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HomeMy WebLinkAbout018-2011-69-000Wisconsin 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)]. Permit Holder's Name: City Village X Township Bast, Kernon Hammond, Town of CST BM Elev: r Insp. BM Elev: ~ BM Description: ~~ Op . p DO.p CS B ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 1 ,' ~ !`C~ LJ~'' G c.x..rit - ~Z~ ~~ Dosing ~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air intake ROAD Septic ... Or SI ~ Or Dosing ~~ p tt Z r i ~ t Aeration Holding PUMP/SIPHON INFORMATION `~~ o• i ~/ Manufacturer f) n Demand ~JL~(, GPM ••• Model Number ~©~ ~~~ttt ~~~ 7 ~~ H Lift S$ Friction Loss System Head -~ TDH ~ Ft S9 ~3• 2.31 r- S• Forcemain Length ~ Dia. ~ N Dist. to well SOIL RPTION ISYS~E~ RENCH idth ~ Length DI EN 3 SETBACK SYSTEM TO INFORMATION Type Of System: DISTRIBUTION SYSTEM _DG WELL /z~1~ ~-1~D r' ELEVATION DATA County: St. Croix Sanitary Permit No: 479227 0 State Plan ID No: Parcel Tax No: 018-2011-69-000 Section/Town/Range/Map No: 30.29.17.1084 STATION BS HI FS ELEV. Benchmark . ~S o3 ~ i ~ a~. o Alt. BM Bldg. Sewer 13.5 r 90.2s SUHt Inlet ~ I ~. / r St/Ht Outlet Dtlnlet Dt Bottom r ~j.p ra p• O Q ~r ~s.. i Header/Man. Dist. Pipe Bot. System Final Grade b p • r oz .9S ,per - ir. ~ OT 8,(o g ~s, c ~ r ~,, Ivl~ 3 q2 y9• g3' PIT LEACHING CHAMBER OR UNIT Dia. Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air In k Pipe(s) N/~ ~ Length Dia Le Dia Spaci SOIL COVER r Preccnrn Svs4ams Clnly YY Mnund nr At-Grade SVStemS Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~~ Yes ~ No ~~ Yes n No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #'~/~~ Inspection #2:~7-"-T-~ Location: 783 157th Street Hammo`nd,r,,WI~,5,4015 (NE 1/4 NW 1/4 30 T29N R17W) E cr s 1st Add lot 6 84 c 1.) Alt BM Description = s~r ~^~•~ `~- ~"• 2.) Bldg sewer length = ~L, r ~ • ~` , f•Q, ,~ ~ ~' 3. 9~~ 1~ -amount of c ver = 2 4 J v~ n I J 1 tJly,,~"'.'r' Plan revision Required? ~~%] Yes No ~ Use other side for additional information. ~ -- Date Insepcto`r's Signature 5~-67` Q (R.3/9~7~- ^ ,- ~ ~ , - ~ v~~ ~ ~lb~ ~dNs ~~ST. crcr ~ ~~~. +~-- ~•. fio - 99•esr ~ .~s-~ r s.~~ - .~I \ /~~'.~ I 1 CePrb~No. Jditj~Lri {~°,1~~rP~CVeivEd/"r~_ 3 0 t 7 o: a ..~ g Box 7162 O P ton Ave hin W W 0 `7 l ~ LY.e r >< ~~ w ~ , ~~ . . ., g as . 2 ~ Madi4on, FYI 537b7 - 71b2 Sanitary Permit Nnmber (to be filled in by Co.) ~~~~~~ (bos) ebb-31s1 ~- q 2Z Department of Commerce - D state Planl.D. Number Sanitary Permit Application ovide In accord with Comtn 83.21, wis. Aam. Code, personal inforntao~on yorr pr ~ Project Address (if different than mailing address) may be used for scoondary proposes Privacy Law, s15.o4(lxm) I. Application Information - Please Ptutt AII Information REC~~VED ,~ /S7'~ 1'T. 1 S Lot d Block ;r property"Owner's Na me .il1N 0 1 2005 ~ / _ ~ ~~~ ry~~ Locarion ert pro Property Owner's M ailing Address ST. hROIX COUNTY y p 7_ONING OFFICE ~- ,~-~/~Sf,section 3d City, State Zip Code P~~ Number 3 8 7.S_ AN q ccircle ~ T~ N; R~E II. Type of Buis ' g (check ail that aPFly) °'" ~ S ""'~ .-- --- CSM Number 5ubdivisian Narne (~or 2 Family Dwelling -Number of Bedrooms ~_ - ~~ / E ~ ^ Public/Commercial -Describe Use "~ - -~ ^Village ^Township oP ~'~~'~~!~ ^City ^ State Owned -Describe Use _ III- Type of Permit: (Check only one box an line A. Caataplete line B if applicable) O /$~- D / - d6D • lD A' ~tew System ^ Replacement System ^ '1'reatmcnt/Holding Tank Replacement Only ^ Other Modification to Existing System List Previous Permit Number aril Date Issued S. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New _ Before Expiration Plumber Owner rv. ype of POWTS Systenn: (Check all that 1) ~ t'ifC.GS ~ - 3 d - 6 k Non -Pressurized In-Ground ^ A+tound > 24 in. of suitable soil ^ Mound < 24 in. of suitable sort ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Weiland ^ Pressurized In-Ground ^ Holdir-g Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand F'dter ^ Recirculating Synthetic Media Filter Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (exPlai ~ 2.O V. Dis reatment Area Information: Design Fiow (gpd) Design Soil Application Rate(gpdsfl Dispersal Area Required (st) Dispa'sa< Area Proposed (sf) SCyste~ E 9~ Z C - .3 ~~ t/ drr o ~ c-t ,Y' ~` gr0 ~ VI. Taal. Info Capacity in Total Number Manufacturer PC c~ S~it~e~ Steel G~ rr Plastic Gallons Gallons of Units o - New Tanks Fxi~nB Tanks ~ ~' r,~ ~~ L Scptk or Npldiu8-Taedc ~' ~ ~ ~~ ~' Aerobic Treatmart Uait Dosing Chamber 7 ~ •v ~ L V ` VII. Responsibility Statement- T, the"iwdersigaed, assume respona6' for' installatton of the POWTS shown on the attached piaas- Plumper's Na me (Print) _ P- 's Si gnaturr~ -~fMPRS Number Business Phone Number Fogerty Piambing ~,z ~ 7j~- .;'s- 9Lo 5 = s 1 ~~ F~'X ~s-~3 7 . . Ptn~~el'~ i`te~~`~' ~ °~) Spooner, WI 54801. Lsi- o,~- oil c " VIII. C - Onl - S/70 - 7 L Saoirdry Permit Fee (' Groundwater Date Issued Signature o Stamps) Approved ^ roved Surcharge Fee) ~ ~ ~ ~ - en Deoiai _ 11 ~w, nn lIX. Conditions pprnv 3~ ©t^ _ $ ~ .~ w ;u.. c 't~ ~ ~-iC S I " SYSTEM OWNER: ~-- r~ /3 i /o s- \ ~ ~k Sp~"t~cQSln.f_'~ ~ 1 Septic tank, effluent filter and ~ /~~ O,~f2_ r e ~ ~~ ills ersal cell must all be serviced /maintained o ~ t~ / b~C- ~ as per management plan provided by plumber. ~~ ~, , A _ ~~ ~~ 2. All setback requirements must be maintained o.XAJ~~ ._~ (aD-t_ L,n~~~ _ as per applicable code/ordinances. ^;~.._ ,~~ „~; .,,Q~~,~ ~ .~a,~.S ~„~, Attach complete plans (lo We County only) roc the sysl m on paper not less than 81/Z x 11 inches in size `` ~,,~.Qd~-r- ~ __-. ...~.,. -a - ------- -.. rt22118A 232&8'!'!lcKenzie Rd. Spcener, WI 5480 (715) 635/-960 (~I~l`yY ~~~A/®~L 8jf$T ~~~r P~ G~ w ~/. to7` ~,~.~. ~p c~Gt ~ AiF~- ~ffrLC • GIV S.~j-P w~ K~vxn/ r~i~ s • ~~ .vai r-~v .F iGL ~/ 1K2 ~reerzoa ~ .. . COPY cr"~ ~_~ .sr Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page / of Z N~ acaucranve vrsn wrnm ate, vv~. rwm. was - Attach Mete site plan on paper not less than 8 i12 x 11 inches to size Plan must County ~ . irx:lude, but nct. limited ~: vertical and trorizorkal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow. and location and distance to nearest road. ~ r, _ 6 _ cd Please print all information. Re ' by Date ~ Personal 6ddormatiw~ You Vmvide r~r be used for secondary W+P~~ (~Y !~. s. 15.04 (~) (m)). . / 0 Property Owner Property location LTj~t. Govt. Lot ~,~ 1/4 114 S 30 T 1 N R/ E Property Owner's Mang Address trot # Block # Subd Name a ( Z ~=~ sT L~- ~: sr~ City state trp t',ode Phone Number ^ city ^ Viflage Gown Nearest Road .t/ cv s^ ( ) 6t~~rt~ri ®'New Construction l1se: C1~'Fiesrdential / Numberof bes~ooms Code derived design flaw rate ~O GPD ^ Replacement ^ PubRc a' r~mmerfy'al -Describe: _ Parent material Tt-Gd Flood Plain elevation iE applicable~_/~ ~/lf fL nrc~m ins: ~o~6~-r~vtw{~ ~ ~'~ 1~ ~~-f^~/ S'~-r~ 5. ~- ~~ ^ ~9 ~~ # ©Pit Ground surer elev. ~9 9 ~ it. Depth to Cm~ting fade ~_ in. Sod Rate Harimrf Depth Daninant Redox Description Texture Strucfiue Consistence Boundary Roots - GP D/fF in. MunseA (lu. Sz. Cork. Color Gr. Sz Sh. 'Eif#1 'Eff#2 1 - y _ .rG d ~ ~S f L p a -- ~ - :3 D- SG s ~ ~ - . 7 -1 6 s L m - ~ .~ -T ~ -- sG. / s "' . 7 ./ x~cJ~ ark ~9 /~~ p L y Irv ~/77~.4 s.c. tm o r- r - ,c .v .,~ ~,~m~ic rii- ~- i-~.~r-: 8orir>Q # Pit Ground stxface elev. ft. Depth to Ming factor ~. Sod Rate Horizon Depth Dominant Cd Redox Descx~tion Textrrre Stnx:4re Consistence Boundary Roots GP D/ff an. Murrssl Qu. Sz. Cont Cator Gr. Sz. Sh. 'Eff#1 `Etf#2 <• c Effluent #1 = BOD > 30 < 220 mglL and TSS > < 1 - - 50 mgA. #2 = BOD ~ 30 mglL and TSS < 30 mglL CST Number CST Name Prik} A .S.y~O/ Date Evakration Conducted Telephone Number .?y73 ~0 GG~>v ~ ~Lr=,E.~ l~.l?. _ f _ SDOmrrr~,~~ 1_ til.in O,~ ~ 7~s = yr6 ODDO 7 7' ,~ Fogerty Plumbing #221180 28288 F~cKenzie Rd. Spooner, WI 54801 (71~) 635-9609 ~~~~ *~ 1~r~`~ ~ l~~ s~ _~o x - / d CEG E ~ ~~'~ ~fIo7~E° ; row ~(E~/)~~ ~,ra~x ~~ x2 ~E .v . Co r~ To so ~rrf> ca~~mu/~s o~ s~ GoT ~r~ri~s y,~zr,FS~ v . X- I t ~ wF:r~t-skt Dep$ er- ,;~'~"w~~ SOIL EVALUATION REPORT Uivis~zryolSafel antis r in ~rxror arn.~e wiUr Conran D5, Wis. Adrn. Cudo (1 Cowtly A(4adt cvnrple Brie ~Cjen ~af~r ~(I~s Uran 1/2 x 11 irrclres 6r size. Plan must lndude, h•rt n Ifmiled to. vertical anii horizontal erence point (BM-~dkSc,•tion and Patcel LU. percent~rupe, ale ar dlrnensions, oorU rvw, nd location and dls c no rest toad. ST. CROIX COUN~~ `/ d O Pfease prlni all In n [Ion. r views Pago l d _ __ r _ COI ~c , ~'~6/i ` ~ 9 - ova . Uale Perwnsl Informal yov prvrlde mey be used !w eecondar purpo ) ~ /~ d S/ Properly Owner rly Lo • C. ~' GovL Lot ~`-j 1/~l NEtl4 S ~ T Z~ N R (, E (ott~W Property Owner's Mailing Address •k # Subd. Name rx CSM# -City (( State ZIp Ccxle Pltvr Numb ~N ~Ci1y ^ Villaye ~,J, fvwn Nearest Ruad ew Consbuctiar Use:~'ftesidential /Number of bedrooms ~~ - Crxlo derive) desiyn Ilvw rate __ ~~ _[ (~_~b __,_ GPD ^ Replacement ^ Public or conunercial - Uescribo: __ - ------ ---- ------------- Parent materiel ^ 1P ~~___-___ _ _ __ __ Fluod Plain elevation if apldic:able ____/e/ ~~ ~ ~ 77.E-~ ~ _ -------- R. General comments Sys J. err yyl Q (2tl : Y~ , ~(~ --/ J „ n O r ~ CbQ '~"`~{,~,~/ e~~_R/~~ arrd recommendalior-s: I ~r VV~-'~ Q U Boring # l lurizon UepU- in. j D ^ Barnry (~ Pit Ground surface elev. _!~' S~_ I Dominant Color Redvx Uescriplion Munsell Qu. Sz. Coral. Cobr b 3 .--~ Cam' t. Ueplh to lluilliny (actor __! V ____ in. __ __ _ Texture Shucture Cvnsistence E3oundary Gr. Sz. 5h. Sr l 2~Sb1_ m~r c~_ --- - __ ___ Soil Application Rale Rrxrl ; GPU/1P _ •Eff#1 'Eft#2 l v.~ . ~ z- 2 - --- S ; cl Zm5 d^n~-'r- ~_5-- ~ _ - `{ ' (r' ~ 7' ~h s Boring # ^ Boriny ~`. pit Ground surface elev. ~~_~ (t. Ueplh to IimiGng factor i-Jl in _ _ _ . Soo ApplicaGor- Rate Horizon DepU- Uorninar-t Color Redox Description Texture Structure Consistence Boundary Roots GPD!(F in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Slr. 'Eff#1 'Eft#2 2 3 I(p"42 ~2-(~0 . (f~ vr4~~ 5 `_; --- ~ LL 5 r_ Zm~hl( 2tr.sb ~_ r»Ssr _ c ~ c S _- - -L-( - ~- 1.O 'Effluent IM1 = 800 > 30 <_ 220 rrrg/L and TSS >30 < 1 ~ my/L ' EUluent #2 = BOU < 30 rny/L and TSS < 30 my/L CST Name (Please Print) nature CST Number ~~ c h k, e ..,.. ~_. 2~3 3 ~~_ - ----------- Address - ' Uate Evalualivn Conducted lelephonn Number r To: ~ (~ ~/ Fr~oM: /~ ~~`~ 1 DATE: / / ° PAGES INCLUDING THIS PAGE: ~ FAX #: FAX #: PHONE #: ~ ' ' • ~ I'!1(iL 311'-~ ,. ~ I.~)I•.!_~.Q~{_t.l•:c;;~•t•I)tac~ltl-'•I•-~)t!?1/~.FI/~1gL~.--r~i,>3~"I~-.1`1,(t,I_~-t(~ir)~ NAIvIL•: s zrv~ - --- -- - Ir SCALG: 1 "---~~ f --- ------- ------ ---- ----- - ~~ ~M~eLCVA~rlor~:--_Lc~~__v ------ __ _ -- ----- --- -:. ~. ~ DM t DGSCRir'ric~rr: ~P c~~_-~-"~~~ -~'~`~e--- - _ t~ht 2 rt_ev,\ - l~ err: --_ ~ S=- `~d - _ - - - ---- -- - _-----~-- -- , nn,12 DcsCiz-r r-~ era: _ ~~ ~-____- ~ . _ ~ --- SYS~I•litil I~I.I~.Vr\ l l~ ~r! ~~` ~~ SYS'1~l?Nt'I~ti'I'I?:---__ ~c~'1u~_I~I=~U/`o•`1 - - - --- -2 _ ____ ~-2 :y~ ~ ~ ~ ~-3 ~`~~s. ~~. .~ / SIGMA"fUlt(:: ~ ..,-~- _- _~ _ -- ...~~ -y - ------ --.. #22118Q 2828$'t'AcKenzie Rcf. SpQ~ner, WI 548Q (/715) G35-960 r!/ ~~ ~~ ~ ~E~A/®Il~ BIfST ~/0 r ~,r ~d~ Sc~~' / ,. ~ yo . ti t r --~ w --- y ,6yy~M. ~,~ n~ ~. /SO ~ s~ ~v~. ~p t~Lf /~ AtFi~i~ t.~fftrGG ~/®sud~. • DId' she w~ K~'vxN tfj~ r • l~~ .vai ~^'~ s icL. fi•~ *a ye,Gyzo,,~ ~ .. . 2,~~ &~~ ~d ~~ ~ ~v~ low' (%~waD1 ,4.l~Z ~4CT .dw , ., K a ~~W~~~ • = ~u,Vd LaJ tam w w~~~ ' 7f c1M~~~ VS 7t .. . ~a j ~* 2 G_.Z C"~ v ~ ~I ~ ~- ~oO ~~E-wr: c - z Po ~ , 8' - 9P•Y ~'Y ~ ~ • ~ r ~ " i 6 _ , 7 ~- y _ pP.o - 9~ F t y wi~~ronsinDepartrnentotC~unnnerce ~' SOIL EVALUATION REPORT Ulvisn:,vl Sefety'and BulWntgs in drxordarn.•e wiUt Comm 05, Wis. Arlen. Code County AiTacfr wnrplete site plan rm paper ,rot less Uran 0 1/2 x 11 irtdres 6t size. Plea must indude, b~rt not Iimlled to: vertical and horizontal reference point (DM)~dk~.•tion and Parr~l LD percent ~ rope, scale ar dirnensbns, norUt arrow, and logllon and dis c ne rest rued. Please prfrlt all blfurr tlon, l d D f v'e'"'e Payo ' of _ CIr61 ~C Uale /S~ i Peraonel InformeNon yoo provide mey be used ror seconder purpo ) - d PropertyOwner try to C ~- GrrvL Lut w 111 NEIl4 S ~ -1- z~ N R ("j E (vtt 1N Properly Owner's Mailing Address •k # Subd. Name or CSMfi' -City Slate 7Jp Ccx)v Phur Nurnb-~ I~~ily ^ Villayv ~,f,fown Nearest RuaJ ew Constructiar Use:~'f2esidenlial J Number of bedrooms _ ~ Cudv derived desiyn Ouw rate __ ~~~ _~~_~~ ____ GPD Replacement / ^ Public orcommercial - Describe: _ _- _____,-___-____ Parent materiel __ ~/P !~_____ __ _--___-__ Flood Plain elovation if aplrlicable _____/r./ ~-___ _ -- -_ _ R General carnnerds p~ Q (erl . y ~ ~~ ~-- ---- -------- arid recommerrdaliats: sys,~ " ~ t/~'+'~ ~~ ~ `b~ "~ ~~~ U Boring # n^ Bainy (n~ (~' --- -- Dt~ Pit Ground swface elev. `~q, 5~ It. Ueplh Iu Ilndtiny lac-ur __! (J_____ in. _ __ _ __ _ _ ___ Sol ~pplicalion Rate Horizon DepUr Uorninanl Color Redox Description Texture Structure Consistence Boundary R«tts GPU/It' _ 6r. Munsell Qu. Sz. Coral. Cobr Gr. Sz- Sh- __ _ 'Elf#1 'Elf#2 ( D _ b 3 ,~-. 5~ 2msblr: mkt- _c~ l vs'_ . ~ 2- 2 - - S i cl ZmS r~r,~,r ~~ `-{ ~ 3 y ~- S ~_ - r . 2, ,7' s ~Fh Efikrent t@1 = BOD > 30 <_ 220 nrg/L aril TSS >30 < 1 r0 my/L ' EUluent N2 = t3UU < 3U my/L and TS5 < 30 my/L CST Narne (Please Print) nature CST Number /lddress T- ~ Date Evaluation Conducted Telephony Number i ( ~~ ~ ° sbf'y~e~-~ k1 ~ ~~{b2-b - ~~~~J.~_~~- 02.7 ~ TD: r ~ ~ FROM: ~ ~ -~ ! q ~ -,ES INCLUDING C THIS PAGE: FAX #: FAX #: PHONE #: Z Boring # ^ Boriny ®- pit Ground surface elev. ~~_~ _ lt. Depth to limiting factor _~~ _ in. Sort A IicaUon Rate Horizon DepUr Uaninant Color Redox Descriplron Texture Struduie Consistence Boundary Roots GP Dlftz in. Murrseli du. Sz. ConL Cobr Gr. Sz. Sh. 'Elf#1 'EQ#2 I d-~ ~ t0 . r313 5/' 1 ms 2 b ~ ~c,~ c 5 I V.~ 2 3 ~ (x-42- ~-2-(00 ~~~ 5 ---- S / L L 5 ~ ~ _ ~ ,~ ~ rn-~ri~ 2r>-, 5b ~- rr~ ~ ~ ~-- c ~ - - - - ~ - ~_ 1, o `~ 4 cn S ~~ rr~_ ._ -- . ~7 1.2 • r Properly Owner _ S`l v ~ _ __-- r i f-I n~fc.,,, Parcel IG If _~ G ~_`~" __~ ----------- ~ ~i r f Paye __~ of ~ « Boring # t'~ ft, - UepUr to linriling factor v '! - in. CJ Pit Ground surface elov. Sob n r icatiorr Rate ' e udure Sl Consistence Boundary (tools GPD f(F Horizon DepUr in. Uominanl Color Mansell Redox Uescriplbn Qu. Sz. Crnrt Cobr xture .T ` _ r Gr. 5z. Sh. - 'Ef01t 'Elf#2 ^ Boriny I~ Boring # n _ r......,.r t„fr7f•P PIPV fl. Ue Ih to IimiGn factor _-___- in. -- p y i Cnn AnnlraNnn Ra1P I r , u r u Texture Slrudure Cunsislence Bvundary Rvots GPDI(ft Florizat UepUr in. Dominant Cvkx Munsell Redox Uescriplion (au. Sz. Cont Cobr Gr. Sz. Sh. _ 'Elf#1 'EffN? U Boring Boring # Ground surface elev. _____- ft. Depth to limifiny factor ____ in. --- ^ Pit _ _ Sorl !1 IicaUon Rale Horizon DepUr Donairaant Color Redox Description Texture Slrudure Consrstvnce Boundary Rawts GPDlfF in. Munsell Qu. Sz. ConL Cobr _ Gr. Sz Sh. 'Eif#1 'Eff#2 Efllatent #1 = BODS> 30 < ZZO mglL and TSS >30 < 150 myll_ ' E4luenl fY1= BODS < 30 mylt and 7SS < 30 nry1L 7 he lleparttttent otCvtnnterce is an equal appurtutaity service provider and employer. If you aced assistance to access services or need nta-erial in an alternate format, please contact the dcpatLncut nt GO8-2GG-3151 or "I"1'Y G08-2G4-8777. sno-urora.orronr - • w ~ 1'r1c1~' 3~~t~~ . l.ur,1 (~q_t.l~:r~~.l,-)Iac~ltll>11~)tarUklii~~u;;-~',1,;3~~t~_,rl,tt, ~~t:(~ir>~ NAME: S ~rc~-~ ---------- --- - ~ SCALG: t "_--~~ 1----- ----------- -- ---- -- -- -- ,,-:,:; ~jMIGLEVA"I~IOtJ:__ 1UG:-v ----- - -- - _ ---- - - + - DM l DGSCIZII' I'f01 l: _~P ~~__~ ,~i[C-- _~~.~e - -- nh12 DI,sClzlr r-~~~-J: _ ~~ v-~_I "Pv4 _~`` pe :: SY5'I'IavII.I.I:v~~ll~~r~ Q~` ~~ sYSrEn~l~rvl'1`.:----- ~v_f!~!'r_~~~u_~~c _ _-- ----2 ~. u G1 D • i ~-2 :y~ 4 v ~~~ ~-3 `~`~• s ~~. ~ ~ - sl~rrn~rllizl:: __ -_ _. -- - ., . "~ ~ ~O~ c - .f~O N~~~ U _~ ,wN~2 `@r. ~ i - la. N ~ ~ f ~ ~ ~ ~ ~ ~ O rr ~ V w ~ - ~ ~ ~, ~, _ ~ o0 0 ~ i ~ ~ ' `~ ~ ~~ ~ \ ~ ~~. `•. `gw i Grp ~.~ . ~~ ~ ; ?~ ----_----.t -R--- ` ~ "' ~ ' ~~_.__ ~ - f~f __ _ _._ _ _ 1 -_ .-_ _; ~ ~ _ _ 1E_^ _s * _- _ i_ ~.-', [~v. r/ . ~ ~ Q ~! ~ mat:-~-:' :~i TT~~ ~~` ~' _ , -: ~ .a p n ~ a ~, vi ! ~ f .~ a; e ~~~ _ _ U -~ °~ ~n ~J o 0 H m Q+ 0 O .~ u V r~ O V O N .Q, t+ O C ~Q~. ~ ~~~, _~ ~~dl a~x~m U i y`N ~ d1 # ~ ~ .~~ DA W ~ °.~ N N a O U ~ Q ~+ ~u ~ F~ ••-~ Q~ o ~~ F„~ O 1r~^^ V, 0 U U W a 3 ~ a N Q9 0 .~ V N .~ w 11 N i cd F ~ a .o! \ .i '1~ i ` ~ ,-~'~ i { ~~ i \ J; ~.- : `.~ . / 11 N 0 0 E-~ O 11 . w '.. ~` ~s: - -_ ._ ;- -- .. ~` v • - '! ''- ** . s~~ . •~i- ~ aa~* ~~ ~ - Q- •.. - .'~ -v ._y - v~ ..'~ ~_ _ ~. +~ f • ~ ~ ~ O ~ ~-' • 'v t --S ji ~ ~ :~~ ~ 4.+~ •' - V '~ -~ $ i::..:.~ .. -. 1 "~~ _ ~- ¢ l ~ _ ~~ v_ ~' ~ _. ! ~. t ~ ~~ j ~;~ it \ I~ S \ ~ ~ ~ a`~ J ~ '. _ VV~ _~4 ^i ~ 11 : jt .~ ~ ~ ~ ~ ~ ~ ~ o I~ ~ 11 l,. p ~ w .-~ i' .~ t ~ ~~ ~ ! as i -~ ~ '~ -_~; ~ J alp i! ~' ~ V `~ .~ O ~ F II rA N .~ U 0 O b d? U "d ~~ !~ O U dl .~ .~ p, 0 ~? 5 l ~ r- 4 , O ~ 3 e ~- '. ~ • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address ~ ~. ~ ~C~/ Property Address ~ Jc- (Verification required from Planning Department for new Cit !State v y - ~~~~ ~~'- ~ Parcel Identification Number LEGAL DESCRIPTION D/g= Zo/! -- bQ- t~ ~ /o~~/ Property Location ~~ ~/., ~~/y,~ Sec. 3a .. T ~.~ N-R~VI~, Town of !.'~isray Subdivision ~,~,t,~,~/ _~~5- / s~' Lot # G9 Certified Survey Map # ~- Volume ^- ,Page # Warranty Deed # ~o~Bp~. Volume ~j ,Page # 3~ Spec house ^ yes [~'no Lot lines identifiable [B-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 masterplumber, journeymanplumber, restricted plumber or a licensedpumper verifying that (I) 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 Natwal 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. SIG ATURE OF ICANT / / 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. SIGN OF ICANT / / DATE- ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *****s ~- ** 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 ,~ 2S9?P 300 1~ ' -~.I I STAT)a BAIF OF WISCONSIN FORM 2 - 1999 t~cument Numlxr V~ARRANTY DEED This Deed, made between Gitlin Farms. Inc. Grantor, and Keraon J. Bast and Richard O. Stout. tenants in common as to rfi interest each Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): NW '/.NW 1/,, Except Certified Survey Map Vol. 14, page 3829 and also except Certified Survey Map Vol. 14, page 3829 and also except Cert~es Survey Map Vol. 14, page 3967; 1WV r/i NE r/~, NE t/, NW '/s, All in Sec. 30-T29N-R17W. St. Croix County, Wisconsin RETURN T8: METRO LEGAL SERVICES, INC. MINNEAPOLIS, MN~55401S2U2~17150 766Q>t~~ KATHLEEN }I. MALSH REGISTER C1F DEEDS ST. CROIX CO. , liI RECEIVED F'OR RECORD 06!16/2004 01:20PM MARRAHTY DEED EXEMGT f REC FEE: 11.00 TRANS FEE: 3300.00 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Ad'd~ss il~ls..~ ~ s-s`~i Metro Legal Sen~ices I '~ ~ '~ ~ ~F- F.L)IRET 433921 A 370744 Lt~D 291?'46 18-1066-6Q000:18-1066-90-000:18-1067-00-000 Parcel Identification Number (PIN} This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this (~ day of June , 2004 * * Gill' Farrns Inc. liy. * ~ - AUTHENTICATION Signature(s) Gillis Farms, Inc. By: authenticated this f ~ day of June ,2004 * Krishna Ogland TITLE; MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Krishna Ogland Hudson. WI54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF ) ---- ---) ss. County ) Personally came before me this _ day of the above named to me known to be the person(s) who executed the foregoing ____. instrument and acknowledged the same. -~ Notary Public, State of _ __ _ _ _ __ __ My Commission is permanent. (If not, state expiration date: ~ i i /~ * Names of persons signing in any capacity must be typed or printed below their signature. Informatron Professionals Co., Fond du La , wI STATE BAR OF WISCONSIN g00-655~t021 WARRANTY DEED FORM No. 2.1999 -- p ~ O !_- O W o~ a W z ~ ,°~ • ` '~. ~ ~ ~ _ a W Z~O m ~ V .r I W (J ~ U I W C) I M.~-V~O t~N - ~ Iteaa ~ s~•tic~ - ~~ss~ ~~ w~ ~trvs - - - - - - - - - - ~E'9LZ4 ~ -- V) L~i. 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