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020-1290-70-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal mformafign you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit N~~der's Name: City Village X Township Vue, Nen Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER /~- CAPACITY Septic F:1 "3 G~- ~ ~ ~~ ~ ~~ ~ZS w I Aeration Hoiding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~~ ~ ~,-<, ~ r ~.~~ ~~ / Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer errand GPM Model Number TDH Lift riction Loss em Head TD Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 463237 0 State Plan ID No: Parcel Tax No: 020-1290-70-000 Section(rowNRangelMap No: 27.29.19.1430 STATION BS HI FS ELEV. Benchmark fo3 ~ 3 ~ ~ Alt. BM 5~,~t-'~ z. ~~.~ 0 lc.~.. W , ~LL, Z 1r a.. ~r 3 ~ ~ C Z si~~-mower ~ ~~- G1 (, , 4 C ~°~;, ~ Cl SUHt Inlet ~ ~~ l ~ I / St/Ht Outlet 7,~~ ~~-Z Dt Inlet ~~ ~\ Dt Bottom ~~ ~. Header/Man. ~O ~~ Dist. Pipe ~~ ~~ Bot. System Final Grade 5~7~ ~7~~ St Cover ~' ` M Z ~ . T t ~~ .s 9z . ~ .Z. /d~S i ~j /L~ BED/TRENCH Width ~, Length / No. Of Trenches PIT DIMENSIONS No. Of Pits ~ Inside Dia. Liquid Depth DIMENSIONS ~ ~ d ~ ? ~ J\~~ * ? ~~ ~ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:__ ~ ~ I~ ~ INFORMATION CHAMBER OR ,L,. , ~ . Type Of System: I / -7S ~ UNIT Model Number: DISTRIBUTION SYSTEM ZI,, E~_.~ 1,, ?~ i ~~-~ Header/Manifold /~ /~ Length Z~Dia 1 Distribution Length ` Dia \ Spacing \ x Hole Size ~ x Hole Spacing ~~ Ve to Air Intake SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems OnIV Depth Over ` Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~~ Bed/Trench Edges\ Topsoil \ Yes ~ No ~1`es ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /, Location: 776 Hill Farm Road Hudson,/WI 54016 (SW 1/4 NE 1/4 27 T29N R19W) Humbird Hills Lot 7 1.) Alt BM Description = ~~ \ ~ C,~J ~-' ~~`~ `~~ ~ ~~ ~ `~- Inspection Parcel No: 27.29.19.1430 5..,5~c....-,. ~ • • • Safety and Buildings Division Comity ` ~ ~ 201 W. Washington Ave., P.O. Box 7082 ~~ iseonsin Madison, W[ 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 261-6546 a 3 Sanitary Permit Applic State Plan LD. Nu ber ,,.1r~~ In accord with Comm 83.21, Wis. Adm. Code, personal inf atiort ~eIV~D maybe used for secondary purpo 'vary Law ~~ 5 04(1 Project Address (if different than mailin address) , . g I. Application Information -Please Print All nfo t~n p ~ C ~ 3 2004 7 ~. Property Owner's Name y ~ ~°'" ~L>' ~ O O S Y O Parcel # Lof # Block # ZONIN G OF F CE Property Owner's Mailing Address Property Locatio uj ~~~ ~/ S i ~? ~ % Ci State Zi ., ~, ect on ty, p Code Phone Number C.~ ~ / .~ L7 (~ -~--(/ tG' . /~- C° ' S ~ T r Q~e T ~N. R~E a~ i~) # l ~ 3 O IL Type of Building (check all that apply) ~J ~ ~,f~ 2 F il lli D N ls'~ S visionName CSM Num am y we ng - .17~t-or umber of Bedrooms ~ ~ ~ ^ PubliclCommercial -Describe Use L~/~~ ^ State Owned -Describe Use .D/ CL'~ ~ ~'~ {" ~ ^City_^Villa e~7' ship of III. T ype of Permit: (Check only one box on Ilne A. Comp a line B if applicable - A' ^ New S tem ys ~ R Iacement S tem ep ys ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number d Dat Issued ~°~/ Before Expiration Plumber Owner 2Q~ ~ ~... ~ / IV. T e of POWTS S stem; Check all that a 1 7 - ~Non -Pressurized [n-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass S r ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatia S thetic Media Filter Leachin C ber Dri Line pe ^ Other Isin) ~ f B Ytt g p ^ Gravel-less Pi V. Dis ersal/TreatmentAren Information: I Design Flow (gpd) Design Soil Application Rat gpdsf) ispersal Area Required (st) Dispersal Area Proposed (sf) System levation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Teaks Tanks Septic or Holding Tank /~ S~ /~~~ •~ ~ 'X ,~ J y ' r e A W v`°'+"' ` Aerobic Treatment Uait ~~ , Dosing l:hamber ~ lh VII. Responsibility Statement- I, the undersigned, assume responsibility for i latioa of the POWTS shown on the attached plans. Plumba's Name (Print) Plumber' ign re P PRS Number Business Phone Number Plumber's Address (Street, Ci State~t ode) / / VIII. nun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (i eludes Groundwater Surcharge Fce) ~ n), ~ Date Issued ~ 2^ Is mg Age t Sign re ( mph.) SYSTEM r:Given Reason for Denial ~ .J~ vV ~ D / IX. o k4's p~ U fns Disapproval ~~y U `S' fJ.~ ~j.~ dispersal Dell must all ¢e serviced / maintained J l b ~ um ~~ as t3r. YY~ All setback requirements must be maintaine y ' ' r ~ 4 ~- U~ S ~ C -~ 3 S ~G1~7 ~ l ~/t`~ yS ~ ~ as per ~dpplicable code/ordlnanca~. / /'C. '><..~ ~-1< ~~ ~ ~bo0 ~Q t ~- ~ y ~~ ~ ~. ~~ _ A -~IS~.B ~ E~~ ~ ~~ , + X3'2 ,~ - ~ 23.2-~ 3 ~ ------, ~ u,cw~ ~i 9~~5 ~y ~;~ 13. ,~ 3~`-a-- -~~ ~..- 1 ~ `~ 3d ~~-~` 1 ~~ Zb I I9 ~( k~ S~ ~' 13 tip,- l ~~ ~~ C~ Tom-- ~,~ ~~' 3 Sy ~y ~~ ~-1<` ~ ~ 1 boo ~~ ', 1 - ~© G~ ~-~ ~~ _ ~ -~Igj.B ~3 ~~~ = ~~ + 232 23.2-~ ~3 ~ --~-~_. ~ ~U~ ~~ ~~~5 r S~/ ~~~ Tom- ~~ i3~ 3 V ~ l ~ `~ 3~ ~. ~ l ~~ Zb J~-~ S y ~ y ~~ ~ d Nov 16 04 10:58a Team Speer Hast 7153868660 p.3 ST. CROIX COUNTY SEPTIC TANK NZp,INTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner113uyer Mailing Address 7°7l~ ~+ C ~ ~~ ~~ R ~ Progeny Address 7 7 ~ ~l 11 !-R12.1~'t Rc~ {Verification required from Planning Department for new constrnction.) ~~f~ Parcel Identification Number ~ ZU " ~ Z~a ~ 7U ~ ~~~ ~CitylState ~ p $Oly ~ ~y L LEGAL DESCRIPTION '~ ~/ , JCS,(' 3d Property Location ~~ %s , lV ~ %. ,Sec. aZ7 , T ~N R 1 / W, Town of t,Crii 6 i !t!~ ~ + l (S ~! p~i•!ti' p F- I~U,DSG ~/ Lot # ~ Subdivision ~ Certified Survey Map # ,Volume _,~ ,Page # Warranty Deed # 7 7 ~ C~ ~ ~ ,Volume a ~ ~ o~ Page #. ~~e Spec house yes no Lot lines identifiable '~s no SYSTEM MAINTENANCE Improper use and marnteaarrce of your septic system could result in its premature failure to handle wastes r ut into maintenance consists of pumping out the sepric"tank every three years or sooner, if needed by a licensed pumpe • Y~ P the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owncr maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Zoning Department a certrf'tcatron form, sigaed by the owner and oum lumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal by a master plumber, j P action and pumping (if necessary), the septic tank is less than 113 full of system is in proper operating condition and/or (2) after tnsp sludge. d have read the above rrquirements and agree to maintain the private sewage disposal system with the Ilwe, the undersigne staadards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wiceonsm• Certification stating that your septic system has been maintauied must be completed and returned to the St. Croix County Zoning Department within 30 days of the three Year expiration date. ~~~~ ~ ~ S GNATURE OF APPLICANT ~i !~s! ~y DATE OWNER CERTTFICATION Ilwe certify that all statements on this form are true to the best of my/our loaowledge. Uwe arnlare the owner(s) of the ` ~ property de ribed above, by virtue of a warranty deed recorded in Register of Deeds Office ~~ ! js'-! OY ~~ DATE S GNATTJRE OF APPLICANT the Zonin ant. •"'"' .«ws.« ettnit bein revoked by g DeP~ Any inforniation that is misrepresented may result in the sanitary p 8 Include with this appiicatioa a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made iQ the warranty deed. j POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION (~ ~ Vh ~ ~ 1'l. D Owner J ~ L(,.S Permit # y ~ ~ a 3 ~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~~~ al/day Design flow (peak-, (Estimated x 1.5) ~ gal/day Soil Application Rate (> : S al/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG1 530 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) 530 mg/L A Fecal Coliform (geometric mean) 5104 c /100 Maximum Effluent Particle Size YB in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Page ~ of 2 Septic Tank Capacity a /o~ S~ al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ~ ~ ^ NA Effluent Filter Mode ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: A Dispersal Cell(s) In-Ground (gravity) ^ t-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: - earl 1(s1 (Maximum 3 years) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Ins ect dis ersal cell(s) p P At least once ever Y~ 2 ' 3 ~^ monthls) (Maximum 3 years) year(s) ^ NA Clean effluent filter S ~~ ~ At least once every: ~~ month(s) ^ year(s) ^ NA Inspect pump, pump controls & alarm At least once every: 0 ea~~s~1s) Y ^ NA Flush laterals and pressure test At least once every: ~ ^monthls) ^yearls) ^ NA 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 tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding 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 ~ of 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 cell(sl. If high concentrations are detected have the contents of the tanklsl removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or-must be taken, to provide a code compliant replacem t system: m' A suitabl replacement are as been evaluated and may be utilized for the location of a replacement soil absorption system. area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~~ T alua ' a o mg ank be ' e ai a ~fZU+~llB TIC ~i~ N~ ~-~NS7Rfl~ D~ ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. AnMr~nN~1 CnMMENTS POWTS INSTALLER Name ~~ U "r"I/Zb Phone . ~(~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ST. ~ ( ~j(/ti/ 20~l~J Phone ~lS- 3gC0~ i'o (~ This document was drafted in compliance with chapter Comm 83.2212)Ib)1111d)&If) and 83.5411-, (21 & 131, Wisconsin Administrative Code. Hov 16 04 10:58a Team Speer Bast 7153868660 p.4 ST. CROIX COUN'f~ ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the V 1,~-- residence located at: ~! ~_W, Town 1/, ter- '/4, Section _~~___~ Town ~ N, Range of ._~ 1_ -~ °^^ _, 5t. Croix County Wisconsln. Upon inspection, I certify that I have four utements of Comm 84,25, and it (they) knowledge, will conform to the req appear(s) to be functioning properly. /~~ -- /Q- Mostrecent date of service Did flow back occur from absorption system? Yes No x (if no, skip next line.) allons minutes Approximate volume or length oftime: g ---- Capacity: low ~_ Steel Other Construction: Prefab Concrete Manufacturer (if known): I ~~~~ ~ ~ s 9 Age of Tank (if known): / q ~ ~-r (License Plumber Signature) ~>~s~,~ ~LVrn r3~'rz_ (Title} (Date) (Print Name) (License Number) MP1NiPRS Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Vlfisoonsin Department of Commerce SOIL EVALUATION REPORT p~ 1 ~ 3 Division of Safety and Buildings • ni a~u+~amnz wpm a,cnnm oa, vvis. r+u~u. ~.uua . COY St. Croix Attach complete site plan on paper not less tha . include, but not limited to: vertical and horizonti~l n an p~ l,p, 02012907000 percent slope, scale or dimensions, north arrow, location and rstance to nears road. Please pant iT t/i- 3 zao4: ~ R Date Personal information you provide may be u ary (P acy Law, s. 15.04 ( ,r (m)). G U/Y~'~ Property Owner T. CROIX CO1J IPI%tp~Y ovation Tony Misura tV14~G.,OFF1 ~ SW 114 NE 114 S 27 T 29 N R 19 E Property Owner's Maiflng Address Lot # Biotic # Subd. Name or CSM# 776 Hillfarm 1 - Humbird Hills City State Z~ Code Phone Number ~Yrllage own Nearest Road Hudson WI 54016 1 6~2-730-5548 I-Iillfarm ® New Construction Replacement Panurt material Gerteial oommerrts and recommendations: * s with discontinuous 1 TO 2 inch bands of ifs, Osg, mfr, 7.Syr4/4 Bow # ®B~^g Pi! Ground surface elev. 98.90 R. Depth to limiting factor ~ in. ~ Sofl Rate horizon Depth Dominant Color Redox Description Texture Stivctiue Consistence Boundary Roots GP Dfl~ in. Munsefl Qu. Sz. Cunt Color Cx. Sz. Sh. `EN#1 'Efkf2 1 0-6 10yr2/2 - 1 2msbk mfr .as 2f .6 .8 2 6-20 1 313 - s0 2tnsbk ~' cw if .6 .8 3 20-98 7.Syr4/4 - ` - s/lfs* Osg mUmvfr - _ ,g* 1.0* 2 Ong # ~ © Bonng 98.00 >98 Pit Ground surfxe elev. ff. Depth to limiting factor i^• Soil Rabe Horizon Depth Dominant Redox Descxiption Texture Stnx~ure Consistence Boundary Roots GP D/lt? in. Mansell Qu. Sz Cont. Color Gr. Sz. Sh. 'Etf#1 'Eif#Z 1 0-11 10yr2/2 - 1 2msbk mfr as 2f .6 .8 2 11-18 1 3/3 - sil 2msbk mfr ~' if •6 .8 g 18-98 7.Syr4/4 - ~fs* Osg mllmvfr - _ .5* 1.0* • ~ ~~ ~~~ Effluent #1 = BQD > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BOD 30 mgA_ and TSS < 30 mgA. CST Name (Please Prirrt) - - Srgn ~~'~ CST Number Thomas C Nelson 227387 Address Date Evak~tion Conducted Telephone Number 1432 120th Street, New Richmond, WI 9/24/04 715-246-2454 Use Residential / Number of bedrooms Public or oomrrreraal - Descnbe: , Loess over outwash sands Flood Plain elevation if applicable )V:4 ff. Code derived design flow rate 750 GPD Property Owner ~ Parcel 1D # 024127000 Z 3 Page of a U ~~g ~~ # ~ Pit su~elev. 97.70 ~. r ~ >104 ~. ~ Ra~ t Depth Dominaari Redox Description Texture Stnxxure CAnsi~noe Sourrdary Roots GP D1lC~ ~. Mansell 12u. Sz. Cont. Color Gr. Sz. Sh. "EtT#1 'EtTA~'L 1 0-5 1Oyr2/2 - 1 Zmsbk mfr as 2f .6 .8 Z $-11 1 3/3 - sil 2msbk mfr cw if .6 .8 3 i1-25 iOyr4/4 - sil 2msbk mfr cw if .6 .8 4 25-39 7.Syr4/4 - gfs Osg ml cw - .5 1.0 g 39-1 7.Syr4/4 - s/lfs' Osg mUmvfr - - .5 1.0 Pit Ground surface elev. ft. Depth to um~g factor _,,~ in. Soil Rage o~ tforizon Depth Dominant Redox Deecrip~rr Texture Stnxx~ae Cor~tanoe eotrrdary Roots GPDI~ in. MunseN Qu. Sz. Cont. Color Gr. Sz. Sh. 'EtF~1 'EtR~ Pit Ground surtaca elev. ft. Depth to limiting factor in. a~ SoN Rate Hatimn Depth Dom~nt Redox Description Texture Struc~e Coneistierroe So~urdary Roots GP in. Mansell Qu. Sz. Conk Color Gr. Sz. Sh. "EfHl1 'Efili2 * EiflwM ik! = t3OD5 > 30 <_ 220 mgli. and TSS >3ti < 150 mglL ' Event #2 = BOD, _< 30 mgit. and TSS 530 mgA. Tie 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 608-266-31ST or T-fY 608-264-877'1. SBI}8330Tat (8.07/00) Tony Misura Lot 1 Hunnbird Hills ~~ ~1 ba: V iw~~. S1ii'~p ~dl eow 1~O.iR ~ Ttp of dr~ia IIN+! vfa 104.x' B'10M.00' ~ 07,x' T#~ona~s 10~an ~~ , +~' ~~ ~~' 1~ Mov 16 04 10:58a Team Speer Hast 7153868660 p.2 ~l :U, 2682P y69 Document Number STA'fF. BAR OF WISCONSIN FORM l -2000 WARRAivTY DEED This Deed, made between Anthon M. tati.sura and Debra L. Mi:sura husband and wife i Grantor, i and Nen Vue and Ba Van Vue husband and rife as survivorshi atarital o e Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St . Croix Cotmty, State of Wisconsin (the "Property") (ifmore space is needed, please attach addendum): Lot 7, Humbird Hills, Town of Hudson, St. Croix Gounty, Wisconsin 'T7E3@3~ KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIH CO. , KI RECEIVED POR RECORD 10/25/2004 01:40Ptt MARRAI!{TY DEED tzf~P; i REC FE£: 11.0Qr TRANS PEE: 829.10 CQPY FEE: CC FEE: Recording Area Name and um Address Title pr ~dltut Realty Title 7os 19 eet so44Q~.S. 2nd St.. #115 stud isconsin Gn, W154016 _ ._._ ,is~~/ Together with all appurtenant rights, title and interests. 020-1290-70-000 Parcel identiPteatron Numbcr(PiTv) This ~is _ homestead property. (is) {is not} Grantor warrants that the title to the Property is good, indefeasible in fee simple and flee and ctear of encumbrances except Roadways, Easements, and Restrictions o~ Rsacord. Dated this 8th day Of Oetaber 2004 , +p~ M. Misura • AUTHENTICATION Signature(s) authenticated this day of ~_ ~ S M 'TITL1;: IVIEM131s'R STATE BAR OF WISCONSIN ([f not, authorized by X706.06, Wis. Stets.) TtI1S RJSTRUMENT A'AS DRAFTL•D BY rtictta®1 x Eorwcki Attorney i. ~,~i~,u~-~ *Debra L. Misura ACKNOWLFI)GMEPiT 5TAT'EOF WISCONSIN ) ss. St ~roax County. ) Personally carne before me this ._ 8t1z day of October 20 4 the above named p~_rhnnv M Mig~ir~ and L. to me known to 13e the person s who executed the farego" ' strume t an ackn d the same. i ]. Notary P ic, State of Wisconsin My Commission is permanent. (If not, state expiration date: +Names of persons signing in arn• capacity must bt typed or printed below their :signature. FORM i~o. I-2000 WARRANTY DE£D STATE 8AR OF VIISCOA151W ttorne} 4(rehael N Potedri 3432 Oakwood Hills Plory Ste 1, Eau Claire wI 54701-7928 t6oy39x5.7.fX Phone: (7 i 5) R35-3024 P,oduc~ wsei ~~,a ~ RE ~Ca„nyryyl!LLCe1t1CI;5 Flnewn Mia Road, crayon Townshp. MiCrlipon +eocis. (800t 3a3~BC5 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SA~1 M l C LE/2 ADDRESS 13D X # Z QZ. Ny~ S o iy c.~s s%~~ SUBDIVISION / CSM# ~y M D 1 IZ~ H ~ LL 5 LOT # ~ SECTION Z 7 T z-4 N-R / 9 , Town of N U .DSQ 1y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y~ ~~ I ~~Ir~ \°j'~` hE- ~o~ ~'---~ ~~ o_ - - - i. __ ~ ~TC-RNH7 ~ AREA L~; 7d E l... 9 ~, DD G A~2d 6~' z`~ y3~, ~- L ~ Nousk • , ,,. ag'w Sc,' W ELL ~~ \\~ 13 ~ ~ <o Z 's b~ i_ L I3 M, s~ikF ~K oit+c ~~ , Tk~~E E-../oo.ao" W ~r.._.______._...._._ ._.._._....___ ._ _.._._ SO ~ T i1 /O T / iiY` INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: 5P/ktr IN UAK T'-Z~E ~~V. = lOd•OV ~~ 9.`~~' ~ ALTERNATE BM : T ~ ,E / , 13 . D ' - Z • 7 z / Toy ~ Nr~~ol~ ~., C ,.~~ SQ.~, ~ ~ ao.- Z SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: wE/sE R Liquid Capacity: 1boO Setback from: Well ~B ~ House I S~ Other Spu`f L. ~ t /; ~~ 7p Pump: Manufacturer' Float seperation Alarm Location -- Width• ~~ Length Model#- Size Gallons/cycle• - SOIL ABSORPTION SYSTEM ~ O Number of trenches --- Distance & Direction to nearest prop. line: (oS • to Sok--'~^- lc~" ~~ ~~..._ Setback from: well: 9 D House y4~ Other Building Sewer r t ELEVATIONS R N ~~~?IE - 10-'36 = `~~~~ M ~~II , ST Inlet ~b,']S = ~y.~o~ ST outlet ~~ ~l~ r I _/. t~~ PC inlet ~~ PC bottom Pump Off Header/Manifold-- Bottom of system- Existing Grade ~, 3 ~ Final grade 7. 3 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: i~1 ~~~ Z ~- INSPECTOR: 3/93:jt LQt~~T~~~,~~~ • 29.19W, PRI~'/ATE ~EWi4G~ ~YS~EM Farm Labor a;+d Human Relations INSPECTION REPORT ` KSafety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: ^ City ^ Village ~ Town of: S }ev.: ~,r~ Insp. BM Elev.: BM{D'escription: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Ll~, a ~ <' / ~.tr" ^' ~1~;~~:~~' Dosi Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic ~, ~ ~ (~~ r ~~' ~ ~- NA Dosing NA Aeration Holding - PUMP /SIPHON INFORMATION Ma ufacturer Demand Model Number GPM TDH Lift Lriction e m TDH Ft Forcemain L Dia. Dist To well SOIL ABSORPTION SYSTEM ELEVATION DATA nitary Permit No.: ax A9400048 5/aS STATION BS HI FS ELEV. Benchmark `,?~c~ ~ ~ ~, ~) ~ Bldg. Sewer St/ Inlet /d 3s ~3 ~ St / Outlet ~~, ~ ~ , G3 J Dt Inlet Dt Bottom Dist. Pipe Z ~ ~ l~~ ~~/ Bot. System / 3, 37 9~ ~~i~ Final Grade ~ 5 ~ 7 ~ d~,0~ ~~ ~ /D ~ n , `35 BED /TRENCH Width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N ~ ~ DIMENSI N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHIN Manufacturer: SETBACK INFORMATION TypeO f r i / OR UNIT Model Number: System: 4; e.~~ ~ (oS~ ~9 9d DISTRIBUTION SYSTEM Header / / ~" r Distribution Pipe(s) r~ ~ ~ x Hole Size x Hole Spac Vent To Ai Intake Dia. Length ~ Sparing Length ~ ~ Dia. SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys s n y Depth Over ,, ~i Depth Over y xx Depth Of x eeded /Sodded xx Mulched Bed lzr~.Center ~ ~~~ ,/ Bed J Edges ~ ' 'rte Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: dson.27.Z9.19W,~SW, NE, Lot~7, ill, Farm Road r Hu ~ ~ L J LCD ,~'~ ~...~. ! 2-~ Gtr`-P ~;' y, ~"- ~: ~ /r~-.' ~ ~ ) ~ J' Plan revision required? ^ Yes Use other side for additional information. ~ ~ ~---~ SBD-6710 (R 05191) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' ~~ CAI~IITARV DFRIIAIT ODpI Il_OTIAN r'i~l~.i iAi -- -- -- - - -- - - - -- ----- - - -- - - - - - In accord with ILHR 83.05, Wis. Adm. Code ~ . couNTY St. CR.6~x . -Attach complete plans (to the county copy only) for the system, on paper not less than STATE SANITARY PERMIT # ~~ g 1°Zi~ 8'/z x 11 inches in size. ^ Check if revision to previous application wee reverse Slde fOr InStrUCt10f1S for COmpleting thlS appllCatlOn. STATEPLAN LD. NUMBER I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 5 LLB 51.~'/4/1/~ 1a,S Z7 T Z9,N,R / E(or PROPERTY OWNER'S MAILING ADDRESS # LOT # BLOCK # zsz ox 7 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER u DSo hl ~,,~~ S o/r. s~lre z7 69 U M Q 1 R D ILLS II. TYPE OF BUILDING: Check one CITY ~ NEAREST ROAD ( ) ^StateOwned O VILLAGE'„'vDSQ~ I.11~~ FARM Rol~D ^ Public ~ 1 or 2 Fam. Dwellings of bedrooms 3 ARCEL TAX NUMBER( ) 111.. BUILDING USE: (If building type is public, check all that apply) ~ Z O ~ 1 Z (~ O , '7 ~ 1 ^ Apt/Condo 2 ^ Assembly Hall 6 ^ Medical Facility/Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ .Church/School 8 ^ Mobile Home Park 12 ^ Service Station/Car Wash 5 ^ Hotel/Motel 9 ^ Office/Factory 13 ^ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ~ New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an System System Tank Only Existing System Existing System B) ^ A Sanitary Permit was previously issued. Permit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ~ Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 Seepage Trench 22 ^ In-Ground 42 ^ .Pit Privy 13 ^ Seepage Pit Pressure 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE ~/ REQUIRED (sq. ftJ PROPOSED (sq. ftJ (Gals/day/sq. ft.) (Min./inch) ELEVATION O ~ S ~ - Sv . 7 / 7 Z (o y S , dU Feet 1 B. DO Feet 7 VII. TANK CAPACITY in allons Total # of ' N Prefab. Site C l St Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks ame Manufacturer s oncrete on- d ee -glass App Tanks Tanks structe Se tic Tank or Holdin Tank X /CJV O / (11/Q.~ S d:r Lift Pum Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on!the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's dress (Street, City, State, Zip Code): (S'OX ~ /Z Z rvw R.~G.lt IYI aN ~ w-t SS~O/ IX. C NTY/DEPARTMENT USE ONLY ^ Disapproved Sanitary Per ee (includes Groundwater ate ssue Issuing A e i nature ( Stamps) Approved ^ Owner Given Initial ~5,`{'~ Surcharge Fee) ~ 3 ~~ Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. " 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VI1. Tank information. Fill in the Capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// septic, pumplsiphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than Sf x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C).complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump pertormance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) Wisconsin Department of Industry, SOIL AND SITE EVALUATION R E P O R T Labo;a~d Human Relations Division of Safety & Buildings __~ ..:,~. ~i ~ in nn nc ur:_ nom..., n_~_ Page ~ of • .....,...,,..........~. ,...,.,..,,,, ...... , ........,,,..~ COUNTY ~? ~ Attach coraiplete site plan on paper not less than 8 1/2 x 11 inches in size Plan must include but ~ ~ Ik , . not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION O ~ REVIEWED BY DATE PROPERTY WNER: PROPERTY LOCATION ~ ~-lt ~ GOVT. LOT SW 1/4 /J ~ 1/4,S z7 T z9 ,N,R / 9 E (or) W PROPERTY OW R':S MAILINCc~~DDRESS ` LOT # BLOCK# SU D. NAME OR CSMM~~ ~ T~COU7 ,~~ ~o~fl 7 uM f~l~ /-I1LL CI ,STATE ZIP C99DE PHONE NUMBER 1 ^CITY ^VILLAGE OWN N AREST ROAD asa,J ~ ~ 5 0l6 (~~s) 3s6-~~ h uf~o~ ~~a~1+~5 ~([ New Construction Use [~f Residential ! Number of bedrooms .3 [ J Addition to existing building j ]Replacement [ ] Public or commercial describe Code derived daily flow S~ gpd Recommended design loading rate ~ •~7 bed, gpd/ft2 O ~ trench, gpd/ft2 Absorption area required b4s • -bed, ft2 S6S trench, ft2 Maximum design loading rate ~•~ bed, gpd/ft2 ©~ Vench, gpd/ft2 Recommended infiltration surface elevation(s) A= 9S•~ 6= 9q •O~ ft (as referred to site plan benchmark) Additional design J site considerations Parent material Flood plain elevation, if applicable ft S =Suitable for system CONVENTIONAL S ^ U MO ND ~S ^ U IN- ROUND PRESSURE C~S ^ U AT- RADE L~S ^ U SY TEM IN FILL ~S ^ U HOLDING T K ^ S U U =Unsuitable for s stem ~ . SOIL DESCRIPTION REPORT Boring # ~r~~ r~~~.....:::;>; Ground elev. /Ol. Osft. Depth to limiting Ufa t~or _ Boring # pyj4 a;4 ~ ~5 n:`•~ ' ': Ground elev. /~0~ ft. Depth to limiting fact r >9~z H i Depth Dominant Color Mottles Texture Structure Consistence Botrtdar Roots GPD/ft or zon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trertdi A - 6 /byre 2/ °r L I b 1C r C 2 O.S ~ 6-/S~ 1 ~ z Z L 2 sbK Z p.~ p 6 $ ~S-~ /oY~ 4 - S, ~ 1 sbK Mv~- ! A•z o.3 gx S /D ~ 4 3 ~ StG,~ r ii'--- ~ ~ ~ 0.7 p.TS Remarks: $, -Z9 /0 4 3 - Sal z sbK M~~~' c ~ ,s 0.6 i8Z -~t ioy 4 - S M ~, l 1 0.7 a g Remarks: Name:-Please Print Phone: ~~~, U~Sr.~,.I ~ I -- Signature: ~'Q''1 Date: 3// 7~7 Number. 3484 PROPERT~OWNER~~m M'~L'~' SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # L6'f' 7 /" ~ y M B r >e D Boring # ~w< `~ ~ ~~ <.~ j\'.ar Ground elev. / OO.S~ft. Depth to limiting factor > l0.00 Boring # •.4i `~'~ 4G ~:; {tt. '~ `, ~' k~. ....•W~ti~.•... ~:•::• Ground elev. 99.2-dit. Depth to limiting ' f~Ct~ Boring # 6~.3ti{~~..>.: i ~ ~\ i4v }i'i 4ti; £: }:: ~4:vvti ~::: i`Cn~n+ih`:i~ji~ Ground e ev. IZ ft. Depth to limiting ? f~t~3 Boring # ,,*'~' ,~• {'r ';:. t..;oi::: Ground elev. ft. Depth to limiting factor H i Depth Dominant Color Mottles Texture Structure Consistence Botx~dar Roots GPD/ft or zon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trench -,z y~3 I - ~ 1 sbK m r z o.9 0.5 z r2•Z4 /bY~23 Z - L Z sb~ ~,~-' e Z O.S p,6 $- ~-37 /av~ ~ S,C. J M s6K .~ r~vr' c i p? 0.3 $~ ~~~ /aye 4 3 _' S~r2 r /1? ~ C ~ p 7 OTb Remarks: ~ 14 /0 3 Z ~ L l n., sbK rh-~r e Z 0.4 o.~ ~~ ~ -~ IOy,~ 4 3 ~ 5 ~L 2 ,ti, sb~ rh~vr~ C. I p.5 O.~ ~z -117 /d ~ 4 S ,~, r ~ J 1 O? O•TS Remarks: Q 0-JL /o ~3 -- L I r~ sb~ ,~Str C Z, .4 ~ O~ 16-3A~ /oy~cq /3 ~" SQL Z rr, s~K rh~vi C ~ 0.~ Q.6 Remarks: Remarks: SBD-8330(8.05/92) ~ ~ V~ .Q M ~, y • Q w c Z ~ ~ t ~ rr- ~~ \ ~~ 1 1 ~Q 4r W ~ r Y {~ ~~ '~r ~ ~ '.~ v~ ~N_'~~~ ~ ~~ ~ ' ~~ ~ ~o ~\\ 1 Q ~ ~~ r~F ~ ~ `M~ ~ ~ ~~ 1 Q 1 Cr•~ ~ P~ ~ .D F- ~ OO, ~~ ~) ~Q~ 1 ~'~ ~ ~'o l ..J l ~a ~ ~ ~ I ~ ~ ~ ~ ~ `~ ~ ti) °. ~ ~G 7 ~ r ~ ~., J ~ W W .' SI 4L D ~ ' Q ~ W O ~ ~ ~ ~ ~ r~ J Z 0 v 1~ SAM /Y!ILLE,C l~uM 1318 D HIILS LoT#7 ~p ~ M., S~'IKE I~ 'T'REE ~-. = 100.00" ,, I -w' Lor'~ z s ~~'~ ~ ~.., ,,~ f ,,~',„~' <<~~ Ii c ~,' ~ ~. ~~~ , ,- Q ~t,~o s~ti I ~.'~° Mibl \ ~~~'~ Phi .ZOd ln~~(~I .~' Rai ~ ~~ 5` J ~~Ll ~ o ,~-: F P a` CT ~ p SE 4r 0 ' ~ ~ ~ $ x so' -~L ,, ,i.,- ~ j ~ ~ra ~ 1~ i i; ~y~czU~ ~ w ~ ~, ioo v ~~ ~ S O I ~ t ys o ` M i Q- • ~ ~ , ~ RE A ~~~ ~ ~ SLnfE_ _ ~ ~ ~ __ ___- 3~~ ~ ~3~ Ho `' ' ~ .Z Ei~ q~loo ~ ~ B' ~ "°~ '~_--- ~ icy ~ ~, ~ ~~~ i ys~ `~ 3 ---63 -~ \ LOT # 7 $•M,_ SPIKE IN , i oA K TREE E~•=~~00 ! Sysfs++a ELEVRTIoNs I o ~ = 95.00' a Q .~'~ y ~ ~'~ ~ 170 ~ ~ ~ a ~ 1Z bbd I~(/E'sT" [oT L /Nt 33a' (~/v Sta1Q~ ti. i l~ '.R2 ~-~ ~. ~. `E z 0 z ~b ao rn O -o b m n ~ -_~ : 0 ~ z ~ v -o v m W a ^^O X V/ T ~~ ~ w N s~ o ~, ' s < ~~ < ~ ~ ~ ~ v ~ o z ~, > .,, ~ ~ a m r ado ~ ~ -o m z z -v 0 Z '~ `~ m J ~TT ~~i T O o ~o ~~ z ''' c~ ~ w -.~«-- rn ~~ z -~, S~ x O O vW TO ~ X '1 ~ "~ V ~z C -o r~ GI w Ih ----- --~ ~ ~~ i ~ ~ o. ~~ 4 I ~' ~" I -n I ~ ~ I '~ o ~ ~ -i ~ o ~ ~ ~ ~ ~ I ~ ~ ~ I R1 ~ ~' rn ~ w ~~ ~ o .~ ~ ~. I q I ~ I ~, 1 I v~ I ~ ~n I o ~ ~ n~ ~ '~ m I f ~W I w j ~~ I I ~_ c,~ N N 0 ~~ ~Y = m O r m ~ `o m vl STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croiz County OWNER/BUYER S•4 /-'1 /VI / L LF~ MAILING ADDRESS B ©X ~ Z 8 Z- ~ u d Soh l~Z Sr/O ((o PROPERTY ADDRESS 7 7Co HILL 1= H K M RO !¢ D {{ ~ ~ se ~ W ~ S S/O /6 (location of septic system) Please obtain from the Planning Dept. CITY/STATE (-~ v ~ S ova l~ Z S"~/O~~ PROPERTY LOCATION S w 1/4, /~ ~. 1/4, Section Z 7 T~_N-R W TOWN OF ~I V D ~ n 1V ST. CROIX COUNTY, WI SUBDIVISION N~~ I RD t-~ I LL 5 LOT NUMBER ~_ CERTIFIED SURVEY MAP ~/9 7 / 07 ,VOLUME S ,PAGE 9 9 ,LOT NUMBER 7 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60%. of the cost_ of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying. that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: ~. i' ~ / ~.~~.~~ DATE: 3 ,~ ~ 7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 T C - 100 • This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- owner of property SA/YI /1~1 /L,L ~2 Location of property~l/4 it E 1/4, Section Z 7 ,TAN-R / W Township_~UD.SoN Mailing address BoX~ZBZ H~~(SO~ c~T SyU/~ Address of site. ']~(~ ~i // ~a/'r{1 R o a ~. l~F~dsov~ c.~; ~ 5 yD/~ Subdivision name (-l vM BI 2D I-FI LL S Lot no. ~ Other homes on property? Yes h' No Previous owner of property Total size of property ~{,,rn 6~, r ~ La.r. ~ ~.o. Total size of parcel ~.aco~f f4 c. Date parcel was created -7 - / Z- ~J3 Are all corners and lot lines identifiable? ~_Yes No Is this property being developed for (spec house) ? X Yes No Volume 10 2/ and Page Number Z S Z as recorded with the Register of Deeds. A WARRANTY NUMBER AND certified delays of references shall also PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 5 ~ z Z o 9 and that I (we) presently own the proposed site for the sewage disposal system` or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. .So Z z o 9 Signature of Applicant Co-Applicant .~ ~ 7- ! ~ Date of Signature INCLIIDE WITH THIS APPLICATION THE FOLLOWING: DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE THE SEAL OF THE REGISTER OF DEEDS. In addition, a survey, if available, would be helpful so as to avoid the reviewing process. If the deed description to a Certified Survey Map, the Certified Survey Map be required. Date of Signature _ .- _ _.. ~ .- .....e. DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-1982 TNIS •rwce Reseaveo ron neconolNa DATA WARRANTY DEED - 5~D2~~~ von ~EGisrtr~~s or~ic~ - sr. c~o~x co., avr Thais Deed, made between ..Humbird. Land Corporation, R::c'd for r;~cord A.Minnesota.-Corporation authorized to do business . in -Wisconsin . .....:......:..::...•-•---•-:_ .::_._:.: :__.:........-------------..:.....__. ~ U L ~. 2 1993 ._. ._:: .... .... _... _..:._, Grantor, , and Sacn E..,_Miller i3t 4.20, r? ~ ~A /~~" Reglstar of Deeds ........:: ...............:...:..............._.. .....-----------------------... _ ._:..__ ., Grantee, _ _ Witnesseth, That the paid Grantor, for a valuable consideration_._._. ._ ~ conveys to Grantee the folloanng deaCrrhed real estate rn $~! CIO1X RCTU RN TO _ - ~.~ '- . ~1 County, State of Wisconsin .:- .~ . - ~~~~ ~ .. a .,;Lots 1, 2, 3, 4, 5, 5, 7, 8, 9, 10, 11 and 12 in the Plat of Humbird Hills, Town of Hudson as filed Ta: Parcel No : ................................... :and recorded in the office of the Register of Deeds for r'~-St. Croix County on April 7, 1993 in VoI. 5 of Plats, Page :'99, Document No. 497107. .~ , . .. - ., ~ . ~ .. :.4 ' ,. Lots~T13, 14, 15,~16,~17, 18, 19, 20, 21, 22, 23, 24 and 25 '"in the Plat of Humbird Hills 1st Addition as filed and recorded .=- in the Office of the register of Deeds for St. Croix County on ,;April 7, 1993, in Vol. 5, Page 100, Document No. 497,108. _p,. .; ~, L ,_ _ ~, .~ _ c~'~ o °~' `~~ ~ ~ p This _......J.~..AQ1a.,:..... homestead property. (is.) (is not). , _ Together wi'h all and singular the hereditamenta aad appurtenances thereunto belonging; And.._Kuolbi.><d..Laasi..~^.~.~QC~i~an.----•-----------••---•----•---------..: .............................................•---•-•---........ wazrants that the title is good,'. indefeasible in fee simple and free and clear of encumbrances except easements shown on the above mentioned plats. a.., -, -~ and will warrant and defend the same. Dated this ........12th.....:.::: .:..::.:::............ day of ...JulY.......---•--•--.._........................._.:..........., 19..93... Humbird Land Corporation, .a Minnesota Corporation authorized to do business in Wiscons ..... .:.. ....... .....: .. ......:... .............(SEAL) BY....c%%'~. ..._ ...........(SEAL) . ~ Austin J. Baillon, President ------._ (SEAL) ... (SEAL) ._.. s ~ AIITHENTICATION ACHNOWLEDGMENT authenticated this :_._:_..day of ........................... 19...... TITLE: 1KEMBER STATE BAR OF WISCONSIN- (IY not . ..............................:.....:..........•-----•--.... authorized by § ?06.08, Wis. Stats.) THIS INSTRJ`AENT W.qS DRAFTED BY .Kueppe r:s r..Hacke L _.&.%uepReLS---------------------•--- .1350-.Gapi tal._Centre,...St...paul,_.MLZ..55 L02_ STATE~~//Off~F W/ISCONSIN ~Y..~:.5,~ . aa. ..---------- -•-•--.......: County. Personally came before me this ...... ~~.~day of .._..____.,Is~;t°-.......---••.-.--..., 19..9.. tha abbbe•'t+gtned ~• --------------------------°--:....:................. .t.1 ~...... ~..~. . -_. :.... .__AA9~.7.A..~T:__Ba11Qn,_•Presiden~.o'f :•';~;~C~~,~ v- -- --- ---k~1l~lbi,Fd--i*agd--~grporatoR'..:!.::_.~.1.~:. '' ~ ~' to me known to be the person ...._.._ cJ kvh~e,)cecuted t1lC f foregoing ' strument and acknowledg~~Pre safnd Q M,: tl~liN b. N~Y~D'Q.a....;i~ ! Notary lic ._..J~...T.... ~ .Q.I.~........._County, Wis. .. 3