HomeMy WebLinkAbout032-2116-70-000 Wisconsin'Depaniment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
'Safety and Building pivision • Sanitary Permit No:
I INSPECTION REPORT 395148 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:
Northe , Paul I Somerset Township 032 - 2116 -70 -000
CST BM Elev: Insp. BM Elev: BM Description:
Id a j 4 r,10 - 11
TANK INFORMATION t ELEVATION DATA
TYPE I MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
P d 3,3 t6 3 /
Dosing Alt. BM 3
Aeration Bldg. Sewer 3
r
Hol ' g Ht Inlet
91 Outlet 3. p 3
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe hit l 5r q�,
mg Bot. System n�'L $ trwo y ry
L
Final Grade
PUMP /SIPHON INFORMATION
Manuf rer Demand St Cover
GPM
Model Number X
TDH Friction Loss Head TDH t
Forcemain Length Dia. Dist. to well
SOI ORPTION SYSTEM (® S Ca
BE RENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM
z , 3
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEPaNtNG Mnn.,f
INFORMATION HAM OR
Type Of System: Mode
� 3 as•�
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
I/ ! Pipe(s)
Length Dia_ Length Z - Dia Spacing AIZ
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 [1 Yes j ] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / j Inspection #2:
Location: 569 217th Avenue Somerset, WI 54025 (SW 1/4 NE 1/415 T31N R19 W) Shadow Lo+ Id Parcel No: 15.31.19.1067
P
1.) Alt BM Description = �v - q K" t. Wa�I Kv we 4 ac� / / �� /
2.) Bldg sewer length= /4, r leQ W 50il S reW Qj'GA Gva�S �t�• ` �`�` hetli! ,
- amount of cover = ? 3 0 io'v �K:e V r (d+ P (a K
3') o d scr u ff tf «.
Plan revision Required? ' } Yes Do No j
Use other side for additional nformation. `-
Date Insepctor's Signature Cert. No.
SBD -6710 (R.3197)
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County St. Cr oix
Attach complete site plan on paper not less than - 8 1/2 x 11 inch iz�e�. Plan must
include, but not limited to: vertical and horizgntal reference po)nt,( M)i,2iifection and Parcel I.D.
percent slope, scale or dimensions, north rrow, and location and'dis6rn '1 0 nearest road. 032- 2116 -70 -000
Please pri t -all info �, Reviewed by Date
Personal information you provide may be gsed for seco' urposes y Law, s. -46.04 (1) (m)).
Property Owner . Pr arty Location
Hartman Homes, Inc. GoO. Lot SW 1/4 NE 1/4 S 15 T 31 N R19 XE (or) W
Property Owner's Mailing Address L�t # Block # Subd. Name or CSM#
271 St. Andrews Dr. &�' 10 na Shadow Pines
City State Zip Code Phone Number. ❑ City ❑ Village ® Town Nearest Road
Hudson, WI. 54016 17 555� Somerset 217th. Ave.
CR New Construction Use: I3 Residential / Number of bedrooms 4 Code derived design flow rate tin0 GPD
❑ Replacement . ❑ Public or commercial - Describe:
Parent material ,atirwash Flood Plain elevation if applicable n a _- — ft.
General comments
and recommendations:
trenches @ el. 95.30; spaced to code 4.00' below grade or to code El F1 Boring
Boring #
g ®pit Ground surface elev. 99.30 ft. Depth to limiting factor 100 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. I •Eff#1 •Eff#2
1 0 -5 1Oyr4/3 none sl 2mqr mvfr c
2 5 -34 7.5yr4/6 none sl 1csbk mvfr gw 1m .4 .6
3 34-10C 7.5ry4/6 none ms Osg mvfr na na 7 1
Borin # r � r Boring
2 g X^1 Pit Ground surface elev. 98.50 ft Depth to limiting factor 100 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f?
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
1 0 -8 10 4/3 none sl 2mqr mvfr
2 8 -34 7.5yr4/6 none sl jcabk
3 34 -10 7.5yr4/6 none ms Os mvfr na na 7 1
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L uent #2 = B < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Gary L. Steel 02298
Address Date valuation tonduRted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 7 -12 -2001 715 - 246 -6200
l
Y
Property Owner Hartman HOMeS, M. Parcel ID # 032-2116-70—()00 Page 2 of 3
Boring # ❑ Boring
3 g ® pit Ground surface elev. 95' 80 ft. Depth to limiting factor 100 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I 'Eff#2
1 0 -4 1Oyr4/3 none sl 2mgr mvfr cs 2c .5 8
2 4 -18 75.yr4/6 none sl 1csbk mvfr qw 1m .4 .6
3 18-10C 7.5yr4/6 none ms Oscf mvfr
]Boring Boring 4 # KI Pit Ground surface elev. 95. 80 ft Depth to limiting factor 100— 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
1 0 -6 10 3/3 none CS 1m .5 .8
2 6 -40 7.5yr4/6 none S1 1csbk
3 40-100 7.5yr4/6 none '7 1
Boring
F-1 Boring # Ground surface elev. ft. Depth to limiting factor in.
El pit Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
' 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 -5330 (R.6/00)
F
Property Owner Hartman Homes R I nc. Parcel ID # 032 - 2116 -70 -000 Page 2 of 3
Bonn # ❑ Boring
3 g ® Pit Ground surface elev. 95 ' 80 ft. Depth to limiting factor 100 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
1 0 -4 10yr4/3 none sl 2mqr mvfr cs 2c .5 .8
2 4 -18 75.yr4/6 none sl 1csbk mvfr 1m .4 .6
3 18 -10 7.5 4/6 none ms Oscr mvf
Boring r�❑- Boring
4 g : U pit Ground surface elev. 95. ft. Depth to limiting factor 100— 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 -6 1 3/3 none cs 1m .5 .8
2 6 -40 7.5yr4/6 none sl 1csbk
3 40-100 7.5 4/6 none 7 1.2
❑ Boring # F] Boring
Ground surface elev. ft, Depth to limiting factor in.
11 Pit
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
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.
SOD -8330 (R.6 100)
STEEL'S SOIL SERVICE
Gary L. Steel Hartman Homes, Inc. 1554 200th Ave.
CSTM2298 SW' S15- T31N -R19w New Richmond, WI 54017
MPRSW -3254 town of Somerset (715) 246 -6200
lot #10- Shadow Pines
N
1 " =40'
BM.= top of 1" pvc pipe @ e. 100.00'
alt. BM.= top of 1" pvc pipe 2 el. 96.80'
�n vt
'oo oil
20
Gary L. Steel
7 -12 -2001
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
6��nsi Madison, WI 53707 - 7162 Pe Address
Department of Commerce S D7
Sanitary Permit Application Sanitary Permit Number
In accord with Com 83.21, Wis. Adm. Code, personal ovide / /
m
❑Check if Revision
ma be used for secondary purposes Privacy s 5
I. Application Information - Please Print All Informa 1 7 State Plad I.D. Number
Parcel Number S 3 / . / q . / 0 ( '7
Proper Owner's Name
-'ZH ( - 000
Property Owner's Mailing Address �q. C �Q t r ; Property Location S T ^�
�: S f✓ J I N, R E
City, State Zip C e be Lot Number Block Number
4 `, ,1
Subdivision Name CSM Number
you
II. Type of Building (check all that apply) ❑City
,91 or 2 Family Dwelling - Number of Bedrooms (%/ []Village
❑ Public /Commercial - Describe Use Township
S Owned Z 3 x 3 Nearest Road
M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). ' Complete line B if applicable)
A For County use
1 New 2 ❑ Replacement System 3 ❑ Replacement oqExisdng 6 ❑ Addition to
S stem Tank Only st em
B. ❑ Check if Sanitary Permit Previously Issued
Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)
44 Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Rec' ating 30 ❑ Other
V. D' ersai/T� eat - eat Area Information: — O
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed Rate(Gals./ Days /Sq.Ft.) (Min./Inch) Elevation
VI. Tank info Capacity Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for hjstanadon of the POWTS shown on the attached plans.
Plumber's Name (Print) Plttm s Si tore RS Number Business Phone Number
M ?Gf� olo2D,3S 7 7is = � S' -G 9y
Plumber's Address (Street, City, State, Zin Code)
VIII. Cotmt /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Surcharge Fee) WD
❑ Owner Given Initial Adverse `
Determination
IX. Conditions of ApprovalfReasons for Disapproval � ,P- � �s
Attach complete plans ( t'^ ' onl y) f" h less than 8112 x 11 inches In sae
SBD -6398 (R. 05101)
�
TO" FROM: l C
C�J l/u rlS� DATE:
5 G 'lJ PAGES INCLUDING
THIS PAGE:
FAX #: PHONE #: p
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Wiscdnailf b epartment of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page 1 of 3
Bureau of Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 112 x 11 inches in size. )_nast -ut?ty
include, but not limited to: vertical and horizontal reference point (BM), ' lion and dk, St. Croix
percent slope, scale or dimensions, north arrow, and location and dista ce tvnearep Pafcela. . #
p" " kf~ we,
APPLICANT INFORMATION - Please print all inform tia�. �`��' by Date
,; e- I �•.,
evi d
Personal information you provide may be used for secondary purposes (Privacy w :'5',,15.04 (1) M.GNClx
Property Owner ! Pr2 01 '
Richard Stout vt. Lot SW 1/4E 1/4,s1 T 31 ,N,R 1 9 E (or}XN
Property Owner's Mailing Address , 0j y Subd. Name or CSM#
1353 Awatukee Trail Shadow "Pines
City State Zip Code Phone Number ❑ City ❑ Village KI Town Nearest Road
Hudson Wi P4016 (715 P49 -6731 Somerset 160th Street
® New Construction Use: Residential / Number of bedrooms 4 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 6 0 0 gpd Recommended design loading rate • 7 bed, gpd/fl 8 trench, gpd/ft
Absorption area required 858 bed, ft 5 0 trench, ft 2 Maximum design loading rate • 7 bed, gpd/ft • 8 trench, gpd/ft
Recommended infiltration surface elevation(s) See plot plan ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material COC2 Flood plain elevation, if applicable ft
E U S = Suitable for system Conventional Mound In- Ground Pressure AT- Grade System in Fill Holding Tank
= Unsuitable for system ®s ❑ u ®s ❑ u f1 s ❑ u I R7 S ❑ u 1 ❑ S E] u ❑ s ER u
SOIL DESCRIPTION REPORT
Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft
9 Texture Consistence Boundary Roots
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 1 0 -10 10yr2/1 -- sil Imabk mfr cs 1f .5 .6 .�
2 10-80 10yr4/6 Ms osg ml -- -- .7 .8
Ground ,
elev.
96. ft.
Depth to
limiting "d /
factor
Remarks:
Boring # • r
1 -10 10 r2/1 Sil 2mabk mfr cs 1f .5 ..6
2 0 -2 10yr3 6 I s lmabk mvfr cs 1f .7 .8
3 24-79 10yr4/6 -- s osg ml -- -- .7 .8 •�
Ground
elev.
96 _3n ft.
Depth to
limiting
far in. Remarks:
CST Name (Please Print) Sign re Telephone No.
Address Date CST Number
1, 70 5c
Richard Sto SOIL DESCRIPTION REPORT 1 rt�w:
PROPERTY OWNER car — Page of
PARCEL I.D.#
Boris # Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
3z" 1 0-10 10yr2/1 -- sil 2mabk mfr cs if .5
-- 2 10- 4 10yr3/6 -- is 1mabk mvfr cs -- .7.8 �-
Ground 3 24- 9 10yr4/6 -- ms osg ml cs -- .7 .8 .�
elev.
95 ft,
Depth to
limiting
factor
7 in.
Remarks:
Boring #
1 V I-10 10yr2/1 -- it 2mabk mfr cs 1 .�'
4 2 10-24 10yr3/6 1S lmabk mvfr cs -- .7 , .8 .�
3 24-79 10yr4/6 -- s osg ml cs -- .7 .8
Ground
elev.
96 ft.
Depth to 3�e 1•b
limiting
factor
7 g in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # 1 -10 10yr2/1 -- it 2mabk mfr CS 1 f .5 '. 6 �
LU 2 10 -2 10yr3/6 -- s lmabk mvfr cs -- .7 ,.8 •�-
3 4 -7 10yr4/6 -- s osg ml cs -- .7 ;.8
Ground
94. 1 '61-
ft
I
Depth to
limiting
M n. i Remarks:
Boring #
I
Ground
elev.
ft.
Depth to
limiting
j factor
in ' Remarks:
SBD -8330 (R. 07/96)
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?2 4 T
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Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number
Number of Bedrooms
Design Flow - Peak (gpd) p
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal)
Soil Absorption Component Size (ft S - L
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) Ft0 �-
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septi nfilte and outlet filter shall be assessed at least
once every 3 years by inspection. Th outles ll be cleaned as necessary to ensu
proper oper io n. The filter cartridge shou 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
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole 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 one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
. f
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep - rooted trees and shrubs .directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
N
67 5)
L
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y.
ST CROIX C01UM
SEPTIC TANK MAINTINANCB AOUD42NT' AND
OwNCRSHIP CERTIFICATION FORM
PAvt, A�`' CtSA /VoQ'rHEY
Owner /Buyer
_ MailinS Address
,Property AQdre
(verification rcqu:rc rrurn I'linning Acpartntrnt for now conatruction)
City /State �° '� �S E 7 t Parcel Idontifrcation Number
U. tcAr DFfigBrr_= ;
Nc' r t
7 R 3/ N - W, Town of
Prcpemy Location S ..' /•....._— h � ---, —�"
Subdivis S H Lot M
Certified Survey Map 0 �- , Volume r-- , Page M
Warrnnty Diced M S` S Volume Pogo 4
Spec house Q yes � 010 Lot lines identiftatble I�yes O no
SYSTEM MAINS$•NANCE :h
improper and rnairtcnancc of yoL< srem.
w,)ii: system ;euld �e:ult in its premature failure to handle wistct. Proper ma,nteranca
I
consists o(rutrpina Our the seprrc tank eery I;rce yeas cr soarer, tf needed by a li;ensed pumper. What you put into rite sy :z
can Wart the (unction of the Sep t. tank as a !rcatment stare in ;he waste disposal system. ; �•
The property owner glees to submit to St Croix Zoning Deportment a ceriincetion form, signed by the owner and by '
nrepcetien and pomp ng (if necessary)
master plumber, jot.rneymin p umber, restrictcA p:umbe� or t licensed pumper verifying thsrt 1) the ots•site wasteweterditpotal syttf
is n proper operating condit,on ancvor (2) *,)c the septic tank is lttt chart. 1l3 full of sludges; ,t
;hc ,in ;ersiSned ha�c -,ad ;h: ubuvc rcyu r,ncnts and at,rcc io rnatnraitt il:c private scwa`e disposal syst4M with the surdudt - 'i
set forth, herein, as set by the Dcpirtrcnt of Cunimcrce and ilic Dwriment of Nstural Resources, Suit of W iscon". Certtf•cauotr
stating that your septic system his beer ma•rtaincd mast 5e co +ttplctcd in;, returned to the St. Croix County Zoning Wce within to
days of the three year expiratien ;fate.
—�--- DATE
SIGNATURF OF APPLICANT
OWNER URIT>FiCATtON
1 twee verify that all stitcrnents un `y .n Regis et of Deeds Offlete I (we) aim (ire) the owneds)
the property described abate, by virtue nl a y
J� DATE t
SICNATL'RL' OF APPLICANT
t••••• Any information that is m; t•reprcteriled w. ay result in the sanitary permit beast revoked by the ZOpinj Wpsrttnent. asset
to Include wltn this sppllcstlon• a stamped warranty deed from the Register of Deeds offi '
a Cary of the Csnified survey map if reference is nude in the wemmty deed
ta'd •eS;QrYt�ZStL na�xl 3�ft��T wd 09:61 « -2t -41319
STATE BAR OF WISCONSIN FORM i - 1998
WARRANTY DEED KATHLEEN H. WALSH
1553 P AG E 48 REGISTER OF DEEDS
Document Number Y 5 PAGE
I'J t ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between DENNIS A. PERRO and EDNA S. PERR O,;; 10-23 -2000 11:45 AM
husband and wife and STEVEN V PERRO and SARA A. PERRO
husband and w WARRANTY DEED
Grantor. EXEMPT I
PAUL J. NORTHEY and LISA WETTERLING— NORTHEY CERT COPY FEE:
and _ e COPY FEE:
husband and wife as survivorship marital property RECORDING TRANSFER FEE: 161.70
- — PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in _ St. Croi County, State of Wisconsin
(the "Property") Recada,y Area
Name and Return Address
of 10 Plat of S hadow P nrs_ the Town of Somerset,
Croix County, Wisconsin.
C k
032- 2116 -70
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property Is good, indefeasible In fee simple and free and clear of encumbrances except — none.
Dated this day of October 2000 )
(SEAL) �� `_--- (SEAL)
�.
« DENNIS A. PERRO . STEVEN V. PERRO
(SEAL) ( aa- (SEAL)
EDNA S. PERRO . SARA A. PERRO
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
State of Wisconsin,
55.
St. Croix County.
authenticate Icla C pe S-Knutson 5 3
a clw. Personally came before me this day of
Notary PUbIIC October 2000 , the above named
Dennis A. Perro and Edna S. Perro
Steven V. Perro and Sara A. Perro
TITLE: MEMBER STATE BAR OF WISCONSIN to
(If not, me known to be the person who executed the foregoing
authorized by §706.06, Wis. Scats.) instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Barry C. Lundeen
MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. Notary Public, State of Wisconsin
110 Second Street, Hudson, Wisconsin 540 16 My commissi . per , a a ne � nt. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not 3 )
necessary.)
Names of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wiscons,n Legal Blank Co.. Inc.
WARRANTY DEED FORM No. I -1998 W—ukog, Wis
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