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HomeMy WebLinkAbout040-1041-80-000 1 • o can C �1 d o A CD rr P4. n N ai O O N a co A • 3 7 n A OD CL O O N J p Co A O \ Q' = Q p 6 w O N � W C 7 n co O 3 7 fll O ~ .y► H p �1 a ! m a> Z D a p m co D d N c 3 t3 0 CL W o00 ° w G) �+ CL ortn CD N O 3 p a o M v 3 co N N c D `may d cr v v ? G) ° d �0 q z o. Z Z 0 v A 2 o co m O A C w co tl1 D A W 01 CL CD ' I p N O 7 TI � C o a CD m y A 99 n J O� \ '4 O p Oo CD A C 0 S> ti V CD oCL o a ` Parcel #: 040 - 1041 -80 -000 10/18/2005 08:30 AM PAGE 1 OF 1 Alt. Parcel M 09.28.19.139C 040 - TOWN OF TROY Current 1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner JOHN JR & MARY J DUNTLEY O - DUNTLEY, JOHN JR & MARY J 424 N GLOVER RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 424 N GLOVER RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.890 Plat: N/A -NOT AVAILABLE SEC 9 T 28N R19W 2.89AC SE SW COM CL TN Block/Condo Bldg: RD 2139.21 FT W OF SE COR SEC 9, N 43 DEG W OF SE COR SEC 9, N 43 DEG W 695.19 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) FT TO POB: N 54 DEG W 1395.09 FT S 89 09- 28N -19W DEG E 373.79 FT S 43 DEG E 1107.28 FT TO POB EXC PART TO TOWN OF TROY IN 578/339 Notes: Parcel History: Date Doc # Cage Type 07/23/1997 39 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.890 60,000 124,400 184,400 NO Totals for 2005: General Property 2.890 60,000 124,400 184,400 Woodland 0.000 0 0 Totals for 2004: General Property 2.890 60,000 124,400 184,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 135 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMENT i AS BUILT SANITARY REPORT Owner - A4 AAD - �©Q f &&w E Propert Address _`��V A e��ko"e QoA� City /State A4jd/.��o^J t-J , c� /G► Legal Description: Lot Block Subdivision/CSM # ;/> 1 /4, Sec. 4 Y , T N -RAW, Town of �PoY PIN # -.?g• /`�" 1 L _ SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer jO CI$TIAOGa Size ST/PV / Setback from: House 14 Well P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Fit�P rte' Type of system: 9WJ0f Width Length Number of Trenches Setback from: House 1' Well 43a P/L ? " Vent to fresh air intake ELEVATIONS Description of benchmark /- i V r S /0��1b 7 Elevation 00.0 ` Description of alternate benchmark Au. I I f NA Elevation 4K: Y* Building Sewer — SST Inlet S L-7 0 7 SW Outlet ff^ 90 PC Inlet �— PC Bottom ''-� Header/Manifold 8�gs3 Top of STEP& Manhole Cover Distribution Lines ( ) ( ) ( ) Bottom of System) t Final Grade (A) Y . Date of installatioV / /�ZPe milt number 2 State plan number Plumber's signature cense numbe Date/O /O Inspector Complete plot plan i NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW !no - FilT2•w tzz ,3 . _ _ � /Qc3 • o�l c� n 6 01, s Aa INDICATE NORTH ARROW i - 7 of Ikq fla t '�q hi - ST. CROIX COUNTY ZONING OFFICE `V CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have }}nspected the septic tank presently serving 7 N U M 6' the o� /Vd 2r�f �j'LOy /�1� , rest nce located at: 5 %, 5 � %, Sec. T_N, RW, Town of - T O O V f St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good co i 'o a it appears to be functioning properly. ,r Last time serviced S'7 Did flow back occur from absorption system? Yes kl <o (if no, skip next line. Approximate volume or length of time: gallons t5 minutes Capacity: /Coo Construction: Prefab Concrete I/ Steel Other Manufacturer (if known): Age of Tank (if known): 1 X7 A"k /Ii natur / (Name) lease Print (Title) (License Number) 10.11. (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle) . Name Signature MP /MPRS Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420437 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: Duntle , John & Jodie _ Tro Township 040 - 1041 -80 -000 CST BM Elev: / Insp. BM Elev: BM Description: OU . 1 00 • r S / TANK INFORMATION V ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic nchm rk Dosing I Ice -4�j Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet S6ieLptic � / � f ' O / Dt Bottom Dosing Header /Man. 1(, gj B- C L Aeration Dist. Pipe .9 7 gll'. '0 Holding Bot. System co (2, ( -9 PUMP /SIPHON INFORMATION Final Grade g 0 0� 1 Manufacturer Demand St Cover l� - GPM ' Model Number TDH Lift F* n Loss System Head TDH Ft r Cis Forcemain Length Dia. ell SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3/ t (am} Gf N SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manu INFORMATION CHAMBER OR -d 29 Type Of System: f t UNIT Model Number: Lc CaoiA, 1 1 Si I 36 12, DISTRIBUTION SYSTEM u - b $o, IF f L Header /Manifold tt Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) ,. 14S' Length 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 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil A Yes 0 No Yes [; No COMMENTS: (Include co f� iscre enci perso rese a � ' Inspection #1: - / Ins ection #2: — T — T -1 Location: 424 No. Glover Road Hudson, WI 54016 (SE 1/4 SW 1/4 9 T28N R19W) NA Lot Parcel No: 09.28.19.139C 1.) Alt BM Description = (N / 2.) Bldg sewer length = -` / 0 .O , amount of cover = ? —'s� "tS - Z - - - -,-- - -- i � ' � 'v - - - -- - - �- - Plan revision Required? Yes No j Use other side for additional information , 'I ��f SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. f - Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 i sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (Privacy Law, s. 15.04(1)(m)) (Submit completed form to county if not o -D 3 0(40 FS state owned. Attach com lete plans to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. Co-�, s' ` �f n _ ` State S P� 't N be ❑ Chock if revision to previous application State Plan I. D. Number O %OF 44 I. Application Information - Please Print all Information Location: perty Owner Name Property Location , �3eJ U✓ > 1 /4.Sh.ol 1/4, S 2 T` .N.P,/, or roperty Owners Mailing Address Lot Number Block Number C �, � - �� . 135 c City, State Zip Code Phone Number Subdivision Napo CSM Number II. Type of uilding: (check one) �� ❑ City ❑ Village ® I or 2 Family Dwelling -No. of Bedrooms : S�TL3 ® Town of ❑ Public/Commercial (describe use):_ lug ❑ State -Owned Nearest Road Parcel Tax Number(s) ID4 D ( .. p - o o r PBJ) . T e of Permit: Che box on line A. Check box on line B if a licable 6. ❑Addition to 1. ❑ New ® Replacemen 3. ❑ Replacement of 4. 5 S stem S stem Tank Only Existin System Permi t Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply)( "I aZ tg Non - pressurized In- ground ound ❑ Sand Filter ❑ Constructed Wetland d • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line 3� r �� 4e,— ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil App licarion 5. Percolation Rate 6. System Elevation 7. Final Grade inJinch) Elevation Required Proposed Rate (GalsJday /sq. ft.) (M y dry V l � a , VII. Tank Capotal # of Manufacturer Prefab Site Steel Fiber- Plastic Information Galo s Tanks �� `C n- Con- glass New to structed Tanks ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for insta llation of the P OWTS shown on the attached plans. Business Phone Number Plumbers Name (print) Plumber's S ature (no stamps): NWI� 1110 l3 _ P lum Ws Address (Street, City, State, Zip Code) IX. Co my /Department Use Only D ,j /n suing Agent ignature Ps) ❑ Disapproved Sanitary Permit Fee (includes Groundwater Approved ❑Owner Given Initial Adverse Surcharge Fes) � U d q yr Determination Li d'� X. Conditions of Approval /Reasons for Disappr v l: J G "' add a � Gds • l%p 'OV 6 � r, e e�.� © %�� x� �i�iv ,a� -roll✓ ►L d ti`-- � a" d oe ! �� ®L'QTIj/ �INL� �X IS f /iU6 4crT/C ritic,. ..PLO ' !,?x/'70 PLOT at CROSS SECTION F't..-.... ZAPPA BROS. EXCAVATING PLUMBING UNIT t i At, � , ^� PROJECT �� `� - A,-• LAW uN LEY K P«OL ��.:J :� %t,- � /r.�.'�'�( j s`1 k//' /itlf' .I�P/k. '`� -- !' y: y: ��w ���cutr�►t L�.a € SD ? ,AVL P ctl�ivls LxiS�' /tilts ivC•(l.��u GJITIA _ /4f UCENSE: S� DATE: .SOIL TESTING BV: The Standard Infiltrator Chamber __7 - -- 1' Overlap at Latching Mechanism 12" i 75• Effective Length �tP7PC fi/fi6$. .PLB tt -'PLOT & CROSS SECTION Pc..,,. ZAPPA EROS. EXCAVATING ��. PµJMBING UNIT PROJECT v 04-1 K ew EjacuCr."ir 't ,IJ SD Q I"UG . 1 F' /.Sc�TCctir1 0��/4 /N 4,. A - 1tote i t ALC �. "�,of t /'k"` �iYt L,.J/ �di cl�l �C•`l� /flit?'f I�2v /�!✓f'td SIGNED *, ' 1 LICENSE: :!!M DATE: SOIL TESTING BY: The Standard Infiltrator Chamber - - - V Qverlap at Latching Mechanism a ism ,... . - -if Q) Ln - - -- - - c cP I I - -- — — 75' Effective Length i r 1576 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code AC.E. Soil & Site Evaluations Attach complete site plan of paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and P D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 040 - 1041 -80 -000 Please print all information. Revi y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 0) (m)). /Ol'3 d Ocatkxi Jo M Q�untle tv Go y SE 1/4 SW 1/4 S 9 T 28 N R 19 W Property Owner's Mailing Address o f Block # Subd. Name or CSM# 424 N. Glover R 2 3 _. City State Zip Code hone Number N C'ltya Village ► Town Nearest Road Hudson WI 54016 715;386 , E Troy North Glover Road j New Construction use:] Residential/ umtx of bedrooms _ 3 — Code derived design flow rate 450 GPD Replacefnent J Public or commercial - Describe: Parent material Glacial outwash _ Flood plain elevation, if applicable na General comments and recornmendations: Install two trenches at 88.00' using 22 leach chambers. Boling # J Going I�f Pit Ground Surface elev. 95.15 ft. Depth to limiting factor >150" in. Sal Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPDIft *E01 *Eff#2 1 0 -10 10yr3 /3 none Ifs 1 fcr ds as 2fm,1 c 0.4 0.6 2 10 -23 10yr4 /6 none Is lmsbk ml as lfmc 0.7 1.2 3 -88 10yr5 /6 none s 0 sg ml gw - 0. 1.2 4 88- 50 10yr6 /4 none s 0 sg dl - - 0.7 1.2 S� t'�Lf/ �� /0 Soil observed by backtnoe pit excavation to 118", - 118"- 1 50 observed by use of 2" hand auger through bottom ct excavated backhoe pit. Boring a Bng # Boring Pit Ground Surface elev. 95.54 ft. Depth to limiting factor >132" in. Sal Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/ft= *Eff#1 *E 1 0 -13 10yr3/3 none Ifs 1 fcr ds as 2fm,1 c 0.4 0.6 2 13 -18 10yr4/6 none Is 1 msbk ml as 1 fmc 0.7 1.2 3 18 10yr5/6 none s 0 sg ml gw - 0.7 1.2 4 82 -132 10yr6 /4 none s 0 sg dl - - 0.7 1.2 a —_ rz 6- ys Sal observed by backhoe pit ion to 112 112" -132 obsenwed by use Of 2" hand auger th� m o * Effluent #1 = BOD 5 > 30 < 22 mg/L and T >30 < 150 mg/L * Effluent #2 = GOD <_30 mg/L and TSS <30 mg/L CST Name (Please Print) Signal CST Number James K. Thompson �--- 3602 Address AC.E. Soil & Site Eval Date Evaluation Conducted Telephone Number 340 Paulson Lace Osceola, WI 54020 8/15/02 715 - 248 -7767 property owner John M.' Duntley Parcel ID # 040 - 1041 -80 -000 Page 2 of 4 3 ] F Boring # Boring Pit Ground Surface elev. 94 ft. Depth to limiting factor -- >125" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : GPD *Eff#1 *Eff#2 1 0 -9 10yr3/3 none Ifs 1fcr ds as 2fm,1c 0.4 0.6 2 9 -16 10yr4/6 none Is 1msbk ml as 1fmc 0.7 1.2 3 16 -89 10yr5/6 none s 0 sg ml gw - 0.7 1.2 4 89 -125 10yr6/4 none s 0 sg dl - - 0.7 1.2 Sal observed by backh# pit excavation to 112 ", 112" -125" observed by use of 2" hand auger through bottom of excavated backhoe pit. ❑ Boring # J 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 GPDAW 'Eff#1 *Eff#2 Boring # - Bon es ,J Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : _ *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD -S_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. • OWNER: PROPERTY John M. Duntley SOIL AND SITE EVALUATION 1576 Page__3 of 4 PARCEL I.D.# 040 - 1041 -80 -000 A.C.E. Soil & Site Evaluations REPORT MEMO Existing septic tank must be inspected to verify capacity & structural stability. Effluent filter must be added downstream of septic tank outlet. Elevation at bottom of existing drywell = 86.07'. Qe # / 57� /1ori,�ro /, ♦ Fleeafion TOh" M. 17a..rtic r P V-2 S/ /1. G / Duet RoQ d f/udson, col, 540/6 /JCi. ilo /oI// -8o -coo BanckYK&rl': aPS;dt A 00 96, o 3 734 IF 0 s o S /ope W cod t-c `„exit �� ofr &,x ¢x ,clan We-if Xis• -fri b3 flkro sysE�"+ ©o�c 3 bcdr aspka /f dri ✓t way /� d q ♦ q� resident[. d yuXlls�I6•(d Peo/ d� � � •h tct = s4 \ c� coded . �. y�y • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS C0vvner _ Septic Tank Capacity o U al ❑ NA Permit # a Q Septic Tank Manufacturer ® NA DESIGN PARAMETERS Effluent Filter Manufacturer � « ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units ® NA Pump Tank Capacity . a l 10 NA Estimated flow (average) o o gavday Pump Tank Manufacturer ® NA Design flow (peak), (Estimated x 1.5) p g al/day Pump Manufacturer to NA Sail Application Rate , 7 g aVda /fe Pump Model CRI NA intiuent/Effluent Quality Monthly average' Pretreatment Unit ® NA Fats, Oil &Grease (FOG) 530 mg/L ❑ Sand/Grdvel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg/( ❑Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 mg/L ❑Disinfection ❑Other. Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s) 1 Biochemical Oxygen Demand (BOD S30 mg/L ® In -ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) 910 cfu /100ml ❑ Drip-line ❑ Other. ' Maximum Effluent Particle Size Y inch diameter • Values typical for domestic (non-commercial) wastewater and septic tank effluent " Values typical for pretreated wastewater. AINTENANCE SCHEDULE vice E Service Frequency Inspect condition of tank(s) At least once every ❑ months ® year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume 1 Inspect dispersal cell(s) At least once every ❑ months ® year(s) (Maximum 3 yrs.) Clean effluent filter j At least once every ❑ months ® year(s) Inspect p ump, pump controls & alarm At least once every ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months. ❑ year(s) ❑ 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatfinent components, and any other maintenance or monitoring at intervals of 12 months or less 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. 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. i System start up shall hot occur when soil conditions are frozen at the infiltrative surface. Page oZ 01 ` inuring 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 cell(s) and may result in the backup or surface discharge of eff pent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to'nestoring 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 soli 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. ASANDON'tMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is property and safety abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. a The contents of all tanks and pits shall be removed and property 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: ❑ 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 GASSES 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 a - t POWTS INSTALLER POWTS MAINTAINER _ _Name Name ;7 _ (A N Phone - Phone �j - 2470 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Agency _ Phone _ D Phone _ This document was drafted by the staffs of the Green lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets 't the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(r) and 83.54(l),(2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMVV ( 1 ) 4 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ,� A OWNERSHIP CERTIFICATION FORM Owner/Buyer ` uyer �► l� h ✓� 1 f Tn L\ /V\ 0. Mailing Address 2 1 V R_ O C" � d o Property Address"` (Verification required from Planning Department for new construction) } �✓l �5 City/State C� r� W Parcel Identification Number r 31 G LEGAL DESCRIPTION Property Location %a, S) % a, Sec. , T9,,K N -Rj!�_W, Town of _ Subdivision 1�' QY�iI boo J Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Pnc_ ? , Volume , Page # 3 Spec house ❑ yes [;K no Lot lines identifiable 0 yes ❑ 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 thg three year expiration date. G TURE 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 th�prop e - ty d bo e, by virtue of a warranty deed recorded in Register of Deeds Office. '$ ATURE OF APPLICANT 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 1♦ DOCUMENT NO, STATE BA: OF WISCONSIN–FORM I ARRANTY DEED Vn 78 THIS SPACE RESERVED FOR RECORDING DATA 5 350515 _� _ - - - -- TM3 DEED, made between REGISTERS OFFICE ,aY,UZ..._aQikcr and allltni eker ST. CROIX CO., WIS. Reled. for R3cord this_�i Grantor day of A.D. 19 -nd coM. rj� tqr� f the q_ !� -9 ­ - ___ --­ M. Grantee, W i It n a a a e It It. That the said Grantor for a valuable consideration -One -D-oll conveys to Grantee the following described real estate in-- - ___5t_. Groix__County. RETURN TO State of Wisconsin: i Atty Ralph E. Senn, That certain parcel of land located in the Southeast 1/4 1 220 S. Main St., River Falls of the Southwest 1/4 of Section 9, Township 2 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin, Tax Key more fully described as follows: This is --- homestead property. Comrienci;ng at the South 1/4 corner of said Section 9; thence5) N 90 E (assurwd bearing along the South line of the Southeast 1/4 of said Section 9 a distance of 505.99 feet to the centerline of a Town Road; thence 11 43*06 'IV a distance of 695-19 feet along said Tom Road centerline to the Point of Deginninc of the parcel to be herein conveyed; thence continue on said Town Road N 43 a distance of 485.55 feet; thence S 46 W a distance of 94.48 feet to the centerline of the former railroad right of way, now a Tom Road; "thence 3 54 E along said present Town Road a distance of 494.66 feet to the Point of Beginning, the above described parcel containing 0.5 acres, more or less. FEB # *0 Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertainin LE- X PT And an Marlene L. -Roeleer-.- n and wife warrants that the title is good, indefeasible in fee simple and free and cl-- of encumbrances except and will warrant and defend the same. Executed at Fa11a, 'jisconsia- t his __2.6_tk_ day of 19-7- . SIGNED AND SEALED IN PRESENCE OF (SEAL) David C. Roeker — (SEAL) karlene L. Roeker (SEAL) (SEAL) Signatures of David C. Roeker and Marlene L. Roeker 09 authenticated this 26th day of U- 19 LSt Gerald R. Lee Title: MOM Other Party r Authorized under See. 706.06 viz. Mot y Puhlic My comdssion axpires: 9/20/81 STATE OF WISCONSIN —County. Personally came before me, this day of the move named_ to me known to be the person— who executed the foregoing instrument and acknowledged the same. This instrument was drafted by Ralph Z. Senn, Attorney —220 3 'lain - , Box 135 Notary Public County, Wis. River Falls, Wis. 54022 The use of witnesses is optional. My Commission (Expires) (Is) 11111h.– of persons signing in any capacity should be typed or printed below their Signatures. sa DEED –STATE BAR OF WISCONSIN, FORM NO. I – 1971 bbk.L ,J /Y` .A �„_ MC M.11 Or Co. v"M StoC_ k_No. 12718 41;A 6LGIS Ci2S 01 .il. cinix CO., WI$. :. .....,. ,..1 .1-.is 21 S cJ May A.D.19_H6 4 e 3 : 00 P iC;Ylr [Space Above This line For Recording Data) -- MORTGAGE 610 00399 '11115 MORT'GAGF: ( Instrument ") is given on ....... .....r14Y.. .... 16th ......................... ...... ... ..... Jaxdah.l- A.un.t 1 ay.....h.u�b.aud. ty .�.d.... Fhe mortgagor is ...>?ohn.. and_ wife- - -- -. -- -- ---- • -- --- - ( "Borrower "). This Security Instrument is given to ..F.i.rst...F.ederal... Sa.v.i ogt;...aud ..1.a.an �ssgcia.Cion..a.f Fau...Claire,_ _s.co.nsx.n ..... ........... which is organized and existing a under the laws of .....tll 4 - Vii.' . eet...$.t .k�.S...of...4 MV,K.I.Cd........ and whose address is .3.1.9..x . ...G.za.9.d...Ay�.�15I�........ PO_ Bux...15.4,8 ,.. Ea..0 CA air.e,.. 141 ..... 54702 ................... ............................... ..... ............................... ( "). Borrower owes Lender the principal sum of .. S i x.t,y- three, Thousand 1.00---- .--- .-- .- .--- . - - -... ------ .--- .- - -. - Dollars . $�3.. NO �.A.O.............). I�his debt is evidenced by Borrower's note ------------ dated the same date as this Security Instrument ( "Note "), which provides for monthly payments, with the full debt, if not .............. This Security Instrument paid earlier, due and payable on .............. .AAA -' ... . 1.,...20.1.6....... ......... .. .. .......... ............. sc�:urc to I.cnder: (a) the repayment of the debt evidenced by the Note, with interest, and all renewals, extensions and modifications; (b) the payment of all other sums, with interest, advanced under paragraph 7 to protect the security of this Security Instrument; and (c) the performance of Borrower's covenants and agreements under this Security Instrument and the Note. For this purpose, Borrower does herebp mortgage, grant and convey to Lender, with power of the following St. Croix ......... county. Wisconsin: described property located in ........_ ............................................................... ............................... The SE- of SW- of Section 9, Township 28 North, Range 19 West, St.Croix County, Wisconsin described as follows: Commencing at a point on the South line of said Section 9 due West and 2139.21 feet from the Southeast corner of said Section 9; thence go North 43 0 06'23" East a distance of 695.19 feet to the Point of Beginning; thence ence North 54 56'23" West along the centerline of a Town Road (formerly railroad bed) a distance of 1395.09 feet; thence South 89 East a distance of 373.79 feet to Lite centerline of a Town Road; thence along same South 43 55'41" Fast a ii: Ld::;`.:' Of 1 iil7 �t� tE7ct .J the PVllll O1 Deglp � C:�..:- iiic i;a - ti%el Cii ii - vCyCll t0 the Town of Troy by warranty deed dated July 26, 1978, and recorded with the St. Croix County Register of Deeds on July 31, 1978, in Vol. "578 ", page 339, as Doc. No. 350515. THIS IS HOMESTEAD PROPERTY THIS IS NOT A PURCHASE MONEY MORTGAGE VOL 1X 06 PAC112 6 f ar t 1 2 SE of t 9-28-19, Town of Troy, more full U,-2 S (-' E l I-) e ( I Commencing at a point on the South line of said Section 9 due West and 2139.21 feet from t1e Southeast corner of said Section 9; thence go North 43 ° 06'23" East a distance of 695.19 feet to the Point of Beginn f th r I to b here conveyed; thence North 0 a "'OV711 Road (formerly 54 56'- 1 A �, s t I C C? e r -1- n e of I 1 0 railrood bed) di—ai of 1395-09 feet; thence South 89 ° 24'53" distance o 1- 3 7 - 1 (4 East a f to ti c centerli-i of a Town Road; 0 - C o - I C alon(1: sar"'.e a �istaiict 1107.28 feer- t he: t I 1 (2 e q k2 - c e p t r e to the Town of: c (-) n c Tr o y b y wa r r �i i i t v d" e'--' e J Ju 2 1 6 1 978, and recorded with the St. Croix County Register o e d s on 7u 31, 1978 in Vol. 578, page 339, as Doc. No. 350515. � I ! p X37 , C , .I 1467 - �• D C�µi ��1 5 - _ ry a - , I , e r� 5'.x C- too A art _� !3 � -.- i.. �• Z..� O0 �•Sirw� �• ti 1) 1 nR �� TS�l3 3.1 mac. , • Av SLY � o , p .1c. - p Yb s IC �- o Le ' P439 _Y S.. c PA 9.D - �o • p i 3 _� I ( � PA � oe