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HomeMy WebLinkAbout020-1359-21-000,,~/~ , ~iVisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. Permit Holder's Name: ^ City ^ Village ^ T n of: LaCasse Homes, Inc., Hudson Township CST BM Elev.: Insp. BM Elev.: BM Description: v .~ ,/ TANK INFORMATION i TYPE MANUFACTURER CAPACITY Septic ~, Lod D Aeratio olding TANK SETBACK INFORMATION ~~ TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic 7 ~ ~~ ~ Z ~ Z ~ NA ing _- ---"-"--- NA Aeration- N Ho ding PUMP /SIPHON INFORMATION Manua Demand Model Number TDH Lift Lriction Sy TDH Ft For ain Length Dia. Ff Dist.T ell ELEVATION DATA County: St. Croix. Sanitary Permit No.: 374952 State Plan ID No.: Parcel Tax No.: 020-1359-21-000 STATION BS HI FS ELEV. Benchmark S ,~ p5-3 D o Alt. BM b 2 , o ~ Bldg. Sewer ,~" ~L Ht Inlet ~ P J s`/ t Ht Outlet ~! i7 Z 33 Header /Man. ~; 5/Z ~~ 7 3 Dist. Pipe (~ TI Z - Z z R'~. 43 3 Bot. System C~ T i 9• ~~ 1 s y Final Grade j' Z S /0p, St cover ~ y ~~ SOIL ABSORPTION SYSTEM , % , ~_ / „ _ /_ BED / T CH Width 3 Length No. O Trenches ~ ~ v PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I -~ DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO ~ ± ~ 3 ~- M E OR UNIT Mo e Num~r: - System: ~ ~ G C DISTRIBUTION SYSTEM Header /Manifold ,./ ~r Distribution Pipe(s) ~ r ' x Hole Size x Hole Spacing Vent To Air Intake ` ~ Length !1- Dia. T 3~ 3-SD a. Spacing Length ~ N' /(~ mss 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 Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: q / 20 / dd Inspection #2: / / Location: 925 Meadowood Lane, Hudson, WI 54016 (SW 1/4 SW 1/4 16 T29N R19W) - 1629192117 Parkwood Meadows - Lot 21 ft f // / - 0+ lU(e,PSC nl~ ~( ~r y~~bStru~Gfir. .~ar5 lvirr Sr 1'~ ~h 1. Alt BM Descri tion - ~ ~icr.~.v~~.~~ ~' w ~ p 1 2.) Bldg sewer length = Z 9 / ~t Sic ~~ ~ ~ ~ ~r ~ ~~ ~a C~ -amount of cover = 7 ~/ 2 r ~ ~ ^'~• Plan revision required? ^ Yes ~ No Use other side for additional information. a 6 (, SBD-6710 (R.3/97) Dat Inspecto Signature Cert. No. ~~ Sanitary Permit Application ~ ~ Safety & Buildings Division in accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 OfISin `~ See reverse side for instructions for completing this application WI 53707-730^ Madison SC Department of Commerce Personal information you provide may be used for secondan~ purposes . (Submit completed form to cou:tty if r [privacy Lati~. s. 15.04(1)(m)] state owner Attach com lete laps (to the county co 'only) for the system. on a er not less than 8-1/2 x 11 inches in size. Coun State Sanitary Permit 1~umber ^ Check if revision to previous a lication State Plan I. D. Number c f.7 I. A lication Information -Please Print all Information ~'. cation: ~ Property Owner Name , '~ti` rty Location 1~ ~{~, ,fq j,, ~ ~~~ // ~j ~j~ ~,r~ Stx'i c5(~/4. S ~(pT ~ (N. R/~ or Property Owner's Mailing Address 1' o"~ Lot ber Block Number ('~ t ~'_.~~ ~ h 17 '~ ~Q C_ CI ~ .~_ City, State Zip Code Phone i~rab~ ~ ; 'L: Su ' ~ i ion N me or CSM N ber ~ p~~ II Type of Building: (check one) ~, y ~ I or 2 Famil Dwellin No. of Bedrooms: ~ ~ 9 illage own of , / ^ Public/Commercial (describe use): ~( L ^ State-owned / / III Type of Permit: (Check. only ene bex on line A. Check box on line B if applicable) Nearest Road _ / G • d0 C q) 1. Q~New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to ( s Parcel Tax Numb r l ~'` Od C ~ ~ ~ ~ ~ S stem Tank Onlv Existin S stem / o ~~ - B) ^ A Sanita Permit was reviousl issued Permit Number Bate~fssaed I b • "~+ • 1 `t • ~ 1 IV. Type of POWT System: (Check all that apply) Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V Dis ersaUTreatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System levation 7. Final Grade ~~ Required Proposed f Rate Gals /dam/ ,~ji~ ~ w (Min./inch) L,~ /'~ 7D ~ Elev6a/t~io{n C.~ ~/ ~ 7 ~ / / / 1 1• / VI Tank Capacity in Total # of nufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks S laa~ ~' /ate ~ ^ ^ ^ ^ ^ ^ ^ ^ ^ VII Responsibility Statement I, the undersi .ed, assume res onsibilit frr irsta!lation of the POWTS sho n the attached !acts. Plumb ( int) Plumber' Signature no stamp ): PRS No. Business Phone Number ~ / ~ ~~ G l~ "- 7 ~..f Plumbe~Ad~s (SUeet, City, State, ip Code) ~' ~ ~ s 4~a o VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ,,Approved ^ Owner Given Initial Adverse Surcharge Fee) as S O°~ ~°`~ ~ ~ /~ ~C~ n F~ Determination IX. Conditions of Approval /Reasons for Disapproval: p ~o~ ~~-Se~,N,+.~ ., b~(cl,~P.eiv-...±•~- ~;ra,a~•--Ja~..wt p~oSh- p l.~.d-50'n. ~61~~ ~ ~ covnManu~G L6Y~St3^v~~'Td~.1 . n~ ~laadlp(a+h ' wtif( 7)~ C ((!il t~~ IaG ~~t/V~-GGG~ ~ WL6vwu~~e~a~vl. `Ijw~ l/L>rt/~J'~ 4~~~~~ ~ ` f ~~1~`:~ ?`~''~-~-.- ',~ ~.ti.~.3.w`.O ~ w y. r~ar.,~-,~. Gtr.. yx lSo - boa 30 ~ SBD-6398 (R. 07/00) ~i ~ _ ~t~ ~w~(1i5~ucl u~ If arc hle, SGftiao~ ,~(~.wd~,ds ~ ~Vl~~IZ w~i( y- ~~ ai G~k.,~~ /~G~~a~s ~, ~(~Q ~ 4 ~~~ ~,~~ ~ad~ ~^~~~ ~ ~ S caw a v X X-a .~~~-. ~~,~- 3 ~~ 175 a ys'~ l~^ ~ r5 ab ~,1 ~s / -~o- ~1 ~~ ~~ i -uARJ`~` N~ i 5~ ~- 9S 70 is oa ~ ~~~~--'~` ~1~~`- M ~ boo To~ l `~~J C, ~r~~ ~r~ = 9yyo (r~ ~ `~Pvc___ ~____.._ ~ ~Yrw L~+Casse. ycs-n+es L~' L ~ t~ir9~nKcvor~d j'~~..aca/aw~ ~~ = to Wiscorisin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings :_ _____a ...:.~. ~~ ~ ~~ ~., .,~ ~.~:., w,~.., n,.a,. COUNTY Plan must include but a er not less than 8 1/2 x 11 inches in size Arlach com lan on lete site St. Croix , p p . p p not limited to vertical and horizontal reference point re~c~io % of slope, scale or ~ PARCEL I.D. # dimensioned, north arrow, and location and dista ~~g~i est read?%:', `.,4 020-102 - ~~..~~-- '~ APPLICANT INFORMATION-PLEASE P ICI BALL FO~MATIpN RE IEWED B ~ DATE r ~\ 3_f} ~a PROPERTY OWNER: __,. )` ,~ PERTY LOCATION LaCasse Custom Homes, Inc. • ~~/~ '' GO .LOT SW v4 SW 1/a,S 16 T 29 ,N,R lg ~(or) W PROPERTY OWNER':S MAILING ADDRESS -- gr 9 Q C ' CO # BLOCK # SUBD. NAME OR CSM # ~ ry/X 521 McCutcheon R ~ Parkwood Meadows CITY, STATE ZIP CODE S~J j' CITY ^VILLAGE [MOWN NEAREST ROAD Hudson, WI. 54016 ~ C 38 - ~5-' Hudson Meadowood Ln. [~ New Construction Use [X ] Residential / Num e`d ~ 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 .7 bed, gpolft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 85.70 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 CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem ®S ^ U ~S ^ U ®S ^ U ®S ^ U ®9- ^ U ^ S ® U SOIL DESCRIPTION REPORT Boring # .................. ................. .................. ................. .................. ................. 1 € Ground elev. 99 . fit. Depth to limiting +ac~4~~ Boring # 2 Ground ele~ • eft. Depth to limiting factor +88" Depth Dominant Color Mottles Texture Structure Consistence Bour>~ Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trench 1 0-11 10 r 2 2 none 1 2msbk mfr 2f .5 I .6 2 11-21 l0yr 4/4 none sicl 2msbk mfr if .4 .5 3 21-30 10 r 4 4 none sil 2msbk mfr if .5 .6 4 30-84 7.5 r 4 6 none cos Os ml na na .7 .8 r R ~ ~ ~~ Remarks: 1 0-9 10 r 2 2 none 2 9-20 10 r 4/4 none sil 2msbk mfr 2f .5 f.6 3 20-88 7.5 r 4/6 none cos Os ml na na .7 ~ .8 ~•S/ .8 Remarks: PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT PARCEL I.D. # 020-1029-40 Boring # 3 ................. Ground elev. 99.4 ft. Depth to limiting factor + " Boring # ..' 4 <.. Ground elev. 99.4 ft. Depth to limiting factor +90" Boring # :, 5 ~~~_ Ground elev. 99.0 ft. Depth to limiting factor +90" Boring # Ground elev. ft. Depth to limiting factor Page 2 ,of 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Borx>dary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-12 10 r 2/2 none 1 2msbk mfr gw 2f .5 .6 2 12-24 10 r 4 4 none sil 2msbk mfr 2f .5 .6 3 24-88 7.5 r 4 6 none cos Os ml na na .7 ~i ,M•~-e-G- c o a Remarks: 1 0-10 10 r 2 2 none 1 2msbk mfr 2f .5 `: .6 2 10-28 10 r 4/4 none sil 2msbk mfr gw 2f .5 .6 3 28-90 7.5 r 4 6`c none cos Os ml na na .7. . ~t~ S . rte w ~s `~ ~ ~' o~ t _ Remarks: 1 0-12 10 r 2/2 none 1 2msbk mfr gw 2f .5' .6 2 12-20 10 r 4 4 none sil 2msbk mfr 2f .5 .6 3 20-90 7.5yr 4/6 none cos Osg ml na na .7, . 2 w ~ s ~1% `~ ~'~ a Remarks: ~ ~ 1 Remarks: SBD-8330(8.05/92} ,... - STEEL'S SOIL SERVICE Gary L. Steel LaCAsse Custom Homes, Inc. CSTM2298 sw4SW4 S16-T29N-R19W MPRSW-3254 town of Hudson lot #21-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 may 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. ./N /1"=40' = top of 1" pvc pipe C el. 100.00' ~11t. BM.= top of 1" pvc pipe C el. 99.40' r ~~ ~~ ~~ L l SL,P ~ kG ~ ~. ~- ei,~~ ti~ ~~~ D~ ?,b - ~ ~, _ ~.~ ~~ ~~ ~~~ a`. c~~ Gary L. Steel 7-9-99 ~`~.~ I rr~sc.Lr~au~vapa~ut~ntorinoustry, SOIL ANU .5'I! E EVALUATION REPORT Pte 1 Of ~ ' labor and Human Relations GivisionotSafety d, Buildings in accord with ILHR 83.05, Wis. Adm. Code CO Attach complete site plan on paper not less than 8 t/2 x 11 inches in size. Plan m lude,. twt t. Croix ~____~ not limited to vertical and horizontal reference point (BM}, direction and % of sl e, scale o~ ~, n~ .PAR LLD, it J7~~__.___.l .~L ~........v.~..v~.,~. ,Vl..l +... v.., v..v ,VVw.,Vll PIIV Vlvlu11V0 \V Ilv ~a.vv~ IVOV, - APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATIO REVIEWED BY DATE PROPERTY OWNER: PROPS TY L TION LaCasse Custom Homes, Inc. F1 va SW v4,S 16 T 29 ,N,R lg ~(or) W PROPERTY OWNER':S MAILING ADDRESS LOT X BLOCK ~ SUBD. NAME OR CSjd N 521 Parkwood Meadows CITY, STATE ZIP CODE PHONE NUMBER CITY (]VILLAGE [MOWN NEAREST ROAD Hudson, WI. 54016 (713 381-5405 Hudson Meadowood Ln. j~ New Construction Use jX J Residential /Number of bedrooms 4 j j Addition to existing twilding [ j Replacement [ J Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpolft2 . S trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate ~_bed, gpd/ft2~_Uench, gpd/ft2 Recommended infllfration surface elevation(s) 95.70 ft (as referred to site plan benchmark} Additional design /site considerations na Parent material outwash Flood plain elevation, it applicable na ft $ _ $Ultable for SySI@m U =Unsuitable for s stem CONVENTIONAL ®S D U MOUND ~S D U IN-GROUND PRESSURE ®S ^ U AT-GRADE ®S ^ U SYSTEM IN FILL ®~ ^ U VOIDING TANK ^ S j~ U SOIL DESCRIPTION REPORT Boring # >~:: :< ;~>>.~ ::~ SAY; ~:'}+ti ~k\A Ground e~~. fit. Depth to limittfloong +~84" Boring # i.:2a'rR~.~: >,' l~si $ ~ 3,?oj ~~~ ~G~r~oyund 99 . lit. Depth to limiting factor + ~~ Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence BoLUtcfttry Roots GPDlft Bed Trt3ruh 1 0-11 10 r 2 2 none 1 _2msbk mfr _g, Zf .5 .6 2 11-21 10 r 4/4 __ none - _ __ sicl .2msbk mfr if .4 .5 ~ 3 21-30 10 r 4 4 none sil 2msbk mfr 4 3D~4~ 7.5 r 4 6 one cos Os ml a na .7 ~ .8 7p __ _._~` ~ `• Remarks: 1 0-9 1Or22 n 2 9-20 10 r 4 4 none sil 2msbk mfr 2 .5 .6 3 20-88 7.5 r 4 6 none cos Os ml na a .7 .8 Remarks: CST Name:--Please Print Ga L. Steel Phone: 7l 5-246-6200 Address: 1554 200th. Av ew Ric and I 54017 Signature: Date: 7_g_gg CST Number: m02298 PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT Page`, PdRCEI L0. ar 020-1029-40 Horizon Depth in Dominant Color Munsell Mottles Q S C Texture Structure Consistence ~~ Roots GPD/ft , u. z. opt Color Gr. Sz. Sh. g~ Trgr~tt 1 0-12 10 r 2/2 none 1 2msbk mfr gw 2f .5 .6 2 12-24 10 r 4 4 none sil 2msbk mfr 2f .5 .6 3 24-88 7.5 r 4 6 none cos Os ml na na .7 .8 RnmorLe. 1 -1 10 r 2 2 none 1 2msbk mfr Zf .5~ .6 2 10-28 10 r 4 4 none sil 2msbk mfr gw 2f .5' .6 3 28-90 7.5 r 4 6 none cv s Os ml na na .7 .8 Anm~r4~• _1 0-12 10 r 2 2 none 1 2msbk mfr ~w 2f .5 ~ .6 2 12-20 10 r 4 4 none sil 2msbk mfr 2f .5 .6 3 20-90 7.5 r 4/6 none cos Osg ml na na .7` .8 r+emarKS: f.7nm.f rbn .• , STEEL'S SOIL SERVICE Gary. L. Steel LaCAsse Custom Homes, Inc. 1554 200th Ave. CSTM2298 Sw4sw~ s16-T29N-R19w New Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #21-Parkwood Meadows This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lvt tines were not established at the time the test was conducted. N 1"=40' BM.= top of 1" pvc pipe C el. 100.00' Alt. Bd~i.= top of 1" pvc pipe C~ el. 99.40' r ~~. ~~~, e ~~ ,. ~~ . .~ ~.~, ~~ B 5' kG'M r 1h• ~~ ~~~ ~~ . ~' 8 ~, 2° P~`~ {y.~ h~ ,~ ~3 ~..7 v`. Gary L. Steel 7-9-99 r 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: System Design Specifications Sanitary Permit Number 3 Number of Bedrooms ~/ Design Flow -Peak (gpd) o O Estimated Flow -Average (gpd) Septic Tank Capacity (gal) ~ ~ o Soil Absorption Component Size (ft2) S/ ~ Z Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) / ~~~ ~ - L 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 septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the 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 other treatment or holding tank for any reason without being in full compliance wifh 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'1' CRO1X COUNTY SBY'TIC 'L'ANK MAIN1'L~NANCL AGRL~L~M)?NT AND OWNLR.SI-IIP CL~It'rICICATION FORM Owner/Buyer ~ Mailing Address ~j 2 l Properly Address ~'Z S City/State LEGAL DESCRIPTION 1'arccl Idcntilication Num~cr C~ ~~ - l 3Sy - d?~-~SDt~ Properly Location S (+~! '/,, S(,~ '/,, ,Sec. 1 ~ , 'I' Z ~' N-IZ / 4 W, 'I'owa of a..i>-. . Subdivisiort (Verification required tiuw 1'lanuiug UcpaiUucnt for new conslruclion) ~y- Lol # Z l . ~_ Certified Survey Map # , Voluutc '- ,Page tt Warranty Decd # ~ o~ qf~,~~ ,Volume ~~~_, Pagc # Spec house O yes no Lul lines iclcntilia~lc ~s O no SYSTL+'M MAINT'ENANCL Iurproper use and maintenauccof yuur septic syslcur could result in its premature failure to handle wastes. I'ropermaiuleuauce consists of pumping out the septic teak every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the futtclion of the septic teak as a treatnrcut stage in the waste disposal system. The property owner agrees to submit to 5t. Croix Zouirrg Departnreut a certification form, signed by We owner and by a nrasterplumber, jounre}nnan plumber, restricted plumber or a licensed pumper verifying drat (I) the ou-site wastewaterdisposal system is iu proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less llutn 1/3 full of sludge. Uwc, We undersigned have read the above requircnrenls acrd agree to maintain lire private sewage disposal system with We standards set forth, herein, as set by fire Department of Conuuerce and lire Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the Sl. Croix County Zoning Office within 30 days c three y arc iratiorr date. o~l~Q/ o a. S NA Or ICANI' DA'I'C OWNER CERTIrICATION I (we) certify drat all slatcnrcnts on 11-is funs arc true to U-e best of ury (our) knowledge. I (wc) am (are) We owner(s) of the r erly described ove, by 'clue of a wanauty decd recorded iu Rcgistcr of Uceds Office. 6d 1 ~ ©n SGNATU OF ICANT DATB *'**** Atry information drat is mis-represented may result iu the sanitary permit being revoke) by the Zoning Department. ****** ** Include with this application: a slarnped warranty deed from the Rcgistcr of Deeds office a copy of the certi[icd aurvcy map if rcfcrcnce is made in the warranty deed , ,' ,~~ i538PAGE 48'7 STATE BAR OF WISCONSIN FORM 1 - 1998 629051 WARRANTY DEED KATHLEEN H. WALSH kEGISTEk OF DEEDS Document Number ~ ST. CkOIX CO. ~ WI RECEIVED FOR RECDRD This Deed, made between HOWARD LaVenture, Three-fifths 08-30-000 11:30 AM (3/5) interest in and Arlene Laventure, Two-fifths (2 5) interest in, as tenants in common. WARRANTY DEED EXEMPT A 17 Grantor, CERT COPY FEE: and ~.,.Ol (nSt,2 (~01,1,3a~M 1 - ~, -~ CDPY FEE: tRANSFER FEE: RECORDING FEE: 10.00 PAGES: 1 r° Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St . Croix County, State of Wisconsin '' (the "Property"): ! Recording Area Name and Return Address / ~ 5a l ~eCwEC,~o~ (L~ ~'~~-bon. W ~ S'-4-o t ~ LOT 21 OF PARKWOOD MEADOWS, SST ADDITION, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. ©o~U ~' 135ct-~ t-ooo Parcel Identification Number (PIN) This r~nPmshomestead property. ~. (~) (is not) !I This deed is given in partial satisfaction of certain land contract dated '~~ Februaury 19, 1999, and recorded in Volume 1404, Page 616 as Document Number 598116 which was subsequently assigned by assignment dated May 28, 1999 and recorded in Volume 1431, Page 352 as Document Number b93~: ~oG-~i3~ I, Together with all appurtenant rights, title and Interests. Grantor warrants that the title to [he Property is good, indefeasible in fee simple and free and clear of encumbrances except ~I all liens, covenants and restrictions of record, if any and any liens or encumberan'ces created~y act of the Grantees and will warrant and defend the same. ,,~~ ~ Dated this .~~~ ~~ day of ~ilCy-ii~~ ~ j~~_• ~' (SEAL) (SEAL) '~ ': * * Howard LaVenture (SEAL) * AUTHENTICATION Signature (s) ~~~~ ~~~s~ ~~ authenticated this _ , * Sa el R. C TITLE: MEMB BAR OF WISCONSIN i. i? ~,~~ C.ri~-e- (SEAL) * Ar ene L.aVentLre i~ ACKNOWLEDGMENT State of Wisconsin, ss. county. Personally came before me this day of the above named i' to ,, l1: c~ ~ o ~ 100'Tc~Iw N.o° ~ ~ / ~ iv L -z - I - - ~ l~ti ~ >> °56~ 180.01' ° :405.31 ~ ~ ~ / c'~ °' 43S~ 29•• w . in 225.30 ~ / . / 4 • • • ;-- . 1,90.90 ~ G~ -~ S 89`46' 21 " E 596.21' / ~ ~ / ~ ^~. N 89°46'21" W 5F)5.67' -- --mac-- - ' --- - ---"~--- ~ (~8.9~ ~: ~ 266.49' o __ ~0 / I 4_05.39' - ~ - 190.28' C~1 - ~ ,y 2.853 ACRES i " I "•'' 2 0 00 /. in: M -~- x 124,271 S.F. ~~ 100' ~ `+'~~ ~ ~~ A/ c' "6 i o 1 , ~~ 2.853 ACRES `s? 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