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HomeMy WebLinkAbout020-1370-37-000/* w1S00f1~" ~ °f cOrt11°r`'A PRIVATE SEWAGE SYSTEM Safety arw~Buikfin9s Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for seaondery purposes [Privacy Law. s.15.04 (1xm)j. Permit Ho is N$me: ^ City Vi lag Town o ndman, raves ~udson ownship / ~~~~ elf/ 1 I ^' TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~. Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic > ~-p r ~ 3 5 ~ -- NA Dosing NA Aeration NA Holdi PUMP /SIPHON INFORMATION M ufadurer Oemand Model ber PM TDH Lift Iction S tem TDH Ft Fo ain Length ell cA11 ARCAQDT1Af1U CVCTFM ~1 I ~ A I _ /) ( ~... - - -- - -- - - - -- 8'!B ENC - - - - - - - ~ cvwv~. - -... width I Lengths N Of Trenches PIT No.Of Pits Inside Dia. Liquid Depth 1 EN 3 ~~•~S ~ Z IM I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Mau ad rer: -- S;rQ~, SETBACK CHAMBER r N / r : um M e INFORMATION Type O > 52~ C 1 "' ~'a OR UNIT u ~ System: • DISTRIBUTION SYSTEM Header / Mani old 4 Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake ~ ~1 ~ Length ~ Dia. ~ ia. pa ~'' } SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~ Oepth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No ~I~lI M ENTS~' (,~ncl de cod discr ncies, persons present, ~~pection #1: o~ / I ° /°j Inspection #2: ---f-~ Location: 984 Parkview Lane, Hudson, WI 54016 (NW 1/4 NW 1/416 T29N R19W -16 Parkwood Meadows-1st addn. -I~o 3~~8"` ~ ( °'~r `...•~-~-~~ T~r.Q~o,~6.~ S .~e~r~ 1.) Alt BM Description =T~~ °"' ~- 2.) Bldg sewer length = 35 ~ l ll, td =loo•go~ -amount o cover = 7 ~~,~,,.,Q.~-t~5~~.~~ ' L;~~~,Qa..~.Q.. 1 l t ,~ =loo. tiw~~ ~ "Gat" -~ ~ } -zoo Plan revision required? / No~ 03 Ob p~ ~(S'?~ Use other side for additi n n. SEtD-6710 (R.3/97) Date Inspector s Signature „ ~ .,}gin Cert No n _ ~~Q2.C~,r 1.,2~t'kueR%Ci~'h~,d( ^ c~~ off. o' Ics-r~nb.~,,~-~-s d~. ~~~yCroix 384~33mit No.: State Plan ID No.: Parce Taz No.: 020-1370-37-000 ELEVATION DAl A "~ ' "~ ` ` ` ` °""" -' STATION BS HI FS ELEV. Benchmark It. BM , D Og ~ Bldg. Sewer $.`f O lob.bo' St / Ht Inlet $- 3 ~ 0 3. 68' St/Ht Outlet $.~-3 o3.y4~ Ot Inlet Ot Bottom Header/ Man. ~ Pe' "T- ~ 6h Bot. System S~ Final Grade $ .~p I Q~{ •001 i over g.o H7t 112.E -- I'~•~a'o •~ 9z- t ~~ ~r e ~~ J~ ~11~ ~ Z ~1~9 ~~ Safety and Buildings Division C~tY -~-- ~ ~ 201 W. Washington Ave., P.O. Box 7162 / , ~ ~ ~seons~n Madison, Wl 53707 - 7162 'te Address h~' De artment of Commerce Sanitary Permit Applic 1z~ f ~~' Percmit Number~ ~ a ~ 2 ~ ' j " you provide `~.~ In accord with Comm 83.21, Wis. Adm. Code, personal ~~ ' ^ Check if Revtsion ma be used for seco ses Priva La 1 I. Application Information -Please Print All Information ~ f 1 fE~ ~ ~ State Plan I.D. Number Properly Owner's Name O ? ?Op =' Parcel Number ~(~, , ~, Gj . / ~ p - S ~~~~ sr ~ O fj - 70 - 3 - O Property Owner's Mailing Address t~WMVG ~, ~F/GE '~ Property Location c/ / /~ l ~ O S ~ / ~. N (.l.) ~, N Lu y~; S I ~ T ~ ! N. R < City, Stare Zip Code ~j Lot Nu~ r Block Number Subdivision Name CSM Number ,U ~~ia ~ ~~s - 38l - syb /5,~ II. Type oP Building ( all that apply) ^Ciry 1 or 2 Family Dwelling -Number of Bedrooms ~ ^Village ^ Public/Commercial -Describe Use ~'owttship ^ State Owned /~ 3 x ~ ~ ~~ ,~ r/ S Neatest R ~~_ ~~. / / / ~/ X` D l te line B if applicable) l e sct-eme for internal use). Comp um ering b III. Type of Permit: (Check only one box on line A (n A 1 ~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition w For County use S stem Tank Onl Exis ' sum Permit Number Date Issued B. ^ Check if Sanitary Permit previously Issued N. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Q$ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Groemd 41 ^ Flolding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Crrade 46 ^ Aerobi Treatment Unit 49 ^ Recirculating 30 ^ Other V. D' rsal/1Yeatment Area Informati Design Flow (gpd) Dispersal Area on: - - Dispersal Area /© - Soil Application Percolation Rate Sysum Elevation Final Grade ~ Required Proposed Rate(Gals./Days/Sq.Ft.) Elevation (Min./Inch) * /: ~0 ~ ~ ~~ ~ a - VI: Tank Info Capacity in Gallons Total Gallons Number of Tanks Manufactttrer Prefab Concrete Site Constructed Steel Fiber Glass Plastic New Existing Tanks Tanks Sepric or Holding Tank dOCJ ~ /~ ~ ~ (,~~_ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for ' tion of the POWTS shown on the attached plans. Plum is Name (Print) Plumber' Signature RS Number Business Phone Number ~~~y ~~~~~ ~aG35 ~~~ a~~~~ Plumber's Address (Street, City, State, Zip Code) ~ S~~o ~ ~ - ~ ~.- V- - - f~ D ~ -- .~- VIII. Coon /De artment Use Onl roved Sanitary Permit Fee (includes Groundwater Date Issued ssu' Agent Si tore (No Stamps) d ^ Disa A pp pprove Surcharge Fee) ~ ^ Owner Given Lritial Adverse ~~ ~ 17 ~ ~ 7 ' . on Dete IX. Conditions of prov easoas for Disapproval _ (~ ^ _ ~ 3 r' n a L S s~ 5 ~ t!~ tb~! CJP~`'" e~rw~ t,t' ~j i cQJ1.K,~,Q ~K.Gt1PA~e .~+... ~ • ~ SYS~tnn.~ ~ r+.at a-a°~""`-~e.S~ CQl~t4tz-"then, n ts ~~,~-~ ~oo•~ Swc,~. ~.s ~ U + ~ ~ ~-.- Attach,c}m~ets planr,.{w the County only) for ttle~k~m °°lieapet not l~than ~i12 x >~1 inches ~ I ~!' 't C '~'~ ~:~w 1 S r'~QB~S~ ~'n"r ~~'`^~~1~~1 '~- L 1 6'~l/~- ~' SBD-6398 (R. 45/01) 1CQ~~ W~tx.~`~~"K.n~U e~= °~a' ~ v`^°"u.` -S ~nti¢.~a~ ~uS. 3 - ,~.~ ~ - /o~ ~ ~~ f - , aoo y.~,.e ~~ ~~ ~ ~,<<~o ~°~ ~-~o s r ~ =ot = / 00 ^ n D ~ ~~` ~4 e ~~ ~~~ ~~ 9' t ~"~, 17D ~ (~b aao357 _ -, ,. ADD a r- a ~ ~~ 3 ~ ,~ ~ - /~ ~ ~~ ~p ~~ t %~ri~I~U ~I°~ a ~{-/0 S _ / ~~. ~=1 - ~ DC~ ~ ~N` ~~ D 13 ~/~ 9' e ~",, 17D ~ l~ aad3s~ _~,. ao~ a r_ a _ goo Wisconsin Department of Industry, SOIL AND SITE EVALUATION R E P O R T Labor aril Human Relations _... _ IlivicinnefSafw1v'R Ruilrlinns ___~._.~.~ ~~ ~ „-.......~ ...~_ w,~[~ n_~_ '' •. Page 1 of 3 iii ca..vv~~ .•~u~ ~~~ ~~ ~ vv.vv, •. vy ...ti~~. lan on a n 8 1/2 x 11 inches in size Attach com er not les lete site th ~`, ~`,> r»>:ist inc "f~t P ra s ~ St. Croix. p p . p p s a , ` ` # f'~f3QEL LD not limited to vertical and horizontal reference point (BM), direction and % ~ft~~D 3Ta•~ie, seal ~ . dimensioned, north arrow, and location and distance to nearest road. ._,._,;' r~ ~ 20-10 -90 + ~~ ED e DATE IF APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATIO ' S ~ ~' r~°9 ~ l PROPERTY OWNER: ~fPE~ N °,/ LaCasse Custom Homes, In. c OVT: Ld7"~1R QFFrt~ N~+1 •,1>g,S 16 T 29 ,N,R 19 ~€ (or) W PROPERTY OWNER':S MAILING ADDRESS L~ . :BkOCK #.. ~ SU$D,; E OR CSM # 521 McCutcheon Rd. 37 ~ tip , ; `- , ood Meadows First Addn. CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^ OWN NEAREST ROAD Hudson, WI. 54016 (71~ 38165405 Hudson McCutcheon {x] New Construction Use [ ~ Residential / Number of bedrooms 4 (]Addition to existing building ]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended d esign 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) 101.00 ft (as referred to site plan benchmark) Additional design /site considerations trenches spaced to code 4.00' below grade Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL ~7 S ^ U MOUND ~l S ^ U IN-GROUND PRESSURE ~7 S ^ U AT-GRADE ~7 S ^ U SYSTEM IN FILL CAS ^ U HOLDING TANK ^ S ® U U =Unsuitable for s stem SOIL DESCRIPTION REPORT ~~.~ ~,~.. ; C--(~e,~'~,,,Qy ~,~(~ 1 Boring # .................. ................. 1' Ground elev. 105.Oft. Depth to limiting factor +90" Boring # :.:::.2:,>..., Ground elev. 105.2 ft. Depth to limiting factor +90" Depth Dominant Color Mottles Texture Structure Consistence Bot#~da Roots PD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trer>ch 1 0-10 10yr3/3 none 1 2msbk dsh cs 2f .5 ~ .6 2 10-2 10yr5/4 none sil 2msbk dsh gw if .5 .6 3 25-9 7.5yr4/6 none cos Osg ml na na .7 i .8 u ~ ~ e~ 'a~.,eew S '~ • a~ , ~ o I .t7 ~ar~. ~ `f ~ ~ (oo - ~ - 7.~ -too I?.v Remarks: ~ 1 0-10 10yr3/3 none 1 2msbk dsh cs 2f .5 ~.6 2 10-2 10yr4/4 none sil 2msbk dsh gw if .5 .6 3 26-9 7.5yr4/6 none cos Osg ml na na .7 .8 of ~ ~~o . .~ 0 . (~ Z• `~ ZZ. Remarks: CST Name:--Please Print G L. Steel Phone: 715-246-6200 Address: 1554 200th. Av w Rich d W 4017 Signature: ~ Date: 29_99 CST Number:. m02298 .....~. PROPERTY OWNER LaCAsse Custom Homes' SOIL DESCRIPTION REPORT PARCEL I.D. # 020-1028-90 Boring # .................. ................. .................. ................. .................. 3 € Ground elev. 103.2 ft. Depth to limiting factor +an ~~ Boring # 4 ................. Ground elev. 101.2 ft. Depth to limiting factor +90" Boring # Ground elev. lO1.Oft. Depth to limiting factor +88" Boring # Ground elev. ft. Depth to limiting factor Page ? of 3 ., _ Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax>dary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trees 1 0-10 10yr3/3 none 1 2msbk dsh cs 2f .5 .6 2 10-1 10yr5/4 none sil 2msbk dsh gw if .5 .6 3 18-9 7.5x4/6 none cos Osg ml na na .7 .8 i /Op.O 3SC~`{--^ `~ Remarks: 1 0-8 10yr3/3 none 1 2msbk dsh cs 2f .5 ~.6 2 8-30 10yr4/4 none sil 2msbk dsh gw if .5 .6 3 30-9 7.5yr4/6 none cos r--- Osg ml na a .7 .8 Remarks: 1 0-10 10yr3/3 none 1 2msbk dsh cs 2f .5 .6 2 10-2 10yr4/4 none sil 2msbk dsh gw if .5 ~.6 3 28-8 7.5yr4/6 none Cos Osg ml na na .7 .8 Remarks: 1 Remarks: SBD-8330(8.05/92) ~_ STEEL'S SOIL SERVICE Gary L. Steel LaCAsse Custom Homes, Inc. 1554 200th Ave. CSTM2298 Nw4Nw4 s16-T29N-R19W New Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #37-Parkwood Meadows First Addn. 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' BM.= top of 1" pvc pipe Cel. 100.00' Alt. BM.= top of 1" pvc pipe C el. 99.40' Gary L. Steel -29-99 ~~J~ 4-30-1995 12=30PM FROM P.2 rrlaceralr~ uipt+rarrsnT qT IrIOUSTry, Leber and Hwnan RelaSor>m Division of Selfety a gultdirrgs SOIL AMU SI 1 E EYALUATIUIV REPORT :n nwr~nrrl uriM 11 LIt1 !,4 AC W:~. Ad.w T..ae f~aEe 1 of • ~ Attach complete site plan en paper not less than 8 112 x 11 inches in size. Plan must include but ~ ~ ~~~ , not lirrlit4d to vertical and horizontal reference •point (9 n anct ~ of slgpe,.ecale or PARCtcI.I.D. a ~mensioned, north avow, and kTeation and dl p APPL)CANt fNFORMATION-PLEASE ~ LL P ~ H BY ,~- DATE -~ ~ ~ wµ- 13 7.rso I PROPERTYOWNt:R: ~ ~; ~` PROPERTY LOCATION ~ _ r LatCasse G~staer Haroes. Iii 'C .'' .LOT NW ti4 NFT 1/4,S lb T 2S ,N.R ; 9 ~E (~ w PROPER'TYCNVNER':3MAlLINGADDRESS i~-~: g~~,~ ~ ~ ~~ ~ 52 ! ~ Q7~ BL~Kt ~ SuBD.NAN~oRCSM~ 1 tlicCutrr>Ieop Rd. . - 7 as Parkwnod l~dvrns Pinst 1l~dst. . CITY, STATE ZIP C ,;; PHON . ~~ , CITY QVILLAQE OWN NEARS ROAD Hud>acr~, WI. 54016 ,,( O5,'-< Htadson MoflitCtruppn (K] New ConstrucborT Use (~q ResiOend ' ~ L donti '"~ 4 (j Addition 1o e><istalg btrikling . Y 1 ~~ • [ l Public a wrnrne ' -,,.- - _ -- Code eerivedgaily fla+rl _..600 ~ ReoOrr>trlended design loading rate • 7 .bed, gpd~t2 - $ Irancft, gpolR2 , Absorption area required 658 ~, ~ 750 trench, ii2 I~zimum design loading rate . 7 mod, . 8 2 Recommended +n6[frar'son ssJrlac>a el8valion(s? 1D1. DO h (as referred to site plan benchrrTark) Adliidonal design 1 sits c~nsNi~apons . trenches spaced to cod_ e. 9.00' belc~ur tsrade . Parent material cutvash .Flood plain elevation, ti applicable nor d l ~ ~~~ ~ ~D L ~ K u = unsui tabte lor tom fCl S O Uu tJ s ^ u ~] s O u ~ p u t~s Cl u ^ 5 ~q u SOIL Df:SCRIPTION R.HPOR7 Boring # 2 ' t,rourld elev. 105.Ott limiting factor •+~~i Spring # 2. Ground elev. 105.2 ft. ~ to limning factor +g0,~ Horizon Depth Dominanrt;,olor ~ Moines -Fex~fe Stn,ctu•re ~ Roots GpD/ in. Munsell Qu. S2. Cont. Cdor .Gr. Sz. Sh. g~ ~, 1 0-IO 10yt3/3 none 1 Zmslslc clan cs 2f .5. .6 2 IO-2 IpIr~5/4 ngne ail 2m+sbk clan gw if .5 .6 3 7.5yz•4/6 none cos Osg mi nor nor .7 .8 ,~ _ 7` ~ Remarks: I • 0-1D 1DyY3/3 norms 1 2~bk clan cs 2f . 5 .6 i 2 10-2 1Dyr4/4 aotte ail Zmsbk clan gv . if _5 ~.6 3 Z6- 7.5yr4/5~ node cos •Osg ml nor nor .~'.8 Remarks: Signaturz: .~.+~ ..,~ ,~ T/~,~~. Uatc: itZ~o nn C5T NutTlber_ trt0229R 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 2. Number of Bedrooms Design Flow -Peak (gpd) Estimated Flow -Average (gpd) Septic Tank Capacity (gal) p Soil Absorption Component Size (ftZ) - Type of Wastewater Do stic Table 2: Soil Absorption Component -Limits of Reliable Operation I~n ~~ C Septic Tank Component Soil Abso tion Component Design Flow -Peak (gpd) CsCSO - ~ Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 P~ 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 se tic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th 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 w: 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 with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 .~~, Management Plan for a Septic Tank and Soil Absorption Component ' Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. s~ , rte" .aE ~~ ~~ a ~- r ~ ~~ ~~ a,~.s~ q~ sr cam. N~ p,~,.~, ~ c~~s) a~ ~ ~ ~ 9y~ z L7i5) 3g6-Y~g~ °-~ 3 S`1' CitOIX COUNTY ~ . ~ ~ SL~I''I'I ~ ANK MAIN'TENANCL~ AGREL AND OWNLILSIiIP CL~RTIrICATION rOitM 4 ~ Owner/Buyer _~r/i3 ~'.C~~ti Gj_ ~~~~~r/ Mailing Address 1a+181.~ ~,~C~ . ~i_-.-~~ .~T. " ~ ~~ ~ ~, ~sr/ ~.~/~-~ Properly Address ~~ ,~ ~%~~ ~i~/ ' ~~".,~~s~ 5~~c~1~ ~~~~,~ ! f~` (VcriGcation required front I'lanuing UcparUncnt for ucw construction) l0 ~P ~~~~~~ .. City/State ~~~~~/`i~1i•. Parcel Identification Number t'.~~" /•3.70 -,3 7 -ocX~ LEGAL DESCRIPTION Property Location '/,, 1~'/,, Scc. _f~, '1'~~N-IZ~W, 'I'owa of Subdivision =y~~~S~~~tJ~ l ~-' /'~:>iTi12,rL_. .Lot # ~. Certified Survey Map # "~ ,Volume ,Page # ~~ Warranty Deed # ~o`'~~`o~ ,Volume 105-. ,Page # ~ ~ z- Spec Louse ^ yes ~.,tto Lul lines idcntifiable~yes ^ no SYSTEM MAiNTENANCI~ Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out tl-e septic tank every three years or sooner, if needed by a licensed pumper. What you put into We system can aEloct We function of We septic teak as a treaUncnt stage in t1-c waste disposal system. The property owner agrees to submit Iv St. Croix Zouhtg Department a certification form, signed by the owner and by a roaster plumber, journeyman plumber, restricted plumber or a licensed pumper verifying drat (1) the ou-site wastewaterdisposal system is in proper operating condition and/or (2) slier inspection and pumphtg (if accessary), rite septic tank is Less than 1/3 full of sludge. I/wc, the undersigned have read We above requirements and agree to maintain the private sewage disposal system wiW the standards set forth, herein, as set by lire Department of Conuuerce and the Departateut of Natural Resources, State of Wisconsin. Certification stating that your septic system has been utaintained must be completed and returned to the St. Croix County Zoning Office within 30 days of lire duce year expiration date. SIGNA OF APPLICANT ~/~ DATE OWNER CERTII+ICATION I (we) certify that all statements on this form are true to the best of ury (our) knowledge. I (we) am (are) We owner(s) of rite property described above, by virtue of a warranty decd recorded iu Register of 1)ecds OtTice. c~ / (~ 10 ~ SIGNATU OF APPLICANT DATE ••rt~r ~ sr~+~**+ Any information that is mis-represented may result iu the sanitary permit being revoked by lire Zouhtg Department. «« Include wlllt th[s application: a stamped warranty deed from lire iLegisler of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~~~ 1655 PAGE 602 II STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between LaCasse Custom Home Inc a Wisconsin Corporation Grantor, and Travis and Lori C. Sandmon Husband and Wife Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, ~i~~esconsin: (if more space is needed, please attach addendum): Lot 37 Plat of Parkwood Meadows First Addition in the Town of Hudson, St. Croix County, Wisconsin Exceptions to warranties: Protective Covenants Dated this 1st day of June , 2 0 O 1 AUTHENTICATION Signature(s) authenticated this day of /~ 64768 _ _ _ ___ KATHLEEN H. WALSH FiEGISTEK OF DEEDS ST. CROIX Cp., WI RECEIVED F~ RECD 06-47-E001 1:15 PM YARRANTY DEED EXEMPT # CERT COY FEE: COPY FEE: TRANSFER FEE: 167.70 RECORDING FEE: 14.00 PAGES: 1 Recording Area Name and Retum Address Eagle Valley Bank 1301 Coulee Road, Suite 2 Hudson, WI 54016 020-1370-37-000 Parcel Identification Number (PIN) This is not homestead property. (-is) (is not) LaCasse Cu om Homes, I c. *Richard W. LaCasse, resident ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County. ) Personally came before me this 1st day of June 2 0 01 the above named LaCasse Custom Homes, Inc a Wisconsin Corporation by Richard W LaCasse President TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ~ >>i'~ ~ a i ;alit":,to,trte known to be the person who executed authorized by § 706.06 Wis. Stats.) -. '' ,,~ti~` ~~., , ' ; , `j~egoi i t~tt cknowledged the same. ~, THIS INSTRUMENT WAS DRAFTED BY ~A ~~~ ' c ~ r'~ a ..,, - ~~ - `'~ - * Ma~ r~e~e K. Linn Richard W. LaCasse - ~ Notary Public, State of Wisconsin Hu son, WI ;~~ ~,~ .My ~~~ssion is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. ~ aFe, , . ~ r~~ ,~~~r apG ~ ) not necessary.) ,°O`er~ OF 1r'i ~ =' e~`'~ 'Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-1999 aCasse Homes Realty 573 County Road A, Hudson WI 54016-7007 Phone: (715) 381-5405 Fax: (715) 381-6541 Jacque Howard T6827560.ZFX Produced wHh TpForrn"` by RE FonnaNet, LLC 78025 Fifteen Mile Roed, Clinton Township, Michpan 48035, (800) 383-9905 ~ - - t sQB.S yW.,. X ~26~52.8 \\ x LaJ x Exls 370.( / TFL'~PHONE -~ 905.4 PEDESTAL ~ Y X x Q x 904.5 ~ 90 .4 ,w o ~o ~ O _O ~ ~- M x 5 I 904.6 I I ' N 0 "~'~g~.-- .0 1 I , 894.3 ` .n ~ `~ 882.1 ^'~ ~a '`° ~ ~. \. ;~,~. ~'~ ~~ 85.1 x I •.~`I :~ .. ~, ;'one: ~ar~~.- .. }c~r........~._ . ~ -4I ~ ~ ,~ ggv~ ~p O 8.6 ° O x 3 O ~ Z 6 5 B- i 17 (CE c LIN J B-5 TER ~\- e- `° o B-4 9 1 o.,~ ~ ~ l / 892.4 ~ O 893.0 X 264, , ~ ~ ~ J ~~ --------'- -'`---~ 894.8 ; 6 ~ I _4 ~9-5 ~~ -5 ~'-~-----.__ 9 .4 `flj ~ - -gam ~ E ~ ~ ° :~ o' tG . 904. \ ~ ~~ mot. M; :o N :y 100' ' 35 ~ ~\ ~ i ~ _ ~xi .~ •ZI -~ ~ 60 . 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