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HomeMy WebLinkAbout026-1151-23-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: . 430559 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: Schulze, Steve & Bonnie I Richmond Township 026- 1151 -23 -000 CST BM Elev: Insp. BM Elev: BM Description: — Section/Town /Range/Map No: co. . 0 j La = csT g� 1 C �3� 20.30.18.1138 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmar Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TAN SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > �Fv 1 �- Dt Bottom Dosing Header /Man. Aeration Dist. Pipe !fl Holding Bot. System •!$' lb(. L6ee Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover V t GPM Model Nu r TDH Lift is oss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTE RENCH idth I Leng No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME S 3 / p q SETBACK SYSTEM TO tt0000 P/L lBtDG IWELL LAKE /STREAM LEACHING Man facturer INFORMATION CHAMBER OR t f t t. S Type Of S tem: f UNIT ���• � � � Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake U Pipe(s) 1 1-ength N Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded f xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ]Yes I :' No Yes I No /� 1 / M 2 MMINT$ „(�clude ii repencies, persons present, etc.) Inspection #1:0e • 0 1 Inspection #2: -- r Location. 1068 144th Avenue New RichrTiond, WI 54017 (NW 1/4 S I 1/4 20 T30N R18 ) Waldorf Meadows II Lot 23 Parcel No: 20.30.18.1138 1.) Alt BM Description = 5.T•Iwa,�l�ec. N" 2. 9 9 Bldg sewer length = 17 , - � - amount of cover = t h "4- • C '� , �) ►'C�* -. L, 3 a1pWG � - ft ' - Plan revision Required? Yes X No / F i . Z d. Use other side for additional information. _ Z _ SBD -6710 (R.3/97) Da � Ins ctor's S ture ._ o. J 7 eta.. RECEI Buildings Division Comity ,O V 6 ton Ave., P.O. Box 7082 eons WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) 8)261 - 6546 Department of Comm rceST. CRO X stare PIan1D.Number Sanit ion k j in accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide Project Addre (if Brent than mailing address) may be used for secondary purposes Privacy Law, s 15.04(I)(m) J I. Application Information - Please Print All Information 1 , -b Property Owner's Name Parcel # Lot # Block # Property Owner's "'A e(ss� Property Location Section City, Scat Zip Code Phone Number � ( circle e / � I V ✓ 1 N; � E o W H. Type of Building (check all that apply) _ o Subdivision Nazpe CSM Number 1 or 2 Family Dwelling - Number of Bedrooms l ❑ publidCotnmercial - Describe Use ❑ State Owned- Describe Use �- S (a� ❑City ❑Village ship of / HL Type of Permit: (Check only one box on line A. Complete line B if applicable) New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑Permit Renewal it Revision 13 Change of ❑ Permit Transfer to New List Previous Permit Number and D to TS ued Before Expiration Plumber Owner -�-)(j ?, IV. Type of POWTS System: Check all that appl Non - Pressurized In -Ground El Mound > 24 in. of suitable soil El 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 C1 Recirculating Synthetic Media Filter Leaching Chgmber p Line ❑ Gravel jl s Pipe ❑ Other lain V. Dis ersaVrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(g // pdsf) Dupea Required (sf) DisAyea posed (sf1 System Eleva on ! ✓ ( �� J (( t/ � VL Tank Info Capacity in Total Number Manufacturer Prefab Site I Fiber Plastic Gallons Gallons of Units � `D Concrete Constructed Glass Na. isting V Tank Tanks r i Septic or Holding Tank Aerobic Ticanient Unit Dosing Chamber VII. Responsibility Statement- I, the undersigne a responsibility for installation of the POWTS shown on the attached plans. Plum 's Name (Print) Plumber's S' MP/MPRS Number Business Phone Number c Z `7 /La. rl/5' G _ Plumber's Address (Street, City, State, Zip � y O . Coun /D artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date issued Issuing Agen igna re ps) Surcharge Fee) ❑ Owner Given Reason for Denial ` V IX Conditions of ApprovaURessons for Disapproval I � SYSTEM OWN 3 (fin 1 Septic tank, efflus{ a serviced / maintain ed by p lumb dispersal cell mu plumber ��` �' f'°T ScGbd as per management plan providsI— �4V uirements setback re All s Girv� Z i� applicable code /ordinances. - per a n S asp PP � fT A h amplete plans (to the County for t� mQ�QP G n gl/2 :11 loches io size SBD -6398 (R. 08/02) Soil st and System PLOT PLAN .PROJECT Steve Schulze DRESS 14295 55th St. N. Stillwater Mn 55082 NW 1/4 SE 1 /4s 20 /T 301 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 11/27/03 BEDROOM 3 CONVENTIONAL XXX IN- GROUND SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 IL BENCHMARK V.R.P. Top of Culvert ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL H. R. P Same as Benchmark SYSTEM ELEVATION 94.0/93.7 4' below qrade Plans Designed Using Conventional Powts Manual Version 2.0 Vent > 6„ Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Long 11" Grade at System Elevation 34" �S Pro 3 B -3 35' Bedroom Vents House 7 10' T 25 5' B -1 16% 145' Slope 2-3'X 69' Cells with >3' Spacing 150' B.M. 144th Ave Soil est and System PLOT PLAN ' PROJECT Steve Schul gA DRE SS 1 4295 55th St. N. Stillwater Mn 55082 NW f 1 / 4 SE 1 /4 s 20 /T 30 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 11/27/03 BEDROOM 3 CONVENTIONAL XXX IN- GROUND &SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 IL BENCHMARK V.R.P. Top of Culvert ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.0/93.7 4' below 4ade Plans Designed Using Conventional Powts Manual Version 2.0 Vent >6 „ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 34" Grade at System Elevation Pro 3 B -3 35' Bedroom Vents House � , 10' T 25' 5' B -1 16 0 145' Slope 2 -3' X 69' Cells with >3' Spacing 150' B. M. 144th Ave ASoilest System PLO T PLAN 7 PROJECT Steve Schulze 14295 55th St. N. Stillwater Mn 55082 NW 1 / 4 SE 1 /4 S 20 /T 30 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 11/27/03 BEDROOM 3 CONVENTIONAL X00( IN- GROUND &SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of Culvert ASSUME ELEVATION loo' Filter Zabel A -100 ❑ BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 94.0/93.7 4' below grade Plans Designed Using Conventional Powts Manual Version 2.0 Vent >6 " Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 " 34" Grade at System Elevation Sj 32 ,`s on I.r t a ' Pro 3 B -3 35' Bedroom B-2 House - Vents 7' 10' T pU ' _ B -1 16% 145' � 1 Slope ,� t� q q�,�' 2-3'X 69' Cells with >3' Sp ing I 150' B.M. 144th Ave.,�_,. r w � rQ.t�i� a .Q �.���n -�.� .5��4� /io'�rri, 51.✓ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County /7 � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must tt include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. / ? percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0Z t0 ' �� - Z > -6w Please print all information. viewed y Date ,l Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owne p Property Location Lk-L� l —� Govt. Lot /1/tJ I14j6 1/4 SZ ()T i J E ( W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# `f S 02 City State Zip Code Phone Number ❑ city ❑ Village X.10 w T Nearest RoiW 17 V K� New Construction Use: sidential / Number of bedrooms Code derived design flow rate _� 2 GPD ❑ Replacement ❑ Public or mercial - Describe: Parent material �� iJt '�� Flood Plain elevation if applicable ft. General comments l5y � / and recommendations J 'Fi U ; :(*tM(.� Boring # .�p�j Boring 9 M pit Ground surface elev / R. 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 I 'Eff#2 11 47 ng # Boring G Pit Ground surface elev l 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 1 - /Z. ``- ' 5/ S Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ture CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address D to Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �� 715 - 246 -4516 I 1 Property Owner _ arcel ID # Page of © Boring # a Boring Pit Ground surface elev.` ft. Depth to limiting factor in. _§R — 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 'Ef1#2 2, Is 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 Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. 11 Pit Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 mg/L 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. seo4330 pt.6(00) f[GVGI V NOV 18 2003 fety and Buildings Division City ,T. CROIX CC UNT201 W Washington Ave., P.O. Box 7082 , 1SC� I NG OFFICE dison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) (608) 261 -6546 Department of Commerce state prat, LD. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sI5.04(1)(m) Project Address (if different than � mailing address) I. Application Information - Please Print All Information t) y ( tom=es Property Owner's N me Pa ## E F Lot # Block # r f "' -3 , -- Property er's Mailing Address Property a / Section 2 —/ t� City, State ) Zip Code 2 Phone Number Cf N; or 11I. Type of Bullding (check all that apply) 9 40 Subdivision Name M N bet Family Dwelling - Number of Bodrootns `r'' f ❑ Public/Commercial - Describe Use �} ❑ State Owned - be Use 2 3 K G0 • S S ❑City ❑villa wttsbip of III. Type of Permit: (C k only one box on line A. Complete line B . applicable) 2f - 6 Z3 A. leme. System ❑ Iacement System ❑ Twatment/Holdi Tank Replacement Only ❑ Other Modification to Existing System B. Permit Renewal ❑Permit vision ❑ Change of ❑Pamir Transfer to New t vious Pe Date Issued Before Expiration Plumber Owner IV. Ige of POWTS System: Check all hWt o 1 on - Pressurized In -Ground ❑ Mound > 24 i f suitable soil ❑ Mound < 24 in. of suitable soil El 11 single Pass Sand Filter ❑ Constructed Wetland [] Pressurized !n-G ound tab"' T [3 peat Filter ❑ Aerobic Treatment U t [1 Recirculating Sand Filter ❑ i Recirculating Synthetic Media Filter hing Chamb Drip Line ❑ Gravel -less Pipe ❑ Other (explain) CSC V. Dis ersalrrreatment Are aformation: Design Flow (gpd) Design Soil Application Rate(gpdsf) Ckcrsal Area Required ( rca opos ed (sf) System ti I / 3 , 6 YL Tank Info Capacity in Total er Manufacturer Prefab Site S Fiber Plastic Gallons Gallons Units Concrete I Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. ResponsibIRty Statement- 1, the undo g assume responsibility for installatio2ofPOWTS shown on the attached plans. Plum 's Name (Print) Plum gttature MP/MPRS N ,Business Phone Number i Plumber's Address (Street, City, State, Zi e)_ VIII. Coun / 711Di s approved ment Use Onl ,Approved Sanitary Petmtt Fee (includes Groundwater Date Issued lssui A Signature (No S ps) A. Surcharge Fee) ner Given Reason for Denial 1 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 t7+� as per applicable code /ordinances. Attach complete plans (to the County only) tar the system on paper not less than 6112 x 11 Inches In size SBD -6398 (R. 08102) 430/ T PLAN PROJECT Steve Schulze DDRESS 14295 55th St. N. Stillwater Mn 55082 NW 1/4 SE 1/4s 20 / 8 W TOWN Richmond COUNTY ST. CROIX 11/14/03 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN- GROUIw RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 ,BENCHMARK V.R.P. Top of 1" PVC Pip = SUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL "H.R.P. Sa enchmark �— SYS EM ELEVATION 94.0/93.7 4' below grade A-LT-• 40 ' P J ( Plans Designed Using t g i Conventional Powts Manual Version 2.0 Vent ALong Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area 1 " 34" Grade at System Elevation 2 -3' X 69' Cells with >3' Spacing Vents 3% Slope B- 10' 40' 25' T 80' Pro 3 Bedroom S House a 60' -1 Vents B.M. * 20' 50' 25' % Slope lbN 20 10' B.M. #2 C OP* 60' Pro Town Road <--- /Lf L1 * A, -�' P T PLAN 'PROJECT Steve Schulze ADDRESS 14295 55th St. N. Stillwater Mn 55082 NW 1/4 SE 1/4s 20 /T 30 / 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 '�' DATE11/14/03 BEDROOM 3 CONVENTIONAL X00( IN- GROUA RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of 1" PVC Pipe = SUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Sa enchmark SYS EM ELEVATION 94.0/93.7 4' below grade J 4 C, ( Plans Designed Using Conventional Powts Manual Version 2.0 Vent ALong Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area " Grade at System Elevation 34" 2 -3' X 69' Cells with >3' Spacing Vents 3% Slope B - 2 10' 40' 25' T 80 ' Pro 3 Bedroom House 4� 60' -1 Vents —' B.M. * 20' 50' 25' %Slope 20' 10' B.M. #2 60' Pro Town Road - 2 Wisconsin I Department of Commerce SOIL EVALUATION REPORT Page t of J Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. ` C Attach complete site plan on paper not less than 8 1/2 x 11 inche Fsl2m a� N ED my include, but not limited t o: vertical and horizontal reference point nd Pa cel I.D. percent slope, scale or dimensions, north arrow, and location and rest road. Please print all information 2 2 2002 Re ie d by Date Personal information you provide may be used for secondary purposes (P1 �QU1NT �- , 19 - 2 4 9D 3 Property Owner Govt. Lot ,,�j(,v 1/4S% 1/4 SZU T N R / E (or)a Property Owner's Mailin Address Lot # Block # Subd. Name or CSM# ��v�r Rd. Z3 0 M c�o�S City State Zip Code Phone Number ❑ City ❑ Village [RTown Nearest Road [� New Construction Use: Residential I Number of bedrooms - Code derived design flow rate Jura �/ 9 GPD ❑ Replacement // E] Public or commercial - Describe: Parent material d L) a S V\ Flood Plain elevation if applicable General comments Sy �m ej ev, yy, 90 and recommendations: © Boring # ❑ Boring �1 ® Pit Ground surface eiev. v ft. Depth to limiting factor 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 &-12 1 D r3t 6 0 Zmah k rn Vr • 9 12-3& I r4 - S i c( 7- — 3 -113 w\1 Boring # ❑ Boring ® Pit Ground surface elev. ; Z ft ft. Depth to limiting factor 06 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 2 !a -I,5 /0 51cl r C I5 -1 !o lD rq1t, M5 trnrn I * Effluent #1 = BOD > 30 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number S�hurtker - - - - -- --- 253 309 Address Date Evaluation Conducted Telephone Number SBD -833n '—,too) z Property Owner Parcel ID # Page of 3 Boring # Boring qq 1 1 Pit Ground surface elev. / ft. Depth to limiti ng factor ` 15 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 nil 2mabk �S Y _ 5 , IbArLAN 5i d r c — L( - ❑ Boring F-1 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 1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring F 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/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L 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. SBD -8330 (R.09/00) � C PAGE 3 OF NAME Gt1 a ld fo TOT #Z LEGAL DESCRIPTION - w %SC X ,S Zo T 3 .N,R, 1 Fl E(or SCALE: I "= 7 / 6 M ) ELEVATION /CO U BM I DESCRIPTION o wc— BM EVATION S d BM 2 DESCRIPTION T, ✓� SYSTEM ELEVATION ALTERNATE ELEVATION CONTOUR ELEVATION I - -2 5G 3 0 i Ll Av led • o MZ SIGN ATURE s DATE !G -o Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 ST CROIX COUNTY SEPTIC - TANK MAINTENANCE A (5REEMENT` AND OWNERSHIP CERTIFIC FORM owner/Buyer Mailing Address �7 s Property Address (Venfic a ion required from Planning Department for new construction) t qu Parcel Identification Number 02(o — 1 S� — z3 - o m G t l 38 ) Cit y /State LEGAL DESCRIPTION Cl/ '/. Sec .6; 0 N- � Iw' Town of /�//- Property a Location /., Z i r Subdivision���f Ll Lot # Certified Survey Map , Volume Page # Warranty Deed # 'I 0� , Volume 231 . Page # �s Spec house ❑ y no Lot lines identifiabl %yes ❑ no CE NIAINTENAN SYSTEM Improper use and maintenance of your septic system could result in its prema failure to handle wastes. Proper maintenance u put into the system licensed r. What yo p sys if needed b a pumper. f in out the septic tank every three years or sooner, y consists ° pumping P can affect the function of the septic tank as a treatment stage in the waste disposal system- y The roe owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a Th property � osal P wastewater di restricted lumber or a licensed pumper verifying that (1) the on -site wa disp sy umber, journeyman plumber, P masterpl ,� Y�nP 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 syste m with the standards set forth, h e' as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification septic stem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 stating Y P Y ea x iration date. days of ee y p A": URE OF APPLICANT DA OWNER ERTIFICATION I e) certify that all statements on this form are true to the best of my (our) kno I (we) am (are) the owner(s) of the pro descri bove, by virtue of a warranty deed recorded in Register of Deeds Office. NATURE OF APPLICANT g DA rE 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 cop of the certified survey m a p if reference is made in the warranty deed I 737765 VOL 2391 pA�E 454 STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER H. DEEDS Document Number WARRANTY DEED ST. CROIX Co., MI RECEIVED FOR RECORD This Deed, made between David J. Waldroff and Julie A. 08/27/2003 03:00Plf Waldroff, husband and wife, Grantor, and Stephen J. Schulze and Yvonne M. Schulze, husband and wife, WARRANTY DEED Grantee. EXEMPT # Grantor, for a valuable conside.,rr con eys and warrants to Grantee REC the following described real estate ilf�Co , State of Wisconsin (if more TRANS FEE: 127858 space is needed, please attach addendum): COPY FEE: CC FEE: Lot 23 Waldroff Meadows H, St. Croix County, Wisconsin. PAGES: 1 Recording Area Name and Retgrp,q ?dress OGLAND E f S � I T 1 R � f E � EN & OGLAND 304 Locust Hudson, WI 54016 026- 1144 -50 -0000 Parcel Identification Number (PIN) This is not homestead property (is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, If any. Dated this day of Aut>!ust 2003 * id J. Waldroff * * e A. Waldroff AUTHENTICATION ACKNOWLEDGMENT Signature(s) D J. W aldr o ff an d Julie A. Waldro husband STATE OF — _ — — ) and wife ) ss. County ) authenticated this _ da f -A ---- , 2003 — Personally came before me this day of / the above named * Kristine Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) — instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristin Ogl Hudson, WI 54016 - - ^— Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, Wl STATE BAR OF WISCONSIN 800 -655 -2021 WARRANTY DEED FORM No. 2 - 1999 i to as ME 4E 4E emu' 8L'S8E 35t,L4.fOS N _ lO G+�CDO V V �,5 � OD 1 i Of _ r 1 <c5' 1� W OOIVa►O�S I �N � I� p I Z IfJ m0)C 4 cv�� CD co 0) Of D p 0 lO I� 1 1 Nzz VIZZZ �. I� m ICS @& a a � 0 34 � W rn cn� c Igo -O I O l ad I PD 1 . 1 1 � 1 � � �; � p 1� p I i Ir'S iO I ,;I, I 1 C m 1� I I '1 cl 1 1 I it .1 1T`I410', �I�1 I \\\� � D D ' o� a 1 I IM1 I I I Iml�l In-4 �� "' �•` i Wllpgn I 121916 z gDr :nO -IZ -0p O O N►rnIU�ZFyo�D�_ r cnMN2 ZZ2DZj 9 o�cn NDDO�O voiTzDZn�c-'N�^��''' DA IO / - D� mz CUC��D1*� e ; r+ O ' � m DO� c >�vc O-'mr4 �� 0m'� Oz m w 8 Nc�z o� ;i0 Z 1000, W zOmZL �' � m M I NN o;o z, o �zzz� O N v g P 9 m N m m o r z cn ro BANGS ARE REFERENCED T 8 NORTH SOUTH RE C THE ASSUMED To B 1/4 ENE OF S�U3 SECTION a '12.6