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HomeMy WebLinkAbout038-1214-40-000 I Wisconsin Department of Commerce County: Safgy and B Ading Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: ( (ATTACH TO PERMIT) 499169 0 GENERAL INFORMA State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. — ti • X Permit Holder's Name: City Village X Township Parcel Tax No: Stock, Bill Star Prairie, Town of 038 - 1214 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: 11.31.18.1175 TANK INFORMATION I ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark y 3' Dosing Alt. BM I Aeration Bldg. Sewer 1•t ., Holding St/Ht Inlet i, � t TANK SETBACK INFORMATION St/Ht Outlet (• 1;' r TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man., l Aeration Dist. Pipe Holding Bot. System Final Grades a PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM ; _t's >. G Model Number i TDH Lift Friction Loss System Head TDH Ft i Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM Bt i' i7 ENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS i SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer INFORMATION INFORMATION CHAMBER OR .- AD s Type Of System UNIT Model Numb 4Y DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air In ake Pipe(s) Length Dia Length Dia Spacing 7J SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over TBed/ Over xx Depth of xx Seeded /Sodded 1 XX Mulched Bed/Trench Center rench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / • / 4, Inspection #2: - - " t / Location: 2244 124th Street New Richmond, WI 54017 (NE 1/4 SW 1/4 11 T31N R18W) River Place Lot 14 Parcel No: 11.31.18.1175 1.) Alt BM Description 2.) Bldg sewer length= - amount of cover = -- - ' )I J Plan revision Required? Yes No Use other side for additional information. Date Insepctor's Signature Cert No. SBD -6710 (R.3/97) Safety and Buildings Division County 1 201 W. Washington Ave., P.O. Box 7162 �scons N Madison, WI 07 — 7162 Sanitary Permit N ber (to be filled in by Co.) (608) 2 51 y 9 1 / Department of Commerce State Plan I.D. Number Sanitary Permit Applicati In accord with Comm 83.21, Wis. Adm. Code, personal information you r may be used for secondary purposes Priva �� Project Address (if event than mailing address) T. Application Information - Please Print All Informs ion -r �'? 1�� 1 cJ [ P r operty Owner's N e � Parcel # t # Block # operty Owner's Mailing Address Property Loca on I � U 1� c� r / %, �"`'' V, Section J City, State Zip Code Phone Number circl ne) T� N; ) E W II. Type of Building (check all that apply) �' �J Subdivision Name CSM Number or 2 Family Dwelling -Number of Bedrooms ` n¢ �l �� p ❑ Public/Commercial - Describe Use ❑City_❑villagoaf of j ❑ State Owned — Describe Use r M. Type of Permit: (Check only one box online A. Complete line B if applicable) (Son S A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal it Revision ❑ Change of El Permit Transfer to New Before Expiration Plumber Owner . IV. T e of POWTS S stem: Check all that a ) n - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade L1 Single Pass Sand Filter ❑ Constructed Wetland ❑Pressurized In- and ❑Holding Tank El Peat Filter El Aerobic Treatment Unit ❑ Recircu rutS Recirculating Synthetic Media Filte ng Chamber ❑Drip Line Gravel -les Pipe ❑Other (exp in) 4 V. Dispersal/Treatment ersal/Treatment Area ormation: Design Flow (gpd) Design Soil Application Rate(gp s Dispersal Area Required (s Dispersal Area Proposed (sf) System Elevati n p g �� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site feel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks � Septic or Holding Tani .7 'T 5 Aerobic Treatment Unit Dosing Chamber VII. Responsibility State - 1, the undersig utne responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print) Plumber' ature MP/MPRS Number Business Phone Number -Z_ z_6 Plumber's Address (Street, City, State ip Co e) r -rl_, t1j _ D /De artment Use Onl Sanitary Permit Fee (� Ludes Groundwater kDateis Issuing Agent ignature (No S ps) FVM.Coun pproved ❑ Disapproved Surcharge Fee) A 7— eReason o enia] IX. Conditions of pr 3 1- (r �S `U - - - c r20 SYSTEM OWNER: / �V�l " 1 Septic tank, effluent filter and o r- dispersal cell must all be serviced / maintained as per management plan provided by plumber. � 2. All setback requirements must be maintained aLASAL as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in sin SBD -6398 (R. 01/03) T A PROJECT, dill Stock PLO P N D A SS 1748 112th St. New Richmond Wi 54017 NE 1/4 SW 1%4S 1'1 /T 31 N/ 1 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9 BEDROOM 4 CONVENTIONAL XXX IN- GROUND URE CONVENTIONAL LIFT HOLDING TANK t/55 gallons LIFT TANK SIZE 9 S E MOUND SEPTIC TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 900 # of chambers 36 IL BENCHMARK V.R.P. Top of NE Lot Stake ASSUME ELEVATION 100' Filter BEST Filter ❑BOREHOLE O WELL H. R. P. Same as Benchmark SYSTEM ELEVATION 90.8/91.0 6' below grade Well is to meet all 360' B.M.* setbacks required by WDNR Rentention Pond 50' Plans Designed Using 2 -3' X 90' Cells with >3' Spacing 3% Slope Conventional Powts 85' Manual Version 2.0 B -1 20' 90' ST 10' 40' Vents 10' B -3 Pro 4 B -1 Bedroom House Replacement 55' area is Original soil Test M 48' B -3 Vent >6„ ARC 36 Biodiffuser 53' of Cover Leaching Chamber with 25.0 ft2 of Area 5' Long 11" 36 71 Grade at System Elevation B -2 18' Property Line 09 v� ` PLO T P AN PROJECT Bill Stock A D SS 1748 112th St. New Richmond Wi 54017 NE 1/4 SW 1 4 S 1 1 /T 31 N/ ' 1 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/18/06 BEDROOM 4 CONVENTIONAL )00( IN-GROUND SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 55 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 900 # of chambers 36 BENCHMARK V.R.P. Top of NE Lot Stake ASSUME ELEVATION 100 Filter BEST Filter ❑ BOREHOLE O WELL H. R. P. Same as Benchmark SYSTEM ELEVATION 90.8/91.0 6' below qrade Well is to meet all 360' B.M.* setbacks required by WDNR Rentention Pond 50' Plans Designed Using 2 -3' X 90' Cells with >3' Spacing 3% Slope Conventional Powts 85' Manual Version 2.0 B -1 r-- 20' 90' ST 10' 40' Vents B -3 10' — Pro 4 B -1 Bedroom House Replacement 55' area is Original soil Test 48' B -3 Vent >6„ ARC 36 Biodiffuser 53' of Cover Leaching Chamber with 25.0 ft2 of Area 5' Long 11 " Grade at System Elevation 36" B -2 18' Property Line - n� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 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 location and distance to nearest road. Please print all information, evie ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1c' Property Owner Property Location Govt. Lot /o L 1 /45L J1 /4 S f , N R, E (oi� W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# /'Y /e) i�� �� city State Zip Code Phone Number ❑ city ❑Village own Nearest Road New Construction Use: Residential / Number of bedrooms Code derived design flow rate 0 GPD ❑ Replacement ❑ Public r commercial - Describe: Parent material 0" l lJ Flood Plain elevation if applicable /a/!,a?� ft. General oomments and recornmendations:,4� L 9/� (� System Type �(/Y�✓ ✓ PVC 1� System Elevation l' ( ' O v F Boring # O Boring i pit Ground surface elev. ` ft. Depth to limiting factor / 3 b 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 Q_ 0 A OV Zo�r� �Da Boring # H.Boring / Pit Ground surface elev. J ft. Depth to limiting factor _ � � in. Soil Applica tion 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 I 'Eff#2 riv l l 31 L --- ��s l� / -j � :7 . 0 2 © (� J • Effluent #1 = BOD > 30 < 220 mg(L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) — — — CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715 - 246 -4516 Property Owner _ Parcel ID # Page of a Q Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor 3 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 CIA- eg -/ S O -n kol F-1 Boring # El Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor )n . _STo_ilApplication 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 '042 a Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Effluent #1 = BOD > 30 1220 mg/L. and TSS >30 < 150 mgA_ ' Effluent #2 = BOD 130 mg& and TSS < 30 mg/L n equal opportunity service provider and employer. If The De artment of Commerce is a q pp tY you need assistance to access services or P Y P need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (RAW) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 �� � ) 1 � �+/� Madison, W1 53707 — 7162 itary Permit Number (to be filled in by Co.) .5se Sl (608) 266 -3151 Department of Commerce to Plan I.D. Number Sanitary Permit Application 4)4 In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04 1 Project Address (if ddiifferent than mailing address) _ T. Application Information - Please Print All Information / 3 O 3 / icl Property Owner's Nam EP Parcel # / t# - B))4 # -:6 L ,I N / - operty Loca Property Owner's Mailing Address / YC K21, Section City, State ll Zip C�o[de'• -� Phone Number / t vV • C V 1 7-/ N V � c E c r W 11. Type of Building (check all that apply) /�/ Ot/1C P S M r Subdivision Name CSM Number 2 Family Dwelling —Number of Bedrooms n _ - ❑ Public/Commercial — Describe Use ❑ State Owned —Describe Use C:!5 ❑City_ ❑Village o shi P9 M. Type of Permit: (Check only one box online A. Complete line B if applicable) A. s ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. El Permit Renewal ❑ Permit Revision El Change of El Permit Transfer to New Before Expiration Plumber Owner t N. a ofPOWTS System: Check all that apply) -Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. 7Aerob ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland Pressurized 1n- d El Holding Tank [I Peat Filter tment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter hing Chamber El Drip Line El Gravel -Other (explain) V. Dis ersal/Treatment Area Information: P System Elevatio D Flow (gpd) Design Soil Application Rate(gpdsf) Disper Required (sf) Did Propised (sf) ' Ca acin Total Number Manufacturer Prefab Site Steel Fiber Plastic VI. Tank Info P tY Concrete Constructed Glass Gallons Gallons of Units New Existing W �.'S �t l� Tanks Tanks Septic or Holding Tank ` + r Aerobic Treatment Unit Dosing Chamber VII. Responsibility Sta nt - 1, the undersi assume responsibility for installation of the POWTS shown on the attached plans. Pl 's Name (Print Plum ignature MP/MPRS Number Business Phone Number Plumber's // Address (Street, City, State, Zi C y��l/t✓ /'� ) /� , �� (2 1-4 C� L , Coun /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date su Issuing t Signa P Approved ❑ Disap oved Surcharge Fee) ❑ Own4 G' en Real r Denial IX. Conditions of Approval/Reasons for Disapproval 3 1 (� 0 (� �o S ngt� o SYSTEM OWNER* r t. Septic U nk d& wt aw and t�J a 4Q, o %,)v.A �.., t AA ..'A ACk, 4 4 raev$.e dispersal toll must all be stsrviCas l m.iMainad as per management plan provided by plumber. � L l_ 2 AN sed�ack requirements must be maMined ,Ii) /VD v y54��- T as par appNcallle code / ardkw *$. // V Attach complete plans (to the County only) for the system on paper not less tha 81/2 x 11 inches in size SBD -6398 (R. 01/03) L T PLAN PROJECT Bill Stock DDRESS 1748 112th St. New Richmond Wi 54017 NE 1/4 SW 1 /4S 11 /T 31 N R 18 W TOWN Star Prairie COUNTY ST. CRs C MPRS Shaun Bird 226900 DATE 9 /DN 4 CONVENTIONAL )00( IN- GROUND P SSURE CONVENTIONAL LIFT MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE IZE HOLDIN ANK SIZE LOAD RATE .7 ABSORPTION AREA 9 BENCHMA V.R.P. Top of NW Lot Stake ASSUME ELEVA Filter ❑ BOREHOLE WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 9 /94.8 4.2' below qrade Well is to meet all 360' setbacks required by WDNR Vent Plans Designed Using ARC 3 io s Conventional Powts >6" Leac ' g Ch ber Manual Version 2.0 of Cover wit 5.0 ft2 • 11" 90' S Long Grade at System Elevation 10 3 6„ 2 -3' X 90' Cells ith >3' Spac B -1 50' 30' ST Pro 4 55' Bedroo House 48' -3 53' Vents B -2 18' Alt. B.M. Top of SW Lot Stake @ 99.6' Property Line f . ^ » :� , � y . � ° . � , \��< . . � � � ¥� ��� � }� f � �^ _ �. � ,�� � � � � � . � � � . . �\ y ,� . *� } �: � ' � # � 'd _ � 6d-7-01 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Cr oix 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. pending Please print all information. Re sewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). O Property Owner Property Location LaCa.sse Development Inc Govt. Lot NE 1/4 SW 1/4 S 1 1 T 31 N R 18 (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# _\ 5 r. rr 14 na River 1�;�T, City State Zip Code Phone Number ❑ City ❑ village RjT Nearest Road Hudson IWI 1 54016 (715 ) 381 -5405 1 Star Prairic - - I - -4� I I W".'�\ I [2 New Construction Use: ® Residential / Number of bedrooms 4 Code derived design I t 0 0 PD [I Replacement El Public or commercial - Describe: tda Parent material rn ah Flood Plain elevation if appli b ni,tc ft. General comments � and recommendations: \ - 10" � trenches @ el. 95.90, spaced to code 4.00' below grade C r I'� Boring S - �4 . Fi Borin # g �] pit Ground surface elev. 99.90 ft. Depth to limiting factor 120 in. Soil A lication Rate 1 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 1 0 -8 10yr4/3 none sil 2msbk mfr gw if .5 .8 •. 2 8 -30 10yr4/4 none sil 2msbk mfr-t gw if .5 .8 3 30-121 7.5yr4/4 none 13rcos Osg ml na. Ina .7 1.2 _ I� t( F- Boring # Boring 2 ® pit Ground surface elev. 99.90 ft. Depth to limiting factor 120 in. Soil ADplication 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 1 0 -9 10 4/3 none sil 2msbk mfr qw if A- 2 9 -25 10yr4/4 none sil 2msbk mfr 9W if .5 .8 3 25-120 7.5yr4/4 none grcos Os ml na na .7 1 2 t • Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ent #2 = BO Y1 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature -- CST Number Gary L. Steel 02298 Address -15A Evalbation Cefiducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 6 -22 -2001 715 - 246 -6200 i Property Owner LaC3sse Dev. CO. Parcel ID # pending Page 2 of 3 F-31 Boring # Boring [ pit Ground surface elev. 101 . 90 ft. Depth to limiting factor 1_ 0 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 1 0 -15 10 4/3 none, sil 2msbk �P 2 15 -40 10 4/4 S _ i 2msbk mfr 1 8 to 3 0 -120 7.5yr4/4 none CrrCOS Os •� r 1� It Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. =oil plication 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 F Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit I 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 5 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.6 /00) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 LaCasse Development, Inc. New Richmond, WI 54017 MPRSW -3254 NE' SW S11 -T31 N - (715) 246 -6200 town of Star Prairie lot #14 -River Place This Boil evaluation vas conducted to satisfy a zoning requireamnt, it may or may not bs suitable for your use. The location of the test may or may not be as shmm as permanent lot lines were not established at the time the test vas conducted. N A " =40' BM. = top of NW lot s e @ el. 100.0,' 'alt. BM.= top of SW lot stake @ el. 9.60' CID f3 t� Gary L. Steel 6 -22 -2001 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. De nto system is not exceed those required as per Comm. 83 ontin e Plan Opti ystem fails, determine cause of failure, use alternate area and install new s ed 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 OwnerBuyer Mailing Address 4 Property Address a la `-F �_ (Verification required from Planning & Zonmg Department for new construction-) City/State Parcel Identification Number U �' l r ZO L LEGAL DESCRIPTION r T �N I �._.� W, Town of Property Location � r /a y � /4, Sec. > Subdivision Lot # l Volume Page .# Certified Survey Map # Warranty Deed # 3q Sb I , Volume , Page i # Spec house yes no Lot lines identifiable yes no 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 t reatm e nt stage in the waste disposal sys� er maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary agrees The property owner a s 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 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we c that tatements on this form are true to the best of my /our knowledge. Uwe amiam the owner(s) of the prop cri aabov , virtue of a warranty deed recorded in Register, of Deeds Office. ,.� 6 Si OF of DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department - * ** Include with this application a recorded warranty deed from the Register of Deeds Office a a copy of the certified survey map if and reference is made in the warranty deed. (REV. 08105) g345�� KATHLEEN H. WALSH State Bar of Wisconsin Form 1 -2003 REGISTER OF DEEDS ST. CROIK CO., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 09/ 14/20M 11:15AK WARRANTY DEED EXBIPT # THIS DEED, made between LaCasse Development, Inc., a Wisconsin Corporation REC FEE: 11.00 ( "Grantor," whether one or more), TRANS FEE: 105.00 COPY FEE: and Bill Stock CC FEE: PAGES: 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): River Valley Abstract &Title, Inc. Lot 14, Plat of River Place in the Town of Star Prairie, St. Croix County, Wisconsin 1200 Hosford Street Suite 201 Hudson, WI 54016 File #: 2691247 038 - 1214 -40 -0 Parcel Identification Number (PIN) This i s n ot homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights -of -way of record, if any. Dated September 12, 2006 •� (SEAL SEAL S (SEAL) (SEAL) i AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. St. Croix COUNTY ) eC * C Personally came bejgre me on S tember 12 2006 , TITLE: MEMBER S �Tgt F �IIN the above named (If not, � � authorized by t. § 706.06) a kno n t e the person(s) who executed the foregoing k o 1 dged a same. THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg v 1200 Hosford Street Suite 201 Hudson M WI 54016 c, t f Wisconsin My Commi lon ( (is is permanent) (expires: ) (Signatures maybe 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. 1-2003 * Type name below signatures. 'Vof •r aelV 1 V • I @9N as dodo pa @CE X3 @ - I i I I I I - OLD MILL ROA -- - OLD MILL ROAD 941.57' 9 — — 372.46' — — — — — — 342.2&- � I S89 714.66' BENCHMARK C I TOP OF 2" IRON PIPE p ELEV.856.84 .ti 33' W CO a LOT 1 C0 2LOs ACRES d I I a 2.312 ACRES 94,356 SG FT G 100,899 SQ FT p I z ; Im 100' • N89 "E 713.22' I V 389.83' 3153.88' p Z 16.50 . _50 LOT 2 w LOT 15 •�° 1.647 ACRES 1.589 ACRES i 71,762 SO FT 69,230 SO FT �z y ------ --------- I iN I ; i m ; Z I , H.W.L. = 938.50 p N89°31'27 "E 712.21' 0 j 364.82' 347 8' N NG EA .�'�. 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