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Home My WebLink About026-1133-11-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT sanitary Permit No: 404917 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: Townsend, John I Richmond Township 026 - 1133 -11 -000 CST BM Elev: Insp. BM Elev: BM Description: loo Ido TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /, S Z C Benchmark . x-0 sing w Alt. BM Aeration Bldg. Sewer r � Holding Ht Inlet )� TANK SETBACK INFORMATION S Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inl Septic ' Dt Bottom g Header /Man. 7 3 Aeratio Dist. Pipe ` < < p` - fo . Pe , Holding Bot. System X PUMP /SIPHON INFORMATION Final Grade y I . D ufacturer — Demand St Cover Model Number TDH Lift Friction Loss em Head TDH t Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r ? SETBACK SYSTEM TO J P/L BLDG WELL LAKE /STREAM ING Man c er: INFORMATION AMB R OR Type Of System: -> 7 �� '7 U M el m r: 7 L DISTRIBUTION 9YSTEM HeaderlManifold Distribution 7 �✓ I x Hole Size I x Hole Spacing Vent to Air Intake �1 if Pipe(s 7J / S 7 3X Length . Dia Length Dia pacing 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 Yes I No ;ri Yes ;i No 1 COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: //Q Inspection #2: Location: 1710 91st St.. Unknown (SW 1/4 SW 1/4 6 T30N R18W) Pine Vall y Lot 11 Parcel No: 06.30.18.924 1.) Alt BM Description = S-� �,ipe ' � W �`/ 4r 2.) Bldg sewer length = 28► - amount of cover = 'Y yL s' �0. e j i e Plan vision requtr d. YY Use other side for additional information. { 2- Z f _- -_� - -- �� -- 1 Date sepc or's Sig at a Cart. No. SBD -6710 (R.3/97) n_6iQR (R YK101) Safety 201 w was�on Badings Ave.. P.O 7162 c G r v! ri�nJ'��h Madison. WI 53907 - 7162 Sim Address II � Department of Commerce _Z_ ,a 9T b Sf J Sanitary Permit Application Sanitaq W ? /? Permit Number In accord with Comm 9321. Wis. Adm. code. personal information you Provide Check N Revision nn be used for secondary purposes Privacy Law, s15. i m I. Application Information - Please Print All Information State Phu I.D. Number Property Owar's Name Number rL (u- Poo 6. z property owner's Mailing Address 2 Z r9A.5a,/ S T N. P,/X City, Stan � Code N�JG OFFICE Number Bock Number ton Name CSM Number s 5 6 -7 4 II. Type of Bull& ( atedt aII that appl aa r 2 Family Dwelling -Number of Bedrooms � ovalage ❑ PubWCommerclai - Describe Use / 0 State owned Nearest Road III. Type of • (Check only one box on line A (numbering scheme for internal toe). Complete line B V applicable) A 2 O Replacement System 3 ❑ Rgdax� of 6 ❑ Addition to For CouMr use Tank sty B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. No of Permit: (Check all that apply)(nnmbering scheme h for internal use) .YJ , Pressurized In-Gro 210 Mound 47 0 Sand F ter 50 0 Constructed wetland 22 ❑ Premnized In- Ground 410 Holding Tank 48 0 Single Pass 510 Drip Line 45 ❑ At4rade 46 ❑ Aerobic Tceatmeffi Unit 49 ❑ Recirculating 30 ❑ Other V. Area Information: r Design Flop Wo Dispasal Area Dispersal Area Soil Apftation Percolation Rate System Elevation Final Grade Required Proposed Rate(Gah./Days/Sq.FL) (Kin./Inch) '76 J, ✓ Elevation ✓ i Capacity in .Total Number Mawfacttrer Prefab Site Steel Fiber Plastic VI. Task Info Concrete Construe Glass Gaikms Gaikms of Tanks New E Tanta Tanks Septic or Hoidiog Tank _ Dosin Chamber VIL _ 1 . responsibility for bffi a tanat[a of the POWTS shown on the attached plans. ResponsIbEW Phm*r 's Name (Print) Plumber's S' MPflutPRS Number Business Phtme Ntmnber 71 j It / I- Plumber's Address (Street, City. State VM. f ,A ,roped O sir Permit Fee (includes Groundwater Daft Issued ns signature (No stagy) S cbarse Fee) 0 owner Garen Initial Adverse �D / 6 Z 7 Deetermination ono of A roval/Reasons for Dina proval I%. Condrti PP ,,,� n/ lvk 'W Attadr coospWe pins tto dw co.oei 000 foe Me Olanos ea paper dot tea. than SW x it tones he was eRn�� M 05/01) ti PLOT P N PROJECT John Townsend A ss 12910 12th St. N Lake Elmo Mn 55042 SW 1/4 SW 1/4S 6 /T 30 N/ 8 W TOWN ichmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7 BEDROOM 4 CONVENTIONAL XXX IN -GROUN ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 IL BENCHMARK V.R.P. Top of Foundation ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark To 91st. i SYSTEM ELEVATION 86.0/85.5 St. 218' Property Line Sidewinder High 2L— Capacity Leaching Chamber Grade at System Elevation Pro 4 Bedroom B House o z; 1 25' y T 0 ' 10 B -3 Vents Plans Designed Using 5' B -1 Conventional Powts Manual Version 2.0 3 , 8% Vents Slope B -2 45' 2 -3' X 94' Cells with >3' Spacing 100' 150' Property Line bi . :N/ OT P AN PROJECT John Townsend A SS 12910 12th St. N Lake Elmo Mn 55042 SW ^ 1/4 SW 1/4s 6 /T 30 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE7/15/02 BEDROOM 4 CONVENTIONAL X00( IN -GROUN ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 IL BENCHMARK V.R.P. Top of Foundation ASSUME ELEVATION loo' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark To 91st. SYSTEM ELEVATION 86.0/85.5 St. 218' Property Line Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" " Grade at System Elevation .54 VJ\ '1. Pro 4 Bedroom B. M. a� House 0 25' 20' 0' T 10' Vents Plans Designed Using 5 5 _ Conventional Powts Manual Version 2.0 3 , 8% Vents Slope -2 45' 2 -3' X 94' Cells with >3' Spacing 100' 150' Prop Line 1 Wisconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope. scale or dimensions. north arrow. and location and distance to nearest road. Please print all lnformatIon. Date Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). Property Location y t ►er J 0 � , T U) Govt. Lot 1/4 �L fi4 S �j T Property owinees Marling ss Lot # I Block # or CSM# city State Zip Code Phone Number r lla arest Road New Construction esideribal / Number of bedrooms Code derived design Now rate 16 GPD ❑ Replacement ❑ Pub!r,9 or commercial - Describe: Flood P —_- -- Parent material lain el if appGcabie /��/ R General comments and _ a Boring Boring Ground surface ele�� ft. Depth to limiting factor in Pit Sod Wicadon Rate Horizon Depth Dominant Color Redox Description Textuue Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '01#2 r 3l In CS , -g✓ 2 - - — Y2 i S �.�,/ S ✓ 2Y JVJ )4 i ® Boring # /f pi Ground surface elev. C/� vit. Depth to limiting factor l Sod Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 L✓ SS sy` Effluent #1 = BOD > 30 < 220 ffxA and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST (Please Print) - - nature CST N q umber /t- Q ewi JJ '2 - 2 > -- C ✓ Address Date Evaluation Conducted Teleptone Number Property Owner Parcel ID # age of ❑ 3 Boring # Boring Pit Ground surface i ft. Depth to limiting factor in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff In. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 •Eff#2 f o' ❑ # ° Boring C] Pit Ground surface elev. ft. Depth to faTOV factor in. Sod ApPliCation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Court. Color Gr. Sz. Sh. •Eff #1 'Eff#2 ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. El Pit Soli Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. - 'Eff#1 •Eff#2 Effluent #1 = SOD, > 30 < 220 mg/L and TSS >30:5 150 mg/L • Ef fluent #2 = BOD. < 30 mg/L and TSS < 30 axA The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. saosauotR&W) t M PLOT P N PROJECT John Townsend A SS 12910 12th St. N Lake Elmo Mn 55042 SW 1/4 SW 1/4s 6 /T 30 N/ 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE7/15/02 BEDROOM 4 CONVENTIONAL X04( IN-GROUNBAKESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of Foundation ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark To 91st. SYSTEM ELEVATION 86.0/85.5 St. 'd — % 218' Property Line Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" Grade at System Elevation 34" u Pro 4 Bedroom B.M. House 0 25' 20' 0' T 10 -3 Vents Plans Designed Using 5' B- Conventional Powts Manual Version 2.0 3 , 8% Ven Slope B 45' 2 -3' X 94' Cells with >3' Spacing 100' IL 150' Property Line hi i Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 `/ ✓ C � Nvi sloonsin Madison, WI 53707 - 7162 Site Address Department of Commerce D 9 ,� .�S` 4 lwt Sanitary Permit Application Sanitary Permi t,l)lu b r accord with Comm 83.21, Wis. Adm. Code, personal information you provide Check if Revision may be used for secot purposes Privacy Law, sl5.04(1)(m) I. Application ormation - Please Print All Information State Plan 1. Number Property Owner's a Parce umber /l —I b b Uv b Property Owner's Mailing Addr opetxy ation 7 ) 1 City, State Zip Code Phon'lD(ulti ;Yy t N a ' Block Number / l Strliivtstpri N to K v CSM Number � IIIJ, Type of Building (Check all that apply.) M City 1 or 2 Family Dwelling - Number of Bedrooms O ilia ❑ Public /Commercial - Describe Use ❑ State Owned [ _ ., est Road III. TypV Permit: (Check only one box on line A. Numb for internal use.) (Complete line B, if applicable.) A. 9--New 3 ❑ Replacement of 6 ❑ Addition to System 2 11 Replacement System Tank ' tin S stem For County use B. ❑Check if Sanitary Permit Previously Issued Permit N r Date Issued IV. 'hype of POWT System: (Check all that apply. Yhmbering is for int "(0� Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sa50 ❑ Constructed Wetland 22 17 Pressurized In -Gmund 41 ❑ Hold' ank 48 ❑ Sin51 ❑ Drip Line 45 13 At -Grade 46 ❑Aer c Treaunent Unit 49 ❑ Rec 30 ❑Other V. Dispersal/Tr ent Area Information• a t Design Flow (gpd) Dispersal Area j9spersal Area Soil Appffdati6n Perco \nRate System Elevation Final Grade Required oposed Rate(Gals. /Days /Sq.Ft.) (Min�� ' Elevation S-z /// Z � o VI. Tank Info Capacity ' Total Number Manufacturer,% Prefab Site Steel Fiber Plastic Gallo Gallons of Tanks Concrete Constructed Glass New isting Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility tement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attach laps. Plumber's Name (P4) Plumbe s cure MP /MPRS Numberrl Business Ph Number Plumber's Addr s (Street, City, State, Zi Code) ll- � � 0 Z s VIII. County ent Use Onl ❑ Disapproved Sanitary Permit Fee ' cludes Groundwater Date Issued Issuing Agent Si a (No Stamps) Approved Owner Given Initial Adverse Surcharge Fee) Determination `7,� IX. Conditions of Approval/Reasons for Disapproval / 1 t -XT" _6,, * 3 I Kvc C 5 ` � - c6 p,1,,,x.�� ttach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size PLOT PLAN PROJECT John Townsend ADDRESS 12910 12th St. N Lake Elmo Mn 55042 SW 1/4 SW 1/4s 6 /T 30 N/R W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/20/02 BEDROOM 4 CONVENTIONAL X00C IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND' SEPTIC TANK SIZE 1260 LIFT TANK SIZE � " DOSE TANK SIZE HOLDING TA SIZE LOAD RATE 1.2 ABSORPTION AREA 5 # of chambers 30 C . P'T p BENCHMARK R o Of Steel pipes - ASSUME ELE ATION 100 Filter Zabel A -100 ❑ BOREHOLE ELL *H.R.P. Same as Benchmark To 91st. 120' O ' SYSTEM ELEVATI 95.9/95.8 St. 21 72-3' Line Pro 4 Bedroom Ouse 15' X 94' Cells with >3' Spacing 10' B- Vents Vents 33' 40' -3 B -2 25' `/ 0' 10% B-4 Slo _ ' TO a 18' ` SQP`Pe B.M. #2 n :v Vent 12" Sidewinder High n, of Cover Capacity Leaching Chamber Plans Designed Using 16 11 Conventional Powts 6' Long Manual Version 2.0 34" Fade at System Elevation •Wisconsfn Department ofCommerce SOIL EVALUAM -REPORT Page — L of 3 Division of Safety and Buildings in accordance with CorArn 85 Wis. AdW. Code ounty Attach complete site plan on paper not less than 8 1/2 x 11 irhbs4n size.��r include, but not limited to: vertical and horizontal reference infjBM), direction�and p cel I.D. percent slope, scale or dimensions, north arrow, and locatioPr -end dis to dearest road. _ ��ev) Pt , ?001 R1§ iew d by Date Please print all informatio ST CPQX _. Personal information you provide may be used for secondary purpos&s 4 ,(P,ri acy Law,QQUIQA �I) .Z� 2G>7 Property Owner j A j I P L a k QS ,/ - t)S .5 1/4,(11/4 S 6 T,jO N R 'g E(o W Pro erty Owner's Mailing Address k # Subd. Name or CSM# I- Car ac \ ^ l • L%6)< I®b I�icllara e I SO,, 1 ,#114iQ /.�etTf'/0 ?n City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road (l 6e4 b lc-e- I mA) 1 55 ho ( 651 ) ?gg--04gg l�s S t New Construction Use: Residential / Number of bedrooms Code derived design flow rate 5V GPD ❑ Replacement ❑ Public or mmercial - Describe: Parent material glclG�Ql dc,{ Flood Plain elevation if applicable ft. General comments inn a- — G s '• ?S' 'rPe Ye . �, , 4 +a s . , r ra �.' r�•^a"i ty,�'3 and recommendations: Q Q r r 1 Boring # El Boring Pit Ground surface elev. V3, D ft. Depth to limiting factor 1 oZs in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color I p - io Vp 3 IA S� a 8 -13 - 7,5YK "A/ S L 3 i3 - - 7,5Vk y y -- � ... '�sLy y a -31 - 7.54R N y SL / S 31 -y7 - 7.5I R 4 1'>f L S The soil test report for lot 3 was discovered to be 6 q' -1a4 7,5 y4 y q ------- 5 inaccurate during the septic inspection on Nov 2, 2001. The soil horizon reported as single grain at- ' z3 5 ♦ 0 d510 &o loamy sand was actually massive loamy sand with Boring occasional pockets of sandy loam. Therefore the Boring # loading rate must be .5/.7 and not .7/1.2. If this Pit Ground surface elev. I . �$ ft. error is discovered on any other lot, additional Horizon Depth Dominant Color Redox Description Texture borings /soil investigations will need to be performed in. Munsell Qu. Sz. Cont. Color for the rest of the subdivision. The plumber should 3 i 'S L make note of the potential for error and prepare for 1 o_$ O the possibility of increasing the size of the drainfield. N Q 9 -2 '7,5 R SL 3 ao -4S 7 YN L S * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L CST Name (Please Print) Signatur n 5;+Ck AC Address f I�!J Property Owner Lo.4es f I�S f•M►c. Parcel ID # Page of F3-1 Boring # ❑ Boring p K Pit Ground surface elev. 1 /, y / ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I 0_ )04R '/A aF6-R m FR a 2 F H 1 ' 'Ll e F c+� F s 3 0jo -41 ,5 qlq S C Fse Fg e N F y .4 l M Boring # ❑ Boring Pit Ground surface elev. / O • / b ft. Depth to limiting factor b in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I 'Eff#2 I 0 -8 164 3 a L �' FR G1 a F .S •2 a $ -11 )ow sy L aFSa K r P F, Cw i F .s .g 3 q- 15 MR ' CL cimsg mFg CW v F I . y .� SL- CVJ b yd -sq �,5 yR y !y a h L S 0 - 5 9 Mq p p Boring # F] Boring Boring 7* + `� a5° Q ( 20 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = SOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = SOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) S��l Sw'l S cc. Ito, 7.3 12.1 ��3 o N 14 M S c.a e ;1 ' Yo j a. oo ,�� c g i A i N v � 3 � OBm) �gM � �i?p, Ver"}, �- �Dri�. � I ►�3.e� �?� 49. �3nn � 98,34 , 1`e�cv►cHc t �+ Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Eff luent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 _71 s- 2�6 -s" /fig v Y--e ix � O V - 7 ,,,.�, Shaun Bird #2 6900 �Z ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address `�� l/. �� e��in -p /�"�✓ O� Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION � sk i Property Location - � /., /., Sec. T 3 6 14 - R W, Town of Subdivisio ` Lot #�. Certified Survey Map # _ , Volume ---, ,Page # ✓ //)) Warranty Deed # y/ / 7 Volume / l� / -� . e # Pag Spec house ❑ no . Lot lines identifi ❑ 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 maw journeyman 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 ;N4A;0F y iration date. ✓, APPLICANT DATE OWNER CERTIFICATION I (we) certify all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the p rty described ve, by virtue of a warranty deed recorded in Register of Deeds Office. 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 f Y1 1673PAGE 603 STATE BAR OF WISCONSIN FORM 2.1999 650194 Document Number WARRANTY DEED KATHLEEN 'H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Hillvale D e velo pment Limited, a RECEIVED FOR RECORD Minnesota Limited Liab ility Partn ership, — — — - - — — — — — 07 -05 -2001 9:30 AN — - -- —. - 1- WARRANTY DEED Grantor, and John W. Townse and Martha L. Towns husband EXEMPT II ad wife, _— CERT COPY FEE: — — — COPY FEE: — — —. —.— - - -_— TRANSFER FEE: 252.00 RECORDING FEE: 10.00 Grantee. — — — PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. C _ _ _ _ County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lots 10 a d 1 1, ine Valley Additon, St. Croix County, Wisconsin. Name and Return Add KRI8TIN%1 OGLANO ATTORNEY AT LAW P.O. BOX 359 HUDSON, W1 WIG Pt 026- 1022 -20-000 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, ifany. pE) (is not) Dated this '26 day of d 2001 Hillvale Development Limited + * By: Ridwd Nelsm AUTHENTICATION , ACKNOWLEDGMENT ^ -- Signature(s) Hillvale Development L a btirpesota STATE OF WISCONSIN ) Lirit T.;pkD tY Lla�p_ srd Nel.9nt ) ss. —__ — County ) authenticated this 2 ek day of Jow 2001 -- Personally came before me this day of the above named . K ristian Oglan ^_— TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me kwn no t, be the persons) who executed the foregoing authorized by § 706.06, W is. Stats - instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY . _ - -- Attorney Kr istine Ogland Notary Public, State of Wisconsin Hudson, WI _ � _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) -- — _ .) + Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Company. Fond du Lac. W WARRANTY DEED STATE BAR OF WISCONSIN 500855.2021 FORM No. 2 - 1999 I > tD I 00 Of _ N M toot- c : Z V .09 - Lss A..01.8S.00m — 0 ooa .os•LS� a o I W • m g gn '�• m _ go Z c' �� tt co 4 y�/ (� �o o �e ``s � � 7MH ��s -- -- :•--- 1N3W3SV.3 39Vry a0 - -- -- - I p W OJ l V 0 _ °s X6.41 9 1 N 6 cn ' „E 1 � 5g W 3 91 •15 33 -H N13 64SlN ms s' '�i or� 3,lSo0N mo< ,�,�"? ,00'0.91 A.01.99.00N +� M ^ .00•L Lz Qd N' c°N a �i N 1t N r,��"� t! -H 001 lZ oclo o N 4�/ti N �_ l ( .00'0.91 g o1.9s \ � a ! o M �M ('W'S'0) ,. 00 ISoOS ON co _��/ M ti 'y0� Lo- IL ' 35. 62 @ 11 \ N • M % I - ry9 R j 35.62 / MI� eW N LL, I N > LLJ 01 1 J I N U Z *• -,H N 00) �` q U I vi W U \ I ONQ M coN Q �,OS V Cf N W i in I _j r,N I D g£ .££ m I D N W W p m i I $ I $ —,Z6 6 L9— - i o n 3. L0,9Z,00N ° �i 99t ,00'09Z Z 6901 A « A 0 -- ----------- ---- - ------ ___---- aNd_l C]311` - ldNn - =M 8l 'N "N 0C'1 '9 03S 30 V /L MS 3H1 30 3NII iS3M