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HomeMy WebLinkAbout020-1454-00-104 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division t. ' INSPECTION REPORT Sanitary Permit No: 487936 .0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for s purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bast, Kernon Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: f Ob B1NA 1 6ST 36.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER Q; ,,,15 CAPACITY STATION BS HI FS ELEV. J Septic WeRkis 5 4- enchmar G au 4,-. ' / ' ' / ZtoO � � Tp r� +�+f,� i3wsing Alt. B g1 . ZALek 4- /C/Z) 0 4.2z 164•a /z Aeration Bldg. ewer Holding St/Ht Inlet q $ Gam/ / 1 L • TANK SETBACK INFORMATION St/Ht Outlet lb' OZ chit Z TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Li / AA,. /s / 7 sb Dt Bottom Dosing T - Header /Man. 11' c/3./1 • Aeration Dist. Pipe /j • 03 93• (`j Holding Bot. System ��' 7 I Z•3Z Final Grade 5 • (o/ 9"r, Sy PUMP /SIPHON INFORMATION Manufacturer GP ^and St Cover ► — • co $' � -Lit Model Number �\ 1 � TDH (Lift Friction Loss 'System Head ITDH Ft Forcemain Len Dist. to Well SOIL ABSORPTION SYSTEM DIMENSIONS Width ! Length � e r No. ;f Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid`th • 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. T t1' /� 1 � - INFORMATION Type u e l ,g J 42 /) , t1 CHAMBER OR Model Number r -� a 1 DISTRIBUTION SYSTEM 1 1 - !4 Header/Manifold 4 Distribution x Hole Size x Hole Spacing Vent to i t tak 4 (s) Z Length Dia T Length Dia Spacing \ .vim SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over J Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center , / / C \ 4+ Bed/Trench Edges Topsoil Yes 1- No Yes i '1 No lQ l COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 692 Mary Jo Court Hud on, W 54017(NV1I 1(4 SW ..— 1/4 36 T29N R19W) Cottonwood Ridge 2nd Add Lot 104 Parcel No: 36.29.19. 1.) Alt BM Description = Z C.+:J�.�S 2.) Bldg sewer length = i - amount of cover = i / Plan revision Required? !°J Yes X No r (� b i _ i MI I 7 Use other side for add information. L _li - -_� —_ �r Date Insepctor's (.nature Cert. No. SBD -6710 (R.3/97) ■ \ . • 'L I � �„ an :uildings Division Co ra m W. 1 • n Ave., P.O. Box 7162 L -PO''k i ` sconsI f adi . ' WI �, 17 - 7162 Sanitary Permit umber (to be filled in by Co.) Department of Commerce & , , Plan ID. Number Sanitary Permit Apphca 0 In accord with Comm 83.21, Wis. Adm. Code, personal information: ou provide � -- may be used for secondary purposes Privacy Law, al 5.04( m) vProject ddress (if different than mailing address) 1. Application Information - Please Print All Information f (j MA4 Jo a1,U.i 1 / Property Owner's Name Pa 1 t K Block 0 L%' I'') a.. (jo"� Owner's M a iling ddress Property Location qits at, e ' Alfitt %,s44, Section 3 6 City, S to Zip Code Phone Number / ad Ljf ( 1 A T N: R i circle ) II. Type of Building (check all that apply) ` �F' S I or 2 Family Dwelling - Number of Bedrooms � • Out S Subdivision Name CSM Number ❑ Public/Commercial - Describe Use C 6A) u "" x�, " ,�� " i r ❑ State Owned - Describe Use ❑City ❑Village U T unship of /4,K)5,6411j III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. C14 v System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System Dappsued B. List Previous Permit Number and ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner o e, `� -- - > �^ 'Tv IV. T of POWTS S ; tem: Check all that a 1 ��.'�s • St rem. / •)r te y ' r ' t4on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Singh. Pass Sand Filter Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculati g Sand Filter ❑ Recirculatin . S thetic Media Filter ❑ Leaching Chamber ❑ Dri . Line ❑ Gravel -less Pi . ❑ Other (...lain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) - Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Gov - 7 85 Z70. 1 3) -(pL VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks , [ . / Septic or Holding Tank / _ j / /) / Ct ./e e. 1 s • (/ Aerobic Treatment Unit / W Dosing Chamber VII. Responsibility Statement - I, the mad , assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name • t) .1u • - `s . ature MP/MPRS Number Business Phone Number J� ' n ' attl yv9" 711 3%fOL Plumber's Address (Street, City, State, Zip C. it VIII. County/Departme Use Only Approved ❑ Disa ve Sanitary Permit Fee (i ludes Groundwater - Date Issued 1 suin: gent Signature o Stamps) Surcharge Fee) i/ 6 Cr. `2 � LS .. • ■ ❑ •_•_• �' n Reason for Denial I s► , ... ,�, -� w .. n IX. Conditions o prov : .P41 11 A C CO-3 G SYSTEM 0 1 R: 3) � Z°" `�-� ��' �'" 1 Septic tank, effluent filter and a 1 5 -•1 Lw..v l ��� ,�,•S dispersal cell must all serviced / med as per management plan provided by y plumber. ti A.4 er. I • X14..0 C.4-v . 2. All setback requirements must be maintained S V s 2 i .t„a Ct . as per applicable code /ordinances. G O h � , _ nl _ � -0 paper not than Attach complete plans (to the County only) for the system on pap /2 s IT has t r s L s o . 705/31) /R k trr SBD -6398 (R. 01/03) S 1 • .P 8 7 PI t M (4,k1 _S ',' d e ttJi nciers5 . _tut ... . ... (3 n _ ... A./4._ l ... _ i/xI. vu C�� bN ���� K � d � �... m,�� der.. .. 1 -� Lice ... r - _.... _ � QQi.,(A, ryl Iry . too. o To 4 3/'`, PV t • • a NA, rnQv)( l.tv--...to ,)) 71'4 3)y" PVC Q- INN cLe I `U . _43 ' n %---41 X3 u, 16 • ( 1 ettntoop-, 04 a well k <------ ,,. p , r t" o h, T1' �.► c �_ s MM F • .. g 1 • . r -..+ e �� � . . 144. ''� g I. b iii•'J II : � I 1110.1 �' _ + • � "`'� Ili . e l . re i I i 1 . • i 1,, , 1 i' 11 ; 1 i (/ t ;pi' I • %A • . - 1 ' 1 , ,. 1 , , I ..ti f i . . ., f.i r, b t ... ' ' . ' — \ _. --- ;' • !.. 1 0 14 7......ie - . 1 . .,,,,„,. ii a. M , 1 g igli % III . .1? 8 . 67 ' Plot /Vt. 3 (1ikL _Side. to / I)/ • i ode r,s .• . ..i.y.t vair 1 ...clealioij C° . le'llV 0N..-. _ s . _ _ ...... /- t1i4%4l - ... _ • -..... ....._. _._...___. el- a R ? ?,U90 . . ______. T .. :: ____....______...._.......... .. ....,.. 0.7 ,_. _ . .7 .. • QQ0(t, rno ,k Icy , loo. o L ,.,,, ,,R I T upo..k I b1+ ReNcl, (j . liv 133' = i U). )� Tup •of 3)y'' Pvc - 1 / % __ ___ , a - ih.NC S to • 3 x 8�•S� ' t l k .3S c—`I9' la ed • I Ia wi p su �f; r • 0 Ln 11 • • <------- . N _ _ _ _ _ ,., k' 1 1 1 `i-D.4 G_ Ill . 1, 6 * 0 # #°4 1. ...i . g . 1 • * 166 Stev _..... . , I . :� . PC 11 i 1 • ,�� ' r E.P. . ill L .. I i (1 i t i 1.11 . L . i • 1 t r 4 1:1q s .s i; - 0 - l' Pt .*41. 17.1s't 41 • 040 -4r t rierrol.-4 ■ 11'46 3 S OIL EVALUATION REPORT #1648 / ScO�IS�/t Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings / Steel's Soil Service, Inc. Attach complete site plan on paper not less than 8% x 11 inches ze. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point : �. ction and percent slope, scale or dimensions, north arrow, and location an. . T7ceo nearest road. Parcel I.D. Pending Please print all information. e • wed By Date Personal information you provide may be us-d for s f izEt Dvacy - , 6.1 ' (1) (m)). s FD a-. I Z 1 S >1t-- ��VVGC Property Owner r >roperty Location Bast, Kernon APR 1 2005 -3ovt. Lot na NW1 /4, SW1 /4, S36, T29N, R19W Property Owner's Mailing Address _ot # Block # Subd. Name or CSM# 948 Labarge Rd. ST. CROIX COUNTY _ 104 na Cottonwood Ridge 2ND Addition City State sip Codtpmp8Mtiqer City ❑ Village ® Town Nearest Road Hudson 1 WI 1 54016 1 715- 386 -7775 Hudson 1 Cty Rd N ❑ New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe: na Parent material Stream terraces and pitted outwash plains Flood plain elevation, if applicable na ft. General comments Conventioal system, system elevation 92.66ft trenches spaced and depth to code 6.84ft below grade. and recommendations: 1 1 Boring # ❑ Boring ❑ Pit Ground surface elev. 99.50 ft. Depth to limiting factor 140 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#2 1 0 -12 10yr3/1 none sil 2msbk mfr cs if .6 .8 2 12 -20 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 20 -30 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 30 - 58 7.5yr4/4 none sl 2csbk mfr cb na .6 1.0 5 58 -140 7.5yr4/6 none cos osg ml na na .7 1.6 2 Boring # Boring ® Pit Ground surface elev. 99.50 ft. Depth to limiting factor 140 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten. Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff#2 1 0 -12 10yr3/1 none sil 2msbk mfr cs if .6 .8 2 12 -24 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 24 -36 7.5yr4/4 none scl 2msbk mfr gw na .4 .6 4 36 -73 7.5yr4/4 cld7.5yr5 /6 sl 2csbk mfr cb na .6 1.0 noncontigous 5 73 -140 7.5yr4/6 none cos osg ml na na .7 1.6 Noncontigous Redox features in horizon #4 due to textureal changes not seasonal saturation 1111EIM INAIMIN 1 =I - elha‘jA- cti1/49-16 ' ==l1W" i''' '' '' ti. ,T' im . -. 7f„ '�: AR elo sv v� wir - Z...�.0 ,n,' -, , , * Effluent #1 = BOD 30 < 220 mg /Lan. TSS >30 < 150 mg/L t - ,: , `y j;}•�ir #$ = BOD < g/L and TS <_ mg/L / CST Name (Please Print) nature: ,` 't^ -,-„,,,t CST . i A David J. Steel " � 248956 / ' ' Address Steel's Soil Service, In Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/11/2005 715 - 760 -0347 SBD -8330 (R.07100) Property Owner Bast, Kernon Parcel ID # Pending Page 2 of 3 # ❑ Boring , 3 Boring ® Pit Ground surface elev. 99.45 ft. Depth to limiting factor 140 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr3/1 none sil 2msbk mfr es if .6 .8 2 12 -30 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 30-48 7.5yr4/4 none scl 2msbk mfr gw na .4 .6 4 48 -72 7.5yr4/4 c1d7 /6 sl 2csbk mfr cb na .6 1.0 noncontigous 5 72 - 140 7.5yr4/6 none cos osg ml na na .7 1.6 Noncontigous Redox features in horizon #4 due to textureal changes not seasonal saturation 47 9 2.6 L �� ss-f2_ of -- . # El Boring Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # El Boring g ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 - * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 <150 mg /L * Effluent #2 = BOD 5 < 30 mg/L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. SBD - 8330 (R.07 /00) Steel's Soll Service, Inc. L I - STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Kernon Bast 994 200 St. CST - POWTSM NW1 /4,SW1/4,S36,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St. Croix Co. Cell (715) 760 -0347 Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449 Lot,104 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend N 1 " =40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe = Alt Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B1 = 99.50 ft B2 = 99.50 ft / B3 = 99.40 ft hb / L% /6 7L `E B4 = 0.00 ft a.g '3 7 3 fig/ / 3 3' , q 3 i wI la- / � g --1— >✓ .� , f ' 50.00' all-- ee3 414.54' -. ROAD LENGTH 196' +I \ (1) \ • DEDICATED TO THE PUBLIC co i c 6 3 1037.1 q X / 1036.4 X • \, . X 103 i. t a - ' ±- LOT 107 _ 2.03 Acres N.B.A. = 2.0 AC ao4 IV • 0 LOT 106 ��� e�,. 11 I 2.02 Acres N.B.A. = 2.0 AC X 1036.4 1► X ■ -� - -+r� '. 01 ' 71.37' - '5.38 11 Iglir \ X 1037.1 \ \ w� LOT 105 x ita w 1835.3 2.38 Acres 1034.4 W \ N. B.A. = 2.4 AC *- AC . t=• 480.73' . 1 ..00 �. , 7 K \ It X . 1435.5 )34.6 - 1035.3 \ - LOT 104 ' 2. s , . • cres �; j N.B.A. = 1.9 AC N 1 - $_ 1 6 --;>\ --- 0_ 14 1 " ++ 30' o �.:....... 1 405.03' -1 - i -- :res -:.::: _ '` = -�`� � 1 033.1 1 35.5 0 ?.6 AC '::;: =: . � 1 � r LO 103 L031.00 2.04 Acre z 1o34s. " N.B.A. = 1.0 AC - _ - - (_ :� = f 1 w t L.B.O. 1035 -00 1 _J w ❑ $ ,M1:: 1033.1 N I S I 1 airs ! , H.W .L. - 10 3.00 __ 1 j :. s�Y 1031.5 t y. : X 249 - -- • glia, DEDICATED TO PUBU -i-. 7 - -------4 -:h \ ,-. r.,-.. - _ n lA nn .1--z-a- 55..,5. _.._. _.. _._._ . POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner te e'/) 1 Septic Tank Capacity Permit # / / �� q3/ ► a � U gal ❑ NA �1- Q ( tP Septic Tank Manufacturer ().)-e - J ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer i= , ❑ NA Number of Bedrooms Y ❑ NA Effluent Filter Model tyj� u ❑ NA 1 Number of Public Facility Units N �� l3 NA Pump Tank Capacity lap NA Estimated flow (average) 3 7 gal 7 S gal /day Pump Tank Manufacturer ,®, NA Design flow (peak), (Estimated x 1.5) ( 0 0 gal /day Pump Manufacturer tRNA Soil Application Rate , # 7 z Pump Model gal /day /ft fir NA Standard Influent /Effluent Quality Monthly average* Pretreatment UnitI°NA Fats, Oil & Grease (FOG) 55_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) < P SS 1 1 _150 mg/L ❑Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ED In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: - -G-NA Other: — B NA Other ANA * Values typical for domestic wastewater and septic tank effluent. Other: --12 MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At (east once every: a ❑ month(s) (Maximum 3 years) ❑ N A � year(s) Y 1 Y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑monthls) (Maximum 3 years) ❑ NA 1l year(s) Clean effluent filter At least once every: ❑month(s) ❑ NA it year(s) Inspect pump, pump controls & alarm At least once every: ❑month(s) ❑ year(s) Flush laterals and pressure test At least once every: ❑month(s) `'6i NA Other: ❑ year(s) At least once every: ❑ monthls A Other: ❑ year(s) - t1 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) 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) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third IY or more of the tank volume, the entire contents of the tank shall be removed by a Setae Servicing p 9 cin Operator an 9 p and disposed of in accordance w' Wisconsin Administrative Code. with chapter NR 113, All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 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. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: g A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER n POWTS MAINTAINER Name .__J1 GO41 n e- --f J (‘ Name y b ti YN , C-e t "' Phone , 9 0 20 Phone ` 11 J - J ce 3 6 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Dprc ivti I S Name S'' . Ctto i<l) Phone 1 a 1 b-)5. Phone 8 V ° t j This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)1d) &If) and 83.54(1), (2) & (3), Wisconsin Administrative Code. f •... VI cm= 1 CR J L /:15 /"19620 08/14108 07: 02am P . 001 • • ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CER1TPICATION FORM Owner/Buyer 4iy y�Z 4 L Mailing Address 948 Zek. gar e -f Property Address � q4 il gity ,, Coat (Venfication required fro Planning & Zoning Department for new 6 �p construction.) / P.--4 ) .(.6.444:1.6. ) City/State Parcel Identifilition Number LEGAL DESCRIPTION Property Location /(/0 . y , ,S4 ti V, , Sec. 3( , T 0125 N R / y W, Town of Masi& . • r,�r,,i - A �� �" �[- � Subdivision i a , ' r i , Lot # / 65i . Certlfred Survey Map # , Volume ___, Page # Warranty Deed # 7f4 /d 9 , Volume 2 7 / , Page # 3/( . Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFKII.TION, e Improper use nsis of and maintenance of your septic system could r.!sult in its prenmture failure to handle wastes. Proper the nt can flsikt the out the septic tank every three yeas o:T sooner, if needed, by a licensed pumper. What you put into function of the septic tank as a treatment state in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Ph acing & Zoning Department a certification f owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on- signed by the wastewater disposal system is in proper operating condition and/or (2) a'ter inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. standards set lJwe, the undersigned have read the above requirements and 1g1 ee to maintain the private sewage disposal system with the forth, herein, as set by the Department of Commerce am die Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained tnus( be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe Ty the t all statements on this form are hue to the be: t o my /our knowledge. Uwe am/are the owner(s) of the property ■ cn' a , , ve, by virtue of a warranty deed recorded in Re gis per of Deeds Office. N ilbero' • iroo9 it SI RE OF APPLICANTS) io l -1 T b 5 DATE * ** ny information that is misrepresented sanitary I by srepresented tray result in the sari errrut being revoked b the Planning & Zoning Department, *** Include with this application a recorded warranty deed from the Regis er of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) U 2739P 318 ? 9 ■3 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORK: 2 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 01/28/2005 03 THIS DEED, made between Neil L. Wilcoxson and Mary Jo WARRANTY DEED Wilcoxson, husband and wife, Grantor, and Kernon J. Bast and Dcnalda J. k:)< Speer -Bast, husband and wife, Grantee. REC FEE: 13.88 90 Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 4212• the following described real estate in St. Croix County, State of Wisconsin: COPY FEE: E CC l PAGES: 2 SEE ATTACHED EXHIBIT A • Recording Area Name and Return Address: Edina Realty Title, inc. 400 S. 2n St. - Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. 456780 • 1— t•— •—• • 020 - 1110 -30- 000... 020 - 1109 -55 -050 Parcel Identification Number (PIN) This is not homestead property. Dated this 28 i .r. y of January, 2005. 1 ( 11 L. Wi cox'. IA. * Mary J o o C ( A-3 3 C-b Cr AUTHENTICA u b 11C - W P ACKNOWLEDGMENT Signature(s) ,.1; �Ca '� Sln STATE OF WISCONSIN ) Clit2-tP • - ST. CROIX COUNTY. ) is. authenticated this 28th day of January, 2005 Personally came before me this January 28, 2005 the • a`rove named Neil L. Wilcoxson and Mary .lo Wilcoxson, husband and wife to me known to be the person(s) who TITLE: MEMBER STATE BAR OF WISCONSIN (If not, execut = , . e fore ing instrument and acknowledged the same. authorized by § 706.06, Wis. State.) f'. / / THIS INSTRUMENT WAS DRAFTED BY "'Chen : rown Peterson, Fram & Bergman - Steven H. Bruns Notary Public, State of Wisconsin 50 East Fifth Street, St. Paul, MN 55101 N y commission is permanent. (If not, state expiration date: /11/2007 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 U 2739 P 317 • EXHIBIT A Parcel 1: A parcel of land located in part of the SW 'A of the NW 'A and part of the NW 'A of the SW 'A of Section 36, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; more particularly described as follows: Beginning at the W ''A corner of said section 36; thence N00°16'10":3, along the west line of the NW 'A of said section, 1248.49 feet to the north line of Lot 1 of Certified Survey Map recorded in Volume 3, page 669 at the St. Croix County Register of Deeds Office; thence N63 °02'59 "E 148.42 feet to the north line of said SW ''A of the NW ''4; thence N89 °26'58 "E, along said north line, 1182.70 feet to the east line of said SW ''A of the NW '''4; thence S00 °21'37 "W, along said east line, 350.04 feet to the north line of Lot 73 of the Plat of Cottonwood Ridge First Addition recorded at said office; the S89 °26'58 "W, along said north line, 10.00 feet to the west line of said plat; thence S00 °27'24 "W, along said west line, 2096.76 fee °. to the centerline of County Trunk Highway "N" and a point on a 1999.00 foot radius curve, concave southerly, whose central angle measures 7 °I0'30 ", whose chord bears N84 °30'41 "W and measures 250.16 feet; thence westerly, along the arc of said curve and said certerline, 250.33 feet to the point of tangency; thence N88 °05'56"W, along said centerline, 83.64 feet to the point of curvrture of a 2700.00 foot radius curve, concave northerly; whose central angel measures 3 °17'53 ", whose chord bears N86 °26'59.5" ti l and measures 155.40 feet; thence westerly, along the arc of said curve and said centerline, 155.42 feet; thence N04 °29'56 "E 244.01 !:eet to the point of curvature of a 167.00 foot radius, concave westerly, whose central angle measures 34 °24'12 ", whose chord bea NI2 °42'10 "W and measures 98.78 feet; thence northerly, along the arc of said curve, 100.28 feet to the point of tangency; thence N2 9 °54' 16 "W 274.22 feet to the easterly extension of the north line of Lot 1 of Certified Survey Map recorded in Volume 12, page 3456 at said office; thence N89 °' 12'45 "W, along said easterly extension, along said north line, and along the westerly extension of said north line, 670.44 feet to the west line of the SW ''A of said section; thence N00 °37'50 "E, along said west line, 496.89 feet to tin point of beginning. AND Parcel 2: A parcel of land located in part of the SW '4 of the SE 'A of Section . ;6, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; described as follows: Beginning at the South ' 'A Corner of said Section 36; thence N00 °27'05 "E, along the north -south 'A line of said section, 1216.78 feet to the centerline of County Tnmk Highway "N "; thence S76 ° 47'47"E, t,long said centerline, 1354.82 feet to the east line of said SW % of the SE ''A; thence S00 °07'02"W, along said east line, 897.02 feet to the south line of the SE 'A; thence S89 °33'25 "W, along said south line, 1326.80 feet to the point of beginning. • r I I a© 0© Avid � a o o te ©© , X I b' f :i 1 a t I i d! �1 9£ NO1103S d0 4/ [MS 3H130 Y/[NN 31•11. 30 3NI 11S1/3 . _1. . 869££ 8L'Z6[ �ZZ'pZ[ L9'99 1N3YY3S1:!3 3JVNIVtiO '� X - - - - 1 1.991. _ - - -- "? � • 1 � 1 . o 0 W T w N. f to 8 r 6 d 0 O II a N O O r g ac 1 J NOD �} Q' J 1 (5 a 1 Q 1 . I- 1 1 g-i i 3 w »» 0 _ , ! 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