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HomeMy WebLinkAbout018-1094-03-000' ~y0 M 3'Dn c C I~! F ~ ~ 1 O ce 3 W ~ ~ ~ ff A y # {~ i ` I I ~~ ~ ~ ~ ~ n I ~ 0 ~~ ~SZ ~~ ~ ~~ ~ • _' ~ ~~ 3 fD ~ y N ~ 3 N ~ MCI c l °'c w ~o ~ ~ ~~ ~ I ~ O ~ -I W w ~ I~ ` 1 l o~ c O r. O A'+ 0 J~ 0 y O C ""' /l ( 3 y C GO 7 d v m I y to v ~ O o a ~ m `~' ? W a rn I ~ ( Qo~ o? I ~ O ~ ~ ° ~ ~ ~ N ~. ~~ ~~ o I Z~ O 0 0 3 i n o c a ~ ~' ° ~ 3 '~ c ~• ~ ~ M I a ~ a; ~ ~ ~ i ~: t~l O O O ~ o O 'o ~ ~ ~ ~' w ~ 0 3 wcntno v ~ I .. ~ ~ ~ m ~vv,cn ~ eo y _ m ~ _ ~ 7 N 3 .. ~ ~ 7 Z 'M C/ 77C =~ 7 O ~ x~ 3 O d ~ ~ A ~ I • m m ~ K N ~ c ~ ~ N I w ~' ~ °-, ~ a a I o. ~ ~ ~ m N -+ -i C/1 ~ 0' ? ' N p~ O A Z COf ' n f D w ~~ ~ p ~ ' ~ A Z O w w ~ _ O I o ~ ~ .. f ~ Z -I ~ w ~ W ~ ~ ~ I °_. < e. ~ .~ Z O C ~ I Z ~ ~ ~ ~ N 3 C m C G (/~ Z fD ~ i .p w I ° w m a ~ a ~ t m a^' • o" o ~ I _T;am'o'm ~ ~ 3'0~- c o ~ 3 a ~o i ~ N N ~ ~. 7 41 O a y O I ~ o m m y g o ~~ ~ . ~ ~ cCD c A o S3 c ~ I ~ a c~ ~ O mom Q ~ N i p d i N N. N 7 O ~ I ' f ~+ °o I ~ I o w I ~ aro w O ~°' ~ ~ a c n ~ ° ~ i ,~° o ~I ,r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Midwest E uities Hammond Townshi CST BM Elev: w a~ lJ Insp. BM Elev: iu v. z~ BM Descrip o n: f- s,7~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~ , r W Aeration ` ho ~' Holding TANK SETB/~CK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ ( ~- ~ ~- Dosing V Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Nu r TDH Lift riction S stem Head TD Ft Force m Length Dia. Dist. to well ELEVATION DATA County: St. CfDiX Sanitary Permit No: 453216 0 State Plan ID No: Parcel Tax No: 018-1094-03-000 Section/Town/Range/Map No: 17.29.17.743 STATION BS HI FS ELEV. Benchm .~ Jo3 • ~ c7 Alt. BM r /1 ar S/~ ~ -r Bldg. Sewer 3 0 .5 ~ ~ ~' ~.~ SUHt Inlet , I 'j 93. St/Ht Outlet ~ (93 -/ 3 • Dt Inlet ~- _~ Dt Bottom -~ ~- Header/Man. ~ Gy ll ~ 3. ~S Dist. Pipe f f R 7 q~ Z~ Bot. Sy tem ~ 0,~ Q 2 Final Grade / .-----'" .b ~ ~~--~ /_ ?o St Cover r'~ S ~c,2~> SOIL ABSORPTION SYSTEM D ~~~ 07 ,Fy4 ,~olCiS%/~ _ ~ 7S ~~-' BED/TRENCH DIMENSIONS Width t Lc;~gt O vx No. Of Tre hr~ es "41,-_'__ PIT DIMENSIONS -"'- N . Of Pits side Dia. Liquid,Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WEL LAKE/STREAM LEACHING CHAMBER OR M r ~ ~ Ty Of System: // ~ ~ / >~~ 0 / -J ~~ ~'' UNIT Model Number: J31~STR~UTION SYST~~1„ ~ 4~- JVE C~~La~./ Header/ ~fok(~^ tk t"11 ribution //~}} / r x Hole Size x Hole Spacing ~-----~ Vent to Air Int~k ~'' !r / Pipe(s) ~(i' 7 g ~7 ~ ~ Length Dia Length Dia Spacin . SOIL COVER x Pressure Systems Only xx Mound Or At-Gra a Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [] Yes ~ No 0 Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_~/ y ~/~ Inspection #2: / / Location: 988 166th St t~~/4 17 T29N R17W) Prairie Run Lot 3 ~ ~ Parcel No: 17.29.17.743 1.) Alt BM Description =~ ~~-5~~~ ~ ~ -~ .S 2. Bld sewe~len th = ~~ ) -amount of cover ~ 7 ~ ~ ~~~~ ~$-2a ~~ /Z.vrn~ ~1^'t~ -~ ~. ,~ ~r~ ~ f" ~ ~ _ --- ----,-C~~ s'-----p -__~----, Plan revision Required? /Yes [] No i ~ Use other side for addition in rmation. __--- ._~. ---_~_-_i ~ __-_- _._ -_-___- -------_-_---------------__-----J I-_- ~--- -- -_ S8D-6710 (R.3/97) Date Insepctor'~Signature ert. o. 5~ Safety and Buildings Division County ~ , 201 W. Washington Ave.., P.U. Box 7162 ` ,~~~~~,n iVladisurt, ~Vl 5~"107 - 7162 Sanitary Permit Number (tv e filled in by Co.) (6L"8) 266-151 l.~,r?J ~ ~ (o Department of Commerce Sanitary Permit Application state 1?lan I I). xutnker ~.: personal information you provid Code Itt accord with Comm 83 Wis Adm 21 PAID , . . , . may be used for secondary purposes Privacy Law, s15.04(lxm) Project Address (if different than mailing address} I. Application Information-PleasePrintAlllnt'urntatio" °`"" ~t,,~~~~~~:,"~"'-'l ~~~ Property Owner's Name t Parcel # Lot # Block # ,• ~- ~ '~„ ~ ©f$- I09 -03- taro C.~`{3 Property Owner's Mailin ess Property Location ) City, State Z.ip Code _ '„ t c, ~-,„~~y~,,,•,_-„_, -----~-- s - - (circlo 0 '1'~ N; IZ~E or~' II "Ty e of Building (check all that apply) ~--~ . p G V"", SubdivisiunName f'tihl Vt!mher 2~ ~I or 2 Family Dwelling - Number of Bedroorns ^ Public/Commercial -Describe Use ^ State Owned -Describe Use 2~ 3 K S , ~~ ^City_^V' age.l~4'ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ~ New System ^ Replacement System ^ TreatmendHoldin Tank Re la~ement Onl g p ' ' y ^ Other Modification t0 Existin S.rstem g B• ^ Pemtit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued $efore Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a I Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed W:~tland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Dri Line ^ Gravel-less Pipe ^ Other (ex lain) V. Dis ersal/Treatment Area Information: _. Design Flow (gpd) Design Soil Application Rate(gpdsfj Dispersal Arta Required (et] Dispersal Area Proposes! (at) System Elevation S O V .Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed •Glass Ncw Existing Tanks Tanks Septic or Holding Tank Aerobic Treaunent Uiut Dosing Chamber VII. Responsibility Statement- T, the undersigned, assume responsibility for installation of the POWTS shown ot- the attached plans. Plum er' a (Print) Plumber's Si t ~ MP/MPRS Number Business Phone Number i. .. i L Plumber's Address Street, City, State, Zip ode) VIII. Coon /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fee) Date Issued ui Agent Signature o Stamps) ~ ^ 0 iven Reason for Denial ~ 250 ~ ~J ( IX. Conditions pprova 1 SYSI"EM OTNNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable codebrdinances. Attac4 complete plane (to the County only) for the system on paper not less thrn SIR x 11 itches In siza- SBD-6398 (R. 01/03) ~ ~ ~, ! \ ~ ~ l ~~ ~ ~ ~ n ~~ 2oubc Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page ~ of 3 ,,, ...,.,.,,..~,,.,., ....., ..,,,,,,., .,.,, ..,~. ~.,.,,.. .,,,..G County C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must r01 - include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~/ \ /~i Property Owner Property Location ~ ~I k Govt. Lot W 1/4,f/~ 1/4 S / ~ T T-q N R / ~'-E (or~ll Property Owner's Mailing Address Lot # Block # Subd.,Name or CSM# City State Zip Code Phone Number ^ City ^ Village [~ Town Nearest Road -lo{titwwrrtd wt Spa/ S (7/S) 79'lo-Z ~9j f~ w. vr~o-1.~ ~G~ ~ ~-. [~ New Construction Use: [~ Residential /Number of bedrooms .~~ Code derived design flow rate y.S~/ G m ~ GPD ^ Replacement ^ Public or commercial -Describe: Parent material / 'T ~ I Flood Plain elevation if applicable _ ~/ ~ ft. General comments Sys~et~ e (t J. 9~j, jU Gaw< ~ cj' '~ ~tJ , and recommendations: a (~w.er .~,~ ~/ ~,~, Ql~f/~ Q ~ Co Q © Boring # ^Boring ® Pit Ground surface elev. . U a ft. Depth to limiting factor ~1 ~ ~ '` in. , Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Cotter and Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ` *Eff#1 *Eff#2 I - z l0 12 s~ I ~ s ~.~ • 5 S 3 3y-10 - Sl. Z - . ~ . `~ Boring # ^Boring ®•Pit Ground surface elev. ~ ZC~ ft. Depth to limiting factor ~S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 z 1 Z -3o ID y /3 Sic.l zm5bk mfr c 5 - 3 3~- o (d ~ Zms.bk m-~r c.5 ~ . 5 .9 4 0-85 ry n-ts d ml "- - .~ l.2 "Effluent #1 = BODS > 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) i nature CST Number ~-c~-, Sc h u,~,ak er- ~ ~- 2S33o ? Address Date Evaluation Conducted Telephone Number Zll3 8U~ J~, ~rner-~.e~ DUI ~S~IdZS //-2~-d ~ ~~i~~2~/7-`/~t1/ .~ ,~ ... StSU-SSSU (KU //UU) Property Owner ~Lti 1 1 S Parcel ID # Page ~ of 3 a Boring # ^ Boring ~~ ®, pit Ground surface elev. /Uo•~~ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ o-I r3/Z - Si l rr~r cS (-~ . 5 .8 Z I - 413 Sic.- k rn~r c.s - y -~ I ~/ `-' S ~ 2m mfr c s - ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soit Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 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 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) ,: .' ~~ PAGE~OF~ NAME ~ (,J~ ~ , ~ 5 LOT# ~ T EGAT DESCRIPTION /UW ~ tiE ~4 ,S l ~- T ~R ,N R, / ~' E(or~~ SCALE: 1"= ~G/ f BM 1 ELEVATION ~yU • ~ BM 1 DESCRIPTION-Eo D o ~- ~ i P vc 0 ~' P 2 BM 2 ELEVATION q9 $ U l '~ BM 2 DESCRIPTION ./, P a -~ ~~ p v c PrP<- -,-- SYSTEM ELEVATION ~ip QK• 3U 1-awe r- 9 ~. ~o ALTERNATE ELEVATION ~6~ cl ~•. (~ O Gou,t~ q ~. Z y CONTOUR ELEVATION 99. yy I~G -o 0 1 K ____ + ~-- 1 SrG~ /~- v I~ ~~ ~r n . ') A d ~~ I~13 a~ i ~' SIGNATURE ~ ~ ~ ~ DATE / Z /S = d/ POWTS OWNER'S MANUAL & MANAGEMENT PLAN )RMATION ~ ~ "•'` _./,~ 3- ' _ ~' SYSTEM SPECIFICATIONS Owner ,~ _. ~ , Permit +a S ~ Z bESION PARAMETERS Number of Bedrooms ~~~ ~ .,;4 ~,,:^ . O NA Number of Public Facility Units ' PIA Estimated flow (average) allda Design flow (peak), IEatimated x 1.5) al/da Sail Application Rate , .. .~, al/da /ft' Standard Influent/Effluent Quality' `"' Monthly average" Fats, Oil &Gresae (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L O NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand 160061 530 mg/L Total Suspended Solids (TSS) -530 mg/t. f~NA Fecal Coliform (geometric mean) 510' cfu/100m1 Maximu•n Effluent Particle Size Y6 In dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. M/1tNTENANCE SCHEbULE ~ ~ ~ "~~` Page ~ of ~, Septic Tank Capacity al ^ NA Septio Tank Manufacturer ~. ~ ,-- r O NA Effluent Filter Mmufeoturor - O NA Effluent Filter Model ~~ ^ NA Pump Tank Capacity al .f~ NA Pump Tank Manufacturer ~ NA Pump Manufacturer ` ~'NA Pump Model ~ ~ ~ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: . ~ NA Dispersal Cellls) ~ In-Ground (gravity) ^ At-Grade ^ Drip•Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other; Other; O NA __ Other; ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ monthls) (Maximum 3 years) ear sl ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,1 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ~ ^ month(s) (Maximum 3 years) ear(s) ^ NA Clean effluent filter At least once every: ^monthls) .3 {~ ear(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) O earls) ANA Flush laterals and pressure test At least once every: ^monthls) • ^ earls) ANA Other: At least once every: ^monthls) ^ eaf(8) ~A Othor: ^ 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 tank(s) 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 inapeoted to oheck the effluent levels (n 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 and requires the immediate notification of the local regulatory authority. When the combined aocumulation of sludge and scum in any tank equals one-third IY,1 or more of the tank volume, the entiro contents of the tank shall be removed by a "Septage Servicing Operator and disposed. of in aocordanoe with chapter NR 113, Wisconsin Administrative Code. `~ •• '• All other services; including but not limited to the servicing of effluent filters, mechanical or pressurized..components, pretreatment units, and any servioing at intervals of S12 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. t3MW '41011 Page ~ of ST,1RT UP ANO OPERATION F ~r new construction, prior to use of the POWTS check treatment tankisl for the presence of painting products or other chemicals tl at may impede the treatment process and/or damage the dispersal ceiils-. If high concentrations are detected have the contents o ~ the tank(s) removed by a aeptage servicing operator prior to use. System start up shall not ocour when soil conditions ors frozen at the infiltrative surface.. .~ G ~rinq power outepes pump tanks may till above normN hiphwater levsb, When power b restored theF exosss waitweter will be discharged to the dispersal De(lls) in one large doss, overloading the oellls) and may result in the beokup or surfsoe disoharge of e+fluent. To avoid this situation have the contents of the pump tank removed by a Septage Servioing Operator prior to restoring p wer to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to rc More normal levels within the pump tank. __,.,__ _ __ Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down elope of any mound or at-grade-soil absorption area. ,, ;,f t Deduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the P~WTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; p Hinting products; pesticides; sanitary napkins; tampons; and water softener brine. AB.\NDONMENT W yen the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pka shall be disconnected and the abandoned pipe openings sealed. • The coatenta of ail 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.ba taken, to provide a code compliant ` replacement system: _ . ,~ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area.. Replacement systems must comply with the rules in affect at that time. ^ 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. 0 Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface, Reconstruotiona of ouch systems must comply with the rules in effect at that time. SE°TIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL (SASSES AND/OR INSUFFICIENT OXYGEN. DO NOT EN rER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RE8ULT. RE8CUE OF A PEi2SON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS ,;, .. ..,, .,r ; .. POWTS INSTAL R r POWTS MAINTAINER Nar ~e ~ Name Phone. - - Phone SEPTAGE SERVICING OPERA~dR ~'UMP~R LOCAL REGULATORY AUTHORITY Narns Name Phone Phone '`' rhlr doc ~msnt wee drafted In oompllanoe whh chapter Comm 83.22(211b-Itlldl&Ifl end 83.64111, 12) & 131, Wisconsin Administrative Code, owner/Buyer Mailing Address Propariy Addt-ess S7C' CRQI(~C CtD~JN~"Y SEPTIC TANK- MAINTENANCE AGRL~EMLNT -AND OWNERSHIP CERTIFICATION DORM ~ ~ ---~-~ ~sC-Ck~. 5~ ~~G~-~ ~ L r ~cv r 0 (~ ~C (Verification rec7uired from Planning Department for new 1,J~ S'f4o ~' City/State ~~-~Z~'1GY1 C~', ~~ Parcel Idec~tihcation Number O I $~ ~° q~'~ ~~ ~ ~ ~ ~~3 ~ I.,TGAJ~ DrSCRXP'1CT(_D~ Property Location Subdivision '/. 'J,, Sec. T ~' I.I-R~~W, Town of ~~~~~°'~-~ .,~_ _-l_ z-~ ~-~- ..~(..~. ~T~ _ - Lot # Certified Survey 1~7ap # ~--- . Volttnie Page t~ Warranty Deed # y17~ 7~/ . Vottttnc ~- 2-~~~ ,Page ~~ Spec house D yes no I.ot lines idetififiable byes D xzo SY~'TI;M[ iVfA.ZN7:'I{,NANC~ Improper use and maintenanceof your septic system could result iu its pretuature failure to handle wastes. Propermainteaancc consists of pumping out the septic tank every tltrec years or sooner, if deeded by a licensed pumper. What you put iato the system can afloat the function of the septic lank as a freattztent stage in the waste disposal system. The property owner agxees to submit to St. Croix Zoning Department a ccrtific;ation form, signed by the owner a>xd by a rnastprplumber,jonrneyman plumber, restricted plumber or a licensed pumperverifyiug that (1) the on-site wastcwaterdisposal system is in proper operating condition and/or (2) a(ler itaspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwc, iltc undersigned have read the above rcquirccneuts and agree to suaintain the private sewage disposal system with the standards set forilt, herein, as set by tlic Dc~arintent of Conttncrcc and ilte Ucpartuteut of Natural Resources, State of Wisconsin- Certification stating ilLat your septic system bas beta maiutaincd must be contplctcd and returned to the St. Croix County Zoning Off cc within 30 days of c three year expiration date. .~ ~Z~ a3 ATU : OI' APPI.ICAN-~ DATI: QWNI;R C~RTIA+'ICA'A'I:d3N I (we) certify that a!I statcnients on this form arc tntc to the best of my (oar) knowledge. I (we) am (arc) tha owners} of the pro rty described about, by virtue of a warranty clecd recorded in Register of Deeds Office. ~ i ~2i a NATU ~ Ole APPLICANT ~~ DATE y information that is rots-represented tnay result in the sanitary permit Gcing revoked by the Zoning Depart,,,cnt. *"`***« :.a.*+ a~ Iaciude with this application: a stamped warranty decd from tlic Register of Deeds oftice u copy oI' tltc certified survey ntal, if refcrcttce is made in tltc warranty deed 'J 2252P 3y0 DOCUMENT NUMBER ~ , NARRANTY DEED William E. Hawkins, Grantor, conveys and warrants to_Midw st E ies, LLC, Grantee, the following described real estate in St. rolx County, State of Wisconsin: Lots 1, ~ 6, 10, 11, 12, 13, 17, 18, 19, 22, 27, 30, 35, lA and 3A, Prairie Ru Town of Hammond. 7 C C 7 5 1 KATHLEEN H. VALSH REGISTER OF DEEDS ST. CROIX CO. , liI RECEIVED FOR RECORD 05/23/2003 02:20PM MARRANTY DEED EXEPiPT # REC FEE: 11.00 TRANS FEE: 594.00 COPY FEE: CC FEE: PAGES: 1 NAME ND RETURN ADDRESS /7? rOeSj` vi-}acs ~. L 9~r ~~/~~~fsf s~iib 18-1037-10-000; 18-1036-90-000 18-1036-80-000; 18-1036-70-050 Parcel Identification Number This is not homestead property. Exception to warranties: All easements, restrictions and rights-of-way of record, if any. Dated this S 3 day of May, 2003. (SEAL) William E. Hawkins AVTHENTICATION Signature(s) (SEAL) authenticated this day of 2003 (Sidnaturel (Name Printed or Tuned) TITLE: MEMBER STATE BAR OF WISCONSIN (If nat, authorized by 5706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED HY: Leo A. Beskar Rodli, Beskar, Boles s Krueger, S.C. P.O. Box 138 River Falls, WI 54022 ACIQiOWLEDCdD3NT (SEAL) (SEAL) STATE OF WISCONSIN ) / ) ss. -w COUNTY ) a ~ ~~~ • ~~22 ~) ~ J` Personally came before me thisQl:J ` :8ay~1i~'~M`3p, x903 the above named William E. Hawkins`' :~ n `' to me known to be the persons (s) whO•ex~~u~the F foreg in instrum t and acknowledge ••thQ.S~tte.0~ ~~ Si nature M,~ ~ ~ M ~ vryS, * C.~-`~.K.~' L' ` 1 V ~'. Name ~(',,r' `6d or T ed Notary Public ~k . ~o~n"'ty, 'wis. My commission is permanent. (If not, exoiratiori date:) ~~~ a~a~ ••-. ~... O °u oc y ~ in .~ . ~ _ ~.., _ M ~ .. ti 2... ° gOQQg. 47 . 2 ••••.a1 J Al ~ ~ w -----..... 3 N AREA M -g ~ g ._ g ~ . ~ °~°, S00° 39' 03" E 92 7. 12' :.~ ~ z a 22 7. 89' 22 7. 89' 216. 58' o ° 7. ~~ _ .,...-•-''' 129.98' ••.ti 313.48' a 3, W yA GE~.- ... N ~ ~ ~ 9 ~ ~ ~ .35 7.88' ~~~ ._ -- ~ w . ~23 ~ •~~' a a, ,,~ ~~ ~ ° ~ to ~ ~ .~; •~"o~, ti ~ ~ ~• •a.~ • e`' •` ~ ti• O "~ 5 8. 5 7 - - .. ~0 ~ ,~ 'o . , ;" ® ~' ~ , \ ~ ~M/ ` L ! NE ~'`' ~ ` N ' \` `` \ ` ~~ a3.8? \ ,,\ ~ ~ g ® ~` ~ `,\® `~ ~ 38,E a N O • .\ \Z ~ ` ~\` ~`\ W ~ ~ 520° ' 1, 0~ M W ~ ~~~ \ ~~` / `~` 322.07 N c~ ~ ~ cn z `` ~ ~,~~' ~ ;~ '' ~ ~~ ode, ~ \ o ~ .' M ~--~ ~ oar \ - ~ /': M ~ ~ ~ ~~ ,~~ era r ~j ~ 2 \ ~ ~~h Q V1 97. 73' 632. 00' 336. 03' % 66 520. 05' NO ~ ~ O ~' 49" W N-S ouARTER SEC1 ~ W~ NO 1 ° 01 ' 49" W 1962. 04' (TO SH ff~ . 7 w~7 !S~!S!S. R~' I rn 4r111TN I1IIART~R