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Home My WebLink About026-1141-12-000 Wisconsin Depavtment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safetyj d BuildrAg Division INSPECTION REPORT Sanitary Permit No: 399620 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: ffq(. /z -0a P.C. Collova Builders, Inc. I Richmond Township 0264096 -60-000 CST BM Elev: Insp. BM Elev: BM D scription: lob D 6 5 TANK INFORMATION ELEVATIbN DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt, BM Aeration Bldg. Sewer Ho mg Ht Inlet G, 9 - TANK SETBACK INFORMATION U Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD 5 n Septic Dt Bottom Dosing Header /Man. y q3. s j Aeration Dist. Pipe �Sr f 3, s' Holding Bot. System L 'L 9- �b 9/ 7 f, PUMP /SIPHO INFORMATION Final Grade nufacturer _ emand St Cover Model Number TDH Lift Friction ss Head TDH F Forcemain Le Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -3 5 / SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM NG Manuf to r! INFORMATION AMB OR Type Of System: 4 � IT Mod Number: �j " r DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake i, Pipe(s) 4 1 L Dia _ L Dia Spacing- 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 Bedlrrench Center Bed/Trench Edges Topsoil Yes [yj No �] Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:/ 1 Inspection #2: Location: 1183 121st Avenue New Richmond, WI 54017 (SE 1/4 SE 1/4 3 T30N R18W) Duck Pond / Parcel No: 33.30.18.518 1.) Alt BM Description = ; � 01 � yJ 04 L/ell 47 1`i� -*� 2.) Bldg sewer length = 1 - amount of cover = : y " A Plbn revision Required*? [# Yes 1 # No I — Use other side for additional information. G SBD -6710 (R.3/97) Date Insepctor's Sicirefiture Cart. No. P T PLAN PROJECT P.C. C ollova Builders Inc. AD RESs 705 Co. Rd E Hudson Wi 54016 SE 1/4 SE 1 /4s 33 /T 30 N/ 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/18/01 BEDROOM 3 CONVENTIONAL XXX IN-GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .9 ABSORPTION AREA 514 # of chambers 30 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Alt. BM SYSTEM ELEVATION 91.6 Top of Lot Sign @ 99.1' * Alt. B. 121st Av e Plans Designed Using Conventional Powts Manual Version 2.0 70' a -� i - B2 id r 15' 45' Property Pro 3 Line Bedroom B -3 75 House 110' elo 10' -1 2 -3' X 94' Cells with >3' Spacing 33' Vent 297' > 12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" 34" Grade at System Elevation Cty Rd E V 2:Q�Jt St e t� OLt AV U Safety mLi Buildings Division County i 201 W. Washington Ave., P.O. Box 7162 7 N*6 COII SII1 Madison WI 53707 - 7162 _ Site Address s+ 1��s Department of Commerce + Sanitary Permit Applicatl , =' "� �� / ' tary Permit Number n 399 620 In accord with Comm 83.21, Wis. Adm. Code, personal info o u p ll k if Revision ma be used for seco ses Privac Law, s15 m I. Application Information - Please Print All Information y �� S4ff T ian I.D. Number r �� Prope Owner's Name G FOY , Part l r 1 I it Ccl Property Owner's Mailing Address _ i _ "yrdpe� u Location 0/ 7 .s- v/ E �t 1 *;`� - - - c•S33T3 be R �> City, State Zip Code Phone Numr Lot Number Block Number Subdivision Name CSM Number H. Type of Building (check all that apply) ❑City 1 o 2 Family Dwelling - Number of Bedrooms _ ❑Village ❑ Public/Commercial - Describe Use ownship ❑ State Owned Nearest Road III. Type of Permit: (Check gnly one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use Nevu_- 2 ❑ Replacement System 3 ❑ Replacement of Addition to 6 ❑ S stem Tank Onl Exis ' stem B. Ch Permit Number Date Issu eck if Sanitary Permit Previously Issued < y '�� I �I IV. of Permit: (Check all that apply)(numbering scheme is for internal use) 4_T T . - Pressurized In-Ground 210 Mound 47 ❑ Sand Filter 50 El Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Diswe rsal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min.flnch) Elevation Manufacturer Prefab Site Steel Fiber Plastic VI. Tank Info Capacity in Total Number Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ Dosing Chamber VII. Responsibility Statement- I, the undersigned, a responsibBity for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S' MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Z' e) VIII. County /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee ) I2/ ❑ Owner Given Initial Adverse ,Z � / � � Determination IX. Co ditions of pproval/Reas ns for Disapgrov a t-LS �e_ t �- 0. � ( ""- C� CP KdK Ct �- Attach complete plans (to the Comty only) for the system on papa not less than 8112 x 11 inches in size SBD -6398 (R. 05101) P OT PLAN PROTECT P.C. C ollova Builders Inc. ADDRESS 705 Co. Rd E Hudson Wi 54016 SE 1/4 SE 1 /4s 33 /T 3 /R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/18/01 3 BEDROOM CONVENTIONAL XX)C 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 .9 ABSORPTION AREA 514 # of chamb s 30 IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Alt. BM SYSTEM ELEVATION 91.6 Top of Lot Sign @ 99.1' B R M 121st Av e Plans Designed Using Conventional Powts Manual Version 2.0 70' 5' 9 B -2 15' 5 ' 45' Property Pro 3 Line Bedroom B -3 5' House elo 10' -1 2 -3' X 94' Cells with >3' Spacing Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" 34" Grade at System Elevation a Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of -Safety and Buildings in accordance with Comm 85, Wis. Adm. Code n County / r Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ! include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Rev' wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).� I Z /ZD�p Property Owner Property Location L n / �7 /, Govt. Lot �L 1/4 �1/4 S T 5 v N R "(or) Property Owner's Mailing Ad ress Lot .# Block # Subd Name or, M City State Zip Code Phone Number City ❑ Village T wn Nearest Roa New Construction uses Residential / Number of bedrooms S Code derived design flow rate s GPD Replacement �� Pulic or commercial - Describe: Parent material Flood Plain elevation if applicable N J ft. General comments and recommendations: P I Boring # ❑ Boring j /) Pit Ground surface elev. ft. Depth to limiting factor L% 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 U Boring # Boring ' Pit Ground surface elev. � ft. Depth to limiting factor �J ln. 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 ID * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Nam (Please Print) a CST Number �v '0 � Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner Parcel ID # Page of F-31 Boring # ❑ Boring V-Pit Ground surface elev, ft. Depth to limiting factor v in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y� *Eff#1 *Eff#2 F-1 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring El 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 /ftz 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 < 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) i h Soil Test Plot Plan !' Project Name P.C. Collova Builders Inc. Shaun Bi Address 705 Co. Rd. E Hudson Wi 54016 #226900 Lot 1 2 Subdivision - ------ Date 12/18/01 SE 1/4 SE 1/4S 33 T 30 N /R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 f� of Steel Fence Post System Elevation 91.6 *HRPSame as Benchmark Al t. BM Top of Lot Sign @ 99.1' '�`B Alt. 70' Q L/O 5' 15' 15' 15' 45' Property Pro 3 Line Bedroom B -3 5' House B -1 Safety and Buildings Division County \r k 201 W. Washington Ave., P. J. Box 1162 1. 4 X nsfn Madison, WI 53707 - 7162 Site Address fSCO z o I g 3 1 . De artment of Commerce Sanitary Permit Application Sanitar Permit Number pia ) D ❑ Check if In accord with Comm 83.21, Wis. Adm. Code, personal information you provide l ` "Revision may be used for secondary purposes Privacy Law, sl5. 1 m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name �_ Parcel Num r Property Owner's Mailing Address Property Location C , � l c _ n r �`�� 1. J- % %;S3 T �B City, State Zip Code Pho ITIumb6r Lot Numbe� Block Number ber R V Ck SOY1 W L S `}o 1 (.p ( bvvision N e CSM Num ✓v r.,. � H. Type of Building (check all that apply) e or 2 Family Dwelling - Number of Bedrooms Jk ti }��+ g C1 Public/Commercial - Describe Use ST CRpIX 1 �- - --}}TY hip n ❑ State Owned ;'.. xpNtP1G C+�F arest Road III. Type of Permit: (Check only one box online A (numbering schem o li t tls omplete line B if applicable) A For County use w 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to stem Tank Only Exis ' stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44;�14n - Pressurized In- Ground "�210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. DispersaVrr eatment Area Information: `7 Ca Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate em Elevation Final Grade Required Propo (pgCp Rate(G s./ Days /Sq.Ft.) (Min./Inch) ✓/ Elevation f &q5 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks c o - /► Dosing Chamber I 1 Q(' VII. Responsibility Statement- I, the and , ass respo nsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum i ture MP/MPRS N r Business Phone Number Plumber's Address (Street, City, State, e) VIII. County /De artment Use Onl �( Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) r Approved ❑ Disapproved Surcharge Fee) ' ❑ Owner Given Initial Adverse a�CJ 60 / p C, Determination EK. Conditions of Approval/Reasons for Disapproval ,. ��'.� /ve�'� -i /,/c.- �.r, -kstb� ��b�all� c�- a��rta n f�- ,rc�'�fper�na►�v��.�tVr-er sPet;�tc4.�h3ns wi ai n, 4ai n i n W' 60-6 - PO r a 15�ru G�u � �� la roa.cQ 5� k-s ! � -end , n plete plans (to the County only) for the system on paper not Less than 81 x 11 Inches in size 7 lhspe ar rte, 5 cs►�d��- s �c�'� � �s pe on SBD -6398 (R. 05101) — PLOT PLAN PROJECT P.C. Collova Builders Inc. ADDRESS 705 Co. Rd. E Hudson Wi 54016 SE 1/4 SE 1/4S 33 /T 3G /R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 / DATE BEDROOM BEDROOM 3 CONVENTIONAL )00( IN -GR ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 680 # of chambers 39 BENCHMARK V.R.P. Top of 2" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL «H. R. P Same as Benchmark SYSTEM ELEVATION 94.4 121 st. Ave c� Vent > 12" Sidewinder High plans Designed Using 0 of Cover Capacity Leaching Conventional Powts Chamber Manual Version 2.0 'Long 34" 16" Grade at System Elevation 0 3 Bedroom House 20' B -2 ST B.M. #1 20' 30 C Ari },�vls B- Vents P 60' Vents 0' 3 -3' X 80' Cells with >3' Spacing B -3 B.M. #2 30' County Road E PLOT PLAN PROJECT P.C. Collova Builders Inc. ADDRESS 705 Co. Rd. E Hudson Wi 54016 SE 1/4 SE 1/4S 33 /' 0 N/R 18 W TOWN Richmond COUNTY ST. CROIX 11/17/01 3 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL )00( I - GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 680 # of chambers 39 IL BENCHMARK V.R.P. Top of 2" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL sH R Same as Benchmark SYSTEM ELEVATION 94.4 121st. Ave a� a Vent > 12" Sidewinder High Plans Designed Using 0 of Cover Capacity Leaching Conventional Powts Chamber Manual Version 2.0 6' Long 16" 34" Grade at System Elevation 0 3 Bedroom H ouse 20' B -2 ST 30' B.M. #1 20' B- 40'; Vents Vents 0 60' 3 -3' X 80' Cells with >3' Spacing B -3 B.M. #2 30' County Road E age of Wisconsin Department of Commerce SOIL EVALUATION REPORT P Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and ti �d i tali o nearest road. Please print all i ►on. `�4 / ed b Date r? Personal information you provide may be used for s d pur Law. 4 .0 (1) (m)). l� Property Owner Pr Location PcL4 c..z ccl' \J � 2 00 Go s 1 /4,S' 1/4 S 33 T 3 (I N R ($ E (or) r�V Property Owners Mailing Address V 1 a ST CHpiX 1 I Block # Subd. Name or CSM# City State Zip Code ore NUm ity ❑ Village [54 Town Nearest Road 15 4 0 1 (0 ( - 11 " e l Ch O C [;Q New Construction Use: [D Residential / Number of bedrooms 3 y Code derived design flow rate GPD ❑ Replacement JJ Public or commercial - Describe: ''22 Parent material Ti Flood Plain elevation if applicable /t//1* ft. General comments .5y sle -4,1 2 /{ tl Qy yo and recommendations: �Gj� V • 9�1� y6 © Boring # Boring U O Pit Ground surface elev. lr�. ft. Depth to limiting facto 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 Q —Q �� ,�3�Z Sid 2. cS Z I -zg 1p r 41 sic] 2 m M C 3 Z- 1 Zm 4 L&8p l yI (0 `— ►rn 5 0:S rMl 2 Boring # Boring Pit Ground surface elev. CkD. 8Q ft. Depth to limiting factor COJ 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 I -10 Id 2 5► cg l v - S $ 2 - 1 0 -I SiLI 2 CS - `{ 3 � - I y s Z sb cs — . .$ ✓ 4 4v(4 ( s 1 - . 1. Z ' Effluent #1 = BOD > 30 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signature CST Number -- S5 Address Date Evaluation Conducted Telephone Number //� 6 S - Soor�e Gv�• S Qzs� zz- 61 71- -Z /:2-�/Qo8 Property Owner Parcel ID # Page Z. of 1-5 Boring # ❑ Boring ® pit Ground surface elev. 3(0 •9(�) ft. Depth to limiting factor �p 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 *Eff#2 I 0 - tl I 3I2 S I Z Iv S -- Pr c- . - (o 3 I y► S 2 an d-(r c - S 8 4 q6 y 16 rn I top F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 F-1 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. E] pit 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 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg /L * Effluent #2 = BOD < 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. SBU -8330 (R.07 /00) PAGE, - OF-,3— NAME CO 100 LOT# ( Z LEGAL DESCRIPTIONS E/*SE' /SS33T30,N R l8 E (or)(@ SCALE: BM 1 ELEVATION BM I DESCRIPTION BM 2 ELEVATION �2 Sec 3 BM 2 DESCRIPTION p d Z O Jc 0 i p e ` SYSTEM ELEVATION GI y • q y t ALTERNATE ELEVATION 9 . 4 4 C) � X CONTOUR ELEVATION At S (0j) - t g C J A t 4va l L a � 4 SKa R �.2 r a-' ■ r g -3 SIGNA - -- -- pvr�Z Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank Is to be pumped once every 3 years. 2. Effluent fitter is to be cleaned once a year. Please note: a larger finer 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 Shaun Bird #2/6900 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND n OW; CERTIFICATION FORM Owner /Buyer (b � � oVA Q 1� rt S e w Mailing Address — 706 w - P d . C /- w�50-y L Property Address J 1 �� l� ` A— (Vcrification required from Planning Dcpartment for new construction) Ll City /State (VP,c.J Qtc.h ennc�- CY�, Parcel Identification Number LEGAL DESCRIPTION Property Location Z5E' /,, 3E_ /,, Sec. 33, T 3 N -R19W, Town of f1tC.\M0n&' Subdivision Lot it �. r Certified Survey Map It , Volume , Page it Warranty Deed # 3 3 Volume ( �Lo Page it (JO Spec liouse ❑ yes Ano Lot lines idcrttifiablexycs ❑ no SYSTEM MAINTENANCE Improper use and maintenanccof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master, plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the.standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 dayl year expiration date. K/ d G F APPLI DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (arc) the owncr(s) of the r y ribed a ove y virtue of a warranty deed recorded in Register of Deeds Office. I L, !l / / -/ 6/ W, NklirE r OF APPLICANT DATE * * * * ** Any information that is ntis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty decd from the Register of Deeds office a copy of the c.ertified survey map if reference is made in the warranty decd t;1i. aU4UG1 : ,1t I STATE BAR OF WISCONSIN FORM 2.1998 tla1 313'9 WARRANTY DEED KATHLEEN H. WALSH D REGISTER OF DEEDS Document N umber ST. Cf:IIIX CO., CD WI This Deed, made between Kenneth L. Brown and Kathleen B. RECEIVED FOR RECORD Brown, Husband and Wire 04 -18-2001 9 :45 AM VARRANTY DEED Grantor, and P. C. Collova Builders, Inc. EXEMPT 8 CERI -COPY FEE: COPY FEE: ,IRPJISFER FEE: 828.00 RECORDING FEE: 10.00 Grantee. R9GESt „r 1 Grantor, for a valuable consideration, conveys and warrants to e Grantee the following described real estate in St. Croix D ( f c k P o N $ QA f L County, Stale of Wisconsin: I r Recordinit Area Name and Return Address David J. Estreen That part of SE 114 SW 1/4 and SW 1/4 SE 1/4 Sec. 33- T30N -RI 8W described 304 Locust St. as follows: Lots 1, 2 and 3 of Certified Survey Map recorded in Vol. 13 of Iludson, WI 54016 Certified Survey Maps, page 3698 as Doe. No. 607591. St. Croix County, Wisconsin 026-1096-60-000,026-1096-60-200, 026 - 1096 -70 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Existing highways, easements & rights of way of record. Dated this day of April 2001 1 � Z, r� • + Kenneth L. Brown + T Kathleen B. Brown AUTHENTICATION ACKNOWLEDGMENT STATE OF Wisconsin ) Signature(s) ) ss. St. Croix County. ) Personally came before me this —1 day of authenticated this 4 day of April 2001 the above named Kenneth L. Brown and Kathleen B. Brown • J. t'j _ - . ..... ... TITLE: 17 F T (1R OF WISCONSIN � � . to nown to be the person(s) who executed the foregoing i ment and acknowledge the same. i y 06 e o6, Wis. Slats.) E •1:WAS DRAFTED BY Aft 71 ' David J. Estreen 304 Ldeu ¢5t: Hudson, WI 54016 Notary Public, State of Wisconsin (SignatureS� a be authenticated or acknowledged. Both are not My Commission is permanent. not, s a e explra Ion a e: necessary.) ) •Names of persons signing In any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM N.. 2. 1996 INrORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800.653.2021 _ T roe; i. 6 g2 0 Z S , �6. 07 3j 5 92 25 25' 6 W 47' Is J Q 2 LOT 11 OT 16 i 87030 Sq Ft. I L T 12 cp A , 'o, \ 200 Ac. _,OT 9 I., o i I �, �� L of � 4078 Ft. LOT 13 -551 Sq. Ft. a o Ac.'' I 2.19 A c. ° X `°'� m 66649 Sq. F / 0 a 1.53 Ac. mI ; 90086` Sq. Ft. / 2.O1�Ac. I I I try c ' C, `2 L— A O. �� ^ P� fi r ] S A • � A` h � \ 16.21 153.90' \ . 2325' 15 7 40.76' 113.14' 153.36' 241.0 �i cP - 174.45' - \ -- - - - - -- -- — — — — — — - _ �— 116.99 53 107.7i' - - - -- N 89'41'01 W 1972.80' - o OF THE SE 1/4 OF SECTION 33 _ 00__ W 2638.57' R.A. 2638.72' UNPLATTED LANDS NOTE: EASEMENTS ALL BEARINGS ARE REFERE T30N, R18W, RECORDED AS TABLES ARE TO BE PLACED SUCH THAT THE INSTALLATION BOUNDARY PROVIDED BY Iv SURVEY STAKE, OR OBSTRUCT VISION ALONG ANY LOT LINE OR TURBANCE OF A SURVEY STAKE BY ANYONE IS A VIOLATION ALL BUILDINGS TO BE CON F WISCONSIN STATE STATUES. UTILITY EASEMENTS AS HEREIN FINISHED FLOOR OR WINDO USE OF PUBLIC BODIES AND PRIVATE /PUBLIC UTILITIES ELEVATION SHOWN. ,tr< , �E THE AREA.