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HomeMy WebLinkAbout020-1374-15-000 n cn o■ m 0 = o g c n k ] E � \ 7 \ ( m � - ƒ � K z {& 7 ® ° A E E Q C @ \ \ , $ / / E § § 9 - Q @ } [ <_ § q / @\ 7 a § w Q t _= 0 >o - § ; \ 2 ( m @ @ % \ ! $ / ; a R E E n`- S f ra , g § � . » 4 & 2 R \ © m \ R E r \ ° / \ \ \ $ � / k k ° r- c o c ~ e k 0 0 o m - « g % * * :0* 2 a E \ - .4 - } \ 7 v o a \ ƒ J % \( R Z + 3 \ ) CL g > \ / k � / (§ \ "Ni 0 } k 71c� . /CL 2 g s , t 0 - : - a # z ° §& pe -0 $ \ G . . 0 / z \ \ § .91 2 \ w D \ g \ \ § Gam \{ a = e \ /}\ //� =rT : 0 \ ; ) 2 / \ 4~ � CD \ /\ \ %5 w E � � / e o 2 \ y /$ \_ ; o CL : 4 ST. CR 0IX CO UNTY ST. CROIX COUNTY LAND USE ORDINANCE FEE SCHEDULE Effective January 1, 2_ Deleted: 2007 PLANNNG & FONNG PRIVATE ON -SITE WASTEWATER TREATMENT SYSTEMS (POWTS) State Sanitary Permit Fee All State Permits include a $75 surcharge that is submitted to the State upon permit approval. Conventional Dispersal (Single Inspection) Pressurized in- ground $450 Non - Pressurized in- ground Dispersal (Multiple Inspections) Mound At -Grade Drip Line $600 1000 -2500 GPD 2500 -5000 GPD $900 >5000 $1,350 Constructed Wetland $900 Dose Tank I Septic Tank $225 Holding Tank $575 Pretreatment (additional fee added to permit for dispersal) Aerobic Tank Sand Filter 50 Peat Filter $1 Media Filter County Sanitary Permit Fee Privy Installation or Modification Non - plumbing Sanitation System Chemical or Physical Restoration (Terra -Lift) $225 Repair Reconnection Miscellaneous Fees Fee On -Site Soil Verification $175 Soil Evaluation Report Review $30 Reinspection $175 Permit Revision $85 Transfer of Property Ownership $85 Renewal Permit $85 Wisconsin Fund Application $175 All fees are non - refundable. Fees will be doubled for applications submitted after construction has been initiated and written enforcement action has commenced. ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner L, voS - iZJ 1b11 IS5 . Property Address -�?yS -5 lr ,RwaeK City /State /- as o.J w 6 �IoI6 Legal Description: Lot 1�5 Block — Subdivision/CSM # 4 SE 1 /4 SW 1 /4, Sec. �, T ° ► N -R Town of /- dso..l PIN # Qa?0- 13 -)s� ode SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC faSO/ — Setback from: House , Well P/L �g Pump manufacturer Model Alarm location i (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: T "04 Width 3 Length G2. !S Number of Trenches 3 Setback from: House t 77 ' Well / /S' P/L /g Vent to fresh air intake ELEVATIONS Description of benchmark `5 'P -V 14 o ° DA-r T sA Elevation 100, 00 Description of alternate benchmark Elevation Building Sewer �l- �'� ` ST/HT Inlet lam% �� ST Outlet `�� �l PC Inlet PC Bottom Header/Manifold ��� l Top of ST/PC Manhole Cover 7 Distribution Lines (4c) 5F0 -• /-'L Bottom of System (ra) Final Grade 9-Z 3D" Date of installation Permit number Vo 5- State plan number Plumber's si natur License number .22 9/'� 6 Date- S/A Inspector � Complete p lot p lan I i NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW G r*? /0 TRcAje-q �16Lc P oe cN 2� e A f0 �' ��• 2'7 '�'o S� INDICATE NORTH ARROW Wisconsin Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Divksion INSPECTION REPORT Sanitary Permit No: 405003 0 Plan ID No. GENERAL INFORMATION ATTACH TO PERMIT state 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: Landsted Homes Inc. I Hudson Township 020 - 1374 -15 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION 4BS HI FS ELEV. Septic Benchmark 09 l OL- 12 S� 3 3.0 6 Dosing Alt. BM , 8 2. �S Aeration Bldg. Sewer a es 9Z• ,3L1 Holding St/Ht Inlet x/- 47/ r St/Ht Outlet TANK SETBACK INFORMATION I• 9Y•S� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic o2 7 f � �! f Dt Bottom Dosing T Header /Man. r Aeration Dist. Pipe CPX D. S Holding Bot. System 1 9 Z- 1 3-47— 99 .2 S �� 42,Zs • PUMP /SIPHON INFORMATION Final Grade 5 Manufacturer De n and St Cover ,Z0 Model Numbe P H I fiction Loss System Head TD Ft l Forcemain Length 'a. Dist. to Well SOIL RPTION SYSTE p T0e fENCtL- idth LengtF No. Of Tre hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 f 3 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING ManuAc�yrer: INFORMATION CHAMBER OR �N-' ier� Type Of System: i I �^ UNIT M del Nu er: DISTRIBUTION SYSTEM Header /Manifold p Distribution x Hole Size x Hole Spacin Vent to Air Intake s P 9 Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ,r;l Yes No 'I Yes iW No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: (� C/ a0Z- Inspection #2: I -- Location: 245 Starr Wood North Hudson, WI 54016 (SE 1/4 SW - 1/4 12 T29N R2QW) Starr Wood Lot 15 Parcel No: 12.29.20.2248 1.) Alt BM Description ok 4�a (—N 6&.N- rye /1 2.) Bldg sewer length = 2l' tt amount of e -�_`� •� (( ' _ / _ 4 �° ` %+►5 . Plan revision Required? I) Yes No t � hk � Use other side for additional information. --L- Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Sanitary Permit Application Safety & Buildings Division 201 W Washington Ave. In accord with Comm 83.2 1, Wis. Adm. Code �.• See reverse side for instructions for completing this application PO Box 7302 Madison, WI 53707 -7302 scins�. in Personal information you provide may be used for secondary purposes Department of Commerce [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 stem, on paper not less than 8 -1/2 x 11 inches in size. County State Sam Permit Number ❑ Chec if n 'sion to revious application State Plan 1. D. Number ST, C,e.D 1 q, 1 I. Application Information - Please Print all Informa Location: Property Owner Name J IVED Property Location A ,��11D�7T�D 1-�� ,uC . PA P!R l wrrcr s Mailing Address Lot Number Block Number property O y3� •�.vL3 Sr 1 2002 1:5 City, State Zip Code ST. R� �Y�UNTY Subdivision Name or CSM Number / T A, DS,>"j G.7. S z N► ,OF�IC 3� -!�✓ >. �i %fvPQ4, 00 OD II. Type of Building: (check one) V s S " ` °"`s ❑ city ❑ village ' J 1 or 2 Family Dwelling - No. of Bedrooms : ATown of /`"� 1 ,0S O r4 ❑ Public/Commercial (describe use):_ ❑ State -Owned Nea=t Roa woo OQl df \ 3 K . n Parcel TaxNumber(s) - - V III. T e of Permit: Check only one box on line A. Check box on line B if applica ble 12.2 4 ZQ 22 A) I. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Date Issued Existing System B) ❑ A Sanitary Permit was previously issued Permit Number IV. Type of POWT System: (Check all that apply) ' ❑Sand Filter ❑Constructed Wetland ))Non- pressurized In- ground ❑ Mound • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. S ' pplication 5. Percolation Rate System Elevation 7. Final Grade Required Proposed to VII. T ank (GalsJday /sq. fQ (Minhnch) Elevation 30' X 7 3 • �3 Q v - ' Steel Plastic teel Capacity m Total # of Manufacturer Prefab Site P tY Con- Con- glass Information Gallons Gallons Tanks Co New Existing crete structed Tanks Tanks ❑ 13 ❑ ❑ 45a ❑ ❑ ❑ /ado G�i� 5 �2 ❑ ❑ VIII. Responsibility Statement I, the undersigned, ed, assume remonsibili for installation of the POWTS shown on the attached plans. Business Phone Number Plumber's Nam Plum �27/ o s s): hfP / �7?; . /f l '(K` rim >�,r(E �% t 7 •3 SIB � 7 b'S Plumber's Address (Street, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved . Sanitary Pemut Fee (Includes Groundwater Date Issued Issui Agen` Signature o stamps) J,P.pproved ❑ Owner Given Initial Adverse 'Surcharge Feg) W 1S �UZ Determination X. Conditions o Approval /Reasons for Di,£aproval:� �� • _ _ '� 1ki•l 5� �._�nu,� a��..«�st�dll «� p�-� �C� 04 ,Maw eew�.ar , c am• l ` c- c �ev�S 5� rgokbwt 60D 6&- /1 o p ti fl "'y'A, 'PLOT h CWG6 GECTION PLANT Soosp / /�1 = �`�. /7 oe so c'� , P,Qopos�iD ZAPPN O ExCAVA7" W C 3 ?Qcucff�s c.�i io S,06IJrti 0Z*lf= 6�.So KU14B Nfi NNIT h 0 "" PM ACT �l�1971►�frS[7S' /OE.Gt�F'rK�►Ct� � ��b �8�C4/"�Ir 0 --!S'Zifve -A 4.PtI4 ic" � �n d85 vk�rlv�u uClNo �?2 ` OATS: iv • 0a FN�SH �o.Pe►gE s ale Te,► sr: Te f! N ! 5 H �7 QhOE t�oG o? 5 I Side View FEE�K�l�.J 'Swl<N ��iroti. rE4 so�c ?EST End View i ts i '- 3�' Fr: � S!v£w�.� ��GM �MpAc�TY M D� E L Z. 30 �' b,is PLOT & Cnose eiC ION PLAW Peo��� ZAPPA 9ROII. IFXCAVATV44 ING 3 T "w --Aes w/ �'� /o S,OFV►.u>7�t2�s ` G2.� numo NA VNIT .. PFIAIHCT • r L loci Sr�D �r�'s LQ 86 Irld-14A tv�**elu i'ovp -o'j /O olop 91 Wk a►g J� 4e. p ' .... �► tK6 !N' av' p,�,� •pats b° �4t 4VAFJ4,'f / 40, 6CALB Y,E�..a eon �rJ• — 085� RV�•riy.�..P : ?F 81ANBD: � �,' ~�� uceNBe' v?2 4176. 7 i �a DATE: o � i.2" MWE f sH kAof E 9�1Nq D.Y: '� ~ li(< Sc N yo PPE . MAXlMuM yYi� ..E��s� ���Q�S.�w Side View ii sA <N BeTrawl TEQ sa c Tf- End View - - l a j L 04 f 34 ' � stOFW ,wiAouQ 4$cm 4'MVAcirY MOQeL Wisconsin Department of Commerce S OIL AND SITE EVALUATION Division of Safety and Buildings Page I of Bureau of Jntegrated 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 � C�eo I x percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - He 1" dhf all ' for '#0 Reviewed by Date Personal information you provide may be used f secondary p o ( Cy Law, s: 1 .04 (1) (m)). W S 2402 WAN Property Owner roperty Location ���� ""'' Q AU ovt. Lot 's� 1/4'- 1 /4,S r 2 T l ,N,R �a E (or) W Property Owner's Mailing Address ? y of # Block# Subd. Name or CSM# City State Zip Co w +j,, P r NWer ti ❑ City 4 ' Village Town Nearest Road y� �t s-) - o Wu1�So••l - r14 3� New Construction use: t Residential / Number of bedrooms I Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow 2 (40 gpd Recommended design loading rate d.7 bed, gpd/ft O• C trench, gpd/ft Absorption area required gy bed, ft 2So trench, ft Maximum design loading rate ©.7 bed, gpd /ft? D.1 trench, gpd/ft Recommended infiltration surface elevation(s) UPy 5"0 ft (as referred to site plan benchmark) C Additional design /site considerations ,VA - r 10 xj QL) lx&k P44r APP VAL Parent material Flood plain elevation, if applicable It S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = unsuitable for system S❑ u UX S ❑ u ZS ❑ u KS ❑ U 4S u ❑ S K u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground `e ft• Depth to limiting 3D / ; lector L in. 5�( Remarks: Boring # "'. 0 1 A 0 - 7 IQ` R 3! — 5 c, f M or m rS 2--T f g R 4 3 SU rn 1 CS i ►�► v 0 _- S 19 33 Ib SG the Ground e , 2 ft• Depth to limiting factor >in. Remarks: CST N me (Please Print) Signa Telephone No. CST 3o� ��vso� � A ress Date CST Number tb li%k Q1 cad so ,o S' X 16 6-I - ZZ 7s7 SOIL DESCRIPTION REPORT PROPERTY OWNER Page of l PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots ........................... in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench .......................... ........................... .......................... ........................... A '' g q — �� ms rn <5 1 6305 p G round I / 6` & +14 Depth to limiting 7 � f ctor in. ' Remarks: Boring # 3 — 5 L, cr m <S 2 ®� 4 s , Cs 1 �, o,1 : $ A -74 75 3 e rns rh CS S Ground 74 -/d I&IRA S 4 1v g ft. Depth to limiting factor 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 # 0 S Q L, (/'d't CC- M C-:5 � 6 A6,5 Z iR, 11 d 4- S4 M5 1 6.7 .a 3 RER 1- 7-VI A44 - s 1 - :7 o 1 Ground elev. 7y, Depth to }' 9 limiting 7� fact r in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) i C�v>x `, J�YI`'S�t n� A, w 6 J �tj Ot is Pi E t Z Db r- v O JGo LN m } N N ^ 1 U J ' , A ` \ — 1` Lam. o 1\ rk POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa 9 of •=Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner L./F,( 1) 5T—et Septic Tank Capacity a l ❑ NA Permit # 003 Septic Tank Manufacturer C� �iES�e ❑ NA DESIGN PARR ETERS Effluent Filter Manufacturer �����E ❑ NA Number of Bedrooms ❑ NA ffluent Filter Model _ g ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) o� gal /day Pump Manufacturer ❑ NA Soil Application Rate / . gal/day/ft' 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 me an) :510 cfu /100m1 ❑ Drip - Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: a 0 month(s) (Maximum 3 years) ❑ NA y ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: n ❑ month(s) (Maximum 3 years) ❑ NA oC ayear(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: ( IR year(s) Inspect pump, pump controls & alarm At least once every: 0 yea�ls) ❑ NA ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ 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 IY or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page a Of START VP 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: ❑ 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 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 tank 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 POWTS MAINTAINER Name Q �Qy� �dls�uc. F 1 J� f Name T r - Zou.v�rw ��•�l ��PG�M► Phone ���. 3�G . Phone ���, 3�� a! SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Wi t- .� /�1 �o /bn► Name �T f�Qa�X �OG!N o•J��l� 0 c Phone Phone ?rb �S• 3ts'r, —fit 3v This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &M and 83.5411), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L.A,z)>a5TE.1J Mailing Address Property Address A `>S J'7,orti2 J%lo o n (Verification required from Planning Department for new construction City /State iLba:r+t Parcel Identification Number 49.2 0 -/-?1 Y -/3 o ov LEGAL DESCRIPTION Property Location %,, .lW %,, Sec. ,9,, T_ -R A>/u� , Ro W, Town of soly Subdivision Lot # �S Certified Survey Map # Volume , Page # Warranty Deed # 4l9 23 y , Volume Page # S S_9 Spec house ;Q yes ❑ no Lot lines identifiable ® 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, journeyman plumber, restrictedplumber 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 the three year expiration da e. OF APP I ANT 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 vi a of a warranty deed recorded in Register of Deeds Office. CSWeAlWE o�- O 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 V�! ? O?.JPAGE Document Number WARRANTY DEED K ATHLEEN 69730 H REGISTER OF DEEDS S7,. CROIX CO., WI This Deed, made between STARRWOOD PARTNERSHIP, LLP RECEIVED FOR RECORD a Wisconsin limited liability partnership Grantor, 01 -30 -2002 11:00 AN , AND LA NDSTE D HOMES INC. WARRANTY DEED EXEKPT N CERT COPY FEE: COPY FEE: a Wisconsin corporation Grantee, TRANSFER FEE: 330.00 RECORDING FEE: 11.00 Witnesseth, That the said Grantor, for a valuable consideration of one PAGES: 1 dollar and other valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area This is not homestead property. Name and Return Address Together with all and singular the hereditaments and appurtenances P4h thereunto belonging; And Grantor warrants that the title is good, ,a, p� 7a indefeasible in fee simple and free and clear of all encumbrances except 0.� " 0 easements, covenants, and restrictions of record, and will warrant and defend the same. L 15, LAT OF STARR WOOD IN THE TOWN OF HUDSON ST. (Parcel Identification Number) COUNTY, SVT CONS1F17 020- 1374 -15 -000 Dated thisZ of 'T& 200 - STARRWOOD PARTNERSHIP, LLP ' By: Gary T. Zappa, Managing Partner ' By; ,Pith A. Green, Managing Partner AUTHENTICATION ACKNOWLEDGMENT Signature(s) .,.�_�a STATE OF WISCONSIN ✓�f COUNTY OF ST. CROIX y P Personally came before me this ` / nC� day of—W 20U -- authenticated this _ day of V e(� the above named By: Gary T. Zappa, Managing Partner and By: Judith A. Green, Managing Partner to me kno to be the erson(s) who executed the foregoing signature ROM D, instru a dge the same. type or print name signature TITLE: MEMBER STATE BAR OF WISC type or pdn e (If not, IgO Fr,. authorized by §706.06, Wis. Stats Notary Public ST. CROIX County, cro a sio rs permanent. not, state expiration date: THIS INSTRUMENT WAS DRAFTED BY s of p ) Robert F. Wall 'Nameersons signing in any capacity should be typed or printed below their signatures. STARR WOOD LOCATED IN PART OF THE SE1 /4 OF THE SW1 /4, IN PART OF THE Z NE1 /4 OF THE SW1 /4 AND IN PART OF GOVERNMENT LOT 3, ALL IN $ SECTION 12, T29N, R20W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. ��� 0 9 P Neoaes[ersTr N (�� � �' 1 10 c 21 lM5ACFft&s . . a"c 20 cc G 78.40 SO Ff LU Zio so Fr E NDLE�; ,y • / ST jf 74eee SQFF \ b 1.7MACM �� B� tee• 7 12 Isff woreat : i p . i J low ,6f eArnES 285.,r 18 sa • / / 3�x`\ • IG ' 19fE sen Mar m � . ?+ner / / w N MM aso.er ee• / \ g ' 144 / _ _ m 17 '"� / \ / ,e-Nwrr I / timACfES W NC,E6, 13 ' A SO FT / Il a, / 16 / / \ ct 54.184 SO Fr 09M B) / cs e 1 001, 322Nr _ AL� ' 10.0 , 0\ 15 m W AY a" 65 90 &1t 0" 9 (MIL — I 9;m txmm I d o, GUN SO Fr I5 %! jIL N saesraw,eeem I L "' • ti Se9W W S99M �COH sa,n UNE N OFT,ESw,K N89°54'04•E 358.86' � 4 etH CCN DETAIL B NWTCeCME Q+c SCALE IN FEET