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HomeMy WebLinkAbout020-1395-72-000 Wisconsin Department 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)]. Permit Holder's Name: City Village X Township Carriage Homes Inc. Hudson Township TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY Septic /~ Dosing n ` I ,lO l Aeration y--`. Holding TANK SETBACK INFORMATION TANK TO P/ dWJI. L i B_L~S.,. Vent Air Intake ROAD Septic ~/ r ~ n f~ /` l~ ~ ~ ing ~~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Nutter TDH Lift 'ction Loss System Head TDH Ft Force ain Length Dt Dist. to well """"''~ St. Croix Sanitary Permit No: 420789 0 State Plan ID No: Parcel Tax No: 020-1395-72-000 SectionlTowNRange/Map No: 25.29.19.2466 STATION BS HI FS ELEV. Benchmark ^ p , N/`J ,- / „ ~~NL ~ I ~ 4 3 r Alt. BM S ~ ~Co :~12- R ~ :s9 BldgSeJ-- 303 ~ ~ `l - ~ SUHt Inlet ~, 3. 92. G S t Outlet . ~ ~ O i / ~ i ~ ?~ 9 2 2~ D nlet ~-- / Dt Bottom /' ~ Header/Man. ~~ f (~~ ~ •~3 ~ -~~ Dist. Pipe ~~ ~, Z ~ ~ 0 Bot. System Z -~ . (os ~~- Final Grade ~._-- ~ s s 3 ~ ~ ~l~- ~ St Cover ~~ ~~ ~ • 0 b• r-d')C - 3 53 c~. c~ ~ I.3 ew SOIL ABSORPTION SYSTEM I ~1~ LQ/6o n ~~- ~-:E!ti.CiG. BED/TRENCH Width ~ ~ t No. Of Trenches Len IT DIMENSIONS ^ No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ [ ~ ~- ~ SETBACK INFORMATION SYSTEM TO P/ LDG WEL LAKE/STREAM LE CHING CHAMBER OR Manu~ur~r: ~n~,~f S.j~ d. Type Of System: / C~~`~~ ~ ~ ~ ~q, ~ Ili / UNIT Model Number: ] Z iy DISTRIBUTION SYSTEM Header/Manifold ~y / N Length V Dia~_ Distribution f y ~ Pipe(s) ~9 cr ~Q ~ / Length ~ I Dia~_~acing~,_ x Hole Size ~~ x Hole Spaci SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over I Depth Over xx Depth of xx Seeded/Sodded Iched Bed/Trench Center ~ ~ Bed/Trench Edges Topsoil L;' Yes ~I No IffIni Yes I ;` No ~V I-' COMMENTS: (Include c e discrepencies, persons present, etc.) Inspection #1:~/ D/~/)~ Inspection #2: / / Location: 746 RegalRidge Hudson, WI 54016 (NE 1/4 SW 1/4 25 T29N R1,9~W~)Sc~en~ic Hlills Lot 72 / `'~ Parcel No: 25.29.19.2466 1.) Alt BM Description = S'r •~ `~~'~ ~ ~~"'~~ ~l^ Qlt2 ~(.~-~j hs ~-~ G<~~ 2.) Bldg sewer length = ~3 / ~+ \ ~ / ~ _ / -amount of cover = ~ `~u~ ~ ~ 1~ (,(~(~ Plan revision Re uired . I Yes No i r Use other side for additional information. i__~ - ~ u I V~__. _-- ----G~ ~~ ~- -- G~y', ~i ~ ~ _ I SBD-6710 (R.3/97) Date insepctor's S' nature Cert. No. ng Vent Air Intake (,, ~- ~ D , visin-~erimentorCornmer+oe' ~ SOIL EVALUATION REE~ORT D/]u~,'"~~ Pegs ! ot~ Divtsior- of satety and Buudings 1 lG m accordance vuifh Comm 85, wrs. Adm. code Attach complete sibs plan on paper rrat lei than 8112 x 11 inches ~ size. Plan must. 5 ~. C O ~' indude, but not limited to: vertic~i and horizontal releserroe pakrt (BAi~, directlon and p~ . peroent slope, scale or dimensions, north arrow, and location snd distance b nearest road. - Please print aH Irrfnrmatiron. by Date jJ F"ersonai hironnadon you Provide may be usedtor~econdary PwPoaes (Privacy Law, s. 16.04 (1j (m)).. ~ O Property Owner .. properly Location . Govt Lot ,(f ~ 1/4,st~~ 1/4 S Z,~'T Z ~- N R J q E (or) Property owners tiA~rg Arid Lot # Block # Subd. Name, or t C,7 ~ L O S~ ~ 1 wa~-I-e r-- vr~,.: 12- S a _. ~ ~ . Clty State Zip . Phone Nun ^. City ^ e f~ Town Nearest Road . ~S'1i 1 L wa.~r YMt v~.. ~5"a ~.z. ( b l ~ . ~l3 4 - Z yl y - u ~' , ~ ~ a( ® New construdion ~ Use: ~ R / Number of bedrooms 3 " `~ code derived design flow tabs LSD l G O O.. GPD ^ Repiaoe~trt ^ PubGc or r~mmerdal -Describe: Parerrrtmateriat DUfc.A?a-~ t~. _ ~P Flood Plain. ~~t~-~~`~-- /~' ft. General canrrrerrts S ~S ~ rrt C.1 ~. V0. f ~b /~ ~ ~ .~ r f Q oc~ . and n3oommendaficns: ~, 1..~ ~ I ~e.~ a'~-; _ ~P 9O~°~ LO "' ~ ~ ~ B~ # t^~1 .. . . r:pr Pit Ground surface elev. q/3o ft. Depth to firrdting fec6or t l l.o in. Soo licg6ion Rate Hor¢on Depth, Dominant Cobr Redax Desaiptbn Texture SWc~ue Consisbenoe Boundary Roots GPD/iP in. Munsiep t;.1U. Sz. Cont. Cobr Gr. Sz Sh. . 'Eff~1 •Eif#2 6 -g lp jy ---- L 5 (m ~ s ~ u ~ - ~ ~.2- Z $-~$ lb r4~ _ m.S S ~S -- .~ I.2 - ~~ I I ~+ ~.- 5 S m ~r c. w . -, 1. 2 Boring ~ ~ ~9 ~ :.' . ®. Pit Ground surface elev. q/ ~a''d ft. Depth m limiting factor / / 0 in.. Horizon .Depth Dom'sumt cob Redox DesaipbOn Texdue ~ . Structure Consetence Boundary in. MunsaO ~ Qu. Sz Cont. Cobr ~ Gr: Sz Sh. .. - ~ Rate Roots GPD/tl? 'EtT#'1 *Etf#2 ' Eftluerrt #1 = BOD > 30 < 220 mglL and TSS ~3p < 1 50 mglt. ' E-f Nuerrt #2 = BOD < 30 mge. and TSS _< 30 mglL CST Name (Please Prlnt) . S pe e.r~ ~ ~--- ~ - ~ CST Number zs-3 3a 9' q ~~ ~ ~d %h .S * • ~(NLa/ S.o-'7" _ U/ l • S ~!1 Z_S- Dab/s Evaluation Conducted !~ '~ ~ ~ Telephone Number 7~.5 ~ Z!~/ 1"'Z ' 67i~ 0 . , '4 Property Gwner ~1.r ~~ ~ Parcel ID # . z ' ~;~ Boring # U Boring .. ~ 2~ in. . . ®Pit Ground surface elev: 9s ~ y {t, Depth to ilitniteg facb~ Shc ration i2ate C b Redcoc Din Texture Structure Consistence Boundary Roots GP DIii? Horizon Depth in. o r Dominant Mansell Qu. Sz Cont. Color ~ Gr. Sz Sh. "Ef8F1 "E~2 ~ v-y Id `f~`f L5 IrY, ,rr,-~ GS... bus .-t:- (-Z. 3 3l0 -tai 1 .~~ 2 _ . _ . . ''~ I - ~ S.. ~ , ~ . 2 s ' .- ' r ,.1 U B°ra'g Boring # ®Pit Ground surface elev.9 ,S d ft. D~th b limiting factor /Z ~ in. Soil. ir~6on mate r l i t C D Redox Despiption Texture Struc~re Consls~roe Boundary Roots GP D/it? Horizon Depth in. o o nan om Mansell . Qu. Sz. Cont Cobr Gr. Sz Sh. 'E~ ~~ 1 ~-~ o ~ ~ ~~ Ii~s ~~ ~s /~~ Z . l~ `~!o '~ ~~... oS /~ ~ ~ %Z' a .Boring # ° . ^ Pit Ground sucfaae elev. R Daptit to lkniGrg far4or' in. Sob ~ cation mate D th t Cob i D Redox Deaatption . ... Teo~ure Strur~ure Consistence Boundary Roots GP DIfI= Horimn ep in. orrr rran MunsaO Qu. Sz. Cont Cobr Gr. Sz Sh. 'Eff#1 " • Etfluant #'1 =- BODe > 30. < 220 rnglL and TSS >30 < 150 mgA. ' Efi'fuent #2 =BODE < 30 rr>gIL arxi_ TSS < 90 mglL The Department of Commerce is gn equal opportunity service provider and employer. If you need~assisiance to access services or need material in an $Itemate format, please contact tithe departmerrt at 608-266-3151 or TTY 608-264-877?. sen.sthm peo~roo~ w PAGE ~ OF_~ NAME ~, y~ k.e.. ~ ~ LOT# ~ ZLEGAL DESCRIPTION,u F `/.c~t,~`/, S 2~I'Zq,N,R la E (or) SCALE: 1"= yd 1 BM 1 ELEVATION /O(~ • o BM 1 DESCRIl'TION y1 a; (~ n a y "O a ~~ BM 2 ELEVATION [OD • ~ Sec . Z~ BM 2 DESCRIPTION via ~' ~ ; n t ~ " r~ a k SYSTEM ELEVATION ~v P q Z • Sy Go w -~- 4 ~.~d _ -l- ._ K ALTERNATE ELEVATION~ot 9Doo c-n~.., ~r $9•a° CONTOURELEVATION R/.off 93. o~ i3~ K .od ~~ ~~ ~ ~av~ a . 6M2 3~t s 83 a a-Z ^ ^ 8 -I SIGNATURE~~ ~ DATE ~ -~ - G ~_ ~-~,3 kl C 2 Safety and Buildings Division County ~ S~ ~ ~ ` 201 W. R/ashington Ave., P.O. Box 7162 t YO ! ~ ~sconsin Madison, WI 53707 - 7162 Site Address De artment of Commerce Sanitary Permit Application Samtary Peraut nmber ~ In accord wilt Comm 83.21, Wis. Adm. Code, perso ortnation you provide ~ ~ ~(~~ ^ Check if Revision ma be used for seco ses Privac w, s I. Application Information - Ptease Print All Informati ~`~~, ~ State Plan I.D. N r Property Owner's Name APR Parcel Number ~ '~ ~ 2v ~ Ca ~~< ~ a ~ s r~ 7a -~~ ~ zo - ~39.~= Property Owner's ' ' Addre/ss ZOCFZC~x CU NT} ~ N~NG Property Location f . Z 1~C6 l~ pFF~ 7:211 Ski ~l flu ~z'Y ~Jd ~ ii .S'~f: S ~J T ~ N, R l g Ciry, State Zip Code Phott Lot Number ~~ Block Number Subdivision Name CSM Number St ` l 7`~s~ ~~S11~2- ~~/- ~ -a Y/ 5~e c ,vii'; , ~/l' II. Type of Building (check all that aPPIY) ^Ciry ' / ~1 or 2 Family Dwelling -Number of Bedrooms ~` ^Village ^ PubliclCornmercial - ~be Use ~1'ownship ~/ , I - / ^ State Owned ~ ~/~~ryLG~t~°~ ~ ~'~ "e ~ Nearest Road 3 ~X ~7 ~ ' . ,.v III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B applicable) '~' 1 New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For Cormty use stem Tank Onl Exis ' stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued .fin 1V. Type of Permit: (Check all that apply)(numbering scheme is for internal use) ~~a-c~r,,,",^ ~ 44~Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ onsttvcted Wetland ~-{~~~.-~ 22 ^ pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line l~S/~ / ~.es~. 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. D' rsal/TSreatment Area Informati on: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Race System Elevation Final Grade / Required / Proposed ~ n r Rate(Gals.iDays/Sq.FtJ (Min./Inch) ~ f~ ~, Elevation VI. 'l'ank Info Capacity in Gallons Total Gallons Number of Tanks Manufacturer ,( / J~ /~ ' ~ ~ Prefab Concrete Site Constructed Steel -Fiber Glass Plastic Ncw Existing ~ ~ ~ (-~ {~ i~~v""""~ / + ~U~ Tanks Tanks Septic or Holding Tank _ / /~iS 0 JG' ~~ ~ ~~ Chattfber (y OQ ~ ~ r VII. Responsibility Statement- I, the undersigned, asstrme responsddility for tion of the POWYS shown on the attached plans. Plumber's Name (Print) Plumber's Signature RS Number Business Phone Number `llrc~n -` 7 ~ /~-3~`G~-31~1 Plumber's Address (Street, Ciry, State, Zip Code) Count /De artment Use Onl Approved ^ Disapproved ~~' Perttrit Fee (includes Groundwater Surcharge Fee) ~ p Date Issued ~ Is ent Signature Stamps) ^ Owner Given Initial Adverse ~a~ ~j , --- / ~ ~ O ~ Determination lX. Conditions of ApprovaUReasons for Disapproval ~ --O f riaE~ut ~ ~L{jTS ~ f ¢es~ ~ y J n ~' v~t'~~Ltr~~• , ',~.,. 'fG'~ ~at/~3 ~~'~ ~' 3 y'~j v i ~r ~ . s ~ - ~ ~ ~3 ~~ ,~~~sz-c, ,,Qa ~' ~ • ~oc AttaEh comprete plans to roe L oWy) ror the em tm paper not teas than aLS x as tncnes m size /~ L'R~~~ ~' ~sf~/ /~ - '~1-~r.~it~/1¢ vim' -,mot , ~ ~ ~-3 '"~. -3t.or- ~ f cd~zo~-~ SBD-6398 (R. OS/Ol) ~~ J ,(~ r i ,. ~ ~ ~~ ~~ ~_ ~~ ~~ . ~ ~~ ~ '`1 ~~ ~\ ~~ -~~~~ ~> v'_ 4 a~°'~' o ~ ~~i ~~', I, y ~~ ._ ~ 4 C~ O. n ~ ~~ ~~~ o. ~ '~ ~ ~ ~" > Q ~1 O ~ 4 ~ 4 , v ~._ u ~~ ~ ~. y~ ~~ ~ ~ c ~~ ~ y ~' ~o ~ ~ ~ ~~ ~~ o ~o ~~ n~ ~~ o. ~ ~" ~ . ~ ~~ a ~= o o auamersiaie Effluent Pump r~, u 3871 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/; maximum. ;--1 • Capacities: up to 55 GPM. ,~ . • Total heads: up to 24 feet. • Discharge size: l'/i NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: ~; maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:l'r'~' NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous . 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor. • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset • Power cord: l0 foot standard length,16/3 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). METERS FEET 10 9 30 0 a w x U a z 0 J Fa- 0 s 7 6 s 4 3 2 1 0 2E 2( 1; 1( 00 lU ZU 3U / 4U / fit! urm G~~9''~R"' 0 2 4 6 8 10 12 m~/h ~,~,~ n/ ^~-' CAPACRY O 1995 Goulds Pumps. Inc. """` ~~ ! ~'~`-' EBecUve May. 1995 83871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATtiBES ^ EP04 Impeller. Thermo- plastic Semi-open design with pump out vanes for mechanical seal protection. ^EP05 Impeller. Thermo- plastic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplas- ticcover with integral handle 'and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• Collodion Standards Ass~iaGon (CSA listed model numbers end in "F"or "AC".) i ; 1 ,.~... ~ ..:,.... ~ ~•~~Y~ ~ ~ i ~ ~ ~ ~ i~ ~~° _ i i _ ""2.5FT".~ 1 ~ ~. ~ -~-- 1 --- ~ - ~ i i _ I ~ ~_ ! ~ ~ ~ i i ~ ~ ~ __ I ~ ' I I~ y r ~~~w ~....~.».:~...,11.~., .~' ;1 ~ ~ i. ~ l~ .. ''{ ~ .~`i ~ I ~ ~ Fti ... J W ~~ .. ~ i ~ ~ ~~i .~'`s i iy''. .`~. ` :. L ? ., . ~ r~ t r 7 . ~, .,`.."'„ ~" C~ VENT P'TPE ~'~ ° ~`RC~M ~GpR, FRE~N ASA Z~1TAiCE 12" M*AI~ ABpVc, GR;,D~' E Y~~~+~a~~' oa FII~~:ShE r~R~L~E o ~+ Y' C ~ RISER •--- ~~ ~ ~ ~: E 1 i N ~ S " MAX . ~`_',~'/~•--'°'°" WA:ER T2Gii: SEALS ~ `"~ ~, _.~"` f ~ A ~PPR4~lSfl c,,.., i...e._.. 'IPE ~' ~ ! R ~ '..~....».., t 1 ~ iL ~..,~... ~~ ~PPROVCB JflIN'f5 WI1`N ~~AROVEa ~rp~ 3' flhtfl sos.ia so;~ ~~ RXSER Ek`T' P£RMS T TED CS~~,Y I F TA.'~ K AxANUFAGT'~r~ER ~iAS APpROVA? - - 5 " ~~r PR a'~ z~D BEADING U ~i~ER TA~tK ~w~G~.r~r ~.b~l.. LiYY r7 SE:'TxC: f DCSE iAN?C MAN~JFACTt,'RER : ~'~~»,r.M '.:ANA! SIZES: SEPTIC o?~ d ~. GAL. DOSE o~ CAL. At,~AR?^~ A1Alv'~~`AG'•TL'PERs , ^L~a,. .~.~` M GD E L 1~U'M$ ER ; .. '~ .d~.,....d.,,.~,_.,. SW S T C N TYPE : ~....~'y„~..,,...~.. ~' r~rr~~,~cTu~E~ : '~ i':C}~Lw JYVi"ifiLe~ e ~ 4 ~ S~'ITCFi TYPE « ""' t KwQ~iRL~A ~iSCNAR.CaE R.>~ E GPM CLtv`CRET£ PAD Nt1M~ER DOSES PER i~AY: ..,...~.:7 _,_ DgSr 'VaLii~1E ZI~C't~D?'NG FLG~~SACK: !~"`~' GAL. CAi~AO ZT'.'. £S : A = ~ .TNC~iES ~ ~„~~,,,~,;SAL . i~~ATNER4~RflC~F ~r',;rtcy~a~r sC~ '~xTh :GND~IT A P FR 0'! rE `I~.NH4%E Curd rye, ~'~ PAItLOCi> 4 ~1r~RNSNG ~,BE~. ......#" P;~v A ~r ___ I L ~ ~ a ,i } GA:~- s T~:GHT ~ `~ ~EA~, 3 ~ ~ E, ..~ B __-_ -TNCI~S- - GAL. C = --INCISE-S=-~ ~ GAS,. PUMP ,G, ALARM k*xRS1VG A.S rER ZLHR 26.Z~' ~'AC VEF~'TyCAL OZFFEkE~vFCE T~E'S~~IEE:~ PiJMP 4F s A.'v'D ~7STRI8?JTTGN PIPE MINIMUM NETG+IAFK SUPPLY PRE r ~' ~~„~,,, FEET Fd7RCEMAIM :~ .mod Fl eipG ~Fi, +FRIOTION PACTflR ~ . T.p:"AL . DYty MIC HEAR FEET ~~ FEET' .~.. ~ pEr tt~E'~Gl,„„ , WIDTH „____. ; DIAMETER ..°--. ,..: ~~_,..._.. 7, i C E i°1 S ?` Nt.` M ~ i~'c : `" ~~....._ EA i E ' .7~' ~i~ ,.~ ,~ , ./8~ Vlfiscor+sin Department of Commerce - SOIL EVALUATION REPORT Page I of Division of Safety and Butldings m aoooraance wrm ~:omm u~, vv~. rwm. t.aae • -- ~ ' 81/2 ' st i Pl 11 i h a ~ c ro ~ an mu es n s e. x nc Attach complete site plan on paper not less than indude, but not limited to: vertical and horaontal reference point (BM), dRec~ion and percent slope, scale or dimensions, north arrow, and Iota ' ~ to nearest road. Parcel LD. D~-v ' /,~ ~5 - 7 a- -CX>t> P/eaae print all f • ~ ! + ' ~ ~~,~ , ate •. by D ~ Personal information you provide may be used for (PrivaaY l.ar/s/~ .04 (1) (m)).. / ~ G~~ ! b C3~ Property OvVner }i •~r, A ° `: ~ ~: is /~ ~° ~ Location ` t GgWI it ( c,~f 1/4 S Z~ T Z 9 N R 1~ E (or) 1/4 r . ./ J , Property Owner's Maikng Address ~ '~ L ~_., Block # Subd Name or CSMI/ City State Zp Code P,,bene . N>y. ^ Ydlage (~ Town Nearest Road <STi. I l w«.~r VYt ~ . ~'SO ~Z (~~(} ~{3 4 -mil ~ ~ ~~ ~, n ,~ ~( v . ® New Construction Use: ® Residenfaii / Number of bedrooms 3 ..- Code derived design flow rate ~Sd ~lo O ~ GPD ^ Replacement ^ Public or commercial -Describer _ Parent material CCU fu?G~_l~_ Flood Piaui elevation if ~pficable ~//~ ft General comments S ~ S ~ rr~ G I C iJaf•b /~ - -foO q2' so . G ~w ~-- q /• So_ and recommendations: ~ _ ~ u, t r ~9 oc~ bb a Pit Ground surface elev. q/3o ft Depth to limiting fador l I ~o in. ~~# ° ~9 _ Sod ir~tion Rate Horizon Depth Dominant Cobr Redox Description Texture Stnrc~uure Consistence Boundary Roots GP DffEt . in. MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eff#2 1 6-~ 10 I~+ L S I m -~- c S ~ v~ - -1 I• Z Z $-~$ t~S r41 _.. m S S cs - -~ I . Z 3 ~ $ ~ I Z. ~-- LS lms 1 cs - .~ I, z - ~~ 1 ~tl~-I• ~S s rv, ~r C w . ~ 1. 2 .~ / Z~ ~~ ~/ ® Pit Ground surface elev. q~ ~'~ ft. Depth to lurriting factor ~ ~ U in. Sou Raba ~~ # ^ ~~ Horizon Depth Dominant Cob Redox Description Texture Stnrc~ure Consistence Boundary Roots GP D/fl? in. Mansell t]u. Sz. Cont. Cobr Gr. Sz Sh. - 'Eff#1 'Eff#2 2 1 , ~~ ~ r ~-{`~ ~- ,,,~ S ~ ,~,~ i - - -I 1 , Z ' EiNuent #1 =130D_ > 30 < 220 mall and TSS >30 < 1 50 mo/l_ ' Effluent #2 = BOD. < 30 mglL and TSS < 30 mglL CST Name (Please Print) S' lure ~ Hlumber ~ 2 f^ Address Dale Evaluation Conduc6ed Telephone Number z~/3 fjo%" s~ .~~.~-~ ~/• s~/aZS G -/- v / ~~s--a~,•~ -yao Property Owner /~.r k~ ~ ~ Paroel ID # page Z °f~ u~ 3 inns # ®Pit Ground surface elev: q~ / U ft. Depth to limita~g factor l 2-~ in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ig in. Mansell Qu. Sz. ~ Cont Color Gr. Sz Sh: *Eff#1 'Etf#2 ~ p -y Id `f ~`~ LS I m r~ -Fr" ~5 I v~- . -l ;r I . z 3 3l0 ~~ I ~ ~~~Z ''---~ ~ _ . ~~- ~ ~J ii y`~ Z _ r ~ U ^ Boring # ~ Boring ^ Pit Ground surface elev. ff. Depth to limiting factor in. ~~ ication Ram on ri H th De Dominant Cobr Redox Description Texture Strud~xe Consistence Boundary Roots GP D/f'r? o z p in. Mansell ~ Qu. Sz. Cont. Cobr Gr. Sz Sh. 'Eff#'I 'Eff#2 Bonng # ^ Bonng - ^ Pit Ground surface elev. ft. .Depth tD limiting factor in. Soil lication Rate Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPD/f't= in. Mansell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#'I 'Eff#2 ' Eftiuent #1 = GODS > 30 _< 220 mglL and TSS >30 <_ 150 mg/l. ` Effluent #2 =GODS < 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 departmerrt at 608-266-3151 or TTY 608-264-8777. SBD.8330 (R07l00) PAGE ~ OF~_ NAME 14 Y` K-e-~ ~ LOT# ~ ZLEGAL DESCRIPTION,U F `/ac1.~`/a,SZ~I'29' N,R -q E (or)® SCALE: 1"= yU w~~~ BM 1 ELEVATION ~On • o _ V~~1 BM 1 DESCRIl'TION VlG1 ~' [ ~ n ~ y ~ O0.- [~ -~ra•~- ~~~"~ BM 2 ELEVATION jUC~ - o ~ ' Sec . ZS' 1/~ v-hL~..~~ BM 2 DESCRIPTION y-a. ,' [ ,' n l o " oak SYSTEM ELEVATION ~aP ~1Z • ~U Goy--v' ~l~.~d _ -}-~ _ ALTERNATE ELEVATION {o e 9D.00 ~. o,., ~ r f5 q• a CONTOUR ELEVATION 9hc ~, 93. o v ~ ~ .oO I ~~ ~ ~ o ~ ~ ~~ 2 ~ ~ ~ ~ ~ ~' ~ _ a_z ;~,' 2 .... ~ `~' I ~' i fI i CC'' ~,..I j ,z0 ~ p E __ --__ _ 4, / ~-- `, okl SIGNATURE ~// ,-- // ~- ~ ~ DATE ~ -~ - ~ ~ IU4y. ~ 1 v ~ y ~~ X ~~ ' ~ ,, ' r 1..~ ,' 1048.8 / ~ _ ~ ~ ~ ~ x I f ~ ,1~ I ' ~ j ~ ~ ~ X ~ ' ~ ~ 1049. ~~ ,1 I 1 ` ~, ' is ~ 1 ~I~ 10.1 ~2~< ,; ,t 02 /.; i r ~- , '! • / r ~ / ~/ X..~ [,_~' w~ a ,, ~7 ~' •83 ~ ~ 1 f ~;--: X ' ~, 971. ~~ ~~~ X Q 97 !a1 © C / , H. ~~t ~~ ~~ A ;`,, -' ,; _ ,, ~}~r4:.'~:~ ~~tri 1,~',Ye~ .~';~~" *~~ .'.'.1b it3~j~ 5~ l.i~~ S: !'I j.U?'ilM1l'z .,,,,..... F-N~` ~ PQl111t'T~ OINI"~E.~'~ MAkUA~. Br Md4WAGilIUl~~4C~' PION p+w _.,~,.. of ~`fi' ~A ~ r~+vt? ~~ q 4~A Aiett~6er ~ i F'adii~Y 4,toiti NA 1€atiotatad ~~ fwaaarlr~fr# .~. ~ flew {MSC}, t~t~n+tMd ~ ~ .51 ka}f Atb~ . iild ~lc!~'L' . ~ tt~tNu~l#KfVE C.tai~!!1- ~ ......~.. MOtithM r+rore0r• t}fi ~ f3asoatr ;Fc?$I S'~b rnp/l. ~~ It~'a Cdemar~ 1~~~ ~2fl rrrgJ4, G 1VA ~'t~ 8e-dod r t't stl0 t1~/i„ +~~eirtad r~ v ,~,- ~ tai ~ lDtlt~sl aC9C m~f L 'fOCar4 t~ttt>l~d fi'b'` sa0 rt>att 4 NA tMaat C~h 1~aarroettiw rneet} x t o" e~u1 a o0at+t M~ lttt l~r 8i~ !~ h tt~. 4 PEA t q h~- *usiwr twede>e1 ter slentl wssae~e~er rnd reesla tir,k •tk~,rnt .,.r.rra ar~r-iru-aYlAarR ~~r 7a1Rk ~' D Q t~iA ~ ~eptio'Ta+k PA~inu~un ~r~ r a NA ~ ,.,,-e L!lluat+t FYar ht;r ~o~iC ms C~ Ufa ~tt~ane F9l4#r Modes , f~'4' G 1~A Pun'+R 'i'a~njc Cap-aailtY ~d t3 NA P>xntfa ?at~ft Manutect~u'er ,•gs ey. Q NA Pa-raro AM~nut+oaWtar ~ ~„~ ~ D ~fA Ihu~sp AibdN ,E' Q' O HA Prf1flKrnIM unit G ~en~dJGraVrd Perot' Q 0.1laaftanMad ftar+tl,e~s Ct Di1<ieMeotlOn ^ i~aat Atcrr C3 VV4refaM~1 C~ Qthar~ ~- ~ ate!! ~trt [~,w ~ rl Itrm D a4t-13tsll~ta Maa.trtd p p~p.l~taw Q Qthrr; ~s N~ ipnxrurb;aedl O~ q NA DNA 1daMldi!~itiN- 04 0} At kt~'t Ono!! •Yery; ,~ Raw+~r+wt t}MA~a1Rwln 9 ywa} t'~ ~t PautKa oat ~ M tanktat Wttsn oambbz+~d ebb and ac~am sqt~ onta~th3rd is~,? of dtt+k vo4+'~rtw E7 #IA ~+-r>~-eo! resat oelHal Ai: 3swet sar~nt wrr~r ,~ ~m ~ yews} D taiA Can ~ rRlrrw' +0.t l~aR weer ~av+rr+~. ~ ~ ~+ >rno~sat >. ~R ao-mo~ia ~ rtarm At 4roartt ones avrr+ri: ,-- p ~ C} NA iateiealrs at~r pr~iatr bsWt At lolrtt once gvrrY; ~" C3 NA At taeaert per e~arx: ~ ~ ° Q l~iA ~1r~1Nat: ~nr~ tM a! Lep~tcr and dt~ auntie ehsi! be rnaclo ter rR iradi~rtwusl carr,~knp ortr of ~ foliowMO 6oittNO ar ,¢rrttfkrttv~ts; ~1f+a~rr Pi4atrlsaMr, tiAaatrr PMia~r elateaia~tad Zero PANTS ImtipAetor PQW T~ M~aMialnet; ~rgps rM+A Qi~-rks-. 7aa9k htrp~tiarta ~ a v~wurt u+e~io~:tax+ ofi tris+ trt+kte} tz'i iderldt~r new antaednE{ at brwkrn haadw~rs, itlaMrrlily ~ araek#a ~ ltirksf araeraitte !Pull. vmtwne of Qoe'~etap o~Qa ehd sou+r< and to e< foc arrr tv~ up or pone~ty o~ taflhaane qri the ltd warlaow, TFre ~ d1at6 ~ v~atteatty~ lneprsrrd to ohsak the rlftvrrti isr~ in t~vet apeetve~n t ~ to a3utrOi~t Px anti' vG M n1'!'Iwnt oai thf armr~t+d e~uf>fwa. li;t~i RoE'tditbp a! erfikasnrs an #ha pcorstrd rurfalaa tray 1ndbabe a faMinq aconditi~ and r 4h~ ~tlnardD~ ~ ~ trwr race} rop~aarv arrtF~arttt~, VMhrtt ~ cansbina4 1~aoa+rwtali+as~ ~ tikaC~re a,ad aoum !n >r~y #wa-ic rqualg ona~ird (1y! ar mote- of tlse tank volun+a, ttllt •nS~rn CwOttCM'~e Ot tAo tank swat 4a rwnoV+ld iiY r SrptaOr $ecvtcF~tO Op,~rrtor at-d rfteporad qi N~ Mo0~r0inod + ohapte- NR t t ~, 4~thAeefsFn d4dlrrCwttetettlw9a Cdr. AS! t!R#~' !6a>h+ify~,pG: Sr'40~ tAtit a'pA4 Nr~ted tC thr a~rvlloln~ pf •1eM,;iast filunt, a~-t~cl~34-icnt et ptrr>rtttiiird +~ta1rip014aR44~ prdl7ifirtMB~tE un~, sutai ar~y ewviaa(rtp ar<t kt6eriralt+ r1 d1 ~ rnontt-a, rbrA ba prrtormsd by r arNl~td PAYVTt~ Madttxdt~er. A atea'vier ~rt rttadt Gw PtAnridetl'~ ~ repel toputatxoy auctwt'Ry witi-it's t0 dAys at ~ of ~Y e~rvyaa aevattt. A,.9~ J.'aa ~o~ ia:~a F~:~ ~i; aaa aa~e sr r_fLt ~~c+ Zt1:'~1\ ~, ~~ ~ ~ Z 87Ai1'!' t!f AN!! p~Jlt*T14~N " FoT fklti~Y 611RMttIt9t~Qt-, ' to t1~ Qi f!M P~gVYI'E tk tTMtRtMt tdnictai tar ttN At~+Ktca iifi ~ pr~k+4a x sffisr ohamioaia ` t~ ~ #~ trti~laltt and/or d~n'-a6e this dhpmtd oMital. if high oar0lrlttationt a!i datttmtd t+strs ~ eortd+enti 011d1a tild~ff# iMfpWd by d sopcaoo aarvh>N~ a~faralol price to 1SN. $yitwea cwt vp net r~aur wha- a~nii itetldMoea aro ieiuan et the +rtfiftratwrt atrfaoa, C>~NlM ' Aump tea ttwY ~ aeow natmsi t~iyhwasar Mvaia. Whirl tloww to rea~rared d+e e~csi+t wastewaar will lsr d~ zlo t9nit d#dpKat! aNi#;t fit ~ #~ detpa. orst-toddinQ tM oalitat arw miY rii~ In tk+* ka~okuq a aurtaaa disoF-arpa of af!luimt. 4p svoid thh i?tWtlar~ have iha aontanttii of the tietrttp tank nmowq by a StpttrOe Yn+3aMO tfpsratet prlar to realerfrl9p power ao ttw a!'ftwrrt p++RN- w oontoa't a Plurttbir ar POW'I'6 Maintalnar to sealer in rnanuaky epsratirro ~ pip oaratroGi to fi~M Aor~yl faYda W~!#1it1 the ptJeltit aetk. Cti0 tt0! drhra a whlakia s ta~ilts and dUlpandi o+NN. Go nor drtiwi a parts owr, w otharwlae dhturh ~ aorr-paet, the a-ae yr- il6 loge down aktpw c+f anY tnownd ar as-prada aoSS abwrl,~pn Nna. Radwisdan or ailrnrnsdan of trse fallo+~ Iroa+ the vn+~-aa* iuiarn may iMprovs ;he parformsnae and tip the 1no of thm f'~VY~'Nt swtioai be1rY w+lpsrt atliaedrt+ ptitta; pwtdortui; cvs<ar+ irvabi; dalN~aaa~a; dsntat floes: diapers; diiir,fae2ar,a: eat? feat+id~on deain #rttmp pWt+pt water; truh artd vipataltM p+et-ifnp:~ dsaoiir~ 6roaas; fiarbioida~a; escape, medioatl0rsa7 fit; paidt~ Arod~k; porc~daR; aanleary napkins; wnpani; Mtd wtlieoor •at~rier ltrir». MAMaO~tP VWhoA rhs iiol~Yf^A ts3fat andfor is panr~anlrtlly taken asst of xievke the folfowtrrg apps ihsit ba ialt*rt ~ Mauro chit tFja sratam fe pmpalY i~nd safagr asaandtiasd in cArr~p11ta0a chapter t:ornrn 6'3.33, WkMaatNn Adndt+ra Coils: e Ail ptYiAR to tanks sr+d pits ihlll lie dk~onneetad and ebe ibando+tsd pipo sPM~IMi ~• Ylti gOf6MM1t# Of i6 Seneca i~e+d t#S;1 aholi ba rturxivad end prapotiy dkttx-iad of by a SaptsOe Sarviolnp Oparsear• a Afar psytpiRg. aM tertks +ind Pia sttayl bi excavatb end removed ar tt1sM aovsri ienawd tttd the vold epa¢a t5tad wisf~ ook. ~rwd r~ .,r iefsit ie~ trtscarw. co~rr~r acAa tf dike Mp1ArT'N tl~a utd tiaratiot ba rapak+ad teeto Fepawinp n+aasurea !}eve bea+~, or mwt be taken, m prrsvida a cads eoct+pi3ant ® A a rop~smu-t sled has siaart avekat~d std tnair b~ utiietd 1a sM iota8#det M a -'~+luamaelt •a~ dbidr~on . TM rlrpt wiwl ahouid ba proRaotsd from diawrt~inos and tflort and el+ould net ba tnfrindect F,~n by i"~gY?trd astbaoiea front ird~ arRtd peopoaod ititletuea, bt iMi+o and woMa, f~bua tlt p+' the ppiarahrant area wlli 1'itMih ki tlii »iAd fsr a nAw ace sad dta avalwtbn to eita6ltaii s iukaibis nplaaarteirst arss. lNpiaartta+-t systems moat 00lNphr M~ld1 ~ tv4ao ks sfhat Ill ~1lt tiMa~ D A s~at~e r~rlaoattsMnt one la teat .wt#dere dw :o iittiac+o artd~a ioN umtsatians. Barrtap advarteata !n pOVJTB tro01Nld1oipY a it+olt~ 1itelit ttNMl ta0 le~dia/ M • tart rlieltrt to hA~ tlta feYad POWTi. tank ~~ ~ ~ D NNItnMd std aNprads slat Idri~pti0rt syasMtsi may bs heonattsaetid bti >sldco foisayrp'1q irl++avsi of the biorrtat at th® trtfli a1~rfOpia. llaaAttiMla't#O~a 04 tYih I~yatfrili rMUat iitttipfy Mlldt the ruses 1n asfeot sc tf-at tattle. ~C ~~'r- y . A1l~i o1'1!~t Ti~llkl'M~iIT xAtt3K6 iaAr ~ON1'AM1 tiarwLL 01Ai~A ANA p~~T axY~l. Dq MtiT !1'1~li A ~R1C. pl~MM t?R oTtrR "~iA't'Mi~i1` TAfrK IIAIDEIwJ ANY ~titS~WlIIA'#'IWC~. DEp,T4f MAY Ri$WIrT. Cott Qp et PilllM~OM f'f#lM TiR ~R OF A TANK tNAlr /it I~IfNiNCtiLT QMt lkAl~l/~. ~~ r r l~ itltortii ~ w- ttY avr awe ~~ Miae*a iMwtt. T?tC3 etpitYtaRt was t~aftad in ~ r„ki, a!+*perr Grasm i~l.D?t~iQtlS'.lldWNt sAd ~.B4i91. 19l 1- tal, WhAOernWn Adn+tnMr+ath,t srrtd~r. SEPTIC TANK MAINTENANCE AGP.EEML'N7 AND OWNERSH[P CERTIFICATION FORM O~~ncr/Buycr _ ~G~~{i's~~ ~~ yrt,e .~ mil/ Mailing Address ~t7~D ST~I~Ltl<~`~/ ~~6z~.~ ~?,~1~/c~~ ~`P~"' /1'l.~ SSG~iz Property Address ~'~'~ r (Vcrifiation crqui rom Planning D nt for new conrnuction) City/State ~~'~~~,~~ d ~~Parccl Idcntificadon Number IIZD~ /~q5 - ~o~ `CSCJA7 ~,FGAL 1lESCRIPTION ~ Property I,ocatioa ~,,~ '/., 5~ '/~, Sx. 2S . T ~~ N-Rl ~ ,Town of ~~sG-~ Subdivision ,~ -t,v<~~ /T~~~~~ .Lot # 7~ Certified Sarvey Map # Volttmc , Pagc # Watz'anty Deed # ~ `~~ `f~`f . Volume ~~~ Z' . Page # 2 ~ Spa boast ^ ya ~ no I.ot Iincs idcntifiabic~°ycs ^ no ~sT~M Nr~.~H~xc~ Itals+opa tsYe and taamteaanec of yoza tcptic xystem oonId zcuslt m its przmattixirfailuse to handle woks. Psropcr mamuaancc of pompasg oai the septic taa>< every thxu yarn or toot, iS txodcd by a li~ocascd pmm~pcr. What you put into ttse eyseem tern affcd tic fimctiaa of the septic tank as a tr+eatmeai flags in the R+asOe disposal syrcem. 'Ibe property aWnac tgtees to submit to St C~vix Zotsiag Dcpanmtzst': eatsf~oafaan._~r~sod by the oWnra ta~d~by as ~-~-~` . _ t _ i _._, . ~ ~ - r _~~a -'~..,..7'ir`w.. H.er (1 ~ afar nn.ntn ~ftewltGr ~J'^'- ~P`~tlPc~l~UCr~ ~LSiiGZoapu~ az a u4AL~v~ayw,x+~+c,+ ...i..J,..b ..~.. ~.~ ......,.. -.~ is hz proper operating eoadition aad/oc (2) :fter iaspodioa and pumping (if necessary), the trpiie taalc is less than 113 ~ of nudge. Uwe. the have cud flu about c,oquineuscuts and agroe m t>caialYin the private sewage disposal system with the st:aadacds set fonts, hcttia, u tct by the Deptrtimeut of Commerce and the Depattsneai of Natural Rtsourcu; State of Wiscaasin- Cccti.~cation ~~~ye~ true rysLCgt _ ' taincd must be coc~Idod aad:ztumed to $ie SL C~aix Cocmty ZoaiaB ~ffice witi~in 30 of tt<e ttsrx year ezpaatioc date. `l~ ~a,~ TURF OF APPLICANC DATE I (wc) ccttsfy ^ - - ctatcmcats on this form uc trot to the best of my (out) lmowledge. I (we) am (arc) tfse owna{s) of the . by virtcsc of a wutanty deed cccordod is dtcgistcr of Dccds Oflsce. ~/ ! / ~,j' SI APPIjICANT DATE •••• •• Any iafocmatioa that is axis tcd may result in the unitary pctmit being tevoiced by ttse Zoning Department `• •`• •• Iadude with this application: a tta wartaaty docd from the Register of Deeds ofTicc a copy of the certified survey trop if reference is made in the warranty deed ~~ . ~ ~~:~ 1fiG2PAG28i7 ' 648604 Docum.µ umbcr KATHLEEN H. WACSH Don,men TSUe REGISTER OF' DEEDS l,,Jarr-c1n,~ ~cc~ 5i. CROIX CO., WI RECEIVED FOR RECORD 46-18-2001 12:45 PM ? WAkRANTY DEED - EXEMPT M CERT COPY FEE: CORD FEE: TRANSFER FEE: 9900.00 RECORDING FEE: 14.00 PAGES: 3 Rxordiaa Atra Name acid Re4uca Address i9oo silvcr Lnkc Izoc~d Ncw ~rlp"t~n ~ MN SS/1'Z C7Zo - 1 D69' ~ 70 - oo v ~ rdesar~aa x~ 0'uq c~~o-ld6Y-~So-vvo. - 02 0 - 106`1 -~1O - v~c~ (~ 2c7 - 1070 - c70 - ~p 020 - 1070 ..'~ -~~ v 20 - 10'76 - zo ~-~ "THIS PAGE IS PART OF TffiS LEGAL DOCOMEN'p - IKJ NOT REMOVE" 'Ihit ia[ormatioo maR bs completed by abmates: ilocrawou tlrfe. mm~e & rcnrrn addror. cord N ar rJ:s sn~as almuet, ksd duaipdan, sae. gray be rbeed on a54 JS,at rasa gJdu or N ~ rdj, Od'cr /ry{arw~adon such ~'~~La .i. Use of dlr mrr Arse adds one pare w your doaw~w and S1.W w dK reco~.*Q7 Placed on adldonal rala+ of die -- ee SPucouuin Sraaau, J-,S17. WRDA 7~-tf r. ~, DOCUMENT NO. . 1' II ~_ WARM1Y71'Y DEHD n 1n/•7 STATE OF W19CONBIN-FORM 8 YO(- 2~` TNta af•AC[ R[[f RV[O iOR R[GOROINO OATA THIS INDENTURE, Made bY-RICHARD N. PEARSON and JEAN M. PEARSON husband and Wife ......---•-• .......................................................... grantor s-. of....St. Croix ........................................................Countp Wixonsin, hpzeb conveys and warFants to..._~~IAGE HOMES XXI, INC. a a ,~ Minn~sota rnrporatLOn, ............................................................ . iwT'asfiington ~i~tp ....--._ :........................._.-_..........-..........................County, ]edf For the sum of Q!?~-..Qollar:..~nd-. no/100.- .(~.1.: Q4)....and other ... ..........................' RErUnN .o L ~, ti,~a 7 ~ f / t • - ............~ood••and valuable oQn-8 ~0,r-a t on•-. ................. ~S//Z Wisconsincn A~l,.t4~..~he-~(9orth...~S.C Quart?.r...L(`1Y~ln._...and• Northou aY' , vF~,.'' %;r 1 J~(+~^-' a1/(•' - -- w ,..-...--H-.lf (N~) of the Southwest Quarter (SW~d) of Section Twenty-Five (25), Township Twenty-Nine (29) North, Range Nineteen (19) west, St. Croix County, Wisconsin, except IfJt 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...... ay..-•-----~ ............................. A. D., Y-(_2001 BIONED AND SEALED IN PR898NCE O[' .................._..... (SEAL) ... .....~ .. .......................(SEAL) M. E1~RSON• ................ ~"..:.~.........-(SEAL) to g~ptd • Wasntinfton ~' `.~. c •••••• -•••••••--••• ••g•••••• .............County. Personally came before me, this.:....... day of-..~...~.............., A. D., 3?~._2.g01 the above named ..RICHARD N. EARSON and JEAN M. PEARSON[:husbdnd and wife, .................... to me nown to be the person...... who executed the foregoing instrument and acknowledged the same. TNIB INSTRUMENT A>( ORAiTEO Y _ ____~AY3v1OUNTAIN Richard J. Ga~riel, #3264 • ~-• 880 Sibley Memorial Hwy,, #114 NOTARY Nota[ Public,. ~~~' NOTARY PUBUC-MINNESOTA SEAL Y ~hn .....---. _ .............................. County, Wis. My Comm. Expires Jen. 31, 2005 M[anr?n~~ v • ~I,F -'n t:G, 7 °-1736 hfy corlunission ([71 (Section 39.71 (ll of the Vyiuo[uin StaNtG Drovidn That all irut[Vmenta to be recorded shall have plainly printed or typewrittrn thereon the names of the jranton, [rantees, witn ucs and note [y. Section 79.)17 similarl7 requires that the name of the De[son vho, or govern- mental agenq wh¢h, drafted such imert[menq shall Ir printed, IYPe~nlten, stamped er v.[itlen thneon in a IegiLle manner.) WARRANTY DEED STATE OF 1'VTSCONSIN Wleoonaln Lo[aI Blank Oemo-ay I~`ORrT No. g Mllwaukae, Wla, (Job 33F.11 1 y~~ 1662P~<<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 UY31Y3Sr+33 ~fNliO AZ ~r ~ J / / / ~ / / ~ r ~,~-~ `~ 1 ~~ i~~i ~~ ~ i ',~. I • ~~~~ I I /, ~) ~'~ ,I~ // / ~ ' /~ ~ ~ ,~ 7~ // I ~• r. ~~ .~ w. w I ~, ~_ V A ~ V I I 1 t I I I f I I I f I l I ,I 1 I I I f ( ~.~,,.. r~.. ..... ~.- 'JJ.avv~ •v~ v K• Marion Standaert Subject: 420789 -Carriage Homes/Schumaker Location: Lot 72 Scenic Hills, Hudson Start: Tue 7/8/2003 2:00 PM End: Tue 7/8/2003 3:00 PM Recurrence: (none) 25.2- ~y z~~~ ~~ 0 ~. C 2 V Safety and Buildings Division COY S~L'Y C ~ ~ 201 W. Washington Ave., P.O. Box 7162 O ! 1 ~S~~~SI Madison, WI 53707 - 7162 Sine Address ~ De artment of Commerce P Sanitary Permit Application S'°inr'' Pernut timber ~~ In accord with Comm 83.21, Wis. Adm. Code, perso ormadon you provide ^ Check if Revision D ~~~ ma be used for seco ses Privac w, a I. Application Information -Please Print All Informati (~`~~~ State Plan I.D. N r Property Owner's Name APR Parcel Number ~ 4 Zo ~ C ~~ Q a ~ ~ .~ oZo - /~9s = ~a --~~ Property Owner's ' ' Add/re/ss CI~OIX C F~ NT y ~ ~ ZGNI/yG Proixrry ~ado1n . Z ~6 ;o /s~ ' . ~ 7.:2~ S/ l Gl Gila ~z"Y /C~J~ /l~ li .S ~+/Si: S ~.5 T ~ N. R l Q City, State Zip Code Phone Lot Number ?~ Block Number Subdivision Name CSM Number II. Type o[ Building (check su that apply) / ^Ciry ~ ~1 or 2 Family Dwelling -Number of Bedrooms ~J` ~~g~ ^ Public/Commercial - be Use i " ~ Township ~/ t'Gf.~ ~ ~ ~ 1 ~ ^ State Owned ~ //~,l Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B applicable) A' 1 New 2 ^ Replacement System 3 ^ Replacxment of 6 ^ Addition to For County use stem Tank Onl E~cis ' stem B. ^ Check if Sanitary Permit Proviously Issued Permit Number Date Issued N. Type of Permit: (Check all that apply)(numbering scheme is for internal use) t_Q~„~,., ~ .fin ( 44~Non -Pressurized In-Ground 21^ Mouad 47 ^ Sand Filar 50 ^ Constructed Wetlazd ~7~~'4~~ 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass Sl ^ Drip Line l~S/~ /~ZA~ 3/ • / ~~ 45 ^ At-Crrade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. D' tment Area Informati on: Design Flow (gPd) Dispersal Area Dispersal Area Soil Application Perwlation Rax System Elevation Final Grade / / Requ ired ~ Pro posed n n ~ f 1 Rane(Gals./Days/Sq.Ft.) (Min./lnch) ~ !~ ~ IIevadon ~ ~~r~ Qd . ¢ 4 ~ ~ ~i } U ~~ ~ 7 4~- . ~~ ~ ~ VI. Tank Info Capacity in Gallons Total Gallons Number of Tanks Manufacturer z ~ /' ~ Prefab Concrete Site Constnrcted Steel Fiber Glass Plastic New ExistinY ~/sy ~ j~~- /~ (7 Tanks Tanka Septic or HokliaQ Tank _ /'+ J ~~ ' ~ Dosing Chamber g~ ~ r VII. Responsibility Statement- I, the undersigned, assume rtxpoasibility for lion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signawre RS Number Business Phone Number `/~~ m ~ 7 ~ /~-38`G ~- 3l ~l Plumber's Address (Sweet, City, State, Zip Cock) Count /De artment Use Onl Approved ^ Disapproved ~~Y Pernut Fee (i~ludes Grourdwater Da Issued Is ent Signature Scamps) ^ Owner Given Initial Adverse Surcharge Fee, ~ ,. ~ o --- a '1 !J y~i ~ , d O Determinafion ~IX. ~C~onditions of Approv~eMaso~s for Disapproval ~ ~ f~~~~ ~ ~~j7,sC~ ~~1' ~ S /~~~ ~ 3 yie P~~ ~ ~ j~ . - ~~ . - s / ~ b~ ~6 Y3 ,~~~~ ~ ~-yt . wn ~/y~ ~ ~ ^ O~ L / Alta/~h oomptae plans to the twq) Lot the oh hac axs [aan aa~s s as ~ucuea m ~ /O C~'u~ Q.7 Na$ ~lCYX~ / -'.tea- •1~"~~.~/~/~ t/L. m. d" . ~.3_.i r SBD-6398 (R. OS/O1) ~'0'~~ ~~''J ~- ~ \ N ~ W n\ 1• ~ v, .p ~ ~, ~ o H ~ ~ ~` ,i ~ 0 ~ \ ~ ~ f ~~ ~~' i, I~ V1 y~ ~~ ._ o ~ o. ~'` 3 } R O. n ~ ~ ~ ~ ~1 ~aa ~ l 4 4 v