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HomeMy WebLinkAbout020-1378-02-000r i i ~ O d N Vii O < ~ ~ a ~ ~ ~ ~ H ~ C_ ~ ~ N ~' ° N ~ - 3 No n Q N ~ ~ C fD C I 3 I ~ ~ "' ~ N fD j f0 C 3 Q p C O O ~ ~- O o ~ ~ I ~ I ~ n I o ~ ~ ~ ~~ c 3 i o ~ ~ ~ ~ m < N Q- z C1 3 0 ~ 7 ~ ~ ~ ~ 7 N ~'c3 ~v c ~ w ~ a~ o ~ a z I ° ~~m ~ N n ' ~ ~ ~ n;, = a y i ~ o N wro~ O ~ O ~ ~ ° ~ Qo 0 ~ ~ ~ ~~ ~ x,30 ~ y ~ ~° o _ ~ ° ~' m I ~ ~- m `yG N Q ~ S c ~ 7' O. N _ d O ~ N ' ~ ~ O "C N ~. O O O ~ m ~ ~ ~ 1 7 N V m 3 g v d a o ~~a n ~ ~ ~ N fD (D p ~ Q- ~~, tNB Sze N W C. a g~~a c ° v o ~ ~ ~ ~ ~ ~ ~ 7 ~ ~ ~ ~ _ ~ N ~ + ~ ~ ~ ~ C ~ G Q V ~ ~ ~ f 3 ~ ~ -o `° 3 :: o w ~ ', c~°r, ? ', O O ~ ', 0 o ~ ~ A a o ~. ~ N ~ O ~ ~ W C` O ~ 0 o a 0 0 ~ a ~ ~ b ~ O O O ~ ~~~~ ~ v v_ ~ fD o .. ~'o ,~_',~ ro rn 3 °-' A .3i C 2 ~ J N~7 O N '~O N v A d ~ g o d ~ o n v W ~ a o :* 3 ~! z w G 'T1 C 7 a 3 ~ o ~ ~ 3 ~ ~ c m # ~ C N N a N P O ~_ -' 7 w ~ ~ c ^' b N ~ ' O .0 0 N ~ Q 3 K N ~ oo° ~I m 3 T7 ~ a N ~ ~ n .a .Z1 ffi A ~ ~ c ~ N <~ z ~ ~ ~ ~ m ~ a C 1• O O ~• fi A E a ao N ti ~V n ti ti dQ ~Al MV VJ ti sconsin DP~nartmeilt ~ Commerce PRIVATE SEWAGE SYSTEM ,afety 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)]. Permit Holder's Name: F , Dou las City Village Township Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic W Q.~ Dosing ~ ~~ . / ~'v Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic y 5/ ~ , ~ Z s `_ Dosing Aeration Holding PUMP~IPHON INFORMATION Model Nu Forcemain Length r Dia. ~ SOIL ABSORPTION SYSTEM /t Il .1_.__ _ L.K. + I frsgi- INFORMATION Type Of .1 No. Of Trenches ~~'7 P/L LDG ti ~' DISTRIBUTION SYSTEM ELEVATION DATA IPaccel Tax St. Croix 395130 0 I 020-1378-02-000 <a~a9./9, .~y~ STATION BS HI FS E Benchmark ~0 ~$0 ®6 • 9/a. ~F~ I Alt. BM ~ b~. ~~' Bldg. Sewer ~ ~ ~ l !i 0 46 los, 8' SUHt Inlet k 3~y 3. r3 n SUHt Outlet `~3Ys~ 3•c.~ o3•t8~ Dt Inlet Dt Bottom 0 2' Header/Man. 8.9 O ~ G~ / • Dist. Pipe • ~0 9e ~ ~, `~ Bot. System j0. ~ ~ qc .9~f Final Grade (~. q0 ~ I~•c`f St Cover ~~cle_ y ~~ Pits Inside Dia. CHAMBER OR UNIT ~t'~ ~ ~.[ ~! Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx 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 ~J Yes [_. No ( Yes ~] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/_~ Inspection #2: "TT'"' Location: 1050 Moonbeam Ridge Hudson, WI 54016 (NW 1/4 SE 1/412 T29N R19W) Moonbeam Ri •~,p Parcel No: 12.29.19.2341 ~S t'S.~ 1.) Alt BM Description = ' ,~. ~ ' y 2.) Bldg sewer length = 3~,~ / ~ ~~ - amount of c~gver =l~ kti L~~~ I~ f'tewt- e°~'~`~ / 2~~ '~f~,~~ .m Q~~ 3) dh'~' °K/ P y"~ ~ / -- -~-- Plan revision Required? j~'es f.] No ~ TI -~ 'i i ` Use other side for additional 'nform~atitQJ~1. i__~1___.1___ ~ ~ __ _ __ _~ i_ ~_ .___ _1-...~ SBD-6710 (R.3/97) ~ ' --"^ ©`~ ~~ r ~~' ,r ~ Insepctor's Signature Cert. No. I I I I I ~ ~ coo a, o I \oa> > ~ y c Fo' ~ ~ ~ N Q. 3 ~ ~ C fOD C I ~ I v I °' ~ ~ ~ m <n ~ ~ a o ~ o. i ~ ~ o O ('VD I c I rt a I o ~ ~ n C C I o y m I m I ~ N I a of ~ o_ 3 ~ ~ w ~ O I o zx<_,~ I ~ m Qo v_, O ~ 7 ~ ~ 3 ~ C ~ W ~ ~ p ~ I a ;~ 3 Z ~~cm ~ ~ ~ ~ ~ y y O O O G y 7 y O fD I ~ W~~ o _. - O ? ( n f~ ~ 7 m 3 0 I ~~ o I ~ fD I rNV a a O _ N O Q d N O I ~ N I °~ m I °- I I I I I I O ~ N p F o L o ~ ~ 3 ~ o C ~ .~v~ c ~ :: ~ ~ ~ ~ ~ ` 1 , A 0 ~ cW0 ~ ~ =~ c N N a Q ~ l y `C ( ;• Y w v N ~ ~ w FBI c l ~ O N y ~ ~ N R O fH p ~ ~ CT e7 Y1 C O O ~ ~ a ~ n $ t ~. a C °3 ~w N o ~ N a o O O ~ N ~ 6 c 3 ~ ~• O d ° O °~ ~y,NNN~ '~ ~i CS SS 1 1 ~ ~ N N U! N - ~ v v_ ~ O ~ ~ W ~ ~ ~ ~ A o ~ •• ~ ° ~ 3 ~ •• ~ a ~ .. C 2~ m ~ ~ n c ~ N~~ 01 N ~ a 7 g ~ ,_ A ? O v n ~ ~ LK Z ~ A ~ W c N D ID I a ~ ~ z ~ ~ A :0 3'~ cn `° m ~ tl! Z ~ W A c T C 7 a ~a fi `~~ N W N O O W ~. A QO N ti w ti Safety rind Buil~:r.~s lir~ts,ca Caury - _.. ._._, 20: W, v~1aa61aatott Ave, . P.O, 9ax T262~ S T C . ' ,~ ~ta-n,~I~- , ~~, ~~ ~~~~ _~1~ ; ~.s r eht t C M ray ll SO ~Qo .~/,d ~m ~P,• •~ 3~ua~tary Permit App~ic~~ u "~"" ~ o r ; ~ p , 131 ~ rr~f: ~~3. Wif• A+ler. ~+t7Q0. ~ l j~W'!' t~dy~f`~ 0 C`}3~i.' i~ ~Y~A~OA ~~ ~ ,,,,,~.~ ~- ~ ~ - lrlst . ',FGE~V~~ ~- : lie ~_~ r ..~ z4- a war ~ , ; ! # t ~ .1 + ; . _ tuari N ~a? . '~ `T . / 4 . 3 Y/ _., pD .Ca-S. _; - ;~~~~ d~[T- / 7I~- 0~-004 r ~ l:0(1Kw~Y' . ~ lie, zONM1G C51r;E ; ~ ~ _..... R ` .~ s ~ ~ q Y f~q 1184 ~C,BM Nljfiber Q'1~if~ ~5`S .55~ i eD ,~ e a~ ~,`~l q.~ ~ ~ ~c. rna oit t+~ eN 36et ~i>iy) a,,s pv. ~,. -" dci~y i ar 7 Ptm~ly - K~C of Taedwoioos ~,.: ~ ~~°'' e, i7VW~ ~ AlWitrlCbnlmaoirll - ~rplibr Uw ~ ~ dso,,t ^ 3ti10 ~ YfOet "~"~"'~! ~• 3 X' ~` ~ ~ ~ ewe. rn ~, Typo of t CCiuolc ool~r ope boar onr Nee A ~ta+~nber!>u tehrme eor iretu~ast tart). Co mte ~w 8 i! ippltabir) } A, ~ ~.~ z ©~ ~ 3 a 3~}tat or ~ c ~ ~ ~ ~. al,1 a~ ~ ~a 8• O Cittak N 3flwtlRry tttmit Pxrvlomdy iau+d Hwt:bet Daa Lcsuod I . ~ = l~ MP1Y) / rcbsmo L for iaaarnal utr) i i4lYtrR «Pt+~wt#atd Ia~t3roraad iiL3 Iwiouad 47 !~ Stnd Fprer Sa Q Corktsvssw~l W.dano I { ~ G ~ b! D T;01dit>s?trsit 4$ ^ 81t>jId P~H S} Q Drly LiAe 4~ ~ At cb ~ 1Ystm+ans Vatr ~s d aeeirout 30 p Qe>a~r v. e r ~. ~e e etr 3~s ~J) Plopoatd ~ 9e Ap~foedon RwtCisle.JthyslSq.Pt.? Pareaatlca AW 8ytn~ F!luvttio ~ ptaui Gza~i.~...~.., (Mta~liacb? Eitvarinn j r ~ ~i~~Y`++* ~(~ . Train 'b ?oai Hnmbez VVV aua ~ i'rtttib sisazJtea! ; !'ibnr i Pleauc ... fislloAl ot?'13alcs ~ ~ Cotiotrati Caatttt:cad ~ C!luss sw tlpr ~ j f p4 or ~~ e v ` _.....,,.~ { V~. Bti•«r~« !ti loon of t~! PQWP81Lowlt Oa t 1i50 ltliehid i ~ ~ttiisltaM b0! / ~~ ~ ,~~r~Gli`sr/K S'GL:C.~aGIGV~ '-" '. O?o7 ~ QC`'lJ ~ p- ~ 7~5 '30 C~"c~/.~/ ~ 3bOt, ~ ~ ~O~t~ ~p ~ y~ t~ tubl C}tattlaAdw#Nr b ~~ ~tttGue , e Starnpe} s ~ Owitlar GIYt<D Issidfi Adaeri0 • ~} ~ Z~ S . ~ ~ ' i ~. ~8~~. ~sL~ L l s CJGt.ciNtA~(C~-'k.~~a-~a.a~ ao f S ' r ~ ~ Z i~ v h O V `~, s. r~ •~ • }~ • ~~ ~, ~~ ~ ~w ~7 ~ ~ A ',~ '+r ey ~~ ~. ~,~. ~ _ a~ ~~ ~S ~~ ~ ~ ~ F a ~ ~ s 1~ ~7 ~~°~~ ~~ F` ly ~; . ~I; ,scorY~in Department of commerce SOIL AND SITE EVALUATION Division of ~afety,ancl Bu+Idings Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ~.-~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # Page ~ of APPLICANT INFORMATION -Please p,(I drmq Rev' wed by Dat Personal information you provide may be used for seco ary purposes (Pnvacyt,;aw,~s, 504 (1) (m)). 30 O Prope Owner ~. -.. ., operty Locafion C~ \` C~ V ~ ;;`': ~ ,`~., G~vt. Lot ~/Gt1 1/4~ E 1/4,S !Z -~ ,N,R ~ cr E (or~V Property Owner's Mailing Address ~ -~ r ~ , , Lot' # Block# Subd. Name or CSM# C4ty` State Zip Cody Phone Number . ~] City ^ Village ®Town Nearest Road ~1.~ Qs~ ! ~,cy F !~ ~ dl~ i (?-f~ ~~~a=i~~ ~- 1~>J psn n, i ,~-.~n ~,n -~~«d ~] New Construction Use: ~Residendal / Number of_bedroiims ~! Addition to exisling building ^ Replacement Public or commercial -Describe: Code derived daily flow ~U gpd Recommended design loading rate bed, gpd/fi2=trench, gpd/ft2 Absorption area required bed, ft2 ~ trench, ft2 Maximum design loading rate ~_bed, gpd/fi2~_trench, gpolft2 Recommended infiltration surface elevation(s) q ~v. ~ ~ ft (as referred to site plan benchmark) Additional design/site considerations !~'l~' ~ ('2 t1 9 to Parent material ~.3V-4'i,UCi-S ~ Flood plain elevation, if applicable /~~ 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 SC)11_ DESCRIPTION REPORT Boring # Ground elev. ~~ft. Depth to limiting factor ~b in. Boring # ,~Z Ground elev. <IXJ. /~ft. Depth to limiting factor 9 b in. Horizon Depth Dominant Color Mottles Structure i t C nd B Roots GPD/fi2 in. Munseil Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ons ence s ou ary Bed ,Trench 1 ~- I Z I c~ ~ 3 ~ ~ LS ~ ~s v- tin, - C~ ~ 4= ~ ~ Z IZ-9 to ~-/ 6 -- ~ ~L - ~~- ; ~ Remarks: 1 v-t ~~ ~ 3 % - LS 1,~ t~t~2 Ls 1 v r ~- ; ~ `lb,~ 9.b , Remarks: CST Name (Please Print) Signature Telephone No. =' - 7l L - O Address Date CST Number r~ PROPERTY OWNER SOIL DESCRIPTION REPORT Page ~ of 3 PARCEL I.D.# Boring # ~/'" Ground elev. ~U.__.~__ft. Depth to limiting factor in. Boring # y Ground elev. .9 ft. Depth to limiting factor Y(Zin. Boring # S i Ground elev. qy 3x ft. Depth to limiting factor I~SZin. Boring # Ground elev. ft. Depth to limiting factor in Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench ~ ~-6 n -~ 3 `- L I w•s ~ ~-S ~ ~_ ~ ~~ ~ - -~I ~ ,6 ~ S VV~ L GS ~ ; ~ .lo Remarks: 1 ~-} ~~ ~3 ~/ -` ZS I tM--~ tv~ ~~ z ~ - 6 ~ ~ . 6 ~-- t.~.s -~ ~ - ~ ; ~ Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/fit in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 V-~( Id 'f -- C v/45 ~ Inn ~ CS ~ r3 ~ ~ ~ •s z -I ~ d ~- wL5 ~ c~s - ~ ~ ~ 3~ ~ ; Remarks: Remarks: SBD-8330 (R.9/98) PAGE~OF NAME (~ ~~ I n UGC LOT# Z LEGAL DESCRIPTION-yc~1 '/~,E'/4 S lL TL `~ N R! a E (or) (~ SCALE: I"= SSD I BM 1 ELEVATION ~O D • U u BM I DESCRIPTION }~ ~ d~ ~ Z Qvc Q~',I~e_ ~ti ~F~ BM 2 ELEVATION ~G • y K BM 2 DESCRIPTION.Eop aqG j/~_~ py~,~,Pc, ~a~-h ~„~/ Flab SYSTEM ELEVATION (lY • ~~/~ ALTERNATE ELEVATION qC0 • 1 CONTOUR ELEVATION ~(/~ x ~ Z I - + aM e ,d r x ~rtvate t'r~stte 1Nastswater Treatmen! Systoim Management Plan Septic Tank And t3ravtty tn•~round Soll Abeorptlr~n Component Pursuant to Gomm $3.54 Wls. Atim. Gode each Private 4nsite Wastewater Treatme~r~t System {PC?VwTS) shall include information and procedures for maintaining the system within the parame#ers of Carrtm 83 and 8d, and the conditions of approval by the department, agent, or governmental uri##. The approved plans and permits far system are an file gt the county zoning or heaittt departmen#. This management plan complies with Gomm 83.54,1+1iis. pdm. Code, and the in-Ground Soil Absorption Corrtpanent Manual far Private 4nsite Wastewater Treatment Syst®ms SBC- '!"sides A . Q~•aie~w~ nna~fY!! ~te~eif~C~li~t'~~ awae•w ~. v sw.....~~ Sanita. Permit Number -- - -- - ~ Number of ~edraarns 3 pest n Flaw -Peak d1 ~~ Estlrrtated Fiaw -Ave e Se tit: Tank Ga aci al otr0 Sall Absa tion Component Size 1 '!' a of Wastewater ~S i?omestlc • I Ab do Cam ngttt - ~tmits of Reffabie ® eratlon Table ~r SOt ~0 Se tic Tank Gam anent Soli Absar flan Gorn Went i3esi n i=law -Peak d cso~o z Maxirrrum lnfuent Partdcie Sine in 918 AAaximurrt 8®d m L 220 Maximum TSS L ~ 5E3 - _._ ~.T.~i]~ The septic tank shall be mairtEalr~ed by an individual certified to service septic tanks under s. 289.48, Stets. The intents of the septic tank shall be disposed art in accordance with NR 9 9 3,1Nis. Adm. Cads (Servicing Septic ar Holding Tanks, Pumping Chambers, Grease lr~terceptars, Seepage Beds, Seepage Fits, Seepage Trenches, Privies, or Portable Restracros). The operating ccr~didon of the septic a~~d outlet filter shall b® assessed at !asst vr~ce every 3 years by Inspectia:a. Th utiet flat ahal~ ~® leaned ~~- necessBN to ensure pro er o ~sra ®n. The flltsr carMdge s not b® removed u enurl ss prcvistans are made to retain solids ir- the tank that may slough off the fli#er when removed from its enclosure. if the , Management Plan for a Septic Tank and Soi! 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 shelf 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 seated 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 unauthorised entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being In full compliance with OSHA standards for enteNng a confined space. The afmosphera within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the Inter/or 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 Abso,~tion 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 an 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 shalt include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage ar 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 impassible 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 t - , iVlanagement Pian fora : eptic Tank and ~oii Absorption Compon~t Plantings of deep-rooted tnaes and ffihrubs diroctly awr of within tan fast of the component shook! be voided since root intrusion into the component may obstruct wastewater flow. Contingency Pian In the everrt of system failure, a new system could be installed in an altsn~ate area. With the installatlan of a diverter valve, the existing system could also be reused after a period of three to four years, It is the property owner: responeibiiity to maintain the aitemate area free from any planting of trees, shrubs, sta. In case of failure of the original system, the sitemate area will be needed. if any trees, shrubs, etc, haw been planted on the alternate area, they will have to be removed at property owners expense. If alteniate area is destroyed, there aro other alternative systems that can be used, in which, could result in added expena to the property owner, Any tank abandonment shall be done in accordance with Wisc. Gods 83,33. Any questions regarding this code, Please contaot your local Zoning Office or contact the installing plumber. ~~ •~ ~` - ~~ ~~ ~~ ~ ~~ 17 ~.~ ~, ~ 1 j ! f}' ~AFI ~J ~ ~~ '~ ` V'. ~~ ~~ ~~S 'C~ _ 1 ~~ ~~ ~ F w ~ ~ Q s ~rg9 ~ ~~~ ~~ ~ i i ~~ \ 1` . ~ ~ 1 i ST CROtX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~n UG/~4-S~l~ ~/'y Mailing Address ~nl/ ~ ~ ~-C,-c /~~r,... or7~' /~~ ~Sa~~- Property Address /~..So dra/~~fr9~1... ~ _ (Verification required from Planning Depa for now constrnetion) City/Stale Parcel Identification Ntunber LEGAL DESCi~P'X'XON Property Location ~ '/.. ~_ '/,, Sec. ~, T~,N-R~W, Town of ~~Soi? Subdivision Loi # a CertiCed Suwey Map # Volume .Page # Warranty Deed # ~~~ ~ Z- .Volume ~ 6 `~ ,Page # 3 ~ Spcc house O yes t~no Lot lines identifiable ©yes 0 no SYSTEM MAIIVTEN CE Impt+oper use and maiat~~^*+~r of your septic system could result in its permaerrafailure to handle wastrs. Propu maiateasace ooasistt of pamping out the scptic tank cvay throo years or sooner, if wooded by a licensed puaoper. Whitt you put into dte system eaa affect the firnetioa of the septic hnk as a treatment sdtge in dte waste disposal system 'Tba property awner agrees to submit to St. Ucoix Zoaiog Department a .certification Eclat, sigaod by the owner wad by s master plumber,lauraeyma:, Plumber, restricted plumber oz a licensed pumperverifyiog $tat (1) flit oa~titc wastcwaterdisposal system is is pauper opexatiag eoaditioa and/or (2) aRer inspection wad pumpiag.(if necessary), the septic tank is Iess than 113 full of sIudgt. Lyre, the ~dezsigned have r+cad the about requirements wad agxre m maintain the private atwagc disposal system with the stsndst+ds set forth, hez+eia, as set by the Department of Commet+ce wad tbo Department of Natural.Resourozs, State of Wisconsin. Cerat'. ration sb ~ your septic system bas a maintained must be completed wad returned w the St. Crouc County Zoning Office within 30 da f t}u+e iza ' te. ~/o I OF APPLI DATE I certify that all meats oa this form ace true to the beat of my (our) knowledge. I (we) am (are) the owner(s) of ~tibod a v' of a warranty deed ceeorded in Register of Dtcdc Orrice, OF APPL D~-~ R"••• Any inforatatioa drat is mis-represtated may r+tsult in the sanitary permit being revoked by the Zoaiag Departmtat. ••'••• •• Include with thi: applicattoa: a stamped warranty deed from the Register of Deeds office a copy of tht ccrtiGed survey map if reference is nude in the warranty deed ~ .~ .. v,,;-1649 PAGE 319 STAT[i BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED Document Number This Deed, made between P. C. Collova Builders, Inc., a _. Minnesota Corporation, -- Grantor, and Douglas A. Fry __ ___-~ Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix __ _ County, State of Wisconsin (if more space is needed, please attach addendum): Lo- t2, Moonbeam Ridge, Town of Hudson, St. Croix County, Wl Exceptions to warranties: Easements, restrictions and rights-of-way I Dated this ~~~ day of _ May _._,_____,.__, 2001_• --- P - --'-- a __ _-. ~_ --- ~ AUTHENTICATION STATI Signature(s) P. C. Collova Builders, Inc., a Minnesota Corporation, by P. C. Collova, President authentica[ed,thi~4l~dayof May ^_-, 2001 ~ Q -- e• 'I'1~'bEti, ~"f}F~°~~ to me ~ a~ not r_ a instru ,~,hR ~,',bY.~a'Z •6. 6 Wi.7 ~3/Z(-~0~ _._... ~~~~'~TA~S~ INSTRUMENT WAS DRAFTED BY ' __ _ Attorney Kristine Ogland___ _ ._ -_ -._- _. _ -..- - Notar Hudson, W[ 54016 ___,^_-_ _ _-_._ - .-- - MY C (Signatures may be authenticated or acknowledged. Both are not necessary.) _____ d I d below their signature. ,Es46SS2 Y:RTHLEEN H. WALSH kEGISTEk OF DEEDS ST. CkOIX CO., WI RECEIVED FOk RECORD 45-31-401 9:10 AM YARRANTY DEED EXEMPT N CERT COPY FEE: COPY FEE: TRANSFER FEE: 19ti.~0 RECORDING FEE: 10.00 PRGES: 1 Recording Area Vame and Return Address I~ IU i M. ~ K1 I C n, /1/1 I~t S S~ L~ 02o-13~g•o2-o00 _ ___ Parcel Identification Number (PIN) This is not homestead property. pfi) (is not) f record, if any. o 'Iders, Lnc. ~ollo~_ va, P ident ____ --..- ACKNOWLEDGMENT OF W{SCONSIN ) ss. County ) Personalty came before me this _ day of the above named known to be the person(s) who executed the foregoing Went and acknowledged the same - - J- - - r Public, State of Wisconsin nnmission is permanent. (lf not, state expiration dot Information Protesabrrela Company. F ~~-2 • Names of persons signing In any capacity must be type or P STATE BAR OF WISCONSIN WARRANTY DEED FORM No.2 - 1999 ~~ ~ s~~ _~ ~, '~ , _-. w o~ 00 w¢ U Z w op wz w0 w~ ¢w O ~~ Z~ ~a w m~ LOCATED IN PART OF 1 COUNTY, WISCONSIN;GNTY REGISTER OF DEEDS C PREPARED FOR: HOME BUILDING EQUITY, INC. 6375 BAILEY RD. WOODBURY, MN 55129 SURVEYOR EDWIN FLANUM NORTHLAND SURVEYING, INC. 856A HWY "65" R~ERTS, WI 54023 ONE 7 5-749-1718 -`"--~ c ~~ ~' ~~ ~~ c~ ~' ~i ~; ~; ~ o~ ~'O' N Q;°. G=~~~ N N ~~ ~' ~' i i~i i i ~~ ~ i a i ~ ~Q r tV ° f~~~5' ~ O o o _ i i _ o~a~ o~ Q~~~ O o~ o' ~' ' o~ o ~' ~~ I ~~ ~\ 6~; • ~y ~i ~~*. ~EDWlN C. ~: FLANUM • ~ 5-2487 -r - ~ ~ HUDSO~ ~ " L ~ ~ G,,, .o 'o ~o ~~ o ~~ ~ o ~ ~v _ ` v ~ o 0 o ,~ ~`, ~~ X 952.1, i"=60' ® 19~ JOB NO. 01-31 DATE: 6-01-01 120