Loading...
HomeMy WebLinkAbout030-1011-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix 2nafety end i3uilding Division INSPECTION REPORT Sanitary Permit No: 506303 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Kinney, Patrick & Jill I St. Joseph, Town of 030 - 1011 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 1 I A ►'" t 5 � 03.29.19.55) TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER . ,.,•C, CAPACITY STATION BS HI FS ELEV. Septic qq Benchmark CJ j J / Dosing v M W�4 �p 99 aY . Q °" BId9'l. S � Holding ` St/Ht Inlet 9� �Z 4f TANK SETBACK INFORMATION St/Ht Outlet �f TANK TO P/ VVELL BLDG. Vent to Air Intake ROAD Dt Inlet �+ 4 -� , �� 0 i Septic Dt Bottom i Se is / p / 5 3. k 7 [� ! 1b'-I 9 , a fo3 � is 3 Dosing / V,•$T[M�J� ! • 5 7 r D Aeration — Dist. Pipe Holding Bot. System SD 97• S5 Ck PUMP /SIPHON INFORMATION Final Grade 6 75 Manufacturer Z �e.,� A -,1,_. Demand Stj6pver 9 Q9 .69 Model Number � � ---- 7X, TDH L Friction Loss Syste ead TDH Ft •`�� O A/.3 . cl Forcemain Len t Dia. Z of Dist. to well ;7 - -- SOIL ABSORPTION SYSTEM BED /TRENCH Width ! Length No, Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5'L \ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING ManufacturerT INFORMATION CHAMBER OR Type Of System r d*� > / If C� UNIT Model Number: DISTRIBUTION SYSTEM /3 i- /3 Z Header /Manifold of Distribution x Hole Size x Hole Spacing Igo Air I ake q Pipe(s) \ "I--, ` ✓ 1 1-ength_/ Dia_ Length__ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only 065 Z Ar6,, Depth Over / Depth Over \ xx Depth of xx Seeded /Sod xx Mulched Bed /Trench Center 2 . 2 Bed/Trench Edges Topsoil � Seeded/Sodded [3 No I ls [] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 608 Old Mill d,,H,,.u,,,ddsson, WI 54016 (S 1/4 SE 1/4 3 T29N R19W) metes & bounds Lot "'') o Parcel No�03.29.19,�5J 1.) Alt BM Description =` s i r `" 2.) Bldg sewer length = 29 - amount of cover = ___-, / t `J CL , J,5 Plan revision Required ❑Yes KNO UT Use other side for additional information. i. _i . _ SBD -6710 (R.3/97) Date Insepctor ignature Cert. No. � 1 ' Safety and Buildings Division County 5 T Ivis consin 20l W. Washington P.O. Box 7162 Meson, WI 62 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 2 `J O U 3 0 3 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy w s l 5.04(1 xm) Project. Address (if different than mailing address) &6,9 0/,0 4!111 ,&P.- H OPS- AJ L Application Information — Please Print All Info v 30 /v // 9O • oo d Properly Owner's Name , A U Parcel ## Lot # Block # � TQ I ' �'� I AJA) 2 2 1 2007 ti /-, Property Owner's M 'ling Address ST, CROI Property Location 7 7/7 19D/G�iS �� XCOUNTY s�v 59 3 .55� City, State Zip Code Phone Number > > Section H V DSD.v GU I 's Z/ D/4 3 P/ •15'f II. Type of Building (check all that apply) r S / `o T N; R E rW Subdivision Name CSM Number I R (T or 2 Family Dwelling — Number of Bed ms R Public/Commercial — Describe Use 4 t �,., /" i j NO UNv S ❑ State Owned — Describe Use ❑City ❑Village PrTownship of T T III. Type of Permit: (Check only one box online A. Complete line B if applicable) A- ❑ New System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Reimit Number and Date Issued Before Expiration Plumber Owner IV. Tvipe of POWTS System: Check all that apply) a v; C� G a No — Pressur In -Ground C1 Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ 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 ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaVrreatment Area Information: P4537 / .V G + O Design Flo (gpd) / I Design Soil Application Rate(gpdst) Dispersal Area Required (st) Dispersal Area Prop s em Elevation 3 / zf� / SOo� g7gS VI. Tank info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Now 117dsting Tanks Tanks 1V / ".5eR 4 j Zc ZY) CK Le (' l Septic or Holding Tank e O O 1060 Aerobic Treatment Unit Dosing Chamber O / VII. Responsibility Statement- L the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) mber's Signature MP/MPRS Number Business Phone Number - R • 7a (bR i ��T Vu ,,..., S• 71s 77A 3 Vq zzce3� Plumber's Address (Street, City, State, Zip Code) z8/ Z /p fZl, 411e - VI oun /De artment Use Onl Approved ❑ rsapprove Sanitary Permit Fee (includes Groundwater Dat Iss Issuin gent Sign a re o S Surcharge Fee) ❑ Given Reason r Denial IX. Conditions of Approval/Reasons for Disapproval nn 1 SYSTEM OWNER: 3 O c� 5 ( S+e 1. Septic tank, effluent fitter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AN setback requirements must be maintained as per appAcOle code / crdmi 1M- Attach complete plans (to the County only) for the system on paper not has than 8112 x I r inches in size SBD -6398 (R. 01/03) s, v lzi o oe. Ln - oo v —'�- -� •— d ® ; • ell Qr Wil dm ICA �U S 4 Ll— O �I �l va fro 3 v c ���d. o c s ) A4 006 666 j y 0 2 X , NN p� �b� f s, 2� W� \ a-- N sv ------ - - - °--0 a cei 0 C4 I, • A LN J � S U — C O I� co ULBRICHT & ASSOCIATES CO. 281210th Ave. • Spring Valley, WI 54767 Reg. Designers of Engineering Systems 715- 772 -3442 Private Sewage Consuftants PROJECT INDEX �/ PLAN ID # DATE � / d 7 OWNER PA-r gi tg 1 1 - // It /N/VE/ PHONE J d / " 4 C ADDRESS CO 8 6IL2 & n �• /✓ VI l A ,/ 0,6;Y0 A) LEGAL DESCRIPTION p/N 030• /O! /• yO- ODD s�� 3 T�2_�' elf w . TOWN OF ��• oSp� COUNTY s • C /2Ol•X CSTM R. LOCAL AUTHORITY/ SUPERVISION PROJECT DESCRIPTION: 13&P4,t . /—&t Adz , / , - Ff i /i.0 o SysT 5 , 4e � 41f 7- FA (: t'-_ ; e 1 S 37-9 Ulbricht & Associates Private Sewage Consultants 2812 10t h Ave. Spring Valley, WI 54 r d. 7 Pg.l INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN j P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. p 11 g . 4 If it if it Pg.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS Pg.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. I The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Trpatmpnt Rvstwmc." (VprRinn 9.0) RRn- 1075- P(N01 /01. 0jt . 1,oai G- ICSO 1 I '0 J U m LL L vt 1 i G' o SS SEC 7/0,0 / wis1�, l Cf . � �Q �T �fid��ov� c�,�f o.��y` � S�'c T / "o•iJ AMM &4h Usti7 cam/° K l� OVER: See Reverse Side for Vent/ Observation Pipe Details. N � rS 1 SEPTIC TANK &'PUMP_CHA CROSS SECTION AND SPECIFICATIONS • AW� /�_ 6 •WEATHER PROOF 4" CI VENT PIPE 12" MIN. ABOVE GRADE JUNCTION BOX APPROVED >_ l0' FROM DOOR, WINDOW OR CO FRESH AA.$ INTAKE WITH CONDUIT MA OCK WARNING LA MIN. I/ O i , INLET r Gr �•U = = GAS- TIGHT r V q �' A t SEAL r APPROVED ALM JOINTS W/ SCD. 40 F 1 B t r PIPE 3' ON QtJG pive, MO0 CL 4 #1 � , D C 3.Z i ON SOLID SOIL 3 SOLID --I- OFF ** RISER E � SOIL PUMP OFF ELEV. FT•_ i PERMITTED 1 13 D ! IF TANK ps per 1 MANUFACTUR %135 4M HAS APPROV .(30 t 3" APPROVED BEDDING UNDER TANK CON CRETE PAD p SPEC IFICATIONS STIC / DOSE TANK MANUFACTURER : PRD�o'rs �i11 C • NUM> ;FR DOSES PER DAY: TIC �� GAL. DOSE VOLUME - INCLUDING TAN SIZES SEPTIC _ NFLOWBACK: �. GAL- DOSE D GAL. - ALARM MANUFACTURER: l+Tr/l CAPACITIES:. A �a` INCHES = d MODEL NUMBER: D. • [. • . B = 2 INCHES = 33 SWITCH TYPE: PUMP -MANUFACTURER: Z4� C = INCHES = DEL NUMBER: Ya .fir'• _ = O 9 MO � � D _ �d INCHES SWITCH TYPE: P x REQUIRED DISCHARGE RATE Z S GPM PUMP & ALARM WIRING AS PER ILHR- 6' 7 � r ' ` FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . FEET + MINIMUM NETWORK SUPPLY PRE -SSURE . . . . . . . . • A • _ ^ ./1'� + 5 0. FEET FORCEMAIN X 0 9 FT / 100 FT. FRICTION FOIC0 . • O FEET TOTAL DYNAMIC 14EAD =. �► 5 FEET TANK L .; Q u'� -D-5p i- L, 317 /r r y INTERNAL NAL DIMENSI ONS OF PUMP TANK: LENGTH 7 WIDTH ; DIAMETER/ V010 0/0- -1 � /� 50 / `lJ a. LIQUID DEPTH J p t) �d5 0 . V .! !, T To p 4 d x— 1 1 /51 1 , j 5-6 T - - Wc spe THIS FOVT S PER M COMM. - V �'�ep INCORPORATE _ sltc�, O 83.44(2)c A PROPER i FILTER MODEL# ► 'JC ZQ �, S �� /00 �Co I ZOELLER EFFLUENT PUMP MODEL.'98 ;CITY CUpvE L 2 5/a o �+ - + s / 2/11 1/2 NPT u.s. au ONs UtEAS 10 2 --- 30 ---_ / 50 /0 70 e0 s0 160 210 0 fLOW PER MINUTE 101At 0YNA►I,0 111 AAltoW rlo ►unul! Irrtutw AND DIWAfInND . WAS CA►ACtIv t2 1►NI1t/M1N � . Fell Yt1tRt OAR* lrtlt 1 x•63 11 P73 t o 11 /.!1 •1 271 tie /! 15 � 0! loekvak• `�— 2 S /li CONSULT FACTORY FOR SPECIAL APPLICATIONS Elactrlcal 8"9111e10r9, for duplex aysterns, are available and tuppNed with an alarm. a Mercury float iwpches are available for conirolling P.Mech0nlcal alternators. far duplex eyelems, are available with or • three �p syslems. single and "OW alarm "Ches. repiggyback mercury float ewdches are available for variable level long cycle controls. 91andald all mode - Weight 39 Ibi - / ,1I.p, 1. r,I.e..Irlo r,P,ru,dz IIELECTIONGUIDE N to lee E. eMpl• Plppybeck mere P� rn• har" twhch, no axlsrrul conUot r•qulred. Model 1 Q h— o + Ph ttlod• Am • _ ilm 1•n trol stiracllon t'rY 0 twhch 01 double PIMbaek mere awhch. Meter to FM0171. «Y. Coal M / 1 Auto 0.6 t Du ItN 2• Mechm" ahernal« 100072 of 10-0075. 1. e•a fM0112, l« oorr•ci mod•10l Eled&W Altorn•lo, "E-Pak" �� D94 200 i _ / 2 —°r t t /. Mercury qn•« Iloal •wtleh l0 1:M 220 1 - No" 1 « 1 i 7 _ duplex 1 « III foal IyllarM - 0Q2i ua�q y con4or acdval« .P•cpy / ! e ' . f "r 141 hole " 1 Pak ". function plax or duplex 0 "(811100% to 00 Q� W M 11on a wkWln IkN• 7. ,re W heM'J.P•k ",1« walwUplt) eom.. _...rt tpllp. �r �Nllw M NqWxy rule Mir W" b wd" an Ce Mw.aon Bu,tN t U111a tlaelrkal A•rnd t«, r rMO01 /; AN Imulae•lk4 CAUTION 11.11!! �� Padya fI; �wtVy,.apx t1A•4y fMt>♦ kii AAwd 11.1 Ne•n••1 • e* �iq t4M a i af,A 1 v4k, N aMr11 ►• 10„• by M• IM uwl r••1n1 Ndlon•1 [I•*4 C•1• (NEC) •n1 ow (eoup t� ru1 HufU Ad p•NAl RESERVE POWEpED DESIGN For Unusual conditions 8 reserve Safely factor la dngineered Into the design of a fiery Zoeller pum low OWNER's MAINTAINCE-OF­SEPTLC SYSTEy POWTS (landowner) is reponsible for proper operation and maintenance of.thi - s system. Regular periodic inspections and servicing is necessary for the safe healthy operation of system. The owner is required.by code to submit all necessary' maintenance /inspection reports to the controlling,authorities. SPECIFIC CONTACT AGENTS ,5� • CR-41X �y *. _Governmental authority/ Inspectors: A. 9 C ���� '. *71s • 3 P6 • yQV CP * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: ZZCQ 3 � S * Licensed servkce / inspection agent other than installer: 7,7.2 Electrician, -for pump, electric controls, wiring units: ec IMPORTANT OWNER MAINTENANCE RE UIREMENTS 1• Winter traffi.c (sledding, shoveking, etc.) across the area shall not be permitted, or frost can /will penetrate into- the cell, freezing up the system. Discontinuos use in the . winter vacact.ion -trip, resulting`in no water.use) can also lead to freeze ups. 2. Water conservation- needs to be exercisedt system can be hydrolically overloaded and destroyed. This sv6¢em was designed for a maximum wastewater flow of 0 gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste'. Any introduction of such waste - materials will overload -and destroy this system. 4. If a power outage - occurs, or a pump fails, it may ; resu_It In a temporary overload of effluent being pumped into the- cell, which may adversely impact the cell (ieakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative"cover (the cells insulation S. erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A the Aystem beneath IS NOT sufficient SYSTEM!! Effluent in ent alone M! mainta a 1 �covsr. 6• Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area t4r�,..,...,. l 1'101. �e.L 2 ___ • _ 7-Y o ss a g o v A; // Rp. // Vps ati Wsconsln Deperbrent of Corromm S EVALUATION REPORT P" / of 3 Division of Sefdyand Buidings er t35. wre. aa�n.cOde Attach con0ste she gran on p not 81 x 11 /. GE WE D T - G R o (' i dude. but ihtfe not d to. vertical and r uoe directiarr and i o. p O - /O // - `l4 • 60 C7 percent slops. scale orb, north arrow. and toc�tian di�tenoe to nearest 3 Please print all i J U L 2 0 200 PMa" tntore 6- frog Porde MY be used rarssoondwy PMPWVOW ;TA, M kiNNEY Govt 1/45E1/4SJ TZq N R// E(2 W PmperW0WwrsMaBrtgAddress Lot>« SubdNameorMIN `1 17 &A0,6 �'•D' N/ 3� !wl.c�fs /3 ov t,p CRY State Zip Code Rmw Number ❑ cily 11 ❑ ~ ® Town Nearest Road JUSa� W I • Sya�C� ( ? ST- NOSE q1/1, ❑ New Construction Lion Use: PL Residential / Number of bedrooms _� code derived design flow raft 1 S D GPD L ieoement ❑ Public oraorrner�i- Desalm materiel 0 Gy� Flood Plain elevation if appl c�le N ft ��cr2� raga �r srti General corureerrts ovz poloAf f . / — N Sfi4 l/ ?,fig vcG� S �S1i.4 , 40 T ,2� Gtirt yE.vP4!U) • 13 U T 5 � 5 2:,vlr i� T7 Boring pit Ground srrbwetev. . R Depth to factor Sol Rate Horimn Depth Om 'Color Radon Description Texture Structure Consistence Boundary Rods GPM In. Mu nsel Cla Sz Cont. Corr er. Sz. Sh. 't ut o - /0 Yle 31 —'-- — GS fwl s!/C' w 3 f .7 10f- 0. S L / Co q • s R 5 ---- -- C w /I- . /. 7 5 ve z A M / v , cl AM Tested w1tW to "I Imponal in un sys e Z so ft tt ❑ � t Bori /00.2G 0 Pit Ground surface elev. R Depth to r is q factor it sa Application Rate Hortwn Depth Dominant Color Redox m w ipfian Texture Strtrctue Consistence Boundary Rods GPOW i,. Munsell Gu. SL Cord. Color Car. Sz. Sh. 'Efi/F1 'EW2 c1*44 GS , wr a/O -7 l 2- Z a, z f .7 . i. s z •D Ama t T v / ..�._ ed svuAbdt for n un s em I 1n " I V `EBt m t *1 = BOD > 30 < 220 nW& and TSS >30 < 150 rngL • Eftmt #2 = BW < 30 TSS :S 30 mglL CST Norma ( P" RO E I ^ r 1 b1z f c z 2- S Aaarem ric t Associates Dd& TeeaitareMxmbar Private Sewage Consultants 5 77A - Spring Valley, Wl 54767 r. 4 Q Dip n= ®p S� d w ;ll �� � C qel U S-e ©f - i4- PVC 4 ` 1WF7 - T9tiK To D 1',5 f f L& 7-- OF 7 -0 5EX 0 A w:c . MW I mmiX MSUMMM, 1-1 mm mm� MIR mm mm asps u�����■®�� owe ®_ ►����_ _m�m �.�_e i � .- i .i a �� :i • i . �i. a ,mot .i .i : r e 1 ; MOW lill 1 :., . to I ( Ci • u •, . 1�. 7 , 1 7 1 , 1 1 �■■ ■■■ ■■■■ ■■■■iii �■■ ■■■ ®s �■■ ■i■ ■�■ �■■ ■■ ■�■■■ ■■® ■■ ■AMA ®M ® M MIR io m■■■■■iii ■■■■■■■■■■■� ■�■ ■■m■■ �■■■■■■e ® ®■■■■■■ ■■■■■■■■ ® ®■■■�■■■■■■■■■■si■■i ®® ®■®��■■■ �■■ ®■■� ■■ ®�■■ a go 07 N CD co p l J Q� r m Ln 0 N I N rl .J N 3 © ;0Q. N C o tit -ti b O � � N s_ r 0 ' �- V . c n � � c z / to � o 0 � s o Parcel #: 030 - 1011 -90 -000 07/23/2007 10:51 AM PAGE1 Alt. Parcel #: 03.29.19.55J 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - KINNEY, PATRICK H & JILL E PATRICK H & JILL E KINNEY 717 BADLANDS RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ` 608 OLD MILL RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 3 T29N R19W PRT SW SE COM SE COR, W Block /Condo Bldg: 486.5 FT, NWLY BY > OF 59DEG 633 FT, SWLY BY > OF 90DEG 33 FT TO POB SELY BY Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) > OF 90DEG 177 FT, SWLY BY > OF 90DEG 03- 29N -19W 64.3 FT TO FLOWG LN WIL RV NWLY BY > OF f / 87DEG 18 FT WLY BY > OF 41 DEG 92 FT, NLY more Notes: q Parcel History: Date Doc # Vol /Page Type �k -p►i, h ( 01/28/2005 783061 2739/060 QC h7 ZD 07/23/1997 829/437- 07/23/1997 780 07/23/1997 75/28 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 65,000 50,300 115,300 NO Totals for 2007: General Property 0.000 65,000 50,300 115,300 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 65,000 50,300 115,300 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 y r i�� ' � � ♦ . , c , ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �A7���C� ,' J i V Mailing Address _? / � / Property Address (D 08 / "' 1 // iP L • L7'" OPS 0A-) V O/ p (Verification required from Planning & Zoning Department for new construction.) q City /State # - V DS Parcel Identification Number 03 LEGAL DESCRIPTION /I Property Location s � %4 , S � 1 / 4 , Sec. 3 , T / �j N R W, Town of Subdivision N S Lot # Certified Survey Map # , Volume / / , Page # Warranty Deed # d , Volume 27 3 ( , Page # 0 Spec house yes no Lot ide4tifiable yes 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 years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 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 Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted phunber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. umb r of bedrooms IGNATUR&JUP APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) OW Ulhr & Associates PfiWite Sewage Consultants 9012 1 0th Ave. Sit % Valley, WI 54767 w a 7660Ea L � • U 2739P 060 7� KATHLEEN H. MALSH QUIT CLAIM DEED REGISTER OF DEEDS ST. CROIX CO.. WI Document Number RECEIVED FOR RECORD 01/28/2005 12:30PM QUIT CLAIM DEED a. ......K7.CA.ri d!. r...... .QxJ[I �. a. Y ......... ............................... EXEMPT # 8M, Jill E. Lobitz REC FEE: 11:00 ................................................................................................................................. ............................... TRANS FEE: COPY FEE: , ................................................................................................................................ ............................... _ CC FEE: quit cinims to .......... Pa. tr. i. c- k.... H._ ..... K. i. nne} r..... a. n, d .... J.i1.1....E._ ............... PAGES: 1 K i.n-neY.R.... husbAp..a.... J w i.f e. � .....................:.....:... ....... ............................... . ............................... .................. Recording Area ........ ................................................ .................. ....... ............... Name and Return Address the fofto mgslescriUed neat estate in............ St CL'OiX „County, .... ........................ / State of Wisconsin: �i 7 /3.�4L~J OeCWr D ulJJv /4r 030 - 1011 -90 -000 (Parcel Identification Number) Part of SW of SE V. of Section 3 -29 -19 described as follows: Commencing at the Southeast corner thereof and running thence West along the South line thereof 486.5 feet; thence Northwesterly by a deflection angle of 59 1 38" 633 feet to an iron pipe monument thence by a deflection angle of 90° to the left 33 Ices to an iron pipe monument, said monument being the point ofbeginning; thence Southeasterly by a deflection angle of 90° 177 feet to an iron pipe monument, thence Southwesterly by a dellection angle ')0° 164.3 feet to an iron pipe monument set on the flowage line of the Northern States Power ('onlpany: thcencc \ortliwesterly by a deflection angle of 87 °30' 18 feet: thence Northwesterly by it dellection angle c )I 41' to the left 92 feet; thence by a deflection angle of66 °to the right 54.5 feet; thence Northeasterly on a ;tmig ht line to the point of beginning. '[ tits . ............15.....C1/13�meaead property. Dated this........ ...... ........ ... day ot............. ..... .. ........ - (is) Or (i4 - ( .L / //y .. t ......... ..MIT)...........1w...R...,.r ......... . r ..... ................... .....,. .......•• . .. ......... r,......r......... .r .r...,rr....r...r.....,........ r.........r.................r.r • ................... Jill.... E _....Kinneyy................... ......................... • ............. ................. .... __ ....................................................... ............... ................. ............................................................................................ ............................... ...._..................................... ...................... ....................................................................... • N A .f AUTHENTICATION ACKNOWLEDGMENT Signalurc( s) .............................................. I......................... ............................... STA�.'�F ......................... ...............I............... ....... tv.. .............(.............. ............ ........................County. Personally came �[�// a0111 authenticated this .............day of...................... ... ............,19._............ before me thi�iyot. 14'. theabOvensmed ......... ...... ... ........ . ..... �. .................................................................... ............................... .......:.................. . .............. ..` f..................... ......................:........ sign: m c .................................................................... ............ _ .................................................................. ............................... _ ........................ ....................... ............................... -type or print name - .....» :... ..................................................... ......................................................................... 7T7L1L MGMI)PIi STAIII BAR OF WISCOWIIJ. I - (if not ................................. .............................................. ............................... ..................................................................... ..................................... ............................... . authorized t>y SS 706.06, Wis. Statutes) to me -known to be the person............ who executed the foregoing Roger D. Severs 10trum t and ledge the same. Notary Public --- .. ............................... . State of Wisconsin 1-f9ur Nantes of persons signing in any capacity should be typed print nabt .............................. or printed below litctr signatures. Notary Pub11e..... .......County, Wis. Jill E. Kinney My Commission is permanent. (if not, state expiration ---------- ------- :�1.7 --- Ba-d- lards ... Road-r----- -- --- --- ---- -- Ilik instrument was cirarted by (type or print name) - date:.. ..... .............. ................. ......yr�......)