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HomeMy WebLinkAbout030-1043-20-000 h ~ 0 O to y po c p C m N O cc = E m E E o U) cnc°> mod wac wv N o m m N c ai •o « p'W a w =O T c c(D m o (D cm a) 3 m a�Ei v E-o' - U c- m L U) c c y f` L O N - N m c y y v 0 m `� o o CO c m m E 0-0 o >= cQ CL (L M4 � O 'i aio 3 o 2m om C.c> E c z o v y �CL m i, W Co 0U) ca (Dc0ocoia ayi E �� ° c -p i0 O em - 7 p c L Z m Q N m O Y 'C O N y Z C t m 3 N C U O C y C Z c S p c O LL C w f6 c 0 _c N y O w c'O 3 11 c O L CO C N c o v3mmv uQ"° > omE - o mrNmQ._ c - _ a�°a`o € N m E H c N ?� = EQ c E E x 3 E d Q c c a m o ° N N QOj.=� X N N O m L O y a N i. 'p O N O Q a� OLV o�HL 3 m> m Q --� 1 > M ° d u c Z E 0-0 E 0 U) = O N p Zo W m m o a v FM- vwJ a m CO c I a m a� c aa) Q c o z z v c v� o w n CD Z !'' E c a En oE X CO E U ° o m M N ��1 m co Q o m d C w E y 4 y o `y in d •� C,4 p L m d m o y O cw 0 L O N Q 0 O m Z Z cn Z N Y I Z d ° E '° N .0 - _ 00 d = o m 30 0 IL a E o 0 0_ H H H H .c F F Fy- c �v � y333 a ~ Iz333 a � •►� 0 a a a a a a CL ` J 7 I � 3 p (n m c0 Q 0 0 0 fA J U 0 O = 0) � O Z c` Z co FV ( N Zti� Ol ° ' 0 y ... O N •m O = 0 •O E Y 0 0 'B E ` U m ° a O m a _ V y tT m N v y Q N A U) m m y N Q Z 0 m \j Q O C cif W C C VN' y C Ill + °o 0 o c `o p v E O o E O O H N c C - c n. p 7 C C V a U L N L m y m N r y m ° p M ai cl an d c °-' ¢ 4..i y M } O y Uf N N am+ 'O n N G C O N (n •(�x�i 1 " a Cl) y N O U C L Q 0 N Z N Z (n O (n to O N 4i E V Q € a € a rte• CL m .2 as a d a r A tia � 0U) 0U) U Meyer Excavating Service October 18, 2012 Steve Wcken 1427 E Oak Trail Houlton WI 54082 I Lawrence Meyer, owner of Meyer Excavating filled in an old sewer system of a house I torn down for Steve B#ecken on October 4t', 2012. Lawrence R. Meyer Excavating SCC,J�R L-cc\�Tcb "t TP- 1883 Country Road D N Emerald WI 54013 715.265.7061 N 715.265.7401 (Fax) Safety and Buildings Division County //,� * 41F 201 W. Washington Ave., P.O. Box 7162 C..�IO Madison, WI 53707-7162 Sanitary Penn it Number (to be tilled in by Co ) Department of Commerce (608) 266 -3151 / cI# Sanitary Permit Appli atiC State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, ersonal i ormation you provide may be used con pu ses P y La sI5.04(1)(m) r100Q Project Address (if different than mailing address) I. Application Information — Please Print All Information L UU J* NZ5 64A 001S r ` ST. CROIX COUNTY l Property Owner's Name ZONIN Parcel # ..be!*- Block # av 11�1�ce1� e- t.✓� t l 63 0-443 - 2 -COD Property Owner's Mailing Address Property Location City, State ZS r � Zip Code � Phone Number J,E 1 A �� A Section o✓ ! �. t,c�i- S�Fo SZ 71-5 - 54 5b`f 36 ircle II. Type of Building (check all that apply) N; R i9 (c E otD Subdivision Name CSM Number ❑ 1 or 2 Family Dwelling - Number of Bedrooms x n ❑ Public /Commercial - Describe Use t ❑ State Owned - Describe Use ❑City_ ❑Village ownship of 5 d". jow IIl. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System p y g p y g y ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only Othe ditic lion to Existing S m r � B• ❑ Permit Renewal ❑ Permit Revision ❑ 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 appl ❑ 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 )6erobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation 1 15 1 3 5 q 3Z. 9/. 75 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units 1 D Concrete Constructed Glass New Existing Tanks Tanks Septic to Holding Tank / 1 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, thi undersigned, 4sume responsib' ' installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si atu PRS Number Business Phone Number -36e�v /s 2-s8 -776 Plumber's Ad dress (Street, City, Slate, Zi de) �la VIII. unt /De artment Use Only Approved r d Sanitary Permit Fee includes Groundwater Date ssu Issuin ent Signatur N tamp Surcharge Fee) l✓ 1 D Q ven Reason enial �f OO IX. Conditions of Approval /Reasons for Dis roval Attach complete plans (to the County only) for the system on paper not less than 812 x 11 inches in size SBD -6398 (R. 01/03) 54,'/ eda/ua �,Yi3 ( P/ - ade ele v.` P�o,cd �i cser (5„c e-6e Ir" s. T.,Pkrn„ bus Ta..,,t'4,(rit Aoly 44e pr(E�,- A/ain2. .l�u��r�brvf'� Cray f y,,,! � k, � E �•rcre�'c ScPb' � � .SG'I'p�sulY; Sec.,zo T. 3a� tom'' V iArC,Yt a Ecn-�aw cdia�n- 16D 6e v� /RSc4/,� be%LJST ;7/ct --+0 f 56 . C►'a ix i - �Os - .zo - CM 3 bedran., -. "M tug" �egrQ,o<Y xe%o, - @e4cesvrt 3 /eas a v �cs:dsnce so'y Flu' Qtr It V O Cb 6.,,f. : T /issu,«td alts °/00.6b' F /owc 1+cd / ® ZNder r 0 -A64 = 9z.86.' aE out ltt` =973.' � T�of S, T• �(o.,be% couw'= 97 x!' A sola/t de(otwa ,(I (,� L /c%c! - 94 7s i � � Gad. c(4d: a-, .5y tot = 97uS ` S S�•n a r'etl . IEC PY 3 �,Yi3�l�g �p /-a de c/e P rof�Cd Gci t sir (onC roEe U S.T•.�kambliS F: (b� r1/aiM. C '� Concre� ScP6'� -dw.t! � SG'�'gC.Scc.U'�,/ �.•zo 7�.��1; 'N ,u� ins a r�cc ter+ I 56.CnlA cent ✓cn'�lepcjr'4�,0,1 0 030 - /Of13 -Z 0 _CM • so'9' Flu x36' d;�,Nvs•/ ca E /cdQ�io�s F/ c W el l A ow r bcd / ® oc .5.T: a , &,e = 91.88. c'r d. clec- alt' $y j 977 OaA T/ Sys a r'eA . X 2136 Wisconsin Department of Commerce S VALUATION REPORT Page 1 of 2 Division of Safety and Buildings in accordance w Com 5, ' . Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8'% x 11 inches in size. an m St. Croix include, but not limited to: vertical and horizontal reference point (BM), di ' n an parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to rest 030-A4420-000 Please p la a D Revi d By Dat Personal information you provide ma be eco purposes (Privacy s. 15.04 (1) (m)). �$ Property Owner Z 3 2008 Property Location Lauren M. Marek & Craig Jewel JUL Govt. Lot SE 1 SW 1 S 20 T 30 N R 19 W Property Owner's Mailing Address ST. CROIX COUNTY Lot # Block # Subd. Name or CSM# 1425 East Oaks Trail54080 z O N ING OFFICE City Stat ip o e one umber I City _J Village 0 Town Nearest Road (715) 549 - 5693 St.Joseph I East Oaks Trail I New Construction Use: 0 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 0 Replacement I Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Soil Eval. completed in preparation of attempted rejuvenation of hydraulically failed 12'x 36' POWTS dispersal cell. System elev. = 91.75'. Boring # -I Boring 1/ Pit Ground Surface elev. 97.47 ft. Depth to limiting factor >108" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftz in. Munsell Qu. Sz. Cont, Color Gr. Sz. Sh. "Eff#1 •Eff#2 1 0 -5 1Oyr3/2 none sil 2fsbk dsh cs 2f,1m 0.6 0.8 2 5 -13 7.5yr4/6 none • sl 2msbk mfr gw 2f,1 m 0.6 1.0 3 13 -23 1Oyr4/3 none sicl 2msbk mfi cw 1fm 0.4 0.6 4 23 -37 7.5yr4/6 none Is /sl 0 sg /2msbk ml /mfr cw 1fm 0.5 1.0 5 37 -92 1 Oyr4 /6 none gr Is & s Osg ml aw - 0.7 1.6 6 92 -108 5yr3/4 none a scl hsbk mfi - - 0.4 0.6 V o l, " Effluent #1 = BOD 30 < 220 mg /L and T S >30 < 15 mg /L Effluent #2 = BOD S30 mg /L and TSS < 30 mg /L CST Name (Please Print) nature' CST Number James K. Thompson 5--- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 154020 7/15/2008 715- 248 -7767 C 114 114 a 6'0,1 Ili ♦ �Xi3 �j„q p-a de e/e I U .La. u �c.,•r�;brvt' Cr a,;y T cai E !/ (pclo.47' /5/.L5 FC?z Tom. c S Erisz: cao�� Eriri� /. spo z �/ SG'ysCScclyy, Se C.ZO 7'3oil Cow,- 'Q. i94,) r.'. oe' .SL_ • TascP ,0 030 -io�3 to - czC � � E1u s�in9 cc n c ✓�n F�q rQ � 8,r►t. 3 6u1r/�ay.r. � ¢.zccss�dc s /oF� iowt bid / ® � of S.T.O(A.&4 = 91.8B.' !o, oEo u.t / c6 = Y7s13.' ' oioof S•T. /0(;A,h e% cov es = 97.x.' 7 AsP /� y��C d�;JC�•Ja ��� (� D•'sP��sa/c�! /aJe� - 9/. 75 ccg y 6�d• c(��of s� 97 C4S ©/to �P��c:a.6 /r siooc �ouy� oit's Tr 5516 . 4�eR. i 0 X0.06' r ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 1�u ,-e-,-, M. areA"e Cra,• �7ewe// residence located at: _de 1 /4, S W 1 /4, Sectio .y , Town 3o N, Range — _2 W, Town of . So 4 , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning rly. Most recent date of service Did flow back occur from absorption system? Yes w' (if no, skip next line.) Approximate volume or length of time: gallons 145 minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known): Age Tank (if known): = 30 yer-ns Licensed Plumber ignature) (Print Name) (Title) (License Number) ?9&-/MPRS Q - 1 X08 O ate) '�" Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Mailing Address 5 ,Yy 6 - 2 Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRUMON Property Location Se 1 /a , 5k) 1 /4 , Sec. 2- , T _ O N R /�_W, Town of -� Subdivision _ A4 , Lot # Certified Survey Map # i14 , Volume 4 e , , Page # 4a- Warranty Deed # 9 , Volume &_ , Page # Spec house no Lot lines identifiable SYSTEM MAINTENANCE AND OWNER CERTMCAI ON 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. Owner maintenance responsibilities are specified in §Comm. 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. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 9 �_ P SIGNATURE OF LIC T(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. 08105) SAFETY AND BUILDINGS DIVISION Plumbing Product Review commerce.Wl.gov P.O. Box 2658 Madison, Wisconsin 53701 -2658 isconsin Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary June 22, 2007 INFILTRATOR SYSTEMS INC. DAVID LENTZ 6 BUSINESS PARK RD. PO BOX 768 OLD SAYBROOK CT 06475 Re: Description: CHEMICAL OR PHYSICAL RESTORATION FOR POWTS Manufacturer: INFILTRATOR SYSTEMS INC. Product Name: REMEDIATOR Model Number(s): REMEDIATOR Product File No: 20070262 The specifications and /or plans for this plumbing product have been reviewed and determined to be in compliance with chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of June 2012. This approval is contingent upon compliance with the following stipulation(s): • This product must be utilized in accordance with the manufacturer's printed installation instructions and this product approval. If there is a conflict between the manufacturer's installation instructions and the product approval, the product approval requirements will take precedence. • The elevation of the system's infiltrative surface must be above the estimated highest groundwater elevation or bedrock by the distance prescribed in column entitled "Fecal Coliform >10000 cfu /100 ml" in Table Comm 83.44 - 3, W is. Adm. Code. • A copy of this approval letter and the manufacturer's printed installation instructions must be supplied to the buyer of this product. • The outlet baffle of the septic tank, which has this product installed, must have installed an effluent filter capable of filtering particles of 1/8 inch in size or larger. • This product must be installed by a properly licensed plumber. • A state Sanitary Permit must be obtained when this product is installed. • This product must be maintained at least annually. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Michael J. Beckwith, CIPE Plumbing Product Reviewer phone: 608 - 266 -6742 fax: 608 - 267 -9566 e -mail: mike.beckwith @wisconsin.gov SBD- 10564 -E (N.10/97) File Ref: 07026201.DOC POWTS SERVICE CONTRACT The proper operation and maintenance of the components listed below will significantly influence the performance and life expectancy of the POWTS (Private Onsite Wastewater Treatment System). This agreement authorizes A.C.E. Soil & Site Evaluations, L.L.C. personnel (Service Provider) or their representative access to the POWTS components during regular business hours to perform regular inspections and routine maintenance of those components. It is herby agreed by and between Owner and Service Provider that in consideration of the payments provided for herein, Service Provider will provide a manufacturer trained and State licensed inspector to perform periodic inspections of the POWTS components as set forth below. Service Provider will prepare a written inspection report after each inspection containing any recommendations for the operation, maintenance, and or repair of the POWTS deemed appropriate by the Service Provider. A copy of the report will be provided to Owner and the appropriate Governmental Unit. Service Provider will supply additional services, parts, or labor only after authorization by purchaser. This agreement does not assume any responsibilities or obligations that are normally the responsibilities and obligations of the Owner and does not cover any costs associated with operation, maintenance and or repair of the POWTS. In no event shall Service Provider be responsible for any special or consequential damages, including but not limited to, loss of time, injury to person or property, or incidental economic loss due to equipment failure for any reason whatsoever. This agreement will be automatically renewed each year unless amended or cancelled by either party with 30 days written notice. This agreement may be cancelled by Purchaser only if replaced by a service contract with another service provider authorized to inspect and maintain the specific POWTS components in question. Purchaser agrees to pay Service Provider the sum of 71.25 per inspection. Four (4) inspections will be provided over the first two -year period at six -month intervals. Payment for the first four inspections will be included in the cost of the POWTS design. One (1) inspection per year will be conducted thereafter with inspection fees billed at the time of inspection. Any additional fees for effluent quality testing (if needed) will be approved by POWTS owner prior to sample collection and submittal to lab. POWTS DESCRIPTION: Existing Concrete septic tank with Infiltrator Remediator Aeration treatment unit, treated effluent discharge by gravity to existing conventional dispersal component constructed in compliance with existing codes at time of construction. POWTS LOCATION: 1425 East Oaks Trail, Houlton, WI., 54082, Located in the SE' /4 SW' /4, Sec. 20, T. 30 N., R. 19 W., Tn. of St. Joseph. Croix Co., WI, Parcel # 030 - 1043 -20 -000. Owner name and address: Lauren M. Marek 1425 East Oaks Trail Houlton, WW14082 (Owner signature) (Date) Service Provider: A.C. oil & Site Evaluations, L.L.C. es K. lompson 340 Paulso Lake Road Osceola, I 5402 ice Provider signature) ate) Instrument Drafted By: James K. Thompson 1111!11 lilil ill!! lilt! ill!! !Till !{I{ IIIlIi liil Ili! * 8 5 7 0 7 2 2 State Bar of Wisconsin Form 1 -2003 857072 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Lauren M. Marek, a unmarried person 08/06/2007 03:OOPM WARRANTY DEED EXEMPT 0 ( "Grantor," whether one or more), REC FEE: 13.00 and Craig Jewell and Lauren M. Marek, both unmarried persons as joint tenancy, TRANS FEE: 382.80 .00 PAGES: 2 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ('Property") (if more space is Recording Area 3 needed, please attach addendum): Name and Return Address Title One 706 19' Street South Hudson, WI 54016 See Exhibit "A" 030 - 1043 -20 -000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Grantor wan-ants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements and Restrictions of Record. Dated / — / Z — Oil r4i / A 0 f (SEAL) (SEAL) * La n M. Marek (SEAL) (SEAL) s * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated o "—N- 0MTA-Ky-P1J5t:1' ) ss. St. C roix COUNTY ) TAIF OF WISCONSIN * Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named Lauren M. Marek (If not, authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing in tru and ackno ledge the sa THIS INSTRUMENT DRAFTED BY: Michael H. Forecki, Attorney * Connie S. Smit Eau Claire, Wisconsin Notary Public, State of Wisconsin My Commission (is permanent) (expires 1/16/2011 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 • Type name below signatures. 1/1,7 File No.: 11907 EXHIBIT A Part of the Southeast Quarter of the Southwest Quarter (SE'/. of SW' /<), Section 20, Township 30 North, Range 19 West, Town of St. Joseph, described as follows: Commencing at the S 1/4 comer of said Section 20; thence N. 1 (true bearing) 817.36 feet along East line of said SW' /. of Section 20 to point of beginning; thence West 633.06 feet; thence N.01 °07'W., 350.00 feet; thence East 633.47 feet; thence S. 1'03'E., 350.00 feet along said East line of SW'h of Section 20 to point of beginning. Also, an easement for a roadway and for installation of electric and telephone utility lines, the same to be located so as not to interfere with the use of said roadway, said easement being located in E'h of SW' /. of Section 20, Township 30 North, Range 19 West, Town of St. Joseph, being all lands lying 33 feet and at right angles each side of the following described centerline roadway: Commencing at SW corner of said Section 20; thence East (true bearing); 2029.0 feet along South line of said Section 20 to point of beginning; thence North 53.29 feet; thence Northerly 193. 67 feet along a 417.42 foot radius curve concave Westerly, chord bearing N. 13° 17'30 "W., 191.94 feet; thence Northerly 121.95 feet along a 274.37 foot radius curve concave Easterly, chord bearing N.13 °5 VW., 120.95 feet; thence N. l OTW., 1510.00 feet to point of termination, said roadway easement to continue to exist until the same is dedicated as a public road. Tax ID #: ,030 - 1043 -20 -000 2 of 2 * 8 7 9 2 0 6 2 Document Number Document Title 879206 KATHLEEN H. WALSH St. Croix County REGISTER OF DEEDS AEROBIC TREATMENT UNIT (ATU) ST. CROIX CO., W RECEIVED FOR RECORD SERVICING AGREEMENT 07/30/2008 01:1OPM AGREEMENT State Plan Transaction Number - EXEMPT # REC FEE: 13.00 Lacc"1417 COPY FEE: 3.00 Name - (Owner) Typed of pr�d PAGES: 2 Being duly sworn, states, under oath, that: 1. He /she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume _ _ Page _ . /La Document Number St. Croix County Register of Deeds Office: Recording Area A parcel of land located in the SF t / 4 of the SaJ t / 4 of Section Name and Return Address . , T 30 N - R I — W, Town of ��++cs ,laSOn 56 • TO seAti , St. Croix County, Wisconsin, being ds��� duly described as follows (include lot no. and subdivision/CSM or detailed legal description): 5 v30- /Df/3 -.ZO- Parcel Identification Number (PIN) Agreement Date: 7 .06 As an inducement to the county to issue a sanitary permit for a POWTS equipped with an Aerobic Treatment Unit on the above - described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Comm 83, Wis. Adm. Code relating to Aerobic Treatment Units (ATU) and the maintenance requirements for the proposed POWTS (Private Onsite Wastewater Treatment System) technology. If the owner fails to have the POWYS and ATU properly serviced in response to orders Issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., the governmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. The owner agrees to maintain a contract with a licensed-POWTS maintainer for the life of the system. The POWTS maintainer will perform periodic Inspections and maintenance as required by the manufacturer and the Department, including, but not limited to: the blower, electrical controls, and treatment unit operation and sludge depth. These inspections are to be scheduled every 6 months for the first two years of operation and yearly thereafter. 3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the treatment unit and to maintain the unit so as to not create a human health hazard as described in s. 254.59, Stats. 4. The owner recognizes that the county, Department of ty P Commerce, or POWTS maintal r ne may make periodic inspections of the components to complete performance monitoring of the unit. 5. The owner or the owner's agent agrees to report to the department or designated agent at the completion of each Inspection, maintenance or servicing event In a manner specified by the department or designated agent within 10 business days from the date of inspection, maintenance or servicing. 6. This agreement will remain in effect only until the county office responsible for the regulation of POWTS certifies that the aerobic treatment unit no longer serves the property. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the Register of Deeds, and the agreement shall be recorded in a manner that will permit the existence of the agreement to be determined by reference to the property where the Aerobic Treatment Unit is installed. Owner(s) Name(s) - Please Print Subscribed and sworn to before me on this date: ,'` �A3� 11 z2, Notarized Owners i ature(s) Notary PO lic rJ, Governmental Unit icial N e, Title - Please Print 4, _ _ v Commission FxnirHS n. .r 'L 64'69 'se1n;e)S u1suoos1M pue juewnoop inoX o; eBed euo sj s e oiled ienoo sfga jo esn '�jEjJ wewnoop eya /o Wed /euoq!ppe uo peoeld eq Aaw ,ro juewnoop eyl /o 0ed f p uo ooe d e few -o le 'uo/ duose eBe 'sesne o Bud ue�8 eye se ons uo eu�o ui �e 1 y� P q > > P I I ! 7 q A ! wo '(pagnber p) � pue e/7 -ju :Jen!wgns Xq peje/dwoo eq isnw uo«euuojui pql „3AOW3H ION Oa - IN3Wnooa ivem SIHI d0 IWd SI 30Vd SIHI. llw)( Ot'n l .s mej AoenlJd] sasodmd tiepuooes loj pasn aq Aew eplAad noA uol ;e o�ul leuos�ed Y ~ :Aq pe4ej4 In !s �elowo llufl uaw 00 File No.: 11907 EXHIBIT A Part of the Southeast Quarter of the Southwest Quarter (SE' /, of SW' /.), Section 20, Township 30 North, Range 19 West, Town of St. Joseph, described as follows: Commencing at the S 1/4 corner of said Section 20; thence N.1 0 03'W., (true bearing) 817.36 feet along East line of said SW' /, of Section 20 to point of beginning; thence West 633.06 feet; thence N.01 °07'W., 350.00 feet; thence East 633.47 feet; thence S.1 °03'E., 350.00 feet along said East line of SW'/. of Section 20 to point of beginning. Also, an easement for a roadway and for installation of electric and telephone utility lines, the same to be located so as not to interfere with the use of said roadway, said easement being located in E%: of S W' /. of Section 20, Township 30 North, Range 19 West, Town of St. Joseph, being all lands lying 33 feet and at right angles each side of the following described centerline roadway: Commencing at SW corner of said Section 20; thence East (true bearing); 2029.0 feet along South line of said Section 20 to point of beginning; thence North 53.29 feet; thence Northerly 193.67 feet along a 417.42 foot radius curve concave Westerly, chord bearing N. 13° 17'30 "W., 191.94 feet; thence Northerly 121.95 feet along a 274.37 foot radius curve concave Easterly, chord bearing N.13 M., 120.95 feet; thence N.I 0 07'W., 1510.00 feet to point of termination, said roadway easement to continue to exist until the same is dedicated as a public road. Tax ID #: ,030- 1043 -20 -000 2of2 County Sanitary Permit Application ST CROIX COUNTY WISCONSIN In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT ` Personal information you provide may b ed for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. (1)( ] 1101 Carmichael Road Hudson, WI 54016 -7710 715)386 -4680 Fax 715)386 -4686 Attach complete p lans for the s stem aper an 8 -1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if re v to previous application I t. Application Information - Please Print all Information Location: Property Owner Name 1/4 6&) 1/4, Sec /e-f1 or'.' e �JG// 30 N, R Property Owner's Mailing Address V Lot Number Block Number _05_4 N �i'ai� ST. CROIX COUNTY City, State F Zip Code Subdivision Name or CSM Number //4C'/_60r1 r,J S r!7�sJ 55 9- 5 93 a II T� of Building: (check one) Mity []Village G9T15wn of I 1 or 2 Family Dwelling - No. of Bedrooms: .3 ❑ Public /Commercial (describe use): Sf • T O SC x ❑ State -owned Nearest Road Tax II. Type of Permit: (Check only one box on line A. Check x on line B if applicable) Parcel Tax Number(s) 1 Repair ❑ Reconnection 3. ❑Non - plumbi 4 '. euvenation A) Sanitation " "' B) Per 'Number,. / n �, / ,, / ' ' / Date Issued ❑ State Sanitary Permit was previously issued V /v/e A JA IV. Type of POW System: (Check all that apply) W Non- pressurized In- ground ❑ Mound Z 24 in. V'itable ❑ Mounds 24 in. suitable soil 11 Mound A +0 ❑ Sand Filter ❑ Constructed Wbtland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In- ground ❑ olding T# ❑ Single Pass ❑ Other 13 At-grade I� Aerobic ,Treatment Unit Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. rcolation Rate 6. System Elevation 7. Final Grade Required Pr sed (Gals. /day /sq.ft.) (Min. h) Elevation �sD .3 S S� 3.3 * 'Cl, & ,34;4 �z r .2 7 d 9/ 75 97 LP/ Information Capaicty in T # of Manufact er Prefab Si on- Steel Fiber- Plastic New Existing G�lons Tanks Concrete struc glass Tanks Tanks / aW / dcvn E7 ❑ ❑ ❑ onsibility Statement '" ersigned, assume responsibil' for repa r /reconnenction /rejuvenation /installation of non - plumbing for the POWTS shown on attached plans. A not required for terralift rep or the in allation of non- plumbin sanitation system. Name (print) Plumbe Signatur $�IMPRS No. Business Phone Number s — 3c� / -2 7 76 7 s Address (Street, Cit a , Zip Code) u/Sar� nty Use Onl Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) ❑ Approved Owner Given Initial Adverse Determination X. Conditions of Approval /Reasons for Disapproval: Rev: 8/05 I aQ 3d.1 /ST D ZOIX COUNTY Z011I1IG OFFICE Croix County', ,Courthouse g 911 4th / Hudson, WI i 54016 i elephone .y Zoning Of f ire offers the service of septic a 71 u w GTLGrL c 11J CiVV1Vi3 to Lending Institutions, Realty Firms, and private individuals. Completion of this form is ess enti �: o that the_proj�_erty c an be located Please provide the following info,,rmation, enclose appropriate fee made payable to St. Croix Cornty Zoning Office, and mail, along with form to the above addr'ss. Testing will be done as soon as possible after fee and for l i l �re received. WATER TESTING------------------ ---- ---- FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 SEPTIC SYSTEM INSPECTION For VOC' S) - -- $25.00 -�I -- � -FEE. _ / functioning at time of (Determines if system is �r© r (bete � p� �y 9 inspection) Property owner's name .S'f0 Property owner's address �a- Legal Description 1/4 of the 1/4 of Section T N -R Town of Lot Number' Subdivision Name FIRE NUMBER LOCK BOX NUMBl,It Color of house 5,, Realty' sign by house ? so, list firm: -/ I PLEASE INCLUDE, IF AT ALL POSSIBLE, A M[AP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF : T11E LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make 'proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: Telephone Number REPORT TO BE SENT 'T'O : _ /c _ Closing date Signature ' _ 1� 1 4 1 J t i ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE {' 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 October 31, 1989 Barb Avery 700 2ed St. Hudson, WI 54016 Dear Ms. Avery: An on site investigation of the septic system on the property of Elwin Tatu of 1425 East Oak Trail, Town of St. Joseph, was conducted on October 30, 1989. At the same time I also obtained a water sample and submitted it to the laboratory for testing. The results of that testing will be sent to you as soon as we recieve them back from the laboratory. At the time of the inspection, the sanitary system appeared to be functioning properly for the existing use. The inspection of this sewage disposal system was based upon a surface inspection of said system and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of this system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, / /la 'I ' E Mary Jen ins Asst. Zoning Administrator TCN:cj COMMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 4:22F ST. CROIX ZONING REPORT NO.S 35640/01 PAGE 1 ST. CROIX COUNTY REPORT DATES 11/02/89 COURTHOUSE DATE RECEIVED* 10/31/99 HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNERS Elwyn Tatu LOCATIONS 1425 East Oak Trail, St. Joseph COLLECTORS St. Croix Zoning SOURCE OF SAMPLE; Kitchen faucet COLIFORM 0 /100 ml INTERPRETATIONS Bacteriologically SAFE NITRATE —NS 2 ppm Under 10 ppo is safe for human consumption. COLIFORN + NITRATE i LAB TECHNICIANS Pam Gane WI Approved Lab Not 19 OF.NDEPEA, 1 v v means "LESS THAN" Detectable Level Approved by: ® PROFESSIONAL LABORATORY SERVICES SINCE 1952