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020-1447-21-000
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: City Village X Township Bast, Kernon Hudson Townshi ;ST BM Elev: Insp. BM Elev: BM Description: L~'~ ..~ SANK INFORMATION E EVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Q Holding TANK SETBACK INFORMATION TANK TO P/L ~ BLD Vent to A.ir Intake ROAD Septic ' ~ t ~~~~ Dosing ~~,~,,.` 7.t • ( Aeration Holding T ~(,~ PUMP/SIPHON.INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Head TDH Ft Forcemain gth Dia. Dist. to well S(lll ~RS(~RPTION SYSTEM X1~t"_ i. -ln C/~1..~ county: St. Croix Sanit2ry Permit No: 463230 0 State Plan ID No: Parcel Tax No: y ? - -~ Section/Town/Range/Map No: 15.29.19. z STATION BS HI FS ELEV. Benchmark ~ ~ ` ~ /d~, D Alt. BM ~ Bldg. Sewer Y ~ ~, ~ d / St/ t Inl~t~ lb. 7~' j~ ~ 0 t Outlet /~ a~7 - / 3 Dt Inlet ~~ ~... Dt Bott --~' Bader/M n. ~ ~ !a ~-* Dist. Pipe r-r-; d ~ / ~~ ~„ ~ O. Bot. System ,~ ~, s .3 F~yBI grade ~.~ ~ (~ 3.1~ St Co ~~ t 5 / D ~ 2 Y1~`S ~f~ ~,rit,,.. 1 / t' /~> r/1/ BED/TRENCH Width f Length No. Of Trenches PIT MENSION No. Of P' s Inside Dia. Liquid Depth DIMENSIONS ~ !n/` ~ tJW/ V 3 SETBACK SYSTEM TO P! BLDG WELL LAKE/STREAM LEACHIN Manuf er: INFORMATION CHAMBE R Ty Of System: ~ ~ ~f IT Model Number: ~ l DISTRIBUTION SYSTEM f~,nn.... ~1'~l 1 a/~1~u~- ~ ~~'~~1~(l.~C/ yeade anifold ~ A Distributio ~ Pipe(s) ~ ~~ 'Z 'F x Hole Size s""- x Hole Spacing -~ Vent to AQir~Intake ~l th Dia L acing th Dia S Len ms I _ eng p g SClll CC)VFR „ oro«.~~o c.,~•o.,,~ n.,r., ..,. Mni~ntl rlr ~f_rrada Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ ~ ~ ~ Bed/Trench Edges Topsoil I I I ~ Yes ~ ~ No i ;i Yes ~ ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / f~ /~ Inspection #2: / / Location: 924 Coyote Lane Hudson, WI 401/6~(NW 1p/,4~ SE 1/4 15 T29N R19W) Coyote Ridge Lost 21~ 2a~ / ~~arcel/~N/~/ 1~2~Q \ 2.) Bldg seDwer ength = '2'' , ~ W ~ v ~~ ~ `.'" `"~ S(,(. /~`~ 7/O~V` Gx'.~"'~ ,%-c~~~ -amount of cover = 3~ ,~ ~~ (~~ ~`~~~ ~~ ~~ f ~p /~ ~ 9 _ _ - - - _ - -_ V ---,, Plan revision Required? I `; Yes °, No j OS - ! - Cert. o. " l__- Use other side for additional information. I~_ -!__ ! v_ __ ____ __.__-- _ _~2__- ~- -~ Date Insepctor's ignature SBD-6710 (R.3/97) Safety and Buildings Division County ~ s 201 W. Washington Ave., P.O. Box 7162 `~~a~~I~ ~ 1, Madison, WI 53707 - 7162 Sanitary Penn ~t Number (to a filled in by Co.) De artment of Commerce 3 ~ Q Sanitary Permit Ap lion [~ State P-an I. .Number In accord with Comm 83.21, Wis. Adm. Code, personal in rmation you provide may be used for secondary purposes Privacy Law s15.04~~ltil (i ~ ?004 Project Address (ifdifferent than mailing address) I. Application Information-PleasePrintAllInformation ST.~R~~;~~~ ZONI uNTY q Z `-~ C.O D-C-6 t;~r1JE Property is Name Pazcel # Lot #~ Block # Properly Owner's Mai ing Address Property Location ~/ ''/,, ~'/., Section City, Stat Zip Code Phone Number ~ ~ ~- ~, ~ (circle ) T~~ N; R~E o~ I .Type of Building (check all that apply) ~ S Subdivision Name ~Imrtber 1 or 2 Family Dwelling -Number of Bedrooms S . ^ Public/Commereial -Describe Use ' ^ State Owned -Describe Use ^City ^Vill Township of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A. '~ New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: Check all that a 1 Non -Pressurized In-Ground ^ Mound? 24 in. of suitable soil ^ Mound <24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ,~ Leaching Ch r ^ Drip L'ne ^ Gr vel-le Pipe ^ er (e lain) V. Dis rsaUTreatment Area Information: 3 Design Flow (gpd) Design Soil Application Rate(gp Dispersal Area Required (sf) Dispe Area Proposed (sf) Sv~tem Elevation / ~ ./ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastid Gallons Gallons of Units _ fJp w Concrete Constructed Glass New FacisHng ~~~~~~ ~ U„ ^ ~ TTtt cT~ Tanks Tanks M"''v' . Septic or Holding Tank _... ~ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assum esponsibility for installation of the POWTS shown on the attached plans. Plumb r' ame (Print) Plumber' Signat 1 ~ MP/MPRS Number Business Phone Number ~1 G .. r~ ~ ~..~~~'7 Plumber Address (Street, Ci ,State, Zip Code) ,.~!) ?,~ z VIII. Coun /De artment Use nl Approved ^ Djan ~~ Sanitary Permit Fee includes Groundwater Date Issued I in ent Signa Stamps) - ~ / Surcharge Fee) ~ 7t' I L~lwn ~ c rven Reason menial ~ --- , pz IX. Conditions pprov SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. nsmca comp~eu pmm tto nx a.omry onry) for toe syacem on paper not ices Wan ell x 11 ine6es in size SBD-639$ (R. 01/03) ~~~ ,~ ~_ ~' G~ `~ \~,~ ' ~~\\© `~ ~~ ~~; ~ ~,. '~~ ~~ ~ ~~~ ~~ " ~~ `~ ~~ ~~ Q~~ _S ~~ ~ r ~~ ~` ~~, , ~ L J ~~ 2G r ~^ ~. . i /7 Q \ X S ti /: ~~ .~ / `f l~ ~ d ~~ a ~\ ~~ COPY ~' ~~ T `\\ ~. t .~ M1 ~ r ~, ~ O i \,' ~~~ ~ , ~ ~,~ ~~ U~ ~~ ' ~~ ~~ y UV ~' ~\ ~\ ~ ~ ~ ~ 'r ~ ~?~ ~~~ ~` ~- ~ ~ ~ „`" r ~_ a ~- ~~ ~,, I.' ~,` 4 ~~ ~ ~-- ~o ~~ V z~ ° x ~\ ' `j ~~ \ `~ e __ j-- -- h ~ R; / \\\ c 1~ r ~~ ~ ~ ~. z ~' . ~. ~1v^ ~, U ~~' i ~~ ~~ Wisconsin Department of Commerce Division of Safety and Buildings 2 ~`~~~ ~ ~' ~~ ~~ ~ SOIL EVALUATION REPORT Page ~ of ._~ in acxvroancx vunn ~.omrn aa, vvis. twm. ~.oue County ~ lan on Attach complete site er not less than S 1/2 x 11 inches in size Plan must a - p p p . include, but not limfted to: vertical and horizontal reference point (BM), direction and per( (,p, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. ~ by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). , p 2 Properly er Property Location '~` -~ 1 ~--~ Govt. Lot ~ 1/4S;,,r 1/4 S / ~ N R ~ ~or) W Property Owner's Mailing A dress Lot # Blodc Subd. ante or C M# City t Zip Code Phone Number ( ) City village Town Nearest Road ~, New Construction User Residential ! Number of bedrooms Code derived design flow rate l~ GPD ^ Replacement ^ Public or commeraal -Describe: Parent material 1~ Flood Plain elevation if applicable ft. General comments I' and recommendations: ~ ~ fy~ ~(_ ,~/~ ~3 ` y ~ Boring # r~~ Boring ill pit Ground surface elev. s1 ft. Depth to limiting factor ~/_ ~O in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl? in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. *Etf#1 *Eff#2 a S 9 a ~ _ _ `~ `' n ~_J Boring # ~ Boring Pit Ground surface elev. ft. Depth to limiting factor ~ in. Soil I'ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/l~ in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. *Efi#1 *Eff#2 i - S ~ ~ ,_~ , ~~ ./S ~~``~ to. " E uent #1 = BOD > 30 < 220 ing/L and TSS >30 < 150 mg/L * Effluent #Z = BOD < 30 mg/L and TSS < 30 mg/L CST Na le ring Signature CST Plumber Address Date Evaluation Conducted Telephone Number .: , Property Owner Parcel ID # Page ~ of a Boring # ^ Boring pit Ground surface elev. ft. Depth to limiting factor 7~ 3~ in. Soil ligtion Rate Horizon Depth . Dominant Color Redox Description Texture Sbuctun: Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz:. Cont. Color Gr. Sz. Sh. *Eif#1 *Eff#2 _q ~? ~ .~ 6 3 ~ 3 ~ .~' 4 a S' Q `~ ^ Boring # ^ 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 D/fF in. MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. *Eif#1 *EtT#2 ^ Boring # ^ Boring ^ Pit Ground surtace elev. ft. Depth to limiting factor in. Soil lic~tion 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 * Effluent #1 = BODS > 30 a 220 mgll_ and TSS >30 < 150 mglL * Effluent #2 = BODE ~ 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. trr 590.8330 (R.07/00) i ~ ~ \ ~ ~~~ ~~.~~, ~ T ~~ ~,; ~ ~~ ~ ~\ z- w ~~ ~~ ~~ ~-- ~ ~ t\ ~~~ ~~ ~~ ~~ 0 y ~~ ~~ ~-: ~ ~; ~ U. '~ -. _.~~. ~~ ~~ a D-~ z r, 1 O~ 0 `h vJ POWTS OWNER'S MANUAL & MANAGEMENT PLAN,,.,,. FILE INFORMATIO ' Owner Permit ~ ~~Z3t~ n1A~1 Nwl'1w\1CTP_~n V 1-.VI V.~ • ~..r .r..~•!.s•+ Number of Bedrooms ^ NA Number of Public Facility Units 1~'FIA Estimated flow (average- al/da Design flow Ipeak-, (Estimated x 1,51 ~ al/da Soil Application Rata 7 al/da /ft~ Standard Influent/Effluent duality Monthly average " Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand leODbJ 5220 mg/l_ DNA Total Suspended Solids (TSS) 5150 mg/L Pretreated E=ffluent nuality Monthly average Biochemical Oxygen Demand (BOD61 530 mg/L Total Suspended Solids (TSSI 530 mg/L ~ NA Fecal Coliform (geometric mean) S10° efu/100m1 Maximum Effluent Partic{e Size yd in die. !~ NA Other, ^ NA * Values typical for domestic wastewater acid septic tank effluent. Pape ~ oI SYSTEM SPec~ttt:A i was ~ Septic Tank Capacity al ^ N" ~ Septic Tank Manufacturer •~~ ~ _~ ^ N'' { Effluent Filter Manufacturer ' `~ ^ Nr. Effluent Filter Model ^ N!: Pump Tank Capacity al ~N~_I Pump Tank Manufacturer ~ ~df. Pump Manufacturer ~N~~ Pump Modal ~-NF~ ' Pretreatment Unit ~-N~ ', ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland O Disinfection ^ 0th@r: Dispersal Cellls- ^ NF" ~In-Ground (gravity) ^ In-Ground (pressurized? At-Grade ©Mound ^ Drip•Line ^ Othor; Other; ^ Nf~ Other: ^ NA Other: ^ NA MAINTENANCE ScrlE~ut.e Service Event Service Frequency inspect condition of tank(s) At least once every: ^ month(s) " (Maximum 3 years) ~- earls) „ , ^ NA Pump out contents of tankis? When combined sludge and scum equals one-third {Ys1 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ..~ ^ month(s) '' ` !Maximum 3 years- - }~ year(s) Q NA Clean effluent filter At least once every: ^ month(s) ~ year(s) ^ Nt~.^ ^ month(s) INF. inspect pump, pump controls & alarm At least once every: Q ear{s) - ^month(s) ~~, , ., . , ; . CJ~N f~ Flush laterals and pressure test At least once every: ^ ear(s) Other: At least once every: ^ monthlsl (~ ear(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankis) 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 Ronding of effluent on the ground surfacr;. The dispersal cell(s) shall be visually inspected to check the affluent levels in the observation pipes and to check -for any pondin;~ 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 loos( regulatory authority. When the combined accurnufation of sludge and scum in any tank equals one-third lY3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. - All other services, including-but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall ba performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service avant. t3MW faro t ,k,•.~• Paye~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment [ankle! for the presence of painting products or other chamicats that may impede the treatment process and/or damage the dispersal cellle-. If high concentrations are deteoted have the contents of the tank(s) removed by a septage Servicing operator prior to use. System start up shaft not occur when soil conditions are frozen at the infiltrative surface. Daring power outages pump tanks may fil! above normal highwatar levels: When power is restored the exoes; wastewater will be discharged to the dispersal coll(a- In one large dose, overloading the osllls) and may result-in~tlN begkup or surtaoa discharge o1 effluent. To avoid this situation havo tho contents of the pump tank ramovod by a Saptaga SeNicing Operator prbt:t0 rostoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually"pparating the pump' controls to restore normal levels within the pump tank. !jo not drive or park vehicles over tanks and dispersal cells, Do not drive or park over, or otherwise. disturb or compact, the arv within 15 feet down slope of any mound. or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts;- condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump- water; fruit and vegetable peelings; gasoline; grease; herblcide$;;;meat~ scraps; medications; ail; 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 shah be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Cade: All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealedtr, 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 aid the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following moasures have been, or must be taken, :to provide. a .code compliant replacement syst®m: ..,;3 ~. ,• :~,:, ,;,~, ., ,~ A suitable replacement area has been evaluated and may be utillzad 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 musi comply with the rules in effect at that time. D A suitable replacement area is not available due to setbaok 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 bipmat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that Lima. < < 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 CIRCUM8TANCEB. ~ pEATH MAY RF.BULT~ RF.BCUE pF A PERSON FROM THE INTERfOR OF A TANK MAY BE DIFFICULT OR IMPOSSI6LE. ,. ADi7lT10NA! COMMENTS ~' tea rr~irrtru:;a ~.. F~rti~,~f .. .; POWTS INSTAL E POWTS MAINTAINER Name ~ ~ ~ Name ' ' Phone ~ - Phone SEPTAGE SERVICING OPERA70R !PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name `' ,., Phone ,~~ , ,~ ., `t f,,..,,. ±his avcumenc wee dreRed In aomptience with chapter Comm 83.221211b11111d1&Ifl and 83.6411), 12l & f3-, Wieconiln Admfnlstrattve Code, Dec 07 04 30:36a Jason Johnson 7153867992 tf'j/Zb/"Lt7tltl ltl:gtl i17.5•.~w.~o ..~~~..__ _•--- - ST CROiX COUNTY SIiP'TIC 'TANK MAlN7'GNANCE AGRECMENT AND OWNI:RSHii' CERTIFICATION FARM p. 1 owaer/8uyt:r ~~^~~' ~ ' BAST 9y~ !.~ .gam t°0. hUvr~ wiscavs/ s~~~ Mailing Address Property Address gay eayo~' w. (verification required trom Planning Depatmtent for nt:w construction) r City/State . y0`xa~ l,~l/~o_~1S/n~ Parcel Identification Number ~ ~ y~3 Z~~j S~- ~GAI DESCRiP'~ION_ Property Location NN/ '/•, SE '/., Sec. _ -, T ~ N-RAW. Town o! _ N~o~ ,Corp Z~ - Suttdivisian Coyote R10Gt/ CertittM Survey Map q Volume ,Page It ,~~ Warrsnry Dt:ed M ,Volume . Page q ~__.___r- Spec house k3l yes O no Lot lines idt:ntiftable (~; yes ~ no SY TFM MAtN1'FN N F Itrtptvpa use and tnaintettance of hour septa s}stem eOrsid neserh to ra Prerruttue fa+ltuc to httsdlW~ut~ ~ iltto the esys<em consists o[ pumping out the septic tank e~ cry three yeah to sooner, if needed by a bcensed tn+t^ix can affcee the funceion of she Sept+c tank as s trcatrnent stage in the wasrr dispersal sy~• Thr prnperty owner sgtcts to subtn+t to 5t. Croix Zoning Dt:patrtincm + cetttficairon forth, stgttttd by ta+t o«wtr at`d y° a ntas+c+ plumtxr,~ottts-eyr•.wn plttn>Der. testricta d plundicr or a liccased pumper •erillnng that (1) the on-ate wasteWaterdisposat systcrr. rs in proper apcroting condition arttLor (2) after +nspc~tton and pumpsag jd ne:eessaryj• the septic unk is kss thaw 1/3 full of sludge. lJ.rc, the undtrs+gncd have read the about: tcquiremettts attd >,gtee to maitttsia tse ¢n~ate sewage dispossl systcrr with the s:sndardt set forth. her , u set by the Dcpantnenr of Commerce nttd the: Departn+e:wt of Natural Restwrces, State of W iseonstn Cem{+catwo ctat+ r s Svxtern ttas been mainta•n, d awst he camplcteA and rctumed to the St C-roia GeN+ntY Zoning Orftce wrthtn 30 t { t arc nation dace. ~o?/ 710 A • APYL1CAht ? DATE RT1 • aTio*+ y ~ a tn~ oW„~af, or (we) c y there art State+neR+s .>n chrq form arc true to the best of m (our) knowlcd e. l (we) am (rej R c pi bout by ~+ru+c of a Narrnay deed recorded in Register o[ Deeds Ofiue. fo7 r 7 : ~ ~- DATE NATU F APPLiCAN ~ ...... `••••• Any information that +s mu-represented may resutt ro the sanrcary perm+c being rcvokcd by the Ztx++ng Depanmert •• tnNudt -vith this application: 0 ~~ o[ 1110 certified survey+m Q Retr+f ecererttesemade fn the wartanty det:d IVov bN/Lb/'LtlGG ltl:u0 r17P•.~O~o ST CAOiX COUNTY SEP'fll' 'C/-NK MMNA~ ANC[ AGREEML•NT pWNC_RSIiiP CEtt71FICATI9N FORM wiG~ ~~ pwnerBtrya ~~~' ~~~ ate' Mailing Address Property Address ataaeat fw tlrw consrra lveriCscxiow+cquircd from Manning 1kP CitytState v0 ~ iouill~iii~ Parcel Identification Number ~ Ec3wt DESC~ ~y SE v., Sec, 1.5.1 T~-N'R~'w• Town of ~----~' Property Location • Lot p o77 SuttdiNA~ ~ ' ~' Volttme ~_---• Page M `-~ Cerutied Survey MaP ~ Volume _~------• Page p ~-----= Warranty Deed M es ^ ~ cs O no lot tines identifiable ~$I Y $pex hoax ~ Y temaane tailwe w handle ^~dslp. Proper ma~menaa'-c gy$7f'M ttliA71~FKAI~ICF us ceneould resttk in tasP ^ttoetned ptttnPcr y/~)rpn par dtlo the tysleat -mpmper nee and maiarenanceof yourt~ ~ or sagna_ i! tletdea by conrises of pttnpns wet the septic sank e+cry w^ste ditpoeal aYN~ro• can alreca the tuwctiWt at tM tc9ra tank u a peatrneat ss~ ~ the ac b Me o+'ocr and S~ a crJatsrcalidd form. sts d Y at systerf. The prrgterty o^rtter .!;Tees to cybetat to St. Cfoia Zonta= DepatrmcO1 that I! I ~ tlMrNC rasu~surdispoT restncscdpluedrer x • liscufedputapcr.cr,fyu~g tactic is kss titan to fu11 of shrdge. maau ptumhet, jostraeymaapltmthcr• rton and puntpittg lit wccesraT7l)•the xPx ~c in proper opcrnine couddio^ a•wlrnr (2) aftn msptx ,,,,~ fie st^adards e a rn^itwin drc pn~^te x+Magc dtst~t ~u'^ Cemficspun read tae above regaircmPUa and ape ~ of rlaaual AcsoWeet. St^u of wiKOnsm~~c w.M~a )0, I/•re. the 't"ed t1K DCPartrrKm of CammcTCC aed the Dcpartm m Zuoiut set fon - a vt rnusr M esagdeted ^Mt retumcd to tae St. ('rtia Gov Y ~ M^ se c cy hn aas a^ar,na.twa.a. of ear ydtr pstat~ da¢' ~/ I'~/~ y':fr^ ~ i ~ DA7E A I~PPL)CAA. 'T[ON t we tun taro) me owaerls! of WN s 4nw..ledsc t ) i e) c ~ y due all statenxms aw tins f^rn. arc rnu to thcM st~o ita of Deeds p(ficc. ap xriacd ilj0 c. aY ~'n+~e wf a v uroaty deed recorded ~T ! - l01f .... ~i~ DAT£ a' S- F Ppt,ICANT anmcrt. ' »••• Any irtfmtnauon tMt is rnss•reprexmrd •nay result ut the sanitary pcrmd ~•°s reookcd by tlx Zontrtg Dep hon. the Repar<r of Deeds office •• 1Mtudc ..eta rais rppt:caaoa. a ssanprd .van^nry deed a tM wan^tay deed a ctNnr ~ the nntfica aarvcr tmp if refcretace a made z•d d66L98ESTL uosuyo~ uoser e6StOl t.0 80 nou '• v1lsaonein DeparbneM of Division of sa~etyand Bemis RECEIVED ~ ~ 5'~ ~~ ~ ~'~-~~~ ~e~--/ o~c 2 9 Zoos SOit EVALUATION REPORT Pace ~ ~ ST. CRO!X CUl_;Pllti _.~ , ~ ~ 5 r. GiQ DI ~ ntra<~, compt~e ~ «~ va~ar not less ~ s ir2 z 11 ir in s¢e Plan must . ~tr,ae. i~ not ~x~tted bo: yr ar~d i,oritor>~ poirrt (efui), won ant, per~cerrtstope, scaieord'irrrensior~s• norms arrow, grid trx~~ottand~ncoety nearestnmd. Pam i.o. ~~- ~ `0 ~!J 11 Please prutt a/t iit~atrtaflon. Reviewed ti9l Oats t~enorni tatomauor, you p~D,rtJe mr a veea torssconusry ov-P~ t~+cr taw. a t5.o4 ti) ca+l>• N W S£ SEGT- P-oPertYOwner ~~if'~vo,V l3ffS 7"- Pr+opertyloca6or+ corc +.ror sVw tirasw,w s~~T Z 9 ~ is ~9 ~~ w Praperiy Ow~rer's Ma~ir9 Add+ess Ld # 81odc S S1bd. Kane or CSMrI ~',V N e4~U©So~ tvi. 5 a~ ? 5 38 •-n7 ~ 5 ^`~"- a ®=gin tt ~voso~- ~~~,~~ adz • ~~ ~ user[ R~idertp~ r i~t.r>ber of bedroorns 3 ` Cods aeriMea desi~ fora rate .~50 - 4"t7 coo Cl Rep{ao ^ PubiFc a oorrrnar~l - oee<xibe: Parent S,4,yDy OV r 4J i¢ sue, Flood Plan eteration # N ff. cenaal oonmarts ~ ~ f}'/E'E'rt- TiS~l~ i5 SU/lfl'~lt~" ~i~ /!•N lNf~'/24vv1~ co~v~-~,vr~ov~-L s ys r~ `T3; a~;,~,~s~ 7~~~s .. ~. D. l~ . •T-,s . n ~ D ~no.zo • > 4~ 3 -~~,` ' ~ qc~ f'0 asou.a sine ee,-. _ u. uepar ro Rr.aB,~r er. snit date Mortxort Oapih Oorerirtartt i~atioot Oesaipibn Texlune Strucive Car~laroe Boundary ttooea in. Glu. Sz. Ctxtt. Coior (3r. Sz. Sh. 'E~'i 'Ef~2 i o ~ ~o ye ------- ~s % z ~- . ~ ~. z /oy sr ---- vt-s ~,~ - . ~ ~ 'B°Arg ~ ~ ~ c~a aurfaoe efev. / d ~' " ° Deptl, b factor ' ~ ( in. Irx ~ ~ Ftotiaon Depth Oorninerrt Redorc Desaiption Tex~me Struchs~e t'.a>noe Barndery tZoota Gi ~li'g kr. Qu. Sz Cont. Cabr G7. Sz Sh. 'Ef&~t 'Eff#2 3 0 --- s o• s ' EAluerd #'I = BOD > 30 <710 mdl and TSS >30 ~ 1 50 ir1Q1L ' i~IlUer$ f!2 = B(3D < 30 rtulA. and TSS _< 30 m9![. ~iJ~ fDD W {~' 1-_ - ` ~ ~ ~ ~ ~ ~r r'Sf`•ro..a i ~ CiS~ Address Qate C-vett~a6at Qonducktci Taieptgne Nunt~er Nnvate Sewage Consultants 2812 10th Ave. ~~N S ~~ Spring Valley, WI 54787 Z p . to ~,7 . 2.c9 • lO~,'7 . Z..o • iol•~ , ToT.q•G of ~a ~ 2 0 • ~~ 30 - qua yd - ~ Y It 1~ ~ERtio,v ~fl-5 7' ~# ^>~ t~ Plt Parcel ~ # G o >~' a ~ Ground stxfaoeelev. ~9~ ya ft. ~-, ~ ' 9~. r,. Z 3 ''~ °f Floriaon Deptl~ Dominard Redooc Desai~iion Texture StrtxXure Come Boundary hoots ~r - GP - WR ~. Nursed Du. Sz Coot Color Gr. Sz Sh. •E1~1 `EtT#2 ~ ~~ s 'Dye ~ - ~s % ,~ c 3 t i~ Z s' 1 /D S --- S C - 0 /o --- ~ 2 u >x ~ . f 1 p~. Ground surer e~„_ a r,o.,o. ~„ ~ ~ ~.,... F+or;mn Depih Dominant Redax Description Texture -o ---- _.. Strtxdtme Consistence Boundary Roots ~ Race GPDillf ~. Mrxrsed Qu. Sz Cord. Color Gr. Sz Sh. 'Eii#1 'EtTI<2 # ~ ~9 ^ prr Ground surface elev. R b I'rrritina !actor in_ ~lorizon Dapdr Dornirard Redooc DescrfpEion. T Struchue Corrsistenoe Bourxlary Roots Sad Rabe GPD~ fi. rtAtnseN Qu. Sz Cord. Cobr Gr. Sz. Sh. 'Eff#1 'Etl#2 !F1 = BODs > 30 <_ 220 mgR TSS >30 _< 150 ntplL ' C-iduent #2 = Epps < 30 rtrgA, and TSS < 30 mglL The Department of Commence is an 1 opportunity service provider and employer. If you aced assistance to access services or aced material in an alterna format, please contact dte depamneat at 608-2b6-3 t S 1 or TTY 608-264-8777. t~rope.boat For issuance of permits and designing Contact; Ulbricht & Associates Registered private wastewater consultant and plumbers 2812 10th Ave. Spring Valley, Wl 54767 715-772-3442 o°~~ W~ G~ ~~ 2 ~' ~i w 3 SCALD % ~ ~~ ` 3D J_ 11 =- CDC ~i~ L ~ N-~...S i 0 ~o '~ 13 Z -~ y d sf.~-e ~%/~-- ~~~'''~ r ~ ~~ o q ~~ g~ `..'~ ~~ ~----_ ~ ` 1~ ~~ 0 / - ~~s ~ J~1~ ~' ~~ ~'` a ~ /~~ ~~~' 8y~ ,~~oP~S~ ~~ T~ n~~ oo~' M~ .~. STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Kemon J. Bast, a married person, Grantor, and K.ernon J. Bast and Donalda J. Speer-Bast, husband and wife, as Survivorship Marital Property, Grantee. Grantor, far a vatuabte consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A Recording Area 7509~+~ KATHLEEN H. >iALSH REGISTER OF DEEDS 5T. CROIX CO. , MI RECBIVEB fi0R RECORD 01!07/2004 12:35PM YARRA}iTY DEED EXEl1Pt # 8M 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 5.2`a St. - Suitc 115 Hudson, WI 54016 41240 20-1027-40-000 & 30-000 &20-00 Parcel Identification Number (P1N) This is not homestead property. Dated this 6th day of January, 2004. * ernon J. Bast AUTHENTICATIeQ,N~COwn Signature(s) C,~ ~, pU1p1~C 0 r~- authenticated this 6th day of Ja~~g TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) TIiIS iNS'I'RUMENT wAS DRAFTED BY ACKNOWLEDGMENT STATE OF WISCONSIN sT. cRO1x 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 the same. ~ ~ , - !(~~ V `~ *Cheri Brown Notary Public, State of Wisconsin Edina Realty Title -Doug Berg My commission is permanent. (If not, state expiration date: 400 Souih Second Street #115, Hudson, WI 54016 3!11/2007 (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 ill WARRANTY REED STATE BAR OF WISCONSIN FORM ~No.T-2000 ,, ~ 2y87P 1Z1 EXHIBIT A The NE '/. of the SE %. and the NW '/a of the SE '/., all in Section 1 S, Township 29 North, Range 13 West, St. Croix County, Wisconsin, EXCEPT a parcel described as: Beginning at the E '/. corner of said Section 1 S; 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 1S seconds West S3S.46 feet; thence South i4 degrees 10 minutes 34 seconds West 93.31 feet to a point on a 80.00 radius curve, concave southwesterly, whose central angle measures 2S 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 S 1 minutes 13 seconds East, along said south line, 570.78 feet to the point of beginning. n cn O e °: 3 ~ co ~ i ~ ~ ~ 3 ^~ Z~ Z O m O A W O N ~ ~ N ~ N O H O N fD ~ . a ~ m ~ D y a a .. m ~ a W ~ O ~ N m N 2 O p N ? 7 ~ ~ ~ ~ O ~ o O 3 fA f/1 N ~ ~ ~ v v m ~ ~ s v + ° ° . . 3 3 °= ~ .. .. C r Z O ~ o ~ ~ ~ o ~ ~ m ~ N ~ y C C N ~ o- a m ~~ ~ ~ ~ ~ O ~ 7 a ~ ~ 3 ~* !~! Z A D a a ' ~ o ~ m T c o ° ' • • m (/1 O EA O O S„ o ~ 3 ~ ~ d ~ ~ 3 ~ ~o a ::. ~_ ~ o .. `~ ~ D ~Q ~ c ~ N N F~ ~ ~ J ~ m O ° Oe ,~.r -~ ,~ 1 O YIJ ~ ~ O C 3 'Y .. n 0 m ~I a m A Z n s ~ ti A Z O •• ~ 7 < ~ O .~ Z A ;U W CO m ~ A ~1 • ~• 0 ~` 0 • H ~C~ A fi A ``ti! O N O 4 H Q W Oq ~ O ~ Oo ~° b ti .~j