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HomeMy WebLinkAbout002-1003-95-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 574320 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Mark, Scott& Phyllis I Baldwin, Town of 002-1003-95-000 CST SM Elev: f Insp.BM El v: BM Descr Lion�:L Section/Town/Range/Map No: �+ u,,, �a.�l� S��' 02.29.16.32 TANK INFORMATION ELEVATION WATA TYPE I MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( D t� /)• Benchmark O 570 �� E Ryr 0. Dosing Alt. BM Aeration Bldg.Sewer ,p 94 YS' Holding v 006 S t nlet 9-q0' ,. /O o�.tro St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding t boo t t >S-61 Bot.System SO 7 �� Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number V. 5 5 -6 TDH lift on Loss System Head TDH Ft T f• t Forcemain Lerfgth ia. Dist.tow / SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No.Of Tre es PIT DIMENSIONS No. Pits Inside Dia. ep DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHIN anufacturer. INFORMATION CHAMBER Type Of Sys te U Mode r: DISTRIBUTION SYSTEM Header/Manifold Distributio x Hole S' x Ho take n Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over 1xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No _i COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1:0$/ 05 tl+spection#2: Location: 2586 110th Ave.Woodville,WI 54028(SE 1/4 SE 1/4 2 T29N R1 6W) 40 acres Lot r — Parcel No: 0 29.1( 1.)Alt BM Description 2.)Bldg sewer length= 54 pr S '< -,0e`er - arnoypWicover= 5 r S�' ''�°' ° u�Ca�l�'f Set.�..K y te.c..�L. Q C.t�°`.v'n cA01. Plan revision Required? Yes No �1-,L Use other side for additional information. i __—_ -- -L—/� t Insepctor's Signature Cert.No. SBD-6710(R.3/97) , 57` �kO/u Cou.OTY 16 LA) WELL b�zL _ 3 a,-q Eke• ��v n + � caSe M, oo.�o zAO." o4 Nom-; S►d, � y Q„ _.._ 7'0 .Ih\ B-ope, _� ° rya County Industry Services Division 'v. ��� 21 Z014 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) »::: ... `; •.' " " ' ST.CROIX COU qTY Madiso 1 57q32O VE PMENT Wtary Permit Application StateTransactionN rr�ier In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit A__ is required prior to obtaining a sanitary permit Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04(l)(mL Slats. I. Application Information—Please Print All hrformation Property Owner's Na a Parcel# C o . f �h l ss a�v po.)1063-11 S'oo v Property Owner's Mailing Address�9 6 ,j Govt.Lot Property Location 7 ' (10 /� � + ✓` City,State Zip Code Phone Number Section /+,, WCJOdLtJ ��{ �, (�� 6 C /•, 5 T .2� ,- 7 u 7—3 3 Eor 6V (circle one I T��N; R� IL Type of Building(check all that apply) Lot# Dkfor 2 Family Dwelling-Number of Bedroom _ Subdivision Name 104 Block# 490 Aj e S ❑Public/Commercial-Describe Use ❑ City of ❑State Owned-Describe Use CSM Number ❑ Village of & Fown of f Lo?,01 IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑New X System R lacement System � y ep y .aq y Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) B. ❑Permit Renewal ❑ Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Issued g El Transfer to New Before Expiration Owner IV.Type of POWTS S stem/Com onent/Device: Check all that apply) ed In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil Yi Holding Tank Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ers reatment Area Information: Design Flow d) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation V1.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units New Tanks Existing Tanks w [ o ar o CCU ti ran Septic or Holding Tank d0 Dosing Chamber VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Si re MP/MPRS Number Bus' ess Phone Number VI V\ oa Plumber's Address(ouo y_Ay,Sta Zip Code) V�Pprov un /De artment Use Only ed P ermit Fee Date Issued Issuing nt Signature �0"O�, ason enial � G50 � z2i Conditions of Approval/Reasons for isapproval albs 4-b 6L a6c.,-.c0 06 P4 co4k i Yta ch to complete.plans for the system and submit to tlff ounty only on paper not less than 8 I x r inches in size SBD-6398(R0313) of Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: Project Name and System Type: ,,� .Location: //p 16 S"y p a e Street Ad ess S of S,Lk SAC. Ta-7,A,) i(o LAJ Legal Description Township/County Design Criteria(Check one): Holding Tank Component Manual: In-Ground Soil Absorption Component Manual: ❑ SBD-10571-P (6/11/1999) ❑ SBD-10567-P (R. 6/1999) 100'SBD-10855-P (3/2007)Version 2 ❑ SBD-10705-P (N. 01/2001)Version 2 Contents: Page 1: P/ n+ PI Page 2: _ 14 ©IAi^G -To_,,., Cho , S Page 3: �0.� n c O�-1 r.a, C a I L Page 4: S< , S Tz'�-vim u Se"s a 2 t Q i Page 5: Page 6: n 1���� 1 �ti k /-L 1A 06 11 'f-- Page 7: f 61 d l e, �G-w t"`. nr G t 't C k o h S Page 8: Page 9: ��Attachments: ,,... e�.�- � �C � � Ff.� Aokok (� _I S�p r� �uwk M�t/h7CnG.nct Ale.SOlV e. ©i- "� 1- hefS� ' Oh,^'� Plumber/Designer: Be n h t--e Signed: Credential Number: b __. Date: _ 2 _ ALI Ar- 1 57` �Roiu Lo�uvey 5 �, TagN-iPt� �� kc 4 lr_� Eke. y7,c� 1 v y C�l� a►�d1 �'�l l�� � r\ Pg -' of 7 Private On-Site Wastewater Treatment System (POWTS) HOLDING TANK CROSS SECTION & SPECIFICATIONS Catrer with warning label 4°min.above surrounding grade or 2 ft.above Watertight junction box and Jock if access opening is established regional flood elevation.untbu greater than B inch iba. access port is outer and gas tight Vent 8 inch min.dia. T , -power source 3 Y" ►w o'k c.00ev-- Building sewer Cleo , gl.oc7 . Maximum alarm on level set at 12"below flank Inlet invert -T, Alarm float or 90% of the liquid capacity S . of the tank below the tank Inlet invert 3". 13--J (If needed, insert different drawing to illustrate elevations, etc.) 5'J' e. I D J 1 lo� IIle /�ec �ct� ita � Pg 3 of 7 Private On-Site Wastewater Treatment System (POWTS) TANK ANCHORING CALCULATION Per Comm 83.43(8)(g),Wis. Adm. Code, all tank(s)must be anchored whenever they are at risk for being installed in an area where they may be located in saturated conditions all/part of the year.Using soil as the anchor has become an acceptable alternative to concrete. Flotation potential is the displacement of the tank calculated by its volume in cubic feet. Line A: Calculate cubic feet of tank. j q�7S3,6 inches high,x 88 inches wide, x/8/ inches long,= cubic inches. Divide this number by 1728 to equal 5Y/, 5—cubic feet. Line B: Convert the displacement to the weight of water. �71•S(from line A)cubic feet x 62.4 (weight of 1 cubic foot of water)x 1.5(safety factor)_ 53 y ,y lbs. of lift potential. Line C: Calculate weight needed to counter buoyancy. S3`1Q-�,Y lbs. (Displacement weight from line B.)-/ g83oibs. (weight of tank per manufacturer)=lbs. of soil needed to anchor tank: lbs. x 33bGa,y Line D: Weight of the soil media including safety factor needed over the tank to anchor the tank adequately. Tank cover width 9,3 inches x tank cover length 18L inches, divided by 144 square feet x 0.083 (1 inch in foot decimal)= q•97 cubic feet(volume of 1 inch of space over the tank cover). Line E: Calculated weight of 1 inch of space over entire cover. 7 cubic feet of space(from line D)x 100 lbs./cubic foot of=?77 lbs,./inch—Space above cover . Line F: Calculate inches of soil needed to counter buoyancy. 33 66--1 y lbs. (from line C) divided by 9q7 lbs.per inch of soil(from line E)=inch need over tank cover. Pg Y of 7 Private On-Site Wastewater Treatment System (POWTS) HOLDING TANK SYSTEM - USER'S MANUAL A. SYSTEM OPERATION: The holding tank system serves to contain wastewater on a site until the contents are pumped and hauled to a proper point of disposal by an individual certified under Wisconsin Administrative Code Chapter NR114. Wastewater from your interior plumbing system enters the building sewer that terminates at the inlet of a prefabricated concrete holding tank system. The tank system has a switch that is set to activate when the liquid level reaches a point 12"below the tank inlet. The switch activates a high water alarm located inside a tank alert box that is installed on a pedestal or inside the dwelling. When the tank is full of wastewater,the switch will be activated and cause an audible alarm to sound. A switch located on thg tank alert box can turn off the audible alarm. The liquid waster carrier contracted to service the holding tank system should be called immediately after the alarm is switched off. There is only a limited reserve capacity left in the holding tank system after the alarm has been activated. B. DESIGN FLOW: The holding tank system has a total wastewater capacity of 30 0 v gallons. Servicing intervals cannot be predicted, as every household has varying water use habits. Use of water conserving fixtures and water conserving practices will increase the number of days before the tank needs to be serviced by a liquid waste carrier. C. WARNING: Failure to have the holding tanks serviced on a timely basis may cause wastewater to back up into the dwelling and/or discharge from the holding tank's manhole cover. The discharge of sewage to the surface of the ground is a public health hazard and subject to enforcement action by Pierce County. Soil settling around the tank perimeter may occur after it has been backfield. All depressions caused by soil settling should be filled with soil material to prevent surface water collection. Depressions left unfilled may allow surface water to freeze and cause frost damage to the manhole riser ring joints or the other tank components. Do not drive over or near the buried holding tank system with any vehicle or construction equipment. This action may result in a cracked tank(s). This type of damage may allow groundwater to enter the holding tank(s) and increase the frequency of pumping. Many disease-causing viruses, parasites,and bacteria are present in the holding tank's wastewater. Even the slightest exposure to wastewater may adversely affect ones health and increase thexisk of serious illness. Please note that the owner of this POWTS must provide the septic servicing operator with reasonable access to the tank(s). This may include(but is not limited to)construction of a designated drive or servicing pad to within 25 horizontal feet and/or to within 15 vertical feet to bottom of the tank(s), foot traffic over and through property,or vehicle traffic over and through property. D. TROUBLE-SHOOTING 1. Wastewater backs-up or overflows manhole cover: a. High water alarm not working. b. Tanks not pumped. 2. High water alarm not working: a. Tank alert box not plugged into electrical outlet. b. Audible alarms switch on silent mode. c. Tank switch installed improperly or defective. d. Tank switch electrical connections faulty. e. Electrical line to switch defective. 3. Groundwater entering tank: a. Tank manhole riser ring joints leaking. b. Tank sidewalls or base cracked. Pg S of 7 E. MAINTENANCE: 1. The tank alert box has a test button that should be pushed once a month to assure the high water alarm system is working properly. 2. The float containing the high water alarm switch may need to be cleaned whenever scum or solids build up on its outer surface. Accumulation of solids on the float may interfere with switch activation. 3. All manhole covers padlocks should be oiled or greased periodically to ensure free movement of lock components. 4. The locking device should be inspected after each tank servicing to prevent unauthorized entry. F. CONTINGENCY PLAN IN THE EVENT OF FAILURE: A badly cracked holding tank may need to be replaced,depending upon the amount of damage and the crack's location. The tank manufacturer should be contacted to make a determination as to whether the tank can be repaired or needs replacement. Groundwater may enter the cracked tank requiring more frequent servicing by the contracted liquid waste carrier until the tank is repaired or replaced. G. CONTACTS IN THE EVENT OF COMPONENT FAILURE REGULATORY AGENCY: Pierce County Department of Land Management 414 W. Main Street, P.O. Box 647, Ellsworth, WI 54011 (715) 273-6747 NAME OF INSTALLER: Name: Address: A)7+ 114 qI mss, l $' Lo Phone: TANK MANUFACTURER: Name: ow S P v- Address: tJ 37/L (,2, S . �ti 10 Phone: C 902 3 S- 9 4 S (1:1 HIGH WATER ALARM SYSTEM MANUFACTURER: Name: S S E h o �s Address: Firs+ C n , e �-q 7,) � Phone: Ls o0 9 71 3 i P g 6 of 7 Private On-Site Wastewater Treatment System (POWTS) HOLDING TANK MANAGEMENT FLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual(SBD-10571-P 6/11/1999), and the Pierce County Sanitary Code. 1. This POWTS is designed to accommodate all wastewater generated by a bedroom residence. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12"below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank,risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a,code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Connection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer: ` .e( Phone: ,(7/S� 77P-3 a7� b. Service Provider: sczj M v Phone: ��S/��47- 30 3y c. Regulatory Agency: P e County Department of Land Mana ent Phone: Cd 8w-000£M:3113 99-ve—SZ2-008 b00Z 'N`df 'n38 CD tool ),8vnNVr :31Va OSLbB IM RADON N301VW 'OU.MH Sn 9tL£M ivnNVV4 011d3S Z\ 1MS:�a NMVaa 3138OOO W 0 ����'� W o \ :31V0 'ON X321 ,t=„4/L :31VOS aW_0002M N O �- v) J z Z w Z H W Li m w Ld W u y- > U �� .. 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Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Etf1M *Eff112 / -c fvy P, 1 - I IL). L 1� 5 Boring# I❑yBoring �I Pit Ground surface elev. ft. Depth to limffing factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/!F In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •EMV1 •Eff#2 w,. rl �0 (o~ f�3 R r C l M-P , a? F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sol!Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPEMF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 •Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L •Effluent#2 BODE<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. sens330(R.07ro0) r � RECEIVED sPAID VVisconsin Departmdht of Commerce O 5�� SOIL EVAt�I�d-REPORT Page or Division of Safety and Buildings �UN In accord with Comm 85,Ws.•Adm. Code xN c°""t,' .fir Attach complete site plan,o Inches In size.,.Pisn must include,but not firnited t� on referencei point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and location and distance to nearest road, 03�,$—DO v Please-print al!Information. :Rpvr wed Date Personal information you.provide may be.used'for.seoondary purposes(.Privacy Law,$.15.04(1)(m)). W' t e I i I, Property Owner / Property Location c c7t,-- PA Y!/ s r �a r Govt.Lot 1/4 Sr::1/4 S T N R E(or Property Owners Mailing Ad rasa Lot# Block# Subd.Name or CSM# Cky State Zip Code Phone Number 0 City [:1 Village 5aTown .Nearest Road WE =n Use' Residential/Number of bedrooms Cole derived design flow rate � Q GPD. Repla Public or commerclal-Describe: ,L oc s r c!Sf_1S✓ 7i// Flood Plain elevation if applicable _.,/U� n• General comments and recommendations: I r J Boring# [] Boring p/ r3l pit Ground surface elev. /7! ft. Depth to limiting factor_�in. soil Applic0on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munseli Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 o 'Y P, r 7,sv 4 b k-- a, LJ r b 45120 /o Y R 7 529 Jf4/VY/( `I F5]Boring# Boring pit Ground surface elev. 97, D ft. DepthZo limiting factor /1*1 in. toll Application Rote Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOW In. Munsell Qu.3z. Cont.Color Gr.Sz.Sh. 'Eff#1" 'Eff#2 2 6 w (. g mtm3p 3 I -X d3f -7s4 L-1 I k LIE I 'Effluent#1=BOD >30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg&and TSS<30 fng/t. CST Name(Please.PHnt Signature CST Number e6 P.So 4i,, �oa9� Address V Date Evaluabo60onducted Telephone Number hln MAITA^I 11I1\ Wnsconsin DepartrMht of Commerce SOIL EVALUATION REPORT Page�ot� Division of Safety and Buildings In accordance with Comm 85,We.•Adm. Code Attach complete site plamon paper not less than 8112 x 11 Inches in size.,.Plan.:must Co�Y Include,but not(imlted'to:vertical and'holizontW reference point(BM),direction and parcel I D percent slope,scale or dimensions,north arrow,and location and distance to nearest road. /6 Q �Fs Q C) Please.print all InforMation.' nevi d by Date L'4 Pefs'dnat information you.provide may bs.usecrfdr.sacondary purposes(Mivacy Law,s:.15.04(1)(m)):. . � Z Property 0%6;t Property Location / // `�s /"i QV Govt.Lot 1/4 a 1/4 S T.2 N R E or Property Owner's Mailing Address Lot# Block# Subd.Name or C9M# / A4 city Criy State Zip Code Phone Number e g City ❑Villa- Town Nearest Road ❑ NewCanstruetlon Use: Residential/Number of-bedrooms, Coale derived design flow rate JIS-Q [WReplacement ❑ Public or commercial-Describe: ~ Parent material o r s r �, ✓ Flood Plain elevation If applicable A14 General comments and recommendations: Boring# tm-1.Boring p// �l Pit Ground surface elev. / 7 3 tL Depth to limiting factor 2_in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots aff-f In. Munsell Qu.Sz. Cont.Color Gr..Sz.Sh. •Eff#1 •EfI1#2 0 f D_j7'C"Y'T_ a• LL) t ' , b 10 Y ,,r7 %DYR r Y Boring* ,© Boring W-Pit Ground surface elev. ft. Depthdo limiting factor ,3 in, Soil npI loBtIon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roota GPD/ft' In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •t:1f#1" •Eff#2 / - b -,7S-Y , 3 •Effluent#1=BOD >30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Name(please PHnt 5lgnature ; 1 �� eSo �CST N[fntier�9a Address Date Eveluati Conducted ephone Number 1�8s r,� U���� �- -3_� 7/57-- �;7D -3�� Property Owner G o /"l 4r Panel ID# COQr�/oa3 ��Q Page ® Boring.0 ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence PBoundary Roots GPDjV In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Etf l *Eff#2 . - i 1 b� I� �- .� r b L t o Boring# ❑ Boring • pit Ground surface elev. ft. Depth to limiting factor_ + Soil-Application n Rate Horizon Depth. Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN In. Muneell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 oy � -- i w � r M , O G(f SY --/ Q D 7 Y F-1 Ong# Q Boring Pit Ground.surfseeelev. ft. Depth.to limiting factor_.In. Soil M61ication Rate. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G EMF In. Munseil Qu.Sz. Cont.Color Gr.Sz.Sh. ' 'Eff#1 •Etf#2 •Effluent#1=BOD,>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2 BODE<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. san-8330(it.07ro0) t AIF wk e r .�.�-a7 7"Bc�Vt o-F (�u�► n ► , a aoa9� ��y of S'�4 5�c .2 T.�9'�11, -Rlbk� i I_ , X ��P I 40' Prof' be O Sec qq S we(I I�roost'ttydrwvit E x;5��9 d 3,, ttBet: Q E!e , 970 II J q , i—�0vvx e d Fk����5 ,$•`t" �" (, plc L�c�rv. (rrc,u•,-.A 61 . 9 S•o 1 u 6� J3•M. Ibo,o �- Co,M�p0.0 <Q House 5���h seal s A-0.0 { — D 7A pn 560950 STATE BAR OF WISCONSIN FORM 2– 1982 ; li WARRANTY DEED F DOCUMENT No VOL 32 5PACET5 _ AEGISTER`S OFFt^E I! Ai Cronk, a/k/a Ai C. Cronk, and Joan M. I ST CROIXCTY Wl Cronk, husband and wife V..du %poW"` j_U N 12 1997, wnv ys� and warrants to — Scott A._Mark and Phyllis A. 2:30 P.m Mark, husband and wife, ` ,i Hegistsrot aeetls II St. I� THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADORE S •J v� I� the following described real estate in_— Croix County, �1 �j State of Wisconsin: i� v i f I I �I PARCEL IDENTIFICATION NUMBER i SEk of SEk of Section 2•-T29N-R16W. �I f �i This i s _—homestead property. II Exception to warranties: Easements, restrictions and rights-of-way of record, iI if any. 1. I�Dated this day of June A.D.. 19 97 1� I� (SEAL) a �S� � —(SEAL) �! Ai Cronk, a/k!a Ai C. Cronk Joan M. Cronk (SEAL) —_ __— (SLAL) AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin. -- -- -- _ — -- -----—._... St . C r o i.x ---- ----- Caultty. can=e hkl,xc e thu _. dny ,Il nuhen:ieatecl thl, __-_— Jai•rd---- ---- _-• ly_-- _ 1'ers,tnalh- :r. _.--- -_J?i n e . -- ---..... 13.9 7 -. the above named -A1��)=12sLLC.r_.-1 • _-____-.-_-___—____. -_-- -and I-11 LE: hlLKILILR MAIL DAR OF WISCa)NSIN ur not. at thori_e-,l-h--r—C7 U_t'•._O_h_. _____ - Public \ is con sin state Wis o nu_—lato-Y n-to 110 (tic the - .. __$ _-w it-o eXevu-tc- d the Il+reg. ilt?: glane T33_rTo instrument and ackno"i"ile the samtr THIS INSTRUMENT WAS DPAFrFU BY Attorney i<ristina vgiartca -• Hudson, WI 54016 — - 1 -r` ------ -.. ------- --- - -------- Nolary u I.e._.—__. 1-..-- '.jt----_County.wtc. (Signatures may be authenticated or ackna,.�icJged. Motif are not ..I cummtcs;,ni I, ,..nnancm tl( wt. st a-pmitut ,`}to Na. o+a r..,n.ag""'t is ate 1,1 h.+vp•d,rt pn:vrd hd- 0-r ., SrAn tt\R OF wlst ONSI` :�•zr.f. tAUV a.�-.,:., . Inrm No 2 - I+,N). '1rIM�.l�a•wax ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owne Buyer <- R Mailing Address S' �// U f Aj,e w, ,J u r 1� o i �'"y/)-1)g' Property Address -2 5'8 //b /l '41',e 1-.a10 ( �-� WT__ 5-! (Verification required from Plamm�Ag&Zoning Department for new construction.) City/State LA)o J J4 (A Parcel Identification Number QQ.�)/O 0 d LEGAL DESCRIPTION Property Location 5)—t:- % , ,5)t- 1/ , Sec. ,T N R I,(._W, Town of �c Subdivision A/A , Lot#�. Certified Survey Map# /IJJ�' , Volume , Page# Warranty Deed# 0 0 ,Volume /� �� , Page# S/3 Spec house❑yes Xno Lot lines identifiable*yes❑no 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,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 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&Zoning 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. I/we,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 Conuncrce 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 Coimty 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 warn ty deed recorded in Register of Deeds Office. Numb b ro ms GNATURE OF AP ICANT(S) 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) Document Number Document Title I I II III I I St, Croix County 8 2 4 3 0 4 2 Holding Tank Agreement Tx:4198913 ermit Number- 998499 v� d- BETH PABST Name—(Owner)TYped orprinted REGISTER OF DEEDS; be-g duly sworn,states,under oath,that: ST. CROIX CO., WI RECEIVED FOR RECORD 1. He/she is the owner/pttrt owner of the following parcel of land 07/14/2014 09:35 AM located in St.Croix County,Wisconsin,recorded in Volume ,A q q EXEMPT *: Page J 3k Document Numb 0 St Croix County Register REC FEE: 30.00 of Deeds Office: PAGES: 1 A parcel of land located in the 5 k- r r A►ee p /.of the$ /of Section weneana 2 T 29 N—R ` W Town of �'�-Un7iS ��d c s�.-� J St,Croix County,Wisconsin,being -fV-e duly described as follows(include lot no.and subdivision/CSM or o cS v -5-40 detailed legal description): �U� p0 SDao -WM Wagon Number(P" Aanmiment Data: 1-0- l l'Je acwlowledge[hat application is being made for the instailetioa of(a)holding tank(s)on the above described property or that continued ua of the existing premises regWrea that a holding tank be Installed on the property for the purpose of proper containment of sewage. Also,the propsrrl)t cannot now be served bs .mtadclpal sewer,or any other type of p onsft wastewater treafinettt system as pemd(tsd under Ch.SPS 383,Wis. Adm. code,or ch.145,Wfs.state. As an Inducement to the county to issue a sanitary permit for the above-described property,vie agree to do the following: 1. Owner agrees to conform tC at applicable requirements of Ch.SPS 383,WM.Adm.Cade relating to hol ling tanks, If the owner fps to have the holding tank property serviced all resPOnse to orders issued by the govemmeMW unit or the a human health hazard described in s.254.59.Stets.,the ovemrtrerrtai wry of to p1°'ro°rt or abate cause to have fire tank to be serviced and 4. 9 (Town)may ender upon the property and service the tardy or services rendered. The ergs the owner by placing the charges on the tax bill as a special sesseament for txtrrerrt charges will be assessed as prescribed by a.88.0703,State. 2. Owner agrees to Pay all charges and Costs incurred by the govemmertel unit or county for servicing and maintaining the holding tank in such a manner as to inn•p�pin9•hauling,or°ihefwlee The goverrvrter W unit shall lucent or abate any human heath hazard ca by the holding tank. the event the owner does n o'er of arty which seal be paid by the owncr within thirty(30)days from the date of w ke. In on the tax roll as a pas the costs within thirty(30)days,the owner apecificady gees that art the casts and charges may be placed apaciW assessment for the sthWerrrent of a human heath hazard,and the tax shah be as provided by law. 3. The owner agrees to cortrad with a person licensed under Ch.NR 113,Wis.Adm.Code,who shag submit to the county on a semiannual basis a report data;tng the aervidng of the holding tank The governmental unit or county may enter upon to property to investigate the corrdtion of the hatding tack when pumping reports and meter readings may indicate that the hoktirg tank is not being properly maintained. 4. This agreement will remain in effect only until the county off=responsible for the regulation W private 0ns88 wastewater treatment$Yomms certifies that the property is served by either a municipal sewer or a private onaite wastewater treatment system that ommuss with Ch.Comm 83,Was.Adm.Code. in addition,this sgreemant may be cancelled by Omarhtg and recording sWd aertittcaton with reference to this agreement In such manner which will Permit the existence of the certification to be determined by reference to the properly. This agreement seas ,and the upon the owner,the hairs of the Owner,and asslgaees Of the Owner. The owner shall submit this agmement to the register Of deeds,and the agreement shall be recorded by the register of deeds in a manner which wil permit the existence of the agreement to be determined by.mferense to the property where the holding tank is installed. Owner(a)Hame(a)-Please Print Subscribed a pbBfxoRrna ell,[rue tlato BONN C. CLEVELAND f C / Notanf PYblle Nota' Owner's Signatu d) Nntan.w.y!1= 2ft of MUNPAIM vein tal n I Name, $e Prind My commission Expires co mental Un Official$ue Persoml ittwmation u provide may be used for secondary purposes prtvaay Law S.15.04(1xm)) "THIS PAGE IS PART OF THIS LEGAL DOCUMENT–DO NOT REMOVE- Tftltt tntbfm da"must be compplated by submifter document t&fidm I Iftm ad0ho,and PIN jlfrequt". Otbe k*m ibn such as Nye 9mnft clauses leagal desa"on,eta may be placed on fts&&P498 of Akre docwrnent or may be pfavad on ad&&v W pages or fee document.iYR& Use of(fds Cover page adds one page to your abatsnerrt and R_00 to fee fflOOn2V fee Wisconsin Statutes,59.43.