Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
004-1028-50-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division -* INSPECTION REPORT Sanitary Permit No: 515035 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: Kindschy, Neil Cady, Town of 004- 1028 -50 -200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 6C� 8 // 1 GS 12.28.15.192C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. / Septic 4 2 . S Benchmark G, L,,-, &c J Alt. BM /63.(4 /ac) r Sit E1e, -fa /ot Aeration Bldg. Sewer Holding _ _ / St /Ht Inlet �� ear /' Y St /Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �� 3r7 / a Pg . / �^ Dt Bottom Dosing o Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover nn ci�t ? GPM - -1. - 4 ri--- NiV aC t. 3 '7 7 ? .9 Model Number - ,_____ TDH Lift ' Friction Loss System Head 1 TH_, Ft _ " " "" __ _ "-- Forcemain Length Di. - Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L � ELL LAKE /STREAM LEACHING - INFORMATION � — CHAMBER OR Type Of System: ___. � UNIT Mod- • ber: �, DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) / Length Dia Length Dia Spacing SOIL COVER x Pre Systems Only xx Mound Or At GradeSyste Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil Yes 0 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 443 325th Street Knapp, WI 54749 (NW 1/4 SE 1/4 12 28N f�15W) NA Lot 4 Parcel No: 12.28.15.192C Lb tpx 1.) Alt BM Description = h( 'ILI .a 1 ......,k CC„ , ti.. 2.) Bldg sewer length = 21.4 I - amount of cover = � �� ` �'� L- ac ii a ❑ �-. d � 1 O J� o f Plan revision Re uired? YesNo 1 � [ Use other side for additional information. 1i 1 * I Date (� Insepcto s Signatur Cert. No. SBD -6710 (R.3/97) `r1'^b/ r , Paid Ma) La rlfrt; . .commerce.wi.gov Safety and Buildings Division C unty 201 W. Washington Ave., P.O. Bo 2 I Croix ti sco n s' n Madison, WI 53707 -7 IF anitary Permit Number (to be filled in by Co.) Department of Commerce 5/50 3 5 Sanitary Permit Application State Tra Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental �� unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. _ _ /L/ .7 3 2 Z C t 4.,,. I. Application Information - Please Print All Informatic n RECEIVED ` 7 J Property Owner's N Parcel # `,/ )0F1 r ; A cil5C®V` 004-1028-50-200 6, / / p Property Owner's Mailing Address JAN 2 7 zoo- Property Location 443 325 St. ST. CROIX COt 11% I Y Govt. Lot City, State Zip Code Z • NRII0014 r NW''%, SE' %, Section 12 (circle one \i„ t Knapp WI 54749 715 - T28N; R 4) \ L ot # ` II. Type of Building (check all that apply) 1 � l� � 6 Subdivision Name Family Dweller - Number of Bedrooms X 1 or 2 Fam y g 01 . Block # ❑ Public /Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Numb ❑ Village of 1 a, /3 ` bl � 2 I X Town of C7�ly III. Type of Permit: (Check only one box : line A. Complete line B if applicable) A. New System X Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) g List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component /Device: (Check all that apply) N - ' d In- Ground ❑ Pressurized In- Ground At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil X Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) T. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 4019i.o ftz ».z ✓ J 450 D N/A N/A N/A -.tt3.l / . 4" VI. Tank Info e r�'v•-• Capacity in Total # of Manufacturer N Gallons Gallons Units V o v o New Tanks Existing Tanks e o Y p 0 n U zD ,,, v s w C7 C�, /` Septic or Holding Tank 2165 2165 1 Skaw Pre -Cast �✓ x Dosing Chamber X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb lgnature MP/MPRS Number Business Phone Number Thomas D Gustum I��J, 227618 7 �!�"cv1(4 -- Yf 1- 715- 658 -1344 Plumber's Address (Street, City, State, Zip Code) VIII. ounty/Department Use Only Approved a isappro - • Permit Fee Date Iss ed Issuing Agent ture ■ 0 iven Re. or Denial $ 50, , /� � 7 • ,, IX. Conditions of A rovaUReasons for Disapproval / J) 6 PP PP /� r 1.4late r /at/AZ(5 �i �i% 'e'kt, - p co ,,f. AL, c ji Z ..%. 4 - 1 f Ltd : A, p )v1 f '#1 / )'( 7 J : t.4.g..: . Attach to complete plans for the system and submit to the County only on per not less than 81/2 x 11 inches in size 2) Ot CO 57rti 4 6,C., Cflo ez-v■It, 'N e_ ebe• (IAA- cocan... - 3) g®. Ou /K mil, 41 l � Lc.J r _ ,�,� . 1 m Q a NI. 0 •ag / wo w ° .- w N tC • Y (D \ O L u D) a� Q 0 d a a I 1 in it.„ I , t w — 1 - tQ) % °gig 1 z IJJ LL z C4 Y z c\ N T L) - J � m Cr) U) III 10 Ji I I M N / 2 .e = M i C N f0 EC U U ' @ In L 5 o c �V oa � c a m m m o M m o . —H a a N C N U 0 (.9 co c O H • Q (n D1 O �y0 C C g WI O N p Oh CV •C a .c O CO w :..=. d0) p 11 11 a 0 • • ~ M = (I m In ir, N \ N 1 _ M p At N a m ________--4 rn co 3 • CD . 2 co o mrn CL • CO r 1 / \ \ I co C0 • _ - l 1 j 0 0 00 Q w...e. / _________ A :„.._ , we .v4 z 0, . . ■ $' o " P- coj- a n . !4 w am am v o ,d 1 / 0 1- C ... p O O 1 o _ N W J J T -C U ' V A co CO (. U i ■ icy8 � CO :CD No = a co j i � R d O L-Z. 1 (6 0.c L — Y U "U A5 1 @ ay m o o a� `�'a m $ C o ov c cn rn cal o n "5 cn F W v 6 3 g o a co o acn 0 ao ., • - co C73 c- N m p w w N1,- W W am ❑ u n co 2 m 20 • N a N - M 0.2 am ∎J?) m m a > 2 d 0 m Q s co rn I♦ N. i "Is uigzc • CONCRETE HOLDING TANK DESIGN Single Tank Option INDEX AND TITLE SHEET Project Holding Tank for Neil KindsclO 1 Owner Neil Kindschly I Address 443 325th St. Knapp WI 54749 Legal Description NW SE SEC 12 T28 N, R 15 W Township Cody County St Croix Subdivision Name Lot No. Parcel ID Number 004 - 1028 -50 -200 Plan Transaction ID Number Cy t` ! \\\ fa . .'" N., -C 1 Index and title sheet Page 1 P :• } - Os Holding tank specifications Page 2 ,. ,.• De $ to J Site plan Page 3 s z 4 Maintenance and contingency plan k Page 4 Designer Thomas D Gustum Signature �y Phone No. 715 - 658 -1344 License Number D 1201 Date 01/25/09 Designed pursuant to: Holding Tank Component Manual For POWTS SBD- 10571 -P (R.6/99) Version 4.0 (04/03) Page 1 of 4 HOLDING TANK SPECIFICATIONS 3 Number of bedrooms Non - residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) 2165.0 Proposed holding tank capacity (gal) Skaw- PRE -Cast Tank Manufacturer 2000 Tank model number S and J Electro Alarm manufacturer 101 'Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 21800 lbs Weight of tank and cover 49.0 Liquid depth below inlet invert (in) 1.50 Safety factor 6.0 Maximum depth of soil cover (ft) 14048 Ibs Weight of anchor required 65.0 Height (in) Outside 20.8 in Soil cover req. for anchor or 146.5 Length (in) Dimensions 3.5 yd' Concrete counter weight 69.5 Width (in) Only HOLDING TANK CROSS SECTION manhole cover with locking device and finished / vent cap junction ( warning label grade box O r 4" min. Nit 12" min. 24 in. > Manhole and vent locations T conduit --> may be reversed. vent pipe 18" min. 0 12.0 In. building sewer service inlet blind plug alarm on A Note: All tank joints, and to seal - joints between tank outlet openings and piping are Electrical as per 37.0 in. sealed watertight. All pipe NEC 300 and vent materials comply and Comm 16 with Comm 84. v 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Holding Tank for Neil Kindschly Transaction Number: Page 2 of 4 HOLDING TANK MANAGEMENT PLAN 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 St Croix County Sanitary Ordinance. 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 433.0 gpd. 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). Con- nection 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 Gustum Septic Service Phone: 715 - 658 -1344 b. Service Provider ABC Septic Phone: 715 -665 -2112 c. Co. Zoning or Health Dept. ST. CROIX Phone: 715 - 386 -4680 11. Project: Holding Tank for Neil Kindschly Transaction Number: Page 4 of 4 r— , HOLDING TANK SERVICING CONTRACT Contract Date: / - c2 3- V ci Tax Parcet Number: OO y - f O a 0 - so - goo (Computer #) Holding Tank Owner(s) Name(s): Pumr We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal description:) NO, SE. S ep Ia. T x8 2.1,E Go, - Toot) oie Coder St . Cfc x COO n1 , *.*...* *** *, . , « ., ..** * * « ***** * **«*. ,. «.**** *...«, A.L* ...*&**+«****.********* 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Comm 83, Wis. Adm. Code and with the County of 51., Gro i X 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumpin equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon the owner and pumper. pumper i 9 um er 3. The agrees to submit to the local governmental unit which has signed the pumping agreement required by Comm. 83.18(4)(b), Wis. Adm. Code, and to the County, a report for the servicing of the holding t further agrees to include the following in the semiannual report: tank(s) on a semiannual basis. The pumper fu g g a P P a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change is this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. *_.***. _ ' ** • *****.** *.**.**� ***.****,i*******sk Owner(s) Name(s) (Print): 4 . 1 '1 / Subscribed and sworn to be on this date: Owner's Signature(s >� i _ &In t-1-a r i 1Z , 2009 Today's Date Pumpees Name (P i I. Ati. ■ , _. i / f Nbt Siatur Pumper's Signet risine AV ,it�0 Pumper's Registration Number: Commission Expiration Date X11 FY I:1414, �i, Notary is for .F . . 0 Ta • N Kindschy only. = * . s 9 9 = ' TOrv( G (m m P »altc(s � ' • ° sG • . Drafted by: V.,•• . • 2 (Rev. 11/02) '' , LA . S' '` `�``` lift, 1II1111111IIHIiII1l 11ill 11111111111 * 6 5 1 Holding Tank Agreement 1 11111111111 � ' s This agreement In made between the governmental unit and holding tank owner(s) BETH PABST *** USE SLACK INK ONLY ON THIS DOCUMENT *** REGISTER OF DEEDS Agreement Date Governmental Unit ST. CROIX CO., WI 1 3 -C # , , Towns Irp RECEIVED FOR RECORD Holding Tank Owners Plan Transaction Number 01/27/2009 03:40PM g () HOLDING TANK AGREEMENT e1 It d chi HOLDING r We acknowledge that application is being made for the installation of (a) REC FEE: 11.00 holding tank(s) on the following described property, or that continued use of the PAGES: 1 existing premises requires that a holding tank be installed on the property, for the purpose of proper containment of sewage. Also, at this time, the property cannot be served by a municipal sewer or any other type of private onsite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch. 145, Wis. Adm. Code. PROPERTY DESCRIPTION: pS1J0, 5E 6.eci1d, T. p en R• f j icy. T v r d f CU Al r` -1 .`�1 -e, x C o(A rl41 Name and return address t 1.o4' 4 (..'S toll /3/ 'Sk.Gc•,s C.oun {y Zcn', A Parcel ID Number /��� Vo ' SO As an inducement to the county to issue a sanitary permit for the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. Comm 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced In response to orders issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59, Stets., the governmental unit may enter upon the property and service the tank or cause to have the tank to be sevioed and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The dirges will be assessed as prescribed by s. 66.60, Stets. 2. Owner agrees to pay all charges and.costs incurred by the governmental unit or county for lnepedtion, pumping„ hauling, or otherwise servidng . and n h paining the holding tank In eatith a manner as to ;prevent or abate any human health hazard: roused lay the herding tunic. The govemmentre wait shall nutty the owner of any costs whloh shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner speclficatly agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner, agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 4. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a semiannual baste a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to Investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 5. This agreement will remain In effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that the property ie served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. Comm 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed. ,`+ llllrr o w Owner(s) Name(s) - Please Print — Subscribed and sworn to before me on this d `,iv i 71 (L� 4t • N Owner's Signature(s) Notary Public _ 7K 1a�jle � c�tvifiz ')� N p 6 : � b Governmental Unit Official Name, Title - Please Print My Commission Expires rF Of W 1s �1 0 ` ` ` Ml . 7001 . ure ' � ' O t W 03 14fRNMf ) 1 . 2,5-2_00- hi p Nfanul + ++' Governmental Unit Official Sian � Y Drafted by: P e1 11, 18 Pe Information you provide may be used for secondary purposes (Privily Law s. 15.04(1)(m)I 1 of 1 7 , co ,` t . F1 LLG S P 3 0 1998 i £ KATHLEEN H, yy A LS11 588063 2 C 119/ 1 CERT - -- 0 VEY MAP BEING LOT 1 OF A CERTIFIED SURVEY MAP RECORDED IN VOLUME 11, PAGE 3093, LOCATED IN THE NW 1/4 OF THE SE 1/4 OF SECT ION 12 T. 28N. , R. 15W. . TOWN OF CADY, 3T. CRO I X COUNTY.. W I SCONS IN PREPARED FOR: NEIL K I NDSCHY N 1/4 CORNER OF SECT ION 12 FOUND COUNTY r "— A0NU AENT. I cii g a V I - � V I r UNPLATTED LANDS EAST OUARTER CORNER WEST QUARTER CORNER 68' WIDE ROADWAY SECTION 12 - FOUND SECTION 12 - FOUND EASEMENT COUNTY MONUMENT COUNTY MONUMENT E - W QUARTER L 1NE7 N 88.43' 20'E 25. 15' N ,Q8.43' 25" E 1343. 3l' / s 88.43' 23 -9rw^0 2648. 38' �G— - - - 43. 1 ' 893.3 r' 1343.31' • i ; 420.=51' m 5 00 48 y S 88.43' sew 66 C 308. '• o _J , Z 0T, L 3 q c '�•NOl s 4i -0 m N I I^'� _ . N 88 07 T30. 1 I' Q - C s A' o) y ....1 - I I I j, • 0. 42.36' L J 6887. 753 co � ' '' / re; r v x I ) nrt {v E 1 SFIED .. 3� bt $ cn cn a Cr) 1 0„1 � HWAY SETBACK �, LOT 4 9.3 • � R'M . :. Pi z ., I a 1 fI 11.-' L IRE K 1299. 89' C N Fli Cr " co 1 ' I $ ' T30. 11' ni BrO.T2' • : ^+�^a-.....j' . co -- I � 00 4 IOC' 1 94' 689. 17' Q • . N -S QUARTER L 1 N J - • S 88 33' 07"W 1340. 83' NW-SE NE -SE LOT 2 C, S. Al, ' ; t '98 S 2 1 i4FOUNDE I * S£ ION p $ VOL. I I , PG. 3093 PIPE. LEGEND ,...;. '..r : w..41 eel' t - 4. ,tn:A V • - FOUND I' IRON P1 PE O - SET I' X 24' IRON PIPE WEIGHING 1. 13 L BS. PER L I NEAR FOOT LOT AREAS: L OT 3 14. 49 ACRES T ^''� S 0 S /° OR 630,978 50. FT. 13.67 ACRES EXC. R'W AND EASE. 1 * OR 591.. 149 SO. FT. / TAMRAA. } LOT 4 6.00 ACRES 1 eons 261, 358 SO. FT. s - 2344 CHIPPEWA FALLS 3.66 ACRES EXC. R/W WIS. � . ; 246,448 SO. FT. ' 4 2 - ,: ,Irk BEARINGS REFERENCED TO THE EAST -WEST QUARTER L I NE OF SECT ION 12. ( RECORD BEARING 1 1" -300' 0 150 300 600 SHEET 1 OF 2 98155A Vol. 1 3 Page 3524 RECEIVED • e N REPORT Page °r NOV i 9 2006 SOI EVAL '' 0 VIASOOnsin pepprUnsnt of Comm ice _ on of Safety and Buildings ST. aTij ith Co m 85, Wm. m • County r D � � ZONING 0 • F ,— inc es in size. Plan us • attach , but not site plan on paper no e 16 _ 1 0 d s 5 ' — �(3 • • percent but or dimensions, north arrow, and location and d stance to nears road. Parcel LD V pats percent swop , r { 12t 0� Please print all information. s =Privacy Low. s 15.0 (t) t au): Personal Information you provide msy be used for secondary purposes f Property Location e , `; 1 /ate /4 S b�TV2 gill P W ProP�Y . r ( Govt. Lot Q ( ( s Lot M B lock M Subd. Name or CSMN Property n s Mailing Address , Na • �f t`t 04450.0 • , .. ( " C ode , 5 lie C ity Village ' Town Nearest oad ` P hone Number ❑ g � h � State ip Code t c � Z � ra ( fl f��� y ' 4:. GPD Code derived w flow rate 0 New Construction Use; Residential / Number of bedrooms ��� (] u tic co mrtisrcial escribe: _ R. Replacement m e rill , 1 .('e = '. , 1. ru - Floo • _ - . eye on if applicable { 5�� Parent material �� 1 - ; N,rx 2 "I Si 0.1 O and fli l comments C../23 \ r p w t!� i K9 l ' 514Q and f.eemmendatio. . CCJJ • t — • ' Boring tt . Oepth to limiting factor in 300 •lication Rata Boring +� Ground surface elev. t3P0IR pa Ground Consistence Boundary Roots • lija pepth D o n s ell for Redox Description Gr Sz. Sh. 'Eff111 'Eff#2 Ms ell Du. Sz. Cont. Color ��' � � � � J C), +,. ' p 65-0 .....4- 1r immorstanseamsioruuraim , ga 6 ,..a .. tD0S Mr aliff414 a2- r 2 - - AID • 11010611.11111111■ 11111111111111MINNIIIMI . 1110111.111. 11110 ■ 11111111MON Boring Q r . Uep tn to Irmiun rector in. .Boring rr Gro und sur e l ev . 1 it• Pit Roots GPC•'i!' in. Muns ��, Consistence Boundary ' � Texture Structure Fior¢on Depth Dominant Color Redox Sz. Cont.'u Color Gr Sz Sh • 2.. ell 0u Sr . Cont. Color �� . .gsS v►�,. i'sii i 1 CI' IMIM 30- -Ni t 041 ' C 4 SIAM r MN • ue = > c m /L and TSS > • c 150 y _ e, mug W2 = 600 < 30 rnon. and TSS < 30 mtYl Pisas' s t BOO 30 _220 9 --- e-- A� �, ,� S .� VI CST Nsms (Pissst PPr Al � •• .. � � _ , id- U.,w F •. �i��s� u �.o,wJ�r1v0 TtWphVn_ r Nun,`v _ 3 Zv �►daa• Soil Testing Service _ - 71-- .. ' Mondovi, WI 54755 • (715) 832 -0020 r00rto11or crass .. •LLL2 All 20 IC C•99Z•809 in tuawuedap n41 rasl(1oa aseald 'ltWJo.) auuwalls um ui 181,1311Sw poou ,,, ,aai ,sins ssaaau of aaueisisso paau no-(II „dnidwa pun iapinOJd nn!Ainn Xi!unuoddo lent)* uo s! nniawwon.lo tuawljedap a4J • 1/6w 0£ > SSl'Pus "Ow OE > `009 = Zs Iuen!y3 . 1/ OS > 0£< SSl pus 1/6W OZZ > 0£ < `009 = to II anto . MIN -i aliZi n . to- %; _ --3- £ _ ; • v V bo� , , cu o N )/, J) �,, - 9 .: 4S zS .J J0100 '11)00 - 7S 'n0 Ilasun •u! ZAN3. 4+1'113. 20100lusulwoa . 41da0. uoz}aH ales u0 11/OdrJ :loon tiepunog oouals!suo� a�n10MS anucol uond{nso0 xopoa peop• • • I! 'mole eaems un } p ap Ind ❑ Ul lopel 6u!I!(u!I o1 U1da4 y ' 6upog 11 * tkle9,--C • • iv. 1 . z-ilac a% --G. 4CI cs 0F & - VQ V g �Q) - V" & z. . . S A D • = � 7 ✓ 2o o 1UO3 . no � Itasunv u! `, ) z 10. • z>K1J3 t./#3. aOUals!suo a nlanlls onv(ol uondlasa0 xopaa Jo!op lueu!wo0 y!do° uotubH dl/Od'J mob tiepunog 0 - ( l ` ea a uone0!!ddy nos ui © �ope� 6un!wg o141da0 W �� p 'na!e a epns punap !Id 6uuog I 1 b 6uuog 0 it • (7-9 •` Cb • .s 6 * a.2.3 ) , —$£ -�� X0!00 WOO 'zg 110 ' Itasunyy. v! t aro• •4S zs . J0 ZOO. 111/0d0 mod tispun0g eouols!suo0 anpruls amuamuck'. uond!ASaO xopalf J0103 lueu!wo0 tudap uoz•oH • • ales uofeonddy nos ul 4 mpg?) 6up!UJ!I 0l 41do0 •8 q,, / nb!a ooeyms punap l!d * 6uuog I D 1 6uuog 0 ll * 01 lowed y 1 )' n4 w+ Jap Avadad ';1 V Ic a6ed i r Property Owner / 2 •T \ Kr 1 4.. Parcel ID 0 Page. of. Boring 3 Boring 0 / I,� • ✓ >� Pit Ground surface elev. 5 ft. Depth to. lifniting factor d In. Soil Application Rale Horizon ,Depth Dominant Color ig,edox Description Texture • Structure Consistence' Boundary Roots , GPI in. • •Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'EffiK1 •Effit<2 C �. 0:. tlgati4' Opt r;J. _• o�.c -J 30 , ' :** - ':442EMillirlaWINUAIHEI 'V r.......C" , p ( • p Boring . Li Boring * , �r g pit Ground surface elev. !� ft. Depth to limiting facto r / in• Soil Application Rate Hgrizon Deptli Dominant Color R'edox Description Texture Structure Consistence Boundary Roots GPO/ff '>» ' in Muhsetl , Ou. Sz. Cont ;Color Gr. Sz. Sh • 'Eff#1 'Eff*2 i; cr' '0 j .tk , - ii"..... .. 0..S z �3'r- ?.11")/e rues - . "e` mil • . • ill . . . a - ' * g Boring 9 Bl�ng ❑ pit . Ground surface eiev. ` . • ft. Depth to timiting factor in. Soil • • •Iication Rale r zon Depth Dominant Redox Description Texture ,. ' Structure. Consistence Boundary Roots GPO/ff in. Munsell Qu. Sz.- Cont. Color Gr. Sz. Sh. •EffIM• 'Effar2 • .. 6 - c1 t i /( ci O> 6%4::• � ('p o . v �b r A . NMI" • In llE , ft' : 5-6 . 1 ram if II, • apt • N • Effluent *1 a BOO, > 30 < 220 mg/t. and TSS >30 < 150 mg/L • Ef iuent #2 = BOO, < 30 mg/L and. TSS < 30 mg/L • The Department or•Commcrce is an equal opportunity service pruvi er and employer 11 you need assistance to access services ui need mntcrial in nn alternate format. please contact the,•depanment ut 608-266-3151 or TTY 608.264.8777. s110.1)70 (a0' P • : a9w;►.A. 3.2 5‘4 SA- 1 0 0e�< k;4_5 ci c(-5 3 �5 c cS�wea- P y F cts t 6 ckV2 L9('5) 5'5 loO& 1 q�' NWlSE (Z -28' iii-ec\ 1 2 * o (o` to So Yo' scal 1 '43a` 0... ` .b \ (,. • . 41 P /4_ ___ ��,te Lore l ._ ,r� ; \ \ et`g get°5.2.444CA 1 er 41 ok s n■ .ti 8IC \ ra t� g : (oa.) Sr 1%rtF4bC1-‘\ \ P5 "4) \ .51v.,), Will Heidt \ i i Soil Testing Service W 3503 Hemlock Rd. Mondovi, WI 54755 \ (715) 832 -0020 \, 1\36 042.I.Joer- 10) ZO • t 0,>c,,ti / 4 . 0 1100:7 - yv je , ,, \l-- 4 • HO DING TANK COMPONENT CHECKLIST 2008 Holding Tank Component Manual SBD- 10571- P(R.6/99) , [ ] Holding Tank Component Manual SBD- 10855 -P(N. 03/07) GENERAL SUBMITTAL INFORMATION Y N N/A O 0 Plans and specifications must be complete and clearly legible and drawn in permanent ink or photocopied. Submittals must be on paper measuring at least 8 -1/2 by 11 inches. O All signatures are required to be original ink. 0 0 Index pages require the owner's name, manual name and SBD no. and legal description of the project. O 0 Plans not using an index page are required to have every page signed and dated by designer /plumber. O 0 Plans not using an index page require the name of the project, legal description and name of the manual shown on the plot plan. X 0 0 All designs shall be signed by an individual who posses a valid credential for designing a POWTS. SOILS INFORMATION 0 0 A properly completed soil test must be included as per county policy. PLOT PLAN MUST INCLUDE: O 0 Plans that are fully dimensioned or drawn to scale (scale indicated on plans) with all property boundaries clearly marked or parcel size shown. /O 0 A benchmark & a north arrow. X 0 0 Proper setbacks as established by appropriate code; (see Table 83.43 -1) .>/( 0 The legal description of parcel /location information. )4(0 0 All nearby existing system(s) or well(s). O 0 Reference to OHWM * when near floodplain boundaries or bodies of water. (ex. - reading of lake elevation vs. ground elevation at/near the tank). *OHWM = Ordinary High Water Mark O 0 A service drive /pad located within 25 feet of tank service manhole(s) must be identified. SYSTEM SIZING: O 0 For one and two- family dwellings the number of bedrooms must be indicated; (ex: 2 bedroom estimated = 200 gpd x 5 -day) = 1000 gallons; The manual requires a tank size of not less than 2,000 gallons. O 0 Public building review require state review unless you are a designated POWTS agent; tank sizing calculations per Table 3 published in the manual, must be included. (ex: total estimated daily flow x 5 -days) = min. tank capacity required; The manual requires a tank capacity of not less than 2,000 / gallons. O 0 �( Sizing based on per capita occupancy or by meter - reading instead of estimated flow require that a ` deed restriction be filed with the county. HOLDING TANK COMPONENT CHECKLIST PAGE 2 Y N N/A TANK CROSS - SECTION MUST INCLUDE: ./ 0 The cross - section detail must contain information regarding tank size and manufacturer, liquid depth below the inlet, depth of high water alarm, (1' below inlet), approved joints /piping material and any modifications (suction pipes, etc.) shall be clearly marked. 0 0 Anchoring calculations if applicable when tank(s) will be located near bodies of water or low, saturated conditions; O O Anchoring calculations required for all tanks located in the 100 year flood plain when submitting per component manual SBD- 10855 -P NO3/07. MANAGEMENT PLAN PER COMM 83.54, W.A.C. MUST INCLUDE: )10 O A management plan that contains information on the periodic inspection, maintenance and servicing of the component including electrical & mechanical components must be included with the plan. O 0 A procedure for abandonment of the tank(s) must be included. O O The management plan must also address tank servicing when the elevation between the bottom of the tank and the pump pad is greater than 15 feet vertically. SEPTAGE DISPOSAL: 0 0 A written statement from owner regarding method of final disposal for design flows less than/ 1 3,000 gpd is required for component Manual SBD 10571 P(R.6/99. j v; �r c+C_.V' O O Flow rates of > 3,000 gpd require state review unless you are an agent; written verification from DNR is required for these types of submittals. MISCELLENEOUS O O State POWTS staff shall be contacted for any plan that includes combined kitchen & sanitary wastewater or Industrial & sanitary wastewater designs. These plans may require a state level grease interceptor review or DNR concurrence per Commerce MOU with the DNR before the plan can be approved. • Tank Anchoring: 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. ) 3 75 inches high, x CA inches wide, x /1441 inhes long, = cubic inches. Divide this number by 1728 to equal 1 3 cubic feet. Line B: Convert the displacement to the weight of water. 3 44 3 (from line A) cubic feet x 62.4 (weight of 1 cubic foot of water) x 1.5 (safety factor) = 3 I 'I lbs. of lift potential. Line C: Calculate weight needed to counter buoyancy. lbs. (Displacement weight from line B.) - 2 lbs. (weight of tank per manufacturer) = lbs. of soil needed to anchor tank: isl D4'9 lbs. Line D: Weight of the soil media including safety factor needed over the tank to anchor the tank adequately. Tank cover width �J ' "inches x tank cover length / 7 inches, divided by 144 = square feet x 0.083 (1 inch in foot decimal) = 5,1 'cubic feet (volume of 1 inch of space over the tank cover). Line E: Calculated weight of 1 inch of space over entire cover. • 557 — cubic feet of space ( from line D) x 100 lbs. /cubic foot of = lbs. /inch space above cover. Line F: alculate inches of soil needed to counter b ioyancy . 1 1-1 lbs. (from line C) divided by lbs. per inch of soil (from line E) = inches need over tank cover. 1 Gra/ 6 Clete c, fe5v i 1 - 6 le_ 20 ;AckiLA • whether troir or anre. fez s valuable consideration- beteby grants, assign. transders awed whedter one or =ore. the ;Vender-3 or Purchasers') interest in a certain Land CfsaltraCi I Yoshi Deeds :!' ott certain lands in the Conzury le__ St . C.r01.-X , State of Wisconsin, together with (the indebtedness therein referred to And) ail the right, title and interest of the Assignor. in and vo said lends. whtich Land Contract Wes recorded in the Office of it ' Thirty-two rr The Assignor hereby covenants 'brat there is Doe owing and =void on said Land Contract, the Sum. of and also batervist ea ""• - per cern pth annum from - , thet ha is the owner of the above r:i ' described Interest hi 4 te Wad ca.Wa." 41, has geod cello so assign thir VenSe. and Oast the coatlitiosi of the Ode or Assignees Interest tt is the *acre as al the titer et recording the land cantraci. Aiem all of Vendee's right, title and interest in that certain Land Contracb3- described above as it relates to the Northwest Quarter (NW 1/4) of the Southeast Quarter (SE 1/4) of Section-Twelve (12), Township Twenty-eight interest all to cteral7 in all other resuccts with the land contract hereby 4 assiche and fr E-... tc hold the assig:or lailess_lherrrim_.___ .. ti i Duane A. 1,3. - ,d ti • • 1 1 4 ___- (Se-l- 1 -- _ ~gn.tth~.~ ____ �.� Title: Member State Bar °, Wisconsin = Other Patty Authorized ."*~ Sec. 706.06 viz �__ _ ' STATE OF W/scOry., �"". - ' c""" ,. ' m,.~^`v.=" before =.. this ' _ - _____ -____-mn.u--_-.-____-_--_ __ .m__-. .^, ahoy, .^=^" .,.. ����� .`~`^,~-,'° who "","°^ the foregoing instrument and acknowledged *°°"m°. r^,. _____ :, ROBERT G. wALTom . .. _ N"�np"^'"'_-_-__-___- -_c"=uvW� '' i :, Commission "sm*°*«* ---- [ N=We°,'7.er`~`° slim " he typed M. printed below their signatures. -------'------ ----- -- A""""°"", OF ^^"" ,",,'^=,-=^`° "^R OF "fS m . w ` ,o"°� ,"^� ~v� ." - __ r , 23 r 1 , , T 28 N. ..., R 1 5 w , i . P -11 SEE PAGE 37 ' O 5 t.....____I N ,74 • t I a 0 r / L.E7S.S7LOP Y4 si . C/791,7`0 U1/01.17ey/ • 0 '/Yeara.- 69°.17 `t-' L,1"2.424:577`4755e' i 441e Tha_ic.Se.- , ,p, . sr , , •76? 67 , ,, 1 4 /4 (.7O/547 r. ,Ber.7 a .-d "o 4 , ■q 0 v 6') , to LS. ers , q , ,..7 _ , •..„., V .... N .Z..gy 9.5- e1/22,/ ' ''' l . //7 e/a/ a s faip r 0 66- 4 )qj i \ i r (i L b r '7 "6 fiet//foS •z io f- k6 1 .7; / • 9- I ' 4 ■-•I-IP$ 6./77a17 ,k1 • e -to /Ay/5es, 'Jr 1-• .......-ma• E. /7C, N Asti CI 1 4 ;oftfay ME ,...re 0 -ass pit •• -/7 1 277 ' 4: " ..7: Cry .004...v • 3 NIN , , - .z9.72. • ' e .z.9.s AS • 41 4/7 'I iC , IIUI a ' .. ie -.1 ‘111111akeew O" /'e///e 0 ;- - Greer, l. lb ti I Jane ' • • .Fe 5 Ma . VIM way 7 np,so /7 , t 4 C Jahns o.-7 r 71/° P i1 7, = 1 - .8 , .-, co. I - i'ss ,),I • • do _ 4re,--44eNs 7 on.s f Geo e Wil/77C2_ 7". 37 _...!.. S..././0" . 1 75" 1 • o'." '6'(.9e 4 ` 57‘ac4 ' 77a '' I t" a: A-Os/zich ,e7 c •\. ). t t t °1 3 AI ch i / t sCad.-: 4 .7 ,90 Frso/7 /40 /4 o • / Gree /7 6o, eru/ofine' li . • way , A , - e.- As (0 - i rk 4 \ • l e - o , • 0' Rex Gew-do.70 • 1 3 tt -____ ro an,i 4 , ..57 , 0cA,77a.., • r4"- .nense,.7 Ralph J a kiabrAse/7 4 42obe..--/- .84 ki Levy? a- .7o • zos Oa vic :a 27a/e f X.-"incischy .77 ve I ct vr . 8 ....„.,.. 1 wa.-, . /=o ,..5'. r C 0 4/o 0 4; .., . LS/e l / • Caro __. . /7 Orl...3- er t Al t -/-,4 4,2 • ..rn c . lo .1/43o ..7,770 c ..../ . LL.S. -90 eta/ • ea . 0 s 6 1 Re,66.4.4' 9 in : • f4541. , s k 4 tss. C (:,•') . 2 45"et,y .,4,z. . - 1 , ,,,,,,,--„,/, 040'GO #770/7,50/7 ..t.. ' 0 • 1 • ac.er- x. SOO l * • ,,.., ., .--- .... do v"); l NO% 1 - A- - - - - ' `j e N,q * ...6 • k ., 1 ,,,, . _., le ' 1 Z 't mith ' 0 - ) Qk 4,(N • l..k. c_Sa_fil 7 e c , , N - *---.... - foe, °. e. .. 40 t MILIIir■- - era i j gerlIy$- 1. is 11 /9 kt % t4 lt Worence (1..• iver- •.% cli , Nk r o '"t• , .t., 0 1 NV\ , ...5on 1 9 -' I) ,„•, ot o , ..4 ,.... .,,t m • \ C• 4 qt.t'' 1:1.') 3 •cq -, s i, , ; 4 LI-oaf? •/;4 ff if 9 0 :',/ t N t • QJ L . N k/ n ■ 's4 (.4 L. • Ccvx at/ •• 0 •• . k \ t,, . 17 tie, c '5c5. N 6eo go Alo/ec 1'1 L ' I V) t O • . IN t , r-ke ? A•f::5 "162..-vin 5 • (0 , ici kV(2/7 /9/ex, Bev e...-ly . • Oryon 8I1. •,.. • c5Y Orion f L/40. qN N , r , V /.-0, = • Timm • -------....„. cro ( - 7- e/ 71 / 4 .S e 6e Swen-eowe// '` \N , do '1.4 et- 70 40...54„,7 40 , I fl . (..7•-• . Zebn ez. Ecy ene f , _ u /so ; _,7 , /T. ///77/77 .../ .5.• /100 '-'Vl C .0 i'l /Ya4-9a4-e/-L'. m 4os •t, ..2) 0/70/c/ , ,? j , .Za. Vero 5 -..nt•ez,-7 fie/me-, ? .;;) %tans a/7 fly i 4 :1 Geznalens )1' ' . 71r/.15 • /4::::9( ,...5ev e.--_ )) do 1 • CI k - (4 /77,77 30 ,For) ‘,„Ta/nes Bo t ti Bo C O 1 . s% Ra i . r4,1 78 \ N Vir De (0,,,.., 1.. Veva...4 1 4A N Z 1/ Zal r 1.... a erne' .4747.4.6 • 'c;.), C6,4-1,19 ,q,)- d • / • t tSo.7 t, -10.77.6 • \ttg A) N 77/774-47 e4a/ \k • ' " 8/5 - 9 e /7 J • 1 79 ..s- 0** _ ,A..s .. . eft, 1 N a , , • go cvv,we As , i/j • / 40 Rh G a..; c -, .F.Dearin r rea ,,,, ,,,e - - -Deez,7 , • Rc,,,, f...p,,,,74,,_ e-, -weft ro"..an k 2 Neubauer. • • 77 /40 1 __ 7;m/77 8 • So 7/ 4-,, ---, • et 2 3.5 c..7, , ,e. 0,•6', No,... f e. v9 o t.S/ao/e y f.- o Of- • ,, 7/a- No/c'en - • 7;' oe/1-e- De/oems . /e■c/al • hacrer- frAzfro 7'7' ....Z12.4.077,5 . 0/5 ,-,, -, -, .5 9, . 40 80 o - - • • • 4 25 cf`a I_ pi0.17 S • A' " ...Dale e/,,,k ioo -/e- ,, ' 7 a5 ' in7/77 7o .zoo 4,s m,,, k1/2 77 e c- /7 ( -. N 4 . Bo _As. 1J (., ,../2. 0 • IF hizry ey I Dan a-id 5 Leon - , -1. t C`k C ) 0 ef0 • , ///7/7/e kado SC s'i / _-___....4 • 7 ' t • //' ■-f % (4 Z t, LI t•1 NJO • • ■••■•■•■••■ • • • ' • • ■ dr•r 9 W."77. H , i, g -; ,f) • • • • • Cr) • 6 _ -c2,--e4 /iary /2 A v er y / ... furalm7 er ., ..,.., •, , '4 pi t,s, '•0, kyo‘ 1 o.../7 /and ,o / a. i I. ...4 . 40 0 cr,o) tr.() o -* * o so V or/7e - .Zance 41a 7 1 , 21:70 &Pi/Cy %Ch. 0 •()k% iJ \ ■ 1, eirth/77e." Wee 1: r■ k u 0 , '4 /*6 _ „ ra,-- I 1 crcs, "K ' .0 POW/7 //7 gr ,co ' ,-• 4.) OR i 62,5 . da .36 • r vt Z4/ 7 ddec, Ay 1 ,' , cra~ sv , §. /i , A7.- • ep °4 • 1 0 to .nar/c/9/7.7.- Wc5//7 a \ n 29 ewe.- 40 g m -Z Fr/ f e -.‘. , t -- ),-\ s1J,„0, //, • ,....i e90 ) I d P P t , ' • r? 128 1-/e... . I M .6;/&., f I: 140 lir , . -■) htg ...Ve/7/piS i Jack t,Z.44 ,Don Lee tS , • ri ... .‘i 11111 • iii....1. . --fo • 5 , .A7-e...6e ,,, ;,: t PIERCE 11 COUNTY ‘"---.---- 11 .c-.1 7"--:.. ( kfAs 1 IIIII Ill FIE 1 III 1111111111 Eli * 8 8_74 6 5 1 * _ Holding Tank Agreement 88 1 This agreement In made between the governmental unit and holding tank owner(s) BETH PABST *** USE BLAK INK ONLY ON THIS ID loCUIVIENT*** REGISTER OF DEEDS . _. Agree Date Governmental Unit ST. CROIX CO., WI 1 93-09 Cad Tocur‘ s ki- p RECEIVED FOR RECORD Holding Tank Owner(s) Plan Transaction Number 01/27/2009 03:40PM C i irNaSth■1 HOLDING TANK AGREEMENT EXEMPT # We acknowledge that application is being made for the installation of (a) holding tank(s) on the following described property, or that continued use of the REC FEE: 11.00 existing premises requires that a holding tank be installed on the property, for PAGES: 1 the purpose of proper containment of sewage. Also, at this time, the property cannot be served by a municipal sewer or any other type of private onsite wastewater treatment system as permitted under Ch. Comm 83, Wis. Adm. Code, or Ch, 145, Wis. Adm. Code. PROPERTY DESCRIPTION: • Al R 1 6" t4-) . pf AN), 5E 5-ec (A, T..) e--• - To,, op Ltd.( , ° I 1 6.51,t,t /3/ 3 Narne and return address i s i c cet x C (\ 7.0 A', A5 Parcel ID Number 00 L I - 11).?-. 50 (9.00 - As an inducement to the county to issue a sanitary permit for the above described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of Ch. Comm 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s. 254,58, State., the governmental unit may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Stats. 2. Owner agrees to pay all charges and costs incurred by the governmental unit or county for Inspection, pumping, hewing, or otherwise servicing, and maintaining the holding. tank In such a manner as to prevent or abate any human health hazard caused by the hording tank. The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice, In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 3. The owner, agrees to contract with a person who is licensed under Ch. NR 113, Wis, Adm. Code, to have the holding tank serviced and to The a copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new seMoe contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 4, The owner agrees to contract with a person licensed under Ch. NR 113, VVis, Adm. Code, who shall submit to the county on a semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to Investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 5. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treetment systems certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that complies with Ch. Comm 83, Wis. Adm, Code. in addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 6. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the agreement to be determined by reference to the property where the holding tank is installed, ottilliiii _ Owner(s) Name(s) - Please Print Subscribed and sworn to before me on this date s ivt.7/tettle • ' • . S . . .. . A? ' . i : k . r. otarized Owner's Signature(s) Notary Public * *. re - 7 . - / it y PI OV t-r-z_ #2944,7747, . , • .... C Governmental Unit Official Name, Title - Please Print My Commission Expires . rri)" • . . ' (-- ' • . " OF w i '■ /I lc k 0 et- "1 - V owneji d ittgew ) 1 ' a.5- 2-0 i 2- %nil 111110 ........_ Governmental Unit Official i • n ture Drafted by: A r 41-A_____ — ro ryv g LA s -Itt rrN r p Aal to i Pe i rso al nformation you provide may be used tor secondary purposes [Privacy Law s. 15.04(am • a N O N o H �" O to O va cNi C N N C C ON C C CZ O ' N O N N T 0 $ v C37 i C en .- co C C €z 0 ) Y c tU Yo 8 c E N CV N N w 4 C V 0 y N W O y C z C Z o u) -o O L i N N LL c LL c w N h C t N v > Q E Q Q L O co o O 8 co as o M N o N ,- W y Z y O E E o 'i cow = o = o ii a c z € o € o E o H Z i aN y m o z v' I I, 1, c o ° 6z v'1 o c N H en� N C • C T • C O '� a) 0 CO e- CO C N N co • a) N c _ CO 0 Z p O a O w t o O S Z Z 1 Z Z Z N N •• O co •• al N in H E co E Z a a o t• H a) N E w a1 a� 3 G O a o ' S O 0 o ° c h w Q o v u) m t/) > j o to t/� m �'� zv> ��333 a0 �� am • a - Q. a O a O • a O a a o. i am I in o 0 c N 0 1 fA J U c o Z t Z tt N 1 N v O M O O _ O O . O o 0 E L m C O m c n cc y Q Z (n • 'O Q • Z (/) f6 N J y N 0 0 O M H C .c N c -p N U '� O N 3 O N N E co 0 E ° ( a) 1 c I Z a c •_ w a . � 4 ° o U � `Q co O L C f6 N = C N d C 4 O � N T M O d N C V a 7 -Op C = . r - iio N C O o >+ O C o N O O R U • oo U Y LO o z 12 Z Y o Z °' Z Z 2 f n O V C r 1 _ € - N it 0 . N a o a '�ww .� c 0 0) 3 1 0 c _1 A U o..2 O IO v i U