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HomeMy WebLinkAbout030-1009-40-200 �Cv>4i t'-e rvwt-.� ��108 ZI Z II Ilillll illlilll III 1111111 i 8 Tx?4181338 1 Document Number Document Title 994268 St. Croix Count BETH PABST Y REGISTER OF DEEDS Occupancy Affidavit ST. CROIX CO., WI RECEIVED FOR RECORD 04/02/2014 09:34 AM d((^ Gtq,� tC�GrdY1 EXEMPT #: Name— (Owner)Typed or printed REC FEE: 30.00 being duly sworn,states,under oath,that: PAGES: 1 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County,Wisconsin,recorded in Volume 1409 Page— 1/ Document Number 5111 26t.Croix County Register of Deeds Office: Recordin Area (59%91 a) Name and Return Address A parcel of land located in the NW%of theAlaJ '/4 of Section-- 3 ,�y.f f l r'ckSa Y► T _N—R /? W,Town of S�. J S 1y �St.Croix County,Wisconsin,being duly described as follows(' clude lot no.and romm tf SEW, subdivision/CSM or detailed legal description): 030 - /009- yo- Zap V%% /6 9 O? Parcel Identification Number(PIN) As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a bedroom home,or a design flow of A450 0 13d. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently a occupants living in this residence; _!�_ cc occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants,the system will need to be modified'to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated this Z day of_ f rl. f AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated this day of St.Croix County. nw Personally came before me this a ""day of z/ the above named _. C•` !t TITLE: MEMBER STATE BAR OF WISCONSIN t, to me known to be the n(— (If no who execut .he foregoing authorized by§706.06,Wis.Stats.) instrument and ackr fge the sam* n THIS INSTRUMENT WAS DRAFTED BY r V G Q •11 �.. * yc^ 1 ti O Notary Public,State of Wiscbnsin /3/ �T (Signatures may be authenticated or admowledged. Both are not My Commission is perm[�nenl: If not state expiration date: necessary) Date /07 b!; "THIS PAGE IS PART OF THIS LEGAL DOCUMENT—DO NOT REMOVE" 779s kdomtabon must be ooetpleted by submitter. document title.name 6 return address.and ply_fd required). Other Information such as the granting clauses,kagal descxiption.eta may be placed on this rest page of um document or may be placed on additional pages of the documw t.hWk Use of this cover page adds one page to your document and$ 00 to the 112220 ina fee. Wisconsin Statutes,59.517. St. Croix County 994268 Page 1 of 1 Wisewisin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildin. Division Sanitary Permit No: INSPECTION REPORT 408212 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: GUllickson, Brian I St. Joseph Township 030 - 1009 -40 -200 CST BM Elev: Insp. BM Elev: SM Description: 5 © .a' �e..s,`3t a ' g�� �•° �°.•.. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmar 'L„ s-� r Dosing Alt. BM Aeration Bldg. Sewer �� �0•�6 Holding St/Ht Inlet Tm 1+ St/Ht Outlet TANK TBACK INFORMATI0 h , `{' ASS• 4 i TANK TO P/L WELL G. /Vent to Air Intake ROAD Dt Inlet Septic f . Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System 2 ' 8 O I PUMPISIPHON INFORMATION Final Grade Manufa urer Demand St Cover GPM Model Num er TDH Lift > Friction Loss System Head TDH Ft Forcemain Length s . to Well SOIL B RPTION SYSTE CA,, � EN Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI oNS 3 6� -/ � SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING fa 4r� INFORMATION CHAMBER OR o • \tom✓ Type Of System: UNIT Model Number: �/ C*v -V - DISTRIBUTION SYSTEM Header /Manifold Distribution x Hol e x Hole Spacing Vent to Air Intake Pip Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bedlrrench Center Bedrrrench Edges Topsoil j 1, Yes ;_ No All Yes 11 No C ENTS: (Inclu o cyperepencies, persons present, etc.) Inspection #1: 1 2 } Ilml Inspection #2: 0 A, _t� � Parcel No: 03.29.19.45D ` Loc o atiorl:� 11$16 61st St udson�Wl 540; 6 (NW 1/4 NW 1/4 3 T29N R19W) NA Lot 2 �Q , I Par I 1�AI,t�yB�MUD•es�cirriptio� 1 n 2.) Bldg sewer Length `�1.5/'�'°`� t ". amount of cover Plan Use other' Re s de for addition n.' No (2— p OZ -p 9 SBD -6710 (R.3/97) Inse for s Si nature Cert. No� 12/1312002 10:51 7152687000 GILLE TRUCKING PAGE 02 .12/11/02 IUD OD: 3D FAX 715 388 4886 so oo E 1 nw ..c ON NG FFI E _ VIA I It __ _i _ 1 ► _ I� .. _. .' F �._...� ~� �� i •- I� � I._��. �� � i ' Ap Weonsin Department of Commerce SOIL EVALUATION REPORT Page _Z Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach site plan on paper not less than 8 1/2 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. Q 3o — /00 9 — �O - X00 Please print all information. R iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). QJW tAn �Z(0 S �p Z Property Owner Property Location Govt. Lot AIL, 114 N&I 1/4 S 3 T a N R E (or Property O7 is Mailing Address Lot # Block # Subd. Name or CSM# 66 ( /o /e. City State Zip Code Phone Number ❑ City ❑ Village 0 To Nearest Rggd New Construction Use: Q Residential ! Number of bedrooms 3 Code derived ign — rate S GPD ❑ Replacement ❑ Public or commercial - Describe: - - �-- Parent material Q—' t- '4'0e J Flood Plain elevation if applicab General comments and recommendations: �.?'... j ® 2002 n,�[._� C��s ICF- F Boring Boring # p [� Pit Ground surface elev. /�. 7 ft. Depth to limiting factor 7, /3 D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 o- 00 K 31Z S tr's- A/ Cn" s .2 LAD ? S e qle !m -T& Ai / a s 3h-) , 7 "Z 3 l30 �3xXs-�6 — s ( 5- f4 �� — �.>n A 7 I z Boring # ❑ Boring 'Z Pit Ground surface elev. 0 1 . 9 Fg ft. Depth to limiting factor 7� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 6 -7 /6 93/ 7- ' C, at S , 41 -vy . s yG ,LS ,w s,r3,C A4 C1 S �► . 7 , 2 T * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) nature CST Number _ .27 /v 7/ Address Date Evaluation Conducted Telephone Number 372 /yo AM-C w,� , a 1 7 40 .2 SBD -8330 (R07 /00) WL Property Owner ® Parcel ID # Page –;�' – of F3-1 Boring # ❑Boring ❑ Pit Ground surface elev. � 7 ft. Depth to limiting factor – 71ZS – 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 d 8` loll 31 , E J& as 3 4 1 q , ro Ail as .2 b Z Borin g F-1 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # F1 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 /ftz 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 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) AO lv AI'S3 Tz9N I9l,*-- zX -9 �7 I, L o?' 2 r Na i ' � G 4 r ' Z 9S' - I ' S1 S i _ i _ � r _ __ -� � ; � _� __ _ __ i — � — s '� , �I i � r I _ I I . - _ r - _ _ -;- �- -- � � � � ' � � I � � � � � � ! � i I i i i � � � j I i i - I � I �I i � I ' - - -- i _ � �_ i i, � � � � i i i - � I � � - -- � � - � I � �- � � � - i _. i ' i it ; i _. ' ' i, � � � � � I � ' � �'r :. � � � - � � -- -I i I i i i � _. I i i �� � I I � � i I I I I I I i I' ' ', i i � � i r i i � - Sanitary Permit Application safety &Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 �SCOns ®h Personal information ma ou provide be used for second purposes p Madison, WI 53707 -7302 Department of Commerce y p y [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not c s - z 3 1 state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. Coun State Sanitary Permit Number ❑ Ch 1rrmie*4o- prexipu application State Plan I. D. Number p I. Application Information - Please Print all Information Location: Property Owner Name a i ` ry �' y Property Location U J�Io�F A H02 `_' Np' 1/4 1/4, S3 121 ,N, Ij�9E (or)® Property Owner's Mailing Address I ST Lot Number Block Number LZC� -; - • Ci Zip Code Phone Number Subdivision Name or CSM Number �,�/ S O / (Ar 1 ° II. Type of Building: (check one) ❑ City ❑ 1 or 2 Family Dwelling - No. of Bedrooms X— ❑ Village ❑Public /Commercial (describe use):_ Frown of ❑ State -Owned It Nearest Ro 3 ' + Parcel Tax Number(s )o7C9,_ lod9_ III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 0 A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. Addi ion to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) jyt cQ "oo PTRF. A Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland P 11 Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ` ` t ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: F V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System vation . Final Grade Required Proposed Rate (Gals./day /sq. ft.) (Min. /inch) levation # , V 7� (0 ? q ,7 J Z. VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks /W V ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assu responsibility for installation of the POWTS shown on ched plans. Plumber's Name (print) P rS§ Signature (no ps): Business Phone Number ' �e 22iy°7 .74?- 6637 Plumber's Address (Street, City, State, Zip Code) 27 /yo V S fi An to 14 GA­ s as IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fe) Determination ?ZS DZ 2at32 X. Conditio of � Approval /Reasons for Disapproval: vw�s Nntt+Hn c 44*1ic tt �tr�Od fV�'"��Tt�sX�*^�� Sn�G(ttCct�`/c`ritt, SBD -6398 (R. 07/00) 3Tz1 NR I ZZ f y71 �FW l _ a G_O 7 z 4 A /oo • Lr• 00 _ _ i ioo f 6 ' .•NI 1 rd lo st to 3s7 s it Nk M SCJ 1 `= v ' .Z a 7 t - z4 h/ b0 J00 l .' ro1s�d �3s'7 I i Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page -of- Labor aro Hyman Relations Divi #on of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code C Attach complete site plan on paper not less than 8 1/2 x 1 Ian must include, but not limited to vertical and horizontal reference point (B �tt pe, scale or dimensioned, north arrow, and location and distanc �ngarest road. APPLICANT INFORMATION— PLEASE PRI L INFARMAI,ION rRZIEWED BY DATE � PROPER OWNER: t , PR LOCATION 1 �3 ,.✓ GOYrI; T d 1/4 t� 1/4,S ' T N,R ,E (or�YV PROP RTY OWNER'3jMA ING A SS y' "' LOTS BLOCK # SUBD. NAME OR CSM # Is = CITY, ATE 1 ZIP CODE P R VIL GE MOWN NEAREST ROAD l S x New Construction Use Residential / Number of be _� [ ] Addition to existing building j ] Replacement (] Public or commercial describe Code derived daily flow gpd Recommended design loading rate gy bed, gpd /ft trench, gpd/ft Absorption area required �& bed, ft trench, ft Maximum design loading rate __,_Z_ gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) / It (as referred to site plan benchmark) Additional design / site considerations Parent material 1 _ Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING T NK U= Unsuitable fors stem I [Z S❑ U C@ S U 0S ❑ U jgJ S ❑ U EIS CO U EIS LA U SOIL DESCRIPTION REPORT 6ILit�;,ra S � zcsvu Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Botxtdary Roots � .:::. ...... in. Munsell Qu. Sz. ont. Color Gr. Sz. Sh. Bed Trench .� Ground - } elev. /42i - ft. y — — Depth to limiting factor 9/ Yf' e,/16 x Remarks: Boring # 7 •`� . �s � Ground el v. ft. Depth to limiting Z factor c� Remarks: CST Name:— Please Print Phone: 3 Address: J Signature: Date: – // CST Num er PROPERTY OWNER SOIL DESCRIPTION REPORT Pag of ,z— PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench as Zf Ground S elev. � } -kv-9"? A4� Depth to limiting factor 7 Y© Remarks: Boring # {� :C ;<:;. L 1 ...... i...... ...... Ground / ' } elev. _ / ft. Depth to limiting factor Remarks: Boring # '�� - - Ground / elev. _ Depth to limiting Sy 6 factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) A/7 ; s�� ; 7 ,✓, �iy'l IN r J l 1 � y s'G '/ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of Z • FILE INFORMATION SYSTEM SPECIFiCA;TIONS Owner Septic Tank Capacity �Q�j al ❑ NA Permit # y Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model /OV ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al NA Estimated flow (average) gal/day Pump Tank Manufacturer O�NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer NA Soil Application Rate , 7 al /da /ft2 Pump Model KNA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit FL NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L t�,In- Ground (gravity) ❑ in- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510^ cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: KNA Other: ❑ NA Other: t�*IA * Values typlcal for domestic wastewater and septic tank effluent. Other: O)NA MAINTENANCE SCHEDULE Service Event Service Fre quency Inspect condition of tank(s) At least once every: ? 13 month(s) (Maximum 3 years) ❑ NA J earls) Pump out contents of tank(s) When combined sludge and scum equals one -third ( %) of tank volume ❑ NA Inspect dispersal ceil(s) At least once every: 3 13 Ryear m ant )(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA ear(s) Inspect pump, pump controls & alarm At least once every: month(s) Syr NA ❑ y ear(s) Flush laterals and pressure test At least once every: ❑ month(s) A ❑ year(s) Other: At least once every: 11 month(s) NA ❑ year(s) Other: � NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (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 14!01) Page Z­o Z � 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 celi(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 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. 13 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. 0 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 affect 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 F med Name ne I ) is — , 2a, 4 1 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5, Phone Phone 7/ g- 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. 06/26/2002 09:01 7152686637 GILLE TRUCKING PAGE 02 ,01/06/01 4ON 16:30 VAX 715 386 4686 ST CRI CO ZONING 0002 Sr CROIX COUNTY SEPTIC TAM MAWENANCZ AGUSUU 'T" ,AND O RSWP CERMCATiON FORM owae�r /flttyas r� cow GO I °� Ie s o ✓� Mailing Address l q P/ yl e w ad Lo we e - A2 , JLU IS ovl ' WT S 61 (o Property Address / � � � /'� � 471J.to✓► ('VesMeadon required fiam Fbmaiag Departmaat for now City /State ,LLRL o 0 1 U_a Paroal IdantifieWon Number Q 3 " 0 QJ,= v " J4DQ L DUClIP` ION Property' LaoWoa N fi, T a�,,, Aj3 — W, ToWU of F. Ss �,.. Subdivision ^ ___,� L)t # r C Survey Map # 2 S7 3 . Volume --, 71 Warranty Deed volume Page: �'k , 06 Speo house C3 Yes Y no lot lines ldenafiable t o y es Q r x UWmpar use and maintenamaoof your septic q0 Could rmU in its pmzAtuxe failure to bmA a wntee, Px'opar =Wjw awA consists of pumping out fife sepdo tank every tbrae yam or sooner, if needed by a ltceaaad pamper. ' VUt you put into the system oaa WW the litaadn of 06 &optic tank as a treatmloat stage In the warn+ disposal tyrstem. The pcopony aw=r agrees to submit to St: CWt ZoWM Doputmt a oettificatiaa form, a gxwd. by &C owner and b a maswplumber, 3outuoymim ph=bex, rests OW A mbex or a lira me dpumpe�r vedlying that (1) tho ask -ti xt a rastewaterdispos&1 system 1& iii pr" operating candtdon aod/ox (Z) after itispe ction, and puaqftg (it SLO atsa y), the uptie tang: i : Loss than In fiA et Shop. tlwe, the undenignad have read the above requirements and apvv to maintain the private sewage dtgpe, ta.l gstem with the standards set WN hciy4 as sect by the Dapartmeut of Commerce and @ILO Deputneut of Natural Resources, Stmt y of Wisconsin. Certifeoatieit stating that your !optic system has boon tttairtWned must be, Curd and itwmad to the St 91% Co ink Zoning 0Twe wid i n 30 day; of the thme Years r`oviration data �� WOXATtTREt OF A"LICANT DATE T (we) eedify fbat all aratemonu on ibis fa= are hue to the 'best of my (our) knowledge. I ( e<ro) dim (an) tito ave►AOKS) of tin~ px*vorty es-edbed above, by virtue of a wexranty deed xecorded in Register of Deeds Office. b / aFJ12 -- SIGNAMU OF APPLEC,A'NT DA'M ..v + :r , iafotmatioa that Let min- reprngontod exla3r seavlt the sanitary peewit being revoked by du ZaAiag Depattwant' " «k +« •+ iatiude with tide application: a 4umped. warranty 4eW Stan tbo Rater of Demb oMoe a Dopy of the oart3fied survey mop if reforattca is made In the vraart tnty deed VOL 1469PALA0 i ut �1l 1 State Bar of Wisconsin Form 1 - 1982 5 38972 WARRANTY DEED KATHLEEN H. WALSH DOCUMENT NO. REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Richard W, .LaCass,e, a RECEIVED FOR RECORD .. married.. person t.. . . . . .. . ... 03 -08 -1999 8:00 AM ................ ..................... .. WARRANTY DEED ... ............ . ............... EXEMPT D................ . ............................... CERT COPY FEE: COPY FEE: . . ................ and Brian . K...Gul.lickson. . a. single .pe.rson Grantor, TRANSFER FEE: 168.00 .. .. .... RECORDING FEE: 12.00 PAGES: 2 ........ . . . ............................. THIS SPACE RESERVED FOR RECORDING DATA ' , Grantee, NAME AND RETURN ADDRESS: WITNESSETH, That the said Grantor, for a valuable consideration .. . ............................... ........................ RETUHf�-' T'•,J: rtTLE ONE conveys to Grantee the following described real estate in St. Croix 706 19TH STREET SOUTH County, State of Wisconsin: HUDSON, W) a01e 030 - 1009 -40 -200 PARCEL IDENTIFICATION NUMBER See attached Exhibit A for legal description This _ is. not..... homestead property. (* (Ys not) Together with all and singular the hereditaments and appurtenances thereunto belonging: And Gra for ... .. .. wa rmits tit�e is good; mdefeasible in fee simple and free and clear of encumbrances except easements, roadways and restrictions of record. and will warrant and defend the 514L Dated this da of Februar _... .Y..... ,19 (SEAL) (SEAL) * ................... ............................... •.�3ichazd..F?:. Lal�asst (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) . . .. .. ...... .... ... .............. STATE OF WISCONSIN s St..,Croix, County. authenticated this .. day of 19 Personally came before me this ............. , day of ...... I--. February ..... .... . . . . , 19 9. the above named .... . .... * .. i;hard..W, LaCasse,,..... ....................... TITLE: MEMBER STATE BAR OF WISCONSIN ................ ..... . . .......................... (If not, . ....... ........ ............................... . . authorized by Section 706.06, Wisconsin Statutes) to me known to be the person . .. ..... who executed the THIS INSTRUMENT WAS DRAFTED BY foregoing instrument and acknowledge the same. AttQZn0y .. ......... . Eau Claire; Wtaconsin - otary Pu .... ..... ounty, ' (Signatures may be authenticated or acknowledged. Both ate not necessuy) My commission is petTnanenI. ( t, state expiration date: • Nauncs of persons signing in any capacity should be typed or printed below their slanawres. ) ... .... ANKy p L ZELif�llOw I9 .... . PUKM IIlOa�aialtaa �q �'��S VOL 1469rAciOr5 I'arlul'NW 1/4ul'NW 1MW'S� 'i l.2t_ , u.U+ n . _ 1 I 1 descriled as li+llu •s: I.++I _ + ' t'r+lilied tirnvc_r Blatt tiled April 17, 1795 in Vulunrc Ill, 1'.r • Together with right Of' ingress and egress its descriled as Access laseneut dated April 11, 1995, recorded Aprif 19, 1995 in VPIUme 1 118, Page 112, as Document Number 527872 Together kvilh a 50 fool wide easement Ibr ingress and egress located in the NW 1/4 ol'llne NW 1/4 ul'Section 3, '129N, R 19W, Town of St. Joseph, St. CI County, Wisconsin; lim'ther describW as follows: Commencing ut the NW corner ol'Seclion 3; thence S 00clegrees op ,1(y W, along Ilse west line ul'Ihe NW 1/4 ol'Section, 682.62 feel to the SW turner or Lol 2 ol'Cerlified Survey Map recorded in Volume I0, Pagc 2907 al the St. Croix County Register ol'Deeds Oflice being the point orbeginning; thence cumiuuing S 00 degrees 01'40" W. alum said West line 50.00 lect; thence S 89 degrees 58'20" E. 324.14 feet to the westerly right -ol =way ora town road being a point on n curve ul'a 80.00 1'o t radius curve, concave southeasterly, whose central an measures 15 degrees 59'47". whose chord bears N 37 degrees 05'56.5" H and measures 22.26 reel; thence nurlhcaslerly, along il►e arc of said curve and .raid right -of' way, 22.34 lim ut the point urcur•vature 411 811.00 Ibol radius curve, concave westerly, whose central angle ueasores 27 degrees 18'40". whose chord beat's N 31 degrees 2(1' 3()' * hi and mcasures 37.77 feel: Ibalce northerly, along the are ors iid curve and said right- of -wa}, 38.1 3 Icct lu (lie Sli curlier ul'said Lot �; thence N 89 degrees 58' 20" W, ;110119 the south lilic ol'said lot, 357.25 Ices w the point ul'bcginnin�� i 52 78'7.3 y � 00 S FILED BEARINGS ARE REFERENCED TO THE WEST Z 9 r- D A►P� 1 9 1995 1 i TO BEAR S00 01 O4 WSECTION 3 ASSUMED " 1 KATHLEEN H. WALSH C Z Register of Deeds A� m SL Croix Co., WI m rt o L v "J I O �A � L. L/ AI ' 4 S m (1 rr o --- - - - - -- - - - -- goy xrn(n p O a WEST LINE OF THE NWI /4, SECTION 3 zz C e W o , n S00 ° 01'40' W w� N X' N• S00 0140 W F0 40 "W 599.62' 83.00 z g z m 1879.53' 509.11' 90.51' f = 0 0) ° Lo Z 0 � 9D � ft rt zc OD w Z Ln o g w r•- ;U O v o 0 • �,, °., _I rn 11, 00 0 P L" y D O �wW � D N IE N 74 .00 z 0z soo 014o w •� �, OD Icy , '-- o I I C - ROAD - DEDICATED - =r0 w -P (�� (_ ~' = I L — — I - N00 ° 01'40" E �' ►� -I • - & tis y F.. +�. C D D Ini �_ 0 19J, 0 ............ ° 1 N� -I = m n rn m o. F p I C7 V !° h w ♦ l`` 6� /C , `- ` d �+ 0 o I r NOO "E 429.54' X00' —J 1� n c rt 0 m (A 0 :E I r 0 -G I ry) OD w z N L4 n '� W a z v -4 ;0 v I w N 8 0 cn N ..I z Z H • 0 O A 1 N W Z V1 � H O 0 r 1300 ° O1' 40 " E 759.24' o X m x o 1 M Z ao -1 o do "t yw m ;r Z -n A N it m m o' 0 z z �' ap z - m v 4 G C - c: m F � G m --1 w' / SHEET 1 of 2 SHEETS ca VOL. 10 PAGE 2907