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020-1307-60-000
n cn O n v, O n cn O g T n c ° c °: c m o 3 A 3 A fD .3. N! h 'B i 3 3 I '� Z (- n z o N) O (n Z m z o A Z z ° CA) C7 2° C fi • �5 N c f� < c 0 ww N a c 3 u, c d a -� (o o m 3 m o a m m o �° � y m CD 00 (D a r,3 Q ft* p C N ? V O. co 0 0 m O p ° ' Q v N 3 m (7 J o m Co W CD O n C O I C n N h � O a : o D °' o a s c o p U) N N N Q N N "' ° C i O y N Cn y C ] !V Z D a p m , v A a N Z D o a CD r r CD x a re, D o. CO _ _ u c ..2 C CD C M p C -.4 - O 0 r ° �, d c - - W o N i Z O N '• N CD M. o �° c m o o m o m n r N rn° N o o? c o IZ CD O O O Z O O O c 0 0 0 0 l l y i i l h -i - c 1 -I A o -I - o h -I - c co 0 N° n � c y CA co — N fn 0— c c 6 '0 O _O 0) ° m e _0 O _a CC c a 9 O O Q• •� N N N N 7 N (D N < w N d CD ' J p, N A 77 O c m T W d 7 m a a ` 3 z 3 D Z -i* Z ° Z G) Z Z Z a O - - o 0 0 D _ - D m D CD fl 0 v O <- O 0 h Y m p h a s (D s �y m � m ° ro m � � cn m �• m m m e y c CD - p (D c w CD a m 0) m m m a w ro m a to a CD 3 m E a 3 m 3 E m o (n - n O n n C O C Y �. CL a A C j 0 Cn -i N WT oov aoT mrj" a `° a fD 0. z 3 0 3 0 3 A ° o ° o r o m co 3 3 3 y Z y Z tlr z A CD co A A A N CL N 0 O Q m Q 3 ° °BCD 3 n 2 cn N . C N W C X N C X M z c m O z c o z a CD o 3 0. o a a N ° o m N o o m T f N 3 cn a ?7 m 0 0 o Ln co , ° OD v w m N go = ",< 'O O N O (SD O m 3 P N - (v � ("-'ate � 00 3 x ma 0 A � 0 C) o o b CD m m x v cfl O O s> O o0 o : o g o :� V r WisconsiNDepartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430019 0 ATTACH TO PERMIT) GENERAL INFORMATION ( State Plan ID No: Personal information-you providA may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Wastrum, Ryan I Hudson Township 020 - 1307 -60 -000 CS_TB M Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 0 b , PV GB1,, 27.29.19.1538 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ash Dosing Alt. BM A- r p.23 a lo. o Aeration Bldg. Sewer D i "44 LZA1 4OU / &PrJk YO. 2 3 Holding St/Ht Inlet 2&.2 TANK SETBACK INFORMATION St/Ht Outlet TANK TO /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic l // Dt Botto Dosing � j yls Header /Man. � t Aeration Dist. Pipe j. q / r7a 0 Holding Bot. System g 2 Final G rade PUMP /SIPHON INFORMATION &,,z / Manufacturer Demand St Cover i GPM pp S &l e& Model Number TDH Lift Fric Los System Head TDH t Forcemain Length Dia. Dist. to Well SOIL ABS RPTION SYSTEM BED/TRENCH Width / 1 Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth qn DIMENSIONS j SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING anuf INFORMATION T CHAMBER OR y e Of System: / / UNIT � - n � � 1 1 / Model Number: IBUTION SYSTEM /Q I q 4 o c _ ft� S pQ C A ,.h� Bader/ anifold Distribution x Hole Size x Hole Spacing Vent to Air IF / u Pipes) �f Length_ Dia Length Dia Spacing i __ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over / p h Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center rench Edges Topsoil 0 Yes 'f No Yes s No COMMENTS: (Inc ode discrepencies, persons present, etc.) Inspection #1: / 2� / -1 Inspection #2: Location: 731 Oriole Lane Hudson, WI 54016 (SE 1/4 SE 1/4 27 T29N R19W) Humbird Hills Lot 61 7 K Parcel No: 27.29.19.1538 1.) Alt BM Description = (.f wM7- eot•Uf /- /,� Mk4,R__ �[,t r,�'1�f//fl p �_�/ � _�_ e 2.) Bldg sewer length = 3� /— G _/V 1k, - amount of cover Plan revision Required? ] Yes No Use other side for additional information. SBD - 6710 (R.3/97) Date Insepctor's ignature Cart. No. 4 \ a Safety and Buildings Division Count ` m as 201 W. Washington Ave., P.O. Box 7082 ` ,sCO�s,� Madison, WI 53707 — 7082 Sanitary Permit Number (to filed in by Co.) Department of Commerce (608) 261-6546 O� Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide / may be used for secondary purposes Privacy Law, s 15.04 ject Address (if different than mailing address) I. Application Information — Please Print All Information RECEIVED 31 Pro Owner's Name M r 2 7 2 U LY3 tercel # t # ( Block # btu Property er'sMailingAtldress ST. :r< — ` Location ZONING OFFICE �! ` Section X7 J 1 ► ' /., City, S Zip Code Phone Number Y., (circl It Type of Building (check all that apply) T Nl; R ir o V IKI or 2 Family Dwelling — Number of Bedrooms Subdivision Name CSM N rob% ❑ PubliclCornmeociai — Describe Use ` k 41 ks ❑ State Owned — Describe U A ❑City ❑Village �fownship of $p NJ III. Type of Permi . ( eck only one box on line A. Co plete the B if applicable) - 3 YNew Sy ysc ❑Replacement System ❑ Treatntwt/tiolding Tank Replacement Only ❑Other Modification to Existing System e B• ❑ Permit Renewal 11 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 appl Non — Pressurized In -Ground ❑ 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 ❑ Leaching Chamber ❑ Drip Line Gravel -less Pipe ❑ Other (explain) i V. DispersaVrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required sf) Dispersal Area Pro pos (sf) System Elevation C9C� .7 g5•-� des VI. Tank Info Capacity in Total Number Marfufacturer Pre9b Site Steel Fiber Plastic Gallons Gallons of Units Coricrete Constructed Glass New Existing Tanks Tanks Septic Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement - 1, the node same responsibility for lusiolisdon of the POWTS shown on the attached plans. \ Plumber's Name ( P ba Sign /MP Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) s A0 le N t c n Aj Vin. NMEV /Department Use Onl P KApproved ❑Disapproved Sanii��Pee Permit Fee , (includes Groundwater Date Issued gg t Signa o Stamps) ❑ Owner Given Reason for Denial ) 4? IX. Conditions of Approval/Reasons for Disapproval coo�� s«�.9 VR�r. to SYS �'►S�►X� -'6+,. �Q �,;.K �u oJ,� �I ( d a — �- /a o " ht s S 5 w v tCQ / in.t c5 d itedC 4 v, ee a �U.x.� Attack complete Plans (to the county only) for the s on papa oat less tk a stn x I1 Inches I■,lae 1- - v ,,�.,,,Q--1, IV SBD -6398 (R. 08/02) ot I Ci�►S �. o h �c I 1 - - __ Oct dot I : I #1 , :54 D6- NO ! i I I I - i I 1 ; 1 , i I I ; I ! 1 7r I I I I I f i I I I i I I 1 � I � I I t i r � I 1 I /D3 ' - -- I i I 1\� : : I l a Y` I , P o �Q� 2 STr ut r l e d oZc/N! � 'I (p JCL°S; o [� lCc h¢. u� c� ►� _S T' �.p � �C C ) 1 Aso �CQ.s CGIQ,cS SAC: n +�rp vv g 1h ' �� +� Sw �o`f Cc�r�v✓..< 10� Poo Na, i o ql Qs 1 � r r s C OPY wiisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page I of 3 Labor and Human Relations Division of safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY s' c� o�•X Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.O. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R EWEDBY DATfi2 OT F NER: �vt�� /,PQ 4f1/. �¢�vD O PROPERTY LOCATION % 0 C - GtiA - y GOVT. LOT S E 114 1 /4,S Z 7 T Z9 ,N,R /f E (or) W NEIT:S MAILING ADDRESS /yi8 dip �? �/` LOT t BLOCK t SUED. NAME OR CSM # ►�lIS (Ptins� 3 , ZIP CODE PHONE NUMBER QCITY �1IILLAGE WN NEAREST ROAD / uL -fN• 55101 (G/2) 2- 2- 2 +1UV-50ti New Construction Use [ ki I Number of bedrooms Addition to existing building I 1 Replacement [ ] Public or commercial describe a- Code derived daily tow e -a2- 9Pd Recommended design loading rate / bed, gpdd/0 ' Vench, gpoltt Absorption area required -"' bed, 0 � trench, ft Ma)dmum design loading rate :� bed, W/O ' -p trench, 909 Recommended infiltration surface elevation(s) J P c . S It (as referred to site plan benchmark) Additional design / site considerations Z/SF cv uE8 TIf'f 5 O-y S 4 oil Dip Parent material 54.5 - s.>�rT,�� Flood plain elevation, if appiiFable It S = Suitabl@ for system MOUND IN- PRESSURE AT -GRADE SYSTEM IN FIi� Q SING TANK U= Unsuitable fors stem L'A'S 13 U 0 S C� Ca S S [" SOIL. DESCRIPTION REPORT c.L- fe . •� 1 ° Depth Dominant Color mollies Texture Structure�� Bouncloly Roots GPD /ft Boring #. Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Twnch y 3// — ,�/ . 2 f s �di� 2-W► �.c° C'S �� , s .�, 1 Ground 3 s /3 Depth to limiting r factor N 2 -,,f- /01. 3 a r¢ Remarks: Boring # 7�i /� -GO l e7,) 2S QP N Z Ground elev. Depth to limiting 0 factor Remarks: _ _ CST Name: - Please Print Q E -�^ u L� I G 7"" Phone: 71 . 3 P6- rle6 Fd res s: . S O' Nis i c_ P Q - RU'DSOA) W /s . S /Co e57 nature: Date: CST Number: 2-1 ,r7 ., _ � .•� . « A .e !' ..:�— -- Q . / CO PY PROPERTY OWNER SOIL DESCRIPTION REPORT Pap 2-o, Gv PARCEL I.D. IF � �Q I H M Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistenm Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tend 0.00 /a !I 2 IoM etc /.// ,S N 2 3e 7, s y Y %e � o, If d-Jl�— c5 , ? Ground 3 elev. ' / / 4 .d ft. Depth to limiting factor Remarks: Boring # O G /aYti° 2 // Y S/ e ©, S . cQ�k , 7 -8 NJ Ground pp elev. / It. Depth to limiting , fac Remarks: Boring # 1 -3- L y 36 7,5V �4 f��xr /C Ground elev. —it. Depth to limiting fac tor t r I Remarks: Boring # 13, I Ground elev. ft. Depth to limiting factor �(EU�Tioti1S co 3lO o-u A, •)- Lo T GQ /O /• d T � GGv , Z ti Ai v W v 0 % S'8 y 90' 0 13M. SvpvF �'� ---,0 AL 7- r P, E Z 12 03H =fi = OTi { Tfi TiRR =i► �.��♦ rri RTT. TiT 'l� 'p .. ART =i ♦Ti ... t v• w i i T fifi Tr 4.6250 ;vT 12 .fir w ►w TT iT Tri 1wT !► '•" r 212 Circ, ftpp G� T =ri = ► ♦.ice ] OAF i =R =1 T♦ RR` =17T TTi =wTw Ti 1T /RRR= TfiT ♦ ♦ w► Tr1T TTww 24 00 J 36" 12 -1r2 CIA. (am►.) 8ivea a: st.ex. of A c t 1° t a Asia PM - 4-6I3 j Void v l Si+dtwait (2 Sidefira I[ wane Per fits R : 3. FS , �u,,,�ip� � ) ilt t ?ilrrR •+�s •` 0.11 ;T tt. 2, t3� — 3. t.c C1, f), or rem c inder r2.5 ilrcls� 6°tt °rtr !!t 2.00 8S2S r orcueae, eye 3.f s _ 1' f r t F2s Twat So il ) "erface ,i �t2ar - a - Fa• 4 r� °1 a.fa. oroutswe hers 17 iecl� t 12in t ft 1 • -s74 , e22 R' Void "*O in 44"** ell . Projeetcafi escf! 7r 112,,,a '.saa4 901 1 tt° Arc. Void w01unft at lsoaopn Sidewatt N= ht 12 m . Y 1 betwcxa cytilu�rs. - '��+'" oAe 1 2.00 SV.Ft. �'°a8 vot yc at tt n r ry 12ie a f , - ( j,. ( l f 2 � ] -0,2)5 ft- 36 in. = 3 -00 sq ft. o+++z tr°t►O ! j crs {t/? orwid rofam 11 Prejecled T"web Area � T0941 yard votes „ fl. f 1 T « mr be�+ween sm sq Ft. fl.42Z +il,9Dt «fl -ZIS« ��tQ- dlS:':- U.1pgfN 1 Gallo Per ft - f .763 X 7. tg > , fl.1 fl8 a, 1 7b3 tt r #► F s ser ' r „ i 36 X lo s , s C} EPS Aggregate Trench SYstem EZi243H Rirtg °Industrial Grou �flo IV 65 1 ndustriCt! P ork Rd. vkfand. T14 -18060 , 1 . 9*XT- ► at i f F i - 27-Ot f r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of '4 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer X25 -P rS O NA Permit * 3 d0 Septic E3 Dose 11 Holding voL gal DESIGN PARAMETERS Tank Manufacturer ❑ NA Number of Bedrooms ❑ NA O Septic ❑ Dose ❑ Holding Vol. gal Number of Public Facility Units ❑ NA Effluent Filter Manufacturer � b D NA Estimated (average) flow d C7 gal/day Effluent Fliter Model v Design (peak) flow = (Estimated x 1.5) (gyp g a l / d ay Pump Manufacturer D NA Soil Application Rate ` 7 ai /da /te Pump Model Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 13 NA Fats, ON & Grease (FOG) 530 mg/L 13 Sand/Gravel Filter D Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L 11 NA ❑ Mechanical Aeration D Wetland Total Suspended Solids (TS S) 5150 mg/L 0 Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Manufacturer Biochemical Oxygen Demand (SOD.) 530 mg/L Dispersal Cells) ❑ NA Total Suspended Solids iTSS) 530 mg /L ❑ NA in- Ground (gravity) ❑ In- Ground (pressurized) Fecal Coliform (geometric mean) 510 cfu/100ml �At -Grade D Mound Maximum Effluent Particle Size I Y. in dia. ❑ NA 0 Drip -UQe ❑ Other: Other: ❑ NA her. ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: 3 ❑ month(s) (Maximum Y Maxi 3 ears) 13 NA ar s) When combined sludge and scum equals one- third` (Ys) of tank volume Pump out contents of tank(s) p When the high water alarm Is activated ❑ NA Inspect dispersal cell(s) At least once every: C3 month(s) a (s) (Maximum 3 years) DNA Clean effluent filter At least once every: ❑ month(s) ❑ NA • ( years) Inspect pump, pump controls &alarm At least once every: D months) 13 year(s) NA Flush laterals and pressure test At least once every: 13 month(s) NA ❑ yea r(s) r Other: ❑ month(s) At least once every: R! NA ❑year(s) Other: , ld 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 (pumper). 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 a 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 treatment tank equals one -third (Y9) 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. GMW (2/02) Page of ( START UP AND OPERATION treatment tank(s) for the Presence of painting Products, solvents or other coon. prior to use of the POk / damage soil dispersal ceM(s1. if high concentratiotns are detected For new constru p the treatment p Prior to use' chemicals that may impede servicing Op have the contents of the to nk(s) removed by a septa9e infittratNO power is restored the excess surface. System start up shall not occur when soil conditaOns are frozen boater lauds. When fill above normal frig in the backup sauce es Pump tanks may During extended Power outag dose may overload them resulting Operator Prior eel to the d'sspersai cealsl in one large ta tank removed by a SePgge Servicing P wastewater win be dischar9 the contents of the pump wally operating the Pump discharge of effluent. To avoid this situation have or POWTS Maintainer to assist in mats war to the effluent Pump or contact a to restoring po or comPa�t► the area controls to restore normal levels within the pump �• or ark over, or otherwise disturb vehces over tanks and dispersal cells. Do not drive P Do not drive or P il and or at -grade soil absorption ate• prolong the life of the Of any ono may improve the Performance and within 15 feet down slope horn the wastewater strewn disinfectants; fat; following condmns; cotton swabs: degreasers; dental floss; diaper oil; Reduction or an tibi o tics; e l i m in ation of the cigarette butts; s; gadsoline; gr oss; herbicides; meat scrap ; pOWTS: antibiodcs; baby wipes; ar and vegetable Peeling ' foundation drain (sumP Patel discharge; tampons; and water so ftener brine. painting Products; Pesticides; sanitary nePldm; ABANDONMENT anently taken out of service the f steps shall . be taken to insure that the system is When the POWTS fails and/or is Pam trance with c hapter Comm 83.33. Wisconsin Admin Code: pro per t y and safely abandoned ba ndoned in cOmP open sealed. eel and the abandoned pipe Pits shalt be disconnect t Servicing Operator • All piping to Links and p and propdialY disposed of by a Sep age with • The contents of all tanks and Pits shall be removed void space filled Pits shah be excav i ated and removed or their covers removed and the • After pumping, all tanks and soil, gravel or another inert solid m aterial. CONTINGENCY FLAW fired the following measures have been, or must be taken, to provide a cads compliant nd cannot be repaired utilised for the location of a replacement soil absorption If the POWTS fails a replacement system: and should n be i nfringed and compaction acerrient area will A suitable r®Placement area h h� evalu tected from disturbance otect the tePl system. The replacement area and proposed structure► lot times and wells. rep l ace ment area. Replacement systems must say and required setbactcs from existing site evaluation to establish a suitable P result in the need for a new advances in POWTS in effect at that time' mitations. Barring comply with the and /or soil li lacement area is not available due to setback failed POWTS• ❑ A suitable ort to replace tank may Installed as a last re S a soil and site technology a suitable rep l ace ment area. Upon failure of the POW( The site has not been evaluated to Ide e a suitable refer yea' evaluation m if no replacement area is available a holding tank to locate ust be pe rforme d the failed POWTS. may be installed as a last resort to replan ft r ules in effect at that time. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at e SEPTI Infiltrative surface. Recons t r uctions of such systems must comply with th dyy C. > > PUMP TANKS MAY CONTAIN LUHAL GASSES AND /OR INSUFFICIENT OXY GEN. DO NOT C. PUMP AND OTHER TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT < < . RESCUE. OF ENTER A SEPTIC. PUMP OR OTHER TREA PERSON FROM THE INTERIOR OF A TANK MAY Be D IFFICULT OR IMPOSSIB App1T10NAL COMMENTS POWTS MAINTAINER pOWTS INSTALLER Name Name ` d� Phone Phone 5 LOCAL REGULATORY AUTHORITY ` SEPTAGE SERVICING OPERATOR (PUMPER) Name Name Phone wilt C Phone Zoning and Sanitation agencies in compliance Weushara This document was drafted by the Staffs of the Green lake ,sons n A�� atwe Code. chapter Comm 83.22i23(b)(i)ldl &(f1 and 83-540). l21 & (3). ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ;rZ IP , CE , R T IFICAT ION FORM Owner/Buyer A-r� N'1 Mailing Address Property Address ^ 731 �! O L G (Verification required from Planning Department for new construction) City /State #a' W-r Parcel Identification Number LEGAL DESCRIPTION Property Location %4, Y4, Sec. j 7 , T Z N -R W, Town of Hu 0s Subdivisio r40 Certified Survey Map # _ , Volume , Page # �! 7 -? / 2ZZ 2Z Warranty Deed # �7 Volume P e # 7 Spec house ❑ yesXno Lot lines identifiableXyes ❑ 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, joumeymanplvmber, restrictedplumber 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification . staF tic em has been maintained must be completed and returned to the St. Croix County Zoning Office withvn 30 dear �pn data SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION (we) certify t all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the qW des cri �y a of a warranty deed recorded in Register of Deeds Office. ' l(o� O SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds.office a copy of the certified survey map if reference is made in the warranty deed I I) 9 ,I Fgrm No. 5 -M- WARRANTY DEED M nnesot. t�na Con�eysmina Eladu rtmai 7 1. 9 7 4 2 Individual (s) to Joint Tenants KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI No delinquent taxes and transfer entered; Certificate RECEIVED FOR RECORD of Real Estate Value ( )fled ( )not required 05/02/2003 09:15AN Certificate of Real Estate Value No. WARRANTY DEED EXEMPT i '19 REC FEE: 11.00 TRANS FEE: 195.00 COPY FEE: County Auditor CC FEE: P By Deputy AGES: 1 P J D 4 Oao -130 -6o - STATE DEED TAX DUE HEREON: $ 195.00 (reserved for recording data) Date: November 12, 2002 FOR VALUABLE CONSIDERATION, Randy Moberg and Ann Moberg Grantor(s) convey(s) and warrant(s) — t- Stacey L. Westrum, and Ryan P. Westrum Grantees, as joint tenants, real property in St. Croix County CoBIIrAadtli>1fd8=, described as follows: Sr CKC)N6 Lot, H umbird Hills Third Addition in the Town of Hudson, —t. Croix County, Wisconsin together with all hereditaments and appurtenances belonging thereto subject to the following exceptions: Randy Moberg Affix Deed Tax Stamp Isere /1_ J Ann Moberg STATE OF Minnesota l COUNTY OF Washington SS. The foregoing instrument was acknowledged before me this 12th day of November , 2002 by Randy Moberg and Ann Moberg Grantor(s). N 7P R T L O IQ M21 RICHARD W. Y110LFF SIGNATURE OF PERSON TAK ACKNOWLEDGMENT t NOTARY PUBW • W NNESOTA MY COMMISSK)N Tu Slatemwts for the realproperty descrihed in this instrument should EXPIRES .AN. 31, 2005 be sent to (include name and addrm of Grantee wee I Stacey L. Westrum THIS INSTRUMENT WAS DRAFTED BY (NAMEAND ADDRESS): I4 l to 4 G j - -5 , i GN Chicago Title Insurance Company A PP I>° �(� E l�'� 4it N • �✓5 2� 7876 Hudson Road, Suite 10 Woodbury, Minnesota 55125 Title Recording Services, Inc. 349174 1043 Grand Avenue #259 St. Paul, MN 55105 2651895 ST. CROIX A CHIC WOOD BASIC IIIIIIIIININ 1111111111101111111111111111 WD WARRANT53 /95 L T ®1999 Cloud Cortographics, /nc. Sc Cloud, MN 5630! Y _ S rE PAas 45 BUCK R! N ° o r ZEPHYR MOUNDS i P0` A 0 11� fi12 RD 9 = r WILLO RIVER `� °¢ ANTLER STATE PARK 3 111 1 III; � �3 RIDGE TODD LN fO PACKER D z s " QO 3 PAUL SURC DROVER Shank AV TR ° Q BURCH CL Lake g� �Yo MINE RD MCCUTCHEON RD MCCUTCHEON D > GREEN MILL 16 15 ° 1 3 ¢ HOLDEN LN TIM) � m Fr a ® F3 im 3 5 3 ® A 1. DORSEY DR DMMER 2. ZANE GREY CL D U . 17 12 Now 8� ECL RA ff LM U � ° < 5 UNG PP JA COBS 2 MUSTANG DR a ¢ ryyRL� �c p� BRADLEY 7 GL ° 22 E ° ��� 23 �P 4 S ¢ STAGECOACH TRAIL 3 > P� KIT LN a Pp !� ACpBOCN U girl 8 x0 ° U BADLANDS D x 3. MUTTON HILL RD 7 (q W F 4. HUTTON HILL CL S. 10 ° g �y RED Ogro ° c 6. KIN D 7. BENDY DR N DRU OR M NORTH i B. DAL4Y CL ° 9. WYLDWOOD LN ®� M 9 M EA KALY LN 10. POLEN DR a 2 27 a CHICKADEE �2 25 y CL ALDRO 3 P R LN o LENERTZ ¢TRANSPORT TR ,��w,,.p`M 4 M �'' RD BflAKKE DR o � .�i y! V$ PETER 71. EXCHANGE DR 12 COM H �Py 0 LN 12 COMMERCE DR Y it 0 35 12 94 9 .q BAKER OUTPOST CL U (,`, c g R 11 CHERRYWOOD LN MA K > ® y.TpT,El7NE RD MAD RST 4. CHERRY HILL LN m 1 LM W 3 COUNTRY LN RTH €RN�tGfffS TIT � 3 LOU d 34 y 0CL 14 3 16. PARTRIDGE CL ° N a RD 17. SUMMERFlELD CL °500 35 17 600 0 115 700 BRUMi ou 16 1 SW P AGE 800 900 5 RELIANCE All Your Family Protection Under One Roof IT PAYS TO COMPARE! ® ELECTRIC MOTORS AMERICAN FAMILY Repaired • Rebuilt • Rewound • Motors • Generators • Starters - . AUTO HOME BUSINESS HEALTH LIFE PAT RAWLINGS In Hudson See: 1621 Livingstone Road • Hudson, WI 54016 Steve McDonald 1810 Crestview Drive (715) 386 - 3633 Hudson, Wisconsin 2 After Hours: (715) 386 -5740 (715) 386 -9494 1lONAIF,E�� Steve McDonald 2c W 41 4 Or C w Y Y• V M C O u 4 w •� w •0 w• PI p7 ••y C OMNwY 04041 w w :3• •CN wCOCYC• WJ f 0 p ' O.+� V+�O+oO w ww O w Y w+.00wuu 0 u gg G !W 1 0. O b. A 4 A w • C Y• Y Y. J Q Y OO �• f �. • O.+ 4 I O w' " 4. C O r I� O M n 41 • O w ill V O 9 0d1 1 m J 1u00 o•0•o 'O• Cwlw 7 Ewy•+�C• y W n r j p ab r4w >Y COw 0i .0AI U 0w AAC•V AU•'OA >Y w••w41oao ow- a..Y,. .eyG..41woao0w• W 11 & 2 ~ ° O.AI'O DM N w m L V 06- w > = E• n A> N M Y w Y A O.0 in � A I W 2 p6 J 02 2W I �2 0 I • J� 7 Q �W I 34 w W = O 19i dC 1 f 500�3913E hH p O W 3� - R Z _ IOI.SO Z 729.92' I ti ^ I I N Q � • G O I � o I I s Q w _ ' 'tj i � o —•� _ S � r 2� �- o° ' 0 w Z &ez LL. Q 3 - ON ' 335' O 171 p N I 1 D Y) Mi JI ?I t JI rJl O4 - ~ ai UI IL CDi Cat O Z CD` a Z TI o R e ~ ' p, N w CAP 0 3 to a Z 2 1 W D W N 4 L) 354.46' N 0 0 = X OI m F- T LL. a 4 1 W W o H po C]I tp _ I-1 Z N ex O Zt W LU m ►n —1 H = V)I OD � I Bow 6 p Z I co it 1 3 � - 190' 143 a0 ' 2 Z Z i F.. a' NI DI D Q 7_ 0I lDl V 0) GI JI w o Q9 S y�g� 1 Q g I N 1i - I tttJJJ __ 2 O m O J I I W 1- w - Y - ff W W Q � J J O a 0 a O o BEARINGS ARE REFERENCED TO THE EAST LINE OF THE )7 SEI /4 OF SECTION 27 ASSUMED TO BEAR SW39'13'E O cc z I � I lK � i "Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Count6T . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitailf9r 19o.: Personal information you provice may be used for secondary purposes (Privacy w, s.15.04 (1)(m)]. 11 Permit Holder's Name: ❑❑ C n- Village Town of: State Plan ID No.: URAND CONSTRUCTION HUD& CST BM Elev.: Insp. BM Elev.: BM Description: Parc) '�2i307-60-000 TANK INFORMATION ELEVATION DATA A9800205 TYPE MANUFACTURER CAPACITY STATION HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inle TANK SETBACK INFOR ION St/ Ht griet TANK TO P/ L WELL BL Vent to ROAD Dt In Air Intake Septic NA Dt ottom Dosing NA ader / Man. Aeration N Dist. Pipe Holding % O l t System PUMP/ SIPHON INFORMATION Fin a ade Manufacturer D/ed Model Number TDH Lift Friction System TD Ft H ead Forcemain Length Dia. Dist. To ell SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenc PIT No. Of Inside Dia. Liquid Depth D IMENSIONS DI E I N SETBACK SYSTEM TO P/1 BLDG LL K STREAM L Manufact r: INFORMATION Typeo R Moe umber: System: Ar 1 1 T DISTRIBUTION SYSTEM Header /Manifold Distributio ipe(s) x S x Ho pacing Vent To Air Intake Length Dia. Len Di Sp ng SOIL COVER x ressure Syste Only oun r At -Grade Sy ms Only Depth Over pth Over / Topsoil x Depth xx Seeded/ Sodded xx Mulched Bed /Trench Center fed /Trench Edges ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Includ1 discrepancies, persons pres nt, etc.) LOCATION: HUDSON 9.19,SE,SE 731 ORIOLE LANE Plan revision required? E] Yes ❑ No Use other side for additional information. L C SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. Safety and Buildings Division ^ SANITARY PERMIT APPLICATION 20 E. Washington Ave. NV Iscons i n wi h Inaccord I L HR Wis. Adm. Code P.O. Box 7969 Department of Commerce t 83 05, Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. 5 y � • See reverse side for instructions for completing this application State Sanita Permit C Number The information you provide may be used by other government agency programs ❑ Check if revisi 6n o previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Num I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location S T 24 , N, R /t? E (or) 1/ a r e. c 7" ,'a er✓ f r5'.E .f Property Owner's Mailing Address Lot Number Block Number e 7 a �d l City, State Zip Code Phone Number Subdivision Name or CSM Number oAlrem a d" WAJ t ( ) u lls d II. TYPE OF BUILDI NG: (check one) ❑ State Owned qt Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No_ of bedrooms jif Town OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo © ;Z el 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ O oor Recreational Facility 3 E] Campgroun 7 ❑ Merchandise: Sales /Repairs 11 ❑ staurant /Bar /Dining 4 E] Church / Sc hoo 8 ❑ Mobile Home Park 12 ervice Station / Car Wash 5 [] Hotel /Motel 9 E] Office / Factory 13 Other: specify IV. TYPE OF PERMIT: ( k only one box on line A. Check box on line B, if app ' ble) A) 1. aNew 2. ❑ R cement 3 [:3 Replacement of 4 Reconnection of 5 E] Repair of an ______S�rstem ________Syst _ ___________TankOnly_ _________ _ Existing ________ Existing B) ❑ A Sanitary Permit was previ issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressuriz istribution Experimental Other 11 ❑ Seepage Bed 21 [] Mound 30 E] Specify Type 41 E] Holding Tank 12 Seepage Trench 22 �i] E] In-Ground ure �� 1 42 E] Pit Privy 13 E] Seepage Pit C � 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 12. Absorp. Area 3. Absorp. Area Loadi R 5. Perc. Rate stem Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) re q. ft. in. /inch) a Elevatign 4-/S7-Cl Feet /to , Feet .4 S S7 D Ca acct VII. TANK in allon Total # Pre a Fiber- Exper. % INFORMATION g Gallons Ta s Manufac er s Name cdlk n- steel glass Plastic App New Existin r Tanks Tanks optic Tank ,0Q Q (,�J ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT - I, the undersigned, assume responsibility for stallatio ni the site seAk shown on the attached plans. Plumber's Name: (Print) Plumber's n • (No Sta P RSW No.: Business Phone Number: .S Qd 7 10 t Plumber's Address (Street, City, State, Zip Code): / k. IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Iss ing Age ignature fto Stamps) ►Approved E] Owner Given Initial / t�t. surcharge fee) 1 6 10C -3 Averse Determination (. W X. CONDITIONS OF APPROVAL / REASONS FO DISAPPROVAL: SBD-6M (R.11/96) 011SUMUT11ON: original to County. One copy To: Safety & auildirgs Oivision, Owner. Number INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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 i<- -suing 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 iocai :.ode administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. 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 into be installed. 11. Type of building being serve Check only one and complete # of bedrooms if 1 or 2 Family Dwel iin Nt III. Building use. If building type is'public, check all appropriate boxes that apply. IV. Type of permit. Check only one oN,ine A. Complete line 13 if permit is for tank replacement, r,, nnection, or repair. V. Type of system. Check appropriate bbx depending on system type. VI_ Absorption system information. Provide-all information requested for numbers 1 t , ugh 7. - y VII. Tank information. Fill in the capacity of every new /or existing tank, list the to gallons, number of tanks and manufacturer's name, indicate prefab or simconstructed and tank materiel: Complete for all septic, pump /siphon and holding tanks for this sy m. Check experimental approval only if tan ceived experimental product approval from DILHR. VIII_ Responsibility state t. Installing plumber is to fill in name, li,cinse number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application forim. IX. County/ Department Use Only. r..` X. County/ DepaXent Uj ly. .. Complete plans and ications not smaller th 8 1/2 x 11 inches must be submitted to the county. The plans must include the followi ' t plan drawn to sc or with complete dimensions, location of holding tank(s), septic tank(s) or other treatm s; building sewers, wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes b prption systems, replacement system areas; and the location of the building served; B) horizontal and vertical y�i�on reference points; C) complete specifications for pumps and controls; dose volume; elevation differervc�s; frictiof*f ump perfotmance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if i d by the�county; E) soil test d4ta on a 115 form; and F) all sizing information. ----------------------------- - - - - -- - - - - - -- -- --------- -------------------------------------- GROUNDWATEI eIRCHAf \oegu 1983 Wi sconsin Act 410 included the creation of surcharges (fees jr a n fi bIated practices which can effect groundwater. ,r The monies collected through these surcharges are used for monito g groundwater contamination investigations and establishment of standards. Go.d �c� 7� fYGe- Y+•'Y llS ✓�G G 2 a v� W 0 h h � I 166 b . c s GP r 4� O ` y } I� 4�l Wisconsin Department of Industry $OIL AND SITE EVALUATION R E P O RT Pagel of -3 Labor and Human Relations Division of Safety 6 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 5T. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY GATE EROPEr TY OWNER: 1 f 11 ,Q� �i/ S -a PROPERTY LOCATION v L- 23 % o ,t/ — GSA /,P.�! 4y GOVT. LOT S 6 1/4 ,S� 1 /4,S 2 T Z9 ,N,R I f E (a) W TY OWNERS MAILING ADDRESS �2i8 f iov£� /��` s7• ( LOT # BLOCK # SUBD. NAME OR CSM # � y) � 3 ATE ZIP CODE PHONE NUMBER []CITY O1/ILLAGE 9MN NEAREST ROAD A vG /�!N• SS /o/ lG�) 2 - 2 - }IuflSo,� New Construction Use (d,rAesidential I Number of bedrooms ' °'P 3 (j Addition to existing building [ 1 Replacement S'S° " [ j Public or commercial describe trench, 91 Code derived daily flow loOd 9Pd Recommended design loading rate / bed, gpolft , Absorption area required -" bed, 112 7�0 trench, ft Maximum design loading rate bed, gpdAt ' trench, gpo19 Recommended infiltration surface elevations) - �� P ! 3 _ fl (as referred to site plan benchmark) Additional design / site considerations *Sf Parent material SAS S�TT,�'� Flood plain elevation, if appliFable �_ It S - Suitable for system C I MOUND IN-GFMND PRESSURE AT -GRADE SYSTEM W FILL HOLONVG TANK U - Unsuitable for system I es O U ❑ S C3'6 I CC'S 0 1 ❑ S 0 S [;Rr ❑ S SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bounc�ry Roots GPD /ft Boring # r dzon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed '0-1 z /o yam° 3// — .�/ . 2 f sl�.� /w� �ic' �S Z f , s [3 yle /7 W J5 c z s Ground W . ,co 7, S�/,e 13 �1 - elev. 7 ye S/ — i Depth to limiting 1 factor, y Remarks: Boring # 2 -11 — $i� 7`i - G4 oTzl� QS _ i`1 Alj Z L -qy , o ye -51, �,s. o, S i i Ground elev. Depth to limiting � Remarks: _ T Name: Please Print ? o Q E p- T- 'u L.� P I' C k 7— Phone: 715 3 dress: (� 5 S CJ' N t i [ - 'P 4 u IPSO A) W /S • S i( e57- / � yeZ nata• CST Number: a PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z01 PARCEL I.D. ! t # (e Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxby Roots GPD /ft In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmrdi le !IX 2 77 ! O2 .1fe79 Ground .3 /P 5 CS elev. # .D ft. Depth to limiting factor 3 Remarks: Boring # � •y .� � �:!/ BLS ti � Ground ' i elev. ! /o ft. _ Depth to limiting } factor i Remarks: Boring # Ground l° , y 1,00,51 CS' �� elev. 9 It. ! Depth to ' limiting factor / � r Remarks: Boring # ' I Ground elev. tt. Depth to limiting �I�U�Tio�1S f3 i /blo, oZ � i /3Z /Vyl �s 3� 5vG6F57iFP Wv �' U�1`Tio us ScA G � 3)0 . T ReN �-G, iv y o - LOr��l Z I� t3 Ro Mi V v 07o ag S'8 y 0 So. LoT L , ' ~ 664,12 S N °30'10 "W 9p° y6 _ � S 45 %U 00" W 86.82' z J " "I hi S44 10' 00" E 66.00' C � Sig 27q� E 46 3.13' Z/8 u� So s9 s� s� . s8 942.42' 42 42 S89 ° 30'15 ° W ± Z �y I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owe 1r,73tty6r Dura Construction Incorporated 124 Juniper Street Mahtomedi, MN 55115 731 Oriole Lane, Hudson, WI 54016 _ a Prot arty M'Jr):1 is (Vcriflckjou required f3rotn Planning Deparunant for new construction) City irate Hudson, WI Parzrtl Idtotifleadon Number 020 -1 307- 60 �,,� _ Pxa '.qty L,c rat :,pal S E y,,, S E t /4, Sot. 2 7 . T -R Town of g i ri c on Humbird Hill Third Edition _, Lot # —fa Cce:; i:fied Srii ," i+ t:y map 0 � -- Volumo , page # W - 7 F( Volume _ �� Page # Spa ; hoiw� M wo CI no Lot lines identiftblo kyee O no tmp# c m,i ' me andmai ntmmm of 7wur sVdc syd= cavld malt in its preitsanue tailura oa handle wastes. Pwper xw it; t01183100 coo 1 3, td Of out the stuptic tank every threw ycara or sootier, if neadedby a Iioonsed.pumper. Wbat you pnt into ^ it: system cans ,;;Filet the.bol'inkm of du 40ptic tank es a treatment stage In the waste disposal system. The in Cai;t+rty owner agireas m submit to St. Croix Zoning Depaaurient a certification form. signed by thus owae ta by s malt ;.rpt}rsa> .: .i :i%neytaanp'lumber, reewctedplumberor a licensWpumperverdybmthact (l) the ou -sita wastewattrdispo System is W. roger eFH't r. +;,:is►g comQitic:n and/or (x) alter inspection and pumping (if necessary), the septic tank is less then I/3 'fib. ° shtdge. l.Il adhave Mad the above requirements and agree to maintain the private sewage disposal system di a:ar~datds to f Ah. ltc0*., A,e set by the :Depoitment of Coramerm and &a Department of Natural Resources, State of Wiscacsim 0 Tvfioation WEst yf. �F:tptic system has been maintained. crust be compiuted and returned to the St. C.soix County Zoni�l Offt �; iddu 30 days :�Y �'.:,r expiration dace. SIGr'':A'i'xJWE. c w CA1:rr D.AT>3 i) r r tlify that at ststagnents on this form are true to the best of my (our) knowledge. I (we) am (srs) tba 0 , r ier(s) Of tbel''bp . slbed above, by virtue of a warranty dead retarded in moister of Deeds Office. SI'r A. ► i; -ANT DATE • * ►* ; ka� ir. r. r', rutatiou char. is mis- represantod my recruit it th ®anitary permit being revoked by the Zoning Nparme 3 t 't' "• "' *" if. tclude wadi Ibis applict,tion. a stamped wattamty deed torn the Register of Deeds offiee a copy of the certified survey trap if rafarence is made in the warranty deed t© 3nGd 7d�L' t� 8Z ° 66EZ�9 PO VOL 11,13PACE'463 5 76878 ji STATE BAR OF WISCONSIN FORM 3 — 14W-- 1 QUIT CLAIM DEED .I DOCUMENT NO. 1 'I Paul A. Durand REGIST R'S OFFICE 5T. CROIX CO,. WI �i t�l4'r /!If i�tlGOrd quit- claims to Durand Construction Incorpor i MPR $ 1998 a Minnesota corporation, _ 8:00 A i Re afar of DNda the following described real estate in St- Cr o ix IL rwvy• ' it Statt;..of Wisconsin: THIS SPACE RESERVED FOR RECORDING DATA Ij NAME AND RETURN ADDRESS I I • PARCEL IDENTIFICATION NUMBER 1. Lot 61, Humbird Hills Third Addition in the -Town of Hudson, r �I I FEE * .J EXEMPT—This— i c not homestead property. (L) (is not) it Date_ this ��� day of April 19 98 _ (SEAL) � / (SEAL) I Paul• urand li ,1 � (SEAL) (SEAL) II AUTHENTICATION ACKNOWLEDGMENT II Signature(s) St_zc as Wisconsin, q I ss. I - - $t. _ County authenticated this day of .19 re:soaaiI -arre before me this day of gp_r- - I9 _.S„R , the above named u - - _Pa-ul- ;- _._Durand (If not. j authorized by §706.06, Wis. Stats.) `l NC,iASY I to me know-: tT nr the person who executed the foregoing T tjst r rF o.vlalge the same. ! THIS INSTRUMENT WAS DRAFTED BY I. !' At torney Kristi Ogla - - —'— Hudson, WI 5401 Notary P i iie_ County, Wis. (Signatures may be authenticated or acknowledged. Both are not .VIy - permanent. (If not, gatr expiration date n cccssa c) - ���,.- -fi -- - - • � N ' lU "E iitG4 1,e s r A:; t`1 Fk N LOT 46 S45%0'Q0'W I—OT 31 HulAsirzo 7— �44 LOT 47 '10 . 09" I to K of x 66.06�' 7 S 76 '2 7 • 6/6 2S 196 ru / , / . � 9 LOT 48 LOT 62 r 9• A(.F% 2 310 ACRES ff OU.OFZ su." 1 7 LOT-F LOT 49 311 Mars 0 r— i i I. -- rn LOT 59 ISJ Ste 2.30 ACRES LOT 50 01 13 1 . o so rr 50 it I LOT 60 I t). •cats 660 ?S 1 . , 1 Bt.]!1 so F 1. !r].00' 2M,&, ....... ....... ............. %. LOT 52 At so ACRES LOT 51 *0- —L 4NE— SO.Fl. I, po &CRIS 99 So It Nos ^2pr9rY 769 S' ....... .... �5 J7 X , LOT 58 *1 03 "*- IOU- --0Rf0LE —LANE LOT 56 1 7) &CRIS .10G.9115 so VT LOT 5 3 LOT 55 till 2"'d Seats 1 29 ACRES LOT 57 'I.Yoct so rt. LOT 54 j ,Y,q 50JI 7 24 ACRES 2, to ACRES JW Wiscon rtmentofIndustry PRIVATE SEWAGE SYSTEM County: kabo�ar man Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Pe ll77 UU jj�Z�Ajj��i rTnlLFLo 6's N3tr�eUL A ❑ City ❑ Village C1 Town of: State Plan ID No.: HIMSON r kY'EE1� 7� CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosi ng Aeration Bldg. Se Holding St/ t Inlet TANK SETBACK INFORMATION Sutlet TANK TO P / L WELL BLDG. Air Intake ROAD Dt Inlet Air Septic NA Dt Bot m Dosing NA Header/ Ma . Aeration NA Dist. Pipe Holding N - System PUMP/ SIPHON INFOR TION F i n a de Manufacturer De nd Model Number G TDH Lift Friction System I TDH F Forcemain Length Dia. H Dist. To Well ; SOIL ABSO SYSTEM BED/TRENCH dth Leng No. ches N Inside a. Liquid Depth DIMENSIONS 1 SI N SYST TO L BLDG WELL AITREA CHING ffl ur er: SETBACK MBER INFORMATION Type O umber: System: UNIT DISTRIBUTION S YSTEM Header / Manifold Distribution Pi (s) H e Spacing Vent To Air Intake Length Dia Length ia. Spacing SOIL COVER x Pressure Syst s Only xx un O -Grad ms Only Depth Over Depth Over xx Depth x Seeded/Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.27.29.19W, SE, SE, JUNIPER STREET Plan revision required? ❑ Yes ❑ No 7 - 1 1 Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: S y�IS+ 4� b r S °a^^^ Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau a BuildingWaterSystem 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less county r than 8 112 x 11 inches in size. �`t • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT /SILL INFORM ON Property Owner Name perty Location �,, ti G 1/4, S o? "l T , N, Rl E (or Pr perty Owner's Whiling Address of Num Block Number /A Y u .t! s' ,e v ? C� City, State Zip Code Phone Numb Subdiv ame or CSM Number 2 // �— � �las•� II. TYPE OF BUILDING: (check one) ❑ St Ow e Nearest Road Public 1 or 2 Family Dwelling - No. of r 9 , �/ `► III BUILDING USE (If building type is public, check all ) e Number(s) IT d �. o � 3 1 Apartment/ Condo j 2 ❑Assembly Hall 6 El Fa li / N / Hom 10 E] Outdoor Recreational Facility 3 ❑ Campground 7 MM an e: Sale airs 11 E] Restaurant /Bar /Dining 4 E] Church / School 8 ile me Park 12 E] Service Station / Car Wash 5 E] Hotel / Motel 9 e / ory 13 E] Other: specify IV. TYPE OF PERMIT: (Check o ox line A. Check on line B, if applicable) A) 1. VNew ❑ Replace 3_ ❑ Replace ent of 4 E] Reconnection of 5_ E] Repair of an System System Tank O y Existing System Existing System B) ❑ A Sanitary Permit reviously issued. Permi umber Date Issued V. TYPE OF SYSTEM: (Check on e) Non- Pressurized Distribution urized Distr' tion Experimental Other 11 E] Seepage Bed 21 ❑ nd 30 E] Specify Type 41 E] Holding Tank 12 Seepage Trench 22 ❑ In- Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Abs p. Area 4. Loa I ate 5. Perc. Rate 6. System Elev. 7. Final Grade r Required (sq. ft.) Propo d (sq. ft.) (Gals/day /s (Min. /inch) l �4/, Elevation ci Feet � Feet Capacit VII. TANK in Ca gallo T al # of Pre Site Fiber- Exper. INFORMATION G ons Tanks Manufacturers Name Steel glass Plastic App New Exist in str ed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ 1 1:1 El El Lift Pump Tank /Siphon Chamber El 1:1 1:1 ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsi i t for installation of the onsite s ge system shown on the attached plans. Plumber's Name: (Print) / tuber's Signature: (N Stamps) MP/ PRSW No.: Business Phone Number: 1 "o :5< tiaol.ta r I f 3 12 e 6 C 3r�1 Plumber's Address (Street, City, State, Zip Cod ): O L2 l IX. COUNTY / DEPARTMENT USE ONLY (includes Groundwater Mate sue Issuin A ntSi nature to s Disapproved Sa n itary Permit Fee 9 9 ( P ) Surcharge Fee) pproved E] Owner Given Initial •� Adverse Determina X. 7-eFOR DISAPPROVAL: a Oh t . SBD -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & 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 a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by th ' rmit issuing authority. 4. Changes in ownership or plumber requires a Sani Permit Tranger / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintaine septic tank(s) must b pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite se ge syst tact your lo, l code administrator or the State of Wisconsin, Safety and Buildings Division, 608 -26 815." To be complete and accurate this sanitary permit li m i I. Property owner's name and mailing address. Orovi hi egal d c 'ti n arcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of d o if or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that ply. IV. Type of permit. Check only one on line A. Complete line B if permit is f an acement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbe through 7. <, VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons; number of tanks and manufacturer's name, indicate prefab or site constructed an o tank material_ CompleYk for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received xperimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license n diber with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form',�,f IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, dpefwnto scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tank � lding sewers; wells; water mains/waVr.service; streams and lakes; pump or siphon tanks; distribution boxes absorption systems; replacement system arebs; and the location of the building served; B) horizontal and vertic#lrevation reference points; C) complete specific ions for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump modeld 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 regula ed practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. 1 e. [,1 J am© d , C 3 L 9� 4 �i t' STC -105 SEPTIC TANK MAINTENANCE AGREEMENT " , n ,�S t.' Croix County OWNERB ,� UYER 1�A L A 61 - / � � D MAILING ADDRESS I Li v� > >���' �L�"1, IW441 PROPERTY ADDRESS '7 4AM C (location of septic system) Please obtain from the Planning Dept. CITY /STATE W05 PROPERTY LOCATION 1/4, 1/4, Section Z 1 1 , T __Z_9_ N -R W TOWN OF [J0 , ST. CROIX COUNTY, WI SUBDIVISION HO X4 6I Q9 bP G 5 IR AQ AO LOT NUMBER G CERTIFIEDSURVEYMAP ,VOLUME_JXPAGE ,LOT NUMBER 4! 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 d returned to the St. Croix County Zoning Officer within 30 days of the three year iration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 TC- 100f 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 g 00k—AA 42 Location of property 1/4 1/4 , Section Z fJ , T Zcf -R W Township Mailing address 1 2 -1 , -L-kA l t S % &T Address of site 1 7 31 0,0 Subdivision name 'y�al5fl l4�Lf Lot no. g5 / Other homes on property? �Yes Previous owner of property - :Tbtg4 1 i`urvta1 /i Total size of property Z.6Z l k'465 Total size of parcel Z- g, -63 "E!5� Date parcel was created Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house) ? Yes No Volume 11 and Page Number as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. 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 �,�_ , 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. SignatQE2_ Applicant Co- Applicant Date of Signature Date of Signature DOCUMENT N o, WARR NTY DEED THIS SPACE RESEPVEU FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 -1982 531653 VOL 1132FAJE 80 .:. HUMBIRD LAND CORPORATION, a Minnesota Corporation .. . 9 5 1995 _ .. ................ - - - - -- - ---- -- - - - -- - -- - --- - --- - - - - -- - ' 9:30 A. „J u. conveys and warrants to PAUL DURAND - - -- ------- - - -• -- -- _. A ci[ --- ---- ..... - -- ----- - .... ................. ✓�, 3 ' l .. . •- --- - -- ------ - .. . ...... ... ... .. ..... .. in Consideration- of__$27�120,00 .. .. ... .. ... ..... ..... .... ... ... . . . ... .... .......... .......... . .... ... RETURN TO Paul A. Durand ,I 4371 Metcalf Drive _.... . - -... - - -- - - - - - - -- ............................. . Eagan, MN 55122 { the following described real estate in --- .. ... ...SC--- CroiX ...... ..........Count}., - - - =- I I State of Wisconsin: Tax Parcel No:.... 20- 1307 -60.. I Lot 61, Humbird Hills Third Addition, Town of Hudson, St. Croix County, Wisconsin. it Together with and subject to any easements, covenants, reservations and restrictions ; of record. -y ik tRANS> o j FEE •I. li >i -, II This -- - - ---- iS_ 140 - --.-.- homestead property. (is) (is not) {I Exception to warranties: Dated this .... Qt� - - ---- --- - . day of - --_ _- july ---- -- ---.., i HUMBIRD LAND CORPORATION, .. -- - - -- - -- • - -- --- --- ---- - --- ----- (SEAL) a Minnesota Corporation: -- -------- - ------------------- -- --• - -- ••--- ------ - - - - -- S : - (SEAL) . - By - .- . C...- �1.+�. _.....( _. . (SEAL) _ Austin J. Baillon,..President___ { 7- AUTHENTICATION ACKNOWLEDGMENT s !i I j Signature(s) — -- STATE OF WISCONSIN ..� i _ ss. w , - - ---- • -------- s14'-- (:>i9I?t ---------- County. 20th authenticated this -------- day of_______ _____________ __ _ _ _ __ 19 ------ Personally came before me this ......- __..._..day of I July ..................... 19.95 - -- the above named 1j T _ ------- Austin .. _ Baillon President of said ' - -- - Corporation - -- TITLE: MEMBER STATE BAR OF WISCONSIN II .................. -- j (If not -----------•----------• •------------------------ - - - - -- ----- - -• - -- ....... fficer - and - - - -- ----- •--- - - - - -- j authorized by 4 706.06, Wis. Stats.) to me known ton .- ____ - - - - -- who executed the deecT t ore ills powI dg � O e t s e. as the THIS INSTRUMENT WAS DRAFTED BY Dj/ LS OM ... - -- �1 � �kG Gilbert ,._Attorney_......... ---------- N at 206 Second St., Hudson, WI 54016 �q da-.Poulln ._ -- - -- - ••----- - - -std Cro' - ---------------------• - ••-------------- --------- -------- ------ -- - - -- -- -- Notary Public . -- - St. - _ - - -- county, Wis. (Signatures may be authenticated or acknowled�d Both My Commission is permanenlK(If not, state expiration I , are not necessary.) dale• �: - ------ - ---- NDaember_.24 .. ... ......... 1996---) ,