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HomeMy WebLinkAbout040-1292-20-000 V Wisconsin Department of Cor>4nerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430572 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: Coleman, Larry Troy Township 040 - 1292 -20 -000 Cg BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: oa.Pe i K 15�1� a iI- 24.28.20.1669 TANK INFORMATION 95.3o ELEVATION bATA TYPE MANUFACTURER CAPACITY STATION r BS HI FS ELEV. 89g -�o Septic Benchmark r r 6 12 (o© .zr 30 Dosing Alt. M -- - . �S 9S• 9S Aeration Bldg. Sewer Holding St/Ht Inlet / TANK SETBACK INFORMATION St/Ht Outlet e7 3 S f TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I $ 3 / Dt Bottom Dosing Header /Man. (0 �� 10, Aeration Dist. Pipe /. Holding Bot. System 7 +Sr � • S � So 9 D - � PUMP /SIPHON INFORMATION Final Grade 3.10 �9S -3o Manufact7 Demand St Cover M Model Numb e TDH Lift r ion Loss System Head TDH Ft Forcemain gth Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS f 3 0 2) 71 SETBACK SYSTEM TO P/L JBILDG IWELL ILAKEISTREAM LEACHING Man f ctur r: INFORMATION Type Of System: CHAMBER OR C 2:� 1 2- ( ' 6 O UNIT Model Numb jr • 0 /1 DISTRIBUTION SYSTEM l Header /Manifold ( x Hole Size x Hole Spacing Vent to Air Intake 3d r Length Di L ] �_> 7 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only = Depth Over Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil f� Yes U] No i Yes No CO M TS: (In_ clude code discrepenries�p ns present, etc.) Inspection #1 �t�M�� t � Inspection #2: Loc�n: 309 Lindsay Road Hudson, p W154�016 (E 1/4 SE 1/4 24 T28N R20W) Troy Village 5th Addition Lot 141 Parcel No: 24.28.20.1669 1.) Alt BM Description 2.) Bldg sewer length = I S I - amount of cover = 3 A- - Ian evision Required? ',; Yes No Use other side for additional information. = ___ �j SBD -6710 (R.3/97) .Da t Insepctor's Signature Cert. No. L� cIj F ED Safety and Buildings Division County . Washington Ave., P.O. Box 7162 I S �� Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department mmer (608) 266 - 3151 2 plication State Plan I.D. Number In accord onal information you provide may be used for secondary purposes Privacy Law, s15.04(l)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Information Z- --1sa Property Owner's Na me Parcel # Lot # Block # L . _-. Property Own 's M ailing Address Property Location '7 4,3 J City, Ste Zip Code Phone Number '/s, S C -k,Section 1 k ii r J Alu U � circle T N; R E or W II. Type of Building (4heck all that apply) aid c� two 3vf Alttxtl 2 C AS • Subdivision Name CSr X1 or 2 Family Dwelling - Number of Bedrooms 1 f ❑ Public /Commercial - Describe Used ❑State Owned - Describe Use �- $ - ❑City ❑Village Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) p — 1242 -- 20 — 000 .166 A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. El Permit Renewal E) Permit Revision 11 Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) ANon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chapaber ❑ Drip Line ❑ Gravel -1 ss Pipe r (explain) V. Dispersal/ reatru nt Area Information: --f CMD Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propose (sf) ystem Elevation ©n - 1 85 �7() ;� %0. `( VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ e Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum ber's Na me (Print) Plumber's S' nature MP /MPRS Number Business Phone Number /y. ) / Plumber's Addre ss (Street, City, State, Zi ode) /& 1 70 Mej zj 7 _56 �+ VIII. Count /DepartAient Use Onl Sanitary Permit Fee (includes Groundwater 4 OV, Date Issued Is um gent Si ature (No Stam s ) Approved El Disapproved � p Surcharge Fee) ❑ Owner Given Reason for Denial 29D ;�* Z4o _ 1X. Conditions of Approval /Reasons for Disapproval 3 \ At- �d� U SYSTEM OWNER: / S.� v� `C^ 1 Septic tank, effluent filter and far dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) I 03 _ �7+ Jy� �YJ Q O � Cam pt'Weq to l a L04 r 14 0 co C u� I .lenn.__.._...._. _ _.. _..__ .--. )er. A—QQ 90-Y .a l�(.o 1 y p e p 190 s � I � . LU �..� C Z ' w LM o P�'� O_ x C/NU i IOL wlsoonsln Department of Commerce SOIL EVALUATION REPORT Page DItMIon of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code County - s - r, C.KD Attach complete site plan on paper not less than 8 112 x 11 inches In size. Plan must � X include, but not Hn*ed 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. 0 9 0 - I LEI Z ` 2.0 Please print all Information. eve by Date Psnp,sl Mrorrnafion you Provide rnsy be used for ascondery purposes (Privraey l.rrw, S. 19.e� Property Owner Property Location OF Ifit 02.1 om-1 1 �� j L j� �ti�� �- CbRr NE 114 SF- 114 S 1q T Zg N R zQ W Property Owner's MalWv Address Lot q Block 0 Subd. Nam* or CSMA I N 0 o A 1✓l- -ULE1� - rJ,E xkriE 1O'D 1L4 1 KDy V I U_-AGE.- - 'rr IF1 + -A bN r State zip Codd Phdne Number n City ❑ Village 8ZTown Nearest Road 1? LA INS f 4 ( 763 757 - - 7 d �OPC] New Construction U!i-;g Residential / Number of b Code derived ign flow rate (� _ —� _ GPD ❑ Replacement C] Public or convnerdsl • Dent �n I — Parent material _Q� Plain elevat)on f sppHca'Die N -A + _ _ 8• General comments �OUNZ Y and recommerulatlons: CON VEJ�T lor�� �tZEnIC S ZOCNING OFFIOE ® ng pit Ground surface sieve ��_ ft. Depth to Nmlting factor 7 1 O 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, 'E"l - EW2 0 -5 Io�Ir� st1 -La�K 0b q4-m o .8 Z s -) to � r 5 i i f - Lab s Ivf --F o. z- a.3 3 1HII IOy L �I I e Sit' rnCOO aS V - � D+Z 0,3 p is 10`112 S 5 Cs D•� I,Z , 22 - 117 \4 4 C-5 lD t i olt- - � ` , 5 14p 5�a CSR, ® Boling >t [] Boring (O I J41 Pit Ground surteca elev. $ ft. Depth to limiting factor i Zy¢ __ n• SoU Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munse Qu. Sz. Cont. Color Gr. Sz, Sh. - Eff41 'E"2 I 0- toy "+/ Z ' ->~ r' b - yn 15 Z y -il Io wR2/I -- Sli 1m S a, 23 3 I I -1y I W,401 C- y s S II i a.,O r , 2- 0, - ) Z 5 51 - Io�►23� s p �- �,� ► Z CN0121 t-1 t1A z5- 35 a. t2 ' Effluent 01 • BOD > 30 _< 220 mg/L and TSS >30 c 150 mgll 'Effluent #2 ' SOD _< 30 mp/L and TSS � 30 mglL CST Name (Ply Printl Q nature CST Number AIARV 10 H s S ZZ483Z- Address Date Evaluation Conducted Telephone Number W9875 logo +``qde, RIVE FALLS WT 5`02Z "(� - 0 '?15 y2b -1�7S Z Whconsin Department of Commerce SOIL EVALUATION REPORT Page of : - Z - Division of Softly and Buildings in accordance with Comm E6. Wis. Adm. Code Attacl+ complete eke plan on paper not tea than ti 1!2 x 11 inches M st:s. Plan mutt coun"Y sr. cleD\-X Include. but not limited to: Y"W and horizontal reference point (9M), dtroction and Perth I.D. oo percent slops, scats or dimensions, north arrow, and location and distance tonearest road. 0q0 - 1 7-q Z please print all Inlormstlon. Reviewed by Dale Penon Wormeson yov pro - cle may be ved tw loomdary purpaes (PNvacytaw, t, IS.04 (4) (m)). A�HV . ?i�P , 2q0 Property Owner Property Loatlon COnrl N ,NTAL VR--LDP1r\�-W CQRt'. 5e im SE im S 24 T 2g N R 20 14 W Property Owner's Melling Address Lot 0 Block 0 Subd. Name or CSW 1 O A >rR D�'En1 .S'T nl • �, u cT� 1'O 1 F,13N V t LL-4\(,L- - FI FT " ADD r CRY State zip Cbdo Phone Number 0 City ❑ vu wge AKI Town Nearest Road r 4�INe >•,1 I 56 ( - 71,3 757- 7 75 (-8 1 UNDSt� ROi.D Now Consdvctbn W.--X Raldentiol J Number of bedroorns 1_ Code de+tved design flow rate L, Q 0 _„ ._ GPO 0 Replacement ❑ Public or owrmdal • Desutbs: _ �- Parent msterlat Ot t - T V.1•RStl Flood Ptah elevation it applicable r i o• Gorwai commsnts end recommendations: C OA V EV� 10>) AL - T IC.e N C fi'& S Boring e D acdng Pit Ground surface elsv. _ 79S % 5_ ft. Depth to U I&V factor In. SoU Application Rate Horizon D&pIK DorNnant Color Redox Desatption Textute Structxe Conslstence Boundary Roots GPDM In. Munsell Ou. Sz. Cont. Color Gr, Sz. Sh. 'Eff#i 'BMArY 1 0 -6 10Y rt zIL Z -F- L m i f r a b 24 -m O,5 ,$ Z 6 10N4" ' I) 6,Z- 0.`S 3 , 2-6 7.5 3 -- s rr1 3 --- s Boring a C3 B Od"g a Pit Ground surface elev. 5!9 ft. Depth to Mmlting rector � � 9 2 -In, SoN Appillcot Rate Horizon Depth Dominant Color Redox Description Taxtws Structure Conslstence Boundary Roots GPDfff In. MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#I •E"2 - Z f aby, rn r do 3\'- rr 0-5 0 -1 Z Z '" St Z _ 0. Z 0. ?j 3 17 - -201 Z' m o,b 'Z- 1 6 3 — -5 f -L QJD K m 0s q ' Miami UI - BOD > 30 1220 rrVL wW TSS 1 1150 m04- Effluent Art BOO < 30 rngll. and TSS 130 mWL CST Name (Please PrW) nature //__ CST Number AIAKI 0 H Lt_ S"TF- ` l ZZ .2- Address Dale Evaluation Conducted Telephone Number W9415 �4p + '�Ao�r R VE F LJ�S W� 5402Z L-I-Z6 -175 •, PLof 1 i�ttYoww: OpiTI!4 .aL Dgs�op- MEWT 4 ( Sd .. / 1 $ y vi � - 7 y i D SF t4 0 F TMV -',F- E �- 50L W/ onc*ioe NO COMM 65 %it3 a PROC3l.EM5 f 1448 % �9+A� a�. 142 141 �•' / �94.e i r 141A 40 /,N1 i 4 I r r 93 r r / 140A 94.3 9ato Of i t x 2zyV 3 Labor n Industry, URelations SOIL AND SITE EVALUATION REPORT P I of - Labor and _i�iufi`j,Relations g _ Divi mrrof Safety &Buildings in accord with ILHR 83.05, Wig. AAdm `Code �,`'. ° COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. 0 n`must include, but- ST ' • not limited to vertical and horizontal reference point (BM), direction and %61'slope, scale or PARCEL I.D. # (Z dimensioned, north arrow, and location and distance to nearest road. r APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REV( DBY _ DATE PROPERTY OWNER: - PROPERTY LOCATION , t14 tIZ 1/4 Y T E( W PROPERTY OWNER':S MAILING ADDRESS • LOT #` BLOCK # I SUP11flAME OR CSM # - 11 0 - 7 L.P CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN N REST ROAD B t u j , fv s 4.'�'y ( ) TQ L��spc -t C�oA� [}j New Construction Use [�Q Residential / Number of bedrooms Y [ J AdditiQn to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow boo gpd Recommended design loading rate — bed, gpd/ft , S trench, gpd1ft Absorption area required 8 S $ bed, ft - 1 S O trench, ft Ma:dmum design loading rate bed, gpd /ft - k trench, gpd/ft Recommended infiltration surface elevation(s) $ '.D Bon- ' weAMS ft (as referred to site plan benchmark) Additional design / site considerations S QIF V JOTS Zo l rv 'STy - u--NZ cy- t Parent material LbF-SS OU \ G tit t st DyT'W ft S N ' Flood plain elevation, if applicable ti A� ft S = Suitable for system I CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem I ®S ❑ U IRS ❑ U I 0S ❑ U I RS ❑ U RS ❑ U EIS Q U SOIL DESCRIPTION REPORT Boring# Horizon Depth DominantColor I Mottles (Texture Structure IConsistencelBarcary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Bed Trerxft ,: Gr. Sz. Sh. * q-3 Z `t 3L Y S t c.l 3'F �ti1� o� Cw • L4 . S Ground 3 3Zba - )-s4i . Y/C W�L.y elev. s 1 i=Sb c g ptt.� It y* 6& —t2.a LkLG S5 Depth to limiting factor > lZg Remarks: Bg3ng # 31-Z' S 1 1 - 2-M h *fI- C43 — S. 6 <` Z lb-IL I oti tz 11 6 — S i 1 2-M A z Ground 3 16 - 1 6 `11 1 VA S � G►. O S 9 wt elev. It Depth to limiting factor Remarks: CST Name:— Please Print Phone: Arthur L. We erer 715 - 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River .Falls,WI. 54022' Signature: ci _ Z 4 7 _ Q Date: CST Number: . �1- 3 d -- g9 220254 PROPERTY OWNER CUKMlQL'kA1Vt. UZQ. SOIL DESCRIPTION REPORT Page? of 3 ' PARCEL I.D. # X.Fb) IV a Borina # Horizon Texture Consistence Bamclaty Roots Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Z 9 - 310 LU`f R VL S) 1 Z. nt SbHt wi�j^ CS - • 5 (, Ground 3 3 L b-111- vl6 - S e! Q. O S3 �,,� J _ _1 •$ elev. �S•y ft. Depth to limiting ' factor ! Remarks: Borin # , ".j,0 ) c) -�2 �UH1Z 3 LZ S) 1 Z`FSbh o�S cw �' >.. ��} Z 1Z - Z � u `1►z 3 1 - s � 1 Z,w► s bk )►� �{'r e.r , S . � Ground S`1R VAI �s) �C�bl� 1� NP elev. W -!6 1 f� 4 VA S C) S9 Y �g •Z •53 J q4- 6 ft. Depth to -S I L)g -t S '1tZ 31 - S Gk OS y nI ,1 . 16 limiting factor ? l 1 l V Remarks: B . rin # . � ' 1 `l L I`: Z -3y t U `l R 3 / 6 - S11 S I, t Wi 'F►- Ground 3 3Y -13S � `tR 3!c/ S *t Gi. OS5 P elev. Kq ,l f t. Depth to limiting factor 2 Remarks: I 3oring # ,round .lev. ft. )epth to imiting actor Remarks: _ 1 • PLOT PLAN Page 3 of 3 SCALE 1"= Sp ' IEm -Z . Sol 1. ��� �czoa PIPc� a. t3oA % e s ^/ w 8.\3CV. '8 LoT \31 � ta6 6 l�� ♦RO►J pt PE 4 SSE 1b �3E A-T Le"T zs `FS?owt `nmeQ o - W LoT \�,O - N3 0 '0�i i � � 5� - -C -- Z.. � �C'tZ�►J ct� �t1- 3' x: � S t a I �'i'�GCf t'cc��`T4_ S LDI� ►^�D�R_L�N. e1��t�L��. �/ Lor Vz 9 .i (715 ) 4 25-Q]69 CST Signature Date Signed Telephone No. C #- Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) y Septic Tank Capacity (gal) Soil Absorption Component Size (ft C Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) v Maximum Influent Particle Size (in) 8 1/8 Maximum BOD (m /L) 220 Maximum TSS (mg /L) 5o 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septi nd outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filte h all be cleaned as necessary to proper operat The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a'Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being In full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the Interior of the tank may be difficult or Impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption components operation must be assessed by inspection at least once every years. P three . The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 I s Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep - rooted trees and shrubs directly over or within ten feet of the . component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails we will replace with another s • Y ► stem P Y at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386 -4680 Boumeester & Sons Excavating 386 -9020 S'1• CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ U Mailing Address Property Address C> .,� (Verification required from 1`164hing Department for new construction) City /state Parcel Identification Numbe r LEGAL DE•SC ipTIC1tY -- , r Y -f tl e 15 YV Property Location /'JG %,, Cyr ' /,, Sec. , T r - !�LN -R W, 'Town of Subdivision ,Lot # 1L• Certified Survey Map # Volume , Page # .1 Warranty Deed # Volume , Page # Spec house O yes Q no Lot lines identifiable yes O no Improper use and asaintenanceof 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 can affect the f Umflon of the septic tank as a treatment stage in the waste disposal system. What you put into the system linmberpr�rty owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterptu journeymenplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wasimmterdisposal system is in proper operathrg o"tion and/or (2)Ki on and pumping (if necessary), the septic tank is lea than 1/3x1 ll of sludge. Uwe, the undersigned have and the abov . and agree to maintain the private sewage set foeth, herein, u set by the and We Department of Natural Resources, State of Wiactonaio�Oe�lgpttdoo dating that YOUC septic system has been mainttt oedmat be completed and returned to the St. Croix County Zoning OfRoe whhhs 30 days of the three year expiration 7 FO NA APPLI �A?� �d d DATB QT CER1'IF'i I (we) cxrdf► that all statements onith s 401 are true to the best of m our knowledge. I we am are the o Y (our) ( ) (ate) wner(s) of the property described above, b irtue of a wtrcauty deed recorded in Register of Deeds Office. 'Y A P PL ll ! a U DATS An infotmatioa that is mis•rep �nty,Mult in the sanitary permit being revoked by the Zoning Deputmut. * + + + ++ !• include with this application: a ah r X41 ' mped.Vau' ' wW deed from "Register of Deeds office a copy of die certified survey map if reference is made in the warranty deed r U 2455P 520 - 7d+Ea523 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI RECEIVED FOR RECORD Document Number 11/13/2003 09:55AN This Deed, made between WARRANTY DEED Troy Development Corporation, a Minnesota Corporati EXEMPT # Grantor. REC FEE: 11.00 and Lam A and Suzanne M Coleman _ TRANS FEE: 539.70 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following describe I estate In St Croix County. State of Wisconsin: I u.::• • +:r.'; Ate:, LcI4 14 of the Plat of Troy Village in the Town of Name and Return Address Troy, St. Croix County, Wisconsin. Larry A. & Suzanne M. Colman Subject to Declarations of Covenants, Conditions and 7633 Nature Path Restrictions for Troy Village, recorded in Vol. 1241, Woodbu M 55125 Page 256, as Doc. No. 559964, and the Declaration of L Golf Course Covenants, Conditions and Easements, recorded in Vol. 1241, Page 301, as Doc. No. 559969, all as appearing in the office of the Register of Deeds Originally Part of i for St. Croix County, Wisconsin, and such other 040 -1251- 90-000 easements, restrictions and reservations of record, aercel Identification Number (FIN) or in use, and the "Buyer" obligations contained in This is not homestead property. the Purchase Agreement for this lot. (is) (Is not) !i it i+ iI I Exceptions to warranties: Dated this 6th day of NoMber 2003 /J Ji I 4T (SEAL) (SEAL) • Charles S. Cook, President Troy Development Corporation !I (SEAL) (SEAL) !' I j AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Lliia ss. Anoka County. authenticated this day o f Personally came before me this 6th day of War, 2�3 the above named Charles S. Cook, Presi Troy Development Corporat TITLE: MEMBER STATE BAR OF WISCONSIN to 'i (If not, me known to be the person who executed the foregoing authorized by §706.06, Wis. Stats.) Instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY TROY DEVELOPMENT CORPORATION Q/,/Y'7 �t�C�+ �•y]W Notary Public. - 5— ofwM -omm Anoka County, Minn. Charles S. Cook, President My commission Is permanent. (1f not, state expiration date: (Signatures may be authenticated or acknowledged. Both are riot _aWuary 31 2005 ) necessary.) ALBREC" NO PUBLIC - MINNESOTA ames N or penota signing in any capacity must be typed or printed below their signature. COMMISSION W , WARRANTY DEED STAT FORM No. 2 W I SCON SIN 1998 w1, JANUARY 31, M iWaukes. Wis. # A s a w r staff j I>p2Z