HomeMy WebLinkAbout030-2141-00-026 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
563892 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. I St. Joseph, Town of 030-2141-00-026
CST BM Elev: Insp.BM Ele: BM Description: Section/Town/Range/Map No:
IF-731 36.30.19.2076
TANK INFORMATION 19 j ELEVATION DATA
TYPE MANUFACTURER r CAPACITY STATION BS HI FS ELEV.
Septic / � Benchmark �.
J v F.i (` A
Aeration Bldg.P3ewer 5`3 9(0.93
Holding St/Ht Inlet / --7.
b i
TANK SETBACK INFORMATION St/Ht Outlet 9 5.79
TANK TO P/k WELL BLDG. Vent to it Intake ROAD Dt Inlet ` \
Septic Zv / ____ Dt Bottom
Dosing Header/Man. 7,3 at 5 3
-7•
Dist. Pipe �{
Aeration 7•I 4 5
Holding Bot. System 7 • `f 3
Final Grade 3• Q �. c�
PUMP/SIPHON INFORMATION o
Manufacturer Demand St Cover z. �� ej 2
J
GPM .���
Model Number
TDH Lift Friction Loss ISyste TDH Ft
Forcemain Length Dia. Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width I Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Dept
DIMENSIONS 3 r„ Z 'f`e0,4, Manufacturer:
X19.[J
SETBACK SYSTEM TO �(! P/L BLDG WELL LAKE/STREAM LEACHING ('
INFORMATION CHAMBER OR
Type of System: -r j UNIT Modp,[N�mt�er: I
DISTRIBUTION SYSTEM z6F A C = — Z J S
Header/Manifo!o I Distribution x Hole Siz THole Spac Ivent o Air I e
Pipe(s) r J
Length_Dia Lengthy Dia_ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only `~
Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center • 53 Bed/Trench Edges Topsoil ` Yes 1 No �es No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 811 124th Ave. NN Richmond,WI 54017(NE 1/4 SW 1/4 36 T30N R1 9W) Natalie's Ridge Lot 26/ f NParcel No: 36.30.19.2076
a
1.)Alt BM Description= ` �'"r �aJ '° GN•G .,-5 4— h-•D�-V��7 a �/�
2.)Bldg sewer length= 2,� VS �
-amount of cover ts Plan revision Required? [ Yes No r Use other side for additional information. ��
Date Insepctor's Cert.No.
SBD-6710(R.3/97)
PLOT PLAN
PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017
NE 1/4 SW 1/4S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST.CROIX
MPRS Shaun Bird 226900 DATE 8/28/13 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 chambers 32
BENCHMARK V.R.P. Top of 2" pipe
ASSUME ELEVATION 100 1 Filter BEAR Filter
❑ BOREHOLE O WELL -H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.0/94.1 5' below grade
All piping shall be SDR 30/34,within 10'
of tank,piping shall be Schedule 40.
I
Town Road
I
i
Pr
Scale is " = 40'
Bedr unless of erwlse
House noted
I
20 143'
Vent
>6" Quick4 Stan and 20' 97'
of Cover Leaching Cha ber
lv�ith 20.0 ft2 f Area B 1
12" fj2pair o end 65'
4' Long •
34 Grade at S em evation
0% Slope
1
2-3' X 66' cells
c6 with>3' spacing 72' B.M.*
i
B-3 18'
I
20'
Vents
i
123'
B-2
224' Property Line
County CC - -
Industry Services Division GJ~` ~5J1_?~------
/r~` k 1400 E Washington Ave sanitary Permit Number (to be filled in by Co.1
i
5 pA~ P.O. BOX 7162
}
S~ Madison, WI 53707-:7,162
P"k
krwc*?` - state on Number
Sanitary Permit Application AUK .Q
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental I'M
j ldress (if different than mad'ng address)
is required prior to obtaining a sanitary permit. Nofe', Application forms for state-owned POW'I'S are subnpt)Ccl to P
the Department of Safety and Professional Servies. Personal information you provide may be used for secorlCOW
purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stalls. _ ---=s C_0~ 1/1 7 J
1. Application-Information ..Please Print All [formation Parcel -
-Qwnei's Name- 0_ U
I5) Property Location
Property Owner's Mailing Address (2-b ;(o
Govt.
s _
City, State Phone Number / 1A, Section ~!Q
-C`
- Zip Code
mole one)
dL~ - t tv, k G or
~
II. Type of Building (check all that apply) Lot N
Subdivision Narne
2 Family Dwell ng- Nt ber of Bedroom ' / `
s-t(jyt_~ Y WQ Block # N
❑ Pttb{ie/Conmercial -Describe Use ❑ City of__..__-------------
_
CSM Number Village of
❑ State Owned - Describe Use.
[If. Type of Permit: (Check only one box ou line A. Complete Mite B if applicable) New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other ModiEicatioti
to Existing System (explain)
❑ rmit Number and Date Issued
Pe
- List Previous
Chan of Plumber ❑ Permit Transfer to New
rmit Renewal CI Permit Revision g'e T
e Expiration Owner
_
IV. Type of POWT'S Syste:..iK ponent/lleviee: (Check all that apply)
Non-Press urized In-Ground ❑ Pressurized In-Ground At-Gracie ❑ Mound > 24 in. of saitablu soil ❑ M u d < 24 in. of uitablc S( )fl
( P 1Le~}tFfln~Cr c ~l~>re . GeJ ~~~9
❑ Ho ding ar+k CI Other Dispersal Component atme+z explain)
V. Dis rersalfTreatment Area Information:
(gpd) y S stem
Design Flow Desig dsI) DisP' a zl Area Required (si) Dispersal Area Proposed (sl
nSoil Application Rate(gp
Capacity in Total 4 of Manufacturer
VI. Tank Info
Gallons Gallons Units
•b c v ; V ~ ~
NewTemks Existing Tanks a u 7, U)
N '
Septic, or11 lding"rank _
Dosing Chamber -
BPlaits.
VII. Responsibility Statetntent- t, the undersigned, assume res o ility for installation of the POIyT shown on the attached
us Hess Phone Num/ber -
Plumber's Name (Print) Plumber's Sig
Plumber's Address (Street, City, state, Zip Code)
G
A ent Si ature
VI Count /De artment Use Only Is mgg
F$~~ mit Fee Date I sued
Approved El Disapproved S.. I'D
❑ Owner Given Reason for Denial
IX. Cjpji#~ cftWll%,`•aI/Reasons for Disapproval s<jsJ
~C
tic tank effluent filter and r J-„' ` AAL ;1)11(4
1. Sep
,e-r l Col-
V( y(~ r
dispersal cell must be serviced 1 maintained
as per management plan provided by plumber. ~L, ,
2. All setback requirements must be maintained tl'-L/ -
s ror the system and sahmit to the County only oil paper not less than 8 U2 x 1 i inches in size
SBD-6398 (8031: )
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 8/28/13
Owner:Shaun Bird
Location: NE1A SW1/4 S36 T30 N,R19W Lot 26 Natalies Ridge St. Josepj
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 Sh t
8.-10. Soil Test
Signature
License number # 1&900
PLOT PLAN
PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017
NE 1/4 SW 1/4S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/28/13 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 chambers 32
BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 94.0/94.1 5' below qrade
of tank, piping shall be Schedule 40.
Town Road
Pro 3 Scale is 40'
Bedroom unless of erwise
House noted
20 143'
Vent s
>6" Quick4 Standard
of Cover Leaching Chamber 20' 97'
with 20.0 ft2 of Area B-1
5.6ft^2/pair of end caps 65'
4' Long 12
34" Grade at System Elevation
0% Slope
2-3' X 66' cells
with >3' spacing 72' B.M.*
B-3 18
20'
Vents
123'
B-2
224' Property Line
1343
Wisconsin Department0 Commerce OIL EVALUATION REPORT Page 1 of 3
Division of Safety and B gg(dings:' ? ) irNdanc with Comm 85, Wis. Adm. Code Tom Schmitt
Attach complete sit plan t p x 11 i hes in siz ~ RIB m t County
include, but not lim ed to: VV I 1eference oint (BM), dir ' n:d St. Croix
percent slope, scat wand loc nand distance to nearest4bad Parcel I. D.
Please print all infonnatfon. Revi By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /p d
Property Owner Property Location
Grand Properties, LP Govt. Lot NE 19 S 1M S 36 T 30 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
712 Rivard Streeet, Suite 300 26 Natalie's Ridge
City State Zip Code Phone Number City Village V Town Nearest Road
Somerset WI 54025 715-247-5900 St.Joseph
be New Construction Use: se Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Outwash (stream terrace) Flood plain elevation, if applicable na
General comments
and recommendations: Area is suitable for a conventional system with a 0 7 gpd/sgft rating. Possible system elevation for Area 1 is
95.90'. Area is flat.
Boring # Boring
✓ Pit Ground Surface elev. 98.93 ft. Depth to limiting factor 98+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
*Eff#1 *Eff#2
1 0-12 1Oyr3/2 none sl 2fsbk mf as 2vf .6 1.0
2 12-21 1Oyr3/4 none sl 2msbk mfr 9w 1vf .6 1.0 I J lb
3 21-35 1Oyr4/4 none Is lcsbk mvfr 9w .7 1.6 I
a
4 35-64 1Oyr4/6 none vcbms Osg ml gw 7 1.6
5 64-91 1Oyr5/4 none grs Osg ml cs .7 1.6
6 91-98 1Oyr5/6 none ms Osg ml .7 1.6
Boring # Boring
✓ Pit Ground Surface elev. 98.93 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft=
*Eff#1 *Eff#2
1 0-10 1 Oyr3/2 none sl 1 mpl mvfr as 2vf .4 .6
2 10-20 1Oyr4/4 none sil 2msbk mfr gs 1vf .6 .8
3 20-28 1Oyr5/6 none Is Osg ml gw .7 1.6
4 28-70 1 Oyr5/4 none vgrcos Osg ml cw - .7 1.6
5 70-115 1Oyr5/6 none grs Osg ml .7 1.6
n
* Effluent #1 = SOD 5> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <_30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt ~~o~+-.~- 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St., New Richmond, WI 54017 4/21/05 715-247-2941
r Property Owner Grand Properties, LP Parcel ID # Page 2 of 3
3] Boring # Boring
✓ Pit Ground Surface elev. 98.86 ft. Depth to limiting factor 110+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots s
'Eff#1 'Eff#2
1 0-11 1Oyr3/2 none I 2fsbk mvfr as 2vf .4 .8
2 11-23 1Oyr4/4 none sl 3msbk mfr gw 1vf .6 1.0
3 23-38 1Oyr5/6 none grs Osg ml gw .7 1.6
4 38-67 1Oyr5/4 none vgrcos Osg ml cs .7 1.6
5 67-98 1Oyr5/4 none grcos Osg ml cs .7 1.6
6 98-110 1Oyr6/4 none s Osg ml .7 1.6
❑ 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 GPD/ft'
'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
I
' Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD5 <_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 matrrt W 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, Wl. 54025
New Richmond, WI. 54017
Phone: 715-247-2941 Subd.Name: Natalies Ridge
Lot No.: _
Legal Description: /4L& l/434J 1/4 S36 T30N R19W
~_`'7'~ OS- Township of St. Joseph, St Coix County
® Soil Boring
A Bench Mark El. 100.00' Top of 2" pvc pipe
0 Alternate Bench Mark EL % o Top of / " J tee
Slope= ®Pxc Contour Line El. A/W
nl\
Scale V = 40'
gyp.
Gt
t3~
C ~y
~F
This soil report was done to fulfill a zoning requirement. It may or may not be in a location suitable for your use.
x 914. 4 `
LOT 25
/ 913,3 / . ~
3.000 AC.
=9 (2.68 AC.) x 915.3
/ L8.0.= 915.5
2
91 b , / F~S• a~
x
LOT 26 914.3 •
/ 914,6 x 3.000 AC. ~•y .
/ • (2.74 AC.)
LAO.= 915.5 i
7x~-
ws
x 914.5
00 27 /
~ .
3.00 5
1. /
45 AC.)
0•= 915.5 / 913.5 /
/ 893,9
3 x
/ 915,2
/ 892.5 x ~K
908.8 'I
0
892.7
x
.r`
895.5
x
x •
907.2 '
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
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 99'
,jv
ent Grade Vent
4" 3'
30/ 34 Septic Tank
5' S' Long i
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 94.0'
B 94.1'
POWTS OWNER'S MAN4JAL, & MANAGEMENT PLAN Pagof
r--Ir_.F INFORMATION SYSTEM SPECIFICATIONS
Owner
- Septic T'~nk Capacity 145V
c gal C t NA
_ J.
Permit # Septic - -
eptic T;:nk Nlanutacturer NA
DESIGN PARAMETERS Effluent Filter Manufacturer t_I NA
Number of Bedrooms CJ NA Effluent I Ater Model ~ NA
Number of Public Facility Units -/-ANA PunIp rank Gapacity i NA
Estimated flow (average) dal/day PUrnp `t'ank. Manufactur -Yr' NA
Design flow (peak), (Estimated x 1,6) 1f~27 al/day 111rnp Marinfacturer NA
gal/ `roil Application Rai,e gal/city/ff2 Purnp Moriel 1 NA
Standard Influent/Effluent Quality Monthly average' Pretreatrrent Unit I NA
Fairs, Oil & Grease (FOG) <30 rrtg/I. IA Sand/Ci,avel Filter Ll Beat Filter
Biochemical Oxygen Dernand (BODs) <_220 trig/L [-I NA 1=1 Mechai ical Aeration I.] Wetland
-total Suspended Solids ($S) <160 mg/l. C] Disinfe: tion IA Other:
Pretreated Efficient Utiality Monthly avoiage Dispersal fell(s) F NA
Biochemical Oxygen Demand (BOD5) 530 mg/l_ ri-,Grotind (gravity) 1.1 In-Ground (pressurized)
Total Suspended Solids (TSS) 53t7 mglL Ali i::1 At-Giaoe 1=1 Mound
Fecal Goliform (geometric mean) 5.104 cfu/*l00rrrl J ❑ Drip-Line 11 Other:
Maximum Effluent Particle Size r Oti'ei: I 1 NA
in dia I] NA
Other:
Other.: [1 NA
Values typical for domestic wastewater and septic tank effluent. Other. 1:1 NA
,._____..__-r_._...___.._..___.._.._.~..~.._..4......_._.,....
IViAtNTCIV'AIUC:E SCHEDULE
Service Event Service Frequency
Inspect condition or tank(s) At least once ever 0 month+:s)
y ears (Maximum :3 years) IJ NA
Pump out contents of tank(s) When corribined sludge anti scurn -quals one-third (F,) of tank volume C_1 NA
Inspect dispersal cell(s) At least once every: Q inuntha s) (IWaxirrrurn 3 years) l.:l NA
Clean effluent filter At least once every: )
rnonfhi s -1 NA
- -
years;
Inspect pump purrrp controls & alarm At least once every. CI rnonthi s)
CJyear(s; 1 NA
Flush laterals and pressure test ❑ rnunthl s
At least once every. U year(s;) 1 NA
Otip( r' - _
Ar least once every rnonthls) ] NA
L] year(s)
-1 NA
NIAINTE-NANICE INSTRUCTIONS
Inspections of tanks and dispersal cells shall he made by an individuai carrying one of the following licenses or cerlitivations- Master
Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; E;eptage Servi ring Operator. I'ank inspections must
include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cricks or leaks, measure the volume of
combined sludge and scurry and to check for any back up or ponding of efFlrient or the ground surface. The dispersal veil(s) shall he
visually inspected to check the effluent levels in file observation pipes and to che(* for any pondii-gj of effluent on the ground Surface.
The ponding of etiluent on the ground surface may indicate a failing condition and requires ttv) immediate notification of the. local
reguiatory authority.
When the combined accumulation of sludge and scum in any tank equals one-,third (/3) (]r' more of the tank volume, the entire contents of
the tank shall be removed by a Septage Servicing Operator arid disposed of n accordant:? with chapter W? 113, Wisconsin
Administrative Code.
All other services, including bcd not limited to the servicing of effluent filters, rnecharical or pressurzed components, pretreatment Ylriits,
arid any servicing ut intervals of s'12 months, shall be performed by a certified POWTS Maintalrter.
A service report shall be provided to the local regulatory authority within 10 (lays of c(mpfetion of an!, service event.
START UP AND OPERATION of---.- I--
For new construction, prior to use of tide poVVI ; check treatment tank(s) for the presence of painting products or other chernicals thal
rnay impede tyre treatment process and/or damage the dispersal r;ell(s}. if Iaigh concentrations are detected have the contents of the
tank(s) removed by a septage servicing operator prior to use.
System start up shall not racxur when soil conditions are frozen at the infiltrative surface.
During power, outages pump tanks may filt ab3ve norrrlal highwater levels. Wlerl power is restored the excess wastewater will he
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup oir surface discharge of effluent.
To avoid this situation have the contents of tho pump tank removed by a 5ephige Servicing Urrerator prior to restoring power to the
effluent pump or contact a Plumber or POWTc; Maintainer to assist in manually operating the pump controls to restore normal levels
within the purnp lank.
On not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwhise disturb or compact, the area within
15 feet down slope of any rnot.rnd 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 lll0\IVT'S:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(surnp pwrr(a) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrap: ; medications; oil; painting ;
products
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently token out of service the following steps shall be taktan to insure that the system is properly
and safely abandoned in compliance with chaptor Comm 83.33, Wisconsin !administrative Code:
ea All piping to tanks arut pits shall be disconnected and the abandoned pipe openings seale:I.
I he contents of all tanks arid pits shall be removed and properly disposed of by a Septage Servicing Operator.
After purnpin, , all tanks and pits shall be excavated and removed or their covers rernoved arid the void space tilled with soil,
gravel or another inert solid material,
CONTINGENCY PLAN
If the POWTS falls and cannot be repaired the following measures have been, or artist be taken, In provide a code compliant
replacement system:
f A suitable replacernent area has been evaluated and may be utilized for the location of :1 replacement soil absorption systern,
fhe replacement area should be protected frorn disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot fines 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 roust comply with the rules in
effect at that time.
b-1 A suitable replacement area is not avnilable dui: to setback and/or soil Imitations. Barring advances in POWI`S technology a
holding tanlo may be installed as a last resort to replace the failed FrC)WTS.
1-1 The site has not been evaluated to idctritify a suitable replacement area. Upon failure of the 130W1-S a soil and site evaluation
must be performed to locate a suitable replacement area, If no replacement area is available it holding tank may be installed as
a last resort to replace the failed POW'i:S.
Ul Mound and at-grade soil absorption systems may be reconstructed in piece fallowing rtrmoval of the lriornal at the infiitrative,
surface, Reconstructions of such sysbwns rnust comply with the rules in effect at that time.
<<WARNING>r
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL. GASSES AND10H INSUIFFICIENT OXYGEN. DO NOT
E NTFR A SEPTIC;, PUMP OR OTHER TREATIVIEN`f' TANK UNDER ANY CIRCUMSTANCES. f]K ATH MAY RESULT, RESCUE OF A
PERSON FROM THE INTERIOR OF ATANK 14AY BE DIFFICULT Ord IMPOSSIBLE,
ADDITIONAL COMMENTS
-
-'C14tU'T'b INSTALLER .
_ POV MAINTAINER,
_
_MAINTAINER,
Namr~
Quo, Name
I'hurlca )
- lIorte
t
°iEI~'I"AGE SERVICING C)PI=RATQI~ F'UM p -
CI ~ OPERATOR Eft LOCAL REGULATORY AU' I'NORITY
Nalnf?
T Name
Phone Phone
Tins document was drafted in cornpliance with chapter SPS 353.22(2)(tr)(t)((1)&(f) and 3113.54 t , ) x (3), VViscnrrsin Administrative Code. ~
4 j 'jj \
1 Y ~0
FILTER CARTRIDGE INSTRUCTION'S l
s r isW Y Dry tit the Ow, case .4wa Chu trend d tht uutlrot pipe to errsuro it ix
cohturrd un4or tiw ill-w" wanblo. If mutt thdm mamr irtbwt two pipe into the
tank titruttirh of aulliot'* wluent weed (Ukw) additlarrai pipe Nrrtc the uuthrt
pipet.
:iTMP a Whyp hate veal dry fln* on the aWielt pipit, Inca earn, tiro 600
uP -YA -inch pip wn.4 to bras, tftu alww to idle tart aw wA it uUtuirry the
rN ull"ai sup", M* SUVOUtt, If' Wria ,rwppart tnathad it hot utlikeed,
preaved m 40 (out}
yrrr• a For iCtttatrtr~utplitir,!y tha optlprluigk%M*W"@47t1 Side r:lrppart:
soiu.r.t weld ifse w- nth pw us,te the finer east- jf We support trnthrtd is hcA
rriiisod, w•otr}td to #bt a wr.
SAhtt nt W* t VOIlltel cars" tlhte the a Ail't Wtrn. fnsdrt the sifter
cartsidgv meta ~he cage, POUStrrr( dam Ow the Sl6w
the vsu. kxim iMta Meet 6wr*11 uls ?lie.
Il e b ~F,
rtrltrlt ips tttfiid irrswt atrr the Tiitxr" and {uclr Ery turmn~ tl~ r
ciockowse
iw7Jt~1$IRI~
:t. "I'h,r tS1rlWsrdl fi►tot ahota~d tee ttersnod artery tiutrt fire nsrfytlC tank (s
5wrviwtri.
l., open the utotiat amese. al tinny to inspaGt tire l'pp atrti flitet;
12Unrp thw stgpuc tW"k tmtrr .L
Itryer ore the pla lid a rnelciPrg sttrri to rtitrruUe the sfudtyu
+hottnrtr of L~Frw t,:rnit and nnt
ON NI tfrO nptrrrr and Igt'lfuurtt,
a. ce the if
„,enu,r (trvoi test t,egn tvMwred bwow thu invert of
urttlet pips, iirarl tai
tttU
cbrtrld y Pull up oil the toter htrndtd tr, d15tl ridge flit!
pew /rrtrr !lt,r rttt;e,
5 S►ltie the rarirhipw Ulr ant) arrrof titw
G, ff a bPtS cfte Erse deattirry, r
siruuld he rwri:nv ar! to env aiBrPn is frlttm4trrt,
with b
wrrtar onli. Y ter"'" "WrItUrduckwism y()wte swftr it
Gard atraaed
7. WIa bo)ifiny I he mortyidab C,ti ►ts !acts
dawn) Drat tilt: yr t nsic u Ctar{►m Hsi r
Only, rrrakin iynnirytr riir psi' s.UrFacU Prrctrrg
ti wire afl arq,te t LFlel rtlrlYlt{pe waft WhYcrY
1t' V" swPtch Is utftixed a urtrttrrfal jr rittsytl v,
back "'t" the hauk,
ttirrnit r rutplig' by iir$rtrr)l sr attd
+ti .i'e,ckwfsrr Sri.. tar) hitS9 • it,
,
9, Ytryart the mmnr greeter
tires bark Punta riar la;kciriu
i:)ro Lrettwurr Of th, 4a", Imusilt
place Wid suclrre this buy l,, ,
bcc ar'b rlPOWU Cite the tattit. 4
.
r• .
-I_
ST. CROIX CO UNTy
SEPTIC TANK MAINTENANCE AGREEME NT
AND
CWNLRS.TIIP RTIIiICA1'ION FORM
Owner/Buyer v
Mailing Address~~_~~~_
Property Address _ j ~ ~
Sv
A
(Veriaation /
quired fro _
~
rn Planning & Zo 8--
nir
~ e1 "tment for new construction.)
City/State~ I
kk'p"_4~
Parcel Identification Number
Property Locataon /a
,ctL~ ,zt.J ~4 , 5ec.3 , [)o N x
L W Town of
Subdivision
Cert>illed Survey Map # Lot #
- _ - - Volume Page
Werra my Deed #
Page #
Spec: house yo no _ ~ - - -
Lot lines identifliab yeS o
SYS1`E.M IVCAINTENAI~CE AN O'WN 'R C:ERTtF'YCA'rTf1N
rmproper use and maintenance of your septic system could result in its premature maintenance consists ofpu:nph,W out the septic ikilure to the system can affect the
itm of the tank every tlvee years or sooner~ifneeded , by a li nny pumper. wastes. Proper
What
responsibilities are specified i n t;o p y p ys you Put into
ed septic tank as a treatment stage in the waste dis osal s tern. Owner maintenance
rnin. 83.52(1) and i„ Cha ter 12 - St. Croix County Sanitary Ordinance.
Thu prapenty owner agrees to submit to St. Cr
owner and by a master plumb oix County Planning & Zoning Department a certification for
er, journayrrurx, plumber, restricted plumber or a licensed pumper verifying that (I) the an••site
wastewater disposal system is in proper operating condition and/or (,2) after inspection and piunping (if necessa ~ signed by the
less than 1 /3 1a1iof sludge. septic tank is
ry), the
1/we, the undersigned Iu►ve read the above reQuiretnents and agree to maintain the private jewage disposals ste
standards set forth, herein, as set by the I7eparianent Of Co
thtl
Certification stating that 1Ce and the Depanmont of Natural R•nsnurces, State of Wisconsin.
Lontn D Your septic system has been maintained must be completed and returned tv the St. Croix County planning &
g eparfrnent within 30 mays of the three year expiration date.
1/we certify that all statements on this form are 1.1, a to the best of my/our knowledge. I/we am/are the owner(s) of the
i property described above, by v of a warranty deed recorded in Registrar of Deeds Office.
Number of bedroo
NAT F APPLICANT(S) DATE
~AT
*'"*Any n>forntation that is misrepresented may result in the sanitary permit being revoked by the Plrtnning & londn Department.
lInclude with this application a recorded warranty steed from the Register of Deeds Office and a copy of the certified surve
jreference is made in the warranty deed. y map if
~:RE'4•. 08/05)
. IIIIIIIIIIIIIIIIIIIIIIIIIII:
1111
81 122-:93,
Tx:4089283'
STATE BAR OF WISCONSIN FORM 3 - 2000 969022
Document Number QUITCLAIM 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, 5, 6, 11, 13, 20, 21, 06and 27 Natalie's, Ridge, St. Croix County, TRANS FEE: 764.10
Wisconsin. 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 tate Bank
* 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.)
THIS INSTRUMENT WAS DRAFTED BY *Ja field
N VCouission lic, State of Wisconsin
My is permanent. (If not, state expiration date:
Michael H Forecki, Attorney 8/7/2016 )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
'Names of persons signing in any capacity must be typed or printed below their- ~-W red' PFl~1F 1
olotary Pubiic
Sirr?' 01 Wisconsin 1 of 2 QUITCLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000
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