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Home My WebLink About020-1359-33-000W' D rt t f C m rce ~~ 1~ 33 I~~onsln epa men o o me 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: I rl City n Village f l Tovun of: CST BM Elev.: Insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ es~.r,~ l2~ ~~ Dosing V, ~~~ o, Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Vent to Air Intake ROAD Septic ~ }5 ~ 2$ ~ -' NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer ~~S Demand Model Number o ~ GPM TDH Lift 6.os Lriction (_Z, Syetem F ~.., TDH ~2g Ft Forcemain Length ,..~~ Dia. 2 " Dist. To WellC~) SOIL ABSORPTION SYSTEM EL~IVATION DATA County: St. Croix Sanitary Permit No.: 353332 State Plan ID No.: Parcel Tax No.: STATION BS HI FS ELEV. Benchmark f ~j. 30 09'•30 6D. D Alt. BM . 9s ) o . ~5 Bldg. Sewer R t,,5 q . 6 S St/ Ht Inlet Ifl ,12 cj q. f g St/ Ht Outlet ^._--, Dt Inlet Dt Bottom ~3.5~ ~-i5. ~Z, Header /Man. Dist. Pipe , 43 ~02.'S~ Bot. System g. ~tS ~, g5 Final Grade ~ ~,O o.5. 3a~ St cover b.is l 03• ~S 8fB TRENC DIM Width , 3 Len th {j No. Of Trenches 2. PIT DIMEN I N No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P 1 L BLDG WELL LAKE /STREAM LEACHING M_anufac urer: ~- S`~c...~~.,&f INFORMATION TypeO ry ~ _ CHAMBER Model Number: System: l~o -ti`~ ~ ~' Z~ 5~ ~~' OR UNIT ~ _ e.c.~ DISTRIBUTION SYSTEM ~ Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake u _.,. / Length~~ Dia. _~ Length - Dia. _._- Spacing ~~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over I 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: 3 /24/00 Inspection #2: / / Location: 928 Meadow Lane, Hudson, WI 54016 (NW 1/4 SW 1/4 16 T29N R19W) - 16.29.19.2129 Parkwood Meadows - Lot 33 ~ w~ ~~~~ 1.) Alt BM Description = `F°P ° Q° 2.) Bldg sewer length = 2S -amount of cover = > yo " So ~ l r~v~-- 3~ ('~~ we~- v+.~" Ce.1S~~~ 0.,-k- -~~ o~ ~ksQe~"~'~a~n Plan revision required? ^ Yes ~( No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. y~~sconsin Department of Commerce ~ qa g ~~~ G SANITARY PERMIT APPLICATION In accord with Comm 83.05 .Code 8~ r~ Safety and Buildings Division 201 W. Washington Avenue P o Box 71 s2 Madison, WI 53707-7162 • Attach complete plans (to the county copy only) fort t 'paper: n`cN,less County ~ -than 8 v2 x 11 inches in size. .~ ' ~ S] • See reverseside for instructions for completing th' licati r" 'L~ - ~. ~._ ~ State Sanitary Permit Number , 1 ,: ~ 353332 Personal information you provide may be used for secondary pu [ r . ~ ~ ~ rt,~ ~^ rE -- ^ Check if revision to previous application - , [Privacy Law, s. 15.04 (1) (m}]. i ""' ~ Ls~"~,~ State Plan Review Transaction Number I. APPLI ATI N INFORMATION -PLEASE PRI LL I ~-TIO F,Y~ r /1/ -- Propert Owner Name ~ : , e o tion R19~(or~ N Zia S 1 ~ T Z ~ , , . , p. O Property Owner's Maili g Address ,^' ., :. .r u Block Number ~, City,. tat Zip Code Phone Number Subdi 'sion Name or CSM N ber Q (7~) -.~ P B IL I G: (check one) ^ State Owned ~ ~ It a Iowan Nearest Road ~ Public 1 or 2 Famil Dwellin - No. of bedrooms OF `L III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number s ~Zo - t 3~~°t -',3-oa o Ito .?5i . t ~ ~ 21 ~ 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 ~ ~rstem ________System_ _____TankOnl~______________ Existing System ________ Existing 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 21 ^ Mound 30 ^ Specify Type 7G3 ^ Holding Tank 12 Seepage Trench 22 ^ In-Ground Pressure ~ ^ Pit Privy 13 ^ Seepage Pit a = .3. ~ ^- 43 ^ Vault Privy 14 ^ System-In-Fill - ~ ~ ,S' 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 Grade Required {~, ft.) Proposed (s q. ft~ (Galslda /sq. ft.) (Min./inch) Elevation ~ -""" e Feet s Feet ~ VII. TANK INFORMATION Ca acct in allons g Total # of Manufacturer s Name .Prefab. Site con- l s Fiber- Plastic Exper. N ti E i Gallons Tanks concrete tee glass App ew n x s strutted T nk Tanks Septic Tank or Holding Tank O0 ~" Q~ ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber QQ "'~ Q ~ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite s wage system shown on the attached plans. Plum er's Name (Pri t) Plumbe 's Signatu e: (No to ps) MP MPRSW No.: Business Phone Number: ~- ~~ ~~ ~ ~ao3s s - y s Plumbe~ Address (Str ity, State, Zip C >: ~ C~~ r~ ~- ~ O 6 - c IX. COUNTY /DEPART ENT USE ONLY ^ Disapproved nitary Permit Fee (~^cludes Groundwater a e ssue Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial surcharge Fee) '2 ~ ~ Q~ 3 ~~ Z Adverse Determination . X. CONDITIONS OF APPR VAL /REASONS FO~t DISAP_ P~tO\(AL: tr .ir t) ~,,..o t3e~oe~s t1~_ e-+.. ~~ `z . T"C.~ -~I+-o o ~ r-t c-E S a~ ~~ sew. Q s ~~ SBD-639B (R.12I99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, 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 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. Onsite sewage systems must be-properly rrYafitair~~c~+ The septic tank(s) must be pumped by: a fiebnsed pumper_wlidne~er necessary, usually every 2 to 3 years. , 6. !f you have questions concernirfg your onsiie sewage system, contact your local code administrator or the state of .- ' Wisconsin, $afgty anal Buildings Division, 608;,2,66-3151. .;,, _ ~ ~ °° ' . ;' _ ., , t.. To be complete and acturat@ this sanita"ry 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 instal-led. - ~ _ ~ ~ - 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 on line 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 i nformation. 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 approval from DILHR. VIII. Responsibility,st~tement. 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 Qnty. . , X. County /Department Use Only. Complete plans and specifications,not smaller than 8 1/2 x 1 1~,inches must be submitted tp-the county. The plans rust include the followting: A) plot plan, drawn to scale cx with co-r-Iplete..dimensions, location of hfllding tank(s), se'pti 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 Igss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system i~ hequired•bytfae.county;-E~ soi! test data or) a,1 15 foam; at~d ~r all sizing information. _, GROUNDWATER SURCHARGE 1983 Wisconsin Act 4ti1Q included the creatiori`ofsurcharges (fees) for a numb~f of~~csgulated~{ir~aFticeswvhch can ~ ' `4 .... effect groundwater. ' ' ~ `e, ~ , The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. , ~' ~ ~ ~ ST. CROIX COUNTY ZONING DEPA AS BUILT SANITARY REPORT owner Property Address City/State -~ ENS- o_~ ~ ~: ~' `~, ,~;~ 1 ~~. Legal Description: ~ ~~~~ ~; Lot ~ Block '" Subdivision/CSM # '-~_~, ILIIUt/,, SGT'/4, Sec. f~, T~N-R~W, Town of ,_,~L~,,,~~ PIN # .~, .. ~, SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC Pump manufacturer Model ~ Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: ~~~~~ ~~ C Type of system: ~"1D ~~"~~`t,Width J Le~gth ~~ Number of Trenches _,~._ Setback-from: House ~ Well ~ P!L ,~:~ Vent to fresh air intake ELEVATIONS: Description of benchma~ Description of alternate Elevation ~~O / Elevation D < 3S ~~jj / ~ Building Sewer 9l~ 6~SThiT Inlet ~ ST Outlet PC Inlet '"'-" t PC Bottom ~ Header/Manifold Top of ST/PC Manhole Cover ~[~~r _~S Distribution Lines Bottom of System Final Grade f ~~~ ~ C r ( ~~~~--~ / ~ /~ ~ ~( 1d ~-~ l( ) Date of installatio ,67 / ddPermit number State plan number --- Plumber's signature ~ License number l1t~o1~83.5~7 Date / / from: House ~ Well ~ P/L~~- Inspector /~~- Complete plot plan ~ -. ~ ~ NOTICE: Please provide the following: A plan view sketch showing everything within 100 feet of the system. Two horizontal reference points to center of septic tank manhole cover. Show alternate benchmark, if applicable. PLAN VIEW a-~~ ~ ~~ l ~ ,~~ lv ~ ~ INDICATE NORTH ARROW LaGAsse Custan Hanes, Inc. NW`~SW'~ S16-T29N-R19W town of Hudson lot #33-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. 1"=40' BM.= top of NW lot stake ~ ei. 100.00' Alt. BM.= top of mid-lot survey stake ~ el. 99.20' ~~roti ~~~ ~o ~,~ ~,.~ ~~ 3~ , ~- n~ 6 - ~t X3.5 ~- /'s ~` ~S~ a ~~` ~~`~ ~aod~ go a N~ 4~ G n /a'` Q Mp ~aassT ~WisconsinDepartmentoflndustry, SOIL AND SITE EVALUATION REPORT Labor and Human Relations Division of Safety & Buildings :_ _____~ ...:.~ ... Ir, ~., .,~ ~.~:., e,~.., n„,~,. Page 1 of 3 ~ "" - 111 GVVV~V ••~1~~ ~~I ~~ ~ VV.VJ, •~V. i.v...• vvvv COUNTY but Plan must include /2 x in size lan on a er not less than 8 1 Attach com lete site St. Croix , p p . p p _ ~ ~ not limited to vertical and horizontal reference p°;''""t~~"` di~dtidn and,% of slope, scale or PARCEL LD. # dimensioned, north arrow, and location and dis~ioe`to-nearest road. ~' ~, 020-1029....-30 ~~NT ALL t'~iMATION\ APPLICANT INFORMATION PLEASE ~ R VIEWED BY DATE - R r ~. ~ ~ , 3 -t q~-20vD PROPERTY OWNER: ~ '-~-°;'~ Idt r PROPERTY LOCATION ' , , LaCasse Custom Homes, In :-' ~ f VT. LOT ~ 1/4 G SW va,S 16 T 29 ,N,R lg f(or) W PROPERTY OWNER':S MAILING ADDRESS ,~; -; r C +`~O~x L~ T # BLOCK # SUBD. NAME OR CSM # 521 McCutcheon Rd. ~''~ 2 ~N ' 33 na Parkwood Meadows CITY, STATE ZIP CODE ON ,(`~ ' CITY VILLAGE [OWN NEAREST ROAD Hudson WI. 54016 381- ~`~ Hudson Meadowood Ln. [ ~ New Construction Use [x] Residential / Numtte 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) 100.85 ft (as referred to site plan benchmark) Additional design /site considerations na Parent material outwash Flood plain elevation, if applicablena ft S =Suitable for system CONVENTIONAL ®S ^ U MOUND ®S ^ U IN-GROUND PRESSURE ®S ^ U AT-GRADE (~ S ^ U SYSTEM IN FILL ®S ^ U HOLDING TANK ^ S L~U U =Unsuitable for s stem SOIL DESCRIPTION REPORT Boring # 1 !~~~. Ground elev. 104.3 ft. Depth to limiting factor +90" Boring # 2 Ground elev. 104.8 ft. Depth to limiting factor +g0" Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trench 1 0-10 10 r 2/2 none 1 2msbk mfr gw 2f .5~ .6 2 10-23 10 r 4/4 none sicl 2msbk mfr gw 2f .4 .5 3 23-35 10 r 4/4 none sil 2msbk mfr gw if .5 .6 4 35-90 7.5 r 4 6 none cos Os ml na na .7 .8 Remarks: 1 0-11 10 r 2 2 none 1 2msbk mfr 2f .5 .6 2 11-21 10 r 4 4 none sicl 2msbk mfr 2f .4 .5 3 21-35 l0yr 4/4 none sil 2msbk mfr gtir if .5 .6 4 35-90 7.5 r 4/6 none cos Os ml na na .7~ .8 Remarks: C5TNome:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave New Richmond 54017 Signature: Date: CST Number: m02298 7-8-9 PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT PARCEL LD. ~ 020-1029-30 Boring # ~> 3 Ground elev. 104.7ft. Depth to limiting factor +90" Boring # 4 Ground elev. 104.8. Depth to limiting factor +~n~~ Boring # 5 i Ground elev. '~ 104.3 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 Baxxiary Roots GPD/ft in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-9 10 1 mfr 2f .5 .6 2 9-21 20 r 4 4 none sicl 2msbk mfr 2f .4 .5 3 21-33 10 r 4 4 none sil 2msbk mfr gw if .5 .6 4 33-90 7.5 r 4 6 none cos Os ml na na .7 .8 .~- oo • SS ~~ • 2^62-- 2- Remarks: 1 0-10 10 r 2 2 none 1 2msbk mfr gw 2f .5 .6 2 10-22 10 r 4 4 none sicl 2msbk mfr gw 2f .4 .5 3 22-36 10 r 4/4 none sil 2msbk mfr gw if .5 .6 4 36-90 7.5yr 4/6 none cos Osg ml na na .7 .8 ~~~Yo4~ Remarks: 1 0-10 10 r 2/2 none 1 2msbk mfr gw 2f .5 ;.6 2 10-19 l0yr 4/4 none sicl 2msbk mfr gw 2f .4 .5 3 19-26 10 r 4/4 none sil 2msbk mfr gw if .5 !.6 4 26-31 10 r 5/4 2 7.5 r 5/8 sil M na gw na np .2 5 31-90 7.5 r 4/6 none cos Osg ml na na .7 '.8 ~~ y/~~. Remarks: Remarks: SBD-8330(R.05l92) ._ t 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 xudson (715) 246-6200 lot #33-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 ' M -top of NW lot stake ~ el. 100.00' t._ B~I..~ top of mid-lot survey stake C el. 99.24' Gary L. Steel 7-8-99 • - ---- - -••• ~_.:+~~os.R utOSS SECTION AND SPECIFICATIONS - - 4" CI VENT PIPE 12" MiN. A80YE GRAOL ~ TS' FROM DOOR, MINDOW OR E wGTyER pRppF FRESH AIR INTAKE JUNCTION BOX APPROVED KITH CONDUIT MANHOLE c FINISHED GRADE 4" CI RISER W/ PADLOt 6" MIN. -- -MARNING 1 ---. ABOVE G ADE - ~_v" MI1 18" IN. 6" MAX. INLET ~ . ~ ;. - a ~ ~ ~ WATCR TIGHT SEALS ~S- ~ „ 4 / TIGMT~ CI PIPE 6AFf LE _../ ~ SEAL , APPROYEp 3' ONTO _ 8 ~ LM JOINTS W/ SOLID -~~- ' ON PIPE 3' 0 SOIL C ' SOLID SOI PUHP OFF ELN . ~-FT. ~ OFF #+ RISER D PERMITTCD IF TANK MANUPACTU? 3" APPROVED BEDDING UNDER TANK HAS APPRO' CONCRETE PAp SPECIFICATIONS SEPTIC / DOSE c` A 'TANK NANUFACTURFR : J'11~.t~lt~w~_ ~rnNK S2 Zr5 ; SFpTZC 1 aOt~ GAL. DOSE ~~_ ~jL, ~-LARH MANUFACTURER: A,~ HODEL NUI'tBER SWITCH TYPE: NUMBER DOSES PER DAY: 3 DOSE VOLUME INCLUDING . FLOWBACK: p~ ~ , GAL. CAPACITIES: A s ~/SINCMES ~(~c B : _,?_ INCHES = ~ D ~ PUMP MANUFACTURER: ~~ c/ MODEL NUNSFR : C ~Sa~INCHES = ~~~.L_c SWITCH TYPE: D = ~ INCHES = ~_~ REOUiRED OisCNARGE RATE r Gp~{ p~,inP E ALARM {„1IRING AS pER ILyR ~ Z6. 23 YGtTICAL DIFFERENCE BETWEEN PUlSP OFF AHD DjSTRIBUTION PIpE . ~~ • MINIMUH NETWORK SUPPLY PRESSURE _ _ ~-~-~.~.__ FEET 1~ FEET FORCE?lAIN X .7 FT/ 100 FT. FRICTION FACTOR . _ ?"~J- FEET TOTAL DYNAMIC NEgp _ -1~~z~ FEET rkTERNAL OiHENSiONS OF PUMP TANK; LFJ~G1.yFEET WIDTH ; DIAMETER LIQUID DEPTH ~~ !C -~---1 ~ ._--_._ • :IGNED: LICENSE MUMOER: n ••ww. ST CROIQC COUNTY SEPTIC TANK MAINTENANCE AGItEEMBNT AND OWNL~RSHIP CL~RTII+ICATION rORM OwnerBuyer ~'~, e ~,, ~ s im ~ r S Mailing Address _ ~! 9 7 I /+ tL ~ ~~ .3 S t-~ 4`] S_ ~ T.~t ~S ~" ~ni-[~, Property Address (Verification required from Planning Department for new constnrction ~~ c~ a~-IO3~--RD c+~~-~oLp_ City/State l~ >,, ~ acs~..~ k1~ Parcel Identification Number ~ Zt~ '-1 y z ~ ~ 3r~ -- o3c~.. i~,r- f LEGAL DESCRIPTION Properly Location ~,~.I '/,, ~ '/,, Sec. j~_, TAN-R~W, Town of j1,~ ~~J Subdivision ~,~}g Li,~~sC'I iR~ ~,:~~e~ S .Lot ## ~~. CertiCed Survey Map # ~' , Volttme '~- .Page # ~1 Warranty Deed # ~ ~ 7 7 y~ ,volume f y S 7 ,Page # ~ ~ Spec house ^ yes [~ no Lol lines identifiable~J yes ^ no SYSTEM MAINTENANCE Improper use attd maintenance of your septic system could result in its prernatrtre failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pamper. What you put into the system can affect the function of the septic tank as a treatment stage in tltc 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, journeymanplumber, 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 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 rehtrned to the St. Croix County Zoning Office within 30 days of ilt a year expiration date. / /vD, SIGN TURF OF APPLICANT DATE _OW_ NER CERTIrICATION I (we) certify that alt statements on this forth are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG A OF APPLICANT DATE *+**** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Iaclude with thls 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 .~ Y~~.1~:87P~~i:406 STATE BAR OF WISCONSIN FORM 2 -1498 This Deed, made between LaCasse Ctstom Homes Inc a Wisconsin Corvoration Grantor, and Thomas Dances Marron and Mercedes S Marron husband and wife Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St- Croix Cotmty, State of Wisconsin (The "Property"); 617740 4CRTHLEEN H. WRLSH kEGISTER OF DEEDS ST, CkOIX CO., WI RECEIVED fOR kECORD 02-01-2600 2:ti5 PN WARRANTY DEED EXEMPT k CERT COPY FEE: COPY FEE: TRANSFER FEE: 119.70 RECORDING FEE: 10.00 PAGES: 1 Name and Return Address ,y~ % /IQ7Y1 RS '-d .~f'>^CFCf PS /'la/'~~1 ~.1 ud `.crt , t c: i ~4 G 1 (o ., t~~.C}-10~$-~fU~ Ua0-1019-oU nab -~aae-3v ono-~Cl19-yv Parcel IdcRlification dumber (PIN) This is trot hottxatead Property. Lot 33 Pazlcwood Meadow: Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any February Dated this a- G1dbD day ofJuwaq, 2000. * AUTHENTICATION Signature(s) authenticated this _ day of TITI E.: MSMBBR STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stars.) THIS INSTRITIviENT WAS DRAFPED BY .r ; A'~ Attorney Krishna Ogland Hudson, WI 54016 ~ i ~' (Signawres may be authenticated or acknowledged. Both are ~';~ rccessary.) ~~~ I-aCasse Custom Homes, Inc. • Rtchard W. LaCasse, Brestdent s ACKNOWLEDGMENT STATE OP WISCONSIN ) //11~ ) ss. It 0 i K County ) Fc j„~~, // Petsonally came before me this /sf day of 3enuery,l20t)0, the above named IaCasse Custom Homes, Inc by Richard W I.aCasse President to me known to be the person(s) who executed the foregoing instrument and acknowledge the ~4sattie~.~7,, , Ite of Wisconsin is permanent. (If not, state expiration date: ~('~. -•) I ` OC -.,tg~~ ,~, ...,,..I~ *Names of persons signing in any capacity should be typed or printed below their signatufcs WARRANTY DEED STA76 BAR OF WISCONSE-0 FORM No. 2 - I9Fa INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 8c0~55-2021