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032-2174-23-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506187 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: Kreibich, Cory & Sara I Somerset, Town of 032- 2174 -23 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /OZ> (ajv� (� T 27.31.19.1478 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i Septic Benchmark 7- /6 . AZ ��4�. ' /L�b �• Z Dosing ' 1 Alt. BM ` WCC'�>�S �.�+- �la,#i ' t (o-lo 77. � ^{ f � ` Bldg. Sewer g • O � �$ . , rV 1 Holding St/Ht Inlet IV TANK SETBACK INFORMATION St/Ht Outlet 10 -`{ 4 1 4 5 • 7y TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet A) /6. 'A W •62 Septic 7!!Z I A /A_ I Dt Bottom Alf. 92 . I Dosing 7 5a / i / Header /Man. Aeration Dist. Pipe Holding Bot. System 4 . !9� Z Oli / F. Final Grade PUMP /SIP HON INFORMATION ,M:� y• 7 �0 /- S Manufacturer / j� Demand St Cover Gd 0 ' do g7 (� . Sr.. GPM Model Number TDH Lift , ) � Friction Lo System `d TD n t Forcemain Length� Dia. Z . Dist. to Well A) F SOIL ABSORPTION SYSTEM !� BED/TRENCH Width / Length 0 No, Of Trencf r PIT DIM�NSfONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS !j 75 7— ,,f�_I SETBACK SYSTEM TO BLDG WELL LAKE /STREAM LEACHING Manufactu r .� INFORMATION CHAMBER OR F�t/�C`r Type O Q iy W Ic i , )� UNIT Model Number DISTRIBUTION SYSTEM ^-4(1CJJ w a +x7 /{/ 5 fi Z�✓ = 5 Header /Manifold it Distribution x Hole Size x Hole Spacing Vent to Ai11nta� Pipe(s) ` i J Length Dia Length Dia Spacing N , ` Q SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Sy stems Only Depth Over Depth Over 1 xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center 2 Z! Bed /Trench Edges \ Topsoil ` <s No �es No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / _ Inspection Location: 596 200th Avenue Somerset, W1 "' � 6J 54002 (NE 1/4 NE 1/4 27 T31 R1 9W) River Hawk . Ridge Lot 23 Parcel No: 27.31.19.1478 1.) Alt BM Description 4 I r; {^eA" G Z' `0'""''V �,/l5G &L 15 2.) Bldg sewer length = - amount of cover = 1' VZ Plan revision Required? Yes > tQ Use other side for additional information. — Date 4insepctorr' re Cert. No. SBD -6710 (R.3/97) commeree.wi.gov Safety and Buildings Division County / 201 W. Washington Ave., P.O. Box 7162 / 1 i sco n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be tilled in by Co.) Department of Commerce 57 6 8 —7 Sanitary Permit Application st ransactioWk In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the approp ental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -o e POWTS ar ect Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used f ary ur oses in accordance with the Privacy Law, s, 15.04(1)(m), Stats. I. Application Information — Please Print All Informat' Property Owner's Name Parcel # 3 - / Property Ow er's Mailing Address Property Location Govt. Lot City, S t� Zip Code hone Number �I/ y <, _ ,J�r ' /a, Sectio �— ircle one T 3Z N; R E o(W II. Type of Building (check all that apply) Lot # X I or 2 Family Dwelling — Number of Bedrooms Subdivision Name �r � � � • ock # ,� ❑Public /Commercial — Describe Use �pJ4P, ��I � ❑City of ❑State Owned -- Describe Use ��/' C'SM Number ❑ Village of 1�4 Town of _ _ Q t � �1�b L.J ZS +- z5 III. Type of Permit: (Check onl one box on line A. Complete line B if app icable) A ' New System p y b p y g y (explain) ❑ Replacement System ❑ Treatment/Holding r Tank Replacement Only ❑Other Modification to Existing System ex lain ) B. ermit Renewal ❑ Permit Revision ❑ Change of Plumber ermit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System /Co m onent /Device: (Check all that apply) ❑ Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank El Other Dispersal Component (explain) ❑Pretreatment Device (explain) V. Dispersal/Treat ent Area Information: Design Flow (g pd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sfy Syste Elevation x VI. Tank Info • x Capacity in Total # of Manufacturer ,0 v Ions Gallons Units L U New Tanks Existing Tanks �nr Cam' �V C t 1 Septic or Holding Tank 6,9 Dosing Chamber V11. Respon''bility Stat emen , the undersigned, assume responsi ilit) for installation of the POWTS shown on the attached plans. Plumber s ne (Pr' t Plumber' S gnatu MP /MFRS Number Business Phone Number Plum er's �d ( tree , ity, State, Zip Code) �L✓ � VII County/ e art ent Use Onl Approved ❑ Disa Per Fee Date [ ued Issuing nt Signature —,lr- �/_� iven Reason for Denial S /5 a7 IX. Conditions of Approval /Reasons for Disapproval 3� ��� G p ti �,•� rca d� P CCw.�.• SYSTEM OWNEW 1. Septic tank, effluent fitter and :50 �� l � /Vt.vb dispersal cell must all be services /„ / as per management plan provided by pMntter. / fir �` ( 3 2. AO settlack requirements must be nql mwtad V t (/ as per a system and submit to the County only on paper not less than 8 1/2 x 11 inches in size 14) 64e'-� C &f 4" SBD -6398 (R. 01/07) Valid thru 01/09 12- 6P C, a J I- ° i� M a3NW:7 %43 "Vl 14 '.. ,. t vA � oO � 3 Q p O� o. \ l Q a o � , . 4 / r— ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �40 r ^c� S�r� ��i e � �o i C- 1 Mailing Address y ( v & . Property Address � c l.0 l 0 7 (Verification regiure�d from Planning & Zoning Department for new construction. City /State - S� Parcel Identification Number -�3 -fin i LEGAL DESCRIPTION Property Location k 1 /4 ,'/4 , sec. ,-2;�, T_NR W, Town of ow ��sr Subdivision Lot Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes Lot lines identifiable SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, 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 s :anuar�:s set forth, herein as set by u epar anent of Commerce and the Deparunent 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 Planning & Zo,ung Depa; anent within 30 days of the three year expiration date. Uwe certify that ail statements on this form are true to the best of my /our knowledge. Uwe amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms w SIGNATURE OF APPLICANT(S) DATE `* *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department * ** de wzth this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if e -z nc is made in the warranty deed. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner' Septic Tank Capacity ❑ NA Permit # � p py gal � Septic Tank Manufacturer - ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units 1 NA Pump Tank Capacity a l 11 NA Estimated flow (average) ! gal /day Pump Tank Manufacturer s ❑ NA Design flow (peak), (Estimated x 1.5) v gal /day Pump Manufacturer 7 ❑ NA Soil Application Rate gal /day /ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit XNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :9150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average . Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD _ :30 mg /L 0 �In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L C� NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) _ :10 cfu /1O0m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank ❑ month(s) s) At least once every: � �3' earls) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 0 year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA JA year(s) inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA J9 year(s) s Laterals and pressure test At least once every: ❑ month(s) KNA ❑ year(s) - At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA 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 inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cells) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding 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 a7v servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service re;::rt si-a;I be provided to the local regulatory authority within 10 days of completion of any service event. I START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). 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 highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to 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. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All 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. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: Yj A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALL R POWTS MAINTAINER Name _ / Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name . Phone Phone -` s document was dra`:e_ - ._ °ance with chapter Comm 83.2212)1b)(1)1d) &(f) and 113,54(l),12) & 131, Wisconsin Administrative Code. START UP AND OPERATION Page _ of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). 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 highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to 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. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All 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. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALL R POWTS MAINTAINER Name 4 _ Name Phone — Phone SEPTAGE SERVIC OPER ATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name s J Phone Phone s document was dra` ::' ante with chapter Comm 83.22(2)(b)(1 ;(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 4 Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and - -i Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented E- Alternate outlet location Forcemain diameter Manufacturer _� 2 in. Capacity 800.00 Gallons Volume 21.76 gal /inch A Weep hole or anti- Dimension Inches Gallons B siphon device A C B j', S Pump off e levation (ff) y D 6 - D Total Dose tank elevation (ft) Alarm Manuafacturer - !� Alarm Model Number Pump Manufacturer V Pump Model Number * �11,4 Pump Must Deliver E� gpm at /2 TDH i MGOULDS PUMPS Submersible Effluent Pump M OD EL 3885 -"& w. WE Series F Tw r � . _.-� PROSURANCE AVAILABLE FOR RESIDENTIAL W APPLICATIONS. �. APPLICATIONS ■ Shaft: Corrosion- resistant, Single phase (60 Hz): can be operated continuously Specifically designed for the stainless steel. Threaded • Capacitor start motors for without damage when fully following uses: design. Locknut on all models maximum starting torque. submerged. • Homes to guard against component • Built -in overload with ■ Bearings: Upper and • Farms damage on accidental reverse automatic reset. lower heavy duty ball bearing • Trailer courts rotation. • SJTOW or STOW severe duty construction. • Motels ■ Fasteners: 300 series oil and water resistant ■ Power Cable: Severe duty • Schools stainless steel. power cords. rated, oil and water resistant. • Hospitals ■ Capable of running dry •'/3 —1 HP models have Epoxy seal on motor end • Industry without damage to NEMA three prong provides secondary moisture • Effluent systems components. grounding plugs. barrier in case of outer jacket ama • 1 HP and larger units have damage and to prevent oil ■ Designed for continuous bare lead cord ends. g P SPECIFICATIONS operation when fully Three phase (60 Hz): wi O ptiona l S tanda rd are available. Pump ubmerged. P lengt P • Class 10 overload protection ■ O-ring: positive MOTORS Solids handling capabilities: must be provided in g P 3 /4' maximum. sealing against contaminants separately ordered starter • Discharge size: 2" NPT. ■ Fully submerged in unit. and oil leakage. • Capacities: up to 140 GPM. high - grade turbine oil for • STOW power cords all have AGENCY LISTINGS • Total heads: up to 128 feet lubrication and efficient heat bare lead cord ends. TDH. transfer. Tested to UL 778 and ■ Designed for Continuous CSA 22.2 108 Standards • Temperature: ■ Class B insulation on g ® By Canadian Standards 104 °F (40 °C) continuous '/3 Y: HP models. Operation: Pump ratings are Association 140 ° F (60 °C) intermittent. ■ Class F insulation on 2 HP Within the motor manufacturer's ce US File #LR38549 • See order numbers on models. recommended working limits, Goulds Pumps is Iso Soot Registered. reverse side for specific HP, voltage, phase and RPM'S MET R5 FEET available. r WE15HH SERIES: WE 120 SIZE: /a SOLIDS 35 1750. RPM: 3500 & _. FEATURES Ito WE20H 5G ■ Impeller: Cast iron, semi- 30 100 sFr open, non -clog with pump- 90 WE15H — _ out vanes for mechanical W 25 80 E10H seal protection. Balanced for 70 smooth operation. Silicon a 20 - E07H bronze impeller available as o 60 _ . WE05_ an option. a 15 50 E05H J -- r ■ Casing: Cast iron volute ° 40 type for maximum efficiency. 10 30 03M 2" NPT discharge. 20 wEO3L - ■ Mechanical Seal: SILICON 5 10 _ CARBIDE VS. SILICON CARBIDE sealing faces. ° ° 0 10 20 30.... 1 50 60 70 80 90 100 110 120 130 140 150 160 GPM Stainless steel metal parts, BUNA -N elastomers. 0 5 10 15 20 25 30 35 m /hr CAPACITY Goulds Pu mps </X> ITT Industries _ : -z—.. www.goulds.com sos/ c� U, 2907P 330 4Bi09179 State Bar of Wisconsin Form 2 -2003 KATHLEEN N. REGISTER OF DEEDS DEEDS WARRANTY DEED ST. CROIK CO., WI Document Number Document Name RECEIVED FOR RECORD 10/12/2005 10:15AN WARRANTY DEED THIS DEED, made between Grand Properties, LP EXEMPT # REC PER: 11.00 ( "Grantor," whether one or more), TRANS FEE: 186.00 and Cory J. Kreibich and Sara, Yreibich, husband and wife COPY CC FEE: PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space rHE RIVER BANK is needed, please attach addendum): PO Box 188 Lot 23, River Hawk Ridge. St. Croix County, Wisconsin. vsceola. WI 54020 032 - 107540 -100 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warran ies: Easements, restrictions and rights -of -way of record, if any. Dated Pro erties, LP (SEAL) (SEAL * *By: ' Michael J. G rmain (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Grand Properties, LP By: Michael J. GAnushl STATE OF ) authentic ed ) ss. //V COUNTY ) *Kristine O land Personally came before me on , TITLE: MEMBER &TATE BAR OF WISCONSIN the above -named (If not to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Oeland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO -PROTM Legal Forms 800 - 855 -2021 www.infoprofbrms.com Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divisicrt INSPECTION REPORT Sanitary Permit No: 463475 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 Na City Village X Township Parcel Tax No: Belisle, Tom Somerset, Town of 032 - 2174 -23 -000 CST BM Elev: Insp. BM Ele 7 Description: Sectionlr Range /Map No: 27.31.19.1478 TANK INFORMATION ELEVATION DATA TYPE MANUFAC RER CAPACITY STATION HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht It TANK TO P/L WELL BLDG. Vent to Air ke ROAD DrBottom t Septic Dosing Header /Man. Aeration Dist. Pipe Holding ot. System PUMP /SIPHON INFORMATION Fin rade Manufacturer Demand St Cove GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to W SOIL ABSORPTION SYSTEM B MENSIONS Width Length o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ED/TRENCH DIMENSIONS I t SETBACK SYSTEM TO /L JBLDG IWELL LAKE /STREAM LEACHING facturer. INFORMATION CHAMBER OR Type Of System: UNIT Model tuber: DISTRIBUTION SYSTEM Header /Manifold IDistributiort 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 Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil [ I Yes j No J Yes ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 596 200th Avenue Somerset, WI 54025 (NE 1/4 NE 1/4 27 T31N R19W) River Hawk Ridge Lot 23 Parcel No: 27.31.19.1478 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes j ] No Use other side for additional information. - -- Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division Co Vi m 201 W. Washington Ave., P.O. Box 7162 s Madison, WI 53707 - 716 `f anitary ermit Number (to filled in by Co.) Al Departme of C ommerce (608)266-3 Caw 3 1 -5- Sanitary Permit Applica Plan D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informati o o 'de`A P may be used for secondary purposes Privacy Law, s15.04(1 � O\X ct Ad dr (if different than mailin ess I. Application Information - Please Print All Information �p1\ Property Owner's Name Parcel # Lo B}eek#- , / 1g Property Owner's Mailing Address Property Locat' C 1 Crty, State Zip Code Phone Number ' _V., Section �Z ctrele N; R E o I1. Type of Building (check all that a ly) S 1 or 2 Family Dwelling - Number of Bedroo Subdivision Name C&M Ntm*er ❑ Public /Commercial - Describe Use 11 State Owned - Describe Use ❑City ❑V' age,JTownship of r III. Type of Permit: (Check only one box on line A. Xmplete line B if applicable A" XNew System ❑ Replacement System ❑ T,3 nt/Holding Tank Re/ meet Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Pe it Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber IV. Type of POWTS System: Check all that a pply) X Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ M d < 2 of suitable soil 11 At-Grade El Single Pass Sand Filter El Constructed Wetland ❑ Pressurized In- Ground 11 Holding Tank t Filter erobic Treatment Unit 11 Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ED] Drip a ❑Gravel -less ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dis al Area Required (sf) Dis I Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total NumW Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of ncrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersi ed,, augie responsi ' ity for installation of the POWTS shown on th-NIftched plans. Plum er' ame kPri t) Plum MP/MPRS Number B ess Phone Number — O '? Plumber's (Street City, State, Zip VIII. Coun /De artment Use Onl Approved 11 D Wt Sanitary Permit Fee includes Groundwater Date Issued Issuing gent Sign (No Stamps) (wlt "at" Surcharge Fee) / 11, ❑ n Reason for Denial 3 � & Ix. Conditions Approva I _ SYSTEM OWNER: 3J S S S` �r>Zn �'y -'�'r ^"'� 1 Septic tank, effluent filter and 6 t dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2, All setback requirements must be maintained as per applicable codelordinances Attach complete plans (to the County only) forsysm on aper not lets aUS /2 inches in sitt t 1 SBD -6398 (R. 01/03) ,� �3 \ l M } I AJ Z �4 _ 13 Op �S ? 9 h v 0 J 0 tj � I / P t- Wisconsin Department of Commerce DEC EVALUATION REPORT Page of 3 Division of Safety and Buildings ST_ CROI a�DOf�@ IC 4t4`Comm 8o, Wis. Adm. Code Coup r Attach complete site plan on paper not less than 81/2 x 1 I size. Plan must " Coo 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. Revi ed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). P a d Property Owner Property Location -7—o,-,n Govt. Lot ME 1/4 /VF1 /4 S3. 7T , j l N R l f I (or)9 Property Owner's Mailing Address Lot # Block # Su d. Name or CSM# A City State Zip Code Phone Number E] city C] Village jgJown Nearest Road SD � Mfr . Gvi sY -4 2,s 1 (71S )25�- 5 0 t)-1e ,-fe 1 5 ft S -New Construction Use: ® Residential / Number of bedrooms _� Code derived design flow rate 60 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable IVA ft. General comments S� }may /a��, ✓ - �, S'G"" (�Yi S'h� �3 and recommendations: l 7 L e L& © Boring # ❑ Boring C� ® pit Ground surface elev. Depth to limiting factor < 6 / in. Soil Application Rate Horizon Depth Dominant Color Redox Descrip ron Texture Structure Consistence Boundary Roots GPD 1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 l 6 3 & D. S d. 9 IF 2 / ©Y,( A tvt ,ph, mvi^- c c-/ 0 ,S - d, 3 203 75 % 114 IVAe M ,/ il IVA a, 5 o. L/ 36 -Y3 7sr� 4 l as 0 1 17, -5 W41 - 71sYe' % A Stf/LS ltvbk Yh✓ii Q S — 0 I, � ® Borin g Boring # ❑ / pit Ground surface ele . a ft. Depth to limiting factor i CJ 7 / m. Soil Application Rate Horizon Depth Dominant Color Redox scription Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Con . olor Gr. Sz. Sh. 'Eff#1 'Eff#2 a--1 0 1011 -ji A �b t 0, 0-q 2 /a l5 /o `/ ,¢ G 2J'') b& ^ u � � c w 0 , 5 - ®. 9 3 1� - 7 fl V 1 SL - 2 I''►fbAr /h- v is c v-4 h 0, - 5" O . y 327 7,sI Y A L. Silk C 6 /m Sbt ^ lr r=o 0-S 6 La 5 ' - X 7, -5 51 : C 2-55 "Y* 5 "1 a L 15 o-Pr. O, y D, 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 P � 'nt) Si gnat CST Number �31 i a.► `I U/'l) e '2313 y Addre Date Evaluation Conducted Telephone Number ,*12 71 s = ? YI 3Z SBD -8330 (R07 /00) l Property Owner /" ` Parcel ID # Page of 3 F51 Boring # ❑ Boring © pit Ground surface elev. 0 � ft. Depth to limiting factor <5y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Mun sell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 t O -lo JDj 3 % I VA 5 L a ME a4l c w 6. 0e 1 ILO--17 /L) '//Z cam 0 ©, q 3 17-2 75Y/ I VA ®, s , q � /V,* GS / ^.sbiz /400c as 0.. 1, .a 6 C P SYl .V,? O'e 5 �- Sid OPI rn 14- 0,0 0 ,'a r Boring # ❑ Boring u ❑ 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 F] Boring # [] El pit Boring 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 ' 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) P40 OWNTTIP� Name 0/-,, CSr Address ave Date . 12 — Benchmark I / % q Benclamafk Soil Lorin __i Suitable area 0 S cale f —_-__ - -_-_ -_ _. .,_ i f i ! I I I i 1 � ! ( I I � I i � i I I I I i t - T - T T 7 —r- t 70' �44 Te rpelf 76 - ---- T - T i T-7-----' / PAEaE Of PUMP CBhMb[R CA055 SECT10k� AN S PECIFICATIONS VE WT CAP r NT PIPE `I VE NT /►PtROYCO LOGKIhtG WEATHERPROOF _ JU WCTIOAJ BOX MA WHOLE COV[.R WITH 25' FROM DOOR, WMWIN6 LnBEI WINDOW OR FRESH IZ•MIU. AIR IWTAKE 6RADC --� y' M au, COQDUIT — IIk1LC T A , 'Al,.i, r A:Al_M -- I III V T — T APPROVED JOIIJ7 A I I ( I A PPKOYCD JOIE. W/ PIPt I III W/ ' PIPE CXTCNDIWCr 3' I I ALARM E%TEUDiuG 3' O1JTO SOLID SOIL I I O►ITO SOLID S., 15 I I I/ OW . C I CLCV. FT. PU11P b oFF I D COUCRCTC BLOCK -- 1 RISCR. EXIT PERMITTED OQLy IF TAWK MAWUFACTURCK HAS SUCH APPROVAL AppAoVEN 6CCDiNG u, TvrWK SEPTIC t SPEC,IFICATIOUS DOSE TAWKS MAUUFACTURC:R: IJLL^1DCR OF DOS - PER DA - -� TAWK SIZE: GALLOWS DOSE VOLUME //0 n ALARM MAUUFACTURCR: - • �� INCLUDIWG OACKFLOW: - 7 GAL:0K MODEL WUM6CR. C AP AC ITIES. - # A I IWCACS OR GALLOU S : A = � _ 514ITCH TyPC: %' �/ 8 =.�---- 11JCNES OR •� { � � GALLOt PUMP MAWU FACT UKCK: _ C n }'/ INCHES OR GALLOU: MODEL MLlMDER: ��� �= �I / � 1 — D- INCHES OR /7�R GALLO). SWITCH TyPC ; ���� /A = w-- IIo F PUMP AUD ALARM ARE TO pC MIWIMUM DISCHARGE RATE _.__2L,�- ___._GPM r^ I NSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFCREWCE OCTWECW PUMP Off At-JO OI.'iTR16tJTIOU PIPL,. _1.._.._ FEET 4- rtIAJIMUM NETWOKK SUPP PRC . . . . . . . 1 ,ter FGCT + • L26 _ FEET OF FORCE MAIN X �,=??- F /o �rr,IRICfI��I �AG7urt,..1�Z�_ FEET TOTAL 0 HEAD - FEET IIJ TCRWAL. fIIMr_U IOWt OF 'i'AWK: LENGTH jwio LIQUID 0CPTH - ►J' Ui:R: _ GATE: - -- Performance buom tmueni .Curves Pumps METERS FEET °° -7..T M.ODEL 3885 25 60 -SIZE 3 /4 "i Solids H WE 15 10 20 WEIGH - 0 • WE07H 15 50 _ WE05H 40' 101• WE00M i 20 WEO4 - 5 �, —+- -a - - 1 0 —' –� 70 80 90 100 110 120 GPM J 2G} SJ 60 2 0 00 ml/h CAPACITY �GOULDS PUMPS, INC, seaA FALLS NEW )m Owe METERS FEET 120 -- i- - —�- MODEL 3885 96 ' - - - —�- - - - — - SIZE 3 /4 " Solids 110 � Ww � E 15HH —t--t- h 90 �---- - -- --t— i 25 80 `�..,. 70 20 �--' --}- -- WE06HH 15 60 --r- - -- - °r— --�- 40 20 -- .-- }— {— ' 10 - L I Zt 0[ 0 10 20 90 40 60 70 60 00 100 110 120 oPM 0 20 90 mJm CAPACITY 1986 GOVI41 PVmP1, Inc. Enwv Jvi� ids POWTS OWNER'S MANUAL & MANAGEMENT PLAN.. Page c:2 FILE INFORMATION SYSTEM SPECIFICATIONS l Owner Septic Tank Capacity gal ❑ Ni, Permit N 3 �� " Septic Tank Manufacturer ,o s" 5 ❑ N' DESIGN PARAMETERS Effluent Fiiter Manufacturer ' ❑ Nr• Number of Bedrooms D NA Effluent Filter Model ❑ N!; Number of Public Facility Units _51�!NA Pump Tank Capacity girp gal C) NA I Estimated flow (average) gal/day Pump Tank Manufacturer S ❑ Nt, Design flow (peak), (Estimated x 1.5) ____g altday Pump Manufacturer ❑ NA Soil Application Rate al /da /ft2 Pump Model CI NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BO0 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑Disinfection ❑Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ED NA 1 Biochemical Oxygen Demand (BOD 530 mg /L 2( In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ,0 NA ❑ At -Grade ❑ Mound Focal Coliform (geometric mean) 510' cfu /1001111 ❑ Drip -Lino ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: Ca NA Other; ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: 0 NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ months) `` (Maximum 3 years) Cl NA Inspect condition of tank(s) At least once every: 3 earls) Pump out contents of tank(s) When combined sludge and scum equals one -third .(Ys) of tank volume El NA s) ' Inspect dispersal cell(s) At least once every: El month( (Maximum 3 years) ❑ NA year(s) At least once every: El month(s) p Ni, 1 Clean effluent filter JR� year(s) ❑ month($) Q Ni. Inspect pump, pump controls & alarm At least once every: 31 ;0 year(s) ❑ month(s) , NA Flush laterals and pressure test At least once every: ❑ year(s) ❑ month(s) -C Other: At least once every: O earls) Other. O NA 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, Septags Servicing Operator. Tanis inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surfacE. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding 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. GMW 1410 Pape of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or, other chemicals that may impede the treatment process and /or damage the dispersal cell(s). 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 highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the oellis) and may result- in backup or surfs" discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior -to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually "operating the pump' controls to 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. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides ;, : meat; scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the systern is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings oealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage . .Servioing 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. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, ..to provide a code compliant replacement system: M` A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. Cl A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be, installed as a last resort to replace the failed POWTS. 13 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area.. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. El Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, " DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name , Name t Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AU ORITY Name Name Phone (his document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.540), (2) & (3), Wisconsin Administrative Code. ST CIZOIX COUNTY S1'FVIC TANK MAINTENANCE AGREEMENT AND O "`NLRSHIP CGR`I'IFICA'NON FORM Ma iling Address -��'' �crrlication requir�l) from Planning Depunmcnt for now construction) t'ilyi5latc _a - � `.3Parcel Idunlilicution Number 0 37- ` J- 174 - Z - 3 — am Property Location /, Luc "1 �,,,N -R — W, Town of U�) �� Lo t # c�4 volume � � Page # volume 2�� , page # 2/C Spec house yes Q no Lot lines identifiable ` yes C1 no SYSTEM NLA1NTE'NANC'E lmproper use and marntcnuncr of your septic system vuuId result in its premature failure to handle wastvs, I'ruper ni I consists of pumpwn nut the septic funk vvery three years or sooner, if nccdod by a liconood pumpor, What you put into the >ystc can aft'ect the funvtiun of the septic tank as a treatment stago in the waste disposal system• , The property owner agrees to suhmit to ;st. C'ruix luninb Department st certification form, signed by the owner ; i); mtisier plumber, journeyman plumber, restricted plumber or a liecnsed pumper verifying that (1) the on-site wastewaterdispos� sv;tc, IS to pruper operu„ iii, cUoditwn uncVor (2) aticr inspection and purnping (if necessary), the septic tank is less than 1/3 full oi' slu ec liwe, the undersigned have rcaa the above requirerrwnts and abrcc to maintain the private sewage disposal system with the stanaar set forth, hcraut, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Cortificatiu: stating that your septic system has been maintained must be completed and rotvmod to the St, Croix County Zoning Offico withrn 3 days the three year expiration date. DA'I'1~ W FRS, Dr Y L i TI N i (we) certify that all statements un Uus form are tnre to the best of my (our) knowledge,. t (we) am (are) the owner( the pro erty described above, by virtue of u warrantydccd recorded in Register of Dads Office, �iGNr1'I'111t1~ O1' APPLICANT DA'f E Any information that is mis•representcd may result in the sanitary permit being revoked by the Zoning Department. •• «� "• Inoludu with this aiiflicalion: a stamped warranty deed from the Register of Deeds office u vupy of utc certified su rvc ma if r fe Y � fence 's P t made in the t warren Y decd i V 2779P 210 KATHLEEN H. WALSH • REGISTER OF DEEDS ST. CROIX GO., WI RECEIVED FOR RECORD i AMENDMENT TO LAND CONTRACT 04/06/2005 04:60PK LAND CONTRACT AKENDKEN EXEIPT # WHEREAS, Alan J. Vanasse and REC FEE: 15.00 TRANS FEE: Patricia H. Vanasse, as VENDOR, and COPY FEE: Progressive Estates LLC, as PURCHASER, CC FE E - 3 entered into a land contract dated December 12, 2003, recorded December 22, 2003 in Volume "2478 ", page 395, as Document No. 749766 as to the following described real estate: A. West 754 feet of the Northeast Quarter of Northeast Quarter (NE 1/4 of NE 1/4) of Section Twenty -seven (27), Township Thirty -one (31) North, Range Nineteen (19) West, lying East RETURN NAME & ADDRESS: of the Apple River. 5 C O // `4 J"u. ✓ O r" B. All of the Northwest Quarter SD Co. ('S. Y of Northeast Quarter (NW 1/4 S -Llpp of NE 1/4) of Section �~ Twenty -seven (27) North, Township Thirty -one (31) North, Range Nineteen (19) West, lying 032 - 1075 -40 AND East of the Apple River. 032 - 1059 -80 Parcel Identification No. C. Southwest Quarter of Southeast Quarter (SW 1/4 of SE 1/4) of Section Twenty -two (22) North, Township Thirty -one (31) North, Range Nineteen (19) West. WHEREAS, the parties are desirous of correcting the legal description of said Land Contract; NOW, THEREFORE, IT IS HEREBY AGREED, by and between Vendor and Purchaser as follows: A. That the legal description in said described Land Contract shall be amended to read as follows: 1. SW 1/4 of SE 1/4 of Section 22- 31 -19. 2. All of the E 1/2 of the NE 1/4 of Section 27 -31 -19 lying East of the Apple River. 3. All of the NW 1/4 of NE 1/4 of Section 27 -31 -19 lying East of the Apple River. ,_. 291.47 " FENCE' 6, 4' ; SOUTH pyrdi d T � A;f `� .. t r i 4 1�0�1� �irVC h .3.15 acres � . ` qq -�pN tiN . 132, 591 sq. ft, I / I I r rrr1 Q� 892.: sq , 04 acres acres A . h' Lor2 Jw 032 s q, 3.01 Q , acres �r � l • �� , MC G7 q� d..QT,G/ 13'0 7 Q 01 • "� �� /�/�/rrac" n 4 r 'f 0 c i '/ a- s ` �� "d am`,( \ ..� .' {:y d � .. e � A .rt � �(�iN.J•{�� '`..