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020-1117-00-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: _ 538708 0 GENES AL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personalliiformation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Thanos, Andrew Hudson, Town of 020 - 1117 -00 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / 0 I 64A ` 6 19.29.19.487 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 24„„ CAPACITY STATION BS / I , FS FLEW. 3• Septic / Benchmark � ��/ /� EKf-,1�: k l `� 1,-3 Dosing J Alt. *I � , Z� e-st& S O rt 75� .. -f GoJ�.. . 78'. `a� Aeration t Bldg. Sew r r Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION it 11,4 9 • 2 4 TANK TO P/L WELL BLDG. VV t lnt�yge Rpgp Dt Inlet y ", q t �� 0 S9 Septic L, l �(� D t Bottom L E�,s1 -:,1 30 3� ,p.,.•-{ r 1) Nil Ito. ci Rtz D / O >5 ' liZ ! , 'Z Header /Man. �, /3 S 1 g , Aeration EwA 64 Tarr—, Dist. Pipe 5 f T qt Holding Bot. System /b •; /3. i 44 Final Grade PUMP /SIPHON INFORMATION OICIG Drxnd q- (o. 3t 17 32— Manufacturer �ei St Cover ��y� s zi 5 J Model Number /) 5(0''' , /waves .) y 1/.t4 t . TDH 1 Li 1 i � Friction Loss N System TDH,„. q F 10 Dia. C---- Fo Length 1 � Dist. to Well z 5?) � SOIL ABSORPTION SYSTEM BED /TRENCH Width / Lengp No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid epth DIMENSIONS 3 GO 3 17 e,� `�. \ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: /� , f! / _ INFORMATION Type Of System: t / z ! J 4 CHAMBER OR Model Number. + /1 - i / T c / ` DISTRIBUTION SYSTEM Net 4 t & / 5 0 .-/ it 4-4 l' Header /Manifold/ li Distribution x Hole Size x Hole Spa ci Pipes) 4 t �� • � i i . Length Z.Z. Dia Length \ Dia \ Spacing \ \ V En,,0,O .�� H' "■., 4 i•(' SOIL COVER / x Pressure Systems Only xx Mound Or At -Grade Systems Only - p,,v..e.n.C 04e, • Depth Over � ///// Depth Over xx Depth of xx Seeded /Sodded xx Mulched - Bed/Trench Center l i / 7 Bed/Trench Edges \ Topsoil \ Yes El No Yes EZ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 898 Willow Ri 1 Hudson, WI 54016 (NE 1/4 NE 1/4 19 T29N R19W) Willow Ridge Addition L t 12 Parcel No: 19.29.19.487 1.) Alt BM Description = TO C- 0'Q - C 66 4/CAA ti-' 52d . Js 2.) Bldg sewer length = 1 \ - amount of cover = , 6 Ejfj 6jk j C J? h lot e Plan revision Required? Yes o WI , zi U Ina se other side for additional information. ,b 161 SBD -6710 (R.3l97) Date Insepctor'sf• ignature Cert. No. - - - , sPAID, , er w\ILlopkuikk cornmerce.wi,gov Safety and Buildings Division County s 201 W. Washington Ave., P.O. Box 7162 5 ' Crep X i S V O fl 5 fl Madison, WI 53707 -7162 Sanitary Permit umber (to be filled in by Co.) Department of Commerce 3 R 76 4 Sanitary Permit Application State Transacti tuber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different thanmailing address) submitted to the Department of Commerce. Personal information y. provide may be used f.' - - — . • u .uses in accordance with the Privac Law, s. 15.04(1)(m), Stats. ��� "" r�`d _, . C r' /,> / � 1. Application Information - Please Print All Informatio Nt 1 .lit , . � • "'" " Property Owner's Name r• Parcel # II d. N I i. hAP A , t r i b26 --11 7- EC -ciO Property Owner's + Mailing Address - $ �TM Location / L)) h W k' 1 t CRQ r OI1 'roperty ■ ovt. Lot C� Q City, State v I-'KP3ON l W) x/ Zip Code �, N E. /, Section ' � J� 1l ( a T T p N; R 19 (circle Eeor one) W U. Type of Building (check all that apply) Lot alip Subdivision Name /l or 2 Family Dwelling - Number of Bedro s i atsi4 Block • 1,x111UW �.1AC ❑ Public /Commercial - Describe Use �'— C ❑ City of ❑ . Stt ta ate Owned - Describe be e Use ' t t u ! l / CSM Number ❑Village of J U►b�' C e Ll'5 L� /$# �u'K44tr ,� Town of �Ab S Old 111. Type of Permit: (Check only one x on line A. Complete line B if applicable) A. ❑ New System NOteplacement System ❑Treatment /Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Issued ❑ Permit Transfer to New Before Expiration Owner 113 A.(„` � IV. T e of POWTS System /Com onent/Device: Check all that al 1 ! r J: _ PPM Si Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ' ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatm nt Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (s Dispersal Area Propos (st� /Oystem Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units , ;? v ,, 1 New Tanks Existing Tanks / r AI c �; 2 ca Septic or Holding Tank ' i(1° ° 1 64. e. �, M � / Dosing Chamber C�1�' ` W ' � N VII. Responsibility Statement- t, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI is Si re MP /MPRS Number Business Phone Number ..'Qr &INu 'N�s r aaa '11)y q/S tL - 9 uo, Plumber's Address (Street, City, State, Zip Code) IU7 P s N Wee V1- . 61� Ai VIII. County/Department/Use Only pproved tsappr. Per Date Is ed Issuin gent Signat e Art m • wnerGiven Reason for Dental $ / /5' ra s / b , IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 3' 6~• rG + - i / • ' sm.. {r aaa6.,.Z 1. Septic tank, effluent filter and 4 b`QkaO14 LZ a��� s; 5 ` -te It" dispersal cep must all be services / maintained i Gv` 4 a Cy as per management plan provided by y plumber. lb •' 2 All setback requirements must be maintained 7� La. r�e / /,ita4 EWIlleeil.e system and submit to the County only on paper not less than 8 t/2 x I 1 inches in size 4' ` ..0 6& 4-0•6-Q... L: G `at3G0 SBD -6398 (R. 01/07) Valid thru 01/09 N ...,; t g,cO . r R. • httlowek ta ik F a:, A - _ .... ...., , 8 9 u 1 014 / . ,7 --, --, r 'N i 1 < ......m i N ■ I -igen' (1 i S cbbklaen.s.--(40177 . ., -Tao L\\-ei I k) " illaiiiiii \ ,., &f*, P. Lit_ k._, B 610 Al - 5',l' +:‘,,, ir i v.! , i I oo.0 iir , ''l 64 1 i SO , s s. to _ L. • pl.4 rnp Chpr.40. \ With SI rbl rie‘i \ Vv ;WA , ‘ , No* _. Q -:' - 0 i c 4 A ' i' ill b AC C - A ' 1 b r ,,, , , '.) (1. [.. r t.41 : ., , 1) c f 4 a s y„.p N 1 6 . ) 1 ›... 1 ct. . o o r CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: K I Z toi npid kry.105 Owner's Name: Owner's Address: s ill8 ) IOW I K)CCtk 1 wool.) ' o 10 Legal Description: NE-f/y NE- IV 5-19 Township: 1140-50N/ County: St. CROik Subdivision Name: Lill low TKly Acid- Lot Number: Parcel ID Number: oao- )(lei -00- 000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: Z.-, Boto-v License Number: aaaclok) Date: 0 11 1 0 Phone Number ' 715 3f3(0 Signature 4 ,4n t ><3 Designed pursuant to th In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SE3D-10705-P (N.01/01). Page 1 Nt • 'Bomtv.1 t.) fkixt:)-1 - Th A „... _6 .-- , , 8cis uilow V.;)(ice ) , i A , , / L o CAA) _ . 1. 1 -ram th (scupAlatits :_c it — 1 .A - 4 ( 1 ' ) . 4 . 3 1 k) 3.0' rr 53' I oc, I W I 13 ' f - • 41 C1 g Er A ila-- :z/tt , )\ ____----tr o VIU ■ MOM) \ 1 rkKI t LACZ- 8 ,,,, 5,a,1,)r..1,0,-,.100. g - ” k rts4 ( L t itg \1 4 \ -\ tk f Cfi lo),) 750 0 • ' Wil s-oz.. 1 000 v y SW L • Pt4 rnp chi:4,441Q afth Si vvl c_in vnivr 110 Wo A \ ')( S An Da \ Nok : S \A.StP11) 11 5 LJ k 51N+ Of (1JL ° i N-1 \I Pk 1 0 p Autkog ;: A b Ens_ do VIV . 1)° OLS TCP1\11f cA 6 a cf-e ci 0 w )\/40 ecC) ) e A- re,c0C'e • /kir) 1)411: eallAv' Soli Absorption System Crro ■14- -- v Pft 4° Sche 4 I Final Grade PVC Vent edul Pipe 0 VNth Vent Cap I I .4 ��. (--Th Leaching _p. Chamber 4--- le em Elevation 3 ft Soil Absorption System Plan View (o O ft C yry beRS 1 3 _1 1- _ ft IIII �IIIIIIIIIIIIIIIIIIJIIIIIIIIIIIIIIIt llI = 31 ft Leaching Trench 1 Chambers 1 5 LQ - I' ki,aM tis ME _i aiiiiui aiiiirniiiiiiiiiil iiii c 4° Dia. Trench 2 Header r Vent Or Observation Pipe r 5l9` I thb►Abxici 1 IIIIMIIilIIiIIIlIII1iIIIiIiIIIIiiiiiiiIIii IIIIIIIIIIIIIIiiiillI Trench 3 Leaching Chamber Specifications Manufacturer And Model ,1\9 `t kV)11.S (3 V: L1 - 1 yy j EISA Rating c1O sq ft per chamber Soil Application Rate • 1 gpd /sq ft GOO gpd Design Flow : 1 Sail Application ate a 0 , EISA = "I 3 Chambers 3 rows of chambers each. Page of J Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and —� Comm 16.28 WAC 4 in. min. /--- Disconnect --i�I Tank component is properly vented '' D=E --i —J E Alternate outlet L location 1 1 Forcemain diameter Wieser Concrete Manufacturer �— Q 2 in. Capacity 750.36 Gallons Volume 20.28 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.00 364.98 B 2.00 40.56 Pump off elevation (ft) � _t_ C 5.00 101.46 r 1 1 88.001 D 12.001 243.36 D Total 37.001 750.36 Dose se tank elevation (ft) 3" Bedding un er tank. 1 87.001 Alarm Manuafacturer ISJ Rhombus Tank Ale rt Alarm Model Number I SJH 1011421 Pump Manufacturer ;Zoeller Pump Model Number ; BN 53 Pump Chamber Calculations I. Force Main: Diameter: Length: ° Flow rate: 8.0 gal. /min. Friction loss: ' •' . cemainx3.30ft. /100ft.) 2. Total dynamic head: 7.82' Min. supply pressure: 0.00' Vertical lift: 6.00' 4 • 1 Forcemain friction loss: 1.32' • 3Z Effluent filter friction loss: 0.50' (Sim/Tech STF 100A) 3. Pump selection: Manufacturer: Zoeller Model number: BN 53 Pump will discharge approx. 38.0 gpm @ 7.82' TDH (Flow Velocity 3.876 ft. /second) 4. Dose chamber: Wieser WLP 750 — MR - 37.0" 20.28 gal./inch 760.36 gal. actual) @ g ( g Sizin : g• A) One day holding capacity: 18.00" = 365.04 gal. B) Alarm setting: 2.00" = 40.56 gal. C) Dose volume: 5.00" = 101.40 gal. (600gal.)(20 %) + (.164)(40') = 126.56 max. dose D) Reserve storage: 12.00" = 243.36 gal. TOTAL 37.50" = 760.36 gal. F 'cc TOTAL DYNAMIC HEAD /FLOW f- LIJ Lij PUMP PERFORMANCE CURVE PER MINUTE MO _ 5l /59 EFFLUENT AND DEWATERING 6 — 20 , MODEL 53/55/57/59 w = t Feet Meters Gal. Liters 15 5 1.5 43 163 >- 4 10 3.0 34 129 0 10 _ 15 4.6 19 72 7802 i Shut -off Head: 19.25 ft.(5.9m) T�• ,/ 2 - 5 .4 009807 /t', — 3 718 6 3118 -.-- 45/8 1112- 11112 NPT 0 i I 10 0 39._.---40-----n ��� '1 3 718 GALLONS 38 l( �-.. LITERS I - 0 80 160 i { : -• FLOW PER MINUTE e� � � • � �,� 4 ; ) CONSULT FACTORY FOR SPECIAL APPLICATIONS � I Variable level float switches available. . il „ .! •Variable level long cycle systems available. ° I r • Available with special cord lengths of 15', 25', 35' and 50'. ' l --,1 I • Alarm systems available. ,0 1116 1 • Duplex systems available. i 1. ■ i I17IG♦♦l�1_11. I & i ■ � ...,. =� ■ - 33/32 '� !� 1 r l v I�'r S10e58 • Single Seal Control Selection Listings SELECTION GUIDE Model Volts Phase Mode Amps Simplex Duplex CSA UL 1. Integral float operated mechanise! switch, no external control required. M53155 & M5759 115 1 Auto 9.7 1 -- ' Y Y 2. Single piggyback variable level float switch cr double piggyback variable level N5355 & N5759 115 1 Non 9.7 2 3 or 4 & 5 Y Y float switch. Refer to FM0477. • BN53 115 1 Auto 9.7 -- Y Y 3. Mechanical alternator "M -Pak" 10 -0072 or 10-0075. • BN57 115 1 Auto 9.7 • N --- Y 4. See FM0712 fa correct mode! of Electrical Alternator. • BE53/57 230 1 Auto 4.8 • -- Y Y _ D5355 & D5759 230 1 Auto 4.8 1 _ - -- Y Y 5. Variable level control switch 10 -0225 used as a control activator, with Electrical E53/55 & E57/59 230 1 Non 4.8 2 3 or 4 & 5 Y � Y Alternator (3) or (4) float system. • Single pggybadr switch included. IA CAUTION I For informaiononadcitional Zpellerprockicts refer tocatalog on Piggyback Variable Level Float Switches, FM0477; All installation of controls, protection devices and wiring should be done by a qualified ElectricalAlte orator, FM0486; MechanicalAitemator, FM0495; SunpJ Sewage Basins, FM0487; and Single Phase licensed electrician. All electrical and safety codes should be followed including the Simplex Pump Control/Alarm Systems, R40732. most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - MAIL 70: P0. BOX 16347 fr v. 4 Louiavii KY 40256-0 Manufackfersof SHIP 70: 3849 Cane Run Road louavig, KY 40211 -1961 hup9 /www.zoellercom PL/MP !D_ (502) 7 31 • 7703892&PUMP � P6 SNCE �,9�i� © Copyright 2004 Zoeller Co. All rights reserved. , 61" 42" z $4„ r N m �. � !� e 3' / 1 N 71 46" 7 I m m 4 lir:27 _ < 1 mD �� m v c rn . , o-0 1 * \ / 0 Ft7 40" 1-P" 07 1 O 0 mD C -i r 0 z T > m 0 Z -1 <0 x m0 U) A < m > X A m 0 -1 • K r = r 0 in z Z 0 0 0 r r E m --1 x -1 0 0 — - — Z 0 -I DN N D Z A G7 c - 0 n p�D GLAD r r DN ___I P N 0 n W _ � m m> Z D rr ) 0 00 r x j D O I0` rp = iOAo r ? Z m A n C = -I C m r N D Z C r < G7 2 (7 • -1 N U -I -i 01 m r p m p m 4,, O Z = O m 1 m � D ?� DAB Nr�A y�N •W N V) r • co r 0 D O W m D N 14 j) (f1 I . 0 m -1 m I) -O 0 Z > mrT1 0 i t o m > I D W J Nf�T1p M • m D r ( ` ''n rT O p n • C G7 — < ' C� Oo Npm Ul 7o o v 0 z i Z 0 O m -I m rn0 �c fi x) X n O D p0 > m AO 4 , Po m m ? m c 0 0 z >a0 0 '> m 0 O A y > vOm 0 p - O� O 0 0 A Z° m 0 ' --I m .. O --I N Z if) 0r 0 N m 0 c Z O • • > p << m i O m r m z 0 Z A r 0 m I N) m 0 > A N (n m m J 73 77 A rrn 0 z O 0 r c_ z m 0 A A m m m --I m m Z N \ U m WLP750 —MR WIESER COOCAETE SCALE:1/4" = 1' REV NO DATE: T DRAWN WN BY:SWT Z SEPTIC MANUAL y/ 3716 US HWY10. MAIDEN ROCK, WI 54750 DATE: JANUARY 2008 \° REV. JAN. 2008 800- 325 -8456 FILE: WLP750 -MR 10/12/2010 10:38 7158747868 PREFERRED PUMP EC PAGE 04/05 r r '' (EtC)110rTPIC r r E , , *,, ta• r ' ,, C"` Law ingintenpno , 1 s, , Ailr, , r Easy instailatioi r (f;', , - , ectends. life ot drainf i .........s , - r TA 1 .C7 _ p 67\ rr Ifripeivps r a • . \ 11 r '' • '' r • . - r rr 1 \ X I 1. ' i • r + i \ri i + -, •,,,,..,.' .\ , , ',^ • t ..`;`,:+- ., t' . The Sim/Tech filter, with it's unique design •-• , 7, ..-. : ,,:„..... r, • . , and mounting location, allows the filtering -- As , - screen to be scrubbed while in operation, , ,, providing maximum maintenance intervals .-- • - •„-,,,,,..„.,,,,-,-, •, with unmatched performance capabilities. '-,•: --- -,..,,,,, • • - .: -, The filter screen is a type 347 S. S. with ,062 diameter holes. It is 3 inches m diameter and 18 inches long with a 69.52 , ''-- • square inch open area. This large 41% ',,-",-- ,,,;,--•: ! ' ; .4..1 open area allows the filter to pass 83.8 gallons per minute at 1 psi. With features ,:••• like these even a partially clogged screen will keep the system well protected and ,., working properly Sim/Tech „- STF-100 .., This perf•ormance product assures quality effluent filter , effluent with lower TSS levels, keeping '.• ,...: p-,,,,, , , •'.`, t.i:, your pressurized system functioning at ', :•-.. ', . , • , • , -,,,,.. , ; 100% efficiency. c l., , ,, , „, - ,,., -,--,• ‘-'4,•,,, ' - ,, n. • .. : - .., - , 4 :, , ‘.•,„,„ ' -, , ,,," ••-• • Engineers and designers now have the ! . , opportunity to offer a simple safeguard to The Sim/Tech filter },.,.'N• ‹,','. , ;•.P , , I meet performance standards now and in , ,, •,,, can be used in both ik" the future. , . ; •,, ,,, ',:: residential and coin-, •-• ; , :, ,-. , I , mercial applications 5 ,,,„ '', ;.; • .. ;•,, ' :, ', - 4 4, , .t''.;.' ' ' , : ,,.• s '' 4110 - _ __:-....... .._.-.- _.:..,-,.-___....._ ..... _,.._ oral heat less .5002 ft. or '.21 psi r Cutaway view showing pr - ,r. • Flow rate WrcleaAscreerr1 20,67203Pb@ 1 psi i'''' r flitei casingahcfscreen Flow rate w/.95bio plugged soTeen: GPD@ 1.8 psi r r r. (s r • f' r WitPOptiCiftbr IrrntPeterilimder if TS naip int itg_fifli_A2 ... STF-111A Wira rand • • POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION rage of Owner hh p a SYSTEM SPECIFICATIONS Permit # p tv ■ raw — _ {'� - `�� b Al 03 Septic Tank Capacity — — — — r V U d gal ❑ NA Septic Tank Manufacturer 10,4? ' ) )4 s ❑ NA DESIGN PARAMETERS Effluent Filter ManWacturer —� Number of Bedrooms S °I TIN I (,� O NA ❑ NA Effluent Filter Model s r fi F. )Ub A ❑ NA 1 Number of Public Facility Units ❑ NA Pump Tank Capacity 1 S 0 ______out_ ❑ NA Estimated flow (average) 3 U U gal /day Pump Tank Manufacturer — NA Design flow (peak), (Estimated x 1.51 S _ — — — - �i �(X - -- _ __ `g al /da Pump Manufacturer �d� 1�Y( ❑ NA Soil Application Rate '7 -- ( al /day /ft Pump Model 6 N 5) ) 0 NA ' Standard Influent /Effluent Quality Monthly average" Pretreatment Unit Fats, Oil & Grease (FOG) <30 m ❑ S g /L 0 NA and /Gravel Fitter 13 Peat Filter Biochemical Oxygen Demand (BOD c220 mg /L 11 NA 1.1 Mechanical Aeration 1 1 Wetland Total Suspended Solids (TSS) 5150 mg /L 0 Disinfection Pretreated Effluent Quality Monthly -- ❑Other: onth) y avers g e Dispersal Cellls) O NA Biochemical Oxygen Demand (BOD <30 mg /L Total Suspended Solids (TSS) 530 mg /L ❑ NA El At- -Grade ( 0 M Ground (pressurized) Fecal Conform (geometric mean) 510 cfu /100m1 [� Drip - Line ❑Other: Mound __ Maximum Effluent Particle Size — Y in dia. ❑ NA Other: — Other': ❑ NA other: "values typical for dom _.. - - -� - -- — ❑ NA estic wastewater Tad septic tank effluent, ❑ NA Other. MAINTENANCE SCHEDULE ❑ NA Service Event Service Frequency Inspect condition of tank(s) ❑ month(s) At feast once every: year(s) (Maximum 3 years) 0 NA When Pump out contents of tank(s) -- -- en combined sludge and scum equals one-third ( Y 3 ) of tank volume ❑ NA Inspect dispersal cell(s) ❑ manilla) least once ever y D (Maximum 3 ears Clean effluent filter ---- - - - - �' y ear (s) Y 1 0 NA At least once every: ❑ month(s) / year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 3-"S ❑ month(s) Flush laterals and pressure test At l � U Di Yearis► ❑ NA 0 east once every: ❑ year(s) month(s) 1:11`NA Other: — —... — At least once every: year( GIs► A IiIAI Other: r. MAINTENANCE INSTRUCTIONS ❑ NA 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; POTS inspections must include a visual inspection of the tank(s) to identify any miissing orb broken hardware, identify�anycp cracks or Teaks, 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 ceillsi shall be visually inspected to check the effluent levels in the observation pipes and to check for any of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires th immediate notification of the local regulatory authority. . When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatm n units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. e t 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 b For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal coins). If high concentrations are detected have the contents' of the tank(s) 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 celllsl and may result in the backup or surface discharge of effluent. `Po 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. * 004 irz (r11 moat asir e+iM rNw ►l •i• 6 /4oa* •• low **ii *WNW fti wrr M 11rw1r w w«+i ii11Y1w 00•0•1411 • 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 replacement system: l A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption" system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O 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. O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank: may be installed as a last resort to replace the failed POWTS. O Mound end at -grade soil absorptiosystems may be reconstructed in place following removal of -the biomat at the infiltrative surface. Reconstructions %such systems must comply with the rules in effect at thattlmet4•. « 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 MAYBE DIFFICULT OR IMPOSSIBLE. • ADDITIONAL COMMENTS • • POWTS INSTALLER POWTS MAINTAINER '° r a . °:r �� •`► +r: Name rti 151)v,k S k)-(12, Name ./1 .■i4ti., Phone 1 L °S - 3%(,1-040 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY '► t ' u � +'' r ' Name Dp tad 1 , "+ Name ` • Q) Cliot ZJfs '`r Phone J' y a I t I i , Phone 1 ( 3/1.1 V•- L" This document was drafted in compliance with chapter Comm 83.22(210b)i111d) &1f) end 83.5411), (2) & (3), Wisconsin Administrative Cods. Page _ of TART UP AND OPERATION or new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents A the tank(s) removed by a septage servicing operator prior to use. system start up shall not occur when soil conditions are frozen at the infiltrative surface. )uring power outages pump tanks may fill above normal h)ghwater levels. When power is restored the excess wastewater will be Recharged to the dispersal cents) in one large dose, overloading the cellls) and may result in the backup or surface discharge of affluent. t ro avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring rawer to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to estore normal levels within the pump tank. )o not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area vithin 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. IANDONMENT Nhen the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is Nroperly 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. ill R IM isliir445MtNN pie *it owe* Niilffi (Niifil mould wyfN i.04000 01411i 000 #01411 .04li 1111104441 N411 Ise M 10000000 �rw.� iiiiY�li 1wMMriMNN?i i • 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. DNTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: Ei A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank, may be installed as a last resort to replace the failed POWTS. ❑ Mound end at -grade soil absorption, ° systems may be reconstructed in place following removal of the biomat at the infiltrative surface. .Reconstructions iOi systems must comply with the rules in effect at that tpmafde '' : <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 MAYBE DIFFICULT OR IMPOSSIBLE. WDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER . Name r� 1 t Sl Name „ , :■4114. Phone 1 t'S' 3�i1' © f t .0 y1 $ Phone ff;t ri. SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY 1 ' r "`�'' "' �' Name p IS ItrLa 1 1 S ! ' ' " Name > (.loo I b )' ) ''` ,...t _ 111 '.L Phone 1 �{a� I GS' Phone 1 1 S 3151/ 31.► j. This document was drafted In compliance with chapter Comm 83.22(2)1b►(1 and 83.54(1), (2) & (3►, Wisconsin Administrative Code. ST. CROIX COUNTY 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 Qry A W N A toll ��P N J 11 S residence located at: NE IA. NE ,, Sec. ) 9 , Tag N, R 1 4 W, Town of 14( 45 ph) St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced MA) ) a0)3 Did flow back occur from absorption system? Yes No� line. (if no, skip next Approximate volume or length of time: gallons Capacity: g minutes Construction: Prefab Concrete Steel Other Manufacturer (if known) : 4iStK Age of Tank (if known) : (Signs ure 3 BbUV+,4 ,511 P1( (Name). Please Print (Titl I TIns Da ),9vy (License Number) 1 • (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis Adm. Code (except for inspection opening over outlet baffle). Name St rh .gbtArh-tRS/0{2 Signature MPJMPRS aaa 4 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A lu e-Q 1+J N A PVC) p N as Mailing Address e 4 i 1 D E ) 4, ■ Property Address (Verification required from Planning & Zoning Department for new construction.) City/ State 1- 40Sois► kAhS C- Parcel Identification Number 0a0 - 0 U- 00 LEGAL DESCRIPTION Property Location N 1/4, NE y, , S ec. 1 , T ) 9 N R 19 W, Town of y>DS oN Subdivision W 1 l Olit g*) c , Lot # a . Certified Survey Map # , Volume , Page if Warranty Deed # 4)6...6-5z77 , Volume /iL3 t, , Page # a . N . Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of puttering 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. Owner 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 Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is Jess than 1/3 full of sludge. Uwe, the undersigned have read F + standards set f , ,4.. a nts and agree to maintain the private sewage disposal system with the forth, herein, as set by the ce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system hag beekmaintained must be co Zoning'Department within 30 days of the three. completed and returned to the St. Croix County Planning & y�i „p�cpltation date. I /we certify that all statements on this fora are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 x /0 ii,„0 SIGNATURE OF APPLICAN'1'(S) DATE ***Any information that is misrepresented may retlt in the sanitary permit being revoked by the Planning & ., Y g Zoning Department. ••• Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ynt 1436oknE 237 ,D 45. • STATE BAR OF WISCONSIN FORM 2 - 1982 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT NO. .,. RECEIVED FOR RECORD Alfred C. Schultz and Marian J. Schultz, as his 06-22 -1999 10:00 AM wife and in her own ri WWRIWITYDOED EXEMPT CERT COPY FEE= COPY FEE: conveys and wa rrants An r Th r' to nnG an A T 1 Than � ys n. TRANSFER FEE: Lj r 642.00 . _ . • : r.• i .. • • • • • It - ' . • • .- RECORDING FEE: 10.00 PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, j / r L e ....... State of Wisconsin: 020- 1117 -00 PARCEL IDENTIFICATION NUMBER Lot 12, Willow Ridge Addition to the Town of Hudson 1 • This is homestead property. (is) f Exception to warranties: Existing highways, easements and rights of way of record. Dated this V '44'' _ day of .Tt trig , A.D., 1999 . (SEAL) .1) —/" l (SEAL) (SEAL) • — _ • �!!!E' (SEAL) • AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin 55. ,cI - C1 O/ X County authenticated this day of , 19 Personally came before me this y ��5., day of Ji 1nP , 19 99 the above named Alfrrr1 C_ Srht11 anti Marian .T_ Salt tlr7, • • • `�<N• . f r ,-, hi ht ts)a anti wi FP WISCONSIN • O TITLE: MEMBER STATE BAR OF .� '� Of not, authorized by §706.06, Wis. Stars.) '� to a km. to be the person , ho executed the foregoing �A 140:0353 f i stru i and acknowledge ;•-. / THIS INSTRUMENT WAS DRAFTED BV ; s ue s � . ` u d, 4111 = J Attorney Kristina Ogland '••. . _ ` " _ _ 114 T.nctist Street, Hudson, WI 540 Notary Public, • c,2,0t t. County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary) l , 19 49 .) • Nantes of persons signing in any capaniy should by typed or printed below their signatutrs. STATE BAR OF WISCONSIN Wisconan Legal Blanc Co.. Inc. WARRANTY DEED Form No. 2 — 1982 Milwaukee. W8S. 1 s �f ,� �r"T Sw .,,r. I , e-v -- - ...,.r.,„ .,.,.....+.rat•....- • «. . � , ' " ' ....NA- +- ..,.... ..,•..,.... . n'a, ,��.. . t �{ x 4 �4 .a' F # �� 4 � E 7 « 1 - ,, y 1 S� y I � l'',* � J 8,}4k r �` . �z t a "S' -si b �. a. � ., \ViLL R„10C E. ADo IT10 5 } 1. ::1 4.x,a 5,n405 4. O.. 44L , u , .r.b ►��e v��et., s .,. 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W N * tx waM w cassiahkb � .1 : 4 Lbfit l.( b S 14 61 14 �4/t .k.... � � _.__. . ___ _ ___ _ _ _ fiC iWaOt r i ` f k 1 4 . . xe 0 l u � N 4e'4 t V M1! x r� • 1.., �._ .... 5 : Ip, "' S $ • M tiiM r 9 "MI ' _ - -- i :s . a 4 *i 3 t Kt ' t i�yi `` H ' - - / .., - , J 7 (I • lu4 ✓14M ,INIt , 'vN14 t .. f Y t > =y ` ^t; ; 1 151 , a �;1s 5 "' i."r -' > h> ,',,e' 9J' Ali: . 4. .,,,. o ...rte.. u F . s ? d a sf2 .7 � r ‘ e. 1 w '° w wwwww Iwo 4 , `T 1 ...# V A* C, .., 14. .u.. . .r . ` ., . -- — l4. 4 0 IS 6 4 . ,, ,, / S. - ' 1 . s j !F s ,lt p 422. , ° 0 • 0 e V '' 14. --- V: t • 4 I P it 0 ,.. c* • ;i, t t ' , ..12, ii" ki . t; tr% e 41 '9 l '-.." . *4 a 4 * 0 6'14 '-trto 0! V * '' ' 0 t y r 5. 1`3 1 4. ,, . ° -C) \ , x. W '4' ._ / ...M .. _ ... IP A ID 2221 Wisconsin Department of Commerce SOIL EVALUATION REPOR Page 1 of 3 • Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and di ce to nearest road. Parcel I.D 4 020- 17 -00 -000 Please print all info ,r Revie Id By le* Date ��( Personal information you provide may c r. (Privacy s. 15.04 (t) (m)). , /5 /Q Property Owner Property Location / Andrew & April Thanos GJ `1,\ Govt. Lot NE 1/' NE 1 S 19 T 29 N R 19 W Property Owner's Mailing Address ' C� Lot # Block # Subd. Na - or CSM# 898 Willow Ridge I O r .RO\ XG�N G O FCC 12 Plat Of Willow Ridge Addition City State ' ip Co .-‘ ,, •' 7 ! . • er J City _J Village lel Town Nearest Road Hudson 1 WI 1 ' • 1 715 377 - 0274 Hudson 1 Willow Ridge I _J New Construction Use: yJ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement 1 Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.7 gpd /sq.ft. /day loading rate. Proposed trench elevations to be 93.25'. 1 Boring # 1 Boring 1l Pit Ground Surf elev. 98.48 ft. Depth to limiting factor >110" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10 Y r3/2 none sil 2fgr ds cw 2fmc 0.6 0.8 2 10 -27 10yr4/4 none sil 2fsbk ds gw 2fm,1c 0.6 0.8 3 27-40 10yr5/6 none sil 2msbk ds aw 2fm,1c 0.6 0.8 4 40 -45 7.5yr4/6 none Is Osg dl cw a 1fm 0.7 1.6 5 45 -110 10yr5/4 none s Osg dl - - 0.7 1.6 q3-Z / O t e t 2 Boring # 1 Boring fJ Pit Ground Surface elev. 96.14 ft. Depth to limiting factor >94" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 10yr3/2 none sil fill na na ci 2fmc na na 2 7 -17 10yr4/4 none sl fill na na aw 2fmc na na 3 17 -28 10yr5/4 none sil 2mpl dsh aw 2f,1mc 0.0 0.2 4 28 -34 10yr4/6 none Is Osg dl cw 1fm 0.7 1.6 5 34 -94 10yr5/4 none ! s Osg dl - - 0.7 1.6 93. z4 35 � it * Effluent #1 = B50 30 < 220 mg /L and TSS >30 < 1 0 mg/L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Sigrtatur . CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 7/13/2010 715 - 248 -7767 v Property Owner Andrew & April Thanos Parcel ID # 0 20 - 1117 - - 000 Page 2 of 3 3 Boring # Boring A Pit Ground Surface elev. 98.29 ft. Depth to limiting factor >108" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr4/2 none sl fill na na ci 2fmc na na 2 10 -18 10yr3/2 none sil 2fsbk mvfr cw 2fmc 0.6 0.8 3 18 -32 10yr4/4 none sil 2fsbk mvfr cw 2fmc 0.6 0.8 4 32 -50 10yr5/6 none sil 1 msbk ds cw 2fm,1 c 0.4 0.6 5 50 -54 7.5yr4/6 none Is Osg dl cw 1fm 0.7 1.6 6 54 -108 10yr5/4 none ) s Osg dl - - 0.7 1.6 V. n Boring # Boring (OD " IP Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # 1 Boring 1 Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD 5 <_30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD -8330 (R.07 /00) A.C.E. Soil & Site Evaluations I. II ,Sp, /e,/a/ua 6r) 1 ! EXi.l& 9 e led, • /aca.t / orquerir s i Scale: / liD' ■ ii ra 44i, f22 2/ t J .. _ ,4 o of{ e,4)...t I 1 1 o 0 7Aaficis V .\&' I/1 ds� J /. sleo/6 a //1 \ /0&./.2, P -occ 2,7/'W ,f c / 4. � .. p . [NI /7E7 »ik7f� SeC, /9 T..29,?., e. /9u)., \�. u / i p O 7- n /- 4,a.(ir, 5 . 1. Cn7iXc . cz/ ., g 0 N /0c---/. X 010- /ll7 -� a l p : a I , I kI i i F%5c/n1 5krwk5 I I cued/ V < i t ' . ; \ \ t Slope es6 \ \\ 1 � b � -L v\ t ...e______— ‘.1.• 3 btdwa -„ -"t. ` \ .% vYs,c%nce ■ i \ 9 - - - - -- 63 ■ \ \ :. ✓ 5 Assu"-e_d ekJ�r. /cv.on' ( 0 • 96 38' oic \ A P Pr ,' S SEcm ° . ex S6; y t ems/s4 a FSevf/c ` ` c.c.s, ( /off /C c - fa.��('i c deyvoelfJ. ` `t e /etkr,c tra �J / / Or, e/ % /ba d as a u wf /4ed 6/ Easem L� crr� o' e ai 9cu. t by age e . 6ed Cw'1ers. *Yr : L&. /,td :11&e.s rutust 6e, /•e.10 ca4 &„ QCGOmpcl -� 5)•3'6- m i45'_//i c i• 15.30(.3 • . 4e s / e,Go r e • EASEMENT DEED I HM111111110 Document Title 8 0 0 0 8 1 9 Document Number TX :4000799 Michael R. Tervo and Lois Tervo, Grantors, hereby grant to Andrew 918094 Thanos and April Thanos, Grantees, the following easement subject BETH PABST to the following conditions: REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06/24/2010 10:17 AM EXEMPT #: REC FEE: 13.00 PAGES: 2 Recording Area {3 Name and Return Address Andrew and April Thanos 898 Willow Ridge Road Hudson, WI 54016 020 - 1117 -00 -000 and 020 - 1116 -00 -000 Parcel Identification Number (PIN) 1. Property subject to this easement (Easement Area) consists of the unpaved and unimproved portion of Willow Ridge Road that abuts Lot 12 of Willow Ridge Addition to the Township of Hudson recorded February 18, 1969 as Document 295311. 2. The benefited property is Lot 12 of Willow Ridge Addition to the Township of Hudson. 3. Grantors own the following described property: Lot 3 of Willow Ridge Addition to the Township of Hudson, which includes a fractional interest in Willow Ridge Road. 4. Grantors grant unto Grantees, their successors and assigns the right to maintain a septic drain field and associated underground piping on the Easement Area as a part of the septic system serving Lot 12. 5. Grantees may excavate as necessary to accommodate the system, but shall grade and reseed all disturbed ground following the installation of the drain field. 6. Grantors will not interfere with the future functioning of the septic system, but Grantors will not be responsible for the septic systems maintenance or repair. 1 of 2 A 1 4 14 S v Michael R. Tervo v % Lois Tervo ACKNOWLEDGMENT STATE OF WISCONSIN } }ss. ST. CROIX COUNTY 0 6 4 This instru e4t was ackno ledged before ? � � me on this 1 day of JEN t 2010 by Michael R. Tervo and Lo Tervo. MORKRID f 1, \ No ary public, State of Wi §consin M '4.M aril expires: ' pry Pfau-) THIS INSTRUMENT WAS DRAFTED BY R. Michael Waterman Mudge, Porter, Lundeen & Seguin, S.C. P.O. Box 469 Hudson, WI 54016 2 of 2 R wad 551 - � 49 ls TE Rs oPpice �3: S c°Ro1x co- wts: Reed. for Record this 31st d©)! of Ili A-D. 19 77 - . - at C1Q 1t,. ,�ME06+1NE1tS AGREEMENT ��: - AIL . Re�ictP/ C4 Deeds WHEREAS, each . of tf a parties to this a eement, kept as otherwise indicated, are owners of land situated in Willow ..: Ridge Addition, Sr. Croix County, Wisconsin, and WHEREAS, said plat of Willow Ridge Addition is subject to certain CONDITIONS, RESTRICTIONS AND COVENANTS as set forth In that certain document recorded in the Register of Deeds Office for St. Croix County, Wisconsin in Volume 449, Page 257, Document number 295310, which conditions, restrictions and covenants were amended and changed by that certain document dated and recorded May 11, 1973 in the Register of Deeds Office for St. Croix County, Wisconsin in Volume 497, Page 504, Document number 316057, and, ZREAS, Willow Ridge Road, Willow Ridge Circle and North View Circle have remained private roads, WHEREAS, to preserve the character of the residential neighborhood and to provide for safe vehicular and. pedestrian III traffic, and to provide for the orderly and effective administ- ration of the covenants, it is necessary to establish a govern- ing committee and body, and, WHEREAS, Randall S. Vogt and Lana Vogt are owners of a residential lot, as hereafter described, which adjoins Willow Ridge Road of said Willow Ridge Addition, and Randall S. Vogt and Lana Vogt by execution of this agreement do agree to abide by said covenants. NOW THEREFORE, IT IS AGREED by and between the parties hereto as follows: 1 1. THE CONDITIONS, RESTRICTIONS AND COVENANTS hereinbefore recited are hereby ratified and reaffirmed. 2. The road and outlot shall be managed and governed by the Willow Ridge Committee, which shall consist of four Willow Ridge Homeowners, elected by a plurality of the lot owners. Each committee person shall serve for two years. Consecutive terms shall not be allowed, except on approval by a vote of at least II 19 of the 23 lot owners. VOL 551 • 3. The `Willow Ridge shall elect its own chairman secretary, and treasurer and shall hold regular quarterly meetings daring July, October, and January of each year, at a time and place convenient to at1 homeowners. Am annual meeting of all lot owners shall be held on the second Tuesday of April of each year. Written notice of all regular meetings of the Willow Ridge Committee and of the manual meeting of the lot owners shall be delivered personalty or sent by mail to each lot owner at least five days before the meeting. 4. At the annual meeting, the Willow Ridge Committee shall present a budget for annual snow removal, road maintenance, and outiot taxes. Upon approval of the budget by at least 19 of the 22. lot owners, the committee shall ':.wave the authority to initiate such services, collect the appropriate amount from each lot owner, and make payment for services obtained. For purposes of approving the submitted budget, any let owner not present shall be deemed to be an affirmative vote,. 5. The lot owners shall approve any decision to improve the roadway beyond that stated to paragraph 4 above. Lot owner approval shall become effective when approved by at least 19 of the 23 lot owners hereinafter named, and shall authorize the committee to contract for such improvements, collect the necessary funds, and make appropriate payment. 6. The covenants contained herein shall bind the parties and their respective .heirs, personal representatives, successors and assigns. IN WITNESS WHEREOF, the parties hereto, owners of the land set forth opposite their names, have hereunto set their hands and seals this 30rh day of March 1977. / • 1 - Description of Property 'CA1- '1_,Z —P_4 Lot 1, Willow Ridge Addition RoWAP �Nug, "i llism F.. ,urt.er . d • i 1 Lot 2, Willow Ridge Addition lean l ut - r . Mc Tervo Lot 3, Willow Ridge Addition - / . 7�, - Lois M. Tervo -2- ��L 5J.L's 7 500 ,_ _ . • • rd C. T s Lot 4 `ii.low Ridge Addition W '" , .'as R Ja, Jr Lot 5, Willow Ridge Addti i .} „__, Ceara 't Si Pc 3 Dkorna d G. Lot 6, Willow Ridge" Addition -. old R. = ertel,sen Lot 7, Willow Ridge Addition V i 'Bette - -en - g E. Se Eder Lot 8, Willow Ridge Addition Co een � Sei . r ,, GeerfilVe F- W - = 1ey q , Jr. Lot 9, allow Ridge Addition 5 ' .e AL ' u ,f-;'. Lot 10, Willow Ridge A.ddia.ttgm a ,,19.111.am, K. s . -o Lot 11, Willer Ridge Addition A' r , ^ ch a Ltz - Lot 12 Willow Ridge . Addition .r • . . 40 - . S a Y. <10. . � $r Lot 14, Willow ,Ridge Addition .�• I._ - l - S L Dub Lor an'�° -J. Cku ph +',' Lot 15, Willow Ridge Addition . w• , 0 , - tr 5,10 - id M. wits Lot 18, Willow Ridge Addition 1 �:. • lei d a ' € avi. C C afo 7 ': Lot 19, Willow Ridge Addition Donald,--D. J •F• s -on Lot 21, Willow Ridge Addition Croly J.,' s Parry xf shal -1 Lot 22, Willow" Ridge Addition Vtv gene Marshall- . T.o, ,. - s 0 ,•. . el„ Lot 23, Willow Ridge Addition D�a`s H.. Ha •-s lid Lot 24, Willow Ridge Addition � - " - . .._.�i. Lunznx Haunschild III _3- vez. 551 _5ai .. , . • . . . . . . . . . . . . . . . . . .. . . pescri'tton of Poser -tv - • Rea -- t . A ohm Lot 2 25,, Willo�s' Ridge Addition is G.baver Ler 26, Willow Ridge Addition • C vR•ll _ . : aU. 3 �„ ,Vogt(- .....m Parcel as described in deed ." - / - ys • recorded in St. Croix County - Vogt ; Register of 'Deeds office in Volume 506, Page 501. Signatures of Thomas E. Nugent and Rosalie Nugent,. ,. William F. Rutherford and Joan Rutherford, Michael R. Te= and Lois M. Terve, David C. Loss and Randee Loss:, H. Paul Brown, Jr. and Carol Brown, Donald G. Wend and Audrey Ward, Arnold R. Bertelsen and V irginia. Bertelsen, George E. Schneider and Colleen Schneider, George F. Vealey, Jr. and Joan Wesley, Eugene W. McPhetres, William K. Olson and Marion Olson, Alfred C. Schultz and Marian Schultz, John C. Huber and Sonia Huber, Lorran J. Church and Doris Church, Donald M. Lewis and Nary Lou Lewis, Cavid C. • Crawford, Donald 0.. Johnson and Carolyn Johnson, Harry J. Marshall and Viviene Marshall, Thomas W. Zoeel and Gayle Zosel Dale H. Haunscbtld and Luann £..aunsc.hild, Robert J. Johnson and Beverly Johnson, Manila G. Shaves and Carroll Shaver, and Randall S. Vogt and Lana Vogt, authenticated this 30th day of March, 1977. . - te A 4-:rci 1 ■° William J ' adasevieh Member: S ate .Bar of Wisconsin Wisconsin Statute 706.06 This instrument drafted by William J. Radosevich Attorney at Law 619 Second Street Hudson, Wisconsin 54016 III . -4- Ynl 1436 ' t 237 f� dEaAnit5.001:7"EA STATE BAR OF WISCONSIN FORM 2 - 1982 KATHLEEN H. wALSH • WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI DOCUMENT NO. RECEIVED FOR RECORD Alfred C. Schultz and Marian J. Schultz, as his 06 -22 -1999 10:00 AM wife and in her own right WARRANTY DEED EXEMPT I CERT COPY FEE: COPY FEE: I conveys and warrants to Ant^lraw Thane anti Apri 1 Thanos, TRANSFER FEE: 642.00 r,ticbaitd arid wi fP as Su rvivorship marital propPrty S: DING FEE: 10.00 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, Fr State of Wisconsin: 020- 1117 -00 PARCEL IDENTIFICATION NUMBER Lot 12, Willow Ridge Addition to the Town of Hudson This iS homestead property. (is) Exception to warranties: Existing highways, easements and rights of way of record. • Dated this u �� day of .Tt1ne , A.D., 1999 . (SEAL) ) 7° (SEAL) • (SEAL) Amigos �kaw_r. (SEAL) • AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, l } ss. e2 Oi X county. JJJ authenticated this day of , 19 Personally came before me this S day of Tuna , 19 99 , the above named Al frPd C_ Srhul 1 and Marian ,T. Schnl tz, 0101100M41 + ht igharM1 anti wi fP TITLE: MEMBER STATE BAR OF WISCONSIN,?ciS. (If not, v authorized by §706.06, Wis. Stats.) A Q � e- � N to e km to he the person • ho executed the foregoing vieF i stru and acknowledge • • ;• THIS INSTRUMENT WAS DRAFTED BY ^` w- _ �s Attorney Kristina Ogland'••, „'.:� �',•- - j �w.sa5. � l - s1 - 304 Tnr Street, Hudson, WI 540i6 Notary Public, • r County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary) t: -`l , 19 4 Q .) • • Names of persons signing in any c:m•ty should by typed or pri below thew sign :nuns:. STATE BAR OF WISCONSIN Wisconsn Legal Mokpo.. Inc. WARRANTY DEED Form No. 2 — 1982 Milwaukee. Wis.