HomeMy WebLinkAbout020-1441-66-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building ®ivisiort ,
INSPECTION REPORT Sanitary Permit No:
430540 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: City Village X Township Parcel Tax No:
Bast, Kernon Hudson Township
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
% of . 4,1,-- 6 q19. 0. t) c o f ' /-y „ 5i-et , l 5-1, 36.29.19.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark ic....42..1- I V , 4; W e 5 - , i . -' 1 5 0 R rn 2- S. G c J o /vet-7--e
Dosing Alt. BM
W k 6t f i i c I i - v>--c i."-e- { G .i
Aeration Bldg. Sewer
< $, o3 'I119
Holding St/Ht Inlet �� Z
- 2464 Fl•!u
TANK SETBACK INFORMATION St/Ht outlet
S / r4 4,40h44 r• -e:-."-' 9.1 ( I(`'.cy
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic „ t san ;1 Dt Bottom
>10 0 n� tit 3 fQ 4 C 1 G S IX- /
Dosing Header /Man.
Aeration Dist. Pipe
`�.2 `J G. OZ
Holding / I Bot. System
(sc�p ) /c. N. 9 7 ---
Final Grade
PUMP /SIPHON INFORMATION n1, 4 vi (• - 4.4. ryi k S 3 S `i , ( "
Manufact rer Demand St Cover
GPM 2.1 / 0z , oz_
Model Number `
C f y / I 47 Toe c ) � 1e4,1,k6.41 /.lo ? 6 /
TDH'Lift Fri on Loss 'System Head TJt-I Ft
Forcem -' Length Di:. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches j PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 '� 2 5
13 /i C'r = +otu1 39
SETBACK SYSTEM TO P/L BL G WELL LAKE /STREAM LEACHING Manufacturer: . - - i n (, ( 7 ‹r
INFORMATION CHAMBER OR
Type Of System: C� 5 n , r CK h, k- / UNIT
/ Model Number
Mew/ C n d,,,i- 7L,)„( 7 5f d
DISTRIBUTIQN SySTEM / , , /i , .),cpIJS
Header /Manifold ( Distribution 3 x Hole Size x Hole Spacing Vent to Air Intake
it Pipe(s) r' /k yr/ AI �..
Length 1,-- Dia Length Dia Spacing C3/29 S
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 Red/Trench ges lopsoU
es J N es To
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 / V3 / D3 cant
ilslon^,n
Location: 826 Wilcoxson Drive Hudson, WI 54016 (SE 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge 1st Lot 66 Parcel No: 36.29.19.
IWO 1k1.04..
1.) Alt BM Description = i . '' (3) AI 1 Pi faS vr.l ar a ( G.. d c h a n : r1 c h � , e'rt
2.) Bldg sewer length = '3'3 . , 1 . l � ,s,14.,,,, i 1 0 ii,,,,, 1
,r 1 l1F,, f , ac C � 1,,..1 5,-,.:. cl; c(p i ..2. . 70 w � Ems.. , . „,
- amount of cover= if % C ;;,.:✓” l3'S /S
'w j h t 111 Ir 3 f A 6=-------
Plan revision Required? � ] Yes � No I ., I i T
I °� I ' l!� _ Al i -- i i `� cl 1
Use other side for additional information. _ _�_ ____J � J.,
-
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No.
Safety and Buildings Division County � C
\' $ sconsin 201 W .'WBh . . 7Aa[
Madiso , •• Sanitary Permit Number (to be filled in by Co.)
30 De • artment of Commerce (608) 261 -6546 c L S 0
Sanitary Permit Api licdttWnl 0 2003 State Plan 1.D. Number
In accord with Comm 83.21, Wis. Adm. Code, persor s1 information you provide /��`
may be used for secondary purposes Privacy Law, sE5104i;I3I ( COUNTY Project Address (' different than mailing address)
ZONING OFFICE )42, ICalX5t�— I) V' .
I. Application Information — Please Print All Information 2,
Property Owner's Name Parcel # Lot # Block #
Property Owner's Mailing Address "perry •i ation
gi3 - A. D, 3 6
�� /. ��. section ,
City, State � Zip Code Phone Number
7/7/CA-11-64A- - �j(�(� �y ° �l / Q 7 , / ,- 5-- 0 2 5 1 6 crrcl W one)
�
II. Type of Building (check all that apply) I fJ -e J1 S 70t� T ay N; R )
"4 or 2 Family Dwelling - Number of Bedrooms y ++ Subdivision Name CSM um
❑ Public/Commercial - Describe Use X / 5 isld .
❑ State Owned - Describe Use 3 A /ST• ( a S p ❑City ❑Villa:e,To ship of
III. Type of P >trmit: (Check only one box on line A. Complete line B if applicable) -
A. PCNew System ys 0 Replacement System ❑ Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System
B. ❑Permit Renewal ❑Permit Revision List Previous Permit Number and Date Issued
❑ Change of ❑ Permit Transfer to New
Be tore Expiration Plumber Owner
IV. Type of POWTS System: (Check all that apply)
, Ncn -- 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 ❑ Put Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter as Leaching C C ber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other explain)
V. Dispersal/Treatment Area Information: ( 01) " �l�1I►WCOV /
Design Flow (gpd) Design Soil Application Rate(gpds» Dispersal Area Required (s1).- Dis. :1 Area Proposed (st) System Elevation
400 - 5— �// iaoo Jr /R - 7,
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units 4 D Concrete Constructed Glass
New Existing
Tanks Tanks 4 ' /'-..-
Septic or Holding Tank /075 4'2? 5 y3 J b- l
Aerobic Treatment Unit ✓ t
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for i Ration of the POWTS shown on the attached plans.
Plum 's Name (Print) Plumber's "i• 7 turevIPRS Number Business Phone Number
L fj1 /9Y U 'A !/ as o35 7 .745-- g - ( 9 4.5
Plumber s Address (Street, City, S -: te, Zip ) Of
/7 v . 0 e I tL-' ✓c— 00
VIII. unty/Department Use Onl
pproved 0 Disapproved Sanitary Permit Fee (includes Gro ■ water Date sued Issuing Agent Si i• : ture 1 . ' t+ . s)
Surcharge Fee) 4 of : -- ) s--0 ey 9/ J � l / 2 / `,�
❑ Owner Given Reason for Denial v vi�
p Con 'ti ns. of Approve aeons for prr ei l uirs, 14/134_, ni � �
(51/STEM OWNER: r' '�/ .i., 0 -
E . lJ e
1 Septic tank, effluent filter and �3 �
dispersal cell must all be serviced !maintained /I - ��
as per manes ='l • • • + - d b •lum•-r J '� ., , �- >.3(0 , 0t.
2. A e 'lack requirements bl ust emaintained
as •er app code/ordinances. /7144..._. 3• I reu vtez - e4GSel .P/Yld- t'. /6.14.70,1
Attach compkte plan (to the Coun only) for the system on paper not kethan 81/2 111 inches In size
f' rlo e •
SBD -6398 (R. 08/02)
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 5r: GR Of
Include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. S.Gt✓ 4e.161.4...7' 4
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. eviewed b Date
Personal Information you provide may be used second purposes (Privacy Law. s. 15.04 (1) (m)). ' s:P 11 ' 1 / 0 OS
Property Owner C E IVE D - _ , • • `rt Location NE of sw 0 q
4,5/"G E'•L W /L'o,X.S o' .. . L se 1/4VGV 1/4 s T'' N R/! Q
¢ (or) W
Property Owner's Mailing Address . t # pock # Subd. Name or CSM# it--,w/c4- ?/47F-
V/ le cry. ivy /I
JAN 0 9 2003 fi � Ns, ock-d gide/. /51 ,./
City State Zip Code Pfoi - .. , : , • City ❑ Village J od
Town Nearest Ro
,yvpSo,v . l u,/. 1 sy "6 7/5D •f' ,41 , w'sa.) I HU., y A/
rej-New Construction Use: (x Residential / Number of bedrooms 3 - y Code derived design flow rate ys0 — C en::' GPD
❑ Reptacement ❑ Public or commercial - Describe: __ __
Parent material /D E'SS 4
a Peg 51 Y d ' i- -414 -s k Flood Plain elevation if applicable N /,� - -~ � _ ft.
n corl.nents -g * 7 57ev 15 so/r4-6/e /v 4 /.vy ovtip
a eral recommendations: , ,4
oe,t9vEf 7 ,ao4) rs , if 5 :,t -a5 /3 roo'Gpt't Cis •
/ I Bating D Boring f9le 2-- • >
® Pit Ground surface elev. ft. Depth to !hating factor 7 o in.
Soil Application Rate
Horizon Depth Dominant Col. Redox Description Texture Structure Consistence Boundary Roots GPDIVP .
In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Eff#2
/ o-? o Y/?3/3 — G /fsh/' ,». f,C' w Zf . / . 6
2 ` /o P2 I S /L- zt5k1C cwt /' CS / • .$ •
3 gia nal 5L 2fsh/e ,m fA. et / f . s . 8
6.90 M i M 5L 2-fshc 4ift a.- -- • s . , ,
/oY25 111111111111�AF5 /f, Is 4, — . .7
B Boring ff. o > g
E l Pit Ground surface elev. R. Depth to limiting factor in.
Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM'
In. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. *En i 'Eff#2
/ o- /o ioy2 3/3 L EWA rytc2 w Z1 .q •-.4
2- /0 .2 /0 /1 , .---- 5 [ er 'r.� MI . S . 8
Inin ___ C w - •. • g
7.Sy/lV itt/ 11111111P a /t — . S •a
/0 W5/ A °p �i 4- 4 . S . -
,ter ? •
i ,, Effluent #1 = BOD > 30 < 220 mg/. and TSS >30 < 150 mg/t. • Effluent #2 = BODD,, < 300 mg&L and TSS < 30 mglL. . Number .
CST ' /3ER r zf /h/e cb T — Signature i •
�✓ 2 CST 5 _
Address Date Evaluation Conducted Telephone Number
Ulbricht A Associates ' ' 2 2 e. • 7- " D 2--- 7/S RG . ef/8_$
055 O'Neil Rd.
Hudson, Wis, 5.401t3 .. p,%US
/vi or Sk) o a C7 • / /b. ? • Ozro
• Se or /1)4.) oao- //09.2o • era° .
IV
� n
Ate ' /3/1 r
0 H 9• y°'
Property Owner
Neil. t (1/l C 0 X SoN o.t p • //01 • ' ° 1-r) 2
Parcel ID # Page of
1 2' Boring ft ❑ Boring ff . 272— >
it Ground surface elev. ft. Depth to limiting factor In.
Soil Application Rate
Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfr
in. Munson Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
I o ` / / /614 3 8 — L /f she 444 & 34rJ 3 - f - • 1 • 4
2- //•22- /61/g ZFShe M.f-be cs /-f .5
8
3 x2'32 io y/ — sL if fie 4$4-c ci. —. . 9 .
4c5 /sfi2 As c s s 7
s *_
fr) /o yA /y s d ► Sy . 4 .7 / Z.
rorostd �4 4 9 U .0 3'S 'It
I I 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 GPDIfr
in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. •Eff#1 •Efffl2
I Boring
I � # ❑ Pit Ground surface elev. ft. Depth to limiting factor In.
Horizon Depth Dominant Color Redox D (Sod Application Rate
aiption. Texture Structure Consistence Boundary Roots GPD/lr
In. Munsed Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2
Boring
# ❑ Boring
❑ Pit Ground surface elev. it. Depth to limiting factor I
Sod Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots SPEW!
In Munsed Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 'Eff#Z._
•
• Effluent #1 = BOD > 30 < 220 mg&L and TSS >30 < 150 mglL • Effluent #2 = BOO. < 30 mgfL and TSS < 30 mglL
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.
13804330 (116e0)
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Fryer ( For issuance of permits and designing •
Contact: Ulbricht & Associates
Registered private wastewater consultant and plumbers -.
655 O'Neil Road
Hudson, WI 54016
715- 386 -8185 or 715 - 772 -3442
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of -, 0
LE INFORMATION SYSTEM SPECIFICATIONS
Own er Septic Tank Capacity ga l ❑'NA
ty
P l
a
Permit # C ✓
3e' -1/ Septic Tank Manufacturer 1 ❑ NA .. DESIGN PARAMETERS Effluent Filter Manufacturer Z, O't./tc ❑ NA
❑ NA Effluent Filter Model �/9� — /d 0 ❑ NA
Number of Bedrooms /l
1 /
Number of Public Facility Units ❑ NA Pump Tank Capacity ga l ❑ NA
Estimated flow (average) 00 gal /day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) l CC) gal /day Pump Manufacturer ❑ NA
Soil Application Rate ` 5 gal /day /ft2 Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatmint Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ 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: ❑ month(s)
it1 year(s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every:
/ ❑ month(s)
,114 year(s) ❑ NA
❑ month(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
P y' ❑ year(s!
❑ month(s)
Other: At least once every: ❑ year(s) ❑ NA
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be emoved by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Co
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of y
START UP AND OPERATION
For 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
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 cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant
replacement system:
❑ 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.
N a lua '• • •• a o •ing ank
b:'. • _ . • • 1.11r1 Mil". ale. - • . '1ZD(dl'f3TIED. Allskl c
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name ,4J A Name
Phone / e _ l 9s Phone
•
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY /
Name Name s�' Cf .0 ( 1(ou tJ1)' 20A ik
Phone Phone '7/S— 3'6„_ S�locS'P3
• ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer )� /v
Mailing Address - ,r0 ' ! ` sue / '
Property Address 8 'LCo r.-Su/ ,0e. / ,44/0 j." -- hip
(Verification required from Planning Department for new construction)
City/State .4 Parcel Identification Number G�� r
JJEGAL DESCRIPTION /
P r o p e r t y Location $ ' / . , » %, Sec. :3 / , Tpc N -R I/ W, Town of
Subdivision CoT!aN/wP O /ac /77.04/ , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # 70 8 Td , Volume 2 (3 S , Page # 3 C .
Spec housees ❑ no Lot lines identifiabl yes ❑ 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
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 less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
ATURE F PLICANT DATE
OWNER CERTIFICATION
e) certify that all statem , is on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the pro ,y described a • j e, by e of a warranty deed recorded in Register of Deeds Office.
S . T TORE • P. • PLI ANT 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
•
J 2 1 3 5 P 3 5 5 - 7 :x88El co
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., VI
Neil L. Wilcoxson and Mary J. Wilcoxson, a /k/a
RECEIVED FOR RECORD
Mary Jo. Wilcoxson, husband and wife, conveys 02/07/2003 02:00PN
and warrants to Kernon J. Bast the following EXEMPT #
described real estate in St. Croix County, State of REc FEE; 11.00
Wisconsin: TRANS FEE: 2880.00
COPY FEE:
CERT COPY FEE:
PAGES: 1
Exception to warranties: all easements and restrictions of record.
This is not homestead property.
Parcel Identification Number(s): 20- 1109 -40 -000; 20- 11 -9 -20 -000; 20-
1109-10-000; and 20- 11 -90 -55 -000
t o s
A parcel of land located in part of the Southeast'. of the Name and 'Edi Realty Title
Northwest 1/4 , part of the Southwest 1/4 of the Northwest 400 South 2nd Street
1/4 , part of the Northeast V. of the Southwest l /4, and part Suite #115
of the Northwest V. of the Southwest'/., all in Section 36, � , " ,ktlson, W 1 54016
Township 29 North, Range 19 West, Town of Hudson, St. ,? "I
Croix County, Wisconsin described as follows:
Commencing at the South % corner of said Section 36; thence North 00 degrees 10 minutes, 01 seconds West
along the north -south 'A line, 1634.77 feet to the Northeast corner of a parcel of land described in Volume 526,
page 259 at the St. Croix County Register of Deeds Office, being the point of beginning; thence continuing
North 00 degrees, 10 minutes, 01 seconds West along said North-South 'A line, 1977.22 feet to the South line of
the North 350 feet of said Southeast %, of the Northwest 'A; thence South 88 degrees, 49 minutes, 51 seconds
West, along said South line and the Westerly extension of said line, 1324.14 feet; thence South 00 degrees, 09
minutes, 43 seconds East 2,096.73 feet to the centerline of County Trunk Highway "N" being a point on
1,999.00 foot radius curve, concave southerly, whose central angle measures 03 degrees, 00 minutes, 19
seconds, whose chord bears South 80 degrees, 02 minutes, 21.5 seconds East and measures 104.84 feet; thence
Easterly, along the arc of said curve and centerline, 104.85 feet to the point of tangency; thence South 78
degrees, 32 minutes, 12 seconds East along said centerline, 712.54 feet to the West line of said parcel described
in Volume 526, Page 259, thence North 00 degrees, 10 minutes, 01 seconds West along said West line 304.75
feet to the North line of said parcel; thence North 89 degrees, 49 minutes, 59 seconds East along said North line
523.00 feet to the point of beginning, all in Section 36, Township 29 North, Range 19 West, St. Croix County,
Wisconsin.
/1
Dated this
f; ',A t day of JCS (,C , 2003.
/ / ,4 ; -- p
Vige
it ‘0JtYChli<
L. ilcox n Mary J. W n
ACKNOWLEDGMENT
STATE OF WISCONSIN ) =''SA Y P(/e :ip
_:
COUNTY OF ST. CROIX ) t�- / Q ‘r
Personally came before me th day of Jl 2003, the above � =med Neil L. Wilcopium d Mary . /,r
Wilcoxson to me known to be the persons who executed th instrum ; acknowledge the In2e DES A, *
PRESTON
Nota Public _ 40, X24
My commission expires: b h1J 9 p�_;.
This instrument drafted by Robert F. Wall. WilcoxsontoBastWD03 -1 h 0FW %S .