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HomeMy WebLinkAbout020-1363-12-000 \ y \ \ 0 _ w 0 . . � ƒ : \ 20 c ) : o 0p7 ) /,0 @ ( E D \ / . � f % ° 4 / z § § CL m Gf § k \ \ % Cfi \ § / M 3 _ m e = \ 2 2 2 ! 5 / ° / ^ : . .� / L) j / \ \ \ / / . z z *I ts ) !/) \ cli .C: ! §( §{ �\ - '\ 0 3 a ° E ) j 2 ° o § § ° z •� I g a a a § § E e = 2 j q 7 @/ z � © - - � 00 / 2 e $ / E / �j ) z ILw § J ] ] \ c \ \ o ;� \ \ \ k \ C:) \ / / / . \ e z a 0 7 a) / CO 2 % \ e a) \ -0 ' t j § -0 \ \ o z -D z Q) 2 / CL / I w § ' k 2 § / 3 a 2 �0 J 3 I r ST. CROIX COUNTY ZONING DEPARTMF AS BUILT SAM[TARY REPORT Owner Property Address �. �1 G D' M City /State dSa _v i 4 Legal Description: Lot 12 _ Block Subdivision/CSM # /Y1e- '/4 - cJ ' /4, Sec. Z, T2LN -RAW, Town of PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer m,`c/wo e f� (- 'Size ST/PC/ Setback from: House ��/ Well P AL Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: ef ) , t ) Width Length 'd d Number of Trenches �- Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark e 7" Elevation AA:? Description of alternate benchmark Tapp G!7`�'m �� Elevation z' Building Sewer �'y� f ST/HT Inlet /2 ST Outlet Z-? C, L PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade Date of installation / / Permit number State plan number Plumber's signature Ao- --- License number Date Inspector rte✓ Complete plot plan � NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 0 / Z 1 q e m � 1 J i _ S I e INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 ( 353216 Permit Holder's Name: ❑ City ❑ Village [R Town of: State Plan ID No.: Con-Spec Real Estate, LLC Town of Hudson Z (a4 f CST BM Elev.: Insp. BM Elev.: BM Description: arcel Tax No.: p6.0 r UQ,O' or 14 I N QtrC . 1DMe QS Cg p endin g TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic 650 ov, BenchmarE ,� oj.00 cro. O Dosing I �D +405b Alt. BM G"50 47, E on Bldg. Sewer 7 `fo q4. s- g St /Ht Inlet '?Q 1 4- 12- TANK SETBACK INFORMATION St/ Ht Outlet 1 6,-X2- e - 3.68 TANKTO P/L WELL BLDG. Air to i ntake ROAD Dt Inlet Air Septic f +- NA Dt Bottom 9 Aw; WA) Dosin NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System IZ.SO 41" PUMP/ SIPHON INFORMATION Final Grade (p,$V 2,4 Manufacturer Demand St cover 7.32- Model Number GPM Lorc F Lift Friction System TDH Ft ead emain n Length Dia. Fi Dist. To Well SOIL PTION SYSTEM ((, KIRENW Width Leng h No f enches PIT No. Of Pits Inside Dia. Liquid Depth D IM NSIONS T D ' IM ' ENSION S SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu acturer: SETBACK INFORMATION Type O � _ CHAMBER Model Number: System: C \W 2 OR UNIT t DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole ize x Hole S aci Ven T o Air Intake Length Dia. � Length Dia. Spacing O� 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 I ❑ Yes ❑ No t ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 121 1711 iInspection #2: Location: 648 Commerce Drive, Ijqdson, WI W1 /4 SEl/4, Section 27 T29N -Rl, 9yV�7.29.1 9. C 1.) Alt BM Description= �`'`� �C ; OT °t 2.) Bldg sewer length= '� �o - amount of cover = (�``� Celrtrl J 4.t ca+* 4L - ' "e �.,t lam/�� . -� e, . a Plan revision required? ❑ Yes X No Use other side for additional information. F 14(4.' SBD -6710 (R.3/97) Date Inspecto 's Signature Cert. No. i I ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I, � Safety and Buildings Division Vi scons i n SANITARY PERMIT �_ LVN 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Comm 83 Adm Codyl r ,, Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the systefn, on paper noffess Coun y than 8 vi x 11 inches in size. I • See reverse side for instructions for completing this apple tion , ;` State anitary Permit Number IPevacy Law, s 15 04 ( 1 m)] may be used for secondary purposes , : e"0 `G op i f- } Ieck if revisi to previous application \ S Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL IN MATION, Property Owner Name e' tion C � 4 G 1/4 1/4, S , T , N, R 1Q E (or)Q Property Owners Mailing Address Lot Number Block Number /8O Y ? < 6_ r.J 14 G e. j2 City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ C It Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms I WTown OF g Ga c Q III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ('ap i3 (� -3 -0 0 O 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 6& Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1 R7 2 Replacement 3_ Replacement of 4 Reconnection of 5 Repair of an ---- � ❑ E] E] E] ystem -- - - - - -- System - - - -- Tank Only -- Existing System -- - - - - -- Existing System -- - - - - -- ----- - - - - -- B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 3q Type ._ 41 ❑ Holding Tank 12 ®..Seepage Trench 22 ❑ In- Ground Pressure / - -� 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill ,�.2 ~ $' +'G� t� ,` dr r e �/ G a r+► y S 7S " = V ABSORPTION S YSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Eiev. 7. Final Grade 7.6"o Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 1,00d l d d h r Q 41. S Feet / Feet Capacity VII. TANK in gallons Site Total # Of Prefab. Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing structed Tanks Tanks Septic Tank or Holding Tank / j Q p( Sy+wY.e ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (NQ Stamps) PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 6 e3 c r? IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) �94 pproved ❑ Owner Given Initial Surcharge Fee) q 4� Adverse Determination �a� CD I ��� I X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4/99) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and BuOclings Division, 608- 266 -3151. - -- To be complete and accurate this sanitary permit application must include: I. Property a ;wner'sri me'arid iIing address, ,.Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 - TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 26, 1999 CUST ID No.267341 ATTN.• POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 y ._. - -11A1 _CARMICHAEL RD RIVER FALLS WI 54022 "`� <' ',I U ONNI 54016 RE: CONDITIONAL APPROVAL A " ° � ��� �`; Identificat' era APPROVAL EXPIRES: 10/26/2001 ,� T Transaction ID N(. 252640 ,Nte ID No. 161384 SITE: r . Ieaherefei .a both identificationrnumbers, Site ID: 1 1384 r: above, in all correspondence with the agency. �, y ' tt�� C'� S27, T29N, R19W 'I GOFFICE St. Croix County, Town of Hudson Facility: Conspec. Corporation - Offics /Storage Build FOR: Description: Non - pressurized In- ground System Object Type: POWT System Regulated Object ID No.: 496717 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. WEGERER SOIL TESTING & DESIGN Page 2 10/26/99 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 10/13/1999 FEE REQUIRED $ 120.00 FEE RECEIVED $ 120.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608) - 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM swim � J @J�" 7633 commerce.state.wi.us 4e r CONVENTIONAL SOIL ABSORPTION SYSTEM Page Nof S For — ��N OF�,CE 191tip S'��G� 3v���lr,,6 LOCATED IN THE K�IE 1/4 OF THE SW 1/4 OF SECTION Z1 , T Z ° L N, R l� W, TOWN OF t (2 - (z ,0 14 COUNTY,WISCONSIN, Lw 1 of LzctiT _y INDEX PAGE 1 of 5 TITLE SHEET PAGE 2 of 5 PROJECT DATA PAGE 3 of 5 PLOT PLAN PAGE 4 of 5 PLAN VIEW -CROSS SECTION PAGE 5 of 5 LEACII CHAMBER DETAIL PREPARED FOR Ct� iV S P E C G01Z 1�02�'Sl ON -- t8o9 rvo2`R�W�s�'L'R.iv AVE,. S nLLwA�, Y -IN ssoc5z or PREPARED BY U DIV. WE= ( GEF : ;ZER SQ I L TEST I h1 CG AND I3ES I (3M S3E4�� ICE CON +� P.D. BOX 74 N. MAIR ST. r •� = PRIVATE SEWAGE SYSTEM RIVED FALLS. VI 54022 ' w � � EA � C onditional l y 715 42`.,-Olb.`i � Eusw i • •h r NSY•• •e APPR0 z ISI ) (w S D BUU9 INGS ' O g Q 0 , �j SEE CORRE ONDENCE JOB N0. q9_ Z I r - PROJECT DATA Page Z-- of S This system will serve an office and storage building with 1 floor drain and 1 catch basin in the vehicle storage area to dispose of snow melt, etc. There will be no vehicle washing or maintenance done in this area. The system sizing is based on a possible future maxinum of 30 employees. ABSORPTION AREA 30 employees X 20 gpd = --------- - - - - -- 600gpd 1 floor drain X 50 gpd = -------- - - - - -- 50 gpd 1 catch basin X 100 gpd = -------- - - - - -- 100 gpd total = 750 gpd 750 - .8 (loading rate ) = 937.5 sq ft min. required. 2 trenches, each 3' by 100' long with high capacity Sidewinder leach chambers by Infiltrator Systems, Inc. will be installed providing 1000 sq ft of absorption area. SEPTIC TANK 750 + 750 = 1500 gal min. capacity required. A 1565 gal precast concrete septic tank by Wieser Concrete Products will be installed. i PLOT PLAN Page 3 of S Scale 1"= y'0 ' Li Tx I T I CoV� SZ p -6` P rSZLcA i vl V I� 6• 6'� 1�I o I 0 J zr i t S I i \S pF �Ol'I1Qty yvp�e Box i 1 �o ►� t�sT_ z.S' t��., - septic -. -) OO FX��ri GE ��.tUE ST'- _ � � I 1 0 PVC b 9Y PCLT�t.lf�T �U�-�t DL3�2�gvlzo+J SuA i s�a�c - Cfiv� i ve 1 Q4 -s' r=ev. ads I��GC S of S pp W e x Q 4V o cri co w � a � _f 1111 � o � a H 3 I X11 rn CD a� m • b x CL � (a 3 � T o Y a CD ID cp 0 e N Ji ll c 0 r,5 E . �. a s d I - f l � V �J \V ♦ / s (D x s o� a r J C e X �• C �'< 17 C c cn -0 CD a v o cn o- (D o - -- �( =; -moo < -� - n (n l< _ 3 ID P _ CO CD — U1 ? `c Q N N W (Q x 'D N :- v (D CJ� O_ 1 ¢ n cn X (D !11 W -. 1 M411 =" C C i CD 0 o Invert 11" a j � o ----1� Y CD r (D c y r aye yr Bureau of Integrated Services in accordance with s. ILH I ; Vft Adm. Code 1 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. ry►nst g rdy include, but not limited to: vertical and horizontal reference point (BM), dir, a 3. 0 percent slope, scale or dimensions, north arrow, and location and distant to nearest road _ + reel I Q: APPLICANT INFORMATION - Please print all information. i R ed Date Personal information you provide maybe used for secondary purposes (Privacy Law,j. 1534 3 rt1))c i�� A Property Owner Property l 0 n i? C. � o Q Q i � �� Gd�t - fob _. '1/4 ' ,1/4,S '�, T . � ,N,R Property Owner's Mailing Address Lot1i1_..' Blbck# , . Subd. Name or CSM# ^ City State Zip Code Phone Number ❑ city village ® Town a t y � Nearest Road (f New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building [] Replacement VPublic or commercial - Describe: Code derived daily flow gpd Recommended design loading rate . -7 bed, gpd/ft gpd/ft Absorption area required --- ft2_______. ^__trench, ft 2 Maximum design loading rate ..__ ­1 bed, gpditi trench, gpd/ft f Recommended infiltration surface elevation (s) ds ) ft (as referred to site plan benchmark) Additional designtsite consi erations ` f C b ' 1 0 R e t r t y'tiQ ` Parent material (} Lt s is (-� ;r` Flood plain elevation, if applicable o ft S = Suitable for system Conventional Mound In Ground Pressure AT- Grade System in Fill Holding Tank U = Unsuitable for system S❑ U El P U S❑ U ❑ S du I ❑ S 11 U ❑ S [ U SOIL DESCRIPTION REPORT Bonng # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench Ground - -- elev.., Depth to limiting factor Remarks: � R � Cn, f G� �'yO' 0, . J !' l} � Soong # .. _.,,r_..... T _ J ,/ " '� p„? • r " W � h Ground Depth to limiting factor 7 Remarks: CST Name (Please Print) Signature Telephone No. - Th in Address S <° 4 n Date CST Number ►- 1-ak t5y� ,,, (�2a ��z 7 3 93'7 PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL t.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed .Trench _, ... Ground elev. Depth to limiting fee in Remarks: Boring # Ground S 1 elev� , Depth to _ limiting factor Remarks: Horizon Depth Dominant Color Mottles Structure GP t in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Boring # 7 V" Ground elev. Depth to limiting factor Remarks: Boring # m Ground elev. ft , Depth to limiting t r__ factor in. Remarks: SBD -8330 (R. 07/96) tMV1PQMtAtM 5 Pt51QfA 1432 120' STREET, NEW RICHMOND, WISCONSIN 715 - 246 -2454 Tom Nelson Certified Soil TesW 227387— Registefed Sodtm im SR00713 10 v� r+�.5 cat `-- 1 SCALE Iry = q d r Tom Nelson $M L - 1 7 ,p n� 1` PVC pip e�q iQU BM 2 (,O c? S t r F e NC 1 of c-arn e r • ' y J � z 9 1 �0 ® o� o 0 F- 3 „T0,00.00 N � 3 wl N ,L8'622 o M M .,10.00.00 S _ _ _ ® M I OI H c \ / "II ~ W ^ I j 0, y N (^ I p ~ ,GC. ,EE W p Co �— I H 1 W p N WI C. p w0 y I �I U U H ¢ -'o W U 50' I ro I ^� �¢ (/1 w cn z L W O n A i Q N � 60 £6r � h m I L A CO J 0% O p c O2 (11 I cn 0, 0� r , 191` In I o I� Z 3� z A a W W �+ az4m o I wo NI 3F II I C aC J Q Z z to � N o�3 I ^o c l 3 F II 3 hl z v� J I 0 W3 2b. N I t _ OD ,90IL81 1 1 N M 1110100.00 S L — ,961L2 CID M V- 19£'082 M 1182,00.00 N N 1 t 0 1 ,LIVJHS 39S H II ,711117 HJ LYN I 1 I 1 I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C O N S P EC- Kaal E--,,tstt r LLB, Mailing Address / A Q 9 Al ft� we ste r a A11 'e 5- x:1 ��l)e_ f r YY� ssog� Property Address eo (Verification required from Planning Department for new construction) City /State H'u c(S d n UST Parcel Identification Number n;2-0 - 10 LEGAL DESCRIPTION Property Location S t) '/4, '/4, Sec. Z7 Y T_?.I_N -R Town of �Iujse'n Subdivision C- A i f Fou Bus: n e s..s &P W, , Lot # . Certified Survey Map # , Volume , Page # Warranty Deed # (:; l3 ?z - a , , Volume / 4 ( , Page # � Spec house ❑ yes 0 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 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 master plumber, journeyman plumber, restrictedplumber or a licensedpumper 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 that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of het a year expiration date. Z /// SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the prope escribed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT 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 V V - 1468PAGE 207 STATE BAR OF WISCONSIN FORM 2 - 1998 r=6 Document Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between C.P.T.. LLC. a Wisconsin Limited Liability Comaany, 11 -04 -1999 9:30 AM WARRANTY DEED Grantor, conveys and EXEMPT D warrants to on sreo i Real F.G r t - ,t- r.T._a CERT COPY FEE: CDPY FEE: a Wisconsin limited liability company TRANSFER FEE: 225.00 RECORDING FEE: 10.00 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 (The "Property "): Recording Area Name and Return Address 020 - 1075 -10 -500 Parcel Identification Number (PIN) This is not homestead property. J Lot 12, Plat of Exit Four Business Park in the Town of Hudson, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any Dated this day of November, 1999. C.P.T., LLC B y By L _ By By * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) f ) ss. authenticated this _day of (/d'a County ) Personally came before me this _ day * of November, 1999, the above named C.P.T.. LLC, a W' co in Limited Liability Compoy b TITLE: MEMBER STATE BAR OF WISCONSIN L W /AlAh (If not, authorized by § 706.06, Wis. Stats.) 6 to me known to be the person(s) who executed the foregoing THIS INSTRUMENT WAS DRAFTED BY instrument and a ' nowledye4e same. Attorney Kristina Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) Notary Pubic, State of Wisconsin s 06 1BEVE y Commission permanent. If not, state expiration date: r id Nsuc ) OF W6CONSIN 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1998 n.irnn. +.TV.•i nn+n ootnnini c rnneneAlV rnmr, n I I Ar. WI