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020-1309-10-000
Court � ^ 1" ;� Safety and Buildings DivisionT, l�cr� ± 201 W.Washington Ave., P.O.BOX 7162 Sanitary Permit Number(to be filled in by Co.) ,a gp r! Madison,WI 53707-7162 _ _ tle 1 zt �z anita Permit Application sta action , ry PP i� overnm 2 /k 3 21 Wis.A .Code submission of this form to the appropriate fst In accordance with S', 38 (2), s. dm g is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitte y�ddress rf d Brent than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary C 0 purposes in accordance with the Privacy Law,s.15.04 1 m,Stats. 10FV4 O�� � � I. Application Information—Please Print All Information p Property Owner's Name Par ,, , qq cel# T RA-r- IlJ loW/e- cok Z© /-07-V( ' "�®O Property Owner's Mailing Address q 6- Property Location Cty Z WA-x0 N 4 tV Govt.Lot City,State ` ]' & 'A Zip Code / Phone Number �4y Section �I s of r Jr- C/O/ 1�N, R f ircle on H.Type of Building(check all that apply) `� Lot# 1 or 2 Family Dwelling-Numberr oof/Bedrooms v / D Subdivision Name ' 9�,) L/1 /S n NC1- Block# �4.r� ❑PubliclCommercial-Describe Use ❑City of ❑State Owned-Describe Use CSM Number ❑Village of W Town of Hgt)50 1) III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑New System IjERplacement System ❑Treatment/Holding Tank Replacement Only Other Modififation to Existing Systerrl,(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber List Previous Permit her d Date Issued ❑Permit Transfer to New t'� `_ [/ / (� Before Expiration Owner 6 � �(r% /a /7 / / 7 IV.T OWT stem/Component/Device: Check all that apply) Non-Pressurized In-Gro ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil Ho mg ank Other Dispersal Component(ex in) ❑Pretreatment Device(explain) V.Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Applicatio Rate dst). Dispersa Area Requi d(sf) Dis ersal Area Pro sed(sf) System Elevation �C 4150 0. 7 6413 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units "a a l pI? c New Tanks Existing Tanks Lt� 5 _ y o y � -�0 ii, I1 it �1 �e� �U Septic or Holding Tank /000 /00c) w/Er c C4 r T Dosing Chamber ©® ®D Uh�./ 7- VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWI..TS shown on the attached plans. Plumber's Name(Print) Plumber's gna e , MP/MPRS Number Business Phone Number :y0k4 ei 5cr�iq cr-T 22376 71,-760 D Y9 6 Plumber's Address(Street,City,State,Zi Code) VIII oun /De artment Use Only Approved Disapproved Permit Fee Date Issued I uing Agent Si afar ❑ L.,_ C El Owner Owner Given Reason for Denial $ 1 .J ' 'U IX.Conditions of ApprovaMeasons for Disapproval j�,� SYSTEM OWNER: U A� � 1.Septic tank,effluent filter and ��j(L_Ccl 5 �" '� hC TD dispersal cell must be serviced/maintained v ���L ix Q-�as per management plan provided by plumber. G � rrU� 2 All setback requirements must be maintained v 1Aj 1; as per applicab*"L9/M"V0W-k%'y for the system and submit to We County only paper not 1 than 8 t!Z z Il inches io size /- ,,• a G Z_ /lCW_-7 SBD-6398(R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Wilcox Replacement Soil Absorption Area Owners Name: Rae Ann Wilcox Owner's Address 942 Waxon Lane Hudson, WI 54016 Legal Description: W1/2, SE1/4, S16,T29N, R19W Township Hudson County: St. Croix Subdivision Name: 2 Acre parcel Lot Number: 10 Block Number Parcel I.D. Number 020-1309-00-000 Plan Transaction No. Page 1 Index and Title Page 2 Plot Plan Page 3 System Sizing&Cross Section Page 4 Dose Tank Cross Section Page 5&6 Pump Curve Page 7 Filter Information Page 8 &9 Management and contingency plan Page10 Septic Tank Maintenance Agreement Page 11 Warranty Deed Page 12 CSM or Plat Attachment Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 4/22/2014 _ Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) PLOT PLAN N Project Name: Rae Ann Wilcox Legal Description: W1 12,SE1 14,S16 T29N,R19W PA-D: 020-1309-00-000 Subdivision Name: Pleasant view Lot#: 10 SCALE:V 40, Township: HUDSON Parcel Size: 2 Acres County: ST.CROIX System Elevation: T1=98.50' Existing 56'Rock Trench Slope: 2% T2=98.50' Existing 56'Rock Trench A BM1 Elevation: 89.97' Bottom of Dose Tank T3=98.00' Proposed 65'EZ Flow Trench BM2 Elevation: 98.50 Bottom of Existing System T4-98.00' Proposed 65'EZ Flow Trench Backhoe Pits: TANK SCHEDULE 2 inch Sch 40-ASTM D1785 A Existing 1000 gal Septic tank 4 inch Sch 40-ASTM D2665 B Existing 600 gal Dose tank+Sim/Tech STF-100 4 inch 3034 - ASTM D3034 C Proposed Distribution Box NOTE:See page 12 for a complete plot of the parcel. 3 B E11 o «© N o�sE � s 63 1 V IaRtvEwA � � � k A006o S1w1/TkClh \ $TF—lE0 e � ry T2 r /OL SOIL ABSORPTION SYSTEM DETAIL/GRAVELLESS LEACHING UNIT Project Name: Rae Ann Wilcox 2 No.of Cells 6.5 Per Cell 3 ft Cell Width 13 Total No of 1203H 65 ft Cell Length 325 sq ft EISA Per Cell 3 ft Cell Spacing 650 sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: to Infiltator Gravelless Leaching Unit Model: 1203H Typical Cross Section Finished Grade 102 ft Observation Pipe with approved cap or vent as ■■■■■■■ � ■ • Soil Backfill 30 in ■ ■ • Geotextile Fabric ■ 98 ft Infiltrative Surface 12 in I I <94.2 ft Limiting Factor >36 in Slotted and Anchored Vent/ _ Observation Pipe with Cap Plumber/Designer Signature: License#: MPRS 223760 Date: 4/22/2014 SECTION:2.20.010 QL/4L/TY PUMPB J�NCE /�7��7 // FM0493 0311 ® �O Product information presented Supersedes here reflects cation. o at PUMP !O_ time of publication.Consult factory regarding discrepan- cies or inconsistencies. MA/L TO:P.O.BOX 16347•Loirsvdle,KY 40256-0347 visit our web site: SHIP TO: 3649 Cane Run Road•Louisville,KY 40211-1961 www.Zoellercom (502)778-2731.1(800)928-PUMP•FAX(502)774-3624 COMPARE THESE FEATURES • Non-Clogging vortex impeller 53 - 57 Cast Iron Series • Float operated,submersible(NEMA 6)2-pole mechanical switch&variable level long cycle systems available 55 - 59 Bronze Series • UL Listed 3-wire cord plug;9 ft.standard for automatic, 15 ft,standard for nonautomatic (For Pump Prefix Identification see News&Views 0052) • Corrosion resistant powder coated epoxy finish • No sheet metal parts to rust or corrode i' M I G H TY-MATE" • Stainless steel screws,switch arm,guard and handle • No screens to clog SUBMERSIBLE PUMP • Watertight neoprene'0'ring between motor and pump U housing ®L FOR • Sold buoyant polypropylene float Tod9dbUL DEWATERING (SUMP) 3tnd$a uLns. • Motor-60 Hz,1550 RPM,oil-filled,hermetically sealed, OR automatic reset thermal overload protected EFFLUENT (SEPTIC TANK SYSTEMS) • Upper and lower sleeve bearings running in bath of oil • Entire unit pressure tested after assembly C CID us PASSES%"SOLIDS • Carbon and ceramic shaft seal (TesWbUL778ad 1'/:"NPT DISCHARGE • Maximum temperature for effluent or CSA222 t08 soh dewatedng-130°F (54°C) AUTOMATIC • Passes W inch spherical solids MODEL • 1%NPT Discharge. • On point-7%' • Off point-3' f • Major width-10 3/32' • Height-101/16' SPECIAL MODEL FEATURES: MODEL 53 MODEL 55 •Cast iron switch case,motor& •Bronze switch case,motor& Alt pump housing pump housing •Engineered thermoplastic base •Engineered thermoplastic base VORTEX TYPE •Engineered,glass-filled,plastic •Engineered,glass-fliled,plastic IMPELLER impeller with metal insert impeller with metal insert •Stainless steel guard&handle •Stainless steel guard&handle •Bearing-lower&upper oil fed •Bearing-lower&upper oil fed cast iron bronze MODEL 57 MODEL 59 •Al cast iron construction •Al bronze construction •Stainless steel guard&handle •Stainless steel guard&handle •Bearing-lower&upper oil fed •Bearing-lower&upper oil fed cast iron bronze •Cast iron imp der •Bronze impeller ALL MODELS ARE COMPLETELY SUBMERSIBLE POWDER BN MODEL HERMETICALLY SEALED COATED TOUGH Watertight-dust fight.Permanently oiled bearings. MODELS AVAILABLE VARIABLE LEVEL CONTROL AutonaticorNonautomatic SYSTEMS AVAILABLE '53-57'-.3 HP,115Vor230V • '55-59"-.3 HP,115V or 230V Note: The sizing of effluent systems normally requires variable level BE53BE57&BN53/BN57 available packaged floats)controls and properly sized basins to achieve required with Piggyback Variable Level Float Switch pumping cycles or dosing timers with nonautomatic pumps. 0 Copyright 2011 Zoeller Co.All rights reserved. DOSE TANK DETAIL Owner's Name: Rae Ann Wilcox 93.93 ft Inlet Elevation with Locking Device ----- Junction and Warning Label • .Quick disconnect fitting ■•r■ •••rr•� �rrr•••rrrrrrrrr■ • •rrr■ n Alternate forcemain outlet G a0 _ Sim/Tech Filter re (a) Dimensions Inches Gallons ------ ------- a 23.28 347.33 n se ara alarm on p O b 2 29.84 --------------- -- pump on C 6 90 dose vol a (c) d 10.72 -- ----------- ------- 160 Total 1 42 1 627.17 off d (d) 92.18 Intake Elevation Tank Manufacturer Huffcutt Pump Manufacturer Zoeller Tank Model 1000/600 Pump Model 53 ✓U�'` Tank Capacity 600 gal Alarm Manufacturer Existing Tank Volume 14.92 gal/in Alarm Model Existing I Filter Manufacturer Sim/tech Ack4 G, Filter Model STF-100 -6) TD H DOSE VOLUME CALCULATIONS TOTAL DYNAMIC HEAD CALCULATIONS Design Flow(DWF) 450 gal/day Min Network Supply na It Number of Doses 5 /day Passive Vertical Lift 9.37 ft—(HeaderlD.Box elev.-Pump intake elev.) —(Forcemain Length x Friction Loss Max.Dose Volume 96.52 gal Friction Loss 0.44 ft Factor)/100+Filter Friction Loss Drain Back 6.52 gal Total Dynamic Head 9.81 ft Design Dose Volume 90 gal Min Discharge Rate 20 gpm NOTE: Pump and alarm are to be installed on separate circuits. INTERNAL DIMENSIONS OF TANK Diameter in Liquid Depth 42 Plumber/Designer Si nature: X_��A, 9 9 License#: 223760 Date: 4/22/2014 co TOTAL DYNAMIC HEAD/FLOW UJ W PUMP PERFORMANCE CURVE PER MINUTE MODELS 53/55/57/59 EFFLUENT AND DEWATERING in in 6 20 MODEL 53/55/57/59 Feet Meters Gal. Liters = 5 1.5 43 163 � 15 10 3.0 34 129 4 15 4.6 19 72 o /r,,3 10 Shutoff Head: 19.25 ft(5.9m) 0 F— 2 00e607 37re sins 5 4 sre 1 1n.11 V NPT 0 3,re 10 20 30 40 50 _ GALLONS LITERS 4 0 80 160 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level float switches available -- • Variable level long cycle systems available • Available with special cord lengths of 15',25',35',(50'230V only) 10 1/15 • Alarm systems available i • Duplex systems available 3 3132 � � SK868 III SELECTION GUIDE 1. Integral float operated mechanical switch,no external control required. 2.Single piggyback variable level float switch or double piggyback variable level float switch.Refer to FM0477. 3.Mechanical altemator'M-Pak"100072 or 10.0075. 4.See FW712 for correct model of Electrical Altemator 5.Variable level control switch 10 used as a control activator,win, "Easy assembly" -0225 Electrical Altemator(3)or(4)float system. ( & )p Single Seal Control selection Model Volts Phase Mode Amps Simplex Duplex CSA UL M53155&M57/59 115 1 Auto 9.7 1 — Y Y N53/55&N57159 115 1 Non 97 2 3 or 4&5 Y Y •SN53 115 1 Auto 9.7 Y Y •BN57 115 1 Auto 9.7 — N Y •BE53/57 230 1 Auto 4.8 Y Y OPTIONAL PUMP STAND P/N 10.2421 D53155&D57/59 230 1 Auto 1 4.6 1 — Y Y • Reduces potential dogging by debris F53/55&E57/59 230 1 Non 4.8 2 3 or 4&5 Y Y 'single piggyback switch included, Made rocks Or bricks under the pump • Made of durable,noncorrosive ABS Raises pump 2'off bottom of basin in All installation of controls,protection devices and wiring should be done qualified Provides the ability to raise intake by adding sections of 1%z licensed electrician. All electrical and safety codes should be followed including the most recent National Electrical Code(NEC)and the Occupational Safety and Health or 2'PVC piping Act(OSHA). • Attaches securely to pump For ftnnation on additional Zoeller products refer to catalog on Piggyback Variable Level • Accommodates sump,dewatering and effluent applications FbatSwitches,FM0477;ElecUicalAftemafor,FM0486;MechanicalAlternator,FM0495;Sump/ NOTE:Make sure float is free from obstrucdon. Sewage Basins,FMO487;and Single Phase Simplex Pump CaiUoMlarm Systems,FM0732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 0 Copyright 2011 Zoeller Co.All rights reserved. AMC l //X�',�,,,/ L� PRESSURE FILTER INSTALLATION &SERVICE INSTRUCTIONS 1455 Lexamar Drive Toll Free 888-999-3290 Office 231-582-1020 Boyne City,MI 49712 Fax 231-582-7324 EmaiV,L_r;.a,;ea¢-simtechxom Web www.gae-simtech.com INSTALLATION: When installing an STF-100, screw filter into discharge port of any pump that has a 2"National Pipe Thread. Pumps with a smaller discharge port may be adapted to fit. When installing an STF-100A2 a tailpiece and male adapter will need to be added to the inlet end of the filter(end opposite of the cap)to the desired height and a 2"union will need to be added to the outlet end (the end closest to the cap&on the side of the filter). Always install the filters in a position where they can be easily serviced. **Always use caution when starting threads to avoid cross threading**. Plumb force main into the 2"sch 80 PVC union. **We recommend that the union remain together during gluing to insure that glue or cleaner does not ruin O-ring or sealing surface**. For best performance, if a check valve is installed it should only be after the outlet of the filter. SERVICE: Service of filter screen is dependent on usage as every system is unique. For most residential systems we recommend inspecting the filter within the first year to determine the necessary service intervals for the filter. In high volume systems we recommend inspection within the first 6 months to determine necessary service intervals for the filter. Once the service interval is determined it should be consistent unless something changes in the system. Always inspect the filter screen for any damage or corrosion and replace if necessary. If our STF-101 service alarm switch has been installed and adjusted properly it will alarm when the filter requires service. It should be serviced no less than when periodic pumping of the septic tank and pump chamber is performed. Servicing will be more frequent if using any one of our optional filter socks(600 micron, 150-190 micron,and 100 micron). Check your local health department for septic system servicing recommendations. If the screen becomes clogged before the periodic pumping requirements,a high level alarm or light will indicate the need for service. If system is equipped with a"pump on light"that stays on longer than normal,this also may indicate a need to service filter. To service filter screen, unscrew the 4"cap. Pull filter screen from canister and wash out thoroughly in appropriate location with proper protection. In some cases an additional filter screen allows quicker service allowing the dirty filter to be washed later at the shop. NCB OW in Cold cotx Nbns the filter cap may be difl *to teniom Keep the#xer In a wam area or pow wwW water over the cap belore toning. tMce th8 fiiiter a s atstaNled k►the tank#mebttains a stable and removrngr die cap will rW be a problem. If the system is equipped with our Service Alarm Switch,the filter screen does not need service until the Service Alarm Switch activates a light or audio alarm. We still recommend that the filter be inspected once a year for damage or corrosion. NOTE: The total dynamic head loss of the system must be increased by 0.5 feet of head to overcome friction loss through the filter. SERVICE ALARM SWITCH The alarm switch is available in three pressure ranges, low head, medium head, and high head. Installation is simple,on SIM/TECH FILTER systems, remove%" plug from base of filter chamber and connect tube fitting. Next, run the tube up into the tank riser and connect to service alarm switch. The alarm switch is fastened to the side of the riser via the nylon strap provided. Run alarm wire to alarm box. The service alarm switch can be wired with its own alarm or with the high water alarm. Pressure adjustment is made by removing the end plug, and inserting the 7/32 alien. Clockwise increases pressure. One turn equals approximately 3 PSI. The low head alarm switch comes factory preset at 8 PSI and is completely field adjustable within it's range(3 to 24 PSI). We recommend the use of a ball valve when using an alarm switch. Once you have installed the filter and alarm switch, the ball valve can be closed off to simulate a plugged filter so that you can make sure the alarm switch is working correctly. ****TRY OUR LID/SCREEN REMOVAL WRENCH. Our wrench holds filter lid firm) and hooks screen for easy removal and Y Y installation. Made of PVC plastic. WARRANTY All products are warranted against defects in material and workmanship for a period of two years from the date of purchase. In no event shall GAG SIM/TECH FILTER, INC. be liable for any consequential damages or any labor, material,freight or expenses required to replace, correct or reinstall the product. GAG SIM/TECH FILTER, INC.'s liability is limited to repair or replacement of the part. All warranties are void if the product has been improperly modified, applied or installed,subjected to misuse or abuse. Except as stated herein,there are no warranties expressed or implied, including the warranty of merchantability or warranty of fitness for a specific purpose. EFFECTIVE Seatember 13. 2005 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Rae Ann Wilcox Tank Manufacturer: Huffcutt r NA Permit# �'(p ` Septic E Dose Holding Volume:_1000 gal DESIGN PARAMETERS Tank Manufacturer: Huffcutt r NA Number of Bedrooms: 3 f N !� Septic E Dose Holding Volume: 600 gal Number of Public Facility Units: fw— NA Vertical Distance Tank Bottom(s)to Service Pad: ft Estimated averse Flow: 300 ga U Horizontal Distance Tank(s)to Serivce Pad: ft Design(peak)Flow=estimated x 1.5: 450 gal/ Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 gal/day/ horizontal is>150 feet.Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: SIMIFECH r NA Fats,Oils&Grease(FOG) s30 mg/L Effluent Filter Model: STF-100 Biochemical Oxygen Demand(BOD5) 5220mg/L f NA Pump Manufacturer: Zoeller r NA Total Suspended Solids(TSS) 5150mg/L Pump Model: 53 High Strength Influent/Effluent Monthly average Petreatment Unit Fats,Oils&Grease(FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand(BOD5) 5220mg/L (o NA r Mechanical Aeration r Peat Fitter r NA Total Suspended Solids(TSS) 5150mg/L (- Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Filter r Other. Biochemical Oxygen Demand(BOD5) 530mg/L Soil Absorption System Total Suspended Solids(TSS) 530mg/L r NA W In-Ground(gravity) r In-Ground(pressure) r NA Fecal Coliform(geometric mean) 5104cfu/100m1 r At-Grade r Mound Maximum Effluent Particle Size: %s in dia. r N r Drip-Line r Other. Other: Other: P-1 NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third(%)of tank volume Pump out contents of tank(s) When the high water alarm is activated mor,n,(S) Inspect condition of tank(s) At least once every: 3 IN year(s) Maximum 3 ears) r NA month(s) Inspect dispersal cell(s) At least once every: 1.1 year($) Maximum 3 ears) r NA !— month(s) Clean effluent filter At least once every: 1.1 year(s) r N IF months) Inspect pump,pump controls&alarm At least once every: 1.1 R year(s) r N m Flush laterals and pressure test At least once every: r month(s) r NA Other: At least once every: r month(s) r NA r- fflonth( s Other: At least once every: r year(:)) r 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 Insepector;POWTS Maintainer;Septage Servicing Operator(pumper).Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on 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 indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third(%3)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 Admininistrative Code. All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components,petreatment 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 30 days of completion of any service event. (Rev.2/05) Page of START UP AND OPERATION For new construction,prior to use of the POWTS check treatment tank(s)for the presence of painting products,solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended 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 and may overload them resulting 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)discharge;fruit and vegetable peelings;gasoline;grease;herbicides;meat scraps;medications;oil;painting products; pesticides;sanitary napkins;tampons;and water softener brine. ABANDONMENT When the POWTS fails 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,pits and other soil absorption systems 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 the opportunity to obtain a sanitary permit for 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations.If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. ® 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: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE.NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE.DEATH MAY RESULT.ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name:John Schmitt Name:John Schmitt Phone:715-760-0486 Phone:715-760-0486 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name: Owners Choice Name:St.Croix County Zoning Phone: Phone:715-386.4680 This document is intended to meet minimum requirements of Ch.Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev.2/05) STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS ,rjt�q rd A Cdr, J L/tD AP PROPERTY ADDRESS W 9*a VV Q.-C O h 4nan (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION We. 1/4, 3L. 1/4, Section Ro T ZCj _N-R w TOWN OF_-f[Ltai_S6n ST. CROIX COUNTY, WI SUBDMSION��( (��, (1 j f-40 LOT NUMBER /D CERTIFIEDSURVEY MAP ,VOLUME ,PAGE ,LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement-that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St.Croix Zoning a certification form, signed by the owner and by a mater plumber,journeyman plumber, restricted plumber or a licensed pumper verifying that(1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping(if necessary), the septic tank is less than 1/3 full of sludge and scum. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: -�`�+ - -- St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, Wl 54016 11193 �. '�.f'^•�'?�,'ar?'�4E!..S..q,,..t.A-.,zr�g�:•c ar..�.. .�.. _ _ F WARRANTY DEED Document Number REGISTER'S OiFiCE ST. CROIX CO.. WI P.w tx 01. SEF 08 1997 Return Address KRISTINA OGLAND 1:40 P Zilz, Estreen 31: Ogland P.O. Box 359 Hudson, WI 54016 Parcel I.D.Number. fi YVernea Waxen, aiWa Vernon E Waxen, and Irese Waxoa, a Irene S. Waxen, t.usband aed write, conveys and warrants to William L.. Wilco: =wR Rue Ann Wilcox, hatband and wife, as survivorship marital property, the following described real estaac in St. Croix County, State of Wisconsin: Lot 10, Pleasant View in the Town of Hudson. SL Croix County, Wisconsin This is not homestead property Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of September, 1997. t4Ld SEAL) ^ x/ (SEAL) a a ernon E. Waxen , S. Waxen 'e AUTHENTICATION 'b TR Signature(s) Vernon Waxen, a/Wa Vernon E. Waasn, "ER and Irene Waxon, a/Wa Irene S.Waxes, hasbo ad and wife, authenticated this -- day of Sepseer, r I"T 5 Kristine Ogland TITLE: MEMBER STATE BAR OF WIC `s w THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 co A'� F'P5� �o OZ I e tC 0 40 00 �•�� 6 I N t/ ni too T Q Rhot W 56`�� / 6 Z pg i ttJ �• 4b / ~ 0 o r / a OZ 5� � � � Z• r o \ � 3'.19, 9Sie60N 96 If 7 r \ o /tv z of 2 CY CO W Z / i a� / z 9e �. w �+ W W W �. a • cr. ° °ci a A V N O N CD N x O� O Fn cli W 10 / O ` O / / / a Z � w `` cm X001 I T � .F O 06 �r O 7'( .1=.Ei �'9 '' 041W \ O 4 ( °OS -� aw _ J° W 3 00 OOo06 N— l _O 00 0 ti c w s so ' e a 0 OgOj / cop LL- -0 0 Q c ~ o 3 0 C) 6r, d c o y a s `e r. 0 0 N in 'r n o x -0 O N 0 I U C ~ O N O 0 1 C (6 U 6 Z ~ C N 7 _ LL cm C co O a1 ro o0 Q 0 z rn w E cn o z ; d d o a m c 0 m O z d c O d Z O to F o (D Z E -2 N co I ~ y m i (n U) c •N CL U O c O O Z H z o N E c - c N N N y i m C 0 co (D (0 0 0 _ O N o O o a E N N N y_ N (A fA U N N N `7.~ a (n Z O O O a a a Al is (V a C F, o 7 O V! O m N -j U =3 0) m 04 M (0 °o rn °o C O O 0) n J 0. n N X M (n O 0) N N Al i+ O £ N C O C C E N LO In O O R o Ln 3_ 'D U) U) v a o o 0 0 C) o a O. c 0 0 y p N N N N N ~ N f0 (D n y~y O r C W r L O n In t!') N r m N 2(0 N f- F' N ]r~~,T i.r N ? C~ co ran E E U • L. O _ 2 N O tI~ to V .T. ID C~ CD !O d 7 a L: CL > rr~~• C~ a d V 0 C *Ali ".t E M Z c Y o A 0 2 0 N 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS .2rr 4/ SUBDIVISION / CSM#___ /y~Qa 5 a,~•~ r Q aJ LOT # ll SECTION T.9,9 N-R If W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ ~`J tyyyG INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK : _ j .14in t 0-5 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well Off- House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length_ Number of trenches Distance & Direction to nearest prop. line: Setback from: well: O -.o,- House :V other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor end Human Relations INSPECTION REPORT ST. CROIX , Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) sanitar2P6e86t78o.: Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: HARWELL, BILL HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9600383 Il G TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic c✓G -5- e-en Al-CCoS ZU Benchmark Dosi n ' g ~ -rr'rvt , 3 S~ GO ' Aeration Bldg. Sewer Holdin St/,O Inlet 98 S ' TANK SETBACK INFORMATION St/Ot Outlet S, 30' d' TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake y Septic NA Dt Bottom r Dosing NA Header. ? (p;~ Aeration Dist. Pipe 30 ' 26. (1o / Holding, Bot. System 8 ZZ' 6, DS PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number M TDH Lift Loss on Syestem TDH Ft FOrcemSln Length Dia. FFii Dist. T Weell SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PI - No. Of Pits quid Depth DIMENSIONS 75- a DIME Nw I MKS- Manufacturer: - SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM _1HA MBER INFORMATION Type O ✓l - CHA Model Number: System: Ccm ~S OR UNIT DISTRIBUTION SYSTEM Header / fdlarrcfvKJ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 1L Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or A ade Systems Depth Over Depth Over xx Depth Of xx Seeded/ Sodded x Mulched x Bed /Trench Center Bed/ Trench Edges Topsoil E] Yes E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.16.29.19W, WEST, SE, CTY RD A Plan revision required? ❑ Yes 2-<0-- Use other side for additional information. 1/Z D1 I SBD-6710 (R 05191) Date Inspector's SignatureO' Cert. No. ADDITIONAL COMMENTS AND SKETCH " SANITARY PERMIT NUMBER: 715 I "A e 5 C" C~., r C' ~ SANITARY PERMIT APPLICATION BureaSafetyu o oand ff BuiluildiinWater S ng Water Systems ~ 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. , Cr oix • See reverse side for instructions for completing this application State Sanitary Permit Number 71 The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location e4 v4, S To?!? , N, R E (or Property Owner's Mailing Address Lot Number Block Number Citt State Zip Code Phone Number Subdivision Name or CSM Number ;Y a e` ( ) l, e d Ser .+r ( II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ city Nearest Road Village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town of 3o G? leol J1 BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) p 1 ❑ Apartment/ Condo C1 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility -3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. D&New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12Z Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev- 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) Elevation D!f S ~/LL 9~', d Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con Fiber- Plastic Exper- New Existing Gallons Tanks Concrete Steel glass App. strutted Tanks Tanks Septic Tank or Holding Tank 1,2W L°S''dd ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber El El El El 1:1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite s ge system shown on the attached plans. Business Name: (Print) Plumber's Signature (No Stamps /MPRSW No.: Phone Number: Plumber's Address (Street, City, State, Zi Code): l r? ? sc , 1 y~ dir IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issuing Age t Sign ature (No Sta s A roved Surcharge Fee) pp ❑ Owner Given Ii al Adverse Determmination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: original to eonni y, one u)py To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS Y 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed- 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. K V U, tB~ 6 3 J J 9c d u~ Ys- i o 1 0 /b ro 2.00 ACRES 9 Z o \ \(87, 170 SO. FT.) o \ F N. o / M W 0 A per' ~ o tD C.S.M. s tHE..`i..PUeI/ \ o~ C 21~ d ~ I co © ~o s a z 3e" 4?e 4 38'~ s \ 0 0.00 f~9 2/, 8s o/~. 36.24 /.Fe , s~ . \ 67005'22 "E 6 6.70 0 -L- h o y, S22054 `38"W ~ 14.75 13 2.12 ACRES 1 / M ( 92, 2 to sO.FT.) ~M 2.01 ACRES /A, (87,473 SO.FT.) I W " I ic> b c 2.00 ACRES PAC ~Z► ° (87,215 SO. FT.) w 00 190.001 3 3 9. 9 1 - - EAST LINE OF THE NW- SE NOTE:'ELCVATIONS SHOWN ARE S-EA r LEVIEL DATUM FROMU.S.G.$.. am. a , if Al~Jw 3 Wisconsin and H uman Department Relati tions Industry, Labor and SOIL AND SITE EVALUATION REPORT Pape L of ' Divisan of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY ST. G fLO t' 11 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 (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 61ERA100 E-. 4VA X OAJ GOVT. LOT WEST -SC 1/4,S 4 T 2- 9 N.R. Ip / E (oljF PROPERTY OWNEIT:S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # $ 1 r-r . 'RD . A PIE4SAPbT UIC-U-) CITY, STATE ZIP CODE PHONE NUMBER [--]CITY (]VILLAGE OWN NEARESTRM .0soZ outs . SS/o / C. (7/5) 9G- 3Y'38 HUP-So,J cry. WA f}' 1-fNew Construction Use ( Residential / Number of bedrooms 3 -Fo y [ J Addition to existing building _ I ]Replacement YSo(] Public or commercial describe - Code derived daily flow &641 gpd Recommended design loading rate bed, gpd1ft2 trertch, gpolft2 Absorption area required bed, 1`12 trench, I12 Maximum design loading rate ' 7 bed, gpW trench, f Recommended infiltration surface elevation(s) S.eQ- h S .3 ft (as referred to site plan benchmark) Additional design / site considerations Parent material SCS So, d,+roTi+ S11/1 Flood plain elevation, if applicable N ' • ft S = Suitable for system coNlQ M Coul~lo U IN G~uNaD U EssuRE ATEIS Ea U SVYSTE O U O S IOLDING TAW U =Unsuitable for system G~~''$S ~'S EIS SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure Consistence GPD/fft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Roots Bed Toth ( I o -1? /o y,03 f . Sr' . 2 A- A< ds C5 f , s • G •S Z g• 20 /0 ye y/y /7` Sk d.4 4,e' 7e- 'Y Ground 0.33 7.S YR YI C.S. D, S ee.2 /oaelev. It 3 . Y ZS ykS/3 5"* /f sdk d A ~c~c' • • S Depth to S V• 9 16 Yle S/ C. S. 0, s • ~ ~ •0 limiting - factor H ( l Remarks: Boring # 1 0 •y0 /o y~P 3 /1 S ('l 2- , she Ws C S z . S • G 2• S Z /0 - z a !1'e 2 A• fX d Ski 4.S • S 3 - s w. y/~ . s. S C.5 Ground elev /0 ye 51,V O's, If - Depth to limiting factor 7 Remarks: CST Name:-Please Print Q~ BEt2 r L Q R l C T- Phone: 715. 3 96 ' 18 S ress: Ca SS O' N ei L 'RD. CSrh 24 gL !r{- u I~So ~ C.e~ t S . 5 y o / ~ 5 - ZG Signature: Date: CST Number: 72, : i PROPERTYOWNER U'eoo wAXatJ SOIL DESCRIPTION REPORT page 2 -Qf PARCEL I.D. / Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDIft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tench 3 f o- 10Ye 311 Y,'/. 2 A-, S6& S eS 3t. . S . G z ir- zo /D YX Y/ i. Zy„ q/~ ~Psti a s . s . G Ground j .20-32- ? • S Y k y/4 An- . s. o= S ~.e c s • '1 • 8 elev. f7.4 f. 1-yo i0 Y,e s/,V - - S. 4, s d,2 •1, .f~ Depth to Nmiting faclor y i y-~'-L I Remarks: Boring # t 0 -/O 311 , S6 dSA C jr 3f . S IL C L o- ip /o ye y/y sE z,,~,, 57,e YS~ Q s 13 T-36 7. S YP y/G S. 0, S . d "e cs . 7 I Ground ~ S 7 elev It ~(o • y/2 d ~ • 1 Depth to limiting >faclara I Remarks: Boring # 0-1)- !o yP- 5 Z -ZO y,t' y 3 0.3 '7 --She 4/ s . o, S . 0> Ground G t Z ~ elev. - 3 2 s y S/3 s ie c S, / / f s b~ d v A a .r Y, S 5F"ft. Depth to s 9 - ~G to y~ s Wiling factor Remarks: Boring # i i 13 Ground elev.. fL Depth to limiting factor Remarks: CDr% 090A/O AC M•f\ e H Q 1 ~ E 4 1 0 N C 7a 00 C A S y Z m D m j 70 " 0 n cr, C o N~ ~ v C r T ~ ` G W 0 ~ O ~ ~C N H 0 N o~ STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNEWBUYER MAILING ADDRESS e ~~r ~Q~d,✓ ~e ,5^ y0 /C PROPERTY ADDRESS ~'y. ~~~A,✓ (location of septic system) Please obtain from the Planning Dept. CITY/STATES C.J ly-^ YOrC PROPERTY LOCATION ~e~~`1/4, S~ 1/4, Section , T~N-R~ w TOWN OF yoA/ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER - CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMMER _ 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a. treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. UWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. ' SIGNED: DATE - - - - - St. Croix County Zoning Office Governrncnt Center 1 101 Carmichael Road 1luds011, WI 54016 11/93 • S T C - loo This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property a,, - Location of property W`''7- 1/4.5 1/4, Section l~,T fir' N-R lQ' W Township Mailing address ",rd ow s M-et s d a% Address of site l/~~e,~✓ ~Q Subdivision name b ,e ~ Lot no. _l1 Other homes on property? Yes_ No Previous owner of property Total size of property Total size of parcel " Date parcel was created Are all corners and lot lines identifiable? ~C Yes No Is this property being developed for (spec house)? .-1 Yes No Volume 190 and Page Number ly'l as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 67Je3.?3~Z , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. Signature of Applicant Co-Applicant - ~F' ! Y Date of Signature Date of Signature VOL 1201PACE144 550232 STATE BAR LANDWISCONSIN CONTRAFORM CT 11 - 1982 Individual and Corporate (TO BE USED FOR ALL TRANSACTIONS WHERE OVER DOCUMENT NO. $25,000 15 FINANCED AND IN OTHER NON-CONSUMER ACT TRANSACTIONS) REGISTER'S 0& i ii c Contract, by and between Vernon Waxon and Irene Waxon, ST. CROIX CO., W1 husband and wife- Reed for Record ("Vendor", 'OCT 1 1996 whether one or more) and William Harwell at 2:00 P. M ("Purchaser", whether one or more). -R Jd.l~, Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance Register o, Deady of this contract by. Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), in St. Croix County, State of Wisconsin: THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS KRISTINA OGLAND RANo FER Zi1z, Estreen & Ogland P.O. Box 359 Hudson., WI 54016 l 020-1309-10 PARCEL IDENTIFICATION NUMBER Lot 11, Pleasant View in the Town of Hudson. This is not homestead property. XsY, (is not) Purchaser agrees to purchase the Property and to pay to Vendor at place Vendor directs , the sum of $29 , 900.00 in the following manner: (a) $ 10, 000.00 at the execution of this Contract; and (b) the balance of $ 19,900. 00 , together with interest from date hereof on the balance outstanding from time to time at the rate of Seven Q%) percent per annum until paid in full, as follows: Principal and accrued interest due at time Purchaser constructs, completes and closes on the spec home he shall erect on the above described property. See Above Provided, however, the entire outstanding balance shall be paid in full on or before the Following any default in payment, interest shall accrue at the rate of % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably anticipated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be, deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. 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