Loading...
HomeMy WebLinkAbout020-1376-54-000. VVl~otxtskt peperanera d Camteooe Sde~r:~ta et~lditgs ohrision GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) P«sontl itMottnation you provide maybe used t« seoatdery pumoass [privacy taw. ats.04 (txm)l. Permit Holder's Name: KY V~ age Town of Hudson Townshi a Msp. 8M E v.: BM Desuiptan: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic e~~a./ Yv-~~-s~~ ~ Z, Oosing _~_ Aeration . Hdding - TANK SETBACK INFORMATION TANK TO P / L WELL SLOG. qr~ eke ROAD Sepu~ > so ' ~. z ~- NA Dosing NA Aeration NA Holding PUMP! SIPHON INFORMATION acturer wand Model ber ,,,,,~ ~'y ~ PM TOH Lift f ~ on S tem TDH t forcem ' Length ia. dist. To well ,m>,~" ~AII ARCARRTIAIU CVCTGI1A~.r\ ~ \ e ELEVATION DATA ounty: St. Croix. Sanitary Permit NO.: 384186 tare P n IO NO.: Parc Taz No.: 1~f'~o~,~~~ X375 STATION BS HI f5 ELEV. Benchmark .~ z I o, e ~, p Alt. BM S ° q`~,.,(, Z t 61dg. Sewer (p. !$" 9g. ~~- r St/Ht Inlet (~, $p •q~, $2r St/Ht Outlet ~.2p ~~• `fZr ~t Inlet ~-'- Ot Bottom '~'~ Header/Man. Oist.Pipe o .~S ~~ °l~'~ Got System ~~ (' ~ o X13. 6 2' final Grade ~• `~"~ 5 3 ~~ ~" e - - \i" J S ~C,µN " h Width ~ 3 length ~ No.Of Trenches g3•}S ~ •" PIT No.Of Pits Inside Did. liquid Dept SYSTEM TO P/L BLDG WELL LAKE/STR LEACHING Man urer ~-..:5;~,1~;N CHAMBER N fNFORMATION ype System: C;D'7t+J ~ ~J ~ -'°..~,~ OR UNIT um er:. o e - c,• DISTRIBUTION SYSTEM (-•+,o ~..x~~.•..e I`"`' J x ' length Oia eng ~ g r ~~ `~ ~ ~ .5 ~ I SAII OVER Y PrpeeurE- Svetame [)nlv YY Mound Or At-Grade Systems Only depth Over Oepth Over xx Oepth Of roc Seeded /Sodded xx Mulched " Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ~ No ^ Yes Q No 72 COMMENTS: (Include code discrepancies, persons present. etc.) Inspection #1: o~L/14 /o- Inspection #2: Location: 941 Florence Lane, Hudson, WI 54016 (NW 1/4 SW 1/4 14 T29N R19W) -1429192315 Sweet Grass Farm -Lot 54 ~ ~~~` ~~ ~~~~/~~~ ~7~ ~~ ~M,~~ 1.) Alt BM Description = ~}-~Q° 2.) Bldg sewer length = Z3 ~~ -amount of cover - ~ ~l c~~ `~ s ~ ~ ~..,~ ~ Plan revision required? Y N ~ U o~ side for additions nform • Zq ZC~ cert. ~~ ~~- p ~~~ C~wC""T ~ ~ ~ Oate ~ ~ _ tnspectofs5iynatur~ 1 ~~ .Z-~-wy -~ ~ o `s E, ~ O 1 '~~ ~~ C2~ T~r~® S~ ~~ ~`~r, ~oRExK.E Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. `~SC0I1Sin See reverse side for instructions for completing this application PO Box 7302 Madison WI 53707-7302 Department of Commerce Personal information you provide may be usedforseooatldary purposes [Privacy Law, s. 15.04(1)(m)J °".=. , (Submit Completed form to county if not ,1 • state owned.) Attach complete plans (to the county copy only) for the syste on paper not=. ss,than 8 -1/2 x 11 inches in size. County , r " Sta~ilta;y~Permit Number ,^ Check i ' ' to prev~`ous applic lion '' , " State Plan I. D. Number '~ 1 ~S ~I~~S t"~': ~'~ tlOO ~ I. Application Information -Please Print alt Information -- ~ - Location: Property Owner Name ,-~ ~^, ~ . O ,~{ °'~ ~ ~N 4 ` Property Location . ., :? ~., ~w ~.~ ~~c ~ l _ / GA1/4 SGt.(1/4, s ~ T!X ,N, K/ (o~ Property Owner's ng Address Lot Number Block Number City, State Zip Code Ph umber ! •,;_. - ' Subdivision Name or CSM Number II. Type of Building: (check one) ^ City 1 or 2 Family Dwelling - No. of Bedrooms :~ ^ Village l~i'own of ^ Public/Commercial (describe use):_ ~ I ~C~ C/'~"~ ^ State-Owned - / Nest oad ~ ,/j I I /'F- Z. 3 j(. (3 ~ -~-ffMC-~-S Pazcel T umbers ~ -a III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) q . 3 ~ A) 1. ew 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System $) 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 U it ^ Recirculat' g ^ Other: ~1.' V. Dispersal/Treatment Area Information: - ~jb 1. Design Flow (gpd) 2. Dispersal Area Re uired 3. Dispersal Pro osed 4. Soil Application Rat e (Gals /da /s ft ) 5. Percolation Rate (Min /inch) 6. System Ele on f - ~ = ~ 7. Final Grade Elevation /~ q r~/~ p y q. . . e ~ . ~- V ~--'lJ ~V v i p~ - VII. Tank Capacity in Total # of Manufacturer Prefab Site teel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks r~ "_ ~ © ~ r ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS show the attached plans. Plumber's Name (p int) Plumber' gnature (no stamps): P PRS No. Business Phone Number ~t~~ ~T a ~ ~s rs ~ -~ ~y Plumber's Address (Street, City, State, Z'p Code) (Jr ~ ~~~' s~6~ IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse Surchaz Fee) ~~ ~ ~ ~ ~ . Determination , 11 ~ Dti ~ X. Conditions oa~f,~App~~tr~o~val /Br~eason~snnfort Disapprov-~__n ~ ~~Q~,~ ' (~ ~ I1~ ~ ~p5~^^^ ~Jl9~,a7n6-~ S v~.0~- ~ ~ ~ , 0~- ~ -Q ;'~ "~.~, -~R. S ttxsz-- ~ ~Tt~~ ~ b~wnve.6~u>•*tl t5 si I.CR. ~~•r N~ -t't.P7~'Txe- S-e~`1.L -t-a,J,1,K-I` `r't' ~-~' t,s cJC~QO~,:e.oc ~.~-ac SBD-6398 (~ R. 07/ 0 ~ GY.S ~P.~. a; tt.C.29~1.IM¢.+~tD~at)l"+ S . (, ~~ l~ ~ ~ ~,~-~-- ~, ~ ~ ~~~ -~~ ~3/~1- ~ao~r~~ %y~~ ~~~" ~~. ~~ ~~~ 7'02 X3,50( ~~~ ~~ 1- ~~ ~;1~ ~ ~''_ ~~ ~.~- s~ s.- ~ 1. ~, , - ~/~~~?>~ '" vSfiscor~sin Department of Commerce SOIL EVALUATION REPORT Page ~ of 'J rYnricinn nF Safety and Buildings ' ~ in accordance with Gomm t35, VYIS. l~arrl. ~ County - , ~-~- Cro ~ . Attach complgte site plan on paper not less than 8112 x 11 inches in size. Plan must indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. and loc ce to nearest road. north arrow scale or dimensions rcent slo e , , p , pe Please print all in ~~.,, ~~ Reviewed by Date 1 ,,,, Personal information you provide may be used for ,¢u~'Po~ (P~inY Lav~;,~~ 1b:~i (~) (m))- ~ ~ ~ is~ Jl l PropertyOwner ~ °°-•- ; y P , . trop l 1/4 S / y T Z ~( N R (q E (or~V ~ ~ ~ U 1/4 / 1 h CGC 2 G r1 ~-r~ -~~~`o (,p .. ~w ^ (,~ .~ Properly Owner's Mailing Address ~ .. ,~~, ,Block # Sulxt. Name or CSM# pLot ~ C) 2 ~ - . a~ ST CRGIX d J W C~ ~-I- G-ra-S S ~y ~~ ~ ~ Nur,~G OF~IG~ ily ^ Yllage ®'Town Nearest Road S ~-: I ~ w«.}c lr W1~ SSo Z (~st );~ ~S-o53 , : ~ ,-~ _ /j'1 ~ Q New Construction Use: ~ ResidenSal / Number of ~• "~ Code derived design flow rate ySd - ~o ~~ GPD ^ Replacement ^ Public or commercial -Describe: '~ ~ Parent material O y k ~ a Flood Plain elevation if applicable ~ Generaloomments S~Sfi°m e.l~ ~'• ~P f-r~ncl-. 9~ cX~ Gower ~~~<ti Q3• ~~ ~~ 4' 7 ~ bow~~ ~-''`^~h 1 ~~~~ -F rsr and recommendations: ~j-G~f • d~v_ fob Boring Boring # ' ~ Pit Ground surfaceelev. ~~ • ~PiJ ft. Depth to limiting factor in. Sorl rcaUon Rate Horzon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GPD/f~ in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 O 1 Z • 10 x312 --- S' ~ ~ rr,-~r C S t V-~ ~ • $ 2 / z- I U D ~ -' C 2 m bk m-~r c - - `1 ~ -~ 3 - l4 ~ ~t Flo ~ rr~S, 0 5 ,,n I - - . ? / • Z .~ 3.s Jr . 2 ,z (D~~.2 p Boring # ^ Boring 9~ Pit Ground surfaceelev.__99.8o ft. Depth to limiting factor in. ~;i ip~ Rate on i H th De Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP DIt~ z or p in. Munseli Qu. Sz. Cont Cobr Gr. Sz. Sh. *Eff#1 *Eff#2 ' Effluent #1 = 80D > 30 < 220 mgll and TSS >30 < 1 50 mg/l * Effluent #2 =GODS < 30 mglL and TSS ~ 30 mg1L CST Name (Please Print) 'nature _ ~ / ~~Number ~i Address Date Evaluation Conducted Telephone Number ~ t! ~, k'n~ 5+ ~f~,v--~.~- l , ~l ~~2,~`~ _3 - 3/-o i C~15)Z41-UQ'~ t' PropertyOwner_ ~G C~.b ~-- _ ParoellD# Page Z. of 3 ®Pit Ground surface elev. ~ft- Depth b smiting facror ~ 2 `~ in. Soil Rate ~ ~~ tion ri D Texture Structure Cansis~noe Boundary Roots GP D/t~ Horizon Depth in. Dominant Color Mansell esc p Redox Qu. Sa. Cont. Cobr Gr. Sz Sh. 'E~ ~' ~ 6- ~ !~ 312 -- S i 1 2 ~ r~r c v ~ - 5 . $ 2 10 13 CZ 7.5~ ~ I ~i~- msbk -fir -' . `-! 3 -~L ~ 1 r ~ RY~o Q~ ~3_~ s2.g /~~, ~;~ # u ^ Pit Ground surface elev. ft. Dept tp uniting factor in. Sod lic.~ation Rate Horizon Depth Dominant Cobr Redox Description Texture Stirudure Consistence Boundary Roots GPD/f~ in. Mansell Qu. Sz. Corn. Color Gr. Sz. Sh. 'Eff#1 'EfFtf2 ^ Pit Ground surface elev. ft. Depth to laniting fac:br in. Sod kcation Rate ~~ # ^ ~~ Horizon Depth Dominant Cob Redox Description Texture Strutfiure Consistence Boundary Roots GPDlft° in. Mansell Qu. Sz Coat Cabr Gr. Sz. Sh. 'Etf#1 'Etf#2 Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 <_ 150 mg/L " Effluent #2 =BODE _< 30 mglL and TSS _< 30 mglL 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. SBD-8330 (R.07/W) K- l • ' ~ PAGE ~ OF~ j( J NAME ~C ~ ~b~ LOT#~/''/~ LEGAL DESCRIPTfONSW '/+ +~°'"/+ S I'~ T L 4 N R I Q E (or) SCALE: I"= YO ~ I BM i ELEVATION ~~' y - r - BM 1 DESCRIPTION Vii' o~ ~y ~ C~oPPe r p ' pe '~ BM 2 ELEVATION 9~ R U f ~`r BM 2 DESCRIPTION -/gyp o ~ l ~~ ~~~ ~~ P~- SYSTEM ELEVATION ~O P yy. 00 ~ow~ r q j. SCE ALTERNATE ELEVATION ~P 47 ~ GowK' 9G. 4b CONTOUR ELEVATION 9y• 5~ 9'9. S U M~ M r I a~ v ~~ o°~ l ~0 A~ ~ ~: ~ 3 3 90 I o~~ 1 -~ ~~ I I I ~ ~ Ci-1 ~ i g-~2 QM ~ _3-0/ Wisconsiri' Departm it of Commerce SOIL AND SITE EVALUATION Division of.Safety and Buildings Bureau of Irlegrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete Site plan on paper not less titan S 1/2 x 11 inches in size. Plan must ~ r include, but not limited to: vertical and horizontal reference point (BM), direction and 5-t- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # APPLICANT INFORMATION -Please print all information. R viewed by Personal information you provide may be used for secondary purpos c ; s,; 5.04 (1) (m)). Property Owner ~ , :~ ' ~ operty Location Page ~ of ,~ Date ~ riu~a.K,~26 f 22c~10 -L v \ r `~ ~~~~ Gout,. Lot tiGcJ 1/45 1/4,S / Y T2 ,N,R f ~ E (or~ Property Owner's Mailing Address / `~ {•;; '?V.K; LoY#.;"; Block# Subd. Name or CSM# City State Zip Code PhoneMt~ft~be~ ~ ~ "' ^ City ^ Village [~ Town Nearest Road ,,, ,,_ . [New Construction Use: ~ResidentialY.,Number of bedrooms ~_ Addition to existing building ^ Replacement Public or commercial- D~serike ` %'~ _ ,-.' Code derived daily flow ~ ~ U gpd ~y Recommended design loading rate _~bed, gpd/ft2~L_trench, gpd/ft2 Absorption area required ~~ ~ bed, ft2~trench~~, ft 2 Maximum design loading rate bed, gpd/fi2~trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ ~• ~9 [~l ft (as referred to site plan benchmark) Additional design/site considerations l~~ y~ r/~ ~`~ • ~ G G a v-e r ~/ 3 2 ~ Parent material ~ V'~~ b ~I 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 ®S ^ U ~ S ^ U ®S ^ U /1 (~^ S .[.~~U( ^ S ~U CAII IIRC~`QIDTIAN RFDART ~-In..)~.~n ~ \ ~..)u~I ~~ Boring # Ground elev. 98•s~ ft. Depth to limiting factor g`~ in. Boring # "L§ Ground elev. Y? y(v ft. Depth to limiting factor `t b in_ Horizon Depth Dominant Color Mottles Structure i B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. stence Cons oun ary oo s Bed , Trenc Z Ib I ~ L_5 1^^ ~ ~~ ~ 3 y -- ~ o ,~. ~ - ~- ~ £s 3`~ ~ • 6 ' Remarks: 1 ~_ ic.7 ~ e ~----__ 5 ~ w.ab~. ~.~~ c.~ 1~~. ti Z to / ---_'.~ 5~ 2:+..c~b1~ 1h~cz ~„ - -~--~ -~ O ~ ~'_ WAS w~~ ~~ _ ~ ' ~ Remarks: SST Name (Please Print) Sign lure Telephone No. Gi v rvt.n.. ~i~-zy7-%GVa Address Date CST Number Z// D~ S~ ~~•~.~~f w~ y~~ y-y c~cJ zs33~Q PROPERTY OWNER `~~~ PARCEL I.D.# Boring # Ground elev. 9$, y6ft. Depth to limiting factor 4a in. Boring # Ground elev. 99.310 ft. Depth to limiting factor ~_in. Boring # Ground elev. 9~L ft. Depth to limiting factor 9(o in. Boring # Ground elev. ft. Depth to limiting factor SOIL DESCRIPTION REPORT ~• Page • of h Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ~ Trench -lo Io 3 /Z Sl. 6k >~ G. ~ W n `~ ~ 1. 1 -~ ~5 ~ -- ~ ; ~ 2`194 0 6 +^~S ,.,,. LS -- ~--; ~ ~_~ Remarks: lU-'`t6 -- vwFtZ C.5 •-~-- ~s ~ ~ -fib o - ~ o S ~ ~ ,-_' Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/fl2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench ~ tl- N 1~ 3 Z '~ S L ~ w. 1, L ~'~ ~ i1 ~ Z \~2 ~ r-- L$ v~.FR ~ ~ ~ Remarks: m. Remarks: SBD-8330 (R.9/98) r- PAGE ~ OF 3 NAME ~~T~cs ~ LOT# 5 y LEGAL DESCRIPTION A/W '/4SG~P/4,S ~H T 2~,N,RIq E (or) i SCALE: 1 "_ ~ ~ C7 `B ELEVATION ~ U U U BM 1 DESCRIPTION+o p oq~ Z ~~ ~(J~,t, ~0; (yam ~a t h of Fh~ ec.~ ELEVATION ~ I • ~ C0 BM 2 DESCRIPTION +-~p o ~ z ~puL ~~-- 7a~r w~r~~GOJ SYSTEM E~VATION `JS •~~ 1 L~~<r wt,,,~r' A TERNATE ELEVATION ~''f • ~ ~ 9 3.2 h CO OUR ELEVATION /~/~ ~~ )< ~ _-t, MZ z ~ ~1p` ~i ~~'~~ ~° az • ~.~~'~ a~ t ~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: Svstem Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow -Peak (gpd) Estimated Flow -Average (gpd) 6i~ Septic Tank Capacity (gal) Z ~~ ' Soil Absorption Component Size (ft2) C3D 2 - ~ i Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation c. t~OM.•~ J Septic Tank Component Soil Absor tion Component Design Flow -Peak (gpd) z' m ih.S 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 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 tic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filte 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 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 pertormed 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 Absoration 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 . ST CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT • AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~=~/6 ~ /~/GYEI~~` i~1~~'s ~ Mailing Address ~~ 9'S~ ~l/f~ N ~-T= , s`,~t/L ~~ G/.r -~~o S ~- Property Address ~ ~~ C T /`~~^"--~-~ ~ !~ (Verification required from Planning Department for new City/State Parcel Identification Number ~ a ~ - ~ 37~ -~Y 4 oO LEGAL DESCRIPTION property Location %, '/., Sec. . T N-R W, Town of /7 ~~'J~-d.t~ . Subdivision .SLf~~~-~~3 ~~~iY~ .Lot # S~ . Certified Survey Map # Volume .Page # Warranty Deed # _ ~ y~~.~ 7 ,Volume ~ ~ ~ 6 .Page # Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE improper uae and maintenan,.~e 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 foam, signed by the owner and by a mastCrplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is is 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, heroin, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that yours 'system been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da of the exp' n date. " ~ ~2~/ O/ SIGMA O PLICANT DATE OWNER CERTIFICATION I (we) ce at all ements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th operty des abov , virtue of a warranty deed recorded in Register of Deeds Office. 3 ~Zd j o / SIGMA O L CANT DATE s**««« 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 ~~ STATE BAR Oh WISCONSIN FORM ~2 - 1998 11 WARRANTY DEED . I nn~c+ e~ Document Number VOL 16l)UPAGE _4J__ I '! This Deed, made between I I RT HARi) C~. STOUT and JANET P STCIUT-, - !_ hLSband and wife, a 641057 Y.A'THL.EEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03-23-001 9:15 AM YARRANTY DEED ~' Grantor, i~ EXE!tPT D CERT .COPY FEE: and u n I.6 11-.-~EI?~Q1J-IC'I' _ - ' • . !~ COPY FEE: _ .~ A MARRIED PERSON TRANSFER FEE: 144.74 j RECORDING FEE: 10.00 Grantee. PAGES:w~. 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following i descri 1 estate in St. Cro1X County, State of Wisconsin: ~~ Lot 5 , Plat of Sweet Grass Farm, Town of RecoraingArea Hu son, St. Croix County, Wisconsin. ~~ Name and Return Address (Eagle Valley Bank, N.A. ';1301 Coulee Rd., Ste. 4~2 (!Hudson, WI 54016 !i 'i i 020-1376-54-000 !! Parcel Identification Number (PIN) This iS riOt homestead property. (ls) (is not) , .. - tS TFp9 NSTRUEEf~Ir Dp/1FTED BY EDNM FUN1M JOB ND. 00.18 DATE 616-00 - dO i .ti98NS 8]IS YNf7 N3Lg1 O J 5 ~ O O q ~'~g o~'~~ ~ °gd3o W ~ 3 ~0 UZZ <~I = ~ ¢ ~ (f e ~ ~~ ~ i° g~~ ~ ~ ~ a• ~_ ~ ~ ~ ;h ~~~ ~ ~~ ~ ~~ 3< o~ ~ ~ ~ ~i 3 ;~ 1 •j. - .j............ .. 1.. I ....p..... ......... .. ~i 1 I 1 '~ N ~ k F- ~9 ~ O Ne F' Z$ O~~ O ~~ v ~ ~ ~g 9<~ Y ZQIp F g~g ~5 1 o~ 1~106~ O~PC~ g9a ~" I -- 3 I 1 I k ~ ,°, ~~ ~~ . ~ ~ ~~ ~~ 1 ..j........... i ~ i i _ __._ h~ i i _ _ - - _ _ 3~ ~~ ~ ~ - - ......j... `` .' I ~ . I ~ ~ g ~ ~ w ~~ x# ~ ~~ ~ ~ ~ ~ ~ F-- ~£ Os~ O ~s ~ O F~ ~ ~ ~ ~~ Z W I ~ R~ ~~ d ~ ; 6 ~ . ~ ~ p W M q LL W W