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HomeMy WebLinkAbout026-1141-25-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division , 1 INSPECTION REPORT sanitary Permit No: 399685 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: P.C. Collova Builders, Inc. I Richmond Township 026- t@9e"ee9600 CST ­ BM Insp. BM Elev: BM Description: P �, I-v ii 1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 0 O F O 10 4 1 , 4 1 pc), 6 Dosing /,C11 Alt. BM _ 5T, /D l- 6 , Aeration CC!! vv Bldg. Sewer Holding St/Ht Inlet s TANK SETBACK INFORMATION St/Ht Outlet -� TANK TO P/L WELL BLDG. VenEtoAir In take ROAD Dt Inlet 4 Septic Dt Bottom Dosing Header /Man. Aeration ist. Pip 2 �'r � (p• a i l Holding Bot. Syst m Final Grade PUMP /SIPHON INFORMATION Manufacturer St Cover 2 /- GPM � > +/• (�� Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia, SOIL ABSORPTION SYSTEM BED /TRENCH Width Len +/ No. Of Trenche PIT DIMENSIONS No. Of Pits Insider Liqu Dep th DIMENSIONS t - - SETBACK SYSTEM TO P/L L W L STR LEACHING Marmfact ef: (Z INFORMATION CHAMBER OR ,ti ! 1� -3 Ty Of Sy 7 ��/ r UNIT Model Number: Y em DISTRIBUTION SYSTEM 3 4SO It cJ ? Header /Manifpld Distribution ! , x Hole Size x Hole Spacing Vent to Air Intake " Pipes) 4,/7 L O ` 11 Length Dia Length Q om '/ Dia pa —� / SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only R Gst I 1 7 Depth Over J Depth Over xx Depth of xx Seeded /Sodded xx Mulched �WnG dS Bed/Trench Center �j / Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_ 6 L/ LL 7 / 0 Inspection #2: / / Location: 1156 121st Ave New Richmond, WI 54017 (SW 1/4 SE 1/4 33 T30N R18W) Duck Pond Esc" kot 25 Parcel No: 33.30.18.1029 1.) Alt BM Description =Sr �.i m4k / -1 � r jA W f✓t `• Vi1 "z j 2.) Bldg sewer length = / 47 �yts � LCR • m 4 a � �j6vt� 1 b0 �ZQk (' ' 7 - amount of cover = > ,O! �/ jai 1 - e0 A � �•S�f��� Plan revision Required? Yes 0 �' Use other side for additional information. � � Date -- Insepctor's tgnature Cert. No. SBD -6710 (R.3/97) I Safety and Buildings Division cOun`y 4�z L �c� I �r 2o1 W. Washington Ave., P.O. Box 7162 `S'COnS,n Madison, WI 53707 - 7162 Site Address Department of Commerce - 9 —d Z O Sanitary Permit Application _ � / `'' Permi N 3 q q &S In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Rkcg k if Revision May be used for secondary purposes Privacy Law, sl5. 1 m I. Application Information - Please Print All Information State Plan I.D. Numpe� Property Owner's Name Parcel Number 3'3.3 p - 1 �O �- L 1ov,, oa-6- q Property Owner's Mailing Address ftoperty Location City, State Zip Code P r Block Number d ST. CROIX COUNTY N CSM Number ZONING OFFICE IL Type of Building (check aR that apply) n p,L _ ock Family Dwelling - Number of Bedrooms �'" Qp ❑ Public/Commercial - Describe Use ❑ State owned 3 3' 8 1 = 13 Newest RoaO III. Type of eedr only one boa on line A (numbering scheme for internal use). Complete We B If applic8ble) County use A. 2 11 Rq*cemcnt System 3 ❑ Re�ecement of ti ❑ Add�on to For Tank stem B. 1 ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. of Permit: (Check all that apply) (numb ering scheme is for internal use) , ,tl 1 6r l r Zt -Pressurized In- Ground 210 Mound 47 0 Sand Filter 50 0 Constructed Wetland rAW 3/. / OPremurized In4round 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other 3 M " . V. Area Information: Design Plow (U4 Dispersal Area ispersal Area Soil Application Percolation Rate El Final Grade Required Rate(Gals./Day > (Min./Inch) '� s� Z 7 1 T 7n: VL Tank Info Capacity in Total Number Manufacturer Prefab Site Fiber Plastic Gallons Gallons of Tanks Concrete Cottahnct Glass New I Exiatioy Tacks Tanks Sep is of HoUn Tank _ P Dosft umber VII. Responsibility Statement- flee tmdeignedA,6ie responsubflity for installation of the POWTS shown on the attached plans. s ame (Print) Plumber's S' MP/MPRS Number Business Phone Number e.-- � Plumber's Address (Street, City. State. ) /De t Use isapproved Sanitary Permit Fee (includes Groundwater D Issued eu>t Signature (No Stamps) Approved ❑D 4 , Surcharge fte ❑ Owner Given Initial Adverse Determination IX. Conditions of Approval/Reasons for D�ap nroval ��Q,U- 1,a.1Lc� Sy�S��r+� `oC�� -d''`am Cu�w W� !�% �i",., • �3. N� Z Attach edam (to tLe Co®t7 00171 !or fhe aritm an papa• not kss rods tan z 11 taehes in She Test and System PLOT PLAN PROJECT `P.C. Collova Bldrs. ADDRESS P.O. Box 489 Somerset Wi 54025 SW 1/4 SE 1 /4S 33 /T N/R 1 TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 22690 DATE 8 BEDROOM 3 CONVENTIONAL XXX IN-10AOUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1 000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION ARE 1212 of chamb s 39 BENCHMARK V.R.P. Top of 1" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.0/94.9/94.8 Alternate Benchmark Mark is To of 1" pipe and is 99.8' 121st Ave 70' 6 3-3'X 80' Cells with >3' Spacing Tested area does not 180' t1 40 , have enough slope to ! Pro 3 8 , 'T 10' Vents 0 establish contours Bedroo House Vents # 40' 30' '� -2 80' , B -1 2% Slope 10 B.M. #1V 4 10' B.M. #2 Plans Designed Using Conventional Powts Manual Version 2.0 40' o Vent Pond >6 „ Standard Infiltrator of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 12" 34" Grade at ystem Elevation Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must I t D include. but not limited to: vertical and horizontal reference point (BM), direction and Parce I.D. percent slope, scale or dimensions. north arrow, and location and distance to nearest road. Please print all Information. Revi to Penionel Wo m bw You Provide mry be used for secondary purposes (Privacy Low. s. 15.04 (1) (m)). T. CROIX COUNTY Propertyowner Property Location ZONING OFFICE 7 C . �v Govt. Lot _1(,"1/4��` 1/4 S T ? N R E ( W Property a Mailing Address /1 Lot # Block # Subd. Name qr CSKW fJ l 1 .2r �s City State Zip Code Phone Number 0 city, villa own Neares oad � Ci✓s S 6�s' ( ) 0 Construction Use: rrtial / Number of bedrooms S Code derived design flow rate Z J GPD ❑ Replacement o l Q Plibl or cgn I - Describe: - - -- _ -- -- Ps" material Flood Plain elevation 'rf applicable ft. GwwW comm" and raoorrtrnettdations :S --��� a# 0 � a Pit Ground surface elev. t I ► ft. Depth to Grtdling fac0or 7 in. Rate Had= Depth Dominant Color Redox Desaipton Texture Structure Consistence Boundary Roots G PDAY in. Munsefl Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 -;� L 7 0 Borin Pit Ground surface elev. 1 ff. Depth to limiting factor Soil AWmatiin Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efl#1 'Eff#2 c � - Effluent #1 = BOD > 30 220 mglL. and TSS >30 ' Effluent #2 = BOD < 30 mg/L and TSS 130 mglL CST Print Si nature Address r Date Evaluation Conducted TeWwShe Number zz i Properly Owner .4—v "�!c� ' Panel ID # � Z(P — lO 96 (06 — DUy Page Z of 3 Uj eodn # ❑ Boring Pit Ground surface elevf�_!�= ft. Depth to limiting factor in. Appl ication Rate Horimn Depth Dominant Color Redox Description Texture St ucture Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz Cont. Color Gr. Sz Sh. •Eff#1 •Eff#2 -25 rV Boring F ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz Cont Color Gr. Sz Sh. •Eff #1 'Eff#2 F Boring # ° Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz Corti Color Gr. Sz Sh. - •Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 mg& 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. Seoi370 pteoo) Test and System PLOT PLAN PROJECT P.C. Collova Bldrs. Y /T ADDRESS P.O. Box 489 Somerset Wi 54025 S\q 114 SE 1/4s 33 N /R 1 TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 22690 DATE 8 BEDROOM 3 CONVENTIONAL XXX IN-GeOUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION ARE 1212 of chamb s 39 BENCHMARK V.R.P. Top of 1" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark - SYSTEM ELEVATION 95.0/94.9/94.8 Alternate Benchmark Mark is To of 1" pipe and is 99.8' 121st Ave 70' 3 -3' X 80' Cells with >3' Spacing Tested area does not 180' ST 40' have enough slope to Pro 3 8' 10' Vents 0' establish contours Bedroom House Vents 40' 30' 25' -2 80' B -1 10' 2% Slope B.M. #1 10' B.M. #2 Plans Designed Using Conventional Powts Manual Version 2.0 40' o Vent Pond >6 „ Standard Infiltrator of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 12" 3 4" Grade at System Elevation Safcty and Buildings Division County 201 W . Washington Ave., P.O. Box 7162 N visoconsin Madison, WI 53707 - 7162 Site Address Department of Commerce �(S (o (Z( jq-JE, Sanitary Permit Applicatio z j Sanitary Permit Number In accord with Comm 83.21, Wis..Adm. Code, personal i o �g! 39 I US ma be used for second purposes Priva Law, s m) ,;� Check if Revision I. Application Information — Please Print All Information to Plan I.D. Number R -CEN Property Owner's Name cel Nttrmber Property Owner's Mailing Address " "e o Location 2ittsdCs "` / /,), L�r� S T N, B Ciry, State Zip Code £ �, Lot uln� Block Number a Z Z� S --� Subdivision Nam CSM Number H. of Building (Check all that apply.) V OCity `or 2 Family Dwelling - Number of Bedrooms �i1Qo+K. O Village E3 Public/Commercial - Describe Use ❑ State Owned — Avownahw �3�3 (o2•SD�-�,, ,�J, t;.�ds �� Nearest III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, If applicable.) A. 2 O Rep{scemcru System 3 D Replacement of 6 O Addition to For County tree S tem Tank Ont Existing System B ' ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering Is for internal use.) )( A- -ltAj , 44 ❑ Non - Pressurized In -Ground 210 .Mound 47 O Sand Filter 50 O Constructed Wetland 22 ❑ Pressurized In- Ground 41 O Holding Tank 48 O Single Pass 51 Drip Line 45 O At -Grade 46 OAerobic Treatment Unit 49 0 Recirculating 30 E Other V. Diversanreatment Area Information. O Design Flow (gpd) Dispersal Area Dispersal Area pl anon Percolation Rate System Elevation Final Grade Required Ptoposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) �' S, El VI. Tank Info Capacity in Total Number Manufacturer Prefab Sud Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks S*tk or Holding Tank Dosing Chamber VII. Responsibility Statement i, the undentped, bility for installation of the POWTS shown on the attached Plumber's Name (Print) Plumber's Signs MP /MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip ode) VIIE :Conn nee partment Use Onl Disapproved Date Issued Issu' Agent Si lure (No Stamps) Approved O Owner Given Initial Adverse Sanitary Permit Fee (' c12�� mwater ,� %, Determination Surcharge Fee) il IX. Conditions of ApprovallRor� n, / _ A 11L h complete plans (to the County only) for the system on paper not less than 81 /2 x 11 inches In size P/8 LAN PROJECT P.C. Collova Buil Inc. RESS 705 ctv RD E Hudson Wi 54016 SW 1/4 SE 1/4s 33 IT 30 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 1/24/02 BEDROOM 3 CONVENTIONAL )= IN -GRO D UESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .9 ABSORPTION AREA 514 # of chambers 30 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Vent SYSTEM ELEVATION 95.8/95.6/95.4 > 12" Sidewinder High Capacity Leaching Plans Designed Using of Cover Chamber. Conventional Powts Manual Version 2.0 6' Long 16" 34 „ Grade at System Elevation 325' Property Line 3 -3' X 63' Cells with >3' Spacing 2% Slope Vents tB*. 121st Ave R 2 40' B��, 5' T 15' Vents 14 Alt B -3 o 3 Al B edroom H ouse a� a 0 M M P -0 PLAN PROJECT P.C. Collova Builders Inc. RESs 705 ctv RD E Hudson Wi 54016 SW 1/4 SE 1 /4S 33 /T 30 / 8 W TOWN Richmond COUNTY ST. CROIX 7 1/24/02 3 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL XXX IN-GROt&D ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •9 ABSORPTION AREA 514 # of chambers 30 IL BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Vent SYSTEM ELEVATION 95.8/95.6/95.4 >12" Sidewinder High of Cover Capacity Leaching Plans Designed Using Chamber Conventional Powts Manual Version 2.0 6' Long 16" 34' Grade at System Elevation 325' Property Line 3 -3' X 63' Cells with >3' Spacing 2% Slope Vents 121st Ave 160' 40' B�� M. 5 ' T 15' 30' Vents 140 Alt. B. B -3 o3 Bedroom House a� 1~ a� a M M Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County �[ . C� ! 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 referent_ point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow,aalcjq apdr�istance to nearest road. r" " t ! Rev wey Please print,all"infAf'iriation: --:,, ,'': d b Date Personal information you provide may be use f ge Ada uroes (Privas}S 1. S. 15.04 (1) (m)). I �� Property Owner + t roperty location b ovt. Lot S Gt1 114.$ E 1 /4 S 3 3 T O N R E (or� 44 C6116 Jo ,� u• Property Owner's Mailing Address -- ST _ of # Block # Subd. Name or CSM# City State Zip Cody iC . .,,\ e\ ❑ City ❑ Village [Town Nearest Road d sv bi 1 5461 I me C- ti Vn wed c E New Construction Use: Residential / Number o ooms _ y Code derived design flow rate � ©Q GPD ❑ Replacement / / mmercial - Describe: Parent material r Flood Plain elevation if applicable / ft. General comments ,$ , 5s ckeL �t U • ?5. <fv and recommendation: yl. 6I-cV, ? F-1 I Boring Boring # I ,I g 40 ft Depth to limiting factor d t7�1 pit Ground surface elev. �_ p 9 7 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 I - Eff#2 Z -r 3 1 o- - I ry Ito -51. Z s l�- 9 S•&� lz Boring # f�r��I Boring S pit Ground surface elev. ft. Depth to limiting factor _1 9_ 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 1 n - 32 S l c l� S • 9 Z - `f 2 r�t�`F — 5. 2r.�abk mfr s $ 3 10 r�tico -- 5r- * 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 �v �.�Pi - -� -- a�5 3 3G Address Date Evaluation Conducted Telephone Number 0113 �� w� S�Y�z -� - zz -oi %� Property Owner �O Ic, ya, Parcel ID # Page ? of 3 F-31 Boring # F1 Boring Q pit Ground surface elev. 95, 30 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /T in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 6 -16 1 3 2 5.1 2rY-v mr 15 V 2 kM� s g 30 F] Boring # El 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 /fF 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/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. SBD4330 (RW/00) PAGE 3 OF 3 NAME C o 1 nova LOT# Z S LEGAL DESCRIPTION Sw ' /4se' /<,S 33T3o N,R 18E (or) Nj r SCALE: 1 "= BM I ELEVATION l� BM I DESCRIPTION {op o k 2- L A e BM 2 ELEVATION q BM 2 DESCRIPTION Io o 2 • Dom 11 - 9 1 SYSTEM ELEVATION ALTERNATE ELEVATION cjs•�o X I CONTOUR ELEVATION q qo 9 S Yd - R 70•0d l a° • o a� c� ` M 7� e SIGNATURE DATE 'Z y cf Maintenance end 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 groases, garbage, and water conditioner discharge into the system. S. 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, determirm cause of failure, use alternate area and i nstall new system or Install system at a lower ekivafion. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715••246 -4516 Shaun Bird #226900 S'I' CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer H OVA 6 11 S _T_,v <_ Mailing Address - 70 00. C /�vQsu -v Lu = Property Address l 1 5 Y.> `�� (Verification required from Planning Department for new construction) City /State I eQ 9%d\M6'nd_ w Parcel Identification Number LEGAL DESCRIPTION Property Location ' /,, ' /,, Sec.7�, T N - R VT W, Town of R n k. Subdivision Y�) Lot It Certified Survey Map 11 . Volume , Page It Warranty Deed # ( �A , 3 Volume (� oZ Page It 6an Spec house ❑ yes m Lot lines identifiable �cs El no SYSTEM MAINTENANCE Improper use and maintenance of 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 wastewa ter disposal system is in proper operating condition and/or (Z) 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 days of a /ceear expiration date. GNATURE OP LI APP CANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owncr(s) of the property described ab VC, by virtue of a warranty decd recorded in Register of Deeds Office. IGNATURE Or APPLICANT DAT Any 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 (lie warranty decd r STATE BAR OF WISCONSIN FORM 2 .1998 4& ,1 1 39 WARRANTY DEED KATHI FFN H. WALSH Document Number REGISTER OF DEEDS ST., CROTX CO., WI This Deed, made between Kenneth L. Brown and Kathleen B. RECEIVED FOR RECORD Brown, Husband and Wife 04•18 -2001 9:45 AN WARRANTY DEED Grantor, and P. C. Collova Builders, Inc. EXEMPT 11 CERI COPY FEE: COPY FEF: IB&PAVER FEE: 828.00 RECORDING FEE: 10.00 Grantee. PAGES:, I Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Rccordinit Area Name and Return Address That part of SE I/4 SW 1/4 and SW 1/4 SE 1/4 Sec. 33— T3ON -R 18W described David I. Estreen as follows: Lots 1, 2 and 3 of Certified Survey Map recorded in Vol. 13 of 304 Locust St. Hudson, WI 54016 Certified Survey Maps, page 3698 as Doc. 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 3� day of April 2001 . �Keen�neth L. Brown �G�_ + 4 Kathleen B. Brown AUTHENTICATION ACKNOWLEDGMENT STATE OF Wisconsin ) Signature(s) St. Croix ) ss. County. ) Personally came before me this !3 day of authenticated this _ day of April ' 2001 the above named Kenneth L. Brown and Kathleen B. Brown TITLE: ME R A'T 8(�R OF WISCONSIN A Iz e .- , to mown to be the person(s) who executed the foregoing i ment and acknowledge the same. * y 06.06, Wis. Slats.) 7 r WAS DRAFTED BY Att e� ' avid J. Estreen 304 Locu5QSt. Hudson W 54016 Notary Public, State of Wisconsin (Signatures be authenticated or acknowledged. Both are not My Commission is permanent. not, state expiration a2 e: necessary.) 'Nunes of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM Nu. 1 - 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800- 655 -2021 518 /. ��" y r� t v I. ll` �� 1 �o /F, I I I a N 6Z' , �� - o� r ��- BS.ZO.ZO N � /�% I I N 1 �� C O Iy� M f � s� QQ N N V) c �n I O 1 L �, I m rn- 1 I I — ° n CV ! o� e C5 Q 1 I b o 3 N _ � � / rn N i N rl s w w t6 w c� v N. Q (n Q / O w CN O Na Q o `° o a° 00 Cti / � Jan U) � a' 6 •. a NO2 2' 31 W L / o / b'£Z l 6 11 ' IO / co Ui 1 /� '�� �..�t'.OZ.£0 y / �E / C } z o �Q LLJ LLJ �x O Q�w \\ 000 U m z ° Er O J 9 �m 3 � 6� / Q a e ZO 4 �,. E /�� / / I Q w i m w 2 v 91~68 O o ° 116TH 'J N TSTREET 0 Q / C Q S 00'36'40" °' d C\2 � i 0o�5£ 91.13 / C14 1 0) I W M a Q z w `L po ll V i W � 04 o w C3 9. x I cn O 1 oQ 5 S 6 U N ° I M w S/ \ CN F - 0 O Ut ^ 5 z a ° ,n� o D _I z Z z II F= O 0 I z 3 0 ALOLI W 0 J 0 J — 00 H �. (/) iv w p �0 � Z wv a 31 ^h. W z >- S w rn rn` ro / Z O W 0' \�� �I � 9 i� / no \N Z j �, cn Q rn ao o