HomeMy WebLinkAbout040-1276-60-000 (2) -� T
Wisconsin_ [,!apartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
420575 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:
Stagg, Tim Troy Township 040 - 1276 -60 -000
CST BM Elev: 9 !�(� �L Insp. BM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic j Benchmar
01w► /. 9 IY6 d' ��Y- 4?
seghcA' Alt. BM 4-3 ? J
Ae ation Bldg. Sewer
s
Holding St/ t Inlet 2Z
Ht Outlet p p�
TANK SETBACK INFORMATION l®
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD In et M -,7G cl 3 Y /
Septic ( � +�y 3 l_ [ �:� D 8 �
� Z ( 1�0
Dos Hader /Man.
Aerati Dist. Pipe
Fih ter, 1�
Holding Bot. Syste
r
Final Grade U
PUMP /SIPHON INFORMATION 7- t'C
Manufacturer Demand St Co r i d
GPM �r [-..I 35el 6%4' 4- 7YZ 3
Model Nu
TDH Lift Fri ctio System Head T Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM 0 C� - 34, �a
BED/TRENCH Width I Leh 5 .t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO PILW JBLDG WEI. LAKE /STREA LEACHINGMa ye
INFORMATION CH ER OR] d �/-
T e Of System: ( / O _ UN Model Number: �Y
Cv
Zl � r�
DISTRIBUTION SYSTEM ,� 4-/116 --
Header /Manifold Distribution x Hole Size x Ho Vent to Air Intake
ff Pipe(s)el < r n 1,h (Ak g l�.� rf '5
L Dia Length Dia 44 Spacin �V
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over 3- Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Ill Yes J No C Yes j No
COMMENTS: (Include code discrepencies, pe c Y�f I spection #1: / / ection #2:
Location: 399 Omaha Court Hudson, WI 54016 (SE 4 E 114 8�724k1N R19W) EAGLE BLUFF Lot 6 Parcel No: 08.29.19.1538
VL(alwwf dr., w/ C s 1 - re�dt't - SyS { �ra�z vt r�r a I �cr-1 e 5171 1.) Alt BM Description = � YtP ai/ �' Y1l2
2.) Bldg sewer length = �03 � l� �PQS� - P a�f- Hq -a-�. ol. o� SY:' �'' ('5T CKa.«�i.¢r
- amount of cover = N (°' o t' " `y 1
j � "� a v., to s i-GI�1 y -H-t�� G� m 5.2s wt4f -Pr�-r 0 0'Vd-s-} v „ 4 6
Plan revision Required? Yes L 'NO�
3 -
Use other side for additional information. GG� " -- -
- -y— - -- - -- -i ..-- - -- --
Da Insepctor Signature /,- Cert. No.
Q l
SBD 6710 (R.3/97) r i� SA e" 1GC „ l �/ K D SO
/� d { l T �[
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7082
ire ®nsin Madison, WI 53707 - 7082' ite Address
Department of Commerce r- 7Z -0
Sanitary Permit Number
Sanitary Permit Application X2.0 SAS
In accord with Comm 83.21, Wis. Adm. Code, personal information you provicit:
❑Check if Revision
may be used for secondary purposes Privacy Law, s15.04 1 m
I. Application Information - Please Print All Informatiotl -_.• °" State Plan I.D. Number
Property Owner's Na me `t Parcel Number
—� 153 9
Property Owner's M ailing Address Property Location
r =
bG; S N. R
City, State Zip Code N Phone Number Lot Nu ber BI N be
Subdivision Name C5M NuyfibEr
II. Type of Building (Check all that apply.) t Aer S ❑ City
I
I or 2 Family Dwelling - Number of Bedrooms ►- a+4s• ❑ Village
❑ Public /Commercial - Describe Use Townshi C
O State Owned Nearest Road
3'X III •%� Ale" c t.Q s 7
4 III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.
A. 1 New 3 ❑ Replacement of G ❑ Addition to
System 2 ❑Replacement System Tank Only Existing System For County use
B ' ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV. Type of POWT System: (Check all that apply. Nuniberiug is for internal use.) - (Oo
44 Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 Ai -Grade 46 DAerobic Treatment Unit 49 ❑ Recirculating 30 C Other
I {
V. Dispersal/Treat ent Area Information: �P
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation
A2 3.3
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 B _
G
Dosing Chamber
VII. Responsibility Statement- I, the undersigne , assume responsibility for installation of the POWTS shown on the attached plans.
Plumber' Na a (Print) Plum is g azure MP /MPRS Number Business Phone Number
0 �/ /
Plumbers Addre ss (Street, City, State, 'Lip Code)
SZ-0 6,
VIII. Count /De artment Use Onl
Disapproved Date Issued ' s g Agent Sig71e (No Stamps)
Approved ❑ Owner Given Initial Adverse Sanitary Permit Fee (includes Groundwater (1
Determination Surcharge Fee)
I Conditions of Approval/Reason ons for Disapproval
-At
�n
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 Inches in size
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SBD -6398 (R. 05101)
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of
Dielsion of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County ST. C:fZUtx
Attach complete site plan on paper not less than 8 1/2 x 11 ize. Plan must
Include, but not limited to: vertical and horizontal referpnEe;nt (B ReQtion and parcel I.D. percent slope, scale or dimensions, north arrow, apd lova) is c� to gearest
road.
f , '
Please print all ' fQreiation. R iewed by Date
Personal Information you provide may be used for r".aary pur�egyijjc yaw, S. 16.04 (m)). l r �V �1) I L_
Property Owner ___i Properly Pation 2 OFTt%E
L i AV—LeS, 6% CfJOK 'i l; E� ( % C i3 SE 114 SE 114 S T Z9 N R (q W
Property Owner's Mailing Address r ST CR Lot # Biock # Subd. Name or CSM#
IIV00 A6eK0EEf\1 51; JUC- 1 •Te C C � y,Y ,C ; A.. — EA6� -E R4uF�
City State Zip Code orS� y ge kj Town Nearest Road
13LA 1117E I AA f� 155 LA4q ('7b� #,7�'� , � \ - T RO to�,JNSV fit l;c`l RD.
Q7 New Construction UseA Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or comm al - scribe:
Parent material SAIJD s VOCE Flood Plain elevation if applicable IV I� R•
General comments 2X IM' 1`I IvN�L 11; eeAt"ES
and recommendations: pp SISTE M f✓ 1,l�V �cT 10iJ 9-57,51 n ur -+;� ` r
Scrt� s u Q 7 4 — i' W Sy/S 6 ✓� (- ^121) � (-1e Sze v►f� i vt
11t�e�Gw�d sa�,.ds -For -� v-�.�v 6�d►-�c.�, cG.a�r,�+5 �,.�
of fs
Boring #
F A E] Boring
® Pit Ground surface elev. 941 71 b l in. 35 ft. Depth to limiting factor Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f1
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0 -10 toyr� 51 r vkr ab Z'j -P 0.3
2 10-20 I 0 412211 S't 1 I f-'m CL V m J -(Ir 0 ,10 2\p - co 0. Z 0.3
3 Zb- 10 y1- 5. F - msb ds I� -m O.S 0.
4 zek-46 0 \110 loy ti b 4 10VY�, Si 1 1 msbK d- 1
S 10-53 t 040,4/3 to Ib 511 1 m 5bK d as a Z- 0•3
l0 53 -101 1 y y — S 0 m O.7 1.2-
�- 935.`13
F�] Bor ing # Boring 5.02- 1 � Pit Ground surface elev. 9 2 ` 6 ft. Depth to limiting factor �!, 100 in. Soil licalion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg
in, Munseell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
It 0 - 101le-4t 511 ZT Y M 0.5
Z 4 -g I a V IZZ 51 1 - Mjfr 244 1 6.5
3 c d - 20 11D 4 mSb1C yr,�r CS 2J 0.L 0 . 3
Li 2t) - 210 - 7.5 \1 4 1 1 rnsbK ash C5 f - 0• 0.(�
5 zb-'i1 7,5`I►2r-I e 4 7 - S K dsh CLS 1 �- b.L4 O.('
-1 o4 — 5 ostA ry\ 1 — 0 I. Z
CouvLC ,1 5>
• Effluent #1 = BOD > 30 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) §Jgnature CST Number
Mh aafa s E 224832
Address Date Evaluation Conducted Telephone Number
W9$ - 15 690 +$% A0 , ve F>4LL Wr 5 11-02 -00 C- 715)4Z6 -1-715
A
I.. or to Page 2 of
Property Owner �� C fi1A I�e L� Parcel ID #
a Boring # ❑Boring
C d f elevS4_ ?O (t. Depth to limiting Soil Application Rate
for, 7 `]J` in.
� 0.
Pit
Ground surface elev. _
Horizon Depth Dominant Color Redox Description Texture Structure Boundary Roots «E GPDIffEff #2
In.
Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
l O-4 Iov ri,�z ) If Jfah 3�r� m 0.4 -1$ toyt2�z — S rns CS 34t -� U (o
3 Ig -25' to `t a . 3 _ 51 .24-M r►4r C 3J�-� 0. S 03
`1 �5 - 32 av �� s 2-f -m m9 5 J� -� D.5 0,9
5 2`5 Ie foY 4 �' s r CS 0.� I,Z
Sb - I(ayYly rvtl C,5 i44 b,7 I.2-
7 G0- 7,5 K /4
a�4 a.b
(im - a2Dri; � HAS 5 G4AftL.
El Boring # E] 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 «Eff#1 *Eff#2
In. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh.
F Boring # [] Boring Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
❑ Pit
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots «Eff#1 E
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
i
« _
Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg /L Effluent #2 GOD < _ 30 mglL and TSS < _ 30 mg/L
e m p loyer. If ou need assistance to access services or
Commerce is an equal o Y
The Department of Com q opportunity service provider and
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777.
WOPEW OWW: ' 0 AKLE5 /'�- 0'
I.�GAI, V� OP 0 b A�r-� �3 ; .uFF r3M- e - rOP OF MAIL- In1 ATC.,WLI-MA
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S - U W 0 p OF 1920 11 A 601 E GRj u v i5-vZt-7tcG .
5 1- C- o\x COIAMIl LAWSCO C1 0. Fl-5OL POMNG W/ PACKHa
NO COMM 85 5�TACK PkOnM5
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Rod Eslinger
From: Jansky, Leroy [ijansky @commerce.state.wi.us]
Sent: Monday, October 28, 2002 2 :45 PM
To: 'Rod Eslinger'
Subject: RE: 85.30 (3) Soil color pattern exemptions
The answer is no. However, this section could be more clear, but when the
entire exemption is read it should be more clear that the intent is to have
t he syste (sidewalls and Al) installed in the "unmottled" soil below.
That's why there must be 4 ft of suitable material below the layer
exhibiting the redox features (12" th' eatment zone = 4
ft). Pretreatment would make a difference where only 3 feet of sui a e
would be needed and so would the thickess of the distribution cell. These
two variables were not included considered in the code and should have been.
The upcoming code revision will rectify the problem of cell thickness and
treatment /dispersal zone.
Remember that just because we give an exemption not to call such conditions
high groundwater, doesn't mean we should plop a system within it or to too
close to the condition. B arn mils are likely tension saturated and cannot
take on any additional water from a POWTS. Hydraulic failure would be
expected i a system were installed within t e ayer. We feel however, that
if a system were installed below the layer that it would not be adversely
affected by the near saturated con I Ions above. Hence, the exemption.
• - - -- Original Message - - - --
• From: Rod Eslinger
• Sent: Monday, October 28, 2002 8:45 AM
• To: Leroy Jansky (E -mail)
• Subject: 85.30 (3) Soil color pattern exemptions
• When a CST describes soil conditions that meet 85.30 (3) 2. exemptions,
• can a plumber locate the infiltrative surface within the mottled horizon
• provided everything else is ok. According to 85.30 (3) 2. the CST can
• discount the noted condition above. I have a situation that meets this
• provision down to the exact inch so I am just double checking.
• Thanks
• Rod
• Rod Eslinger
• Zoning Specialist
• St. Croix County Zoning
• 1101 Carmichael Road
• Hudson, WI 54016
• phone 715- 386 -4680
• fax 715 - 386 -4686
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010slon of Safety and Buildings
in accordance wkh Comm 85. VIA& Adm. Code County
sT, CQOtX
Attach complete site plan on paper not less then 8 112 x 11 Inches In size. Plan must
Include, but not Umked to: vertical and horizontal reference point (8M), direction and Parcel 10.
percent slope, scale or dimensions, north arrow, end location and distance to nearest road.
Please print all Information.
owed by DI(
Personef inlormotion you provide may be used for secondary purposes (Prlvacy Law, s. 1 5,04 (1) (m e )).
Owner Property Location 7 o F T� E
Property
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« POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page __L of �—
FILE MIFORMATION SYSTEM SPECIFICATIONS
Owner - � Septic Tank Capacity al E3 NA
Permit # q7_0 -- � Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer L ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model to ❑ NA
Number of Public Facility Units rWNA Pump Tank Capacity a l ❑ NA
Estimated flow (average) )`v al / da Pump Tank Manufacturer "A
Design flow (peak), (Estimated x 1.5) al /der Pump Manufacturer 9111A
Soil Application Rate (9 al /der /W Pump Model PPNA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit / EVNA
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 g Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L vfJn- 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: ❑ NA Other. ❑ NA
"Values typical for domestic wastewater and septic tank effluent.
Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ nth(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: �j r(s)
Pump out contents of tank(s) When combined sludge one -third YI of tank volume ❑ NA
d e and scum equals l a
g eq
is At least once every: IS-
❑ monthls) (Maximum 3 years) ❑ NA
Inspect dispersal Ins d p cells O years)
�
` ❑ month(s) ❑ NA
Clean effluent filter At least once every: 2 ear(s)
❑ monthls) 7NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
' ❑ month(s) j"A
Flush laterals and pressure test At least once every: ❑ year(s)
Other:
13 month(s) IPNA
At least once every: ❑ Y ear(s)
Other: "
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 g round surf may in
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.
other services including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
All o 9 .
9
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.
Page _ Z
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting proEducts or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). 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:
Q 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 limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ 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.
❑ 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 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 t ,,, Name
Phone S S . 3 1 �{�' Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name 155, L(Lo rK Cs0cA- l -"69 ►1 �
Phone [ 7 Phone t 5 , 3gb • 1�
This document was drafted in compliance with chapter Comm 83.22(21(b)(1)(d) &(f) and 83.540!, (2) & (3), Wisconsin Administrative Code
ST. CROIX COUNTY
SEPTIC TANK MAINTANANCE AGREEMENT
A"
—' OWNERSHIP CERTIFICATE FORM
Ownet/Buyer i + PV1 4 "d —
Mailing address 706+ +%t�C�I V W 00d bU!N M 1V 12 9
Ptnpert Address 3 11 L ) /??a/7a Cou rf^ Mld w! Y40 t 6 y�
(Veri/lcation Nquired Qom Planning Departm" for new conwwtion)
City/StAc AVdG0n __„ Parcei ldentiflcwion Number_OI 1276 — (phi ^ OC)o t s3g
LEGAL RESCRIPTION 2�
Property Location S E ff ' /., SE ' /.. S,-- T P-R Town of
Subdivision ie• � � T � L.otN � J
Certified Survey Map# , Volume _Page
Warranty Deed# 6_14690 , Volume 4 E Page 95
Spec house yes �/ no Lot lines identifiable d es — no
SYSTEM MAINTENANCE
Improper use and maintcnanae of your septic system could result its premature failure to handle wastes.
Proper mainiatance consists of pumping out the septic tank every three years or sooner, if needed by a licensed
pumper. Who 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 masterplumber, 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.
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 th Department of Commerce and use 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 10 da s of the three year expiration dale.
.--
1
Slr,,hQf
YRE M 13 U DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge I (we) art
(are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of
Deeds Office.
SIGN E OF RPPL~ DATEr
..,.•, Any isbmtation tint is tensest asntad nary rewh in the sanitary permit being revoked by the Zaai% 0eWft%at•••
s• Include with thn appticatim a ata+stpad warranty dad ftm tfta Repstar ort)eeds affm
a cosy o(tha eauAed aarvey ntsp ifrel rgme is made is the v mat) dad.
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a STATE BAR OF WISCONSIN FORM 1 - 1998 674690
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., kI
RECEIVED FOR RECORD
This Deed, made between 03 -27 -2002 11:00 AH
Troy Development Corporation, a Minnesota Corporation
WARRfWTY DEED
Grantor. EXEMPT #
and Ti d tvdy 5 T' R GC� REC } 'S v { TRANS FEE: 11.00
_ TRA FEE: 299.70
__ - - -- COPY FEE:
Grantee. CERT COPY FEE:
Grantor. for a valuable consideration, conveys to Grantee the following PAGES: 1
described real estate In ,_,. St. Croix County, State of Wisconsin
(the '
Name and Raturn Addraea
Lot L f the Plat of Eagle Bluff in the Town of r SO - 7a,55
t. Croix C unty, If sconsin.
OC)a .00'b
Subject to Declarations of Covenants, Conditions and W 0 5 IaS
Restrictions for Eagle Bluff, recorded in Vol. 1589 J 0`�
Page 516 , as Doc. No. 638946 , as appearing in 0 Z —�
the office of the Register of Deeds for St. Croix
County, Wisconsin, and such other. easements, (� 'J C, ._ f � - 7& 4c - COo
restrictions and reservations of record, or in use, Parcel Identification Number (PIN)
and the "Buyer." obligations contained in the This is not homestead property.
Purchase Agreement for. this lot. (i (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 rice and clear of encumbrances except
Dated this tq- C) &w - r 4
day of ✓Y��r � ,
3 C o
Ag T - (SEAL) (SEAL)
. Charles S. Cook, President
Troy Development corporation
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
11innesota
Signature(s) T__ _ State of Wheorttfrr
1 ss
A noka___ County. f
authenticated this day of
Personally cattle before me this – day of
.the above named
C harles S. Cook, President
Troy Development Corporation
TITLE MEMBER STATE BAR OF WISCONSIN - - -- t o
(it not, me known to be the person _ who executed the foregoing
awhortzed by §706.06, Wis. stats.) instr,nnent and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
_ Troy . ., Developm corpo ration
Ric Johnson
Notary Public.5uw -a22 - rwn Anoka County, 14inn.
Charles S. Cook, President My commission is permanent. (If not, state expiration date:
($Ignawres — maybe authenticated or acknowledged. Both are not
January 31 2006 ,)
necessary.)
• N'e it - iii Iµ . urn..1y, iir ix it s,ry ant. riy ii ��r.i i . lytwvl ur Nrin'J Iw•1 ilir�i, riµrwli iir
STATE BAR OF WISCONSIN w-sranern Legal Bmos °o.. Inc
WARRANTY DEED FOR .
M No. t - 1998 Miweuke6. W�6.
■
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Flovurr q.�euc - fs+fsou
MY COIrNiAISS10N EXPIRES
JANUAA�' 31,2008
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RODLI,
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BESKA
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Stuart J. Krueger
T7�/�TT
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Munkit
UL1 �L1 = K� 7 • • Catherine R. Munkittrick
ASmiceCo><pwaU Kenneth C. Pletcher
Attorneys at Law
219 North Main Street PO Box 138
a River Falls, Wisconsin 54022
`� Fax (715) 425 -7586 Phone (715) 425 -7281
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