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Home My WebLink About020-1411-16-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety 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: City Village X Township Ber strom, Crai Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ ~; ~ Z ZwG~ ~- /tom Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ ~ ~' ~ ~ ~b ~ 3C' Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Len Dia. Dist. to weu SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 453292 0 State Plan ID No: Parcel Tax No: 020-1411-16-000 Section/Town/Range/Map No: 13.29.19.2586 STATION BS HI FS ELEV. Benchmark G, t _I / /~ ~ 4 /0~ t Alt. BM ~ n Bldg. Sew r /d `3 /o / , 3 SUHt Inlet 1 I •L~ !00 SUHt outlet // • SZ- R9 •7 6 Dt Inlet \ Dt Bottom Header/Man. 1Z_84 ~g •~ ~- Dist. Pipe 12 ~ ~~ , 7 , j Bot. System ~ ~ ~3 . ASS 97 • ~S Final Grade ram" 9 .q~} /61, G St Cover ~~ ~„ ; /J ' 4' ~ ~ ~' 4' (0 a~ (/1~ a BED/TRENCH Width ~ Length ~ No. Of Trenches PIT DIMENSIONS No. Of P~t~ \ Inside Dia. Liqu' Depth DIMENSIONS ~ c~Z ,[,r i~~~ ~ \ \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture r;.~ INFORMATION CHAMBER OR 1 Type Of System: /// / C~ / /] UNIT 0~ Model Numbe DISTRIBUTION SYSTEM l3 p~,.r HeaderlManifold~ /~ Distribution Pi e(s) x Hole Size x Flole Spacing Vent to Length ~q,lo Dia ~ p Length Dia` Spacing\ SOIL COVER x Pressure Svstems Onlv zx Mound Or At-Grade Svstems Onlv d~ S~, ~i oo ~SC~ Airlnt~ke. 1I ~~~ ~'~wl Z ~~ Depth Over Depth Over xx Depth of xx Seeded/ dded xx Mulched Bed/Trench Center Bed/Trench Edges \ Topsoil ~ Yes ^ No yes ~;;~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~ Inspection #2: / / Location: 825 Hillside Tr Unknown (NW 1/4 Sp,Wp, 1/4 13 T29N R19W) Alexander Meadows Lot 16 Parcel No: 13.29.19.2586 1.) Alt BM Description = ~ nfo-~ ~a~~d~~d /~ ~//~~~ n / / ~Q ~ L~ _ J ~ ~ n 2.) Bldg sewer length = $4 /~,~~ ,~' A ` ~/ -amount of cover = °~ ~ ~ ~" """" G(~Gt~/~ j~^~~, ~(~`,S/s~ , Plan revision Required? [ _! Yes No Use other side for additional information. SBD-6710 (R.3/97) -_ ~ ~ zy '~ i oy ~~ ~ -- `___ Date Sulbiy uml Buildings Divisiun Ilex 71G2 hin ,n ~\vc 1' O ~i 2U1 W Wa County / , ,/ . . l , , . s Madisun, WI >37Ur1 - 7162, ~S1 ~ ` _ ~Saniluty~tit Nuntbrr (tv be lillcd in by Cu.) I SCOf 6US 266-3 I S l ( ) ~' Qepartment of Commerce State Plan I.A. Number Sanitary Permit Application , _ j ersonal information you pro i~~D d Ad C 21 Wi o e, p m. , s. In accord with Comm 83. may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) I. Application Information -Please Print All Infurmatitttt.~,,,, ~ 0 2• S ~~ LLS (d ~ ~ ~~-~L Property Owner's Name '" °'" "' Parcel # Lot # -lilaelt•* ^ A ress Property Owner's Mailin Property Location ~ . ~ i City, Zip Code ~ ~ ~j~4? ~E ~ (circle o ) l • S '^^~~ y) ,~ II. Type of Building (check all that app Subdivision Name CSiW-Nnmtrar ~1 or 2 Family Dwelling -Number of rodrus l ~Z ~~ - '~ j Q Public/Commercial -Describe Use 1 '1` ^ State Owned -Describe Use `'~ 3r k ~ r Ciry_^Villaga ~' hip of I 1i1. Type of Permit: (Check only one box on line A. Complete line B if applicable) _ `~' ,G~New System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Petmit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New ' List Previous Permit Number and Date Issued Beforo Expiration Plumber Owner ' ` IV. T e of POWTS S stem: Check all that a Non -Pressurized In-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland Q Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatin Synthetic Media Filter ^ Leachin Chamber-- ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) ~ V. Dis ersaVTreatment Area Informatio ~ °~' 'O 4 Design Flow (gpd) Design S ' ' at' n Ras S ~ isp r Area Required (sf) o Dispersal Area Proposed (sf) ~ System Elevation . ty,~i Z'.e VI. Tank Info C achy i Ga ns Tote Gallo er of Units Manufacturer w~~Q /tr-/~D - Prefab Concrete Site Constructed Glass lactic I New Existing '~ . Tanks Tanks Septic or Holding Tank f s Aorobic Treatment Unit ~' i Dosing Chamber VII. Respon 'bility Statement- I, the undersigned, a urne rrsponsiblllty for lastallation of the POWTS shown on the attached plans. Plumbe 's a Print) ~ Plumb 's S' re MP/MPRS Number Business Phone Number /C / ti ~- Plumber' A dress (Street, City, State, Zip ode i ~~ VIII. Coun /De artment Use Onl oved A roved ^ Disa Sanitary Permit Fea ( includes Groundwater Date Issued Issu' Agent Signatu o Stamps) ppr pp ^ Owne iven Reason for Denial , Surcharge Fee) ~ ~ ~ ~.~ ~ IX. Conditions pprova / SYSTEM O ER: 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 codelordinances. Attac4 complete plans (to the County only) fur the rystem on papa nut kss than Sl/2 x 1l luchw la sixt- SBD-6398 (R. 01/03) ~y~-G ~.~~la.57~0/yl ~s ,////,:~,~ Tom/ - l ~i.Casonl G~(/-1 S~~/~ ~_` ~/ O~ / ~''/ ' fi'c/as e.~/ --~~/r.~r-/ ~~~~- ~s~ v~'/ ~~tlc_ - ,~-C /~ o ~ ~ '--yam' .scr~ ~f ~a~5 9~'' S ~ ~~,~ ~--_. q~.~s ~ n ~ _ _ ~ 3 toss ~ .3, /d.~. s r4a sc -_ _ g.~J ~ ~ io~9~ T~epasao 33~ 5 , S' ovEl/ ~ ~,~~ -s~sfr~ ,mil 9~ 5r ~:pe,~~ o~ ~~- ~~ ~ ~ ~-~ L.. ~ G ,~.c,t°~7~os~ ~~,t~sa.J G~1` S~/L ---~ ~~~ 5~~~~~1- s tc /3 - T~~?9~t/- ~Q/~/r~J >`yC4L~S D~ ~~"",t~,,~,~~~~- ~,~ of .'~ ~~ .~d~. ~ ~,~ g9,as- _ __ --- --- --~ /~ /r~GS //l~ do /~epasao wk~ ~ o:,c~: ~`_ t-- 3~ _ ~~ ^ 1 0? /+Qc~ihsF--~ ~~-~ it ~/ 1, ~s S,~~f,~ ~~,ar.~o~t/lvc~s s~ ~ 4~ .~C -sl ~„~~~ 9 q~i.is~ /~.~. s /a~~~ ""`~_S s~~,~-~ ~ 9s. ~°" j/ ~,f<,~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 1054 Page 1 of 3 Steel Soil Service County Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must St. CrOOc include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. (J Zo- ~ /(f/in~~ f~j(3 L~ Please print all Infon»at/on. R y tSe~tYCt Date Personal information you provide maybe used f secondosrssfP~vpgy~Layy~s. 15.04 (~) (m)). ~~v ~/a7 (~ Property Owner ~ C 11~, ," Pr rty Location ~aCasse Development , Inc. ~ ~ ~ 1 Govt. of NW 1/4 SW 1 /4 S 13 T 29 N R 19 W Property Owner's Mailing Address 4 2 ~ ~ 2 Lot Block # Subd. Name or CSM# 573 Cty Rd " A" 6 na Alexander Meadows ST. CROIX COUNTY ag Town Nearest Road City State Zip a Phg~J~y~~~FICE ~~ ~ City _ ; Vill e Hudson WI 54016 715-3 - Hudson Alexander Rd. ice' New Construction Use: ~, Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or c~nmercial -Describe: Parent material Glacial Drift " -/ '~ ' ~ P~-P " ~ Flood plain elevation, if appli le na ~ Jd Q~~ '~ ~ L ? 2 5-~- iG~-~ `- -- /L- ' General comments f,GC'C~C ze / d r -~ ~- S T~t~ I2!d and recommendations: system elevation 100.95 ft, trenches spaced and depth to code 4.00 ft below grade .3 ~, Y o Boring # Boring 96 V_ Pit Ground Surtace elev. 104.55 in• Soa Application Rate ft. Depth to timi6ng factor Hor¢on Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlRZ 'Eff#1 'Eff#2 1 0-7 10yr4/4 none sil 2msbk mfr gw 1c .5 .8 2 7-30 7.5yr4/4 none scl 2msbk mfr gw 1f .4 .6 3 30-50 7.5yr4/4 none sl 2msbk mfr gw na .5 .9 4 50-96 7.5yr4/6 none sUls 2msbk mfr na na .5 .9 lod- yf , cf3 z` C~ , Horizon # 4 has stratified layers /'"=~ ~ ~ ~. ~p !~- ~~~ Boring # _ : Boring A! Pit Ground Surtace elev. 104.55 ft. Depth to limiting factor 96 in• Sod Application Rate Horizon Depth Dominant Color Redoz Description Texture Stnicture Consistence Boundary Roots GPD/ft= 'Eff#1 *Eff#2 1 0~ 10yr4/4 none sil 2msbk mfr gw 1 c .5 .8 2 6-14 7.5yr4/4 none scl 2msbk mfr gw 1f .4 .6 3 14-32 7.5yr4/4 none sl 1 msbk mvfr gw na .4 .6 4 32-96 7.5yr4/6 none sUls 2msbk mfr na na ~ .9 Horizon # 4 has stratified layers Effluent #1 = BOD 5> 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mglL and TS5 <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 540 8/2/2002 175-246-5085 Property owner Lat. rise Development , Inc. Parcel ID # Pending Boring # _.- Boring • ~~ Pit Ground Surtace elev. 99.55 ft. Depth to limiting factor 96 in. xizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary 1 0-12 10yr4/4 none sil 2msbk mfr gw 2 12-20 10yr4/4 none sicl 2msbk mfr gw 3 20-36 7.5yr4l4 none scl 2msbk mfr gw 4 36-55 7-5yr4/4 none sl ~- 2msbk (~ mfr cs 5 55-96 7.5yr4/6 none sVls 2msbk mfr na Horizon # 5 has stratfed layers Page 2 of 3 Soil Application Rate toots GPD/fP *Eff#1 *Eff#2 1f .5 .8 1 of .4 -6 na .4 .6 na ~ ~ / .9 na .5 V .9 Boring # _' Boring 15 99 th to li De ft miting factor 96 i /~ Pit Ground Surtace elev. . p . n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *EtT#1 *Ef(#2 1 0-12 10yr4/4 none sit 2msbk mfr gw 1f .5 .8 2 12-18 10yr4/4 none sicl 2msbk mfr gw 1 of -4 .6 3 18-27 7-5yr4/4 none scl 2msbk mfr gw na .4 .6 4 27-5 7.5yr4/4 none sl 2msbk mfr cs na -9 ~ ~ G 5 50-96 7.5yr4/6 none sUls 2msbk mfr na na .5 -9 Horizon # 5 has stratified layers * Effluent #1 = BOD 5> 30 < 220 mg/L 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. )f you need assistance to access services or Boring # !Boring _ -- --- - - Page 3 of 3 STEEL'S SOIL SERVICE David 3. Steel 1564 Cty Rd GG CST-PdWTSM LaCasse Dev., Inc. New Richmond, WI 54017 L1C. # 248956 NWl/4,SW1/4,S13,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715} 246-5085 Alexander Meadows, Lot 16 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. 202 ~ ~~.y~ f~ sy~~.~,...._ w. ~'~ i3 ^~ t~~ F~. ~~z~~f-~ ~h ~., ~' Za Z" S~ -~ ~~~~ a / _ ~ 'I 'To~a~ I/2~' ~VL ~~~'~' ~~ Bari r~S 13ori n~ ~'(eva.~~'o~s Bl , /o ~. S5~r X33 = ~s.5~r -N ~?' ~~~ I?' ~~J ~5 ~ ~f -! 12 a- 2oz' POWTS OWNER'S MANUAL & MANAGEMENT PLAN.. , Page „~ or~ FILE INFORMATION Owner ' Permit # 2. Z-• , DESIQN PARAMETERS Number of 6adrooms O NA Number of Publio Facility Units ~NA Estimated flow (average) al/da Design flow Ipoakl, (Estimated x 1.5) al/da Soil Application Rata ~ al/da /ft~ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Graase (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220. mg/L O NA Total Suspended Solids (TSS) -5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mgil Total Suspended Solids (TSS) S30 mg/L ,1~ NA Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Ye in dia. O NA Other: O NA *Values typioal for domestic wastewater and septic tank effluent, MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septfo,Tank Gapaoity ~ ~~. ~;; , !: al O N< Septic Tank~Manufa0tt~ror~~i~t~ -~ ~` . t:r : O NF, Effluent Filter Meinufacturor ' ~ ~ ~~~' ~ ' ~ O NA Effluent Filter Model O NA Pump Tank Capacity al ,S(NA Pump Tank Manufaoturer ~; ~ r~ ti Pump Manufacturer j~`NA Pump Model „ . ,;. ,.. , . ~ ANA Pretreatment Unit ,: j~NA O Sand/Gravel Filter O Peat Filter O Mechanical Aeration O Wetland O Disinfection - ~ ~', Q Qthers , Dispersal Ce(lls) O NA ~' ~In-Ground (gravity) O In-Ground (pressurized( O At-Grade O Mound O Drip-Line O Other, Other: ' ' O NA Other, -, , ~.. O NA Other: O NA f; Service Event Service Frequency Inspect condition of tankls( ~,; ~, , At least once every: ~.: month a ~ ,,; ear ~s ,,~ , lMa~tfnum 3 y*ars) O NA ', Pump out conteMS of tankls) When combined sludge and scum equals ono-thirtl,lYe) of tank volume - O NA Inspect dispersal ce(lls) At least once every; -~ ^ month(s) ~"' (Maximum 3 years) ~ earls) O NA Clean effluent filter At least once every: O month(s) earls( O NA Inspect pump, pump controls & alarm At least or-ca every: ^ month(s) O earls) -; .; . -~NA Flush laterals and pressure test '~~ ' At IeasT once every: month e~.~,'~; ~ fi :rl;`-: .~ ~ ~=~~!~~ ~ ~ O earls) ~9QJA Other: At least once every:. O month(s) ,;, O earls( O NA Other: Q NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shsll be made by an individual oarrying ono of the following Iloenwa or oertiflcations: Master Plumber; Master Plumber Rearioted Sewer; POWTS Inapeotorj POWTS Maintainer; Septage Ssrvfoing .Operator. Tank inspections must inoluda a visual inspection of the tankls) to identify any missing or broken hardware, identify any oreaka or leaks, measure the volume of combined sludge and scum and to check for any bank up or pending of effluent on the ground surface. Tha dispersal ce(lls) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending of effluent on the ground surface. The pending of effluent on the ground surface may indicate a failing condition and requires thu immediate notificatipn of the local regulatory authority. ,. -~ ---• - -- - - When the combined aocumulation of sludge and scum in any tank equals env-third IY,I ,or more of the tank volume, the entire contents of the tank shall be removed by a Septago .Servicing Operator and disposed of in ~ppor~ance wf>4Ft chapter NR 113, Wisconsin Adminlstrativo Code. `" ; `~t"! ;t - a ' ~ - •'.'{`d .~„ ::. ~'.. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any sorvfoing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of ovmpletion Of,an~ service event. ,.. :;t:~ OMW I~+/O1) Pa9e~ of START UP AND OPERATION • For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products, or other, chemicals that may impede the treatment process and/or damage the dispersal oelllsl• If high concentrations are-detected have the contents of the tankls) removed by a septage servicing operator prier to use. ,.~ Y, y _, , System start up shall not occur when soil conditions are frozen at the infiltrative surface. ` __ .During power outages pump tanks may fill above normal highwater levels. When power is restored the excesf wsstswater will be discharged to the dispersal celUa) fn one large dose, overloading the oelllsl and may rowlt In•the backup o~ eurfao• dlsaharpu of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servlcinp Operator pr10t'to reatorinp power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually';p~o~afln~ the pump; Control;; tc restore normal levels within the pump tank. _...,., .~ ,~,.,~• ,,, ~,.,~.,,. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwlae~dlaturb or compact, the ara~ ~.. ,v.. .,~. within 1 b feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers;'dislnfectants; fat; foundation drain Isump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides;,;trlRat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine..- , ,__ :•<. ; ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin. Administrative Code; .. ` • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.,. • The contents of all tanks and pits shall be removed and properly disposed of by a:Septagq ServioiRg Operator. - • After pumping, all tanks and pits shall be excavated and removed or'their coyara, r8r[1QXAd .a~ld:Sk.-.9;Yoid 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 takan,.,to provide. a Code compliant replacement system: ~, ,, ,. ,r, •, A suitable replacement area has been evaluated and may be utilized (or the location of a replacement Boll 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 Imes and wells. Failure to protect the replacement area wilt result a need for a new soil and site evaluation to establish a suitable replacemenYarea '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. Bettina 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 availabl@ a h0ldina tank may be installed as a last resort to replace the failed POWTS. - • . :. •~- .~._:. ~. O Mound and at-grade soil absorption systems may be reconstructed in place following 'removal of the, bi0met at the infiltrative surface. Reconstructions of such systems must comply with the rules In effect ~t•,tshat~ime.` ~ • < < WARNIN(i> > 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$UIT, RE8CUE OF A PERSON FROM. THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS MAINTAINER Name Phone ' Name . ; , ,~, s,.-, ;., .. . _,. , Phone _ . SEPTAQE SERVICING OPERATOR PUMPER) LOCAL RE ULATORY AUTHORI Name Phone Name S • ,, Phone ' '., ,,. ;f, ,; . ;., ;~.. This document was drafted in compliance with chapter Comm 83.22(2-Ibl1111d1&(f) and 83.64(11, (2) & (31, Wlsagrgkti Administrat)vs Code. ST CKOIX .COUNTY SEPTIC TANK MAINTENANCE AGREEMENT.: AN1~ , 0`'~'NCRSHIP CERTIFICATION FORM 0rvneri'$uyer ~ ~~ ~ See 1`~~r-- Sfv~ Mailing Address • Property Address ~ ~~ ~~ I I st'~e i t~~ (VCri(ication r~quircd (torn Planning Deparnnent for new construction),,,! t;ity/Slate ~^ Parcel ldcntificution Numbor ~ a~ ~ ~y ~~ "~~_ 000 I,FGAL I~ESCRiI?TIQN 1 ropcrty Location .1Y..~`L~ ''/a; S~/ ;!,, SUC, l3 , 'I' ~~ N-R E 4 W, Town of ,~ctid Sdv~ Subdivision 14 ~ e ~c ctv...a e,,, Itil c.QS.I o ,.,v S ,Lot # ,^,~~. Certified Survey Map # ,Volume ,Page # `~~'arranty Dced # ~~~~~ , Volume~~~-- ~----, Page # ,,,~„~';~~' Spec house O yes ~ no Lot lines identifiable O yes ^ no SYSTE M INT NANCE • Improper use and maintenanccof your septic system could result in its premature failure to handle wastes. Proper maintenance CVIII51ti UI pUlllpln6 VUl lllc septic taltk curry lhrcc years ur soonrr, if Herded by a licanscd pumper. What yuu put into the systcu~ tai: atl•cct tl~e 1•unction of the sclSllc tank us a trcauuent slags in the waste disposal system. The propcrry owner agrees to submit to St. Croix Zoning Dcpartmcut a certification form, signed by the owner and by s master plumber, journeyman plumber, restricted plumber or a licensed pttmper venfyiog that (1) the on•site wastewaterdisposalsysrem is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic, tank is lass thaw 1/3 full of sludge. I/wc, the un~iersibned have read the about requirements and agree to maintain the private sewagC disposal system with the standards set t'orth, herein, as set by the Department of Commerce and the Department of Natural Rcsourcos, State of Wisconsin. Certification stating that your septic system has been maintained tt~ust be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date, .. S^ ~C S/ 1`I/a `( ( S[GNA E OF APP LI ANT 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 owncr{s) of the property described about, by virtue of a warranty deed recorded in Rag;stor of Deeds Office, S1GNA URIn OF APP 1CANT DATE '"•""'"' Any information that is mis•rcprescntcd may result in the san.tury permit bring revoked by the Zoning Department. •••••• ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survoy map if reforonco is mado in the warranty dead ~. ~ ~~ f ~ i . air L.O~' 1 i wee t+a,Masa frf \~ U 2ti5' ~ 37`~ S'i'ATE BAR OF WISCONSIN FORM 2 - 1999 W ARRAIVTY DEED Do.umesu Number This Deed, made between I bc'asse Develoome>a~ilc~ a WLscattal ~__1'~ anon Grantor, and ~a.~ g,$eTastrom and Susan R. Bg eh'om• it~isb nd and e "" C,rantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the foliowirag described real estate in ro Cotutty, State of Wisconsin space is needed, please attach addendum); of 16 Plat of Alexander Meadows [n the Town of Hudson, St, Croix ountr, Wisconsin. 7 4~., 9 8 ~+' KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIK CO. ~ MI ItEC£LYED FflR RECORD 11106/2@@3 @3:30Pri MARRANTY DEED EXEMPt li RBC FEE : 11.00 TRANS FEE : lci7.70 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address WESTCONSIN CREDIT i3NI0N Cr PO BOX 308 Y RIVER FALLS WI 5k022 QZ~1411-16.000 Parcel Idenrificadon Number (PIN) This is nok homestead property (is) {is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this _~~~ day of1l~Qbet' ..?sue., ~~ • LaCasse Deveinpment, Inc. -- --- -- _ _ ._ __ ___ _ ¢~,- AUTHENTICATION ACKNOWLEDGMENT Signatures} _ -_--. _-- .-_ STATE OF 4 ~~Q`l~ _,_. } ------- ) ss. County } authenticated this day of 1'ITLE~ MEMBER STATE BAR OF WISCONSIN (if not, __ _ __ _ ___ __ authorized by § 7rJ6.05, Wis. Stats~Oger DD.pB@V®t'S 'i'HIS INSTRUMENT WA5 DI~A'P'iEi~ BY" ~~~~C Attorney l~ristina_Ogtand _____ Late of W iseonsin Hudson, WI 54016 4. ___ _'N _.,___._._ (Signatures may be authenricated or acknowledged. Both are not necessary.) " Names of parsons signing in any WARRANTY DEED Personally me before me this .3~ day of _ _ 2003 the above named 8etvbeti ~ _ - La se Development, Inc., s^1'Visconsin Corporation by ___ its _,!_1 •• ' ~ _____.__.._ ---- - -- to me known to be the persons} who executed the foregoing instrument nd ackn d the same. _-._ _ ..- ~, • __..__. •___. ~~__r_.___ No blic, S ee of __ T_._____ Commission is germane . (If not, state expiration date: ~` ,~.~-> must Ix typed or printed below their signaldre. 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