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020-1033-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 203 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Swenka, Benjamin R. I Hudson, Town of 020-1033-10-000 CST BM Ellee]v: rJ Ins .BM ev: BM Description- Section/Town/Range/Map No: q /- U - 1 / �T cdZ.cQ/L� 17.29.19.146F TANK INFORMATION V U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �^ �b Benchmark JT Dosing �i l ?— Alt.BM Aeration Bldg. ewer `( 1 D �i° d y Jw d Holding St/Ht Inlet 70 Alk a 0 Z. >S/ St/Ht Outlet TANK SETBACK INFO TION >S/ St/Ht o TANK TO P/L WELL BLDG. Vet to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing T Header/Man. �r Aeration Dist. Pipe Holding Bot. System ��� PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number �. TDH Lift Friction Loss System Head TDH Ft SC d sf Forcemain Length Dia. Dist.to well s� SOIL ABSORPTION SYSTEM 4&,t4� - BEDITRENCH Width Length No.Of Trenches PIT DIIWNSIONS No.Of Ots Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER IT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 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 Bedrrrench Center Bed/Trench Edges Topsoil 0 Yes E No 0 Yes [0 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: P l Inspection#2: / / Location: 970 Priester Lane Hudson,WI 54016(NW 1/4 NW 1/4 17 T29N R19W) mete�sl&bounds Lot Parcel No: 17.29.19.146F 1.)Alt BM Description= —70 r{vjw �'b Plm, ay in yn G'� 6/144,n�,f/�A0.4 a ►¢.Cd{Q Wt� 2.)Bldg sewer length= �Jj h /',� — y •S�,tA�?J� -U U -amount of cover= Y �*WA- Plan revision Required? Rfl Yes R#/No Use other side for additional information. Id SBD-6710(R.3197) Date linsepctorrs Signature Cart.No. Ceti �L7��5 TIMM EXCAVATING aos Route 1 BOX 192 SHEET NO. OF WILSON, WISCONSIN 54027 CALCULATED BY I'v DATE 3—Z)-'—o?j (715) 772.3214 (715) 386.5443 MPRS #3224 WI MPCA #696 MN CHECKED BY/ DATE SCALE 30 : i --------- f i i ' .... ................... ..... .... .... ...... _._ ... ...._ .. .._ i i i .... .... ... ................ .... ...._ ._. .. : I ....__y......_.............:...........:..........:_...... .... ._ ... .... ..._ .... ....- ..._ ... ... e _......—........c......... .... ........._ _.. .... .... ... ._ ... .... .... ........... ..... .... .... .... .... .... _... .... ..._ ..._ ... i .........._... ._ ...... - ... .. _.. el t ...... .................... ..... 1.....................:.... _ .. .... _ _.......... .»..... . .. ..... ...................:.._.. ........... i L . ..'k1.i..ck..-.,. 17t�C,r...... J _ ... -... _.. .. _...�...._.. ._ ....... _..... ...: ............ _ ........ . ........ '�-tx{� .... ........ _........... ... .. .... .... .... __ .... , G a - �. -'�.. ... . _ .. . t \ h- ....: _ ..._.... & k' . p ...��,... .... 7 �; `0 _.. . ............_.. P� ......... .... ............... ... . ... b............ ... .. _ _. ...... __._ .. ........ ....... .. ! ..... ��...... _:._.. _ __....... .... .... � `� a `� _ .: .._ .. .. ... . .. _ .. . ...... ...... __. ., _..... . ......... ;. .v ... . ...:._ ...... ......_.. ........... .. ....................... . .`�y /a .... . . ... _. ..... .............. ..... ......... ............ ............ .......... ..............p -1..................... .......... ................ PROD=2Q5-1/A-6—W?W—GmW,Mm ON71.To 0rt*M4 ETOLL FREE 14W2a o ® County Sanitary Permit Application ST.CROIX COUNTY WISCONSIN �v In accord with Chapert 12 St.Croix County Sanitary Ordinance PLANNING&ZONING DEPARTMENT Personal information you provide may be us Aorqlary, rposes ST.CROIX COUNTY GOVERNMENT CENTER G` [Privacy Law.S. 1 (11" 1101 Carmichael Road Hudson,WI 54016-7710 (715)386-4680 Fax(715)386-4686 O O ttach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. oO ty Sanitary Permit# ❑ Check if revision to previous application I. AppllcationjoWmatlon-Please Print all Information Location: Property Prope((rtty O Y�Name �} 114,Sec L)Z 51 � a Yn S w N, R I E Property Owne'ri.Mailing Address Lot Number Block Number City,State Zip Code Phone Nuber Subdivision Name or CSM Number II T e of Building: (check one) C [amity ❑Village I4Town of C 1 or 2 Family Dwelling No.of Bedrooms: � Q yy Y 9 / ❑ Public/Commercial(describe use): � 9f v,'4-- V� D ❑ State-owned Nearest Road It.Type of Permit: (Check only one box on line A. Check box on line B if applicable) 6 t ii o0 Parcel Tax Number(s) A) 1.111 Repair [2-),W Reconnection Non-plumbing 4.❑Rejuvenation f1 V Z.D" Sanitation B) Permit Number Date Issued State Sanitary Permit was previously issued 2 { C IV. o System: ck all that apply) Non-pressurized In-ground ❑ Mound>_ 24 in.suitable soil ❑ Mound:5 24 in.suitable soil ❑ Mound A+0 ❑ San ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ffik Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating V.Dispersal/Treatment Area Information: 1.Design Flow(gpd) 2.Dispersal Area 3.Dispersal Area 4.Soil Application Rate 5.Percolation Rate 6.System Elevation 7.Final Grade Required Proposed (Gals./day/sq.ft.) (Min.Anch) Elevation qD U �' (o ff Z -q 0.'1 VI. Tank Information Capaicty in Gallons Total #of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks A 7 Concrete structed glass Tanks Tanks r bu V 10 D o lea e 4, ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII.Responsibility Statement I,the undersigned,assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. Plumber's Name(print) Plum Si ture(no stamp ®/MPRS No. Business Phone Number �___ _ �� yl Plumber's Address(Street,City,State,Zip Code) , III.CounW Use Only Disapproved Sanitary Permit Fee Date Issued ssuing Agent ignature pamps)Approved Owner Given Initial Adverse 2 Z S 0✓ f 0/2t//u Determination /IX.Conditions of Approval/Reasons for Disapproval: SYSTEM OWNER: 4 � 1.Septic tank,effluent filter and /maintained nq /�� c I �"� _ dispersal cell must be se pi_ lumber. MYVI vl{t�Lad C��/}Y2 S Cr as per management plan provided by p - b . S QS�392, 6 2 2.All setback requirements must be maintained v't 1.L y ) 13 10( V// occae*-o,_-y , d scat fir= 30 � . - i ' .... .... .... ... ........... _. .... .... .... ...?........_T..........y... .... 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CROIX COUNTY TIECEIVED SEPTIC TANK MAINTENANCE AGREEMWF0 7 2'014 AND OWNERSHIP CERTIFICATION-kROIX COUNTY ITY DEVELOPMENT C�7��eruyer � Al r --�V\1eN le A f ' Mailing Address Property Address q -70 LI"/V m Planning&Zoning(Verification required fro g g for new construction.)p City/State �UD S 4 w.�-- Parcel Identification Number 0 03 3 — /0-0dj f LEGAL DESCRIPTION Property Location A /?4r, 1/4 , Sec. 1- , T ?, I N R W, Town of Subdivision Plat: yZ� , Lot# Certified Survey Map # , Volume , Page# QV�f C14 4V' C VV*rramy Deed # qq � C 2, (before 2007)Volume , Page# Spec house D yes piiio Lot lines identifiable kyes D no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning&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 wastewater disposal 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ` � - � �`V�V l bb )W7 SIGNATURE OF APPLICANT(S) DATE * "Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) !! 11 PA A I)IIIIIIII�III�IIII��IIIIIII II) �, 8245909 Tx:4201184 i i State QUrr Wisconsin DEEED3-2003 . 999125 BETH PABST N REGISTER OF DEEDS ST. CROIX CO., WI 07/24/2014 12:21 PM THIS DEED,made between I==Sweoim EXEMPT#: SM "wht�r one ormom), AEC FEE: 30.00 and Ben,�amin R Swealm _ P AGES•. 2 ("Cmnnee,"whether one or mon). Grantor quit claims to Grantee the following dewribed'real estate,together with the Rwallog A= rents,profits,fixtures and other appurtenant interests,in St.Croix County, State of w'nconsin ("Property") (if more space ia needed, please attach Name and Return Addms fey Bony G Lnodoao )' 110 Seoaod Stroet SEE ATTAC IM LEGAL DESCRIPTION. P.O.Ban 469 HW=WI34016 -THIS DEED GIVEN PURSUANT TO THE TERMS OF A JUDGMENT OF DIVORCE ENTERED IN THE CIRCUIT COURT OF ST.CROIX COUNTY, WISCONSIN. 020.1033-10000 Pmd IdmdScalion Number(P" Midi;is bmuwtmdpmpacy. Dated Jul)►22,2014 ;r (S�) (SEAL)t +Lcuise Swenlm (SBAL� (Sl3AL) AUTHENTICATION, - ACKNOWLEDGMENT signeaue(s) t a u��e P.S tvenk.�, . STATE OF WISCONSIN ) Z Z St.Croix COUNTY )U. • ae t a .QISr,� Personally came before me on TITLE:MIEMER STATE BAR OF WISCONSIN the aboveaamed {If not, to me]mown to be the persons)who executed the foregoing audwrizod by Wis.SUL 1 706.06) inatmment and acknowledged the same. Tms IIJSTRIJMENT DRAFrID BY: AttorneyBegyC.Lundeen Hudson WI$4016 Notary Public,State of Wiaconsin My Commiusdon(is per)(expires: ) (Signatures may be aatbemkdW or admowledgaL Botb tee not ow wry) NOTE:TMS IS A 6TANDARD FORM.ANY bmDIFICATIONS TO TBIS FORM SHOULD BE CLEARLY IDffi41II M. QUTr CLAMDXSD Q 2003 STATE BAR OF WISCO M FORM NM 32003 •Type wine below . St.Croix County 999125 Page 1 of 2 i zXm3ff AL. Patoftbe Wth of.NW 44 ot'Sagiop 17,*'1 ai fb*=.a=Om Neal quwteioomp of$sid 3wdao l7,go Noi&Z depelei 30 miharom Wett a distinee of .4 i eet 1 beva_te Norib 74 dspeeea 29 miaptas Fast a dWm a COMA feet,thence North'J4 ae�xi.?4!tines Fmcgaigeooe zt i d feee..lagi tadxoy.!Leave NoHe 63 deea;is mlwa4s Fief;diet�pe of 3s4 E fea'al«�g e{oadwey,tbeaoe No►1A 34:degreee.12 aurea Eatt a diWnoa of 146 7 feet alemg ewdway,.dia�ce Nottb deiers.04 miattteti Piet a diiwiee of 363.6 t3eat along a roidwiy m w'ho'a aWtie,tb®oe Soiuh 7J degteoq 14 a4fimtaa Weet a diitiooe.of 33A feet to ea itaa ' P .! .of deep 6 tot the parCei to be eosveyed hatein;thence North 7J degsr;ea 14 tadou0e�Feat diitaooe o..236 2 felt o;m item pipe d6c,&d"Ninth 26 deg m 37 miiw=-W. earl dW=pe of266.7 feet tp..o hmpipe I"sk*browof die hell abovethe•kjvtit,t ObO tut m d e dW*w,bRiva, b of dWlw Bitu 6o a pmnCNchx6 digp 3a eomi W6t of cpopY oiSqddwtali ong 1ab lhgeC;Oe tbmge$autb;26 dagreei 37 mlttatal;F,iit'a 4iataoee'of 62:fed..mae ot�Isq,•td im�pipe atalae.st the biow pf$q hql;thdaet( - ooidatdog Soui4 26 degrees 37 mitadee Fiat s diataooa 220.J fit is point ofbeghamtg,toaeahes with aneeaefomt lb�.m ata:eaq read along Ibe roidwiy'aa above deeaibed to t pohg..the Fiat tioiof dte exig6ag lows mad.•filCCSPT pert o4 Thonuu R Qmaioe ao4 Wmaoa C:Qm"m VoL 7J6,papa 162:' AND A parcel of lard l MAW 10 00300thrroat Quirts of the l oNd!rmt Quaotr,of Searoa Lf,Tama*29'mw&.NAP 19 V/4"'Town ofHadion deeanlW w tbllvwi:AU.head iy1 between me South IIoe of waoteei property de mlw in VOL 406;Page 391, 1>eeiaomt Nwbei 277462 so the Nomh'Noe'of a'eatiin prlyite toad aaaanraN dwagbod in VoL•646.Page 103 as Domuaatt Nwakr276192 St:CMbt CAMUIYLVAICOOOM "adudiog all bA6 Ift between ft above d=ribed ateaodar line*W the cant ehanod ofthe Wi11ow River lying bm m the. ezteWho of did and line,bearing MS dogeeet 3r 00-V iad i line bee"at the ddd ofmid m-Jw ling bim ft N26 digrew 37'O ' ' . St.Croix County 999125 Page 2 of 2 • .. IIII illllllllilllllllillllll I II 8258538 Tx:4211309 Document Number Dowment T"t 100'1997 St. Croix County BETH PABST REGISTER OF DEEDS Occupancy Affidavit ST. CROIX CO., WI RECEIVED FOR RECORD 09/24/2014 09:36 AM ,rG J EXEMPT #: Name— (Owner)Typed or printed REC FEE: 30.00 being duly sworn,states,under oath,that: PAGES: 2 1. Helshe is the owner/part owner of the following parcel of land located in St. Croix Co Wisconsin,recorded in Volume Page Document i Number1911 St.Croix County Register of Deeds Office: Recording Area l Name and Return Address `a A parcel of land located in the 1) ' f the AW'/.of Section �� 1� fW EP T 29 N—R_ /9 W,Town o /� so./l S� 0170 fR\eSTER County,Wisconsin,being duly described as follows(include lot no.and N dDSoA) W1 51016 subdivision/CSM or detailed legal description): DESc � Pi !oN• G 03 56f T�' JD .Ec L Pamel Identification Number(PIN) As owner of the above described property,I acknowledge that the septic system serving this residence is sized for a bedroom home,or a design flow of_�J&gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently 1 occupants riving in this residence; (# occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However,I understand that N there are intentions to exceed the number of permitted occupants,the system will need to be modifiec`t to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. S tbel. ��Y Dated I.3 t� car of�._ g� SwENKr4' • AUTHENTICATION �l�%1111111/11' ACprOWLEDGMENT �s STATE OF WISCONSIN ) Sig ( ) ` )ss. � A autietcated his day of oTaR =�S Cvr�o�ix County. � a me t dy to e named * ern ?t rYu ej TITLE: MEMBER STATE BAR OF WISCON _4154 may; me ` Pe (s)who ed the foregoing (aauthortwd by§706.06,wif not. : its.Stets.) :Jai OF W tS ` and a edge the same s wsTRt�IENTwAS orsA�o s��i111t11111t��, 4606. 7-m-"4w. Notary Public, e OfW s consIn (S� ,„ay be or acknowledged. Both are,not My commission is It not.state woration date: necessary) Date: "THIS PAGE IS PART OF THIS LEGAL DOCUMENT—DO NOT REMOVE" T?rrs irdbrrnaflon must be conVeted by subrr er ,DMI 6 refum address,and E'J,�(O • Ottrer lnforr►ratJon such as fire gn rrg causes.kao desagof K eta may be placed on this first page of orb on andln nsf P s, Of 00 doctxnerrt. Use of ft covwpage adds one page to yow document S2.� St.Croix County 1001997 Page 1 of 2 A` Ohs zxmmff A, PiR otde w7,otlVit''/�,ofsei 17ID deernee ei fol6vtv�•6om ebe Waeletteirboaatotp�d Seedco}7.ye Nei6t�, daptdei 30 mimaas Wept a dwaaat of 10?4�eei Ttmeoe troitl+'!4 de�ea 20 miooke Tait,dlmaoe .;Ws6-R 10ea,oimasNoiytt 34 • .deaieq.l4 nm�aae.�F.aie:atprmee�1 i�t�ac.tooi�to.aw,y.awe tfa�63 ae�ieee is miaaw:I•:.al�pw'otts4:�:�eoi'.tog�'. . emedv.Y,..ttmooeNc�34sdeg�xs•1?.mi�aeE.�ti�eot146.�''teAelam6!rodoslg•d�aoee 3iiejias.C4m}aaiWt�t .�inoceof363;6A+�t+ILK!!oidweD'1o!n'bw�lle,.tl�o9,s q�h7sa°fnao!I/mtomleewe�tediaN�o i3?lAfeeilomtrga ' pip¢entot;a•t6c•Ro�pi ot'b�A6tottpeDe�W,1�i�emmyedbsaie:t�Na�7J�g 14 miamipetEeet�db0eooe of2S6.3. , ara m m l�yea ?+o�x6 s7 war�,0 �rs66a; tpr.ee k*00 lob.ao,e um wdm ain gore V r m�r�taaa�new am to ".��!pa �taQ moae or. +lb*me eprn* WOMOM M ► 7 a Ibp' tiddie wglow iitYed oo'e PoW' 126 degidpJ7 wad tm+ . >bmdv S4udi16 dime 37 mirl>meP,iii'e q�pse'of 61:foat,,awte,o►'k�r►a#o iron Vfpe eWae�t tiu b's�n7>bo ttiU;t>ayooi '' i =WmA i 8iai6 a26 dc*M 37 ia6ie Bid iauflim 410 3(bet topoiol oflieehados; aUh eaasdmit tbi m ioCdai taut i dpp j�roidwiy'u.bovi deepi64d 10 s poias cu d1e£mtliodotB+teR�doi towo rod.'BXCi�'1'hart oR T6odoe�. .oA ; mammiC:QM"ibVOL 754.7 p 164. . � •�pnoelo[limdloatfadlathe8owbaeuQuirteroftheNa�EwedQoitarofSecHOaLi.Tow6rbiP?9NoA4Ria�a19Wa4toan oi!ftodeoo dtdedbed o Jbhoai Ab,iaml ly4ni bbttiiian the 8oWd llae otiniotoee P�Dab'daiaitiod. ,hp Sri. I isvoL IOd Diemomt t+iawtiar 377464 dad M Nam•tiop'oLraetiht priva:tone eaaemant de.aribed to VoL•648.>`ye ills a Doasmmt � N,a:�q.47at9i. st:d0i cdow.whanwim -Udmilm,.uteabft ►did skmd*96ee'meufth Md d-004=metacmew rCoev.aiverlyU�tanwem�ee. e ttfttrs aad tine.be+afai 1146 degiea 3T.WV aM i lice t et ltie aid oFedd memdtr IEeR lieuioe ITi6 dadros i St.Croix County 999,125 Page 2'of 2 i St.Croix County 1001997 Page 2 of 2 § j / $ K 0 a � 2 C14 $ qb k 7= > t� . _n a_ CL % k) >2t § 7 c (14m= . $ kk§ -(k ( N0 � f ;aEkJ72 7 / k\/)k 2 7 S « � @2 m0f k �}�f/N z8 n © � § � 3k � [ SE — � LL k © �fk§� E \ \k >) co § n � «_ $ n§n ik - tE _0 k R > § t J 4) e ==t p t CL m <2 § a �= 8r � 0z C 2 ) k2 � . k k 7 ' ) % k 2 2 ® 2 I § k ) [2, 2 J / EK§ c m ; o� § s o -� { ) / /J D § \ ) B ) \ k 3 m 2 f § Q 2 k k .. ) . = 2 E � \ \ tea / m o a ) E U) k k E L 0 0 0 o E § -Pb $ £ a a a 7 § @ n n $ q ] 8 o (2 2 I $ , e 0 >- 'a m n § ) S? § ° \ k § § # G = § # & / k a G 2 ® n m a _ < (D k ° 2 \ % ) 2 3 E « cc § / k / (D / § I _ C') % c ` e © ? - k 2 & / ) § f S . § 6 o R ) ¥ / a a . 2 m 2 5 2 0 0 k § c m § / f ) g o z / ) ) k 2 � 7 « % D 2 � E L: (L E t c k a § / J a 2 3$ J 1 ~ . Parcel #: 020-1033-10-000 0$/11/2006 0$:52 AM PAGE 1 OF 1 Alt. Parcel #: 17.29.19.146E 020 -TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - KOLLS, JAY & REBECCA JAY & REBECCA KOLLS 970 PRIESTER LA HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description SC 2611 HUDSON * 970 PRIESTER LN ~ ~0 ,/ ~ SP 1700 WITC ~' ~~ /// /~``'' ~ ~~ ( r ~~ UY ~~~ Legal Description: Acres: 1.367 Plat: N/A-NOT AVAILABLE SEC 17 T29N R19W 1.367AC PARCEL IN W 1/2 NW 1/4 F OM W1/ ' Block/Condo Bldg: R 4 COR GO N102.4 TH N74DEG E306.9' TH N54DEG E 211.8' ALG RD Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) TH N63DEG E 254.8' ALG RD TH N34DEG E 17-29N-19W 248.7' N363.6' TH S75DEG W 33' TO POB TH N75DEG E256. 2' TH N26DEG W266.7' CONT more... Notes: Parcel History: Date Doc # Vol/Page Type 06/26/2002 682686 1916/533 WD 06/24/2002 682436 1915/01 TI 10/25/1989 452901 855/64 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.367 129,900 276,500 406,400 NO Totals for 2006: General Property 1.367 129,900 276,500 406,400 Woodland 0.000 0 0 Totals for 2005: General Property 1.367 129,900 276,500 406,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 124 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wiscgnsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety arisl Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Kolls, Ja Hudson Townshi CST BM Elev: ( Insp. BM Elev: ~ BM Description: ~ OO . o tip . p CST T3 w~~ ~ TANK INFORMATION ELEV ON DATA TYPE MANUFACTURER CAPACITY Septic E~t aoo Dosing 1 L~ Aeration Holding TANK SE~K INFORMATION TANK TO P/L WELL ~ BLDG. Vent to Air Intake ROAD Septic .r 5 O 1 ' ~vc 0( Dosing ~1 ~< <r Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ^ Demand s Dy~,Q.[G GPM Model Number tL~D TDH Lift Friction Loss System Head TDH Ft Forcemain Length ~ Dia. ~ Dist. to well r ao Z' > y~o SOIL ABSORPTION SYSTEM lI~DI C Width 1 Length /' DIMENSIONS '3 C~ ~(~ ~- . Of Trenches ~Z-• county: St. Croix Sanitary Permit No: 420756 0 State Plan ID No: Parcel Tax No: 020-1033-10-000 SectionlTown/Range/Map No: 17.29.19.146E STATION BS HI FS ELEV. Benchmark < 1C X03• Cjp.fl Alt. BM Bldg. Sewer e!G St/Ht Inlet L I I t/ t~ IZ •~ ~j0 Z91 SUHt Outlet Dtlnlet Dt BottaFi~j ~ 1 ? (s ~ •7 it 1 ~ / •Y4 = ~o. Header/M j~lp" S~ ~J L~ 9~• ~ Bot. Sy m `~ ~ ~ ~ 9~ ~ / I Final Grade ~ St Cover csr rz~. (. 3' s ` ~ 3. ~~ g9.8i SIONS I No. Of Pits I Inside Dia. SETBACK SYSTEM TO P/L BLPIG WELL LAKE/STREAM LEACHING Manufa t ~r:_--1__ INFORMATION CHAMBER OR '1'~ f`' Type Of System: ~ -~- $o UNIT Model Number: ~ ( f d` ~3 DISTRIBUTION SYSTEM ~ /~ sz ~.~ ito: ti ~ Header/Manifold ~ I Length~~'" Dia Distribution Pipe(s) Le is Spacing x ole Size x Hole Spacing Vent to Air Intake b ~ 1 SOIL COVER x Pressure Svstems Oniv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedfrrench Edges Topsoil Yes ~~, No [] Yes No ?~ Q` COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1;~~/,~~,3 Inspection #2: Location: 970 Priester La Hudson, WI 54016 (NW 1/4 NW 1/4 17 T29N R19W) NA Lot ~~ lI1___ D_ Parcel No: 17.29.19.146E 1.) Alt BM Description = P,~Jy~,. ~ `~ •'^~""~ ~`~'r ~ S Y``~ ~ D.T. ~-n~ . 2.) Bldg sewer length = ~ 7 _ _ U~,~._/ - amount of cover = ~~ --~ ~ - Plan revision Required? ~ Yes ~ No _ t~ Use other side for additional information. ~ 1 I _ - J~ _~ SBD-6710 (R.3/97) Dat {nsepctor's Signature Cert. No. • Safety and Buildings Division County ~(~ ,~ ~, 201 W. Washington Ave., P.O. Box 7162 S~ G~ fx ~ ~seons~n Madison, wI 53707 - 7162 Site Address De artment of Commerce '~ s`r~^^ ~~ 1 R.1~~-lC-- EICt Sanitary Permit Application S~'t~'' P` ~`2 p ~~ In accord with Comm 83.21, Wis. Adm. Code, personal information ou ^ Check if Revision tna be used for seco ses Privac I. Application Information -Please Print All Informatio State Plan I.D. Number Property Owner's Name ~ ,~ ~ c~ 6 _ ~w, ~~ ,.. ~ Parcel Ntmtber v C -~ ~v S o ~v ~ ~~ ~3 - ~ - ~ ~~ . Property O er's Mailing Address S t. -' ~` Property Location ~ ~U ~r I ~ ~ / ~-F~~-R. ,y ~ ui IV i.4: S I ~I T ZQ N. R ~ E City, State Zip Code Phone Number Lot Number, ~ Block amber j~ 1 ~ ' ~ ~~ Subdivision N/ame CSM Number ~ ' ~ C S~Y~ t Y C' Z. ~ fJ 9 d~' r'~'~-W . Type of Building (check all that apply) II OCiry 7 d ~r 1 or 2 Family Dwelling -Number of Bedrooms .7 ^Village d- ^ Public/Commercial -Describe Use ~Z 1 ~ r X ~o$ • ~ ~^ ~.R. ~~ ownslup (~ U~ ^ State Owned ~ Nearest Road ,~ ~e ,r ~c~.. III. Type of Pet~rtit: (Check on 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. I S stem Tank Onl Existin S stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering 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 /~~ ~ ~ ~ C :~ ~ ~ ~`°r 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersal/Treattnent Area Informati on: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation ~ 5a ~~ ~ ~ ~~ ~ d' , 7 .--- q~ ,~ ~9 S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic j Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~~ r_ (~ ~ p /~ l r / Lam/" . Dosing Chamber ~ ~ 1 /~~ ~ VII. Responsibility Statement- I, the undersigned, ~~,..,,e responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Nttmber Business Phone Number ~7 - ~,/l ~1 ~ ~a ~s~ ~ ~ .- ~~2- 3 Z~ City, Ste te, Z i p Code) Plum is A dd r ess (Street , ^ ~ ~ 7 / i 0' C / ~ 3 1 L-8 C71.0 ~vi 17Z~Q "V ~ ~ Z VIII. Corm /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surchar e Fee) Date Issued Issuing Agent Signature (No Stamps) g ^ Owner Given Initial Adverse . ~ ~~ ~ js- ~ z} ~ - Detertninadon IX. Conditions of yyA,y,~p~wp~VrovaUReaLso,,ns for Disapproval~~-}}'- ~~~.{/.. ~J~ ~ ~/J~ ~I~ _0 .. ~ p~ :LL_ Gll2/ ~^~t "- 1 ~{Yl `.L S~/Sl-° ` W.~pPC. SYS1 ^~-c C tLNM~ ~ ~`^'`~~ ~/ W ~ P'(y ~ ~ t / 1 ¢ ^ ~~~ 4 ~~ Ct.~ka/ T~'au m C . ~ _ }•~'t.e~^- oM V (lt.d~l Ei~1' ^I ~t~.o~k-~~ . S Y Ste. wu+,s~- ~e W ~ ``1I S ~S 19~h 4~,0~ .A~A~ a'1 S S SFQ•w~ ~ xv. \~^~, OKRA . ~_t1.~`l4 txJ Q.wQ~ i ,S ~ 1 s ~ h~X1~ `L Attach complete plane (to the Coun t onl~or W ~ per n~ 8 z 11 In-•ch~es-In siz/~Vl~2~d1. Vv~'F~tC/~ "tC ~~: ~.Q.~ e~ . ~ o~4~Vli-C~M~~I ~ bV~ a.'-'ut•~ S SBD-6398 (R. O5 ) ~t • c s. ~ ~' -}~ ,~..t~ ln.~OO.-s w~-Q~ . ~;~`~( p~.c,Qt. -~ g--r~ ,~~ -°,~.sE~-Fi an . ' Y `. , i Wisconsin Department of Commerce Division of Safety and Buildings ~~RIG~R~AL SOIL EVALUATION REPORT in accordance with Comm 85. Wis. Adm. Code 1681 Page 1 of 3 Certified Soil Testing Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must i d l b t n t li it d t d h i rti l t l f BM di County St. Croix nc u e, u o m e o: ve percent slope, scale or dime an or zon ca a re ), erence point ( ~ti ~.._...;~~~ ~~~~~ ~ rection and nce to nearest road. Parcel I.D. 02 0' I o~ 3- l o `~ P-ea a pril i i. R iewed By Date Personal information you provi a may be used for secondary purposes (Priv y Law, s. 15.04 (1) (m)). `~ - ~~ '~ Propert w er Property Location Kolls, ~ & Rebecca Govt. Lot NW 1/4 NW 1/4 S 17 T 29 N R 19 W Property Owner's Mailing Addr 970 Priester Lane s; ST. CI201X COUNTY ZONING OFFICE Lot # Block # Subd. Name or CSM# Vol 855 P 65 , City State Zip Code Phone Number ;City Village ~ Town Nearest Road Hudson ~ WI 54016 Hudson Priester Lane New Construction Use: v Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD /', Replacement _ Public orcommercial -Describe: Parent material Sandy/loamy outwash Flood plain elevation, if applicable NA General comments and recommendati ons: install 2 - 2.83' x 68.42' (St'd-Infiltrator, 22 shells) stipulation 1099 chamber trenches @ system elevation of 96.5 ^ Boring # Boring Pit Ground Surface elev. 99.5 ft. Depth to limiting factor > 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 7.5YR 2.5/2 - sl 2 f sbk mvfr cs 1f/m .5 .9 2 I 8-22 7.5YR 3/2 - sl 1 m sbk mvfr gs 1 m .4 .6 3 2 ~ 7.5YR 3/2 - Is 1 m sbk mvfr cs 1 m .7 1.2 4 i 40-58 10YR 414 - s 0 sg ml cs 1 m .7 1.2 5 ! 58-68 10YR 4/4 - s 0 sg ml cs - .7 1.2 6 68-110 ----- 10YR 4/6 - s 0 sg ml - - .7 1.2 I y't" 91o c$0~ Borin °n~ * ~ 2 Boring # -- 9 /', Pit Ground Surface elev. 99.7 ft. Depth to limiting factor > 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft= i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 i 0-12 ---- 7.5YR 3/2 - sl 1 f sbk mvfr gs 1f/m .4 .6 2 i 12-21 _-- - 10YR 4/3 - Is 1 m sbk mvfr gs 1 m .7 - 1.2 7 3 j 21-71 10YR 4/4 - s 0 sg ml cs 1 m .7 1.2 4 71-73 7.5YR 5/8 - s 0 sg ml cs - .7 1.2 5 73-120 10YR 4/6 - s 0 sg ml - - 7 1.2 --- 1c. ~ ` Effluent #1 = BODS> 30 < 220 mg/L and T S >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS _< 30 mgr CST Name (Please Print) i ature: CST Number Henry F. Grote i 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 12/20/2002 715-233-0398 r/ Property Owner Kolls, John & RebecCd Parcel ID # Page 2 of 3 ~ ~ Boring # !Boring ~!' Pit Ground Surface elev. 100.1 ft. Depth to limiting factor > 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots = in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 7.5YR 2.5/2 - sl 2 f sbk mvfr cs 1f/m .5 .9 2 8-24 10YR 4/3 - Is 1 m sbk mvfr gs 1 m .7 1.2 3 ~ 24-65 10YR 4/4 - s 0 sg ml cs 1 m .7 1.2 4 65-80 7.5YR 4/6 - s 0 sg ml cs - .7 1.2 5 80-120 10YR 4/6 - s 0 sg ml - - .7 1.2 -- ~ .2 . 2. - - --- ^ Boring # ~ Boring ~ ', Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~I i ~ ---- Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P I ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 j ~ i I i i -- I i Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sao-s33o (R o7/00) Certified Soii Testing ,~ • 4` `~ ?. ; ~ ~.,, 1.0.,,E t~1r,,- _ ~ w~~ WILLOW RIVER a r EDGE OF WATER ~~' -'~ ~ EDGE OF SZ ~5• \, 2 CONCRETE PATIO 2 '~ r~: ~~o ~~ k `. .., o ~o ,~~ 5 Hous S~E~ ~r~6 , o ~c,. ,.% -- cw...e.as-l~c O ~ ~ ~~~ ~,/ i ~)t is h~/ ,: '` ` >>~ . r ~1 ~~ ~ ~` ~ tloo~~~ ,.! ~ ~~ O tr! O~ GA Q~~t w~ S J v~,l,.Q O ~" Sa,,,,,~e ~ az,3 e~a~,, ~ ~., ~(~0.. )~ t 1 _ I~~ Z, EJ' Y 19~~Z1 ~~.sl~~.lls ~ ~ ~: , E 'w~(l 1~•q \ ~~~ ~~ ~ J ~~ ~ ,3 ~ ~ o~ o~~ ~ ~ ~'' ~ ~ Q f ~-~ { ~ sb' s e~M1~ rs.4 Z~Za3 Ss r ko. ~.,. Na;.~(,eK ~,.~.1~ O 2 `-' BEGINNING AS `~ ~~'~ °" ~~ ~' N VOL. 855, PG. 65 ~` ~, .~ :AST 832.19') ` 5'56"E 832.35' ,- LLJ SCI LC, ~ J ~ ~ ~L! ~ / ` Q«0. l~.o~~s J n~ ... 4 ~ ~b ~T _G~ ` ~~ -~~ I N y '"(~ ZZ mZ c~,,`t l` ~SO i1 Z~ ` /~~" G !+~ 2'LZ ~ ~4 ~~l o $ S SQ~ bo.c4 ~o~o1,n...e o ~ ~lLv ro S-O' ~.,. e 1 ~~30~3 v GR\BE~ ~N ES p p.FZGE~` g55, pG' 64 256.2`l v OL' So 14, EPS~20, N~R-~N ~4 O~,~E 256 MEN ~ N751 ~ N EPS~/ ~ 3~ - oFISN-°-' 2 ~ 5~~ ---No/o3~1 J_, t TIMM EXCAVATING Route 1 Box 192 WILSON, WISCONSIN 54027 (715) 772-3214 (715) 386.5443 MPRS #3224 WI MPCA #696 MN 1 J~" ..... i ~: JOB ~ I ~~ SHEET NO. OF CALCULATED BV `e'v ~ f h DATE ~^ 2~ UJ CHECKED BV GATE SCALE / '' ~ `~ S>~~r GI VNODUCT ZOS1~lat., Grdon, Mw.01171. To OrOer PMGNE TGLL FNEE 1~800~Y1563B0 PRODUCT 20x1 ~ Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1-600-225-6360 \ 1 L. X i ~- 1 J Q.. T •. , 1 w ""c C1w,, _~ '~1T1 C.I. GIVE 3. ~ffp NDiCS^TuRBED S01 L. . ~~. ,LY, MAN. A1ti T ~pp-~ROVLD SKET Jbi+T'~ .~. Dt/R ~*w ELTI Olio E~e~, SEPTIC f DOS[ 6'~ 24" _.~. M4~ttiCLE SPEGIFIGAT101JS tiJ~r r o.~-~ MA~r. WE1-T1IERPRGOF n .JUNCTION J ~ ~coc IZ• ~ii~.i~i 4"C.t. VENT M4 i v w wLLD NO:r C.Z. Pt- 3' o•~o VKpt,STtiiR>S GaouKo PuNP CorvuE-rF . 6coCK lJ ~i`+, 3•g S TAWkS MAIJUFACTURCR: ~+-~ (Jl1MDER OF DOSES: PER OAy TI-AJK SIZC ; ~~~~`~~~ ~~\ GI-LLOUS ,DOSE VOLUME ALARM N1IWUiACTUR,GR' S~ E,a..i~° ItJCLU0IAJG 6ACK/LOW !+~-~ +~~ GArr~O-JS nooc~ 1JUMpcR: ~ ° ~ ~'``' CAPACITIES: ~ _ ~wCHES OR 333 ~5( wu.oUs eWITCH Ty1[: ~~~=`" "~~D g = ~ i-JCNES OR 33,3v wLLOUS PUMP MANUFACTUR[R: ~O"` ,1 C.~iUL-IES OR...,L.Z.t~`SZ GAL-.OUS MODEL WUMDCR: ;~ }1 ~ P`~ `"! D~ ~ I~iCNES OR~~ GALLO-JS SWITCH TyPC: ~"`6'"`"'"_~ 1"''~'~O IJOTE: PUMP A1J0 ALARM ARC TO OC MIAIIMUNI OISCKARGC RATE GPM INSTALLED OAl SEPARATE CIRCUITS VERTICAL DI-FERCIJCf DETW[[IJ PUM- OF/ AUO OISTRIDUTIOAI PIPE.. ~ FEET I + MINIMUM WET WORK SUPPLY PRELS;URTT,E//.. .. © FC[T + a~ FEET OF FORCC MAIIJ X ~~~ F/oorciRlCTlo-1 FACTOR. X022' FEET ~ ~ ~ = TOTAL DyUAMIC NEAP = 9' ZZFEEr LDCKING~GOVfiR -\ tvvn'~u,wc ,c ~BE~ . Gvr'cK D~acow~~cT--~. t 4-J :'~ ~l AL4RN 2" pN - 8'r " vcr ~„ ~~ INTERIJA4. DIMEIJ510/Ji 0/ TANK: LEIJ6TN ;WIDTH _-;LIQUID DCPTH , -~ Goulds ' Submersible ., Effluent Pump C~ 3871 EP05 ,.. Y ~ .~ ,~ , . T,,, ; • `s .P4 . _.. ONS ' .Fasteners: 300 series ;~~:, ,`stainless steel'' 1, ~~esgned for the . Capable of running '` M`fd11o~ " dry without d2,mage to ,,• Effl ~~•' ~ ems components. .y ,., s ,F: ~ MOtor: °~,~ ~ • Lisa ~.,yty~sump • EP04'Single phase: 0.4 HP, • • Wateriransfer 115 or 230 V, 60 Hz, 1550 --RRM, built in overioad with ~` t, ~ , Dewa~er(r ~, 0. automatic reset. ~$PECIFIATIONS •EP05 S(ngle phase: 0.5 HP, 6 115 V, 60 Hz,1550 RPM, !~~ °.~ ' mpt'EhO~t`~ ~ built in overioad with "' '• Solids handling capability: automatic reset. .~- ,'/+' rttazimum. • Power cord: l0 foot s up to 55 GPM. standard length,l6/3 SJTO ');ota~ ~:~up to 24 feet. with three prong grounding +D) . ~size:l'/z' NPT. plug. Optional 20 foot ~M ~' I'seal: carbon- length,l6/3 S~1TW with . ; rotar~~~erdmic-stationary, three prong grounding plug BUNA-~i;elastomers. (standard on EP05). ~• Temperature: -~ .~~.t '104°F.~40°C) continuous ~"~ 140° {t ~ (60~C) intermittent. ., ~~~;FaStenefS:300 series ' _ , °, ;>stainless`steel: . !Capable,.of running `dry without damage to components. Pump:--EP05 • Solids handling capability: ~Y; maximum. Capacitlest up to 60 GPM. ^~~Itital~~'~ads: up to 31 feet. ~, ~,Discliarge,size:l'ft` NPT. ~ ~ • Mechanical, seal: carbon- ;rotary'"~i~Camic-stationary, continuous intermittent. ;., ~;~,, ^`~`.,~ ~~."`' ' }~ .©1998 ( Pwnpe, Inc. ,< METERS F-EFT 10~ s~ 81 x g s ^ 5 o. J 4 F' 3 2 1 • Fuily submerged in high grade turbine oil for lubrication and efficient heat transfer. Avalfable for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and presut at the factory. FEAI~URES ^ EP04 Impeller: Thermo- plast~c Semi-open design with pump out vanes for mec.'lanical seal protection. ^ EPt15 Impeller. Thermo- plasticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrc~ion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplas- ticcover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• Canadian Standards Aasociadon (CSA listed model numbers end in "F" or "AC".) Effective May, 1995 B3A71 i_ t 2 t 6 8 10 12 m~IN CAPACITY System Management !vanagement of this system is critical. As a condition of approval of these plans this system management section must be rep iev`ed ~~ ith the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715-772-3214, or the St. Cron County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the boner and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. ~ 1 I f the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. Install water-saving appliances whenever and wherever possible. Repair even small water leaks as soon as possible. -t fever pour grease or oil down any drain or stool. Garbage disposals are not recommended; if you must have one, use it sparingly. 6 ~o paper products other than tissue should go into the system. ~o chemicals should go into the system. -~~oid suree flows of water; try to spread laundry throughout the week. Maintenance The septic tank must be inspected every three years by a properly licensed person. 1 f necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. t'`'hen the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and th filte must be back-washed into the septic tank to remove accumulated material. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. If [his system contains specific treatment components other than those mentioned here, maintenance requirements will accompany [heir specifications. b The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump !f the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve .apacin to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or :~•~ dais should pass before any necessary repairs can be made. - avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. ~ avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. U Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased Eros[ depth. 0 Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.E-1 i?), Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ST CRCI~ COeJN`1TY SEPTIC TA~.~ i1-.Ai~T1;,iVA.'tiCF AGREE~r.NT • AN.D~ Cat+4`'_ti'ERSHTP CERTIFIC?.TXOI~' FO1L~i C}v~Jzierr'L~.tyer IVI2iiirSq Address ~ ~1 7U ~/ P.S I-CY P*aperty A3dress ~.n,n,u,~ ~ • v~.aavuuvat City/State t~l~Sa'i-~ ~' p~cat I~~;atification i~«'ur7.ber Lice., n~sc T~a~r c~zo- ~~~3- ~-G~d (. 15~-=, Frog arty Z,oCation N G~J . `f,, '''~ W './, Sec.. 17 e T Z~N-Zt~'J~, Town of ~~-d~-vt . Subdivisian /dpi ~ ~ ~~~~~ %,ot # Certified Survey Map # , ~- , ~rolume - ~- page # `-~ Warranty heed # ___ ~ _~ .~ (o81p ,Volume ~ llo Z, Pagc # ~3? . Spec hawse ^ yes ,~ no Lat lines identifiable ~ yes ^ no • SYSTEM MAi>\17CE1lTANCE Improper use aru3 maintenaacecfyoursepric system caulu reaslt is its premature faiiurz to handle wa: tes. Properr~aintenance coasists of Pumping opt the septic tank every three years or sooner, :f needed by a licensed pumper. What you put info the system can affect the function of zhe septic tank as a tceatxncat stage it: the waste ~lisposaI system ~~ Fmpe:'ty owner agrees ro subrut io St. Croix Zoning Department a certification farm, signed by the o~•ner ~.nd ley a mast.rplumber,,jo~uneymaaplumber, ree;;trict?dplumber or a Iiceasedpumpervctifying that (1) the oa-site wa,tervaier~3i,saossl system is in proper aperating condition andlor (2) after inspection sad purnging {if aeceasary), the septic taus is less than 2'3 full of sludge, Utivc, the undersigned have read the abo~•e requirements and 3e*ree ro maintain the private sewage disposal system: •~~ith the standards set forth, htteia, as sat by rte Deparrntent of Commerce cad the Department of Tvatural Resources, State of Wisconsin. Cectiticaron stating that your sepdc system bas been maintained must he completed and refixrtted to the Si. Croix County Zoning ±~ffice within 30 days of e c year e ' . tion date, SiG gTiJRIr JF PLICA NT lo~ yr U pAT~ OV4'~'ER CFRT1FrcaT~~aN I (wej certify that ail stat~crrients on this far•.r, ar:, true to one best of m • our knowled e. I ~+e? : ~ pcope escribed above, by virtte of a warranty deed recorded in I~cgistcz of Deeds (ii'fice { 'n' (are) L'te awner(s, o#' sllrr.. of .tip I. cal-~T DATE ~"*" .":ry inf3rma~on that is mis-c•eprWsented znay resin! in the sanitary permit being revoked'oy the Zoning Deparn^ent. k~f~-ff '• In:Iude with this applr'caticn: a stanped warranty deed from rF:e Register of Deeds office • a copy of the cerified survey t7ap if reference is trade is the warranty deed aic~m riar_uing ~%kpattrnert fir aew• const~~uction} -- _ U 1.910' 533 STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Eleanor Bourgin, a single person, by Juliano R. H. Matthews, her attorney-in-fact, _ _____ __ ____ Grantor, and Jay Kolls and Rebecca Kolls, husband and wife, Grantee. Grantor, for a valuable consideration, conveys to Grantee the followins described real estate in SL Croix County, State of Wisconsin (if more space is needed, please attach addendum): (See Attached Exhibit "A") Recording Area 6 8 2 6 8 6 KATHLEER H. MALSH REGISTER OF DEEDS ST. CRO1X CO., M1 RECEIVED FOR RECORD 06-26-2002 9:30 ATJ WkRRANTY DEm EXEMPT t REC FEE: 13.00 TRANS FEE: 984.00 COPY FEE: CERT COPY FEE: PAGES: 2 Name and Return Address The First National Bank of Hudson ATTN Pat 0505237402 PO Box 187 Hudson WI 54016 020•iD33-10-000 ______ Pazcel Identification Number (PIN) This is _ homestead property. ..---(is) A~}1t~0 Exceptions to warranties: Easements, res[rictions and rights-of-way of record, if any. Dated this -}~_ day of M~_ All'CHENTlCAT10N Sir;nuture(s) authenticated this _ _day of 2002 G~l~ tnr Ott rr _~ _ ~g ~i "Eleanor Bourgin, by Julian R. .Matthews, her attorney-in- ACKNOWLEDGMENT STATE Or ) -- rMri-ftal~~'t'OM- ) ss. ~.fu/~, _ __ County ) Personally came before me this ~1~_ day of May _ 2002 the above named _ , -., Eleanor Bourgin, a single person, by Juliano R. B. Matthews, her .- -- -- -. ____ - attorney-in-fact, __ __ _ __ TI"CLE MEMBF,R STATE E3AR OF WISCONSIN --- ' --- "---- "-- --- t me known to be the person(s) who executed the foregoing (It 'tot, ins •ument and acknowledged the same _ _ -- ----- - __ --- q ti N authonzed by q 70G 06, Wis. Stats.) -~, _ ~~ A 1'IIIS INSTRIIhgENT W'AS DRAFTED BY + ,-. ~ ~ „- ~iy'' yO~~,1~7 -~'~.~, - \`C-_ tel... ~'---- -F=' ' - Attorney Krishna Ogland _ ____ Notary Publtc, State ol'dd~i>•couam ~~ M 8nd ;, - - -- -- Hudson Wf 5301G My Commission is permanent. (Ifn, ;`~i~oxxgTfdtlBr>,d=e'. (Signature> ntny be authenticated or acknowledged. Bo[h are not necessary.) _\~,~- ~_ 4'-4:a.'~ ';%._- `)~ Names of persons signing in any capacity must he typed or printed below their signature, i~ro.meuor Proie+ ` ' ~ raax.~4e~ ua~ w~ ~~daass-.azt S'1'A'fE BAR OF W ISCONSIN • '"?~ ' ~ Q W'ARRAN'TY' UtiF:D FORMNa.2-1999 ?~~••••... 'J 1916 P ~53`f EXHIBIT "A" Part of the W'/z of NW'/. of Section t 7-29-19 described as follows: from the West quarter co-ner of said Section 17, go North 2 degrees 30 minutes West a distance of 102.4 feet, thence North 74 degrees 29 minutes East a distance of 306.9 feet, thence North 54 degrees 24.minutes East a distance 211.8 feet along a roadway, thence North 63 degrees 16 minutes East a distance of 254.8 feet along a roadway, thence North 34 degrees 12 minutes East a distance of 248.7 feet along a roadway, thence North 3 degrees 04 minutes East a distance of 363.6 feet along a roadway to an iron stake, thence South 75 degrees 14 minutes West a distance of 33.0 feet to an iron pipe stake at the point of beginning for the parcel to be conveyed herein; thence North 75 degrees 14 minutes East a distance of 25fi.2 feet to an iron pipe stake, thence North 26 degrees 37 minutes West a distance of 266.7 feet to an iron pipe stake at the brow of the hill above the river, thence continuing on same course a distance of 50 feat, more or less to the east channel of the Willow River, thence Southwesterly along tha east channel of the Willow River to a point North 26 degrees 37 minutes West of the point of beginning, thence South 26 degrees 37 minutes East a distance of 62 feet, more or less, to an iron pipe stake at the brow of the hill, thence continuing South 26 degrees 37 minutes East a distance 220.5 feet to point of beginning, together with an easement for an access road along the roadway as above described to a point on the East line of the existing town road. *EXCEPT part to Thomas R. Quasius and Suzanne C. Quasius in Vol. 756, page 162. AND A parcel of land located in the Southwest Quarter of the Northwest Quarter of Section 17, Township 29 North, Range 19 West, Town of Hudson described as follows: All land lying between the South line of grantees property described In Vol. 406, Page 591, Document Number 277462 and the North fine of a certain private road easement described in Vol. 648, Page 103 as Document Number 378192. St. Croix County, Wisconsin. *Including all lands lying between the above described meander line and the east channel of the Willow River lying between the extension of the east line, bearing iv26 degrees 37' 00"W and a line bef;inning at the end of said meander line, bearing N26 degrees 37'00"W. 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