Loading...
HomeMy WebLinkAbout020-1331-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST CRO X Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 338949 Permit Holder's Name: ❑ City ❑ Village $I Town of: State Plan ID No.: KNUTSON, RON HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: d lQb l /r i�e,� c6014e! S &) 1 020- 1331 -20 -000 TANK INFORMATION ELEVATION DATA A9900197 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic [ a _f p0 enchmark 164 QU e,. 4 17 Dosing �i " �-� Nf B 5— Aerati --� Bldg. Sewer d 9 Ho ding Ht Inlet IZ,06 �y6�" TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Air I to ntake ROAD D et Air Septic , 15 Z / NA PJBottom Dosing f('5 N 3 �' 5 NA Header / Man. j'gs Aeratio Dist. Pipe 5-, T Holdi Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer k � Demand odel Number Li Z�•�PM TDH I Liftq,-�$� Friction System 5 TDH l Forcemain Length,'9 / Dia. Z// Dist. To Well N SOIL ABSORPTION SYSTEM . BED / EN Width Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME N Z / i DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER /� Model Num er. Gc System: —�� -� A OR UNIT DISTRIBUTION SYSTEM Header / Manif Id Distribution Pipe s) / �� x Hole Size 0 x Hole Spacing Vent To Air Intake r � �� Length Dia. Z Length Dia. / / 7 Spacing ) + s 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 E] Yes El No E] Yes E] No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 23.29 9.1736,SW,NW 733 WALDROFF FARE RD qj Z9 AfN Y/ jCuy) Plan revision required? ❑ Yes Od No Use other side for additional information. Z t (D SBD -6710 (R.3/97) Da a Inspect Signature Cert No X- r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: mma �.W .,. �,.. tl -t-i t... I - till f i f -- T__ m � u . _ _ I . a ma e i_ 'V R b [ .. r� , 1 -1-1 V - 1 1 . ,... e.. LA m P am mom. � } i .em m i e i E E � t i � ». ......... ... . ...... .. .... e»IN.em ..e_ r ., ., ea..m. • ....v .....,,. ... e.. ., .. .. _.e ,.. „. Ad 4 3 S F x x G m a ee gr »n ee 7 -- l - T , 1 1 - - LA 1 a e a E 1 � It 1 { g i e T x 1 A s n .�»- «... », e, .m,.� m P x � s r F m .. .,, , x x x V ®® a �,. .. .... —. .... .. 3 x ; b...,.,,. �...�..,,.�_-- e r r � _ 1 A -4-4-- -- 44 - i i , _ T �. 1 , m s r Safety and Buildings Division Visimnsin SANITARY PERMIT APPLICATION 201 Box Washington Avenue In acco r d with I d e Department of Commerce t IL HR R 83 05, Wi s . A d m. Co Madison, Wt 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application state Sa ' r Permit Num er ry purposes Personal information you provide may be used for seconds ( � r vi . o revidus lica►ion (Privacy Law, s. 15.04 (1) (m)]. I t IJY/ at a p Pp I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Prop y Owner Nam Property Location 5cyal1A N U t1/4, 5 23 T o�`'f , N, R/'? E (or) W Property Owner's Mailing Address Lot Number Block Number 3 57 city, S to Zip Code Phone Number Sub ision Name or CSM Nu II. P BUILDING: (check one) E] State Owned Nearest R ad ❑ Vil age Public 1 or 2 Famil Dwellin - No. of bedrooms Town of III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0,W -13 3/ 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 K New 2 E] Replacement 3, [] Replacement of 4_ ❑ Reconnection of 5. E] Repair of an System ________ 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 Wound 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 (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation S"O -37 ! - 773Feet -- Feet Capacit VII. TANK in g allons Total # of Prefab. Site Fiber- INFORMATION g Manufacturers Name Con Steei Plastic Exper. New Existin ucted g Gallons Tanks concrete strlass App. Tanks Tanks Septic Tank ❑ 11 El El ❑ Lift Pump Tan r El ❑ ❑ I ❑ ❑ SIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber' m : (Pri t) Plumbe ' Ignat : (No S p) fUPQPRSW No.: Business Phone Number: a'7� O 3S Plum er Addres�treyt, C V IX. OUNT.Y / DEPARTMENT USE ONLY [] Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing A e Ig ature ( Stamps) Approved E] Owner Given Initial � urcharge Fee) Adverse Determination 3 ds X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.19I97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 1 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 AIdminisUat'ive Code will be applicable. 3. All revisions tot his 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: 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. 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 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 se — c ion 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 investigatigns and establishment of standards. Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 I,SCOT I si I Tommy G. Thompson, Governor Philip Edw. Albert, Acting Secretary Department of Commerce October 09, 1998 CUST ID No.267341 ATTN. POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY PO BOX 74 1101 CARMICHAEL RD RIVER FALLS W1 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL , APPROVAL EXPIRES• 10/09/2009 Identificatoi►Numbers �tC` Transaction ID No 180727 a 1VED Site . No. 161428 .. SITE• _ T 1 Please refer to both identification numbers, 1 g9$ Y above, m all correspondence witli t Site ID: 161428 k ST CROIX St Croix County, Town of Huds -'� r�UNTY an SW1 /4, NW1 /4, S23, T29N, R19 / `►INGQFF , Evergreen Estates Subdivision - Lo r �' Richard La Casse / G FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 428886 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Slats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 09/30/1998 FEE REQUIRED $ 180.00 and M. Swim FEE RECEIVED $ 180.00 POWTS Plan Reviewer - Integrated Services BALANCE DUE $ 0.00 (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim@commerce.state.wi.us page 1 of 6 MOUND SYSTEM FOR A BEDROOM RESIDENCE LOCATED IN THE SW 1 /4 OF THE NVJ 1/4 OF SECTION Z3 ,T N, R -9w TOWN OF p S 0 N , ST cRduC COUNTY, WISCONSIN.. l 3T VZ OF INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN `SFp O FD PAGE 3 of 6 PLAN VIEW -CROSS SECTION- 8 4,4- So .PAGE 5 of 6 PUMPING LUCIHAMBERPE LAYOUT y � NCO 998 PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR R N CN A � LR Ci sEs , �2z.o QRk►.v�o� Lf��E N- t,oso�, wi s4v1� . PREPARED BY WEGEF:ZEF:Z SOIL TEST AND . e 4 ' C ®° N `�/ r F.O. B01 74 421 K. KAIK ST. 4 . 1 J A PT HUR L RIVES? FALLS. KI 54022 1 W o y15 P ELLSWORTH, % Q 'T.S• 715 -4�► -0365. . ot� tlitaonully . 7 �� NT p ,, �� Y,J� E ♦ � ®,er® � losses p ..... $--I �'� it ZMEY GOM B M � RAGS ! �PAR 6, LION S � - Z -7 -�'C) C URRESPON iACE JOB NO. PLOT PLAN Page Z of � Scale 1"= Sp' r N r r �a i 1 A i 01(3'OF Z PVC /Ij� V - -- NOTES -1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be � nQ� ASO gallon capacity manufactured by 5. Bench Mark 6. Divert surface water around Sys tem to prevent ponding at the uphi side. Page 30f Approved Synthetic Covering sT�'► c 33 Distribution Pipe Medium Sand H G Topsoil F Elev. 3 E 'I D ., b % Slope Force Main Plowed Trench of -,"-2k From Pump Layer Aggregate Undisturbed D V•1 Ft. Soil E \.o$ Ft. Cross Section Of A Mound System Using F D. S Ft. I Trench For The Absorption Area G N.a Ft. A Ft. H t S Ft. B q 4 Ft. I 16 Ft. Linear Loading Rate = GPD /LN FT J 8 Ft. Design Loading Rate= 0.3 GPD /SQ FT K l0 Ft. L 11 , 4 Ft. Awe rite -Pesi on-a -e �e� rn �_ W 18 Ft. L Force B K Main W Distribution Trench Of 2 - 2 Pipe Aggfegate Observation Permanent,/ Pipes Markers (Anchor securely) Mound Using I Trench For Absorption Area Page ) Of 6 Perforated Pipe Detail 0 End View End Cap. Perforated � PVC Pipe s a Install permanent at end of each lateral Holes Located On Bottom. Are Equally Spaced Q End Cop * ti PVC Force Main Distribution Pipe Lost Hole Should Be Next To End Cap Dist Pipe La P y ( Ft. X L/3 Inches Y V ?) Inches Hole Diameter � �Inch Lateral 1 ley Inches) Manifold Inches Force Main Inches # of holes /pipe Invert Elevation of Laterals 49 - '6 Ft. Place lst hole Z`I from tee with succeeding holes at Y1" intervals. Last hole to be next to the end cap. Combination Septa - c;Tank and PUMP CHAMBER CROSS SECTIOM AND SPECIFICATIONS PAGE S OF rr, - T CAP WEATHER PROOF JUUCTIOIJ BOX 4'C.I. VEUT PIPC APPROVED LOCKILICP 1 FROM DOOR. MA WHOLE COVER A01 .rIUOOW OR FRESH 1 wARt.111JG LIK9EC.. ALR MTAKE coTapu>r r I 4 M IU. y PIPE PROVIDE i — -- IIJLET - T AIRTIGHT SEAL I I ! I APPROVED JOI APPROVED JOIUT BA�PL�S A I I I W /C.I. PIPE�pic W /C.I. PIPfaR Tank construction 11 III shall comply with - I I ALARM ILHB 1;3.15 and 83.20 a ! ! 1 I I ow c •! I LLEV. � ,S FT PUMP - -� OFF 0 COIJCRETE BLOCK ?.. �v. 8, L.ou' Y APPRovED K15ER EXIT PERMITFED OIJLy IF TAU MAIJUFACTURER HAS SUCH APPROVAL 1 SEDDIN( SEPTIC f SPEC.IFICATIOUS D05E ►JUM1iER OF DOSES: ' Z PI-K DAy TAWK MAUUFACTURER: TAWK :)IZI: \LOUp /LSO GALLONS DOSE VOLUME I ALARM MAUU FACT URER: S.S. �L'�t�1Z0 Ste( $ IMCLUDIMG OACKFLOW: ` GALLONS MODEL NUMBER: CAPACITIES: A= IUCHCS OR GALLOU5 SWITCH TYPE: B = Z IUCHES`OR 3C G( LLOIJS PUMP M \-1> q AUUFACTURER: Go L- S C = OR \S GALLOIJS ; CALLOUS MODEL AIUMBER: I � D � .__L— IIJCHES OR X1 5WITCH TYPE: DOTE: PUMP AUD ALA M AR TO 6E MIMIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS v[KTICAL DIFFERIM CETWEEU PUMP OFF AU0..DI5TRIBUTIOU PIPE.. FEET + MINIf•1UM NETWORK SUPPLY PRESSURE .. . . . .. .. . • 2.S0 FLIT + X 1.0 FEET O F FORCE MA X �' b� F � FRICTIOU FACTOR_. �.� FEET IOU FT. TOTAL 09IJAMIC HEAD = "� FEET DIAMETER Pump chamber 3E3 IWTF -KLIAL DIMLWSIWN OF TANK: LEIJGTH ;WIDTH ;LIQUID DEPTH BOTTOM AREA 231= _ GAL /INCH AS PER MANUFACTURER = ``1.O GAL /INCH Goulds P � 6 o 6 Submersible 1 Effluent Pump F 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle Available for automatic and Motor: and float switch attachment •Farms manual operation. Automatic • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical p oints. 115 or 230 V, 60 Hz 1550 Float Switch assembled and � • Water transfer ■Power Cable: Severe d RPM, built in overload with • Dewatering preset at the factory. rated oil and water resistant. automatic reset. ■Bearings: Upper and lower R 115 V, 60 Hz, 1550 RP SPECIFICATIONS • EP05 Single phase: P M, , FEATURES heavy duty ball bearing Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plastic Semi -open design 3 /4 " maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal rotection. r�! ) • Total heads: up to 24 feet. with three prong grounding p SP' Canadian Standards Association • ■ Discharge size: 1 NPT. plug. Optional 20 foot sc Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with Plastic enclosed design for „ rotary/ceramic- stationary, three prong grounding plug improved performance. end in "F" or "AC .) BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to s 30 ` -. .- 5GPM components. ! I Pump: EP05 8 - — - Fr • Solids handling capability: Q 25 3 /4 maximum. w l— • Capacities: up to 60 GPM. r i • Total heads: up to 31 feet. 6 20 i • Discharge size: 1 NPT. 5 • Mechanical seal: carbon- a 15 i rotary/ceramic - stationary, 4 BUNA -N elastomers. o r Temperature: 16- 3 10 z ° I 104 °F (40 °C) continuous I.;. — 140 °F (60 °C) intermittent. 2 -- - 1 5 I_ i (. 0 0 i I 0 10 20 30 40 50 GPM 0 2 4 6 8 10 12 ml/h CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 Wisconsin Department Industry SOIL AND SITE EVALUATION Labor and Human Relat ons Page / of 3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x 11 Inches in size. Plan must County ? n 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. # PEiVDI�J (,-- APPLICANT INFORMATION - Please print all Information Reviewed by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location q 11W131 `4, CDC° Govt. Lot SW 1 /4/UW 1/4,S 23 T 2 9 ,N,R / E (or )(0 Property Owner's Mailing Address E' S T Lot # Block# Subd. Name or CSM# 33Z NiNNesoT Sr h0 L l- . � FUER(s�PEE•v ESTiq-TES City State Zip Code Phone Number Nearest Road /y�tl1! /Z ST P�4u L N INS 5 6 / 01 (& 1 2-) 2 ZZ - 55 55 El Civ p visage To d411 �'�u y D , New Construction Use: EIR / Number of bedrooms 3 - Addition to existing building ❑ Replacement ySo - El Public or commercial - Describe: Code derived dally flow 69 gpd Recommended design loading rate bed, gpd/ft2 3 trench, gpd/ft Absorption area required _SOb bed, ft french, ft2 Maximum design loading rate _� � 3 bed, gpW trench, gpd/it Recommended infiltration surface elevation(s) ✓rEE / ` • 3 ft (as referred to site plan benchmark) Additional design /site con0ftations Si 1F 50 /, /e- elf' 7"yj 19-90 , 12 Parent material 5GS 8 P� 7 r-7 Flood plain elevation, if applicable S Suitable for system Conventional Mou�nd In-Ground Pressure , A�T -G System in Fill Holding Tank U - Unsuitable for system ❑ S Ly U 2 S El U El S L"f U L� S❑ U ❑ S ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /tt2 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots - Bed , Trench ,pry f-,e /rS /I , 2- ; 3 2- z -L /0 v1? 31 3 fyi /;M 6 e_ G'lc> %f Ground 3 - /� �� SG /7 S`i `?` , •S elev. 9tl• Ott. s- /o s / e y <s/ S /G6 /ze5he /m A/" Depth to �,1� 1tr, /O S/ /O y Z. S Q, //y Q .( i 7 limiting 1091�& factor 4�F In. Remarks: Boring # Q - �5_Z 11� e,&� 06 /0 Yle XZO Ground *1 of /6) V A ,5/ S 0 S Depth to � yn llP limiting l2.... factor 5�2_ 1 n. Remarks: CST Name (Please Print) Signature Telephone No. ROBERT 24L6P_i C-ttT" 7 /,r 396 Address Date CST Number i tes �'IdIJ • / �/— /rf CST�'-1 z y� Z Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 OR IGINAL K w PROPERTY OWNER SOIL DESCRIPTION REPORT Z 3 Page of PARCEL I.D.! Bolin # Horizon Depth Dominant Color Mottles 9 Structure Dvft Texture Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. B ed ,Trench y i v $''L / / ,�sh� Z z - 2,ff io Yle3 /2— 5L 2 / f 5he /* 1w c 4t ;.5 Ground 3 to D �_ 5 /TS G�, L S elev. /� L- �J —;-(- i Depth to limiting factor l " Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Boring # Ground elev. tt. • , Depth to limiting factor rn. Remarks: Boring If Ground elev. ' H. . Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) e Il i / � 'k b ao oT N v O� N - • �I r . \ I ` O 0 C Ll y vi 1 f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer � 1Y X -' t:rm � ./.4 o�yL� Mailing Address �7-1 - 3061 1 - 4L, L C'M� Property Address 7 -3 LtLdj"'y (Verification requited from Pla ing Department for new construction) t Swv C , City/State - 9(, _ Parcel Identification Number -0 t-20 f 3 -3 j - a o LEGAL DESCRIPTION Property Location �✓ /�, N Q y,, Sec. Z� , T � N -R_Zff W, Town of Subdivision _ / ,6 J f� Lot # Certified Survey Map # . Volume . Page # Warranty Deed # 0 Volume _/ 3 7 ? . Page # 13 Spec house O yes no Lot lines identifiable N' 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 in 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 masterplumber, journeyman plumber, restrictedplumber 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. Uwe, 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 of the three ear expiration date. , SIGNATURLi OF 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 the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. / 24 SiGNATLYE 6F APPLICANT DATE * * * * ** Any information that is mis represented may suit in the sanitary permit being revoked by the Zoning Department. * * * * ** '.* 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 1:377PAcf 0 59161 WARRANTY DEED to Document Number ST. CR01X CO.. WI Return Address Rot f•� R+;•rd EAGLE VALLEY BANK, N.A. NOV 16 1998 1301 Coulee Rd., Unit 2 Qv 0 Hudson, WI 54016 1••`` for 0004 Parcel I.D. Number: LaCasse Custom Homes. Inc., a Wisconsin Corporat conveys and warrants to Ronald E. Knutson and Patricia Coates-Knuts husband and wife, as survivorhsia marital property_ _ _ the following described real estate in St. Croix County, State of Wisconsin: Lot 12 Evergreen Estates in the Town of Hudson, St. Croix County, Wisconsin. This is not homestezd property. I Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this / day of November, 1998 j !_Rcz be Custom Homes, Inc. TRANSFER 0 1 0. By !�. � u }.2s (SEAL) Richard W. LaCasse, President ACKNOWLEDGMENT STATE OF WISCONSIN ) ! ) ss 0 i k COUNTY ) Personally came before me this )12 k' day of November, 1998, the above named LaCasse Custom Homes, Inc.. by Richard W. LaCasse. President to me known to be the person(s) who executed the foregoi'g --i ent d acknowledge the same. � • /� Gar �Pn� ; n � �,. * . MAR���� Notary Public ', i x County, WI ?Y; .N Ol My commission expires G THIS INSTRUMENT WAS DRAFTED BY: C Attorney Kristina Ogland %t,ONSIN Hudson, WI 54016 aL. .43 � .'%Uq'4W "ffi.: Ile'% .'.l._....,.. Ra.-. b!aR.af,. :fit: :+.' ..rte.. 4.A�S -M-0 +�`^tY •d T1eaad..�l +: :+w. s / _ ° o i� - �Y w N � Na Z 3 L oa D 3s SS j3 ,OFQ 2S4 n p m qTF s ° tl Y o \ S Sr st -1 06 • � �vY 4O qo . 0 0 - r N /3o 8 400 N WD � r O 2 O® p� N i CD W N la 4D : 'TI A f ° o 0 ; f N tO N r N N CD -� © 6 0 i a �o N rn 0) r N O i N� O oN v a m -4 S05 048'00 m A 37 7.68' - I tr u 3 , NI °08 3 g "E i w F w I N CD �� CD 9 O 0 w (A l 4 W N to .,r r CR =_ �, o 30� @ @, � O N.- o 33 9 4 •9 \ � O oN r � -- °° U o 0 D --4 ......... W W r N C M M �O W W U a m N ti 0° fo0 ,q N r O N W O O q CD W O U D 01 .� OD 0 O O CD W 0 D N ;D N N O V . m N -1