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HomeMy WebLinkAbout026-1153-29-000 Wisconsin Department of Comokrc- PRIVATE SEWAGE SYSTEM County: St. Croix Safi - nd Building Division f INSPECTION REPORT Sanitary Permit No: 463044 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: R.F.K Construction Inc. I Richmond Township 026- 1153 -29 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: � % � T 19.30.19.1167 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � J Benchmark g Alt. BM >t e. Le.� � ` ` �d Z •57 - 3 , 9's 16a Aeration Bldg. Sewer , ZS 7T Holding St/Ht Inlet (. y'7. - TANK SETBACK INFORMATION St/Ht Outlet N- � 1 7. Z.5 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic J ' � � � j � � / � � _ Dt Bottom Dosing "7 1 Header /Man. Aeration Dist. Pipe Holding Bot. System ` S PUMP /SIPHON INFORMATION Final Grade _Z5 1 ? '6 Manufacturer De and St Cover Model Numb TDH L Friction Loss stem Head H Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r _9 Z L 7 7 e,& j `� •— SETBACK SYSTEM TO `P P/L B�LDG� IWELL LAKE /STREAM LEACHING Manuf rqr: INFORMATION CHAMBER OR .) Type f System: UNIT Model Numb DISTRIBUTION SYSTEM H ader /Manifold /� Distribution ro, e Size x Hole Spacing Vent to Air Intake Pipe(s) ` t,.G -S Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over % Depth Over xx Depth f xx Seeded/Spdded xx Mulched Bed/'french Center Q Bed/Trench Edges Topsoil � L D as No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 920 145th Ave. New Richmond, WI 54017 (NE 1/4 NW 1/4 19 T30N R1 8W) Glen iew ] ot 29 Parcel No: 19.30.19.1167 1.) Alt BM Description = &O. V, 5 2.) Bldg sewer length = 2-4 qyv\, L = p (� � - amount of cover r V 3 4& gnature Plan revision Required? Yes No j J Use other side for additional information. SBD - 6710 (R.3/97) Date Insep Cert. No. of an Division 2 County Alf Air I COI ��III M "son, WI 3 Sanitary Permit Number (to W filled in by Co.) (60$) 66 -3151 Department of Commerce U Sanitary Permit gwcog °4 State Plan 1 D. N In accord with Comm 83.21, Wis. Adm. Code, perso . t4 addces may be used for secondary purposes Privacy LA W, s FF /CE J ect Address (if ditTerent dusts Avg L Application Iltformation — Please Print All WOrmation - 000 property owner's Name AU= # � Lot N Block # l� 4�� 11 ) . property t Les Mailing Address 1't°petty Location o -. �-SM600 a . State T.t�p Phone Nuntbrr , N;IR W C I `1 1V� IL T of Building (check all that apply) 3'Pe � h Subdivisio Name CSM Number r 2 Family Dwelling - Number of Bedrooms PublidCommataal - Describe Use City_ V wnsbip State owned - Describe Use _III. Type of ermiu (Check only one box on line A. Complete line B if applicable) A ew System Replacement System TteattnD110Holding Talc Replacement Only Other Modification to Existing Sysiom B. Permit t Ravi s' n Change of Permit Transfer to New . [Sst Previous Permit Number and Date Issued Before Expintio Plumber Owner 1 �l 3 ©A q C2 JS/ IV. T e of POWIS S : (Check all that appl �ih -prsssmrized in-cnound Mound 24 in. of suitable soil Mound <24 in. of suitable soil At -Grade Single Pass Said Filter Constructed Weiland Pressurized in and Holding Tank Peat Filter Aerobic Treatment Unit Recirculating Sand Fd Recitcullting Synthetic Media Fdter ' Cthamber Dri Line Gavel -less Pi Other ( ilin) V. Di tment Area Info on: Di Area (st) Sysem Elevation Deai�(gpd) Design Soil Application Ratr(gpdsf) Dispersal Area Re (� sPe� p � . I - ----- — C/ � /7/ Fiber Plastic Cap acit y in Manufactu Total Number rer Prefab Sim S VI. Talk Info GP tY Concrete Constructed Glass Gallons Gallons of units New Existing Tub Tanks Sepuror Holding Talc Aerobic Tidtment Unit Dosing CLamha VII. Res tmsibili Statement- I, and a usibility for installation of the POWYS shown on the attached [� plumbers N ' ) Plumbers t� Busirtess J Phone (^ /� /^ Plumbers Address (Strt:et, City. State, zi.p vs rtjmnt Use Only Date issued ASWA Si a e (No Stamps) Sanitary Permit Fee Approved PPro� Surcharge Fee) �Q • Reason Denial (l � ia. Conditions of Approv"easons for Disapproval 3) Z� er' n r _ �+�C 0 SYSTEM OWNER: �`�` W r � ��2 S ,� S 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. AttarL coutptete plans (to the County onty) for the system on paper not leu th sm x 11 inches is an oil Test and System PL PROM %CT R.F.K. Homes 5042 1/4 NW 1/4S 19 /T 3 N /R,18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/8/04 BEDROOM 3 CONVENTIONAL XXX IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers none BENCHMARK V.R.P. Top walkout foundation # s ,� ASSUME ELEVATION 100 , Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 96.0/95.9 3' below qrade Alt. BM Top of 1/2" Pipe @ 99.8' Plans Designed Using Well is to meet all Conventional Powts Pro Town Road setbacks required by Manual Version 2.0 WDNR Vent Scale is 1" = 40' ALong Standard Biodiffuser unless otherwise Leaching Chamber with 3 1. 1 ft2 of Area noted " 3499 Grade at System Elevation 609' 2 -3' X 69' Cells with >3' Spacing 5' Pro 3 B -3 Bedroom �- House p B.M. * 15' 2 70' 15' 20' ST 0% Slope 20' Vents 5' B -1 150' G Pro Town Road oil Test and System PLOT PLAN , PROJECT R.F.K. Homes 55042 1/4 NW 1 /4S 19 /T 3 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/8/04 BEDROOM 3 CONVENTIONAL XXX IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers none ,BENCHMARK V.R.P. Top walkout foundation r AjV�� •� ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark r� SYSTEM ELEVATION 96.0/95.9 3' below qrade Alt. BM Top of 1/2" Pipe CC 99.8' Plans Designed Using Pro Town Road Well is to meet all Conventional Powts setbacks required by Manual Version 2.0 WDNR Vent Scale is 1" = 44' >6" Standard Biodiffuser unless otherwise of Cover leaching Chamber with 3 1. 1 ft2 of Area noted 6 Long 11 " 34" Grade at System Elevation t , 609' 2 -3' X 69' Cells with >3' Spacing 5' Pro 3 B -3 Bedroom House 0 B. M. * 15' 2 70' 15' 20' ST 0% Slope 20' Vents 5' -1 150' Pro Town Road M R Wisconsin Department of Commerce SOl REPORT Page of Division of Safety and Buildings in a h C m 85 Wis. Adm. ti Cod 'S Attach complete site plan on paper not less this 1/ 11 ' ches in �� .�PIf rqust ' include but not limited to: vertical and horizontal r er ce ight irection do �/� reel I.D. percent slope, scale or dimensions, north arro t neareNa$d. Please print all i ation. �F� y 'ewed by Date Personal information you provide may be used for s ry purposes (Privacy law, s. ) (m)). Property Owne� � � ^A 0 - ^ Property L n G • "`-,� Govt. Lot 1 /4 4 S T Property Owner's Mailing Address Lot # Block # SLPd. Name or 0SM# �(/ of 't:�� City State Zip Code Phone Number ❑ City villag low Nearest Road New Construction Use' sidential /Number of bedrooms c Code derived design flow rate GPD ❑ Replacement ❑ Public or gdjhmercial - Describe: Parent material OLA;6.zl� Flood Plain elevation if applicabl 11 ft. General comments and recommendations: �yv� Q�C� ✓ %N' ' / b ' C f J 1 /f/ ' 41 L' r �� o Boring # Boring I Pit Ground surface elev. ft. Depth to limiting factor I� `� in. Sal 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 - Eff#2 Ong # 0 Bqring E�j t 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 Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 �- ----------- Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- Effluent #2 = BOD < 30 mg/L and TSS 1 30 mg/L CST Name (Please Print) Signature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715- 246 -4516 AV Property Owner _ Parcel ID # Page of ®Boring # �, ❑,/Boring (19 q / `bd oit Ground surface elev. r 1 ft. Depth to limiting factor l &D 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# *E 2 (9 )0 /Dyll F] Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 I 'Eff#2 Boring # ❑Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Pit 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 'Eff#2 Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L service provider and employer. If The Department of Commerce is an equal opportunity se y ou need assistance to access services or c p y need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SB"330 (R.6100) A l Safety and Buildi County 1 t 201 W. Was ' Fe 7162 r p ro V 11 1 seonsin M SOn, 7162 Sanitary Permit Number (to be ed in by Co.) Department of Commerce (608) 266 -3151 Sanitary Permi A ti S tate Plan I.D. N In accord with Comm 83.21, Wis. Aden Code. nal inf o¢e� u maybe used for secondary purposes Privacy Law, s 5.04( >N�NG Project Address ( di nt than mailing address) 92 O L Application Information - Please Print All Information Property Owner's Nance Parcel # Lot # _ Block - # Property Owner's Mar7mg Address fon city, State Zip Code Phone Number V4. '�'• Section I s so n - 1 , �� E IL Type of Building ( \Use apply) �°` 4 101, 2 Family DwellinBodmoms ubdivisio Name CSM Number Public/Commercial - G State Owned - Describ S7". C � W city— r ty_ rllage�fo III. Type of Permit: (Check only on x on line A. Complete line B U applicable) A ew System Rep Treatment/Holdiag Tank R Only Other Modification to Existing B • Permit Renewal Permit Revision Change of Permit fer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Dm of POWTS System: (Check all that a on - Pressurized In- Ground Mound 2t 24 in. of suitab it Mound < of sum soil At - Grade Sin Pass Constructed Wetland Pressurized in Holding Peat Fil Aerobic T t Unit Recircu Sand ter Recirculating Synthetic Media Filter Chamber vel -less Pi (ex lain) V. Dbper=Vf reatment Area otmation: 10 D I Fr iE7 S p . Desi Plow (gpd) Design soil Application Rate(gpdsf) Dispersal (sf) Dis VL T4nk Info Capacity in Total Number utacturer to r Plastic Gallons Gallons of Units Conc ERA New Existing Tanks Tanks Sepdcor Holding Tank ofro Aerobic Treatment Unit r Dosing Camber VII. Responsibility Sim m I, the n responsibili foc installation of the PAWS shown on the attached PlmoWs Name (Print) Plumber's MP/MPRS N tuber Business Phone Number �5 ���q ��� Wiz, 6 Plumber's Address (Street. City, State, zip , s t VIII. Coun me rtment Use Onl s,„,,,,,,,,a Disapproved Permit Fee (includes Groundwater Date Issued t sgnatune s ) .'r"' Surcharge Fee) � Owner Given Reason for � � , � S a 7 IX. Conditions of App oas f royal}, a taus as i�pp �6Z- l/ O SYSTEM OWN 07p t t an F, e uent filte nd l�Ll�c/ dispersal cell must all jbe serviced / maintained as per mane rovided by plumber. 2. All setback requirements must be main are as per applicable code /ordinances. Attacb complete plans (to the County only) for the system on paper Vlot less x t; inch is sift / Gd vY: 6(h� 2 15 -ea-af ° r W , x b �i► w 4b fi -y y' 1 i 4 /NDPRESSURE T PLAN PROJECT R.F.K. Homes DDRESS 1390 Neal Ave N. Lake Elmo Mn 55042 1/4 NW 1 /4S 19 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 2269W DATE 9/12/04 BEDROOM 3 CONVENTIONAL XXX IN -G CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chamb s none 7 2 IL BENCHMARK V.R.P. Top 1/2" pipe �UA4 --7 ASSUME ELEVATION 100' Filter ZabelA -1 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 97.2/97.0 5' below qrade Alt. BM Top of 1/2" Pipe @ 99.8' Plans Designed Using Well is to meet all Conventional Powts setbacks required by Manual Version 2.0 WDNR 209' operty Line Scale is = 40' ve unless herwise note >619 Standard Biodiffuser of Cover Ching Chamber wit .1 ft2 of Area 6' Long 1 1 e 1% Slope 3411 Grade at Sy Elevation p B -2 50' 2 -3' X 69' Cells with >3' cing nts 5 ' ��, fir' B -3 35 , 10' O P 5' .S 40' � W ST - BM � Please note: survey w o 30' completed at time of testin , ro 3 setbacks from lot lines may Bedroom change. Installer must verify House 609' all lot lines and setbacks before installation. Pro Town Road I /NDPRESSURE T PLAN PROJECT R.F.K. Homes DDRESS 1390 Neal Ave N. Lake Elmo Mn 55042 1/4 NW 1/4S 19 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE9 / 12/04 3 BEDROOM CONVENTIONAL )00( IN -G CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DO/ebel HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of c 7 22 P pip �. Filter IL BENCHMARK V.R.P. TO 1/2" I 7 ASSUME ELEVATION 100 , 0 El BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 97.2/97.0 5' below Alt. BM Top of 1/2" Pipe C 99.8' Plans Designed Using Well is to meet all Conventional Powts setbacks required by Manual Version 2.0 WDNR 209' Pro Line SCa is 1" = 40' Vent U SS Odle ` ted >6 » Stan Biodiffuser Of Cover Leaching mber with 3 1. 1 ft2 rea 1" 6' Long 1 1% Slope 34" Grade at System Ele on P B -2 50' 2 -3' X 69' Cells with >3' Spac' Vents 5' B -3 35' 10' 30' g 1'h Y2 40' St ST -1 BM Please note: survey w o 30' completed at time of testin , rd setbacks from lot lines may m change. Installer must verify 609' all lot lines and setbacks before installation. Pro Town Road . Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _l_, Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code n County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ° L " 1 - q' 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. �o D Please print all information. viewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �b Property Owner Property Location I. d3" P,) Go Lot IIIR1 /4 S T3 0N R E (o W Prope Owner's Mailing Address of Block # Subd. Name or CSM# City tate Zip Code P one,Number ity ❑Village XT o Nearest Road New Construction Use:X 31 Residential / Number of bedrooms �— Code derived design flow rate " GPD 0 Replacement ❑ Public or commercial - Describe: — __ - -___ _-------- _____ -- __ -- Parent material Flood Plain elevation if applicable General mm comments data vs� � i/tit J(. i` �. and recommendations: O E] Boring Boring # a pit Ground surface elev. ! v t ft. Depth to limiting factor 0 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. 'J • J •Eff# •Eff#2 "S c a .3 ®Boring # Q Boring JC pit Ground surface elev. ft. Depth to limiting factor 0 Y 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 `Eff#2 f - �, a ✓ rte ' LS Q rn S / V C 65 r7 /� � - 7 /. t Effluent #1 = BOD > 30 < 220 mg(L and TSS >30 < 1 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 _ /� o 3 715- 246 -4516 Property Owner _ Parcel ID # Page of 37 Boring # E] Boring ��? 14 Pit Ground surface elev. _1 V ft. Depth to limiting factor in Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ 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/f * in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 Eff#2 Boring Boring a # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Appl ication 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 'Eff#2 Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mgA- ' Effluent #2 = BOD <_ 30 mg/- and TSS 1 30 mg1L 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 (RAW) Soil Test Plot Plan Project Name Lakes and Hill Development Shaun Bir Address P.O. Box 10598 White Bear Lake Mn 55110 CSTM 226900 Lot 2 9 Subdivision Glen View Date 7/1 03 1/4 N W 1/4S 1 9 T 30 N /R w Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" Pipe System Elevation 97.2/97.0 *HRPSame as Benchmark Alt. BM Top of 1/2" Pipe @ 99.8 Scale is 1" = 40' unless otherwise noted 209' Property Line Please note: survey was not Please Note: Tested area B -2 50' completed at time of testing, may not be suitable for setbacks from lot lines may desired building area. change. Installer must verify Check system location all lot lines and setbacks before excavating. 5' before installation. L B -3 M. 35' 10 B.M. 30' 1% Slope 5 Not enough slope to establish contours k -1 609' Pro Town Road ST CROEK COUNTY MA .'INTENANCE AGREEMENT SEPTIC IANK AND 0 y Bg SHIP CERTIFICATION FORM Owner/Buyer n /� spa Address 13 ? O Mailing _ � � Address Department for new construction) Property (V required fmzn Plannin8 3 Parcel Identi fate fication Number �2 City /S. /W LE GAL DFC9�PTION /�'� c � Town of ' p Location Lot # Subdivision Page # Volume CertiSied Snrvey Map # Volume � Page # Deed Lot lines Dee # y Warrant3' identifiable C3 Ye o Spec house /z r no wastes. Proper snaiatenance S premature failure to bandle into the system in its P t You Put YS _._. ,.,r,►T� WE r Wba Y P o 8CPti0 system could result needed by a licensed pua� groper use atta s�amtenBIICe f your every three years or sooner, disp osal system. cut the se ptic as a treatment stage in the waste disP consists of P��on of the sop signed by the owner and by a can affect the fun m a certification form, orate owne I system owner agrees to submit to St. Croix Zoning D that (1) the on - site waste c The property d pumper verifyi l or a license 1/3 full of sludg restrictedp (• the septic task is less masterplumber, journeymanplumbe than r, ec if necessary), is ra Proper operating nditio con and/or (2) ate' tion and Pump sy stem with the standards e to maintain the private sewage d�spos� ents and agre anent of Natural a s°urees, State of Zoning 0 d have read the above re4u'r�0 returned to the St. Croix County Zoning set f the undersigned t of Commerce and the Department set forth, herein, as set by the De P,edmust be completed stating that your septa system bas been main j days of the three year expiradon date. SiQrNA l'CJRE OF APPLICANT ICA'T'ION ' eds Office. knowledge. I (we) am (arc) the o wner(s) of nWNER CER on this form are true to the best of my (a�� I (we) certify that all state ments deed recorded in Register of De described above, by virtue of a warranty / O the property DATE OF APPLICANT revoked by the Zoning Depatttncnt. * " "« S QNATURE errI being sss * «* An information that is finis- npresentedmay result is the sanitary p ed d warranty de from the Register of Deeds office e certified survey map if reference is made in the warranty deed ** Include with this application: a stampe a copy of th Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent 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 C Plan #1. 1 ystem fails, determine cause of failure, use alternate area and install new m tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 • U 2g51P 1q3 - 7 -4 !!59 nZ3 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST CROIX CO.. WI RECEIVED FOR RECORD This Deed, trade between Hillvale Development Limited Liability 11/06/2003 11: 30AN Partnership Grantor, WARRANTY DEED and RM Construction Inc Grantee. i:XEMPT I Grantor, for a valuable consideration, conveys and warrants to Grantee R EC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 951.00 (if more space is d, please attach addendum): COPY FEE: CC FEE: Lots 5, 9, 17 29, A0, 31 and 41, Plat of Glenview in the Town of PAGES: 1 Richmond, St. 1x, Wisconsin. Recording Area Name and Return Address 030 - 1056 -30 -000 030.1_055 - 90.000. 030.1055- 95-000.030- 1055-20 -000• Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of November 2003 - .. -. _.. — ..... --- .................... - ....................... __-- ... ...................... .._............... * » F=vale Development Limited Liability Partnership * - ---- ---- -------- ----- - - - -- AUTIMMCATION ACKNOWLEDGMENT Signature(s) STATE OF Vl,� ---- ) --------------------------------- rac ) 55. v L ` County ) authenticated this NotPrY Public s mte Of lsconsin Personally came before me this day of November , 2003 the above named Hilivale Development Limited LiabilitY * §y_ Ri chard Nelson TITLE: MEMBER STATE BAR OF WISCONSIN — � (If not, to me known to be the person(s) who executed the authorized by § 706.06, Wis. Stats.) ins and aclol wl a same. THIS INSTRUMENT WAS DRAFTED BY A ttorn ey - Kristin Ogland - - - - -- --- . ........... _ ... - - -- * � - - - -- - utkt—p-1 --- - - - - -- - -------- 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.) ( Z= , - -- ) -- ---------- - - -- — — * 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 800 - 655 -2021 WARRANTY DEED FORM No. 2 -1999 i lJ C.1 1 1 N 11731 D , v I T 1 1'1 32 3 1 , 1 'z ' % v % s , ? 33, ?1 40' ; jL 9F A 68 4 68 12' / 2S S / C 1N3W3Sl / y // a �y� �; i 3�Id N � I •I OD / (A y 1 I rn;T1 v N ( I r ~ A / o N O I D ;a N O jam— 0 rn En ` / n - � 1 if m cn •o I � I ;►1 \ - - - - -- �� ------ - - - - -- wr vV � p i` N Nx 'f► CD w