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HomeMy WebLinkAbout038-1121-40-110 Wisconsiri U"apartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix S.t&ty and Building s)ivision Sanitary Permit No: INSPECTION REPORT 430575 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: Dalton, Donald Star Prairie Township 038- 1121 -40 -110 CST BM E j I M Dee i ev: k Insp. BM Elev: BM � ( / n Section/Town /Range /Map No: "' u 1 0 0 l D 6 I "� s�F -�- 30.31.18.502A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ' q I I Benchmark 9 /O Dosing L �G- 1'� �� U Pi✓ Alt. BM w . Vg Z . Aeration Bldg. Sewer Holding St/Ht Inlet -Ss TANK SETBACK INFORMATION SUHt Outlet 7. /S , 7S TANK TO �P/L WELL BV�Air Intake ROAD Dt Inlet Septic �� ` Dt Bottom C � Dosing eader /Man. p g CI'?'Z Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION "�" $3 x.'7"7 Manufa and St Cover / Model Number TDH Lift Friction Los m Head TDH Ft Forcemain Le Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LA /STREAM ACHIN Manufa' S' INFORMATION HAMBER OR / Typ Of System: � ed � I ` � UNIT Model Number: DISTRIBUTION SYSTEM /"I 7 yc He r /Manifold Distribution x Hole Size x Hole S�r'a� Vent Air Intake / �r Pipe(s) d 4 • �/ Length Dia Length Dia Spacing D SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 3 Bed/Trench Edges Topsoil — Yes U. No ;,Jl Yes COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:/ 2_g /o� Inspection #2: Location: 1954 County /R/oa.,d/CStar Prairie, WI 54026 (SE 1/4 NE 1/4 30 T31 R1 8W) NA Lot -pip -p Parcel No: 30.31.18.502A10 1.) Alt BM Description = WW krd A v' � -411 1 � -� 2.) Bldg sewer length = 19 / L - amount of cover = t� �� !`�►.. J a i LL S� � �GL Plan revision o Use others de for additional Information _ 6 1/ SBD -6710 (R.3/97) Date Inse or Signature Cart. No. Sanitary Permit Application Safety & Buildings Division ' In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 NV i sconsin Personal information you provide may be used for second purposes p Madison, WI 53707 -7302 Department of Commerce (Submit completed form to coup if not [Privacy Law, s. 15.04(1)(m)] ( Sbi p �' state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number �ir 0 o I. Application Information - Please Print all Information Location: Property Owner Name a roperty Location p J I ( S V N, Ak�' J1 'e't /4 '--z , �a 0 Property Owners Mailing Address Lot Number Block Number le � City, State Zip C de Phone Number SM Number c II. Type of Building: (check one) ❑ City 1 or 2 Family Dwelling - No. of Bedrooms: Village Public/Commercial (describe use):_ Town of ❑ State -Owned f / V Neatest Road P el Tax Nu ber u c� z q_ o /vZl - -/o /lo 16 d III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1. P5.14,ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) %Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Ra System Elevation 7. Final Grade Required Proposed •g Rate (Gals./day/sq. ft.) me )_ �� El ion ��° VII. Tank Capacity in otal #of Manufacturer --- Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks r© fS ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) r Plumber' ature (nos MP/MPRS No. Business Phone Number G e e 0 or s Address (Street, City, StaTE, Zip Code) I.X. Coui ty/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I suin gent Signature o stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination 2 �'— r &V Z(p Z(p X. Conditions of Approval /Reasons fbr Disapproval: SYSTEM OWNER: 3) � ca S 1 Septic tank, effluent filter and - - -. dispersal cell must all be serviced / maintained Cci( S y. +� as per management plan provided by plumber. ) / (0 r Ss -- D f� " 2. All setback requirements must be maintained .� Q SBD -6398 (R. 07/00) �.�-- PLOT PLAN PROJECT Donald J. Dalton ADDRESS 1643 100 th st. New Richmond w. 5 4 0 17 SE 114 NE 1 /4S 30 /T 31 N/ 18 w TOWN StarPraide COUNTY ST. CROIX �� DA M PRS Byron Bird Jr. 2205 TE 11 -25 -03 BEDROOM 4 CONVENTIONAL XXX At- ade 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 k BENCHMARK V.R.P. top of Steel post ASSUME ELEVATION 100' ❑ BOREHOLE ( DWELL sH.R.p. same as BM Vent SYSTEM ELEVATION T- 1= 87.8T -2 =87.7 > 12" r Q, °f Chamber with 31.1 G' �" �ld� h Z Cov ft ^2 per chamber ��- i M : ���� �- 69 , 6" � 10 1 eva on 239' PL Garage 4 bed house 182' Drive ay 30' CoRd C O ob pipe t3� B2 3 B1 5 70 o� 1 BM � t B 238' PL 45' 45' PLOT PLAN PROJECT Donald J. Dalton ADDRESS 1643 100 th st. New Richmond Wi. 54017 SE 1/4 NE 1/4s 30 /T 31 N/ 18 W TOWN StarPrairie COUNTY ST. CROIX 11 -25 -03 BEDROOM 4 MPRS Byron Bird Jr 2205 DATE CONVENTIONAL XXX At ade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 BENCHMARK V.R.P. top of steel post A SSUME ELEVATION 100 ❑ BOREHOLE Q WELL *H.R.P. same as BM [Vent SYSTEM ELEVATION T- 1 =87.8T -2 =87.7 > 12" Of Chamber with 31.1 Cove f per chamber I � . F M ,�61 � —, i CTrade. at System L01 LS eva on 239' PL Garage 4 bed house 182' Drive ay 30' CoRd C st O ob pipe 45' B2 bI B3 B1 BM 5 70' 238' PL 45' 45' t B y Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner ® Property Location ? /"' f7 +' t4lei Gt Govt. Lot 1/� i14 S . L ti T�L N R E ( / Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# F 3 /z7v 14= "" City sta Zip Code Phone Number ❑ City ❑ Village Town Nearest Road New Construction Use: (,Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or tom rcfal - D tribe: Parent material ��_ c , cz �Gt a� Flood Plain elevation if applicable ft. General comments and recommendations: r r 7 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 GPDHF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1-1 O d-- Boring Boring # Pit Ground surface elev. y Depth to lim ' 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 I 'Eff#2 AA 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 ffi4ease Print) 7 c ignature � CST Number Address ate Evaluation Conducted Telephone Number A d�1 / Property Owner h � Parcel ID # Page of 1 Boring # 'M Boring /` _ 9 ❑ Pit Ground surface elev. / g, Depth to limiting factor Z/- - - ! Pe - / in. Soil Appli cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 zov F -1 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 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 GPD1fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD a 30 mg& and TSS < 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. SBD -8330 (R.07/00) Soil Test Plot Plan Project Name Don Dalton Byron 'rd Jr Address 1643 100th st. NewRichmond Wi. 54017 CST 4 #220527 Lot 1 Subdivision Date 712912003 County CROIX SE 1/4 NE 1l4S T 31 N /F W Townshi StarP [] Boring Q Well PL Property Line# Alt. BM Base of steel post 96.1 ,BM or VRP Assume Elevation 100 ft top of steel post System Elv. T- 1= 86.8T -2 =86.8 H.R.P. Same as BM 239' PL Garage 4 bed house 182' Drive ay CoRd C 91' 90' B2 BI 30 ' 70' BM 238' pi, 45' 45' alt BM s i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan st 6 � T- L ;-: ZZ - - include, but not limited to: vertical and horizontal reference point (BM), direcoo Parcel I.D. / percent slope, scale or dimensions, north arrow, and location and distance to Please print all information. ev' ed by Date Personal inforrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Atw 7 Property Owner Property Location J 160 I't 4 � GZffo n Govt. Lot - :5E1/ 114 S T_,? N R Property Owner's Mailing Address tot # Block # I Subd. Name or CSM# city S to Zip Code Phone Number ❑ Clty [3 Village own Nearest Road / cl New Construction Use: Qi Residential / Number of bedrooms Code derived design flow rate ei-n= GPD ❑ Replacement ❑ Public or com rcial - scribe: Parent material 6c Flood Plain elevation if applicable ft. General comments and recommendations: Boring # 5= Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor 7� 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 -c. r r • S ' 30 ®Boring # Boring ' Pit Ground surface elev. ft . Depth to limiting fa !4 in. Soil Ariplication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Av e G ,7 -� 3� - Z- Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = SOD < 30 mg/L and TSS < 30 mglL CST Nine Print) �f c ignature CST Number ! D f'1 ✓�i'�G' V r ' rah Address Eval ate uation Conducted Telephone Number 49, �I Property Owner"7 Parcel ID # Page of FYI Boring # Boring ❑ pit Ground surface elev.. -ft. Depth to limiting fa in. Sal ADDlication 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 '01#2 ®., �Z o �f ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Lure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # E] 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 Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 5 150 mg/L ' Effluent #2 = BOD, _5 30 mg/L and TSS 130 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. SB (R07i00) Soil Test Plot Plan Project Name Don Dalton By ird Jr. Address 1643 100th st. NewRichmond Wi. f�g� 54017 CS #220527 Lot Subdivision Date 7 12912003 County CR41X S E 1 /4 N E 1/4S T 31 N/19 W Townshi StarPrai n Boring Q Well PL Property Line lt. BM ase of steel post 96.1 ,BM or VRP Assume Elevation 100 tt.top of steel po_ System Ely. T-1 =86.8T-2=86.8 H.R.P. Same as BM 239' PL v Garage 4 bed house 182' Drive ay CoRd C 91' % \30W' B`- BM 5 70' alt BM 238' PL 45' 45' • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al 13 NA Permit # O S-�S— Septic Tank Manufacturer �� I ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer -r- 13 NA Number of Bedrooms ❑ NA Effluent Filter Model ��❑ppNA J° Number of Public Facility Units 'MNA Pump Tank Capacity al 1 NA Estimated flow (average) g al/day Pump Tank Manufacturer L4�DIA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer A Soil Application Rate al /day /ft2 Pump Model WNA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit CPNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other; ❑ I Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: El NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ ear( ) (s) (Maximum 3 years) 13 NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume 3 ❑ NA Inspect dispersal cell(s) At least once every: ❑O month(s) (Maximum 3 years) E3 NA Clean effluent filter At least once every: ❑ month(s) ❑ NA earls) ❑ month(s) A Inspect pump, pump controls & alarm At least once every: ❑ year(s) Flush laterals and pressure test At least once every: ❑ m 1 ANA E3 yeaarr (s) (s) Other: ❑ month(s) A At least once every: ❑ year(s) Other: A 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. 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 to 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 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 (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cellls). If high concentrations are detected have the contents of the 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. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter 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 shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another 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: ❑ 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 and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitatio Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POW 2uay ite has o been ev u ed to id tify itabl rep cement a failure o the OWTS a it a site u tion ust pert med o loc a sui ble r lacem tare If no re lacement ar ble hol ng b talled a a t resort ace the PO nd 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 CONTAIN 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 FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name h Name ,� u ; 1 7 Phone Phone q 6 — � SEPTAGE SERVICING OPERATOR (PU R) LOCAL REGULATORY AUTH Name Name �i �^� f � Phone �^7 ✓ Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54111, (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY ` SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address \ oo Property Address ` _ (Verification required from Planning D p e or new construction) - `� , ®` l f �A City/State Parcel Identification Number LEGAL DESCRIPTION Property Location ' / a� ' /., Sec r,- T N -R W, Town of Subdivision . Lot # Certified Survey Map # r lv 03 . Volume !L . Page # O�a� Warranty Deed # 4 24166 O , Volume o , Page # 07�� Spec house yes ❑ no Lot lines identifiable J2?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 mastorplumber, 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. Vwe, 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 day7so 0 a year a te. Si 1 V - OF APPX:IC "ATE OWNER CERTIFICATION certify that all tatements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the perty escrn v' e f a ty deed recorded in Register of Deeds Office. s ; a TURF OF & AlCkif D « « « * ** 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 74�6.Q U 2'i 5 6 P 2 3 Q � STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX Co., WI � This Deed, made between Robert R. Maitrejean and Doris A. RECEIVED FOR RECORD Mait_rdean: husband and wife Grantor, 11/13/2003 02:15PH and Donald Dalton WARRANTY DEED Grantee. EXEMPT # Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 210.00 space is needed, please attach addendum): COPY FEE: Lot 1 ertified Survey Map recorded in Volume 8, Page 2260, located CC FEE: In part of the SE 1/4 of the NE 114 of Section 30, Township 31N, Range PAGES: 1 18W, Town of Star Prairie, St. Croix County, Wisconsin. Recording Area Name and Retyrr 0. d�e� 16{ N , w P A,,nov,- Wr S (A 038 - 112140-110: 038- 112140 -120 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptio to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 7 day of November , 2003 X * * R obert R. M * * Doris A. Maltrejean AUTHENTICATION ACKNOWLEDGMENT Signature(s) Robert R. Maitr and Doris A. Matti ejeat , STATE OF ) husb and wife _ -- ) ss. fit., County ) authenticated this day of Nov ember , 2003 Personally came before me this day of the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ _ to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristin Ogland Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) I ,) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800.655.2021 WARRANTY DEED FORM No. 2 -1999 C10 AZ FILIED AUG2 1199pr• JAMES Ot Mh 461603 CERTIFIED SURVEY MAP ' Located in part of the SE4 of the NEa of Section 30, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. LEGEND OWNER County Section Monument Robert R. Maitrejean � Computed Position of Section Corner Route 1 Somerset, WI 54025 0 1" x 24 Iron Pipe Set, weighing 1.68 lbs. per linear foot A OVER AUG <:au;g S55 0 43'09 "E CC)MR J IMVEPARKSPLANNING 71.14' , AND YQN1Nv rOMM1TEE �. e•� r: a 1 Is S' p 00 401 9' A S V ° B t ° 0 cn Note Temporary Cul —De —Sac to be , to ,Q��'o� ��%S 3 �° / N �, ; N removed upon extension of % w'h� 1 00 GO 19 d C ' ro Private Road Easement as �Q % A�nP t7 Ft• a 0 0 shown on this map. '� �� �;I, 238E , O� Gi v r z i , N ib 0� a I to ` �Q,�v ��• f J'Sb' N 4J 41 0 0; N00 037'35 "E 66.00' ' P sS s ` •i o•a '�' i N N S89 022'25 "E m w m 1 6. 00' `, 6 G C?/ G Oj So 9�, Q NE CORNER OF N B O - R= -� /. / g3p / ��/ SECTION 30 O -� S 34° 16' S1 "W k' / 2 j 44.78' N89 0 22'25" W / w 16.00' M o SCALE IN FEET o' o d i 0 geal ' a ge M y o i 0 f00 200 300 1 v 1 $ N vp j/ N to c 1 a I Z N89 0 22'25 "W 1105.19' 4374.47' East West'1 /4 line of Section 30 w W I/4 CORNER OF E I/4 CORNER OF V S ECTION 30 SECTION 30 0� a 0 i This instrument drafted by Fran Bleskacek Proj. No. 88 -29 SE CORNER OF VOLU"E 8 PAGE 2260 SECTION 30 t 7634 1 7 1� 2 b 7 7 ' 1 7 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., NI This Deed, made between Donald Dalton and Belinda J. Dalton, RECEIVED FOR RECORD husband and wife Grantor, 05/21/2004 10:00AN and Jerry W . Barrett , A STNrT.R PF.RSf1N Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT # the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 (if more space is needed, please attach addendum): TRANS FEE: 1020.00 COPY FEE: Part of SE IANE'/.Sec. 30- T31N -R18W described as follows: Lot 1 of CC FEE: Certified Survey Map recorded in Vol. 8 of Certified Survey Maps, page PAGES: 1 2260, as Doc. No. 461603. Together with a 66 foot private road easement as indicated on the subject certified survey map. St. Croix County, Wisconsin. Recording Area Name and Return Address David J. Estreen 304 Locust Street Hudson, Wt 54016 1 =z) 1 .. 038- 1121 - 40-110 Parcel Identification Number (PIN) This i (N O+ homestead property 40 (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 11 day of May 1 2004 * * Donald Dalton * _ * Belinda J. Dalton U AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF W ( ) ) ss. S 1 . �i�G ► V County ) authenticated this ___ day of Personally came before me this i 1 Aay of �01_. May , 2004 trieabove named _ Donald Dalton and Belinda J. Dalt hug anti TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who ex ted authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. t' THIS INSTRUMENT WAS DRAFTED BY 1 / w , Attorney Kristin Ogland Hudson, WI 54016 Notary Public, State of WTRCONSTN My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, W1 STATE BAR OF WISCONSIN 8011.65' 2021 WARRANTY DEED FORM No. 2 - 1994 .._.. _. _ n @o! ■�� e � 2 E §� - � oƒ 2 e 0 S 0 ®/ S �. o e \ o a } / K(� °° obi.§ o . a ; q o + ® § § BCD k �k� ■ ( E CD ) o o E o E E 4) / § ± ¢ 0 $ � § ) \ C @ 00 Q -< 2 § �: m k S/\ A f§ "*4. : -0 -0 - 0 \ E } 0 0 0 Or o 0 \ § S § > > } 2 ( M § ° § g K 2 2 ( , & g @ / .. C CD m \ @ 0 2 � � \ k \ / � ° 2 A CA ƒ 3 E / / § ) 0 ®� @ t 2 I�# § % \ § , ^ \ � > § 0 \ � k c ƒ % t � � \ � ' $ � R � $ � \ � � e � 0 G � � 81 � a,2