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HomeMy WebLinkAbout026-1012-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: $t. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572842 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)]. Parcel Tax No: Permit Holder's Name: City Village X Township 026-1012-10-000 Nutzmann, Raymond & Beverl TRUST Richmond, Town of CST BM Elev: Insp.BM Elev: BM Description: ` Section/Town/Range/Map No: 04.30.18.43B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r`d►� CAPACITY STATION `B eE Septic I Benchmark A ND� v Alt.BM —7.4 Gag Dosing / �(, / APr^tine L�O Bldg.Sewer rtt �� 7 St/Ht Inlet 3,3 9 Z. f Holding St/Ht Outlet TANK SETBACK INFORMATION TANK TO �P�� WELL BtLDG a it Intake ROAD Dt Inlet Septic Dt Bottom �3L 57 Header/Man. t� Dosing / /3L1 7 7 t Dist. Pipe Aeration Bot.System Holding Final Grade 5.D PUMP/SIPHON INFORMATION J + Manufacturer +f ` Demand St Cover/ ( 7. 4 ZO Qi`! -� GPM (�i loo qp / Model Number �� Z�� 3 O V 3 3 TDH Lift Friction LOSS System He d TDH Ft (. Forcemain Length / Dia. Dist.to We11 j 3 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No.Of Trench PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth . DIMENSIONS 1:4 q/ `_ P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK SYSTEM TO CHAMBER OR INFORMATION Type f ste r UNIT Model Number: \� S i� �3Z DISTRIBUTION SYSTEM x Hole Spacing ve to Air Intake Header/Manifold Distribution it x Hole Size 5 p ✓ ^ Pipe(s) Z Length Dia Length V 1t, Dia _ Spacing_ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only J Depth Over Mulched Depth Over xx Depth of xx Seeded/Sodded xx Topsoil Yes 0 No Yes No To Bed/Trench Center .3 Bed/Trench Edges �\ p l COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: t/ / 7 / Inspection#2: / / Location: 1136 Hwy 64 New Richmond,WI 54017(NE 1/4 NW 114 4 T30N R1 8W) metes&bounds Lot CIa __ nn Parcel No: 04.30.18.436 I Did 0 �l: 04. n�1. Alt BM Description � P V 2.)Bldg sewer length= 167 -amount of cover= � n _ 6jGq,w O J� w 1 Z o � ko(2l _ Plan revision Required? [] Yes Celt.No. l C � ` ' --- Use other side for additional information. Date Insepc rs SiAe SBD-6710(R.3/97) PLOT PLAN PROTECT Ravmond Nutzmann ADDRESS 1136 Hiahwav 64 New Richmond Wi 54017 NE 1/4 NW I/4S 4 IT 30 NIR 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 98.4 10/21/14 3 DATE BEDROOM AT-GRADE XV IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none IL BENCHMARK V.R.P. Bottom of shed siding ASSUME ELEVATION ISO, Fisher BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall,be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Scale _ 1 /4'1 = 10, Property Line 98' 98.4' 99' D B-i 1.3 Acre Parcel Area 15' below system 3�Slope is to remain Shed undisturbed Wei I 0 Existing 3 Bedroom House B-2 ST Huffcutt Combo Tank OW Old system is to be Grads ng is to be done to pumped and buried divert run-off array from system Tank is to be properly bedded and provided with lockdown covers with approved warning labels Line (D, Property Line Highway 64 Property Safety and Buildings Division County�� 1 V X { I 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) $ Madison,WI 53707-7162 State Transaction Number i �O �.Vpfary Permit Applicatio a� 3-7 th accordance with SPS ,a sanitary_Wis.Aden Code,submission of this fium to the appropriate governmental unit is required prior to�airli�'a sanitary permit. Note:Application forms for stake-owned POWTS are submitted to Project Address(if different than mailing address) the�p Of gl_ i3nd Professional Servies. Personal information you provide may be used for secondary oses in actor with the Privacy Law,s.15.04(1)m,Slats. L A lication nformation—Please Print All Information / Parcel# Property Ow�n�N*ame _ Property Location Property Owner`s ling Addres � (/ j Govt.Lot rp Code Ph on ,e Number Y ;:,Q 2v' , Section City,State cle n 0/ T3 y N; R W '� Lot# 11.Type of Building(check all t apply Subdivision Name Family Dwelling—Number of B /yl Block 1 acst.�.e 0 Public/Commercial-Describe Use ❑City of CSM Number ❑Village of 0 State Owned Describe Use wn Q{ �Z c III.Type of Permit: (Check my one box on line A. Complete line B if applicable) A. y 0 Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System(explain) New System acement System t; ' List Previous Permit Number and Date Issue B. 0 Permit Renewal 0 Permit Revision ❑Chan ge of Plumber [I permit Transfer m New Before Expiration IV.Type of POWTS S•stem/Com onent/Device: Check all that a l dam. r I ❑Non-Pressurized In-Ground El Pressurized In-Ground At-Grade ❑Mound>24 in.of suitable soil 0 Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain ❑Pretreatment Device(explain) V.Dis rsal/Tre ment Area Information: Ir Dispersal Area Proposed S cm Elevation Design Flow(gpd) Design Soil Application Rate(gpds Dispersal Area Required(E l 1 po ( J� Capacity in Total #of Manufacturer u c VI.Tank Info Units Gallons Gallons �° v F-New Tacks Existing Tanks t, 9 Septic or Holding Tank i Dosing Chambc j VII.Responsibility Statement-1,the undersigned,assu esponsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' ature MP/MPRS Number Business Phone N ber 2� vv l� Phmt s ddi ess(Street, rate,Zip Code VIII.Countv/De artment Use Only ,,�+ Per/mi^t�Fee Date �sue j� Issuing, ent Signature PProved iven a $ 1111 G� Cib w riven Reason for Denial DL Condi{iS asons for Disapproval / s /�(J(6� f. 9600 tank,efthAant filter and 3 `�"'� i rr!i dispersal cell must all be services 1 malhtO-129 �� � �� I Cir— LA-0 1 '(-t^''^� �µ� ° as per management plan provided by plumber. 2 Ap seWack afks,r�ust bEr: nainta ie� �/ L ' 4b �a K n pK appikablacode/ordlrtancss. T Attacb to complete ptans for the system and submit the County only oa pa not less th R tn-z t inches in sic SBD-6348(R. 11111) SHAUN R BIRD Page 2 11/4/2014 • The system was designed to meet the influent quality defined in SPS 383.44(2)(a) The quality of influent discharged into a POWTS treatment or dispersal component consisting in part of in situ soil shall be equal to or less than all of the following: 1.A monthly average of 30 mg/L fats,oil and grease. 2.A monthly average of 220 mg/L BOD5. 3.A monthly average of 150 mg/L TSS. • SPS 383.54(3)(b)(b)The servicing frequency of an anaerobic treatment tank for a POWTS shall occur at least when the combined sludge and scum volume equals 1/3 of the tank volume. • The inspection,maintenance and servicing reports shall be submitted to the governmental unit within 30 calendar days from the date of inspection,maintenance and servicing. • The owner is responsible for the operation and maintenance of the private onsite wastewater treatment system (POWTS)in accordance with SPS 383 and the approved management plan • The owner of a POWTS shall be responsible for ensuring that access opening covers remain locked or secured except for inspection,evaluation,maintenance or servicing purposes. • Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Provide a copy of the approved POWTS plans and this letter to the owner. • Prohibit vehicle traffic and soil disturbance within 15 feet of the downslope edge of the mound pursuant to"At- Grade Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10854-P(N.03/07,R. 01/12). • Insulate 4"0 conveyance pipe as necessary pursuant to SPS 382.30(11)(c),W.A.C. • Install cleanout(s)as required in 4"0 conveyance pipe pursuant to SPS 3 82.3 5 (3)(b)L,W.A.C. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 _Z� This Amount Will Be Invoiced. Z 0 When You Receive That Invoice, Edwin A Taylor Please Include a Copy With Your Wastewater Specialist,Integrated Servi s Payment Submittal. (715)634-3484,Monday-Friday 8:00 am To 4:30 pm WiSMART code:7633' edwin.taylor @wisconsin.gov otirnxTM F� DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD o " HAYWARD WI 54843 9 Contact Through Relay wv4w.dsps.wi.gov/sb/ 9Z www.wisconsin.gov �O 'ssION�� Scott Walker,Governor Dave Ross,Secretary November 04,2014 CUST ID No. 226900 ATTN.•POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/04/2016 Identification Numbers Transaction ID No.2473726 SITE: Site ID No. 807560 Raymond Nutzmann Please refer to both identification numbers, 1136 Old Hwy 64 L above,in all correspondence with the agency, Town of Richmond St Croix County NE1/4,NWl/4, S4,T30N,R18W FOR: Object Type:POWTS Component Manual Regulated Object ID No.: 1510288 Maintenance required; Replacement system; 450 GPD Flow rate; System(s):At-grade Component Manual,Version 2.0, SBD-10854-P(N.03/07,R. 1/12),Pressure Distribution Component Manual-Ver.2.0,SBD-10706-P(N.01 101,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.A-ECORRES" P P.O.W. stats. The following conditions shall be met during construction or installation and prior to occupancy or use: AV vok • A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on with the Department. Changes to the approved plan must be submitted for review and approval. Failure to properly attach the approval and index page to plans that match the copy on file with the Department may r in enforcement action under s. 145.10,Stats. • This system is to be constructed and located in accordance with the approved plans,and the"At-Grade Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10854-P(N.03/07,R.01/12). • This system is to be constructed and located in accordance with the approved plans and with the"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0"SBD-10706-P (N.01/01). • Prior to construction of the dispersal area,check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil.Proper soil moisture content can be determined by rolling a soil sample between the hands.If it rolls into a 1/4-inch wire, the site is too wet to prepare. If it crumbles,site preparation can proceed.If the site is too wet to prepare,do not proceed until it dries. • Abandon the existing system components per SPS 383.33 SHAUN R BIRD Page 2 11/4/2014 • The system was designed to meet the influent quality defined in SPS 383.44(2)(a) The quality of influent discharged into a POWTS treatment or dispersal component consisting in part of in situ soil shall be equal to or less than all of the following: 1.A monthly average of 30 mg/L fats,oil and grease. 2.A monthly average of 220 mg/L BOD5. 3.A monthly average of 150 mg/L TSS. • SPS 383.54(3)(b) (b)The servicing frequency of an anaerobic treatment tank for a POWTS shall occur at least when the combined sludge and scum volume equals 1/3 of the tank volume. • The inspection,maintenance and servicing reports shall be submitted to the governmental unit within 30 calendar days from the date of inspection,maintenance and servicing. • The owner is responsible for the operation and maintenance of the private onsite wastewater treatment system (POWTS)in accordance with SPS 383 and the approved management plan • The owner of a POWTS shall be responsible for ensuring that access opening covers remain locked or secured except for inspection,evaluation,maintenance or servicing purposes. • Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Provide a copy of the approved POWTS plans and this letter to the owner. • Prohibit vehicle traffic and soil disturbance within 15 feet of the downslope edge of the mound pursuant to"At- Grade Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10854-P(N.03/07,R. 01/12). • Insulate 4"(d conveyance pipe as necessary pursuant to SPS 382.30(11)(c),W.A.C. • Install cleanout(s)as required in 4"0 conveyance pipe pursuant to SPS 382.35 (3)(b)1.,W.A.C. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Edwin A Taylor Please Include a Copy With Your Wastewater Specialist,Integrated Servi s Payment Submittal. (715)634-3484,Monday-Friday 8:00 am To 4:30 pm WiSMART code:7633 edwin.taylor @wisconsin.gov Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/21/14 Owner:Raymond Nutzmann Location:NE1/4 NW1/4 S4 T30 N,R18W 1136 Highway 64 Richmond Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01101) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 1 ly 6. Pump Curve 7-B. Maintance and Contigency plan C OMt0,ERCE 9-11. Soil test p Q BUIL c 12. Filter Specifications Shaun Bird Signature License number 900 PLOT PLAN . PROJECT Ravmond Nutzmann ADDRESS 1136 Hiahwav 64 New Richmond Wi 54017 NE 114 NW 114S 4 IT 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 98.4 DATE 10121/14 BEDROOM 3 AT-GRADE )X IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LEFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P, Bottom of shed siding ASSUME ELEVATION 100' Pinter BEAR P11ter ❑ BOREROLE (D WELL *H.R.P. Same as Bsnchmark All piping shall be SDR 30134,within 10' of tank,piping shall be Schedule 40. Scale _ 1 /4" _ 10 Property Line 98' 98.4' 99' D B-1 1 .3 Acre Parcel 3%Slope Area 15' below system Shed is to remain undisturbed Well 0 B.M. Existing 3 Bedroom House B-2 5T Huffeutt Combo Tank DW Old system is to be Grading is to be done to pumped and buried divert run-off away/ from system Tank is to be properly bedded and provided with lockdown covers with approved warning labels Property Line Property Line Highway 64 At-grade System Sloping Site Cross Section and Plan View r + Dimension Feet E ' • ■ ., I • •Y y yay■y■y■ti•4 y'L.4rL-■..L■ti-�-t•4•'••:tir}!���1i fi1•t+•�}r•J}r�'ti:,••r4:L:■s•J4 y■4 L.4 ',�...1.�J•l■ J•l■l■J•J t■l J■J��ti.3-L•L ti•ti L• ■y.'.4. }•��■Y4•ti■4•L•yti•{y■ti■�,�Y• �'•�! d.1�J■J■�■l■1•r•,L■f f r. •f�r•r.}r•1 l 1 J•r•r-r•l.l r-J•l.l■!1,J•l■ •i1ti+1r1�S�1�y�•YL-*••••'�.4-tir4■ti- I •■y.L■ti-v■ti■}4• 'p vL ti ■�4f}j}�;r�r}r j}J■r.�•l■l■l■r j•l■l■1 j,'ritiiSJ'Li}itiil�i • ■ J r■r r■1■1r■r r�• 4•L•3 �•'•y I J•� J• v.ti v.3 L•;•tirti ;}';i4fb Lrti"rtirL,r�l r■�•f-1 :tir•}■IIk'. 1 y■}•S•'y'4• Cti�Yy�%"r4f�a}tirLrti.}.ti} :'■Ct;1}l}rU■rSilir.'��Jr} ■ti I 1/6 B •r.1.1•�;•�•; •�";7.;.'L1''yry:tiY!r'4'rti j2.. f�ti•:1.'1��■ri%_ w% 'f'Lf■ y■y■}r4 1 L 4 L■ • • t■'�■J■Cj ar S,.L■LryrL}■ti ti ■ l■r•J•1.1}J■l■r J, !•r■t{14■ 4•S• L■YL•L ti■•■aLa'�•�-�.•tir�■1■J.d•r■j.1!r �r■l•1•r•J•l•J J•J■t• •1•J J ■ A I �+SiyjL�L v■L.L■4■L■L•ilriJyJ r:r■1 ■ ■ , !7. 1■r•j■d■r•r•r•r r•d•J •S■ yF4•tia3■4 Ll}l�i���LfRltif:f}�•�1iJ'ifify�}��J~r• t ■y,t,L•yr aLrti■�•yaL•L.i.S■ �l•rr-J•j•l•+�•1■• • aL■� L 4■1.4■4•L■y�L■i•••••■}•}•L I l■r■}•J■r} r■rr •1■r•1 NrJ• }!•�■r"1 J•lr!■r+r,l.l l■t•l 1 1• JJ • ■ v.ti■y4•} L.4 L ti■yr S•L•3•L tigiL•S■S L•ti S■L�,■y� r•`•L■•■ •j i t i• }1 l•r.�J- �itir J•�■, .°��y:'Lr�i•a�-S?•arSrl��i���r4f■■Lry:�r3��L�'L'•■'1L''r.�•r•1- 1 ■ a ■S■4■4.Lr3j�■4 ■r.J•J■�j. ■j.!■j•j■,�■laJ■J•J•r•r■J r+;■■ r J•r,L{'• 4■L�• •. ti i •L■L} �' S. I igitifiS■SaS■S•1•S L .S•4•L■k■Sa3•L•trLayS•� Ll~�■f�JsJ}i rr■1■J'+�1'f "j•r■�•r-1 I l•r-l•lrr•�■l.l■1+1rlar■J J•.ayi1■��ryj{jy1:,14fa ■ • • . r■raJ J• ,] r tir}■iL•S!S-L•La■r 3 L•ti•}■3■L-tis.Sr}I} }i V.5 •L•'■ •S"}i■}■i■3.'Nl 4�tij���.LJ.J.l•r!-l•l■r l■l■rrJ■r�SrS�,Yf;1■r•.■■S.y-R.a3•S I t. ;r 1.}}l■r Jtii�.iS.ftiitii3l• ti■3■+i ■L■L■r.■4.y 5.� y■ya r3.4•} r■J. �■r• l■}• l.l.r.r. 1■l• l.l■l}l■l J•l•1■1 �'h�•■ S.-••r�■�•S I G I.0 ■ti'••ti•:}}j■r.r.r.r"r.�}f•r.r,r• .ti.3rL'�•L•�.ti'�L.y.ti.y.�r■�rtL 3•;• r.r7l.r.r,r•J• I ' �S •.■ti■ ■S■S��L■3■S■•■■L ■ ■ r �'.rY-l.l.f■l.l•�� • • ■La4■1� �}ji��J■}•d'j■!+ l�ti���'ti■r�il'Lrti�ti�L-ar�ti■Wtir4•S■tir■L■tia4• ■L■ti■1,L ■L+4"a I 3■�■S•SaY1.-4- L E �ti _ 1/6 - - - - - - -- - - - - - - - - - - —� E Slope _ L I– =Plowed MA =Clean aggregate � =4 in. sch. 40 pvc I basal area Ack 1/2 to 21/2 in. dia. observation pipe L _ .A Lateral with 2" Topsoil Cap aggregate over pipe Observation Pipe Geotextile wG:�:i: ��'," '' '; With Can Fabric •;.�M1V��ryi, ��<�•:�, :-�"�tv+tt�Y�1'�,°Y�wr� rf�1fi?;���' . Ft Lateral Invert •r.r 1J t y.L.y.•y. L• Q ti��, ,;. Topsoil Cap r�.. J j•l•!■1�,r rr:{iJrJ�riJ:J-r6 j e)`:.�.�.3 :4•n,,au q. S■1 ryry■L■L■fi.4•y ■}■}•S'rti■'■■}';r�-•■• ■ .P'S '4 ;',�4'.�ik•a�'NR� �r�,• l■lN'•t•j l■l.l.r• J J l.� J J l�'■ J■J;.r ' r'� � V 4•� r'1 ��i ' • v■v■ti.S•L 4■L �` y.}•4r}+tij�•1�;,r'-■•r;■fi�"J�1y1-_._ �I ��is rry ���'r,�S' '" �ie -a . .J J•l l r l• r 9 Ft Contour ti■�.ti.� �■a.4 01, a JCjilirirr t jrl■ •J r .;•fir eve :rr■ ■ !{..•' �••, I` ; D Plowed Surface C Slope Direction ` 110.. GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil 'is wet enough at the plow depth to form a 1/4 inch soil wire when a sample is rolled between the palms of the hands. The.A,x B area is covered by clean aggregate deposited overhead by a backhoe. Special -care must be used when placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative, growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place, 03/05191 Page of pressure Lateral Layout One Lateral — End Manifold .0---Tkreaded Cleanout Lateral Turn-up —♦ plug Force Main X ---� L Long Sweep 90 Bend Pressure System Construction Distribution Network S ecifications Lateral Diameter -7 Tin. Laterals are constructed o�Schedule 40 PVC Orifice Diameter In. pipe orifices a are drilled b t and fare down. � the pipe with a sharp X Orifice S acin Lateral tum-ups tenno:imte with a threaded L Lateral Len ki Ft' � Iri. clea:oout plug and are enclosed in a 6-8 inch Force Main Diameter Sv I diameter lawn sprinkler valve box accessible Force Main Len h from 1;Inished grade. • • • • • • • • • • • • Crrade 6-8 Inch Lawn Sprinkler Valve Box i 03/051gj Page of^� • ornance Specifications Septic-Dose Tank Cross e ction And pip pe tuner - P e s2 Tank 1Vlamxfac'turar p Model Number /U --� Tank lviadcl NUmbCr 4 AIUM MarnAfMGUFW Total ankank CTcY 6 3 Alarm Model Number G- ��y���, ,y T Ma.•Bur `W � Switch Typo Tot ynamic)land(TDH)�Feet Filter Mode!Num er �'�• �ge �� ss ' -1It1 gub1�1�erfbrnnaucg �]CP14/L Q Ft TDH ��. Outlet!Manhole Min,4r Above Grade With Man�le Locking D Above GMda Y,coking De4ice. Inlet Manhole Securely Mounted <6"Below C1c0de Sealed Watertip:ht Weather-proof 1 Junction Box .. Finished Grade _� T Vot Min. 12" Disconnect Above Grade Means with Vent Cap r• '►:Ja :•Li• :ri i.; •.F•.:;.�di lj.•� 'i r{'i ..1 ',.outlet Fitter ----- 'at et Baffle Inlet Inl r A :ti Yll a and Reserve Capacity Weep;witch$ ' Ted Vohune GPI : Hole a,r; H Inches Volume Dirtteneion Gal• . off Elevation C arm) B 2 30` ; . ' C . .S~ 7.� if ..�..r► Bottorr (dose) Elevatic dam,) D 3� D Total 6 i -r--r a. <1`. i.'r i'e Y r'••••r r r . . ' ii:. t�'i:•'r'• ,i•r4.'.�rS'.'.Y:.Y.iY�•i`::r,�i:as��:>S�S��.i.-Xr;.� ti;iYti�►i ti.5••a l<!r•. f•a •. GMRAL INSTAL' I ATION: The sepdddoee tank is bedded and back fted in accord r may of manufaeturees product approve!specifications. Maximum depth of bwy as spaWW by the X e � ,� ��Nz ee,�wW to grade hsve an effective looking device(padlock) be installed. Piplug at tho inlet and ouklet is of approved material, connected to the tntdc with waioertigirt fi[ting9, and bridge the tank ntiain is sleeved with 4"Sch.40 PVC laid on stable soil to prevent settling or sagging. The forces to excavation and the sleeve is sealed vmtetitight Electrical service complies with NBC 300 and Comm 16.28. 02105 L1' Page of TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING HEAD CAPACITY CURVE MODEL 152/153 ,s3 52 ( 1d00tL i N Feel NieLers Gai. titers I Gal. raters 50 ' I 69 251 77 291 5 1.5 ]53 I 10 3'' 61 231 I 70 265 15 4.6 53 11 201 61 231 12 40 152 0 6 1 44 167 52 197 2 25 7.0 34 129 I 42 1 159 1 30 30 g ± 23 87 33 125 ' 65 I 22 r t1 42 20 40 1 E,2 1 4 ' LOCK Valve: 35.0 `l. ;t, E't)I44.0 C2 v fit• ('3krn) � , oture 4 10 1 0 40 60 80 100 zo 6 ,ia L GALLONS LITERS O SO 160 240 320 - 3 27/32-1 - a 5/9 I"LOW PPR MINUTE i 3 2 7/32 { i CONSULT FACTORY FOR SPECIAL APPLICATIONS , 27,32 Timed dosing Panels available. •Electrical alternators,for duPIM sy stems,are available and supplied with � I an alarm. y variable level control switches are available for controlling single phase l 1 systems- -Ff 1 Double piggyback variable level ftaat switches are available for variable I I level long and short cycle controls. Sealed CWk_BoX available for outdoor installations.See FM1420. , I 1 •Over 130°F.(54°C,)special quotation required. 12 it's n. 1521153 S®Gies C ntro Sol io 5 1/8 ex 3 lAOOEL SI I pu lax l I Model t/oKs.Ph Mode B r ! _ sxaoas S t N152 115 1 8.5 InUu3ed 2 or 3 9N152 119 1 AM E152 230 1 an 4.3 1 2 a 3 N 8.3 Inclead 2 or 3 BE152 230 , Auto A.3 3 ss_l.�cT1o>v GUIDE N153 113 1 Non 1D.5 lncluied 2or3 back variable levelflaal 9NIS3 116 1 Auto 5,3 1 2 or 3 1. Single PI49ybar k variable level fbat switch prdouDle ploy beck 230 1 Mon 5 3 I�uded 200 3viteb. Refer t0 FM0477. BE163 230 1 AuW 2. See FN14712 for oorrerx model of Electrical Alternator r:-Pak du � 3 a,t:J1UTION on o1 controls,t�ro�0"devlce5 and NIMp ghoul ow dd nclud ng+*,e m n 3. Variable level cronvol swfuh 10-0225`r9ea as a comrol aetivalor,speuh P { Alf i"KWIeal codes lnouta Dc fa or(41 fle8t system• lIcKmd aleaWCW,An d�tt,eai and safety race0t Nad'a Erecaic Code(NEC)eAd the occuDaROne(Safety 2nd Health Act lt)SNA). RESERVE POWERED DESIGN For unusual cold! ns 9 reserve safety factor is engineered into the design of every Zoeller PUMP, AeA&TO:go.BOX 16347 MenulecoxrJSOf.. L0uisvirle,KY 402W347 SHIP To:3649 Cone Run Road rl�s dNOB•7�+M 6ousvi9e,Ky 40211-1961 Q//a/JTY � � 778.2731.1 r600192WUMP FAX f502)774-3624 4D Copyright 2000 Zoeller Co.All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ILE INFORMATION SYSTEM SPECIFICATIONS NA owner Septic Tank Capacity � D !fLl Permit# Septic Tank Manufacturer 0 NA Effluent Fitter Manufacturer D NA ESIGN PARAMETERS d NA Number of Bedrooms DNA Effluent Filter Model NA 'Pump Tank Capacity al —NA Number of Public Facility Units �NA j Estimated flow(average) al/da Pump Tank Manufacturer l Pump Manufacturer ANA Design flow(peak),(Estimated x 1.5) -27 al/da I Soil Application Rate sf a da /flz Pump Model jStandard Intlueat/Effluent quality Monthly average" Pretreatment Unit Fats;Oil&Grease (FOG) 530 mglL ❑Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (SOD4 X20 mg/i_ ❑NA D Mechanical Aeration d Wetland Total Suspended Solids (TSS) 5150 mg/L D Disinfection D Other. !Pretreated Effluent Quality Monthly average Dispersal Ceti{s) D�' O n-Ground(gravity) ©(n-Ground(pressurized) Biochemical Oxygen Demand (BODs) 530 mg/L ❑Mound Total Suspended Solids (TSS) S30 mg/L de Fecal Coliform(geometric mean) 5104 cUl00m1 D Drip-Line 0 Other; ❑NA other. 1Mandmum Effluent Particle Size 3l,in die. DNA other A Othert ID NA other, 0 NA .*values typical for domestic waetwooter and septic tank efterrL AINTENANCE SCHEDULE Service Frequency to Service Event ❑months (Maximum 3 years) DNA 4nspect condition of tank(s) At least once every: ear s (Pump out contents of tank(s) When combined sludge and scum equals one-third('b}of tank volume L7 NA 0 month(s) (Maximum 3 years) L7 NA Inspect dispersal 0911(6) At least once every: yea s) months) O NA clean effluent filter At least once every �t earls ©month(s) 0 NA Inspect pump,pump controls&alarm At least once every: earls ❑montih(a) 0 NA Mush laterals and pressure test At least once every: ser(s) D month(s) T]NA 7tner. At least once every: 0 ye s) I 0 NA ether. N(AINTENANCE INSTRUCTIONS Innspectlons of tanks and dispersal cells stroll be made by an individual carrying one of the following licenses or ceriifiicattivns: Master Plumber,Master Plumber Restricted Sower,shall be Inspector; POVVTS Maintainer;Septage Servicing Operator. 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 to check for any beck up or ponding of effluent on the ground surface. The dispersal cell(s) shall be ,visually Inspected to check the effhaent levels in the observation pipes and to check for any ponding of effluent on the ground surface. 'The ponding of effluent an the ground surface may indicate a 'failing condition and requires the immediate notification of the local (regulatory authority. When the combined accumuiabon of sludge and scum in any tank equals one-third (%)o more of the tank volume,the a dre Wisconsin {:he tank shall be removed by a 5eptage Servicing Operator and dispose Administretive Code. 1411 other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components,pretreatment units, land any servicing at Intervals of 512 months,shall be performed by a certified POWTS Maintalner. ,Ik service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page—,of START UP AND OPERATION for the presence of painiing products Or other chemicals that e dts tme c;ell(s}. If high concentrations are detected have the contents of thl• For new consWcljon, prior to use of the POWTS treatment tank{sy may impede the treatment process and/or operator damage to use tank(s)removed by a septage servicing op wastewater will bla System start up shah not occur when soil conditions are frozen h the it levels. Wuhece•Power is restored the excess discharge of eftluenit. During power outages Pump tanks may fill above normal ding the c levels. MY rsult in the backup or surface over to tide In one large dose, e Servicing OPI Prior to restoring P v"al levels discharged is ts���ion have the}contents of the pump tsr+�moved yss SeplY e um Bois to restore norm To avoid this o erating the P effluent pump or contact a the or POWTS Maintainer to assist in manualy p pact,the area within Within the pump tank. or otherwise disturb or oom Do not drive or park vehicles over tanks and dispersal ceoln area not dive or park over, 15 feet down slope of any mound or at-grade soil absorption +m rove the performance and prolong the life of the POWT-'P- m the wastewater str6sm may P diapers: disinfectants: fat; foundattaod rain Reduction or eiirninat+on of the following from aiming p antibiotics-, belay wipes; cigarette vegetable pe8lings�gasQ gasoline', grease herbicide af meat scraps: medkations; oii; p (sump pump) water; fruit pesticides;sanitary napkins;tampons;and water softener brine. ABANDONMENT and/or Is permanently taken out of service the following steps shall be taken to Insure that the system is prop®fly When the POWTS fails an P and safely abandoned In compliance with chapter Comm 83.33,Wisconsin Administrative Code' shall be disconnected and the abandoned pipe openings sealed. • All piping to tanks and pits a Septage Servicing Operator. • The contents of all tanks and pits shall be removed and properly disposed of by • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with 601, gravel or another inert solid material, provide a code compll�nt CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures hew® bay• or must be taken, to P s stelm. replacement system: replacement soil absorption y coon and should not be infringed upon by requlifed 17 A suitable replaceareat should be pceotieeted om d�urb ice andecompa location a 1 cot ent area will result In the neled The replacement proposed structure,lot lines and wells. Fallure to protect the rep v�the rutefl In setbacks from existing and Prof eoement area. Replacement systems muse Damply for a new soil and site evaluation to establish a suitable rep, effect at that time, advances In POWTS techno109K a ❑ A suitable replacement area is a last available to replace to the failled/PrOWTSmrtatwns. Barring holding tank may be a suitable replacement area. upon failure of the POWTS a soli and beeinatalledl a=OVI he site has not been evaluated to i( replacement area. If no replacement area is avellable a holding tank may / mgt be performed to locate a suitable rep last resort to replace the failed POWTS• _ Mound and "rade soil absorption systems may be reconstructed rules place ffect fit 618 8me removal of the blomat at the inftitraliv+ ee, Reconstructions of such systems must comply «WARNING» SEPTIC,PUMP AND OTHER TREATMENT TANKS MAY CUN TAI AN LETHAL CUMSTANCES. OEA MAY R SUL.T r RESC�O�' ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS PO-1W--TS MAINTAIN R POWTS iNSTALLI'sR Name � - ida>ine � �.F-- Phone /f� Phone �JJ b -� LOCAL.REGULATORY AUTHORITY BI=PTAGE SERVICING OPERATOR PU ER Name E Name Phone �/J r-o,2 Phone 2 &(3),Wisconsin Administrative Code, This document was drafted in compllance with chapter SPS 383.22(2)(b)(1){d (t}and 383,54(1),( ) Property Owner_ Parcel ID# Page of Boring# ❑ Boring 1 Pit Ground surface elev. ft. Depth to limiting factor in. Soil lioation 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.-Z O F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 F-1 ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. Cl Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 I 'Eff#2 Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mgA_ •Effluent#2=BOD5 130 mg/_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. SOD-8330(RAW) RECEIVED ', P A 1 Wisconsin Department of Comme SOIL E ALUA I ION KLP'ORT Page / of 3 Division of Safety and Buildings ACT 2 4 2014 in accordance with Comm 85,Wis. Adm. Code ST. C R C U CO1r'�' ��, f. � � Attach complete site PI ST.�T.f�C{R U&Mrin as in size.Plan must include,butnot limited tt5�'1>i;it'h�l`d h,� (BM),direction and Parcel I.D. percent slope,scale or dimensions,north anrow,and location and distance to nearest road. �� _ ` C 1 3 1?J Please print all information. Revie by Dalte Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location LfZM,:, Govt.Lot NE 1/4 f,014 T O N R E( W Property Owner's Maili ddress Lot# Block# Subd. or M# f b Z City We Zip Code Phone Number El city ❑Villa ge To Nearest oa ❑ New Construction Use sidential/Number of bedrooms Code derived design flow rate GPD eplacement Public or commercial-Describe: Parent material Flood Plain elevation if applicable ft. General conrnents and recanrnendations: /� Q System Type > / System Elevation 9 U O F/-1 Boring# � 9� � fa Pit Ground surface elev., ft. Depth to limiting factor _in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 Z 3- O -� 7 J Baft a # pa� Boring 9k pit Ground surface elev. ft. Depth to limiting factor tn. 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 lly -.Z3 J • Effluent#1 =BOD.>30<220 mg/L and TSS>30:5 150 mg/L 'Effluent#2=BOD,<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signat CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 715-246-4516 i Page of Property owner Parcel ID# Q ❑ Boring U v� ® 9annB# Pit Ground surface alev, f[ Depth m imitirg factor Sol Rate DescdPfiw' Te><ture Structure Consistence BoundarY Roots OPDR Horttrn+ Depth Oorninard Redox Gr,Sz Sh 'Eft#1 'Eff#2 In. Mansell Qu.Sz Cont.Color �.. 1 z zo Or Al J Boring# ❑ BoB ❑ Depth to Gnnitlng Pit Ground surface elev. R factor In Solt ication Bale Horizon Depth Dominertt Redcoc Description Texttare She Consistence Boundary Roofs GPDIff TIM in Munsel Qu.Sz Cont.Color Gr.$z Sh. *PEE ❑ f3orvtg in. a��# Ground surface elev., ft. Depot to�ft Tecmr^-r'� Sol RaNa ❑ Pit Har¢on -aplh Dominant Redox Damson- Tetttue SUCIUM Con319tence 9oundwy Roofs In. M1s1w Qu.SL Cora.Color Gr.Sz.Sh. � • 'Eswrit#2�BOD �30 mgL end TSS 130 191 •[f luerrt#1=BOD,>3b<220 rngrL and TSS>30<150 09L "— The Departm=t of Commerce is ao equal opportuniy service provider and employer. If you need sssismce to acctSS services or need material in an ftmzte format,Please contact the department at 608-266-3151 or TTY 608-264-8777- SSD4Wo pL6%) W Soil Test Plot Plan Project,Name Raymond Nutzmann Shau Address 1136 Old Highway 64 New Richmond Wi 54017 CISW #226900 Lot ------ Subdivision --------- Date 0/21/14 NE 1/4 N W 1/4S 4 T 30 N/R18 W Township Richmond ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of shed siding System Elevation 98.4' *HRPSameasBenchmark Property Line 98' 98.4' 99' ❑ B- 1 Scale = 1 /4" = 10' ' 1.3 Acre Parcel 3% Slope B-3 Shed Well 0 B.M.* Existing 3 Bedroom ❑ House B-2 ST DW Property Line Property Line Highway 64 .z . FILTER CARTRIDGE INSTRUCTIONS Installation STEP 2 Dry fit the filter case onto the end of the outlet pipe to ensure it is pipe he opening. either h t tank hough the outlet or solvent (glue)additional a to te outlet pipe. measure 2 While the case is still dry fitted on the outlet pipe, measure the length of 34-inch pipe needed to brace the filter to the tank end wall if u[ilizing the optional supplemental slide support, If side support method is not utilized, proceed to step four. STEP For Installations utilizing supplemental side 5UPPQr`t� solvent weld the 3A-inch pipe onto filter case If de support meth is not utilized, proceed to step our. STEP 4 Solvent weld thee case rl filter i o ntil the filter into the Of cartridge �sn the case. STEP 5 If a VRS switch is utilized; insert into the filter and lock by tuming - clockwise 90e. Maintenance 1. The effluent filter should be cleaned every time the septic can is .� serviced. 2. open the outlet access opening to inspect the tank and fitter. remove the sludge 1 making sure to 3. Pump the septic tank complete Y, 9 I laver on the bottom of the tank and not just the scum and effluent. 4 outlet pipe firmly 1pull tup on the filter handle to dislodge heme r 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 90° 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 900• 9. Insert the filter cartridge back into the case, pressing do wn until the filter locks into the bottom of the case, 10.Replace and Secure the access opening on the tank. BEAR ONSrMn,FILTER CARTRIDGE-FIv£-YEAR LIMITED WARRANTY to , H+ar Unz{t¢hire,<and4as are wa�Trree to oa`:x o d=5etr a enel one ;Crlcnt3tista9 107 hvN:5 eed s`rom tre�as<o- con-urnmr ourthests, filEAR ONS1TE-n pili6r Ca9a-tJfetim¢I,Imieed WarrasnLy n, ✓7q no.'rr•31 V;a rJr:`t2 L,$god 0 ilr.tu REdr:,n9-t v d Kant-,­e site:253:viii DE"te=1 Ctr:evL?,rr mate°,a{rnd ueark,•as:a C' G Kite Q':?:.el p er'..a5V- '15 Ine Cr L•C_G:. mb%C iet'Gr.,¢n=bar:d'�'>Y'u=L•0' 1`a UeiBCI iCUnd'h nr,-nat use,near On5[te f9,oL,LS s{eC+on,r4adtr.��ro::=1r`a with Irt5;rucUOns t!C�'IdeG daorwridte acgww: ?n:,Oarndot U a arocur,,aJ3ed oy aocroe•tt,nrs45e,o'dbJaa,5 rut<�.nred Ov:*::war,Oriv lmT011e, Cdr¢o isle ci�OnF resu{D;,g from ugRS n0:In Sr2Pk0�opera:td o-matnwince!',nGCUraan-r= »id ire v_drrnny �iLes l Ct,rdid5t Coif nc81i S7les 12cer0.1 rnUii t?e DroV,600 rC p,O.er ons,te with all wwrenzy-u��mF sacs, On6�.e,5 n7 re5paR5,Dlt((K IdDdr cRa,aes,r~mo�a1,'-r1d7�CS,1.)5tdllaper,rN CthG,nuoet5sl or cens:.ttucnt,al costs. In nC¢gent Shall;na i,Bbth f Zf Dear;1.^.stta eAcr_ed tnt mpchn-e DO=Or O'd proOUCi. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Mailing Address Property Address (Verification required from Planning&Zoning Department for new construction) City/State Parcel ldeiitifi ti catioNiii i- .ibe - O,�b--- 19 )�-4V(Obb LEGAL DESCRIPTION Property Location - ',/4 /t44-) '/4 , Sec. T N W, Town of c-� Subdivision Lot# Certified Survey Map # Volume Page-It Warranty Deed# C-71-1 0 ' V0[time Page Spec house yes 60 ) Lot fine: ideutifiabl z9ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its pr-mature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, ij needed,by a licensed pumper. What you put into the systern can affect the flinction 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&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 inspec.don and pumping(ifnecessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be complete,I 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 forin are true to the best of iny/our h nowledge. I/we andare the owner(s)of the property described above,by virtue of a w, anty deed recorded in Register of Deel Is Office. N Nur of bedroom _ SIG S ,I(Y F APPLICANT(S) DATE ""Any information that is misrepresented may result in the sanitary permit being Invoked 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) V01_15-00 PA 620716 KATHLEEN H. WALSH REGISTER OF DEEDS STATE BAR OF WISCONSIN FORM 2-1998 ST. CROIX CO., WI Document Number WARRANTY DEED RECEIVED FOR RECORD 04-05-2000 9:30 AN This Deed, made between Raymond M. Nutzmann and Beverly E. EI APIT # DEED tr 16 Nuumann, husband and wife, Grantor, and Raymond M. Nutzmann and CERT COPY FEE: Beverly E. Nuomann, Trustees,or their successors in trust, under the Raymond COPY FEE: M. and Beverly E. Nutzmann Living Trust, date May 25, 1999, and any TRANSFER FEE: RECORDING FEE: 10..00 amendments thereto ,Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St.Croix County, State of Wisconsin: Recordinst Area Name and Return Address Raymond and Beverly Nutzmann 1136 Highway 64 New Richmond,WI 54017 Pet el I Pn�c2ation Num6etO(PIN) Title is - honestead property. Cs ) Part of the NE1/4 of NW1/4 of Section 4-30-18 described as follows: Commencing at the SE corner of said NE1/4 of NW1/4; thence W on the S line thereof 560 feet to the point of beginning; thence continuing W on said S line 129 feet; thence N0°401W 266 feet; thence E parallel to said S line 129 feet; thence S0140'E 266 feet to the point of beginning, EXCEPT the right of way of State Trunk Highway "64". i Exception to warranties: Easements and encumbrances of record. Dated this 8thday of June, 1999. `Ray and M.Nutzme nn "Beverly E.Nulzmann AUTHENTICATION ACKNOWLEDGMENT Signature(s) Raymond M. Numnatrn and Beverly E. Nutzttlann, STATE OF ) husband and wife ) COUNTY) authenticated thi3oth day of June, 1999. Personally came before me this day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. t +So VhE:d,, L TITEMBER STATE BAR OF WISCONSIN + (if not, authorized by§706.06,Wis. Scats.) Notary Public, State of My Commission is permanent. (1f not. state expiration dare: THIS INSTRL-M1rN7•WAS DRAF=BY •) Joseph P.Earley,Attorney New Richmond,WI 54017 (Signatures may be authenticated or acknowledged.Both are no necessary.) +Nstnes of pent,signing in any r pscity should be typed or printed below their si®naatres WARRANTY DRRD ffrATR BAR OF wrSCONSIN o a> O 0 � � ° I c .Q N E a o I � 0 I E h o ai 8 1 Z c c c 0 O� LL- 0 Q z 0. t 3 ° v (D Z w 0o Z = 0 z y o vF- z am d' I N O z d C � m � o N � I a> z c 47 F" E E E c 0 E E CL LO m —o. •N a o 0 z z z N ° I c ro ca Z CL c a o a` Ey y N a.X000 • �' a a a IL tm J U rn rn �y Z 1[7� j a) d N m m c O 'C N Q 21 ,Ni c N Q Z m C7 O O 7 r y w Al o m c c 0 O �+ o I- a� v -0 O U E c U) N W O 0 m .� N N C� O E N O C y Q� • �' o E Z O z y Z Z '�+�' (n O d y a a r 3 _ - L a � • � 0. d .2 d 1 E ` c c 3 �a 0 3 s O � A v a2 o m L) �1