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HomeMy WebLinkAbout020-1481-06-000 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556371 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: 020-1481-06-000 NWP Holdings LLC, fka Suzanna Johnson Tru Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: UQ. b d 6 U i3m 07.29.19.3055 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark l j o v U Dosing Alt. B ~A nan Aeration Bldg. Sewe 5,N Gjs (o Holding St/Ht Inlet sC d Z 9S• 3 St/Ht Outlet ~ S C~ 5 r TANK SETBACK INFORMATION TANK TO P W~ BLDG. vent o Air Intake ROAD Dt Inlet Septic I f Dt Bottom 10, ~~j /0 Dosing I eade Map 9 y . T Aeration Dist. Pipe fv7 EiT Holding ®R Bohr / F3, Final Grade PUMP/SIPHON INFORMATION 2' 0 Manufacturer GPM St Cover OVe 17 /,I -je Z, 2 yr y . 3 Model Numbe TDH Lift IFriction System Head TDH Ft Forcemain Lengt Dia. 1. ell SOIL ABSORPTION SYSTEM 4v4A_~ 51- 4 BEDITRENCH Width I Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid epth DIMENSIONS (Q/ v g /I- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBEIR OR an~7j. 1 S~ Lam, INFORMATION Type f System: / I UNIT Model Number: DISTRIBUTION SYSTEM 2S a Head anifold Distribution x Hole Size x Hole Spacing Vent to Air Intake DC Q~ I / I Length-' O Dia _ 1- ngth D U Dia _ Spacing > S SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / I Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center rx~p Bed/Trench Edges Topsoil Ed Yes ~ No ❑ Yes FRE No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ I / 2 (/Y Inspection #2: / / Location: 1029 Autumn Oak Trail Hudson, WI 54016 (SE 1/4 S;wr 2 W) Whispering `Oaks 'Lotth6 Parcel No: 07.29.19.3055 1. Alt BM Description = 0 d7C u~ + ~Ul ' `r ~L l~r 1 t hst 2.) Bldg sewer length D / ~ -~~~il~~ ~ v • p~"" ~ - amount of cover =n✓ C~i"~/tQ pl S42~lw d Plan revision Required? ❑ Yes No ( 2 Use other side for additional information. - Cert. No. Date Insepctor's Signat e SBD-6710 (R.3/97) PLOT PLAN PROJECT NWP ADDRESS 397 Eaale Bluff Ct. Hudson Wi 54016 SE 1/4 SW 1/4S 7 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/25/12 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA # of chambers 41`- BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEV/A'~ION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark SYSTEM ELEVATION 91.6/91.4'6' below qrade All piping shall be SDR 30/34, within 10' Well is to meet all of tank, piping shall be Schedule 40. „ , setbacks required by Scale is 1" = 40 WDNR unless otherwise Amber Ridge Drive noted Scale is F = 40' unless otherwise noted,,. r J o r/,~3 B room o e (1 140' 15' Ian s > s' vtf ~t4-f rYU.t f ) 10' B-2 1,110 ' - B. M. i 2-3' X 78' Cells with > sp c 40' Vent >6" Quick4 Standard Y B-3 50' of Cover Leaching Chamber L" 20.0 ft2 of Area 4% Slope 10.2ft^2/pair of end caps 4' Long 12" Grade at System Elevation 34" 283' Property Line 1 s . J .P ~ I D Wrscons Department of Commerce SOIL EVALUATION REP$T Page of 3 Divisiorl of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County A Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Dal/ Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road. (O Please print all information. viewed Date Personal Information you provide may be used for Law, s. 5.04 (1) (m)). /a Property Owner P pertyLocation /AO Go . Lots 114 5501 /4 S 7 T 2t9N R E Property Owner's Mailing Address O Lot Block # Sul me or CSM# 52.1 42"~O-' g,,C,4A n5] - tX COUNN 1G CrJ r f n Q City fate Zip Code Phone Z City Viilag T Xvn Barest oad ( p~N AT ~t New CW5tructioni Usej2l!::~esidential / Number of bedrooms w Code derived design flow rate fl'446VO GPD ❑ Replaoement ❑ Publi r commercial - Des pt material Flood Plain elevation if applica le General comments and recommendations: RQ System Type G ~U/!-t~► _ System Elevation r/✓ . a Boring lit ElBonng Q ( K pit Ground surface elev. ft. Depth to limiting factor ;ZU in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM So" In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Etf#2 Y 6 3J Z - - -5/ 0 91W 01,11 - ,,V 7 -7 .S O s x1M A 1 Boft 2 # Boring Pit Ground surface elev.` ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDrTf° In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 o// 3►L m C'r -J 2- -7 /01 P)14 • Effluent #1 = BOD > 30:5 220 mg1L and TSS >30:S 150 mgA- ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg& CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 715-246-4516 Soil Test Plot P1 Project Name NWP Holdings S ird Address 573 Cty Rd A Hudson Wi 54016 S #226900 Lot 6 Subdivision Whispering Oaks Da 10/18/10 SE 1/4 S W 1/4S 7 T24 N/R19 W Township Hudson ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1" pipe System Elevation TBD *HRpSame as Benchmark Amber Ridge Drive 1 15 Scale is 1" = 40' unless otherwise a l noted Fa 140' 1 5 B.M.* 97.5' B-2 100' Br40' 96.5' S0' B-3 4% Slope 283' Property Line Parcel ID # Page of Property Owner - Boring # © Boring © Pit Ground surface elev. ft. Depth to limiting factor ~n' Soil Application Rate AX ,Sr k - Roots GPDM H~zon Depth Do minant Color Redox Description Texture structure Consistence Boundary •Eff#1 'Effit2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. p -I Z q3 i- 1 L- 0 / s 5 ~ ' 3 /1 O S n 1 ti I v) , 6 ❑ 9 ~ Gn Boring # Boring Ground surface elev. ! ft. Depth to limiting factor 7 " in Sal Application Rate Pit Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#GPD/fFEff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Ie Z-7---Z d E Boring in. ❑ Boring # Ground surface elev. ft. Depth to limiting factor Pit Sol Application Rate Horizon lePth ❑ Dominant Color Redox DescriPtion. Texture Structure Consistence Boundary Roots GPDM Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' I • Effluent #1 =BODE > 305220 ngA. and TSS 30 < _ 150 mg/_ Effluent #2 BOD6 30 mglL and TSS 30 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD4330 (RA/W) CO oV Safety and Buildin s s gg w 201 W. Washington j"'❑"~'~7 2 s Madison, WI 7-~It>Z--- WJF S-h~+*County t~ it area y Pvrnat umdur (m bo fi11vA in by Co.) - 71 ~UiftVY ermit Application State Transa«ion Number [submitted amwrdance with s. . 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental AU J~ it is required prior to obtaining a sutitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) to the Department of Commerce. Personal information you provide may be used for secondary es in accordance with the Privac Law, s. 15.04(! m , Stats. . Application Information - Please Print Ali Information Property Owner's Name Parcel Nu-) 6L~v 0ZD- 1091-61, - coo Property Owner's Mailing Address Property Location ,S 5 S 0 5 - Govt. Lot l~ City, S Zip Code Phone Number -7 Jac u~cte o IL Type of Building (check all that apply Lot T N, R/[ / E U 2 Family Dwelling - Number of Bedroo Subdivision Name 11 Public/Commercial -Describe Use 6 AL & W_ ❑ City of } ❑ State Owned - Describe Use CSM Number ❑ Village of y Q j v 'M et N~. 5 wn of In. Type of Permit: (Check only ne borr on line A. Complete line B if applicable) A ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) R. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner Q~ IV. Type of POWTS S stem/Com onent/Device: Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of ssuii-- ble ! ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) ( LQ.rr 6 /3' V. Dis rsal/Treatm Area Information: ,r Flow (gpd) ign Soil A lication 7in pdst) Dispersal Area Required (s Dispersal Area Propose ystem Elev 'on 'VL Tank Info CapaciTotal # of Manufacturer GalloGallons Units U New Tanks Existing Tanks d✓ Q", C--.- [ ~ w a c~ a v y cn u' c7 w 1sepiic oHolding Tank - 4 ht~ !Dosing Chamber I VII. Responsibility Statement- 1, the undersigned, asau onsibiUty for installation of the POWTS shown on the attached plans. ?lumber's Name (Print) Plumbe ' ature MP/MFRS Number Business Phone Number 1>lumber's Address (Street City, state, Zip de) IZz a r~, 191 Count /De artment Use Only ~ivffl. Approved ❑ Permit Fee Date Issued Issuing ent Signat asonfor e ' $"17~r On /0 2S/~L IX. Condit*ekipmWeasons for Disapproval 1. $e~ic tank, effluent filter and 3 I~ t dec. N e,e P~ J' h'e'"`J m^~er dispersal ced must all be servlces / maintaitted W 1 ''J VN eL r r ti t~Or Crn . as per management plan provided by plumber. 2. ."ft=k requiremel1ts must be maintaindd -n per Code,/ Attach to complete plans for the system and submit to the County only on paper not less than s t/t 11 metes in size '18D-6398 (R_ 02/09) 4 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/25/12 Owner: NWP Location: SE1/4 SW1/4 S7 T29 N,R19W 1029 Autumn Oak Lane Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet Signature License number #226900 PLOW PLAN PROJECT NWP ADDRESS 397 Eaale Bluff Ct. Hudson Wi 54016 SE 1/4 SW 1/4S 7 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/25/12 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 780 # of chambers 38 BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 91.6/91.4'6' below qrade All piping shall be SDR 30/34, within 10' Well is to meet all of tank, piping shall be Schedule 40. „ , setbacks required by Scale is 1" = 4O WDNR unless otherwise Amber Ridge Drive noted Scale is F = 40' unless otherwise noted Pro 3 Bedroom House 140' 15' S 10' B-2 100' B-1 5' B.M.* ents 2-3' X 78' Cells with >3' spacing 40' Vent >6„ Quick4 Standard B-3 50' of Cover Leaching Chamber with 20.0 ft2 of Area 4% Slope 10.2ft^2/pair of end caps 12" 4' Long 34" Grade at System Elevation 283' Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 10.2ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 97.6' Vent Grade Vent 3' 411 3' .A~30/34 Septic Tank 5' Long 5' S' Long 1 Grade at System Elevation 36 " Grade at System Elevation Spacing 5' 2-3 X 78 Cells Same on other end Observation tubeNent z::: At end of cell A B 19 chambers per cell System elevations: A-91.6' B 91.4' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE;: INFORMATION SYSTEM SPECIFICATIONS EPermit ner N Septic Tank Capacity al ❑ NA # Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS , Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA NA Itl Number of Public Facility Units A Pump Tank Capacity _ al Estimated flow (average) aUda Pump Tank Manufacturer Design low (peak), (Estimated x 1.6) gal/day Pump Manufacturer NA Sail Application Rate al/da /ftz Pump Model NA Standard Influent/Ef#iuent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease ;FOG) 530 mg/L ❑ Sand/Gravel Filter 0 Peat Fitter Biochemical Oxygen Demand 03006) 5220 mglL ❑ NA CI Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5160 mg/L ❑ Disinfection ❑ Other: Prstreatd Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (SOD6) 530 mg/L -Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/t_ ❑ NA ❑ At-Grade 13 Mound ❑ Other: Fecal Coliform (geometric mean) 51le cfu/1o0ml ❑ Drip-Line Maximum Effluent Particle Size in dla. ❑ NA Other: [I NA Oiher: 13 NA Other: ❑ NA L Other: ❑ NA *Valusa typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE: Service Event Service Frequency 11 month s) (Maximum 3 years) ❑ NA Ir!spect condition of tank(s) At least once every: ear s Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA onth(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every; >04ear(s) month(s) ❑ NA C lean effluent filter At least once every: ar s ❑ month(s) ❑ q Inspect pump, pump controls & alarm At least once every: ❑ ears ❑ month(s) ❑ A Flush laterals and pressure test At least once every: 0 year(s) ❑ month(s) NA Other: At least once every: ❑ ear a) „ NA Other: ster MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the Servicing, ~Tankifi anon : must plumber, Master Plumber Restricted Sewer; pOWTS Inspector; POWTS Maintainer; gee Inspections identify any cracks or leaks, measure the volume of include a visual inspection of the tank(s) to identify any missing or broken hardware, combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be the visually inspected check the effluent levels In pipes and to eck for any conditon and requiresnthegImmedatetraN cation of therlocal The ponding of effluent o g regulatory authority. with cvolume, hapter entire contents of When the combined accumulation r and scum nany lr and equals the t 113, Wisconsin disposed of in accordance the the tank shall be removed by Y a Septage Servicing Opperato Administrative Code. Ail 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. Page of _ START UP AND OPERATION For new construction, prior to use of the PO S check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or d mage the dispersal cell(s). If high concentrations fire detected have the contents of tie tank(s) removed by a septage servicing opera}or 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 will oe discharged to the dispersal cell(s) in one large dose, overloading the ceil(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 restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. 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 life 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; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is propt* 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 property 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 replace ent 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 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 and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. he site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as R~aNast 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 infltra1ve surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE Ow= A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS - POWTS INSTALLER POWTS MAINTAINER Name Name Phone ,Z Phone 71,,-. SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name 12 1 E Name Phone Phone % / This document was drafted in compliance with chapter SPS 383.22(2)(b)(i)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. T RTRIDGE INSTRUCTIONS A~ Installation STEP I Dry fit the filter case .into the and of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. 5'n1P 3 While the case is still dry fitted an the outlet pipe, measure the length of +l4-inch pipe needed to brace: the filter to the tank end wall if utilizing the optional supplemental side support. If side support method. Is not utilized, proceed to step (out: s - F•t' I For installations utilizing the optional supplemental side support-, solvent weld the %-inch pipe onto the filter case. If side support method is not utilized, proceed to step four, . Solvent weld the filter rase onto the outlet pipe. Insert the tiller ',rr'.l cartridge into the case, pressinit down until the filter locks into the bottom of °?i;••.`r the case. ' •i.•±,i . If a VRS switch is utilka-d: insert into the fitter and lock by turning of +iti: tq. clockwise 900. y+~C+'Y'e• t r..'+;>~;4', ' Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. [ r f 2. Open the outlet access opening to inspect the tank and Mter 9. pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tarik and not just the scum and effluent. ' 4. Once the effluent level has been lowered below the invert or the outlet pipe, firmly pull up on the filter handle to dislodge the ' cartridge from the case.' 5. Slide the cartridge up and of it of the case for cleaning. ~I 6, if a VftS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 900 and cleaned with water only. i. While holding the cartridge on its side (large fiat surface facing y + down) over the access opening, rinse off the cartridge with water' ¢C. only, making sure ab septagr> material Is rinsed back into the tank- • .i r ' a. If vRS switch is utilized, replace by inserting into filter and turning clockwise 901. ;it+~rl 9. Insert the filter cartridge back into the case Re• y t,,"'' , pressing down until ° . the filter locks into the bottocn of the case. 10.Replace and secure the access opening on the tank. ~7 ~:.:n ° +ls'•yr; , hii ;'R:TAfrt' ; le'Qi-'9 r..r .l,~t';.ta :N:.a±rsa.v•. www.beamnAte.com 877-ML-FILTERS (653-4583) /2- -,(Z,_, 4 4 ~p C~ y~ ~ ~4_yPDp YAP .re's jk* He it i e Cl) m~ OD T3 Ln .4 fiD t4 Ml 00 > 0 9 yv aA 0 tR to 4z ST. CROI K CGUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIDP CERTIFICATION FORM Owner/Buyer ti 1k) 1 Mailing Address ~i -7 4-u8soA (.U! s-qok- U Property Address l 0',)<ct Au~v vvwv_ ©G.L t1 V1e___ (Verification required from Planning Department for new construction.) City/State audsc)IA Parcel Identification Number - l ~ 0 ' LEGAL DESCRIPTION P r o p e r t y Location '5f_ Y4', 5W % 4 , Sec. 2 T a ci N R1~Town of v o Subdivision c s r~ C~ 1~ S Lot #P Certified Survey Map # , Volume , Page # Warranty Deed # Volume , Page # Spec house yes no Lot lines identifiabl ye no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wast . 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 ma' tenance 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 Zoning Department a certification form, sign by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site tewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is 1 s than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage dispos system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Stat of Wisconsin. Certification stating that your ptic system has been maintained must be completed and returned to the St. Croix County Zoning Department 3 a three year expiration date. A OF APPLICANT DATE _OWNER CERTIFICATION Uwe-certify tha statements on this form are true to the best of my/our knowledge. Uwe amlare the o er(s) of the prop describ , by vYgie of a deed recorded in Register of Deeds Office ~e,~ /GtJ l o l '-~/"4UIIE OF APPLICANT DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning partment. Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certif. survey map if reference is made in the warranty deed. i 1111111111111411 EEl11 !1111 IIIII 1111 !11111 11111114 8 8 1 5 2 2 2 State Bar of Wisconsin Form 7-2003 881 522 TRUSTEE'S DEED KATHLEEN H. NALSH REGISTER OF DEEDS Document Number Document Name ST, CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between First State Bank and Trust 09/17/2008 10:15AM TRUSTEES DEED as Trustee of the Trust Created Under the Last Will and Testament of Charles G. EXERT II Johnson, deceased ("Grantor," whether one or more), REC FEE: 13.00 and NWP HOLDINGS, LLC, A WISCONSIN LIMITED LIABILITY TRANS FEE: 1110.00 COMPANY PAGES: 2 ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Recording Area needed, please attach addendum): Name and Retum Address River Valley Abstract and Title, Inc. Legal description attached hereto as Exhibit "A" 1200 Hosford Street Suite 201 Hudson, WI 54016 z~9Rys- 020-1002-50.000; 020-1004-90-000; 020-1003-10-000 Parcel Identification Number (PIN) Dated / SYJ * (SEAL)* V f (SEAL) First State Bank and Trust, Trustee * (SEAL)* (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. COUNTY ) * Personally came before me on s,"s ! S, , TITLE: MEMBER STATE BAR OF WISCONSIN the above-named A0j1&4z #1, r-,(-~irst State Bank and Treat, Trustee (If not, of the Trust Created Under the Last Will and Testament of Charles G. Johnson, deceased authorized by Wis. Stat. § 706.06) to me ow be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY; ins t cknowledged the same. Brent R. Johnson * E Lornmen Abdo Law Firm, Hudson, Wisconsin Notary Public, State of Wisconsin ~1~ My Commission (is permanent) (expires.!/ - ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. TRUSTEE'S DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 7-2003 * T.VInamc below signatures. N O_ N ;Cn ZD [*1 'D m R g HC7"ro ~~1 :4 A r, C rly ~ ~ - v 2 C 000 ~ ~ M■ R9.o a r w~ $ p P ~ K c Lr C P c- b-i o ` P n° H H Q N P R •-'A b'C •Pt? =1 fi V., C nd O p H. O $i y 0 p ~'O•, »ma~ b tf cyo 93• n O O O M~21~ O 51 0 - c r„ O x n H CV/~j o 2J ~jJ y o rJ "Q o a cl QQ~i a O r a ? O m P R G N tis W 61 N 0 v Q V. U P n Ry i rA O nJ ab :A N O `G ~ r H a 2 r G~ rA N 7y CE rA to, m a✓, :n op H i n n ^ro ~ ~ m £ 'z ~ ~ O Z o a o c R. ~p z tdily~ ° d .f' d z `~°yy C N y^- N ~ H to O z d d~ w z -•9 a r O F S ~ ~ ? p ° y w~ a H o k R ~ qy ~ ~ ~ o0 =1 b Ic a; C ' " o Parcel 020-1481-06-000 08/24/2012 09:39 AM PAGE 1 OF 1 Alt. Parcel M 07.29.19.3055 020 - TOWN OF HUDSON Current 1XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 11/08/2011 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - NWP HOLDINGS LLC NWP HOLDINGS LLC 573 CTY RD A STE 100 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1029 AUTUMN OAK LN SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 1.010 Plat: 11-039-WHISPERING OAKS 020-011 SEC 07 T29N R1 9W PT SE SW WHISPERING Block/Condo Bldg: LOT 06 OAKS LOT 6 (1.01 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W SE SW Notes: Parcel History: NEW FOR 2012. RETIRED 020-1002-50-055 TO Date Doc # Vol/Page Type CREATE 8 LOTS & 2 OUTLOTS. 03/22/2012 952988 COVNTS 11/08/2011 945347 AGREE 11/08/2011 945346 11/039 PLAT 06/24/2010 918098 EZ more... 2012 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/18/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.010 30,200 0 30,200 NO 05 Totals for 2012: General Property 1.010 30,200 0 30,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount I Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 e THE EAST UNE OF THE SW 1/4 OF ` Z ¢ SECTION 7 BEARS S00°13'45'W AS N of w O a REFERENCED TO THE ST. 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