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HomeMy WebLinkAbout020-1447-20-000~ ~ o I ~ ~ o° a I c ~ ~ I ~ ~; ~ 0. a ~ I ~ t i o p I 0 N O O ~ I ~b~' O ~ N (i, ~ E O .C T ~ ~ ~ N 0 ~ a0 N ~ I ~ ~ ~ N c Z ~ o 7 LL m ma~ O E N 3 ~ ~ ~~,~ n Q a I t ~ I a3i ~ I Z y I ~ d' v ~ Z v N~ a m I I ~ z o I o Z '~ ~ ~ I a' r d Z ~ O Q ~ o I ~ In F- r ~ ~ N Z I c d ~ ~ N M I N ~ ~ ~ v 7 ~ •~ ~ ~ L p I -~ 4 0 0 `° I °mz z z N l d ~I N .. 10 ~ N I ~1 m ~ d a b C ~ a ~ O ~ ~ ° I o va ~ ~ ~ 1 j ~ - U I U N ~ I u, •'v ~ a a s ~ N I a ~ ~ % J U o o ayi t ~ ~' ^~ ~ N N ~ ~ ~ ~ ~ O f~ ~ J _ m ~ d <CZ<n C e ~_ U ~ a o I ~ ~ O M H C 4 C o ~ o ~ 7 r o ~' E a ~O c ca ° ' I v c Y - r c3 I C Ci y ~ Ch m a c ' _c ~ ~ ~ L ~ ~' ~ S ago v o N Z ~ Y ~ cn I ~ .. '~ Y ~ .. ,` I € V ~ d w a m I '~ at °. :u a ~ da • `iv ++ d ~ ~ c c °: ~ Q U a g G N U , WisconsiryDepartment of Commorce PRIVATE SEWAGE SYSTEM Safely and 8uil~'ing 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: City Village X Township Bast, Kernon Hudson Townshi CST BM Elev: ~ Insp. BM Elev: ~ BM Description: ,~ "~ - ~~ ae,u.~ ~ ,p ~ • O ._ CST ~ u~. (.*c TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic '~~' -r`t-` Ldp Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO PIL WELL BLDG. Vent to Air Intake ROAD Septic ~, ~ - ~ t ~~` Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Nu er TDH Lift rction Loss System Head TDH Ft Forcemai Lengt Dia. Dist. to wen SAIL A~~ORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No~ 463159 0 State Plan ID No: Parcel Tax No: SectioNTownlRangelMap No: 14.29.19. STATION BS HI FS ELEV. Benchmark oar ,~, l ,5, 3 ~ oS, 3 i rn~•b Alt. B C°l~~ a•S5 9.3o t Bldg. Sewer `~ O~ q•7 _ , IG•~S SUHt Inlet ~. ~ ~• 3S , SUHt Outlet 4' .OSt Dt Inlet Dt Bottom Header/Man. Dist. Pipe •0 0. Bot. System , ,/o $,- i , Final Grade St Cover ~•`~• 9~-20 ~} gM •~ ~ A t~ g,o) .~ 3.30 RENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM ON t ! ~ l~~,CJ'~ 2Q• SETBACK SYSTEM TO r P/L BLDG WELL LAKE/STREAM LEACHING Man tprer.~- INFORMATION CHAMBER OR G~GC ~ Type Of System: , + / UNIT K Model Numb r ~v. ~ L ~~ . .v DISTRIBUTION SYSTEM Header/Manif Distribution x Hole x Hole Spacing Vent to Air Intake p Lengths Dia P• Length Dia Spacing r ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of ~ xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil [~] Yes ] No ~ Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_~i• O }~~ Inspection #2: Location: 934 Coyote Lane Hudson, WI 54016 [NW 114 SW 1/4 114 T29N R19W) Coyote Ridge Lot 20 Parc~e~l N~o:~1~4j.29.19. 1.) Alt BM Description = `'~~ .S~ t,yR,~ ~ ~ ~-~"~~°'" -""'r'[ ~' '~"r'`'~ 2.) Bldg sewer length = - amount of cover = I Plan re sion Required? ~_ No fit' IS Use other side for additional ' for do ` Date SBD-6710 (R.3l97) ~ f~ J - -- __ _. i Insepctor's S' nature Cert. No. ~,,, rte- ~ 2,0~ `~. ,.~ s- Safety and Buildi 'vision 201 W W County ~ ~ ~ ~ . 2 ashington Ave. P.O. 71^6 - _ ,i-~ ~ ,~~~~~,~ gyp . ~ Q adiso is ' 2 , (to m ber led in by Co.) _ - • P~rmit Nu Department of Commerce (V/ 60$) 266- 51 _ / 2 ~- '~ >~ s Sanitary Permit A i `` ~ T 2 5 Y C Stagy Platt I.D. Number ~~ 1 In ac~~rd with Comm 83: Wis. Adm. Code, personal informs on u provide may be used for secondary purposes Privacy Law, s15.Q4(1 ZpN ~ OCpt1N ~ject ddress (f different than mailing address) G L Application Information -Please Print All Information ~ a ~ n ~ ~~ l.~ / Property Owner's N parcel # Lot # Block # 11~ti/ ~~ T V `~7 Property 's Mailing Address ~ g~ro~p~e~ ~ ~ ~~ ti '/ ~ S City, State Zip Code Phone Number +, - i, ec on .~.L /=~L ~~ J Z (~ ~, one ~ N; RE r VY of Build' chtdc all that a t~ ~,, Type ~ ( PPS) ~" 5 _ i N 3 ~or 2 Family Dwelling - Number of Bedr+ootns - - vis on Name CSM umber N Public/Coanmcrcial - Destxibe Use i++ Z a~-d~ 1 0 State Owned - Drxcribe Use ~ Ci ~ Viilagt:~wrrsbtp of III. T ype of Permit: (Check oily one boz on line A. Complete line B if applicable) A' .System Replacement System TteatrnenUHoldingTsnk Replacement Only Other Modifidttian b B,lristing Syaoem B • Permit Renewal Permit Revision Change of Permit Transfer to New Last Pavrous Permit Number and Date Lssned Before F~rpiration Plumber Owner IV. T e of POWTS S m: Check all that a 1) - a -Pressurized In-Ground Mound > 1A in of suitable soil Mound < 24 in. of suitable soil At-Grade Single Pass Sand Filter Constructed Weiland Pressurized in-Ground Holding Tank Peat Filter Aerobic T~6nart Unit ~ecirculadng Sand FilOer / Recircula ' S c Media Filter ynrbee " g Chamber Drip Line Gravel-less Pipe Other (ex n) -Q (a.~ V. Di ersaVrreatment Area I ormation: Design Flow (gpd) Design Soil Application Rate(gpdsf) DispasaJ Area Regatrod {sf) .Dispersal Area Ptopo (sf) m He ~ ~ VI. TaWc Info Capacity in Tote! Number Maatrfacturer Prefab Sioc Fiber Plastic Gallons Gallons of Units Concrete Conafructtd Glass Akw Foisting Tanks Tanks Septic or bolding Tank ~~ • Aerobic Treatment Unit I)osi~ (umber VII. R onsibility Statement- I, the a e 'bility for installation of the POW75 shown oa tLe attached Plumbet' (Print) Plu MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, f ) /~ ~/'~~~'C./ lam/ ~ r~ VIII. Coon /De t Use Onl / rov Sanitary P ~ t Fee (inclades Gcound~vater Date Issued Issuing t Si re Statrgrs) (/ nrratarge ~ ~~~'-- V wR or Denial O Z~- ~ lX. Conditions p 3~ - :~-- ~3 i S ~ ~~`~.t~ !~ ~ SYSTEM OWNER: - n~n 1 Septic tank, effluent filter and c~,.,,,~ ts+~ dispersal ceA must all be serviced !maintained ----~:~~-- ) ~ ~ p , lumber ided b l ~ _ dam, y p an prov as per management p . 5-~ ~ i d ne 2. All setback requirements must be mainta ~~~ CtA~q ' Urt1 ~. as per applicable code/ord'inances. \ AttacL compkh plant (to the County Daly) [or fhe system on paper not less than Sl/Z x 11 hrchea is sine PROJECT Kernon Bast NW 1/4 SW 1/4S 14 /'r `Z' ~ ~' 12/7/04 4 MPRS Shaun Bird 226900 2 DATE BEDROOM CONVENTIONAL XXX IN-GROUNb~ ~,'~p OVNTCONV NTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1250 gallon J`F IF TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 ,BENCHMARK V.R.P. Top Of 1/2" pipe ASSUME ELEVATION 100' Filter ZabelA-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 88.7/88.8 ' 7' below grade 40 2-3' X 88' Cells with >3' 10' 165' Spacing B- B.M. 324' Property Line X261' Property Line Please note: survey map I have shows B-1 next to lot Well is to meet all 50 line, the north lot line will setbacks required by B-3 4 be field verified and system WDNR will be installed accordingly - 120' 10% Plans Designed Using 10' 25' Conventional Powts Manual Version 2.0 B-2 S 10' 20' B.M. #2 is top of 1/2" steel pipe @ Pro 4 261' 99.3' Bedroom Property House Line c-Went >6„ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 11" 6' Long PLAN S 948 La Barae Rd Hudson Wi 54016 /R ~V~i f'Q Hudson COUNTY ST. CROIX at System Elevation Pro Town Road F , + Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings Fn accoraance wnn wrnm aa, vvis. ram, t,uue County t Plan must Attach complete site aper not less than 8 1/2 x 11 inches in size lan on ' p p . indude, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. PI68S@ Pril7t 8ll lnfOI1178t%O/!. R 'awed by Oate Personal iMorrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ ~~, . Properly Owner Property Location Q,l !')~1J1~/ Govt. Lot j~1 /4 4 S T a, N R E( W Property Owner aili ddress Lot # Block # S`' .Name or M# ~{ r`~ ~ Z~ ~` [- n City State e Phone tuber Zip Cod ^ City ^ Vill Town Nea st Road , e New Construction U Residential /Number of bedrooms Code derived design flow rate GPD ^ Replacement `-~ ^ Pub'tic or Comm 'al -Describe: __._____ __- Parent material U Flood Plain elevation if applicable ~~' ft. General corruner><s and recommendations:~(~-(~,/` ~~~ ~~ Boring !~' _ /- ~~ # it Ground surface elev. / ~' `~ ft. Depth to limiting factor % ~in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Eff#2 Z 10-- ~ ~.-.~ ~ ~ ~ ~,3 89. ~ os.c~ a ~~ # ^ Boring pit Ground surtace elev. ft. Depth to limiting factor in. Soil licatron Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fY- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 nxilL and TSS >30 < 150 mglL • Effluent #2 = BOD < 30 mg/L and TS5 < 30 mg/L CST Name (Please Print) Signatu CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Con clad Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~.~ ~.,2.~ 715-246-4516 w~ Property Owner Parcel ID # Page Ong # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 ^ Boring # ° Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 ^ >~r;~ # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Col Redox Description. Texture Structure Consistence Boundary Roots GP D/ffZ in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Efi#2 • Effluent #1 = BODE > 30 < 220 rrglt. and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 rnc,IlL. and TSS < 30 mg/L 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. SB0.8330 (8.6/00) • _ ~ LOT PLAN PROJECT Kernon Bast ADDRESS 948 La Barae Rd Hudson Wi 54016 NI1N 1/4 SW 1/4S 14 /T 2 N/ 9 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 10/24/04 BEDROOM 4 CONVENTIONAL XXX IN-GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1250 gallon LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 ,BENCHMARK V.R.P. TOp Of 1/2° pipe ASSUME ELEVATION 100' Filter ZabelA-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.0/942' 4' below grade 16 ' 324' Pro a Line 1 Plans Designed ing Please note: survey map I Conventional Po have shows B-1 next to lot Manual Ver i~ 2. 40' line, the north lot line will B.M. * be field verified and system will be installed accordingly 1 10' 261' ~ B-1 Line ems, ~ Vents ~" ~ 2-3' X 88' Cells with >3' ~ Spacing Well is to tall ~ti 50' eta s uired by "~~~,~ B 3 40' W \ 120' % lope ' ~ Pro 4 x Bedroom G~ 1 25' House 0' T 10' 0~2„ / p 261' ~ steel pipe @ Property 1 9~, .. Vent >6„ Standard Biodiffuser ~~' of Cover I-eaching Chamber ,~/ with 31.1 ft2 of Area 6' Long 11 " Grade at System Elevation ~~ 3 4" Pro Town Road ' . ~ LOT PLAN PROJECT Kernon Bast ADDRESS 948 La Barae Rd Hudson Wi 54016 NW 1~/4 SW 1/4S 14 /T 2 N/ 9 W TOWN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 10/24/04 BEDROOM 4 CONVENTIONAL XXX IN-GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1250 gallon LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •7 ABSORPTION AREA 872 # of chambers 28 ,BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter ZabelA-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.0!94.2' 4' below grade _ 165' _ 324' Prouertv Line Plans Desigrled`~ Conventional Pow Manual Version 2 ( ..( !61' ~ 'roperty .,ine ~ ~ Well is to tall i~ eta s uiredby `~--~,.~ B-3 W \ ti~ .~- % lope / ~ x ~ 1 261' ~ Property ) lrie r~ ~~~~~ nVent >6" of Cover ' 11" 6' Long 40' B. 10' B-1 Vents 50' 40' 120' /Please note: survey map I have shows B-1 next to lot line, the north lot line will * be field verified and system will be installed accordingly 2-3' X 88' Cells with >3' Spacing Pro 4 Bedroom 25 ~ House ST 10' #2 ' p o 2" steel pipe C 99.3' ___---~ Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area at System Elevation Pro Town Road r -- RE~EI EV ®~ - 3 1Ksoortshr oeparoxrsrd t:onre ~ 9 2003 ~' SOiL EVALUATIC}N REPORT Page ~ of Division of Saf~yand n acooraarroe wmm u:~, rns. ,gyn. i.oae s~r. cROix couNr~~ Cattily 5 ~ G/Q O/ ~.- Aitar~ caom Pt~s must le~e site iN~ t 81/2 1 i i hes in size p er nc . ir>ckde, but not Flo: v~ertica Point (BMj, direction and Paaet I.D. ,!~-~ ~ d~ ~ per~cerrtsiope, scNeordarrertsiorrs, north arrow.arid bt~tfonarW d~roeto nroad_ - Ptease prior a!J tntamaffon. R ~` t~ Peron~t 1nbm~won you veov+de tt^y be wed tort+eoaaery o t~- t..w. c tsa t+~ ttN)• A/ W S£ SEcT. [ Pnoperty`O'wner /c ~lp/V ~N ~~ c/' ~ PraperlyLot~ion C3aut. Ld /V ~t1 1/4`s~ 4f4 S=f'l T '~ / Pf R ~ ~ ~i(orj W PnapertyOwner's>Addr+ess ~l y G~ • ~r4-le G'E" ~`'D ' t~ot# Z• o t3fodc# Stbd. Name ort E',V N '" cc y'o rE' ~ ~p~~' •, ~l~pSo~ W , syalp ?15~ 38l~•???5 ^ t:~y ^ vrlage Town Nearest Road lfvOso~ 13A~~i~~ ~~ - Newcon~nx~ian user R~d~tsal ~ Number of bedroorrx 3 " cone derived d flaw rate ~5.0 -- -~~ t3PD © ~ Pu66c a oarrrneraiet • !?e®aibe- .- Parent materiel /o£SS a u~,, s.4vO v ~ o v r u~,4 .Fiona Plain eteva6on # s~ppr~te ti ~. ~t~ ~"`' ~ • >4iP~it- T~ sTiE~ ~S ,SV/T~4~3~ ~/~ /1'•v iii~j'/~ov,up -. C/~Vtl~ T-!'D~vi4-~. S yS 7"~'~t C ~. (~: Cc? .T `. S. Q 6 0 i q~ 04 - ,~ ~ p ~. ~ ~ ~ t~otxrd surface elev. _~~, tt. ~ a in. ~ ~ ~ Morixon Oeptlt in. Doe>inarrt Rsdox Oesp~iption a1. Sz t,`,ont. t,'.cior Texture StruNue taY. Sz Sh. Carnoe Boudery Roots '~ '~ ,~ o• ~ a y~ 3i -- SG s h - ~ w 3 f- s 3 7 S yR- ----- ~ GS /iwt S G • ~ l• Z-- ~o~ a -~~ > °~ ~~ ~~ • ~ - a ~~ ~ R 1a h- tot Pit t3rota,d surface rev. Sol Rate ~ ~ o - (~ io R ~ SL Z-Fsh~. dsG, w 3 . s . ' , .Z S --- G•S /iwl ~ - o - p. Z • iit #1= t30D > 3t i _< 2~0 m~ and TSS a3ti ~ 1 50 myl. ' E1Rusnt #2 = BO D < 30 mgil and TSS <_ 30 mpit. . ~- CST'1Jurrirer csr t ot3 ~T' ?~ ~ b I? i C ~-l - ~`~ ~ ~, 2, G 3 z S ~y~ L1sAe Evalua4on L'orKkuied Telephone Ntrtirer ~VDv. ~~ • ~o0 3 715•"7?a•3~t~~-• Private Sewage Consultants O 2812 10th Ave. ~jN •S /roil TDTig'L. o~ O 0 Spring Valley, WI 54767 Z p . !o ~..~7 . Z o • o-a-a 20 • /0~.7 • 30 • ~ z.o • io~7 . yp.- oa-~ ~~ Ca yo TE- ~;~~ ~, ~'ERtia~ ~~-s ~ Lo T Z o Z 3 p''°pe't)' owns. Parcel ~ # Page of # ^ o CP ~; ~ Plt ~,,. 9 5 • ~. ~, ~ r tee > 9a ~, ~~ ~ Dormant R .~ i M edox Description Textun3 Strt~tue Gace Boundary Roots OP QIfP ~ ~ n. o /o unsep /o iQ3/ ~ S Qu. Sz Cont. Cdor SL iL Gr. Sz. Sh. zfsh~ / s S~ ~ $ 3 / •Ftf#1 ,S . Z. 'E1f#2 , ~ .~ z~ .~ # U ea;ng u •~ ~ccss~~ ~ . ^ Pit Ground suriaoe ~. a. to r ~ ~,. Sati Rate Fiorizort Depth Dominant Redax Desaiption Texture Sttuchwe Consist~oe Boundary Roots GPDVIf irr. MunseA Qu. Sz Cant Color Gr. Sz Sh. 'C-tF~1 ~ 'Eti~2 # a Bates Pi- Ground stp'tace elev. ft. Dew to ~nitina factor rn Fiori~an ~ Domeratrt Redox T Stricture Comae Botmdary Raots Sal Rade GPDlff in. MunseN t]u. St. Cart. Color C,r. Sz Sh. 'Eff#1 'Efi~2 EtAuent !f1 = BODs > 30 < 220 mgfL ~ TSS >30 < 150 mglL • Eflkrerrt Ii2 = BOD < 30 t s mga. and Tss _ 9o mg~1 The Dcpartment 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 caattact the department at 608-266-3151 or TTY 608-264-8777. saa.auo~> --TMw~ i~ k©~,n fi~r~- ~ ~o v AT A7•W . Lpt" Y d 0 J Lak w X21 ~ nor i9) ~ ~ T" 2 0 ~4 ~ yP°` ~ . ~ i i ~ ~` 1 /D s ~~ . ._-~ ., 4 ~o r ~,~ o' .~ s~~/.,~ : 1 "= 3 0 ~ ~. Gdv ~ tl /'2 G~.t/..QS ~v r---- ~a r o ~~ # ~ lap °~ Y~ ~,~-~- ~'~~' For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater consultant and p}umbers ~h ~ ~ ~': T°p °f ~Uf~~Or Nb ( r p D yL~ Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in orderto extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per comm. 83 ncy Plan ~ ption #1. system fails, determine cause of failure, use ~ ti~rnate ar~~ and install new s in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 COUNTS E1ViBNT` 5T CROLX _ - .. CE A~~ ' EEpTiC-T M~II~TTENAN . ~, ~ ~ ~ ~ HIp CER~ICATIQN FORM . OWNED ~ V ~ pw.nerBuyer s~~l ~ Mailing Address _ _ - ~ti,Q_.,- AddzeSS ~ 3 Department for new construcdoa) Property ~Ierification required from peel Identification Nunabez ` City/State Li ~, ~r,~c('RIP'I'ION w~ Town of Location ~= 1/•, ----- X,Ot # - PropertY ~ l Subdivision ~ ?age ~ ---- ,~ ~_ Volume _--------_-' Certified Survey Map # .. ~- Page # 2~ Volume 2 `~$ Warr$ntY Deed # s O no Lot ]ins identifiab~ S ec hous~~Y~ a no p failure to handle ~sus• proper ~teysaee CE traits premature What you put into the system m could resin ed SYSTE es use ~ ~tenaace of your sCptzc sy~ r sooner, if needed by a lip aa. P~'cr' ~~ ~g 'out the septic task e ~ ~~nt stage is the waste d~spos~ sY b the ow~r ~d by a c°nsists of p~ coon. of the septic tank cation form, signed Y oral system can affect the tun nt a ter ~t {) ewaterdisp to submit to St. (}oix Zoning DePs<~e 1 the on-site wart of sludge. r a or a licensed purr verifying the septic teak is loss than 1!3 full The p a~~' °~r lumber, rest~oudplualba if necessary) . ~.sterplumber, journey on and/or (2) after tmpection and P~~ {• tem with the standards ~ is proper operating ~~ the private sewage d~sPosal sys cation eats ~ agree to main gesources, State of Wisconsin- Cemfi artment of ed °ot the St. Croix County Zoe ~~~ ~~ 30 I{we. ~ uade~~d have read the abovi of fierce and the DeP as set by tem has beenasatataia~ must be completed and return s~tiaS~thsht Y°u~r s~Ptic sys I~ days of a three Year expiration date. DATE SiC3Nl~FURE OF AppLICANT knowledge, I {we) am (arc) the owner(s) of OW1vER .~~Q'r~cR'ICATION form are ~~ to the best of my {ours I (we) certify that au b~jy~e of a wa~tY deed recorded is Register of Deeds Office. the property described ahoy , Y ~~~ ~ DATI; the Zoning Department. *"'``"` SIGNATURE OF pPPLICAN'r ermit being revoked by «# ormation that is ~-represented sstaY result in the sanitary P `*s` ~ Any ~ ester of Deeds office decd deed from the Reg• de ~ the warranty lieatioa: a stand warranty if reference is ma «s Include with this aPP a copy of the certified survey snap STATE BAR OF WISCONSIN FORM 2- 2000 Document Number WARRANTY DEED THIS DEED, made between Kemon S. Bast, a married person, Grantor, and K.ernon J. Bast and Donalda 3. Speer-Host, husband and wife, as Survivorship Marital Property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A Recording Area ?509#+ KATHLEEti H. YlAI.SIi REGISTER OF DEEDS 5T, CROIX CO.~ NI RECEIVER FOR RECQRD 0.1/07/2084 12:35PM 1fARRAHTY DEED ~z~at ~ rlb REC FEE: 13.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 2 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Name and Return Address: Edina Realty Title, Inc. 400 S. Z'a St. -Suite 115 Hudson, WI 54016 412540 20-1027-40-1}00 & 30-000 &20-00 Parcel Identification Number (PM) This is not homestead property. Dated this 6th day of 3anuary, 2004. * ernon J. Bast * A UTH E NT ICATIQN~r ~~{tln Signature(s) _ cih8C1 ~,b~\C' authenticated this 6th day of 3a;~g * TITLE: MEMBER STATE BAR OF WISCONSIN (1 f noi, authorized by § 706.06, Wis. Stats.) TH1S INSTRUMENT WAS DRAFTED BY Edina Realty Title -Doug Berg 400 South Second Street #115, Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature * * ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this January 6, 2004 the above named Kernon J. Bast, a married person to me known to be the person(s) who executed the foregoing instrument and acknowled ithe same. ~ ~ ~ *Cheri Brown Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 3/11/2007 ) ~3 WAKRANTY DEED STATE BAR OF ~i'I5CONSiN FURM No.2-21100 f ' . . . . U 2`I87P 12Z EX~IIBIT A The NE %, of the SE %, and the NW '/, of the SE '/,, ail in Section i 5, Township 29 North, Range 13 West, St. Croix County, Wisconsin, EXCEPT a parcel described as: Beginning at the E '/, corner of said Section 15; thence South 00 degrees 47 minutes 33 seconds East, along the east line of the SE'/, of said Section, 407.27 feet; thence South 89 degrees 08 minutes 15 seconds West 535.46 feet; thence South 14 degrees 10 minutes 34 seconds West 93.31 feet to a point on a 80.00 radius curve, concave southwesterly, whose central angle measures 25 degrees 34 minutes 33 seconds, whose chord bears North 54 degrees 32 minutes 33.5 seconds West and measures 35.41 feet; thence northwesterly along the arc of said curve, 35.71 feet; thence North 14 degrees 10 minutes 34 seconds East 76.12 feet; thence North O1 degrees 07 minutes 26 seconds West 400.07 feet to the monumented south line of Certified Survey Map recorded in Volume 1, page 217 at the St. Croix County Register of Deeds Office; thence North 88 degrees 51 minutes 13 seconds East, along said south line, 570.78 feet to the point of beginning. • . f i i ~ J ~ m ~ 's ~ W ~ ~ r ~ ~ o ~ !~ $ , w~ ~g~ ~~ ~~ ~ W i ~ 6$~ ~~ ; ~cy`ti ~~. ..,; ~ ~ -,~ ~, / .~ ~~ /! ;`~ % i ~ ~ i i ~' j ;_ , ,~• ~ ~ I i i ~ i ~ i ~ ~ I I ~^ i j ~~ i ;i 1~ c+ Q I N h I ~ m J ~ ;` `i ~~ . ~ ~~ i i L30 _. 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