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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM ~~u~„y.
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) 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:
LaCasse Develo ment Hudson To nshi
CST BM Elev: Insp. BM Elev: BM Des dption: SectionlTown/Rang
TANK INFORMATION ELEVATION DATA `
TYPE MANUFACTURER CAPACITY
Septic
1 2- (O Z5
Dosing '
W
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air to ke ROAD
Septic \ (
l ~ 7 f /
~
tQ.
Dosing PJ
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
Friction Loss
Forcemain ILenpth / IDIa. [Dist.
SOIL ABSORPTION SYSTEM
St. Croix
453205 0
020-1437-20-000
22.29.19.2725
STATION BS HI FS ELEV.
7
Alt. BM ~ r /'„
J w ~~-L L~, Zi ~ 1,
BldgBldg. Sewer
/b.~~~ ~,.til ~~727 ~~'
St/Ht Inlet
~~3 rl~
/
St/Ht Outlet ~ Q , I ~ r/
d
1
Dt Inlet ~ ~~
Dt Bottom ~
Header/Man. ~ ~ ~ Q 2
-1
/
Dist,-\F~ l d ~'r`I 3
. ~'
Bot. System
3
~ Z.
Final Gra e ~, ~ ~~. fy:
St Cover ~~
~r
~-r'l° f~ i,~
S
~' ~n ~ X
BED/TRENCH Widt
/ Length No. Of Trenches PIT DI
MrFptSdONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS h ~
(! G~ `mil"'' ~
SETBACK SYSTEM TO P/L LDG WELL LAKE/STREA EAC G Ma ufact ~] [
INFORMATION
CHAMBER OR ~~~
' I T /'~L
T
Of S 1 .
(
y
ystem:
y( U ~ ~~~ ~ ~ / UNIT del Number:
D RIBUTION SYSTEM
Iru DA.a~' ~ ,~ ~~r~
Heade anifold Distribution ~
/
~ ~ Hole Size x Hole Spacing Vent to Air Intake
/ ~,
L
th
Di
~ Pipe(s)
~/ej
~
~r ~ /2
eng
_
/j~
a_ Length
Spacing
Dia
SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv
Depth Over ~
Bed/Trench Center
r ~ Depth Over
Bed/Trench Edges xx Depth of
Topsoil xx Seeded/Sodded
~ Yes L No xx Mulched
-
', ~ Yes i~ No
COMMENTS: (lnclud"e code discrepencies, persons present, etc.) Inspection #1:~/~/~ Inspection #2: / /
Location: 805 Ross Rd Unkno/w~~n (SW 1/4 SE 1/4 22 T,2/~9N R19W) Kelly Estates Lot 20 ~ Parcel No: 22.29.19.2725
1.) Alt BM Description = ~' ~U ~C.IL~ K-~%~/~ ~1~.r ~ ~ S'~'',".`~~/=~ ~Q~y ~-~O
2.) Bldg sewer length = 2, S~ S }/jr~-Qiyr. ~~ ~~~ S ~~ ~/ ~ ~- `~'_ (/~
-amount of cover = ~~ /((}tQJ1ti / l
> ~~~ sus-~-~ > ~0` ~fF-d r~cu,~- ~ ~a~~,~
Plan revision Required? ;_~ Yes ~~ No
~- - -- -
Use other side for additional information. I __J L____ _ ____ __ ____ ~ ! __ __ ___~
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No.
.~
Satety and Buildings.Division County
201 W. Wushingtgn Ave., P.0. Box 7162 s „ ',~
~ r.
~scons~
n Madison, WI 53'07 - 7102 Sanitary Permit Number (to be filled in by Co )
i (608)266-3151 ,r-~53zps
Department of Commerce
Sanitary Permit Application ~ Plai, 1.D. Number
In accord with Comm 83.21, Wis. Adm: Code, personal information you provide _~
may be used for secondary purposes gjy, c~ Law. s15.04j1xm) ~„ Project Address (if different than mai' ing addres>~
L Application Information -Please Print All Infor atiod °'" "' ~ """
S'
y
Property wner'sName ~iAY ~ 2 2004 tr~/i~ i
Parcelq
//
C
~ 7
- . 1
h .
2c~- ( 31~- ZD- oa'0 . 2 2S
Property Owner's Mailing Address >? ~tl !X ~ JU fv ` ^ Property Location
r ~ ZONING OFFICE
Section
%,
.,~I~
'/.
~~
City, S ~ Zip Code Phone Number ,
,
,
,
(circle
E
T ~ N; R
L~
e of Buildin
(check all that a
ly)
IL `T .~ .,
,.
~
g
pp
yp ber ~
~f?~A4-i'F
1 or 2 Family Dwelling -Number of Bedrooms ~S.
ttm
Subdivisio N me
blic/Commercial -De
ib
z
~~
^ P
U
scr
s
u
e
//,,//
^ State Owned -Describe Use "!~ ~• k ~•~,
^City_ Vill ge YJ 10 ship of I
2
III. T ype of Permit: (Check only one box on line A. Complete line B if upplicable)
A' ~ New System ^ Replacement System ^ Trt:aUUCnUI lulling Tank Rupluccmcnt Only C I Other Modification to Existing System
II. ^ Permit Renewal ^ Permit Revision
^ Change of
^ Permit Transfer to New List Previous Permit Number and Uatc Issued
Before Expiration Plumber Owner
IV. T e of POWTS S stem: Check all that a I
,l~Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Ar^Grade ^ Single Pass Sand Filte; L
Conswcted Wetland ^ Pressurized In-Ground ^ Holding Tank ^Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^
Recirculating Synthetic Media Filter Leaching Chamber ^ Dri Line ^ Grave;-less Pipe ^ Other explain)
V. Ais ersal/TreatmentRrea Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ,
a 7
VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units ~
Q ~. ~Qp
b+
/~a Concrete Constructed Glass
Naw Existing .
-
r
„~'~
Tanks Tanks
Septic ur Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII, Res nsibilit Statement- b the undersigned, a time respunslbiUt fur iastallatlon of the POW7'5 sbowu oa the atWChetl aa. ~_
Plum r' am (Print) Plum 's Si ue Ml'/MPRS Number Bw noea tone Number
r ~
~~ ~
~~
Plu tier's Address (Street, City, fate, Zip Cude)
<~
VIII. Coon /De artmen Use Onl
Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater
F Date Issued I ui Agent Si (No Stamps)
^ O iven Reason for Denial Surcharge
ee)
~~ ~
~ 3
IX. Conditions Approv I
SYSTEM NER: ~'~ N o C9~ i ~n~:w+d ~eJ~.~6•t.re.~ .~
1 Septic tank, effluent filter and
~,~ eO~
~~-/
~
~ ,
dispersal cell must all be serviced /maintained "~`-
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code/ordinances.
Attach complete plan, (to the County only) for ttu system on ppper not Ices t4gn titrz x 11 tacnu in atu-
SBD-6398 (R. 0 l /03 j
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• z + 1225
Wisconsin Department of Commerce SOIL EVALUATION REPORT ~ ~ :' ~~ ~ ~'` 02P~ 1 ~ 3
Division of Safety and Buildings in accordance wdh Comm t35, V1/is.'Adm. Code i _ Sod Service
Attach complete site plan on paper trot lass than 8'/z x 11 inches in size. Plan mtet Cou --°.° - ~..
int~e, trtA trot lenited to. vertical and horizontal refet> point (BM), duedion and
percent slope, scale or dimemsiorts, north arra+m, and Eocation and d~tance to nearest toad. Parcel I.D.
Pending
Please print all information. ` ,~ • _~~ nDate
Personal information yrw provide r t~ay be °s~t~~oe~de~cPrivac'y ~arr, s- t5-04 tit t~I)- ft~n . ~1.~ _ J~1~K13.~ _ >~Mw. Y D 3 .
Property Owner Property Location
Regartt Developers LTD MAY 12 ?ppq. Govt. Lot SW 114 SE 1kt S 22 T 29 N R 19 W
Property Owner's Mailing Address Lot # Block # Sutxl. Name or CSM#
9900 Valley Cttreek Rd_ Suite 35 20 na Kelly Estates
City %c~D~~,cc~' a Zi ( v,Kli'X LG' ~ E
c (. ~~~~}?I~er City Vllage Town Nearest Road
\l MN 55 - - 4 Hudson Ross Rd.
~!"; New Construction Use: tr Residential I Number ~ bedrooms 4 Code derived design flaw rate 600 GPD
Replat~ment Public acommercial - Destxibe:
Parent material outwash plains and stream terraces Flood plain eleirartiori, if applicable na
Genera! comments
and ret~rrimendations: System elevation 94.37ft, trenches spaced and depth to code 5.83ft beknr/ grade
Sonng # _' Bonrtg
1/i Pit Ground Surface elev. 100.20 ft. Depth to limiting factor 110 in.
Hotizon Daminmit Color Redoz Deser~tioti Tezftxe Stnreture Consi~er-ce Batxrdary Roots
1 D-10 10yr3/3 none sil 2msbk mfr gw 1 f
2 10-22 10yr414 none scl 2msbk mfr gw 1 c
~, S rr 3 22-37 10yr4/4 c2d 7.5yr5/6 scl 2msbk mfr gw 1 of
4 37-49 7.5yr4/4 none sl 2msbk mfr cs na
5 49-110 7.5yr4/6 none ms osg ml na na
C~Q•9tr~os•9~
Sod Applicatan Rate
GPDftt:
'Eff#1 ~ *Eff#2
.5 .8
.4 .6
.4 .6
.5 .9
.7 1.2
8txing # ~"~
'
110
Pit
~! Ground Surtace elev. 100.20 ft. Depth to limiting factor in. ~ ~ {~
Norizort Depth Domiria~ Cdor Redox Dhoti Texture Strircfure C onsistence BourMary Roots GP Dfft=
'EtT#1 'Eff#2
1 0-12 10yr'3f3 none st 2msbk mfr cs 1f .5 .9
2 122 7.5yr4/4 none sVls 2msbk mfr gw 1f .5 .9
3 42-110 7.5yr416 none ms osg ml na na .7 1.2
~~.°~~~1 os•9~
' ttttuent rt't = t3UD 5> :ip < ~ rrig/L grid T55 >30 < 150 ing/L ` Eftiuent #2 = BODS< 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) S~nature: CST Number
David J. steel f o~ _ ~ 248956
Address Steel Sal Service ~/ Date Erraluation Conducted Telephone Number
1564 CR GG, New Richmond, Wl 54017 10/23!2002 715-246-5085
Property Owner Reliant Developers LTD paw ID # Pending Page 2 of 3
Boring # Boring
10
97
Depth to
ft
limiting factor
110
i
Pit Ground Surtace elev. . . n. ~~ gppl Rate
Horizon Depth Dominant Color Redox Descri~ion Texture Stricture Conssterx~ Roots 6PDIft~
'Eff#1 'Eti#2
' 1 0-8 10yr3/3 none sil 2msbk mfr gw 2f .5 .8
2 8-20 10yr4/4 none scl 2msbk mtr gw 1 c .4 .6
~' 3 ~/1
l 3 20-33 10yr4/4 c2d 7.5vr5/~, scl 2msbk mfr gw 11 .4 .6
4 33-58 7.5yr4/4 none sl 2msbk mfr gw na _5 .9
5 58-110 7.5yr4/6 none ms osg ml na na .7 1.2
# ' _ Boring
' Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Apples Rate
H ~ Depth Domirtar~ Color Redox Description Texture Stnxiure Consistence Souxiar}r Rods C,PD1tt~
'Eff#1 "Efi#2
'~ 4~ ~)
~q • 9 ~~l °S-~ (~
~~~
"Effluent #7 =BUD $ 30 ~ 220 mg/L and TSS >30 ~ 15o mg/L ' Effluent #2 =GODS <30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity sen ice provicir=r and employer_ If you aeecl assistance to ari~ec services or
Boring # Boring
Page 3 of 3
STEEL'S SOIL SERVICE
David J. Steel 1564 Cty Rd GG
CST-POWTSM Reliant Developers LTD New Richmond, WI 54017
Lic. # 248956 SWl/4,SE1/4,S 2o,T29,R19W (715) 246-6200
Town of Hudson, St. Croix Co. (715) 246-5085
Kelly Estates lot 20
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be saitable 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 soil test was conducted. Legend
1"=40'/
Benchmark El. 100.00Ft
~0 of '/z"pvc pipe
i .~ Alt Benchmark E1.99.SOFt
~
op of/2" pvc pipe ' ~
^ =Borings
Boring Elevations
B 1 =100.20Ft
B2 =100.20Ft
B3 =97.lOFt
B4 =OO.OOFt
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~~ ^o! '- ~ ` ~~ ~ ~, 416.f~3 N01'OS 08" ~ I ' , ~•'.
hi r*„I'j~~l ~~ ,~, ~~9,: .~ .fi - {lcsru+iau~' t,~ I \ 1 ' ;` I''~1 :t• ~
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~ 11 . i f- 1.-'~a. ..~ IA I ~_~4F~~~ ~-Z ~~s Ne ~ f ~r/
.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Peed ~ or 7
FILE INFORMATION ~- /~
OWnef
~~~
Permit +~ ~5--3 zoo
DESIaN PORAMETERS
Number of Bedrooms ~ O NA
Number of Public Facility Units ~ NA
Estimated flow )average) al/da
Design flow Ipeakl, (Estimated x 1.51 al/da
Soil Application Rate %' al/da /ft~
Standard Influent/Effluent Quality Monthly average'
Fats, Oil & Grease IFOG! S30 mg/L
Biochemical Oxygen Demand IBOD6) 5220 mg/L ^ NA
Total Suspended Solids (TSS) 5150 mg/L
Pretreated Effluent Quality Monthly average
Biochemical Oxygen Demand fBOD61 530 mg/L
Total Suspended Solids (TSS) 530 mg/L J~NA
Fecal Coliform (geometric mean) S10• cfu/100m1
Maximum Effluent Particle Size Y, in dia. ^ NA
Other: O NA
'Values typical for domestic wastewater end septic tank effluent.
MAINTFNABICF Cr_NFrllll F
SYSTEM SPECIFICATIONS
Septic Tank Capacity al O NA
Septic Tank Manufacturer S O NA
Effluent Filter Manufacturer O NA
Effluent Filter Model O NA
Pump Tank Capacity al [,XNA
Pump Tank Manufacturer .~ NA
Pump Manufacturer ~ NA
Pump Model ANA
Pretreatment Unit
^ Sand/Gravel Filter
^ Mechanical Aeration
^ Disinfection
O Peat Filter
^ Wetland
^ Other: ,1~`NA
Dispersal Celllsl
l~ln-Ground (gravity)-
^ At-Grade
O Drip-Line ^ NA
^ In-Ground (pressurized)
O Mound
O Other:
Other: O NA
Other: ^ NA
Other: ^ NA
Service Event Service Frequency
Inspect condition of tankis) At least once every: ^ month(s! (Maximum 3 years)
~ ear(s) ^ NA
Pump out contents of rankle) When combined sludge and scum equals one-third 1Y,1 of tank volume O NA
Inspect dispersal ceI11sS~~ ~ At least once-every: ~ ~ earls! (Maximum 3 years) DNA
Clean effluent filter r ~ ~ • At least once every: ^ month(s)
~ earls) O NA
Inspect pump, pump controls &_alarm .., ,
: _
At least, once every: ^ month(s1
^ earls)
d~ NA
Flush laterals and pressure-tast._._ __ . At least once every: - ~ = ^ yeanlsl(s1 .J&NA
Other. -At least once every: ~ ^ earn Ilsl ~NA
Other:.. O NA
._
MAINTENANCE; INSTRUCTIONS
Inspections of tanks and dispersal cells. Shall be made by an individual-carrying one of the following licenses or certifications:
Master Plumber;.. Master. Plumber Restricted Sewer; POWYS Inspector, :POWYS Maintainer; Septage Servicing Operator. -Tank
inspections must include a visuatinspection of the rankle) to identffy any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined'sludge 'and scum and to check for 'any back up or ponding of effluent on the ground surface.
The dispersal cellls) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on. the Around surface may indicate a failing condition and requires the
immediate notification of tfw-local regulatory~authority.
When the combined accumula#ion of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entiro
contents of the tank shall ba rempved by a Septage Servicing Operator and disposed of In accordance with chapter NR 113,
;Wisconsin Administrative. G,~„ „ ,
All. other services, includirlp but not limited ,>io the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servloing at intervals of 512 months, shall be performed by a certified POWYS Maintainer.
A service report shall be provides) to the local regulatory authgrity within 10 days of completion of any service event.
~~ _, _ .
(isMW 14/011
c~uze,
Pape p~ of ,
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tankfs- for the presence of painting products or oilier chemicals
that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents
of the tanklsl removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions era frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal celllsl In one large dose, overloading the celllsl 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 Saptage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid malarial.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time. '~It
~ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
..~. _ .. ... ,,,.. -<tectutologya~.h~olding. aak~tar~ay-be,aastaUed-as alast;:casort,tareplace tha.failed POWTS._ ., ...
^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and sift:
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 POWTS.
^ :Mound.: and at-grad~a: soil .absorption: systems. may bq reconstructed in place following removal of the biamat at the
infiltrative surface.,,Raconstructiotas;pf such systems must comply with the rules in effect at that time.
< <WARNING> > :~
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNOER'ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
K fiAAY BE DIFFICULT OR IMPOSSIBLE.
PERSON FROM THE INTEfR1:OR"OF' A TAN,= , ,\ , .
ADDITIONAL COMMENTS = ~
~,,, ;
:., _.
POWTS INSTAL ~ ~: ~~ ~, ~:. _ ,... . POWTS MAINTAINER
Name f .r4 , ~ ~ .... 1... ,
~.
Phone r -~_ ~-. _
SEPTAGE SERVICING OPERATOR IRUMPERI ~.
Name ~ ~ ~ _ ,
Phone ,;.>>~ ~~.::, .. ,
Name
Phone
LOCAL REGULATORY AUTHORITY
Name t ~ ~ r
-Phone 5•~ , _3
This document was drafted in compiiance~with chapter Comm 83.221211b)11)Id1&lf) and 83.6411), i2) & 131, Wisconsin Administrative Code.
. _,.i,~ i;,,~: ..
S'I' C'12U1X CUUN`I,1'
SI~P'J'Ir_.' "1•.~NK N1A1N'I'I~NrWCJ? AGR.k:1MJNT
c~~1~;;i:I:SI•II1' ~,'l_I:I,hIC'A'I'ION f~UJZ.M
O~vnerii3uyer 1~G,45`,~- _~t~~+'h-~~ :•ay~~ .
~rvl;.iling Address (Z7,~ c~~[ ~ ~,. ~~~..~ U~~
l'r~ h~.rt; .Address
S~
d.
(Vetiiicat~un rrauireJ Iron, Planning I)cparunent Ibr new construct
c.:ity/5ltrlc ,,~•~t~~„~~ L7~.Ll~ _ 1'arccl l~icntilictttion Nuntbor 02 1`F3
1..~ C;•,~I ~SCRIPTIUN
J upcl-ty Location ~~ ~/~, 5~ ~,%~, Sec. ~Z , "I'?~t N-R,_,:(_.~t,.W, Town of
,bciivision ~ _~~v__._. __• ,Lot #
^_
( ~~rtifietl Survey' Myth tl ~~ ~~~ __, V~.,lume ,Page #
`~`'arraaty Dccd # ~S~-S3,6
Spec house ~ yes O no
Yulume ZS3S ,Page # ~~'S
Lot lines identifiable l~7' yes O no
S` ST;;'r11'I Mr1IN7'F,N~~NCIs
ln~proper use and maintenance of your sct,tic• sysirnt cvul~l result in its prentaturc 1'aiiure to handle wastes. Prupcr m:nntcr.~n~c
c~ ,fists of Irucnping out thr septic uutk curry three years ur sooner, il' needed Iry a licensed pumpor, What you Nut urtu the sy~~cu,
ca, atl•cct Uic; function o!'tha s~lst,c lank as rJ treatment slubc in the wtiste disposal system.
'•I~ha propcrry owner agrees to submit to St. Croix Luning laeparhnent a certification fOtitl, ssgpad by tho owner and b;~
master plumber, journeyman plumber, restrirtcd plumbrror a licrnsc~.l pumper vCrifying that (1) the on•site wastewatetdisposa) sy.tcu,
is in proper oper;tting cun.ditiun and/or (?) allcr inspection and pun-,ping (if necessary), the septic tank is less than l13 full oCsluubc.
I%wc, the undersigned have read the above rcqurrerrtcnts and abrce to maintain the private sewage disposal system with the standards
sat forth, herein, as set by the Dc;partment of Commerce and the Department ul' Natural Jtcsourcos, State of Wisconsin. Certificanoa
stating that your septic system has been maintained muss be complete(! and returned to the St, Croix Couory Zoning Office within 30
days of the thre year expiration date,
,.~., l 21 / v y
SIGNATUI L OF APPLICANT DATE
OWNER CERTIFICATION
1 (wc) certify that all statements on this form are tn,c to tt,r best of my (our) knowlcdg~.. I (wc) am (arc) the owner(s) of
(the property described above, by virtue of a warranty decd rccordr;: Ott lZabistor of Qecds Office:
!~~ j ~ l/ r1
SIuN~~'fUltJ.f ~JF ANPI,ICAN"1' DATE
*'•**• Any information that rs mis•rcprrscntcdmey result in the sanitary permit being revoked by the Zoning Dcpartrrtent,'••"'
"' Include with this application: a stamprd warranty decd from the Register of Deeds office
a copy of the rcnif~ed survey map if referenco is made in the warranty dead
U 2535P ~i95
Document Number
STATE BAR OF WISCONSIN FORM 2- 2000
WARRANTY DEED
THIS. DEED, made between Reliant Developers, LLC, Grantor, and
LaCasse Development, Inc., Grantee.
rantar; for a va ua a const eration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin:
Lo 2, 3, 4, 5, 7, 8, 9, 11, 13, 14, 15, 16, 17, 19,0 nd 21, Plat Kelly
state , St. Croix County, Wisconsin.
Recording Area
~s~a~~
KATHLEEN H. NALSH
REGISTER OF DEEDS
ST. CROIX CO. , WI
RECEIVED FOR RECORD
@3l29l~@@4 @9:1@A!t
KARRAHTY DEED
EXEMRT #
REC FEE: fl.@@
TRANS FEE: 4@?4. @QI
COPY FEE:
CC FEE:
PAGES: 1
Name and Return Address:
Edina Realty Title, Inc.
400 S. 2"d St. -Suite 115
Exceptions to warranties: Hudson, WI 54016
Easements, restrictions and rights-of--way of record, if any. 423495
020-1060-30-050,020-1059-90-0 dO
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 26th day of March, 2004.
Reli evelopers LC
B ~~
* ick Toston, Chief Manager, Reliant Developers, LLC
*
Signature(s)
*
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
ST. CROIX COUNTY. ) ss.
authenticated this 26th day of March, 2004
*
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Peterson, Fram & Bergman -Steven H. Bruns
50 East Fifth Street, St. Paul, MN 55101
(Signatures may be authenticated or acknowledged. Both are not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature
Personally came before me this March 26, 2004 the above
named Ric oston, Chief Manager, Reliant Developers, LLC
,to~~me~~known to b the person(s) who executed the foregoing
instrument and ackn ledged the same.
,~
*Tui1°°'Zarleu '`
Notary Public, State f Wiscons
My commission is ''Ii'">Z(}!!'~it~ ate:
lli4i2oo7 /` JUDY LARRIEU!~~ )
State of Wisconsin
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000
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-- 'r~~ ~ w, - - A169. g' o r s+e~ 6267 S,
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'` ~ (2.489 AC.) N89'19 31 E W W
30 AC.) ~ ' ~ ~ ~ ~ NO DWELLING \' !" - ~ N N
~~ ~ ~" ~~ ~ EXTERIOR ~ I I
~ N ` OPENING BELOW ~ i+
1 ~D-~o~ 1 ELEVATION 923.8' ~ a! ~I`
°' ~ ~~-
~42_W 461.58' -----~_.~ __
--__..------ -, ~- - N89'19'31'E_411.77'_--__--- ~, N~~~,
°~° ~ 33~ ~ 33 _;~ ~ TOP STEEL PIPE-'~ "? ~0~
l O ~' ~ ELEVATION n .'~1~`~I
50'1 ; ~ ~, 2~ 930.92'
.)
1 ' ~ ~ ~ 50. S.F /f'. 4'3.53
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~ ~ - ~ -~"~ e'er / '
Z ~ ; 0 ~ ~ +~ NO DWELLING -"~"'- ~;~, / ,~o ~
132441 S.F. 1 i i ` EXTERIOR ~ o,~ ~ . + u')
(3.040 AC.) ~ I i OPENING BELOW ~ `- ~
N% ~ ~
1 ~ ~ ~ ELEVATION 919.7' ~ " ,~ ~
y
1
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'~ ~ L -~ - - - N89'19'31'E 381.42' _- _- _- ~ i~~g
~ - - - - - _
' ' - - - -
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1'35'42"W 495.96' - ,_ - - 1 ~ -c
~ ~
----"------- --1; 11 I ~ C
- ~ I , 21 I
I ; ; I 105538 S.F. ~'` 1 i °z
i i I ~ (2.423 AC.) 3 t (
I I NO DWELLING EXTERIOR ~ ~~c
I 3' 33' I OPENING- BELOW ~ ~ ~ . ~ I
I 1 I ELEVATION 919.7 o~ - n
129751 S.F. 50 0
(2.979 AC.) _ I ~ O1 5~.
se`' 1
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I -1 I t ~ I ~~ I MONUMENT ANO g ~,~\
p MONUMENT AND ~ $ I ~ I ~ I i I"'-:'_'- LANDSCAPE ~ ~~j~j\ ` 111
'- LANDSCAPE" =• _i__ p o L~--~" EASEMENT 374.07 -'~~-, - --
EASEMENT r ' I z v~ ' .r - - - -- "' "" "" '"' _.
Judy Kahler
Subject: #453205 K.OConnell / LaCasse Dev. Inc.
Location: T of Hudson, Lot 20, Kelly Estates
Start: Wed 8/4/2004 11:00 AM
End: Wed 8/4/2004 12:00 PM
Recurrence: (none)