HomeMy WebLinkAbout020-1353-63-000 /*
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM fount
Sat�ay and Buildings Division INSPECTION REPORT S Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 383997
P rmit Hol r's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
Sharer Jlm Hudson Townsh
CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.:
tot') , p ' I , r Tip e - 020 - 1353 -63 -000
TANK INFORMATION ELEVATION DATA 3la' aq•(q, Z063
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
'5-141,, c lJ 12 o / Benchmark (– 1, 2.01 g e,8 o �, v r
Sept —
Dosing Alt. BM 0 .$0 98.01
BId Sewer 5:rov
Aeration 9� 43•20'
Holding St/ Ht Inlet ( .344 92 , yb f
TANK SETBACK INFORMATION St / Ht Outlet (9.55 92.2?
TANK TO P/ L WELL BLDG. Ventto ntake ROAD Dt Inlet —,
Air BLDG. .
Septic ?'S c(o/ ----- NA Dt Bottom -
Dosing NA Header /Man. 4 . ae l 91. 1
N Dist. Pie (2i-12! 9 /$�
Aeration P 0 9t. �e'
*5 9o. 3$i
Holding Bot. System 6- V s• 90. a S '
P P / SIPHON INFORMATION Final Gr (rO°" / ,ti y, c cf 20
M • • facturer Demand
St cover C ntl
Model 6 I b- GPM
TDH - gt•SSion ft dm I TD Ft
cemain 1 Length N - - – . To well
SOIL ABSORPTION SYSTEM 4 5 ) f ,
BED / TRENCH Width
b eng . ti is .1 )04 , 4 N O Trenches ( {T No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS � 3 � DIM ENSIONS
Manuf ure :
SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING tr _ c jA
INFORMATION Type Of t - ∎ 6k) `�' CHAMBER Mo ee Num bbeer.
System: Cdr) . }?O o�.�,b UNIT 144 — G4 4 . .
DISTRIBUTION_$�YSTEM 5Z' - " •
I Header / Manif ,\- t� Distribut i . • - ize ole Spacing 1 Vent To Air Intake
Length Dia. `"c ength Dia. .. in c
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges • Topsoil 0 Yes ❑ No ❑ Yes ❑ No
/ COMMENTS: (Include code discrepancies, persons present, etc
spection #1: o�l0510 t Inspection -- T
Location: 625 Alice Circle, Hudson, WI 54016 (NE 1/4 SW 1/436 T29N R19W) - 3629192063
Cottonwood Ridge -Lot 63 t
1.) Alt BM Description = S ill aie g at c ,,e , )
2.) Bldg sewer length = 21. '
- amount of cover 4 n
3 – (o-oc t .
Plan revision required? ❑ Yes tg No al-- or- QI�! Hill
Ie other side for additional information. J'-_
3D-6710 (R.3/97)
Date Inspector's Signature Cert No
� y
vv4
Arr
•
' I
a73 ?7
-# ((Z.5 A-f ; c_ _ C,'`-rJ,e, Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application y p y PO Box 7302
` iscbnsin personal information ou provide may be used for second purposes
ores Madison, WI 53707 -7302
Department of Commerce
[Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
_ state owned.)
1 Attach complete plans (to the county copy only) for the sy „oi) paper n ties than 8 -1/2 x 11 inches in size.
CountyY� 4 - x State Sanitary Permit Number ❑ Chec t Us pre cation State Plan I. D. Number
(, 35319 ,
I. Application Information - Please Print all Information r - , `
m Location:
Property Owner Nae '' N peyty Location \
v' J �^� Sam Pi t� i , F x r,� 7 r!2� 1/4 $G /4, 5$ho E ( r)) W/
vl Property Owner's Mailing Address +, it Lot Number Bloc lf Num a' 3 3 E, / N 63 �-
City, State Zip Code y none Number Subdivision Name or CSM Number
JJ t
/�O / /4 -, s3 S t ❑ (: ) �o ,./�,
I I. Type of Building: (check one) ` " -- ❑City
1 or 2 Family Dwelling - No. of Bedrooms : I O Village
❑ Public /Commercial (describe use):_
Town of
State - Owned C�� � i _/
earest Road
C 3 t k 9.7-s 4 Q. tsig S Patsel,`�un'be -� — g3
I III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) C (, � .'9 9 , q , 0673
A) 1 New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
1 IV. Type of POWT System: (Check all that apply) .& Z-o.,a 4 - . - L4 i
pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
Q ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
0" ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
M
0
V. Dispersal/Treatment Area Information:
s.s. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
/� Required
sdc Proposed s 0 0 Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
7
3 3 6 �z
9 �
VII. Tank Capacity in Total # of Manufacturer Prefab Site Stee Fiber- Plastic
formation Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
— it ;.0(-2 7.-7... - ---C— , X /260 / (/ . P" ❑ ❑ ❑ ❑
3 VIII. Responsibility Statement
44. I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) r Plumber's Si a e (no stamps stamps• MP/MPRS No. y Business Phone Number, 9
Plumber's Address (Street, City, State, Zip Code)
,/ 7 g /4 2 ,® 'v+° // i L� 55 7
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
Approved 0 Owner Given Initial Adverse Surch ge Fee) to
Determination 2 2 S. �ly� 1 � 20D
VCIXIA;•%. -VA66e-
X. Conditions of Approval /Reasons for Disapproval: — Sa-
_ n n n S . f -n " , L _ (1 n
o-uz_,
. '£ Pre,., ,-..., s so i ( e - e -
'� e—. �...' - U c X4. e4D c0
0_�r 2. C -� .Q.. t2 `�6 < — go. Q5
.e.�.C..b. c t ,� n� S S t1'Ac -4-is . icri IA 1 S S w i T � . s `/ 4 - 5 i zek {6p
- ,, he-. ti -t) � ow& to y t ► Cerw wt.. C b f- �3 - se ,c'� c. odd . Leto„ e.- 4-' L o f.e,� c Ms ge. �i o,�t
4. :C• S Lee_ +L - tk c+.p-itc. -�-o.�k `Re, t s cQno•�ed/ wlu i
as d� w.�e at 5 �*264,04444d-1 n 1/4 .4,- . w101 (¢.cCoow■ 0-1neQ 5 - c , hu...St_
SBD -6398 (R. Mr) 5. ,,Q
6 -5 c4- 4" (3et0Aree�, t b+' 5¢4-ic tdi(,Q I N.ertA, — Cawpti s�
OT PLAN
PROJECT Jim Sharer a ADDRESS 2133 Ruabv Rd. Janesville Wi 53545
NE ' 1/4 SW 1/4S 36 /T 21J R 19 W TOWN Hudson COUNTY ST. CROIX
MPRS Shaun Bird 226900 ' fi DATE 5/5/01 BEDROOM 4
CONVENTIONAL )00( IN -GR 61 PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 500 # of chambers 30
■ BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL •H.R.P. Same as Benchmark
Alt. BM SYSTEM ELEVATION 90.4
Top of Steel Fence Post with Orange Ribbon @ 97.7'
Property Line
A
Culdesac Road
215'
Alt Pro 4 Plans Designed Using
Bedroom Conventional Powts
House Manual Version 2.0
v 10 9 50, 0'"� 35'
I B.. 20' a
Site has <1% Slope and
9 40'
thus no true contour
2 -3' X 94' Cells
15' lines can be established
with >3' Spacing Vents
B -1 Tested Area may be cut
to raise house elevation .
45'
Vent
B -3 3 > 12 Sidewinder High
Capacity Leaching
of Cover Chamber
N
a 45' 6' Long 16"
a • • 34
„ Grade at System Elevation
• a2
Vents
'A OT PLAN
PROJECT Jim Sharer ADDRESS 2133 Ruabv Rd. Janesville Wi 53545
NE 1/4 SW 1/4S 36 /T 2''j R 19 W TOWN Hudson COUNTY ST.CROIX
MPRS Shaun Bird 226900 / 111' DATES /5/01 BEDROOM 4
CONVENTIONAL XXX IN-GR41 PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 500 # of chambers 30
■ BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Alt. BM SYSTEM ELEVATION 90.4
Top of Steel Fence Post with Orange Ribbon @ 97.7'
Property Line
0
Culdesac Road
615'
,`` Pro 4 Plans Designed Using
Bedroom Conventional Powts
10' House Manual Version 2.0
50'
• • 35'
B 20' P I
Site has <1% Slope and
Z ,
40' thus no true contour
2 -3' X 94' Cells
15' lines can be established
with >3' Spacing Vents 7 B -1 Tested Area may be cut
to raise house elevation .
45'
1 Vent
B-3 11.4.. t 3 >12" Sidewinder High
of Cover Capacity Leaching
Chamber
N
3 45' 6' Long 16"
34" Grade at System Elevation
n
ct B -2
V Vents
Wi Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County elL C J i
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Reviewed by � Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ��F ��+�' � 1 Mo . 11,2401
Property Owner Property Location (�
d ; 51 aver- Govt. Lot WI: 1/45(,I/4 S3 4,T 29 N R /f E (off W/
Property Owner's Mailing Address � &I Lot # � Bh # Subd. �� r C j # � 21
� „,,4
City J tat Z ip Code P a Number ❑ City ❑ Village ;,Town Nearest Road
✓QJ..4v:l/ )Q) I6/ t 1 53S I ( ) #Ge- r:(GO -."—. 1
x New Construction Use Residential / Number of bedrooms Code derived design flow rate b -00 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material 0 1-.4-4i .c -4C4.1-1-.0 Flood Plain elevation if applicable fit/ /Tr ft.
General comments c-- Ste- -Q l-2) �`�
and recommendations: l
1 Boring # ❑ Boring
Pit Ground surface elev� 3ft. Depth to limiting factor yz 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 o /4y - 3/z / s/ ca7--. f./' m . ? - S - ,
a. 2 33 ,70y -5/' z.. e/ /,h.sd i 1., J (A -ca. -3
-3 3'7r ./� 6” �- 1.�' iiiii4 /-9,1 - 7 / 2
r :#- 90.4D i
Boring # 0 oring !
Pit Ground surface elev.- .- ft. Depth to limiting factor // 2 - 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
0-10 4;/- /26,-- 5/ 22 �� t%'� t7,4" , -S I
D )0'1 4 `ryy—<s/� o -,� � / -.1/ ,;lam ft., /.7C . . D
`3 - /�� / .� ..lei)-.,( i �� h r / Z
j �s�c / � X1 7
5T.4/93.C. .
* Effluent #1 = BCD, > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BCD, < 30 mg /L and TSS < 30 mg/L
CST Name (P Lc a Print) i �� "' Signature �� c9 ST / e 6 15
//- tti l f f
Address Date Evaluation Conducted Telephone Number
&e / Z.- J4r-e-- GY/Wc J ►2i e y sV2/ 5 7/
SBD -8330 (R07 /00)
t,,
Property Owner Parcel ID # Page of
Boring
B oring # L/ /�
3 pit Ground surface elev. / 7 ft. Depth to limiting factor //V in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. JMuu�nsell Qu. Sz. Cont. Color I Gr. Sz. Sh. *Eff#1 *Eff#2
1 O—�3 /(/ /.� �!/ —V r /71-4-- e ,r-- a, .. " P
1 a /3-va*..0 c/ /ms 744) - g .02 .3
3 %2-/X /4/.1 s 0_ , / w wng .. - 7 4 Z
Boring # ❑ Boring
❑ 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 # ❑ Boring
❑ 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 < 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)
Soil Test Plot Plan
Project Name Jim Sharer Sha' O rd
Address 2133 E. Rugby Rd. ! �Al
Janesville Wi 53545 M #226900
Lot 63 Subdivision Cottonwood Ridge Date 5 /4/01
NE 1/4 SW 1/4S 36 T 29 N /R19 W Township Hudson
El Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post with Orange Ribbon
System Elevation 90.4 *HRP Same as Benchmark
Alt. BM Top of Steel Fence Post with Orange Ribbon @ 97.7'
Property Line
Culdesac Road
r 15'
Alt. Pro 4
•M• Bedroom
House
10' 50' 35'
B.M.
40'
• B -1 Tested Area may be cut
to raise house elevation .
45'
B -3 30, Site has <1% Slope and
thus no true contour
lines can be established
45'
•
B -2
isc Department of Commerce SOIL AND SITE EVALUATION 3
Division of Safety and Buildings Page I of
Bureau of Integrated Services in accordance with . 1-1F1' Wis. Adm. Code
r
Attach complete site plan on paper not less than 8 1/2 x 11 inches in i Plan nysl '' C0OO
include, but not limited to: vertical and horizontal reference point (B ;'direction arid 'r '' 7 S., Cry 1 . 4
percent slope, scale or dimensions, north arrow, and location and stance to nearest road:" ' Parcei' ",LD. #
APPLICANT INFORMATION - Please print all infori(tetlon. rn, Revi e by Date
Personal information you provide may be used for secondary purposes (Privac4ew, s. 1 " r f 4 n l� 1 7, f 9G1(�
�fKH�"VV l l 1
Property Owner
�� ` Property Location
Imo, lc_ NG S- o ,: Govt. tot _ '` 1/4sAj 1/4,S � TZ t ,N,R / c( E (or) (0
Property Owner's Mailing Address ' 127R- #- *--- etSok# Subd. Name or CSM#
t35 Avva-1u1See 7 • lo3 CO Lnwood P‘dae�
City State Zip Code Phone Number - udt 30n City ❑Village Town Nearest ad
❑ Ci
I W y � l, c a l >5' - I�- c��1 � l �- l son i Cry 2d N
fli• New Construction Use: 131.Residential / Number of bedrooms 3" Addition to existing building
El Replacement ❑ Public or commercial - Describe:
Code derived daily flow BOO gpd Recommended design loading rate • bed, gpd /ft , / C trench, gpd /ft
Absorption area required /ZOO bed, ft /cod trench, ft 2 Maximum design loading rate ....c bed, gpd /ft (n trench, gpd/ft
Recommended infiltration surface elevation(s) /U• C ft (as referred to site plan benchmark)
Additional design /site considerations y � 4t) L • 70 ■ CO
Parent material � t (1 C I al Lu-E wash Flood plain elevation, if applicable HwL /63`7.0 ft
Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
S = Suitable for system y g
U = Unsuitable for system ® S ❑ u 1 S El U 14 s U El S ❑ U ❑ S iZ U ❑ s u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
t (rl(P IUy 31 -- ) 2mo 111 mc'r CS I -P , FD ; '
2 lio -51 leyr z-1I
Ground .3 51-125 11)Vr (-1 1tP — k OSa mI c- 5 -
elev. J
C(S.rOft.
Depth to -
limiting '
factor
122 in. '
Remarks:
Boring # n
1 0-I5 )c�yr3 / — Si1 2rr�ctbk 1Y) PI- CS 1 C . 5 . (o
2 2 15 -3 lU r LI I4J c.1 3rYsbit m C i LS - . L1 . 5
3 3c155 - I.5.p r 41 cP — LS l m s m l C S 1 c . - I . g
Ground t 5S I 1 b y r 'I I& Fs of.fl m1 C.3 — • 5
elev.
'S ?6 ft. , ��!! _ '
Depth to � k pub
limiting
factor
1?lvin. Remarks:
CST Name (Please Print) Signature Telephone 41
/4 darn 5c LA rvIa"ker 7 ( II S)2517 -Li on?
Address Date CST Number
L $ Ceder S4. - i Samer ,5e4, a )/ 5402.5- ` -is -9 y 25 3 30`1
i
1 1 1 M-
PROPERTY OWNER 3 IOU SOIL DESCRIPTION REPORT
Page of
PARCEL I.D.# •
Boris # Horizon Depth Dominant Color Mottles Structure G D /ft
g Texture Consistence Boundary Roots R
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3 1 o•-IS u yr 312 -- Si 1 21 Mfr L5 if :
2 )54, )0 yr Li 'Li — C I 3 m5bk S - . y 5
elevund 4p() - 131 i)yr l_f ko t S c 30 M■ Cs _ J - Co
Qatoft.
Depth to
limiting
factor �
l31 in. (Q I'o 00
Remarks:
Boring #
v -14 ibyr3JZ — SiI 2 rr bk tl 'r L - . (p
2 iy -A, in yr LI ILI — LI 3r co-rt L S • y . 5
3 34,-I2 t lily r cS m1 S `" .
Ground
elev.
Depth to
limiting In \.7 Qr,�
factor �Y
l2g in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP , Dift2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring # p -% Iayr 3/Z — 51 2rY)G:.bK r c . 5 Zo
5 2 2 CI -3 msbk M j C S - y • 5
3 -123 10 y r 9 1 t -CS 'MI CS _ ) - (�
Ground
elev.
9s, 3Oft.
Depth to
limiting
factor
Zg in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R. 07/96)
_ I
/r - MIPPr L 4 c 3 °- 3
30.04-e— 1 ".=-- XX> 1
net :1; Erik. IM.
RI I e(tv . vv. 0
s'E Lc_ Tbp o- -e- I "rleer. p: p _
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7
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4 d I
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Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
Contingency Plan
1. If system fails, determine cause of failure, use altemate area and install new system or
install system at a lower elevation.
2. Replace any other failing components as needed.
Plumber: Shaun Bird 715 -246 -4516 1
5 (,- ;� Ce9 t7 j - 7, r--- 3 % 6 6 O
Pu,naer 1(04 ,,�, ,;L 7/ S- ` g
Shaun Bird #226900 ;\ i\
i\
s t
/ f,/ I f r I
F J
� V
L
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
• AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address C/ 33 E ( J 1 '• c 1 e
Property A d d re s s a 5
(Verification required from Planning Department for new construction) s_
City/State Parcel Identification Number / 3 3
J.EGAI. DESCRIPTION
Property Location // 1 /4, (i / Sec. 3 6 . T N -R / W, Town of ,a t; ti .
Subdivision Ce L 2 , Lot # ‘3.
Certified Survey Map # , Volume , Page #
Warranty Deed # 0 7 7 / , Volume / � o e , Page # S 4 .
Spec house 0 yes no Lot lines identifiablp--yes ❑ no •
SYSTEM M4„INT ENANCC
Improper use and mai teaanceof your septic system. could result is 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 age to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restrictedptamberor a licensed pumper verifying that (I) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fttI1 of sludge.
I/we, the undersigned have read the above r+equirenents and agree to maintain the private sewage disposal :postern with the standards
set forth, herein, u set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin, Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Mace within 30
• of the throe year • . , . date.
111 111 10/ S / g
C
ATUR3 OF CANE DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. 1 (we) am (are) the owner(s) of
• describe • ( •v , by virtue of a warranty deed recorded in Register of Deeds Office. J/)
eit
SI a ffAT[JR,E OF APPLICANT DATE
•* **** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Dept ttntnt. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey reap if reference is made in the warranty deed
May 13, 2001
To Whom It May Concern:
Our home is a four bedroom house. The den will be
used as a den or office.
weri
James Sharer
• 'i ( , � PAGE ‘,/,)0
Ewa o"7 "7 z
W ARRANTY DEED u.f1T'-IL:.EN H. WALSH
Document Number RCOI TER OF DEEDS
ST, CROIX CO.. WI
This Deed, made between RECEIVED FOR RECORD
Jason A. Bast and Jana S. Bast
03-13- ?901 100 FM
,Grantor,
AND James and Jean Sharer Trust WARRANTY DEED EXPIPT tl
CERT COPY FEE:
CDPY FEE:
, Grantee, TRANSFER FEE: 212.70
RECORDING FEE: 10.00
Witnesseth, That the said Grantor, for a valuable consideration of one PAGES: 1
dollar and other valuable consideration, conveys to Grantee the following
described real estate in St Croix County, State of Wisconsin:
Recordin! Area
This is not homestead property. Name and Return Address
Together with all and singular the hereditaments and appurtenances
thereunto belonging; And Grantor warrants that the title is good, �,1 % -'r 99 - I �i
indefeasible in fee simple and free and clear of all encumbrances except
rights of way, covenants, or utility easements
and will warrant and defend the same.
0 1— - 3 -63
(Parcel Identification Number)
Lot #63, Plat of Cottonwood Ridge, Town of
Hudson, St. Croix County, Wisconsin.
x/r purig s 15da of March 2001. ^ �� ✓^ —
,Tasnn A. Bast • Jana S. Bast
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF Wisconsin
COUNTY OF St. Croix
Personally came before me this 15 day of March , 24D
authenticated this _ day of the above nary -, 4 c4KFAR'•PtB.fc Jana S.
Bas
to •wn t 4 t •(`iG n de Jsa fy 1 y,tM � foregoing
fore oin
' + w N g
signature instrument a a ?
type or print name A
signature i
TITLE: MEMBER STATE BAR OF WISCONSIN type or r nt name • • • s -
(If not, Nota , Public County,
authorized by §706.06, Wis. Stats.)
My c•mmission is permanent. (If not, state expiration date:
THIS INSTRUMENT WAS DRAFTED BY 4 -01 -02 )
Jason A. Bast •Names of persons signing in any capacity should be typed or
printed below their signatures.
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- _ : -. 24'g 3 „ 1 I DATUM 1929
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1' IRON PIPE
1 OF 4 SHEETS