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HomeMy WebLinkAbout040-1281-80-000 Wisca isin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420681 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: Derrick Construction Inc. Troy Township 040-1281-80-000 CST BM Elev: Insp. BM lev: BM Description: Section/Town/Range/Map No: igi 4• ) o 0q. 10 cS r ; ~ ( 19.28.19.1589 TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet I / TA SETBACK INFORMATION St/Ht Outlet G 02~ TANK TO P/L WELL ]BLDG. Vent to Air Intake ROAD Dt Inlet Septic t ` t Dt Bottom w Dosing Header/ an. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM D • ZD S-6Z Model Num TDH Lift ' 'on Loss System Head T H Ft Force m Length IDia. I OIL ORPTION EM( 9)6 1 rr,4ek RE C Width Length No.(3) f Tren es PIT DIMENSIONS; No. Of Pits Inside Dia. Liquid Depth DI NS 34 1~ eA•/ SETBACK SYSTEM TO P/L G WEL L LAKE/STREAK LEACHING Manufa ttuure: _ INFORMATION CHAMBER OR Type Of System: UNIT Model Number: t DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Siz x Hole Spacing ]Vent to Air Intake / !tf Pipe(s) Length Dia Length Dia Spacing _ 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 ~ Yes No Uh M N (Includecode e i s, per ns present, etc.) Inspection 1: ••lInspection #2:ion: 228 MArf eldCTrl Hudson, WI Al 6 (d1/4 SW 1/4 19 T28N R1ZV T ; ~o 1.) Alt BM Description = P-- ~r. Op, , s 2.) Bldg sewer length = •r 3~t4~ 2 , $ ` a /3 , dZ f amount of cover = C> Lit ~+i « j~t~ 8},493 QLr Z J t ° 8~3.0~ 1. • F OCR 3) webt : + ~',m%,s6w-. 6*"; OUAL - -t!o =~°!2 Plan revision Required? Yes X No Use other side for additional information. 23 SBD-6710 (R.3/97) Insepctor's Signature Cert. No. c.~Qs-• S S*ft ad &dMk W Disiiers a~4r 701 W. Waftipw Aw, PAS UK 710 l Uii% TR JIM7 7UR s& Ad bm y"Rafta of Cow 1 ` i6~0- A-- If 2-0 1r aoard Say Irwwi 4 ❑ ta..t r O~rvihaw t Apokoks hftuw&a - >tlrw TAw Y bhumoks soft Pw P.D.1LW" r ~ © J li *5 kk) s T N It 199 ~4". sd« tlsdr Parr lrr►Mr i~t Msak Nu&w sabow" Nam N csw rww&- TAP a[Itaii6 WMA ai wt a cu5 s w n.. 1 w 2 FIN* Drs - li■iirr di~isnss ~ KNOMMIN Q -~U tt a s is O.rd ~ I 03 11ttie calm a +IC~reiew is ire O a•.r.i6 aatar~r t9rr Me~aP aaa~. ~w ias s r a~.w 2 C] »swcr.~ wr. s L11y1sos~ a st t C] A*M*n fa s G coma w smdsi 3 ftwo rm, &a rlr arssd Pw1r 1a~.dw.. w. true u IV. !ja at{ tea ai Pw M~ aLlrrrR i •r Yae~d aaa) S K Q~iUI~. -ftan dudlrb.ra 210 Wood a 0 $ad Mr su I] Cumm~ee 22 Aalww-1 - ar~ihsrd Q D now" 'lad a 0 sb* ans $10 Ddp Lim ~ C7 Aegu* 2 LO +Awft Tummar Lair aORjWqgft 90 C3 Ww 1yn1 cimee lOr~ ~L..a 114srat Aws ssit Adis lMradrrr is R7 7~/ Tg, vL IAA i1n 710 i.. P~.ed► a" PaM. Poetic HtreerE GAINS OfTIMI&I ~1.. ■Yea Own Oft o* ~rstwne- tPr dlr dt111t l0 > OOMM" ww t#r s lfte 177- aslrr Man. PaeanN Ckv. Sam, zb osdt : S~-k ; Ono* + iq.pmMd 0 WAIW rd 3 Pke`. k" n a DOW Imsd ~ !tom steps) ~Zzs~ ~~3 F Er. C...s par el.. Se i 8 f- cQa /a~z3la~ f~.-'~ W ¢q Q C C ~9at 5 yu ~JC l S S,I s L t 'k1,.3 cQ'Xe add ~f /2q~94~ n f ~ a.~+~s•Lr•e*ta.aws~r.~.+~i~w'~ri~Irrrs1111sti1~iini Citi &A^4QR fR tKlifil l i i II I I Q I ; 1 tt S!( 1 ; cvYw I - 1 1 I j ~ I i I i ~ i 1 I 1 -Sfr "61,0 et, 10 ~ I 1 i I ~1 11~ low A).~Ikf~ , I 1 I - - - - I j l I ! I I I~ I I I~~ i I I} f I I i-- u I I I I I ( ! I I I ~ I I i . i I ( I aF r _ I ~ ' I-1 I i _ I - I l ~ r l I~ , I I I~ i. I I I I I I 1 i i I JIl K 1- -4 , I 1 ~ ~ ~ I I I . I I I I M I ; ; -r---I I f i Ot ~ I ~ I I I I I 1 ~ ~I I~ I ~ r ! I ' I i l i ~r I i I ~ -I i i ' ! I I I- + I I ' r I I- t i r.. , I , -I i I ~ I I I ! ( I~ { ~ ~ I i ' I I I I I I~ I ~ I I r j i I ~ , , i~ 1 I I I ~ r- I ~ I I I I I i j I } I , -I I I I I I i • I . I I ; i i I i I a-t -Race- yf~ S'',(~t 'Ti SW S W o lj~o,c s -rr I/ u o r 4116 C yn - ,1 S t - D -000 c,~ , ~ , ,e ray Ooo Jk4loo Ez- `Q>~~ _i -3{`0-- 1 Fay r _ ~y if 89b~ Wisconsin Department of Commerce SOIL, I~UA110K REPORT Page ~ of 3 Division of Safety and Buildings ~~~x in accordance with ~ ' Is. dm. Code ' County Attach complete site plan on paper not less than 8 1/2 x 1 'rtes in sikl-le include, but not limited to: vertical and horizontal referen poiht (BM), direction and karcel I.D. I hi 6 percent slope, scale or dimensions, north arrow, and to And nea ad. Please print all informat oil evi"ed y Date JT. Croix P;vir ersonal information you provide may be used for seconds u viva La60Jf6TIN 1 m Property Owner H'CT 1J • CfC2ll~ S • °WU roperty gea(i Cu►V~~1`Pc%._Vp~C~./t L°-01ZP_ 1/4 S W 1/4 S T Zg N R 1 °1 E (or W Property Owner's Mailing Address Block # Subd. Name or CSM# 1,'8 00 IBZZZb ?J S~, NE SuL'~- 1oD 1Z6 T'RpY \J1,0-K(-Z- )4T)+ Rio, City State Zip Code Phone Number. ❑ City ❑ Village ® Town Nearest Road ~L.iPCll~lty MtV SSgg9 (~b3)'i57-~56& ~1ZA~-f ml-ARIFtts b [Z. (R New Construction Use: ® Residential / Number of bedrooms - Code derived design flow rate 60o GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material \-wU ss OUe"2. C,. LrrciftL• aw'rw "H Flood Plain elevation if applicable N A ft. General comments l ~s~,ftL 3 and recommendations: CELLS of H+1614 aAT-YW-tTLt StD~W!/vtA---R L rre~ c4pr -l BeP.S S - K)6T- 'tU l N S1Yt-L.LtM ...C-ia► l Z$ Boring # ❑ Boring t ® pit Ground surface elev. Fc)y Z ft. Depth to limiting factor 1 la in. . - - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz: Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1- -ls lotirzZ1Z sal Z'~sb12 m~F~ cw 1v~ -S -a Z iS -ZS 1oY2313 - S)1 ~`Fsbk m`f~ _ S -2, 3 Z.S 3b lb~t2 3~6 _ sl ~ Z`F's6~ ►v1~1- cs ~ _s ,8 3b=--c" Iova S/6 _ l.~ O s9 w) 1 cS . S -9 S Y3 =118 10 12 Y//, - S O S5 In Z I Boring # ❑ Boring pit Ground surface elev. ft. Depth to limiting factor 7 1 LB in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - 'Eff#2 1 0-11) S h 1 sblz m; Z lD-Z2 l0`l rZ 3l3 - Si ~ 1 Sbk wl cS - , ~ . 3 7-Z-39 tbLI VZ. s 1'6 l ~s 1 ~s bk Yh V'~t- CS - ,1~ ' Effluent #1 = BODs > 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) Signature CST Number Arthur L: Wegerer 00=31~=~Z6 ' 220254 Address W e g e r e r Soil Testing & . Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, WI 54022 1 p-Z3-0p 715-425-0165 Property Owner Cau`Sln l t~tc. DLL _ ° (..M-P Parcel ID # 1'~DUu G Page of 3 126 Boring # ❑ Boring ® Pit Ground surface elev. 8 q 6 it. Depth to limiting factor ? 1d 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 i o -13 o(1 R- Z! Z - 511 l`~Sbk m `f - e-ki 1 %0 f - Z - 3 2- 13 ZZ LpyR-313 - S! I Z`{'Sbk !r!`~- CS - - S 3 zz_~$ lo`ZrZ Sl6 1 s! 1cSbk y►1.'Fl-. cg -Z ~ 3 4 Lk--wo lpL( R- V/6 - S d S9 I - • 5 -Q 196 Boring # ❑ Boring kit. Ground surface elev. °!00 • S ft, Depth to limiting factor ? 1 l 3 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 O o l oK bz 31 z 511 1~5 biz n1-Fy. ch, 1 U `Q-' • Z • 3 2, to ZZ d b`~2- ~3 - g! 1 Z`FSbk cw - - s - g 7-Z-3b 10-m 3A Z'fsbk 36 -s I l oK iz S 16 - s I 1 I C-s bk m `f^I- c - - - 2- - 3 S S/- ~l3 !U`?RY~6 _ S ~`Fs D S m ~ - . S -9 ❑ Boring # ❑ Boring,. ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD6 > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODE < 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. s8069330 (R6100) PLOT PLAN Page 3 of 3 Scale 1' = SO ' t3n~ _ Q- $a~l_ lu o►J 3Qi> 8qs ~9 6 g-kzs~ e .Izs o L, T-Vz-s so 898 J n S U LTK~3~~ PnzL~- ~0'IZ }N~`R ~L ~ t~6 ~ ~~~=2~~-`rte s~►. s tt~ s $g 812.E A a SJ? -T Q 1 iJ STM-I_~'~2 : . h l ~[7CL.L Z°-~LC.S FYT L~`~3T _ S y ~ > tom? . ~3vT I\j M'I U iZ 't1~PC'1v 7 2 " ~ S~Sr w! ~tEUP'RuAvS R'r 'nm o~ uv o►v 1_'Xa .pp 715-425-0165 220254 Oo-318 -1Z6 awL CST Signature Date Telephone No. CST No. Job NO. EZ1 2VJH oaf ( ~'Tf TTTf ~ ~ TTwfwf• T. TT7~'f f.. ' VV V' Tfw PVTV VVw- to VV IPVV i WV V 4.62511 w T f VV sT♦ T• VV r v ►I V. I : IF • 1 1/2 cam. =18.84,, Tf TwTTT \i. TfT VV VV MTf T. ♦T TTff WTT►ff=. Tf f TTT~ 2411 Boom 3611 I2-112" D.IA. (typ.) Void COCWwient in Agtpe given at 57AX. lo_, t~M Area Q.D. of 4= .1eag~ ~s1< pipe = 4.623 inches / Sidtwal► ~ Stdepra~) v 18.8<in Void volume per 1+Ixat tl. = I 3.14 -(2 JZS'U 12in = 3.13 t it Bottom ]R Q.D. of center cylinder = r2.5 inches 2.00 Vold volume is a8>$n:tweoCCenter cylinder 14 6-2 '574 Total Sat lnterrace Area 5.14 S(1. •~5..~ 1.J4 •~`''1--t#r(r3° ^1 12in r 0 ..422 R Ili- ' 0* D' of outside cylinders.. 12 inclas Void vohwft in o _ Projected Trench Area outside cylinders = 2.3,f 11~ . 1 90J ft. J '.S74a / Sidewaii Height = 12 in. -2 Void 2.00 Sq.Ft. volume at bottom between cylinders = ~j 24b bw 1 ( Bottom s:, 36 in. =3.00Sq.Ft. t2ia/ft E2init} ltff 0.215 ft. Void vo t 12in ft Projected Trench Areas t Irrrire at outside bottom co 5.08 5@ Ft. rags (1/2 Of "id volume between cylo,~) 0-215 r Z = 0.108 ft, Total void votes „ O. 117 + 0A22+0.901 +8.215+0.105= 1.763 cubic ft,,, Gallons per tJ = 1.763 7C 7.43 .1,3.~.Lallnns new tt o 31-61 EPS Aggregate Trench System EZi 203H 65 9`tPdustfio! Group WO w ndustfio! Park Rd. Ooklond. TN 18060 SCALE FILt /t*s¢. EZ12DZH-.vat S►dtT: t of 1 11-27-01 i WTS OWNERS MANUAL & MANAGEMENT PLAN Page of PO VTank SPECIFICATIONS ❑ NA =S E piiFORMATKlN ufactureir Fortran # u9 l .QSSi~ Ov~ ~ ~ g vol.gal nufacturer ❑ NA pA O NA ❑ Septic 0 Dose ❑ Holding vol. gal Number of Bedrooms ❑ NA Number of Public Facility Units ❑ NA Effluent Fil=:= Effluent RlEstimated (average) flow al/da = (Estimated x 9.5) al/d Pump Manufacturer Design (Peak) flow ©NA al/d /ft' Pump Model Solt Application Rate Pretrea~nt ))rill ❑ NA Standard (nfluent/Effluant Quality Monthly average' ❑ Peat Filter ❑ Sand/Gravel Filter Fats, Oil & Grease (FOG) 530 mgiL Biochemical Oxygen Demand (BOD51 5220 mgA- ❑ NA ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other' Total Suspended Solids (TSS) :5160 mg/L Monthly average Manufacturer ❑ NA Pretreated Effluent Quality Disperset ~ts1 Biochemical Oxygen Demar (BODE) 530 mg/l_In-Ground (gravity) O In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/l ❑ NA ❑ At-Grade ❑ Mound Fecal Conform (geometric mean) St W cfull OOMI Other: Ya in dia. ❑ NA ❑ DriP- ❑ Other'm Effluent Particle Size Other: ❑ EN-A Other. Oder: 13 ❑ +vatues typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Frequency Service Event ❑ (s) (Maxiiintnan g 7years))e ❑ NA Inspect condition of tank(s) At least once every: one-third{Y,1 of tank ❑ NA -3 ar(s) ❑ When comb fined sludge aril scum equals Pump out contents of tank(s) ❑ When the )sigh water alarrn is activated ❑ month a) (Maximum 3 years) ❑ NA Inspect dispersal c ell(s) At toast once every. year(s) ❑ rnortth(s) ❑ NA Clean effluent filter At least once every: I fearts) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) El month(s) ❑ NA Rush laterals and pow" test At bast once every,. ❑ year(s) ❑ month(s) ❑ NA Other: At least once every: ❑ year(s) ❑ NA F)tw MAINTENANCE INSTRUCTIONS one of the following licenses or certifications: inspections of tanks and dispersal cells shall be made by an individual carrying Master Plumber: Master Plumber Restricted Sewer; POWTS Inspector, PO T m ai broken hardware, Oidentify ator any cracks (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any s or of effluent on the ground leaks, measure the volume of combined sludge and scum and a check for any back up or ponder and to check for any surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation Pes failing condition and ponding of effluent on the ground surface. The ponding of effluent on the ground surface may requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment 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 chaplet NR 113, Wisconsin Administrative Code. pretreatmen All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, onned by a certified POVYTS Maintainer. units, and any servicing at intervals of S12 months, shalt be P~ Walton 10 days of completion of any service event. A service report shat! be provided to the (Deal regulatory authority GMW (2102) I START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septege servicing operator prior to use. System start up shall not occur when sal conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be urged to the sal cell(s) in one large dose and may overload them resulting discharge of effluent. To avoid this situation have the contents of the in the backup ra surface pump tank removed by a Septage Servicing to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manuallo Operator prior controls to restore normal levels within the pump tank. Y perating the pump 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 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; dia the life of the foundation drain (sump pump) discharge; fruit and vegetable pars; disinfectants; fat; elings; painting Products; pesticides; sanitary napkins; tampons; and wafter softener ~blrbrine e; herbicides: meat scraps; medications oil; 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 Property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shag be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shag be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINENCY 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 areacement soil absorption system. The replacement area should be upon y protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, let lines and wed. 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. technology a holding tank maybe installed as a last resort to Barring advances in POWTS 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 t T POWTS MAINTAIiAM Name 1 Name one S S'S Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S- 1 Phone Phone is G This document was drafted by the staffs of the Green Lake, Marquette and Waushare County Zoning and Sanitation agencies in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3). Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND . OWNERSHIP CERTIFICATION FORM owner/Buyer Dc-/2-44cle- ~G ~f S~'~c i t W Co 6J CO J I A-1 Mailing Address _ 100 60 u qrj SJ11 "EW /2 C 44 440 k( of 4V-T- 40/-7 Property Address 2_15r /;'jut te_.Fj e LN (Verification required from Planning Department for new construction) City/State Parcel Identification Number d q~ a LEGAL DESCRIPTION Property Location 1" V., scj Sec. , T 2V N-R11 W, Town of d V Subdivision L-~- a . Lot # 2- (e T Certified Survey Map # Volume . Page # Warranty Deed # _ ! . Volume Page # Spec house Dyes ❑ no Lot lines identifiable<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 treataent 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 masterphnmber, journeymanpl*mber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal 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 the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification. stating t~at your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o e_three a irati a GNATURE OF APPLICAI# DATE OWNER CERTIFICATION (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 pr 'bed abo , y irtue of a warranty deed recorded in Register of Deeds Office. i✓`~ b GNATURE OF APPLIC 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%A VLI\ VrILLI.. 1 rILIV I V\nk, I 1 Qh • I L..' IVV I VV4 JQI 1 JV LVVJ 1L . VJ r. VV ~9 2r s1s 66 as R'l Joe STATE BAR OF WISCONSIN FORM 2 - IN$ Rim-is ~ O wA1t SN SI3IS~I F D$EDS WARRANTY DEED ST. CRCIl E Co. , NI oo«ea~►u NuRtFler RECRI VIM ;FOR R1"sCORD Tws Deed, made between 06-19"2ft$. 9:30 AN at, a YtneaOtit Corp t on attd rr c on Gnmtor, . s 11. -pany. Inc- C Fat t 9s f pTTopyCOPY FIRE.- AGES, Gtarttor, for a valuable cortsid Granite, etatltm conveys and warrants to GnwAte the lbllowlng described real estate in St. CroX County, State of Wisconsin: 1a6~ 127 Iat & Of the P],at of T ! Retx> WO Arne rCY Village 41h _ i :_w:',. -7TdSLx~..~'~,+iifi 2 Addition in the Tmm or Troy, St. Croix County, NWN Arad MtUM Allen >rTisrcanlain. Derrick Construction_ClbmAany, In I Subject to Declarations of Covenants, Conditions and P.O. Box 445 Rstetricticne for Troy village, recorded in vol. 124i, New Richmond, WI 54017 Page 286, as Doe. No. 559964, and the Declaration of Golf Cour" Covenants, Canditicne and 'Easements, reaordGd in Vol. 1241, Fags 301, as Doe. No. 559969,-. i 040~i281-+80-Opp • (~-1281T90-( it all a$ appearing in the otfics of the Register of Deeds 040-12MO-M 040-1282-10-0 i' for St. Croix County, Wisconsin, and such other P:< aemiiicatlort Nlatabe► F" ~ sasements• restrictions and mervatiorm of record, This not or in Use, and the "Buyer" obligations contained in ~is -not propert}t, ' the hard ]ase Agreemer►t for this lot. (u) (is not) Ir i; i! Exceptions to warranties: I. a Dated this 1 day of Nay 20M ' r• (SL (SEAL) ~i • Charles S. Cook President Troy Davelopment Corporation (SEAL) AUTHENTICATION ACKNOWLEDGMENT I' stmt w* Minnesota State of 4Vf calislrn " Anoka Cqunh. authenticated this day of Personalty came before me this day of 1 I , sheave nem.et 1 1 SEERes S. Cook Frss fdent . ~ -~Y A~'aeiobatcnroortttiort ! TrME: MEMBER STATE BAR of WISCONSIN ~ f to me known to be the aeon suthorbted person who executed the foregoing by $706.06. Wis. SrAts.) instrument and ecknowled=e the same. ;f ;i Thle INSTRUMENt WAS OFlAPTED BY ~Q ) ii TROY D$VELOPMENT CORPORATION • $ick A. 99hnsson Anoka County, Minn. Charles S. Cook President Nom' Pubtk. Sio& My cammiuioo is permanent. (If not. state expiration dais: ftutmms may be authenticated or acknowledged. Both are not anu 3 II N-- of Mme air" M"capeaky mi1M be typ e w primse kJow their 1 nee. ii WARRAN'ly DUD STA FORM NOo. 2 sC9so'►,tt, iN NO A JOHOW"'t L• Ias1 es ,abe. 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S\ M o° 0 0 00Z ~ ~ PAGE ~ 129 o I / h At M 1.036 ACRES p~- w 45,130 S.F. / N ✓XLAGE - / l ~I~I 11 °o S 89028' 14" E W ol1 0l ~~II Z 57.89'_.~' y~l1 y~l \ POINT OF in ~0 BEGINNING KIWI ~I I I _ n \ oo ~IUI '"~IVI 6 co C~ O N ~IVI "'I $9028114" W 57.89' 01A15p \ m\ Z 322.55' 'I 66.0011 1210.33' N 89°28' 14" W 395.17' - - - -