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Document Number Document Tide
991330
St. Croix County BETH PABST
REGISTER OF DEEDS
Occupancy Affidavit ST. CROIX CO., WI
RECEIVED FOR RECORD
`JOGS �� 01/10/2014 3:43 PM
Name— (Owner)Typed or printed EXEMPT #:
REC FEE:
being duly sworn,states,under oath,that:
PAGES:: I
1. Helshe is the owner/part owner of the following parcel of land located in St.
Croix County,Wisconsin,recorded in Volume A 4 5Z Page 4,n Z Document
Number 7 41 St.Croix County Register of Deeds Office: Recordinq Area
Name and Return Address
A parcel of land located in the.S vI r/,of the U'A of Section Z'
T_L- —N—R 19, W,Townof St.Croix 83°I N) 14 1-A„J66-4 T4
County,Wisconsin,being duly described as follows(include lot no.and "OSonJ val 5YO110
subdivision/CSM or detailed legal description): C O 4 Z of ,mitt 1414-L5
0Z-V -I 395 . r Z-o0o
Parcel identification Number(PIM)
As owner of the above described property, )acknowledge that the septic syst em serving this residence is sized for a
q bedroom home,or a design flow of j 00 gpd. The design flow is calculated by assuming 150 gpd for 2
individuals per bedroom. There are currently 5 occupants living in this residence; 33 occupants are permitted
based on the design flow. Therefore the septic system serving this residence is code compliant. However,l
occupants,the System will need to be
permitted ,
to exceed the number of P Y�
understand that if there are intentions Pe
fled to accomodate any wastewater flows and/or contaminant loads. i also acknowledge that I will make
mod Y �
this information available to any future parties interested in purchasing this property.
I
Dated this L10'/1C*of
")Ail n /bCfC6Ei�
AUTHENTICATION ACKNOWLEDGMENT
Signatures) STATE OF WISCONSIN )
t,,�rlara���/ 1�•
�, /St.Croix County. )
autheNtcated this day of H,g Personally came before me this day of
thl above nw
c�
9
TITLE: MEMBER STATE BAR OF WISCONSIN ;y . ,Q
• "to�the�rson(s)who the foregoing rot
audxxized by§706.06.Wis.Slats.) ��4 L I C f•' _ 'admowtedge the sa
THIS IN tTIT WAS DRAFTED BY '�jp�► .....••''��
Ar.w arr1% o✓\ �� wfSCO�� ,
Notary public,S e of Wisc onsin
(Signatures may be authenticated or acknowledged. Both are not My Commissio Permanent If not,state exPiradon date
neoassary.) Date.
'THIS PAGE IS PART OF THIS LEGAL DOCUMENT—DO NOT REMOVE"
Ttds kAxmatlon must be compieted by suba0w dow-mot tdte.name A return eddrs&and Il f!l nxp*eW. ovw Jrrforrnation such as the
groa ft dousm bWd description,etc.may be placed on WS first papa of the dommont or may be placed on addNonal pages of the
doarnent. lam; Use of ibis covwpage adds one page to your docre wd end SAW ID the rr90056no fee. v4sconsln Stabile%59.517.
St.Croix County 991330 Page 1 of 1
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL h:IFGIRNPATION (ATTACH TO PERMIT)
Personal information yon provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township
Grande Desi n Hudson Townshi
CST BM Elev: Insp. BM Elev: BM Description:
/0~•U /OVA 8~~/
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic ~e.E~9 yy ~ °~
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL
__~ BLDG. Vent to Air Intake ROAD
Septic /
~~ -) /
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
GPM
Model Num
TDH Lift Frictio System Head TDH Ft
Forcemain h Dia. well
SOIL ABSORPTION SYSTEN
BEDITRENCH Width Lenc
DIMENSIONS 3 ~ ~
J i
SETBACK SYSTEM TO
INFORMATION
Typ~Of System: ~
DISTRIBUTION SYSTEM
~ No. Of
P/L A
ELEVATION DATA
county: St. Croix
Sanitary Permit No:
430023 0
State Plan ID No:
Parcel lax No:
020-1395-62-000
Section(rown/Range/Map No:
25.29.19.10 y
STATION BS HI FS ELEV.
Benchmark ~+ ~ `O~~ ! D~ , ~
Aj~B
Ok
Vl/
• p
4 , 0
Bld~wer ~ f ~• 9~0- p /
/ S
SUHt Inlet
d h 0' ~ ~(v.ad~
SUHt Outlet
Dt Inlet
.~~
Dt Bottom ~
Heade an. ~,~~ qS~
Dist. Pip ~
d o 8,9$' 9(.(.'/
Bot. System ~'3-
Final Grade 3 y
~[k 0 S
St Cover
ov.
3~' g"S' ~ I b~
~ Cvvtn /~ .2 ~ C~
Of Pits I Inside Dia. ILiquid Depth
CHAMBER OR
UNIT
3 I~rr.o~ ~~uSe v
Number: ' ~ ~ ~
~ ~ ~ ~~
Header/ anifold ~
(/ 2
Length D' 7~Dia
~~ Distribution
Pipe(s)
Length ~
~
Dia
~~~1~'
paang ~
/
7 x Hole Size
_„~'- x Hole Spacing
.~~~ Vent to ~r Intak
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
BedlTrench Center Bed/Trench Edges Topsoil ~ Yes ,J No [, i Yes ~j No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ /~ Inspection #2: / !
Location: 839 Highlander Tr/ Hudson, ~W/I/,540~~16 (SW 1/4 NW 1/4 2~T29N R19W) Scenic Hills Lot 2 Parcel No: 25.29.19.
1.) Alt BM Description = s(o~r'h t~0[iv-eC~~~~ ~'~~~ .
2.) Bldg sewer length - ) J ,~Q~~ (~
- amount of cover~~ O~ ® ~~~ ~ 7 ~ .
~ 3'
-- - ~ - _,
i --
~ ~; T ~ - - - - - ----- --- -,,
Plan revision Required? ,Yes No ~ 3 ~G~~~:~~-- ~~%~`~ ~ ~'
Use other side for additional information. ~~ ~ ~ J ~ _ ~ ~ _ .ICI
___--___
SBD-6710 (R.3/97) Date Insepctor's Sig ture Cert. No.
Safety and Buildings Division Cody
' G
201 W. Washington Ave., P.O. Box 7162 .$T
1
I~COn~'In Madison, WI 53707 - 7162 ~ Site Address
Department of Commerce
~ ^~
g3 ~~ D~"~.
Sanitary Permit Application Sanitary Permit Number
~~
In accord with Comm 83.21. Wis. Adm. Cade. personal info Check if Revision ~~ ~
ma be used for ses Priva Law, sl 1
_
I. Application Information -Please Print All Information
tats Plan I.D. Num~r
Property Owner's Name atcel Number
Property Owner's Mailing Address ZONING OFFICE ~PertY Lbcaaon
City, State Zip Code Phone Number Lot Number Block Number
Subdivision Name CSM Number
~i ~
S 1- 7 -G /~
~ ~ -
II. Type of Building (check all that apply) Q ~o.Qi4/ ^City
1 or 2 Family Dwelling -Number of Bedrooms ,.r1~ ^Vt7lage
^ Public/Commercial -Describe Use ~'owtuhip
^ State Owned Z ~ ' ~ `-Q~~ Nearest Road
i G L '-
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A' 1 ~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use
stem Tank Onl stem
B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued
lv. Type of Permit: (Check all that apply)(numbering scheme is for internal use)
44 ~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Coasnvcted Wetland
22 ^ pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line
45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recii:eulating 30 ^ Other
V. D' rsal/Treatment Area Informati on:
Design Flow (gpd) real Area Dispersal Area Soil Application Percolation Race System Elevation F"mat Grade
Required Proposed Rate(Gals./Days/Sq.FK.) (Min./Inch) Elevation /
~ ®® ~ ~ 57, ~ ~, ~ ~ ~~ 9 ~ 9 q'
-
VI. Tank Info Capacity in .Total Number urer
Manufac Prefab Site Steel Fiber plastic
Gallons Gallons of Tanks t
/
?~ _ ~ „ Q'
_ ~ ~
V ~tc~ Concrete Consaucted Glass
New P s
:
(~
Tanks Tanks
I Septic or Holding Tank ~ _ - ~ x
Dosing Chamber
VII. Respons-bi'1ity Statement- I, the undersigned, assume responsibflity for installation of the POWTS shown on the attached pleas.
Plumber's Name (Print) P is Signature /MFRS N her Business Phone Number
Plumber's Address (Street, City, State, Code)
6 - - - .s o
VIII. /De artm Use O
pproved ^ Disapproved ~~Y Permit Fee (includes Groundwater
Surcharge Fee) Date Issued em Signs (No Stamps)
^ Owner Given Initial Adverse ~f
`--" ~ a ~ - ~
/~/ D
G;~yh`
Determination
~ ~j~
IR. Condi~pp~ _ns~or Di~~oval~ 4 ~/G~ ~/Qe;~j,~,. f- ~ /(1~~ /,~~ ~• ~•
:;aate~
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Attach eompkte phma (to the Comp ad7> ror the on poper not ieas ttin u tacha
SBD-6398 (R. OS/Ol)
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Wisconsin Department of Commerce
Division of Safely and Buildings
SOIL EVALUATION REPORT
in acxordance with Comm 85, Wis. Adm. Code
1155
Page 1 of 3
Tom Schmitt
County
Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must St. Croix
irxaude, but not limited to: vertical and horizontal reference point (BM), direction and
D
Parcel I
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. .
.
020- 395-s2-ooo
Please print all information. R ie y Datg
Personal information you provide may s. 15.04 (1} (m)). 3
/f
V
Property Owner Properly Location
Grande Designs Govt Lot SW 1/4 NW1/4 S 25 T 29 N R 19 W
Property Owners Mailing Address MAY 2 2 2003 Lot # Block # Subd. Name or CSM#
781 Crestview Drive So. 62 Scenic Hills
City Stat Zip ~bd6F~db`fa€QirFPrl3~f City Village / Town Nearest Road
Saint Paul ~ M NING OFFICE
Hudson Highlander Trail
/ New Construction Use: y Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial -Describe:
Parent material Outvrash Plain Flood plain elevation,rf applicable na
General comments
and recommendations: Area is suitavle for a conventional sytem w/ a 0,7 gpd.solft rating. possible system elevation for Area I
ranges from 95.4' to 91.3'.
^ Boring # Boring
/ Pit Ground Surface elev. 99.03 tt. Depth to limiting factor 129+ in•
Sal Applir,~ation Rate
Horizon Depth Dominant Color Redox Description Texture Stnxture Consistence Boundary Roots GP D/ft2
in. Muns~) Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-7 10yr3/2 none I 2mgr mfr cs 2f .5 .8
2 7-16 10yr4/4 none scl 2fsbk mfr cw 2f .4 .6
3 16-25 7.5yr4/6 none Icos Osg ml gw 1f .7 1.4
4 25-69 10yr5/4 none cos Osg ml cw ------ .7 1.4
5 -129 Oyc5/6 none ms Osg ml - -- .7 1.2
Boring # Boring
/ Pit Ground Surface elev. 98.94 fl. Depth to limiting factor 131 + in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Stnxture Consistence Boundary Roots GP D/ft'
in. Murtsell Qu. Sz. Cont. Caor Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-12 10yr3/1 none sl 2mgr mfr cs 2f .5 .8
2 12-17 10yr3/4 none sil 2fsbk mfr gw 2f .5 .8
3 17-28 10yr4/4 none sil 2msbk mfr gw 1f .5 .8
4 28- 10yr5/4 none cos Osg mt clnr ----- 1.6
5 53=131 10yr5/6 none ms Osg ml ==__ ____=_ .7 1.2
~~ /r / f
* Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #Z = BODS < 30 mg/L and TSS < 30 mg/L
EST Name (Please Printj Signature: CST Number
Thomas J. Schmitt ~, .+%,~- 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St., New Richmond, WI 54017 5/12/03 715-247-2941
Property Owner Grande Designs Parcel ID #
020-1395-62-000
Page 2 of 3
Boring # Boring
/ Pit Ground Surface elev. 97.29 ft. Depth to limiting factor 121+ in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Stnicture Coruistence Boundary Roots- _ ___
in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef~1 'E
1 0-11 10yr3/1 none I 2fsbk mfr a 2f .5 .8
2 11-18 10yr3/4 none sil 2fsbk mfr gw 2f .5 .8
3 18-32 10yr4/4 none sicl 3fsbk mfr gw 1 f .4 .6
4 32-52 10yr5/4 none cos Osg ml cw ---- .7 1.6
5 52-121 10yr5/6 none ms Osg ml - ------ .7 1.2
^ Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. $a1 Application Rate
-- ---
Horizon Depth Dominanf ColoF Redox Description Texture Stnlcture Consistence Boandary Roots
in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2
^ Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. ~~ gpplication Rate
Horizon Depth Dominant Color Redox Description Texture Stnlcture Consistence Boundary Roots
in. Mansell Qu. Sz. CoM. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
"Effluent #1 = BOD 5> 30 < 220 mg/Land TSS >30 < 150 mg/L ' Effluent #2 = BODS <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
naaA matarial in an altarnatP format nlaaca nnntart tha Aanarfmant at (.f1A_7(.(._21 G1 nr T"i'V (.1152_7(.A_R777
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it
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of y
~~
FILE INF~RNLATI~N '
Owner ~~/~N~F ~ES'/~/1l -CRRRiAG-~ f}drt43
Permit # - ~ ~ L~. ~-3-
n~mn_~~ ownwueTeoe
Number of Bedrooms ^ NA
Number of Public Facility Units ~f NA
Estimated flow )average) allda
Design flow (peak), (Estimated x 1.5) al/da
Soil Application Rate al/da /ft2
Standard Influent/Effluent Quality Monthly average '
Fats, Oil & Grease (FOG) 530 mg/L
Biochemical Oxygen Demand (RODS) 5220 mg/L ^ NA
Total Suspended Solids (TSS) 5150 mg/L
Pretreated Effluent Quality Monthly average
Biochemical Oxygen Demand (RODS) 530 mg/L
Total Suspended Solids (TSS) <_30 mg/L ^ NA
Fecal Coliform (geometric mean) 510° cfu 100m1
Maximum Effluent Particle Size Ye in dia. ^ NA
Other - ^ NA
'Values typical for domestic wastewater and septic tank effluent.
~vereu ~O~rIFIr_eT1ANS
Septic Tank Capacity - al ^ NA
Septic Tank Manufacturer - - ~ ^ NA
Effluent Filter Manufacturer - O NA
Effluent Filter Model ^ NA
Pump Tank Capacity al I~ NA
Pump Tank Manufacturer 181' NA
Pump Manufacturer ~ NA
Pump Model ~ 10' NA
Pretreatment Unit
^ Sand/Gravel Filter
^ Mechanical Aeration
In action
^ Peat Filter
^ Wetland
^ Other: ~ NA
Dispersal Celllsl
In-Ground (gravity)
^ Drip-Line ^ NA
^ In-Ground (pressurized)
^ Mound
^ Other:
other: ®NA
Other: ~ NA
Other: B' NA
MANY 1 CIYAIYGC ,GI'7CVVLC
Service Event Service Frequency
Inspect condition of tankls) At least once every: ~ ~ earl Ils) (Maximum 3 years) ^ NA
Pump out contents of tankls) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA
Inspect dispersal cell(s) At least once every: ~ yea~(sjlsl (Maximum 3 years) ^ NA
Clean effluent fiker
s
~~
At least once every: ^ month(s)
~ yearls) ^ NA
^ monthls) ~ NA
Inspect pump, pump controls & alarm At least once every: ^ year(s)
' ^monthls) ®NA
Flush laterals and pressure test At least once every: ^yearls)
Other:
At least once every: ^monthls)
^yearls) ~ NA
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 tankls) 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
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third IY31 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 2of y
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cellls). If high concentrations are detected have the contents
of the tankls) removed by a septage servicing operator prior to use.
System start up shell 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 celllsl in one large dose, overloading the celllsl 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
replace ent system:
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 replacem nt area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a oldin ank ay b i stalled s last reso t replace the ~ d POWTS.
si e h of e a a d t id tify suita a repla ement rea. Upon ail re of e P a s it site
e lua~ion u t e p rm to to e a suit le placeme ar If no epl eme t ar a is avai able a ho ing tank
infiltrat~ie surface. Reconstructions of such systems must comply with the rules in effect at t
< <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
Name E
Phone _ ' _~~
POWTS MAINTAINER
Name
Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name
Phone
Name ~~ -~
Phone ~ _
This document was dratted in compliance with chapter Comm 83.22(211b11111d1&lf) and 83.54111, 121 & (3), Wisconsin Administrative Code.
ST CROIX COUNTY
SEPTIC TANK MAII~TENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer [ r-/~!-1 Nf> e~ ~c ~i G i-! ~ ~„¢ RR !A/.=~ f~Ol~lc 5~ / iYC _
Mailing Address 7 ~ % ~ ~ C S T ~~~ /i> /~ ~ S , ~A,~ ~~b~~ ~'~ s S /~ ~
Property Address
(Verification
City/State y-~n s~ ~ G~~i~ _ Parcel Identification Number ~~®- / 3 95 - ~~ - Doo
LEGAL DESCRIPTION
property Location •Se~a '/4, ~'/4, Sec. ~ f . T~~.N-RAW, Town of ~/~UOSOn/
Subdivision Sc~lvi~ ~-~i'~~ c .Lot # ~~.
Certified Survey Map # ,~/rPS~'~/ f ,Volume ~ O ..Page # .Z. 7B~
Warranty Deed # % ~y ,Volume / 6G,2 .Page # ~ 8 9
Spec house ~ yes ^ no Lot lines identifiable f8f yes ^ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
~ affect the function of the septic tank as a treatment stage is the waste disposal system,
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
mastorplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as sot by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
d/ajy~s of the three year expiration date.
1L /~ ~'. ~.._~,~~ S I eta/o3
GNATURE F APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the ownez(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
` S /,ZO/ o~
_l
IGNATURE APPLICANT DATE
****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ******
** Include with this 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
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k:ATH!_EEN H. WALSH
iiECzTSTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOk RECORD
Ob-18-2001 12:45 RM
WARRANTY DEED
EXEM~'T H
CERT C0~'Y FEE:
COPY FEE:
TRRNSFER FEE: 9900.00
RECORDING FEE: 14.00 '
PAGES: 3
Recording Area
Ntame and Return Address
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"THIS PAGE IS PART OF THIS LEGAL DOCIIMENT - DO NOT REMOVE"
This information mustbe completed by abmitter. doeunresu title, name & remrrr addrus and P!N (rf regrdredJ. Odur irrformacon such
ar drt jrrsrrtin j daura, legal Qeseripaon, tre. Wrap be placed on this first pace oI r/u docrmrcnt oror gray lx ptaccd on oddiriona! paaa of the
docYarrar. orc: Use of chit rnvrr page adds one paac to your doc:arrcru mrd ~2.t70 ro the retardurt fcc. Wireonrur S•^~~-•, S9.S17. WRD.t ?J5'6
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DOCUMENT NO. -_ it WARILANTY DI;PLD I
• it STATE OF WISCONSIN-FORM 9
.,. C VVV TF/IB SPACE RESERVED FOR RECORDING DATA
RICHARD N . PEARSON and JEAN _ M-.----•----•.-.
THIS INDENTURE Made b ----------------
Y
PEARSON, husband and wife,•--------------•----------........_........_....---..._......--•-----.....---. i.
------...--=-••---••-•--------------------•-----------------....----------------------------------------------------------------------------- ~I
gr~antot. s.. oY..-St. Croix --,--__..--CARRIAGE HOMES XXICoINty, Wiasconsin, ~
h reb conve s and war ants to ...............................................................................
Minn~sota corporation,
---- ----- ~~ii~~nn gg.{~.}}...
-•----- -.,_...-----•--•-----•--•-•--------•--•--------•--------•--•-------•--------------~iAc~~i4H Qrantee-------- °f
Washington t
-----•--•-•---•----•--•----•------•---• ..............•-------••-•---••------.County, or the,, sum of,
One•-Dollar.:-and.-no1100----01.00)-•-and. other.-good--and--valuable.--~~RETUR( TD L~, ~~ s., ~ ~er (:«(~e 12c~-
~onsideration ~ v /
the following tract of land in_.-_St-.-.Croix-_-_----•:-.--•-•-----,- .....County, s"S//2,
Wisconsin: .A1-7~•-of-•the•--Northwest--Quarter-.-~NWA)-.--and--North.-Half (N 2) of the Southwest
Quarter (SWa) 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. 518444.
See Attached Exhibit A
Parcel Identification Number
This is not homestead property
In Witness Whereof the said grantors.. haVe._.-_. hereunto set.___.....their :_ ,hands... and seals.... this
--•---------• .............•- day of... ~al'..:..__..._...._.._....-..-......._._.., A. D., Y~C..20D~
............................................................. (SEAL )
i 6I6NE.D AND SEALED IN PRESENCE OF
,f.~ -. .-. ~. P~A~tS ..... ........................(SEAL)
Q~{/L ~'`.-~ _..._.... (SEAL )
...................................•-•---•--....... ~ M.... SOTV -.............. -----------
CE/I~iC ffi'c ~ ~ ~ ~~ ~ Z
S-
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TE 1/4 OF .THE .Ni~1/4, SE 1/4 OF .THE N~/1/4, -P.ART OF
Nib 1 /4 OF .THE Si~1/~4 .AND .IN .THE NE 1/4 OF THE
TO ~'N OF HUDSON, ST. CROIX CD UNTY, WISCONSIN.
~ EE SHEET 1
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SU R VE
DOUGLAS
S8N LAND
2920 ENLa
HUDSON, ~
PREP
CARRIAGE
6750 STILL
snuwAT~
61 ~1 `~
88,947 SO FT~~~
2.042 ACRES ~~
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Wisconsin Department of Commerce ~ ` SOIL EVALUATION REPORT Page I of
Diu~sain of Safeiy End Buildings
! in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 i/2 x 11 inches Ht s¢e. Plan must
inducts, but not furnited to: vertical and horimntal reference direction and parcel LD.
percent slope, scale or dimensions, north arrow, and ~ d,to nearest road. Q Z d - (3 ~l S'(~ ~- - CY~(~
.~.,,... ~ by Date
,Please print all i n. ~ T '
Personal Mrormatlwr you provide may be used for ,~ Law. r:1 (1) (m)), ~'~''C~/YYL~ I
Property Owner - ~ c~ '`- ~ k (, P Location
~ '~~r ~' ~ ~ GovEL sw 1I4,Vw 1l4 S Z S T Z. °1' N R 19 E (or~
Property Owners Mai~rg Address ~ ~ S~ . _ ~~~~ Lot# Block # Subd. Name or CSMIf
S e ~~
City State Tp Code -~ t3FFl~~ ^ Y~lage ~ Town Nearest Road
<Sti: L L w«-~--~r Yh vl . ~So ~Z. ( i~,~.~~~:.z~- " ~ s Y, ~'~ r,. ~~
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® NewConstruction -Use: ® Residential / Number of - `{ _ Code derived design flaw n3te LSD ~(o O O GPD
^ Replacement ^ PubNc or eommer+dal - Descnbe:
Parent material Oy fcaJ0.S (~. Flood Plain elevation if applicable /~' tt
General comments S S ~..~ rrl e, l e. Ja f .b /~ - ~ P 97 3ev G ° ``' ~'" g'l • FS o ~ ~ ~s~.,~~i
and recommendatwns: ~ U~ e, I ~e-~ a. ~: d >~ - SOP ~1l~ ~ ° ~O~'" ~~f S ~~ ~ -~/-2~t.-~rh~
~ ti.' (T, o
.~i~ S S~irn. ~ D- .Sal ,~
t3oring # 1~1~~11 ~g
r:pr Pit Ground surface elev. ~~ ~ d ft. Depth to limiting factor ~ ~ ~ in. Sort ' n Rafie
Horizon Depth Dominant Cobr Redox Desaiption Texture Structure Consistence Bourxiary Roots GP D/fi?
,
in. Munseil QU. Sz. Cont. Cobr Gr. Sz. Sh. 'Eti#t 'Eff#2
2 I~-~ I~ y -_- iI ~ m~~ cS - , 5 ~ ~
III I~~ rc_fI -_ m~ O` m( - -1 ~. 2
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Z Boring # ~ BoAng
®Pit Ground surfaoeelev. ~O/. 3 d fL Depth to limiting factor / / 3 in. S~ ~~
Horizon Depti~r Dominant Cobr Redox Desaipfion Texture Stnrcture Consistence Boundary Raots GP D/fP
in. Mrxrsell Qu. Sz. Cont. Dolor Gr. Sz. Sh. - 'Eff#1 'E1f#2
r v-~y la ; 31 ~ ~ ~~ ~ s~ 1 ~ ~r,~-,ank ,~-~~- ~s ~f ~r . 5 ~.~
2 / y_~z$ . ~~, c-{ f ~ ~ l 2 r~-,ahl< ~ rY~~ c 5 _ , 5 . ~
-- -
' Etfluerrt #1 = Bt]D > 30 < 220 moll and TSS >30 < 1 50 ma/L ' Effluent #2 = i30D < < 30 mglL and TSS < 30 mglL
CST Name (Please Print) Signature CST Number
e.r 25 ~ 3oq
Address Date Evaluation Conducted Telephone Number
2(~3 -uS-I~. -Sores ~ e;~ ~ 1~ 5'-IC' _ ~-1- o ~l -2'~~-~ac~`
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Property owner 1~-r ~~ l ~ --
Parcel ID #
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Page z of ____~_
Bonn9 # ^ ~~
®Pit Ground surface elev. OG ~~ ft. Depth to limiting factor ' ~ ~~ in. Soil ' n Rate
Horizon Depth Dominant Color Redox Desaiption Textun: Structure Consistence Boundary Roots GPDIff'
in. Munsell Qu. Sz. ~ Cont Color Gr. Sz Sh: `Eff#1 `Eff#2
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^ Pit Ground surface elev. it. Depth to limiting factor in. Sod ication Rate
Horizon De
th Dominant Color Redox Description Texture Struchme Consistence Boundary Roots GP D/tf
p
in. Munsell .
~ Qu. Sz Cont Color Gr. Sz Sh. 'Eff#1 `Eff11`2
Borng # ^ Bormg
^ Pit Ground surface elev. eft .Depth tp limiting factor in.
Sal lication Rate
Horizon Depth Dominant Cobr Redox Desaiptan Texture .Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 `Eff#2
`Effluent #1 =GODS > 30 < 220 mgll and TSS >30 _< 150 mglL ` Effluent #2 =GODS < 30 mglt. 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.
SBD-8330 (807/00)
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NAME 14 r K~-I L LOT# (y Z• LEGAL DESCRIPTIONSw ~~4~1I4~SZST2~i N R 14 E (or)~
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BM I ELEVATION /00. O ~
BM 1 DESCRIPTION o I ~ ~ - fi
BM 2 ELEVATION ~ ~ • ~ S '~ S ~ X / ec _ Z5
BM 2 DESCRIPTION~,~ a -~ ~ ~~ O~Jc. P~'A~ ~
SYSTEM ELEVATION ~P R 3 3 ° Low+c~' 4 ~' ~~
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