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HomeMy WebLinkAbout020-1454-00-111 f - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division . R INSPECTION REPORT Sanitary Permit No: 488121 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)]. - 1 Permit Holder's Name: ' City Village X Township Parcel Tax No: Bast, Kernon Hudson, Town of 020 - 1454 -00 -111 CST BM Elev: - f Insp. BM Elev: BM Description: �,1 Section/Town /Range /Map No: ri 99 g . 9q..Sb ('ST ti _ t t we ' 1 r A 36.29.19.2926 TANK INFORMATION ELEVATION DATA TYPE (/ MANUFACTURE CAPACITY STATION BS HI FS ELEV. w A -t u o E, 9`1.P Septic Benchmark \ Dosing Alt. BM 2.96 /00.6 Aeration Bldg. Sewer -7 ?7 9(47 Holing St /Ht Inlet r.(17 r •� 9 1 St/Ht Outlet TANK SETBACK INFORMATION g.1 '5 9 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / Septic l 1 i �% Dt Bottom Dosing Header /Man. ` Aeration Dist. Pipe l i (, s t 9sol Holding trot. System 1.1-5 I / . ' Final vrade 3 / PUMPASIPHON INFORMATION I )0D. f(o r anu ac , - — uemana St Hover Moaei NumDe ' �b j j .. - vt.d , c- im -a- I A ---) � ng .-r:miiiiiiiiiiii . . ■ , - 72 Q .. . . .... DIME a g -7- • .04.. -- - I�iiiliiili�1 I INFORMATION / 1 CHAMBER OR • bo� 1 Al / UNIT � - I L ��T P -,... i Ir gth Dia Length Dia Spacin. � C'i • ' • x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Ovet Dept!' Ove 'ur apt AA - Seedeu /3udded A. Mululied Bed/Trench Center Bed/Trench Edges Topsoil ' Yes I -!; No 1 , Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1.: \tuf- 0120k, Inspection #2: ` / Location: 678 Mary Jo Court Hudson, WI 54016 (NW 1/4 SW 1/4 36 T29N R19W) Cottonwood Ridge 2nd Add Lot 111 Parcel No: 36.29.19.2926 S / � 4) tieO1 0 t C.a.A{,rut� o .02 ` r 1.) Alt BM Description = `� � i� � 2.) Bldg sewer length = 25 v .St-X »4` I 4 24 1 = r� - amount of cover = � o � IS Use other for informa on. No lam- Ll'i ? ' 7 z SBD- 6710(R.3/97) 0 Q U1 s-Ldl ‘0u�Q / Safet and E u ildin9}�����(� s p�r� T r C ou ry fi • 4 SC11flS I I1 20 W. Washington Ave., PO. Box 7162 Madison, WI 53707 — 7162 Sant ry Permit Number (to be filled in by Co.) 1 Department of Commerce t (608: 266 Ali 0 7 2006 /2 / Sanitary Perm •1. h • ti ST. CROIX COUN 1 Stat Plan t. D. Number I ; In accord with Comm 83.21, Wis. Ad personal i . •u provide may be used for secondary purpos -. . w, s15.1 rro� ct Address (if different than mailing address) 8 1 L Application Information — Please Print All Information l (t mom V o (. p. J 8 Property Owner's Nam # Lot # Block # QRNo i.i to,-� (g'ea_tel j 1 1 / Property Owner Maili C lig�A�� { � � � Property Locati ` ' City, State 4 Zip Code Phone Number W /' W h, Section AINS) (ciEni rcle 9pe) �Ab�O� SZ J 7 Q�� —j�� T � i N; R 1 H. Type of Building (check all that apply) \/, . Su- I//v. "t IN or 2 Family Dwelling — Number of Bedrooms ! o r 4 Subdivision Name A CSM Number ❑ Public/Commercial — Describe Use CA 0i+ WOVW pa lr,� ± ❑ State Owned — Describe Use ❑City_ ❑Village DTownship of11 N III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 020 — i f S — c O — i// (. 292.6) A. td4Vew System ❑ Replacement System g p y Existing Y ❑ Treatment/Holding Tank Replacement Only 0 Modification to Existin System B List Previous Permit Number and Date Issued ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner Ns 1 IV. T e of POWTS S stem: Check all that a • • 1 ©�a�iit!i'.�� • ! _QNjIA I � — � '11 (ion — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ D i • Li e ❑ ravel- ess Pipe ❑ Oth r (explain) V. Dis • ersal/Treatment Area Information: A ra lliiir • �ZiS�T71A►, Design Flow (gpd) Design Soil A llication Rate(gpdsf) Dispersal Area Required (st) Dispersal Area roposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units 7 r �n C �1 Concrete Constructed Glass New Existing CW r� 7 e C /a �f �} / 'F� Tanks Tanks �i l /j Septic or Holding Tank 1 .—. ' / A kit 1 1 1- p }� / Aerobic Treatment Unit 1 V V I {/v ` F+ �f Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print) P 's Si ture MP/MPRS Number Business Phone Number 1 >r' Uf % 4e-eS n °lay 9o9 l i - '3 P, 96O Plumber Address (Street, City, State, Zip Code) 1 1 ViV � 3 N j N4 PSDU L.)t s y V1G VIII. County /Departme t Use Only Approved ❑ Disa. proved Sanitary Permit Fee ncludes Grou ' Date Issued 1•. wing • : nt Signatu (No Stamps) Surcharge Fee) i / ❑ Q.• Reason for Denial ' • I 0 ') I IX. Conditions o Approve '/R aI SYSTEM OWNER: 1 Septic tank, effluent filter and ' dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained 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) • . .1 ti 6 / / lot: � � /c•. .► �� 1 � iki S 1 cl e. uJinc�fe r.s. vir ..caedttioz-L. PYgn -. C"oa . :. . .e.../Ce.f),5e. .,,IL ,_.77,_;/"A 9014. ... ...._......... 5 124 L6-1- . / -51-7 -04 —77,---------- ... P/0 . ,, - ----- - . , _ _________________:____________ , _______ ti, PVC k AttIC ¶ _ IQy � 99,86 1- 1' of 3/y" PVC • 1 83 C Y� X� r l l e s ;4pe • it a G, � ` [ 31/2 87 5� rnehie �� 7 k 1-'N.0 '1 i fft.htoti ) 4.... or 1.)Gu 5,,,,f,-, wip-14.,,, zisi,„) ri vy . 45 Vt 4 1111P C.V c a .' ,-V,(t: 1 4 ify I EM ------\\\\\ .. acs i .-lk i . & Ji" . • 4 , G o 1, kz --- --.--- 1 i F. vti U 1°h � Yl� i,r C Lo Cj 71-, g e 0 1 4., _S i c/ e IA)/ ncie !'.s' ..Cil eaLCia—_____ '.�, 4. CGS ..- .... J .. . 14;1): :. ,90 .. E _.._.. ... . 07 . , /14. I,-) rip 3 5�," PYc. v -i��. : (3�,�<t,n,Art TI�y 4 . rip o) 3 /y" pv‹. U 1 a3 �? J r Al+ n = a c terols (1" � +�*p l /6 �14�� • air e � q 31/2 87.Sv r�h�� 190' �=- Cs- f2 "oKi I D LL) 50, to A 100 ?,,,L„) r\ f f 9 is y 13+ 011v4 . • (t ■ ( r 1 1 pi..... , - . k. 13'U-iCJ1r 1Y9''4G, r j).1.., / ...,. , )) i 1y . 1 4, r ,e i Wisconsin' ' SOIL EVALUATION REPORT #1631 Department of Commerce in accordan with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Q Steel's Soil Service, Inc. County Attach complete site plan on paper not Tess than 8% x 11 inche - 'r - Plan must St. Croix include, but not limited to: vertical and horizontal reference poin : direction and percent slope, scale or dimensions, north arrow, and location and • •s. nePto nearest road. Parcel I.D. Pending Pleaseprint all information. ..piewed By Date II I Personal information you provide ma, be us s (Priracy La `s' -.04 (1) (m)). 13 24,0(0 Property Owner Property Location Bast, Kernon Govt. Lot na NW1 /4, SW1 /4, S36, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 948 Labarge Rd. CBDIx Cnl INTY 111 na Cottonwood Ridge 2ND Addition City Sate ZieffING OlhomENumbei City Village XI Town Nearest Road Hudson 1 WI 1 54016 1 715 386 - 7775 Hudson 1 Cty Rd N ■ New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD E Replacement ❑ Public or commercial - Describe: na Parent material Stream terraces and pitted oukwush 0 /4, - /?5 Flood plain elevation, if applicable na ft. General comments Conventional system, system elevation 96.30ft. trenches spaced and depth to code and recommendations: 4.45ft below grade. 1 Boring # ❑ Boring ® Pit Ground surface elev. 100.75 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color *Eff#1 *Eff#2 1 0 - 14 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 14 -29 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 29-44 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0 4 44 -120 7.5yr4.6 none cos osg ml na na .7 1.6 , I 4 * ` l b •39 4,f (=M.& 2 Boring # El Boring Z Pit Ground surface elev. 100.75 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color *Eff#1 *Eff#2 1 0 -14 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 14 -24 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 24-44 10yr4/4 none sl 2msbk mfr gw na .6 1.0 4 44-58 7.5yr4.4 none cos osg mvfr gw na .7 1.6 5 58 -120 7.5yr4/6 none cos osg ml na na .7 1.6 ST / r 30 AiJ t o‘-', `1 * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <_30 mg/L CST Name (Please Print) S jnature: ,z' -. CST Number David J. Steel ■ 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/10/2005 715 - 760 - 0347 SBD -8330 (R.07 /00) Property Owner Bast, Kemon Parcel ID # Pending Page 2 of 3 3 Boring # ❑ Boring ►� Pit Ground surface elev. 100.45 ft. Depth to limiting factor 120 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 -13 10yr3/1 none sil 2msbk mfr es lvf .6 .8 2 13 -25 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 25-44 10yr4/4 none si 2msbk mfr gw na .6 1.0 4 44 - 120 7.5yr4.6 none cos osg ml na na .7 1.6 Boring # [1] 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 # El ❑ 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) Steers Soil Service, Inc. STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Kernon Bast 994 200 St. CST - POWTSM NW1 /4,SW1 /4,S36,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St. Croix Co. Cell (715) 760 - 0347 Cottonwood Ridge 2ND Add. Fax.(715) 684 - 3449 Lot,111 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend N 1 " = 40' / ♦,� = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe Alt Benchmark Ele. 99.80 ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B1 = 100.75 ft B2 = 100.75 ft B3 = 100.45 ft B4= 0.00 ft NsP Via©, :4 ra c)57/- 16" V5 r J ‘f 4 70 c Sou&-/ Ll 1-.0 "Pk; .10 .r / 42?"_ i � r V\. . 449.,. . 1 - 1 ... - - LOT §6 • x ,x 216.84' :x, . 2.00 Acres 1043.1 = T _ LB.A. = !.0 AC DE DICATED TO THE PUBLIC _ JO ,�35, y 282.73' - - - - - ' / . . . . . . . . . . . / 1041.1. \ • / / X 1 1 , : r .4 ' cg• / - • x • / ry�,14�`' /./ 1040 a ti ` p, / 2.03 Acres 8 LOT 111 / N.B.A. = 2.0 AC 2.01 Acres ' -1 / N.B.A. = 2.0 AC 4 0.0 / X • -- 1040.7 1 fc 9:, X ' ry • f 1040.4 • 111 01 . LOT 109 x 27 .'$ SS, x •49.5 I 2.01 Acres 1038.7 2 �3� N.B.A. = 2.0 AC WEST 1/4 LINE OF SECTIOI,'36 0 cl 1039.3 i. O I. O (. `V • - • LO 10 8 • - - 2.01 Acres r . . s. - x N.B.A. = 2.0 AC x (LOT 5,Q / ' • • 1037.1 1037.1 - - NI i 50.00' 63, 414.54' -. ROAD LENGTH 196' ti , 6 DEDICATED TO THE PUBLIC co 0 \ 1037.1 n \ X 1036.4 X oi , d e / x 103 . • LOT 107 ( :. • - - - • . • 2.03 Acres i . - ' N.B.A. = 2.0 AC I % 1 •. LOT 106 %2� "' L�O`t? Cs • 2.02 Acres o �` 1 10- N,B.A, = 2.0 AC (1 x . POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 1-R 1QNUW 151) Septic Tank Capacity 0,4 U ga l ❑ NA Permit # Lf g'g' /Z( Septic Tank Manufacturer •■) (-11.t5 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Zp\ l A-) U b ❑ NA Number of Bedrooms 4 ❑ NA Effluent Filter Model ^ ! (p (. ❑ NA Number of Public Facility Units ®►NA Pump Tank Capacity gal -61-NA • Estimated flow (average) T 0 0 gal /day Pump Tank Manufacturer 6+NA Design flow (peak), (Estimated x 1.5) v b gal /day Pump Manufacturer er`NA Soil Application Rate • 1 gal /day /ftz Pump Model ItisNA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit I$ NA Fats, Oil & Grease (FOG) 5530 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 IEWn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSSF 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: a ❑ month(s) 513year(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) e year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once ever :_ f ❑monthls) ❑ NA y . 1• I 121 year(s) Inspect pump, pump controls & alarm At least once every: ❑month(s) "61. NA ❑ year(s) Flush laterals and pressure test At least once every: ❑monthls) 151,NA ❑ year(s) Other: ❑ month(s) At (east once every: ❑ year(s) (3�NA Other: b 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 (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of 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 cellls). 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 fife 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: {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. ❑ 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 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 --1 r•• Q bn r.-I aJ (t.R Name Phone S - 3 (e. 9 O a O Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name " D p+c rt -10 t Name S , (K6nt, ?olvl tif, Phone S' 1 Phone 3 t / y 6 This document was drafted in compliance with chapter Comm 83.22121(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Owner/Buyer �t�00/ .ii Aw - _ Mailing Address 9W 1.4. 4,t Al, /71,2103-1 4L7 5 Property Address 7 7 Ke t1 // C 5 % - i —_5' (Verification required frot tanning & Zoning Department for new construction.) I� � qq � / ► City /State 11san l t/„L Parcel Identifi ration Number 020 - [ 4..0 --0 — i I I ( . 2 / 2 0 LEGAL DESCRIPTION Property Location ,V ) ,,Std y , Sec. 76 , T . 2? N R /, W, Town of Ntt/A,frt . Subdivision L 7 tt...)0S /e 4e p? ° /.4 �, '-(i cvv� , Lot # /,/ Certified Survey Map # , Volume , Page # . Warranty Deed # 7,?4 0 , Volume 7rs? , Page # 3/ . Spec house CP no Lot lines identifiable a 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 pumping out the septic tank every three yeah 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 sta;e 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 Ph nning & 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 i 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 an 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 Planning & Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on this form are true to the be t of my /our knowledge. Uwe am/are the owner(s) of the property desc i above by virtue of a warranty deed recorded in Re gister of Deeds Office. Nu ,era i - 'rno c . �Al_ /3 /C6 / SI . i ' T RE OF AP' LICANT(S) DATE ** Any information that is misrepresented may result in the sanitary t ermit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Regis er of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) U 2739 P 31 6 - 7 6>1Qa9 k � • KATHLEEN H. YALSH REGISTER OF DEEDS ST. CROIX CO. , 111 STATE BAR OF WISCONSIN IR)RM 2 2000 RECEI FOR RECORD Document Number WARRANTY DEED 01/28/2005 03:15PN THIS DEED, made between Neil L. Wilcoxson and Mary Jo WARRANTY DEED EXEMPT t Wilcoxson, husband and wife, Grantor, and Kenton J. Bast and Donalda J. Speer -Bast, husband and wife, Grantee. REC FEE: 13.00 Grantor, for a valuable consideration, conveys and warrans to Grantee TRANS EE 4212.90 the following described real estate in St. Croix County, State of Wisconsin: COPT E CC FEE. : PAGES: 2 SEE ATTACHED EXHIBIT A • Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2 St. — Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restriction3 and rights -of -way of record, if any. 456780 1 1— 1•— 0 -0 1 020 - 1110 -30- 000... 020 - 1109 -55 -050 Parcel Identification Number (PIN) • This is not homestead property. Dated this 28 , y of January, 2005. ./ Al I /fir ��� ��w (41,< cert)d c5--7 it L. W" cox !, * Mary Jo i(oxson ! • * tV't �C)wI AUTcIENTICA , pub1IC 1n ACKNOWLEDGMENT Signature(s) .. \ ; C C' S STATE OF WISCONSIN ) Cte �a • • ST. CROIX COUNTY. ) ss. authenticated this 28th day of January, 2005 Personally came before me this January 28, 2005 the * above named Neil L Wilcoxson and Mary Jo Wilcoxson, husband and wife to me known to be the person(s) who TITLE: MEMBER STA' .'E BAR OF WISCONSIN execut u s e for e oing instrument and acknowledged the same. (If not, ' / authorized by § 706.06, Wis. Stats.) / THIS INSTRUMENT WAS DRAFTED BY *Cheri : Town Notary Public, State of Wisconsin eterson, Fram &Bergman — Steven H. Bruns P Pe East Fifth Sheet, Paul, MN en 11 My commission is permanent. (If not, state expiration date: 50 3/11 /2007 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names ot'persons signing in any capacity must be typed or printed below their signatJre WARRANTY DEED STATE BAt( OF WISCONSIN FORM No.2 -2000 U. 2739 P 317 EXHIBIT A Parcel 1: A parcel of land located in part of the SW ''A of the NW ' and ; art of the NW %, of the SW '/, of Section 36, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; more particularly descrii■ed as follows: Beginning at the W '/. corner of said section 36; thence N00 °16' 10 "E, along the west line of the NW Y4 of said section, 1248.49 feet to the north line of Lot 1 cf Certified Survey Map recorded in Volime 3, page 669 at the St. Croix County Register of Deeds Office; thence N63 ° 02'59 "E 14.42 feet to the north line of said SW 'A of the NW %.; thence N89 ° 26'58 "E, along said north line, 1182.70 feet to the east line of said SW '/, of the NW '/.; thence S00 °21'37 "W, along said east line, 350.04 feet to the north line of Lot 73 of the Plat of Cottonwood Ridge First Addition recorded at said oficc ; thence S89 °26'58"W, along said north line, 10.00 feet to the west line of said plat; thence S00 °27'24 "W, along said west line, 2096.7t" feet to the centerline of County Trunk Highway "N" and a point on a 1999.00 foot radius curve, concave southerly, whose central angle measures 7 °10'30 ", whose chord bears N84 °30'41 "W and measures 250.16 feet; thence westerly, along the arc of said curve and sad centerline, 250.33 feet to the point of tangency; thence N88 °05'56 "W, along said centerline, 83.64 feet to the point of curvature of a 2700.00 foot radius curve, concave northerly; whose central angel measures 3 °17'53 ", whose chord bears N86 °26'59.5 "W and measures 155.40 feet; thence westerly, along the arc of said curve and said centerline, 155.42 feet; thence N04 °29'56 "E 24.01 feet to the point of curvature of a 167.00 foot radius, concave westerly, whose central angle measures 34 °24' 12 ", whose chord bears N12°42' 10"W and measures 98.78 feet; thence northerly, along the arc of said curve, 100.28 feet to the point of tangency; thence N29 °54' 16 "W 274.22 feet to the easterly extension of the north line of Lot 1 of Certified Survey Map recorded in Volume 12, page 3456 at said office; thence N89 °'12'45 "W, along said easterly extension, along said north line, and along the westerly extension of said north line, 670.44 feet to the west line of the SW %. of said section; thence N00 °37'50 "E, along said west line, 496.89 feet to the point ofbeginning. AND Parcel 2; A parcel of land located in part of the SW V, of the SE ''A of Section 36, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; described as follows: Beginning at the South '/, Corner of said Section 36; thence NOC °27'05 "E, along the north - south % line of said section, 1216.78 feet to the centerline of County Trunk Highway "N"; thence S76 °47'47 "E, along said centerline, 1354.82 feet to the east line of said SW '/ of the SE '/.; thence S00 ° 07'02 "W, along said east line, 897.02 feet to the south line of the SE '/,; thence S89 ° 33'25 "W, along said south line, 1326.80 feet to the point of beginning. `-. ..`\ o - - w E 0 ` w . \`\ ° 4 ' LOT 88 ¢ . \ . \ . ` ' 2,07 ACRES Z _ \ \\ \\ Ci s \ \ \ a 90119 SQ. FT, z OC \ \ C� L.B4O. ' 1038.00 0 .. \ \ .X \ \ t \\ l i\ t \ \I { \ \\ t 70' I` 1 \ k _A � ._._.__.__.__. ,,,,„Iv 1 E • r f, a J N89D3819'W 216.84' ,�. - ' "� ,'� .r� N89 ° 3819 °tN 262.73` ° MARY JO COURT 0: 6142._ ._._..____ .... r • y i w- LOT 110 ' LOT 111 2.03 ACRES 88243 SQ. FT, I ` N ; 2.01 :. g _ v. [LaU a2 389 $� 531 S2$ .F�'8 i 64� a i 22 , 272 -u • EAST • WEST 1/4 LINE OF SECTION 36 I A% r "♦ m . _........._... ,........._ 4 ...._ ..., otP t2. L 108 8 O 2.01 ACRES 01 I s 87471 SQ. FT. O N � -r --'" N a t � ° � 2 �a�w a�a.5a I a � ,,,,