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HomeMy WebLinkAbout020-1118-00-000a y o N ev= bq V'1 OQ r, 0 6 H ti i „p z a c tz y ~1 ® pv N .~ i~ ~~ V S"r i:+ L O L~ R ~.~ Jl c A Y ,~ ~ C ~ LL , ~ C E a~ U (6 ~v7 a ~ ~ N O Z ~ ~ ~£ O ~ L Z .- `m m °~ °' w a m H Z o Z 'd' ~ c v ~ ~ ~' o v N H r ', O c N N fJ 0) ~ d N ~ fn ~ ~ ~ ~ ~ o a~i Q o Z m Z a ~• ~ E L A ~ d a 'm ~ m > N ~ 1n _~ ~~ ~ a a a ~m Q- o VJ ~ U = 0 0 O N N ~ W ~ -O _ O ~ r r 3 OO ,~ > .~ N d N ~ w O T O C O O O ~ ~ ~ 2 ~ O ~ O L 01 ~ N N i O p ~ N n o ~ 2 ~ v o T "' L r.+ ~ d Q. L a a c, ,~ w £ ~ ~ 3 R ~ Ua ~.'OinV ~ ~ o I O o I ~ O C O ~ N U (0 C .~ a O >, (4 :n C C O .~ ~ y •L C O i Z ~ ~ c C ~ U ~ LL O ~ O _ Q ~U I E I M i a ~ N E •• O ~ .~ O ' d d i a m N I 0 ~ c ~ ~ I c v ~ O N N 01 ~ I O d ~ ~ I N ~ ~ ~ O ~ I Z Z m I ~ I y a £ L a _ 'm ~ a L 0 ~ d i E cv o ~ 0 a fA N (A 2 ~ N a a a ~ c i ~ N Z = O O ~ n 0 I ~ O O 'J ~ 0 N CD '~ ~ . ~ Q7 n. I 3 O O O N Q Q Z 0 ro 0 ~ O ~ ~ ~ N 0 N N C O 0 = O O ~ O N N C C ~- O O (6 ~ N N N_ N to CO = _ C cu (0 ~ ~ 'O ~ N r ~ ~ N ~ O c t6 ~ L `~ I o ~' Z ~ to ~ rn o i w a I ~ a w c ~ ~' 7 O y U ~ o° O ~ C O N ~ N N ~v E C C w O O .. N U O U > ~ maU~ >~ QN 3 t r• is U (~• O C t0 p~ N ,m N O ~ O N~ U ~ C O O N ~ m~ Z UooiOE C ~ C ~ fl. O +. + ~ ~ 'O O N-C~ Q a~ N a 0 a E o. ~i ~ m ~ ,N ~ E c' ~ 'O U ~ ~ O O L n ~ ~ Q dl ~ O Z m N ) Q } O U N C C O O f!1 fn N - c z z 7 -~ ~ E E N ~ ~ O~ O - o ('-~J N O ~= N O Z o U~ O ~~ O ~ N , d N ~ ` Q "! N ~I p OI N ~' ~ a N ^T ~ I Q' O M ~ d b ~ a w C b O O N O M w y C d ~i •~ 0 N •~ ~~ r~ V •~ ~~ V t`I~i t >> a O>j W ~Z a Z .- O W ~'~z o zv' to H r c 0 Q m m _o N R a fA J V O F t~ e~ o ~ 0 ~ c .= ai y N -O o ~ 2 at ~' 3t a a ~ ,~ ~ ` c cva~ A ~ ~ N I I I I I ~• C ~ y C ~ = Z ~ 7 N ~' I ~ LL. C p _O U t0 C ~ - Q ~ Q ~ ~ M I ~- I ~ N '•: OD •d d a m I o I ~ ~ I c w o I rn ~ z I c ~ -o v ~ ~''~ I a~ y •~ ~ ~ I a y ~ ~ I a` ~ _ ~ I O ~ o ~ ¢ w I Z m Z o z I c l d y ~ ~ N ~ ~ o. - ~ CO y d ~ ~ L G D d ~ v ~~~~ ~n ~ I a ~ o I z ~ a a a y o I N = O O Z N V ~ O ~ O ~a o I o ~ ml ~ nom. I v ~, Q m a~ 3 ~?+ Qzin o I N 7 ~ GOD H C o v o E I ~ a~i c ~ ~a°o I = c € .cEo c ~ ~ I m rn ~' ' a I r ~t6 ~ d o Z y Z~ '~ (n I I ;; ~ I £ a 0. ~ ~ c :: ~ ~ I O u'~i V ertment of Commerce PRIVATE SEWAGE SYSTEM ,mg Division INSPECTION REPORT _RAL INFORMATION (ATTACH TO PERMIT) ,nal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. ermit Holder's Name: City Village X Township Marshall, Harr Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ s lao Z~.~~ 1 Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic / i ~~ ~ Z4 , Z ~ , Dosing • ~~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 487999 0 State Plan ID No: Parcel Tax No: 020-1118-00-000 Section/Town/Range/Map No: 19.29.19.497 STATION BS HI FS ELEV. Benchmark ~ ~ a, P Gb,~, • z 5 /63. z5 ~~ Alt. BM Bldg. Sewer O is ,`fie 9Z•gJ SUHt Inlet fa14~ $' St/Ht Outlet Dt Inlet c Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover r ~ ~~„ Gt,~ 3, o~ ~ ./8 BEDITRENCH DIMENSIONS Width length No. Of Trenches ~ PIT DIMENSIONS No. Of Pits Inside Dia. liquid Depth SETBACK INFORMATION SYSTEM TO /L B DG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: Type Of System: ~~ UNIT Model Number: I~ISTRIRl1TI~N SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing Still _ CnVER v Drucenre Cve4emc (lniv YY Mnnnd nr ot.Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ ~i Yes L] No i~ Yes ~ _~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 882 Willow Ridge Hudson, WI 54016 (NE 1/4 NE 1/4 19 T29N R1Q9W) Willow Ridge Adcjjtion Lot 22 1.) Alt BM Description = ~ CS~dZ, T„~- jJ')v 2.) Bldg sewer length = 2 5 1- ~ -amount of cover = 7 (p ~ , ~~ R; ~ -- - --~- Plan revision Required? ~ ]Yes No 12 ~ O Use other side for additional information. ~_ ~ Date Insepctor' Signat e SBD-6710 (R.3/97) Inspection #2: / / Parcel No: 19.29.19.497 Cou.,~- ~-- ~ ~ l~ _.~ ~' 3l~ Cert. No. Safet d Division 201 W ~ Coun ty s T G~ Q~~ ` ~ ~ as Ave P.O. Box 7162 ,~~~l~sl n n, Wl 7 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 6 66-3151 G Sanitary Permit ~ tj State Plan LD. Number ^~/~ In accord with Comm 83.21, Wis. Adm. Code, personal in rmation you provide may be used for secondary purposes Privacy Law, I5.()<1(t~~ 5 -'~ ~ ~ ~) ~ project Address (if different tttan mailing address) ~ ~ i. Application Informafion -Please Print All Information ~ ~ . 'RpixG UNTY ZZ Properly Owner's Name ~'~/pl Mme/ SL1i9'~~ w~//off /cip~P Parcel # Lot # Block # 020' ///~- ODo~U Pro Owner's Mailing Address ~~ 2 w~i~ow ~,to ~ ,~o. ~ G'~7 %~ ~ N~ ~ ~ / ~ ' ' City, fate ~~ / ~U~t~Q.tJ ~V ~ . Zip Code /~~/- s ~(~C!/ PhonfeN/umber ~CJ (tom ~ D~f, ~+> Section q ~'~ ~ y , ~(circ T N R II. Type of Building (check all that apply) , or W ~1 or 2 Family Dwelling - Number of Bedrooms ~ ~~`~~~ ~ Subdiv ision Name CSM Number ^ Public/Commercial -Describe Use / W l~~W ~~~~E /9'~~~T ^ State Owned -Describe Use ^City_^Village ~'1'ownship of ~11~~'O III. T ype of Permit: (Check only one box on tine A. Complete line B if applicable) `4' ^ New System ^ Replacement System ~TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a t ^ Non -Pressurized ln-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soi[ ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Dri~'Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Area Information: Designwjgpd) Design Soi! Application Rate(gpdsf) Dispers Ai ~ R~uired (sfj Dispe~~ Area Proposed (sf) System~evation VI, Tank Info Capacity in Total Number Manufacturer Prefab Site Stee! Fiber Plastic Gallons Gallons of Units Concrete Constructed .Glass Tanks Tanks ~..,p ~ ~~G /~ Septic or Holding Tank ODO / `T/ ~ ~ . `~/ Aerobic Treatment Unit Dosing Chatnber ~ D ~ C D VII. Responsibility Statement- i, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) R . it~t3RI~~Ti Plumber's Si tore %~~- MPIMPRS Number z Z~ 3 ~ S Business Phone Number 7/5 ~ 77,2 ~ 3 ~f ~ Plumber's Address (Street, City, State, Zip-Coda) ~ ~ ~ ~/~ ~/' 1~~ Z / ~ ~- ~-//,Q S~~ ~ /4' / S ~ 7le VIII oun !De artmen't Use Onl Approved isapprov Sanitary Permit Fee (includes Groundwater D Issu Issuing t Signatu (N ^ Surcharge Fee) \ ~ ~ 5~ /Q ~~ ~s en Reason for Denial ~ / ca IX. Conditions of ApprovallReasonsforDisapproval ~ ~I 7 SYSTEM OWNER: 3 Gc ma ~ ~ c.. U a 1, Septic tank, teMwnt filter tsttd dispersal cell must all ¢g services / maintakled ~ ~ ~ 6 ~ P~~ ~ ~=~-e.t.a `-L~~ as per management plan provided by plumber. U , All setback requirements must be maintained 2 ! ~~1 ~' . ~ t/ ~ yS . i as per applicable code !ordinances. U naacn compteie plans do ine i;otmty only) for the system on paper not kas titan 812 x I I inches in siu SBD-6398 (R. dl/fl3) ~. ~~ ~~ ~~ ~ ~~ ~~ ~.. ~ ~`~ ~~ ~O~ U 0 ~' rl J , ~• ~ 4~- ~ v ~o ~ i O ~tI`I W J x ~o ~Q ~_ ~ v ~~ ~ `~ ~- z ~ ~~ 3 ~~ ~ o ~2 cL v J ~~ rYn~ o~ o ~ 1~ ~ •~ ~ ____ ~ o o •-'~~~~ ~ ~' ~ ~ . q l ~v ~ ~ ~1 ,~ ~ ~ M -,~ i ~ ~ ~ I I f +N O i 1 i t ~ 11 ~~ Q I ~. i 1 ~ I ~. y ~ 1 I ~' ~~ ~ ~ .~ I~ i 1~ '' I ~,, , 2 a3a~ ~° `~ ho i~ ,~~ i ~~r> ~ ~~ ` Qom.. ~ ~ ~ I o~ ~~`L~~ ~ V I ~. I ~ i h ~ r l ' ~' I ~~ i , ^O O ~ ~~ ~ 0 ~ z~ ..~ ~. ti ~ ~ ~„ °- `~ -} _~ -~ ,i ~~ 3 ~~ ~~ ati ~~ ~~ ~~ ii'' ~ ~J ~ V J _ ~• ~ ~ v Z, ti J i O }~ J x O •90 a r-- ~ ~~ v ~~~ ~~ ~~ ~ ~~ ~ ~2 cs.. v ~t \~ _~ ~1 ~ M © ~4 a ~t ~ ~ ~~ ~ ~° ~ `~ ~, ~ ~ °~ '' ~ ~ e ~ ` 1 'RO ~ h _~ ~ ~~ 1 1 ' ~ I ~ ~ tom. .I ~ ~~i~ t ~ i~ ~ ~o ~- J.o ~ t ~, ~ ~- t ~,t ytt 2 ~~Q~ ~ ~ h o ~ ~u ~ ' ~ ~ to c>> ~ O ~ ~ lv ~ ~L + ~ .c ~ t ,~ ~ ~ i ~ ~N ~ N QM.. ; ' ~ ; ~ ~ ~. t'i1 I ~ ~ t H I t ~ ~ (~ t t ~ t 1~ 1 ~ -~ ~~ 0 Q ~ O ~~~ z~ ~- o ~ ~ c~ \~ v --} _~ r , ' ~ o ~ ~~ r~rr 2L 5 y s r ~.~ C•,~ s f~.~..~ ~~~ ~~ Wisconsin Department of Commerce SOIL~LUATION REPORT Page ~ of Z' Division of Safety and Buildings ,1 rn accoraance ~ wpm' m~aa, rw was ~ntY ST ~i/~ ~/ x Attach complete site plan on paper not less than 81/2 x 11 inches 7fa't~ Plan t e . ~ include. but riot limited to: vertical and horizontal pint BM d~ 'on an Pan:ei I.D. ~ z ~ • ~~~ Q-~~D percent slope, scale or dimensions, north arrow, nd lov~n ~d~d16tar1ee~lp t road. C ~ ~ ~ L! ' Please print ail i rmatio~. by Date Re ! ~~ 7~ Personal irdorrna6on You Provide maybe used for dory (P ' afy 15.04 ) (m)). ~ ~~ ~ ~ ~// ~~ E / ~ ~9 ` ~n /~ ST. CROIX COU 1`40 N R ( W 1/4 T 1/4 Propert Owner's Mani"~ Address•~ Z I N G F F I C Lot # Bbdc # Subd Name or CSM# y ~ / ~/ ~Gf! /~- /~t~/L ~f~7~~ State Zip Code Phone Nrmrber vvso~ ~~ sy~~ (~/s,3~~•0~ ^ G(y ^ Yllage Town .Nearest Road 1~voso,~ ~vrr~o~ ~~o ^ New Canstrudial Use: ~ Residenti~ / Number of bedrooms Code derived design flow rate ~ GPD (~,Repiacement ^ Public or comrtnerciainD~escribe: __ Parent material •s~/~,Y BU ~"~~/~d f~ Food Plain elevation if applicable ~~" / Jl Y ft. Gerrer~ oommeMs and recommendations: a ~~ # ^ pi~n9 Ground surface elev. ~~• fJ ft. Depth to Gmitirrg factor > / Sal Rate ~iorizott Depth Dominant Redox Desaip6on ~ Texture Stnxflrxe Consistence Boundary Roots GP D/IE in. Mtu~ell Qu. Sz. Coat.. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ o• ~ /a y/~ 3 ------ L Zfsh~ ~ ~~ w ~ ~ . ~ Z D l ------ 's/L 2 S mil f / ~ •~ 3 l,~ S L ~~ ~.Yr c -- - y •s ----- ~. s ~, e -- ~ .~ 1D- ~- /. ^ ^ Pit Ground surface elev. ft. Depth to limiting factor irr. # ^ ~~ Sod ic~lion_Rate Horizon Depth Dominant Redox Description Texlure StrrxAure Consistence Boundary Roots GP D/lF in. Mansell Qu. Sz. CoM. Color Gr. Sz Sh. 'Etf/f1 'E8#2 ,_ T ' Etfkrertt #1 = BOD_ > 30 < 220 rrro/L and TSS >30 < 1 50 mall ' Etliumrt #2 = BOD_ < ~ mall surd TSS < 30 mall , CST Nar ~ O(P~ Prirfl' -u ~ R ~ ~r,1 T I Z ~ 3N Address Date Evaluation Corrdrx~ed Telephone Number Ulbricht & Associates ~U . q • rD ,$ 7/S • ~ ~~ • 3 ~y riva a ewage onsu an s z8~ z i otn Ave. Spring V~I{ey, WI 54767 t-GX i 5 Ti.r~ ~( s ~/ S T-~ivt.. C T~~.v Gf ~'/-P vim- 7-io,~J S ~ _ .~ . Property Owner ,, <~•" ..t-r Paroel 1D # Page of ~9 # ^ Bormg ,"` ^ Pit Ground surface elev. ''fit. • , Depth to g factor in . Sad ication Rate Horizon Depth Dominant Col Redox Desaiptron Texdxe Sbucture Consistence Boundary Roofs GPD/ff= tn. MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. •Eft#1 'Etf#2 o f ^ ^ Pit Ground surface elev. it. Depth to 9 factor in . Sod Rate Horizon Depth Dominant Redox Descri~ian Texdae Strrx~se Consistence Boundary Roots GP D1fF ~. Mtmsea (lu. Sz Cont Color Gr. Sz Sh. 'Eff#1 'Etf#2 ~~ # ^ ~9 ^Pit Ground surface elev. ft. Depth fo limiting facoor in. Sod Rate Horizon Depth Domu~nt Redox Desa~lion- Texhue Structure Corrsistenc:e Boundary Roots GP DJff? in. Mures flu. Sz Cord. Color Gr. Sz. Sh. _ 'ER#1 'Eff#2 ' Effiuerd #1 = BOD, > 30 < 220 mgA, and TSS >30 < 150 mgll. ' Eft1ueM #2 = f3OD, < 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 608-264-877?. sec-u3otR.~out ~~ c `~ 1 N S W P N W Q ~~W ~ ~ o Q ~ ~~~~ r O, C ~~~~ u o ~ ~ ti` ~ z o .~ ~ Q ~_ v ~ ~~ ~1 ~ -. ~ o° ~. ~, t~ ~ i ~ ~- ~ . ~~ ~~ 1 r r~ o~ ~ ~ ~ ~- ~ z ~ ;~ ©~~ d 0 ~~ (l~~~~ ~ ~.: ~. ~n~w 1 ~ MM~ 0 ~ X" o ~ D ~ ~ ~ c~ ~~~~ ~ O~ ~ c V ~ ~ ~ 1"i i 1 ~ ! ~ 1 ~ ~ ~ ~ 1 ~ ~ + ~ ~ ~ ~ ~ v ~ i -a w ~ , ~x ~! ~ ~ ~ ~' ECn t ~ ~ I K ~ ~ ~ ~ ~ C ~ ~ ~ ~ ~ ~ ~ ~ t t I ~ 1 ~ ~ 1 ~ + I ~; i I ~ ~ i ~ ~ -~ - N ~ ..1 rn / ~, / ~____ '°d 3 .~ a 'l w c ~ 3 P 1~ .~ d -~- -'~'~ G ~ ~, ~ ~ ~ r G ~ ~ ~ VJ s --~ ~' ~, ~ ~. ~ ~ ~ ~ d ~~~ ~ ~ ~.' i L ~ ~~ ~o~ ~ ~ ~~ ~ N _ N ~~ z ~~ a ~~ x `~ r c O~ ~ ~~ ~~ _ ~ t(1 ',' c.. O '' 1 V _~~ ,~ ~y ~~ v ~~; c~ ~~ ~~ . ~ ~~ y ~ ~ ~ ~ ~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND 3 OWNERSHIP CERTIFICATION FORM IID ~ ~~ D~ OwnerBuyer ~/~~1~ ~ V ~ ~ ~~N1~/[~~ ~~S ~ /4 l ~ ~ l Gj~ ~~ ' Mailing Address 15 ~~ ~(l' t~~~bLV /C /~~ 1G~- Property Address (Verification required from Planning & Zoning Department for new construction.} CitylState ~ (, ~~ ~~ ~, - Parcel Identification Number ~ ~~ " ~ ~~~ ' ~~~ LEGAL DESy OPTION ~ ~ ~ ~ 2 Property Location '1a , ila ,Sec. , T ~N R / ~ W, Town of ~ / (f ~s~ ~ Subdivision ~ ~"" ~ ~ ~'D ~ ~!/~i, T~ D ~ I,ot # ~' 2 Certified Survey Map # ,Volume ,Page # Warranty Deed # 2y'trD ~ ~ ~ ~ ,Volume ~ 5 ~ ,Page # Z~~ Spec house yes no Lot lines identifiabl es no ~~ SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic s}~~tem 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 i~o the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner r~intenance 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 Flanning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted phunber 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 #hree year expiration date. Uwe certify that all statements on this form are true to the best of my/our lmowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. rn,~1 Numberef dooms 3 ~ Z ~ U N~ ~_ SI NATURE OF APPI;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) ~~ _~ i. 2 ~ ~ 1 ~ ~ I DOCUMENT No. _ _ ~ _ Mortgagor Mss:essae Aescription Coaaidaration Tax Clause Inntnwco Clauasc Martgagsx may cure De€au}La' Opdoa C}ausse Remediu Power of Sete Forecbaare Expenad LtmitaNon oa Pesaoaat Liability xNOW ALI. MEN, ~,atHarry J....Mar~hall and.Vlyiene.-..5.._,Mar~h>~_l:].,,,,.,hs w$.fe of...:,<.~.111f~J~.~2Xli....~~.IS1:G~~,~.D......._. ...._ .. _, ... ...... ....... .. _ ............. ...-. .., herein called the mortgagor, whether one or more, mortgages O],d R $@rtel^agIl_,_aY1d ~~Tg~il~a A $ertelsen:...hu~pand...and wifei as..~t~.,.. .._~.~~n,__.Niiac,c~ts.jn. ..:•---..; ,;.:.;...- ....:,_......_.-.. ......... ........ ... herein,called the mortgagee, whether sfpe of tntue, the following ' described real estate ln.-....,,...-t~.~.+.....~i~:(~.~~f:..... .-_.....Gounty, State of Wisconsin: Lot 2~ ©f ~lillc~!w Ridge Addition to the Tt7lvn~hip oaf Hudson. This mortgage is given to secure the repayment of._..-S.,X --tY10USand ^--------^~'-.Dollars (; 6 , aQp . 00> according LO tht tertll9 Of a note nr nOteS bearing even date here~th, executed by the mattgagot to the mortgagee. , The mortgagor agrees to pay all taxes and assessments on said real estate;. to keep the premises insured for fire and. extended coverage for the suni of at feast $...._ ..... Y10 .--_ .................... ....._., to pay the premiums thereon when due, and to comply with any coinsurance provisions, in companies approved by the mortgagee with loss payable to the mortgagee as interest may appear, and all policies covering the premises shall be deposited with the mortgagee: In case of default in the payment of taxes and assessments, of in case of failure to keep the premises so insured, the approved policies deposited, the mortgagee may pap such taxes and assessments, and effect such insurance aad pay the premiums thereon, and the amounts paid shall immediately be repaid, and unless repaid, shall be added to the indebtedness secured hereby and beat interest from the date of payment at the rate of....7....-..-% per annum. In-case of default in payment of any principal, interest, taxes, assessments, and insurance premiums when the same shall become due, or in ease of failure to keep approved poluies so deposited, the whole amount of the unpaid ptincina! shall at the option of the mortgagee become due and payable without notice, notice being hereby expressly waived. In case. of default, the mortgagee may gua at law or foreclose by action or advertisement and the mortgagee may sell the same and give deeds of conveyance to the purchasers pursuant to the statutes. In case of foreclosure proceedings, whether abated or not, all foreclosure expenses, inckudin$ reasonable attorney's fees, shall be added to the principal, become due as incurred, and in case of judgment, shall be included therein. Unless an individual mortgagor is also obligated on the note or notes herein described, such mortgagor shall not be personally liable on any money lodgment. IN WITNESS WHEREOF, this mortgage has been executed and delivered this....._....-.~.Z'5~.._ ................._.-................. day of ..... ....:..._ _ llT~ ...___.._ . ___..... _..., A. D., 19- 6g . SIGNHD AND SSAL$D IN PaxsENCB OP .~ __ Agar hall _.._.__.._ -- Sus n. _Gar . __- % ' --- - ---___._._. .._ - arr "J. / . !'~~j/_ r~~ ' GJ Ruh F. G~!in _.---_-____.___ _ __Viv®ne _S; Marshall -. ' INDIVIDUAL ACKNOWLEDGMENT . ti- STATB fQP WISGCaNSIN, ) [ `` ~ , ~ w )} & • ° , Gounty of ..._.,t'~:~r.....-..~~.Q~~C.._ ............. ss. ~ a ~ ,.. ..... Personally tame before me this............3rd ................ ..__...-. da of....°........ ~$~ 69 the above names. ...:._~~.~~'y---~.x....~t~rs.~?all...a>11:d--.Y.~.V.I~~Q....~....--.I~a.rsha~ ~ .1~'.Y~.~. #. :~' -- to me known to be the persons who executed the foregoing instrument and ackn I/cd/gGd the aam ~, '~- „ ,' ~~ °lflfl7llH 4~~~~/° ~" Notary Public,............---.~~-.....tvxQ~]C........_.....Connty, Wiuonain My Commission ~espires.-........15....~.x'.iDA.71~,CIt ................_.__._ CORPURATS ACKNOWLEDGMENT STATB OP Wl3GbNSlN, County of ._..,:.. ........ .._ ............. ~ ss. Perwttally came before mr this .............................:......................day of................................---.....---........................._., 19............, ......:.............._..r....................._.....-.........,......................................_......_........-------•--..-..............-......................-....-............., President,. and ........_.._ _ ................M.. .:...._.._ . ...:... ....v.... ......... .. ......... .._..._ ....._.. ...»......., Secretary of the above named cotpotRtloa to me kaowtt to be such persons and officers who executed the foregoing itlatrument ani~ acknowledged that thep executs~ the same as such officers as the decd of card cotpoation, by its snthority. Receired for Rtcptd this......_....E?tit?...._.....,..,-.day of . ..:..--•-•~'3t-----.. __.., A, D., 19~.Q..,.at,....~.A~Q......o'clotk.~,.M. tad recorded 1n Vol...._~~,,.....»....... ._...._ , .....:.. .' ~' ULBRICHT & ASSOCIATES CO. 2812 10th Ave. • Spring Valley, WI 547fi7 Reg. Designers o/Engineering Systems Private Sewage Consultants • 715-772-3442 PROJECT INDEX ~ / -- ds Plan I.D. # N(~ Date ~~~• Owner ~~~n~~ / ~>~~ l~G~ __~-- • Phone 7~.5 ~ 3 ~l0 ' ~~~~ S~ r'e Address g~Z. ~!l/~~Orv ~/~~'~ /r~l'• ~~ ~~~D•v~ S ~O/ ~p Legal Description ~~- ~ 1,Z. ~!j% G(J ~DG-~ ~%N ~ ~ ~ ' `~! ~• 0044 • y l,~7, iU ~. ~S'~'-c .~ ~ T 2.y' rJ /2 / l ~J Town of LSD ~ County ~~`- G1~Oi- ~ _ _ ... ------- C.S.T. ~,u~h~jG2%,aL-~ ~ Z2~3 7S Installer ~ ~l`J~iG~i~T Local Authority/ Supervision S T . Gil ~ ~i~ j/. ~ ~ (' ~ Cr--- PROJECT DESCRIPTION s r' ~ ~ ~ ~ 7 w Gam,`. `"~'~- ~ N~~v ~%~ ins 'o,~s . ~Pb ~c %~,v ~. ~ °~ ~~~ 7 :-:: POWT SYSTEM SHALL ;i~l;;ORPORATE PER COMM. ,~~_~- NON-CONS" - ~~`v~ta 83.44(2)c A PROPER 2ABEL ., ., FILTER MODEL # ~ ~ /~ ~ 1 °(~EiEA~'MENT TANKb bHALL ~~„~ ,- ~ C b ~ (~ C dE AQANDONED ~RO~ERLY ~,'T PER COMM. 83.33. ~' Associates U bricht swage Consul~~ private S X812 i0th Ave. valley, W 154767 ~pri Pg~.S ~ -zZ~e 3 -1 S ~ ~,~ I w -~ Pg.l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS ~ SYSTEM PLAN VIEWS {REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC/TOP FILL DETAILS) Pg.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN OUTS) Pg.4 DOSING CHAMBER CROSS SECTION & SPECS. Pg.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) Pg.6.OPERATION~ MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS - -- -----..._.~..,~.,~. rrwT~rnrTt+ mn P'OWTS t~WIVER'S MAlVt1AL & MANA{~EMENT PLAN PILE lIYFQFtT.IIA"ftOAl Owner - - -- t ~l,r ~' Permit # 1 DESIGN PARAMETERS Number a# Bedrooms ^ NA Number of Public Facility t7nits -___g.p}A Estimated flow {average) allday Design #low {peak), {Estimated x 1.5} 0 ga{/day Soil Application Rate ~ ~ gal/day/ft2 Standard Influent/Effluent Quality Mon av gem Fats, Oil & Grease {FOG} < mg/L Biochemical Oxygen Demand {HODS} _220 mg/L ^ NA Total Suspended Solids {TSS} <1 yq Pretreated Effluent Quality onthly average Biochemical Oxygen Demand {HODS} <_30 mg1L Total Suspended Solids {TSS} <3Q m ©NA Feca! Goliform {geometric mean} <~ cfu11 t3gmt Maximum Effluent Particle Stze Ya in dia. ^ NA Other: ^ NA '~~Jalues typical for domestic wastewater and septic tank effluent. MAtNTE11tANGE SCHEDULE ~~ , Service Event Service Frequency Inspect condition of tank{s) At least once every: month{s} {Maximum 3 ears} ©year{s} Y ^ NA Pump out contents of tank{s} When combined sludge and scum equals one-third {y3} of tank volume DNA Inspect dispersat cell{s} At least once every: ~ ^ month{s) {Maximum 3 ears) year{s) '~ ^ NA Clean effluent titter At Least once every: months) - ^ year{s} ^ NA Inspect pump, pump controls & alarm At lease once every: months} ~ ^ year{s} ©NA Flush laterals and pressure test At least once every: "` ^ mon#h{s} A ^ year{s) Other At least once every: ^ month{s} ^ year{s) ^ NA other: ' ^ NA I6FIAINTENANCE tNSTRUCTIONS Inspections of tanks and dispersat cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Ptumtaer Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual 'snspection of the tankts} to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell{s} shalt 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 Iota! regulatory authority. When the combined accumulation of stodge and scum in any tank equals one-third {%31 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. Ali other services, including but not Limited to the servicing of effluent filters, mechanical or pressurized components,•pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the focal regulatory authority within 1t3 days o€ completion of any service event. Ulbr~cht & Associates Private Sewage Consultants 2812 10th Ave. Snrirtrs t/al(lAU ~n11 ~.l~s-7 SYSTEM SPECIFtCATtONS Page . " a` Septic Tank Capacity gal ^ NA Septic lank Manufacturer ~ ~s~ ^ NA E#fluent Fitter Manufacturer 2 ~' ~ ^ NA Effluent Fitter Model ~ ' ~d CJ ^ Nq i Pump Tank Capacity ~ ~ j D gal ^ tyA Pump Tank Manufacturer ~ %~~ ~ - ^ NA Pump Manufacturer ~~~`~n ^ NA Pump Model ~ yZ C~- P ^ NA Pretreatment Unit ^ Sand/Gravel Fitter ^ Peat Ftter ©Mechanieal Aeration ^ Wet{and ^ Disin#ectian ^ Other: ~NA Dispersal Cell{s} ^ NA ~In-Ground {gravity) ©1n-Ground {pressurized} ^ At-Grade ^ Mound ^ Drip-Line ^ Other: , Other: 2 ~iV~/nf S S !X ~ ~ ^ ~lA . Other: ~ ~ • j/L ~y n , p ~ ,~ S~l 'V L %W ^ NA G h ~ other: ~C l/Cl~ j ~'( P!~/ ~'T~^ NA / ~ START UP AND O~ERAO TtON - ,, -~, For new construction. prior to use of the POWTS check treatment tank(s) for t6 Pa9e Z of G that may impede the treatment process and/or damage the dis a Presence of painting. products or othet chemical: of the tank(s) remov persal ce!!(s). t# high concentrations are detected have the content: ~s~tage~ servicing operator prs`or to use. System start up shalt not occur wh ~ it conditions are frozen at the irifittrative surface. During power outages pump tanks ma fill a discharged to the dispersal cell(s) in one Large d se; ~verfoading the c!I(s) and ay result en th backup or~ rf~e disc r wrtt 6E effluent. To -avoid this situation have the contents of the pump tank removed b a power to the effluent harge of pump or cantagt_ a Plumber or POWTS Mlaintainer to assist $n pmanu ~~y op~a~eermer prior to restoring restore normal levels within the pump "tank. - 9 pump controls tc ~o not drive or park vehicles over tanks and d' -sPersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 9 5 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 andlor is permanently taken out of service the following steps shalt be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: V tl piping to tanks and pits shat( be disconnected and the abandoned i e P P openings seated. • The contents of ati tanks and pits shall be removed and ro erl dis osed of- P P y P by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space titled wit soil, gravel or another inert solid material. h C0111TINGENCY PLAN It tie POWTS faits and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: CI A suitable replacement area has been evaluated and may be utilized for the location of a replacement sot! absor tia 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, tot tines and welts.. Failure to protect the replacemem area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Reptacerrlent systems must comply with the rotes in effect at that time. D A suitable replacement area is not available due to setback and/or snit (imitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the fatted POWTS. The site has not been evaluated to identify a suitable replacement area.:.. iJpon failure of the evaluation must be Performer 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 tt,~e infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNlNG> > .. - SEPTIC, PUMP ANp OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYG ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DFATH MAY RESULT. RF~CUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSI8IE. ~DD1T10NAL COMMENTS 'OWTS tNSTALLF~ Name Q ~ ~` i~ POWTS MAINTAINER ll Name ~ ~' Phone / S' - ~ 7 dam' Z_ Phone y~ EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S T. C O l G'~ , Z~ .C, l ~ ~S- Phone p /- Phone ~ 6 Cow. ~ ~~ pis document was drafted in compliance wish chapter Comm 83.22(2)(bl(tt(d)&(f) and 83.54(1), (2? & (3l, Wisconsin Administrative Cade. Ulbricht & Associates - Private Sewage Consultants 2812 "10th Ave. Spring Valley, Wl 54767 z~ FILE iNFORMATtON Owner ~r " L..:~L ~ Permit # DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Fac[Tity Units ---A-AIA Estimated flow {average) al/day Design flow {peak), (Estimated x 1.5} Q gallday Soil Application Rate ~ 7 gal/da /ft2 Standard InftuentlEffluent Quality Mon av gem Fats, Oil & Grease {FOG) 5 mg/L Biochemical Oxygen Demand (SODS} _220 mg/L DNA Total Suspended Solids (TSS) <150 Pretreated Effluent Quality anthly average Biochemical Oxygen Demand (SODS) 530 mg1L Total Suspended Solids (TSS) <30 m ~ NA Fecal Gotifarm {geometric mean) 5 cfu1100m1 Maximum Effluent Particle Size Ya in die. ^ NA Other: ^ NA 'rVatues typical for domestic wastewater and septic tank effluent. MAiIVTE(NANCE SCHEtJtJLE /.1 Service Everrt Service Frequency , Inspect condition of tank(s) At least once every: months) {Maximum 3 ears) D year{s) y DNA Pump out contents of tankts) When combined sludge and scum equals one-third {Y3) of tank volume O NA Inspect dispersal cell(s) At Least once every: ~ ©mon#h{s) (Maximum 3 years) year{s) DNA Clean effluent titter At feast once every: month(s) - ^ year(s) ^ NA Inspect pump, pump controls & alarm At least once every: months} ©NA O year(s) Flush laterals and pressure test At least once every: ~ 'II month(s) A D yearfs) Other: ;; At least once every: D month{s) ^ year{s} ' . ^ NA Other: ~ NA . MAINTElVAINCE ti1lSTRUCTIOAtS 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 tankts) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check far any back up or ponding of effluent on the ground surface. The dispersal cell(s) shat( be visually inspected to check the effluent levels in the observation pipes and to check for any paneling 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 {Y3I or more of the tank volume, the entire contents of the lank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 913; Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized companents,~pretreatment units, and any servicing at intervals a# 512 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. Utbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring galley, X1111 54767 POWTS QINNER'S NfANUAL & MANAGEMENT PLAN SYSTEM SPECIFlCATlONS Page . y of Septic Tank Capacity gal ^ NA Septic Tank Manufacturer ~ ~'S~ ^ NA Efftdent Fitter Manufacturer !i ~' L DNA Effluent Filter Model ~ ~ • ~Q j> DNA Pump Tank Capacity ~ ~ D gal L7 NA Pump Tank Manufacturer%~~.~ ~ - ^ NA Pump Manufacturer ~U~/`~~ DNA Pump Model ~ J Z ~i#.. ~ DNA Pretreatment Unit D Sand/Gravel Finer D Peat Fitter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: ~.NA Dispersal Cell(s) ^ NA ~in-Ground (gravity) ^ ln-Ground {pre~~~(} O At-Grade Ll Mound D Drip-Line ^ Other: , Other: 2 ~~ "/ • S S ~X /' J!-' / f p NA Other: ~ I ~ //~ ~+ S~~P ! ^ NA Ocher. ~t~l`~ ~ ~! .~/'~~~~~~II NA 2. ,: i _ 9 ~ 2 0 ,, R , h ~ ,~ _ . ~o ~ ~ ~ ~ l `~• - 333.64 ~ Q Q ~ Q j EAST ,j1 ~ ~ Q N N `~ ~1 oNro tU~ ~ d ^Q p 2j 'p ~ 2So' ~ E a, ST ? 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