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HomeMy WebLinkAbout020-1370-38-000/* ~~0Of1~nD~rOf cOr"r`~r~ PRIVATE SEWAGE SYSTEM Sadery and Buitdirlgs Division INSPECTION REPORT `GENERAL INFORMATION (ATTACH TO PERMIT) Personal in{omlgtlon you provice maybe used for seoondery purposes [Privacy .x.15.04 (1xm)I. ss, 1 rOy er s Name: ^ City J"7 V Jag j~ 4owns ~ip CST BM``Elev.:-/~~ Insp. BM Elev.: BM Description: / Spc ,l ~ /I~:wA,[lY -~- I ~ Z • sfl ! ~,I111 1. '~ R ~ "^,'.~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic „~, tnlt,vQ~ (orj D Dosing Aeration Holdin ~ft'~Croix S~I(11t~rYp~rmit No.: StSSa22tSSe Plan IO No.: Parcel Tax No.: 020-1370-38-000 _ u . a ~ n u ELEVATION DAT A ~~~ ~ • • "~ - ~`~^' STATION ,Q llo , FS ELEV. Benchmar ,~ g! ~ a p Z , S'a It. BM D•~8 /p9• Irk Bldg. Sewer ~ ~Z ~Q (o •D 3 St/Ht Inlet ~•9S' a3•.~' St / Ht Outlet . 3 S 3 . ~ Dt Inlet ""-"~ .,, Dt Bottom --- Header /Man. Dist. Pipe d Bot. System See I Grade ~ ~j .9S' Z,~ j >, ~ I ~YS ~ --- ^ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic ~ ~' p' '--~~ NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION .. Model I TOH 1.L-ift \~Fnctlon I stem I Toy-/ Ft ~ Fhrcemain' length I Dla. I Dist.ToWelt ~ _~ SAIL ARSARPTIDN SYSTEM Z ~? ~ .n ! _ ~ I..._~ - j'R ~ - .r..r.-.~........ - - Width i ngth ~I No. f renches 3 p ' ` - ~ - PIT DIME t No.Of Pits Inside Dia. liquid Depth 1 EN I N 5°r-O ' "' '3 LEACHING Manu act rer. SYSTEM TO P / L BLDG WELL LAKE /STREAM ...~,~ SETBACK CHAMBER r N INFORMATION Type O 2a! + r 3 ~ ?~ ~. ~o ~ : um e Mo a OR UNIT ~ u System: _ ~ ~ ~. DISTRIBUTION SYSTEM ("~"I' ~" ~ ~~' ~"'~D``' P""'~ Header / Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Iota e Length Dia. ngth D ~ 9 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 BedlTrenchCenter Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, ~~nec Ion #1:0~- / I v/ D( Inspection #2: rt-- Location: 988 Parkview Lane, Hudson, WI 54016 (NW 1/4 NW 1/4 16 T29N R19W - 1 s S s`~ j . Parkwood Meadows-1st addn. -L t 8 ~~ ~~~ C~„ ,,~,~,~,. Q~) ? 1.J Alt BM Description =~et~ ~ -, "_7_ ^ ~ I ~ . (~ ~9, 3 2.) Bldg sewer length = 3D C,~'Q -amount of cover = i `+ ~ ~ ~- `" °° P~ ~'"'""'~' P'~~~1°^• ~ 2 • l ~'~' ~~Q ~ "~~' C~ ~~ ~ ~ an revision required No a Use other side for additi Inform >~~~ ~ I 5 e ors gnatYre Cert No. SBO-6710 (6.3/97) ~ ~ `' C a,n7f : S ~ / r~ I I X ~ ~- „~veQ . g~ q39 ~ 7 Safety and Btuldings Division County s ~ ~ "'t d 201 W. Wash' Ave: I'.Q. Box 7162 ~i -a ' - ~ i~eons~n ~~ , ~ 53707 - ~ Site Address 98 C.c,+11-~'- ,e ~ Z Department of Commerce ~ . L . :~;% ,- ~ Sanitary Pernut A at~o~ ~ _~.~ Sanitary Permit Number ~g~. 2z g In accord with Comm 83.21, Wis. Adm. Code, pe ` ` information you provide , ^ Check if Revision ma be used for seco ses Priv c ` 'r w, s15 1 I. Application Information -Please Print All Inform ioui i~ - ~ LN(~ ' "' ` State Plan I.D. Number ` ~ a Property Owner's Name z~~G pFFI~ ~- Parcel Number i o-3~_a oa6 ~ _,. - Property is Mailing Address ~( I 1 ~~ ~ (~~ ~ / `fC~ L~.(J~-N'` Property Location N lM y, /V W5i • S ~ U T . R City, State Zip Code Phone Number Lot Nttn1~{~er Block Number y~ r"-~ Subdivision Name CSM Number . Type of Building (check all that aPP1Y) a5 rw ttit ~"'a'L (~ ~"r• II ^Ciry I{,,// U9J or 2 Family Dwelling -Number of Bedrooms ~ - ^Village ^ public/Com~rcial -Describe Use ~ownship ^ State Owned N~/eJ~a_rejs~c~JR~oad, l , III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to ' For County use - O O Q ©~~ ~, ~ 3 ? 0 -• 3 8 S stem Tank Onl sum Eris Permit Number Date Issued B. ^ Check if Sanitary Permit Previously Lssued aZ a0 G.~9. ~1 N. Type of Permit: (Check all that apply)(nttmbering scheme is for internal use) 44~Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Ae is Treatment Unit 49 R itcula ' 30 ^ er ~ ~ V. D' rsal/Treatment Area Information: - ,S a " ` Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Proposed6~eL~ Rate(Gals./Days/Sq.Ft.) (Min./Inch) l evation Required ^ '~ VI. Tank Info Capacity in .Total Number Manufacturer Prefa Site Steel Fiber plastic Gallons Gallons of Tanks Concrete onstrttcted Glass Ncw F-xisting Tanks Tanks Septic or Holding Tank /6~-Q ,~ ~6 S~ / Dosing Chamber VII, Responsibility Statement- I, the tmdersigned, assume responsibility for tion of the POWTS shown on the attached plans. Plumber's Name (Print) PI s Si RS Number Business Phone Number 7~ b 35" - 5 Plumber's Address (Street, Ciry, Stan, Zip ) ~ ,v _ V. ~~ s1 Yea VIII. Count /De artment Use Ottl Sam~ry Pernut Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ^ Disapproved Surcharge Fee) ~ ~ ^ Owner Given hvtial Adverse ~ ZS' I'"~ l ~I w`~^" Determination ' IX. Conditions of Approval/Reasons for Disapproval ~ ~ ~. ~. Q ~.f° f~ COW ~ R , S ~ ~ ~ ~ ~ ~ i o . +~~ ~ • u~a'- ` near C~ 2 ( y ~~ $ys4~. e~'l+ua~'-"~^ w ~~ r,Q ~ -i't.%s s~{s4-e.~,,.e~tu.~~» 9~C'~~~I?~ S`~s~'"' "^~'8-`-- J r"te". ~.~Q / - ~~ ~ ~ ~. ~ txs ~ Lo~•~ ~~- s ~a plde plena (to the Cow ody) ,foLr e ~ ou papa not las Haan ail siae ~ ~ f J l I - ''~ ~;~q~' dS S '4oY L~9~i~'-D~. ~ ~ I.s Ci(.~+~2dC /1MrU /1~ i SBD-6398 (R. OS Ol) a~ ~,a/ a 3= ,b~. /6So y~ Tom. ~ -iop z ~~~aU T / - l3 ~~ i S~ ~ ~ 1 g . 7,; ~ r ~~- ~o ~ ., S~ yg.;~ ,~~o ~_ No ` ~9~ r°~~' ~3s7 ~,~ ~ . ~ ~'.yo 5 ~wr~y~ i ~ i 3= ,~- 03~-~ ~9~ ` r~O as X=_ R//4 ~~ 3- ~ . A n~'br~ Br` /- ~~so y~ Tom.. ~~~a~T /3 ~~ /f-/o ~ N6~ S~ yg.;5 3ld Wiscoo~in Department of Industry, SOIL AND SITE E V A L U AT I OfN -Hf f ~-QR T " L~borand Human Relations • ~, °>7ivision of Safety & Buildings in aCCOrd with ILHR 83.05, Va{tg tAdm.-Code :. ~~ ~ ~.. r, _ y Attach complete site plan on paper not less than 8 1/2 x 11 inches in size ~faRmust include butt' not limited to vertical and horizontal reference point (BM), direction and °/g of scope, scale or '- dimensioned, north arrow, and location and distance to nearest road. i _ ~'" _ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATIf~f~t. •~;r I"~~~ i~(.r; , '~, St. Croix PARCEL LD. # ~0-1028 0 IEWED B~ ` JJJ~~~~~,, ~ .! Page 1 of 3 T..-_w tZ /~ PROPERTY OWNER: ,P OP ~b~i1~ ~ ` ! LaCasse Custom Homes, INc. GpV'fLQT NW 1/4<~°~,x'a,S 1 T29 ,N,R19 ~(or)W PROPERTY OWNER':S MAILING ADDRESS 521 McCutcheon Rd. LO '~-. 38 ".Bi. CK # _- Sll NAMEE OR CSM # rkwood Meadows First Addn.' CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE [MOWN NEAREST ROAD Hudson, WI. 54016 'pl5)381-5405 Hudson McCutcheon Rd. [xJ New Construction Use [ ~ Residential / Number of bedrooms 4 [ ]Addition to existing building [ ]Replacement [ ] Public or commercial describe Code derived-daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 98.50 ft (as referred to site plan benchmark) Additional design /site considerations trenches spaced to code 4.80' below Grade Parent material outwash Flood plain elevation, if applicablena ft S =Suitable for system U =Unsuitable for s stem CONVENTIONAL ®S ^ U MOUND ®S ^ U IN-GROUND PRESSURE ~S ^ U AT-GRADE ®S ^ U SYSTEM IN FILL D S ^ U HOLDING TANK ^ S C~ U SOIL DESCRIPTION REPORT ~ti~,,,(`dQe ;F'.~_ ~,,.Q,r,~ (,Z,ono -'-G~`", Boring # 1 Ground elev. 103.Oft. Depth to limiting factor +90" Boring # 2 =~- Ground elev. 102.OCD Depth to limiting factor +90" Depth Dominant Color Mottles Texture Structure Consistence Bour>d~ Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trend'i 1 0-13 10yr3/3 none 1 2msbk mfr gw 2f .5 ~ .6 2 13-36 7.5yr4/4 none sil 2msbk mfr gw if .5 .6 3 36-46 7.5yr4/4 c2d 7.5yr5/6 sil 2msbk mfr gw if .5 .6 4 46-90 7.5yr4/6 none cos Osg ml na na .7 .8 VI bo \ ~~w s ~eu. Remarks: 1 0-8 10yr3/3 none 1 2msbk mfr gw 2f .5 i.6 2 8-37 7.5yr4/4 none sil 2msbk mfr gw if .5 .6 3 37-90 7.5yr4/6 none cos _.-- Osg ml na na .7 .8 { 39 Remarks: CST Name:--Please Print G L. Steel Phone: 715-246-6200 Address: 1554 200th. Av . w Richmond WI 4017 Signature: Date: -2.._c~c~ CST Number: m02298 PROPERTY OWNER LaCasse Custom Homes SOIL DESCRIPTION REPORT Page 2 Lf3 PARCEI. LD. ~ 020-1028-90 Boring # 3 Ground elev. 101.4ft. Depth to limiting factor +90" Boring # 4? ................. Ground .elev. 99.0 ft. Depth to limiting .factor +90" Boring # S .............. Ground elev. 98.8 ft. Depth to limiting factor +90" Boring # Ground elev. ft. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structure Consistence Botx>dary Roots GPD/ft in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-9 10yr2/2 none 1 2msbk mfr cs 2f .5 .6 2 9-17 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 17-31 7.5yr4/6 none is Osg mvfr gw if .7 .8 4 31-41 --- 7.5yr4/4 c2d 7.5yr5/6 sil 2msbk mfr gw na .5 .6 5 41- 9 7.5yr4/6 none cos Osg ml na na .7 .8 i. s 1 G..~.~. ~,X- ~- y o• Remarks: 1 0-6 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 6-36 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 36-90 7.5yr4/6 none cos Osg ml na na .7 .,8 Remarks: 1 0-10 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 10-30 7.5yr4/4 none sl 2msbk mfr gw if .5 .6 3 30-36 7.5yr4/4 none sil 2csbk mfr gw if .5 .6 4 36-90 7.5yr4/6 none cos Osg ml na na .7 .8 Remarks: Remarks: SBD-8330(8.05/92) ~~~ STEEL'S SOIL SERVICE Gary L. Steel LaCasse Custom Homes, Inca CSTM2298 ~4~4 S16-T29N-R19W MPRSW-3254 townof Hudson lot #38-Parkwood Meadows First Addn. 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted.. N 1"=40' BM.= top, of 1" pvc pipe C el. 100.00' Alt. BM.= top of 1" pvc pipe C el. 97.30' 'D Gary L. Steel -29-99 !6" 6 ~ " Q' / . 4-30-1995 12=31 PM FROM P-3 vnseonsln usparanenc or ~nwavy, ~a6or and 1lumarr Aerations L~rMSIl+Ia of'safety 8 BU1rdlags av~aL Anu a~ It t trnr~uA"i lun Mtl'vFi I i- ~rwl...:.w rr Lao erg na awr.., w.~w. r..d., rape ~ or ~ attach cornptete alto plan on paper net less than a 1!2 x ~ ~ iocwas ~ size Plan muse intrude but St. Croix , . , . ~ ! not limited to vertical and horizontal reference point Sid directirxrr ~slope, scale or PARCEL I.O. / •dimensfened, north snow, and location and disfand~ tp,neaielsYropd ...~ f 02 1.028-90 APPLICANT INFORM4710N-PLEASE PF~INT AIL I ~~ IO~r t"°. I BY oATE ~,_,~t~rr ~ -'~ ~j-I3-O PROPERTY QWNER: R 7Y LOCATION Ia'i(:d{38@:' (13Stat1 HClmes, INC. ~ ;', `t , _,.~ R LOT h1W. t/4 Alin1 1/4,S 16 T 29 ,N.R19 ~ci~ yy PROPt:RY!/ OWNER':S MAILING ADDRESS ' ° 521 • McCutcheon Rd. :` ~~ Gf~C BLOCK • na UBO. 0R CS B >~>~k~ rseac~vws Ffrst Addtx-' CITY, STATE ZIP CODE E CE VILLApE QWN NEAREST fiQAD Hudson, lr~. 54016 ~ 1~5; Hudson Rd. 1~9 New Construction UsQ [ ~ Residential ! [ ] Addtion m existing building 1 1 Replacement [ ] Public or eamrrreraal describe Code dArivep ttaily flow 600 gpd Recommended design boding rate - 7 bed, gpd/R~ . 8 Uertch, gpdrtt2~ Absorption area required 858 bed, it2 75___0 r~ trends, R2 Maxa<num design loading rats . 7 had, 4Dd/(k? _.8 trer~lt, gpd~ Remmmended infltrallon surtaoa etevation(sl 9$~; 50 R (as referred tp site plan benchmark) Additional design ! site aort$id~ations ti elitChes sDaCed to code 4.90 •'. belyMr Qrad~ • Parent material ~ otrt,wash Flood plain elevation, A applit~bletda_ _ . _ _ IY S ^ Srirttable for System CONYBYTIONAL U = UrtstMable for tam ~7 S ^ U MOUND ®S ^ U IN•f3ROUND PRESSURE ~6 D U AT-GRAD@ ~ S ^ U ~ SYSTEM IN ALL A~ S C] U NgLDING TANIf ^ S ® U 501E DE5CRIPTION REPORT Boling # - ~~ ;.~~ 1 , Grouts elev. 1p3 ,Olt, Qepth b Grtridng factor +9 " Boring ~ 2 Ground elev. 1Q?w.9ti Depth b Iimlting factor +90" Hori2on Depth in. Dominant Gotor Munsell MottlQs Qu. Sz. Can Color Tezture Structure Gr. Sz. Sh. Corts~'terroe ~Y Roots GPD/i !~ Tierr~l 1 Ow13 10yz3/3 Hens 1 ?z~ eafr gar 2f ..5 .6 2 • 13-38 7 ~. 5yr4/4 none sf 1 2msbl+: mfr c~pr 1 F . 5 .6 3 36-46 7,5yr4/4 c2d 7.5yr5/6 sit 2msbk mfr gNr if .5 ,6 4 7.5yr4/6 none cos Osg ml na na .7 .8 = ~'I, t7~ i Remarks: 1 0-8 XOyz3/3 none 1 2tnsDk mfr gv 2f .5 ? .6 2 8-37 7.5yr4/4 none ail 2tesbk mfr gror if .5 .9 3 37-90 7.5yr4/6 none cos Osg ctrl na r-s .7 '. .8 Remarks: 1 Sigr+xture: ~ ~ . ~Y? ~ bate: ~~~-99 CST ItltunDert ttwz~9s 1: ' 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 22 Number of Bedrooms s Design Flow -Peak (gpd) 7 -^ Estimated Flow -Average (gpd) cp Septic Tank Capacity (gal) Soil Absorption Component Size (ftz) (oZ~ Z- Type of Wastewater Dourest Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) Z_ ~ Maximum Influent Particle Size (in) 1/8 Maximum GODS (mg/L) 220 Maximum TSS (mg/L) 150 y~ ~ ~,~"~ 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 and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filte shall be cleaned as necessary tQ ensure groper operation. The filter cartridge shou d not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for wa#er tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance wifh OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 .' 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. a.~. s.~,~-- ~ s o-.~ , nom" .aE ~~ ~~ a,~ q v-d`- ~~ ~~ N~ p,~- ~ c~~s~ a~ ~ - ~ 9y~ L7i5) 3g6-y~g~ z~ 3 ' ~ ~ S'I' CROIX COUNTY SEP'1'I ANK MAINTL~NANCE AGItEEME T AND OWNLItSi-IIP C~RT1rICA'I'ION rORM Owner/13uyer ~ ~sG.~~` `~~,~~r/ -~~~.~7.~~~r/ ~~ Mailing Address 1~~~ '`' ~~.~./~ if/~r.~i`~~~~~~i. ~`~/OS.~ Property Address ~~~~,~l~/r,~J l.¢.r/,~ (Verification required fionr Planning UcparUncut for ucw consttuc City/State ~.~~~~ ~i~i Parcel Idcntificatiou Number f7a0 ~,37a 3$ bbd LEGAL DESCRIPTION Properly Location UJ '/,, ~ '/,, Scc. ~, '1' Zq N-lt,~_W, 't'own of _~~~(~[~-• !~ -~- Subdivision ~'C~Igcrk-~~ad i-~.~C(cA~tJS ~ ~~ ~ckd t~-t yn~ , Lol # ~~. Certified Survey Map ~E , Voluntc I'abc # Warranty Deed # ~~ ~ ~ % ~y ,Volume ~~ ?J / . Pabe # 3 Spec house ^ yes ~no Lot lines idcntifiabl es ^ no f:%~~~, SYSTEM MAINTENANCE Improper use and rnaintenanceof your septic system could result ire its premature failure to handle wastes. Proper maintenance consists of pumping out We septic tatrk every three years or sooucr, if needed by a licensed pumper. What you put into We system can affect We function of We septic teak as a treaUucut stage in the. waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by We owner and by a masterplumber, journeyman plumber, restricted I~lurrtber or a licensed purrrpcr verifying that (1) We orr-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), lire septic tank is less than 1/3 full of sludge. Uwe, We undersigned have read We above requiicurarts and agree to u~aiutain the private sewage disposal system wiW We standards set forW, herein, as set by We Department of Conuuerce and the Departnuut of Natural Resources, State of Wisconsin. Certification stating that ye tc s stem has been mairttained must be cori~pleted and returned to Ure 5t. Croix County Zoning Office within 30 days of 1h~tiu'e y xpiration date. / ~ / ~. DATE ~NER CERTIrICATION I (we) certify Urat all atatenrcuts ou this form are Uuc to the best of my (our) knowledge. I (we) am (are) We owner(s) of We y describ move, by virtue of a warranty deed recorded in Register of Deeds O[Iice. `/ ~ ~ ~ d SIGNA O LICANT DATE ****** Any infomration that is nris-represented may resutt iu the sanitary permit being revoked by Ure Zonhrg Department. *~`**** ** Include with th[s appllcaUon: a starnlred warranty deed from tlrc Register of Deeds office a copy of the certified survey map if reference is made in We warranty deed tl 4C;..1~31 SAGE 231 STATE BAR OF WISCONSIN FORM 2.1999 Document Number WARRANTY DEED This Deed, made between LaCasse Custom Homes Inc a Wisconsin Corporation Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: (if more space is needed, please attach addendum): Lot Plat of Parkwood Meadows First Addition in e Town of Hudson, St. Croix unty, Wisconsin Exceptions to warranties: Protective Covenants Dated this 13th day of _ April 2001 s AUTHENTICATION Signature(s) authenticated this day of * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Richard W. LaCasse Hudson, WI (Signatures may be authenticated or acknowledged. Both aze not necessary.) Recording Area Es44444 KATHLEEN H. WALSH kEGISTEk OF DEEDS ST. r_ROiX CO., WI RECEIVED FOR RECORD 05-03-2001 8:30 AM YAkRANTY DEED EIEMPT R CERT COPY FEE: COPY FEE: TRRkSFER FEE: 176.70 RE~OkD?!IG FEE: 10.00 PAGES: 1 Name and Return Address Eagle Valley Bank 1301 Coulee Road, Suite 2 Hudson, WI 54016 1370-38- Parcel Identification Number (PIN) This is NoT homestead property. (ir,) (is not) LaCasse Custom Homes, Inc. *Richard W. LaCasse ACKNOWLEDGMENT STATE OF WISCONSIN ss. 3t. Croix County. ) Pe ovally came before me this ~ _~ y'~' da of ~~<-~ , ~CXJ l the above named LaCasse Custom Homes Inc A Wisconsin Corporation by Richard W. LaCasse President to me known to be the person who, executed the,fq~egoin in~~.ackngwl?,~g@dthe¢ante.~ .. ~% , *t~rlene K. Linn Notary Public, State of Wisconsin My Commission is permanent.~lf not, statg expiration datei: March 15 . ~ -: ~ '~ r, ~~= ) Names of persons signing in any capacity must be typed or printed blow their signature ~ N r rr t n t tt WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2.1999 aCasse Homes Realty 573 County Road A, Hudsan WI 34016-7007 Phone: (715)381-3405 Fax: (715)361-6541 Jacque Howard T633844LZFX 7noduca0 wrath ZipFOnn*' by RE FormsNet, LLC 18025 Hawn Mib RoeQ Clinton 7ownsitp, MiUpan 48035, (800) J83.9t105 „1.9~ 905.7x I ~~ ~~~•\ ~ ~ `~ B82.1 ~~`~ ~ ~'` ~ ~~` ~.,~~~~ I 26 2.8 ~ ~ ~85. t x ..._.. x ,..., w •~~ 304. ~ . . 5F EXIST _ ~f$,,::~~;;. .,..,.~,.. T L'~PHONE -I 905.4 370.Of I x / ~OESTAL y 2 -5 882 1 B 1 X U X \ 904.5 pQp 90.4 1 B- I w ) 3 R X11! 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