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026-1126-47-000
Nisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix INSPECTION REPORT Safety and Building Division ' Sanitary Permit No: 488073 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: city Village X Township Parcel Tax No: Effertz, Kevin Richmond, Town of 026- 1126 -47 -000 CST BM Elev: Insp. TO BM Description• Sectionrrown /Range/Map No: (� L `7 ( 12.30.18.808 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 2 Benchmark �z��� -- /Z t 7.x Alt. BM I '� �. g O l d lc c cE y C `� /6 7, 1 7 F-, J. Y, Aeration Bldg. Sewer Hong � St /Ht - Inlet l i 5 • Z� /0 Z , � / TANK SETBACK INFORMATION S t/Ht O ut l et TANK TO P/L WELE_ BLDG. V ent o it In In l e t ep Ic - 7 Z�J : Z / 1 7 � % B ottom osmg Head er/Man. 7 %7 97.8 A eration Dist. Pipe 7 p o Ing Bot. system PUMP /SIPHON INFORMATION F inal G racl e 7. (0 anu ac urer Demancl St Cover GPM F,1 ZAS /OS . 3Z m odel um e 97_0l nc ion LOSS ys em e /O.l `i7 . of Lircemain ng 1 i r; . �� 9'J, b� SOIL ABSORPTION SYSTEM DIMENSIONS Q� 3 I �e .k(„ I C INFORMATION CHAMBER OR UNIT j ( ! ii 1�clf a- -4 Z 1.4 d -z'fzX P O Pi es \ \ I t� �� �u•^^ Lengt Dia Length Dia Spacing ___'� SOIL L;DVETZ x Pressure Systems Only xx Mound Or At - Grade Systems Only Bed /Trench Center ` c1 fd/Trench Edges Topsoil Yes No ?Yes j No ""� COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1651 Water's Edge Drive New Richmond, WI 54017 (SE 1/4 NW 1/4 12 T3 ON R18W) Water's Edge Lot 47 Parcel No: 12.30.18.808 1.) Alt BM Description = �•� ` �a���' �l�'cti� �`S '� (� �[ 1c C'� i 2.) Bldg sewer length - amount of cover = Plan revision Required ?� Yes to Use other side for additional information. SBD -6710 (R.3/97) Safety and Build' A I County W 201 W. Washington Ave., P. . ox i— � ' Q�sjn Madison, WI 53707 — 7 f Sanitary Permits Nu' (to be Bled in by Co.) De artment of Commerce (�8) 2 'f Sanitary Permit Applicatio tare P I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informatio u pr maybe used for secondary purposes Privacy Law, s15.04(1 m) r [[3 Q 9 2 QO project lddress (if different than mailing address) I. Application Information — Please Print All Information ST. CROIX COLIN ' ( uj ct��4 (S C Property Owner's Name Z ONING Lot # Al Block # a(V A -Dvo Property Owner's Mailing Address Property Location { Cuy State r ` Zip Code Phone Number Sw �' Section 51 013 cite! ) T 3 O N ; R Eq 11. T of Bni+kling (check all that apply) �5 §I or 2 Family Dwelling— Number of Bedrooms Subdivision Name t GSM Number /V /} ❑ Public/Commercial— Describe Use c �ct. � M ❑ State O be Use ❑City_ ❑Village Vownship of t n III. Ty o ermit: (Check only one box on li A. o fete line B if applicable) A. VNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System El Permit Renewal ❑Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number ate Issued Before Expiration Plumber Owner Pte" IV. Type ofPOWTS System: Check all that apply) f ( Non - Pressurized In- Ground ❑ Mound _> 24 in. of suitable soil ❑ 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 ravel -less Pipe ❑ Other (explain) V. DispersaVrreatment Area Information: Desi Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposal (sf) System Elevation I o u0 qb•� VI. Tank Info Capacity in Total Number Manufacturer fab Site Steel Fiber Plastic Gallons Gallons of Unit W PL 5z� ncrete Constructed Glass New Existing Tanks Tanks -(1 l se ar (ding Tauk 11 50 Lo 'e S `ers � Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement - 1, the andersig responsibility for is . of the POWTS shown on the attached plans. um `` ber's Name P nt) tuber's gnature M PR umber Business Phone Number \ u ` moo{ CAS S c2 /3 Plumber's Address (Street, City, State, Zip Code) 9 &:T 19E;''K A" I-' 04-t �► � J o r VIII. Coun /De artment Use On Approved ❑ Disa Sanitary Permit Fe Includes Groundwater Date Issued Issui g Agent Signature (No Stamps) Surcharge Fee) , /�,,,� r Denial r �( ❑ ry Reason `{)U IX. Conditions Approv SYSTEM NER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumbers 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plan (to the County only) for the system on paper not less than $1/2 x I I inches in size SBD -6398 (R. 01/03) of I : I Ea IJ� -?_� I ' I I f I , I I i I I I : T I t. 100 - -- - - - - - - -- - 79 : f i ` Qo/ Q I 1. ' 1 : _ f I I I f I , I f I I - -. - - -------- - -- I I I I ` , 1 I i I I I I I I I I I I t I I I I i I i I : I 4< ��`,�e�z � E y E0. m N 1, Lo C L d Se'I B ►r�'fo �; � ��P �. �; � r oo � � D t00. v- _ /Q°' $ r j Wisconsin Department of Industry SOIL AND SITE E V A L U AT I O E PLO R ��. Page 1 of 3 Labor and Hriman Relations Division of Safety & Buildings in accord with ILHR 83.05 Wi m. Cc% • COU St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Pla t inclu tl ,%% t not limited to vertical and horizontal reference point (BM), direction and % of s scale or RCE Vl ` CI. . # dimensioned, north arrow, and location and distance to nearest road. �t�� 1 q din'° APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION S � U Ff f BY DATE PROPERTY OWNER: PRO C Derrick Const ruction, In c. GOVT. L #f4 12 T 30 N,R 18 fX(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BL AME OR CSM # 1505 Hy. #65 47 na Brushy Mound Lake CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [SOWN NEAREST ROAD New Richmond, WI. 54017 715) 246 -2320 Richmond I 140th. st. iM New Construction Use [x] Residential /Number of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 1200 bed, ft 1000 trench, ft Maximum design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Recommended infiltration surface elevation(s) 9R . 3n ft (as referred to site plan benchmark) Additional design/ site considerations trenches spaced to code 3.50' below grade Parent material glacial drift Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL 1 HOLDING TANK U = Unsuitable fors stem 1 ® S ❑ U ®S ❑ U ® S ❑ U I ® S ❑ U ❑ S L3 U ❑ S i7 U SOIL DESCRIPTION REPORT N-__� '.kV ut ( - 2400 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench f « 1 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 ,� LU 2 2 -30 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 0 -84 7.5yr4/4 none sl 2msbk mfr na na -5 .6 S elev. 10 ft. Depth to limiting fact +84 q -g`� Remarks: Boring # 1 -11 10yr3 /3 none 1 2msbk mfr cs 2f .5 .6 -r 2 1 -19 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 3 9 -38 7.5yr4/4 none sl 2msbk mfr gw na .5 .6 •S Ground elev. 4 8 -84 7.5yr4/6 none sl 2msbk mvfr na na .5 .6 -S 10 ft. Depth to limiting fact - +84 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. New Rich and WI 54017 Signature: Date: 6 -20 -2000 CST Number: m02298 PROPERTYOWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # r _pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boirxivy Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 -9 10 r3/3 none 1 2msbk mfr cs 2f .5 .67 .S 2 -19 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 9 -84 7.5yr4/4 none s1 2msbk mvfr na na .5 .6 .j elev. 10 ft. Depth to limiting factor +84" `{ cZ . Remarks: Boring # 1 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 :< 4 2 -21 7.5yr4/4 none sicl 2msbk mfr gw if .4 3 1 -84 7.5yr4/6 none sl 2csbk mvfr na na .5 .6 .� Ground elev. 1 Depth to limiting Z factor +84 Remarks: Boring # 1 -11 10yr3 /3 none 1 2msbk mfr cs 2f .5 .6 `< 5 2 1 -30 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 3 0 -84 7.5yr4/4 none lfs 2msbk mfr na na .5 .6 ................... Ground elev. 1 �{ L Depth to limiting factor +84 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, INc. 1554 200th Ave. CSTM2298 NE4SW4 S12- T30N -R18w New Richmond, WI 54017 i MPRSW -3254 town of Richmond (715) 246 -6200 lot #47 Brushy Mound Lake This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shOm as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top of 1" pvc pipe C el. 100.00' Alt. BM.= top of 1" pvc pipe @ el. 100.10' h� 1� 1 moo A l �f Gary L. Steel 6 -20 -2000 i I Cos I _ CQ5Ctk�e Is E J y e bt\ � o EZ1203H } vvvovov. 'r" ^ ;'"'; - � ,l:�• •ovvsvve evosvvv vvvovov p p p . ,4Y •:Y. .,ti VVVp p p p 1 2 H i vov • ,i: ' -i ' vov VVp N OOv 24'► 7pV :a�' .pp vvv ova WVV 4.625" VVV vvv VVV W V V V v tl 1/2 Clrc. = 18.84" vvv dev vvv vov vvvovov pv svvvsvovvvv vov vvvvevv v vvvvvvvvvvvv vvvovo Vpep epp ev vvvevvvavvvv vvvovo v p Opp000 pop pvepepp VVVVV V WVWWr 24 B Bottom 36 12 -112" DIA. (typ.) Void Volume Sail Interface Area jn• to F-L. �a L Void Coefficient in Aggregate given at 57.4%. Sidewall (2 Sidewalls) 7 4 18 : 8 O.D. of 4" pipe - 4.625 inches 12in - 3.14 Ift Void volume per linear ft. = 3.14 • z.3125i, Ift = 0.1 17 If Bottom 12in /ft 2.00 Total Soil Interface Area 5.14 SQ — O.D. of center cylinder T2.5 inches Void volume in aggregate of center cylinder = 3.14 • 6 ' 25 '" _ 3 , 14 . ' 3125i° , (12i1 /ft) ( 12in/fy - .374 -.422 ft O.D. efoutside cylinders= 12 inches 1 Projected Trench Area Void volume in outside cylinders= 2.3.14( bin 1.574-.901 f Sidewall Height = 12 in. •2 = 2.00 Sq.Ft, 12in /ft Bottom = 36 in. = 3.00 Sq.Ft. Void volume at bottom between c cinders - ( 24m , 6tn 6m y 12i,/ft IZin/ft)�( 14(12in /ft) =0.215 W Projected Trench Area SAO Sq.Ft. Void volume at outside bottom corners (I!2 of void volume between cylinders) 0.215 12 - 0.108 ft' Total void volume - 0.1 17 + 0,422 + 0.901 + 0.215 + 0.108 - 1.763 cubic ft / ft Gallons per ft = 1.763 X 7.43 - l3 eallons per linear ft !I X f� = SO EPS Aggregate Trench System EZ1203H EZ'Ow Ring- tndustrial Group 65 Industrial Park Rd. Oakland, TN Z,8060 SCALE FILE NIA1,te: EZ1203H -vst SHEET: 1 at 1 11 -27 -01 • f C4 C = > Zm0 � (P O 0 z �- a cu m O _ Z 171 m ,,; m X -� � �NQ co) - n "n rn r ;u X m p O M :,,.� I CO) d t it n (3 *1 m m o U) z v c p z --� n 4 N c Z 9 0 -� rn ;a r" w �Z Z r c v n z I(1� �- r �■■� C 7C C� CO) C O) Z N X - X < 0 70 Z n Q M< 0 In : may. n o M o m O `p ° �B N I �� fY ?d�� 1 i� ; 0 0. � •O W " W , -gag � wp !$ 5 o N i s ! a o = CL 0 s 7 I I 7 1 °O O ° � o O a " • Z 5 1 I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of FILE IN ON SYSTEM SPECIFICATIONS Owner Permit # ( �' r I Z F-Efftuent 773S 13 NA 13 NA IiES1t3N PARAMETERS 13 NA Number of Bedrooms El NA Filter Model PL a 13 NA Number of Public Facility Units 13 NA [Pump mp Tank Capacity al NA Estimated flow (average) 0 al /da mp Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) g al/day Manufacturer Soil Application Rate S r aPump da /ft2 Pup Model A �NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 m /L �NA 9 ❑Sand /Gravel Filter ©Peat Fitter Biochemical Oxygen Demand (SOD 5,220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ITSS) 5150 mg/L ❑ Disinfection ❑ Ott Pretreated Effluent Quality Monthly average Dispersal Ce1l(s) DNA Biochemical Oxygen Demand ttiOD 530 mg /L �n- Ground (gravity) ❑ in -Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other. ❑ Other: NA ❑ NA Other: ❑ NA Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA �NANCE SCHEDULE Service Event Service Fnmpen Inspect condition of tank(s) At least once every: ❑ months) ears) (Markman 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) years) tMaxbnurn 3 Years} ❑ NA Clean effluent filter At least once every: I ❑ month(s) ❑ NA years) 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 Other. ❑ year(s) At least once every; ❑ month(s) Other: ❑ yeas) b NA ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS 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 back up or ponding of effluent on the ground surface. The dispersal cell(s) 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 tank equals one -third %) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator 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 <12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. i START UP AND OPERATION Page , of For new construction, prior to use of the POWTS check treatment tank(3) for the presence of painting products or other chemicals that may impede the treatment process aril /or damage the dispersal cents!. if high concentrations are detected have the contents of the tankls) removed by a Septage Servicing operator prior to use. System start up shah not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cells) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides, most scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. 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 chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits 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. • 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: tq 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 that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL MASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name � Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S� [` O ` �0 n ` Phone Phone '( ( S 31 ' This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), f2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer l NJ E'� �IzT -- Mailing Address ' 00 S b ���' t +'wj �,L lac C�4 A4 /" S S l L - j Property Address 1 P�"t'1L5 �f'L�V c (Verification required from Planning & Zoning Department for new construction.) IZt �Lt-t e,4.0 t4C� (3 - � I L10 � $`7 - o O — J City /State \N� S40 11 Parcel Identification Number LEGAL DESCRIPTION Property Location j /4 , l /4 , Sec. �L , T'-N3 N R �g W, Town of Subdivision _ �lV p-'� « , Lot # 4 , Certified Survey Map # �` , Volume , Page # Warranty Deed # r i , Volume , Pago # �- Spec house yes no Lot lines identifiabl yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consist-, of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Conan. 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 inspection and pumping (if necessary), the septic tank is less than 1/3 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue o a warranty deed recorded in Register of Deeds Office. Number of b rooms 2 / 7 / o e SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08 /05) 8 1 5 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIR CO., WI RECEIVED FOR RECORD THIS DEED made between Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership ( "Grantor ") and Ivy" 01/05/2006 10:35AM Efferti and Angela A. Effertz. husband and wife, as survivorship WARRANTY DEED marital property ( "Grantee "), EXERT WITNESSETH, that the said Grantor, for valuable consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: TRA FEE: 11.00 TRA FEE: 103.50 COPY FEE: CC FEE: Recordin Area Lot Forty -seven (47), Plat of Waters Edge in the Township of Name and Retum A ress Richmond, St. Croix County, Wisconsin. Brushy Mound Partners PO Box 445 New Richmond, WI 54017 026- 1126 -47 -000 (Parcel Identification Number) This is not homestead property. Grantor, Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership, is an affiliate of Derrick Homes, LLC, a Wisconsin Limited Liability Corporation. Grantor develops land and Derrick Homes, LLC is a home construction contractor. Grantor agrees to sell this lot to Grantee on the condition that Derrick Homes, LLC will be the builder of the home for Grantee. If Grantee does not commence construction with Derrick Homes, LLC as the contractortbuilder within two (2) years of the date of sale of this lot to Grantee, Grantee gives Grantor the irrevocable right to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. If Grantee desires to sell the lot to another purchaser before constructing a home upon this lot, Grantee gives Grantor the right of first refusal to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. Dated this Ird day of Janua , 20QE. Ro 4tever(s " I R AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this Lrd day of January 2006, the authenticated this _ day of 20_ above named Michael R. Stevens and Ronald L. Derrick, as partners of Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership to me known to be the persons signature qtype uted the g instrument and acknowledge the type or p rint name P TITLE: MEMBER STATE BAR OF WISCONSIN LA . RUTLEDGE If not, ( authorized by' 706.06, Wis. Slats.) t name amela J. Rut le a N� . Public n St. CroixCoun Notary ublic S , Wisconsin. ry County, THIS INSTRUMENT WAS DRAFTED BY My Commission Expires: July 27th 2008 Brushy Mound Partners *Names of persons signing in any capacity should be typed or PO Box 445 printed below their signatures. New Richmond, WI 54017 NEB J2tCkI MDl�lD J 1/4 0 9' `�ld /kllE in P :IhCk. _ QK, EbyE 3 Y w LDCAMOM MCI' • 4! 4Z 43 39 40 ..S5. 3 L �¢ •44 - Z F.: 33 A. z7 3 vl 4-57 Z2 3Z 3 1 3o Zo Z� s i°i t8 6 - 7 4°! 16 q t"3 ��t�l -�'s� �1ukD. L WA T'EKS E.DCaL p —NORTH 114 CAVAM \ .SEC7xw f? -36-78 PO wr ALIAIAhf s/ C LIGWTY A/OYICAYIENT ® I W N 76.1r ETCH L .,ME n I •�' LOTS I AREA TO 11161LE I = 99AU SO. FT. •a AREA 10 MEARIM LM 93,310 S4 Fr. 2 2.14 ACRES N1Y7771'Yl 5727d 4et j •sue � ' *° OYERML FAST WEST 1/4 UM:' L O T Q = ,01. 5!974• a2es.o7' - -- mm TO 11101E, 64 Fr -- -. .. .. - .. � 7:L ,s7 r . / ", 3g5&2 ' -- AREA TO wEMmER LW-. ' 4 — — T L IN 77.=7 / o \ >� 77 SM Fr. }_ 1421 1 EAST 1, SEMA 2.17 ACRES 1 6S a .791lIT. 1 UXE 41� ' j 37469 Il���, too, / / ' • �: L O T ! L {secse orw — �D j I T. • �� / "775e ACRES I I AiEA O TO s 4 m b �y y f AMU 10 wEAmER LM* in I.Sft ACRES , ae ArnRES FT. R� P I f� L TarAL u B } I ��t •�, I S 94187 54 FT. IM ACRES 7X.* !'- • • y ; 5 tl + �' • —� 4 4461 I j A� 10 NGRM- I 1. GLM* SM FT. NC A 'A1mEl1 LM 1� I 3 i 9 J ® \ 1 ACRES Fr. � LO 94779 04 FT. 210 ACIE3i •. // � / �, 0 ` ✓•• \ \ \ / LOT 10 AEA 7 S M FT . : 0996* 4 FL 1 1.9ft ACRES AND 10 IMEANDER LM I % / 94071 S4 Ff. � 1.50 ACES �p \\ `��� s FF.E 10=0 -a2AW 7664 - 'LOT11 / AEA To 11101E , . 0 410!* S4 FT. 2.a2k ACRES ' • • • ' • ' • ' ' • • ' �'ri, mu in wENOE71 LM / ' • is LOT14 1A gc Fr •• /,/ \ '� AFA TO 11mR. LOT 1: F.F.E. 10050 'C •'/ ' 32 M 7 * 90. E',. qq A1EA 7O 1110110 •' \ - AEiA MUM= *611: LOT 141 A s ift ACMES �• Q i \ \ \ 140,314 S0. FT. TOLL AIEJIe AMA TO IEN®1 LM \\ 371 ACRES 103471 S4 FL A 79.364 S4 FL .r 536 ACRES 1.82 ACRES mvn+ S W of BE A1F 114 �}�• • \ � I r ��� laL2r. 34909 -- 726.20 usu�AM! _. O UNDO A KE 1RPLATW m �. MUM 114 c OV? r . .sECnav 12-M-78 SHEET 3 C Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Sah?ty and 6301ding Diosion INSPECTION REPORT Sanitary Permit No: 420488 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Brushy Mound Partn rship Richmond Township 026- 1126 -47 -000 CST BM Elev: Insp. BM Elev: BM Description: ! Z. 30 , J C , Ir0 2; TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATI St/Ht/et r TANK TO P/L WELL BL Vent to Air Intake ROAD t t Septic Ot Bottom C 000r Dosing Header /Man. Aeration Dist. Pip Holding Bot. Sy em Final de PUMP /SIPHON INFORMATION Manufacturer Demand St Cov GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to ell SOIL ABSORPTION SYSTEM 6 BED/TRENCH Width Length No. Of Trenches IT DIMENSI No. O is Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WE K /S AM LEACHIN kManufacturer: INFORMATION HAMS R O Type Of System: IT el Number: DISTRIBUTION SYSTEM Header /Manifold Di ibution ' x H Hole Spacing Vent to Air Intake P e(s) Length Dia ength Dia Spaci SOIL COVER x Press s On xx Mou&v At - Gra 40111 O Depth Over Depth Over 1xx 90pVtT ded ] xx M ed Bed/Trench Center Bed/Trench ITqroiI No ]Yes No COMMENTS: (Include code discrepencies, pers present, etc.) Ins eON /ate.'s / Inspection #2: Location: 1651 Water's Edge Dr. New Richmond, WI 54017 (SE 1/4 N 4 W) Edge Lot 47 Parcel No: 12.30.18.808 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = _. - - -- - -- f T r Plan revision Required? �, Yes �l No i I Use other side for additional information. _ — T SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. r r�' � ��' i � �r . ��� '• .� � � • - -+ 0 e A c Q , ,��' . ,� s r .� M � 1 � t � a ' -� t 1. ! � �. �' r w e, rY e L + s. ��... ,... vo.av raA $10 400 4505 ST CR% CO ZONING 0 001 SAW sad HitOdi Division CM 201 W. W*b fttm Ave, P.O. ®w17082 Mme. Wl $3707 - 7082 S w 0a o in by Ca) aC tllllZtlt of CommeTCe (SM 261-0" Santry Permit App - I.r r PAw As egad � eewa $"I. Wis. Adw. Gawk Pesostl �`� E D m y ae rand tat s°°ondrY pwyoaes t 1 , a15." [. AP0 x�a Adlscea of d�fli�s dry write sdd� 11nges a.et;.. Pie.ee re�R M tafan..ti.. l .,j IV L ��l t� \� �c� Ze ham" ovowes now Mftk t•7 M Owaa's Ad*m fib, LAcal s N� '�`') iro S �� �. raeAa Nttaabar IL TM K>� (dieek sG dot � � � T R E w �vb) 9 1 ar 2 Psa�ily Dw - Nssrba of 8ot0000Nt �Y " CSM NWAW , PlAkAC*mwwcW- Dwtn - ftUn —� e ❑ Sts10 4rsed - Daett'be O �' �Toa�wlklP a[ a ln. 't'fye o8?ersaitr ( Ne 1s= M lies A. Css1*itic appikslle) A. jpj4W SY*M 0 R SYMMI 0 Tloatstatsli6ft" Tsak Rgftcawm Doty 0 0 OAea ModR aftco to SYMM s. I3 ftWA R®ewal lrp--* R D Cksaso of O Parstil T"Whr so the P— oos FvW Nwrber sod Dery Imad soom ftpiesrisa phw*w OWNwe D 'K S' ft W of rows ftaftw- CUsrk aN Non - P=wfted ia-0tor A d MwtA? 24 Y o Mk soil 0 !land < 24 WL d "I 0 A14O Pikes cwmnu*o wwwo 0 PmvAtead ❑ T=k 11 Pew Fisa 0 Tmourwl uta ❑ R- Fipot Sytame k eft MkW 0 tasckis8 Ckswbar M* uM V. tseeeet Ares lol6n ew6w- E adp n— (,mod) Daaipt Soi Ap6Cwoo R+tdtp Ara sn Syass• pp '134 YL T spk to Tot.1 NW*W sk e Swd Foer rwdc • cm%" aruWJ i ato, tales Trig l , ' IMYwRTwt �' Taswaesa lhirl Oaaiy Giesler Vii. RapeadbMT SlsteaWM- 1 Iles psdas4pAj snno tar POWTS aMw1t N 11te sae►ed %& P sNorte S it ; r Plsaker`s Ad6M (8ttees. Cllr Sege, S e k -p w i l�J� c) VM. ets"M shoe 0 Diaappso�ied VAN PCMW F— tAte ) \ StsekwpFee) 0 0-w Gi.a. Room (W Daaial f)t. Cesodltbss sEAp � � r prnrsl cwt• <aN» . wl�rw .►t.rskeiry�....,�...Mee.rwlln.H t..e■ 7 SBD -6398 (R. 08!02) " ,. .._ � � ' «�.�e �:� w� Bf cts F E ' 12 03H fr • , �� „wwewwwi ww ': 'rf,ww w,w ,�' �r 12h } } ++ wi► f i f_♦ A 12 Ciro. wi w rr �ff lO.Oy� r — 24 �--- 1 .2 -1 D V (typ o.n ar: fi let j � rare = w!le f < 3.,d t t3w1fi 'tst antt W - i7•S c.,d 1R , .0- Sect iau i >er eF -a, r. - s.T34 �' T.tst erlaee Ar ejj cy y O.1). ofauts „�� tr2aarR 1• s�.. s22fi. I -Id ! 7.t tJ •.SFa 96i1 t3 F - Jetted TrprCok Area ' )' Ord lu 'w S w at! I me ae t>orklm j$ht tt tZ An 6 n cF PrxxleA1 -� �'w er. t f _ t3o1 _ 2-00 36 tn. r - ara rbt 1 -T% a t atrs+6e t I t ?� x fi < tt_215 ft. Tacit = 3 pp Sq.Ft_ tam iwttern+s t tr? aF wtQ stew 1 PreJecttd 7reuce Area S d war ��' bcc [yt 3.OY q-Fl, I fl_t22' fl.9flt +- t.? fl.273 . log � tOd t}' � 26 C3 Gatbltt her tt - fl. ° dg <i3. 7 wh+rfirfi f t f j EPA A gregQZe Tree h System El l 2 H Re''9 `kldttstriat Gran . 1'0W 55 I ndustrial p p Oakland. TN � .i806p Rd- SCALE ! -"M7 FU i c_3? -Dt t 201 M par a P.O. Swt 7182 3 I�t�iioR, Tn S37a'1- 716 ` o -tz z 0019 Cog saukuy Permit APPS ` D rwi At Amt tir LD. llrisc L Afftat1w !dam - Pert Tdo Al I*atadm j 00 E P� ll�ia: (O— Laoim d � trat=syt g SC- �,Nww. ( .), r -iv R � Code rr.s rirAa Lat D1oet roer Cigr. �s N // cm t S . a17 '7 (S ( Q3a s Ed IL Tyr 41 ro„ lids wm* as so opw �i ar s a•+lr vw.t�s - rrw� ar iir+�.• e ____________ >o D sm Owmd C 1 I Z "j da r r aL'TjPe i!'rem wb w Ms m A p 1� sdw�rs iUrr �?- irs f i[ A 3 D D �C�•a4r +� 1 1tw sD � � of 6 Taft as& soft DM Ismod s. D o.oR it sw.r..� wo.rc bws" r>�r �t +�s,�i... r /1r r.E..1 Ne. - t�...�..r D � a O s..+ sa Cl c�a�a Wedud xi D � >ta�aafd a u i� TIM* 480 s�.ais si O ait Lim 45 D A&GOo a 46 lmml s U" 400 DO O pir Y. AAM Gawk 11,d�PMrwl � AMM } �srados LOoa I � ate.. ae yoft Tom .rw+i. Sc7 t ; 14 2SIP s Z A im �.. „�,� w, it i!�7R!>R rr•..w 1�s arMeia sll�r �rrree I trope Nsabar ts a SI f 6 s Adbim OW. Soft Zit cow �- a. how bwA AN" 040 sow DWW Q � i o � MW A,� p 2 l, za> M Cmwittiws or AW61 rmes iw , ` [ Cf oa- t t t PIP w� l AtYU! t� i=�rfl�ss) wr �r+s`s • r1 sYf =ura..r cRr"'AQR fR orsi n i iA I �f � I 'I � � � i +-- _- 1-- - - __ ` �'/icDf i�= -•S ro I '____ _..1_ __i i 1 • i� i � I I I I I 4,--j - - -- - -- - - _ A 1 I 1 u�f i 1 i : • I I --I , l i �} a I - y i { I I • I ! _ I • i i ; i l� I I , I I I I - I I r I r j f ( I i 'u rt a r'� v�.os�' /h'1 ! sfQv Q v--S ev 1uu7yy S 34 q 4L5 3 V -C& I IL ve ; RA4 pv ph q Better War W--" q. I ffff ff 34 w x76 - =I1" Opdi 6 ate + aid i� ewu omicw 'F Maxim Qf Prow* unlna Provides the 'bleetive� �� leachi � mn amount �nm aslted o provide an s. Its desi dewall to allow o p e n bott ._ _.—... apillary actio e fflu ent m and = hieved b n in all directions. tO flow via SPECIFICgj mom with a n�no aitional L the ph h f trd as been ftbW d erVM...........7 LOMB unit ent tide the JOUVe1s aloe . Open g« f' i � I al ong the flow t ° un g the sides. Wk*h...... 340 L�9th . 7 6 . des igned a hM l en " SM o ws � ed Hit ......... W� ...... . Patt 14. 34~ to allow effl +wert ...............9. Height ...........11 -ornpa�� bacicfitl w � r �Pass� ini Bi Mvert .._ ra 8 into hiJe reve o the °� 8eM� a .......•6.5 / th e chamber p nting it from �AehY90d �. w m of 2" or 17- Wit and to jnstaMed '' h �- lgnd ver 1 / factors ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND . OWNERSHIP CERTIFICATION FORM Owner/Buyer ��•t -/ S� /Llo v � a e+z. S M 1 C,f+A G k", Mailing Address / 60_x Ncw P- c-44 Ma oV O �lll1 SS /iO /? Property Address l (off / CUJN XA -5 ("D (4 c _ 'b 2 I ---/ c (Verification required from Planning Department for new construction) City /State Mfw 4 L ^'t'O 14 6 \ 4 49 Parcel Identification Number 01,6 -ti a b ' LEGAL DESCRIPTION Property Location V4, � 4 yv '/,, Sec. /L JC N -R / d W, Town of /e w4 tt a . Y-o Subdivision d7�-S �� Lot # / /�7 Certified Survey Map # , Volume , Page # Warranty Deed # �7 �,� ZS '1 Volume . Page # f 4 O Spec house *es O no Lot lines identifiable xes 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 masterplumber, journeymanpl*ber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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. 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 thatybur septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of qpir a 'on da S I ATURE ICANT DATE OWNER CERTIFICATION I e) 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 pr des 'be Zbovb rtue� warranty deed recorded in Register of Deeds Office. SIdATURE OF APPECANT 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 66� 57 ';.14 31PAGr 169 6042 STATE BAR OF WISCONSIN FORM Z • 1998 KATHLEEN H. WALSH REGISTER OF DEEDS � ST. CROIX CO., WI . This Deed, made between David L. Naser, Grantor, and Brushy RECEIVED FOR RECORD Mound Partners, LLP, a Wisconsin limited liability partnership, Grantee. 06- 03-1999 9:30 Ali Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The WARRANTY DEED " Property "): CERT FEE: COPY FEE: See attached Exhibit "A" TRANSFER FEE: 1047.60 RECORDING FEE: 12.00 ' PAGES: Recordiniz Area Name and Return Address Hendrick W. Van Dyk VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 127 New Richmond, WI 54017 Pen of 026. and 026,1019,10 -000 Paros:Identification Number (PIN) This is not homestead property. i , rh Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated this 28th day of May , 1999. *David L. Naser * * AUTHENTICATION ACKNOWLEDGMENT Sianature(s) David L. Naser STATE OF WISCONSIN• ) (•,uessaoau Sou oil tryog 'poEp*jAwgos 10 Meop=pm oq (eul saltusuEt$) (- -' LZT YOg aOWO ISOd mvp uonvuTdxo olins '3ou;o 'O'S 'U2MS 7 9 MOEW 'XXQ NVA •3uouv=ad q uotssT=oo XW 1 =A 'M T=PuaH uisaoosiM ;o a 3 e 3S'o?jgnd kmo JCS amAyja S'dM.LNSmuLm mu ('mmS •s?M'90'90L § Aq p azuoipm '3ou 31) NI9NOOSIM dO Wil ELVIS 'OEMW :f3'LLI.L 'amts aTg 02polmouxov pus liaomm isM 1 4 CI uaA 'M xUapuaH 8uto8aio; oq p oqm (s)uosia ag oq o uMoux au3 03 .M J pauTSa anogs aq3 —6i ' jo /Csp sp auu alojaq au = X11raosaod 666 T gI4 j° CepL F 3sor1uag3ne ( kunoO •ss ( - n .„+ re CD � a ID q tr , o � �, o 0 0�� qq �t O &i '.1' n Vr 'O N M V f]. C RL ( (D (D O rZ A rt n O '�� �• fD -4 " p- 0 O° n n C O CD Qiq o �. 140th Street I I I _ Q S Q I � falAwo Acuunluu co wrr MavAVVr ® W ; N53v335•tr T cov t N AREA 70 24M ,� I = 2 tat ACRES Sa Fr. ° >s• j V AREA TO MEANDER LM C1 2 2-46 1 I NlY9Y'31'N 57270' _ °1� e ' - RO�'"��,• __ �';� MULL ��� � , core � — — . —.. —. ,_.. —.. m7aatsa 77.857 1M FT. T 5R� L /NE , \ ,M'3 'W Ng 25' -- ACRE �►am LM' 19 — .. � CH t1 ` •`•• -- Q- a — No-&02'E 3 1 CAST 1, r Founw Fr. SFr. �/ /� \`� t i - - -� Lor7 I r Q AREA M *M 1.27* ACRES AREA M WOMEN LM M20 SM FT. 1.81 ACRES 41 t „ 4e, ' • L O r a ' ' Seraa'a'w >u j1 1 I — a0 1 a il? #/ mrAL A1EA •�� 207 ACRES .. ♦ a �g $ t 1 . LOT d d ms 4 AMU 10 110M 84.974& Sia FT �A M IWANM LM tS • ( S 73 SM FT 1.61 ACRES LOrp 3 ,'E WJL ARE/N t 53 maw I 95.157 SO Ff. '' t ®'® 27t ACRE I • ' 7,31A _ >, Lore4 3 + S; • �i A µ 5 i t ; AREA m FT. . S 8 � N( i 11 t -rwttM 1 104* A M Ff 1 1714 j p AM 10 IFJAM LM 1� w ,'�� 1 • V ( 59.949 S6 Fr. J 111 1.51 ACRE low AFE* (3.779 SR1. Fr. Z' y � L13 ACRES R �'Woo • \ \\ \\ // J* jLw d L O T 10 AREA m SNOB` � 59.495t So. Fr 1g iii ACRES LM am SM Fr. „tr•�` ' \\ ��1,� �. �, • \, '�' �jT F i 1 Aa 0 Y �• LOT 11 / �'•• d � AREA m 9►iae ' i 52a* �R. �. • • • • • • • • • AM 'M tEAp7F71 Ism V LOT ir e4m 90. iT. .i•' + AREA m awm y a LOT 1� ,� F.F.L. 113. ,ao:.a �..ri � 143.417* 50. FT. "� ARA m lIOR6` A"m EAtm use :� LOT 10 izsot, s ,40,314 90. FT. IOUL AWAt t AREA m IEAMM UND \ 3.72 ACES IOJ,a71 SQ F7. p 70.351 S0. FT. \ t 2.35 ACRES m 1.52 ACRES SOM LOW Or HE ME 114 VX HE Sw 114 ., r ' tUL2r. 34554 V N� LA 1115+LA77lD was b. 5i7 V1 114 cicwnl R MCnW 17 -.-1d �(fL1UH7 1' Nl1Al AI°IE) SHEET 3 C . x POWTS OWNER'S MANUAL & MANAt BMMT PLAN Pape 1 ai ME mm SVStp CaCT10M6 — C-U5A un rl' e I Swft To* �. DNA P+emtit `tzo , 4 9 0 Septic TW* MawfaC"m (uJ l%AS ❑ NA l PAIfA TENfi Ef%mW Filter Mwwftctww O NA PMW"bw edrooms 11 NA Efikrent War Model Q C7 ❑ NA y Units Pun* Tak Capacity ad ) L Pump Tm* Manufacturer NA timated x 1.5) �O Pump ManufaChxer A S Pu m a - � NA ft Quality M!anth1v average Frotimdrersrrt Chit gV NA Fats. () ii 6 Grease (FOG) 530 mg/L O SWKUGr&vot Faro ❑ Peet Fitter EAomhernicsl Oxygen 06"Md IWDJ 5220 mg/L ❑ NA O Mechanical Aeration 0 wetland TOW Suspended Solids (TSS) s f fi0 MO& O Oiakwhiction D Other: Pretrersted Effluent Quenty MOWA* every" piepersal COW O NA Bic Mcai Oxygen Demand (WD) s30 irg& Q(h4round (Oravityl ❑ irt- Growrd (prmtuizedl Total Suspended Seepds ITSS) S30 mgit ❑ NA ffAt -Grade D Mound Fecal CoWarm f9emnstric mearei 51W cfWtOOoN J O Drip - Line D Other: Mtrdnnum Effluent Particle Sizes Y in dia. Odor: ❑ NA Odhrn: 0 NA • Vakm typkw fm dwasatic rvaalt wecer ear septic trek dfkmrre. Ocher: 13 NA M+11Ni ENAMCS SCt a - Event B Inspect condition of tank(&) At Meta once every: 01mdmammi 3 reams) O NA AMP out contents of tanks) When c orrnbined skmige and sawn e4uakt one -dritd (151 of tank vokune ❑ NA Inspect dispersed calsl At khvet once every: II morhdhls) (gym 3 jltrars) O NA Clean effluem filter At Nast once eves V: sl O NA Inspect Pump, purnp aontroia m alarm At Iona once every: 0 +ne tt DNA Flush letsraM and pnsaure test At least once every: Q nhonthia) O NA Other: (03 months) At issat on every= D 0 NA other: 13 NA li/ANIIi1ENANCfc OBSTRUCtlt)NS kmPvet)ons Of tanks and dispersal Ceft shall be made by an individual carrying one of the foNowirg fi wwm or certifi"dons: Nester Pkrth6er. Master Murnber flestricted Sewer: POWTS kWpeCtor; POINTS Meintakier. Septege Servicing Operator. Tank inepactions moat kx*W* a visual inspection of the tw*fs) to idernffy any rrtiaak or broken hardwere, identity any cracks or leaks, rthsasure the vokmm of combined sltdge and scum and to check for any beck up or ponding of eftlusnt on the ground surface. The dWPWSW CeWs) shah be vmWRy inhsPMW to Check the effluent levels in the observation pipes and to oheek for. arty pandirg Of efft" t an ttm ground surface, The pontbng of attiutrnt on the wound surface cosy indicate a failing condition and #w in'nrrhWin& nodfication of the local regulatory authority, VWhen the c O"*"md accunlulation of sk+dve and scum in any tank squab one -dwd In) or mom of the tank vokinhe. the entire contents of the tank chap be removed by s 5aptage c.,a Wisconsin Administrative Code. wicing Operator and disposed of in accordance wMh tdtiaptsr NR 113 All ether sarvicm. including but not limited to the servicing of effkmnt filters. medhsnical or Pfd components, pretreatment cute. and any servicing at intervals of 512 months. shalt be pwfonhhed by a certified POWTS MNntainer. A service repot shall be provided to the local regulatory authority Within 10 days of completion of any service event. GMW (4101! ART Up ' OPERATMN For s new won Prior to the _ �• th of tfte�tatt " ttr pro � aeatnront tankfsi for the prime of � System, start Est. ff high cones detected � comer OCON start up not Buying Power ou tages Pump ta�tks n fill errs frozen at the in iitratn a a a" com �iuent. To avoid #03 to the d Est in �Ve nomad highwater levels. When Power It Power to the effluent sit"bon have Contents of the o° Nand may Ofed the °""°ss waetewatar win t Punv rg restore entree! few w the tact a Plum or POM/TS tank jernoved by a the backtm or e t 00 not drive Pwtro Lank. iwairttainer m assist �PaRgr t within 15 feet Park O1"°r tanks and dowry dope a f over monks an at sal cafla. Do not diwe or P ark O $; on f t the Wast ewater �Pdonstr� ' over. or otherwise dbturb or compact, the are; ation drain f=MW y cigarette butts; � Y Prove the WfonnanCe Painting Products: Pesticide' *t* and yegeta Cot ton degr�ee►a: dental !foss. and p tfw We of the ANOOII - n :tangs: and water softener brittle. resat mss; m ��; a�. the P01NTS fads and/or is Permanently taken Y and safely � in wilfi out of service the �yr� �e0e shaft be taken t � o • '�Pter Comm 83.33. W AAll 9 to tanks and Pits shop be disconne and cted /lei�e Coyle: a Mat the system is • The contents of all tanks and the abandoned Pipe oParairrgs seaMd. Pits sl►aN be • d a nd PnMmrtv AAf e r wing. all tanks and Pits shat! be e>< dosed of by a Sepgge ckrg Operator. Ems/ PLAN Myatt snit! ma eriai. c•vated and renwved or their covets ranoved and the void space filled with �t *MOM: carrot be f°Pai►ed fire foNowing In have been. Or must be taken. to Provide a code cornPfiant A s urtax repfacernant area loss been ev systssd The reMacernern 00111 mould be protacted �` be utdi eed for the location of a result in s f� and MoPOeed Attu•, lot mind won and shaddmP ni sob , �WY with the rules �eeta that � ration to establish a e a b � 1 the moa cwtient . Win ❑ A suitable rePfacerent area s not ava�le sYStems must to s uob9Y a holditg tank due to Setback and/or snit �atione. [3 The � irtataNed as a last +•sort to replace the felled �1�/'fs wing advances in P01NTS The a" free not been ev ��+atiwt must be perform locate �y a suitable replac7nem area Upon Wure of SW E] Hotrod and ode sod r"Ott to rapiace the faileda � area. ff no r� area leis available a hobs t in" be installed as a infiltrative surface. fie8" sY� �Y be reconstructed in pla -CWAf > > bona of systems "prat SPA► with the tube in removal of the bin So P' affect at that time, mat at the AL GASSES '"80" FMM 11* WT MQR OF A TAISCS MAY COXTAM UnX OT"ER AMORAL CoUROM, A TA TIMEATRUM T ILT OR tg pp ANC. IDEATH� T USE !F A T UHT& igf8T/1LJLER Nana POUlf1S MAMITA phone lS SC Nan° TARE �ATQS fpm Phone Name LOCAL �WJITOQIY AUT"MM ° fie Name C i bcisrprnt was draped in with �o+ts - 71,S j1 Pte+ Comm 83.22 f 21 (b)fIJfdJbfry end 83.64(11, f21 & (31, v yVlsconsin Adinkileftetivs Code. IV I — i L�1�t�k2��S.__ 1 , ( }} I T- — IA— a 1 _ I f i t