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HomeMy WebLinkAbout032-2163-14-000 o ° p cR eo ° h c c 4 0 ~ c C 0-0 0 CL CU ~ y y C 0 y U 7 'O 7 O 'O w N O (N y a) C L O L .p > CL) D, ~ 8,-o- 1 - cc o v O C O O a) N N C_'O lC Nm UY L Z! a7 N L 0 0 0 0 0 0 M 75 4) 'D 12 " c - f4 O N C a) I' a7 'O O_ E a7 c4 9 > E N O d E N d c a U C Q d ,a N N N of o m aaU o Z E N~ 3 a) o c my c o c !i c ao.oo-aa.o~ c .0 04 > o U M i~ 3 CD 4) Hoc (D CC a °:5 = CL0 >wV I Z y (n E z L Z (L L m 1 I O Z c 1 (D nF O a 1 c E m ~ I aa) c N_ f6 a) 7 ~ N • III 4") O I Cli o a O 1 O °=a 1 N Z w 12 E ts (2 + E U Q o G r p 47 m L N CO oa a(~ r tv F- H H = i 0 n 0 0 0 a m 1 •N a ~aaa ~ 1 (~j a N L INS 0 U M g a M a 1 in E °o °o Z 1 N N LO 0) C7 o Co ° ° ° Z 1 ~l O 0 0 0 Y n CO O N N Ili O O o > .N- _O ml 01 Co U _ Q A (A N #A to aN-' w e o E I Co 1 a o aai c cai a °o (D 00 04 °o 0 1 r \ 6 ~ - O N C ~ 'S7 N N N CD Co N C) v f0 O Cl) 7 C 7 N N C r q} a) N *-4 C O CO N M E m O r.+ 7 E C L • O Z N d Z fn Q 1 L - m v m R a d - L a m m c - m c `1V c E o L A U a O U) U ' I II Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430143 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: Germain, Michael Somerset Township 092 7-1( ? -I Y CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /O V - j0 -a ~r 6tq( 14.31.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ) Z_ U Benchmark (00. 0 Dosing Alt. BMf-619 CASI /o 5 Aeration Bldg. Sewer / es~ cued q, Holding St/Ht Inlet i ii~ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P WBLDG. Vent to Air Intake ROAD Dt Inlet Septic r > Dt Bottom ~o0 5th 5 N~°~ Dosing HeadeN Aeration Dist. Pipe '2 2 6, Holding Bot. System y _ ~j 0 1 Z PUMP/SIPHON INFORMATION Final Grade co 3 %A1 Manufacturer Demand St Co er dd ~~4,V ~ d] d d GPM /bc_k "G>Lu[ b5 Z q 7,19' Model Number TDH Lift Friction System Head TDH Ft of - Forcemain Length la. Dist. :t.Vell I 9J7 -3 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 4 rl/ SETBACK SYSTEM TO P/L 6/61BLDG WEL LAKE/STREAM kE CHIN Manufacturer: INFORMATION Typ Of System: 1 1 (`HA UNIT OR Model Number: DISTRIBUTION SYSTEM / P .V4-;-q/t Header/Manifold Distribution ' x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) V® Length Dia Length Dia Spacing z Pressure Systems Only xx Mound Or At-Grade Systems Only SOIL COVER e r / 2 0✓ mwre above- Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil J Yes , No Yes No ' COMMENTS: (Include code discrepencies, persons present, etc.) Inspection spection #2: -14 Location: 2117 62nd St Somerset, WI 54025 (SW 1/4 SW 1/4 14 T31N R1 9W) Gavin's Acres Lot 14 T a arcel No: 14.31.19. 1.) Alt BM Description _F0 I' 6_ UAL" _04_UXJ4tf_ IVl~te 2.) Bldg sewer length = /V - amount of cover Plan revision Required? Yes No l i-- - - Use other side for additional information. 1 ( L__ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) PLOT PLAN PROJECT Mike Germain ADDRESS 1359 Awatak rai udson Wi. 54016 SW 1/4 SW 1/4S 14 /T 31 ,~/R 19 W TOW Somerset COUNTY ST. CROIX MPRS Byron Bird Jr. 22052 -DATE 9-9-03 BEDROOM 4 CONVENTIONAL XXXX rade C VENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gat LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE ❑ LOAD RATE .7 ABSORPTION AREA 857 # of chambers 28 ,BENCHMARK V.R. .Base of window ASSUME ELEVATI 100' D BOREHOLE O WELL *A.R.P. same as BM vent SYSTEM ELEVATION T-1=92.89 T-2=,91.64 - r Z5 ATI Standard Leaching I q Chamber with 31.1 ft^2 per chamber 6" _-A,-Ciradeat System Long 34' Elevation r 62nd st Drivewa Garage $ bed Hous well $M 24' PL 10 61 :77' > > 100' Pi 7 B2 B3 s > 50 to PL ❑ BI Or BM PAID NVI'sconsin Safety and Buildings Division County C 201 W. Washington Ave., P.O. Box 7082 f Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 261-6546 Y30 Sanitary Permit Application State Plan I.D. N~her/~ In accord with Comm 83.21, Wis. Adm. Code, personal inforgiVion you provide O A may be used for secondary purposes Privacy Law, slp.kl)(W) Project Address (i different than mailing addresy) .~E 1. Application Information - Please Print All Information Property Owner's Name y Parcel # Lot # Block # Property Owner's Mailing Address ~y j Property Location C w ,/4, Section City S Zip Co~d/e' / ~Phone Number -4-&/' Q / 4 !l l 3 / / circle one) T / N; RE or W II. Type of Building (c eck all that apply) Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms IN ❑ Public/Commercial - Describe U ❑ State Owned - Describe Use - ~j 57,x/ ❑City❑Village ❑Township of 1r III. Type of Permit: (Check only one box on line A. Complete line B if applicable) - A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision 11 Change of Permit Transfer to New List Previous Permit Number and Date Issued ❑ Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a 1 1PIflon -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 Ching Chamber ❑ Drip Line ❑ vek s Pipe Other (ex lain) / V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required f) Dispersal A&a Proposed (sf) System Elevation 4 f Sr Tr 7 0 VI. Tank Info Capacity in Total Number Manufacturer Prefab Si e Steel Fi er Pias Gallons Gallons of Units Coe Constructed Glass New Existing / U Tanks Tanks Septic or Holding Tank G~ < Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumbs' ame (Print) P lumber's Si MP/MPRS Number Business Phone Number 4- Plum s Address (Street, City, State, Zip Code) ~G r VIII. C on /De artment Use Only, pproved ❑ Disapproved Sanitary Permit F c udes Groundwater Da Issu Is ng Agen Signature ps) Surcharge Fee) ~5 ~ 17 ❑ Owner Given Reason for Denial - / 0 IX. Conditions of Approval/Reasons for Disapproval _ ~J~ / t [~iYt /r 1~6~ C&,~' 3yvf- A~~- 041~tW~~ Attach comp to ptans (to the County only) for the system on Paper not less than 81/2 x 11 inches is size te SBD-6398 (R. 08/02) S -;fo f4 PLOT PLAN l /J PROJECT / ADDRESS / jY G{~j u f ~GC 7,_ ,,,,-114 1145 IT N/R ~L W TOWN rne,- f~/ 4UNTY Gro BEDROOM MPRS Byron Bird Jr. 22051 DATE CONVENTIONAL XXX At-Grade CONVENTIONAL LIFT HOLDING TANK I MOUND SEPTIC TANK SIZE ~/2-~ 61j LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE L 7 ABSORPTION AREA !~j # of chambers BENCHMARK V.R.P. a ASSUME ELEVATION 1100' ❑ BOREHOLE O WELLLV -H.R/P, C~ nt SYSTEM ELEVATION - ~tr ,2.~ AT' Sidewinder High Capacity L eaching Chamber with 17.2 / t^2 per chamber r ` ul'~t Gv Long 34'? Grade at Systern ~y ~ say • rq14f,IJ e- 49u ~ gD -FO sys IZY Sys.~fivvi ~t.2ed,Q ~ de B q5, j4 gat 49 PLOT PLAN , PROJECT ADDRESS ! cJJ !it'4/ u ~Gr /l GG ~ G r~ Gs ~ 114~ 14 IT N/R w TOWN 11AOV iT _ Gro s, - - - f-0 2 BEDROOM MPRS Byron Bird Jr. 2205' DATE CONVENTIONAL XXX At-Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE X1,_2 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA .,l('5 7# of chambers BENCHMARK V.R.P. oZe o ~ a ASSUME ELEVATION 100' ❑ BOREHOLE O WELL H.R.p. Vent SYSTEM ELEVATION >12" Sidewinder High s ' Cov Capacity Leaching Chamber with 17.2 C~iLvn y 6„ t^2 per chamber ' _D_ lip Grade at System Long 34" Elevation ~I /~eAg~ e- 4~qa ~o r~ o $b• ~p~ Y. 40 r ° f ~7 11,2 Gv f t~av~h s ~G~-S 1126 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt 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 I. . Please prfn a117rf1i~fbn Personal information you provide may be u for ; s.1 .04 (1) (m)). V wed Date q a1 utir, 7 d Property Owner roperty Location Grand Properties, LP 2002 out Lot SW 19 SW 1/4 S 14 T 31 N R 19 W Property Owner's Mailing Address t# Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 ST. chOix cou i 14 Gavin's Acres City State i City Village 1/ Town Nearest Road Somerset WI 54025 715-247-5900 Somerset 60Th St. New Construction Use: ie Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: q0--- 600 (Tel) Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating. Possible system elevation for Area I is (step trenches) High 95.15 Low 94.15. SWlope is 11%. Boring ❑ Boring # ; fe, Pit Ground Surface elev. 99.14 ft. Depth to limiting factor >97 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. *Eff#1 *Eff#2 1 0-7 1Oyr313 none sl 2mgr mvfr as 2f .5 .9 2 7-18 1Oyr4/4 none scl 2msbk mfr gw 1f .4 .6 3 18-29 1Oyr5/4 none I 2fsbk mfr cw .5 .8 4 29-40 1Oyr6/4 m2d 5yr5/6 I 3msbk mfr cw .5 .8 5 40-97 10yr5/6 none ms Osg ml .7 1.2 *2 foot rule applies 91the-redox features in horizon 4** Boring # Boring e Pit Ground Surface elev. 99.14 ft. Depth to limiting factor >98 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 1 0-7 10yr3/4 none Is 1 msbk mvfr as 2f .7 1.2 2 7-28 1 Oyr4/4 none Is 1 csbk mvfr gw .7 1.2 3 8-98 10yr5/4 none ms Osg ml 7 1.2 6i p' h -2 foot rule applies to the redox features in horizon 4** " Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 130 mg/L and TSS S.30 mg/L CST Name (Please Print) Signature: ✓ . CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valle View Trail, Somerset, WI 54025 6/15/02 715-549-6651 i Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 F3 ]Boring # Boring Y Pit Ground Surface elev. 95.14 ft. Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDR in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E'ff#2 1 0-9 10yr3/3 none sl 2msbk mvfr as 2f .5 .9 2 9-15 10yr4/4 none st 2fsbk mfr 9w .5 .9 3 15-30 7.5yr4/4 none Is Osg mt 9w - .7 1.2 4 30-96 7.5yr5/6 none ms Osg ml .7 1.2 **2 foot rule applies to the redox features in horizon 4** ❑ 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-I Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Stnlcture Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD S> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS j S-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 m all matArial in an altPrnafn fnrmaf nlnacn rnntant the 1.-4-f of AAR-')ll.-'2 7 S 7 nr TTV AAA-')(.A-8777 l PMz 3o -F3 02 lo , oz El ~fU~~ 14 ~6 '*I= o 41r- //A 'YO 2 p6 r ?(Z?d g6tj lye, f /~1 6 yf , r rs L Y~ -714 Je S"t' 65 TM Ste', ~ ~ Sqq n+S tL; p ~ T _ ers.~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -L of ~ FILE INFORMATION SYSTEM SPECIFICATIONS Owner C t' Septic Tank Capacity al ❑ NA "let Permit # 30 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A~L 'le-67 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) p gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) Q al/day Pump Manufacturer ❑ NA Soil Application Rate al/da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit A Fats, Oil & Grease (FOG) :530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) _:150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD6) 530 mg/L n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ys in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA ,Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ❑ ear(s) Pump out contents of tank(s) When combined sludge and um equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) ,2,year(s) (Maximum 3 years) ❑ NA Clean effluent filter 5 MDED At least once every: month(s) ❑ NA Z- ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ 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 include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. 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 performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of 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 contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacem t system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. he si s not bee ev ated to identi a s 'table replacement ea. Upon failur a POW a soil and site A /V valu tion st be erform to locate suitable lacement a . If no lace nt area is ailable a holding tank a be instal a last resort ace the failed P S. ❑ ound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name y- cr Phone Phone .S SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name r Phone 6 S Phone This document was drafted 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 Clt2 th 10 Mailing Address 7u lkr-« Property Address ~d (Verification required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION I/'/4, f C '/4, Sec. Property Location: 1 , T,2-N-R W, Town of ~o ~Y Se Subdivision GL Lot # , Certified Survey Map Volume , Page # Warranty Deed Volume t -'fp , Page # ~ . Spec house ❑ yes (;~no Lot lines identifiable Byes ❑ 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, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by 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 the three year expiration date. C ~~~a=~~dlelk~l 211-1-03 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 owner(s) of the property described 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 U 1952P 5 8 5 667537 STATE BAR OF WISCONSIN FORM 2. 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., MI This Deed, made between Walter E. Germain and Debra C. - RECEIVED FOR RECORD Germain, husband wife, - - - 08-20-2002 9:30 AN - - WARRANTY DEED - - - EXEMPT 1 Grantor, and Grand y~Kqpe LP - REC FEE: 11.00 TRANS FEE: 916.50 COPY FEE: CENT COPY FEE: Grantee. - PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix -County, State of Wisconsin (if more space is needed, please attach addendum): The W 1/2 of SW 1/4 of Section 14, Township 31 North, Range 19 West, Recording Area St. Croix County, Wisconsin, EXCEPT: n 1) Lots 1 and 2 of Certified Survey Map in Vol. t, Page 236, Doc. No. Name and RetiSC~ 1CRI OGLAND 332995; 2) Lots 3 and 4 of Certified Survey Map in Vol. 3, Page 746, Doc. No. ATTORNEY AT LAW 353786; P.O. BOX 35 9 3) Lot 5 of Certified Survey Map in Vol. 9, Page 2454, Doc. No. 480266; HUDSON, 1 4016 4) Lots 3, 4 and 5 of Certified Survey Map in Vol. 10, Page 2889, Doc. No. 526637. 032.1010-80-000;032-1041-10-000 - Parcel Identification Number (PIN) - This _ is not - - homestead property. 0j) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this dM day of June 2002 ~ • Walter E. Germain - a Debra C. Germain AUTHENTICATION ACKNOWLEDGMENT ) Signature(s) Walter E. Germain and Debra C. Germain, STATE OF WISCONSIN - ) ss. husband wife, - County ) authenticated this day of June 2002 _ Personally came before me this day of the above named • KristinaOgland TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) - - - THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _ - - - - ' - - - Iruormatim Professionals Company. Fond du ~L,Sa. Ha • Names of persons signing in any capacity must be typed or printed below their signature. , STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2.1999 ! A I LOT 1 RL~ 11 CSN PGC-A PAGf 7J6J I +M RMALO AND DONNA WMAW - b'RAGE/S M]e'g7MY a15-270TN AME p I Enc O ! 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