HomeMy WebLinkAbout020-1479-09-000 County
�►+ 'w G Safety and Buildings Division
r✓ 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(m be filled in by Co.)
1 b7-7162
4
2
40� fv
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� State Transaction Number
�,� ermit App is on — ��,
In accordao0ld 3PS 38321(2 Wis.Adm.Code,submission of this form to the appropriate governmental unit
is required'pnor to obtaining a sanitary permit. Nobs Application forms for state-owned POWTS are submitted to Project Address(if diiiererrt than mailing address)
the Department of Safety and Professional Servies. Personal information yon provide may be used for secondary
in sho with the i Law s.15. 1 m Ste. Vb� A J
e
I
ApplIcation Information—Please Print All Information Parcel#
sProperty owner s Names c-a 4- O t _ 4+79 - a9- coo
Property Owner's Mailing Address / Property Location `.3 a 3o
J p Govt Lot
—C it bate Zip Code / Phone Number Q � _�/,, �'/ti Section t�
4t2--a JJ!`l C . 7��/ T�N; RL7`—'tE W II.Type of Building aU ply) �j
/ Subdivision Nano
1 or 2 Family Dwelling-Number of Bedrooms 1
Block
❑Public/Commercial-Describe Use ❑City of
CSM Number ❑Village of
❑State Owned-Describe Use sin of
S ., L)
III, o P it: (Check only one box on line A. Complete line B if applicable)
A. System ❑Replacement System �Treatment/Aolding Tank Repiacemau only ❑Other Modification to Existing System(explain)
B. ❑Permit Renewal ❑Permit Revision ❑Change of number ❑Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration aver
IV.T of POW'I S S stem/Com onenVDevice: Check all that apply)
❑Non-Pressuuized In Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>_24 is of suitable soil ❑Mound< sn a so
❑Holding Tank ❑Other Dispersal Componeut(explain) Afttreatmcnt Device( lain) 00
V.Dispersal/Treatment Area Information: Elevation
Design De sign Soil Application Rate(gpdso Dispersal Area Requued(sfj Dispersal Area Proposed(st) System
DO AS VL Ta Total #of snufscturer _
..
Gallons Tauter Gallons Units
New Tanta 8 rn C7 a
Septic or Holding Tank Ltd ;7 C.
Dosing Clamber
VII.Responsibility Statement-I,the undersigned, a responsibility for installation of the POWTS shown oil the attached plans.
Plum gtnature MP/MPRS Number Business Phone Number
Plumber's Nerve(Print)
ell
Plumber's Address(Street,City,State,Zip Code
VIII.Conn /De rtment Use On
Permit Fee Date sued Issuing Signature
App..d ° s A/d e3 (� 9
en Reason Denial
DL Conditi ns for Disapproval �' ;VG5 �t t
t ptia'tanli,efflu�snr fl�fe� rind° 3 w''S $74 ''^-
dispersal cell must all be services/maintained / �� ���
An—
as per management plan provided by plumber.
se(t a4k requirorrtisnts must be4naintairf€d S � d
ere per appWeai�ft t�ci orfJinaitices. 6`'
Attach to eomo to plans for the system and mbmit m the Comte only as pa/ not Imes tW 8 0 z I I ioehav is size� ,
SBD-6398(IL 11/11)
PLOT PLAN
PROJECT Scott Swanbera ADDRESS 2901 W. Armour Terrace St. Anthony Village Mn 55418
SW 1/4 SE 1/4S 36 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX
SYSTEM ELEVATION none BEDR OOM 3/4
CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE
400/715 Hoot System DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers
BENCHMARK V.R.P. To be determined ASSUME ELEVATION 100'
❑ BOREHOLE O WELL *H.R.P. SW corner of property.
YostDrive
Pro 3/4
Bedroom
House
30'
H-600 Hoot pretreatment system
300'
100'
30' Sanitary Easement
531' Property Line
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 6/5/14
Owner: Scott Swanberg
Location: SW 1/4 SE 1/4 S36 T29 N,R19W Lot 9 Cottonwood South Hudson
System type: Hoot Pretreatment unit H-600
Manuals Used: none
Page#
1. Cover Page
2. Plot Plan
3. Hoot Cross Section
4-6. Maintanance and Contingency Plan
Signature
License njer#226900
PLOT PLAN
PROJECT
Scott S
wanbera ADDRESS 2901 W Armour Terrace St. Anthony Villaae Mn 55418
SW 1/4 S 1/4S
E 36 /T 29 N/R
19 W TOWN
Hudson COUNTY ST.CROIX
SYSTEM ELEVATION none BEDROOM 3/4
CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE
4001715 Hoot System DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers
IL BENCHMARK V.R.P. To be determined ASSUME ELEVATION 100'
❑ BOREHOLE O WELL *H.R.P. SW corner of property.
YostDrive
Pro 3/4
Bedroom
House
30'
H-600 Hoot pretreatment system
300'
100'
1309 Sanitary Easement
531' Property Line
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page a
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner S � Tank Manufacturer. 4./&-44v ❑ NA
Pernik# ❑Septic
15 Dose ❑Holding Volume:%Grp ,jam (gal)
DESIGN PARAMETERS Tank Manufacturer: OCA
Number of Bedrooms: ❑NA ❑Septic ❑Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: ANA Vertical Distance Tank Bottom(s)to Service Pad: (ft)
Estimated(average)Flow: (gal/day) Horizontal Distance Tank(s)to Service Pad: (n)
Specific servicing mechanics must be provided N vertical is>15 feet or
Design(peak)Flag=(estimated x 1.5): (gay) N hafzontal is>150 feet. Specific Instructions to be provided on back.
In Situ Soil Application Rate: — (galiday/fe) Effluent Fitter Manufacturer: p NA
Standard(Domestic)Influent/Effluent Monthly average.. Effluent Filter Model:
Fats,Oil&Grease (FOG) 40•mgR Pump Manufacturer:
Biochemical Oxygen Demand (BODs) s220 mg/L ANA • NA
Total Suspended solids SS 1160 mgfL Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit — Gibr
(FOG) >30 mg/L - Manufacturer 13;60"- [1 NA
(BODs) >220 mg/L NA JZMachanical Aeration ❑Peat Filter
SS >150 mgA. bisinfection ❑Wetland
Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other:
(BODs) s30 mg/L Soil Absorption System
(TSS) s30�mgIL ❑ NA ❑In-Ground(gravity) ❑In-Ground(pressure) �A
Fecal Copform(geometric mean) s10 "
❑At-Grade [3 Mound
Maximum Effluent Particle Size 36 in dia. g'NA ❑Drip-Line ❑Other.
Other: NA Other:
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) [3 m When combined sludge and scu equals one-third(1S)of tank volume
❑When the high water alarm is activated
❑month(*) Maximum 3 years) ❑NA
Inspect condition of tank(s) -At least once every: IR 91 year(s)
Inspect dispersal cell(s) At least once every: ❑month(s) (Maximum 3 years) ❑ NA
❑year(s)
Clean effluent fitter At least once every: month(s) ❑NA
❑ s)
Inspect pump,pump controls&alarm At least once'every: months) NA
Year(*)
Flush laterals and pressure test At least once every:. month(s) NA
❑yea►(*)
Other: At least once every: ❑month(s) NA
❑year(s)
Other: NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and sop absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
Tank inspections must include a visual inspection of the tank(s)to identity any missing or broken hardware,identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil
absorption system 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 and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third(%)or more of the tank volume,the entire
contents of the tank shall be removed by a Septage Servicing Operator(pumper)and disposed of in accordance 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 servicing at intervals of S12 months,shah be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
GMW-005(02/05)
Page of
START UP AND OPERATION a'
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process'and/or damage-the soil absorption system. If high concentrations are
detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prim to use.
Pump tanks may fill above normal highwater levels prior to startup or due to,pump failures. Start up or restoration of power under these
conditions is not recommended,as the excess wastewater will bei-discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of efOnent.and damage ld the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to-the pump or contact a Plumber
or POWTS Maintalter to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. Do not.drive or park over, or otherwise disturb or compact,the
area within 15 fed down slope of any mound or at-grade soil absorption.area.
Reductlon or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment
tanks and soil absorption system: acids, antibiotics, baby wipes,-cigaretta"butts, Condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain(sump pump)discharge,fruit qpd vegetable peelings, gasoline, greases, herbicides, meat
scraps,medications,oils,painting products,pesticides,san M,,.Ty napkins,solvents,tampons,'and water softener brine discharge.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with s.Comm 83.33,Wisconsin Adriiinistridve Code`.
• All piping to tanks,pits and other soil absorption systems shag be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be rernoved and properly disposed of by a Septage Servicing Operator(pumper).
• Auer pumping, all tanks and pits shag be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert sold material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be 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
effect at the time of their permit issuance.
.❑ A suitable replacement area is not available due to setback and/or so il'limitations. If the soil absorption system cannot be
rehabilitated and baring advances in POWTS technology,a holding tank may be installed as a last resort.
❑ The site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be instaged.as a
last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biornat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING TREATMENT TANKS., PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN UFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
C-1-
POWTS INSTALLER POWTS MAINTAINER.
Name`x ew / Name
Phone - Phone„
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name Name
Phone J C Phone -;7/J
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(b)(1xd)5(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code.
PREPARED FOR.- COUNTY PLAT
COTTONWOOD SOUTH
Mw..e{eeoe'�ewortef LOCATED IN PART OF THE OF SW t/4 OF THE Bet/4.IN PART OF THE setµOF THE SW114 AND PART OF
THE NE114 OF THE swt/4 OF SECTION 26,T29N.R76W.TOWN OF HUDSON,ST.CROD(COUNT',
SURVEYOR WISCONSIN;INCLUDING LOT 1 OF CERTIFIED SURVEY MAP RECORD®IN VOLUME 6,PAGE 1642
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ENGINEER
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EHElT 1 OF.1 NIEEIs
TREATMENT SYSTEM INITIAL. SERVICE POLICY
/ d 0 Ow.Comp y.�i rt. ° j ,will operate and maintain the Boot Aerobic System
located at/ i tip taa _ (legal description only)
Permit# , for the period of 2 years beginning.,.. ,:j. __J,,a�.-.__,_
yo _and endin g
This contract will provide for all required inspections,testing and service of b ur HOOT Aerobic Treatment System. The policy will
include the following:
1, '2— inspections a year/service calls(at least one every months),for a total of _over the two-year period
including inspection,adjustment and servicing of the mechanical,electrical and other applicable compone t parts to ensure proper
function. This includes inspecting the control panel,air pumps,air Filters,diffuser operation,and replacing or repairing any
component not found to be functioning correctly.
2. An effluent quality inspection consisting of visual check for color,turbidity,scum overflow and examination for odors.A test for
chlorine residual and pH will be taken and reported as necessary.
3. If any improper operation is observed,which cannot be corrected at the time of the service visit,you will be notified immediately in
writing of the conditions and estimated date of correction.
4. The Homeowner is responsible for maintaining a chlorine residual ofat least 0.1mgtL in the treatment system. This c an he
accomplished by using chlorine tablets designed for wastewater use, NOT SWIMMING POOL TABU 15 Upon visit,if the
system needs chlorine tablets the service provider will add them and charge the customer. If the customer fails in their responsibility
to add the chlorine to ,they are in violation of law and appro i4te action will be taken.
Initials of Installer - Initials of Ilomeowner
S. Any additional visits,inspections or sample collections required by specific Municipalities,Water/River Authorities,County Agencies
the TCEQ or any other regulatory agency in your jurisdiction will be covered by this policy.
At the conclusion of the initial service policy,the Service Provider will make available,for purchase on an annual basis,a continuing
service policy to cover labor for normal inspection,maintenance and repair. According to state law,all owners of aerobic systems must
maintain a factory authorized service provider for the lifetime of the system.
With 48 hours of a request for service (weekends and holidays excluded), your system will be visited by the service provider listed
below or their authorized agent. If there are any items which need correction and can not be immediately remedied,the service provider
will inform the home owner,in writing,of the conditions and the estimated repair date.
The HOOT Homeowners Manual roust be strictly followed or warranties are subject to invalidation. Punching of sludge build-up,for
reasons other than due to warrantied mechanical fluilure,are not covered by this policy and will result in additional charges, By signing
this form,both Installer and Homeowner agree to the terms of this policy.By signing this form,both the Installer and the Homeowner
agree that the Homeowner has received a copy of the Homeowners Manual and the Installer has trade a reasonable effort to explain all
pertinent information to the Homeowner.
HOOT is not responsible for service,it is the SERVICE PROVIDER indicated below.
NOME OWNER SERVICE PROVIDER
t r
N Name of Service Company R qpr yen t v
Address c
"Add,ess
City S
I I - t —
nc Phone ..
Sigtieture of Home them Si iec Provider and License#.
-6-
IIIIIII
1
8 2 3 4 8 8 4
Tx:4192160
Document Number Document Title
996868
St. Croix County BETH PABST
REGISTER OF DEEDS
AEROBIC TREATMENT UNIT (ATU) ST. CROIX CO., WI
SERVICING AGREEMENT RECEIVED FOR RECORD
06J06J2014 0$:54 AM
EXEMPT #:
State Plan Transaction Number- REc FEE: 30.00
PAGES: 1
_Scott Louis & Lois Marie Swanberg
Name—(Owner) 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 CW isconsin, recorded in Volume, Page,
Document Number dated o/O, St. Croix County
Register of Deeds Office: Recording Area
A parcel of land located in the SW '/a of the SE '/a of Section 36, T 29 NAME AND RETURN ADDRESS
N—R 29 W, Town of_Hudson , St. Croix County, :F0 /L/,O
Wisconsin,being duly described as follows (include lot no. and
subdivision/CSM or detailed legal description):Aef
Agreement Date: G' Parcel Identification Number(PIN)
S-0
V
As an inducement to the county to issue a sanitary permit for a POWTS equipped with an Aerobic Treatment Unit on the above-described property,
we agree to do the following:
1. Owner agrees to conform to all applicable requirements of SPS 383, Wis. Adm. Code relating to Aerobic Treatment Units (ATU) and the
maintenance requirements for the proposed POWTS (Private Onsite Wastewater Treatment System)technology. If the owner fails to have
the POWTS and ATU 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 to maintain a contract with a licensed POWTS maintainer for the life of the system.The POWTS maintainer will perform
periodic inspections and maintenance as required by the manufacturer and the Department, including, but not limited to:the blower,electrical
controls, and treatment unit operation and sludge depth. These inspections are to be scheduled every 6 months for the first two years of
operation and yearly thereafter.
3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the treatment unit and to maintain the unit so as to
not create a human health hazard as described in s.254.59,Stats.
4. The owner recognizes that the county, Department of Commerce, or POWTS maintainer may make periodic inspections of the components
to complete performance monitoring of the unit.
5. The owner or the owner's agent agrees to report to the department or designated agent at the completion of each inspection, maintenance or
servicing event in a manner specified by the department or designated agent within 10 business days from the date of inspection,
maintenance or servicing.
6. This agreement will remain in effect only until the county office responsible for the regulation of POWTS certifies that the aerobic treatment
unit no longer 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 shall submit this agreement
to the Register of Deeds, and the agreement shall be recorded in a manner that will permit the existence of the agreement to be determined
by reference to the property where the Aerobic Treatment Unit is installed.
Owner(s)Name(s)-Please Print Subscribed and sworn to before me on this date:
Scott Louis Swanberg
Lois Marie Swanberg Maw( 30 A01 q
Not ed Ownenature Notary Public r q
Governmental Unit Official Name,Title-Plea&6 Print My Commission Expires
4 .� t� j7V u 31 01
.�..�c.�at,.--
Governme Unit Official Sig ture Drafted by:
4.
Perso al info tion you provide may be used for secondary purposes[Privacy Law s. 15.04(1)(m)]
KIM Nbj"CAVALLARO
itmesota
My Oonrmleelorr ExgtrM Jeer 31,2018
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT—DO NOT REMOVE"
This information must be completed by submitter.• document title.name&return address. and PIN(if required). Other information such as the
granting clauses,legal description,etc.may be placed on this first page of the document or may be placed on additional pages of the
document.Note: Use of this cover page adds one page to your document and$2.00 to the recording fee. Wisconsin Statutes, 59.43.
ST. CROIX COUNI'le
SEPTIC TANK MAINTENANCE.,kGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer -
Mailing Address
Property Address g5 7
(Verification required from Planning&Zoning Department r new construction.)
City/State Parcel Identification Nuiaber
LEGAL DESCRIPTION
Property Location,5LQ r/4 , '/4 , See. 3 �,, T ZLN R_0 W, Town of —
Subdivision L u-)mk 5cg, t _ , Lot# 7
Certified Survey Map#_ — , Volume T' ,Page#
Warranty Deed# / /� U , Volume , Page#___
Spec house yes 0 Lot line,, identifiab - yes o
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner,0 needed,by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance
responsibilities are specified in§Comm. 83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance.
The property owner agrees to submit to St.Croix County Planning&Zon kg Department a certification form,signed by the
owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site
wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is
less than 1/3 full of sludge.
Uwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the
property described above,by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms /
SIGNATURE O APPLICANTS) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV.08/05)
111111 I IIII IIIII IIIII Ilill CIIII 1111 IIIICI CIII 1111
910287
STATE BAR OF WISCONSIN FORM 2-2000 BETH PABST
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., WI
THIS DEED,made between Kernon J.Bast and Donalda J.Speer-Bast, RECEIVED FOR RECORD
Husband and Wife,Grantor,and Scott L.Swanberg,and Lois M. 01/15/2010 11:OOAM
Swanberg,Husband and Wife,As Survivorship Marital Property, Grantee. WARRANTY DEED
EXEMPT a
REC FEE: 13.00
Grantor,for a valuable consideration,conveys and warrants to Grantee the TRANS FEE: 291.00
following described real estate in St.Croix County,State of Wisconsin: PAGES: 2
Recording Area `�-
Name and Return Address:
Edina Realty Title,Inc.
400 South 2nd Street,Suite 115
Exceptions to warranties: Hudson,WI 54016
Easements,restrictions and rights-of-way of record,if any. 993740
020-1479-09-000
Parcel Identification Number(PIN)
This is not homestead property.
Dated this 4`I'day of January 2010
rnon J. Bast Donalda J.Spil 6-11ast
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
St.Croix COUNTY. )ss.
authenticated this 4t'day of January,2010
* *
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, Personally came before me this 4`s day of January,2010 the
above[Kernon J.Bast and Donalda J.Sneer-Bastl.
Husband and Wife
authorized by§706.06,Wis.Stats.) to me known to be the person(s)who executed the foregoing
instru,p.—nP..d acknowledged the same
THIS INSTRUMENT WAS DRAFTED BY
Martin D.Henschel Notary Public,State of Wisconsin
50 East Fifth Street,St.Paul,MN 55101 My commission is permanent. (If not,state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature
A. WiiiT�an
Notaly Public
State of Wisconsin
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000
1 of 2
Rif-cel L
Lot '), Cottonwood South, St. Croix County,Wisconsin.
AND
Parcel 2:
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Tx:4192160
Document Number Document Title 996868
St. Croix County BETH PABST
AEROBIC TREATMENT UNIT (ATU) ST.REGISTER CO Ewis
SERVICING AGREEMENT RECEIVED FOR RECORD
06/06/2014 08:54 AM
EXEMPT #:
State Plan Transaction Number- REC FEE: 30.00
_Scott Louis 8c Lois Marie Swanberg PAGES: 1
Name—(Owner)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 C e�Wisconsin, recorded in Volume, Page,
Document Number 7 dated /-`/-ato/O, St. Croix County
Register of Deeds Office: Recording Area
A parcel of land located in the SW t/4 of the SE 1/a of Section 36, T 29 NAME AND RETURN ADDRESS
N—R 29 W, Town of_Hudson , St. Croix County,
Wisconsin, being duly described as follows (include lot no. and
subdivision/CSM or detailed legal description):.4 o l q'F�
oa -o v0
Agreement Date: G�S r�/ r. Parcel Identification Number(PIN)
As an inducement to the county to issue a sanitary permit for a POWTS equipped with an Aerobic Treatment Unit on the above-described property,
we agree to do the following:
1. Owner agrees to conform to all applicable requirements of SIPS 383, Wis. Adm. Code relating to Aerobic Treatment Units (ATU) and the
maintenance requirements for the proposed POWTS(Private Onsite Wastewater Treatment System)technology. If the owner fails to have
the POWTS and ATU 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, Slats., 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,Slats.
2. The owner agrees to maintain a contract w a licensed POWTS maintainer for the life of the system. The POWTS maintainer will perform
periodic inspections and maintenances as required by the manufacturer and the Department, including,but not limited to:the blower,electrical
controls, and treatment unit operation and sludge depth. These inspections are to be scheduled every 6 months for the first two years of
operation and yearly thereafter.
3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the treatment unit and to maintain the unit so as to
not create a human health hazard as described in s.254.59,Stats.
4. The owner recognizes that the county, Department of Commerce, or POWTS maintainer may make periodic inspections of the components
to complete performance monitoring of the unit.
5. The owner or the owner's agent agrees to report to the department or designated agent at the completion of each inspection,maintenance or
servicing event in a manner specified by the department or designated agent within 10 business days from the date of inspection,
maintenance or servicing.
6. This agreement will remain in effect only until the county office responsible for the regulation of POWTS certifies that the aerobic treatment
unit no longer 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 shall submit this agreement
to the Register of Deeds, and the agreement shall be recorded in a manner that will permit the existence of the agreement to be determined
by reference to the property where the Aerobic Treatment Unit is installed.
Owner(s)Name(s)-Please Print Subscribed and sworn to before me on this date:
Scott Louis Swanberg
Lois Marie Swanberg Mo"(f 30
�NotVfzed Owne .SignatureW Notary Public
Governmental Unit Official Name,Title-Pleabb Print My Commission Expires
A14— f LN-�J�l Sd-. Gee: J71./j 11 3/ ;Z0!
Yti•�C.Y
Governme Unit Official Sig tune Drra^ft'ed/by:
c�/l CL 1L r✓
Perso al info tion you provide may be used for secondary purposes[Privacy Law s. 15.04(1)(m))
M M.CAVALLARO
Notary Public Minnesota
OKI
y Commbsbn Fjores Jan 31,201a
iw.nMn�,t...an.
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT—DO NOT REMOVE"
Rfs>i>at6iotunbn9b16>��S E1RQptetW By submitter.• document title.name&return address.and P/N(if required). Other information such as the
granting clauses,legal description,etc.may be placed on this first page of the document or may be placed on additional pages of the
document.Note: Use of this cover page adds one page to your document and 52.00 to the recording fee. Wisconsin Statutes, 59.43.
i