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HomeMy WebLinkAbout040-1135-10-000 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. ❑ Water (VOC's) $185.00 ❑ Septic $25.00 Wt?ater (Nitrate & Bacteria) $35.00 (Visual inspection) Owner: al Requested by: 11; Address: - Mli p 0 j W M Address:? City & State: , for City & St. Zip Code p a-� Zip Code s yaaa Telephone N °: Telephone N °: ( - 2/6 ) ' oS ! 731 Property ad ess (Fire N & Street) : /nm Location:_l Sec. 3� , T _Zk�_ N, R l W, Town of St. Croix Co., WI. Tax ID N4 Parcel ID N House color: Realty firm: Lock Box Combo: Water sample tap lcication: TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwelling currently occupied? ❑ Yes ❑ No If vacant, date last occupied: Septic system installed by: Year: Septic tank last serviced by: Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y ON Slow drainage from house. ❑Y ON Sewage Back - up into dwelling. ❑Y ON Sewage discharge to ground surfa road ditch or body of water.g �, •1�G ❑Y ON Slow drainage from the dwelling. ❑Y ON Foul odors. �• "� ti ��� �., d, ; Other comments relative to system operation: -, __.,...��l I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: I r - OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 4 IN TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on file? ❑Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system ❑Below grd ❑At -Grd ❑Mound Approx. size $X 11 ❑Gravity ❑Dose ❑Pressurized Ft. ❑Bed ❑Trench ❑Dry Well Molding Tank ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: ❑House ❑Well ❑Prop. line ❑Other Dose tank Setbacks: ❑House ❑Well ❑Prop.'line ❑Other ❑Locking cover ❑Warning label ❑Pump /Floats " ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks : OHouse ❑Well ❑Prop. line OOther ❑Pondings ❑Discharge: General comments INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title C0RMERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 "Colfax, Wisconsin 54730 715- 962 -3121 800 -962 -5227 FAX - 715 - 962 - 4030 5T. CROIX COUNTY GOVERNMENT REPORT NO.: 45008/01 PAGE i CENTER REPORT DATE: 7/19/93 1101 CARMICHAEL ROAD DATE RECEIVED*# 7/15/93 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER Michelle 6 Bob Lubinski LOCATION: 796 A. Cty Rd. Mai, River Falls COLLECTOR: M. Jenkins DATE COLLECTED« 7 -14 -93 TIME COLLECTED: 1:30pm SOURCE OF SAMPLE: Kitchen faucet DATE ANALYZED:7 -15 -93 TIME ANAIYZED22S00pm i COLIFORM,MFCC: 0 /100 mt INTERPRETATION: Bacteriologically SAFE NITRATE -N: 21 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria /100 ml 11 12 Nitrate- Nitrogen: mg /L. Wi da ,� OFF\GE Z �N�NG LAB TECHNICIAN. Pam Gane 9� i. O ,. \NDECFNOF WI Approved Lab No. 19 V 5 ( Means "LESS THAN" Detectable Level Approved by'. PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST CRD� cOUNTY May 5, 2008 Kevin Harmon Harmon Investments LLC 318 Jefferson Street River Falls, WI 54022 Code Administration 715- 386 -4680 RE: Septic tank to Property Line Setback for 796 Cty. Rd. MM Town of Troy Planning Land I nformation Parcel #040 - 1135 -10 -000 (Computer # 35.28.19.556P) 715- 386 -4674 Real Property Dear Mr. Harmon: 715 - 386 -4677 On Monday May 5, 2008 this office was contacted due to a concern that Recycling the recently installed Private Onsite Wastewater Treatment System 715-386-4675 ( POWTS) may not meet the minimum setback to the south property line on your lot. As required by the Wisconsin Department of Commerce under Comm. 83.43.8(4)(1) POWTS septic and /or holding tanks shall be located so as to provide the minimum horizontal setback distances as outlined in Table 83.43 -1. The setback from a property line to an exterior subsurface treatment tank component is 2 feet. This setback is measured from the edge of the tank. Planning & Zoning staff inspected the site today and attempted to determine the location of the property line based on the metes & bounds property description of 173' x 361'. It appears the new septic /dose tank is much closer to the south property line than what the POWTS installer, Tom Wang, estimated during the POWTS inspection on 4/30/08. Since e property's iron pins were not visible, the lot corners will have to be determined by a licensed surveyor. Until that information is available, it will be impossible to verify whether or not the tank meets the minimum setback. Please have the surveyor mark the lot line so that the setback can be documented by county staff. If the tank is less than the minimum J v feet from the lot line, you may apply for a variance with the Dept. of ommerce. If the variance is denied, or if it is determined the tank D �` \ Vito) extends south of the lot line, the tank will have to be moved. The exposed soil left from excavation for the tank and POWTS dispersal i' cell must be seeded and mulched to es re grass to your lot and areas Y� p ST CRO /X COU T GOV N ENT CENTER 1 101 CARMICHAEL ROAD, DSON, W1 54016 7153864686FAA damaged on the neighbor's property. Additional work is still required to complete the POWTS installation. An electrician needs to properly wire the pump and alarm — the extension cord currently connected to the house is not code compliant. Locks will need to be placed on all above -grade manhole covers when the electrical work has been completed. You have thirty (30) days from receipt of this letter to complete all of the above required compliance activities. Tom Wang will need to notify county staff and schedule a re- inspection to document date(s) of completion and status of compliance. Please be advised that fines and /or forfeitures of not less than $100.00 or more than $500.00 per day may be assessed for non - compliance every day beyond the 30 -day period. If you have any additional questions feel free to contact me at 715 - 386 -4680. Si , Pam Quinn, Z ing Specialist & Ryan Yarrington, Zoning Technician CC: Tom Wang, Wang Excavating File ST. CROIX COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD, HUDSON, W1 54016 715- 386 -4686 FAA Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514854 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: Harmon Investments LLC, c/o Kevin Harmon T Troy, Town of 040 - 1135 -10 -000 CST BM Elev: Insp. lev: BM Description: (( �� Section/Town /Range /Map No: 171 , I ct) T 35.28.19.556P TANK INFORMATION 0 ELEVATION DATA TYPE MANUFACTUR CAPACITY STATION BS HI FS ELEV. Septic Benchmark 6-5 AD-5 Dosing T Alt. BM 666 Awesmr Bldg. Sewer K 5 1 a L Holding SUHt Inlet / I t St/Ht Outl t TANK SETBACK INFORMATION 11 av �— . ` 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet `! Septic Dt Bottom 6x_: 6 4- ,, cam, Header /Man. GS - 5 3. g Z Aeration Dist. Pipe D 7� `#( 9 . tic, Holding Bot. System 97 . c (� t1J Final Grade �` /, . 7 PUMP/SIPHON INFORMATION Manufacturer Demand St Co �V GPM rJ 2- `? 7' Model Number �P e Z^ �oJ TDH Lift Friction Loss System Head TDH t 5.1(o C). 91 N r4- 1 (.., Forcemain Length _ i Dia. Z Dist. to Well > s SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS ,3 7 tewv SETBACK SYSTEM TO P/L ! BLDG IWELL LAKE /STREAM LEACHING Manufacturer:.. -- (' INFORMATION CHAMBER OR Typ Of System: UNIT Model Number: YZc✓tLj eaV' � 162 DISTRIBUTION SYSTEM („Je� , +F,�+w - fit Z .}- = qSl Af,�� Header /Manifold �� Distribution x H Size x Hole Spacing �- VerNo Air Intake �/ Pipes) ` 10 /VJ 1 1-ength 1iL Dia '7 Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only EE Depth Over xx Depth of xx Seeded /Sodded xx Mulched enter Bed/Trench Edges Topsoil 3 .(o 4 ` \ Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 796 Cty. Rd. MM iver Falls, WI 54022 (NE 1/4 SE 1/4 35 T28N R19W) metes & bounds Lot Parcel No: 35.28.19.556P 1.) Alt BM Description = `� ���� � 5 �"O Q ✓` —� 2.) Bldg sewer length = �� - amount of cover ell Plan revision Required? Yes No t ] b 1 0 Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's nature Cart. No. It commerce.wi.gov Safety and Buildings Division County l epartment K w 201 W . Washington Ave., P.O. Box 7162 sco f � iL� ] n Madison, WI " 07— 2 Sanitary Permit Number (to be filled in by Co.) of Commerce ELL S5 Sanitary Permit Applicatio Mate IranssacdonNumber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental /V4 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted t the Department of Commerce. Personal into se o secondary # ^� /1✓� u oses in accordance with the Privacy Law, s. 15.04(1)(m), St ts. L Application Information - Please Print All I 4 nor ma n Proper Owner's Name Parcel # t APR 2 2 2008 4 p�' /35 , & 000 rty Owner'sMailin ddress��. Property Location Prope pST. CROIX COUNTY �✓S U v l 7QNING OFFICE Govt. Lot CkCtat+e ry� / ZZi�p Cod o ( um r `) 2 /� � E � y, Section -! - 0v txnn� circle one T t7`� N; R�EoW I1. Type of Building (check all that apply) Lot # I nr 2 Family Dwelling -- Number of Bedroom. Subdivision Name l Gir Block # ❑ Public /Commercial - Describe Use ❑ City of ❑ State Owned -- Describe Use CSM Number ❑ Village of ®-Town of Q:St- l�ll5 �✓ ZZ *Z( cI1�� III. Type of Permit: (Check inly one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑Treatment /Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration OwnerF N• f' IV. Type of POWTS System/Component/Device- Check all that appl Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area Information: _ Design Flow (gpd) Design Soil Ap lication e(gpdst) Dispersal Area 7quired Dispersal Area Proposed ) System Elevation fU e n 9a,v , 43. v VI. ark Info Capacity in Total # of Manufacturer Gallons Gallons Units ° y New Tanks Existing Tanks () / �v / A 1 C / j l '1 A, Septic or Holding Tank A) b J 6'0 I 'X Dosing Chamber —rte!!/ VIL Responsibility Statement- I, the under igned,MWne responsibility for installation of the POWTS shown on the attached plans. Plu ber's Name (Pr in Plu r Signature MP /MPRS Number Business Phone u ber 0 0 S Plum is Address (Sweet, City. t ,Zip Cod s �-- 9 � � 6 7O v r `/ 1: VIII. County/Department Use Onl Approved rove Permit Fe /e� Date Iss�u Issuing g tit Signature $ I' n R n nial $ # �T IX. Conditionbreiw sm '7 as per management plan provided by plumber, �w� IT 2. All setback requirements must be maintailted as per apps' / Wdirt uW45. Sry $ . 9! C.. Attach I 0 mple plans for the sys ton ;ud sub it o the Countv only on pap r not less than 8 iQaP l in size lqp SBD-6 (R. 01/07) Valid thtu 01/09 , — QZ LU NO ' o X678' _ o , '�-s 1A D EcoPY 4z A—Z x tc, Ir 1 41 i 45 4y � f ) Qj Qj 1 -4t Cl aj Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 5'r ch o " Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point ( dire ' n a Parcel I.D. percent slope, scale or dimensions, north arrow, and location and n ea t ro . 7 Please print all information. Date. /I Personal information you provide may be used for secondary purposes (P L2— � Property Owner RECEIVED Pro t rty Location > r\ e y " . f d H ) o /it Go Lot "4 1/4 S,F 1/4 S3' T - N R 17 -E(or) W Property Owner's Mailing Address 1 20 07 Lot Block # S-� CSM# 3 / 3 �--� r'fs, APR Cs a. /s 7O City State Zip Code hone Number ❑ itY ❑ Village 191 Town Nearest Road { 4 a ST. a r OUNT /37 n User Residential / Number of bedrooms Code derived design flow rate (,' 00 GPD ryCrttiefH ❑ Public or commeraal - Describe: �� � ��� , ' ,� l� � fin' � � i �� Flood Plain e if appli le /V � ft• E .s•f 0 �' / $x p / vrs 3� ue � l�cdi set cl�1.., y`C{ -1 Q� 02 cLfE/'7�1e s'y'ia ve' "/C. u�r ..,, y c /c� .G e �° jr .t' �e .-a �E'.' /. o e? � i 8 g � /' �'• �+�'aa- et. tip" _ ;_ ..'.. O - 7 = caM �. - c..'c «s i s r E c,. ® Boring # Boring o _ ❑ Pit Ground surface elev. ft. Depth to limiting factor } /� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 0 1 7 7,7 a '� .� a yea r r �' 0.7 1 - 6 Al I 50 ❑ Boring ^� a g Boring # Pit Ground surface elev. 7 ft. Depth to limiting factor b � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color ) Gr. Sz. Sh. *Eff#1 *Eff#2 t -J I ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print CST Number `) � Si lure Z � d 6 Z - � C4 2 , --Aer W/C t`2 � Address Date Evaluation Conducted Telephone Number oil I Property Owner Ke V" n < / a 4 o� CS O - l C9 -0 O � � of P rtY Parcel ID # � Page Boring # El Boring ❑ �j Pit Ground surface elev. � , " � � ft. Depth to limiting factor / ` OQ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I * Eff#2 /ow 4 1 3 - 3l s 0.7 / t if A4 i t ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOO < 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) I K 3 4" In IT if f 1a3 -099 OOOLdlM :3113 9SIVS — SH - 008 9002 'NV 'A32J cj 800z k8VnNvr :31Va 09L49 IM 'N00?I N301VW 'OLAMH Sn 9LL£M Z\ O 1t1f1Nb W 0Ild3S 0 1MS A8 NMVifa 313N000O 13531M � (D :31Va ON A321 l = „ti /l 3lVOS la3 -099 000Id'1M I N H w Z Of W N W U � H O O C� J W 0 z DO d N N Z O C O w o D w N U wl- _ N� F- :2 g =- I O p I� o O a C U DO Q ° m0� zz � a LL- U F- J Z J \ Q U F-. H aQ aJ N a Q G m(nJw U< Z WZ UO (N (n 0 m wa a� �O' ° Q oa o LLJ O " 0- 0 .. O N m (w N (00 � d\ w 0 _j O W r7 NJ� JaU JZ )- Z N LLJ L) H (n O cr O a - `' nor= = �� oQw oz z N m � N I- O (n N 0 G __H ?i 0 = U Y ° d Z m LJ W c z zc�ZO °��' z: aZCn a Qcwi>o Nm QO oQ`ww wcy Q�0 Q3 U O U � 7 Y 7 Z�m C) i co�3 F 0 Z �� ZZ O L W W W Q z H U 0 J J O O Q w 0 Z Z J J f- 0 LLJ Y O of N Q 1- W O~ U Q J H W F' N D Z O U Q z �+ w n > n < II _ II N II � II Y z a o_ I � I a W 1 I I O 0- W � Q o wo � I U) _J Q ' @ W m L II 11 Li `� M w J Z „9ti „ZL „LS I UOMDi.naElon b and PUMP CHAMBER CROSS SECTIOIJ ARID SPECIFICATIOUS ' PAGE OF - VEIJT CAP WEATHER PROOF JUUCTIOIJ 80X . -i'C.I. VENT PIPC APPROVED LOCKIMG - - - --- _ 10 FROM DOOR, MAUHOLE COVER P01V — � wARN1NG 1.14QEt -. :/IAIDOW OR FRESH AIR_IuTAKE caap�Ir m 6 mt • -:31t- f Y MiIJ. l� ` 1 y "IuJOetnapa --- PROVIDE I - - - -- IIJLE T "- AIRTIGHT SEAL I f APPROVED JOItJ7 A I I I APPROVED JOIIJT: W /C.T. PIP6BR Tank construction ! iii W/C.I. PIPE shall comply with ALARM ILHk ;3.15 and 83.20 a ♦f i f C I 1 OIJ ELEV, FT PUMP -� --j • � off 0 COIJCRETE 5LOCK RISER EXIT PE:RMITfED OWLy IF TANK MAIJUFACTURLR HAS SUCH APPROVAL UDDINrQ, ,, BFDO I , SPECIFICATIOUS J SEPTIC f I DOSE , 1� Q ' a t'-lZgC .3 IJUMBER OF DOSES: PER D" Y DOSE MAIJUFACTURCR• TAIJK :SIZE : \ k `og 1 6S0 GALLOWS DOSE VOLUME � I pCfjQ, ALARM MAUUFACTURLR: "S- ��'Q- ` 5� '�S IMCLUDIIJG 6AGk/ OW: LLON - MODEL tJUMBER: "I\ \aW CAPACITIES: A_ IIJCHES09 30 G A!b Gay SWITCH TYPE: �1 . B = Z IUCHE$ ~ OR 3 y G(U.'CUS ' ".. PUMP MAIJUFAGTUKCR: a i O C = 9 IU EHES OR �' 3 GAILlkS Ili 3 \ MODEL IJUKBER: D INC HESOR \S3 GALLUM SWITCH TJPE: IJOTE: PUMP AKID ALARM ARE TO BE MiWIMUM DISCKARGE RATE � GPM INSTALLED OW 5EPARATC CIRCUITS �52 "lit VERTICAL DIFFEREIJCE DETWCEU PUMP OFF A1JO..DtSTREBUTIOU PIPE.. FELT -1- tAIwIMUM WETWORK SUPPLY PRESSUR�E / . ; 2 5 �� u FEET ° -I- q-S F EET OF FORCE MAIM X , F /o orr. FKICTIOU FACTOR—A-13 FEET TOTAL Dy►.IAMIG HEAD .r FEET Pump chamber DIAMETER %JvTERNAL. DIMILIJ51OU t OF TAUK: LEW&TH ;WIDTH ;LIQUID DEPTH BOTTOM AREA 231= GAL /INCH 6 A � � a 9 9yv U 2 6 15 P 17 0 768617 KATHLEEN H. KALSH STATE BAR OF WISCONSIN FORM 3 - 2000 REGISTER OF DEEDS Document Number QUIT CLAIM DEED ST. CROIX CO., MI RECEIVED FOR RECORD This Deed, made between KEVIN J. HARMON and KAREN K. 07/13/2004 10:00AM HARMON, husband and wife, QUIT CLAIM DEED EXM i 15S Grantor, and HARMON INVESTMENTS, LLC, A WISCONSIN LIMITED REC FEE: 11.00 LIABILITY COMPANY TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor quit claims to Grantee the following described real estate in ST. CROIX County, State of Wisconsin (if more space is needed, please attach addendum): EAST 361 FEET OF NORTH 173 FEET OF NE 114 SE 1/4, SEC. 35- T28N -R19W. ST. CROIX COUNTY, WISCONSIN Recording Area Name and Return Address ! LEO A. BESKAR, ATTORNEY RODLI, BESKAR, BOLES & KRUEGER, S.C. 219 NORTH MAIN STREET, PO BOX 138 RIVER FALLS, WI 54022 040 - 1135 -10 -000 Parcel Identification Number (PIN) This is not homestead property. plug (is not) Together with all appurtenant rights, title and interests. Dated this 1ST day of JULY 2004 T * *KEVIN J. HA QNJ Q'--- * * KAEN K. HARMON AUTHENTICATION ACKNOWLEDGMENT Signature(s) KEVIN J. HARMON and KAREN K. HARMON, STATE OF ) ) ss. County ) au icat this 1ST day of JULY 1 2004 Personally came before me this day of the above named * LEIQ AY BESKAR TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY LEO A. BESKAR, ATTOR Notary Public, State of RODLI, BESKA B OLES & KRUEGER, S.C. My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) — _ ) * Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN QU1 LAIN1 DEED FORM No. 3 - 2000 INFO -PRO ( 800 )655 -2021 www.infoproforms.com ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM e Owner yer % Mailing Address0 /'" Property Address (Verification required from Planning & Zoning Department for new co struction.) City /State 1 1A)�U GG 4), � Parcel Identification Number LEGAL DESCRIPTION n p � Property Location .' /4 , 0 j E ' Y4 , Sec., T N R,", Town of Subdivision , Lot 9, Ma # �U P , Volume , Page # Certified Survey r Warranty Deed # _ , Volume , Page # Spec house yes Lot lines identifiable ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance 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. I /we, 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. Nuinber of b ooms IGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** r 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. (RE V. 08/05 1 M r - eursuant to Comm 83.54, His.ddm. Code Sectic Tank The septic tank shaff -be maintained by an bcbWu, a1 ce VW to servxx septic tank shat be dtsFosed of in Wft under s. 281.48_ Sorts. The contents of the a=Wance wit NR 113 outlet stint be assessed at feast . Wis. slur. Code. The qperabng won of the septic tank and enstue prot�r vperaticn- The triter oncz ever/ 3 Yeam by inspecdon. Tne cutlet M Sha be deaed as necasswj to VQY stou9h off bet ervuts� caltndge should not be removed ursless provisoes are amde to mtain solids in the tank that . #W ahem is OCS18W reraa'red Srom ertc:rsura. 8 the iDer is egtdFpet; wtft an .the bit 6e 'serviced t septic tank shy have alarms may etc a surge ft" a an id g r�rn MMUS akm The "I*- t Ule' of the tank the of a and =;m in the t ezeeed3 13 the votttrne of 1he'amer of when the next set tx needs t rw oval at Um time of a try - _ 2w Wn t- The add8ion of P to anoktah less than. n adgim . products �� is g 0= y W reGuued. .. of Casta&ce, •„af and 1 ?aerpa Tank . ( ) �lr& shat lam i %Wcl at least a=loe ve* Proper If an e� t liar ls rd� Ile W* shat be Wpeced and stub" b At ade Comoonent and Pressure Distribution S o. al e p es .ors stem s s o ante or c sale t era the ;perimeter and we to the component shall be seeded and mulched as r for pr erosion and to` provide some protection from frost penetration. Traffic (other vegetative aaintenancc) on the component is not allowed. Cold weather install- ations require the component to be heavily mulched for frost protection. Influent quality into the at-trade 8 system may not exceed 220mg /L BODS, 150 mg /L TSS and 30 ag/L FOG. Influent flow may not exceed the maiimia design flow specified in the permit for this IWtallat3on. The preamm IWWW diobutiorr system Is t»ed w a w ed of D P** at the end of each . NW ti k b soils It lat once every 18 moms Wbw a pressure hWh � each go am C dafRrnrr+e lEor�ce cbgging has Observation pipes wthin the dis Bonding levels as w be re persal cell shall be' checked for effluent ponding_, as an im ported to the owner and any levels above '4 inches considered' accordanc p Coma. 8833.52f t2)ure requiring additional, �eore frequent monitoring in General drtea shall be operated in accordance with Comm 12 -84 tiis.Adm.Code and shall be - aaiataiaed in accordance • state , rules per with it,s component manual SID 10570 -P (gal /99) and _local and ta3aiag to system maintenance and Maintenance reporting._' No ant sboWd everentera PAP ta=il sb � t, l , s, t snag 6e praseat that cxtld ca=me dea8t- S�iic aed — pt�g � wltit Coma 83.39, Wis.Adm. Code when Is W is ite no longer wed as Seek or P=P to* MWA ale and covers Mould be aes�dbt'seeMoeand kepocted tawder aadsandness. Access d by = 0 araud b tb*ra assets be s � melon ds nit - ap q d eemed elocldtt9 device b prevent aoddenmi orrpt —� senyofts '� - ' s rip Pavpr<gp + b'c'"'° ed�re+he tank or T dW be lepoked or ne" blow w the �AP�od�P�`ateaaarwtaedwiaaQb sdtetnde6e�eoo�p��be' ;��_` apftiad+ ttAltatcomporwttaftfrsameaagwtPedormaaoa, coo to !'shin to acct t xaatt�e:"'o ds'sse taatsratai co the , anud satiaae, it spay be saceammy to install _ ap asrobfc �lsze fta fit• LdU anal, sites sad :i=t Pr� treats�eat wait or addixioaal plus mar need to be prepared and app"Weed by the De par °t t be am*. and - Safety and Ini2dngs ion. tmea of Commerce,* - _ he operation or wain �•- ,. teamce of this system shoald be directed to ;.. Ttda Comaty,,Eomiat Off3ee at �'11 S .. 1'1 -1- b-?Cg7 P1 i� . s 1 f 38 1 99e i The system Imtsller at L^�- hJ ?he teak :etmsrer at fl� 32$_ 8�15�, Wl t,.sit The effluent filter' mmufacturer at - L 8- 21 S7 Z � Z r'C'f3�Z- auM p ' t • _ 6 3 O- .8?.o_y.p q P Coos r) 1) 7V/ y it r - - t (, o r 6 Goulds Submersible Effluent Pump EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully satin s' in to ■ oft Housing: Cast iron Specifically designed for the steel. grade turbine of for for efficient heat transfer, following uses: ' =d= ru to . a efficient strength, and durability. heat • Effluent systems components ■ Motor Corer: Thermoplas Homes Available for automatic and tic cover with integral handle Fames motor. mamral . Anbo�fie and float switch attachment • EPO4 Single phase 0.4 HP, points. Water transfer • Heavy duty sump 1 15 or 230 V . flo 60 Hz,1550 l RPM, built in overload with and water automa�bic reset. t at the factory. - EPOS Single phase: 0.5 HP, ■ Bearingic. Upper and lower SPEOWTIS 115 V, 60 H7,1550 RPM, FEATURES heavy duty ball bearing Pump: EP64 bull in overload with ■ EPO4 hapeller. Thermo- • Soles tiandft auwaft reset plastic c 3 / 3 /4 , maximum. • Power cord. 10 foot Semi-ope design AGENCY LISTING • Capaatlos: up to 55 GPM. standard longth,16/3 SJTO m e pump out vanes for � •Total heads: up to 24 feet. with three prong grounding mehanigl seal protection. sp• w • pl EPA Impeller. Discharge size: 1 NPT. plug. Optional 20 foot sign Ther • Mechanical seal: carbon- length, 1613 SJTW with P emdosed design for (�frsted model numbers rotary/ceramicnry, three prong grounding plug improved performance. end in F or AC -) BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged . Temperature: thermoplastic design provides 104 (40 continuous superior strengths and 140•F (60°C) intermittent. corrosion resistance. • Fasteners: 300 series UETM , FEET stainless steel. 10 • Capable of running dry without damage to s 30 - - 4 © sc Pump: EPOS a ( z5 Fr • Solids handling capability: c Q • :up to 60 GPM. s 20 • Total heads: up to 31 feet. - • Discharge size: hid' NPT. z 5 • t+lect>atlloal sank carbon- a 4 rotary /Ceramic - stationary, ° ' g" q BUNA -N elastomers. �. T_ • Tom: 3 10 ! 104 (40%1 Continuous : 3 g ! EPO4 140°F (60'C) irdetmMeriL 2 - _ - °_ - - 8 s v : 0 00 10 20 30 40 so GPM L j - L 0 2 4 6 8 10 12 M11h Parcel #: 040 - 1135 -10 -000 04/20/2007 04:08 PM PAGE 1 OF 1 Alt. Parcel #: 35.28.19.556P 040 - TOWN OF TROY Current X 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 O - HARMON INVESTMENTS LLC HARMON INVESTMENTS LLC 318 JEFFERSON ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 796 B CTY RD MM ) SC 4893 RIVER FALLS L k SP 0100 CHIP VALLEY VOTECH/.�G�(� Legal Description: Acres: 1.430 Plat: N/A -NOT AVAILABLE N E N 173 FT Block/Condo Bldg: E 361 FT OF NE Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 35 28N - 19W Notes: Parcel History: Date Doc # Vol /Page Type 07113/2004 768617 26151170 09/14/1998 586964 1356/530 WD 07/23/1997 7 07/23/1997 596/375 1 77, 2007 SUMMARY Bill #: Fair Market Value: AssesseA with 1 42 b Valuations Last Changed: 121120 5 r Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.400 42,000 143,900 185,900 NO Totals for 2007: General Property 1.400 42,000 143,900 185,900 Woodland 0.000 0 0 Totals for 2006: General Property 1.400 42,000 143,900 185,900 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING OFFICE I CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK Thi is to certi that I have in� ected he septic tank presently serving the b Of S1 h4. l y � residence located at: 1 /4, S '14, Section ; Town N, Range Zg W, Town of � , 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 properly. Most recent date of service W 36) 0 � v Did flow back occur from absorption system? Yes No K (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Y Steel Other Manufacturer (if known): 1.t b 14 Age of Tank (if known): (Licensed Plumber Signature) (Print Name) (Title) (License Number) MP PRS (D a ej Form to be completed b licensed lumber s. 14 p y p ( 5.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) c7 fn O 0 N O K 'o n d _1 3 N � O N A n (D 'o A� • K 'O K a # r N I N DI N rx 3 C) C31 2: w o n o o v a o m o m o a °1 S-11 -0, L• w c R m_ a a m iD a CD m CO w < OD CL m CD U CD rn a' O - ►*a O CO cn OD -4 a o ° 3 a a 0 3 y a) l ] N N C, O. 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