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HomeMy WebLinkAbout026-1167-30-000►. pr County �,�/j axe �•r �il v 1 X �'� '�. Safety and Buildings Division 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) (fi' $� Madison,WI 5 ©716 //�� p 'a $ ( -_ SV-7 2 ( 0 ,4SI41NP _________ State Transaction Num r Sanitary Permit Application A In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if di erentthan mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary — l�_e J4 .�"1 purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. ��•yip r]kC� mend I. Application Information—Please Print All Information ry Property Owner's Name Parcel# Property Owner's Mailing Address T � Property Location I r^� ( 3 S-iee /1lLFt.�ST CRQIx., . / 33 2-) y`3 l ? i g-f - µ Govt.Lot �$(� City,State �(* �+a (/ V v/.. Zip Code Phone Number N V, of E. '/4, Section a '�/l�( 6 -� �jcircle on .e,~J `, / s407,9„.„- 7is e Z) - 9 ? 3/ T ,7 t N; R ICj Ee o II.Type of Building(check all that apply) Lot# Subdivision Name gt 1 or 2 Family Dwelling—Number of 1B.eed'rooms l _ 1 313rZ- r lJPi'e12— $t(,±LLri N..` L1 V�e G Block# L4II��5 I riser v ❑Public/Commercial—Describe Use ❑City of CSM Number ❑ Village of (� ❑State Owned Describe Use V Town of R IC'h177 fill i III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ANew System ❑ Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) List Previous Permit Number and Date Issued B. ❑Permit Renewal ❑ Permit Revision ❑Change of Plumber ❑Permit Transfer to New Before Expiration Owner IV.Type of POWTS System/Component/Device: (Check all that apply) ,,77�� <2 in.of suitable soil CJ\Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade� ❑‘27,--a"M Mound>24of suita ley/oiJl J ou 2 Ve" LJ P�treihedt evice(eai ,, ❑ Holding Tank ❑Other Dispersal Component(explai •• z- p�wo I L (V/v G `..S—,=L,C�"1 V.Dispersal/Treatment Area Information: (��///t T (�y�.'jJ3�f Design Flow(gpd) Design Soil Application Rate dsf) Dispersal Area Required(sf) Dispersal Area Propgf) System Elevation n Cj. 4 C.�� 1 So i . - LJ 4s' 17e grJ� VI.Tank©o Capacity in Total #of Manufacturer N O b U Gallons Gallons Units t U u _ „ ,, •: New Tanks Existing Tanks YQ. w o °' E e 2 Q-r�V, (20)/14 a, ch m v) is a Septic or Holding Tank I?K(��0///��0 k K-- / � i LA Sal- �0 y�Q (Pied sf V v'r Dosing Chamber �� VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) ' Plumb 's Signature MP/MPRS Number Business Phone Number Q at 1 p ht r e I,s e item /7 Diu c9 3$4 z s(-4f-9-b'3?1 Plumber's Address(Street,City,State,Zip Code) VIII. ounty/Department Use Only Permit Fee Date sued Issui,• Agent Signatur +r Approved ❑ Disapproved e/YI P,y ❑Owner Given Reason for Denial $ / 5- `` 12/2413 IX.Conditions of Approval/Reasons for Disapproval © �t�_ T i (fdea k, Come ca.,b SYSTEM OWNER: (/N*�h `�'m'a2��� G 1.Septic tank,effluent filter and be®'�' i/y' "h�='O7,U� Gt�e, .*A - n / dispersal cell must be serviced/maintained �&Lem 3 C /��(/N2 ���"O as per management plan provided b lumber. 2 All setback require y p � 37'�5 '9t mifibllg(af1ai11edy.temand submit to the County only on paper not less t 8 1/2 z 11 inc s i ize as per applicable code/ordinances. Y�Q j, Then u fr 4 ( r P Q'"L S _.- SBD-6398(R. 11/11) 71270 AI. S -;21 ����j� ��(�C/4.�-I 7t.�2 Gl(2 dt CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: j'i!r tk5by Owner's Name: C Q1J 5 '1 Owner's Address: 1 3 9 Y )? 9 5 N �1c ri7Oni Legal Description: Al Tz n}t, 5e c , 7 / '30 R) 1.4 Township: CA 'ry►On) County: (o j Subdivision Name: (,(,t,n1 S vf C 5e r v Lot Number. Q Parcel ID Number: () a/,—,f' /7 -- 0 v 0 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing&Cross-Section Page 4 (Filter Spec Page 5 Maintenance Information age 6 =:: .- • Page 7 St.Croix C Se•tic Tank Maintenance Form ✓ Page 8 Warranty Deed /age 9 CSM or Plat /� �tachments: Soil Test&House Plans Designer/Plumber. l''ct,f 13. f Ic,5 ' License Number. O_<_5.4 Date: Phone Number j Sl ' 491-g5,4 Signature /0 , Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 -7\ ------ e--=--- 1 ,• I 1 , I .11 i Ai 3 1 i 44 2- 'Pk 0 ,5":e I 0 I •A e 11.5 e''ck L-1/10 -101 r,,,— 1- l.,914., 13,c ,t14 1 , 4 sc0 i- I AQPicc° ( n■i k, s 4‘ 9,- ,- c 4, o' 3er iofq5e ..L. _n u, ,et,2i r"-.7-- .., - , 0 , 1,--r.ey -o'a ul 571-7- 12.11 1-9‘( ' ,Q,-... ro C , 1 --- ■ ,s,_ , T--- 99 .1 ggisi fiervw," v e,s-- c 4 r ''a 1 ' 1 ] - q_sP.d lrz2dR-- , r.....,„:40, _ pce ,rovt-14'.\or , c. , 4 eV c-if°"1 /waidll al'44101 - -- 4 cr 1,)) i , 51,o Id cl• be aj s ----, 1 - , 4 W sconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 1 e • 1f� i L include,but not limited to:vertical and horizontal referen .: ••int 'argt Parcel I.D. / �7�3�/mil percent slope,scale or dimensions,north arrow,an. • . .n nd distance to nearest road. a 24, // ip / cc` k Please print all inf. JUN 0 1 2004 Review-• : Date Personal information you provide may be used for second a 4Privacy Law.s.15.04(1)(m)). I , VA/1 \.__ - Property Owner ST. f - '•vr"L•cation A ,014 ,OFF! PE 1/4 /4 S T N R E(oi W ' I, j/r' _ w /r �L' 7ari1118i/ Property Owner's ailing Address L t# Block# - • Name or CSM# —7 0 AML. -S�, S. 29 /0l sc fir m City State Zip Code Phone Number 0 City ❑Village I: ' •wn Nearest R O o, iG‘ . //O New Construction Use.. 1 Residential/Number of bedrooms )' Code derived design flow rate -_ 6 00 --- GPD 0 Replacement 1 Public or commercial D scribe: -- �¢ Parent material, i s y -''>��A�+�7 _ Flood Plain elevation if applicable AV`,r ft. General canvne S / C (� !� . a s / and recommendations: /P,,,e.!x/1/0 ! ( ' / 9 o 9 3 • ad...)2...., 0y y/?„,_. # (,� L� Pit Ground surface elev.-/ • / ft. Depth to limiting factor 1/17 in• I mil Application Ra q 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 2— - /Z _ Cs- Mar 0 2 11-310/0 S�1l I 41". sn f 7r- f r Boring# .jile3.3ring �j //_ // Ground surface elev. / l i y ft. Depth to limiting factor LL—in. ( Soil Application Rate Pit _ 7-' 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 I /4/ ►Q (3/7 — i a ic m rrr c s v f 3 p- i , 3 Yoz-h; r1 f`�/� 1 r,s h r ria,_clict-- i `7/ , 7 •Effluent#2=BOD <30 mgt and TSS<30 mg/L •Effluent#1 =BODS>30<220 mg/L and TSS>30<1 ,�,• s �,� CST Number CST Name(Please Print) CST Numb Bird Plumbing, Inc. Shaun Bird / Telephone Number Address Date Evaluation Conducted 1008 192nd Ave, New Richmond, WI 54017 `'fl 715-246-4516 4 Property Owner Parcel ID# Page of 3 Boring Boring# ��/q1 g 411)--in. Soil Application Rate Pit Ground surface ele . / r � ft. Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots +E GPD/ft?E in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. I (1-1D IOar 3) S \ amur (In F'r c_s- 3_,,,-. ,(4 1. 0 a 33 1 { shy- c I 10r1,t,-)1c Er 5�.,� I -F' , �, , 3 � t 1 cs 00-Pr n a , a_ . ' 7 I I I I 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/ffE in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ❑ Boring Boring# ❑ Pit Ground surface elev. ft. Depth to limiting factor in. I 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 •Effluent#1=BODD>30<220 mg/t.and TSS>30<150 mg1L •Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity please contact the department lat 608-266-3151 eord TTY 608e264-8777,services or need material in an alternate format,p SSD4330(8.6100) Soil Test Plot Plan Project Name Environmental Holding L.L.P. Shy/ ird Address 706 19th St. S. Hudson Wi 54016 `STM #226900 Lot 30 Subdivision Lundy's Preserve Date 5/24/04 N 1/2 NE 1/4S 27 T 30 N/R 18 W Township Richmond 0 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 94.5/94.0/93.5 *HRpSame as Benchmark Alternate Benchmark Top of Survey Iron @ 96.0' B*M. Alt. B.M. /ii 40' 438' Property Line B-2 ,0, • Scale is 1" = 40' unless otherwise 8% Slope noted B-1 • 100' 35' 97'; 40' B 100' 99' A 376' Please note:Soil was Property N done to satisfy Line county zoning requirement. Soil test may not be suitable for owners desired building location. ■ n RECEIVED JUN 0 1 2004 . Lundy's Preserve Comments: ST.CROIX COUNTY ZONING OFFICE The soils in this subdivision are quite variable and differ across the 80 acres. Some consist of a clean outwash sand,other consist of glacial tills. In certain areas,the medium sands have a very deep red color unlike I have seen in all of St. Croix county. The color does not indicate high ground water because the color is so consistent. If you go through the red sands then the sands turn off white/yellow but not those of a sand stone. In talking with Pam Quinn from zoning,she commented that there could be a different chemical reaction with a sands. I believe this is the case for the sands have a consistent size, and no mottles were found above or below the sands. Sometimes bands were present, but were very slight, and were mentioned to have the systems sized a little bigger in order to accommodate for any inconsistencies in the soil. Also it is worth mentioning that the intersections of lots 6,7,8, and 9 have a extremely poor soil present not suitable for a mound system. The surveyor and I discussed this condition, and the resulting tests were spaced as far away from this area as possible. All the soils tests were done to the best of my ability and I hold no liability for anomalies and other oddities that can be found on this site. Shaun Bird CSTM #226900 i 5/28/04 , / " POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner {r-C` GA))� �2:4(P 1� s Septic Tank Capacity )O 0 0 gal ❑ NA Permit # V 5( Septic Tank Manufacturer p s ❑ NA ln� 1 e c:Y 16r DESIGN PARAMETERS Effluent Filter Manufacturer (p() L� c ❑ NA Number of Bedrooms 4. 0 NA Effluent Filter Model S a 5 ❑ NA Number of Public Facility Units I NA Pump Tank Capacity gal 0 NA Estimated flow (average) 4 S-O gal/day Pump Tank Manufacturer VI NA Design flow (peak), (Estimated x 1.5) CO gal/day Pump Manufacturer 18 NA Soil Application Rate C C . 4 gal/day/ftz Pump Model ]8 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit q Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5.150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Disper Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) 5_30 mg/L -Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 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 'j s) At least once every: ❑ month(s)Ifiyear(s) (Maximum y (Maxi 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ monthls) .� 121-year(s) (Maximum y (Maxi 3 years) ❑ NA Clean effluent filter At least once every: /� Ermonth(s) ❑ NA ❑ year(s) ❑ month(s)Inspect pump, pum p controls & alarm At least once every: ❑ year(s) NA Flush laterals and pressure test At least once every: ❑ month(s) B'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. II 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) P- -• Page of , 5TAR1 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 replacement system: XA 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. ❑ 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 tanjc 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 INSTALLER J POWTS MAINTAINER— LIST A-VA i i t Name �Q.r i ./Jc,.s a Name -F-26-111 CV UJ y Phone 2.3/ _ 4 fe2 - g c 9i Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 57 (. C� IA P; 2 a 19 14 Phone Phone 7/S 6 - -4/4 if 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. 1 W YT INSTRUCTIONS M � I 6 i h, FILTER ARi. " " I r l' IO` 7M Installation -_ STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is y � centered under the access opening. If not, then either insert more pipe into the _ tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the k'=1 optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not 'I utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 90°. Maintenance 1. The effluent filter should be cleaned every time the septic tank is Tn serviced. �µW 2. Open the outlet access opening to inspect the tank and filter. * & 3. Pump the septic tank completely, making sure to remove the sludge } -_p -' - "s" __ - ± layer on the bottom of the tank and not just the scum and effluent. :::4:1_ ,,, _ ,,,,, ,,:, _ 'Fiji ',„-.=- 4. Once the effluent level has been lowered below the invert of the o "1 utlet pipe,firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. 6. If a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 90° and cleaned ' _ with water only. ., t.>�. '- - 7. While holding the cartridge on its side (large flat surface facing �" r down) over the access opening, rinse off the cartridge with water only, making sure all septage material is rinsed back into the tank. ' g, 8. If VRS switch is utilized, replace by inserting into filter and _ turning clockwise 90°. . .; - ' 9. Insert the filter cartridge back into the case, pressing down until _ •, the filter locks into the bottom of the case. „ :III _ 10.Replace and secure the access opening on the tank. BEAR ONSITETM FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five(5)years from the date of consumer purchase. BEAR ONSITET"Filter Case-Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product. • If a defect is found in normal use,Bear Onsite will,at its election,repair,provide a replacement part or product,or make appropriate adjustment.Damage tc a product caused by accident,misuse,or abuse is not covered by this warranty.Improper care or malfunctions resulting from units not installed,operated,or maintained in accordance with instructions provided will void the warranty.Proof of purchase(original sales receipt)must be provided to Bear Onsite with all warranty claims.Bear Onsite is not responsible for labor charges,removal charges,installation,or other incidental or consequential costs. In nc event shall the liability of Bear Onsite exceed ° the purchase price of the product. €€ # Oct-19-2010 01:59 PM St. Croix County Plan/Zon ng 715-386-4686 1/1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer_ in'. F J e l <, fr. VJ Ci/0 3(S f' H(J,S f y Mailing Address_ ,.7 4. 3 - - Property Address,J 3 1 1 2 ` (Verification required /�from PInmting&Zoning Department for new construction.) City/State 1d b W i �1� Par Identification Number l�y 7-' 3'O t LEGAL DESCRIPTION . r Property Location t�v'4 . �!e '/ .Sec.,-17 ,T 30 N R (a W,Town of ICHfl aI/L Subdivision Plat: L f 's i1` g ,)rot#;30 . Certified Survey Map# ,Volume ,Page# Warranty Deed# [o Q 7 (before 2007)Volume ,Page# Spec house •yes Lot lines identifiablo405 no SYSTEM MAINTENANCE AND OWN ER CERTIFICATION 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. Owner maintenance responsibilities arc specified in§Comm.83.52(1)and in Chapter 12-St,Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&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 end/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 fiat of sludge. 1/we,the undersigned have lead 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 Planning& Zoning Department within 30 days of the three year expiration date. 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, Number If bedrooms ILISJL3 �+ NATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Deportment.*** Include with this application n recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) NOV Lc/ 2013 l MIII11Il 111111 srPk�QI-ENFy 8 1 9 2 9 3 9 '""*"^. Tx:4160342 STATE BAR OF WISCONSIN FORM I -2000 988607 BETH PABST Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Enviromental Holding Company LLC, a 11/04/2013 4:17 PM Wisconsin Grantor, and C & J Builders, Inc., a Wisconsin Corporation EXEMPT#: NA Grantee. REC FEE: 30.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 42.00 described real estate in St. Croix County, State of Wisconsin (the PAGES: 1 "Property"): Lot 30, Lundy's Preserve, Town of Richmond, St. Croix County, h4innesota.Wi scons in. t»6 Recording Area Name and Return Address: Land Title Inc. #407403 2200 W County Road C,Suite 2205 Roseville,MN 55113 Together with all appurtenant rights,title and interests. 026-1167-30-000 Parcel Identification Number(PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Easements,Restrictions, Reservations, Roadways and Rights of way, if any, of record Dated this 151 day of November,2013. Environn -ntal I-o •• ( • ny, LLC • 1 :1 ili ■ * William -rman, ember * * * P�.,EEJ.�, ACKNOWLEDGMENT AUTHENTICATION �,,.••••.., �,y+t� Signature(s) `I OT& ' ' STATE OF WISCONSIN ) • _ 1 ST.CROIX COUNTY. )ss. authenticated this 12th day of September,20 t.t *:7''`'A�/BL1G ,. i Personally came before me this 1st day of November, 2013 '''+.Opwisco�;A+'4 the above named William P. Sherman. a Member of d..w""""""*r Enviromental Holding Company LLC, to me known to be the * TITLE: MEMBER STATE BAR OF WISCONSIN person(s) who executed the foregoing instrument and (If not, acknowledged the same/ authorized by§706.06, Wis. Stats.) 4 'kg THIS INSTRUMENT WAS DRAFTED BY *Merile. J. Bone Notary Public. State of Wisconsin Larry S. Mountain,Attoreny at Law My commission is permanent. (1r not,state expiration date: 10/17/2017 ) (Signatures may he authenticated or acknowledged. Both are not ncL scary.) *Names of persons sliming in any capacity must be typed or printed below their sienature 1 of 1 WARRANTY 03:1:1) ti FA IT 13AR OF WISCONSIN FOItdi N . 1-21)00 - - ' . I �' ,i*e *1. mimis, et i • =Imp . ' _ _ *.' ;. r� . ' 96 a i •• +. a illir es* It r Ib' WI!kik 4r- i as i 3 ot 61 3 „.._ 0. 0, 1 1 . II - $t�. i F ';.., 4 , i.,r. ...-.1.-...." . _ " li I E � NO