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HomeMy WebLinkAbout020-1359-01-000 0 co 0 c m 0 d O m d O 3 n 3 Ny ro ro o m Z a c ^ � 3 \ ro 3 ? N Q y wa d CD rQ `2 ;3 -4 y N r..i. CO O 07 a m '.7? OD w O W �+ ' 1 t a. x' N N N N :. O O p O 0 0 0 m N N * O O Co CO N O 7 v 0 7 N 3 O O ° ro O v = a �1 n ro C co o co vro ° m G W 3 O O j O O f N N O O n !� � co co r c C7 Vi m cca 0 O c w n .. c D co ro 0 O O O X c D o E c O O a W ^ m L O O N �p r ro a N a m cu (D r. d 3 cn 0 CL O _O N rn z z z rn o 's' N O O K�5 O O N N = vC1 O 7 a 1 m C) v � m --I N c `A z 3 a C) .. � N a z 13 3 m Z CD A (D N Q 7 O a o O y v O n C x .D a a J . cn n N z �+ O O N O 1 7 n O =r O N f0 I 3 N CD O Q y O N N O O � fC O kv N L N O O A O O CD yq L o 0 0 i Parcel #: 020 - 1359 -01 -000 10/24/2007 04:37 PM PAGE 1 O F 1 Alt. Parcel #: 16.29.19.2097 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner MICHAEL T & CHERYL M LESCARBEAU O - LESCARBEAU, MICHAEL T & CHERYL M 521 MCCUTCHEON RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description ' 521 MCCUTCHEON RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.504 Plat: 07- 066 - PARKWOOD MEADOWS LTS 1/33 1999 SEC 16 T29N R19W PT SW NW PARKWOOD Block/Condo Bldg: LOT 01 MEADOWS LOT 1 2.504AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 16- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 09/26/2000 630516 1545/287 WD 09/28/1999 611113 7/66 PLAT 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.504 79,200 229,400 308,600 NO Totals for 2007: General Property 2.504 79,200 229,400 308,600 Woodland 0.000 0 0 Totals for 2006: General Property 2.504 79,200 229,400 308,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 020 - 1029 -00 -000 10/24/2007 04:36 PM PAGE 1 OF 1 Alt. Parcel #: 16.29.19.129 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - LACASSE CUSTOM HOMES INC LACASSE CUSTOM HOMES INC 573 CTY RD A HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 16 T29N R19W SW NW NKA PLAT OF Block/Condo Bldg: PARKWOOD MEADOWS Tract(s): (Sec- Twn -Rng 401/4 1601/4) 16- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 02/19/1999 598117 1404/619 PR 02/19/1999 598116 1404/616 LC 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason OTHER X4 1.000 0 0 0 NO Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 . I ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner (. U, G• Property Address City /State —� Legal Description: Lot Block Subdivision/CSM # ' IV t / a, Sec. [f�, T29 N -RAW, Town of PIN # maa-ZQ g - 3 e SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC /aotl/ OO OSetback from: House ; Well DSO P/L 7L Pump manufacturer Model 62 S Alarm location - (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width Length �� Number of Trenches Setback from: House 55/ " Well -," ?S" P/L Vent to fresh air intake 7 .SO ELEVATIONS e ! Description of benchmark o ! Elevation Description of alternate benchmark Elevation ICW _ 98� Cl Building Sewer ST/HT Inlet 9 2, 9 ST Outlet PC Inlet t � f PC Bottom �J� Header/Manifold t5 a_ Top of ST/PC Manhole Cover Distribution Lines () 75 0q ( ) L ! Bottom of System Final Grade () () ( ) Date of installation 5 /9l Permit number 3VY78o State plan number Plumber's signature License number AA, �6?0 ay? Date 5 A? / 9 Inspector � Complete plot plan � NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW l 4 4 /os 0? INDICATE NORTH ARROW x: • Saf ety and Buildings Division of Commerce PRIVATE SEWAGE SYSTEM count CROIX Safety nd Buildings D Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar ff2r4i782: Personal information you provice may be used for secondary purposes [Privacy L.*, s.15.04 (1)(m)]. 9erQit HTIcXr9't HOMES EhiftcMNIlage ❑ Town of: State Plan ID No.: CST BM Elev.:- ' Insp. BM Elev.:� BM Description: Parcel T — TANK INFORMATION ELEVATION DATA A9900051 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic, ../ f Benchmark Dosing , Aeration Bldg. ewer g- /D.y Holding St 1 Inlet / /10 0 9a " TANK SETBACK INFORMATION St/k Outlet TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet ir Septic ' 7 56 , c/ ,) - ' —?S NA Dt Bottom Dosing Sv'SD i/.2 >J6 NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade ,�/,� V. Manufacturer Demand Z/ 96./09 Model Number 10 (� S r GPM TDH Lift (� , Friction o bL( Syeaem TDH/),�I Ft Forcemain Length 16!5-' Dia. AI Dist. To Well y SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengt N. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ?5 (/� Z DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREA LEACHING M ufact rerl SETBACK CHAMBER j-j TC3 INFORMATION Type O Ivlo el Num er: System: L/ > 9S 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 TDepth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center /Trench Edges Topsoil ❑Yes E] No ❑Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION• HUDSON 16 521 MCCUTCHEON ROAD L r'1 yea.. <,.'_. ti .A�2,L { � /6 6, 6 0 Al Y Al. �F /A.6° � l(.- �.R,,.+ ���✓ lCl�i�,,,� -f Plan revision re fired? Q No Use other side for additional information. / 1 q9d SBD -6710 (R.3/97) Date nspect 's Signature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r r £ E e I a i 1 x ? 3 t 4 ? 7 ! t P f £ a C_ 2 3 a ,, ,.= 3 � ...�....�_.. #. ..� --•. ,.,, P�6 .....tee �m� .�_.. ...... .. _ ._ ... _... �.. e . E , a a 3 F t 1 E € £ F 2 A�m m 3 3 s i 5 3 a q t S - t P s _.,_ m s a . ? e r s _....._r. ........... .._ S A t % 6 d E ! m. € E 3 E S I E t F t amm ®e t .. »A e € �� 3, ,.,.. �« ,« A ... »,...... 4 .. � . » .. .. �. , — .a.:.3 � £ _.e.e �.a.� � ........ .. , r _.n.@, .— e k a �S 2 ,,. _. , .,......� .. ,�f......., ., ...... ....,,,. �...,... .... y. ..?.,.,.. y... ..�r.W ge dame ..... w.. ..«.�......,.. S..v...W .+.»�. .,..,,K.=.= ... ..„s.4 aaa a.� 3 A .... r ...e, ma ee.m.,.. ....... e..._e._.� ,... . .� m. £ r d } o 6 @ x 6 a e SANITARY PERMIT APPLICATION Safety and Ave Avenue ' A scons i n 201 W. Washington P 0 Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County T than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State SW evision S y Permit Number Personal information you provide may be used for secondary purposes [] Chec previo ppR�a n� (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Prop yOw Name T� Property Location G o Sik(lA �U ja1A, S l �p T r� ( , N, R �1,�(or) W Prop yQw er's Mai ing Ad s Lot Number B Number 7 r City State tip Code Phone Number Subdivision Name or CSM Number 11 . TYPE F BUILDING: (check one) ❑ State Owned ❑ It Nearest Road ❑ Vll age oA Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 1. Ill. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) / L(p, 291 � 1 1 ❑ Apartment/ Condo O R O - / 0, ;_ ) ` v Q 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. WNew 2. ❑ Replacement 3, ❑ Replacement of 4 E] Reconnection of 5. ❑ Repair of an ystem System Tank Only Existing System Existing System B) [:]A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 E] Mound 30 E] Specify Type 41 C] Holding Tank 12 ja Seepage Trench d' I a.S� 2 ❑ In- Ground Pressure r 42 ❑Pit Privy 13 ❑ Seepage Pit T 3 43 ❑ V Privy 14 ❑ System -In -Fill #1 VI. ABSORPTION SYSTEK4 INFO MATT 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 (sq. ft.) (Gals/d sq. ft.) (Min./inch) / Elevati r © ® / s /� ��dlfl et 4 79 Feet Capacity VII. TANK in g allons Total # of Pretab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name concrete Con Steel glass Plastic App New Existin structed Tanksl Tanks Septic Tan g ank /Soo � ❑ ❑ ❑ ❑ ❑ ift Pump Tank ber . � ❑ ❑ ❑ ❑ ❑ NW01LI1'Y STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plure: (N St ps) M /MPRSW No.: Business Phone Number: ,e a7G mber' Sig u as P u (S reet, City, State, i ode): IX. COUNTY / DEPARTME USE O ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuin gent Signature (No Stamps) Surcharge Fee) Approved E] Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (11.11197) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, 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 -3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's_name and mailing address. Provide the legal description and parcel tax number(s) of where the system isto be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. 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 isto 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 81/2 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 if required 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. N uJ - 6 p T /oG //h H4 o3s o o j l ie vJell1 'tic - S, �1 7o i � ay l PUMP CHAPIBE;R CROSS SECTIOIJ AMC) SPECIE ICA1 jok15i VE LIT CAP Y" C.i. VEAIT PIPE ' 7j WEATHERPROOF APPROVED LOCKMIG - 25' FROM DOOR, JUMCTIOIJ BOX MAMHOLE COVER WItJDOW OR FRESH 12 "MIU. AIR IAITAKE GRADE I Y' MIIJ. I IB" ml m. COUDUIT -- __________ ki 11� All IAILET PROVIDE ( - - - -- - T AIRTIGHT SEAL i I f I * */ A I I I I I I I I I ALARM a I II I I *APPROVED I I ow JOINTS WITH ELEV. FT. APPROVED PIPE 3' ONTO PUMP J OFF D SOLID SOIL CONCRETE BLOCK RISER EXIT PERMITTED OIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICA_TIOUS OOSE TANKS MANUFACTURER: A20018 IJUMBER OF DOSES: —_L- -PER DAy TAWK SIZE: 0 GALLOAIS DOSE VOLUME ALARM MANUFACTURER: l'I IMCLUDING BACKFLOW: GALLON MODEL ►DUMBER: �� IJ CAPACITIES: A - 2 11 - " A - ��� 1__L �CHES OR � LLOAI: SWITCH TYPE: 5= � yW INCHES OR LLOM`. PUMP MANUFACTURER: C= INCHES OR L g ( ' ?GALLON! MODEL MUMBER: EPOS D= INCHES OR -LE M LLO SWITCH TYPE: > MOTE: PUMP AND ALARM ARE TO DE MINIMUM DISCHARGE RATE aS GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMUM METWORK SUPPLY PRESSURE , , , '� FEET + `� FEET OF FORCE MAIN X — J_ /OOF FACTOR - FEET TOTAL DyA1AMIC HEAD ; WIDTH / 7 it J IAITERAIAL DIMEWSIOIJS IJ OF TAUK: LEGTH Al �ll' tl �_ ,LIQUID DEPTH SIGIJEO: LICEUSE "UMBER RA G203S7 ✓�� DATE: -�a' • 1 MO . • '04 '0 Su bmersible Effluent Pump GOULDS .0 p METERS FEET ,0 MODEL 3871 flis 9 30 Solids, a Maximum 8 Motor ; 7 Single phase: 115V Materials of Construction 5 Brass/thermoplastic g 5 t5 EP05 Features and Benefits ° *Top suction eliminates a ' 10 impeller clogging. z EPO4 5 *Corrosion resistant , construction. ° ° o ,o zo 30 40 5o usaM •Float actuated switch. o z . 6 8 ,o ,z m0mr CAPACITY METERS FEET 7 25 MODEL DVPO3 Pump Specifications Features and Benefits 0 5 20 4 / w and' /2 HP • EPO4 impeller- semi -open design = 5 Up to 60 GPM pump out vanes to protect 4 15 Maximum head to 32' mechanical seal. Discharge size 1 NPT • EP05 impeller - enclosed design 0 3 70 Solids:' /." maximum for improved performance. Rugged glass - filled thermoplastic s A ll motors feature ball • casing and base design provides 0 ° bearing construction. superior strength and corrosion ° 5 10 15 20 25 30 35 40 U.S.GPM resistance. Single phase: 115V 0 2 4 CAPAC1T1' S • 10m'�' Materials of Construction • Cast iron motor housing for I. Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. *Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division 6tSafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (B Mr rec fi ii�d:�o of slope, scale or PARCEL I.D. # � 020 - 1029 -00 -000 dimensioned, north arrow, and location and dis —00� arest APPLICANT INFORMATION PLEASE PFAIT.a4LL INFORMATION. ' rREVIEWE BY DATE PROPERTY OWNER: `PROPERTY LOCATION Richard LaCasse 1 GOVT. LOT NW 1/4 NW 1/4,S 16 T 29 N,R 19 for) W PROPERTY OWNER':S MAILING ADDRESS CROIX LOT" f BLOCK # SUBD. NAME OR CSM # 871 Kelly Rd. na na na CITY, STATE ZIP CODE �I QNE - F a ITY ❑VILLAGE ®TOWN NEAREST ROAD Hudson, WI. 54016 �,?l ` Hudson McCutcheon :r, ] New Construction Use [x] Residential / Numbe 4 ( ] Addition to existing building J ) Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate ._ bed, gpd /ft gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.25 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem I Pt S❑ U M ❑ U Q S ❑ U 97 S❑ U LA ❑ U [Is CUJ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer>ch 1 0 -12 10yr3 /3 none 1 2msbk frozen cs if .5 1.6 1 2 12 -25 10yr4 /4 none sil 2fp1 mfr gw if np .3 Ground 3 25 -84 7.5yr4/6 none ms Osg ml na na .7 .8 elev. 9 9.0 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -15 10yr3 /3 none 1 2msbk frozen cs if .5 .6 2 2 15 -30 10yr4 /4 none sil 2fp1 mfr gw if np .3 3 30 -84 7.5yr4/6 none ms Osg ml na na .7 .8 Ground elev. i 98.6 ft. Depth to limiting factor +84" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th Av . New Richmolid, WI 54017 Signature: Date: 12 -29 - CST Number: m02298 0 PROPERTY OWNER Richard LaCaSSE SOIL DESCRIPTION REPORT Page 2 'of 3 PARCEL I.D. # 020- 1029 -00 -000 _ Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTwich 1 0 -12 10 r3/3 none 1 2mabk f rozen cs :`.``':':`::` "' 2 12 -30 10yr4 /4 none sil lcsbk mfr gw if .2 .3 Ground 3 30 -84 7.5yr4/6 none ms Osg ml na na .7 .8 elev. 9 9.2 ft. Depth to limiting factor Remarks: Boring # 1 0 -22 10yr3 /3 none 1 2msbk frozen cs if .5 .6 4 2 22 -3 10yr4 /4 none sil lcsbk mfr gw if .2 .3 3 38-84 7.5yr4/6 none ms Osg ml na na .7 .8 Ground elev. 99.25 ft. — Depth to limiting factor + b Remarks: Boring # 1 0 -15 10yr3/3 none 1 2msbk frozen cs if .5 .6 5 2 15 -29 10yr4 /4 none sit lcsbk mfr gw if .2 .3 3 29 -84 7.5yr4/6 none ms Osg ml na na .7 .8 Ground elev. 9 9.2 ft. Depth to limiting factor +84" �� v Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Richard LaCasse 1554 200th Ave. CSTM2298 New Richmond, WI 54017 W W S16- T29N -R19W MPRSW -3254 town of Hudson (715) 246 -6200 N q 1 I1 =40 1 EM.= nail in tree @ el. 100 Alt. BM.= nail in tree @ el. 98.70 �1 @ co(/t���1 zp . r Olt It y t I 6 lo o i Gary L. Steel 12 -29 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address - Z ! 1-S" 4_ Property Addres (Verification requited from Planning Department for new construction) City/State _�Ldtxm Parcel Identification Number - /O a21 - 3� LEGAL DESCRIPTION Property Location s /,,W y., Sec. T Z`! N -R Town of Subdivision` =JJ S LA Ce, Lot # , Certified Survey Map # N.l , Volume , Page # Warranty Deed # 6 ° c^, // `) Volume O Page # Spec house Oyes O no Lot lines identifiable l7 yes O no SYSTEM MAINTENANCE 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 ' ep g m the, waste disposal system. The property owner agrees to submit to St. Croix 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 wastewaterdisposal 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 Zoning Office within 30 =ofthe ye expiratio n date.F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th roperty des 'bed a ove, by virtue of a warranty deed recorded in Register of Deeds Office, SIGNA 6F - APPLICANT DATE * * * * ** Any information that is mis represented may sult in the sanitary permit being revoked by the Zoning Department. * * * * ** -- t* Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VOL 1404PAu619 STATE BAR OF WISCONSIN FORM 5 — 1982 S�� 11.7 PERSONAL REPRESENTATIVE'S DEED REGIST H. OF DEEDS WALSH DOCUMENT NO. ST. CROIX CO., WI RECEIVED FOR RECORD Howard Laventure 02 -19 -1999 11:30 AN PERSONAL REPRESENTATIV as Personal Representative of the estate of EXEMPT # 17 Arena LaVenture CERT COPY FEE: COPY FEE: TRANSFER FEE: ( "Decedent "), RECORDING FEE: 10.00 for a valuable consideration conveys, without warranty, to PAGES: 1 LaCasse Custom Homes, Inc., a Wisconsin Corporation Grantee, the following described real estate in St. Croix County, THIS SPACE RESERVED FOR RECORDING DATA State of Wisconsin (hereinafter called the "Property " ): NAME AND RETURN ADDRESS Heywood & Cari, S.C. Box 125 Hudson, WI 54016 SW a of NW a of Section 16, Township 29N, Range 19W, St. Croix County Wisconsin. 020- 1029 -00 THIS PROPERTY IS IN THE WELL ADVISORY AREA. MM EMMTITMATION NUMBER This is in rtial satisfaction of a land Contract dated February 18, 1999, Recorded in Vol � Page Personal Representative by this deed does convey to Grantee all of the estate and interest in the Property which the Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. Dated this 181H day of February 19 99 (SEAL / ":I— I (SEAL) Howar LaVenture Personal Representative Personal Representative AUTHENTICATION ACKNOWLEDGMENT Signature(s) Howard LaVenture State of Wisconsin, ss. County. authe cared this 18 �ay February 19 99 Personally came before me this day of / 19 , the above named Samuel R. Cari TLE: MEMBER STATE B OF WISCONSIN authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Heywood & Cari, S. C. Bo 125 k Hudson, WI 54016 Notary Public, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary) 19 .) Names of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. PERSONAL REPRESENTATIVE'S DEED Form No. 5 — 1982 Milwaukee. Wis. , FEB -22 -1999 MON 16:91 ID:LACASSE CUSTOM HOMES TE L:716 -3 61 -6541 P:01 d 7 tl' A if P "t Fa st rM V W r LL as I