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HomeMy WebLinkAbout040-1303-00-001 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574389 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: Cievering Homes LLC, aka Oevering Pro ertie Troy, Town of 040-1303-00-001 CST BM Elev: Insp.BM Elev: IBM Des ' tion: Sectionrrown/Range/Map No: /O V `0 DU`D fl,R L 22.28.19.1736 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark m I &- oG-P OD' V Dosing � Alt. BM-To o , rQ, /0 V• Aeration Bldg�4�C Holding St/ t Inlet SG/V I/ TANK SETBACK INFORMATION it Outlets v0 / 2 C! y TANK TO e/L ��* BL Vent to Air Intake ROAD Dt Inlet /V Septic , 1 30 I Dt Bottom Id Dosing _ Z•�r eader/ j� oY4r /DQ (o Aeration Dist. Pipe (l►'1 C Holding ste • 6� � 7 II .o �I�• 7t'G PUMP/SIPHON INFORMATIO Final Grade— • O /OZ4 Manufacturer ( Demand St Cover f z.s o y. y Model Number TDH Lift Friction Lo System Head TDH Ft y. Forcemain Length Dia. Dist.to Well _ r _ 31, SOIL ABSORPTION SYSTEM Z �, 3/• //2S i BED/TRENCH Width ► Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid epth DIMENSIONS SETBACK SYSTEM TO P/L B D WE LAKE/STREAM OACHIN Ma fact INFORMATION Type Of System: I IHAMBER R .� `���L � �.( ��.. Model Number: , DIS IBUTION SYSTEM �'4 z •t G: fa't S -- I /ls: �£` ZG�C . 'a Z -.v 'az.C'vi-j , <' 3G ��nhr anifold N Distribution x Hole Size x Hole Sp �g ent t Air Intake gt u Dia ( Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 2•Q Bed/Trench Edges Topsoil Yes E No L Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / J 4'' 1 Inspection#2: 4 E 1/4 SE 1/4 22 T28N R19 Wal ut.H�TI►Farm aka The Trib Parcel No;.22.28.19.1736 Location: 642 Tribute ParkwayLRIVERtF,,ALLS,WI,5�02Q2�(S W) , p 1.)Alt BM Description=�� 07 �1-AK - i �t ' Y?k L't, G L( 1.>> 2.)Bldg sewer length= 317 ski b! 4% C.67 I ' � -71q f) ��- -amount of cover= 4V frtcY,4A- , , Plan revision Required? [] Yes ) Use other side for additional information. L `' S Date Insepctor s Sign r Cert.No. SBD-6710(R.3197) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX SYSTEM ELEVATION 98.0/97.8/97.6 3.5' below grade DATE 9/22/14 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 •4 ABSORPTION AREA 1 137 # of chambers 57 hL BENCHMARK V.R.P. To of 1/2" steel conduit Top ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark ' Property Line Vents 3% Slope B.M.#2 ' _ . caIB-310' � i B-2 50' 140' -{ 10' 3-3' X 78' Cells Pl ase note: System may be with>3' spacing shifted to downslope towards be er soils, System elevation mq be lowered and a additional 60' bor g would be done to lower sit m elevation. �'Sots h e 1 1 B-1 64 17, 1` 15' -3 1,'' � 1L'X' (Ut;';, 13 7' Pro 3 Bedroom ��W , rn House � �� West Lot Li e All piping shall be S R 30/34,within 10' Vent of tank,piping shall e Schedule 40. >6„ Quick4 Standard f Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps ' Long 12" 34" Grade at System Elevation Tribute Parkway .J I i � -�'-->✓-lam ���� County "r s /�►�,� � Safety and Buildings Division 201 W.Washington Ave77.��P.7O�Box 7162 Sanitary Permit Number(to be filled in by Co.) Madis �L State Transaction N m* wt Q� it Application I In accordance witJltsE7� ),Wis.Adm.Code,submission of this form to the appropriate gm'etnmental unit is required prior tdbbtaining a sanitary permit. Note:Application fortes for state-owned POWTS are submitred w (-Project Address(if different these trzatltng address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary I 4 ses in accordance with the Priv Law,s.15. 1 m Stars. L A lication Information-Please Print All Information Parcel# property Owner's Name Q C L G i ! / Q _ 1 . / O _ Property location /7 ?I (h' Property Owner's Mailing Address 3 C� i Govt Lot �J City State lip e Phone Number i 4e- '/, �1/4, Sxtion 6 L cock one W TN; REQfH f B.Type of Building(check all that apply) 0 / Lot# / ` Subdivision Name ; 1 or 2 Family Dwelling-Number of Bedrooms ( � [� , f y}'u_ k L(/1-�- �X. Block# � Qv" PubiicJCbmutetcial-Describe U ❑City of Village of CSM Number e7 ❑State Owned-Describe Use f �� of C/ 111.Type of Permit: (Check only one box online A. Complete line B if applicable) ell New System ❑Replacement System Q Treatment/Holding Tank Replaoetuent Only I Q Other Modification to Existing System(explain) i B. ❑Permit Renewal ❑Permit Revision i ❑Change of Plumber 11 Permit Transfer w New List Previous Permit Number and Date Issued Before Expiration Owner IV. of POVVTS S stem/Com nent/Device: Check all that apply). �. esstaized In-Ground Q Pressurized In-Ground �t-Grad Mound Ic soil Q Mound<24 in,of suitable soil S/'CGZ; Z h C �JI Pretreatment Device(explain)T ❑Holding Tank [I Otber Dispersal Component(explain) - , V.Dis rsaVrreatment Area Information: / ds Dis Area (sf) ✓ Dispersal Design Flow(gpd) Design Soil Applie Ratc(&p f) persa! I al 6[l VL Tank Info Capacity in Total #of Manufacturer `>saltons Gallons Units U i New Tmkz I Existing Tanis ' 1� a`U m in a c. I Septic or Holding Talc Dosing Clamber VII.Responsibility State t-1,the undersigned,ass esponsibility for installation of the POWTS shown oa the attached plans. Plumber's Name(Pnnp Plum egnatttre MP/MPRS Number Business Phone Number Plumber's Address(Street,City,State,Zip Or/-✓-�I VIII, ountv/De artment Use Oni o Agent Si tie Permit Fee s ,� Date Iss ed Issu>;tb Ag pproved ❑Disapproved j/ / G;' �i- ^ ❑Owner Gives Reason for Denial DL CO&fIaTfiMfgld&1/Reasons for Disapproval 1.Septic tank,effluent filter and 'dr� dispersal cell must be serviced/maintained t as per management plan provided by plumber. `ii✓►'t` L y''' /f�`m U` 2.All setback requirements must be maintained L Attatb to comp plans dr the system and sabroirt to tlu County only oa paper not te9s than 8 ra z 7 7 iocbes in size SBD-6398(R. 11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 9/22/14 Owner: Oevering Homes Location: SE 1/4 SE 1/4 S22 T28 N,R19 642 Tribute Parkway Troy 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 Specification Sheet 8-10. Soil test Signature License 4der#226900 II PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4s 22 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX 'SYSTEM ELEVATION 98.0/97.8/97.6 3.5' below grade DATE 9/22/14 BEDROOM 3 CONVENTIONAL XXXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 137 # of chambers 57 BENCHMARK V.R.P. Top of 1/2" steel conduit ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Property e Line P Vents 3% Slope B.M.#2 cafe = 1 /4" = 10' 22' B-2 50' 140' B-310' B.M.* 4' Please note: System may be with>3' 10' 3-3' X Cells shifted to downslope towards spacing better soils, System elevation may be lowered and a additional 60' boring would be done to lower system elevation. B-1 15' 100' S 101' 25' Pro 3 102' Bedroom House West Lot Line All piping shall be SDR 30/34,within 10' Vent of tank,piping shall be Schedule 40. >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" 34" Grade at System Elevation Tribute Parkway Cross Section of Quick 4 Standard Leaching Chamber Typical i l 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 101.5' Grade Vent 4" 4' x/30/34 Septic Tank ,iv,ent 5' 4' Long 1 3 4 Grade at System Elevation 3491 Grade at System Elevation Spacing 5' 3-3' X 78' Cells Observation tubeNent Same on other end To be located on end of Cells A B System elevations: C A98.01 B 97.8' 19 chambers per cell C-97.6' Proper[YONMer Parcel ID# / page L ai 3 131 t— /L-5 Ground surface elev. ft. Depth to�factor in Soil ' ' Rate ltortzon Depth inant RedoxDesa"on Texture Structure CorWstence Boundary Roots GPDW in. unsell Qu.Sz Cont.Color Gr.Sz.Sh. `df#t *Efl#2 / o•!/ le 113 /-Fshie dS4 cw z , y . C F—] SL ! s c •S S D E I Ong# ❑ pit Graund surface etev. ft. Depth to ftW g factor Sod icatiort Rate Horizon Depth Dominant Color Redox Description Texture Shucture Consistence Boundary floats GPDff to Munsell ChL Sz. Cont.Color Ear.Sz.Sh. `EM °Eta ❑ Pit Ground surface elev. ft. Depth to nrn� or ke Soft AMIcallon Rate t tortzon Depth Dominant Calm Redox Desniption_ Texture Consistence Bamcfary Roots Ow in. Munsell Qu.Sz cat Cola Csf. Sh° 'Eff#t - 'Eff#2 Boring# Boring F-1 t s Pit Groctnd surface etev. ft. Depth to Wmling facer &r. Soft Application Rate, Hoslzon Depth DorninantColor Redvx Texture Structure Consistence Soundary Ftooft GPON IM Munsell Ou.S7-. Cola Gr.Sz Sh. `EWt 'Etf#2 e Effluerd#1=BODS> 220 ffQ&and TSS>30<160 mg1L °Effluent#2=BOD5<30 mg&and TSS<30 mg(. The Department of Comore ee is an equal opportunity service provider and employer. If you need assistance to access services or tteeci material i an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. sen-aa_�a(R<6ma1 t+lonsm bepartment of commerce SOIL EVALUATION REPORT Page � of 3 r� Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. code County 57• C-A$I Y--- •V Attach complete sib----....----..tea'---.,.__e-n..-- :_:__ rv——.—. C include.but not ft'' Parcel I.D. L vT �� ti pwcerttslope.scat EROSION CONTROL PLAN must be p�.vDi� fr— b completed before sanitary permit issuance Re ' b Da Pommel k1fbMM*M. Properly Owner r ORO) ,) Property Loca T-•00P Z3ERS T•e"f�Tf C/O �1G^' n� Grnrt LAt �!l 5 1/4 S�L T ZB N R /9 A(or)W Property Ownees Ma7rmg Address Lot# CSIM c SGAm t r � �l I A��`'(a t S CA MLcAv.2 • 't4/A'/, o` C*Y --tAIMR State Zip Code Phone Number ❑City ❑Village W Town Nearest Road trlPo�� EfT; MAl 5S07CP ( &51)ay8. 1DfF T-Roy so. erlou6R 0 P1 New C inshm*on Use 0 Residential/Number of bedrooms Code derived design flow rate � � Da GPD ❑Replacement ❑IPt�u"blic or commercial-Describe: –;7� ,--- t Parent material 1,0E-5S' 4V— SAVOY 042'10 Flood Plain elevation if applicable ft. General comments and reoommendatiorts: e 4A-:',rt- 7AT Boring N ❑ Boring Z- # ® Pit Ground surface elev. /0/. ft. Depth to limiting factor �O in• saa Application Rate Horizon Depth Dominant Color Redox Description Texture Shkj" Consistence Boundary Roots GPDJfft b in. Munsell Qu.Sz. Corti Color Gr.Sz.Sh. 'Eff/f1 'Eff#2 / 0• / /oW 31 — T i w • s • k 3 o Borkv# ® pit Ground surface elev. r o,• ft Depth to limiting factor� ut ~ Sol lir�tion Rate t^ Horizon Depth Dominant Color Redgx Description Texture Struchrce Consistence Boundary Roots GPDiffz in. Munsell Ou.Sz. Cont.color Gr.Sz.Sh. 'Etf#1 'Eff92 (� D•13 io s/3 f-jh1 df4 w Z • 5�` - N a 13-l F to f �K d54 �- • 3 N Z12 Merit#1=BOD >30:5 220 mglL and TSS>30<150 mg& 'Effluent#2=BOD <30 mg&and MS 130 mglL CSTiVirnber csr Name( Print)R•-u 1Z R i G iT Signature t`�2 G.S7 5 Adams Uibricht &Assgciates bate Evaluation 77N y3y Z 7 • Private 2812 10th Ave. Spring Valley, WI 54767 caw wnw � S amend J �/ J .(/n/fa/Xr1� °�Ut ' /off s • SD ' � $ /O Orm oy0 /o*( ?o • ozo oyo - /ong - & - Mo PLOT PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3 Contour elevation lines. • = Backhoe Soil pits. O = Benchmarks set, maRRED WITH FLAGGED lathes. 1/2" steel conduit pipes. � r r P �'� (0 � SCALE: 1 " _ N a• Lo T GrN..�--- 717, z /O v 53 1 /n-1 . (z� &6 3 67O /©!o ' tlUT L 1� 3 J POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page at FILE INFORMATION SYSTEM SPECIFICATIONS Owner ( Tank Manufacturer/ ❑ NA a I Permit# r� 7 eptic ❑ Dose ❑ Holding Volume. �(9 ) Tank Manufacturer: 'O NA DESIGN PARAMETERS Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: NA Vertical Distance Tank Bottom(s)to Service Pali: J (h) Estimated(average)Flow: ---50 > (gal/day) Horizontal Distance Tank(s)to Service Pad: (ft) Specific servicing mechanics must be provided if vertical is>15 feet or Design (peak)Flow=(estimated x 1.5): e/ _12]) (gal/day) if horizontal is>150 feet. Specific Instructions to be provided on back. In Situ Soil Application Rate: (gaUday/ftZ) Effluent Filter Manufacturer: ,ari9�Z_ ❑ NA Standard(Domestic)Influent/Effluent Monthly average Effluent Filter Model: Fats,Oil&Grease (FOG) 530 mg/L Pump Manufacturer: A Biochemical Oxygen Demand (BODs) x220 mg/L ❑ NA Pump Model: Total Suspended Solids(TSS) s150 mg/L High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L - / Manufacturer: NA (BODs) >220 mg/L /�``, A ❑Mechanical Aeration ❑Peat Filter SS) >150 mg/L ❑disinfection ❑Wetland Pretreated Effluent Monthly average ❑Sand/Gravei Filter E]other: (BOD5) s30 mg/L Soil Absorption System (TSS) 530 Fecal Coliform(geometric mean) 00'm�L r vrade (gravity) ❑Mound and(pressure) I] NA / ❑At-Grade ❑Mound Maximum Effluent Particle Size '!I)in dia. ❑ NA ❑Drip Line ❑Other: Other: NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) hen combined sludge and scum equals one-third('h)of tank volume P ( n the high water alarm is activated months) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: ar(s) onth(s) Maximum 3 years) ❑ NA Inspect dispersal cells) At least once every: 5 ears) At least once eve l C month(s) ❑ NA Clean effluent fitter every: ❑month(s) NA Inspect pump, pump controls&alarrn At least once every: ❑year(s) Flush laterals and pressure test At least once every:. ❑month(El yeaarss))r( ) NA Other: At least once every: ❑month(s) NA C3 year(s) 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 tracks or leaks, measure the volume of combined sludge and scum 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 ('f)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 servicing of effluent filters,mechanical or pressurized components, pretreatment units, and any servicing at intervals of 5512 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(02/05) Page !i of C/ START UP AND OPERATION her For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products,igh concentrationstarre chemicals or sediment that may impede the treatment process and/or damage the soil absorption system 9 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-discharged 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 situation have the contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to the 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 the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge,fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps,medications,oils,painting products, pesticides,sanitijry 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 grope y and safely abandoned in compliance with s. Comm 83.33,Wisconsin Administrative 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 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: 7A 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 r wth the rules need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply 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 resort. ❑ 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 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 Name / J Phone Phone -� SEPTAGE SERVICING OPERATOR PUMPER LQCAL REGULATORY AUTH RITY r �— N y� Name Name Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Bayer___Oe er.' 4 Mailing Address A Property Address­ (Verification required from Planning ung tniction.) City/State g zo for Identification Number Oyo-)3?. -� tJ0 — LEGAL,DESCRIPTION Property LOGation3,E V4, Sec. 2 2—, T N R Y Town ol Subdivision Certified Survey Map Volume A— Page# Warranty Deed Volume -------- Page# Spec:house yes no Lot lines identifiable.Ono SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance maintenance consists ol,pumping out th of Your septic system could result in its premature failure to handle wastes. Proper the e septic tau every three years 01'Sooner,if needed,by a licensed pumper. What you put to responsibilities affect the function Of the Septic tank as a treatment stag,ill the waste disposal System. Owner maintenance arespecified 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 turn.4 Signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying tiiat(1) wastewater disposal SYStern 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, the on-site I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fijrth,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 Pla ing& /oiling Departlilent within 30 days Of the three year expiration date, nn I/we certify that all statements on this form are true to the beat Of MY/our knowledge. I/we arn/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 6�NATUP-4— ***Any information that is misrepresented may result ill the sanitary permit being revoked by the Planning&Zolling Department. Include with this application a recorded warranty deed froul,the Register of Deeds Office and a copy of the certified survey map if ref6rence is made in the warranty deed, (RF.V.08105) FILTER CARTRIDGE INSTRUCTIONS Installation he end of the outlet pipe to ensure it is STEP 1 Dry fit the filter case onto t P P centered under the access opening. If not,then either insert more pipe into the tank through the outlet or solvent weld (glue)additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 900. Maintenance 1. The effluent filter should be cleaned every time the septic tank is 4�i+ gq�r 'i' iafi 71'" + ri serviced. �a 2. Open the outlet access opening to inspect the tank and filter. 3. Pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe,firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. 6. If a VRS switch connected to an alarm is present,the switch should be removed by turning counterclockwise 900 and cleaned with water only. ; 7. While holding the cartridge on its side (large flat surface facing .; down) over the access opening, rinse off the cartridge with water only, making sure all septage material is rinsed back into the tank. 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 90°. 9. Insert the filter cartridge back into the case, pressing down until o the filter locks into the bottom of the case. ' 10.Replace and secure the access opening on the tank. BEAR ONSITET"FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY Bear onsite filter cartridges are warranted to be free of defects in material and workmanship for five(5)years from the date of consumer purchase. BEAR ONSUET"Filter Case-Lifetime Limited warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the pe'"told of time the original purchaser owns the product. If a defect is found in normal use,Bear onsite will,at its election,repair,provide a replacement part or product•or make appropriate adjustment.Damage to a product caused by accident,misuse,or abuse is not covered by this warranty.Improper care or malfunctions resulting from units not installed,operated,or maintained in accordance with instructions provided will void the warranty.Proof of purchase(original sales receipt)must be provided to Bear Onsite with all warranty claims.Bear Onsite is not responsible for labor charges,removal charges,instailation,oi other incidental or cvnsequental costs. In no event shall the liability of Bear Onsite exceed the purchase price of the product. ffil Ig I I I III II IIB IIIII 8194391 Tx:4161632 STATE BAR OF WISCONSIN FORM 3 -2000 988962 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and Oevering ST. CROIX CO., WI Homes,LLC,Grantee. 11/12/2013 2:46 PM Grantor quit claims to Grantee the following described real estate in St. EXEMPT#: N/A Croix County,State of Wisconsin(the"Property"): REC FEE: 30.00 TRANS FEE: 636.90 PAGES: 2 Properties sold`as is'. SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Title One File#20076 Together with all appurtenant rights,title and interests. see attached Parcel Identification Number(PIN) This is not homestead property. Dated this 8th day of November,2013. Citi State Bank * ene Haberman,Vice Chairman * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. )ss. authenticated this 8th day of November,2013 Personally came before me this 8th day of November, 2003 the above named Citizens State Bank to me known to be * the person(s) who executed the foregoing instrument and TITLE:MEMBER STATE BAR OF WISCONSIN ac r ed the same. (If not, e......... authorized by§ 706.06,Wis. Stats.) PvQ Jae er THIS INSTRUMENT WAS DRAFTED BY NOTpgy'•. ; Notary Public,State of Wisconsin My commission is permanent. (If not,state expiration date: PUBLIC..: 12/11/2016 ) Michael H Forecki,Attorney '•;��,;_••• ,.' (Signatures may be authenticated or acknowledged. Both are not n* *Names of persons signing in any capacity must be typed or printed below their signature 1 of 2 QUIT CLAIM DEED STATE BAR OF WISCONSIN FOPM No.3-2000 File No.: 20076 EXHIBIT A Lots 1,6,30, 34,41,64,and 71 of Walnut Hill Farin,Town of Troy, St. Croix County,Wisconsin. Lot 41 of Walnut Hill Farm,Town of Troy, St.Croix County,Wisconsin; together with driveway easement over lot 42 as shown on said plat. PIN 040-1303-00-001; PIN 040-1303-00-006;PIN 040-1303-00-030; PIN 040-1303-00-034 ; PIN 040- 1303-00-041; PIN 040-1303-00-064 PIN 040-1303-00-071 i 2 of 2 qw 0 OD co '7 '' ` i Looe Eom* j i I mi OIWM a� - A-W AqW F; ks Em j TULU Rol man air sir ^ g � i o i