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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL I'~IFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I.
Permit Holder's Name: City Village X Township
Carria a Homes Inc. Hudson Townshi
CST BM Elev: Insp. BM Elev BM Description: -
~3
TANK INFORMATION ~' ~ ~~G»C!L ~Jb Lf,(5l`~ ELEVATION DATA
TYPE MANUFACTURER CAPACIT
Septic
~ SG-2,.
12 5
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic /
~ ~
'~ t
2`d
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Number
Loss ISystem Head
n
SOIL AB RPTION SYSTEM
BCB RENCH Widt ~ ,~,~~~ Len
DIME 1
SETBACK SYSTEM TO 1
INFORMATION
Type Of System:
V.
DISTRIBUTION SYSTEM
c o vKCVv
~ No. Of Trenches
~~
P/L BLDG WELL
>j ~~ ~ ~~ ~
Ft
County:
St. Croix
Sanitary Permit No:
420485 0
State Plan ID No:
Parcel Tax No:
020-1395-15-000
a2S. ~9. i9. °z yob
STATION BS HI FS ELEV.
Benchma k
.~. -~.
la.~
1~2•~`
9~~~
A[t. BM ~ • fo ~ ~~ r
Bldg. Sewer
~.
9 ~_ 2~
SUHt Inlet Qj, ~p
l ~}3.9'~ ~
St/Ht Outlet Q
~ o
p g3• ~
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
Bot. System
E I S
Ilr to S
o. o'
Final Grade
St Cover
3.20 r
9.80
~' E ~ ~~~ VLt.S GC 0
PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
LAKE/STREAM LE CHING Manufacturer:
CHAMBER OR
UNIT Model Number:
Header/Manifold tt
~~ Distribution
Pipe(s) x Hole Size x Spacing Vent to Air Intake
Length
Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Svstems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center BedlTrench Edges Topsoil
[~ Yes L~ No -- -
[ _ Yes !j No
C ~ME~y,TS: nc de code discrepencies, pers ns present, etc.) Inspection #1: ( t~~---~ Inspection #2:
c~,,~000((__ ~ert:~"_ d ~i Sarv. ~. ~... 5~ b~^--- ~~b~ - e [-S~ c!~ dam, 1``"
Location: 819 Prairie MeadowLs (Dr Hudnson~, WI 54016~NW 1/4 NW 1/4 25 2`9N R19W) Scenic H[Ils Lot 15 Parcel No: 25.29.19.2409
1.) Alt BM Description~o(JoQ Qati~~rX~•Oi^ ~~~~~/'~•~S~J ('~/~ / ,~-., (1 r/ ~~/~y .~
2.) Bldg sewer length = 3a (,i~~ ~ 1 •~ ~ W(~' .~ ~ 0 ~ / ~~~~~yG1"' ""'"
- amount of cover = ~ 3pi15ai (~~~ ~~`Uw ~ ~ _. ~-~~ _) ~ v ~A q~~
;,~.. _ _
Plan revision Required? ,_ s r,l No - ---t l'' L_ _ _ -- ---- I --I----1-- 1-- ;
Use other side for additional i formation. __i I __ _ _~ _ _ ~
SBD-6710 (R.3/97) ~ ~~~" Date I ~ insepctor's Signature Cert. No.
rl~~,,,.~~ian ~~IC. 2~ ~~~O.ao
C
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~~e~'lZ!/~'tl~- /~1/l.~ifd~'" Plete Plana)2~~~~~7 y or em qn pan I 8 x es 1n size ~ ,.~ ~ p~ ~~~pG¢lf.,~~'c-
SBD-63,98 .(R. OS~/0~ v~^~ !Gi-,, . ~.~]~~ ~ '/~y~~~.crL- ~,t//~,'oyn~•-• ~'3. ~3-/
Safe and Buildin s Division
201 W. Washington Ave., P.O. Box 7162 County
s F'ey' ~ r ~
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~ Madison, Wl 53707 - 7162 Site Addgress D ,, - ~^
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ment of Commerce
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Sanitary Permit Application sanitary Permit Number ,Q
~~ ~
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide v
^ Check if Revision
ma be used for seco ses Privac Law, s15. 1 m
I. Application Information -Please Print All Information State Plan I.D. Nunl
hJ /~
rty Owner's Name Parcel Number Z S • 2 ~ „ ~ ,
~ G~'
~ ~Z ~' ~ 3~15~15--1~
a~'r~ c~ ..~
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Property Owner's Mailing Address Property Location
,~ /!
-_ =-QY S u~ L.a.v~
.if~GJ '~~C~LI~ 54: S To~9 N. R f
City, State Zip Code Phone iitYlber•-••-,.-...__~ Lot Numbe~~~ Block Number
Subdivision Name CSM Number
II. Type of Building (check all that apply) / ^City
~1 or 2 Family Dwelling -Number of Bedrooms ~ a '~ ^Village
^ Public/Commercial -Describe Use
ownship ,,tJ
~ ' ` ~ _
,J2000'"~ Nearest Road
~ k// / ~ ~~y~2.~c~~t.cc
^ State Owned ~
7
J ~' ~t'~'" '
3 JG C lam."c~C
III. Type of Permit: (Check only one box on line A (num ring scheme or internal use). Complete line B if applicable)
A
1~New
2 ^ Replacement System
3 ^ Replacement of
6 ^ Addition to For County use
S stem Tank Onl Exis ' S sum
B. ^ Check if Sanitary Permit Previously Issued
Permit Number
Date Issued
IV. Type of Permit: (Check all that apply)(ntunbering scheme is for internal use Y r
GZ~~
S~
,
50 ^ Constructed Wetland ~
,~
44 Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Fitter
22 ^ Pressurized In-Ground 41 ^ Holding Tanlt 48 ^ Single Pass 51 ^ Drip Line ~• ~~ /~%'~"`~
'
'
~~
^
/
2
Gvr1
Other
45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30
V. Dis ersaUTreat
Desiga Flow (gpd) ment Area Informati
Dispersal Area on: ; • ,e 1~ ' ~
Dispersal Area Soil Application
/S
F
/D
t
~ 1' ~-~
Petrolation Rate System Elevation Final Grade
Elevation
/Inch)
(Min
Required / q.
.
ays
i4ate(Ga
s.
Proposed ~~, ~~ '
.
l
•
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~~~ /~ ~/
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VI. Tank Info Capacity in Total Number Manufacturer •Prefab
rete Site
Constructed Steel Fiber
Glass Plastic
Gallons Gallons of Tanks /I
~ ~ ~iJ~
New Existing ~ ~
Tanks Tsnks
Septic or Holding Tank ~ - 1~Qd ! f/i~ c~l~ ~' J~-.
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for ' on of the POWTS shown on the attached plans.
P[umber's Name (Print) Plumber's Signature RS Number Business Phone Number
~'i/,ate s~~~.~~~~y ~/.~;~ ~ ~~~QQ~d ~~.s- -3~a
Plumber's Address (Street, City, State, Zip Code)
/~7G c. ~ ~ so •
Count /De artment Use Onl
roved ^ Disapproved
A
~~' Permit Fee (includes Groundwater
Date Issued
suing ent Signs o Stamps)
pp
^ Owner Given Initiai Adverse Surcharge Fee} ~
~a ~ S -~ ~~/Z /
i d
~sy,.~ ~liYYy.'
Determination
7^' IX. Conditions of Approval/Reasons for Disapproval ~ ~~~ y~' Syf~ ~'
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wrswnainDepartmentofGommeroe - SOIL EVALUATION REPORT Page I ofd
Division of Safely and Buildings
m accoraance wrm t:orrnn uo, vvrs. rwrn. was '
8
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Pl
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ct Coraliy
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Attach corrrple~ site plan on paper not lei t ze.
us
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inducts, but not timid to: vertical and horizontal direction and
' Parcel l.D. G1
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Z
'
percent slope. scale or dimensions, north arrow a rf $tSd tl to nearest road.
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4
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Please print all '~~ n.
.~. / by Date
Personal information you provide may be used for ,
taw; ~: j5. (~) (m))..
C~YV~^~1 ~-G Q
Property OMrner - P" .. Location
I'~ ~~ ~ ~~ Goyf.' of N w 1/4 ro W 1I4 S Z rj T 2 9 N R i ~j E (or W
Property OWn@r'S Mailing Address ST L' RQiX Biodc # Subd. Name or CStVI{f
Cv~ZO 5~1~~w "~
- ~~~. S e -
City State ZP Coda ~'
'" .City ^ Y dlage I~ Town Nearest Road
_
~S7 i' I l wa.~-c r -'Yt r~ . ~S0 ~Z ( ~;i
\
~ ~' ~
~ K ~ r, r, Rd
® New Construction -Use: ® Residential / Number of bedrooms 3 _ ~f Code derived design flow rate ~Sd l (o O a GPD
^ Replacement ^ Public or cxxnmeraal - Descnbe:
Parent material Ov fc~Ja-$ l.. Flood fain elevation ~ applicable , 9 2 y : 3 ~.
General carnments ~ ~ S ~..~ rvt e. l e iJa f .b n - Q9 . $o
and recommendations: ~, L~ 2., I ~2.J 0. ~-~b ri - .~j I .OCR
' Boring # i^i~~il ~9
r:pr Pit Ground surface elev. ~y .1,o R Depth to limiting factor l ~ 5 in.
Sod Rate
Horizon Depth Dominant Color Redox t]esaiption Texture Structure Consistence Boundary Roots GP DHt~
in. Munsell Qu. Sz. Copt Cobr Gr. Sz Sh. 'Eif#1 •Ett#2
Bonng # ^ 8onng
® Pit Ground surface elev. g 3.70ft Depth to limiting factor ((O in. ~ ~~
Horizon Depth Dominant Cob Redox Description Texture Structure Consisbnce Boundary Roots GP D~
in. Munsell Du. Sz. Cont Cobr Gr. Sz. Sh. 'Etf#1 •ER#2
I o -l, ) 2 --- LS ) m c .~' .. Z
2 ~_ i i p ~ ~ ~ rri 5 I - - , -7 1. Z
~ 8'
* Eftiuent #1 = BOD_ > 30 < 220 ma/L and TSS >30 < 1 50 ma/L ' FJfluent #2 = BOD. < 30 mglL and TSS < 30 mglL
CST Name {Please Print) Si atupe CST Number
Address ~- Dale Evaluation Conducbd Telephone Number
Z i i 3 ~bn' S-~.~ Somer-~-~,~ c~ r ~~2s (o - l - o I 115 Zy ~ - y0o~ ~
Property Owner /a.r k~- ~ ~ Pan~11D # .
Page z of ~_
Bonng # u ~~
®Pit Ground surface elev. ~1) . $~ ft. Depth to limiting facxor ~_ in. Soil ication Rate
Hor¢on Depth Dominant Cobr Redox Description Texture Stnuture Consistence Boundary Roots GPDli~
in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh: 'Eff#1 'Eff#2
_.
2 ~~~ ~ mS ~ ~ - : ~ 1- Z
~~ ~
~l ~ (,frf' (6.e ~r~~~-cr 92 93.0
~~ # ~ Bonng
^ Pit Ground surface elev. ft. Depth b limiting factor in. Soil. ication Rate
Horizon Depth Dominant Color Redox Desciptbn Textun; Structure Consistence Bourxfary Roots GPD1i'J?
in. Munsell Qu. Sz. Coat Color Gr. Sz Sh. 'Eff#1 'Eff#2
Bormg # ^ Bormg
^ Pit Ground surface elev. ft. .Depth fo limiting factor in.
Sal licatbn Rate
Horizon th
De Dominant Cobr Redox Description Texture Structure Consistenoa Boundary Roofs GP D/f[:
p
in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 *Eff#2
* Effluent #1 =-BODE > 30 < 220 mg/L and TSS >30 <_ 150 mglL * Effluent #2 = GODS < 30 mgil. and. TSS _< 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBp-8330 (8.07/00)
PAGE ~ OF~_
NAME -4 Y` ~ •E- ~ ~ LOT# - S LEGAL DESCRIPTION~Jw '/4.(,tv'/4,S z,STZ4 N R (Q E (or~
SCALE: I'~ yU
BM 1 ELEVATION /OD • o
XJ
BM 1 DESCRIPTION #o~,o ~ I ~ ~~ P/~ p~'~e ~
BM 2 ELEVATION ~q• ~ ~ ~ G
BM 2 DE5CRIPTION~ p a ~ 1 ~ y c.~0 ; Q~
SYSTEM ELEVATION ~ Q' So
ALTERNATE ELEVATION 9 ~ • ~' ~
CONTOUR ELEVATION g7•oo, 93. o~, qy.o~, 95' vU
aZi{.3
~ \
~{-v~`I ~
0 9 yo ~
SEPTIC TANK•MAINTENANCE AGP.EEMENT
AND
OWNERSH[P CERTIFICATION FORM
Ov-~ncr/t3uyer ?~c~2 ~ ~ ~ ~UyJ-) ~ ~^llJ~.
Mailing Address c' o ~/'~~"'b STI ~ Wf~- ~3 ~ VD • ~/'/ c~G Gt/A'r~'~' , /Y/~ ~
5~b ~
Pzopczty Address ~ ~ ~ ~~-12 / ~ i'~~~ 4 w S
(Verificalioa rcquirrd from Piartaing Department for acw construction) ~--~ j
(~ty/State fl D S~ ~.l ~ ~ Parcel Identification Nttmbcx ~ ~o ' / 3 J S ~ /S - DUU
~~c~a~ nESCnxP~orr
T ~,,~~~, /n r
Property LocatioQ ~ ~4~ ~~ ~~4, $CC. v
T~N-IZ t ~ To 0
Subdivision ~C~El~ll L 1~C(L.~-S .Lot #
CerHi'ied Satvey Map # , Vollimc .Page #
wa~nty need # ~ ~~ ~ _ , volcune 1 G G v . Page ~ 2g ~
Spot hawse ^ yes ^ no
I.ot tines idcutifiiabie ^ yes ^ no
SYSTEM MAII~ITENANCE
. Imisoper use sad ata~Geaaaee of your septic system oonld result in its pefa~ure to handiewssLcs. Proper mstntcasace
of pcm~iag oat tfse septic tsatc every three yests oar soak if smeeded by a ii~oeoscd pamper. What you pcct inter the system .
am aS,xt the fuaetioa of the septic taalc as a tneatmmt stage is tl~e ~raste d'uposal sysflcm.
Zee pnvpaty owner agrees to tuhmit to St Croix ZACting Dcpartsacat t artifioatioa facet. siga+od by the owarc and b'y a
~P I~Y~P res~idodptumber or a liaeasod pumper vaifycag that (1) fire oa-aitc ~vutewaterditposal system
is hs proper operating condition andlor (2) aRer iaspodioa nerd pamping.~if noccssary). the scptiatadc is less than 113 .~ of sludge.
Uwe„ the bzre ncad the above :,ogairemcats nerd agave m >u~ia the pcivatc sewage disposai sysbcat with the staadacds
tet forth, hct'eia. as aft by flu Deptrtzncat of Commerce nerd the Dot of 2latutal Resources; State of Wisconsin. Cectificatioa
stating that your tysLeea has boea tnaiatained must be ccxapi,dcd nerd tttamcd to the SL t~oix t;ouaty Zoning Office witbin 30
drys of the abuse year eapintioa date.
SiGNA7URE OF APPLICANT
~-
DATE
O'R'1~ER CE~T~CA'1'I;OrI
I (wee) certify ttatemeats on this fozm are true to the best of my (oux) Imowledge. I (we) am (arc) the oavnct(s) of
the , by vittae of a warranty deed rorordcd in register of Deeds Office.
SI APPI:ICANT DACE .
..«.•s Any ioforniitioa that it xnis edmay resuit in the sanitary permit being revoked by die Zoning Dep~~L `• •`•~
" Iacludo with this application: a w wairaaty docd from the Register of Deeds ot1'ict
a copy of the certified ssuvey map if reference is made is the warranty decd
J 1 t..KVtA l..V Ulu i !
SEPTIC TANK MAINTENANCE AGP,EEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owncr/IIuyer
Mailing Address
Property Address
~6 McA~~s
(Verification required from Planning Department for new
Gyty/S~u ~ ~ Parcel Identification Ntunbcr 0 2U ~ / 3 ~ S- / S
LFGAL DESCRIP'li'liON
Property Location ~~ `/~,~~ `/•, Scc..~,~ T~N-R1~W, Town of ~~~56./J
Subdivision ' l ~i~i~~" /~ ~~ .Lot #
Certified Sarvey Map # , Voltrtnc . Page #
FYarranty Deed # co 'y~GO ~ .Volume ,~dc Gy • Page # -~~--~-•
Spot ~nnse O ycs~no
I.ot Lines identifiab[e~'ycs D no
SYSTEM MAINZ'ENANG'E
. Im~+oper use snd tnamtaaance of Your septic rystem could crsult is its prc~tazfat~n:+e to handle wssLcs. Proper
camsists of pam>piag oat the septic tank every tfa,x y~ or sooner; if needed by a lioeased pamper. What you put into the system .
eaa afi'ed ~e fiau~on of the eeptie tank as a tc+eatatrst stage is !hc ~vasCe dLV<~i system.
The property away tgrees to submit to St Croix Zoning Dcpartmcat : artificativa fotm. si~od by the owau and b'Y a
~~ joaazcycnsuphm>bez; r~tcidodptuaiba or a li,aasod pumper unifying that (ij the oa-site wssteFntcsdisposzt system
is is pc+oper operating condition atsd/or (Z) after iaspodioa and paaipiag.Cif necessary), the scptic~tank is less than i/3 .~ of sludge.
Utive„ the madetsigned lure tad the above toquicrmeats and ag~et m maiat:ia titre private sewage disposal system with the staadacds
ett facto, hatia, as set by tlu Depattcaemt of Comuteree and the Department of Dlatural Resources; Swoe of Wisooasin. Certification
ttatiag tbat year septic sY~ has been cnaiataiacd must be cocnplded and returned to ~e SL C~+oix Cocmty Zoning Office within 30
drys of thrx year expintioa dale. C .
r~ P G~ DATE
SI F APPLICANT '~ 1`' ' - fj0'
OWNER CERTIF)iGA'I70N ~
I (we) etttify statements oa this form an trot to the best of my (our) knowledge. I (we) am (are) the ownc:{s) of
the , by virtue of a warranty decd rtcorded in ~Rcgistcr of L?etds Office.
r --h~"~'.-...~'
SI APPLICANT DATE
s.«.•s ~, iafocmalioa that is tstis ttdtnay crstilt is the sanitary pcttnit being revoked by the Zoning Department. ""`~
•• Include xith this application: a stn wariaaty dtcd from the Register of Deeds office
a copy of tlu certified survey map if reference iA reads in the vrartaaty deed
,.
~`~ , Prtdat® Onslte Wastewater Treatment System Management Plan
Septic Tank And Gravity In~Ground Soli Absorption Component
pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POVVTS~ shalt include information and procedures for maintaiNngdtheepa Yrtment, agein#,
the parameters of Gomm 83 and 84, and the conditions of approval by
ar governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stets. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Cade (9ervicing Septic or Holding Tanks, Pumping Chambers, ~naase
lnteraQptors, Seepage Beds, Seapape Pits, Seepage Trenches, Privies, or Portable
Fiestrooms).
The operating condition of the septic tonic and oukiet biter snail be assessed at least
once every 3 years by inspection. The outlet filter shaA 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. i# the
This management plan complies with Comm 83.54, Wis. Adm, Code, and the In-Ground
Soli Absorption Component Manual far Private Onsite Wastewater Treatment Systems SBD-
1 p5i37-P (R.6/99).
Management PJan for a Septic 1'arK era Sci; Adsorption Comgor~ant
' filter is.e~uippad wish en warm} the filter shell be setvlrad if th® alarm fs activated ~ntis~uausly.
i'ntarmittent filter' alarms may Indira surge flows or ors impending contitluous alarm. The
septfa tank shall t,av~ its contents romoved when the volume of •cum and sludge in the tank
exceeds 113 the liquid voiurtu of the tank. it the contents Of tht tank era not nrnVwved at the
time of an aseatarnent, malnoanance penOnnai >shall advice the owner of when the sbroiee
needs to be patl'ormed to ma#ntsln less Irian maximum scum end sludge accumulation to the
tank,
Manhole rictus, e~ss risers and ocvera should ba inspected ft~r water tlghtnoss and
soundness. aaoass openlnps used for serolca; and assessnSent shall be sealed watertl~ht upon
the completion of aervir~. any openln~ deemed urreaund, det'eottve, or aub~ect to tat#we rnus;
be rsplaced~ ,Exposed ecxasa oprnle~ge grsaterthan 8-lrrehes to dlametir shelf be stcurad by
an ef~eottve ic,~cln~ da~rica ~o prevent accidental or unauthorlated entry Into tie tank.
No one aho~ld ~sntsr a aaptlc ar o>thor tr+eatrnent or hotdhtE bnk for
~rny raaon without tier In lull aompltanae with 08NA s~rni r-or
erstaa~ln~ a oobtlfned tpiee. Th• ~h»aphen w!lhtn the aeptlc or atAer
trMatt ot!< hd~ap~ t:-tk may ~bNn ht-~ha! sea. and rwrcuv o~ +~
pe~eon s In~rlor of ~. a~ nuybt d~~+~ o~ lmpautlbla.
Tank abandonment shall be lrt acaorder~os wtth Comm 33.33, Wis. a1dm. Code when tr-e
tank is ~ kNsger used as a P4WT8 component.
The soli absorption component servinS this structure la dealgned to accopt domestic
w~uttewa#®r from a residentlai faci~ty. The limit: of oparatton of this Cornponettt era shown In
Table ~~
Tim longevity of a edit absorption oornpanent depends greatly on proper and timely
rr~lnleererrae, and system use within or below the ilmtb of roilable aparatlon. C~aod water
conservatlan praattce: by aft oc~cpants and tl~e lruteitrs#ian of water conserving plumbing
fixtures err key faatara #n extendlnS the useful lift of this component.
T'he sail absorption component's opara~an moat be assessed by inspection at iee~st
ones every three years. The Inspec~lon ahail Include ntcprding the levels of pondlrtp, ff any, ~n
the obeervas~iot~ pipet, and a victual tnspeaion idr any evtdenca of surface sa-epage or dssaharg9
frarn the aompor»nt. Qn steepiy:lopinQ slut, areas at e%sior~ should be identll9ed and
reported #o the owner tar repair. The suAas~ dischar'gs of dornestia wet3tewater ar Aswa~e
from the system is prahtblted and canslderod * human health hazard.
Tr~-ftic around or aver the sell ebsarptlon component should be mvadsd partloularly
during' winter rronthe, The compaction or removal of thaw rover crest the component may lead
to hydraulic failure by freezing. This type of failure i* usually temporary, but is dt!'~ault or
lmpossibfe to repair rantil weather Conditions improve, in general, soil compeictlon over this
t~ompOnent wilt rsduco diftutlOn of axYAtn Into the soli and diRpersal call, which may lead to
rrton9 t~sna~e, and earlier, ot+panio clogging of the soil.
3
-, .
.+ ,
iVlsn~ement Peen for a Septic Tank end $ofl Absorption Component
Plantlnps o~ d~eep.rooted ~ ana shrubs dtrsctiy over t# wtthln ten fret cf the component
should be availed Nnos root intrusion lMo the component may oi~vct watt~n
Corrtingency Plsn
In the evarit of systarn faflun, a now system could bs instalir<i in an alternate ant-a. With the
lnatallatlan of s divsrtsr valve, the existing system could also be nosed s1<ter a Period of three to
ro~ yar:.
It fs the property owners responlfbiifty to maintain the alternate area ~_~'+ any Planting of
tna, shrushrufae, etc, haw bMn gtar~tsd on~the •~ ~~arsa~they wlli h*veWto be ~
any trees,
it owners ~•
if aterr-aa era is destroyed, theta en other eiternative systems that can bs used, in which,
could remelt frt rdded e~apu+a to ti*+s property owner.
~nq th r t~,C4e, please ccn~ ycour ilooaa i ~ninq Otl~oe o contact tins ~intallinQypiuen-bsr. ~
c~ {7 iS~ 3~ ~.~ 31 a,1
~t;.~~ ~.k..,~, ~1. v~,er,1a ~ s.+
' ~~.
~~ ~ 1GG2P~~289
• ~ 64$6.04
Document Numbce KATHLEEN H. WALSH
DavmentTStla REGISTER OF DEEDS
~,~ar rti-~~ ~cce~ S'T. CkOIX CO., WI
RECEIVED fDR RECOkD
.. ~
:
~ 46-18-2001 12:5 PM
1
, . , WAkkANTY DEED
- EXEMPT q
CERT COPY FEE:
COPY FEE:
TRANSfEk FEE: 9900.00
RECOkDING FEE: 1.00
GAGES: 3
Recording Acee
Name and RtWarn Addrev
L..a,.l T ~ -F 1<, Inc. .
igoo S'~lvcr Le.k~ Zoe.d
Nc~,.~ 13rJ~~n ~ MN SS/lZ
dZ0- 1D69'- 70 -ooc~
Pared rdm Nm~ OPII~
C~ZU-(c~bY-Ito-~vo
O Z n ~ 1465 - ~JD - vw
~ Zv - ! D70 - coo - ~,x}0
020- 1070 .,iv'-c~t~
U 2c~ -) 0 7f~ - Zo -~
aZo -
"THIS PAGE IS PART OF THIS LEGAL DOCOl~NN'T - DO NOT REMOVE^
T'hIr io[orwtiaa mtua bo coonplctad 6y aubmirtac: doctanou aGl
ar the irmuGg elaerer, kgal deser{pdon, e+F be - mm~c & norm addntr and e{N (6/ n4'dred}. Od~cr jtyforn~afion rueh
mar placed on A/tr}&yt Pate R/dre dona~enr or
dacrarwiL ntc• Vte of tlJt cwtrPuic addr one pair w roof drxranart mtd F2 Q7 W du rrto ~ 6c placed on adddaw! paler oJdc
~, ee Nucronrin Sraoaes, J9.JI7. W1lDA 71A6
'' DOCUMENT NO.
wexnnNTy Delan
--
STATE OF WISCONSIN-FORM B
1
~(+ 1662r,,~= TNtta ~IAGE ptCOERVEO FOR pgCORO1N0 DATA
THIS INDENTfJRE, Made bY,RICHARD N. PEARSON and JEAN M.
PEARSON, husband and Wife, .............................. ••--..........................
grantor. 5.. of..._St. Croix Countp Wisconsin,
h~rebY conveys and warFants to..._~~??IA~ HOMES XXI INC. , a
Minnesota corporation, ...............................!
Wasfi>n ton
n T /
Q._~. pollar.-.and _ no/I00 _.01._00).• and otherood~an~orvaluable f i
,RETURN TO L L\ ti-'(:~ l l T
GQF).S141eF~tion........... 7Sfi1:1f/~13 /~lC`c Srl~~t~~ L<tl(rl~c.P.
5f 1vc
the following tract of land in.....$t.._,_~roi,lc..-•--••_. ••-.•.• County, ~ s // L
Wisconsin: .A~..i,..Q~...khe„)VO;i;hwe$,~__Q~arter_-,jNWa • and- -- r h Half. (N~) of the Southwest
Quarter S ~- ~°~•---°
( W;a) of Section Twenty Five (25), Township Twenty-Nine (29) North, Range
Nineteen (19) West, St. Croix County, Wisconsin, except Lot One of Certified Survey
Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. Croix County Register
of Deeds, as Document No. 518994.
See Attached Exhibit A
Parcel Identification Number
This is not homestead property
In Witness Whereof the said grantor..`-- have...... hereunto set......... their
... .......... day of... ~aY....- ....................- - ..., A. D., Y~C-2.QOl
BIDN7$D AND SEALED 3N PRESENCE O['
hand 5... and seals.... this
...................................... •-----.. (SEAL )
~- __
~_
I .............................................................................................. (SEAL)
n
Stta~te of bta
t
,,,,.,-_Wdsnng
On-. ....County. Personally came before me, this.7~'.~`. day of.. ~.':.~?....... .
01
......, A. D.
t~..~9
the above named -.RICHARD -N,_, ,
,
EARSO[V-.and JEAN..M. PERRSON husband and wife,
to me known to be the persons-... who executed the foregoing instrument and acknowledged the same.
THfe INSTRUMENT Aa DRAFTED AY
Richard J. Ga~riel, 03286 ati• .. _ ......................
.- .kAJ3F~Y~v10UNTAIN
4 ~--
N~wyT Notary Public
~:~' NOTARYPUBUC :MINNESOTA Co
nt
Vi
`
880 Sibley Memorial Hwy., , .
u
y,
r
s.
#114 M
ExpfresJan
31
2005
Camm
PAPndeira Flei:ght:s-, F~J ~5d-4-8 .
,
.
y
-1736 1,iy commission (eyl ' ..........................................:.........................
t5eEt10n Sp.SI p) of the Miscoruin
the names of the ~>nton, grantor, StaNtu provides that all Instruments to be recorded shall have plainlT printed or typ<wsiKen thereon
witnesses and nobry. Section 39•)33 similarly requires that the name of the person who
or
ovem•
mental agent' whah, drafted such ,
g
instrvmenq shall IK printed, typewritten, stamped or written thereon in a 1<giLl< manner,)
WARRANTY DEED STATE OF WISCONSIN wlxonaln Lcgnt Blenk Oomoan7
FOIU[ No. 8 Milwaukee, Wle, (lob 3Jg 11 3
v~~ .1fi62Pa~>~ 291
EXHIBIT A
Parcel Identification Numbers
020-1069-70-000
020-1069-80-000
020-1069-90-000
020-1070-00-000
020-1070-10-000
020-1070-20-000
- ` ' • • ,,,,. MillerlDavis Co. ° St. Paul, MN 651-642.1988
117-M-Co ration Minnesota Uniform Conve~~ancuig Blanks (19'18) __....- -.
. rpo _.. _ _ . _.
- ~ STATE OF MINNESOTA Ss. Affidavit Regarding Corporation
COUNTY OF _ _ _ ._ _ __ _ _ _ _._ __.._... _.
and _....._..____-...---...
being first duly sworn, on oath says(s) that: .and the
_ . __
1. ('They are) (__ he is) the - -- ------ -- - ---------- - --_
respectively, of _ _ -- Carriage_Homes.XXL.Inc,.. -- ---_----------------
--- - -
_Milllle ota __-_-_-__ _-_.-_ corporation, the corporation
a ___--- __._ ___ --
named as ------ -- - - . _ - ----- -- - -- - -------- - _..._. ------
in the document dated _._ - , and filed for record -- ----- - ~----
as Document No. (or in Book -__.__-- of -------------- ---- .-.----_
--
- ----
Page _____________. _ _.) in the Office of the (County Recorder)
of __- . _ _ St. Croix__ .- _- _. __ _ County, ,Minnesota.
__ '
_--- -
2. Said corporation's principal place of business is at _ _- - - - ------------- -~ ----•-~-------'---'-----
and said corporation's previous principal place(s) of business during the past ten years (has) (have) been at:
3. There have been no:
a. Bankruptcy or dissolution proceedings involving paid corporation during the time said corporation has ha
any interest in the premises described in the above document ("Premises");
b. Unsatisfied judgments of record against said corporation nor any actions pending in any courts which
affect the Premises;
c. Tax liens filed against said corporation; except as herein stated:
4. Any bankruptcy or dissolution proceedings of record against corporations with the same or similar names,
ding the time period in which the above named corporation had any interest in the Premises, are not against
the above named corporation.
5. Any judgments or tax liens of record against corporations with the same or similar names are not against the
above named corporation.
6. There has been no labor or materials furnished to the Premises for which payment has not been made.
7. There are no unrecorded contracts, leases, easements or other agreements or interests relating to the Premises
except as stated herein:
8. There are no persons in possession of any portion of the Premises other than pursuant to a recorded document
except as stated herein:
l
i ~
encroachments or boundary tine questions affecting the Premises for which Affiant(s) ~
9. There are no ~
(has) (have) knowledge. '
ants know(s) the matters herein stated are true and make(s) this Affidavit for the purpose of inducing the ~
Affi ( )
passing of title to the Premises.
~~. ~.
~!~c~ 7 .ir ~- ~
Carriage_Homes. ' ~/ --- ... _._.. _.. _.. -_.._... _ _ _ .._
.
I
,, o.._. _..__
~-n ~ Q~-,..cam
Subscri ~d sworn to before me this _ . _. _... __ .
day of ~ / ~' u__ ~ . _ _ .2001..
_ . - cv~>
~~:: ~ ~ •' ~ DOCUMENT NQ. / _ ~,(J / _O
• ~ i; - ~ r
1 . s..~_.. ..
?HIS INDENTCJRE, Madc b RICHARD N. PEARSON and JEAN M. l
.... .... ....................................................
pF,ARSON, husband and ife,
grantor. S.. of....st _.. Croix ..............................•------...................County, Wlsconsin,
h~reb conveys and war ants to....~!~?IAGE HOMES XXI , IN_C. ~ a
Minn~sota~ oor~oration ~ .................................................................~-~^... _.......,
.._........_...._......_.........._ ................. ................................................................ I
. ................._.._.---.............................._........_........_.....................................ralitee....~... of II
~'as~ing~on County, ~i~~~i2i~ or the sum of
pcT~_~q~i,~~r-.-and,•no1100__..(~1:00)...and_.other,._good..and...valuable••• RET~AN
SS~ILg~~~7.52~ ............................................................................................................ -
.... _...._.__...._.......__..~ .............................. .............................................................I;_
.....
the following tract of land in....~t.:...C~41~ ................................................County,
Wisconsin : .A~.1..0.~...kh~...N9K.kh!~?~5.~..QUs~.~t4.~...(.N!~l~~Z,..and...~lor$h..j:(alf (N~)
Quarter (SW~) of Section 'Twenty-Five (25), Township Twenty-Nine
Nineteen (19) West, St. Croix County, Wisconsin, except IAt One
Map filed June 29, 1994, recorded in Volume 10, Page 2782, St. C
of Deeds, as' Document No. 518444.
WAItILADiTY DICIDD
BTATC OF WISCONSIN--PORM 0
7HIY frACt RLiLRVtO 1'Oq RLCORDINO DATA
ro
of the Southwest
(29) North, Range
of Certified Survey
roix County Register
s ve their,,,-.._.._. hands... and seals.... this
In Witness Whereof the said grantor...... ha.......... hereunto set:......_.....
.. ...... day of... ~aY ........................................ A. D., Y~C..2QD~
- ....
......._......_. ,(SEAL
BICiN~D AND a10Ar.ED JN I'REBSNCrS OF
..........(SEAL)
ti,
............................................................
M':.. t501V
.......................................................................................... f (SEAL)
to
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