HomeMy WebLinkAbout020-1371-27-000
Jisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division INSPECTION REPORT sanitary Permit No: 420348 0
r
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No.,
Personal in' mation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Parcel Tax No:
Permit Hat7e?s Name: city village X Township 020-1371-27-000
Nelson, Mike Hudson Townshi
CST BM Elev: Insp. BM Elev. BM Description:
TANK INFORMATION -P, a.~IasJ-I•~ j ELEVATION DATA
CAPACITY q STATION BS CHI FS loEb '
M NUFACTURER
TYPE
k
• q- Septic / / Benchmar
W ~-v
Dosing Alt. BM 6
w Z1,hd log ~/le 8Q6 ln~& Aeration Bldg. Sewer 1
of ~Fl 2-54
Holding St/Ht Inlet ie TANK SETBACK INORM ✓Q
St/Ht Outlet
TANK TO ent to A ntaROAD Dt Inlet Dt Bottm Septic j I 1 Z - a, s
Dosing Header/Man.
Aeration Dist. Pipe /.t.0 b -3
Holding Bot. System /1J 1(~Z ,r7D l~
Final Grade J 1 / ! /U`! -
PUMP/SIPHON INFORMATION
Manufacturer / Dema Cover
GPM ~y
Model NumberD a
TDH Lift a Friction Loos Syste He Tq Ft
( 4
Force n L th Dia. I Dist. to well
(XI
SOIL ABSORPTION SYSTEM
BEDITRENCH Width / Length No. Of Trenches PIT DONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/ BLDG WE LAKE/STREAM AN Manufacturer:
INFORMATION CHA R OR
System: nr 29~-' CD / Model Number:
DISTRIBUTION SYSTEM t-
x Hole Size x Hole Spacing Vent to Air Intake,
Header/Manifold Distribution
A Pipe(s) 'JS
L Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
L Depth Over xx Depth of xx Seeded/Sodded xX Mulched
Depth Over T~ Topsoil 1,i No JYes ~I No
Bed/Trench Center ^ Bed/Trench Edges Yes
Y
COMMENT (include co disc epenci s, parsons res nt, etc.) Inspection #1:~/ 2 / 02 rw Ins ecti n #2:
ocation: 744 Nicholas Drive Hudson, 1 54016 (SE 114 NSW 1/4 23 T23 29N 19W) evergreen Estates Lot 27 Par 3 el No: 23.29.19.221
'xiv asY~d~ .
P of /Z17
1.) Alt Description /1,~4 jr(,~Q L
2.) Bldg g sewer length = ~Gl ~ K J~
- amount of cover =fir Z r`cJ~ j h q~ln ~M ` "
3.) Contour =
O fA Ei
rm Yes No
Plan revision Required? ~
Use other side for additional information. - - Date J L Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
PLOT PLAN -Page 3 of -7
Scale 1"= SW
\Vj
F~~zr-t R~-77
V_ 1. V L
cvtr_y~-Snc
4 ~~~GG ~.yp
1nJtt~ L,uc~ 1~1UtJ q
j' L 0,~
ool_ ,n r()
rt o F
_5
Y"o k
Zjp )NAT Cowlpfrr
o~ DIST~P-~
o.S
~ 3. ' ) o cwt
~ g
.s 0`5
u ~'~q Y'1 U CLZIL L
TL Q . 5 11 ~t~hPr
1) C) Q 'M P OF
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation ipes with approved caps.. ( Z required).
3. Septic tank to be V%.)o a 0gallon capacity manufactured by
In,~ t. tide c•~ c~ 1.,.1,E ._..100 U F1 LTU: r~,
4. Bench mark's SCIZ 0j3C)\jE
5. Divert surface water around system to prevent ponding at the uphill side.
1690?
AA Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
Iviscoftsin Madison, WI 53707 - 7162 Site Address
Department of Commerce t O t/
Sanitary Perrot Application Sanitary Permit Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision
may be used for secondary purposes Privacy Law, sl5. i m
I. Application Information - Please Print All Information State Plan I.D. Number
rty Owner's Name Parcel Number
Aridw r-5 o O a O
Property Owner's Mailing Address , Prope Location ' W t
;S T R E
City, tate Zip Code Phone Number Lot oc
Su ame CSM Number
a- ll) SSa V f _ kg
II. Type of Building (check all that apply) {3- e- 4- f Ih/ ❑City
A or 2 Family Dwelling - Number of Bedrooms ❑Viltage
❑ Public/Commercial - Describe Use jWbwnship
❑ State Owned r ~P~ U/JD W1 D )S-r . OV ( Nearest Road b
0,5
M. Type of Permit: (theck only one box on line A (numbering scheme for internal use). Complete line B if applicable) 3 A-9 -
l ~l
A. 1 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use
ste Tank Only Existing stem
B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV. Type of Permit: (Check all that ap numbering scheme is for internal use)
44 ❑ Non -Pressurized In-Ground j M 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In-Ground 41 Holding Tank 48 ❑ Single Pass 510 Drip Line
45 ❑ At-Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other
V. D' tment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed / Rate(Gals. ays/Sq.Ft.) (Min.Anch) Elevation
cv 0,
boo 1, - Irl e- ~
VI. Tank Info Capacity in Total Number t a Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks C t ~ Constructed Glass
New Existing 14,-/(V 0 ( !
Tanks Tanks
Septic or Holding Tank /
Dosing Chamber /
VII. Responsibility Statement- I, the undersigned, assume respo •bility for ' tion of the POWTS shown on the attached plans.
P hrr is a (I Plumber' igna Number Business Phone Number
'PP
?za
Plumber's Address (Street, Ci ,State, Z' e) ~ ~~Do
0
VIII. Count /De artment Use Only
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued su ent Signature o Stamps)
Surcharge Fee) cT G~
❑ Owner Given Initial Adverse
Determination
p7,dWiti~ I'huQ-t
. Condit ovaUReas or Disapproval aj 71
~y e `
.a~ complete plans (to qePounty ) for tae system on leis than 81/2 x 11 tncba In size
Qj'd~m ~J2 s an d~a c~ nod r^ ax-~ c~ arzea- • /1'1uz zi/~.sz ea'r'l'
SBD-6398 (R. 05 101)
r
Safety and Buildings
401 PILOT CT STE C
WAUKESHA W1 53188-2439
' - - TDD#:-(6o8) 264-8777
\tisconsin www.commerce.state.wi.us/sb
Department of Commerce ------'"isconsin.gov____
Scott McCallum, Governor
Philip Edw. Albert, Secretary
August 06, 2002 ®
'ECEi ED
CUST ID No.691727 A7TN: POWTS Inspector
GG 1 2 2002
ARTHUR L WEGERER ZONING OFFICE
WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPI gT a.
PO BOX 74 1101 CARMICHAEL RD ZONING OFFICE
RIVER FALLS WI 54022 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/06/2004 Identification Numbers
Transaction ID No. 775641
SITE: Site ID No. 648972
Mike Nelson / Better Build Homes Please refer to both identification numbers,'
Nicholas Drive above, in all correspondence with the agency."
Town of Hudson, 54016
St Croix County
SWIA, SETA, S8, T27N, R16W
Lot: 2, Subdivision: Csm Vol 9 Page 33
FOR:
Object Type: POWT System Regulated Object ID No.: 865196✓
Description: 600 gpd design wastewater flow mound system.
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Septic Tank Effluent for Private Onsite Waste Treatment Systems" SBD-
10691-P (N 01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment
Systems" SBD-10706-P (N 01/01).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans. In addition,
the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of
mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project. A0
O~ •
i ust be iven to the owner of the tank explaini that c e filter is
required. Access to the filter for cleaning must be provided per Comm 84 p uct a co ns.
Y s ~
~n • A Sanitary Permit must be obtained from the county where this project is loca ccorde with the
requirements of Sec. 145.135 and 145.19, Wis. Stats. Q
j
Inspection of the private sewage, system installation is required Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
i
ARTHUR L WEGERER Page 2 8/6/02
A copy of the approved plans,_specifications-and this letter shall be-on-site during construction- and open-to - - - - -
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/instal lation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure; or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
n Fee Received $ 175.00
Balance Due $ 0.00
Thomas J Perkins
POWTS Plan Reviewer, Integrated Services WiSMART code: 7633
(262)521-5064, 7:30-4:00
tperkins@commerce.state.wi.us
cc: Leroy G Jansky , Wastewater Specialist, (715) 726-2544
r-T
• TITLE SHEET Paoe \ of -7
FOUND SYSTEM
FOR
A BEDROOM RESIDENCE
This plan has been prepared in accordance with the Mound Component
Manual SBD-10691-P and the Pressure Distribution Manual SBD-10706-P
(N.01101) ~Olmroj se/NW 1*csd (N.01101)
LOCATED IN THE N~ 1/4 OF THE StiJ 1/4 OF SECTION Z3,T Z9 N,R lq W,
TOWN OF SO1J Sr- ~-U LAC COUNTY, WISCONSIN.
INDEX
PAGE 1 of 7 TITLE SHEET
PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN
PAGE 3 of 7 PLOT PLAN
PAGE 4 of 7 PLAN VIEW-CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT
PAGE 6 of 7 PU%IPING CHAMBER CROSS SECTION
PAGE 7 of 7 PUMP PERFORMANCE CURVE
PREPARED FOR
~ ~1Z ~vt L~- ~ ~'1 ~
16 19.E `Tl-~t 2D S I , S`a uT1~ Cov2T-
PREPARED BY
WECGERER S;M I L TEST 2 !VG
AND.
DES = CS1q S~RV S CE
P.O. Box 74 421 N.Main St.
River Falls, WI 54022
Phone 715-425-0165
Fax 715-425-6864 } {r(
ARTHUR t
r WEOEREA
Dd114 ► '
fiLLSWOR
4
oZ
Fti
JOB NO. L7Z-~~S
. PLOT PLAN -T
Page 3 of
Scale 1"= 50'
a.lS `ni * -N
W
2s~,
Cv~-l~~-SAC
U~
/ Znot~ PVC
G~
Q --o
J
N ZQO~OF
ZrpV@ F,3y.
~o ttio'T C.t~t^1,DP~
op- DIST~P-~
I-VKS
' o.S •
q~
a. ► A e~rH
1
\ e
V' L k~1. 9 8. D
O` aQ 'TQ 6>0F 1`` PVC Pt~E.
N •
Page ) OT ~
P_pprove. Synthetic Covering
)d),'~ Distribution pipe in . ey,
AST.~i C33 d
Medium Sand TP
Topsoil --N IG Fle
E
3
jjj% Slope
Distribution Cell of Force Main Flowed
z" to 2.1,2 r' Aggregate From Pump Layer ri_
E O-a Ft./Os,
CROSS SECTION OF A MOUND SYSTEM F p_ 8 Ft./0
G b-5 Ft.
A Ft. Fi 0 Ft.
Linear Loading Rate= -O GPD/LN FT B Ft.
Design Loading Rate=O.LLSGPD/SQ FT j 1 Ft.
J S Ft.
K Ft.
~ Position L 3 Ft.
o.
Force Mein W Z S Ft.
i -Observation Pipe
A e--~----~ 8----
T _
Distribution ~ - ~ 2 3 .
Cell of to =
Pipe
aggregate
Observation Pipe
(Anchbr sec=e1Y )
PLATT VIEW OF A MOUND SYSTE,
Distribution Pipe Layout Pa&e S of 7
Place the holes at the bottom of the distribution pipes
at equal spacing. ?remove all burrs from the pipe and holes.
Extend the end of each lateral up with the use of long tum or 45 ° fitting to a point within six
inches of the final glade. Terminate the ends of the late..-als with a valve;:threaded cap or
. threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug,
•-cc`ss aoti_
C.
Lateral Manifold 1`1\1) C
Lateral
X X X X x2 x/2 x x x X
Lateral Lenath - Lateral Lenqth - p
Distribution Line
V E~
1C~,F~s SpjS
0-
- -o
hM'TtJ1F-0~
S
y
0- -
I - GQ
v C 1'o~tC>r 1"1 r}r N
P Ft. Hole Diameter 'JS Inch
S 3 Ft. Lateral 1 Inch(es)
X 3 Inches Manifold Z Inches
Force Main " Z Inches
n of holes/pipe 11
Invert Elevation ofr- ~Laterals ~ 9,0 Ft.
- Combination Sept,ic:Tank and
PUMP CHAMBER CROSS SECTIN AMD SPECIFICATIONS ' PAGE ~ OF
NEWT CAP WEATHER PROOF
JUUCTIOU box .
Y'C.I. VEUT PIPE APPROVED LOCK IMG
110' FROM OOOR• MkIJHOLE COVER yv1"fE{
i1IMDOW OR FRESH wApt.3WG Lf4gEL..
w Nri ~ ~ AJR IUTAKE cawpu~r
F 14
GCE j
IMLET i" PROVIDE I
Ai
RTiGHT SEAL /fill
T
Approved Approved
joint w/ ~_~g00 I joint w/
PVC pipe 6 I ~f ALARA PVC pipe
I I oU
C I I
CLOY. I
7 Pump,,
OFF
D COUCKETE
e`sV $1, p O BLOCK
RISER EXIT PERMITTED C)QLy IF TACK MAWLIFACTUR7.R HAS SUGFI APPROVAL 3NAPPR
_1Br=DO t NQ
SEPTIC F SPECIFICATIONS
DOSE
TAWKS MALIUFACTURER: w` ~Z C01JCiZ~T~ 1JUMbER OF DOSES' S~
1 BOO DA..w
T,kMK JIZC : ! ~O BO0 GALL.OUS DOSE VOLUME r
ALARM MAIJUFACTuF L;z: _S . J . \ZSL[ gr-Em S INCLUDIUG 8ACKILOW: ~ S~• ~ GALLOWc
MODEL IJLIABER: IQ) I HW CAPACITIES: A= '-IZb.~
1" 112.c_UZ IUCHES OR CALLOUS
SWITCH TyPC: ~ ~ y '
$ = Z IUCHES OR S G~LLOA15
PUMP MAUUFACTURi}A: GCU LAS
MODEL IIUMBER: C= L3)y IUCHES OR ~ S2'I GALL0J5
D= q ~~y INCHES OR ZO S'~ GALLOWS
SW[TCH TYPE: ~Z_U`COTE: PUMP AUD
ALARM ARE TO 6C
MIISIMUM DISCHARGE RATE-_)'" GPM INSTALLED OU SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWCEU PUMP ~0_015TIZIBUTIOQ PIPE., LL-LL-1 FEET/
f MI►.11MUM K1ETWORK SUPPLY PRESSURE , • , 6 -,SC) FEET rs_ 0 K 1, 3>
+ FEET OF FORCE MAIN X I' 6 3 F jo Fr FRICTIOrJ FACTOR.. 3 ' Z FEET
TOTAL OtWAMIC HEAD Zo•q~ EET
As per manufacturer ZZ_ -IV gal/in. Liquid depth
i
Goulds iE
Submersible
Effluent Pump
3871 EP04
EP05
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
following uses: • Capable of running lubrication and efficient strength, and durability.
• dry without damage to heat transfer. ■ Motor Cover. Thermo las-
• Effluent systems components. tic cover with integral handle
Homes Available for automatic and
• Farms Motor: manual operation. Automatic and float switch attachment
• Heavy duty sump • EP04 Single phase: 0.4 HP, models include Mechanical points.
• Water transfer 115 230 V, 60 Hz 1550 Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering RPM, , built in overload with
automatic reset. preset at the factory. rated oil and water resistant.
■ Bearings: Upper and tower
SPECIFICATIONS • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EP04 built in overload with ■ EP04 Impeller. Thermo-
construction.
• Solids handling capability: automatic reset. plastic Semi-open design AGENCY LISTING
3/4" maximum. • Power cord: 10 foot with pump out vanes for
• Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SP Canadian StandardsAssociaGon
' • Total heads: up to 24 feet. with three prong grounding _
• Discharge size: 11/2" NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC".)
rotary/ceramic-stationary, three prong grounding plug improved performance.
BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged
• Temperature: thermoplastic design provides
104°F (400C) continuous superior strength and
140°F (600C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel.
10-
• Capable of running
dry without damage to 9 30 !
components.
Pump: EP05 8 r, ,
• Solids handling capability: n z 25 j t
/4 maximum.
• Capacities: up to 60 GPM.
S2 6 20
Total heads: u to 31 feet.
• Discharge size 11h" NPT. a - i--
• Mechanical seal: carbon- c 5 15 '
rota /ceramic-station
a ~
ryry,
i
BUNA-N elastomers. 4-
P054-
• Temperature: 3 10 i f i
104°F (400C) continuous
1401(60°C) intermittent. 2 ; -
5 !
t I
i ~
0 00 10 20 30 40 50 GPM
L L L
0 2 4 6 8 10 12 m'/h
CAPACITY
0 1995 Goulds Pumps, Inc. Effective May, 1995
r Mound System Management Plan
Page of 7
Pursuant to Comm 83.54, Wis. Adm. Code
Septic Tank L~a 0 317/
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter shall be assessed at least once outlet filter shall be cleaned as necessary to
~j ensure roe a filter cartridge should not be removed unless provisions are made to retain solids in t e an a
may s ough off the
l/' filter when removed from its enclosure. If
the 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 sludge and scum 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 a triennial 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required.
However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and
Buildings Division.
-
__2~o i4llrr ~isPosL a~ 'YE-72
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound c
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic U
(other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the
infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather
installations (October-February) dictate that the mound be heavily mulched for frost protection.
~tr Influent quality into the mound system may not exceed 220 mg/L E3005,150 mg/L TSS, and 30 mg/L FOG. Influent flow may
not exceed maximum design flow specified in the permit for this installation.
~/_The pressure distribution system is rovided with a flushing point at the end of each lateral, and it is recommended that each
'7 feral be flushed of accumu accumulated solids at I t n e eve 18 months. When a pressure test is performed it should be
compared to the initial test when the system was installed to e e e if orifice clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,
and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its'
component manual f8ft 5 - and local or state rules pertaining to system maintenance and maintenance
reporting. SBD-1'o_io 6- F
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed
' unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall
be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump,. pump controls, alarm or related wiring becomes defective the defective component shall be
immediately repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions about the operation or maintenance of this system should be directed to:
The County Zoning Office at BLS-3~6-g6$13 ST-C1,Z~ \X
The system installer at q9,S uTGf~~
The tank manufacturer at ~-ppZ S -(j klt~R
The effluent filter manufacturer at ~oiJ - ZZI - S~~Z ZPR3~i-
The pump manufacturer at - 3p - ZZ- R 6puL\-) S
Wisconsin 9' "ment of Industry, SOIL AND SITE EVALUATION REPORT,— Page 1 of 3
Labor and Human Relations
Division of Safety & Building* in accord with ILHR 83.05, Wis..Adm. Code
.1 114 1 r i
I COUNTY"
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Ckoix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D.,#
dimensioned, north arrow, and location and distance to nearest road. 020-1062-70-000
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION FTEVIEWEDPY DATE
r
PROPERTY OWNER: PROPERTY LOCATION
Richard LaCasse GOVT. LOT, NE 1/4 ! WK ,Wi9 23 T 29 N,R 19 R(or) W
PROPERTY OWNER':S MAILING ADDRESS OT # BLOCK- M0 SM #
521 McCutcheon Rd. na unknawa.
CITY, STATE ZIP CODE PHONE NUMBER CITY []VILLAGE J&OWN IN REST ROAD
Hudson, WI. 54016 (715 381-5405 Hudson W
[xI New Construction Use Pc ] Residential / Number of bedrooms 4 [ ] Addition to existing building
I I Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate - 5 bed, gpd/ft2 .6 trench, gpd/ft2
Absorption area required 500 bed, ft2 500 trench, ft2 Maximum design loading rate - 5 bed, gpd/ft2 .6 trench, gpd/ft2
Recommended infiltration surface elevation(s) 98.70 ft (as referred to site plan benchmark)
Additional design / site considerations system el. based on contour 1 ine of el. 98.70
Parent material sandstone uplands Flood plain elevation, if applicable na It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE 7SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S IN U ®S ❑ U ED S CR U El S 1:1 U ❑ S CR U 11 S CRU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Be Trench
1 0-7 10yr4/3 none sl 2mgr mvfr gw 2c .6
2 7-18 10yr5/4 none lfs Osg mvfr gw lc .5 .6
Ground 3 18-33 10yr7/3 none vfs Osg mvfr gw if .4 .5
98e 5 ft. 4 33-55 10yr6/8 c2p 7.5yr 5/8 lfs M na gw na .4 ! .5
Depth to 5 55+ 10yr 6/8 sandstone na na na na na np np
limiting
factor
55"
Remarks:
Boring #
1 0-7 10yr4/3 none sl 2mgr mvfr gw 2c .5 .6
2 " 2 7-24 10yr4/4 none fs Osg mvfr yw lc .5 .6
3 24-40 10yr7/3 none vfs Osg mvfr gw if .4 .5
Ground' .
elev. 4 40-65 10yr8/2 2d 7.5yr5/8 sand tone resi uum 9W na np 'np
97.7ft.
5 65+ 10yr8/2 sandstone na na na na na np np
Depth to
limiting
factor
40"
Remarks:
CST Name:--Please Print Gary L. Steel Phone: 715-246-6200
Address: 1554 200th-Ave., New Rich d WI 54017
Signature: Date: 11-18-99 CST Number: m02298
PROPERTY OWNER Richard LaCasse SOIL DESCRIPTION REPORT Page 2- of 3
PARCEL I.D. # 020-1062-70-000
r
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmr>dary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Trench -BeO 1 0-6 10yr4/3 none sl 2mgr mvfr gw lc .5 .6
2 6-19 10yr5/4 none is Osg mvfr gw lc n-7 .8
Ground 3 19-4 10yr7/3 none vfs Osg mvfr gw if .4 .5
941.9 ft. 4 44-6 10yr8/2 none sandstone residuum na a np np
Depth to
limiting
factor
44"
Remarks:
Boring #
13
Ground
elev.
ft. -
Depth to -
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev. j
ft.
i
Depth to
III limiting
factor
I ~
Remarks:
SBD-8330(8.05/92)
4
STEEL'S SOIL SERVICE
Gary L. Steel Richard LaCasse 1554 200th Ave.
CSTM2298 NE4sw4 S23-T29N-R19w New Richmond, WI 54017
MPRSW-3254 town of Hudson (715) 246-6200
lot #2-
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test. may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1"=40'
BM.= top of 1" pvc pipe @ el. 100.00,
Alt. BM.= top of 1" pvc pipe C e k. 94.50,
.4o% vlo
&
e~
Gary L. Steel
11-18-99
OWNER EVERGREEN ESTATES 111
RICHARD LACASSE LOCATED IN PART OF THE NEt/4 OF THE SW1/4, PART OF THE SW1/4 OF THE NW1/4 AND PART OF THE S F THE NWi/4 OF SEC
871 KELLY ROAD TOWN OF HUDSON, ST. CROW COUNTY, WISCONSIN; BEING PART OF LOT 2 OF CERTIFIED SURVEY MAP RECORDED IN-00 LUM 13, I
HUDSON, WI 54016 LOT 9 OF THE PLAT OF EVERGREEN ESTATES RECORDED IN VOLUME 6 OF PLATS PAGE 92 AT THE ST. CROIX COUNTY REGISTER
N ac~avo®9o sip
amaum 2a TOWN SOARS RESOLUTIC
by
$ t o [VCRORE
CID11Tr TREASURER'S cCRTifICATE Rkl-V LAGccr 1. CM Cv" M
1red, that lyraby aPProt•
wwW~ state or MAscomit I is
o g r--iy or st Crop
) ,lMnfpn,owr~______° Date--
wr,• .le.n LNwTara. b"m the Sty al►stN, R1~ UFM+'9 actl.q T1wn C1oLrn.n
Trtnn of St Orpp Ct ty, ro in►ey cwLrr that thr
eecwwoorr'~~yysRRs.y(~"`~
ofrlcr shoo no ve•osesrter tax any ro 1rtpNr taxes > 1 hereby Conley tMt the farpobq Is a cope
N tl
mwpC
assKs-ts of of of Kt9~ ' r V M ipn RWr/ or the Tpn of
- ESTATE
20 LarR/ alrar.a w plat oil-Vi : - - -
ect.
01,
T* l]r
kl~
_i Oat:
~~fA CvyJnn ~ llstr~,-_-
OF Vv TOW TREASURER QRTWICATE
xOM STATE Or WISCONSIN ,
) SS.
T- J Y ST. CR01S CmwTr )
F 'a ee Ila9lea_
a7 7 V>IfYB. 6NfY L Selrerly A -111 +sae kRnp the rRAy elector, 1
~ Goan ireasver o/ the iaan o► I►Rrso7L nerrbi
_ .lth yr rKOHc a. wp elate. Parr w ro u
~4 9® aaaatwnarlls as er 1'n any of
i. i Q PI0.Sti2'15YW Rat or EWEAfAEEN ~STAfiEf 114
D0.te--
NOO'13'54'E 6~ I T tan irreaatra
WLAt COINER 50.00' 2 I 6004
I
srsrlwv A El.tr-WEST 1MUaELENGTH -®m.ts
r4mm SW46'WE 90624
iaeas.ss stops
.I \ ♦ LOT 28 A
Nssroa 15w 1 I
• A 2054 AFRf.'ES
-6 A . 89,471 SO. FT. .
¢ L? 27
__6004 94 ~ ~ t+ a • . % v,3
/ ♦ \ \ / 1181BI5p. Aft`
4 h~
A c'yp
i \
LOT 23 ape \ `
3 / \ iP
2174 APICES
1 ~ 94.719 SCL FT.
1 .
;i Z %
~ I
LOT 26
R ► LOT 25 4.179ARCES
g p ; LOT 24 2424ARCES MOOSQFT. 7~s~Rrt~
' 3.32E ACESS
1 y 105,5Ri8so.Fr.
~ 1x4,959 100. FT. .
O ~r>~
-
IL/ d
, ,
NOME g~ ~ o
o
DWM BURIED E
RACED ORSTi&7L per, i .a
DISREBANysRASLE,ROBRYAN6i
N ETAOF7171TUTASUNETSUWKEBIMS * HEFI N BAVI SET MIYLOOSET PSrUS 00'13111! .35'
OFINM ONSI
ZBUCO DEE.N LFFILITY FS RE Oa FOR'THIE sOE£X SERVET USE OFI f+r9`d
PteucoD~ AtD NNAlEPUKXR19uGLnune UllOIES HAVel6T THE RrA+rro SEMETHE MAF<=A
D
EAMPMrEL"MNONTNEMMFlA1)66LRUEL7TOSrATF COl1MT.ANDTONW1-eP lJ----- D r~1y ,
LAWS, RUMA D F MAAT10NS r.E. WETLANDS, MMMAR LOT sf. ACCESS TO PARCEL EM), u U o
BEFORE PIAlCFW91N0OR OL1ElOPpOANY PNRCEI.OF LAND CONTACT THE ST CROIKOOUNTY
ZONING OFFICE AND APPROPRIATE TOWN BOARD FOR ADWCE
CREWE DATA
MAABEA LOrr PAD" CENTRAL CHORD CHORD ARC UNGM TANGENT
ANGLE aLm" LFNOTH LENGTH
1 110.(b` OP0a1' N02uW49RE law I&W NW43 E NW4945-E
2 zn Y4T31• sw2 ?W10E 19306 7161.101 S07IME S3943/fE
3 187.0 46.1901• sot77N.6E 132.67 1311.44f SISWI E SM43114E
U&W 9r3rAr 3902996E a" 99101' swistre sw4379E
a MIST 40f10 SW1171E stir 07100 962,173WE 8177p7DE
s Mw TN•OrJ01 NzT1021E II&W 371.19 s171inve STr17t4W
15 MIRY 6POtr s1PAoeE T7Sr ap.W 0.173229E 67ete42E
26 Mw ertl® NW4a1sE /ase 130M s7pwdn NDI'WWE
27 MOST 634939 N2r11L" T2:er 71ST ND"MIFF N49102M
29 a0W sr3Hr NTAOSSW 71.11 111JB N411,10" 37r1rim SCALEN FEET 1'-100
7 a6W 49Hr N9rfralw ply W-W Ple"Ur NM NR'49arW
a "7.W 9V•3V4ff N4~aIAW 706 71.49 Nems" MIMS' p 20D
Sl1RVEYOR'S CERTIFICATE
a. TM. R1 9W. 1, Douglas J. Zahrer, arglstwrrd Wisconsin Lard Surveyor. hereby certify
that In Full COMPllance w" the provisions of Chapter 236 of the
% ANDPART F Wisconsin Statutes, and under the derctton Of R1Chord LaCassr, o.rrr
=EDS OFFICE. of
the Iand descried on this plat, 1 have surveyed, div,Mr and mapped
EVERGREEN ESTATES 1111 that such plat correctly represents the
exterlor boundaries and the subdMleion of the land suurveyedl and that
this plat is located in pelt of the NE1/4 of the SVI/4, M part of thr
thr Toen or err- SVI/4 of the NVL4 and in part OF the SE114 of the NVI/4 of Section
.w Dp"ra 23, 729N, R19V, Town of Hudson, St. Croix County, Vlsconsrn, being Lot 2
OF Certified survey Map recorded in Volume 13, Page 3726 at the St.
Croix County Register of Deeds OFflcei further described as follows,
vwiiWtewn adoptrd - Commencing at the Vest quarter corrw, or sold Section 231 thence
389'46'06'E, along the rest - west X lid of said Section, 132953 feet
to the west line of sold NEI/4 of the SVI/4 being the point of
begWw*Vl thence h%*04'13'V 54.07 feet] thence NW'0273'W 4.03 feet
to the easterly right-of ■ay of Valdroff farm thence Np093341E.
along said easterly right-of-way. 50.00 feet to the paint of curvature
of a 167DO foot radius Curve, concave northeasterly, whose central
angle measures 0529'51', whose chord beers N02.58.495'E and measures
1(L02 Fret, thence northerly stamp sold right-OF-soy and the arc of
said curve 16.02 Feet to the point of curvature or a 233.00 foot
radius curve, concave southwesterly, whose central angle measures
wactNp 48'57131'V, whose chard bears S62'41393'E and measures 193.09, thence
y that h ccvd.rcr _ easterly along the arc of said Curve 199.10 feet to the point of
,wow pr sppcpu tangency, thence S3811334'E 2038 re: to sold east - rest X lt'Kl
nd ecl./wd in w thence S89.46'D6'E. ahonp said east - west X Une, 896.94 Feet, thence
MV29271V 410.42 feet] thence S2Vl7'35'E 20399 fort, thence
i 351.02'44'E 10552 rent, thence S57114T7'V 592.95 fret, thence
( N83*WI3'V 409M frets thence N1W0rVrV 885.011 feet to the point
of beginning. Described parcel contains 18.298 Acres C797,061 Sq. Ft.).
1 Parcel subject to sU easements, restrictions and covenants of record
EU4 Comm
1 eraara~ as
J 1 1 x9mv
rl 1 ~ i
1 ~7
1 Q
01 1 L1
Rau 9 zT. wpc calbrr PLwdra, zau~6 AND PAaxs rawdTl[E RESDLUrION
9 ae,phrd, that w Pl.t of evattlEU+ HATES 1n a w Town or NutorA
p # aunard LaC•sse, owner, Is hereby owircrra by w St. Crow cw ny poont il.
CSw&RL ON hi 1 Coin Zomi W P•rN. Co,Ntter.
n I
pate--~r----
$ ~ 1 a i ~ Chdr..m
~ti-~~~----
1 tiring Dlrecta
1 merr
Canent y orliFy wt the f."901mg Is • of • revolution "toted
by 1 / the St Croix Co-tY A"rMA. Z-Amil -0 ►"rlus Cswttrr.
)J ~
/ / Sus M ark Mtr
ClerM
/i
/ OV,ER'f CCIJTFICATE OF DEDICATION
/ As owners. W hereby Cwrwy wt of CWM" w our reserbrr an vas Plat to to %Wveym
dmuew, maYpyped and dencated as raprwsant.r en ass Put W. alas cerM1'w"l try we via 1%.t K
the I- r f •P or abJeethen ft
Cro CmgY 2-3'1Lna, Zomng v% be suilwittie following Porks C-Ottre "wl
WITNErA
/
vlrh[ss w send .rd sew] of sW owner thi_--- ar or
O / 1. w P-mo c. of.
- - - -
State of AAfcami in ) IS
Co.nty of St. cmbd
LEGEND p.rean.uy wow - VA& - way or ___-x_-. w "bid" n"med Qh&w d
Loc awn to m e.o.m to br the prrsarns wtw wwr C.trd w to odrnp hwtrnwwnt and
.ci,w.Ar0 ed w same.
AuANNw COUNW 36cmaN --.--r-__
cannel MONUMENT FOUND
Matwry P.40C. -
r SON IVE FOOD My Corvn.YOn .gales--------------------
0 rx W MON PIPE$TOFICilwla
Deb UDS PER UNEAR FOOT
MOM ALL onion LOT CDANEA4 MGM OF MORTGAGEE
WONUNeir®wITN rxw
"wpm WBOmmiOt me& =V"" Dar W. Finn ft rta"prw or the above descrbPd Load, dews henry cwnsrmt to w
PER U EM FOOT e. i,riarnp, rnappep and dedication of w Isnd drocrbed on na► d•t. aid lows hereby
Consent to w bove Certificate of LoCasr Cwtan Nora, inearmatwd, aerwr.
. 1-W FEW FOUND In witness whereof, the wW E valley D V Ms caurrOr prwsents is er snprned
by (:Hells E. Dotty. His president, at Muba% tAScw COmiu, aid its its ewrporatr seal is be Iwrrnwnto
affYr/ tld -_--_----tY of Lss0.
~ 3M'R®4l POlI1D
E.P. VWey 4nk, Mil
X- X -X E10EINO F84CElrE PY'wwyemt-
WtK G Oaty
4WSM) mtN40Uat.Y AE OMED DATA
Stat► or LASCane.r) ss
Canty of St Crain)
• • • • • • • w FAIADwAYDEI'MUKUE
Pwrow .uy canr rrorw nvr this -__-tr or Da_--,
Cwtis E. Oaty, Presyent of W "rove nod Sse fttbwy to . morn to be w person 1,a
rweeuntA w Iaregobnp hftrvwnt, and to nr low to or svcm prudent of spy assAciatb.,
PFOPOMDA E sin acbrodMSrd wt M waecvt.d w Fit F*q Mtrwnt as such officer as V. weed ar
s"u aswocove, by its auwnty.
A saLrDAec
17WOEUNUMi- MEW xet.ry PwNt. --`-----------------.W,.r..~:.
y Carvdsslon ewpwws-°--------------------
Safety and Buildings
401 PILOT CT STE C
WAUKESHA WI 53188-2439
TDD (608) 264-8777
m0ns,n www.commerce.state.wi.us/sb
E C V www.wisconsin.gov
Department of Commerce
Scott McCallum, Governor
6 2002 Philip Edw. Albert, Secretary
August 06, 2002 _u.
CUST ID No.691727 ATTN: POVVTS Inspector
ARTHUR L WEGERER ZONING OFFICE
WEGERER SOIL TESTING & DESIGN ST CROIX COUNTY SPIA
SERVICE
PO BOX 74 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/06/2004 Identification Numbers
Transaction ID No. 775641
SITE: Site ID No. 648972
Mike Nelson / Better Build Homes Please refer to both identification
Nicholas Drive numbers, above, in all
Town of Hudson, 54016 correspondence with the agency.
St Croix County
SW1/4, SE1/4, S8, T27N, R16W
Lot: 2, Subdivision: Csm Vol 9 Page 33
FOR:
Object Type: POWT System Regulated Object ID No.: 865196
Description: 600 gpd design wastewater flow mound system.
The submittal described above has been reviewed for conformance with applicable
Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been
CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10),
Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to
occupancy or use:
• This system is to be constructed and located in accordance with the enclosed
approved plans and with the "Mound Component Manual for Septic Tank Effluent
for Private Onsite Waste Treatment Systems" SBD-10691-P (N 01/01) and the
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment
Systems" SBD-10706-P (N 01/01).
• In the event this soil absorption system or any of its component parts malfunctions
so as to create a health hazard, the property owner must follow the contingency
plan as described in the approved plans. In addition, the owner must insure that the
operation, maintenance and monitoring duties as described in section VIII of mound
component manual are complied with. A copy of this information must be given to
the owner upon completion of the project.
ARTHUR L WEGERER Page 2 8/6/02
r Z
• Maintenance information must be given to the owner of the tank explaining that
periodic cleaning of the filter is required. Access to the filter for cleaning must be
provided per Comm 84 product approval conditions.
• A Sanitary Permit must be obtained from the county where this project is located in
accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for
inspection shall be made with the designated county official in accordance with the
provisions of Sec. 145.20(2)(d), Wis. Stats.
A copy of the approved plans, specifications and this letter shall be on-site during
construction and open to inspection by authorized representatives of the Department,
which may include local inspectors. All permits required by the state or the local
municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require
changes or additions should conditions arise making them necessary for code
compliance. As per state stats 101.12(2), nothing in this review shall relieve the
designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number
listed below, or at the address on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others
who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $
175.00
Balance Due $ 0.00
Thomas J Perkins
POWTS Plan Reviewer, Integrated Services
(262)521-5064 , 7:30-4:00 WiSMART code: 7633
tperkins@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544
Rug 15-a2r02:56p Justin Nelson 715-796-5350 p.l
ST CROIX COUr4TY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP C.;RTIFICATtON t?O[ttvl
OwnertBuyer
Mailing Address S
tkD
Property Address t for new coststiUCpor►?
(Verification required from Plarmg DePa
~s parcel Identification Numbef vav
CitylState
bES N /
sec. Z 3 TZ~ 14.R I W, Town of
7 property Location aIGE% ,
vas C.~<~ t r Loth
Subdivision
Volume . , Page #
Certified Survey Map #
Volume Page #
Warranty Deed #
Spec house ❑ yes R no Lot lines identifiable ~ yes Q no
SYSTEM 'TE AN drr stdt is its ptematsae w.. to ha me wastes. Propermarawunce
tmtxopernse sad c~ she systcmcoul if neodcd by a lieeased ptrtnpcs. Vn at you put into the tysum
consists of pumping out the ~c tank tvery dmc yum of sooner,
can affect rive fnataion of tax she t u* as a etaaocat stage in the waste disposal 'ram
11c prgpeny owner agrees to submit to St. CM3L Zonist Dept a utiati► fords, aiaaOd by &e otwrs and by a
zaaster, rora liceesedponva verifying that (1) the on-site wraatewaterdisporA system
is u in ppr ploper o operating cottranpe joincon~Plditioama~~• lor (2) ttxa after P it~e ctioa and P if necasm), ft septic lank is Ices thaw 113 M of sludge.
in ig ( arc storage dislwsat system with the standards
stating that your septi have read the above requirrmcats and awe to maintain the priv Certification
Uwe, the b=in ias so em of Natural Resources, Sere of W is ons;a Of~ wit est on
to forth. hers i r s )bc by the system has beec at WUW awl be eom**d aad~ to ft St. Croix County Zoning
days of the untie year mWinbon date. /
DATE
vV p 7 I I
SIGNATURE OF APPLICANT
Ox
9W[~j K~ERTI CATION L lo►ow C. I (we) am (are) the owner(s) of
I (we) cc 'fy ttmi all stattntasts ca this form. tuae mare to
is Rtsgister of Ueeds OtFica.
the Rbove, by vidw of a wamntY
/ 31"`
TE
SIGNATURE OF APPLICANT int. •••••e
(ZZ06-ing
Any information that is rrtis-reptaeuted maY result in the swit-Y Peanit being revoked by t
Deads Include with this application: a stamped wsmnty deed frc the '(e is knee is mado zt the warranty deed
a copy of the certified sun Y P
']NllklftHJX3 '1'1021x : 41083
to WbFZ:Ot 7-OOZ ZI '6ny 90LS9pZSZL 'ON XUA
j 19.171 3tf4
' 682780
STATE BAR OF WISCONSIN FORM 2 -1999
KATHLEEN H. YALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX Co., NI
This Deed, made between LaCasse Custom Homes, Inc., a RECEIVED FOR RECORD
Wisconsin Corporation 06-27-2002 8:00 AM
WARWK y DEED
EXEMPT ti
Grantor, and `Michael J. Nelson and Molly Anderson
REC FEE: 11.00
TRANS FEE: 266.70
COPY FEE:
CERT COPY FEE:
Grantee. PAGES: 1
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):
Recording Area
oLot27,WIt of Evergreen Estates III in the Town of Hudson, St. Croix Name and Return Address
isconsin.
TG~ -
Fu
020-1371-27.000
Parcel Identification Number (PIN)
This is not _ homestead property.
Q8) (is not)
Exceptions to warranties: Easements, restictions and rights-of-way of record, if any.
Dated this ZED day of June 2002
LaCasse Cu tom Homes, Inc.
+ + Richard W. LaCasse, President
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) [~t`C~! ll'1d ~n~• ~EA~Q~i~L STATE OF WISCONSIN )
) ss.
St. Croix County )
authenticated this Z(t a a J N % ~~d
- Personally came before me this day of
June 2002 the above named
O &,-,A Ar7n LaCasse Custom Names, lnc., a Wisconsin Corporation by -
' - . Richard W. LaCasse, President
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by 0 706.06, Wis. Scats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogtand
No[ary Public, Stale of Wisconsin
Hudson, W 154016 My Commission is permanent. (If not, state expiration date:
(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. lnimmatlon Proless,onals Company. Food du Lac, W1
WARRANTY DEED STATE BAROFWISCONSIN 500-656-2021
FORM No. 2 - 1999
St. Croix Omity Register of Duda
N. E TATE
111 S
= THE NW1/4 AND PART OF THE SE1/4 OF THE NW1A OF SECTION 23, T29N, R1 9W, I'
P
2 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 13, PAGE 3726 AND PART OF 0
6 OF PLATS PAGE 92 AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. P
1RD RESOLUTION t
s
i ESTATES III in the Town of Hudson, LaCasse Custom Homes, Inc., owner, is
C
_ 5'- 9-3L -00 S
Date N
e
w
s a copy of a resolution adopted by the Town !Board of the Town of n
f
Date _ P
V
RTIFICATE t
r
OF W"S,
elected, qualified and acting Town Treasurer of the Town of Hudson, co OUGLAS
th the records in my office, there are no unpaid taxes or special ZAHLER
any of the land included in the Plat of EVERGREEN ESTATES III. * 5.2145
HUDSON,
Date I WIS.
SW46WE 5303.18' W @[L. w o P@. 1@-§
C~J
S89°46'06"E 906.24'
398.19
X
T2
8
-ARCES
SQ. FT.LO 27
CIO 2.713 AR p'~
118,181 SO. FT.
W@[L.9
~ O X39 P@-;P§28
SCALE IN FEET 1` = 100`
N85°11'51 "W
9d7 oro