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HomeMy WebLinkAbout020-1402-13-000Wisconsin Department oyCommerce PRIVATE SEWAGE SYSTEM Safety and Building Division - INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village x Township Allen, B[II Hudson Townshi ;ST BM lev: Insp. Elev: BM Description: ~~' ~ - N o TANK INFORMATION TYPE MANUFA TURER CAPACITY Septic '-~.a~'~ ~ 257 Dosing L1J Aeration Holding TANK SETBACK INFORMATION TANK TO P/L ~ WELL BLDG. Vent to Aiclntake ROAD Septic ~ r ~ 1 ~ ~ l „/1 ' Dosing ~j c ~ ` Aeration Holdin PUMP/SIPHON INFORMATION ~~Sl ~ u~M ~y Manufacturer ~ Demand PM Loss Dist. to SOIL ABSORPTION SYSTEM BEDITRENCH Width ~ I Le h '~ o. Of ren~ DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL INFORMATION Typ f System: ~,~ ~, / IBUTION SYSTEM Header/ nifold Distribution '_ Length Dia ` ~ Peng sth ~ / • ~ / Dia~_~ pac~ ~( SOIL COVER x Pressure Svstems Onlv ELEVATION DATA county: St. Croix Sanitary Permit No: 420350 0 State P{an 1D No: Parcel Tax No: 020-1402-13-000 STAT ON BS HI FS ELEV. Benchmark Alt. BM ~ o~r~ ~ ~ ~~, B~.Se~r /' ~ t d •~~ l~' SUHt Inlet / .~~ (S /-, V St/Ht Outlet ~ .3 Dt Inlet ~- Dt Bottom Header/Man. l+~` i1 ~~ Dist. Pipe ~. ~ 5. (o Bot. System u r" w - g~ ~ Final Grade St~O~-- ~o • 2 ~ . St C~c rer~ / aq -/ I- n'~ Of Pits (Inside Dia. (Liquid Depth N~ Manufacturgl. 1 ~ -' t D Model Number: /~ xx Mound Or At-Grade Svstems Onlv to Air Intake Depth Over ~ ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ 2 Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes ^ No lC. COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: D /~/ Inspection #2: / / Location: 1030 Crescent Circle Hudson, W~I/ 54016 (SE 1/4 SE 1/4 11 T29N R19W) Misty View Lot 13 Parcel No: 11.29.19.2524 1.) Alt BM Description = ~ 6~'S/Q /~3 !-~ ~®~ 7 ~ L~ ~'~j~ 2.) Bldg sewer length = ~ ~ GliT 5~ -amount of cover = ~~ > 3' ~~:~~ Plan revision Required? Yes [ ~ ~ ~ 'i I Use other side for additional information. ~_..___ i_ j ____ __ __~_____.____ _ __ ~_ _ _~ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. ' ntnO' 3~n d ~1 ' ~ ~ ~ v' K ': ~, xt ~ ~ i 3 3 ~: i ~ # ~ p . ~ ~ __ ' O w 0 j , o N~ ?~ a N ~ H ~ 1 N a y fD O ~ W _ ~ ~ A 7 it O A I ~ ~ N ~ N ~ ! r~~ ` \ 1 O I ~ ~ W R O a W O ~ ~ X00 ~- 3 fR (') C ~ O p~ ~ ~ ~ d fD n !~I Q W O ~' o m N Z I o N C i o a N n r to ~ = ; . Q 3. ~ ~+ ~' I C ~ co ~ ~ ~ ~ 0 ~~ N N N j w 3 vV I v 3 rn , ~ v v, ~' ~~ ~ a ~ .. ~ li N I ~ -~ N I z z z O O D D o I o .~ ~ ~ ~ N~ ~r m ~ ~ I ~ . ~ - m ii _ ~ a ~~ ._ ~ ~ i ~ ': O ' ? Z • in Q fl. ! ? (Z 3 .. ~ ~ ~ j ' I N m ~ I a `~° 0 3 ' -' z ~ I c ~ I ~ ~ ~ N ',I mp .. z ~p A ~ ~ Q ~. C G ~ C ~ O i C N i I I ~ I ~ I I w I ti o I I I I ~ o cn I m Oq O ~» O co ti ti a ° ~ ~' - o i ti. o~~a~ ~- Safety and Buildings Division County ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~ l./ `~'' ~, ~ ~ ~seons~n Madison, WI 53707 - 7162 Site Address De artment of Commerce l b ® ~ Sanitary Permit Application Sanitary Pe~2o 35~ In accord with Comm 83.21, Wis. Adm. Cade, personal inf ao E D ^ Check if Revision ma be used for seco ses Privac Law, 15. I. Application Information -Please Print All Information Stan Plan I.D. Number ------~ Property Owner's ame Parcel Number r ~ ST. CROIX COUNTY ~ -- ~D(~ '~~~' ~ Property Owner's Mailing Address Property Location 377 s~'4~~S4:S T ,R/ E City, State Zip Code Phone Number Lot N r Block Number - Subdivision Name CSM Number ~ v - ~~ a~~ .~ - ~ ~r ,~ II. Type of Building (ch all that apply) (te, P.er s ^Ciry 1 or 2 Family Dwelling -Number of Bedrooms ^Village ^ Public/Cotnmercial -Describe Use ownship ^S~ ~` a - i ~. ! ~ T Barest Road ~ ~~ ~o III. of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A' 1 New 2 ^ Replatxment System 3 ^ Replacemetu of 6 ^ Ad~idon to For County use stem Tank Onl stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal ase) 44~Non -Pressurized In-Groin 21^ Mound 47 ^ Sam Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Crround 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobi Treatment Unit 49 ^ Rec' a ' 30 ^ ther V. D' rsal/'I'reatment Area Informati on: -/ Design Flow (gpd) Dispersal Area Disper Area Soil Application Percolation Rate System Elevation Final Grade Regtttred /~ ~ ~ t7 Proposedg~l ~ Rate(Gals./Days/Sq.Ft.) (Min./Inch) ~ Elevation C / (p~ ~~~-~ 1 ~' 9~ VI. Tank Info Capacity in .Total Number Manufacturer Prefab Siu Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constnucted Glass New Existing Tanks Tads Septic or Holding Tank °~b _ as~ Dosing Chamber VII. Responsibility Statement- I, the undersigned, ass~e responsibility for installation of the POWTS shown on the attached plans. Pltunber's N~rn~ ~ ~~ PI 's tore RS Number Business Phone Number ~/~ 7' ~0 3S 7 ~~~ - a6 g-~ ~~ Plumber's Address (Street, Ciry, Stan Z' Code , ' / ~~ !~ ~ ~ Q VIII. Coon /De ent Use Onl Approved ^ Disapproved ~~Y Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ^ Owner Given Initial Adverse 7 ~ ~~- L S~ ~ ~ , Determination ~~ IX. Conditions Approval/Reasons for Disap royal ~w~~c~1D~ Ww.+.~` ~ ~" '~° ~},c~n~v. ~ ~ OAllO~ 1 '~ ~ S~SI~ ~.~ . L - /Ci!~' ,,, _ -„~ - Attacp~ c~~_n"p`k~re~p~ana (w me wuocy my) ror me s~uem ou PrPc+' nv~ ,ess .,,... o.,~ ,..~ ,......w ......,~ ,.}.- 1 SBD-6398( *.. OS/Ol/Ol ~-iE+.(~l-~'"",'°'~`ri`~ "- c.Q~_~ "~`cu'~e~,G ~~-- c/~ ~ ~~-t~-ac y- ~`~ 1 ~~a = 98~~a ~~~ ~~ 4-/00 ~~, r ~-/D ,B~-o- - // ~ i w I~O ~-L 3~7 r /~L . aa~o 3.57 ~G y _~ y- ~ .~ ~-- ~ .~y~ ~~'yo, d ~ ~ _ /OD r 7~0~ ~~- l~~ l3 A :3~7 r aao 3S7 ~ _~ r of Commerce t~uicrn of Sabaiv Anrl Bui~inas ~o~Z7~~1 ,~ z112~~ 3 SOIL EVALUATION REPORT ~ Page ~ of in accordance wltn c:omm ts5, wls. f+am. ~oae County ~ ' I Attach complete site plan ~ paper not less than 8112 x 11 inches in size. Plan must include, but not Ignited to: vertical and horizontal reference point (BM), direction and Parcel I.D. scale ordimensions, north arrow, and location and distance to nearest road. percent slope , Please print all informadon. Reviewed by Date Personal itdormation you provide may be used for secondary Purposes (Privacy law. s. 15.04 (~) (m)). ~ 2.2- PropertyOwner P~rtY ~~ ~~~ Govt Lot S /~ 114,j/~ 1 /4 S / / T Z 9' N R / 9 E (or) Property Ownel's Mailing Address Lot # Block # Subd. Name or CSMf1 l35 ~ e Trc,-t ~ 3 ~s ~ ~ City State Zq~ Code Phone umber ^ City ^ village Town Nearest Road d UJl U ('115) 4- cfSo n n lG [,~ New Cor>struciion Uce: (~ Residential / Number of bedrooms _ 3y Code derived design flow rate y.S'a /~9 ~ d GPD ..~-~' ~ j... - ^ Replacement ^ Public or c~mmmeraal -Describe: ` ` .~ _ ~ ~ r ~ fl- Parent material CJ v Flood Plain elevation if ap ~~ General comments $~/ 5 ~~ Ll-Q- tl- 9~ o o d i sU ~'-;i ~ 4ti '~ ~~~,~t ~F,f and recommen at ons: ~,~/ , ~ ~.e, J . ~3.. ~~ l.1 ~ 4 ~ ., R'!4~1' i _~ , ~,: Pit Ground surface elev. ~ ~ ft Depth to Nrrriting fador ~~ in. Soil lion Rate r i n H De th Dominant Color Redox Description Texture Sure Consisten ~ Boundary Roots GP D/ft'- zo or p in. Mansell Qu. Sz. Coat Corr Gr. Sz. Sh. ~,_, _°- , 'Eff#'1 'Eff#2 ~ o-IZ 1 >^3~2 --_ 5~/ 2„-,cbk m~'r c S ~ v . 5 .~ 3 5`la IQ r ti - ms Qs m ~ - - • ~ ~~ 2 .a~ 4~ Borir>9 # o ~^~ ®Pit Ground surface env. q~ d d ft Depth to Ircrrriting factor in. Soi! ~~ Horizon Depth Dominant Cobr Redox Description Texture Stnu~ure Consistence Boundary Roots GP D/ft= in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I v--o f~ ~2 -- Si I 2mcbk m-~r c 1 v~ • 5 • ~' Z g `t ~ _' Sit -fir c5 - g 3 2 -ll(o i0 r to _ 5 s f - - . ~ /. 2 60 L ' Effluent #1 =GODS > 30 < 220 -rrglt. and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mglL and T55 < 3V mgft. CST Name (Please Pilnt) Signature CST Number A~~, ~c hum~.~,er /~ ~ Z ~~09 Address Date Evaluation Conducted Telephone Number 2t t'~ B~'~ ~ elrrr,pr ~e~, w t 540zS /G / --~/ Cl l5~ 24~ - Novi 8 r ... properly Owner ~~"f~ 1-~- Parcel tD # Page ~ of 3 ^ ~~g Bonng # ®Pit Ground surface elev. ~,Z~ fk Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Sure Consistence Boundary Roots GP Dlt'f in. Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 "Eff#2 I O- I lD ~ 312 ____ s i I Zmc,,b rn-~r c 5 ~ v-~ ~ 5 _ 8' 2 -25 `t ~ `-~ - S i 1 ~'r c5 - . 5 . ~ .~r ^ Bonng # ^ Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sal fication Rate Horizon Dapth Dominant Cob Redox Description Texture Structure Consistence Boundary Roots GP D1fF in. Munself Qu. Sz. Conk Cobr Gr. Sz. Sh. 'Eft#1 "Eff#2 ^ Pit Found surface elev. ft. Depth tD IHnitirxl factor in. ~9 # ^ ~~ Soil fication Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/ttz in. MunseB Du. Sz Conk Cobr Gr. Sz. Sh. "Ef(#1 'Eff#2 * Effluent #1 = BODS > 30 _< 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mglL and TSS ` 30 mglL 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. SBD-8330 (R.07/00) r' -a, property Owner ~~f1(1[ 1-~- Panes ID # Pie 2 ~ 3 3 ^ ~b9 Bonng # ®Pit Gnwnd surface elev. ~Zd ft. Depth to Ymifing fador ~• Sa1 Rate i H Dominant Cob Redox Description Texture Sfnx~rrre Coruoe BourMary Roots GP Dfif or zon ~ in. Murrseh Qu. Sz. Corrt. Cobr Gr. Sz Sh. 'Eft#1 `Eff#2 I p-~ lD ~ ~2 _ Si 1 2mc~b mfr cs 1 v-~ • 5 • 8' 3 ~s l ~ l r y 1c~ --- r,-, s s - - . -7 /. 2 ^ ~i„g # ^ ^ Pit ~~~ surface elev. ft. Depth to limiting factor in. ~ ' n Rate Horizon Depth Domirrarrt Cob Redox Description Texture Stnrcture Cons~tence Bourxfary Roots GPD/ff in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 'Etf#2 ^ Pit Ground surface elev. ft Depth to limiting factor in. ~9 # ^ ~~ Soil nation Rate iz n H th D Dominant Cobr Redox Descri tion Texture Stn~dure Consi~ence Boundary Roots GP DRF or o ep in. MunseA p Qu. Sz Conk Cobr Gr. Sz. Sh. `Eff#1 `Eft#2 ` Effluent #1 =GODS > 30 _< 220 mgJL and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mglL and TSS _< 30 mglL 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. SBD-8330 (R.07/00) PAGE .3 OF ..3 NAME S1~ y ~ T OT# ~3 I FGAT DESCRIPTION ~ ~.SE i4 ,S !/ T L q ,~,R, / 9 E(or)~ SCALE:1"= yU BM 1 ELEVATION /OU • ~ BM I DESCRIPTION dap a ~ (u.fl~ ~3 ~~ /-~, w ~, BM 2 II.EVATION ~ ~. ~O BM 2 DESCRIPTION -(o ~ o ~ luf1, Z ' ~ J~-.~ ~ SYSTEM ELEVATION q~/• G U ALTERNATE ELEVATION 9' 3. S d CONTOUR ELEVATION 4g, py ~ y q, 0 0 c ~~ groZ ~ W ~~~ ~•, ~ $ ~J M N Sec. / 1 _ -E- X > . ~ ~ a~°",~ La1' Skpf~ i SIGNATURE /~{~ , ~~~--~' DATE /O~1~/-0/ POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION Owner Permit # ~ S-D DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ""'~~ ^ NA Estimated flow (average) 0 al/day Design flow (peak-, (Estimated x 1.51 ~ al/da Soil Application Rate ,~ al/da /ftZ Standard Influent/Effluent Quality Monthly average " Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODE) <_220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) S30 mg/L Total Suspended Solids (TSS) <_30 mg/L ^ NA Fecal Coliform (geometric mean) <_10° cfu/100m1 Maximum Effluent Particle Size Ys in dia. ^ NA Other: ^ NA "'Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Page ~ of Septic Tank Capacity Q al ^ NA Septic Tank Manufacturer (~~_ ^ NA Effluent Filter Manufacturer z ^ NA Effluent Filter Model - ~©~ ^ NA Pump Tank Capacity ^~'' al ^ NA Pump Tank Manufacturer - ^ NA Pump Manufacturer ~~ ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal CeII1s) ~In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ earl l(s) (Maximum 3 years) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ earls)IS) (Maximum 3 years) ~Y ^ NA Clean effluent filter At least once every: ^ month(s) ,~ yearls) ^ NA Inspect pump, pump controls & alarm At least once every: ^monthls) ^ yearls) ^ NA Flush laterals and pressure test At least once every: ^ earlslls) Y ^ NA Other: At least once every: ^monthls) ^yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the 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 tankls) 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 be 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 IY31 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, 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. Page C~of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) 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 tankls) 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: A suitable replacement area has been evaluated and may be utilized for the location 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. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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 POWTS INSTALLER ,. iOI ~,Vlo~n,'n~.~.n ~ 1-f~P.a~1hQ Name Phone ~l _ a POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S T, 2 ` Phone 7is - 3 ~ 6 ' ~'~ a This document was drafted in compliance with chapter Comm 83.22(2-1b11111d1&Ifl and 83.54111, 121 & 13), Wisconsin Administrative Code. sT cROI~ CouNZ"Y SBPTIC TANK. MA1N'i'BNANCB AGRBBM]fiNT AND O~gRSHIp CgRTII~ICA,TION FORM OwnerBuyer /!~ ~` ~~~~/ i9LLf~/ ~; ~ _ „n - - ~s ..D~~ ..mow/ ~Z, S Mailing Address Property Address Gi. ~'S~A'.( (~/erificatioa required frmn Planning Depart ~ new `t/.~" Parcel Identification Number d?-o -/yob - l 3- De° City/State ~~GAL DFSCRIL'TION~, ~K ~~~~J / 4 , S ~. /, Sea ~, T'~_I N-_,+_"~-'~~ Z`own of y~0~~,/ property Location ~ ~a .... !~ OG /y!/s /~i~/ Lot # /3 Subdivision ~ Volume -Page # Certified Swrvey Map # - ' .Volume ,~ Page # Warranty Deed # ,~~`~(e ~yy - _.~~ Spec house ^ yes~no Lot lines identifiable Yes ^ no SYSTEM NLpi]~1"L`ENANCE Improper use and maintearwceof your septic system could result is its prernatm~e failtue to handle wastes. propermamtenaaee out the septic tank every three years or sooner, ~if needed by a licensed What you P~ ~O tha system cons~stS of pumping m the waste disposal ~m°- can affoctthe function of the septic tank as a treatm~ stage a tioa form, signed by the ovvn~er and by a The property owner agrees to submit to St. Croix Zoning Dt«i~s that (1) the a~n site wasbewatrxdisp~al pltrmbe~ jomneymanPl~~ restrictedplumb~xor a licensedPumper ~ ~ props operating conditionand/or (Z) after inspection and pumpin8 (if necessars-), the septic tank is less than 1/3 fiill of sludge. sad agree to maintain the private Sewage disposal system with the standards ~ ~ oade~gnod have read the above nx~ of Nataaal Rasouroes, State of Wisconsin. Certification set forth, herein. as set by the Department of Commerce and the Department to the St. Croix Coaaty Zormrg ~~ ~~ 30 stating dint your septic system has been mainttainod must be completed and nafirned days of the three year expiration date. DATB SIGNATURE OF LICANT OWNER CERT`IP'ICA1'ION our lmowledge. I (we) am (are) the owner(s) of i (we) certify that all statements on this form am true to the best of mr of Deeds Office. the property descrr'bed above, by virtue of a warranty deed recorded in Registe ~'~ DATE SIGNATURE OF LICAN'T }x~g revolood by the Zoning Department «««*«« «««««« Any Formation that is mis-rapreseated may result is the sanitary Perosit deed &~ the Register of Deeds office s« Indude with this applicatloa: a stamped waaanty ~. refC~a ~ made In the vvatzanty dad : copy of the certified survey map U_ 19y?P Sy3 ~; - STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number ''~ This Deed, made between f' RICHARD (~ STnt1T and JANET P - STOLLT - !~ husband and wife, ~; - Grantor, and WIT.L•TAM ,T AT.T.F.N and SHARQN A ~T.T.F.)\1T _ hus an an wi ~, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St Crol.X County, State of Wisconsin: Lot 13 Plat of Misty View, Town of Hudson, roix County, Wisconsin. ~"~ ''`~- (SEAL) Janet P. Stout ~~Vl~ 020-1402-13-000 Parcel Identification Number (PIN) This 1S riot homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated this ~ ~ ~ day of August ~ n 0 2 . 1 (SEAL) Richard O. Stout AUTHENTICATION Signature(s) au[henLCaked this .day :.f (SEAL) ^br TITLE: MEMBER STATE BAR OF WISCON _ _ ~ ~ 686944 KATHLEEN H. IiALSH REGISTER OF DEEDS ST. CROI}I CO. , MI RECEIVED FOR RECORD 08-14-2002 3:15 PM NARRANTY DEED EXEMPT # REC FEE: 11.00 TRANS FEE: 209.70 COPY FEE: CERT COPY FEE: PAGES: 1 ':. Recording Area -_ _._.. j Name and Return Address ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St. Cro1X County. Persona!1y came before. me this S ~ day of August 2 0 0 2 ,the above named R' hard O_ S o~ and Tan- P_ Stout to I L- (889°30'OOMI) ARK TOP OF 1" _ 8:9°52'3:"W 722.;1' E ELEVATIONI L-3 L-4 "' -• 56.01' O I I 299.35' 367.25' GI I MIN. FLOOR "l J) E , P 1 • i ELEVATION OF 903.50 v �, ICI _ -� t�/ 1 0 Qa iv I I N C� V HWL = 901.5 ,/ MIN. FLOOR Q, Q co I LOT 14 m LOT 13 ^ ELEVATION O ( c a d�m 2.000 ACRES ° �`� I 87,125 80 FT N 2.960 ACRES ` or ry OF 903.50 a Q ——_ o p 87,120 S0 FT A \ , ZG , O � V7 I ' m �' --� o 9 v* ICI SA�� Ca m� ' � N co � °ry I n ga o = �,, I�j �'�, c '` ry`D LOT1 a Qa - O I VV ---/- O 2.000 ACR S [� '� �(° .. o o(p I I / / ' \ 87,134 SO FT �fl © co o N M I I •�, i. —. / '/ \\\\ - ' Ig E ICI �• \ • / -.,, LOT 15 / e )< K " 2.001 ACRES / @ \ \ 87,147 SO FT / \ ' rile N- I I MIN. FLOOR I I O • ' ELEVATION • aO4 �` _ L OF 00 I �/ • 886 45'05'W 283.65' 161.57 N. J / — \\ / / V �. / E HWL = 911.00 s6?°48 i / / • V 06,• / / MIN. FLOOR "c / 1:0'< it• / cl // ELEVATION S8 0 LOT 11 ' �,` l07- CD OF 913.00 LOT 1 G �' V'S ry . S // 2.00o ACRES co % / / O rym ^ry ry0 O 87,120 SO FT // R?: 2.008 ACRES / / 87,450 SO FT/ / / ^As Gerry"^P MIN. FLOOR `k\ F. ,' /Y ry0'o 0) ., / ' ELEVATION OF `\914.50 \ i of — _ _ _ _ _ — _ _ — Jry0�mo, / / S88°29'13"E 472.36' ,' '� Volt tv o' 281.89' 00, 4ry 0' / / / W�' 5, 0 08 6 a Apt` / • MIN. FLOOR LOT 1 O :9 2�ao ' — • ELEVATION OF 2.000 ACRES 914.50 87,120 SO FT / ►�, a • _� Cr ��� \ \ \ N © o0 MIN. FLOOR \\ \\\\ \ '\ N87°42'17"E 425.96' o ELEVATION OF \'' y\ \ `Z g°MJ 900.00 ly `�\ 4,\\\ N 41 LOT 3 \ m \ m • � O$ �NtAfAu 2.500 ACRES _W 150• C • 5; I 2.000 ALOTCRES col of °z N 87,120 SO FTZ VA o N r1 G \ O Q I 1 C'J // 8 800 \i 2 i�iy IN U' 01 \ O / i i //LOT 4 1 N g Z IS86°23'04"E 377.98' i 276.52' / • / \ O 6 1 •W 1 \ -_ 2.001 ACRES \ .1 N O \ C 4' ' ± — 87,143 80 FT \ \ p \Q. 1 7 � \ LOT 8 2.000 ACRES I` -n L-23 • \ \ 87,121 SO FT 0 \\ HWL = A `� N= i "'-892.50 =N pP Od N,, \' . - • 4,,--- z Oryb \ \\ `\ ,\C? .�`` --I// — — i '• CENTER OF 8( to ^ ro N' C?\q� • •CUL-DE-SAC j 4 \ S:9°39'33'W 187.30) EASEMENT TC L� t, •° - --- /, �\ \` _ ao 0 EXTINGUISHE �� _ , m '0 c • \ \ \ N89°39'3_3"E 187.30'0 ROAD EXTEND —._—.— ✓�La \ I • j -A 0 HWL = / \ u ;�L"?'-- _ 903.00 �, LOT 5 L - I— 0— -— - - ---------* Z$ ) 2.536ACRES i.. V i I 110,489 SO FT — — dOO 4 QG� c 1 CO 0 66, /-1, / ©o@OH. OIL dQ[14 a? \ i MIN. FLOOR 0 N .. Li, 2,PLAIE 009 c4 o e * \\ 65 i ELEVATION OF = `\ / 905.00 W 1 1- CI S( ----'' $ LOT 7 0)1 o N 889°28'59"W 368.72' CA 2.002 ACRES N W co 87,198 80 FT 0 Z 41440g ii9 Olei6Piti*IV X t" 410 \~ \ 4N _. ~~~~y~ Qjtiv rol •~ ~~ m p m x C ~~ A ~ ~ ~ ~Oy ~ ~ ~ ~. 'pg~1~L£ ? C1 ~ ' ° D ,~ I ~ • ~~ ~ ~ ,~- mm Z Am ' '~ N ._l. _ X ~ i N h~~ _ VN W O• =~° r r' m z g N g p ~~ i ~~ ~ - ', t ~. ~ ~` ~ `. ~ N ~~ ~' ~ __~ ~ r i~~ ~ ~~ 1349.37' \~~ .73' _________ 238 38' -------- rz ~Q~ ~.~ ~ ... ~ ~ >i ~ ' ~ N ~ u ., -8~ ~~ ', a '~ ~e ''~ ~ ~>~; .- 01 ~ ~ ~~"'~~> ~ ~ ~ 71 449.76' ° z O ° 270.34' _ ~ 189.42' ~ I C~DG°~`~4 L~IDDD4DQG`~ 5~0 4Ll~G~C~'l O aDDC~a[~ ~(?C~~~Qd aQp~~Q~i `~ I ~P I ~~ i ;s7 ~ ~~ I i - _ _. . .. ~ .._ , _... , ~