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HomeMy WebLinkAbout020-1374-09-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety � nd Building Division L INSPECTION REPORT Sanitary Permit No: 420775 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: Schuknecht, Schoen Hudson Township 020 - 1374 -09 -000 CST BM Elev: Insp. BM Elev: BM D cription: Section/Town /Range /Map No: U 12.29.20.2242 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - Benchmark iva �3 Dosing yV 1 , 7 e Alt. - 0✓ �./ Aeration EVfdg. Sewer / Holding St/Ht Inlet / V 7. TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic y /� Dt Bottom Dosing Header /Man. 11 Aeration Dist. Pipe 'f jam• Holding Bot. System Final Grade 3 0) PUMP /SIPHON INFORMATION 33 Manufacturer Demand St Cover �• PM �( Model Number TDH Lift Friction Loss em TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No. Of Trenches PIT DIMENSION No. Of Pits Inside Dia. Liquid Depth DIMENSIONS fi 3 .S SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING )Manufacturer: INFORMATION CHAMBER Type Of System: • Model Nu r. DISTRIBUTION SYSTEM Header /Manifold 113istribution Hole Size x Hole Spacing Vent to r ntake ( q 7 / Pipets J� 7 Length Dia Length Dia Spacing —� r,0 CJ�Q SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Z I^� Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes r] No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: ­ 7 Inspection #2: Location: 216 Starr Wood Hudson, WI 54016 (NE 1/4 SW 1/4 12 T29N R20W) Starr Wood Lot 9 � Parcel No: 12.29 .2 20.2242 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = +� f toy, Plan Use other de for additional in Yes No Required? formation. L_ � � � L � SBD -6710 (R.3/97) Date Insepctor's gnature Cert. No. Safety and Buildings Division County *jI , 201 W. Washington Ave., P.O. Box 7162 sconsin Madison, WI 53707 - 7162 Site Addrew ; Department of Commerce 9 Sanitary Permit ApplicE tion a Permit Number t In accord with Cornet 83.21, Wis. Adm. Code, personal info do `, e D ma be used for mmo purposes Privacy Law, s 5. 1 m 9 v G 11 Check if Revision I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name - 2 Parcel Number f N ST, CROIX COUNTY ./ Property Owner's Mailing Address Property Location _ ,2zyzi City, State Zip Code Phone Number N r Block Number S 'vis' Name CSM Number U. Type of Building (check all that apply) � �/� � ,+� �ayRin • ❑City 1 or 2 Family Dwelling Number of Bedrooms ❑Village ❑ Public /Commercial - Describe Use ®Township ❑ State Owned ` Nearest Road 3 � U Ti9i+ ; M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 & New 2 11 Re Iacement For County use p System 3 ❑ Replacement of 6 ❑ Addition to stem Tank Only Existing stem B• ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ® Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. DispersaVrreatment Area Information: Design Flow (gpd) Dispersal Area / Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals.lDays/Sq.Ft.) (Min./Inch) Elevation "" C2 cr VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks _ Concrete Constructed Glass New Existing i Tanks Tanks Septic or Holding Tank Dosing Chamber I VII. Responsibility Stat - ent- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/IviPRS Number Business Phone Number Pl is Address (Street, City, State, Zip Cod - V, VIII oun ty epartmelit Use Onl Approved El Disapp roved ��Y Permit Fee (includes Groundwater Date sued Is ent Signature Stamps) Surcharge Fee) � Owned Given Initial Adverse 3 t 7 � Conditions of Apprlval/Reasons for Disapproval _ 0 o �� ,, /) _ '� ,�ttac� complete the o,t > r gatem on papa• not t«s tban 81n :111nch« m size SAD -6398 (R. OS /ql 3 �avYi�.l�i, ���/'� �- Csnt„a.. �3• V3 —I �fNW - .'SP/ KE 1N .2�! �O kK 'regg 7 • _ _ ,� � � Pf.OT �c t:NObi SECTION Pfr' � � (b ?/IpP/19iIpEr EK�AYA� ' i t P6UlISM u wT z �l PAOdbGT °Rk evw&(&wr —.� �( Aer ~ ' 4 1,".44 20 RE EIVED Q /.2� c�icsce Lw.�. A 4&9 itu 7 2003 ' peop o I l�Si.osaw �E Ay6� �(• q P L S7 CROIx COUNTY 6T e*61K eccwTV 3 NEw O� .y" Ak Sc�Ft/Q M.4106 E ONING OFFICE Stwee �,�/J F yo S�ip�+Qp TiuF�t•Rkl�! �' eA~64P6 s*kro Dw VwT' • e 0A4m /A iou 0 ,At � GII/b�18E� 'FP�"� f/K N Ea10 mL' *AJ F� s sc 916 A-016l ort tn- -:Ti VEN c �P utE• �� y'7 �s�e OATS: 3 ^a�-os &e The StarWat W N am Chamber ' = V�;� F 1' O%*lap at tatChkV ar A � _ SID E' V ie w 7s ' �f�lWMldtK- .SPIKE tN.��!'D f� � Nti &Ak0'MAW- SP, KF- 'Al 9'04 C ?fJ tLkv). qE 91" ,N i ? /�' x 1 P�.O? saacT10N PL 5 LAM mm OWAVAno _- Pik iJMT PPAJECT *Ah Asw,44"ff f o 6g ` a SOT 4 RE EIVED 0� 4.r0t C TAm,% Nfr# O �Qo ?oSE� 7 2003 t z.� Ays� d y►• of �/ricsaw �• gE� S r- CRUIX COUNTY �QOIX �N tY E ONING OFFICE �fW 5fwee �,intF , 40 ST�x1i0i!'QA '.�iuFtt'rlMt7�f VeNT me DBSErtJn!riau >Pt� /N qt � � S � ��lnn•� .22•`r� F e l� fie - s f��S�l�4rfo or{ i2` A63oc 6wrsm VEty c e ice• �iN� s� �ie�aE DAM: t�s'1�c r,vtawt �k•�at,r� y ° �fc �,��o�.RE . cMe Mu ff 1". W: no tof C hambw 8*Vlh« F4iEvA-naJ tie o SeGE� V tEw T5 Effective LwVh Wisconsin Department of Commerce SOIL AND SITE EVALUATION Dividion of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 1 incheRfs0Rlvim County include, but not limited to: vertical and horizontal referenc point (BM), direction and - C� ) Y percent slope, scale or dimensions, north arrow, and loca on and distance to nearest road Parcel I. D. # APR 3 2003 0 -1.3 APPLICANT INFORMATION - Please print a i infgr" Q��� R awed b Date Personal information you provide may be used for secondary pure es (Privapgly}�y�d� (m)). Ldp Z 7' Property Owner Property Location / j A R� WC)0/) L Govt. Lot 1145W 1/4,S / Z T �9 ,N,R XU E (or) W Property Owner's Mailing Address � " Lot # Block# Subd. Name or CSM# A0 ' Z ON State Zip Code Phone Number ❑ city ❑ t Village Town Nearest Road k e�� w+ S4 6/4 ('76 ) 3g- xvsb u4�� 5 ) 4 3� New Construction Use: PO Residential / Number of bedrooms A k Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6cso gpd Recommended design loading r e S d, gpd /fi d . 6 trench, gpd /ft Absorption area required /200 bed, ft /U0 trench, ft Maximum design loading rate bed, gpd/it Q trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations - Parent material G Lh t/ AL - 7 Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system WS ❑ U Qp S❑ U IX S❑ U k os E U I 5� s ❑ U I ❑ S 10 U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench A 6-9l z & Yiq L /A? Cr CS :,hF'" $ 9 -24 . / 5 r15 f4 Cs o,� Ground $ Z 4 - 46 YR 3 S m CS ,7 ,d . $ le .� vYk .4 — S 6 S �, d A 7, sy� Depth to t limiting ���' G factor 3 _ Q� k &e_ in. l 5 Remarks: AA AAJA EL P /V Boring # C '6 Tr V - 0 4 4 S6 Ground R / �� S r►, M 7 f�,$ elev. /Left. Depth to limiting factor j t2Q?_in. Remarks: AsyA Pa/ j 8-A CST Name Please Print) 1 Signatu Telephone No. Address Date CST Number PO &3e 9 ASc�� L� Ji /T -03 ZZZ 7S $ I PROPERTY OWNER rAAV -)G06 SOIL DESCRIPTION REPORT Page Z of j PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench S d 3 / I rh cr m f' S . _- Ground /b&Y P A C I 9 v ft Depth to limiting (7 _ V71 Z K d3. 2 a factor >/ 0 in. Remarks: QE rb 4i\J _ & ' bC - CPU Boring # 5 /Rah Ground Z 4 elev� U Depth to limiting factor J� �,�,p 120 in. Remarks: 1( 1��VICA kAJA NK -ZPCAj 6: fl Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring# 6- / Y�3 l L 1 N r>'t c 2 aA o,S m - 43 7 YQ 40r M S 1 S K Ground ';Y4 V fhf M 0.0 ev. �ft. Depth to / L( limiting f in. Remarks: PL1L1 Boring # [3 Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9198) rn LAJ a r �ple Im a� � cr -7S � r fl in Ob cU Z � i NELSON PLUMBING PLUMBING & SEPTIC SYSTEMS 122 E. Summit Avenue Ellsworth, Wl. 54011 (715) 273 -4444 • -4446 leh 7 4 0 r�U1,r� z� i • .. ..;> :.,, . . J- F ' .... . , � .,-.,, ' , x.; . . .. I�_.. Y Wisconsin-Department of Commerce SOIL AND SITE EVALUATION 3 Division of Safety and Buildings Page i of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and >7 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Pleas 11 Reviewed by Date Personal information you provide may be used for C ry pu se s ivacy La a' 1 4 (1) (m)). Property Owner = -u _ roperty Location Y 4vt. Lot 1/4161&)1/4,S If Z T Z ZO E (or) W Property Owner's Mailing Address 2000 t Block# Subd. Name or CSM# SIT ev J',,v cl�ax I rr;.. >T APRW Ga m City State Zip Cod � ` Pfitfcw Nearest Road ❑City Village Town Nu b K New Construction Use: ® Residential / Number of bedrooms _� Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow ZOO gpd Recommended design loading rate QQZ bed, gpd/ft C_• 6 trench, gpd/ft Absorption area required _ bed, ft / Gee. trench, ft Maximum design loading rate QK bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) 9S. ors ft (as referred to site plan benchmark) Additional design /site considerations ��f'�Ol j) TiCal`f i opol[ T 0 * PLAT- A PPI�OVAL- Parent material 6 LN G 1 4 L T I L L Flood plain elevation, if applicable ft S = Suitable for system Conventional I Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U S❑ U 4 S ❑ U a S ❑ U S ❑ U ❑ S U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench -2-4 3 - S4 rn r-A CS - ,a Ground -/�� 5 54 /' 61 C S t 6 0 qn�ft- 0S64 Depth to limiting ; lector JS Remarks: Boring # .:; r llp l- 4� Ma /�y� 4 3 � � 5 ri 5 7. SYk 3 �C, M S /h CS Z 'O \1 Ground 0 O elev. Depth to limiting 7 f , /or �in. Remarks: CST RUAY me (Please Print) Signatur Telephone No. 6ijlgs,6N Ad ss Date CST Number �d &x 9l 9uLS4ry s d & - ifz -oo zz 7 - y SOIL DESCRIPTION REPORT Z " 3 PROPERTY OWNER Page of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench -34 In rK Ground my e C M 93 S(6 PIS Depth to limiting tacWr in. Remarks: Boring # C�- /A 31 — L. Z -3Z /0 94/4 �2 -sc 7, , _ -' SCa /bls rh c�s Ground S� }r- -� 5 ;o. elev�, , Depth to limiting fac r jp� in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # M Cr GS 2 1 g, -zl / 4-1a 54 ri►s m s l vh 6,' /- 7. Q4 3 S4 rnS m es — , Ground 3 7, sYp2 4 5 le Depth to limiting fBclar ?T ' Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) t �G f Y'1 n r �� fR Db 1 _ rc w ro \ ` t\ vt . / d° n r M Db z � �A 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page —/— of FILE INFORMATION SYSTEM SPECIFICATIONS Owner -N r T Septic Tank Capacity ga l ❑ NA Permit # a Q Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of B ❑ NA Effluent Filter Model U ❑ NA Number of Public Facility Units ® NA Pump Tank Capacity gal ® NA Estimated flow (average) gal/day V Pump Tank Manufacturer ® NA Design flow (peak►, (Estimated x 1.5) U v gal/day Pump Manufacturer M NA Soil Application Rate al /da /fta Pump Model ® NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit ® NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ® In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS} 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ® NA Other: ® NA Other: fl NA 'values typical for domestic wastewater and septic tank effluent. Other: M NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: months) (Maximum 3 years) ❑ NA cZ ® ear {s} Pump out contents of tank(a) When combined sludge and scum equals one -third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every : IM ear s;(8) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: Q month(s) ❑ NA 10 ear(;) Inspect pump, pump controls & alarm At least once every: Q ears) IN NA Y Flush laterals and pressure test At least once every: O year(s(s) 0 N Other: At least once every: 0 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 (Y 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 (4101) r Page —2- of Z 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(31. 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: IN 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. The L'te has been eva at to identif a suitable replace t rea. U failure o POWTS a soil and site evaluan st perf ed to' locate suit le replace t area. n epla m area is !e a oldin tank may ailed as�a t resort to\ l ce the fail S. ❑ Mound and at -grade soil absorption s be reconstructed in place following removal of the biomat at the p systems may stems must comply s f such s P Y with the rules in effect at that time. ' a surface. Reconstruction o mfiltrativ u ace. Y C < 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 A G' Name - Phone _ �-� Phone 6_ SEPTAGE SERVICING OPERATOR (PUMPERI LOCAL REGULATORY AUTHORITY Name _ Name �` u Phone , _ Phone 01- 6_ This document was drafted in compliance with chapter Comm 83.22(2l(b)(1)(d) &(f) and 83.6411, (2) & (31, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer .Se>NJ L� +ZT_ SCkcp �. e '47 r_ I r Mailing Address Property Address � _--'- -� - -__ W KES o'1 /6 .5rA w (Verification required from Planning Department for new constructro City/State }4L)b6o,- -> Parcel Identification Number 0 ` /37Y- LEGAL DESCRIPTION Property Location >J-'� '/4, Sc-- '/4, Sec. iA . T q9 N -R90W, Town of Subdivision STA2(� ��� Lot # Certified Survey Map # , Volume , Page # Warranty Deed # ' 2 0 .'P�p x/ Volume o� /3 5 ' , Page # / SoZ Spec house ❑ yes 0 no Lot lines identifiable 49 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes: 'Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, joumeymanplumber, 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. I/we, 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 a three year expir lion ate. /71 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 operiy described above, by v' a of a warran eed 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 1 2 1 3 5 i' 1 5 2 - 7ra88ti. i KATHLEEN H. MALSH STATE BAR OF WISCONSIN FORM 2 - 2000 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX Co., MI This Deed, made between Landsted Homes, Inc., a Wisconsin RECEIVED FOR RECORD corporation, 02/07/2003 10:15AM EXERT t Grantor, and Schoen A. Schuknecht and Patricia A. Schuknecht, REC FEE: 11.00 TRANS FEE: 372.00 husband and wife, as survivorship marital property COPY FEE: CERT COPY FEE: PAGES: I 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:) Recording Area Lot 9, at of Starr Wood in the Town of Hudson, St. Croix County, Name and Return Address Wisco sin Q3 — lG \Z. 9 River Valley Abstract & Title, Inc. 1200 Hosford Street - Suite 201 Hudson, WI 54016 020 - 1374 -09 -000 Parcel Identification Number (PIN) This is not homestead property. 6ix) (is not) Exceptions to warranties: Easements, covenants, restrictions, and rights -of -way of record, if any. Dated this day of February 2003 LANDSTEED HOMES, INC. --s " * By: Aark M. Erickson, President * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. ST. CROIX County ) authenticated this day of Personally came before me this day of February 20 the above named Landsted Homes, Inc., a Wisconsin corporation, by Mark M. ,kickson, President TITLE: MEMBER STATE BAR OF WISCONSIN pubic (If not, WWII in own to be th erson(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) rn t a a e ame. THIS INSTRUMENT WAS DRAFTED BY * Brent R. Johnson - Lommen, Nelson, Cole & Stageberg, P.A. Notary blic, State of WISCONSIN Hudson, Wisconsin My Comsion is p (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) I / —� w ) Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN INFO -PRO (800)655 -2021 www.infoproforms com FORM No. 2 - 2000