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HomeMy WebLinkAbout020-1330-80-000 ST. CROIX COUNTY ZONING DEPARTMENT/ AS BUILT SANITARY REPORT Owner 2 a a 1.e, T ,E�e �. ,� , c.� c� v FO Y /� f l .l Address %g9$ _. y�. ST CROIX � n City /State fa ct sail / couNTv NG OPFICE Legal Description: Lot 0_ Block Subdivision/CSM # fy e V�2 ' /. '/< &A2, Sec. 3 , T -RAW, Town of �� �C_�o rrJ PIN # O22 -a e© SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer ;,1u1 es 7`ct -.• Size ST/PC / Odd /ds0 Setback from: House Zs , Well P/L SQ t Pump manufacturer z,,aweC1,5 Model _ �,raa S" Alarm location Ao & �� (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: 4;2xu,y ,,t Width Length ; Number of Trenches Setback from: House /mod Well x l,2 P/L / d ' Vent to fresh air intake z O o ELEVATIONS Description of benchmark TOO o � /'o N Elevation /4 Description of alternate benchmark 9-f Elevation Building Sewer 7 5' ST/HT Inlet _mil, 9 ST Outlet- PC Inlet PC Bottom f - 02 Header/Manifold Top of ST/PC Manhole Cover 74' 7Q' Distribution Lines ( ) �G- �; z O ( ) Bottom of System( ) ? Final Grade Date of installation d / / & Permit number 30 7 State plan number 6 75 zoq?& Plumber's signature � License number Date G Inspector e Z I (Complete plot plan �r 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 4AV t s % � o a� h o v b 0 v b � INDICATE NORTH ARROW WisrohsinDepart County • Department PRIVATE SEWAGE SYSTEM ST. CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitn P°rmi tjVp_: Perso inf you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)), lJJ �� �� (� j6�,ityt e &' m k CHARD [Je _Qk illage []Town of: State Plan ID No.: CST K B i'R MElev.: Insp. BM Elev.: BM Description: Parcel T3'��'— :13 30 - 80 - 000 l D �0 T 0 1 LD D 6� Iry svV TANK INFORMATION EL VATION DATA A9800088 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , rr 7 OO® Benchma &k,� I 103 Dosing Co`�J gC4,6M k II - 17 6 t I.Q3 Aeration Bldg. Sewer 0 13.77 / f,0 ' �Z. S Holding St/ Ht Inlet 11 7Z- ?'i qS TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic I Z.0 IF — 7 6L Z9 1�- /, NA Dt Bottom 15 — 78 OZ Dosing I q0' NA Header / Man. �p�. qrA 5,9 1 96 �c Aeration NA Dist. Pipe ,s qS 1 �(, •CJ2 Holding Bot. System SOD, PUMP/ SIPHON INFORMATION _ Final Grade Manufacturer Demand 670 v l d �IY1 F: �. \ .?-`6 7 102$7 1 (]U Model Number P dGPM Atf f3nh I,s-c( r13_7 9� �l3 TDH Lift��f.9'� Lriction� System .s TDH23j�Ft S fi ,� I,r l,, c o �17 ��IC' 90.7 Forcemain Len th — Dia. Dist. To well g I � Z it SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid De th DIMENSIONS S 75 DIMENSION SETBACK SYSTEM TO P / L BLDG F WELL LAKE / STREAM LEAC G Manufacturer: INFORMATION Type of CHA ER mo Numb System: KA o D 5 h t� OR UNI DISTRIBUTION SYSTEM Header / Manifold Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake S r Length Dia. 2'i length Dia. � Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of x Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil IZ Yes ❑ No Yes E] No COMMENTS (Include code discrepancies, persons present, etc.) 7 ,c i 1 �j (, ,2 LOCATION: HUDSON 23.29.19,SW,NW 734 WALDROFF FARM ROAD qs.L 21 At +. M _-i o /owl r" G ' R Plan r v s on r quired? ,❑ Yes ® No Use other side for additional information. X SBD -6710 (R.3/97) Date Inspector's Sig ture Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. * L onsft In accord with ILHR 83.05, W is. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • 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. a " • See reverse side for instructions for completing this application State Sanitary Permit Number y ou p rovide may be used b other g overnment agency p rograms 3o�7r The information y p y y 9 q y p 9 C heck if revision to previous application (Privacy Law, s. 15.04 (1) (m)). State Plan 1.Q_N ber I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION yy 02 z v ProDe,rty Owner Name Property Location f1 ' 6,1 114 A ) 114, S7 Y Ta f , N, R/4 E (or) Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number ( ) — P . TYPE OF BUIL (check one) ❑ State Owned C1 it� Nearest Road [] Vll age Public Q 1 or 2 Family Dwelling - No. of bedrooms own OF "d .404) k) v101_ aV/1" XV III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 o —1 3 3 Q A)— GD D 2 ❑ Assembly Hail 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. New 2. ❑ Replacement 3. E] Replacement of 4 E] Reconnection of 5. [] 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 [$LMound 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 Y ' .S_d 7 S` 3 r to LL 9lr • S Feet j ',' 0 Feet Capacity VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper. INFORMATION New Exist Gallons Tanks Manufacturers Name Concrete st uc zed Steel glass Plastic App Tanks Tanks s a v,J N ❑ ❑ 1 ❑ ❑ ❑ Lift Pum T er ! r 7� ® ❑ ❑ ❑ ❑ ❑ Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. do Plumber's Name: (Print) Plumber's Signature: (No Stamps) VANYPRSW No.: Business Phone Number: & r Gt 2 ? 1,-5 o I s- Plumber's Address Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee (includes Groundwater ate Iss ued Issuin Agent Signature (No Stamps) j Approved []Owner Given Initial n gO pp/ Surcharge ree) `. Adverse Determination L /!G L r { r /Gl fy1Z (j X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.1IM) DISTRIBUTIOM: Original to County. One copy To: Safety & Buildings Division, Owner, Phm*w SAFETY AND BUILDINGS DIVISION 2226 Rose Street visconsin La Crosse, WI 54603 Department of Commerce Tommy G. Thompson, Governor 27- Mar -98 William J. McCoshen, Secretary Wegerer Soil Testing & Desig RICHARD LA CASSE 421 N Main St PO Box 74 River Falls WI 54022 EVERGREEN ESTATES LOT 8 Plan ID 9820426 SW,NW,23,29,19W Municipality of HUDSON Inspector: Leroy G. Jansky County of St Croix (715) 726 -2544 Private Sewage plans including the following element(s): MOUND 450 GPD The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for compliance with all code requirements. This plan action is subject to the conditions listed on the following page(s). 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. All permits required by the state or local municipality shall be obtained prior to commencement of construction /installation /operation. This project is under the supervision of a state inspector. As inspection concerns arise feel free to contact the state inspector at the number listed. The inspector for this project is listed above. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when making an inquiry or submitting additional information. Sincerely, &ard. Swim POWTS Plan Reviewer (608) 785 -9348 SAFETY AND BUILDINGS DIVISION 2226 Rose Street ON LaCrosse, Wisconsin 54603 Nvisconsin Toirin G. Thompson, Govemor Department of Commerce William J. McCoshen, Secretary Page 2 9g 20446 - 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, prior to installation. - 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. Stats. SBD- 5524 -E (R. 2/98) File Ref: WSTANDARD PARAGRAPHS APPROVAL LETTER.DOC Page 1 of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE Z 3 Z4 l 9 W S N T N R LOCATED IN THE E 1/4 OF THE W 1/4 OF SECTION , , TOWN OF 1 S , ST• C tWlX COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION: p W.T.S. PAGE 4 of 6 PAGE 5 of 6 PUMPING CHAMBER LAYOUT Conditionally PAGE 6 of 6 PUMP PERFORMANCE CURVE AP P DROVED pEPARTMENT OF COMM RIAINGS Ivisl f SAFETY PREPARED FOR -- SEE CORR ONDENCE: t Z Z o c��h. wo�t� L�vE RECEIVED MAR 2 6 1998 SAFETY � PREPARED BY WEGEERCEFZ SQ I L. - TEST I thtG ,`°,„►..,. AND. ti`` {•, ©�� ',• P.Q. 20174 421 K. MIN ST. RIVES FALLS. VI 54022 - : W _ • -•�� ; 715- 425 -014 ELLS "AlORTH JOB No. Page 3 Of Approved Synthetic Covering Distribution Pipe Medium Sand H G Topsoil 3 E �� '' D b `1 % Slope ( Force Main Plowed Trench of 4"-2k" From Pump Layer Aggregate Undisturbed D \•0 Ft. Soil E \•3S Ft. Cross Section Of A Mound System Using F O.8 Ft. Trench For The Absorption Area G N.n Ft. A S Ft. H 1- S Ft. 6 - )S Ft. I \ S Ft. Linear Loading Rate= 6- GPD /LN FT Ft. Design Loading Rate= 0•'3GPD /SQ FT K 11 Ft. L z"7 Ft. W °11 Ft. L Force . B K Main_ y ' � W Distribution Trench Of 2 - 2 '2 Pipe Aggregate ! Observation Permanent-/ Pipes (Anchbi securely) Mound Using t Trench. For Absorption Area Page Y Of b Perforated Pipe Defoll 0 J /"" E.d View Perforated End Cap. b\c.l' PVC Pipe . a Install permanent - marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cap Q �1. * PVC Force Main i Distrbution Pipe Last Hole Should 8e Next To End Cop Distribution Pipe p Layout P Ft. X 34, Inches Y 36 Inches Hole Diameter ) IV Inch Lateral 1 / Inch(es) Manifold _ Inches Force Main " Z Inches # of holes /pipe Z Invert Elevation of Laterals x,7.0 Ft. t x 1. V _ ��! - - Zg. g G Place lst hole IV' from tee with succeeding holes at -61 intervals. Last hole to be next to the end cap. I Combination Sept;ic;.Tank and PUMP CHAMBER CROSS SECTIOM..AAID SPECIFICATIOUS ' PAGE OF (� -.VEtJT CAP WEATHER PKOOF JUIJCTIOAJ 80X 4'c.i. VENT PIPC APPROVED LOCKING 110' FROM DOOR, MAWNOLE COVER AJIV .,IIUDOW OR FRESH 3 wAR►.�IIJG L"14gEL.. ALP, IIJTAKE cowDu�T r ,�- s � b NA-X . �� i `I' MIU.. IB' MIU. L —_ y "►uS0echaa PIPE M PROVIDE -- 11MLET -T AIRTIGHT SEAL APPROVED JOINT A I I APPROVED JOINT: A C.I. PIPE OR I III / W/C.I. PIPE��c / Tank construction I II I ALARM shall comply with ILHIR (83.15 and 33.20 Is I I to I I oIJ C I I I LLEV. �6.�5 FT Pump � OFF D COUCRETE tl ev 7 6. 0 0 DLOLK 4 3" APPRo+:'. RISER EXIT PERMITTED OIJLy IF TAIJK MAUUFACTURCR HAS SUCH APPROVAL gEDDINl4 SEPTIC E SPCGIFICAT10KIS OOSE 11 '11flVy jT jJ �1 '3'T IJUMBER OF DOSES: 3.�{Z PER DAU TAMK5 MAUUFACTURCR: TAIJK SIZE: kzm 16SO GALLOWS D05F VOLUME z ALARM MAUUFACTURCR: S_S . IMCLUOw6 aACKFLOW: `S _ GALLONS MODEL WUMBER: CAPACITIES: A= IUCHES OR 3 0 1 0 GALLOWS SWITCH TYPE: 8 = Z IIJCHWOK 3 =L _ G ( LLOUS PUMP MAUUFACTURCR: GOV l.Q S C. Iu[HES OR , S 3 CALLOUS MODEL MUMDEK' 38 � I �YOS D - 9 IMCKS OR 1 S 3 CALLOUS I"1�1 ZCCJ�lY' M OTE: PUMP AUD ALAKM TO 6E� SWITCH TYPE: 1 " MtU1MUM D15CIiARGE RATE Z GPM INSTALLED ON 5EPARATC CIRCUITS VERTICAL DIFFEKEWCE DETWCEU PUMP OFF AUO.D15TRI5UTIOIJ PIPE.. Z0.2 S FEET t MIAIIMulA WETWORK SUPPLY PRESSURE .. .. .. 2.50 FLET `•`� FL FRI U FACTOR - . - 2.o9 FEET + � F E E T OF FORCE MAIN X /OfL TIO G .= TOTAL 0JUAMIC HEAD = Z FEET Pump chamber DIAMETER 3$11 IUTER/JAL. DIMLIJStOW� OF TALIK: LENGTH - .WIDTH ;L.IQLIID DEPTH BOTTOM AREA 231= GAL /INCH AS PER MANUFACTURER GAL /INCH - - Goulds Submersible Effluent Pump :. 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 • EPO4 Single phase: 0.4 HP, manual operation. Automatic points. • Heavy duty sump models include Mechanical • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■Bearings: Upper and tower RP 115 V, 60 Hz, 1550 RPM, SPECIFICATIONS • EP05 Single phase: , FEATURES heavy duty ball bearing Pump: EPO4 built in overload with n EPO4 Impeller. Thermo- construction. • Solids handling capability: automatic reset. plastic Semi -open design 3 /1 maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. sp. cm" sf Az ion • Total heads: up to 24 feet. with three prong grounding m EP05 Impeller. Thermo- - Discharge size: 1 1 Y NPT. plug. Optional 20 foot plastic enclosed design for (GSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with end in °F' or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140OF (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running; dry without damage to 9 30 components.a Pump: EP05 8- Ah • � S i � olids handling capability: c 25 UY /•1 maximum. 4 z W • Capacities: up to 60 GPM. _ • Total heads: up to 31 feet. s 20 8 • Discharge size: 1 NPT. = 5 • Mechanical seal: carbon- e 15 rotary/ceramic- stationary, -j 4 BUNA -N elastomers. o • Temperature: 3 10 104 °F (40°C) continuous 140OF (60°C) intermittent. 2 5 1 �^ ° 0 0 10 . 20 30 40 so GPM R 0 2 q- +R g g a�f0 12 mYh " kx CAPACITY '' y O 1995 Gaft Pun". lnc .,: " Hfedlve .1995 May - 63971 Wisconsin Department of Indust p 'y SOIL AND SITE EVALUATION Page / of Labor and Human Relations 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 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. # PEA-�D /N f>--- 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 II(fif 13400 L-4NP 4!P) Govt. Lot SGV 1141 ``,, W 1/4,S i3 T 2 9 ',N,R / E (or)(0 Property Owner's Mailing Address E S T Lot # Block# Subd. Name or CSM# 33 MiNN1= soT-,� Sr �K c. �-- . FvER�r�PEt�v E5Ti4 City State Zip Code Phone Number Nearest Road //IV ! /1 -IT- P �- N INA X510 � (�I Z) 2 22` SS � �iu � Village To Ie � //(�Gc y /2 1) New Construction Use: Residential / Number of bedrooms 3- Addition to existing buckling ❑ Replacement ySo - El Public or commercial - Describe: Code derived daily flow 6 900 gpd Recommended design loading rate • ? bed, gpdfi trench, gpd/ft Absorption area required 50 e) bed, ft 2 'r ' trench, ft 2 Maximum design loading rate , — 7 bed, gpd/fl gpd/it Recommended infiltration surface elevations) 5EE Pf . 3 n (as referred to site plan benchmark) Additional design /site conk ations 1 - t b u j /7 TY PE - S YS T , Parent material yCS 8 - P/ r ' Sf rTvE /Dw • Flood plain elevation, if applicable ! S = Suitable for system Conventional Mound In- Ground Pressu a AT-Grade System in Fill Holding Tank U = Unsuitable for system El S 0 Cis ❑ U El El S [R ' - u I ❑ S 2 U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bounda ry Roots - - Bed ,Trench Z yi /0 Y 31 - L S Ground 3 2 G '3 / ` SL. /4 Il /YNl qi e4- elev. p d - 7,1 Y I Q 4 / d&4 LE tis 7E� �i ° tom✓ Depth to , limiting V I factor 4-e N N 5•S • Remarks: Boring # o iz. /a YR 3/L — GS /.m 1 f C5 / ' 2- /1 -,23 /o k,e 313 LS / f Ground V IT t !5 - elev. 7 5 Y2 c I f $ L �( 5., . I i/ (J `I Depth to limiting factor 33-In. Remarks: CST Name (Please Print) Signature Telephone No. Rol3ERT 24L(31zi 64T 7/5 Address Date CST Number i tes 'yLDU• /2` /q�G 0-5 Z ve Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 ORIGINAL w 1 PROPERTY OWNER SOIL DESCRIPTION REPORT Z 3 c ,O Page of PARCEL I.D.# LO f 8 �d.Gt yj� ��GVtJ �S T�"1 TES Boring # Horizon Depth Dominant Color Mottles Structure 2 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed . Trench -� 1s Y)e 3 / LS 11w f/2 S c5 — .7 • T °eV "d 3� D 4 &°—ft- y/ /o YA Depth to n l AM 2 P JAL / Q s N N limiting $' w 6, factor Remarks: Boring # L j 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 GEDilv Boring # Ground elev. ft. • Depth to limiting factor in ' Remarks: Boring # . Ground elev. ft. . Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) 1 l °Z 0 U C� d � I�N � �LA < C N OA �V N �o � g n ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A , - d., -* = ,R, r C-1< m , t t e, Mailing Address l/ 3 q h 4 Property Address 2S Y Y7 A r Y (Verification required from Planning Department for new construction) City/State tj u A S,-hj 10T Parcel Identification Number 6620 (, g ® LEGAL DESCRIPTION Property Location `�i! _ '/4, � '/4, Sec. 013 , T_-J�_N -RA_W, Town of Subdivision 5' t g j e� , Lot # Certified Survey Map # . Volume , Page # Id 7 Warranty Deed # r; 7,g', ? ,Volume Page # Spec house ❑ yes 2 Lot lines identifiable ® yes ❑ 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 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 day of the three ye r expirat' n date. '2 J/' SIGNATURE 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 perty described a bove virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result 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 13 1, 3 PACE 136 WARRANTY DEED Document Number ,..F. r--; � RECfSTER'S__'bff10E 3 G � 3 ST. CRbix co., W! Return Address APR U 8 1 998 q /� �1�� {� ��J� ✓ 2:30 PM Register of Deed# arcel I.D. Number: 020 -106 -50 Richard W. LaCasse and Grace J. LaCasse, husband and wife, conveys and warrants to Richard T Formiller and Jode Frick Formiller, husband and wife, the following described real estate in St. Croix County, State of Wisconsin: Lot 8, Evergreen Estates in the Town of Hudson, St. Croix County, Wisconsin. TRANSFER This is not homestead property. $ E Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 9 day of April, 1998. (SEAL) Richard W. LaCasse G ce J. LaC s ACKNOWLEDGMENT STATE OF WISCONSIN ) Q � / � ss COUNTY ) Personally came before me this day of April, 1998, the above named Richard W. LaCasse and Grace J. LaCasse, husband and wife, to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. MEWS NOTARY PUBIX I\W aiy Public EC f County, WI DE My commission expire ?� ? _AS4�Q THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland Hudson, WI 54016 -- - 0 v 0 0 ... ...................................... ............................... OT 4 rya LOT 5 (THL) 3.20 ACRES .OI ACRES a 139,295 SO. FT. 31 , 116, SOs FT. ti a 4 — h� h \b NO ~ 1 5 Q ...... N 13 CC) 6 LOT 6 ti -1 r *5 �` 3.06 ACRES 0 / 133,103 SO. FT. _ M _ _ CL 11 41'1 W � I 85 ° 2 OT 12 \ —I r � ?.II AC ES i a2, 114 S FT. \� \ <I 1 \� N Lli 7 LOT 7 W >I 0 2. 50 ACRES O I \0 ^� 12 108,898 SO. FT. OD c . i ao O rn A F— I /o 1 Oa ss' 0) m 0� "'� � LOT 8 N i •. ; 2.50 ACRES 01 108,898 SO. FT, . J 00 N89 623.24' (o ,• PO�DING EASEMENT HWL= 948.0 LOT 9 0 O N00 • I ° "E 50.00' 3,54 ACRES N U 154,279 SQ. FT, I S89 ° E 644.23 EAST -WEST 1/4 LINE OF SECTION 23 �3 I \ e � p 7 Vol \ w N N z N \ \\ m p p F N \ 1C cn rt �a rt r \ o N �rt u o ty rt dr r r � 8 r• a �o � EA p N Pt e n 0 H. t$ s o I ro ro ~' a p� ' y a to a ,r • H. m ct 4 a' M Q �C a 1, N rt N m O O M N W N W H ^ fD a S N rr trNHO ►� M rt m x aa o Oi mo z 2 o ul ro (f� r-4 <n b — (D b a N •r•I 4) 'I 0N4 4J 1 14 4-J �.i 4-J •r4 U b r-A to 1~ cn ro U1 W O a k a 0 ¢� 0 0 (1 9 - ra 4J U 41 y 4) > y fol N r U 0 •r4 S-1 • f `D ro L4 U Aa r d 04 m 0 v v aro a+0•ra 0 Q) 3 r-I Z ° d�z •rA (0a to b 4J 04 01 ul n o k E.4.)8 - ro ro 4J aA 0 0 tn 0 a� N 0 N ( : p o 04 -V � N °' \ \ . r-a r 4J \ M ` N N a J \ co I a 'rq \\ 14 Z14 C 4 C4 M 111 �O \ ' 1. j r �! 3 v U� .'0 ��0� o a rj 0-- � 3 J � J N �Y r