~ 1 Dosing ~ /~~ ~ ~4' g~ / -- Aeration Holding PUMP/SIPHON INFORMATION ~C ~~ Manufacturer / '' I / L f~t~~ lit or,J~'"_' errand GPM Model Number ~ ~ ~ ~n TDH Lift Friction Loss System Head TDH Ft $. .3 3.9 /5. ~ 1 Forcemain Length i Dia. ,~ Dist. to Well / ~ ~ Z /V SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 499157 0 State Plan ID No: Parcel Tax No: oo<l- /ok~ . 90 - oz5 Section/Town/Range/Map No: 20.28.15. STATION BS HI FS ELEV. Benchmark ly 35 la3.sq $9. Z</ Alt. M ,, Go,,.Q.... z •~5 /~ . ~f Bldg. Se r ~'' ~.5 Jay, ~y~ SUHt Inlet ~. SUHt Outlet ~ ~ Dt Inlet Dt Bottom //• l / Header/Man. Dist. Pipe Z , Z ,D~ , Bot. System 2•~ / ~0 • ~~ Final Grade / . ~ 1DZ • µq C~- ~o t y`~ 99, /~ BED/TRENCH DIMENSIONS Width i g• Length / s7 No. O Trenc s ~~ PIT DIMENSIONS "'\ No. Of Pit` Inside Dia. ~- Liquid Depth SETBACK O SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING-• , CHAMBER OR Manufacturer ~~ INFORMATI N Type y~O jm: , 1~~ $ 7 ~ ~~ w) ~ UNIT Model Number: _` IIISTRIBUTION SYSTEM Header/Manif /ld ~ ~ Distribution / Z ~ ~ J . x Hole Size x Hole Spacing ~ / V t to Air Intake Z ~ Pipe(s) !~ Z S i ~ ~ /~ 3 / lO L ~ Length Dia pac ng / Length Dia 4 A- ~~ s 9 z ~y ~~ 5 ~ a~ SOIL COVER v Prncenro Cvetnme (lnl~i YY Mnunrl nr At-Grade SVStemS Only Depth Over / p Bed/Trench Center Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/Sodded xx Mulchced/ X ' /I 0 \ ~ es i No ') Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 9 / Z Inspection #2: / Ser tS parcel No: 20.28.15. Location: 246 290th Str t Unknown (NE 1/4 SE 1/4 20 T28N R15 ) L 1 ~I J~~ ~ p~ `~.~ C ov ~ 'ara~~e. ~C~ o 1.) Alt BM Description = ~ w, ~ Sa.~ VSt.. c~,;~Q /J~a~ 2.) Bldg sewer length = 49 1 I r - amount of cover = , / ' ~,1~• w~ ~,'~ ~"~ hD VI,t,S d ~'~• Plan revision Required? 'Yes No ~ 2-~ ~~ Use other side for additional information. Date SBD-6710 (R.3/97) __ _ _ . ~~~5 __ __ _ _____L- . Insepctor's gnatur Cert. No. + Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County ~ // ~ ~ x ,SCO~~,~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266-3151 ~ ~ ~ ~ 5 Department of Commerce State Plan I.D. Number Sanitary Permit Application ersonal infonnation yo rovi Adm Code Wis 83 21 i h C ~ ~ . , p . . t omm , In accord w may be used for secondary purposes Privacy Law, sl )( dress) nt than mailing ad ect Address (if differe P ro j ~ { - g ~ - ~ t All Information i P Pl i *t~ 2~ ~ ~! `~ ` ' r n ease on - I. Application Informat Property Owner's Name d Parcel # ~~a.. Lot # Block # `~' ~' ~ ~ Property Owner's a//fling Add s C -/ Z•j S.. c.~T , `, I v ~ Property ocation ~ y, ~~ %<, Section City, State Zip Code ~ ~ PhonepNu,~ber OJ .~ ~ L Sell 2 ~ ~' fin( n ) ~ cEcl ~ l! f 1 ~ N, T k II. ype of !ding (check all th pp1Y) ~ O S CROl~SOI.1N Subdivision Name CSM Number Dwelling -Number of Bedrooms 2 Famil 3 59 ~ y or 2 . ~ ^ Public/Commercial -Describe Use 's"b"'"` ~' J~_ ~ ~ ^Villa wnship o ^City ^ State Owned -Describe Use g ~ 5 e _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) p'' New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ge of ^ Chan ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration - Plumber Owner ~ IV. T e of POWTS S stem: Check all that a 1 O `~'~ le Pass Sand Filter ^ ^ Si d ^ ng e At-Gra ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soi < 24 in. of suitable soil Constructed Wetland ^ Pressurized In-Ground ^ Holding Tan ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating San~lter ~ ,~ ~ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis etsaUTreatment Area Information: Design Flow (gpd) Design Soil Application dsfl Dispersal Area Requir (s~ Dispersal Ar Propos s ystem Eleva ton VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Concrete Constructed Glass Gallons Gallons of Units n New Existing ~~ (.7 ~Y ~ ~ ~, Tanks Tanks Septic or Holding Tan!: Aerobic Treatment Unit Dosing Chamber 3~ VII. Responsibility Statement- I, the undersigne ss a responsibility for installation of the POWTS shown on the attached plans. Business Phone Number Plu er' Name (Print) Plumber' re MP/MPRS Number Plumber's Address (Street, City, State, C e ~ ~ ~ ~ . Coun /De artment Use Onl Sanitary Permit Fee (includes Groundwater Dat Iss d Issu Agent S a (No d ^ ~ ve A pprove Surcharge Fee) 5.5D aD ~7 ^ caner rven R n for Denial IX. Conditions of ApprovaUReasons for Disapproval ~J` J YSTENI owlreR: 3) Ca ;'!'-; ~.~, ~ , ~ s~-~,~L~c-- s ~.. e~=ec~- c.~~ ~~ eNat~ services ! mainta~ ~ e.~- °-e~ 1. I c as per ~l Plan provided by plumber. 2 AN salbaclc roquirements must be maintained as par applicable code /ordinances. ... ~-.~ el.on Rln r 11 inches in 31Ze Attach complete ptaas ito me wumy ua,y~ w, ...~ ~~~....•• ~•• ,•-r-• l~ SBD-6398 (R. 01103) PLOT PLAN PROJEC'~ Barrv Taolin ADDRESS 236 290th St. Sorina Vallev Wi 54767 NE ~ 1/4 SE 1/4S 20 /T 28 N/R 15 W TOWN Cady COUNTY ST.CROIX SYSTEM ELEVATION 101.5' 1.5' sand lift! BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BOREHOLE O WELL Filter Zabel A-100 B.M.#2 is Top of 3/4" pipe @ 25~-th Ave 89.24 I Scale = 1 /4" =10' ~c re ~S"~~~~P~ Tank is to be properly bedded and provided with lockdown covers with approved warning labels Well is to meet all setbacks found in Comm. 83 Pro 3 Bedroom House Property Lin 2 5 0' (not to scale) Huffcutt Combo Tank Slope was scaled out to be 9% and designed as such! Area 15' below system is to 9% Slope remain undisturbed B- Cell and mound are to be slightly curved to follow the 100.0' Contour . ~~ B.M.#1 is top of 3/4" pipe @ 91.36' 300' Grading is to be done to divert run-off away from system 'B-2 101' 100' 9 9' 9 8' PLOT PLAN PROJECT Barrvl'anlin ADDRESS 236 290th St. Sorina Vallev Wi 54767 NE -1/4 SE 1/4S 20 /T 28 N/R 15 W TOWN Cady COUNTY ST.CROIX SYSTEM ELEVATION 101.5' 1.5' sand lift! CONVENTIONAL AT-GRADE BEDROOM 3 CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BOREHOLE O WELL Filter Zabel A-100 B.M.#2 is Top of 3/4" pipe C~ 25~jUth Ave 8g,24 Scale = 1 /4" _ ~ Q~ B.M.#1 is top of ~~ 3/4" pipe C~ ~~c re ~ ~ ~~~ 91.36' Pro 3 Tank is to be Bedroom properly bedded and House Property Ling provided with (not to scale) lockdown covers 2 5 0' with approved warning labels Well is to meet all setbacks found in Huffcutt Combo Tank Comm. 83 B -11 300' Slope was scaled out to be 9% and designed as such! Area 15' below g% Slope system is to remain ~-- undisturbed B-3 Cell and mound are to be slightly curved to follow the 100.0' Contour Grading is to be done to divert run-off away from system B-2 101' 100' 9 9' 9 8' t Wisconsin Department of Commerce ~' ,a S L VALU t C Division o£ Safety and Buildings i.,..a~.n ord with C mm 8 , i c~~ Attach complete site plan on panene'~t lea han ~'/: x I 1 inches in size. P~u~ O Z ~ ~ 6 Include but not limited to: vertical and horizontal~re e~renc~e point M), d' n d Percent slope, scale or dimensions, north arrow, and BM reference to nearest road. Please print all information ST. CROIX COUNTY Personal information you provide may be used for secondary purposes (T'ri Property Owner Property Location Page 1 of 3 `'"""`' St. Croix Parcel I.D. 004-10,4690-000 B Ta lin Govt. Lot NE v. SE v. s 20 T ~$ N R 15 E (or) w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 236 290' Street ~ City State Zip Code Phone ^ City ^ V$lage 0 TOwn Nearest Road S rin Valle WI 54767 715-772-3228 Cad 25~' Ave. H New Construction Use: HResidential /Number of Bedrooms ~ Code derived design flow rate GPD ^ Replacement ^ Public or Commercial -Describe: Parent Material Flood Plain elevation if applicable ft. General comments and recommendations: NE 10 acre pazcel in the '/<, '/< section described above. Boring # ^Boring CI Pit Ground Surface Elevation 100.0 ft. Depth to Limiting factor 18 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu_ Sz. Cont. Cobr Gr. Sz. Sh. 'Eti#1 'EtT#2 1 0-9 10YR3/2 None SIL 2-m-gr ds cs 3f 0.6 0.8 2 9-13 10YR5/4 None SIL 1-f-pl ds cs 2f 0.4 0.6 3 13-18 10YR4/4 None SIL 2-m-sbk mfr ggs 1f 0.6 0.8 4 18-25 10YR4/4 10YR5/6&5/2 m-2-d CL 1-m-sbk mfr gw 1f 0.2 0.3 5 25-34 10YR5/4 5YR4/6 c-2-d S 0-sg ml cw 1f 0.7 1.6 6 34-40+ 10YR5/6 10YR6/1 m-3-p C 0-m muff - - 0.0 0.0 2^ Boring # ^ Boring EIPit Ground Surface Elevation 100.0 ft. Depth to Limiting factor 39 '~ . Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftZ in. Munsell u. Sz. Cont. olor Gr. Sx. Sh. 'Eii#1 *Eff#2 1 0-8 10YR3/2 None SL 2-m-gr ds cs 3f 0.6 1.0 2 8-16 10YR5/4 None SL 2-m-sbk ds cs 2f 0.6 1.0 3 16-23 10YR4/4 None S 0-sg ml gs 1f 0.7 1.6 4 23-39 10YR4/4 None GRS 0-sg ml cs 1f 0.7 1.6 5 39-45+ 10YR5/4 10YR4/6 f-1-f CL 2-m-sbk mfi - 1f 0.4 0.6 "Effluent # 1 = BODs > 30 < 220 mglL and TSS > 30 <_ 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS 5 30 mg/L CST Name (Please Print) CST Number Mark Iverson °-~`~ ~- 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 Mav 31.2006 715-796-5664 Property owner B~' Taplin Parcel ID# 004-1046-90-000 page ~of 3 Borin # ~ Boring g HPit Ground Surface Elevation 98.0 ft. Depth to Limiting factor >40 m. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. M nsell u. Sz. Cor-t. Color Gr. Sz. Sh. "EfI#1 'EfI#2 1 0-8 10YR3/3 None SL 1-m-sbk ds cs 3f 0.4 0.7 2 8-18 10YR5/4 None S 0-sg ml gs 2f 0.7 1.6 3 18-40+ 10YR7/3* None S 0-sg mi - 1f 0.7 1.6 r-- '~'Ran.le of 1(1Vi2d/d eanil _ flea ~ ml Boring # OPit Ground Surface Elevation ft. Depth to Limiting factor in. Soil lication R to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring Boring # 0pit Ground Surface Elevation ft. Depth to Limiting factor in. Soil lication R t Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfF#t1 'Eff#2 • EBluent # 1 = BODS> 30 <_ 220 mg/L and TSS > 30 <_ 150 mg/L * E8luent #2 = BODS <_ 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'I"I'Y 608-264-8777. Page 3 of 3 0 ft. 24 ft. 40 ft. 80 ft. place system on the 100.0' contour N ~ O ~ 7 O ~ ~ O ~ -~. N W West and south property lines were not marked. Hof North Fence 0 Property line approx. 300' east of B-1 BM# & Description Elevation = Boring Location & Elevation Owner: Barry Taplin Site Information: Completed By: Mark Iverson 2336 290th Street NE 1/4, SE 1/4, S20, T28N, R15W 680 Larcom Street Spring Valley, WI 54767 Town of Cady Hammond, W154015 Phone: 715-772-3228 St. Croix County 715-796-5664 PSS#198 / CST# 46672 `96: "~ - =Bench Mark B"~ commerce.wi.gov ^ ^ isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 07, 2006 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING INC 1008 192 ND AVE NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/07/2008 SITE: Barry Taplin 290` Street Town of Cady St Croix County NE1/4, SE1/4, 520, T28N, R15W AT TN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1287542 Site ID No. 659322 Please refer to both identificationnumbers, above, in all corres ondence with the a enc . _ FOR: Description: Three Bedroom Mound System ' Object Type: POWTS Component Manual Regulated Object ID No.: 1084821 Maintenance required; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner; as defined in chapter 101.01(10), Wisconsin Statutes; is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Cond ~-PP~ DERARTMEN' ,8191~N OF (~~, SEE CORRI • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated .county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SHAUN R BIRD Page 2 7/7/2006 • Comm 83 22(71 A copy of the approved plans specifications and this letter shall be on-site durinir construction and open to inspection by authorized representatives of the Department which may include local inspectors, Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise' making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility. for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner ar-d any others who are responsible for the installation, operation or maintenance of the POWTS. SincerelQy, ~i'IC~G~~ ~~~lC~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charlie.bratz@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 2633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 h Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Cover Page Date: 6/ 27/06 Owner:Barry Taplin Location:NE1/4 SE1/4 S20 T28 N,R15W 25th Ave Cady System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01 /31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil Shaun Birc Signature License ni F~~~% w SqF~~ ~ ,~I y ~ ~ o~ ~~o L~,;,~ f ~.L~ ~~io~~rdd'v ''o® OF COMA;ERC~ SPONDENC ._.--- i'~ r • ;fir No Date Non-Woven Filter Fabric - 4" flbservatiaa Pipe Perforated ~p,strebvtian- Pipe Below Filter Fabric ; bST~i C-33 ~ ~ n ~ ~ ....J t ~ `- ~_ __ E ~ -,. q 7. SioPt fled dt - *- 2 `~ Force #Fain ~_PioweG i ~ ~~ ~Z Fram Rutsti¢ Layer Qrain Rock /;. -- s Cress SECiion Cat A tr~ound SYsttm Useetq f. , ~ ~ ~ A Sed For The Absorpt~an Qrtn ~.''~D ~ r} ~ - _ - ~ ~ . ~ Ft. r ~ . -.... . r -.- ._..._-- - - - - - - . _ L ~~Ft.. -~ ______- 4 C?bservoi ion Pi¢e-~ ' ~ ~ l r ~ _._ _..__-- -- --- ----..._ : ~~ - ~ ~ 1 ° _ _ ------------__-_----- 1 Farce Main . ~- w "' 1° ~..~--~----._.- ---- ~ From Pump L ~ r ~. ° D4strib~tion Bed E}t /Z - Z'Z - a Droin RocK Pipe i :~ 4hdbtervatien ~ipt { r~~~=~. Perm~ne~t Ntarker - ~St7~r / t ~Y~ ~3 ~ia~ tx'~-rf~~ ~ pe or Rods P#on View OfrMound ~tin~ A Bed for Tt~e dtisar~tion Area _ PI-GE__, 4F.,_ ~~ iaca~e4 Qa 8ati~.. Eq~+a~Y gpOteet . xgT g~ wtsxY :a Canaet~mn ~" ~~~ g ~ J Signed L i cei~se Humber Gate: r X `~ i rtChes ~ ~~~ Incnes~; Mole Diameter .. r~~ inch i.ateral -" _ ~,. - Inch{~s~ . ~nifois~ ~ _ ~-. I;tthes Force plain " ~-~ int't~es # of hotesfpipe ~._~ r~ver~ tiev~t~o~ of tatera~s~a2.~~t... Pt-€erate4 ~{CS petaii ~~ ss HAMBF-R CF.flSS C 3 5£~Z';DN AND SPECi~ FCq, T~t}NS SEPTIC TANK MP ~ .~ #t£A~~tPR~Ot~S ~__ G~ VE13T PIPE }2" MYN. ABODE ~RAI1E ~ ~R ~ J~NCTiflN $4X App$OVID E C0~1ER MANHQI > ~~` FRfli~i DQflk. IdIND~I ~~TH CQA1I3UiT . WI PADL~3CK ~ F'RES~ ,~?L:t ;NTAKE ~~~[n ~ ,. ~ ~ [/ gy ~ irIARtiIAtG iA$~~ ~,, . p ~~ = s x~LET } , i = ~,;A1'£R TI~~ S£ALS ~ TIBHT = s L ~lAppit~E~ Ji3IliT5 4i;TN ~#1.T~C.1Z - ~- SEA ` ' ~ ~ ~ PIPE APPt~~ B `"3F"'" . _ _ , ~ S(~,;t# SOIL . ~~~ ~. C Y s $+t AppR~3YED BEs7D~l+T6 t,ii~3£R '~~R r, COi~CRETE PAU ~ =IS~c~..ll~o S prCIF ZCATZ t3N5 -= ?ER i1P1Y SEPTIC f t1aSE i~. ~ rt~r~8~ BIISF_S -- iAl~i~C P'dANi1FACTf3R£EZ: ~lU., ~ ~ ^, ~ SEpTiC GAL. _ .;}QSi y£yr,E7M~ p~#~j rt$AC~K~' / SAL- TANK SIZES = flOS£ 3~...._ GAL. _ ~~ ~' 6AL r ~ 5~23~iG8E5 C1~iFAC~~Z~' f, ALAS T~tANEIFACT~RER;• Ut',C~' S ~ $ c 2 IHCIi£S = ~_GAL. BITCH T~~'£: f ~~~" C ^ ~- S ;NOES = !_ ~ ~'~'. ~.~ ! a = Li y1~-~L Pt7KP IiA~1FAC1'~R£R z h- i I1 = ~ ~Z3~+CHES ~[;TCi~£ 3'YPE. 5; - 15.23 irIA.C ~,~,~ ~ !fP ~ ALARM isIRZI1~G AS PER Il~.iig REt}~IRF~ D;gCHARGE RATE ~_ C/ FEET E£i~ pUi3P t}i F i~I+iB I3ZSTitIBU'~'I~ pIP£ - 3 ~ ~~~.~ ~ER'fYCAL DIFFEgENC£ $ET~ _ _ _ ± MINIt~~i NET~TtiRiC SDFgLY PR£SSiTz'~~T13i~€3 ~FT. FRIC'FIf}N FACTQR ~ FEET / f Jp _ FEET F4?iC~PSA,I~ ~ ~fl'TAL 13Y~C ~i/ ~/ ^.~l --- . S''!; Sir;DTH C? DiAME'TER _._.~._- FNT~iMAL IIIi~£NgIDi~~ ~F FiJM? TA,iSIK= ~.iQ~3ID I~A:E= L£CENSz. ~MB£g S I~i~EII: . ;I~B ~>rt,t. by: tr ta~>rr.,et. at~v; i !la b~'L tltf~t MSy-5-(16 2:56P~1; P8ge 213 9EH SERIES SUMP/EFFLUENT PUMP $ Specifications tea ttia suss s uw~~a ~ tn¢aa ttt.~ t~eerrtc ~. ~ ~ ,~ ra..w w ~ ,t t~ ~ ~, ~" ~ a~ A=tx~ 9Etl~lti 509330 01lCSJt tr0 t15 3A 13.0 1000 70 fr 55 at 32 t3.B ZQ 2a 9.tt stt.61x89a 994tA1t 509300 191CS- 4"~0 230 3a 6.5 1000 70 64 55 47 32 t3.B 3F 2t 8.it xtlblx&90 86i~04tEG 5093ri4 4~0 515 3i4 53A 5~ 70 tid 55 d1 32 13$ 20' Z7 9.17 xt1&1x8.91 980iL1-ITd 5D9860 It/rSR aY0 230 311 l+5 t00D 70 GI 55 a1 32 13.$ - 2Q - ~- _- -9.11 x 11.61 Y 9.9s Co~n~us ttyly Wkd-"4~e fSsrdMhsl~ntorP~2eRta0etlcoognua-sOuaYas baYasEuY~ennwunsin ~epW6ShedraNptlnrl}xzxmnps•' FIOw- LtTERSitaOltR - / o t0oo zoos 3000 W 0 W W W.~~t~CGIBlI~.PISQi{y.GOtII ;onstruct~on Mofor Housing Impellu ivlateriat l0 aau coca a y }n. volute ~s W Powcr Card W Mechanitsal Shaft Seat 5 ~ a .- Fasteners Shaft e.s •- ------• --- Bearings o ... .. r Closod Vane ABS ..-. _. . S1TW-A _ Nitrile with carbon and cetautic facts ~ Srainlers Stcet ..._ Stainlescc Steel ~ Upper Steeve and Lower BatlBearin~ I.ittte Giant Pump Ca PO 8nx OI918 • ()idriat~a City, OK 73157 PtiOxIC: 1M5.!'17.]5!1 •)''a•i: ~05.22tt.1559 E-mxt~: csstooettreTfos~lle~nattota t?3 fottn 995235-U7~03 0 20 a0 60 80 ~'L8V- GALI.l7wS/!eIN(fTE PUMP PERFORMANCE CURVE ItSt/ bOHZ 83238'9 VOL 21 PAGE5259 KATAL~SiT H. RSGISTfiR OF DfiEDS ST. CROIJI CO. MI RBCfiIVfiD FOR ~tfiCORD A8/17/ZAHG H8:~5A11 CfiRTIFIHD S11RVfiY MAP RfiG FEfi : 13.00 COPY Ffifi: 3.00 PAGES: 2 CERTIFIED SURVEYMAP NO. 832389 VOLUME 21 PAGE s259 Being the Northeast 1/4 of the Southeast 1/4 of Section 20, Town 28 North, Range 1 S West, Town of Cady, St. Croix County, Wisconsin. ~O% ~O/ or ~.awrra ~Q / J/ 2SOttI.~`f7'eE ~- S o0°25'27" W SOO°25'27"W.------------ ------- d~~ ~1 ~o q/ N ~~ ~ i~ ~ ~~ ~O ~ r ___.__.-._ ,., __..~....~s ...r__.__ I 632.56' S 00°24'02" W _ 33_87' S Op°2q'02" W 6$0.12' 33• 4' eexroarc or paKw~Y I I ~ '~ OK ~ tYe1~ eF A11p 76TH - ~ - -- .__ ._- - ' ,.. ._ _- ~'I LOT 1 ~~ f ~'~,~„~ 1 I j N~ 4 putt ~o ! . "~ I ~~~~`o~uw~ir ® $ n I I n `y' ~ I I i OV ® ~~ Fweludino R/aht-of-Wov N jy n ~~ 393.205 50. FT.t M ~ I i; 9.07 ACRES* ^+ I ~ tvwrwHr wvo) ~ I ~ N o0°22 ~"E 66z.zT W I c I I p ~ I ii ~ ~ ;.-~ ,~ I~,~ 0 ~ ~ I j ~D M ' ¢' I a I a; .o I ~ it ~I Ct I ~ II ' I ~x+omm~oa+o aerc ueam Iwo oxr agar LOT a 435,601 SQ. FT. t 10.00 ACRESt r .ludinQ-I~ipht-of-Wev 416,536 SO. Fi:3• ~ 9.56 ACRESt ftraNr wro) ® ® ~`~ wva'vo~i,NOeaa~aao rbor - ~,.... _ u+ooreeouo taon 00°19'59"E ,,NOS .n ~ ~ ~~ ~°" 5-2821 3 ttt3 ~'' •••• /'7~ ~~ ,may P Prepared for: rr•.~0 3UR~1~;~ ~+ BARRYTAPLIN rrr•••••••••• 2$6 29oth STREET SPRING VALLEY, WI 54767 1 of 2 C~>Efo.ra~+e .iuie»aa .ox I I I I tE3lTIl01E lOIMYEMr QN A yb I aa• x r oaraacre woo ® urmlanoun c~s.c I ~ I DETAIL ONE / I SCALE 1' 10' --- -- ------ --aa.1311 OVlBtAalO NOfAYE ~ 0 max: senor O rrar t+c er of Nr vs nc se r/'- 654-,~' " 1315.59 1RBED WIRE FENCE - -""" swr+~-sr otaMlrn T t'J11'. V/obi r~ ~a/ N M J¢ LEGEND y.~ FOUND IRON RAIL ROAD SPIKE. f )= FOUND STEEL BERNTSEN NAIL _ /_= q = SET 3/4" x 24' IRON REBAR. ~O WpGN1NG 1.50 LBS/UN. FT. M E1DP = EDGE OF PAVEMENT g171I: R/GhIT-OF-WAY ~ ®=Telephone Pedestal ~ ®=Soil Boro Tsst Sile ~ = Powsr Pole ®=Electric Meter ~ = Fence Js 13' West of ast rotor. 2 : Fsnce Is 8.5' West of set rotor. s Fence extended is 2.8' Weat of set rebar. Fence terminotes of c North. East, and Weat interaectlon. 12't North of set rebor. FEAR@IGS AXE REFERSr"fC~D TO NOTE: THE EAST LINE OF THE 30U1TiEA.9T I/4 OF SEClYON 20. UNDERGROUND ELECTRIC IIHTCH I3 A33UYED TO BEAR LOCATED BY DIGGERS HOTLINE s oo•~'xr" w. o' i o' 300, SC.AI.E 1 " = 300' SHEET 1 OF 2 Vol 21 Page 5259 LOT 3 856, 723 SD. fT. f 19.71 ACRESf ~ -r~.!~dinQ~Qht-of-Wav 836,832 SQ. FT.t 19.21 ACRESt RB L9ND SURVEYING, INC. S:f24 COUNTYROAD "Vv" MONDOVI, WI.SCONSIN6¢755 • U. 2 6 1 1 P 3 6 6 768099 KATHLEEN H. MALSH STATE BAR OF WISCONSIN FORM I - 2000 REGISTER OF DEEDS UocumentNumber WARRANTY DEED ST. CROIR CO., NI RECEIVED FOR RECORD This Deed, made between Rita M. Hampton, a sinele individual 07/07/2004 10:30A?1 Grantor, and Barry L. TaDlin and Susan M. TaDlin. f/k/a/Susan M. Knoll, husband and wife, as survivorship marital property Grantee. MARRANTY DEED Grantor, for a valuable consideration, conveys to Grantee the following EIElPT # 17 described real estate in St. Croix County, State of Wisconsin (the "Property") REC FEE: 11.00 (if more space is needed, please attach addendum): TRANS FEE: The Northeast Quarter of the Southeast Quarter (NE 1/4 of SE 1/4) of COPY FEE: CC FEE: Section Twenty (20), Township Twenty-eight (28) North, Range Fifteen PAGES: 1 (15) West. Grantor advises Grantee that an abandoned well is located oa the premises. No warranty or representation of fitness is made by Grantor. Grantor believes the well is useless. Grantee accepts the premises "AS IS" including the abandoned well. Recording Area This deed is given in consummation of that certain Land Contract by and Name and Return Address between the parties dated May 22, 2003 and recorded in the Office of the Robert J. Richardson Register of Deeds, St. Croix County on May 30, 2003 in Volume 2257 at Bakke Notrttan, SC Page 409-410 as Document Number 723669. 5233 McKay Ave., P.O. Box 399 Spring Valley, WI 54767 Together with all appurtenant rights, title and interests, 004-1046-90-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, highways, utility rights and reservations of record, and will warrant and defend the same. Dated this o~d day of June. 2004. * Rita M. Hampton AUTHENTICATION Sienature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Robert J. Richardson, Bakke Norman. SC S233 MclCav Ave., P.O.Bx 399. SprinP Valley. WI 54767 (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. PIERCE County ) Personally came before me this c"p day of June , 2004 the above named 1 to me known to be the person(s) who ex~cn~ed thd~oreea~u:s.'4; instrument and acknowledged the same. ~ ;~ 1~~ ± ~ ~ ~, ~y,. T * Marv L. N son '~~~^ i Notary Public, State of Wisconsin ~''~ . ~ f,~;., R ,~,••'' My Commission is permanent. (If not, state expira4,t~li daig,~~r December 12 , 2004 .) E~ * Names of persons signing in any capacity must btyped or printed below their signature. INFO-PRO (soo~ss-2021 www.infoproforms.cortd'rATE BAR OF WISCO WARRANTY DEED FORM No. l - 2000 w ~. r r n r~ -.. • raj rg-,. - d^-,S i ~9-,r # r¢i} rd-,9 ~"rL ~'-r~ ~ J~'~ _r ~"~ ~' ~ 3 1 4 i ,/i' . 1 .. .. Il000 0ltlr0 Wir~!!1 • • f I .. . ~: as to,,~, du ro '. aooo~avo a~a+b .. i f ~. ~ / ~~~ ', +i aau rqr g f4 r 3a db E) I s ~ f 3 iMN? N NIM I~7ilOMr ; ! ~ / ~~ f . I ICYC i / \ f !~ ~WAIi 10 fU .' 1 / \• l ~ I 7 \\ 1 • / \ 1 ' I r \ ' ./ ` f - ! i I. ~ ~ l r 1 / 3 1 y.~y~-' ~- --------~ c ~-~"---~-) ~' 1 / \ ( to n . • I • >~ Or¢ fU { Ste. ~ IILN o1Z f'U J 1 L _ ~ J i I~/ ,\! p1M ! ~ f) A 9Z^tibGAIE ~~ f .~ 1N!GM `T1M! .fv4 ~ ~ i rn+ uric ~ n~ ~ . 1 ,• • r~ i r ~ ~ $3 1 i ' .~Z l~ ' ~ ~ ~ ~ sacuE ~ ~ N .. ~~~~FF ~ •nrr~~pi~• f ~ j'~ ~ c r =I,DI-~! • rt _ ". ~ ,Z-'„JI ~ ~ ->' N y "' W : - { ~ ~ • - r, . r .i ~ ~; r{~p7 ~ ! •3i~D-' ~ r 9GIt10 JDl j' ~ ~ .7~J r f "~ s it ~ _ "~'~" 111111 r • I ~ i /'' '"- =~ 311^' _ • ail ~ .y 4- dl-r1 Ir ~ ~ ~ /' .~ ~ yE a ~ r f . I G • + ~ 171 A ~ ~ ~ ? m ~ rssc- ~, .s-,u ' ,~ i ~ ~, r~j '.s 1',4~/~J r~l .• }} r17 ~a ypW1 ic',rt ~ ~.".~ ~ ~~ ! I _ (•~' r ly0y$1 4 I r__~__-__-__ ==- . ' ~ ~~ • ro++ 4 I ~ OE9tilfl 9!o'YJ9 ..~ se:mu a;a~ ~ el pus: .: ~A_ ~ sJr ~~ xrss ~ x I I . 1 f ~ L ~ .~m~oo' a9 rFS~ort xrrt't ' rlq I ` r ! +~t ~ 07ar~rai.LLn6WIrP - ctjr ~7.~!-.i I t~ ~ E : 6ogrslliLlgiS-4la7!lOIRJJ ~+f 1 r~-~71 /r R1 i I I i -- - i--'-- rNn~N1 ~Irl - •~ 1 . r. ~ Ewa Ov-tt+lER'S 1V(ANUA~. 8~ Mq,I±~AGE1~tE.I'IT P~.AN POWYS __..«tr-sTx~sti[S EStrat'1 PARR~dt' ~ ~ D ~iA ~borsf Bedrooms . Number ~ Commerce units ~ aYd Ectitrit~bed ~ {~ r 4~ J aild ' 7 fir! tl~ {posh, C~'''~ " 1-'' - . G.~ Sod ~'tiPP~Or' i~abe Monthly s~re~e~ ir>ficrart~Ett2~QuatitY Oil & Gnease {FOGS t ~ ~/1. 1L Fa s„ C)xyg~ ~~ {BQDs7 BiOd'~: ~ sores t~S53 SZ2fl mg ~ 50 m /L " Monthly average Pried Effluent Qua~1Y (BODs) S30 mgn- B'~emical Oxy9~ Denis TataiSusPended So=ids {TSS) Sat) mgn- eta` ~I4t?Oml t ~~~ (geOmetnc rrseaft) Feca Maximum EtYiueat Pa~de 5Qe 3a inchdiameter Pagt of WNTgt~ipNCE SCHEDULE Service Frequency tMa~cfirrtusn 3 yrs.) Servttx Event ^ monttss r(s3 Inspect cond'~ion of tank(s) At teasL once every ~ tK) p{tank volurrre yyhen combined sludge and scum e4u~ on . (Maximum 3 yr;.) Pump out contents of tank(s) At least one ever3r D month rfs) r(s) - tnsped dispersal oe=1ts) ~ least once every D nsontfis s) ~ PIA Clean efliuent tuber Rt least once every Q ma-nhs s) O t~=A mnLnots ~ atara+ =nsped Pump, pump ~ ~~ onoe every ~„? Q month O IVA Rush and p~,sure test pt least onoe every a months fl year(s) ottmc: Q tenths II Y~rts) o h1A At least once every one of the fQBewin9 Gcertses or t<idAiNTENANCE iHS'LRUCTIONS = ~, made by are iad'nriduai cartysng ta'o~ Sep'ra$e tr~spec5ons oftariks anQ dispersa- °~~p=~n,~ Ftestric~+ed Sewer; POWTS irssPec~°~ ~ or breaaen osr't~. M ~~ must indude a visual inspection of the tanktsl m and to check for any beck up SerrfoTitB ° ore the volume at combined sludge and scu fa check the etliuent teveis ~~ 3riyr cracks or leaks, tTte~ 'fhe disperses aell{s) shall be visually ~~-~ ofi effluent On the ~ of et#luent on the graur+d pond'n9 of efRuen#_ an the 9rerand surface- $utiority. in ~ ~ pipes and to check ~rres the immed'sabe notif~`fi°n of the ioml ~utac°r~' ground stn'face ~Y indite a felting ~ciitlon and req ~ pf the tank volume, theme e and scum in any tank equals one-this {~7 of in ~ee'ntth ~'' Whoa the combined ac+cun't~fOf1 of stu ~ ~ a $eP~9e Servicing pperator and disposed entitz~ ootttetrts of the tan!< shah be r~ett~ - ~ t oamPon~ts: and any t13,1Ni9e~k-AdmirUstratnre Code- onents, pretriat~n Maiatatner_ anicai oar pressuriztsd POWi'S mmp a pOYVTS the senridng of eftivent gets. mec~ ~ fetxon of any sty ~°~ after m~rtti;rrance ar mcmitotitlg at into t7f 12 months or less shalt be P?~ o ~rnF Aser~e rshan~be provided to the last regu(ab°tY a~taliiy wifhln 1Q ~ STAKE" UP MIO OPERATION ~ p~tjng ¢roduds ar ether For (tear wcistrct~#vn, p~ ~ u~ of tt ~P~~~S-~d~ ~~ ~ ~~ p~ ~(s fi). Iztgtt conCenlral~or~ ~ diemicafs t[iat may impede the trBatm dted tia+te the ovntents of the tank{s} removed hY a septage servicing opera6or Prior Lo use: . vetoes iYPt~ for doeaesi~ trw~:......o. -- uent- .~ y~ i~ types for Pnsosste~'~ast~~ a .ter :. ~,,.,_,__af !' Sy~m SEad up shall not ~r vvtseri srn"I~cz~nd'siions are frozen at the infcitrative surface- . Dcaa r9 P ~~eS PAP ~~ ~y ~ BbO~le riOinta~ #ttghYl3LeC ~eY~elS. ~l'iE?ii f iS S~E`.5~'DDEd ~ E'JOE~$ ~er-m~l be discharged Lo the d~~ ozlt(s) in one larige dose. overloading the cells} and may result in the badaup or surface deschar9~e of efitc~s_~?t To avoid this si6uabion have the ra~ratents of fire pcirTSp fank removed by a • age ~ pt~ot~~RI ~~~ to the effluent pump ar contact s Pltttnberr a< P4YY't S Mafitainer bo ` 9SSi5t liI tl78ti[tally ~` !~ ps~P ~~?l5 to restore rlomtai levers wi[fiin tfie p~urnP tank. Do not dtitire ar pafk veh~s t~rtat talit~s and dtsp~ l~41s. Do net s~mre of Rai o>~j or ~etwise d15~Liib or compact. ~ ~ y 15 feet tlwm sbpe of ally trtoiarid flf at-grade sal'! abs4rp~n area_ tram the vrasteyvater sineam may imptvtre tflt= petfcxtt~rtoe artd protalg ffie fife Redcrctiort our-eTanlnatmis of the #al(os~ng cigarette btafs; condoms, ~tton svsrabs; degnBasers: tfen~( tfoss; drapers of t[te POWTS: arrtlbta6w; •baby utn x~er fiuit altd v etatsle peefri'lgs~ : S~~ ~~% itaeat dam; tai' fourida~ion tltalii ~sumP P. P} 89` iised"iraCsoas: old {>a~i'tg P~u~ ~isadszs~ ~"~~ rraplcins; tampons; •and snra~efsafr~er htirte_ ABANdQ[EN7 taken out of service the inttaEVfing steps sfraif ~ taken ~ hsscrr>; tisat fie When the POWtS testis srsdlor is permane~Y system is properiy~a~rsd safely abarsdarsed in canspfance with rh_ Comm 83.33. wiscx~nsin Adminlstrative Coder ~ Alt plpbsg ~ tank's arnd pits shat! •be disconnected and the abandoned pipe openings sealed 7Z+e oo~niw~?t's of 2til tarllcs grid ~rc'Cs shall be removed and property disposed of by a Septage ~Setvsdng Operator • After pumping, alI tanks and Pits shat[ t7e excavated and removed or plait ewers removact•and the v~d space h!!ed with soil, grav+ei yr ariolYaer inert sofrd material GOH7Il-IGENCY PLAAi if the POW!'S tails and cannot be rrepairrrd thin following measures have been, or must be falCea. m Provide a code cnmpGarst r+epiaCemeni syst+ern: . fl A suitable reeplacement"ar+ea has hers evaluated and may be u~ized far tPre tocatiors of a repfaoernent sod absorption m~_ Ttse rep~Cement aura should tre prQLected from disttrrbancs: artd compaction and should tact ~ ~~~ yrppn ~ ~~ setfracics from e~ng and proposed structure. [ot Frees and weils_ Failure to p~~ the rePlaoeirtent ate ~7I result in the need for a new soil and site ~evaluatiars to esrdbfrsh a suitable repiacemerst area- l~ep]aGer7lerlt systems must carnply tsrith lire rotes in effect at that tiesre_ D A suitable replacement area is oat avas7abie due to setback andlor soiE fmita5ons_ $arrrrtg advances in POw'fS technology a tsot6rng tarrk•tnay be irrstafied as a last resort io rspiaoe tine fazed PO1lVT3_ The site tress trot been, evaluated to identify a suitable repfacernert area Upon farZurte of fhe POVYT'S a sa3.and ~ ~l~jpn must ~ perivn•ned ~ locate a suitable replacement area. Ff no repfac~r:tent area rss avarrable a. ldirs9 tank may be installed as a last resort to replace the failed PO~Yi"S_ Mound and at-grade soli absorption sYsfertss may be reconstructed in place fiatlowfng rerr~rnra! of the Diamat at frrfrlh'atisfe st~rtaoE~, FZeaonstru~orzs of such systems m ast comply wiitr tine rotes to etiect at that• tirrr~ <NftARTttA!©~ SEPTIC PUrfdP AND OTHER TREATMENT TANKS MAY CC)IHTAIirI LETKAL GASSES ATif31©R tNSE7EFiCiENT OX1~~Ehl. DO NLl'!' EtYTERA SEPTlC, PUMP QR Q1'Hl`R TREATi4fENT TANK UNDER ~4MY' ClRCUtiIf.STANGES_ DEATH MAY RESULT_ RESCUE.OF A PERSOAi FROM THl/ INTERIO6t Q~ a TAltitK IVtAY BE DIFFICULT OR I~ifPOSSiBLE ADDRIONEiL COMMENTS POllif?~ INSTALLER Phone ~i~=.,~.~-- S/s-~ . POWfS i41AII~f'AiTfER Name ~,~ ~,c „~~/ ,~/'`~, ,~°~/ / PiZ~7ft~ ~ fJ`1~~C ~'~ T `~! 6 SFPTAtsE SERNClNG QPERATOR MP LOCAL REGULATURYAU~HQRffY Name ~~ ~.._- YY9 ~ A9~~3' ~,":~f j ~/~ Phone ~ /.~ ~ c~.l` ""- ~~~`' Peons /.1 ~- ~ fa iris ao ~.as arateae by ~e smdf§ of the ~n Lake. Ariarquetfa and wausfrara Co~.~nty totting and Sandatinrr . 'lttls daauaent rrreets me mur&nam regvie~erns of di C.osnrn 83.22(2}(bXtXdj3~f1 acrd 83_Sa(1), {2} 8, (3), WisGnrtsin AQrrfnLStrltivz3 Cede. Else of th>s docrrrne~rt d0e6 rl0t guarantee the performance of the POWi'S_ {,i~tW (?1t)f} ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address City/State Q l` '~' -Z3 S ~~ ~u~~~~6~ ~~ tt~ D (Verification required from Planning & Zoning Department for new~constructioLn~. 9 j~~~ Parcel Identification Number ~ ~l '/~! ~ ~ / ~ !`"` " LEGAL DESCRIPTION /j Property Location ~'/a , 5~ t~ , Sec ~ ~, T ~ ~ R W, Town of ~--~- ,Lot # Subdivision Certified Survey Map # ,Volume ,Page # Deed # ~~ ~ ~ ,Volume ~ Page # •b Warranty Spec house yes no Lot lines identifiable ye 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. 'GVhat 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standazds 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the ertyiescribed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~ ~i/ i_o~ SI ATURE OF 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. 08/05)