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HomeMy WebLinkAbout020-1376-47-000/~ Wisconsin Department rce Safety and Buildings Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) GENERAL INFORMATION rersonai Inrormanon you prvvice may oe useu wr ~ecunuary purposes ~rnvacy uaw, ~.t5.u4 (1)(m)] Permit Holder's Name: ^ Cit VHU~SOri ~O~I~S~11 Stout, Richard y ^ p CST BM Elev.: Insp. BM Elev.: BM Description: /60 7csv ~3w- ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY tic '!~ f ) t C, t~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic ;~, ~~~ ~~ Iq r Z~ r NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer De and Model Number GPM TDH Li Lriction System TDH Ft Forcem ' n Length Ff Dist. To well SOIL ABSORPTION SYSTEM ELEVATION DATA Croix 376-47-000 STATION BS HI FS ELEV. Benchmark ~ 3) a~ j~ / v v ~,•~o (V/_ ~/ Bldg. Sewer ~ 6~ ~j~ ~3 St / Ht Inlet sa s( 97. Y St/Ht outlet l,.b~' 4'7_x-3 Dt Inlet Dt Bottom Header/ Man. 8, o~ ~~, L ~ Dist. Pipe Bot. System - i z q.,,y iaz_ 9S~• Final Grade ~ ~ Q8 ~~ cover yL ,od.,, 1a Gil. ~: ~j,31 4ss-i BED /TRENCH Width y ~ Lengt ~ ~ No. Of enches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 1 N 2- DIM N I SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufaclyre;~ SETBACK ° INFORMATION Type ~. ~~ ~ Ca f ~ -~"~~ '~ CHAMBER OR UNIT Mo el Num er: C Syst m ,. r ~{; ~ ~ 4~. DISTRIBUTION SYSTEM `~ Header /Manifold rr Distribution Pipe(s) ~~ S S x Hole Size ~ x Hole Spacing ' Vent To Air Intake Length _~ Dia. y' Length COL Dia. ~`'~ Spacing - -- SOIL COVER x Pressure Systems 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.) Inspection #1. 6 / ~ /~i Inspection #2: / / Location: 971 Florence bane, Hudson, WI 54016 (SW 1/4 NW 1/4 14 T29N R19W) - 1429192308 Sweet Grass Farm -Lot 47 1.) Alt BM Description = ~~ '~~''~ ~ `n't kbu~~ r,~ Ob~vk~sa~. ~`Ivcs a~,G lbw,~~~ ~'"° s °~°~.,~'~ 2.) Bldg sewer length = L ~. i n ~ ~~~lie~ (.• 1 *~ k. sk'"` a /cv -am`-ou t of cover = ~ d ~~ ~ ~~ ~~ zi,~ I h~i ~T' 4.~Y L ~ M^'~C~•/5 ~ l~'6K~ /'~ ~ ~G{i~s ~,~,t bccskd• j+•~ S c.ltl ~}! ~ 0~ - ~GobG ( V `'~•t,c ~re(ut. S~~t' ~o~,.~„~. Plan revision required? ^ Yes No ~ J Use other side for additional information. ~~ SBD-6710 (R.3/97) Date Inspect Signature Cert. N 1 a ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~~~.~~ f ~ r4NF Sanitary Permit Application h C 21 Wi I d i 83 Ad C d Safety & Buildings Division 201 W. Washington Ave. w omm , m. n accor t . s. o e See reverse side for instructions for completing this application PO Box 7302 isconsin personal information you provide may be used for secondary purposes Madison, WI 53707-7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)J (Submit completed form to county if not w state o ned.) ' Attach complete plans (to the county copy o ly) for on paper not less than 8-1/2 x 11 inches in size. County State Sanitary Permit Number 1( ~ ~ r v' i n revious application ~ ~ ---~ --~ State Plan I. D. Number 3g3S - , , ; ., ~ I. Application Information -Please Print all Informa o ~• ~ Location: Property Owner Name ~ ! ~ j~' Property Location t'`'.1 -<, 1/4 /4,S~y'~ ,N,K~ (or Property Owner's Mailing Address "" _ Lot Number Block Number _ '3 w ~ 7 City, State Zip Code L: ' Phone Number Subdivision Name or CSM Number / II. Type of Bui ding: (check one) ` - ~ 1 or 2 Family Dwelling - No. of Bedrooms :_~ ^ vi e f 7'Town of '^ Public/Commercial (describe use) L zI~~L /~-l6dD YdY` ~. ~'~'yq ~ , , , I ~ f ^ State-Owned $' ( 3 X j6~2.> ~ /~yv~ !~ ~ ~ ~ X dZ~s ~ Neazest Road Z ~ Part I Tax Nu ( _ ~,.,J III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) °r . a3~~ A) 1. New 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System B) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) -1 pp Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ~ ^ At d ^ A bi T i ^ R i l i ^ O h ~ ~~ U -gra ~ - r' ~ _ ero c reatment _ n ec rcu ng t er: j t at V. DispersaUT'reatment,Area nfo mation: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevat o 7. Final Grade Required Proposed Rate (Gals./day/sy. ft.) (Min./inch) Elevation 6~ SDl~ S f .3 / ' ?-3 pyi 9 -~~ ~ VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete strutted Tanks Tanks ^ ^ ^ ^ F' /2O 2Eb ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): _ MP/MPRS No. Business Pho n e Number /~ Of-~ ~ ~ ~- 2 ~ ~ D / ' p. ~~~` (D S~~- ~ B 7 umber's Address (Street, City, State, Z p Code) .~' d/ '- / ~E r~.~ Q IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ,Approved ^ Owner Given Initial Adverse Surypparge Fee) Determination oZ.oLS. ~ [ ~ - - X. Conditions of A rov 1 /Reasons forpi pr val• ~ /~ ~ p~ .~,e" „E~ ~~ f¢ U~~red~ ~ ~ s (~° , ~oux+e~ 'Eo a-~pe~. S ic~t... ~o-cutt~ 1~ t`"•4-t Q Off- ~ U P . c ~ o~ ~ s~ f s ~it~, . -~ o~- y-•a= SBD-6398 (R. 07/00) / '- 7 `~" ~~ ~ 7 ~.~" C~~~~~~ S ,q +t 2 r- a ~ F r x.$-! f(E/RAE,c X ' \\ E---- ~oi4c ~/4•Frv ~ \ I f~ 3 L / l'f'L 1. 1 • s~c~LE• ~ "_ yp d. ~l = gar, T~~ a ~ ~ "~ v~ _ /~r,A'~, ~q7.p ~ .4.,r~ s B~cr, Td~ o F ~ "~dc- K = /~.r~~ ~ - t Dl~~ LO% Cc~R/~=~5 Q = ~ .2pd 6-~• S.T. - tvE,E'~s ®- ~~-~ ~ ~ -F,~~, ,ter ~,~ e~ syr~r~. T1jfit~is~.~'S': ~ l Q~,2' s'L. ~s' Fogerty Plumbing #221180 _ 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 ~~ f //- / Oo `aT y 7 s~~- ~1~ss 3~' I - E-S ,e~ y~ ,- - - 1 ~' ~ / ~~ I~ •~. L r-~ Qv. ~ , > Po , ~ ~•s 6~ f i l y ..uw. wu ...icrw u.,a.. n v. .. ,. u... w Division of Safety and Buildings ~- ~- -- 5fk~ ~- '~j '¢~s~i~.~.~--. vv.~ ....s +...v• +++v+. +..-. ~. ~ rayts / v~~ in accoraance wrm i.omm esa, vws. rwm. was County 1 Plan must 81/2 x 11 inches in size it l t L s th A h l t t 5 , C O // an on paper no an . comp e e p es ac e s t include, but not (invited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale ordimensions, north arrow, and location and distance to nearest road. Please print ail information. Reviewed by Date Persona! information you provide may tie used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). - .},C ~ (" ~'-~ Property Owner Property Location ~,~,~ ~• v-E- Govt Lot s(,LJ 1/4NW 114 S/~{ T Z,~ N R /Q E(or)~l Property Owner's Mailing Address Lot # Biotic # Subd. Name w CSMIk 1 S" 3 l~c,t~ -~-v kc ~ f - ~ ~ e ~ ~-~s-- ra S S City State Zip Code Phone Number [] City ^ Village [Town Nearest Road ~~-.s~ w Sy4(~ (7/S )sy9-G~- ~ cJC~I n Y/arenCS~- ~ahR [~ New Construction Use: C~ Residential 1 Number of bedrooms 3 - y Code derived design flow rate ~ ~ ~G O d GPD ^ Replacement ^ Public or commercial -Describe: Parent material C) (.~ -~- W ~ S ~ Flood Plain elevation if applicable ti ~ ft• General comments SY S~ ~ ~ ~ ~- U ~ ~ .e ~ ~ ~ Z Gow e r q y • Z ~ and recommendations: IIAA 2I~2 V- u (Ier-- 9` ~ • Z ~ u cve r q 3' Z ~S nL~' ~ and iVl a iOJS O1r1'j O~ ~T~2oY\Z. [3or inoJ#~„ ~ J-~pr:Zo~ 2 Yk+o-I-~-{~ ~i 1-F- ~l(S 1Q " ~ r.. cl iaw.v.~-$ r 1=a ~ ~`,( V r 6ori nca~ I~Z.. a ~Qv(.c.. 19~P~11<5 Foi' (•(of.L~ l,7'~,~•~c~ta.'~'ftit "."7~ C ! u- 10"x' ~r~n # Z` ic5srof or Y Boring # ^ Boring G]c' pit Ground surface elev. ~ 9.7 ~ ft. Depth to limiting factor ~ / ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tt' in. Munsetl Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 Z { - S 1o r /~{ ~ .s ~ 1 v~-tct~~. -~ ~ C- -5 - ..5~ ,3 y$-~IZ r /CO - ~ l -- ~ /, Z S. Zo ~` `~ 9G /`1a ~ ® Boring # ^ Boring © pit Ground surface elev. q 7-S d ft. Depth to limiting factor ~~ z- in• Soii tigtion Rate Horizon Depth Dominant Color Redox Description Texture Sfirudure Consistence Boundary Roots GP D/(F in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eif#2 3 ZI-z $ Q rsl - ~r `~rna~(~ vt1 u ~ C ~ - ~ Z~S"y0 ~ S y CZ 7,S ref/~ 5~~ 3mab(~ v,~ C w -- . S yo ~~ ~ l ~ - mS ~? 5 ( -- 1~ ~- 'Effluent #1 = BOD > 30 < 220 mall and TSS >30 < 1 50 mall * EiBuent #2 = BOD, < 30 mg/L and TSS < 30 mgJL CST Name (Please Print)// ignature / CST Number Gi ScCwv~el ~~''" ~~r ~ - Z S`3 ~j U Address Dafie Evaluation Conducted Telephone Number Property Owner ~ 1~' ~ -'4' Parcel ID # Page ~ of ~_ 3 .ng # [^j Boring ® pit Ground surface elev. ~,~_, ft. Depth to limiting factor / O in. Soil liration Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIff in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Ef!#2 L ~o-zZ i ry/~ -- s~' Zv-~a~lc - 3 zZ-3z i~ rs~ - 5,~ 3~d~,~~ ~-~~ ~ s - *.~ . ~ 32-~y tU r'~ , S t'o ~~~ 3 n-~b k ~.~; ~ w - < ~ • cf (j yy lzo t a r ~(p -~ ~S ~ V/t I - - ~ ~ Z f~ ZO ~r~/$~• r ring # ~+-- Boring ~ ~ ~ Pit Ground surface elev. y~_#. Depth to limiting factor-LL_ In. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/Ff' in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 `Eff#2 I G-s Z a Z ~' S ~~ 1 l w~a,b~ ~~r^ S I u~ ,~ Z ,z-z tv r 1 -- S ~' ~ Zmubk ~~i C S - . 5~ 3 Zy-ya , ~ - s~~ l hna.bk w~~~; cw - ~ ~o-ttg l D r y/to - v-~ d5 m - ~ l Z „r- 9~'•2~ . 3r'a f8' 3lv Boring # L Bo~'ng ® Pit Ground surface elev. ~ ~~ ~ g ft Depth to limiting factor ~ ~ 3 in. Soil lication Rate i H th D minant Color D Redox Description Texture Structure Consistence Boundary Roots GP D/tl? or zon ep in. o Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. `Eff#1 `Eff#2 0--12 v~ l z. - S~ ln-i,a,51c ~ r G S 1 v~ Z 3 Z -z-yZ J - s; t amabk wt c S - < S • 8' ~z-i/3 0 1~ - ~ wl ( - - • ~- /~ `Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L " Effluent #2 =GODS _< 30 mgJL 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 608-266-3151 or TTY 608-264-8777. sac-saso nt wioo~ .r - SNiscons n u~partment of Commerce SOIL AND SITE EVALUATION Divisiotz-of Safety and Buildings Page ~ of bureau of Integrated Services in accordance with Comm 83.09, Ws. Adm. Code Attach complete site plan on paper not less than B 1/2 x 11 inches in size. Pfan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ~ ~ , e !'(, I percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION -Please print a ~--~a#ian: ~ ~ ,. Reviewed by Date Personal information you provide may be used for secondary vacy Law; s. 15.04 (1) (m)). Property Owner 1,~,~, .,, ; ° r, ..; ~ . ~~ C -~ l~i~~ ~-~ Property Location Govt. Lot S G,,) 1/4 ~1G..1 1/4,S /,~ T Z ~ ,N,R i q E (orK~ Property Owner's Mailing Address 13~ ~ e~ ~r~ " " i . ,Lot # '. , ~.~ -~ Block# Subd. Name or CSM# Seek CUSS City State Zip Code ,Phone Number ^ City ^ Village ®Town Nearest Road e~ ~ 6Yl ~ 1 `'~ `115 );... !~'':~"`~'~`' . ' l-~vcl So r~ ~(ure~el~- Icz v~-e ®New Construction Use: [~Residentiai / Numt7eK.L~ ro I ' \ ~^y Addition to existing building ^ Replacement ~~__ ~~yy~~ ^ Public or commercial -Describe: Code derived daily flow ~ gpd Recommended design loading rate b 7 bed, gpd/fl2~trench, gpd/ft2 Absorption area required ~S~ bed, ft2 ~~ trench, ft2 Maximum design loading rate ~_bed, gpd/ft2 ~ ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) vfl ~~j^ 9 SZ ~ Gowt r• qz'(• Z ~ ft (as referred to site plan benchmark) Additional design/site considerations L-f • eT ~~ Z Ga ~ 3. Z rS Parent material ~~ V T ~~ 5~ f=lood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in rui noia~ng ~ ariK U = Unsuitable for system ®S ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S ® U SAIL I]ESCRIPTION REPORT Boring # Ground elev. ~~ft. Depth to limitin fa r 2 in. Horizon Depth Dominant Color Mottles Structure B d R t GPDlft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary oo s Bed ,Trench i -~ ~ ~5 1 -~ ~ 2 ~ 3 I -y ~ ~`~ Z ~~, r `1 Si 4 `~ ~ - ~ 3 l4 f~ ~ ~ •~ ; .g , .._. ~ d r a lv ~ ~ l1, 5 c b _ s _ ti~ t~,t , CS ; ~ ~s ; is r` '` +~mark5- !/h o ~' -~' ~.-G~ S , ~~' ~ Gc (If ~ i !~ ('~ r'r ~ z r~ r~ z ~Q ~~ ~'.. fJ~ a n'l,~-~-r' Boring # `. Ground elev. ~ 9ft. Depth to limiting factor min. Remark CST Name (Please Print) IQ{.~a Y-'~ ~I 'f' 12 v ~ /y-p,~~i' 1 S -S-a r ~Ce S f l 2 ~ r ~J --~ /~ ~rZOr Address Date Z (/ 3 ~ ~ ~ ~- ~javt.C/ S-C ~ ~tI ~ S~G~az .Sr ~/_ ~~--~ C~ t~- D l~ ~ C.~ r \ ~ ~ 11 C_._S ~ V 3 zi-y~ Id ~ C:Z -~. y l ~ ~ i ~ 3 m~~ ~ ~ - ' ~ ~ ' ~ ~} o nz its os m~ ~s ~ . ~ ~ . $ ~ ', ~w ~ dL.~p Telephone No. 71..5 =Zy 7-yGC~ F~ CST Number ~.S-3 3oq PROPERTY OWNER S~y~ SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # 3 Ground elev ~~ft. Depth to limiting factor l20 in. Boring # Ground elev. 9~~..ft. Depth to limiting factor 1~~in. Boring # Ground elev. 9~~.ft. Depth to limiting factor f13 in. Boring # Ground elev. ft. Depth ro limiting factor ~~' w , . Page ~ i~t' ~~ Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Z -o_ r y 4 ~~ S, J~.. m~ c - 3 zz~+ d ~SJ~f ZP~S r`k b ~ m ~ ~w - '. ~ `~ - t ~, -- rns ~s m 1 cs - ~ ~ - ~ Remarks: ! t=too-t Q~ Ce ~-.nPlt~ c ~„r- ~~5~-- az« /!ten e G~ ~ f ~-iZ z `a1 1 ~ . Z- 3 4d-i i 8 1~ ~ 1r1n .~ ~ m t c 5 ,- .1 ~ - Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/tt2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench ~ 012 [~ v ----- s ~ I i ~~ -~ ~ ~ v~ . z ; - 3 3 ~r~-II I~~ 1 s ~ m ~ ~5 -- . ~ ; ~ ~ Remarks: ~n' Remarks: SBD-8330 (R.9/98) ~~- ~-'~ ~. ,. ; PAGE~OF~ NAME $-(~ U -I- LOT# y ~ LEGAL DESCRIPTION.SW'/4,G~}/<,S /4! T29',N,RIQ E (or SCALE: 1 "_ ~ 00 BM I ELEVATION /~ , O BM I DESCRIPTION-~pd.('2~p~;p~ lo~rh wr/<klc+} BM 2 ELEVATION q. ~a BM 2 DESCRIPTION iop d~ Z ~pdc ~a., ~~1~ ~,,~~Fla~ SYSTEM ELEVATION„on c r `1 S. Z ~f co«.er 9Y• Z`d ALTERNATE ELEVATION Yrl•Z~SaPp6r 93•ZS~aw,er- CONTOUR ELEVATION ~ ~ I--- X~ t 1~ ~ o as ~ ~k ~ ~ ~` p3 05 ~ ~a 'vl ~. ~ Qt`~/ ~,F,~i .y fi ~~. ~/-y-o~ 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: ; Permit Number Number of Bedrooms ssian Flow -Peak (gp Estimated Flow -Average (gpi Septic Tank Capacity (gal) Soil Absorption Component Size of Wastewater Table 2: Soil Abs n Flow -Peak (gpd) Influent Particle Size Maximum BOD; Maximum TSS cations '3 Domestic Component -Limits of Reliable c Tank Component Soil f Z ~o q, ` ration 1/8 220 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter fnspect once a year and clean at least once every 3 Soil 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 nd outlet filter shall be assessed at least once every 3 years by inspection. T outlet felt hall be cleaned as necessary to ensure proper operation. The filter cartridge shou d 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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/r ,~,r~rg_~11 1Ti~i..~7~ Mailing Address l ~~~ ~/~fiGt't~F' ~ Gr~~_~~ ~'~'o/~ Property Address ~ 7/ ~i (Verification required from Planning Department for new construction City/State ~s~~ ~~a..~ot'yt//f~ Parcel Identification Number Az.~~ ,~3 ~ ~ -- ~~''-° LEGAL DESCRIPTION - / Property Location t~ 'l4, ~kJ't<, Sec. ~ T~N-R~~~iT, Town of ~~1fl~4~1/ Subdivision _ 5~~~s- -~-J9-1e Ly, ,Lot # ~~. Certified Survey Map # ~- .Volume ---- .Page # Warranty Deed # _b~~/,~ ~ .Volume ~.~~ ~ ,Page # Spec house ^ yes 1~1 no Lot lines identifiable 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. T'he property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanplumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 expiration date. SIGNATURE OF APPLICANT ~~ 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 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 this 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 y kP,u~- von 1539PAGE $~ x2'9124 STATE BAR OF WISCONSIN FORM 2 - 1999 Y,pTHLEEH H. WALSM WARRANTY DEED kEGISTER OF DEEDS Document Number ST. CROIX CO., WI This Deed, made between Donalda Speer, a/k!a Donalda J. RECEIVED FOR RECORD Speers, a/kla Donald J. Speer and Kernon Bast, wife and husband, 48-31-2000 1:30 PM a k a Donalda J Speer-Bast D _ YARRAHTY DEE E%EIDT N 3 Grantor, and Richard O. Stout and Janet P- Stout, husband and wife, CERT CDPY FEE: '- - COPY FEE: TRANSFER FEE: -- -- RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): 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 Ptat of Swee[ Grass Farm between the above Grantor and Grantee hereto in that certain Deed recorded in Volume , t~ 3 ~, Page Sao , as Dtx. No. lna.°I D S R . Name and Return Address f Qt elute tf fl ~ s?w~ - #t1QSvF.~. WL S-,.Fot~ 020-1021-60, 019-1021.80, 020-1021-90, 020-1022-t)<1 &, 020.1062-20 Parul Identification Number (PIN) This is not __ homestead property. 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/Wa Donalda J. Speers, alkla Do al J. S eer and Kernon Bast, wife and husband, authenticated this ~y of August 21N10 « Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (I f not, authorized by § 706.06, W is. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland udson,Wl 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) Names of persons signing in any capacity must be typed WARRANTY DEED Ot) (is not) ~ ~ _ -~~~ +-~ a Donalda J. Sp rs, a/Wa Donald J. Speer + ernon Baat 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 foregoing instrument and acknowledged the same. + Notary Public, State of Wisconsin My Commission is permanent. ([f not, state expiration date: kAanaalion ProN+aanals GanW^y, FoM a Lac, vin aoo$sszoz+ ~~e~, or printed below their signature. STATE BAR OF W TSCONSIN FORM No. 2 -1999 I , ~~CD ~an~ ~D o ~ ©4_----- --- ----- aCG°3~ i I t :,.- . I I ~. ~. 25' ~N i I° 4, I C1 ~ / i Ewsnr~ ERNE ~ I ~ ~ i f'"Y' Ewsnrvc3 ~RniE _..i . I I I i =NORTH UNE OF THE S12 OF~E NW1/4 SECTION 14 ~ ~ I ~ _ McCVTCNEON Rpgp ~,~ ~ - li - ~ - _ ~ 100,„ h. 8 ~ °Q - m ~ ' p~C x°73 ~ . g I .8~3•s • ~~ ~ ~~~lpr~~ H.W.L.=Z24.a ~ $ ~ ~ LOT • .............. .....~ .. ~ ..... . I 46 $ 1NIN aIJILDINO 2.04 A~ I ~ d-~ _ >117.0 1104PZ 80 FT MIN BUILDING • 000.14' i . I ~~ I 33' 33' I • 1 ~ I ~ ~ $ I LOT 47 ~ I 11 ~0~ I ~ ~•- _,_ • X0.14' I Ir I O ~ LOT 48 ~o z ~ i '?~ n $ .~ Im i _.___ I• i ~.,4' m I . I ~ i ~ LOT 49 ~.ae,~lEe ~ 111540 eo Fr 11as.a ~$ NN'4d'OO'!` 1100.14' CZ~ MIN BUILDING ~.~ .`...-.. !L!1/.. 0.90.0 ~Y ~~ ELEY.. NO.O 1: r' ,~ -~~ 11 ~.~ H.w L.. ~ 4 11~N WILD R 8L'V.=o9