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HomeMy WebLinkAbout020-1300-80-000Q o ' M ~ o~ ! ~ ' ' 7 a ~ o C O ti o i t N i , N ti U tl ~, ;n I ', I ~ '', '', ' I ''. a C 7 LL 3 ~ ' ll 3 M ~ ~ 'I Z N ! E rn In = O ~ \v E o z > N > ~, d I I d m n H Z I '', o Z d' c ~i ~' ~, m z g ~ ~ rna ~ .. v _^ ~w N V . WSJ ~ I •-.i I ! y ~ ~ ~ a j' ° N ~ o ' o Q ~; zmz ~' ~ w ~ H E ~~ W ~ ~ J d d ~ ~j \~ ~ _ > > W d ~ o ,~^ o oa a~ ',=333 ~ ' aaa • a~ °, M J U I N N l0 ~i I U `~ °r `_ O r O ~ it c .0 N 7 a~ O 0 °~ N C O ~ O r C aOO ~ ~ d m a V 4~ O rO I' ~ ~ ~ j y ~ O N i ' ~ N ,^ . C O • N ~ ~ O ~_ ! j -Oi M O O ' Y N rS^ ~ ~t ir' = E `/ e~ , a c `1~i ~ a v ~ E ~ c °' c r ~ A cia~ '',ou~ici I O ~ I c O r I W U~ I M r O ~ w V o I `~ ~ 1 ., ~ I c m N N ~ N ~ N N ~ L I O Z ~ c ~ CO O w~~ 1° Q oV I I m M O N N a O I I N m ~ ~ °' ~ ._ ~' o I N N I ~ d c c co ~ ~ 0 0 o I L N 1fl V N O ° ~ ,~ o V- N C O ZZo I I m ~ 'O 7 ~ a ~ I y I ~~ I Q O a Z ~ m N N -) O _ ~ O m 0 c d ~ O) N ~ rn N Q A (n 0 I O E ~ r N C 7 ~~ ~ u a o 0 0 l Q ~ _ ~ N N N f` ~ C ~ O ~ O 7 Y ~ w 7 C .a C O~~~ Z N Y U` ~ in I I I I I I of Commerce PRIVATE SEWAGE SYSTEM vision INSPECTION REPORT ~atr~e JnSiQ FORMATION (ATTACH TO PERMIT) ~_anN....,dn you provide may ire used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Jensen, Paul Hudson Townshi CST BM Ele~ ~I -~~ In~ BM ~ ~ BM D~scriptio~n~•~ ~ ~ ~ ~ TANK INFORMAIT/"ION ELEV TION ATA TYPE MANUFACTURER ~- CAPACITY Septic ~ ,~ ©~ ~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL 1 BLDG. Vent to Air Intake ROAD Septic / ~~-/ ~ ~;/ I f ~' Dosing . Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand Model Number TDH Lift Fric ss System Head TDH Ft Forcem ' Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ~/ /~,~,~~, County: $t. C~OiX Sanitary Permit No: 399625 0 State Plan ID No: Parcel Tax No: 020-1300-80-000 ~~ ~yS-i~ ~>~s STATION BS HI FS ELEV. Ber~tchmark /rt ~ ` ~ ~~ Alt. B v~-e- . ~~. 3~- y2 ~- ~'~ Idg.S e~~`~~A~ ,~ ~'~ ~~-~d S Ht Inlet ~ ~ ~~~ Ht Outlet 9• $ ~' 3.3 Dt Header an: s s~"- ~~;3 ,/, ~ Dist~e ~,1,~ (~ Bot_S,ystem ~, ~ gq~ Final Grad - ~ ;~3 9r~ s> St over 2 ~~ BE ITRENC Width ~ ~ Length ~ ~~ No. Of Trenches PIT DIMENSIONS No. Of P~ Inside Dia. Liquid Depth DIM ONS ~, ~ ~T] ~,/~ ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHt G Ma fa urer. ` , , INFORMATION CHAMBE R r Tygq Of System: ~ / ~ ~ ~ ~ ~ ~ / ~~ Model r. DISTRIBUTION SYSTEM Ii ~Au1f,/ mn, ~ n.tin o~ /,~,; _7n~1 ~'~iil-~, b~ti ~ ~ Header/Manifol , Distribution j x Hole Siz e / x Hole Spacing - Vent to Air e u Le~ng~ ~~ / ~ Length Dia_ Dia Spacing - SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Only Depth r Depth Over xx Depth of xx Seeded/Sodded xx Mulched Be rench Center ~ l ]t 1.. Bed/Trench Edges ~~ Topsoil ~~ „/~ ~ Yes ~ No /Yes ~ No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: / ~ g / ~ ~ Inspection #2: / / Location: 930 Carter Cirrcle Hudson, WI 54016 (NW 1/4 SW 1/417 T29N R19W) Park Vie s t s A Parcel No: 17.29.19. 1.) Alt BM Description = ~it-r,r~~~- of SUr=~L~Cm~~a01rE'-- ~w ~d SZu~LY' ~~ij~~1-~Zi~~A~ -~(L-.~'~v4`. Y~v'~t~E'~'~ ~~:S~~h ~L~'~~u 2.) Bldg sewer length = ~. ~~ rYZ24~.~.CAO~ ~-~r~t'i°~ ~ ~~nSIG~ ~2t~-e -amount of cover = ` ~>f~~~ yr ` j ~6~/j Plan revision Re uired. 1 Yes No I ~ I ~ ~~~~~ ~ Use other side for additional of l__ ~ ~ ~._ ~ ~ ~ c SBD-6710 (R.3/97) ~~,v-G~ Date ~ nsepctor's ig n; _ Cert. No. sys;.~ ~ d ~\'7 •~ .~ J _. S 4- z ~~~~ ~ ~J V ~ ~ ~ '~--,.. _~'~ - ~ ~ Safety and Buildings Division ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~S~~ns'~~ Madison, WI 53707 - 7162 De artment of Commerce 0 do 7 Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy l..aw, s15./)4(ixm) I. Application Information -Please Print All Information ^~- '-~. Prop Owner~ame 1 Q~l~t~.,l~/h ~ 0 ~ t ~ia `~ " 1 ,' . ~ a r, n • , ~ ,,__,.~ ,k Mailing Address :~ff• .Yu T. ` Site Address Car~t~r Ci re 2, C~' ~~ Sanitary Permit Number ~j Q ^ Check if Revision ,!-l " ~ ~D Z~ State Plan I.D. Number , t / (, 0~ Parcel Number ~ .~~ Zr, . ,G. 7 (f / S/ r j S 54;5 T N,R~ E City, State Zip Code ^Pl~ne N C- e ~ ~, ^~~ Lai:Jal r / Block Number ... ~~ ~"~r' ' :~K)t9N!nl Std 's n blame CSM Number ~~ Q/ ~ , / (O ~ ~ .6L~ II. Type of Building (check all that apply) ©City n I ~. { ~~ S) (~1 Ei~- 1 or 2 Family Dwelling -Number of Bedrooms ~ ~ ~ " :~~ ^Vill , ~ age ^ Public/Commercial -Describe Use hi 'i owns p ^ State Owned Nearest Road a III. Type of Permit: (Check only one box on line A (aumberutg scheme for internal use). Complete line ~ ~ applicable) A' 1 (New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use stem Tank Onl Exis ' stem B • ^ Check if Sanitary Permit Previously Issued Permit Number Dace Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Non -Pressurized In-Groin '~ 21^ Mound 47 ^ Sabe Filter SO ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Lim 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Reciicalaling 30 ^ Other V. rsal/TYeatment Area Informat ion: lit Design Flow (gPd) Dispersal Area Dispersal Area Soil Application Percolation System Elevaflon Final Grade Required Proposed Rate(Gats./Days/Sq.Ft.) (Min./Inch) *~ / _ M ~ Elevation g ~~ VI. Tank Info Capacity in .Total Number Mam~facturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concreu Consirrcted Glass New F.xia6nY Tanks Tanks ~na >/1M - - //1f'11~ ~ I ~ ~ ~ VII. Responsibility Statement- I, the undersigned, awe responsibility for ttoa of the POWTS shown on the attached plans. Plumber's N (Print) ~ ~ Flambe S' - MP RS Number Business Phone Number f~ ~3s 7 his-a~ s ~~qy.~' Plumber's Address (street, city, state, zip > VIII. Cotm /De artment Use Onl -, Sanitary Permit Fee (includes G water Date Issued Issuing Agent Signature (No Stamps) Approved ^ Disapproved Surcharge Pee) ~,~.~ ^ Owner Given Initu~l Adverse ^^~~ 6 O ~ Z ~ ~ ~ 'D ~ ~`,~(/t , Determination ~d"~ /~ ~ IX. Conditions of ApprovaUReasons for Disapproval {(~(~ ~~ ~ l~cQ lwM - ~o MG ~` C (t- `~ P(' f vwv~~,tis ~'.~~ ons,blw ~~ ~~ „~eHC~v~-c.r, p ~ Fb~,Jrs e~ ~'~l4ar- .~ u~nt.~' ~ (~~ wl,,,~+. ~l (~ wkkr<~ S-a./ti.,..~,~ f Gar Co~rvt ~3. t(3~'~L~) ' mly) [a• the system on paper not teas than Stn z 11 inches m size SBD-6398 (R. OS/Ol) ~Gg~' ~-/d° l~ 7T a ~~- ~/ ^/ O r jDoa to-~--~- ~ ~~ {tit - a = T ~ ~/Y ~~~'~ f~ ~ T / - ~~~® r ~=a ~ ~ $~, 5d P~~ a-3 ~."~15 e x c~ ~ ~ . D q .~-~-; :~ ~ ~~ r~ a ~~ 3`~~` ~ I ~`` ~ ~.z~s i~- is .~-_, . (1 ~ ~ ~~ ~~ 13 ~ .~, I3 ~-~I R~~ /~1 ~ ~, Hof I~~ Y~ u°v ,.1 ,~ ~ ~~ Q c~,- (s ; 1 ~ ?r o~ (' ~~ I ~ UO ----fir ~~ ~~`~ ~~~ ~~ ,~ ~g `°~.~~ S~, ~~ i /~~d ~; - ~~~.~.~ s~ r~ r~or~~~-ss ~ y3 o Cr9.~rF~ c,:~c~~-- 'Msconsln Department of Commerce SOIL EVALUATION REPORT livision of Safety and Buildings in accordance with C 8 ~ Attach complete site plan on paper not less than 8 1!2 x t n ~~ in size~{an muss include, but not limited to: vertical and horizontal reteren 1(BM nd er '' cent si ~, P ,scale or dimensions, north arrow, and to and disfeM~~~resl Please print all fnform '' ~ ~ ~ ~ ~ ZQ~ ~ Personal information you provide may be used fn. ~e~....a........w_ •_ ,.. , l I Boring # ^ Boring ~~ •~ ~ ,--J ,~ Pit Ground surtace elev. fL Horizon Depth Dominant Color Redox Description In• Munseil Qu. Sz. Cont. Color o • ~y ioye 3/ ._._ Z / •~ ioy~Q 3~y 3 ~ • /oy~ _____ ~oRy S ~' 1L /~ R c2~ N ems s yr2 y/~ ~ -~Y ,~P~'cPv~'it'~S ^ Borin Page / of ~ ~ - ~-/[ vi /` 1/4 `~ ~1/4 S ~~ T 'Z'~ N R /~ tE for) W Depth to limiting factor .S ..S.S' in Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft~ Gr. Sz. Sh. 'Eff#1 'Eff#2 SiL / S ,~ ~~ tv / f . Z . 3 SQL S~ ~ /~J ~ /fstik ~/v v~ ~~ c r' -- • Z . z • 3 tcG l~ ,~ ~ aU /? ~ ~S S7`~' > 30 < 220 mg/L and TSS >30 < 150< t50 mg/L iJlbricht & Associates Private Sewage Consultants 855 O'Nett Rd. Hudson, Wis. 54018 Depth to limiting factor >/~~ in ' Effluent #2 =BODY < 30 mg/l. and TSS < 30 mg/L a Boring # g Pit Ground surface elev,~ ~ •O fl r~ '~ ,c~ oi,0 ' t+3 0 ° 3 Property Owner ~~ d~ Parcel ID # Q ~ ' ~ Page Z of a Boring # ^ Boring ~/~~~ y pit Ground surface elev. • it. Depth to limiting factor //~ In. Horizon Depth i Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/fiz i n. • l l Munsell /o!/~ y Qu. Sz. Cont. Color -- Sic Gr. Sz. Sh. / ~' ,~ ,,,+ ~ • •EN#1 - Z •Eff#2 . 3 ~~ ~~6 , _`,A $•r Boring # ^ Boring ~~ . ~ ?. ~//~ ~i1 rrl~~I O prt Ground surface' elev. tt ne..~ti r„ ::..,:.:..,..__.__ Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots y a '3v ~O R -'- Sit! ~ ~,fi• c / I I Boring # U Boring u ^ Pit Ground surface elev. ft. Depth to limiting factor In, Fto-izon Depth bominant Color Redox bescription Texfure Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Soil Application Rate GPD/ft= 'Eff#1 •Efi#2 .y .~ .2 3 .Z .3 •~ /2. GPD/fly 'Eff#1 ~ 'Eff#2 ..~., ;Effluent #t =BOOS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 =BODY < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider end employer.' If you need assistance to access services or need material in an alternate format, please contact the department at 608-2G6-3151 or TTY 608-2G4-8777. ~, ~'^~ ~ ~s~ ~-r~° S ~Sy r' ~l ~ v ~' ' ~ g~-y° c I-~i~ ~~ /~, g~, ~`~ ~° ~h~ ~ ~~ ~~ ~ ~ ~ ~" i3, I~ /3 5 ` ~~ • ~-~ 5e -o---. io' 13M 7'b QUC Db ~~,~~~' ~~ D ~~ co ~.~ Scfl/-e : / ~~ - y0 ~~~ ~oo~s /2 ,,.~ ~~ LD ~3 7 `~ ~ ff~"'' ua ~ ~~, y P ~~ ,.P . . ~ ~~~" ~ . /o~~ M ~ _ ~-J 7"Tl tJ/P G/.V-~~' C A'J~ T~ C~ iP CG 1 30~ •~ i 1 . , •. r .~ `~ LOT 134 Ao `rJ, 1,91 ACRES v`~s 83,092 S0. FT. M LOT 135. ~ M 2.11 ACRES ~ j 92,088 SO. FT. d. I ~~. r W 1 ~°a. (~I ~I ~j w ~I -I ~ MI tt') I M I o W I ~' ° / N7T 48'25"K, / ~ I 342.32' OI Oz > I ~ LOT 136 1.35 ACRES / Z I O I N 1 58,740 S0. FT. ,, © c\ _ wl " o m \ UI o a ~ ~ ~'~ I ~~o I pa„~ I N88°5655"E 386.40' \ ~O- ~O .~ m LOT 137 S88°56'55"W 217.47' ~ 1.08 ACRES N ~ 46,849 S0. FT. !'~ M N LOT 138 _ o~ ~ 0 1.00 ACRES cif 43,734 S0. FT. ~ S88°56'55"Y1 21G.CC~ N ~ 9q•56'- ~_ NT9°56'37"w ~~ N28°57' 35"W ~~ y, V~o ' ~ e 0 DRAINAGE EASEMENT - --41.45 Q ~ S~ ~ / 2~ o ' " t01O 'a~ O, p,,~ij. 55.76' "'~ o • . W ' - J z / ~i~, 1° LOT 139 M ~=W Op ~ D j` ,~ _o°~ g 1.39 ACRES /~ 00 `v`. Q ~ oil n' 60, 474 S0. FT. 6j ~ M °Ir. O N I z rL00 o Od I / yy~ ~ 1 ll~ i ~; ~, I ~ / ~o ~ 1 *~ F ~ yp, $, to O I aNOI °,_ i ~ ~,IZ . JI 30' ~ ~ ~' 9 F ~--- ~ ~ ~ ~ u LOT 141 ~o ~ I , ~ ~ j I.OI ACRES `~ 0 I °-'. -' ~ 43,930 S0. FT. ~1 ~- ti ~~ S OI~ ` 1 ~ `~o Q J C~ / J? ~-- W, ~ ~ ~~ F D ww Y I _ 0 BF?Q~KwO - i~ l ~ j $ o LET 140 ~ ~_ -~- ''~ ~ ~ ~ _ ~ 1.02 ACRES ~i~ ~ ~ o ~ 44,469 S0. FT. ~~,,, O '" 0 M ~i75T~ p ~~E Q ,~ DRA1N~ 00 DETER POWTS OWNER'S MANUAL 'NFORMATI N Owner ~¢.,.~-erg-~ Permit # 3~-1 ~ ~O DESIGN PARAr'it ~ tx~ d ~ ^ ~• rooms Number of Be Number of Commerdal Units n UA Estimated flow (average) ~©® gal/day Design flow (peak), (Estimated x 1.5) ~/S"~ gal/day Soil Application Rate f r ~ gaUdaylft2 Influent/Effluent Quality Monthly average* Fats, Oil 8~[ Grease (FOG) X30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solids (TSS) x150 mg/L Pretreated Effluent Quality ' ^ NA Monthly average* * Biochemical Oxygen Demand (BODs) <_30 mg/L Total Suspended Solids (TSS) s30 mg/L Fecal Coliform (geometric mean) <_10~ cfu/ ] OOmI Maximum Effluent Particle Size i~ inch diameter MAINTENANCE SCHEDULE Service Event Inspect condition of tank(s) Pump out contents of tank(s) inspect dispersal cell(s) Clean effluent fliter Inspect pump, pump controls 8t:alarm Flush laterals and pressure test Other: Other: Service Frequency At least once every ^ months 'year(s) (Maximum 3 yrs. ) When combined sludge and scum equals one-third (Y~) of tank volume At least once every „~ ^ months ~ year(s) (Maximam 3 yrs.) At least once every At least once every At least once every At least once every At least once every ^ months ,~ year(s) ^ months ^ year(s) ~ NA ^ months ^ year(s) ^ NA ^ months ^ year(s) ^ NA ^ months ^ year(s) ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: a< Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspectic must include a visual inspet:tion of the tank(s) to iden ~ an nba k up o~ ponding of effiuention the ground surfaceeaThe ddispersal volume of combined sludge and scum and to check fo y cell(s) shalt be visually inspected to check the effluent found surface msay ndicate aefailingt~onditionoand requires the immediaten the ground surface. The ponding of effluent on the gr notification of the local regulatory authority. the entire When the combined accumulation of sludge and scum in any tank equals one-third (Ys) or more of the tank volume, Wiscor contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Administrative Code. The servicing of effluent filters, mechanical or pressurtz~de OVJ ~ be performed by a certified POWTS Ma n~tainer.ny °ther maintenance or monitoring at intervals of l 2 months o A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWT at heekthe ~ pe~a~cell(s)f o If h'gh oncentrations are detected haveththe conrc that may impede the treatment process and/or d g ~t ~~ rar+lr(s'1 rarnovPd ~y a SentaRe servicing operator prior to use. SYSTEM yrec:iFICATIONS Septic Tank Capacity (~~ al ^ ~ Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model a ^ NA Pump Tank Capacity ~--- ~-~~ Pump Tank Manufacwrer n U a Pump Manufacturer - '-'''~A Pump Modes ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) I~.In-ground (gravity) ^ In-ground (pressuriz ed) ^ At-grade ^ Mound ^ Drip-line ^ Other: * Values typical for domestic (non-commercial) wastewater and septl~ tank effluent. * * Values typical for pretreated wastewater. oast . ~.~ System start up shall not occur when toll conditions are frozen at file InNtratlve wrface. OurinE power outa>res pump tanks may flp above nomul hlehwater levels. When power h t,atored the excess wastewater will be discharEed to the dlsperYal cell(s) In one lame dose, overloadlrlS the cell(s) and may result fn the backup or surface dltchar~e vl etlluent. To avoid this situation have the contents of !fie pump tank removed by a Septaee Servicln>t Operator.prior to restortnti power to the effluent pump or contact a Plumber or POWTS Malnalner to assist In manually operagltE the pump controls to restore normal levels wlthln the pump trek. Do not drive or park vehicles over sinks and dispersal cells. Do not dove or park over, a otherwise dtswrb or compact, the area wlthln 15 feet down slope of any mound or at•grade sob absorptJon area. Reduction or elimination of the to11ow1nE from the wautewator =trearn may Improve the performance and prolong the lik of the POWTS: antlblocla; baby wipes; cl~arette butts; condoms; cottots swabs; deereuers; dental floe; dtapsrx; dlslntectana; fat; foundation drain !sump pump) water; frvft and vetfetable peclir>Es; Euoiine; crease; herbidda; meat steps; medicafwns; oil; palntlnR croducts: aesticldes; sanitan napkins: tampons; and water softener brine. ARANDONEMENT When the POWTS fails and/or is perrnanentiy taken out of service the followln; steps shall be taken to Insure that the system is property and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All plpln¢ to sinks and pia shall be disconnected and the abandoned pipe openlnEs sealed. • The contents of aQ monks and pia shall ba removed and pre+perly disposed of by a SeptaEe ServkinE Operator. • Aker pumping, all t<snks and plu shall be excavated and remove4 or their covers removed and the void space filled with soil, ¢ravel or another Inert solid material. CONTINGENCY PLAN !f the POWTS falls and cannot be repaired the following measures have been, or must be liken, to proVlde a code Compliant re c nt system: suitable replacement area has been evaluated and may bt utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infrirt~ed upon by required scebacks from extstlnE and proposed strucwre, tot tones and wells. failure to protect the replacement area will result In the need for a new soil and site evaluation to esabllsh a suitable replacement area. Replacement systems must comply with the rules In ef>`ect at that tlrne. O A suitable replacement area is not available due to setbaclt andlor soli limltatiotu. 6arrlriE advances in POWTS technvlo~ry a holdlnR tank may be lnstaped as a Iasi resort to replace the- !ailed POWTS. O The site has not been evaluated to identity a suiwbk replacement area. Upon failure of the POWTS a soli and site evaluation must be performed to Locate a sulubk replacesrtentarea. (f no roplacerrlent xea is available a holding tank may be Instilled as a Iasi resort to replace the failed POWTS. O Mound and at•grade soft absorption systems may be recons<rttcted In place followln~ removal of the biomat at the InQluatlve surface. Recoruwalons o(such rystems must.comply with Lhe rules in effect at that time. < <WARNiNG> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT t;NTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTaNCES. OEATH MAY RESI,iIT. RESGLIE OF A PERSON FROM THE INTERIOR OF A TANK MAY sE DIFFICULT OR IMpl1CtIR1 i. ADa1T10NAL COMMENTS POWTS INSTALLER Name Phone '~ _ ~ ~ „ POWTS MAINTAINER -.Name Phone SEPTAGE TERVICING OPERATOR (PUMPER Name Phnn• tACAt R>rGULATORY AUTHORITY AaiencY ~3T Citcr•-~sz- hon - ~ - ~ ~ ST CRUIX CUUN't'Y SBPTIC TANK MAINTBNANCB AGRBEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address ~ C) 3 .~ ~•. ti„ tM c~~ ~ ~~ ~ ~' D -S ~''~ , ~ ~ y Properly Address CD C~.Y.~-~~~_ C ~ '~ L~ ~ (Verification required from Planning Department for new City/State ~..~ ~~ iJ 5 cJ .~ ~ ~ Parcel Identification Number ~ ~ ~ ~ J 3 v o ~~ p o cu ~ LEGAL DESCRIPTION Properly Location -/V ~~ %*, ~ ~~~ '/4, Sec. 17 • T ~ ~~ N-R,. ~ 9 W, Towa of ~ ~j ~ ~ °'U Subdivision ~/~/L ~- y z ~~ ~s -7,,~,~s .Lot # / -~' 7. Certified Survey Map # .Volume ..Page # Warranty Deed # ~ ~ 7 ~ U ~ .Volume ~ ~ ~~ Z .Page # _~ Z-~ Spec house ^ yes~no Lot lines identifiable yes ^ no Sy_ S?TM 11~IAINZ'ENANCE 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 caa affect the fimction of the septic task 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 mastorplumber, joumeymanplumber, restrictedplumber or a licenscdpumper verifying that (1) the on site wastewaterdisposal system is is 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 of the three year expiration date. ~~~ ~l ito~ of SIQNA OF APPLICANT DATE OWNER CERTIFICATION 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. f~~9.~.~~ ~r ~ ~a ~ ~ ~ SICINAT[JRE OF APPLICANT DATE *!**** Any information that is mis-representedmay 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 v 1722PAGE ~23 N Darrel E. Wert and Beverly A Wer:~husband and wife individu llv ~.+d each in their owr, ri¢ht. Grantors convey and warrant to Paul A Jersen and Monica L Jensen husband and wife as survivorship mantaI Drooerty Grantees the following described real ate in St. Croix County; State of Wisconsin: LO'f 137, PARK VIEW ESTATES SI}CI'H ADDITION TO THE TOWN OF HUDSUN This Warranty Deed is given in full satisfaction of that certain Land Contract executed between Darrel E. Wert and Beverly A. Wert, Vendors, and Paul A. Jensen, Purchaser, dated August 28, 1997, and recorded August 29, 1997, in Volume 1260, at pages SUO-SU1, a:: Document No. 564566. 'this _ is nut ____ homestead property. (is) (is ,ot, 657106 :.~N ~-. V,'RLSh ,.. ,S~~S7Fi: ilF DEk:DS .!... iii. tJi ri;EiVEG FOk RECOkG anRRA1;T1' GiicD .i. %CGY EE: rhti$~dk~h~t' .:i,i~ s ::i: iI.JD r'.~iG~: 1 THIS SPACE RESERVED POR NECORDINO DATA NANE AND RETURN ADDRESS: OWIN LAW FIRM, S.C. 430 Second Street Hudson, WI, 54016-1510 420-1300-80 PARCEL I.D. NUMBER OR G.I.S. Exception to warranties: TOGETHER WITH AND SUBJECT TO any other easements, Covenants, reservations or resui. cons of rr.~c:rd, it any, but this shall not be deemed to extend any such other recorded encumbrances beyond the term estabiisned by law therefor, and liens or encumbrances created by acts or defaults of the grantees. Datccf this_~GY_~ day~ofcl Se;~otjember, 2001. L(.~-~G ~~ `- ! (~-~~ ~ (Sear arrei E:. Wert K- (Seal) ' Bevcr~ A.. ert AUTHENTICATION (Seal) ACKNOWLEDGMENT STATE OF WISCONSIN Signature(s) Darrel E. Wert and Beverly A Wert authenticatgfl this t-day of September, 2001. ~ /' ~. f % i-, win TITLE ME BER STATE BAR OF WISCONSIN (IC not, authorized by §706.06, Wis. Stats.J (Seal} COUNTY } Personally came before me this day of , 20 ,the above- named to me known to be the person _ who executed the foregoing irtatrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY: Hu¢h H. Gwin GW1N LAW FIRM, S.C. 430 Secund Street Hudson Wl 54016 (Signatures may he authenticated or acknowledged. Both arc not necessary.) Notary Public, County, WI. My commission is permanent (if not, state, expiration date: , 2p r r .i ~A° LOT 134 `TJ, 1.91 ACRES ~'~1 83,092 S0. FT. o LOT i35 `~ M 2.11 ACRE S ~ 92,088 SO. FT. ~ I "Q W I °~. CSI ~I ~j w .. ~t ~ M) -I io MI ~I M tt') I M I °o - W I N N7T 48'25" / W / ~ I 342.32 ~ ~ ~' ~ LOT 136 1.35 AC ~ / Z I V I o f 58 ~~ ~-- ®(\ J) ~I N ~~ wl _' ~ ~ i% I ' N88 56'55°E 386.40' \ ~j .~ a .~ .~ LOT 137 S88'S6'S5"W 217.47 ~ ~ L08 ACRES N W ~ 46,849 S0. FT. M N X ~,~P""' _ .. LOT o~ ~ ~ 1.00 A ES 43 SO. FT. S88°56'55" ~' 21G.CC~ N d' N799q'36' ~' 'S6 37"W l0 ~ e i W \ W ~~p '3 DRAINAGE EASEMENT - --~al.a5 N ~ S~ o, / 2~ ~ 55.76' '~~ in l0 ~ 1 J g / ~v`• M .w LOT 139 ~~ a D ~ ~ -o°~ $ I.39 ACRES /~ ppp ~i~, p ~ O1le 60, 474 SO. FT. ~ ~,y ~ ~ ~ °I= Zp0 ~ °pap0 N ~ / yy~ / l t~ ~ o OI al o I ~2yA ~~. ~_ / ~, II . ~ LOT 141 ao ~ I ~ ~' p~ ~ I.OI ACRES 0 I ~ -' ~/ _„ 43,930 S0. FT. OI ~~ ~ ~i 01 ~~ 1 ~' ~- Jw 3 I ORS '' _ i i i ROOKw00D ww Y I B__----' ~----~i~~_ ~g o LOT 14~ ~_ .~~ Q.I _ ~ 1.02 ACRES m I u to 44,469 SO. FT. O N Ci~`,~O pDpO E ~O~ ,~ DRAINS ~O DETER