The URL can be used to link to this page

Home My WebLink About020-1359-28-000' Wisconsin 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)]. Permit Holder's Name: ^ City ^ Village ^ Tplwn of: La Casse Custom Homes, Hudson Township CST BM Elevf.:- Insp. BM Elev.: BM escription: 'p 6 ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic , ~s , L Oo Dosing ~p O Holding ~._~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic y ~5- y ' i NA Dosing > ~s ~ 3 S ~ ' ~9 ' NA Ae A Holdi (~..U7f rvwir r ~~rnvr~ ~~~rvnmr~ ~ iv~~ ', Manufacturer ~ Demand Model Number ~ ~J~ ,~S/GPM TDH Lift Lriction ~ System X TDH ~• Ft Forcemain Length yy' Dia. Z " Dist. To Well ELEVATION DATA county: St. Croix Sanitary Permit No.: 363934 State Plan ID No.: Parcel Tax No.: 020-1359-28-000 STATION BS HI FS ELEV. Benchmark ~ ~ Alt. BM Bldg. Sewer ' ~t'Ht Inlet ~~• ~ ~ q~, Dt Bottom q, ~ f ~ U • Header /Man. ~, ~1~ q ~- O S- Dist. Pipe ~ ~~ ji ~ ~• Z~ Bot. System _ (`) 7 r l2 L /6'S' ~~~ Final Grade '2S /vv• ~ St cover ~ Z~r 9 ~ ~~-- r` c.. ~S ~ 1~~. SOIL ABSORPTION SYSTEM z N „(~ ~ , / ~ _~ BED / T E Width ~ Length ~ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 3 Z DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEA RING Manufa urer: SETBACK T A BE M d INFORMATION ype O , 3~ > ~( ~ ~--- O IT e u er: o ' System: ~ ' DISTRIBUTION SYSTEM ~ ~ ~ Header /Manifold r~ Distribution Pipe(s) / ~ ~ th ~ Dia L ~ L n th ~ Di cin - ~ ~ S x Hole Size x Hole Spacing /~/i(a- Vent To Air ~ take '7 _ eng . g g e a. pa 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: ~/l / /fJ0 Inspection #2: / / Location: 503 Green Mill Lane, Hudson, WI 54016 (NW 1/4 SW 1/4 16 T29N R19W) - 162919212/4 Parkwood Meadows - Lot 28 )C ~/` y)SY S~tr,~ wat L'~col ~ Q ~ ~~~"'~'~-, 1.) Alt BM Description =~° ~ s' d,~ ~d`'u« ~~ 2.) Bldg sewer length=y~~ -[~~~~c'2r/~,k`w~ ~wc~ ai'/~i"'e'~'fF.r.., p(~ P~~ -amount of cover = ~ (i' a~'u S f~ 5~. K ~o- se a f%.~-.. ~So J~o ~r) 3'Sepcrrti~-~ [~1'~s ~~y~.~.Q /90 -~a~'~l~ 61st Plan revision required? ~ Yes ^ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. r ,- - SANITARY PERMIT AP N ~~scons~n Department of Commerce In accord with Comm 83.0 is 1t~ r y Ci .~, • Attach complete plans (to the county copy only) for the s , o`~~'~~ less\~ than 81a x 11 inches in size. ~ Ii'C • See reverse side for instructions for completing this app ca lon'~N ~ ~ Zfl~~ ~, Personal information you provide may be used for secondary purposes ~ ~ SZ Cox Safety and Buildings Division 201 W. Washington Avenue POBox7162 Madison, WI 53707-7162 ., . ~ ~C ~'n t Sanitary Permit Number 3~393~ x;k if revision to previous application Irnvacy I_aw, s. i ~.uv t I / tm/J. !O~ ~~CG ~ ,~//r // / U "( (/ L 1 J ~F~~ C-`/ Plan Review Transaction Number 1. APPLI ATI N INF RMATION -PLEASE P RI NT ALL ~ N Property Owner Name C „~~~ a'ti N R E (or~ S T : ~ ~.. 'S Lu ~1 mt c , , , Property Owner's Mailing Address Lot umber Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYP F B DING: (check one) ^ State Owned It Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms •~ ^ Village Town OF 1Y.2-cL +'v.~ at r I11. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) vzc-1369_ Z P-ooa !G. 29.9 Z/Z y 1 ^ Apartment/Condo B ~ 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/ Repairs 11 ^ Restaurant/ Bar/ Dining , 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. Q New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of S. ^ Repair of an ______System____--__S~rstem__________--"TankOnl~r _____________ Existing System _________ExlstingS~fstem- B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Othec 11 ^ Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ~ Seepage Trench 22 ^ In-Ground Pressure 42 ^ Pit Privy 13 ^ Seepage Pit , 43 ^ Vault Privy Fill ~ O ~~~« ~'~r ~s r~~ a ~ S 4 1 ^ System-In- r VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) roposed (sq. ft.) als/day/sq. ft. (Min./inch) Elevation ~ ' ~ SCJ ~ ,V t~ ~~~ '7l~ Feet q Feet VII. TANK INFORMATION Ca aut in allo s Total # of Manufacturer s Name Prefab. Site l st Fiber- Plastic Exper. N E i i Gallons Tanks Concrete act ee glass App ew x st n st ed Tanks Tanks ticT orl-IeM;'ncftdffk"- / ~d SEC d / ~~c~wr13r7`t ,N~ [lilt ^ ^ ^ ^ ^ Li umpTa ~nber / ~~ ~~Q t ~ :fJ~ty'1`~j/,!/ ^ ^ ^ ^ ^ SPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plu m ber 's Name: (Print) Plumb er' Signature: (No tamps) s _.~ N P P RSW O .: Number: Business Phone / f / ~ !+t/ . L < r ~ ~ii ~ ~ ~ ~ ~~ t ~ / r;~1i~WY~,-'^~' C%~~~ ~ n Q / // n •~r /~ f 7 ~ Gi / Q (5 ~ C ~ `- ,~ l ~ 1 Plumber's Address (Street, City, State, Zip Code IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee Ondudes Groundwater ate SSde Issuing Agent Signature {No Stamps A roved ~I pP ^ Owner Given Initial Surcharge Fee) /~ Z 2S Od ~~~~ Adverse Determination X. CONDITIONS OF APPROVAL 1 REASONS FOR DISAPPROVAL: ~ / ~ r~~b~.~~.t/.~d/- ,~~ sYs~~.~ ~/v. a<</qy ~o ~o ,,.~.,K~~~, ek~rr~ la~v~,- % h . ~/ 0~ `O/GL ~/K~ /'~~ . /H -5 ~~P cJ ~Cl ~ !r`~Cr~,.,/ /G$ ~~C tt ~Oi'rn,ey {a SBD-6398 (R.12199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS - . ~~ 1. A sanitary permit is valid for two (2) years. ~ "~' .. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved;t~~ thQ permit issuing authority. 4. Changes in ownership or plumber requires aSantary. Perm_ if Ttahsfer /Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed:. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one online A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval on{y if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County! Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic. tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 1 15 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ~., . ,. ,i.ay O~' q PUMP CHAMBER CROSS SECTIOr.I AL1G SPECIFICA~r10~~5 `i~~C.I. VENT PIPE ~ 25' FROM DOOR, WINDOW OR FRESH AIR IAITAKE 18"MIN. ~ IAILET I LLEV. FT. A 6 C 0 VE tJT GAP WEATHERPROOF JUUCTIOAI BOX 12"M I U. I GRADE I I I COIJDUIT ~-- V ~' PROVIDE AIRTIGHT SEAL *APPROVED JOINTS WITH APPROVED PIPE 3' ONTO SOLID SOIL PUMP --~ C0IJCRETE 6LOCK rnr.,l cF APPROVED LOCKIAIG MANHOLE COVER 'i" MIIJ. 18"MIN. I I III I II) I ICI I i I I ~ I ~ ALARM ~ II I I ~ I oIJ I I I --~ y OFF RISER EXIT PERMITTED OIJLy IF TAIJK MAIJUFACTURER HAS SUCH APPROVAL SEPTIC f SPEGIFIGATIOA.IS oosE TAWKS MAfJUFACTURER: J ~~`~~v~aS~y•~y NUMBER OF DOSES: ~ PER DAy TAA1K SIZE: ` ~' ~ GALL01J5 DOSE VOLUME ' ' ~ IAICLUDING 6ACKFLOW: ,~~ ` ~ GALLON: ALARM MAIJUFACTURER: ~~ m ~ ~L ~ MODEL -JUMBER: ~`~z ~` CAPACITIES: A= ~°a INCHES OR ~ GALLOAIS SWITCH TYPE: ~-~' /C - g =~_IWCHES OR s 6ALLOAI: PUMP MAIJUFACTURCR: _ ` ~~Q~/~-s C=~I-JLHES OR L.SG~ GALLOIJ°. MODEL IJUMDER: ~~11` ~~ D = ~ INCHES OR ~ GALLON! ,_ SWITCH TYPE: ~ Y,.9~~ NOTE: PUMP AUD ALARM ARE TO DE MIAIIMUM D ~ iNSTALLEO OIU SEPARATE CIRCUITS ISCHARGE RATE GPM VERTICAL DIFFEREIJCE gETWEE~I PUMP OFF ARID DISTRIBUTIOI~I PIPE.. ~~_ FEET ~- MIAIIMUM NETWORK SUPPLY PRESSURT,E/.. .. ,=••~'~' FEET • ,~~~f7 FEET OF FORCE MAIIJ X a~~J F/ooFLFRiCTlo1,1 FACTOR...I~~y FEET = TOTAL Dy1JAMIC HEAD = ~ FEET IWTERIJAL. DIMEIJ510AIS OF TA-JK: LEA1CsTH 'WIDTH - - 17~rP~l. •~LIQUID DEPTH SIGIJE D: ~~~ LICENSE AJUMBER: ~a? ~ ~~ DATE: ~ °~ dG a~ ~. .\ _ APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/4"maximum. ,-- • Capacities: up to 55 GPM. ~'-1 • Total heads: up to 24 feet. ' • Discharge size: l'/z"NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: 3/a° maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: l'/z°NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. r `~.` ~- • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz,1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: l0 foot standard length,16/3 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). METERS FEET 10 9 30 8 2s o ~ a U 6 20 z 5 0 15 J 4 F 0 ~ 3 10 2 o~ 00 iu zu su 40 50 GPM 0 2 4 6 8 10 12 m~/h ~~~~~~ ~ Goule~ ~~~~~~Slbl~ ~~~~1~~~~ ~~~~ 3871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermo- plastic Semi-open design with pump out vanes for mechanical seal protection. ^ EP051mpeller: Thermo- plastic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. r~ i_J EP04 EP05 ^ Motor Housing: Cast iron for efficient heat transfer, strength. and durability. ^ Motor Cover: Thermoplas- ticcover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SA• Canadian Standards Association (CSA listed model numbers end in "F" or "AC".) I ( 1 ! ! i ,, ~ I ~ I I I ~ I -1-~SGPM, ' ~ ~ I I I I ~ ~ ~ I3~•~l i I EP S O : ~ EP04 ~.~ I CAPACITY wiscon';in Department of Industry, SOIL AND SITE EVALUATION R E P O R T Labor ane~ Human Relations r)ivioi~nofSafwtvRRuildinnc ._ _____~.-.:.~ n Ilr..,•,..~ ...:_ w.~.., n_.a„ Page ~ of _g • - - 111 QVVV~V ••~l~l ~~I 11 ~ VV.VJ, .~v. •~~~~~• vvvv COUNTY Plan must include but 8 1/2 x 11 inches in size ch c lan on a er not l Att l ss th t it St. ' , p p . a omp e e p e e s an not limited to vertical and horizontal reference );~jre ~ and % of slope, scale or PARCEL I.D. # 020-1029-30 dimensioned, north arrow, and location and ' t~3~c~..t~o-• eake~i;%rcY~ld`-~, ~ `•" ~' APPLICANT INFORMATION-PLEAS ~R~1~NT A IA~ORiNATI~N IEWED BY DATE ^~ PROPERTY OWNER: ,~ ~ r PROPERTY LOCATION X ~ ' ~ ; -, r' LaCasse Custom Homes '' 1/4 GOVT. LOT 1/4,S16 T 29 ,N,R 19 f(or) W PROPERTY OWNER':S MAILING ADDRESS? ~. ST 9 G~/ 9 - LOT # BLOCK # SUBD. NAME OR CSM # X 521 McCutcheon Rd. ? , ' 28 na Parkwood Meadows CITY, STATE ZIP C E,`, BER :C '~j ^CITY ^VILLAGE [x]iOWN NEAREST ROAD ;` ) [ ~ New Construction Use [X] Residential / ' o~ ti s 4 [ ]Addition to existing building j ]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, gpd/ft2.8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.70 ft (as referred to site plan benchmark) Additional design l 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 ®S ^ U IN-GROUND PRESSURE [~ S ^ U AT-GRADE C$S ^ U SYSTEM IN FILL $~ S ^ U HOLDING TANK ^ S X41 SOIL DESCRIPTION REPORT Boring # .................. ................. .................. 1 <`: Ground elev. 99.9 ft. Depth to limiting factor +88" Boring # 2 Ground elev. 99.3 ft. Depth to limiting factor +84" Depth Dominant Color Mottles T re t Structure Consistence Bounda Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color ex u Gr. Sz. Sh. ry Bed Trer>ch 1 0-12 10 r 2 2 none 1 2msbk mfr 2f . 5 I .6 2 12-24 10 r 4/3 none sicl 2msbk mfr gw 2f .4 .5 3 24-34 10 r 4 4 none sil 2msbk mfr if .5 .6 4 34-88 7.5 r 4 4 none cos Os ml na na .7€ .8 5n• ~f • `( Remarks: 1 0-8 10 r 2 2 none 1 2msbk mfr 2f .5 .6 2 8-20 10 r 4 3 none sicl 2msbk mfr 2f .4 .5 3 ~ o ~. 20-30 10 r 5 4 c2d7.5 r 5 8 sil M na if n .2 4 30-84 7.5 r 4 4 none cos Os ml na na .7 .8 .2 Remarks: CST Name:--Please Print Ga L. Steel Phone: 715-246-6200 Address: 1554 200th. v .New Ric mon I 54017 Signature: D~ Date: 7_10_99 CST Number: m02298 ~ ~ PROPERTY OWNF.A LaCasse Custom Homes SOIL DESCRIPTION REPORT Page 2 ..of 3 PARCEL I.D. # 020-1029-30 Boring # 3 ................. Ground elev. 100. ]ft. Depth to limiting factor ~an~~ Boring # ... 4 <` Ground elev. 99.7 ft. Depth to limiting factor +g4„ Boring # <" 5 _.. Ground elev. 99.3 ft. Depth to limiting factor + ~~ Boring # Ground elev. ft. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structure Consistence Bot.~ndary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-15 10 2 15-31 10 r 4 3 none sicl 2m mfr 2f 3 ~ ,~ 31-40 10 5 4 5 8 sil 4 40-9 ,~ 5z•~ . g Remarks: 1 0-10 10 r 2 2 none 2m ,6 2 10-25 10 r 4 3 ne ,5 3 rr" 25-36 10 r 5 4 c2d7.5 r 5 8 sil M na if n .2 4 36-84 7.5 r 4 4 ------ none cos - Os ml na na .7! .8 4 ~} a~ ~y„ Remarks: 1 0-13 10 2 2 2 3- /2 ,, 4 42-90 7.5 r 4 4 none cos Os m na na .7 .8 R ,~ x/3.2 ~9.z" Remarks: Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel LaCasse Custom Homes, INc. 1554 200th Ave. CSTM2298 ~4~4 s16-T29N-R19w New Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #28-Parkwood Meadows ~' =40 Alt . 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. Gary L. Steel 7-10-99 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~,, ,aC_~ ~ ti e.. ~{ a ,M ~ Mailing Address ~ ~ ~ ,,,n ~~- ~i{ ~~ j„ ~ Ems,., ~ ~. ti ~.d ~~--- Property Address $a ~ 3 ~~~.•`.,,~; ~ ~ ~~ ~,n~_ ,~~, ti~ ,,, ~ (Verification required from Planning Department for new construction) .P~12_t~ City/State t~ u r~ ~ 4-w. Parcel Identification Number LEGAL DESCRIPTION Property Location ,~~ '/a, S u, '/,, Sec. / ~ . TAN-R~~W, Town of I a u ~l s ~-~. Subdivision A,IJ~ 1-c ~. ~,,~~~ ~ Q„~~r,~. ~ ~ .Lot # ~. Certified Survey Map # ,Volume Page # Warranty Deed # le ~ ~ `Y %~'Y ,Volume ? ~~~ ~ ,Page # ~~ Spec house O yes ~o Lot lines identifiable M yes O 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 form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposalsysrem is in proper operating condition and/or (2} after inspection and pumping (if necessary), the septic tank is less than 1!3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. 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 ear expiration date. ~2~~ Df~ SIG 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 th roperty des ribed above, by virtue of a warranty deed recorded in Register of Deeds Office. tp l ~3/ ~ f] GNA OF APPLICANT DATE *'**** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *****~ ** 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 STATE BAR OF WISCONSIN FORM 1 - 1982 ~ WARRANTY DEED DOCUMENT NO. w Y6~ 1522PA6E 5U. Howard LaVenture, three-fifths This Deed, made between (3/5) interest in and Arlene LaVenture, two-fifths (2/5) interest in, as tenants in common. _ Grantor, anti ~ ~ K~Yt: ~ ~~ Grantee, Witnesseth, That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate in St . Croix County, State of Wisconsin: LOT 28 OF PARKWOOD MEADOWS, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN 625424 KATHLEEN H. WALSH kEGISTEk OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06-~6-000 3:45 PM EXEMPTTN DEED 17 CERT COPY FEE: COPY FEE: 4.04 TRANSFER FEE: RECORDING FEE: 10.04 PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS L.a,C'l~~e C~ ~s I n cr . 52t -~c~1,~,4~eon ~cE. SD~n W ~. SL(oi to ._ . PARCEL ENTIFICATION NUMBER L This deed is given in partial satisfaction of certain land contract dated February 19, 199 acid 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 60323 This is not homestead property. ~`i3~ (is not) '. Together wi[h all and singular the hereditaments and appurtenances thereunto belonging; ~; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except all liens, covenants and restrictions of record, encumberances created by act or default of the Grantees and will warrant and defend the same. Dated this ~ 3 day of June + AUTHENTICATION Signature(s) ii if any and any liens or i I' li ~~ 2000 (SEAL) ~ (SEAL) + Howard LaVenture ii I, (SEAL) ~it pJ.~in . (SEAL) .~-~ ~ .. + ~ Arlene LaVenture ~' authenticated this ~ ~~~ + TiTI F• MFMRFR STATF RA F WiS("[1NSIN ACKNOWLEDGMENT State of Wisconsin, ss. County. Personally came before me this day of 19 ,the above named ,00'9L o ,00'5 ,09'6'6£ 8l °00 S o 3 ,09'~L£ ~S8'89£ ~- -- .8t:'Z9Z l M „Z£ ,8 L o00 N ---r--- -~--t- - U r~ \ -~ ~ r ~ ,£6'86 ~. - ---~ \ `J T ~. rn ~1 ~n UN 3 W~ 3 ~ 3 \~ I WW ~ QN - - li N ~!'~ ~ (n W \ V1 ad. M • ~O Nn ~_QN N1~ UN N1~ a(n I (~ aD in W: ,3, „Z£ ,8 L o00 S N ~ u~ N A rn o M N N Q oNO M N ~ a I ~ ~ ; ~ ,00'OS l~ ~; ~ o> M ~ o o~ M ~ °D ~ °i `I (v ~ ~n tNQ ~~ IZ ;~ Z Z Z N O I ~~ O N Q~ O:r) I p~.-. O M Z 111 p;~ I I 00 pp ~ Q (n 00: p) _ ,OL'6l Z vl a0 a°o ~ w : ,00'991 .00'0£ : . z ~ 1 ,OL'68L Z ,00'021 ,00'9~l ,00.992. ,pQ•S9Z ,0 •000£ . ~ ~ ,bZ'~T~ ~ _': ' -3b'6~`~ ~ . :6a'O~Z . . ~'bS~- . .Oa'6~`Z- I I OL'fil£l M „Z£ ,8L°00 N ~ N 1 I U ~ ,0l U to ' d- a tD ~~ w~ 3~ _ N 3 3 3 ~ T7 W~ _ _ ~ ` V Nom.. ^' '- MU~ Ui ~ fn 0I W W O) W W M O e I~ 1 WQW ~ :~ 1 ~QcD N~ UN Nh U~ Np N~ ' ;st (O t7 (~°'~ ,°rMi; :o Noo ~n~ C~QO~ ~.t Q~ ~o ....M..,.6Z,~6Lg00 IV sir- ~. ; No o ~o ~ CV ~o ~ ~3: ,10'012 ~ , 3 ,09 N - ~_ - _ N~'- 1N3W3Sd3 .~ ~ZL'9~Z l M „6Z ,~ l 000 N - - - ~;°0 39~/NI'd2i0 ° o ° •ao rn ~* o rn:~ o 9a0 ,91'6£ °D' ,S l'6~Z z . ,L '9~Z _ . ,00'092 . ,QO O9Z. 'aS~_ . z: . , l 0.O L Z_ ~ - ,_,^,~, ~ Qb~a ~~~b4 ,S6' - LZ z~lo °rnz ~Q~ Jib U Z~ N Q U A SaNd~ a311b'~dN(1 ~o z =o u ~ I ~NFN--mU m~J a~ ~oN :off ,,~ :NOf 00 Z ~ ~' ~.SZ ~Yl Q M