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HomeMy WebLinkAbout038-1211-80-000 Wisconsin 6epartment of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 429964 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: LeQue Construction I Star Prairie Township 038 - 1211 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 06 , o /!�0 a R M / 13.31.18.1156 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmar d 6' 1 106,6 Dosing Alt. BM w , < #.0 oo- (-, Aeration Bldg. Sewer Holding St/Ht Inlet / U TANK SET ACK INFORMATION St/Ht Outlet 7 7 TANK TO /L t WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t�O�� r/ �� / VVI Dt Bottom / Dosing / Header /Man. / q6-- 49 T Aeration Dist. Pipe N Cf . L 11 r �s�y S J Holding Bot. System V' Final Grade UV V J PUMP /SIPHON INFORMATION S57 99.0 Manufacturer Demand St Cover Ica Model Numb TDH Lift Fri s System Head Ft Forcemain gth Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width r Length / No. Of Trsgches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /�0 SETBACK SYSTEM TO P/L JBLDG JWE LL LAKEISTREA LEACHING Manu L 7 � INFORMATION CHAMBER OR d Type System: r 44S t ,,/�� UNIT Model Number: �-1 DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 1 y Pipe(s) � r / T' y Length Dia Length � Dia Spacin �(J 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 Bedlrrench Center / �� Bed /Trench Edges Topsoil [] Yes ❑ No ',7J Yes I J No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:t1 - / 0 - 7 Inspection #2: Location: 1339 212th Ave Star Prairie, WI 54026 (NE 1/4 SW 1/4 13 T31 RI 8W) Northgate Lot 66 �"C Parcel No: 13.31.18.1156 1.) Alt BM Description = / edLtAl l gyp„ /,,f�Qa ltdR,4e y►' -4 J lZ.t- 2.) Bldg sewer length =25 S j " I' � "" Q " B r . , - amount of cover ��")/ .S Use de for additional information, Yes No se other 03 641n s epctor�'sSS C � % SBD -6710 (R.3/97) Date nature Cert. No. Q C\ Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7082 sy C ab NVI Madison, WI 53707 - 7082 Sanitary Permit Number (to be 'filled in by Co.) Department of Commerce (608) 261 - 6546 / / / Z Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, pe Cwt) i may be used for secondary purposes Priv y Law Project Address ( if different mailing address) I. Application Information- Please Print All Informat on -g- /33 / 2.12 A v e. � MAY 0 6 2003 f Property Owner's Name Parcel # Lot # Block # N R • � i �r-s ST. cROix coUNT r 035— pail - 8n 0M Property Owner's Mailing Add Property Location 12; S � t N � ' /., �W ' /., Section City, State Zip Code Phone Number 1 � e T rc 3 N• R EoW II. Type of Building (check all that apply) a� Swb ,� ans , -J�G3- Subdivision Name CSM Number or 2 Family Dwelling - Number of Bedrooms A ❑ Public /Commercial - Describe Use / KK ❑ State O - D ribe U e / ❑City ❑Vill ge piTownship III. Type o ermit: (Check only one box on lin A. Complete line B if applicable) A. X_New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B • ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl Non - 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- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (st) yytem Elevation VI. Tank Info Capacity in Total Number Minufacturer Pr6fab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic o Holding Tank i ICi A Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, responsibility for inst "of the POWTS shown on the attached plans. PI tier's Name ( PI be Sign ure /MP umber Business Phone Number S a as rS a (b SJJ Plumber's Address (Street, City, State, Zip Code) VIII. County /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Iss ing gent Signatur (No Stamps) Surcharge Fee) ❑Owner Given Reason for Denial IX. Conditions of ApprovaUReasons for Disapproval � � C - � Q �� ^✓ Attach co lete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size l SBD -6398 (R. 08/02) r #ROPMOWNER UrewV00a rnLerprzs SOIL DESCRIPTION HEPU 1 rage —of PAgEL I.o. 038 1055 - Boring # Horizon Depth Dominant Color Motes Texture Structure COnsis* 09 ROOts GPDlft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bid rerKh W. 3 J *9 2 ' 111 ' Ground 3 Z -84 7 elev. 9 8.5 tt. Depth b fimidng WICK Remarks: Boring # Wes;} 1 0 10 2/2 1 lcsbk mfr if .4 .5 4 2 14 -35 10yr 4/4 none sici icsbk mfr QW if .2 .3 Ground - A ia na 1 .7 .8 elev. 98.4 Depth to - -- - -- -- -- Imiting factor +84 Remarks: Boring # . ��- 1 0 -12 10 r 2 2 none 1 lcsbk mfr if . .5 2 12 -20 10 r 4/4 none sici lcsbic mfr if .2= .3 Groin 3 20 -34 10 r 5/4 none sil icsbk mfr gw j na ;2; .3 4 34-AA nene MI na 9 8.3 ft. Depth .7 .8 to fwwr +8 4" Remarks: �� S Boring # Z p _ Ground ft to iirr�ng Wiscorisin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Hyrnan Relations bivigion of Safety & Buildings in accord with ILHR 83.05, 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 St- Ornix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 038 - 1055 -10 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R EWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 1 1 Greenwood Enterprises, Inc. GOVT. LOT NE 1/4 SW 1/4 13 T 31 ,N,R 18 k( or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1416 qlhirti St 66 na NorthGate CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE RrOWN NEAREST ROAD Hudson, WI. 54016 (715)386 -3674 Star Prairie I 212th Ave. New Construction Use [ ] Residential / Number of bedrooms 4 [ J Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd /ft •8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft •8 trench, gpd /ft Recommended infiltration surface elevation(s) 94.80 It (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem (2 S❑ U C2 S❑ U a ❑ U n ❑ U K7 S❑ U EIS ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh ................. <..1....', 1 0 -14 10 r 3/3 none 1 2msbk mfr gw if .51 .6 ................. Ground 3 30-84 7.5 r 4/6 none ms osa ml na na .7 .8 elev. Depth to limiting factor +84 ' �b Remarks: Boring # 2! <> 1 0 -14 10yr 3/3 none 1 2msbk mfr gw if .5 .6 U Ground 2 14 -32 10 r 4/4 none sicl lcsbk mfr QW if .2:: .3 elev. 3 32 -40 10 r 5/4 c2 7.5 r 5/8 sil lcsbk mfr gw na .2 .3 9 8.6 ft. Depth to 4 40 -84 7.5 r 4/6 none cos osq ml n + ! �a/ 9 .8 limiting S o factor +84 11 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246- 620✓>�+ Address: 1554 200th. Ave. Now Richmond WI 4017 �'` Fie Signature: Date: 11 - - ,g`r m02298;' �, PROPERTYOWNER Greenwood Enterpris SOIL DESCRIPTION REPORT Page_ 2 of 3 PARCEL I.D. # 038 - 1055 -10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trend 3 1 0- 2 10 -20 1 sici Icsbk mfr QW Ground 3 20 -84 7.5 r 4 6 none Cos na elev. 9 8.5 ft. Depth to limiting factor +8 4" Remarks: Boring # 1 0 -14 10 r 2 2 none 1 lcsbk mfr qw if .4 .5 4 2 14 -35 10 r 4 4 none sicl lcsbk mfr - w if .2 i .3 Ground 3 35 -84 7.5 r 4 — none cos I 0SQ ml I na na .7 .8 elev. 98.4 ft. — Depth to - limiting factor +8 4" Remarks: Boring # 1 0 -12 10 r 2/2 none 1 lcsbk mfr w if .4' .5 5 2 12 -20 10 r 4 4 none sicl lcsbk mfr 9w if .2 .3 Ground 3 20 -34 10 r 5/4 none sil lcsbk mfr 9w na ;2' .3 elev. 4 34 -84 7.5yr 4/6 none cos osg m1 na na .7 .8 9 8.3 ft. Depth to limiting factor +84 11 Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) r STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave. CSTM2298 NE4SW S13- T31N -R18w New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #66- NorthGate This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top of 1" pvc pipe C el. 100 Alt. BM.= top of 1 pvc p ipe el. 99.10 let XN o p �3 X51 � � � O �Q0 Gary L. Steel 11 -8 -98 - ci I I N T�sCr`(��► S:tl_`r - -E, ;r✓ - - _ • I� t ` Y t i I ' I I I I � 1 : I, / i I � - � I I I ' I I I + I , i i , I I + 1 1 ; i I i : r 1 I I r P . , • , : • : I i i - - - w , V�'t - ' 99. <a - _ - - _. A o I , i ' : I I f ; - - -- i ao� t (� \ \ 1 1 • •�la� �cch .c;e t u``W�ev�S N ��� Sec �3 31►J IQ1�t1J ©T (� (� star vrc� it( ( * e (D loss El Ilt ol 57 7 TT liss �1ar i �1 gi° a ff e .. aoo-' _ .. .. ... E Z 12 03H :..... Ty. P ft'k Y- y •rs���� — 241r ;;• 1 u 7.1TY�r T vvw 4.625f1 .. .. T ... . T.. .. ... *' w v r ►, •T♦ "`••+ ... 112 Ciro.18.S�t� • -.st v v 2A 1t { r r 2 P �A 36" 4 Y4 12 -1121, D.e•t`f.. ' Caet{ in q ` g+ta+ u 3 7-4 1 4, § �� i O.D. of 4^ >t5�e 4.623 iinctts vcW V014"* - i;rttar It 14 • 2 Ji2Sa ^"exalt (? 3jd,..Usj s� ? 17 1p ( �. !8 gam, 3. U.D. °tcYlr= 4'2.3 en,6, 8ottorn !R yow wi�m""' t tetce,� h er x (114 •� s =s1/ Total Sail .!'terrace Arc, 2,00 i oray ndera . t1 tnrpa t Itesrp ' -s1�.. 4 ,� nt► �1 ti' a1d roi1� it, awside cpii+dcrir � 2 • ,� 4ae 3.r , __.__) •.see. .i w Prajecte/tTrpq Are,, [ ltlwrA '901 tib` Sidcwaii 1ef vgiti� u �� ��t = t3rn_ •2 � rycxh -*- . T -_. ba, B ottom '2.U0Sq.FL ! OW Volufft ° 2a1 7rr�i m ° twttora s { t!2 of „ { t i r A� tt 2 t 3 R' prolectet� Trr,rp Area art. -3.00 Sq Ft. j J 5.69 S� Pt 0, t 17 + U.42 + t+etw�n cyirs► d.2 l S 2 .0 i 9ti } void twit© 2 U.�OF 1 .763 x7.43 3 O.tO$ai_;6.3 c zhbkic tk r/t 36 x to EPS Aggregate Tree ch Syst EZ 1203 RingAndustrial Gro 65 ktdus•trici Far kRd. � EZIMN , .,1, S►tEET; t of , tf_ a7 -or t POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of FILE INFORMATION SYSTEM SPECIFICATIONS Owner IIL o Tank Manufacturer ;,'�PS 'Qrs ❑ NA Permit # 4 12 1 % Septic ❑ Dose ❑ Holding vol. � D ©� gal DESIGN PARAMETERS Tank Manufacturer ❑ NA Number of Bedrooms ❑ NA ❑ Septic ❑ Dose ❑ Holding vol. gal Number of Public Facility Units ❑ NA Effluent Filter Manufacturer ❑ NA Estimated (average) flow oc) g al/day Effluent Filter Model 4 (pp Design (peak) flow = (Estimated x 1.5) S gal/day Pump Manufacturer ❑ NA Soil Application Rate r al/da /ft= Pump Model Standard influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, ON & Grease (FOG) 530 mg/L ❑ Sand /Gravel R{ter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5230 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Manufacturer Biochemical Oxygen Demand (BOD 530 mg/L Dispersal Cell(s) ❑ NA Total Suspended Solids ITSS) S30 mg /L ❑ NA X In- Ground (gravity) ❑ In- Ground (pressurized) Fecal Coliform (geometric mean) 510 cfu/100ml ❑ At -Grade ❑ Mound Maximum Effluent Particle Size Y, in dia. ❑ NA 0 Drip -Upe ❑ Other: Other: ❑ NA her: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. der: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tanks) At least once every: - 3 ,0 month(s) (Maximurn 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third W3) of tank volume O NA ❑ When the high water alarm Is activated inspect dispersal cell(s) month(s) {s) At least once every: ear(s) (Maxinwm 3 years) ❑ NA Clean effluent filter At least once every: / ❑ moat h(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA 13 years) Rush laterals and pressure test At least once every: ❑ month(s) ❑ NA y ear(s) Other: ❑ month(s) At least once every: ❑ (s) ❑ NA Other: Q 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 (pumper). 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 a 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 treatment 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 12102! Page of ;TART UP AND OPERATION k fitment tankls) for the pre sence of painting products. solvents or other ON prior to use of the POWTS /or damage the soil dispersal cali(s). if high concentrations are detect For new constr uction, a the treatment process o rator Prior to use. chemicals that may i ed th tank(s) re moved by a servicing surface. Pe have the contents of the sepn at'e frozen at the infli trative System start up shaft not occur when scut conditions hwater levels- When Power is restored the excess fill above nonmed fag resulting in the backup or surface During extended Power outages pump may dose and may overload them p orator prig ed to the dispersal colts) in one large tank removed by a Septage Servicing P the pump wastewater wilt be discharg the Contents of P TS Maintainer to assist in Manua operating discharge of effluent. To avoid this situation a plumber to restoring Power to the effluent Pump or controls to restore normal levels within the Pump tank. or ark over, or otherwise disturb or compact, the area ark vehicles over tanks and diispersai cells, Do tint drive P Do not drive or p at-9ra soil absorption area• prolong the lif of the within 15 feet down slope of any rno urid may improve the per and m the wastewater stream l floss; diapers% disinfectants; fat; Reduction or eliminattnm of the follow+ frobutts; condorris% cotton swabs: degr e88ers; denta herbicides: meat scraps: medications; oil, pOWTS: antibiotics, baby Wipes; cig fruit and vegst� peelings; gasoline: grease; foundation drain lsuMP pump discharge; Mons% and water softener brine • painting products; P esticides; sanitary napkins• following ing steps shall be taken to insure that the system is A B AN DONMENT the ne TS fails and /or is Permanently taken out of service 83 fat abandoned in compliance with chapter Comm . the 33. Wisconsin Adm{ sealed Code: properly and safety the abandoned pipe opening • All piping to tanks and pits shall be disconnected and disposed of by a Septage Servicing O P orator. • The contents of all tanks and Pits shall be removed send property disposed filled with • After pumping, all tanks and pits shah be excavated and removed or their covers removed and the void spa soil, gravel or another inert solid material- CONTINGENCY PLAN aired the following measures have been, or must be taken, to provide a code compliant If the POWTS fails and cannot be rep absorption replacement system: be utilized for the location of a replacement soil abso on by A suitable replacement area has been evaluated � m a � tion g di and compacrid should not infringed �, will t area should be Protected lot limes and wells. Failure to protect the replacement system. The replacement and Proposed smicture, bie replacement area. Replacement systems must required setbacks from existing site evaluation to sate bGsh a sulfa result in the need for a new soil and time. Barring advances in POWTS comply with the rules in effect at that aaid/or soil limitations. ❑ A suitable replacement area is not as a lest resort to replace the re of the POWTS a soil and site failed POWTS- tec h no logy a holding tank may on fail tank u UP ❑ The site has not been evaluated to de e naplaceme^t area. a suitable replacement area. If no replacement area is available a holding evaluation must be Performed t the failed POWTS• may be installed as a last resort to replace be reconstructed in place following removal of the biomat at the rade soil absorption systems may t comply with the rules in effect at that time. ❑ Mound and at-g ons of such systems must infiltrative surface. Reconstructs DO NOT < <WARNING> > TANKS MAY CONTAIN LETHAL GASSES ANDI DEATH MAY RESULT. RESCUE OF A SEPTIC, PUMP AND OTHER TREA TANK UNDER ANY CIRCUMSTANCES. ENTER A SEPTIC, PUMP E A TANK MAY BE D IFFICULT OR IMPOSSIBL PERSON FROM THE INTE RIOR OF ADDITIONAL- COMMENTS ' POW'TS MAINTAIi6ll pOWTS INSTALLER Name Name -51 Phone Phone LO CAL REGULATORY AUTHORITY OPERA TOR {PUMPER) Name S•� SEPTAGE SERVICING Name Phone [ S ience with Sanitation ag enci as M comps Phone Lake, Marquette and Waushera County Zoning and This document was drafted by the Staffs 3. the Green► Wisconsin Adminisuative Code. chapter Comm 83.22121(b)(1)(d) ") and 83.5411). l21 & I3), ST�CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer r-S Mailing Address S 01 7 Property Address 33 �U P Y (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION �- , i 3 ' N -R r �W, Town of -S r .C� 4 - 1 Property Location � /,, �� /�, Sec. � ,�, T_�_ �L.Q Subdivision N © pl� Lot # _• Certified Survey Map # —� . Volume , Page # Warranty Deed # I $ �'I 2 . Volume _ Z 7-1 , Page # Spec house yes ❑ no Lot lines identifiable ;4 yes ❑ no SYSTEM MAINTENANCE Imptoper 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 certificatton form, signed by the owner and by a master plumber, joumeymanphimber, restrictedplumber or a licensed pumperverifying that (1) the on -site wastewaterdisposai system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 expiration date. / SldKATURE OF 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 (arc) the owner(s) of the property d 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATIME OF APPLICANT DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. *' Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I 3: > to I I 1 1 RA x t+ � X n o : m x ± •a I _ o X 299' - a W � � ( � I 1 N �• O '\ • k � V Z x to . I" (fl x �► N � N I I � m I I I I J AL 14 IN - CD x I N 1 60 SO I T N I I �n> 1� p x o i t o I � I I I X . t fit. I I I X U 1 � I ' goal wccce> Aw L uls.LIWWLNia NORTHG ATE 11 . •ah,.eR.�'s r•x,rf.ax> xuh'r 1SY ('W Ir.f 1 nJ+f Y 1.. L (x >Rexukr r:i lkeat allmlx'mn ). iil RIIA, TuwruEV.I ure Ni: +. r. iuxrnr I .... i.il`.. WS! n 1161 ND *T 'R' ,e. F•.+urr..!,,.. v.� •q1- zw rF:... r ' • x I • § _ _ 31 • i , m r'1t5.'1..�1.�1 � 42 _ > � � r Y..:W.w.:ra ..... 1.. uR R l " ��. ''Rnww:ka:kea >ur.+r�trol a wsa ✓p •" r -t4 r' .: h :. .. J t - J t �a \'' /R � rJ' -•� ;,+�.,; � xw w . n I+ � sr� r,�n _ _ T M , Iz r r I" f J: '.: i ._ > - - .. •. N Jr' YiT'iF 1::: -:�." ( S y 0'f ry 1, „_ :l 5`l.. (1111 fl ( 9i 9( A '1 'l. L v. x s ors u ?. v. .•� WWC. YJ /,, ..4 I f.) ....`f3 I c. I 5G - � rF sr. ..... .:, •.,-. ,,� .:1.7 «. 7 ,� l „ - .'S' IIxW (: I' w. fl. .'� w.fl :.� !4C. s IC lve r fl l h -:^5,p XNrI..., S88 5 fRE s uN J .._ ...... .. .. ........ 1 \ RY M :ADf U1 1 N i Af I N 3 P x\ r f k\ RRwsaasaevax �Y.Y, ,k K ra,tk, rv < .a, _,+ akun. emoc R.we saw r.,;e,rn> z V UWVIke .17.00' 24.00" N89 0 07'26" , 11.00 . 213 .00' 209 "00' : 190.00' 181.00' : 28-00' 160.00' 209.00' 225.00' 209.00' Q, 238.00' AINAGE EASEMENT C� a' F N N ti co W 3 r cu _ A * T 45 W 46 cu 4 7 —- W . cu / ° O O _ Cn �t N -- tU z z N o T �- 231.56' - Z z o r N88 °51'00'W LOO ° °, oo .•� © — - --209.00' 207.47 9 S�o•QO 19 588 °51'00'E - -- th � �o. QOo� - 21 2 - -- Av E. 16 N 000r� 6' 15 ��o r- o o� -- - -- 211.99': -- 127.01' -- -� — in — 15' M Ln CD sr Cd / W 0 0`. th • cu � cu �� n v "a LO W cu 64 W cu WI • 0 1� ° 67 Q� 66 65 Z `r ` �d S 88 E E N S 88 °50'52' E NI ! 35.00' ° z z 207.00' W S 88 °50'52' E 1927.33' IMAGE EO SEMENT MAX. ELEV. 1004.0 (' S ALL ED IN EASEMENT (0 207.39' I . ' 212.00' z 157.39' 216.65' 1 180.( 88 °50'52" E 14 _ 15 -C_S.r 16 - V OL o wlvExs: ---- -- - - - - -- _ -- Greenwood Enterprises, Inc. rP \ 2141 C.T.H. "C" GENERAL NOTICE STATEMENT: The parcels shown on this plat ar( New Richmond, Wi. 54017 and Township laws, rules and regulations (i.e. wetlands, minimum lot s; Before purchasing or developing any parcel, contact the St. Croix Coun >t SURVEYOR: appropriate Town Board for advice. This statement put on this plat at th 5 James E. Rusch Croix County Planning, Zoning and Parks Committee. =.: 141 County Road C ew Richmond, Wi. 54017 This instrument drafted by James E. Rusch STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED Document Number This Deed, made between GrP Fni �,pg� Tn(- a Z l WisconGi n Cc)rnnrati on Grantor, andR rian LeOue / Le i _ Rrn i ldf-rs 7-/ l C- �jz� /o3 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property "): Recording Ar Name and Return Address t 6 of the Pl of NorthGate II, recorded in the Of - f ice of the Register of Deeds for St. Croix County, Edina Realty Title Wisconsin on June 20, 2001, in Volt:Ime 8 of Plats, at 400 S. 2nd St., #115 Page 55, as Document Number 648882. Hudson, WI 54016 03 Parcel Identlflaetlon Number (PIN) This iffi fit; homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, and reservations, if any, of record. Dated this day of April 2003 GR n? , INC. (SEAL) (SEAL) * * JlZs F. Rusch, President (SEAL) (SEAL) _Mary Rusch, Sec /Trews. AUTHENTICATION ACKNOWLEDGMENT .Signature (s) State of Wisconsin, �. S5. i St. Cr0lx County. authenticated this day of Personally came before me this z_ day of April , 2003 the above named Tat G . R1is h, its, PrPSjrjent an-1 — Mary R. Rusch, its _ /Trea TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person s who executed the foregoing authorized by §706.06, Wis. Stats.) instru nt and acknowledge t same. THIS INSTRUMENT WAS DRAFTED BY j Mary R. Rusch * Sandra G, _hrke Notary Public, State of Wisconsin New R i ehmand , I TL5401 Z My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not September 1 4 , 2004 ) necessary.) - .. ___.._ _. - -- ........_................-. ........................... ............................... __— .._................................................ Names of persons signing in any capacity must be typed or printed below their signature, i STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED FORM No. 1 — 1998 Milwaukee, Wis. I i