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HomeMy WebLinkAbout020-1435-02-000Wisconsin Department.of Colime+~ce PRIVATE SEWAGE SYSTEM ~yvU~~~Y St. CrOiX Safety and Building Division ,_ .. _ .,• _, ~ ~ s 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 Baypoint Development Hudson, T wn o CST BM Elev: O f Insp. BM Elei 6B~M~Des~criQ~ion: TANK INFORMATION ELEVATION DATA TYPE MANUFA TURER i C ACITY - Septic ~''~-~f " ~ Z~ Dosing Aeration of Ing TANK SETBACK INFORMATION en o u na e ep Ic ~ 1 ~` J fl ~ osmg era Ion o rng PUMP/SIPHON INFORMATION anu a rer eman GPM o e um r 1 nc Ion oss ys em ea m In g l ~Z ~~ `[ _ C wrl 020-1435-02-000 ~ 11.29.19.2702 STATION BS HI FS ELEV. Benchmark Z, {~ d J ~ , r Alt. BM BI g. ewer V ~~ ~p.I l02- -~0 t net 2,0 o~S. / t t utet ~~~~ O'`2g./ ne 0 om ,ea er an. r $• Is . Ipe r o. ysem $"'.~ •~~ Ina ra e e Ir1` ove ~ ~ y~.,~ 3.3 2 ® 0 DI S ~ 3 I 0 ~) z~ • INFORMATION CHAMBER OR ~ ~V ~~ 1 ~~ /~` J UNIT G UIJ 1 RIGU 1 IVIV J i J 1 GIYI ~ 1 ~ 1_ l ~L/_ t// / ' _ _ . ,-. x Pressure Systems Only xx Mound Or At-Grade Systems Only BedlTrench Center Bed/Trench Edges Topsoil ~~ Yes ~~ No L] Yes L-] No CO-M7~N ~ (In I de cod)a~screpencl s, rsons present, etc.) Inspection # v'P~ /~_ Inspection #2: Loc Li"on~: 10 2 LabargeQR,~oa~d Hudson, W~6 (SW 1/4 NE 1/4 11 T29N R19W) Joshua Hills Lot 2 02 1.) Alt BM Description = I~.SR-- s ~ - ~~'^'~ C~~i! ~~ ~"" = _ i - ~~ =$r a ~ ~ ~~ ~~,B.QQ ~ ddt~ ~n C.~{lb~ 2.) Bldg sewer length = (~ J' t~Ir ~ ~ ~r~ ~, -„am/ unt of co~ ~~.eV ` _"""`,,' . l ~: 2.7~'~~~^""'~'s ~ >~ . (.U``7;( ~~!V s`~~- -- ---- _ Plan revision Required? ^ Yes ~ No ~- Use other side for additional information, ~~ ~ sl ~ ~ ~ ' ~ Z~, '~~~` -- SBD-6710 (R.3/97) ' aad Buildings Division ~~y f ~/ d ~ ® 201 n Avc., P.O. Box 7162 t ! ~~~0~~~~ , Wl 53707 - 7162 O8) Z66-3151 Sanitary P 't Number be filled in by CoJ De ertment of Commerce Sanitary Permit a Un ,, a Plan LD. Number ~---- In accord with Comm 83.21, Wis. Adm. 'm you provide tray be used for secondary p aey w, sl 04(1 xrH)P R 1 9 20 0 6 H ;°~ Address (if different than mailing address) I. Application lnformatlon - Please orma ST. CROIX COUNTY ~" 0'j2 Property Owner's N 1 Lot # Block # Ptnpcrty Owner's Mailing Address L.ocatim E e t ~ D ~ e r G ~ ~ Sectim ~/~ N~ '/• '/ Ci , Stat ~ Phone N W , ti T N; R~E o V~V 11. Type of Building (check all that spp1Y) ~ S /' b S ~ ~P ~1 or 2 Family Dwelling -Number of Bedrooms 'F /~ f ~ er M Num Subdivisim Name C Pl-t~ of- ~cv~-vim ~z cls ^ PtibLdCiai - Dexn'be use ^ State Owned -Describe Use ^City_^Village~ownsliip of rJ.S dY'I . e of Permit: (Chock only one boz on line A. Complete line B if appllcsble) ~ z©- -O 2 - pQp • 2 ~O 2 Lll. Ty p A. ,, y ~y N~;K~++,• ^ Replaoemmtt System ^ TreahumUHolding Tatilc Replacammrt Only ^ Other ModificaUm to Existing System B. ^ Petmit Renewal ^ Parnilt Revisim ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiratim Plumber Owner IV. of POWfS Item: Check stl that a 1 ~' Nm -Pnssurimd !n-(bound ^ Mound > 24 in. of suitable toil ^ Motmd < 24 ia. of suitable soil ^ At-Orade ^ Single Pass Sand Filter ^ ConstrtY'ted Wetland ^ Prasutized hr(irouad ^ Holding Tank ^ Peat Filter ^ Aembic Txeatmmt Unit ^ Recirculating Sand Filter ^ Rech+cula ' S tbetic Media Pilfer (]wnrba ^ ^ vel-le Pi ^ Other ) V. Dis nal/lY~estment Ares llaformstlon: Design Flow (gpd) Design Soil AppUcatim Rate(gpdsfj Ih al Area Required (sf) Di parser Area Purposed (af) System Elevation It DD, ~ •7 ~S'7 ~~7 ~So Vl. Tank Info Capacity is Total Number Maaufachutsr Site Steel Fiber Plastic Clallaos (ialllans of Unite ~ Constructed Glass Naw 13xietiag R~ ~~MQA Tub Twlcs Septic oriteid~-Tads /~V f t ?~ J I ~~ ~"!'(`•c~ ~ /~ Ae~nbic Trcamic^t Unit Doing Chamber Vll.1Zes nsibili Statement- k the nn ed, ass nslbifl for brstalWtlon of the POWTS shown on the attached Plumber' aura (Print ~ PI Si " ~ MP/MPR5 Number Business Phone Numbs = `10~D L az ~ /~ 9~6 Z 7~.~ 23,5 Z~ ~y Plumber's Address (Street, City, State, Z1p ~~~ ~ 76 6' ~ ~~ C`l a~ nl r~ fi/ L f~2-,I7 V11L Cotm / De rtment Use ~ppmvod ^ D' Sermit Fe¢~includes (3r'oundwater s Date Issued ]sluing Agent 3i (No Stamps) • ) ' ' ~ - ^ Owiser (33ven Realm for al fit IX. Conditions ro SYSTEM OWNER: .~ tr ~~ ~ v'^~ ~ ~ ~ ~~~ y 1 Septic tank, effluent filter and i U ned I dispersal cell must all be serviced /mainta as per management plan provided by plumber. ~.~.\ ~, I -\ (~ ,, G ~,~ o,,.. ~~ , ~ ~ ~} 2. All setback requirements must be maintained ) `"~'~ )~~ \ ~"` `''""-~ '~~~ ~' """"°~C. , as per applicable code/ordinances. ~- AttaN eompbts pWU (te tat Cou^ty o^ty) ror the ryaoem o^ paper ^ot tea tau errix : 1I ueres u size ~ Sys-- ~ ~;~ SBD-6398 (R. 01/03) I ~~~~ t~ ~~~ ~./~~ a l~ ~. ~~ ~° ~ ~ ~~ ~~ z ~° ~ ~ ~ o A ~ ~~ a ~ ~- ~ ~~ ~ ~ ~,, ~- ~. ~ 1 L ~` '~' N ~. ~ ~ ~ ~~ -~ s~ ~` ~, 3 ~ ~~ ~' ~ V ~~ o a~ ~ ~~ v~-o r~ ~d J D ~~ .~ ~~ ~, c~'P cr ~`'~ ~, ~ .~ ~~ ~~ ~ ~~ ~~-- (~7 \\~C -,., 2 ~~ ~ o ~ ~ ~~~~ ~ w ~. ~ ~ L ~ ~ N ~ ~ ~ 1~ -~ s~ ~` ~, 3 ~v ~ ~ ~' ~ V ~. ~~ o~ Z ~v~o ~~ ~d ~ ~~ ~ ~ y\ .~ c~~ ?~ ~ a`i ~1 ._.-~ ~~ ~ ~ T-=~ ~~ ,~ ~~ ~L X ,~ r ~. -- N 1 t~ ~~ ~6 ~~~~ ~~ 3 '~ ~' 2 o; ~~ ~~ „~ ~ ~~ *~ C b Y v ~~ J .3~ A i; ~ ~ ~ 1O Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in arrnrdanra with Cnmm 85 Wis Adm_ Code 1317 Page 1 of 3 Steel Soil Service County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must St. Croix include, twt not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsioru, north arrow, and location and distance to nearest road. . . Pending Please print anon. evi d BY Date Personal infomra6on you provide may be u for seco~~ji r~s~~fi~~v, s. 15. (1) (m)). f Property Owner Pr party Location Felling, Bill & Liz ~ G .Lot na SW 1/4 NE 1/4 g 11 T 29 N R 19 W Property Owner's Mailing Address L # Block # Subd. Name or CSM# 1026 Tanney Ln. ST ~~ - 2 na Joshua Hills City State Zi ode ~114u[r»t~t;E ~ City ~ Village 1/ Town Nearest Road Hudson ~ WI 54016 715-381-1240 Hudson Labarge Rd U" New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement J Public or commercial - Describena Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments `~ and recommendations: System elevation 98.20tt, trenches spaced and depth to cod 3.50ft below grade. _------~ 'A M irvl 6 Boring # J Boring 1+ Pit Ground Surface elev. 98.5 ft . Depth to limiting factor 120 in• ~ ~ '~ Sod Application to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr 3/2 none sl 2msbk mft gw 1f .5 .8 2 9-24 10yr4/4 none Is osg mvfr cs 1f .7 1.2 3 24-120 7.5yr 4/4 none cos osg mvfr na na .7 1.6 ~- 9 S .c~ Boring # ~ Boring i/~ Pit Ground Surface elev. 101.7 fl. Depth to limiting factor 120 in. Soil Application Rate Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/RZ in. Murtsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-16 10yr 3/2 none sl 2msbk mfr cs 1f .5 .9 2 16-60 10yr4/4 none v cos osg ml cs na .7 1.6 3 60-120 7.5yr4/6 none cos osg ml na na .7 1.6 9 .~~ Rs.o~ ~Z (o . `"1 ' Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Si nature: CST Number David J. Steel 248956 Address Steel Soil Service `-"` Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 5/14/2003 715-246-5085 ~S .L~ .~ ~~ .~ .~ .~7~ . T Property Owner Felling, Bill & Liz Parcel ID # Pending Page 2 of 3 Boring # J Boring /~ Pit Ground Surface elev. 94.20 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-18 10yr 3/2 none sil 2msbk mfr cs 1f .5 .8 2 18-42 10yr4/4 none sl 2msbk mfr cs na .5 .9 3 42-120 7.5yr 4/6 none cos osg mvfr na na .7 1.2 ^ Boring # -~ Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ~ Boring _f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 . ~e .~ . ~- * Effluent #1 = BODS> 30 < 220 mglL and TSS >30 < 150 mglL * Effluent #2 = BODS < 30 mg/L and TSS a 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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel CST-POWTSM Lic. #248956 Bill & Liz Felling SW 114,NE 114,SI 1,T29N,R19W Town of Hudson, St Croix Co. Joshua Hills, Lot 2 1564 Cty Rd GG New Richmond,WI 54017 Bus.(715) 246-6200 Fax (715) 246-9372 ~o~ ~~~, l J~ W-A S J- ~i~ Legend 1" = 40' • Benchmark Ele. 100.00Ft p of 1/2" PVC pipe`-- • Alt Benchmark Ele. 99.70Ft op of 1/2" PVC pipe `~' • _~-----•---------.~-- Iii °O 'O E 610.50' ~ ~-._.~ i---- - - •~._. 1 ~ ~1.'i~---'"... 09.23' ~'~.\ ?~53 . _ = -`2'J 3i1 27' 189 _ ~_ ~-` ~ % ~ ( - -~~=: -1 i l ~' ~ 1. ~.~ --- --.._. -~- `~.~_-=_- 4-~-x -~ = '- z ~ ~ ~''~'~- ~~~ ~-- -•- "' • 900 ~ -~ ~- ~- j 1 ~- (1 ~\~ / j /i 1.1 1! I~ If 1 \' .-.. ~.~.~._. '--1-'i ~:~:1,J_r \ ill ~.""~ ICI 11 _~ ~ ~ -~. i. '1~-- _-;~ \ •1..__.__~~ ~Q 389, 7 3, ~ i %' ,. ;; ~ ~- ~ !_s / / j '~ ~'. . ~ \_ - 1 1 ~ ~1 t L ` yl I, -II~I~ 11 1 1~1~ ~ `'/ % _ J ~~ - - $80 . / i % _ :' S lir•-•--- r--•- Y- ~~ - _ r---~ • -~ ,. _ ~ ~ ~ 1 ~i ~ ( i ''~ ~ I % ~ ) _} ; 1~1 ~ ~ ~ ~ s i l -._ ~.-~--_. ~ ..,..~ •;I ~ ~.m rn .,~ 1 i i ~ ~~~~-,•, ~. i ' -~ jir ~ p~'iill .Ili.l~l ~-~~ j ~. 1 ~ ~ ~i i o~J/~ ~ ~ J %~!' / ! / /~i // ~~ _i. ~~~~~ ~ ~~% f o 1 ~i~ , ~~'/ ~~ !~ i i~ - ~'li. .~'i '~ 1 I^ 14 ~i ~~ ,~ r ~I.`'1Ly~'~ 1~~j ; I 1 V ' ~ ~ 1~1''• ~ ~ ~. :~ .a 'f ~131~ ~ Y 1 I I I ~ L='(~ ~i ~-IT t ~t'~~ =x_ _ -r ~.~•lyf~ 1 I 1 I 1 -(r Litz ~- - \ ~:~L- ~. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner aS ~ ~ ~~ Permit ~ ' DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units ~'NA Estimated flow (average) D al/day Design flow (peakl, (Estimated x 1.5) 6 0 r) al/da Soil Application Rate ~ al/day/ftZ Standard Influent/Effluent Quality Monthly ave rage" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD5) <_220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly ave rage Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) <_10° cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity 7~~ al ^ NA Septic Tank Manufacturer ~yl~,~ ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model `TD~ZZ- l /,jj~ ^ 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 Cellls) ~'In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA ^• A 1\IT~\I A \I/~C Cf~1J 611111 C IVIHIIY 1 CIYHIY IiC Jai 17CV VGG - Service Event Service Frequency Inspect condition of tankls) At least once every: ^ month(sl (Maximum 3 years) ~ ,Jy 3 ,t31 earls) ^ NA Pump out contents of tankls) When combined sludg e and scum equals one-third (Y3) of tank volume ^ NA Inspect dispersal cell(s) At least once ever Y~ ~~ ~ ~ yearls11s1 (Maximum 3 years) ^ NA ^ monthls) ~~ ~ ~.~feat' ^ NA Clean effluent filter At least once every: ~' yearlsl ^monthls) NA Inspect pump, pump controls & alarm At least once every: ^ yearls) ~ ^monthls) ^ NA Flush laterals and pressure test At least once every: ^yearlsl Other: At least once ever y~ ^monthls) ^yearlsl 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 -_ 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 celllsl. tf 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 cellls) in one large dose, overloading the cellls) 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: ,~l 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 Name / 'G.~/ L ~~~' fv L-' Phone '?(S'' (i7 ~~ ~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERA PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S ~~,l~ CD. 1~/[~ Phone 7lS - '~8'6 - T"6 ~D This document was drafted in compliance with chapter Comm 83.221211b111)Id1&lf) and 83.54111, 121 & 131, Wisconsin Administrative Code. FROM :MC FASSINO FAX N0. :715 386 0902 Apr. 20 2006 04:39PM P1 s~r c~oix cou:~T~~ SEPTIC T 4`~'K ~tiiwYI~TENA:`CE AGREEMEI~`T A'~t"D pW'N$RSHIP CEATIFICATZ4N 1; pRM QwrierrBuye- So Mailittt; Addrersa ~ _- ~ ~ ©-~ ~bs c l (~ Property Addrees (Verifieatica ra~uited ~orr- Planning Depa:ema:it fos new caa~nuccion) I Pa~co1 Idaac:~'icatit~n Numoct Qaa -- t y- r~.~ CitylsCette ~, ~r`r~ sT rQ'SCY.~T~ ON ~_ '/,~ Sec. ~.~ ..., T~_N Town of ~{ r~~ ~ -- Pxope~y Location W i~•- '~ ~5 ~0. ~ Lot # Subdivlstor_ d Surve Msp p .,,,, ~~~ ~ - VelumcrJ ~ , P~~e # ~~• Certiile Y _, V olurne ,_~ . Pa$a # Vy xrranty Daed ~ $poc hobo ^ Yea~ae Lot lines idcn:inable~Y~ C ra Irap:opor tree and taaiap:satsceaFyour sep'i: system could rrault in its Frataarite frilura to e~r~Whxt You put~into thle sys*.uKn con5isu of ptmpin~ out the wP~ ~• eV~' torte years or aooaer, if noeded b} s licaassd Rump eau affect tha faction of tie septic toss's sa a trastment nsge is ebe ~.+aste disppsal syseera. d by a 'Kbo ptogerry oyvnas sgtoas to wubmit to St.ti ~ a uc~ pu `~vet~y~B ~aL ~1~ ~ ~" it~e. ws~t wa`' d 9gosel svazc:n rasaserplurabsr,Joyrseyasanplumbar.rea~'ictodplum v ,. rbe s tic tazslr is loss thew 113 full of al;idge~ er oprratinS eonditiea aadlot (~) a~oc sugeotjoc and puaapir-8 (i. ttecessasy), ~ is In prop Uwc tI~ ~dersigttod havo road tha above sequiremeat9 e-cd a~ee tc rtasiat; of N:•tural Rese~aa~S oaaof W!9 vnssu. ~ Csrtsfi auC a set fottb. horeio. ai yotbY ~ Depstt;t-eAt of Cosamarcc and the DegareR~nt orating that your sesgde system l~s bsea msis~tslaed must be ooenpleted atu3 rehumed to the St. Croix t`,ouaty Zoang Oftlce within 3~ a~ys ~i ~ th:o• ~~ exy~irettica dzte. ~ ~~~ C . t].O~.w-A DATE 9ICENA DF ARP CANT ]d.~,>`~~ t^sI!'d"1`TI~GA't'Y~1V 1 (we) CortiP7- t&at ail etatentents oa tbis farm a;r tn-e to the best of my {Q'a:) kaowladga. I (wey ara fare) tl:e ow•nar(s} the ptoptrty described above, by vi;R:6 of s w~tsenry deed recorded ;n Register. of Deeds OYiicr: t • I j / ~1~ ,~ ~ DATE SIC3NA'riJ1i8 F AP C T ++. ~.. •wf•..- day iatormatioa that is tnis.tepriasatadtsgy tesnl! is the :ani~.ty per~tti; boinX rtva>ted by the Znts:a~ Depestmeat~ ~" ineludo r-!tb tbll sppueatiob: s stamped ws:raery dead &orrs the Register of Deady o!YlCa a eopY aY ~-~ t:estit~tti wrvey' tntp is reference ie toads in the w~aciry deed s~r c'zolx cou~T~ ~, SEPTIC T.4tiK ~SAINTENANCE AGFcEE?v18NT Awe ~o~ 0 ERS .P C RTIFICATION FCRM~ '~° ~~2° n ~ ~ r_ ~ Oa~nerrBuye* o 5 15 ~ o ~ C ~ o ~ ~ c~,5 Mailing Address I O3 a- ~~ Pro erry Address L p f ur ~ ~-~°~ P r (Vcrificatioa requued from Planning Depst~tmant for new con~iruction} Ciry!State ~..~2. ~ ~~~---- Parcel Identification Numoer ®~0 '" ~ `~ 35 - ~ - 0 Z'}o 21 j~~T, DBE _~pTION t ~ ~ N-R I W Town. of ~~ ~ ~ ~-' Property LocatianS~ /•, .~E ~,, Sec, ,~..(_.~., T,~`~... Subdivisior. ~--o f a,s ~ Lot # a _.__ 5~ ~ ~S , volumo 0~5 `~" ,Page # ~-~7~. Certified Survry Map # ~2 -_r______ Volume _, Page # ~'s~rranty Deed # Lot lines iden:iiiable .~ yes C ra Spec house O yes ~na lmprope: tie Tsui ~iateaanee®f your ap~~ system couol c=oif In edrd byr a lie aced pumper~dWhat you putpinro ihetsys:urr. consisu of ptmpin~ cut rho i4Qtic tarot evory three years ar so , eau affect the p~mction of the septic taalc as a treacrxteat stage in the wn~te disposal system. artrtsnt a cartificatiua form, signed by she owaez nrd by a The property owner agroes to submi. to St. Croix Zoning Dep~ rasterpltuubec,journeymanplumber,ressic`odpluatbacoralicensndpumperverifyingtnettl)tibotankSisPlz s~thanal~3dfu~ooflstudge,. ie in proper opentiag condition ands or (2) at,er ,nspect?oa 0.nd pumping (i. uoceESary), `F Uwe, tlu tuiderai~nedhavo rood the abovo roquiren-cnts and agree to main of ha al ResourBaKaSta:e of yWis ~~ ~ *Ceriifica:i,,n set forth, horein, is sot by tike Goputmeat of Comm®rcc and the Depaxame stating flat your septic tystoat has been raaintainad must be completed and retutued to rho St. Croix Coanty Zoning Office withi:~ 3L drys pt tiu thr year dxp son dau. .~ ~ ' ,C`~~ -~ ~~ ~ ~ ~.. ,_. - DATE SIGN OF APP ANT nwNFR CFUT FII CATYON I (we) certify that sll etsttruenu oa this form era true to tie best of my {o~~:) knotaladge the grope desczibod above, by vim:e of a v~•attbnry deed recorded to Register of Deeds Office• SIG TVAE OF APPL A2~"T ,( 1 (we} am (are) t};e own":r(s~ ~ ~~ Arl: ••+••~ Aay•int'orrrutioa that is rnia•repreaen:ed raay :exult in the ~aaitary perm: beinY revoked by the zoning Deparimen:. sa.••~ `• Includo with thiw tppllestion: a sumpod waaacry deed from the Regiacer of I)eeda afYlce a copy of tl:e certified survey map ii refarenco is mado in the warranty deed ~. 277y P 210 State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Number l Document Name THIS DEED, made between Michael J. Fassino and Maw C. Fassino, husband one or more), ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, Fixtures and other appurtenam interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach dd du ~,ots~ an~~, Plat of Joshua Hills in the Town of Hudson, St. Croix County, Wisconsin 7~-3~~13'7 KATHLEEN H. YALSH REGISTER OF' DEEDS ST. CRUIX CU., NI RECEIVED FUR RECORD 03/30/1005 03:00PK QUIT CLAIIt DEED EXFPIGT 1 15 REC FEE: 11.88 TRANS FEE: COPY FEE: CC FEE: PAGE5: 1 Recording Ana Name and Return Address M iahatl +T, Fass:n~~ 757 Pager Dry vim. H ud 5o n, W I 5~{ o f to 020.1435-02-000.020-1435A3-000 Parcel IdeatiScatim Number (PIN) This is not homestead property. (is) (is not) I R 1 Notary Public Minnesota W Cor~misaion Expires .lanuary 31. Dated this day of , 2005 SEAL ,SEAL) ( ) • •Michael J. Fassino * - -- A Signatures authenticated on s TTfLE: MEMBER STATE BAR OF WISCONSIN (If notL authorized by Wis. Scat. § 706.06) THIS INSTRUMENT DRAFTED BY: Marv C. Fassino Hudson WI 54016 ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix COUNTY ) Personally came before me on /hFi/'~XI ~ , ~+, the above-named Michael J. Fassino and Mary C. Fassino, husband and wife to me known to be the person(s) who executed the foregoing instrument and aclonowi ged the same. r No c, State o isconsin My Commission (is permanent) (expires:~y,~ l.Aa$ (Signatures miry be auttreaticitted or acknowledged. Both are red neeawry.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THLS FORM SHOULD BE CLEARLY mENTIETED. QUIT CLAIM DEED ®2003 STATE BAROF WLSCONSIN FORM N0.3-2503 • Type name below signatures. ~~ ~ roc wrar~o~s ~ gar Nuroere~ ae ~ x~~ iua~ ~~~ o ~ ~~, ~ ~ - - ~~~ ~~ ,~ -~ ----- I~ ~ 9~.00~ i~ ~Y w ,~ I{ :) ~ \ ~ 604 94 ~ ~ ------ \ ` ou~~.anc c~wrearro ee ex,raousi,mwa+ ORiNMON Of TiE Rd1D. O ~ \ ~\\\ 0 D D D 0 P AOU @?~6_84C~{?~ ~8 ~1D00 ~06e 9y,_G?b~Q LOCATION SKETCH SECTION 11, T29N, R78W ~~e~~ .~ '~. _ag4 1 t 1 I t I t 1 1 1 _~ aop ~~ ~' i i ~~ a G91 604 X57 --'6004_ ;::. ~„ - ~~~ E a.. ~.. t ~Niaie H.W.E. PRELIMINARY PLAT OF: JOSHUA LOCATED IN PART OF THE NW 1/4 OF THE SE 1/4 AND PAI 11, TOWNSHIP 29 NORTH, RANGE 19 WEST, TOWN OF N 1M COR SEC. tt ~ t iO o . t7 t ___._ ~~ ; ^I t I NJln~ipL~l!145r1y,D_6~GID~ °_ - - °- ~7 Oo_~_ G.~3 ~ 1 ~...~ ------ t DQG3~C~6 OQJ N/Oo_6_84~PG~@~ ~ L~qD d06. 4p,Dl.IC~C~ ~ _ ~ t ~ 1 --- -~- i -. t. oougtb a Carr. ttoyrtone rwcaer Land Sxvoya, hMWy a«uy met mo oUae awerbod .er ewpyW prayrey roa w,n.~.e 0r nrr « u~d« my ewer oup«r4bn enr mot ar. yep r • eonret nprMMbebe b oeeM e/ iM 4prWerta b IM Ual of my 4eoMO0go oM OeML ~~ RECEIVED AU G 2 7 2003 ST. CROIX COUNTY' ZONING OFFICE LOCATION SKETCH COUNTY PLAT OF: JOSHUA HIL CATED IN PART OF THE NW i/4 OF THE SE 1/4 AND PART OF TH1 11, TOWNSHIP 29 NORTH, RANGE i9 WEST, TOWN OF HUDSON, U TOWN OF ST.J~ TOIJN OF UDSOM _ S, . -~ ea w,o•s To,.ronnm ~ cw-oesnc (~ IEas~e~r ! 1~ ~. Y ` ~~ N.O.E ~ ed<.nn ~ 1 I 1 1 1 / r~ ~--- / 1 ~ / 1 ~ ` N89°39'38'E 1270.00' T~iuT'TCnu~ ~---~ ---- __ ~__-"-o.r_-"-----_______ __---- ----~ Q nt MA/I p' 1Nt iCl/ S89°39'38 1267.09 ~ ~~ e L 1 10N , ' ~ ~ ' SECTION 11, T29N, R79W I 1 - ~~~ -~- 1 1 ~~~ r - S Ip~^~ ~ ~ _ „ / ~''`r i -~ e- 1 1 ~ 1 1 1 , ll ~ S u dJ cD+^ 1 ('~ ~ ~~ a ~'u-~.Dl.~J1~~oM ~~ . 1 ~~9.aJC M~`~~ ~o~ coo rte? o 1 ------- 1 pQL3C~_C#6 IXr`d ~9 oOd__84~ PaC~ ~ ~ nlOl~, 9~vP~ ~_ t ~NI ~j Y/ W ~ N89°59.10•E '320.00'_ ~ ~ ---- ; u~o.3s~ - S ~~ ~ e i `~Kr.c - Benno ~ ~ °"' 1.14. • elm _ z ~ 2.21~~~ ; ~~ 99 °°~ ACRES ` r',s o.rlloc ( ~ S89°59'10"iN 1. I ~ 6 i . Z ~ ^ ~ / agg~ ~ L '~ 2.00 ACRES I / ^ ry - ~ 1 ~ ~ p~p' Q QI r ~ "'~E..9.OB 1 8 / ~ ~ ~ ' ICI W / e° 1 ~1.0~ . ~t0e :/g j '~ ~ __~~_PI ~ • i f 1 ~ ~ ~ ' ; Y ; 2.00 ACRES ~. - • ~ _ ~N ew I ` ~ SB1~`• - `~~ 2S 1 n O -~ ~ 2.00 ACRES ~ a°g ~. / ~~ '~ , 1 sz~.er 5 12.53 ACRES d~P6p4'~GC 6@74 1® 1 1 1 1 1 I ~I i i 1 pi i o T 1 1 O) 3 ~' ~~ a ~ ~ ~i N 1 i 1 ~~ / ~ \vC \ 0 .~ 1 ~ ,.~~,. - ------ / ~4 94~~ SOUTH LINE 0~ Ti£ NEl/1 ~ T1£ SVI/~ "-' 1 Q/ 1 / ~~ / ~ / GiIOO [Ails _ + o e o o_ -o GJ L~.OO4 9g ~ ~ / _ISO4 ~0 ~ ----- ~ Q,~~' ~ P 1 ~ 1 I ~~ d04 ~9 ~ ~ 1 ~ 1 _GJQoQp~•po ,o o_ o _ 1 I 1 ` 1 r--- PRELIMINARY PLAT OF: JQS'~U LOCATED fN PART OF THE NW 1/4 OF THE SE 1/4 AND PI 11, TOWNSHIP 29 NORTH, RANGE 19 WEST, TOWN OI ~~ -__60048 I I I I -t 1 i I I I I I 1 1 1 1 1 1 SECTION it, T29N, R19W &Oq_C~D ~6d3C~3 NJI~IG~6Q5~i C~'DD L~fr~~ GD ~Cl 04C~L~ -------------- -- C?GQG36gd OGd ~?06~8~~P1!1C~L ~ IaG1D C+JO(~ 9~1?Q6g 3 5300 G~If~D G6oG~G~, ~ / / N 1M OOR. SEC. tt - - ~ I .w..._ J I i I 1 t ~ 1 ~ 1 = I ~ 1 1 [ '%~, l ~ ,\(\j S tN COR, / // ~,~/'~ ~ ~a a zatwr, rtwt:wne r tone SurvOyor, tw.by u.uy coot too aeoY. a..«Aw ena TOPOOA eray«ey wm tawwr00 Or ma « ua« n,y Cr«t ~rLion ono teoc Mis nwp H O OenOtl r~pOwllOtl9n tp Ky0 OI UN (101Mb0/y~ l0 IM Msl OI Ty knoMOelgf and tNp01, LVCATION SKETCH