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HomeMy WebLinkAbout020-1134-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 574302 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: , I Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. I Permit Holder's Name: City Village X Township Parcel Tax No: Rivera, Raymond & Brenda Hudson, Town of of 020-1134-30-000 CST BM Elev: L Insp. M Elev BM Descri � n: ^ _ I'h�C� Section/Town/Range/Map No:0.C/ tr Z a `L z,,V c,4,t) 17.29.19.653 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Bench ark Z 30-12 ing Ali .7 Aeration 01 Bldg.Sewer Holding SUHt Inlet �V SUHt Outlet TANK SETBACK INFORMATION l J D 1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Inlet Septic c��o / �T l s > (��r O CAW,,. � �d C44 b � b.'�J� � • 3 7 eader/ an. Aerati Dist Pipe �0 C Sf (ot4S C�•� �D(o (off u 2 Holding Bot.System FS S•In Final Grade PUMP/SIPHON INFORMATION �" wa '� Manufacturer Demand St Cover q I GPM --�� �' Q` �2 Model Number TDH Lift Friction Loss S ead TDH Ft Forcemain Length ia. Dist.to Well SOIL ABSORPTION SYSTEM t3 �- 13 BED/TRENCH WdtF� Length No.Of Trenches DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 X 5 h -� [ I 1 —4 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER OR Manufact INFORMATION Ty Of1S,ystAegm:: ,1 f� (0i1 > (O O/ UNIT Model Number: DI T BUTTON SYSTEM Z5 Header/ nifol Distribution 4- 'Z--- �Z x Hole Size x Hole Spacing Vent to Air Intake Length_Dia Length Dia Spacing �- SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over /� f Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ✓C� JB Edges Topsoil Yes No ("l, Yes QALVV"- "T 41 064 1 COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: / / ) Inspection#2: Location: 907 Willow Rid a Road Hudson,WI 54016(NW 1/4 NW 1/4 17 T29N R1 9W) Willow Ridge 2nd Add Lot 44 Parcel No: 17.29.19.653 1.)Alt BM Description= 0 liaj ma,, ' "'�— "- - an 6'`_ �" 2.)Bldg sewer length= 15��� C l ✓ CG(/4/t -amount of cover= 5 Plan revision Required? [,' Yes [ . � -Y- Use other side for additional information. qSinat�ure Date Insepcto Cen.No, SBD-6710(R.3197) t� pQ 1 a P941P 0 s Pmt Vf- �2�v P Grb �g��1�'►"v `�j�- F ST. CR O =� "''` TY Land Use Planning&Land Information Resource Management Community Development Department Thursday, June 26, 2014 Raymond & Brenda Rivera 907 Willow Ridge Road Hudson, WI 54016 Regarding septic inspection for Raymond & Brenda Rivera. Location of Property in St. Croix County: Municipality: Hudson, Town of Subdivision or Plat: Willow Ridge 2nd Add Certified Survey Map: Lot: 44 Address: 907 Willow Ridge Road Dear Applicant: A septic inspection of the above reference property was conducted on June 25,2014. This property is located in the NW 1/4 NW 1/4 of Section 17, T29N R1 9W, Willow Ridge 2nd Add (Lot 44 ), Hudson, Town of, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a 4 bedroom home. Additional Notes: Site plan shows approx. location of existing seepage bed & new cells. Tank certified for re-use &adding Weeks 261 filter tank below valve between dispersal areas. 4 cells w/13+13+13 +4 chambers stepped down from 86.62' system elevation. If you have any questions regarding this, please contact our office at 715.386.4680. ;ly, Pam Quinn Zoning Specialist cc: file Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W154016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/stcroixcountyw cdd@co.saint-croix.wi.us C) 11 o p °ES p °va M e010 N N Q c c ar O O o v�� I mw III 3 N C y N p b N = NV fA ON N > 01 •y N N t y —CD i•'. w-. >M N 1n'0 O O N w 3 to V t _ �O(pp!•=M t O Om ` 0 N O tC 'D Ll oay � a a`) n o I c Z `� �a°'ico `• c Z ° a°ic m oaf @ � � m vo E CLL O CL 0) mT.Q•� LL o 8" 8 C S N C D.E j . N N C a1 0 CL E Q w CO N'o U N Q C otS 8 d N V M Ix E Z c z :; o I im rn3 � am a z v 1 r = U o 0 N Z �d' N I C c I p� H r a E C E N N N Y •j N N •� N U N O) 4 = 7 f6 N N y N • O N (n N a N AR 0 I a O O O Q O O N Q O '0 O Z C Z Z m Z N Q 0>�_ c CD cli LO LO 7 _ @ E o M 1B V) C Q l r C 3 = N N g I N ti H N 30 0 0 0 o a c o a 0 camtnV) = = tnrmtn 2 � o •� 17) CL oaaa CL C N o v N w °n on O N J V ! O O } O (A z N N O N N Z O O N N O N O O E E N N M (�O M m c m c p Q LM N �- o m Q n in m v °—' Q z in N C cif y H > Iv O C O U N = n W t N N N = V (_O M O T N C C C a 0 N C C G a O O O 'Vv L y C C "O N E N E E N '.0 75.- •'CxV) Ci (A y as N 0 0 2 N N 2 'O O p Vi — 0 c N 'O C N N M N O N = n N w m O U O W O O R U • O .- S 2' � O Z !� a M to o z N z z 2 to O c m IL CL L CL L: 9L • Cd C N N N C N C r`1v o R 3 ! 3 '0 3 '2 o r A vo. 2 OtnU 0 mU V TSmwy - 1W1% W Safety and Buildings Division O < !- 201 W.Washington Ave., P,Q1 "r­ Madison, WI � mit Num ber(to be filled in by Co.) Q V 7 1 V,3o z' Sanitary Permit Application 3u State Transaction Number In accordance with SPS 383.21 N-1 N L (-)>Wis.Adm.Code,submission of this form to the�p�io '1 x.is required prior to obtaining a sanitary permit. Note:Application tbrms for state-ow&ek "d the Department of Safety and Professional Servies. Personal information you to to Project Address(if ifferent than mailing address) purposes in accordance with the Privacy Law,s. 15.04(I (m),Stats. y used for secondary I. Application Information-Please Print All Information J Property Owners Name _ Parcel# i Property eCs Mailing Address 1 tY Q e 000 + Property Location 01 W IIOW P�)d �053� City,State Govt.Lot ? Zip Code Phone Number /4, Section�— T e (circle one) II.Type of Building(check all that apply) Lot# 1 N; R_ E or W N41 or 2 Family Dwelling-Number of B drooms _ Subdivision Name S 77/V i Block# 1 �tR1 9�1 ❑Public/Commercial-Describe Use t ❑ City of_ __ ❑State Owned-Describe Use CSM Number ❑ Village of R Town of -14 U_pSUW � III.Type of Permit: (Che - y one b on line Complete line B if applicable) A. — ❑New System 'Replacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑Permit Revision ❑Change of Plumber List Previous Permit Number and Dare Issued Before Expiration ❑Permit Transfer to New an Owner IV.Type of POWTS S stem/Component/Device: (Check all that apply) v` i Non-Pressurized In-Ground ❑Pressor edd In Trou�/d�- ❑At- �j ❑ d> 4 in,Qf s� le soil ❑Mound<24 in.of suitable soil 1 ❑ Holding Tani El other Dispersal Compdri�rit'exp"la ttY'j `S �J ST� V e ent. ice a la _ V.Dis ersaUTreatment Area Information: Design Flo gpd) Design Soil Application Ra�pdsf) Dispersal Area Required(sf) Dispers Area pro System Elevation VI.Tank Info Ca aci 40 Y3 / � $.�OU-�"BI��o4 OC Capacity ut Total #of Manufacturer Gallons Gallons units )�sd ❑ o New Tanks Existing Tanks Septic or Holding Tank t / `n " w U Dosing Chamber VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name Print) A ers S� tore MP/MPRS Number Business Phone Numb r Plumber's Address(Street,City,State,Zip Code) J U v b o N 1� 0 IA. bosom VII Count /De art4bent Use Only Approved Disapproved Permit Fee Date Issued Is ring Agent Si atu ` ❑ Owner Given Reason for Denial $ LI 7 s. 7-- / /L/ IX.Conditions of ApprovaUReasons for Disapproval / A / SYSTEM OWNER; V d&q- (� q-v /2Q l/►�j S" /�- / (f /'fP,G() z�/(�,�,� 1.Septic tank,effluent filter and dispersal cell must t plan provided/maintained k4d l as per management plan provided by plumber. 2.All setback requirements must be maintained as per applicable 16Et@Wl7rdINFR1>#1N1pns for the system and submit to the County only on paprr not less than 8 tie x 11 inches in site SBD-6398(R- 11/11) 2362 Wisconsin Department of Coma Z SOILSiAPLUA I IVN REPORT Page I of 3 Division of Safety and Buildings�. and ROO C �with Comm 85,Wis.Adm.Code A.C.E.Soil&Site Evaluations ABash complete site cal �tlhan 8%x 11 inches in size. Plan must County St.Croix include,but not I' ontal r eference point(BM),direction and percent slope,sca a or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. 020-1134-30-000 Please print all information. Reviww" Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). j�(,�yt�.� /, 2 3 Zel Property Owner Property Location �v Raymond&Brenda Rivera Govt Lot SW 1/4 SW 1/4 S 17 T 29 N R 19 W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 907 Willow Ridge Road 44 1 Na I Willow Ridge 2Nd Addition City State Zip Code Phone Number 21 City Village Id Town Nearest Road Hudson WI 1 54016 1 715-377-2851 Hudson I Willow Ridge Road New Construction Use: Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial-Describe: /v o 1) Parent material Glacial Outwash I 7 Flood plain elevation,if applicable Na General comments r and recommendations: Site suitable for conventional POWTS dispersal cell with 0.7 gal./sq.ft./day loading rate. linfiltrative surface elev's to be 36-52"below contour at 85.0',84.0',&83.0'. a Boring# 2j Boring Pit Ground Surface elev. 85.77 ft. Depth to limiting factor >92" in. Sol Application Rate Horizon Depth Dominant color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu.Sz.Cont.Color Gr,Sz.Sh, -Eff#1 I "Eff#2 1 0-3 1Oyr3/2 none sl 2fgr mvfr cw 3fm2c 0.6 1.0 2 3-8 1oyr4/6 none Is Osg ml gw 3fm2c 0.7 1.6 3 8-33 1Oyr4/6 none gr s Osg ml cw 1fm 0.7 1.6 4 33-68 10yr5/6 none s 0sg ml gs - 0.7 1.6 5 68-92 10yr5/4 none gr s Osg ml - - 0.7 1.6 Horizons# &5 conatin approx.25 gravel,cobble-&stone. a Boring# 2j Boring J Pit Ground Surface elev. 89.93 ft. Depth to limiting factor >104" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots G /ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. -Eff#1 -Eff#2 1 0-5 10yr3/2 none sl 2fgr mvfr cw 3fm2c 0.6 1.0 2 5-12 10yr4/6 none Is Osg mi gw 3fm2c 0.7 1.6 3 12-39 10yr4/6 none gr s Osg ml cw 1fm 0.7 1.6 4 39-k8 IOyr5/6 none r s. Osg ml gs - 0.7 1.6 5 58-104 10yr5/4 none gr s Osg ml - - 0.7 1.6 izons ,4&5 co tin Upprox.25%gravel,cobble&stone. *Effluent#1 =BOD 5>30<220 mg/L nd TSS>30 150 mg/L uent#2=BOD <30 mg/L and TSS<_30 mg/L CST Name(Please Print) Sign ure: CST Number James K.Thompson 3602 Address A.C.E.Soil&Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane,Osceola,Wl 54020 6/18/2014 715-248-7767 Property owner Raymond&Brenda Rivera Parcel ID# 020-1134-30-000 Page 2 of 3 a Boring# Id Boring Pit Ground Surface elev. 89.73 ft. Depth to limiting factor >96" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture StRicture Consistence Boundary Roots in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh, *Eff#1 *Eff#2 1 0-5 10yr3/2 none sl 2fgr mvfr cw 3fm2c 0.6 1.0 2 5-9 10yr4/6 none Is Osg ml gw 3fm2c 0.7 1.6 3 9-35 10yr4/6 none grs Osg ml cw 1fm 0.7 1.6 4 35-63 10yr5/6 none gr s Osg ml gs - 0.7 1.6 5 63-96 1 1 Oyr5/4 none grs Osg ml - - 0.7 1.6 F-1 Boring# Boring Ji Pit Ground Surface elev. ft. Depth t0 Limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 F-1 Boring# Boring Ed Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GP 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(K07/00) A.C.E.Soil&Site Evakial:IM /e: �oe �LtiC. %o c o'e,�'�or,e cla.- �¢ � 56q�°• Ass�.ncd � Exis�i�q�'acle c/t da-�n ryja,,dole Cow/ �/�. =9o.yZ: Qayd�°xo�d4 �►ve�a�oiop. 87.oz' ScC.i7,T.2 -,e well £ o hfA,,;ry wcvdAd V ra a eon k¢Q✓i!y wadded I brres/•r vr' � Q rr. c� B av �oP owdjLt-87115;. `Y Afyo�aX./ecr�cr�.` n dts�a�lSa/ ai Pass w/ �YF/Enu✓! p�" sw�4c�c/u!oas.2�' Q. w;llo� �d9 / �Q� CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AN TI'T'LE PACE Project Name: _. Owner's Name: Owner's Address: �o .. � F � ow. , 14..�1_ Legal Description: Township: County -WA Subdivision Name:W�r'10w C� OS Lot Number: Parcel ID Number: —0-40-- 1131-!3 3a -000 Page I _ Indent and title Page 2 Plot Plan Page 3 SystemSizrn & dross-SpCtign Page 4 Filter ipecs,_��� } Page 5 Maintenance Information f Page,E _._M'anal3am'ent Plan,._ Page 7 St. C;pix My Septic-Lank Mainte:naagao Form Page 8 _ ,- Warranty Doed Page 9 C1M or Plat AttachrhaMs: ;Sail-"est& 1.10Lu,Se E�'lans Designer/P'luMber: 'J"M �1�Q Q {(L License NuMbor: p�a 9V Date: h ' - Phone NumberL `" Signature Designed pursuant 4thPCGround soil Absorption Component M$nuat for POWTS Version 2.0 SI31D.107M-n'(N.0'1/01). Plop 1 I Map R")*trtA 3700\ P, 4;ceose 04""j f � U Oe�k �Vu pit S�� sv�{90 9a � I IYfu" 0 v W Pi . 2, Sall Absorpti-a n Sntsm ryas Section c/o N� o ! _ --- 4"Seh^sjule nD Final ra�ir PNIC APent pipe With Vent Cap Chamber. ( � go.o �1�7ystieym Elevation 4f* Soil k aqWflon Sy9fgrq Plat q ft Trench 1 ChambeN 4"Dies. � nr-,li Header -� �+t'ant Or�3bser'vation Pipe re a ct Ln Hall Ufacturer And Model EiSA Rating J > q f Per chamber Soil Application Rate . gpd/eq ft _- __ Soil APPlicetion A Rate � _oS � m r 'f -------- _ __.Chambers _ 3 crows of C hambers each, Page po') r).Ok JAc. Pap 1. of x Mbar;fe in'tifb� 11 S� 1 I E'calyiCk Ims, 3 Fa iMeld Blvc1 6!Ir2llimgfc49•d.F T r ,r 1..r.,r ,, .r.r.i 1 ^ YOU a } Q ?� ali'rral!{wren,^ ° a�8 ern ells ptal�rltak rnnn Y+a" q r� �r r rG1�thG.tl�Pt�114 r r,,,,,,,,,,,,,"..,..............._.................._.....,......,.,............... ,.,,,.,.,•„„a.,,w r i 4 r y 1�, P • 1. •1 i r E"FL > p'. Rafalin t'h* bsr in filter tachnalc PL-05 Effluent i,q Filter Die.S,C r1ption `a �f�We1�t Fiitr�t� 1'c{ylok,inc Is ?aleasect to geld its new commercial filter to its oxisting lino of r{W,RIity affle,tent i ! + l- r"' .�,. it mrs."f'he PL-a;�5 is reteci for'over`10,000(BPD((oraflons Par Day)makinr4 ft Ant?ref,the largest=MmerGial filters in its r..l,4ss,It hfl5 G,J'.S linear fciet of 1116”tfitr'ation slats, t_ifce the i Kiwi`s&miser C;ovem r Pillylgk PL-122,thA new RNY101c PL-628 1108 an lutornatic shut cff haif installed with ever filter,I n the fihar is rhmrwr}for clearrinr the kaFtll will fliaat:ap and tempt rmrily spurt nff Dist)fbwtl.>on LIu Am the synfsm Whe qM1 uGnt Urg11't IL%ays tho yank. No OT1101 filter on this melrktit can make tllat Acceasrariss I:rrar• rlair"n! Pumps, engine, Prarnnp „ rd ring ln`GawrM y;icarr i s Stop sysrG1,3MS i�Ci�C.{ESk E(ZWOtE iiel�lteel Prndra ka --- _ .. u i Seals/Geskets +:•ate+wmmnw” 139fts,Sanitary Tana ,• +� Rated for'10,()(30-r,,,J(Gallons Per Clay) }� + 575 linear feet o;'1110"filira'tion ( akaar p�rCSr--W— �x Enlarge for details • Accepts 4"and 61'Ss;;N(�,�D pipe psiacq,% A utomatic shuiRoff ball when fftar ig )v©d ndles send Racepven e Alarm accessihilfty 0 Accrepts FVC extension handle ns 1 Lando ps I Drainage The PI_"•52S Ef<lurant F"dt.�rr shaulcl epErrat�a�afFir..lPrltly h7r S�vvtaral,e f"'"""°"'°"'"""""°""'"""^"°""°"w°"••'�-�°^ conditions I�efnrp req�ririnq cleaning. it is recmm�l®ntlsr3 that.rh fit bwca ciear1et�levertf 4 Farm r,&Clamps, tillle khP.kariit i9 punlpPCi of t least P,wely ti1fAC y�`61'9.I't tile+ingtallac�mite!'�C7n'ixltl$ optlonel 2lai'n1,the nwner will lip ncttffed by In alarm whin the f1lt0e ery1 tel ( I W i; l3ldl�t9 Seniicing shaLlid he done-.by a certified Septic t��11k pumper qr inatAllsr. cone eta A w�aar�rias resswre Fitters 1. Laaate the outlet of the septic,tank. d r Cron.rol P c# 2, Remove rank cover and pump tank if neces;�ary- �_ 'sbar-----, U 3. Do not'd$O plUfting When liThfir is rramc)vod, i �e�k��r"i^�`�8�r1 CN�U A.• gull C'L 57.5 o<et ai the horasfnq. Gr� t9Al"Il '. Nose off filter aver the seOic,tank.Makin sere all sralicls fall insert the i1rPr eartridg beck into the I1rauwinq makinci aurE l e filtkargi4 properly ' bar 8401W and ID Gt aligned end rcmpl�rt iy mSei4ed. ". 7. Replace aepfir.;tank cover,PI-525 9rlstallstir,n;Ideal meal°residenr.IK I enr�ccnlmercial I�e�rsratiae Landsroepa wasie Ylcwrs lap to 10,000 C111011s Per D,sy ' T�chrtRr�ai� Mati�+! " P Installation Instrurrfl ns. 1. Loc ��ialtt"GJ Rrr�W� �. Remove an�raMiter anI;l pij i�tank. l Pt,Mp Filter and atitM 3. Clue that filter haarsinq ta�"hrr 1"tor 6"f r i,Mf�t pipe, the milker i,reef renrered rar7dr r +{ 'me filar Rear tr,E ev,cess 4 i� Irrg erne a ('aiylnk Factttn 9 LORI ar pie Pipe ko cxant,Er filter. Filter Alarm Panel an A. 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Standard Irfluarit/~ffiu e nt Quality Monthly avorsP Pats, oil&Grasse (i o(a) 420 mall, Q Sandleravol Filter l:l Feat PlItar 6ioahemiosl 0xv;ran Demand Iii Ds) X220 cr+g/L 0 NA. Q Maaharrlrml Aeration 0 W40nd Solids (TS ) _~ .Total Suspends Sl t f E Q Other Rratreetad)~fivant Quality Monthly average Dispersal cell(s) l„I NA t ioQhemitaal C?xygdn Damend (30041 A'S'lo rngl� L5►.In^&ound (gravity) 0 In-Ground (PrewsurizOd) Cl At^tirade G� Mound Total$u4pended Soma ITS`3! A�Q a1�tglR, �INA Q Drip-rAr da 0 Mahar, F"al Col,fcrrn(gaomstrIc M8e0) N104 ofull Al'M Q NA Me-XIMurn Effluent Particle Size kn dia, NA 0 NA _ - CJtl7eY� Other; i:l NA t)thnr: *Valatss lypiaai Ear d�?aaasallc wa�tswater and eapfla tank eflluarrk. MAlN'I'13N#l�' S 1Erk q.4J!1� $Ial'vike 1#4 tl$Nov, .%rutca 5,rrent I"i IN i1f ((4EIANIt"urn a yearns) M NA inspect condEtkcn of tsnk(sf At teal"enas every/ 8Sr wt contents of tarrklsl When combined sludge anti scar,(egwaie eneµthiid I"I/a}of tank ��ma i NA Pump o _ - m"tl1(li<} (Nl tai►Yltuwr 3 yOatrs9 Q IAA At l�aast anoO Ovary' 1 Inspect dispersal retl(a1 rdnt:il1 0 NA: At,lead:Once()vary; Chan sfflugnt ffiter p cwntrols&aEerrst At least once every. Q ear Inspect OM P, ump � �f'>iriwt",.'fs) WA At least Once every; a •. .,.�,� ,.�. _.�.,,-.�. Flush istarafs and pressure 1',Oat �_..� � Al WA cltil,ara At least CMOs avery� ,.�- �� D NA Other, MAINTMAXGB INSTRUOTIONS Inapsovons of, tanks and disper ( 1Ss shall lay made fly an I &iCtrY�l pCir S �itit ill r �ctln�Qgsrator, Tank Master piwmber; MzaTer plumber Restricted Sower, POWTS In p oraakm wr leaks, inspeotlan�a mast nclaad'+s a vlsuaE it speaticc at the tank(B)to identify any missing at broken hardywrre, 1014 ify arty measure the uglurtrr() of combined glwdea and sogrn sntf to check'fcr any hank up or pons; no of efflwerll;on the ground a orrd ng The dispersal 041149)Shed surfeaealtTlae ponding cad effluent can lue gYCwnd1 surfaca may ndiaata aspflalking 0ndttiOn And aragw res the ;pacted to check The pf effluent on the gr w Immediate notification of the local regulatory authority or M,0*Of the tank vOlulne, the ent're When the oomWned senumulatkon of$.Judge and s 9 M 111 a17y tlnki QRU i s d d p e }f In sa ordanre with shaper NR 113, contents of the tank sheli Yee removed by a Sep4e s Servicing rap Wioconidn:Adminlmtreriva Code, All oter serviaes,including but not lim"iitRe0 to the s8fvlakng P arm�tlfilters,e mechanical T i l iE�taf r a(Yipsrtf9rtfal Aratreertment units, and any eVOCIng art rn"tetVala R1A .51 months, shall be p. A snrvina report shall he proVroad to the local regulatory autbnrtry within 10 dcsys of 00MIxtetion of WW"rwua avant. G"w,14,181) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK. This is to certify th.at. I have inspected the septic tank presently serving the &,.me,l,A !t 9"NA0 Q i yerc., residence located at : Sec . _, T o% N, R_d_W, Town of { kA td0IQ St . Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condi ion and it appears to be functioning properly. Last time serviced ( l Did flow back occur from absorption system? Yes No- (if no, skip next line . Approximate l-Um� or th of time : gallons minutes Capacity: 12 Construction: refab Crete Steel Other Manufacturer (if known) : Weld_ Age of Tank (if known) : Nip I (Si n u e) _ g (Name) , Please Print (Title) (License Number) -a 1 (Date) Form to be completed by licensed plumber (s . 145 . 06 , Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition,. I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83 , Wis. Adm. Code (except for inspection opening over outlet baffle) . Name Y) YV) Signature MP/MPRS :k 0'10 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Q] U W ) Kb-lop Property Address _ 71, S b mR (Verification required from Planning&.Zoning Department for new construction.) City/State u4�st)w ask. Parcel Identification Number Fo b`n 3l/ - �o-ewo LEGAL DESCRIPTION Property Location SW r/4 r/4, Sec. 1 I , T o�7 N R )9 W, Town of PJ Ohl Subdivision Plat: p fiwy IZ1 I"V� !!tL Lot#�. Certified Survey Map# , Volume , Page# Warranty Deed # `7 �o C9 -1 (before 2007)Volume ( � , Page# 3 3 Spec house 0 yes>kno Lot lines identifiable g yes 0 no SYSTEM MAINTENANCE AND OWNER CERTII6'ICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 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&Zoning 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 than 1/3 full of sludge. Uwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Nur3ber of bedrooms _ SIGNATURE O APPLICANTOS) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked 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. I (REV.09/07) DOCUMENT NO. WARRANTY 1Jt+;it) 1 rilS SNACls 1`10UV 1UL17 FOR ItGC'cTRDER:S USG: 1 o i s_u PAC:'_ .��) This Deed,made between James A.Braxmeier and E-ugenia REGI TERMS C1FF�t;E � Braxmeier,husband and wife,Grantor,and ti ................................................................................... . 5r.cR01 x cry,W! RaXmont� A- Rive—a and F3renda J. Rivera, FICedfafRaxrd l .►U....w ............................................................ arltai: ./�ip0 O 7U�� 1?ro^arty....................................... ...................................,Grantee, 1 tY G3 �, Witnesseth,That the said Grantor,for a valuable cor sideration.. ........... .... ..................................................................................... ......... conveys to Grantee the following described real estate in St.Croix CUL11.l„ ..��,,;'adf,�_ .�a o State of Wisconsin: Tax Parcel No.020-1134-30 IJ. f l f✓I f_. !4� k.��.... Lu[ ++,'vtiiiiow Ridgy 2nd Addition in the of Hudson. St.Croix�" otiitty,Wisconcin This ..................../.- ..............................homestead property. (is) (is not) Together with all and singular the hereditamenis and appurtenances thereunto belonging; and James A.Braxmeier and E.Eugenia Braxmeier warrants that the title is good,indefeasible in fee simple and free and clear of encumbiances except and will ivarraiiii aild delCllU aw sanie. /lV aced this A� ir;ixmeie................... ...........................day of........... . .. .. �- ................................................ ............. , 19..�. .. ... .......... ...................:...............,... .. �...,. e-e- ci........... iE Eugenia axmeier ACKNOWLEDGMENT SFER STATE OF WISCONSIN _ ................County. - R..�..... Personally came before me this.... 2.......,day of......!•h 19 �0...the above named Janies A. Braxmeier and E.Eugenia Braxmeier,husband and wife to me known tAbe the person .......:.+` 176 �Ited the foregoing instrument and acknowledge the same. ............................... ...............................,................................. SUkLISSA fa (h:GCet� Ali:>TRENG � ... ... Notary Public.; l..... ..... .............County,Wis. qTF r0�� Mycommission is permanent. (If not, state expiration date: ............ ...................................................., 19..l...,..? "Names of persons signing in any capacity should be typed or printed below azcir signatures. THIS INSTRUMENT W,A.l)DRAM ED BY SAFETRANS 10125 Crosstown Circle Suite 380 Eden Prairie, MN 55344 Laurie Inberg 39899