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HomeMy WebLinkAbout022-1050-70-500 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Qivision INSPECTION REPORT Sanitary Permit No: 453494 0 GENERAL INFORMATION (ATTACH TO PERMIT) to Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. O,s =. _Fe4f- -. ZZ Permit Holder's Name: City Village X Township arcel Tax No: Cudd Brothers Construction I Kinnickinnic Township 022 - 1050 -70 -500 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: b , Z:) > kj GAJ 18.28.18.276A50 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 4 f //V. ioa- o Septic ,` Benchmark r 1 2-20, C7D. Dosing ' Alt. BM Aeration ��V (M _ B ldg. Sewer ro 3 � Holding St/ t Inlet -Ij ID6 -COI TANK SETBACK INFORMATION t/ tt O utlet _ 2Z TANK TO � P /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet N:� — �3 Septic �� ! 6b q S t D Bottom �.J — Ii l0 •� /O D y ader /Maw_ " Aeration Dist. Pipe Holding Bot. System '�•(o lD(o�� Final ' S PUMP /SIPHON INFORMATION 10,0 Manufacturer Demand St Cover / {�l GPM _3 3 X13 (� Model Number � /� � � � Y .� � b� •� TDH L' Z Friction L 0 s+ Systenq Head TDH Ft �_ , 9 . Forcemain Len t b Dia. 2 �� Dist. to well ci- SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSION No. Of Pits Inside Dia. ui DIMENSIONS / t� SETBACK SYSTEM TO PIL BLDG WELL LAKE /STREAM LEACH G anufacturer: INFORMATION CHAMBE Typ�,Qf $,ystem: , ' 2 I el Number. DISTRIBUTION S�Y� E C M ``( Header /Manifold Distribution d C x Hole Size x Ho acing jVen�t t o Air Intake Length Dia Length D •J Dia Spacing _,� / 303 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 01'� Depth Over Depth Over xx Depth of xx Seeded /Sodded M he Bed/Trench Center Bed/Trench Edges Topsoil -] Yes No xx F] Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #(1: OCI � Z= Inspection #2:1 D Location: 365 Vorwald Street River Falls, WI 54022 (SE 1/4 NE 1/4 18 T28N R18W) �NA 4 Parcel No: 18.28. .2 50 1.) Alt BM Description =40P 4 fd of &S. N 0 � CGf� 2.) Bldg sewer length amount of cover = / 44 n Xp2� Plan revision Required? ]Yes No Use other side for additional information. o `f � L -- _--1 L _ Date e sepctor s Signature Cert, SBD -6710 (R.3/97) l� // � �h ` A Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 sT. cROIX i sconsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 - 3151 q5-3 Lf I I n Sanitary Permit A gig, PP lication State Plan I.D. Number . lo � l S 3 a , In t accord with Comm 83.21, Wis. Adm. Code, personal information you provide - 4 • � maybe used for secondary purposes Privacy Law, 05.04(1)(m) ojcq Addre ' different than mailing address I. Application Information — Please Print All Informption Vorwald Street Property Owner's Name f arcel # t # Nwiv # Cudd Brothers Construction J � Z ? ®� 4 Z:k _ Property Owner's Mailing Address Property Locatio , 1645 River Ridge Road 1 SE NE ' /<, Section 18 City, State Zip Code Phone Number River Falls, WI 54022 715 - 425 -8053 T 28 N; R 1 p(circic one) II. Type of Building (check all that apply) p ,,, ft 3 , atls, '' 1 or 2 Family Dwelling — Number of Bedrooms a CSM Number ❑ Public /Commercial — Describe Use <� P fY b 2 3 ❑ State Owned — Describe Use ❑ 1_ City ❑Village township of Kinnickinni III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. © New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only [I Other Modification to Existing System B• 11 Permit Renewal ❑Permit Revision 11 Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) = 23, cao Z ❑ Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil 13 Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ® Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: O . 7Z Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s � System Elevation 450 0.4 (/ p 5") 450 450 0 6.64 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1000 1000 Weiser X Aerobic Treatment Unit Dosing Chamber 750 750 Weiser X VII. Responsibility Statement- 1, the undersigned, assume repponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe ' Signatur MP/MPRS Number Business Phone Number Roger Nelson MP 226497 715 - 273 -4444 Plumber's Address (Street, City, State, Zip Cod 122 East Summit Avenue Elllsworth, WI 54011 VIII. Coun 7 i oi artment Use Onl Approved Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issu' g Agent Signatu o Stamps) P Owner Given Reason for Denial 3 5V— L 2 IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper pot less than SI /2 x 11 inches in size SBD -6398 (R. 01/03) IVvro✓.�1� -Scree - r 40 1 - 0 CTHSS DM1 � a o -Sca I e 19 3 1% o N W Lot C'orie cr ''ct 10S.aS" To 117a M ", 17 t ,v V � 'mac •� , � ` O 7 u ,r ,3 L3 c d rom. --e • 4 rgsG O OLUELL Nor*/i i I C 4 t r I I P v i 0 r i 5 . ,�`.' I �i� Safety and Buildings • 4003 N KINNEY COULEE RD commerce.Wl.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us /sb www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary August 23, 2004 CUST ID No.226497 ATTN.• POWTS Inspector ROGER D NELSON ZONING OFFICE NELSON PLUMBING ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/23/2006 Identification Numbers Transaction ID No. 1053808 SITE: Site ID No. 688380 Cudd Brothers Construction Please refer to both identification numbers, Vorwald Street above, in all correspondence with the agency. Town of Kinnickinnic St Croix County SE 1/4, NE 1/4, 518, T28N, RI 8W Pending CSM - lot: 4 FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 976347 Maintenance required; 450 GPD Flow rate; 13 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.0 1 /0 1), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD- 10691- P(N.01 /01). The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)". • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. i3 v ROGER D NELSON Page 2 8/23/04 • Comm 83 22(7, - 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. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 3 bedroom Mound 9 AC Owner's Name: Cudd Brothers 0 Owner's Address: 1645 River Ridge Road River Falls, WI 54022 Job address: lot 4 Vorwald Street Legal Description: SE 1/4, NE 1/4, S 18, T 28 N R 18 W Township: Kinnickinnic County: St. Croix Subdivision Name: Lot Number: 4 Block Number: Parcel I.D. Number: 022 - 1050 -70 -000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Roger Nelson License Number: MP 226497 Date: 08/10/04 Phone Number: 715 - 2734444 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) °� ' z,? Version 4.0 (R. 04/03) Page 1 of 8 ; ,i, .�t r�7y Ai; b ��o E - 7 7 M E40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE O 50 100 150 200 250 300 350 40 12 35 10 in W 30 W J � f- 2 Ivo l ►Z-t 2S e J a 15 a 0 h- 4 ~O 10 E.. 5 2 O O 0 10 E0 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE G pm 1101 Myers Parkway, Ashland, Ohio 44803 -1923 419/289-1144 FAX 419/289 -8658 Telex 98-7443 K3326 7/91 Printed in U.S.A. �a�c 708' ?'Ol 46CCC C74.(CTI1 — )LIT 4 nTA1-1'1V7 %1WLJ1J-W=C .104.2 /f1 4.n 07 .1P1.1 'MSCOn9In Department of Commerce SOIL EVALUATION REPORT l livislon of Solely and Buildings Page of in accordance with Comm 85, Wis. Adm. Code Allach complete site plan on paper not less than p 112 x t 1 inches In site tan must County s T Cj(�o /• ,/ include, bul not limited to: ventral and horizontal reference direc on and /`- percent slope, scale Of dimensions, north art �.p Parcel I.D. 0 Z Z RR � Y nce 1 nearest road. Please print al lnfo►'rttatlon. Reviewed by Date Personil infnrnratlon ynu provide may he used for .condary p o- s Iv n� Properly Owner (m))• CSM E, �7 GouN Pr rty location ,Q p !/ 7L' S . G OFFIGE .` lot .! f, 114 Property ner 114 S / V T N R /Q t (or) W Ow's Wa ing Address l_ol p Block A Svbd..Name o► f! City � 2-2'0 �; vES �x� f y . y P �,,W6. CS M �4 Slaife Zip Code ty []Village Phone Num er 55,o7s, . 7�s 38�p • �1��j ❑Ci own Neatest l2oad ! ) iill�i G�N�i'G jyGu � Ij -New Conslructlon Use: ( t Residential / Number of bedrooms Code derived design now role _ r � Replacement [, y`s� �• � 6V GPD Public or commercial - Describe: r'areni material �oESS ay Flood Plain elevation If applicable General comrnents y/� - - -_ n• and recommendations: U goring 0 L] Goring 1 6 0. 0 5 Z SS$ V9 PII Ground surface elev. fl. Depth to limiting factor M, horizon Depth Uominanl Color Redox Description Texture Siruclu►e Boundary Roofs Son G PD / 11 E1. Bale Consistence In, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, o •7 AoyAO (313 Py 3 y �s ye -- 5G, 6t /)m-�X Cs f seL goring 0 U goring � S S..SIS 111 ��� 111 � � Z N Pit Ground surface elev. n. Depth to limiting factor M, I Iorizon beptft Dominant Color Redox Descriptlon texture Structure Consistence Boundary oots Son Ilcatlon Rate In. Munsell Qu. Sz, Cont. Color ry GPD/Q' / Q • 1b YR 3� Gr. Sz. Sh. .011 'EINl2 --� 1 zM^shk Ah-Fie e zu 3 f , s • &' z 7.1 �o ale Y/ Sic, z S �► cs• Z • s • �, Effluent Of = BOD > 30 < 220 mg/l- and TSS >30 < 150 mg ' Effluent 02 =BOD < 30 tnglt and tSS < 30 tnglL CST Name (Please Print) • _ Signature CST Number address /V 2- Z 4! 3 Z s Dale Evaluallon Conducted Telephone Number Ulbricht & Associates s r • 71 s . U ol • d o S Private ew 655 O'Neil Rd. Hudson, Wis. 54016 �- oN ' s• •rF Ur �i«Tiov ORIGINAL ` t �Property Owner y parcel Ib X Page of `i 1 Prningp Poring �� U pit Ground surface elev. _ n. Depth to mmiling factor Z � M, I Iorizvn Ue n Soll cation Role p U01111nan1 Color Redox Description Texture Slruchlre Consistence Boundary Roots Gpp/n: In. Munsen Ou. Sz. ConL Color Gr. Sz. Sh. l D •$ /D y,� 3J3 •En�l TIM L 1- F56/� 8• z A R Ylb ctv s ? �•SyR 1 Lz— s�. z- Fcsb,e Wit►, -�/I' c5' / f . 5 �. 7 YS' I M G G S . L • 3 I Poring ffrPoring U1 Pit Oround surface Atev. n, Depth to lilnlling factor M, lfeflt0n UepOt rJt Mitianl C;olot fledox beseripilon Texture Structure Consistence Boundary Rools 9011 A PPReellim GI DMP sit g M. Munsen Ou. Sz. Cont. Color Or. Sz. Sh. 'EIf1f1 'Eff!!2 U Poring 8 L) Poring U pit Ground surface elev. n. Depth to n mlli ng factor M. t I Iorizon Depth Dominant Color nedox Descri Ikon SoN Application Role P Texture Structure C ce Boundary Rools GPD/fl' In. Munsen qu. Sz. Cont. Color h. 'ISM 'Elf#2 i . Effluent of - BOO > 30 < 220 mgIL and TSS >30 < 150 nMIL ' Effluent 92 = BOI), < 30 mgA_ and TSS < 30 mg1L r t he f)CpathI1C111 o f ( ' ' "11111jerce is an eftllaf nppnfhlnily Service ptovirlcr qnd employer. If you need assistance IO aCCCss Services or need material in an Alternate formal, please Contact the department at 608- 266 -3151 or 17Y 608 -2 0 acce SRh.1111" fit fum) 5 7 ,F, v ez o LAI a kA .� Q N ' UIN Q � Z N N LI N D l^ J m J N � N � ,i s a 02; ~ �0 a o L01, ,, c � r ' ~ • Y/o ✓ w��d s' trGGfi 2q�',� - CTHSS DMA � a -Sca I e I ''= y0' ay,� _ ° t °x O' 193 NW Lof 16 a Tj ��ZSEK' /OOO sr�Of,'c Ta.►.f ,` °�' p v 3 Ld y s � u ,r 4 rstl � � Woo e v O U)IFL L p No.-tA I w r i J P4R r of 3 4 144Zs 'Ntsconsin Depa,trnenl of Commerce SOIL EVALUATION REPORT • "sion oI•Safely and Buildings page / of M accordance with Comm 85, Wis. Adm. Code Attach cornplelo site plan on paper not less than 8 1/2 x t 1 inches In size. Plan must County 5;r include but not Ihniled (o: verlicat and horizontal reference point (BM), direction and Percent slope, scale or dimensions, north arrow, and IocaOon and distance to nearest road. parcel I.D. Z 2 /0,5'j •70 • eZr Please print All Infonnatlon. R ewed by Dale LA AA Personal Inlorn,ntion ynv provide may he used for secondar Y purposes (PrivyrY lmv, S. 15.0 (1) 1m)1. %, Properly Owner Properly Location C xz 6e&A LE� vE-RTL Govt. Lot 5; g 114 G 114 S 1 6 T 1 B N R /8 E (or) W Properly Owner's Malling Address Lot N -- block p S Name or CSMp Z G %�� '.57 4 c e �X NEE' �IA f'F'Nni,V W CSNj City Stale Zip Coe Phone Number S / • PA vL AN. 556 /b [] Cily [) Village � TO" Nearest Road 75 1 c 7 15) 3 $ (o • S2!(� Ki,vwi�.�i v vi c �[ t Y. SS New Construction Use: X Residential / Number of bedrooms t� Replacement Code derived design Bow rate y�'O ^ �O Ob GPD Public or commercial - Describe: Prnenl material 7? & flood Plain etevalion if applicable General comments n and recommendations: /'ER IrdWM, 9-5 3 O (2) C C d J 5 ; 7;G - 1 T�smi> f yA R Ole Adw did s'fjf!/�!- T o� �¢ Gov vp sJ'S'7�.c / f AV/ Tj -&A-f4 L Boring # d Boring / a �,/ ? 2 / S S• S 01 Ground surface eiev, f ] 11, Depth to limiting factor 1lorizon Depth Dominant Color Redox Desedplion Texture Structure Consistence Boundary Roots Soh A GPOM".. Rate In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EQfI'1 'EII#2 / o• y io ye 1/3 -- c 3, sdK s 2 �• /oy 3 3 G 1, s 3 �•i3 �oy� 5 I 2,fS ufi? O /l o7-s Cs c� / sh �r v . K Z 3 r i J 'Boring # U boring 111 -- 111 Pit Ground surface elev. / i it. Depth to Ilmiling factor In. Florizon Depth Dominant Color Redox Descriplivn texture Structure Consistence Boundary SON pllcallon Rate Roots GpD/IN In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, "Elffil •E0#2 d col 3 �o •/s io 1- z sh /4f/ �s . s •g e �Ie6l - 7 - y TVA /J" ioy S "4-1 s GG /�' . Z 3 SY/z 4'/ Effluent 01 = ROD > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent 02 = ROD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) — — Signature , -- CST Number ° � T le ZM6,1 ti 224, 3 - 75 Address Dale Evaluation Conducted Telephone Number Z vL. A - l�l , a3 �•,�C 7is• 3�1v �i � S Ulbricht & Associates ZOd Z Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 For iasuslrlee of p9ra to and designing Conhct: Ulbricht & Associates Registered private wastewater consultant and pkunbers 655 0 N41 Road Hudson, WI 54016 ORIGINAL 316.8185 or 715- 772.3442 2 z - �aso• 0•� 2 3 f`r0pe11y Owner r Parcel lb N Z Page of [ 3] floring 0 1111 B oring 1016 Id FII Ground surface elev. 1t. Depth to flmiling facto In. Soil App lication Hate I Iorizon Deplb Uomhrnnl Color Redox Descripilon Texture Structure Consistence Boundary , Roots WON 1n. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfI #1 ' -1102 M YR 2 — L 2 ^nJbk i►r�2 c5 3 1 . S • $ a / 3 Z- / f .w► cs Z / . y 3 o l /e S �� 2-f5h f cs /0► � $i L / C — • Z 3 ✓ c' 'so /Oyu s� CZ, P 1 W V r ' CL S /�+1 v • 'Z YR V41 Goring it ,Boring rr p it Ground surface el6v. It. Depth to flmlling factor In. u - - -- — ` Soil Applicant.. Rate 11.1110. Uepth DOminanl Color Redhx Descriplion Texture Structure Consistence Boundary Roots GFUmx In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. TONI 'Effl12 1 Boring f! Ll Ooring 1�J L] Fit Ground surface elev. fl. Depth to limiting facto In. Soil Application Rate ITo►11.n Ueplh Dominant Color Perim Uescriplinn Texture Structure Consistence Boundary Roots GPD /flt In. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'E"l 'EIV2 'F flMuent ff 1 = BOU > 30 < 220 mglL and TSS >30 < 150 mgA- ' Effluent N2 = BOb, < 30 mg/L and TSS < 30 mg/L r 'I lie Depathnenl of Commerce is an equal oppothmily service provider qnd employer. If you need assistance to access services or need material in an alternate formal, please contact the department at 608-266-3151 or TTY 608 -264 -8777. SPhR)Jn (R 6lIM) I� r � o Z o,F5 T 1- 7' I 1, \ 0 v O O N \ O k \ o O P p J � a \ I _1 L-N l.� l ST CROIX COUNTY SEPTIC TANK MAINTEI�ANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 40 R te �' ���i -( c ; Mailing Address �(� t J 4� r 17 �clel-�S Property Address .3 (S Uo r "./d <S T (Verification required from Planning Department for new construction) City /State Parcel Identification Number Z Z — /O,S7f - 70 - 470 9 LEGAL DESCRIPTION 2�� A 'S0) Property Location /,, � � / Sec. Z8' T N -R4 t*- W, Town of k( V VIC��T•r/4t/ /C Subdivision , Lot #. Certified Survey Map # , Volume , Page # Warranty Deed # _?(� �S ) Volume ZOE 3, Page # Spec house O yes l4-no Lot lines identifiable Dyes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of a three yeatepiration date. �..t'YJCJ Q SIGN OF PLIC T DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a rranty deed recorded in Register of Deeds Office. SIGN OF LICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed J 2088 P 360 - 7 12D3��_ 15s STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. NALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. MI Document Number I RECEIVED FOR RECORD This Deed, made between Frederick G. Lenertz AKA Frederick G. 12/23/2002 68:55AN Lenertz Sr.. Sinale Grantor, and Cudd Brothers Construction CA;). EXEMPT # Grantee. Grantor, for a valuable consideration conveys to Grantee the following REC FEE: 11.00 described real estate in St. Croix County State of TRAYS FEE: 131.70 COPY FEE: Wisconsin (the "Property"): CERT COPY FEE: PAGES: 1 Recording Area N me and Retum Address Cu Broth Constru n X Co oad SS RI" WI 54022 voles -l0 5 0 - 70 -000 Parcel Identification Number (PIN) This Is not homestead property. (is) (is not) Lot of Certified Survey Map filed in oY i• 16 , Page 4422 as Do__ume_ nt I� of 1706 ?� 3. located in part of the SE '/. of E Y. in Section 18, T 28N, R 18W, Town of_ Kinnick nnic, 8t - Cr_oix County, Wisconsin. Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 16th day of December, 2002 (SEAL) (SEAL) Fr denck (SEAL) (SEAL) x AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, .` 8 ­: w y? St. t 'kntY authenticated this day of Pna came before me this 16th day of ? u ,• '�1 2 the above named O�j • Fradelidit Q. Lenertz rick Q. Lens Sr.. in I �'�i, / 11 { • �.� ttrt2g�ltnown to be the person who executed the TITLE: MEMBER STATE BAR OF WISCONSIN r instrument and acknowledge the same. (if not, Y authorized by §706.06, W is. Slats) THIS INSTRUMENT WAS DRAFTED BY N ary Public, St a of Wisconsin Coldwell Banker Burnet 1301 Coulee Road My commission is permanent. (If not, state expiration date: Hudson. W i 54016 2 -54233 (Signatures may be authenticated or acknowledged. Both are not necessary.) ` Names of persons signiM in ca act must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 — 1998 Milwaukee, Wis. I �s ti 7dZI 1 623 VOL 16 PAGE 4423 KATHLEEN H. NALSH !" THIS INSTRUMENT DRAFTED BY: WILLIAM KANE REGISTER OF DEEDS 5T. 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ASSUMED TO BEAR SOO'39 " DEC 1 0 2002 II D m �v N N it not,ou. ou "....nu au oays of Z Go g $ SHEET 1 a►�Fpvat�at l*lUbe Vol. 16 Page 4423 `�I