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HomeMy WebLinkAbout020-1418-10-000Wisconsin department of Commerce PRIVATE SEWAGE SYSTEM Safety and building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1 )(m Permit Holder's Name: City Village X Township Johnson, Glen Hudson, Town of CST BM Elev: InsR . BM Elev: BM Description: ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / ~~~- ~~~/ Dosing ~~ ~" Aeration ~/ / d ~ ~.-~ Holding ~~_ TANK SETBACK INFORMATION TANK TO Pi - W ELI . ~ BLDG. Vent to Air Intake ROAD Septic ~ l ~ ~ ~ , 3 ~ Dosin ~-- p~ UU Aeration -- Holding , ~D r r PUMP/SIPHON INFORMATION /r, I , Manufacturer Demand GPM Model Number s~-~~.~~1 ~ ~~ TDH Lift ~ ~ Frict~n L s System H ~,d ~ ~H ~~t Forcemain gt ~ Dia.2f, Dist. to Well > ~~ ~ SOIL ABSORPTION SYSTEM o BEDITRENCH Width ~ Length DIMENSIONS ~ (' ~ ~ SETBACK SYSTEM TO INFORMATION _. _ DISTRIBUTION SYSTEM ELEVATION DATA County: $t. Cf OIX Sanitary Permit No: 488193 0 State Plan ID No: Parcel Tax No: 020-1418-10-000 Section/Town/Range/Map No: 20.29.19.2649 STATION BS HI ; FS ELEV. Benchm r Alt. BM ?~ a ~ ~ z, ~.Gt ~b ~ 3 Bldg. Sewer 3d3~P 1a~5 ~. / ~ St/Ht Inlet ~ ,,Z < j ~ (~ v 0 ~~ SdHt Outlet i C J Dt Inlet ~ Dt Bottom /~• y ~~ ~ Bader/Ma ~ L ~~ 7 ~ . (_ / ( ~ 3 _ Dist. Pipe .5 G, O / ~ 3, `~ S ? Bot. Syste)n . Z d-~ .~~~ - ~ 6 ~, p y Z• -1 S Final Grade I~ ~i'f/ rtv r 6141x- s.~ S q ~. r o St Cover ~ .iy '' 3 No. Of Trenches BLDG IWELL ce 1~~ ~ Depth CHAMBER ORS" nufah~,/ ~ / ~ UyLT~ Model WBmber: _ ~ , r O ader/ nifold -~J ~ Length / Dia Distribution '^ ,~ Pipe(s) 1 ti~ lY~ f' Length 1 )Z Dia~_ Spacing ~7' x H leo Size._ F' ~ x Hole Spacing -~-~" Vent to Air In SOIL COVER x Pressure Systems Only xx Meund Or At-Grade Systems Only ~ ~~ t~ ke CfS G8~4,r~ Depth Over ~}- Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center C '/ J Bed/Trench Edges Topsoil a a No Yes ®Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ Z ~/~ Inspection #2: / / Location: 458 Wren Circle Hudson, M/I 54016 (NW 1/4 NE 1/4 20 T29N R19W) The Glen ~L~ot"55 `f(~/~iC) Parcel No: 20.29.1~9f.i2f64~9 / 1.) Alt BM Description =~ ~ ~QiYIVI ~ S l ~ -tciV~- ~ ~/ ~ ~ ~~c~~~/t-~/~v(~(/b/ 2.) Bldg sewer length =~ ~ ~ /Q ~j~j/~ /' b7~[ , ~ik,G~ :Z~ 4/ U~ ~ °~ l U ~_~~~~~ ~ ~~ -amount of cover = ~ ~ f ~..~ ~ ~ ~~ ~- . d ~C 77, ~~ rii ------ Plan revision Required? ~~ Yes ~` o I~~ ~ / ,6 ~ / S tJ Use other side for additional information. ~__la ~---- ~J _~ _ ~ tP _~ SBD-6710 (R.3/97) Date Insepctor's Sign ture Cert. No. r. RE'~~'~'~' Safety and B 'Idi gs Jaivisian t:ounty , N ' 201 W. Wasfifitgton P. ~~ 7 6 -~ , ~~ ©~ X l~c~~s` j~ A'IadiS , S 07 -~'b'7 ~ ~ 1 ~ '- nifary p rmit Number (to be filled in by Co.) De artment of Commerce 8} 66 1 ,/$~,~ ST. `?' Sanitary Permit AppliCat __ scare Fla LD. Number in accord with Comtri 83.21, Wis. Adrn. Code, personal information you provide N~-- may be used for secondary purposes Privacy Law, s15A4(ixm) Project Address (if different than mailing address) I. Application Information =Please Print Ail Information ,~, LfCQ / ~~,e~ ~; r n Property Owner's Name //JJ Uv (~/ esC~, ~'` 1 , ~ Parcel # Block # `T' 1 ^` S a` Oh ~0 ~ 2\1~.G 1 v~l ~~ ~-~ ~-? Property Owner''s /Mailing Address Property Location Crty, State Zip Code Phone Number II. Type of Building {check elf that apply} e~ o ~ J~ ! SUaOM~+~ ~1 or 2 Family Dwelling - Number of Bedrooms J ^ Public/Cornmercia! -Describe Use ''''~ ^ State Owned -Describe Use ~~~~f,-5 GrJ / z~_~'zg III. Type of Permit: (Check only tree boz on Line A-. Complete line B if applit:able) A.. New System ^ Replacement System ^ TreatmendHolding Tank Replacement Unly B• ^ Perr.;it Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration i Piumhe!r n,.ma. {V W ~l,, ~~ ~,, Section a O (cirole one} / / ~ f~ T ~ N; R_I_~E or®C ~ ~ lQ 7 Subdivision Name CSM Number ^City_^Village.~"iTowttship of~~d~ ^ Other Modification to Existing System Petmit Number and Datc IV. T e of POWTS S stem: Cheek al! that a l Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound <24 in. of suitable soil ^ At Grade [] Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ holding Tank (.~ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter [] Recirculatin Synthetic Media Filter ,~6.eaciting Chamber ^ Drip Line ^ e es ipe ^ Other (explain) ( V. DispersaUTreatment Area Information. t L7 =- 77-ir _ I r~estgn glow {gpd} Design Soil Application itate(gpdsf) Dispersal Area R s Dispersal Area Proposed t) System Ele lion VI. Tank Info Capacity in Gallons Total Number Gallons of iJnits Manufacturer Prefab Site Steel Fiber Plastic New Existing ranks teaks C/ /¢- /~ Concrete Consrruoted Glass ~~ ( ~ S i H ,,e „ u- ept c or olding Tank /s~ / ! Aarol~ic Traatment Unit _ Dosing Chamber ~~ LSD ~ r-- ( , } `~a",~`y" ., ~„ Plumber!s Signatuume responstbliity for ins PRS Nu berPOWTS shown on the attached plans. Plumber's Name Print Business Phone Number Gi/~`lla.r.-+ ~Gla,~.~?lrr C~ ~-- ~?2?~'9~ ~i.S'-38C~3ta> Plumber's Address (StrNet, City, State, Zip Code) L3 ~ ?~ ~ O G~ ~ r ,S1-YGf t' VIII. "oun JDe artment Use Only Approved ~pprove Sanitary Permit Fee (includes Groundwater Da Issu Issuin ant Signatur tTlo ps} Surcharge Fce} ~~ ~ S /9 Jrven Reason r I~niai IX. Conditions o,[~p oval/Reasons for Aisapprova! SYSTtt (SrVrVNtEF~ . 1 1. Septic tank, effluent filter and 3J ~ 1J i ~ ~¢,~, ~ Su(~ b t.l (r~~ yM.a; n n dispersal cell must all be services J maintained / u as per management plan provided by plumber. D C,G~Q1~' ~ D ~i~, a vt~t P,O 4J ~~ 2 AN se(back requaementS must be maintained J_ +~ PK ippliable code / crdirnltces. plain (to the County only) for the system on paper not less thin 81lL z J t inches in size SIID-b39$ (R. 01/03} ,e,J .fia ~t,rl-s a..~ G d rrlS ~ -K A ~ a~ /~ off` ~"' ~ /~ ~-,i1~~~ ~" S% ?" ss' ~~ ~/~e~ ~~~ . ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm_ Code County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. Rev" Personal information 1~ provide may tx; used for secondary pu 04 (1) (m)). Property Owner g ~,,,;, •- '° P rty Location 1132 Page 1 of 3 Steel Soit Service St. Croix pending Date Sienna Corporation Gott. lot NW 1/4 NE 1/4 S 20 T 29 N R 19 W Property Owner's Mailing Address ~, ~- ,~ :~ ~ ~( ~; ~ L~~`4~# Block # Subd. Name or CSM# 4940 Vil king Dr. Suite 608 ~ ~ ~5 na The Glen / City ~i~rj4 State Zip ode P)~s{~q{rtt~k)! ~ City Village ~ Town Nearest Road i. MN 55 r 5 :1~52a "°°' Hudson Dorwin Rd. ip NeW Construction Use: iV Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial -Describe: Parent material Pitted oufinrash Flood plain elevation, if applicable na General comments fS2~ / - / ~° eCG. ~f ~ ~t and recmnmendations: System elevation 93.60ft, trenches spaced and depth to code 3.50ft below grade r .~G,ls ~ ~ 8/ q' Boring # Boring ~ )r, Pit Ground Surface elev. 97.10 ft. Depth to limiting factor in• Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftz "Eff#1 "Eff#2 1 0-13 10yr3/4 none sil 2msbk mfr cs 1f .5 .8 2 3-96 7.5yr4/6 none ms osg ml na na ~ 1.2 V l0 '~O `/ ` / y 2 ~ , i ~ Boring # .Boring ~~ ~ /S ~- Pit round Surtace elev. 9 .10 ft. Depth to limiting factor 96 in• Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots GPD/ft2 'Eff#1 *Eff#2 1 0-14 10yt3/4 none sl 2msbk mft cs 1f .5 .9 2 4-96 7.5yr4/6 none ms osg ml na na O 1.2 i i ~a . ~s '~~~ s js,~ ~=~~~- . trrwenr ~~ = csuu 5> su < <[u mgrL ono l 55 >3U < 150 mglL "Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L SST Name (Phse Print) Signature: CST Number David J. Steel `=1J~~"E~~ 248956 4ddress Steel Soil Service (~ ~ ~ Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 9/12/2002 715-246-5085 Property Owner Sienna Corporation Parcel ID # Pending Boring # 'Boring / Pit Ground Surtace etev 94.10 ff. Horizon Depth Dominant Color Redox Description Texture 1 0-12 10yr3/4 none sil 2 12-19 10yr4/4 none sicl 3 19-28 7.5yr4/4 none scl - 4 _~ 28-96 7.5yr4/6 ~ none ms (oo`' ~~ Borina # Boring Depth to limiting factor 2msbk 2msbk 2msbk osg mfr mfr mft osg Page 2 of 3 96 in. Sod Application Rate Boundary Roots GPD/ftZ *Eff#1 *Eff#2 cs 1f .5 .9 gw na .4 .6 gw na .4 .6 na na ~ 1.2 * Effluent #1 = BOD ~ 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 Borina # Boring Page 3 of 3 STLEL' S SAIL. SERVICE David J. Steel CST-POWTSM Lic. # 248956 Sienna Corporation NWl/4,NE1/4,S 20,T29,R19W Town Qf tin, St. Croix Co. The Glen lot 55 1564 Cty Rd GG New Richmond, WI 54017 (715) 246-6200 (715} 246-5p85 This sail evaluation was€onducted Ea-satisfy a g requireme~tt, it may er may-not be suitably for your use. The location of the test may or may not be as shown as permanent lot lines were not ~!~~~' o~(f 14I established at the time the soil Est was cenductedt Legend ,~'o' ~, °~ ~ ,,, _ •0' 3p' 24~ Gh k 11: lOfT.00Ft ~+~~' to oll ~"' ipe J: r~ n~rr g.QSFt N pipe levations OFt OFt OFt ~OFt _~~f r4 j i _______~ ' I L- 1 -~ _ ~. j ~- ~ iq 11 ' ~ 'p „ ~..-,.: ~. ~ _..` I 31~ II ,, ,_ ~ ~ , .,. . ~; ~ i~ ~ ,. .--- .-, - - r ~ 0 io tl ~4 ~, ~ ; , -, -; . ~ ' '. ~~ ~ 57~ ` ~t :: Iii i! I v y:. ~~ .; ~ _ ~ • i ,, '~~ -'~: a~ i 1 ' ' .~ r'' _~., '~•. 417•• ~I ` A '~~,. I t, ... ~ t t .' 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' .l ... _ -_ 1 It L'4 66 i -~ ~ l °.~._.. , ~ .> _ .. `.~ ._ ,. .,a`' ~+ _ 344 ~' _ -. _ 1 .~ . -r ' _ -may A T,e~ . ; ,. sf ~~ 11 ''t .. j1 _ ~ 1 .- a_° - -- _~ t ~ ,I t Ytry t` y`~j .. 4 ~ , ~ _ z -- _ _ ,,, , ,,' I~ ~ ~ 67= ~, 7 , '~ „- ~- r •,. .. l , • I' , 1 r r. , _.. 4 , , ,, ~ It ,:~ p 6 a _.. .~,~ . , ., a ~ - •3 r ~ ~_ .~... -. , .. •, l ` - ~... l_-., ~i 1 [ 1 ~ a 681. ,~ - {~J" ~. ~ ~ a ~ ~ 1 1 ~ 1 Ili '~ ~\a ~R, . _. t l ~.., , N 1 TP /• 1, .: . • _. 1 1 _.. 39 . t 4 . ~ "' .. .. '-~ -'- \ -,' _ ~~ l ~± ~ 'h r64 69 .,, _ I ;7 r .. a .__ i ., ,' _ ~ '.. ~ t 1 t n t ' I ~ ~ - a''- 24S 1 t "138 ' 332 ~`~ 1 ... ~,~~ r ~ ~ `t I-:.1 1. .l 1 ~, t ~. 1 , `~,~ ... alb, ~~ f .`~ +!~^ ~ I l; I 1 _`,. \ 1'' I I \ _ !~ ~ , ~ ' ~. l ~ 4 rep ` r~ 1 tl ~ ' ~!e - `a, .. I I „' I j , :v' ~ . ~, .. • ~ ~ .. ' ' r i ,\ ~. } ~ ,^ 11~ 1 r `! - ~ l 4t . ~ III 1- ~ ; , ~.. ~+~ 1 ...1. , , ,..~ i „ f Ili ~i. ~-~'------- 1 -j ~ ~ `a ~, M r . I: I ~ I •t t - - l: l lr i I'e;, .ll ~ ~ ~I~/ t it .1,x'1 ,r ~~ , a2~- ~~ ~ , 1. I ~ ~ 1 ...~ ;t 1 , t a . .- ~, \; , , QI ~ t.. „ ~~~ lx,,~ r ; ~ rr,, :;: ~ ~ , a a -~`-' ;~+, ~ ~ as ~ ; •:. as ~, ` tt ..f~i:1, 1: ,4141_' ' `b\ '~ ' ., t t _ i ~ al . ;. .`4 1; ! ~ Ii I f ;1 1 ,~~ I _ ~~ ,~ ., -.~ --l _ _ _ l iii I ~26 ~~~ ~ .r. / 1 1 .:~ . .__ _ _. I'~ THE GEEN ~„~.~,.. ! (!) and (2), l..a~ae ~+ Ma .+~ ewer ~ 6.. ~ . w ~• M~ sarM~oN Mrrar of Mr gav7-wst or+rar. to tpa 9 MrNar et /N Nwl~rwt 6rwer, W M. Nartlaoot Ifn M 6rorb-. N 6M NMMM11 of 6n '~aeiMOOOt Mme. M M• MrlMOrot 0rriv ai M- !Nr t~uerlar aM a tln 8o~ta.arpt OYaNar of Ma~ Groo~Ear, ~rt N -A t tl Mot o/~Y ti MMvnAa F8, i'~-r 3J0~, all M foo6on ~ ' 2! MOr#. Mw~a N 1Ww A 1Yrraw, ~. 6nmt J J,~ - r..""' ~N , ~ . ~~~ ~~ I I ,~ ~~ ~i I J I I I I ~ bY.~ elo 6a~elin6 I ~ w.oort nw+o' I \ I I eases ara~ ~ \ 1 ! xr \ \ I ~ ~i ~~ ~i'' \\ \ ~ P i (1.072 AG) ~~ ~~ ~ ~ I \ \ I ,~. \\ \ ~ ""~ i '~ .'~ BLOCK 6 \ \ ! \ I , ~ i\ \ ~ ( ~+~ir ears.® \\ I J /ice ~-'----+--u ~ s~sw ae` \ ~ ~ ~ 58 I I / /~` I \ ~'' I i ~ f i~ ssa6s sr. \ \ `~. _J L~ ~ ~ \ ~- i ~ ~ ~~ ~ ~ \ i ~' f .' \ ~ \ ~ \ ~l ~ ~ ~~ .~-------- see \ (- -- \ 1 ~' I '~ ~ _ _ , ` ` i / v / s3 ~a ss ,~ ., ~. (1^[~- h ~k ~ ~ F sir -- •c= ==~--.-- ~ ~ ~~ i i \ ~ (1.015 AC.) T ~~~ ~i~ $Z '~ ~~ \ \ . ~ .' ~ ~ •3690&F. ~ \ '~~i/~~~ (t.eo3 ec.) ) \ SEP-84-2392 14 15 3 ~: .::~ ~ ~ A ~ ~ ~ ~ ~ p ~ 1 r= z O ~~ Z ~ ~1 ! Q ` N : ~ N ~ 01 _ P I ~ ~ S I EtdNA CORP 752 83S 'i.: i i~ i ,I (' I I I _,.J I~^- H'~ .. TY• ~ I,; ~ 4 ~ _ ~~ z.'; ~ ! i ~, ~.- _~ 6 /,~ ,~ ::; ~ I- •'6~~ '? :~~.~ '~~ x^ i I ,., .:' "~,.~ ~ I - •- . ••.. a. t ~ff r •. •.: ~-.... I I' I ~~ ~ ~ ^ I~ --- -iii I I ill I•I I ~ _ 1 '•'~_~____,__, ~aw_,_ ,,.. .'I~. i t ~ I I I ~~ T EX-~ ALT N !~ James ~. Hif I, lnc, SIENNA CORPORATION PLAMNFM ~ ENdN`~RS ~ S11RYE'(ORS .au ~..~ wr<. 7uic nt ~., ~. ».» ~ YCD , en. W .t x~t 174 i~c,ra, .w :'6JSt na(: raip~o-~a~ r.c: I~:Kso-e:~~ '?aFJ8 it P. 05%~ TOTAL F.3 U 2856P 333 Document No. ~ STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED SIENNA CORPORATION, a Minnesota corporation, conveys and warrai GLEN JOHNSON CONSTRUCTION, INC, a Minnesota corporation, the following described real estate in St. Croix County, State of Wisconsin. 6~ 2 1 3 7 KATHLEEN H. MALSH REGISTER OF DEED ST. CROIX CO. , M RECEIVED FOR RECl,]RD 08/03/2005 10:00AM WARRANTY DEED EXEIPT # REC FEfi: 11.00 TRANS FEE: 298.80 COPY FEE: CC FEE: PAGES: 1 NAME &c RETURN ADDRESS SCENIC TITLE AND ABSTRACT, INC. 220 LOCUST STREET, STE. 1 HUDSON, WI 54016 ~~~~3 FILE # ~~ Tax Parcel No: 020-1418-10-000 Lot 55, Block 6, Plat of The Glen in the Town of Hudson, St. Croix County, Wisconsin This is not homestead property. Exceptions to Warranties: Easements, reservations, and restrictions of record. Dated this ~_ day of ~ Ti ):1 , 2005. AUTHENTICATION Signature(s) (SEAL) SIENNA CORPORATIO~a Minnesota corporation By ~ C L.s.~Jt (SEAL) Marsha A. Pierce Assistant Secretary authenticated this day of 20_ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06 Wis. Stats.) This instrument was drafted by: Sienna Corporation 4940 Viking Drive, Suite 608 Edina, MN 55435 ACKNOWLEDGMENT STATE OF MINNESOTA } }ss. Hennepin Gounty } Personally came before me this 3a day of 3'. vJ6 , 2005, the above named Marsha A. Pierce, the Assistant Secretary of Sienna Corporation, a Minnesota corporation, on behalf of the corporation, to me known to be the person who executed the foregoing instrument and acknowledge the same. , Catherine M. Thornhill, Notary public Notary Public of Hennepin County, Minnesota. My Commission expires January 31, 2010 Signatures may be authenticated or acknowledged. Both are not - necessary. CATi~IERINE f1A. 7HOF~IwLL NOTARY PUBLIC-INWNESOTA Ny Oandulon ~ .Yo. 31.2D10 Names of persons signing in any capacity should be typed or print POWTS QWNER'S MANUAL & MANAGEMENT PLAN Rage ~.. of Frr.E INFORMATION Owner Permit # DESIGN PARAMETERS Number of Bedrooms ~• p NA Number of Public Fac{lityYUnits A Estimated flow (averagei ~17L'J alida Design flow (peak), (Estimated x 1.5} ~S4' a!/day Sail Application Rate ~` ,_ _ gallda /Y ft2 Standard influentlEffluent Quality Monthly average" Fats, Oil & +Grease {FOG} <_30 mg/L Biochemical Oxygen Demand {BOOS} 3220 mg/L ^ NA Total Suspended Solids (TSS} x750 mgit Pretreated Effluent Quality Nlanthiy average Biochemical Oxygen Demand (BODbi x;30 mg/t Total Suspended Solids {T5S} 5S0 mglL ^ NA Fecal Coliform (geometric meant 514° cfu/100mi Maximum Effluent Particle Site ~- Y~ in die. ^ NA ~' _.- Q?1100 --_...______m___ L7 NA 'Values typical for domestic wastewater and septic, tank affluent. MAINTENANCE SCWEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity l~~j` ____ _ gal ^ NA Septic Tank iVlanufacturer ~~ C~z:.Y O NA Effluent Filter Manufacturer ;Zd k ~ ^ NA Effluent Fitter Model /~Q' DNA Pump Tank Capacity ~s-© al ^ NA Pump Tank Manufacturer ~ ~ cos' ~ r- ^ NA Pump Manuirrcturer ~.~~ _ _ ^ NA Pump Model ~` ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Fitter ^ Peat Fitter ^ Mechanical Aeration ^ Wetland ^ l3isinfection ©Other, BiapersaE Ceflfsf ~~ C3 NA ^ in-Ground tgravityl ^ tn-Ground tpressurized) ^ At-Grade Q Mound ^ Drip-Line ^ Other: gther: ^ NA Othe~_..~ . ' ~ _._..,_. ,..._~ .. ~.. ^ NA - Other: ~~_~ ~ ~~ ^ NA Service Event Service Frequency inspect condition of tank(s) ._...,.__ At least once every: .3 month{s) {Maximum 3 ears) ear{sl y ^ NA F'ump out contents of tanks} 'When combined sludg ___ e and scum equals one-third (r;) of tank vaiurne ^ NA Inspect dispersal ceil{s) _ __ ..---......_.~.~ _.. ._._. At least ants ever y: _ [~~ onth(s) ,~ (Maxlmurn 3 years? ~fiCyear{si N ^ NA Clean affluent filter _. __ At Isast once every: _._ __.._... D monthis) ~~ ~ ear(s~ .__...._ __ ^ NA inspect pump, pump controls & alarm .._.- .._._ At least once every: ,,,_ ~ month{s} ^ year{si ^ NA Ffusti laterals and prESSUre test ~ At least once every: - _ ._ ^ month(s) ^ yearts} - __ ^ NA Other: __._..._ _ Other: ~ast once every~ ^ month{sl ^ .~. ~- -~--~~^ D year{s1 ~^ NA ©NA MAINTENANCE INSTRUCTrONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Piurt+ber; Master Humber Restricted Sewer; POWTS Inspector; POW7S Maintainer; Septage Servicing Uperator. Tank inspections must include a visual inspection of the tanks} to identify any missing or broken hardware, identify any cracks or leaks. measure the volume of cantbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(sl shall be visually inspected to check the effluent levels in the observation pipes and to check far any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludya and scum in any tank equals one.-third (%s1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 1 t 3, Wisconsin Administrative Code. Ap other services, including but not limited to the servicing of effluent filters, msc;hanicaf or pressurized components, pretreatment ran+ts, and any servicing at intervals of 512 months, shall be performed by a certified PCIWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. apo~ an.~elis!urwpy ufsuoost~ry '(Ef'8 Ibi '4tlbq't;8 pu>3 !!}'81P}fLllq)(Z?ZZ'E8 u,u,a~ ~eldeya y~inn saueitdwo:•~ u! psi;e~p senn.iuausn~op s!yl OS °l/~ - ~ ~~' - S/~ euoyd auo4d ~J~ ,. ewe fy AIIaOH111t1 Jl>:IQ1t/1t1J3!! ltfOOl (ii3dVYl1d} !lOlba3dQ JNi~lAa3S 3Jb'1d3S euoyd aweN !l3NiV1NIdW S1MOd I v'Ic: --,.~8~' ~ ~ L euoyd !l3~iV13Nl S1MOd stN3wwoo i~iN0i11aav '31913SOdWl NQ 1'1lt~id3la dg AVW SNbI b d0 2l01213iNi 3H1 WOad NOSil3d V~ d0 3f10$3!! '11f1S3H Ab'W Hlt-~q '33aNV1SW110a10 JINV ii3aNfl ~NVI 1NHW1V3d1 lISFi_!O t!O dWf1d 'OI1d3S d d31N3 lON OQ "!V~O.AXO 1N3talddfiSNi i30JgN1l S~SStlO 1tfH131 NlV1N00 AtIW S~NVI 1N3Wltl3>dl !l3H10 pNK dwnd 'OI1d3S < < DNIN>dbM > :• •aw~l leyl le lae~;a ul sa~n~ ayl yliM A{dwoa lsnw swais~ts yons ;o suoilan~lsuoaRd ~eae;ins anfle~lli;u! ayl le iewoEq ay} ;o ~enowaj BuIMO{~oj aae~d ur pelanalsuoaa~ eq Aew swaisrts uo}ld~osge bias eC+e;~-le pup punoy>l ~ 'S1MOd P©Ife~ ay1 aaefda~ of ~~ose~ lsef N se paffelsuf eq Aew xuei Bu!pfoy a afge!!ene s! eeae luswaaefdaJ ou ;! •eala iuewsaefde~ s!ge~!ns a eieao! of pew~o;.tad aq ~snw uo!lertfene al!s pue }!as e S1MOd ®yl ;o a3.,n!!t3; uodn •ea3e luewaaefda~ efget?rts a R;:luepf of palen!ens uaaq 1ou say at.!s eyl ~ 'S1MOd Pei!e~ ey2 aae!det of 1~osa~ ~sef a se peffeisu! aq Aew >fue~ Swpfoy a A6ofouyael S1h1Ud ~„ seouPnpe Bu!~~eg •suof~.affwff Eros ~o~pue ~aegias o: anp afgeliene lou si ease ;uewaaefdaa afge;{ns b 0 ~awil leyi ie laa~~a u{ sa~nl ayi yl-M ~~dwoa isnw swalsAs iuaweaefda~ •eeae iueweap~dsa afgelms a ys~~gelsa o; uofxen~ena ells pue Ifos Mau a ~o# paeu sy; u} i~nsa~ !!!nn ease luewaae!da~ sy2 loaiaad of can{{sd 's{{aru- pue saui~ 30~ 'emlontls pasodoad pue 6uiasixa woe; s~apglas paainbe~ Aq uodn pe6uusu! eq you pfnoys pue uo-laedwno pue eauegan~s!p uta.,; peloaiwd aq p!nays ease ;uar,uaoe{dea ay,~ 'walsAs ua!;dtasge f!os Yusuaeas!dg~ a ;o uo!ieoof e4t, ~o; pez!!nn aq Aew pue pelen!ene uaaq seU eeae iuaweaefde, efget~rs d p luetfdwoa epos a ep~no~d a3 'ue~fel aq 3$nu, ao 'uaaq envy salnseew Euinnof!o; ayz pa~!eda~ aq louuea ue, seesAs lueweaefda~ P I ~ S1Ml?d a4a 1! NV'1d AON30NI1N00 'fefaaleu: p,fas uaui ~ayioue ~o fane~6 '~ios y~~nn pel~!~ aaeds prop aq~ pue Penowaa saanoa neyl ~o panotuo~ pup paleneaxa aq flays slid pue s~fuel ~fe '8+aaduand eel;~ •~ale~ad0 Bu!a!nlc~C aseidas a nq to pesod9fp Afaedo~d pue penoura~ aq flays si!d pue s~uei !fe to siueruaa a4~. p®fess s8u!uado sd~d peuapuege sy~ pue psiaeuuaas!p eq tfg4s slid pue s~fuel o; 8u~d,d fib ;apo0 enile~isfufwpy u!suoasfM 'EE;'g!3 u1wo0 laldeya y~;nn eauerfdwoo of pauopuege Ada;es pue Alaado~d sr walsAs ay1 leyx a~nsw of ua~{el cq ffgys adais SufMOffo~ eyl aaln~as ~o ino us~el Allueuewjad sl to~pue s;ie~ S1MOd e4~ uayM 1N3WN0®NtlBd ~au-aq ~auauos ~eieM pue :suodwe; :su,tldeu Aae;!ues :sepiailsad :saanpo.td Bu!lured :fto :suo!;e;,ipew :sde~as ae®w :sepfary.tey 'esse.,8 :au!fosQB :s8ulfaod alge~a8an pue ~1!n~; :,te~enn (dwnd du,,nsf u!e~p uoliepuno; .'gyp; :sluQlae;u!sPp ~s~ede!p :ssof} fe;ugp ;s,,esae,rBvp :sgeMS uoaloo :swopuoa :sling ozlele8fa :Sad nn A e +ay1 ;o a;i! eyt &uofoad p~.,a eauew~o;gad ayi eno~dwr Aew euee~js ~elennelsenn e 1 wog Su!MO o e q q :sorlo~grlue :S1MOd . y ~ tl f yt ;o uo!~eulwffa ao uaponpafj ease ayl '2~aeduaoa ao gmisrp asfM3ayio .to 'nano ~faed ~o snap ou!oQoss~ f~afes ads p pue s~fueWaeno sa!~ yen ~ ed to ant t ulyltnn . p lou op o~ s!a,t~uaa dwnd ayl Bufletedo A!fenueur ul lslsse of aau!elufe 'duel dwnd eyl uiyliM s~ena~ lew~au ejolsa~ Buuolsaa al aor.td to;et~+d0 Bu!a!naag aBelda e A W S1MOd ~o aagwnfd a ioeluoa ~o dwnd luanf;;a ayl o~ aennod ;o e8aetfoslP aae{.rns ao dn~aeq sy3 u $ q Penowe.r ~fue1 dwnd ayj ;o siua~,uoo aye aney uoi~enl!s slyi p!ona of 'luenf~;e aq fi!M .ra2enneisenn sseaxa gyl peaoisa~}s! aeMOd upUe (slllao ayj Bufpeafleno 'asop a6~ef Buo ui (s)Ilea ipe~edstp ayi of pafi~eyos!p yM 'S{9AAf 183eMy61y fewlou anpge flt; ABW Stluel dutnd gp8eln0 18Mad Ouun(l ~eae;ins enlxe~i!!;uf eyl le uaxol; ale suor~lpuoa Iles usynn ma5o lou gays do upls weis,(g slua2uoa ai l ens 'asn of aoud aalpaado Bufa;n~as aBeldas a Aq panowe~ (s?duel a a 4 palaelep app suo{lelluaauoa yBly !i '~sjUaa ~es~edslp eyl e6pwep ~a/pue ssaao~d luawlea~l ayl epadwl Aew leyl sfea!waya ~aylo ~a slanpad 9utluled ;o ®ouasa~d eyl ao; {si>fuel luawlpaal ae a ~___ ~ y S1MOd ayi to asn o1 ~of~d 'ual~an~lsuoa nnau gad ;a ---- eked NOt11yl~3d0 aNt! do laV1S START uP Anra oP~RAritoN ' PAQe _ of ___ lcor new construction, prior to use of the PpWTB check treatment tank(s) for the presence of painting products or other c V that may impede the treatment process and/or damage the dispersal cell(sl. :f high concentrations are detected have the consent of the tank(s) removed by a Septage servicing operator prier to use. hemicals s System start up shall not occur when soil candit}ons are frozen at the infUtrative surfac®. Ourinfl power outages pump tanks may till above norms! highwater levels. When power is restored the excess wastewater wiN be discharged to the dispersal cell(s) in one large dose, overloading the Bettis! and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prier to restarir~g paver to the effluent pump or cortact a Plumber or POWTS Maintainer to assist in rnanuallY operating the pump controls to restore normal levels within the pump tank. Qo not drive or park vehicles over tanks and dispersal cells. Oa not drive or park over, or otherwise disturb or compact, the area within 7 5 feet down slope of any mound or at•grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve rtes per#ormance ar~d prolong the life of she POWTS: antibiotics; baby wipes; cigarett© butts; condoms; cotton swabs; dagraasers; dental fleas; diapers; disinfectants; fat; foundation drain (sump pump} water; fnrit trnd vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine, ABAND©NMENT When the POWTS fails and!or is permanently taken out of service the fallowing steps shall ba taken to insure that the system is property and safely abandoned }n eomhtianee with chapter Comm $3.33, Wisconsin Administrative Code: • Ali piping to tanks and pits steal! be disconnected and the abandoned Rine openings sealed. • the contents of all tanks and pits shall be rerraved and property disposed of by a Septage S«~rviairtig Operator, • After pumping, al! tanks and pits shall be excavated and removed cr their covers removed and the void space filled with soil, gravel or another inert sn}iC! rnaterial. CONTINGENCY PLAN if the POWTS faits and cannot be repaired the following rrreasures have bean, ar must be taken, to provide a code compliant replacement system: O A s+litable replacement area ha6 been evaluated and m.ay be utilized for the location of a replacement soft absorption system. Tha replacement area should be protErcted from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wolfs. Failure to protect the replacement area wilt result in the need fnr a new soil and site evaluation to establish a suitable replacement area. Repiacemer;t systems must comply with the ru}es in effect at that time. A suitable replacement area is not available due to setback and/or sot} limitations. Barring advances in Pn41/TS technology a holding tank may be installed as a test resort to replace the fasted POWTS. D The site has net been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soft and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed P4WTS. Cl Mound and at-gra+~e soil absorption systems may ba reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. •: < V1fARNINO > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN L!?'TNAL QASSES AND;OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTIiEFI TREATMENT TAMK UNDER ANY CIRCUMSTANCES. DEATN MAY RESt1LT. RESCUE OF A PERSON fROM THE INTERIOR dF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWT& INSTALLER Name ~jr1l'eF, y„ , S'C~tu Yn~st/f~:Y ._.. Phone ? ~. „ .98'x"-~ ~ l~l PUWT$ MAINTAINER Name Phone SEPTAGE 5ERViCING t)PERATOR (PUMPER) LOCAL REGULATORY AiJTHORtTY Name Name ~-• GCoi ~C ~/ ~~+~n:,n ')- o ~.n Phone Phone 7/5 - 3~ ~ - yb 80 This dorur+nent was drafted +n compliance with chapter Comm $3.22(2}tbl{1l{d}&{ft and $3.54(11, (2} & i3}, wisconsln Administrauva Code. r.r~ui ~ •,~.nui w~cr~ r~u~ ioiiru rnn ~r~. (1JJtSOJ1Gl J2p. uJ trrr~a lYJ• JJru i rc ~T. ~~l~otx covrlTx SEPTIC TANK MAYNTL~ANCE AC3REIrMENT AI~7'D OWNFRSHTP CERTIFICATION FORM OwnerBuycr, C--,ism ~1'~ ~-.r.~`1'rv~C~1~c'-~ Mailing Address -_,_,"tr~3~ ~~,~,~_~~... ~~~=~'1 t,,.l; ~ ~~~ ~ -- PropcrtyAddress `7`~ ~" ~rJy~,~> ~w rcr~.,l=~ (Verification required from Planting & Zoning for new oonstzuction.) City/State c~-c.~"~ L.~> ~_ Parcel Identification Ntambtr a ~ -~`~'~/ ~ ~.,/C~ -CSC Property Location _ ~Jl? '/, , t~~'/. ,Sec, ~U , T ~~N Rl~W, 'town of ~~~~n Subdivision i~ ~L-%~ _ ~ , I.ot # CerLliitd Snrvey MAp # _ ~ ._, •• ~ ., Volume . .•, ,,,,~~ Page # warrau,ty Deed # ~ , Volume .Page # _ Spec house yes ~> Lot lines identifiable yes no $'YSTEM Mr4YNTENANtCE AND S~~V~V~$ C,~~~:~~1T improper use and maintenance of yow septic system could result in its p~rrtnaturo faihtro to hancllo wastes. Proper IDaintenartce consists of pumping out the septic tank every tlirrc years or sooner, it 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 rystem. Owner maintenance responsibilities sue speeifted in $Counm. 83.52(1) and in Chapter 12 • St. GYoix County Sanitary Ordinance. 'I'hc prvpcrty vwcwr a~roo~r to submit to St. Croix Gounty Plaanittg &t 7.e+ntttg Aepanme:st s u~rtlfleation form siYn~:ri by chc owner and by a mreur plumber, jouttsoymsn plumber, rossricted plumber or s llconsed puinpet verifying that (l) the nn-Aire waatewatct disposal system is in proper operAung condition and~'or (2) sftcr inspactittn and -umping (if noeossary), the septic task- is ltst than l/3 full of sludge. Uwc, the uttdecsigtied have read dte above requirements and agree to maintain ttte private etwagt dispose! system with the standards set forth, herein, as set by the Department of Commerce and the Department of Marton! Roaotuces, State of Wisconsat. Certifipttioa :rating thst your septic system has been maintained must be cotnpietnd and tetumed to the St. C'aofx t:.aunry Plattnmg dt Zoning Department within 30 days of the three yosr expiralicm date. ilwe certify that a!i statements nn this fornt are trot tv the bast of my/our knowledge. !,'we artyare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ~. ', ~ ~ ~ ~^ '~ ..~~~~'s'''~ ~-~'''' ~.rut;_,;~t ~r-~ .fin e . t? / i ~ ,~ SIGMA QF PI,ICANT(S} ~ ~ HATE •••Any information diet is tnisrepresetttod may result in the sanitary pcnnit being revoked by the Planning & Lotting Department. "' include with this application a reeordad wamutry deed from the Register of Uaeds Office and a copy of the certified sur`'ey map if reference is made in tale warranty deed. (itEV. 08/05 PUMP CHAMi;ER CROSS SECTIOw AA1G ~PECrFeCArr0~15 `f~~C.i. V~!~IT PiPC ~' 2s' ~'ao^~ DROR, Wlf`JpOW QR F'i2C5H AIR ltJ~"AKE f 8"~'~ I Al. ti11LET *~ A a C E~.EV FT 0 wcaT-~eRQROOF .luucTlaN Box IZ"MiU, I GRADE t `~ I GOIJOUIT ~--' V PROVIDE AlRTIGH7 SEAL *APPROV~O JOINTS WITH APPROVEQ PIPE 3' ONTO SOLID SO1! PUMP --~ co+~cRCrt r,LacK rAr,t _~ c:F ~s~. y ~~ 5~~ APPROVED LUCK'A;G MANHOLE CC1VE F, "I" MIiJ. 18" M ~ 1.1. ~ III I I ~ ~ ~~i I I 1 I ~ ALARM I I I I f au I --~ ,~ ofF \/ ~- RISEA EXIT P£.RMI'1T~E0 AA1L`~ iF TAiJK MAAluFACTL)R7~R HAS SUCH APPROVAL ~~q i sEPTic E SPEGIF1G Ai"f0111S oosc ' TANKS MAtJUFACTUR6R: ----.~. ..~~'E'_Y-Y ~JUMBEit OF t]OSE3: ~ I'ER DAJ TAIJK 51ZE : ~d GA4.l.O1J5 DOSE VOLtlMC ~~ 3? ~, ~ y~~ o+_k'!~-t ALARM MAl~lUFAGTURER: I1~{GLUDItaG 6ACKiLOW: r GAt.LOM r~an~i A!LlMDrLR : I~z ~ CAPACITIES: A = z2 IAtCHES 41t ~_~GA~I.OU, SWITCH TyP[: r._. ~+° ~ $ : "' tIJCHt:s aR y~~ ~ CsALLOf.f PUMP MAIJt.1FAGTURtR: ~~` l~5 -- , _____, ~~ f 8. ~7 ._,. GA~t.01.1 C = ' IAILFiES dR ~ Mt,7DEt_ AiUMD¢R: ~~~,~ ~ 8 D^ ~`~ INCHES ORL?2_ GALLOI,! SWITCH 'fypE; _/'yj~,t''c ups PUMP qWp ALARM ARE TO 8[ MII~IIMUPI GiSCNA'RGf< RATE 3..........p.~.GPM INSTALLED OIJ SEPARATIR CIRCWTS VERTICAL DtFFEREAILE DETWCCU PUMP OFF AAlD OtSTRiDUTtpiJ PIPE.. l~ FE[T + MIAliMUM AICTWORK 5UFPLy PRi<S5LIR E , ~ ~ -„ F"CET ,,~~ 2 CL TT, + ~ FEET OF FORCE MAIN X .x,05 Hipp ixFRlCTtas•,! FAC~IOR. ~~ G~ FELT ~' Z % • / -- TOTAL ®'31~111MIC NEAR .= ~y' ~yFEET ~3- ~~s J~~! peg ~' ' ` 1A37ERR1AL t7IME1.15tt3A!>; Ot: TAIJK: LE1~1CsTN-„- „-,,,,,;WIDTH.~_.,....~...?LIQUID DEPTH ~GOULDS PUMPS • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. 3 V / 1 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATION5 • Solids handling capability: '/e"maximum. • Capadties: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/:° MPT. • Mechanical seal: earbon- rotary/ceramic-stationary, BUNG-N elastomers. • Temperature: 104°F (40°C) continuous 140°F {60°C) intermittent. • Fasteners: 300 series Stalnle55 Steel. • Capable of running dry without damage to components. Motor: • EP64 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: l0 foot standard length, 11513 SJTOW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). Available for automatic and manna! operation. Auto- maticmodels include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP041mpelier: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. Submersible Efi~luent Pump ^ EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for effrdent heat transfer, strength, and durability. ^ Motor lover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power table: Severe duty rated oil and water resistant. M£TERS FEET : _. .,.. ...._..... 10 I . ....... :.. ........ .............. .. ...... ...:...... .... a z 0 a 3 z i 0 ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~' CanarGan standards Assodation (CSA listed model numbers end in "F" or "C".) Gourds Pumps is t50 9001 P.egiste-ed. n z a s s is iz ~~m CAPACITY Goulds Pumps ~ 2000 Goulds Pumps Ef4ective February, 2000 83871 ITTfndustries ~Qui~k~'~ STANDARD CHA1f~,RFR ~uick4 Standard Chamber -r _ ,~`,. ~. l411ultiPort End Cap r ~~"~+`~ ~~ t~2• ~ i ~~, --. ! ~ ~ ~~ ~i !I i 'fir __. --'- --- -------._~. .,. i ~ ., \ '~, _, ,, ~ ~~L~~.~. _.., __.. ,~ 1._ ..- -- --_.. _ _ z_ ~...-~ t~ ~~ ,, r~ ^--~ ~'~~~1 ~ 1_~... __ ~ ~ _ t _ __'` ~. f ~~ sio~ via=w FRONT VIEW t~ .:a, .y „, ,;.,. Qctlck4 Standard Chamber:Nominal`'S ~ peciilca3ians~~• Size {W x L x H) _ _ _ __ _~~ 34" x 52'' x 12" Effective ~an~th _____ 't$" envert height _ 8"_ ~....._._.. _ _- 52"------- __.~_____aaa- - {EFFECTiVf LENGTH) r~. ~~ ~ j 1 ~~~ slog VfEw -T-- i6" ToP view f °#; , r; S M ittS" . Six2'(WxL`xH ~ ,,~ `' 34°xi&"xi2" _,_,,,,•,.,.__...p.._.~._.__.. _._ ~ _ .~ Invert Nei nt __ ~ _ _-- 8" ar i 25` lNFILTRATOj•i ~1(,STEM5, IN~~TAN~A.Riz~rl~T~..~-~IIR~.NTY wK+.~ratai ~+ t ;'r~+ ,..p r l ca , 1 u r ~ o? h a',a.. ~ d DbaC, wuA4 . ar.9 n?Mr avr-wlN+nv nrarr "r riY1 yy 4.111 P+.r W NI9 1 ~ .,«rr~~• n ~ I art ! eh Gl do c t, _-. u c 9y,;tem nl Ncwrda•1cw wah Nlea alro"s final t Iqn , .a wa a 1rN) lU ltm 1 ,ll J~aaa r. I,A,ier') a er~(al• ar(t w!*'ai ar 51uVJ hw exec raw !n°n thv ~atY that U,e eaS4a; Harm 1 b ~.,aurrf';r c »N sryAk aystt i A Nah m,'y ihet U : Vrc ud row,,+r+r. x:,.11 a a8f~ir per'n 5 •+!t r9UUa..'1 Uy aDT>ficaala law. a,e warren v Rari[xt wiU batlnt c'9a" fi0 dafA lha'. ,c1allAluxl 01 the Selxt. SyF.nn oor~rrlar,~~.a.•. 'o P[ rU$rl Il9 waRa(I'} c )i*'S. HMtle1 rttpsl hdlfy hIT'aral0r N1 .urang at 'nF t brnnrate M}3'.~a',N fer3 to Qld 9ayGmna f,On 1etAa:ut w«.IMI 5lfoan { l J) tiay^ l des al!glad ru;lec.. -„tlltraly wiN auaO!Y r+~iaoamali Units td' ,.~nas nelan±lran1 Lq !1d'llralnr IP t~l oaMroti by tnie L-:nalari Wan ardv. ?an a c>: Uahiaty sl ar ilti -4~' ertb alas ale asst ;A •amm'd aryYur 'nf$altatAn d Ina 'J++as. _ +f t tir,l' ~D W4Ry+a~i ~~Y AnC ~EME~rES fN cJIIHVAPAGRN>H la1 AFtE r:K,Lt1:iwE t IFRV° Aa YG ~]lNrr WARRAf:TiE'i WcfH RL.E~f:'7 _~' t( 1Ci~ INiU DIN a NO IMN!.)ED WARRANTIES ix 1hER( HAN'ABt1.ITV OA PlTiul n.. l t1'i A'•M 1 VJIAH F'IJNF'lJSE: v or Iiw r1,BRlher gyslan, t rtt1U1Tr((aert f h1WM+` OIt 'M.r ~~ Inlil(r 11 W- 1119 LYr,, xt WarrB!,ty [MIBe (<I } C~n rn 7 M , r 7 I AI. 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PdylUtt, b"napl,f>d'• WP ~s N rt;gisterg0 tra4emarlt in Mntl[x>. i'.onloUr, Go*+tour SwNet t;orxlection, _._: ,,..:. ; , ... ,, :,,;o,na"rte ,nl Inrirtrator Svstens inc ?~ 2003 I,~tliitralOr $ySiAm5 N.C. h~t~lP.(1 fn U S,A. nacrt+tn^nvavea r~ ~ li /'J~'~i~-~ stc:l lots vtew Parcel #: 020-1418-10-000 05/19/2006 10:23 AM PAGE 1 OF 1 Alt. Parcel #: 20.29.19.2649 020 -TOWN OF HUDSON Current ~ 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 -GLEN JOHNSON CONSTRUCTION INC GLEN JOHNSON CONSTRUCTION INC PO BOX 809 HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 458 WREN C1R SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.072 Plat: 1983-GLEN, THE 02 SEC 20 T29N R19W NW NE LOT 55 BLK 6 THE Block/Condo Bldg: 6 LOT 55 GLEN Tract(s): (Sec-Twn-Rng 401/4 1601/4) 20-29N-19W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 08/03/2005 802137 2856/333 WD 12/21 /2001 666080 1797/613 W D 9A(1R CI IMMARV Bill #: Fair Market Value: Assessed with: -- - - - - ------- - - - - 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.072 78,100 0 78,100 NO Totals for 2006: General Property 1.072 78,100 0 78,100 Woodland 0.000 0 0 Totals for 2005: General Property 1.072 78,100 0 78,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00