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HomeMy WebLinkAbout022-1084-50-200 County: , partment of Commerce PRIVATE SEWAGE SYSTEM St. Croix uilding Vision � INSPECTION REPORT Sanitary Permit No: 404901 0 RAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Al information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Holder's Name: City Village X Township Parcel Tax No .man, Dean I Kinnickinnic Township 022 - 1084 -50 -200 f BM Elev: Insp. BM Elev: BM Description: I <7 irw— 106 1 /co I vpa d � � ��L TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. A 16 + b� Septic Benchmark it Dosing Alt. BM 2 2.572.,/o fv Aeration f I g. Sewer Holding , S t Inlet S. 733 S Ht 6utlE r TANK SETBACK INFORMATION D.G TANK TO P/L / WELL G. Vent to Air Intake ROAD et 3n r y2, Septic Dosing - -- Header /Man. 4 Z V 0 o, 1 - Aeration sit. Pipe, ]^ ��L�kYY1 � n x` t":�! Holding ot. System - "' �'•Z'" _ =` Z Final r L L PUMP /SI PHON INFOR ION • A� .7 `I Manufacturer Demand 0 St Pover 2 •0 /O/ Model Number TD H Lift Friction s System Head DH Ft Forcemain Lengthy Dia. o Nel! SOIL ABSORPTION SYSTEM BED/TRENCH Width r Length No. Of nches PIT DIMENSIONS No. Of Pits. Inside Dia. Liquid Dept DIMENSIONS ' ✓ SETBACK SYSTEM TO P/L " BLDG I WELL _ LAKE /STREAM EACHING Ma u acturer. INFORMATION �7 - CHAMBER O M L T pe Of System: 16 A rya, I N l Model Number. ) I " r f 1 h� , r DISTRIBUTION SYSTEM v t Header Distribution - V Zk ,SG - x Hole Size x Hole Spacing Vent to Air Jntake 11 Plpe(s) f '/ �.. [ V L Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Qu94 Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed ench Center, �'? )� Bed/Trench Edges Topsoil , f Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: '/ /S i d �`— ] #' . _ _ -,_ Par el 29.2,3 1 $ 4,4�20 Location: 10 River Drive River Falls, WI 54022 (SE 1/4 SW 1/4 2 N R1 8W) NA Lot 2 � CtGvtZo 1� 1.) Alt BM Description = C�Ynz - `�� � � �� C � 2.) Bldg sewer length = ! )? +V - {7 n,� { � _ rl �� Z4 CLld , l �5 - amount of cover =� jj F y r�f U 2y r Plan Use other side Req Yes s de foradditional in i, No yyll ; h -- revis formation. � Date� I sepcto��ign SBD -6710 (R.3/97) ature -� r ' '"j % {_,k,e..d fc' r'1 �'C,L�2 �t i' �,'a , -G ✓ �, Lam,; �Vi�' >t ,T � i'l;� ? Es.L._ ��'.�� / V � C N L i c h I - ran a I i I " 4 ',r � r 1 i ct. A4 fhrQr C_ka. L4, ee e.e_ C i �) Safety and Buildings Division County /� 201 W. Washington Ave., P.O. Box 7162 5 d r m / IL �V &Consin Madison, WI 53707 - 7162 Site Address a7 Department of Commerce 4 40" PjV(. _ Sanitary Permit Applicati , , Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal infor ti a provide Check if Revision may be used for secondary purposes Privacy Law, (m) I. Application Information - Please Print All Information � rate Plan I.D. Number i (1 Property Owner's Name VW Parcel Number Z Z peA� h F 022— 1084 — Sti — 20� Property Owner's Mailing Address �� O� r Property Location S.7 1 S'd ltw'A; S T oZ g N, R City State Zip Code 0 "berr ," Lot Number_ Block Number 4- T S 1 7/ S a 35 - 3 1j Subdivision Ndme CSM Number H. Type of Building (Check all that apply.) f O City ti O 1 or 2 Family Dwelling - Number of Bedrooms y &/L ®o vh O Village O Public/Commerci - Describe Use 1`I ownshi , , t iM k ❑State Owttedlo OprrFu•t C t / � 2 � 3 x s ,, n Nearest Road n U G�n (1) 3 k 8(. 2S 135�,� ,e, v cL �- a, III. Type of Permit: (Check only one box on li e A. Numbering is for internal use.) (Complete line B, if applicable.) A. $1ew 1 13 Replacement System 3 O Replacement of 6 O Addition to System p y Tank Only Existing System For County use B ' ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued v IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) j 449- Non - Pressurized In- Ground 210 Mound 47 O Sand Filter 50 O Constructed Wetland 22 O Pressurized In- Ground 41 Holding Tank 48 O Single Pass 51 Drip Line 45 O At -Grade 46 OAerobic Treatment Unit 49 O Recirculating 30 ❑Other bb V. Dispersal/Tr ent Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade / Required S h. /s Pr oposed S Ae 1 /S Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation G� a 57 . v '95 7, r y /V poi 5' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank --� Dosing Chamber 1 QQ • N VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. S Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number s — o i q 3 s- ii 3 Z Plumber's Address ( eet, City, State, Zip ode) Al S6 3 X Z,a S% S VIII. County /De artment Use Onl Disapproved Date Issued Issuing Agent Si /9 Approved O Owner Given Initial Adverse Sanitary Permit Fee (includes Groundwater g g gnature (No Stamps) 1 / Determination Surcharge Fee) ZZS . (Z 2 1X. Conditions of Approval/Reasons for Disapproval a,n S,o' tri, C� unct� �i lam/' InAe�iu.t-lQ / �^ Attach comp ere plans (to a County only) for system on paper no ess tim x 11 inches - W size FROM ROGERS PLUMBING FAX NO. 715 235 0867 Feb. 12 2002 02:22PM P3 w Not 1 she � D 7 , 1 ~ d� �'"�" �Ye FROM ROGERS PLlM1BING FAX NO. 715 235 0867 Feb. 12 2002 02:21PM P2 Zvi o A/ AA o fJ Lv T 4 R p q ers e T jrc� (�� Aq �t C Lo�d.�,. � I�s� � - `� PLOT QT � � V yq �d- O���rts -- L'�ia�r.b+rS �&,woe 31® ST /ZODftao lvirtrr '�'ywl� LQT z /a. Ao m p �l,Gi a'c gs/ FROM ROGERS PLUMBING FRX NO. : 715 235 0867 Feb. 12 2002 02:21PM P1 ROGERS PLUMBING, INC. N4563 320 STREET MENOMONIE, WI 54751 PHONE: (715) 235.1 FAX (715) 235 -0867 Fax Cover Sheet Date: To: Company: 54 & t,; v e Fax #: yG ?� -- - Re. Pages: Comments: /J / J From: i FROM ROGERS PLUMBING FAX NO. : 715 235 0867 Feb. 12 2002 02:22PM P3 ter. rr� ter• Za X . 3 si,r1 f re ill � , a., r ,, OLc FROM ROGERS PLUMBING FAX NO. 715 235 0867 Feb. 12 2002 02:21PM P2 _ -n r u ttk f L� pp p d FL- o AI �Z it- 1 �, o�s V i i i ° � r I N t Lu T �- y Melee. 11 + sr 's y y Sirs ^O,�F',.sr� Lrltah.b+rS �9J S/S(a 3 3Z� .17' / 8 OO�raiv iv i rfar �'rw� � i f4 E ,�r�sazy I V. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 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 include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. P��lhlG Please print all information Re iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 41 f e4 - 200 - 1 S • 1 i Property Owner i=_ CUOD p Property Location GOY61:et' S � 1/41uW 1/4 S 19 T - Z, ft N R E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1 0 q6 D 1� R.PrI IZL E "00113 'Z) R.L U C. City State Zip Code Phone Number ❑ City - ❑ Village ® Town Nearest Road ftt kjl S4o2 ( - 1 IS) 4LS IQ QQZ - 0 ILI.UL E New Construction Use: Residential / Number of bedrooms �_ Code derived design flow rate boo GPD ❑ Replacement ❑ Public or commercial - Describe: Parent rtiterial _ C LPre.L P� O tJ'F VJV1 -91 + . Flood Plain elevation if appligble N - ff General comments and recommendations: RECQ h 1v- y CELLS, E_� t i�1 L3 U►.i cTS Or — 1j - 6 14 e- 1�c t`ry s t��W 1 rvp L�PceCl elf tlwt�3�sfzS P�'IZ ��'� L 1 U/ 1�CiSL pUi"'Lp . Sit Sl�' - ! LIZ _ �� ° t� ► r �ftl. Ut Lg: ❑ Boring _ .. . Boring Borin # ' ® Pit Ground surface elev. q q - I ft. Depth to limiting factor 60 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Gr. Sz. Sh. *Eff#1 Cont Color Eff#2 Z 23 -3Z toY►i3�S _ _� 1CS�k m\j 3 3Z bc� ta`irL SL6 .. 66 - �o LO `UZ Sly Cif - 1.3 vs O 59 rh � - �;' • 9 wyv -� ❑ Boring t. . `, r i N Boring # .. _ - GSJ�► FF �. ®pit Ground surface elev. 100, I ft, Depth to limiting factor � 6 r '' Horizon ` � - %` : Soil Application Rate Depth Dominant Color Redox Description Texture Structure Consistence Boun 1 :Roots GP /ftz In. Munsell Qu. Sz. Cont. Color Sz. Sh. ,. _ Z la -Z.7 1oYti /3 L 1C.Sbl7. env 3 17 -til to -If-Y /y 1 T. le-Sb . mUIN- CS l o eta 2. S /8 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Prints Ignatu ST C Number . - ;0.1.` .05 _ _ .- Arthur'L: Wegerer 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number .. . 421 N. Main St. River Falls, WI 54022 715 -425 - 0165 Property Owner CWT/ �V�- -1� LI�J S k Parcel ID # Page Z of 3 Boring # Boring F1 Pit Ground surface elev.'[ ft. Depth to limiting factor > in. Soil o 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 -Zy t0 HR 31 �( 1 5 1 s b�C Y A\J CLAI Z V4--q - I. -3vr/ -YjY — 1 g C-S�k M\J t- Cg _ :, 77- -Z 3 c)3 S I `� SY iZ 31y s ,I CS blz M'gh CS — SI -ft 10 12 Sit; 'PS 0 S 9 . YA) Z 3 g, 6 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 F-1 ❑Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate - Horizon Depth Dominant Color Redox Description _Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color . Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 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. saD -8330 (8.6/00) PLOT PLAN Page 3 of 3 Scale 1' =5Q' lam *-I 1,0 I U s � 3LDC'. 0 LtN �0 �f J� r4 I �I J I LTL too.o ' /- e l`ltTi2U L OF 1�Jujkn - ��'�- 2_ �_�L�Z -. �1Q- �'__0�4 GRUV►�i SV�Zt= -�-C.� �j"_ _LtiT' coiz.�v�Z�� - - -- 5 220254 O 1 --O S— Z CST Signature Date Telephone Ito. CST No. Job NO. 00 ooPP ply r ooO %Q p r o 4 r c�oa�*oo 000PPP O h7 W 3i Ili 4" `d y N Zo A Fly of :4 O W r"` N CGf F. N Q `d �' p� N W A V, w '4 p� an; v sr c m P �(A-40C N n� �fJ1 VCC)NIV � � a ��NioLOI.i � � � �Gtt'+1CD�D N c. a $', a '` •• _ -+ c c c � 0) 0 w W m 0) 46 w o) >�p yooyyaoo�� �Q C. op pN�� L C7p� O w'�w� N poAW(JH �A� O A SRS 0 Q AO�•1W LW,1C3 � a7 O W a a LA ca Na w�c�av o c ��' x nwo o or ^ 'a C `�'w'c�+'25c�cr1 S 0 r oo cn A a w t7 � a� rr�v t -4 Ir W IJ n �� a N .• -+ � a ^J co � s t0 S11 c0 tiJ' t11 l mm mco0) 7 o- ,$- �G !� W W N 0 C71 W N N N S 3'+- (.J N •+ �. •� v, 24FO 0c co w vlW Vi Q c�..a�+ccc�N cc R i as i7 cU7�� ^d V d "J N �+) v '�: 'V (,• N N tJ N �7 n a h7 C!t ` C N Iv tv -y O N N tt ©NCh m0 � l7iN ChC71 � U1 ChU10UlQ) y GA LM LA Cis GTE G'1 +. .� �. .., rn -. .. m i C wa' e ��" N W ?aaaw �i Q ~ ilia mc* N tV IV cps o N ,, �9 N tV 7,4 Ch to fJl 41 6 CA ~ vi of vi (A V, y C11 Ul CH Ch CA � Co 10 fli rte+WW N IA o Q3 A Ri i.� W W a, F;; W Q! 98 Cc IV N N 8 ~ R Lo N Cn C N C CNJi N N ~ N (7' Vt C~h w l -4 'R 0 LA POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of v FILE INFORMATION SYSTEM SPECIFICATIONS Owner -E&Ct'i Septic Tank Capacity zoo a l ❑ NA Permit # 9 1 Septic Tank Manufacturer �� ❑ NA DESIGN PARAMETERS 1 Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model o'n ❑ NA Number of Public Facility Units )(NA Pump Tank Capacity FM a l ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer j_o e _(C&yAgc) ❑ NA Design flow (peak), (Estimated x 1.5) O'd gal /day Pump Manufacturer ZDD6um ❑ NA Soil Application Rate g al/day/ft' Pump Model kt 16 -2- ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit XNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODd :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 `J 1�In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L ❑ NA /❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: NA Other: ❑ NA Other: NA * Values typical for domestic wastewater and septic tank effluent. Other: A MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ marts) s) (Maximum 3 years) 11 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 ? j g year(g) ❑ month(s) ❑ NA Clean effluent filter At least once every: — Z Xyear(s) Inspect pump, pump controls & alarm At least once every: ❑ m ) ❑ NA 3 yea r(s) rls) Flush laterals and pressure test At least once eve ❑ mo year(s) NA P every: ❑yearls) Other: At least once every: ❑ month(s) �-y�� A ❑ year(s) 7 Other: 7-- 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 c n the round surface. check for an back u or p onding of effluent o g e y P P 9 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 authori - When the combined accumulation of sludge and scum in any tank equals one-third IY or more of the tank volume the entire contents of the tank shall be removed by a Septage Servicing Op erator 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. �• Page Z-, 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. • 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 Name Phone S 23 5 ) (3 Z Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name - r , C¢o(x / /4 P er Phone Phone - 4{ S', 3gt _ `i' This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX C O UNTY SEPTIC TANK MAINTFNA,NCE AGREEMENT AND OA C „RTIFICATION FORM Owner /Euyer C>F Mailing Address �"'72” �j � 1�l �N �I1 1 4 757 1 /OZ.7 Property Address AO 9 56 (Verification required fmm Planning Department for new construction) LEE City/State .. )v / G✓ - Parcel Identification Number L1� CA,L D�u� ilRT11:t�N Property Location :51 ! /,, &!�. 'l�, Sec. a?2, T,$ N- R-j_&W, Town ofk Subdivision _ Lot # Certified Survey Map # _ 6 � 22S . Volume _ ,15 . Page # Warranty Deed # � 6 $ � . Volume -J? 3 3 , Page # Spec house CJ yes no Lot lines identifiable O yes ❑ no MC NANCE Ituproper use and maintenanec of your Septic systcut could result in its pmauiti to failure to handle wastes. Prgwx main me consists of Pu=91 zg out dw Wp& tack every three years or sooner, if needed by a licensed ptmnper, What you pat into the Sy*M can affect the fiunction of the septic tank as a treatment stage in the wustc disposal syst The property Owner 'glees to summit to St. Croix Zoning Department a certification €arm, signed by the owner and by a maAm P lumber ? jouraeymauPiumbcr, restrietcdplwuber or a liccusedpumpervedfy* that (1) the on- site vrAaewatu< isposal system is ia proper operating condition and/or (2) aftor inspection and pumpng (if noacssary), th Septic Tartic is less dm 1/3 fun of shoe. I/wc, the Undersigned 1mve read the above requirements sad agnx to ,maintain the Private sewage disposal system with the sranAards set forth, herein, as set b y the Department of Commerce and the Department of Natural RcsvarceS, Stare of Wisconsia. Cerdfication stating that your septic system has bees maintained must be completed and mmmed to We St Croix County Zoning Office within 30 days of the three year expiration date. Cj ' rK 2 / ? `.), ' a. SI A°IVE OF APPLIC'AN-r DATE ® A niv (we) certify that all statefnents on this farm are Lm to tho best of my (our) knowled I (we) am (are) the owner(s) of the property described above, b> virtue of a warranty deed r=rdsd in Register of Heeds Office. SIGNA,'l'ME OF APPLICANT Y DATE "**** Any infotmstiaa that is mis- represented may result is the sanitary permit being revoked by th Zoning Deparment, • * * "' " Include with this application: a stamped warranty deed from the kegister of Deeds office a copy os the certified survey map if rc:fer::nce is made in the warranty deed Ed wd9i:�.o MOZ tai=. °Uef 0OLs9t77-ST- : °OJ XUA 9NI1Hn 17MM : w06-� f I I I I I I I ---------- AD x D p m Z J i� u L � wa o� I I m0 1 - m O' X o --1 0 L l - 0 x 0 L , Ff :o oz :7 'm r N ` N ^^Z n D W �m `K -- D -------------- -- - - - --- _ - -- N / Z ^ V Z Q V, V Z om = U 8m — ;o "D0 60 = > CO K W I N = l i m > X O A W �0 r T ou m N o 0 X n n N0 �m qC mO 1 x 0 C9 CO -z _ \ \1 r 22 14• 10' 4 I m� rlG) c6 m 20'5 N 19'8 c 17 3'3 1 �6 4'4 jC k r A { 01 A T ND mO HOW a - k A ce A � W 1 �1 rn W � 4' r x Z X r0 Wm c v TH W A f i m 16 v k 7 N xp q� x O A � C5 {f1 1 PF, r V i.R -. a sus -r�M i W aLL i 5\TIE Ati N -- t \ 0 PaRCrtr f i a N Lo T 4 FL QT ILL , A L OT 2. , QvEz 2.9, �E AltN 4, 5DIME E KMA • VOL 1833 PAGE 66 STATE BAR OF WISCONSIN FORM I - 2000 6. L KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CR O I X CO., WI This Deed, made between Robert J. Kolashinski and RECEIVED FOR RECORD Randall P. Cudd and Yvonne R. Cudd, husband and wife 02 -11 -2002 9:30 AN Grantor, WARRANTY DEED and Dean G. Ekman and Roberta C. Ekman, as EXEMPT # survivorship marital property CERT COPY FEE: COPY FEE: TRANSFER FEE: 164.70 Grantee. RECORDING FEE: 11.00 Grantor, for a valuable consideration, conveys to Grantee the following PAGES: 1 described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): Part of the NE 1/4 of NW 1/4 and Part of the SE 1/4 of NW 1/4 of Section 29, Township 28 North, Range 18 West, St. Croix County, Wisconsin described as Recording Area follows : t 2 of Certified Survey Maps filed April Name and Return Address /T") 19, 2001 in Vol 1 5 Page 4065 No. 643225. Edina Realty Title 400 S. 2nd St., #115 Hudson. W? ��� 7 S Parcel Identification Number (PH J) Together with all appurtenant rights, title and interests. This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions of record. Da a 's 5 �ra . M. 14wvag " . - * Ra dall P. Cudd *Robert J Kolashinsk'.` *J Onne R. Cudd * ? * -Z C AUTHENTICATION ACKNOWLEiij N �► STATE OF WISCONSIN �''.,lF �gG Signature(s) St. Croix County.. authenticated this day of Personally came before me this 5th day of February ) 2002 the above named Randall P. Cudd.Yvonne R. Cudd TITLE: MEMBER STATE BAR OF WISCONSIN Robert J. Kolashinski (If not, to me known to be the person s who executed authorized by §706.06, Wis. Stats.) the for oin ins a and know the same. THIS INSTRUMENT WAS DRAFTED BY Randall P. Cudd Notary Public, S . e of Wisconsin My Commission is permanent. (If n a expiration date: Si tares ma be authenticated or acknowledged. Both are not necess .) *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2000 entury 21 Premier Group 706 19th St, Hudson WI 54016 -2161 Phone- (715) 'iMR707 Fay- (7151 3R6 -6651 RnndAll P Oidd T4R47656 7FX Aeyf ann - y- N I 0 1 � Lo T - P% m �ry►- - �° 9 P D Roa P(&CM Inc ��a�� ale // F O T /1 eo 4r5 o - D ���'�Srr O- A,40m -5 I L.. VT �I_ �, !» � e y q N yS'6 3 n Z3S / /3Z 7." -/ /SZ Pu�►p l`.) 'EQN 5MWE EkmA SJs. E' /�vN olio.. 971 �� ✓` � r 1 v � �► �ASv IA 1 ,. ...; maw 77 J i N RL ED 9 APR 1 9 2001 s � IL111ILEaJKWALSR 1 S�LQ u ER FIE S Randall P. Cudd and Robert J. Kolashinski Located in part of the Northeast �', of the Northwest % and part o the Southeast %. o the Nor 1 1 f hwest /, of Section 29, Township 28 North, Range 18 West, Town of Kinnicfltnnic, S. Croix County, Wisconsin. N OWNER'S ADDRESS ---------------- 1080ARAJRE NOON MW' RNERFALLS, IN 54W LE_ GEND �'.1r ADM M fa CORNER' SECWNLMEOFSECWNA 0 1'x2PWONPIPE11ET , S R E�C�T W i4 . TTnN ` T: l W, ASSUMED AS (MK Wt. -1.13 L8JLSL FT.) BERNTS N 88'f E 01 FOUNO 1• WON PIPE Q $I AWUMM SCALE' i'*3D0' CONCgETE (PX) NAL 8ET MCNUMEKq ) I � W 8f BfTUNIfpOB PAVENBR .' � � }52.07-. r' 1 � l 100 0 100 200 300 0 (AS�NO E m SECT+CN,,*A - W 0; LQT 2_ I Ia •) M CaRM A9 LINE • ' ' 1. CERTIFIED SURVE_ VI MBA - _LANDS , �- -- - VAR OW WDTN - - - - -- Q, z MAP VOLUME 7 (DE�OIt°.ATED l � IR- EA Z �+ � TO � THE N BB'0. W E 8!G' Sri (19,Beesq.lLa0.3141c. 52@ - , s '^Si' , _ ------ PAGE 1902 (R. __ -- NORWMAMLfVE _ RN D� - N a ° 33S1 "F uz 6T- ed �'• LOT4 -• , . C - - -- ERTIFIED SU RVIV MAP — 296 E0 that' , wl , s 296 00 RAERDRW Q' g I4 �Q' -N ee Srsr E & ttzs9V- g Y �� VOLUME - -- - 9, PAGE 2543 ' °, Sao a �% _ - - -- - - -------- W BOLDING S. LINE NE 4/4 N. LWSEfi4M"/4 LOT 1 tar tar LOT Z s LOT 3 x y �~ 4 29sotr ss CERTIFIED SURVEY MAP see°SZS1• w swv5r w 502.01 " �' VQ LUME 6,_ PAGE 17,54 AREA LOTS IAND2- 1037 /� �A,, b 98,898 SQUARE FEET OR2224AC. 100 't��•°o (87,128 SQUARE FEET OR 2000 ACRES (R=N90100WE 33 pp � RAVLNe EASTRYERORWE EKCLUDOYG TOWN ROAD RIGHT OF WAY) hem 54 F f - " , : TM 33.01' 1 I SEE DETAIL (PAGE 3 OF 4 ) -t 1 2 3 AREA LOT 3 EASEMENTPER DEED ~�' =�►v+ -- I VOL SU P. 486 AND EASEMENT PER Cf)i 97,007 SQUARE FEET OR2227AC. C.SM. VOL 1. PAGE fd2 vOL.7fa P. 405 Z: (67,217 SQUARE FEET OR2002ACRES NORTH �n i ,o t � ERTIFIED _$l�i�VEY_MAP Si £_ ExCLUDAVGTOMROADMGT•ITOFWAY) c.s. v►?�,i�a VQ�I�M_E6, PA (3E_1519 •� a Lu, x •n+ z' LOT 4 1 CERTIFIED W �• 1 ' w> srLaE �� , �f C.S.N. 5'�y� $' I h LAURENC )E 1,172,808SQUAfE MAP �� MU � y P raY FEETOR28.924AC. � WRYF-y I6 7 713 (1,181,544SQUARE �1 W ". // FEET oR2a.s5 5AaES -- -------- -- - - - CERTIFIED VOLUME 1, hl RIVER : a o ExCLUOWG TOWN �da3 I is !. Wo 5 ' Fi RoaDRforfroFwarl h� SURVEYMAP PAGE 162 �� `' ` .... ��„ o •- LA NO ''VOLUME 1, PAGE 2 / n:` N9D'D000 P *O RNER -- -- - - - - -- -- �jNPLATTEI UNPLATTED LANDS SBD'48'IS'E) SE114,W1l4 SWCaVtAERC.S.M. - '- - -- °------- N88 1296.57 SOUTNLAESE+ItMMtM 2813 EASEMENTPER - N88'173VE934-W- EAST WEST IN SECTIDNLWE' ST•WEST 1H SECTKW LNIE C.S.M. V OL. P. 204 (R` S 90170170• Wj ' (R'S 89 rr 5204.3/) EAST V29. ER - N88•f390"E p 5204.07- T28At, R1eW N28. WEST 9,721 C 728 N, SECTION 2 9, r28N R I w UNPLA77ED LANDS W A UMM � BERKTSENALUUNJU U 8 DATED. 1-1e- xAPPROU^,LO REVISED. 3- nnina 7m t42S4CROIX COL; ;ry , + r.. • r . SEOTK7N 2Y, T (F S EN N, R 18 W WNDBERNTS MAR 21 2001 ALUMINUMMON(JUBT TNS INSTRUNFJYTDRAFTED BYJERALD L LARSON SHEET 1 OF 4 If notrumoeu wauri,t OPProval da Vol. 15 Page 4065