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HomeMy WebLinkAbout038-1195-00-000 0CA0 3 - 0 n C'7 o v1 m ? 3 A. h. �Tn `-' c I r � CD 0 (n x M v, Z o 00 2 cn ca ° w :r • A m 7 m M D N C m 'C 00 W �! N °- 7 Q y °- (D O O = (D O O Er 3 C O ° 7 f%1 0 > � O v Si ° O ° cn D (D (° v Cn i 7 W CD CD a 3 a A A y C FP W N �� i�3 pa CD C) r CO) y rn a) N 3 ^• _Q T r O O O Er N MA a r to tI� (n 0 I to D m n 3 N s 3 I ° N D o n a o v 0 N c CD p �• y C lN_l N _ N v c CD _ � m ti c s -1 co c D c � 0 N CL A z 0 .. Z w M m (^' m m Z CL I C A X r: Z (n Z A C A I CD a I ° � N C o a CD N I _ I ° e ti I v I � ` CD ti OD I � N N 7 m o I a � o °p m Dro o w o p o m o y ° o o ti Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: � (ATTACH TO PERMIT) 488118 0 GENERAL INFORMATION 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: Halle Builders Inc. rao� d B Star Prairie, Town of 038 - 1195 -00 -000 CST BM Elev: f Insp. Elev. BM Description: Section/Town /Range /Map No: a - �,�p ,Q� �OCmx¢, 13.31.18.1015 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ben hmark r 94 z. qa ol.�0 1�• Dosing Alt. r , /,10 M_7 Aeration Bldg. Sewer U 3 Holding St /Ht Inlet .9s TANK SETBACK INFORMATION S t /Ht O TANK TO P/L WELL BLDG. Vent o Air Intake ROAD Dt Inlet ep Ic y � r Y S3 Z� Dt Bottom osing J ea er an. i era Ion Dist. P ipe m olding Bot. bystem 0 2 ,w F inal ra e r PUMP /SIPHON INFORMATION anu ac ur r D emand ver G PM - 3,L>' 2 , .6fl m o d el ume I L ITT ric Io oss ys em New or emam j L7 U1 Sol 5ORPTION 5Y5 I 3(, ^ DI 3 cc) (edt Z } INFORMATION CHAMBER OR �j� C&AV _EM To r UNIT N.,t-/P L Pi s) Length Dia Lengt Dia Spacing > ( + r x Pressure Systems Only xx Mound Or At - Grade Systems Only UPI! I Of Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes ]No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: -T XLP ZW � l Inspection #2: Location: 2182 134th Street Star +Prairie, WWII 54026 (NE 1/4 NW 1/4 13 T31N R18W) Pine L Acres , Lot 20 Parcel No: 13.31.18.1015 1.) Alt BM Description = U —�' �VU� `�� J r / 2.) Bldg sewer length - amount of cover = u — - - — Plan revision Required? _ N � i Use other side for addition in atio n. Z r� f oar sepctofs — C � SBD -6710 (R.3l97) r � M�, - Y�t� C_ I7ivfs" n County n L 201 r P.O. ox 7162 j , Madison, WI 53707 – 71 2 Sanitary Permit Nu er to b filled in by Co.) f6pg Department of Commerce MAY a 1 V np t � rY State Plan I.D. Number Sanitary Permi I A r In accord with Comm 83.21, Wis. Adm. C e, personal information you p ovide may be used for secondary purpo Pr T in Project Address (if differ than mailing address) I. Application Information – Please Print All Information Property Owner's Name Parcel # Lot # Block # 2 .0 Property Owner's Mailing dress Property Location A � v A AA&_ /a, Section City, State Zip Code Phone Number 777"'�— q cucl n �J�til/ ICJ�� w t J T � N; RE r W 1I. Type of Building (check all that apply) Subdivision Name CSM Number or 2 Family Dwelling - Number of Bedrooms X? ❑ Public /Commercial -Describe Use ❑ State Owned - Describe Use ❑City_❑Villag ownship of. % l III. Type of Permit: (Check only one box on line A. Complete line B if applicable) // © S System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit NumbeXate Issued B. El Permit Renewal ermit Revision ❑ Change of [I Permit Transfer to New Before Expiration ; Plumber Owner �� IV. Type of POWTS System: Check all that appl n - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -G and ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter hing Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) 5. a fib V. Dispersal/Treatment Area Information: D . esigt Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the under ne , ss e r)wKnsibility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) Plu s natu j MP/MPRS Number ;Business �Ph7oneumber Plumber's Address (Street, City, Stat Z' de) VIII. Coun /De i ;; Sanitary Permit Fee les Groundwater Date Issued Issuing Agent ignature (No ) A proved El Disapproved Surcharge Fee) n{n( �� ❑ or Denial IX. Conditions o (� P Att complete plans (to the County only) for the system on paper not less than 8112 x 1 t inches in size SBD -6398 (R. 01/03) PLOT LAN PROJECT Halle Builders Inc. D ESS 1113 Hwv 64 New Richmond Wi 54017 y 1/4 NW 1/4S 13 /T 31 / 8 W TOWN Star Prairie COUNTY ST. CROIX MPR9 Shaun Bird 226900 , "% 4/26/06 BEDROOM 4 DATE CONVENTIONAL XXX IN-GROUND CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 900 # of chambers 36 IL BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark B. M. SYSTEM ELEVATION 92.5/92.3 5.2' below qrade 160' 405' Property Line 40 Vents — S — � L' F B -4 70' B -5 L� ?L'� P C 15' B -3 15' 70' 1% Slope B -2 B -1 0 ' 2 -3' X 90' Cells with >3' Spacing Pro 4 40' Bedroo )O House Vent > 6" Standard Biodiffuser of Cover Leaching Chamber with 25.0 ft2 of Area 5' Long 11 " 3 5 " Grade at System Elevation Plans Designed Using Conventional Powts 250' Property Line Well is to meet all Manual Version 2.0 setbacks required by WDNR 410' Property Line 148' Property Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Divisiorrof Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County t 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. vie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ,�(( NC ( t 2 , Z L J , �a �, Govt. Lot 1 /4/(i(,dA S/3 T 52 N R A E( r) W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# Zv ;. 4- City State Qlp Code Phone Number ❑ City ❑ Village wn Nearest Ro d P�N ew Construction Use: esidential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Pla' levation if applicable General comments P► C.� Sc ^uC l/" i�o r/ vi— and recomirnendations: q System Type System Elevation T Boring C] Boring yy�� / # a pit Ground surface elev. /v' 0 ft. Depth to limiting factor / � � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 I 6-1b lot" 31z- F -1 Boring # E] El ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Cnducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715 - 246 -4516 Property Owner _ Parcel ID # Page of ' Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. _9oi_lApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 ❑ Boring # ❑ Boring ft. Depth to limiting factor in. Soil lication Rate F] Pit Ground surface elev. 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 F - 1 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. E] pit Soil icafion Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8370 (8.6/00) ety and Buildings Division County ( Y 2 Washington A VISCo n, WI 5 707 — R�C V itary ermit Number (to a filled in by Co.) (60 2G6 151 Department of Commerce Sanitary Permit App ' a APR 0 kftate PI I.D.Numberr In accord with Comm 83.21, Wis, Adm. Code, personal in o ation yo provide I( may be used for secondary purposes Privacy Law, sl 1)(m S T.IDRUIX't sect A r (if different than mailing address) Z l BZ i3-/ I. Application Information — Please Print All Information lr,� j� Q � _A70 # # Property Owner's Name ' Parcel f t r Block # �s. C /1 ✓� / " r c z <� Property Owner's Maili g dress Property Loc / /., tion City, State _ Zip Code Phone Number cir e one) l� T N, E W `/ ♦ J II. pe of Building (check all that apply) Subdivisio ame CSM Number or2 Family Dwelling —N of Bedrooms boo 0 ❑ Public /Commercial — Describe Use Ikt ❑ State Owned — Describe Use ���5 / g ❑ ty ❑Villag ship of III. Type of Permit: (Check only one box on line A. omplete line B if applicable) , A_ ew System ❑ Replacement System ❑ Tr ent/Hol�ng Tank R acement Onl [I Other Modification to Existing System B. List Previous Permit Number and Date Issued ❑ Permit Renewal El Permit Revisio ❑ Change o 1 ❑ P it Transfer ew Before Expiration Plumber 6lwner r 1Vjjpe of POWTS System: Check Il th a 1 c) on — Pressurized ln- Ground ❑ Mo d > 2 in. o ' ble soil Mound 4 in. itable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized I - ound of in Peat Filter Aerobic Treatment Unit ❑ Recirqd Sand Filter p Recirculating Synthetic Media Filter in be Line ❑ el -le, Pipe ❑ Other (explain) V. Dis ersal/Treatment Area of rmation: Des i Flow (gpd) Design Soil A plication Rate( ds Npersal Ar auired (sf) persal Area Pr osed (sf) System Elevation 7 VI. Tank Info Capacity in Total Numb Manufacturer Pre lab Site 961 Fiber Plastic Gallons Gallons its Concrete Constructed Glass New E)asting Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit l / Dosing Chamber VII. Responsibility Statement - I, the undersigned, responsibility for installation of ike POWTS shown on a attached plans. Plumber's ame (Print) 4 Plumber's S MP/MPRS Number usinee Phone Number Plumber's Address (Street, City, State, Zip' County/Department Use Only Approved ved �.rial Sanitary Permit Fee (includes Groundwater Date Issued lssuin n i Surcharge Fee) / iven Rea l 0c, �VJ IX. Conditions of Approval/Reasons f Disapproval (� I — SYSTEM OWNER: 3 Q I l 4 5t,>7( ,� DLJIta - Ma co— tank, 1. Septic eff nM and � dispersal cell must be.services /_mahalned G as per management plan provided by plumber. 2. AN setback requirements must be maintained as per applicable cede / ordinances. r\ n I 46 b a a( - �i �— Attach complete plans (to the County only) for the system on paper not less than 81n; x 11 inches in sine SBD -6398 (R. 01/03) V4 70Wo m3T i va PLOT PLAN PROJECT Halle Builders In A DRESS 1113 Hwv 64 New Richmond Wi 54017 1/4 NW 1/4S 13 /T N/R 8 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 1� DATE BEDROOM BEDROOM 4 CONVENTIONAL XXX IN OUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark B.M. SYSTEM ELEVATION 94.2/94.1 4' below q/de 60' 405' Property Li 40' 2 -3' X 88' Cells with >3' Spa B -4 70 , B -5 1 35' B -3 Vents 15' 5' 0' ' B -2 7 1% Slope B-1 P ro 4 B edroo m / \ House Vent >6 „ Standard Bi diff ser of Cover Leaching C ambe with 31.1 2 of Ar 6' Long 11" 3 4" Gr e at System Elevation Plans Designed Using Conventional Powts 250' Property Line Well is to meet all Manual Version 2.0 setbacks required by WDNR 410' Property Line 148' Property Line Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of Division df Safety and Buildings in accord with Comm 83.45, Wis. Adm. Code Attach complete site plan on paper not less than 8 11 inches in size. Plan must County include, but not limited to: vertical and horizontal referenge {eir* direction and percent slope, scale or dimensions, north arrow, a foc�tign afid:dist" to nearest road. parcel LD.# '. B APPLICANT INFORMATION - Pl print all i�tformation\ a �Y�G('�— ding Date D Personal information you provide may be used for ndery purposes jP Lew, s. 15. (1) (m)). - - - -- Property Owner - Propgrty Location �;� Lake & Hills Development s t ,�' Govt.lot tJ F 114 N_ W 114,5 13 T 3 ,N,R 18 ❑w — Property Owner's Mailing Address k — Lot # Block # Subd. Name or CSM# 0 __ _ Pine Acres C itv S f Zip Code Phofidgto F City illage Town Nearest Road Y 'fac ��, ,r , , ! 134 TH. ST. �❑ New Construction Use: Z Residenti*4Jum Brooms 3 ❑Addition to existing building ------- ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpdtft trench, gpdffl Absorption area required 643 bed, ft= 562 trench, ff Maximum design loading rate .7 bed, gpolffa .8 t rench, gpolfl? Recommended infiltration surface elevation(s) 94.3 ft (as referred to site plan benchmark) Additional design 1 site considerations Parent material - - - - -- Flood plain elevation, if applicable ---- -- It S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system Zs ❑ u ® s ❑ u ❑ S ❑ u ❑ S ❑ U ❑ S ®u ❑ S ® u SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture ! Structure Consistence Boundary Roots GPDIft? Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh• Bed Trench 1 1 0 -11 10YR3 /3 ------------ - - - - -- I lmsbk mvfr as if .4 .5 2 11 -25 10YR 4/3 - I l msbk mvfr gw lvf 4 5 -- - - - - - - - _ Ground 3 25 -50 7.5YR4/4 ------------ - - - - -- cs ❑ osg m1 gw I - - -- I 7 8 elev - - -- � - -- - - 1 98 t 4 50 -89 10YR4 /6 - - - -- — - - - - - - -- ( s 1 osg ml - - -- - - -- .7 .8 De pth ❑ limiting g'� � factor >89 R arks: - s ��'tc�/ wh &4,94cn - a� _sue f 0 G6 ti 1 0 -11 10YR /3 ------------ - - - - -- 1 lmsbk ❑ mvfr as if 4 .5 2 - 2 - - - -- - - -- -- - - -- - - - - -- - - - - -❑ ----- - - - - - - 11 -25 10YR414 ------------ - - - - -- 1 lmsbk mvfr i gw lvf .4 .5 Ground 3 25 -54 7.5YR4/4 -- - - I cs osg ❑ nd gw - - -- 7 .8 - - - - -- -- - - - - -- elev - - 2a.2 ft. 4 54 -89 10YR4 /6 ------------ - - - - -- s osg ml - - -- - - -- 7 8 Depth to limiting. factor >89" Remarks: - CST Name (Please Print) Signature: Telephone No. Jacque Hawkins _ V7 - Y Address _ -/yr / Date CST Number Ref # 1 / J G► cs� h itC `+U� 3 4/8/00 a 6 L 392 l PROPEiTY OWNER: Lakes & Hills Development SOIL DESCRIPTION REPORT Page 2 of J PARCEL Depth Dominant Color Mottles Structure GPD/ftz Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots Bed :Trench 3 1 0 -12 10YR3/3 ------------ - - - - -- 1 lmsbk m vfr as if 4 .5 2 12 -23 10YR4/3 - -- -- 1 1 msbk mvfr gw 1 of .4 .5 Ground 7 g ------- - - - - -- cs os ml gw - - -- elev 3 23 -59 7.SYR4/4 - - - -- g 98.5 ft. - - -- - - -- . .8 4 59 -90 7.5YR4/6 ----------- - - - - -- s osg ml Depth to limiting ___ _�__ _ - ---- --- - -- -- - - -- - -- - - -- factor - �/ `' v ia, _ — > 90 11 - Remarks: __._ - - -_— -- --- - -. - -- 1 0 -9 10Y R3/3 ------------ - - - - -- 1 lmsbk mv fr as if .4 .5 - - - - - -- 1 lm mvfr 2 9 -25 10YR4 /3 ----- - - - - -- gam' 1vf . 4 . Ground elev 3 25 -56 7.5YR4/4 ------------ - - - - -- cs osg ml gw - - -- 7 .8 98.8 ft. 4 56 -94 10YR4 / 6 - - ----- - - - - -- s osg ml - - -- 7 8 Depth to limiting — - -- -- - -- — - - - -- factor >94" Remarks: 1 0 -10 l 0 YR3 /3 --------- - - - - - - 1 1 msbk mvfr as i f .4 .5 ---------- - - - - -- 1 lmsbk mvfr 2 10 -26 10YR4 /3 -- $`w lvf .4 .5 Ground ____ 7 8 eleV 3 26 -57 7. ----- _ ---- - - - - -- cs — osg ml gw 98.8 ft, 4 57 -95 10YR4/6 --------- - - - - -- s osg ml - - -- 7 8 Depth to limiting - - - -- - - -- - -- - -- — h factor p >95" Remarks: -- -__ - -— - -- - -- Ground - - � -- — -- — - elev ft. Depth to limiting —__ - - -- - -- - -- - - -- - - -- - -; - -- factor Remarks: _ — - -- - -- - J r I 3 �� ��� ,� 2'7 �� / • / .� �� 82,146 sq.ft. acres 1.89 acres 01c Gry 0/ / u 02 _ 21 1 1 S12• 3 l 535 \ S,9 \ � O7 H , 68,652 sq.ft. s1 "� I � 2.3p — o 80. N 1.58 acres +� c29� . W w ho sq.ft. c� TO ���0 31.s )cres 22 C 4 52y / � 70,332 sq.ft. 110 A 1.61 acres ��� �o�O / 23 �,�, �,� 78,324 sq.ft. 3 `'��, 1.80 acres 0 93,346 sq.ft. $ F 20 , 1 1p g 2.14 acres 2 2 o N00 � 93,110 sq.ft. 378.98' 2.14 acres OUTLOT 3 ��- Droins & �� / 109,642 sq.ft. p 1 Ponding Easement o 2,52 acres 0o r100YR HWL 987.3 o 0 11 - 2 0 390.96' 307.61 -- 250.83' 9 11 10 3 1310.43'(mew.) 12 - -- - -- t s� -- 1;00 0 08 50##E y�, 1310.45'(rec.) co R0 -11 RICH o� PRAIR 4 Ift �z a C � Lw N~ �� GRAPHIC SCALE a �; 1 zoo ,00 c o ,00 i V) ( IN FEET) o ° 1 inch = 100 ft Z SLIMED BEARINGS REFERENCED TO THE WEST LIN EAR F N00 ° 00' 1/4 132ND STREET_ - rnT1llAl 1 T 31 N.. R 18 W., ASSUMED TO B _ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ( OWNERSHIP CERTIFICATION FORM owner/Buyer &I II e Ls Mailing Address Property Address 21 '6Z 1 �:)Z d� (Verification required from Planning Department for new construction) City/State 6TAI; P EA I CIE i w I Parcel Identification Number © 3S - I � J ' 0 - 000 LEGAL DESCRIPTION j� Pro Location '/4, /f. '/4, Sec. l . T �' N -R W, Town of � i PAY Subdivision `-j ) N e h . Lot # y Certified Survey Map # , Volume , Page # Warran ty Deed # ! D 7 , Volume �� Page #� Spec house 0 yes ❑ no Lot lines identifiable a yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastorphmaber, journeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year xpiration date. ATURE F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the roperty descri above, by virtue of a warranty deed recorded in Register of Deeds Office. Ll x /Oca IGNA OF APPLICANT DATE * * * * ** A information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** *• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is :Wade in the warranty deed r J 2069P ?29 7el 1 ell 46 ! 1 WALSH STATE BAR OF WISCONSIN FORM 2 - 1999 K H. RATHLEEN DEEDS OF DEEDS Document Number WARRANTY DEED ST. CROIX GO., MI RECEIVED FOR RECORD This Deed, made between Lakes and Mills, Inc., a Minnesota 12/05/2002 11:00AN Corporation _ EXEPPT # REC Grantor, and Halle Builders, Inc., a Wisconsin Corporation TRA oration TRA FEE: 11.00 I[S FEE: 138.30 COPY FEE: CERT COPY FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lots 2 d 40, Plat of Pine Acres in the Town of Star Prairie, St. Croix Name and Return Address ounty, Wisconsin. 38- 1195 -00-000 038 - 1197 -10 -000 Parcel Identification Number (PIN) This is not homestead property. 0j) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of December 2002 Lake and Hills, Inc. * * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) (�� ) ss. c! J County ) authenticated this day of Personally came before me this day of December 2002 the above named Lakes and Hills, Inc., a Minnesota Corporation by D tr its ✓1 TITLE: MEMBER STATE BAR F S to me k to Apledged p erson(s) who executed the foregoing (If not, inst the same. authorized by § 706.06, Wis. ' THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogiand Notary Public, State of Wisconsin Hudson, WI 54016 My ission is per nt. (If not, state ex ' tion te: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their sign re, information Professionals company, Fond du Uac, wi STATE BAR OF WISCONSIN 8004655 - 2021 WARRANTY DEED FORM No.2 - 1999 Maintenance and Contingency Plan for a Septic S stem Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 C c Plan ystem fails, determine cause of failure, use alternate area and install new 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 Parcel #: 038- 1195 -00 -000 04/06/2006 03:46 PM PAGE 1 OF 1 Alt. Parcel #: 13.31.18.1015 038 - TOWN OF STAR PRAIRIE Current X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - HALLE BUILDERS INC HALLE BUILDERS INC 1113 HWY 64 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2182 134TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 2.140 Plat: 2304 -PINE ACRES 2000 SEC 13 T31 N R18W NE NW LOT 20 PINE ACRES Block/Condo Bldg: LOT 20 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 13-31N-18W NE NW Notes: Parcel History: Date Doc # Vol /Page Type 12/05/2002 701046 2069/329 WD 06/07/2000 6244360 1517/272 WD 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.140 32,700 0 32,700 NO Totals for 2006: General Property 2.140 32,700 0 32,700 Woodland 0.000 0 0 Totals for 2005: General Property 2.140 32,700 0 32,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r rn 1 rn r rn D 1 O z 4 L 4 4 L 4 L L n =1 L`4 L a C =l C=3a L L - L L o ❑ ❑ QN LL ❑ 4 ❑ 4 0 � 4� rn rn r r rn rn p < i 4 LL Z 4 L L L L aq LLLL D �❑ LL L 0 0 �Q - o_ 4 4 4 4 ® LL A 4 L ® 4 ® LL L O ® LL rn �L� L D L J LL z V" L Al n 0 0 a 1 f sr-v O O o I 3 1 O 24400 I A x � U U - A U U 2O j > 14' -1 31 R I d hl 214R ----- 6 p- - - -- = p N x A n X° V 3 ------- - - - - -- Q 6V m � z S 2 � L O TIS fB -60 O p r _ 0 p 3 Oro Fu r 4 W9Y -3�i0 H( I I - - - - - -- O i i - - - - -- ww,rrr o O II 0 o 1 I l4 j � s 1C O A -4 x rn ll eo O Z a Q J - r vwu� e,v N ins >m X < © Z Z O X Z A:N2 - ZCi 24•-0' 20'-a O � rn A g 1 .,•. vuw.en ndac oa,n,saw