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018-1036-70-300
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM .Safety aiid Buildir~ 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 Munson, Patrick Hammond, Town of ;ST BM Elev: Insp. BM Elev: BM Description: ~~ l .-+ ,. r~NK INFnRM4T1C)N ELEVATION DATA TYPE MANUFACTURER ~ ~5- CAPACITY Septic ~ ~~ ~ y~ ~b ~Q Dosing ~ /~ v ~~ F,. Holding ~ ~~ f b "'.n, TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~.. -Z o4f ,_,,., s c~' Dosing Aeration Holding PUMP/SIPHON INFORMATION ~SIr Manufacturer ~~~ ~; Demand G P Model Number G ~ TDH Li i 2 Z~Q Frictio~ L~ Z System Fad TDH~, Forcemain Length ~ Dia. i/ Z Dist. to Well Cnll ARCnDDTI(1AI CVCTFM county: St. Croix Sanitary Permit No: 506249 0 State Plan ID No: Parcel Tax No: 018-1036-70-300 Section/TownlRange/Map No: 17.29.17.257A30 STATION BS HI FS ELEV. enchmark ~ ;' 00 ~ 1 2 J ~7. / _ Y' Q..~.3 Alt. BM Bldg. Sewer x. ~ St/Ht Inlet ~Z p7 g$ ~a3 SUHt Outlet t Z ~ ~ $ 5. Dt Inlet I Z , ~j ~'S . 3 5 Dt Bottom ~s. 5~ $Z• ~~Ip Header/Man. ~~. 3z. Dist. Pipe Bot. System Final Grade St Cover ~t.~ ~~ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ CHAMBER OR INFORMATION Type Of System: ~ ~ UNIT Model Number: IIICTDIC11TInAl CVCTCIIA Header/Manifold Distribution x Hole Size x Hole Spacing V n to Air I ke Pipe(s) ~ J Length Dia Length Dia Spacin "' Cnll /`nVDD .. rn-,.........., c.,~~e.,,~ n..i.J ~. n 6Yll..~~ne1 nr DI_Rrarlw SvstPmc 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 discrepencies, persons present, etc.) Inspection #1: ~ / a~/ ~ 7 /~ Inspection #2: / /_ `•{Q~-- 257A30 Location: 1699 99th Avenue Hammond, WI 54015 (NE 1/4 NE 1/4 17 T29N~iR17W) NA Lot 3 Parcel No. 17.29.17. 1.) Alt BM Description = I " ~ ~~ 2.) Bldg sewer length = `'L -amount of cover = ~ ~ 7 Plan revision Required? I,°al Yes No A Za,t 0'7 ~ 3 Use other side for additional information. a Date Ins ctor's Si ature Cert. No. SBD-6710 (R.3/97) commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 _ i sco n s i n Madison, WI 5 3 707-7 1 62 be filled in by Co.) Sanitary Permit Number to Department of Commerce Q Sa (p Z ~ l Sanitary Permit Application State Transaction,~ber ~,,ll//// submission of this form to the appropriate governmental Code Wis Adm 21(2) rdance with s Comm 83 cc I , . , . . . . n a o unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS aze Project Address (if different than mailing address) submitted to the Department of Commerce. Personal informa condary u oses in accordance with the Privacy Law, s. 15.04 1 (m , Stars _ I. A lication Information -Please Pri 1 Informati n Prope Owner's Name ~ ~u~ a 2 zo~~ arcel # ~ _ _ Property Owner's Mailing A dress ~ ~7 ~-1'. C(~Ol~( ,C~~T'Y Pro Location Q ~~ / Z~ 7/ ~ ~ - C Lot (r Ct , Sta Zip Code one u /,, ~~ y., Section ~~ ,l _ ~ circle o-n~e9 N; R ~ E'C~"' e of Buildi!!a (check all that apply) iI T Lot # . yp bdi i i N ~~ I or 2 Family Dwelling - Number of Bedrooms `..~ ame v s on Su Block # ^ Public/Commercial -Describe Use ~~ ~ ^ City of ' y J ^ State Owned -Describe Use CSM Number ^ Village of rd .fir Town of III. Type of Permit: (Check only one box on line A. Complete line B if appl 1 `4' ^ New System ^ Re lacement S stem p y Treatment/Holdin ank Re lacement Onl g P Y 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 ~ bs IV. T e of POWTS S stem/Corn onent/Device: Check all that a 1 ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) Dis ersaUTreatment Area Information: V . d ( P i l A stem Elevation / S Design Flow (gpd) Design Soil Appli ation ,R~ate(gpdsf) Dispersal Area Requirc~(sf) // ropose s rea spersa D ~ y X3.3 V .Tank Info Capacity in Total # of Manufacturer ~ ~ Gallons Gallons Units ,D ;; v d ~ y ° T k ti Tank E i ~ o ? ~ ~ °'o ~ ~ New an s x s ng s G. U y ~ h rn . u, C7 P, Septic or Hoiding Tank - Dosing Chamber VII. Respott bility Statement- I, the undersigned, assume res onsibility for installation of the POWTS shown on the attached plans. i Plumbers ' me (P ~ t Plumbe 's Si a •- MP/MPRS Number Business Phone Number Plum is A dress treet, City, Stat Zip Code) / `r ~ ~p /G VIII. Coun /De artmen Use Onl Perrnit Fee Date sue Issuing A t Signature Approved isappro $ ~~ ' ~ vcn Reason ial IX. Condi~p~pt,}g~Reasons for Disapproval 3~ ~) ~ .~.~ ~ ; ~~, J~.,,~,~ 1. Septic tank,. effluent fiNer and dispersal ce8 must all be services t maintained n ` ~ ~~ ~ ~ / ~ ~ e~ J f ~ ~ plumber ' f ~ f l rovided b l t , an p p as per managemer- y 2..AM sethack>ti~irerneMs must be meir~ted ~..~ C. ,n. ; o ~oQ~ . ; ~ w e ~ . ~. ... o . aod.J~. t s Attach to complete plans for the system and submit to tae county omy on paper nor teas tnxn o uc 1 ` ~..~..~~ ~.. ~...~ , l 15.2_ . SBD-6398 (R. 01/07) Valid thru 01/09 Aa ~) May 1, 2007 Kim O'Connell 504 3`d Ave. Osceola, WI 54020 RE: Non-Compliant POWYS, Town of Hammond Code Administration 17.29.17257A-30 Lot 3 Permit # 430548 715-386-4680 Dear Mr. O'Connell: Land Information ~ Planning 715-386-4674 The ur ose of this letter is to notif ou that the above mentioned Private On-site p p y v Wastewater Treatment System (POWYS) is in Violation of St. Croix County Real Property Ordinance Chapter 12.1 and State of WI Comm 84.25(2)(b), which requires 715-386-4677 POWYS treatment components be water tight. Recycling 715-386-4675 A County onsite .determined that wastewater levels in the septic tank do not reach the filter or enter the pump chamber even though water could be heard entering the septic tank. The pump tank has a thin layer of water on the bottom however the water level is well below the pump floats indicating the pump has never run. The septic tank must be pumped to determine the extent of damage to the tank. If the tank can be repaired a County Repair Permit is required and the repair must be done according to the Manufacturers specifications. Upon repair a pressure test is required to determine if the repair is water tight. If it is determined that a new septic tank is required then a New State Sanitary permit is required. The repair or new installation must be completed by July 3, 2007 Please be advised that fines and/or forfeitures of not less than $100.00 and more than $500.00 per day everyday the violation exists will be assessed if installation has not been completed by the above stated deadline. Sincerely, Ryan Yarr' gton Zoning Technician CC. Jackie Munson 1698 99`h Ave Hammond, WI 54015 file ST CROIX COUNTY GOVERNMENT CENTER 1 1 O 1 CARMICHAEL ROAD. HUDSON, Wl 54016 715-386-4686 FAX Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and --~ Comm 16.28 WAC (~ ~ 4 in. min. (i Disconnect ~~_ Tank component is properly vented Manufacturer Ca acity 800.00 Gallons Volume 21.76 gal/inch Dimension Inches Gallons A ~ 8 ~ .sue D 8- Total 3- Alarm Manuafacturer - - ~, Alarm Model Number i Pump Manufacturer Pump Model Number t7J.~~~7/.C Pump Must Deliver ~~~c~pm at / ~ ft TDH E- Aftemate outlet location Forcemain diameter ~_ 2 in. A Weep hole or anti- B siphon device C P~ ump off elevation {ft) D ` Dose tank elevation (ft) ~- -- - ~ ,C,cX f//~tN~'onl STA-RITE' COMPOSITE CURVES sa 70 so F uWi 50 Z 0 a S J ~0 40 30 20 l~ CAPACITY LITRES PER MINUTE 0 50 100 150 200 250 300 350 400 450 500 550 90 _0 7S '• 5^ 75 100 CAPACITY GALLONS PER MINUTE Fti> '~o .~yA I i Fc9 . ~yA F~~SO ., F y~so , ,2yp ~~A ~, Fc6so '. I ~cQ i y %yA ~> A F~~ ~~o yA F~~ yl~jyT ~~ A .l -- __ \ 2s 24 22 20 1a 16 ~ W W 14 Z 0 a W S 12 ~ a to s 6 4 2 0 125 150 Dose Tank Information Electrical as per NEC 300 and -~ Comm 16.28 WAC Disconnect Tank component is properly vented Manufacturer Capacity 800.00 Gallons Volume 21.76 gal/inch Dimension Inches Gallons A 3, B ~ .sue D S- Total ~- • , ~- A B C D Alarm Manuafacturer ~~~~~(,~~ , ~ ' Alarm Model Number Pump Manufacturer ~~~ - •~ Pump Model Number ' - e Pump Must Deliver ~-~~f> l~pm at / ~ ft TDH ~~~,~,~ .-' sue/ _ ~~ 9~ Jyi ~ ~os.E' /D~,3~.~~ locking cover with warning label and locking device and sealed watertight 4 in. min. E- ARemate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P• ump off elevation (ft) D• ose tank elevatio ~~',~z~~ css ~~~D ~•GOU~DS PUMPS Submersible Effluent Pump WE Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: 3/;' maximum. • Discharge size: 2"NPT. • Capacities: up to 140 GPM. • Total heads: up to 128 feet TDH. • Temperature: 104°F (40°C) continuous 140°F (60°C~ intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM's available. FEATURES ^ Impeller: Cast iron, semi- open, non-clog with pump-out vanes for mechanical seal protection. Balanced for smooth operation. Silicon bronze impeller available as an option. ^ Casing: Cast iron volute type for maximum efficiency. 2"NPT discharge. ^ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA-N elastomers. ^ Shaft: Corrosion-resistant, stainless steel. Threaded design. Locknut on all models to guard against component damage on accidental reverse rotation. ^ Fasteners: 300 series stainless steel. ~ Capable of running dry without damage to components. ^ Designed for continuous operation when fully submerged. MOTORS ^ Fully submerged in high- gradeturbine oil for lubrication and efficient heat transfer. ^ Class B insulation on '/3-1'/z HP models. ^ Class F insulation on 2 HP models. METERS FEET 40 130 1zo 35 110 30 100 90 0 w 25 80 a 20 70 } 60 0 F 15 50 40 10 30 5 20 10 Goulds Pumps © 2003 Goulds Pumps Effective July, 2003 63885 Single phase (60 Hz): • Capacitor start motors for maximum starting torque. • Built-in overload with automatic reset. • SJTOW or STOW severe duty oil and water resistant power cords. •'/3 and'/ HP models have NEMA three prong grounding plugs. • 3/4 HP and larger units have bare lead cord ends. Three phase (60 Hz): • Class 10 overload protection must be provided in separately ordered starter unit. • STOW power cords all have bare lead cord ends. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously without damage when fully submerged. ^ Bearings: Upper and lower heavy duty ball bearing construction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. Standard cord is 20'. Optional lengths are available. ^ 0-ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS S ~ ® rest•dtoucne~ csa zza toe s>a~~ By Wiwfian standards C US ~ #I1t3e549 Goulds Pumps is I50 9001 Registered. -5 GPM FT 00 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM 0 5 10 15 20 25 30 35 m3/hr caPaaTv vvww.goulds.com ~" ITT Industries ' JVisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildipg Divis~ton " INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Midwest E uities Hammond Townshi CST BM Ele/v~- Insp. BM Elev: BM escdption: . TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ,/ n «!jt..~l l ~-~ d Dosing D~ Aeration YnaPirt Holding ~ ~ TANK SETBACK INFORMATION TANK TO P/ WEL VU LDG. Vent Air Intake ROAD Septic , I > 7~ ~ t Dosing ~ f > t , ~b r Aeration ~_ _--- Holding -~` " PUMP/SIPHON INFORMATION Manufacturer / Demand ~w GPM Model Number ~ ~ /~ TDH Lift 2 3 riction Loss System (ie n TDH Ft r ~J J--',r Forcemain Length Dia. Di . to well 2 ~~ ELEVATION DATA county: St. Croix Sanitary Permit No: 430548 0 State Plan ID No: Parcel Tax No: 018-1036-70-300 Section/Town/Range/Map No: 17.29.17.257A30 STATION BS HI FS ELEV. Benchmark ~ ~ ' ~~ Alt. BM Co.~C~f -ems"'-._.aQ(/V tr V.~y G-s 3 Bld .Sewer .Q~(, : ~ ~1 't"~» ~,~ Z ~~- 2~ t/Ht Inlet 3. ~S ~7 St/Ht Outlet ~/~ 5.. Dt Inlet ~~ ,/ yO ~y ~ ~ Dt Bottom eader/ an. ~ S•~ 9 . Dist. Pipe ~ ~ ~~ ~ . t7 , / `~' ~~ ~Y~ 6'6" X13 3 Final Gra~ '~ "+G ' 2" G' l St Cover• rites q - ~ SOIL J~BSORPTION SYSTEM t/.C-~D = 20 X~i .-I- !7. SL .~. USA?•'~"` BED/TRENCH DIMENSIONS Width ~ I Length ~ No. Of Trenches 2 PIT DIMENS S No. Of Pits Inside Dia. Liquid Depth ~ U l SETBACK SYSTEM TO P!L BLDG L LAKE/STREA LEACHING a rer: r INFORMATION CHAMBER OR ~'' Typ Of System: ~/ > '~d r U Model Number: ! DJSTRIBUTION SYSTEM - / ~a ~~~.~ !~i/~'~-rn~-~~.~-T Head Manifol/d~ t t~V length Dia Distribution _ ~ ~~ () Pipe(s) 2 Q CX~C / Length Spacing ~, x Hole Size ~ x Hole Spacing,- J Vent to Air Intake `~ ~d ~ 7 SOIL COVER x Pressure Svstems Only zx Mound Or At-Grade Svstems Onlv Depth Over `' U t/"~ / Bed/Trench Center T f Depth Over B rench Edges xx Depth of Topsoil xx Seeded/Sodded xx Mulched i ' N ~ U Yes ~ No [ Yes o COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~ Inspection #2: / ! Location: 1699 99th Ave Hammond, WI 54015 (NE 1/4 NE 1/4 17 T29N R17W)~ N~A~,L~oJt 3 ~~,~J Parcel No: 17.29.17.25`7A~30_ - 1.)Alt BM Description = ~i!1~~~-~'~-Ci o~l>~ E ~"" ~~ ~ /~ ~~ 7 ' "" 2.) Bldg sewer length = ~ Z ~ - amount of cover = `• Ptan revision Required? j~es ~] No Use other side for additional information. SBD-8710 (R.3/97) _-~-_--1 --- _I ---- -- _ i-~~ --! ~ ---_ ---- - --- -- -- ---! __ 1_ Date Insepctor's Signature Cert. No. RECEIVED N/lll ~ A ~nn~ Sa and Buildings Division City ~ ~T. CROIX ~~ W ashington Ave., P.O. Box 7082 ' ~ ~S~jO NING O FICE Bison, WI 53707 - 7082 Sanitary Patnit Number (to be filled in by Co.) De artment of Commerce (608)261-6546 tJ 30 ~~p' Sanitary Permit Application State Phan [.D. Number In accord with Comm 83.21, Wis. Adm Code, personal information you provide "'~--. may be used for secondary purposes Privacy Law, s15.04(1 xm) Project Address (if different t h a n mailing address) ( J I. Application Information -Please Print All Information ~ ~ , pn 2 ' l7 ~ , Property Owner's Name ~ ~ t Parcel # Lot # Block # ^ Property Owner's Mai ing d Property Location ~' S i ~ ~ ~/ ~% City, Late Zip Code Phone Number ., ., ect on _ ~ ~ _ (circle off) ^~ ~ ~ Z/~ R E o d(J ~JIJ T N II T f B ildi h k ; . ype o u ng (c ec al! that apply) 1 or 2 Family Dwelling - Number of Bedrooms _ _ _ Subdivision Name ^ PublicJCommereial-Describe Use ~n ^ State Owned -Describe Use 3 X av • S City ^ '1 ge ~ownship III. T ype of Permit: (Check only one box on line A. Cowplete line B if applicable) A' ^ New S tem ys ^ Replacetnent System ^ Treatment/I-folding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision Change of ^ Pertrtit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 3~ "1 sib f ~ - Z - o ~ IV of POWTS S stem: Check sB that a Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filtw ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/'I'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ,~ 3 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Talcs Septic or Holdimg Tank __ 7C Aerobic Treatment Unit Ildsing Chamber VII. ReS nsibillty Statement- I, the undersigned, ssume responsibility for installation of the POWTS shown on the attached plans. PI 'Name Prin ~ Plumb 's MP/MPRS Number Business Phone Number .JE ~ - - Plumber's Address (Street, City, Stat Zip e) ~'i~ / h S VIII. Coun /De artmen Use Onl Approved ^ Disapproved Sanitary Permit Fee 'ncludes Groundwater Date Issued Issuing ent Signature (No mps) ^ Owner Given Reason for Denial Surcharge Fee) ~ , IX. Conditions of ApprovaVReasons for Disapproval ~ SYSTEM OWNER: ` n r ~( 3 _ _ ~l ~ 1 KSW 7 Septic tank, effluent filter and ~~~ dispersal cell must all be serviced / ma~ntein as per management plan provided by plumber. ~t S ~ 2. All setback requirements must be maintained .7 as per applicable code/ordinances. _ n /~ wttach compkte plans (ta the County only) for the system on paper sot kss than 81/2 :11 Inches Is dre `~ SBD-6398 (R. 08/02) --- - - - -- _ _ _ - - _ - - _ ~ --fi - ~ ~ ~~/ _~ ~~ D ip ~ 4 ~ ., ~L \` _ ~v `~ ~\\ \k ~~ .~ _ - V __ ~ `,, _ .~ _ ~ ~ -~ ~_~~ _ ~~~ ~ ~L ~~ ~ _ I ~~ ~ ~ ~ ~, ~ _ t ~ ~ ~ ~~ ~ ~ ~ ` ~ 1 ~~;~ ,~ ,,, _ / ~~ti~ _ __ ~~` ~F" _ 1 _ ~ ~~~ M ~"~ ~ ,~ _ _ \~ ~~ __ _ _ ,~ u M _ __ ~ ~~ ~ ~~ ~~ ~ .~,~ ~' ~ '~ ~-~ ~~ ;., __ ,~~ ~, ~ `~ _a ~~ ~ _ . POWTS OWNER'S MANUAL & MANAGEMENT PLAN . ,, , Faye ~,,~,-, of ~ FILE INFORMATION SYSTEM SPECIFICATIONS Owner ^S' Permit # ~ p DESIQN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units ~NA Estimated flow (average) al/da Design flow Ipeakl, (Estimated x 1.51 al/da Soil Application Rate al/da /ft2 Standard Influent/Effluent duality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen .Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent duality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size Y8 in did. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAl1UTFNANCF C(_HFr)111 F Septic Tank Capacity ~J al ^ NA Septic Tank Manufacturer J= ~' ^ NA Effluent Filter Manufacturer 'L O NA Effluent Filter Model ~' O NA Pump Tank Capacity al ~ NA Pump Tank Manufacturer O~NA Pump Manufacturer .I~NA Pump Modal ^ NA Pretreatment Unit ^ Sand/Gravel Filter ' ^ Mechanical Aeration O Disinfection - ^ Peat Filter ^ Wetland ^ Other: ~A Dispersal Celllsl ~In-Ground (gravity) O At-Grade ^ Drip-Line O NA O In-Ground (pressurized) ^ Mound O Other: Other: ^ NA Other: O NA Other: O NA Service Event Service Frequency Ins ect condition of tankls) p At least once eve ry~ ^monthls) (Maximum 3 east) ear(s) y ^ NA Pump out contents of tankisi When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: O monthls) " (Maximum 3 yoarsl aerial ^ NA Clean effluent filter At least once every: O monthls); ear(s) ^ NA Inspect pump, pump controls & alarm At least once every: O monthls) ^ year(s) ,~ NA Flush laterals and pressure test At least once every: ^monthls) ^ year(s) ANA Other; At least once every: D earl -is~ " ` '~ NA Other. ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any. ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a`failing condition°auld requires the immediate notification of the local regulatory authority. When the combined accumulation, of sludge and scum in any tank equals one-third IY,1 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 AdministraUvo Coda All other servicoa, including but not limited to the servicing of effluent filtora, mechanical or pressurized oomponents, pretreatment 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 10 days of completion of any service event. GMW (4/011 Page of START UP AND OPERATION - ~ ' For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or of:her chemicals that may impede the treatment process and/or damage the dispersal cellls-. If high concentrations are detected have the contents of the tankls) 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 power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cell(s- and may result 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 ptherwise 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 Isump pump) water; 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 kie 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 and pits 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 prgvide. a ~o~e compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must .comply with the rules in effect at that time. ~> °°Y= ° O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. O 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 mu:t comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO N0Y ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALL R POWTS MAINTAINER Name I Name Phone _ ~ -- Phone r~ °c. _ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY- ' Name Name 7 Phone Phone This document was drafted in compliance with chapter Comm 83.2212)Ibllt)Id)&If) and 83.64111, 121 & (3-, Wlaconaln Adminlatrative Coda. VyisconginrDepa went of Commerce PRIVATE SEWAGE SYSTEM Safety and 3uilding Didision • • ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Midwest E uities City Village X Township Hammond Townshi CST BM Elev: Insp. BM Eiev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Dem< GPM Model Number to SOIL ABSORPTION SYSTEM DISTRIBUTION SYSTEM ELEVATION DATA County: St. CfOIX Sanitary Permit No: 399546 State Plan ID No: Parcel Tax No: 018-1036-70-300 Ht Outlet Inlet Bottom Dist. Pipe Bot. Syste Final Gnat St Cover Ft I HI FS Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL OVER Y Procm~ru Cve40mc (lniv YY Mnund Ar 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 discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 992170th Street Hammond, WI 54015 (NE 1/4 NE 1/417 T29N R17W) NA Lot 3 Parcel No: 1T.29.17.257A30 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ^ Yes ^ No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) d S~r.P-e~- .~:- ~ 36 '^'-'..""`' ~ ~ Safei~• tnd8+uld;r,~a %„,:s;~~ i Caua~Y ~~ f •~ • ; ~ ?~? w. w~shia~tonAvti,. F.C~ ~qx?~b2 ~ '~ Permit t~ppl#C~t~ t2 r, 3a~ s~~ W MIOld whit t~l~ 11.75. ~• !1/>s1• ice. +~ psrovi~ .., , ~ Cl Cb~olc tf' Aw~ioa cEwE ;~., x , ,~ l x, A _ I'7, z ,~~A-3a .,~ ~, Q ~ T a ~ 2Q01 ~ ~g _~ ~3(~ - ~ ~ ......~. r~'GtJB ~ Kr/r~~' ST 1 ~ ,~~~ , &r7 a9 9a ~ ~' ~ ~` ~.' ? u~arnr j \1 ~ 3 J ~~{ t Jr ~aDo2 NCO ~i~-~J o~ O ~YdLt`r '~r~ [~, ~'~ t Gi /~ ` 0~' t ~,1-~j ~.. ~ erz a! 3 ~ lu - Drop °` '~n.,~ ~ ~ ~~ n~ ~4 aos a~ A ~rwmb~ clams t'or ~= tw)~ C ~ ~ ~pp~ Ty-p~r ~t t ~ ~ d Rs~i~oe~at if 6 ~ A~d~#aa ~ ~ t t~- ! ©~ i ~. d C~ itis~- Ths~ ~' ' ~ ~>~ ~I ~ i~1 • Ntlll •lpliM~ld ~'~ E:~ AdOrod ~7 Iltttd et~d 6i Q iioWyY? ~ It1a~Y~ t+w s} ~C acrau~ ao ~~ s tT +~ ; , ~t ~ pleat ~rse,~ a .IDy~l64•PR}~~Ia.JI~ Ain ~J lhbe Plt~ ' r uc l a-t-e ~ GI1Std011 of T><olu ; ~ ~ CO~YIrM Ot Q l~ ( ~ i BS ~' f^ w ~ i tm '~ ~- ' ~~ ~~"" ~~ ~ ~ /~ ~~~9 . F / 7/S- 38G-3/~ i ~ ~ r Ap,~wt ~ ~ FH3 11- Z ( ~ ~-e-C,! 1 ©~t'q~d~AQYMfIf• o~~ ~/VU r2t' S ~~~s i j1~, rr~~ mJne/' -~ r~p~ns b~¢.sa+~..wu~~~.~ev-anee I~W.e e.~F1„~.~+~'~l~,~ea"-~an of b ~ ~_ ~ ~v s4' a lS -~at~' ~raw.~ ~vv~(-S ~*,.wlL ~ ~~ ~- ~ ~{' .~fa~~e ~ ~~ `~ 1 I~.x.2.~1 v+ti IAs ~i~ ~ U.d v~.-l~-i t2.-~tacG~/oC~- SW-1 ~J~~i~-~.~.Y-c~A1a,( becG'[~vts `~.5 15 ~ S ~ v~~ W w S ~ w ~. L r/1 ,~,~ >< r b « ~d~, ~1rtb L1 ~'?t„5 a k«.v~c ~i.^7~ Lwkos ' ~ ~ 1 ' w ~~ y y. ~ ~. ~~, ~' rb ~~ ~ ~~y ,~ ° ,~° ~~ I~ 0 ca a r v fo cc ~n ~ ~ ~r o~> > ,r c ~ p r a °'' c t4 V ~ N P ., y 0 N ~ ~ ~~ ~~ ~~ o ~. 0 b ~ li° `C Q < <. ~~~1~,~ ~~~l I~ 1 IR' ~_ _._.~ s ~_,L ~~1 ~~ 3 ~- a ~' ., 1l c~ ~ y,~ ~ , ,~ ` ` 0 .v ~~ ~ h ~~ o~ e`/ ~~ N J ~ y" s ~~ r 9 ~A Q M r M r ~ i,A n- J~ 9 ~ ~~ .. o 0 O 'A~~ as o ~~q K ~~ ~~~ ~~,a 2" ~~~ ~~ .~ Iw'§in Department of commerce SOIL EVALUATION REPORT Page ~ of 3 Division of Safety and Buildings ~ __ . in accordance wim c;omm s5, vvrs. fvam. ~.ooe __ County ~ f ~ i X S-~ t . Attach complete site plan on paper not less than S 1/2 x 11 inches in s¢e. Plan mus include, but not limited to: vertical and horizontal reference pant (BM), direction and Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. percent slope , Please print all ina~a>Ir ~ ~` -.~ ;' ~ ~ by Date Personal information you provide may be used for~phdely`purposes (p'y,.Caw>s. 15.04 (1) (m)). Property Gamer ~ ~. r ~f~r~ 3~I1 k Pr4perry Location Govt. Lot E U4 ~{ E 1/4 S ~ 7 T zR' N R ~ ~ E (or ~ Property Owner's Mailing Address y Lot Block # Subd. Name or CSM# City State . ~ Code ,~.,,. , -Y ' ^ City ^ Yllage ~ Town Nearest Road -•., ~T ') j ~ 93 ~' ~.n`no ital / ~Q '~~ ~ ( o ~ . .. ~ New Constn~ction Use: ~ Residential / Num ~~ irr~m~ .~,-,~'~ Code derived design flow rate y~0 ~ QC~ GPD ~. a ^ Replacement ^ Public or commeraal -~~ Parent material OU ~- l.Jc<<S ~ Flood Plain elevation if applicable N~/-k ft. General canments 5 }~ Sfc rvt e I ~ v. 93.3 D and recommendations: ~, L,~ e/•e.V • Qv~• 3d ~, ~ S ka //o ~./ a r~o o y (.~ , ~~'p•e ~I-'yPe--Sys~cmS ~ s V k " - y heSe ~4-rencwt.~S -v~us+ JDe Roc 1 ~ I Boring ~~ # ® pit Ground surface elev. 9y ~ a ft. Depth to limiting factor S y in. Soil ication Rate th l D i t C tion dox Descri R Texture Strudure Consistence Boundary Roots GP DIfP Horizon Dep in. nan or o om Munsell p e flu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 p- ~~, ~ D 3 ~ - S. I 2 mabk m-~r' cs I v-~ Z 1 -3~ ID r 5 J~+ Sicl Zmsbk rn-~' L5 - . y . to 3 3~-~ D r `~I'~ LS I mfr c. s -" . ~ I ~ 2 `-E s`I~tolo 1 Sl i -" Fr ~'-na. s~+ - -" - . d , d LS.cv~Sl•ro a3.3c~ a Boring # ~ Boring © pit Ground surface elev. 9y~o ft Depth fio limiting factor _~_ in. ~ti ~~ ~ Horizon Depth Dominan4Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft? in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eft#1 'Eff#2 3 _ ~ SL. 2msbk ~r c~ - .5 . `/ (S~a - ;~ ' EiflueM #1 =SOD > 30 < 220 mg/L and TSS >30 < 1 50 mg/L. ' Eflfuent #2 =GODS < 30 mg/L and TSS < 30 mglL CST Name (Please Print) re CST Number ~ 25 9 Address Date Evaluation Conducted Telephorre Number Properly Owner T~K~ ~~ 1 ~C/n5 ParoellD # . •,- Pam z ~ ~ • ®Pit Ground surface elev. 9 O ft D~th to limiting factor ~_ in. Soil ication Rate # ~ ~~ tion dox Descxi R Texture Structure Consistence Boundary Rooffi GP D/Er= Horizon Depth in. Dominant Munsell p e Qu. Sz. Coat Color Gr. Sz Sh. 'Eif#'1 'Eff#2 l 6-I io -- sll Zrn ~~ . 5 . $ 2 3 l4 38 3$_Sy ~ I I r y 3 `-- `- 5u 5~ 2rnsbk Z mSbk v~ c s cv.l --~ -- . y • 5 . (o . ~I `+ -cat la r y Il9 F I F ~ s y 13 5 L ~ rnSbk. ~ - J . ~'l . Lo ^ Pit Ground surface elev. ft Depth to leniting factor in- Soil lication Rate ~~ # ^ t C b i D Redox Descxiption Texture Structure Consistence Boundary Roots GP D/f~ Horizon Depth in. o r an nan Munsell Qu. Sz. Corn. Cobr Gr. Sz. Sh. "Eff#1 'Eff#2 ^ Pit Ground surface elev. ft Depth to limiting factor in. Borg # ^ ~~ Sod Rate th D t Cobr i D Redox Description Texture Structure Consistence BourMary Roots GP D/fF Horizon ep in. om nan Muns~l Glu. Sz. Coat Color Gr. Sz. Sh. 'Eff#1 *Etf#2 "Effluent #1 =BODE > 30 _< 220 mglL and TSS >30 < 150 mg/l. ` EfftueM #2 = BODs _< 30 mgA. and TSS <_ 30 mgll. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07/00) E PAGE1~OF 3 .51 NAME ' n LOT# LEGAL DESCRIPTION N E '/ '/4 S I F T 24 N R I ~- E or SCALE: I"= v BM I ELEVATION ~ UO • d ~ X BM 1 DESCRIPTION l1a ~ l ~'~ Yy po~pre ~feP '~' ~' BM 2 ELEVATION IQO.O ~C BM 2 DESCRIPTION 41 u .' 1 ~ • n 4{O ~ •;~00(~ « e SYSTEM ELEVATION Y3.3Q ALTERNATE ELEVATION q 3' 30 CONTOUR ELEVATION Q3.G0 ~ 9y GQ ~. ~oc..l~ ~ r ; Pe s Ystcrn orl ~7r ~_ V B-3 ^ B - •` P ~ \ ''~igrr A <~ ~ ^ a-Z \ j3M l / • ~ 9 ~ 6a gM2 \~~ 0 y- s = ~i Private Onsite Wastewater Treatment System Management Pian S®ptic Tank And Gravity in-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Tre System (POWYS) shall include information and procedures for maintaining the system the parameters of Comm 83 and 84, and the conditions of approve[ by the department or governmental unit. The approved plans and permits for system are on fife at the zoning ar health department. This nagement plan complies with Comm 83.54, Wis. Adm. Code, the In-Ground Soil Absorptio ompanent Manual for Private Onsite Wastewater Treatme ystems SBD- 10567-P {R.6f99). Table 1 • S stem Desi n Specifications • y Sanitary Perms umber Number of Bedr s Desi n Flow -Peak { ~ ~ Estimated Flow - Avera e (p o0 Se tic Tank Ca acity ( al) ~~ Soli Abso Lion Com onent Size (ftz T pe of Wastewater Domestic r..w.. ~f. t"..a e4.~.,~r.+inn r'•_nrnnnnpnf Its o$ RellBble Op6ration Qi.71® i. vvn .r+~rvv~ prwa a v.w...R.....~.. -- -- - Se tic Ta Com ent - Soil Absorption Com onent Desi n Flow -Peak ( d) 00 ~ Maximum Influent Particle Size (in) 1l8 Maximum BODE (m } 220 Maximum TSS (m /t) 150 Table 3: aintenance Schedule Septic Tank In ect and/or service once eve 3 years Outlet Fitter ! ect once a year and clean at least once ev 3 ears ~nii Ah~emtion Comnt~nent snect once every 3 years Septic Tank The septic tank shall maintained by an individual certified to service septic tanks under s. 281.48, Stets, The ntents of the septic tank shelf be disposed of in accordance with NR 113, Wis. Adm. Code (S icing Septic or Holding Tanks, Pumping Chambers, Grease - Interceptors, 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 shaufd 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 Manag®ment Plan foe a Septic Tank and So11 Absorption Component filter is equipped with sn alarm, the filer shall be serviced if the alarm is activated continuously. Intecrnitient filter atarrtts r1~Ay Indicate surge flows or an impending continuous alarm. The septic tank •h8tl have Its contents removed when the valurns of scorn and sludge to the tank exceeds i/3 the llquk! volume of the tank, If the contents of the tank aro net ron~oved at the time of an assesscrient- rrtain~riance paroonnel shell advise the owner of when the n service Heads to be performed to maintain lass than maximum scum end sludge eccumulatiOn in the tank, Marsh risers, ecGess risers and covens should be inepectad for watt tlghtnass and soundness. A are opentngs used for sarvftai and assessment shell ba '~ led watertight upon the rAmpletlon o ervioe. Any opening deemed unsound, dafectivef ar ~a sect to fatiure must be replaced. ,Expo.. access openings greater than 8-inches in die shall be secured by an effective loc~drtg d ice to prevent a~idental or unauthorized ant into the tank. APo one ah enter a saptFc or otter trwbnan! holdlnp bnk a-or any raasorr vvlth h+rlrtgr !a tuft cornpllsn+crr wr atsnda~nds !br entetit~ a apace. The ~ttmoaph~ w! fn firs septic or other trwr>t of boleti nk may contain Hntial wy and rescue at a psraor~ thorn the Irttsr at fife tanlr may ba cult or lmpoasibh. Tank abandonment shall be ~ cdanar with omm 83.33, Wts, Adm. Code when the tank is no longer used ee a IsOWTB co rtent The Boil absorption component servin is cturo Is designed to accept domestic wastayvater from a residential facility. Ths ii of lion of this component are shown ir1 Table 2. The longevity of a X01! absorption ponent daps greatly on proper and ttmaly maintenance, end system use within or aw the limits afro le aperettan. Oaad water cansarvatian practl+c~ by aril aacupant and the lnstallatlan of ar conserving plumbing 1~xtures ace logy furs in extending ueefui life of this tampon t. Ths soli absorption come once every three greara. The ins the oi~ervarion pipes, and a vim Pram the component. On steep! reported to the owner far repair from the system Is prohibited n t`s aparatian moat be sasses lnapbctian at least ion sha11 Include retarding the isv of ponding- if any, in lnspectlan for any evidence of aorta apege or discharge doping sites- areas of erosion ehauld be ttfled and 'he surface discharge of domestic wsstewa ar sewage considered a human riselth riatard. Traffic around ar aver ~ia soil absorption component should be avoided particularly during winter months, The compaction or removal of snow cover over #hs component rt~ay lead to hydraulic failure by freezing. This type of failure is usually temp8rar"y'. butte dlf8tult or Impossible to repair until weather candltions improve. in general, soli compat#'san over thin component will radur~ diffusion of oxygen iota the soil and diepsraaf tali, whtth may lead to mare intense, and earlier, organic ciagging of the solo. i%~ . ,° I • r ~ ;, ' Management P}an for a Septic Tank and Soil Absorptiarr Component Plantings of deeQ-rooted frees and stuubs dfrectiy o+rer of w4thin ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater #t Cotrtingency Plan In the event of system >Eeliure, a new system could be Installed in a senate area. With the ina#aliatfon of a diverter valve, the existing system could also bs r® after a period of three to four years, it is the props rrs responsibi}Ity to melntain the ate arse free from any planting of trees, shrubs, etc, in of failure of the or}gina} syste hs aitemste anw will be needed, if arry gees, shrubs, etc. w bean ptanted on the alts srea} they will have to be rsmavsd et property owners expan if aiterrtate arse is destroy , (here are oth ltemative systems that oars tae used, in which, could r~suit in added expense t e props er. r Any tank abandonment shell be accordance with Wisc. Cods 8,33. Any Questions regarding this Dods, please content y i Zoning Office yr contact the installing plumber. S ~, w.rr. o»1r',,~.,.ri. v~, mr,1~ ~ na c~ ~ t S~ 3 `$ to ~ 3 4 ~ ~ . '~ ; ~~ '. ~ ST GRQIX C4UN"L`~'~RS SEFTIG TANK MAINTBNANCB A ~MENT '-AND OWNBRSEiIP CBRTIFICATIC)N FGRM I~ , t 7 i~5 ~,~ - .. -- ddress ~ o ~ ~l .~ f S v /' ~ o tailing ~~~ (Veriftca ion required from Flanning,Depattment for new Parcet Identi~eatian Number G `~ ~'~ o ~ty/state a m ~lz ~~..~.-~-- ~!(.~.t~Y1~ ~~' 11l.Rll .~...~=-= - ~ Sec. f 7 T.~N-R-~~' Town of ,.,~~2. m rno r~ ~. u Lot # 3 pub&vis~an dad Volume /~ ,.Page # ~(Q ~l~ Certlfi Survey Map # ~'~ page # Deed # Volume ~'C'arran~y ~ Lot lines identifiable ~ yeS C1 no ho,~se a yes ~ na reurature failure to handle wastes. Proper uiainte~ce ~' ~ ~ ~~"~~~ ~ tem could result in its p usa and maintenanceof your septic sys b a licensed pumpeT• What you put iato the system ~~ paging out the septic tank every three years or sooner, if needed Y to the waste disposal system. Cott a~ the fitnCtinn pf the Septic tank as a tPeatment stage atiment a cettif cation form, signed by the owner and by a ~e rppedy owner agrees to submit to St. Croix. Zoning Deg that (1) the on site wastewatcrdtsposai system p lumber, reshictedpiumbor or a liccnscdp~r v°n~'ying the ties tank is less than l!3 full of sludge. n7astGrplr',lourttcYP Lion and pumging (if ncrss ary), ~P is ~ prom operating condition andlor (2) after insgec II taro the private sawagc disposal system ~~ u1e stance State of Wisconsin- Cartiftcatt°n Uwe, thc~undcrsigned ltavc d the above requirements and agree torment of Natural Resources. Office within 30 set forth, herein, as set by thDepartmcnt of Commerce and the Dep ttc tem bas been maintained must be completed and returned to the St. Croix County Zoning statir<g t your sap ' ~ days of a three year cxpizatinn date. ~O/ o /Llr4 ~ DATE ~ A Or APPLICANT R C~RTL~CAT~UN our knowledge. I (we) am (are) the owner(s) of I (wc) certify that all statements on this form are truce ded ineRegister of Deeds Office. the gro crty desc~ibad above, by virtue of a warranty dead re /D / /D/ G l ~~ DATE NAt OP APPLICANT «****• ~ t being revoked by the Zoning Departrucnt' ««««« Any inforxrtatian that is rnis-represented xnay result in the sanitary p~ Iicatian: a statnpad warranty decd from the gegtster of Deeds office +• Inc ude with thts app a cepy of the certified survey map tf reference is made in the warranty decd ' ~,~~ i66 ~ P~<< ~ DOCUMENT NUMBER LAND CDNTRACr 6 4 8 3 96 KATHLEEN H. WALSH kEGIS7Ek OF DEEDS ST. CkOIX CO., WI RECEIVED FOR RECORD CONTRACT, by and between Nilliam E. Nsrkins ("Vendor", whether one or morel and Midwest iQuities, LLC {»Purchaser" h h 06-15-2001 10:00 RM , w et er one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and: .full perlormance of this contract by purch LAMD CONTRgCT aser, the following property, together with the rents, profits, fixtures and other EXEMRT N appurtenant Interests (all called the "Property"), in St. Croix County, State of Wisconsin: CERi COPY FEE; COPY FEE: Lots One (1), Two (2), Three (3) and Four (9) of Certified Survey Map d TRRNSFER FEE• f4ti.90 kECOkDIHG FEE: 1.00 recor ed May 29, 2001, in Volume 15, Page 4097, as Document Number 666720 ae located in the Northeast DES' 3 Quarter of the Northeast Quarter (NE 1/4 of NE I/4) of Section Seventeen (27 ), Township Twenty Nine (29) North, Range Seventeen (27) Weat, Town of Hammond, St. Croix County Wi , sconsin, NAME AND RETURN ADDRESS l2od 1' , ~~wz ~ ~:1 P s~ ~ 018-1036-70-000 Parcel Ident lcation Number This is not homestead property. Purchaser agrees to purchase the Property and to pay to Vendor at the sum of $a8,300.0o in the following manner: (a; $32.400.00 at the execution of Chia Contract; and (b) the balance of $15,900.00, together with interest from date hereof on the balance outstanding from time co time at the rate of six percent (64) per annum until paid in full, as follows: On June 11, 2001, Twelve Thousand Four Hundred and 00/100 Dollars ($12,4ao.0ol and on July 11, 2001, the halxnce in f••ll Provided, however, the entire outstanding balance shall be paid in full on or before the 11th day of July, 2001, Following any default in payment, interest shall accrue at the rate of 12t 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 asaeaementa, fire and required insurance premiums when due. To [he 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 race specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time after date of closing. In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as ~.:npaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as E:rsc specified above: provided that monthly payments shall be continued in t..*.e event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Purchaser states that Purchaser is saciaf ied with the title ae shown by the title evidence submitted to Purchaser for examination except No exceptions. .y ~Jt1N-c''i5-~ 1 ' .. TUE 15 G °9 NELSEN-IJESEE LRND SURti~EY 1 713255661 1 • . c=r. c ~ ~ a g Q '"''' t w ~ ~ ~ ~ Wi c .. ~ 0 n. ti U ~Sd ~ r cc '~ w 2~a ~Y ar x ~/~~~Y r4 W W Ul G7 Wr-S' ~ ,~'~ 0 cv ~ ~+«'a ac _s r. ~" ~ ~JCn LI ~Iti ~ ...~~ ~cri . W ~1Z Cn k CERTIFIED SURVEY MAP L OGATEb ! N THE NE l /4 OF THE NE ! /4 OF SECTION 7 7, T, 29N.. R. ! 7W. . TOWN OF HAMMOND, ST, CRO/X COUNTY, WfSCONS/N t NORTH QUARTER CORNER NORTHEAST CORNER SECT t ON 1 T - FOUND NORTH L WE OF THE NE /i4 SEGT f ON 17 - FOUNf~ 2' IRON P ! PE AL UMI NUM IyONUf1~NT 26oz. 2a' _ _ _ _J ~- - - - N89 ° 04' ! 4' E l 00 f h o, N83° 04' 14' E 685, 60' w _ - - (9 ! 6. 68; ...... - °? 326. 30' w 353. 30' .~ t/~N(~E~ r ~ -- -- p ~ ~ 326. 30' ~ 326. 30' 1 O g w v N89° 04' I a' E $ w $ 652. 60' ~ $ - O ~ HIGHWAY....-.....SETBACK o N ........................... ~ oN,I $ cO~ w g ...... - ..... `: v LOT 2 ~,, r -" gt o ~ 8 2 L OT ACRES ~ $ 2. 47 ACRES ~ ~ ~ ~ : -~ c., 107, 789 SO. FT. 6 6' ` $ 97, 889 So. FT. g p, 00 AGRES EXC, R/W ^' 1 m '=~ 2. 00 ACRES EXC. RAW o g 7, I P 1 SO. FT. ~ D ; CN g 8 7, 12 t SO. F T. 0 33. 00' ~ : n 326. 30' S89°04' f4`W 326.30' S89°04' f4'W 359.30' ~ :~ ~, 33' 33' Z PREPARED FOR : ~ - ~ ~ ~ a WILL l AM HAWK l NS ~ LOT 3 g ~ $ "' o `" " ~ -- ~ ------ ~„ 2. 47 ACRES $ ~ $ JOT, 789 SO. FT. o ~ ~ ro '- ~ 2. 25 ACRES EXC. R/W g ~ °- ~ w ~ LEGEND w 97. ess so. FT. c, ! ~ ~ r c g t ~ -~ = HIGHWAY SETBACK; ~[ , ~ t O SET !"X24" IRON PFPE {+YEIGHING :Zp ~ y. LlNE326.30' 33_/O`O~ p I~ ~ ;r !. 13 LBS. PER L JNEAR FDO7 ~(" ~ Q O 1 ~..~,p MM~~ ~~ : a - O - GOVERN~rr` ~E~~S NOTED '~ 589°04' 1'4°W 359. 30 ($ ~ ~O :rn A :-1 ST. GRP~x COUNTY N89° 04' ! 4° E 3',59. 30' Ptann+nq Zuninq and Parks Committee ~ d ( : ~ f-, 326. 30' v, 33 00, MAY 2 9 2aa~ 4 ~ . . /dl GNWAY,.. .,_,.__.~_ ~I o ' T y S 4f not recorded witflln 30 days of ` ~ cwo. LOT 4 m ! 00' ~ ~ ~ ~ gp¢(OY3f ~L' AQPfOVaf St13ff (?@ A i~1lar~cSvoid w 2. 47 ACRES ~ ~ ~'.~ g ( ~r ~ 107, 789 SO. F T.: '^ ' N z. 25 ACRES EXC. i R/W ~„ ~ :~ ~ , -' pc~ 97, 889 SO. FT. : $$ :-i -~ - 33. 00` 326.30' ~ : I ;r -------- S89°.04~--./4.°.W...._. 3~9. 30~- - z - -~ r g 1. .. ------~ ~ UNPL ATTED LANDS I ~° " ~ j ~ ~ ................................- m ~ f~ ~ EAST QUARTER CORNER SECTION 17 - FOUND 2' 1 RON P 1 PE „ ``l`~~~~lC tist~~ttl~~i~~~~`o BEARINGS ARE REFERENCED TO THE EAST -:'~~~ ° S'/~~~i L I NE OF THE NE f iq, SECT / ON 17, c~ MIEASURED AS SOO°39~ 03'E. CST. CROfX ~~?~ JAMES M. COUNTY COORD fNATE SYSTEMS i.,' ~ ~~ ~. r: ~ ~;r rN 4 4:.~ O O 75 t 5 0 300 SHEET l OF 2 JAMES .~~, ~, yMg. 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