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HomeMy WebLinkAbout020-1441-73-000 Wisconsin Department of Cammerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453005 0 (ATTACH TO PERMIT) GENERAL INFORMATION 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 020 CST BM Elev: I Insp. BM Elev: BM Description: Section /Town /Range /Map No C � tn& 2 36.29.19.2799 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic tZ� . Benchmark 5 •I O 5 .0/ 3 ` l 11. • if Dosing , Alt. BM 0 "_�e ` (S� • MW'cv.00.. Aeration Bldg. Sewer �- / J : . 99 - sti 33' Holding St/Ht Inlet G 15 b 48: TANK SETBACK INFORMATION St/Ht Outlet r ,. � 9 S 7.8s TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t / 2 Li t .. Dt Bottom Dosing Header /Man. 9 7.03 • Aeration Dist. Pipe 4-.112 / l Holding Bot. System g. 94• 0V' 8.81 % • 02 Final Grade 1 -_ PUMP /SIPHON INFORMATION 4 620 )c7p• 23 ' Manufacturer Demand St Cov q GPM 3.0 / .11 . _ , / Z �O (. 1 Model Nu .ber \ o� _p // 4 TDH riction Loss Head I 'Lift 'System Dist. to Wel TDH Ft Forcemai Length Dia. ..� Q! J SOIL ABSORPTION SYSTEM MIMI. - 4 ITRENCH Width c Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM NSIONS 3 �T DT ) (2 ) SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING n 4 rer: ^ S.6,444,12 INFORMATION CHAMBER OR Type Of System: % �� r ( - () UNIT >.0 ". Model Number: l2 a DISTRIBUTION SYSTEM -� ` i„` tom pL ) Header /Manifold Li Distributio x F x Hole Spacing Vent to Air Intake Pipe( Y Only Y / '� - -r ' / Length Dia i f Length Dia S cing 1- S SOIL COVER x Pressure Systems Onl xx Mound Or At -Grade Systems Only I , Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes No Yes No COJ MENTS: (Include code discrepencies, persons present, etc.) Inspection #1 l 11 2 Inspection #2: -- -f - Location: 675 Maryjo Court Hudson, WI 54016 (SE 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge Lot 73 arcel o: A29.19.2799 S.T. w► - c f) e2 A. -i'oo & ` ■.. 1.) Alt BM Description = � C�'� • � z 4' Sly 2.) Bldg sewer length = \ — ,,.. , (� _p 4. 3 3 amount of cov 4 1 04, . fel: a �Q�ti `�." S r 'S ) 4) b) l,J+ - M� CA.L roptckeivi S• Plan revision Required? Yes X No - 11 'I`� I l d Use other side for additional information. l ei ' J '�F' _ n Da e rlsep - tor s Signatuure Cert. No. '1 SBD -6710 (R.3/97) J l ,T�'Y',,�, 1 �1,{ s �� :Ili -9...0..1, ciCid.... A04442— - N.1° '''IQ' . Safety and Buildings Division C.unty ,. 201 W. Washingt∎ • t+ , - $7 c ry Madison, 1 53 '�• ' • a ' Wisconsin tart' Permit Number (to in by ) r (608 266 -3151 - Commerce 5353005- De • artment of Comm Sanitary Permit Applicati 1 n ' , "' . e Plan LD. Number •■•••■•■ In accord with Comm 83.21, Wis. Adm. Code, personal informer in yot rc Ocilx COUNTY may be used for secondary purposes Privacy Law, s15.I 7}(m) ZONING OFFICE EV ect Address (if different than mailing address) 1. Application Information - Please Print All Information Property Owner's Na me �� Mike C «'l Parcel # Lot # B}e�r /I Property Owner's M ailing Address 91/$, /Ada -r�-e ei Property Location City, State Zip Code i Phone Number s �ti, ,,Ult.) 3a (circle o ) II. Type of Building (check all that apply) T ;2 q N; R /9 E org cf 1 or 2 Family Dwelling - Number of Bedrooms oa S� Subdivision Name CSM Number ❑ Public /Commercial - Describe Use L _ L ❑ State Owned - Describe Use - — Deity ❑Village ETownshipoffrA..,4sp I1I. Type of Permit: (Check only one box on Line A. Complete line B if applicable) o20 - 114 - - (b - avrt ) A. fry poi.. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B 0 Permit Renewal ❑Permit Revision ) ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner I I E 1V. Type of POWTS System: JCheck all that apply) _ )C J Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter Li Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter U Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter RLeaching Chamber ❑ Drip Line ❑ Gravel - less Pipe ❑ Other (explain) I V. Dispersal/Treatment Area Information: >'Y - Z. - r. ^' X'� e?^ 2 k % .$a I Design g (gpd) Design Soil Application Rate(gpds ispersal Area Required (st) j Dispersal Area Proposed (st) ystem Elevation 1 Flow ' '� 8"�0•� P'S �4 VI. Tank Info Capacity in Total Number 1 Manufacture Prefab • Site Steel Fiber Gallons Gallons of Units (...., I I Plastic ` h „ Q k..., Concrete Constructed i Glass 1---- New Existing Tanks Tanks 9 Jti"� t i ' , , ' I I {{{ Septic or Holding Tank I_I � Aerobic Treatment Unit 1 11111111111111 Dosing Chamber g / VII. Responsibility Statement I, the undersigned, assume responsibility for it allation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature 1 1PRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) 1 17l 3 �'l` ���'? l T JTTY • 111. Count /lie artment Use Onl /-'` Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater ! Date Issued Issuing _ent Signature o Stamps) Surcharge Fee) « 2 56 �_- 1 ❑ Owner Given Reason for Denial ia1A - a _ I IX. Conditions of Approval /Reasons for Disapproval t 99"�� SYSTEM OWNER: 1 Septic tank, effluent filter and 3) u..‘ S4 S uNV�. e �.�� -v� dispersal cell must all be serviced / l finer. i. ill _l lt � K ? as per management plan provided by y plumber. W Ki p,� 2. All setback requirements must be maintained r as per applicable code /ordinances Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size { SBD -6398 (R. 01/03) `C , \\ % ... (, %. '4 il � � a V . a ry l . W N. til ''.4. .- '--- i N 7 it v n -so r , d s l ts .t% tn 11 r , ,, c. 's,; 4:-. , , -,-,.... ry i N k i0:4 e‘, si- ep D d _. GO • o NI Y • t ,( K ■ b , .\ ,,' 1 `&• % D • r ` N v N N l % 1 " ' ! ''' • „,-/ i % Ili \s r l u 1 .,/7, T r+,'..4r D h \ i. ,L0 so .5;.. . ,v - ri .P. HA `(1 0 -1 Ns /30104E72. Ic'ERAVoA) /34.51 3 f2o,vN4 5FEt/e 13.9 -s r 9 q ' /* BAR(re RP • HHvose -), till: s ifo/ 4 ' . , Wisconsin Department of Commerce SOIL EVALUATION REPORT / 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 Couxuty s r 1 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel 1.D. lee.- �/d ✓ti 4- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. • Please print all Information. _ - wed by Date Personal Information vide m be used for seconds you Pro may secondary purposes (Privacy Lim s. 15.01(1) (m)). I F6 2 f t if Property Owner � ' ` 1 RECEIVE rt " _ _ —..,." /VEi'L w /LGD)C.S' Lot se 1/4o(I/, 1/ s 36 T2 Q • N R if I€ ( Property Owner's MaW Address Lol # - - , or CSM# fE'NO /ti � C-- YA'/ gke cry. fiiv fi JAN 0 9 2003 C� – 4,6( . 3 ,e cQ / 41 City State Zip Code PhonerN Rat X y [ City II Village Town Nearest R ijopSa,v I GV / • • I sy oi 4 I.( �' 4 c , 'c , Inv.S$A) I //zaY /t/ (2-New Constuctfon Use:() Residential / Number of bedrooms 3 -y Code derived design flow rate yo & O a GPO ❑ Replacement ❑ Public or commercial - Desaibe: Parent material DES S OO47? 5..4A2/7y 4 /AM4• ktflood Plain elevation if _ applicable _ __ N / � ~Y._ ft. General comments and recommendations: w 44 7 5 a/7 ,48 / •0 49 covvb".v77 /4, . IN 9i .P v. 'z ?.0 GO 775 . CA%'. r`Fvst7c' ea/5) I / eodn # 0 B °' i ng 7732_ ® Pit Ground surface elev. ft. Depth to limiting far 2'0 In. Soo Application Rate Horizon Depth Dominant • • Redox Description Texture Structure Consistence Boundary Roots GPD/fr in. Munseo Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / v' /0 f/e3/y L UM 14i fi w 3 f . 9 • Cto 6'9 /o $/L 15Z5a i,c' >a •. ' QlE� _ NerA is* cs -- . ) /• z =WM '/ IN 61 Fir ,.• ____ . 7 T. Z__ . NM 75'' ( Z Boring # Pit Ground surface elev. 9 " ' d . Depth to limiting factor/ Z in. Soil Application Rate Horizon Depth Dominant Color Redox Desaiption Texture Stricture Consistence Boundary Roots GPD/ff M. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2 o - 9 /oyie - L /7 44t9 /) 3? • • ' . e." Z- 9•/6 1tV,4fly — •S /G hs/e, {/'Cs, /- • z. • 3 •zZ /oe 4 , --- 54 / f i g 4 1 , � f e e s / 7` .. V . • y .?2.35 7 s y2 y/6 - ---- -- , zs . /4„ f d s c5 . / Z 5 .35 •y3. /D Vie 4 /9 . 5 . O. . ,.Q,_ . .) /• • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOO < 30 mg/t. and TSS < 30 mg!L • CST Nam (Please T Z! /h/iei C,, r S Ro /3 / • 2 Cs S Address Date Evaluation Conducted Telephone Number Ulbricht & Associates - )Q C- //— ZO'e Z 7 /S' 3 PG. g'/8S C55 O'Neil Rd. Hudson, Wis, 5401(3 - P/■VS N� F oat • &ay•yo•� SE of NO old //09.2 • Cuo , : :,_,:., , , ... i NIA , . :_; ! , Li , ,, . L u V02- K 1) • /345 r ,1(L L/� 020•I /t* y o•v Property owner 4t1/l C 0 K . o).0 • //b 9 • �O ' _ 3 Parcel ID # Page of 13 I wing # ❑ Boring W.-Pit Ground surface elev. 7 lo ft. Depth to limiting factor ',° in. Soil Application Rate Horizon . Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1 in. d MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EB#2 • / 0 8 /oy/e3/ ( fs4C j'c) 3f 2 - 2 /9 s/ /fShe, f, 5 /f , z • 3 /r. 3y 2 s y�� 4 $ /40 fie ds . 7 I. 3y y� /®ye s/� 5 . 0,1 IL --- Bodng # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Rate Boundary Roots GPD/ff' in. MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. 'E1F#1 'Eff#2 long # Boring CI CI Pit Ground surface elev. ft. Depth to limiting factor in, 1 Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDR In. MunseA Qu. Sz. Cott Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • I 1 Boring # ° Boring Li Pit Ground surface elev. ft. Depth to limiting factor In. Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Soil Rate Roots GPD/ft° in. MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. 'Effif1 E f#2 • • Effluent #1 = ROD. > 30 < 220 mgfL and TSS >30 < 150 mglL • Effluent #2 = BOD < 30 mg& and TSS < 30 mgfL 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. 581:14330 (R.6/00) • W S T L-o 7 t . • . ' a ijl / ____--_ . II O N vs N •• O -11 P N., V = all n T - cw v n C u N . W N 1 ? N •o to oz g \vu Q. .0 a I A Nt) . ■\\b c l 0 ) l'..z. A N , _.....1 .........______ .,. *t..___ ......____ ‘...,ki‘ 4 ,,,,,,A_________ ...k... ,...,____ ___. 407,--______----- ---‘ ... „ N. l` V - b d O 1N a z s, — LF71 ::' MBER CR:S`'EC Ti CN A:';D 5 "P CIPICAT ONS 4" CI VENT PrPE 12" MIN. ABOVE, GRADE E t S' *'ROM D ©UR , *�i ND QW OR WEATHERPROOF' FRESH AIR INTAKE __ JUNCTION BOX APPROVED WITH CONDUIT MANHOLE COv ER FINISHED GRADE W! PADLOCK �}L,� 4" O/ RISER — .41 WARNING :.ABEL ""„ , 3g" �b4iN. . . 3_� r 4" Mih . ._ E,� M K. ...... ' WATER TIGHT SEALS ` GAS- I ' _ - { " r i'IGLII , , . PROVED t LPPROVE�3 ( r JOINTS WIT H 'APE 3� A+.M APPROVED PIPE 3N?"a S,7t,t4 1 - "' a ONTO ;OIL G 1 1 SOLID, SOIL PUMP OFF ELEV . FT. ° -� �--` I''"CF: ' ; *�' RISER EXIT D 1� ITRILT ONLY ..................................J Li. ' MANUFACTURER 3" APPROVED BEDDING UNDER TANK HAS APPROVAL CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE :'ANK MANUJFACTURER: "—.-- NUMBER DOSES PER DAY: I'AN1 SIZES: SEPTIC _LE V GAL. LOSE VOLUME INCLUDING DOSE reici GAL. FLONBACK: /59 GAL. ALARM MANUFACTURER= A� c1.rta.� CAPACITIES: A = = INCHES GAL. MODEL NUMBER: i ?vC..ES a �-:� SWITCH TYPE: low B = 2 INCHES = 412 GAL. 'UM? MANUFACTURER: 'U ? t r ' °se C INCHES : .� G L . MODEL NUMBER : ,r- ., - !„",�„_,_„aA� SWITCH TYPE: �� D INCHES = ..U4 GAL. 'EQU ;RED DISCHARGE RAT ..1..� .. GPM PUMP 6 ALARM WIRING AS PER I .. L�J Z6 3 =RTICAL DIFFERENCE BE. - OFF AND DISTRIBUTION PIPE . /,2 FEET MINIMUM NETWORK SUPPLY PRESSURE ' FEE'' rORCEMAIN X FA) FT/200 F:". FRICTION FACTOR ` ET A.,TOR / - 7 F FEEET TOTAL DYNAMIC HEAD = OULV ►rEMT NTERNAL DIMENSIONS OF PUMP TANY: '_.ENGTH LIQUID 'P' WIDTH DI ETER .---. =-- LICENSE IV mEER DATE: 1 • _ ... . (4a4,400-b4 WEGERER SAIL TENTING r�AraE �9 GOUldS prNSE ', 0P' 3 - Submersible A - Effluent Pump r r 3 i 71 EPD4 EPO5 APPLICATIONS • ftetenerr 300 sorter �.••••. bl IM steel. rad far a WNy; Cafe iron SOW* designed for the t following uses G MN oS (ar transfer, systems t o dim to had eticleai :trsrgth, Mid duribi< F iume M Mt*, Carer. opless. • War A rallelde ter adasset and tlr **kb" hsndie Heavy • may+ sump • Poe SIno p a motel oRuigaa Ammo Root switch attachment 115 or v, e0 Hz modals Made "intt. RPM, burin overlaid eh float kW h we Pow COO: Swans d • Water truster uty ritEC resit, Pleat at 1hi hefty. rated of and rowan r = Aflt3fa • 11S • EPOS , e Ie pl sea R5 , il e a U PW and r . V, ea 1550 RPM, FUG howl duty biH hearing �I in o o with conat ucKorL itrdN►t why t iuortratic tarot • !'Pie knOwi r: Memo- -' • 1 h '�• h Power 56 t?PM Power a0rd: 10 foot Plate Semi-open design t iength, isa SJ10 sa for AeEwCY MN . ,1 rabU ands: up to 20 fr et with tMaa i 0 (nutting O rolscttort . • = plug. Oolong 20 toot 4 II EPOS Impeller Thermo- 111 a+•irr M o1 rpq� ryf *Oh. t 6?3 SOW with Astic aWslO sd d ivan for (CU kited model numbers TUNAS ( erre prong erd an grounding plug ImOtored parbr�ttce, end in 'F• Or `AC ".) ' 104-r d0•C)� continuous • dgn Rugged ��" C) item. corrosion arm • Feeteners: 300 Soles Mai agar • CAPabil of el. I I' �Y without dlmipe to e i NNW EPOS handling ` mi hdri capabil f ' �" • Coldest: vp b d0 QPM, ' t Inning. w...ririw., • �''�: ua rooat asst a �• ���,,� ' f !hk t K NPT, • i�llk� teat carbon- E �� `�1 � ...._ . 23V rillYi i 4 . illininUININEM • Tommatiirc ! 0 ' 11111.101111111MMIllinga 1°4 *Mention a ° N" .1111111111111111111111111111111111111 j r . 0 3 ft, it aft CAPACItY * 1185 Gouts Pump* OW % If • 8 1 1 1 4 --. anu f —÷ 4 0 7'1 to T 03�' t 111 I[n ' nllllrl , z = 0 • - �r=�,,�, y A • 4 v xr I . Iffftiiu th i i ii i ' � m l g E 2 x _ P i IIJIIIloJHI a to � ''- � CT7 ' lt� n o _ a .m c • � , ft 1 tLiIiiiiiiIIi:itt X11 - --- � . � al 6- " i t �1 i i t t u m n '� rn > Q. � �;i irlllll } ° ac �, " X r il A t-l Iraqi n . 8) — CL .0) 2. ± ' c,c1 fu .›.4, II 1 iin itin l 1 y i illuiiiJijrj� il hnlI 1, I1 t II! Sidi Pilaw f f I If II _ I1IIi i 01, i pg Will III I IIll hib'iitI I - pplimmil b o . �� t t z li f ► . iUit►� � � 3' lnru — y . lin 1 O • u 1, -13 L� ij iul 1 1[ [1111 — : . IcaJ ro 11111111111111 � y . Q # U. JJ _ a C 8 c_AFT \\\ \ . 0, 5. . • 1► A .► 3; • J i I rte. ..1 n "' ---- n, . 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner rr 1 4d s 7 Septic Tank Capaoity 1,'1 s"lJ g al 0 NA Permit # 153 ©05- ___. Septic Tank Manufacturer z) 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer z el 4 41 2 O NA Number of Bedrooms y' 0 NA Effluent Filter Model /SD' 0 NA Number of Public Facility Units v4 A Pump Tank Capacity g.efQ ga l 0 NA Estimated flow leverage) Aril Pump Tank Manufacturer „t es allda s +err O NA Design flow (peak), (Estimated x 1.5) lv G gal /day Pump Manufacturer ,. 0 NA Soil Application Rate ©• • al /da /ftt Pump Model f2O (f 'Q NA Standard Influent/Effluent Quality " y average' Pretreatment Unit I 4A Fats, Oil & Grease (FOG) 530 mg /L Q Sand /Gravel Fitter 0 Peat Filter Biochemical Oxygen Demand ;SOD 5220 mg /L 0 NA . 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSB) 5160 mg /L 0 Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal Collis) — 0 NA Biochemical Oxygen Demand (80DO S30 mg /L iti Ground (gravity) 0 In- Ground (pressurized) Total Suspended Solids (TSS) 130 mg /L 0 NA 0 At -Grade 0 Mound Fecal Coliform (geometric mean) 410" ofu /100m1 0 Drip -Line 0 Other: _ Maximum Effluent Particle Size Y in die. 0 NA Otter: 0 NA Other: Oth ❑ NA 0 NA * Values typical for domestic wastewater and septic tank effluent. Other: 0 NA MNNTENANCE SCHEDULE Inspect condition of tank(s) At least once every: 3 . p i s (Maximum 3 yews) 0 NA Pump out contents of tank(s) When combined sludge and scum equals one -third (V of tank volume 0 NA Inspect dispersal cents) At least once every: g a oar h(s) (Maximum 3 years) 0 NA Clean effluent filter a month e) At least once every: is antsy 0 NA • Inspect pump, pump controls & alarm At least once every: r— f month(el 0 NA 0 carte) Flush lateness and pressure test At least once avert': ' • mon (a) 0 NA O • arts) Other: • month(s} At least once every: 0 aria) DNA Other: 0 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 1 inspections must include a visual inspection of the tankts) 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 collie) 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 removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shalt 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. • •apoo anitauslulutpy uwuoOSIM 1C) 9 (Z) 'I l)4S'B8 PUe I VIp)(l)(g)(Z)ZL'ce wwoo Je3dsg0 *VA aouvfdwQo u! pep sem lu.wneop 8!41 aS* %A -�� } oo4, euogd nl fvo OX i (� eUUVN AilhOH1fY Aa01V1f1D3>* 1VO01 .... (li3dVUld) VOIVll3d0 DNIOIAIl3S 3011,1439 euogd rrrS~ --,2 j.c - L' / c euogd suniN *44 77 ettleN `"�" 113NIV1NIVW SJ.MOd tl31 IV1SNI S.LMOd SIN3WWOO 1VNOWGOV 11818SOdWt 430 1Zf101ddlO 38 AYW )INVL V 40 43O)d31N1 3H1 WOad NOS413d V 40 311093a 1.if1S31I AVW H1V30 •S3ONVISWf1OJI3 ANY 1130N0 NNW. 1N3WiV31i1 U3H10 U0 dWfld "011d38 V 4l31N3 ION 00 'N3DAX0 iN3131ddflSNI 80 /ONV S3SSVD 1VH131 NMINOO AWN S INVI IN3W.V3211 413H10 ONV ANN! 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AM 1941 s!eo!wega 19410 Jo slonpold 8utiu!ed ;o OoUes9Jd e41 J0; (0» U0t 3Uewle0J1 VALID SIMOd 041 10 asn o3 4014 'U011onJisuoo Mau Jodi NOLLYH3dO ONV an JJIVIS to seed ST CROIX COUNTY' SEPTIC TANK MAINTENANCE AGREEM AND OWNERSHIP CERTIFICATIO rORM 1 CO± u r OwnerBuyer i - a 40 .1 A ' . L ' Mailing Address c1 : I- Cl 4'- , e, - d C 01 • Property Address Lot 73 G R. i (Verification required from Planning Department for new construction) " Parcel "., , 2419 / SI , (.31 Pl Identification Number - I`Pi1 - 13 ^c�ND - ) City. Stat � t�. SO LEGAL DESCRIPTION Property Location „SE. 1/4, WO 1/4, Sec. 3n , T N -R I9 W, To of f f iniS dY1 . Subdivision. Co i# ajoosi R i ttr 1st A , Lot # . 73 . - -- _ Certified Survey Map # ,Volume , Page # Warranty Deed Volume , Q t 35_, Page # ,.,, . _ _• Spec house IN yes ❑ no Lot lines identifiable 2 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to hand wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pump 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 b t the and by a master plumber, journeyman p c -man lumber, restrictedplumber or a licensed pumper verifying that (1) the al a e. is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank . is less than 1/3 i of 8 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 st,:.• . t • septic system has • . - •maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of • r. ea year e Tun ,; , 'on • ,, /�/ x ' ' _ � SIG - TU O - r PLICANT DATE we) certify that all state nts on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of --- = prop ,I described ab • o re v',i - • a warranty deed recorded in Register of Deeds Office. l x l/ 4 L DATE SIG A'fURB OFI ' PL1CANT ** * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. `* r * * * ** 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 VW f I i y e r )(a ■ ■� i ID r 101 r 0 i = I ED] a s s • - N . VIII ag '...". lilt 1111 r 'c a n t r .t 1- t t 1 -- /` .• Standard Elevation ..,-,_, N .. ii Din. 13.11x141 H _j F ■I r j 14txua �"'�" 1 Gar. Bay Pointe Development, Inc. ..i. 1111.1, M D.7x234 757 Packer Drive Hudson, WI 54016 4:1 GitRRL h EPA E. r Porch Standard First F VW loor Plan a y 14' ' Bnn.3 .1 Btm.2 o f` ■ C 311x113 10410141 , PI arion y h >Jcl PO U 1 `\ fl EMI 3 Bedrooms 11X ti:ii tt 2 112 Baths % , , x 3. - il Loft Length 86' -0" F' � Including garage L — I _1141x13 Depth 43' -0" First Floor........ 1,245 sq.ft. Standard Second Second Floor....1,182 sq.ft. Total Area ......2,427 sq.ft. Floor Plan 11 C 2003 WH/SBS AO y 'J 2 1 3 5 P 3 5 5 - 70e88ta RE H. DEED 1 WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., NI Neil L. Wilcoxson and Mary J. Wilcoxson, alk/a RECEIVED FOR RECORD Mary Jo. Wilcoxson, husband and wife, conveys 02/07/2003 02 :00PIi and warrants to Kernon J. Bast the following EXEMPT described real estate in St. Croix County, State of Wisconsin: TRANS 2 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 Name and R tg.t0. A parcel of land located in part of the Southeast % of the hain eaity T i tle Northwest 1/4 , part of the Southwest'/ of the Northwest 400 South 2nd Street 1/4 , part of the Northeast %4 of the Southwest1/4, and part Suite #115 of the Northwest 1 /4 of the Southwest 1/4, all in Section 36, }dson, WI 54016 Township 29 North, Range 19 West, Town of Hudson, St. 1 ,' 18 ' 4 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 '/. 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 ' /, line, 1977.22 feet to the South line of the North 350 feet of said Southeast '/4 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 1 g minutes, 2 .5 seconds East and measures 104.84 feet; thence Easter) along the arc of said curve and centerline, y, g 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 Iine 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. Dated th -0 t day of / 1 G>! , 2003. 4 1 L. iim n Mary J. Wiz •#on • ACKNOWLEDGMENT STATE OF WISCONSIN ) COUNTY OF ST. CROIX ) /A_ / „s- p Personally came before me this day of J( ►7 , 2003, the above med Neil L. Wiicoltiory d Mary . rf Wilcoxson to me known to be the persons who executed th foiogoing instrume a acknowledge the frilre DE 3P 4 A * PRESTON Note Public My commission expires: ' C � 3�`1 J � 9rct. * This instrument drafted by Robert F. Wall. WiicoxsontoBastWD03.1 '"h)11,�F r • . , REPARED FOR: C OTIO RNON BAST AND LOCATED IN PART OF THE SE1/4 OF i NALDA SPEER-F3A5 I NE1/4 OF THE SW1/4 AND PART OF 3 LaBARGE ROAD TOWN OF HUC DSON. WI 54016 • • N URVEYOR :.,.. VIN C. RAN( 1m i RTHLAND 5(11IVI.YINC3. INC. ! l l A HWY "65" \ 1 (. ) HOY 1,1 LLJ LL , ..' 1 3ER FS. WI 5402: , LLJ )NE 715-749-1718 Lit 11... 715-749-1719 al LL 1 11.1 _ , Er " liJ NGINEER LL -■ , CO U, OTT KRAMER . 2, DESIGN • ( .Ti -- Ci. . I ?8 ARND I LANE. • • • I LI CLAIRE. VVI 5470 I , .LOT 74 • .,,,. 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" • _ . . { 3: DW AY ;.F.E.1BACK \ • . 3 " NIA' OH (V,.; '3! KiwN) , , .. ..,. '' .., , 3 i3 ; - --' J''-'r. ' 1' ' ,I1 -1)F- ;/1.i L HIGi 1 WATER LINE H. N 1. ' .r3r: :1 • FL EVA 1 I ON f 100 YEAR EVEN ; r i.O•v^; i.ThIL 0111:.; t.:YEt\j1Nr, ;=. . LOT 72 ' :' A011F75 -.! u._ ! , ) )1 ,, !.," 7 !:.() !. I ,„ LOT 71 „ 0) ,,. , , z .3 ' AL;RES -7 LT) 1,,1 tr(! , : s,2., i- 7 1,, - ,,) ,.. ,-, 11.1 - L . 0) '3 ..: tu .,- 1 , 1 ' (- 7 ) 1 u.1