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HomeMy WebLinkAbout020-1395-19-000 (3) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420546 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: a Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Carriage Homes Inc. I Hudson Township 020 - 1395 -19 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS Hl FS ELEV. Septic Benchmark 'L 2 I � 2 S �ex () a Dosing Alt. BM v T .�►r /09. Aeration Bldg. Sewer / g , Holding t Inlet , SYl to 7• / TANK SETBACK INFORMATION St/ Ilt Outlet y , TANK TO WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 51 33 / D ottom — Dosing Header /Man. (t l7 6--71 /D�• Aeration Dist. Pip ) �--� TAP Z Yfe !03 . '7'7 Holding Bot. ystem 7 . 4 � Final Grade �� PUMP /SIPHON INFORMATION �' - S/ S' /D 7.2 Manufac rer Demand St Cover. M / 1►�Q1nJ 2 `O /� /r v I Model Num r TDH fiction Loss I Sy Head Ft orcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM / 0 BED/TRENCH Width I Length / _ o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � �� ,, t(/ '1 SETBACK SYSTEM TO P/L C JBLDG WELL LAKE /STREAM LEACHING I anuf u er: INFORMATION CHAMBER OR Ty Of System: / UNIT DISTRIBUTION SYSTEM fS Header /Ma ifyld Distribution _ l� x Hole Size x Hole Spacing Vent to Air Intak h Pipe(s) �� ifs d r Sb I Length Dia Length Dia pacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only I! G 6t1'i. ''�" Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center s' Bed/Trench Edges Topsoil ®Yes No f ] Yes No COMMENTS: (nce code discrepencies persons present, etc.) Inspection #1:/ V lud Inspection #2: Location: 843 Prairie Meado Dr Hudson, WI 54016 (NW 1/4 NW 1/4 25 T29N R19W) Scenic Hills Lot 19 Parcel No: 25.29.19.2413 1.) Alt BM Description = f��(.O�C�►� —�� P.�° lilt 1Q'P4,. L 2.) Bldg sewer length = S-71 - amount of cover = Plan revision Required? ❑ Yes o Use other side for additional information. U SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST, CAM( visconsin Madison, WI 537 Site Address N ent of Commerce _31/0'3zy RFE Sanitary ermit Sanitary Permit Application Number I accor with Comm 83.21. Wis. Adm. Code, personal information yo providi cb,, if Revision may be used for secondary purposes Privacy Law, s15. I ip I. Application Information - Please Print All Information S . Stem P I.D. Number Property Owner's Nam PIRMT?furnber 2q4 3� Kt:Llr- 0 2-0 = 19 — 'D 3;1 6 IA� I - Property Owner's Mailing Address 4" Property Location I& -A Val-A; S Z T2FN, R City, State Zip Code _1 Lot Numb-or Block Number Subdivision Name CSM Number 55 a V,4 11. fype of Building (check all that apply) AAA Ocity A I or 2 Family Dwelling - Number of Bedrooms e L o-, ❑village ❑ Public/commercial - Describe Use JWTownship &YOSOY ❑ State Owned Nearest Road Jg - A- M. T o f p (Ch eclk only one box on line A (numbering Aeme for internal use). Complete line B if applicable) A. I X New � 2 0 Replacement System 3 0 Replacement of 6 11 Addition to For County use system I Tank On]- I Existing System I B 0 Check if Sanitary Permit Previously Issued I Permit Number Date Issued TV. Type of Permit: (Check all that apply)(nt mbering scheme is for internal use 44 KNon -Pressurized In-Ground 21❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Welland 22 ❑ Pressurized In-Ground 41 Holding Tank 48 ❑ Single Pass 51 Drip Line 45 ❑ At-Grade 46 ❑ Ae Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D' e lsaUTreatm e n t Area Information: 1 11 Design Flow (gpd) Dispersal Area Dispersal Area "'Soil Application Percolation Rate " System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation 5 0 6q /0 S Y,_ 3 t# 53, /!t 3 jVA Y or, VI. Tank info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plasti Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank /000 Dosing Chamber V11. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) r P is Signature MZ±9kNum� Business Phone Number ", 9917XI :1;7z -f - 199-_ 6 6 Plumber's Address (Street, City, State, illp Code) SA L I E I/ t2 /&&2 _rR. VIII. epartm t Use only X Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) El Owner Given Initial Adverse 2 Determination EK. Conditions of Approval/Reaso for Disapproval Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 Inches In size SBD-6398 (R. 05101) 3•S 3.� PR, 46F NkAoo cu A A c 3� PROP Pdrpast*O 8 _ /3CARoCN f - - -- 81'4 - - - -- - - - - - /oG V ,8j7 / oP _ / " Lo T 5 gIct _ /DO, a- 1 y - r PACT 0/7 1 oa_ _Z `- P Ut P-1 L 80RE - 9044 -S _ - 'r� � -- // o lGok Jd S ysTCr7 _ cc: /o y.__so n V/I/4GU /NG- /GDrP; !/ `O.Z D152 w 1,ve, z3Y CAR12 i A C- 45 #0/-/ 4ES - e ��� 3 'T'/ .�%._ Lr3 /�'� ���� � =" � l►�I! 5 S. L3 ��,� ;; �0/�1�/1.5'�T Gl�� J. yD� — �, /I /N 3 " D a'N7 PRAIR 6 Nj A ocu R cz PROP - Pitc� � '_ 83 ' 1 .r 3 jerv/2acHy rrrr 1 \ A4r l of -_ / r L o T ST_A/rt- = /Op, 11 r JA PI P E- S DRAW � Nw F'a�, r/- o d � u1o�rG- ��?,tw C, 11a /`I - 5 l Arc 1144 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt County Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R viewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). (I I (3) D L Property Owner Property Location Grande Designs Govt. Lot NW 1/4 NW 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 781 Crestview Drive So. 19 Scenic Hills City State Zip Code Phone Number City Village ✓ Town Nearest Road Saint Paul MN 1 55119 1 Hudson Prairie Meadow Drive ✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd /sgft rating. Possible system elevation for Area I is 104.50' (high trench) 103.0" (low trench) based on a 13% slope. ❑ Boring # Boring ✓ Pit Ground Surface elev. 108.15 ft. Depth to limiting factor >1 14 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 PD/ft2 Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. 1 0-13 10yr312 none I 2fsbk mfr cs 2f .5 .8 2 13 -18 10yr5/3 none sil 2fsbk mfr gw 2f .5 .8 3 18 -29 10yr4/4 none scl 2msbk mfr gw -- - .4 .6 4 29-42 10yr5/4 none grls lmsbk mvfr gw - - - - -- .7 1.2 5 42 -114 10yr5/6 none grls 1 msbk mvfr - - -- - - - - -- .7 1.2 I� -SD Lt3� g ❑Boring # Boring ✓ Pit Ground Surface elev. 108.10 ft. Depth to limiting factor >110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E GPD /ft Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -9 1Qyr3 /1 none sil 2mgr mfr cs 2f .5 .8 2 9 -19 7.5yr4/6 none sicl 2fsbk mfr gw 1f .4 .6 3 19-30 7.5yr4/4 none Is 1 msbk mvfr gi ------ .7 1.2 4 30 -110 10 Y r5/6 none Is 1msbk mvfr - - -- - - - - -- .7 1.2 3.2 9•L * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < mg /L and TSS S mg /L CST Name (Please Print) Signatu < CST Number Thomas J. Schmitt '� 227429 Address Tom Schmitt Date Evacuation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 10/22/02 715- 247 -2941 '14O t 166 1 ` `/,° 1 - _ 1 n TGn,.S `ln !'GVV�dQ �+e S i f kLs Y 781 C r - es ,Dr, 2,- e S . C5 7 /l�c✓1 Ot/�.J � S .1's� 7'���v.� /Q� � ; -,. s Z, o /e W isconsin Department of commerce SOIL EVALUATION REPORT Page 1 of DWion of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must f • C r0 t 1 Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and I distance to nearest road. Please print all 1 n. ` ? Revue by Date Personal information you provide may be used ry purpW (Privacy (spw, .15.04 (1) (m)).. Property Owner .: C., I `,, f' rty Location %. CC.1 Lot N ' 11/4 N W 1/4 S ZS T Z 9 N R 19 E (or)/ Property Owner's Mailing Address CT) JU � 001 t Block # Subd. Name or CSM# �� s����w °�- x -� s e "c- c ity State Zip Code one N city ❑ Village Town Nearest Road di , ZONIt G OFFICE �Srti: l wa cr V11 A.. I CEO 9Z 1 1, 4 j3 4 'Z L) as 0 14 ir, n d ® New Construction Use: 91 Residential I Nttmbe - Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial -. Describe: Parent material OCU fc'ja -s l^ Flood Plain elevation If applicable N ft General comments S y s k Wv e- (C ua0. f .b n - cko - OU and recommendations: (�J a � Y� 9l„ • oU Boring # Boring ❑ © Pit Ground surface elev. Its i • ZO ft Depth to limiting factor in. Sod ication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPQW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Fff#1 'Eff#2 I o - - IO t0 1 '5L Z r0Sbk 2 • 16 - lctt5 I yl ms as C, Yr a Boring # . ❑ Boring ® Pit Ground surface eiev. i Co .['Z ft Depth to limiting factor i Z O in. [Sol Application iFaW Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu.'Sz. Cont Color Gr. Sz. Sh. 'Efr#1 *Eff#2 v-lo lv 13 SC 2m b K cS � `.s $ 2 16 -12 I r C. � n S !� — � � l • Z ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg& and TSS a 30 mg& 1. CST Name (Please Print) S' re CST Nurrber e.r 25 30 Address Data Evaluation Conducted Telephone Number 2113 $ TM 54. SC' er I - _o) -i IS- 247 -yoo8' Property Owner �^ k< < � _ Parcel ID # . Page z of 3 Boring # ❑ Bari Ground surface elev: I Cb .b6 ft. Depth to limiting factor. I l in. it I' Rabe D pit So Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 L 3 — SL 2m 1 m� c S I v - L . S ib v r 1 4 19 i 2 cb k 5 'j F—I Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soll,Appl Rats Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDflf in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Etf#1 'Eff#2 F-I Boring # ❑ Boring ❑ Pit Ground surface elev. ft Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture St uctw'e Consistence Boundary Roots GPD/ff in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. *Efr#1 *Eff#2 ' Effluent #1 BOD > 30 5 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 2648777. SBD4330 (807/00) PAGE 3 OF 3 NAME 14 r k e. L LOT# j q LEGAL DESCRIPTIONA/F ` /4�/`0 /a,SZsTZa ,N R /9 E (o r)(1 SCALE: 1 "= yo l BM 1 ELEVATION I= • O x BM 1 DESCRIPTION •fop a / z pdc BM 2 ELEVATION qY• 96 BM 2 DESCRIPTION - fop o l ; "o uc p e SYSTEM ELEVATION IL O O ALTERNATE ELEVATION a CONTOUR ELEVATION �Y o�, /oo • o , /o i. c P ro ased. d r 0 �o 99•QO � a -L a»+Z rl � oo•o CA \ /0 1.0 a SIGNATURE - ��� DATE .AR ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner �• Septic Tank Capacity 0,00 g al ❑ NA Permit # Se tic Tank nk Manufacturer — — ❑ NA 2D P DESIGN PARAMETERS Effluent Filter Manufacturer L ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A—Zop ❑ NA Number of Public Facility Units 0 NA Pump Tank Capacity a l KNA Estimated flow (average) g al/day Pump Tank Manufacturer J5 NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer Of NA Soil Application Rate 2 gal/day/ft' Pump Model NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit Ja( NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD :530 mg /L %In Ground (gravity) ❑ In Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA other: ❑ NA Other: - ❑ NA Other: ❑ NA r "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: [3 month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: r ❑ month(s) ❑ NA Myearls) ❑ month(s) IKNA Inspect pump, pump controls & alarm At least once every: ❑ yearls) ❑ month(s) 19 NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once ever ❑ month(s) ❑ NA y: ❑ year(s) Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding surface g of effluent on the round The ponding of effluent on the ground surface may indicate a failing condition and requires the 9 P immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third IY or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank( for the presence of painting products or other chemicals that may-impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents ' o of the tank(s) removed by a septage servicing operator prior rior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or•must be taken, to provide a code compliant replacement system: )f A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name S Name — Phone � J Phone ' SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 0 _ Name p Phone I Phone l — (, This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54{1), (2) & (3), Wisconsin Administrative Code. FROM SCHMTT & SONS EXC PHONE NO. : 715 549 6651 Nov. 14 2002 04:05PM P1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREBMBNT AND OWNERSIW CERTIFICATION FORM OwwBuyer Mailing Address / 5,5 -7- s i Al 0, 4AA ,6: E6120 ArA, 5 S lJY� Property Address . 9: IK 3 PkAa- E /Y-aA 0ta i j DIE. (Verification required from Planning Department for new construction aty/State /7 UOSDAl Parcel Identification Number AL RESCRIP'I'ION Yrnporty Legation .&-L/)-' /s, &.a—) %, Sec. � s. T.�,LN R_a—W, Town of A/ Subdivision _ b ar a &/" // Z [,L S Lot # � ce ra ed Sarvey Map # . Volume _ Page # Warranty Deed # - -_- __ , Volume lw . Page # Spec house yes ❑ no Lot lines identifiable PIr'yes ❑ no Z MARUSANCE . Iaprww use and mamtenaaoe of your septic system could result in its premature failure to handle wastes. Proper maintenance oousists of pumping out the septic tank every three years or sooner, if no&dby a licensed pumper. What yon pit into the system can Off" the time inn of the septic tank as a treatment stage in the waste disposal system. The proporiy owner agn= to submit to St. C rom Zoning Department a certification form, signed by the owner and by a miftrphmber. joarnoymanplumbe4 matricted pimber ev a licensed pumps verifying that (1) the ore -sit o waswwater&voul system is in proper operating condition and/or M alter inspection and pumping (if necessary), the septic tank is less than W full of sledge. _- Ifwe„ the - undersigned have read the above re"iremenu and agree 6D maintain the private acwagedispWd system with the standards set fords, leads„ as set by the Dcpar6mcm of Commerce and the Department of Natural Resources, State of Wisconsin. Cestificafm stating that your septic been maintained must be ex mplatcd and returned to the SL Croix County Zoning Office within 30 days of oa date. SY SIPR&Tupja COAPPLICANT DATE OWNER CERTWIC n I (we) certify that a st gents on this form ate ftuc to the best of our know I we am ( am) the owners) of my( ) �g ( ) a ( the abo virtue of y a warranty deed recorded to Register of Deeds Qfiice, SIONAnME OPWPPLICANT DATE «e•• "' Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •' Include with Wls application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed �`; 648604 KATHLEEN H. WALSH Document Number Doatmeat r EGISTER OF DEEDS ST. CROIX CO., WI T�c� RECEIVED FOR RECORD 06 -18 -2001 12:45 PM ;:.. WARRANTY DEED EXEMPT N CERT CORY FEE: COPY FEE: TRANSFER FEE: 9900.00 RECORDING FEE: 14.00' PAGES: 3 Rococding Arta Name and Retam Address ",.L -F1 (e- , I r C- . � qoo 5'� w � r Lek e Zo�d Nc„� 3 t -��kb � MN SSl f z 07- 0 - 106cl - - 70 - 0o cD Pastel Idem6&ation Nmnber (PIN) 0— f(.) - �50 — CIO C) -- O2 0 1 oc,y -cfo - 000 C7 Z — t 0 -2 t7 - 0,0 - DO0 020 - 1070 0 _C "THIS PAGE IS PART OF THIS LEGAL DOCUMENT — DO NOT REMOVE" This informatioa must bo completed by submalucr: docwncnt title. ramie & return address, and PIN (if rcq%dred). odor informadon such as du jrmitits clauses, legal descripnon, ese, may be placed on dais ftw pad, of dtc docuns n; or may be placed on additional pages of dte document. Noce. Use of ddr cover page adds one page to your doetanera and $2.00 to the recor&„r fee. Wisconsin Stanaes, S9.S17. WRDd 2196 000uxxs � J�Tm� | x�^oxu^NrYmnmD � | ^ -- U STATE OrWISCONSIN-FORM o � ������ ����x� !� , � V0L K K �K�' ~ ��[/���U� ` T1410 "~^" °c��. " ,"x ""�"x�°° "^,^ � | ~^^~~°- --^-�� ! "'^" ""��, � | | ` 'rBIS by,.RICBABD.0._ _ and _JEAN .��i��___.��| »« � ` 0�[ ^% ----------''—''-''----'-------'----- / 0� �� ' '----' | --- ~� =° PEARSON, husband ' - gcuuhnr.'�- --_'_------''---_--Couuty. W,ounoin | hqreb conveys and w ants u� ' — C&BRIAGE || MI. ar ;sota corporation, '------'---'---------'-----| !H! ... ...... ... ...... . ..... .. .........'������������'���'�'�.�.����'�����'�� | ______._._.______________.___________ ------'-'-- ruu�c cu / 100 and °~^ | '� f/� �... ..-----------'---' D�I � qgnsideration —'------'''''----'---'''----''-'----�---|�_ / �~ �/ Uzr 6 -----'-__-_-__-_-''''_----_--'-_--'--'---'--'--.'� / � ^^// � r, ��� `,^ �� 1^- following tract { land i �$t� �Kq�� County, / Wisconsin: .A.U.Dt tU�J����b�� �f the Southwest Quarter (SW,) o� �eotion �wenty-�ive (25}, 7\�*oshi� �weotv-0ine (29) North, Range Nineteen (19) West, St' Croix County, Wisconsin, except Lot One of Certified Survey Map filed June 39, 1994, recorded in Volume 10, Page 2783, St. Croix County Register of Deeds, as Dcxzumeot 0o. 518444' 388 Attached Exhibit A Parcel Identification Number ` | / � ! / ! / | � � \ | ` ` ` � ! This is not homestead property . In Witness the said gruutoc.g.' 6aY� .-- hereunto set .-_ i .—.. 6uu6.�- and o,^��.- this -----.—._.'-' Juro{'_B�Y------.--.---., A. D, XK-ZODl - (SEAL) `J 6c ADD .1a IL110 -1 (Iga(I AINVdxves ( [i scc qor) sIM 'aoKnve nlK rIISt107SIA' d0 RJ V, HuvIH 11110, uisuoas1.11 uaiiuroad Rl aluud a,l Ileys 'luawNlsw yms pal)c�p 'y�lyb tiva�c 1eluam 6uvawo0 ( nuuew atyl8a! e w uoalayl ua)1um "o paSwcls P o aweu x welt sa�inbai AI'Tllwis 41S'6S uO103h vql s u pue s s a iniv m •saalu 's111Jo 1) to of Ny1 ulano9 Io 'oy.0 uoc�aJ ayl) I I - uoa�ayl ua17!�^adu so paluud 6lwetd aney Ileys PaPlOaal aq of sluawNlsm Ile leyl sapinoid salnlxlj uisvoxl� xh )o (l1 1S'6S 1 S) - - . - -.- xa) uo�ssnumoa �1Q 98LT ......................... ................... A MH Tei:IOW@W AaTq!S 088 • ue lldx sa. wo w�AW Ztl3s 6TT# 5ooz'�£ ..._. . .. �i19nd1(JEao� auvJON 69828# 'Tatzgp� 'r p��gOig s,M ' Ouno' dlOS3NNIW - Oh90d / dtl10N ;! ,� AH �731dtlua StlM LN3wnki.LSNI SIH.L NiV.LNno " .. ... N G awES aqa pa4pa�MOU��E puE avawn�asu 9uiOJajOj ;)III paanDaxa OqM ---- 5Uosjad aqa aq oa uMou� aw oa - •..-------- .._.......-- • - - -• -- _. -• - .._..... - •- ..••.- ....... pawvu ano9E aq) ........... ................ ............... -. - - - - -- - ---- - - - -- - ----- - --- - -- --- --- - -- ------ - - ---- - -•.--- - - - - -• , a_ TM- q ue puegsn . ' NOS2i eI ' L1 �1F13L' Pue NOSi � [q Q2i`dHOIti � ......... •..._.P.. ... jo E siga 'aw aaojaq awEa AjlvuOSla,I i)uno' UO.4 UT Sem Q 'd ,� i -� 3o la � s . Q m s TOOZ ktkt ( zv3s) ................................... .. ............. ............... �Q �a Vol. 1662 PAG 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 5 SHEETS W,MMAM oTO TM WEST LM OF nE NW114OF SECROH •!� I 1 25,ASSNOTO BEAR S- 13 1 � 1 1 . t � t + l i XIs ° `4� fA •, '\ r � flii i � m P . m � mm amuurmw,MM /M. 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