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HomeMy WebLinkAbout012-1020-85-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORJR/IATION (ATTACH TO PERMIT) Personal informa~on you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village x Township Germain, Allan Erin Prairie Townshi CST BM Elev: (~` Insp. BM El/e~v: BM D,(e~sc~ripfti~on~~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic (~ ~ , ~) ~~ s~I /~~( d {xJfJt/y /(~ Dosing //~/ _ L /~y ~~~ Aeration w Holding ELEVATION DATA county: St. Croix Sanitary Permit No: 420460 0 State Plan ID No (Parcel Tax No: 012-1020-85-000 STATION BS HI FS ELEV. Benchmark S ,~I s~/ 2- ,O /O 2 . / a~ , d Alt. BM Bldg. Sewer ~ ~ ~~~~ d a a SUHt Inlet D ~~ / ./ St/Ht Outlet „ ~ 9~-~s-" Dt Inlet ~- Dt Bottom ~- ~ H a r Man. o~ Dist. Pi //.7 p 0 Bot. Sy m ~ a•g ~ 'O~ Z Final Gra e ~3 •R S Cover 'I,d TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic C I > ` ~~ y ~ ~ t Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer _ Demand Model Numb r ,- " ~ TDH Lift Friction Loss System Head TDH Ft ,,, Force~nain Length Dia. Dist. to well ~. SOIL ABSORPTION SYSTEM ~2~~,tyy( /„~,~~ BED/TRENCH Width / L T Length, < No. Of Trenches PIT DIM SIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ I D! SETBACK SYSTEM TO P/L G WELL LAKE/STREAM LEACHING Manu ct re ~^ INFORMATION CHAMBER O ~ ~ ^fj• Type Of System: ~ t ~ ~ a / UNI Model Number: V VD ~~ ~~ l DISTRIBUTION SYSTEM ~1 ~~ ~ Header/Mapifolc}7~ V / Distribution ~ ' _ G / ~ Pipe(s) ~~ ~ L/~ ~,j~~ x Hole Size x Hole Spacing Ven o r Intake ~ 7 ~c~~ E / / ~ L t Di L th Di i ~~ S eng a eng ng a pac SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over .~ B d/T h Otht ~ Depth Over B d/T h Ed xx Depth of T il xx Seeded/Sodded xx Mulched e renc er ~ renc e ges opso j~l Yes ~~; J No ~I Yes i , i~4, No COMMENTS: (InclGde-~o0de discrepr ies, persons present, etc.) Inspection #1:~/ ~{ / V y Inspection #2: / / Location: 1571 162nd Avenue New Richmond, WI 54017 (NE 1/4 SE 1/4 7 T30N R17W) NA Lot 1 ., Parcel No: 07.30.17.1050 1.) Alt BM Description = -x ~~ 3 ~~~, r~ G~ ~ ~~~ ~s-~~ ~~_~' 2.) Bldg sewer length = `~"~ f ~ildyir~~ I ~ vtP~1 ~.l~~H SV?~PJC "-'i7 p'~'`~Cc ~~~~ ~L~'~ -amount of cover =S ~L~G~,~,~ ~M'~~-- (g c, i~~ -~ -- ~ ___ Plan revision Required? Yes No // !~ ~ ~ ~ I f ~ Use other side for additional information. ___--- ~ _._I i -1~~~~ - -~~ ---- ---_ _ __.___~ L. ----L ---~- SBD-6710 (R.3/~J7) Date Insepc or's Signature ~,~` I _ ~~j Cert. No. ~~ ~~•~ ~ k t,~.s Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application `~SCO/fSi PO Box 7302 n Personal information you provide may be used for second u oses Department of Commerce ~ p ~ Madison, WI 53707-7302 [Privacy Law, s. 15.04(1)(m)] -(l -/ 1 -V 'Z 3 ~D ~ Z~ Submit com leted form to coon f not ( P ty i . Attach complete plans (to the county copy only) for the system, pap ` B state owned.) -I12'x- l i-linches in size. County /' I State Sanitary etmit N tuber ^ Check if revisio to previo -a t:iftibn` ~ G/P'A/ Q • [e Plap I. D. Number / a N I. Application Information -Please Print all Information ~°? ~ ~ f ~ ocati n: Prope er Name - ~~ ope .Location ~ r ' r/" N x7(o W Property Owner s Mailing Address ---~-- .. _ , , 1~ot N • Block Number City, State / /~ Zip Code Phone Number Subd~ ' on Name or CSM Number II. Type of Building: (check one) 1 or 2 Family Dwelling - No. of Bedrooms :~ ~~~5~~'1 `j ~/~ n 5 ^ P ~ ^ ~;ty ^ Village ublic/Commercial (describe use):_ -- ~/ 3 rx / l ~ i ~ 1 q C%~~it~w- la-Gr1`7 own of ` ~ 1 ~ /- '^ ^ State-Owned / i ~ ~/ ~ j ~~ ~~~ Nearest Road ma n a %' ,G~4 ~ ~ ~ e h.~ ~ ~ ~ ~~ Pazcel Tax Number(s)~a _~~~ _ III. Type of Per it: ( nl a box on line A. Check box on line B if applicable) A) 1. ^ New eplacement ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only B) Existing System Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ~' /~,~~r ~•o/Cw~n ~on-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland~~%S.9 - ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ~ '_' ^ At-grade ~Q~ ^ Aerobic Treatment Unit ^ Recircul 'n ^ Otl}er: ~ a 62 s- !~ CL ~,y, r t V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevatio 7. Final Grade Required Proposed ~ad ~ Rate (Gals./day/sq. ft.) Min./inch) ~-~,_~ = j', j EI ation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks ~(Jl~~.~/7` ~ Con- Con- glass New Existing / Crete structed Tanks Tanks 0 ~ ~ V ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. ' tuber s ame (print) ~ Plumber' i afore (nos s): MP/MPRS No. Business Phone Number e~ ~i-~ ~~e S.~ ? 7~,~~'-~'T~I.C ' Plumbe ddress (Street, City , tate, Zip Code) S ~" y f IX. County/Department Use Only pproved ^ Disapproved ^ Owner Given Initial Adverse Sanitary Permit Fee (Includes Groundwater Surchazge Fee) ' " Da Issued r d . umg ent Signature (No ps) Determination 1 S--r ,i ~ ~ ~ O L G~ .Conditions of Approval/Reasons for Disapproval: ~ .~ ~,,' ~~,,,~,,,,,, , ~3. 3 3 1 ~'Jo~rinG~Y` ~~i5~m` ~ ~ ~ ('_ "~ ~/KAGV I~1~i/J.(/YI ~h fK A~'~.(lr~. G.sN ~na . /mil /'le G i..., „ i ~._ A d ~ ~ /rf ~ - - - -- - - - - .. cr-cs ) - SBD-6398 (R. 07/00) ~40~ ~.,.s~.e c~.c-o~- /~~~~az PLAT PLAN K~~/"~~ PROJECT Allan Germain ADDRESS 1571 162nd ave NewRichmond Wi- 54017 ~/~D~6d NE 1/a SE i/as 7 /T 30 N/R 17 w TowN ErinPrairie COUNTY ST. CROIX ~! 10-1-02 4 MPRS Byron Bir XXr. 2205 A -Grade / ~ DATE BEDROOM CONVENTIONAL CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ~ LOAD RATE •5 ABSORPTION AREA 1200 # of chambers 39 ,BENCHMARK v.R.P. Base of sideing ASSUME ELEVATION 100' '-"-°-`--°~-~~- -.- ^ BOREHOLE O WELL ~ g,R,p, same as BM Vent SYSTEM ELEVATION T 1-92 1T 2-92 5 > 12" of 6" Long 34 Ob pipe r~'- > 100' to B2 60' Sidewinder High Capacity Leaching Chamber with 17.2 ft"2 per chamber Elevation B 1 78' 6' B3 60' 9, 45' 1260 st gal weeks ~, 7' below roa Driveway 70' adition ~'~'-' `~ ~ 0 2002 n _ ~• ~v~ ~ l d~~.3 /4 z/ (•DO• Ws• 'and Septic tank w! ill be pumped and filled with dirt 18'~~ ~ 18' t Existing Powers 1000 gal septic tank 33 1 g, Baffles were all good 4 bed house 45' well PLOT PLAN PROJECT AUan Germain ADDRESS 1571 162nd ave NewRichmond Wi. 54017 NE 1 /4 SE 1 /as 7 /T 30 N/R 17 w TowN ErinPrairie coUNTY ST. CROIX 10-1-02 BEDROOM 4 MFRS Byron Bird Jr. 2205 DATE CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK ZE HOLDING TANK SIZE ~ LOAD RATE .5 ABSORPTION AREA 1200 # of chamber 39 ,BENCHMARK V.R.P. Base of Sldeing _ ASSUME ELEVATION 100' ^ BOREHOLE O WELL *g,R.P. same as BM Vent SYSTEM ELEVATION > 12" T-1=92.1 T-2=92.5 of Sidewinder High Cov ~ aci I-eachin El S~ ~cl 3D• g-~-~~~ am er with ~Z- ~~ (" t^2 per chamber 30.E Long ~~~ Elevation ~¢~l Ob 1 3 c ~~ 3,~ > 100' to B2 60' 124' 60' 45' ~~~,.~,~. ~ P 3.33 30' DW and Septic tank will be pumped ~~ 3 d~' and filled with dirt st A•/ Driveway 18' /pipe will be 70' t ~L(~Q/t,D Q jC" F2j'~ -~„ 7' below road d i~ala Q-~{-t.~CGc.2 ~ h.?•li1 6~~~ adition7 4 bed /-" - ~/ _ house / 45' well PLOT PLAN PROJECT AUan Germain ADDRESS 1571 162nd ave NewRichmond W. 54017 NE 1/4 SE 1/4S 7 /T 30 N/R 17 w TOWN ErinPrairie COUNTY ST. CROIX s 10-1-02 4 MFRS Byron Bird Jr. 2205 DATE BEDROOM CONVENTIONAL XXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK ZE HOLDING TANK SIZE ^ LOAD RATE .5 ABSORPTION AREA 1200 # of chamber 39 ,BENCHMARK V.H.P. Base of sideing ASSUME ELEVATION 100' ^ BOREHOLE O WELL *g.R.P. same aS BM Vent SYSTEM ELEVATION > 12" T-1=92.1 T-2=92.5 of Sidewinde ' acity Leaching r:c S~4 ~2~d 30. ~-~-~C;~~;,-,,,1~, Cove am er with 1.~.2< 6" t^2 per chamber 30.E ~, Long s4 Elevation Ob pipe 1~,.1) 118' > 100' to 60' 124' 60' 45' ~ "~` . ~~~~n.d~-x,~~ x'3.33 30' DW and Septic tank will be pumped ~~ 30 d~' and filled with dirt st A" /dD Driveway 18' 18' /pipe will be 70' t ?' below road and i~e-lat 20' adition? 4 bed -" house 45' well Wisconsin pepartment of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with C:nmm A5 wic Arlm r ~e Page ~ of Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County _ Gro include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . . © /p2 ~lO~d Please print all information. eviewed y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~EJ/~ ,f ' (/ Property Owner ~ Property Location ~jl etrl ~ ~ w~ ~, c Govt. Lot /~~ 1/4~t 1/4 S T ~ N R ~ 7 E (or~ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State _ Zip Code Phone Number a ^ City ^ Village "Town Nearest Road ~~ y ^ New Construction Use: [,~ Residential /Number of bedrooms Code deri ed d fet~~t„. GPD Replacement ^ Public or commercial - De cribe: _ ~~ ~ ~~ ~-„ `- Parent material ~ ~ ~Cl~i d Plain el ation if applicable ft, General comments F " ~ ~ t~ ~~~~ y and recommendations: ~~0 ~~ ~h / = ~~ ~ ~) . T~_~-,yi~ <<,;, ~---t--I Boring # ~ oring (I Pit Ground surface elev. ~~~ ~t. Depth to limiting factor ~ a in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / c ~%' ~ • t t5 ., i~jfi>~ ~ ~ ~ Aa- R2~~ ~ S,al~ !/ Boring # ^ Boring d7. / Pit Ground surface elev. ~~' '~ ft. Depth to limiting factor ~~ol in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 /~ ~ ~ r G/ ~ ~ ~~ r Z `f " _•••""••• •• '-""'5 - "~ "'y~~ Q11U ~ ~~ -~V ~ ~JV uiyi~ - CTTIUeni ~fL = tSUUS < 3U mg/L ano 155 < 3t) mg/L CST Nam Please Print) ,~ ~ /~''~ ` Signature/ /y~ CST Number Address - D to Evaluation Conducted Telephone Number SBD-8330 (R07/00) Property Owner ~j/~~ `~ ~~~K~ ~ Parcel ID # Page 2 of 3 Boring Boring # ! `~ Pit Ground surface elev. ~s ft. Depth to limiting factp~ ~ Soil Application Rate i H De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz or zon p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ~/ ~ r ~~ „ ,.3 ®_ ® G .~ :.5 ~ yti ,~ Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil Application Rate i H th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz zon or p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 * Effluent #1 = BODS > 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. SBD-8330 (R.07/00) 3 ~~3 Soil Test Plot Plan Project Name Allan Germain Byxo ird 3r. Address 1571 162ndAve NewRichmond c Wi.54017 CS #220527 Lot 1 Subdivision csm 7 1965 Date 10!1!2002 CountyST. CRQtX NE 1 /4 SE 1/4S 7 T 30 N/R17 W Township Erin Prairie ,BM or VRP Assume Elevation 100 ft.Base of siding SW corner ~] Boring Q Well PL Property Line# Alt. BM SW comer of house base of siding El. 100' System Elv. T-1=92.1 T-2=92.5 >1C B1 H.R.P. Same as BM POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of /' FILE INFORMATION Owner Gth Cl^IJ'IGt ~ Permit # o2Q `~~b DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units C9 NA Estimated flow (average) Q`j~ al/da Design flow (peak), (Estimated x 1.5) ~~ al/da Soil Application Rate , ,j al/da /ft2 Standard Influent/Effluent Quality Monthly average" Fats. Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS- 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L' ~q Fecal Coliform (geometric mean) 5104 cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity ~p al ^ NA Septic Tank Manufacturer ~e ^ NA Effluent Filter Manufacturer ~,c~.~~ ^ NA Effluent Filter Model ~ ~-a ^ NA Pump Tank Capacity al p` Pump Tank Manufacturer O-N"A Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ^ NA I~In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other. ^ NA Service Event Service Frequency Inspect condition of tanklsl At least once eve ry' ^ mo th(s) Maximum 3 ears) ear(s) y NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume NA Inspect dispersal cell(s) At least once eve rY~ ^ onth(s) Maximum 3 ears) gear(s) y NA Clean effluent filter S N~D~ 9 t least once every: ^ m th(s) ear(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ year(s) 0'I~A Flush laterals and pressure test At least once every: ^ month(s) ^ year(s) O,aA Other: At least once every: ^ month(s) ^ year(s) ~~ Other. ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter -NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/011 • Page ~ of - START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals.`.;. that may impede the treatment process and/or damage the dispersal cell(s1. If high Concentrations ere detected have the Contents of the tankls) 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 be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring , power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls tta 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 scope 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; fst; 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 lie "taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another. inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may .be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,. lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. .Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a sukable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the .biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > - SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN.. DONbT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE. ~k~ PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS nnurrc 11/Al11tTAl1UCQ onuure ialcrel 1 FR Name 1 r+ yi < /~ h Phone - 6 ~ ccnrer_c ecavlr•_Inlr, nPERATnR (PUMPER) Name ~~ ~~ Phone ~O~- ~ ~Z. rV~~ ~v mr+ Name a^. vyn~sc~ Qhone c~6 ~6~ ~nne~ oe~±~n ATnOV e1lTtanRrTV - LV VMV .I..V Name Vr.r^. ~ - '• - G,^o , ~ ~ ~~'n <.rz . ,Phone This document was drafted in compliance whh chapter Comm 83.22(21(b1111(d1&(f) and 83.54(1), (21 & (31, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGRBEMENT . AND OWNERSHIP CERTIFICATION FORM OwnerBuyer r Mailing Address /~~~ ~~vZs, ~~.e,` Property Address ,r~ ~ /C~ G City/State 00 (Verification required from planning Department for new constnrction) ~it~ !Y~ ~ c,, Pazcel Identification Number _~~-' ~~~` ~~- LEGAL DESCRIPTION Property Location/~~ %4, J`am'/., Sec. ~, T~~fiT R1~zW, Town of lr• %~ ~'~~~+~ Subdivision Lot # ~_. Certified Survey Map # ~.370~-~.5~ Volume Page # ~ ~~~ Warranty Deed # __ ~ .3 7.>" 1 ~ Volume ~~ l .Page # Spec house ^ yes j~no Lot lines identifiable.l~yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than I/3 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 Zoning Office within 30 days of the three y date. SIGMA OF PLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property des a y virtu f a warranty deed recorded in Register of Deeds Office. SIGMA F APPLICANT DATE ***•** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** «* Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in dre warranty deed DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-1985 WARPANTY DEED ~~. s~~ ~ R 811 •,,~:`~~~)~ This Deed, made between .._-Robert A. Blaiser and Patricia A. Blaiser, husband and wife as _ survivorship marital propeitx ..................._. _................. .. _..._ ................ ....................... Grantor, a„~ Allan J. Germain~•and .Telaine M.-Germain, _ _ _. . . husband and wife, as survivorship -Lnerital .. ~ • ~ .. property ... .. .. _ .._. ... ...... ... .., Grantee, ~t'itnesseth, That the said Crantor, for a va.uable consideration --_. One dollar and other valuable consideration concr~s to Grantee the following described real estate in _-._ St. Croix County, State of Wisconsin: TNIt t•AC6 REtiRVEO FOR RECORGINO DATA REGISTER'S OFFICE ST. CROIX CO., WI Recd for Record MAY 2 3 198$ et 10:20 AM C,~„iVC~C Q R~ytiter of Oeed~ RETURN TO Century 21, Indianhaad Realty New Richmond, Wisconsin 54011 Taz Parcel No: --------•--•---•-----°----•---•--- Part of the NE)y, SE~y, SW~ and NW'r: of the SEA of Section 7-30-17, more particularly described as follows: Lot 1, Certified Survey Clap filed May 12th,, 198$ in Volume "7", Certified Survey Maps, page 1965, as Document 0/437245. Subject to recorded easements, reservations, and rights of way. I`hAN~;E'ER ~D Thie _..._is..__...... homestead property. (is) (is not) Together with alt and singular the hereditaments and ap purtenances thereunto belonging; Anci. Robert A. Blaiser and Patricia A. Blaiser a-al•rants that the title is good, indefeasible in fee simple and free and clear of encumbrances except no exceptions and will warrant and defend the same. Dated this .. 18th da.y of ._ .-_. -- - - (SEAL) ..(SEAL) - May _ ..._ - _.__.. _., 19..88 -. '" "' .`,'-"-. "...~-. ..'Y~1~'e1.~--~ (SEAL) , Robert A. Blaiser ~~:~i~ _ A .. ~]\~i.u>.:: ~ . _ _ . _ (SEAL ) Patricia A. Blaiser AIITHENTICATION ACKNOWLEDGMENT Signature(s) ..-.._---......._ .................................._-____ STATE OF WISCO<YS[N - .._.. St. Croix ss• ..-•--•------- -----------------•---- County. authenticated this ....-._.day of ................... ....... 19...... Persona]ly came before me this ..-.18th ___-day of ..-- May---------------- --------------- 19..88.. the above named •-------••---------------- •-•--•---•---•-------.......-----.......------------- --- Robert--A.- Blaiser and Patricia A. '-- -----• -------•------ -------- -----• •------- ------ -......-----•---•-- Blaiser TITLE: '~IF,bfBER STATE BAR OF WISCONSIN (Ii not- -- ------- -- -------- aut orized by $ ?06.06, Wis. Stats.) to me known to he the person ....s_.--- whn executed the forefioi instrument and acknowlc~lge/~he~,.,~me,. THIS INSTRUMENT WAS DR4FTED BV //' ~ • ~ /~ I'rd~~i~" Eric J. Lundell, Box 157 - ;~ -~-- •.a~• -~-~ - -~--- C, John D. Walsh ------ --- •- -- --- - ---------- -- 0 • rtA " ••,w ,,... ... New Richmond, Wisconsin 54017 ~ - - - ~ ire •• '~~' -..__.-....-- - - C -- - - -----•-- --- ---------- - - ------ Notar•: Public St. Cro oenty, ie. (Si,nature; may he authenticated or acknowled;;ed. Bnth ~~' Commi:;sinn is prrmam t. (tl• rifii~.~!`f ~e~ira •~ are not necessary.) December 10, J p date: _ _ _ _ f _ - 13:~ 1 •Nsmer of Dennns si,tn inR in sn~. cs pxcily ahuu!d be ts'VMI nr prict~d ~1•~w th.~ir ?.Rnnn,nre. ~ ~ ~~Ubt-~ i ti, RGM~IIerCpnp.ry~ BTATF. flAR OF WltifOtitilN v~j ~ ~t ~ (, ~ + ~, FORK Ne. 1 - 1982 •~I~1 C ~Q,K ~~. ~`~ ~~~ ., 43`745 CERTIFIED SURVEY MAP Located in part .Qf .the NE a-SE a and the SE a-SE a ; SW~-SE a ; NW:-SE a of Section 7; T3'ON, R17W,~ Town of Frin:Prairie, St. Croix County, Wisconsin. OWNER N} corner section 7 T30N, R17W Robert Blaiser Rt. 1 Box 40 New Richmond, Wi. 54017 SCALE IN FEET 100 50 0 200 s~ ~ ~ ~~~ ~' ..~ of ~` ~I ~~~~ ~~ o -" "'"~ '~~ N I `9 ~ vi .~ CI ~1 '~ N87°35'30"E 0 1146.98' .north line of the SW~ v~ of the SE} ~~ 0 ~Ft N d s w 'o ~ ~ d C ,~ .,, ~o ~--~ .ti n .~ 1L ST. Ct2CG~ .. AND a~~~ t d s O c .o d A a C Bearings are referenced to the north E south one-quarter line assumed to bear N00°24'16"E. unplatted_lands-owned by-platter _~ _ - iP189°10' 44"E 564.45' N ~] 97.86' Ql.li.t' Claim Deeds °D ~ Vol. 808, Page 469. Vol. 810, Page 264 O M • ~ Vol. 806 Page 470 ~ ~ c barn ~ N QgalEage M O N I N N ~ house - 97.97' .-north line of_the SE} _ SE __ am ~ '° 162nd_AVE; ,°o L =. 1 NOTE: County road maintenance records ~ show 162nd avenue as being 0.21 miles 'n in length from C.T.H. "GG". No other - ~c records found. r` ~ ~ ' W • ~ N LOT 1 0 ~ '1a W I to ~ I t O ~ +• ' o O ~ ~ c O I "' O ~-~ ~ N 1 W Q ' W N89°42'45"W 564.27' un Tatted lands owned by platter r` r` N ~ ~ s O d' O 0 O .a.+ A a A C s 0 ai -v i ci .=°+ a+ I _w __ __ io so ~I ~I rl~ ~I :+° al ~I A 1 ~ 1 dl cl o~ N I 'O 1 NI ~ I ~v ~I ++ I ~I .'~i 1 ci ~I ^ e,,l1+i~.a ny~., J n~. LEGEND . ~~'~`•. ~ ~~ ~ .:,,~.. O 1" x 24" iron pipe weighing 1.68 pounds per linear foot, set. ~,~: ~, a ~;,~' »t ±~, .4: .n .r County section corner monument found. "~ 1•'~~~ ~;~;.i}~~, ;~ S} corner ~~~`rY.n;Cj SUS section 7 ~.4as,n~p~ 4~~`'~ T30N, R17W this instrument drafted by Fran Bleskacek job no. 88-14 VOLUME 7 PAGE 19b5 435,600 sq. ft.)INCLUDING R/W 10.00 acres ) 413,663 sq. ft.)EXCLUDING R/W 9.50 acres )