HomeMy WebLinkAbout038-1207-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
405077 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:
Dreyer, Vince I Star Prairie Township 038 - 1207 -40 -000
CST BM Elev: / Insp. BM Elev: , BM Description: N
( vo,o �c io I P vc-
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer q� 7St
Holding SUHt Inlet A I
St/Ht Outlet /
TANK SETBACK INFORMATION �o •$�• 3�
TANK TO P/L WELL gBLDG Vent to Air Intake ROAD Dt Inlet
Septic 61 Dt Bottom
Y Dosing � n L Header /Man. �, �.�• ��� �/ �
Aeration Dist. Pipe
Holding Bot. System
,lo l
Final Grade
PUMP IPHON INFORMATION IC at•t
Manufacturer Demand St Cover �. et.
Model Nu er
TDH Friction Loss System Head TD Ft
Forcemain Length Dia. S. to well
SOIL ABSORPTION SYSTEM /
BED /TRENCH Width Length No. Of T ench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS g�•�� �� Z
SETBACK SYSTEM TO P/L JBILD0 IWELL LAKE /STREAM LEACHING Manufayt� r:
INFORMATION CHAMBER OR i,4 .
Type Of System: / ...� UNIT Model Number: �I
C.O•tn.J 1 — Z
DISTRIBUTION SYSTEM
Header /Manifold ! tl Distribution x Hole Size x Hole Spacing Vent to Air Intake
c P.
Length Dia Length Dia pacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over TBed/ Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center rench Edges Topsoil
1 i
Yes [N# No ❑ Yes EM] No
COMM (Include code iscrepenci p sons resent e ) Insp ction #1Vj�!/ 03, . � Inspection #2:
Location: 215 6th St New Ri- c--_olndd,, WI 54017 (SW 114 NE 1/414 T31N R181Nf _P�r(aiirie View Estates s Lott 24 Parcel No: 14.31.18.1119
1.) Alt BM Description = r ) &3. �""� �
2.) Bldg sewer length
amount of cover
revis Plan
Use others de for i
u additional
Re quired? � es No
information. C !
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 53 cev ily
N) Pisconsin Madison, WI 53707 - 7162 Site Addre C 15 $ I z t,Yf1 5T,
Department of Commerce S - �� -Oz-- O11._c7 N6W
Sanitary Permit Application S anitary Permit Number
So �-�-
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
C1 Check if Revision
way be used for secondary purposes Privacy Law, sl5.04(1 )(m)
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name Parcel Number
C-E C_ MAY 1 0 m3S -/ Zc7- yo —cco
Property Owner's Mailing Address Property Location �
ST. CROIX COUNTY 6LJ tti AJE 14; S T 3 I N, R J
910 _ G6P JL- sr.
i City, S :_te Zip Code Lot Number Block Number "/// 7
.3 `/7C3 7 15 2i�^ `Zfv Subdivision Name CSNf Number
I
11. T} pe of Building (check all that apply) , s Pam S
X l or 2 Fa^tily Dw'e ling —Number of Bedrooms ❑Village
J Publiz. Corn: rciai - Describe Use ownshio S E
I ❑ State Owned f Nearest Road
Ck c exxs � s
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
7s , Ne2 ❑Replacement System 3 Replacement of 6 ❑ Addition to For County use
ystem Tank Only Existing System
1 B. ❑ Check if Sanitary Permit Previously Issued I Permit Number Date Issued {
IVFTe of Permit: (Check all that apply)(numbering scheme is for internal us - lQ0 1 44 n - Pressurized In- Ground 21❑ Mound 47 ❑ Sand Filter 50 11 Constructed
Wedand
22 ssurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other
V. Dispersal/Treat e a In o mation:
Design Flow (gpd) ispetsal Area ispersal Area VSoil Application Percolation Ra System Elevado Final Grade
Required Proposed te(Gals. /Hays /S .F (Min. /Inch) Elevation
cro
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank m
Dosing Chamber J 1
VII. Responsibility Statement- I, the undersigned, assume responsibility for 4ist#Uation of the POWTS shown on the attached plans.
Plumber's Name (Print) , Plumber's Signature iPRS Number Business Phone Number
S �y 175 -11V6 � ox
Plumber's Address (Street, City, State, Zip Code)
-We S14 G r L.12 S'5 � - 2-
VIII. County /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Surcharge Fee)
C1 Owner Given Initial Adverse zzJ 2 ,10 Determination
LX. Conditions of Approval/Reasons for Disapproval
saA� �` 4v 0 o pa-. M
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 05101)
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SOIL EVALUATION REPORT Page 1-_of 3
Wisconsin Department of Commerce
Division of Safety and Buildings
in accordance with Comm 85, \Ms. 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},. kection and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance tonearest road. pendin
Please print all info malion. j "�, R ewed by Date
Personal information you provide may be used for secbnd2�/purpogps P ace �w 5 15 04 (1�(m)).
Property Owner Property LA cation
n '�s "*Vt. Lot ".SW 1/4 1/4 S 14 T 31 N R 1 8 Wor) W MR
Property Owner's ailing Address _ Lot # - block # Subd. Name or CSM#
Si'`.
1430 220th. Ave. .,T� 2 na Prairie View Estates
City State Zip Code Phone Numb E3
❑ Village ❑ Town Nearest Road
New Richmon , WI 54011 (71'5 '2 $. -731 3: Star Prairie CTH "C"
[ New Construction Use: Residential / Number of b;3 -`� t ' Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material outwash Flood Plain elevation if applicable na ft.
General comments
and recommendations:
trenches @ el. 100.30'
Boring # Boring 9 +100
5 P9 pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication 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
0 -11 10yr 2/2 none L 2msbk mfr cs if .5 .8
2 11- 2510yr 4/4 none sicl 2msbk mfr gw if ,4 .6
3 25- 407.5yr4¢4 none cos osg ml gw na .7 1.2
4
4- 96•YD/
1 . +
F 2 Boring # Boring 00 120 ® pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicati on Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft°
in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. 'Eff #1 I 'Eff#2
1 0 -10 10 r 2/2 none L 2msbk mfr cs if .5 .8
2 10 -217.5 r4 4 none sil 2msbk mfr w if .5 .8
4 none cos oscr ml qw na .7 1.2
na na 7 1
.Y
* - < TS S 30 m L
Effluent #1 - BOD > 30 < 220 m L and TSS >30 < 150 m /L uent #2 - B 30 mg/L and T S _ g/
' Efflu _ g/ 9 -
CST Name (Please Print) Signature - . CST Number
Gary L. Steel jµ 02298
Address Date Evaluation Conducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 11 -29 -2000 715 - 246 -6200
i
l
Y
Property Owner Ewlen Propert Ltd. ParcellD# pending P age 2 Of 3
B,firig# ❑ 8oriN
3 ® pit Ground surface elev. 99.90 ft Depth to limiting factor +120 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 3-12 0 2 2m bk mfr Cs 1f .5 .8
19-1?7 w if .5 .8
3 32 -60 .5 r4/4 none Cos osg ml gw na .7 1.2
4 60-1 0 7
`
4 7 DS
i
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
Boring # Boring
F
El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ligtion 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 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 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 altemate format, please contact the department at 608-266-3 151 or TTY 608 -264 -8777.
SBD4330 (86/00)
I •.
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Ewlea Properties, Ltd. New Richmond, WI 54017
MPRSW -3254 SW'- E NE'' S14- T31N -R18W (715) 246 -6200
town of Star Prairie
lot #24- Prairie View Estates
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 Shawn
as permanent lot lines were not established at the time the test was conducted.
J i N 1 . =40'
BM. = top of 1" pvc pipe @ el ..100.00'
/Alt. BM. = top of 1" pvc piep @ el. 100.30'
0
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Gary. L. Steel
11 -29 -2000
Private On -Site Wastewater Treatment System (POWTS)
Index and Title Sheet
Owner:
Project Name and System Type: �; ,�E /7i«E2 - y.� /.�z��• Q L����rY �o�r r
Location: Z"/-" EsrR re-_r
Street Address
Legal Di5icription /
1 10.,✓ aF �S tFit st.aai -fir. � . o rr
Township /County
Contents: Page 1: / oo rz r
Page 2: Get o r G t. " la o .rs l r4 riow
Page 3: V 7 ou.✓rz s �,s.✓a� �,a,✓.is �.y�.✓ r. " ��.�,✓
Page 4:
Page S:
Page 6:
Page 7:
Page 8:
Page 9:
Attachments: ..> o�� �vo��.,or�o.✓ ��.00� r
• _ Signed:
Plumbe ,
r, y ,�
Credential Number: „�- a�.78i� Date:
POWTS OWNER'S MANUAL AND MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner �/,✓� is«.:
Septic Tank Capacity oo ❑ NA
Permit # S"o W S tic Tank Manufacturer f r ❑ NA
Effluent Filter Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Model - oo ❑ NA
Number of Bedrooms 100 room ❑ NA Pump Tank Capacity UVA
Number of Commercial Units' NA Pump Tank Manufacturer M NA
Estimated flow (average)* ocs ga Uda Pump Manufacturer ❑ NA
Design flow (peak), estimated x 1.5* Z oa al/da pump Model ❑ NA
Soil Application Rate g al/day fV Pretreatment Unit ❑ NA
Influent/E8luent Quality (NA ❑) • Monthly Average ** ❑ Sand/Gravel Filter ❑ Peat Filter
Fats. Oil & Grease (FOG) 5 30 mg/L ❑ Mechanical Aeration ❑ Wetland
Biochemical Oxygen Demand (BODS) p Disinfection C3 Other:
Total Suspended Solids (TSS) 5 220 mg/L Manufacturer. Model:
5 250 m Dispersal Cell(s)
Pretreated Effluent Quality ❑.. • Monthly Average * ** ein- ground (gravity) 13 In-ground (pressurized)
m
Biochemical Oxygen Deand (BODS) 5 30 mg/L p At -grade ❑ Mound
Total Suspended Solids (TSS) 5 30 mg/L t7 Dri line G Other .
Fecal Coliform (geometric mean) <10 cfu/1 /L ch _ I�
ing Chamber Manufacturer IA'6 r'" r °ti
Model Zri to LayingLength/Chamber
Maximum Effluent Particle Size 1/8 inch diameter Soil Application Rate 2
— gpd/f Area Req. RS7 /
*Wastewater Flow Verification and Calculations: Infiltrative Surface/Chamber -ESI Ratan / f3
(Other than bedroom based) Minimum Number of Chambers
p Aggregate Desi Flow/Loading Rates if min
** Values typical for domestic (non - commercial wastewater COMM 84 and be install per manufacturers specifications
and septic tank effluent.
** *Values ical for pretreated wastewater. and approval letters.
DESIGN CRITERIA
❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990)
❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler.
Publication 15.22
E3 "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6
❑ "Design of Conventional Soil Absorption Trenches and Beds ". RJ. Otis - ASAE Publications 5 -77 and "Design Manual -
Onsite Wastewater Treatment and Disposal Systems ". EPA 625 /1 80 October 1980
❑ SBD - 10570 -P (8.6/99) "At -Grade Component Manual Using Pressure Distribution"
❑ SBD - 10567 -P (86/99) "In Ground Absorption Component Manual"
9SBD - 10705 -P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0
❑ SBD - 10628 -P (N.6199) "Recirculating Sand Filter System Component Manual"
❑ SBD - 10656 -P (N.6199) "Split Bed Recirculating Sand Filter System Component Manual"
•❑ SBD - 10572- P.(R.6/9.9) "Mound Component Manual"
❑ SBD - 10691 -P (N.01/01) "Mound Component Manual" Version 2:0
❑ SBD - 10595 -P (8.6/99) "Single Pass Sand Filter Component Manual ".
❑ SBD - 10657 P (8.6199) "Drip -line Effluent Disposal Component Manual"
❑ SBD - 10573 -P (R 6/99) "Pressure Distribution Component Manual"
❑ SBD - 10706 -P (N.01101) "Pressure Distribution Component Manual" Version 2.0
❑ Drip -line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units
MAINTENANCE AND MANAGEMENT
MAINTENANCE MONITORING SCHEDULE
Service Frequenc
Service Event
Inspect condition of tanks At least once eve ❑ months 3 ears "mum 3
Pump out contents of tanks When combined sludge and scum equals one - third 1/3 of tank volume
Inspect dispersal cells At least once eve ❑ months 3 03 (Maximum 3
Clean effluent filter At least once eve ID'months ❑ Year(S
Inspect pump, um controls & alarm At least once eve ❑months C] ears [3 NA
Flush laterals and ressure test At least once evere ❑ months ❑ ears p
Valves At least once eve ❑ months ❑ ears ❑ NA
Other. At least once eve ❑ months ❑ yearos ❑ NA
Page � of S
START UP or other chemicals that
For new construction, prior to use of the damage, check dispersal c n ll(tan)kIf high coon��� concentrations painting have the contents of the
may impede the treatment process and/o r damage the dispersa 8h
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.
OPERATION
The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity
ormance and longevity of your POWTS. The installation of water- saving
and quality of the wastewater stream will affect the perf
appliances and fixtures along with prompt repair of leaks reduces ices and foundations vote sh0 d be discharged e of th gr �
softeners, iron removal units, other clear water waste, showers, dishwater, etc.
whenever possible. Note: this does not include laundry
wastewater nd , however the disposal of food based greases a oils, vegetable/fruit
This system is designed to handle domestic strength Toilet tissue is the only
peels and seeds, bones, and food solids such as those produced by a garbage disposal should be
non-biodegradable sanitary napkins
paper that should be discharged into the system. Other ble items such as baby wipes. tampons, um products, paint,
condoms, cigarette butts, dental floss, and cotton swabs should not enter the system Chemicals 1 linage your POWTS
disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they Y
and contaminate your drinking water supply.
Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components.
Compaction of snow over the dispersal unit may cause it to freeze up.
❑ Valves
Valves shall be operated in the following manner:
E3 Alarms sound
individual licensed to service
Alarms should be tested on a regular basis by the hom'owner. operating ffan alarm conditions, howeve wa er should be conserved until any
pOWTS, There is normally a 1 day reserve under regular
problems with the system are corrected to prevent back - up of sewage into the dwelling or surfacing.
INSPECTIONS
Inspection shall be made by an individual carrying one of the following licenses or certifi cations: Master Plumber, Master
Plumber Restricted Sewer, pOWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule).
Septic Tanks Component an missi or broken hardware, identify any cracks
Tank inspections must include a visual inspection of the tank to identify y g
or leaks, measure the volume of combined sludge assessment shall be sea ed and/or locked upon complet of service. Any
surface. Access openings used for service or asse
defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective
locking device to prevent accidental or unauthorized entry into the tank.
When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin
Administrative Code.
The outlet filter(s) shall be inspect m an e cleaned retain solid Filter cleaning may be necessary at mo r's
e
specifications. Provisions are to
frequent intervals than stated in the maintenan ce schedule to keep the system operating
E3 Pump Chamber/Treatment Tanks Component and floats. A visual check must be
The inspection must include a test of all electrical equipment such as pumps,
made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters
Any service needs or repairs shall be promptly taken care of.
na Ground Gravity Component Dispersal Cells on for any
'eve inspection shall include recording the levels sclarge t the ground surface must be promptly reported t the regu
Any d
evidence of surface seepage or discharge. y la ory
authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending
hydraulic failure necessitating more frequent monitoring. Page/ of S
C3 Mound, At- Grade, In- Ground Pressure
The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any
evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory
authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure
necessitating more frequent monitoring.
The pressure distribution system is provided with an opening at the end of each lateral to W used for flushing. The laterals
should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to
ensure that equal distribution of effluent is occurring to promote the longevity of the system.
REPOR
Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative
Code.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is
properly and safely abandoned in compliance with Ch. 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 shad be removed and properly disposed-of by a Septage °Se rvicirig:Qperator.
After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or other 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:
MI"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 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.
C3 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.
c3 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.
p 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 CONTIAN 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 THE INTERIOR'OFATANK 1Vr.AY. AE. DIFFICULT OR
IMPOSSIBLE. .
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER - ,✓ow.r
Name Name
Phone r/,s 3 - sf'o y Phone
SEPTAGE SERVICING OPERATOR (Pumper) - Wv N,,,,✓ LOCAL REGULATORY AUTHORITY
Name A en r. �o eu o
Phone Phone 71 .,8d: - o
KAWPDATAIEJAPOWTS OWNER'S MANUAL doe Page of .5L
r �
gr CR01X CoVN L Y
SRPTIC TANK MAMMANCB AORBEMENT
AND
OVMRSIO CERTIFICATION FORM
pwaer/Buyer
Moiling Address 1141 ee .
proporty Address ,!;J / ' iV• k' .
(Verifi'ieation required from Pla=w& Department for new constmetim
to Parcel I
�.au� t-�.1 _ ticntification Number
CitylSta
ZgAL pESQUEMN
Property Location , ' / {, .�� 'l., Sec. 1 • T _N R / W, Tows of !� ra i ✓rte
Subdlvldon ? - 69 4L .Z � � ,ecc� . Lot # �. . •
Certified Survey Map # . Volume Page #
VVarrnnty
# _ (' �' `�� . Volume �� Page # 2z '
per house O yes l3 no Lot lines identifiable ❑ yes ❑ no
improper use and mainteaaneeof your septic system could result in its premature failure to beadle wastes. Proper t.,:wnae e
ooAS,izts of pttmpiug out the septic tank every Chore years or sooner,
if seeded by a flowed pumpor. Wbat you put into the system
caa affect the function of the septic tank as a treatment stage in the waste disposal system
to submit to St. Croix Zoning Department a cattitication form. u ned by Ile owner a� b' a
The property owner agrees that (t) the or>•aite wastewater disposal IYAM
utastt rplumbey jW=y=nplumber ►���P�� or a licensedpump� ve z7�� the tic fault is less don 1/3 full of stodge.
is is proper operating condition and/or (2) after inspection and pumping (if Y�
sad agree to =m
um the private sewage disposal 0%= with the standards
here, the undersigned have head the above requirrmeats eft of Natural Renounces, State of Wisconsin' Cerdfication
set forth, bmW, ac set by the Depart mnt of Commerce and the Depadm Op fi� within 30
�g that your septic system has been Wort med must be completed and l oomed to the St. Croix County Zoning
days of rho thM year Otpiration date. ,
DATE
3IONATME OF AP>i CANT
certify that all statements on' tbis form are true to the best of my (out) lmowledBC. i (we) am (ar the owner(l of
I (we)
the rty described above, by virtue of a warranty decd recorded iu Register of Deeds Oflice.
s,Juz
JAAL
� . ---• -- DATE
SIGNATURE OF LICANT
a.as•• App information that is mis- represented may result in the sanitary permit being revoked by the Zon DI Deparaneat s « ♦s "r
•• Include with tWs application: a stamped warranty dead from the Register of Deeds office
a copy of flu certified sntvey map if fefeneace is nsade in the warranty deed
TOOLS OKINOZ 0D YHD IS 9891 989' STL XVA 69:CT f1IU ZO /60 /90
V 1889P 221
' STATE BAR OF WISCONSIN FORM 2 -1999 6 6 4 9
Document Number
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS RE
ST. CROIX CO., NI C CE
This Deed, made between Ewten Properties, Ltd., a Texas RECEIVED FOR RECORD D
Limited Partnership, -- —
- -- - - - - -- e5- 03-2 002 y:is AM MAY j
_ WAF�MN7Y DEED 0 2002
Grantor, and Vince E Dreye a single person and _ EtEO B ST.
_ Cara A Holz, a s ingle pe rson as oint tenants _ REC FEE: 11.00 ZONN�
T --_— —_— TRANS FEE: 67.00 GOFFICE
COPY FEE:
Grantee. - - -- CERT COPY FEE:
Grantor, for a valuable consideration, conveys to Grantee the PAGES: 1
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum).
Recording Area
Prairie View Estates, Township of Star Prairie, St. Croix County, —
WiscOnSiff -. Nmnc and Rcium Address
Vince Dreyer and Cara Holtz
916 Cedar St
Eau Claire WI 54701
C�S9 —)Z - y 0 --D
Parcel ldentlficalion Number (PIN)
This — is not homestead property.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Of) ('snot)
Dated this 24th day of ril 0
Ap — , 20 2
P en Properties, Ltd.
By: P aul An derson, �KU Man ager _
EWLE A Man LL
.General Partner —
AUTHENTICATION ACKNOWLEDGMENT
Signaturc(s) — STATE OF WISCONSIN )
— —.— — ) ss.
County )
authenticated this day of __
Personally came before me this �� day of
—• Apri _ _ _ _ , 2002 the above named
t Ewlen Properties, Ltd„ a Texas Limited Partners by Paul
Anders
TITLE: MEMBER STATE BAR OF WISCONSIN W
TITLE: FERNANDEZ
(If not, to me known to `n(se
authorized by § 706.06, Wis. Stats.) instrumoppq and a ed the 117, 7005 ' es
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina O land (�)
Hudson, 15401 – Notary Public, State of Wisconsin
— My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledgcd. Both are not necessary.)
Its
• Names of persons signing in an capacity must be d — 1 --
Y P Y type or printed below their signature. inrameaan v.we..ba.0 company. Fond au t.c. %M WARRANTY DEED STATE BAR OF WISCONSIN e00 6554021
FORM No. 2 - 1999
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