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Home My WebLink About020-1371-26-000/* PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Wisoc~sin Oepi}rtmeM of Commerce safely and euitdings Division GENERAL INFORMATION Personal inforrnafbn you provice may be used for secondary ptxposes (Privacy law. x.15.04 (1)(m)). Permit No er s Name: ^ City ^ VillagE ^ Town of: g, John Hudson Township CST 8M Elev.: Insp. BM E ev.: BM Description: D~ / _ G~ TANK INI-VKMAl1UN TYPE MANUFACTURER CAPACITY Septic ~ .~ ~ Z ~U Dos Aeratio H ing TANK SETBACK INFORMATION ount St. ~roix Sanitary Permit No.: 384291 State P an 10 No.: Parcel Tax No.: 020-1371-26-000 ELEVATION DAB A STATION BS HI FS ELEV. Benchmark `, y~ ~ S Bldg. Sewer ; ' ? - ~ lU - S Ht Inlet lp'3 ~s ~t Ht Outlet ~U3. Header /Man. Dist. Pipe c /o . ~/ ~ Bot. System Final Grade ~°~S ~ S t Cover A TANK TO P/L WELL SLOG. vent to Airlntake ROAD Septic ~~ NA __ NA q~ ~ NA Holding an rer mand Model Number G M TOH Li Friction stem TDH Ft F emain Length Dia. Dist. ell PUMP /SIPHON INFORMATION _/ BED / ENCH No.Of Trenches length width cPIT No.Of Pits Inside Oia. Liquid Depth I EN ~ ~ ~ Z DIM I N SYSTEM TO P / L BLDG WELL LAKE /STREA LEACHING Manua ur - SETBACK o e Num er: INFORMATION Type .} s '7 .~~ O IT System: ~ J SUIL AK i' I IVN SYS 1 tM (,S ~' DISTRIBUTION SYSTEM Header / Mani old u ~~ Distribution Ppi~pets) ~ x Hole Size x Hole Spacing Vent To Air Intake Length Dia. 7 Length !3•~~Oia. ~ 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 Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present)REdaection #1: ~ /2L /6% Inspection #2: / / __ Location: 747 Nicolas Drive, Hudson, WI 54016 (NE 1/4 SW 1/4 23 T29N R19W) - 2329192218 Evergreen Estates I11 -Lot# ~ ~ ~/-)~v~~% ~4s~ /,(~~ ~/n,,,~ .dal -„+ c~P~ra,.•': ttc~u;ra~~ -~ 1.) Alt BM Description = GS~ ~lr~ov ~ct~J„E Plwr..~icr ~cr!cv~s icy arc i~ .,~ .k/'a~ 2.) Bldg sewer length = ~S -amount of cover = 7l~ r~ ,bo,-,;.~s, kt W<<~ ~oU-P dt-v<lq,f,- /oc~c Cef ~t~s`p 3 ~) -~ ~~ ll at ~`;.~1 Plan revision required? ^ Yes ^ No Use other side for additional information. SBO-6710 (R.3/97) Date Inspector s Signature Cert No Y +IN~ ~~ 44 •ls ~g2'( ~~' ~~ ~ ~ zy, l e 0 1-~ rsl~ ~ ~ ~ I ~. q Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Ctwnty ~ ~- ~~~- ~ ~ ~scons~n Madison, WI 53707 - 7162 ' Add s Department of Commerce Sanitary Permit Application S'°`~3 ~ `t `~ `~ ~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision ma be used for seco ses Privac Law, s15. 1 m I. Application Information -Please Print All Information ~ \!~1, ~, ` ` ' "'' ` - , ; State Plan LD. Number ~3.~R ~ , a ~ Property Owner's Name ~' ~ 1.~, ^n ~ ~~ ~;~fl ~ _ ~<P Number ~/~ ~~ O ~3 7/ - o?(~ --ODD V (" " Property Owner's Mailing Address ~ ~ v ~ ~ ~~ Pty Location ~j SG ~~ ~ ,~ ~~a1 ~~ /N.R T USf;S l4. er : _~~c;~„ City, State Zip Code `Phone Numb % t r Block Number ^^ ~~`Jl~!1 ~ ` a .~~ ~ .~ 'visron Name CSM Number ~ C~~ 7~5~:~ $ ~- ,.b~ ~. U II. of Building (check all that aPP1Y) ^Ciry ~ ~1 or 2 Family Dwelling -Number of Bedrooms ^Villago ^ Public/Cottmurcial -Describe Use ~ ~T'ownship ^ State / 2 X ~ a - is ~ 7-~-~ Nearest R ,ao ~ III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A 1 New 2 ^ Replacement System 3 ^ Replacemem of 6 ^ Addition to For County use S stem Tank Onl Eris ' S stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued l:V. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44~ Non -Pressurized In-Ground 21^ Moube 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. D' rsal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation mal Grade ~ Eleva6on Required Proposed Rate(Gals./Days/Sq.FtJ (Min./Inch) ~ ! ~ ~~ p,~ b ADD ~1 ~ ~ -- t-a _ ~ ~ ._._.---~- VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Concrete Constructed Glass Gallons Gallons of Tanks New Existing Tanks Tanis Septic or Holding Tank ~OZ ~ ~ Ia ~ ~ ~'`~~ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibr7ity for tion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe ' Si tore RS Ntunber Business Phorre Number S a~ g ~ ~y 7 ~ ~C'/t- U~G~ o~~ 7 Plumber's Address (Street, City, State, Zip Code ~ ) J _ , Cam`--~~ -~ t~~ ~ U . .-. VIII. Count /De artment Use Onl .~_~ ..m.~ rte.. .. e..... c;.,,,~n,,. !Nn Stamps) Approved ^ Disapproved oa,u~.y rcuaua rcc ~ua,.,uuw ~+......a......-. --- ----- ---- - .- Surcharge Fee) ^ Owner Given Initial Adverse ~ ~ 25~ Determination IX. Conditions of Approval/Reasons for Di~sap~roXal ` Prll ~a~ rw.xo~t-be..~w~~ ~ per- ~ Attach c~pl plena (to the County ody) for the system on paper not less then 8 ~ inches In siu/~Z ~ . ~ T~.C~-) Sn~-~ S~ ~sus~t~ -~ -;-~~ S i-eQe. ~e~u,~tA~ o.,sL. ~ ~ .-'`~"~~CJ SBD-6398 (R. OS/Ol) L V~ N 1~J ~~ ~ C~ a'~ a ~ J /O -~ s~ /ad ~~~ (~. N~ ~~~ ~.5. .,~ / ~° 7S / ~ ~ 7 !r d Ql K = / b0 f rv~ ~ f ~v ~~ ~ X1.7` .61'+ . /~D. ~ ~" ~7y0~~/~ /v~ g a u~u.~. -/b~ /_r ~ S~~ H•/o S ~J)`~ ~$ c M" P aao3`J N ~~J ~o ~~ a~ S-/O --_ s~ /b~ 7S~ N~ ~~~ S. ,~ . ~ oo, 7s ~ ~ ~ 7 ~, ~' ,~~ _ ~bo ~ r~ ~ ~ ~; ~ -~~ s , ~ -/b~ 7_ r r S~ N-/v S `I)~l~ 5-25-1995 4-39PM wpiRa!-il.'R+r~ veFe~uidR~. w N~auwu~, tenor an>, NYMAn Fietati0r~s e._I_~•_ .:~_r FROM 'V1L A1111J OI 1 C CYALtJA l IVPI KC1~'VI'! 1 ~J.- h~J_ P. 1 r'~yb ~,~ill ~,..,...... _. ~._.~ .. ~_.,~-r IR aGGVrp wan RLfln p.a.u~, .na. r....... vr..c (i cuty. Croix but t i clud Pl n e, an nws Attach wmplete $ite plan on paper not less than 8 t>2 Y 1 t inches in sizo. PARCEL IA, ~ not limited to vertical and horizontal reterenoe point (BI1~, direCtiOn and 9'. of sbpe, scale or and location and distance to nearest road. Werth strew dimensioned @~ ~ ~. '~ , , APPLICANT INEORMATIOM-Pl84SE PRINT ALL INFORMATION R I D BY D TE o PROPERTY OMMER: ` ~ ROPEAM LOCATION ~2G~ L ct>.rt_ LOT t~ uo S"rAt tras23 T 29 .N,R 19 ~qor) w PROPERTY OWNER'S MAILING ADDRESS LOT a>; Bi.OCK a SUED. NAME OR CSM e GITY, STATE ~ tIP COD PHONH NUMBER na f'IY OVILLAGE OWN N S ROAD I~.tdsan, WI, 540Ifi h15) 3'81-5405 Hudstm Wakt9r~ff P1m. Rd. ~) New. Construction Use [XJ Residential / Nurttber of bedrooms 4 f 1 Addition w etcisting building (J Replao9ment ( ~ Public yr COnMne-clal describe Code detNed daffy Now 600 gpd Recommended design baling rate . 7 befit 9P~ . a ~~, ! Absorption area t~equlred 858 bed. it2 750 trencfi, R2 Maximum design loafing tale . 7 bad, gpolit2.8 trench, gpd11t2 iieoorrurerttied infiltration stFlace elevation(ti) 100.75197.00/56.85._ . _tt (es reberred ~ sib plan bentdan>ark) Additional design 1 si1B aptlsideralfarts ea of B~3 f>z~• ha~trFi t t ed 1re Parer-l material vu,~wa~ Flood plain elevation, i(appNcabie ~ A 5 ~ SUi18~ Ipr ~~ CgNVEWTIONAL ®S d u MQIJND ®5 O U I1WGRpt1Np PRF.&sURE ®S D U AT•GRADE ~ S ^ U SYBTtSII W FILL I~ S^ U t1oLDIkG TANG D S ~{ u u= Unsuitable>hor s stem 501E DESCRIPTION REPORT Boring # 1~ Ground elev. ~0~75 wpm rs ktttiting Lector ,~ IR Boring ~ 2 Ground elev. 104.7, Depfh to Ymiting t * 2" Horizon Depth irt_ Dominant Calor Munsell Motes pu. Sz. Cont. Color Texture Structure Cit. St. Sh. ConsLS,~noe ~Y Roots GPD/ft Bed Trerdt 1 ~ -9 10yr3 3 nom 1 2rtsbk ettPr gw 2t" . 5 .6 2 -30 10yr4/4 ttione tai]. 2mslik mfr gw 2f .5 .5 3 0-37 ~ 7.5ry4/4 Wane sl 2tn6ktlc atvfz' g9r if .5 .6 4 - 7.5yr4/4 reeve cos 0s3g eel na na .7 .8 71zr9 _. (v - o ~ _ Rernarks~ 1~ 1+4 10yr3/3 nc~e 1 Ze:tsbk gtfr gx 2f .5. ~ .t3 2 4-35 lOyr4/4 none s~i1 ~bk mfr gv 2f .5 .6 3 5-92 7.5yr4/4 none . co a Ot3g ml. na tea .7 .8 Remarks: Signature: ~~/S ~~~! .~ l~rr: g_29-99 CSI' Ntttabor: mOZZ9$ +~ Wisconsin Department of Industry, $ O I L AND SITE EVALUATION REPORT Page 1 of 3 Labor ar-i' Hurrtan Relations Division'~f Safetv & 8uildinas :_ _____~ ...:.~ n I In ~., .,~ ~•,:,, w,.,.., n,.,~,. ~ ~ - - 111 GiVVV~V ..ilia ~~~ ~~ 1 VV.V V, •.~V• r.V~~~• vvVv COUNTY St. Croix Plan must include but er not less than 8 1/2 x 11 inches in size Attach com lan on a lete site , p p . p p not limited to vertical and horizontal reference point ( nd % of slope, scale or ~ ~ PARCEL I.D. # "~d Qv ~d. dimensioned, north arrow, and location and dista t ~ r ~d - ~!7 (O ~ 1 APPLICANT INFORMATION-PLEASE P ~ LL I~ORMATI!0 E WED BY DAT PROPERTY OWNER: ~ OPERTY LOCATION Richard LaCasse VT. LOT NE 1/4 SW 1/4,S23 T 29 ,N,R 19 f(or) W PROPERTY OWNER':S MAILING ADDRESS L T # BLOCK # SUBD. NAM OR ~ySM # 521 McCutcheon Rd . cD iT 2 na o{(o CITY, STATE ZIP COD HO CITY ^VILLAGE ®fOWN NEAREST AD Hudson, WI. 54016 Hudson Waldroff Fh1. Rd. ~ J New Construction Use [x] Residential / N r$f r 4 [ ]Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate . 7 bed, gpd/ft2.8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate . 7 bed, gpd/ft2.8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 100.75/97.00/96.85 ft (as referred to site plan benchmark) Additional design /site considerations area of B-3 to be backfiiied to code Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable for s stem ®S ^ U ®S ^ U ®S ^ U [~ S ^ U C~ S ^ U ^ S f7 U SOIL DESCRIPTION REPORT Boring # .................. ................. .................. ................. 1 << Ground elev. 104.75 Depth to limiting factor +88" Boring # 2 Ground elev. 104.7~t. Depth to limiting factor +92" Depth Dominant Color Mottles Texture Structure Consistence Baxida Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trench 1 -9 10yr3/3 none 1 2msbk mfr gw 2f .5 ( .6 2 -30 10yr4/4 none sil 2msbk mfr gw 2f .5 .6 3 0-37 7.5ry4/4 none sl 2msbk mvfr gw if .5 .6 4 7-88 7.5yr4/4 none cos Osg ml na na .7 .8 ._- op. (D D - 4$ 8 ~ Remarks: 1 -14 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 4-35 10yr4/4 none sil 2msbk mfr gw 2f .5 .6 3 5-92 7.5yr4/4 none cos Os ml na na .7 .8 8 Remarks: CST Name:--Please Print Ga L. Steel Phone: 715-246-6200 Address: 1554 200th. w Richmond WI 54017 Signature: _ ~ ~ - Date: (-29-99 CST Number: m02298 ...,, PROPERTY OWNER Richard IsCAsse SOIL DESCRIPTION REPORT PARCEL I.D. # D ~d ' ~ f] ~ 2 ' ?0 . (QO Boring # .................. Ground elev. 101.8. Depth to limiting f+96 Boring # ~? 4 ................. Ground elev. 99.9~t. Depth to limiting factor + '~ Boring # 5 €> ................. Ground elev. loo. Rf5 Depth to limiting factor +96" Boring # .................. Ground elev. ft. Depth to limiting factor ~ , 2 3 Page ~ f Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax>dary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T~ 1 0-15 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 15-52 10yr4/4 none silk k mfr gw 2f .5 .6 3 52-58 10yr4/4 none s 2msbk„ mfr gw if .5 .6 4 58-96 7.5yr4/4 none co sK 0'sg~ ml na na .7 ~ .8 q.~ ~~~ ,r'8.2 q~. 2 - Remarks: 1 -8 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 8-19 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 19-26 10yr4/4 none sl 2msbk mfr gw if .5 .6 4 6-84 7.5yr4/4 none cos Osg ml na na .7 .8 Remarks: 1 -12 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 2-48 10yr4/4 none sicl 2msbk mfr yw if .4 ': .5 3 8-96 7.5yr4/4 none. cos Osg ml na na .7 ~ .8 Remarks: Remarks: SBD-8330(R.05/92) - .~ STEEL'S SOIL SERVICE Gary L. Steel Richard LaCasse CSTM2298 NE4SW4 S23-T29N-R19W MPRSW-3254 town of xudson lot #2-csm ~N i 1 "=40 ' ~ BM.=top of 1" pvc pipe C el. 100.00' 'Alt. BM.= top of 1" pvc pipe C el. 100.65' 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 ~~ ~^.'`'/~ Gary L. Steel 6-29-99 ,; w~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system'iivithin the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. ''~'"~ This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number 2. Number of Bedrooms Design Flow -Peak (gpd) Estimated Flow -Average (gpd) vD Septic Tank Capacity (gal) Soil Absorptipn Component Size (ftz) _ z- - Type of Wastewater Do estic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absor tion Component Design Flow -Peak (gpd) S- Z- ad ~~- Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 ~~~ Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and andness. Access openings used for service and assessment shall be sealed watertight upon completion of service. Any opening deemed unsound, defective, or subject to failure must replaced. Exposed access openings greater than 8-inches in diameter shall be secured by effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic grater from a residential facility. The limits of operation of this component are shown in 2. The longevity of a soil absorption component depends greatly on proper and timely intenance, and system use within or below the limits of reliable operation. Good water iseroation practices by all occupants and the installation of water conserving plumbing ures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least e every three years. The inspection shall include recording the levels of ponding, if any, in observation pipes, and a visual inspection for any evidence of surface seepage or discharge i the component. On steeply sloping sites, areas of erosion should be identified and ~rted to the owner for repair. The surface discharge of domestic wastewater or sewage ~ the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly ring winter months. The compaction or removal of snow cover over the component may lead hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or possible to repair until weather conditions improve. In general, soil compaction over this mponent will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to ire intense, and earlier, organic clogging of the soil. 2 1 ~ ' Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. a:~, s~ ov` 5 0-~ .~;~~ ~ ,6E ~~~~ ~- ~~ f9,,~ q ,~"~"~" ~~ ~~ c~~s) a~ ~- G 9y.~ sr ~ zo~- G7i5) 3g6-y~g~ ~S'1' C1tO1X COUN'1'1' SLl''1'1C ' ~ K MAIN'I'L~NANCI? AG1LI?1?MLN ANU OWN1?ItSllll' Cl?lt'I'IhiCA'I'ION I~O1tM Owner/Buyer .-,~lJ.~i~ ~ SdBirl'i~ ~~ Mailing Address '1~,~..r „~ / ~~ccl~~z'~lf~I~~r~T is~5~~~_l~,~ ~~i/~~ Property Address (Verification requited liom t'lawiing Ucpa~lmcnl fur new cousUuctioi City/Slate ~.ul.~ sL/~ .. 1'nrccl Idc;nlific:ltion Nunlhcr _ D~ ~ " ~ ~ 7~~ ` ~ ~ `©t?'~ LCGAL DI;SCRI1'1'ION Property Location ~ '/,, ~ '/,, Scc. ~, 'I'~N-IL• ~ ~ W, Town of Subdivision CerllCetl Survey Map # _, Lot # ~. Vulunlc , I'ngc /~ Warranty Deecl # ~~~ ~ ~ ~ ,Volume I 1'nl;e # _ Spec House ^ yes [~J tto 1_ul lines irlcntilinhlc ~1 yes L I no SYSTTM MAINTCNANCL Improper use and maiulcnattcc of your scplic system could resull iu its p~cmatu~c failure to liaudle wastes. Proper maintenance consists of pumping out Ute septic teak curry there years or sooner, if needed by a licensed puntpcr. What you put into the system can affect tee function of rte septic lack as a trealntcut stage in the waste disposal system. The properly owner agrees to submit to St. Croix Zoning Uepartntcul a certification faun, signed by We owner and by a ruaslcr plutuber, jounteynrau plumber, restricted pluutber or a licensed pumper verifying Iltat (I) the ou-site waslewaterdisposal system is in proper operating condition and/or (2) alter inspection anJ pumping (if necessary), the scplic tank is less than I/3 full of sludge. I/wc, trc undersigned have read We above rcquitcuunts and agree to maintain the private sewage Disposal system wiW the standards set font, herein, as set by Ute Department of Commerce and the Department of Natural Resources, State of Wisconsin. t;etNfication stating that your septic s stem his been maintained roust be contplctcd and returned to the Sl. Croix County Zoning Ollice within 30 days oie tueq~ycar iration dale. // 1 ft-. of ~~ / / ~ . . DA're f I (WC) CCrtt tlat all StatCn1C111S OII tltls fUtnt a1C (IUe l0 lllc best of ury (our) knowledge. I (we) atn (are) the owner(s) of rte eery dJ~scri ` ae, by virtue of a wananly decd recorded iu Register of Uccds O(Ticc. .G. `. S NA't'tJRIIOF ANT DATII ***: • Any iufonnatiou that is mis-tcprescutcd may resull iu the sanitary pcuuit being revoked by We Zoning Department. ****~`* •• Include wllh thls appllcaton: a stamped warrauly deed from llie Register of Uccds office a copy of the certiftcd survey map if reference !s made Iu the warrauly deed ~i. ~6t)~PpGE STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Jon K. LaCasse Grantor, and John P. Long and Bonita J. Long, husband and wife, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 26, l;vergreen Estates III, St. Croix County, Wisconsin. 2001 020-1371-26-000 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~~~ day of March * * AL' T I:ii~1TICATION Signature(s) Jon K LaCasse authenticated this ~~t~day of March 2001 l~ * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) E~ ~:C]E~8OF6 i~,l'~`iF1L.EEbE H. WALSH REC:?STER OF REEDS ST. CF;t1IX CC1.. LJI ltEfiEI~EII FOR RECORD 43-EIE-P441 9:34 AR ~ARRAI~)T~Y DEED EkElRPT # CEfiT COPY FEE: C~~~ FEE: TRANSFER FEE: 884.7© RECORDT_NG FEE: 14.04 p~01;~::.:., 1 Recordins Area Name anur~~(F1r~sS OG~~~ A'Ri~OT~~'!` '-1V AT LAW p ' ~°~ 359 HUG~~..._ . ~, WI 54016 ACKNOWLEDGMENT STATE OF WISCONSIN (~) (is not) on K. LaCass * ss. County ) Personally came before me this day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: ~) * Names of persons signing in any capacity must be typed or printed below their signature. ~nformatlon F~oressfo~a~s comPa~y, Fong d~ tao, wi STATE BAR OF WISCONSIN eoo-655-zo2i WARRANTY DEED FORM No. 2 - 1999 \ s•n y ._ . ......._ ~.._ ... ~ ~ t~ ~ _~. ~ ~ ~ T .. r, ' .. L9 ~t~ '~ '~, 1. E j \ V ~}~~ 11a.7±i~ . . ~ f. ~ ~- is .' ~~;'~` ~' /' ~R~ ^^ J~ ~~ ~~~~"~ ~ .~~~ ~ ~~ s~ ` ~ v, / _ 91.719 S FT. `t ~ ) 1 ~ . _ ... ~':°w~'r~ ,,. ~~ ~~ ,., ~ .y, - ..,., . ~ • jj\\ , ,{' ~ ~7 ?39?t - ~ 1 ~ ~ °~ / (J ~ I , -1 ~x C;~ i T 1'IiYy.c _ _ FLE'. _ . 3.123 4RCFS 105..:+~'? ~U t 1 ~' tsa,9b9 SO Ft ~; ~ Q~ , ~,,: X ~ ~ ~ q fti \ ~~. 4~ d ' / rp }~ x~ c' ~,, r `,~ .~,~/ / ,,..,''. ,,.> 1~'?~ i - .. ~ loj;.~•~, _ ;1 ~~. `V\ CUI_;til"l I'i<r:,\~UKN;E~':; ('i'.Ftf?r'~ ..1'~;: ~5.. ';~;~~ StRf•• Of itl:+,:oll:iill , ;~> ' C?l1U}.j Jf C~ C1'~IIC j ~ 1, Mary ,1^,, .1 l.i~-rru;.,~••:, 1,~ i„y ttte d,,l ~ elected, .< Cf4;+"nJ~ 4F i~"~~ENT T.v•,'t.,r t~11d11i1C~1 f)t,+l A:'fi?~~ ~TaNi1.1~.•1' Of Sl. l~„tC ~O'Itlf , d^ h~•r•,~,, c,,•t.if~ ll) l~. lt~t• r.~r..,r•t, in • ~p oitir.e lean Isiu ~xi,-,3.;,~ 1... •.,?,,•~ , ~h,l,r ^,i L'ct,..~,r: ~,l~tl f.i1~X Vt4If'i Rf~•f! !)C U4 ,ql•l 19~~ t9N in Se;,i,~,,~; sw l l~, ~ te, •~ or ~l,rr ikl R,. ~~r,.•ntq Pa of :~ - 1~2.69 1:~f, eF _y?; °», ~ : Sw u,a•_ _. -r•.':eCiirg lt~e -_ 9d~ 99 E6 grorltlr~ ---_. __ .__.. s. sr ~ ~, - l Fer~,r..