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Home My WebLink About030-2141-00-006 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561010 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: Bird, Shaun R. St. Joseph, Town of 030-2141-00-006 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No. Irn ( GS 36.30.19.2056 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Z'••- Z / Benchmark /Ox/ b Alt. BM 2 • { /d jj raj Aeration Bldg. Sewer 9 5 •.5 Holding St/Ht Inlet SS' • Z TANK SETBACK INFORMATION St/Ht Outlet $ •S ~f TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 17 16 DtBottom Dosing Header/Man. 9 Aeration Dist. Pipe 7,6 Holding Bot. System /6. a F 3. PUMP/SIPHON INFORMATION Final Grade 3. 7 <79. 7 Manufacturer Demand St Cover q GPM G,• I Ca ! ~Db . Model Number TDH Lift Friction Loss System Head T Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Dept DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact rer: INFORMATION CHAMBER OR a Type Of System: UNIT Model Numb r. 6 re AA- DISTRIBUTION SYSTEM ec 3Z -1-1 d ~ Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air In alke Pipe(s) A f Length G Dia _ Length Dia pacing .n SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 1xx Depth of xx Seeded dd xx M hed Bed/Trench Center / 3 Bed/Trench Edges Topsoil a No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ! / Inspection #2: / / Location: 822 126th Ave. New Richmond, WI 54017 (SW 1/4 NW 1/4 6epT30N RI 9W) Natalie' Ridge Lot 6 Parcel No: 36.30.19.2056 1.) Alt BM Description = Fl J{~,,, 1 t_r r 2.) Bldg sewer length = ~^°r~ n r (I -amount of cover= ritvi 4Z t' V1_ r +L4 6r .7 Plan revision Required? ❑ Yes No Use other side for additional informat n. Date Insepctor Signature Cert No. SBD-6710 (R.3197) PLOT PLAN PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017 SW 1/4 NW 1/4S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/15/12 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 .7 ABSORPTION AREA 651 # of chamber 32 BENCHMARK V.R.P. Top of 1/2" rebar ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Scale is 1" = 40' SYSTEM ELEVATION 95.0/95.1'4' below qrade unless otherwise Property Line noted All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Well is to meet all Vent B-1 setbacks required by 32' WDNR >6„ Quick4 Standard of Cover Leaching Chamber ~O~ with 20.0 ft2 of Area 10.2ft^2/pair of end caps 4' Long 12" ~ ~ 34' Grade at System Elevation g 6 2-3' X 66' c lls with > ' spacing r -3 i S 4' Pro 3 30' ST 30' L.0 Bedroom House B-2 34' i 157' Town Road Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 3 ] Boring # J Boring Pit Ground Surface elev. 99.11 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-13 10yr3/2 none 1 1mpl mfr as 1vf .4 .6 2 13-26 10yr4/4 none sl 2fsbk mfr 9w 1vf .6 1.0 3 26-37 10yr4/6 none gris 1 msbk mfr gw .7 1.6 4 37-53 10yr5/4 none grco Osg ml cs .7 1.6 5 53-96 10yr5/6 none ms Osg ml - .7 1.6 [Y] Bor ing # 3 ~ Pit Ong Ground Surface elev. g ft. Depth to limiting factor / 2-Ko in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft2 *Eff#1 *Eff#2 Clu) JO Ot- ❑ Boring # Boring `f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODs< 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ~mrrrrer+cta.vtr~ _ 5<ltety and 13ufJdtngs Uivrstun- - l o,n,ty /y lUl W Washingtu[ y.(:). 13ox /1 f vt l 71Gz . ~t~►ns r I~a~tlsru,, 3 J , 1U2 ._-i.... ~ u~ 1J JJrcr (te.. Le [Llocl Ly is-r.- ~ anlt "Ir3'.„Permit Appficat r on w$I~,AcI~V~Tt;. R~ slutu'!'rrlrrsucliuli filet t[ In accordance with s C;o,nrn. 83 14NtrtlitL [iwUd,li6,ycission of Ilya turrr. I °a 11 6 \ unit is n y„ued prime to obtuiuur} r ssar,tar Qa° y lanrnl. Note Applltatrta y Drj ► tb[rts or 1rtvrtutl l'OW"CS art' ' ruhmilted Eu tt[8 bapartrneut of C orrur,etac. 1'ajrsunal ir,t(xluatioll navu~ 1 rolecl Adth s f lltiierenl thtur rt[ lift xticlress) oars in a, cordate a wifft tl,e Privuc C ut r, s l s.p4 ! ,n stats, You Ilr~ TqW *A~ ATV 1 r second xry y l _ Y. A 1:-atien information S%79197?4 . _ b Please Print All rnatyuu er'SNwru - 1'ropertyowtt 1'r0perry Owtu:r's Maili[tg Address - Lovalloll za J City, state govt. Lot ZipCeukt Phouc Ntur,be, Y4. Swim It. Type of Burbling (check all that af+l)ly) - - - '1 rv tt _ Lot !1 ur 2 F':meily I) e;tlir,g - Nun,l,er of"lS ciruorns _ SO&lVisiou Na,ut: lilac k 11 , 11'ublie/Curtuuerci:d - l)eseribe Use s _ State; (awned - Ih;scrilre Use ("iM PCurnlrt:, - _ C1 Village of. _ YII. a of Yreruit. (CbeclC only mite box on Ime A. Coruplete fine B if applicable) New Systerr U ReplW"r1natt SySte[Il C! Treuhttuat/Holdiug l wtk IZOplacetnwlt Only Ll Other 11Audif'icutita, to l:1xistiu6 Systoru (explain) - - Penttrt Itcuewal O .Ponnit Ctei•isivu list C'reviau! Pcnuit Nnrulrer,md 1)atu (ssue,f [J Chat,gc of l'Iwabt r [ 1 r..lit Tra„ stet to New C3efore hxpnalion _ oweer 1 V. 1 - - 1'S 5 JCerrrpoa,:nt/DnWit u_ (i heck all tbnt u [ ! - Non-Press ure -d fit-Ground _I I7W*strr irec! l[r (rrvund Al-Grad, Mound ? 24 u, ul"sttYtatrlt u ~l Mound : lrl at of Nitilabh anti . I lolding laah lJ thher Dispersal Ctare ponertt (explain) I J _ Z 3 At 4j l'relle` nt u7 a tt c t xpl:, Wll~ O tier. Diiv!nal/'I'reat[neat Area Intorratatiort: I)esigrt Izlow (gpd) Design Svit Applimion Rat ~ ~ pdst) ] I)rslr! u1,4 rcs Re qu[red {s() T)rspersal Arut 1'ropuse (st) systetu l.l,rfr;aiu t o V1. Tank Info Ca.r tt tty in ' "Total /1 ul' - lUf:mufacturer - (rations Gullw,s U„its blew '1'aulcs - ct ~ 7 `w n n~ Jib t e ~T J S y,ic or Haldiug 7.adc T' " rn r~ i. V IL Responsibility Statement- 1, the widersirgued, assu a espousrbttity t' It 461114ttrtrrr oft 1PNOM1'S shown, on a attat.Irt.d plumb _-be-r s Nt--ur--te e-(Pr-iti-t)-..--•---- - - irro Pl ~ Plurabur' • - ` - - afore _ f CvIP/MFRS Nn,nbe r Busiuess Phone Nuirmr Pau.u,be)r's Address (Street, City, Sly. Zip C ucit:) V l ll 'uunty/I}e~►artment Use Onf - " " " - Approved Uisupp,uved 1)xtc 1 sued 19 ttltg Agent S nat e CI Owner Given Item( 1Jr Ile W. Con tr~~~ /~ensons Air Disapproval _ Sys-! 0 4 1. Septic tank, effluent filter and dispersal cell must be serviced /maintained S~ e?' ~ 6 as per management plan provided by plumber. / 2. All setback requirements must be maintained > 3 t► G%U~t~ e- - ----------_----as-peF-ap -cctdelnldinan~~>----------- T - ttactr to complete Idu,~ tar We system add suLu,it to tl,e Couu y u - u pupvr ne`f less au t4 t -sc t uwLceiu si~ - (~'~-v 5131)-6398 (R. 02/09) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 12/15/12 Owner: Shaun Bird Location: SW1/4 NW1/4 S36 T30 N,R19W Lot 6 Natalie's Ridge St. Joseph 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 Specification et Signature License numb 226900 PLOT PLAN PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017 SW 1/4 NW 1/4S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/15/12 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 .7 ABSORPTION AREA 651 # of chamber 32 ,BENCHMARK V.R.P. Top of 1/2" rebar ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL IH.R.P. Same as Benchmark Scale is 1" = 40' SYSTEM ELEVATION 95.0/95.1'4' below qrade unless otherwise Property Line noted All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Well is to meet all Vent B-1 setbacks required by 32' lip, _Ak WDNR >69' Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 10.2ft^2/pair of end caps 4' Long 12 77 Vents Grade at System Elevation 6' 34 " 2-3' X 66' cells with >3' spacing -3 4' Pro 3 30' ST 3 0' Bedroom House B-2 34' 157' Town Road 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 To be >1' above grade 10.2ft^2 pair of end plates Finish grade elevation Typical Installation 99.1' Vent Al Grade Vent 3' 4„ X30/34 Septic Tank 5Long 1 5' ;31 ng 1 Grade at System Elevation 3 6" Grade at System Elevation Spacing 5' 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A-95.1' B 95.0' 1319 Wisconsin Department CD R Q S~~ UAT~ON REPORT Page 1 of 3 Division of Safety and Building i !Wis. Adm. Code Tom Schmitt aj0#*4r~~f",; Attach complete site plan on paper not less t n 8'% x.11 inches in size. Plan must E County include, but not limited to: vertical and hon) I referee (gM);(dkbbl'ibir and ' St. Croix percent slope, scale or dimensions, north a , and looM0jN#dgit ~ nearest lroad. Parcel I.D. D3o- / y l - Pco-m lease print all information. D 7zkL-,~- Property Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Owner Property Location Grand Properties, LP Govt. Lot SE 1/4 NW19 S 36 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 6 Natalie's Ridge City State Zip Code Phone Number `f City _J Village d Town Nearest Road 2 Somerset WI 54025 715-247-5900 St.Joseph 66+h iat. $M New Construction Use: SM Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7gpd/sgft rating. Possible system elevation for Area 1 is 95.50'. Slope is 0% (flat). Boring # I Boring k" Pit Ground Surface elev. 98.78 ft. Depth to limiting factor 92 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence tld-undary Roots GPD/fF 'Eff#1 'Eff#2 1 0-13 1Oyr3/2 none I 2fsbk mfr as 2vf .6 .8 2 13-25 1Oyr4/4 none sl 2msbk mfr gw 1vf .6 1.0 3 25-40 1Oyr5/6 none ms Osg ml cs .7 1.6 4 40-68 1Oyr5/4 none grcos Osg ml 9w 7 1.6 5 68-92 1Oyr6/ none ms Osg ml as .7 1.6 6 92+ 1Oyr8/1 none vfs Om cemented - 0.0 0.0 9 3(0'`" 6a ~l wjtds Boring # J Boring C/,5,7 i 7 7 (0 yo, 0 N Pit Ground Surface elev. 99.18 ft. Depth to limiting factor 98+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz -Eff#1 *Eff#2 1 0-10 1 Oyr3/3 none I 1 mpl mfr as 2vf .4 .6 2 10-19 1Oyr4/4 none scl 2msbk mfr 9w 1vf .4 .6 3 19-27 1Oyr4/6 none grsl 2msbk mfr 9w .6 1.0 4 27-75 1Oyr5/4 none grcos Osg ml cs .7 1.6 5 75-98 1Oyr5/6 none ms Osg ml - .7 1.6 • Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD5<30 mg/L and TSS <-30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 12/18/04 715-247-2941 Property owner Grand Properties, LP Parcel ID # Page 2 of 3 a Boring # Boring Pit Ground Surface elev. 99.11 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 'Eff#2 1 0-13 1Oyr3/2 none 1 1mpl mfr as 1vf .4 .6 2 13-26 1Oyr4/4 none sl 2fsbk mfr 9w 1vf .6 1.0 3 26-37 1 Oyr416 none gds 1 msbk mfr gw - .7 1.6 4 37-53 1Oyr5/4 none grco Osg MI Cs .7 1.6 5 53-96 1Oyr5/6 none ms Osg ml - .7 1.6 ❑ Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 'Eff#2 Effluent #1 = ROD s 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODs < - 30 mg/L and TSS <X mg/L - The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Page 3 of 3 Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: Grand Properties, LP Thomas J. Schmitt, CST 227429 Address: 712 Rivard Street 1595 72nd St. City, State, Zip: Somerset, W1.54025 New Richmond, W1.54017 Phone: 715-247-2941 Subd.Name: Natalies Ridge Lot No.: ` Legal Description: -f~l/4N/J l/4 S36 T30N R19W Township of St. Joseph, St Coix County Bench Mark El. 100.00' Top of 1/2" rebar Alternate Bench nd k El . %X S7> / Top of 1 /2" rebar Slope= O1 Contour Line El. /VA rn/a Scale 1 40' ~ aN1 ` ~Y M /1/o CC t77& ~R C~•vr~ T Sl y Pi'cPdSa Read( fell 4. This soil report was done to fulfill a zoning requirement. A preliminary plot map was used, no drainage easements or driveway locations were established at the time this soil and site evaluation was conducted. POWTS OWNER'S MANUAL & MANAGEMENT PLAN page of___ JFrLr= rntl=olRMgrtoN ~ LOwner SYSTEM SpECIflICA`r1oNS Permit # _ -l O Septic Tank Capacity l , g s l 0 NA (p ) V Septic Tank Manufacturer 7E5lGN PARAMETERS - _ t, U NA Effluent Filter Manufacturer `-__--A Number of Bedrooms - 0 NA Effluent Filter Model Number of Public Facility Units O NA - Z11NA Pump'i"dnk Capacity ~I j Estimated flow (average) 7...- - NA " Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) -_N ice..' al/da Pump Manufacturer Soil Application Date NA Pump i Standard Influent/Effluent C~ualit = -....aUday/ftl Model Y Monthly average" NA Pretreatment Unit PaN, Oil & Grease (FOG) 530 mg/t. I NA Biochemical Oxygen Demand (l3pps) ~22p m /L ~ Sand/Gravel Filter O Peat 1=111er Total Suspended Solids (TSS) 5150 mg/i. El NA El Mechanical Aeration Cl Wetland !Pretreated Effluent Quality 1:1 Disinfection Monthly average ) Biochemical Oxygen Demand (HODS) 530 mglL dispersal Celt((ss) In-Ground ravit I-7 NA Total Suspended Solids (TSS) tat} mg/L A 11 Y) I I In-Ground (pressurized) fecal Collfonn (geometriv mean Ht-Grade C i Mound ) 5104 cfu/1 t)Oml # i Drip-l..ine iMaximum Effluent Particle Size - - D Other: - A in dla, 0 NA Ot - her. C] NA 'Ili ,ANA "Values typical for dwnestic wastewater and septic tank effluent. IA NA Other: MAINTENANCE SCHEDULE --0 NA a~ Service Event Inspect condition of tank(s) Service Frequency At least once every: F4', V moat s) Gump out contents of tank(s) (11liaximum 3 years) L7 NA - - - When combined sludge and scum equals one-third (X) of tank volume dispersal I aspect dispersal call(s) ' At I J NA At least once every: 7 month(s) a years) (Maximum 3 years) U NA I ;lean effluent filter _ At least once every: d month(s) _ 1 aspect pump, pump controls & alarm 0 NA At least once every: El month(s) lush laterals and pressure test - d year(s) NA At least once every: d month(sj - - Ither: - U year(s) NA - least once ever l to h s - - - MIAJNTENANCE lNS7RUC110NS NA Ilrrspections of tanks and dispersal cells shall be made by an individual carrying one of the followin licenses IFII'umber; Master Plumber ~testricted ;;ewer; l'OWTS inspector; I'OW7S Maintainer; Se tage linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure easuire a the v the v master icr,~mbined sludge and scum and to check for any back up or pondin of effluent on the Serwring Operator, Tank inspections must wrsualiy inspected to check the effluent levels in the observation pipe and to check for an lea, measuolume of lie '1 Fre ponsp of effluent an the grut.rn surface he indicate a failing c ground surface. The dispersal cell(s) shall e, ''ocfulat d author of may condition and requires hregimm diate tr oti~ catrarn ro f the local I0,1hen the combined accumulation of sludge and scum ire any tank equals one-third or more of th the tank shall be removed by a ~veptage Servicing Operator and disposed of in accordance Administrative Code, the tank valurrte, the entire ro cif 1441 other services, including but not limited to the servicing with chapter NFL 9 ~3, Wisconsin sconsin l3rrrd' any servicing at intervals of 542 ►'rionths, shall be performed b y a uant filters, certified ptJWi'S mechanical Mainntainer, pressurized components, pretreatmer7t units is service report shall be provided to the local regulatory authority within 10 days of completion of any service event. of START UP AND OPERATION Page For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thEll may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thr 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 will by discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenlt. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to I.-Ne effluent pump or contact a Plumber or POWTS Maintalner to assist in manually operating the lump 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 whhln '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 POW I',J7: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralin (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produels; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system is props i.ly 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. • 'rhe contents of all tanks and pits shall to 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 sal il, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must bo taken, to provide a code compflipnt replacement system: suitable replacement area has been evaluated and may be utilized for the !ovation of a replacement soil absorption sysblm. l~he replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot Nnes and wells. Failure to protect the replacement area will result In the nEied for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule:i in effect at that time. 0 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 assort to replace the failed POWTS. C] 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. CI Mound and at-grade sell absorption systems may be reconstructed in place following removal of the biomat at the inflltrajive surface. Reconstructions of such systems must comply with the rules In effect at that timo. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NiOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, MEATH MAY RESULT. RESCUE CIP A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER - _ PC)WTS MA iNTA! E R7 Name0 _.Phone o ` Namfle SEPTAGE SERVICING OPERATOR PUMPER Name LOCAL REGULATORY AUTHORITY UN~-L_... _ Name Phone C Phone 'finis document was drafted in compiiance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative code. ANN M.AWTEN: C Atvr AG.ttt,BMOIN .1.' I r AM I O'W1~1~~t~,~T1:P PrOPerty Addres 2 _ ,r tt__ / - atrnitlg ~ ~oniri .~OPartrrYer,t f (:qty/Stag fox L16(j__ YrevvcctrlstnlctiorY.j )N Ou ~Sc Pr'apOrty r~, See. Subc~'1 Z a uvv • • b Warrauty bead volumv, I'[l~ ~~Y18B Y[~811f1~1N 1~8 Ves n() ri.7.REM,~A]~~'`~"` }O+r w Y A ~Y `0 cr, - 4i r~r xT ~yy~ t rtnpxY,per tree anti rr,ai,ctonance mrtinteftrxca consists of your hepti ' sWcm Coakt .resuit in its re the system can affect ~putrrpiy,g out Ulu of fieptiC tank every three 1 rnatrtre tiriirrrc. to turrxdle w , t`~p+ansibiiifiieg ato s eai xrrcttt,rt oft septic tank as a .yearn; or aoarrrsr, if meded, fr rites, 1 rdr,tl~. A tied in ~~#+L o~CrM 93.52(1) firattrrent stage irr tire; waste ~'rr iM :e~nstsd inr'Ver. Mimi YOU anti irr C.'haptar 12 - dispusul sPh'111. Owner put auto M4lriteriullce rho ro St. t ~oix f,armty Sartitttty i:.ltdiriatrae, o'w,rer and by a ctt~vYrer agates to suhulit to St_ Croix County Platrruu r wages wrtier dis xia8t lr plurnher, .jowerYe t f iurrrl~ar g ~ zo,agr ptr8al s stcrrr .is, in i r,xt,per cr x'estticted phrrrrber or' u lie nnse •I)epar tl ellt a oertificrttion frt ea5 than 1/3i full of W1140 peratirrb cM dition lurcVor Z tunriri;,• verifying that (I) t c~ixr_eisigned b~ j]", ( ) after xrrspei,tlan he and pnprng (tt rrecess&ry), 'tire septic tunk is r/vine, ttte undereig"e t i,xevcy react i Standards set. forth, irnreir,, as set Y , the dLe rrhtrve x'etlurre,r,ents bnct agree the privafiej . - Departalcut of Certx vatic gtetYnbr t11Nt (,+o Zatuin .lie ll septic syst t" rr,airrt air, t lli IlRS it terct Arid tfte l) a +~wagr clisposai s ete g f,Ytr[Yneat wittri .3(Y eetl h'witrtbined n rted a of' I7 eaotn-,r . Stater u "lay" Wrti, tt,t, r/ days oftfitr tltr~ year expiration date. mast be c:ompletcC and reiaraed tc, ttre fit- C-=xcrix C"c,uyity Y ,1&t]tlitl j 'wa certify tLat W1 slates mein. i lrrctperty tiese ribed itbave rr ~ Vitftrte ,)fa an tins fo,rrr g h't Yt ~ w are trite to the best ofYnylrrrn awl m anty deed recorded iri Register of I)eels I~ rr trrbter t' bddr `fle'a Ulu/tar, tllri OW rt • - _ af~xce. m'(bl of the GI`JAITNL r3F APPLSt srrliittrxn flint is Ynisreprt;sc;ntecl tnb, y result in t jrrr<.ruele ~tlr tws rre axriitar y'pertitit• being revs►ked b eafr:rertce ib tirade i fire Walt, 1orYing rprYCat9otY a rec:orcfed vvanaxity deed frorrY the rtegiste,r a.f'Ddedb by the i'lur,,, n nty Office l:>fi' a co ~'X~;', OtilUSj py c,f tire; Certified Sul tresy tulip if LTNPLATTED LANDS N89°51'08"W 2642.99 231.32 231.32 231.32 BLOCK DIST ~ 2079.88' BENCH MARK: TOP OF 1" IRON PIPE. LINE TABL ELEEVAIION 940.8 DRAINAGE 1S F ; EASEMENI 30 t t / O1R£CT70N I F1 N0079'19' F2 N8951'06 t t F3 N72V914 0 t F4 S70'3S'13' I FS S0079'19' F6 S8951'08' t t LOT 4 L 4 m LOT 5 LOT 6 'q LOT 7 3.000 ACRES 3.000 ACRES _ ACRES G 130,882 SO. FT. ^I 130,682 SO. FT. 130.882 SO. FT Lt3.0.• 940.5 L.B.O.- 940.5 t i t t t t t tt Pt Fi 1 DRAINAGE H.W.E 918.0 FA SEWN 7' OF 0 S8931 '08"E 2084.21' -126TH AVENUE i N89'51'08'W 1314.68= 33' .W.E~ 940.8 DRAINAGE cA 5' EASEMENT I LOT 19 F $A LOT 2'I 130,6130 3.000 130,6130 SO A 13 FT. 75' L.B.O.- 942.8 S89110WE 583.99' i m m LOT 22 to I 30 S 0 SO. FTS. m 130,&W 1 - • I ■ A~ J A Illllllllllllllllllllllil11:11~ 8 1 1 2 2.j 3' Tx :4089283' STATE BAR OF WISCONSIN FORM 3 - 2000 969022 Document Number QUIT CLAIM DEED BETH PABST REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, a Wisconsin banking ST. CROIX CO., WI corporation, Grantor, and Shawn Bird, a single person, Grantee. 12/07/2012 1:23 PM Grantor quit claims to Grantee the following described real estate in St. EXEMPT#: NA Croix County, State of Wisconsin (the "Property"): REC FEE: 30.00 Lots 4, 56.,, 1, 13, 20, 21, 26, and 27 Natalie's, Ridge, St. Croix County, TRANS FEE: 764.10 Wisconsi PAGES: 2 Lots are sold `as is' with all faults. Recording Area Name and Return Address: Title One Premier Group 706 19th St S Hudson, WI 54016 # 18811 Together with all appurtenant rights, title and interests. see attached Parcel Identification Number (PIN) This is not homestead property. Dated this 7th day of December, 2012. Citi n l,Atate Bank r~ * Gene Haberman, Vice Chairman * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. ) ss. authenticated this 7th day of December, 2012 Personally came before me this 7th day of December, 2012 the above named Citizens State Bank by Gene Haberma, * Vice Chairman to me known to be the person(s) who executed TITLE: MEMBER STATE BAR OF WISCONSIN the foregoing instrument and acknowledged the same. (If not, authorized by § 706.06, Wis. Stats.) *Jay field THIS INSTRUMENT WAS DRAFTED BY Nb 42 lic, State of Wisconsin My, co ission is permanent. (If not, state expiration date: 8/7/2016 ) Michael H Forecki, Attorney (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below [heir's ign'~aY red; PFNFIE _1) "dolary PuNic 5ia~ h of Visc~ a^•gi,in 1 of 2 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000