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HomeMy WebLinkAbout020-1365-02-000;, sin Department of Commerce PRIVATE SEWAGE SYSTEM ' Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ T n of: P.C. Collova Builders, Hudson Township CST BM Elev.; Insp. BM Elev.: BM Description: Qyv.S~h S a -- / r~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~ . ~ ~j Dosing Aeration Holdrng TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~S-' ` NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Ma ufacturer Demand Model Number GPM TDH Lift ~on S stem TDH Ft For am Length Dia. .:Dist. e-I ELEVATION DATA County: St. Croix Sanitary Permit No.: 363952 State Plan ID No.: ~-----. Parcel Tax No.: 020-1365-02-000 try ~-1(~ ° C G~ Gl. L L~. I~ ~ STATION BS HI FS ELEV. Benchmark 0 •ZS oU .Z ~ - 0 ~ Alt. BM Bldg. Sewer ,j.2v gS.es St/Ht Inlet S, c~ ~'`( ,g~' St/ Ht Outlet S~SZ 9~. }3 ~ Dt Inlet r-~ Dt Bottom Header/Man. Q 8.5 9(.~Sr Dist. Pipe (~ ~'' 20 9 3• bs' Bot. System ? (o • gyp, (S I Final Grade Jr.c9 r RS.25 St cover ~$~ 99 '~FS SOIL ABSORPTION SYSTEM ('[~'> !-.~nr,._.~/~ ~Q..~ -~-rP,vir.C~ TREN Width ~ 3 ,Length ~ Nq ~ f Trenches ~ d~ PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N 5• - DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O , CHAMBER Mo a Num er: System: ~o'~J ,' (o ~6 `~ OR UNIT DISTRIBUTION SYSTEM Header /J1Aanifold ~f Distribution x le Size x Hole Spacing Vent To Air Intake r Length Q.Q.-- Dia. ~ Length ~ Dia. Sparing 7 ~O~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Sw„ Inspection #1: °9/ 157o't) Inspection #2: / / Location: 640 Todd Lane, Hudson, WI 54016 (NW 1/4 SW 1/4 10 T29N R17W) - 1029192162 Riverpark Meadows -Lot 2 1.) Alt BM Description = N~A- 2.) Bldg sewer length = ~. 2c~~ n n /~ (~~-- ~SY moun~f cov r = ~ a~ ~O ~r,%vae <,cr~ a~ S~ ~~ ~~~ec~ an~(rc l'zo-~,.-_ l.~ ~C''~c,~~ ~ eau' Plan re ~ision required? ^ Yes ^ No ~ Us other side for addiliprtal inf~or~~matiQn.,, ~l L~-- v~ ~ Z (O L~ ~ w~-- ~`~`~'~ - ~*~'( Date Inspedor'S Signature Cert. No. v SB 6710 (R.3/97) ~--.{y ty~, c~te+-, . ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~~~ ~ ~ .~ M ~ ~~ w.. e~ .u ~. ~ ~ ~ ~~ ~. _~~ 1 ~..~m _ ~W ` _ _ ~a ~ __ __ ~. ~. _._. , ~ ~_ ~s. _ _ ~ .~ ,_._ __.. ~. .~ ..~. Sanitary Permit Application w Safety & Buildings Divisic In accord with Comm R3.2 [. N'is. Adm. Code I 2111 W. Washington Av ~~ ' See reverse side for instructions for completing this application PO Box 73t n SCOns% Personal information you provide may be used for secondan~ purposes Madison. W1 53707-73( Department of Commerce (Submit completed form to coutrty if r (Privacy Law, s. [ 5.04{ 1)(m}] state owner Attach com fete. laps (to the count ~ co ~ only) for the s •stem. on a er not less than 8-1/2 x I I inches in size. County State Sanitary Pemtit Number 'Check if revision to pryYie teen ~ State Flan 1. D. Number ~; ~ ~3 Sz ~ _------- I. A lication Information -Please Print all Information •• ,~ ocation: Property Owner Namc ~ `t ~ 'r . Fioperty Location /I I , d e r s ^~ ` . 1 ~G:.I Y~~`~J ,., ,'1~4~ 1 /4..5 ~(J l l .N. ~ Or roperty Owner's Mailing Address ~ ~ ,. ~, r _ ~ Lot Ntjmber Blocs: Number ~ ~i~C~ s S eP~ ~~ ~ ~ 2 Ciry, State Zip Gode er G~L,v,Y Phone SupdiNision Name or CSM Number Zory1N,; G~x.~ II Type of Building: (check one) , ; ~.- _._.._...i •,t"•~ ~- ~ ''~ ~' ~ ] ~ ~ City ~ Village y j D 1 or 2 Family Dwctling - No. of Bodrooms:~_ '^-~----' Town of 0 Public/Cornmercia! (describe use)' ~ ~ s' ~~ O State-owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road d ~ ~-a ~~- A) i. k7 New System 2. ^ Replacement 3. ^ Replacement of 4. O Addition to Parcel Tax Number(s) S stem .Tank Onl Existin S stem B~ permit Number Date Issued Sans Permit wss reviousl issued v'3 q - 2. -' 18 ' ~ IV. Type of POWT System: (Check all that apply} ~G U ~'s ~'d 'Non-pressurized In-ground ^ Mound ^ Sand Filter O Constructed Wetland © Presstuized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line o At•grade D Aerobic Treatment Unit D Recirculating O Other: V Dis ersaUTreatment Area Informatian: 3d S~~ e-sv.~vd~.% C/fo,-~.,~ aye aa" .• ~'Y e~ ~.~ 1. Design Flow (,gpd) 2. DispersalArea 3. Dispersal-Area 4, Soil Application S. Percolation Rate 6. Syste Elevation 7. Final Grade Required Proposed Rate (Gals.lday/sq. ft.). (Min.linch) r~ ~ q3, a0 Elevation c e b ~s s 7 . ~C~ z~` ~ ~,~ Q~ ~d y'~ s VI Tank Capacity in Total # of Manufacturer Prefab Site Stee! Fiber- Plastic Information Gallons Gallans Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ,~ ~ ou 1 ~ e 1`t: v.fJ a ^ a o 0 VII Responsibility Statement the undcrsi ed assume ros onsibilit far instal4ation of the POWTS show the attached lens. Plumber's Name (print) Plumber's Signs re (no stamps): P PRS No. Business Phone Number ie rra $'c ,ss ale r ~ a a ~ 9'9D j! S' 3 8 1. 31.'z 1 Plumber's Address {Street, City, State, Zip Code) / ? Sco ~ Rd s o,,d ` D/G VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued issuing Agent Signature (No stamps) .Approved ^ Owner Given Initial Adverse Surch a Fee) ~ t / I ~ t"" Determination fit) • ' ~ ( Q~y IX. Conditions of Approval/Reasons for Disapproval IQo~ ~ S ~ e-.-. = ~ °~-~- ~ ~ ~ ~~~ SBD-6398 (R. 07!00) .- SCa.~~ /'' ~D' 8~1 / ~~+ o f Fwa~a~etl ~~~d /Od. ° ~y~ e f ~ w ~ ,~~ aaa spa "/~/ed ~ ~~ ~ ~ ~U~~ ,~ Wisconsin Department of Commerce SOIL EVALUATION REPaRT Page ~ of_~ Division of Safety and Buildings in aCGOraance wan ~,omm w, YV~S. HOm. 4WC Attach com lete site lan n 11 i hes in size Pl n m st a e t l th 8 1!2 County s. ~-- ~ ~~ `~ p p p o p r no x nc . a u ess an include, but not limited to: vertical and horizontal reference point (BM), direction and Pane! I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print aN information. Reviewed by Date Persona; In€ormaaon you provfda may be used for secondary purposes {Privacy law, s. 15.04 (1) (rn}). ~ - 2,~ - ~ Property Owner Property Locafion -e r. IOUCz- ~u~`~~e s" Govt. Lot ,f/~ 1/4~r-'~ 1/4 S /G~ Ta~ N R /~ E {,or~ Property Owner's Mailing Add ress Lot # Block # Subd. Name or CSM# ee ~~ ity State ZIp Code Phone Number ^ City ^ Village ,,Town Nearest Road ~Yli.dsa.v ~`, 5~i'O/G t?~ l -S9 1 a s ..,~/ oB ~a.ri ~ ~. New Construction Use: ~ Residential ! Number of bedrooms Code derived design flow rate ~ d 1) GPD ^ Replacement ,,// ^ Public or commercial -Describe: Parent material /`/~ ~ a ,` a. (~ic ~~iJe 5'!-z f=lood Plain elevation if applicable General comments and recommendations: ft / 1 Rnrinn fP ^ BOring f) ~ i ' J ~ Pit GrOUnd Surface el@V. 7 ~.7 ~ 7 fL. Deptn CO llmliing Tactor [ac V in. Soil A lication Rate i H th D min nt Color D tion Redox Descri Texture Structure Consistence Boundary I Roots P Diff or zon ep in. o a Mansell p Qu, Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 O- /d .~ -- 5..~ /y-ab ~ ~ .T ~ ~ ' d - p, ~' -- .fit ~ a ` C - ! . ~ c p -a / y r- s s ~ - ~ .7 1-~ E ~ ~ i t ~ ~s/,a t ~~ anri„~ ~ ^ Boring RA r _~ l -~ J ~ ~. Pit Ground surface elev. s7j . 0 ft Depth to limiting factor ~U ~ ~n• Soli Iication Rat9 th i;orizon ` De Dominant Color Redox Description Texture Structure Consistence Boundary j Roots GP D/fr= p in. Mansell Qu. Sz, Cont. Color Gr. Sz. Sh. { `Eff#1 *Eff#2 ~- D D /~ ~ /D ---- ~ ~ ~ ~ a C9 ~ ~ ~ ~ r ~ fo~'0 0 '~ * Effluent ri'1 = BODY ~• 3D < 220 rt?giL ana T55 >30 < 95U mg/L ~ tmuem ~z = cub ~ ov i~iya~. a~iu i vv - ~v ~ ~~y~~ _ CST Name (Please Print) Signature GST Number /~, .i ~ ., S'c~u.`n~/f~s~ /~ ~tiy~ ~2'zQQ~ Address Dato Eva;uation Conducted Telephone Number ~~~ ~~~ f~' . Property Dwner~C_,, ~, f~ I~ Borng # ^ Boring are Parcel ID # 47 /~ / n Page ~ of ~ J IA-J F'lI vwul~uauiia~oc~cv. s i - v n. vcNui w nnauny ~cc.wi _~ vv - ui. Soil ication Rate Horizon Depth Dominant Color Redax Description Texture Structure Consistence Boundary Roots GP DlfF in. I Munsell flu. Sz. Cont. Color Gr. Sz. Sn, `Eff;!lf 'Eff#2 r ~ i rr~3~ 6 --- ~ a a c.~ -- ~ g 4 s o ..r ~ ~- - ~ /.2 t goring #~-~ Boring ^ Pit Ground surface elev. ft. Depth W limiting factor in, Cnil Cnnfirai,-nn ~?ata Hcrimn Depth Dominant Color Redox Desorption Texture Structure Consistence Boundary Roots GP D/ig ~~ in. h",unseU au, Sz. Cont. Color Gr. Sz. Sh. `Eff#1 l 'Eff#2 I T i i i i ; I l r i ~ __._1 I ~ Boring ~ Boring # r--i rrni ~nrV ei ~rr~nc cle" ft Rcnfh fn limifinn Fnrfnr . u ric -- - } Hori~ zo~rQepth Dominant Coior Redox Description Texture Structure Consistence Boundary' Roots r SoH A licaclon GPD;fi~ in. Munsell Qu. 5z. Cont. Color Gr. Sz. Sh. `Eff#1 ` `E`F#2 I i I I I f I i ` Ef~uent #'1 = BOn~ > 30 a 220 mg/L and TSS >30 < 15G mg~L 'Effluent #2 = SODS ~ 30 mg/L a:id TSS < 30 rc~g/L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need. material in an alternate format, please contact the department at 6QS-266-3151 or TTl' 608-Z64-5777. 3~D-b33U !,A u7i!Yi) J/ ~fl~~~ _C~ d: f~ t' - y- ~~I ~~ Q ~ ~"p6vp~Rre.~ G ~+Gd~ %1.~~ r~ ~5_.,LdF 3 r%/°~ ~'~ ~ frr _.~~''~r G yo o dQ' La ~e Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. ~ See reverse side for instructions for completing this application PO Box 7302 ,~~~ Personal information you provide may b dary purposes Madison, WI 53707-7302 p¢partmettt uf;Carfimerce 0$O ]C f [privacy Law, (Submit completed form to county if not ` !., j ~ state owned. Attach com lete lans to the coon co oni s st on a e ot•le than 8-1/2 x 11 inches in size. County ~T ~ State Sanitary Permit Number eck 'f re ~~qt~ revious lic lion ]] State Plan I. D. Number s cYe , x Z C I. A lication Information -Please Print all Informati Location: Property Owner Name ' t i ~~, 1 Property Location ~` ~` a-' ~u-< ~~~ ~ S ~ ~' _ S ~AO~ f, cn ~(~/ 1/4SG~ 1/4, S D 9 ,N, /~ o roperty Owner's Mailing Address G F f 1GG U C~ -, Lot Number Block Number ~ y; 20h,v Q Co o~ City, State Zip Code o e '` \ ,./ -~ • Subdivision Name or CSM Number f~~ SO.~C~ / O! ~ ' i ~ L ~ ~U B w. / ~ C.c~a S' II. Type of Building: (check one) ^ C'ty ^ Village ~ 1 or 2 Family Dwelling - No. of Bedrooms :~ Town of ~ ^ Public/Commercial (describe use):_ . ^ State-Owned Neazest Road od~ ~~-~ Parcel TaxNumber(s) G .. ~ S ,~~^ III. T e of Permit: Check onl one box on line A. Check box on line B if a licable /d _ Z 9 • / - Z ~ p) 1. New 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to S stem S stem Tank Onl Existin S stem B) Permit Number Date Issued ^ A Sanita Permit was reviousl issued IV. Type of POWT System: (Check all that apply) ® Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At- ade ^ Aerobic Treatment Unit ^ Recirculatin ^ Other: V. Dis ersal/Treatment Area Information: Z (S ~ ~ 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Applic lion 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation God -~ / GQ / ~ ~9 ~3 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ^ ^ ^ ^ /ago r .~ivesr~Y./ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersi ed, assume res onsibili for installation of the POWTS shown the attached laps. Plumber's Name (print) Plumber's Signature (no stamps): /MFRS No. Business Phone Number ,'ll~a s~ /,, -3~' 3~a~ Plumber's Address (Street, City, State, Zip Code) IX. County/Department Use Only ^ Disapproved Sanitary Pemut Fee (Includes Groundwater Date Issued Issui gent Si afore (No stamps) Approved ^ Owner Given Initial Adverse Surcharge Feek ~ Z ~ U GU Determination "' ~ X. Conditions of Approval /Reasons for Disapproval: f~~prr dst4i~t tc~`<<7`4/c°~" S /'CCisn ~J7 /e~,._S '~`~ ~Jt !r'~R~/1 jl./in ~t {'i/tCr // ~ O~SSee~ ah -i'v ~k~kie oc~h~i ~ ~1t~n*Cn~nCc ;~~o~n~.~a`..ti- ~o ~ , , - r ~ ~ 6 ~-tt t!1 e ~ S ~ C ~ r S ' ` c ~ ~ S ~~ L C ll~ (JlR- .NCL ; l c~ E ~i S ~ ~' ~ ~ ~' !J z Y , f ~tL r i~ 1'~'lz~u~c+..G! .S T Ni~ c9 F ,6l« d S~e,~J /Y . SGa~ -e, i , ~/O r~~~,2 l ~~ i''VG ~~ ~~~ ~C.o:2 Sc~r~~ Tam K T ~e p~ ~~~~ a r.2~eaYs io,~o ~~~ ~~~s ~ , r-e° ~` ~~~~ J ~ r.~1/ ~o ,, ~ GJ~r~c~ ~ Alob o$~ _.~ ;_ / ~ 1..~~ f S, ~ ~~ • _. A "` ~2 a T ~ ~~ ~~~~ ~J,~=...~~,~~-~----"' /'~ f ~~7 ~ ICJ ~~~% J i Wisconsin Department of Commerce SOIL AND SITE EVALUATION 1 of ,} Division of Safety and Buildings Page Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code 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 S ~ - C r~ ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # APPLICANT INFORMATION -Please print all information. Reviewed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). "~- ~ ~ O Property Owner Property Location Pi4 -~- ~C) ~ Govt. Lot ~ 1/4 Sw 1/4,S (~j T Z ~ ,N,R f ~ E (or)~ Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 7~ ~ -~.. ~. I-' L ~~~ e ~ ~ ~~~ City State Zip Code Phone Number ty ^ Village ~ Town Nearest Road ^ Ci {-lucS.Scsr~ ~ w t isy©/~ i his )sya-s~~~ ~ ~~ ~ sa ~ i e~y IPA r~ ® New Construction Use: ®Residential /Number of bedrooms 3 ' ~~ Addition to existiny building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow GU gpd Recommended design loading rater ~ wed, gpdfft2 ~ g trench, gpd/ft2 Absorption area required bed, ft2 ~ L` trench, ft2 Maximum design loading rate ~ ~ ~d, gpd/fly ~ g ~ench, gpd/ft2 Recommended infiltration surface elevation(s) ~C/. r~ ~ ~ ft (as referred to site plan benchmark) Additional design/site considerations %~f• ern, ~ ~ ~ ~ Parent material U y ~' W 4 S ~ Flood plain elevation, if applicable /~ f4 ft S = Suitable for system v~nvcnuvna~ rvivunu nr~a~~wiu ricaawc ~~-~aiauo oyaiani a~rw ~~~~~uiy iann u = unsuitable for system ~ s ^ u I~ s ^ u ®s ^ u ®s ^ u ^ s ®u ^ s ® u SOIL DESCRIPTION REPORT Boring # J Ground elev. y~ $ ft. Depth to limiting factor , /D (n in. Boring # 2 Ground elev. gZ.33 ft. Depth to limiting factor 1VU in. Horizon Depth Dominant Color Mottles T xt re Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color e u Gr. Sz. Sh. ry , Tr ~ U --IS ' ~:J 3( I YY1Cti r C S ~ v~ . 2 .3 3 43p •ID ~i 5 OS C~ - ~ ' . ~ ,~ , Remarks: ~°~'< ~~ r ~`"~ t -~--T i o-I2 •ip rj~I - S;I (m ~~ ~~ ~4 •Z 3 z ~ ~ • la y -- S 5 z~" ~ ~~+~ ~• g:- s~ ~;;ti N~NG fFi ~ ~~. Remarks: :.ST Name (Please Print) S'gnature Telephone No. Address Date CST Number y ~ ~ V~ SOIL DESCRIPTION REPORT PROPERTY OWNER 1 PARCEL I.D.# Boring # i :2 Ground elev. qZ,G 3 ft. Depth to limiting factor ~in.~ Boring # ~-t Ground elev. 93.z~ tt. Depth to limiting factor , /(JrJ in. Boring # 5 Ground elev. q3./3 tt. Depth to limiting factor ~,~in. Boring # Ground elev. tt. f Page ~ of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry , T ~ 32. '~ ~ ~~ Remarks: ~ 0-9 - ~(~ r3J~ ~ I bk ~r .2 ;.3 3 ~-,~, • 10 r N m S o ~n I c. 5 'I Remarks: Horizon Depth Dominant Color Mottles Text re Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color u Gr. Sz. Sh. ry 1 Q-t -I 3~i i r C Ivy .z ~ . 3 3 4-75 ~ ~ ~ mS u ~ L 3 ~ .~ ' Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) t i NAME ~ U ~U LOT # ~ LEGAL DESCRIP i .r SCALE 1 "_ Zjy BM1 ELEV. yG. Z3 ----_ DESCRIPTION-T~po~ I`~rwc R'Q '~ BM2 ELEV . 9G. GZ I --~--~ DESCRIPTION-~Ta~ o.C 1 `Puc p.°Qe SYSTEM ELEV. Sf~,.~ ALT. ELEV. $~ ~7 3 CONTOUR EL• EV . Y1 v n ~ ~~ N X PAGE _~. OF - _-__ _ _ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSI-iIP CERTIFICATION FORM Owner/IIuyer ~. ~ . ~ (~ oV'A g l ~ -~ S ~n~ ~ Mailing Address l (>~ ~v . ~t cf! ~ Hv/~su~v ~U Z. .~4-v 1(~ Property Address ~ ~ (~ ~~o d~ ~,c.~G (Verification required from Planning Department for new construction) ..~.//~l_t~ _ City/State Pazcel Identification Number D ~ ~ ~ 3Ga5 o a ot~ O LEGAL DESCRIPTION Property Location 5~~' %,, .51~t/ %,, Sea ~O , T~N-R~W, Town of ~r/~spr~ Subdivision 1~I' ~ UC'~.4f2K l~F.f ~ ~ r.~;.s ~t # 2. CertiCed Survey Map # Volume .Page # Warranty Deed # _ ~O t"~ o'Llo ~ Volume ~~ 3 J ~ .Page # ~~ Z Spec house ^ yes~no Lot lines identifiable yes ^ no SYSTEM MAIN'I'CNANCE Lnproper use and maintenance of your septic system c~ul result i~ its prematureSailure to handle wastes. Proper maintenance consists of pumping out the septic tank every-tbre~-~r~~r soorie°r, i~ee~ed 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 properly owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner. and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) We 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 privatcsewage disposal system with the standazds set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Cerli~cation stating that your septic system has been maintained must be completed and returned to the St. Cmix County Zoning Office within 30 da o ce year expiration date. ~ ~ IGNATURE Or AP ICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form arc true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the ~p~e~r~~-y~described ab~ov_e, by virtue, of a warranty deed recorded in Register of Deeds OfCee. .. ~~-~ ~ ~ o3i G c SIGNA 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 iy STATE LL4R OF \VISCONSIN FORM 2 - 1982 V(%ARy4jtry(A'(~(K/l~-3TY DE`ED COCUM6NT N0. 'el~. 1'JllVPAC~ Civ2 •~ ~~ "Marjorie Halernee, Frances Auguat and Faul Katner ns tenants l,n summon a k/a Francis _ _ AlIRU6t currvcra and wuranu tc •~• •o_ aya Bu tort, Iua, a . Wtsi;oltsin Corporaticn is - _ t _. 64626'7 KATHLEEN H. UALSN REGISTER 0p DEEDS ST, CRDIX CO., UI T~cElvEn Foe RECORD 07-06-1999 9:10 AN YRRRANTY DEED E1r,ElDT tl CERT COPY FEE: CORY FEEE TRANSFER FEEE 1310,0 kECORDIHi FEE: 12.00 PAGES: 2 THIS a>RC,'E rtes ERVED fOR RCOOROII:O DATA dlc lollou~ng deserilxd :u) estate :n t, ro x [aunty, L~r-lYlf ' J, GS7REEa'~ sla:R of \Vi3rCrlsin: 304 L 7CUST . ' 1". SE 1/4 94. ] J4 Sec. 10-T29N-R19W excepting therefrom Lot ( ~iUDSON, WI 540". "~ of Certified Sur•roy Map recorded in Vol,7 of Certifled Survey t•)apo, page 2089 as Uoc. No. 441309, also excepting 02U-1010-20 the roilrcad right of wad. 020=1024-90• 020-]025-90 1fE 1/4 PIW 1/4 Sec. 15-T29N-R19W exceptins tharefrcm Got IPMCE3 sscBllflGAl K1V NUMBEF of Certified Survey P1ap recorded in Vol. 10 of Certified Survey Mapc, page 2701 ca Dac. Vo, 5C7i28. 1(t) 1/4 NE 1/4 Sac. 15-T29N-R19W This is not homcstcad paopeny. -Jkl-_ (snuu Exacpdon to warranties: ~j ~~/~ Dautl this .~__..~_., day of Juna ! , A 9 99 ~ Faul Katner :ushcutlated thts day of , :9_ Tltl_: MEMBER STAtE B.qR OF w15CJNSIN (if nut, 1 (sEau i ACKNt7WLEDGMENT ,I State of ~v~di'bil~on SEE ATTACHL'D~t lEBI{IDIT "A" 't J( , s. King County ~ I`erso:ul!y came bcfure me thts 26th day u( ~! Juno 19 99 , d~~e abot•c named j rzances uguct j • authorlscd by fi706.06, P/u. Stan.) to ere knuwr. to b he person_ who tututul the foregdrg inu t ac rl n wledgc D sar e. T,11S 1~3TgUMEN7 1`145 DRA:TEn aV y Hevuood & Car., 9.C. b Halter :lodynaky E. 204 Locust St., P.O. Hex 125 H.s stm, TI 54015 Kln¢ Notsry Public, ..__..__._ County,-Ula,- 4~A (Sidr.a:css nlay be nu:L•eaticated ur acknow'xdged. kAith are not Aly ceauuisrion Is permmenl. ;If net, acre exptraiun data: ' nrcasary) Septeober 1, 2001 1<1bT_.) `?hma d prmnaaigmng in nlT opvUy s6onH 6y ypd or pnnud beWx meu ,igrawtrs. • «Ait0.enTY OCEU STATE eAR OF W'ISCGNSIN Wiconsn t.a~rc O'a+utCu.. vc Foral No. a - 1983 MbpAap. VF,, ~Iuu1 „~ ~~ ~ i h y i ;I"p°~ ~~• ••R' h ~~ ti ~ ~ ~ QQ~ p• E• 3p5 ry`\ 33' 3 ~~ 5p ~ Q ~ ~ ~ ,~, 2 ~ ~ ~ ~ ~ Q~ 5~8o p 5p~ `~~ ~ ~ v ~ h\ ` ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ,' 0 ~ QC.i~~ O -' cn ~ 3 i ~` ~ ~ 4~ N \ 'O ~ ~~ < ~ : ^~ . i _ - -~ ~ • ~~} ~~~ • app • ~ ~~ Q~ p~.. \ O .• ~ . SQ$ ~ ` co ~ ~ ry.. ~ Cl'• ~, Q a`O `~ ~ ~• ~ z ~• o Q ~° ~ \ sa o h ~ ••ss ~ ~ ~~ O ~ ~ ' N Q• . O `~ ~ •' Z'•. 2 .t 3p •~~ cy o 'o••.. Z O. ~ ~ ~/ ~ .{/. ,••' QQ~~~ ~~'' ti ~~0 Q~~ ` gay 28 • ~ \cyh• p ,----- P i .~ i ~ ,. . ~ ~~ / ,~ ~ i ~ ~ ~ ~ Qh ..,_,, ,~. 1 ,~ ~ ~ ~/~~ ~ ~Q ~ ~ . 2 .. ~~ ~3 ~,\ ~_ ,~ ° ~ ti-t ~ ~ 4. ~~ ~'\ INMNNN~N^ -- rrrri November 13, 2000 P.C. Collova Builders Attn: Laurie 705 County Trunk E Hudson, WI 54016 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 Fax (715) 386-4686 RE: Septic Inspection for P.C. Collova Builders located at 640 Todd Lane, Riverpark Meadows (Lot 2), Hpdson Township, St. Croix County, Wisconsin Dear Laurie: A septic inspection of the above referenced property was conducted on August 31, 2000. This property is located in the NW 1/4 SW 1/4 of Section 10, T29N R17W, Riverpark Meadows (Lot 2), Hudson Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386-4680. Sincerely, Kevin Grabau Zoning Technician /sm cc: file