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HomeMy WebLinkAbout032-1063-60-200 . . . . . n ■ o ■ - 0 c V n © � T ' � 4t ® 2 / o -D' J § } [ Q § ƒ e , \ \ / \ ( © \ \ k ° �0) f 0 ` = g ; @ ° \ / > i \ k \ ® § 2 CD cl 2 -4 $ Q / 8 8 ) � w C.) K � � ca 0 � § � \ 0 0 0 3 ` / \ 3 }) k J § �� � N) ] E § m & I .4 Z .. z @ z � > a \ o § D 7 ƒƒ �- ;o § ° 2 N \ 3 E [ . ` _ z CO2 & m a § / & 0 Z # § R 0 . ca T 2 k 0 § / 2 § F 2 2 ƒ 2 � � ■ I � §[$y Ems& �\ c �D0 % / &a/ . �%/ § cn CD . \ / }3 > k �D w \ /� 2 /° 2 0 < § \ @J �@ kQ. �2 • Parcel #: 032 - 1063 -60 -200 05/18/2005 12:59 PM PAGE 1 OF 1 Alt. Parcel #: 23.31.19.317C -20 032 - TOWN OF SOMERSET Current X! ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * KEARNS, AARON F & LAURA AARON F & LAURA KEARNS 674 200TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 5.000 Plat: 0878 -CSM 13/3677 SEC 23 T31 R1 9W PT SW SE BEING LOT 6 Block/Condo Bldg: LOT 6 CSM 13/3677 Tract(s): (Sec- Twn -Rng 40114 1601/4) 23 -31 N-1 9W Notes: Parcel History: Date Doc # Vol /Page Type 10/22/2003 744499 2441/363 WD 05117/2002 679296 1893/018 WD 05/06/2002 678145 1884/625 WD 05/06/2002 678144 1884/624 mo C�C 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 10228 80,200 Valuations Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 58,000 10,000 68,000 NO Totals for 2004: General Property 5.000 58,000 10,000 68,000 Woodland 0.000 0 0 Totals for 2003: General Property 5.000 58,000 0 58,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12104/1998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 6.00 . . 0 7 r 2) o tv m V f � ° ® ƒ f (D ƒ t ( ƒ w S - �� to )'} /\e 8 2) a @ 0 w d ® E K 2 % E g � c © 2 @ z > I % @ \ - A c 3 >In co _ _ # 3 \ § C @ § § $ / C. 8? g E c w w I � » cn z 0 0 0 3 ` / I ca (A CO) \ k > OI Q . \ ) { 7 _ c N) ] 7 # m m z j 0 .. \ 7 > 7 0 G §� 7\ �- � ƒ m § N § 3 E \ _ CD >a $z� - � - / + z K w M \ \ & CL 0 i \ k rn / z 7 2 / . ® /E±\ E§`& E =CD /0 CD % % E o E »o (n i($ }0 ¢ e > �n0 3 \ . 0 g < § / 7© §/ �\ � � Wistongin Department of Commerce SOIL AND SI ALUATION Division of Safety and Buildings c� Page of Bureau of Integrated Services in accordance c� �, I�F�1..aJ09�tAlis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches rilsi .Plan ms�ss.. C6unty include, but not limited to: vertical and horizontal reference point gyp; direction percent slope, scale or dimensions, north arrow, and location an di.9jancei rest road' ' { �,; Parcel LD. # APPLICANT INFORMATION - Please print all info ii 10 17. G R eylewed by Date Personal information you provide may be used for secondary purposes (Priv S. . ). W .- g i `� Property Owner t Pr op erty ,_.torT�.` ? /4 4,S�� T,-X? ,N,R l� E ( W Property Owner's Mailing Address Lot Block# Subd. Name or CSM# 30 / -- -_. City State Zip Code Phone Number City ❑ Village (,Town Nearest Road 4 d�3 ( ZZ 5LNew Construction Use: AResidential / Number of bedrooms _ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow _ o�6 gpd Recommended design loading rate bed, gpd /ft J trench, gpd /ft Absorption area required _ > bed, ft 100 trench, ft27 Maximum design loading rate gy bed, 9Pd /f> trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations ./ - If Parent material � 11 _ Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system �Z S ❑ U S ❑ U 59-S ❑ U Rs ❑ U ❑ S X-U ❑ S -�R U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench .......................... / Ground � A elev.. Depth to limiting factor y y S in. �- / Remarks: Gv Boring # r i Ground elev. ft. j i Dept�d l T_ T imiting factor 4/--in. Remarks: CST Name (Please Print) ignature Telephone No. Addresp q. Date CST Number I� I SOIL DESCRIPTION REPORT PROPERTY OWNER Page ,� of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench /� Ground / el le ev. Depth to limiting factor, 7 Remarks: Boring # �_ f , Ground elev. Depth to limiting fac %in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # .247- Ground elev. - eft. Depth to limiting facto Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) Soil Test Plot Plan Projcct Name � Byro ird Jr. Address C X02 d - , Lot �� Subdivision Date 6 _� f- 1/4 114� N/R /� W -,- Township Boring O Well PL Property Line County BM or VRP Assume Elevation 100 ft System Elevation *HRP /f�� r � I Scale 1/4" = 10 Ft. When Dimensions aren't stated Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building' Division INSPECTION REPORT Sanitary Permit No: 430519 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: Kearns, Aaron & Laura I Somerset Township 032- 1063 -60 -200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 23.31.19.317C20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark p _ s� O Dosing Go Alt. Aeration BI Sewer"' 6w& tl $ r y � Holding SUHt Inlet 3o3'f iLl TANK SETBACK INFORMATION St/Ht Outlet S' �J 7. - 7 TANK TO P/L WELL BLDG. Vent t it Intake ROAD Dt Inlet Septic 20 � 1 2 / + i Dt Bottom —_ Dosing l!/ Header /Man Aeration Dist. Pie p Holding Bot. System (6 •qZ Final Grade PUMP /SIPHON INFORMATION S�3� 9� 2 _ Manufacturer Demand St Cover GPM Z rj. s 3 Model Number TDH Lift ion Loss System Head TDH Ft Forcem In Length Dist. to Well SOIL ABSORPTION SYSTEM — BEDITRENCH Width [ a Length I N . Of Tre es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Q - SETBACK SYSTEM TO ((JJ P/L BLDG WELL LAKE /STREA LEACHING 4 anufacture : INFORMATION Ty p f System: 3�r / I CHA OR odel Number: DISTRIBUTION SYSTEM Header/Manifold Distribution Q / x Hole Size I x Hole Spacing Vent to Air Intake L t 1 1. 1 Pipes b k . -7� ' eng h D a 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 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 2 r ,,� , Yes [ No [ Yes : COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 1 2 - / 5 / / Inspection #2: / / Location: 674 200th Street Somerset, WI 5 (SW 114 SE 1/4 23 T31 R1 9W) NA Lot 6 �� Parcel No: 23.3 1.) Alt BM Description = �#, j dt C.7 � �/ . �f rot& � � T � 2.) Bldg sewer length = Z(a - amount of cover = � 2 Plan revision Required? Yes No �� V3 Use other side for additional information. V ` SBD -6710 (R.3197) Date Insepctors 49nature Cert . N . I � � r Safety and Buildings Division County M N 201 W. Washington Ave., P.O. Box 7082 scon in Madison, W( 53707 — 7082 Sanitary P it u mber (to be filled in by Co.) Department of Commerce ( 261-6546 20 t Sanitary Permit Applic io IVEp to Pan I.D. Number a In accord with Comm 83.2 1, Wis. Adm. Code, personal info ation you provide may be used for secondary purposes Privacy Law, s .04(1)(rrt� 1 Y J 3 2O roject Address (if different than mailing address) I. Application Information — Please Print All Information ►�Vi UU 14 -5k ST . cRoix co 2Dt� Property Owner's Name OFFI CE Parcel # Lot # Block # t• 31 —20) Property Owner's Mailing Address Property Location Crty, a rate Zip Code Phone Number _'� ��� �� �ti Section _ (circle ) i II. Type of Building (check all that apply) awu T�L N; RE or � 5 � 'J56 or 2 Family Dwelling - Number of Bedrooms SubdivWurtiV2ne CSMNumber i ❑ Public/Cotnmercia! - Describe Use - ❑ State Owned - Describe Use ❑City ❑Village f Township of III. Type of Permit: (Check only one box on line A. Cdfiiplebi line B if applicable) - A. 5iNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System 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 t olding Tank/ �,e.,att Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter Cl Recirculating Synthetic Media Filter hm k kcn ]Sri 'L" L"" ❑ Gravel -less Pipe er (ex lain V. Dis ersaL/Treatme t Area Information: 100 Design Flow (gpd) i ign Soil Application Rate(gpd Dispersal Area Required (so spersal Area Proposed (so rem Elevation NY Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New I Existing Tanks Tanks Septic or Holding Tank _ Aerobic Treatment Unit Dosing Chamber VII. Responj ibility Statement- 1, the undersigned, assyme responsibility for Installation of the POWTS shown on the attached plans. P rint) , Plum Si r rP/MPRS Number Business Phone Number 19A __� 71,� ` I r Plu 's (Street, City, State, Zip Code VIII. County /De artment Use Onl ?(A pproved ❑ Disapproved Sanitary Permit Fee includes Groundwater Date Issued Issuin A t Signature (No S s) Surcharge Fee) 5 V ,�— ❑ Owner Given Reason for Denial LW IX, Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable Codefordinances. Attack complete plans (to the County only) for the system on paper not less than 8112 s 11 lathes in size SBD -6398 .08/02 I I �� � - -•�- �--.. -.. --- ±- 1, / - � I ���� r �p ..- -.y i I : I r a t - - 7 i® - }- - - - -j- i- - - I T i ( i i I M �94_� ' i I f , � 1 i X23-T3J.1�Z19l� Rot M ,a✓�s a � 95 i �g Wisconsin Department of Co merc RECEI!/ED► IL EVALUATION REPORT Page of S Division of Safety and Build! s NOV in aejoRoe ) with omm 85, Wis. Adm. Code County Attach complete site plan o paper not less than 8 1/2 x 11 ches in size. Plan must include, but not limited to: rticalc4ndJPaWrb�1M r�nce int (BM), direction and Parcel I.D. percent slope, scale or dim nsions tti�k6�6, to and distance to nearest road. a a - zoe3 Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 114 114 S T N R E (or& Property Owner's M Ping Address Lot # Block Subd. Name or i 7 I Sta a Zip Code Phone Number City Village [Town Near st Road RA New Construction Llse: R Residential / Number of bedrooms Code derived design flow rate GPD Replacement Public or commercial - Describe: Parent material r � ; Ki/ Flood Plain elevation if applicable ft. General comments and recommendations: M Boring # [] Boring fa Pit Ground surface elev. _ ft. Depth to limiting factor in. ' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Co . Color Gr. Sz. Sh. *Eff#1 *Eff#2 d ,S y r -z Boring # ❑Boring J2 Pit Ground surface elev. ft. Depth to limiting factor s? in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 I *Eff#2 - 9 g * 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 Nam P ase P ' t) Signature CST Number Address 1 Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) 1 Property Owner Parcel ID # (� - /� /o_ S� - lD - Page _ of 5-31 Boring # ❑Boring Pit Ground surface elev. ft. Depth to limiting factor � in. 1 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 A4 3 A/ a -� >< F Boring # E] 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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.07 /00) f � � J .r � �� off' 3 .h?�Oh1 c� �,u�r'�ir- �r.15t'�.tJS _ _ �5ti1'�y -s;� �- s�� �3- �� /� /9_t�� .� .�.�.�� ���� ��� � ��,�,� /,�;�,z ,mot �aoa�� ,,,�s. i i'-� ���/ �� ��� _- � sr� aasa� 4 _ _ � � � � � . {� � � � ' i � . 9� " �,��� f ���� 6�� __ _ }8 �1�� _� �� � � ,�QD �� . O AGEMENT PLAN Pag of POWTS OWNER'S MANUAL &MAN g �, C2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner r / Septic Tank Capacity a l d NA Permit # O Septic Tank Manufacturer l ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units [ANA Pump Tank Capacity al 6NA Estimated flow (average) , , gal/day Pump Tank Manufacturer P4 NA Design flow (peakl, (Estimated x 1.5) , D al /da Pump Manufacturer _,NA Soil Application Rate 7 al /da /ft2 Pump Model MNA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit Z&LNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter, Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD S30 mg /L El in Ground (gravity) ❑ In Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At- Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other. ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ monthis) (Maximum 3 years) ❑ NA fi� year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y$) of tank volume 0 NA Inspect dispersal cell(s) At least once every: ❑ month($) (Maximum 3 years) ❑ NA ;I year(s) Clean effluent filter At least once every: ❑ monthis) ❑ NA 2) year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) Ed NA ❑ ear(s) Flush laterals and pressure test At least once every: ❑ month(s) Z NA ❑ year(s) Other. At least once every: ea�� 1 NA Other: ❑ 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 (Y 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 512 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, GMW (4/01) Page of a START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages um tanks g p g pump 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 cell(s) 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; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. r ABANDONMENT When the POWTS falls 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: �1 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. O 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. O 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. O 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 GASSES. AND /OR INSUFFICIENT OXYGEN. DO NOT INTER 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 IN TALLEF c POWTS MAINTAINER Name I . Name Phone _ _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULAT RY AUTHORITY Name Name �' Phone Phone This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(00) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROI X COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address S �"D Property Address (Verification required from Planning Department for new construction) City/State m� ` Parcel Identification Number – 1( 4 , llQs3 LE GAL DESCRIPTION Property Location kA) a T�N -R�W, Town of k O 3 s l � J0\ � P- " 1 315 - Subdivision t1 � G , Lot # � Certified Survey Map # I_n , Volurne _ ,Z_:�j Page # ;x/17 Warranty Deed C Volume , Page # 3: x Spec house O yes I no Lot lines identifiable yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 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 Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. a� 4SA OF APPLICAIJ.T DAT * * * * ** 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 U 244 1P 363 - 7 4449 ID STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., NI This Deed, made between Christopher M. Marshall 3ECEIVED FOR RECORD Grantor, 10/22/2003 03:00pX and Aaron F. Kearns and Laura Kearns WARRANTY DEED survivorsh wital property Grantee._ EXEMPT it Grantor, for a valuable consideration, conveys and warrants to Grantee . the following described real estate in St. Croix County, State of Wiscorisig. REC FEE: 11.00 TRANS FEE: 213.00 if more space is needed, please attach addendum): ` COPY FEE: Lot 6 f Certified Survey Map in Vol. 13, 2US367 recorded as Document.. CC FEE: umber 605976; being located in part of the SW 1/4 of the SE 1/4 of PAGES: 1, Section 23, T31 N, R19W, Town of Somerset, St. Croix County, Wisconsin; being part of Lot 3 of Certified Survey Map recorded in Volume 8, page 2395. Recording Area Name and Rqx "Tmie ,• 4 V!; r t 1SCO -: ? l _. CAO P`B'11 P "I"N 55112 F NO. 0 3z- !o(D3- Coo -amp Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 20th day of October ' 2003 * * Christoph M. Marshall * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) ) ss. WASHINGTON County ) authenticated this day of Personally came before me this 20TH day of October 2003 the above named Christopher M. Marshall 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 � N Am e , 4 \ _ Kristina Ogland, A ttorney at Law 304 Locust Street, Hudson, WI 54016 Notary Public, State of INNESOTA _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both a not necessary.) ) • nnnnnnnnnnr • Names of persons signing in any capacity in d o i t ' el w s atu [NFO -PRO (800x655 -2021 www.infoprofonns.com r . NO ARY P**kj�rlW(jj *1 ONSIN WARRANTY DEED My Comm. ExpireVORMNIZOTS a • FILED L UN 3 0 1999 1 . H. WALSFI c� egister 0f Deeds �i4J9�6 sL CroixCo!M I CERTIFIED §eliVEY MAP Q Ln LOCATED IN PART OF THE SW I1 OF THE SE 1 OF SECTION 23, T31 N, R 19W, TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN; BEING PART OF LOT 3 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 8, PAGE 2395. OWNER z LEGEND DORIS CAMPEAU as 330 CHURCHILL ROAD C3 SOMERSET, WI 54025 ALUMINUM COUNTY SECTION CORNER MONUMENT FOUND Z 1' IRON PIPE FOUND ..<„ . <.;•.. ca 0 V X 24' IRON PIPE SET WEIGHING 1.13 LBS. PER LINEAR FOOT "" 100 ROADWAY SETBACK LINE a ' r- W = U W a 2' IR ❑N PIPE FOUND a ~ (6 v A O C O � EXISTING DRIVE z A v m :rcf. �' \ 00 X X — X EXISTING FENCELINE - z w rn < W fncy kr TGai::, W Q W W W V1 L- 2 m n0i w F- Cn + iAi 2i W O _ Lj Lo J N Z = N Q'I— UNPLATTED LAW D.S - _ F CAMcu .. �D N89 "W 656.20' r r---------- - --44 --� — — t O ; 328,07' 328.13' LOT 4 ; Q LOT 3 t , ------ - - - - -- -- - - - - -- t t� .r - -- A; C. S. M, VOL. 8 - PG. 2395 -------------------- Lr, o+ LOT 5 a m N j j O 5.000 ACRES Q ; 217,803 SO. F r. LOT 6 ` ° 4.752 AC. EXC. RW 3 (4 5.000 ACRES ° - w; ,� W 206,977 SO. FT. c M 217,804 SO. FT. %0 c CD CD OD 0.34 ACRES 6 `° 4,752 AC. EXC. RW In o 7ILDABLE in °0 206,976 SQ. FT. I C3 A - - -.'. SE COR. S1 /4 COR. SOUTH LINE j (D C? C? 656.20' ° o SEC. 23 SEC. 23 OF THE SE1 /4 i M 3M. 70 M x ' 32M. ' i M _ 589 "E� 7' S89 "E V �a 681.1 S 89 . 5 9'4 6 "E 65 r,_ + 1337 i �200TH__AVENUE , C.S.M. -------------- UNPLATTED LANDS ------------------ - - - - -- - ----------- - - - - -- ; YOL. 2 PG. 547 ---------------- SCALE IN FEET 1' = 200 NOTE: LOT 6 IS TOTALLY BUILDABLE EXCEPT SETBACKS, RIGHT -OF -WAYS, 200 0 200 400 WETLANDS AND OTHER RESTRICTIVE AREAS. Vol . 1 3 Page 3677