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HomeMy WebLinkAbout026-1130-09-000 Wis;onsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safe and Building Division I INSPECTION REPORT Sanitary Permit No: !d - 3 v � z — 408285 0 GENERAL INFORMATION (ATTACH TO PERMIT) 3Ka State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Wiz koski, Rob I Richmond Township 026- 1130 -09 -000 CST BM Elev: Insp. BM Elev: BM Description: 101, .S_ i0 /. St-I :l►ti C- -S-'- TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � Benchmark 2 249 10 �� /�� Dosing //�� �� -k U Alt. BM '/� C4 - X4 m �U Aeration Bldg. Sewer Ct'j, ` /0 6 Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet bJ 6 Septic , k i Dt Bottom > SO I /S > i Dosing n 6rv\ Header /Man. ` �0✓ Aerati Dist. Pipe3'� 7 97. 3 Holding Bot. System 9�t8 .Q PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover ' GPM q ,` Model Number j+ TDH Lift ? Friction Loss System Head TDH Ft r"A4AtA J r Forcemain Length Dia. �, Dist. to Well 6 1 Z �J6� r/J r✓T SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenche PIT DIMENSJONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �/ SETBACK SYSTEM TO P/L BLDG WE LAKE /STREAM LEACHING � del INFORMATION Typ L Of System: 7 CHAMBER OR _ � /J 3 '1 UNIT Number: DISTRIBUTION SYSTEM L J� Header /Manifold x Hole Size x Hole Sp 'ng Vent to Air Intake P) I " _ � 1 C Length !/ Dia Length s Dia Y , y / �paang _3_� 3 QJaSe'YV, SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Z Bed/Trench Edges Topsoil Yes [] No Yes ® No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: ) D / Iq Inspection #2: Location: 1383 141st Street Richmond, WI 54017 (NE 1/4 NW 1/4 25 T30N R18W) Red Pine Corner Lot 9 Parcel No: 25.30.1 1.) Alt BM Description = '� �� Z) 0 —cu don-k// —+ `1 X ys ) �/ 2.) Bldg sewer length = / 5 SF -wit►+ ems-` Sl - amount of cover Plan revision Required? � 4 Ln., es ❑ No Use other side for additional information. 10 SBD -6710 (R.3/97) Date Insepctors sijhatLTre Cert. No. For A, PLO PLAN PROJECT Rob Wizvkoski DRESS 1123 Western Ave. N. St. Paul Mn 55117 NE 1/4 NW 1/4s 25 /T 30 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/24/02 BEDROOM 3 CONVENTIONAL IN -GR Outa SURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE 630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of Survey stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark B.M. SYSTEM ELEVATION Set @ 2.5' Below Grad 95.5/95.0 23' f1TT'L(.AX 5' 44' A1t.B.M. B -1 36' 40' 12' Vents 9/V~g S � Property Line 5' 7% -2 103' Slope B -3 Ve s a� a 3 -3'X 63' Cells with >3 Spacing o 0 M M Pro 3 Bedroom House I Vent Combo Tank >6 „ Standard Infiltrator of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Long 12' .54 " Grade at System Elevation Plans Designed Using Conventional Powts Manual Version 2.0 141st St. SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" Cl VENT PIPE 12" MIN. ABOVE GRADE >r WEATHERPROOF > 2S' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W1 PADLOCK E FINISHED GRADE WARNING LABEL T�Kw. �..... - 4" MIN- >Ry� 18 " I N . y t • Z• al6E0.w►�ioa Fife INLET 1 GAS- , ` WATER TIGHT SEALS "T" TIGHT � \IWROVED A SEAL JOINTS WITH FILTER -- ALA APPROVED PIPE APPROVED a ON 3' ONTO PIPE 3' SOLID SOIL ONTO SOLID 1 SOIL PUMP OFF ELEV .� T . OFF D 3 APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: TANK SIZES SEPTIC GAL. DOSE VOLUME ZNC LUDING �j DOSE -��'- GAL. F LOWBAC K : .,� /. GAL. ALARM MANUFACTURER: CAPACITIES: A = (/_._.r� AL. INCHES = G MODEL NUMBER: B = 2 INCHES = GAL. SWITCH TYPE � C = / INCHES = v GAL. PUMP MANUFACTURER b MODEL NUMBER: ._._._._._ D = INCHES = D +L• SWITCH TYPE: _ y REQUIRED DISCHARGE RA �,,,� GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC 2 FEET 1� VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ,FEET + MINIMUM NETWORK SUPPLY PR SSURE . • • • • • ` + FEET FORCEMAIN X, > FT/100 . FRICTION FACTOR•. FEET TOTAL DYNAMIC HEAD ' ,.7 S • FEET ZZ INTERNAL DIMENSIONS 0 PUMP TANK: LENGTH WID;o- -.6- -: DIAMETER LIQUID �_-- 7 � � gy�pp;; - � �- S � W DATE SI GNED: LICENSE NUMBER: 1/88 TOTAL DYNAMIC HEAD /CAPACITY HEAD CAP . CURVE PER MINUTE EFFLUENT AND DEWATERING MODE 152 153 MODEL 152 153 UJ 50 Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291 40 10 3.1 61 231 70 265 12 152 15 4.6 53 201 61 231 20 6.1 44 167 52 197 v 30 25 7.6 34 129 42 159 z 13 30 9.1 23 87 33 125 ° 20 35 103 -- -- 22 85 O 40 12.2 -- -- 11 42 4 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 10 _ 014506 0 20 40 60 80 100 GALLONS 6 1/4 LITERS O 80 160 240 320 3 27/32 4 5/8 FLOW PER MINUTE . 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _ •Timed dosing panels available. °' ® 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. I • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. I • Over 130 °F. (54 0 C.) special quotation required. 1 1521153 Series 12 1/8 1521153 MODELS Control selection t Vofts -P h Mo a Sim Duplex 1/8 115 1 Non 8.5 1 2or3 115 1 Auto 8.5 Included 2or3 same4 230 1 No 4.3 1 2 or 3 230 1 Auto 4.3 Included 2 or 3 N1 115 1 Nat 10.5 SELECTION GUIDE BN153 115 1 Auto 10.5 EI A variable level float E153 230 1 Non 5.3 1. Single piggyback variable level float switch or double piggyback 230 1 Auto 5.3 Incl switch. Refer to FW477. O CAUTION I 2. See FK 0712 for correct model of Electrical Alternator E-Pak. AN Inswadon of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator. Specify duplex (3) licensed eiectrician. All electrical and safety codes should be followed Including the most or (4) float system. recent National Electric code (NEC) and the Occupational Safety and Health Ad (OSHA} RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. HAIL T0: P.O. BOX 16347 Latisvl9e, KY 40256-0347 manufacturersov. . SHfP 70: 3649 Cane Run Road Z Louisville, KY 402„ -,ss, Qr9a laulns SW- 11fiff � �. (502) 778.2791 •, (800) g28 -PUMP httpJ/www.zoell PUMP !O. fax (502)774 -3624 © Copyright 2000 Zoeller Co. All rights reserved. PLOT PLAN PROJECT Rob Wizvkoski A DRESS 1 23 Western Ave. N. St. Paul Mn 55117 NE 1/4 NW 1/4s 25 /T 30 / 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/24/02 BEDROOM 3 CONVENTIONAL IN-GROU4PRESSURE CONVENTIONAL LIFT )00( HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE 630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambe 30 BENCHMARK V.R.P. Top of Survey stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark B.M. SYSTEM ELEVATION Set @ 2.5 Below Grade95.5 /95.0 23' 5 44' A1t.B.M. B -1 3 12' Vents Property Line 5' 7% - B -2 103' Slope B -3 Vents 2 -3'X 94' Cells with >3' Spacing a� a. 0 c 90' 0 M M Pro 3 Bedroom House 14 0 , Vent Combo Tank >6 » Standard Infiltrator of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Long 12' 3 4" Grade at System Elevation Plans Designed Using Conventional Powts Manual Version 2.0 141st St. Division i y� Z01 WS•afWa P.O. Box 7162 VIsconsin Madison. WI SM - 7162 She Address Department of Commerce d-�� —o z � t �'3 Sankaw Sanitary Permit Application"` In aoeoed wi& Comm 0.21. wis. Adm. Code. personal Wftmadon you provide OChackif my be used for secondary pwTo§q Privacy Law. $15. 1 m L Application Infazvtation - Please Print Ali Inf Soft Plan I.D. Number EIVED property Owner's Name }}__ Parcel Nuit>be�up 30 �D Q I,� .' � V !� 25.30.18. 8(� P Owner's Mailing Address Pj;WM Location ti Ii ; S��T�N. City. State Zip Lot Blocs Number Subdivision Name CSM Number �54, AJ M U 7 DL Type of Btriwiug (check all that apply)' 2 Family Dwelling - Number of Bedrooms ❑Vi'iviga ❑ PublieWAmmerraal - Describe Use ❑ State Owned Nearest UL Type of ` (Check only one box on litre A (numbering sch me for internal use). Complete line B if applicable) `�' ❑ Repla =M System 3 ❑ Replacemnat of 6 ❑ Addition to Bar Carroty We Tank sty B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. of Permit: (Check ail that ply)(mumbering scheme is for internal pse) p, Pressurized In-Ground 210 Mound 47 ❑ Saud Filter 50 ❑ Consnricted wetland 22 ❑ Pressurised la-Ground[ 41 ❑ Holding Tank 48 ❑ Single Pass 510 Drip Lime ✓ 45 ❑ At-Grade 46 ❑ Aarobic Treatment Unit 49 ❑ 30 ❑ , V. Area Information: a - Z - > gam, ( Area Area Soil Application Percolation Firm Grade Required Proposed Rate(Gals./ Days /S4.FL) QXM/Inc6) Elevation VI. Tank Info Capacity in Total Numb" Manufacturer Prefab Site Sleet Fiber Plastic Galls Gallons of Tanks (� / Concrete Constructed Glass Tanta Tacks �/ `� �� / / !� Septic Tarok - b Chunber SA w VII. may Statement the r esponsRiuity for Installation of the POWTS shown as the attar plans. Number's Nam (Print) Phnnber' Mp/MP0 Number Business Phone Number Numnber's Address (Scree[. City. State. ) , Sanitary permit Fee (inchdes Groundwater Date Issued Agent ° �) use only ed ❑ Disapproved Sumbar FWW PAC)J / D S � O ❑ owner Given Initial Adverse Determination nditi a rs o ppraval/Reas�s for Disapproval b wj.eG iK am �6�, A, k /9 las r� qed �IOSwtfl p ✓0r ;1`sf�llwfiisy, e sy5 - � -t �, �� tia►tirere✓ �> riaP�S�It l3>' f�� tsar► s , yj /h `` � �� � � soy) for °a i to ,(� I ADRE PLAN PROJECT Rob Wizvkoski SS 1123 Western Ave. N. St. Paul Mn 55117 NE '1/4 NW 1/4s 25 V30 OWN Ric hmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/24/02 BEDROOM 3 CONVENTIONAL M IN -GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of Survey stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL •H. R. P. Same as Benchmark B.M. SYSTEM ELEVATION Set @ 2.5' Below Grade95.5 /95.0 23' 5' 44' B -1 3 Alt.B.M. /t 2' Vents Property Line 5 ' 0 B -2 103' Slope B -3 Z, /o o Vents 0' 3'X 94' Cells with >3' Spacing a T 0 i 8 o M i' Pro 3 Bedroom House Vent >6" d Itrator of Cover Leaching with 31.1 ft2 of Area 6' Long 12" 3 4" Grade at System Elevation Plans Design Conventional Powts Manual Version 2.0 141st St. r l ' PLO PLAN PROJECT Rob Wizvkoski DRESS 1123 Western Ave. N. St. Paul Mn 55117 NE '1/4 NW 1/4s 25 /T 30 18 OWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/24/02 BEDROOM 3 CONVENTIONAL XXX IN -GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 IL BENCHMARK V.R.P. Top of Survey stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H.R.P. Same as Benchmark B.M. SYSTEM ELEVATION Set @ 25 Below Grade95.5 /95.0 23' 5' 44' A1t.B.M. B -1 36' 12' Vents 40' Property Line 5' 7% B -2 103' Slope B -3 Vents 2 -3'X 94' Cells with >3' Spacing 10' ¢ T 0 r 8 0 M M Pro 3 Bedroom House Vent >6 " d Infil�tr of Cover Leaching Long 12" with 31.1 ft2 of Are a 6' � 34" Grade at System Elevation Plans Design Conventional Powts Manual Version 2.0 141st St. Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _1_ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 8 1/2 x I irtcFiei ih Plan must include, but not limited to: vertical and horizontal refen' W Cepoint (BM), directloeand Parcel I.D. percent slope, scale or dimensions, north arrow, anti locdtion and distance to neatest road. di na Reviewe b r – Date Please print all yhro - . ati Personal information you provide may be used for liacondary purpdsbb ri�acy 6w, s. 15:04 Property Owner ; ;_ j ropef*t cation Oakwood Land V 1 meri . Govt. L - t 1/4 NW 1/4 S 2 5 T 3 0 N R 18 &(or) W Property Owner's Mailing Address C Lot i�,, lock # Subd. Name or CSM# 1 61 1 Hwy #10 N . E . Z(-44IN6 OFFIC na Red Pine Corner City State Zip Code Phone Number { I ❑ Village EaTown Nearest Road Spring Lake Par ,MN J322 7;$ 1 =� Richmond 140th. St. [.:0 New Construction Use: Q Residential / Number of bedrooms 4 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material q1 ari A 1 dri ft Flood Plain elevation if applicable n ft• General comments and recommendations: trenches starting @ 96.60 trench in area of B -3 to be @ el. 94.67' ❑ Boring # Boring 100.1 +84 1 ® 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 1 0 110yr 212 none L 2msbk mfr 9E 2m .5 .8 2 10 -23 7.5 4 none sicl 2msbk mfr 9W 1m .4 .6 23 -84 7.5 4 6 none sl 2csbk mfi na if .5 .9 Boring # F] Boring 2 ® Pit Ground surface elev. 100 +90 Depth to limiting factor +90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 L 2msbk mfr 2m .5 .8 1 0- 10)Zr2/2 none 2 6 -18 7.5 4/4 none sicl 2msbk mfr gw lm .4 .6 3 18 -48 7.5yr4/4 none sl 2msbk mfi gw if .5 .9 4 48-90 10 4 4 none HIS osq ml na na ' 7 1'2 ` Effluent #1 = BO ) > 30 < 220 mg/L and TSS >30 :5 150 mg /L ' EMueqt #2 = BOD < 0 mg/L and TSS –< 30 mg/L CST Name (Please Print) Signature �D CST Number Gar L. Steel v` • Q � � 02298 Address a e Evaluation Cond cted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 715 - 246 -6200 f I Property Owner WjQWQW Tand Dey. Parcel ID # penr9 i nq Page 2 of __ 3_ F -1 Boring # E] ❑ Boring 97 70 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/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 2 8 -17 7.5 4 4 none sicl 2msbk mfr C1W 1m .4 .6 J• •5� F-1 Boring # ❑ M iring E] 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # Pit Boring roun ❑ Gd surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I `Eff#2 ' Effluent #1 = BOD > 30 5 720 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 30 mg/L and TSS 5 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 (8.6100) Property Owner _ a Tantj T V Parcel ID # i ng Page 2 Of �# _ ❑ Boring ❑ Pit Ground surface elev. 97 ' S0 ft. Depth to limiting factor 70 F in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 2 8 -17 7.5 4 4 I none sicl 2msbk mfr I qw 1m .4 .6 a Bonng # ❑ Boring ❑ pit Ground surface eiev. ft. Depth to limiting factor in. Sob Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ❑ Boring # E] Boring Cl pit Ground surface elev. ft. Depth to limiting factor in. Soil Appl ication 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 nwjL and TSS >30 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS —< 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD4330 (8600) H . STEEL'S SOIL SERVICE Gary L. Steel Oakwood Land Development 1554 200th Ave. CSTM2298 , NE 4 NW4 S25- t30N -R18w New Richmond, WI 54017 MPRSW- 3254 town of Richmond (715) 246 -6200 lot #9 -Red Pine Corner This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 " =40' BM top of survey s @ el. 100.00' Alkt. = nail in r pine tree @ el. 101.50' v a �1 Gary L. Steel 11 -15 -2000 • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 2 3 Property Address 3 3 y Sfi (Verification required from Planning Department for new construction) O Z6 - l l 3-0 _, A g a 7J city/State Parcel Identification Number LEGAL DESCRIP'T'ION u r. Sec. -� T 3QaN � w' Town of �- Location , /•, Property L. / � Lot # �._. Subdivision l & / 7 ✓ Certified Survey Map # Volume page # C,g a ? Page # Warranty Deed # . Volume Spec house ❑ y %�. Lot lines identifiabl %yes ❑ no SyS M jyjAUMNANCE t� failure to handle wastes. Proper maintenance improper use and maintenanceof your septic system could result is its p Wbat y � put into the system consists of pumping out the septic tank every three years or sooner, if needed by a licensed purer- can affect the function of the septic tank as a treatment stage in the waste disposal system a certification fom�, signed by the owner and by a 'The property owner agrees to submit to St. Croix Zoning that (1) the on site wasbewaterdisposal system masterPlumber ,lourneYmanPlumber• rtctedplumber or a licensedpumPa c tank is less than 1/3 full of shidge. is in Proper operating condition and/or (2) after inspection and pumping (if � and agree to maintain the Private sewage disposal. system with the standards Uwe, the undersigned have read the above of Commerce and the Department of Natural Resources, State of Wisconsin. �ficWm set forth, herein, se set by the Department c omp leted and returned to the St. Croix County Zoning Office witbin 30 stating that your septic system has been maintained must be comp . f the tbree year expiratio date. DATE` SI ,GNAIURE OF APP ANT OWNER CERTIFICATION knowledge. I (we) am (are) the owner(s) of I (we) certify that all statements on this form are true to the best of my (our) described above, by virtue of a warranty deed recorded in Register of Deeds Office. /��_ I /a'� DATE SIGNATURE OF APPLICANT « « « « «« « « « « «« A information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed V j q (0 STATE BAR OF WISCONSIN FORM 1 —1998 A E 6 0 H. . WALSH REGISTER OF DEEDS WARRANTY DEED REEDS ST. CROIR CO., MI Document Number RECEIVED FOR RECORD This Deed, made between Oakwood Lan epev loame Inc. 06 -04 -2002 9:00 An Corporation , Grantor, and Robert Wizykq6i and Krista Ann Wizvkoski. hudband and wife Grantee. WARRANTY DEED Grantor, for a valuable consideration con s to Grantee the following EXEMPT i described real estate in S Croix County State of REC FEE: 11.00 Wisconsin (the "Property"): TRANS FEEt 110.70 COPY FEE: CENT COPY FEE: PAGES: 1 Recording Area kNew and R lum Adld.- rt Pi W e sk (lr C�CUCY;i I mon WI 54 uu x 1 t,G�.t.fYti, JJYJ� 026 1072 90 000 026 1130 09 000 / Parcel Identification Number (PIN) / This is not homestead property. (is) (fa not) Lot 9, Red Pine Corner Together with all appurtenant rights, title and Interests. None Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 17th day of May, 2002. (SEAL) (SEAL) Oakwood La eveopment, Inc. (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, } ss, St. Croix County authenticated this _vb4d GWAUNA, NOTARY PUBLIC Personally came before me this day of May, 2002 the above named STAT Oakwood Land Development, Inc By Ore-gory J. Peterson . President to me known to be TITLE: MEMBER STATE BAR OF WISCONSIN the person who execut the foregoing instrument and a know ge the same. (If not, authorized by §706.06, Wis. Slats) THIS INSTRUMENT WAS DRAFTED BY w l r l r1a� Coldwell Banker Burnet Notary Public, State df Wisconsin 1301 Coulee Road Hudson, W1 54016 My commission is permanent. (If not, state expiration date: 2 -23744 kh - o C (Signatures may be authenticated or acknowledged. ) Both are not necessary.) Names of persons signing in any cap acity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. [WARRANTYDEED FORM No.1 —1998 Milwaukee, Wis. U U O O r- '- G7 c m M M c0 ` 0. Y O O, D 0 C7r o U .- x w —` a a Uo u o ar m c L 4 CL F:-: io �U) ` o o w W y am c c < W O E w% N 'fl N 0 p 3 T 'b C (3 U- c o MEo xo - v , o ff o 0 o E Z O c_ �a v c o +; 3 3 3 L *•� v c 'v_ a 0 t D t t E a J O r 61 — 0/ O• O� C N O N 0 (N � lL- m d 0 0: N =_ 2 G U N Li Q I W J C U. Q • O d j 3 3 Z 4 ^: . / ro '' v ( c� P % C� / Iro i' i O 0019 ) t/l MN 3Kl JO 3N 3W -10 3N17 1S3N •O A' 4 0 10 A �p ,• Oj �o• �O + ! � O / O i O _� � � S x• �5 0 •�O � � O W i qL x- .O h 4 ^ j A do �, / • �� o p O . b 4 `O! 2 �'Qob \ Off, i O 6► sp I �h .p i � s 0' O S OA n �o .Q W ct g� i