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HomeMy WebLinkAbout020-1439-44-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453281 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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: Lansted Homes Hudson Township 020 - 1439 -44 -000 CST BM Elev: Insp. BM Elev: BM Description: / y Section/Town /Range /Map No: / 0 6 -6 1 1 3 W pvL_ 25.29.19.2770 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Z Septic — Benchmark Dosing Alt. / j (pb • � Z � �f Aeration Bldg. Sewer /t D. 7 Holding St/Ht Inlet a7. it TANK SETBACK INF ORMATION St/Ht Outlet 2_ / 0 TANK TO P /Lp , WE BLDG. Vent to Air Intake ROAD Dt Inlet Septic j '/ 1 r Dt Bottom Dosing _ Header /Man. --- a Tyr- el Li Aeration Dist. Pipe I C 111 Holding Bot. System v L Final,Gy� de j S j 11 I `� 1 .2 `[ °� - PUMP /SIPHON INFORMATION r V of Manufacturer De m nd Cover Model Numbe TDH Lift Friction Loss Head T)H Ft Forcemain Length ia. Dist. to Well SOIL A RPTION SYSTEM BED/TRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 INF SYSTEM TO P/L BLDG WELL LAKE /STREAM E Manuf AT ON CHAMBR OR Type Of System: / , / UNIT Model Number: DIS IBUTION SYSTEM /[ HeaderlanTld Distribution / x Hole x Hole Spaci Vent to Air r h " Dia rj Length Dia _ Spacing to 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 Bed/Trench Center 1 Lt Bed/Trench Edges Topsoil ( rr 1-K Yes 0 No [] Yes r I No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:10/ �/t0 Q ! 't Inspection #2: Location: 1 Highlander i 1 54016 NE 1/4 NE 1 4 25 2 N R19W Indigo (,( Parcel No: 25.29.19.2770 92 H g ander Tra I Hudson, W ( / T 9 ) o Ponds Lot 44 g 1.) Alt BM Description t = K. ow 2.) Bldg sewer length =2 - amount of cover = 3 f Plan revision Required? ;.] Yes No fS i a ture Use other side for additional Information. SBD -6710 (R.3/97) Date Insepctor's Cert. No. -cam r ''PLOT Ik CAM SECTION PLANS Pk =APPA DFM. EXCAVATING PC PW*IIN6 UNIT � -oJN o7� os o.cJ i � /�5b (o/k� cacFSS'p �xPn'c G.�ttH �qg�6 18as>5 Ak7a:C Y� ��L EA9.t Er1JT L.i.vE rh iitl a Apr oF ,��e.te f E SGLE �ir6t4'V� Ew — � JAt7" P, 101 ©ISS'1I14TIOwI Oft SIGNED: V EN re-At' U CENISE: �f 7 N ts� L DATE' =.RSl �Of // 1AK a �r1l�Nt �G' i46o o af N `Alf- Sw N 140 P ., aL ES BY: The Stand& d Ini ilti for Chamber V Overlap at Latch ft Tfr�kH 8o'1r�n kh4VAl 1 T m in SIDE V rEw 75' Effective Length Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 S l N V . 1511OOSIO Madison, WI 53707 - 7162 Sanitary Permit Number (to be filed in by Co.) Department of Commerce (608) 266 �!r 3 a Sanitary Permit App c _ State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, pars! inforQE(; pJJ0 #; A may be used for secondary purposes Privacy w, s15.04(1)(m) Project Address (if different than mailing address) I. Application Information — Please Print All Information Y 2 8 20 l Property Owner's Na me �i 1, C RC)IX CC)uW Parcel # t # Block H �Q ZONING O FFICE I�ZD "l Property Owner's M ailing Address Property Location # 2-7 -7 0 _ 'A, AS' City, State Zip Code Phone Number 3cF _ (circle one) II. Type of Building (check all that apply) / ® 1 or 2 Family Dwelling - Number of Bedrooms V S bdivision Name CSM Number ❑ Pub] is /Commercial - Describe Use �1 ❑ State Owned - Describe Use - 2 "DIST • i �+� , .5 r XQ ❑City_ ❑Village NTownship of III. Type of Permit: (Check only one box on tine A. Complete line B if applicable) A. ® New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Onl ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) ® _Non - PressurizM In- rawund Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter VLeaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Othe explain) V. Dispersal/Treatment Area Infor ation: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Z<0 C.) 1 , 1 ivep,; I (:P,;2b,0 X9.96, 69svo VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank X Aerobic Treatment Unit or Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature MP /MPRS Number Business Phone Number G n�7 Plum bee Addre ss (Street, City, State, Zip Code -PzX7 4 yU VIII. County/Department Use Onl pproved El Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial IX. Conditions of Approval/R ow ' Disappr� S m�✓1 ��12 !�� G i� TE Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained y� L as per applicable codelordinanc es. Attach complete plans (to the County only) for the system on paper not less than SM x 11 inches in size SBD -6398 (R. 01/03) -c -,e 'PLOT & CROSS SECTION PLANS Pia oSF� ZAPPA OPM. EXCAVATMIi'i INC PVUNBM16 UNIT .. . PROCr � $�ne� Duo �i4�/3o�rr IDES. s,— I& H G i /0 &p C &.UF5EP 'XPmG 17jAK GorrH ���e� /tt� FtcT�F d PJL �r�GaLf�vT �,i� — � ±� l AJ kt i�l ao g 694 A P E r Db� ° ENt� N r SQUE S 4 � Vero — EJeVA-r70,j P, Pd ©I�S�+II14T1O�I O2 SIt3I�D: � V EN T U!P UCENSE: .22 q )0-,/NI DATE: GN��e .soILTESt�IO sr: . The Standa d Ini 11h ator Chamber 1 Overlap at Latching n sm � �3 I �ErJc H Bo1r� ��,�EN��► �� S a t `rti'l 12' m to 0 c d ^ SO S o r' sloe V ,Ew 75' Effective Length , a � 1797 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than BY2 x I I inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 20- 1439 44 -000 Please pri RUIX COUN I Date Personal information you provide may be sed for Law, s. 5.04 (1) (m)). � J O Y Property Owner D roperty Location Rosamji, L.L.C. MAY 2 8 2004 . Lot NE 1/4 NE 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Address # Block # Subd. Name or CSM# 2141 Co. Hwy. C _ • ' T _ j 44 Plat Of Indigo Ponds OFFICE City State City _j Village 0 Town Nearest Road New Richmond I WI 1 54017 715 - 248 -7071 Hudson 1 921 Highlander Trail IM; New Construction Qce: tI' Residential 1 Number of bedrooms 4 Code derived design flow rate 600 GPD _f Replacement J Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at elevation = 9&50'& 95.00'( 55 below existing grade) using 28 leaching chambers. FT] Wng # Boring Pit Ground Surface elev. 102.04 ft. > 123" in. Soil J Depth to limiting factor App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 'Eff#2 1 0 -3 10yr2/1 none I 2fsbk mvfr gs 2fm,1c 0.6 0.8 2 3 -9 10yr4/3 none all 2fsbk mvfr cw 2fm,lc 0.6 1.0 3 9 -20 7.5yr4/6 none sl 2msbk mfr cw 2fm 0.6 1.0 4 20 -31 7.5yr4/6 none Is 0 sg ml ai 2fm 0.7 1.6 5 31 -55 10yr5/8 none s 0 sg ml cw 1fm 0.7 1.6 6 55 -123 10yr5/6 none s 0 sg ml - - 0.7 1.6 -s�- g`" 102, F2 # 1 Boring 0 Pit Ground Surface elev. 103.24 ft. Depth to limiting factor >118 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu_ Sz. Cont. Color Gr. Sz. Sh. •Eff#1 "Eff#2 1 04 10yr2/1 none sil 2fsbk mvfr gs 2fm,1c 0.6 0.8 2 4 -12 10yr3/3 none sil 2fsbk mvfr cw 2fm,1c 0.6 0.8 3 12 -30 7.5yr4/6 none Sid 1 msbk mfr cw 2fm 0.2 0.3 4 30-46 7.5yr4/6 none Ifs 1 msbk mvfr ai 2fm 0.5 1.0 5 46 -54 7.5yr4/6 none s 0 sg ml cw 1fm 0.7 1.6 6 54 -118 10yr5/6 none s 0 sg ml - - 0.7 1.6 Effluent #1 = BOD 30 < 220 mg/L and SS >30 < 150 g/L vent #2 = BOD < 30 mg/L and TSS <,,0 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson / 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 54020 5/182004 715 - 248 -7767 e Property Owner Rosamji, L.L.C. Parcel ID # 020 - 1439 -44 -000 � -� Page 2 of 3 I , 2 I a„ri.... « 1 Borinia • 6 3 •� ♦ Ele�'af �� 5 Cale \ �Qe o l6 r ' �/ / 79 7 ppt \ \ p( Q Lp Hof Y7 Tno�iyO /1 OnCV$� afdJ �\ 4� 5e C . 7 Ti,.OF' C/ 1- - ) , o�o �0 L 6 na, I in 20 „ s BZ 0 . - ■-'B3 99•D. -' 9 7.0'C - ,, Ea-r - ►�ch K: T)a o{' • "!"e bar: Ass umed e/eµ= AMcr v 1270 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and ment slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. QZ 6 _ p df Please p " eviewe rt 7Date Pe nel information you provide may used f _ pa r • aey Law, .15.04 (1) (m)). Property Owne Property Location ROSAMJI, L.L. 1 MAY 1 3 2003 Govt. Lot na NE 1/4 NE 1/4 S 25 T 29 N R 19 W. Property Owner's Ma 'ng Address Lot # Block # Subd. Name or M# 2141 Cty Rd. C S C. �G�x CJUN' Y a 44 na Indigo Ponds " '' e City Stat � City _J Villa e Town Nearest Road New Richmond WI 54017 715 - 248 -7071 Hudson Highlander Trail J! 601 New Construction Use: Residential / Number of bedrooms Clseva gn flow rate 600 GPD Replacement J ublic or commercial - Describe: Parent material Sream terraces and ifted ash plains na General comments and recommendations: system elevation 9 . 5 ft, trenches and t 6 . ❑ Boring # I Boring 0 Pi t Ground Surface elev. �02.95�k epth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description ure Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Gr. Sz. Sh. "Eff#1 'Eff#2 1 0 -8 10yr2/1 none sil 2msbk mfr gw Ile .5 .8 2 8 -30 10yr4/4 none is 2msbk mfr gw 1 c .4 .6 3 30-42 7.5yr4/4 none sl 2msbk mfr cs na .5 .9 4 42 -120 7.5yr4/6 none osg mvfr na na 1.6 cos ti COS <35% oarse fragments = 36" & >35% - < % = 60" below system Boring # I Boring s Pit Ground Surface elev. 102.95 ft. Depth to limiting1actor 120 in. Soil Application Rate Horizon Depth Dominant for Redox Description Texture Structure Cons tence Boundary Roots GPD/ft in. Mu ell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 1 0 -6 402 none sil 2msbk mfr cs 1c .5 .8 2 6 -32 10yr4/4 none sicl 2msbk mfr cs 1 c .4 .6 3 2-1 7.5yr4/6 none cos osg ml a na .7) 1.6 Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg /L Effluent #2 = BOD < mg /L and TSS < 30 mg /L CST Name (Please Print) Si gnat re: CST Number David J. SteelZ -- 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/26/2003 715- 246 -5085 r Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST - POWTSM ROSAMJI, L.L.C. New Richmond,Wl 54017 Lic #248956 NEl /4,NE1/4,S25,T29N,R19W Bus .(715) 246 -6200 Town of Hudson, St. Croix Co. Fax.(715) 246 -9372 Indigo Ponds Lot 44 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend 1 " =40' ,} ♦ = Benchmark Ele. 100.00Ft N Top of 1/2" pvc pipe • = Alt Benchmark Ele. 100.30Ft Top of 1/2" pvc pipe 0 = Borings Boring Elevations B1 = 102.95Ft B2 = 102.95Ft B3 = 100.85Ft B4 = 00.001 Por 4 0 1 8 � Ae fff— 4 2h• 0ai. - - 00 tug � LWA ►'�t $off ? ?� ��i,�'t s G,► ? . � N O ooh l i p �® ►��� �'i►S�� �i •rte .: � ?,�o ., �` 0o4��s� :��'�oodo�•.��o�o'��'�sr. -o,�o ±�,; :, . �o,�,�o , k �� �� i► J �► ss '� ��'` �'�i t► o�?•d PONITS OWNER'S MANUAL & as PLAN has Ffi.E fNPOpMATdON S�J 1 �a I'cw?�s x pr 4 F Tank 3f 1 X50 O NA Owner 1�.�nvos Sa m Prrmit d SMpdc Tank Wieser O NA EfluMrrt Aar Mwnd* m Zable O HA DEW= PALVAETIM A -1800 O NA Numbw of Bsdroortr 4 O NA EtAuarr< Hoar Modal Unite AcNA Pomp Task Caliaoity DNA Nursbsf of Publ'io F"" DNA Es*nmd flow trm*W 400 DNA Pump Tank Manrdaatwa► HnnP � Design f w Ipeakl. IEMdmawd x 1.81 60 D NA .7 Pump Model IMorNldf► A, P � D NA Standard bfuerrllEO'S Ouafty G Sardmmd Aar O flat Pilar Fats. 03 i finesse S80 ®iochw*d Oxygen Dasrd lewd S0 no& •O NA O Mewha*d AwaRbn OWN*" Tool &NNW ed Solids tTSSI s1 So n*& O Di kdso on O O NA Od►a: � OiaO� � Prevented Eflktant Q,uawy D In�Gm" IorarltYl O In &MAW IprMaMaisedl OW&A " Oxygen Oamra 190Os1 S80 O Mound Tota1$uapendad Solids M S90 � O /1t•Grade Fecal Cordons tpson�riw elsanl 1o0n11 D Oro" D Ode ONA �� ONA Ma imn Effk" Partiwls Solo % OMnr R NA Oehar: Z70r1► odw. m NA •vawa typiaad for dorr»ade wm%W@ K WW @SPda tmk di>wet. p1A0N?BiIANCE SCNID KE Lo ammolm Serrlos FrMrrt 3 pa■r+1 O NA Inspect condition of unklal At loaf one awry: 2 Pwrar out contents of tanlctsl NAM ow dmW Mudge and swum aouab cn�•*W W dank vakune O NA inspect dispersal ceNsl At bw once wall: 2 3 > i O NA O NA Ciean eflNNm filter At ImW one wary: 1 + O� rt�cr¢ss Onvoom At Nat once awry: O lul�"s ®w► Inspect PUMP, pump cormb i SWIM ® NA Fktsh Maas and PUMO SW At Nat anoe awry: D off: At bW 0= wary: DNA oar DNA aiiA1NTENANCE INSTdINCT10Ni one of dw tobwing No wwM or owtitioarions: of tanks and dispersal affM *M be mWo by an individual mater Pkm*wl Mow Pho" Raatriwtad Swrar: POWTS bapectori POWTS MdntdW. S~ 8ary 0 + Tank inspections mug kwhWo a visual inapeation of the taMtiai a Wway any mb*q or brW Mn handwsm WSWV wY 9mb Matisse ' measure the volums of oasbinad sudge and swum and to whack foe my back up or PI I I 10 of MflMt m on the Ooh d ow3 d oWW shat be vboh to ohewk the sffu@M bvab in the obaa n a is and m d" tot SOY p The of effluent on the ground sofas. The pond m of offbm" on the growid surface raay a fail co os and fequiras knnudiate notification of the boat fegulatmy sudwwky' When the emnbrod aoourtwllation of Modge and swum in WW tank a4" �'� IV or rnors of ft tank voulrte. the amine ewntents of the tank Ad be mmow d by a Saptage Swvb Mg Opwalor OW of in a000rdum wide ahw#W NR 113. UMwconsin Admini:tradw t odM. AM other services. kWudbg but not drMtad to Via swvick* of d&ww Mw - nlaoharWwal of prraauriad ooOlponalta. anise. and ant► semW" at kw vaN of S1Z mondK. "be paforored'by a owdf m POWTS Maintainer. A SWVice rePat shah be provided m the bad "WAB y a dhorkY with'n 10 data of oompladon of any af11ima event. 6�fYll Hlptd pop a �. VART UP AND OPERATION tanklsl for the pressnCe Psi products or other ahemicale For new �.•iro prior le woo tft � the AsPersal aNsl. if 1t* a d M° the cwd" that MY at +e tank( $) rerr-*VW by a 9~ serVW4 operator prior to "es. are frown at the infilarad sarfaos- System stare all shay not occur when soy conditions may water levels. When power is ratorod.the mom wastewater will be During power outages Pump tanks above normal high wo to the dispersal o0sl in one large dose, 01rark�sd'rn9 rm and may 00 1 0 �� � to restoring eff0uen o Mid this situation haws #0 conma of the pump t rom �� �� the pump controls to mairrtainer power to the effluent pump a contact a ^ or POWTS restore normal levels wshin the pump tank. and dispersal �. Do not drove a ner Park over, or odwnse disturb or compact, the ores Do not drive or Park vehicles am tanks soy absorption area• within 4 5 feet down slope of any mound or aR grade of the star Stroam may imp ov e diapers; d'aaofectarots; f Reduction or eyrtdnation of the foyowirg froe+ ! , cWon swabs: doWoosers: dental • medications; pOWTS: antibiotics: baby WOW �' , gasoliroe. Vessel. fib' meat sorsPs, oy: foundation drain 1 pesticides l � softener brine. painting prod ABANDONME taken out of service the fcyowbg steps shay be taken to insure that the system a POWTS When operiy and safsiyfabandon°d in O0 wndo �« Comm 83.33. W AdminaRratlw CoQe: * All piping to tanks and PSs shop be � and the abandoned pips openings so". Shall be nrroowed and pt' °P�11 d of by a SO~ 8 enw c ft 0 �� . ® The contents of all tanks and Pits mmoved or their oovsrs rem "d and the void space fNed with ® After pumping, ay tanks and Pits shall be e000svatsd and soy, gravel or another inert ON serial. CONTMKl1ENCY PLAN muss haw ban, a must be taken, to provide a cods comp if the POWTS fails and cannot be repaired the meow re0acement System: and may be udbW for the location of a replacement soi absorption Xg s a emplacement area shoved be Prate o and wells. 111uro and s W* Ow � am w vwMs. Faiurs to protect setbacks from endstirg and proposal Structure Eves and area. Replacement systems must mwww the need for a rlew soy and site evaluation m atabyeh a suitable rsplacemsnt comply with the rules in effect at that time" gaming advances in POWTS area le not sva�able to replace the few POW due to setback andlor soy yrnoications• (; A suitable m0ecsrnent as a { resort TS. S soy and site q � n �gy a holding tank may be �dy a aCero no erlt failuro 411 the ways a tank t r has be to a tae /v ss a rout to rMi tow �� may be reconstructed in p � wing removal of the biomat at the ® at 90% soil absorpdo Sy: oust cemoply with the rules in ethct ore that farce. infiltrative surface• Reoons of such WSW" _ TANKS MAY CONTAN LETHAL OA8StES' AMIOR N Ox. RESCUE DO NOT < <WAWWG> > Sg=. Ip PUS OTH OR OTHER TREA'TM TANK UNDO • NTH MAY RESULT. iMSCUE OF A PERSW A FROM THE W1 MOR OF A TANK MAY /E OAT OR AL COMA "A POWPow" MrTAM I OWrS IWALLE R ) Nance Ben Mor a Na<ne Phone 715- 386 -2130 Phone 715- 386 - 2850 LOCAL �LATORY ALfTHORTTY Of f d& E STAGE SERViCMIG OPEAATOi1 Nantoe E t . Croix County Zoning Name Tri County (Ben Morgan) phone 15 -3 -4680 Mom 715 - 386 - 2 130 , WlscorrinA*WWW* ate ... �..�... r„wrn 83.ZZIZIIb IXIII1AM and 83.SMtl. (M b 181• 6- 4 -C4; , .27AM;Le Idsted H --m .s 1C. .715 566 6671 # L. S T CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND L OWNERSHIP CERTIFICATION FORM Owner/Buyt r _ atVtk L L C IAJ Mailing Address ! C c Property Address [ Z I w T1rq (Verification required frc6 Planning Department for new construction) a' f ,,) City/State t�dd��t/1� (A) Parcel Identification Number 02 LEGAL DESCRIPTION Property Location N r t /4, AIF %4, Sec. 2 T - ZLN -R `� W, Town of Subdivision _ Vk t P av , 4 , Lot # Certified Survey Map # , Volume , Pagc # Warranty Deed # �� 3 , Volume Z 3 , Page # �d 6 Spec house 0 yes Kno Lot lines identifiable yes Q no SYSTEM MAEST Improper use and maintenanceof your septic system could result in its premature failure to dandle 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 can affect the function of the septic tank as a treatment stage in 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 masterplumber, Journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system ism 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, tho undersigned have road the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set 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 days of the three year expiration date. Af';- AcLAAC, — L SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this farm are trng 49 4114 b4St 9f My (91tr) kRQWlCdgc i (we am (arc) the Q)N%cr(s) 4f the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. "'V, jW LiL b / , tt- SIC3 ATURE OF APPLICANT DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include tvlth 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 U. 2567P 237 7ci' =-)44 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIK CO., WI STATE BAR OF WISCONSIN FORM 2- 2000 ECE RD Document Number WARRANTY DEED 05/07/2004 01:00PN THIS DEED, made between Rosamji, LLC, Grantor, and Landsted, WARRANTY DEED EXEMPT # LLC, Grantee. Gran luable consideration, and wan-an Grantee PAGES: 1 il. 00 th lowing described 1 estate in St. Croix County, State of Wisco TRANS FEE: 330.00 COPY FEE: Lot 44, Plat of Indigo Ponds in the Town of Hudson, St. Croix Coun CC FEE: Wisconsin. Recording Area Name and Return Address: E .'i�t!s, hw. 40". 20a Exceptions to warranties: Hudeee,- W444016 �� Easements, restrictions and rights -of -way of record, if any. 416544 020 - 1439 -44 -000 Parcel Identification Number (PIN) This is not homestead property. Dated this 7th day of May, 2004. Rosamji LC BZ B * Sandra M. Gehrke, Manager for Rosamji, LLC * M anakYSA.Qsamji, LLC * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this 7th day of May, b�1C Not m Pu ng�'n Personally came before me this May 7, 2004 the above .nl'SCO named Sandra M. Gehrke, Manager for Rosamji, LLC and Mary R. Rusch, Manager for Rosamji, LLC to me known to be TITLE: MEMBER STATE BA IMP WISCONSIN the person(s) who executed the foregoing instrument and (If not, acknowle d the s fi authorized by § 706.06, Wis. Stats.) to �o x— THIS INSTRUMENT WAS DRAFTED BY *Cheri Brown Peterson, Frarn & Bergman - Steven H. Bruns Notary Public, State of Wisconsin 50 East Fifth Street, St. Paul, MN 55101 My commission is permanent. (If not, state expiration date: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) 3/11/2007 *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Rfl LI , C Mailing Address 0 26A'! JJefe L ew Ac 646N Property Address 2 I th k �l1 (Verification required from Planning Department for new construction) City /State Parcel Identification Number 62o2 o I YJ.Y — "'Yo o 0 LEGAL DESCRIPTION Property Location NF- '' / *, Nf- %4, Sec. 2.5 , T 2f N -R W, Town of � �� d N Subdivision ( �vV \� Lot # Certified Survey Ma'p' , Volume , Page # Warranty Deed # 1 l I q I I Volume 2 2. Page # 3 6— Spec house ❑ yes Kno Lot lines identifiable Byes ❑ 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 can affect the function of the septic tank as a treatment stage in 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 masterplumber, journeyman plumber, restricted,plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set 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 day f the three year exp date. SIGNATURE OF APPLICANT �/o 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 owner(s) of the petty described ab by virtue of a warranty deed recorded in Register of Deeds Office. /'? SIGNATURE OF APPLICANT DA E * * * * ** 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 J 2223f' 306 1�1 STATE BAR OF WISCONSIN FORM S- 2000 7 1 9 3 3 PERSONAL REPRESENTATIVE'S f A KATHLEEN H. WALSH . Document Number DE ED REGISTER OF DEEDS ST. CROIX GO., WI Judy Niccum. as Personal Representative ofthe estate of Florence K. Polen RECEIVED FOR RECORD ( "Decedent'), for valuable consideration conveys, without warranty, to Rosamil, LLC Grantee, the following described real estate in St. Croix 04/29/2003 03:00PM County, State of Wisconsin (the "Property) (if more space is needed, please PERSONAL REPRESENTATIV attach addendum): EXEMPT # Please see the attached legal description'. REC FEE: 13.00 TRANS FEE: 3448:80 COPY FEE: CC FEE: PAGES: 2 Recording Area Name and..Return Edina Realty T It 400 S. 2nd St., #11$ Hudson, u son, WI 54016 j„ •. / 1 Personal Representative by this deed does convey to Grantee all ofthe estate and (. interest in the Property which the Decedent had immediately prior to Decedent's death, Parcel Identification Number (PIN) and all of the estate and interest in the Property which the Personal Representative has This Is not homestead property. since acquired. (is not) Dated this 28th day of April 2003 8 r Judy . Niccum .. Personal Representative Personal Representative AUTHENTICATION ACKNOWLEDGMENT Signature(s) Judy . ,Niccum STATE OF WISCONSIN ss. ST. CROIX County ) authenticated this 28" day of April 2003 Personally came before me this 28" day of April 2003 the above. named • jo� . c4jel Judy.' Niccum TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Heywood, Carl & Anderson, S.C., 1200 Hosford St., Suite 106 • P.O. Box 125, Hudson, WI 54016 Notary Public, State of WISCONSIN My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) • Names of persons signing in any capacity must be typed.or printed below their signature. INFO -PRO (800)655.2021 www.Woprofornv.con, STATE BAR OF WISCONSIN PERSONAL REPRESENTATIVE'S DEED FORM No.5 - 2000 J 22231' 307 Parcel A: That parcel located in part of the Northwest Quarter of the Southeast Quarter, the Northeast Quarter of the Southeast Quarter, the Southwest Quarter of Southeast Quarter, and-the Southeast Quarter of the Southeast Quarter, all in Section 24, Town 29 North, Range 19 West, and the Northwest Quarter of the Northeast Quarter, the No Quarter of the Northeast. Quarter, and the Southwest Quarter of the Northeast Quarter, and the Southeast Quarter of the Northeast Quarter, all in Section 25, Town 29 North, Range 19 West, Town of Hudson, County of St. Croix, State - of Wisconsin; further described as follows: Beginning at the south quarter corner of said Section 24; thence North 00 degrees 31 minutes 05 seconds West, -(for the. purposes of this description the south line of said Southeast Quarter assumed to bear North 89 degrees 53 minutes 05 seconds West) along the North -South Quarter line of said Section 24, a distance of 158.37 feet; thence North 89 degrees 56 minutes 47 seconds East a distance of 79491 feet to the point of beginning of a line hereinafter', described as "Line A"; thence North 00 degrees 16 minutes 57 seconds East, along said "Line A", a distance of 1049.18 feet to the point of termination of said "Line A "; thence North 47 degrees 03 minutes 07 seconds West a distance of 118.06 feet; thence North 27 deg 46 minutes 10 seconds West a distance of 196.02 feet to the center line of Badlands Road; thence North 67 degrees 30 minutes 13 seconds Past, along said center line, a distance of 708.39 foot, thence North 67 degrees 56 minutes 31 seconds East, continuing along said center line, a distance of 674.75 feet to the westerly line of BOUNDARY RIDGE, according to the recorded plat thereof, thence South 00 degrees 25 minutes 17 seconds West, along said westerly line, a distance of 1826.90 feet to the southwest corner of Lot 7, said BOUNDARY RIDGE; thence North 89 degrees 43 minutes 38 seconds West a distance of 66.00 feet to a point 66.00 feet westerly of and perpendicular to said westerly tine and hereinafter described as "Point A "; thence South 89 degrees 56 minutes 47 seconds West a distance of 961.84 feet to a point 66.00 feet easterly of and perpendicular to said "Line A "; thence North 00 degrees 16 minutes 57 seconds East, parallel with said "Line A", a distance of 1036.45 feet; thence North 89 degrees 25 minutes 43 seconds East a distance of 82.43 feet; thence North 77 degrees 28 minutes 43 seconds East a distance of 343.87 feet; thence North 83 degrees 18 minutes 47 seconds East a distance of 201.86 feet-,'thence North 58 degrees 53 minutes 32 seconds East a distance of 263.23 feet;. thence North 54- degrees .19 minutes 28 seconds East a distance of 112.69 feet; thence North 42 degrees 13 minutes 44 seconds East a distance of 46.55 feet to a point 66.00 feet westerly of and perpendicular to said westerly line of BOUNDARY RIDGE; thence South 00 degrees 25 minutes 17 seconds West, parallel with said westerly line of BOUNDARY RIDGE, a',distance of 1370.64 feet to said "Point -A'; thence South 89 degrees 43 minutes 38 seconds East a distance of 66/00 feet to said southwest corner of Lot 7; thence South 00 degrees 25 minutes 17 seconds West along said westerly line of BOUNDARY RIDGE, a distance of 163.55 feet to the North line, of said .Northeast Quarter of Section 25; thence South 89 degrees 53 minutes 05 seconds East, along the north line of said - Northeast Quarter and the south line of BOUNDARY. RIDGE, . a distance of 760.7'5 feet to the northeast comer of saidNortheast Quarter, thence South 00 degrees 29minutes 03 seconds West; along the east line of said Northeast Quarter, a - distance of 2616.18 feet to the southeast corner of said Northeast Quarter; thence South 89 degrees 25 minutes 58 seconds West, along the south line of said Northeast Quarter, - distance of 2606.35 feet to the southwest corner of said Northeast Quarter; thence North 00 degrees 24 minutes 10 seconds West, along the west line of said Northeast Quarter, a distance of 2647.29 feet to the point of beginning, St. Croix County, Wisconsin, except , m, p that part described as follows: AI! of the Southwest /. of the Northeast /, and `also the West 550 Feet of the Southeast'/ of the Northeast 1 /4 and Also the South 250 feet of the Southeast'/ Of the Northeast %, except the West 550 Feet, all in Section 25, Township 29 North, Range 19, Town of Hudson, St. Croix County, Wisconsin. 1X0 a�O- l��'� Ao la�cf -y�oa� �o��o��� -ate 1 ao, /00 yo ~Dtoo al_ 16)09 ja -O� �� i � • � ` � 114, \MY/• k rat f r dam&' _ TA 0.0? f { 1. .... � I } i s Il k CA