HomeMy WebLinkAbout032-2145-40-000 Wisconsin Dep ,ment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
r 420784 0
GFINERAL 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:
Hin er, Pat I Somerset Township 032 - 2145 -40 -000
CST BM Elev: Insp. BM Elev: BM Descriptiop ' Section/Town /Range /Map No:
(�Q` d o 13.30.19.1266
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
bo
Dosing G W A Alt. BM !�'T J q1-33
Aeration Bldg. Sewer i
Holding St/Ht Inlet SCE(
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic > 1 / Dt Bottom
Dosing u Hea Man.
In
Aeration Dist. Pipe l
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION t'`
Manufacturer Demand St Cover
GPM
Model Numb
TDH Lift ' t' oss System Head T Ft
Forcemain Length DI Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Le h) �� No. Of Trenche� PIT DIMENSIO No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3
SETBACK SYSTEM TO P/L BLDG WEL L, LAKE /STREAM LEACHING Man ufa re .
INFORMATION Ty p Of System: e CHA UBER O I I I
>20 \ / f ` del Number:
DISTRIBUTION SYSTEM / "tJ
HeaderlManifold Distributior 2 :� I x Hole Size x Hole Spacing Vent t it In ak' /110
h Pipes) (Q 3
Length Dia )Kgth 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 �� Bed/Trench Edges Topsoil Yes, No Yes No
t
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / � / G Inspection #2:
Location: 867 156th Ave New Richmond, WI 54017 (W 1/2 NE 1/4 T30N R1 9W) Nathan Hills Lot 4 Parcel No: 13.30.19.1266
1.) Alt BM Description = ST (- � ,, O , v
2.) Bldg sewer length =
N� � ( Sk� Vt4 jjL SM,ds
- amount of cover = Zs/ � I � f It 4e �� a ✓ 3 , S' ��
-31 03 ; - -- - ana ure Use revision
de for in Yes 1o?'No 0 formation. Date Insepctor's S Cert. No.
SBD -6710 (R.3/97)
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Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7082
lv miconsin Madison, WI 53707 — 7082 Sanitary it (608) u ber t �5 filled in b Co.)
Dep artment of Commerce (608) 261 b546 � y
Sanitary Permit App ' a tl on State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, person info rovide
maybe used for secondary purposes Privacy w, s i .ilr} i - 7 7777 ,
Project Address (if different than mailing address)
1. Application Information — Please Print All Informatio / /�/ -f r
6 (,
Property is Name ,jj� Parcel # Lot # Block #
(�6 L. (/
Property Owner's Address w (j� -;C Property Location
T ` ` 5 W d A/, k) � - Section 7
City, tate / Zip Code Phone Number
1 " L t� - q�c t
o�
II. of Building (check all that apply) T N; R / � 1
❑ i or 2 Family Dwelling — Number of Bedrooms
Subdivision Name -CSM- Number
❑ Public/Commercial — Describe Use fd &J
❑ State Owned — Describe Use ❑City ❑Village �rownship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) -
A ' ew System ys ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B List Previous Permit Number and Date Issued
❑ Permit Renewal )( Revision 11 Change of ❑Permit Transfer to New
Before Expiration Plumber Owner 0"
IV. Type of POWTS System: Check all that apply)
*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 VLaching Chamber QDripLine Gravel -less ipe QQi&r (explain)
V. Dispersal/Treatment Area In m
ration: / "p�
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sfJ Dis r System Elevation
(Z 0 98t5
VI. Tank Info Capacity in Total Number Mamufactu Site 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 installation of the POWTS shown on the attached plans.
Plumber' Name (Print) Plumber's Signature MP/MR&6-Number Business Phone Number
��L - A 22 b �CQ 7 Z
Plumber's Address (Street, City, State, Zip Code)
VIII. n /De artment Use Onl
Approved ❑Disapproved Sanitary Permit Fee �!ncludes Groundwater Date Issued ssuing Ag Signature ps)
Surcharge Fee) QT <
❑ Owner Given Reason for Denial ���"`Ilf /J Z
IX. Conditions of Approval/Reasons for Disapproval 07
'74 ytp 4e6l�GL G</'cl-X.- � 7 lU `lid
o it Comic vh &A kf
Attack complete plans (to the County only) for the less on paWblot less than gltl x 11 sachet In size
SBD -6398 (R. 08/02)
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of - 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
S j
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County �2v 1 X
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. 03 Z —2 L qS — 4 U-000
Please print all information. Reviewed by Date
Personal information you provide may be us cy Law s. 15.04 (1) (m)).
Property Owner Property Location
6eyE:- " S w IM M6 S 3 T 3 (� N R q E (o' 1/ j
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
�� C - U NT Y — 1 L.
City State Zip Code Pho�N}g8FFICE ❑ City ❑ Village [3 Town Nearest Road
-S O M E;1Z SE 7— I \ S ` fw �
EL New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate y S y GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material G S—�l Q U _S H Flood Plain elevation if applicable
General comments
and recommendations: CE, LS. 3 '- >o G w/ t1 v�t
k rv/ - 7 U ti,
F I Boring # ❑ Boring
® pit Ground surface elev. C 1 ft. Depth to limiting factor } B3 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
Z S Z4 ) 0`-t• CL 316 wy 'f 1,- C "')
3 -y ,S Cw
3 �.�` � S U S9 — .� 1• Z
❑ Boring # ❑ Boring
® pit Ground surface elev. C) ) • S ft. Depth to limiting factor }�' Z 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
I -S 1o'-- P- zlz - L Z r �n v - a.S �� _s - 8
10 `��3�6 — L Z`Fsb k hn.
3 2.1-30 s 1a-sS ir- 'mv`v- Z 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) Sign tun: CST Number
Arthur L 'Wegerer oy ' � -- �Z 220254
Address W e g e r e r Soil T e s t i n g & Design Service
Date Evaluation Conducted Telephone Number
421 N. Hain St. River Falls, 11I 54022 �f Z9 —LU3 715 -425 -0165
I
Property Owner \- f l YQ 6e) Parcel ID # O - Z `l s - 4 0 —w3 a Page z of 3
5 Boring # ❑ Boring
® Pit Ground surface eiev. C) 1- ft. Depth to limiting factor 7 8 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
l o -S tb- ;-,/ - L _ z'`�) S -g
Z S -1 S 1 y 12 3/ 6 — L Z Sbk )vt 1- C W
3 1g 30 - ).S Y2 31Y � S 1 s M vfv e I-5 - - Y, Z
U - c-i P- v1 — S D S9 M
F] Boring # ❑ Boring
❑ Pit Ground surface eiev. 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 ff#2
Boring # ❑ Boring
❑ Pit Ground surface eiev. ft. Depth to limiting factor In.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L '
17ie 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.6/00)
PLOT PLAN Page of 3
Scale 1'
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-29-03 715- 425 -0165 220254 03 - 6
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CST Signature Date Telephone No. CST No. Job NO.
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7082 C t`X
�sconsin Madison,' WI 53707 - 7082 Site Address
r Department of Commerce '—
Sanitary Permit Application Sanitary L, �[., r
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide [I CheC,k�tfARevision
may be used for secondary purposes Privacy Law, s15.04(l)(m)
I. Applicatio formation - Please Print All Information State Plan I.D. Number
G
Property Owner's Na me 1 Parcel Number
Wr ' , ( — fOAJ v Z 4ed _ 0 0
Property Owner's M ailing Address Property Location X1;.(4 (o
ST. CROIX COUNTY IAJ o 6, y; S T N, R [ MI
City, State Zip Code Lot Num er Block umber
Subdivision Name CSM Number
II. Type of Building (Check all that apply.) LNeares 3
1 or 2 Family Dwelling - Number of Bedrooms ❑ Public /Co ercial _De " scrihe ITg �e , � ❑ State Owne � p�t L t -7i .�N oad
CA > tAkkS ) s .-
III. Type of Permit: (Check only one box on line A. Numbering is r Internal use.) (Complete line B, if applicable.)
A. 1� New 3 ❑ Replacement of 6 ❑ Addition to
2 ❑Replacement System For County use
S stem Tank Only Existing System
1 — 1
B. ❑Check if Sanitary Permit Previously Issued Permit Number 7Datesued
IV. Type of POWT System: (Check all that apply. Numbering is for internal use.)
44„* Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland �-
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
S
45 ❑ At -Grade 46 ❑Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate PSystem Elevation Final Grade
Required Proposed tom` Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume esponsibiHty for installation of the PO shown o n the attached plans.
PluT Na me (Print) Plumber's Si gna re MP Number Business Phone Number
lC �6 Wed 2 2,6 q
Plumber's Addre ss (Street, City, State, Zip de)
W �.
VIII. County Department Use Onl
❑ Disapproved Date Issued Iss ing Agent Signature ( Stamps)
❑ Sanitary Permit Fee (includes Groundwater
* 9 Approved Owner Given Initial Adverse
Surcharge Fee) eft D etermination 1 79 0,3
IX. Conditions of A proval /Real " for Disapproval
�. mAgA
tL O. z $e aXo 1 V t J. - J
3 z Y a
Attach complete plans (to t e County only for the system on pa not less than 81/2 x 1 k inches in lize
VA
04 fVott tkak C64-0.4
SBD 6398 (R. OS O1)
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' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Dfvlslgh of Safety and Buildings'
in accordance with Comm 85, Wis. Adm. Code ��
County .7�' .-
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 d by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z o3
Property Owner Property Location
I F) C 1. Nj�k k _j c
Govt. Lot VQ ) t" ''1/4 S > T j N R E(or 6W
Property Owner's lVibiling A Lot # Black #! I Subd. Name or CSM#
gar
City tatQ Zip Code Phone Number City [3 Village Town Nearest Road
I R: ff4®
New Construction Usel&Residential / Number of bedrooms Code derived desig el GPO
(] eplacement /❑ Pubi) or commercial -Describe-,
Parent material te11 dCi Flood Plain etevatio t licabi ft
General comments -,, WWI',
and recommendations:
G 0.t,0 e ry A/ elh vl — C f cR rvr —
F-11 Boring # ❑ Boring �� i "� �%�rvt d?JLt/L
Pit Ground surface elev. ft. Depth to limiting factor in
5oi1 Applicatllon 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 'Efl#2
1-_4k cs a dS
3 ,6
X� 5 q 0
Boring # ❑ Boring
spit Ground surface elev. �` ' ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftx
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
e v GJ
o-o - 7 4 Z
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >3V . 0 m L ' Effluent #2 = BOO < 30 mg/L and TSS < 30 mg/L
CST Name (Pleese Print) lure CST IVumbec,
6 /
Address Date Evaluation Conducted Telephone Number
�9a. sL ' s- -d� ls"� /Jr
SBD -8330 (R07 /00)
r=roperty Owner Parcel ID #
2 _
goring # goring Page � of `_ --
Pit Ground surface elev. _ ft. Depth to limiting factor
tdorizcn Depth Dontinent Color Soil Rale
React Daoription Texture Stnx�re Consistence 13Zrodary Roots GPD/tf
in. Mw"11 flu. Sz. Cont. Color
Gr. 5z 5h. •Efflltl •EfN2
d -1 3 12
� is sy1 ti L
a goring # ❑
❑ Pit Ground surface elev. R. Depth to limiting factor in.
l4elison apt . Domktartt Redox Desc iption Texture Structure l con Rate
kt. Munsep Ou. SL Cont. Color COn�ewe Rots P pm Car. Sz. Sh. , Ear
awne # ❑ �
Cl Pit G1'ound surface elev, _ ft. Depth to limiting factor in.
Sol Hwten Depth Do ninant Redox Desa( Rate
pttpn Texture structure Consistence Boundary Roots
Murtaeil Ski. Sz. Cont. Color Gr. Sz. Sh. •EMM •E
W w d 01 ■ SOD s 30 S 220 mgll. and TSS 2 = iso mg& ' Effluent 02 = SOD 130 nVL and TES 130 mpll,
The Depammept of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
heed material in an alternate format, please contact the department at 608 -266 -3151 or 'TTY 608_264.8777.
lsoD•ttH {awou�
Soil Test Plot Plan
Project Name Brian Boardman Shaun Bir
Address 824 East 11th St. 1
New Richmond Wi 54017 C TM #
Lot 4 Subdivision Nathan Hills Date /13/01
W 1/2 NE 1/4S 13 T 30 N /R W Township Somerset
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Nail in Oak Tree
System Elevation 89.6 *HRP 1n"s -Sensh a
Alt. BM Top of nail in Poplar Tree @ 96.8'
Pro Town Road
175'
Soil Test was done to 97 , 96'95'
fullfill zoning 94'
requirement, test may not
be suitable for desired
building location 40' B 2 100'
10'
B. • 10%
35' Slope
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Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567 -P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number O
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal) `&V
Soil Absorption Component Size (ft')
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) lecocl. 04
Maximum Influent Particle Size (in) U 1/
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least
once every 3 years b inspection. The outlet filter hall be cleaned as necessary to e�
p roper operatio The filter cartridge should not be removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during inter months. The compaction ompaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep- rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
PLif_ T Pi� - 7Cs - x - 73
CO T� S r •� 7� �` • z 73 6 7
3
01/09/1995 04:36 7152737753 NELSON PLUMBI43 FAGE 01
ST CROIX COUNTY
SrPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
(_ wner,Suyer
Mailing address
Property Address —
(Verification required from planning Department for new construction)
City/State
ParceleI'tcation Number__ -�- ` O80
� ��i. b •�GRi'
Property Location `/� G /4, Sec. �, T 2_ N-FL—W, Town of 5 4
Subdivision
( L & , Lot#.
Certified Survey Map # , VOiwMe _ , Page
Y
Warranty Deed # – —�1 Z� I � , Volume � ��� --- Page #
Spec house O yes R -no Lot lines identifiable Dyes 0 no
MK5= MAiNTE
Improper use and mainttnaneeof your septic system could result io its premature failLre to handle wastrm preper maintenanc
Consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. %Vhat you put into the syster
can affect the function of the septic tank as a treatment:taga in the waste disposal system..
The property owner agrees to submit to St. Croix Zoning Department a certifrcatiou fors., signed b', the owner and by
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifyiag that (1) the on -site wastewater dispc sal s ystet
is in proper operatirig condition and/or (2) after inspection and pumping (if necessary), the septic tank is less titan 1/3 full of sludge
144, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the st3twarc
set forth, herein, as set by the Department of Commerce aad the Department of Natural Resources, State of Wisconsin. Cerdlicatic
slatisrg that your septic system has been maintained roust be completed and returned to the St. Croix County Zenirrg Off-cc within '
days of the three year expiration date.
! r
SIGNATURE OF APPLICANT DATE
OWNER CER11FICA`x'ION
I (we) certify that all statements on this form are true to dic hest of my (our) knowledge. I (wc) am (arc) tl;e owners)
the pr erty described above, by virtue of a warranty decd recorde(I in Register of Deeds Office,
ATE
SIGNATURE OF kPPLICAN1 44
° ° ° ° °• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Deparim --it . 00.
Include with this application: a stamped warranty deed frotrs the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty dted
1 794P 47 ,+
STATE BAR OF WISCONSIN FORM 2 - 1998 665617
Vr THL EEN H. iWALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number C.ROIX CO., WI
This Deed, made between Nathaniel Stephen Enterprises, LLC, a RECEIVED FOR RECORD
Wisconsin L imited Lia bility Company, ?2- 19-2001 5:25 AN
- - -- -
- 6flRkflNTY DEE
EXEMPT N
Grantor, and Patrick Matt Hinger and Amy Jo Mager, husband and wife, CERT COPY FEE:
ur FEE:
TRANSFER FEE. 187.50
RECORDING FEE: 11.00
PAGES: i
Grantee.
Grantor, for a valuable consideration, conveys and warrants to
Grantee the following described real estate in St. Croix
County, State of Wisconsin:
Recording Area
Name and Return Address
The First National Bank of Hudson
G ) lat of Nathan H ills in the Town of Somerset. At tn: Pat
PO Box 187
Hudson WI 54016
032 - 2145 -40
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: municipal and zoning ordinances and easements of record.
Dated this 13th day of December 2001
N,QTHANIEi,, S E ENTE RPRISES, LLC
+ v
By: Brian K. Boardman, Memb
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
) Ss.
Signature(s) _ __ ST. CROIX County.)
Personally came before me this 73 bk day of
authenticated this day of December ' 2001 the above named
Brian K. Boardman, as Member of Nathaniel
Stephen Enterprises, LLC
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the forlegoing
(If not, instrument and acknowledge the same.
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY �— ....
Judith A. Remington, Remington Law Offices +
P.O. Box 17 New Richmond, WI 54017 Notary Public, State of Wisconsin
(Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. not, state expiration ate:
necessary.) J
'Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 - 1998
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800. 655.2021
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