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Home My WebLink About020-1380-33-000 (2)>' Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Stanke, Tom Hudson Townshi CST BM Elev: ' Insp. BM Elev: BM Description 1 ~ . ~ Iw •c7 ~a , re•... re~oO,i ~ CST B w~~ ~ TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~, ~~\ l Z~r .-~- Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift F ' ion Loss System Head T Ft F emain Length Dist. to Welt SOIL ABSORPTION SYSTEM /IS ~ rD..~.,,.~.e /1,ne.AC~. ELEVATION DATA county: St. Croix Sanitary Permit No: 399461 State Plan ID No: Parcel Tax No: 020-1380-33-000 STATION BS HI FS ELEV. Benchmark & ~•S ~f I~qs- ~ Ic~.O Alt. BM ~~ IZZ.sz (o. ql S. 61 t Bldg. Sewer ~o1Y~2~ t Inlet °t.aZ IZ•bo` Ht Outlet ~~•1~ , IIZ•3'{ Dt Inlet Dt Bottom Header/Man. ~pq.s'`E ~o.SO 99•oyt Dist. Pipe l l • O 98 •Si{ t Bot. System ~2..ZS ~ q~.2°J Final Grade •~ s ~-~ lol•~9r St Cover z. S2 ~•2~ ~1~• 2`f RENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM S ~~ t ~3•~ Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufagqturer: INFORMATION CHAMBER OR Q>,IO.DIFFu~'S Type Of System: ~ ~ ~ UNIT Model Number: ~~ DISTRIBUTION SYSTEM Header/Manifold It Length~G~-- Dia Distribution Pipe(s) Length Dia Spacing x Hole Size x Hole Spacing Vent to Air Intake ' /~ ~ SOIL COVER r Pressure Systems Only YY Mound Or At-Grade Systems Onlv 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 discrepencies, persons present, etc.) Inspection #1: I ( / 2°I / O ~ Location: 645 Packer Drive Hudson, WI 54016 (NW 1/4 SW 1/4 11 T29N R19W) Homestead-1st Addition Lot 33 1.) Alt BM Description = Oyu,, u.LR ST• '^^°"'^'~10~ COt~ °= ~"'S°''"~c"'~ ~°O'~ 2.) Bldg sewer length = ZS-• D ~ -amount of cover = > b ~~ 3 ~,MI+,Ec_ sl• -1 tm 6Gl': •~~. „Q ~a~~S ~to+ti. -~ ~ S . Plan revision Required? ^ Yes ~No ~~~~^^, Use other side for additional information. -~>~• ~ ~~ Z~Z SBD-6710 (R.3/97) Date Insepctor's Signature Inspection #2: Parcel No: 11.29.19.2359 ~~OMC~/ ~ • (O ~ , @) ~s = 'F*.., (~~~~) Cert. No. f ~~S c~c ride- ' ~ Sanitary Permit Application safety & Buadings Division In accord with Comm 83.21, Wis. Adm. Code '' 201 W. Washington Ave. ~ PO Box 7302 i~S,~i~~w~r~~ See reverse side for instructions for completing this application Madison, W[ 53707-7302 Oepertment of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned. Attach com lete lans to the coun co onl for the s stem, on a er not less than 8-1/2 x 11 inches in size. ~~h, State Sani a it Number ^ Check if revision. -ication State Plan I. D. Number I. A lication Information -Please Print all Information ~ ='" Location: Property Owner Name ~, ~ ~..-'"r°~ ~ ` , `~ RECE~ V CO P w '~" n / B ~ ~ '°~ l/4 1/4, S TZ N, I~ { E o W Property Owner's Mailing Address Number Block Number ~ ~_-~ ~ ~ T ~ 1 20Q1 ~ _ 3 ~ X , ~ ~ p ~ Number "~ ivision Name or CSM Number City, State Zip Code ~tiq , ~'f ~x 1--lulo~~ ~1~ - G ~on~~ ST~aD IST ADD ^ city II. Type of Building: (check one) ~/ . c;-,~`~-. ,..- ••' ^ village ^ 1 or 2 Family Dwelling - No. of Bedrooms : ~ ; ~` ' \ own of ^ public/Cotrunercial (describe use):_ 3 ~`' .~~`, 5 ~ ~ U L~ s Q ^ State-0wned ea~`~d zi v ~ / ~ ~/ ~` 1 Tax Number(s) ~~ 3 3.75 ,~ kd a ~sar~.- l?.7~'t, ~ III. T e of Permit: Check onl one box on line A. Check box on line B if a licable 5 6. ^ Addition to A) 1. ew 2. ^ Replacement 3. ^ Replacement of 4. ,r 3 - Q~Q Existin S stem stem / S stem Tank Onl ~ Date Issued B) Permit Number ^ A Sanita Permit was reviousl issued IV. Type of POWT System• (Check all that apply) ^ Sand Filter ^ Constructed Wetland ton-pressurized In-ground t/ ^ Mound ^ pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At- de ^ Aerobic Treatment Unit ^ Recirculatin ^ Other: V. Dis ersal/Treatment Area Information: 1. Design Plow (gpd) 2. Dispersal Area 3. Dispersal Ama 4. Soil Application 5. Percolation Rate 6. System Elevation Elevation rode Required Proposed ~ Rate (GalsJday/sq. ft.) (MinJinch) / ~ ~p QQ ~b0 ~T S ~ f ~ ~~ . Z. ~7, Q Z,00 VII. Tank Capacity in Total # of Manufacturer Prei ~b Site Steel Fi ass Plastic Information Gallons Gallons Tanks Cor.- Con- g New Existing Crete structed Tanks Tanks ^ ~ ^ ^ S ~P T~ 1 z a~ - u1~ f S~ 2 ~ o ^ ^ ^ ~ ~ L ~a~ ~"~ ?~- VIII. Responsibility Statement 1, the undersigned, assume res onsibili for installation of the POW'1'S shown on the attached tans. g„siness Phone Number Plumber's Name (print) ~~ Plumber' Si a (nos ps~'C MP/IvII'RS No. Plumber's Address (Street, City, State, Z.ip Code ~ ~ b ~ ~ ~~ ~~ ~ / IX. County/Department Use Only 'n A ent Si azure (No stamps) ^ Disapproved Sanitary Pemrit Pee (Includ<s Groundwater Date Issued !; g gn pproved ^ Owner Given Initial Adverse Surcharge Pee) ` ~ l~ /~~, Ol --SZsTen tatton C7Zp`V - j6QLj X. ~irtC tons of Approval /Re ns for Disapproval: ~ -- --- Effluent filter to be installed and maintained per manufacturer's recommendation 2. Floodplain mapping =Zone "C" 3. All setbacks to system and residential structure must meet applicable code requirements. 4. Well setbacks to be maintained per NR 811 & 812. 5. There shall be < 8 ft. of cover over the top of the system. V ~~ ~~ .~ ~ ~. Q ~ 1, ~~ ~ n.1 O ~~ ~ ~ ,~ tl ~~ v~ ~- . ~ h ~` ~ _ ~'1 ~~ (~1 ~~ ~~ ~~ .,~- .~ ;~ ~i o M .! '~ F~ A .~ Z . `Jt W ~ a1 0 ,tea ~, r~ ~ ~ ,, - . , j/ ~ ~ ,~ i~t' s -~ ~, ti..~ ~ ~' ~n ~ ~~ :~n~ M~ ~. v~ ~ ~ ~ ~ 4ii ~ tli ~ !`_" ;E < ~ .~ ~ _ ~~ y '"" 1 ~` .,-.~ -j --- ---~"'~ M .~ ~ ~"'"'~i.~ --- --~~ '' l! ;~~ ] _ -~M ,~- - ~!' h 4t ^~ 4~ S~ a --__.._ . ~~S C ~ (.~-are ,'« L ~~ ~ ~ <~ ~. ,~ :~ /p ~~ r 1° g~ P i~ Pla.. -~ ~, ~' y~ r V `~ ~1 ~'~ !~ .n ~,' ~ CT- ~n+ ~ ~- ~ `~ ~ A ~" ~i ~+ < + ~ ~a ut ~ i~ ~ ~ ~ ~ _J ~ M y r ve Z' . C ~ ~ ~ ~ ~ ~ ~- "~/ 3 ~7 "t ` ~ ~~~ ,ate, + ~ ~ M'~ ~ ~r/ ~~ ~ ~ ~ ~ r-- - _---•^:.~' `~ ~ ~ ~ ~ ~ by -_ ~ r--_ -_- ~~ , ~. ,. ` ~ D ~~ ~ ~=~ ~ Fq N ~ ~ ~ t; ~~ 4 v .` ~~ ,~ tl v ,~ ~ ~~ ~.. ,~ ~- ~ ~ ~,,,, ~ ~"3 ~l~o o ~. , S-Ti~ ~ ~.- M ~ Ll..~ N v-rvt.~ ~?„~-,~ ~ ~o'T-~`.3 3 X43` 1~' F~ c IMF fl.. ~ ~' ~ ~~ S ~ ~~'1., .~- / • 9 7, .S ~ ~ ~ - ~'h°f~iI1,C~~/~ 5 - ~ ~ F~c ~T ~~c N~ H` `'• ~ ificat~ons ~ B~oD~ffuser Spy ~~~ -~ z -L- s'a 3~ T POWTS OWNER'S MANl1AL ~ t"ttirt+uct-,cif ~ es. a rvcneMATInU rla.l. ^..^........._^ Owner "~ p y~ ~.~,~ Perrniti # ~ .,~~.w owowMG'rGQc VG.7lYlt ^~vti~r. r.~ Number of Bedrooms ^ NA. Number of Commercial Units -~-NA Estimated flow (average) gal/day Design flow (peak), (Estimated X i .5) gal/day Soil Application Rate a ~ gal/day/ftZ Influent/Effluent Quality Monthly average* Fats, Oil 8t Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solids (TSS) s 1 SO mg/L Pretreated Effluent Quality ^ NA Monthly average* * Biochemical Oxygen Demand (BODs) <_30 mg/L Total Suspended Solids (TSS) <_30 mg/L Fecal Coliform (geometric mean) <_104 cfu/100m1 Maximum Effluent Particle Size % inch diameter MAINTENANCE SCHEDULE Service Event inspect condition of tank(s) Pump out contents of tank(s) inspect dispersal cell(s) Clean effluent filter inspect pump, pump controls 8t.alarm Flush laterals and pressure test Other: Service Frequency At least once every ~ ^ months ''year(s) (Maximum 3 yrs.) When combined sludge and scum equals one-third (Y~) of tank volume At least once every At least once every At least once every At least once every ^ months pyear(s) (Maximum 3 yrs.) (• ^ months .•-O'year(s) ^ months ^ year(s) ~ NA ^ months ^ year(s) t7~i'dA At least once every ^ months ^ year(s) ~A At least once every ^ months ^ year(s) .0~-i'dA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shah be made by an individual carrying one of the following licenses or certifications: Ma Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servidng Operator. Tank inspecti~ must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersa cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent of 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 (Ys) or more of the tank volume, the entire contene of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 1 13, Wisco. Administrative Code. The servicing of effluent filters, mechanical ormonths orlessOsha 1 be performed by a~certified POWTS Ma n~tainer.ny °ther maintenance or monitoring at intervals of 12 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 produce or other c err that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the cone ~r ~1,a ran4(s'~ ramovPd by ~ SentaRe cervicinR operator prior to use. SYSTEM SPECIFICATIONS Septic Tank Capadty / aG O ai ^ NA Septic Tank Manufacwrer GtJ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~ ~ OQ ^ ~ Pump Tank Capadty gal ,0'NA Pump Tank Manufacturer L~.NA Pump Manufacturer .~ 1`i/' Pump Model ~ NP Pretreatment Unit ~~~' ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) .(~'~n-ground (gravity) ^ In-ground (pressurized) ^ At-grade ^ Mound ^ Drip-line ^ Other: * Values typical for domestic (non-commercial) wastewater and Sept tank effluent. * * Values typical for pretreated wastewater. System stars up shall not occur when Boll conditions are frown at the Infiltrative surface. During power ouUEes pump tanks may flq above Homo) hlChwater levels. When power is r+esWnd the excess Wastewater will be Qacharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result In the backup a surface discharge of t:fiiuent. To avoid this situation have the conunts of the pump tank removed by a Septage Servking Operator.prior to restorinti power to the effluent pump or contact a Plumber or POV+1T5 Malntatner to assist in manually operatllmg the pump controls to restore ncrmal levels within the pump tank. . 0o not drive or park vehicles over unks and dispersal cells. Do not drfve or park over, or otherwise diswrt~ or compact, the are, within i S feet down slope of any nmound or at-grade soil absorption area. Reduction or elimination of the followinC from the wutewater stream may improve the performance and prolong the lik of c'me POWTS: antibiotla; bevy wipes; cJgarette butts; condoms; cotton swabs; degreasers; dental fioss; diapers; dlslnfectanu; fat; foundation drain (sump pump) water; fruit and vegetable peelings; guoiine; Crease; herbiddes; meat scraps; medications; oil; palntinR Grodttcts: aesticldes: sanican naokins: tampons; and water sofuner brine. ALaAN DON EM ENT When the POWTS fails and/or Is permanently taken out of service the following steps dull be taken to Insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Adminlsuatlve Code: • All piping to tanks and plu shall b~ QlsconnQCted and the abar-dontQ pipe openings sealed. • The contenu of all tanks and pits shall be removed and properly disposed of by a Septag!e $ervking Operator. • Aker- pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with loll, gravel or another Inert solid material. CONY(NGENGY PLAN If the POWTS !alts an<i cannot be repaired the (ollowlnC meut:ses have been, or must be liken, to provide a code Compliant replac ent rystem: ~7 A suitable replacement area has been evaluated and may be utJllced for the location of a replacement soil absorption system. The replacement area should be protecuQ (turn disturbance and compaction and should not be Infringed upon by required setbacks from extstinC and proposed strucw+'e, lot (lnss and wells. Failure to protrct the rsplacement area will result In the need for a new soil and site evaluation to esubllsh a suitable replacement area. Replacement systems must comply with the rules In effect at that time. O A sultablt replacement area is not available due to setback andlor soli limlUtlons. 6arrlrtg aQvances in POWTS technology a holdln~ tank may be Instaped u a Last resort W replay tFte failed POWTS. D The site has not been evaluated to identify a suitable replacement area. Upon failure of the POV~TS a soil and site evaluation must be performed to tocau a suitable replacement area. tf no roplacerrlent xea b available a holding tank may be Installed as a last resort w replace the failed POW7`S. O Mound and at•grade soft absorption sysums may be retonstructed in place following removal of the biomat at the Infiltrative surface. Reconstrvalons of such rystems rrlust.comply with the rules in effect at that time. < <WARNiNG> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR 1NSUFFIG(ENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RIrSULi"• RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY RE DIFFICULT OR IMVf1Ct1Rl i. ADD1710NAL COMMENTS POWTS INSTALLER Name /M ~ Phone '' q POWTS MAINTAINER -.Name Phone SEPTAGE SERVlGING OPERATOR (PUMPER LQCAL REGULATORY AUTHORITY Name Ati'etxY J` Phn~• on Wisconsin Depprtment of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT nrrl.~nnc uri+h (`rvnm Rri 1A/ie Arlm (`.rv'la 1299 page 1 of 3 A.C.E. Soi18< Site Evaluations ---- -- County Attach canplete site plan on paper not less than 8'/z x 11 inches in size. Plan must St. Crolx include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arr and•IaFa6on.aRd distance to nearest road. 1^ , 7 • . . 020-1012-40 ID# 11.29.19.546 , ` iniidhnation. '~, Please print R •~ gy Date ,~ Personal informatan you provide may '~'°" for secondary~rposes (Privacy La ~~5. 15.04 (1) (m)). / ~v ~ L ~ tM~ ~ Property Owner ~ i ~ Properly Location Miller, Sam ^' ' -- - ovt. Lot NW 1/4 SW 1/4 S 11 T 29 N R 19 W Property Ovvner's Mailing Address __._! ~ r- ^ ;? ~j ~ E{~{~~ of # Block # Subd. Name or CSMI~ P.O. Box 151 ~' J -- ~„ r 33 1st Addition To Plat Of Homestead ber City St ~ Code ~}gl _„~ City ~ Village Tawn Nearest Road '~ Hudson WI ~~ 0~.6Z "'~`fi Ff386 2769 \ Hudson Packer Drive ~~• .,~ ~ ~ I~ New Construction Use: Res kOtfaYJ Nutnl'~df rooms ~ Replacement . { Public or cor~fni'rt;taT -Describe: Parent material Glacial outwash General comments and recommendations: 4 Code derived design flaw rate Flood plain elevation, if applicable 600 GPD nd Boring # --~ Boring /J Pit Ground Surface elev. 103.75 ft. Depth to limiting factor >135" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft= 1 0-14 10yr3/2 none sl 2msbk ds as 2f,lm 0.5 0.9 2 14-28 10yr5/4 none sil 2fsbk dsh cs 2f 0.5 0.8 3 28-81 10yr5/6 none s Osg dl cs if 0.7 1.2 4 81-135 10yr6/4 none s Osg dl - - 0.7 1.2 'ts \ t ~ 1J~ a1. Boring # ~ Boring Pit Ground Surface elev. 104.63 ft. Depth to limiting factor > 133" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIftZ 1 0-8 10yr3/2 none sl 2msbk ds as 2f,im 0.5 0.9 2 8-19 10yr5/4 none sil 2fsbk dsh cs 2f 0.5 0.8 3 19-52 7.5yr4/6 none s Osg dl cs if 0.7 1.2 4 52-84 10yr5/4 none s Osg dl gs - 0.7 1.2 5 84-133 10yr6/4 none s 0-sg dl - - 0.7 1. x -- S. 'Effluent #1 = BOD ~ 30 < 220 mg/L and TSS > < 150 * E ent #2 = BODS < 30 mg/L and TSS <~0 mg/L CST Name (Please Print) Sign ure: / CST Number James K. Thompson ~~ ~- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number Osceola, wl 5ao2o 9/18/00 715-248-7767 i i ply O~~ Miller, Sam Parcel ID # 020-1012-40 ID# 11.29.19.546 Page 2 of 3 Boring # -°=~ ~~ Pit Ground Surface elev. 100.79 ft. Depth to limiting factor > 129" in. Soli Application Rate ri ti R D r T t Structure Consistence Boundary Roots Z Horizon Depth Dominant Color p on edox esc ex u e , *Eff#1 *Eff#2 1 0-12 10yr3/2 none sl 2msbk ds as 2f,im 0.5 0.9 2 12-36 10yr5/4 none sil 2fsbk i dsh cs 2f 0.5 0.8 3 36-75 10yr5/6 none s Osg dl cs if 0.7 1.2 4 75-129 10yr6/4 none s Osg dl - - 0.7 1.2 Boring # Boring Pit Ground Surface elm. 99.19 ft. Depth to limiting factor > 120" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 1 0-16 10yr3/2 none sl 2msbk ds as 2f,im 0.5 0.9 2 16-40 10yr5/4 none 2fsbk dsh cs 2f 0.5 0.8 3 40-93 10yr5/6 none s Osg dl cs 1f 0.7 1.2 4 93-120 10yr6/4 none s Osg dl - - 0.7 1.2 Boring # ~ Boring h to limitin factor > 123" in. ±ld Pit Ground Surface elev. 98.85 ft. Deft 9 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-il 10yr3/2 none sl 2msbk ds as 2f,im 0.5 0.9 2 11-32 10yr5/4 none sil 2fsbk dsh cs 2f 0.5 0.8 3 32-78 10yr5/6 none s Osg dl cs - 0.7 1.2 4 78-123 10yr6/4 none s Osg dl - - 0.7 1.2 * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mglL * Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/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 608-266-3151 or TTY 608-264-8777. . P: ~ / ~ ~ E/eda-~on ~/ p~ ~ , t3enc-I,-vlarK:7oap rejaci; I ~ Scar/c: ~ 1 ~/~ f~ssu.~.td ek~l: • ivo.ca' ,~- ~ /~~~ .5/0 ~ B3 er 8`1 8S ~o~ .3.3 o~P~o,~~d i#`.~rd. ~ l'~~a~ off' ~Oir,(,.5~ T o~ ~icc~So», ~E''Cro~X Co.~ r,,~/. ~ Alf. ~.+q.: Two f3/b'., rcbai; ~le~: = 9st~' b O R~''`iz~ ST CRO1X COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OwnerBuyer _~ a OWNERSHIP CERTIFICATION FORM Mailing Address ~~~ ~Q-~/ ~~-- T~ ~ ~~ e ~ Property Address ~-! ~'" tom' ~ ~ k ~ / +~ ~ , / Q,.,.__ (Verification required from Planning Department for new City/State 1~-~ (.J.~S41~ (A~ ~ Parcel Identification Number o Z~ ~ /~ ~ Z ~ '`~a ~FGAL DESCRIPTION /! ' ~ l.~Gf '/., Sec. ~ / , T~ ~~ N-R/~, Town of T'' ~~S ° ~~ Property Location ~ /,, / ~°" ~, .~ ~ Cy ~ ,Lot # ~bdivision t v~ C`',~lf ~ ~ ~ ~ ~/~ CertiCed Survey Map # ~ ~ ~'`- 5 9 ,Volume ~ ,Page # 3 ~ Warran Deed # ~' ~n l.~ , Volume l ~ ~ Page # ~- ~ '°' Spec housed ye~no Lot lines identifiable ~ yes ^ no SYSTEM MA_TNTFNANCE lmprnper 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 masterpltunber, joumeymanplumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to~the St. Croix County Zoning Office within 3D days of the three year expiration date. ( / ~ SIGNATURE APPLICANT DATE '. •~:ri~WNER CERTIFICATION . ' is t'(we) certify that aii statements on this form are true to the best of my (our) knowledge. th rapt't'ty,.descri ,above, by virtue of a warranty deed recorded in Register of Deeds Office. ~~..;: '~ SIGNATURE O ~ ~ PI.YCANT I (we) am (are) the owner(s) o / /~ DATE «•s«s« 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 ... ` ~ u~1~.1~1~PAGE ~~.0 STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED Document Number This Deed, ade between Sam E . Mi 11 e r , a ___ s ingt~e person ____ _ Grantor, and Thomas J. Stanek and Pamela D. Stanek hus an and wife as survivorship marital property Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in S t , C r O 1 X County, State of Wisconsin (the "Property") Lot 33, Homestead 1st Addition in the Town of Hudson, St. Croix Coun~.y, Wisconsin Ear4-,267'3 KA~i'Hi.EFN H. WALSH kEL~IB'fER QF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04-12-2001 10:45 AM bdARRANTY DEED EXEMPT # CERT DOGY FEE: COF~Y FEE: T#tANSFER FEE: 141.00 REC~kDING FEE: 10.00 • AAGEu.: ,.~ i Recording Area Name and Return Address .Thomas J. Stanek 986 Drover Trail .Hudson, WI 54016 020-1380-33 Parcel Identification Number (PIN) This 1 S n O t homestead property. ~(SjC~fs not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easement, covenants and restrictions of record, if any Dated this _ day of Ap r i 1 2 0 0 1 J (SEAL) (SEAL) Sam E. Miller (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated this day of State of Wisconsin, ss. St . CroiX Count r. Personally came before me this ~ day of ~P ~ ~ ~ ~ (,~ ~ ,the above named r~ ~ ~,. :z't TITLE: MEMBER STATE BAR OF WISCONSIN =~r _~F~' , to HbM E STEAD ~Sf ADDiTIoN ~ot*~~3~zt9 VOI.g PRGE 31 a[S11// CCRN[R S[CIN111 11 1,19N.-8.11 4 - - .'._-M4!1'te!!IGO..Lr~NRS )' Al1MNIM1 COUNI- yO1RJY[Nt EAST-WEST 1/1 LINE OF SECTION 11 SB9'15'OS~E 1]1510' - -- - ~~1 v .11.» - 1 ~Y~~ i - s».12' -- I I ~1 ~ v17 Q • ~ ~ LOT 38 { LOT 35 q \ 7 07 Ac. 3 t » (- ~° ~ ~ ~® \s `..,' 11 90311 s9_ 11 939Q NO• 11 ~I ~ ~ g `` ~ ~ ~ c ~ ~ ~~ ~ c,y ~ ~ ~ 6 ~ ~ $ 1 ~ N))yP•3j' ~ 1 y ` 1 `~ N 1a907~/ ~ Ali f0'P . t ACK ~~' \ - \ ~ eR Oq/j,E, 1 /~1i7o71 ~ ~~ ~ ~ w l0T ]7 / / / ~ _ _ ~ ~/ 2.51 Ac. / / ~' ~ I ~ ~ ' ~ 1 - -- ~W i 100562 aO. 11 // /• ~ ~~ / / ~ ~ ~ ~ I ~ / w a ~ 7 / ~ i r-S9 ~ / ~ ~ / \ / ~ / ~ ~\~.. M77YIb~,ly ~ I 2 ]] Ac _ ' ~ ~ ; ~ 7015., a4. 11 ~,,. ~/-; ~ i W ~ ~ ~ ~ h `_; ~ ~ Z ~^ ~ / ~ ° ~` ~ ~ ~,oi_~. ~ r ~ ~ ~ ~ d' ~ w r ~ /Ld I 1 LOT ]1 ~ o ~ for 32 f ~ 01 At z ~' ~ ~ , ~ ¢¢t ~ 2.3] Ac. ~ / Fi ~ Bk•F . .0 2.15 Ac. 101352 W Il ,~'~ I !"" I 9]602 sq 11 . . 871 11 ' S89'35'13'E k' I 1 1 I ~~. 6.22 _ _ ~tL-- ; /9 ~ ~ ~ 0 ~ ~ LOT 29 2.79 Ac. - 4 ~.-_ $ y 1 IY IN.N vl M9{'19'1T1114 ^ ~' I 1 ~\ i ~ r + A.1>! OLD HOPKINS P.~ACE'~'~ \ {+ ~~ y°~~ 9 10' 9~ ~ 7'E N1 Y ' - ~ 121520 fa. Il ~'• ~! •-- N9 .- - - . . ,` ~ ,j,- 7 c 7w u N1nr~. _ 1,)Y1'E 191.41 r a - ~, \ \ ., ------ -- n-or -\~, ~~ i 1 t ~ )a.61' t \ w [?u~Ni DRAINAGE EASEMENT \'4fI 'f' _ _ _ ~ --~ ~` \\~ 00 ` ~ HWE •901. ' ,G N ' Y`` \\ ) 1a»sru'la 7»ai ~ • \ '\ N~01d ~ ~ \ O ° Kc I ~ ' \ \ 7 / ~ ~ ~ ` ~ T ~ : ~..~ ip tMANAQ [AS[Y[N q o ~ ~ pRAINACE ~ASEMENt ~ M)O ~ HWE ~ 907.00\ Q ~/Ss• ~~ ~ ~' ~ ~17i ~ 1)i ~ jf17 ~ 33~ ~. I.~~ ~5~~ ~o [ASf 1/~ CORN[R ' S[C. 11, 171N. R19w )' KUYINIAI C01RIli IIONIIY[Ni x) e)' T 31 ~ tl AC. e. ~ !5 a0~ Il ^i n n ' )M ~ [ ~Tae N7f L01 33 1 ~ 2 06 Ac. 69579 W 11 $ ~yS c ; VI 1 91NCN YMN TOP 6t \ ~!' ~aT 1' NNf1 VIP[ [UVAWN . si)fY 3 ~~.~ 1917 USGS OAIUY = I ~ 1 'E ' ' ~ n ~'~ 1] ]5 SB9 99.00' ~ - tt2.7Y - LoT se ~ 2.91 Ac. 126127 s4. Il (p ~ Z '" ~ ~ \ \ ~ ~ ~ ~ ~ " "~ (073 ~ \ P ~ , ~\, e ~ ~ ~ fo ~ _ (~ LOT J9 2.62 At. LOT 10 k ~ 2.27 Ac. +~ LOT 11 211 Ae. ~ ~ ~ ~ ~ \ ~ ~ + \ 1 LOT 27 +, 11121 sa• 11 98958 sq. 11 91673 sQ. II ~ ~ t ]]' ~! ` 1 1 ~ 1.20 Ac. 182.916 aV• 11 i . . ~ ~ S O ~ ' 1O f--R ~ ; ~I~ ~ ; 1 (~s~ 9[NtM YARN l0V O7 )/i NON MI 1q/AY909 OA1YYa• I ~ i ~ I i I ~ ® ~ s a 0 ~ ~ ~ I I ~ . y ' Iw. r ))•.u• 6 ~si•vl 6p7JTH ,`W 1/1 - 6W 1 . OI 6ECTION N N69'3513'W 1112,e3 / \ \ [ouNo YOMM[NI AS YORD \ rR4l?!Qy SIEIUl N12Mf ]! I )) I ~ rAl!ltiStE~R.l~AQ!US29 ~ ~ ~ ~ Long 9T C911N[R RI/w _ . 9w CORIKR w 1/, a *I[ ~ fw 1/1 ~ I . / f19N, l0T 7 \ ~l \ r0/RRttN1 ~ ~ .•. I i I / LOT. 1~ ~ = I \ i~ / ` ~ \ . r