HomeMy WebLinkAbout020-1365-12-000
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w'~c°"sl"papa`ru'~ernofCatxnerce PRIVATE SEWAGE SYSTEM
sltsery and 8u~ldings Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal iMortttatlon you provice may be used fa secondary Purposes (Privacy Law. s.15.04 (1 j(m)y
Collova,
CST BM Elev.: Insp. BM Elev.:
TANK INFORMATION
Hudson Township
TYPE MANUFACTURER CAPACITY
Septic („)~ •~~
Dosing
M-ration
ff=,tding
T~>~IVK SETBACK INFORMATION
ANKTO P/L WELL BLDG. Vent to
Airlntake ROAD
pt;c ~ sfl 1 a e~' ~- NA
.sing NA
~;eration NA
3olding
SUMP /SIPHON INFORMATION ~ ..
€ZAodel Numb
TDH lift Friction
Forcem ~n Length Dia.
SOI ABSORPTION SYSTEti
EN width L
( 3
SETBACK SYSTEM TO
~NFORMA710N TYPe
:VATIO~
STATION
.BM
Bldg. Sewer
St/Ht Inlet
St/ Ht Outlet
Dt Inlet
Ot Bottom
Header /Man.
Dist. Pipe
Bot. System
Final Grade
Cover
GPM 1 ~ #
TOH Ft
Oist. To fWell
D .a... I~t ("S ~ n rl.
C~.yu~ ~ .. .`~
68.45
P/L SLDG
4-~ ~ ~a~
Trenches
WELL I LAKE/
St. Croix
Sanitary Permit No.:
384268
State Plan IO No.:
Parcel Tax No.:
020-1365-12000
BS HI FS ELEV.
~~
r
.~z 8S•s`I
~- 8s-, 33
~~ --~
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'~.~a ~;Z/ar
y•os' &3.911
~(, 0 88'• ~ r
2.lofo Qo~3or
'>~ !o ir8' • 8~ 1
No.
Oia.
LEACHING.~N 4
CHAMBER M e Num r:
OR UNIT ~ -- ~°coQ o-c
DISTRIBUTION SYSTEM
HeaderlMani old ~ OistributionPipe(s x HoleSize x HoleSpacing Vent To Airlntake
(.,~ '~ ~D
Length Oia. I ength a. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Oepth 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 presentlpi~ection #1: D~ /IR /~~ Inspection #2: ~~'
Location: 981 Katner Court, Hudson, WI 54016 (NW 1/4 NE 1/415 T29N R19W) -15291921 2 Ri erpa k
Meadows -Lot 12 J G~ - ~ _ .~~
7.) Alt BM Description -~(oQ~ ~~-.. €jc..~ Un~~ ~t.oMn 1,
2.) Bldg sewer length = 2~ rr ~~°`'` .
-amount of cover = 31P ~- s''' ~ ca,e,~ ,
3~ D~e.~lriz~o~n.lJGu~ o„~, z`"~ ~ ~ ~ ~ ~ ~
Plan revision required? ^ Yes ®No ,,,,..,,QQ ~~
U of r side for additi~otn I information. r7~ ~q D I ~ ,.i'.Y~Cru+. ~~'(S ~L
~ Oate Inspector's Signature n
~' se-s~1o(a.a/s) - ~.de.~~- ~~~t~.c.Qs~-'~~s.
~~~ 5 ~} ~
t ..
~~
Wisconsin Department of Commerce
Division of Safety and Buildings
SOIL EVALUATION REPORT
Page ~ of
m accoraance wim ~.omm ao, vvis.~.n~rri~ tsaaq ; /
~ ~
must
n 81/2 x 11 inches in si
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comp
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ss
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include, but not limited to: vertical and horizontal reference point (BM) on a
~~ par
~
~~(~ 1
~ "'- lL
-
3l
percent slope, scale or dimensions, north arrow, and location and dis to nealt, r /
~
Please print all information. ~ _`i
` Revie ~ y Date
rN:;'~:
jrC3Yv, s. ~5€64' (1) ~))~
Personal information you provide may be used for secondary purposes (Priv
QO~
Property Owner ••'"
'
Prope
~ --7
~ ~ /~
~cl-~-~ Q t ~ vt?E~~CEr/ /4 S/ T N R E (or)~V
Property Owner's Mailing Address o Blo ame or CSM#
(j ~ `~ ; c da
City State Zip Code Phone Number ^ City ^ Village [Town Nearest Road
[~ New Construction Use: ~ Residential / Number of bedrooms 3" y Code derived design flow rate ~o C~C~ GPD
^ Replacement ~ ' I ,~^ Public or commercial -Describe:
Parent material (Z cr1-~J~-S /n `, Flood Plain elevation if applicable ~.~ ft•
General comments SySi~ ~'-'~ G ~~ U• 9 a• ~ 5
and recommendations: ~,~. e',ev• q$.Q~
Boring
Boring #
® p t Ground surface elev. ~ ft. Depth to limiting factor ~~ s in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
~ io ~3 z. -- ~ I Z~rtac r CS I . S' 8
f ~
z 3 0 - m m l '- ~~
~y~ ~a r -- -- , ~ / 2
Z Boring # ~~ Boring
If~Yit Ground surface elev.ro~.~sft. Depth to limitingfactor~ in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft'-
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef(#2
- ! o r L -- Sr' ~ M't r C~5 ~v ~ .~
3 •L-z~ o r -- s vn. ~ --
* Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODg < 30 mg1L and TSS < 30 mg/L
CST Name (Please Print) i nature CST Number
a (~.~/ ~ s'33~
Address ate Evaluation Conducted Telephone Number
z 113 kD ~ ,~~ ~~-~Gf w/ .~'~'aZ s~ ~'-~ -mod ~iS=zy7- ~a afs
Prope-ty Owner CO) ~OVG~. Parcel Ip #
Page ~ of
3 Boring # ~ Boring
~~ Ground surface elev. loo•ZS ft. Depth to limiting factor 1~_ in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0- 8 a 3 z -- s~ Yn ~ r 5 v.C ,.~ .
-Z ~
r r
1 ,~
.~
a
3 2!0- -- m 5 rr~. ~ C - . ~ / Z
~{ 3~-~ ~- OS ( -- --
^ Boring # ^ Boring
^ pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth pominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
^ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
^ Pit
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP bJff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mg/L * 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.
ssn-s33o ~x.o~ioo)
PAGE 3 OF
NAME 7 A-}. Cca ~~oJa LOT# ~Z LEGAL DESCRIPTION,V~ '/a{W'/4,S /S T2y ,N,R 1 `j E (or)
SCALE: I"= ~da ,
BM 1 ELEVATION ~O G~ {~
BM 1 DESCRIPTION ~ ~. (,v Leh F /e~~n ~ t3oy
BM 2 ELEVATION ~ / • 70
BM 2 DESCRIPTION -(oP e.~' S~{ee[ G.,C., ~IoS-f-
SYSTEM ELEVATION q~. OS~
ALTERNATE ELEVATION ~J 8'. dS
CONTOUR ELEVATION /(/~
~-
I X
._.., -~-
~ - --s-
-Q~
-#~. 94 I ~. ~E~ C%.
r'~~ /15?'~090
- Safety and Builtiings Division County ~
201 W. Washington Ave., P.O. Box 7162 S r CYd ,' X
i~~~~~~i~ Madison, WI 53707 - 71b2 Site Address
De artment of Commerce ~~ T ~ ~ e~
Sanitary Permit Application saaitary Permit •°~g
'
Ia accord with Ctmnn 83.21. wis. Adm. Code, persons] iaf P ^ Check rf Revtasan
be ttaed for Privac
1. Appiteadan Information - Piteasa Print All Informail ~ ; ~'
'' State Plan T.D. Number
O
.
Property Owner's Name
_ ,:, Parcel Number
Property Owner's Mailing Address _.. S ~ GApiti -
~`"1
y Pggpetty Location '
/~fW_ N
~GtS
•'' i'1' sk si; S T a N R% Q
City, state Zip Code ,-
.a
~;~ s ~~~°ti ~`
~,l
~ Lot Number Block Number
~~
~ , ~ ''~~`''
,~ „- Subdivision Name CSM Nutttber
II. 'Type of Building {check all that apply} ~ 0.5 ~s ~M~ P(yµs, ^City
~1 or 2 Family Dwelling -Number of Bedrooms 3 ^Village
^ Public/Corwmercial -Describe Uae ownshlp s,y
^ State Owned Nearest Road
7" r C
III. Type of Permit: {Check only one box as line A (attmbering scheme for internal use). Complete Iiae li if applicable)~~---1~ ~
',' 1 New 2 ^ Replacement System 3 ^ Replacement of b ^ Addition to ' For County use ) S. aq • /9 , a / ~~,
S slam Tank OnI Existin S stem ~
B. ^ Check if Sanitary Permit Previously ]ssued Permit Number Date Issued
IV. Type of Fermin (Check all that apply){numbering scheme is for internal use)
44 ~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed Wetland
22 ^ Pressurized In-Oround 41 ^ Holding Tank 4$ ^ Single Pass Si ^ Drip Line
45 ^ At-Gratte 4b ^ Aerobic Treatment L'nit 49 ^ Reclrcula ' 30 ^ Other
V. D' r~salpTreat ment Area Informati on:
Design Flaw (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rata System Elevation Final Grade
Required Proposed Rate(Gals./l)ayslSq.Ft.) (Min./inch) ~,~ ~-. ~ Elevation ~
O ~ r S~
VI. Task Info Capacity in .Total Ntttnber Manufacturer Prefab Site Steel -Fiber Plastic
Gailoes Gallons of Tanks Concrete Constructed ~ Glass
New Bxlatissg
Teat:
T ~
Septic of HoIdia; Tststt
Did
-~s~
Dosing Chsraber
VII. slit Statement- I, the code ,assume reapondhUtty for a of the POWTS shoAa on the attached pleas.
Plumber's Name {Prltu) Plumber's SignaarroD /
~ RS Number Busfness Phono Number
We 1, a m ~c u~ v r ~
•+~L=-~i~c=l~vt~% ~ 7 1c C~ l S"~ 3 G -- 3/d J
Plumber's Address (Street, City, State, Zip Coda)
r~ ~ U ~ ~- ~~ ~~
VIII. coon / De tn'tment Uso O
Approved ~ Iiisspproved Sanirdtl+ Permit Fee (iacludea Cirouttdwaur Date Issued Issuing a ignaturo (No Stamgsj
^ Owner Gives taitial Adverse " S~rchatge Fee)
~~pp ZZ S. ~
•
Iktermiutadon
IX. Canditiaas aP ApprovaUReasons or Disapproval
'fEOrt ~oa+~c-Q.v~nw~C3 Sep' CSTn~~-E- ~ ~oL.~Q ~ wit ~.e.~ P r~~ ~ ~S~S
~ ,Ikll ~e-4'-~~ t~-t- ~~~. ~'~ ~ • w. L. ta~a,., ~ Q13. Z l ~ yL.~,~,,,~, o,... ~t~,Q
weres campspe psws to me s:omsT X77 ter the sricear on paper not sea tssaa sus x u mesa m ~e
~,.; ~~~BD6398 (R 05101) .::~
J~ G Co /ln ua ~ ~,~/~,er s ~.vl` .2 aP~c,~eY ~v.rf~ b~e.~.~o~o s loiv..do~ ~4-~1sa,~/
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..Wisconsin 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
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and S7 . CC rd °
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
._ I~ d y_ i._ .1 t i
APPLICANT INFORMATION -Please print all information, a 'wed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). .l ~,
Property Owner I t Property Location
~(~;-1-- C(jf I(.~~A Govt. Lot G~,~ 1/45~1/4,S ~~~ T~7Cf ,N,R ~ E (orj V~
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
"1c~ C' Rd . r= P Z R,.rer ~~~< mec~b(,,~s
City State Zip Code Phone Number ^ City ^ Village ~ Town Nearest Road
Nt.~50+'7 I ~~I I Fi'-lut(c I ~ ~IS~ j 519-~q~~ ~~-~I ~SDn I k~~tt e~ C'nr,r'~
.New Construction Use: QResidential /Number of bedrooms ~ L Addition to existiny building
^ Replacement ^ Public or commercial -Describe:
Code derived daily flow (~0 gpd Recommended design loading rate ° ~ bed, gpd/flz • o trench, gpd/ft2
Absorption area required ~S5 ~ bed, ft2 '750 trench, ft 2 Maximum design loading rate ~ ~ bed, gpd/fl2~trench, gpd/ft2
Recommended infiltration surface elevation(s) c ~n~ ~~') Gower S ~U ft (as referred to site plan benchmark)
Additional design/site considerations v R r _ S~('y`Sd Lv~,; ~f ~SCo w
Parent material DU f ~.~sh Fiood 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 ~ ^ U [~.S ^ U ®S ^ U ®S ^ U ^ S ~ U ^ S ~ U
a..
,VIL UtSC:Hi1F'I IUN litl'UFi I ~~C,~p, : GHQ-ec~F . ~ ~.-~ ~ r t~`• '~;1a~
Boring #
Ground
elev.
y/, 3 r~ ft.
Depth to
limiting
factor
1 t ' in.
Boring #
7
Ground
elev.
9(,1~n.
Depth to
limiting
factor
~Zl in. Remarks:
CST Name (Please Print)
Address
~(Og ~dcx
Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench
l 0-I l0 3ll - S+ 1 ( k m-~r c I v~' . 2 ~ .
Z y ly -- 5; ~ Z ~ ~; ~ ~ ~ - -~
3 icy ~Il~o - ms ~ ~t ~s - - ~t ~ -~
Remarks:
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7
Page ~ of
~~ Telephone No.
__ ~/s-Z`/ ~-Y~o
Date CST Number
l ~- ~-59 2533v5
PROPERTY OWNER Cby ~ ~cJ SOIL DESCRIPTION REPORT
PARCEL I.D.#
Boring #
3
Ground
elev.
gift.
Depth to
limiting
factor
.~~in.
Boring #
`.1
Ground
elev.
f~C~2ft.
Depth to
limiting
fact r
l 1 ~ in.
Boring #
S
Ground
gelev.
U~t~Lft.
Depth to
limiting
factor
Zl~ in.
Boring #
Ground
elev.
ft.
Page Z of
Horizon Depth Dominant Color Mottles
Texture Structure
Consistence
Bounda
Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trench
1 a-i Z / ~ - ' I ~ m ~r ~-5 I Y ~' • Z
Z ~2-3Z 1 Nay --- i 2 k ~. ~- • S ' -/o
3 3za1 1 ~ ry1 to - m5 ~s JY~ ( ~5 - . ~ ~~ .
~•d
c fZ,~-Z . ~-L" ,
Remarks:
1 U-f~ lU 2 --, LS ~ ~ Lg ~ ~ ~ ~ ~, .
Z lo--If ~ ~d `1 --- m5 rn ~ ~ s - -~ ~ . g
~~,~~
~{Z. ~-Z-
Remarks:
Horizon Depth Dominant Color Mottles T
xture Structure Consistence Bounda Roots GPDlft2
in. Munsell Qu. Sz. Cont. Color e Gr. Sz. Sh. ry Bed ,Trench
~ 0-13 tU r3~1 ~l ~ ~ m~r GS ~v~' .Z' .
~- 13- 3~t i ~-I ~ `~ `" 5 i I 2 ~~~~ c, S - - 5 ; . !o
~f
g. ~z $~(.
Remarks:
IDmtingo I I I I I I I I I I
factor
in. Remarks:
SBD-8330 (R.9/98)
NAME
SCAL
BM1 ELEV.
DESCRIPTIC
~I BM2 ELEV.
DESCRIPTTC
SYSTEM ELE
ALT. ELEV.
~~ONTOUR EI
PAGE ~j OF
_._ ~.
__
..~,.
Private C~nslte Wastewater Trsatm+ent Systom Managr~msnt Piatn
Septic Tank And Gravity in-~3round Soli Absorption Compane t
Pursuant to Comm 93.54 Wis. Adrn. Cade each Private Qnsits Wastewater Troatmant
System (P41NT$) shah include itlformation and procedures for maintaining the system within
the param®ters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and parrnits for system ase on flie at the county
zoning or health department.
7hls management plan complies with Co n ~~ ~~$tewate Trea~'t°mdent Systems SBDund
Soii Absorption Component Manuafi for Private O s
10x87-P (R.fi19S}.
The septic tank snail be maintained by atic t~rtVk shsi bsid~pased of~n accordance with
under s. 281.48, Stets. The contents of the sap
NR 113, Wis. Adm. Code (Servicing Septic or Holds ~ Trenches~PriviesCor Portabie~rease
interceptors, Seepage gads, Seepage Plts, Seepag
Restrooms).
The operating condition of the sap ' nd outset fifiter shsi! be assessed at sea
once every 3 years by inspection. Th out et slit hail
proper open tion. "i'he fitter cartridge sh notltar whenaemoved fromiits endosurea If the
re n so ids in th® tank that may slough off the
1
- W N9anagement Flan fcr a Septic Tank and Soil pgsorption Campar~ent
filter is equipped with an alarm, the Pillar shall be serviced if the alarm is activated wntinuousiy.
intermittent Miter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shaft have its contents removed when the volume of scum and sludge in the tank
exceeds 1i3 the liquid volume of the tank. If the contents of the tank are rrat removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next sere"ace
ns8ds 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 tigh#ness and
soundness. Ace:ess openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening d®emed unsound, defective, or subject to failure must
be replaced. ,Exposed atxesa openings greater than 8-inches In diameter shall be secured by
an sgtfective Pocking device to prevent accidental or unauthorized entry in#o the tank.
No ane.ahould enter a aeptlc or other #rMatmsnt or holdln~ tank for
any reason without being !n full complP:nce with OSHA atenderds for
entering s confined space. 7'f» afmosphsrr within the septic or other
trwtttnent of holding tank n>ray contain wlhal gases, and rescue of •
person lb~om firs tnterlor of the lank maybe difficult or impossible.
Tank abandonment shall be in accordance with Gamm 83.33, Wis. Adm. Gods when the
tank is no longer used es a PUWTS component.
The soft absorption component serving this structure is designed to accept domestic
wastewater from a resider:tial iaciiity. The Nmita of operation of this component are shown iri
Table 2.
Thrr longevity of a soli absorption component depends greatly on proper and timely
maintenancr!r, and system use within or below the limits of reiiabPs operetion. Good water
oorrser+ration practices by ail occupants and the installation of water conserving plumbing
fixtures era key factors in extending the useful fife of this component.
The soil absorption component's operation moat be assessed by inspection at Least
once every three years. Then inspection shelf include recording the Pevels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
fr~arrs tike 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 fs prohibited and considered a human health hazard,
Traffic around or over the soil absorption component shautd be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydrauitc failure by freezing. This type of failure is usuaPiy temporary, but is difficult or
impossible to repair until weather conditions improve. in general, soli compaction over this
component wit! reduce diffusion of oxygen into the soli and diapersai cell, which may lead to
mare intense, end earlier, organic cicagging cf the soil.
2
i
tVlanapsmant Ptan for a Septio Tank and t3oti Ab~orptian Gamponant
Ptantin8a of deep~rootsd tnw and ihruQs directly over of within ten het of the component
should be voided elnoe roo! lntruaior, into the component shay ~itruCk wastewater flow,
Conttnpency Sian
in tits want of sy~mt tatiun, a now system coule be irntriied In sn aitsrsute area. V11ith the
irtitallatlon of a diverter vaivet the sxi#!np iysrtsm could olio be reused attar a period of three to
four ysen.
k li the property awr+sn niponetbiliiy to maintsin the aiterrtate arse frN from any planting of
trenr, shrwbi, etc. to case of sailors of the onppinal system, ttte alterr~e arw wtii bs needed. tf
arty tntta, shn,~as, etc. have been pisnted cn ate attsrnats arse, they viii haw to be +e>hnowd at
p otrMnen +~~.
if altsmate ens i= ds~royed, there era other aite:Ytadw systems that qn be used, In which,
aould rvnuit In added expense to the property oamer.
A,~ty tank abandonment ahail br done In eooordanc~ with Wlso. Code 83,33. My questions
rspardinp thl• Dods, please content your i00e1 Z,otti~ 4tNos or eontaat the IMtaltinp plumber.
5'~d,~~,~~,~~,~~.~.~;.v~ ~ ~'Gw ~- 3r~Lr
S'1' CItO1X COUNTY
S[?P"I'IC "PANIC MAIN'1'I?NANCI? AGRLI?MP_N"I'
ANI)
OWNP.RSIiIP CLItTIPICATION r0[tM
nn
Owner/I3uycr IJ.
~ . ~ IUVA
g ~~~ tt S
~~ ~ ~U rZ rn~ A
~/~
Mailing Adclress -7c~~ ~~ • ~ ~ . F' /w'Su,v ~u :Z. 5 ~-v 1(~,
Properly AclcJress
(Ycri(ication required front Planning Dcparlntcnl for new cons
City/Stale ~lld5y/~ ~~Z Parcel Idcnlificalion Nuntbcr
r.rcAr, nrsr_IiIP•rroN
Properly Location ~~ t/,, ~ E t/,, Sec. ~s , 'I'~N-R~W, 'rotvn of cJ dS(71J
Su~divisiott _ /bf'I UE~
Ccrtificcl Survey 11'Iap i'i'
~j
Voluntc
I.ot 1E ~~
Pa~c #
Warrnuly Dcctl # t!a C~ (o .~ Co'`7 , Voluntc ~~ ~ , Pale ~~
Spec house Q ycs~ito
Lol lints idcnliGahl~cs ^ no
-¢_S
SYSTrM n7AIIVT~,NANCI;
Improper use and maiutcuance of your septic syslern could result iu its premature failure la baudle wastes. Proper maiulcnar
consists of pumping out the septic tank every three years or sooner, if uccdcd by a liccascd puutpcr. What you put into tlrc sysie
eau affect lire functioa of lire septic tank as a ircalmcnt stage iu llre waste disposal systcnt.
•Ilre propccty owner agrees to subntIt to St. Croix Zoning Dcparlnrenl a certification luau, signed by the owner and h~
uraslcr pluntbcr, journcynran pluurbcr, restricted plumber or a licarscd pumper verifying drat (1) the on-silt waslcwatcrdisposal systi
is iu proper operating condition aurl/or (2) aQcc inspection and prrutping (if necessary), the septic tank is Icss than 1/3 full of sludg
Uwc, llrc undcrsigacd have read the above rcquiremcuts end agree to ntainlain the private sewage disposal syslern with the slandai
set forth, herein, as set by tlrc Department of Commerce and the Dcparimcnt of Natural Resources, Stale of Wisconsin. Ccrtifcati
stating drat your septic syslcur has been maintaiucd must be completed and returned to the St. Croix County Zoning OfGcc within
days ea ex tirali dale.
5~~~~
S ATURLt ~ APPLICAIJ'I' DA'I'C
owtvlrR crliTrrrr_A
. I (we) certify drat alt siatcntcrrls ou this form arc true to Ilrc best of my (our) lrtotvledgc,
ll-e pro 'bed above, b virtue of a wa anly decd recorded in Register of Dccds Ollice.
SIGNA7URI? Or APPI:ICAN"1'
I (wc) am (arc) lltc owner(s)
Z~ ry l
DAT'fs
****~'~ Any information thatts ruffs-represented may result in the sanitary pcrntil being rcvol:cd by the Zoning Dcparhnent. **
** Ltclude tvlth lhls applicallou: a slnmped warranty decd front the Register of Dccds olYice
a copy of tl-c ce[li[icd survey tnap if rcfcrencc is ntadc Itt the warranty decd
• ~ ~~ `- ~. .ice.. vv vu i.l.. . au ..JU ~1UUJ .+L ~.i,.i VV t.•ll,ll/V I~IUUI
~Y
STATE DAR OF WISCONSIN FORM 2 - 1981 60t62Ej'7-
VI%ARytR,r(A~~KnnTY DEED
1'
~ KATl1LEEN Hp. IlAISH
E
E
DOCUMENT N0. 911.
J IJVPiG~ ~
~2 STG
CkOIX CG~~
YI
~
~3 ~ RECE[4E6 FOR RECORD
Mnrjorie Nalernee, Frances August and Yaul Kstner
nu tenants n cumtnon a k/a 'Francla 01-06-1999 9:30 All
._- Austust YARRAHTY DEED
E1d:lPT 1
~.T;.
cunvrys and warrants tt: .n_ ova Bts cera, ttc., a
~ CERT ~DPT FEE1
COPY EEo
. Wtsrottsin Corporaticn TRAIiSFER FEfo 1310./0
~• - ~C
D11G FEE:
2.00
,f'' - ~
2
: .._.
' This mace nesenveo ron Aceonou:o DATA
the fallowin0 descrilxd sal enate r t! Cox Cuunty, 4f-t V it ' J. ESTRE~;J
stun of wi{eenein:
304 l.'1CUST . • r.
SE 1/4 S4; lJ4 See. 10-T29N-RL9W excepting therefrom Lot i HUD50N, ~/~ 5A0 ~'~
of Certified Su=ray MaF recorded ict Vo2,7 of Certified
' Survey !lope, pnge 2084 as Doc. No. 447309, also excepting 02U-1010-20
the railrcad right of wad. 020=]024-90~
07.0-1025-90 t
?7E 1/A NW t/4 Sec. 15-T29N-R19W excepting tharefrcm Lot 1PAPCElUli11I1fICA1gVWM8Eq
of Certified Survey Flap recorded in Vol. lU of Certifisd
Survey Mapc, page 2701 na Doc. Vo. 5C7i28. '
if-: l/4 NE i/4 Sac. 15-T29N-R19W '
j
,'
ibis is nnc hcxnl:MCnd Froputy t,
--IkY- Is not)
Fx:cptlon to a'unnties: ~ •
/~
~~jj ~~''
Dated fhts .,,_^~ doy of Jun , A }9 49
e. '
Frunces Au ust ugus~n~ ~ ".~+\te~• ~;•.,\~'~~ lsr:AL)
, Paul t;atner •j
' ' .,t'
~
y
~l~
.~
o
.
- 1.Eat)
lrartorie .:alernee
'fy~'';tiM,lrc ,
' : ;t:, ,r\,y r~
.
AUTHENTICATION l~~N n i
ACKNO\VLEDGh1ENT 'I
Sigau•~m;e),_.__ Statr. of \~~bii3i~on SEE ATTICHL'D~i
EEI[IDIT "A" .
} sf
-----
auduodated this dry of , :9~ .
K[ng Courtly J
fersoasl:y came bcWre the UtLL 26 [h day of t
:t Juno 1g 99 _,d~cnbovcnant«l j
ilTl_: \1EMOER:IATC D.9ROF WISCJNSIN I
Trances ugust j
Uf not. ~-
' awhorlccd by 1706.06, Wis. Stsu J --- -- ~
to rre Ynuwr: to b he persen_. who t~etaued the ksegdcg
inM tar r n wlydgc su a.
T.tl9 IV>TRUMEff7 1'!46 tKiA:TEn PV
Hevsfcod 6 Cer: B.C. b Waltcr !lodyneky
204 L~cueC St., P.O. llcx 115 H.t son, lI 540 15
Klftt; __
NotaryPuhlic. „County,-ssfp,- r.:p.
(Sibr.aa:at ntuy bx nu:be:+deated ur uknow:adged. D.ith tm nut fly cuauuluion k pinnment. ;I( nct, oafs aleplrt{un dsr.: '
natswry) ~ Septeuber 1. 2001 ~~~-.)
• flsrtel of pauom sgmn8ln mf oatw:Uy sbnli bf pgxd sr puled beb» 7M~t ,lirawln. ~ • .. ~ ~ .. '
1~'Ait0.Ap]Y OEL•U sw: sae or• wlsecnstn wlxmsn lpCatmne:LL.trC
form W. 2 - 1981 Mf+wta, va,.
AD4WS
4 OF SECT 1 ON 10, AND 1 N THE
1 i4 OF THE NE I i4 OF SECTION 15,
ON, ST. CR01 X COUNTY, W 1 SCONS I N
~' ! ~'~ c. s. ~c va. ~, P6. 1893
I
I I I
I
I ...............................
asa4rarr ............................. -
sEARINes REFERENClD m TIE NptTN LrNE of T-E
RE IN sEI:TILW le. rA:AeuRED At wta4•~a7'E.
............ 4f r. TD' ...............:
aa.4r rare, ra~ -~_ f (aT. cxolx rnuwTr oooRDJRATE araTEaJ
-- J
W
I frollrttEASr IaolrtER
'
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LOT 2 / n ~
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aD.
a~te
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.....
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e N 00 E l4 T. AE' , ~ I ~ ~
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t EAtElEIIT i
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' LOT /9 E g -- ~- - -- --
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3
1
1 ~ ar-Nr ~ sE-Nr tfP-I~ ~ 1~~wE
fst. w ~~
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'rD ~......- ........................` ' ~ ~ I LOCATION SKETCH
;.t n~ea r._afr.,~o•
`
lu ~ ---
I -------------
--
(tar m QCALFJ
ar r.v AJD r1E ee
~~®
o I
1
f rnf GF eECT-t)N ro AND r)E
li !~{ AND T-E NE rn{ OF eECTIfNt r0
I
T
A
.
i ~
F
I I ,
LL
N
.lrN.. N. IiI ,
fill ~ IADAaI. tT. p101X C~OIJNIY. r'IACpI?1M
:1 ~
~i i
= LOT 18
~ I ~ I
I
!
~'•
r.ca ApPEd " ; ~ as
el,lteDaFr.
1 I
1 -
I
d:
I
~ I °p j L I~NO
~ I i J< FOINp Y IRd9 PfPE
1
~
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i
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• FdND !' IRaN PIPE
'• ~'
' 1 T Q>. i
~ i ' G tEi YJAd /flaw PfPE fJEfeNIIIB
e. 110 16t. PER LINEAR FODT
~
I ~
Ate!
t0. FT. '•.,1~ ,
'
I
yi OE7 I'X[4' IRaw I/IE eEfBNfNa
ilI L~ R LINEAR F00T AT N.L OTIER
~.1
.......................
.
.
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' I
~ -i--____ aTIIITT EAOEIENT (M. )
1
1 ( J - RECCROED DATA
I
I
..........- - senAala
---
' 614
te' -°_-_-_----- ____-~ • - allvErwr LocArraNa
. I L
RQAQ
'011 fD _• - _ - _
)a PQf 011 IfARIED GIILEd ARE TO DE PLACED fllctl TINT r11e INSTALLAT10w f101N.0
DIa17AM ANY aLIPYEY BTANE. CR aaTRNC7 vlalar saws ANY LOT LINE aR a)REEr
L IJff.
nRr aunfReAlr<ar aF A erRl~r trAKE er ANraNE fd A vlq.ArrgN DP eEerrar tee.ar
aF rulrnwelw arArurEa. rJrlLlsr EASE,rwra As IN eEr Fawm ARE Paw rlta
~EA~ PUOL IC IODIEt MID PRIVATE arlL fTfEt NAVIIN TJE RINIT m eERYE 7rE
j,
• RIVERPARK ti
' ~ p' LOCATED 1 N THE SE ! i4 OF THE SW
~ ;' __.. - % ~`~l NE 1 i4 OF THE NW 1 i4 AND i N THE ~
' ~ P~~ _ ~`. ``'` •~~ ALL 1 N T. 29N. , R. 19W. , TOWN OF H(
~ '~~ ..r ~~.' ~+
. ~ , j
i ~
~ ~ ;
. ~'
i / / ~'
i . ~
, ~ ' -
t
i ~
1 ~ ` ~
; ~ ~ ~- S
' ~ -' 2 .-c.•s. ~ voL. r r, P0. soe3
; E LOT 25 ~~ •~ I ........._ ........................................
~ ! _
.
V
pQI ; - ~~ ~ ~tx WMTER corNYER NoRm uRE of TrrE NE r.v
BECTfaN 16 - FCUND
; ? ,y AtINfINfM11RNNNEMT fMNMe tl`W)
OI ~ aECrraN ro N89'49' 37' E 13/8. Y 1'
-'--- eECiiaN ra ! r• 8 ~ P
, ; ~~ :....................;...................................................., .-........_......................; ..rear.71:...................................., .....
.......... :
•., ~.
, ••. ~.
: _
.. , •.
•---------------------L\\ ~ ,fib LOT .'4 `~~ LOT tP ~
.~
'- ANA \ ;o, •., ~ s. n M.xES r. r-! Acme
,,
~, ~ •• rae.7r7.aFr. rre.oKaaFr.
~ `~ '•
.............._....~!(`.... , a~~ \ d~•'' ; JiRLIlINIfE 1\ ••`~ • LOT t3 $ o
V ~•,`~~ ar ' .• i` d. 4! Afaltte w '• ••...
~;1 `' \ \~ ~` ; -'•. ', 11x.714 B0. FT. ~ ®-
LOT 8 e ,~ •' , ~ :: ~.
; tee Aa+Ee <~
~ /Pa. SaP 80. i7 ~ /'; -- ~ ~ / ` J
~; , ~
: :.............•NaWN'PP'E 86t. N...........: ~ %.~ . e~. ~'.,,,~ ~~.
' .m
O : 8 ; is''~ : I ~~ ~ N. 1 w \~ N. Oa6 80. F7. • •t
~ r SSS ~
WO '•
d ~ LO7 /0; ~ •~ ®` a ~~. G~ '. s. ro Aa~Ea •= y~ •.... ~ •,
O' ;.i.~ t eo Aclh=e `• ~ . ~ raa. IN 80.iT. ': ' ~ ••dd ~~ N0.i 04' 1'J'' ,
~ IPP. Oaa 80. FT. 1 a~~ ~ - ~ -ab Q~. a4' ~~
b a $', -~, ~'"~ ' I ''911 ~:=.• LOT rs f m '
~'
' i <, 1 L 40 ACAEB
b •• MIaM Ml~ i" ~ ., , •'~'••. : ~ N.14! 80. FT. °••~~
Z ,' ~~• - ~'' '' is ~N i ..
V • ; i .Ili ; -:.~ ••~~~ - ~~•.: •• f, « s q : ~ ,,... ~.• • ~.
1
t ,
. ~ i '_
L' . 3
• ,•-' toT ~r r _ • , ,; ,aaan,.rr for rs '• ~,
N. Ns ao. Fr.
. --_J
;, v
,k, '~-.,, _ saalbt'1o•r rea4.N• '~ $~R wt. ~. sea % ee
e , $ ]a. t1' eEDIQ1TEe TO r!E PINILlC
----
S89.47'3t'W 348.99' .!!!4~t!T.~o4! ~ S88.4T'08'W /31t.t!'
~$1 b J
.. BWTN ~ rl~ aF rfE MF r.4 aF T!E NE r~
wram ~.~,'la~ UNPLAT7E0 LANDS
Rl X~ ~~ NN~R CQR7R:R
A~i.~ir°kR~erruaw~ SHEET r OF 3