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HomeMy WebLinkAbout020-1376-12-000 c a~°i °o y ~ ~ ! N a ~ ' o ~ ~ ~ O p L L ~ i N f- N ~ O N M p ' L ~ N 3 y ~ w c ~ ! a ka Q ~~Oo ~ ~ N n UO c •- ~ m a. a u, c o ~ ~ c p •- a p ~ N ~° ~m m -o o ~a.pc ~ c Z p ~ v 3 LL N C = =O N c 'p o ~ 3 ~ m ~~~'~ Q 3a a ~ 3 ~ ~ o 0 > ~ > Z N ~ w ~ = ~ Z O O y 4 C O ~ ~ ~ ~ ' z °' w ~ !, a m ' E m ~ ~cn i °'a ~ ~ c c~• C U' ~ ~ N O Z`" ~ ~ 0 c C p O O N N a i Z ~' In I- ~- ~ I c ~-a~ ~ ~ N ~ c m N N I I N ~ ~ C O ~ i ~ ~ N ~ N ~' d ~ d a O c m 0 ~ Z Z Z N ~ :: _ '. ~ y y N ld ~ .. R - d ._ N T a f4 ~ L Q {~ W d d i 'c L m N ~ oa ~ ~ ~ 3 ~ ~ m ~ Fes- !N- o ~ rn ~ ~ 0 0 0 a •N ~ aaa a ~ ~ O ~ ~ o ~ fn J U I A N ~ I p ~ Z O , c ~ i o m y ~ 'z3 ~ J ~ C ~ N •a m N Q ~ ~ ~ ~ ~ Q Z U) ~j ~ 00 o I ~ u~~i C -~l O ~ ~ M C r N ~ I p) ' C O r~ C ~ ~~ ~ p 7 ~ I"~ ~ ~ y ' N ' !, w ~ ~ y ~ C~ Q •~ ~ ~ p 0 ~ 2 7 i ~~ O • Z C Q. t ~ ~ .~ r ~ ~ _ ~ d V ~ `H ~ 3 i A o R t~a~ t 3 :° o ~o<nc~ Wisconsin 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)]. ermit Holder's Name: City Village X Township Reuter, Scott Hudson Townsh' .ST BM Elev: ~~, ~~ Insp.~M~~ BM Description: ~ •~ 'ANK INFORMATION /J`vJ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ !~- I Z d Dosing _ ~~ ~ r ~ ~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L W~ BLDG. Vent to Air Intake ROAD Septic ~ 5" ( V , r 3 ~ 1 ~ stn S Dosing Aeration Holdin g PUMP/SIPHON INFORMATION ~'-y2~ , Demand GPM Ft to County: St. CrOiX Sanitary Permit No: 405053 0 State Plan ID No: Parcel Tax No: 020-1376-12-000 STATION BS HI FS ELEV. Benchmark U~.' qq+ / 1 .f0 Alt. BM ~~ off' td~~ (.'i oZ. Bld er S ,~~~ 5- p ~ 3 SUHt Inlet ~~ 7• SUHt Outlet ~~ ~, I / ~ 9 C r Dt Inlet ~~ ~ Dt Bottom _/ Header/Man. Dist. Pie ~ ~ ~ Q,yn / ~2 GJ'S , Gj (~( Bot. System .~ ~S.O Final Grade ~ ~~ oaf- ~ • ~ 9. ~' ~ r St~ ~ ~ 2. s ~ • ~ r r (- fW ~.Q SOIL ABSORPTION SYSTEM ~ ~( BED/TRENCH Width f Length ,/ ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Q~ S V ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHIN Man er: INFORMATION CHAMBE OR (~ FV Ty Of System: ~~ ~ ~ ~ I / T Model N berms /~^ ,~ ~ ~ r11~FI71'{211T1('1N CVSTFM IM.rn ~l S /~WI tw -~ eader/ nifoldVl / Distribution ~/ " x Hole Size x Hole Spacing Vent t ~ir~t ~ e /I t 'S I'~ ' ~ Pipe(s) 1 ~~ Length Dia Dia Spacing Length cnu rn\/Fa .. o-........-,, e.,~Es..,~ n..i., ..., nn~~~n~ nr nr_r;rarra svsrems unw Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~! Yes I, No `_s,., _ ~~ Yes ~~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~1 G~/~~ Inspection #2: / / Location: 959 Fraser Lane Hudson, WI 54016 (SE 1(4 NW 1(4 14 T29N 9W) Sweet Grass Farm Lot 12 Parcel No: 14.2 .273 1.) Alt BM Description - ~j ~~, 2.) Bldg sewer length = "~?~-~~~ .J // ~., -amount of cover = ~ ~ ~~ ,~ ~~S ~r714~ Plan revision Required? I Yes Ie;_ No [ ~ ~ ~ I; Use other side for additional information. ___~__. I J L_ __ _ _ _ _ ----- ~ ~-- Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County ~ ~ ` ,~CO~~~~ Madison, WI 53707 - 7162 Site Address De aftment of Commerce Ste- -O Z- ©~~~~ ~" Sanitary Permit Application ~~ Permtt Number In accord wide Comm 83.21, Wis. Adm. Code, personal ' ormation you provide ^ Check if Revision ~~~ ~~ rna be used for ses Priva La , s I. Application Information -Please Print All Information CEit VED - Stan Plan I.D. Number Property Owner's Natne APR26 Parcel Number ~ O O - - •O Property Owner's Mailing Addres S R01 C Property Locati o n Y N1N `! ', '' S 14 lr~: S T N, R E City, Siate Zip ode Phone Num Lot N er Block Number . Subdivision Name CSM Number ~" .5S ~ rs- ~ - 9 G~ II. Type of wilding (check all that apply) ~ ~ L`?~ S~ rZti'n 6Y1~.~~'i~/ti OCiry (~ ~ ;~.h ~.1 or 2 Famt7y Dwelling -Number of Bedrooms / ;,~ ~~~~ ~~ ~e Y"~~~ /~ ~ ^Village ^ pablic/Cot»tttercial -Describe Use ~~ .~ '-^~``~. X ~'~-'~'-'~- ownship ^ State ~~ Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ew 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use stem Tank Onl Ezis ' stem Permit Number Date Issued B. ^ Check if Sanitary Permit Previously Issued PP y ~ ~~G' v/ /'/-. ~; l[V. Type of Permit: (Check all that a l)(numbe scheme is for internal use) ~'~ ~"E'~~ - ~ ~ '_ ~ S lLL 44 ~ Non -Pressurized ht-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed Wetland ~/ • ~ .CSj' ' ~ /~, ,~ _' 126 ,(~~S 1 22 ^ pressurized In-C,round 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line ~~~~~ ~ . ~~ 3 ~'~~ ~ . ' 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other D' rsal/'IYeatment Area Information: c~ r' ~ -: _ - ~ r_ ~ r 3 r~ ~ -a`n7~~''% ~ V . ~~ Flow (gpd) Dispersal Area Dispersal Area oil Appiication Percolation Rate System Flevatign Final Grade ?r' YVI-"~/ur.. IIevation ~ ' Rate(Gals./Days/ (Min./Inch) ~ ~3° Wo~~L_v T-=, -~ , ~~~ ~ ~I (v l Co +p /~/~ ~ ~->L, v 4 ~ ~~ 7~ ~ O O V VI. Tank Info (:aIracity ~ Total Number M c Prefab Site Steel Fiber Plastic Conccete Constructed Glass Gallons Gallows of Tanks New Existing Tanks Tanks Septic or Hokliag Tatilt ~ Q ~ Dosing Chamber VII. Responsibility Statement- I, the unde ed, asslmle respo ility for ' lion of the POWTS shown on the attached plans. Pl r' N e (Print) Ptum Si MP RS Number Business Phone Number ~ ~ r _ aab3s ~ ~ is - a` a - 6 ~ phimtie~~ ddress (~ t, City, S ,Zip ~, VIII. oust / De artment Use Onl Sanitary Permit Fee (includes Grotmdwa Date Issued Issu' Agent Sign~03re (No Stamps) Approved ^ Disapproved Surcharge Fee) _ C~J ~ ~ f h ~~/ G~ ^ Owner Given Initial Adverse ~ ~~ ~ Z ~ ~ ir/j/ . ~ Determination IX. Conditions of Approval/Reasons for Disapproval ~ ' ~ ~ c*r~, ~ . ~~ -~-t ~ ~a.~~ ti~-' j ~~ `$~'S~2y,-' ~' ~ ?~ ii ~ U'' ~ ~/ ~ ~ ~ ' C~~t/ , l~ ~ ~ ~ /" ~ iy .~~ ~ .- ~' ~ ~>v7 ~ ~ (O ~ ~ -~~ /~~r ~~ ~,~ ~.~~C ~,~7~yT ray ~~, -Y.~-4 ~.c ~ _ ... s, ._-„ ~ 1-:: ~,~_ _. _. i , _.._~ ~ i-_., _. ~ -, .>' i.:i -:1.7-' a~L 2~ /7~~d I ,~~' l~l~--f L%/~A.:' "' /T/°NU/~~~y Attach enmplde plain (to the County ody) for the system on paper not less than SI/2 x 11 toches m Sze SBD-6398 (R. OS/Ol) ~- / ~-- ~~.~ N o ~-~ ~~- to ~ ~.~ . ~ ~ -h`.~!n-__-_ _~----_ r ~. y~,~~ .~ la 8D c~-- i ~ I=~flO ~~ i ~ ~s ~" j~/~aao ~T ;~- .~, ,;}~ ,~ ~~ ~~ ~scons n department of Commerce SOIL AND SITE EVALUATION Page ~ of Division of Safety and Buildings 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 ~- C„Q.+~ ~ ~C percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel LD. # ~ ~ Gj `~~~~~ ~~' -__ -,.~ , a,•'' _ ,y ~e -- ~' f i to - RMATION Pl Mr i~ LIC T INF ie b R Date -r ease n a v n. i - l APP AN O a we y ey ~~ ` ~ ~ / - 'j ~ ~ Personal information you provide may be used for se dary,purposes (f~ivacy Law, ~. 15.04 (1) (mp. ~? .a. ' ~ ,~,, ~ 'f'r t P F : .'~~f~~ Property Owner Property Location `~~ ~ ~~~ Govt. Lot 1/4 1/4,S T ,N,R E (or) W Property Owner's Mailing Address ~ , r ~" ~ ~ ~ ` ~? .~ Lot # Block# Subd. Name or CSM# S s ~ ~~ Y~ r : ~ , ~z L~.e~- U City State Zip Cod ~ PhQ a Eldr' 'vY?~ia ~~ ~ ~~ ~ City g [~. Town ^ Villa e Nearest Road C~ Cc%'f ``tOf ~~ `~ 15 )~-{.F~Z 6 rG . p Cn . ,..,. .. n ' ' '~>`~ I New Construction Use: ~ Residential / Nur~itrernf~b8~rooms 3 y 'Addition to existing building Replacement ^ Public or commercial -Describe: Code derived daily flow ~ ~~ gpd Recommended design loading rate ~ ~ bed, gpd/fl2 - ~ trench, gpd/ft2 Absorption area required S7 bed, ft2 ? SU trench, ft2 Maximum design loading rate ~ ? bed, gpd/fiz • ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) q~•~~ ft (as referred to site plan benchmark) Additional design/site considerations~~9~' ~~ Parent material ~ U'fw-~-5 /'1 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 ~ ^ U ~S ^ U [~S ^ U ^ S U ^ S ~ U C(111 f1FSCRIPTIAN REPORT Obi, u~~ ~0 Z(°.,-I Horizon Depth Dominant Color Mottles Structure i B d R t GPD/ftz in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. stence Cons oun ary oo s Bed ,Trench ~' ~ I6 3 ~ Z - ~ ,~,.~ iN~'F L 1 J F Z Z i3r~ (L7 ~ ~ ~'-"' S, 2v~~~~ ~e w~r~ LS , ~ yy-u o ti/ 6 ~--- iM n 1 c v ~ ~~ ~ Remarks: 1 Is o 3 1 Z '' ~ ,1 1 W.~b t cZ ~s ~~ 2 ; 3 f ~~~.1 ~' , ~'~ ~' ~. RPmarks~ CST Name (Please Print) Sign Telephone No. Address Date CST Number PROPERTY OWNER ~ % ~ v--~ SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # Ground elev. !oG .,~ ft. Depth to limiting factor ll~' _in. Boring # Ground elev. 4g. 9~ ft. Depth to limiting factor 1/0 in. Boring # 5 Ground elev. .9b tt. Depth to limiting factor 1 i~ in. Boring # Ground elev. ft. F ~ ..~, Page ~ of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ~ Trench ~ o-W 1a / 2 ~- S z ~5 ~ J F Z~ 3 Z r - -o / 4 - 5,1 Z ~ - - s 6 ~~ ~ q ~' ,,, Remarks: / f '' / `~ ~ , 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 ~ d-iy io ~ - ~.1 I w.r~ ~s I~ F ~ ~ 3 ~ 4z-ry 0 / C - - C 5 -- ~ ~ Depth to limiting ' factor in. Remarks: Remarks: SBD-8330 (R.9/98) -~ - -~ s PAGE ~ OF NAME s r ~ y'~" LOT#~Z LEGAL DESCRIPTION '/<tiw'/4,S /K TZf ,N,Rl4 E (or~i SCALE: I "_ ~~ r BM I ELEVATION ~6 O ' ~ BM I DESCRIPTION ~~ o ~ /~®p~c. pt/J~. )a+h w~G/oJ BM 2 ELEVATION ~ 1, q BM 2 DESCRIPTION+vOo-`' 1 Svc p, .~ la~6t flame SYSTEM ELEVATION qCc • I (O ALTERNATE ELEVATION 9~J~~'n~CO CONTOUR ELEVATION ~~!%~" . -r- . x I 1 1~ ' ,~ i ~,~ .5 AL f, ,i Q3 I m.~~ ~ ~n2 R ~, 4Z ~-~- DATE 7~J~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address ~~(~ ~ }~//~Q.~, ~o n ~~ L h ~ ~ ~; ~~m~J 21 Property Address ~J s ~d /6 (Verification required from Planning Department for new construction) City/State 1Iy C(~~ n ~~T Parcel Identification Number 17~CL_l ~~~ - /~ - UO LEGAL DESCRIPTION Property Location ~ ~ %4, 1/a, Sec. ~ ~ , TN-R~W, Town of ~ v Subdivision _~~~~~~" ^~ti S ~, Sri, Lot # ~,_. Certified Survey Map # Volume ,Page # Warranty Deed # ~~ ~jC~7 Volume ~~,~, Page # U Spec house ^ yes ~` no Lot lines identifiable l~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property-owner agrees to submit to St. Croix Zoning Department a certification form., signed by the owner and by a masterpIumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standazds set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the thre ear expiration date. /07 / ©c~ S GNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are tnie to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT / / DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with tf~is application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner C' Permit # J , ~ ~i DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~d gal day Design flow Ipeak-, (Estimated x 1.5) 6 gal/d ay Soil Application Rate (( \ l/d y/ff , a Standard Influent/Effluent Quality Mo I erage* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (GODS) <_220 mg/L ^ NA Total Suspended Solids (TSS1 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) <_30 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) <_10° cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Ocher: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer - (~d ^ NA Effluent Filter Model ~ ^ NA Pump Tank Capacity - al ^ NA Pump Tank Manufacturer ^ NA Pu p Manufacturer ^ NA Pump Model ~ ~---- ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disi ion ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cell(s) In-Ground (gravity) ^ At-Gra e ^ Drip-Line ^ NA ~^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA a M~INTFNONCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s- At least once every; p~ ^ earl 1(sl (Maximum 3 years) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal celllsl At least once every: ^monthls- (Maximum 3 years) ,.year(s) ^ NA Clean effluent filter i At least once every: ^ yea~ls s) ^ NA Inspect pump, pump controls & alarm At least once every: ^monthls) ^ yearlsl ^ NA Flush laterals and pressure test At least once every: ' ^ monthls) ^ yearlsl ^ NA other: At least once every: ^ month(s) ^ yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing 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 completion of any service event. Page 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 cellls-. If high concentrations are detected have the contents of the tankls) 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 fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to 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 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; condoms; 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 and properly disposed of by a Septage Servicing Operator. • After pumping, all 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 soil 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. < <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 RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone ~ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name w Phone - ~ Q This document was drafted in compliance whh chapter Comm 83.2212-(b-1111d)&If- and 83.54(1), 121 & 13-, Wisconsin Administrative Code. U 1875P `181 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED 6 ~ 6 8 I¢' ~ KATHLEEN H. MALSH ' REGISTER OF DEEDS Document Number ST. CROIK CO. , MI RECEIVED FOR RECORD This Deed, made between __ RICHARD 0. STOUT and JANET P. STOUT, _^ 04-22-2002 9:30 AM husband and wife, _ _.- uRRRtaftTY GEED _ _ __ _ _, Grantor, E%EMPT / and _,. SCOTm it ctF.[TTFR and SHFRRT RF.[iTFR~ _ __husband and w f ~ as survivorshi mar REC FEE: 11.00 P ~-~-Rr~t3' TRANS FEE: 158.70 _ __ _ _ _ COPY FEE; Grantee. CERT COPY FEE: -- -- - PAGES: 1 Grantor, far a valuable consideration, conveys and warrants to Grantee the following described real estate in St l'rni x County. State of Wisconsin: Lot 12, Plat of Sweet Grass Farm, Town of Hudson, St. Croix County, Wisconsin. Name and Return Addrass _ / , ~~~ Y 2 -qC"{' ~E:s~~`ci~_phh~~y ^,~ tray ~,, ".".~ "-x ~~ Rylf1W µ~ilV BRiul~l ~~ j h~N ~1i2 020-1376-12-000 Parcel Itlentification Number (PIN) This 1s nOt homestead property. (is) (is not) Exceptions towarrannes: easements, restriction, rights-of-way and covenants of record. Dated this 1 9th day of Apri 2002 n ~(~ rf ~~, ~ .L I `k°~~ \~ ~~~ (SEAL) ( ffL2`-'~' ~` (SEAL) \.. t Richard 0. Stout `Janet P. Stout __ (SEAL) AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (IF not, authorized by §706.Ofi. Wis. Stats.J THIS INSTRUMENT WAS DRAFTED BV Janet P. Stout 1353 Awatukee Tr. Hudson, WI 54016 ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St. Croix County. Personally came before me this 1 9th __ day of April 2002 ,the above named Richard O. Stout and Janet P. c i-r,,, t _ -- C' to me k t be ecuted fore obi ~R4R1AR5-.t-~~~~ {~ - ~_- R g Not ry Public. State f Wisco~n~stn My ommfsslon is per~~m~~an~~ent. (If not. state expiration date: (Signatures may be authenticated or acknowledged. Both are not _.__ .~g~~1~- necessary) Flafary- ~ubs~c ' Names of persons signing in any capaclry must tx rypcd or printed below their signature. f W~SCOrtC ~9 STATE BAR OF WISCONSIN estate O 'wRtdh'1i~ Legal Blarik Co., inc. WARRANTY DEED FORM No. 2 - 1998 ~iarbara ,• Burke Mawaukae, wis. ~ ~ ~~ ~~~ ~ ~~ ~ .,. ~ ~,~~ • ~ ~ `",~ ~ ~•. ~ `~ rpT .. ~~\ ~ n ~~ ~ ~ i ~ +V r-- ' N ~ O W ~ ~~ ~ ~ ~~ ~ - ~~ A ~ a ~ ~ ~•~ ,~. r $~ r ~~ O '~~ N ~ ~~ ~•~ a1AL~6 ~ `~ u o~ ~ g o N r ~ ~~ O !~ ,~ ~~ r W ~ ~ ~~ ~, ~~ a _i _ _ O ~ O d (D ~ ~p n N o 7 a ~ Z N (Q ~ W m c n - O ^. Z O ~~ (p C d ~ a o' m W ~. O s m (0 C fD m ~ a C ~ ~ -. ~ N ^-" ~ - N O z am o N O N c °' 3 0 m 07 ~ CSC ~ --I ~ N Q 7 S C ~ N ? N O C y fD 7 N f/1 O 69 ~ O ~ O d n<nO c :: ~ ~ ~ ~ ~ ~ A ~ :'•' o a .Z7 ~O ~ U7 ~ w O a °' m ~ a r o ~ ~ ~ o CD N = N C O_ N N j ~ ~ 'o ~~~~ ~~~~ ~ o v A m A rdi N 3 .°'. m 3 D D m Ul V1 C N~ a 7 O C a ~ ~ a 3 C •'•' 3 ~: Z f A T C 3 a 3 ~ c ~' ~ ~ ~I y ~ c"D ,~ i! C ? O a IV O ~ ' ~ v ~ ~, O N N ~ W O °, °o N O C 3 :~ a .. N ~ fD m d N N i v' ~_ --I fA A Z n J ~ M ? ~ 3 m ~ ~ A Z .P d A rt A:. A'+ A~ '~ i h~l `~ O K ~. 0 O • ~• a4 O tr. x A O~ A 'c ti a N O O A A. O A ti ti ti ti Parcel #: 020-1376-12-000 02/16/2005 10:23 AM PAGE 1 OF 1 Alt. Parcel #: 14.29.19.2273 020 -TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner * CLINE, BRIAN H BRIAN H CLINE 959 ERASER LA HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 959 ERASER LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.760 Plat: 2530-SWEET GRASS FARM LTS 1/78'00 SEC 14 T29N R19W PT SE NW SWEET GRASS Block/Condo Bidg: LOT 12 FARM LOT 12 2.760AC EZ-U-1558/119 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-29N-19W SE NW Notes: Parcel History: Date Doc # Vo!/Page Type 04/08/2004 758983 2544/79 WD 04/22/2002 676807 1875/481 WD 08/31/2000 629124 1539/081 WD 08/25/2000 628820 8/8 PLAT 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 50172 200,000 Valuations: Last Changed: 06/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.760 49,900 104,800 154,700 NO Totals for 2004: General Property 2.760 49,900 104,800 154,700 Woodland 0.000 0 0 Totals for 2003: General Property 2.760 49,900 104,800 154,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00