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HomeMy WebLinkAbout016-1022-20-000o Nv ~ d N a N ti C a O N 0 '~ r •~ N }~ y .~ V • ~~ V t'I~i t C O W ~"r FBI e~ w .~ c~ a~i A V I C ' 7 LL 3 3 ° v _ ~ z ~ w c v~ •" o z w am °~~ c t9 ~ o z H r N N 0 otS a N a a in ~ U 0 °o c ° m o N ^ ~ N ~ O N ° ° C ~ O ~ o .- C~ ~ a ~ ~, u 3 v a ~ Y C M H O ~ V' .c ~ ~ _ O Q Q ~ = z z U aci v R E °o ~ _ R _ d c Q. ~ +`-' N H N ~ ~ o o a N > O O O Q a a a N °N ~ N rn o 0 d 'a - ~ ~ u~i c O N C (h Fes- ~ O :.. ~ ~' a a ~ c °~' c O to U a~i o 3 0 O ~ m c O O ~ ~ O ° ~ O N C~ Nt ~' N d. 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Department of Commerce PRIVATE SEWAGE SYSTEM Safety ~-,aid Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Townshi of Glenwood Glenwood, Town of .ST BM Elev: Insp. BM Elev: BM Description: ^ ,_ e CI~ . 6 I QD: b ~~ V~ Govt-c~u~sl (,~'-dC'~t 'ANK INFORMATION ELEVATION TA TYPE MANUFACTURER CAPACITY Septic Dosing Aeratio Holding ~ J? jjD ~ TANK TO P~' / i~f . ~~ WELD ~ BLDG. Vent~r ~ntake ROAD eptic ~~f 7 ' Dos g ration 1 Holding \ ~ ~ f •."~/e~~11~~A-1 ~~IrAPf 11IATIA\1 rulvlri~lrnvl~ u~rvr~irrr~i rvr~ Manufacturer Demand GPM Model Number TDH Lift Friction Lo System Head TDH Ft Forcemain Lengt Dia. Dist. to Well J( TANK SETBACK INFORMA ON C(lll ARSl1RDTlt!~N SYSTEM County: St. Croix Sanitary Permit No: 506325 0 State Plan ID No: Parcel Tax No: 016-1022-20-000 Section/Town/Range/Map No: 10.30.15.1726 STATION BS HI FS ELEV. Benchmark yS . o Z,p~ ~~2. ~ /~a~ v Alt. BM ~ - ~ .~ y i~ a: 5~ Bld .Sewer jjZ ~ ~ _ Va1-f 6 n'T s /_ ` f KL / , ~ ' ~ S ~ o ~ - S~3 SUHt Inlet / . /v G ~ Q / t Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover -E 7.Z ~ ~rs -' I S~vS. BED/TRENCH Width th No. Of Tre s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO / BLDG WELL LAKE/STREAM LEACHING Manufacturer: CHAMBER OR INFORMATION Type Of System: UNIT Model Number: f11CTRIRI ITICIN SYSTEM Header/Manifold Distribute x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Spacing C(lll (_f1VFR ., o~«...e~..~ie.,,~ nnr., ,r.r IUn~in11 (lr D1_r~rada Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ' No ~qj Yes ~:' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:1~/ {-(~ Inspection #2: / /_ Location: 3099 160th Avenue Glenwpoo~[dj~ City, WI 54013 (SE 1/4 SE 1/4 10.~(~T~3-0(~N~R15W) metes & bound L Parcel No: 10.30.15.1726 1.) Alt BM Description = `"~°~ - C~'C `~ ~ ~ ~" ~~ - - 2.) Bldg sewer length = ~~ r -'r~,_ ~.~ ~~~ / n d ~ ~,/ n _ G - amount of cover = ~ ~ ~ri ^~. ~~~~ 'r~-(~y.,.l~ ~ C ~~1 ~'p 7t •~ ~XJt Plan revision Required? ~ :;~] Yes ~o ~ ~> -Z (~ .7 G~'~~~h.~C-G. ~ Use other side for additional information. Date Insepctor's Sig ature SBD-6710 (R.3/97) ~~ t~ Cert. No CQITIITt@fGG.W1.gOY Safety and Buildings Division County ~ « 201 W. Washington Ave., P.O. Box 7162 ,S ~~ n Q ~ n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Departmertt of Commerce ~b ~ 3 ~ S Sanitary Permit Application ransactionNumber Stater In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission oti this form to the appropriate governmet / / ~ ~/ unit is required prior to obtaining a sanitary permit. Note: Application f - are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you pt vide n~ dary u uses in accordance with the Privac Law, s. 15.04(I)(m), Stats. 30 ~ O RYE /1 L A lication Information -Please Print All Information Property Owner's Name CEP J arcel # s-wi/5'i~T ` ~~,t/cd o o ~ ©/'(a - /62 2 - 2 v - GYM w Mailing Address P r operty O ne t's ST. operty Location /~ / ~~ ~ , , ~ / d / O'I~i/l1 C.L~Q,K ~/~Ly~f"{~7'14 ~TSS t r . / Govt. Lot l/ J City, State Zip Code Phone Number S ~' y,, S~ ~/<, Section ~ ~ G LE/V era ~ Y'`t ty 54G ~ 3 ~ ~ S - 2~o S ~ 4352 T •~0 N; R ~ ~circlE oi~}~(J Il. Type of Building (check all that apply) Lot # n 1 or 2 Family Dwelling - Number of Bedrooms ~ Subdivision Name _ jj k # Bl ~ ~~ bt~ r ~~ oc > '~ Public/C ommercial -Describe Use /O~~ u S dt~ . ~ ~~~ ) L ^ Ciry of ^ State Owned -Describe Use CSM Number /G /t ~ / / ~ ~ ~O -~ L' ~Gp ^ Village of Town of ~~W (Il. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' New S stem y ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ 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 Owner IV. T e of POWTS S stem/Com onent/Device: Check all that a 1 sur'zed 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) sal/I'reatment Area information: Design Flow (gpd) Design Soil Application Rate(gpdst) ~~- Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation ~--~_ Vl. Tank Info Capacity in Total # of Manufacturer c Gallons Gallons Units ~ ?? N T k E i i T ~ c ~ ~ ~ A ew an s x st ng anks a. U ~ v~ ~ Y ~ w C7 P. Sep[ic or Holding Tank ~ ~ ~ 6 ~~ ~~ f<S ~rd G~t, I~ Dosing Chamber i VII. Responsibility Statement- [, the undersig d, assume responsibility for i [allation of the POWTS shown on the attached plans. Plumbers Name (Print) PI tier's Si ore MP/MPRS Number Business Phone Number ,~~/.I. lNy~.~s 2!v?~85 ?~s-<4~-25zd Plumber's Address (Street, City, State, Zip Code) p~~ a ~ « s a VllI. nt /De artment Use Onl Approved ^ Disapproved Permit Fee U L $ .~ Date ssued ~~,y ~ ~ ssuing Agent gnatur ^ Owner Given Reason for Denial ~ ~~ IX. Conditions of Approval/Reasons for Disapproval ,~~// ~ / // SYSTEM OWNER: ~-l ~~a~~- ~~~~ Gtit'~~ ~ ~~ v 4 ~+L ~/~~` ~ G~L2Q~ j• ~ ~-~ II Wis.-all be serviced /maintained dispersal ~~ ~'S P c it./ as per management plan provided by plumber. 1. HII SOIbaCK reClUlreAlU~l4tc~ l`1t1t118>itp~al~tg$If111816~8~~n and submit to the County only on pa`er not less tnan x uz x t r mcnes sae U as per applicable code/ordinances. jM ' ~ SBD-6398 (R. 01/07) Valid thru OI/09 i ~, ~~$ ~-- --- 04~ S ~ ~~ ~ 4 ~~~ 5 ~~ J r,, o ~.~ ~e ~- ,-~- =w p7~ - _ 3 moo m~~ _. _. N;L1, a~ K '~ I f~^~ S P`~~ u L~, ~ ~ - - -~ I1ti o w~2 ' J ;~ ~z SE'~~ SE`/.¢ S Io T3o J~( ~i~5 "`~' SCgt,E l •. = ,4~, ~~--~.~ .lit-0 r-~.~ 2 (~'? ~ 8 5 -~ a l Parcel #: 016-1022-20-000 Q9/13I2007 11:28 AM PAGE 1 OF 1 Alt. Parcel #: 10.30.15.1728 016 -TOWN OF GLENWOOD 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 -TOWN OF GLENWOOD, TOWN HALL TOWN HALL TOWN OF GLENWOOD 3099 160TH AVE GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 3099 160TH AVE SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 1.000 Plat: N/A-NOT AVAILABLE SEC 10 T30N R15W 1 ACRE E COR SE SE TOWN Block/Condo Bldg: HALL Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-30N-15W Notes: Parcel Hjstor~r:-..,;-~-----~'"""~~~--~~~-`"" ~~. ~\ . Doc # Vol/Page - . e Type ~ /V d C~~~ ~ ) ~./ ~nm cl IMMARV Bill #: Fair Market Value: Assessed with: - - - - - ------- -- - - 0 Valuations: Last Changed: 09/08/1988 Description Class Acres Land Improve Total State Reason OTHER X4 0.001 0 0 0 NO Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 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 commerce.wi.gov ~ ~ . iscon~~n Department of Gommer~e Safety and Buildings 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188 -3789 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary September O5, 2007 CUST ID No. 267985 MICHAEL J MYERS NORTHLAND PLUMBING INC E1556 STATE RD 64 BOYCEVILLE WI 54725 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/05/2009 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Glenwood Township Shop Building 3099 160TH St Town of Glenwood St Croix County FOR: Identification Numbers Transaction ID No. ]436]31 Site ID No. 729877 Please refer to both identification numbers, above, in all corres ondence with the a enc . Description: Holding Tank for One Employee Object Type: POWTS Component Manual Regulated Object ID No.: 1150358 Maintenance required; 3 GPD Estimated Flow rate; System(s): Holding Tank Component Manual, SBD-10571-P (R.6/99); Commercial System The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 'This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD-10571-P (R.6/99). In the event this holding tank system or any of its component parts malfunctions so as to create a health hazard; the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VI of the holding tank component manual are complied with. A copy of this information must be given to the owner upon completion of the project. ' `: ^n _ ,~ The proposed tank may be located in an area subjected to saturated conditions. If it is determined to be subj~cito saturated soils at time of installation it must be anchored per Comm. 83.43(S)(g), Wis. Adm. Code tb,pr~Yent floatation of the tank. Documentation of the method of anchoring and calculations to prevent floatation itre to be attached to the plan prior to issuing of the sanitary permit. ~- , ~:. ''`~ All holding/treatment tanks are to comply with Comm. 84.25(7)(a). ~, ~\ '~r A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. MICHAEL J MYERS Page 2 9/5/2007 Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction instal lation/operation. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the components} utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Si rely, Julia Lewis-Osborne POWTS Reviewer 2 ,Integrated Services (262) 397-6005, Fax: (608) 283-7481 j ulia.lewis@wisconsin.gov Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 WiSfviART code: 7633 Holding Tan Cover Page Page 1 of 5 Project Name: Glenwood Township- Shop Building Owner's Name Glenwood Township Owners Address 3099 160th Ave Glenwood Ciry, WI 54013 Legal Description se I • %4, % sE 'I • /, Sec 10 T 30 N, R 15 I w Township Glenwood County Saint Croix L --- Subdivision Lot# Parcel I D# Table of Contents P9 1 Cover page 2 Calculations and Drawings 3 Management and Contingency Plan 4 Plot Map 5 Holding Tank Agreement total # of pages: 5 Designer Name: Michael J. Myers License #: 267985 Date: 8/28/2007 Ph. #: 715-64 -2520 Signature: ~~= ~j e Design Methods Used HOLDING TANK COMPONENT MANUAL FOR PRIVATE ONSITE WASTEWATER TREATMENT SYSTEMS" (Version 1.0) SBD-10571-P (R.6/99) ~~ ~ '~~~ :;~, Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: 3ba(d~3badvisefnent`com . ` .. ~-_ Page 2 Calculations and Drawings Site Conditions Site Type:l Commercial D ____ ---- Estimated Daily Flow GPD Minimum Tank Volume: 2000 Gallons Tank Volume Chosen: 3000 Gallons Holding Tank Manufacturer: Wieser Concrete Depth of Tank From Bottom to Inlet: 48 Inches Cross Section of Holding Tank Vent Cover with warning label and lock if access is greater V~fatertight than 8" diameter. Junction Box ~12" Min ~„ Ml n Alarm Float Maximum alarm on level set at 12" below tank inlet invert or 90°l0 of the liquid capacity of the tank below the tank inlet invert. Building Sewer 3" Bedding Under Tank Page 3 of 5 Holding Tank Management Plan pursuant to comm 83.54 W. A. C. Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component, locking device, alarm system, and access. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, failed components, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department as required by s. Comm 83.55(1) WAC. Holding Tank: Holding tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. When tank is pumped (at or before the alarm sounds) tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. Holding tank should be routinely inspected to be watertight and of good repair. Performance Expectations: The holding tank must be serviced by Icensed pumpers. An alarm system is installed to activate when the tank is less than or equal to 90% full. At the time of servicing, the service provider files a report with the department or designated agent. Contingency Plan: If the holding tank or other components therein (including floats, alarms, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If repairs are not feasible, a new system is to be constructed. HOLDING TANK SERVICING CONTRACT Contract Date 9 -- / G - v This contract is made between the \ ---------------P-------------------------'---- Holding Tank Owner(s) Name(s) and i Pum ers Name I //~~ I CT LFit/W'~ ~ptv.v ~'}(-~~ ~ J e E 1?~rzC-~~S We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptions:) sE /4 SL~,l~. S/o T~o,/ R/S ccJ 7`vu~ Uf" ~~.c/Gus~ s~ P,eo-<~. ~.~ry ., 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Ch. ILNR 83.18(4) (b), Wis. Adm. Code and with the County of 8T~ eR.b~aC 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local govemmental unit which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local govemmental unit and the County named above within ten (10) business days from the date of change to this service contract. owner(s) Name(s) (Print) G~e-I'1(.UOc~i 7Jrc~Yt~ ~~ Name (Print) Pumpers Registration Number ~~ a. ~ ~ Owners Signature(s) I 1 I i /J i ~~ ~.~ , I U I I I ~~. - i Pumpers Signature I I 4~:3~~ ~~ ~/~ l~ " -" Drafted by dj'lf' #-~lv ? 9~S Subscribed and sworn to me on this date: ~l-~ o- a~o~' Commission Expiration ~ Julie A. Stansbury mac.. Notary Public State of Wisconsin ~-in- o~ Todays Date Notary Public Slgnatu~ _ 06/1 B/2007 E12: 10 7152657502 LOFTY 4CRES _ _PA_ Gc 02 ~---f I - i _ t~ ~ t t~z~ ;.~.~. p i t I ~ ~.: ~ 1 ~~ _1_-J"r --, y I ~-' I .. j~; ~_-~. I _ ~i.--.;--' i ~ 4 l i II ~..`~j7.~•~ r~t~..l ~~ ~~, I 1 .I " I ' I 1 i ~ Y 1_ I I f _i -. ~y,~ _.r-- i ~ ~ , t- ~ I I i ~, 1~ ~ i ~~ T~i ~~~ .t ~~ _~.;.~ _ ~f ..~--~-.--I .. I i ` j,_._. I _ i ~--'--L---~ I ~ I~ - }~` i ~ + I I I .{ ~~ ice. '~ 1jI,~ ~ I i ! ..~. .~~...~.;._...r-;, !, -'; -~-- ~ •__._~.;:.".r ~.._.. jam' ., l I ~ ! -'- i .~ ~ ~--~--~--- ~~~ _1 i , ~ . i ~- -r--1 w • + ! i l ~ I £t _,~__ ,.......L.~..I~.~ ..._ ~ -__-__~_~- X I ' ~~ ~ ~ ~ ~ I i~ i ~ ~_ _ ~~ _1_ ~~I--, -I--~.__~ ~_ -~---=- `t- " i J_~..~..-~~.._ Ipy ._, ._ ~r ~ -~~ f ~..._ ~ i ~--~- I ~ .I _.t,_.. ~ I r.4 1 ~ ~ i ~ I f ~ l ~ .1~ _,.. ~~_~ ~~-_ j ..~._-~._ .....~~ { ~~ ~ ,~ ~ i ~ I E ! I' ~ I ~~-.~ I ~I ! i ~ l ( ~, i `IMF _ -• j~ ~ I -I. ~7W j j ~ ~ ^ I ~! ! i, I I f_` II ! j ( I -- I _-...I {•~ I i ~ ! ~I i 1 i St. Croix County Holding Tank Agreement State Plan Transaction Number - -/~~-u,~-ao~ Name - (O ner) Typed or printed Being duly sworn, states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume /~~ Page ~ Document Number ~ St. Croix County Register of Deeds Office: ~~''~~Uj /~1~~ A parcel of land located in the SE '/4 of theSt 1/4 of Section _!~ , T 3 d N- R i S W, Town of /fiyi ~.U-a o ~ , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal d scri tion): ~ ~t.~,,~ _ ~~'ro ~~-2/ ~~ ~~~ ~Tt~n ~~ ~o ~ ~ Agreement Date: ~~- ~~~ J ~~~/ 9/D ~ 'ecording Area Name and Return Address Parcel Identification Number (PIN) We acknowledge that application is being made for the installation of (a) holding tank(s) on the above described property or that continued use of the exist+ttg premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, a municipal sewer cannot now serve the property, or any other type of private onsite wastewater treatment system as permitted under Comm 83, Wis. Admin. Code, or § Ch. 145, Wis. Stats. 'As an inducement to the county to issue a sanitary permit for the above-described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Comm 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stats., the governmental unit (Town) may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.0703, Stats. 2. The owner agrees, pursuant to Comm 83.54(2) and Comm 82.40(3)(e), Wis. Adm. Code, to have a water meter installed in the structure. The water meter shall be installed by a plumber authorized by the Department of Commerce to make such installations, wish said installation complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit or the Department of Commerce to enter the above-described property on a regular basis to read and/or inspect the water meter. 3. Owner agrees to pay all charges and costs incurred by the governmental unit or county for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The govemmental unit shall notify the owner of any costs that shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of anew service contract, with the governmenta- unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that either a municipal sewer or a private onsite wastewater treatment system that complies with Comm 83, Wis. Adm. Code serves the property. in addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shah submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner that will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) -Please Print Subscribed and sworn to before me on this date: Notarized Owner's Signature(s) Notary Public 8!. Croix County Moldla~ Tank A~~ana~t tat+a PE~n 7rant~,~ kurnber • ~~, I~stne -- (Owner) Typed or pr~atet! Hai. doh, rvrora, estates, tnu;rr oat~t, that: 1111111 Illll 11111 !IIII IIIII IIIiI III! III111 IIII IIII 862727 KATHLEEN N. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 10/19/2007 03:lOPM HOLDING TANK AGREEMENT EXEMPT w REC FEE: 11.00 PAGES: 1 1, biorshe is She ewnerfptslt ow:trer of the tbllowtag pt,rcul of land Located 'th 5t. t:.saix County, Wiscondu, retarded i~) Vo;~u»u S PaSe ~ Z Dacumerst: waemb~ry~ St~C ~ ~ Co t~JStar~~ea ctPDttrttlds ©!'!'iaa,: >i'/~ lJlo A parcai rwf land laasttsd in tlta St tl. of the SFY+ og Su.tir~a a"a n' a C%~K- ~.r_. 7" o RJ - R ~_ W , Town of Cam[-~=NU/aa ~ ~T~u~ /o iyss Gry- ~'a X Gc.e , St, Croix County, Wiraan:l':lt, boiuS ~:;v~,~,u,~ C,n rci~ S y~/ ~ duly described as fs>'llow~ (inaludo lot tto. Lead bubdivibi,:><vC':1M or dtrcailed i~gai ddOCY1pt10ri): / LI-c,eE E. Co.~ ~~ %y S~% b!4- 022.2• - ooc~/6-o-/~ ( ,p ° rroa' JT f j AeIrrIMrM ilsta; ~ vj0 ~ ~ ~ ROGC-s (~t,~t 6(( Z~ ~ G~ ~Q~ /LC~G`-w ~~Yi-,~'' '.1N+rtaitrgwNorgr rf:at aparraadon to oainp r•+aeN tprth+ (natarlafion qt {a; 'reittr.a wnk(a) en d;+ abtivr ~rr~rfc:ao at:p+rry ar tnst eontrn~gE uQa er tns sy9sa'p~ppQ ptamnlM 7{Q~rlrq tart ^ h01~irgs .arN bs JMtalNd or kM prppany for t'+• t~UrtlO~a Ot pti7pe' gOn'•aI~Tlnt qt ssWaps~ Atae. a /nunierpt;l qwv' ~rYlbtrWw :arw rna propa+ty, w sty etrw type of presets ona~ta wsstawsts~ :reu!~nrns syatrrn rr psrn+MSas urktrr Cemrn r3. Yvro. Acmrn. Cods. or ~ ~ ch, tlb. Wll; itala "itta, ~~ fnduoama~nt hf ffla OO:Inb to trot! s sanMary prmtt itn itnl abava-drsc;tre~ (sropnrl~, wa sproa tc do tnr to;lorulny: 4. Cwnar apraa tr: GvtNCrrn tp s.l sPptitirblr raqu+rsrt-rnts of Corym 83. dJri. ,dn'!. 0o7a twfattnpp W treltllnQ treks r' the owner h+ls to havr tea htkdltrg ank Dro¢tlrty asrrrwC >r 'aaDtxtaa t0 Or3ara rrsuatl vy )1111 po~~sun Trrnw unit or ttw f3aparsmrnt of r,,omrrfxw to prevent or sfirta a numsn traadtn Mind tM ttwcrifro fn • 4b4.b9, 8rasls .lift prvrmm~nw~ ~~rtlt ,*owns may antes upon u~,u properly ami alrvta tees ta'1k ter wuaa K tWa Vta tank tp ties tiary'Cfd afro ehart;)a It>• oWnK pltgrnlf It10 ChrrgN tYt the tax drw ar i apaalal aaprtNnaM k)r CL'"ant aaMgtl ~rndarrKt. Tnq aharYr+- wWt bf aaaaa+atl aK pr+oribra by a. b0.137Q;1, grata. 4. Tns erns! arNN~ pvrwant to ~TR7 t6s.itl(Z) end Oort+m r>l.aaf0),a!. Y~nr. Aam. Gagr, to nrw a water mslrr tnrtMUra rn me s;nxrr». ter waW .mater attsJ! des thauNao try s 9lumbar auttforlaard by the gt-pr,nr:eam of Ccntrttsrea is makr stJ[1r Jrwta:"a~tors: a-tat"sain :ns:;rrrsaan eantpty:ra W+Mt t1YN NruNttlen0 and manufaat~fan 1Matlostlona. TWs awnar sQnas a ties YrranclaUy rortp~'talbfi for the puronaaa. inatakstign, rn11r'tananaa, end repair of the MAtK rnatr, area s4ttiw to giur+ tM QO+a+.nrr1i11rr ytttt or the WprartR>+int of Gommatek !t rnwr ;na abowdattaNbstl riroprrty an s rapular bass b rand an~/ar rrtapaot Mta bw,tgr ,na(ar, 3, Ownrr agraaa to pry ell rharpaa end posts incurrod by the poyernm:nti yr f a- trounly for 3nspYnclan, pump:np; tf.+,Gnq, tx tn-+a-w;aa Sp~;einC ~ std mot,lttilrilnq the noldinp tank In auofi : mrnrvf as u pravu+e w srsxtr sny tr<:ms1; har,tr+ ft.>rrrrer ea;asad by the hatdtnq tank. 7kr QoraMr:rantd Will atsrtt no¢fytnf t7Wilaf Of anY CYttta that ahatl ha pNC :t tees awnsr Wntlttn trUrgi (90) tlaya ttim tl+r dNs of notlea. to tns s~rr.: trr~ owt-wr lioaa ttat pry tees «aan wtN;tr thtny ;101 ttsya, trii owner gpse+nrw~V arrwa teat a l • poets atrtcl ohar~a stay w ptio•d on the brc roll as s spadrJ saaatattant for thr sEaa-manc of a roman harth nssar" and tlAa tax Jftfsl rip ptllta0latl 1>ti prpviaad b)+ lraW. a. 7ha aWArr sprssa b osntrset until r Dafaon who rr uattaad ttntlrr CN. Nit t 1S, Wis. Juf!n. Coda, t0 hrw tht ho)di/tq trek salvfoad anC :~ ^:a stn wyiNMw oenMrat.NwNJf qw aQowrntnM~t~bt uni: w~thMa t3) bWJr nu /tr +JaYShbm f~ ~~oh t4>f wryf~w~~ p~~, cr r :rrDY a •. T1sa owner yt~rr t0 aaatrrot wNt+ a Parson Ilpamaad urMMr Ch. hIR Yt3. Wit, wtlm. Cotla, who attaA sub'nlt to thr ootPuby On r +em.srr:wsl t:satc s ~1-Ori dataCMa tttr illNidnp of tk+ hrrdrnp tank. 'f Ma bOVl~n:~tt~+tni Lntt or n0unty 7riay rnlK upon thr pn7Dw'tY to lt1W,QfpatO tfte terrdillnn 6t llla hartlinb bnk Whan pun+ptnd r~poris and Mstar Nadln~r •r.~lY I~tdroab Mat thr hOtyinC Leek ;c not tian9 proyrly matrtarnaK• I ~. ltda rpnrMMt WIN rrrnair; ,n Mart a,ty u+t<!1 1ha eounly 0ltfaa tNpafla Llb for tees ttibufrttat et D'wata Onalts Waa~wigf trtntmant ayatar+a eartl!hn 1fin art4ar r murttdDrl tNws+" w a D'Wita a!lalr wrstrwittar itm¢mtant rYJgatn teat por7•:nllq YApt CoMm ~. Wla. Adrr„ Coda aarv~a the property, .fi ttclallfron, thy tJWNtnrrti may bs ate+aatrt,e by aJtacutSrp~ tirfd raaprrJin~ Rld tlpRlflcaHlPn wtM nrrtaronw tD thls aprsetnant fn arch mrrnrwr which wAl Qerm It tlsa bKhNtt4r of the oa!tYbrtlpn ZD or drtt+rmlMq Cy refartlnOb to thM PAPrKY~ T. this sprasr»ant ahMl ba tantlfnp upon the awnar, the hPlfa of UM Ow'tar, and tpr,pt+ar o" ,na ottittar, 'r'ha owner Mar auDtnlt thla apraatrtrrrtt eo tttr rap~atar tN OPad•, rno the apnf'nant -hsl: br raaortlad by tea ~r~ra+~r of deeds [n s r*++annsr that wtM psh+frt the sxNtortca o! thq ay-aenuant !n ties tla;rmanad by Mhranoa to 1ha property wl+rra the nd,Jr~a W ^k I+ frob;}rd. e ftii4NaAtW rWpT TC pq "rY ms Mr t~s ^.sii ~~-- ~ of 1 _.,. Qt~T CLAI2! DHHD ...,._-_. ...:.... ... ..~ _.,. STATE OF Wl$CON8IN-FORM NO_~_;; ____,_, _ _.. ,. ____,_ _n_s.,~uuES_co.._~uaruitu--2,}y _..._ 2~~ 4 9 ~- ~ - -- -- ; ThIS Indent,Ire, Made bY.. s~no4~,_ Ustri&t No. _ 4., of ,the Town of Glenwood, St. by~yrtue~of ~thesLaws ofn ~h rtp~tate~ o~r&~SCCpoo~ganlzed and(`e nty, W cons n deal and~j ... quit-ciaimrzto......T.Qw~ of G~,e~w.aod, St, Croix. County, Wis., A Munc.ipal Corporation __ .. -... _ _._ _..._... _. __ grantee..- , of_.__ ~.L" . CrQlx. _ ('aunty, Wisconsin, for the ~'. sum of._QXIe._.(.~.~..QQ) -- --------- --------------- --- ------------- --..Dollar the following tract of land in ._ St,_ CroiX (~ounlt, State ~~f 1•\'i~~•~msin: Parcel in the South East Corner (SE} corner of Section 10, Townsh_tp 30 North, of Range 15 West, more particularly Described as follows; Commencing at the South East Corner of Said Section 10; Thence North ~ Rods; `!'hence West 20 'mods; The:ice Sout;;i ~; f~.ods; Thence East 20 Rods to the Point o.f csef;inning. ~~'~i~ :r ~~.,~_ ~er~c_~' ,.reA ;~,- hi, ~_E.o .~~s ~~,~- ~~~(,;, r,o r~:F?1"'~,' fi;1 Q:i ~ 1'.~,rnv' (")! ~-~r'~, ;~C~! !E?T'i~ (l r• ,. 1;° C!•'.. n~~ ~ .'iA' (~C7. ~ -. ;ir>.-. _ i ~ -, ~_,~. ,n liv-. Grp f're(; :~' e ~, ~, ~r ~;sc .. -..~Lii i~r ~"r , ca~.zsec~ t-~ use I>r'e;;ents to be sij*ned h In Witness Whereof, the said grantor. ha .5.. heretm+rr~t-w,r.~~--____,~;~.rul..__.~iuL-+~e.~l._.,~4~.i~: :its director and Clerk ?,,h_is _~ Glenwood :~C~":O 7, ll1rS'.--~ . i`i0. 1.~, ~~'OwIl ~f (sliAl.) SI ' AND SEALk,D IN PRES[iNCB OF' r~~ ~ ----._... _ _.. t~ndrew i~~,aes i.ireetc>r. - -- --- ,~ _~c3 ;~, ,-~r•,a _ ~r~ND; ~~ STATE OF WISCONSIN, 3 ~~~ . Croix ~ ~~ _.._ .__... _(~uunty. r `.. ______..... J Personally came before me, this-. ._ ^" ,:.~.,;c:. - __ clay .,f _ _1•ia,,~ _. , A. r)•, 19 .5~1. r.. ; . the above named ..,r1~7't'h i~:1~:5,- .~?~~C..;Q2',-. 3 i~l_ ~ E-'G'.'?c1l :I n;attlc', „lerx ~~, the a1~oVe ndr~ed Corporation, to rite ;mown to Le the i>er~or.s who e.xE:ctzted the .fore~oi.n~; a _... , ~n ~,,.r-~rmar~t- an(i...=r,o ..~nca-..lc-nov~n ~t<-~- .}~- -~ ,~c~..i~yr.~c ~r~r... a;:uY. C1erI: 01'. said- .or.pora t.i on atcl .ti~ey aclcnowled~;ed that t}ie,~ exec~~ted't'r,e foregoing instrument as s?tc~i a --tc~~zle.kwcHUl-tohe..tba.percou.......w.iaoewecutod.ihe..fertgo+.r~ i+~stuKnv~r::uut.ac~kcu~vl~cl.Krd-tlw~arue, f officers as the deed off' s~i.cl Corporation, by.-tt;s a~_ztho~=jty. ~-'~ J fi~'~'ty1STER5 OFF'ICc ~~' ., ~ . ..- ~--r %S ~_ /f