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Home My WebLink About020-1376-59-000r Wisconsin Department of Commerce ~ PRIVATE SEWAGE SYSTEM Safety and Building Divi, ion INSPECTION REPORT ' GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Keiser, Wa ne Hudson Townshi CST BM Elev: / ~~- ~ Insp. BM Elev: /U~ v BM Description: ~'~r>~I 6.~.s~..~o4',n~.- Pic- , TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / / ~ (/C/ / ~ ~.., ` S U Dosing ~ ~ /~ ~ Jl ' Aeration Holding TANK SETBACK INFORMATION ELEVATION DATA county: St. Croix Sanitary Permit No: 420475 State Plan ID No: Parcel Tax No: 020-1376-59-000 ~ 1~ STATION BS HI FS ELEV. Benchmark (p•U l~• ~ L a Bldg. Sewer !~/4- .a /~ 3..3 St/Ht Inlet /~ z. ~ SUHt Outlet ( ~/ , ~ /02 , Dt Inlet f ,/ Dt B t m ~ ~ ~- Hgad r/Man.~~~ -~ O ~~ •~ ~-y o p ~- ~ ~~ j~2..a ! a,. o q -c~ Bot. System ~.~f- ~ •A 3 • d Final Grade ~.3a `7-?7 St Cover (~ ' O ~ /~.S` b /~' O. o j}~ -o BEDlTRENCH DIMENSIONS Width / 3 't Lengy}.--r ~. ~ ( No. Of Trend PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ( , , / r,,.-- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHING Man tur r. ' / ~,, ~ INFORMATION CHAMBER OR /Try( ~ ~l Type,Qf System: , r~ '~ , 130 ~ T ~ ~ O - Model Number: ~ ~ ii DISTRIBUTION SYSTEM Header/Manit Id ~l i / M Length X Dia ~f' Distribution L Pipe(s) `!T',,, ~•r ~ ~ 'f' Length Dia ~ J^S-pacing x Hole Size ~ x Hole Spacing. ~ ~~ Vent Air Intake ~ J •~ S ~ 7 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only do ~ ~-~-~"^ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil ~ Yes (~I',~ ~ Yes f`„~ o ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~l p~'Y Inspection #2: / Location: 917 Florence Lane Hudys~on, WI 54016 (SW 1/4 SW 1/414 T29N R19W) Sweet Grass Farm Lot 59 Parcel No: 14.29.19.2320 1.} Alt BM Description =~~ ~ /'1~d--~-~ ~• wa~j '~~'`e-~S • ~ dY~~~~3~~ yZ/,r/Y/ery~~c/k. br;-fol,ladc, 2.) Bldg sewer length =~ ~ ~/~gL~n-~-G /ST yto/i~ZC/y-t Gx ~ 7"'-~+ ~''r%1GiL[Glc~-~ !/k_Sdy/ -amount of cover = ~~=1- /'~O'4,f' - ~j~'e`QI yLo~~~ ~ v~ ~i a.•.. P~d~'ya-w~~ an- r-_ I -T- ~ ~- - - Plan revision Re uired~ `:, No !' ' ~ , - _-___ ..~,~ -- - - ------ _- -~~L--~JI ~ I 1 ~ ~ ~ ~ ~o_ SCI ~ __ ~'I Use other side for additional information. ~._ _ ~- SBD-6710 (R.3/97) Date Insepctor's Sig ature Cert. No. PUMPISIPHON INFORMATION ~ J ' , ~~ ~~M~ i ~~ ~~ ~1 o ~.~ ~ ~~ ~5 Safety and Bttildings Division County 1 ~ ~ ' ' 201 W. Washington Ave., P.O. Box 7162 ] ~, ,~ ~0~~ ,~~ Madison, WI 53707 - 7162 Site Address 'De artment of Commerce /o yi_~-t 3~Fo~tF lj Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide n ^ Check if Revision ~~v ~~ ma be used for Privac Law, s15. 1 m I. Application Information -Please Print All Information rate Plan I.D. Number Pt+operty Owner's Name ~ 1 Number Property 5 Mailing Address ° ° , ; ~ Ity Location . a~ao ~ ST. C"<~)1X_ (;G~11J i''! S4 ~(~.~: S T N. R City, State Zip Code ne r ~ ~ ~ ' ' ' = t N r Block Number Subdivision Name CSM Number -- 0 7is = 38G • as II. Type of But7ding (check all that apply) a ~,ty ~ ~1 or 2 Family Dwelling -Number of Bedrooms ~u~1~.aQ~v,-- ^Village ^ Public/Commercial -Describe Use ownship ^ ate Owned ~C Tjy~ ~ ~ ~ ~ ^ Nearest O u c ~" G='Z -~/ " _' ~ Type of Permit: (Check only one box on line A (numbering scheme for internal rue). Complete line B if applicable) `,' 1 New 2 ^ lacement stem Rep Sy 3 ^ Replacement of 6 ^ Addition m For County use stem Tank stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that appiy)(numbering scheme is for internal ase) s.~(, ~,, 44~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 54 Consaucted Wetland ~/~~~7~ K r ~ 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 3 f ~ ~ 45 ^ At-Grado 46 ^ Aerobic Treatment Unit 9 ^ Recirrula ' 30 ^ Other °~B V. D tment Area Informat ion: Design Flow (gpd) rsal Area / / Dispersal Area Proposed Soit Application Rate(Gals.rDays/Sq.Ft )' Percolation Rate (Min./Inch) System Elevation y 5' Fnml G ~3 Elevation r , ~// , ~~~ ~ q COQ 8~s 7 ~7D 7 T- a = q5 ~ ~ ~~ ~ "~~3, ~ ® VI. Tank Info Capacity in Total Number Mam~facturer Prefab Site Steel Fi er pl, Gallons Gallons of Tanks - Concrete Constructed Glass New F , , / ~ ~ C ~ (~ Talcs Tsoks V" Septic or How Tank ~ t7 ~ O / Dos[n8 Chamber VII. Responsr'br'Itty Statement- I, the undersigiued, 9~~ responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) ~Y ~T Phunber' RS Number Busi~ss Phone Number - , o..~.~ 7 7~.s - ~- s Plumbers Address (Street, City. State, Zip ~~" .~~a v /De artment Use Onl Approved ^ Disapproved mit Fee (includes GrouMwater Per ~~Y D a t e Lcsued Signature (No Stamps) ^ Owner Given Initial Adverse e ~ ~~,¢X, )~ 'l ~' ~ ~ "~~77"" O~- '-- / - ~ I v// O Determination IX. Conditions of Approval/Reasons for Disapproval ~ ~ Pdwr~ ~. -la ow-ytak.. ~v~taPU~., ~~ ~ ~ L' ~ . t~. .et. r, e-- r ~~ ~ - l~.~r~rv k~~ -~rTrv>7. ~~ ~ ~~ S 5 ~ SBD-6398 (R. OS/Ol) ~~~ ~4lsconsin.Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Bureau of Integrated services in accordance with Comm 83.09, Wis. Adm. Code ' County Page ~ of Attach complete site plan ort paper not less than 8 1/2 x 11 inches in size. Plan must C U ~ include, but not limited to: vertical and horizontal reference point (BM), direction and S ~- r ( I'" percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # LoT APPLICANT INFORMATION -Please print a ,~~ r4r~erian. viewed Date Personal information you provide may be used for secondary p o~By{Privacy Lays. 15.04 (1) (m)):, ~~ :,_... Property Owner , ' r Property Lgcation C ~ ~ Govt. Lot ~~~ 1/4S c.v 1/4,S r ~r T Z ,N,R / E (or~ Property Owner's Mailing Address r ck# Subd. Name or CSM# - ee , Ir.' , . 59 f SWee-~ C-~rasS City Sfat\e Zip Co''d\\e Phone Numbert • ~` ^ Villa e ® Town Nearest Road ,~ ~..___--- L [New Construction Use: ~ Residential /Number of bedrooms ~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: --~ Code derived daily flow ~ gpd Recommended design loading rate bed, gpd/ft2~p trench, gpd/fiz Absorption area required ~7 bed, ft2 ~ S~ trench, ft2 Maximum design loading rate ~ ~ bed, gpd/ft2~_trench, gpd/tt2 Recommended infiltration surface elevation(s) ~ ~' ~ [' ft (as referred to site plan benchmark) Additional design/site considerations r4-~-'F y~J~ e r ~+ S-• G.~ d Gb w-e r' ~ ~' S~ ~~/ Parent material C) V -F-w 4 3 ~ "~~-~ 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 [1~S ^ U ®'S ^ U ~ S ^ U ^ S ~ ^ S ~ U cnu n~eCRtaTinN RFPART Boring # 1 Ground elev. 9~•3t ft. Depth to limiting factor ~_in. Boring # ~~. €Z Ground elev. G~.z( n. Depth to limiting Horizon Depth Dominant Color Mottles Structure d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boun ary oo s Bed ,Trench f ~-1b ~~ ~ 2~ -°- ~ I m5b~ C ` ~ v~ ~ y ~ ~ ~ ~ ~o--~ ~ ~+ I ~S l ~s - .--~ ~ . 8 ~ i~-~8 ~-l I l.o - ms i ~~ - - ~ . ~ /~ Remarks: I d~ I ® 3 ~ - SL ` ~i bk -fir c. l ~-~ . 4 ' . 5 ~ -81 D 4 ~5 vs ~s .~ ' .$ R1 in. Remarks: CST Name (Please Print) Signature Telephone No. ct vvl r,~. v .~" ~--~"~ ~- (~ ~~~ 2 G/ 7 -G~~ c~S Address Date CST Number ~~~-4- SOIL DESCRIPTION REPORT PROPERTY OWNER PARCEL I.D.# Boring # 3 Ground elev. 9~ft. Depth to limiting fac~ r _~in. Boring # Ground elev. 9~ft. Depth to limiting factor ~~ in. Boring # Ground lev. ~7.b1 ft. Depth to limiting f for ~~ in. Boring # Ground elev. ft. Depth to limiting Page Z . of 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench ~ ~ --+o lC~ Z ~t 1 m5b1~ mF`r c ~ - `f ~ .S Z -2i - L ~ ~ LS • ~ ~ . 3 ~-8y ~p ~I - rns` I c5 - -~; .g 3 .'3 2 ,,((~ `'f' S ~ ~' Remarks: 0-8 lL~ (2~ ~~ ~ m~rr c -~ ~ v~- • `~ ~ • S ~ z~ ~i5 ~D ~ ~ s ~ ~ cs , ~, ; . g Remarks: ~L ~~'~~~~' ~~ G-' Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. ry Bed ,Trench o -~ Z m ~S V-~ ~ • S 3 -g p 4~ m5 5 i C5 ~-- ,-, ;.~ _d ,~ Z" . ~ (2 ~ Remarks: factor in. Remarks: SBD-8330 (R.9/98) PROPERTY OWNER ~ ~ ~+ SOtL DESCR{PTION REPORT Page Z of 3 PARCEL ItD.# Boring # 3 Ground elev. 9$,1 ~ ft. Depth to limiting factor ,.~_in. Boring # `~ Ground ev. 9~,fc. Depth to limiting factor _~in. Boring # Ground ev. .01 ft. Depth to limiting f or in. Boring # Ground elev. ft. Depth to limiting factor in. Horizon Depth in Dominant Color M ll Mottles Texture Structure Consistence Boundary Roots 2 . unse Qu. Sz. Cont. Color Gr. Sz. Sh. Bed .Trend ~ b -io 1 2 Sl 1 m5bk rr>F'r c .t-~' - `~ ~ .S 2 -21 1 -' lS ~ ~r LS - .~~ . 3 .'3 2 , s ~ s. , Remarks: ~ zy 9a ID ~t ~a - - s G ~ cs -~ ; . g Remarks: ~ ~t,~~~n~~ Clh.e ~-- Horizon Depth i Dominant Cobr Mottles Texture Structure Consistence Boundary Roots PD/ft2 n. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 2 3 o-i -g Z D ~~ ~ ms ,m 5 ~ GS c5 V~ `- ; . S .~ '.8' . ~ (Z ~- _~~ Remarks: SBD-8330 (R.9/98) Remarks: I~ ~_ _ ' PAGE~OF~ NAME `J ~ U ~' LOT#~~ ~ LEGAL DESCRIPTION 5W '/.541/4,51( T?~t ,N,R ~ q E (or) r SCALE: I"- I60 BM I ELEVATION SOU . U BM 1 DESCRIPTION ~vp off?" prc. Pr,o<- BM 2 ELEVATION 9 9, U l .. BM 2 DESCRIPTION to p al Z " pyc, (~~' p i- SYSTEM ELEVATION ~~, ~ ~ ALTERNATE ELEVATION~re..~AS.oU ~~u.~r 9y,31 CONTOUR ELEVATION/~~ i _-r- K I cL ~ }L; ~ ?~~, ~ 3 ' ~ ~~ R ~°~- SOU r °~~' . ,~ ; 4~~ " ?D r J~~~~~~ ,P~'a ' ~ ~~ u y- ~- ~ CJ ~- ~ 1 N~ a_ino7.~ l'~p0 r; ~ '- ~ ~~~ . ~-~ /~ a_~~ ~-~ -~ysi ~s , ~-_ a _ ~ a '' ~~- oo ~- ~ ~ ~~ ~ ~ ~ ~ ~ ~~ a '' ~v ~~ a - y~,o~ ~~ ~' ~~ o, . ...f ~; ~~~ a~ ~~ ~'~~ ~ ~ ~~ ~~ ~ T ~ ~,'a- 3,h -~°'` C T.~ ~ ~-~ B_ ~ ~~o r- ~ S~ yys~ ~G ~ -lo T-a sy - ~s N e \ ,k ~ ~. ~. ~ A x , • s ~ N ~ `~ x` ti ,' 0 0 C ~.J `° ~ ~ a ~ ~o ~ ~, ~. ,, X ... .. . ", .~ ... ~ a , .~ ,~. ~a ~ , ___ ~_ ; .. ., ~ r: ,. ~ ~, . . _ .: ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OwnerBuyer Mailing AddrE Property Address (Verification required from Planning Department for new ~sy~i? City/State ~(w~l•~-~~, tit~.~ Parcel Identification Number ~ ~D= t 3 7~ - S y' 00~ LEGAL DESCRIPTION Property Location ~%., ~'/., Sec. ~, T~N-R~W, Town of Subdivision _ `->i~1P Certified Survey Map # ~' Lot # ~~~~ Volume ,Page # Warranty Deed # ~ ~ ~ a ~ 3 Volume o2 Page # _ ~, Spec house ^ yes ~ 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, The property-owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, 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 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. SIGNA 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 descr/ibed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~~lG~ ~z l ~ ~ / / SIGNA 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 OWNERSHIP C;~RTIFICATION FORM POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of ?/ FILE INFORMATION Owner Permit # --L ,,T- DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ~'-"` ^ NA Estimated flow (average) ~ al/day Design flow (peak(, (Estimated x 1.5) al/day Soil /gyp ~ ~ al/da /ftZ Standard tnfluent/Effluent Qualit Monthly average ` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (RODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mglL Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L A Fecal Coliform (geometric mean) <_10` cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA "Values typical for domestic was/t(/e~w~a/ter~a~nnd septic tank effluent/. ^^ w u~~w~ w un~ ~nu~n~ u ~ ! -/ /1 / V!Y/~7 / ~^Yl ~~ SYSTEM SPECIFICATIONS Septic Tank Capacity Q al ^ NA Septic Tank Manufacturer ' ^ NA Effluent Filter Manufacturer a r ^ NA Effluent Filter Model ~ ~Q d ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ O NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: A Dispersal Ce(lls) ,~ In-Ground (gravity) At-Grade - ^ Drip-Line '~ ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA n~~n ~ u~ruw~ vv~ ~a.vv~a. vv - -- v v.. Service Event Service Frequency Inspect condition of tank(s) At least once every: ~ eBf~S~ts) Maximum 3 years) NA Pump out contents of tankls( When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal ce(lls) At least once every: ^ ea~Is)(sl (Maximum 3 years) A Clean effluent filter ~5~f t:~~~- At feast once every: ^ month(s) (~yearls) ^ NA ^ month(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ year(s) (s) ^ NA Flush laterals and pressure test At least once every: ^ ear(s) Y Other: At least once every: ^ month(s) ^ year(s) ^ 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 tankls) 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 IY31 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 Z oft START UP A11D OPERATION For new cpnstructiora, prior to use of the POWTS check treatment tanklsl for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tanklsl 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 dnve 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 sha{I 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 replac~em~e 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 Name Phone f POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) GULATORY AUTHORITY Name Phone LOCAL RE Name S~ (~,~.~ Phone / b 7/~!" ~ ,3g~ ~(O Z3 b This document was drafted in compliance with chapter Comm 83.221211b11111d1E~1f1 and 83.54111. 12) E~ 131, Wisconsin Administrative Code. ! 1892P y86 . STATE BAR OF WISCONSIN FORM 2 - 1998 ' WARRANTY DEED ` • Document Number RG S 9 OF YALSN EED$ ST. CROIX CO., MI Phis Deed, made between -. RECEI YED FOR RECORD RICHARD, 0. STOUT and JANET P ST UT ___, d 05-16-2002 husban and wife, 12;30 ply _, Grantor. ------------- -----'---- ~RRFINTY DEEP and _ .W.$YNE KETS;R CONSTR T TIn~, TNC' EXERT t __ _ - -.---- _ __. _ ____. ~-- REC FEE: 12.00 TRANS FEE: 179, 40 - - COPY FEE; -------- _, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following CERT COPY FEE: PAGES: 1 descri d estate in y St . CroiX Counly. State of Wisconsin: Lot 59, Plat of Sweet Grass Farm, Town of ~.,~- ~t.,, ,. Hudson, St. Croix County, Wisconsin. Name and Return Address 1~; c ~ S-ra,.ti? (3s 3 ~~ ~ Tt' . {'aid srv~_ 1 w I ~(~ / h 020-1376-59-000 Parcel Identification Number (PIN) This 1S riO~omcsteadpropcrty. (is) (is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated this ~~~ day of April -~ l~~ \~1 ~ (SEAL) Richard 0. Stout AUTHENTICATION Signature (s) (SEAL) authenticated this day of 2002 ~~~-c'"'r ~ /'~L.(~ (SEAL) Janet P. Stout (SEAL) ACKNOWLEDGMENT State of Wisconsin, - 55. St. Croix Count. ~j~ Personally came before me this ~_-~__ day of ~p~ 1 200. the above named Richar~ n .Stunt apjj__J3n,Et~P~ 77TLE: 61EMBER STATE BAR OF WISCONSIN '~! S _' _ to (If not. ~ E. N me known [o be the persons who executed the foregoing authorized by §706.06, Wls. Stats.) ,. Q~,cJ~ t ~ in ent and ac wledg a me. ~ ,~. THIS INSTRUMENT WAS DRAFTED BY ~/~G/S'q~Of~~\ CS~i`a\~~ ~-• _ - Janet P. Stout ~~~etwnutu~' ~' 1353 Awatukee Tr. w _y~~~. ~l,sp~.~ HlldSOn, WI 5401 6 Notary PubUc. State of Wisconsin __ _ My commission is permanent (I( not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not __ _.,~ ~-I _-i ~~~) necessary.) ' Na~,us of pes~,m s~gnmg in eery capacity must be typed or pranced below cheer signature. WARRANTY UEEll STATE BqR OF WISCONSIN FORM Na. 2 - 1998 Wisconsin 4aga~ Blank Co., inc. Milwaukee, Wis. __ _ _ __ ~ ~ ~ A!' L' A 4.£ x.006 . ,~ vw a ,fL•arv a~.o~~c~.ooN 3Mo~l i - ----- s•i~ -•,~ ..- ~ A %~ ~-~. ~. MATCH LINE SEE SHEET 4 OF 5