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HomeMy WebLinkAbout032-2141-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety atad Building Division • INSPECTION REPORT Sanitary Permit No: 53415 ' 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide maybe 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. Somerset Township 032 - 2141 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: I Sectionrrown /Range /Map No: /LL7 0� !� b � �v 03.31.19.1237 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM �. 2` d Jd 3 I Aeration Bldg. Sewer Holding SUHt Inlet 7.1 77 9S TANK SETBACK INFORMATION St/Ht Outlet 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic 7 Dt Bottom \ \ Dosing J Header /Man. 71 ' Aeration Dist. Pipe Holding Bot. System Cf . . I I 9 0� PUMP /SIPHON INFORMATION Final Grade 4 - 7 — 1 /M , 9 Manufacturer Demand St Cover M Z.a I63, l Model ber 69 r"QA_ TDH I Lift Friction Loss System He H Ft Forcemain Ling Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length o. Of Trenches PIT DIMENSIONS No. Of Pits` Inside D� Lipuid Depth DIMENSIONS f Z �( r \\ SETBACK SYSTEM TO lO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer• INFORMATION CHAMBER OR rp�• S�- Type Of System: L / J , I UNIT J Model Number: C�6 Aye, o f• - � ^401 r DISTRIBUTION SYSTEM I.'A C Header /Manifold /� Distribution x Hole Size x Hole Spacing Vent t Air Intake Lt Pipe(s) NN Lengt L Dia 1 Length Dia Spacing ��ff SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of \ xx Seeded /Sodded Mulched Bed/Trench Center r I Bed/Trench Edges ` Topsoil a r Yes [q No Yes Ew] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: '7 / Z,b / b(1 Inspection #2: / / Location: 529 239th Ave. Somerset, WI 54025 (NW 1/4 SW 1/4 3 T31N R19W) Deer Trail Estates Lot 12 9 _Parcel No: 03.31.19.1237 1.) Alt BM Description= 2.) Bldg sewer length = I Z • - amount of cover = -74 j 4 Plan revision Required? Fay Yes �J Use other side for additional reformation. _, � 7 - - - -- Date Ins ctor's Si re Cert. No. SBD -6710 (R.3/97) oil Test and System PLOT PLAN PROJECT P.C. Collova Bldrs. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 NW 1/4S 3 /T N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8 / 11 /04 BEDROOM 3 CONVENTIONAL XXX IN-GCOY6 PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of Basement foundation ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL H. R. P. Same as Benchmark SYSTEM ELEVATION 95.6/96.0 4' below qrade AL Well is to meet all Town Road setbacks required by WDNR Plans Designed Using Conventional Powts 150' �� Manual Version 2.0 V `2 -3' X 69' Cells with >3' spacing Pro 3 de �° -3 30, Bedroom 10' House * St ,Vents B.M. 25' B -1 70' 50' 7% 2 ' Slope Please note: basement floor /foundation must be >2' above drainage easement. Drainage easement Tested area is >1' above rentention area. Vent >6» Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 34 " Grade at System Elevation Safety and Buildings Division Coon 201 W. Washington Ave., P.O. Box 7162 ' l7� VVis consi n Meson, WI 53707 — 7162 Sanitary Permit Number (to fillod in by Co•) (608) 266 -3151 'A- 3 j 6// Department of Commerce State Plan LD. Number Sanitary Permit Application _ . .. / i IK� I, In accord with Cornet 83.21. Wu. Adm. Code, Personal infOrmad � 3 - r-$ Irrojcct Address (f different than i maArliaB address) may be used for secondary purposes Privacy Laws s15.04(1in 3 Ct 0 d L Application Information — Please Print All Information Parcel #k Lot M Block #k pri Name �QI Property Owners Mailing Address 1'mperty Location I a3 y� e se�ioo City. Stand 0 eone Number , T N. EL of Buildnng (check sA that apply SGt/✓Y`Q- ivision Name CSM Number or 2 Family Dwelling - Number of Bedrooms -- -- ic/Commataal - Describe Use City_ Villageawrp State Owned - Describe Use only one box on line A. Complete line B if applicable) _ Pctmit: Check III. Tppe { A- System Replamment System TreatmwtfNoldiag Tank Replacement Onl Other Modification to Existing System B. permit Renewal t Revision change of pextnit Transfer to New List previous Permit Number and Date hissed Before Expiration Plumber Owner IV a of POW1S S (Check all that a 1) Single Pass Surd Filter Non 4"viscarr In- Ground Mound _> 24 in. of suitable soil Mound < 24 in of suitable soil ��' SSW Filter Constructed Wedand Pressurized In-Ground Holding Tank Peat Filter Aerobic Tt O t `nit Recincalatin8 Recirculating synthetic Media Filter Chamber I)ri Litre Gravel -less Pi fiT..7k ent Area Informatloa t U AKa� ( DisPecsal Area Pow (sf) System now Design Soil lieahoa Rate(gpdsf) Dispersal , Site peel Fiber Plastic Manafacntter Pmt Gallon in Torah Number Construct ed Glass C oncre te Gallons Gallons of Units New Existing Tanks Tanks Sic or Hording Teak Aerobic Tcatmwt Unit Dosing C7v<mber e nsibilit, for installation of the POWTS shown on the attached VII. Res onsibili Sts t- L the rand MPlMPRS Number Busttiess phone Number Nam Plus Na (Print) Plumber's Q 6 b "� i Vl b Ck- Plumbers Address (Street. City. State. Zip l J s yDI VIE Cou use only Agent ignaturts (N ) Sanitary Permit Fee (includes Groundwater G'G�itC ` Approved Disappmved Surcharge Fee) ( G✓ owner Given Reason for Denial Q(. Conditions of Approvd%easons for Disapproval l 4 vO . �t r` onl stew oa paper not kra than SO x 11 Well" is size Attach Complete phase (to the County for the 5Y ACM oil Test and System PLOT PLAN PROJECT P.C. Collova Bldrs. ADDRESS P.O. Box 489 Somerset Wi 54025 SE '1/4 NW 1/4s 3 /T N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8 /11 /04 BEDROOM 3 CONVENTIONAL XXX IN- O ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 IL BENCHMARK V.R.P. Top of Basement foundation ASSUME ELEVATION 100' Filter Zabel A -100 [ — ]BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 95.6/96.0 4' below qrade Well is to meet all Town Road setbacks required by WDNR Plans Designed Using Conventional Powts Manual Version 2.0 150' 2 -3' X 69' Cells with >3' spacing B -3 Pro 3 30' Bedroom 10' 10' Vents House B.M. * St 25' B -1 70' B 50' 7% 25' Slope Please note: basement floor /foundation must be >2' above drainage easement. Drainage easement Tested area is >1' above rentention area. tE Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area 3 4 Grade at System Elevation Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code f County �- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference 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. Reviewed by / Daie� Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). O l Property OwW Property Location 2 e , C o /[ �� Govt. Lot 15e!5 1 /4 14 S J T3 / N R E (or Property is MailinYdress Lot # I Block # I S ' Name or CSNW , /Z City State Zip Code Phone Number ❑ city ❑ Village own Nearest Road 3 ) --S' ew Construction Use: esidential / Number of bedrooms —'4 Code derived design flow rate J'� GPD ❑ Replacement ❑ Public or co eraal - Describe: Parent material �.L /rllJ J Flood Plain elevation if applicable ft. General comments and recommendations: Q T^ �} ` v F 1-1 Boring # El Boring Pit Ground surface elev J ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 d s ! 1 ® Boring # Boring � Pit Ground surface elev/ l " 3 ft. Depth to limiting factor f , in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 r 3 7- S �--- i Al Effluent #1 = BOO > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) r CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address ate valuation Co ucted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 -- 715 - 246 -4516 Property Owner _ Parcel ID # Page of F5 Boring # Boring / pit Ground surface elev. /9 ` ' 5 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 e r Z 2 , .r l = bZ F] Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Cj F Boring Boring # Ground surface elev. ft. Depth to limiting factor in. 11 pit Soil ication 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 1220 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 (RAM) Safety and Buildings Division County / Q / 201 W. Washington Ave., P.O. Box 7162 ' T Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Visconsin (608) 266-3151 j 3 G l Department of Commerce g�Plw . Num ber S Sanitary Permit lication p P i Application Ai in accord with Comm 83.21, VS. Adm. Code, personal information you provide Project Address (f different than mailing address) may be used for seoondaty patposes Privacy law, sI5.04(lxm) L Application Information - Please Print Ali Information` ` f _ Parcel # Lot # Block i Property Nj� pro L / MailingAddtess � a ; is t_ °� f no I ocatio --f / y / acrJ y., ✓t�/ Sf. section Zi Coae i Phom Ndm 2 3 City, state T N; e c: 0 IL Type of Building (check all that apply) S ivision Name CSM N or 2 Family Dwelling - Number of Bedrooms' Publictcommercial - Descnu Use City_ v�Awnship state owned - Descn'be Use a D/ i III, Type of Permit: (Check only one box on line A. CompleikuneBif applica ) t Onl tfication to Existmg�Sysoem A tacen>ent S Treatmca dutg Tank R Y ew System Rep Y S. Permit Renewal Permit Revision Change of t Transfer to New Ust vin Befote Expiration Plumber IV. a of POWTS System- (Check all that a ! ) on -Pmssudzed In- Ground Mound _> 24 in. of suitable soil M < 24 in suitable soil At Grade Single Pass Sand Filter Filt A is Treatment Unit Sand Filar Constructed Wetland Pressurized In-Ground Holding Tank , s f � Recirculating S ndictic Media Filter Gravel -less Pi lair i tment Area I ormation: t 0 roposed (st) z� V. D pi ems+ R (s? r I Application aN� How h Destgn Fl (gpd) Design So � Site S Fiber Plastic VL Tank Info Capacity in Total U m ar Manufacturer Glass of Gallons Gallons Conte New Usting Tanks Tanks Sep6ror Hokrtog 7.1 { �Q A ra is Tteatm w Unit � e/ �✓ - Dosing Chamber VE ResixmsibIllity Statement L the risibility for instauadon or the POWTS drown on the Busy ffi' Number PjumW � s �. N al� (Print) Plutmbu's S' MP/MPRS Number Pi bees Address (Suva Qty, state, ) J Q f VIII. Coun /De t Use Od Date Issued Issuing Si to �+) Sanitary Permit Fee ('includes Groundwater roved Disapproved surdiarge Fee) ds 2 S� �� -7 2 � D Owner Given Reason for Denial �/ UL. Conditions of ApprovaUReaso =Orsa roval STEM """" eptic tank, effluent filter and f' dispersal cell must all be serviced / aintained as per management plan provided by plumber. 2, All setback requirements must be maintained as per applicable code /ordinances. Attach coaipkte plans (to the County only) for the s}atem an Paper not less than ii1lL x 11 inches in stn j1jNs OT PLAN PROJECT P.C. Collova Bldrs. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 NW 1 /4S 3 //R 19 W' TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE7/18/04 BEDROOM 3 CONVENTIONAL )00( IN -GRa RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 IL BENCHMARK V.R.P. Top of nail in 16" maple ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Sameasl3enchmark SYSTEM ELEVATION 93.0/92.5 4.5' below grade 285' Pr operty Line ? Alk Well is to meet all Plans Designed Using setbacks required by Conventional Powts 100' WDNR Manual Version 2.0 B -3 2 -3' x 69' cells with >3' spacing Vents 30' 20' T 30' N 50' 5 25 B.M. * 10' B -1 25' Pro 3 Bedroom B.M. Alt. B -2 House Top of nail in maple @ 100.0' 10' 5' Prc perty Line ? Vent e ALo Standard Biodiffuser Leaching Chamber " with 31.1 ft2 of Area Grade at Syst em Elevation 34 350' Property Line ? 100' jlj OT PLAN PR6JECT P.C. Collova Bld ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 NW 1 /4S 3 //R 19 W TOWN Somerset COUNTY ST. CROIX 7/18/04 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL )00( IN-GROif RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of nail in 16 " maple ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL • H. R. P. Same as Benchmark SYSTEM ELEVATION 93.0/92.5 4.5' below qrade 285' Property Line ? Well is to meet all Plans Designed Using setbacks required by Conventional Powts 100' WDNR Manual Version 2.0 B -3 Vents 2 -3' x 69' cells with >3' spacing 30' T 30' 5 4 �� 20' 0' S 25 ' B. M. * B -1 10' Pro 3 25 Bedroom B.M. Alt. B -2 House Top of nail in maple I @ 100.0' 10' 5' Prc perty Line ? Vent ALo Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area 1 " Grade at S ystem Elevation 34 350' Property Line ? 100' ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and locatigna tance to nearest road. os? Z ll' f l - �k - O4'O (. (L3 ' 4 Re wed by Please print all infgr[gat �1..: - -_�. Date Personal information you provide may be used for sec4i'f 6rposes (P 'vacy Law, S. 1.:04 (1) (m)). F 16 Property Owner Propefty Location er Govt Lot $ 1/4 41W1 /4 S 3 T N R I R E (or)apU Property Owner's Mailq Address � r 1 J Lot* - Block # Subd. Name or CSNW -3 ST CRGtx -?- e �5 S ity State Zip Code Nummb ❑`City ❑ �Ilage ® Town Nearest Road ZONINCi C)Fc!C " C SCeOlq W I S�40 ( � y - s -e� S [P New Construction use: Residential / Number of "' 65 Code derived design flow rate (o Od GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Ct V j rt.,s h Flood Plain elevation if applicable ft. General comments S y ,54 -err% -e tcirp j y U 0 L aw "� 9 3 • � d and recommendations: �� -Q, �/ , 4-er e 4 2- G-u ` ` w . O' Boring q I ' Boring # ! s �U , Pit Ground surface elev. ft. Depth to limiting factor _ in. Soil lica 'on Rafe 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 6 -q -3 /,Z t S' I mabk r v� .2- 2. qk s it 2 0 C. — . 5 .8 l L S I'1'1 /1rl�J" r 1 1. Z 2 Boring # � Boring y$„ to /D -] © 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 I . 6 -5 / lL $%1 / rr)abk w 4 k S I v-P . L .3 * 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) Signatu CST Number �C/Ck -m sc h 2,53 Address Date Evaluation Conducted Telephone Number 2 3 S•6 i:? Sf . .So m me` e &J Z 9 (745 ) 2417 - V&-)& l Property Owner &, rlC owsk r Parcel ID # Page 1 _ of - F — Boring # ❑Boring ® Pit Ground surface elev. 9� � ft. Depth to limiting factor JI 3 in. Soil Application Rate Horizon . Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Z Sil l . 2 • 3 LS rrr� - - 1 • Z z F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring ❑ 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/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. SBD -8330 (R.07 /00) i PAGEOF NAME y r �,a� S k LOT# LEGAL DESCRIPTIONSE ' /oNw'1, S j T3 f N R I Q E (or) d SCALE; 1 "= /OU BM 1 ELEVATION j Q . U / BM I DESCRIPTION ha, ( *r, (a� ►^�a — + X � 3 BM 2 ELEVATION Q • 0 BM 2 DESCRIPTION VI �" t.�ower SYSTEM ELEVATION ' 9 3 61 ALTERNATE ELEVATION qT -00 c [.06 CONTOUR ELEVATION IVA Q � � Q .�- 5 •� Sew, d -s.o.. ; > o�.�y �. �...,�., �. � / w �a. c� -+... � w�e.� SIGNATURE DATE ad 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. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan ption # . If system fails, determine cause of failure, use alternate area and install new sys em in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P. L &)'i ea ,]�e - Mailing Address Li k 54 Q O5 Property Address 5a2 a,-j2,4h Q (J 1 (54 Cy 5 (Verification required from Planning Department for new construction) City/State -3nry1t(�Ce-� Li Parcel Identification Number 0 3 2 q I— 7q-60C-) LEGAL DESCRIPTION Property Location N Q '/4, 5 U ' /,, Sec. , T 31 N -R I W, Town of - 5cmt(se Subdivision Lot # Certified Survey Map # Volume Page # Warranty Deed # 55 '?� Volume ) 9 56 Page # 3 Spec house es ❑ no Lot lines identifia yes ❑ no SYSTEM ENANCE 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 ccrtification form, signed by the owner and by a masterplumber, journeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year nation date. Qz d SIGNATUAE O APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statemcats on this form are true to the best of my (our) knowledge. I (we) am (are) the owncr(s) of the perry des ed above, by virtue of a warranty deed recorded in Register of Deeds Office. `i d l o ff IN 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 ccrtified survey map if reference is made in the warranty deed WARRANTY DEED 645991 STATE P E_W SIN — FORM 2 KATHLEEN H. WRLSH V O L f jpAl,� 3�7 REGISTER OF DEEDS DOCUMENT NO. ST. L'R(.),I.X Co., WI RECEIVED FOR RECORD This indenture, Made this 1Sth day of May A,D lop 05- 21-2001 9:30 AM between Kowski Farms Inc . 1 , j; a Corporation duly WARRANTY DEED organized and existing under and by virtue of the laws of the State of Wisconsin, located at CENT P COPY FEE: Wisconsin, party of the first part, and COPY FEE: P.C. Collova Builders Inc., a Wisconsin corporation TRANSFER FEE: 1158.30 RECORDING FEE: 10.00 PAGES: I part_ of the second part. Witnesseth That the said party of the firs[ part, for and in consideration of the sum of 586 ,100.00 to it paid by the said part ies of the second part, the receipt whereof is hereby confessed THIS SPACE RESERVED FOR RECORDING DATA and acknowledged, has given, granted, bargained, sold, remised, released, aliened, conveyed I NAME AND RETURN ADDRESS and confirmed, and by these presents does give, grant, bargain, sell, remise, alien, convey and confirm unto the said part of the second part, their heirs OAKEY & OAKEY TITr E and assigns forever, the following described real estate, situated in the County of Box 126, Osceola, WI 54020 — St. Croix State of Wisconsin, to- wit: i� Lots 8, 9, 10, 11, 12, 17, 18, 19, 20, and 21 of the Plat of Deer Trail ates, according to the recorded 032- 2t'4t'= '0 — i Plat on file and of record in the office of the 032- 2141 -40 -00 Register of Deeds, St. Croix County, Wisconsin PARCEL IDENTIFICATION N R 032-214 —5 032- 2141 -60 -00 032- 2141 -70 -00 032 - 2142 -20 -00 032= 2142 -30 -00 032- 2142 -40 -00 032- 2142 -50 -00 (IF NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE) 032-2142-60-00 Together with all and singular the hereditaments and appurtenances [hereunto belonging or in any wise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To have and to hold the said premises as above described with the hereditaments and appurtenances, unto the said part of the second part, and to their heirs and assigns FOREVER. And the said Kowski Farms, Tne party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said part i as of the second part, their heirs and assigns, that at the time of the ensealing and delivery of these presents it is well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all encumbrances whatever, and that the above bargained premises in the quiet and peaceable possession of the said part of the second part, their heirs, and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT and DEFEND. In Witness Whereof, the said Kowski Farms In party of the first part, has caused these presents to be signed by Rooer Kukowski its President, and countersigned by nlor aan K tkowetk; its Secretary, at Wisconsin, and its corporate seal to be hereunto affixed this 7 Rth day of —_ May A.D., JaL-2 D.QI . SIGNED AND SEALED IN PRESENCE OF Kowski Farms, Inc Corporate Name ' Gam• P�. >. President Roger Kukowski COUNTERSIGNED: Secretary State of Wisconsin, l Norman Kukowski y ss. Polk County. JJJ Personally came before me, this 18 th day of May A.D., it4c 20n Rover Kukowski President, and Noz•man Kukowski Secretary of the above named Corporation, to me known to be the persons who executed the foregoirig instrument, pnd tb'tAe known to be such President and Secretary of said Corporation, and acknowledged that they executed the forego i suvment as *urh offlcets as the of said Corporation, by its authority. THIS INSTRUMENT WAS DRAFTED BY - - " Y. "' Z •` —""V` • /'�+�"'— "'� Ronald L. Sillier NOTARY BEVERLY MOOR& VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 118 Notary Public, _ 5� !LPpTk County, Wis. New Richmond, WT 54017 My commission (expira) (is); .9/2/2001 1 l5ccuon 54 51 (U I J W' ons n G r u•s p u n t that all t umen Fn• reco J al shall ha plainly pnw J or q pe t ut thercon the naft>et of th • tA �rabrs, grantees w iii—ses and 110W)•. Seel on 5Y.513 vmiIady regnhat the name of the rwr%ri who, or governmental agent) which, drafted wch in w 5 t struttient, shhall be printed, tyrwwrluen'4tmm pq4 pr: written thereon in a legible manner) WARRANTY DEED —by Corporation STATE OF WISCONSIN Wisconsin Legal Blank Co.. Inc. Form No. 2 Milwaukee, Wis. ' .: u�.. re ➢,'. , , ... ..: :. } � ",rx: .971+ .;.. '.• `.. AW774 50 . 300 ACRES V A/N. 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