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HomeMy WebLinkAbout020-1411-08-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Ha ,Mark & Laura Hudson Townshi CST BM Elev: Insp. BM Elev: BM Des iption: ~~.~ /6Z~~ZS TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ' / ' Dosing ~ 71 _/'1~ /~-' W Aeration Holding TANK SETBACK INFORMATION TANK TO P/ W~ BLDG. Vent to Air Intake ROAD Septic ~ 06 ~ 0 > ~-~ y2/ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss Sys ead TDH Ft Forcemain Length ia. Dist. to Well SOIL ABSORPTION SYSTEM S County: St. Cir01X Sanitary Permit No: 45321$ 0 State Plan ID No: Parcel Tax No: 020-1411-08-000 Section/Town/Range/Map No: 13.29.19.2578 ELEVATION DATA STATION BS HI FS ELEV. Benchmark I •5 ~ `f• / D o ~ Alt. BM S7~- Bldg. Sewer ~ ~ (~ ~~ 2• ~S SUHt Inlet ?)D 3 t. f 12~ 3 /!~ ~• ~ SUHt Outlet . ~o/. 9 ~/ Dt Inlet ~' ~- Dt Bottom ~- Header/M n. - Dis~e o o ~, 5 ~~ ~ v/ • Z Bot. ~~~ 1 y • /aZ~ Z ~ Final Grade II•YS ~a3.1 St Cover ~~ _I 1s r: ~f pp' 7 ~ J ~ ~~ /~ Zlvv ' I g•3y /D(o~Z( i BEDlTRENCH DIMENSIONS Width ~/t L ~ gth ~ ~ ~ No. Of Tren~ hes i~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL AKE/STREA LEACHING CHAMBER O Ma~nur r j~~L r / TU f , Typ O S~ ~ O~ _ ~ `J~ --7 / D+ UNI Model Number: DISTRIBUTION SYSTEM ~ (, /~~~r~,/~~/ C eader/ anifold Length Dia Distribution ~~ t Fipe(s)~ ~ ~ Length ~ Dia Spacing x Hole Size x Hole ~_ > ~~ ~~ `~ SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv ~ ~-~ ~~~'` ~~ C~!%lGr/Ht(F~` Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~_] Yes LJ No ~ ~~ Yes _] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~ Inspection #2: / / Location: 814 Hillside Trail Unknown (NW 1/4 SW 1/4 13 T29N R19W) Alexander Meadows Lot ~ "C Parcel No: 13.29.19.2578 1.) Alt BM Description = .S1' , C~V~_ 2.) Bldg sewer length = / 2 ~ -amount of cover = ~ 2 N ~" ~ _ _ / r- -- --~ -- _ ---- ----- - - - Plan revision Required? [] Yes ~ ~ No Cj ~ ~ ~ ~I ~ ~ I~ /_ ~ ~ Use other side for additional information. _._ J -_.__-- ~ ~ .--_-.~ ~~___- _ -.- _ -- - - GG~!v~^-__---- ' L _-J Date Insepctors Si ature Cert. No. SBD-6710 (R.3/97) _~ Spacing Vent to Air Intake i ' Safety and Buildings Division County ~ ~ • 201 W. Washington Ave., P.O. Box 7162 ~ ~ ~SIII ISCO Madison; WI 537,rJ7 - 7162 Sanitary Permit Number (to be filled in by Co.) i (608)266-3151 ~ Z' Department of Commerce Sanitary Permit Application p~p State Plan LD. Number personal information you provid ~b'is Adm 21 Code In accord with Comm 83 ._ . , . , . . may be used forsecondary purposes Privacy Law, s 15.04(1)(m) e..._ _-~ Project Address (if different than mailing ac:dressj I. Application Information -Please Print All Informat~tn'~' ~ ~ ~ ~ ~,~~ ~ ~ T ~•~ & .. , Property Owner's Name ? Parce~ of # Property Owner's arlmg Address n rty Loca tio P ro e p ~~'<l i ~ ,.,~1ui'.~ ~ ~ / ~ ~ ' J ~ vv t ~ Section. V. ~+ City, Stato Zip Code . . , , x{.61`. (ctrcl T~ N; R~ S e of Building (check all that apply) I1 T ~ . yp i bdi i N ~~ S s I or 2 Family Dwelling -Number of Bedrooms ame v s on u blic/Commercial -Describe Use ^ P 1~ "1 ~' _ u , ^ State Owned -Describe Use / KBD QCity_QVilla Township of z z III. T ype of Permit: (Check only one boron line A. Complete line B if applicable) A' ~ New System ^ Replacement System ^ TreAtment/I-Iolding Tank Replacement Only ^ OUter Modification to Existing System B• ^ Permit Renewal ^ Permit Re~~ision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issue Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a I Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ~ Single Pass Sand Filter Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ~ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter L] Recirculating Synthetic Media Filter eachin Chamber ^ Dri Line ^ Gravel-less Pi ^ Other (ex lain ,_ ~_. _, V. Uis ersal/TreutrnentAree Info merlon: _~ _ _ .__ __ Design Flow (gpd) Uusign Soil Appli~;`tq~ a Ratu(ypdsD Uisp~~rsul Aru;t IZcyuu~J (sl) Uispersul Area I'roposcd (st) Systan Glrvatiun ,AVI ~ D VI. Tanklnfo Capacity in Total Number _ ~ ,,w[anufacturer Prefab Site Sleet Fiber Plastic Gallons Gallons of Units w/ ~ n~Px([. f~--GtA ConCrota Constructed Glass New F-xistiag 1' Tanks Tanks Septic ar Holdwg Tank '- O _ Ae~ ~bic Treatmenr Unit ~ - - Dosu~g Chamber VII. Respo ibility Statement- i, the undersigned, a ume responsibility fur installation of the POWTS shown on the attached pleas. Plum 's am (Print) Plum is Si e ~ MP/MPRS Number. Business Phone Number z ~ / ~- . Plumber's Address (Street, City State, Zip /ode / ~~ C %rs. / L VIII. Coon /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued uing get Signa r o Stamp) Surcharge Fee) Q 0 ven Reason for Denial ~ _ IX. Condltioas Approv SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not las than 81/2 x 11 inches ta slze- a SBD-6398 (R. 01/03) 3y/~5' ~~ __ ______ --~---_r____. - ~ / // ~N~ x ~~~~f~Fti 3o i 1 ~~ N~ -~ ~y~ `~ Q ~~ ~ ~~ ~ ,~ • L~ /8 t ~,z.J~~ i~~°~/ ~~P o ~' ~~ts ~ l~ ~~ - /-L /6'D.~i ~' ~~s.`~~6.1:.~as' v/~;~/ .S .c y ~,~,~ ,:,~/~ Jam' " ~ c7. ~f~c~ t d3 (. ~~ I ~~z \ i j~s~ . ~-- ,\ ~I ~+8 ~- ~~, ~~-,1 3 - /~~l~px I o' l I~ ~~ ~~ ,~ GpP'! ~~,~';! ~,vv/a,~le~o~s~ ~ti' ~`~~'7 ~`fc~~asosl ''~b~I - -----. - --- _ ~ ~ ~ ~~~~. ~~wih~ti 3o j a~~ _ _ _ ----- __ --- )D _s ~~ ~~ ~ ~ j J ~' i 'Fa ~ / ~ ~r"~`"'~' ~ ~~ /' ~~' a p~ 2S ~ I / fC~~,SrD .~ yJkll I ~~ /.~c6pd~t= O ~- ~ / ,/ /~~~ ~~z Lj_ ~I. /~ r ` i ,~ / l7Rhl~:N1A~ ~e ~ ~/' v,~ ~• ~ , ~ak5 ss,1 y ~,e.r' ,.~~~ / ' ~~ ~~ -f ~~' ~ 3 ' ~ ///~ ;P~ ~~ ~~ -~ " r-- 1046 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Sal Service County Attach complete site plan on paper not less than 8%: z 11 inches in s¢e. Plan must St. Crooc include, but not limited to: vertical and horizontal reference point (BM}, direction and percent slope, scale or dimemsions, north anow, and location and d~tance to nearest road. Parcel I.D. d ZQ . / / ~(-Q ~ ~ ~ pending Please print all infon»ation. - R By Date Personal information you provide mey be for s~r~er~'(~nvi~c Lew, s. ,5.04 (1) (m)). 3/27 Q Property Owner roperty Location LaCasse Development , Inc. A ~ ~ ~ 4 ? ~ Q ~ ovt. Lot N W 1 /4 SW 1 /4 S 13 T 29 N R 19 W Property Owner's Mailing Address of # Block # Subd. Name or CSM# 573 Cty Rd "A" ST. CROix COUtvTY 8 na Alexander Meadows City State p CaieZEtlttlAi~E City ~~ Village ~ Town Nearest Road Hudson WI 54016 715-381-5405 Hudson Alexander Rd. New Construction Use: ~/,, Residential /Number of bedrooms Code derived design flow rate GPD Replacement Public or commercial -Describe: Parent material Glacial Drift Flood plain elevation, ff applicable na General comments and recommendations: system elevation 101.80 ft, trenches spaced and depth to code 4.00 ft bebw grade Boring # Boring 96 ~! Pit Ground Surtace elev. 105.80 ft. Depth to in. limiting factor Sod application Rate Horizon Depth Dominant Color Redox Descripton Texture Structure Consistence Boundary Raots GPD/ft2 *Eff#1 *Eff#2 1 0-12 10yr4/4 none sil 2msbk mfr gw 1f .5 .8 2 12-22 7.5yr4/4 none scl 2msbk mfr cs 1vf .4 .6 3 22-54 7 5 r4/6 none Is os mvfr w na ~ 1 2 . y g g . 4 54-60 10yr4/4 none sl 2msbk mfr gw na .5 .9 5 60-96 7.5yr416 none Is osg mvfr na na .7 12 k /~ ~ ~, Boring # Boring 96 1! Pit Ground Surtace elev. 105.80 ft. th to limitin factor Dep g in. Sod Application Rate Horizon Depth Dominant Color Redox Description Textun; Structure Consistence Boundary Roots GPD/ft2 *EtT#1 *Eff#2 1 0-10 10yr4/4 none sil 2msbk mfr gw 1 f .5 .8 2 10-16 7.5yr4/4 none sicl 2msbk mfr gw 1vf .4 .6 3 16-27 7.5yr4/4 none scl 2msbk mfr gw na .4 .6 4 27-55 7.5yr4/6 none Is osg mvfr gw na ~ 12 5 55-66 10yr4/4 none sl 2msbk mfr gw na .5 .9 6 66-96 7 .5yr4/6 none ms osg ml na na .7 1.Z Q tttwent ~~ = t3~u 5> ;i0 < 220 mg/L and T55 >30 < 150 mg/L * Effluent #2 = BODS< 30 mg/L and TSS < 30 mg/L SST Name (Please Print} Signature: CST Number David J. Steel ~ 248956 4ddress Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 8/1/2002 175-246-5085 Property owner LdCasse Development , Inc. Parcel ID # Boring # ;Boring ~/` Pit Ground Surface elev. 103.00 Pending ft. Depth to limiting factor 96 in. Page 2 of 3 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Cons~tence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-12 10yr4/4 none sil 2msbk mfr gw 1vf .5 .8 2 12-20 10yr4/4 none scl 2msbk mfr gw na .4 -6 3 20-36 7.5yr4/6 none sicl 2msbk mfr gw na .4 .6 4 36-72 ~ 10yr4/4 none sVls 2msbk mfr gw na -5 .9 5 72-96 7.5yr4/6 none ms osg ml na na .7 1.2 horizon # 4 has stratified layers Boring # Boring 103 00 ft th to De limitin factor 96 i / ; Pit Ground Surface elev. . . p g n- Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0-9 10yr3/2 none sl 2msbk mfr cs 1f .5 .8 2 9-22 7.5yr4/4 none scl 2msbk mfr gw 1vF .4 .6 3 22-36 7.5yr4l4 none sl 2msbk mfr gw na .5 -9 4 36-55 ,/ 7.5yr4/4 none sVls 2msbk mfr gw na .5 -9 5 55-72 7.5yr4/6 none sums 2msbk mfr gw na .5 .9 6 72-96 7-5yr4/6 none ms osg ml na na .7 1.2 horizons # 4 8 5 have stratified layers * Effluent #1 = BOD 5> 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Boring # 'Boring - - -- --- - - b Page 3 of 3 STEEL'S SOIL SERVICE N David J. Steel i 564 Cty Rd GG CST-POWTSM LaCasse Dev., Inc. New Riclunond, WI 54017 L1C. # 248956 NWl/4,SW1/4,SI3,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246=5085 Alexander Meadows, Lot 8 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. ~~ r~~~ ~7 I ~a~bo~- ~,--~/~% 8_ ,.~z POWTS OWNER'S MANUAL. & MANAQEMENT PLAN ~ILE INItOI#MATION ' ` ` Owner Permit ~ ~S3Z~Cy OESI~N pAR4ME7ERS Number of 6edrooma ,,, ~>- ^ NA Number of Public Facility Units ~ NA Estimated flow laveragel~;} . ,; ;,.. - ~` al/da Design flow Ipeakl, (Estimated x 1.b) al/da Soil Application ,Rate al/da /ft' Standard Influent/Effluent duality Monthly average" Fats, Oil & Grease fFOG- s30 mg/L Biochemical Oxygen Demand (80D`I 5220 mg/L NA Total Suspended Solids' iTSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBODsI 530 mg/L Total Suspended Solids- (TSSI 530 mg/L ~ NA Fecal Coliform (geometric mean) .510• cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater end septic tank effluent• MAINTENANCE SCHEDULE ~~~~~~~ SYSTEM SPECIFICATIONS Pago ~ of },__ Septic Tank Capacity , .~ , i , al ^ NA Septic Tank Manufaoturer ,. O NA Effluent Filter Manufacturer O NA Effluent Filter Model ^ NA Pump Tank Capacity . ,;, ,; sl . ~ NA Pump Tank Manufacturer ~ NA Pump Manufacturer -® NA Pump Model .®-NA Pretreatment Unit O Sand/Gravel Filter O Meohanioal Aeration O Disinfection ^ Peat Filter O Wetland ^ Other. A Dispersal Cellls) ,Bt In-Ground (gravity) ^ At-Grade ^ Drip-Line O NA O In-Ground (pressurized) ^ Mound ^ Other; Other: - O NA Other; O NA Other ^ NA Servfce Event Service Frequency Inspect condition of tenklsl ~ At least once every: ~ monthls) (Maximum 3 years) ears . ^ NA Pump out contents of tank(s) ~ When combined sludge and scum equals one-third IY,1 of tank volume O NA Inspect iisperaal celllsl. At least once every: O monthls) (Maximum 3 years) izh earlsl ^ NA Clean affluent tiller '~ ' ~ At least onoe every: monthls) ear(s) ^ NA inspect pump, pump controls & alarm , At least onoe every: ^ month(s) O earlsl ANA Flush laterals and pressure test At least once every: ^monthls) ^ earlsl ANA i Other: ~ At least once every: O monthls) ^ earls) ~NA Other; . O NA MAIN':^ENANCE INSTRUCTIONS _ Inspections of tanks and dispersal -cells shall be made by an individual carrying one of the following lioenaes or certifications: Master Plumber; Master Plumber Restricted Sewer, POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a.visual inspection of the tanklsl to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of oombined sludge-and scum and to check for any back up or ponding of effluent on the ground surface, the dispersal celllsl shall be, visually inspeoted to check-the effluent levels in the observation pipes and to cheok for any ponding of effluent on 'the ground surface. The ponding of effluent on the ground surface may Indicate a failing oondition and requires the immediate notffioatiori of.the local. regulatory authority. , When the combined accumulation. of sludge. and scum in any tank equals one-third IY~I or more of the tank volume, the entir© oontents of the tank shall bs removsd by a Septage Servicing Operator and disposed of in acoordance with. chapter NR 113, Wisc main Administrative Code Ali o~~her services, inoluding but not Iirrilted to the servicing of effluent filters, mechanical or presaurized_components, pretreatment units, and any servicing. at Mtervais of 512 months, shall be performed by a certified POWTS Maintainer. , ..,,.,.. A"ilervice Yepbt~ shall,^~!i'"1~kJdd''~~"th`~ lode)°re~i T~tory'authority within i 0 days of compietiori of any service event. .M.~ ... ~ ~ . .~ a 4 BMW (4/011 4 . :.t,• Pape ~ of 8TART UP AND OPERATION For new construction, prior to use of the POWTS cheok troatment tank(sl for the prssenoe of pslnting products or other ohsmioals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tank(s) 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 till above. normal hlghwater levels. When power Is restored the exoeta wastewater w111 ba discharged to the dispersal Dellis) In one large dose, overloading the oslllsl and msy result In-the backup or wrfaoe dlsohargo of effluent. To avoid this Ntuation have the ~oontenu of the pump tank removed by a Septage Ssrvloing Operator prlorao restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump' controls to restore Hormel 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; sortdoms; 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 grid properly disposed of by a Septage 8ervioing Operator. • After pumping,`'aIl tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: .. , A suitable replacement area has been evaluated and may be utilized for the location of a replacement soli 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. t <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 RE$ULT. RESCUE OF A PERSON FROM THE INTERIOR OF A YANK MAY BE OIFFICULT OR IMPOSSIBLE. ~DDITIONAI. COMMENTS 'OWTS INSTAL ER I POWTS MAINTAINER . ~t Name _ Name Phone -~ Phone ~EPTAOE SERVICING OPERATOR (PUMPER LOCAL REGULATORY AUTHORITY Name ,, ,:~ Phone ~. .r; Namo ' •'?L i ~ i, Phone ~, :~ his document was draRed In oompliance`wRh chapter Comm 83.22(211b11U1d1&If- end 83.64(1), 121 ~ 131, Wisconsin Adminlstratlve Code. S'1' CltO1X CUUN'!'3~r SLI'7'IC 'I'.r11~tI~ M1lIN'I'LNANCI? :flGIZ1?LM.L~N'I' AND UWt~ll?1ZSIIlI' CI?[L'I'll~ICA'I'ION I~Oltivt K?~vllcl'll3uycl' >4}r )t ~ ~..4 (~~~ or. Y r ' I`rlaitia[g Address $~Y Goc...1.~v-~ Wt~ac~.a4~ j~~~w4w4[frsL.Tf ~~.~.~ S~GL-31' I'r~Itel-ly Acitit~ess (Vcrilicaliuu rcquitc(I tiau( 1'I;nu-iug l)Cpart-i1Cnt fUf nC~V C(IIIStltlCtlOn) .~ CilylSlalc ~u_c>~~-~~~-,. I'ttrccl I(Ict-liticttlii-tt Ntttr-l)ct' ~,~Q,~/~-~g-i?D~J ~ 2~~~ LEGAL, 1<}I~SClltlt''I'ION Prolaerty Localiol[ ~~ '/,, 5 ~ '/,, ;,cc. ~, 'I'_~t~(-IZ~_V4', 'Ct~~vu ([C ~ct~SU-.~ Subciivisian ~~~'~ -•-r7-~~~._j~,~~~c~~w 5 Lot it _ `~. -'~_ Ceclifiecl Sur-vc}~ R~iup ~l `~- _, V(-Iltlrrc ~-1'n~c ~l ~'~jt1Q'g'da>ilty ~cecl ~x 75/2 Z.7 Voltrtttc ~~ . I'trl;o t!E ~"S~ Spec house ^ yes ~ nu . Lt)t lines i(lcltli(ittltlc ~ yes ^ no S~`S'1'IaMI Ii~lt~ if N'I'i1!,N A N C 1+, Iu)proper use attd maiuteuartce of yui+( sclltic system court res~tlt iu its lr(cnuttur a titiiure to t-audle wsrstes, I'ropernrairttcuauce cousisls of 1)utrgllug aul the seplle tank cvc)y Ih(cc yca(s ur souncr, if needed by a licensed Inunpcr, What },rou put iulo rite systear cart afrccl the t'uucliott of the sepl[c teak as a t)ealn-cnt sln(;e iu the wnslc disposal syslenr. Tlrc properly osvncr. agrees to suhuril ti- St. Croixlouing [)cparturcut n cerliticaliua forur, signed by the owner and by a n)astFrliluntbcr, journcyntau pl(uitbcr, reslr iclcd p.lurubcr or a ticcnsc([ puu)pcr vcr ifyiny that (1) tlrc at-silo wastcwat>crdisposal syslarr is iu proper apcraling condition and/ur (2) alter inst~cclion om1 pumping (if necessary), the septic tank is less than 1J3 full of aludgc, 1/wc, the undersigned Iravc real[ the al>ovc ralniicn-cnts and al;rce to nlaiulaiu the privntc scwa6c disposal systeru with the slnttdards scl I'oriir, Irereirt, aS 6Cl by.t[IC DCpnthllCnE Uf C:Ilnrrncrcb nlll[ ti1C 1)CllaltnlCn( tl(' NntUfAl IZC6Olll'CCS, State of Wisconsin. Ccrtificn[iou statir)g that your septic systeru has been rnaintaincd nwst he cumpietcd and rctu)ncd. to the Sl. Croix Couuly Zoning OlTicewithin 30 days of tl-e tlrrec year cx iralion dntc. ~I ~ IG~~ . SIGN 'I'URL~ Or At'1'L ANT D~l'I Lt a~~tN>i~t~ C><,ir~'>l'!r>i~ic~'rI~ i (wc) cetllfy Ural all stalcnrcnts un this f~nn+ aic t+uc I(~ tl~c best crf my ((nn) knowledge, the prol)crly described about, by virtue of n wauanly (Icc(I rccur(Icci iu Itcl;isler of I)cc(is Oiiice. SI.C)t .'I"UIt~ CF /Lt'PLIC ?' . i (wc) atn (arc) the owner(s) or S 1 ~Id`~ U ATB ° ~'"'"~* ~it)y iflfOC[tAatiOn [flat is nris-rcprescnlcd play result 'tu Ehe sanitary pentlil being rcvo[:c(i, by fire Zottirtg DepartntcuE. *'r'r~¢~` ~* Irr.clud~ tllit 4[(ts al-l-licatt(-rr: a siau(l~al u~ri(rarlt}' (iced fio+n ti-~,I;c.~ister of Ua~<is ofTice_ . ~ . .. f „- _ _ ' _- _ _•_ a col~v:r~; tf,,:.isc:ttttc(E~str(a~c-~°.~i-ni;~ir't f'~-oti:;:; is tr-ai{~tu.ttt~~wnr-raiity-cletcl~ `' ~, U ?_y2`iP 553 I STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number I WARRANTY DEiD This Deed, made between LaCasse Development. Inc., Grantor, and Marv Robert Hay and Laura M. Hav, husband and wife Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee We following described real estate in St. Croix County, State of Wisconsin S~ space is needed, please attach addendum): Lo ,Plat of Alexander Meadows in the Town of Hudson, St. Croix County, Wisconsin. KATHLEEN H. MALSH REGISTER OF DEEDS ~T. CROIX CO. , MI RECEIVED FOR RECORD 10/01/2003 10:30A?f WARRANTY DEED E1:EMP7 ~ REC FEE: 11.00 TRANS FEE: 221.70 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address o2o-lau-os-ooo Parcel Identification Number (PlN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this __E~'~" day of September , 2003 ---- -- J ` ' ~C~ "`' - -- v * _ *_ LaCasse Development, Inc., by: _ * * AUTHENTICATION Signature(s) authenticated tl~ta f,~ da p U~r •• et7-O'A'. - _ -- ~' V C~~-~~%--- -- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) p CKNOWLEDGMENT STATE OF \~-.- ) Ct~'-~~~5~ ) ss. ) County ) Personally came before me this~L~~~y of September __ , 2003 the ab ve named LaCasse Development, Inc., _ __ its to me known to be the person(s) who executed the foregoing ' trument and ackno ledged the same. Notary Publi , Sta a of w My C mmts on is ermanent. (If not, state expiration date: 1~ of persons signing in any capacity must be typed or printed below their signature. Information Protessionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800-655.2021 WARRANTY DEED FORM No. 2 - 1999 .~ ~ Z J33HS 33S _t .: m ~W et N h M m Z. 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