Loading...
HomeMy WebLinkAbout020-1378-03-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and BuildiWg 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 Soder uest, Jackie Hudson Townshi SST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~ /1 p // V `.~ (7 4 SV `Z O"~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ [ ~ / ~-~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Num r TDH Lift ricti oss System Head T H Ft FOrcemairi L ngth Dist. to W S[111 ARSARPTIAN SYSTEM 1 C- ~ ___ L_ /~ ELEVATION DATA county: St. Croix Sanitary Permit No: 395217 State Plan ID No: Parcel Tax No: 020-1378-03-000 ~2. X9•/9. asya STATION BS HI FS ELEV. Benchmark . ~ ~ o~•' I w• v Alt. BM Bldg. Sewer L .$S St/Ht Inlet / ` S.e2 SUHt Outlet Q S•~~ Dt Inlet Dt Bottom Header/Man. Dist. Pipe ~k 1a }, S'1` . '4 Bot. System Q• °S- (~. BO • to 98.8 ' Final Grade St Cover /J ~ e 3 B ENC Width No. Of Trenches Length PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN NS f 7 r q;- ~,,~. LZ> SETBACK SYSTEM TO P/ BLDG WELL LAKE/STREAM LEACHING nu gt~er:_ INFORMATION CHAMBER OR ll Type Of Syste~ ~W=y.~n. ~a! --~. ~ r UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake y Pipe(s) ` Length Dia Length Dia Spacing SOIL COVER Y PrassuPp Svstams Only YY Meund Or At-Grade Systems OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center SedhTrench Edges Topsoil ~ Yes ~ No (] Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/ b.~ Inspection #2: ~/-/ - Location: 1046 Moonb''e(a~m Roladl udso~n, WTI, 540~16/(NW 1/4 SJE'1/412 T29N R19W) Moonbeam Ri Parcel No: 12.29.19.2342 1 J Alt BM Description = ~ ~~ 6'` ° ~W nJrfi3 ~v~-~ `"~+~"6~`" ~ StJ k~ul[„ Cp /"~tr 1 2.) Bldg sewer length = (~ - amount of cover = 2~}'` ~ 4 ~ >r -tt ~, ~ ~~- ~ ~, s~,(_ \,r,,, ~,~ 3'~rs+~r.~t w.oacQ rr~ S~- i Y~~ ~ ~-Q..S ~ S~+•--~ L., ( `~ 2 7~pf'~~^+^a' -^`yC.. Plan revision Required? ^ No ~ Ii ff Use other side for additional ~nform lion. L__ SBD-6710 (R.3/97) Sy ' ~ D ~\ fep/_ _ _ C tom- ®Q - n ~~ ~~Cert. No. 1 ~r~ ~ J ~ ~ ~ U'~~ F"`+'~i~eY Ti z ~; v ~ °"`+~'# ,: 4 ~s ~~., ~ ~_~ ` \/ ~_ ~ '' ~` -~°,~,1 ,~ .. -, 7~s_~- ~s .,r, y~ , i j ~~'£r <-~~' .~~ ~ 9 ~~ I t Safety rind ~luitdir,35 liwisicn Ca±ts~y _,_~____~__.._ ~ ~' ' S~T 20. W. Wathiaaloa Are,, P.O. &ta 71 6Z L/o ~ ,~C -.-I ~~~,~~ f Mtd>sott, WI 33107 - 71 2 ~ Add<ara ` Os r ~t ai C mm r ~ ~ Q ~ 3au~tary Permit Appifcstion 3 ~"~ ~ ' to eeeoad N~ ~Cemleetn~31. ~, AiaM1. Cads, pstiomsi edort you ptovi~s Q Cbe4k it' AevUian ~ ~ is ~ ~ ! ~K Wit; ~ ~ ~ LD. Nulribel ~' ~ 12 rme fir,.-- -- ~, gua~t /2 Z9 l9 z3yZ I G`ixy~ •Saw ~ • , P f ' HZnck Ntu~er ~ , ~ ~ 3 • ~ / ~~ ~`~ z ~~ ~ ~ t~G of `, _`', ubdfn q ~ ~"""~' CSM Nwaber ~ 1C. 'i~ps of trhset all tl,tst apply) 9 CC.AIr t cr 7 Pemily ~ ~1lpabrt aZ aeBaOOau ~o r 4 L7VWefe i iSlibliClCvO~i'4i~t ` lywctlbe L1rte . CI See Nletea .30 ~"""""""'"`~ ~?6'0'.d,6tcL ~ m. Type of tt~eok mly ow boa ala A ~mnberla~ uhewe for faalet~i ure)• Comte tiaa 8 it sppliaable) A, i tsaw ~ ©~ 3 fl Z~itcemeat at 6 ~ Adslidoa to ~ ar Cautly vu al da Sate H. ©C6ealt !t 'i' peadt Ptrvltnuly Iruued Nwabst Dw Iaaved ~ • T~ ~ t aFPlB) p tEClleme !e tat iateruei sau? 44,~+taa »FpNlLtdtld TsaM0lauad zCJ Mo~aad t7 ~l Band Fitter s>ti a Carutsa»rr~! w.s~s~d • ~2 a ?nom I>M~eaoad 61 ~ tio>dEnj Teals 4g D 81ttiZs PsN St Q Delp Liar i3 L~ A 46 ~ i31ta-vstaac Utz 49 Q Rteirast 30 ~ Gthet _ V, f Dett~ttt ee Aemt 4o Ap~pttalalon PsrCO~tiott Rai lty+sstirn Btrvatioa 4 Nsau Cfrede Ptup~sd RW1G111./>'lyr~/Sq.Pt.) ~ p-Zln,/tpcb} ~~~ So T! Etcvstian ' ~S ~ ~s~ ..~ i ! y~/~ ~ O ~~( . TNk W .Taft r#~itoos t~nba a! Teaks Muauiaaatnr ; Coll~3a 9i>a Gozttmtcad Stoal , l~bnt Plssuc ', i Qls+ss ~ ! ~ ~ . 1 VIt. 8 !)r tmr atltke FOWTS ibowA eos l . be sttaehe$ ' s e ; Z~ust:rws Phoas ura6ar ~ !~ . ~ L I~7 (J .5'G d ~L Gc SD.~ fc~ / ~J L Q ; O ~ - ,»`'w» " Z~eaCit ( Citavadwuel tEl Tt~ Anent j7taGita !1~iQ t~mfisl I i1 ~ltldel AdY4lif • QMrDerr ~!Y ~C!>~f FIO) ~,- r IY. Cme~!laals ei' Ayr~ra'raillleeaeeu ibr D~+ptot+s! f r t v .~ Sy 5~(e,... a ~e ~ of ~ o~ ~ ~t ~~"_ ~~ / ~~ ~ J /+ // /~ ~~ pG{Q (,c,~ /p/f r`'~ hltf q /~ot0~ e Q ~4yt, /~,(,~ I ~7/-v ry.- /~ k 1><he , ~S'~1.f~n~ SL-~r 5ys~ih G~,Ia~J ~L h l'.v~WQ ve~ ~c!'v~/ ci.o. d.G(c11 ~` -l~`r,,.,rJ ,~1, p/ry o4' Ucvv ~ f // AOIf~ Mw/¢II~N ~r !~" W~ _CIIMq' Ni~11~ {M Mail{ eM ~yQ OIi iMf IAY R-~ s si n ,~~ ~Sy 5'~a,,,, ~, yttit,~7~/M/~ ~t fy.-~ f~Qi/ICU (~WI'so~.~ 6'~ l~V~t c`l~a.~c P.aSI/+r.~r%~5~ ~~/ ~iba~/s"o ~ r d 3 a Q ~ v ~ ~~ ~ ~ "~ , 4 o 9z o ~ o M r -, M 0 a °.7 ~ D a ~u U l~ ~ ~ ~ ~ v ~ ~. 1 ~ ~~ £ b'y ~_^ z 0 ~ 7 M ~~ ~y~ ~- . y :P ~T V ~~ O 7... ~ W G. ~~ ~ `~ ----,~L I I~anul 1- -`~° J ~n N /i Jl~ ~ ;i~{ ;~ ~; llJ `~ ~ ^ W I }~ My W . ro ~ ~ --c~>c m`~o w ~ ~ U ~ ~ ~ ~ ~ -~ G T C ~ E~ a~ ~ ' V: ~ CC cC .a N ~ ~ O O "J ~acdo. ~~~~~ ~~Q7.= O ~ G ~'- ~ N ~ ~ T ~ C~ cJ~V l~ Chi 7 ~ C ~ ~ ~ ~ i p ~ 3 ~ _ ~' ii ~ T~~ a I o~~ aQ'; ALL. ~= N C a .... u7 r t c~ !~ V ti C Q 4+ V ~ ~ Cl ``U I u ~~ i I~ a 1~ ch ++~yy IlII ,,+~~I ^ ~ ~ ~ Mi x u? y ~ ~ ~ x ~ m ~~ T 1 1 X~ 1 x ~ as ~ a 'm ;~;~~I~ Ch L ~ N h ® ~ ~ U ~ u ~. ~, C~9~j ~~ ~~r ~ ~ ~ ~•mD {•p j (~ rCO ^ R m 4 v a 0: o~ N G ~ • Y . ~ ^~ S7 ~ ~ V L" U N 7 ~y A ~~ ~~ ~~ ~,. ~' i~ ~~ ~~ Aa ~~ ~~ U p Y n ~~ 'a ~k~k ~k a~ 9 §~ R" ~• r ~ ~~ ~~ Y .> ~.I ls,. ~ . i,r.,... ~..~ . ... _ . _-_.-. Wisconsiia Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page ~ of _~ 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 5 ~ G a percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # APPLICANT INFORMATION -Please pri~~llt~nfmr Revi wed b Date - Personal information you provide may be used for secon~ryrpuiposes jPrivacy Caw s.'t~5,.04 (1) (m)). ~ Z Z Property Owner ~, ,~ " ,. Property Location Gbvt. Lot ,V w 1/4j~ 1/4,S ~ ~ T2 ,N,R ~ E (or) Property Owner's Mailing Address _ LoY~k Block# Subd. Name or CSM# ~~5 ~ 'ZA ~ }MC7~117 t3GAw~ 4Z ~ Df;~t Stat Zip Code' Phone Nurr4et- ' Ci ty ,^ City ^ Village ~ Town Nearest Road ` c f~+~3p ~n n! x,-3.1 ~ 01~ ~ t,'~ /5 ~~ =.a"~. ~'~- ...-' ~ ~ • ~ r.J t^'lQ©U .,,. ca D New Construction Use: ~ Residential / f'r pf b ~ ~ sj,~_ Addition to existing building Replacement ^ Public or commercial -Describe: Code derived daily flow ~ ~ ~ gpd Recommended design loading rate ~ bed, gpd/ft2~_trench, gpd/ft2 rench, ft2 t Absorption area required bed, ft2 ~~~ Maximum design loading rate ~ bed, gpd/ft2~trench, gpd/ft2 C ~ Recommended infiltration surface elevation(s) ~ l • 3~ ft (as referred to site plan benchmark) Additional design/site considerations ~'j' ~ ~ • ~ ~ l U` ~S'F't ~so~ V if applicable /l//~}- ft Flood plain elevation . 1 Parent materia , S = Suitable for system Conventional Mound ^ ~ In-Ground Pressure (~ S ^ U AT-Grade C~S ^ U System in Fill ^ S [~ U Holding Tank ^ S U = Unsuitable for system S ^ U S U Cf111 IIPCrRIPTIAN RFPART Boring # Ground elev. 93.2vn. Depth to limiting factor f (O in. Boring # .~ Ground elev. gI•Koft. Depth to limiting r in. Horizon Depth Dominant Color Mottles Structure B d R t GPD/ft~ in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary oo s Bed ,Trench i -I© Z lb 1 Z ~ b tM-r < < ~i- ~ ~ ~ Z -_ y y I R b w~. F `~ .- ~ ~ 3, , yp~ n , Remarks: • D -fir \(1 Z. S' ~ n-. iM. ~2. L ~ V r 5 6 K w`- C ~ ~ Remarks: ~--r-- - - - - _ __. _ CST Name (Please Print) 'nature Telephone No. c~ ~c - ~ ~?/~)z~17-y Address Date CST Number ~- f. ~ (,ill ~~OZS 5-7-do ~~3d SOIL DESCRIPTION REPORT page Z- . of3 PROPt=RTY OWNER PARCEL I.D.# ~ Sri Boring # /~/ Ground elev. ~I.zv ft. Depth to limiting factor ~ ~_in. Boring # ~~ Ground elev. ~~ Depth to limiting f~ctor . ~_in. Boring # S Ground elev. ~~~d ft. Depth to limiting factor ~_in. Boring # Ground elev. ft. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 _6 ~~ , r - ~,1 t,,~F c-S 1 ~ F S ~ ~ 3 - io 16 oS ~ LS - ~ ~ ~~ ~ ~ , P~~ Remarks: ~ , o-~ ~ I z - ~o L wek ter ~S 1~~ (' N ' ' y,. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench - i~z-sz ~ @ y 1 y z, M~~i~ - - ~ ; 3 6 - „~ o s ~ C - $ Remarks: m. Remarks: SBD-8330 (R.9/98) v ~ • s 1 PAGE ~ OF~ NAME CO ~ h dCt LOT# ~ LEGAL DESCRIPTIONYw '/aSt'/a,S tZT 2~(,N,R LPL E (or) ~-- SCALE: I "= ltd ~ BM I ELEVATION `~ •C) BM 1 DESCRIPTIONnQ;~, ~ g"~;~ .,tit/a~ BM 2 ELEVATION~Qp. D BM 2 DESCRIPTION~a;~,,,. (, "C`dc~ ~,••~/~ SYSTEM ELEVATION 4SCl. ~d ALTERNATE ELEVATION ~7•~ ~ CONTOUR ELEVATION .il/!~' t! Z ~ I ~` ~s aK l9Gt' ag p.;,,,.~r • • •A Qy~Z A~ lSnlb I S O ,,; +Ptivat~e i~ntito VYaatowator Treatment Syat®m iVlana~omont Piar~ S+~p#~c'Cank And Gravity In-Ground Soli Abaorp#lon component Pursu~lnt to Comm 83.E Wis. Adm. Code each Private Onslte Wastewater Treatment Systsm (PCWT$j shall Include information and praceduros for maintai»!ng the system within the parameter; of Comm 83 and 84, end the conditions of approve! by the depsrtmen#, agent, ar governmental unit. The approved plans and permits far system are on file at the county xon(ng or !~#Ith department. Th1s management plan complies with Comm 83.:84, W(s. Adrr. Code, and the ln-3raund 3ni~lQAbeorapt!©JJneeComponent Menua# far Prfva#s Cns#te WastewaMr Treatment Sys#~--ms SBp- 10S87-F ~R.i~l~0~. Table 1: 8 stem Oesi n tficatlons 8anl Permit Number Number of rooms eeI n ow - k d ~ © ,.,r.. Sett low -Ave e ~ a Tar-!t Ci l z o Sail tioil ertt ixe s" at oe#ewadrr i'~omestic Testa ~: 8~ii Abaoret#e~n CQmnoneM - 4imlts of Rpltable ~ratian 8e tic Tank Com onant ii Abao on Com Went esi n Flaw -Peak d Maximum n article in 118 Maximum OD m '~~ Maximum 8 i. 15fl The ee~tt#c tank si'ta#i f?e tt~a#ntalned by an lndividua! cerdfled to serv'~ce septio tanks urod+ar s. 281.48, State. The acntents of the septic tonic steal! be disposed o€ In aa:ordan+~ with SIR 113, W~. Adm. Cods (8ervicing Septic or Halding Tanks, Pumping Chamber:, ©rease interceptors, Seapa~ Beds, Seepage Pits, Seepage Trenches, Pilules, or Portable Restroams). The operating condtsleon of thg septic tank e-~d otatlet toter shat! be ~esse~ssed gt least once every 3 yoars by irtspectlor~. The outlet filter she#i bw dsanbd rs tlbCeesary to a-ns~sre proper Opsra~On. The filter cartridge should not be removed unless proti-islans are m8de to t+et8in So!(dS itt the tank th8t may slough off the tutor when removed from its enclosure. !! the ~ w- _. Management Plan far a Septic Tank and Soif Absorption Component filter is equipped with an alarm, the liter shall be serviced if the alarm is activated continuously. intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shaii have its contents removed when the volume of scum and sludge in the tank extols 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 far water tightness and soundness. Access openings used for servit~ and assessment shaii be sealed watertight upon the completion of servloe. Any opening deemed unsound, defective, or sub)sct to failure must be replaced. ,Exposed access openings groater than 8-inches in diameter shaii be secured by an effective locking device to provent accidental or unauthorized entry into the tank. No one should enter a septic or other tnitatment or holding tank for any reason without being in full compliance with OSHA standards trot ®nhring a conf/nsd space. Tho atmosphere within the septic or other trastmvnt of holding tank nay contain htha! Asses, and r+satua o! a Penton firom the interior of the tank may bo dfii?flicult or lmpoaslbis. Tank abandonmen# shall be in accordance with Comm 83.33, Wis. Adm. Code when the tonic is no longer used as a POWT3 component. Soil Absorption Component The soil absorption component serving this structure Is designed to accept domestic wastewater from a resldentlal facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption r~mponent depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by ail 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, fn 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 ar sewage from the system is prohibited end considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction ar removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, bu# is difficult or impossible to repair until weather conditions improve. In general, soli compaction over this component will reduce diffusion of oxygen into the soil and dispen3al celi, which may lead to more intense, and earlier, organic clogging of the soil. z .._, z i~ltanagemerrt Pian for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly owr of w{thin ten feet of th~- cornpanent should be avoided since root intrusion irno the component may obstruct wastewate,- Clow. Contingency Pian in the event of system failure, a new system could be installed in an alternate area. With the inatatlati+m of a divvrter valve, the existing system could also be reused after a period of three to four years. k is the property owner: rvsponsibiiity to maintain the alternate area free from any piantir~q of trues, shrubs, eta In case of failure of the original system, the alternate are: will be needed. if any trees, ehruios, etc. have been planted on the alternste aroa, they will have to by removed at property owners expense. tf alternate area is destroyed, there are other alternative systems that can be used, in which, ooutd result in added expense to the property owner. Any tank abandonment shall by done in accordance with Wisc. Code 83.33. Any questions regarding thin code, Please contact your togi Zoning pffice or contaot the Installing plumber. ~,~,~.~,~k..ti ~~wn,~~N~ C, ts~ ~~ a-.~ ~ a t l(. YOL 1 ~oOPAGF ~ ~ 9 St. Croix County Occupancy Affidavi>f r , Name - (Owner) y d or printed being duly sworn ,states, under oath, that: I. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume ~_ Page a~ Document Number (out St. Croix County Register of Deeds Office: A parcel of land located in the~l) %. of the'/< of Section ~a , T~ N - R--19 W, Town of ~So;-! , St. Croix Cottnty, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): o~ ~ 5D acr>'s I ~~ lx I'Yt c~ii l~ec~m ~d . i!1'l ocn bcum R; ca~~ L.v+ 3 Ea59S69 KATHLEEN H. WALSH nEGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD OB-14-2401 2:c0 PM AFFIDAVIT EXEMPT # CERT COPY FEE: COPY FEE: TRANSFER FEE: RECORDING FEE: 10.00 PAGES: 1 Name and Return Address ~CIC,K;t Soclerr~,.~:~ a3~3 s~rna~ ~Y l~cJcril~vey, l~)f 5^51x5 boo- 1.~7A- b3- om Parcel Identification Number (PIN} As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a bedroom home, or a design flow of ~ gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently ~ occupants living in this residence; _ occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads. t also acknowledge that 1 will make this information available to any future parties interested in purchasing this property. Dated this ~_ day of f x ~ ~ " NTICATIO Signaturb(s) ~ --'~ -X--.`~.',~ <>~~ ~o ~. authenitcat is day f vv, l : ~ ~ ' .. * ~ Z TITLE: MEMBER STATE BAR OF WISCONSIN 3 { (tf not, authorized by § 706.06, Wis. Stats.) ip m r TH1S INSTRU ENT WAS DRAFTED BY ~ ~ N Z ([/m~~ N .~ D (Signatures may be authenticated or acknowledged. Both (~(~, END p~,~KNOWLEDGMENT STATE OF ~y}~ ~~ ) ~~~~~~' iss. Personally came before me this (~ day ofC~; l the above named , to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. 0 D z m r m m z z fZ *, Notary Public, State of Wlsconsln My Commission is~n anent. If not, state expiration d te: necessary.) Date: $~ TD'S! ~?-C~~ "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This information must be completed by submitter: document title. name 6 return address. and ~ (ifrequlred). Otherlnformatron such as the granting clauses, leagal description, etc. maybe placed on this first page of the document o/ mey be placed on additional pages o/the document. Note: Use of this cover page adds one page to your document and 52.00 to the recordinv fee. Wlsconsln Statutes, 59.5f7. ... .. .......~....., ..._....~. .~.~., re-MJne rvu. ~1> >a7 X711 Jun. d/ 1N1~1 1~:1~M P2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OwNL•RSHIP CERTIFICATION FORM Owner/$tsyer 'C ~~`Q~ iNailittg Address ~ 3 7 3 v~,~- c ~a-~ Proputy Address f 0 5~(p c~ci~~.R-ry! (VerifrcatioD rCquired frwn Planting Dope c for new carstruct~) City/5tate Patrcl Identification Number LEGAL~CR[P, /T[ON I't+opctty Location N ~ %., ~~ '/.. Soc. ~ T~N-R~ W, Town of tI~SO Stt6divisioa i~ I.ot # Gerti!`iea Snlrvey- Map # .Volume __ _ Page # ~_r,. Warrsnty Deed # ~ ~/~/~~? Voltmte ICs9 .Page # ~G Spot hottse O yes CB'no Lot lines idmtifiabk 13~ yes Q no ~ ANGT Im~Dpe:. are and mainte>tiaDOe of your septic sysoew cwtld result iD is prcreature.Srilure to handle waste. Prepar eaaualeaana ooasists of p~p~ net tbt: acpti4 fence every ehtee yenta or sooaa, it needed by s licensed ptrmprs. What you ptR ioLp the tiystCnt an stgaet the fuorwo of the septic ~ as a ttea~eat m~ iD the enwle disposal tryst~an. Tic prope:<y oraer agaeec to submit Oo St (~Dia Zonio6 Depart a catitxatoa !@~ Biped by the o+v~r and bf' a ~a*Pl~.lottmeyaoanpLrmber, restrietedplumherora licensodpumpcr verifyitls that (1) the onsitc.rAStewatardispnsai tysxrp as m proper opaaRoa cooditioD sgDd/or (2) aAer impeetioa and p~Ph-8 ~J °OG~"y). the septic rank is kss than 1!d fnll of a~. Ihtre, the ondtxsigaed have :end the about rogD'gemenit and a~ W mtisoriu do prirate aettttse disposal system rash tlrc strmdard~r eat forth, hereria4 at set by the Dcpactment of Commetoe and the Dcpattment of Narura! . State of Wtstaensia. Cesdfkadon antiat that youc septic system has Boca maiDtaiaed attut be dirt of the three ye ~ expiration date. CO7°°~~ aad rs:ouned to the Sc. droiu County OlTiee within 30 ~,_ ~, .. '. ~~ Si~NA'Itll~ F APPLiCA1~iT DATE OWNLR. CE~t'tTFICATYON I (we) ceatify that eU apternears on this form are tine to the best of my (our) Imowjedge. l (we) am (are) the owaet(s) of ~ Pr'ePe~' ~ above; by virtue of a tvartatrry docd ,recorded in Reaistcr of Dada OEl"rce. / , // ~ Stt3NA71 ~~ P NtT DATE :~""°aa Any iatorttytau t11at is +~-*vPresented may result iD tLe sanitary permit beias reunited by the 2,onirt6 Depatarteuc. ••••.• as [Delude with this applteadAn: a srempcd warranty deed from fhc Rc6isoer of DsCds o~te e copy of ti-e certified survey mop if reference u made iD the wansnty decd Td Wt:19z:80 i00z ii 'ant" Z6ZL20Li59 'ON Xti~ sa~-naas Ipsaantt.q-~ ~,~ vi:~.1~59Pacr 2~9 STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between P. C. Collova Builders, Inc., a Minnesota Corporatiop, Grantor, and Jackle L. Soderquist 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): Lot 3, Moonbeam Ridge Addition, Town of Hudson, St. Croix County, Wisconsin. ACKNOWLEDGMENT STATE OF WISCONSIN ss. - County ) 020-1378-03-000 Parcel Identification Numt-er (PIN) This is not homeskadproperry, Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. ~) Its not) Dated this ~ ~~ day of Juae 2001 P. ts+ Builders, Inc. • -- ' . C. Cot[ovn, Fresident • ~- AUTHENTICATION Signature(s) P. C. Cottovs guilders, inc., a Minnesota Corporation, by p- CD. Collova, President authenticated thi v ~y of 3nna 21101 Kri~tina O land TITLE: MEMBER STATE BAR OF W[SCONStN (If not, authorized by § 706.06, Wis. Seats.) TE[IS INSTRUMENT WAS DRAFTED eY Attorney Kristian O land Hodson, W t6 _ (Stgnaturts may be aunc~nticatcd or acknowledged. Both arc rwt necessary. ot~ persons signing in any cal WARRgNTY,DECD 645.193 KATHLEEN H. WALSN kEGISTEk OF DEEDS ST_ CROIX CQ_, WI RECEIVED FOR RECORD 06-I'-2041 8:45 AN trYti~ANTY DEED E)IEMDT N CERT copy FEE: CORY FEES TRAlISTQt FEE: 197.7Q RECORDING FEE: 14.04 DA6ES: 1 Recording Area Name and Return Address fllr~ 'T,llc ,Ins rJIJDM 1.~Fvn, .u~ S~zFt~ Personally came before me this day of . z, the above named to me known co be the person(s) who executed the foregoing instrument and acknowledged the Same. Notary Public, State of Wisconsin My Commission is permanent. (If oat, state expiration date: roust be typed or printed txlow their Signature. , ~` ) S1~TE QAR U6 WISCONSIN t"t~~etbnPtdestion~leCampre,y ~~t~~ FORhI Nu. 2 - t99'! 800655.Tp2t jd Wd8S:E0 i00i? Si 'unt' Z6ZZZaLiS9 'ON Xdd say i n.~as t es.~an i un W02id SITE PL LOCATED IN PART OF THE NW1/4 OF THE SE1l4 OF SECTION 12 N COUNTY, WISCONSIN; BEING LOT 3 OF THE PLAT OF MOONBE, REGISTER OF DEEDS OFFICE. W oQ o ~ m I UVUOo Oo l!V ° LSL~~l1Vll W I -----G°~ODC~C ---- o ----------- W~ ~° zg I ~ = N89°57'29"W 541.: ~~ r ~~ ---- / HARTUNG RESIDENCE / / ~ ~ 2.50 ACRES / ~ ~~ Q ~ ~ ~- ~ ~ // MINIMUM BUILDING / o i ~ N ELEVATION = 910.0 / ~~ ~ / ~/ / / ~l . r / / / / ~~~~ 1 ~ / / / / ~ © ~ ~ ~~~~ ~~ N = 904 5 H W L // // / / Q i i . O . . . / / i / 40' DRAIN/ Q ~~ ~d o~ O N / ~---------- ,Q. ~ ~ ~ ~ i N89°5729"W 535 ~;~~ ~ ~ -- --- ---- o,a, ~ - -- `a l j V U I ~I / O ' 1 ~~ I / ~ ~ I O ~ I M 1/' ~' L1Vt1~ nnn L~ I - ~~ _____ ~/ / 1 I LEGEND ~ 1" IRON PIPE FOUND X 952.8 SPOT ELEVATIONS • • - - • - - • 50' ROADWAY SETBACK LINE ® 192 NAIL IN HUB SET JOB NO. 01-32 DATE: 6-01-01 N ~29N, R19W, TOWN OF HUDSON, ST. CROIX ~ RIDGE RECORDED AT THE ST. CROIX COUNTY BENCHMARK TOP OF SPIKE ELEVATION = 950.50 ~ i i i ' '~ i ~ i i ,~ ~~ i i i i I i i i j~INAGE EASEMENT EASEMENT --~ ~~ \ ~L1V ° L5L=.1Lll/U ~O c ~O • APPROXIMATE SEPTIC SITE LOCATION \ ~~~ ~~ N ~Z 0 S~ ' `~ ~~ ~\ 17 177 \ ~I O n \$ 9SO ~ 175 1: g I 72 ~ 6. ~ 1.. I 92 ~ ~~ ~O ~ ' 'v ~ ~/ ~~~ / / /rye ~ iy ! / PREPARED FOR: HOME BUILDING EQUITY, INC. 6375 BAILEY RD. WOODBURY, MN 55129 SURVEYOR EDWIN FLANUM NORTHLAND SURVEYING, INC. 856A HWY "65' ROBERTS, WI 54023 PHONE 715-749-1718 NUMBER Cl RADIUS 167.00' DELTA ANGLE 49'52'50' CH^RD DIRECTION S01°10'41'E CH^RD LENGTH 140.84' ARC LENGTH 145.39' ~~ ~~~~ ~ ~~ -----G°~OD~C~ ---- ~~~~s~~~~iii~i .~~` s~oN '~~• ~~ ff EDWIN C. ••• L * FUWUM ~ ~~ _ ~ _ - Z ~Ii .~ ','~~ h~uRi ~`~~~'b~ G' SCALE IN FEET 1" = 60' O 60 120 +/ N Q ~n ~ n \ ~ \\ \ / ~ 0r7~~ ~ ~t ~ LL \ _ ~ \ \ ow ~ Z p~ N •- ' - - 1~83 - -- ---~-------- ~ ~ N Q O ~ 1 ~ ~ Z m Z LWL 1891 i -ram--- _-~-\ \ ~~~ ~~ o ~ u. -~ 9 sus 31891 ~ , •ca i.. \ ~ . ~ ''~~ 8 \ ~i,' 0 ~ ~r -,~bs, \ 3 ~ ~ \ ~ S ~ Z w 052~~~N~ i ~ $'~,, , c0~ ,, ~ \ I~ ~ s2 VO ~ t7 p ~~\ ~ IN ~ ( ~ . Q ~ c0 N p 9 ~ S\~~ ~1 Opp ~ I ~-1 M Ct~ ~ (~ l!>J J I'I Z wW ~~ \ z ~ I ~ I.I. .. w ~ ~ ~~ n C N ~ LL \ - I ~ ~ ` CV C\, Z ,~ ,r Q ~ __ 9 o \ ~ ~; n o N' O Z_ W C7~ ~ ~LL Z II 9 ~ ,,' m W `~ ~ ~; . ZW ~ LL ~y ;6'Z~Z 19Z~561 .~?6 Oc' I_ ,~S L9E _ ----..._ -_ .--- ~NI~ b/ L H1flOS - H1ri0N I ~I 11 \ ~ \ I I 1 ~~ I 1 1 I ~ 1 I 1 ~i I e~ r ~; 11 ~ ~~ ~~ a J a~ 11 ~~ \~ O' ~ I 1 ~~ ~ o~ ~ I I di 1 ~i I / ~ I ~ 1 I 1 I' 1 ~ ~ ~~ mncv'7n /~ n i~n~n n n~~r-+~r ~r~nn~\c~ra 3 ~ ~ c ~ ` ~ ~ ~ O ~•~~ ~ I W~ ~ ~ ~ n ~:. ~ ~ ~ o N$ ~~Z y ~ O C N N ~ ° ~ ~ ~ O d> 7 N ~ W ~~ D N C O v C _ _ O t0 V 0 ~ ~ O N p A~ 7 M ~ ~ ~ cn' ? O ~ C R I 0 I ~ ~ v D ~ p ~' W c' I c ~ ~ W n rn 3 c ~ o _ O M pp ` ~ N N o O ~ ~ ~ O O 003 tn/~0 Q ? l r 0 ~ 3 : • ~ Z 0 0 0 2 I o cn v c n w ~ -~~, ~ ~3 tnytn~ 8 ~ ~ ~~0 I ~ ~~~~ d d c 3 N ~ ~ ~ .. r ~ d a of ~ ~ °' .' ~ ~ I 0 3 ~ o ~ =; wNa~m ~ O ' ~ ~ ~ ~ I ~ ~mg ~~mvw ~• m onv ~ mm d d O~ N N (yD fyD 7 D. 7 N a ~ 7. ~ W d d f/1 ~ C ~~ ~ j d N fD ~ d a I v° d m m 3 v o a m -~ ~~ ~~ vi Z I o ~ ~,~= a ~ " o a A Z _. ._ > > N C ' N (~/1 N 7 a Z O A~ 7 I ' ~, ~ .. 3 c c7 M W ~ z -~ ~ ~ N ~ o a ~ ~ Z ~ ~ ~ A .Z1 I ~ (n O ~ m Q, ~ ~ m ~ I i ~ Z ~ ~ ~ ~ I I ~° u> a ~~ a ~ ~ o• ~ o 3 3 c 0 , ~ "o o N a ~ N ~ ' '00 A fD yC ~ b y n O O' O ~ y ~ N ~ ~ O W y ti I o I N Gq ~ I c ~ ~., c/1 ~ ° O ~ o a ~