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HomeMy WebLinkAbout026-1296-08-000 epartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix uilding Division INSPECTION REPORT Sanitary Permit No: 644903- 0 F G7�EN ERA L INFORMATION (ATTACH TO PERMIT) State Plan ID No: ersonanormation 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: 0210— L v V 1 �' f 41,`.,n 0 CST BM Elev: Insp. B Elev: BM Description: Section/Town /Range /Map No: /a> (� GS C" �,, N 9e.29. 413zIS TANK INFORMATION ELEVATION DATA 07, 30 IT{, /537 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. X" z Septic t�$�'tG. ✓� ;i 3 Benchmark .Z Dosing 6Aol6. t0� 4&A, a dr S ��13 ?4eraier— ges�- �� �� Bldg. Sewer 915 • -7 Holding St/Ht Inlet g •75 1s• y s TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / , s , y It 15y 1 Dt Bottom Dosing �� S , , Header /Man. Aeration Dist. Pipe 5. ' Holding Bot. System 94. b PUMP /SIPHON INFORMATION Final Grade 2 . 1 /b? • / Manufacturer ' 1 Demand St Cover •� 79,5 GPM �rq.Jl.�G.Li ✓�� �.� �la Model Number / E z,4.3 c l G�� /66, Z TDH Lift Friction Loss System stem H ad TDH 9.5 ,, ( r s • Z§ Forcemain Len h S / * Dist. to Well MS' SOIL ABSORPTION SYSTEM BED /TRENCH Width j Length I No Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r(� 76 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: U Model Number: Na' NHS NIT � DISTRIBUTION SYSTEM Header /Manifold Distribution + // x Hole Size x Hole Spacing Vejto Air Intake \ Pipe(s) $Q' . '5 ` �J Length Dia Length V Dia Spacing � Z Z SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center / • C'j Sed/Trench Edges �` Topsoil 1 es No es No COMMENTS: (Include c ode discrepencies persons present, etc.) Inspection #1: Co / 2 5 / b$ Inspection #2: 1 4 Location: 446 N. Glove Rd. Huds WI 4016 ( W SW 1/4 9 T28N R19W) NA Lot 2 NOW d� Parcel No: p9.28.19.137G 1.) Alt BM Description = br rv.ti� a �� ~ � Gl.� n 5 O ✓` �^•1'`sCx 1 l vt� VS�.p' 2.) Bldg sewer length = (4 4 1 / a5 a - amount of cover Plan revision Required? ❑ Yes No ( � ZS 0 2 Use other side for additional information. J __ ___ _ c! SBD -6710 (R.3/97) Date Insepctor's gnature Cart. No. i 4 ' 7 Safety and Buildings Division copy J ) ' /1 �� 1 201 W. Washington Ave., P.O. Box 7162 ') ( rij Madison, WI 53707-7162 Sanitary Permit Number (to be fill i ed n by Co.) �(/ (,- /6 Sanitary PP Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Aden. Code, submission of this form to the ap o riate ov tal / 3 / - / unit is required prior to obtaining a sanitary permit. Note: Application forms for O are ject Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may vurDos in accordance with the Privacy Law, s. 15. 1 m , Stats. L Application Information — Please Print All Information Property Owner's Name Parcel # q p ' - ) � I6 7 Q6 J CB Property Loeafion cr's Mailing rnE CE11lED �, 05_3q) ,d, is 04- City, State Zip Code Phone IliAppb4� 4 7 O O T -� 1 V, won 7 L Ed ✓� 5� of ­7 flrr ff(( GG T R/E W 11. Tip Building (check all applY)- LotXT. IX COUNTY 2 Family Dwelling Subdivision Name Itug— Number'ofBedrooms n- ) �/f 3-13 �" I / — Block # !� �� / -rJ / Kt ❑ Pubiic/Couunercial L.—� �� ❑City of ❑ State Owned — Describe Use CSM Number ❑ Village of �-- wn of ? /� III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A System ❑ Replacement System ❑ TmatntentlHolding Tank Replacement Only ❑ Other Modification to Existing system (explain) B. ❑ 'Permit Renewal ❑ Permit Revision 11 Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of PONM S stem/Com onent/Device: (CbeclCaft that 1 ❑ Non - Pressurized In- Ground ❑ Pressurized In-Gro t Gradc ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank 11 Other Dispersal Component (explain ❑Pretreatment Device (explain vs 71! V. Dis ersaIlTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dis ersal Area aired (st) Dispersal Area (st) Sys levation -15 _7D 1 491 VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks Septic or Holding Tank X Dosing Chamber i9 VII. Responsibility Statement -1, the undersigned, assume responsibility or fa ation of the POWTS shown on the attached plans. Plumbers g ame (Print) Plumber's Signature MPIMPRS Number Busince* Phone Number Plumber's Address (Street, City, State, Zip Code) VIIL untyl De ent Use Onl pproved ❑ Disapproved Permit , Fee � Date Iss d / Issui Agent Si ❑ Owner Given R eason for Denial UL Conditions of ApprovaUReasons f Disap o al SYSTEM OWNER: 1 Septic tank, effluent filter an� dispersal cell must all be serviced / maintained as per management plan provided by plumber. Ire ij a anbmu to the County only on� fc 11 MCb.K* as per applicable code /ordinances. SBD -6398 (R. 01/07) Valid thrn 01/09 PLOT PLAN PROJECT 'Country View Ridae LLC ADDRESS P.O. Box 176 New Richmond Wi 54017 NW 1/4 SE 1/4S 7 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 99.4' BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. Top of Sgirvey Iron ASSUME ELEVATION 100' Ffiter BEST GF10 -8 [:]BOREHOLE O WELL +H.R.P. Same as Benchmark B. Prol2ertv Line 9.4 ' 00' Grading is to be done to divert run -off Scale = 1/4" = 10' 99 B-3 away from system Tank is to be properly bedded and provided with lockdown covers with 5% Slope approved warning labels Area 15' below B-1 Huffcutt Combo Tank system is to remain undisturbed Well is to meet Pro 3 all setbacks Bedroom found in Comm. House 83 399' property line 1.7' Acre parcel 4 165th Ave Safety and Buildings 4003 N KINNEY COULEE RD C0111111 @rC @.WLgOV LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 • ww w.commerce.wi.gov /sb/ ent of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary April 18, 2007 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/18/2009 Identification Numbers Transaction ID No. 1385957 SITE: Site ID No. 724224 Countryview Ridge LLC Please refer to both identification numbers, 165th Avenue above, in all corres andence with the agency. Town of Richmond St Croix County NW1 /4, SE1/4, S7, T30N, R18W Lot: 8, Subdivision: Countryview Ridge FOR: Description: Three Bedroom At -grade System / New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1126596 Maintenance required; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s): At -grade Component Manual, SBD- 10570 -P (R.6/99), Pressure Distribution Component Manual - Version 2.0, SBD- 10706-P (N.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Depq m�,1 vl h�'mag include local inspectors. Conditionalv DkPARTMENT 017 COMMERCE 1�.1VISION ; ETYtlyA BUILDINGS SHAUN R BIRD Page 2 4/18/2007 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, a Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 erard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633' jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. RECEIVED APR Y 2007 Q C'E SAFETY tipp� & BU aQ � 11 010 Cover Page BU ILDING S sPF� Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 4/9/07 Owner: Country View Ridge LLC Location:NW1 /4 SE1 /4 S 7 T30 N,R18W Richmond Lot 8 Country View Ridge 165th Ave System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01 /81) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -11. Soil test Shaun Bird Signature r" License number 2V6900 SE-E 70RP,ESPO ENCE ' PROJECT Country View Ridae LLC PLOT PLAN ADDRESS P.O. Box 176 New Richmond Wi 54017 NW 1/4 SE 1/4S 7 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 99.4' BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑BOREHOLE O WELL +H.R_P. Same as Benchmark B. M. Pror)erty Line 100' 99.1 Grading is to be done to divert run -off Scale = 1/4" = 10' 99' B-3 away from system B -2 Tank is to be properly bedded and provided with lockdown covers with 5% Slope approved warning labels Area 15' below B-1 Huffcutt Combo Tank system is to remain undisturbed Well is to meet Pro 3 all setbacks Bedroom found in Comm. House 83 399' property line 1.7' Acre parcel 165th Ave >sJ -2:5 $ £ - we �Faf.Mn� ....� - . r 5 • W � � STAStZ: Z' �,D o��YltT►ses �Eit. 2t 5 J./ 6 1/ ZB I'LL F - TE ELL Of L Ft. rC pt Sit mkt, i' Otc Distri 3uT#8!'� i~C #83C3i Soil Cover Neil t - • • � �•'` , , N ! � �V1fED � -AY�fC • 2: A Crsras Ssctzor+ of ;iiscorasi� At- $t'ld+e �'_ �t�h a Pun Via Ad a Site Siva A1SOZQZidri ArEa ort 3 Slop $ Page_ Of Distribution Pipe Oet it for Lateral getwwk hecerr - _, C Force Pain T 4 E " P Last Role ShwId Be text TO - Z 3 Hol a Dia mew' P U V fit. ,,� I�t(es) X �.r -=-- inches i,,ateral �#iameter _._..�..— Force Hairy Viawter L#�s Imes Force Of Holes /pipe �� Invert devaati0n of Later' ------ ft. Signed; License Hnrber= Date: Sp ECIf -ICATIONS C"tt OSS SI;C�i A Iy ' 1 Ap'pROV ED ABOV E GRADE lICTION BOX MAO£3LE COY ER C f T £'I pZP£�� 4� £o3 / glC o nom Fit tSli 1411. I aE _r I GAS, ` TIC'EIT s�A TlG s M; a pig£ 90L1 O rr � •-- F' � . — ELF - SOIL UnDtR TAN CD E"tE PAID ' �tsB� DO SF.S• �� .:. StMC DOSE s - JoLUHE' � T �— - -- �-}� �i�ER GA L _ #) TRNK g ;ZFS = DOS C CR ^c'Ts: S = GAL ZY SUM As PER TION PZP �.— s�� ---YF RELY ;RE pr,11iP OFF Arm DI �� �� FEET . E $ E SvRE - �g ;C I FAC'F� ' VERTICAL I#1,F£ER z ' F �I4g F � ;C �I / IC 'Y PRA €�Y t milil m �1.fl�� X � SAL ; VIA" g ��. S I M F TA"- --"°�_ � •'�.. • LICEN NP LaserJet 3100; 1 713 =L Me , Sent By: 9 .;E S ER IES IEs ZI sUt�lP/ EFFLUENT PU�� P a95 o a �ateasEtaaA > Naga lwr� » OEM to !theta 1WOt cm Ow v 1166 was* 4199= f SI fO Oa S a7 32 SAO 27 24 L11 111axas 8@Ftld Mom 4118 115 39 530 10(A 70 W 32 113 27 3& 5.4121i54z%m �p 3m 63 1000 70 Sd 55 h 599310 0N3► 4114 41 32 138 2g v 8.tt z 1t.64:880 �40wti td8 90m mm 490 S45 a 1" 5000 70 84 55 41 1 s Me Won 70 is wow iaea��ossOsbROmi —"'� i'aamr►r1i011o4rgraM�dnol�l�a4 FLOW- LITERS/FMR MSlt�#iOR Cow Cost Ilan p Sa00 2000 3004 IM pd!5 MatUW Closed Vvm _ 10 —•- AM � volute .. ` Power Coed SJT1N A Nit&e with carbon and X20 Mecbaolilct Shah Seri ceramic faces ' 5 Fasteners _ _ Sriin}ess Stael i ' Shaft Stainless Shed Sa 2.3 BtatmBs - -- #( upper Steave and t.cwer i Bail Bearirw a 20 40 sQ 90 FLOW- caLLOW -fto n Lie C&IIt Pump CAL PUMP PERFORMANCE—CURVE =V 501iZ ! L?9�st]alOV•rJIChllomRab.�73i37 t b=,41'3l47.Wn •Fan: 4 W aaat� N'f wJAweG"mtPt mp.CAM R3 faerr 1233 —Q7N9 IW- Wisconsin Department of Commerce S ALUATION REPORT Page —L Division of Safety and Buildings --...0 . ' in accordance with mm 1�� t "ty S-11, Cr� Attach complete site plan on paper not less than 8 1/2 x 11 i ches in size. Plan must include, b limited to: vertical and horizontal reference int (BI ,�IiPe nand arcel I.D. 02-6,1 � percent slope, scale or dimensions, north arrow, and locatio ' and dis ni e t nf3er d. Review by Date Please print all informati ST CR O�XC � 5: O O4 Ui / Personal information you provide may be used for secondary pu ivf� � 6. 4� )). Ip 1} 5 Pro e Properly Owner� n f,- U ' 2 K� r�, -/Y- Govt. Lot LU 1/4 A S T � N R E( w Property I's Mailing AddrKs Lct # Block # Subd. Name or CSM# City State Zip Code hone Number C' ❑ illage To4W Nearest Roan New Construction Use: esidential /Number of bedrooms Code derived design flow rate -fa GPD ❑ Replacement ❑ Public or menial - Dgscribe: Parent material �z4 W Z/ J Flood Plain elevation if applicable i°!/�� ft• General comments - and > J � and recommendations: f+ 5'c � (! .G� CA � Se - S fe M Bori # pit Ground surface elev. 9 1 ' 7 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 F� 3/L S l c -�] Boring # Q Boring j / �Q�� pit Ground surface elev. y� 7 ft. Depth to limiting factor _y-e 5L in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure g;ary Ropts GPD/ff in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 'Eff#2 6 IC 3 a , (o Z-0 A IA J I < • Effluent #1 = BOD > 30 < 220 mg& and TSS >30 1150 mg/L ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 nxyL CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 J �� — 715 - 246 -4516 r � a Al- - 6�� Property Owner _ Parcel ID # Page of 3 3 ng # Boring / Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate -9 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfE in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E / ff#2 'L rj C( S �� �r (A. f- ` r �o - 7, 5 y/ 4! F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil )cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Boring a # ❑ 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/fF in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD < 30 mg& and TSS 1 MOIL 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. seo•e330 (x.6/00) Soil Test Plot Plan Project Name Country View Ridge LLC Shau Address P.O. Box 176 New Richmond Wi 54017 #226900 Lot 6 Subdivision Country View Ridge Date 5/20/05 NW 1/4 SE 1/4S 7 T 30 N /R W Township Richmond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron /Nail System Elevation 99.4 *HRPSameasBenchmark B.M. Ac 220' property line B -3 0' B -2 10, Scale is 1" = 40' IF 59 45' unless otherwise noted 35' 5% Slope 100' 90' B -1 99 ' 399' property line ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEt►IENT AND OVNERSHM CERTIFICATION FORM U' owner/Buyer p u Mailing Address Property Address / / 6Q (Verification required from Planning & Zoning Department for new construction_) yam/ City /Statef VQ� ' M w✓- Parcel Identification Number LEGAL DESCRYp'i'ION • � To wn & 1 /� � S ec. T AL I � property Locatlon , �____ r/ , S Lot # - «� Subdivision Volume Page# Certified Survey Map # ,Volume 2 Page : # O V_ I Warranty Deed # '� Spec house no Lot lines identifiable no SYSTEM iCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure ce bsz�dle wastes. Proper ears or soonez, if needed, by a licensed p> What you put into .maintenance consists of pumping out the septic tank every three y Croix County s Owner maintenance the system can affect the fb=don of the septic tank as a treatment stage in the waste C oun t y sa finance - �ponsibihties are specified in $Comm. 8352(1) and is Chapter 12 - St ) to St Croix County Planning & Zoning Department a �ficall t rm, signed by the The prop owner ag submit to restricted plumber or a licensed Pumper verifyu g that (1) on-sit tic tank is owner and by a mastat plumber, journeymen P lumber, on and pumping (if ), the s ep wastewater disposal system is in proper operating condition and/or (2) after inspection less than 113 full of sludge• tam with the I/ tmdersig�n to maintain the private sewage disposal system ed have read the above requirements and agree of Natural Resource& S� of Wisoansin- standards sei forth, herein, as set by the Department of Commerce and the returned to the St C C Planning & Certification stating that your septic system has been maintained must be completed and Zoning Department within 30 days of the three year expiration date. Uwe am/are the owner(s) of the Uwe certify that all statements an this form are true to the best of my /our knowledge. described above, by virtue of a warranty deed recorded in Reg ffices Register of Deeds O P d�c DATE SIGNATURE A,ppLICANT(S) �� ZOn3ng jkpenL* Any *** An information that is misrepresented may result in the sanitary permit being revoked by the Plaanmg Include with this application a recorded warranty deed from the Register of Deeds OM= and a copy of the cGreified survey �P d reference is made in the warranty deed. (REV. 08/05) PLjuq ipowrs OWNS S SYS SP � D NA ls 10 LZ saw I�iklt� Q i�hl II KA �.3 Elm X30 13 NA Psrr'i#r�Tank NA ;:- ' .................... ... . ................... .. �u� pwnpT� GHQ .PesmP II NA tVoted urn Rego 0 Pam JIM0,260 o ClV v bftnd trdt� m9 L C3 II Other ..,O Grasse 42 Q� wdado*von Demand " e" £3is Ce riCs? II � �I Toad &Wad* P e - a Mound � �; � Feces C0 3/ inc'hd[SMOW s ' yseceatsa pale sue vauaes fl rsborz�x fs3 i� s yrs j Event At feast once We"Y (3 )ref tw* v olume fns n of Watcts) Why, cac�nt:inr siu�ge and s3 (nsurn s-) �p oon� of to KS) At least once every S II resorY�'is s) � tt!(s) j once every ' s} CI NA C r At yeast once every --III $) ' Q HA fnspd pupvs PLMP cc aisrsss At least orwe OVwY rnord C3 NA FI-* and e t At ieas•t once TWY II fl yeat{s} C3 NA O" At least Of=* OWW of orle i� � ��01It5 calf° sf� be rrs d by �cs ruS PO ft w o -. P� bwiwn cww" boar. Tw* the �rwUn of sd to swwwgs crodw cr leaks• cs shad T ����� in the obi P a and (s of of to � �h car- M 9 odF s'�B and sc�sm m � per � of in Wham tam and be removed bY a � - � gonpits. aid any the todc(s) 10 kid backfaranybodOP or V 1 � or prewuri� p©WTS aom�• � by a pDtIYTS ,# �$ °f mss. r � j .�2 moms be of 21 - o�rr� � to tie fatal' 4€3 days of M prior to UM �of Pakd% START AND OPERATION PD�S ate �trT�wt t ok(s) sot' , e p� � aid For flew �• Pm a us h. cr€ #ie t arWar daMc- #fie do � vi t nw a ii�e mad by ;2 sepra38 servtartg °P d � ate Z • Fie �....r- i ,a• are f at the ink SLa .� std zsa: . Wheili pow abohre aom asp. tt�e cWs7 and try regain the D p s e � to I � s have the � of t p� to* �� to s Pdw w S poe►et t or Pt7 TS Sepwasemb tie P pQe #a t r tfm�E Or Pafk t?: : aA d OAS. Do pa s1&jm or ape of ow from m° or a.g We sod! ab� am- � and ptvfocx� to v Z �e Kral peter Qr.�� bWk. condoms; s12 n imp � ' derdd Soso � .�.� �,�e• pesficeder a ' AAAUDONOgElT tak�xt out c�i`senrice ts�e s s: Coda fie Why UM pig � �ler� a3" onrr�plrarsca %ft ch_ Corz:crr 83.33. W A,dti�'tsscafe�+e ,s= a pc�y'� and the ab.,dwad i� � seaTAd- Ai< [ t sttd pits stse be and 6--* sed of by a Sew s ilae ooe> t ate IwTx ed ar Vlar eo`"er.� te�"°M'd 8� • P ffiedttt soQ cmea cr sold roaieriai. PLAN rszeasur�s r have been. c nwa fie 10 Pie a code t#be f sowty sad Canz= b japanvd be u tEz�e�d €or tine toc�On ara s� If t" POWTS faft try Las bawl � and's 3' and cornpacSort and sb=W not Q A MIS n a area shouid be pcote� from d Eoi Saes and v eifs: tM semadcs tcorn ex nS and PAP �a be in ltse rseed tm a now soil and sifle'e L vai mat Slat titste . systems must QOmpiy vvM the rules in efiiact l� ' Pte$. ati�a nvw uble to setback an&cr coif O fJ A� $ � as a Last resort is mpiace the farm P� of pOW,� taUUM ieieeeSf3' a sf =dge repl2=ement area Upon a soiE and - Ztye sibs tm natbasn ewa was is a+�ble a / spe e+r� auts t be � t o locate ar sumbie n � esst a�S teo 't twkft tank tW be d 3s a 'go hart to In pklO-- of ra bbumd at assd must comply vvffis ttte rtties elTe+ct�!!>atffis iise �e FA=OrJS V L I=5oMC f SUC hSySftWrCS • q {flfK3 lt�tSLlFl =lt 11Tf OX!'GM < SfPM pUMP AND CrTfM R IrISA3�T TANKS M t:t3i i. ETfiA{ - A RC. DEATH MAY pD nor g T ER^ on O TMM Tp,6AT&qEMT TANK UNDER pR OF TANK MAY DtFPIC�i'F OR TH E RESULT_ . RESCUEOF •ADOMONALt -N POWTS MA WTANO!- POVWVTS tHSrAt.L�i name S ¢ a Phone ! � — Phane S�PTAGE SER1tiC�1IG tl �bRATQtt '�.flCAi REGULATORY Ai��IEHQ AgerICI Mme ' I ' V-,-A- phone 1 Phone rereets a�esdradrd bxvjs iwft df dw GPM Late AA4aMUaft and Watata= Cam' �d Ot roe e�lelt Vaasa BXtlCfi3 awd ffi.�f f ?. (�} AC�7. ;l►r'�!�' D° � D"° ofs Q fir} � yor6amcr�ce ailLre POifYI'S. 2656 P 061 774312 STATE BAR OF WISCONSIN FORM 1 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIK CO., WI This Deed, made between Gerald A. Kieckhoefer, Jr. and David RECEIVED FOR RECORD J. Kieckhoefer Grantor, and Country View 09/14/2004 10:20AK Ridee, LLC Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT # the following described real estate in St, Croix County, State of Wisconsin (the "Property ") (if more space is needed, please attach addendum): TRANS FEE: 13.00 See attached Exhibit A TRA FEE: 1410.68 COPY FEE: CC FEE: PAGES: 2 Recording Area Nam Return Address �Q k�yv/K` lllvl'�i, AID N26-1025-40-000 Together with all appurtenant rights, title and interests. 026 - 102430 -000; 026 - 102440 -000; 026 - 1025 -30-0 Parcel Identification Number (PIN) This is not homestead property (is) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any, of record. Dated this 2- day of 2004 * Gerald A. Kieckhoefer, Jr. * David J. Ki khoefer * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Gerald A. Kieckhoefer, Jr, and David J. STATE OF ) Kieckhoefer ) ss. County ) authenticated this da of 2004 Personally came before me this day of the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland, Estreen & Ogland 304 Locust Street, Hudson, WI 54016 Notary Public, State of 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 Co., Fond du Lac, w1 STATE BAR OF WISCONSIN 800655 -2021 WARRANTY DEED FORM No. 1 - 1999 I U 2656P 062 Exhibit A Located in part of the SE % of the NE '/. , SW Ye of the NE Y. of Section 7, Township 30 North �Ran 18 Of the of the SE' /. and the of St. Croix, State of Wisconsin described as follows:) 9 West. Town of Richmond, County Commencing at the East quarter comer of said Secti n , this also being the Point of Beginning; Thence S 'NV S00 °37'10 °E along the East Line of the SE'/ of said Section 7 a distance of 880.99 feet; "W on the northerly line of a C ad Survey Map recorded In Volume 13, Page 3752 a distance of 610.00 feet; Thence S00 °37'10 "E on the westerly line of said Certified Survey Map 428.42 feet (Record 428.50 feet); Thence S89 along the south line of the N % of the SE % of said Section 7 a distance of 1146.36 feet Thence N00 ° 33 1 53"W 1384.45 feet; Thence N88 0 57'22 "E 1048.00 feet; Thence N51 °00'00 "E 25 .00 feet; Thence N88 ° 22'35 "E 507.00 feet to a point on the East line of the NE'/ of said Section ' Thence S00 9 40'35 "E along Bald East line of the NE % of said Section 7 a distance of 248. 0 feet to (he Point of Be terminating. ginnln and there ere I lrn I 114 v CD N N r. ° Q oo O 00 N I 08 o S ao I N Z - 0 0 cV I I ra I N � I I ,£9'66£ M I w r l w I N I O No I �(D o col ,-; to N M N Z O bo N W 0 0 00 0 ( r, b .££ rA I I N ,� I .00L I t0 p I N cli fl I ,£9'66£ M `o N tC M V1 C+ c AN N 1 w 14,0 N C4 0 C4 pr. atop U L m �C '$� m mm� o �I I p W M O r � ��' � �j ` V C O C O Go CL 10, 00 Q O r -Qp 41 O N d' N V m F- p� � � -V N °i ca N w A I� N I 0 0° ° 1 � f—