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HomeMy WebLinkAbout020-1359-20-000~C o o ~' o a ti ti w C O 0 N a O y ~0 b h •~ N . "~ N •~ ~~ V `iU~j ~i O C~ W H i~i .~ ~, AI v _~ ~ z `~~~ O Z ~ ~ d 2 ~ H r 3 0 v a~i ~p O N a .: t!1 J V O ~ O ~O r N N ~ ~ ~ ~ C ~ ~ N N 'p 7 O ~ 2 i! ~` 3 ~ a a d ;~ c ciao .0 C 3 LL 3 3 v a~ Z y •~ O a m c ~ ~„` O V ~ n, C ~p ~p U N p~ ~ _ O a Z ~ Z c d A G ~ ~_ ~ ~ ~ O tl! m ` ~j D O d 3 ~ a a a v x J N N ~ N 3 0 0 v° ~.~~ O H N ~ h C O fy0 N N m Q M O € a a c N V ~ °o 3 0 O ~ 0 y U ~ C 3~ N ~ ~ C O y ?+ N ~ ~ w U°~`o a,~ o°C d ~ c E oEco •- >, a o a~ Z ~ mZ m ~a~~ ~~ O y ~ O M ll'f ~ Q ~i f0 ~k api fn .~ t y amp ~ z -- d U ~ C ao N 7 ~ y a~ N y ~ ~ C ~ O 7 N y V U E C y C ~_' ~xo ~ ~Q o ~r 'p ~ '"' N d E_ L ~ l0 G O m ~ m T 1~~0 m n ~ 7 O1 n. ~ a~ v d •~ O Z ~~ =' O 'o m' ~ c m Q n in 7 N O ~ N ~ C d O N N Z ~ Y c 0 .~ 0 Z .a M C O U O z c N cl O O O ~p N U N w O ~, ~ .d N ~ O O E N o d ~ O O U d O O ~ -O N N A ~ ~ 7 N ~ ~ ~ ~ O _ _ r .~ ~ ~ ~500"~"~°~~"tOtCO~r`"~ PRIVATE SEWAGE SYSTEM Safety a3uld euil~ngs Div'ISiOn INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Persatal irtformation you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(mp• Permit H is Name: City Village Town o Adams, Jason Hudson Township CST 8M E v.: Insp. BM E ev.: BM Description: ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~,,~ ~ Oosing ~ ~,,,u, Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. ventto Air Intake ROAD Septic ?'}~; •~ Q ~ - NA Dosing NA Aeration NA Holding PUMP I SIPHON INFORMATION Manufacturer - Demand Model Number ~ GPM TDH Lift Friction S~rst~m _, TDH Ft Forcemain I Length 3p ~ 4 Dia. z a SOIL ABSORPTION SYSTEM /11 ELEVATION DATA (~L; wfq~X. ounty: St. Croix Sanitary Permit No.: 384127 State Plan 10 No:: Parcel Tax No.: 020-1359-20-000 I I¢ , z.q ~ c ~ r ~. t I ~o STATION BS HI FS ELEV. Benchmark (~. b2 Ob•6 d0 , O' Alt. BM , ~~ o , g Z,' Bldg. Sewer _ (Z. ~O 93.9 Z St/Ht Inlet ~ 13.~o RZ•~•r St/ Ht Outlet ---~- Dt Inlet -~-~ Dt Bottom ~'~,~-~- 88•SS Header/Man. $•20 8, 2 ~ Dist. Pipe ~'g~ `~b•~'}~ Bot. System ~ ' ?a c l ~ I'f7 2 Final Grade , ~ l~ , 8S ' St cover ~ Dist. To Wetl ,a(~ ~ Q ~ ~n.rr ~ ., , .~, .Lr~rt.r.~n , ~'/ E Width ~ Len th ~ ~ o. IT nches ~ ` ~ PIT No.O its Inside Dia. Liquid Depth E 1 3 •~ 02. ) DIMNI SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manu rer: j SETBACK ~ INFORMATION Type C ~ '0~ ~ ' ~~ CHAMBER Mo a Num er: ` ev~J . System: 5 3 OR UNIT - au DISTRIBUTION SYSTEM v ~ v Header / ni old Distribution Pipe(s) x Hole Size x Hole Spacing o Ai~ Intake Vent T {r I Length~C.L Dia. ~! Len Oia. Spacin ilil ~ TS SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Oeptfi Over Depth Over I xx Depth Of xx Seeded 1 Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (include code discrepancies, persons present, etc.) Inspection #1: x/23/0l Inspection #2: --~--t^ Location: 929 Meadowood Lane, Hudson, WI 54016 (SW 1/4 SW 1/4 16 fT(2~9N R19W) - 1629192116 Parkwood Meadows - Lot 20 ~ ~ n .Il,'~ _ ~ s ~. /01~e,.i ~j Ids . ~.¢,,•• 1.) Alt BM Description = ~ ~ ""~~` ~~"T ~l 2.) Bldg sewer length = 30 r -amount of cover = > `~Z u S~+ ~ ~~ Plan revision required? ~ Yes( ^ No Use other sid~r ad itiont a~l infor~~ l Cert. No. SBD-6710 (R.3/9~ ®.~ Date ~ ~, Inspector s Signature ~ ~ Q~ ~~,a~ ~ r~, ~`'~, ulv ss re•N -3 Sb S~. Pct /o -iY-o r y 73 c(2~ lM,~ Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. `~ See reverse side for instructions for completing this application PO Box 7302 SCO/fSin personal information you provide may be used for secondary pu oses ~ Madison, WI 53707-7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit Completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system a er not less than 8 -1/2 x 11 inches in size. County State S nary Permit Number ^ Chec re islo tp y~ application State Plan I. D. Number ^ r "~ , I. Application Information -Please Print all Information ~i ,,~, ,~ f _ Location: Property Owner Name ~ ~.~ 1 _~~+q!!' t ~ } C Property Location 1 J^ ~ ' `,~ . / s(.~{ 1/45G~11/4, S ltP T ,N, R~~(or~ Property Owner's Mailing Ad ess - i.? ~ ~.;~ '; ~~~~ ~ Lot Number Blockl~tumber . ,,,' ~ 57 CAOIX a~ C ,State Zip C de on QFFtCE Subdivision Name or CSM Number II. Type of Building: (check one) a~ ~~ / 1 or 2 Famil Dwelli f B - N d ~ ^ CitY ^ Village y rooms : ng o. o e ~.~ a r ^ li Town of ~ ub clCommercial (describe use):_ ' / ^ State-Owned !7 Nearest ad ~ Parcel Tax Number s III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) D - O G d A) 1. ew 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only ~ , ~ 9, ! a ~ ~ Existing System B) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) .i~Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ pressurized In-ground / ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade / ^ Aerobic T ea ent Unit ^ circulatin ^ Other: V. DispersaUTreatment Area Information: - /dQ 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area pp Ica ~ ion ate 6. System Elevation 7. Final Grade ~~ ~~ ~ Required ~ Proposed Rate (Gals./day/sq. ft.) (Min./inch) - Elevation S~ si i, a - ~,.~o n VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed j, Tanks Tanks ~ ~~~ Idov - 1doo / ^ ^ ^ ^ A ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS show on the attached plans. ~ Plumber's Name rint) ~1~p ~ 3 ~G Plumb 's Signature (nos ): PRS No. Business Phone Number ' ,l i G ~ ~ ~ao.~s ~~s a~~- ~ y ._.5 Plumber's Address (Street, City, State, Zip C od~e ~ - IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signa re (No stamps) Approved ^ Owner Given Initial Adverse Surc~rge Fee) ~ ~ ~ 5~ ~' ~v 1 ) z ~ Determmatton - - • ~,, j • .~ X. Conditions of A proval /Reasons for Disapproval: ~, aE -~"H- o~ n)~c~ f'hrK , ~~pE~ ~ ~-rq•25~ S,A~1D P-~Q~cl~&,~Tr`~Go ~-~ ~t -tiGTfl!°~~S l - 1 ~ '- ` - i~l/l .E wt~lNl ti~t ~ ~ PEA - ~j~tc- "TfIh1K- ~FtUEx~T FILTH- Wu.t.~ Ig'E I~-ow..~I~l~t 8-Al s. . ~ cu. ~~~ iN rc~ r~•wrr .~.~,.~~ ..-.-,.., t es~ w~Y'[-E~ NK-~oR '~ S t~9"~r.~ +~-~ ST~7-e..e.- k~'tet/, bR SBD-6398 (R. 07!00) ~` ~~ r~M-4ST~ t~~ l~Tf~ C(S ~- ~ycF~~ KS ..-rp o FL t U f/y04 t_. 5 ° t ~- T£~T- /N~ ~ ~ -/o s~ p,G,. ~~. ~o ~~ ~ ~UL 1 ~~ ~~- ~a s' ,7s ~~ ~ /~ ~+~- .a y a~ Rl~ ~~- C°Q ~' ~G~ ~ aao3~s soap. ~~ . H~-;~- ~/N~ ~ ~'~S ~ T~ ~ -io ~/-~-goo z~--e. s~ ~,G,. ~~. so ~ 1 r~~ /`~~G ~~ ~..~~- 3a ~' 7y/ r l / ~~~ ~~ i ~~ ~~ .a y R~~ a~- Q ~' /~~~ I ~aao3~s AnI rIORY ~ V1Fiscc>rASin D nt of Industry, bo;,and~H~: t.a Relations ,, niv~s~on of Sxa SOIL AND SITE EVALUATION REPORT Page 1 of 3 & Ruildinas ~_ ____-~ ...:.~ ~~ ~ m .,., .,~ ~A/:.. A..1... !'~....1 .. COUNTY Plan must include but a er not less than 8 1/2 x 11 inoh~in size Attach com lan on lete it St. Croix , p p . p e p s not limited to vertical and horizontal reference point (B recf~n din , . ~qf slope, scale or PARCEL I.D. # 0 dimensioned, north arrow, and location and distanc o`~J~~ rda-~i-!•." ~'~., 020-1029-4 APPLICANT INFORMATION-PLEASE PRI T,, vLJIN RATION=.~ ~'~, R tEWEDBY DATE PROPERTY OWNER: ~`'1 - ~ Pf~OPQRTY LOCATION LaCasse Custom Homes Inc. `:--t ./~l~ G©V=F OT SW t/4 ~ 1/a,S 16 T 29 ,N,R 19 ~(or) W PROPERTY OWNER':S MAILING ADDRESS ST ~. ~ ~t7rX LQT#;t BLOCK # SUED. NAME OR CSM # 521 McCutcheon Rd. -°` 2~ na Parkwood Meadows CITY, STATE ZIP CODE ~ p~j J _ ~'^Cy Y ^VILLAGE ~¢fOWN NEAREST ROAD Hudson, WI . 54016 ( 81-540 ,. ;~> ~~ ,%~ H Meadowood Ln. [~ New Construction Use ~c ] Residential / Numt~er o 4 [ ]Addition to existing building (]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate _~_bed, gpd/ft2_trench, gpd/ft2 Recommended infiltration surface elevation(s) - 96.30 ft (as referred to site plan benchmark) Additional design /site considerations Na Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system U =Unsuitable for s stem CONVENTIONAL ~] S ^ U MOUND ~1 S ^ U IN-GROUND PRESSURE IBS ^ U AT-GRADE ®S ^ U SYSTEM IN FILL ~S ^ U HOLDING TANK ^ S ~ U SOIL DESCRIPTION REPORT Boring # 1 !>` Ground elev. 100.0 ft. Depth to limiting factor +ss„ Boring # 2 "~~' Ground elev. 99.2 ft. Depth to limiting factor90 Depth Dominant Color Mottles Texture Structure Consistence Boundar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trerx~ 1 0-12 10 r 2/2 none 1 ~ 2 12-19 10 r 4 4 none sicl 2msbk mfr 2f .4 .5 3 19-30 10 r 4/4 none sil 2msbk mfr if .5 .6 4 30-88 7.5 r 4 6 none cos Os ml na na .7 .8 ,a.~,uwr~ (DD S H S ~y y fob. Remarks: 1 0-12 l0yr 2/2 none 1 2msbk mfr gw 2f .5 .6 2 12-17 10 r 4/4 none sicl 2msbk mfr if .4 f.5 3 17-24 l0yr 4/4 none sil 2msbk mfr gw if .5 .6' 4 24-32 10 r 5 4 c2 7.5 r 5 8 sil M na na n .2 5 32-90 .5 r 4/4 none cos Os ml na na .7 .8 - ~~ ~ rw~e Remarks: - CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave. e Richmond I 54017 Signature: ~ Date: 7_10-99 CST Number: m02298 PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT PARCEL I.D. # 020-1029-40 Boring # ' 3 Ground elev. 100.8 ft. Depth to limiting iactor +90" Boring # 4 ~.. Ground elev. 99.9 ft. Depth to limiting factor +88" Boring # .. 5 .. Ground elev. 100.1 Depth to limiting factor +96" Boring # .................. ................. .................. ................. .................. ................. .................. Ground elev. ft. Depth to limiting factor Pa o`f~ ~~ ~~r-, Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax'xiary Roots GPD/ft in. Mansell tau. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 1 0-11 10 r 2 2 none 1 2msbk mfr 2f .5 .6 2 11-19 l0yr 4/4 none sicl 2msbk mfr gw if .4 .5 3 19-27 10 r 4/4 none sil 2msbk mfr gw if .5 .6 4 27- 10 r 5/4 c2 7.5 r 5/8 sil M na gw na np .2 5 3 - cos Os - ml na na .7 .8 0 5 Remarks: 1 0-11 l0yr 2/2 none 1 2msbk mfr gw 2f .5 .6 2 11-30 10 r 4 4 none sil 2msbk mfr if .5 .6 3 0-3 sil M na if n ' .2 4 39-88 7.5 r 4 4 none cos Os ml na na .7 .8 _- - z ~f3. 2~ f o; • Z (. Remarks: 1 0-14 10 r 2/2 none 1 2msbk mfr gw 2f .5 .6 2 14-25 10 r 4/4 none sicl 2msbk mfr gw if .4 .5 3 25-38 10 r 4/4 none sil 2msbk mfr gw if .5 .6 4 38-49 10 r 5/4 c2 7.5yr 5/8 sil M na gw na np~ .2 5 49-96 7.5yr 4/4 none cos Osg ml na na .7 .8 s`'~ ..f Remarks: Remarks: SBD-8330(8.05/92) 1-81-1995 9-14PM FROM P-1 . ~,,. PER'tYOWN(:q LaCasse Custam Homes SOIL DESCRIPTION REPOR ~ P Z of 3 PaRC~I LD. # 020-1029-40 - / ~~~~~ •- ` - • Boring # .~: ;u 4 :N~ Vi'i' /25'a'a t'm?i. ~:i1...,, Ground elev, 99.9 ft. Depth to Gmitirg -~SS Horizon pepth C)ominam Color MotSfes Texture Structure Cans-stal1oe 6ou1Claty Roots GPO/ft . in. Mansell Ou. 5z. Coat Color Gr. Sz. Sh. ~~ ~rrer>~ 1 011 IO r ~/~ ~~ ~ ~~l ahk mfL 2 f 5 6 „ _ --~-- - ---~--• .. - s _... _._..... .. ~?_ . . . . .. 2 11-19 l0y'r 4/4 none sicl 2msbk mfr gW~ if 3 19--27 1 Oyr 4/4 ztone sil 2msbk Imfr yw if , 5 ~ .6 , .. •_ 4 27-34 10Yr ..-5/4 ~ -Syr _5/8 -- si 1 M ~za gw na ... np•.LL .- ? . 5 ~~ x[._4/4...--•- -----~rsaae ~ ~ na ~? 7~.8 -- -.. -.,..~_.. ...- ._ ,..._ - , .. ..-........ Remarks: _.. .:. ~-- .,._-.._._......-------, . , ..---~_.......__ .._. . 1 0-11- lOyr 2/2 ..._ .... n°rte . _. .. .... ~,- -- - 2mslok T mfr gwr 2f _ 5 _6 2 11-30 ?Dy_r _~/4..._._-_~ none. -... ~ sil 2.msbk u~fr ~y~ if .5 ~ .6 3 30-39 ~ ldyr .514....,.... c2~7.5Yr.-5/6 sii ~1 na. " ....~... l.f __ n~ .2 4 ' 3._.. -. ~.-~x_. 4/4 ~ ncne _• _.__~ _ ~ cos _..~9'...... _. xnI na tea _ .7 ` 8 ...1 z _ -.. _. ~ ~~.~ .._..Da ........_._...... Remarks; -_- BCrirlg ~{ '.C~iaw'i,,~a >9":. :..; ar ~:7 ~~~ Ground elev. 1Q0_I~ Depot m limiting fa~ror +96~. Remarks:,. , ---...._......__. ...._-----. ._..........___._ ._Y_ 1 0-1~ 10~r 2~2 none 1 2msbk mfr ~ gw ~ 2f 5 6 .- . . 2 -•- 14-25 ._-_..-_ l0y.r. 4/4 i .-none .._ -..... .-.... y - s~Cl Ztnsbk - --_-. --.. mfr .... .... ... - gw .. ..- ~.f _.. ,4 i .5 _.._ . . 3 ..-....-- 25-3$ --.... 10 r 4/~ none ..._X._......_..... sii 2msbk I mfr .__. if .5 .6 . 4 -.,...._.. 38-49 ...--- l0yr 5/4_ c2~7.5yr 5/$ - - -. sit -- ... .. .. .. 1 M .....--- na g~" na np .2 S , 49-96 ---. 7 . Syx 4/4_ notes .. _ ._...__.._..... ~ -- cos -..... . .. g Os --. .....-- m7. - -.. _-._ zla ...._... tea . 7 ; 8 .. . I i _.. ... .. .-•-~ -•--- -.. - .. ~~~ --..._- .....- k -~-~--~ ....._ _... .~.~~__ sY +._ ~. Lf ~.1 ~xx .... . r,~ .._._. . . STEEL'S SOIL SERVICE Gary L. Steel LaCasse Custom Homes, Inca CSTM2298 SWQSW4 S16-T29N-R19W MPRSW-3254 town of Hudson lot #20-Parkwood Meadows 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 This soil evaluation was conducted to satisfy a zoning requirement, it may or a+ay not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. "=40' top of 1"pvc pipe C~ el. 100.00' t. BM.= top of 1" pvc pipe ~ el. 100.00' 3" ~~. ~~lb ~ ~ PJ% ~~ ~ ~~ ~~ ~/ ~~15 ~`. i~°~` ry L. Steel 7-10-99 :~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS} shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: Svstem Design Specifications Sanitary Permit Number l Number of Bedrooms Design Flow -Peak (gpd) (r,.oD Estimated Flow -Average (gpd) 0'b Septic Tank Capacity (gal) Soil Absorption Component Size (ftz) ~ Z Type of Wastewater omestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Abs rption Component Design Flow -Peak (gpd) ~ - aS Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the sep ' and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filte shall be cleaned as necessa to ensure roper operation. The filter cartridge shou d not be removed unless provisions are made to retain solids in he tank that may slough off the filter when removed from its enclosure. If the ` ~ Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or ofher treatment or holding fank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic. wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 S'I' CitO1X COUNTY SL~1''TIC 'PANIC MAIN'I'L~NANCL AGRI?L~ML~N'I AND OWNLRSIIIP CL~R'1'11~ICA'I'ION FORM Owner/Buyer __~J ~Syn~ l9cr'~,,~ Mailing Address _ ~ ~' 3 l ~bKw ~ d,~ ~ ~ ;,.~ t ~, ~,v..r~~,~r,-~ /mot Property Address (Veriftcatiou rcyuircd from I'launing Ucpa-Uncul for ucw constructi City/Slate Nu ~,5~_ LJ' I'arccl Idcntilication Nunther (5 o2h -/D p2 y - yd i LEGAL DESCRIPTION Property Location ~l~'/,, SW '/,, Sec. ~_, 'I'AN-IZ~W, 'I'owa of _ lac-ra~S~ SuUdivision ~,g.~~;~~ ~~,~5 , Lol /t ~. Certified Survey Map # Volume ,Page /~ Warranty Deed # _ /_ ~ 3 C~ ~f ~ ,Volume Page # `7 7 Spec House ^ yes ,$1 no Lul lines idculiliaUle I~ yes ^ no S~YSTL+'M MAINTENANCE Iutproperuse and mainteuauceof your scplic syslem could resull in its pren-ah-re failure to Candle wastes. Propermaitrleuance consists of pumping out the scplic tank every three years ar sooner, if needed by a liccused pumper. WI-at you put into We system can affect the fwtctiou of A-e septic lack as a trcatn-cut atagc in the waste disposal syslem. The properly owner agrees to submit to St. Croix Zoning llcparUucul a certification form, signed by We owner and by a uraslCr pluutber, jounteytnau plumber, restricted plunrbcr or a liccused pumper verifying that (1) We ott-site wastewater disposal system is iu proper operating condition and/or (2) a[ler inspection anJ pumping (iC necessary), tl-e scplic tank is less than I/3 full of sludge. Uwc, We undersigned have read We above requi-cments and agree to maintain tl-c private acwage disposal system with We standards set forth, herein, as set by the Department of Conunerce and the Uepartnteut of Natural Resources, Stale of Wisconsin. Certification stating that your septic system h been utaintaiucd tuust be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expi t' rt ale. / ~ /~. -~ . SIG ATURE O ~ APPLICANT UA'TE OWNER CERTIrICA'rION I (we) certify that alt alaten-cuts on ll-is form ate Uuc to the best of ury (our) knowledge. I (wc) am (are) the owner(s) of the pr ~erty described above, by virtue of a warranty deed rccordccf iu Register of Ueeds Office. `~-~-'-~ SI TURE OF APPLICANT DATE ****** Any information that is nris-represented way resull in the sanitary permit being revoked by the Zoning Department. ****** ** Include wlth this appllcallort: a stamped wa-rauly deed from the Register of Ueeds office a copy of tl-e ccrti(ied survey map if reference is made in the warranty deed Y(~i 1~U (PAGE ~ . ! t7 613096 STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Tbis Deed, made between LaCasse Custom Homes Inc. a RECEIVED FOR RECORD Wisconsin Corporation Grantor, and Jason K. Adam and Kimberly A Adam 11-02-1999 9:00 NM husband and wife YARRANTY DEED ~^~ EXEMPT N Grantee. CERT COPY FEE: COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee TRANSFER FEE: 110.70 the following described real estate in St. Croix County, State of Wisconsin RECDRDIN6 FEE: 10.00 (The "Property"): PAGES: i Recordin Area Name and Return Address Hoitsa m: RacKagiRg D shWPY>9 apt Fkst Fsdsral Savings Bar1k P.O. Box 1888 l.a Crosse, ~ 54602-1868 ~o ozattns-9o; 020• •ea-- ~ tub atoz9.ao QaD - i ~9-,tp ~L Parcel Identification Number (PIN) This is nd homestead property. Lot 2 , Plal of Parkwood Meadows in the Town of Hudson, St. Croix County, Wisconsin. ~~ Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any Dated this ~ ~ day of October, 1999. r AITTHENTICATION Signature(s) authemicated this `day of TITLE: MEMBER STATE BAR OF WISCONSIN., ,,,,, (If not, .:``::,!.....tgtirifr authorized by § 706.06, Wis. Stal~~O( Ci114 c~4 THIS INSTRUMENT WAS D{L4FI' BY Attorney Kristine Q tlRE£N K ~ Hudson, WI 54~7r KISH0. (Signatures may be authenticated or acktl~vled d. Hoth are necessary.) i~ l~ ,~ , TFOF `^; I Gp. LaCasse Custom Homes, Inc. ' Richard W. LaCasse, President ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. S I'C (,te; ; ~ County ) Personally came before me this ~ da of ~_ Y October, 1999, the above named LaCasse Ctutom Homes. Inc., by Richard W. LaCasse. President to me known to be the person(s) who executed the foregoing instrument and ackttowledge the same. ' 1L~.1A.tc Ut-Prt-~ t_C~ Notary Public, State of Wisconsin My Commission is rmalfent. (If not, state expiration date: . ~.) 'Names of persons signing in any capacity should be typed or printed below [heir signatures W AARANI'Y DEED 57ATE BAR OF WISCONSIN FORM No. E - 199a INFORMATION PROFESSIONALS COMPANY FOND DU IAC, WI 8(x}855-2021 CRE$ S.F. 29" W n ~~ . ~ ~ V) 32 t $ ~ N I +~ 2.389 ACRES 104,082 S.F ' ~ ~ i I I , . , 50 i 50'• Q ° I ~t N 89 53' 29" W ~ 1 ~ 392.77' I I 24 2.321 ACRES 101,118 S.F. 31 ~ Via, 6' 3 °°~ 3' 33' I~ ~ 3 ~. 2.507 ACRES / • 109,215 S.F. / / r ~v ~ ~ ~ / ~ ' / ~ ~ ~~~ i _ C' °' _1.90.90' / / ~ 2.525 ACRES Z ~ c 109,997 S.F. N; S 89°53' 29" E ; ~~ .....150.00'... N 89°53' 29" W 4,00.p0. t 000 000 0 200.00' 3 ~ .....................o 200.00' ~ N 89°53' 29" W_ M` N p 18 g•° 2.852 ACRES 124,223 S.F. ~ _ z n ~°~, M ~ ' 21'_ E 598.21'- / / / / \ -- _~.~c- ;9°48' 21" W 595.67' ~ • - - - - - - - _ _ _ 286.49'--' ~0 1 ~ ~~ i9' ° _ 190.28' ' ,,/' 2.853 ACRES 124,271 S.F, c o / ~ ~ 1s' 2. 2~ "'s 6~ 853 ACRES t~~ ,, ,~ 51 ~`~% ~ . 3 5, 124.264 S.F. ~$ Q~i ~ ~/ ~ OOG ~ j,1~g2 ACRES .~~'~. c ~ ~ J0 ~~ ~ ~ ' N Q~G~ :3 ~ / ~..~ W 405.77 :_ 2.852 ACRES ~ G '~, 3, ~ 124.238 S.F. ,r 15.00' .. o / ~ `~~'~,~~ / ~, ~3`.~, ~ ~~ ~ . ~ P~~S ~ ~ ~'~~o a ~/ ~ N G ,CRES ,•)cv ^`~ n :Z / .~~~FiO ~ ~G~ r 1 ~„ .` ° o; ~ s /''~ 5' P PG ' / ~ g o ~ •~5 ~~o ~ ~ • UNPLATTED LANDS / - - - ~~, r W r ~ r o r O r z r r ;- - - - - - - - - - - - - - - - - - -' I r LOT 2 ~ '~ r C. S_M_ i r VOL. 12 1 r 10 r PAGE 3346 -- ~~ - -_~-- - r DOC. X564969 ~ o ~, 0 0 ~~ N W z J N Q I / /• ~~~ 13.00' ~/~/ tG .~ ~ I +~ I _~ ~ 3 N ~ w \~ Y 0 1 _~ ;+ 3 I `~ 1 = ~~ W I~ Z ~ J i ~ Q W ~) Z~ ~~ WI ~~ Q~ z ~~ B T o~ I Q~ '. I- i I _...I I I ~ ~ 2.3 z ( ~ I ~ ( 10' ~i I ~ M ' ~ ~ N 89°46'121" W I ....... ~......... 180.01' F- • ~ Qw ~ ; I ~„ ~N Q'~ i ~' Q IN 100'~W I N 180.01' ~° ~. ~ - ~p- M S- ~ ~M~-~ ~ 1 .iltJ• 3. , I O ~ Ci:M O N.^ I z 100' .~.~ .-•~., BENCHMARK: ~ .N ' °o SPIKE IN --~ ~ :~ z: EAST SIDE OF °~° ~ , ~•'• 3.c POWER POLE ( °' Qo~' t3 ELEV.=897.63 °oo I '~ ~~. v • .~•. ~ I ~ N'89°46' I ~ 1634' 3 1 ~ °' I N -------~ I 3.4 I ~ ° ~ 144 ~- z W 13 c°o UN In ' _ PLATTED ~ .~. LANDS ~ I - / • T 133 3' I 5 .y'I 6 6 °0~~ 'S / I S / ~ JI,~II ~Q,,o,~ LOT 1 ,• (o~ ~~I C.S.M. VOL. 7 ~ ~~ _ PAGE 2! ~ , ~~ DOC. ~4 SW CORNER ~ ~ SECTION 16 I I ~ 100' I ~ ,, %~ ~~ ~ N 2.525 ACRES Z: ~ ~ 3 ~ ~ I I 109,997 S N F 2.389 ACRES I ~ i . . ~ N; S 89°53' 29" E : ~~ 104.082 S.F. ~,. I 50• 150.00' 1iES t N 89°53' 29'"• W 400.00%' SF. i 200.00' 200.00' . N 89°53' 29" W I ~ 3 ~ _ ~ ~ ~ ~ ~2UU OU' ~ 29" W 392.77' 1 ± . ~ N 89°53' 29" W_ 1' '~ , ~~ Mo ~o 18 Z ~ ) ~' ' 33' r- i g u°~ 2.852 ACRES 2 q - I 2.507 ACRES / ' Z 124,223 S.F. ~ a _ 2.321 ACRES 101.116 SF. 109,215 S.F. / / 1 ~ / y ~ / ~ n '~? M Of ,~ / f _ _ ~ \ 5.31 _ / /' G~j c, _ , 225;30' 190.90' / ~ ~,~ ~' 21 _ E 596.21' / / / / °46' 21" W 595.67 - - _ -'7~, _ _ _ ~ 2 9, o . ~o ~, 190.28' - _ ----_ - - 15 .. 2.!!~. ACRES : 5' 124,264 SF. i$ 1RES s.F. :o ~ ° :~ ~ ~ ., 2.853 ACRES / 124.271 S.~ :~ / . Dc66~ i QG ~ 1ka `Li / 55• ~~.F_ 2 ~ '~ .~% 405.77' 3 2.852 ACRES ,~. 4rk. :. 124.236 S.F: ~ ~ _ ~~ ~~• RES °"Nq~ ~• / ~ g.. • ~.o II ~;o /I / ~`~ .~ ~ ; ~, ro ,~ soon :.~,- z./ ' 4 ~ ~GE yi Y ~ ~ /• Q Pj ~5' i /. / ti~31y. :. _ _fi. UNPLATTED LANDS ~~ W ' I O ' 2 ~ j -- - - ._ _ _ - - - - - - _ _ ~ ~ LOT 2 ~ ~ C.S_M_ ~ ~ VOL. 12 ~ i ~ ~ i PAGE 3346 ~ DOC. 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