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Home My WebLink About020-1447-29-000• Safety and Buildings Division ` 20l W. Washington Ave., P.Q. Box 7162 ,~~On~~~ Madison, WI 537 - 7162 (fig) 2 De artment of Commerce Sanitary Permit Application ~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provid may be used for secondary purposes Privacy I. Application Information -Please Print All Informatio QEC l `~ 2004 ST. RGIX COl1NT`r' ING OFFIC State ,e~ip Code Phone Nui II. Type of Bnilding (check sll that apply) ~ / / D r/ ,,~ZQ2~~ Subdivision Name C (~ 1 or 2 Family Dwelling - Number of Bedrooms ")' ~" ^ Public/Commercial -Describe Use , a2 ~ (ST• W ~ Z ~'Z 3 ^City_ Vt~~ge~f•wnship of ^ State Owned -Describe Use / Alm Number III. Type of Permit: (Check only one box on line A. Complete line B ifapplicable) - V` A' New System ^ Replacement System ^ TreatmentlHofding lank Replacement Only ^ Other Modification to Existing System List Previous Permit Number and Date Iss B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration Plumber Owner Non -Pressurised In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized~I,nf-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatine Svnthetic Media Filter ~[( Leaching Chamber .Drip ine ^ vel-less Pipe Other ) Design F/low (gpd) Design Soil Appucatton xate(gpastl utspersai n~ca rcy~..u+ t~v w - / lJ s' S VI. Tank Info Capacity in Total Number Manufacturer Prefab Si Steel _ I'~ Plastic Gallons Gallons of Units Concrete Constru Glass New Existing Tanks Tanks Septic ix Holding Tank .-- Aerobic Treatnxnt Unit I ,1 .~ Dosing Chamber V" VII. Responsibility Statement- I, the undersigned, assume responsibility for i Ration of the POWTS shown on the attached plans. PI bet's Na a (Print) Plum Signs P PRS Number Business Phone Number Approved ^ Disapproved y • ~~~••., . ~° ~...~.„° ~.-_.._--__-. _ Surcharge Fee) ~~5~ ~ i ~ (~ ^ Owner Given Reason for Denis{ ~ ~ ~ ~ ~ , ,~ ~, ~ ~ ~ /~ ~f ~,(~ IX. Conditions ofApprovaUR son~PProva`Zw"-' /~~ w ~-(~ r"" " /~ STEM OWNER: ~ 7~~~ ~ ep fc an <, a uent filter and ~ S s.~iyyt LGLt,~,(' ~ ~"``r ) dispersal cell must all be serviced /maintained ~ ~~~'~Ww dkJ as er management plan provided by lumb r. ~~~/~ /; 2. All set ack requiremen s mus a maintained ` '" 5~uh~ ~ 3 /• 27 ~-I'~'~'-^ N G~ ' as per applicable code/ordinances. ~ ~ ~ d_, „~~ ,..,nw Atheh complete plain (to the County only) for the system on paper not less than 81R :11 iaeha in sift County r Sanitary Permit Nu (to be fills 3a~ State Plan I.D. NumAber Project Add (ifditl'erent than n ~9 ? ~~ Parcel 11 Lot q E ~~Y., /~Y., S~tion ~ -~, ~ ~G(circlegae} T N; E W SBD-6398 (R. 01/03) Wisconsin Department of Conar•?erce 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 CST BM Elev: Insp. BM Elev: BM Des ' tion: 48.40 ~- C5 ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~` ~ ~ ~ ~ S l~ V Fi (i ~ O 18 G~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ Sa ~ _7 .7 !~~ ~ Zf ~ Z ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Nu TDH Lift riction Loss System He TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 463259 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 14.29.19. STATION BS HI FS ELEV. Benchmark ~~`~ ID~7.7 ~$ .moo Alt. BM '~k~.- GcJI~~ 3.4a D y •33 Bldg. Sewer (o , ~ /01.2 ~ SUHt Inlet 7D /~ . c~ St/Ht Outlet ,7+ ~~ ~~ ZL~ Dt Inlet Dt Bottom Header/Man. 11.t~,7 ~~ `~ Dist. Pipe /~ • ls1 ~/ ~a . ''~ ~ ot. System IZ•73 9S Final Gr~~ ~ ~ ~ c~ g7 9'~_ ~Sb St Cover 3 ,tlp ~d~ • ~3 BED/TRENCH Width ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ Z ~~. ~_ - SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturerrn, ( ^ INFO MATION ER OR CHA -/~'l 'f"'1 R Type Of System: ~ ~ 5 7zS ~ r ~ `~ ~,I ~- LIN Mode! Number: ~ IIICTRIRI ITICIN SYGTFM Header/Manifold ~ ~ Distribution Pi x Hole Size x Hole Sp ~ ~ e s p O \ i th ~ Di ~ S L Length Dia ng a pac eng Cf111 ('_fIVFR ., o.,.~~...e c..~~e...~ l1..1.. .... M.,..nrl (lr A4_(:ra`ia SvetPms rlnly Z ~ 7.3 = y .7 / ad-~.X~ acing V,en/t to Air Intaker ~ V e.~~-- f, ~- G.$ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center a ~~ J Bed/Trench Edges Topsoil es No ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /_ Location: 697 Pine Timber Lane Hudson, WI 54016 (NW 1/4 SW 1/4 14 T29N R19W) Coyote Ridge Lot 29 1.) Alt BM Description = ~~ 0 v'~ 7 \ Rlrln ec~niar Icnn4h a ... ~ ~ Inspection #2: / / Parcel No: 14.29.19. ao ~ I ~ / ~ ~= ~~ ~?~s~ /~`~ ~ do ~ ,-'_ yo ~c~s~ ~~~ ~ ~. ~, DEC 2 9 200 r ST. CROIX COUNTS ~ 3 ~~~ ZONiN(~~M.O AT1ON REPORT p~ ~ ~ Division afSaf~rand 8ui~s in acoaderxe v~ Comm 85. Wis. Adm. Code Courxy S T Cf2 D/ ~ Attach mmde4e site plan on paper nd fees tlian 8112 x 11 inches in size. Plan rest s~ude, txR rwt 1&„uea !o: v~BrfiCal ar~i horizor~ retetence point (BMj, dir~edion ana Parcel ~• ~'~ ~ `o ~(J ~1 per+oent slope. scale orb, rwrlh arrow. grid lorsitiorr and d~noe to nearest ~ Please print alt Ir~ornzalion, tteviewed ~w " _ eta Persorr.i tatoraatlon ron provide n~yr w uses torseearaary t ~. a tsA~t (~) t~N}- uic' .. ~ cC ~J ~f S>< t SEGr. t S k'~it'~vo,v l3fFS T`_ • ,vw ,lases ,w s~-~ T ~ 9 N ~ / 9 4dor~ w Property Owr~a Address ~ Biodc 1€ Srbd Name or CSMtJ E.v /N ~Y LA • ~BA-R Grp" ~~ • 2 9 " Co yo rE' ,~ f~6~E " Code Phone Ntxt~er ^~e ~Towtt t+fe~eestaoaa hFUD.So~ tvl• S`fath t?t5~ 38h•~75 fi`vOSo•J l3q~~,G'Fw ~~ - ~~~+ t, ~ / Nkenberot'bedroocns 3 - cone derived ~ rate y.SO -• o'a GPD ^ ~ ^ Ptr6Gc a oomrneroiat - t)esawe• Peru SAND y d Ul'Ctl /~} ,Sf ~i_ Flooa Plain lion N /t/ tt General carrrtrtents ~ and ' A~~E~` 1 EsT~O Sc>r•T/~-QC.E- ~~2. ~.tJ /,~1~jPovt1D a o, .og / ~ pit Gratrrtd surtaoe slay: / R Deptl~ fo Ikri6r~ factor ~~ in. SoI Fie Horizon bapih DotNnant Riedort Oeediption Texlue 8trrx#tse Cor~lerroe 8ourrday Boots H. i Du. Sz t;ortt. Color f~ Sz. Sh. 'Eisilt'i 'Etf82 v- /o yR 3/ SL ~ s 5' w • s • 9 Z • 1 .5 `/R LS /lest .Q- G - i • Z 3 g• ~o R7 S o,s ~ t• 2 ~,~ ~ ~oz•~ ~ ~ ~ - ~ ~ (3rorxrd srsFece eter. ,~. w l ~ ~- - , .. sor ~e t~r~r+ DepQr !)onninent s'h~re ca>oe sor,nderry tae c~ o~ tn. tlRtrraseM tlu. sz. core. caolor CY sz Sh. -mot 'Eif#2 ~- /o R ------ StL ~ S hk fn cS -F- , 2 . yz~ 5~ o ~ c~, ~ s . ~ t• Z --^ s 1.2 • ax f11 ~ BOD > 30 < rlo mdt. and TSS >30 < 1 50 mM. • Efluent #2 = soo < 3o rrrrm. and TSS ~ ao mef L ~` ~~Rr zt ~b ~~ ct~.~ ~-- Z Gear Address i?a6a Cron Conducted Telephone Nunber ua~f~sl~~-ass ~ /lio U . l y- ~-:~a 3 7r5 • '1 ~a • 3 ~t ~f Z. eeitriw=s . rnvate Sewage Consultants 2812 10th Ave. T~'G F O Spring VaNey, W! 54767 ~~N •s 1~R T~ o O ~ l~ Zo • .01~. yo. ~ « • ii +/ ~~Rti~~ ~~-s r- Paroe110 # ~'`~ ~ ~ ~~ z 3 Pane er Pit Ground surtaoe elev. it. Depth to fsrdtlng factor in. SoN Rate Horimn Depth Dom&rant Redauc Desaipuon Texture Struc~ra Con-ce Boundary Roots CiPDliP in. Munsep Qu. Sz Cont. Color Gr. Sz Sh. 'F~1 'Eff#2 ~. 5 R S LS ~ s c S - !. Z, o - n~aP . S D. S .~ I. Z ._ ~ 3 Z c. f . -Z ~ .. ^~ ^ ^ Pit Ground surface elev. it. Depth 10 ~9 fac6or ' ~• Sad Raade 1-lorizon Depth Dorrdnant Redox Description Texture Strtrcdire Coradstenoe Boundary Roots GPDVtI? in. Mansell t1u. Sz Cord. Cobr Gr. Sz Sh. ~ 'EffiAtl 'Efflf1 n `+...w y # ° pro C`...,~.,A e~.~in.b da,. A / M.d{. ti.. P....it:.... i w.- L v rn - -- ------- o ----- -- Sod fizrte Horizon Depth Dominant Redox Desgiption. Texture Structure Came Bourrdrey Roots t &r. Mtrsefi t1u. Sz Cord. Color Gr: Sz Sh. 'Eti#1 'Eff#2 Eflkient !ki = BODE > 30 < 2Z0 and TSS >30 < 450 ntg11 • E1&uent #2 = 80Df _< 30 rnglt. and TSS _< 30 rngll T'he Department of Commerce is a equal opportunity service provider and employer. If you need assistance to access services or need material in an al to format, please contact the department at 608-266-3151 or TTY 608-264-8777. i ~ M e CL t~ S N o_ G D 7" G r~,V1~-- r S ~~'~~~~~ 703 , ~ w~~~ o ~ ~° \ ~ ~'01~I.v 12~ ~ 133 r-- ~, ~D ,~ ' D 8L toy ~~ ~z/ ` BH S ~T 5 ~-~~- I\ west ~,pT Gi~<- L ~ ,- ~ y °~~~~ D "rod o~ Yy.c e ~'~ /63,3 For issuance of permits and designing Gontact: Ulbricht & Associates Registered private wastewater consultant and plumbers 2812 10th Ave. Spring Valley, WI 54767 715-772-3442 Parcel #: 040-1081-70-050 12/16/2004 10:13 AM PAGE 1 OF 1 Alt. Parcel #: 21.28.19.323A-10 040 -TOWN OF TROY Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner * SLATER, THOMAS E THOMAS E SLATER FERRY HEATHER A FERRY HEATHER A 420 RED BRICK RD HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description " 278 SADDLE RIDGE LN SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 13.026 Plat: 1627-CSM 17-4449 040/03 SEC 21 T28N R19W PT SE NE CSM 17-4449 13 LOT 2 0 Block/Condo Bldg: LOT 02 ( . 26AC) AFF/CON/EZ Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-28N-19W SE NE Notes: Parcel History: Date Doc # Vol/Page Type 04/15/2003 717249 2205/226 LC 03/28/2003 714990 2186/400 AFF 01/29/2003 707532 17/4449 CSM 07/23/1997 927/150 more... 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 26775 136,500 Valuations: Description Class Acres RESIDENTIAL G1 13.026 Totals for 2004: General Property 13.026 Woodland 0.000 Last Changed: 07/20/2004 Land Improve Total State Reason 136,800 0 136,800 NO 136,800 0 136,800 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 040-1081-70-000 12/16/2004 10:12 AM PAGE 1 OF 1 Alt. Parcel #: 21.28.19.323A 040 - TOW N OF TROY Current ^ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 3 Tax Address: Owner(s): " =Current Owner RETIRED NUMBER WOODRUFF 'WOODRUFF, RETIRED NUMBER Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 13.500 Plat: N/A-NOT AVAILABLE SEC 21 T28N R19W SE NE EXC P323B AS DESC Block/Condo Bldg: 817/136 NKA CSM 17-4449 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-28N-19W SE NE Notes: Parcel History: Date Doc # Vol/Page Type 01/29/2003 707532 17/4449 CSM 07/23/1997 927/150 07/23/1997 800/452 07/23/1997 729/418 2004 SUMMARY f This parcel will not get taxed. It exists soley Assessed with: ~, j for parcel history tracking purposes. Valuations: Last Changed: 04/28/2004 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 13.500 2,700 0 2,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ,Y~Q~/~ 5~' Mailing Address Property Address City/State LEGAL DESCRIPTION identification Number i ,f~, Property Location N ~ ~/., ~ U-L~/t, Sec. 1 ~ T~N-R~W, Town of r~ a- Subdivision Lot # Certified Survey Map # Volume .Page # Warranty Deed # ~$f5 ~ ~® Volume ~~ Page # Spec house ^ no Lot Lines identifiable yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of 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 foma, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber or a licensedpumperverifyingthat (1) the on site wastewaterdisposalsystern is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of stodge. Uwe, the undersigned have read the above requirements and ague to maintain the private sewage disposal system with the standards set forth, herein, as set by the I)epartme~ of Commerce and the Department of Natural Resources, State of Wiscrosin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SI~ ~ //3 / O ~ TUBE 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 property described above, y virtue of a warranty deed recorded in Register of Deeds Oice. g'/3 ~ ay I ATURE OF APPLICANT DATE «s«*** Any itnformation that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** from Planning Department for new construction) `~`~ ** 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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 FILE INFORMATION Owner ~ ~ J~ J~~ Permit # DESIGN PARAMETERS ~~1 Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow {average) ~j0 al/da Design flow (peak), (Estimated x 1.5) ~OQ gal/da Soil Application Rate ~ al/day/ftZ Standard Influent/Effluent Ouality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) _<30 mg/L A Fecal Coliform (geometric mean) 5 ° OOmI Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA 'Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~~s`(' al ^ NA Septic Tank Manufacturer ~~y.` ^ NA Effluent Filter Manufacturer ~ r ^ NA Effluent Filter Model - O f~ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cell(s) ~J In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: ^ month(s) ,'year(s) ^ NA Ins ect pump, pump controls & alarm P ry: At least once eve ^ month(s) ^ year(s) ^ NA Flush laterals and ressure test P At least once eve ry~ ~ ^ month(s) ^ year(s) ^ NA Other: At least once every: ^ month(s- ^ year(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 tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s1 shalt be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, 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 be 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 event. Page 2 of 2 START UP AND OPERATION ~ ' For new construction, prior to use of the POWTS check treatment tanklsl for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(sl. If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the ce(lls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may 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; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the foNowing measures have been, or.must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~~ T alua ' o ing tank be ' e ai ~R01-/18 T?F.1~- ~Di2- N/~n/ G'ONS7K(J~?LDr~I ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name Phone POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S A C l d V ~~~~ Phone ~(S- 38'(p_ (p (~ This document was drafted in compliance with chapter Comm 83.22(2-(bl(11(dl&(f) and 83.54(1), 121 & 131, Wisconsin Administrative Code. V.~~8~ f -zo STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Kernon 3. Bast, a married person, Grantor, and K.ernon J. Bast and Donalda J. Speer-Bast, husband and wife, as Survivorship Mazital Property, Grantee. Grantor, far 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 75C2394tZ>` KATHLEEk H. itALSIi REGISTER OF DEEDS ST. CROIJi CO. ~ MI RECEIVED FOR RECORD 01/0?/~099 12:35PM MARRA}ITY DEED EXEI4PT # 8M REC FEE: 13.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 2 Name and Return Address: Edina Realty Title, Inc. 400 S. 2"~ St. -Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights-of--way of record, if any. 412540 20-1027-40-000 & 30-000 &20-00 Fazcel Identification Number (FIN) This is no homestead property. Dated this 6th day of 3anuary, 2004. * ernon J. Bast AUTHENTICATIQ COW't1 Signature(s) Gre~1~ b~~G o~~'.''' ,.~.._ authenticated this 6th day of Jag ' TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stars.) TH1S INS'['RUMENT 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 the same. *Cheri Brown Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 311 I/2007 ) 1.3 WARRAN9'Y REED STATE BAR OF WISCONSIN FURM ,Yo.2-2000 ~ 2`l87P 12~ EXHIBIT A The NE'/. of the SE %a and the NW '/a of the SE'/., ail in Section l5, Township 29 North, Range 13 West, St. Croix County, Wisconsin, EXCEPT a parcel described as: Beginning at the E 'h corner of said Section 15; thence South 00 degrees 47 minutes 33 seconds East, along the east line of the SE '/a of said Section, 407.27 feet; thence South 89 degrees 08 minutes 1 S 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 S4 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. ~~ i ~ ' o ~ ~~ 1 ~ Z i ~~ d { i , { ~ { { ~ $ ~ ~ ~° s~ ~@Q'18Z 3.EF,,L~-aCOS{ ~r~ssz~ ~ x ~ ~ ~ ~ ~ .so•tez Q a ~ y, ., ~ ~~zc~~` ~ ,... ,~e'~oe~eetb~oos x . ~ ~~ ~~ `"' ..1 ~ ~ LLC ~~. O ~: ~ I ~ ~:n .. U ' i ~ W ~ ~~~- LJ Lii ~ ~ i ~ ~ ~~ ~;~ N ~ ~ Fd ® ~ ~ U ~ ~ w ~ ~ 't ~ rti) ~ t i ~ ~ ~ % Q 4 M O x ~ ~K~3 1 ~ ! ~ N ~" m ~ '" ~ °v h v a~ jrt i ~ ?•~'•~~'' Of J h- !~ ~ Z Z y Z Z Z i ~ f ~ i ~ ~ ~ .I W x 1 ~ r~ ~ ~ ~ ~ ~ 3 ~ ~ W W W ? ~ ~i ~+ ~5q"'J3 E 315.Q1' ~ c~ ~ c ~ ~' ~ ~ 'n i i c7 `~ Sr' y~ ;r ,y ~ , P. ~ ~ ~ b~ ~ "s ~ , ~ $ car v°4 a °z z z z° /~ { ~ x { '° i jj + W ; M ~ ~ T•d 099898£SiL ~seg .aaadg weal dZS=ZT b0 6U ~aQ