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HomeMy WebLinkAbout026-1064-40-100 0 o ca ��� / §_ A § � 0 ( w a $ 0 £ w 0 ° t ƒ§ B - 7 e \ m I E [ « m =§ e a 9 0 - m E o g ¥§ 2 2 E w @ ° £ k @ \ 2 CL 8( / k 2; o 9 E E E § 2 k Q § { J © e z@ z> _ « z e z> E R > 2 E C >to E a >e >1 R CL k 2 \ k o o§ � o o ® 3 o o - C) $ I 4 4 � 4 @ § 2 q ƒ o ƒ 0 G B n r■ w « T % . � } z o 0 o } rr a _ -0 1 :9 a : k k r 3 - 2 % % 3 ■ ■■ K § E CD w 2 0 2 2 • ■ e \ \ ƒ { 7 Al w § & E § w ( 2 5 3 7 ƒ \ § _ @ ® £g £� K■ ; E ° A M E _ " CD C.) �k 7 C �¥ S. —. 0. z a§ 2 z 2/ 2 n� w � 2 = o_ 2 k z . �� � �� /I� k oC k o� @2 E 5.0 {/ £ f m w §/� ±m ±m CL zz &E &i §.. 200 �z A, % 7 � \I& \I� g£= 222 [$ kk C /} /} % = o = o j / j 7 E E y J 2 & / / =r _ SN � { 3 § § § \ n 2 � 2 7 2 � ■ ƒ 0 % a :3 § a � f f C. 8: 8 0 � I■ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix afety and Building Division INSPECTION REPORT Sanitary Permit No: 420639 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: Peterson, Robert Richmond Township 026- 1064 -40 -100 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark L)c. l , L off -u ©� Dosing Alt. BM Aeration Bldg. Sewer Holding SUHt Inlet t `x • 63 � Y-S'9 � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , ` g _ Dt Bottom Dosing ) Header /Man. 10-30 / •3D 93.92 Aeration Dist. Pipe [ o . 0. x 9 3 SZ / D Holding jBot. System 11. 2r .1� NI."Zz 93• cm Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM �o �� �7•�l Model Number I TDH Lift Friction Loss System Head Ft Forcemain Length la. Dist. to Well SOIL BSORPTION SYSTEM WRI ENCH Width r Lengt�i No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS p 3 a QQ . 2 SETBACK SYSTEM TO P/L DG IWE LL LAKE /STREAM LEACHING Manufacture INFORMATION CHAMBER OR Type Of System: n - ^• � �I f UNIT Model N�ujnsgr: DIS TRIBUTION SYSTEM Header /Manifold I � Distribution r, HoleSize x Hole Spacing Vent to Air Intake �p L Pipe( O / Length �`— Dia Length Dia Spacing 3 __ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [ No [K Yes [j No COMMENTS: �(IInclu a r c�o�dee�discrepepcies, per ons pre mt, etc) A Inspection #11: —_ �i / Inspection #2: Location: O�T2T tlV�nr RicXond, WI 540 1/4 SW 1/4 211 T30N R18W) NA Lotl J , Parcel No: 21.30.18.321A10 1.) Alt BM Description= S .T. t- ' - 2.) Bldg sewer length = 3 •41 (� - amount of cover = t-%5J W �f-k -'� S ex.nz �...�: [ s Si e.o„er- Cie) 3) W 4 : t Cf>�sti�� an revision Required? j' _I Yes No Use other side for additional informs on. _ Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) f �� �____� I J50 4fit{t3 ST CRX CO ZONING 0001 U&6 ad DivW= Catwq 201 W. Whoa Ave.. P.O. Boa 7062 I vIl o wnsin IWdnea. WI 53707-7M (to e i I igN Ca) De trn*nt of Commerce (6M 26145" I � n C �Y W Sanitary Permit Application "• ""M HWbW IN actotd % tl Caulw &mi. Wis. Adn. Cady Pansad isfaawaias yos P"i& MW 10 >K sledtar Y Pia Frivary L&W a1s'q%1 xa0 ft4%— Address (4& f6w go dull auiUaP address) L Apppe adso Inhmmiew - !base Petal Ar I rweMiw / Mk s i E A -,e ^' m Paroea a lril M / 81ook ti � bak rf Z 0 d ? !•,qsb, tan � _ J . ib. Stile zip ll�: ybK Soctio ypegonvolowgtememds aN tbm "Ply) � T 3L-1,m R� t K 2 FaaMy DMA - Nether of 8edterotw V QiWi e Gt/v viwaw A1une tSM NW" f I PobGrl Q=MCW- Dwainilre (0 Sooto Elwlad - OSly_Ov>71i6iTianu110 of r ILL Type of P"VtNa {Chock Q* one Da>R w A. Cimplik time a if appitealia) A. qj N nr SYS" 0 It*,,. S yaao 0 TNWM- td!loeding Tre Rapla -Opm 001r 0 other Modaoeoa to stomas SWM 8• © Raoewai KFCMW R"W" 0 Cie of Oft.* T'wf' w Nw i ' w F+�"0 w N4u►her,oe Dive sofmo P%MWA a owner t Iv. Type ofmwna Yam Check an that K Nas - Prtapstaed ltrQmtmd d Mound; 24 is. e f.awie seal 0 M0aad < 20 hL of sdubk tn6 ❑ At dada 0 3MPh Pact Sand F iRW 0 CoMmtet.a Wa"ad Q Rnmurimd M onuod ❑ NofeisP Tarrh 0 Flu n" TM"ov t Lb& o Reftcul aa6 Sad R1W 0 "aft Fast O Lmcbm a n aw D D np cw�et less 0 Oar ( OW > V. osetw rat Am Ioferwe bate; Deailp Mur WQ D—p SW APpbcoou Rate{ pigrrsii Alm (iq Arm Pe pMW (at) sy"M EIrvolies 00 VI. Took Into Capscig TOLM Nwsar 145gumfimtwow Fr4m Site Ron Ptaade ( lum t111t" of us is CAOcsae Co sattaad Cr"es tta. try r«t ` v Op Ar 1luparw ilai Dasiq tywler VM &**mm- 1, at snarls J060MANy dir a! the r0Wr3 gloom oa the adoeW pa Phookwa TNeee s 5 Boom" Fhaw M Ntssha �:� S3 7rs Pbmar'a Addan (saes+. Cloy. Soto, ziP ) via. rttsawt the oal © t)i »pP.aved Smarr Pamar Fee( t3raurNantw ) s,.�e fee) 0 0.". Cu.." Rawo far DaaW x 3 Q � ilt. Caoidi/toria of Apprava[fitessoas for Dkoppr oval t� An.�tv.r�srkM.rt »ar . eK,.. ylrafNr gloom ..,,rRrallM.,mst/saei ar.r SBD -6398 (R. 08/02) • � iC.J�Yr\DVI� 1 { EZ1203H JJ 4" t `43 TTfse "T Jj r R Ts ( '•♦ w i• 12 it �p Itj 4 . 6 2 510 +.. :: 6. 511 yT T H �,' 'T' .. t i.T T Vi � T ..T * w I to Vr wv v 112 Cj 12_ ,1 f I/ ., D IA. (fir.) ` t °r1r, , n, Ate,, o.0 at :" #ate - 4 .62:3 B old w itxy,e per lxreal _ 1.1v - �.. r s° �' Spa►► (� sue) L IQ EL � 18 d .8{in i l�--�� 3 Ii i 6). U, ofCa, t , cyii� z- r,,, rns� �ORaRa E rfl j � �, i Id voi ;,, a of cer lrr ettl„, �! 3_ rs a Y Tnta1$ # Iatw.., A"" ' UR r f l # ?ir lt♦� _ 4 , 422 10 5.3+t, S --� t .iF t = 1 � t uora v�, p f ( 12- � '.srr 901 tY roicttcd Treoc.6 A... f t � Rot9 s , 1 O at t�ntla :iie "i�Yh�II11 Htl� ,� 1 2 IR. C4ti Oaw L ` o# tL1At x a'�.rF #. f j " vni tIa.rry t to R �a.r : 36 tR f Hsu at o�+iti#e t t t2i•. t}� � '�. t 5 R' �_.__ ' 3 baltoln rar�,rs; tn_ ut JJ Ftlslr _, naM recce Area'----- - Lai 0. I r 7 « 0.422 + 0. � �1" cKhs3 o.a JS Ud h' q.fit. rs 1 F } f 1 t :ps Trench Aggregate EZ 1203H Ystem 1 9 r r ndustr;sra p i j+() Gran _ Wa nd. 3#ts i SMALE l ur w _ t it SANy art MAW Dkktr caror'b' VL ant W. . Ar I P - 7 t wR �t710 ST f ��ett� �[ 711- �it� � I1+Ytew p of cow LIJ wo -It a.� S@rrg Part A 'W �' ' �` ' �` ft ma" db O . SM. W e... Yom p-i ee -T°�a (o � L AWMadkw ft wii"m NWM aws "MO L.D ru � N s v. 200 p C - l b!o b - l (30, l$-I m owmr - summmAdmism ST CRO ,COUNT i pow" O F 'E vW v- SoZ k T 3 6 N It / Ca►.vim 2Iri'lrie fVrir LaR lledtnwmlbn Nears csm Alm" or7 � s pay �— /0 0 1 7 / 0 ; of Z Ewsw � am at #d Mgt @"W - per, V 13 3 fweeik Dodge - li ah r 4999 wom C3 FCNWMNKYxid - Doodle tam L ®aura Gwer 3'X Gar, Ys "No"Ohow �e r � 3.75 0 e \kct / "5�-- H1. fthm* sWbr wit Ma sw *m • AIM rei�bw kftmd aatj. aea*1wt ire i it s 2 0 awboom s *mn 3 o vwpmm� s o Ate " • Oak AMR f � +ride ae•r•v brit „ean�..,�,,,b,.. redt to +� 4i'lwmkr of �t �«r�rir aei_m r far l =a o r +a�no � �satw.a 210 mmuma qtr o mad few 30 u eo.ia.ea d l/ u Q lmertiw0 i t at o mambo Tads 4 o xmgb pass Sl o D* Late 4D 46 0 Amok a U* 410 13 AWWWMIS 30 0 06W Am ]dusted Am 3ei ApOkM a V%Wmk m lws %� � pied Gila r oa gawk" flafeerd ✓ �a g � liJ S7 C{ 'i yfrie hft it ' old � fee" at mad flat Pfrmtir iilrr•as arum at7k*a oeesateee comma td MIN Stok to+e e•rercti..�. !i MwMmmdMft >lmomart s. is llir aiis>KllfRreeee�reedweii O 7 leiienee fl.ae Nhr.lees T9 �QCA o ri.s C)�3 7 a -S - t S t cm t>as ® Dia�aeved swam fr Dr Un d Wiese P O O Com ws air --- au Or & V � / paW7 M ,-nu .3y,� -s • ��+ .__ J a-ell� � [ � w`. � 4?.rra CRT% -,cage fR nimt �' 3 �3 i I I I I I I r I I � 11 Ao a ' --------- i - I I _ f I Ifil rll l i� l l li ill i r 1 I I I I f 47o ! I I 1 I 1 i t I , , • I �_ -^ _aid_ _ - -�_ ._off s - - -- -- -- - -- -- - -- , ' I .6 P K A L cv�, o� �:;� �� rv�o ►1�� - �� 7 tea, — 106� eq C—/ ?— 3D �s tt , k y - 75 sys ': _ _ '_ I wob moonsir Department ofcornmeroe SOIL EVALUATION REPORT pap of Division of Safety and Buk►9s in accordance wUh Cam 85. Wis. Adm. Code County � Attach complete ske plan on paper not less than 8112 x 11 kvches in size. man must kucude. but not limited to: vertical and horizontal reference point (BM), &ecuon and Parcel D. St O _ 0 scale or me dinsions, north arrow, and location and distance to nearest road. slope Data Please 0 1 a �D / Panto" Ydomww rw MovMM m" be v ad for seamy pwRowmw (WPr&"*wY s.15.04 (1) NN)- ui�Yl�► �/ J owrxx r 3 21 — (d )AN 6 7003 Gpyt gip( IV(,J 114 114 S oZ T 3&N R W PropertyOwr�s Address T o x COU Y # Block# SUM Verna ( 0 0 t- f to N ❑ ca t ❑ Town Nearest Road Stater zip Co&;--?MwMwtw N -v-4 w s a /ia a New Constrvodtoru Use Rial i Number of bedrooms Code derived design flaw rate �� C GPD ❑ Replacement ❑ Public or commer" - Describe: — Parentmaterial ood Plain elevation Kapp _ n Fl General comInerds artd neaomrnerldatiorrs: 5 q-1 g'), F /I r 8 # ( Pft Grotaw surface elev. _1SP� ° . #- Depth to WrftV factor h• Sd AmNication Bountlary Platoon Depth Darntruard Redox Desai�on Textural cure Stru Consistence Roots `Eft#1 1 'EW in. Munsel ca S& Card. Color Gr. SL Sh. 1 p- g id r a /2— 5 b k• kN r S 3 A a # ❑ egg U kr Pit Ground uarfaoe elev. _ 17 - fL to Sod Appkation Rate HoMw Depth Doniaud Redox Description Texture Struct re Bon y Roots GPDIfP 'Eff#1 in. Munsd M S?- Cont. Color Gr. Sz. Sh. C 'EfFl12 , M S mlrr r 5 r ' Et ont #1 a SOD > _ 220 ffek and TSS 3-30 < i ' Eftluerd 92 BOO ,: S 30 mglt. and TSS 5 30 MG& CST Number tT tl' ao S Date Evaluation Conducted Teleptwne Nurrrber Address n f toq- t� 5`�i'`I u -¢. fJ ek.� Kick a iu S �� 71'S c !3S , I Property Owner RC L 1 D •D� Q r.&o r- Parcel ro # Page � of &*w F ® pit Ground surface Bleu. , 7 ft. Depth to 9� in. SO Application Rete Horiaon Depth Domkwd Color Redox Descarpf;on Texture Structure Corwisterm Boim *y Roots wnw In. Munsell Qu. Sz. Coat C )W Gr. Sz- Sh. 'Eff#1 Min l o - 9 /4 h3 L N ar e- 5 K f (� .z. S6k rAr7 P 1 ( rn 1 2- �� cr F eorkV # ❑ Bodrg ❑ ph Ground surface elev. ft. Depth to kn&V factor in. Race Hortarxt Depth Dorninerit Color Redox Descdpdon Texture Strucdxre C,onskaenoe Boundary Roots GPOW in. Munsell Qu. Sr- Cant Color Or. Sz. Sh. 'EtTl 1 •Eff#2 F - 1 # ❑ piB t Grou wlece etev. ft Depth to irnitlrt8 factor kr Sol Application Rate Hart= Depth Dominerd Calm Redo(Daeaiptim. Text" Shueb" Cormistgrm Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Ei#t1 TIM • E111uer t #1 = BOD, > 30 1 710 rng& and TSS >30 _< 150 mgA ' Effluent #2 = BOO, 30 mgtt. and TSS 1 30 nV& 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. sBD41M(r AW) plo tv' ula `I �� std` / S a 73�; of R N .uu:all CY\vr\o +•c�. �� � � alQ l � - 140 [n Lo a,�N 7 I, A 8 A 0 N I d i d �r, ..� 40 �� ', � i - 4 ' ', '.. I, ', �. � � � '. III _._ _.. _.. .... _. _ - _ _.. _ _ _.. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pape --1 of E TNNit SVSTM Slt3 1CAT10M Owner ) Y\ Tank Capacity l get fE3 Parrnit � �" (li Septic Tank Manufacturer SpV'S txl PARIIMETEtfS Effluent Filter Manufacturer�j Number of Bedrooms 0 NA Effluent t=ar Model O NA plumber of Public Facility Units 0 NA pump Tank Capacity O NA Estimated flow (average) r] Pump Tank Manufacturer O NA Design flow (peak). (Estimated x 1.5) LP ©D pump Manufacturer O NA gauday Soil Application Rate P mdei O NA Standard lnfktenVEffluent Quality Monthly average • Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Grovel Filter O Peat Fitter Biochemical oxygen Demand IBOD 5220 mg/L ❑ NA 11 Mechanical Aeration O wetland Total Suspended Solids (TSS) 6150 mg/L O Disinfection O Other. Prsdeated Effluent Ouak Monthly average Dispersal CON(s) 13 NA ModwrAcal Oxygen Demand 180DJ :rn mgfl- G (n- Ground (gravity) ❑ in- Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L 0 NA 0 At -Grade O Mound Focal Coliform lgoometric mmeen) S10` cfu/100m1 O Drip -line O Other: Maxbywm Effluent Particle Size Y in dia. 13 NA other- O NA Other: Other O NA O NA 'vakwa typical for domesm wasteww Old > ff ' tank affkant. Other NA MAMITEIYANCE SCHEDtAJE Service Event Service Froqixincy Inspect condition of taakts) At least once every: mont (Maxilim h 3 years) O NA Pump out contents of tankls) When combined sludge and scum equals one -third IY of tank volume O NA Inspect dispersal c oll(s) At bast once every: O month(sl (NNaudnsunnn 3 yam) p NA yearts) Clean effluent filter At least once every: O months) O NA fi'year(s) kupect pump, Pump controls & Warm At least once every: O momth(s) O NA O s) Rush laterals and pressure test At least once every: O m►e s)(s) O NA otinar: At least once every: 0 s) O NA Odor. a NA MAWTEMAIMCE WSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Plumber: Master Pkrmbw Restricted Sewer; POWTS Inspector, POWTS Maintainer: Septsge Servicing Operator. Tank inspections must include a visual Inspection of the tank(a) to Identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to deck for any back up or ponding of effluent at the ground surface. The dispersal ceN(sl shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding Of effluent on the ground surf ace. The ponding of effluent on the ground surface may indicate a fadbV 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, 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) CART UP AND OPERATION Page of For now construction. Prior to use of the POWTS check treatment tank(s) for the Presence of that may impede the traament proceaa and /or damage the dispersal +mss). M high afire Products or other 'chenical of the tank(N removed by a septage servicing oPeretor pry to use. detected have the content System start up shall not occur when soil conditions are frozen at the infiltratr ve surface. Outing power outages pump tanks may fill above norm highwa ter l v When discharge to the dispersal mss) in one power u restored ac excess or wastewater will dispersal effluent- To avoid this situation have the Overlo the ceq( and may result in the contents of the puttee tank removed backup � surface discha o Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist prior to restorirnl restore normal levels within the Pump tank. mam pump controls tt Do not drive or park vehicles over tanks and dispersal coos. po not drive or park over. or within 15 feet down slope of any mound or at -Breda soli absorption area. di sturb or compact. the arm Reduction or elimination of the following from the wastewater stream uay move the performance and of POWTS: � b ey wipes, cigarette butts: condoms. cotton swabs; Pro long the de fife s . the foundation drake ( Pump) water; frtdt and vegetable peelings, gene: Was", Painting herbicides rtneant scraps: Medications; f oil; Products sanitary napkins: tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is Permanently taken our of service the following steps shae# be taken to insure that the system is Properly and safely abandoned in COMP"NICe with chapter Corrim 83.33, Wisconsin AdrninWtretive Code: • All piping to tanks and Pits shall be disconnected and the abandoned pipe open sealed • The contents of all tanks and pits shall be removed and property disposed of by a SePta9c Servicing Operator. • After pumping, ON tanks and pits shall be excavated and removed or d iir covers remove and the void space filled with SON, gravel or another hwt 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 unkeed for the system. The replacement sP t area should be protected from disturbance and location of a l n osrrnernt soil absorption required setbacks from ex' action and shoul n ot be infrKngod upon by result in the need for a new soil and evaluation to establish a suitable - Failure to protect the a area aril! comply with the rules in effect at that time. Replacement systems must ❑ A suit" replacement area is not available due to setback and/or soil Grnitations. 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 evahf mtiorh 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 stoma absorption systems may be reconstructed as piece follow infiltrative surface- Reconstructions o f such irsg removal of the biomat at the systems must cotruply with the rotes in effect at that time < <WARNING> > SEPTIC. PUMP AND OTHER TREATMElff TANKS MAY CONTAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT BITER SIC. PUMP OR OTHER TREATNBIfT TANK UNDER ANY 'A . DEATH MAY RESULT. POISON FROM THE INTINOR OF A TANK MAY IM DIFFICULT OR IMpOSSMLE. RESCUE OF A ADDITIONAL CtN loww -p TS P'OMRS INSTALLER f'OWTS MAINTAKiIER L ;;;L -7 j.S ✓� o w G �� Nave / phone SEP TAGE SERVICING OPERATOR pVUI E U LOCAL RED J1TORl/ AUTHORITY Name Name Phone � This document was drafted in can p ance with chapter t:omm 83.22Q)(b)(i Rdtaftl and 83.54(1). (21 ark (3). Whop sir Adn+irnistnldve Code. ST C COUNTY RECEIVED SEPTIC TANK MAINTENANCE AGREEMENT AND JAN 0 3 2003 OWNERSHIP CERTIFICATION FORM ST. CROIX COUNTY Owner/Buyer SOS ZONING OFFICE Mailing Address p M - 0 y) / n Property Address 1���_ /l Z. �'� J NE � , C �i YYtOh CX (�t) i 5 �/ ' Q/7 (Verification required from Planning Department for new construction) �P City /State Parcel Identification Number ta 10 taU - U Q 4o 0 - ?Z/A - /0 LEGAL DESCRIPTIO (� Property Location �� %., %, Sec. , T�N -R�W, Town of Il L CL. Subdivision , Lot # Certified Survey Map # � no , Volume + 13 . Page # 3 _ - T1 Warranty Deed # i �7 Z� Volume ),I �(� _, Page # Spec house O yes a no Lot lines identifiable yes 0 no SYSTEM MARMNANCE Improper use sad maintenanecof your septic system could result is its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the fiutction 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 wastew An disposal system is in proper operating condition andtor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Irwe, the undersigned have read the above requircatents and agree to maintain the private sewage disposal system with the standards set forth, Herein, as set by the Department of Commerce and the Dot of Natural Resources, State of Wisconsin. C.ertificittion stating that your septic system has been maintained moat be completed and returned to the St. Croix County Zoning Office within 30 days o three year a iration date. Ja ,c�3io SlGfqkTURE OF APPLICANT DATE OWNER CERMCATION I (we) certify that all statements on this form arc true to the best of my (our) knowledge. I (we) am (are) the owner(s) of tht pr described above, by virtue of a warranty deed recorded in Register of Deeds Office. 5- - �'� ,, 4 60- �� - 0 -� - j - o ff SIGf4ATURE OF APPLICANT DATE * *'* *• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. *****0 ** 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 decd VOL 14 66 PAGE 199 6]..2775 STATE EAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH nent Nwnber WARRANTY DEED S CRO OF DEEDS Doctu ST. CkOIX CO., WI This Deed, madetx:tween David.J. WaldrotT and ,JulieA. Waldroff, RECEIVED FOR RECORD husband and wife 10- 27-1999 9:30 AM ORRANTY DEED rantor, conveys and warrants to Robert A. Peterson and Patricia A. EXEMPT B t/ Peterson, husband and wife CERT COPY FEE: COPY FEE: TRANSFER FEE: 120.00 Grantee. RECORDING FEE: 10.00 Grantor, for a valuable consideration, conveys and warrants to Grantee PAGES: 1 the following described real estate in St. Croix County, State of Wisconsin (The "Property"): Recording Area NamKaiftJaye f�A OG LA ND Z" l Estreen & Ogland P-0. Box 359 Hudson, W1 54016 026-1064 -40 — t tab 321 A - to Parcel Identification Number (PIN) This is not homestead property. Part of the NW li< of the SW 44 of Section 21 -30 -18 described as follows Lot 1 of Certified Survey Map filed September H 1999 in Vo . age 3717, Doc. No. 610046. TOGETHER WITH and SUBJECT TO 66 foot wide access casement as shown on said Certified Survey Map. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of October, 1999. Waldroff / A. Wal6"If ACKNO W LEDGNIEN STATE OF WISCONSIN ) AUTHENTICATION ) Ss. County ) Signature David J. Waldroff and Julie A. Waldroff husband an wife Personally canto before me this_ day of October , - -- 1999, the above named to tie known to be the authenticated this ' "' day of October, 1999. person(s) who executed the foregoing instrument and i acknowledge the same. ' Kristin Oglan — _ T __ 1'I "1'LE: MEMBER STATE EAR OF WISCONSIN Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: (If not, ) authorized by $ 706.06, Wis. Stars.) - rHIS INSTRUMENT WAS DRAITED BY Attorney Kristina Ogland Hudson, W1 54016 ,SignanucS nmy be authenticated or acknowledged. Both are not necessary.) `Names of persons signing in any capacity should be typed or printed below their signatures w ARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 - 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, Wt 800 -655 -2021 Better Wa ! R � ��A �� S C> V, Y w = w nits. + o pen "Anne boft O r �v KGPM� a sid M `Or and i � ° PC Y ** "rte . n* ms ' s af un 'rrlasked Provi the fV 'blective is ��� leachin s °Ptimum amount unmasked to provide an o u bo lts desi Pillar dew allow open bottom , ,, and all to effluent to Y actin flow via - hieved b n in all directions. T his SPEC{FICAT )ttom with a n o fg the has been onahw Stem tom = Rent in louve s open Len M..........76. ! t Low p ft Unit l al ong the full ��� flows roong the sides, width.......... _.34~ , >' LerM ........ 76' f designed to 1 8th of each side un Compacted 'tht ...........14- With ....., 34" _o nzpa � ed allow efflu to The louv ....... ........9" Height .......... 11• ra�into backfill w ent pass into bile Preto the BiopTM a )Overt ........... 6.5• the chartiber. nttng it from of P and �. *'hen in or 17- With $ .104 H -i 0 20 r rs 31, / /j r ` x.0046 D 2 &1 - THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON JOB NO. 99 -43 DATE: 8/23/99 ry ao < D BEARINGS ARE REFERENCED T❑ THE z Aty� y r - I EAST - WEST 1/4 LINE OF SECTION 21, < n rq ASSUMED TO BEAR S89'36'37'E � r- 1%4 .3 b 0 Z ND� -.� •� 2 G 1 - 9 r9 ty n w D o D CD V1 Z Z Z V1 (A V1 Z !n r O a' OD V OD OD V D ON OD Z V '0 N0 N 1 ,0 ry �p ,0 '0 rl wwwwwwwww (ii ~: -it ~: : n y y Cw�ww�w�w r- V r'l r'1 r , 1 r'l fT1 O CD N ° ► 0 col �p %0 " cn %0 = V % .a .- wwoww -- r p -4 ONN V r O Vl 11 OD A O A CD %0 T� a !y _� o C3 UNPLATTED LANDS "� M ° 'y CD o � � O •li OWNED BY PLATTER o X � 3 � .p D --------- ---- ----------- -- -------- - - - - -- W O Z W N Z Z M _ 500 "W 688.03' z < - T d D rrl D 00 J 1� N Z r Z Z Z Z M A n m M m f7 rl �, r D pi D O �\ C N A Z -I rZ- Z C-) A :z °.° `4 N Z r ' V) z �J o n m 0 O m � G � D� Z ;0 D ;r o n y Z ro`, / m ro m CO �A ri :Z ' z I 'D 66' WIDE ACCESS EASEMENT o w S00'04'54 "W 688.03' m N � d ' 622.03' 196.19' `�� 425.84' � r 66.0 O �' 10. w co `� ro v ► O o Z I ;Z Z o 9 c ► S00 '04'54 "W 572.14' "' � ;ty M G� w z N .D �r*; 0 U1 4 0 3 N w o rj i V NCDI N D WDC � ► Imo ;` z CD 1 N r'1 M O �� w D r %0 b D �p f7 \ (� I w_ ;Z V o z �' rn y 1L m n z 0`1 m� V r�i V' :m aN W vi • I C w o ra x ° Z W S o ` J a n v v v v� �' y w V . d -i ht i - 9 r*1 x -. P v < bd i .. ............................... .. ® D \... Oho °� ;0 w w %D A —� w ► ► va o ;_ N00 " 608.94' — — g N 00'04'5 E 428.65' 4 9 - - � -- 623.29 -- -- -- 574.22' - - ;� hm -- —�- -- 688.03 --------- - ------ - -- N00 "E 1262.25' Q 1 12 T _E E T Z EAST LINE OF THE NW1 /4 OF THE SW1 /4 �w H Y W I N aD UNPLATTED LANDS o o� M OD n OD 2� 3 W OWNED BY ; F% %01 q9 ri i S) -v ) b *A- 3 L �. Vol. 13 Page 3717 ti