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HomeMy WebLinkAbout020-1374-23-000 n 0< m 2 0 c ( (D M \ / k -3 \ 7 f ( _ ) i f � to � e« « z \ -> I r o / z ,$ /,' y \ { e \ \ Z E @ \ _ to a » a G ° _ 9 § \ \ © @ \ 2 j a c , a Q a- / ° ZD- \ ) \ & G ^ E 2 E\ a E . E « m , E CD > 3 . � \ § ) \ / ) ) k ° ® o c C { C 0 0 0 m . S — � � \ _ � � \ 0 / § ) 7 E I � \ § � > / 0 � } ( c { G ( / \ a , CD ; m \_ 3 k a- ; ¥ z o C) e . \ § / G { z 0 Cl) \ 5 » / ƒ i = a)2£± r -4 § . . 3 / . §$® § o = z e ¥g0 \ cn < §_ . ) - /� \ 0 2 \ 3 \ � ! a � . z \ ° § + f . \ } \ \ S 1. C & CO UNTY ST. CROIX COUNTY LAND USE ORDINANCE FEE SCHEDULE PLANNING &. ZONING Effective January 1, 200& Deleted: zom ZONING PERMITS & APPLICATIONS Land Use Permit Fee Lower St. Croix Riverway Overlay District Floodplain Overlay District Shoreland Overlay District Grading and Filling $350 Riprap Sign Temporary Occupancy Nonmetallic Mining Tower (co- location and stealth facility) $550 Animal Waste Storage Facility Livestock Facility $1,000 Permits Processed in Conjunction with a Land Division, Special Exception, or Variance $50 Other Permits and Applications Fee Rezoning $1,100 Special Exception $1,100 Variance $900 Appeals of Administrative Actions $450 Each Additional Item Considered Concurrently (Special Exceptions, Variances, Appeals) $175 Miscellaneous Fees Fee Readvertising for Public Hearings $225 Copies (Per Page) $0.50 Mailing Fee $4 Faxing Fee (Maximum of 15 pages) $ 5 Water Test ($50 + lab fees) $55 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 D-AAJU& & Or Property Address 211 ~PC-c *ojD City /State /.�uZ)9®Al & G�'Yoi Legal Description: Lot �T Block — Subdivision/CSM # iocr 5 , h - t /4 '/4, Sec. /.�, Tj ff N -R O W, Town of 14 nQSo•U PIN # D -/37d/--P3 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer (Jl -'SDP Size ST/PCA - / Setback from: House 1 ' Well �3 P2 1 Pump manufacturer — Model — Alarm location r (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM '�ov foc <kAl f �51rbuDAebO Type of system: 'fe E N Width �� Length 9 7 !Q) ' Number of Trenches Setback from: House �y , WelV 4!: P/L So `N Vent to fresh air intake SG' ELEVATIONS Description of benchmark A411 ..y 4* 0* ?Ply Elevation /tip Description of alternate benchmark Elevation Building Sewer /0G 03 r ST/HT Inlet /00- Z/9 ST Outlet / • PC Inlet " PC Bottom t-- Header/Manifold • SG Top of ST/PC Manhole Cover 103• Distribution Lines ( ) () ( ) Bottom of System (A) ��•�! (�) mi l. 7e ( ) Final Grade (A-) � � (B) W -1 D A*- ) Date of installation /It /a Permit nu ber yas/5'� State plan number Plumber's signatur icense number Date Inspector Complete plot plan i 1 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. 7 /..j (� /�SdQ ! 5�Gr4L Sa pr�7 �,�c ,V 4 A I'fbo.f cTAP �• / �s 4 INDICATE NORTH ARROW Wisconsin Department of Commerce . PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 405155 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: Arndt, Daniel and Elaine I Hudson Township 020 - 1374 -23 -000 CST BM Elev: Insp. SM Elev: BM Description: oo .o' I . (w.ID S .j ,K ." �- TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 11 '0 1 a r Dosing Alt. BM ? b Aeration Bldg. Sewer , / 1 1 `r 6.06 Holding St/Ht Inlet /a. 2'f ►uo.�6 TANK SETBACK INFORMATION SUHtOutlet 10 •� �aD TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �r /,G / Dt Bottom Dosing Header /Man. `I • �v Aeration Dist. Pipe f . /D q f` (0 .qD r i Holding — Bot. System I S q 5 - - / r, o I r- X PUMP /SIPHON INFORMATION Final Grade ll. Sn c1q ST I Manufacturer Demand St Cover S18 M Model Number TDH Lift Frictio ss System Head TDH Ft Forcemain Len Dia. Dist. to Well SOIL ABSORPTION SYSTEM QjiiP/TRENC1% Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI ME+WAeh'T -3 r20 SETBACK SYSTEM TO P/L DG WELL LAKE /STREAM LEACHING Manu_ factyrg� _ t n INFORMATION Type Of System: CHAMBER OR -k-v�l To �Nv. UNIT Model Number: 1 rt DISTRIBUTION SYSTEM Header /Manifold U D engt istribtion x �HoleSize x Ho Vent to Air Intake Pipes) / Length Dia L I �D Spacing Sb SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded T Mulched Bed/Trench Center Bed/Trench Edges Topsoil 101 Yes n No �] Yes CO M NTS: (Include code discrepen le persons present, etc.) Inspection #1:�/ /l � Z Inspection Location: 211 Starrwoodudson, WI 54014 (SE 1/4 SW 1/412 T29N R20W) Starr Wood Lot 23 Parcel No: 12.29.20.2256 1.) Alt BM Description -1 � 2.) Bldg sewer length = Zo r 3 - a mount of cover = { S � a _ Plafi revision Required. Ys i No _ •� Use other side for additional information �! Z D Z.J Date Ins SBD -6710 (R.3197) epctor's Signature Cert. No. '2 � ( 3I�rtRt�tx90 d Sanitary Permit Application Safety &Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 nepaCtment of Commerce [Privacy Law, s. 15.04(l)(m)] c (Submit completed form to county if not � 1 / Y �' state owned. Attach complete plans to the count J copy only) for the system, on paper not less than 8 -1/2 x I 1 inches in size. State Sanitary Permit Number ❑ Check if revision to previous application State Plan[. D. Number County ST. Yo S I. Application Information - Please Print all Information Location: Property Owner Name Property [.oration .{ F 114 %rM14, S T A9,N, W613, (o r Property Owner's Mailing Address Lot Number Block Nu Subdivision Name or CSM Number City, State 1_1p Code N FFICE ❑City II. Type of t ding: (check one) ❑ village * 1 or 2 Family Dwelling -No. of Bedrooms: 11 Town of ❑ Public/Commercial (describe use) :_ ❑ State - Owned N t Road 0 2 a r k "fi , n f f Parcel TaxNumber(s) plo III. T e of Permit: Check on! one box online A. Check box on line B if a licable 6. ❑ Addition to u A) 1. IN New 2. 11 Replacement 3. ❑ Replacement of 4. 5 System System Tank Onl Existing System Permit Number Date Issued B) ❑ A Sanitary Permit was previously issued � Tom¢ � IV. Type of POWT System: (Check all that appl w� Z•94F` 1 1 `'` n ® Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland Ilk �(9"" ❑ Pressurized In ❑ Holding Tank ❑ Single Pass ❑ Drip Line 5 ❑ At- de ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dis ersai/Treatment Area Information: Grade 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate ;6. System Elev on Ele final Required Proposed Rate (GalsJday /sq. ft.) (MinJinch) 60 v.� -, '9s5 90 , s v VII. Tank Capacity in Total I # of Manufacturer Prefab Site S Fiber- Plastic Information Gallons Gallons Tanks Con - Con- glass New I Existing crete structed Tanks Tanks 4 ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement 1, the undersigned, assume responsibility for inst allation of the P OWTS shown on the attached plans. Business Phone Number Plumbers Name (print) Plumber's ignature no stamps): MPii�iPRS 1 "O v �A dd.(Sd City, State, Zip Code) I&Av IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss g Agent Signature (No stamps) KApproved ❑ Owner Given Initial Adverse Surchar ee)� Determination G!� ZoOZ X. Conditions of Approval /Reasons for Dis pproval: F53 A+ le� l2 So � � ce.xl� ehr�! �""`� pd pa, r,,. u� . C,t� e Ao,, lmo., 4L6LAMer iu Afd M Spc c�-►'ers• / PLoT O cRoss sECTiON PLANS %. / r►f' Tic �{,ss � ��' _i \ ZAPPA BROS. EXCAYATINU WC P<UMBINa UNIT _ A'c'° _ PROJECT 41 il L,. / pm O �` DE C K � t/ JgtpPoo.►1 RtS rO��us.. _ (� � � G` -� f�f '' - � ,{ SCALE SIGNED: -- APr'/?ov£/J V EAvr C,,0 UCENSE: GATE: — FN , S/4 y " lid[ S c H ya V" Q PE 801L TEST" BY: • �hX/ MuM � /'+/�V� ��AM/3tk �A/2 ✓F � I/�'/�'/Y�1�A �/ — Side View F1'c�h - lEJ<H &TrOjn So,e. TLs End View OI L 1. 34. _ I 1 F- L �r��fr�r'r Oop L •7� � �7 .__ .__. _._. —_ �_ —_ __ � � � ., � f/•� ( .� c I.'� A/ ter alt' PLO 6 PLO 4t CROSS SECTION PLANS f-.' -/rtf �Jv<G{�5 , S - . �._- - - --,. i/1F'PA EROS. EXCAVATINb INC KUMBINO UNIT .. PROJECT b c r �e y , r,r t-J) 774 Z.�r.ct K A?6 fir. �E yv �• �J'r �iaoiac C�ur� "' .D EC K ��• / S Poecr/ - .7 X w 6AWAI o D O 's Q� E r W l F SCAM pe pf e r," �aU� FUCENSE: {�PP/tov�a VENT �.FO DATE: O IZ91 -0 FNrS/4 4 1 S c r+ ya ✓ u� Q, PE sal TEBTIN, BY: MhXrMuM �D. Azov, . �M 4A/3C�' ✓ Side View f �� ( ro, ! _ EA< N 64 7T_ 0 Tt End View LIJ T —^ I II -i s � I Wi sd�roJp Department of Commerce SOIL AND SITE EVALUATION / 3 Division 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 S 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ,5T C - /)( percent slope, scale or dimensions, north arr q�.jTpZWR rra(id distance to nearest road. Parcel I.D. # APPLICANT INFORMATION •Please ri�,all i {/ . fdiFinahon. Re 'awed by Date r{�T -t Personal information you provide may be ged for secon�ypks69 (Privacy Law s. 15.04 (1) (m)). R S V - z Property Owner -� Property Location t J ' ` Govt. Lot 114 N / T Z! ,N,R 16 E (or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# v tj,,ttq�GOFF . z3 S7,a,e wda City State Zip Code Phone N 'ev, Nearest Road ❑ City d Village Town _ . _ _ LSdvl 'S N 35_ New Construction Use: Residential / Number of bedrooms 4 1 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow lyp,o gpd Recommended design loading rate 0.2 bed, gpd/ft trench, gpd /fie Absorption area required �d bed, ft 2S Q) trench, ft Maximum design loading rate _0. bed, gpd /fl2 49,.P _ trench, gpd/ft Recommended infiltration surface elevation(s) 92, d o ft (as referred to site plan benchmark) Additional design /site considerations EV AZQr A l o) /10 o is V'4� rLA A to 1 ,eOV L Parent material f/ LLd j AL.. `n L 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 S❑ U S ❑ U Q( S ❑ U ( S ❑ U S❑ U ❑ S U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench IS 'F a -S" /CS�/f23 / — L f� /?�<r f`' Ground I -IQ / ��� 4 s� ►'h S d .0 Depth to limiting fa�c��tq%( ? &4 in. Remarks: Boring # p - 43 I&IP, 4 a Ground Q7 v. , Depth to limiting fa�ctpr 1 0t in. Remarks: CST Na a (Please Pri Signat Ve Telephone No. OeV &v :�a6 4o�0 Ad / Date CST Number t �c� 1 Mabswj s I ,/ 2- G 6 2 Zz.7 7 SOIL DESCRIPTION REPORT Z PROPERTY OWNER Page of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ... Q 3 y 5� C SC, Ground IJ2. C'/ o 4 V J4 R-S /�') ®•� 0 elev l ob -A ft. Depth to limiting M n. � i Remarks: Boring # Q- ' 3// — L < r rh C5 6 ,D SCE no ray I cs 1 C7 613 Ground t p ` 7 Qyl� s Z s q l. v z ft. Depth to limiting ' in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /fie in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # A _3 I �, r m Cr" m -21! lbV 9+' � SCi M 5 M S Q 8 -6,44-7 1bV / C S�i Ms $ Ground M olex. , Depth to limiting f c r >in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in ' Remarks: SBD -8330 (R.9/98) \�' r�j rr ° 1 rn IN _I- 1 � � LID Gb , 1 rri r re n d L d z % C -� POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of of FILE INFORMATION SYSTEM SPECIFICATIONS Owner _ Septic Tank Capacity v a l ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer A ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ® NA Pump Tank Capacity a l ® NA Estimated flow (average) 5 4 , l op gal /day Pump Tank Manufacturer ® NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer ® NA Soil Application Rate al /day /ft2 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) <_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 1530 mg /L N In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ® NA Other: NI NA Other: ® NA *Values typical for domestic wastewater and septic tank effluent. Other: 01 NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank ❑ month(s) s) At least once every: ! ear(s) (Maximum 3 years) ❑ NA CZ Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume 5a NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ® year(s) Clean effluent filter At least once every: ❑ month(s) 13 NA I@ year(s) Inspect pump, pump controls & alarm At least once every: ❑ mo nth ❑year (s) ) I@ NA ls) Flush laterals and pressure test At least once ever ❑ month(s) year(s) ®NA p y' ❑yearls) Other: ❑ month(s) M NA At least once every: ❑ 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 (4/01) i Page ,� of G 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(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 lsump 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 ~ ' Name - o Phone v Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name r Name P Phone Phone - - This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND n OWNERSHIP CERTIFICATION FORM Owner/Buyer pa1�► d- , ��4 / h r2 AV"yl Mailing Address tq , 00 4 6k�QA M/y Property Address ` S� sd V1 !� o l LI ,t (Verification required from Planning Department for new construction) ��tNl C✓ City /State �� UGlSaln k/T Parcel Identification Number 02 — (37`'f - 2 3 LEGAL DESCRIPTION Property Location % <, sW %4, Sec. 12 - , T Zg„N -R Zy W, Town of Subdivision S-6 ry V y oo �— Lot # 23 Certified Survey Map // #/ t� , Volume , Page # Warranty Deed # b 6 2 I Volume 7 b 2, , Page # Spec house O yes ■ no Lot lines identifiable ■ yes O 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, i ourneyman plumber, 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 the three year expiration date. l t S` 1 2 1 111 0 2 SI ATLW 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. r 9IGNAtURE OF APPL 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 ��,. 762 PAGC 17 WALSH 662045 Document Number WARRANTY DEED REGIST R H. OF DEEDS REGISTER ST. CROIX CO., WI This Deed, made between LANDSTED HOMES, INC. RECEIVED FOR RECORD 11 -14 - 10:50 AN a Wisconsin corporation Grantor, WARRANTY DEED AND DANIEL D ARNDT and ELAINE T ARNDT EXEhPT fl CERT COPY FEE: COPY FEE: marital roe Grantee, TRANSFER FEE: 372- husband and wife, as survivorship p ro p er ty rty 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' R000rdina Area This is not homestead property. Name and Return Address Together with all and singular the hereditaments and appurtenances *, � thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of all encumbrances except easements, covenants, and restrictions of record, an will warrant and defend the same. ( - 1 - 0 — T2 LAT OF S.TARR WOO IN THE TOWN OF HUDSON, ST. CRIDI COUNTY, WISCONSIN. (Parcel Identification Number) 020 - 1374 -23 Subject to the Private Road Access Easement for Lots 24 and 25 as shown on the Plat of Starr Wood. Should Grantee not enter into a construction contract with grantor to construct a home on the above lot within nine months of the date of this deed, grantor has a ninety-day option to purchase this lot at the price of $124,000.00. Should grantor not exercise this option, grantee may sell this lot on the open market or choose another builder. L . Da th M,, I NC . 4 of d✓ 2001. . _� ' M k M. rtc son, President ` AUTHENTICATION ACKNOWLEDGMENT Signature(s M44 k M STATE OF WISCONSIN COUNTY OF ST. CROIX Personally came before rpa this day of 20 nti ed authe this _ V %y of the above named Marx M. Erickson, President to me known to be the person(s) who executed the foregoing signature ,- WA. L ` instrument and acknowledge the same. type or print name signature TITLE: MEMBER STATE BAR OF WISCONSIN type or print name (If not, authorized by §706.06, Wis. Stats.) Notary Public ST. CROIX County, My commission is permanent. (If not, state expiration date: THIS INSTRUMENT WAS DRAFTED BY ') Robert F. Wall 'Names of persons signing in any capacity should be typed or printed below their signatures. r o o D 1nco,E ssc,a S'Wt /d. IN PART OF THE I !VERNMENT LOT 3. ALL IN T. CROIX COUNTY, WISCONSIN. off$ �o S87 ?308.46' NORM UNE OF It* SW114 , 56]I • o � t 8 M $ C� N ® y O Z AM �.SSaewea ,ma' - ,was :om "�'SI.1/1viM.ly 8 3 fi �7.Te66o TT � 5 r 6 ;.�� w $ T i 6 ea� ,m ar 2156.=16 R 7 g ,�.Y .... _,„ Y Y t ,. Y cl wood ' U►66 ads'++ 0 au, . �. ` \�:-'• 8 ce 091.90" ATJ16,C EA6E61Blf � �.. 24 ,� \' \\ l AFIE O p FA6USENT 1 �.� • 07AM 30 Fr sev7os/w som66W 56rgww565.a ��} O o,aN+ „spa usao assr Ac �L16 {pRNANOa /"°6'o6s"' 1a� wrrwiEaaaes i 8 9 25 ! 22 g __ N y (SEE Nmal ` / N 1SMACM a 1A AfEANG FASO/Of TT II E2�A� $ A a46s 90 FT sMACF" c7 me NOTE lA I AAEAM-FASM,gTT ^,6 11 7t5.7t s6a 165oFf ',t, aLau slaar ,]nAOE6 1� - - - -- - 10 IEAND TO 8E ONMED BY OMEOg; A490- N e'�a �I] ACF g PAS y NOS, 'v>•j O (��j ( U alFE avAwIl6A5F7Ae ra �JJ wwe � +nm CENTMLANUM 'row N 20 nf�Q� 3. a,aa w0j" NORa7fE m A,1C LfSaM 3w (AMBIT N37W n TANCIENT N6Er111F SHEET 10 3 SHEETS