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HomeMy WebLinkAbout032-2128-60-000 r � Wi.:onsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division 9t. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitatv_g pj No.: Personal information you provice maybe used for secondary purposes [Privacy Law .15.04 (1)(m)). SttSS yy �' LL P rmit Holder N e: ❑City [] la e o of: State Plan ID No.: N I�ai 'ian V 9 oM se CST BM Elev::- Insp. BM Elev.: BM Description: Parcel T x N .: 10 t IUD , ID / I Z-u,� 052128 -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic FF I 6 Benchmark 1.? C(' /Ot t ,D Dosing It ' Aeration Bldg. Sewer r Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. V take ROAD Dt Inlet Septic 3 5b r cZ :7 / NA Dt Bottom • Soo I Dosing 11 ` `' 34 1 NA Header / Man. Aeration NA Dist. P' Holding t. System 9s, PUMP/ SIPHON INFORMATION inal Grade V . Manufacturer /�0�' Demand " 1• /q Model Number yyII15 D 7 -' -7 GPM ` TDH I IOFt , g'7 Friction System TDH Lift( I I S !� / Fi Forcemaln Length t Dia. Ztf I Dist. To Well 7� L— SOIL ABSORPTION SYSTE cW TRENCH Width / I Len th No. f renches PIT No. Of Pits Inside Dia. Liquid Depth D IME 3/• 3 DIMENSION Manu act rer SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING INFORMATION Type r I CHAMBER Mo Number: IL System: (.0ntl.I (7 acc DISTRIBUTION SYSTEM �ro . n Pi s x Hole Spacing Vent r Intake Header / M Distributio Pipe( s) Length 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 Bed/ Trench Center 3 ' / ' Bed /Trench Edges Topsoil ❑Yes No Yes ❑ No 640 J / CO MMENTS: (Include code discrepancies, persons present, etc.) (o Z of Location: 1637 52nd Street, Somerset, WI 54025 (NW 1/4 SW 1/4 9 30N R19W) - 0930191148 Wagner Estates -Lot 20 s t , �� • �r 'Y 1.) Alt BM Description ` 2.) Bldg sewer length = 30 amount of cover 3) PAOj�7 04 94 Plan revision required? []Yes No fir) s n4 `A / Use other side for additional information. bb SBD- 6710(R.3/97) Date Inspector's Signature Cert No. Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 14scons Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 i nches in size. County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number I. Application Information - Please Print all Information Location: Property Owner Name Property Location ? CL Q 0--- 1 () �JL� U— fv — Q N N,, J /4, S T Qr`l, R E (or) Property Owner's Mailing Address Lot Number Block Number 3 3 z; ao City, State Zip Code U ( hone Number Subdivision Name or CSM Number s)Z- 6s) -7 hone H. Type of Build g: (check one) ❑ Ci '$P 1 or 2 Family Dwelling -No. of Bedrooms: � D �Gt yl ❑ Village ❑ Public/Commercial (describe use):_ � 'Kown of s � ❑ St -O Ja a Y� Nearest Road Parcel Tax Number(s) © i\ 13 Zs- (op_ III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) p 1 ' 1114f A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing Syste B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) on - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other V. Dispersal/Treatment Area Information: ro s 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Applicat n 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed U99.14(o Rate (Gals. /day/ q. ft.) (Min. /inch) Elevation VII. Tank Capacity in Total # of M ufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks -) x 1:1 0 ❑ ❑ v VIII. Responsibility Statement I, the undersigned, assume r esponsibility for installation of the POWTS shown on the attached plans. Plumb 's Name (print) Plumbe gnature (nos ps): MP/MPRS No. Business Phone Number Plumber's Address (Street, City, Stat ip ode) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) 1 Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination ZZ�"a X. Conditions of Approval /Reasons for Disapproval: -fir• . Q¢5 • Zbv(rl� « � �iop��l�cr�Y1. G Ko 44 vkdl Y�a[ OG[ ccti %'� �h e ote4 VJe- -45 Ce5 ltd WK d"— x, wyd 1� � - S� -p�rz ., ,E - --� K a,w SBD -6398 (R. 07/ ) 4 e P1 l�k ' P T PLAN PROJECT Nathan and Diane Neuman ;" DRESS 3563 Bailev Ridae Dr. Woodbury Mn 55125 NW 1/4 SW 1/4S 9 /T 30 ' / W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/24/01 BEDROOM 3 CONVENTIONAL XXX IN -GRO RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 LIFT TANK SIZE600 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 643 # of chambers 39 IL BENCHMARK V.R.P. Top of electrical box ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.0 Alt. BM Top of Telephone Box @ 100.2' Plans Designed Using Alt. Conventional Powts 45' Pro Town Road 240' Manual Version 2.0 B.M. 5 6nts 98' 97' 96' B3 550' 15% Slop 6% o .dd Slope 0 5 3 -3' X 82' 90 Cells with >3' E o a Vent Spacing 0 o � B- > 12" Sidewinder High Ven of Cover Capacity Leaching Chamber 10' -2 6' Long 16 0' 34" Grade at System Elevation 15% Slope 45' 40' wed (51 1 �G / �,► s 30' -, w--.ef Tested Area is on a Combo Tank Pro 3 5c-- („" (�� �� u rr ••.s Be droo m plateau shape P r N ff hilltop 187' Property Line i�, SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SpE;IFI — k" Cl VENT PIPE 1 2 +' MIN. ABOVE GRADE WEATHERPROOF 425' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W1 PADLOCK S FINISHED GRADE WARNING LABEL p "µ'in. u" MIN, 4 C.Y. a�gi,Y pm �Ya nf t � t8 M4N INLET ' ` GAS- WATER TIGHT SEALS ' � TIGHT � � PROVED P1 LTE.P, -� --+� A SEAL JOINTS WITH APPROiIED B ALM APPROVED PIPE PIPE 3' "F" ON SOLID SOIL ONTO SOLID C i SOIL PUMP OFF ELEV . FT. ---- OFF Y..` D 9" APPROVED BEDDING z ONC £ PAD SPECIFIC l SEPTIC / DOSE IJ / TANK MANUFACTURER: l Lt`s k± NUMBER DOSES PER DAY: / Oti bC�r °rx 1rs 1 s TANK SIZES SEPTIC /bd GAL. DOSE VOWME INCLUDING GAL. DOSE o _ GAL. FLOWBACK: ALARM MANUFACTURER: ,��r r. u y� ^ ^l CAPACITIES: A =c:- iNCHES c 3 y�GAL- MODEL NUMBER: ID d g 2 INCHES = �? v GAL. SWITCH TYPE : PUMP MAmurACTURER : (r'� r`` • C = S INCHES 2 MODEL NUM : L '`'(- SWITCH TYPE: r D = INCHES = GAL. REQUIRED DISCHARGE RAT a S GF�S PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE SETW P OFF AND DISTRIBUTION PIPE . Ion- FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . • . . . . . • !+ FEET + FEET FORCEMAYN X * /� FT /100 FT. FRICTION FACTOR . FELT TOTAL DYNA HEAD /= FEET ; wlDj INTERNAL DIMENSIONS OF PUMP TANK: j" DIAMETER LIQUID � . 1 -4 6 _ �._._�.... 1 SIGNED: LICENSE NUMBER: C "C�-m e SATE: Z / —2— 9—�� 1/89 3 �(N tF� 4 1 , Engineering Details - SHEF40 Performance Data 40 1 30 Pump Characteristics Pa Mora Ut Sdtwers& 1Z 20 Maeuol8lodds SHEF40MI I SHEF401112 3 Aoftm k IMAM SHIF40AI I SHEF40A2 10 r 4/10 I'd Lad AMPS 12 1 6.5 Motor Type Shaded Pole (4 Pale) R.P"M" 1550 10 20 30 40 50 60 10 PhM 10 GPM Vahop 115 1 230 Total Head (feet) 10 1 14 17 21 25 28 30 35 Hats 60 _Tew ere 120 F tllax. Ftuld Tea (n+) 3.0 4.3 5.2 6.1 7.6 8.5 10.7 NEW Dul A GPM (US. GPM) 70 60 50 40 30 20 10 0 hs&du Class A ( rs /sec) 4.4 3.8 3.2 2.5 1.9 1 1.3 .63 p4dwjp She 11/ NPT Dimensional Data t sold: 3/4' WdW 28 Bts. 42 98 (.} sa /8 "—. — ere° ( +es.z� 1. All dimensions in inches. (Metric for Pewer Cord 18/3 SJMf 20' std. 5" (12� ittternationa( use). (30' eptlowd) 3 8.42 2. Component dimensions may Materials of Construction `' vary 11/8 inch. H41& Stddess S L4W DISCHARGE 3. Not for construction purpose LWykatin Of 011 (98.42) e1 1 - + /2" NPT unless certified. Moron Hoyft C 1t Iroe — w----- OAT 4. Dimensions and weighs are Pun t Cost troy Shaft Sleet approximate. Maknw SW fum Cwba /brwdc 5. We reserve the rig to make shaft seal Sod Wr. A"ed Steal revisions to our product and their Sp k ra -N Iw Statdes: N wsr specifications without notice. Iw Cud Braze Sleeve Bear 11 �° Iayls° (288.92) (258,76) Lower Row Bd 11w briaw Plaro Coated Steel steaers Staides$ Steel t92.o�) Legs FAgW Bred Nc 2' (50 ) O C m J 1998 Hydrootic" Pumps, Ashland, Ohio, All Rights Reserved. Flf � HYDROMATIC a - Your Authorized Local Distributer - 1840 Baney Rood Ashland, Ohio 44805 tel: 419.289.3042 Fax: 419 - 281.4081 Web Site: www.pentairpump.com $ACES OFFICES IN ALL MAJOR CMES AND COUNTRIES "" Rd r f■ "Pumps" M the Yellow pooaa of Year phatra dtnctory for year (oral Distrrb uW _1 UwnF W O? -6680 1 199 3M 1 t 1 [ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of DivisiGn of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County c e Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must J 1 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.O. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 01 . il�� I �& Property Owner Property Location Ci N + ) �� h l� Govt. Lot /�1i� 1/4S /4 S T >U N R J E (o W Property Owner's Mailing Address Lot # Block # Su or�C City State Zip Code PhontAumber ❑ City ❑ Village Town Ne rest Road New Construction Use esidential / Number of bedrooms Code derived design flow rate S U GPD ❑ Replacement ❑ Public or commercial - D scribe: Parent material C`� �i; /ns Flood Plain elevation if applicable General comments— // and recommendations: 5V / �4, _ � t uCti'r — I s . 0 F11 Boring # E] Boring � E] pit Pit Ground surface elev. G1 Q 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 I *Eff#2 Boring # ❑ Boring �. Pit Ground surface elev. ft. Depth to limiting facto 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 , a to �v * 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 N m (Please Print _ Sin re �J AST Number C OC b/ 0 Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner Parcel ID # Page of © 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 a 16 z o r sl el lrn 4 , a 3 Boring # ❑ Boring © r / Pit Ground surface elev. D 1 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 1 Al) Boring ❑ El Boring # Ground surface elev. ft. Depth to limiting factor in. Pit 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) ` Soil Test Plot Plan Prdject Name Nathan and Diane Nueman Shaun Bi Address 3563 Bailey Ridge Dr. Woodbury Mn 55125 CS #226900 Lot 20 Subdivision Wagner Estates Date 4/24/01 N W 1 /4 S W 1 /4S 9 T30 N /R W Township Somerset n Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Power Box System Elevation 95.0 *HRp Same as Benchmark Alt. BM Top of Telephone Box @ 100.2' Alt 45' Pro Town Road 240' B.M. 5' 98' 97' 96' B 3 40' 15% 550' Slo 99' 6% Sloe c 5 ' 90' a� H o ° B- -2 10 ' 0 ' 15% Slope 40' Tested Area is on a Pro 3 plateau shape Bedroom hilltop House 187' Property Line 1 ;Wisconsin DepartrnentofCommerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and loca0io a tgzhstenge to nearest road. Parcel I.D.# APPLICANT INFORMATION - P /ease ff mformatfon:" 032- 2035 -10 ID#9.30.19.607 you p y od�ryp rpos jjvacy Law, s' S5. m Reviewed By Date Personal information u rovide may be used fors u es (1} ( )). Property Owner._ grope Location Gaylen Schilling, Bu er: Greg Joh "son` TLBloc NW 1/4 SW 1/4 S 9 T 30 N,R 19 W Property Owners Mailing Address �- u k # Subd. Name or CSM# 498 150th Avenu Plat Of Wagner Estates City State Zip bode PhoneNufi �r Village ZTown Nearest Road Somerset WI 540 Somerset 50Th Street ❑ New Construction Use: ❑ Resident* NNumbef of 4edr' s 4 ❑Addition to existing building [] Replaceme n t Public or commerOhatdBsc be ❑ Code Derived daily flow 600 gpd Recommended design loading rate •5 bed, gpd /fF .6 trench, gpd/ft Basal area required 1200 bed, ft' 1000 trench, ft' Maximum design loading rate .5 bed, gpd/ft .6 trench, gpd /ft Recommended infiltration surface elevation(s) 101.0' at 12" above 100.0 contour. ft (as referred to site plan benchmark) Additional design / site considerations Parent material Glacial till Flood plain elevation, if applicable NA ft S- for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system [IS M U ® S❑ U ❑ S U ❑ S® U EIS R U ❑ S M U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ftz Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consisten Boundary Roots Bed Trench 1 1 0 -11 10yr3 /3 None sil 2 msbk mvfr as 2f,1m 0.5 0.6 2 11 -16 10yr3/4 None sil 2msbk mfr cw Ifm 0.5 0.6 Ground 3 16 -22 10yr5 /4 None sil 2m mfr gw - 0.5 0.6 elev 98.91 ft 4 22 -35 10yr4 None sil 2msbk mfr cw - 0.5 0.6 Depth to 5 35 -52 10yr5 /4 m2d7.5yr5/8 sicl lcsbk mfi - - 0.2 0.3 limiting factor 35" Remarks: Horizon #2 is a mix of horizons # 1 & 3. 2 1 0 -9 10yr3 /3 None sil 2msbk mvfr as 2f,lm 0.5 0.6 2 9 -16 10yr5 /4 None sil 2msbk mfr cw Ifm 0.5 0.6 Ground 3 16 -21 7.5yr4/4 None sicl 2msbk mfr gw - 0.4 0.5 elev 100.64 ft 4 21 -28 10yr5 /4 None sil 2msbk mfr cw - 0.5 0.6 Depth to 5 28 -34 10yr5 /4 f2d7.5yr5/8 sil 2msbk mfr cw - 0.2 0.3 limiting factor Yr � 6 34 -48 10 5/4 m2d7.5 5/8 sil lcsbk mfr - - 0.2 0.3 28" Remarks: CST Name (Please Print) Sig ure: Telephone No. oe James K. Thompson 715 - 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceo a, Wl 54020 5/8/00 3602 1239 PROPERTY OWNER: Gaylen Schilling, Buyer: Greg Johnso SOIL DESCRIPTION REPORT 1239 Page 2 of 3 %RCEL I.D.# 032- 2035 -10 ID#9.30.19.607 A.C.E. Soil & Site Evaluations Horizon Depth Dominant Color Mottles Texture Structure �o nsistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -10 10yr3 /3 None sil 2msbk mvfr as 2Qrn 0.5 0.6 2 10 -17 10yr5 /4 None A 2msbk mfr cw lfrn 0.5 0.6 Ground elev 3 17 -22 7.5yr4/4 None Sid 2msbk mfr gw - 0.4 0.5 99.08 It 4 22 -25 10yr5 /4 None sil 2msbk mfr cw - 0.5 0.6 Depth to limiting 5 25 -35 10yr5 /4 f2d7.5yr5/8 sil 2msbk mfr cw - 0.2 0.3 factor 25" 6 35 -52 10yr5 /4 m2d7.5yr5/8 sil lcsbk mfr - - 0.2 0.3 Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: 3 P, A Va � � ?� Plc. o-1 (�ne/ �s fz�.�es , ` ■ � T . aF `�►rnr'.se� 56 „��o iX Co � c�.� /. 1 1 1 B ■ � / i r i Co.-+-&Oar ■ n � i /�rapose_d �i osl 5�f0.1p5� 95. o /' A Acs B. 7 barn �our�d« -fQo,� . E/e t! = 95.9 tr�'SL'aI encc /. "ne Barn 8ena4.hnarK: �'!u; /;,, BexcE✓a��ee• rye 0 /AS? i 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. 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 '! ro 1� P - rn�o e � - d� c 6 -�Y Shaun Bird #226900 I ST CROEK COUNTY SEPTIC TANK MAINTENANCE AGREEMENT' ANA OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Z 3' Property Address r- (Verification required fi-om Planning Department for now construction) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location , l /,, �/,, Sec. �, T�N•R—Z/ Town of i r Subdivisions Lot # Certified Survey Map # — Volume . Page # Warranty Deed # Volume . Page # Spec house ❑ ye no Lot lines identif �es ❑ no SYSTEM M'�'tyety Impropor use and maintenanceof 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 fhactioa of the septic tank as a trcatmteat 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. restrictedplumberor a licensedpumper verifying that (1) the on-site wastewaterdisposal 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 bees maintained must be completed and returned to the St. Croix County Zoning Office within 30 da f the year exp date. S 3NATuRE OF APP DATE OWNER CEBMCATIOT I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr erty de abo , by virtue of a warranty deed recorded in Register of Deeds Office. po 0 OF ICANT DATE * * * * ** Any infotnation that is mis- representedmay 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 VOL 1 3 2PAGE 3 - STATE BAR OF WISCONSIN FORM 2 - 1999 � :34 WARRANTY DEED KATHLEEN-H. WALSH Document Number REGISTER OF DEEDS ST:- WCROIX CO., WI This Deed, made between Nottingham Development, LLC, RECEIVED FOR RECORD byGreg Johnson, its sole member, 05 -03 -2401 3:15 PN WARRANTY DEED Grantor, and Nathan K. Neumann and Diane D. Neumann, husband EXEMPT # and wife, CERT E: 0 IN E AGE• Grantee. !'tD 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):' Q �A01 ST CFk)IX /f Recording Area r >�\ COUNTY ZONWN Lot 20, Wagner Estates in the Town of Somerset, St. Croix County Name and Return Ad e Wisconsin. 'Ri i 6&Goh I w4 s o1 b 032 - 2128 -60 -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 May 2001 in ham Develo me LLC * * Greg ohnson, i e me ber * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Nottingham Development, LLC, by Greg Johnson, STATE OF WISCONSIN ) its sole member, ) ss. County ) authenticated this" day of May 2001 Personally came before me this day of Lam-- the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. information Professionals c ompany, Fond du Lac, Wl 800-655.2021 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 o La M to • • W LO ha . 6t - ft CD :i:.:.:.:.: N ro .::::• ::: :::. 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