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HomeMy WebLinkAbout261-1084-51-001 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572802 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: X City Village Township Parcel Tax No: Haffner Construction LLC, Robin Haffner I City of New Richmond 261-1084-51-001 CST BM Elev: I Insp.BM Elev: BM Descripupn: Section/Town/Range/Map No: QQ////)•S 1 9). 5 5 ` 02.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELIE Septic Benchmar t4� �- Dosing / , Alt. BM�� �(1 /C `C� 1.0 /0 h Bldg.Sewer Aeration Jr", IdL / Holding SUHt Inlet I� �•O5� y 5 St/Ht Outlet TANK SETBACK INFORMATION V-3 y' C TANK TO /ec/L Q WELL BLDG. Vent to Air Intake ROAD Dt Inlet r 7 Dt Bottom Septic ; i'� � l� / �� Dosing �! Header/Man. / Dist. Pipe �k ►o 2• -1 Aeration Holding Bo�t_System / 3 v ILM Final Grade 01 PUMP/SIPHON INFORMATION s ' 3 Demand St Cover Manufacturer GPM Model Number C c TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width^t Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS _S SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER O Manu�pturey^ INFORMATION Ty Of System: I I I- JS! LINI Model Number: ZD % Z ,/" ✓�vv D BUTION SYSTEM Header/ nifold Distribution x Hole Size x Hole Spacing ent to r Intake I M Pipe(s) ' Length_Dia _ Length `' Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Depth ed/Trench Center !` / Bedrrren h Edges Topsoil of xx Seeded/Sodded xx Mulched L, Yes 0 No Yes 0 No COMMENTS' Include code discrepencies,persons present,etc.) Inspection#1:�/7/ �j nspection#2: q-55' Location: :Z-�Cty. Rd.GG New Richmond,WI 54017(SW 1/4 SE 1/4 2 T30N R18W) Peninsula Hts.City of NR Lot 1 1 Parcel No: 02.30.18. 1.)Alt BM Description= 2.)Bldg sewer length -amount of cover= > `r� �t�1F B3 Ctn�au2� Plan revision Required? F Yes No Use other side for additional information. Date Insepctor's Si ature Cart.No. SBD-6710(R.3/97) PLOT PLAN PROJECT Haffner Construction ADDRESS 404 S. Green Ave New Richmond Wi 54017 SW 1/4 SE 1/4S 2 /T 30 N/R 18 W City New Richmond COUNTY ST.CROIX SYSTEM ELEVATION 91.5/90.0 4' below grade DATE 9/30/14 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 .7 ABSORPTION AREA 650 # of chambers 32 BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Cty Rd GG Scale = 1 /4'1 = 10' All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Vent ALo Quick4 Standard Leaching Chamber with 20.0 ft2 of Area �5.6ftA2/pair of end caps 2" G 34" rade at System Elevation Pro 3 3� Bedroom House Ham, t 115' S vaz B.M.* 2-3' X 66' cells with>3' spacing ' k 1 0' B-2 30' 50' 15' 96' 20' B-1 94' 30' 92' 15% Slope Property Line (` County ^ ` Safety and Buildings Division C p a 4 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) s S�;?'. Ci 2201NN Mat, 17162 Atli ,at,�. �X Gov tfiENT �� Yol twyjA-C`` 0fiary Permit Application State TransactignNpgtber In accordatt with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit �L is required prior to obtaining a sanitary permit. Note:Application forts for state-owned POWTS are submitted to Project Addr s(if different than&Y�74/Ii add ) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary �,7 purposes in accordance with the Privac Law,s.15. 1 m,Stats. I. Application Information-Please Print All Information 1 Property l�'s Name # Property Owner's Mailing Address Property Location q S j U_-,� Av-e� Govt.Lot City,State Zip Code ^ Phone Number ' Section IL Type of Building(check all that apply) '> Lot# �/+ f Subdivision Nam �}-or2 Family Dwelling-Number of Bedrooms� c ✓ D -7 ;1 6��--�L(-4� Block# C�if f 1,4!,�. It /-) ❑Public/Commercial-Describe Use ?V�� V" V�"� , ty of El State Owned-Describe Use CSM Number ❑village of ❑Town of III.Type- nn (Check only one box on sine A. Complete line B if applicable} A' ew system,,/ ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) 13. ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued ❑Permit Renewal Permit Revision Before Expiration Owner IV Type of POWTS System/Component/Device: Check all that a I Non-Pressurized In-Ground ❑Pressurized In-Ground At-Grade •❑Mount]g 24 in.of su ab1 soil �]Mound<24 in,of suitable soil G t' 1-y Gi!:It ,, G-,el 17 El Holding Tank El Other Dispersal Component(explain Pretre t Device xplain) V.Dis ersallTreatment Area Information: Des Fiow(gpd) Design Soil AppticatioryRate(gpdsf) Dispersa Required(sfa Dispersal Area Proposed s� System El vati O VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units v o New Tanks Existing Taal p Septic or Holding Tank Dosing Chamber VII.Responsibility Stateme t—I,the undersigned me responsibility for installation of the PORTS shown on the attached plans. Plumb 's Name(Print) PI er's Signature MP/MPRS Number Business Phone Numb Pr /S Plumber's Address(Street,City,State,Zip c � 2 > VI Countv/De ailment Use Only Permit Fee ,c Date Issued Lssuing. t Si afar Approved ❑Disapproved $ ❑Owner Given Reason for Denial DL Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1.Septic tank,effluent filter and �1tL` E ` Lme �C/6r_ � dispersal cell must be serviced/maintained as per management plan provided by plumber. 2.Ali Setback d submit to the County only on paper not less than 8 in z 11 inches in six as per applicable code/ordinances. SBD-6398(R. 1 1/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 9/30/14 Owner:Haff ner Construction Location: SW 1/4 SE 1/4 S2 T30N,R18 Lot 1 Block 1 Penisula Heights New Richmond 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 Cor4ingency Plan 7. Filter Specifications S et 8-10. Soil test Signature License numbe # 26900 PLOT PLAN PROJECT Haffner Construction ADDRESS 404 S. Green Ave New Richmond Wi 54017 SW 1/4 SE 1/4S 2 /T 30 N/R 18 W City New Richmond COUNTY ST.CROIX SYSTEM ELEVATION 91.5/90.0 4' below grade DATE 9/30/14 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 .7 ABSORPTION AREA 650 # of chambers 32 IL BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Cty Rd GG Scale = 1 /411 = 10' AL 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" 3 4" Grade at System Elevation Pro 3 Bedroom House 15' 115' ST B.M.* 2-3' X 66' cells with>3' spacing B-2 30' 50' 10' 15' 96' 20' B-1 94' 30' 92' B-3 15% Slope 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 To be >1' above grade 5.6ft 2 pair of end plates Finish grade elevation Typical Installation 95' Vent A Grade Vent 3' 4" 3' X=Septic 5' Long 1 5' Long 1 3619 Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 66 ' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A-91.5' B 90.0' Property Owner_ Parcel ID# Page of Boring [] Boring # n I qx Pit Ground surface elev. ` ft. Depth to limiting factor I in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 EJ 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/f? in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 -Eff#2 F-1 Boring# ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 `Eff#2 Effluent#1 =BODS>30 1220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD,130 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(R.W00) 1' , PAID j .e 1 Wisconsin oeparment of SOIL EVALUATION REPORT Page of Division of Safety and e\-" C`t O\X�GG�V dance with Comm 85,Wis. Adm. Code qty /� Attach complete sit a�r{�aper not less than 81/2 x 11 inches in size.Plan must l include,but not limit L9 cal and horizontal reference point(BM),direction and Parcel I.D. percent slope, dimensions,north arrow,and location and distance to nearest road. 1 _ fGj C Please print all information. Reviewed b Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). / ✓1^�ti �j Property Owner Property Location W,L-Wr&`L,l eo 5 �� Govt.Lot JAL/ 1/4 55 1/4 S Z, T -30 N R E( )W Property Owner's Mailing Address Lot,# Block# Subd.Name or CSM# s . ep, I City State Zip Code Phone Number jR�tity ❑villa,?e Nea st Road n N �; w' SYo r ( ) Z► (vn Construction Use:residential/Number of bedrooms `-3 Code derived design flow rate GPD ❑Replacement L ❑ Pu�b}''c or commercial-Describe: Parent material d[.[ Flood Plain elevation if applicable /V)A ft. General comments and recommendations: r System Type_ Per ' System Elevation 5 F I E4 Boring# E] 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 Z s i © Boring# E] Boring Q pit Ground surface elev. 9-� > 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 0 2 (o ® / S In y✓I y� 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) ture CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Condlpcted Telephone Number 1432 120th St, New Richmond, WI 54017 2 715-246-4516 Soil Test Plot Pla Project Name Haffner Construction Sh �i Bird Address 404 S. Green Ave ' New Richmond Wi 54017 OTM #226900 Lot 1 Subdivision Penisula Heights Date 9/30/14 S W 1/4 SE 1/4S 2 T 30 N/R18 W City New Richmond ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe System Elevation 91.5/90.0 *HRPSame as Benchmark Cty Rd GG Scale is 1" = 40' unless otherwise noted 41 �1 M. B-2 96' 30' 50' 94' 30' 92' B-3 15% Slope Property Line POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page If of � FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer: �� ❑ NA Permit# -� � )6-aeptic ❑ Dose ❑ Holding Volume:/VV-0 (gal) DESIGN PARAMETERS Tank Manufacturer: 244A Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: A1 NA Vertical Distance Tank Bottom(s)to Service Pad: // (ft) Estimated(average)Flow: 3 (gauday) Horizontal Distance Tank(s)to Service Pad: /v / '4 (ft) Specific servicing mechanics must be provided I vertical is>15 feet or Design (peak)Flow=(estimated x 1.5): ,� (gauday) If horizontal Is>150 feet. Specific Instructions to be provided on back. In Situ Sal Application Rate: /—� (gaUday/fe) Effluent Filter Manufacturer: ❑ NA Standard(Domestic)Influent/Effluent Monthly average_ Effluent Filter Model: Fats,Oil&Grease (FOG) s30 mg/L Pump Manufacturer: Biochemical Oxygen Demand(BOD5) s220 mg/L ❑ NAp Total Suspended Solids(TSS) !150 m Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer. (BODS) >220 mg/L -/NA PdA TSS) >150 mg/L ❑Mechanical Aeration ❑Peat Filter [3 Pretreated Effluent Monthly Disinfection ❑Wetland Y avera 9 ❑Sand/Gravel Filter ❑Other. (BODS) s30 mg/L / Soil Absorption System (TSS) 530 mg/L /�.NA Fecal Coliform( eometric mean) s10' round(gravity) ❑Moun In-Ground(pressure) ❑ NA Maximum Effluent Particle Size '�in dia. AA DriGrade ❑Mound ❑Drip-Line ❑Other. Other: Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) n combined sludge and scum equals one-third(A)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 earls) Inspect dispersal cell(s) At least once every: months) (Maximum 3 years) ❑ NA ear(s) Clean effluent filter At least once every: ❑month(s) NA ear(s) 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 ❑yeags) Other: At least once every: ❑month(s) NA ❑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 cracks 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('h)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:512 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 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 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: 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,sanii4ry 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 properly 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: 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 resort- 0 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 bio mat 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 f 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. Naes,m Name �c�c�w Phone �� n1�d•— ' Phone SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Names Namej� Phone �/J�O7j 7 0 Phone / r 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. F ILTEF' CARTRIDGE INSTRUCTIONS r �0 nr InstallationR STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is 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. g' 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 � serviced. y3f N � 1 2. Open the outlet access opening to inspect the tank and filter. 7 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 , r should be removed by turning counterclockwise 90 0 and cleaned with water only. II h 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. V i iVR 8. If VRS switch is utilized, replace by inserting into filter and r turning clockwise 900 � v 9. Insert the filter cartridge back into the case, pressing down until the filter locks into the bottom of the case. 10.Replace and secure the access opening on the tank. BEAR 0NSITET1 FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY Sear 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 ONSITET"Filter Case-Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workman ship during normal use for-the period or 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 n alfurctions 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,or other incidental or consequential costs. In no event shall the liability of Sear Onsite exceed the purchase price of the product. ST. CROIX COUNTY SEPTIC TANIC MAINTENANCE AGREEMENT AND OWNERSHIP CER-TTFlCAT1(-*jN'FORM Owner/Buyer_/ji-�' i - Mailing Address _---yo-41- zwo Property Address (Verification r-cA-- Froth Planning &Zoning Deparcrient for new construction.) City/State, 00 ) LEGAL DESCRIPTION Property Location„'), 'I/, S N R W,64;iw 6 Subdivisian /ZI) Lot# Certified Survey Map lttrrle Page Warranty Deed# page It Spec house es no 1-.ot lino,i identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in.its promature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, it 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§(.omm. 83.52(1) and in Chapter 12-St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning&Zo-n aig Department a certification form, signed by the owner and by a master plumber, ourneyman plumber,restricted plumber or a licensed pumper verifying that(1)the oil-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. 1/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 Department of Commerce and the Department of Natural Resom-ces, State of Wisconsin. Certification stating that your septic system has been maintained must be conipletet I and returned to the St. Croix County Pla nnulg& Zoning Department within 30 days of the three year expiration date. Iiwe certify that all statements on this form are true to the best of City/our h nowledge. I/we andale the owners)of the property described above,by virtue of a warranty deed recorded in Register of Deei]s Office. Number of bedroom S Sj(j X�j OF APPLICANT(S) DATE "**Any information that is misrepresented may result in the sanitary permit being riwoked 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) ..-----.................. --- --- ---- 155- co � lop k k r � 982 02 w °� I State Bar of Wisconsin Form 3-2003 8 1 4 7 2 8 1 Tx:4119584 QUIT CLAIM DEED 976782 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED,made between St. Croix County,Wisconsin `04/12/2013 2:41 PM EXEMPT#: 4 ("Grantor,"whether one or more), REC FEE: 30.00 and Haffner Construction,LLC PAGES' 1 ("Grantee,"whether one or more). Grantor quit claims to Grantee the following described real estate,together with the Recording Area rents,profits,fixtures and other appurtenant interests, in St.Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Name and Return Address addendum): St.Croix County Clerk 1101 Carmichael Road Lot 1,Block 1,Peninsula Heights,St.Croix County,Wisconsin and Hudson,WI 54016 Lot 2,Block 1,Peninsula Heights,St.Croix County,Wisconsin Conveyance exempt from transfer fee pursuant to Wis. Stats. §77.25(4)and transfer return pursuant to Wis.Stats. §77.255. 2b1-1084-Si-001 and 261-1084-51-002 Parcel Identification Number(PIN) This is not homestead property. (is)(is not) Dated Ao,,; (SEAL) Ca. O � (SEAL) * *Cindy Campbell,St.Croix County Clerk (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ` • authenticated on �����: �i� j ss. NBNS oix COUNTY D/ * 01ARYP sot Sly came before me on TITLE:MEMBER STATE BAR OF WAS SIN th �d9e-named Cindy Campbell J► pu8�,('j co (If uthorized by Wis. Stat. § 706.06) �i��` � no�w.. to be the person(s)who executed the foregoing `OF W�y� umerft,an�d acknowledge the same. THIS INSTRUMENT DRAFTED BY: Cindy Campbell St.Croix County Clerk *Amy J.Hans n Hudson,WI 54016 Notary Public,State of Wisconsin My Commission(is permanent)(expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. 9 1,(T1CLAIM DEED ©2003 STATE BAR OF WISCONSIN FORM NO.3-2003 Type name below signatures. Parcel #: 261-1084-51-001 10/07/2014 G 1 PM PAGE 1 OF 1 Alt. Parcel#: 261 -CITY OF NEW RICHMOND Current �X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner 0- HAFFNER CONSTRUCTION LLC HAFFNER CONSTRUCTION LLC 404 S GREEN AVE NEW RICHMOND WI 54017 Property Address(es): *=Primary * 1435 CTY RD GG Districts: SC=School SP=Special Type Dist# Description SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST Notes: SP 1700 WITC Legal Description: Acres: 0.625 SEC 1 T30N R18W PT SE SW PENINSULA HEIGHTS BLK 1 LOT 1 Parcel History: Date Doc# Vol/Page Type 06/10/2013 980201 QC 04/12/2013 976782 QC 12/30/2011 948178 TAX DEED 10/06/2000 631296 8/15 PLAT Plat: *=Primary Tract: (S-T-R 40'%160%GQ Block/Condo Bldg: *08-015-PENINSULA HEIGHTS BLKS 1/4 2 01-30N-18W SE SW 01 LOT 01 2014 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/14/2014 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.625 12,700 0 12,700 NO 04 Totals for 2014: General Property 0.625 12,700 0 12,700 Woodland 0.000 0 0 Totals for 2013: II General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 +qq +.gg qq�� 2 7'-�'iq 1 . .3�- 1114 13'-33 c3 ' FT. 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