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HomeMy WebLinkAbout020-1395-28-000Wisconsin Depar{~nent of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1){m)J. Permit Holder's Name: City Village X Township Carria a Homes Inc. Hudson Townshi CST BM Elev: Insp. BM Elev: r BM Description: ~ ~~ IoZ- 3a v>~ TANK INFORMATION u TYPE MANUFACTURER CAPACITY Septic (,JG ~ 2 Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 1 So r (' ~ \ 2 3 / _._-~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Model Number Loss (System Head / ITDH Ft Forcemain Length Dia. ist SOIL ABSORPTION SYSTEM Z$' BED/TRENCH Width I Length No. Of Trenches DIMENSIONS 3 g~~-t n ~L\„ SETBACK SYSTEM TO ~~,~, /L BLDG INFORMATION Type Of System: (u ~ ~ Y~ lS+ ~ l9 ELEVfaITION DATA County: $t. CrOIX Sanitary Permit No: 408273 0 State Plan ID No: Parcel Tax No: 020-1395-28-000 STATION BS HI FS ELEV. Benchm k ~ e l ~~ B~ l oz. 3v Alt. BM ~~ Bldg. Sewer ~~~5 r lob •~ SUHt Inlet -$5 os'.3o~ SUHt Outlet ~.a ~pS',~pr Dt Inlet Dt Bottom Header/Man. ~`f~3n .8,,s~ Dist. P' e pp S C~a~ G~ t • 30 t .3C ~~~r Sot. System t '-~6p .~~~ r S qq.o Final Grade - - st Cover ~, 30 10 (Q .$S.. r PIT DIMENSIONS INo. Of Pits (Inside Dia. CHAMBER OR 17iDd•~"k3el3 UNIT Model Number: ~i 1 l •~ ,~-~.~~ DISTRIBUTION SYSTEM( (~') ~~ij~~ /Y-r~e,u~~ _ Header/Manifold . r t, `" Distribution Pip s) x Hole Size x Hole Spacing Vent to Air Intake t ( Length Dia Lengt Dia Spacing ^' (~.~ SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Ed es g To soil p ~ Yes !~ No ~ Yes [] No CQ`MIV~EN~ ~(I ,~du co discrepencies, person r sent, etc.) Inspection #1: ~ ~ / Z~/ oZ Location: 846 Highlander Drive Hudso~n_, W[I~ ,,54,,016 (SW 1/4 NW 1l4 25 T29N R19W) Scenic Hills Lot 28 r~- 1.) Alt BM Description = u~ S -~~ ~"`~""'" C~"'~' ~~ ~~ ~~~ ~- ~" - 2.) Bldg sewer length = 3a - amount of cover = Inspection #2: ---f--~-~'~ Parcel No: 25.29.19.2422 Plan revision Required? ~'~ Yes .No i ~ Z 2~p2 I ~ ~ I I~! -( ~~ ( ~- ~ T Use other side for additional information. ~ ~ i _____.~ ___ _ _ _ _ ! _ _ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~ ~ ~ 20l w. wasltuteton Ave., r.o. sox ~I62 `~s~~~s~'~ , wI 53707 - 7162 Sine A~ress -.t~ ~ `- r~~~ De artmeni of Commerce a7 OZ 3.SS3 D {O l/ ~ Sanitary Permit Application ~~' Petmn NgumbeZr 77 Z 3 In accord with Comm 83.21. wis. Adm. Code. peraoml information you provide 7 " ~ CheCk ~ ton mz be used for Pri Law, si5. 1 m b I D N ! I. AppiicaNon Information -Please Print All Information RECEIVED er }n . . um p _ __~~-~_~~-,~.~~~:__ PtopeRy Owner's Name J _ ~ Nuesber / ~`'! S Properly Owner's Mailing Addr/ess/ ~ ,, f ~ ~ / / CROIX COUNTY ST Lotion p't ~ O c~+Cil-d'r4/ p ~`~-! G 7` C . pit /~+~A• S T ~ R ~ City. Smoe Zip Cade Number Block Number ~ ~~ ~ 'J N b er um Subdivistoa Name CSM II. Type of Budding (check all that apply) '~~,I ~ " C7City S ~ S~ ~.1 or 2 Family Dwelling -Number of Bedrooms ti ~~ O Public/Commercial - Describe use - Imo' 'o ~ State Owned Nearest Raad K ( ~.~ /N III. Type of Permit: (Check Daly one box oa line A (numbering schmu for internal use). Complete line B i<ap ) A, 1 Q~New 2 ^ Rephwemeut System 3 ^ Replacement of 6 ~ Addition to For C°unt7 use stem Tank aoem B. ^ Check if Saainry Permit Pmviousiy Issued ~~ Number Date Issued t ~ ~( a+`/ IV. Type of Permit: (Check all that apply)(numbering scheme is for internal ase) d 44 Non -Pcesairized in-Ground 21~ Moues 47 ~ Saud Filler SO ~ Conatrucoed wetland 22 ^ PresAtrized In-Grottnd 41 ~ Holding Tank 48 ~ Single Pass 51 ~ Drip Line ~ ~ ~ - ` ` , ~G 4S ~ At-Grade 46 ~ Aerobic Treatment Unit 49 ~ Rec" 30 ~ 0~6er V. t Area Information: ~ lr ` o ~ ~,- - ~ Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Race Fiord Grade Proposed Raoe(Gals./Days/Sq.Ft.) (Min.Mch) Q4, Elevation Require d ( ~ ~~C/ ~t/ ~ ~ ~ - ~ ~U~ VI. Tank Info Capacity in Total Number Mamtfacturer Prefab Site Steel Fiber Ptasl Gallons Galioas of T'attka Concreoe Construcoed Glass Nero Fin{ Taakt rants Septic oc Hoidi4s Tank _ ~ ~~ (i~,-.C e s (~" !' Chsa~ber VII. Responsibility Statement- I, the tmdetsigned, asst®e rYapo~biuty for lnstauatier- of the POWTS shown on the attached plans. Plumber's Name (P/ri~nt) Pltmber's S' MP/I~RS Number Business Phtnte Number Phtmber's Address (Street, City, State, Zip Code) ~~ // VIII. Coup /De ent Use Dal Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issual Issuing Agent Signaau'e (No Stamp Surcharge Fee ^ Owner Given Itntiai Adverse ,L•7~~~ De _ IR.CC_o,~nditions of Appr easons for Disapp~ ovnal n ,, n ~ t~~ ~ ,~,.,,s, ~~r s ~S S~ ~ a -+~eerr ~'a't~oQa.~t~. o~d~ ~~~'0r`~ C~~,, ewwt C s~2 t ~ ~'~ ~'" '" ~ .~. .e . t~ . C~- ~`t' ~' ~ ~~~w~osz ~, -b e r~sK- l~o ~`~"~' ~ ~ c . ~ 83 "~) 11 //~ ~ ~ ,/(,. ~.~ _ ~ ///,~~~~~~ ~//~ ~//~<~/,//Q / < ~ /gyp II__..wr.. un~ u~1/A~ Pldvw / YAal_7LI CAA. ~r~~ .I~J[1(iC~1/M~ T~I~TV ~/i ~\ aK-u~ ---- - - - - - (~- ,~ ' - - - - - - in I laC~lE/ la iii! L =..~ .~. ' '6 ~~ .~ ~ I U . y~ ~/ .( ~// .....r. ~ -- ~ • ~~ ~~ 1 '. .. ~~ ~~ 1 ~1 ~o ~ t ~ 1 ~1 _._.....r-• ..mss ~. ~'~ I • ~'~~~ ..~ ~~ ~ ~ ~ ~J ~. ~~ ~'°~ ~7A ar .. , IQQ1. _ •f S.~ ~ ~ ~© ~ ~p 1 - 1017. 5c. i ~,~. i i _.»' ~;~: ~ ~ ~tb ~~ r '~ d ~ ~ ~ r • - ~ ~ .~~ -, ~ J ~ .., ~~ ~.~. ~ - -- _. - _ _ _. 1 ~ ` ~ i / ' ~ I 'I I ~ .• ~ ~ , I. • ~ ` , } li , ` 1, 1 f ' ~o ~ T 1~ _____--. n i aJ~~-~ ~ r ~e • /Q ~~ .~a~ ~ .,~ozt ~ rp t ~ 1017. 5~ ~ ~ ~?`` _ I ; ,',.,' ~ t~l ~ / `*7 ~dr~ ~ , .• ,/ 1' '' . Raw ~~~~ y ~ ~' ViilsCOnsiri-Departrnerit of Commeroe SOlL EVALUATION REPORT Page I of ~ Division of Safeiy and Buildings m aoooraanoe vuim wrnrn ~, vvrs. rpm. t.we ~ Pl m i i 8 /2 11 i h 5 C o c an mu ze. x nc es n s 1 Attach complete site plan on paper not less than indude, but not limited to: vertical and horizontal reference point ~, d'rection and Pauoei LD. . percent slope, state or dimensions, north arrow, and 1 nd to nearest road- ;'~ Please print all I Win: ; R by Dam . ., Personal information You Provide may be used for ~ law. ~ t~~ (1 j (m)). ~ ~~.._ Properly Owner ~ / , ~- - c.: Piaojie Location . - ~ ~ . .f.~ S ~ 1!4 n.~w1/4 S Z ~ T z.9 N R / 9 E (or~ Property Owr~s Mai~ng Address ~ .~ S7 ~ ~ ppix Lot~iF- Block # Subd. Name or CSMfy . City Stale Zp Code NunFp~G o ^ Ydlage (~ Town Nearest Road _ ~S7'i. L l wa-}~cr Y11 r\.. ~So ~Z ( ~ - . ~ ~•~, n ~. 2d ® New Construction flee: ® Residential / Number of _ ' `{ Code derhred design flow rate DSO llo O l7 GPD ^ Replacement ^ Public w oommerdat - Desabe: Parent material Ov fc,JC~.S (.~ Flood Plain elevation iF applicable /02 I . r~ ft General comments S ~ S ~ ri1 e. ! c v0. f • b ~ - +o~ ? 9 . s0 L o w ~~ y ~. ~ t and recommendations: ~ ~ ~ E, . i ,e.~ a .~.,`c r~ -- .~ (' 9 g Sb t,a wp,~~i ~ . ~c ~ (0 ~ ~ ~ ~ Z roo-~ C Boring # Ground surface elev. oft Depth to limiting factor ~ I ~ in. -:C~ Pit Sod icsrtion Rate Horizon Depth Dominant Cob Redox Description Texture Sirudure Consrsterroe Boundary Roots GP D/f~ . in. Munsep QU. Sz Cont Cobr Gr. Sz. Sh. 'Efi#1 •Eff#2 ' o -i z o ~ ~ 3 - I 2r~~~ b1: ~ c v ~ ~ `~ Z Boring # ^ B0""g ~ ®Pit Ground surface elev. ILXs • `~0 ft Depth to limiting factor l ~ in. soa ~~ Horizon Depth Dominant Cobr Redox n Texture Stnrc~ure Consistence Boundary Roots GP DIff= in. Munseil Qu. Sz. Cont Dolor Gr. Sz. Sh. 'Eff#'1 'Eff#2 I o - i~ i (~ 3 ~ ~ S ~ 2m ~ ~ ~'-~ cis l ~~ ~ . 5 - g Z ~ 0 - ~ ~. f ~ S.c.l Z Cyr ~ _ , y . Co * Effluent #1 = BOD_ > 30 < 220 ma/L and TSS >30 < 1 50 moR. ' FJliuent #2 = BOD. _< 30 mgll. and TSS < 30 mglL CST Name (Please Print) Signature - CST Number l~~ Add V1/~ ~ ~ ~ ~ 2 r v ~ Date Evaluation Conduckd Telephone Number Property Owner l~.r k~ ~ ~ Parcel ID # Page Z of~ Sonng # ^ ~~ ®Pit Ground surface elev. CO 2. ~~ ft. ~p~ ~ Innibng ~~' ~ ~ in• Soil I'x~tion Rate Horizon Depth Dominant Cofer Redox Description Texture Structure Consistance Boundary Raots GPD/if= in. Mansell Qu. Sz. Cunt Color Gr. Sz Sh: 'Eff#1 'Eff#2 Z il- 3~I i ~ ~I ly --, S; ~ 2m5bk m c ~ ~ ~ 3 3`-I- il'1 Ib tilto ~ -=- : mS. ~ ,.,m I - . . - , ~ 1.2 °l`~-S"D ~ v~ d. ~G,~ Bonng # ~ ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor in. ~~ icaGon ~~ rizon H De th Dominant Color Redox Descxiption Texture Struc~uure Consistence Boundary Roots GP Diif o p in. Mansell Qu. Sz Coat Cobr Gr. Sz Sh. 'Eff#1 'Eff#2 ~~ # ^ Borrng ^ Pit Ground surface elev. att. Depth ~ limiting factor in. Soil ication Rate Horizon Depth Dominant Cobr ~ Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Efi#1 'Eff#2 " Efifuent #1 =-BODE > 30 < 220 mg/L and TSS >30 <_ 150 mglL ' Effluent #2 = t3OD3 <_ 30 rrgll-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 (R07/00) r - , PAGE ~ OF,~ NAME I~• Y` ~-e-~ ~ LOT# Z$ LEGAL DESCRIPTIONSw '/aNW'/4,S zS'TL4' N R (9 E (or}~ SCALE: 1"= y0 BM 1 ELEVATION /O U - d ~ o ~ t' BM 1 DESCRIPTION na ~ ( ~ ~ ~( ~~ n C~ Pv,s f -" ~ BM 2 ELEVATION q9~ (o Z i ~ cG Z .S BM 2 DESCRIPTION~a: I~ n N" w o o d Fcn ep- Qas t- SYSTEM ELEVATION ~v Q ~~ • S~GowR~ 9 S ~ s 6 ALTERNATE ELEVATION tvP q`6 •S° ,o w e.~'47 So CONTOUR ELEVATION u ;v u i - ~~ -1-- _~ ~ 14 ~ ~ i i _ __ ~ ___._ _ _ __~~ .~ _..._l-. .. ._ .~__ .__.E.__ _ } ._.~ 1-- - ' . POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of _ . ,. FILE INFORMATION Owner f d ~t.~ Permit # DESIGN PARAMETERS Number of Bedrooms C~ ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~(y al/da Design flow (peak), (Estimated x 1.5) ~j-O al/da Soil Application Rate ~ ~ al/da /ft~ Sta~pd Influent/Effluent Quality Monthly average ` Fats, Oil & Grease IFOG1 530 mg/L Biochemical Oxygen Demand (BOD61 5220 mg/L ^ NA Total Suspended Solids (TSSI 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) S10° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ~NA "Values typical for domestic wastewater and septic tank efflusnt. SYSTEM SPECIFICATIONS Septic Tank Capacity ~a~r/ ~ ^ I Septic Tank Manufacturer ~t [ tom/- ^ f Effluent Filter Manufacturer ~ ,` L ^ P Effluent Filter Model zet,le ` ~Oo ^ f Pump Tank Capacity al ~' Pump Tank Manufacturer '~I Pump Manufacturer ~P Pump Model Pretreatment Unit ^ Sand/Gravel Filter O Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: Dispersal Cell(s) I:~n-Ground (gravity) ^ At-Grade ^ Drip-Line ^ P ^ In-Ground (pressurized) O Mound ^ Other: Other: other: ~ r Other: ~ P MAINTENANCE SCtltUUr_t Service Event Service Frequency Inspect condition of tanklsl At least once every: ^ monthls) (Maximum 3 years) ~ ~ earls) ^ ~ Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume ^ P Inspect dispersal ceII1s) At least once every: ^monthls) (Mavcimum 3 years) year(s) ^ P ^ monthls) ^ p Clean effluent filter At least once every: gear(s) ^ monthls- Inspect pump, pump controls & alarm At least once every: p year(s) ^ monthls- ~.. Flush laterals and pressure test At least once every: ^ year(s) ^ month(s) 19~ f Other: At least once every: ^ year(s- , Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certificatic Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. T inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or le+ measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surf; The dispersal ceII1s1 shall be visua!!y inspected to check the effluent levels in the observation pipes and to check for any pone of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,1 or more of the tank volume, the er contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 1 Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatn 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 focal regulatory authority within 10 days of completion of any service event. ,. GMW 141 Paps of _ START UP AND OPERATION For new construction, prior to use of the POWTS check troatment t~klsl for the presence of painting products or other d>e,nH that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations aro detected have the Conte of the tankla) removed by a septage servicing operator prior 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 wil discharged to the dispersal cellls) in one large dose, overloading the celllsl and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to rests power to the effluent pump or contact a Plumbs or POWTS Maintainer to assist in manually operating the pump control 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 e 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 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; 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 systar 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 ba 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 v 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 comps replacement system: A suitable replacement area has been evaluated and may be util'~zed for the location of a replacement soil absorp~ system. The replacement area should be protected from disturbance and compaction and should not be infringed upor required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems a comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in PON 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 sukable replacement area. Upon failure of the POWTS a soil and evaluation must be performed to locate a suitable replacement area. !f no replacement area is available a holding t 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 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 ~ ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 0 PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~~ Phone '7 . , ?p~-C~/ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name~`~ ", C~OI~C, Ct9tl~.Il1 l tf ~'~`j ~ Phone Phone ~~ - This document was drafted in compliance with chapter Comm 83.221211b111)Idl&If) and 83.5M11, 121 & 131, W~co~ Administrative Code. 1 APR-16-200 07 05 P•~/~ o a ...a~vass wrv •••• ~ • sic r~x n~a~~!-K'c~ ~I~ ~ . wrl~tsHIe c~~tcartox ~o~ . ~c/!-~ ~he ~~ Qw~/13uyor _ L'~rtQ~~E~ ~ ~ k' K .~ _ /N r~iting ~~ 7~0 5' ~~~ /c.~,w.~v l3 /y~ A/p ~o~i <lCc.~c~v ~ ~5'c~~ js~ ~L .Propady A .. {vatifieatiaa:ogNic+ed f~ Plstoaiag ~ tar tuaav coasts<t~Cdoa) `~~~ DaG ~y~r W [ s d_ Pturet Ide~ti~cation Nua~bac _`~ G~~l3Q r =-~..i 4~ ,yam, .~ 02 t2 w town of _~,~,- `" -JG--~ Property Location ~ y., ~ y~, ~ ~ T-~~-H ~-----~ .. .. subdivision ~ C ~` ~ ! ~S Lot # ~~ ._. ~rtffiad. survey Map # _, '~otume ~ -, Page # - . ~ ~2 , P # ~`~'~ 'R~'atrranty Deed # ^.,,~.~ ~ ®~~.;.-_ ,Volume _ ~ ec haEusa C] yes {~. no Lot tines idez~i.f able ~ yc~ ©no t-se aad maiai~ea~suaaf year septye system cantd resolt is is pcematare faiIum t4 handt,a Psoper ~ wca~siats of p~~t.°~.~.a ~ e~-asy t~ years or . if onnededb7 a Licensed pax. ~ W1~t ~.~ toeLa ~ sn'~ ern iff~t ~a litactiost ai the a tank as a ~ sragc im tlu Rrasto disposal sys6em. T>1a propacty tYwnar agt+oe~ to tatbtott tQ St. t~+nix 7~8 l~tst~t a ~ ~ s~ ~ ~"0 or+wnoe sud tyy a iP~ic~odpl~:mbaars 13~d~~S~{t} ~e a~-ii'larv~ws~c~ostl ~ ~ i~1~ ~ aemdttiao- smd/ae {Z} s~eor boa and pameping C~ Y). ~ matt k las ~ Yl3 ~ at'sI~- slWe, the paderatg~tad have head the drove ~ toad std `o t~ ~atc sewage cYct ~ tiro ~s s±ex fot~ 1 ~ 6d by t~C of CaWmszce ead ttx Dtg~~ of Nasmal R,eaoia+oes. fitabe of Wiio4ll~. ~ fitting tlsat yoar septic tisuc bocn tnatalaiaedsmsst t)a co~+od:adt+cbanud to See $t. Croix t~rsmty ~ ~ioawithia 38 Ap>~CANT DA'Ti# d ~ N ~lcrmants a~n this foam are true to the best of my (oiu3 ~avtlodgG. I {we} stm (ua) the ms{s} of Y (w~c) ~cttfjr the PLO by virtue of a wa~aty did rooocded m l~agic~er of Deeds Qtfice. s /S =o Z >zA'r'B t3F APPI.ICA21T ~,, aw-w. irMr»s ~ j~q,~tioo that is mic-~edmay t~estrlt is the :anitarY Pcimit bGn$ zevokdd by ib~G..oda4$ ~' ++ f¢ctudo wili~ this ap~Itcatioa: a 8tt~rupvd trait'nah- daod from the Rregtstrr of I)eedz office . a copy of tba ctttitf cd sarvCy map if t+eferaaca is ~xda itt rho warrstxly rSeed `AP,R-16-2002 07:05 P.03/05 ' / * ~~ GTA7L OF WI6CQNi1N~POR7r t~ ~ I', ~ ~ ~ . Y@f ~~~~~'~ j~ THfi fwwD[ raciiliViD Fow 11[OO1tDINA owTw I I~ ' _.... .. _ ._ . ~ ~~ i 1"HiS IND13~~, Mad by RICFIARD, N. _ 1?EAR.SON and, ,TEAN. M............ PFARSCIN us nd an w_i ~e , ~ • g,rs.I-tor_s.. of ._ Sr,-. ~•--.__.__ .. ...........•--._._......... ----_,.~....._Coankyq, Wisconsin, ~ hFrcbp convoys cad war ants to:...~:~~~ HOME'S XXI, ILVC. r a :r MirineBOta oorporat~on ~. ........................»............. ...»..._.......... ~~ • • ._.... ___...._......._.~.r ......_.~...__._.-•- -----...__ ................_._...-------- ---...---.........._ ~ II ._ - , . • ~grantce...,..__ of Ij WasSington "~_-_--------._._---•-• ............... Count.» ~cr the Sum Of~l -_....... ......_-.....-..__.__.__..._..__.._._._.._.._.. y, Ong»~l~a~;,~ru~„no1~00 01.00), and other ODC1 and valuable IIAETUAId TO L~ti~ T~~l~ the.following tract of.land in....~~:,...lK~A~4?~........._._ ..............._----...__Count~-, .. 's'~~`/Z Wisconsin: .1'+1~._Qii..~h~..I~S~~~!~ti;?~~k..1241~~~~~.:.i~,..~~i~..N9~SJ~l_.~~~.f (N~) of the Southwest Quarttr (S(am) of Section ~aenty-Five (25) , Township Trrenty~-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 Regfster of Deeds, t~ Document Na. 518444. ...See Attached Exhibit A •~ Parcel Ydentification Number This is not homestead property ,~ ., :~ ;• ~' I . I ~; ;: ;< .' Ia Witness Whtx+ro~the said grstltor. S . ka'Ve ..... hereunto set_......., the lr-----.---.- haad.~ .. and sestl~.... this __._ ..»»..»_»..___. day of.__....X ...............__._.._............, A. D., XiiC..ZQ01 EId7~SA AND e~~T.~rn IN PR1F>I~NC~ OD' ~~ .~..... z l t ' ~gGHLV M k~i~J~v-- 5t~t~ of r~,td ; __,__Was 1 ~tG1~ _ _,County. Ftrsonally came before mc, tbis.~ ~":~` day of :~c .~.. .:.. -.-:, A: D., ~•.:~QOl the above named ..~F?r~~ .N:. ~. di?d~ JEAN ~ • PEAR50N~,' husband and .wife , • to me known to be the persotr4..., who executed the fors8oing instrument uid acknowledged tht samr. , ..~ ; ,, i TF116 tA[BTRUMEPt AS D AFTER Y ~.,.~L-A,F~~MOUNTAtN Richard•3. ~a~ris~, #3264 '-'" ' Ko'reRT Notary Public . ~' J;tQr~RY PUaUC -MiNNES01'A County, Wis. ' 880 Sibley Memorial Hwy. , #114 es"'~ ^~ Myctunm. Expiias.J~-.3+.~ ^1735 My commission (ex _r ........................ ..._.. 1 • ' ~ _-.~-,'.' (SKtlott 79.)1 l1I of the V7iXO0ain Statutes provides that x1l i~+atrummts to be rctwded shall haws plainly printed or t~pavrittM abttttttsn .... _.~- _.-~~ ' IM oxmn o[ the ~7antors, gr+ntoa, witatues Rnd not,ry, Stetion 59•ii'J sitrularl~ rct;uire+ Wat We nxtne o[ the person wbo, oc ~orera. . amW asettq which, drafted such inututneAl, xhall IK printed, typctvnNen, stamped Ot written tlst:reoo in a ItgiWt mfnner.~ WABB.aNi7'Y DffiD STATE OF` WISCONSIN Miiatsuko ~wt`t., 81 ~ T bs~1i~) r^onu xo, o ., . , ... . /. _ ~~I L' -APR-1b-002 07 05 ~ w ~ ~ ~z .~ ~ g CD W . ~ a ... ..: cgaoo aap4o~' o nooccp~~tiC.~..e~ oa~Qa°s ~~~~~~ N ~ ~ O oooce~~' v P.04/05 • 'APR-16-2002 07 05 x ~ •• U ~ J <• 1r ~4 Vfi .LUUtrPIIG~ ~,0~7 • . .. 17oe~eat'Rdta ~a ~ ~-+~~ . .•,,. ~~rr CC P.05/05 p~~V~~ ' KRT'HLEEN H. WpL$H • RE@I57~f~ Of DE~115 5T. CRpIX ~Q.y WT RECEIVED FOR RECORD Ob-(8,2401 12:45 PM uAR~~rm ~ EXEMPT 1 CERT C(ipY FEE: CdPY FEE: TRANSFER FEE: 9900.04 ' RECQRDINO FEE: 14.84' • PAGESa 3 1~toeoeaia~j ke* Name aed Reem~ Addrest ~ goo 7~'~tvz r l..o,,k s ~ i s_ Ft _~_ t.. _ . _ _ _ . ~ ~ 4 ~ ~ V / V 1 r ~~ O' Q ~~~~ }}yy y G~y _ _ **,~~ iiif.0 WN~ ~ . C~ZC7 - 1 46q -~ LSD - v cy p . p 2: o - i d6q ~cjrj _~ dov p, Zn .- '1 p7o ~ cao - CEO 020 ~' t0~'O ~ I c7 •-~7acJ .U2a -- ~o~d~zo~~ "~S PDuGB IS PAB,T OF TSIS LEGaL DOCENT - DO NOT B~OVS" '[llis ioolbemt0on mob. mo~de~ad bjr dQeaa~ tide. ~. ~ +~ and l[L fif K4~~+aD. O~itr p10~' .. d1K _ •roorsr, ~ der~crtrdaw..re..~ap~ i. rlaeo~d.w d~ts,lina pq~s q/ww 1....wre or ~' ~ plaod .R eddYarw+r~rp~a 4 f ~e 1.o.~o1c ~'. tlrs ~dJ+ ewrpe~e od/. wtis ~e w. ~o.ar ledawou dw[;tzao a d~~-dtn;~,~. Wvs+oRri~ 3perre+, srsn. ~N ?~6 TOTAL P.05 0 ., . ~; '.,..: ~~-:--- '~ ~ T ~b O +Ol Z .L.T.THS ~~75 ~I ~~ „~ r ^~~ ~ / \ Y n l+ a ~ \ . ~ 4 ~ g ., ~ ~ - ~ l . ~ ~ ~~ ~,~ ,~ ~. ~ ~~ _ ~~ p ~ Pl '$ ~ 1 ~~ e~ R ~ ` ~N x o_ x q ~~ s ' ~ ~ VY _ ^ ~~ ng a ~ ~~ ~ ~~ ~ ~ N~ w ~ aswss 3.-asaoos a avow ~NNa areou asroooos - .~ ~ aV~H A3NNp t~J @~fli 1~ ~ ~ ~ ~ ~~ ~ ~~ ~ ~ ~ ~ o ~ ~ ~ 3 ~~ i ~~ ~~ ~ ~~~ ~ ~~ ~ ~ a ~ ~ ~~ ~~ ~~~ ~~ ~ ~ ~ ~~~ ~~~ i I . ~ ~R - ~ C ~ = ~ ~ C-- f