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HomeMy WebLinkAbout038-1208-20-000 Wisconsin t �, commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and �igDivision INSPECTION REPORT Sanitary Permit No: 420783 0 (ATTACH TO PERMIT) GENERAL II�FC3RMATt�ON State Plan ID No: Personal informatjoh 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: Gei le, Darwin I Star Prairie Township 038 - 1208 -20 -000 CST BM Elev: / Insp. BM Elev: 48M Des ti n: Section/Town /Range/Map No: • M • 0 1 14.31.18.1127 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J .b r\soe Benchmark r:VjA 12428i 2 !7 o z•ii L5D a Dosing Alt. BM Aeration Bldg. Sewer , q6' Holding St/Ht Inlet 6. / TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' si .w Q � ! Dt Bottom Dosing � Header /Man. Aeration Dist. Pipe — • Holding Bot. System a • ZO/ 93.3o' PUMP /SIPHON INFORMATION Final Grade 1 96 •� Manufacturer Demand St Cover �, z �� • f GPM Model umber TDH [ Li F ' ion Loss System Head TDH Forcemain h Dia. Dist. to Well SOIL A PTION SYST RENC idth / Length ( No. O Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME S D� Z SETBACK SYSTEM TO � P/L JBLDG WELL LAKE /STREAM LEACHING M f r: INFORMATION CHAMBER OR Type stem: t� Q�G t wa UNIT Model Number: 111 w ` DISTRIBUTIOV SYSTEM a o►6A # — I&D Header /Manifoldw p P Distribution ize Hole Spacing Vent to Air Intake fM� � �` Pipe(s) � 1 Lengt Dia Length is Spacin 5� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No [3 Yes [] No COMMEI�yjTS' (In ud cod dis epencies, persons present, etc.) Inspection #1: / �,j Inspection # . r � Upti Location: 12217th Ave Somerset, WI 54025 (SE 1/4 NE 1/4 14 T31N R18W) Prairie View Estates Lot 32 Parcel No: 14.31.18.1127 1.) Alt BM Description = 5.-T-. 2.) Bldg sewer length = 2.01 ` amount of 31 D " co ver IV _z" C��"`"^ �+"' ' h'�� AA, Plan revision Required? L_i Yes X No Use other side for additional Information. c � SBD -6710 (R.3/97) q Signature Cert. No. `S Insepctor's r Safety and Buildings Division County , 201 W. Washington Ave., P.O. Box 7162 (j►^s� vsconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 ZO Sanitary Permit Application State Plan I. D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informatiQpyQu.QWXjde may be used for secondary purposes Privacy Law, s15.04 1)(m) RECEIVED t Address (if different than mailing address) 1. Application Information - Please Print All Information MAY 1 2993 _ fw6-. Property Owner's Na me ^ e Pa el # Lot # Block # Gt r6(1 /1 ( /�' 4e t l s r CROIX COUNTY 3 2 Property Owner's M ailing Address Pr perty Location 1 9 ti 5- 4?19 City, State / ` Zip Code Phone Number �`'- A I / �"� ©l ircle --�— c I. Type of Building (check all that apply) Subdivision Name CSM Number &Al2 / � r� T N; RE or 2 Family Dwelling -Number of Bedrooms t , � Public /Commercial - Describe Use (,l 01 1 ,C 6 Cr. tJ f ❑ State Owned - Describe Use 2 - City []Village ❑Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) p7,g'- /2 CM , M A. *New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal MPermit Revision Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration P tuber Owner IV. Type of POWTS System: (Check all that appl A- - tft I -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(gpdsf) al Area Required (sf) Dispersal Area posed (sf) System Elevation s , _ 6 T VI. ank =nfo 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 `C ✓ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's re MP /MPRS Number Business Phone Number 14Z, � 1, 961 s Addre ss City, Zip Code) VIII. County/Department Use Onl Approved ❑ Disapproved Sanitary Permit (includes Groundwater Date Issued I su' Agent Signa a (No Stamps) Surcharge Fee) $ ` El O ven Reason for Denial 50 • OD IX. Conditions of pro� eas for Disapproval l t^,Qs melt t5 C's. o, ew t `(der" �.�.�- � C�o.�•a. � �n(yN� o.d w. 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. 01/03) PLOT PLAN PROJECT Darwin Geiale ADDRESS 325 W. 9th st. Ant. B NewRichmond Wi. 54 001 SE 1/4 E NE i /4S 14 /T 31 N/R 18 W TOWN StarPrairie COUNTY ST. CROIX 5 -16 -03 4 MPRS Byron Bird Jr. 22054 Y DATE BEDROOM CONVENTIONAL XXXX A r- a CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE o LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 BENCHMARK V.R.P. top of foundation ASSUME ELEVATION 100' ❑ BOREHOLE (D WELL sH.R.P. same as BM Vent SYSTEM ELEVATION T -1 =93 T-2 =92.8 o f Sidewinder High C ov Capacity Leaching Chamber with 17.2 6" t ^2 per chamber -C -nt System Long 34" Elevation 125' Pl 36' O ob pipe �c P l. well 2 B 1 B2 87.5 100' 30' 4 bed house ) ' 4' vt garage � 96' driveway _ al M 97' �Q PLOT PLAN PROJECT Darwin Geiale ADDRESS 325 W. 9th S t. Ant. B NewRichmond Wi. 54001 SE 1/4 NE 1 /4S 14 /T 31 N/R 18 W TOWN StarPraide COUNTY ST. CROIX /1' 5 - 16 - 03 4 MPRS Byron Bird Jr . 2205 DATE BEDROOM CONVENTIONAL XXXX t� rade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 BENCHMARK V.B.P top of foundation ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as BM Vent SYSTEM ELEVATION T -1 =93 T-2 =92.8 AT' Sidewinder High Capacity Leaching Chamber with 17.2 ' t ^2 per chamber ho Grade at Systern Long 34 " Elevation 125' Pl 36' O ob pipe P well B � BI B2 1S' 87.5 100' 30' 4 bed house st 40' 4 ' gage B3 96 , driveway alt JIM Q �, �9 ' Wisconsin DepaMnent of Commerce ALUATION REPORT Page of Division of Safety and Building s [ MSOI Wis. Adm. Code County �rOC Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parma I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. ev' by Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner Property Location 1 Q Govt. Lot j� 114 , 1/4 S/ T N R E (o Property Owner's Mailing Address / / l Lot # Block # Su Name or CSM #) .,[ e Zip Code Phone Number ❑ city ❑ Villagg Town Nearest Road Cud ! r O >) 60/ CR New Construction Use: ®.Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or ce 11 Describe: / Parent material C' - JG f 'c (f /Ge, a 54 Flood Plain elevation if applicable ft. General comments and recommendations: Boring # Boring y7 Z Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a o x- , Boring # � Boring Pit Ground surface elev. �' ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color l Gr. Sz. Sh. - Eff#1 'Eff#2 n 5 - _ G ` Effluent #1 = SOD > 30 < 220 mg1L and TSS >30 < 150 mgA. ' Effluent #2 = BOD < 30 mglL and TSS < 30 mg& CST Name ( Print) ignature � CST Number 0 Address Date Date Evaluati Conducted Telephone Number I _ r 2 Property Owner �'� " Parcel ID # Page of 3 Boring # 1X Boring F -3 - 1 ❑ pit Ground surface elev. ZA —' ft. Depth to limiting factor in. Sal ftplication 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 w -vZ F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal 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 ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. 13 Pit Sal 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 1 30 ng/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. SBP8330 (R07/00) f Soil Test Plot Plan Project Name D G Byr n Bird Jr. Address 325w 9th st. apt B Ne Wi. 54017 TM #220527 Lot Subdivision PriarieVeiwE Date 5/16 /2003 County CROIX S E 1 /4 1/4S T 31 N /R W Townshi StarPra F] Boring Q Well PL Property Line# Alt. BM top of foundation at garage ,BM or VRP Assume Elevation 100 ft Top of foundation g System Ely. T- 1= 93.OT -2 =92.8 H.R.P. Same as BM 125' PI i 36' F well B ° BI B2 100' 30' 4 bed house 40' 50' gage B31 driveway alt M 971 Safety and Buildings Division County l 201 W. Washington Ave., P.O. Box 7162 Nvi wonsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 20 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal T in n may be used for secondary purposes Privacy L s15 tC - �D Project Address (if different than g address) Z I. Application Information - Please Print All Information AP 0 8 2003 Property OwneMN ' Parcel # Lot Block # ST. CR(JIX COUNTY L ZONING OFFICE Property Owner's Mailing Address PVLocation � Section City, State p Code Phone Number O T circle E W II. Type of Building Neck all that apply) m P,¢r � � or 2 Family Dwelling - mber of Bedrooms Sub ion Name CSM tmber ❑ Public /Commercial - Describ sew J . t p t ❑State Owned - Describe Use 2 x 1 - - City _ ❑Village ownship of .v • III. Type f Permit: (Check only box on line A. Complete line B if applicable) A. �4 ew System y ❑Replaceme ystem El Treatment/Holding Tank Replace me my ❑Other Modification to Existing Sy B. El Permit Renewal ❑ Permit Revision El Change of [I Permit Tr er to New Li vious ermit Num nd a rued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that ft y) on - Pressurized In- Ground ❑ Mound 7 24 in. o table soil ❑ Mou 24 it uitabl ❑ eGrade gle Pass S ter El Constructed Wetland El Pressurized In- Ground ❑ ing Tank ❑ t Filter A 'c Trea nt irculating ter Rec irculating Synthetic Media Filter aching Chamber ❑ Drip ❑ Gravel less Pi ❑ er V. Dis ersal /Treatment Area Info ation: Design Flow (gpd) Design Soil Application Rate(so Dispe a Required (sf) Dis rsal Area Propo m va "7 S 3 3 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Fiber Plastic Gallons Gallons of Units Concrete Cons ed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigq responsibility for installation o POWTS shown on the att ed pl Plumber's Na me (Print) Plumber' AWKture MP /MPRS Nu Busin s Phone mber Z 2 A 22 A � — _ 4- 5 Plumber's Addre ss (Street, City, State, p C ) VIII. County Department Use Onlyff Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued �IssumAgent Signatur (No Stamps) Surcharge Fee) �— 11 El Given son for Denial � ( j IX. Conditions of Approvalllponsfor Disap r val ,4 Ll %,-6ck b� Nn� Wrl— o J;lc4tti_ CO&/ 5ro cLA - L t;RCa_>4&-\ a_Q "-maa� Q ( Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size i SBD -6398 (R. 01/03) - r r''� �;.. s' �'' �° _ ° �. it � SllyR.... S � � ' � u � .� � ,�. ° � � ��? ,�`, �F.>'� '}. !, N PLOT PLAN PROJECT Darwin Geiale ADIVRJR 325 W. 9th St. Aot B New Richmond Wi 54017 SE 1/4 NE 1 /4S 14 /T 31 N/R 8 OWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/6/03 BEDROOM 4 CONVENTIONAL )= IN- GROUND P SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 1;00 BENCHMARK V.R.P. Top of 1" PVC Pipe ASSUME ELEVATION 100' Filter Zabel ❑ BOREHOLE O WELL .H.R.P. Same as Benchmark SYSTEM ELEVATION 96.0' 210' Prope Line AV Vent >6 „ Standard Biodiffuser Plans Designe sing of Cover Leaching Chamber Convention owts with 31.1 ft2 of Area Manual V on 2.0 112 6' Long 11 " 3411 a at System Elevation B.M. Vents 10' 20 30' - T Pro oom r 47' ouse 9 3- B -3 45' C� i 45' I ` Alt. 1 Vents B.M. 6' Town Road .40" •- Arm .G's::Ai.' 3 tY 4`4 PLOT PLAN PROJECT Darwin Geiale ADDR SS 325 W. 9th St. ADt B New Richmond Wi 54017 SE 1/4 NE 1 /4s 14 /T 31 XR8 OWN Star Prairie COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE4 /6/03 BEDROOM 4 CONVENTIONAL )00( IN- GROUND P CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 IL BENCHMARK V.R.P. Top of 1" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 96.0' 210' Property Line Vent >6„ Standard Biodiffuser Plans Designed Using Leaching Chamber /000, of Cover with 31.1 ft2 of Area Conventional Powts Manual Version 2.0 1 6' Long 11 " 3 4" Grade at System Elevation B.M. Vents 10' 20' 30' - Pro 4 Bedroom r 47' House B -3 45' Ar 45' • ` Alt. 10' Vents 6 ' Town Road I I e rv � CIA u ^ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of 3 Divisiorf 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, ertq nd distance to nearest road. pending I R iewed by Date Please print all inf Personal information you provide may b¢ "used for second*purposes K(iiydC ^aw, S. 15.04 (1) (m)). -1 3 Property Owner r4�, = Property Location EWlen Pro ties Ltd; Govt. Lot SE 1/4 1/4 s T N R or) W Property Owner's Mailing Address ? Lot # Block # Subd. Name or CSM# 1430 220th. Ave : , �,�;,� �._. City State Zip Code Phon, ❑ City ❑ Village Town Nearest Road New Richmond WI. 54b17 ; Oft)' , - CM 111 * New Construction Use: Q Residential / Number ofb4deoogm 4 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. 96.00' Borin # F1 Boring F i g � pit Ground surface elev. 1 , . 2 ft. Depth to limiting factor +110 in, Soit Application 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 'Eff #2 1 0 -10 10 2/2 none 2 10 -22 7.5 4/4 none scl 3 22-110 7.5 4 6 none 5� • `r Boring # ❑ Boring g a pit Ground surface elev. 1 ��' 4 F - 21 ft Depth to limiting factor + 110 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 -12 10 2/2 none 2 12 -30 1 7.5yr 4/4 none scl 2msbk mfr 9W if ,4 .6 3 30 -110 .5 4/6 none ms os ml na na •7 1'2 i Effluent #1 = BOD > 30 220 mg/L and TSS > 30 < 150 mg/L ' ffluent #2 = B0 9Z 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatures CST Number Gary L. Steel 02298 Address Date Evfiluation Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 12 -4 -2000 715- 246 -6200 i Property Owner Ewlen Properties, Ltd, Parcel ID # perndinq Page 2 of 3 3 ❑ Borin # Boring g ® pit Ground surface elev. 100.0 ft Depth to limiting factor +110 in. Soil Application 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 'Eff#2 1 0 -12 10yr 2/2 none L 2tnsbk mfr Cs 2f .5 8 2 12 -28 7,5yr 4/4 none sCl 2msbk mfr qw if ,4 6 3 28 -11 7,5 4/6 none ms Osg Mi y 8 4`f Boring # ❑ Boring ❑ 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/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. F pit 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 mgA- ' Effluent #2 = BOD < 30 mg& 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 (RAM) STEEL'S SOIL SERVICE Gary L. Steel Ewlen Properties, Ltd. 1554 200th Ave. CSTM2298 SE- NE'' S14- T31N -R18w New Richmond, WI 54017 MPRSW -3254 town of Star Prairie (715) 246 -6200 lot #32- Prairie View Estates 'Ibis soil evaluation vas 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 stmym as pwmnent lot lines Were not established at the time the test vas conducted. -- N 1 " -40 'BM.= top of 1" pvc pipe @ el. 1 Alt. BM. = top of 1" pvc pipe @ e1. 10 0.60' S Gary L. Steel 12 -4 -2000 n �� 1 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. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. 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 y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNE16H1P CERTIFICATION FORM Owner /Buyer Mailing Address l 7 o P ert r, Address Property ZQ (Verification req ed from Planning Department for new construction) City /State Parcel Identification Number 0'�; 1' LE GAL DESCRIPTION Property Location S 4 !L 1 /4, ' /4, Sec. , T / N-R_ ^ ZW, Town of S/"X / Subdivision �' /Gule2w_ � 1 1 t -�—c %C ,s� , Lot # Certified Survey Map # , Volume Page # Warranty Deed # (0�6 , Volume I `�3`j Page # S4 Spec house ❑ ye no Lot lines identifiab�es ❑ 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 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. I/we, 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 cqs of the three r elpiration date. Gjw't-t ea . V / y /0-3 SIGNATURE OF PLICA 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 owner(s) of the property described a ve, by virtue of a warranty deed recorded in Register of Deeds Office. / 4 /03 SIGNATURE OF PPLICAN 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 1/ J 193`9 i lStt STATE BAR OF WISCONSIN FORM 2- 19W 6 x 5 6 9 9 s WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., MI This Deed, made between EWLEN Pr operties, Ltd., a Texas RECEIVED FOR REGARD Lim ited Partnership, -- - -- -- 08-01 -2002 8:30 AN - -.� - -- WARRANTY DEED Grantor, and Darwin Geigle a Janet Mastel EXEWT # REC FEE: 11.00 _ TRANS FEE: 80.70 COPY FEE: Grantee. i 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 aaach addendum): Recording Area Lot 32, Prairie View Estates, Township of Star Prairie, St. Croix County, Name and Rctur "r('s B � 1 I'� e Wisconsin. 10 i St ly S' AIMO16lot X 10 SKte 10 US* sker U,PwRzk,ro� 03 1 208 -20 -000 _ Parcel Identification Number (PIN) This is not homestead property. N) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this ;x day of June 2002 E "N Properties, Ltd. • + By: Paul Anders Manager EWLEN A sset Management, - -- — ur, C 7erdl Parupx AUTHENTICATION ACKNOWLEDGMENT Signature(.,) STATE OF i�tS6AiW311VT1�/yQY ) ss. -- _ -_ _County ) authenticated this day of Personally cwttc before me this day of June 2002 the above named Ewlen P roperties, Ltd a Texas Limit Partnership, by + EWLEN Asset Managem LLC, Gener Partn TITLE: MEMBER STATE BAR OF WISCONSIN - -- to me known to be the per y u r oin (If not. inst ment and acknowled ;1, •Sie.3NARON FERNANDEZ 'P authorized by § 706.06. W is. Stats.) �ysn ry Notary Public, State of_Taxas j THIS INSTRUMENT WAS DRAFTED BY + „<< sswn xpires t r 11, -29 @S- Atto Kristina Ogland ^_ — Notary Public, State of Hudson, W 54016 My Commission is permanent. (If not, state ex :ration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ... 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