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Parcel #:.020-1388-03-000 o7i27i2oos 04:00 PM
PAGE 1 OF 1
Alt. Parcel #: 14.29.19.2377 020 -TOWN OF HUDSON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): ' * =Current Owner
JOHN F & CHERYL A COSENTINO * COSENTINO JOHN F & CHERYL A
952 SADIES LA
HUDSON WI 54016 ',
Districts: SC =School SP =Special Property Address(es): * =Primary
Type Dist # Description * 952 SADIES LN
SC 2611 SCH D OF HUDSON
SP 1700 WITC ',
Legal Description: Acres: 2.859 Plat: 1960-FIELD HAVEN LOTS 1/7 020/01
SEC 14 T29N R19W PT SE NE FIELD HAVEN Block/Condo $Idg: LOT 03
LOT 3 2
9AC
8
.
5
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
14-29N-19W SE NE
Notes: Parcel Historyt
Date poc # Vol/Page Type
07/26/2002 685070 1934/01 WD
09/27/2001 657610 1726/533 QC
09/05/2001 655975 1714/291 WD
07/30/2001 652511 8/62 PLAT
9f1Ad SI IMMARY Bill #: Fair Market Value: Assessed with:
50273 366,900
Valuations' Last Changed: 07/21/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.859 50,100 X33,700 283,800 NO
Totals for 2004:
General Property 2.859 50,100 X33,700 283,800
Woodland 0.000 0 0
Totals for 2003:
General Property 2.859 50,100 191,700 241,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
018-RECYCLING SPECIAL ASSESSM ENT 27.00
Total
Special Assessments
27.00
!Special Charges
0.00
Delinquent Charges
0.00
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
,< INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name:
Cosentino, John City Village X Township
Hudson Townshi
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic
1..~ I r/S~-2__ ,Z~
Dosing
Aeration
Holding
TANK SE~BACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic ~ ~ ~ ~ ~ ~-S ~ 3
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
.--
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County: $t. CfOiX
Sanitary Permit No:
420304 0
State Plan ID No:
Parcel Tax No:
020-1388-02-000
STATION!... BS HI FS ELEV.
Benchmark /~ ,
~'~ -
Alt. M ,
Bldg. Sewer
SUHt Inlet
SUHt Outlet ~ p ~ ~ 1 I- ,L
'f
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
Bot.System
131 B l,.t
E y'~ g q2 ~,L
Final Grade
t,t.a2
,SD
~.(®.
St Cover 2,~5 Q~' ~5
RENCH
DIM Width /
3 Length ~ No. Of'7Trenches
g7.5~ a Z PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
SETBACK
INFORMATION SYSTEM TO /L BLDG WELL LAKE/STREAM LEACHING
CHAMBER OR
' Ma factou[[@r
~ 0(k
T ..
ype Of System:
~J ~
~ 5 ~ ~
~ /
,~, ~O~ UNIT Model Numl~gr: ~ i,
DISTRIBUTION SYSTEM
Header/Manifold U Distribution x Hole Size x Hole Spacing Vent to Air Intake
~0 Pipe(s)
Length t~ Dia Length 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 discrepencies, persons present, etc.) Inspection #1: s~~2 Inspection #i: -~--i
Location: 952 Sadie's Lane Hudson, WI 54016 (SE 1/4 NE 1/4 14 T29N R19W) Field Haven Lot 3 Parcel No: 14.29.19.2377
1.) Alt BM Description = ~` J . ~`~`,' ', 5. (o ~ ~ ~C'1'~
2.) Bldg sewer length = ~ ~ o t~~~ ~ ~~_ ®~ t
- amount of cover =
3) ~-~.-~.e.Q /~ • ~~ C-T~ . ~ ~~ Pte- ~.>~. ~ sub- -.~.P ~. ~+~~~.~ra~.', )
Use otherlside for additional In Yes ^ No ~ ^- - - -T- ~
formation. i ~ __ ~___ __ ~ 1 -I
SBD-6710 (R.3/97) Date Insepctor's Slignature Cert. No.
~'~ o~rtl~~ Pf`f~ t~ ve>~
Sanitary Permit Application Safety & Buildings Di'
' 201 W. Washin for
In accord with Comm 83.21, Wis."Adm. Code g
® See reverse side for instructions for completing this application PO Box
iseonsin personal information you provide may be used for secondary purposes Madison, WI 5370?
Department of Commerce (Submit Com leted form fU county
SAY [Privacy Law, s. 15.04(I)(m)j P
0/ DO state o~
Attach tom lete tans to the count co onl )for the s stem, on a er not less than 8-I/2 x 1 1 inches in size.
Coun ~ ~ State S i Permit Nu r ^ C eck if revision o previous application State Plan I. D. Number
03~
1. A lication Information -Please Print all Information Location: ~
erty Owner Name ~ ~~~~~ ~ Property
Lo
ca
tion ~ ~37'
e
'
/
1/4~'/~ /4
S T
perty Owner's Mailing dress
! E y 2002 ,
I
Lot N_ umber Block un
Ciry, State Zip Code SPTht~rw~ji).-~~~ _
~F~(,~_ Subdivision N me r CSM Number
(~.~~ r-~~, Ala - ~.,,~,~, ~
II Type of Buildi (check one) ~
I or 2 Fa
il
D
lli
N /~'
4
J o Ciry
O vill
m
y
we
ng -
o. of Bedrooms: ~
~
p
-- - age
O Public/Commercial (describe use):
^ State-owned ~" /2(To~yn of
~~th[
III Type of Permit; (Check only one box on line A. Check box on line B if applicable) Nearest Road
A) 1. New System 2. ^ Replacement 3. O Replacement of 4. ^ Addition to Parcel Tax Number(s)
S stem Tank Onl Existin S stem ~ ~ - g ~ d~'~
B)
^ A Sanita Permit was reviousl issued Permit Number Date Issued
t v. type of rV w l aystem: (Check all that apply) .1 •T~E~CJ l~3" Gv~ ~j16 D~FwS~~Z S-rt~. l~~-~r~l~GuA,~g S~
Non-pressurized In-ground ^ Mound O Sand Filter ^ Constructed Wetland 3 ~x $7
Pressurized In-ground O Holding Tank ^ Single Pass ^ Drip Line ~/~-NSi6nL'
^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: ~~
V Dis ersaVTreatment Area Information: ~-/tom // a x 3 i ~ = 8?O ~
I .Design Flow (gpd) 2. DispersalArea 3. Dis ea 4. Soil Application 5. Percolation Rate 6.~5yystem Elevation 7. Final Grade
Required / Proposed + Rate (Gals./day/sq.,ft.) (Min./inch) 3 b2f!oi~S6tt~ I ation~
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- lass
New Existing Crete s trutted g
Tanks Tanks
I,~.u.a~
a o o ^ ^
VII Responsibility Statement
I, the undersi ned, assume res onsibilit for install ation of the POWTS shown on the attached lans.
Plumber's Name (print)
C
T
~ Plumbe 's Sin re (n /MPRS No. Business Phone Number
t!
G/~
Y ado 3S 7 ~is~ - ~~~ ~-~~~
Plumber's Address (S,tree1t, City, St te, Zip Co ) `~
~ /~ ~~~' ~yd ~
VIII Countyr'Department Use Only
^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued uin gent Signat (No stamps)
pproved ^ Owner Given Initial Adverse Surcharge Fee) ~ 8
Determination ~~ ~ - ~' ~ ~ Q ~- G~Ja-tp.(~~.- Q~,.~
IX. Conditions o/f Approval /Reas_on/s for Disapproval:
~, ~/(l,Q.~(Y-'U,lo.'7 ~st vr~%S~QX~ ~ZS~-'raw.- f` ~Sdt ~'d»~t 5f/S~Grr+• ~-~~tOiL S~(~c~a~-{~"-Oti~~'
-"'~-~ 1~ C~»,n~. 8'3.+:(3-!. `
J-l m.ua,.~" hrcue. e f~'-~n~ - e ~t.~cd ~i~`s~'.ec~d a~c~ttd~~ ~ rna~-~
S~G..edcc.t?.e_ ~- ~-- i~e.~JTS 0 urrtiPrl~ s( l~t'T l~ ! wt-ht ~G~. m~u,a~- 6~ P t-d v~~Led b~
,t',~n-ua.crr .
SBD-6398 (R. 07/00)
H /~+A.
la~o u~
~ -goo zdG-~
N~ h~
~. - ~y ~ T~-~. ~ ,'' No
s~ ~. yy 80 ~ f,~;Q~. N~~
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0
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~- `~ 9
q~,
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a " ~""°~ -~- .
i
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H-/o S ~ H-ib
5.~ ~-fi. 95! 80
N- /~*A.
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DD~
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a - iy ~~-G-~ T ~ i'' No
S~ ~. 9y So ~ -F,+..~Q~. N~.~
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are-a = yg.$a~ ~~ ~ 3iy"' ~"
- ~ r;
f- ~-~ ~aaa3
wiscone.-xr~~ap~~trnentofCommerce SOIL EVALUATION REPORT Page I of~
rliviainn of Safety and Buildings
` in accordance with c;omm ts5, wis. Ham. was -
County ~ ,
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and
scale or dimensions, north arrow, and location and distance to nearest road.
percent slope Paroel I.D. ~ 0.3 '"C~
p~0 - /3 b'~
,
Please print all information. Re ' by Date
~ ~
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~~- (5
Property Owner Property Location
~ Govt. Lot g~ 1/4 N~ 1/4 S ly T Zcj N R ~ E (or)
Property Owner's Mailing Address Lot # Blodc # Subd. Name or CSM{~
573 ~~- ~ 3 Feld
City State Zip Code Phone Number ^ City ^ village ~-Town Nearest Road
d can C~ l o~ (l > -~ y ~ludsan Mc
[~ New Construction Use: ~ Residential / Number of bedrooms 3 `~ Code derived design flow rate '. ` ~ ' . GPD
y
`}
,
^ Replacement ^ Public or commercial -Describe:
~
~
~
'
"
~
Parent material O V'~- W crS Flood Plain elevation if appligble ° '~ _
Generalcomments -SYS{-rrn~ "' 3 ~ ~~ ~.~, r~C.L~ f ..~ `
and recommendations: ~ ~• {. e. (~e U . q Z. • ~ O ~:~ r n t {,
t
I
~ /
~' _ .
ST CflC~k
GOUrdTY
v 1CE _. _
I ^ Boring ~, ` ,'',
Boring # ~~ `~' ~ ~`
pit Ground surface elev. ~ ~ ~ ft. Depth to limiting factor ~ / J` in. ~' -.: Soil. ' lication Rate
l
C n
D
i
ti
d
R Texture Structure Consistence Boundary Roots GP DJfi?
Horizon Depth
in. or
o
Dominant
Munsell escr
p
o
ox
e
Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
b-I Z lU r lz. - S i t -Fr S v~ . 5 . F
2 12 -2~ is ~yl~ _ 5 m 5 m-~r 5 ~ • Lo
3 -u l~ ~y `~ ms d r»1 -' ~ •-1 /•Z
t f ~r~ea
Boring # ^ Boring
® pit Ground surface elev. 9rZ• 8•d ft. Depth to limiting factor //~ in. Soil lication Rate
H
i De
th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~
or
zon p
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
I - ID r32. 5l~ c v~~ -5 .$
~ -n /0 rye ~' s D I -- ~`' /. Z
* Effluent #1 = BOD > 30 < 220 mg/L and T55 >3O < 1 bU mg1L - tmuen~ ~c = ovu ~ .n, .. ny~ a. w ~ ~~ - .... ~,.y,..
CST Name (Please Print) Signature CST Number
25
Address Date Evaluation Conducted Telephone Number
21I ~ ~~ ~ Jdmer~~~,-~ L~t ~/ ~~Q~~- 3 -/ - o~ C 7L~~ Z~f ~7-`~OC~ _
•+ .. - i
Property Owner- LG C!.'_ 5~'e Parcel ID#
Page _~ of ~_
3
u ~rin9
Boring #
®Pit Ground surface elev. q ~• $~ ft. Depth to limfing factor (f (~ in.
Soil ication Rate
H
i th
De Dominant Color Redox Descxiptan Texture Structure Consistence Boundary Roots GP D/f1?
zon
or p
in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. *Eff#1 *Eif#2
I b-I 10 i ~ 2-n I ~~ . 5 . ~
3 25-ItD ~ - 5 rn I _' • -~ ~' Z
Boring # ~ Boring
^ Pit Ground surface env. it. Depth to limiting factor in. ~~ lication ~~
Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GPOIff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
~~ # ^ Bonng
^ Pit Ground surface elev. ft Depth to I"urri~ng factor in.
Soil lication Rate
Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP ONf
in. Munsell Du. Sz. Cont. Cobr Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BODS > 30 < 220 mg1L and TSS >30 _< 150 mglL " Effluent #2 = GODS _< 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.
SSD-8330 (R.O7/00}
i r
PAGE 3 OF_~
NAME Lct ('a,~S ~2 LOT# 3 LEGAL DESCRIPTION S G ~/,NE'/4 S [ y TZ 9 N R ! `~ E (or)~WJ
.,,~~
c rr.~.r a ~rr r~ F ~ - ~~' ~ DATE .3 -' ~ - ~ ~
t
~'~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION
Owner
Permit #
DESIGN PARAMETERS
Number of Bedrooms ^ NA
Number of Public Facility Units t1~A
Estimated flow (average) r~Q al/da
Oesign flow (peak), (Estimated x 1.5) al/day
Soil Application Rate al/da /ft2
~
Standard Influent/Effluent Quality Monthly average "
Fats, Oil & Grease (FOG) <_30 mg/L
Biochemical Oxygen Demand (6005) <_220 mg/L ^ NA
Total Suspended Solids (TSS) 5150 mg/L
Pretreated Effluent Quality Monthly average
Biochemical Oxygen Demand (BOD5) <_30 mg/L
Total Suspended Solids (TSS) _<30 mg/L ^ NA
Fecal Coliform (geometric mean) <_10° cfu/100m1
Maximum Effluent Particle Size YB in dia. ^ NA
Other: ^ NA
1°Vatues typical for domestic avast/eweater and septic tank effl~ue/n~t.
u naurcw sort erucn~ u c 'T- % /fYl~L~~/D / I ~L~ l~
SYSTEM SPECIFICATIONS
Septic Tank Capacity QQ al ^ NA
Septic Tank Manufacturer ^ NA
Effluent Filter Manufacturer ~ ,, ^ NA
Effluent Filter Model QQ ^ NA
Pump Tank Capacity al ^ NA
Pump Tank Manufacturer ^ NA
Pump Manufacturer ^ NA
Pump Model ~ ^ NA
Pretreatment Unit
^ Sand/Gravel Filter
^ Mechanical Aeration
^ Disinfection
^ Peat Filter
^ Wetland
^ Other: NA
Dispersal Cellis)
~In-Ground (gravity)
^ At-Grade
^ Drip-Line ^ NA
^ In-Ground (pressurized)
^ Mound
^ Other:
Other: ^ NA
Other: ^ NA
Other: ^ NA
•~
Service Event Service Frequency
Inspect condition of tankls) At least once every: ^ ea~~s~ls) (Maximum 3 years) ^ NA
Pump out contents of tankls) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA
Inspect dispersal ceII1s) At least once every: ^ yearls-1s) (Maximum 3 years) ^ NA
Clean effluent filter
At least once every: monthls)
year(s) ^ NA
1s) ^ NA
Inspect pump, pump controls & alarm At least once every: ^ ear{s)
Y
Flush laterals and ressure test
P At least once eve
ry~ ~ ^monthls)
^yearls) ^ NA
Other:
At least once every: ^ monthls)
^yearls)
^ NA
Other: ^ NA
MAINTENANCE INSTRUCTIONS
nspections 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, includin but not limited to the servicing of effluent filters mechanical or pressurized components, pretreatment
units, an any servicing at intervals of 512 months, s a e performed by a certified P WTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of comp etion o any service event.
r
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tankls) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above nomnal highwater levels. When power is restored the excess wastewater wiN be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal Levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may 'smprove the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant
replaceme t system:
'H' ^ 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
POWTS MAINTAINER
Name
Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHO ITY
Name
Phone
Name ,s CiC..v-~.
Phone ~~ - 3 ~ "
This document was drafted in compliance with chapter Comm 83.2212)Ib11111d1&If) and 83.54111. 121 & 131, Wisconsin Administrative Code.
S`l' C1tO1X CUUN'1'Y
SLI'7'1C '1'AIJIC MAIN'1'I?NANCL AGItI?1?MLN'1'
AND
OWIJ1?RSIIII' CI?It'1'11~ICA'1'ION DORM
Owner/Buyer ~(J~n ``.
Mailing Address
I'roparly Address
~~I~s-
~~r .~ p ~
(Verification tcquilal liunt I'launing Ucpatln~cnt fi-r new conslniclion
City/Slnlc't~Wic~(~1 , W ~ ~ 1'arcc) Iclcnlilic;Uicln Nnntl)cr ~0~813~ O~dUC.~
L1~GAL llrSCR(1''1'ION
Properly Location ~ %,, NC '/,, Sc~;. ~, 'f ~ 1J-!t ~ W, 'Town of _
SuUdivision _~IP ~ ~~ I.ot 11
Certified Survey ><~inlr 11
Valuate
QQ 1'ngc 11
~Ynrranty llced 11 ~i, C~ ~ ~ ~ ~ , VOLuntc l ~ 3 ~" I'ttgc # ~~ _
Spec house ^ yes ~ito
Lul lines idcnlililtl)lc~yes ^ no
SYS'1'I!:M MAIN'1'I~NANCI~
Iuy)roper use and Inatnteuauccuf yuu, septic systen, a,uld lcsull iu its p,cn,alule titihuc to halulle wastes. !'roperntait-teuaucc
consists of putnplug out the septle tank evcly tluce ycals ar sooner, if needed by u licensed ptuuper. What you put il-lo the system
can atY'cct the function of the septic lank as a Ilealrucut stage in the waste (lishosal system.
T1-e property owner agrees to submit to St. Croix `Coning Depaltn-cut a culilicalion form, signed by the: owner and by a
masterpluulbcr, journeyman plumber, Icstricled plunlbcr or a licensed pumper vcr ifying that (I) the ou-site wastcwaterdisposal system
is in proper operating condition and/or (2) alter inspection and pumping (if accessary), the septic tank is less than I/3 full of sludge.
1/wc, the undersigned have read the about Icgai,cnlenls and agree lu nlainlahl tl,c private sewage disposal syslent wi111 the standards
set forth, horchl, as set by t!-c Deparlulcnt of Conuucrce oud the Ucpatlntcal of Noturnl Resources, Stale of Wisconsip. Cettificaliou
stating that your septic sysleut bas been nlainluincd nulst be cony,lclcd and Icluu-cd to the St. Croix Couuly Zoning Otiice within 30
days of the l ree year expiration date.
f
6, 6~
SI A'IURLr Or APPLICANT' DA'I'Lr
~'YNI!.R CI!:R'I'IhICA'1'ION
I (we) certify that al( slalcnlcnls on this ti,In1 ulc Uuc to the best of a,y (our) knowledge
Ilse pra rly described above, by vhluc of a wanunly decd Icculdcd in Itcgislcr of I)ccds Otticc.
S`I A'i'URLr OC APPL
ICANT'
t (wc) am (are) the owner(s) o~
7 ~~, 6~
UATL~
~~
****** Any information that is mis-represented n,ay lcsull in the sanilaly pcnuil being revoked by the Zoning Deparb
*• L-clude with llrls application: a stamped wauaaty decd from the Izegislcr of Ueeds olricc
a copy of the cettificd survey crap if tefcrence is utade In the watTanty deed
7 19~=ii' OU1
V
'
685iD70
STATE BAR OF WISCONSIN FORM 2 - 1999 HATHLEEN N. MALSH
WARRANTY DEED REGISTER OF DEEDS
DacumentNumber ST. CROIX CO., MI
This Deed, made between Scott H. Jerentosky and Lisa G. RECEIVED FOR RECORD
Jerentosky, husband and wife 07-26-2002 8:30 All
WRRRiYtTf HEED
EIElWT t
Grantor, and oho F. Cosentino and Che 1 A. Cosentino, husban d
wife REC FEE: 11.00
TRANS FEE: 194.70
COPY FEE:
CERT COPY FEE:
Grantee. PAGES : 1
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):
Lot 3; PI of Field Haven in the Town of Hudson, St. Croix County,
Wisconsi .
Recording Area
Name and Return Address
EAGLE VALLEY BANK, NA
1301 Coulee Rd
PO Box 70
020.1388-03-000
Parcel Identification tuber (PIN)
' is homestead propcny.
Q¢) (is not)
Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any.
Dated this v~ y" µ day of July , 2002
r
AUTHENTICATION
Signature(s)
authenticated this day of ,
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland
Hudson, WI 54016
(Signatures may be authenticated or acknowledged. Both are not necessary.)
• Names of persons signing in any capacity must be typed or p
WARRANTY DEED
+ Scott H.
* Lisa G. Jerentosky
ACKNOWLEDGME
STATE OF WISCONSIN )
ss.
y~, l,yp /~ County )
Personally came before me this o~T ~ day of
July 2002 [he above named
Scott H. Jerentosky and Lisa G. Jerentosky, husband and wife
to me known to be the person{s) who executed the foregoing
instrument ar d ~cknaN'tedged ~aerrtie: -
• ~ L t3rcifen~is
Notary Public, State oC Wi$consin •
My Commission is permanent: (If not; state expiration date:
a-a~~, .)
IMormation ProfeuiwWi Canpany, FonO Ou UC, W~
eoc.ss5-zatt
rioted below their signature.
STATE BAR OF WISCONSIN
FORM No. 2 -1999
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