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HomeMy WebLinkAbout008-2015-15-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556349 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: Weckwerth, Paulette Eau Galle, Town of 008-2015-15-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /db Q /VL / 65-F 19.28.16.591 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing CO to V/ gQQ Alt. B Sr"5.75 Aa aWn Bldg. Sewer ZQ • ` Holding St/Ht Inlet Z6 1 79 , St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. V t to Air Intake ROAD Dt Inlet Septic 7 50 6 Dt Bottom ZS. • Dosing ' SU I Header/Man. .73 Aeration Dist. Pipe 4`7 93 Holding Bot. System 7 12. 0A, PUMP/SIPHON INFORMATION Final Grade 3 Manufacturer Zo e, (L GPM Demand St Covert !t'• 5 FS .17 Model Number TDH Lift o L Friction Los ISystem HgacA _ TDH Ft tl~ i O •7 214 M Forcemain Length a Dial $ / Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 571 ! K G Is Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture INFORMATION CHAMBER IT Model N Type Of System: , - ' V UN OR Ge.k✓c^.~-7 /66 /V DISTRIBUTION SYSTEM Header/Manifold GG Z Distribution x Hole Size x Ho a Spacng VePo 71n Pip e(s) Length S Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Lie Depth Over Depth Over xx Depth of xx Seeded/Sodded xx M ched Bed/Trench Center Bed/Trench Edges Topsoil `N L_ jf No Yes M No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: I I Location: 2122 21st Ave Baldwin, WI 54002 (NW 1/4 SW 1/4 19 T28N R16W) Star View Acres Lot 15 Parcel No: 19.28..1.6.591 1.) Alt BM Description = rt` t ~Jt~ 14CA. ~r Ve.16LL 2.) Bldg sewer length = 1-6 A--CJ 15(` p •~f o,}G SD • ( t.~.~~ ~'~C, - amount of cover = ~ O 1•Y .6& $d .•1S l►a.~ $ r G, vKO~ Plan revision Required? ❑ Yes No Use other side for additional information. SBD-671 0 (R.3/97) Date Insepctols gnature Cert. No. SITE PLAN NW,SW,S 19,T28N/R16W Eau Galle township St. Croix county LEGEND IBM: 199-0~ Nail in 'y •j~. ~q , 6" wood post 2BM: 97.0"top of _ 1" PVC pipe's S X - pit 1~ - boring k ® - grade elevations - - contour ~~,Y. - No DSPS 383 setback problems h~ Scale 1" - 40' except where indicated ~ a System Elev. 92.6' or shallower in W area of 95.0'threw 97.0' Szx a}~ 3 cells3ft. By 80ft. i3~~=1 x Gle,.~~ N L4 v C ~a ~~~t1r V1LW r1P2~S 1~ project: WECKWERTH page 10 of 10 County Wisconsin Safety and Buildings Division St. Croix Ii~ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Department Safety A Madison, WI 53707 - 7162 55(o347 Professional Servic 17 ?_0 'l. State Plan I.D. Number State Sanitag Re it Application ~~1- In accord with SPS 383.21 (2) Wi~S:IU. Code submission of this form to the appropna a ntal Project Address (if different than mailing address unit is required prior to obtaining a sanitary permit. Note application forms for state-o* submitted to the Department of Safety and Professional Services. Personal information you pro 1. is SWF, 2 1 5 may be used for secondary purposes in accordance with the Privacy Law, s 15.04 1)(m), Z_ ~ 2 /Z 1. Application Information - Please rint All Information a J Property Owner's Name Parcel # V r Paulette Weckwerth 008-2015-15-000 6 1 Property Owner's Mailing Address Property Location 1601 Liberty Circle 7V _ 61627 Govt. Lot City, State Zip Code Phone Number NW SW Section 19 Shakopee, MN 155379 612/384-0082 T 28 N/R l6 w II. Type of Building (check all that apply) Lot 15 Subdivision Name X I or 2 Family Dwelling - Number of Bedrooms Four ea Block # r V ,'e, L,) Ac, G Public/Commercial - Describe Use City n CSM Number Village of State Owned -Describe Use CeAl> w I X Town of Eau Gal le III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. X New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision _ Change of ❑ permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) X Non -Pressurized In-Ground Pressurized In-Ground _ At-Grade Mound >24 in of suitable soil -Mound Q4in of suitable soil Holding Tank Other Dispersal Component (explain) Pretreatment Device (explain) V. Dispersal/Treat nt Area Informatio e- ` D 1 Design Flow (gpd) Design Soil Applicatio ate(gpdsf) Dispersal Area Required ( Dispersal Area Proposed (sfJ System Elevation 600 0.5 1200 sq.ft. 1200 sq.ft. 92.6' or shallower VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks or Holding 1200 1200 1 Weiser Concrete X Tank Dosing Chamber 800 800 combo X VII. Responsibility Statement- I, the undersigned ssume r ponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe 's afore MP/MPRS Number Business Phone Number Kent Hoke MP224199 715/962-4155 Plumber's Address (Street, City, State, Zip ode 200 Bremer Ave., Suite D, Colfax, WI 54730 VIII. oun /De artment Use Only Approv Permit Fee Date Issued Issui gent Sign e :;Disappro ' en Reason for 1 75' ad Z IX. Conditions of Approval/Reasons for Disapproval I _ SYSTEM OWNER: 3' ~D 4rt~ p 6 lax. 1. `Septic tank, effluent filter and dispersal cell must all t services / maintained 1 nos, e✓~5 t2.tM.e as per management plan provided by plumber. hll_~, 2. Alsesck requlrsmerds must, bt,maintainl as r>er . cod. / oranola; C^A 6_6 ta 1- KccO! Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size PRIVATE ON-SITE WASTEWATER TREATMENT SYSTEM (POWTS) New Site Index and Title Sheet PROJECT NAME AND SYSTEM TYPE: WECKWERTH / Conventional system by lift tank OWNER: Paulette Weckwerth 1601 Liberty Circle Shakopee, MN 55379 LOCATION: Street Address Legal Description NW1/4,SW1/4,S19T28N/R16W Township/County Eau Galle township, St. Croix county Lot 15 of Star View Acres II CONTENTS: page 1 title page page 2 owner's manual page 3 operations page 4 reports page 5 filter information page 6 effluent pump information page 7 tank detail page 8 tank cross section page 9 cross section page 10 site plan / Attachment: N.A. PLUMBER: H & H Plumbing, LLC SIGNED: -Hoke CREDENTIAL MP 224199 DATE: Septemb 10 2012 POWTS OWNER'S MANUAL MANAGEMENT PLAN I POWTS MAINTAINER: H & H Plumbing LLC ph. 715/9624155 LOCAL REGULATORY AUTHORITY: St. Croix Zoning ph. 7151386-4680 SEPTIC TANK PUMPER: H & H Plumbing LLC ph. 715/962-4155 DESIGN PARAMETERS Influent/effluent quality (values typical for domestic (non-commercial wastewater and septic tank effluent) fats, oil and greases (FOG)<30mg/L, Biochemical Oxygen Demand (BOD)<220mn/L, total suspended solids (TSS)<250mg/L SYSTEM SPECIFICATIONS FOR NEW SEPTIC Four bedroom (600-GPD) single family residence 1200/800ga1 Wieser combo tank Orenco FT0822-14B filter three distribution cells, 3ft. X 80ft. with Arc 36 infiltrators soil application rate 0.5gpd/ft2, area required 1200sq.f1. absorption area credit 25.0 per 5ft. chamber, proposed area 1200sq.fl:. (components must comply with DPSP 384 and be installed per manufacturers specifications) DESIGN CRITERIA SBD-10705=P (N-01/01) "In Ground soil absorption component manual" Version 2.0 MAINTENANCE MONITORING SCHEDULE Inspect condition of tank(s) at least once every year (maximum 3yrs.) Pump out contents of tank(s) when combined sludge and scum equals 1 /3 of tank volume Alarm and float to be check at least once every year Inspect dispersal cell(s) at least once every year project: WECKWERTH page 2 of 10 OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brim or waste from water softeners, iron°removal units, other clear water gent devices and foundation drains should be discharged to the ground surface whenever possible. Note: This does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkin, condoms, cigarette butts, should not enter the system. Chemicals such as petroleum products, paints, disinfectants, pesticides, etc. should not be flushed into the system as they can seriously damage your POWTS system. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septic tank pumper. Septic tank component inspection must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings >8" in diameter shall be secured with an effective locking device. When the combination of sludge and scum in any tank exceeds 1/3 or more of the tank volume, the entire contents of the tank shall be removed by septic tank pumper. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacture's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Pump Chamber/Treatment Tanks Component inspection must include a test of all electrical equipment. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any services needs or repairs shall be promptly taken care of. Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact and individual licensed to service POWTS, There is normally I day reserve under regular operating conditions, however water should be conserved until the system is corrected to prevent back-up of sewage into the dwelling or surfacing. Pump Tank Filter inspect at least once a year. Remove filter from canister. Clean if needed. In-Ground Gravity Component Dispersal Cells inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths >75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. project: WECKWERTH page 3 of 10 OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the urine or waste from water softeners, iron removal units, other clear water treatment devices hagged to the ground surface whenever possible. Note: This does not __and foundation drains should be disc include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system, Other non-biodegradable items such as baby wipes, tampons, sanitary napkin, condoms, cigarette butts, should not enter the system. Chemicals such as petroleum products, paints, disinfectants, pesticides, etc, should not be flushed into the system as they can seriously damage your POWFS system. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid traffic over all system components. Compaction of snow over the dispersal unit inay cause it to freeze up. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber. Master Plumber Restricted Sewer, POWTS Maintainer or Septic tank pumper. Septic tank comRonent inspection must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings >8" in diameter shall be secured with an effective locking device. When the combination of sludge and scum in any tank exceeds 113 or more of the tank volume, the entire contents of the tank shall be removed by septic tank pumper. The outlet filter(s) shall be inspected. and cleaned to remove any accumulated solids according to manufacture's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Pump Chamber/Treatment Tanks Component inspection must include a. test of all electrical equipment. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any services needs or repairs shall be promptly taken care of. Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact and individual licensed to service POWTS, There is normally I day reserve under regular operating conditions, however water should be conserved until the system is corrected to prevent back-up of sewage into the dwelling or surfacing. Pump Tanis Filter inspect at least once a year. Remove filter from canister. Clean if needed. In-Ground Gravity Component Dispersal Cells inspection shall include recording the levels of pondir_ig, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface roust be promptly reported to the regulatory authority. bonding at depths >75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring, project: W.ECKWERTH page ' )of 10 REPORTS Reports for maintenance, inspections and monitoring shall be submitted in accordance with DSPS 383.55 Wis. Adm. Cade. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with DSPS 383.33, Wis. Adm. Code. 1.) All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. 2.) The contents of all tanks and pits shall be removed and properly disposed of by servicing operator. 3.) After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other 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: { } 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 are will result in the need for a new soil and site evaluation to establish a suitable replacement area. { } suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank maybe installed as a last resort. { x } 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 located a suitable replacement area. If no replacement area is available a holding tank maybe installed as a last resort. { } mound and at-grade soil absorption systems maybe reconstructed in place following removal of the biomat at the infiltrative surface. Reconstruction of such systems must comply with the rules in effect at that time. WARNING SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN 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 PERSONFROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. project: WECKWERTH page 4 of 10 EFFLUENT FiLTERS Si zing sid.tubes' Effluent Filters Fou 4. rmzm 81tmm EWW Rms These charts show the relationship between Riotube filter size (diameter), design flaw, and mean time between cleanings. The larger the filter and the smaller the flow, the longer you can go between cleanings. For example, a typical three-year cleaning frequency would require an 8-in. fitter for up to 2,5Q0 gpd, a 12-in. filter for up to 5,000 gpd, and a 15-in. filter for up to 8,500 gpd. Assumes a properly sized watertight tank and residential strength waste. See Orenco document NOA-FT-FT-i for more information. 1250 Residential Applications 900o Commercial Applications FT0822-14B 8000 FT1554-36 0-- 1000 FT131824 FT1254-36 80 ® • • • • • • F T0444-36 7000 FT0854-36 FT0436-28 6000 3 750 FTJ0418 0 0 FTi-0418 0 5000 LL 625 o `M ° ® ® = 4000 0} 500 % % 0) am . ® 375 °'°•o~~e~® 3000 ••°•~•®~,""~•as 2000 250 • 1500 125 1000 500 0 0 3 4 5 6 7 8 9 10 11 12 3 4 5 6 7 8 9 10 11 12 Mean Time Between Cleanings Mean Time Between Cleanings (Years) (Years) 7 .-Effluent Filters (FT) esidential -17 Fr Series Base Inlet AoIddel NOMENCLATURE FI" BO Toptions: A = float bracket F FSQ a overflow plate Base inlet model Cartridge height: 14" standard FT-Sedw Base Inlet Housing height, 22" standard Effluent FrKBr Filter diameter (inches) 08 = 8" Bfanl: = 118" filtration P 1/16" filtration Biotube effluent filter series -A1300-348-9043 EFFLUENT FiLTERS Sizing r s - Effluent Ftcum 4. Stamm DtOTUDE Emu€rs FILTERS _ [`nese charts show the relationship b&veen Biotube filter size (diameter), design flow, and mean time between cleanings. The larger the filter and the smaller the flown, the longer you can go between cleanings. For example, a typical three-year cleaning frequency would require an 8-in. filter for up to 2,500 gpd, a 12-in. filter for up to 5,000 god, and a 15-in. filter for up to 8,500 gpd. Assumes a properly sized watertight tank and residential strength waste. See Oreaco document NDA-FT-FT- i for more information. 1250 Residential AppiiGations goo0 Commercial Applications d-~ FT0822-1413 8000 _ FT1554-30 • FTB1824 FT1254-36 $ 1000 ® * ° FT0444-36 Q 7000 FT0854-36 FT0436-28 M 6000 750 ` FTJ0418 ~ FTi-0418 a 5000 tt. 6525 a r LL C r_ 4000 ,0) 500 ®~a~ ~ 011 ®•a® ~°1a~ 3000 Q 375 ae®®°O+~~s~p~ 0 2~afl 00 2000 1500 125 1000 500 0 F t o 3 4 5 G 7 8 9 10 11 12 3 4 5 6 7 S 9 10 11 12 Mean Time Between Cleanings Mean Time Between cleanings (years) (Years) FLU, FT Series Base Inlet Model fvtOMENGLUURE - FT 02 - 4130 T Options: A = float bracket FSO = overflow plate Base lnict model Cartridge height: 14" standard FT-SBRes Base Inlet Housing hcieht: 22" standard Ervuent Filter Filter diameter (inches) os = S" Bank = 1/8" filtration F = 1/16" filtrarion r ' Biotube effluent filter series CALL ! 800-348- 43- 541-4-59-2884 (Z")e c_g L~ t' t~ r;-ct~ N s 1L TOTAL DYNAMIC HEAD/FLOW a ~ PUMP PERFORMANCE CURVE PER MINUTE MODEL 140,'4140 EFFLUENT AND DEWATERING ~JI 4 MODEL 94014140 a8 I Fast Meter; Gag. Liters I StrSY 10 3.0 as 303 t~~'~h? 15 46 73 278 2 40 20 6.1 68 250 140, 4140 25 7.6 59. 229 ` ; ,uz-n,~nar ss 3'3 9.1 49 185 9 a 35 10,7 3R 144 40 12.2 28 106 45 13.7 17 s4 - f II 1 > 8 25 o+oe4a Shut-of Head: 50 R 15.2m) i l j l •.2,332 r W_~l 4 774 1: 1Q a SSt i... + S MS24A 2 - 3 0 Sea[ to 2C 9G 4~ 511 W k 80 S,7 Double Design GALLON$ Weight 63 lbs. 1R6R5 0 cW tcn 240 ?20 FLOWPERWNUTE 93"w i -+y t ~•F CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and supplied with an l~ - alarm. ti • Mechanical alternators, for duplex systems, are available with or without =,•z-,,.r~r, alarms. I • Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. I r f kri • 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 Qwik-Box available for outdoor installations. See FM1420. ~l • Refer to FMO806 for applications above 130°F (54eC). ( l$-Q L.L_ SK15248 SELECTION GUIDE 14014140 MODELS Control Selection 1. For automatic use single piggyback variable level float 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 o cnunonr BN140 BN4140 115 1 Auto 12.0 All installation of controls, protection devices and wiring should be done by a qualified BE140 BE4140 230 1 Auto 6.0 " licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). 'Single piggyback switch included. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. UM TO: P.O. BOX 16347 E ~E Louisvift, KY 40258-047 ~m SNP TO. 3649 49 Cam Run Run Road Y Ay r~ L f.98. KY 40211• ~fly'0z AV YA7tT6• ~i7u r` (542) 778-273- 7 - ! (800) 928-PUMP W zoe//e1 com L!!Y!F ~L/. FAX (502) 774°3824 {~r~o Je~t ER- « '10 53" 41" 96" r (A PI n II 11 II ~ ~ 44 CD r 1 1 PnX~ U) I -I 0 \ mm Ii 1j, 16* rmn 1 1 1 642 I n(70) D Z 11 (1 T' i I ~ 39" V 0 ~ c c 0 Z N Nrn D Z r Z n A ` -i 0 ~ m-1 mn rn z zN IEi' DZ n Ogz atz Apmo mro oaO~' rn m.. r1// o >0 2nd 00 252110 ~r m N V) m n m s A rnnO~"w" {V n -;PAC r" Pty x > Z NW N~ (A 1 m-1~..0 sO. P --4 CID c, r" Y ZP*1 6 NA tnma 1 OQ- Tl p O \ A01 1~T1 t~*1~ br W VN a~j v' O O D O Z Al O ftI ~ 0 0 > err' a r-1, 0 n yz z t` p~ ° f"7 0 O N y .-..N. ~o~ 00 Ny e10 Z C C ~*1 r -1 rn 0 d.. W) 0 OF 2 m Z Q ~v m O A X m Pti C r 0 0 r r~i m K m m z -4 - mP,0a $00-M WIENER COflCBETE1'e'V NO. UATI:. SEPTIC MANUAL \ Y W3715 US WnO. MAIDEN ROM. W 547W DATE: JANUARY 2008 \b REV. JAN. 2008 800-325-8456 Fa:w+,alzoo e00-M1: t u c;c : W C: C.Y.W to Vy% 53" 41" ? 9b` r- m c.; n n „ 1t 6' any 44" a zt a nx; Q 0 m < lI < / m m 0 a !I nco ~ w u m - rn 0 z c C7 rn M° n z v r z Z p ca bFX 0 v a>O> >z mom©nm>oQ 03 f:5 0> ~ CO r o 0 NC70 S AS a0ZM J, rr'z -b m to ~ v5 r*i m CJ d-a 4 ' to > MOO rn a rn 3N C~ rn ° o ao ,,,w 4tn-~ En 1 -a m --'ir -'o ~ p C7 ca`i ?3 a rn o N cmn m n i m P v ?'I 0 L7 g ~Ql morn 3r o v o z ~o o " O D Z c ~ -y to r> t7sD>0 r° rn C) m Z Z co 0 ~ d (n ~ 'O . v ~ LS a*t ~d tWi~ H ;u -0 0 z j 20 a m -t rn t7 O G rn to rn c) >u crs ti z ai c rri v z o ~i cra " ~ m rn t5 z ° ti c m 0 t- 70 m r -i z m r rn wLP1200 800-MR SCALE:1/4"_- I' REV NO, DATE- m MIEGER coneRETE DRAWN BY.SWT SEPTIC MANUAL. z W3715 US MWIG. MAIDEN ROCK 'M 54750 DATE: JANUARY 2008 V REV. JAN. 2008 800-325-8456 PILE-WLP1200 800-MR ru \7 >s COMBINATION SEPTIC TANK / PUMP CLAMBER (No Scale) 4.11 Approved Locking Manhole Cover Approved Cap, With Warning Label Attached Warning Label Wgatherproof Approved Junction Box Vent Cap 141ku. apWA 11A alkh 12" Minimum Final Grade-N, i i .4 Minimum ff ( - 18" Minimum ' Di►i ck Disconnect % 1/4" Weep Hole Baffle - i Approved Joint -P i p wl~f', sJC~IA Pe i Extending 3 Al arm tN Onto Solid Soil dt B Approved Joint On -r - i WIT A .e rte: a,~~_r ~a~_ a C Extending 3 Ssu• i Onto Solid Soil Off tS't Conc. Block ,J___,D t - 3" of Bedding Under Tank--/ lzo,0. to.~ Pub d A1arm_Ar-e Qm Separate Ctrcutts WL t~o~~ Tank Manufacturer: g..' 'A Tank Size-Septic/ ump: zav boo L:P ons Al arm Manufacturer : _ e Q,j 1 t Model Number: m 3 zr Capacities: A 1 g I nches or X0.3 a Gal 1 ons Switch Type:. mrAc~ncr.r,*wn I + B 2 inches or Gallons Pump Manufacturer: ~ t. + C inches, or all ons Y5 I all ons - Model Number: ~ o + D~i nches +or Minimum Di scharge Rate: Total.....- ,;a(o nches or p 6a1 Ions Vertical Difference Between Pump Off and Distribution Pipe : 12,o Feet 2 Z - Minimum Required Supply Pressure:..~ ji V.3 +.,.---,--Feet c?( Feet of Force Main x .3 } Friction Factor/100 Feet: eet 2 Inch Diameter Force Main a Total.Dynamic Head:...!IL. Feet project: WECKWERTH page 8 of 10 CROSS SECTION - not to scale Three cells 3ft. by 80ft. (identical) observation pipe Finish grade or 95.5' vent pipe (12" above grade i >12" of filled material s 3ft of Natural soil t ; drain back to tank y System Elev. 92.6' or shallower >3ft of suitable soil System installed using ARC 36 infiltrators 16 chambers per cell = 400sq.ft. X 3 cells _ 1200.0sq.ft. proposed 1200.Osq.ft. required TOP VIEW - not to scale front of cell 45 fitting at end of r insert pipe toward top of chamber is' drain back to tank 2~ "manifold vent at end of cell ARC 36 infiltrators end of cell 4" by 2" fernco /or PVC observation All three cells (identical) 3ft. by 80ft. ea. project: WECKWERTH page 9 of 10 CROSS SECTION - not to scale Three cells 3ft. by 80ft. (identical) observation pipe Finish grade or 95.5` vent pipe 12" above grade: j >12" of filled ! material ,'H r ! 3ft of I 1 t, Natural soil NIA drain back to tank 3 System Elev. 92.6' or shallower >3ft of suitable soil System installed using ARC 3 6 infiltrators 16 chambers per cell a 400sq.ft. X 3 cells = 1200.0sq.ft. proposed 1200.0sq.ft. required TOP VIEW - not to scale front of cell 45 fitting at end of 2" insert pipe toward top of chamber 15' drain back to tank 2" manifold vent at end of cell ARC 36 infiltrators end of cell 4" by 2" fernco /or PVC observation All three cells (identical) 3ft. by 80ft. ea. project: WECKWERTH page 9 of 10 SITE PLAN NW,SW,S 19,T28N/R16W Eau Galle township St. Croix county LEGEND 1 BM: 100.0' Mail in 6" wood post 2BM: 97.0'top of 1 1'VC pipe X - pity 8 - boring ® - grade elevations Y\ e -contour No DSPS 383 set back problems Scale 1" - 40' except where indicated ~ you \ j~ + 5, ci 94, 3v., System Elev. 92.6' I or shallower in area of 95.0'threw 97.0' 3 cells3ft. By 80ft. -,J \-J ~i ll i ~ ~s e ~~}0.r v1~tJ ~P2o.S ~1 project: WECKWERTH page 10 of 10 wiac«ne:~ IL EVALUATION REPORT Page Of Division of Safety and suHdmCa~ 1%, m in 85, Wis. Adm. Code COUFTIY At>gM Mete site plan ov s not less than 81(2 x 11 in L indude, but not 8milad to: Vier y and horimntal a Parcel I.D. percent slope, scale or dime0siortsr north arrow, and road. Peraonar in(oreraeon yar provide may aae~ ace Privacy Garr, s 15.04 (1) (m)). / Prop~vertyOwner PmpertyLocatlon v GU Z l r Govt. Lot V(, j 1/4S(Ai 114 S (c{ T Z~?N R I& E (or)(1 # Block # Subd. Name or CSM# Property Owner's Mailing Address PO y ❑ Village C3 Town Nearest Road City State Zip Code Phone Number Cit EP New Construction Use: U Residential J Number of bedrooms Code derived design flow rate !!I X53 / & ` 0 GPD ❑ Replacement ` (cer comG% C~Tf~ ft. Parent material bod Plain eleva ' n d a placable _ r General comments S ~f~ G~ r1 Q yd ~-1 Sd sP/LLGa and recommendations: /1 _ / v Ll' _ rte,; d.LC ~ ,~-~-o•2~.d ? S o 020 o s/ © Boring # pit 7 ' 0d ft. Depth to limiting factor U in. g Ground surface elev. a Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure kConsistence Boundary Roots GPD/ffr in. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 .Eff#2 IZ o r 3~3 v( Is Iv ( / ZrnS C5 - ,r Lao u~ 0 r l ~ 5 oS L 'I yn Boring # Boring pit Ground surface elev. ? (0 _ ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIftr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 0-1y v V4 C S l S , LIZ - r c 5 - , 5 ~IZ~Y ; Z VIA Merit #1= BOD 30 < 220 nWL and TW >30:! 150 mg/L ' Effluent #Z.= B005:1 30 mg/Lard TSS < 30 mg/L CST Name (Please Print) S tune L CST Number "JaYA L zss 33a Address Date Evaluation Conducted Telephone Number /o G k. L . LL Parcel ID # Page of L Property Owner C] Boring L7 (9 ❑ Boring # Pit Ground surface elev. Q-5, Od ft Depth to limiting factor in. Sod Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD *Efl#I *01#2 in. Munsel Qu. Sz. Cart Color Gr. Sz Sh. i 31~ S, ✓ -<OL VYV~ i- C S If lS Z i Z-z° r` 5L zm sb r►~-~~ _ , S- o- ~Ce !v r ( S os w~ r ❑ Boring ❑ Bonng # Pit Ground surface elev. ft. Depth to limiting factor in. E Sod ication Rate ❑ Horimn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft: in. Munsel Qu. Sz. Cont. Color Gr. SZ Sh. 'Eff#1 '0112 Boring Boring # Ground surface elev. ft. Depth to limiting factor _ in. ❑ Pit Sod cation Rate Horizon Depth Dominant Color Redox Desu don Texture Structure Consistence Boundary Roots 'E GPD 2 in. Munseil Qu. Sz Cart Color Gr. Sz. Sh. * Efduerd #1 = BODS > 30:S 220 mglL and TSS >30:S 150 mok ' Effkm t #2 = BODE 30 mglL and TSS 30 mglL The Department of Commerce is an equal oppommity 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. Sao-owta:Wam } Property Owner Parcel ID - - Page Of ❑ Boring # Boring q,5, 06 R Depth to knifing tactor.~ in. sou ication Rate Pit Ground surface elev. Structure Consistence Boundary Roots GPD/fF Hatizon Depth Dominant Color Redox Description Texture Gr. Sz Sh. 'Eff#1 'Etf#2 in. Munse6 t1u. Sz Cant Color G S S os VYN ❑ E] Big Boring Pit Ground surface elev. R Depth to limiting factor in. Sol ioation Rate ❑ GPDIft: Horizon Depth Dominant Color Redox Description Texture Structure S Consistence Boundary Roots .Eti#1 'Etf#2 in. MunseU Qu. Sz. Cont Color ❑ H Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Sol ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots '0191 GPD2 in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. • Effluent #1 = BQDS> 30:S 220 mgfL and TSS >30:E 150 n4L ' Effluent #2 = BODE 30 mgfL and TSS 30 mgfL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or aced material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ' ssn-oaocR:ot+cm Adam Schumaker CST - Lic. # 253309 _ 2113 80th St. ph. # 715-760-0279 LOT 18 N Somerset, WI 54025 Chris Kusilek Lot # Plat of Star View Acres 11 1 LOT=" liai= wr a UM I T FRACTIONAL SW 1 /4 OF SECTION 19, T28N, eea~► +'~"IJ R1 6W, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN. saris _ ® SOIL BORING ar y ~y e maa LOT I 5~C~ nn el-c-v SCALE IN FEET I"= 4 s~ 100 0 100 . . . . - 00 . . . . ti . . 30v . . . . . . - - . . . . 0. . . . . . . . . . . . . 3~bRq!kA4 MF Nr Fft OT 15 \ v qT 3.25 ACRES \ (2.89 ACRES) U LAND SURVEYING INC. GLAS =20 SHLO ZANLER THE COUNTY PLAT OF: STAR VI EW ACRES I I DOSON 4I ~j a t ATED IN PART OF THE SW1/4 OF THE SE1/4, AND IN PART OF THE FRACTIONAL SW1/4 SUI10DasTKEn LLP ECTION 19, T28N, R1 8W, TOWN OF EAU QALLE, ST. CROIX COUNTY, WISCONSIN. HUDSON, wI $8019 o LL U PREPARED FOR: F t K TRUCKING AND O' Z LOCATION SKETCH EXCAVATING, INC. 9~ 141 HWY W "STAKE. UTILITY EASEMENTS '>O1d1EOE RIVER FALLS, WI $4022 N8E'8b'07"*17*,C. NO POLE OR BURED CABLES ARE TO BE PIACED SUCH NOT I°-".~ A Bf UVI O jODINO AW MT LOT UNE OR j { KE.E. OR OR OBSTRUCT VISION Al NE OR STREET UNA NEDISTNUOFI~SFEOFA StIJI STAKE SV ,IL WSCORT BTAFOATHEIELNEIUIVOFEAIENEN18 A9 SAND STEi FORTH 'TAT T PUBIICBOm ESAND TlN LIMt E PRIVATE MBUC MMB HAVNS THE NOW TO SERVE p NttK ~MI$RI EES N ~B j AI` 4 j ~ ufcND p TABLE • DRAINAGE 1L1 n ® FOOD r stttsl gam wo. am= NNOS. I EASEMENT-V• IN FPM t t/6' NNfIDI 91m Bum n AO° i"~ S • FPM N/r 991st Bwsa See 119E SECTION 19, TEEN, R1 EW I D 669a7+AF11 m01d9' i' Arc . t1S0 M • ram r mast NNfm Rm F9t 3 A ANarrotr nEM i z.,B~ malt p~ys~ ~ ~ p1q I i A almll7a'E' a11rs' / q C 1~ 9t 1OMM iM 18L ICI ufMlFa lo' 9FfyL 7If ~mFNNLP~ a N i A iOSim'rl11• NM% / / ,,,r,Ex qi 1 w NAT, 1N! MOI ANTONIO ws well I=. Oar 99fw IIPEEOIIS ON m _ j awaas z t9 w~N F9t i wr~ws~Nwl~1t011s1s PcINO1~~ . mLG la Fs I 1r vam Lvaw f" ffM& Be NN NV Z8 W AM l* RA Ef,~aM=a mNDI•~O, w I I tar IINaMr S[NAm a Itlt~ FNKa aMTR1t10f 1[ 371~13~- LOT 13 out N Now I / /M 7aat AB1m llf CURVE DATA TABU (AIL IDNt1t sm N FuM 9N1yF FFAP~ am QIP40 PASO Need OWN! "N" he 1r owns Am Lot LND ge =a, L-0 wo ~ LI 1~ORM1 9Bt a 11740 IS INA Np miM Ni 9Lq IfgtitY NN7FW'9 C .t 2-t NtL. Emb WON WA= t12WAm b' O/A7 IS am OOMr.W411W luW w7410 "41woY MNJT~ It IpFp~ PELOD ODeD N SON tt9td NNN'b/'9 71US /8N N*26ww tNVOM1 ` L&0. IDIOF ND9N q N N9S YYb• SSYMNrN RAt 2m" SNWNY SS91P797 um vw sr DOMTANL a NI~N NY swwvL E is im aomw"44~t w w Slat t 0616 WWW WMWn NJS SON 819t749t MlOSSt OF 6699 690rW NMW4rt Nmm UM NNrrst ION UV N 1Nm6 S6rOTW IIIgr " 170,45 taw mw4m N110EOIr w sum "NOW $"Nn FNS ESLS SIS $4YrMt i NRNO tae, Sam, i1M0/ Imvran 7SII 7!S NNO/✓" IfnrWL rAMp7 IF RIM r 44ap 6G\p@»$ I ' IN 19R t1e6 a7p~6q ~p0® ®C7 O4C0~ LOT 14 F Mtaf = tR A(SES S'T \ i lloA6{9 1", NaaYT'2p•7YaM.Oa' Om7M q~D7ttMty~ . 878.88TJ`4J \ ~4 L10.. itNN Py N 909 1°-"' '10.88' \Nmli./W.0 ~ - Q TABLE • DRAINAGE A I• EASEMENT•U. \ _ ' at N Adww7.' fate ` ^ '^PW~• C I v ' M! w m'' \ fI' I I I lxsw"v ^W IN ANA wA • LOY is LOT 1s LtNAwp r L Z & LOT 17 I II I w xww" lit"" L&& . ° F'. Iy W NAM LL0. ttll0 7! I Iq S I o w JUU` N TABLE • DRAINAGE tr ~ AIMS D I N/ ' d, LL46 1sq I Iq~ I EASEMENT Y• IN I57 I I ammm 1 W Wm M91tltV V HEN' MI S 9F'►7r /SNAw•OW Naa9rnr Am" au AA/NwT AWW . A I® we Y S..••11 as Av a* aN r ever s, n N7 a W Ins move" After 'j,' i I w7 soFwY NOJI N9N8Fw saw r...• I II I. uff mEfYFt9'[ GAAr Ins NAInt" ~ ~wT Aw gg ~A t~°+Rat ,per ! I I 7w mvwv INNS' \ ,7y MK,S1r ti'>/ II I _ S, NO 12-W .1 tw mNNwT 4%wr PUBLIC SHIFT I N86'29'16"W 477.98' SOg1 YMS O OININF9~INL7 1' J~ o 12•B IJ6N LOT 12 + a69.9B' i I ~y f nwswrt. C ioNr NI1L . "%G Igo y 10. 1LM 6 AL 11 It 0pa i J R Aw LOT8 LOT 11 oe Y ¢ tNLLaF°°iF~. 11,76 AIND ' KwL. tW \ NA./1N0 V'~ big 1311,365 SQ. ff. LAAA 114" 1=2 a I~ i H LOT 10 I° Sfgl NRNIh I / 220 88J•a2D.B"B 886,08, °0.°°° Y1N" Nw~N( nNt I I Mql NRfO I \ lw Q<1011101' I TABLE • DRAIIUGt I EI6NFRI/SL1 ~q EABWBNTM _ I I MWAW I Iqq M Mg177'r' SLN' N7 NIR471T ""Ar 1•--- ao57 E (C.51_DA. OG4 Iv7 N AWM" Aw Ha mtrsar't A w 1 I I 1 p N AVON" rATAr NO, NFww % mar' I I M®6o 9b f7Y0 _~4~ f~l , ~fz] N Moor" Aw NN Notion" ASS' I Q'd~-9 1 N N7N017 ANY IN OWNS-% ALIT 1 a• " I N atFr181'ar meat w ANwsT mO.w' 1 b7 pp I N N92ra" nM Be AtrwarT ItLAF• I I° I I I 1 1~ 1 I N S199a'JIY YN• 1!F ANS'mIT IWIP' I I 1 I Na N9w" JY1' If7 A9171rrr •M L 6p,,, NI Apart" MM No, N9wwT /N/9' I I 6H aAw ww 6wM NO N9S714 Afs' I I I I NI emwv" Y0r i o mart ~ I I I lt (Nw,TU ~ ~ Iw aNwst fp%;w ~ I 9'I I 1 mmyol• r I 7r I it ~WOI NE =M RO9aaON1L SH/ _ I AVEENUEJ -+tssrrrt ..T. ~.1.~ a7aT=]~ '~L MO ~6.ffi~,Gq,2pp2 20TH I N ,ffidp I i I 6N7p 2 C~.ffi.~. Op W5.1-0 M1 . Wl I 33 I ~LmQ 6QW SCALE IN FttT V. 100• _ - _ _ 1 I ® ~ C4Y4000Wp 1 ~ ~ I TNR Mwlar won w wawa tAIS M w NNit SAw H/Smm SHEET 1 OF 2 SHEETS r PROEOT. G~ 91I-en im N1 STAR VIEW ACRES II t.,.w-jlA "°B-°°-I °`xem"On „N11" 11/23/04 CHRIS KUSILEK „ ~Iz TOWN OF EAU GALLF. ST. CROIX COUNTY, WISCONSIN 7. ow rEa ear-o2 REF rEC 5991-92 FINAL PLAT Ruth Conaulting/assodates S&N Iand Stn'vek M WAN Ib SON-= esww tImmIRNL NANEt DAR State Bar of Wisconsin Form 6-2003 SPECIAL WARRANTY DEED Document Number Document Name THIS DEED, made between First Nationei Bank of Riser Falls. a national beams corrlommm ("Grantor," whether one or mote), and p YYeckwwth ("Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Ra=din Am SL Croix County, State of Wisconsin ("Property') (if more space is Nanw and Ram A*bm needed, please attach addendum): PaW e,*- W er-K-we j- jn LOT FIFTEEN (In STAR VIEW ACRES B, TOWN OF EAU GALLS l40 ! LLB b e-r" L'f rctll ~ 1 ~ 1088 008-2495-15-000 Parcel Identification Number TK This is not , homestead property. (is) (is not) Grantor warrants that the title to the Prnpedy- good; 'indefeasible, in fee simple and fee and clear of encumbrances arising by. through, or under Grantor, except: easements, restrictions, and righifs'of wey'Qf record, if any. Dated iux't-4 5 2c) First National Bank of River Falls T (SEA L) vl (SEAL) ► * By: Connie A. Ruppert, (SEAL) (SEAL) k ~ AUTHENTICATION ACKNOWLEDGMENT ;ignature(s) STATE OF ) ) ss. uthenticated on 1~h2J COUNTY ) P Personally came before me on c, ` 3 r cov the above-named Connie A. Ruppert, Vim President TITLE: MEMBER STATE BAR OF WISCONSI (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) w instrument and acknowledged the same. 'HIS INSTRUMENT DRAFTED BY: butfield E. Neuhaus - Attomey at Law Notary Public. State of VV ~r over Falls, Wl 54022-0138 My commission (fit} (expires: 3 a(4-2J-D13 ) (Siaatura may be andwadestad or aekeok d. Both are NO NK"nry ) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. PECIAL WARRANTY DEED OM STATE BAR OF WISCONSIN FORM NO. i-ZW Type name belows4panum. a1FOPRO"w+rraov ao'" I E~ ~ ~8 ! ! Q 1 5 State Bar of Wisconsin Form 6-2003 Tx:4045356 SPECIAL WARRANTY DEED 959508 Document Number Document Name BETH PABST REGISTER OF LEEDS ST. CROLX CO., W1 THIS DEED, made between First National Bank of River Falls, a national 0-7/06/2012 12:12 PM EXEMPT#: N/A banking corporation REC FEE: 34,00 TRANS FEE, 42,00 ("Grantor," whether one or more), and Paulette Weckwerth_______.___-_-_ PAGES, 1 - ("Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Recording Area St. Croix County, State of Wisconsin ("Property') (if more space is Name and Renrrn Address needed, please attach addendum): W eJr___V W ew'ti LOT FIFTEEN (15), STAR VIEW ACRES II, TOWN OF EAU GALLF. C_::r kV-r 1-t) 044-C_& J<DP-e el MA/' 653'79 jaa 008-2015-15-000 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 arising by, through, or tinder Grantor, except: easements, restrictions, and rights of way of record, if any. n~ First National Bank of River Falls Dated / j L.t 2 ------(SEAL) , UP (SEAL) * * By: Connie A. Ruppert, Vice esident (SEAL) (SEAL) AUTHENTICATION - CKNOWLEDGMENT Signature(s) STATE OF 1 ss. / P, ct COUNTY) authenticated on Personally came before me on ~J t ( t J j~ the above-named Connie A. Ruppert, Vice President TITLE: MEMBER STATE BAR OF WISCONSI _ (If not, .R to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.00 C ` 'til instrument and acknowledged the same. THIS INSTRUMENT DRAFTED Maxfield E. Neuhaus - Attorneyt Law Notary Public, State of River Falls, WI 54022-0138 My commission (i&poAQ4 e n0 (expires: 3 -D_4-2013) (Signatures may tie authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. SPECIAL WARRANTY DEED (02003 STATE BAR OF WISCONSIN FORM NO. 6-2003 "Type name below signatures. INFO-PRO`" www.mtoprotonns.com Document Number Document Title St. Croix County Occupancy Affidavit AJe.4e- WcP Lje-r44, Name - (Owner) Typed or printed b being duly sworn, states, under oath, that: ` 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume - Page - Document Number95 508 St. Croix County Register of Deeds Office: Recording Area Name and Return Address A parcel of land located in the N+J of the me of Section 9 PaJI e-fk-- l J we ,r1(._ T 2-8 N-RW,Townof E,,., Gully ,St.Croix /~,D1 ~,b~ G:ttQi County, Wisconsin, being duly described as follows (include lot no. and Q-e. M 1'.1 5 5 3 7(7 subdivision/CSM or detailed legal description): Lod- per, C sl-z,c rie~ /~G es .rt- 00'9 - 2-015- ~ r S /'T 1~- , f o' " 6 Parcel Identification Number (PIN) As t er of We a've described property, I acknowledge that the septic system serving this residence is sized for a 4 bedroom home, or a design flow of (gob gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently _ occupants living in this residence; $ occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to ac comodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated this day of t AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. authenticated this day of St. Croix County. ) Personally came before me this day of the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledge the same. THIS 11STRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not my Commission is permanent. If not, state expiration date: necessary) Date: "HIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This information must be coaWleted by sutirrWer document true. name 6 r@t 0 address. and rd iequlred). Other information such as the granting clauses, leagal descdpt w. etc. may be placed on this rust page of the document orre~~ ~ W n~ ~a 9 . 5_ 517- document. Note: Use of this coverpage adds one page to your docament and $ZQQ to Me - - - - - ST. CROIX COUNT"- SEPTIC TANK MAINTENANCE AGREEMEN`" ANE" OWNERSHIP CERTIFICATION FORM Owner/Buyer ; m Mailing Address , Uj01 l_lr¢2 Property Address (Verification required from Planning Zoning i7epart.ment for new construction.) City/State lau'LvIN Parcel Identification Number 2-0157- I5 - 060 I LEGAL DESCRIPTION Property Location SW '/4 , Sec. 19, T 2Tb N R J& W, Town of Subdivision Plat: 5Thipz V 1 I of ti , Certified Survey Map # Volume . Page # Warranty Deed # (before 2007)Volume Page # Spec house yes 09-o Lot lines identifiableKes'- I no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic syst.in 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. 53.52(1) and in Chapter 12 - St. Croix County= Sanitary Ordinance. The property owner agrees to submit to St. Croix County Plannino & Zoning Department a certification corm, 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 conditio<t and/or (2) after inspection and pumping (if necessary), the septic tank is less than I1 full of sludge. Uwe. the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,. herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on tht, form are tnie to the best of myi'our knowledge- I/we am/are the owner(s) of the property described above, by virtue of a wa anty deed recorded in Register of Deeds Office. N ber of bedrooms SIGNATU VF0FPPLIC , 'T(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) +wowwwn..wwrw.~.v~...s asasrstz (su) xvi 33MaI M s~ zt Esc.:w caaa) ,I 08d ISIHIMANOWOMW Opi.yRioarryroaawJa~eepy~ssp~~A )C)O15NNH 'ON NVId 9tuenv:Nrom a Ra i a e~ 'a. .a 'a. 'a. J A.M F.s Q ? Y A. 4Yi t ~1 L ~ y y6~ + i :i i X ~ • ~ ~i~ n o iit is } ~ ee i ons ~ Mw¢aovYl OeA t*t i ~I a ~ ~ 18I F.. x z J n r 4L ~I 8 Yi to .M•i .et .e,. ,H .t F.K Fi .aJ A.s , ' F:N a .al AJi .~R ..'.K AF 6 V r 1 .KF rA`F 7 + S L J y ! i p 9 ~ 2 i ~ fi e A ax i ~ • i • y x . ~A ip I~a ~~i x ~p n 1 I o 4 3 ~ •i b Lr J ? A , N A r 4 = ~ V Y A . 0 • O I Ua A ~9 x y,t~ a i d k i { } Q 9 $x it -t • A ~k ~ .oa A~ LL .M Aa L . F a~ Q 3 L. J .rsR•iuer AM A./ AM • r+ J', F 1 kR • A:R J 1 1 1 L~J LpJ LVJ ul Y •1:V •l:V r ar~ 6 O u n~ a `V S l:Y I:V woare......1 ~l - } 3 ~ O W9~ IIgt11 3iL , ` .M-,Y .MJ AJ i4. 7F ~ f . n.n0.1 .W p O ~ U Rl Q 3 a I z O z O d- q W z O W's W a J O kc~aaa~'~ r 5. ! 5~