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HomeMy WebLinkAbout026-1149-22-000 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division • INSPEC" tON REPORT Sanitary Permit No: 430121 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: Gustefson, Cara I Richmond Township 026 - 1149 -22 -000 CST BM Elev: Insp. BM Elev: BM Descri ion: Section/Town /Range/Map No: 3 . 9 3 , q 1 BM — 7i 36.30.18.1122 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Ll C1 1 Dosing Alt. BM f•. ST • C� V Aeration Bldg. Se �03�{ 5D�3 � �Z• 9 Holding SVH nlet ed a " 7 q . TANK SETBACK INFORMATION SVHt utLe(/�� s q p TANK TO P/ WE BLDG. VenjUo Air Intak ROAD Dt Inlet / / Septic , ► s� D B tto Dosing Hea r/ a 1 4 �d T b Aeration Dist. e _� a1 Holding Bot. Sys tl PUMP /SIPHON INFORMATION Final Gra de • q3 , (I Manufacturer Demand St Cover / GPM' ` tE7G Model Nu er 1 • S TDH Lift rict' oss I System Head TD Ft Forcemain ength ia. Dist. to well r SOIL ABSORPTION SYSTEM C 6t�y,2 BED/TRENCH Width r L Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I I b, , SETBACK SYSTEM TO PIL S BLDG WELL I LAKE /STREAM LEACHING Manuf to er• INFORMATION CHAMBER OR Type f System: 'S 7 O / UNIT r T / Model Number: RIBUTION SYSTEM Header Manifqld Distribution f x Hole Size Mole Spacing Vent to Air Intake / Pipe(s) Dia h S / > /� x Length Dia Length Spacing J f' �/ V 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 Bed/Trench Edges Topsoil -, 't `_ I Yes ,_ No J Yes ! =1 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /? / Inspection #2: Location: 1403 126th Ave New chmond, WI 54017 (SW 1/4 NW 1/4 36 T30N R18W) Torey Pines Lot 22 Parcel No: 36.30.18.1122 1.) Alt BM Description = ST ' Co C 2.) Bldg sewer length / _9 1-6 (4 f / n• L., _ - amount of cover l!J `t �S Plan revision Required? Yes No a O O Use other side for additional information. _ O I gi� Date ,,,,,,111 Cert. No. SBD 6710 (R.3/97) r v vv ,l r Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 15 X Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 266 -3151 Y -3012-1 • State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15,04(1)(m) _ __, Project Address (if different than mailing address) I. Application Information - Please Print All Informatio '^ ' " + Np3 17-6� /�Vts . Property Owner's Na me Ep i t Parcel # Lot # Block # Gc f,3a a z �- Property Owner's M ailing Address T Property Location 1 A, �k,Section City, State Zip Code Phone Number `rid (circle II. Type of Building (check all that apply) „a 5 �� ► T 2 Q N; R e or V l or 2 Family Dwelling - Number of Bedrooms S. Subdivision Nam CSM Number _❑.P.ublic /Commercial - Describe Use ❑ State Owned - Describe Use X S ❑City_ ❑Village ownship of ,'G III. Type of Permit: (Check only one box on line A. Complete line B if applicable) p - q - - 0 Z - CUD( 112-2- A. KNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System rl List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ,, Permit Transfer to New Before Expiration Plumber Owner i IV. T ype of POWTS S stem: (Check all that a ply) Non - Pressurized In- Ground ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (go) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) ystem Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab ite Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII, Responsibility Statement- I, the undersigned, assume responsibility for t llation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature 21 PRS Number Business Phone Number f Plumber's Addre ss (Street, City, State, Zip Code) VIII, Count /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I suin Agent Signature ( Stamps) Surcharge Fee) ZS (p Z O 2 ❑Owner Given Reason for Denial I ( 3 IX. Conditions of Approval /Reasons for Disapproval -f C — A) r 1 - r—""' A tad complete a onnty on y) Athe system on paper no less than x nc es n size SBD -6398 (R. 01/03) 1 D d u N �1 3 3 � I � � e D y �• %3 r � o 0 v p U D � N �1 i 3 e a 9 D , y b J : s Y1 Ofi Wisconsin Department of Commerce SOIL EVALUATION REPORT page I of Division of$afety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inch" in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Marcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please all /nq by Date Personal information You Provide may be used for (Prlvacj7 Fv s. 5.04 (1) (m)). /2 G>'O 3 Property Owner I r rly Location r"7 of W 114NKI 1/4 S (, T 3c'j N R I E (or Property Owner's Mailing Address [�j, L Block # Subd. Name or 2 ^ TO City S tate Zip Code Phone NuMWOU .t�E A ❑ Village Q9 NearelFt Road . ZPS kW` ES New Construction flee: [it Residential / Number Code derived design flow rate �.S �O o Q C, GPD ❑ Replacement k Public or oommercal - Describe: Parent material 1 Flood Plain elevation if applicable ,�J/�I 8. General comments SyS t W\ •e (-t• J • C(• O and recommendations: .� - e I ,e V - W 7 • 3•6 Boring # F1 Boring 1 Pit Ground surface elev. 4 13. 26 ft Depth to limiting factor _ in. SW Rate Horizon Depth Dominant Cob Redox Description Texture Sftcture Consistence Boundary Roots DAW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *0102 S�I 7- c `am lvC 2 - ^� S ;• �t w r � •o Coo 3 60 2 Boring # Bo w /h l xl, Pit Ground surface elev. 9 Z, 4 A40 ft Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. 'Etiifl 'Eff#2 2 k m C- C 5 • s 8 W - 1 - 101 10 ms D Wit �• L ' Effluent #1 = BOD > 30 < 720 mg& and M >30 150 mglL ' Eftent #2 = BOD _< 30 mg& and TSS 1 30 nglL CST Name (Please Part) S' 2 CST Number Address Data Evaluation Conducted Telephone Number r �� �v /Se zS /C�- zS - ocJ �i.S >zy� -�6G Property Owner ,,�_ Parce11D # � Page 2 of _ Boring # ❑ Bow ® Pit Ground surface elev. 7 6.50 ft. Depth to lanitirg factor 9 in. Soil Appl ication Rate Horizon Depth Dominant Color Redoc Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Or. Sz. Sh. i *Eff#1 *01#2 � U -I ( 1 L -- $i 1 Z c � v� • 5 Z —tai LS 1. Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor m. 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. *Ef1#1 *EfW ❑ Boring # Boring ❑ Pit Ground surface elev. ft Depth m Ipni6ng factor in. MEMMI Rate mi Horizon Depth Donant Colo or Red Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. fr#2 " Effluent #1 = BOD > 30 5 220 mg& and TSS >30 150 mg& ' Effluent #2 = BOD < 30 rng/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 60 8-266-3151 or TTY 608 - 264 -8777. SBD -8330 (R07/00) PAGE - �_OF NAME S LOT #a2 LEGAL DESCRIPTIONSw ' /avwl /4,S3(,T3y,N,R ISE (or) C SCALE: 1"= 7 BM 1 ELEVATION /�}Q • O 1 x BM 1 DESCRIPTION n C A: 1 ; n (9 j}(,J t, rlot— + BM 2 ELEVATION q 3• y 7 1 3(o BM 2 DESCRIPTION } p o � - I," (!Or, ch . + SYSTEM ELEVATION 3 • < i�O ALTERNATE ELEVATION 7' 0 CONTOUR ELEVATION q 3, Fw, gy. Y�, S• go �s S%o� x '1 2 V� U 0 —'► I � , i V� r Oikr- Qt a �•S �e 4P g f 95 0 pp out Ci SIGNATURE — DATE �� ��' — 0 CJ SEPTIC TANK & PUMP CHt' -M8 ER CROSS SECT10N AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE & WEATHERPROOF > 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT M 1 OCKV &R FINISHED GRADE WARNING LABEL 4" Cl RISER #,,.,_ MIN. � at 18 IN. 6 " MAX. ' NLET t WATER TIGHT SEALS GAS• ' TIGHT PPROVED A SEAL { JOINTS WITH �- ALM APPROVED PIPE a PPROVED B r ON 3' ONTO IPE 3' — f'"" , SOLID SOIL ri1T0 5(}LIO C ** RISER EXIT OIL PUMP OFF ELEV . FT • --" OFF PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS_ SEPTIC / DOSE TANK MANUFACTURERS ','e Y NUMBER DOSES PER DAY: TANK SIZES SEPTIC _Zgakf - GAL. DOSE VOLUME INCLUDING DOSE ! GAL. FLOWBACK: io GAL. ALARM MANUFACTURER: ,� �$l� � � CAPACITIES: A = �.E._ INCHES = GAL, MODEL NUMBER: 12 y B = 2 INCHES = - yi2 GAL. SWITCH TYPE: meYc- PUMP MANUFACTURER: 6, C = $ INCHES = L GAL. MODEL NUMBER: Z� e D = INCHES = _ SWITCH TYPE: REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER I LHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . .,.. FEET ♦ MINIMUM NETWORK SUPPLY PRESSURE . 4OW FEET . • � . ��. FEET + FEET FORCEMAIN X �• FTI100 F TOTAL I DYNAMIC A HEAD �- l3 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH,_„•,__,_; DIAMETER LIQUID bZPTH - __..j�Q_..__ , �1 0?�79 - DATE SIGNED: LICENSE Iv�t.1MBER: - ------ 1/88 Submers Effluent Pump t 387 EPt4' EP05 APC fl • hs�enera; 303 series + Fu31 sub merged in t+ipt► i i cr 4Nw Cast iron Aft wrbine OR for fore fdrrrt h tnmster, �t • { of nmmp dt end N�doc►t strettiptlt ehd+dttrab�fly. � SO dtmape to i� �Cor� Thtrmoplas- he8t trsnsfet. With irlwo hkAlt compwer , t1 Avoll" I V f"YY igh �t Fun MOW a a N omwomu p er, EM S hale. 0,4 HP d 11 or W V, 60 H& 1530 M g �a�uab�lal u�l w �r Cliff: %Are duty R PM, buil in overlced with 0� �� rabd d end w�terrssrdtaot. autaft mat ,.......... 115 V, Ni,155Q RPM, RfJt — �WL ball baft p1m: wo bulgy r with g gM Impel*. Then- + Safe WOO V; pike W-open dwP AUG u1no Ile mtdmum, + Pow cord: 10 foot wdh pip " Woes for oe — • coodet up to 56 GPM. etsndend WO . 16/3 SJTO mecfw kw of pm"on• ' es l • TOW tbeds: up to 34 w2h bu Arorq g ■ W. Thermo" DWft Nat, t'h" t�A't', plug. Opt+orml 24 foot c eamW dmtign for end kW r "A T numbers ripth,16J3 SJTW whit eel !rt "g" Or "AC.g l9 � Mec�lt 1te1: can { throe Qroundinp plug mproved pruiorsrstu+ee. 9UNA -N A t4mers. ;= on EP05a. • end Bopped T thermopiaabc design provides 1 V) sinuous supfrior strorsr and 1411 (WC) ftmift, corro�on ne�ce. . FMW. 300 WW MMAS PUT • of rim ming dry wi�out dw*6 to a so + hlr►dllnp 01014: o 7 , • :up to60 GPM, ' a s° i • ft up to 31 feet, • The M o e i 1 V` NP'T. ! — S � • W.: WWII. l�l��a�etestornsrs• m ' ( ` 3 r +; 4 Y 3 t0 I 1401 .�t30'G� k1lor nt. 1 oL ..! mom "men f3I= d &A" D MAC pate_ OYf m" feu. 1091 t)3 1.`03 XoN 14:45 FAX, 71" $6 W44 ST CRT, (:tl ZG:" NG powT$ OWNER'S MANUAL & MANA6�E1lAEi��' PLAN t�,qs � of 2— ,�Y liY SFrEi`.liiCATWM6 Owner � � �o a Swc Tank Cawkry �d l 0 NA Permit i Septic Tank ManufaatulOr , a V D NA Effluent Filter mwwfsatw•er Z o X e- O NA Number of 1I14drac ra 3 0 NA EffkW* MW Modal ,� led C NA Aiumbar Of Pt PA ft FSWlkY Unite D KA "p Tank Capacity Eatirrtatad flow (ever"41 Y :5 D Pump Tank Manufacn"r GJ- `C,�e 0 NA Design flow (peakl, (Eatimated x 1.5) �l5 t3 Pump Manufaaturar / D NA Sold A►ROW;w Data 1 7 Pump M*del epO 1 l O NA in NA Standard influerweffitrsl" Quality Monthly avorW* Prevastment Unit F aft Oil A Gram lFOG) 530 mg/L G SandAlravel Filter 0 Per FRksr )lk*j rniaai Oxygen DWW4 1800sl sZZQ rnWL k NA► LI Macnenioa! Aeration O W*tiand TOW n fpla►dad Sollds (TSS) $1 50 rng1L O Disiltfa0ldon f0 Qther: Pretested Bt W4 4,�U&Y Monthly average DI*PWW Califs) ®tVA, 8la0hart ICA Oxygen Ownanci is000 M motL 4"rou"d tgr Wkyl O ln.t3MUM (pressurized) Total IBuspanded WWo tTSS) 00 mg1L I�dSIA 0 Avl1rade 0 Mowd Paw Coftrm lgeornatft Mann) I x10" afuf100nti a Drip" C! Other; Maximum effluent Particle RED Y in din. D NA C NW 0 N A 0 NA "YslWa tyOloN irX dos ww wastawasar end *alpha tank •Tfluant. �tlwrs O NA §CtWDUL1l SWAN fevwA l;MVisa Igr+4wnsY "mm oonon of UAWS) At keg #vary: 3 tNasdrrtua+ 3 yaae) © NA d'di PLOW ctrl oorrtarrtdf of tank(s) wh wmbkas sludge and auum "unit aetrthird IV of tank vokune G NA tn►Naaat call(`) At lseet *me ovary: 3 "O"rnontl+fal (Maximum 3 years) ❑ NA rtw d NA. Clean effluent Mw At tene once evwvw :2 - 0 NA Ingo of PWW, Rums oontrals $alarm At ieaat ono# ovary: N 01m ar m Fluush §W& And pressure tarot At least once every; O M NA is At least once every: O NA r: a NA MARITINAAM WWRLICrioNs waRaatlona of tanks and dispersal Cells $hall bs mjW,@ by an individual carrying one of the following fioanNa of oert�cst �' Mentar Pkar6w. Master Plumber ttlestzicted $*wet; POWT'S Inspector( POWTS Msit+tainw; UPtW t{larvtain0 ppwatar. Tank impactions `trust inch a visual insoacticn of the tankful to identify arry missing et broker'` hmdw w% idanitlfY AMY 01 O' leeks, n+raeurs the volume of awnbined dmdip aril scum and to check for am back up Of pondino of sffkwrtt on the Qrortnd 8urfaae. The dapsraai coiner) shall be visually insWtsd to cheok the affluent lavala in rho obwvatior► pipes and to shack far any ping of offluant our the ground surlaoe. 11* Domhr6 of affluent on ttm grouted surfeco may Indicate a falling ccndtdw and MQUiras the wwddatts rx"icedw of the local repulatory au wrhy. or mom of the tW* vok*m, the emir* When the casnbined accumularaon of *kxtge and *earn in any tank equals an isod (Y,1 osed of ire aoaardana vM chapter Npt 11 S, odntaMS of the tank slate tern ramoved try a Septage %witig Operator and disp Wiseansin Adtr!rinistrrttive Coda. Ali atuw aewlim, Mwluding but not WOW to the servloing r f efrfuant tlitsm. mechanical or presstrrlsed �anSX ts, pcertrantmartt unl a, and any wryiaing at intervals of 612 mamhs, snag be tawfarrttad by a cer tified POVYTB Maintainer. A aarvioa report shill be provklad to Of 10041 NgulatWY authority within 10 days of eNnpietion of any sere' M "ant. p� � 31'03 91t3A 14:25 F3FAX : 13 386 4QkB ST CRL co ZCNI\ 'y STAVIT UWAND tj5RATM ate or other otuernioa►s For flaw eon uodon, prior to use of the pOWTS dmak treatment tonic(*] for the presence of paintiM Pr*& that may irrtpeda the Sr'$attrlent prow$ and/or damsae the dirgse►sa( caiita ?. If high oanoentratl4m are detected have the content« of the ten si rwwnd by a spume servicing operator prior to use. Syatartt start up SW not occur when evil aondhWe we frown at the infilt»tiva sudsee, Cu" powar mum pump tanks may fib above normal highwater Wall, Who: power it restored the exoee$ w astewater will be dleoharped this ditpers$i call(:) In one tame dose, ovaioadir#9 the osllis) and may result in 6 the v bac up s � it to restoring ems. To 6"W this 41huation have the contents at the pump tank ►arno'ved by • 8ep' aC *, pump controls to Power to the a�ffkWd pump or *Won a Plumber or POINTS Mauttainu to seek( in manually Operating Mere AeM1aI level within the purnp tank. Do not d*s or park vehicles over tanks and di$p$rsa] *60- Do not drive or Park aver, or othanniee disturb or oamPaat, the wee whW 1 if feat dorm slope Of any mound or at grade soil absorption arse. Reduction or adminsdon of the following from the w*steM►etlri' $tream nosy irr►prove the perforrnaACe and prolong L 114 s, the POW": antihio+tiae: baby wipes; clgarette butte, eortdorne% cotton swabs, de"asera% dental floes; diapers% mad is irons c oil; foundation drain (au►np pump) water; fruit and vegetable peelings; gasaih % grease, herbicides; meat SOM"% painting pro&=, paetioides% sanitary napkin; ternponat and water Softener brans. Ai3MMONi fT yylydn th MO1NTS talks erxilor is pennenently taken out of service the following steps she* be taken to inauro that she ayscem Is pfcoidy and oaf* abandoned In compilanae with chapter Gomm 63.33, VltMsoo:<eir+ Adrnl^istreRivs Code; e Ali p]pkta to tanks and pit$ shall be disconnected and the abandoned PIA$ epft$ ees(ad. e The aorrtents of all tanks and pits shall be removed and propuly disposed of by s SaptMe Servicing Operator. e After ptrrnping, all tanks and pits Shall be excavated and rernovid or their eovers removed And the void apace filled with sail, PIwd or WMther inert told material. CONTWIGIGNIM PLAN if the POWTS felt and nmot be repaked the following Musures have been, or, must be taken. to provide a code compliant f or the loos * sultsbte repisoement aria has bow evatttated and may be utiiir,ed ,d f ehould not "ad y System. The repieoement ores should ba protscuW from disturbSnoe end oasipaodon orbs will required setbacks from advOW and Proposed struetura, lot lines and we"' WW" e � � system moat Me* in the need fora new �soll and &its evaluation to establish a eultable replaasm$ nt sc arne eow4W with the rules in West at Mat tiM0, _ E3 t su t frays no ttsli a eb trait:rtBetbap�kianatheidlsdlF'Q setting advances in PAW'f8 and she Q tank D Mound and at Wide sell Wwrption system may be reconsttueted in Alaao following rafriovel Of tr+e bigr^at at the infilUstve surface. Rsconstruadone of such systems must comply with the n.Ae$ in effect at that time' -c <WARNM> a T 0 Y LT. aFtQtEN. E8Ct7E DON O1t T (dill ill Akin? OTHER TREATWMT TANK$ MAY CONTAIN LETHAL 8 ANIDIOIt UFM MAY It 1lACyMR INIIM A 00rM. PUW OR OT}MR TtilEATM9NT TANK UKIXR ANY CIi1IMM&TANCtoti. OiEATtI pOWN MM Ti1M WfWO OF A TANK MAY U 111IMC ILT OR OAPOUM• SU n ffli r A� pours M►►ihralwri� thou pitos II" OPIRATOFI UMPM LOCO L WOULATORY AUTHORITY /lv M L Ihone 5. 3 This dovime was drafted in �om 1,41 a with ohapter eat*rm 83.22(2104(1I(dl&M crud 83.644 (21 o (.91 W►aoarain Admen "t" Cpcia- I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM 4 O 'OwnerBuyer . r p Mailing Address o t /l.'Ueer `ls /'o,'S�/o 1yQ3 ue- r Property Address (Verification required fr Planning Department for new construction) City /State Parcel Identification Number LE GAL DESCRIPTION Property Location - t`A, ✓V�cd t'A, Sec. 3a , T Yd N.R 19 W, Town of 4P %mil+ �'•��� Subdivision _ To's�C V;rJeS' Lot # �Z Certified Survey Map # , Volume , Page # Warranty Deed # Y , Volume �� , Page # 09 Spec house 0 yes no . Lot lines identifiable (Kyes O 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, joumeyman plumber, restricted plumber or a licensed pumper verifying that ( I ) the on -site wastewaterdisposal systcm 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 I/we, 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 Depanment of Natural Resources, State of Wisconsin. Certification stating that your septic systcm has been mauuauud must be completed and returned to the St. Croix County Zoning Office within 30 d s of the three car expiration date, SIGNATURE OF APPLICA DATE OWNER CERTIFICATION I (we) certify that all statements on this form are tnrc to the best of my (our) knowledge.. I (we) am (are) the owncr(s) of the operty describe above, by virtue of a warranty deed recorded in Register of Deeds Office. to . O SIGNATURE OF APPLICANT DATE 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 the warranty deed J 2 2 8 1 P 0 8 5 726443 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Ames Investment Corporation, a 06/18/2003 02:00PN Minnesota Limited Liability Company WARRANTY DEED EXEMPT # Grantor, and Cara L. Gustafson and Anthony C. Rubis, both single REC FEE: 11.00 persons TRANS FEE: 119.70 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Return Address Lot , Plat o Torey Pines II in the Town of Richmond, St. Croix County, �S Te—. l3w,,IL Wisconsin. a01 S. ca S-t. 026 - 1149 -22 -000 Parcel Identification Number (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of June 2003 yAmes tv— '14)� AUTHENTICATION ACKNOWLEDGMENT . Signature(s) STATE OF WISCONSIN ) ) ss. J� County ) authenticated this day of Personally came before me this 1A day of June , 2003 the above named Ames Investment Corporation, a Minnesota Limited Liability ' Company TITLE: MEMBER STATE BAR OF WI (If not, .( to me k wn a the person(s) w o executed the foregoing authorized by § 706.06, Wis. Stars ins ant acknowled s d i'�• �. < THI5 INSTRUMENT WAS D � D Attorney Kristina Ogland d" ti Notary Public, State of isconsin Hudson, WI 54016 v' .: "°•"' My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both bt.+4et nary.) ' Names of persons signing in any capacity must be typed or printed below their signature. information Professonals company, Fora du Lac, wi STATE BAR OF WISCONSIN 800. 655 -2021 WARRANTY DEED FORM No. 2 -1999 LOT 24 : CD }I 2.019 ACRES (87,966 SO. FT.) f I S 810 5 , 40w E 417, E i dOO 4 �3 P�Q4 : i o LOT 23 g N ' � 2.027 ACRES (88,314 SQ. FT.) .. . . I . I D I / Na89°31'46" E 330.00' 9' t X46- E r60: �& 33.W 297.00' 457.19 740 313, p — TOWN ROAD E�EVAnoN =1020. N 89°51'46" E 9 O Z . —. s 7. l Z R O ATER RETE ?2, I IN N AREA ro 1 _ iG7 ri 5 ' � H.W. - 1006.0 .......... ...... .. . r . . 14 I a g ; , LOT 22 ...... 4 y� ACRES (72,052 SQ. FT.) N f �...... . 1N m m LOT 20;f............ z i� _ 340.00 L 2.489 ACRES (108,433 SQ. •FT.). I o w i ........... i ............ T se�°a�4001W 3�3.Oa � ........... N S , � ........... MIN FFE = 1009.00 ........... . . . J 6e I o �� I Z OCR QOG3C��I POI�IC� ------ - - - - -� W \\ avt co) � . 1 4 LOT 21 a 3.745 ACRES (163,117 SO. FT.) Q MIN FFE = 1009.00 104 9 s 4 � ©C� 40G�L��'I IP�fiv1C� x I 30 DRAINAGE EASEMENT .a I j I SOUTH UNE OF THE NW 1/4 1/ 474.76 tE ON 36 t M HM A44CEU 1AHIM co