Loading...
HomeMy WebLinkAbout032-2045-50-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574316 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: Boardman, Elaine G. Somerset, Town of 032-2045-50-200 CST BM Elev: Insp.BM Elev: BM De riptio - Sectionrrown/Range/Map No: L le • d GOD 0 A&6 s[. g o S�G�t�, 12.30.19.656B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septicl Benchmark U(�CJ Alt. BM ,1 n s/�e Ae n BI Sye H e-r/(0 , 7 SSt/Ht Inlet ow GN �• 93 G/ � �� S4� St/Ht Outlet L/ � 3' � TANK SETBACK INFORMATION (( TANK TO P/L WELL BLDG. Vent to Air Intake L d -- ROAD Dt Inlet Septic Dt Bottom / ,- y 1 Head %an "w�/ /��+ Dosing 9 Aeration Dist. Pip /M O Holding Bot ystem J o Final Grade Go ^ —= PUMP/SIP ON INFORMATION R3� Manufacturer Demand Stir 9�7 Gf(�.� GPM 1 ��y�1� G•�. / Model Number 2 TDH ZdQfion Loss Isystem Head TDH Ft Forcemain Length Dia. Dist. o SOIL ABSO N SYSTEM /S'dot 4A BEDITRENCH Width / Length ( No.Of Trenc es DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS t/!/,o SETBACK SYSTEM TO P/L BLDG WE KE/ EACHING Manufactur r: CHAMBER INFORMATION T Of System: �� OQ l / � r UNIT Model Number: DISTRIBUTION SYSTEM S �Yt -mod l Sf Head /Mnr+ifeld Distribution � � x Hole Size x Hole Spacing Vent Air Intake / // Pipe(s) / �--- f >l Length Dia Length_ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only k-1� M41 Yvfj-, Depth Over Depth Over xx Depth of ;jxx S eeded/Sodded xx Mulched p nch Ed es Topsoil Yes I No Yes No Bed/Trench Center 9 COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: /2 /�� Inspection#2: Location: 822 160TH AVE New Richmond,WI 54017(SW 1/4 SW 1/4 12 T30N R19W) NA Lot 1 Parcel No: 12.30.19.6566 T 1.)Alt BM Description= I i r 2.)Bldg sewer length= 1147r7 W (P7 *'7uL ivl 10-i' +t, -amount of cover=> 2 , V'hXY ;;Aalkx 11U-411 Plan revision Required? 1A Yes No n�^^� � ��-y -4 S�S Use other side for additional information. Z_.� �_____! L---C =-— - �tT-: n - Date Insepctor's S+gna re Cert.No. SBD-6710(R.3/97) PLOT PLAN PROJECT Elaine Boardman ADDRESS 822 160th Ave New Richmond Wi 54017 SW 1/4 SW 1/4S 12 /T 30 N/R 19 W TOWN Somerset COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 7/15/14 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 916 # of chambers 45 IL BENCHMARK V.R.P. Bottom of shed siding 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 92.0/91.0/90.0 4' below qrade of tank,piping shall be Schedule 40. 160th Ave AL Scale is 1" = 40' Well 55' 120' unless Otherwise � Existing 3 noted Bedroom House 30' 25' 100' Existing system is to_ 20' ^_ � `�-.�a 30 e `' d be pumped and buried 4 f° '� r;�"� t- B.M. ST 0' '' Failed D � Vent I�' � ST 80' B-2 � 60' >6» Quick4 Standard B-1 Leaching Chamber en of Cover with 20.0 ft2 of Area 15' 12" 5.6ft^2/pair of end caps 96' 4' Long 3419 Grade at System Elevation (o 94' 3-3' X 62' cells B-3 with>3' 10% Slope spacing Property Line r�.. County y �• �� Safety and Buildings Division 201 W.Washington Ave.,P.O.Box 7162 Samitacy Pamir Number(to be fitted in by Co.) RECEIVED Madison,vin X707 7162 � al (o bus ermit Application Stu T 'on In aawrdaax with SPS 38321 Was.Adm Code,shnissiam of this fo®to the approptiata gwamnaitrd umat is required prior to 016 � )i(oee.APPhc�mfo<mffiion you provide may be used secondary ��Address di�aeat than mailing adders) vmposax in a000rdama with the Law s.ls. 1 m stets. L Appfigm#2n Wermation-Please Print All Information Parcel property owner's Mailing Address ZaGovt Lot Cate.State Zip Code Pheme Numbs � //yi, Soctioof� TAO N; R..Oeir e IL Type of BaiWing(cheek all Zrof t apply) .-- Lot# Subdivision Nsme X",2 Famrly Dowelling-Numb -� !� Block f ZJ 0 Public/Commacisi-Desaft Use }r^ ❑City of CSM Number VMW of 0 State Owned-Describe Use r_ own of �2 eirE III.Type of Permit: ( y one a ' A. Complete Use B if applicable) A- 0 New Sya. S ❑TreatmentlHold'mg Tank Replacement Only 0 Other Modificatim m Embng System(acplain) B. 0 Pamit Renewal 0 Pamir Revision ❑Change of Plumber 0 Permit Transfer to New List Previous Permit Number and Date Issued BeEm Espiratiaa I Owner IV o Com seat/Device: Cheek all that apply) *3an-Praastaiaai ❑Pressurized bo-Chormd 2:24 MO.of suitabit xg ❑Mound<24 in.ad soluble soil Idimg Tank 0 Odw Dispersal Campmeat(expW HOC V.Dim VTreatmest Area Information: c4!'!/ v Design Flow Wd) Design Sot?Application Rate( Dispersal AMa R (sp Dispersal ( sy Elevation z e!e/_10/1 e9119101 0 VL Tank Info Capacity in Total o Gallons Gallous units New Tsoks Fsiscra Tama $$2 Septic or Ho&ft Talc Dig Cbobw yM Statemenri for iastallatioa at the P lw7s ►ewe oa the asbcL� ' ) Flambe, up�S Number Busimms phase Number Name 5PhiEba's Address(Street.City.Stag,Zap f eat Use Only 0> � Permit Fee �U Date Issued AB�t Si Ltd -C- 0 Owner Gwen Reaaam far Denial IIX.Cosd'Op ff# iR "ff nw°s for Disapproval 20/Z 1.Septic tank,effluent filter and fI ✓�O,i� S`P �3 3 3 dispersal cell must ta_a erviced/maintained i7G as per management plan provided by plumber. 2.All setba(ck requirements must be maintained sysles wad w Wk p Urc Csaoty•may M P.P.-ast ism Una 8 to:11 ivel m is sine SBD-6398(R.11/11) , Cover Page g Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/16/14 Owner: Elaine Boardman Location: SW 1/4 SW 1/4 S 12 T30 N,R19 822 160th Ave Somerset 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 SpecificatiojSh t 8-10. Soil test Signature ' License numbe 26900 PLOT PLAN PROJECT Elaine Boardman ADDRESS 822 160th Ave New Richmond Wi 54017 SW 1/4 SW 1/4S 12 /T 30 N/R 19 W TOWN Somerset COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 7/15/14 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 916 # of chambers 45 BENCHMARK V.R.P. Bottom of shed siding 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 92.0/91.0/90.0 4' below grade of tank,piping shall be Schedule 40. 160th Ave AL All L Scale is 1" = 40' Well 55' 120' unless otherwise AL noted Existing 3 Bedroom House 30' 25 100' 53.x.� 33 Existing system is to 20' 30 Shed be pumped and buried Co B.M.* ST 0, Failed D 50' 80' B-2 Vent ST 60' >6„ Quick4 Standard B-1 Leaching Chamber Vents of Cover 2 with 20.0 ft2 of Area 15'of end caps 96' 4' Long 1 Grade at System Elevation 34" 3-3' X 62' cells 94' B-3 with>3' 10% Slope spacing Property Line 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 96.0' Vent Grade Vent 4, 4„ 4, x/30/34 Septic Tank 4' Long 119 5' 4, Long 1 Grade at System Elevation 34" Grade at System Elevation 34" Spacing 5' 3-3' X 62' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A_92.0' B 91.0' 15 chambers per cell C90.01 Property Owner_ Parcel ID# Page of Boring# ❑ Boring 0 ) pit Ground surface elev/ 3, 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 2 d,,� 3 S- O�C- �� � l• d F-1 Boring# ❑ Boring ❑ pit Ground surface elev. 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 i 'Eff#2 Boring# [] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth 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 mg/L and TSS>30<150 mg/L 'Effluent#2=BODS<30 mg/L and TSS 5 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. SOD-8330(RAM) JUL 17 2014 Wisconsin Department of Commerce `p� WUEVALUATION RAR � Page of Division of Safety and Buildings ST.CE' — ��pptvlENT -3 ,I©�� � omm 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. percent slope,scale or dimensions,north arrow,and location and distance to nearest road. �- 6 Please print all information. L2� Date < Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). l al Or it Property Owner Property Location 1'6&0 r1� Govt.Lot 1/4s 1/4 S �Z T �j� N R ZZ E(o W Property Owner's Mailing Address Lot# I Block# Subd. Name or CSM# Uc)- 16 n9A,4-, 0 'Cae4up-, S City State Zip Code Phone Number ❑City ❑Village KTown Nearfst Roa ❑ New Construction Use 'Residential/Number of bedrooms 2— Code derived design flow rate .�0 GPD eplacement ❑ Public or mmerclal-Describe: Parent material G 127 ood Plain elevation if applicable General rtts h C C�/�GLr►�l ' ( U ,/',Sell and recommendations: System Type L �rl/G/��t �iD System Elevationf����. F T] Boring# l q Boring A/ !c] 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/fP in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •.EEff#2 ZQ—. •--� /�7 . i ® Boring# a Boring cJ/ Pit Ground surface elev. ( tom Q ft. Depth to limiting factor 12 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 e2 Effluent#1=BOD >30<220 mg/L and TSS>30<150 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Name(Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 _� 715-246-4516 Soil Test Plot Plan Project Name Elaine Boardman Shaun Address 822 160th Ave 'Vo New Richmond Wi 54017 C*M #226900 Lot 1 Subdivision --------- Date 7/16/14 S W 1/4 S W 1/4S 12 T 30 N/R19 W Township Somerset Boring Q Well PL Property Line County f CPO I BM or VRP Assume Elevation 100 ft. Bottom of shed siding System Elevation 92.0/91.0/90.0 *HRpSame as Benchmark 160th Ave Scale is 1" = 40' Well 55' 120' unless otherwise noted Existing 3 Bedroom House 30' 25 100' 20' 30' Shed B.M.* ST D Failed 80' B-2 60' B-1 35'10 96' 30' 25' 94' B-3 10% Slope Property Line POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page or FILE INFORMATION SYSTEM SPECIFICATIONS Owner % a , Tank Manufacturer: ❑ NA Permit# 1 eptic ❑ Dose ❑Holding Volume: (gal) DESIGN PARAMETERS Tank Manufacturer: >11,NA Number of Bedrooms: ❑ NA ❑ Septic ❑Dose ❑ Holding Volume: (gal) Number of Public Facility Units: 6M Vertical Distance Tank Bottom(s)to Service Pad' (ft) Estimated(average)Flow: (gal/day) Horizontal Distance Tank(s)to Service Pad: Design k Flow= estimated x 1.5: Ada ) Sperm servicing mechanics must be provided if vertical is>15 feet or g (p88 ) ( ) J (9 Y It horizontal Is 1-150 feet. SpecHic instructions to be provided on back. In Situ Soli Application Rate: S_-(gal/daye) Effluent Fitter Manufacturer: Z�7 //M_ NA Standard(Domestic)Influent/Effluent Monthly average.. Effluent Filter Model: Feb,Oil&Graass (FOG)• 40.mg)L Pump Manufacturer: Biochemical Oxygen Demand'(SODs) s220 mglL ❑ NA • A Taal Susperlded solids SS 's150 MaL Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg1L \�� Manufacturer. (BODs) >220 mglL IA p Mechanical Aeration ❑Peat Filter NA sS >150 m Pretreated Effluent Month average ❑Disimfectlon ❑wetland IY .�L�`aN ❑Sand/Gravel Filter ❑Other. (BODs) s30� Soil Absorption System (TSS) s30�mgIL n-Ground(gravity) ❑in-Ground(pressure) Fecal Coliform(geometric mean) s10 ❑ NA Maximum D Effluent Particle Size )L in dia. 13 A 13,NA ❑Mound ❑Drip-Line ❑Other. Other: NA Other: MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) en combined sludge and scum equals one-third( )of tank volume ❑Wflen the high water alarm is activated Inspect condition of tank(s) -At least once month(s) (Maximum 3 yeah) ❑NA Yaw Inspect disperse!cell(s) At least once month(s) (Maximum 3 years) [I NA '>Z yearf Clean effluent filter At least once every: �� month's) ❑NA Inspect pump,pump controls&alarm At least once,every: month(s) ❑ NA ❑year(s) Flush laterals and pressure test At least once every:. month(s) ❑ NA .❑yWs) Other' At least once every: ❑mo h(s) [3 NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an Individual carrying one of the following licenses or certifications: 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 cracks or leaks, measure the volume of combined sludge and stun 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 of 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 swAdng of effluent filters,mechanical or pressurized components, pretreatment units, and any servicing at intervals of X12 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 products, solvents. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting chemicals or sediment that may impede the treatment process'and/or damage-the sail absorption system. If high concentrations are detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)Prior to use. Pump tanks may fill 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=discmarged to the sod absorption system in one large dose causing an overioad that may result in the backup or surface discharge of effluent.and damage'to the system. To avoid this siWation have the contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to testorirg power to#ia pump or contact a Plumber 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 soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or timer 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 wee. Reduction or elimination of the following from the wastewater stream roey improve the performance and prolong the life of the treatment tanks and soil absorption system: adds, antibiotics, baby wipes,-cigaretteabutts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain(sump pump)Ifischarge,fruit apd vegetable peelings, gasoline, greases, herbicides, meat scraps,medications,oils,painting products,pesticides,sanV napkins,solvents,tampons,'and 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 ProPalY and safely abandoned in compliance with s.Comm 83.33,Wisconsin AdrMnistradve Code`.: • All piping to tanks,pits and other soil absorption systems 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(pumper). • After pumping, all tanks and pits shad be excavated and removed or their covers removed and the void space Oiled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement System: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system- The replacement area should be protected from disturbance and compaction and should not be infringed upon y required setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area WIN 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 sod absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sod and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed.as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the.biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING 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. Name �� NameY<q�41 e/— Phone �jJ --o�Y — Phone --�1 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Names ✓c�� �t✓� Phone J 41 Phone 7� --_— This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS repulatary agencies in compliance with sections Comm 83.22(2)(bX1xd)5(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. �'•� � FILTER CARTRIDGE INSTRUCTIONS STEP 1 Dry at the War can ante the mad of the outlet pipe to ensure it is centered under on access opo+Ma. it not than.afar insert eon pipe intro the tank through the outlet or soJvmnt weld(slue)additional pom ate the outlet Pip - STEP 2 While the case is 01 dry Atted on the outlet pipe,f11eas,re the length of riti•h+dp pipe needed tb brace the fi t w to the tank end wen if utiit"the optional eupplamar"side aupPWL It side suPPort method it not utilized, Koaeed to stop loon: 5'7EP I for installation ut9tizing the Optional We support: sWwm*weld the%-inch Pipe orbs the fter case. If side snPport method is not udbed,proceed to step four. Solvent weld the filter calm onto the outlet �~��r} pips. Insert the filter ,• �%•;r; cartridge into the rue.Pressing dorm until the f er locks into the bottom of �s• the cast. t; If a M switch is utUtred:insert into the ARu•and lock by hand clockwise We. n4 ,4�+ MaWmaace L The efauent Alter should be dmanad every cloy Ole septic tank Is serviced. 2. Open the outlet access opening to Inspect the tank and niter. 9• Pump the septic tank OMPimtmly,making sure to remove the sludge layer on the bottom of tta tank and net just the scum and affluent. s. Once the OM w*tevml has been lowered below the invert of tht ` cartridge pull up on the Attar handle to dislodge the S. Slide the csrtridge up and out of the cafe for cleaning. 6. If a VAS- N A connected to an alarm is present,the switch should be ran aW by turning aw te►dodmAw 90e and cleaned with water only. . 7• While holding the catb•idga ann its side(hrge Act surfau facing a down)over the access opening,rinse ON the cartridge wlth water i maft making mm an s•Ptage rnntrr W tot rinsed bad*into the tank. B. If VRS switch is utilized,replene by inserting Mo Alter and hm'ebng dockuds*ge pe. fie/ ' S. >wt back into cartridge ba in to the a",pressing down until locks We fine bothun of the cafe. I0.RmPlaea and sewn the access opening on the tank. ..:k>r rl�:E-•'J r..:i IMIL .e'•v..iW.t,v". WWWJ a W-CM 877•NLFUxM(6S34S83) ST. CROIX COUNJ'y SEPTIC TANK MAINTENANCE YiGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Addressa Property Address Sal__ (Verification required from Planning&Zoning Department for new construction.) City/State Parcel Identification Number02' LEGAL DESCRIPTION Property Location.5 4d '/4 ,.�Ld '/4 , Sec. �- , T.3�O N R,/Z W, Town of Subdivision '^ _. f ,Lot# Certified Survey Map# Co eg ,Volume ,Page# Warranty Deed# J �aZ , Volume �1�, ,Page# Spec house yes (/no) Lot liner identifiable yes no I SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintmiance 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&Zontug 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. Vwe,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 Departrrient 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. Uwe am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Numbe 5 of bedrooms SIGNATURE OF APPLICANTS) 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 Uffice and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05 n0CL:r-1FNT NO <:T:TE 8A1% OF WISCONSIN FORM a5^1982 TI-S SPA•_E RESERVE) FOR REC-On.- PERSONAL REPRESENTATIVE'S DEED VOL .- .-- . REGISTER'S OFFICE AG )�� J7 GROIX C'iY.,4J1 '. R3'�JlcrR>�.5 1 ._-G_.__?QA dma11-------•-------•---•----------------°-----------•-------------•------•--- I ............................................... -•--•- J IJ U 19 1996 as Personal Representative of the estate of Ben3amin_J,__13oardm4n______ et 9:30 Ah1 ................................................. . --....-•°-""-............................ ----------•---• [`� Dwelt. ... ("Decedent"), Cis�lsterCSCleos for a valuable consideration conveys, without warranty, to ---Elialia-q---i.s...... ... r- 73A,3.XS1mamL----------------------------------------------------------------------------------------------- ---- ---•-- -- -- -- ......................................._ .. . Grantee, '771`Rerult 7a....,.r .......................................... the following described real estate in .... -.!. r.Qlx..... .....................County, N�5TRA & VAN DYK, S.C. State of Wisconsin (hereinafter called the"Property"): 201 S. Knowles Avenue New Richmond, WI 54017 The Northeast Quarter of the Southeast Quarter (NEJ SEJ), 032-2042-80; Section Eleven (11), Township Thirty (30) North, Range Tax Parcel No: .... 2-2045-40;___ Nineteen (19) West. 032-2045-50 and ` The Northwest Quarter of the Southwest Quarter. (NWJ SW*), 026-1007-80 Section Twelve (12) , Township Thirty (30) North, Range Nineteen (19) West. The Southwest Quarter of the Southwest Quarter (SWi SWt), Section Twelve (12), Township Thirty (30) North, Range Nineteen (19) West. ;;West Half of the Northeast Quarter of the Southwest Quarter (Wj NE} SWJ), Section Three (3) , Township Thirty (30) North, Range Eighteen (18) West, EXCEPT the East one (1) rod of North Sixty—nine (69) rods and the West Six (6) rods of the South Eleven (11) rods , o£ the East Half of the Nortbeast Quarter of the Southwest Quarter (E} NE$ SWJ), Section ;Three (3), Township Thirty (30) North, Range Eighteen (18) West. i —p�yF�yE�jE EXEMPT`` .j �1 1I I( 11 Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which I� the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Dated this Representative has since.aI B .°_- day oP .--..'"��- ............................. ••............. s -.1 J 1 11 li �i ..............................(SEAL) lg_/--------- ----------- -- ----(SEAL) -- - Elaine G. Boardman ------------------------------------------------------ ---------•- ...................... `�I Peraonnl P.oDreaentative Peraonnl Itenreeentative ii AUTHMNTICATION ACIiNOVVLEDGWENT Signatures) _.E aiDe---Q, J3-QAL•d-1!4)..................... STATE OF WISCONSIN ss. •-----------------------------• County. r authentica a th�isQ_._��_rda, of---- _____ __________ 19-�_ Personally came before me this ..........------day of crfi�^�S Via. ------------•-- ........ the above named --•-----"-- ---- ---- -- Hendrik W. Van Dyk ------•--•--- ................. TITLE: MEMBER STATE BAR OF WISCONSIN °----_--__-_-•-......_------------------------- ----- I (if not, ......--•-••-------------•--•---°--•---.......... -------°- ....................... --------------------- ------------- authorized by § '70G-OG, Wis. Stats.) 1 to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED B-1 REINSTRA & VAN DYK, S.C. .......... ..... .... ....... ... ...... ... . . ... . .... ............ .. 20I 8outfi" KriowTes _4veniie _-.........__... �............. ........ _. .New..Rirahmond-, -1LZ.54-0-13--------------------- ----------- Notary Public .......................... ...............County, Wis. (Signntures play be ;authenticated or aaknowledeed. Roth My Commission is permanent.(I£ net, state expiration are not ncco .snry.) date: _.. ..- ...... ......... 'Nomen of I+—.— in a., —1--ity shnvl.l he ,>s•...I .. i.II,^•i h•]— Ih,i; i—n-r-- r k-1'1-: 1tAlt OF W'1KI nNSIN - W u.nnw 1-... In PERSONAL REPRF,SL•NTATIVE'S GEED 1.O It N1 tie. .:—1:,52 . cs _ 68='510E� Y. V L L 6 PAGE 4345 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., MI z RECEIVED FOR RECORD z� Qcxopz o 5 ;m 07-25-2002 3:10 PH CERTIFIED SURVEY HAP m"0� REC FEE: 13.00 c G)° o� COPY FEE: 3.00 uzi cn 2ih p a o F. j mrr m BEARINGS ARE REFERENCED TO THE c SOUTH LINE OF THE SW1/4 OF SECTION m 12,ASSUMED TO BEAR NW14'08"E. z x o rn A rA � O P IO;Cs ------ ------ LCQG� --- too OG9Gv1CD C3�'l PdGQ44CG3 o 00 Z �+ z 600°45'52"E 387.37' 0 ! i m m ['33a 350.79' .O Jii a z N C� m33 F Fri W D C2 G 0 Z CO co M l 1IIf i rf p s� o � m rr (� (pD loaA N oC7 O Z C W� ^^W O O w \/ O is C 119 m ; f W i1T1 IT1 tl VVIOP z W ,§ O O ° i i� o T I° IcS S N cn_ z 34.34' 350.79' O A N00°45'52"W 385.13' N m Nm � u mP��GD L&,HEO� 0 9 z [v]CD W 9 VED 8 ST.CROIX COUNTY M Z 42 4 PlarminC Zoninn and parka Committee Z i 0 m JUL 2 5 zooz m if not rec--j vlfhirl 3J days of O p Z approval dale approval 5f)71l 9e Z m c; num and void m z� • O N� ' � X o� /e-� mMzo ^y SO i O z aro°. mz L! OO2z ` Z DO n p 9 C m 0�= �$@ m Z O Z p -^ y o m Z 0 o rn w S ~2 Q z Z v Z n Vol. 16 Page 4345