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HomeMy WebLinkAbout018-1090-64-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy law, s.15.04 (1)(m)1• Permit Holder's Name: City Village X Township Yeboah, Ernest A. Hammond Townshi CST BM Elev: ,,ee~~ InsplBM Elev: BM De~(sc ' tion: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ias~ Dosing w ~~ - Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic / >s0 ~'~ Z' Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer -- mand / ~ _.. - G Model tuber TDH Lift ion Loss System Head H Ft Fo ain Length s . to Well SOIL ABSORPTION SYSTEM //7 /~ ~,,,.,,. //fir ELEVATION DATA' County: $t. CrOIX Sanitary Permit No: 420356 0 State Plan ID No: Parcel Tax No: 018-1090-64-000 "'~ STATION BS HI FS ELEV. Benchmark _3, q6, ~~p.a It, BM ~,. ~ tfa~-~--5~ 7 ~ 2.8s ~1 ~O Idg. Sewer ~i` ~1d. ~ St/Ht Inlet s,~ ~. StlHt Outlet s. yi- i Dt Inlet / Dt Bottom /- ~ Header/Man. ~- ~ ~~- Dist. Pipe~- I D o.~i/'~ ..J p, d Bot. System ~ ~.e~t? ( s ~. s ~ 8q Final Grade 3 ~ o ~'3 . -s' St Cover / , .~ ~ 5 . ~~ ~ BEDITRENCH Width / Len th t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ Y S ~~~/// ~~ SETBACK INFORMATION SYSTEM TO /L C BLDG WEL LAKE/STREAM ACHIN CHAMBER O Man c u I f ~~~ ~ / Type f Sy steeem , ~ ~~ ,(~ l ,~ UNIT Model Number. `` ,^ V~v~ U L. DISTRIBUTION SYSTEM Header/ ani~old r/) a h Distribution ~~ S ' n ~I~'1 ~ ~ Pipe(s) / ~ x Hole S~~ x Hole Spacing Vent to ir~ak~0~ Q Len th Dia , Len th V ~ Dia S acin _- S g g p g -. SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Oniv 3 °~- Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~j Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ I O-~ Inspection #2: / / Location: 1759 96th Avenue HammonFd, WI 54015 (S 1/4 N~E(1/416 T29N R17W) Pheasant Hills of 64 Parcel No: 1z6~..2~9~.1~7~.7~29 1 J Alt BM Description =J~1 ~ a~l~' I ~ ' "~'e ~' ~ ~~L~-~ (~ f ~~~ +r `~"v'~. 2.) Bldg sewer length = ~ ~/ P ~ QYto/ 7v 'mac" ""~ ~,,..-"'. `y - amount of cover = r~~ Plan revision Required? _I Yes [ No '~ ~ L/~ 2 ~ L Use other side for additional information. / ~ / ( I ~ _ , __ _ _ _ ~ ~ ~~ SBD-6710 (R.3/97) Date Insepctor's Si nature Cert. o. 1 -t-~ l~-.S'~1 4i "~ f~v~_ O l 9 a~ ~ Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 `~SCO/fSin See reverse side for instructions for completing this application d Madison, WI 53707-7302 Department of commerce ary purposes Personal information you provide may be used for secon [Privacy Law, s. 15.04(1)(m)] (Submit Completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x I 1 inches in size. Coun State Sanitary Permit Number ^ Check if revision to previous application State Plan I. D. Number I. Application Information -Please Print all Information Location: Property Owner Nlam~' a//{~~ ~~ .AA ' '' ~,vL~l~ ~ ~~©~t"~ Property Location /f ~~1/4~f,1/4,S Ta~,N,Rr (or) ~ ~ ner's Mailing Addre s w Property O Lot Number Block Number s ~~f ~ ~ p f ~ J' ~ City, State Zip Code hone fNG ~,~ FICE Subdivision Name or CSM Number S~ ~~ ~ ~~ S51 D c lv?o 1 ~~~~ih9T- s I .Type of Building: (check one) ,/' as w~, ww: ~ S of Bedrooms :!~ Dwellin - No 1 or 2 Famil ^ City ^ Village Qn~ ' g . y fown of J~ Public/Commercial (describe use):_ ~ ~/iv~' ^ State-Owned i Nearest ROoad O Parce ax Numbe s) III. Type of ermit: (Check only one box on line A. Check box on line B if applicable) p) 1. ew 2. Replacement 3. Replacement of 4. 5. 6. ^ Addition to ystem System Tank Only Existing System B) Permit Number Date Issued ^ A Sanitary Permit was previously issued ype of POWT System: (Check all that apply) u on-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland~~~ r...~5 Li ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip ne Ow '" ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: ; ~~ V. DispersaUTreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. S m eva 'on 7. Final Grade d Rate (GalsJday/sq. ft.) (Min./inch) ~ Elevation e ed Propos ~ Requir , _ 2 r n ~L _ C " ~ [l ~V ~ R ~ ~ UY~/V J VII. Tank Capacity in Total # of Manu~'acturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed n T a k s Tanks Q~~~ ~/Pi'1' ~ l G' ' p 9 s ~ Lev ~- ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for i la f e POWTS shown on the attached plans. Plu ame (print Plumb ign re (n ps): MP/MPRS No. Business Phone Number L- ~ n~z- P ~ ~ ~~s=z~ ~~ Plumber's Address (Street, City, State, Zi Co / ~ /•~ ~ py ~ ~ IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse Surcharge F u ~~ Determination r r 'ss{fo ~ ' a v S ~p~i ' n o S ~~ ` ' ~' k l M ~ 2 , ~ ~ ~ ~ -~ s~ s- ~ -~sf~ty~ ~ ~.,,~ -~. o_ ~ ~/-~z~~.,~ s --~ ~r sly. ~~ ~.-C .~ I _ . w. L. ewe, A'~s ~ ~ S9-tf~ ~~~'~Lut~- ~~d~''f'fl h2-_ U""°u'~~,~#1 ~ S~Sf~'~^'~' ~~~2~CC~CQvbL?~t/ S• 17C , T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54'751 ~p ~ Fax: ('715) 235-2592 ~- www.tlsinzplumbing.com ~ier~lrsr r4 Y~ 6or4-N ~w Y~ ~E ~i~ ~ ,~ rz~ ~ ~,,~ Ta,,~ ~ o r ~i-wt wt o ru ~ ~r ef'o„~ ~ o . ~T b~ ~i~srr~vl 3 - z•7 X ~r~,so ~ri~P~ .~NFt lt~.rf~~ ~c.i_s ~~s >E~/ 8~, o ` T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 ~o ~ Fax: (715) 235-2592 ~- www.tlsinzplumbing.com E~~sr~ ~4 Y~ 6or4-N ~w Y~ ,~~ `~~f s lro rz9 l2 i~~ To,,~~ Dr wto~~ ~r ef'o„~ e o , ~T b~f I~bl~~4-sr~7' ~~S ~ ~1~~ ~P''g~6v ~i~st'~vt 3 - z.7 X ~~,so ~7~P A~tO .~NGc l fr~-p ~i G~F.cl_S ~~ ~~ s ~lF~l ~, o ~` Wisw*sin DepartmeMof,Commerce ~ SOIL EVALUATION REPORT Page ~ of,~ Division of Safety and Buildings m aocornanoe wrm c:artrrn ts~, rns. twin. ~.oae ~~ Pl n m t 11 i i 81/2 d ~ i N l h us x n res s g. a an an on paper not ei t Attach oorrtpbte s te p induce, but not 6mieed to: verficad and horizontal referetroe l ~~)+ direction and Parcel LD. percent slope, scale or d"errensions, north arrow ~~tip~atrd disf~e b nearest road. ~ t ~ ~ ~ Please print n. ~ Date py CPS Law, s. 15.04 (1) (m)). Patsatai inrormation You Pie ~Y ~ us;~di~rry u Property •::~ r" t c: ~ ~ 1 l' C " ,Property tot~ition ~__.;~ ~ Govt Lot SL~f 1/4~/~1/4 S ~~ T Z. N R E (or~ Property OMmer's MaiNng Address ; t ,.:, ~ ~• ' .. of # Block # .Name or CSM~ - 1 ~ State ~ '' ~`• PIS t CE ~ ~' ~ ~Y ^ ~ Town Neatest Road . [~ New Cor>strucfiion Use: I~ Resid~rtiat / Num - Code derived design flaw rate GPD ^ Replacement ^ PubNc or commerdal -Describe: Parent material ~, l r f=lood Plain elevation if applicable ft. General comrnertts S'~ $~C I'Yl 'G ~ t J • ~• ~ ~ and recommendations: ~ ~ e ~C V . ~l . Q d ^ Boring Boring # Pit Grarnd surface elev. ~i 3.9~R. D~th to limiting fatlor I ~d O in. Sai Rate Horizon Depth Dominant Cob Redox Description Texture Structure Consisbenoe Boundary Roofs GPf 7~ in. Munaeq Qu. Sz. Coot Color Gr. Sz Sh. 'E~ ' t D r ---- 5 J 2 ~ -^ . ~ - ~5 1 - ... ."~ !. 8q.~~ 4~t-~ ~ f _ o f o~ Pit Ground surf~.e elev. 5Q • ~ R Depth to limiting facbr ~ ~ ~ in. Sotl Rate Horizon Depth Dominant Cob Redox Descriptbn Texhu+e Stnrcture ('. Boundary Roots GP DII~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `E~2 ..._,~ ~, Z ~ ~-. S mv-~'• c -- . 2 l Ir -- S f~ - _' . Z ~-~-y o. " Effluent #1 = BOD_ > 30 < 220 ma/L and TSS >30 < 1 50 mdL ' Eflkrent #2 = BOD. < 30 mgA. and TSS < 30 mglL CST Name (Please .Print) Signalu CST Number Schu 533c~`1 Address Date Evaluation Cor-ducitied Telephone Number 2~~ ~~ ~- 02~ -~ -coo ~s-ay Property Owner ~~ ~'~ Parcel ID # ,.,. Page Z ~ 3 Bonng # u ~~ Pit Ground surface elev. • ~~ ft. Depth to limiting factor~_ in. Soil licatbn Rate Horizon Deptlr Dominant Coior Redox Description Texture Stnxxure Corrsister-oe Boundary Roots GPD!(1? in. Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. "Eff#1 'Eft#2 ~ 2 ~-- ~ < < '~ 3 ~ -~ ~ , ~.Y 2. ^ Boring # U Boring ^ Pit Ground surface elev. ft. Depth to limitlrrg factor in. ~ Rate Horizon Depth Dominant Cob Redox Descriptbn Texture Structwe Consistence Boundary Roots GPD/P~ in. Murtsell Qu. Sz. Coat Cobr Gr. Sz. Sh. 'Eff#1 *Eff#2 ^ Bonng # ^ ~~ Ground surface elev. ft. Depth to I~nidng fador in. ^ Pit Swl 6cation Rate Horizon Depth Dominant Cob Redox Oesa~tion Texture Structure Consistence Boundary Roofs GPD~ in. Munsell Qu. Sz. Coat Color Gr. Sz. Sh. 'Eff#'1 *Eif#2 ' Effluent #1 = BODg > 30 < 220 mglL and TSS >30 < 150 mglL ' Elfbent #2 = GODS _< 30 mgll. and TSS _< 30 mgll The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the departmerrt at 608-266-3151 or TTY 608-264-8777. sso-as3o (n.mroo~ . r PAGE~OF 3 NAME ~j(~ ~ ~~ LOT#(n ~ LEGAL DESCRIPTIONSW '/<tiEy4,S ((o TZ~f,N,R l ~E (or) (~V~ ~. SCALE: I"= ~~~ BM I ELEVATION l~U' U BM I DESCRIPTION y~rt ~ ~ ~ it ~ + P~ n -e BM 2 ELEVATION I UO - U << BM 2 DESCRIPTION Vtu ~Q .,/,n ~!j-~ ~; /~-e SYSTEM ELEVATION CJ^ I ' ~ V ALTERNATE ELEVATION `~ ~ ' ~~ CONTOUR ELEVATION_~ /~j~ -~- - x' l ~ rgf8,i28~`O1 TUE 15:11 F,4x 715 386 4686 ST GRx CO ZONING ~dr~ (~]D~1 POVYTS OWNi1it~'S 1"'IAN1dAL ~ 1"'1ANtAUC!'~t~! !'LAJt'! 1 eat a sutcnQrtATt~hl Clwner ~ ~'% ~ Petmfit # ~Zp~ S~ ' ~.....-. necsrty tlrOAMIG"rC.1lS ~rrravas a r+.~ti •~•T- Number of Bedrooms - ^ ~'• Number of Commerdat Units _ - ^ NA Estimated flow (average) s~ ~ji4ylo S gaVday Design flow (peak), (Esd led x ,5) gat/day Soil Application Rate r gaVday/R~ lntluenVirFtluent Quality Mondity average Fats, Oil 8t Grease (FOG) s3Q mglL Biochemical Oxygen Demand {$ODs) <_220 mg/L Towi Suspended 5ofifids (TS5) 5150 mg/L Pretreated Effluent Quality ' ^ NA Mvnthty average" 6iochemicai C?xygen Demand (BOC3s) 530 mg/L Tots[ 5uapanded Solids (TSS) X30 mg/L Fecal Conform { eometric mean ~ 10~ cfu/ 1 OOmI Maximum Effluent Particle Size i5 inch diameter SYSTEM Si~EC:IF1GA11~iN] Septic Tank Capadty 7.~ i ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ^ NA Efnuent Filter Model ~-~a ^ NA Pump Tank Capacity ---~ 8ai ~ l~lA Pump lank Manufacturer ---~ Q NA Pump Manufacturer --~ ^ NA Pump Modei ~~ ^ NA Pretreatment Unit p Sand/Gravel Filter Q Mechanical Aeration ^ C?isinfectlon Manufacturer D Peat Filter ^ Wetland D Qther: ^ NA Dispersal Cell{s) ground {graviry) d At-grade ^ Dri -fine Q in-ground (pressurized} ^ Mound O Other: * Values typlCB! for domestic (non-commercial} w#scrwater and septlt tank effluent. * + Values tybtcal tar pretrelud wastewater. MAINTENANCE SCHEDi1LE Setvico Event inspect condition of tank(s) Pump out contents of tank{s) inspect dispersal cell{s) Clean effluent Alter inspect pump, Pump Controls at:afiarm Flush laterals and pressure test At least once every Service Fregtzeacy ^ months e or(s) (Maxi=mum 3 yrs. ) (Ysy of tank volume or(s) {M~udm-um 3 yrs.) When combined sludge and scum tquaEs on At tease once every 3 ©months At least once every At feast once every At least ante every At least once every At itast once every ^ months ~ ~ear(s1 ^ months ^ Year(s} NA _ ^ months Q year(s) NA ^ months ^ Year(s) d NA ^ months Q year(s) NA MAlNT>rNANCE 1NSTRtIGT10NS Inspections of tanks and dispersal caiLs shall be made by an indlvfidual tarrying one of the following licenses or cei'tiflcadons: Mast Plumber; Master Plumber Resuict~ed Sewer, POWTS inspector; POWT5 Maintainer; Septage Servidng Operator. Tank inspeaion must lndude a vistuai inspection tsf the tank(s) w identify any missing ar broken hardware, identfiN arty ~~ or leaks, meuure uh volume of combined sludge and scum and to check for any backup or ponding of effluent on die Found surface. The dlspQrsa[ cell(s) shat) be visually inspected to check the effluent levels In ilia observation pipes and to check for any ponding of effluent an the ground surface. The pondinix of effluent on the ground surface may indicate a failing condition and requires cite immediate notifleation of the lava[ regulatory authorfty. When the co ~binak h it be removedslby a Septage Servicing Operatoriand d piosed o)f in accordan eewith ch.lNR 1 ~3, Wtscansi contenu of th tan Admintstradve Code. The servicing of etnuent (liters, mechanical ar pressurized pOWTS componenu, pretreatement componenu, and any other maintenance or manltarfng at intervals of 1 Z months or less shall be performed by a certified POWTS Maintainer. A service report :hail ba provided to utie local regulatory autfiority within l 0 days of tompkdon of atsy service event. START UP AMID OPS>EtAT10N For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting produar or other chemtc~ that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have tYte cpnten~ nr rlws rantrfs'6 ramoaad 5Y a C@t1ta,R~ servicing areruor p~o~ to use. r•tgs!28!C31 TUE 15:11 FAX 715 386 4686 ST CRX CO ZONING ~ 002 P~~c __ of ,.•_ System start up shall trot occur when Sat CondWons are frown ~t the Inf~uttl++t wrfice~ During p4Wir autaEes pump tanks may fill above narrnal htehwatar levels. When power ~ rtsta~+ed ~ ~~ W3SteWatFr wi!! Gr d'ucharged w the dlspersat cell{s) in one large dose, overloadlr~ t1-s Celt(s) irxl may rcsuii M the bar~fcup or ~rtic~dtsocha ~u~ efPiuent. 'Co ivvld this situat}on have the Convents of d1a pamp fink rerrloved try ~ ~u~ Setvkln>~ Ops P >r power to t!x effluent pump or convect a Pk+mber or t'UW7S Malntatntr to ~slst !n manuiflY opevagng the pump Controls to restate ncrmai levels within the pump lank. Do nat drive or park vrhrcles over tsnks and dispersal cells. Do not drive or puk ovrr, or atherwlss dtswrb or compact, the area wlchln ! 5 feet dawn steps of my mound Or at•Erada soft absorptJoh xt'ea. Reduction ar rllminatlon of tht following (torn the wanewatar strtarn rr-ay improve cite perlfo~rnzir e~Rp W~s~tsref3 r t~ PC7WTS: antlblatlcs; baoy wipes; clgarttxt butts; condoms; tOttO-7 swaix; dt;rtase>s; denta faun6auon dram (sump pump) water; Eruct and v+tg+ecab(e pttUn~ i:iioNtle: fR'e~l herbdc~Q~s; m.K scrap:; medicatwnc; oil; palntlnR prodtirts: nestiddes; sanitary napkins; tampons: end water softener brine. ABANDON EM E.N7 When the PC3WT5 (ails andyor is ptmtanentiy taken out of service the folfowtn>I Saps slut! bo Liken to insert that the system is property aad sifelY ~b~ndoned to ctxrlptlance with ch. Comm 8~.~'~, Wisconsin Admtntru'attw Code- • All plpla~ to tanks grad pets shat) bt Qlseonrraettd one! flit sbaetdor+sd pipe epinl-->ts stalsd. The contents u! aft tanks artd pits shag bi removed arsd preaper~ dosed v- by a Sept~e ServitlnE Operator. • Aker lyurnping, a!i tanks and pfu shall !x excavarxd xnd removed or tf~tlr covers removed. and the void space fllied with sa'sl, ~ravei or another inert solid matrrtal• CONTtNGENCIf PLAN If the PUWTS falls xnd cannot be repalrect cite fallowing mtasurts have peen, or must be taken, tv pror2de a Cods CornpU~nt retstxement system; a A suitable replacement area hats been evacuated and may tx utlflzed for the location of a nplietmtrrt self absorotlo~ syswm. The rtptacerntnt area should be pratscta6 from dtsturb3ntt and Compstgan and should not bt lnfrineed upon by re4t!lred setbacks tram axl:t)ng and proposed strvcwrt, tot Rna~ ind wells. failure to protect the rtascement aa•*.a a~rill result 3n tAt need for a new Solt and >itt evaluiit4tt t0 f-sc~Wlstt a suitable replacemem rte. Replacement ryst+trns must comply with the rotes in street it (tut tlrnt. p ~- 3ttitabk reptatt-»ent area B not ~valt~bte due w setbaCk~ and/or salt tirnitatlot-i• $t;<rttnR a4vu-ets (n POWTS technulv~. a holding tank miY be ItlstitieQ :s a last resort W reptact t~tx t'~Red PQW"f'S. o The site has not been cwltsat~ed la Idet+tliy a s~+lcabta nlstseeac+~rit atw. llpoa fatt---re of the t~41N'i'S a soil and site evaluation must bt ~rtormed to locate • suitable replacs~feert area If r>a »plac.mtrit irli ti avattable a holding tank may ba lnscalkd as a last resort W replies the faltt+d POWTS. p Mound and at•grade sa!( absorption systems miy be recw+stn+tted In plat( fottowlnr remove! of th¢ biomat at the Inlliuathae surface. Reconstrvatans of such rysterru n~ttst.comp!'/ wtitt the rvki ir- etftct u that ttrne• < `wAiftN>ING > > SEPTIC, pUMP AND ~TItER TREATMENT TAkKS MAY CONYAIN LETH/4L GASSES AND/OR IMStilJplrlGlEt°!T OXYGEN. Oil NOT Et~lTER A SEPTIC, PIfHP C1R OTH~:R TRfEATM~NT TA1a1K U1~1DER A~(Y CIRCt;IMSTIlNCES. 01~A'iti MA1( RESUttT~ RESGti~. 4F A PERSON FROM YIErE 1!i?ER1Oit Olt A 'CA7~iK MAY it DIFFICLItT 4R -~aryic-ral tr. Apt7t7tONAl, COMMt£>hITS ?©WfS INSTAI.Li:R Nirne dr ~- Phone SizPTAGE >:ERVICING OPERAYQR P Ml'ER i~a~a POWTS MAINTAINER ~Phor-e - L W G TORY Au'r'1~! ~~ Sr ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM tJwnerBuyer ~ r n e s• A Ye h o a I', Mailing Address 1004 W l_ A F a n d A., ~ Sd - Pa., l~ M N S S 10 y 159 i Property Address 6y Ptie~ (Verification re i e ~~ga ~ lanning Department for new +ti City/State E4arr-m on d r w'r Pazcel Identification Number o t 8 - 10 9 0 - 6 y - 000 LEGAL DESCRIPTION property Location ~'/., ~_'/., Sec. 16 , T z9 N-R I} W, Town of Ha,M~e ~d Subdivision Pin t~n-,sar~~ H i Il s l s~ F~ c)d i-1 t o n .Lot # ~ y Certified Survey Map # OoG # 6KY 4SZ ,Volume a ,Page # y~ Warranty Deed # (o fr( `fb3 ,Volume ~~°~ ,Page # 0~ Spec house ^ yes ^ no Lot lines identifiable .~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 mastCr plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating 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. ~' /i4 / oz SIGNA OF APP CANT 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 thecproperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. C~ ha~ $ ~ ly ~ oz SIGNATURE OF APPLI ANT DATE ««+~««« «««««« Any information that is mis-represented may result is 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 l~ 'J• z g~ a ~ ANY 1998 CONSI FO 661403 - STATE BAR OF WIS KATHLEEN H. YALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO. , YI Uoct°nerx NurttbM RECEIVED FOR RECORD This Deed, made between^ Ronald C. Bonte 06-10-2002 2:50 Pp enn nu son IrARRWdTY DEED EXFlIDT # Cantor. REC FEE: 11.00 and Ernest A. Yeboah TRANS FEE: 139.50 COPY FEE: CERT COPY FEE: , Grantee. PAGES: 1 Grantor, for a valuable corulderetton, conveys to Grantee the following described real estate In St . Croix County. State of Wlseonsln (the 'Property): gecadln0 ~~ Nama end RNtm Adttua Part of the SW } of the NE } of Section 16, Township 29 North, Range 17 West, St. Croix KRISTINAOGLAND County, Wisconsin, described as follows: ESTREEN & OGLAND 304 LOCUSt Lot 6 of Pheasant HIlls First Addition WI 54018 HUdSOtI filed May 8th, 2001 in Volume 8, Page 48, , Document N644952 018-1090-69-000 ParoN ldanldfcatlon Number 1%N1 This is nOfi~meslead property. (Is) (ls not) Together wtth all appurtenant rlghu, title and interests. Grantor warranu that the lttle to tha Property Is good. Indefcaslble In fec slmplc and free and clear of cncumbrances except Easements, licenses, zoning ordinances, and restrictions of record. Dated this 4th / day of ~ aon2 1... ~ (SEAL) (SEAL) Ronald C. Borate • Glenn A. Knudtson (SEAL) (SEAL) AUTHENTICATION Signature(s) authenucaud this day of , TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wls. Stau.) THIS INSTRUMENT WA8 GRAFTED BY Ronald C. Borate 1011 170th ST Hammond, WI 54015 (715)-796-2500 (Signatures may be tuthentluted or acknowledged. 8oth.an nol.• necessary.) ' N.~.u. of pr~swu 1lantna N .nr c.palty muN b typd or prlntd Mlow 1MIr alanaarn. STATL lAR OP WISCONSIN WARRANTY DEED PORM Ne. I - 1991 ACKNOWLEDGfv1ENT State o[ Wlsconaln, ss. St. Croix. County. Personally came before me this 4th day of June 2002 ,the above named enn nu son to me known to be the person S who executed the foregoing Irottvment end ;cknosyl9dyrtfie~stme. _ ,._ r: C I Ql y~f ,nom st~te~ ~lettlon date: E~ ) 1GIZ) Li"~l N Noury Public. Sute of Wlsa My carnmisslon Is perms W4eomh l.pal BlerYr G.. K. MhrnkM, W4. HE RIGHT TO SERVE TO AREA. i ~~ SHEET LEGEND _ _ _ _ ~ FOUND 1" IRON PIPE ~ EV. - I I PT. Tb • FOUND 2 ` IRON P / PE O - SET 2" X 30" 1 RON P 1 PE WE 1 GH I NG '0' 3. 65 LBS. PER LINEAR FOOT •~2' ~ NOTE: SET I" X 24' IRON PIPE WEIGHING i 1. 13 LBS. PER L 1 NEAR FOOT A 7 AL L ~~'~~__ ~` OTHER LOT CORNERS /2~ ro 43' -~. - UT 1 L 1 TY EASEII~NT (TYP. ) --T--- ••••••••••• ^ SETBACKS ® DR 1 VEWAY LOCATIONS ( ) - RECORD DATA ~, HWE - H 1 GH WATER ELEVATION 100-YR - 100-YEAR FLOOD ELEVATION L~o c ~#" ~o ~ `~ R S a, Rt~~~.T~`R~5 bF~'~ l_ OT 6 I sr,.c~tx~ .u~ ~ ~p ~~ ------- ~A .~QQ 2 ~~~..~. _ --------. ~µS~ ~ • ~~ ~rs~r a~ .:I~df BEARINGS REFERENCED TO THE EAST-WEST QUARTER LINE OF SECTION I6. INEASURED AS S88 ° 27' I T" E. (ST. CR01 X COUNTY COORDINATE SYSTEM) 100 0 100 200 300 GRAPH ! C SCALE -FEE T d Q 1 p ~ ~ ~ ~ W ~W ~ " ~ 1 cn W o j ~. ~l^~ .. 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