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030-2019-75-000
- I o 0° d o d ID d 3 CD 3 _ T o o(n o j o oW ` • _ _ cn : 2. rl (D 7 Q OD - L N O p, N m 0, O O cp N N C N p v N fD O o O ! O O h CJl m 3 ° T o 0 , A CD 0 7 v z D m a L� 1` !D (o O O Q 0 cn CD 3 m 41 s;. o o W N lo t En c\ cn O @ 00 ., N N ` rn o co co CD n r N Ri j co * o c !fir co w C7 a �'•+ v 0 <Lnz ° r 3 - lA N cn 0 D CL N H 0 OJ !'z CD M = m :E 9 N m — cn A O , � o P C " A p 5 z CD • O a N' �f c Q CD N CD c M a z W m CL z 0 ^. z N 3 co C A C (D a cn D !: 3 7 O Q � co T v 3 �?' = < CD r: Z -0 ' 5 °. CD o N Z �_ cn ° - cn ' y Vl N N (Q O O � N CD A CD < W N I 2. ON c O O D (0 Z I * 9 < co W co O w N O1 (.J ti O CO O b � O 0 b O +C N W yq N Efl i� N A 0 ° ici n N 0 n N O$ n 0 d F 0 m F c m 0 C m .c3. c'o 0 ro .a s "*1. 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(D O Q 3, 0 N DJ F N 0 v C N 0 N �' 6 O -0 CD O S 3 0- O- (OD _0 O O D < p N -n Q (D N (D •`. 3 0 0 b O CD O ip w O 0 O A O 0 0 0- N `i Wisconsin Dcpartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515168 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: Cari, Samuel R. & Teresa I St. Joseph, Town of 030 - 2019 -75 -000 CST BM Elev: Insp. BM Elev: IBM Description: No: / 06-0 6pn 01.29.20.425F TANK INFORMATION ELEVATION DATA TY MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 4 Benchmark d�• /�.�v 2. 66 Iv2 � / D Z� Alt. BM Aeration Bldg. Sewer c41,� WeV V. Holding S/�It nl • � ? 5 ,, � 6, y7 G, / �.I J 3 TANK SETB CK INFORMATION St/Ht O �t�.. 3 .1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / Sep 'c `Sn � Dt Bottom / sing I_ r j ti- Header /M4a T;, 74 5 Aeration Holding Bot. System Final Grade PUMP /SIPHON INFORMATIO T L I / Manufacturer GPM nd St Cover 6 Model Number rw N TDH Lift Friction Loss Syste eacl TDH Ft ea Forcemain Length Dia. Dist. to We SOIL ABSORPTIONS EM 7 BED/TRENCH Width / Length [ o. Of rench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS - SETBACK SYSTEM TO P/L BL G WELL LAKE /STREA LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: �\ r UNIT Model Number: D T IBUTION S ^ Y /_ STEM w He 'M nifold Distribution L / x Hole Size x Hole Spacing Ven!tAjr ITntake' '2 1 Pipe(s) 7 / 7-'( T° Length Dia Length Dia Spacing 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 Ea No R Yes [� No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: I ( / Z /� Inspection #2: / / Location: 235 River Crest Trail Hudson, WI p 54016 (NW 1/4 NW 1/4 11�T229N R20W) / NA Lot 5 �Q Parcel No: 01.29.20.425F 1.) Alt BM Description = � _ �� r I � / ' V -Wv " " ' � 2.5 "t�wg-�vx�t. 2.) Bldg sewer length= e SIN - amount of cover = Plan revision Required? 2 Yes Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. r Commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P. o 71 St. Croix i s c o n s i n Madison, WI 5 Sanitary Permit Number (to be filled in by Co.) Department of Commerce Sanitary Permit Application NaateTransactionNumber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different t1an mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary 235 t p urpos es in accordance with the Privacy Law, s. 15.040 m Stats. 6 rCr4— I. Application Information - Please POKAII I orm ion Same Q M/C.. \ Property Owner's Name RECE Parcel # 030 - 2019 -75 -000 �c Samuel R. & Theresa M. Cari �47 J Property Owner's Mailing Address OCT 0 9 2009 Property Location 235 River Crest Drive wuw i r Go Lot 1 City, State Zip Code dWft3 �tON NNG OFFI 1 /4, Section 1 Hudson, WI 54016 (715) 549 - 6424 (circle one) II. Type of Building (check all that apply) Lot # T R 20 me ® or 2 Family Dwelling - Number of Bedrooms 5 1 Sub N; division Name 5 Na -0 m 1 k # ❑ Public /Commercial - Describe Use N City of CSM Number ❑ Village of ❑State Owned - Describe Use Vol. 7, Pg. 1949 ® Town of St. Joseph III. Type of Permit: (Check only one box on line y. Complete line B if applicable) A* New System L Replacem Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) System B. ❑ Permit ❑ Permit Revision ❑ Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Expiration I i IV. Type of POWTS System/Com ponent/Device: Check all t hat appl Non - Pressurized In- Ground L1 Pressurized In- Ground ❑ At -Grade 0 Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal /Treat ent Area Inform n: Design Flow (gpd) Design Soil Applic spersal Area Required (sf) Dispersal Area Proposed System Elevationy 750.00 sq. ft. 0.50 1500.00 sq. ft. 1,543.20 sq. ft. 94.70 VI. Tank Info Capacity in Total # of Manufacturer w Gallons Gallons Units o A Uv New Tanks Existing Tanks H H a a Septic or Holding Tank 261 wl pol Lo 1200 1461 2 Weeks Conc./Unknown ❑ ❑ Dosing Chamber S C f� h+ 11:1 0 El VII. Responsibility Statement- I,�e under gned, assu a responsibility f st lation of the POWTS shown on the attached plans. Plumber's Name (Print) umber' Signatu MP/MPRS Number Business Phone Number James K. Thompson 30021 715) 248 - 7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, WI 54020 - 5413 VII oun /De artment Use Onl Approved d Permit Fee Date ssue Issuing t Signatur _ w enial $ roval/Reasons for Disapprov t o 1 Septic tank, effluent filter and 1 ,J dispersal cell must all be serviced / maintained —�-' 5 �Cc�ropM as per management plan provided by plumber. y I �►w�L- C tCA 2. All setback requirements must be maintained lOW1641_ CA_ 2 eA , C -L . ns for the system and submit to the County only on pa r no 1 t a 81/2 x 111 hes i,,e V � r SBD -6398 (R. 01/07) Valid thru 01/09 �} s �JC.c_; � � — �GLM C� /'i S J��Q9r, -, �� ��o�'G SyS�¢ �►-� � /2d0.�iGn.S �'XiSL'rz) /,2G� �ct.P. l.�r✓e.�.�'on �Ja-�L: 97 ., 7 .3' �� oc to o ld. = 97 11' pu t1 l7 A. Spc,rs� Cc.11 = ST" 30.331 �� wooded io �sc.� r/ ✓C. irlg 75 / -fo sa/i ?aI.;I'OCtAd �. Sd �e�4 /ua•�i'on�. E EXi3_ Well = ,per- 2.1-7' �o rlQ, 'arl S �. r►1_ = 16 6v '� 60/0 �Fy� . qo P. d.C. '. its, G s� ✓aP. 7�.,gyq, �"�. / mot / 5.77 57 t 4 � S2c. /, Tz9/l,rP.20«J. �"xi3 d, s�eisaPCel �iti�/tia�iL �araJQ e Sd.SeseP�, 5t.c Co u Di 03D ages �c►` -,� R es :lence Pala 6 /otf'a� tfap ateo� R,r sr, a� 0.y r� Gf �j L me* �q E UC' o �4cJH > o f'D, t = 97.E - j��oposed e,.laeos c''eic AP('��C. /ocaa6'enoF r -- - Sepbc — / /"C Pl - S 5� d� e l"I've i era,to" -f f- . �lve- (Yt ,Qtd Pne3 SL "%tSTir13o.3 Aae LA k � v Br,• - ,9asU.0cd cIZ4"— 14'"P' 63 r �� ✓�r �e L�r. P Se-dols�su�ce!/. I'-rr04r �/' c C9� eI7 G•�.�5 a-� 02 ^o L a rte° �r IT]CO PY �C oe • � Sd %e ✓4 /ua•fon� %E �l�./�.rrj, _ /O.Z•ZSa�fy,00�'��e a.�ST.rrLS• ^� O. its, G S�7 ✓� 71• /f U. A( .3 ,Zo/? - -- i. o3 Qcres O f p 04 ACA �'d` -, Res�:[e►�ce Pala b /o�a•E t.^t�p door per S•T . H1o✓��/f Codi•✓ n .4P,orQx. / � �ro ytd c1 i verse 0 P,-opps /y /aC P1 L£ � 2 S reu�d � tllversi c v�. i � o� DPI CAM ' V i -� -- SC'jlSTirl3o.�5 t� fed Peres Qr u /} 3s u r»ttd ck4l - o�e 63 SQG CrC ) af— Prcpcsecddispe-sa/ce //. 3 'IT 7S'14.)l �r�rc� ,n�' /dam u ✓c' A X 9187 ' O A e� " 2184 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations I Attach complete site plan on paper not less than 8%: x 11 inches in size. Su County St. Croix include, but not limited to: vertical and horizontal reference point (BM), di [� percent slope, scale or dimemsions, north arrow, and location and distan arest road _ Parcel I. A (� 030- 2019 -75 -000 Ple print all rnformatron. Re vie d By Date Personal information you provide may be u for r rivacy Law, s. 15.04 (1) (m)). JL Property Owner Property Location Samuel R. & Theresa M. Cari Govt. Lot 1 1 4 IM S 1 T 29 N R 20 W Property Owner's Mailing Address OCT 0 9 Z009 Lot # Block # Subd. Name or CSM# 235 River Crest Dr. ,uuw 5 CSM Vol. 7, Pg. 1949 City State _J City J Village _Jy Town Nearest Road Hudson WI 1 54016 1 (715) 549 -6424 St.Joseph I River Crest Dr. New Construction Use: Wl Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD 0 Replacement I Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Soil suitable for conventional POWTS with 0.5 gpd /sq /ft/ loading ratre. Recommended system elev. _ 94.75'. Boring # I Boring e Pit Ground Surface elev. 99.41 ft. Depth to limiting factor >108 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 1 0 -8 1Oyr3/2 none sil 2fgr dsh cs 3fm,1c 0.6 0.8 2 8 -19 1Oyr4/4 none sil 2fsbk dsh cw 2fmc 0.6 0.8 3 19 -27 1Oyr4/6 none sicl 2msbk dsh gw 1fm 0.4 0.6 4 27 -33 7.5yr4/6 none ' sl 1 msbk dh cw 1 vf,fm 0.4 0.7 5 33 -40 7.5yr4/6 none ,7 Is Osg dl gs 1fm 0.5 1.0 6 40 -108 1Oyr4/6 none 1 gr s Osg dl - 1fm 0.5 1.0 Horizons #5 & 6 contain a high percentage of fines and 18" - 2" bands of 7.5yr4/6 Is. Loading rate of horizons adjusted to compensate for reduced permeabilities associated with fines and banding. a Boring # I Boring ✓J Pit Ground Surface elev. 99.76 ft. Depth to limiting factor >113" 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 1 0 -9 1Oyr3/2 none SO 2fgr ds cs 2fm,1c 0.6 0.8 2 9 -21 1Oyr4/4 none sil 2fsbk ds cw 2fmc 0.6 0.8 3 21 -30 7.5yr4/6 none sl 1 csbk dsh gw 1 vf,fm 0.4 0.6 4 30 -34 7.5yr4/6 none Is Osg dl cw 1 vf,fm 0.7 1.6 5 34 -46 7.5yr4/6 none fs Osg dl gs 1vf,fm 0.5 1.0 6 46 -113 1 Oyr4 /6 none rl gr s Osg dl - - 0.5 1.0 Horizons # 6 ontain c s a high percentage of fine - "bands of 7.5yr4/6 Is. Loading rate of horizons adjusted to compensate for reduced perme bility associated with fines and banding. * Effluent #1 = BOD? 30 < 220 mg /L and fSS >30 < 15 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signatur . CST Number James K. Thompson y-_. 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9/18/2009 715- 248 -7767 , r Property Owner Samuel R. & Theresa M. Cari Parcel ID # 030 - 2019 -75 -000 Page 2 of 3 3] Boring # Boring bri Pit Ground Surface elev. 99.95 ft. Depth to limiting factor >110" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/2 none sil 2fgr dsh cs 3fm,1c 0.6 0.8 2 8 -19 10yr4/4 none sil 2fsbk dsh cw 2fmc 0.6 0.8 3 19 -25 10yr4/6 none sicl 2msbk dsh gw 1fmc 0.4 0.6 4 25 -34 7.5yr4/6 none sl 1msbk dh cw 1fmc 0.4 0.7 5 34 -44 7.5yr4/6 none s Osg dl gs 1fm 0.5 1.0 6 44 -110 10yr4/6 none gr s Osg dl - *29.90 0.5 1.0 Horizons #5 & 6 contain a high percentage of fines and 1/E r- 1 " bands of 7.5yr4/6 Is. Loading rate of horizons adjusted to compensate for reduced permeabilities associated with fines and banding. F-1 Boring # J 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # J 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 P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 *Effluent #1 = BOD 5 > 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) A.C.E. Soil & Site Evaluations �. Sd�2 ✓4�ua�i'on/ M I Fj(13 {i q well i1 E� 81 / LCI� ! /Q Gam„ qO P. Ca. ?3S IP, �erC�es f 0.-. f�udson, Sao /( /6.Z. & F�sa�ST.rKC 5. %auk /e f C�nv = 97�'* ,[ot6, c-s YW71. /fs17, T,29R, �6.Clti/& uD4 \ v►`•, ` Resw; a ice Pa.Cre 6 1ecra - 6 t..�ap door �'or s,r io�.3SS,: �icl A, AAProz / �Q P4•,C Of f� ��?9 oy i � r o, DPI laia•, •h� �t� ltd �'ntS ry 3kf.y/D�Dd,C.P %�• /} SS U rn4ed 4/40'- 14?• 4 p (3� t��n�lc ¢.5 � ff � ,, 3 o < 6e - 99. (A/' rh ; �E�o �. ✓� cu r r� t ���� n Sa G I Ev 6e = 95! 75 w/ r)0 o �r �tC O e_ < �.3 Soil Absorption System Cross Section �� ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap �9 ft Leaching -- Chamber - 91 1 , 7 — o ft System Elevation ,2.8'3 ft 6, ft ft I Soil Absorption System Plan View �B. o ft I 2.83 ft { (�• 60 ft Leaching Trench 1 Chambers 4" Dia. Trench 2 Header Vent Or Observation Pipe [UNIIIIHIIIIIIIIII 11HIIIIIIIIIIIAM Trench 3 Leaching Chamber Specifications Manufacturer And Model T�n ; /z�idfor u�' EISA Rating .�O (5 0sq ft per chamber Soil Application Rate D.SO gpd /sq ft 7S0 gpd Design Flow D•SO Soil Application Rate + W.60 EISA = 76 Chambers rows of 9 chambers each. Page of I Conventional Septic System Management Plan Pursuant to Comm 83.54 Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10705 -P (N.01 /01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the excee 3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October - March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule b use of a diversion valve. Valve to P Y Y be turned diverting effluent from new dispersal cell to older cell at 4 year anniversary of new system installation. Afterwards, valve should be turned diverting effluent from cell currently in use to resting cell on a two -year cycle coinciding with septic tank inspection and maintenance. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248 -7767 or the St Croix County Zoning Department at (715) 386 -4680. ST Sizing Septic Tank Sizing Domestic Wastewater Based Residential Septic Tank Sizing Number of bedrooms Service frequency (yrs) Service frequency (months) Minimum septic tank size (gal) Commercial Septic Tank Sizing Design wastewater flow (gpd) Service frequency (yrs) Service frequency (months) Minimum Septic tank size (gal) Residential Service Frequency Based on Tank Size 1461 Tank volume (gal) 5 Number of bedrooms 2.10 Service Frequency (yrs) 25 Service Frequency (months) Commercial Service Frequency Based on Tank Size Tank volume (gal) Design wastewater flow (gpd) Service frequency (yrs) Service fequency (months) Version 6.0 (04/08) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND O,W�NER -S -HIP- CERTIFICATION FORM OwnerMox, 5 u�•y u Pte/ /C , `. / !l t..–�S �t � �-�'/ Mailing Address A 3 S GC�'�er Cres f D r Property Address 6a .Ke ,,r/ Verification required from Planning & Zoning Department for new construction.) City /State /` L4AJ6 t� /- Parcel Identification Number 030 15 yo /,L LEGAL DESCRIPTION G100 6. /0 Property Location 1 /4 , t /a ,Sec. �, T �N R 2U W, Town of � 6& 4 Subdivision Az , Lot # S . Certified Survey Map # 1357 , Volume 7 , Page # Warranty Deed # 483 Y_ , Volume , Page # 0Z' Spec house >y no Lot lines identifiabl yes SYSTEM MAINTENANCE AND OW CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. y Number of bedrooms SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 80 pool 148 NVZO "Is *940"1444 DATA is" Wage RVACII IlIt" DOCUMENT NO. STATE BAR OF WISCONSIN "RM 1-- WARRAMW MM swismws ofma ST. mix Co., W1 R. Landry and Carol J. Reed few Rwc This (d Deed, made between ....................... ................... Landry ----- APR 5 IM ................................................... ...................................................... -- ................................................................................................................. Grantor, at 3:15 PM and .......... !!! ....... !� .................... ri, a nd wife j.t eari anti Teresa M. Ca ---------------------------------- Wjjjl;�jj4 i ............................................... ................... ..surv ....... ...... ..... ..... .... • . . . jqy ..........•• ------- ............................ if-A-11"Wer of 0*06 •-- •- ------ - --...... —, Grantee, Witnesseth, That the said Grantor, for & valuable consideration - -_ ...................................................... .......................................................... 510=01104 TO conveys to Grantee the following described real estate in S;�,,..qroi ---------------- County, State of Wisconsin: Part of Government Lot 1, Section 1, Township 29 North, Range 20 West, Town of St. Joseph, St. Croix County, TRz r*md No: ----------------------------------- Wisconsin described as Lot 5 of a Certified Survey Map on file in the office of the Register of Deeds for St. Croix County, Wisconsin in Vol. 7, C.S.M. P. 1949, as Document Number 435702. Together with an easement over the private road shown on the above referenced Certified Survey Map and an easement over the road desc - 1bed in an Easement Agreement recorded in Vol. 654, Pages 55 - 57. And, togetber with and subject to all of the rights, obligations and interests created or imposed by the Declaration of Protective Covenants recorded in Vol. 676 , Pages 274 - 280. sul, 'SVFA b I r1n This ..... not _ .. ________ homestead property. (is not) Together witli an and singular the hereditanients and appurtenances tboreoida belonging; ----------- And.F,rc ntors John R. Landry and Carol J. Landry --....... ..... .................... .................................................................... ------- - Y --------------- warrants that the title is good, indefeasible in fee simple and free and clear of enewabrances except easements, covenants and restrictions of record and will warrant and defend the same. -- ---------------- - .................... Dated this ----------------------------- ------------------- day of ---------- ---- APT -- "- (SEAL) .................... (SEAL) . ..... ..................................... 10 ---- �John R. ry a --------- -- - ------------------------ ............................................................. .... ----- (SEAL) ...... -34 Land ............ .(SEAL) 1, Carol dry ......................................... ------------------------ --- ---- •--- •--- -..... _------_-- AUTEB14TICATION ACKX0 VLZDGM1CNT Sigrature(s) ------------------------------------------------------------ STATE OF WL -------------------------------------------------------------------------------- St. roix - - - - - -- County. -------------- ____ i 5Ah authenticated this __.-----day of -------------------------- 19._..._ Personally ease before me this ------------- ... day o* I 1988 the above named ------------------------ ....... ` . ................................................. John R. Land_py rol__j_. -Landry ----------------- ......... ... ... --------------- ..................................... ............... ........... ------------------- TITLE: MEMBER STATE BAR OF WISCONSIN .................... -:_4 .......... 1 9 .... . . ......• .• (If not ------------------------------------------------------------ ----------------- authorized by 1706.06, Wis. Stata.) to me known to be the pirso4 2 * : * w execu the foregoing instrusimmt an&,tckn?;X * o THIS INSTRUMENT WAS DRAFTED Sy - :P — --------- V ---------------------- ----------- ------- by Samuel R. Cari ------- -------------------------- - - ----- Notary Public ----- — ------- �S W q jA --------- County, Wis. - 204 -- L?5tU9r -- Sr - - -- q --- Hudson ---- Iff ------ - 5 m commission is perma not, state expiration (Signatures may be authenticated or acknowledged. Both are not necessary.) date: ... ------------ — ------ - - ........•. 19 .- - • -- -• *Nanws of persons sigulus in an capacity should be typed or printed below their zituature- WAPJt^NTT DEAD STATE BAR OF WISCONSIN Wisconsin Leval Blank Co. Ine- FORM No. I —196! Milwaukee. Wis. RLED (OF AR 3 0 1M immovoom a 0 18 Is s1t01�ItOn.M1 435702 CERT IF I E MAP LOCATED IN GOVERNMENT LOT 1, SECTION 1, T29N, R20W, TOW ST. CROIX COUNTY, WISCONSIN NW CORNER PRIVATE ROAD _ N 1/4 CORNER SECTION 1 NORTH LINE OF SECTION 1 SECTION 1 T2 I, R20W T29N, R20W -c 834.25' S89 0 47'49 "E� C1,41 00 S89 0 47'49 11 E 478.18' 66' i SCALE IN FEET o 1 1 w zt N (� ( 0' 100' 200' O 1 1 w z al 1 -4 1 � a4 o I D I - c.7 H Q I I z ! o � wl 1 w + UNP LATTED LAND S a` _ - - - - - - o c� ° - - - - - W o E I z I POINT OF BEGINNING ` H� al I H x a, p I I w i S89 0 47'49 "E 486.46' U'I P 00 zl cal z of ` i zI � 61 H ` I, Hal E-+ \ LOT 5 � 6 o z wl \ 3 \ 3.027 AC+_ °. w E--41 131,871 S.F.± ° o ELI LOT _2 \ � A 2 0 -941 \ o al �\ o H zl I ' � \ O En S 1 88� 8 , 2, N 1 s • 22, I I LOT __4_ � OWNER & SUBDIVIDEk JOHN R. & CAROL J. LANDRY R.R. #2, BOX 86A I HUDSON, WISCONSIN 54016 1 This instrument drafted by Michael E. Burke No i! 1 : $E CRM VOLUME 7 PAGE 1949 ry PgRIGSPL4NMNG: AND ZONNG c0ktxnuE c ° c d v 0 C Y1 �' ° .°°. (D m (D m n s i ft 3 - 3 0 0 _ o O 1 o m v o N .. 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A C N V D 0 o 00 'D O O .� O TI p O N Qo O O N m O R CD M 0 � CD lD (D iI7 z D G O N Q N T Go &) x. rt O O W Un N co C) o N �. c N Z N (D n CA .. S CD ro O O O o A--4 o D Cn a) c v G o 0 M N W CD — 9 N C (D °-' cn a A A � „ 7 o O O z z A Q D o 3 Z N w 2 O — Pd. a 00 0 Ch N (n CD CD o g _ �f In C Q CD _ •f I m c a CD m (p N 0 a j' z Z —I -' * m a `�° z 3 A 3 z N N m A C CD 7 a o to D F a m a ?1 3 c) co ° 3 CD �' -M � m w 3 z a M - - o a z W O _. cl, 3 y V^ y N Co O O CD A O W CD O 0 p D o 5 o CD (0 e CD c C , a 0) W CO O b 0 � � N dC A ,6q O o <D ti y } Widci_ sin Department of Commerce PRIVATE SEWAGE SYSTEM County �. Safety and Buildings Division INSPECTION REPORT ST . CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar8lent'.: Personal information you provice may be used for secondary purposes [Privacy LeAv, s.15.04 (1)(m)]. ftRf Holt r'sMame: [$ rty 46ftvlQ Town of: State Plan ID No.: fl� CST BM Elev.: Insp. BM Elev.: BM Description: Parcel _D'3W--:2019— — 00 TANK INFORMATION ELEVATION DATA A9800195 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer [ Holding St /Ht Inlet TANK SETBACK INFORMATION St /Ht Outlet TANK TO P/ L WELL BLDG. Air I to ntake ROAD Dt Inlet ir Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH I Lift Friction System TDH Ft oss H ead F Forcemain Length Dia. Dist. To well 7 F SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeOf CHAMBER Mod Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 1.29.20.425F,NW,NW 235 RIVER CREST TRAIL Plan revision required? ❑ Yes ❑ No _7_1 F Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' 3 SANITARY PERMIT NUMBER: I . ► ^ " Safety and Buildings Division e-�■�nr. SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave., In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. 3., c l k • See reverse side for instructions for completing this application State San ©w it Num The information you provide may be used by other government agency programs ❑ Chec,4 rsion to prev ous application [Privacy Law, s. 15.04 (1) (m)]. S a—al'e, State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Na a Propert Location ter ui4 W 1i4, 5 T z, q, N, R2(' E (or& Property Owner's IV14Lng Address Lot Number Block Number S C� e5 �' J City State Zip Code Phone Number Subdivision Name or CSM Number 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Clt Nearest Ro ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Rr — 'rown OF 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) �.a9.ao 5F �4a �zo l ° I -7s 1 ❑Apartment/ Condo O 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable), A) 1. E] New 2. ❑ Replacement 3. E] Replacementof 4 E] Reconnection of 5,pair of an System System Tank Only____,_________ Existing System _ _ Existi System Ve e# B) ❑ A Sanitary Permit was previously issued. Permit Number Date I ued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 1 WSSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (s . ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation ( es-1 . - 1 c 13- ° JS Feet c Y4 , 6 Feet Cap acity VII. TANK in Ca allo s Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Se ticT / 200 1 tA P41< rid w A ❑ I ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ 1 ❑ ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT [, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Name: (Print) s Signature: (No Stamps) o.: Business Phone Number: ee��� ei� t �b ��� �• 6�Z �c7LJ P r s ddress (Stree , City, State, Zip Code): S 1 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issui g Ag t Signa re (No Stamps) ' *Approved ❑ Owner Given Initial / Surcharge Fee) Z '8 Adverse Determination [ 2FO tov X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: r - �� - rlei v V IC_KA� ' SBO -6398 (R. 05/94) DISTRIBUTION: original to County, One copy To: Safety & Ruildings Divi. ion, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type_ VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water - mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system drequired by the county; E) soil test data on a 115 form; and F) all sizing information,. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ST. CROIX COUNTY WISCONSIN - -- `L ZONING OFFICE H I N N Inn move. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road - — Hudson, WI 54016 -7710 (715) 386 -4680 AFFIDAVIT OF SYSTEM REJUVENATION Property owner: Address: Day time phone: ( 216 7 �Y •}c — (,4 Parcel I. D. # "_zO - Zp1c{' - '7S Legal Description of property: _KIL-1 ; tA t,J ;, Sec. Zq N. , R. 'Zo A. , Tn. of St. Croix County, WI As owner of the above described ro er p p ty, I acknowledge that the septic system serving this residence ( # /is not) undersized by current code standards. I understand that the issuance of a sanitary permit to allow the attempted rejuvenation of the septic system does not imply that the system meets current code sizing requirements, nor does it imply that the proposed procedure will be successful. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Signature: Date: 5/97 . a f • ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT A FOR UTILIZATION OF AN,EXISTING SEPTIC TANK I This is to certify that I have inspected the septic tank presently serving the �a w. C-CIr` residence located at: _ tAW 1/4 1/4, Sec. ��_ T ZA_ N, R 2 W Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes �No (if no, skip next line) Approximate volume or length of time: q -oC gallons minutes Capacity: 1' Construction: Prefab Concrete Steel Other Manufacurer (if known): Age of Tank (if known): (Signature) (Name) Please int Cam., �c /lam Tom,', • Aa a k F3o 5� (Title) (License Number) Izo19S (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR -83, Wis. Adm. Code (except for Inspection opening over outlet baffle). Name Signature MP /MPRS 5/88 R ' 9 Si 7' ?Soil c�v.¢lv7t7i(o.J -f 'o R T E k!P A • c. (F T` PE'3'uA_ i A r I'a i 3 . •Wisconsin Department of Industry SOIL AND SITE EVALUATION 2 Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County sr . C)e01 • X- Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # o3o• 0 /9• 73 7 APPLICANT INFORMATION - Please print all information. RevIeV by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 3� � Property Owner 3 11 � e^ , Ae. Property Location �) Govt. Lot 410 1/4 4 1/4,S � T .2 Q ,N,R 2.0 E (or )(0 Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 235 �'; v�,P c,�P�sT 7�f.° • 5 s.�t. voi 7 P�.. q City State Zip Code Phone Number Nearest Road //V,Od A 4j /. Sy I ( 715 ) 5 1/f - &fb El City El Village Er ❑ New Construction Use: esidential / Number of bedrooms Addition to existing building ❑ Replacement // ❑ Public or commercial - Describe: Q Code derived daily flow 60 gpd Recommended design loading rate-- / bed, gpd /ft O trench, gpd/ft Absorption area require 9S I ed, ft 2 L= trench, ft 2 Maximum design loading rate • / bed, gpd/f1 trench, gpd /ft Recommended infiltration surface elevation(s) 9457/x, S'YSr = 13 d S It (as referred to site plan benchmark) Additional design /site considerations ��,, Parent material �' DV TWA V, _ G r $ Flood plain elevation if applicable ft S = Suitable for system I Conventional , Mound in- Grround r AT- Grade , System in Fill Holding Tank U = Unsuitable for system ag U L�"S ❑ U LAS 1:1 U I u U ❑ S [� [� El S � SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots U in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench . //• 23 /o YA 31� S/L /7`s!� A-41" es . z' • 3 Ground . 3 . /o ye y/ & - s L. / s d,� �.► `/ el v. lo. ft. o S D • 7 9 •y � s/ Depth to limiting far or 7 (((( ( j Remarks: s /S I E COJ?E • SYST . Boring # Ground elev. ft. Depth to limiting factor in. Remarks: CST Name (Please Print) �o�T � d!C Signature Telephone No. ! S CJIC tiTz pis • 3 86 Address Date CST Number • z Private Sewage Consultants 686 O'Neil Rd. Hudson, Wis. 54016 I � 1 � SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Ground elev. ft. , Depth to limiting factor in. Remarks: Boring # Y �'9AT, Ground elev. Depth to limiting factor In. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /fl2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. n. Depth to limiting factor in ' Remarks: Boring # Ground elev. n. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) O q �.� . p .57/1 f u ,j D �. S C S 7- ��a1eg , j%btl $e s9e r _ ons "110'0 s pvivateNe%% Rd• p16 ' 6550 N11s. 54 Hu„ds�on ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer !Sc.►,, Mailing Address 2 3 5 Z', _, C, I T. Property Address _ Z 3 t5 ' R sj� (Wrificatioa required from Ph=iag Department for new construction) Cit3atate � - k-A �.� �- Parcel Identification Number Zy /9 ' 7 S LEGAL DESCRIPTION Property Location _RU %, _AW /, Sec. T -aN R ZA�),W, Town of 54 • M5,r��'1 Subdivision Lot # . Cettified Satvey Map # =� Oa- Volume _ - 7 . Page # / �! Warranty Deed # _ '`� ��) S;' Volume 90 . Page # 1 _ Spec house 0 yes no Lot Lines identifiable 9. yes ❑ - no SYSTEM���i�4SN�NAN(� - • Im�tmpecasesad aoeofy' curse)ticgd=couldres*iaitspc ratutcfaili tohandlewastes.Proper . consists of pompiag oat the sgnic t=k CVCY three years or sooner; if necdedby t Ucensedpumpm Rlhat yom put.iato the syst= caa:ffcet*c fimcfim of do septic taalcas_a tieaftmenttuge imam waste disposataysbcm. Tie Y owner to submit to SL dune Zoubg Dot iL .cetfication form. sigua by ft owner and by i P�ictodphaabcrorsli�ocasedpumpaveafyiagtbat( IjdLeoa�ita�rasteavaterdssposalsysbcm ism prop"E condition and/or (2) after iaspoctioa and p=piag.Ctf neoe=w), the scptic 1= bran W . fiS of dudge. . Iw, ibe b -rid the above required and agroe to — ;-&I- &c private sewage disposal system with ft staadatds foA h=in.vs setbytine DotofC7oma c=sadthe DepartmentofNatudP=omccs Static of W n.. Certificahan starM9 system has born Completed and r WmedtotheSt: Croix CouatyZoning - Officewithin30 days of iration data. SI TURE O APPLICANT DATE O ON I (we) o that all meats on this foam are tme to the best of my (our) knowledge, I (we) am (are) the owner(s) of the pno" ab virtue of a wamaty deed r000rdod in Register of Deeds Office. SIGMA OF CANT DATE ssssss ormatioa that iS mis ssssss i -�nxeated may resalt in the sanitary Permit being revoked by the Zoning Department. ss Include with this apptication: a cUmpcd warranty dood from the Register of Dodds office a Copy of the cmetod survey map if reference is made in the warranty dcod I - g07 148 took p GOCUMENT NO. STATIC BAR OF WISCONSIN FORM 119sii "+�°ts 1°a aseoao'Ne DATA - - WARRAMTIf DM 43195 REGISTEWS OF ICE V. CROIX CO.. W1 John R. Landry and Carol J. Rata for Re Cati Land l ry a Deed, made between ............................. .......... ..----•---•--........ ................... .............. ............... -- APR 519! Grantor, 0 1 3:15 PM Samuel R. Cari and TEresa M. Cari, husband and wife sad ..... .. .... ................ ...... .......... auzvivors rahip marital property ..................... . .• - -• ......................... a .. .... ......... •- •...•• - - -- ................... ..-- -•.... _•-- •--------- •----- • -. - - -- -- - - rafORads ..._. ... .................•--••--•--......---••--•--.......--•----•-----•-- •----- .-..- •--- •-- •------ -• -... Grants% Witnessettl, That the said Grantor, for a valuable consideration__ - - -_ ....... ................ ..... •--•- •--- ..__...._........ •-•---------•--•--•---•-•-•--••-------_......._•-•••------ conveys to Grantee the following described real estate in St. Croix ___________ __ ssvwa w, To County, State of Wisconsin: Part of Government Lot 1, Section 1, Township 29 North, Range 20 West, Town of St. Joseph, St. Croix County, MaxFared No: ................................... Wisconsin described as Lot 5 of a Certified Survey Map on file in the office of the Register of Deeds for St. Croix County, Wisconsin in Vol. 7, C.S.M. P. 1949, as Document Number 435702. Together with an easement over the private road shown on the above referenced Certified Survey Map and an easement over the road desc in an Easement Agreement recorded in Vol. 654, Pages 55 - 57. And, together with and subject to all of the rights, obligations and interests created or Imposed by the Declaration of Protective Covenants recorded in Vol. 676 , Pages 274 - 280. N�F'EQ This .... is not---- - -- -- -- homestead property. OW (is not) Together Wit:: all and sing+llar the hereditaments and appurtenances thereauto belonging; And.grantors John R. Landry and Carol J. Landry ---_--__-_____--- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants and restrictions of record and will warrant and defend the same. Dated this ....... 5th day of - April -------------------- --------------------- 1988 ................ ... ..... . .. ...••- ............--- ._............. ...(SEAL) .... - 1_Z!� ± -- --- ---......(SEAL) a John R. La ry ----• ..........................••------ ......•-- •----------- - - - - -- -- -- - - - - -- •-- - -• - -- .......... ......................... (SEAL) .. -.- is ' -- CeG /� <' (SEAL) . Carol Jc Landry f - •--- - - -• -- - -- --------•------------ -- ----- --- •-- ---------- - - -• -- --•---------------------------------------••---------------•------ AUTSBNTICATION AC=NOWL$D[iMENT Sigrature(s) .. ........................... ........................... . .•. STATE OF WISCONSIN es. -------------------------------------------------------------------------- - - - -•. St . Croi — CID --- ----C. authenticated this -------- day of ........................... 19 - - - --- Personally came before me this ._.._.. -- -day o! -------- ---- -- April -_ . 1988 the above named John B. Land C rol J. - jLAp . d ry v� - TITLE: MEMBER STATE BAR OF WISCONSIN _ :. -� ;�( ; •• . , d----- - - - - -- �: (If not, - - - - -- ---------- - - - - -- - -- - - -- i ... --i authorized by 1 906.06, Wis. States) - - to me known to be the p r" g _. w e#ecuted the foregoing umazummt an AaOW ame. THIS INSTRUMENT WAS DRAFTED BY -- --------- ---- -IiFXT 001)> - by Samuel R. Cari a • �` ' `r t - - - - -- - - --- - - - - -- f - 204• - L - 6tumt - 'Sr - : ;•- Hudson - - { -------- 540-16--------- Notary Pubbe ------------ . -.S -�r Croix - - - - -- ..County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permane" ,(if not, state expiration are not necessary.) date: J ------------ .' 19 ------ -..1 'Name, of yemns signing In any capacity should be typed or printed below their signature- WAB.RANTT MIND STATE BAR OF WISCONSIN Wiccon:in I.eual Blank Co, Ine. FORM Ne. 1 -1962 Milwaukee. Wis. 4 FLED MAR 3 O JON 43570% CERTIFIE MAP LOCATED IN GOVERNMENT LOT 1, SECTION 1, T29N, R20W, TOWN OF , ST. CROIX COUNTY, WISCONSIN NW CORNER _ P R I V A T E R O A D_ _ N 1/4 CORNER SECTION 1 NORTH LINE OF SECTION 1 SECTION 1 T29N, R20W T2 , R20W -c 834.25' S89 ° 47'49 "E M °p S89 ° 47'49 "E 478.18' Q 6 SCALE IN FEET _ w v mI ° o I z ZI I 0' 100' 200' ° w z al El 04 I U � QI I z I o - w ( U N P L A T T E D L A N D S rn H- - - - - - - - - - ° z 0 c o W H I I I POINT OF O H H ^ a� U, ; BEGINNING v x a w l w 1 4 S89 0 47'49 "E 486.46' cnl <4 H 00 Z 1 o z 1 zI o al � a \ z \ z \ 6 LOT 5 _ X Q I \\ 3 3.027 AC± °. w HI \ 131,871 S.F.± °� o HI LOT _2_ \ \ U I 2 o al 3 w wl o a Z rn H xl GAL ���d' ♦� \ AAG� �� �SU \ ♦� 1 'z -r OWNER & SUBDIVIDER LOT - - - JOHN R. & CAROL J. LANDRY R.R. #2, BOX 86A HUDSON, WISCONSIN 54016 I 1 This instrument drafted by Michael E. Burke st �CD(00(X VOLUME 7 PAGE 1949 om 53, CONM�IfREE