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HomeMy WebLinkAbout020-1015-50-100 ~•~~ ~ :"' ~~ ~ ~~ ~ ,~ ~ ~ ~ ~ n ~: o f/) ''y .Z1 7 Z ~ Owo N _ C N N `C ~1 • _ ~' m ~' N f~D H ~ d ~ N ~ H Cy 1 ~~ ~ C N C O N 7 ~ CO71 O ^ O N No °- ~ 7 ~ ' ,,..~ 01 G co o ~ l ~ ~ a y d i ~~ O ~ I ~ ~ ° o I s m ~~ W a A I I I __ ~ 0 ~ O r ~ V ~ O L O tin m c ~ ~ ~ ~ fA O C 3 ~ I ~ ~ ~ a 'v 'o ~ y O O O ~ °: `~ v1 o < I ~ m 3 Vi fn u1 O D i n ~.~ ° v ~ o „-~ ~~ ~ coo ^' m w N O. ~ w •• tG I Z .. O_ ~ = Z ~ ~i O ~ f~ O ? O ~ ~ N Gt 4l ~. C C `~ N W ~ ~ a ~ A Z n ~ y ~ O ~ C ~ ~ ~ a ~ ~ ~ I o .. "'\ N N W ~ m . Z a 3 .. ~ ~ I ;* i 3 m ~ •• ~ i A ~ ~ I a a ~ 0 ~ T L I o a I ~ N I I y I y I I o ~ ~ A ti ti ~ ~ p I A I o :^ I ~ ~ o o ~ ~ N ° ~ v' o - i ~ Parcel #: 020-1015-50-100 01/11/2005 05:19 PM PAGE 1 OF 1 Alt. Parcel #: 12.29.19.690-10 020 -TOWN OF HUDSON Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' =Current Owner *SANDQUIST, TERRANCE & ALANDRA TERRANCE & ALANDRA SANDQUIST 1004 ARCTIC TRL ROBERTS WI 54023 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description ' 1004 ARCTIC TRL SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.643 Plat: 1137-CSM 14/3949 SEC 12 T29N R19W PT NE SE BEING CSM Block/Condo Bldg: LOT 1 14/3949 LOT 1 3.643AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 12-29N-19W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 10/08/2001 658495 1733/207 EZ-U 04/17/2001 643054 1620/279 W D 9nnd cl IIUIMeRY Bill #: Fair Market Value: Assessed with: 47678 346,800 Valuations: Last Changed: 06/05/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.643 52,100 216,200 268,300 NO Totals for 2004: General Property 3.643 52,100 216,200 268,300 Woodland 0.000 0 0 Totals for 2003: General Property 3.643 52,100 216,200 268,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 550 Specials: User Special Code 018-RECYCLING 001-WATER Category SPECIAL ASSESSMENT SPECIAL ASSESSMENT Amount 27.00 0.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 /* Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM satety and Build'vlgs 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)J. Permit Holder's Name: ^ City ^ Village Town of: 5andquist, Terrance Hudson Township CST BM Elev.: Insp. BM Elev.: BM Description: II r - TeNK InIFnaMeTlnnl ELEVATION DAT TYPE MANUFACTURER CAPACITY Septic W { A J~ { Zl00 Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic .r ~ .Y $'f~ Z~$(o ZQ~ ~ NA Dosing NA Aeratio NA Holdin PUMP /SIPHON INFORMATION . Manufacturer Demand Model N er GPM TDH Lift Friction m TDH Ft Forc ain Len Dia. Dist. To well r~u wn['AnnT1At•1 GVCTCIIA County: St. Croix Sanitary Permit No.: 383980 State Plan ID No.: Parcel Tax No.: 020-1015-50-100 STATION BS HI FS ELEV. Benchmark ~ Ie3, lp ~ Alt. BM •'~ Bldg. Sewer ,ct 9'g;g Stf Ht Inlet ~• e(g,Z~ St/Ht Outlet Tb ~'e.~ Dt Inlet Dt Bottom Header /Man. 7 . `f (P• L~' Dist. Pipe Z .7 6 ~ S• q ~ Bot. System g•~`f g•~s~ ~ ~ •~~ Final Grade ~.'~ ~~• d k' over Z..z ~ p /.5 y w~~.wrv.•. ..~.- .. ~...--- Oi th uid De Li BED /TRENCH Length No.Of Trenches Width PIT No. Of Pits p q a. Inside 1 1 ~ Zi foLS DIMEN 1 N SYSTEM TO P / L BLDG WELL LAKE / $TREA LEACHING Manu adure~ ~ ~1 fr r SETBACK CHAMBER er: N INFORMATION Type l;• 7 ~~$• ' ~ OR UNIT um Mo a H - / v 3a System ativti l1~tTf1~~r ~TIAL~ GVGTCIIA v ^.r..•.rv ..v.- ...... ~ Header / M ni old ... Distribution Pipe(s) ~( / x Hole Size x Hole Spacing Vent To Air Intake ~~ ~~ length Dia. Len th ~Z'~ Dia. 3y Spacing `r 9 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 tied /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No spection #1: ~ ~ / ~ / p1 Inspection #2: / / COMMENTS: (Include code discrepancies, persons present, et Location: 1004 Arctic Trail, Hudson, WI 54016 {SE 1/4 SE 1/41 T29N R19W) -12291969010 -Lot 1 1.) Alt BM Description = ~o~a"" ~ ~7GPi~ k-ba v~~-~'I-v ~~`~i1~ 2.) Bldg sewer length = Z$.~r s ~u~,..~ ~~a~ ~1~.•1~ ~~$~~°~ -amount of cover = ~2, j ~e.~c> t1 •, D ~ scftu .tr~'I-~t~ ~+~5 wte lor/ct~PeC~ Qx.•14,i? 'Z'`~ ~~~ lau 'r .t?~d~t' Plan revision required . ^ Yes ^ No ...~ Use other side for additional information. I [ ~ ~ 0 Oate Inspecto s Signature ert No. SBD-6710 (R.3l97) ~ : 0373 G ~ -,., t-~ ~} (._~+ i , ;; ; k ~~ 1=- Sanitary Permit Application ~ ~ Safety & uildings 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 iSCOnsOn Personal information you provide may be used f ~ dary purposes Madison, WI 53707-7302 Department of Commerce [Privacy Law, s. 15. ) ~ ~ Z ~ (Submit completed form to county if not _ state owned.) Attach complete plans (to the county copy only) for system, on p ern s an 8 -1/2 x 11 inches in size. County s~- ~a State Sanitary Permit Numbet ^ eck if revisibidR vio sap ~ t n so ,t/r- State Plan I. D. Number E N g3 I. Application Information -Please Print all Information c-: Location: Property Owner Name ~ ~: ~"~ Property Location ~ ~' erran~;e, ~ A 1a1~,:~r~ bS~b~.~ u,s -'.; 4 _ 1/4 ~s"1/4, S T ,N, (or~ Property Owner's Mailing Address -~` ZL~vHVG UrFtC~ Lot Number Block Number ~ 3 J C c~- ~e/- C ~% (a~t~r ~/~ a~.~'d~ss uu/! %„/ ~~ f .~~z/i ~ ~' City, State Zip Code Pho b~ i , 'y Subdivision Name or CSM Number I~G(~d,~0/? ~~Jl ,~~f0/4= (~/5' ) J ~'~''~~~~ DncumP~f~' (, ~g 895 II. Type of Building: (check one) / as ~ s ~.e<~ P aMs , ~ ^ City ^ Villa e ~ 1 or 2 Family Dwelling - No. of Bedrooms : t~"G ~ / z/ g ®-Town of Nu.dSor~ J ~j ^ Public/Commercial (describe use):_ ~ ~Zf~ ^ State-Owned ~ Neazest Road ~ Z -~3n a,~' arcel Tax Number(s) ~~v-ions-sv-goo III. Type of Permit: (Check only one box on line .Check box on line B i plicable) l ~ ~ ~ (o C -- D A) 1. ew 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System B) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ~e-- 14 - IO~p Non-pressurized In-ground ^ Mound Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. Dispersal/Treatment Area Information: ,2 rj, h r ~,~,; 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Applicatio 5. Percolation Rate 6. System Elevation 7. Fin Grade Reg ui r ed Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation Q ' ~ VII. Tank Capac~y in Total # of Manufacturer Prefab Site Steel Fiber- antic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the P TS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no slam ~A4P/MPRS No. Business Phone Number Pl m er's Ad ens ( eel, ity, State, Zi Code) p IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Is uing Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse Sur azge Fee) ~ ~ ~ Determination ZZ. X. Conditions of Approval /Reasons for Disapproval:n - nn ~ f~-~~ ~~..~-~r..5 rvu.~f' ~n.e_ w..n.~.ti.-~-a.,.w~aaQ t-~' ~?~C ~ ~- ~ 1 rh Aso.` ~i tn.QyQQ. C,~ v-~~~V•.uwq G2S , , ~ s e n ~ aG au SBD-6398 (R. 07100) Fogerty Plumbiet` #221180 28288 McKenzie Rd. Spooner; WI 54501 (715) 635.9609 ~~ ~J' `- ~ 2z y 2G i/ ~~s~ ~'~ ~fs~'. ~~~ ~s o1T'/poi (Jp /~.?~ / M' Z(/ ~ \ / dA--~ ~•m~ of ,~rl~ toT fi~k~; ~ >/ e~~0 ~ ~ / I r /tz• f7 ~ , ~ ~ go'~r"'~ ~ ~ lysT~"~ ~v _' Wolff TitE'~~£ r Ta ~}~ ~ r !~ pY•sr' ~ ! , / ! ~F. S~s~t i xs (~ Ilec~~ '~ its ~c~ plod - ~~ o ~ . ~'' x a-~ ~ w X ~ ' B~ ~~~~ ~~ ~r .•- zs ~ ~ uao hl~s s~ ~i Q# .333.5 ~ Fogerty Plumbiq~ #221180 28288 McKenzie Rd. Spooner, Wt 54802 (715) 635- ~~ 1' (o X a-y f~,f~ 3~~-~ zz ~f 2~~ DoT ~/ scs~t~ / "~ Yo ~ d~~ i?Df of ~~ toT sr~k~; ~~D r~.~, r~ w F'L~ ~ .s o ' ~~o~C~,v I~l~ ~ ~ ~~ e F ~'c~tr,~'~-~t lysr~'~ ~v -- I~oTFf T,cF~~b`~' r ra ISM' ~ py~ ~ ` l \ / / , ~ I ~ i, ~ / ~ / / ~ /, ~ / ~~r _ ~. ~ ~~~ I 1 g~ ~~ I ~I ~r , \Wisconsri Department of Commerce SOIL AND SITE EVALUATION 'Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Page 1 of 3 A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limbed to: vertical and horizontal reference point (BM), direction and St. CrO1X percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION r 020-1015-50-000 ID#12.29.19.72$ - PI > ~ll/ ation. ~ ~ -- -_ Personal information you provide may t)C us s ~ ary purpos Law, s. 15.04 (1) (m)). viewed By Date Property Owner ~ tEO ~; ~: Property location L4CI1~ Richard & Sharon Helm ..~ L C Govt. Lot SE 1/4 SE 114 S 12 T 29 N,R 19 W Property Owner's Mailing Address cam- ZOOa _ ~ ' ~ ! ' Lot # Block # Subd. Name or CSM# ~ t r ' '~ ' P.O.Box 1112 r 1 Pro osed CSM City S te,,~Zip Codes' bet ^ City ^ Village Town Nearest Road Hudson ~ O 1 7 Hudson ~ Arctic Trail Off 100Th Ave. New Construction I rooms 4 ^Addifion t0 existing building Use: ^ Replacement ^ o r ' ascribe Code Derived daily flow 600 gpd Recommended design loading rate ~ bed, gpd/ftz .7 trench, gpd/ft2 Absomtion area required bed, ft2 t357 trench, ftz Maximum design loading rate 0 bed, gpolft~ .7 trench, gpolft2 Recommended infiltration surface elevation(s) 94.5' ft (as referred to site plan benchmark) Additional design /site Considerations Install stepped trenches using high capacity infiltrators. Parent material Glacial outwash Flood lain elevation, if a liable na ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ®S ^ u ®S ^ u ®S ^ u ®S ^ u ^ S ®u ^ S ® u SUIL Ut5(:KIY 1 IUIV KtF'VK 1 Boring# Ground elev DA 00 H Depth to limiting factor >98" Ground elev 99.49 ft Depth to limiting factor >102" Depth Dominant Color Mottles Structure COnsisten Bounda Roots (~ Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ry Bed Trench 1 0-11 10yr3/2 None sl 2fsbk mvfr as 2f,lm - 0.5 2 11-19 10yr4/4 None sl Zmsbk mfr gs lfm - 0.5 3 19-33 7.Syr4/4 None is lmsbk mvfr cs - - 0.7 4 33-72 10yr5/4 None is & s Osg ml cs - - 0.7 5 .~-- 72-98 10yr6/4 None s Osg ml - - - '~ 0.7 R~f.Sa ~t t s ~.8'S ~t -~ ~6 . ~ Remarks: Horizon #4 contains stratified bands of Osg >s &_s that are boo numerous to designate as mdrvtdual honzons. 1 0-12 10yr3/2 None sil 2fsbk mvfr as 2f,lm - i 0.5 2 12-26 10yr4/4 None sil 2fsbk mfr gs lfrn - '~ 0.5 3 26-36 10yr5/4 None sil Zmsbk mfr aw - - 0.5 4 36-41 7.Syr4/6 None is Osg ml gw - - 0.7 5 41-102 10yr6/4 None is & s Osg ml - - - ~ 0.7 ~° '( o Remarks: Horizon #S contains stratified of Os ]s & s that are too numerous to designate as individual horizons. CST Name (Please Print) Signature: Telephone No. James K. Thompson ~ s-~ 715-248-7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, WI 54020 7/18/00 3602 1266 ,~,~, Z 5 GPD/ft2 ,~ PROPERTY OWNER: Richard & Sharon Hjelmgren SOIL DESCRIPTION REPORT PARCEL 1.D.# 020.1015-50-000 ID# 12.29.19.72D ~' Ground elev 99.20 ft Depth to limiting factor > 102" 4 Ground elev oa ~~ e Depth to limiting factor >93" 5 Ground elev an cn a Depth to limiting factor >96" 6 a/ Ground elev 99.79 ft Depth to limiting factor >108 ~~ Page 2 of 3 A C F. Soil ~ Site Evaluations H Depth Dominant Color Mottles t T Structure nsistence Bounda Roots GPD/ft2 orizon in. Munsell ex ure C,u. Sz. Cont. Color Gr ~ ~ ry Bed ~ Trench 1 0-8 10yr3/2 None sl 2fsbk mvfr as 2f,lm - 0.5 Z 8-23 10yr4/4 None sl 2msbk mfr gs ifm - ~ 0.5 3 23-34 7.Syr4/4 None Is lmsbk mvfr cs - - j 0.7 4 34-80 10yr5/4 None is & s Osg ml cs - - ~ 0.7 5 80-102 10yr6/4 None s s ml - - - ~ 0.7 6 • ~- • - KemarkS: ttonzon rf4 contains stratmea banns of usg is ez s that are too numerous to aestgnate as matvruuat nonzons. 1 0-8 10yr3/2 None sl 2fsbk mvfr as 2f,lm - 0.5 2 8-23 10yr4/4 None sl 2msbk mfr gs lfm - 0.5 3 23-34 7.Syr4/6 None is lmsbk mvfr cs - - ~ 0.7 4 34-80 10yr5/6 None s&gr Osg ml cs - - ~ 0.7 5 80-93 10yr6/4 None s&gr Osg ml - - - ~ 0.7 Kemarks: 1 0-12 10yr3/2 None sil 2fsbk mvfr as 2f,lm - ~ 0.5 2 12-22 10yr4/4 None sicl 2msbk mfr gs l fm - ! 0.4 3 22-32 IOyrS/4 None sil 2msbk mfr aw - - ~ 0.5 4 32-41 7.Syr4l6 None Is Osg ml gw - - ~; 0.7 5 41-96 10yr6/4 None Is & s Osg ml - - - ~ 0.7 Kemancs: 1 0-8 10yr3/2 None sl 2fsbk mvfr as 2f,lm - ~ 0.5 2 8-20 10yr4/4 None sl 2msbk mfr gs lfm - 0.5 3 20-36 7.Syr4/6 None Is lmsbk mvfr cs - - ~ 0.7 4 36-75 IOyrS/6 None s&gr Osg ml cs - - 0.7 5 75-108 10yr6/4 None s&gr Osg ml - - - ~ 0.7 ~S `~ ..~ Kemarks: .. ~ "` . Lot / ~o~o~sedCsr-1 sESes. ~~,~z9r~,,Pi9.~~ (-~. 3 ~"3 55, $ancl~ wla•I'~~ Top of M:d lob sba+t~. ~gssu.m~dE/Q/!` ~~oo.c0,: By ~ ,~G G~, A ~~ sk ~ ~ ~r~M c~`I ~ ~ 3 S{e ~-" IaGQ ,,,~,o,n ~ ~ ~ ~ b2 ^ ~ ~'~ .b i ~~ v v E/e~` = ii1.8~ ~ a A ~ ,kale: / = s~o ^ So; l for, l0'E J '. Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: Svstem Design Specifications Sanitary Permit Number - Number of Bedrooms Design Flow -Peak (gpd) Estimated Flow -Average (gpd) t3~ Septic Tank Capacity (gal) tsD Soil Absorption Component Size (ftz) 2 - -- t Type of Wastewater D estic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) Z - as Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 (~- U f ~v~.r CIAO-~~ M, - ~ Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the ~' ~ ~ ~ Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other freatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address~/3 S C'a~r ~ r~l ~- ,. Property Address (Verification required from Planning Department for new City/State /.~ .S DYI . 6~~ f Parcel Identification Number' d~0--1olS'-S7 "" /G~ LEGAL DESCRIPTION Property Location Ste' %, s~ '/,, Sec. [~ , TAN-R~W, Town of ~/Gr1~SD/I~ Subdivision -~'- .Lot # ~_. Certified Survey Map # G29 9s ,Volume ~_, Page # ~~9y~. Warranty Deed # ~ ~3~~7 ,Volume , f ~ ,Page # Spec house ^ yes no Lot lines identifiable (~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result is 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 masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying 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 30 days of the three year expiration date. I NATURE OF APPLIC l~SlU DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. /~~ I ATURE OF APPLIC 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 d-o~ 1ii2~PAGE 2 i 9 STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Richard C. Hjelmgren and Susan M. Hjelmgren, husband and wife Grantor, and Terrance Sandquist and Alandra Sandquist, husband and wife Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croiz County, State of Wisconsin (if more space is needed, please attach addendum): C-s~~3054 KATHLEE:I,I rtt. WALSN REGISTER OF DEEDS ST~.:aCROIX CO., WI RECEIVED FOR RECORD Q~r~7~-P001 1~:~5 P!1 YARRANTY DEED E>Q:~7 1E CERT COPY FEE: COA>G•FEE: TRANSFER FEE: lIi8.00 SING FEE: 10.00 PAGES::.. 1 Recording Area Name and Return Address Lot of Certified Survey Map filed September 14, 2000 in Vol. 14 of Certified Survey Maps, ap ge 394.9, as Document No. 62 95 ocated in part Edina Realty Title of the NE'/4 of the SE'/< and part of the SE'/. o the SE'/. of Section 12, 400 South 2nd Street T29N, R19W, Town of Hudson, St. Croix County, Wisconsin. Hudson, WI 54601 020-1016-50-000 C.orrect~-~or Lok I:o:o-io~~-s -ioo Parcel Identification Number (PIN) This is not homestead property. ~j (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this 13~, day of April , 2001 AUTHENTICATION Signature(s) authenticated this _ day of ---- N * Notary Public ae TITLE: ME AR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson,WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ~', t',/~ /~' County ) Personally came before me this ~e~Y~ day of April , 2001 the above named Richard C. Hjelmgren and Susan M. Hjelmgren, husband and wife to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * Notary Public, State of Wisconsin My Commission is permanent. (If not, fate expiration date: * Names of persons signing in any capacity must be typed or printed below their signature. information Proressiona~s company, Fong au Lac, wn STATE BAR OF,WISCONSIN eoo-ass2o2~ WARRANTY DEED FORM No. 2 -1999 t _N FILED N t(p7HLEENH.WALStI ~.r~~,~ R~I~°t°~ CERTIFIED SURVEY MAP ~j~-rC~^CATED IN PART ^F THE NE1/4 OF THE SE1/4 AND IN PART ^F THE SE1/4 OF THE SE1/4 ^F SECTION 12, T29N, R19W, T^WN ^F HUDSON, ST, CROIX COUNTY, WISC^NSIN. ^WNERS RICHARD & SUSAN HJELMGREN P.O. BOX 1112 HUDSON, WI 54016 ~I nnnl U I QI I ~~ OII~~I nOp n^ I LAnS~ I VI UQ I L"JI I I ~; a ; a LJ I n~n~p l O I ~I CJ I ~I I n~1 I I ~i ~I ool r I ° i ~° ~~ ~ I ~I OI O I I I I ~I di nnr~~ ff11 ~ I O I ~~ o I ~ I I Q ~ APPROVED sr. cROlx couNTY arming Zoning and Parks Con S E P 14 2000 MATCH LINE CND ~ -~ W N ~ w LOT 4 ~ 6.114 ACRES ~ ~' 266,319 SQ. FT P~~ of wis~oy '~ DOUGLAS J. ~Z 0° ~ QQ I * ZAHLER 5-2145 ~i ~i ~I ~i HUDSON ~i Qi ~i ~i WiS. " 0 ~I ~' nn~nl Ol I ~ Oi Di ~~ loo I ~I ('7 ~~ Oi ~I ~i Oi ~~~~~ nnn /~~ I O ~j u~ ~~ V~ ~I O QI ~~ ~I a I I o ° ~ al / -~ ~ c N89°38'11 "E 8 231.22' z HOUSE & • r GARAGE ' i ~ SHE OO EXI TI ~ SEPTIC ~' • -NG DRIVE .~ 66' cv .~ ~ ~If not recorded within 30 days of approval date approval shall be ~ T null and void o~' ~ d,~ i ~~~/ ~©~ ~~r ------- ~ ~~~o ~ ~ ~ `~ OO~ / / ~ ~ ~ O~ ~~` Q / ~ w ~ ~ `.~ ~j ~~vv ~ ~ / / d~~ ~ ~~q~r bo 3/4" REBAR FOUND ~ ~ S86°52'06"W, 7.85' m ~ FROM SET CORNER. c0 o... ..--..--.- -~ 298.76 • • LOT 2 ' ~ 3.643 ACRES c~ 158,681 SO. FT. `''Should Lot 2 access from the existing access for Lot 3, the access would be required to . be upgraded to County road Standards. . .. 7"E 518.77 DRIVE 284.80' • • : ~ ~ c~ N pV- ~' N 4. U ~ Z W Z D.' ~+- J Q] W ~ a' Q W ~ Q~o Z I (~ ~ H Q ~ Q N W m 0 o 1 ~I ~I n n a uI V I I ~I ~I ~~I ~I QI ~ I ~I LSI ~i0°iLw1i oi~t (1~1 OO I ~I ~I O QI ~i ~I ~I a; n l L~ I ~.oy. - ~, v4'ryV 459.13 p ?2' co 320.2a~ - ,;,;1_t1T f 3.643 ACRES 158,707 SQ. FT. PROPOSED_ DRIVE i ~ ~° ~I ~I a ~I J ~ " I ~I 71 I QI ~I ~I L CSI ~I nn nnl Qo ' HI nn OI Dlul I~I ~I Qi ~I /OB~I ~1i oo ~ Op ~ ~I LJI t~~ ~j ~I ~I ~I ~I ~I ao ~ Qi °~i ~l Q !' 33' al al I