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HomeMy WebLinkAbout032-2183-04-000 (2) Wisconsin Department of Commerce Count Safety and $uildingl�ivision PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: 514860 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: Grand Properties LP Somerset, Town of 032 - 2183 -04 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 23.31.19.1552 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing t. M Aeration BI ewer Holding rz let Al TANK SETBACK INFORMATION t Outlet TANK TO P/L WELL BLDG. ent to Air Intak J IJAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWEL L LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx 0 Seeded /Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes E] No No E] Yes E No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2088 62nd Street Somerset, WI 54025 (NW 1/4 NW 1/4 23 T31 IN R19W) Gavin's Acres South Add Lot 4 Parcel No: 23.31.19.1552 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. tot11 wroe.m.gov Safety and B ' Division County 201 W. Washingto e., P.O. Box 7162 gyp X M iscon s i n Mad' WI 162 Sanitary Permit Number to be Fitted in by Co.) of Commerce / d Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appr late g mental tk� LA unit is required prior to obtaining a sanitary permit, Note: Application forms for sta POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you p urposes in accordance with the Privacy Law s. 15.04(l m Stats, 1. Application Information - Please Print All Information Property Owner's Na e ty er /- P APR 2 9 008 Parcel #p 3- J 3--, Property Owner's Mailing Mailing Address Property Location W <�Z`� 34 ST. CROIX COUNTY Govt. Lot City, State Zip Code �z. -`Gff y, �� j y,, Section - S"61+►� B Y,5"v?'' r ^ ��0,?..� l� �' �/7 -•,� Qd. (010"ony II. Type of Building (check all that apply) Lot # T -71 N; R f E [A] or 2 Family Dwelling - Number of Bedrooms Subdivision Name �i�G /� J � ❑ I� U �r ,c m� rI l& //� / Q. ih� Block # blicJ ommerctal scri se T( �� ( -- ' ��� [ City of ri State Owned - Describe Use Number Village of tW C& al CSM — Town of �e #-;, e- Y�G 7' III. Type of Permit: (Check only one box on But A. Complete line B if applicable) A. X New System Replacement Treatment/Holding Tank Replacement Only Other Modification to 13histing System (explain) System B. F1 Permit Permit Revision 11 Change of r Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Expiration 1V. Type of POWTS S stem/Co nsnt/Deviee: Check all that a Non - Pressurized In- Ground Pressurized In- Ground At -Grade LJ Mound ?24 in. of suitable sot Mound < Z4 in, of suitable soil TJ Holding Tank ❑ Other Dispersal Component (explain _ , � r eat n Device (explain V. Dispersal/Treatment Area Information: u Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer Material Gallons Gallons Units New Tanks Existing Tanks Septic or Holding Tank Dosing Chamber �e�✓6 1 _ / VII. Responsibility Statement - I, the undersigned, assume respensibsity for bustiination of the POWTS on tie attacked plans. P Name lPrintl Plum s Signature Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) %� S VII Coun /De artment Use On l pproved _ Disapproved Permit Fee e .(� I , to I I l Ag t Sipg j _ Owner Given Reason for Menial $ f ✓ y 21 rZL -C� IX. Conditions of A pp roxltl/Reasons for Disapproval SYS - NER: Septic tank, effluent filter and dispersal cell must all be serviced I maintained C f as per management plan provided by plumber Tv vv 13 5 `/ mrWO - w — brAt to the C on paper not ksr than s t o INOW IN Sim as per applicable co e- or to nc s SBD -6398 (R. 01107) Valid thtu 01/09 G�/It 12 ��/'d��S�7i ��/� • 6 G' I 1���L' �G S _�J/9 f11G't� �N i f20 t+ / - f 7 4 it � py �� rC � v N l� E o -, 7N Z Q f I ti 2 Ecopy AfdomY�i`�S i �e p YS 20 4-/- a � o �� as ry 41 1 2 a� SEPTIC 'TANK t* PUMP CROSS SE (C T'G) AND SPiCIt'iL�+ 4" CI' VENT ' PIPE ' 12" RtR, 'ABOVE GRADE WEATHERPROOF y 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED COVER FRESH AIR INTAKE WITH CONDUIT M W/�PADLOCK & FINISHED GRADE WARNING LABEL 7 4" CI RISER - ----- —1 4 " Ml N. ........... j8tf IN. 6 MAX NLET t, WATER TIGHT SEALS GAS -'#"' TIGHT � APPROVED A SEAL t JOINTS WITH ' ALM APPROVED PIPE PPROVED B t ON 3' ONTO IPE 3' - T - " SOLID SOIL. NTO SOLID C ► ' ** RISER EXIT OIL PUMP OFF ELEV. FT. OFF PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL all APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE NUMBER DOSES PER DAY: TANK MANUFACTURER'. /,),�,,,,, S� ✓,.._._____ TANK SIZES SEPTIC _Zg4V „ GAL. DOSE VOLUME INCLUDIN GAL. DOSE � � GAL. ALARM MANUFACTURER: / �&-0./ v -- CAPACITIES: A = INCHES =_ l GAL, MODEL NUMBER: H 2 INCH = 3 GAL. .. . SWITCH TYPE: � ----- �� C _ $ INCHES =GAL• PUMP MANUFACTURER: C9autz� MODEL NUMBER: o D = INCHES = SWITCH TYPE: REQ UIRED DISCHARGE RATE �� GPM PUMP � ALARM WIRING AS PER ILHR .16.23' WAC Q _.lam -- FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • FEET ft + MINIMUM NETWORK SUPPLY PRESSURETIlflfl•FT.'FRICTSON FACTOR•. FEET + _ G� FEET FORC£MA .3.�2. TOTAL DYNAMIC HEAD �y :7 FEET ; ; D INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH I�AMETER LIQUID �� 1�,..._ • �CT� �,���" SIGNED: r J LICENSE NUM 292f DATE 1/88 [QGOULDS PUMPS Submersible Effluent Pump i1 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller Thermoplas- ■ Bearings: Upper and lower eciflicail designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically Y 9 lubrication and efficient improved performance. construcdon. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- 4' can "%nd&* A90dWW • Heavy duty sump matic models include resistance. • Water transfer Mechanical Host Switch ■Motor Housing: Cast iron (CSA listed model numbers end or "C " for efficient heat transfer, in " • Dewatering assembled and preset at the F" .) � strength, and durability. SPECIFICATIONS ■ Motor Cover. Thermoplastic Guilds GPs is 60 9001 L*ftre& FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 10 maximum. ■ EPO4 impeller. Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1 NPT. seal protection. • Mechanical seal: carbon - rotary /ceramic- stationary, BONA -N elastomers. • Temperature: 104°F (40 continuous � � -- 140°F (60 intermittent. '0 } I } _ ; • Fasteners: 300 series stainless steel. a 30 1 • Capable of running 4 ....... _ dry without damage to $ 2-5 Fr components. 25 _._ _. Motor: x 6 _.._ • EPO4 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 s RPM, built in overload with - n automatic reset. a 4 Eros ..._. f , • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, s 10 _.-.. .._ .... ..........__`..._..._..w _.__ _.. _ - built in overload with automatic reset. 2 n • Power cord: 10 foot 5 E standard length, l 6/3 1 .._... S1TOW with three prong grounding plug. Optional 20 0 00 ........ - a 20 ... - __. .. _ 40 so GPM foot length, 16/3 S1TW with three prong grounding plug 0 2 4 6 8 10 12 nw /h (standard on EP05). CAPACITY Goulds Pumps © 2000 Goulds Pumps <& ITT Industries Effective February, 2000 83871 1214 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 f Division of Safety and Buildings T Schmitt in accordance with Comm 85, Wis. Adm. Cade Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must County St CfODr: include, but not limited to: vertical and horizontal reference pant (BM), direction and I D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Pa Please print all infonnation. Revi B l Date Personal information you provide may be used for secondary pub (Pmacy Law, s. 15.04 (1) (m)). — f� Property Ownerq Property Location O Grand Properties, LP Govt. Lot NW 1/4 NW 19 S 23 T 31 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# yn�� / 712 Rivard Streeet Suite 300 A F R 2 3 4 Gavin's Acres:n City Sate Zip.Cp e�Ph9ni gtpber J City _J Village tIJ Town Nearest Road Somerset I �6 G -59 Somerset 62Nd St. 16 New Construction Use: 0 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial - Describe: Parent material Ouiwash Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0. S gpd/sgft rating. Possible system elevation for Areal is 97.74'. slope is 6 %. 2 Boring # I Boring !ol Pit Ground Surface elev. 100.44 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF `Eff#1 'Eff#2 1 0 -8 1Oyr4/3 none Is 1csbk mvfr as 1f .7 1.6 2 8-17 1Oyr4/4 none Is lmsbk mvfr gW if .7 1.6 3 17 -31 7.5yr4/4 none sl 3msbk mfr gw .6 1.0 4 31 -54 1Oyr4/6 none sl 2fsbk mfr gW — .6 1.0 5 54 -96 1Oyr5/4 none s Osg ml — — .7 1.6 54"- W' 1" bands of 7.5yr4/6 Is 1 msbk Boring # Boring 16 Pit Ground Surface elev. 98.49 ft. Depth to limiting factor 98 + in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft - Etf #1 - Eff#2 1 0-8 1 Oyr3 14 none Is 1 msbk mvfr as If .7 1.6 2 8-29 1Oyr4/4 none Is 1csbk mvfr gW 1f .7 1.6 3 29-49 1Oyr4/6 none s Osg ml gw .7 1.6 4 49 -98 1Oyr4/6 none fs Osg ml — -- .5 1.0 Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS <_�10 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt ,,, ., -,� 227429 Address Ton Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond WI 54017 4/15/04 715- 247 -2941 Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 • ] Boring # — Boring 01 Pit Ground Surface elev. 100.24 ft. Depth to limiting factor 69 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOff *Eff#1 *Eff#2 1 0 -9 1Oyr3 /4 none Is 1msbk mvfr as 1f .7 1.6 2 9-35 1Oyr4/3 none sl 2msbk mvfr cs 1f .6 1.0 3 35-57 7.5yr4/6 none Is Osg ml gw .7 1.6 4 57-69 7.5yr5/4 none s Osg ml a ---- .7 1.6 m2d 7.5yr5/8 5 69 -84 1 Oyr5 /4 7.5yr5/2 sI 1 msbk mfr --- — . 4 .7 Sr- 69" 2" bands of Is 7.5yr4/41 msbk. 4] Boring # Boring sm Pit Ground Surface elev. 102.39 ft. Depth to limiting factor 94+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM *Eff#1 *Eff#2 1 0 -12 10yr4/3 none Is 1msbk mvfr as 1f .7 1.6 2 12 -31 1Oyr5 /4 none s Osg ml gw — .7 1.6 3 31 -74 10yr516 none s Or-9 ml cs — .7 1.6 4 74 -94 1Oyr4/4 none sl 2msbk mfi — — .6 1.0 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 GP *Eff#1 *Eff#2 * Effluent #1 = SOD ? 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. fie; Page 3 of 3 • Conducted by: Conducted for: Schmitt Soil & Site Evaluations Name: Grand Properties, LP Thomas I Schmitt, CST 227429 Address: 712 Rivard St. Suite 100 1595 72nd St. City, State, Zip: Somerset, WI 54025 New Richmond, WI 54017 Phone: 715.247.2941 Subd.Name: Gavin's Acres,;'« Lot No. A.Ld� lya 1/4, /W/ 1/4, S 23, T 31 N, R 19 W Township of Somerset BM El. 100.00' Zoe o ` ' % SVe e % /o t - Cerzw;x Alternate BM El. /o 3 7 y' �, �+ ' �" Alit 6'/1 Slope= ( ° 10 Contour Line EL AW Scale: F'= 40' add` 6y j o� i r 3 � 6 2r,.d /()0( S f r� ��s yyd��►I/ Sn� / a. 3S Js .r 1 i j 113 U �3 F8 I I This soil report was done to fulfill a Zoning requirement. It may or may not be in a location that is suitable for your use. No permanent lot markers were in place when the test was conducted. i POWTS OWNER'S MANUAL & MANAGEMENT PLAN page --� of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner N a Q -� � P Septic Tank Capacity g al ❑ NA Permit # [ EEfffluent k Manufacturer CS�es Cl NA DESIGN PARAMETERS lter Manufa cturer (� e. 13 NA Number of Bedrooms ❑ NA Effluent Filter Model 14 4'd ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 4 ga l ❑ NA Estimated flow (average) al /d Pump Tank Manufacturer „ga ❑ NA Design flow (peak), (Estimated x 1.5) al /da Pump Manufacturer �D a l ❑ NA �D Soli Application Rate Q• gal/day/ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Di Celi(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg/L J24n-Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids ITSS) 530 /L XNA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) >sC �cf 100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other. ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency m (MaAnmrn 3 years) E3 NA Inspect condition of tank(s) At least once every: 3 ear(s) Pump out contents of tanks) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) (Maxkmm 3 years) El Inspect dispersal ceN(s) At least once every: 3 Wyeads) month(s) ❑ NA Clean effluent filter �S At least once every: ♦ earls) ❑ month(s) ❑ NA Inspect pump, Pump controls & alarm At least once every: t ❑ year(s) ' ❑ months) ❑ NA Flush Laterals and pressure test At least once every: ❑ earls) ❑ month(s) ❑ NA Other: At least once every: ❑ year(s) ❑ NA Other. MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank idtify any cracks or leaks, inspections must include a visual inspection of the tank(s) to identify any esa u or missi or pond ar e ent on the ground surf ace. measure the volume of combined sludge and scum and to check for y P nding The dispersal cell(sl shall be visually inspected to check the effluent levels in the observation pipes and to check for any po of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event- Page 2 of START UP AND OPERATION oducts o other chemicals For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting Pr that may impede the treatment process and /or damage the dispersal cell(si. If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal o the call(s) and May result in the backup or exc ess rface d scharg of wgstawate levels. When powr i rstored the discharg to the dispersal cells) in one large dose, effluent. To avoid this-situation have the contents he pumpMaintainertOassist in maanuaB r Y oper 9 he pump controls sto power to the effluent pump or contact a P or restore normal levels within the pump tank. Do not drive or,park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. diapers; disinfectants; fat; Reduction or elimination of the following from tt a a�de amstcottan swabs; deg reasers: denta performance loss; and prolong the life oft the POWTS: antibiotics; baby wipes; cigarette 6 asoline; grease; herbicides: meat scraps; madicaions; oil; foundation drain (sump pump) water; fruit and vegetable peelings; g painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out o following t ps shrill taken Code to ,nee that the system is properly and safely abandoned in compliance with chapter Comm 83 33 • Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGIEN PLAN or.must b� taken, to provide a code compliant If the PO S fails and cannot be repaired the following measures have been, replace nt system: may b A suitable replacement area has been evaluated from distuebanae and compaction and should not b replacement e nfrnged upon by system. The replacement area should be protected required setbacks from existing„ and proposed at on to establish a wells. Failure to Protect the area. R system must result in the need for a new sal and site evaluate comply with the rules in effect at that time. nd/or soil 13 A suitable replacement area is not available due to setback to eplace he failed POWTS. limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort site tank ❑ T site e � 13 Mound and at -grade soil absorption systems may be reconstruct tfie n a time. he biomat at the infiltrative surface. Reconstructions of such systems must comply w ith < <WARNING> > O XYGEN ' Do N01 C PUMP AND OCHER TREATMENT TANKS MAY CONTAIN I.ETHR GAS AN D/O R DEATH MAY SEPTI RES RESCUE OF t , ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOS ADDITIONAL COMMENTS POWTS MAINTAINER POWYS INSTALLER Name Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone - Phone This document was drafted in compliance with chapter Comm 83.2212)Ib)i1)ld) &1f) and 83.5411), 12) & (3), Wisconsin Administrative Code. r�vi •.�..� luiir-inGr� r�ul'r0�1`N� rM^ Mi. • (1JJ00J141 P. 1W Guu;.) A.U- JJt - 1 rr- ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AOREEMENT AND OWNFRSHTP CERTIFICATION FORM Owner/Buyer , rc_ Mailing Address 0 - , uo S a s Property Address 0 �; A (�� N " S -- (Verification required from Plan ting & Zoning Departntetit for new construction.) City /State Parcel identification Number 3vl " J - iD v o ?JU d LEGAL DESCRIPTION ` . / sy Property Location 1 4, '/. , Sec. a`Z3 , T N R W, Town of � .l subdivision "1 r1C z ,�� ; (I? , Lot Certified Survey Map [ , Volume . Page Warranty Deed # t�� , vo lu me 2 , Page # Z� Spec house no Lot lines identifiable Des no SYSTEM MAINTENANCE AND Q R C,F'RT,HCATjON Improper use and «winsenance of your septic System, could result in its prrmature failure to haw2o master. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensod pumper, What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities rare specified in §Conan. 83.52(1) and in Chapter 12 - Si, Croix County Sanitary Ordinance, The prvperty owimr agrom to submit to St. Croix County Planning & ?.onmg Department a oortification form, signed by the owner and by a =star plumber, journeyman plumber, (estrictod plumber or s lleottsed pumper vorif'ying that (1) the on -site wastewater disposal system is in proper operating condition and,or (2) agar inspoctiou and pumping (if necessary), the septic tank is less than 113 1 of sludge. Uwe the undersigned have read the above re uircments and a to maintain the pri sewage disposal system with the 8 4 l� t� 8 sP Ys standards set forth, herein, as set by the Department of Commerce and the Depamnent of Natural Resomcm, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiratim date. 1 /we c that all statements on this fore► are true to bout of m /our knowled Uwe amhre the owner(x) of ttie certify the e. y g property described above, by virtue of a warranty deed recorded in Register of Dods Office, Number of bedrooms SIGNATURE OF APPLICANTS) DATE ` "Any information that is misreprescatod may result in the sanitary permit being revoked by the Planning &'Coning Department. 4 " Include with this application a recorded w=orry deed from the Register of No& Office and a copy of the certified surrey map if reference is made in the warranty deed. (itEV. 0>i/0 ' J 2580 P 298 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX GO. NI This Deed, made between Walter E. Germ RECEIVED FOR RECORD ain and Debra C. 05/25/2004 11:50AM Germain, husband and wife Grantor, and Grand Properties, LP WARRANTY DEED Grantee. EXE)iPT It Grantor, for a valuable consideration, conveys and warrants to Grantee described real estate in St. Croix County, State of Wisconsin REC FEE: 1 the following n'� TRANS FEE: 1972.88 (if more space is needed, please attach addendum): COPY FEE: See Attached Exhibit "A" CC FEE PAGES: 2 Recording Area Name and Return Address �p Q ED �-r `71 �� d a,rd st S6- .Q-t - s e-" 032 - 106040-000; 0324060- 80-000 032 - 1060 -90 -100: 032 - 1060 - 90-500 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of May , 2004 * * Walter E. Ge * * Debra C. Germai AUTHENTICATION ACKNOWLEDGMENT Signature(s) Walter E. Germain and Debra C. Germain, STATE OF ) husband and wife ) ss. County ) authenticated this l day of May , 2004 — ! Personally came before me this – — — — day of 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 authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland - -- Hudson, W 5401 Notary Public, State of 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 Co.. Fond du Lac, IN, STATE BAR OF WISCONSIN 800 -655 -2021 WARRANTY DEED FORM No. 2 - 1999 2580P 299 EXHIBIT "A" A parcel of land located in part of the Northwest Quarter of the Northwest Quarter, part of the Northeast Quarter of the Northwest Quarter, ana part of the Northwest Quarter of the Northeast Quarter of Section 23, Township 31 North, Range 19 West, Town of Somerset, St. Croix County Wisconsin, including part of Lot 3 of a Certified Survey Map recorded In Volume 15 Page 4037 as recorded In the Register of Deeds Office for said County, described as follows: Commencing at the Northwest Comer of said Section 23; thence, on an assumed bearing along the west line of the Northwest Quarter of sale Section 23, South 00 degrees 13 minutes 19 seconds West a distance of 938.33 feet to the south line of Lot 3 of said Certified Survey Map and the point of beginning of the parcel to be described; thence, along last' said south line, South 88 degrees 56 minutes 22 seconds East a distance: of 415.04 feet to the southeast comer of that property described in Volume 2077 Page 239 4s recorded In said Register of Deeds Office; thence, along the east line of last said property and the east line of Lot 2 of said Certified Survey Map, North 00 degrees 13 minutes 19 seconds Efist a distance of 574.67 feet; thence, along the east line of Lot 1 of last sold Map, North 05 degr$es 14 minutes 28 seconds East a distance of 330.65 feet to the southerly line of 210' Avenue (A Town Road) as dedicated on the Plat of Gavin's Acres; thence, along last said southerly tine, South 88 degrees 49 minutes 54 seconds East a distance of 959.37 feet; thence North 00 degrees 09 minutes 35 'seconds East a distance of 33.01 feet to the north line of the Northwest Quarter of said Section 23; thence, along last said north line, South 88 degrees 49 minutes 54 s.econ4s East a distance of 1271.30 feet to the north Quarter comer of said Section 23; thence, along the north line of the Northeast Quarter of said Section 23, South 88 degrees 60 minutes 02 seconds East a distance of 155.50 feet; thence South 01 degrees 03 minutes 38 seconds West a distance of 625.87 feet, thence South 88 degrees 56 minutes 22 seconds East a distance of 102.52 feet; thence South 01 degrees 03 minutes 38 seconds West a distance of 693.00 feet to the south line of the Northwest Quarter of the Northeast Quarter, thence, along last said south line, North 88 degrees 56 minutes 26 seconds West a distance of 235.84 feet to the north -south Quarter line of Section 23; thence, along the south line of the Northeast Quarter of the Northwest Quarter and the South line of the Northwest Quarter of the Northwest Quarter, North 88 degrees 56 minutes 22 seconds West a distance of 2370.40 feet to the east line of that property described in a Volume 1227 Page 497 as recorded in said Register of Deeds Office; thence, along last said east line, North '00 degrees 04 minutes 38 seconds East a distance of 320.00 feet to the northi line of last said property; thence, along last said north line, North 88 degrees `56 minutes 22 seconds West a distance of 306.19 fleet to the west line of said Northwest Quarter, thence, along last said west line, North 00 degrees 13 minutes 19 seconds East a distance of 66.02 feet to the point of beginning. 04( 18/20 PAGE 20 8 11:33 17152473622 ^ � 4O , ..., ,,,,, w e c[ ( n E "� SWV7_W :>: E o E N S5 48 T 774 t 7 E � 1 �a � 1 Ld LLJ -j6 to C� - 7 - C E �. �� D W I t� �1 o X4'56 ( / 0 1 *41 _ 1.30,76J sq. ft.' `� i E n 3.00 acres _ `.� z w LBO = 934.40' _ 6' E w g I b ' 1 fi L 0 B �—• E � E � N�5 f N > -97' r U ' 1 Iv N A , LOT 3 s r " Y _ ` 41K S CR I B ED _ _ _ I N , ' PG. 239 130, 812 sq. ft. \ "/ 1 3.00 acres LBO = 934.40' ' p '22 "E " '..04' 130,690 sq, ft 1.¢ s 3.00 acresl LBO — 932.20' V: 0 131,155 sq. ft. ti 4 N J. 01 acres \ s e © M LBO - 932.20 Drobog z Easement s'9� 130, 810 s 9 J. �, \t _ �� ,sue 00 acre �. LBO 935- , 2� -- 1200.71'— _____ 455.90' 1. 46r 107.59' '��