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HomeMy WebLinkAbout020-1174-40-050Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ,; INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village x Township Beinlich, Kurt Hudson Townshi CSTM Elev. SJ~ - Insp. BM Elev: BM Description: CI C\/ATInAI f1ATA YIYA IIYr VRIYIM11Vlr TYPE MANUFACTURER CAPACITY Septic ~' Dosing '~~' '- Aeration Holding TANK SETBACK INFORMATION TANK TO /P~//L f't ~~ ELL N. BLDG. Vent to Air Intake ROAD Septic -r-?~j `~ f ~ ~ ~ ~c; . ~~' 1 ~ Uf Dosing Aeration Holding PUMP/SIPHON INFORMATION Demand t~M Model Nu TDH Lift Friction Lo System Head TDH Ft Forcemain Len Dia. Dist. to Well SOIL ABSORPTION SYSTEM /~~ Gl ~~,.~.- ~~_~ BED/TRENCH Width ,t] / DIMENSIONS .j~JJ SETBACK SYSTEM TO INFORMATION Typ Of System: ~~~`~ . IIICTDIRI ITInAI CVCTFM ~ No. Of Trenches a P/L BLDG WELL ~Z ,~~~ ~ ,~~ ~ F--,,~' ~ .. ~: -f„ i. Of Pits. Inside Dia. ~. .. ~-. r/~ councy: St. Croix Sanitary Permit No: 399677 0 State Plan ID No: Parcel Tax No: 020-1174-40-050 STATION BS HI FS ELEV. Benchmark ,~ 1 jo q ,~, AIM CS'rL,~~ ~ D>'., ~ d ~, ,. 37 o S9 g. Sewer Bl ~ ~ ~ / O SUHt Inlet + ~~ ~ . D S Ht Outlet ~ ~~ `Gj~ D t ~. ottom ~' z3 s ~~l~- ~U~t `/ ~}' 3 ' .Z~ 5 "73 Header/Man.- 9 l ` j_ S3. /~ S. .1 Exi~f~! b' Sb' Dist. Pipe S' Bot. System _2 y~ Final Grade cs-rjD ,`~. C St over ., S,~ ~~ 3 ~ l _ ,~~, UNIT Header/Manifold ( ~ // '11 Distribution , ~ i V I ~, Pipe(s) ~~ / l~ ~~ ~ ~ ~ x Hole Size ~ x Hole Spacing ~ Vent to Air Intak~ '~ lJ 1 'r ~ D Length' fFi~J ~a_~ Spacing 9 Dia ~ '~ Length ~ ~' , ~L't7 Cnll CnVGR ., ~.,.........., c.,~~e...~ nnl.. .... Mnnnrl rlr Af-r~radP Systems Onlv Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ Bed/Trench Edges Topsoil ;Yes ~', No I' ~~~ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / l,' / C ~~ Inspection #2: / / Location: 927 Ridge Pass Hudson, WI 54016 (SE 1/4 SW 1 17 T29N R19W) NA Lot 96 Parcel No: 17.29.19.1095A 1.) Alt BM Description = ~,u,~~i`+-~k i~~¢;~~dc~ 2.) Bldg sewer length = Cq~+ ~ -amount of cover= 7 ~ ~~ ~-~i-(~~Y(,)C~.~ ~t`uh~~-(Yp~'~ ~. -C~C(d i1z-} I~L~~Ut (~ V _ __ _ ~ Plan revision Re uired? ~:, Yes ~ o i ~ '_ ~ ' / ~ ~ ~ Use other side for additional information. ~ ~~~ Date -~ Insepctors Signature Cert. No. SBD-6710 (R.3197) z ~ 92~- ~L~Ci~ PF~SS n ,-i) '~ ~ C711 ~ Sanitary Permit Application Safety & Buildings Division ' In accord with Comm 83,21. V.'is Adm. Code 201 W Washington Ave. ` ~SC~ns~~ See reverse side for instructions for completing this application PO Boy 7302 Department of Commerce Personal information you provide may be used for secondary purposes P i Madison. WI 537n7-730"' ($Ubmll Cd'mpleled fofm (0 COU:i[ if r ( r vacy Law. s. 15.04(1)(m)] v state owner Attach com lete tans (to the county co • only) f'or the s~'stem, on a er not less than 8-1/2 ~ 1 I inches in size. Count ~_ C~ / State Sa~tary~erniit Number O Check if revision to previous application State Plan I. D. Number I. A lication Information -Please Print all Informatio -- Location: Property Owner Name ~ y~, ~`'- _ ' ~ T/ 1 Property Location ~ ~ q S , _ ~ dG ~- '; ~ ..' /~ S/~' I/4 5(~lA/4. S ~7T 2 /,N, R (or) ' Property Owner's Mailing Address °' Lot Number Block Number ~; ~ N/~ Cit, State ~ Zip Code ~ ~} p,[ ~ s $Ph mbe~ ^- ~ Subdivision Name or CSM Number ~ ~ s~o /6 ~ -~ ~ ~ sr~ 6 f f~ P y~~~ II Type of Building: (check one) ~'~~~ I 2 F il D ~ O Cit O villa e or am y welling - No. of Bedrooms ~ ~ Public/Commercial (describe use): as h,..;.. -Ate..,.-, ~S) g Town of ^ State-owned ~ . III Type of Perr^.it: (Checl•; o.^.!~~ ene box on line A. Check box on line B if applicable) Nearest oad ~Cc S' A) 1. New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax N tuber(s) S stem Tank Only Existin S stem ®2A- ~/ 7 _ r,-c75~ B) Petmit Number Date Issued ^ A Sanita Permit was reviousl issued IV. Type of POWT System: (Check all that apply) -~c -[t7U ^ Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ~ ^ Aerobic Treatment UniS D Re t culating ^ Oth r: ^ ~ C~ 3 ~ G~2 •Sa' n V Dis ersaVTreatment Area Inf rmation: 1. Design Flow (gpd) 2. DispersalArea 3 Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. day/sq. ft.) (Min./inch) Elevation VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ^ ^ ^ ^ ^ VII Responsibility Statement I, the undersi red, assume res onsibilit fer installation of the POWTS shown on the attached laps. Plum is Name (print) Plumber's Signature (no tamps): MP/MPRS No. Business Phone Number ~ ,~.~, ° ~ ~ ~Z~o~2 ~ ~ - 772 - 3Z i 5~ Plumbe Address (Street, City, State, Zip Code) 3 ~ ~ ~ h u.e ;1 1 1 ~~v Z 7 x , . VIII County/Department Use Only Approved ^ Disapproved ^ Owner Given Initial Adverse Sanitary Permit Fee (Includes Groundwater Surchar Fee) - Date Issued ss ng Agent Signat re (No stamps) D ~,~ 2 ~ ~ etermination LG ~, , :~~~„tn,-- IX. Conditions of Approval /Reasons for Disapproval: ~-ai..~r.~ c,o P-e.,~ CooQst_ .tsa,. 6.~., v~ ~ ~sesQ~o~r S -)E" A-l ~ . \ ../ f ( ~ s -~ ~'t~r-~nQ on.D[ Cy~'c-~ t^M CJ~~p~ f ~~1~ ~ ~b c (~ , f -~ I~n~-+~J " ~ _ -. / tn~cuQ~^ Se.~t.~ -~1t~._ 1, I~~ 't-~~ oo P.e..~ e_ s SBD-6398 (R. 07/00) TIMM EXCAVATING Route 1 Box 192 WILSON, WISCONSIN 54027 (715) 772.3214 (T15) 386-5443 MPRS #3224 WI MPCA #696 MN cos hUrf ~/~-2//~ ~~~Lj SHEET NO. Of CALCULATED BY ~ DATE ~~ ~~~ U2 /CHECKED BY DATE / ~~~: tea, SCALE .........:......... Vii.......... ~. PRODUCT205-t~lx., Grdon, Mm.01/71. To MEer PHONE TOLL FREE t-BOb115b3B0 ~ ~ ~u.-t C,~eir /,may JOB TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY ~ ~ DATE ~~ I~~ !>`2" (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN /CHECKED BY ~/ DATE / ~ i! `" r i SCALE ~ ~~~ t..... . ...... ....... .~....... i. ~ ..~ .... ._.. ..._ ..... ..... ... ~.. PRODUCT 205-1®Inc., Groton, Mass.01/71. To Order PHONE TOLL FgEE 1-BOU225~3@J .. r ~ Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT ~~ ~~~~ Page ~ of rn accoroance vnm uomm n~, vns. ram. ~,oue County ~ C ~ 2 Plan must er not les in size it l th 8 1/2 11 i h Att h l t I (X C e p an on pap s an x nc es . comp e e s ac r ' ! r include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. ' ~ (~ .-~ / - - 4 (~ - Q j (~ P/ease print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.114 (1) (m)). ~,~ ~v , Property Owner Property Location ~ ~ ,(~ KC3 ~~- ~- ~ ~ / ~ / L ~ Govt. Lot J ~ N R ~ 1 E (or) W 1I4 jL,1/4 S) 7 T Z Property Owner's Mailing Addre ' Lot # ~~ Block # Sulxi. Name or CSM# /~ ~~~ ~ ~\` ~~~7 " :~ ~ ft~ ~ c~ 1 City State Zip Code Phone Number ^ City ^ illage Town Nearest Road New Construction Use; Residential !Number of bedrooms Code derived design flow rate ~,. __._...... '_! GPD fp ~ i ^ Replal~ment ^ Public or commeraal -Describe: __-__-_ ~.__. - Parent material h~~~ r ~~- y UT'WM ~ ~ Flood Plain elevation if applicab ~ ~ ft. General comments ~+ _ '~~ /~,~ and recommendations: ~~'~ ~JYS l ~ M 1 L) ~dS ~' 7a ~)4Y !J1!T' U~'' ~ Dta-a)~~cf~r~ >r~~ wx~YS . ~~~YU w~ ~r c~~~.~ ~ ~ s C~c ~~~Z .,. ' Boring ~`,/` Boring # ~C~ • , ~ ~~~ f-.~,_,. _, _.. ` , ` [~ pit Ground surface elev. ft. Depth to limiting factor in. f ~ i ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ i n. Mu sell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 / n ,t ~'Fe / ~ j L ~'1 J~'j Y" ~ ~'~"1 %~. o~ Boring # Boring Pit Ground surface elev. ~ ~ • ~ ft. Depth to limiting factor ~ `~~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ~~~ I ~ .~ 'Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L - tmuern 1i"L = rsuu < 3l) mg/~ ana t ~ < ~ rr)grt CST Na (Please Print ignatur CST Number Address Date Evaluation Conducted Telephone Number ADZ Property Owner ~~/ N L /~l•1 Parcel ID # ~S?-CD- f /7~°~ ~Ci - C~~e' Page ` of 3 Boring # ^ Boring ®Pit Ground surface elev. ~ ~ •~ ft. Depth to limiting factor~~ 5~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~~- ~ 4 - 5 ~. i M ~ K n-, s / X1.6 3~-/~ ~ ~, -- ~i5 SCE / ,~ [~?,. 2 Boring # ^ Boring ~ j ~ ~] pit Ground surface elev. ~ 7~1 ft. Depth to limiting factor~l47 in. Soit lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eif#1 'Eff#2 7-6 7.s y,29 Q -- ~ s c~, ~ S -- ~ ,~~ 1. '~ i~ ~ ~«. 0. Q Z S a r ~ Boring # ~ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Cdor Redox Description. Texture Structure Consistence Boundary Roots GP D/f'f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =BODE > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BODS < 30 mglL 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-6330(8.6/00) .. • .{ ~~ ~~ 9 I ~, ~~' a d ~ 1`1 r Z r / J .... ' i ~ m ~ ~ o~ ~ ~ ~ w ~ ~ ~ ~ ~ ~ .~ ~ ~ ~ ~ J J _,p ~ J ~ N ~ ~ ~ -b 1 ~ ~~ ,' ~ \d `cf ~ ~ ~ / , < `. ,,, _ do ~ ~ z 3 Z ~ ~~ ~ N ~~ °z . ~ ~~ ~~ ~~ \~ t~ \~ ~~ ~....- m xcn.-. V)A3 = go N¢W .~ o MAN N3A v o LLU~~~. w m=~x~ LL NWWOQ ~ W,=.. W --~Y~ c Wc,N ~JU1Uw ti a-(p~[w T_H V ~Y LI L'] ....% 653553 Y.A'IHLEEN H. WALSH kEGISTEk OF DEEDS ST. CkOIX CO. WI RECEIVED FOR RECdRD OB-10-2001 12:00 PM COPY FEE: 3.00 RECORDING FEE: 12.00 is`~'ER T I FI ED SURVEY M,4 P Locatedvn Lots 95 and 96 of the pia.t of Willow Ridge East, located in the Southeast quarter of the Southwest quarter of Section 17, T29N, R 19W , Town of Hudson, St. Croix County, Wisconsin. Owned by: Garrett Conover 931 Ridge Pass ~\ Hudson, Wi. EQST Bearings referenced to the plat \ LOT 94 of Willow Ridge East. ~ ~, 3 _ ~ Curve information is shown g , ~/ - on the back. G~ „~ ~ , ' ~ ~ M Q 0, / ~ S 00'49'13"E ~~ , ~ -50 r00 ' '\ 10, ~~_ ~ ~ POB 55~ ~ ~ ~ ~ oL P,~ ~~'~ ~~ ~ F Q~ ~ i ~ \'Q< ~ ~ ~ mss, ~ ~. ~^~ i .' ~ ~ IL®7l 95 I o -~ ~s ~ /~ , ~ 76967 Sq.ft. II ~ ~~ \ ^~ / i (1.767 acres). i N ~, Z. \> ~ N e i O ~Li ~ / ~ ~ i 0~ ~~ ~ ~ ~ ~ m ~ ~~/ s~ / ~ I N Q 1~~ O ti , ~/ ~.1 I p C~/ ti h ~ ~ I N N~ ~' / i ~ / O~ ~O~ ^~1 ~ ~ i N i . o 0 \ hy. ~ -tyro ~ ~ i l ~. ~ ~i i ~ ~~ ._ ' l ~~ ~ y~~ ', ~ _92,61 g. g.W I i ~ ~ ,.. a 33' ~~ \F 57586 Sq. t. ~ ~ 33 II ~ ~ (1.322 acr s). p O; ~~ ~._ 1~ OI W C ~+~ N ti 0 \ ~ O~ J ~ fy IA Iss.~o' -~I cv N 01'51'40 -332.40'-- ~ ---= N ~~ ~ LOT 97 I •~ - `f _WILLOW RIDGE _ EAST_ I ~ ----- - - Legend ° 1" Iron pipe weighing 1.68 pounds per lin„ foot set. ~I • 2" Iron pipe found. ~! Note: No new lots have been created. The • 1" Iron pipe found. purpose of this map is to change the lot line between Lots 95 and 96. SCALE IN FEET /~= 80 O 80 /60 240 This instrument drafted by: 4012709 Vol . ] 5 Page 4] 47 ~, ' > . POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~) of Z FILE INFORMATION Owner ~~~~ `-lC-k'~ Permit # 9~ ~~_ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ~NA Estimated flow (average) ~ gal/day Design flow (peak), (Estimated x 1.5) (Q (SD gal/day Soil Application Rate ~• ~- gal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (GODS) <_220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBODSI S30 mg/L Total Suspended Solids (TSS) <_30 mg/L ^ NA Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Ya in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity ~ 2..64 al ^ NA Septic Tank Manufacturer W~c K ^ NA Effluent Filter Manufacturer ~- ^ NA Effluent Filter Model ~ ~ (d'p ^ NA Pump Tank Capacity al ~VA Pump Tank Manufacturer '~NA Pump Manufacturer C5.(uVA Pump Model ~ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: "O~NA Dispersal Cell(s) ~In-Ground (gravity) //^ ``At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tankls) At least once every: ^ month(s) (Maximum 3 years) 3 (i~-yearls) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cellls) At least once every: ^ monthls) (Maximum 3 ears) 3 ,f~yearlsl y ^ NA Clean effluent filter At least once every: Z ^monthls) yearls) ^ NA Inspect pump, pump controls & alarm At least once every: ^monthls) ^ year(s) ^ NA Flush laterals and ressure test p At least once ever y~ ~ ^monthls) ^ yearls) ^ NA Other: At least once every: ^ month(s) ^yearls) ^ 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 cellls) 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 tank equals one-third IY3) 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 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 _<12 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. Page 2 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. 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 cell(s) in one large dose, overloading the celllsl 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 otherwise 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 (sump 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 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 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, alt 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 provide a code compliant replacement system: ~1, 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. ^ 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. ^ 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 must 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 NOT 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 INSTALLER Name ~_`~„~,,,,~ Phone ~ {~-,. 2- '3 ZI POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name l . C.QDI~C C~,I,NT`(' ~~N61 Phone ~- 3d° ~ ~to6 v This document was drafted in compliance with chapter Comm 83.22121(blll-{dl&If- and 83.54{11, 121 & 131, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address ~eiN lip (Verification required from ~-oSo City/State u.c~~vY1 L~ Parcel Identification Number LEGAL DESCRIPTION Property Location '/., 1/4, Sec. ~ TAN-RAW, Town of ~ <S'v Subdivision ~1 ~ ~Q6tJ ~~~~9E" Ci¢S7'` ,Lot # ?~. Certified Survey Map # ~ 5 3 ~ 5 3 ,Volume /.~ ,Page # ~// `~~ Warranty Deed # GSA ~`~ ,Volume }~~ ,Page # 23~ Spec house ^ yes ~' no p Lot lines identifiable ($ yes ^ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal 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 Zoning Office within 30 days a three ear ex tion date. /~D/~~ N OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge the perry desc 'bed a ve, by virtue- a warranty deed recorded in Register of Deeds Office. IG ATURE OF APPLICANT I (we) am (are) the owner(s) of l l a/ d ~~ DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~~1.1718PAGE235 • STATE BAR OF WISCONSIN FORM 2.1999 Document Number WARRANTY DEED This Deed, made between Garrett S. Conov_e_r and Deborah M. Conover, husband and wife, ~'--- Grantor, and Kurt B. Beinlich and Lynette R. Beinlich, husband and wife, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix_ County, State of Wisconsin (if more space is needed, please attach addendum): A parcel of land located in the ~Qf Willow RidP,e East in the Town of Hudson, described as follows: tt ot~~~9 77of Certified Survey Map filed August 10, 2001, in Vol. I5, Page 4147, Doc. No. 653553. + G re .Conover -- TC!~ ~ Deborah M. Conover 020-1174-40 Parcel Identification Number (PIN) This is not homestead property. Ot) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this _~~~ ,day of September _ , 2001 AUTHENTICATION Signature(s) Garrett_S. Conover and Deborah M. Conover, _ husband and wife, authenticated this I day of September__ 2001 i Kristine Ogland TITLE: MGMQER STATE E3AR OF WISCONSIN (]f not, _ __ _ audxxized by § 706.06, Wis. Stets.) -~ ~-- rHIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson, W 1 54016 _ (Signatures may be aulhenticatcd or acknowledged. Both arc not necessary.) 'Names of persons signing in any capaciq' must be typed or printed below thei WAKKANTY UEEU STATEBARO ACKNOWLEDGMENT STATE OF WISCONSIN Ss. -_,.- ---.-- county } Recording Area 656494 '(: i"rILEEN H. WALSH FiE(i.iEiTEfi OF DEEDS N'i., CKOTX CO., WT kFCEIUFD FOk RECORD 03-i3-2001 9:30 AM iigkkAkTY -EED cX 4i: i A CFF.T i:OF'9 FEk: ~.:JF'f cE: TkANSFEk FEE: 21b.00 k~CuROTNG FEE: 1L 00 pflGES: 1 Nwne and Return Address KRISTI-'!1 r`~LAND ATfOF '.' AT LAW p , '''< 359 HUG.,_.~, vVl 54016 Personally came before me this __ day of .._.._._ --- -_.- the above named to me known to he the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, Statc of Wisconsin My Commission is permanent. (If not, state expiration date' f 5lgnaltlte. IMormaticn Profeacanale Comparry, Fwq du Lac, WI F W ISCONSIN eoo~s tr'2i FORM Na. 2 - 1999 • ~ __ 653553 m=`om'-' ° !',A~THLEEN H. WALSH cnra3 s ©° REGISTER OF DEEDS N J LtJ co s o ¢~`' '° "'~"' 5T. CROIX CO. WI N3A v o ~ ~ ~ ~ -:; RECEIVED FOR RECdRD m=~ o ~ s H ~•- o c~ 08-10-2001 12:40 PM WW~w .°v w~ wr- s ~ ~ LL p •• COPY FEE: 3.00 _ ~ ~ ~ 4 ,~ ~ RECORDING FEE: 1.00 '=`~ `~ ER T I F ~ ED SURVEY M,4 P Located vn Lots 95 and 96 of the plaat of Willow Ridge East, located in the Southeast quarter of the Southwest quarter of Section 17, T29N, R 19W , Town of Hudson, St. Croix County, Wisconsin. Owned by: Garrett Conover 931 Ridge Pass Hudson, Wi. EAST Bearings referenced to the plat LOT_ 94_ of Willow Ridge East. \~- ~, Curve information is shown p~'~ ~/ _ ~.-- - M on the back. 6~0~' ~ / ~' M gyp, ~ S 00' 49' i3"E R~ ~ / ! 50=-00 ' '` ooe ,o___- O~ ~ ~ Q P~~' / ~ ' ~ / / i / / Iii ~~~< n ~ ~ ,o .2 ~~ ~ ~ ~ /' ~ ~ 76967 Sq.ft. 'I ~ ~~ i ~ ~/ , (1.767 acres). ~ N ~, Z, \ i m ~~ p . ~ , , ~/~~ / = 0 ~ ~ i ~, r O i ~ / Q~ a ~ ~ tD i ~ ' ~ i '•~ O, ~; ~V ~ ! Ol ~ ~'.. ~~ ~ 1!! ~ ~ ~ ~ ~ o ~ W~ y ~~~~ o "~ 1 ~ ~' `~ ~ ~ ~ ~ , _ 2,61 g"W i ~ ~ ~ \ tL ®7~ g 6 '29~F: '~ N 13.29 i 33' ~~ \` \~ 57586 Sq.ft. ~ 33' ~ ~ ~ • (1.322 acres) . p O; ~ ~ \ \ ~, ~S i lU o ,p N a-~ U7 ~s9.+o' ti m J~ ~ I v LOT_ 97 ~ WILLOW RIDGE E~iST ~ -- -------- ----- --- I Legend ~ l~~ Trnn 1'll1lP wniahino 1 _EiR nnundc nPr