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HomeMy WebLinkAbout020-1376-43-000,* ~L: F~~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal Inrormatlon you provice may oe usCU iur sewnuary purposes ~rnvacy yaw, ~.7D.V4 (1 J(m)). itoutt,~icYiara~ne: a city u'N'u~sbinT~'"ovPinship CSt BM Elev.: Insp. BM Elev.: BM Description: 4rA~ Ocwe_ Cs~7' TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic („~ Z Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic ~, g-D~ 26 r '~ NA Dosing NA Aeration NA Holding ELEVATION DATA count~t. Croix 5anita~~r~riis,No.: State Plan IyyDs INo.: Parcel~~~N~ 376-43-000 STATION BS HI FS ELEV. Benchmark ~, p (. D ~ 'Or ~,,,,,~ S`Ir' Bldg. Sewer y •~ x, ate- S• ' St/ Ht Inlet (o. qt $~ St/ Ht Outlet ~-• ((~ g c.(' Dt Inlet Dt Bottom Hea / Mari. ~, $d r , p Dist. Pip Ory` bt~ Bot. System ~ .~„ ~,,~„ Final Grade 3.90 ' ~p St cover 3 oy. •g(p' SOIL ABSORPTION SYSTENIIt e1,. 1. ___ L._... _ ~,L.~,~r~r.~ ~p / Width W '.- Length r ~~'~ V w _ _ N . O Trenches PIT No. Of Pits Inside Dia. Liquid Depth IMEN I N r ~~ IMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manu y t rer_ 5,,~• A ` ~~/" - SETBACK INFORMATION Type O ~n V ~ •'f / _~ CHAMBER OR UNIT er: o ~ Num ~ `- • System: V~I~ S ' DISTRIBUTION SYSTEM (~1~5.•,a!'(~. e~L) Header /Manifold r Distribution Pipe(s) x Hole Size x-Hole Spaung Vent TorAir Intake length'' Dia. ~ Leng ~ ..,. ~'"F I SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded !Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ~ ^ Yes ^ No ^ Yes `~ ^ No COMMENTS: (Include code discrepancies, persons present, etc.~nspection #1 Location: 966 Florence Lane, Hudson, WI 54016 (SW 1/4 NW 1/4 14 Grass Farm -Lot 43 ~ ~~~ / 1.) Alt BM Description = , 2.) Bldg sewer length = ZS.a -amount of cover = 18~~~' ~q'~`~~r 3) ~~~ ~-h ~ ~ ~~ X11 Plan revision required? ^ Yes ~ No ~_ I.,,~I ~. Uf o r si a for addit' information. ~/D}lq f? Inspection #2: ~-~--~ DJ-R4~W) .-,1429192304 Swf~~(~'!' ..b... ~. ~ ~ ,~ ~.S yet" S~-6710 (R.3/97) _ ~ e~9 S`f+ Inspector's Signature ' ~- •~b c. $~. ~Z 9.sz 6w.t~ g.2a q.~~ ~/ ~~~~ Cert. No. PUMP /SIPHON INFORMATION r ~~'I'Z6 ,'~t-l~ ,S~Zb ZlS'b ' ~ ~/Ja'Z6 ~ ~'b 5 ~5~ ~. i ~ Z b• £!' ,~~b ~'t Shy Sn'a~ ~ ~'1 ~ ~ ~ - , ~-N :~ . .~ a~ ` "/(~ 6 ~Lo Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. 0 ~~SCOnSin See reverse side for instructiops€arportlpletingtMs application 3B07--7302 Madison, WI5 Department of Commerce Personal information you pr de lady be used for secondary purposes [Pc1V y,Lay+T;~ s. 15.04(I)(m)] - (Submit completed form to county if not state owned.) Attach complete plans (to the county ly) f , on paper rot less than 8-1/2 x 11 inches in size. County State Sani Permit N ber+ ^ htc',k'i evtsion to previous application State Plan I. D. Number 3S3 :-- ,,; I. Application Information -Please Print all Infor on . ~ :_~ ~ Location: Properly Owner Name 5T Property Location , L!~ ~, ti='~'}, i"(3l~IRNG'OFFICI 1/4' `(t'/4, ~/ Ti~9,N, (o Property Owner's ailing Address ~ Lot Number .Block Number ti ,~~ ~ ~3 Ctty, State Zip Code Phone umber Subdivision Name or CSM Number ~~ ,~ w~ yon ( ) y - II. Type of Building: (check one) !/ - a s ~ _SO,w_- Q '""' ' ~' ~S ~'~'" ~ ^ C;ry ^ Village ~s+~r. 1 or 2 Family Dwelling - No. of Bedrooms : 7 ~' F ~Z~[ L ~ ~ ~ 1 Town of ^ Public/Commercial (describe use):_ ~ _ ^ State-Owned T / .~ 3 ,1rL~ e4~'PV~ /G Szt~,~auzvL~'R ~,~LLS L(~ ,~ , ~? s- - Nearest Road 1 t X 102- S 3 3 rv.~t~,r.~. e.~S el ax N .. " III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) , a q.. R , a, Q A) 1. New 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System g) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non-pressurized In-ground ^ Mound - ^ Sand Filter ^ Constructed Wetland- ^Pressurized In-ground ^ Holding Tank ^ Single Pass , ^ Drip Line , ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. DispersaVTreatment Area Information: . Z ~ - r 5 ~ K S 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil App rcat 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft. '(Min./inch) Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete strutted Tanks Tanks ~ir~ L `"- /~ / GLI~,L~1' ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the P TS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no slam i MP/NIPRS No. Business Phone Number Plumber's Address (Street, City, State, ip Code c~tt /-KGs/- Y©~ - ~/° 2 ~ ~ ,EN ri' ~~ o IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Is wing Agent Signature (No sta~~rps) Approved ^ Owner Given Initial Adverse D i Sur azge Fee) IN . 22.5• ~ ~0 ZOp ~ eterm nation X. Conditions of Approval/Reasons for Disapproval: , ~ X4-1.( l~- ,. r~-~-~ts.H...a.~.,;. ~s~-Q- F~ l~ . L. ~ `~30 •~ t u~ ~o.~. ~.~~. tS re,SQ,~,~ s~~ ~ ~~~L 1'~ ~ is . -1'r~~ _ // _~ 0 /} r ~,QQyyq~'ytt~try'ied~ ~ p~ ~re.t,B++1.M X15, SBD-6398 (R. 07/00) r1 !' T ~ ~ ~ 7 !"~ e°~-r ~~ */ ' ~'~ Tod of 1' Pvc ~ /s+v.o ' d ~ s . ~. ~i . la/' oF' ~'~vL, ~9 s7 ` X = 6acrJ~ O = ~,~~ ~c s r. ~ _ ~~Np LoT ccyc~v~'i~S ~YG~ > Se9' /=iCOiK ssit/y ~~ of sYsr~• / ~'~ l.,c'v~G ff~~v~'ie ,?> F-,~1• G~CL is GI. T ~ Lo,rJ~ tECC ~r'cav rs ~f'.o ' 3' fj~crivr ,y~l~vnE-.rJ c,~ccs - sJ sra~~u~-.varitr ~,cy ~~ 7 ~, A '~ ~~ N ~` ~ ~1~ I ~` f/~G ~3o~v 1 t c i J i Fogerty Plambing #221180 28288 McKenzie Rd. Spooner WI 54801 (715) 635-9609. .~~ ~i y/o l o / ~ I ~ - //6G ~~~ ~~ ti ~ h ~- 1 ._ -N v~ ~` c~ ~g`yzr~ ~~~--- ~~ _~ { I I I LBT '~ Y3 I 1 ~~' I I I r , 1x h e^ N 1' ~ I ;. ~; ~ , s'~ s ~ ~~~ -~~ scjt~ t p= s~ ~ ~ d~ */ _ ~~ ~~ of 2' Poc ~ /~ o . vL( +e i ~ .qtr, ,~•~ , Ia~+ of ~'~v~, 9ys7 ' X = ,6cKs,~~ • = Fa~vdp LcT c~yc.v~'i3/S = c~'~, > so' riCO~ ss~vy ~c/cT of sYsT~• ~'~ L~Yi,~"L ~'~D,ER 2>F,i1• GFLG ~S GI• T ~ Lo,rJL c~GC a-oav rS ~'f'.o 3 ` jJ~rcriv~ ~~l~acfrJ ~~ Sf frA~'~cu-.r~0~~t a~oy ~~ z ~, la I „c N 1w~ ~, ~ ~ I ~, ~ c~ ~zr-- ~ ~~ ,, ~ - - - ` ~I I I 4 N wo. ~ __---- I X30.0 1 I c , rn' t ~ i ~ -~ I I ,. lmj ~ ~ y2' . r Z~ ~~~a~ Fogerty Pldmbing #2211$0 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609. ' .~~ /`~i y/OG~o / ~ I ~ - //6G -c 1 1x h ," I ns Department of Commerce SOIL AND SITE EVALUATION Division bf Safety and Buildings Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less tttan 8 1/2 x 11 inches in size. Plan must ""`' include, but not limited to: vertical and horizontal reference point (BM), direction and ~--~ , ~ r~"j t` percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # i.~ ~ ~ ~.~ APPLICANT INFORMATION -Please pri aiR ,' Srmatldn. Reviewed by Personal information you provide may be used for second pv„rposes /IPrivLa, s. 15:04 (1)-(m)). r~ ~-.. Property Owner ~,.-,r s ~,. Property Location Page ~ of Date E (or)~ ~~C~Q>'U u~ s ,. Govt. Lot Sw 1/4~(j~ 1/4,S /Gr T ~G~,N,R Property Owner's Mailing Address ~;~ - Lot # Block# Subd. Name or CSM# I 5 ~~4-~-u11. ee r - - u>e~ ra3S City ' ` \~\ ~11~~ ~~ lStat\~e Zip Cuode Ph-7one Nuu~Dtf~v~~ I~'~' ='`= W ~ t ~ ~ ~p ~ ' l i J~ ~~1 ~ ~ - t0~ I' , '~ f~ity -~' ^ Village A ®Town LY S U ~ Nearest Road ~~U/t Vl C~ ~a /- Q [~ New Construction Use: ®Residential l Number of bedrooms 3 _ ~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: C Code derived daily flow ~ gpd Recommended design loading rate bed, gpd/fi2 6 trench, gpd/ft2 Absorption area required ~,SZ_bed, ft2_7 S~ trench, ft2 Maximum design loading rate bed, gpd/flz_~ c~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ~y' ~~ ft (as referred to site plan benchmark) Additional designlsite considerations ~y $a ~// Parent material ~i (r~cv ~ S ~ Flood plain elevation, if applicable /~/ fi'- ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ®S ^ U ~ S ^ U ®S ^ U ®S ^ U~ t, ~ ^ S n®U ^ S r®~yU CAII 1'1FSCRtPTION REPORT N ~ .~ ln~ ~7 ~ ..Qt. ~ . ?-0Z30 ~ C't~-, Boring # Ground elev. . 7~ ft. Depth to limiting factor i2U in. Boring # ~. Ground elev. ~~ 3dit. Depth to limiting factoc~r !f`1'in Horizon Depth Dominant Color Mottles Structure d B R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary oo s Bed ,Trench i ~-r2 1~ r31z JAI Im~bk c lv-~ ~2 ~ ~3 2 ~Z-~ ~ t y - ~ ~ I Ir,-~bk ~~ ~ ; - .~ ~ - ~ 3 r so ~ s~) 2 k ~~ ~~ ~ - I r ~I ~' m~ a ~ ~ '. . ~ ; R`~.a r 4$~to`f , Remarks: I 0 l~ 12 r-- 3i I ~ YYl'a~~ GS I v~ . Z ' - .~ Z iZ-2 ! y r-- 5 ~ 1 2 m ~ ~ - ; - ~ 3 ~-s~ 1 S -- s. k m~' ~-~ `- ~.- ~ . ~ ~ ~-I I `i t~ --- ~ ~ s - .~ ~ . g fo'S-. (., ~ . (, , Remarks' CST Name (Please Prin/^t-) lure Telephone No. Q W~ ~CNI V VVIU. ~~-~ G `7/52-! 7 - yGGB" Address Date CST Number 2 r~3 ~~~ -~ sG ~./s~-~- ~, s- yo zs- ~,' y- ° ~ zs 3 3 G y PROPERTY OWNER S (y y ~ SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # a Ground elev. ~.5~ tt. Depth to limiting factor lZc~ in. Boring # Ground elev. ~. 70tt. Depth to limiting factor 11 in. Boring # 5 Ground elev. ~$Qft. Depth to limiting fac~pr 11 `~ in. Boring # Ground elev. ft. 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 ~ ~ -~~ ID ~ Z `mil I ~ b I- tYr c~ i v y . 2~. 3 3 -~ t~ 5 `._- 2 t~ ,~~ ~ 5 - ~s ~ ~ y ~~0 1 - - ~ I ~ ~ .-~ ~ . g Remarks: I o-is /v 1 Z ~--~ S"~ Inr-~ m ~r c.S I v y - Z'~ 3 Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/fl2 in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. ry Bed ,Trench I d -! Z (~ Z ~--- rn-P r L 1 v~ . z~. 3 Z z-zl ~ I -~; c~ - . s ~ ~ 3 lD '- ` I m~ ~ c 5 --- y =, y -- d tirr-, ~ ~ - . ~ ~ ~ 8 Remarks: Depth to limiting ' factor in. Remarks: SBD-8330 (R.9/98) PAGE~OF~ NAME ~S'IZ7c•~ LOT# y3 LEGAL DESCRIPTION .~'/a,l~e!'/a S/Y TZ~/ N R /9 E (or)b SCALE: 1 "_ /lkS BM I ELEVATION ~O(j •C~ BM 1 DESCRIPTION~p „~ ''per ~; p.e, BM 2 ELEVATION ~ ~ S BM 2 DESCRIPTION tp p ~ Z ~• ~c- (~~ O~' U ~ SYSTEM ELEVATION GIq(. ~S~cU ALTERNATE ELEVATION d Y• Uv CONTOUR ELEVATION ,(/ jA. -~ ~~ t -+~- /b S (upe. D~ X32 8~3 • • 5 4' t,+~ 0M ~~ ~~ ~ ,nom ~S ~ i l~'°~ ~~ ~ w I v ~ t ,~!"- 1 ~ ~ ~j9" ~, ~a},, ' t ~'~\,p~ 1 ~ ~ ~~ ~ ti ~ ~ ~ ~ys , '~ ~ii-~Q ~~ „___ __ _ -- - LmT ~ y~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number ~ Number of Bedrooms Design Flow -Peak (gpd) ~ Estimated Flow -Average (gpd) Septic Tank Capacity (gal) 2. ~zbo ~ Soil Absorption Component Size (ft2) Z~ _ ~ Type of Wastewater omestic Table 2: Soil Absorption Component -Limits of Reliable Operation • Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) 12, ab ~ Z a ik Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) ~ 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soii Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se tic tan nd outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the v Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the.tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. ' Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component _ The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in 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 or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or , impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. P~~~,~x ~ '~oT~'s:• ~ Kc'ESS~E' ccs£ 0 F' Bt,Epc~t'~'S sc~rG L .~ .IT pert ~ ~ ~rx ~cr.~~, Ti~i~' ~ B~'to~~ ivo~J Fri.vc 7`.ItN~/~ r! ,c"kc~s='vC ,~~oaNT~ o~ ~E~9S'E ~~`y' taus.c' ~oai~ Si~~trc ,~ aR ~u~!r ro ~t u s crP . r,~~ ~~~o c.~usi= $•~`'" aI' ~.v~ Yo~iz H~cur~=. . ~/~!/~ ~p~//C S'G'~T~G I'/1~~d~c ~c?/F_!~j jLU/v // i'oa/~ c F !1~/es. c~",~. T/S~x'vf//r OF ~~~'i dotrs~ uF ~u s r~ ~s w~Iz ~uT . D D ~ c~ cuoa r~ ovG~/ 9cr,~ ru~.rJ .zr - .sso~ ~.~rr.. . Fogerty Plmnbing #221180 ' 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 7i>'- 7Y~-Sd sd ~~ • ~ ~i 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Bu3~er _~'!rl/ft~~ f~k7'' Mailing Address Property Address (Verification required from Planning Department for new City/State /~'~i ~-~ Parcel Identification Number d1o- /37G--7.~-0~_ LEGAL DESCRIPTION Property Location ~ '/,, if/k/'/,, Sec. ~ T 2~_N-R~VI~, Town of ~~f/'~i~ Subdivision ~C~i~~~' ~~vtl'S ,Lot # ~3 Certified Survey Map # ,Volume ,Page # '"'-- Warranty Deed # ~~~ /.2 ~ ,Volume /~"3 9 ,Page # ~''~ Spec house O yes ~ no Lot lines identifiable O yes D 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying 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 standards 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 three year expirati~oAn~d~ate. • ~~A_ ~ 04~ /Q¢ /o/ SIGNATURE OF APPLICAONT~'' 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 owner(s) of the property d~e~sJcribed above, by~v'irt~u-e}'of a warranty deed recorded in Register of Deeds Office. l~^~~ • < <K`°`"""' C~// Grp/O/ SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *****' ** Include with this application: a stamped warranty deed from the Register of Deeds office' a copy of the certified stuvey map if reference is made in the warranty deed von 1539PAGE ~~ g2,gt~~,4 STATE BAR OF WISCONSIN FORM 2 • 1999 Y.ATHLEEN H. WALSH WARRANTY DEED kEGISTEk OF DEEDS Document Number ST. CkOIX CO., WI This Deed, made between Donalda Speer, a/Wa Donalda J. _ RECEIVED FDR RECORD Speers, a/k/a Donald J. Speer and Kernon Bast, wife and husband, 08-31-2404 1:30 PM a k a Donalda J. Speer-Bast _ - - WARRANTY DEED -- EXERT q 3 _ ~__ __--------- Grantor, and Richer ut and Janet P. Stout, husband and wife, CERT COPY FEE: ------ - COPY FEE: ANSFER __._.________-__-_-._-_-- -- - --_ - TR FEE: RECORDING FEE: 10.60 _ _-__ _ PAGES: 1 Grantee. Grantor, for a vaiuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area All of the Plat of Sweet Grass Farm in the Town of Hudson, EXCEPT Lot 1 of said Plat. This Deed is given to correct the ommission of additional lots in the Plat of Sweet Grass Farm between the above Grantor and Grantee hereto in that certain Deed recorded in Volume t~, Page ~a0 , as Doc. No. Ua°I 0 5 ~ Name and Return Address ~Qtut,~A o • sT~T . ~rl/~So~J, Wt S:{pl(~ Parcel Identification Number (PIN) This is not __ homestead property. pE) (is not) 020.1021-60, 01,0-1021-80, 020-1021-90, 020.1022-00 &.020-1062-20 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~' ~ day of August 2000 AUTHENTICATION Signature(s) Donalda Speer, a/k/a Donalda J. Speers, a/Wa Do al J. S eer and croon Bast, wife and husband, authenticated this17 ~y of August _ 2000 « Kristine Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by 6 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson. WI S401ri (Signatures may be authenticated or acknowledged. Both arc not necessary.) "Names of persons signing in any capacity must be typed or printed below thei WARRANTY DEED + ppeAfda•Speer, e/k/a Donalda J. Spgprs, a/k/a Donald J. Speer + croon Bast i! - ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Personally came before me this _ day of the above named to me known to be the person(s) who executed the instrument and acknowledged the same. No[ary Public, State of W isconsin My Commission is permanent. (If not, state expiration date: J IrdprmNion PI010iignelf ComW~Y~ FmC a lac WI eco~ss-zozt I~~~. STATE BAR OF W ISCONSIN FORM No. 2 - 1999 ~~~ ~~ o ~~ J ~~ N~ ~~ ~ ~g~ 0 ~8 tV ~ r O~ °~ ~ ~~~~ ~ o~~ J a' Q ~~ ~~ O NO .- Inl i ~ ~ i ~ __ __ i ~ 200.00' ° 200.Oa I • , c~ N00'13'10'W 873.96' 123.86' ~ ~Z 9 ~ a ~~. 800'13'1 O'E 973.96' 21e.1a A ~ ~A<~~~°~N "_' .. - . - -` I 1 _ . _ ~ 200'~~ _ _ .~ ~ ~ f ~~ ~: ~ Est \ • t '~--- ..~...__ ` ~l Zit t2"f~8~ V ~ l' ; ~~.. ~ ; ::... ~ ~ ~ ~~~ Z r: a G ~ ~ ,.~, ~ / . t ~~ ~, f O ~ 08~ 1289,36' ~_ - , ' w...~1,8,~ )F SECTION 14 I MGJG?dQ~p dQ~ID~ O[~G~JL~D ®~7 D~1CG~~3 i i ~ ~ 6.a9' 1 ~-- ~• . I 'S?"E 137 9.68' ~ ~ . ~.o®' i ~ ~ ~' ~ d0` ~ ---- ~ doh ~ ~~_ --_ __ __-- ---- s- r 'ih'r~consin Department of Commerce SOIL EVALUATION REPORT Division of Satety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less t x es in size. Plan must inGude, but not limited to: vertical and ho e~ i M), direction and Parcel I.D. percent slope, scale or dimensions, no ,and IocaLO 6~i nce to nearest road. ~j, ~, Please 11 i~~np1f n. ~ Rdvrewed by Personal infomration you provide may ~~ for se1Cb ry purposes (Priva ' ~, s. 15.04 (1) (m)). Property Owner ~ i w~ -•---~ Property Location ~ ``•'~ ' ,_~~,'`~ ~~,`71` 1 ~~, Govt. Lot Sct> 1/4,v,~t/d 'S ~ Properly Owner's Mailing Address O~~ -=. Lot # Block # Subd. Neese-er-6& City State Zip Code ~,~ A Phone Nurmtref~ ^ Ciry ^ Village Town Page ~ of Z- -7S"-LL~d • Date I > ~ ~ N R/~ E (oi~ :~' Ne~~ary.es~~t,, Rp/o~~a_~d ~~ ~~J ~Ys~ S/V i New Construction Use: ~ Residential / Number of bedrooms _~ Code derived design flow rate GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~i~7ri//,~llll~ Flood Plain elevation if applicable ft. General comments ~~ ,~~/.LY~~ ®~ ~~s ~ gn, s r><~~ ~3,b.,~~ and recommendations: )~ s Tit d~ ~ . ~/1 r~S~ TAO~~ jv~t~rV'c Gcvf/r"ac~em G~~ alt ~* sr.~tG Lars--r~'0 ,~~I ~`~' t~l~i~i~L .~,e~, s~ft~r,~ ,~'~/= ~2. T Boring # ~ Boring ~/ ~D ~ Pit Ground surface elev. G ft. Depth to limiting factor 7 7 in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture SWCture Consistence Boundary Roots GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - 'Eff#1 •Eff#2 L _ _ ~--~-- su ~ . 2 , 3 t 2 B ~ "'~ - GS ~ G S ~ ~ ~ - / ! --- L -~- -~ . 2 Bori # ~ Boring , ng Pit Ground surface elev. Q.Q / ft. Depth to IimiGng factor in. Soit Apptigtion Rate Horizon th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~ p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 - - F ~• • _~ .- , . . L - emuenr ~i = n~u, ~ su ~ ctu c a~a r as ~w_~ rav nryi~ ,(,Tease PrintL ~ fur Fogerty Plumbing & Perk Testing - ~~ ~/©~ ,r~cnuc nt. wt ~.~n ~ ..- ---s_ -- ---a y, Property Owner ParcellD # Pape of ^ Boring # ^ Boring _ ' ^ Pit Ground surface elev. (t. Depth to limiting factor In. Soli A plicalion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~ 'Ef(#1 •Eff#2 Boring Boring # ^ Pit Ground surface elev.. (t. Depth to limiting factor in. Soil Appllcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff/t2 ^ Boring # ^ Boring Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rad Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 • Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 ~ 150 mg/L ' Effluent #2 = BOD, < 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 need material in an alternate format, please contact the department at G08-26G-3151 or TTY G08-264-8777. seo-u~o ta.dooi iii' d ~1 = ¢er, rb~ of 2'P~c , /gym ` ~9 s7 ~ - ~~~ .. ~awD LoT ccrc.url~/S ~~r ®F sYsr~• ~.D L~'v,~L y,~,f*D~ie .z~ ~, c,~~ rs ~,z, s ' Lo.rl~ c~GC ~tav rs 9'Y.o ' 3' fr~crirJ~ ,p~rcvc,~.d c,~tts sl ~~-~~,~j ~~y ,~c~s3 ~RL' i s ' L°if'~ B' ~~ X2.9 i f- Fogerty Plumbins #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 .~1~ ~i y/o`lo i ~, ~~i ~~6 P 'c x (~ ~` 0 0 U ~ _ .~ ^_ _~ d ~ ~ N I h ~ ~ i ~ ~~ ~vz.~ ~~ ~\ ~--- ~` ~I _ I_ _i ~ / H w~• ~-- r~3o~0 ~ ` 1 L~T'~ y3 ~ I ~~ i .' ~_~ I ~. t~ ,~ .aye. ~^ 2 ~or«~/cE Lrt/ --