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HomeMy WebLinkAbout020-1359-30-000• ~Wiscons~DepartmentofCommerce 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 ^ T~(~vn of: Scharber, Peter Hudson Township CST BMElev.:- Insp. BM Elev.: BM Description: ~ ~ cTU . D r ~S j i?wt'~ ~ -_ ~ ~~...~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ P ZOO ~ Dosing ~j Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic > SO ~ •.~ z Q r ---. NA Dosing ~ ~D~ tc 33 NA Aeration ~ NA~ Holding PUMP /SIPHON INFORMATION ~1 Manufacturer and tLtVAIIVN UAIA County: St. Croix Sanitary Permit No.: 363868 State Plan ID No.: Parcel Tax No.: 020-1359-30-000 STATION BS HI FS ELEV. Benchmark '- ~' oS:SS (C5~ .c~ r Alt. BM 6.6 `~'8- g o ' Bldg. Sewer /~- ~ y ~ 3 •`~ 1 St / Ht Inlet Iz. 33 ~i' ~ -z.-Z St/Ht Outlet Dt I l t n e Dt Bottom jlo. ° S Header /Man. Dist. Pipe ~,~, 8, z s q~~ 30 `~Bot. System ~ g 9S•~ Final Grade ~, .~, e~r i qS. S D St cover ~ D r `(~-•s'S' ~,~ Model Number (~ a~ GPM ~~ ,tti TDH Lift ,+{~ Lriction ~,,+(j, System TDH 8.~` Ft `~" Forcemain Length ~(p + Dia. F~ u Dist. To Well , SOIL ABSORPTION SYSTEM (iz1 rD ~. - ~.o_~~ e ,~ D ~. ~ ~B~rB TRENCH Width ~ Length Y No. f Tr nches _ _ PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N .3 ~S Z ~ "DIMEN I N SYSTEM TO P 1 L BLDG WELL LAKE !STREAM LEACHING Manufacturer: 1 - 5i~ ~ SETBACK S ,.w c INFORMATION TypeO C ^' S ~ "'3 `~ ~ CHAMBER OR UNIT Mo a Num er: .BN^f ~ System: 3 ~ , DISTRIBUTION SYSTEM v Header / Mani old ~i Distribution Pipe(s) x Hole Size Hole Spacing ir Intake o A Vent T Length ~ Dia- ~ Len Dia. aung w n ~ _'v r 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: ~/! 9/ ~ Inspection #2: / / Location: 948 Meadowood Lane, Hudson, WI 54016 (NW 1/4 SW 1/4 16 T29N R19W) - 16.29.19.2126 Parkwood Meadows -Lot 30 1.) Alt BM Description =`~ ~ u,~-ia• ~ ~ Bw S~ ~ u'~'l 2.) Bldg sewer length = 20' _ - 2 `~ es.,~-. -amount of cover - ~ ~ ~~ Plan revision required? ^ Yes ~ No • ~ Z. Use other side for additional information. nS 1 q ao SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ~ + SANITARY PERMIT NUMBER: ~ ~ y ~ 1~ow ~ ~~ ~~SC011S%11 SANITARY PERMIT AP TIC rl ~ Department of Commerce In accord with Comm 83 Y1(i i • Attach complete plans (to the county copy only) for the , on of 1 than 8 vi x 11 inches in size. _'~ •' ~'~~~~~ U • See reverse side for instructions for completing this a ~i~ation ,~~1. ~~ Personal information you provide may be used for secondary purposes ,_ ~ ' [Privacy Law, s. 15.04 (1) (m)]. ~~ ,~ ~ t`i~.R~ Safety and Buildings Division 201 W. Washington Avenue POBox7162 Madison, WI 53707-7162 county - ~ >< OC, :~ ate Sanit~ ~ rmit Num 1 r [~ Check if rewslon~ ewous appbcahon to Plan Review Transaction Number I. APPLI ATION INF RMATI N -PLEASE PRINT A'~L` F ON ~ '~ `~ -"' Pro rty Owner Name i .; - ope,. n Property Owner's Mailing Address Block Number + cr City, State Zip ode Phone Number Subdivision Name or CSM Number YP B ILDING: (check one) ^ State.Owned ~ It Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ^ Village ^^ wn OF Cpl./ ILL .BUILDING USE: (If building type is public, check all that apply) ~ Parcel Tax Num ei(s~ ~ ~1 ~~D / ~Q ~q ~ e s~9~ ~ 7 _ 'Y• ~! - ~ 1. ~ ~f0 l~aa 1 ^ Apartment/Condo 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) q) 1. ~] New 2. ^ Replacement 3_ ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an _______~stem ________System _____________ TankOnly______________ Existing System _________Exlstln~System - B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed _, /, ~ St~~ 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 eepage Trench ~ /r ~(~~2 ^ In-Ground Pressure 42 ^ Pit Privy / , 13 eepage Pit 43 Vault Privy 14 ^ System-In-Fill ~ ~ VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day ~ 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Csrade Required (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) p. ~ .Elevation s ~ ' , ! Z -t Feet Feet _ VII NFORMATION Capaclt in gallons Total # of Manufacturer's Name prefab. con l St Fiber- plastic Exper. N E i i Gallons Tanks concrete ee glass App. ew x n st strutted Tanks Tanks Septic Tank a ~--- ~ ^ ^ ^ ^ ^ Lift Pump Tank ber '~' ~~ elm ~ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum 's Sig ature: (No St MP/MPRSW No.: Business Phone Number: a~ ~ ~a ~ ~ - s -~~ Plumber's AddKKress (Street, City, State Zlp Cod ~~D 11~ IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee flncludesGroundwater ate ssue Iss ing gent Signature (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) ~~ ~~ Adverse Determination D X. CONDITIONS OF APPROVAL /REASONS FO DISAPPROVAL: ~1~~G~ C --Tloc~PlGUtiI ~~ ~ -~ SgD-6398 (R_12/991 DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber _JN.STRUCTIONS ~ ~ Z 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 by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onste sewage systems-must be properly maintainpd.<-The septic tank(s) must be pumped by a licensed pumper vvh`enever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your focal code administrator or the State of Wisconsin, Safety and°.Buildings Division,, ¢p8-266-3151: 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 oe 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. r. 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 only if tanks received experimental product approva- 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 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dirne~sions, 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 th.e county; E) soil test data on a 1 15 form; ant~'F). all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices whi~c~ ca-~~ effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. •T - ,, ~3/~ = /oo / ~UL ~~ 30 /~ ~ J I' Nom- u.~ ~ aoo~ ~ oa ~;,~ . ~ ~ 1 ~ ya, ~~ ' nlrt -tio ~, L ,c, 1 t ,. ~ ~OV --~ Jrw"1~..~.'`2 1 Eaac...l.vt.-~ i ® kf~ ~~ ~~iLL U4~ S ~ Losv~~y w i ~. - - o ~ ~ Cv n~ wt ~3 ~ N ~ ff( L -- , ~ --------- ..._..~. t ~ laaa ~ E'oA 1 _ t/~ 3,~ ~.~ ~_ a 4~..~ _ x ~~ - x ~. 9 S•?a l S0',F' a ~~U x ~ -~,~.~ a~~ - ~"~ X~3'~ 'r X ~~ I~ , 13~ ~ 99.74 SO;; ~,;._ /~c~ aao3.5'J ~G yy ~ t`f-/o G ~ ff-/c~ s~. ~, .9s ~~ ----- -"'=--.':^+•'nL~ ~KOSS SECTION AND SPECIFICATIONS 4" CI PENT PIPE I2" MIN. ABOVE GRADE 8 ?S' FROM DOOR, WINDOW OR WCATHER PROOF FRESH AIR INTAKE -- JUNCTION BOX APPROVEC FINISHED GRADE 4" CI RISER WITH CONDUIT MANHOLE 6" MIN. W/ PAD LO - ABOVE G ADE ~-'WANING 18" IN. bit MAX. `~---4" MI INLET ~; ~ +- ~ ', WATCR TIGHT SEALS ~ • GAS- ' ~` k" ~ TIGHT. ' CI PIPE BAFFLE ~ A SEAL ~ , gpPR 3 ONTO --L-. OV £D , B ~ ALM JOINTS W/ SOLID -~-- + ~ ON PIPE 3 ` 0 SOIL C ~ SOLID SOI PUMP OFF ELLV . FT. _.~._. ~ ' OFF ~* RISER D PERMITTED IF TANK 3" APPROVED BEDDING UNDER TANK MANUFACTU~ HAS APPRO' SPECIFICATIONS CONCRETE PAD ~FPTIC / DOSE ~-- •---•---... -- -........_ ...... . `TANK MANUFgC~R£R: NUMBER DOSES PER DAY: ----._._ 'rnNK SIZCS: SEPTIC ~ OC? GAL. DOSE VOLU!'fE INCLUDING DOSE GAL. ALARM MANUfgC~RER: FLOWBACK: ~ ,~D GAL. MODEL NUMBER: CAPACITIES: A ~~'~~IRCHES = ~~-c,~ SWITCH TYPE : O ~.[~.! -,:~~ ~~.L6 _ i'`t~.~.-t--~. B = _?_ INCHES = ~Q C PUMP MANUFACTURER: ~~ ~~ MODEL NtJMB£R : C SWITCH TYPE: .1L~31NCHES = y 6Q-' K£OUIREO DISCHARGE RATE D _~ INCHES = r.~0_e GPM PUMP ~ ALgRy ydIRING AS PER ILHR VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION pIpE ~ 16. 23 + MINIMUM NETWORK SUPPLY PRESSURE , ` .__.,.,5 FEE T ~_;'S4 FEET FORCEMAIN X ,(i~/FT/ Zpp ~FT, FRICTYON FACTOR . '~°~ FEET . . TOTAL DYNAMLC HFAp _ --~ FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH F££T "_,.~: WIDTH ~~~ pIAMETER LI QU I ~ LICENSE HUMBER ,~ ~aa6~ Goulds Submersible Effluent Pump ~C~ 3871 EP05 ApP~ICaTIONs Specifically designed far the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/a' maximum. • Capacities: up to 55 GPM. • Total heads: up to 24 feet. • Discharge size: 1'!z" NPT. • Mechanical seal: carbon- ratarylceramic-stationary, BlJNA-N eiastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C} intermittent. • Fasteners: 300 series 5taln{ESS Stee}. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: %," maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:lYz° NPT. • Mechanical seal: carbon- rotary/ceram ic-stationary, iiUNA-N elastomers. • Temperature: 104°F (40°C) continuous 144°F (60°C) intermittent. C~ 1995 Goulds Pumps • Fasteners: 300 series staiMess steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, f 15 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 overtaad with automatic reset. • Power cord: l 0 foot standard length, 1613 SJTO with three prong grounding plug. Optional 20 loot length,16l3 SJTW with three prong grounding plug (standard on EP05). METERS FEET io 9 30~ 8 25' p ~ a m x U 6 20 S } 5 o ,5 ~ 4 H 0 3 10 z 5 1 0 00 • Fully submerged in high grade turbine oft 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. ^EP05 Impeller: Thermo- plasticenclosed design for improved pertormance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplas- tic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and wafer resistant. ^ Bearings: tipper and lower heavy duty ball bearing construction. AGENCY LISTING Canadian standants Association (CSA listed mode! numbers end in "F'° or "At',^.) f --~SGPM 2.5 FT G~~APACtTY ~ ~J / ~ ~` ~" E1recGve May, t 995 B3g7t Wisconsin Department of Industry, SOIL AND SITE EVALUATION R E P O R T Labor and Human Relations f)ivisien of Safaty A Ruildinns _ _J - :.~ u 1 1 n n u:. A J.... n.. J.. Page 1 of 3 ' 111 ClVVV1V •.Illl 11-111 ~ VV.VV, •.IV. r.V ... vvvV COUNTY Plan must include but in size om lan on a er not l n 8 1!2 x Atta h l t it s th S , s p p . c c p e s e s a e e p ' artd;% of slope, scale or not limited to vertical and horizontal reference poin ) diriiscxioh PARCEL LD. # i. __.. dimensioned, north arrow, and location and dis c~~tj.~+~~res4 road. ''~..- 020-1029-30 APPLICANT INFORMATION-PLEASE R I ALL~'NF~MATION '°. E R IEWED BY ~ 'T , ,, . '` Y ~ _7~ PROPERTY OWNER: // `- ~ PROPERTY LOCATION / 1 s Inc ~~~ GOVT. LOT ~ 1i4 ~ v4,S 16 T 29 ,N,R 19 ~(or) W PROPERTY OWNER':S MAILING ADDRESS f` T 0~1 ~ .LOT # BLOCK # SUBD. NAME OR CSM # 521 McCutcheon Rd. '~ ~> ~ k 30 na Parkwood Meadows CITY, STATE ZIP CODE ", ON ~JCITY (]VILLAGE [SOWN NEAREST ROAD Hudson, WI. 54016 x,),,381- X05 , H udson Meadowood Ln. [ ~ New Construction Use [X] Residential I Numbe be ~ 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 /site considerations na Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system f CONVENTIONAL ®S ^ U MOUND ®S ^ U IN-GROUND PRESSURE ®S ^ U AT-GRADE C~ S ^ U SYSTEM IN FILL ®S ^ U HOLDING TANK ^ S ~U ors stem U =Unsuitable SOIL DESCRIPTION REPORT Boring # - 1 ~: Ground elev. 99.9 ft. Depth to limiting factor +88" Boring # :.:.2....>. Ground elev. 99.6 ft. Depth to limiting factor +88" Depth Dominant Color Mottles Texture Structure Consistence Bour~r Roots GPDlft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-13 10 r 2 2 none 1 2msbk mfr 2f .5 l .6 2 13-24 10 r 4 4 none sil 2msbk mfr 2f .51 .6 3 24 31 10 r 4 4 c2 7.5 r 5j8 sil 2msbk mfr gw if .5 .6 4 31-88 7.5 r 4 6 none cos --- Os ml na na 1 .7 .8 .~ ,y Remarks: 1 0-10 10 r 3 none 1 2msbk mfr 2f .5 .6 2 10-24 10 r 4 4 none sil 2msbk mfr 2f .5` .6 3 24-88 7.5 r 4 6 none o s Os ml na na .7~ .8 •~g z.~ Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. .New Ri hmon I 54017 Signature: Date: 7-8-99 CST Number: m02298 PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL f.f). # 020-1029-30 Boring # 3 ................. Ground elev. 99.6 ft. Depth to limiting factor +88" Boring # '4 Ground elev. 99.5 ft. Depth to limiting factor +84" Boring # ..... 5 Ground elev. 99.4 ft. Depth to limiting factor +84" Boring # .................. .... ................ Ground elev. ft. Depth to limiting factor Horizon Depth Dominant Coior Mottles Texture Structure Consistence Bax~dary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-14 10 r 3 3 none 1 2msbk mfr 2f .5 .6 2 14-26 10 r 4 4 none sil 2msbk mfr 2f .5 .6 3 26-88 7 cos 0 ml na na .7 .8 ~.~ .8 Remarks: 1 0-10 IO r 2 2 none 1 2msbk mfr 2f .5 i .6 - mfr 2f .5 .6 3 ~<< 28-36 ZO r 4 4 c2 7.5 r 5 8 sil 2msbk mfr if .5 .6 4 36-84 7.5 r 4 6 none cos Os ml na na .7 .8 +iS'~ Remarks: 1 0-9 10 r 2/2 none 1 2msbk mfr gw 2f .5 .6 2 9-19 10 r 3/3 none sicl Zmsbk mfr gw 2f .4' .5 3 - 4 4 none sil 2msbk mfr if .5 .6 4 30-84 7.5 r 4/6 none cos Osg ml na na .7 .8 Remarks: Remarks: SBD-8330(8.05/92) s STEEL'S SOIL SERVICE Gary L. Steel LaCasse Custom Homes, Inc. 1554 200th Ave. CSTM2298 NW4SW4 s16-T29N-R19W New Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #30-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 lot lines were not established at the time the test-was conducted. /N ~1"=40' ton of 1 "nvc nine (~e1 _ 1On _ nn' t. ~ -....., GaRY L. Steel 7-8-99 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer~ ~` ,~4',~.~..r? .x.1~.~1~,2 Mailing Address ~y ©.~~i~~ G~%~c~,.C.E ~~~~~T.UJi~ .~yo1~ Property Address y`~~ ~,~~~~~~~/~ ~~~~~~•1/; F~Jj _ .~~1~ (Verification required from Planning Department for new construction) City/State ..~.~2~0.~/ !~i . Parcel Identification Number Oo? D - f D o2 ~f - 3~ LEGAL DESCRIPTION Property Location~~ %.,_ SCE %., Sec. ~~, T~,N-R~W, Town of ~s~~.~~~ Subdivision-~(~~~~~/~ ~.~..~~~~ ,Lot # ,~. Certified Survey Map # ~~ ,Volume .Page # Warraaty Deed # ~ ~ ~ ~ ~ ~ .Volume ~0 7 Page # Spec house ^ yes ~no Lot lines identifiable~es ~ no SYSTEM MAINTENANCE Improper use and maintenanceof 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, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 s g t your septic sy em been maintained must be completed and returned to the St. Croix County Zoning Office within 30 o ar ex do te. ~ / SIGNA OF APPLICANT DATE OV + R CERTIFICATION I (we) cedify that 1 state nts on this form are true to the best of my (our) laiowledge. I (we) am (are) the owner(s) of p e descri bo , by v e of a warranty deed recorded in Register of Deeds Office. r 5 / ld SIGNATURE 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 ~r~~.1467Pa~~ 4~9 STATE BAR OF WISCONSIN FORM 2 -1998 This Deed, made between ,_ LaCasse Custom Homes. Inc., a Wisconsin Cor ration Grantor, and Peter Thumas 5charbcr and Heather Scharber husband and wife Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described teal estate in St. Croix County, State of Wisconsin (The "Property"): o~ 6130385 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD S1-OZ-1999 9:00 AN YARRAHTY DEED EXEMPT N CERT CDPY FEE: COPY FEE: TRRNSFER FEE: 113.70 RECORDING FEE: 10.00 PAGES: 1 EAGLE VALLEY BANK, N.A. 1301 Coup=e Rd., Unit 2 Hudson, WI 54016 et Brozatoze-9o, ozo•toz9-oo wla ozo-1029-30 & 024102941/ Parcel Identification Number (Plt~ fl k0. This is not homestead property, d ~ ~S Lot 30, Plat 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. LaCasse Custom Homes, Inc. c.~. ~a. * Gr J. LaCasse, Secretary-Treasurer AUTIIEIVTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) (1' ) ss. authenticated this _ day of ~ - u 0 tX County ) Personally came before me this a s~" daY of October, 1999, the above ttamed LRCasse Custom Homes s Inc by Grace J LaCasse Secretary-Treasurer. _ - to me kttown to be the TITLE: MEMDER STATE IIAR OF WISCONSIN person(s) who executed the foregoing instrumem and (If srot, acknowledpo-tt ne. authorized by 4 706.06• Wis. Stets.) ~,,~ ,,, TEAS INSTRUMENT WAS DRAFTED BY ! ' 1=~ ~-i'- ~ ~ Attorney Kristine Ogland Hudson, WI 54016 - -~~~snndx3 u tary Public, State of Wisconsin ol~vd ion is permanent. (lf not, state expiration date: (Signatures may be autltentlcated or acktawled oth are not 4ti necessary.) ~p~slM io 3;81 ~~ 1 { clot) / _ ) NNII'~ 3N- •Names of persons signing in arty capacity slaxiid tx typed or printed txbw their signatures WAaRANrY DEED El'AlE BAR OF WtECON6D1 iORM Ne, t • t99a -i~~. INFORMATION PROFESSIONMB COMPANY FOND W IAC, Mrs af1D85340at f of ~~ ~?~; .N i.00 25' I i o' 91,519 5.h. 10' 1 ~~ ~ SANE z ~ _ ~• C3, ~ _~--~- - I i . , ~ils.oo' _ 51.73' _ ~ C p9 V ~ ' 23ss9' O. ~ .y o 9 ~ . ,~-• ~ • _ • ~ _ . 20.00_' _ 2.450 ACRES ~ 16/ ~ ~ S0' -~ ^-- 20' 106,716 S.F. ' / ' ~~ ~ ~ y1 ism ~ 150' 3 ~ 10;1 0 , ~6 ~ 33r133' ~ w ~' _ ~ _ ~ ~ Doti /~ .~ , ~ ~~ r j01: :OfM 1 q. i i o ~ ~~ 43. C. ~ 5/ S ~~ 16°c'~ p~0 MN iaoi~ :vS'o 2,755 ACRES /6 ~ I I °o °~~ pN~ :Np 120,000 S.F. I°53' 29" E _ _ ~~ ~ '~ I 28 2.419 ACRES 105,385 S.F. I )0' o ....... ... ...................... t~ 404.13' I ~ I .. 27 2.320 ACRES N 101.066 S.F. ~ ~ 1 ., s~°«, n~„ 3I (V I 26 ~ 2.322 ACRES 0 101,140 S.F. M 0 ~ O I a~o Z N 89°53'29" W °o i 404.72' z ~- I ' 25 2.324 ACRES 101,213 S.F. 7i 1 1 N 89°53' 29" 405.01' 89°46'121" , W, , , ...-;so:o~~ ~~ :3 24 in C9 W '' Q ~ :N g 2.321 ACRES ~ ?Iw :;l. 101,116 S.F. N Q N 0:~ 100' of W `~':o M S 89°46' 21" E 596. M - - - - J~,y~ -- ~.~ -- / ,n ~• ~ I pp 0 29 ~ . o ~ 2.928 ACRES I M `°o a 127,564 S.F. o S 89°53' 29" E I I .,'~ Q'...... I N 8 9" W _ ;N 392.77 g DRAINAGE o"' ° ° o EASEMENT ~°n: - N ~:O r' •O 180.00' ...... ............. N 3 0 N 89°53' 29" W -° 2.389 ACRES 0 o 104,082 S.F. co N I I ~ I I ur 'ago i I N ~i I ~ 89°53' 29" W 3 392.77' iv I M I .o 0 31 '~Z 2.389 ACRES ~• 104,082 S.F. ~ ~ I Z • Q N 89°53' 29" W 392.77' I III 32 2.389 ACRES 104,082 S.F. -') ~ o IN o O I ~ O O _ _ io z cn ~ ~--20' rO _ _ ._ ' .o O 91.81' 0 0 . N 54°37' 25" W 'moo :.Z h ` o ~ 15 p ~ N: o N 2.525 ACRES ~.wo Q W 109,997 S.F. 'opo 4 Q ~ 1 I .~ > ~ I w st9°53' 29" W '400.00' W p N O M ~ n ~• of . o I ~. II I to •° ~ci ~I N I^ ~I 150' I --- ~ ~~ ~ ~• 3' 33' 33 / 2.507 ACRES / Y 109,215 S.F. / ~ / / ~1 / i ,d ,~ti I~ I ~' ~U i R9o~t~~ . A?~;?~ O., '•, ~ ° 16 2.525 ACRES 109,997 S.F. : c o: p. 'r ~~ 89°53' 29" W '~: 400.00' 3; t N: M;' co: ~;i ° ~ 17 ~; 525 ACRES 2 Z: . 109.997 S.F. , in N; S 89°53' 29" E 150.00' , ~ 1 400.00' 53' 29'"• W vv..,.. :.~.........,.,..,., ... ~ 200.00' 3 N 89°53' 29" N ~ N "'_ co 0 18 o ~ 2.852 ACRES O 124.223 S.F. Z _ _ , G/ ~ -~` 435 ~4 y.. 190.90' / ' ~ ' ~'~ _. / / !-11- -- --7G-- - ~ -- -- -- _ ~I n