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020-1262-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563821 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: Xion , Destiny Yer & Xai Une Hudson, Town of 020-1262-20-000 CST BM Elev: Insp. BM Elev: _ BM Description: Section/Town/Range/Map No: f 0 6= ~o /0 6 0 Cvlrl~lv ~1C -4n 20.29.19.1269 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. SC IC PS I 'L)a,AlA., le'3 J Benc~h_mar~k A4 .BM ~of l0(0 D g ~ Alt. BM Aer f Bldg. Sewer H94d+ng" St/Ht Inlet lj C. / TANK SETBACK INFORMATION St/Ht Outlet /o/2~! TANK TO P/L WELL BLDG. Vent to Air Intake ROAD e j _ V n /QD J s l 30 L co IX" Bader/m ,)n. Aeration Dist. Pipe /S s~ (J 0 Z Holding Bot. Syste l/ ~ f q ~o z 5 cy PUMP/SIPHON INFORMATION Final Ira e~3 S 4" 1 3 1) / d 5 2 U Manufacturer Demand St Cover _kul GPM / 6" ulc Q, 0 7, -3 Model Number VJ/ (3 TDH Lift Fri Loss ]SysIeacl TDH jFt Forcemain Length Di cr ! OQ~ 3 2 SOIL ABSORPTION SYSTEM ~70 -f- -70 7S 4. BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS wef7 1 r SETBACK SYSTEM TO P/L BLD WELL LAKE/STREAM G nuf INFORMATION OR a T/GKJ l0 _ S Ty Of System: Model Number. FkVA~ uYLe_ S ux -4 D TRIBUTION SYSTEM Header anifold p/ Distribution, x Hol Size x Hole Spacing AIM t Ai ntake yl f b t/ Pipe(s) 0 1~ s Vh. D Length Dia Length Dia Spacin_ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only h Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mul e Bed/Trench Center X'/ Bed/Trench Edges Topsoil F Yes ❑ No ~ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ► / -i Inspection #2: / / Location: 851 Lassie Lane Hudson, WI 54016 (SE 1/4 NE 1/4 20 T29N R1 9W) Pine Grove Heights 2nd Add Lot 24 Parcel No: 20.29.19.1269 1.) Alt BM Description 2.) Bldg sewer length = U_yj_< j7 - amount of cover = t i Plan revision Required? ❑ Yes /No ! or Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Jury-26-2013 0355 PM 5t. krobx County Plan/Zoning 'x'15-386-4686 1!8 ~l STC - 104 118 BUILT SANITARY SYGTHM REPORT riN y2~ t a ~C~ omm J t nif A~asgel W, :rLzda SUBDIVISION / CSX~ 1H LOT 4 SECTION ?.0 T V Y N-R- L? A? Town of I•t u D~~ N ST. CRcxx COUNTY, WISCONSIN v~aw SHOW lsvzpy MING WITHIN 180 FEET or SYSTEM ^01 Z-0 27we FA wew%7 17~ V GI►4N6J~ ~ ~ i 6-kil - pRlye WAY /11l`l~ 8s' ti nose ~ a!'r!z rt ~ ~ wscc qo • tf, - j, M $y sT6M $1. too-oo i I1t=17' Ndt E : CuT T+* B,E M408 To 1AA1,MrAt14 Dorm kX Q 01 xMil yTs i 6 5-0 fa ft Talf OF 719L WA A r Aw. cot' "M R Fr..mpaa' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 l11 ~ w County ceo Safety and Buildings Division T` .Tr 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit slumber (to a filled in by Co.) $ I41 Madison, uVl 53707-7162 ~s X63 ~z1 } ~'l• State Trans ion Number Sanitary Permit Application A- in with SPS 383.21(2) Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are s fitted to Project dress (if different than mailing address) the Department of Safety and Professional Servies. Personal info on you provide may be used fo~ary u oses in accordance with the Privac Law, s. 15.04 1 m , s. J 1. A lication Information - Please Print At f a 1 # Prope wner' Name 07 --1,9 C/1k-OLC/ Property Location Property p6mer Address ` 'x'00 Q SS t 1/~n p Govt. Lot KK Al Code Phone Number~~'/4, Section /90 City, State circle one) / r 33 'T N; R Eor J) Lot # Ii. Type of Building (check all that apply) Subdivision Name 1 or 2 Fa ily Dwelling -Number of Bedroot~ Co is d d ~G~ • „ I ~ `i,/Y/ Block # ❑ Public om ercial - Describe US \ ❑ City of CSM Number Village of ❑ State Owned - Describe Use .Town of N / f SGYI III. Type of Permit: (Check only one line A. Complete line B if applicable) C] A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) List Previous Permit Number and Date Iss ed B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New 3 , G Before Expiration Owner IV. T e of POWTS System/Comp onent/Device: Check all that apply) Non-Pressurized Iti-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Pretreatment Device (explain) ❑ Holding Tank 11 Other Dispersal Component (explain) r V. Dis ersal/Treatment Area Information: DisPe rsat Area Req red (sf) Dispersal Area Proposed sf) yttem Elevatio L Design Flow (go) Design Soil Application t p D ~ / ! U ~51 0 t ~ VI. Tank Info Capacity in Total # of Manufacturer Gallons o a N 15 Gallons Units w ~ U; New Tanks Existing Tanks 0 2 £ - o U iin y cn w C7 0. e ,p p Septic or Holding Tank 1 ©b !O ! ` S er >-Z Dosing Chamber VII. Responsibility Statement- I, the undersigned, as me responsibility for installation of the POWTS sPhon o Number attached Business Phone Number Plumber's Name (Print) Plu be Signature y~ ~t s ~ Plumber's Address (Street, City, State, ip Code) %9" A- ~wer F4 A r ~ 7cl VIII oun /De artment Use Only Iss 'ng Agent natu Permit Fee Date Issued Approved ❑ Disapproved -7/I ❑ Owner Given Reason for Denial g y 5-t L" CA- COnYjt IX. Conditions of ApprovaUReasons for Disapproval ® -~KK~ -f ~jyL~ SYSTEM OWNER: t~ Y 1. Septic tank, effluent filter and dispersal cell must be serviced..lmaintained n as per management plan provided by plumber. e Ions for the syste bm;t to the-County ply op pape~~ not less 4than 8 /z 11 inc es ins. as per applicable E2lt~L9dPfi4i°a9'~ 4 C~ SBD-6398 (R. I I/11) ;un-26-2093 03:55 PM St. Croix County Plan/Zoning 715-386-4686 1/8 1 is STC - 104 Ae S-TILT EXXXTARY BYSTffiM REPORT .v VA V ~AAX ADDims t.•.. sg At c,c,tt SXMDMSION / COX# 21 ME (AR 10 ML I Ed M!rI LOT #0 SRCTYON t Q T 2.'t N-R_4!A? Town of ..l~ u p ' ST. CRCIX COUNTY, WISCONSIN ]PE+7~N VIM SHOW JSVLPRYTMG WITHIN 100 PENT OF SYSTM ,9"71 40- 27wr 4,44 47 77 7% x7' (p#QAt$ 1 VIA bt x0t Dti YR WAY d, f t rE ~/Ar BARE 3s' ti V4nasp, bs ' y~ Ifi v~lEtt yd+; ih yCHb.icS w y► $fAt 'f~ rc 5yyTtm Ei.IL too.oo' ro Not E; Cv7 To RE M4Of To ryipil~TA~1►l 1/~1T pEP7'N lt~4U~R~,e4r~'s ~ t r f N M*1-1& M. To* OF 714. M dr -";4w Or C"Af R F"' Mg,"' INDICATE NORTH ARROW 'o rrrs Provide setback and elevation information on reverse of this form. Provides 2 dimensions to center of septic tank manhole cover. P S~ q js f' Pg of Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: Project Name and System Type: !l~ C~ Z° roL de ~rC ~v. ~Y~`Oly V Location: ,QS S (~Shc~ l~-~✓®1 Street Address 5F /A E sa Legal esc iption , whs~tro TownshiplCounty Design Criteria (Check one): Holding Tank Component Manual: In-Ground Soil Absorption Component Manual: ❑ SBD-10571-P (6/11/1999) ❑ SBD-10567-P (R. 6/1999) ❑ SBD-10855-P (3/2007) Version 2 IN SBD-10705-P (N. 01/2001) Version 2 Contents: Pagel:., VJ I P l R Page 2: ~G S C1 C r t11~'1 Page 3: 79a I", ttA ~L ss 0 V, w Page 4: < Page 5: I Page 6: Page 7: Page 8: Page 9: Attachments: Plumber/Designer: r hlWSigned: Credential Number: g Date: Soil AbsorDflon System Cross' Section ~ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft L ching Ch ber.. 3 , ft ~ System Elevation 16M ft Oo • 10 ft Soil Absorption System Plan View ' 7' ft /4b•d~ft3~-{ a t7•b f t Leaching Trench 1~ Vent Or Observation Pipe 3 Chambers 1 3~ f'~ Y cY` 4° Dia. Trench 2 Header 1a©• 3~ 1 'TIZ~7VGF-f 3 Leaching Chamber Specifications Manufacturer And Model EISA Rating ~0, 4-q ft per chamber Soil Application Rate , gpd/sq ft gpd Design Flow + Soil Application Rate + /D j EISA = 5~1 Chambers 3rows of-I-Ir chambers each. page Z Of POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of Z N I SYSTEM SPECIFICATIONS FILE INFORMATION p NA ffPe er fSeptic Tank Capacity al +t # s~ 3 Septic Tank Manufacturer JA) ❑ Effluent Filter Manufacturer PO/ k ❑ NA DESIGN PARAMETERS ❑ NA Number of Bedrooms p NA Effluent Filter Model 3 a Number of Commercial Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gal/day . Pump Manufacturer ❑ NA Soil Application Rate , al/da Pump Model ❑ NA ❑ NA lnfluentJEffluentQuolity Monthly average Pretreatment Unit ❑ Sarud/Qravei Filter ❑ Peat Filter Fats. Oil & Grease (FOG) 530 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODE s220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 mg/L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD5) 530 mg/L Q In-ground (gravity) ❑ in-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L O At-grade ❑ Mound Fecal Coliform (geometric mean) 5104 cxu/100m1 ❑ Driine ❑ Other Maximum Effluent Particle Size K Inch diameter vawas typical for domestic (non-commer iaQ wastewater and septic tank effluent Vak,es typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume Inspect dispersal cell(s) At least once every O months O year(s) (Maximum 3 yrs.) Clean effluent filter * At least once every 3 ❑ months ,(year(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Other At least once every Omonths ❑ year(s) ❑ NA J'Cco7~r.rsw cis aa/eIJ4 AV - "C p- Very 3 L/6x dwr ec•.a a,s d t4,-!- MAINTENANCE INSTRUCTIONS yam,• c/teh .Ftllri every f'.+// to ~V•!ca~~ dC +he w1wo-cr'- Inspections of tanks and dispersal cells shall be made by an individual carrying one of tyre following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. Tank Inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall bd visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatVment c omponenK and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event START UP AND OPERATION. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Y t l raft ckAr~,1u~~S X1,0 la>t~ v Sg•~. ~.al~ a 1 ~ ~ twos ~ o~~, ~ ~ aovn. 3 q tuj W- I b© "/t~ ~a'~an Page 2 of 7i START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant replacement system: , 4A/ -may w l „ A W/n~ *1L pf i4 't/"`suitable replacement area has been evaluated and may be utilized for the loc tion of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ' Iv T ted to i4&-~tif !TS = soil a"4-site 11f 110 1uplecelifiv aluat' a o ing tank be ' e ai ef2D}-l i~ 1TD1Q- A/$1^~ ~NS7RCI~TI.DrJ ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS e POWTS INSTALLER POWTS MAINTAINER Name --/-D 'I Name Phone 7 / L - Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name s-1-, Gk6 ( Phone Phone 3W(10- (G O D This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is tg certify that I have w ssDected the,sep is tank presently serving the X /I IL VA( E zS5 1 A4 391 e a residence located at: _ 1/4, 1/4, Section o.7 © , Town N, Range W, Town of MA s e 1~ , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 6121-11"')01-~ Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: L~ . gallons minutes Capacity.. 1,d D Construction: Prefab Concrete k Steel Other Manufacturer (if known): &j ; p s eh Age of Tank (if known): 1 u rT (Licensed Plumber Signa ) (Print Name) is tey-n c 6 0/'7~z (Title) (License Number) MP MPRS lllh~ (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) P. ~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Cer/B yer TW 1 Mailing Address Property Address (Verification required from Planning & Zoning Department for new constriction.) City/State Parcel Identification Number Oc~o - tl " I to LEGAL DESCRIPTION f Qsb~ Property Location '/q Sec. 090, T ~N R~W, Town of Subdivision r` D U _ Ac/'~Ps %d Lot Certified Survey Map # , Volume , Page # Warranty Deed Volume , Page # Spec house yes Lot lines identifiable 1C no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 NaturifResources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by A of a warranty deed recorded in Register of Deeds Office. Number of bedro s 12 SIG URE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) L ~II I " _ 1 II~II~ I~I II I~I~I WARRANTY DEED - BY CORPORATION g 0 0 1 8 9 2 STATE OF WISCONSIN FORM 2 9001 Q9 THIS INDENTURE, Made this 2P day of June. 2009, between BETH PABST CO., DEEDS ASSOCIATED BANK N.A.. duly organized and existing under and by virtue of the REGISTER CROIX STER OF DS laws of the United States of America, CONVEYS and WARRANTS TO: DESTINY XIONG RECEIVED FOR RECORD - YEK 07/16/2009 08:05AM Witnesseth, That the said party of the first part, for and in consideration of the sum of WARRANTY DEED One Dollar (100) & Other Good & Valuable Considerations to it paid by the said party of EXEMPT t the second part, the receipt whereof is hereby confessed and acknowledged, has given, r REC FEE: 13.00 granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these TRANS FEE: 537.00 presents does give, grant, bargain, sell, remise, release, alien, convey and confirm unto the PAGES: 2 said party of the second part, its heirs and assigns forever, the following described real estate situated in the County of ST. CROIX, and the State of Wisconsin, to-wit: LOT 24, PINEGROVE HEIGHTS SECOND ADDITION IN THE TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. 13 Return to: o 029-1262-20-000 PARCEL IDENTIFICATION NUMBER Commonly Known As: 851 Lassie Lane Hudson, WI 54016 (NECESSARY, CONTINUE DESCRIPTION ON REVERSE SIDE) Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except SUBJECT TO RESTRICTIONS, RESERVATIONS, EASEMENTS, CONDITIONS, COVENANTS AND PUBLIC OR PRIVATE RIGHTS OF RECORD. Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said party of the second part, and to its heirs and assigns FOREVER And the said Associated Bank. N.A., party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said party of the second part, its heirs and assigns, that at the time of the ensealing and delivery of these presents it is well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever, 1 oft p~ 4 ~ and that the above bargained premises in the quiet and peaceable possession of the said party of the second part, its heirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT AND DEFEND. In Witness Whereof, the said Associated Bank. N.A., party of the first part, has caused these presents to be signed by: Dennis P. Schenk. Vice President, and countersigned by: Eileen J F1ugaur Supervisor Loan Payoff Department, at STEVENS POINT, Wisconsin, and its corporate seal to be hereunto affixed, This Z e June A. D. 2Qff. SIGNED AND SEALED IN PRESENCE OF ASSOCIATED BANK N.A., a Wisconsin Corporation Dennis P. Schenk Eileen J. Flugaur Vice President of Associated Bank N.A. Supervisor, Loan Payoff Department of Associated Bank N.A. STATE OF WISCONSIN ) ) SS COUNTY OF PORTAGE ) Personally came before me, this 25~h, day of June A. D.2009, Dennis P Schenk, Vice President, and Eileen J. Rum= Supervisor. Loan Payoff Department of the above Wisconsin Corporation, to me known to be the persons who executed the foregoing instrument, and to me known to be such Vice President and Supervisor Loan Payoff Department of said Corporation, and acknowledged that they executed the foregoing instrument as such officers as the deed of said Corporation, by its authority. O~PAY pV~ This instrument drafted by: OTAR Notary Public SEAL Cailin [oom Cailin Bloom I~ CAJV Associated Bank 1'f My Commission Expires: March 3. 2013 N WISC~S? 2 of 2 „I.,........,. 111 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 5/1 144 /11 FiZ ADDRESS /3o k SUBDIVISION / CSM# ~)/NE C/Zy YC, {l2E'~ gib LOT #-Z S/ SECTION ZO T 2-9 N-R Town of 14uP.5 c,,-l ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM z7 7S. _ I I// 6R2HGf I aZ.'/ 7( 3 L yy s _ DRIVE \AIAV At -f-re AWE ~ A&EA 8s' ?~XSL i 4~ V 2Za - y7- - - - - - - - SOS, - 18 ,yEU i _ h h - - - 9 0-- M ~C I- yon E N 1 ~ Sy STEM E 1. = too.oo n bE,2T tvoT E . Cu7 To 3E m4DE To MAINTAIN IYow bEPTN kE Q U i2MENTS v h 3 9I-6.M. Tod of TEI..FEP. At 5-W LOT CDRNfk F/. 100,60' INDICATE NORTH ARROW SoVTH to'r L/NE 5/(0(0, Sjs' 1" SCAIE~ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 0 l ~ .1 BENCHMARK: Top oT -rEL.]:~Ep AT S►'y Co FNE,~ Ei. = /D(7,C~c) l 2 ALTERNATE BM: `Tof of 14oU5f r0upA710hl AT SE foRA4FR Ei= S 7~ SEPTIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: WE/SIP- Liquid Capacity: / 000 6,4Z. Setback from: Well(oS House Other Pump: Manufacturer NA Model# Size Float seperation Gallons/cycle: - Alarm Location SOIL ABSORPTION SYSTEM Width: I Q~ Length L(o Number of trenches Distance & Direction to nearest prop. line: 75' To A10i27-N /_oT L Setback from: well: 90 ' House `i 7 Other I H o TO you i LcT 11W ELEVATIONS Building Sewer - ST Inlet; 16D-75- ST outlet PC inlet PC bottom Pump Off Header/Manifold ~h yS~ Bottom of system Z_ _ Existing Grade Final grade g-/ DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: /UIPie S O 3S"DO INSPECTOR: 3/93:jt Wisconsin Dtpartmentof Industry, PRIVATE SEWAGE SYSTEM County: Lahor-and Human Relations INSPECTION REPORT CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town o : State Pla MILLER, SIAM CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ' l~ TANK INFORMATION ELEVATION DATA 2 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , Benchmark /0? IK&I Dosing 1 ( /06.-LEI Aeration Bldg. Sewer Holding --7 St / I f Inlet 10.75 164 6S- TANK SETBACK INFORMATION St/ FO Outlet / a5l~ TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header tom- c Jw,~rS Aeration NA Dist. Pipe Holdin Bot. System .L25 , ~ PUMP/ SIPHON INFORMATION Final Grade / r Manufacturer Qemand Model er M TDH L' Frictlo Loss ead Ft orcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / Tit=EFI-i Width , Length! No. Of Trenches PIT No. Of Pits Inside ,7 . iquid Depth DIMENSIONS _ t SETBACK SYSTEM TO P/ L BLDG WELL LAKE45TREAM Nl anu aCturer: INFORMATION Type O C 9ER M e R UNIT System: lae.~,l ?S/ /oo DISTRIBUTION SYSTEM` Header / Manifold Distribution Pipe(s) f; x Hole size x Ho p nt Ai*Intake Length Y62-~ Dia. ~z Length ar Dia. Spacing O SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syst s O ~.F Depth Over Depth Over „ xx Depth Of xx eded / Sodded d-N" ' ` Bed/ TD0914,Eenter .5 0 Bed /ages Be, Topsoil Yes ❑ No o _ COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson - 22fl _ 2-g . 199 SE , NE: Lot 24, Li sie Lane S'oa~e~l t i_ Plan revision required? ❑ Yes to Use other side for additional information. a-- SBD-6710 1 05/91) Date Inspector's Signature Cert. No. gs ter , SANITARY PERMIT APPLICATION Bufereaauu oand B f of Buiildiinng Water Systems ~ Bu201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less CountQ1 than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application state s,,~,lyjr ;elr2t rv~,mber 0( cX The information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location L(9 SF 1/4 E 1/4, S Z-0 T Z-y , N, R E (or)&D Property Owner's Mailing Address Lot Number Block Number Box Z_0Z _ zY City, State Zip Code Phone Number Subdivision Name or CSM Number 7 el V SON W I S%l ( ) Z 6 1 N F_ C, R OVE (-FE G N7 S 2N APP- 11. TYPE F BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road ❑ village Public 1 or 2 Family Dwelling - No. of bedrooms Town of HU Dso N 14A'551F- L4N,E III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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. New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System Tank OnlyExisting 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 ❑ Holding Tank 1211 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 ►-~5 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft-) (Min./inch) Elevation (o `l $ 7 X o D, / 00,00 Feet 10%4O1 Feet TANK Capacity VII. in gallonTotal # of Prefab. Steel . Fiber- Plastic App- INFORMATION - New Existing Gallons Tanks Manufacturer's Name Concrete strutted glass Appp. New Tanks Tanks Septic Tank or Holding Tank 10 D O / VV F. g F ® ❑ ❑ - ❑ 0 ❑ Lift Pump Tank /Siphon Chamber El ❑ ~ El ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Photii&". MIKE M-DO N ELL 114PR S 035-001 °71S -3 9 Z= Plumber's Address (Street, City, State, Zip Code): 4b l G`LAEIII M LL- LOWE 140 D5oN w l !9 5/0 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issuing Agent Signature (No Stamps) j Approved ❑ Owner Given Initial Surcharge fee) Adverse Determination jg~o X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: S8D-6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. 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 DwF~lling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank rel.rlacement, 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, numb(, r of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for t)/1 septic, :Jump/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 arefix (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 10 x 11 inches must be submitted tc'he unty The plans must include the following: A) plot plan, drawn to scale or with complete dimensions loca.i Dn of fu,ldincl tank(s), septic tank(s) or other treai_ment tank-,, building sewers; wells wa er mains/w t~.:: sc~ " e, stre': s or J lakes; pump or siphon tanks; distribution boxes; soil absorption systems; reolzcerrent system ar(<3 s; anu the log '.o( f the building served; 13) h:)rizonial and vertical elevation reference points; C) complete speci ficatio_ ; for purnp, aric controls; dose volume; elevation di fferences, friction loss, pump performance curve, pump model ano ump cr,~ i.ifoc urer; D) cross section of the soil absorption system if,required by the county, E) soil test data on a 1 15 1 Jrm; a)d r) al sizirg information. GROUNDWATER SURCHARGE 1983 Wiscs n Act 410 included the creation of surcharges (fees) for a number of regulated practice; which can effect grouwater. The monies collected through these surcharges are used for monitoring groundwater- contamination investigations and establishment of standards. LASSIE LANE VVOS 40r- G141-- Z -Z, z y y' o ~ t~ r z N IA s m { >A 7v D M r ~ % n 70 (A n c Trr J. m m c ~ ~ y LA v► I N N -I ~ r L ° rn In 0 m ra g, T D - jfi x nl 0 0 1 W~ _ t 1T 0 l 0 u' a o i ~ f~ ITr O N RI vi O ~ S a w, m - -go - ~ ~ N frf Iw z - \ ?v I i t ~ Z D d Tn z fT) 13 A x-- ~1 rin a m o w v, 0 U ~ c M. rn O 1 E 4Sr /-®r UA/E Z 3 3. 3s N s 7c y ~ l A J m .I ~ f I- Z I ~ j I c~ ~ ~ cn I I -o I ~ ~ rI I I , m I o I I I rn I z I I I O O ~ ~ I I ~ I 0 1 Q`IN ¢ m m I I I I i i i } V1 I ~ I I I I P m -nom NSJ z I j M j z ~ ~ I I n C I ' ~F; I I W I ~ O v I I I L4 I T' -d I I I ~ 4h. I -v I I t z 1 =i z R° X y J O O 0 Azo ° x ~1 ' ~--4 v = m o N o m -p Lt; z m o X o m z m I`3, ° M o WisgonsinD n,oc~use' SOIL AND SITE EVALUATION REPORT Page I of LLabdr arW , Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY -ely Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPER OWNER: PROPERTY LOCATION S-4 en / i- u, P, GOVT. LOT'S r_ 1/4 N ` 1/4,SZ6 T 11 N,R /j E (or) W PROPERTY OW R':S MAILIN DDRESS LOT # BLOCK # S D. NAME OR CSM # TR6LJ-7" lze ~A~ Z , G ~7s CI , STATE / ZIP CODE PHONE NUMBER []CITY ❑VILLAGE OWN NEAREST ROAD New Construction Use P0 Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 0, bed, gpd/ft2 01% trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate O 7 bed, gpd/ft2_0,Y trench, gpd/ft2 Recommended infiltration surface elevation(s) k>- l At4s - /tom tX5 It (as referred to site plan benchmark Additional design / site considerations 4 c't cT fa .LL 1'C r' c-Ti F k0" - AjT i P f- 4 ~ f- 4 76 r , " 1~`F- PT N Parent material Flood plain elevation, if applicable ft S - Suitable for system 0 VENTIONAL MOUND IN ROUND PRESSURE T•GRADE VTEM IN FILL HOLDING T K U=Unsuitable for s stem S❑ U 14S ❑ US El U ❑ U ❑ S SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Barclay Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed reach -/I i~ . 3 2 5~K n^ r` w l fl-z4-1 yp,4 no, b.7 o~ 54 M r I f a.7 6 Ground - rl it elev. 111.6 ft. j -1-7 S O M M Depth to limiting factor 7 l F-1 Remarks: Boring # 4 lc~-n /-Z' L K~ A 1 t r W .5~ ilk Z r S' E-X K- 7- y r Ground I elev. 4410 a 3 18 Ic-3.--~ z ft. Depth to limiting fac 1,17 7-T Remarks: CST Name: Piease Print , Phone: Sn 11 Address: k. f )a, , / <J Signature: r~ 2 Date: „3 ~ CST Number: PROPERTYOWNER-SAf4 SOIL DESCRIPTION REPORT Page 2 of 'PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench . . inla#k C" 6.2 Ground L/DYk 4 elev. i `09 Depth to limiting factor -Z Remarks: Boring # r 27 `7, j Ye2 I ~F ~J.4 7-51 / . k 4 J-0 &Y 0,11 ~ ''r r~ I CS 7 CS elev. i Ground to n.s limiting factor 7 Remarks: Boring # r S 13 24- 16YP~44 J>~ s b nor L J I 2 ~ikviivJtvr:i Ground 4A. n r, fh 1,j elev. at 0:7 m O i c,rKA, ft. Depth to limiting factor Remarks: Boring # y{,~. Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PAec 30~ 3 ► / rD iD / x 1 ~ '~a sZ I SZ M ~Z I qp r ~ rJ Q Q Z ~ a r 4 N a i s ~ 'r r ICZ z La~ss) L L,4,1 g 71 Ida PPINEGROVE HEIGHTS SECO LOCATED IN PART. OF THE NE I/4 OF THE NE 114 ALL IN SECTION 20, T29 No R 19W, TOWN OF HUD LEGEND • 2' IRON ►IPL FOUND LOCATION `SKETCH i n w n • 1' IRON PIPE FOVND > Y, x~v IV ter. 0 2' x SOS IRON PIPE WEIGHING ].65 L6S. = n _ 't M. , P[R LINEAR FOOT, SET. po u a' F~ 1• • ALL OTHER LOT CORNERS ARE MONUMENTED WITH A z A 1' x 24' IRON PIPE WEIG NINO 1.66 L85. PER LINEAR u p n - FOOT. u " i A A alp - _10' WIDE UTILITY EASME NT - "a x O n ~4, rl...Vt z A e9 p not A00. r_le ue no objrcGOns to this pWt with r0spect to secs ]15,, ° c 1 2>7,16. 23620 and 236.21 (1) and (Z. Wis. Stats.. and ILH1:J 4VIS. Admin. Code as provided by Sec. 236.12 (6), Wir t cennitiod this..Z sy o1 bZt 1 1.w E AACOSt LA.t Department of Agrteulturs, Trade i Consumer Pro SCALE IN FEET 200 150 100 50 0 $Do 200 CURVE DATA CURVE LOT RADIUS CENTRAL CHOf10 CHORD ARC TANGENT BEARINGS 3AINBER NUNBER LENGTH ANGLE SEARING LENGTH LENGTH ,1 - 2 200.00' 17°00'00" NO7o31'32"E 52.12' $9.34' NOOp58'2e"W W16001'32"E 3 - 4 266.00' 16059'07" N07012'Sa.S^L 78.57'. 76:,86.'- N16°01'32"t NOOa57135"Wf 23 IS°01'23" NOe030'50.5"L 69.55' 69.75- 24 01057'44 NOOa01'17"E 9.11' 9.11' - S - 6 200.00' 90000'00" N44002'25"E 282.64' 314.16' N000S7'3S"W N69002.25-% 7 - 6 266.00' 90000'00" S44002 25"11 376.18' 417.83' S89002.25"W 500057'35"E 'a road 7300617• 5520261'16.5"W 316.96' 339.55' 36 1605143' S07028'16.5"W 78.00' 76.28' OI • 9 - 10 200.00' l6°59107" 507033'58.5'W 59.07' 59.29' 500057'35"9 626001'32"W al 11 - 12 • 266.00' 17000'00• 507031'32"W 76.631 76.92' S160G1'32"W 500°58'26"E " ' JI tl , rl JI • AI SURVEYOR'S CERTIFICATE - ' I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, do hereby certify that in full compliance with the provisions of Chapter 236 of the Iii sconsin Statutes and the LanC 5ubdivi cion Ordinance of the County of St. Croiz and the Town of Hudson, and under the direction of Richard Stout, owner of the land described on this plat, I have surveyed, divided and mapped P3negrova Heights Second Addition; that such plat correctly represents the exterior boundaries and the subdivision of the land suiveyed, and that this land is located in part of the NEk of the NEk and the SEk of the VEI., all in Section 20, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; further described as fol love: Commenq I n g at the Eh corner of said Section 20, ■aiel corner also being the point of beginning of c1:i6 description; thence N00057'35'W 1380.04 feet along the east line of said NEk; thence 589002'25'W 266.69 feet to the point of curvature of a 266.00 foot radius curve concave southeasterly whose central angle measLres 73008'..17' and whose chord bears 552028'16.5'W and measures 316.96 feet;. thence southerly along the arc of said curve 339.55 feet; thence N70014'45'W 481.76 feet to the east line of Lot 1 of Certified Survey Map recorded in volume 3j page 725 in the office'of the St. Croix County Register of Deed:; thence 500°4940'£ 113.55 feet along said east line of Lot 1; thence 584022.2D^W 362.67 feat along the III th line of said Lot 1; thence 500052'SO-E 1219.98 feet along the west line 'Of.said SEk Of the NEk:_.--thence N88058'40'E 1335.28 feet along the south l'ne of said NEk to - the point of beginning.: ,he land described above contains 1,719,946 square feet or '39.71 acres. - - JC 7ALLE. c 4 ALLEN C. NYMAGEN la: REGISTERED LAND SURVEYOR, 5-1407 MUS=~'~. / - IC' i 05101,l- DATED THIS DAY OF 19__. .~~`•,`f'r hp I I A AUUITION NE COq NEo; SECTION 20 - T29N, N19W AND THE SE 1/4 OF THE NE- 1/4 , I COUNTY MONW 'SON, ST. CRO IX COUNTY, WISCONSIN. _ CERTIFIED SURVEY. ' R•AI VOI UML~ . PAGE VOC UArE 3,' IIj7! Tt; W z \ \ I 589• G2' 25• W 266, 669' o W Q Ss \ . z _ at n I _ ' 90VTN t wE of TnE I/4 \ 7 1*6_110 H N8B•OZ'27:L_ ON AS E RECORDED . W ±+62,67 AREA W S84' 22'20 4 330.38' RECORDED AS 33 UI Qi „ • n 2.19 ACRES / 130, FT. CI I • I ~i 3.00 ACRES n n I w' l W 3 4 N6e• 58•.0'E 439 67' a La a Nee•5e ao'c aee.e9' 12x. 191 Sa Fr. 1 c ( J o x.el 4c RC3 f . w vOR ARt F' w 2 00 A[RESFT. a o tl ow-,"- 2 1 tl / Y a 6T, 122 50.FT. _ 2 00 ACRES 329 22' - ' --440 4si ~ Se8. 5140` W 769.55• p ^ I~ - - PUBLIC - - -STREET- - -=-a- •ee eo o ~1 CD j 29e eo' 5 Nee• 56.40• o. 789.70' m <I I ci 7 v N 26 c!~ 67, 122 50. FT. ``I! h I I 2.00 ACRES 01 W O n r a68.69' „ ►1 •i W - • rI n JI LC FT. 1 6 SO. FT fa e 2 N N ,601 SO.'T 3 ,398 25 3 l' m N i 3.00 ACRES 2.50 ACRES e 2.50 ACRES o 87.122 S^. FT. O 1 v rf 2.00 ♦CRC9 ' o o-II 8 .'I~ Ne8. 5a'40•E 466.69' e c w MATER p (n F V • •1 DRAINAGE N CFJ 1.. w I - AREA J i 2 4 2<O 241.28' 66' 288 60' e 377.47' 393.27' 1 77074 i /J 10 e,9o1 so. FT. n w 2.50 ACRES N + Ne8.5e'40'E 46685' 30 0~ • 29 o T u 4 ° ZI t3 50. FT. - - Y ISO, 0. FT, h e / V SOO W 31 Y - 3 00 ACRES •0Iq 3.00 ACRES W O ! N a: .0;00ow I • „ ~ w Nn / e O = R _ _ a. 907 so. FT. 3 - 8n. • /`cJ 2.50 ACRES s 31 Os' 72 .77' 377 47' 352 30' 6600 - 506.46' E V4 CORNER I SOUTH LINE Of THE NE V4 N88' 58. 40• E 1333..28 - - - - SECTION 20 I 1 I A. COUNTY MjHuM 1 I 1 , I I/NF GROVE \MC!GNTI ILn,~21 f1P'F S 1 EFP1I1?tl / LnII al 1 I al J~ I / I J! - Is 19 ' 1 ~ 1, I I ~ 1 i t STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERIBUYER 5AM /mot (4-L- a . MAILING ADDRESS L3O X' Z Z T__ ~kj D o SyV f 6 $51 ((~s~ met r'~e ~/14(rs PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE Y U JD 50 IV -r-/()/6 PROPERTY LOCATION 5 E 1/4, NE. 1/4, Section Z O T Z 1 N-R / W TOWN OF //U b,50 !,1 ST. CROIX COUNTY, WI SUBDIVISION -P/NE Cpce 0 VE H E 16 HT 5 LOT NUM13ER y CERTIFIED SURVEY MAP , VOLUME , PAGE , LOTNUMI3ER Z 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. [/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: c3C f' DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Iludson, AV'I 54016 1I/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property s.4M M / eLEye.. Location of property _5 C_114 NE 1/4, Section Zo , T219_N-R_ Township _u D So Mailing address goy # ?-?Z- R L) p -Z! o Uj l & Address of site I /-455 /E L,4NE Subdivision name PINE e4oyE /,roc/~/fTs Lot no. Zy Other homes on property? Yes/ _No Previous owner of property DAN /El W, TlF- D E MANN Total size of property Z, S'0 AC- Total size of parcel Z, S~ Acl Date parcel was created S- 9 S Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house)? Yes No Volume //09 and Page Number ZO 7 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. _S4zlf f4 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. jz %s e(I :&raA gnature of Applicant Co-Applicant Date of Signature Date of Signature r ' nOCUMEr4T No WARRANTY DEED 711 ~ SPA F H[,E LD -R RE--NO DAIA STATE BAR OF WISCONSIN FOR:1t 2-1982 5A.491 G vii 11(1 TReed R'S OFFICE SX CO., W! Daniel W. Tiedemann and Carol J. Tiedemann, Record husband and wife,, JAN 9 1995 convv}., and warrants to Sam E. Miller at 10:15 A. M - - - - Register of Deeds ';ry •o the following described real estate in S_.t.. County, Sias of Wisconsin: Tax Parcel No: Lot 24, Pinegrove Heights Second Addition in the Town of Hudson. ~ o0 Is This is not homestead property. OW(is not) Exception to warranties- Easements, restrictions and rights-of-way of record, if any. raced this P day of January 19 95 . (SEAL) ,1~ Y1N l vl~`4J I;F.'at.l Daniel W. Tiedemann (SF;ALj °>1 'Ce-,z rl (SEAL/ Carol J. Tiedemann AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN 1 ~3. St.CroiX - ------County. authenticated this ...--..-day of 19..---. Personally carne before me this ....J."'. _.day of ...January--------------------- , 19_.95.. the above named - - Daniel. W,-.-Tiedemann .and .Carol. J..-..... . _Tiedemann,.-husband. and-.wife........ TITLE: MEMBER STATE BAR OF WISCONSIN (If not.. authorized by § 706.06, Wis. Scats.) to me known to be the persons. NO-o executed the forevoin:; instrument and acknowledge the Carle. WS INSTRUMENT WAS DRAFTED BY Diane M. Barron Ogland__._... Notary Pu l'rd~ >t . ir~i" . Attorney at Law of WI Notary Puhlic 1 • Cf~ ` county, Wig. (Signatures may be authenticated or acknowledged. Both JtY Commission i permanent. (If not, Mate expiration are not necessary.) date: .Names of Persons signing in any ea Pncity shuu.d !.e tl eed r..r prig o• j I,, T- 'h it .hr.a c. rr.. WARRANTY DEED STATE DAR OF WISCONSIN FORM No. 2 - IV, .L~~.o,.n~.c :Y>C."