HomeMy WebLinkAbout020-1365-20-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Buildings Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: I fl Citv fl Village fl Rown of:
C.
Hudson Township
CS T BM Elev.: Insp. BM Elev.: BM Description:
q~.~Y ~ ~T6. ~y' CST 6~ ~1- _ ~~ 2" PAL
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic ~~
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. vent to
Air Intake ROAD
Septic ~ (~ ~ 3a r -~ NA
Dosing NA
Aeration NA
Holding
PUMP /SIPHON INFORMATION
Manufacturer Demand
Model Number GPM
TDH Lift ~ n stem TDH Ft
Forcemain Length Dia. Dis . well
ELE1/ATION DATA
r:
County:
St. Croix
Sanitary Permit No.:
353338
State Plan ID No.:
Parcel Tax No.:
pending Qa, p - J~~ S'
/s. a q. I9.a ~8~
a~
STATION BS HI FS EL
Benchmark (p ~a o3.6y (o . ~t~r
Alt. BM 3 ,8p 1,
Bldg. Sewer Z5~ 9'
St/Ht Inlet ~,~ },23'
St/ Ht Outlet G .~j ` qL,~S `
Dt Inlet
Dt Bottom
Header /Man.
Dist. Pipe ~ hers %o , 3a q 3.3 `f
Bot. System ` ~O ~
i/.ro 'Z
q~,.or
Final Grade >< q~,p
St cover ~, 3 } qg. 2~-
SOIL ABS.CZRPTION SYSTEM (ql ~D,,,~_. L,o~c ~N~ ~A ~_
TRENC Width I Len th No f enches PIT No. Of Pits Inside Dia. Liquid Depth
DIMEN • Z ~ IMEN I N
SYSTEM TO
P / L
BLDG
WELL
LAKE /STREAM LEACHING Manufay~urer•
~'-
(~-~- S.
SETBACK ,
,
INFORMATION Type O
' ~
"
C~
- CHAMBER
NIT
OR M e Num er•
~
System: c ~ S ' I D2. U ~.
DISTRIBUTION SYSTEM
Header~anifold t< Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
'se
Length ~ Dia.
L ia. Spacing r
7 13~
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over a Depth Over xx Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center ~ ~ f Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: CXo/ott/ t~lnspectYOn ter,: ~ ~
Location: 989 Marcy's Court, Hudson, WI 54016 (NW 1/4 NE 1/4 15 T29N R19W) - 15.29.119. Riverpark Meadows -
-Lot 20 ~~( _ / OS
1.) Alt BM Description = ~~ t,'h~ ~~ .p.~ I ~ s Z ~ s
2.) Bldg sewer length = 3 a ~ ~ ~ I $ « a 5 f" I?e~ (~ a~ _ IRf~y^~ ~
-amount of cover = ~
PI~1r0~i Ion required? ^ Yes ~ No
Use other side for additional information. a ~D ~ Z
SBD-6710 (R.3/97) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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`•ISCO/1S%11 SANITARY PERMI APPLICATION
Department of Commerce In accord with Comm 83.05, Wis. Adm. Code
• Attach complete plans (to the county copy only) for the system, o P~rln,
than 8 tie x 11 inches in size. ~`~ ~ ~ ~ -
• See reverse side for instructions for completingthis applicaf~i6ta~,~` ,, ~.,
/r
`~ ~ -.
Personal information you provide may be used for secondary purposes `~ r'F
[Privacy Law, s. 15.04 (1) (m)]. N- . Y~
Safety and Buildings Division
201 W. Washington Avenue
POBox7162
Madison, WI 53707-7162
S to Sanitary Permit Number
C k if revision to previous application
Stat~an Review Transaction Number
I. APPLI ATION INFORMATION -PLEASE PRINT A '~`- F R Nw ~ ~'
Prope Owner Name
G, IG '
`~ ''Location ,' -.
ia, S-' T a, , N, R f ~(or)
Property Owner's Mailing Add
rgss " y' ~ Lot Num a `'v Block Number
~ . .
City, State Zip Code Phone Number b i is CS Num r
u.t.~ S (7/ 7
II. Y F B I N (check one) ^ State Owned
3 ^ !ty
^ Village
a Nearest Road- r
Public 1 or 2 Famil Dwellin - No. of bedrooms Town of Gc
.L~ G r
III. BUILDING USE: (If building type is public, check all that apply) Parcel lax Number s)
oa o - ~oi~ - as
v 0 - !o ~Y - o
1^ Apartment / CAndo o O" 6 - O
2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility
3 ^ Campground 7 ^ Merchandise:Sales/Repairs 11 ^ Restaurant/Bar/Dining
4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash
5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an
-_____System________System_____________TankOnl~__________ ____ExistingSystem________ Existin~System-
B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ^ Seepage Bed ~ 5 ~,~1 ^ Mound 30
~~ '`''~'~""-~'- ^ Specify Type. 41 ^ Holding Tank
12 Seepage Trench
22 ^ In-Ground Pressure 42 ^ Pit Privy
13 ^ Seepage Pit
~ 43 ^ Vault~rivy
14 ^System-In-Fill .. ~jV,..,
t ~ a( = ~ 3~, ;, ,
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
L~ Required (sq. ft.) .Proposed (sq. ft.) (Gals/day/sq. ft.)
~~ (Min./inch) ~ Elevation
ID
"
~-
/
s 57~. + Feet
Feet '-'
.
VN. TANK
INFORMATION Ca acct
in gallo s
Total
# of
Manufacturer s Name
Prefab.
Site „
st
l
Fiber-
plastic
Exper.
N E
i
i Gallons Tanks Concrete act ee glass App.
ew x
st
n st
ed
T nk T nk
Septic Tank or Holding Tank J ~" Qr*JQ l ^ ^ ^ ^ ^
Lift Pump Tank/Siphon Chamber ^ ^ ^ ^ ^
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plum s a e: (Print)
~~ Plumb s Sign are: (Not ps) P PRSW No.:
~ Business Phone Number:
°
-I/ ~P~
7/S a~
Plumb is ddress (Street, Cit ,State i Code): ~~
~
... 6~
IX. COUNTY /DEPARTMENT USE ONLY
^ Disapproved S ary Permit Fee (Includes Groundwater ate slue Issuing Agent Signature fNo Stamps)
~A roved
pp
^ Owner Given Initial SurchargkFee)
Z
ZS ~
3 -/ ~" t,
Adverse Determination o
o
X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL:
SBD-6398 (R.12I99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner,
INSTRUCTIONS
A sanitary permit is valid for two (2) years.
Your sanitary per'ri'-i't mey be-renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the
county prior to installatidn~
5. Onsite sevva~e systerr>s roust be properly m~intairr'ecf: `°The septic tank(s) must be pumped..by ~..ti'certsed'pvmper whene~~~r
necessary, usually every 2 to 3 years.
.0. 4
6. If you have gyestions concerting your onsite sewage system, contact your local code administrator or the State of ~ ~'~
Wisconsin, Safetyand`B,uildings Division, 608-286-3151a ' ;' ~ .'" m ? _ ~,,
~ ~ i ,. - t
Td be comp)"ete"and accurate this san7tary permit application must include:
.i
I. Property owner's name and mailing,addGes~. Provide the legal description and parcel tax number(s) of where the
system is to be installed. ~' .,
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7. ~ #'
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number w+th appropriate,,~tr2fix (e.g. MP, etc.),
address ar~d phone number. Plumber must sign application form. _ ;
IX. Count,,y/Department Use Ortfy. _ ~, , _
X. County /Department Use Only.
Complete plans and Specifications not smaller than 8 1J2 x 11 inches must. be submitted to the county. The pl.a~s rrtust
include the foltovv~~g: A) plot plan, drawn to scale 0r with complete~dimer~sions, locatao~ of holding tank'(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; Dj cross section
of the soil absorption system if±'equired bythe.cb~inty Ej. soil test dataona 115 form; ald`F) all sizing information.
GROUNDWATER SURCHARGE
.s ,
1983 V1%sco+~srn Act X310 included the creation s~# Surcharges (fe""i?3) fbr a number of regulated practFCes which card ~~ -
effectgroundwater. . - -,-
,.
__s_. , ._ ~ ,.
_ \ .. ,j ,1
The monies collected through these surcharges are used for morir'toring groundwater contamination investigations
and establishment of standards.
• r
/. - ~ .
4E U I~vIJ~ LOT # Z U LEGAL DESCRIPTIONSu~-sw -~C`I '2 `r-/4 -w
1.
ALE 1 "_ OU /
-^~. ELEV. .7`l
SCRIPTION- ~ o.~ z" uc .r f
'~ ELEV . 9~~~ S~
~-.~-
SCRIPTTON- of ~~
STEM ELEV. Y~•/U
,T . ELEV . R Z . ~ O '~
~NTOUR EL• EV . ~I d n ~
i~~
a -9 ~,~..-~-- r
S .~.~• ya, to ?.
~ ~~,~ i ~j
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• (,jL
i
Rs1
P~
e
6m Z-
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page ( of
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 -~ . ~` • •
~~ X
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - P/ease pr/nt all /nformat/on. Reviewed by Date
Personal information ou rovide ma be used for seconds u oses Privac Law, s. 15.04 1 m)). 3 ~ f ~`
Y P Y rY P rP ( Y ~) ~ ~
Property Owner Property Location
~C~ ~O~ ~~ ~~ Govt. Lot S`~ 1/4~ W 1/4,S j ~j T Z ~ ,N,R /c~ E (or)~
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
~L~ ~` (~c = Le ~t per (~ir k cr~<Jo~.~.S
City State Zip Code Phone Number ^ Ci g ®. Town Nearest Road
11 i ty ^ Villa e
1-'~t.tCi~t-~ I i.t ~l I S4(~Itr 10"115 )`X-19-S~f77 ~1 -C~S(1rl I lv,'/lv~ ~?.~-~r- G~rnc
New Construction Use: Residential /Number of bedrooms ~ -`-I Addition to existiny building
^ Replacement ^ Public or commercial -Describe:
Code derived daily flow ~~ gpd Recommended design loading rate - ~ bed, gpd/ft2 ~ trench, gpd/ft2
Absorption area required ~~1 bed, ft2 ~~D trench, ft2 Maximum design loading rate . ~ bed, gpd/ft2 g trench, gpd/ft2
Recommended infiltration surface elevation(s) ~l 7. / U ft (as referred to site plan benchmark)
Additional design/site considerations s4 ~ t • ~ (~ v Q Z • (()
Parent material OU ft~'CA•~h Flood plain elevation, if applicable 1V~ ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system ®S ^ U Q S ^ U ®S ^ U (~ S ^ U ^ S [~ U ^ S ® U
SOIL DESCRIPTION REPORT
Boring #
~.
Ground
elev.
Q~ft.
Depth to
limiting
factor
~! (o in.
Boring #
Z
Ground
elev.
~/j 2r) ft.
Depth to
limiting
factor
f!~ in.
Horizon Depth Dominant Color Mottles r
T
t Structure Consistence Bounda Roots GPD/tt2
in. Munsell Qu. Sz. Cont. Color ex
e
u Gr. Sz. Sh. ry Bed ,Trench
~ a-~~ t~ 3jZ I ~ ~s ~'' . Z ~ . 3
~ 3 I ~ ms ~ t c_s - • ~ ~ - g
Z•~ '
l.~ ~ '
Remarks:
1 ~-~a ~rJ ~ ~ Z ~-- 1 r)'tC~ rr~r ~ ~ ;v. ~ 2 ; - 3
3 3--I )~ ~ 1] ~ "-- rnS US Y71( ~ ~S t''r;- rr^ ~ ~ `~~ t~
_. , ;
F t_~ ~~~
)
`%
Y NTY
r`
~
. y. !C~
~ ~, :~ r
Remarks: ` --~-'"~~
CST Name (Please Print) ignature Telephone No.
- dCtm Scl~ er ~ 7!s-Z ~(7- yv4
Address Date CST Number
~ ~~<}yc~ SOIL DESCRIPTION REPORT
PROPERTY OWNER
PARCEL LD.#
Boring #
3
Ground
elev.
qS. U ft.
Depth to
limiting
factor
1!-~.in.
Boring #
Ground
elev.
Q~~ft.
Depth to
limiting
factor
Z _in.
Boring #
J
i~
Ground
elev.
9y GU ft.
Depth to
limiting
factor
~ 1 min.
Boring #
Ground
elev.
ft.
Page 2 of ~ - +
Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo
da Ro
ts 2
in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. un
ry o Bed ,Trench
~ O-t2 ~~ r3)Z Sri ( c lv~ .2 ~ •3
3 ~c,-~'y I (9 r `I ~ to -~' rr U i cs -' .1 g
Remarks:
1 U-I 2 10 3 Z -- 1 rv~bk rn~r G l ~ ~' . Z -
2 tz3b t~ ~ `~' S~ Zm~bk ~ - • 5 ~•~
3 -t ~ ~~ ~t ~ YYIS ~ ml c.S - . ~ ~ . $
Remarks:
Horizon Depth Dominant Color Mottles Te
ture Structure Consistence Bounda Roots GPD/fiz
in. Munsell Qu. Sz. Cont. Color x Gr. Sz. Sh. ry Bed ,Trench
I a-Ib co ~- 3l z --, 5~ I ma k ~S I v~ • Z ~~ . 3
Z ~-L3 ~U ryJy -' S; ! 2 k L - • 5 '
~ z3-I I ) ~ r y I lQ `" ~~ S ~ 1 ~ S . ~ ~ .
o
Remarks:
Depth to
limiting
factor
'n' Remarks:
SBD-8330 (R.9/98}
NA}~IE' •~y (~ y ~J ~ _ _ LOT.... #
SCALE 1"= /OU
BM1 ELEV.
DESCRIPTION- ~ 9~.7`l
O o.~ z "puc pw~ (~fh w/I?
BM2 ELEV .
-~..~~
DESCRIPTTON-loo q~/~ ~`6
or z"auca~pe 14f ,., ~Z,'b
SYSTEM ELEV. ~Z•~U
ALT. ELEV. ~l Z ~ l0
CONTOUR EL• EV . {~ 6 h ~
__ PAGE '~ OF
U LEGAL DESCRIPTIONSw-~ ~ -~C9 -?q'/4 -w
It
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer P, ~ . c ~ ~ I o~,q I
I~In s ~~,~.
Mailing Address -7D~ ~~ • ~t d ~ /~~/~sa•v l;uL .5 4-v ~ (d
Property Address ~~~ °~ ~ q ~ e ~ `S C ~, ~~
(Verification required from Planning Department for new construction)
1~ C~av-- /O/b-aD
City/State ~tUdSdN ~~ Parcel Identification Number ~o~a - toay- X10
Oa o - /o - ~
LEGAL DESCRIPTION
Properly Location ~ %,, 111 E %, Ste, /~ , T~N-R~W, Town of ffvt~ SDn~
Subdivision _ ~ i ~' C2.P A2 ~ /~ ~ ~ o W ~
Lot # ~ U
Certified Survey Map # Volume .Page #
Warranty Deed # ~ ~ / ~- S Z- Volume C ~ ~ Page # ~v ~
Spec house O yes~no Lot lines identifiable yes O no
SYSTEM MAINTENANCE
Improper use and maintcnanceof 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
masterplumber, journeyman plumber, restrictedplumber or a Iicensedpumpcr verifying that (1) the on-site wastewaterdisposalsystern
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
da e e year expiration date.
3! !~A
GNAT[JR.E 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 scribed above, by virtue of a warranty deed recorded in Register of Deeds Office.
GNATURE F 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
i iv
DOCUMENT N0,
f~3~Mar~orie Malernee, STATE SAR OF WISCONSIN FORM 2 - 1982
WQ RRA (N/~~TY DEED
y('..17i~JPAG~ ~,rj~Z
Frances August and Paul Katner
as tenants n common aikja Francis
August
conveys and warrants to P • C.
Wisconsin Corporation Co ova Builders, InC . , a
EaC?62Ea7
KA7HLEEH H. IJALSH
REGISTER OF DEEDS
ST. CROIX CO., uI
RECEIVED FOR RECORD
07-06-1999 9:30 IOI
EXEIpi t DEED
cERr coat FEE:
CDPY FEE:
TRR#15FER FEE: f3f0.40
RECDRDIM6 FEE: 12.00
PREiES: 2
THIS SPACE PESERVEP FOR RECOROwG DATA
the following described real estace in St . Croix County, L:QV~' ~ J. ESTRC`i V
State of Wisconsin: ,`j~ L'7CU~ ~. _
SE 1/4 SW 1/4 Sec. 10-T29N-R19W excepting therefrom Lot 1 +iUD~N. W~ ~J~~~''
of Certified Survey Map recorded 1n Vol.7 of Certified
Survey Maps, page 2089 as Doc. No, 447303, also excepting 020-1010-QO
the railroad right of way. 020-1024-9'6
020-1025-90
NE 1/4 NW 1/4 Sec. 15-T29N-R19W excepting therefrom Lot 1PARCEL IDENTIFICATION NUMBER
of Certified Survey Map recorded 1n Vol. 10 of Certified
Survey Maps, page 2701 as Doc. No. 507728.
NW 1/4 NE 1/4 Sec. 15-T29N-R19W
This 19 not homestead property.
-~K}._ (is not)
Exception to warranties:
~
~
~7
~
Dated this
'" day o[ June , A ., 19 99
,,~~,.
r
(SEAL) i
a a ranC
• Frances Au>;ust ugust • ~l
tsfl~:... -•
.~~«•;V~`f~~
Paul Katner
~
~ F~tl~!
z (SEAL)
; ..
flar orie lernee -+}
,1. ~,~
AUTHENTiCAT10N ACKNOWLEDGMENT'
State of ~easse~rsgtRQn SEE ATTACHED,,;
"
l
Signature(s)
~~ A
EX[iIBIT
ss.
i
Ki
ng County.
' authenticated this day of , 19~ Personally came before me this 26th day of r
June , 19 99 ,she above named ,
I
i
TITLE: MEMBER STATE BAR OF WISCONSIN Frances August i'
(IE not,
authorized by §706.06, Wis. StatsJ [o me known to b e person ---- who executed the foregoing
inst tan c n wledge sa e.
' THIS INSTRUMENT WAS DRAFTED BY
Heywood & Cari, S.C. by Walter Hodynsky
540 16
204 Locust St., P.O. Box 125 Hudson, WI Kin
g County,.~ltie.- WA
Notary Public,
(Signatures may be amhenucated or acknowled ged. Both are not My commission is permanent. (If not, state expira[ion dace:
necessary) September 1, 2001 X~g )
' Namts of pawns signing in any capw:ity sFwuld by typed or primed below ~brir sigmwres.
STATE BAR OF WISCONSIN Wiseaein regal Blark Co.,lrc.
\YA RRANTY DEED Form No. 2 - 1982 ~"'~a°• wa.
t
``~~~~~~O111gUNlp~/
Pp,l AL
S'''~,
~
.
T o:• ,
`~'
~
~
/'.
~~ ~ PAMELA B. BOTKiN
;,,~ `~
~''
'
~- .
R-~, ~ NOTARY PUBIIC, STATE Of OHIO
~
* _s
-i~ ~ ~~'~
~ My Commission fxpire8
~ ; K'~i
I ~O`
,~
>
.'
. ~ Mx, 27, 2003
'~
9
~ State of Illinois
State of Ohio )
ss.
Franklin County. )
Personally came before me this 28th~y of .Tune , 1999,
the above named Marjorie Malemee to me know to be the person who executed
the foregoing instrument and acknowledge the same.
~.t~....G_ ,B ,3fa--
Notary Public, Franklin County, OH
My commission is permanent. (If not, state expiration date:
3-27-2003 ,'•)
~~~;.1 ~39PAG~ ~! ~~
EXHIBIT A
ACKNOWLEDGMENT
ACKNOWLEDGMENT
~ county
}
> SS.
)
Personally came before me this .~9 day of *~+ , 1999,
the above named Paul Katnet to me know to be the person who executed the
foregoing instrument and acknowledge the same.
* ~/S~Lc2 ~ i i
Notary Public,~..ae._ County, IL
My commission is permanent. (If not, state expiration date:
~f /S/dOo o , i'~3')
OFFICIAL SEAL
LAVERNA R SNEER
NOTARY PU9L1C, STATE OF 411N0~
MY GOMWNSSWN EXPMES:W114100
~ +•hnn
,\
-~ ~ ~. ~
:ti>. N^ -- rrrri
yl~. 1. 1 -_--._=~5
June 23, 2000
P.C. Collova Builders
705 County Road E
Hudson, WI 54016
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680 Fax (715) 386-4686
RE: Septic Inspection for P. C. Collova located at 989 Marcy's Court, Riverpark
Meadows {Lot 24), Hudson Township, St. Croix County, Wisconsin
Dear P.C. Collova Builders:
A septic inspection of the above referenced property was conducted on .This property is
located in the NW 1/4 NE 1/4 of Section 15, T29N R19W, Riverpark Meadows (Lot 20),
Hudson Township, St. Croix County, Wisconsin. At the time of the inspection, this septic
system was found to be code compliant for a three (3) bedroom home.
If you have any questions regarding this, please contact our office at (715) 386-4680.
Sincerely,
Kevin Grabau
Zoning staff
cc: file
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680 FAX (715) 386-4686
May 17, 2001
P.C.Collova Builders
Attn: Laurie
705 County Trunk E
Hudson, WI 54016
RE: Septic Inspection for P. C. Collova located at 989 Marcy's Court,
Riverpark Meadows (Lot 20), Hudson Township, St. Croix County,
Wisconsin
Dear Laurie:
A septic inspection of the above referenced property was conducted on 06123/2000. This
property is located in the NW 1/4 NE 1/4 of Section 15, T29N R19W, Riverpark Meadows
(Lot 20), Hudson Township, St. Croix County, Wisconsin. At the time of the inspection,
this septic system was found to be code compliant for a three (3) bedroom home.
If you have any questions regarding this, please contact our office at (715) 386-4680.
Sincerely,
Kevin Grabau
Zoning Technician
/gm
cc: file
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