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026-1165-35-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No 567238 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: Oeverin , Kenneth J. &Am aro Richmond, Town of 026-1165-35-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: q?. F' 22.30.18.1301 TANK INFORMATION A ELEVATION DATA TYPE MANUFACTURER t� CAPACITY STATION BS HI FS ELEV. Septic =.,� , Z Z Benchmark t v / cad F.t �c,� �• �.+• Dosing ! Alt. BM J 7 / Ao;aWA Bldg.Sewer 1 Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION �. 9 TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt Inlet /2-to V. g 0 Septic 7,;S / 76 Dt Bottom 16.4 Dosing g /aZ C, C 1 � Header/Man. C.D c7 t! � Aeration Dist. Pipe- Holding Bot.System 7.O PUMP/SIPHON INFORMATION Final Grade .3•L 16z 7— Manufacturer ^ f Demand St Cover GPM C 4- ' Model Number TDH Lift Friction Lois ,/ System}ieap[ TD bo- t-e I /� Forcemain Length` Dia. // Dist.to WelIl 02— SOIL ABSORPTION SYSTEM BED/TRENCH Width Length INo.OfTrencahe4 I PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS Z � /+yt,G %--SETBACK SYSTEM TO !' P/L BLDG/d WELL LAKE/STREAM LEACHING Manufacturer INFORMATION Type Of System: / t CHAMBER OR �A�C ••Q l 1 �1 `7L 4— MC% Numb r: �,/ �1A1 e C-M4 54—c • DISTRIBUTION SYSTEM = pj-:s Header/Manifold Distribution x Hole e x Hole Spacing Ven o Air Int Pipes) �i �- � ✓Length_Dia Length Dia pacing 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 Q� Bed/Trench Edges �_ Topsoil Yes ❑ No es 1 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1467 129th Street New Richmond,WI 54017(NE 1/4 SE 1/4 22 T30N R18W) Lundy Meadows Lot 35 Parcel No: 22.30.18.1301 1.)Alt BM Description 2.)Bldg sewer length= l/ -amount of cover= i � • "' �� Q/� IV Plan revision Required? [ Yes o I (� Use other side for additional information. Date jInsepctoess nature Cert.No. SBD-6710(R.3/97) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: $ - INSPECTION REPORT ry 567238 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: Oeverin , Kenneth J. &Am aro Richmond, Town of 026-1165-35-000 CST BM Elev: Insp.BM Elev: BM Description: 0 Section/Town/Range/Map No: V40 0ja.+i o--*N- 22.30.18.1301 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER/) CAPACITY STATION BS HI FS ELEV. KtMf Septic A- Benchmark Alt.BM Aeration Idg. Sewer O Holding S Ht Inlet i �1 1 /Ht Outlet �� TANK SETBACK INFORMATIO TANK TO P/L WELL BL ent Air Intake ROAD Dt Inlet \ s Septic 3(e 7.3a — Dt Bottom \ Dosing /v Header/Man. g. 7 93\ 2 Aeration Dist.Pipe C/ • 3 r. '1 931Z Holding - - — Bot.System 4• Y ;Z 4 9 .9 7Z- Final Grade '/ Z PUMP/SIPHON INFORMATION 3 .'t Fqg �v Manufacturer Demand St Cover Model Number Q TDH IL" Friction Loss System Head TDH --lit- yf 7 1 Forcemain Length 17' .to Well C jeV SOIL ABSORPTION SYSTEM BED/TRENCH Width ) Length No.Of Trenches IMEN o.Of Pits Inside Dia. Liquid Depth DIMENSIONS IS Z �n�^�" SETBACK SYSTEM TO P/L BLDGG WELL LAKE/STREAM LEACHING Manufactur : INFORMATION Type f System: A///j/ CHAMBER OR ,` � /V I� Model Number,r— /J DISTRIBUTION SYSTEM So �� �� O Header/Man f Distribution x Hole Size x Hole Spacing Vent to Air ntake Length Dia_Z Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over IDepth'Over xx Depth of` xx Seeded/Sodded xx Mulched Bed/Trench Center r-��L Bed Trench Edges \ Topsoil ` Yes No Yes [E No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#`1: / / Inspection#2: Location: 1467 129th Street ee't New Richmond,WI 54017(NE 1/4 SE 1/4 22 T300N R1 8W) Lundy Meadows L.of 35 Parcel No: 22.30.18.1301 1.)Alt BM Description= �0✓w A- 2.)Bldg sewer length= 3 -amount of cover= '/ (►n .7 ow, Plan revision Required? Yes No Use other side for additional information. SBD-6710(R.3/97) Date InsepYdCs re ' [,� / Cert.No. J PLOT PLAN PROJECT Andrew Solomon ADDRESS 1467 129th St. New Richmond Wi 54017 N 1/2 SE 1/4S 22 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 7/2/14 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 60 IL BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATI ' ELEVATION too Filter BEAR Filter ❑ BOREHOLE Q WELL H.R.P. Same as Benchmark All piping sh all be SDR 30/34,with in 10' SYSTEM ELEVATION 88.5/88.1/87.7 5.5 below grade of tank,piping shall be Schedule 40. Scale is P = 40' * Alt.B.M. unless otherwise B.M. noted 170' 326' Property Line 20' Vents 3-3' X 82' B-1 Cells with>3' spacing 30' B-3 3 5% Slope >50' 15 Well -2 30' 94' 92' 0' 90' ST Vent 59 >6„ Quick St and Highw y 65 DT Leachi C ber of Cover with 20 f Area 297 5�ft^2/ it nd caps ' Long 4 2- 337' Property Line 3 4„ Grade t S e evation 1 ' �,. ZJ Wastewater - i . : a SEN-40 Series 4/10 hp Submersible Effluent Pump, 3/4" Solids Construction Flow-Liters/Minute 0 50 100 150 200 250 300 Cover Epoxy-coated cast iron 35 11 -' t ' Motor Housing Epoxycoatedcast iron 10 - ... 30 9 Impeller Material Thermoplastic Elastomer 25 s Impeller Ty" Non-clog x y .... ,.n. mz .. 7 LL 20 6 Volute Epoxy-coated cast iron 0 1 s 5 Power Cords n , S�T1N o �._ i 4 = Mechanical Shaft Nitrile with carbon and 10 3 Seal ceramic faces 5 2 `'Fasteners' tainless 'teel � " 0 0 Shaft Steel 0 20 40 60 80 vg"'z ' p'perslnt�ered sleeve' Flow-Gallons/Minute Bearings p . anc�iower ball bearing 9.80' �--4.88---� 0 + 9.15 8.15' 1 6.80` 6.96' �-4.63' 9.60' SEN-40-AF SEN-40 Specifications fib SEN-40 509211 4/10 115 1-1/2" FNPT 9/920 80 70 60 45 25 32 14 20 26.5 1750 SEN-40 509212 4/10 115 1-1/2" FNPT 9/920 80 70 60 ; 45 25 32 , . '14,' ,30' 27.5 1750 SEN-40-AF 509213 4/10 115 1-1/2" FNPT 9/920 80 70 60 45 25 32 14 20 27.5 1750 SEN-40-AF 509214 4/10 115 1-1/2" FNPT 9/920 80 70 60 45 25 32 r A4,, ;"30; .28.5 1750 Franklin Electric 400 East Spring Street,Bluffton,IN 46714 Tel:260.824.2900•Fax:260.824.2909 Form:996199 7-11 www.franklin-electric.com cowly Safety and BLAWIngs Division 201 W.Washington Ave.,P.O.Box 7162 samftery Permit Nmmber(to be fiDed in by Co.) 03`�d Madison,Wi 53707-7162 G00 0011 5lD z J ermit Applic StMTrxnswtionNva*w In accords=wide SPS 3 is.Adm.Code,sutmrssian of this fom to the a,ppropriaeo governnarW remit /VA- is remmired prior to smrxy permit. Nate:Application forms for sbte-ov n POWYS are nbmitted to Project Address Cif diflereat thm uwhng address) the Depwtmaot of Safety and Profaasienal Servies. PersaW information you provide may be axed for secondary pupows in accordance with the Law,s.15. 1 m Stets. 5 C_ti'`'V /2 / /oGl L n Information—Plem Print All rnation e�L Property Owner's Name Parcel# Property Owner's MWing Address Loondon !Lt 6 .�� � (v� 1361 City.staoe Zip Code Phone Number yes.(Sex b.2 M-4401 w T-30 N; ��E II.Type of BuBding(check all that apply) Lot# �, 2 Family Dwelling—Number of Bedrooms 3 J Block L Nae 11 PublioComera D — w a ❑City of 6r► ►` ❑State Owned—Describe Use 6,y`j CSM Numbs ❑Village of i of IH.Type of Permit: (Cheek only one box on line A. Co Ike lies B If applicable) `, system ',Roplaoomeot Sysmm ❑TratmeatlHoldiog Tank Reptwc Only ❑Other Momcab'oe to Exiatmg System(explain) B. ❑Permit RtmmW APcrout Revision ❑ J at Previous Permit Number and Dale Issued Chaagc of Phtotber Permit Transfer to New Before Expiry ion .— — — t'I IV. of PO%"M on neaViWee: Cheek a0 that �" ou-Pressnriaed In-Grand ❑Prasmuiaed In-Oramd ❑At 4.& ❑Noncan>24 m of sohabie sort ❑Moond<24 in of suimble soil ❑Holding Torok ❑Otbar Dapemt Componetrt(evi m) ❑Preircutonat Device(explain) v we V.Din UI Area Iaforumdoo• Design Flow WdQj Design soil Application Dispersal Area Repaired(A) Dr Area Proposed(so S3%=lavv VL Taukldo Capecity in Total #of MammScbaer � (canons Gallons Units HIewiadra Taola �E a � vBi at�7 8 sopw-or Hamm aTorok f Deeinpe7rom a 7 I VII State$ 1,the andeawigaed, for iamataiatloa of the POWYS a►owa ua ffie atrb>e�piaaa< Plaember's Name ) MP/MPRS Number Business Phone Nrapba�/qZ46?or)'5A'A� -6) /v I Moro 's Addteas(Sheet,City,State,Zip e 3Z—VIII.Co est Use only If B- PunlitFee Date Issuing signature 31� ' am Reason fiocr . I IX.Co s for Disapproval ff t. Septic tank,effluent filter and 3) dispersal cell must all gala i to intaiet (J /�, ( _ n a( /��� - i as per management nt plan prpvided by.pl �.�cr , /;J} 50-& 1 2 All sg .requirorpantaMotlt11i1iM ► J as per spy tom/oMlf>tno� , p l` 0 MUM&to aaplose picas tor'eke syssear and nbmk to are Cows only er Popw ON tea dM a m x 11 iwbes is sae SBD-6398(R.11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/2/14 Owner: Andrew Solomon Location: N1/2 SE1/4 S22 T30 N,R18W 1467 129th St. Richmond System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tank Cross Section 9. Pump Curve 10.-12. Soil Test Signature ///7 License number#W6900 PLOT PLAN PROJECT Andrew Solomon ADDRESS 1467 129th St. New Richmond Wi 54017 N 4/2 SE 1/4S 22 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 7/2/14 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 60 , BENCHMARK V.R.P. Top of survey iron 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 88.5/88.1/87.7 5.5' below qrade of tank,piping shall be Schedule 40. Scale is 1" = 40' * Alt. B.M. unless otherwise B.M. noted 170' 326' Property Line 20' Vents 3-3' X 82' B-1 Cells with>3' spacing 3 0' 3 B-3 5% r Slope >50' 15' 30' Well -2 94' 92' 0, 90' I ST Vent 51 >6» Quick4 Standard Highw y 65 DT of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5 Vt^2/pair of end caps 4' Long 1. 337' Property Line 34„ Grade at System Elevation .Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 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 93.5' Grade Len 4" 4' X30/34 Septic Tank .1vent 5' 4' Lon3 4" Grade at System Elevation 3 4rade at System Elevation Spacing 5' 3-3' X 82' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A-88.5' B 88.1 ' 20 chambers per cell C-87.7' ST. CROI K COUNTY SEPTIC TANK MAINTENANCE.AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer--14 S Q t 1) •rw Mailing Address_ `� 03 12,`t 61 f y Q')- J � ) It o v' Property Address J (Verification required from Planning&Zoning Department for new construction.) ' City/State Parcel Identification Number LEGAL DESCRIPTION Property Location 1/ , 5 '/a , Sec.2 Z- , T 3'ON R1�W, Town of _ Subdivision /-u �L _ ,Lot# Certified Survey Map# ,Volume ,Page# Warranty Deed# , Volume ,Page# Spec house yes Lot line., identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION improper use and maintenance of your septic system could result in its premature faihae 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 wasir.disposal system Owner maintenance 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 Planning&Zon:mg Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less dean 1/3 full of sludge. Uwe,the undersigned have road the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on dyt form are truc to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a 7inty deed recorded in Register of Deeds Office. Number of bedrooms -3a/IV t 7- SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being ri voked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Fj� Tank Manufacturer. /f ❑ NA Permit# ptic ❑ Dose ❑ Hoiding Voiume:/,2,j 1'__(gad) DESIGN PARAMETERS Tank Manufacturer: [I NA Number of Bedrooms: ❑ NA Septic ❑Dose ❑ Holding Volume: 76 j (gal) Number of Public Facility Units: Vertical Distance Tank Bottom(s)to Service Pad: Estimated(average)Flow: (gavday) Horizontal Distance Tank(s)to Service Pad: 6 (ft) Design k Flow= estimated x 1.5: sing mechanics must be provided if vertical Is>15 feet or 9 (P88 ) ( ) (gs aY) ti horizontal is>150 feet. Specific instructions to be provided on back. In Situ Sod Application Rate: 6V (gaifday/ftz) Effluent Fitter Manufacturer: ,-'e, ❑ NA Standard(Domestic)influent/Effluent Monthly average.. Effluent Filter Model: Fats,Oil&Grease (FOG) s30-mg/L Ptanp Manufacturer: P Biochemical Oxygen Demand (SODS) s220 mg/L ❑ NA ❑NA Total ded Solids( Ss 'also Pump Model: . High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg1L Manufacturer. MODS) >220 mglL Q SS >150 m ❑Mechanical Aeration ❑Peat Filter Pretreated Effluent Month averse ❑bisirtlGra n ❑Wetland IY 9 ❑Sand/Gravel Filter ❑Other. (BODs) s30 mg/L Soil Absorption System Fecal Colitorm eometric mean) 5W- NA round(gravity) ❑in-Ground(pressure) ❑ NA Meximrun Effluent Partide Size 36 in dia. ❑ Nq ❑At-Grade ❑Mound [3 Drip-Une ❑Other. Other: Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) hen combined sludge and scram equals one-third N of tank volume ❑When the high water alarm is activated Inspect condition of tank(s) -At least once every: month(s) (Maximum 3 years) ❑ NA s) Inspect dispersal cell(s) At least once every: 3 month(s) (Maximm u 3 years) ❑ NA Clean effluent fitter At least once every: month(s) ❑NA year(s) Inspect pump,Pump controls&alarm At least once'every. .Eh(s) ❑NA Flush laterals and pressure test 'At least once every:. ❑m(s)s) NA Other: ❑month(s) At least once every: ❑ s) NA Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an Individual tarrying one of the following Iloenses or cerdflcadons: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware,Identify any tracks or leaks, measure the volume of combined sludge and iicum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 treatment tank equals one-third(%)or more of the tank volume,the entire contents or the tank shall be removed by a Septage Servicing Operator(pumper)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<_12 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005(02105) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process-and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s)removed�,y a Septage Servicing Operator(Pumper)Prior to use. Pump tanks may fell above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended,as the excess wastewater will be-,ctscharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent.and damage'to the system. To avoid this�oo a �r contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to the pump or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when sod conditions are frozen at the Infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not.drive or park over, or otherwise disturb or compact, the are@ 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 fife of the treatment tanks and soil absorption system: adds, antibiotics, baby wipes,-dgarette"buutts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) is"rge,fruit;Ad vegetable peelings, gasoline, greases, herbicides, meat scraps,medications,oils,painting products,Pesticides,swillIqy napkins,solvents,tampons,*end water softener brine discharge. - 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 property and safely abandoned in oxmpdanoe with s.Comm 83.33,Wisconsin Ai*>ihl*vtive Code': • All piping to tanks,pits and other soil absorption systems shad be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shell be removed and properly disposed of by a Septage Servicing Operator(Pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with sod, 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resat ❑ 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(folding 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.biornat at the infikrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, .PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Namj Name j Phone J o? Phone �.—p? —i•f SEPTAGE SERVICING OPERAT PUMPER LOCAL REGULATORY AUTHORITY Name U"' Name Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory egencies in compliance with secdons Comm 83.22(2)(b)(1xd)3(f)and 83.54(1),(2)8(3),Wisconsin Administrative Code. oiv r � F LTER A a: , CARTRIDGE INSTRUCTIONS _nstaNation STEP 3 Dry ft the taker tats seta the"a of ire nutlet pipe to ensure it is centered under the atom opo ft. 0 POk than dthnr I tm t mops pips bete the tank through the outlet or solvent weld(ghee)adANO W plpe onto the outlet pipe. STEP 2 While the Can is sir dry litlid on the outlet pipe,measure the length of NA-Inch pipe needed to brace the Okay to the tank end vial if utNtsing the OPUNW=*Plamental We won't+If lids 1%*Port method.IS not ud mod, protesd to step%= "t 7 F.P 3 For krsI 1 11,ns utllMng the optional sq*kwwnW side support: solvent weld the%finch pipe onto the fist•case. N side support mtthod is not Utilized,proceed to step four. Solvent weld the lNter case onto the outlet t't Cartridge into the op, r 6c Insert the ott r pressing down until the liner locks Into the battorrt of rti X the ease. ':.c • :y t .1.�,� If a VRS switch is utilised:insert into the Mier and rock by tuning . clodmise w. Nan mane 1, The effluent After should be cManed ovary time the septic tank is serviced. 2. open the outlet access opening to inspect the tank and inlet 9• Purrtp the septic tank cerrgdst*,making sure to remove the sludge " layer an the bottom of the tank and not just the scum and effluent. 4. Once the effkhart level has beery lowered balm the invert of the ` Barb t P", m fkmly the cell up on the finer handle to dislodge tin S. Slide the cartridge up and out of the ass for cleaning. 6. Y a VRS swdtdh connectedd Wan Warm bspr�esye_nt,the switch should be removed by tor"�t�,+odmise W and clasned with water only. 7. While holdkrg the cwtridge an its"(tarp!flat surface facing e , dwn)over the access epWd ft rteste of the cartridge With weber i o+d1l.+rrakdni sure as 300410'ngRerted is rinsed bad*into the tarok. . 'e !L If VRS switch is utifted, replace by utsartirp into tester and tra7drrg dodcwis!90•. Insert the RRW arVklp bad*Into the case S. the ter locks into the •pf°celo4 down until r • a' 10.Replan*and so*"the access aPOft on to tonic. -� WWWAbOW 5a lr•.:h�^:"+7t'!S:�1f�d:7!(e� vl�'E-•'1 C,.:trMt•(.L'A'AkM.7.Y". •-t• 1'• 1. .. ...yC•..M •+'••r if• � • i ftAM;l 0/7-MLRUMRS iW 6S3( -4583)) Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Minimum Pump Performance R: ired Tank Model Number Z i7 GPM @ Ft TDH Total Tank Capacity -Z tQ Marc.Bury Depth 2 ,,- Total Dynamic Head(TDH)••Feet Pump Manufacturer mac/ Elevation Head l Pump Model Number a "i- s3 Distal Pressure Alarm Manufacturer (/ Network Pressure Loss '—'- Alarm Model Number v Force Main Pressure Loss i Switch Type e-Cjy j r, Total .140, Manhole Min.4"Above Grade vt� With l..ockuig Device Vent Min. IT' Weather-proof Above Grade. With Cap Junction Box �- - Finished Grade — -� -- �' " -• Depth of Cover Ft Disconnect Means I Outlet Switch Settings and Reserve Capacity __In Tank Volume GPI t t '< Dimension Inches Volume Gal. A '< ;a (reserve)A a Y-P > (alarm) B 2 -:5 B Weep < t Hole (dose) C f Off Elev. , >< >< (dead) D `f l j 3 � q,;Ft >t , s Total ' yt , < Bottom of Tank Elev. 7 r Ft D ; GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material,connected to the tank with watertight fittings,and laid on stable soil to prevent settling;or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight..Electrical service complies with NEC 300 and Comm 16.28 Wis.Adm. Code. 03/051gj Page of N TOTAL DYNAMIC HEAD/CAPACITY w w HEAD CAPACITY CURVE PER MINUTE LLJ g MODELS 53/55/57/59 EFFLUENT AND DEWATERING 25• Model 53/55/57/59 6 20 Ft. Meters Gal. Ltrs. 0 5 1.5 43 163 15 1.0 3.1 34 29 z 4 15 4.6 19 72 r 0 10 Shut—off Hecd 19.25 ft. (5.9m) ,I 0 2 5 �l 3 15/16 6 5/32 —► a 5/8 1 112 —11 /2 NPT 0 U.S. GALLONS 10 20 30 40 50 3 15/16 LITERS 80 160 FLOW PER MINUTE oosee7 4 1/16 CONSULT FACTORY FOR SPECIAL APPLICATIONS * Variable level float switches available. *Variable level long cycle systems available. T Available with special cord lengths of 15',25', 35' and 50'. * Alarm systems available. 10 Duplex systems available. I 3 3/32 Skase smo i � I seat can" selecaon SELECTION GUIDE Model Volts phm SAuto R9. Duplex csA uL 1. Integral float operated mechanical switch,no external control required. M53/55&M57159 115 1 1 -- Y Y 2. Single piggybackwariabte level float switch or double piggyback variable level N53/55& /59 11 1 2 3 or 4&5 Y Y float switchRater to FM0477. BN53 115 1 Y Y 3, Mechanical alternator"%Pale 10-0072 or 10-0075. BN57 115 1 _ Y Y 4. See FMO712 for correct model of Electrical Atemator. •BE53/57 230 1 Auto 'MS&D57�s9 230 1 Auto 4 8 1 -- Y Y 5. variabl8 level control Switch 10-0225 used as a control activator,with Electrical E5N%&E57/59 1 230 1 Mon 43 2 3 or 4&5 1 Y t.Y Alternator(3)or(4)float system. •Single piggyback switch induded. For information on additional Zoeller products refer to catalog onPiggt'bedc variable Level AM switches,FM0477; Ali ins+w;aticn of controls,protection devices and wiring should be cc ne by s qua lified Electrical Alternator.FM0498;Mechanical Alternator FM0495;Sump/Sewage Basins,FM0487;and single phase licensed electrician.All electrical and safety codes should be followed a cl ud'+ng the most Simplex Pump ControltAlarm Systems,FM0732. revert Nationai Eteetric Code tN,ECj and the Occupational Safety and H ai_n Act(OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O.BO Loulsvdle,KY 40250 Manufacturers of-- SHfP TO:3649 Cane Run Road w r t 0 LwsWle,KY 40211.1961 �)Uaww sny/fff ® (502)778-2731"1(800)928-PUMP http:/nvwwso flsr corn �L✓/Y/� L O FAX(502)774-3624 --------—--- ®Copyright 2002 Zoeller Co.All rights reserved. Illlllllllilll 111111 Ilflllll 1 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-2003 8 2 2 0 0 1 6 WARRANTY DEED TX:4180525 994055 BETH PABST THIS DEED,made between Oevering Homes LLC,a Wisconsin limited REGISTER OF DEEDS liability company("Grantor"whether one or more)conveys and warrants to ST. CROIX CO., WI Andrew G.Solomon and Regina A.Solomon,husband and wife as 03/27/2014 11:52 AM survivorship marital property("Grantee",whether one or more),the following described real estate in ST CROIX County,State of Wisconsin: EXEMPT#: NA REC FEE: 30.00 Lot 35,Plat of Lundy Meadows in the Town of Richmond,St.Croix County, TRANS FEE: 807.00 Wisconsin. PAGES: 1 RETURN TO St.Croix County Abstract&Title Co.Inc. 219 S.Knowles Avenue New Richmond,WI 54017 Tax Parcel No: 026-1165-35-000 This is not homestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them,recorded easements for the distribution of utility and municipal services,recorded building and use restrictions and covenants,and further except 2014 real estate taxes. Dated this 25th day of March,2014. Oeverin s LLC,a Wisconsin limited liability company By: Oranzo J.Oevering,member AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 20 ss. COUNTY OF �G V2(�C * TITLE:MEMBER STATE BAR OF WISCONSIN Personally came before me this 25th day of March,2014,the above (If not, named Oevering Homes LLC,a Wisconsin limited liability authorized by§ 706.06,Wis.Slats.) company by Oranzo J.Oevering its member,to me known to be the person(s)who executed the foregoing instrument and acknowledge the same. �f` THIS INSTRUMENT WAS DRAFFED BY Oranzo J.Oevering/Oevering Homes LLC * IA L L ' IL( yIA-S ) Ll Notary Public County,Wis.,,..-l'"' I 1316685/asc 's , My Commission is permanent. '�'. "'•.,rJ� (Signatures may be authenticated or acknowledged. Both are If not,state expiration date: -TA R Y�'•• -- not necessary.) 'Names of persons signing in any capacity should be typed or printed below their signatures. e WA RAN DEED Form No.1-2003 St.�rolx'�ounty 994055 Page 1 of 1 f�,� County / r r .y. • Industry Services Division r�t.Cc / , i i•d � 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) - P.O. Box 7162 ', ; r , Madison,WI 53707-7162 �j b73$ Pc,,ir anitary Permit Application State Transaction Number In accordance wit SPS 383.21(2),Wis.Adm.Code,submission of this form to the approrkifte pzovernmen O grit / r is required prior to obtaining a sanitary permit. Noce:Application forms for state-owned POWTS ate submittlq. Project Address(if different than mai'ng address) the Department of Safety and Professional Servies. Personal information you provideAnpy be use for,second trq purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. t%4 ��i rf V/ / • I. A.1 lication information-Please Print All info l at';� '•, f t7 ((��`` " Property Owner's Name © &/P Parcel# Property Owner's Mailing Address / ,f�' Property Location /vJ 3 (C`riDl�e4i9 vv c5.-,f 1i Govt.Lot ���`�� City,State a Zip Code Phone Number /- y,,`W 4 Section Z II.Type of Building(check all that apply) Lot# R } or _Cr2.Family Dwelling-Number of Bedrooms 3 Subdivision Nam OK. o4 '' ._ Block l�CLI „/0 ❑Public/Commercial-Describe Use ��11 t �fGvV:oJ'S (ev(sl Dom• ❑City of ❑State Ownned-Describe Use I CSM Number ❑Village of 3 O CeL5 ,✓/ 20 G�t,,�locr.� Caqt . Cwn of i11.Type of Permit: (Check only dhe box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑ Permit Renewal A rmit Revision ' ' '❑Change of Plumber ❑Permit Transfer to New t r List Previous Permit Number and Date Issued Before Expiration /vim<r� ei ' - Owner J v7-1 2 3X //Z 1/13 IV. ype of POWTS System/Component/De ice: (Check all that apply) on Pressurized in-Ground ❑ Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil`D Yi rNT�y ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) L Cl..,..ler V.Dispersal/Treat ent Area Information: ' 4 Desi low(gpd) Design Soil Rate(gpds/ Dispersal Area Required(sf) Dispersal Area Proposed(sf)�Syste levatio Vi.Tank Info Capacity in Total #of Manufacturer Y , Gallons ' Gallons Units „ o'4 ez.New Tanks Existing Tanks ' I L A.. �� d o B 2 8 .8�a 2 Septic or Holding Tank / yp+r /• / 1 Dosing Chamber /"� �J / VII.Responsibility Statement- I,the undersigned,assume res; , ity for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Si?, MP/MPRS Number Business Phone Number r —534 te A(.../ ./''',te-e .../ 215%en Plumber's A dress(Street,City,State,Zip Code) ��- .-,,2 7 # -I r- ,1. /7 / A > / Vl�unty/Department Use Only pproved ' pproved PerQmit Fee Date sued issuing ent Signature / ❑ • en Reason for Denial '$ 'V S' '241 7 13 IX.Conditions of Approval/Reasons for Disapproval A R Qevt/iI�` �Q cs t ili a / 1,, ./6-1241 3' /� Qe �, ('a- s�. ►��.� 1. Septic tank,effluent filter and 3> J ` dispersal cell must ail be services/maintainer( \_ JeI".........J 1-- % .as per management plan provided by plug. n. -C)`''.)"`'�'� w` �'1 2 AU se a c k m i e d i e W 1 p a 1 1 1 h> 1i1$�r d submit to the County only on paper not less than 8 112 x I I inches in size toper applicable aide f Ordinance* SBD-6398(R0313) PLOT PLAN PROJECT Ken Oeverina ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/2 SE 1/4S 22 /T 30 /6,/R 18 TOWN Richmond COUNTY ST.CROIX �- MPRS Shaun Bird 226900 1 DATE 12/5/13 BEDROOM 4 CONVENTIONAL XXX IN-GRODUF I/ RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 60 ■ BENCHMARK V.R.P. Top of foundation ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Alt. BM Top of 2" Pipe @ 100.2' SYSTEM ELEVATION 92.3/92.2/92.1 All piping shall be SDR 30/34,within 10' .M.EI IA of tank,piping shall be Schedule 40. 170' 326' Property Line A Scale is 1" = 40' Went unless otherwise >6,, Quick4 Standard noted of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 34" Grade at System Elevation Pro 4 Bedroom House drainage A B.M.* easemen 3-3' X 82' Cells with B- ..9: 35' >3' spacing �►1 B-2 10' �� 90' ' 15' 1 in 0 � 25'i 50' Vents m 10' .1 B-1 10' 337' Property Line Wisconsin Department of Commerce SOIL``EVAI1UATION REPORT Page of Division of Safety and Buildings / P �,. / in rdance with COinrp 85 Wis kdint. Code County Attach complete site pl r on Oa¢er+ ess than 8 1/2 x 11 inches in size:Ri must t' _ include,but not limite¢to:.yeitica d horizontal reference point(BM),direction and Parcel I.D. percent slope,scaler difne ns,north arrow,and location and distance to nearest road. 6 6 - II 4,c-3 - . Please print all information. Revie by / / Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). i I /2/10 Property Owner Property Location / KK / C"-, a e 0.e r;,, Govt.Loth 1/4,5 1/4 S ' T 0 N R j g E(ore Property Owner's Mailing Address Lot# Block# S . Na ' s •+M# �����ffffss ejpciiv /4? 2 Cer,.aA1 t - -- . i .3c — 4 c City State, Zip Code Phone Number ❑City ❑y�lage ! r Nearest Ro tZ►�,,tQ Ic t)� I /D1 71 ( ) _ �t.'c I /02 7r 5/- ,New Construction UseB,esidential/Number of bedrooms ! Code derived design flow rate ‘ifG GPD ❑Replacement Ap ❑ P lic r com ercial-Describe: Parent material 11 �r//� Flood Plain elevation if applicable w/ 14 ft. General comments and recommendations: System Type L�/Yt„/�j System Elevation "r� r •. _ �_ 1 Boring# Boring la Pit Ground surface elev.?3' ft. Depth to limiting factor /x2-0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 *Eff#2 ( e9-fg. �4 "3/Z. ---- 1- ,1-, �� - C - i 1 1 2 4 _____ c W —�. , 4( is � io�l� � ��t�' ,� �,� ! ✓ . J yo; 3 Yr�- /Oy, 1—r- it ),,. ,�'/ 1 ' wet /' 1 9-2 I iifd iii Boring# ❑ Boring /} '� Pit Ground surface elev.I 0 ft. Depth to limiting factor / 20 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 I te` o�/tAle- 4 /_f" - 6 ' 6' z- /6-Y7/Y�./y J -6k . , '1W i4 -� e / g2- 2" li 'Effluent#1 =BOO,>30<220 mg/L and TSS>30<150 'Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name(Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 1 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 /07.---c— / 3 715-246-4516 Property Owner_ Parcel ID# Page of Boring# k,Boring n 2 Pit Ground surface elev.f g- ft. Depth to limiting factor Il/' in. Soil Application Plate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft? in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 2 o- 7 / *-3/t-- - -' J ,97/1, -- It • 17CL. /are 3 .g-120 j4-ez • ry / 0 , 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/ff in. .Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 'Eff#2 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 •Effluent#1 =BOD5>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(8.6/00) County i ` fed z+ Industry Services Division (/0/x : ,, Si 1400 E Washington Ave Sani ry Permit Number(to be filled in by Co.) V 'p �l P.O, Box 7162 � �'l 'Q� \ , Madison,N/I 53707-7162 �/ �7 31 �i State TransactionN umber Sanrt. � '' " it pplication ,\// In accordance with SPS 383.21(2), .Code Ission of this form to the appropv( e)ggvemmentgj',fn,(t is required prior to obtaining a sani. rmi fe:Application forms for state-owned PO al submitt jitky Project Address(if different than mailing address) the Department of Safety and Profe !trial ervies. Personal information you provide racy be usSdfft s conda u ses in accordance with the Privac Law,s.15.04 1)m,Stets. / i/6- 1. Application Information-Please Print All Information ,Li/ i Property Owner's Name -,,C''G Parcel# e P 0 oe ei,,, p 26 - 3S-- 6 Property Owner's mailing Address / Property Location c / ,{ Pi i 3 Th et°0 Z-910U).c . /t r'�C.� S /9 Govt.Lot ( V C/iitty,State // Zip Code Phone Number N /�5'� /�, Section2 2._ /��.�.t J Ri J�" t�tJ ) ✓ )) Y ; R J irclE. II.Type of Building(check all that apply) G,� Lot# / )Sr o 2 Fa ily Dwelling-Number.f Bedrooms / E J---r Subdivision Name n� ✓/�///�/ � �q Of • 11 L� Block# Z �l // cceA7w—r.- ❑Public/Commercial-Describe;Ise ❑City of ❑State Owned-Describe UstC 1t-r •/ sr+ ,y 1 CSM Number ❑ Village of • I // su d own of III.Type of Permit: (Check only one box on line A. ompl te line B i 1 i e) A. w S stem ❑ Replacement System p y ❑ eatm t/H in n eplacement Only ❑Other Modification to Existing System(explain) V fro B. ❑ Permit Renewal ermit Revision i List Previous Permit Number and Date!mu Before Expiration ' O � '❑Chan.• .f P tuber ❑ er to New la :3S 3 g - �V/Z 23/3 IV.Type of POWTS System/Component/Device: (Check all ' ,t apply) X-Ikoi-Pressurized In-Ground ❑ Pressurized In-Ground ❑At-Grade ❑ Mound> • in.of suitable soil ❑ Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) n V.Dispersal/Treatment Area Information: r"7i� f�P/cx.t� /Y.�il -- Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Ejev ion � .6 , .s-- V /moo / / v 1 g8, 87, g ; VI.Tank Info Capacity in Total #of Manufacturer 0 Gallons ' Gallons Units /�, Q s1.1--e- to New Tanks Existing Tanks '� c ;, .2 2 777��/ a.U r' ' vn w t.7 a Septic or Holding Tank Dosing Chamber • , VII.Responsibility Statement- ,the undersigned,assume °nsibility for installation of the POWTS shown on the attached plans. Plumbe's Name(Print) Plumber'- 'ol"ture MP/MPRS Number Business Phone Number ri,e.- f2✓` ,�2 0.1 7.1)'—pZY� 67i Plumber's Address(Street,City, te,Zip Code/� 3 2— 1 20 t (57/. /L47,t J1,1 /Z 'Cie C ( ,) ‘-- >4N 7 VIII ounty/Department Use Only • Approved ❑ Disapproved Permit Fee 00 Date Issued I .uing Agent.ignat _ ❑Owner Given Reason for Denial I /2IJ;3 / / a L J/t/V IX.C nditions of Approval/Reasons for Disapproval' ,` 43 �f Q/2- vv •• Q tJ Attach to complete plans.for the system and submit to the County only on paper not less than 8 1/2 x 11 inches i si 4 _ SBD-6398(R0313) PLOT ' AN PROJECT Ken Oeverina AD r t ss 1433 Cernohous Ave Suite A New Richmond Wi 54017 N 1/2 SE 1/4S 22 /T 30 N/R / W 'OWN Richmond COUNTY ST.CROIX Al S Shaun Bird 226900 ///f DATE 11/21/13 BEDROOM 4 CONVENTIONAL XXX IN-GROUND P' " :/RE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZ 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 60 ■ BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Alt. BM Top of 2" Pipe @ 100.2' SYSTEM ELEVATION 88.1/87.8787.5 5.5' below grade All piping shall be SDR 30/34,within 10' .m.a ?iA of tank,piping shall be Schedule 40. 170' 326' Property Line B-1 20' Vent '" 3-3' X 82' Cells >6" LQuick4 Standard with>3' spacing of Cover Leaching Chamber 31 with 20.0 ft2 of Area B-3 .6ft^2/pair of end caps ` 4' Long Scale is 1" = 40' 34" Grade at System Elevation ` unless otherwise Slope oted Pro 40' Be ro _ 15' Vents 94' House .4_40. ST /255 9� �G ddrtio ra e wf done if needed for s it ',2i 2 replacement area 05. gi 1 337' Property Line v� vt - County ���_ �_-__. ��' �' X Industry Services Division �S r (a wU. c' '1400 E Washin• - Ave Sanitary Pen tanketoe filled ii by Co.) }., ti wr P.O. Box . S di. ? ,�_ ',I IVladison,WI 53 . — ■ S J `7 2 3 ' � Sp '7 J U Sanitary Permit Applicatro I' State Transaction Number In accordance with SI'S 383.21(2),Wis.Adm.Code,submission of this form to the appT $j . en. unit /1)14— is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POW IS a itte to Project Address(if different than maili ig address) the Department of Safety and Professional Servies. Personal information you utbrittic ply be used for secondary -i'>` �• purposes in accordance with the Privacy Law,S. 15.04(l)(m),Suits. _ f,i 9 I ' / I. Application Information-Please Print All Inl'ormatit _ --U, -y lease Owner's Name -- — Parcel N __.. --.-- - --__-- "c ,,,e c 4 � n/ �6°vr�i _ D021---// .1---- 3� - 64(''' Property Owner's Mailing Address/ I / — Property Location (1 CO 11) `?-3 c to.-,720 �1 - �' __ _ Go L t City,State Zip Code Phone Number d./A- /,, s etion Z2-- A` --)P I'd.400..1)-• — '' _2__ I le on Q___iv; le - L'ttf W II.Type of Building(check all that apply Lot 1f^— --- — \`/ E or Family Dwelling-Number ofBeddrLror Subdivision Name ❑Public/Commercial-Describe Use _ City of _ ❑State Owned--Describe Use CSM Number U Vi age of Z3+Z3 CIA., • Town of j_-.l_. III,Type of Permit: (Check only one bo on line A. Complete line B if applicable) A' New System ❑ Replacement System ❑"treatment/I lolding Tank Replac rient 0 ily ', uth odi" • n to tng Systi n(explain) B. ❑ Permit Renewal ❑ Permit Revision ❑Chan e of Plu r t List ous Permit Number and Date slued g L Per it ransfer t New Before Expiration O ,r i ZA hl/ � r �. .._ IV.Type ot'POV4'TS System/Componcnt/Deyice�hccl t •t _ — � � /vim as _ on-Pressurized In-Ground ❑ Pressurized In-Grant. ■ , -C ra i,, (I Mow -;Ain of suitable soil L) Mound<24 in of suitable soil U Pretreatment Device(explain) V. Dis persal/Treati nt Area Information: ( P A _ _ Ito rn Tank Other Dispersal Component ex tai Design Flow(gpd) Design Soil Application Rat pds • spersal Area Required .f)- Dispersal Arm Proposed(sf) System Lle ati t - VI.Tank Info Capacity in Total 4 of Maiufacturer Gallons Gallons Units 1 a' o '� 0 New Tanks Existing Tanks ' / l n �' `r', �Y 3 ems, r Ci i1' E. - Septic or Holding Tank Dosing Chamber VII.Responsibility State_m_ent- I, e undersigned,assume . onsibility for installation of the POINT S shown on the attached plans. _ _ _ Plumber' Name(Print) —_ Plumber' .'_•'elate MP/MPRS Number Business Phone N nn�berer �40---'1 , i h----— — --- �Ct Z7 /J�02 /��� Plumber's Address(Street,City,State,Zip Code) ZY3__Z-_-- /Z0 ''t 574 . /1/&-e-Y f '' / I hti KW 7 VII1,County/Department Use Only — _ Approved i rsapprived Permit Fee Date Is red Issuing'. t Signature -/ Ow. en Reason for Denial ('7 - Da /21 z3 4.3 ' IX. Condit' easons for Disapproval D��1 ©e _1 p'0,A: -� Ae .J V�o�i+ ' 1il8�il i�: JJ p ttfo - 1 Septic tank,effluent filter and dispersal cell must all be services/maintained W I t'1^- 4-12A./e;) G 4 0 Q 4`c..a.. f tiFa r o^n - per management plan ts provided by plumber. . .A e en must be taintained / e n com p e e nns o m 1/11 1/11 p r• a syste and submit to the County only paper not less t ta an a its x I I inches Sr.size SBD-6398(80313) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/22/13 Owner:Oevering Homes/Ken Oevering Location: S1/2 SE1/4 S22 T30 N,R18W Lot 35 Lundy Meadows Richmond 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 S8.-10. Soil Test Signature License number # 00 PLOT PLAN PROJECT Ken Oeverina ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 N 1/2 SE 1/4S 22 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/22/13 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 .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION loo' Filter BEAR Filter ❑BOREHOLE (DWELL *H.R.P. SameasBenchmark Alt. BM Top of 2" Pipe @ 100.2' SYSTEM ELEVATION 88.1/87.8' 5.5' below qrade All piping shall be SDR 30/34, within 10' Alt. B.M. of tank, piping shall be Schedule 40. B.M. 170' 326' Property Line B-1 20' Vent 2-3' X 94' Cells >6" Quick4 Standard with >3' spacing of Cover Leaching Chamber 30' with 20.0 ft2 of Area B-3 ong 12" 5.6ft^2/pair of end caps 359 Scale is 1" = 40' 4' L 34" Grade at System Elev Sion unless otherwise Slope oted -2 Pro 3 40' Bedroom 15 Vents 94' House ST 92' Highw, y 6 337' 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 , 5.6ft^2 pair of end plates To be >1 above grade Finish grade elevation Typical Installation 93.0' Vent Al Grade Vent 3' 4" 3' ,A/30/34 Septic Tank 5' Long 1 5' S' Long 1 3619 Grade at System Elevation Grade at System Elevation I I I I I i Spacing 5' 2-3' X 94' Cells Same on other end Observation tubeNent At end of cell A B 23 chambers per cell System elevations: A-88. 1' B 87.8' A SOIL EVALUATION REPORT Page~of Wisconsin Department of Commerce Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. U R ewe Date Please print all information. ~3 6 Personal information you provide may be used for secondary purposes (Privacy Law, s- 15.04 (1) (m)). Property Owner Property Location ~j ' Govt. Lot 1 / 1 /4 S T N R E (o W s / G.vJ Property Owners Mai ' Address Lot# Block # Subd. Name or M# City tate Zio Code Phone Number ❑ City ❑ Village Nearest Road New Construction Us • Residential / Number of bedroom Code derived design flow rate _ GPD ❑ Replacement Public or merGal - Describe: Parent material Flood Plain elevation if applicable lfie I L ft. General continents ~'J Q S~Q~ ~fi and recommendations: , ©i I Boring # Boring /~l Ground surface elevf ' ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 L 2 Boring # Boring Pit Ground surface elev~~" ft. Depth to limiting factor ~ in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 2 S C- q vas (i I f✓ g~ 1 3 0 I/ l~ 1 11~ r ! Z <11 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:5 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L CST Wants (Please Print) tur CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address 100, Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 -3 Property Owner _ Parcel ID # Page of 5_1 Boring # ❑ Boring surface elev. + Pit Ground - ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 3 C6 P 2 J` i C_ b~ u ~D r G of- ~ 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 '042 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 Effluent #1 = BOD; > 30:< 220 mglL and TSS >30 < 150 mgA. ` Effluent #2 = BOD3 < 30 mg& and TSS 130 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-9330 (8.6/00) Soil Test Plot P1 Project Name William Stock/Steve Dalton S ' aun Wrd Address 1748 112th St. New Richmond Wi 54017 7STM #226900 v Lot 35 Subdivision Lundy Meadows Date 8/11/03 N 1 /2 SE 1/4S 22 T 30 N/1318 W Township Richmond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 88.1/87.8 *HRPSame as Benchmark Alt. BM Top of 2" Pipe @ 100.2' M.E[SA ~k .M.g 170' 326' Property Line 20' B-1 30' 35' B-3 Please Note: Tested area may not be suitable for desired building area. Check system location 5% before excavating. Slope 0 Scale is 1" = 40' B-2 94' unless otherwise 92' noted Please note: Installer must verify all lot lines and setbacks before installation. tn o 3 x 337' Property Line POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner - - Septic Tank Capacity T -gal ❑ NA Permit# Septic Tank Manufacturer ? i ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer -0 NA Number of Bedrooms _ ❑ NA Effluent Filter Model - - - _ ! NA Number of Public Facility Units --NA Pump Tank Capacity al NA Estimated flow (average) al/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) J~ gal/day Pump Manufacturer - - NA Soli Application Rare . Pump Model NA aUda /ftz Standard Influent/Effluent Quality Monthly average" Pretreatmont Unit NA Fairs, Oil & Grease (FOG) 530 mg/L ❑ Sand/G•avel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mecharical Aeration ❑ Wetland Total Suspended Solids (TSS) 516O.mg/L ❑ Disinfection - ❑ Other: Pretreated Effluent Quality - Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :530 mg/I_ ❑ At-Grace ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/1 _ 1 ❑ Drip-Line- - ❑ Other: Maximum Effluent Particle Size in dia. ❑ NA Other: NA Other: - , A Other. ❑ NA `Values typical for domestic wastewater and septic tank effluent. Other: - _ - NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition ol'tank(s) At least once every: m ants'~s} (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-thi rd (3a) of tank volume ❑ NA Inspect dispersal cells At least once eve onth+sj (Maximum 3 years) El NA ❑ months s) Clean effluent fitter At least once every: s Z ear(s; G NA Inspect pump, pump controls & alarm At least once every: S) ❑ Year(s' NA , - - - Flush laterals and pressure test At least once every: ❑ monthls) NA 1 ❑ year(s) - Other: - At least once every: ❑ monthl s) 13 NA ❑ 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 cr--acks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent or the ground si+rface. 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 (6) 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, mechar ical 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 an%, service event. I Page w_„_, of START UP AND OPERATION For new construction, prior to use of the POWTS' check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or darrage the dispersal cell(s). If high concentrations are detected have the contents of the 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 ab3ve 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 tho pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWT:; 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 cabs. 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; condoins; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrape; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently baken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chaptiv Comm 83,33, Wisconsin Administrative Code: e 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 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. e replacement area should be proiected 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 9%milable due to setback and/or soil limitations. Baring 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 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. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following namoval 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 AND/OFI INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATIIAENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK 14AY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER - - Name gName COL Phone ~J ne SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name - /J2,..~.'~ Name t~ Phone Phone This document was drafted in compliance with chapter 8PS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3),1Msconsin Administrative Code. ILTER CARTRIDGE INSTRUCTIO NS s r op 't Ury [it the oft' cusp INN t6 OW iit tit* autj%c 044 1u wsrrr,wrYk it ix Cwhteir tow rurdier' tlws 14r wfi, uµrnirry. It o", Ow, vow Ii'ison town plod oity (hwr Uink HrYUugh itiaa o"Mat 4r• weir.®rwt wwd (91") adikdriiial pipat iodt, the itwiet Mile- :iYLtp a WhgA the A w 16 am dry 114 al on the otmut ldnu, M rr tbtw 6avilt ut *-Iowa plq r uwd~Y t4ibrsclu tike flaw to MW parnit wuI W" it t8lifikio tilp upLobi styra~~srn.nWlri eA6 UrrtwOWL•. IV wddwl a oovirt trwwathad Ir rrat trtlfized, ltrutallYd to A p ka* s t t Fw M t jutllf;riritl Oft ulrthrwri zalaakt Wald 1fa rNr-•haff ' #gWalwwewtarl skin ufidth f+ pdµu orrkwr thwx filEtr r,"&- -ft owe tiwlpiJUrt trtrftiir1wf is wwal' utWaad, prw>4~rlod to r~u >6rw1. W+1~d ",filkel caw t*ato tiwta at*j&t a'. c:aYWd tl inttr ,Ire iwitr, tli,ar„rt tilwar liltrr 9 tar(;rr plrwl slug ritrWte dJIM till flf*r iciekw, itrtn thrr butlu.r, ,f Re tHd rvs<._ If a VIks wood) w utfkayd orrrwrat ikter rlwa • akd ivt,ft It y ttflit u t-iockwite 90' J i ,iii" •r~lrx, ' . wra~itetial~rc~ I'hr rrNluurdi MOP sfwowyd b, ehsmrhed rrvtry ilar[t ry, tt nelptlc Ci}hIt I, ~ervicilrf. t. 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Wlult hw4ftld t'fle f;WWdjjt, oty titrr w/twvtr) over thw, _ _ r ywK.rra>s u Iltb il~rt - w arrl y, +Y,ahln per""O' vi!►6[I Ufa` Iitet [;rylf:rJd ~Ck fa/ lk~ Fl anrrr all Uuptuhr,: tuWe"al C>r t flrr With wNritcrY ` rr'vub Switch is utliLraal krrrell baclr I ~ lur~yyt+•. turait r rripMur n try iomerwt lrtu tfln twrrl , tti wiYrekwiswt ofil Nltu NICeY arltf @~. r. ttrsart the iotor umiltridgrr Larc(C jyy ""i y6,. t tare tlltwrr lrrckn 1141'u tiler brrffom *of tf,, ifte tr& "a li'Y!(♦5611y1J dttlNfl'tNYCir .i ' 10'"4061t:wt litlrl swelfrrt ttrb a";414 llPtlilill ~ r V Itrr the tttr _ , ~a" . ''!i "yr: , OUI: yt ;~rryN • {r r aw ay' r, , r r.' t 11w1 i,r`. ~t~''~~1~9.'>it'Jrvlt~nl~YIGIW~t~I'17H11 C~"`9tµ,~~'1!r'~' . . ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~ ~ ► ✓ l( p Mailing Address Property Address tt~7. 02 (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number - LEGAL DESCRIPTION Property Location.,&) / i Sec. T ~ O N R W Town of Subdivision In ~c r` Certified Survey Map # Volume page # Warranty Deed # . ,Volume Page # Spec house yes no trot lines ideatifab yes no SY3~'EM MAIlVTENANCE OWNER GER,1,CATION groper use and maintenance of your septic system could result in its maintenance consists of pumping out the premature failure to handle wastes. Froper the nten nl can affect the function of the aseptir, tank every three years or sooner, if needed, by a licensed sYWtic responsibilities are ~ tank as a treatment stage in the waste disposal pumper- What you put into specified in §Comm. 83,52(1) and in Chapter 12 - St. Croix Coup Sam r Oy r Owner maintenance rdlnaACe. The property owner agrees t to submit to St Croix Co owner and e a master plumber, journeymsm ubm plumber, resGounty Pig & Zoning DeP~nent a certification form, wastewater disposal system b in ro P umber or a licensed pumper v s' by the less than l r ~ of sludge, p per op~~ Condition and/or (2) after inspection and Pumpenfyives the on-site Pumping (if f necessary), the septic tank is I/we, 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 b Certification satin that our apart ment of Commerce and the Department of Natural Resour r°ning Departu ent within 30 datic system has been maintained must be completed and returned to the St Croi~r aunty Pta»g & days of the three year expiration date. Uwe certify that all statements on "form are true property described above, by virtue of a the best tr r ofDe knowledge. Office. I/we am/are the owner(s) of the ~y+ deed recorded in Register of Deeds Office. Number of bedrooms_z 04 ~IGNft~OF APPLICANT(S) /d DATE *"'*Any information that is misrepresented may result in the sanitary permit being revoked by the Planning dt Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed, (REV. 08/05) rO•" o \w$~h"' N 3 wc v ~ N h 1111 ~ 6 ~ °N. 'pl ~•t9t °n y / 111 a 9OV60 -foa I3! 'yt t 1 1 = o ~ v q ~ ~.(1• x o ~tltl"' `I, W 74' 392.L----- - - 0 ` 13 N 05-36'19' =Q e o G y T 1`I t - o o I r.~z A $ / \ 508 *59'37 / z 'Af W0859'37r~f.6O'~ /t Atv\ N 'A9 79 F\s M 3! mss' , j• 46,.68 f i V J / .0 1,03E •3 ,'~7• \ f .3~.;« tf4g, A N/ UN YY N y v 1 w SJ k" rj l!1 ,q `"tom cM y ~M y "'y i io ~ $ .~I 1 ...................................~c ....WAGQE, t' ??7.79'- - 271.78' -253 BB 38Q "4 1 o, iYOO J3'~s "N' 1Jf6 01 . u STATE TRUNK HIGWAY _65' SEE SHEE S00°17'41 "6 1315.69 c,,,,, C, e!?3 a East line or tAS SE 114 --50077 /1 lr 26J1.J8 ' 9 0 0 5 7 2 1 900572 STATE BAR OF WISCONSIN FORM 2- 2000 BETH PABST REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Oevering Homes, LLC, a Wisconsin 07/22/2009 08:OOAM limited liability company, Grantor, and Kenneth Oevering and Amparo WARRANTY DEED K. Oevering, husband and wife, Grantee. EXEMPT s Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 11.00 described real estate in St. Croix Cpunty, State of Wisconsin: TRANS FEE: 128.40 PAGES: 1 Lot 35 nd 36, Lundy Meadows in the Town of Richmond, St. Croix Coun y, Wisconsin. Recording Area 1 Name and Return Address: ,f Oranzo Oeve ' g PO Box 17 `7v New Ric ond, WI 54016 026-1165-35-000 & 026-1165-36-000 Parcel Identification Number (PIN) This is not homestead property. Dated this tD day of kb- , 2009. Oevering Homes, LLC, a Wisconsin limited liability company * * B $y: AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) COUNTY OF ST. CROIX ) ss. authenticated this Personally came before me this 17 _ day of Ji l+le- the above named Oevering * Homes, LL9 a Wisconsin limited liability company to me known to be the person(s) who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN in ent and acknowledged the same. (If not, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY * Notary Public, State of isconsin r Robert L. Loberg My commission is permanent. (If not,•sta Q' O Loberg Law Office sw/ SFA7235 t l ~ go (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature • .ST0 WARRANTY DEED STATE BAR OF. WISCONSIN FORM Na2-2000 1 of 1 1 ~