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HomeMy WebLinkAbout040-1272-30-000 /0) 0 r / � § % I � � ■ � � E � 0 m $ 0 & 2 _ - a ° 1 . » E ( o k CD / CL \ 7 § Co § o n _ e ■ 4 E #� o E / ® § £ % § L w o = 21 a - � r � § 8 Q Q m. f / / % § E c 0 § - � � � � � � • � / 0 0 o I } 0 \ ) § § \. k / / z m St / / } ( \ � k 1 �I / / E z { m I @ 0 } \ [ R 4 # / ƒ G. } CD CL ° / \ 0 CD � 0 0) -1 � 0 \ $ 0 f / m T f d a E§ �z � » m § Cl) � q z / i . % 7 � . N 0CL ] vCD (D CL j (70]o E §[aƒ go/ §ƒ£ to CD %o« @ � ]ƒ [ CD $ 3m W ; §[ a �G 2 E/ i e ; 0 < A § \ \0 a� � k r Wisconsin Dartment of Commerce County: Saf� ai�d�ilding Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: 453012 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: Warner, Phillip & Kristi I Troy Township 040 - 1272 -30 -000 CST BM Elev: Insp. BM Elev: BM D scription: ,, ,,__ -- C _ Section/Town /Range /Map No: D-6 to()-6 Q,t,(� �'V ` (J� 1�aj 17.28.19.1510 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 12, (o b Benchmark Z I ' L.I.2 r �J C) . Dosing Alt. BM ..3 /y Aeration Bldg. Sewer �0 -O IN. Z ` 6V- - Holding St/Ht Inlet � - �5 St/Ht Outlet J , / TANK SETBACK INFORMATION 5 G LEI D z TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom 3 Dosing Header /Man. Aeration Dist. Pip b 0 Holding Bot. S stem ( d v i im . I PUMP /SIPHON INFORMATION Final GradI6 Manufacturer Demand St Cover GPM rrSe lit/ I Q (d 3 v Model Number C TDH Lift Friction Loss System TDH Ft Forcemain Dia. Dist. to Well SOIL ABSORPTION SYSTEM Z BED /TRENCH Width Len�gt No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WE L LAKE /STREA LEACHI Ma urer: •t w INFORMATION CHA OR Typ Of System: / UNIT Model Number: + DISTRIBUTION SYSTEM , 9 -ft di Header /Manifold Distribution I C / x Hole S� x Hole Spacing Vet to Air Intake Pipes) /y „ / Length Dia Length Dia pacing r+d SOIL COVER x Pressure Systems Only xx Mo Or At - Gra de Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / , Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: =/_,2:�7 d Inspection #2: Location: 427 Lost Rock Lane Hudson, WI 54 (NW 1/4 SW 114 17 T28N R19W) Troywood Lot 34 � Parcel No: 17.28.19.1510 1.) Alt BM Description = '�I O 'v" "t l�r I J ��/!�� (, 2.) Bldg sewer length = ( 1 GLS - amount of cover = , /es k4vd e, Plan revision Required? No Use other side for additional information. SBD -6710 (R.3197) Date Insepctor's Signature Cert . No Ar Safety and Buildings Division County W 201 W. Washington Ave., P.O. Box 7162 vi Madison, WI 53707 - 7162 Sanitary Permit umber (t be filled in by Co.) De artment of Commerce (608) 266-3151� Sanitary Permit Application state Plan I.D Numbers / In accord with Comm 83.21, Wis. Adm. Code, personal information you may be used for secondary purposes Privacy Law, Project Address (if different than mailing address) I. Application Information - Please Print All Information G 604 a A Property Owner's Na me / i P arcel q Lot Block N I GR01X C0 E� Property Ow is M ailing Address O Property Location s / 5/0 'A, 'A, Section i_ City, State 7Ip Code Phone Number -7© — (ciirc / le ) -'� T �C4 N; RIG 9 } if. Type of Building check all that apply) v p 1 Subdivision Name fi t= I or 2 Family Dwelling - Number of Bedrooms r�'YCr� ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use D S c &us bf/ alb /L� /7� 3 - 9 ❑City_ Village Township of 1II. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' �t^J� Syste ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System List Previous Permit Number and Date Issued B. [] Permit Renewal ❑ Permit Revision ❑ Change of ❑ PetmitTransfer to New - -- - - Before Expiration Plumber Owner IV. Tv of POWTS S stem: (Check all that apply) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter !) Constructed Wetland El Pressurized In- Ground El Holding Tank El Peat Filter ❑ Aerobic Treatment Unit ❑Recirculating Sand Filter L ] Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑Other (explain) V. Dispersal/Trentment Area Infor ation: 1 D f 'ru "- Deci$'n blow (gpd) Design Soil Applic lion Rate(gpdsf) Dispersal Area Required (sf) ispersnl Area Proposed (sf) System Elevation fox � tieeov� V1. Tank Info Capacity in Total Number t/ �M�anufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Z�`�`- A-100 Concrete Constructed Glass New Existing Z1� nu Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit posing Chamber V11. Res nsibility Statement- 1, the undersigned, m me responsibility for installation of the POWTS shown on the attached plans. Plumher' Na a (Print )_ PI be 's S, a e MP /MPRS Number Business Phone Number Ph tuber s Ad re ss (Street, City, tate, Zip Code VIi Count /Dc artment Use Onl I Sanitary Permit Fee (includes Groundwater Date Issued issuing A nt Signa ( o Stamps) Approved ❑ Disapproved Surcharge Pcc) � - , = _ (7 Owner Given Reason for Denial sf €1f"� �v"r`v efkApprovnl /Rencons for Dlsapprovnl � 1 Septic tank, effluent filter and Ct ��• S Z / V / dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per pplicable code /ordinances. 77 i Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 Inches in size RD-6398 (R. 01/03) A,AI i � 3 Z7 /JP�ase� /Lb�t'SF'OWK�� y iJ ° �SG1r /rte i 1 /C��es��o iNel/ 1352 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Gustum Septic Service Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow and location and distance to nearest road. Parcel 1. D. O O: Please priP41 iilfvrnhattion. ��eflcFiq��` � , 'awed Dat Personal information you provide m�peir�dfor secondarX purposes (Privacy Law, s. 15.04 (1) (m)). - / O Property Owner ; '� _ {- Property Location Humbird Land Corporation r `_;.? �'° '' Govt. Lot 1/4 SW 1/4 S 17 T 28 N R 19 W Property Owner's Mailing Address -' J <;9 ?;' Lot # Block # Subd. Name or CSM# 332 Minnesota Street, East 1404 d00 34 n/a Troy Wood Subdivision City Stare Zip C 11" Number ` _j City ;j V Illage ✓ Town Nearest Road Saint Paul 'MN'" ..5 lki c4 22 Troy E Cove Rd / Lost Rock Lane ✓� New Construction Use:'' i6enpal� o� Kedrooms 3 Code derived design flow rate 450 GPD _A Replacement �( Pub�T w-d' auxierct - Describe. Parent material o utwash plains Flood plain elevation, if applicable n/a General comments and recommendations: Part of 1.51 acres. BM #1= 100.0'. BM #2= 102.95'. Recommend 101.0' system elevation. P37 from prelim inaryboring work done 5 -5 -00. [ P37] Boring # __j Boring ✓ Pit Ground Surface elev. 103.95 ft. Depth to limiting factor >72 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 -11 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 11 -18 10yr3/3 none sil 2msbk mvfr cw 1f 0.5 0.8 3 18 -27 10yr4/4 none sil 2msbk mvfr cw - 0.5 0.8 4 27 -56 10yr4/6 none sl 2msbk mvfr cw - 0.5 0.9 5 56-7 10yr5/6 none s fs " 1 msbk mvfr - - 0.4 0.6 I I Boring # .___I Boring ✓{ Pit Ground Surface elev. 102.55 ft. Depth to limiting factor >72 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0 -13 10yr2/2 none sil 2msbk mvfr as 2f,lm 0.5 0.8 2 13 -17 10yr3/4 none sil 2msbk mvfr cw lf,lm 0.5 0.8 3 17 -25 10yr4/4 none sil 2msbk mfr cw 1f 0.5 0.8 4 25 -33 10yr4/6 none sill 2msbk mfr cw - 0.5 0.8 - 5( ' 33-38 10yr4/6 none sl 2msbk mvfr cw - 0.5 0.9 6 38 -72 10yr5/6 none Is �msb mv fr - - 0.7 1.2 * Effluent #1 = BOD s> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <, O mg/L CST Name (Please Print) Signature: CST Number Tom Gustum Ar 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., New Auburn, Wl 54757 11/20/00 715 -658 -1344 Property owner Humbird Land Colo ration - -- Parcel ID# - p ending Page _ 2 Of 3 F21 Boring # 16 � > Pit Ground Surface elev. 102.55 ft. Depth to limiting factor 72 in. 16 - _ _- _ - - -_ -- - - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ - _ S,P_M' -_ *Eff#1 *Eff#2 1 0-4 10yr2/2 none sil 2msbk mvfr as 3f,1m 0.5 0.8 2 4 -13 10yr2/2 none sil 2msbk mvfr cw 2m,1co 0.5 0.8 3 13 -20 10yr4/4 n one sil 2msbk mfr cw 1m,1co 0.5 0.8 4 P45-52 10yr4 / none sil 2msbk mfr cw 1 m 0.5 0.8 5 10yr4/6 none O 2m sbk mfr cw - 0.5 0.9 6 10yr5/6 none Is 1 msbk mvfr cw - 0.7 1.2 7 52 -72 10yr4/6 none Is �lmsb mv fr - - 0.7 1.2 F J J 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 *Eff#1 *Eff#2 f - I Boring # --J Boring round Surface _— ft. Depth to limiting n. J PR G ou Su elev . - - - - - -- -- - factor i Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots * Eff# 1 ff#2 I ' Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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 alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. 0 _ o o a N C o r Q J — � = M � U o a N ar Q ci o fl. S � V t^ � o N cn o 0 0 — w w cn w w Q �N m \ 1 \ N \\ \ 1 1 \ CO 1 1 � lf7 O CD 1 \ \ 1 I \ 1 1 \ � 1 I \ i \ \ J 1 \ \ —� Lnl \ tf] \1 1 \ � o � J co \ c2 \ 1 1 L o O N C l O m U U C tIJ f\ 6� C m C M p N / N C N p N O 0 O N C O U S o 2 'S �a N Z N Z O O N AMA- Z - '0� c C C�� Q Z gm E$ > 00 2W2,A H -z P v m < I Feb. 23 04 12:10p Jason Johnson 7153867992 p.2 FEB --23 -2004 10= SB BROWNSON & BAL LLKJ F'LLF bal 'DJC 4GCJ r , roc ST CROIX COUNTY SGATiC i - ANK MAINTENANCE AGRL-EMENT AND OWtN1-.RSHIP CERTIFICATION FORlti7 Owner/Buyer Mailing Address 7� � l.,�i�Gri�rP,O Property Address � (veri ,cation requarcd from Planning Department W n" Construct ���� ; t ation Number 7 — °� —a6D Cityt'$tare /YGl�S / // Parcel (dent ft LE GAL !2 ESCRIMOIV • /� /O ?roperty Location �✓�l/ /., .s6y Y., Sec. TN -RW, Town of �'eo -� Lot N . Certifled Survey Map V . Volume a Page 0 '25 Q Page IV 31 D h1'tlrraory Decd # 7 5 - S -- 7- 3/ .Volume . - Spec house O ycs #'-"o Lot lines identifiableyyes a no SYSTF�IK MAINTENANCE kapsopee arse and nis+ntenancc of your septic svatcmcould result to its premature railorc to handle wsles. Proper Nfa:rtsnaaCc consists of pumping our the septic tank cvccy three Y EWS " sooner. ,f needed by a laccesed Pumper Wlrat you pul ntto the system can affect the runcri an or the septic rank as a treatment case in the caste dispose) aysttrtn. The prnpeny owner ogre" to submit to St. Croix Zoning Deparhncn► a cemftption form. signed by the owner and bw a alaiea.9 plumW. jottmcyntaa plun►bct. restrictcdfajil nbe: at a lieensedparnper verifying that (1) the on -acre wa traterdisposal systcrn n in proper operating rundstion antkor (2) ararr tnspccticn and pumpir.0 (i ►necessary). the septic rank is less than I/3 full of sludge. Itwe. the undersigned have recto the above rcquirctrienes and agree to mauaaie the private se wage dtaposal system wa"h the standards tit forth. herein- as scr by the Department or Ct> nmeree and the Department of Natural Risourees. State of Wiseonset. Certtfacatwn stating tbat yow sortie systern Ant (seen ni4ii,r:%..a0J +.rust he tornpleteti and returned to me St Croix County Zonirig Office wahrn 30 days of the three year captravan dote. :0 WOW OF APPtlCAAT DATE OWNER CERTIF7CAIION 1 (we) certify that 311 staurnents on ibis faun, arc true to the best of m y (our) knowictlge. 1 (ve) am (are) the a..aicr(sl of the p aperay describ d ahavc. by van tic of j .rrranty deed recorded in Register of Deeds Office. 0 t�31 SIOMTURE Of APPLICANT DATfi ` a•••a` Any information that is mis•rcprescntcd may result rw the sanitary perinat being revoked by the Zoamg DcPsnmcrt " Include with this application. a uaniried warranty deed from, the Register of Deeds office o copy of the certified survey map it reference is node in the warranty deed TOTAL P.02 i ST CROIX COUNTY StiP'ri TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address� Property Address 7 Z'7 (verification required from Planning Department for new construction) City/State Parcel Identification Number LE GAI. DESCRIPTION Property Location /,, /., .�11I '1., Sec..., T %L N -RW, Town of Subdivision �ly /.r/�rd. . Lot i1. Certified Survey Map N , Volume , Page N Warranty Deed N , Volume , Page # Spec house 0 yes T/no Lot lines identifiableyyes i] no SYSTEM MAINTENANCE improper use and tttainienanceof 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 b a mastct plumber, journeyman plumber, testrictcd plumber or a licensed pamper verifying that (I) the on -site waste water disposaI system is in proper operating condition andior (1) after inspccnon and pumping (if necessary), the septic tank is less than 113 full of sludge. llwe. 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 ntaittl.1u1eri utttst be completed and retumcd to the St. Croix County Zoning Office within 30 days of the three year expiration date. 1 � SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all stmemenis on this form are true to the best of my (our) knowledge. t {we) am (are) the owncr(sl of the property described above, by viriuc of a . deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE "• *•• Any information that is rues- tcprescmcd may result to 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 seined survey map if reference is made in the warranty deed l i 2 d i. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of FILE INFORMATION SYS SPECIFICATION Owner Septic Tank Capacity a l O NA Permit # 3 0/ � Septic Tank Manufacturer 1 �' D N�, DESIGN PARAMETERS Effluent Filter Manufacturer 0 NA Number of Bedrooms ❑ NA Effluent Filter Model O NA Number of Public Facility Units j2l'•-NA Pump Tank Capacity a l 12 Estimated flow (average) g al/day Pump Tank Manufacturer i�tiA Design flow (peak), (Estimated x 1.5) i al /da Pump Manufacturer `. Soil Application Rate al /da /ftx Pump Model 11--NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 2 - .A Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Watland Total Suspended Solids (TSS) 5150 mg /L O Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (BOD 530 mg /L Pubn- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L O NA O At -Grade 0 Mound Fecal Coliform (geometric mean) 510` cfu /1 OOmI O Drip - Line O Other: Maximum Effluent Particle Size Y in dia. O NA Other. 0 NA Other 0 NA Other: 0 NA "Values typical for domestic wastewater and septic tank effluent. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) ' (Maximum 3 years) 0 N %. earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume O NA Inspect dispersal call(s) At least once every; F ?� O month(s) (Maximum 3 years) 0 NA fE( earls) ., Clean effluent filter At least once every: O month(s) O NA Ti( earls) Inspect pump, pump controls & alarm At least once every: O month(s) El NA O year(s) Flush laterals and pressure test At least once every: ❑ month(s)0 NA ❑ ear(s) Other. At least once every:. O month(s) 0 NA O ear(s) Other. Q NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must includ6 a visual inspection of the tanks) to identify any missing or broken hardware, identity 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 surfacu. The dispersal cells) 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 tho 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 NH 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 erformed b a certified POWTS Maintainer. P Y A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) 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 cell(s). If high concentrations are detected have the cc itents 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 collis) 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 contras tv 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, tl aruo 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 fillet wiu� 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: :� v ,[!( suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be prvtueted from disturbance and compaction and should not be Infringed upvn b, required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wifi result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the r as in affect at that time. Q suitable p ce ant area is not v ilable due to etback and / r oil limits ' s, Berri dvances •LPOW e no logy �foldin tank a be, in ells as a last r ort o replace ha f lied PO �- - site h not ben a slue ed iden 'fy a sui able re lacem t area. Up n fail re of the P WT a s / v luation ust be �ft rmed to ocate a uitabl replace eni ea. If n r lacem t ea is av i lea h / may be in alled as resort to replace �e f led 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 INSTALLE POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR PUMPER ) LOCAL REGULATORY AUTHORITY Name Name Phone ` Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.6411), (2) & (3), Wisconsin Administrative Code. V. 2 5 2 0 P 31 0 75573 1 t STATE BAR OF WISCONSIN FORM 2 • 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS 5T. CROIX CO. WI Docume Number RECEIVED FOR RECORD This Deed, made between Day Farm Investors, LLC, a Minnesota Limited Liability Company 03/03/2004 11:30AN WARRANTY DEED EXEMPT # Grantor, and Philip C. Warner and Kristi K Warner, husband and wife REC FEEL 11.89 TRANS FEE: 329.70 COPY FEE: CC FEEL Grantee. PAGES: 1 Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix _ County, State of Wisconsin: Recording Area Name and Return Address Lot 34 Troy Wood, Town of Troy, St. Croix County, Wisconsin � / ,6� h 1216 ► 040- 1272 -30-OW Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to notes, easements restrictions,covenants and rights of way of record, if any, including but not limited to those for drainage,water retention ponding,and or utilities as may be shown on the plat of Troy Wood recorded in Vol. 8 of Plats, page 28,St. Croix County, W warranties of this deed, either expressed or implied are limited by the grantor to the grantee, or anyone in the chain of title, to an amount not to exceed the consideration expressed herein, that being the sum of $109,000.00. Dated this 23rd day of February 2004 Day Farm Investors, LLC • b�_ President « . Austin J. Baillon AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ]tamsey County. ) Personally came before me this 23rd day of authenticated this - day of February ' 2004 the above named Austin J. Baillon Y TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledge the same. authorized by § 706.06, Wis. Slats.) 4 THIS INSTRUMENT WAS DRAFTED BY PAULA. pAILLON Paul A. Baillon, Attorney at Law ' Paul A. Bwuon u , TARP PuaUC soTA Notary Public State O SII[Y COMMISSION EXPIRES 14 (Signatures may be authenticated or acknowledged. Both are not y Co � 31 ion is pe 2005 necessary) Janua ) *Names of petsota signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 • 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 600-653.2021 1 42 \ ` No / O 33 1.52 ACRES \ \660 03 o3 80. Fr. 1 0 , 34 1.51 ACRES 1 N 1 ! 5,717 SQ. 35 ! a .RES 1.54 ACRES ! 2 ►0. Fr. _ - GF,853 80.+ NC M THIS OU7LOT IS TO BE OWNED By / co ` TROY WOOD ASSOCIATION, INC. FURMER / ' SUBDIVISION PROHIBITED AND BUILDING DEVELOPMENT PROHIBITED IN ACCORDANCE W WITH ST. CROIX COUNTY ZONING / ORDINANCE SECTION 17.09. _ 832.89' / 30 W W \ tip a � r \ CH