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HomeMy WebLinkAbout006-1021-70-100/* .Wiscona~sn Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Builc~igs Division ~ ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes (Privacy Law, s,J5.04 (1)(m)]. CST BM EI ~~ . ~' I Insp. B (~v.~ , I ~ ~ r~p~0 J'O~L cff SCf.>~~l lW~'"~ 7~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic .~ (~ Dosing Aeration Holding TANK SETBACK INFORMATION. ,~-~~~ TANK TO P / L WELL BLD vent to Air Intake ROAD Septic 2 Z~/ ~ Z,` s r --- NA Dosing ~t tt t~ NA Aeration N Holding PUMP~IPHON INFORMATION Manufacturer ~b ~ Demand Model Number ~ Q GPM DH Lift ~.~(, Lriction x,51 System._.. TDH ~~.q~'Ft p • Fi Forcemain Length Dia. Z r` Dist. To Well SOIL ABS.QRPTION SYSTEM ELEVATION DATA CountySt. Croix Sanitary,P.ecR~it.Alo.: State PIS ~fJans ~ Il1l1DJJNoVb.: Parcel Ta~D1o1.021-70-100 STATION BS HI FS ELEV. Benchmark '~•$ S~ p 2 ~ ~ . ~ Bldg. Sewer ( ~o' yt d, O ~3 ~v ~ r St/Ht Inlet Ca f~~~ ~2•ocf r St/Ht Outlet Dt Inlet Dt Bottom . f r S~-9'f Header /Man. (o- 9 S $'; 90 ~ Dist. Pipe ~. 2~ A ~ / ,r, ~ Bot. System .S 9'`~. 30 r Final Grade ~ oa ~ $. ~ r t cover d~,evC racQ2. ~~- r" l a ~- I o'2.. I S~ A-ti-(r8~ ~~~ p.8q (l03.o IoZ •t~rr BE'D TREN Width - Length 1 N . Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N 3 (o~•~ Z DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING =~~~rer_s_ ~_ o SETBACK CUCs) T INFORMATION Type O r / ~ CHAMBER Mo a Number: System: oy~,g', ~s {- ~'/tx~ 7~-$ ---''~ OR UNIT i DISTRIBUTION SYSTEM ~~' ~-- Header /Manifold It Length Dia. Distribution Pipe(s) Le ~a. Spacing x Hole x Hole Vent To Air Intake i ~ 1qD 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 ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: (2 /~( /~ Inspection #2• -~--,`~ Location: 2347 County Road ,Deer Park WI 540~t~/4 NW 1/4 10 T31N R16W) - 103116138A -Lot 1 1.) Alt BM Description = y ~ 2.) Bldg sewer length = ~?~ G %~ -amount of cover = Plan revision'required? ^ Yes J$ No Use other si a f/~-or additio Info~m~tjgn._ 02 IZ o t ` ~ S~D~6 1~7~t'~((J'C~ ~~ (,--((~~// ~ C C ,~ Inspector's Signature Cert. No. ~-) ~~ cr,,,o-~ I~.Ma.~~reteQecQ ~--~ tip ,Q G1d~-~e d~n~ a.~~'~ $aII1taI'y PerIIllt APP11CSt1oII Safety & Buildings Division ~ In accord with Comm 83.21, Wis. Adm. Code t 201 W. Washington Ave. PO Box 7302 f `~~ ~ See reverse side for tnstructions for completing this application Madison, W[ 53707-7302 ~~~'S` ~epactmert of Carrunerae Personal information yon prtivt'Efe may be used for secondary purposes (Privacy Law, s. 15.Q4(Ixm)] (Submit completed form to county if not state owned. -- Attach com l ete lens to the coon co onl for the o r ss than 8 -lR x 11 inches in size. Count} State San~3ermit Number Chx ~ ~si.. ~ ~ on State Plan I. D. Number ~~ (K 5 lication Information -Please Print all Information ~_ ~ / •= I. A Location: Property Owner Name '~ ~ ~ r %f Y,, C' .Property Location /~ c _ fir ,-. 1r/ r ~ a ~') ` O U /t . ~ /4 /4 ~~ T ~ ,N, R~E or r ~~ s Mailing Address ne A t + Property Ow ~~ t umber Block Number /1 / ! !fV / /~ ~ ~r~~[~__rk ~ 1 ~ ( / r City, State Zip Code ,~irort~N '~~: F ~ ~r Subdivision Name or CSM Number ~ v. 9 II. Type of Building: (check one) ~ ..-'~ ~•"~-- ~---° ^ C'ty Village ^ ~ 1 or 2 Family Dwelling - No. of Bedrooms : nt ~ C TOWn of ^ public/Commercial (describe use):_ ^ State-0wned N Road f' _ ~y ~ ` '~ tK~S o`er Parcel T ~ ~~6 2 ~ 70 ~ /~ O III. T e of Permi : Check onl one box n line A. heck box on line B if a licable ~C~ •3 I !p. -38 ^ Addition to 6 p) 1. ^ New 2. ~ Replacement 3. ^ Replacement of 4. 5. . Existin S stem S stem S stem Tank Onl Permit Number Date Issued B) ^ A Sani Permit was reviousl issued N. Type of POWT System: (Check all that apply) ~ 1 ^ Non-pressurized In-ground ^ Mound [~ Sand Filter ^ Constructed Wetland ~ Pressurized In-ground , /~ ^ Holding Tank ^ Single Pass t Unit ^ Recirculatin T t bi ^ ~ bg ^ Drip Line ^ Other: rea men Aero c rttAC~. • ^ At- e 2 V. Dis ersallTreatm I. Design Flow (gpd) ent Area Information: 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Elevation / Requited Proposed Rate (GalsJday/sq. R) (Minlinch) Z C o~) ~ / ~ 9y. z 97, z So 4 , 7 3 s 3 VII. Tank Capacity in Total # of Manufacturer Prefab C Site Steel Fiber- Plastic lass Information on- g Gallons Gallons Tanks Con- Crete structed New Existing Tanks Tanks ^ ^ ^ ^ /000 /QOo ^ ^ ^ ^ ^ ~~ ~~ u VIII. esponsibility Statement I, the undersi ed, assume res onsibili for installation of the POWTS sho ched fans. Business Phone Number Plumbers Name (print) P s Signa ( tamps): /MP / ' 7 f~6s--6637 ~ / // ZZ/~ ~ iS , Pfumbet's Address (Street. Ci17+, State, Zip C e) j,~ ' ..~ SS~a a ~ s ~ ~ Q/~ G~ 37 z / Yo IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse S~chazge Fee) I D~ ~ ~ ~ Determination ,~ ~ X. Conditions of Approval /Reasons for Disap rove!: .. .„ .. .~ •, C~~ ~.~ ,,.. ,~V _ ~~ w-~~ w,c~..~,. aS. 't~~~Y~N s S1~.s JtJtcts-~ ~ Pa~lceQ. ~~ p ~~, ~rr 2 z / ~7 / ~~ ~ s fa r 3 e Nn ~~ ~-f~ ~i'~ 9y~ z .~--~- ~~ ~ ~ ~~ ~~ ~ ~ ~u~ ~ ~ ~/ Z ~- 00 x fit, r ~O jjrr++r ~ h! ,i 3S / ~ S C`~ ~ ~ ? S~~ ~~ ~~~ Wisconsin Department of Commerce Divisionof Satety artd Buildings SOIL EVALUATION REPORT Page ~ of U In accoroance wrtn uomm tsa, wls. ram-. woe ust Pl 11 i i i 8 1/2 h th n County ,~- rd x an ot less Attat~t complete site plan on paper an m nc es n s ze. indude, but not limited to: vertical and horizontal reference- percent slope, scale or dimensions, north arrow, a io ' t BM), direction and ce to nearest road. ~nc~ p~ l,p. ~ Q ` - ~ z ~ ' 7 t7 "" f~ ~ / -`-- Please print al o ron. ~~ ~',~ ~~ " \ Reviewed b y Date ~ Personal intorrnation you provide may be used f r dary r o~J~(Priv cy La~C, ~t'r~.04 (1) (m)). ~ S^ Property Owner - ~ Prgp rty Location Govt of NE 1/4I~W 1/4 S~Q T ~ ~ N R~~7 E (or~ Property Owner's Mailing Address ~ ~ ~ sT cwotx i ;~F Block # Subd. Name or CSM# r ~ °l~ j'/ /o ~~ 1 3517 .- City State Zp Code one tJF~IC€ ~ Ciry ^ Vllage ~ Town ~ Near st R~~ ~~ sy©~r :~ ~ ~ ~c > ^ New Construction Use: ^ Residential I NumberZtF• ~~ ~ Code derived design flow rate ySV GPD Replacement ^ Publi or commerdal -Describe: ~" f'anent rrtater~al ~° q ~/ Flc ~ Pl4in elavatior. if ~pplic=b!e General comments `2~, w ~ __ / / ~ 'Z and recommendations: ~""'"` ft. Boring # ^ Boring ^ Pit Ground surface elev.~7 7, Z ft. Depth to limiting factor~S Y in. Soil A lication Rate i C ti D i R d Texture Structure Consistence Boundary Roots GP D/ftt Horizon Depth in. Dom nant olor Munsell on ox escr p e Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 O- 7,~YR311 - sc ~d~i~ ~~~~ a ~~ • ~ ~ ~z ~u .,~ u ~ Boring # ^ Boring ^^~~ ~ 'S ~ ^ pit Ground surface elev.~~' ~ ft. Depth to limiting actor ~ in. Soil A ligtion Rate i H D th minant Color D Redox Description Texture Structure Consistence Boundary Roots GPD/fF zon or ep in. o Munself Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ ~-~ ~ ~ ~3 - s~ ~ az l,~ ~ , y , 2 -9Z .S' ~ ~ S L ~ 7 "Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' trnuent 3F'1 = tivu < su mgn_ ana i as ~ ~u ~~~y~ CST Name (Please Print) ignature CST Number Address Date Evaluation Conducted Telephone Number 3~Z /~d ~ s 1 d'~h~~e~' Gv1 -9'- 00 7ir.~68=~37 ,~~ ~; Property Owner r Parcel ID # Page ~_ of Boring # ^ Boring ^ pit Ground surface elev. 7 ~ ft. Depth to limiting factor in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ~---- 3~ ~~ ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fi? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 `Effluent #1 = 8OD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. L~7" ~. s fo i ~ ~ t~t21'~ ~ ~ ~S!z -~ rr• ~ ~ ~ f:~ l~G~ srJts~ c~a~ °~ ~~ ~,~~, ®~ ~ ~,c~C - ' - Lo ~ /, ~ 9 _- O r f 3g~ ~ G~ i «~ ~~~~ ;~~' T~cw a'a: ~o r,+A rJ~ sad. aanu ST CRX CO 20NIAiG =~PIJ/t~~ l~p,~f1 CROSS SCtTIOIJ ANG ~!'CCIF iCI. t'i0~15 `1~ C Vt'JT PIF'f ~ FR01"1 'JOOR, rill ;~W G1R F'FtCSH a:is I.ITAKE Y" MiW. Ga:AOE IV"K11J• IfU LC T # A a EL :.~..~.. FT. -^ .... ~` LJCATNE%tPRUOf' ~ diikL~Vi~G LO::K1t,1t'. ~ JUIJLTIOIJ 90X'~~ ~~ MAIJHOt~ c.O`rE-'. IL'MtU. C 0 ~ f ~~ i _. CpA1DUtT ~~ Y PRa~+ ~ c AlRTIGNT StAI. I * APPR4VE4 aoiwTS wtTk APPRpYED PIPE 3' OMTO SOLID SOIL E } 1 I I i f Lt MP -`` L=-.~.~ ~.. ~ COuICRCTt btOGK ill 002 j ~``~.. jl~ ~~I J ALARM pu oFr RIS£R CXI'r PCRM17TfC OiJL`J 1F TAIJK MAIJUF/~CTUii~Q HAS 5t1G1{ AP/ROYAL. PTIC f Q~~ a lr ~ ~ :~K~' MAUUFACrURILR: -_ _ bJL1Ml,ER OF DObES= PER D+~b T^i~K SIZC ~ ~~Q Q O /1L1.O1JS COSC VOIt~MC / yL~ i1 tCLURIAdG ~AGKF! OWE /7~ ~LON G1 ~~~11M MAfJUFACT1dR,f-R' , - - MOpSL Alt3MSER: _- UUL. -- v CAPACITIES: Aa27Y.5~lUCNES OR~.?/~ y/ GALI.<7-i aW~Ttaa TSP[' ~ a ~ _.IUCNES OR =...~ _„ W.LtOIa IMP MAWUFACTLlRCR: Z /1 ` G:/ 7'S~t~1GiiFS OR17~,, ~~ W-t.l.ol.- MoDCI IJL1MeCR: O~~INGHESOR 7z- GAtiO+. SWFTC H TliP[: ~ A10TE PUMP AAIO ALARM ARt TO pC MIAl114UM 0lSCMARGC RA ,,,,,,, . ~M INSi'AILEO OW SCPARATC CIRCUITS ;KTICl1L OIffLREIdCE dCTWLCU Ptllt'1P miR 11AID OtSTRiSUTI > OAI PIPE.. ~L~. Ff:>;•7 NIAJiPtLIM I.IE:TWORK StiPP1.J P R>r65t1R C . ~ _ _ `~ - S " ' FCtT TT // J 7 '~ , A S? ' /.~~ ,. F'EE7 OF i'O1tCC MAI1J Xa'~~ ~oor[FRiCT~ou VAt~'411-.~ F£C'f •-=~ TO7AL Ry1JAl"tIG FIiAD -- - F1LET 't'CRA7/1L O1MEiJStOAI~i ot< TAISK: 1_irtlCsTN. WIDTH ..-.....,..._._.r~LIQU1O pCP1'H ~_.,, i C.I`-EO: ._.__ .. ~1t.[1JSt: IJWMBER; DATE:.._.._._,.._ • FEB-29-OQ,TUE 03:4:? PM JN LRRSON r,r C /A ~~ ~. ~.,, •~ I i i 1 ±!". ~~ ~'~ ~~ ~, . ., ~~/ ` \ ' f LOW l•E R AAINtJTQ l0`>1. c~vnM~tNna+tav-t~MAlltft 11llUfA4AMIt0E W~fMING f GAtACRY '~ NtAO YNITSIMNN ~ M[T Mt1l11t t011t0 t!M 6 t.et ~ r~ tr•a 10 t1 Q4 ~ {S ?31 70 ~ !T •5 4f~ _ za s 40 os ~ ~s ~J,y~i~..,.._.. .._;Zz~ { J r `: ~ 'h 3746 t i .-~ ~~~ . .~ , `` . ! t s ~~` +,~ ' 1 . ! ..~ ~~ 4 A ;ir/0(i ! . ~ t,~:,,~: CONSL-~T FACTORY FOR SPECtAL APPI,~~. ~ T1QNg , • ~NstrlCN a1Nt'natoftl, for duplex syslerne, are ewiJebPO end VOrtabi8 !c+•:P+ s~~,t*, ~ s F,rr, .;vaitebft; fog conlrc~lltn9 ttingk- Wpplied vertth awl! Num. and three ~~~.rse ~~, ~- • MlehandcM •ltunst0ls, 10f dupts>< iyt11+3tTtA, are dvsi?able w'th goublt! K'i99VCa• k ~ ~ . "eve! fi0at lwitGflOS itl~ ~1vA11,~blct Of tAdfFlppf a111sfR1 lwitCllN. lnr variabitr levP ' r~ ,~ coretrois ~,,.,,~~~~~R10„~f~,_;_Wof,~ht .`!! lbs. • 'h M. P. . e sa.ar n _~„_ .r.Z ~• ~ 4 7 ... Epl ?~O 1 Non I l ? ~ ? JIr E ~ or 1 tl 5...~ ~..~..... ....,.~,.. ._. ~. ..r,... t +ntegtat ro.t, .~,»~oar . ? Suty'sp'9DYLatti vVa)Alr floAt Iwlrcn Rnr~• to r"M^ , 3 tVSChNnise, ~M••nar^. tlnst ~ytrRm •9rgGN+to• 4~(.i1K Cjul•w'. 1 two (2) nve J~Po~. !u~ ,+ t~~ c~wE • ' +t~ cel Iwr:eh, no OMterr>•tCOflStgt tOgti~r~C a t I,. arch Or tleul-le- pt00Y~'+~ rtu ktb10 klvrt,, C'f ' ~ ~' sec , ce' Alttl~,•RGtr. G-POk. ~:•' wa;B71rQ1 f CC'fnttt:}tOn Ot IY+IOd..~ .': ? =~~a: oun cr tpN~O -AJliv^k ICe11ti0t'4~bnOh00~IMNN~OtlwrpOd+danl~rto~blOpM~a-tO, aIOAtIMr.fMOSr~,PgpylUdk Att tn~tNi~ts ~ ,,, ,.~ ~ . ~ c ~F.~ies ae VMMIt614~MltNMI:Aq.OM~1'7;EItCYbNAkOmItOt,it~01N1~llcn/rotiMAfkrnatr,.,fM011t.eurrpr tlun~austncr,~,.rr- n„c,~.,; ,sa,.r Owlanp~houldMOmtt4rfatHlilhO MtIM,fIMpNt;m~d~trt PlIIM1RNhOttK y , Yc.t•6c4{+Wa~flOt401fGMI0di11Ct{iN1A~~11lIIi07lI i1~ pk PuTpCa~natr~ta,tnb ~t~RS -N^l9? roconrn~rrnr ~ ~,t . •;,~~, a~~t occurttrnral4afttrlMN/ISt(tArtfOltiA} RESERVE P0INERED DESIGN For unusual conditions s r~tsefve satrty factor ~' en~-neetbd ;~tG !np gar, ,,~ txv~ry I.oe+ler pcmt~. (SOl~ Ile.?/,7 t . f (I; k'+ i%R P; . ~.• /Q,•Ukg1' .~YAr4Y (~ ~ .T• .?a j O -~ J o~ v V ~ ~~ ~ ~ ~ b ~ ~~3 0°--~ _ ~-. . -~ d ,, ~ ------ ~ ~ ~ M ®" ~. _ ~ O ,~ _`~' N - - ~ v -~ a - -- 4i~o~ ~ ~ 1a~ (- G N / o~ ~"" ~„ V ,~e ~. Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Desian Specifications Sanitary Permit Number ~ b Number of Bedrooms Design Flow -Peak (gpd) Estimated Flow -Average (gpd) u~o Septic Tank Capacity (gal) Soil Absorption Component Size (ft2) -~ S i i Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) L Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance 5cneauie Septic Tank Inspect and/or service once every 3 years Outlet Fitter Inspect once a year and clean at least once every 3 years Soil.Absorption Component Inspect once every 3 years Seatic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease {nterceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the ., Management Plan for a Septic Tank and Soil Absorption Com}~onent~ ~ , filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or ofher treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absoration Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. -.The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ~. Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~/ i ~ \r, ~~ Mailing Address a 3 y ~ Cis ~d ~~ Property Address ~~ ~- /Q.,~ J~ ~/ ~~~~ (Verification required from Planning Deparhnent for new construction) ~q0 -l City/State Parcel Identification Number Ob6 - IoZI - ~ - I ~ LEGAL DESCRIPTION Property Location ~~ '/<, N~ %4, Sec. _~o , T ~ I N-R~W, Town of ~~~ Subdivision Lot # Certiified Survey Map # ~F}b `f~ `~ ,Volume `~ ,Page # ~ `FZ ~ Warranty Deed # ~~~ `~ S ,Volume 2-° Page # ~ ~ T Spec house ^ yes ^ no Lot lines identifiable ^ 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, journeymanplumber, restrictedplumberor a licensedpumperverifying that(1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property ~des~cribed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~d~~-1 ~ l SIGNATURE 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 v~:~ 929 FA~~ 10~ - ~ .- ~ ,,. I..I:, 1.t~ ,t.\~i\ I~U',..! ~.-198: LAND CONTRACT ~_ontract ~ :- i r,e~:~„: Kermit F. Thomp; ~n and. Gloria J Thompson, husband and wife, • . ; ,.. , :.,. .,., ; ,br; an_L -F~.t1iiS and Shaxon ri .. ~lcs., husband and wife, as survivorship marital pcapezty. ;~. ,: ,~: ~. .chrtidr ,~:,.• ,. ;:1~~, •.r.. ~ ' ~: .. : ~ .rr•...uu ..tors'.. ::., ;t`c,i Ct:r "1't ertp.. . st. Croix r'o°.~ntt, .le of i~.=r,r,,in REGISTER`S OFFICE ST- CR01X CO., WI Rec' 3 for Record ~. •~n i1:25 A. M N1 ite9hte- of Deeda Tax an el Su. Lot 1 of Certified Survey ~fap filed December ~, '.991 in V ume 9 of Certified Survey ::aps at -~^£e 242 Document i1o. ~+_76494; being located in t!.e tiEh of :IW1~, Section LO-31-1b, at. Croix: Coaaty, Wisconsin. is not ~~,.: their order t~.. <::, ,,: r 40 .000.00 . 10 , 000 .00 30.400.00 ,. 9 ~.. .. "'~'~'~`'~ ionthl~: na_.^^ents in the amount of $406.29 commencing with a pa,rr:ent on the lst day of July, 1991 and continuing on the Lst day cf each ,:ronth thereafter ,. ~ Lst June x.~20~90 • 12 gx:Xx.+~Xxxx~cx~:cx~xxxxltxxx~.~cxxxa~x~cxxxxxx~txxx~ ~xxxx:xxxxx ~xxxxxxxxxx :4xXXXxxXXxxxxxxx xXxxxxxxxxx?t:cXxxxbcaax~cxxxXXxxXXxXxxxxxXxxxxx~axxxkacxtxx7sx :4X3i?iaUCX xX XX?GX }f~:XXXX X xX z'xxx-x 3G?4X XR lcX?CXXX~+XX X `FR XXXh'Xx X`~4:4g X FcX}c'}G3e~c.{JC~:7'C}CXXX X`.~: X X~7iX X3E )EX?QiS~ X7S 7C x.~?GX?i X hhX X ~:i X 3CX 7Q}C }:'~GX XXX }C X76 7QG X~X?CXX X.7iX SG]GX?i.X:'4x k!X 5QX :{7GX`X J~XX X xX:ti &3~K X ~4 X K7CXX X JLXX X'?4B X?C'X X~EX~XXXX}iKX3fS~X3iXXX2CX~Q1~xYkYXR~X74X'iCl.~:XIC7Q3dXXXX'{?C~4._7{~C:iX~CXX~iX:~X~C:'.1CY.: '.~:::{X::ld?d'id t rn ~ ,. ..-, .,... Vendor si~rtl pay tine 1991 real estate taxes c•:hen die <-inci n;1:ab1e it i992. Purc't~aser shall be responsible For and pay all real esG~te taxES ti:ereater. Tl;is writter, ccrrtract ratifies .rnd ccrtfi>:-ns an oral ccmtract entered into ;et~;e.r: Vendor and ~lrci~~rser on .7i~ne 1 1991. date he: eo[ :,~:., V~~ 9?9 ~ ~~s 105 ` Purchaser pn,mises.to ty when due aU taxes and a~nensmentr levied on the Property ur upon Vendor's interest to it and to deliver to Vendor tin drmaral receipts shoR-ing such pa, went. 1't:mha,er nLat! ke•.•p the uupmvcments on the Property ut~un•d against loss or damage occasioned by flee, as- tcnded cuvrraga y:er,L~ and such otl.er hrtzards +s Vendor may n•yu,rc, wit!tuct co-insurance, through insurers approved I,y Ven,lur, in the s~.m uf}~Lfllll ].T1Sllr3b~..e Valt.te ,but Ver•!ur shall not require coverage in an amount more than t:,e balance uwrl under this t'uniract. Purchn~r•r sl,al! p,,y the :n,urunce premiums when due. 'fhe policies shall ruuL..n t. .t.,l:::.rv! ~ la,x,- u, savor ..f t'r,c Veodor'.~ ,terr'st ac„+, u,,!;ss ~'endur othrrAi-e agrees in writing, the original of all l.o'.':'~•ua r•,trn:.f_' the 1'ru,,erty sh:aJl bu dcirosited with 1'rnd;.r. 1'ur~.rhaser shall prom,tl}' give notice of loss to in~uru:.r c•~,r.ha~:,es :,r,d \'rt•dur t'nless Pun':aver atad Vend+;r .,Cl.,•r•.ciar• agcee in writing, insurance proceeds shall be apl,l:ed t„ n~- r"ruh„n ur r,•pa~:r of the i'ruperty d:unay;ed, prot~u!cu tLe Vendor deep :the restoration or repair to be erum,tnicail~. :cas~t.ie. f'cn-r,a.;er ,•,~,n.,nt, n„t to cnnunlt u•r;te u~r al'•,u• w;rste t„ i,e ~,,mn+,tted on the Prc,pert~, to keep the Property rn •~.1 tcr,xnt;,hie cundunln and n~+air, t<, keep the 1'rupert~~ !r.'e Cr.rn bens superior to the lien of this t'ontract, and G, .,,n:;•ly tt tth aii iaw,, orct.aanees and rey;ulatiuns aff•ecUng ti.e !'r~l r. rt}~. 1'.~~dnr agra•, ti.at ru , a._ the purcilare prise w,th interest and otiur moneys shall be fully paid and ail conditions .hall be tuliy l~rrtr,rn.ed at we ~uues and in the ntan~cr abut~c .;pecttivd. A'enuor will on lemand, execute and deliver to u,e t'u- '.a.,er, :. 1i'arrunty Deed, to Cee sunpic, of tl.e Yropo;-t}, ime and clear ui all 11~~ens ana encyymbran ea, except :u,; I,•rr~;, or er,. :: ftrxr,ce, cnatrti y the fact , defa.:! of ;'nrchaer. and except: T111n1Clpal an~ - _ --- zoning ordinances o record`, and recor~ted easements, restrictions-_..---- _.. __ and reservations. .- - •----- r .r.r ,- ._r , ,_ ,,; rr,• .-c~,.t al°~1 cal in it .•. .i :r default in the p:,,n.t•ttof tiny' principal or rltcr ~-t .~ r. ,, t . nn• r u., n• e c•er -;1 ,,. 3U d.t: ; f,~IL.-.~ Ins; t,~t• apt., :tit•d our date or Ibj i n the event of a default in 30 ilerf•~r^ an•-, ~~! en} :,I:,~c,ri.,r...F I'~,rcha~cr tcluc.. contu:uo, f,~t <, •,eriod of. - dag ~ ~ ,,:raving written notice rj:• n~ ,. A' i.:r , ~.•~t • , rt,+. y~. 1. liy~ „r +r.a+le.! he eertitie•d urti!,, then :~e entire nut~tandtr.~ ba!~u,te .ruler this contract -,;' ,.. .. _,:., :c:,ly :, I~ucaRir ~n full, rat A-cr.,l,.r', „I:tln, ..r:d ta,thoa notice I •.thnch Purchuser hereby ~.., , .. .., : t":: ~r ~,I „ I~.,c+• tl..• •'!~rn:n~ rig-l;b u,.~i „~~~ :ll, , I-:.Li.,~r to unc Iim:G, • ::. l,rocided by lau•) in ., ... .. .. .. I,., 1 i. : t,•. ., •,c ..r : •u,r, : Ili A'en,l, r ~ :., c, at fl .n., t,~rmir,:tte tt:i> . ~ ~ ~ r t::tr~rrt and Purchaser's ti°•~ ('r~i~ rr.. 1, t ~ ,,_ -, in rlcl. - an:i r, .:. ,r .-, I'I,;,rtc ., tir.l~ly;h <tnct turc~~ '•,-, re tt~lth unv equity of I ~.. k , .: ~ ..,u" r`- :III 1 -, ,. . ,:a! nndiuy~ hafan.,• , t ., , rest therec,t•. tmm , ~ • , ;, ,: , ., . , , ,.u <.: ,... ,, d .n,,,..i,t. . , her<,:ndet . in wl.iche auu,::rats p. ~riously r:t.,! I ,~ ... , ~ f , r .. k.. ~ - ., i;,il t, i +n _ - r ~,:, t„ `ultill this Cuntt .:+t and a- rental 1'nr the r 1 • .'n l,orforluunre i':~ r r.~, ,,r I It A,: t - ,, t'~::< r, •,t.:,c[ to compel r ,.- ~_:, , :,t ., ro .+t , Ir ~ h_,I ._ +~; ..... tt .. .,n alt tnr ra: ~ o• t. ,~t the date of !~ ., ,L: - !, '•r ,- ,~t, l,. I'r, n~. h, auctioned xt ~ ~• ~ .;,I . •,, .,ud Purchaser ~-r r' . , rt~rc un,uri,l p u rc .. ~ .:,f ' ~, .r , u I A'. i r ~,t . , c r:a -~~n : ,: ,~ !:r., ..r nnp p~,rtion try-, l~. ~ ., ~'. _ ,~ r:.r.tt:,,' :.t :,n ! :u::l n. 'r~:. t',tt+trac. sart~ ~ • ._... in a ~tuirt-title . ~ I ~ ~ !•~ r:f-.~r - ,n..~~ul ,. :,n,l ,t r A ,,.•r n,a~ have h'~;ri•• ., from pl,,,ession r . i'r: ~ .. ~ .,; a c- ! ,t -,r_, _. :r Lrotits dnrin~ .. r.r_ of arc action :-, 1. :. . ! _ ., ,~ u,~et, or act. ~n- ~ A, ,r, .. r•!,•rtion ,f any ...' .. _ ~ - , . .n!~. ' A .,. l :. ,d in lit_at~ r '! „ .and expenses ~\ 1, - \ _ :I .,r, I ere:nd~r ro; ~ ,l .t,•d ,r rot) to the - . , ! ~ , . ! - .. .. ~ to pr:nr psi , r `i t ,l h~ !' rrtt ~,I user, as in- : ,.. J t~ t: , ndr:~~y n~ a^ .,. ,,, ,r•~co-ore of tiny r . ~ .. .. Yurct:aser consents F'r ~crtt, ;!u,:.n~ _. ... ..~•r~;t, to coll,•ct t ,E~ ^ . :, ~.rr cr t e , ~..<? and Profits of F rt. .. _ , .,. ..,•%, r. u,d :ci .. ~! profits n-hen ^.c ,il;•cted st.sll be held and . ,+, !' - _~,-r. ,:. :,t~ :u. .,.! •,,~1`t,,i; cterest in the Pr~l, ;~~ Ib~- a.~~gnment of any , f f , . , t ~ I,' _-', r•^ r :;; ar.p other tea. , tt`'h a the prior ~critten • .. ,' . r •. ,t r_„ntract .ir, ... ± :n .!I nr the interest .r - - t ~nct s !cl~ ,r; >, „r ,tit indebtedness of , ~ .. ~ . !nr' trri*_!?n ~ •-mire outstanding , .. . ,, n full, rat \", ,: .:~ n tcithout notice. ~ _.. :mli a ~ .. t'' :,~.. I,n the date of ' :, ,r. , . ~ ,~ ~e <e <c Pr: Bided Purchaser .. .. I~ ~ : ma•; n t;•.,• ., ::c-rats diretrtly to .. ~ ~ ~ ~ •~ sha!' ~ i ,,,:cents made nn \^ - .. ! _ .t.,,^ ..,,i -:are, to ' e hcnefits of +,hN ~ • eirr•. !eFal representatives, >_-r, ., t' ;ant an ..,~rrr ~~` the Frnnertp the sec= -- - ~ e ~' V'e~dor `,or a valua5le '-,._ the :h c•ct f r,,.•er*~: and agrees to , . ~r, tt a execution of the ,ie..! • ~ - . • .•... ~ • .. 30th December ,;s 91. .; . _ ~~-~ ~ :~~tc ~ -~ _~-~~-~ij~z-T'l ~ : / }: ~ Kermit F. Thompson ~~-/~ Gloria J. Thompson S rlrti _,ert D. Petersen, ,'.tt~rne. .rt L,:rw C ie<tr :.;il:e , hall ~ +OJ ~ ~ t~EALI Brian C. Fouks Sharon c~ . Fouks ACHNOVt'i.EDGMENT Polk ! ~`' ~~1i~~~ -~ :;e 1.,.. ~~_ ~ r,.,, 30th_...day of ~eC2rnDer~~ ,, g~ the above named Kermit F, Thompson and..G.lori.a.- J. Thompson, and Brian- C,-_._ __-.__- Fouks and Sharon ~i . Fouks, fig' •.cl.,, ececcted tt~ >:!'7.^ ':r.~"~`~ ..:.ail, ~,j -..:ws. cnt~?p, ~~- +~ 1 " +~ ~~ Bert D..,pol~rsen t. C'ountc. R a, ,.1, ._ .. ~ ~ .. <ta:,~ esr:rntion . lA .l i ~~. ., v CERTIFIED SURVEY MAP Located in part of the NE~a of the NW'ya of Section 10, T31i~, R16W, Town of Cylon, St. Croix County, Wisconsin. NN Corner of Section 10 ~, j~ N90°00'00"W ~ ~`- 2213.22' ~ LEGEND Aluminum County Section Monument Found 0 1" x 24" Iron Pipe Set, Neighing 1.66 lbs. per linear foot. •••••••••••••••• Roadway Setback Line ~ Cal ZI QI Cal F~-I I--I ¢I or SCALE IN FEET 0 30 60 120 ~,Y" , , C ' ~ i~~ Q ~ o ~~o'~ J v ~~ 1, ~' o ~ ,t r ~~ ~d ~~ c ~, z ~.'. 5 .~ , :-, ~, ., i ~ ;~ ?: ~ a `" f ~~~ ~.~ '. 2 G~ ~ ,~•~e},' 4 EI UNP~ATT~~ LA~~S North line of the NN>t of Section Al - M N90°00' 00"W 305.73' `" N90°00'00"N :, 10.00' C T H r1Hr~ m o N} Corner of ,,: M m Sectionl0 ~. ;N90°00'00"N 305 73' ° 3 . d v o ~ ~ d- O N O ~., o wo 10 v o 0 - r'I ~ > ~ v-tra lD c .-~ V7 C/N c z w z t ~ ~ ~ r a N d' " ~ I rn QI ~ ~ 4. M LOT1 o °° ~ ,. " ......._ ........................... .. .......... House ...... 1.69 Acres Including R/N• N •••••••• • W ~ Ai , d m t ^ ~+~ ~ 740 Sq. Ft. 13 ~ H '~ ~ i° , ,,~ I o We~~ 1.46 Acres Excluding R/N ~ ~ m '~ ~ ~ 651 S Ft 63 M ~ ~ q. , . M o ~, ~ Septic Vents o OWNER o z N Kermit Thompson N88°00'26"E 306.21' ~~Q~ATT~~ ~AN~~ Tiis instrument drafted by Brennan J. Coz Proj. No. 91-24 ~~ wetland~q ,v l~ 1u ,, ~ 2336 235th St. .4. ~Dter.'FDrr1c. NI ~ ~~~ n~, ~ ~ ~ .~, J Sd• ~~~~t C x ~~rh,~ ;~ a~ `~` ~~ a `~ n ix' ~U~3ill"~~ ~~' ~J:S, i ~ F ~~. 1~J ` pys '1 ,~~ ; N N W sC a rn ~a 0 7