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HomeMy WebLinkAbout006-1064-60-000Wisconsin 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 Krue er, Richard C Ion Townshi CST B ev: Ins . BM El~v: BM esc'ption: 1, Jp _ /`'a.c~~; ~' vts r -K~ TANK INFORMATION tt ELEVATION DA A TYPE MANUFACTURER CAPACITY Septic ~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L/~ L1~~) Kt,~ WELL BLDG. Ven to Air I~~)1ta~ke~, !/ 14_. RO/ AD ~lu Septic ~ i •,~~ A ,~•~. , i~ ,,~ ] ~- ~ r I - I .~" Dosing -- Aeration Holding PUMPlSIPHON INFORMATION county: St. Croix Sanitary Permit No: 405022 0 State Plan ID No: Parcel Tax No: 006-1064-60-000 STATION BS HI FS ELEV. Bt~~f-lmr~ ~~~- r v~ ~ ~(G pL ~G l Df' ~ Alt. BM ~~r a " o~rrt~C~s- U 1. ~'~' /GO ~ 7 3 Bldg. Sewer S t In~e~ ~ 5~ ~=~ ., ~ % St/ t Outlet S ~ Xr D Dt m / -~ Header/Man. ~~~~ Z• Dist~ipe 10. L ~ ~ ? ~ c . ~ Bot. Syste ~ ~ Final Gra e ,2 (o~ St ver GPIOt Model Nu er TDH Lift Fri Loss System Head TDH Ft Forcemain ength Dia. Dist. to well SOIL ABSORPTION SYSTEM BE RENCH idth / Len th No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI SION ~ ,f ~~ ~~ ~ i" SETBACK SYSTEM TO P/ ; BLDG WELL LAKE/STREAM EACHIN nufactu er r INFORMATION / HAM R ~ ~~ TYp~ f S~~ •I'L~(~t,"Yl.. • ~~ I" ~~-I/ ~ ~~ i ~ UNIT odel umber: r11CTRiR11T11f1N RYRTFM T _ _ I, .. r . ~ 1 ~'. ~ .J ,; :-. ~ i^,' Header/Manifold ~l ~ ~ ~ , ~- - - Distribution Pipe(s) / x Hole Size -~ x Hole Spacing Vent to Air Intake Length~_ Dia Length Dia Spacing / ~ SOIL COVER v Proec~~ra Cvc4amc Only xY Mrn~nr1 Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil ,~ ~; Yes ~] No J Yes (:JI No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~ /_~~~~ Inspection #2: / / Location: 1943 Highway 46 New Riichrr)ond, WI 54017 (NW 1/4 SW 1/4 29 T31 N R16W) NA Lot Parcel No: 29.31.16.447 1.) Alt BM Description = ~I ~-~,~,~ ''It~,~ r' '~ ~'1-6Z,(.~ ~`' G" 2.) Bldg sewer length = ~' ~ - amount of cover = ~ ~ f --~ ~ ~~ , - - - - _ - - ~ ~l Plan revision Required? la~~ Yes No i - J ~ Use other side for additional information. ~ _ ~ ~ _ ~Z~ _ ~~i~/K!Iz/ - _I ~"!Y~ ~ _ ~J Date Insepctor' Signature Cert. No. SBD-6710 (R.3/97) °~ , ~ i, ~~~ ~ µ~~ ~0~ .~ ~ ~ .,r ~`~=~ ~ /' ~ ~~, d_i'l~/ O~ ~[/kNk ~jt,~~ ~~ ~~~~ 7 . 7r D ~ " Btuidings DtvttitOn ~a~ P.a. Box 7162 wa Ave. 201 w waaltio , . g Madison, VVI 33707 - 7162 ~~~~~,~ `~-zz ~-~ ~ - ~'«~ ~~ ~ 9 - lie artment of Cammert:e ~ Sanitary Permit Application ~S-o zz za ~:a .alt comsat s3.21, win. Adm. code, peraoml ia~ormarion r«r Proves ^ cn«~x ~' Revision ~ ~ used ~ Isw, a15. 1 m h Apptkation Irtforaoadas - Please Print Ali Inf Star Plea LD. Number _ '3 Name Parcel Number ~ P ~ ~ U ~ - Co - _ C7~ O ,$ Address Property Location ~ ~ ~ ST. CROIX '4 SvJx• S T N, R ~• ~ ~ ~ ' G Lflt N B 7 Subdivision Namt CSM Number II. Type ~ Building (~ alf that apply) ~Cuy 4 3 ~vt7lage 1 or 2 Family Dweuing - Number ~ Bedrooms Pnblia/Commercial- Dese~e Use L~ro e Q~Od Nearest Road ~ State • ~'~ ~ 3~ s ~ `~~ ~ w IQ. Type of Permit: (t~lCClr ~ etae hos ant line A ( tame for hlternal use). Complete line B k) `,' 1 ^ New 2 ~~ Syt~em 3 ~ R,eplaexaoear of 6 ^ Addition m For Canty use Tank rms Number P Date Issueai $. ^ C6exk if Sattinry Femrit Prcviousiy Isserod e IV. Type of Pernik: (~ alt Wat apply)(nunaberiog stdteme is for internal tme}~ y 14 ~ Non -Presstrrined In-Gtvuod 21~ Mound 47 l] Sam Fiber 50 ~ Construcud VNetiand ~ (] p d 41 ^ HotIIiog Tank 48 ~ Single Pass Sl ^ Drip Line 45 0 At-Grade 46 ~ Aerobic Trnnmar Unit 4'9 ~ ~ ~ ~r platy ~) Atea Arn Sot? Apples Percolation Rate System Elevation Grade Elevation Raue(Ga1s./DaYsJS9.FK.) (Min•IIncW ~ . ~~ ~~, ~ q~',g ~ 33 ,s ~ q ~ ~ YI. Tank Info C~~' ~ Total Number Mager Prefab Sleet Fiber Plastic crtre Camatrcoed Glass Co o (3ai1~s Gallaas of Tauits Nea Fit Taab 'rad~s Scptlc HoldioaTadc - p~~ W ~ ',~ f~ ~~~ ya, StatemEnt- ty tLe rm r'esponrddiRt7 ter at• the Powrs aLown as tine atixduui Pbmtber's Name: Pbmrbtr'a MP/MI'RS Nnmber Businexs Pbone Nmnber ~~ ~-~ as ~ 5 3 `t ~ s a4~- P1-mtLer's Address City. Smte, Coda) j ` S ~ ~`~ ~ /' Y111. WWR llJi uaacaaa Y.Tr var - ~( Approvtd ^ Dwpproved ~ ~ (includes Grotmdvvater Ihoe Issued Isuaog Ageffi Stgnanue; o Pet) ^ owner Given Lritial Advet~ ~ 225 ~- ~ \ - -- ~, C:aed ~1 of pproval/Reasa~ ~ Distapproral ~ , _ ~S ~--f ._----~ ~ •-~ ~-~"LC_. -et°°e°kRe p6~~(to t~caw adz) ae .~em~L[~ ~ ~ 0.. ~ ~ t~l~. ~ I~, r") -• 1 ~~ . cIiT1,.~Z4R CR t15Intl 1, ~ra~r aw w.+...-~s~- ------ j ~ 201 w. Washington ~~.. P.o. Box 7162 isconsjn ~°°. ~ ~'~' -'lam ~9' 3 Oe artment of Commerce ~~ Permit un~a Sanitary Permit Application ~{os-o ~ Ia accord with Cotam 83.21, qr~ Adm. Cade, personal ~utormation yon p~~ ~ deck if Revision ma be urea far Law, sIS. I m L Applkatida Information - Piase Print All Inf Stan INaa LD. Ntmtber_~ 'a Name Parr[ Nnmbar ~y Owaer~a ~~ Property Loattoa t ~: , r Z f (..... / f ~ ST. CRniv ~r,~ ,.,_.. ~ iv'~ S ~~' S ~`t T ~ ( N R I (4 ~ ~• Staoe `~ ~ Code Lat Numbe tsloctc r r Subdivision Name CSM Number n 'Type of Bnnah>g (~ an that aPPIY) ~ ~ I or 2 Faintly Dwelling -Number of Bedrooms Pnblic/Commerrlal - Desesibe Use ~I'O ^ State~O~ed Nearest Read 'ic ~,~, .3~ S 27 ~~ ~ w nI.1`1Pe of Permit: (Check only one boz on line A ( she for internal nse). Complete live B app le) A• (~ 3 ^ Replacenueat of 6 [~ Addition m For Ce®t7 rase I ^ New 2 Replacement Sydem Talc Dace Issued B. ^ Check if Sanitary Permit Previwsi Permit Nomb y Issued er IV. 3ype of Permit: (Check aII that aPPi7')( n foe internal nse}.~ 44 ~ Non -Presmrized In-Gcouad 21~ Mound 47 O Surd FIIter 50 ~ Coastractod wsdand 22 0 p 41 ~ Holding Tank 4g ~ Single Pass 51 ~ Drip Line 45 ~ At-Grade 46 0 Aerobic'IYeanooer~t Unit 49 ^ 30 ~ Other 1 pyoy~, ~ Ara Sotl Appluation F PerrAlation Rate System Elevation /inch) (Min Fiml Grade Elevation t.) RatKGals./DaYs/S9. . ' N~ ~~, ~ q~'.5 q~~ ~ ~3 rs m VL Tank Info C>1~kY ~ .Total Number Maaifa~trer Prefab Site Concrete Comttnctod Sped Fiber Plastic Glass G81oas Gallons of Tanks New Ezisvoe Tads Taalcs sevae Hwa;ns Tads _ ~ ` ~,~ ~ Kn-1 Dodo[ t]~err VII. i$ty Statement- 1+ the mod, reaposs~ty for of the YOW'L'S shown on the attached piatt9. Phunber's Natae Phrmber's S MP/MPRS Number Business Phone Number as ~ 5 ~ `t ~ 5 alb-S ~ 3S _ ~ ~ ~'~~ Phmober's wddtess ( city. state, code) ` ~, ~ ~ lr~l~`-r- ~ V t ~. /De Use Sanitary PermN Fee ('toclndes Groundwater Dace Issued issuing Agent Sigmture (No Stamps) Approved ~ Dtsapprovul Surcharge ~~ ~ ^ Owacr Given Initial Adverst ~ ~ i)eoermirntion ' 22S IX. ~l ditiogs of ~iPProvat/Reasons or Disa~ ~ ~ ~ ~~~// ~ ~ ~~ / ~ s ~ ~~5 ~` enn..~zoA rR rnSm, ~ ~a~ ~ ~. ~ ~~~~° 4 3.7s ~ ~( 91, 7 o~ `~~~• ~f ~ ~ 7-ca~ ~( ~.~3T , ./ s~~ = ~ ~ Act, B o~ ~ ~'~ Q` ~! ~~;4 ~--- No~ 1 1~ ~~ I~ B 3~ N'~,~y s~;Y~ sagT 3~ IIl 2110 c~ fog. /~s~ c~~~~ .~~~_-~ ~~~ - ~bc~y - ~ - ~-7°r° ~ ~ ~-- ~ ~ o L ~ _ ? ~~~~_ 1 ~~~ ~~ ~~ a~ ~~ N~~~ S~y~ S~qT 3~ u ~~~~ C ~ fog. /~s~ C~~ ~~ ~ ~.erc~ 4 3, ys C~ ~~ °!!t 7 o~ - ~ ~~~T ~ Sc~_~ _ ~ ~ Bn~ _ ~~o~~ 5~~~,.q ~) 100 Q; Atfi, B oQ ~ ~~ Q~ ~~ /oD;q ~-,.-- Nor _i ~~ 1 I~ g. 3Z /~~ ~ o~ ~ - ? ~ ~"~ - ~'- ~_-. o~~~^~ SOIL EVALUATION REPORT ~, ~,~~ in aoaadaeioa wrn caaRan es, wls. IWm.. tbda ally pMn an pa~sr naR Ms wan d v2:13 ind+as rr- siaa. Plat- aaaR ~`~'"'~` ~ ~, ~ M~+da~i~iad 1ec w1~l.dN~eanlN ~ o~ ~, „rad p~oantalopatsai~ram,~„~,~ ~'+~ ., ,, aiar~a.w~ocr~l~nawaw~aa.~a~w~.rcw.o. _ (~ to _ooo ~~~~~~~M°~~'~'1Mrla~ItiM~oariw,s.1S.M(t)p~. ~ I '~ ~ et` 6srt tmt W u61rJ !M S T3~ N R ~ w ~! ~a~,< , ~ , _ - : ` ` .. . , ~, > ... t+ot ~ efo~ ! Rubt N~r+a a ~ ~ ; 3 ~, ... ...~ . •. ... w ~ Vlfapa o+w^ - ~Ro~d ~ . © Nllwr ~)seci$t~.aM.nar~N~w~b~rae.e~aen~s 3 coa~ad.~.ed..~nsv.-.al. Apo ~ 0 P'~boraaasaaww-p~~ a~tn~ew ~wrn.r~.~r.p~aa ®s~aatovaanw~ 6--- aAl/ ~K .~= y~~ - ~- ~ ~Z ~ `I I ~ ~Z APR 1 8 2002 Q ~ ~ ~ ST. CROIX COUNTY ~~ ~~~~~ ~~~~~~ ~d ZONING OFFICE fiviUon _ D~ . Daa~irnt Rado~cDaaaip~on Tsa~w sraodnt Raals ~ +f~ ~ Goat ~.~ t,1~ Ss 8R `~f ~ O 1a ~. J ~ fs~ik r G S + ~ a-35 `-'- S. c rr 3 ~~ ° `~ 1 .~ s - ~ '~' o ~~ s - v .2 q • a~ !a2• ~$• ~ 4'L ~ ~' .:. Ram Taaty ~ ~ ' ~ R ~ la I X adR ~{, ~ 4L SL. ~. ~ ~ ~ ~ '~'~ ~ b - / r -------- C ,S Z S ~ Slk ~ 3 _ ~ cs ? ~ , 5 CS '" • I, L • ~- ~ O~S y Mti Jr ~ l~ .Z , 2 Elk ah ~ sap < ~p ~ aad TSS ~ < 160 nipll. Q ~ <aD aad:TSB = att nApA_ . _ lam Cl3Tti~nibar /tidd~ws / p Z Paapa~rCwn.r3-GR Av~c~ t\ '~ ~--~ ~w~vr ~~~ i _ S I ea~~nf ~ eai~+o !SU > ~ ~ ~•o• ,~.d_...~.. ~ J ~6J plt ctiounesu~o..~s~-. ,/ ~-~ tt o~paao~saor,,r o~• ••. lb~0+o~ O~pM~ Oe~irn! ~iMbc TI1~a ~ tn. Nu~ae Gu. Ss. cant Cover Or. b~. SIB 'fit ~ 'E a a ,___._ ~X n , 5 .. --- ~z Q ~ Ci~aad a~sfacaalar. a Drpt+ b i~ilne Laar ~- soa caran WI. Mo~ooa o.pa oa~.nt. R~esc o.w~fon T.s.. ~.. ooilMoy~ souien~r Noa~r ~PDIR h Misw~ O~ St Govt Go1ar (#r. 8s. SA.' _ 'i~1'. "~ 4 .. • .. ~ .. +k; 1 , ^ P! t~oandsw~iwaiar. 1L capb a Rio ye~or i'~- ~~ O Iioileon Oopb Oaw~t RaArat Oaaodl+iow. TwAai Sew ~5adilMio~ Aoa~ h I~u~w/ On. Coal. Color Or. 8a Sf~ -~ .,_ ,~,, ,: , S , , - E~IIUaf1t ~ = BODE a ~0: 22D mpA. and T53 >30 _< 160 mpiL • E1Uuant ~2 ~ BOD, ~ 90 rt~pll and T'$S : 30 n~pA. T'he Daparwent of Comaneree & as ealwl oppocwaity setvka ptovldar end sa~bpa. if yrw aced asdsW-eee to ac~ops oan-loea or Hoed. a+uerial b ~ aitatnaoa toeaNt.'pleara aoatact the at b08-Z66-3151 0~ T[Y 608-Z64-8T!'i. ao+aNp~aao~ ~l~c~~ ~r~^-e ~ ~V ~,.~~~~ Sw`~ S oZ.q ? 31 N ICI ~OC~ 1, 3 {~ w e~ ~ ~ o r. / S~ . CPS i~C 1 N..~.~.: ~,c~.nno7~~,r.~i syO1 > ~a~ ~` o~c~ - r~~~_ too - ~ ~ ~a 7 s , .,.•q ,, ~~~ ~. as ~', s ~~ ~--- ~ 4 `-~''~1 ~s~s~ ~ , ~a „r ova There- Is q gaff . er Weyr • BjaDiffuser~ Units: 34p x ~~" x I4" or ~ x76"xII".- or gT~ter storage vo1~e ~' QPen bottom el~imiinates n'asiung or shado~- effect •' ~-ouvers pmtect "open sidewails • Sidcy~.a~ oPenin stu'face and ~ m infiltr~ • improved n ~~'g eft + Ver perform~~ y eCOn©mical M~~mizes unmasked leaching The Bioaff~~ra, provides th of unmasked effective Iea a °ptim objective is to ching surface. Its design unmasked sidewa 1 toga low °pen bottom and capillary action in alI direct ons. Tt to flow via achieved by combinin his has been bottom with a series of g uVersr aion onal, Effluent inside the oFen chamber flows to g the sides. ~oiI along the full length of each uncomPacted ire designed to a11ow effluent to e' The louvers ~ncornpacted backfill while pass iota the vgrating Ito the chamber Preventing it from ~`~~ ~ru~o ~o/~ --- ...si X13: 011gin~ Standab Unit Length Low pbhle Untt ........... 76 N Width Length ..... 76~ .............34 Heght " .... Width ........ 34" ........... Y4 Invert .... Height ....... 11 ........... gN •.•. .... Invert BioDiffuSe~ ""' ..........6.5„ of eithe size, when installed atro~ Q9~7ded and. coact sails to d . withstand H-in , ;, ^^epths~ ro~..~,..e . _ . P'OWTS (3WNER'S MANUAL & MANAGEMENT PLAN Page C of~ FILE INFORMATIl3N Owner ~ r~ ~c.,~e s ~~ Permit ~ ~ ~r nccrnar oeaewA~RS Number of Bedrooms 3 ^ NA Number of Pu61ic Facility Units NA Estimated flow )average! al/da Design flow Ipeakl, (Estimated x 1.51 ~,~j ~ al/da Soil Application Rate cj al/da /ft2 Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG! 530 mg/L Biochemical Oxygen Demand (BOD51 5220 mg/L ^ NA 7otai Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids iTSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510` cfu/100mt Maximum Effluent Particle Size Ys in die. ^ NA Other: ~NA *Values typical for domestic wastewater and septic tank effluent. cvcT~fie SPE(JFICATIONS Septic Tank Capacity OOG al ~ NA Septic Tank Manufacturer ~ ~.~r.. ^ NA Effluent Fiker Manufacturer Z ~ ~ ~(~ ^ NA Effluent Fiher Model 6ti ^ NA Pump Tank Capacity al NA Pump Tank Manufacturer Pump Manufacturer 'B~ NA Pump Model ~~` Pretreatment Unit ^ Sand/Gravel Fiher ^ Mechanical Aeration ^ Disinfection ^ Peat Fiker O Wetland ^ Other- ~A Dispersal Cetlls) ~jn-Ground (gravity) /^ At-Grade ~ Drip-Line ^ NA [7 In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ PIA. MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer, POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections 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 cents) shalt be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of affluent on the ground surface. The ponding of effluent on the ground surface may indicate a 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 IY31 or more of the tank volume, the entire contents of the tank shalt 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 (4101 i ' Page ~ of a °~irART UP AND OPERA'~"10N For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or otfter chemicals that may impede the treatment process and/or damage the dispersal cell(sl. If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wi0 be discharged to the dispersal cell(sl in one large dose, overloadeng the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a septage Servicing Operator prior to restor~g power to the effluent pump or contact a Plumber or POWTS Maintainer to assist en manually operating the pump controls to restore normal levels within the pump tank. Oo not drive or park vehicles over tanks and dispersal calls. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the 1'rfe of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump- water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/ar is pemnanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback andior soil limitations. Barring advances in POWTS technology a holding tank may be installed as 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 performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <waRNIN~> > SEPTIC. PUMP. AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~; V ; ,n Ov.~ ~ rs Phone ~- S ( 3 POWTS MAINTAINER Name Phone SEPTAGE SERVICING ,OPERATOR (PUMPERI LOCAL REGULATORY AUTHORITY Name Phone Name ~ ~ ~ Phone (~ 3 This document was drafted in compliance with chapter Comm 83.22(2Hbl(11(dl&(f) and 83.54(tl, (2) & (31, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND - - OWNERSHIP CERTIFICATION FORM OwnerlBuyer __ _~<<~~ __~f`v~~{~,'"' Mailing Address mor~_.<~~~ ~VOt Property Address _~(~ ~~~ (Verification required from Planning Department for new construction) City/State LEGAL DESCRIPT><ON Parcel Identification Number ~ O Ia - 10 (o ~/ - to (~ - O~c'~ Property Location ~ W %.,~~J %,, SeC. ~, T~N-R ~ DPW, Tawn of ~ ~ ~ Subdivision -~-~~~ „ _~.r, C7 ~ ~- ,Lot # Certified Survey Map # ~-- - Volume ~ ,Page # -~-~- Warranty Deed # ~ ~7 a;l 3a-- Volume ~ Page # ~~ ~ Spec house ~ yes ~ na Lot lines identifiable ~ yes ^ no SYSTEM MAINTIL~N~i, E Improper tsse and tnainttnanceof your septic system cold result in its premature failure to handle wasits. Proper rnaiattnance 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 agues to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, lourncymaa piaunnber, restricted plumber or a licensed pumper verifying that (i) the oa-sift wastewater disposal system is in proper operating condition andtor {2} ai~er iaspcction and pumping {if necessary), the septic tank is less than I/3 foil of shtdge. Uwe, the undersigned have road. the above requirranients and agree to maintain the private sewage disposal system with the siaa~rds set forth, herein, as set by the Department of Commerce and Ilie Department of Natural Resources, State of Wisconsin. Cer~icmtibn stating that your septic system has beta rrtaiatained must be completed and returned to the St. Croix County Zoning tae within 30 days of the three year expiration date. ~~ 'uf/1~ ~l / d SIGNATURE OF APPLICI T DATE OWNER CERTIFICATION I (wc) certify that alt statements on this forte are trot to the best of my (our) knowledge I (we) am (arc) the owners} of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~ _ I 10` SIGNATURE O APPLICA~ DATE ***'*• Any information that is mis•representedmay result in the sanitary permit being rcvokedby the Zoning Department,'**•*' •' Include Kith this application: a stamped. warranty decd Crom the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. '~ ~ ~ ~. T$i3 Indenture, Made by Arthur E. Krueger and Gertrude Krueger, his wife, grantors of St. Croix _ County, Wisconsin, hereby conveys and warrants to Richard G. Krueger grantee ! of __ St . Croix County, Wisconsin, for the sum of Fifteen Thousand Dollars f$15 000 00) the following tract of land in St . Croix County, State of Wisconsin; South Half of the Northwest Quarter (S z of NW 4) , North Half of the Southwest Quarter (N2 of SWµ) and the Southwest Quarter of the North- east Quarter (SWµ of: NE µ), all of Section Twenty-nine (29), Township Thirty-one (31) North, of Range Sixteen (16) West, St. Croix County, Wisconsin The said garties of the first part also convey, quit claim and release all their interest in the above described real estate by__reason of the i zl ~ er est in favor of the parties of the first part and the survivor of the said parties of the first part of the small dwelling on said real estate, including the yard about the same, garden and the joint use of the driveway to the said dwelling, and said parties of the first part re- lease all their interest, a~~crr_~ c~;r~ax~rtx~t Croix This deed is given in fulfillment of a certain land above parties, dated April 1, 1947 and recorded May 289 of Deeds, page 34 in the office of the Register County, Wisconsin. contract between the 20, 1947 in Volume of Deeds for St . IN WITNESS WHEREOF, the said grantor~._ ha _~.e_hereunto s1a _-t}1e1~_hand 5.. and sea1S_.__this __-__ ,1-9th __._ day of A ril ~ , A. D.. 196__..._ . ~NED AND SEALE~ N PR~ESEN Harold D. Olson Pearl Grotenhuis f ~ _-- (SEAL) r ur a er - _ ~~- .(SEAL) Gertrude Krue eg_r (SEAL) (SEAL) STATE OF WISCONSIN, St . Croix ss. _County, Personally came before rie, this 19th --_day of __ April ~ A. D., 19 63 the above named Arthur E Krueg.~r and Gertrude Kru,.._ hi s wife to me known to be the person ~.. who executed the foregoing: instrument and acknowledged the same. Received for Record this ~~rd day of ;rK ' ~ ~~{ / J ,' ~, ~) ^~ Agri A. D., 19~at1.00 o'clockp"• ~~~' ~' ''~ / Z„J t :(SEAL') ~ =' aro d ~. D~Ison y _ ~ ~' ~ t. roix ~=" -=~ :Notary Public. County, Wis. Register of Deed; ,_:` ~M commission i c nPrmanP Deputy Register of Deecls.,~ ~~;~,, This instrument drafted b}~ _Harold.J'~~f'i~ln, ~~1t~orney at Law WARRANTY DEED-SPATE OF WISCONSIN. FORM NO. 9 .~`~:'°~ ~ ~~"~ ' l r, e. rn~Ee co.. ruw~uctc smt i . ..~. _ _ .- - --- ._.- ~C~~m ~~ N0. ' j~~~~ Arthur E. Krueger and r ii ~~ I,. ',~ Gertrude Krueger., his: wife, it TO Richard G. Krueger WARRA1vTY DEED REGISTER'S OFFICE, ,,, STATE OF WISCANSIN, 'l I '~ County, Received for Record this.. •• day of !i {it~li~'A~ ~ e et o~~~~, and recorded ~~ J~~1L in Vol..~,,.A.}.p/~~edsM1A~ i LJ/~iVi fiVt~G. REGISTE.~ 0~' DEEDS Register of Deeds. Deputy. RETURN TO -~1__-- 1