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HomeMy WebLinkAbout030-2108-70-000 (2) � /�)��� J r Ln ) % / 0 ƒ(( E 0 ° m» :® 8 S { § c _ § c § \ / ( o o \ / \ / \ k / ° @ E , a ° 9 f % , : © w § ) 8ƒ Q c r m ;§& e e co 7 § § S E E o � to 2 @ v y CL § { \ \ 7 $ B \ \ am, } \ \ o k \ n r CD ■ o c ) o o r \ ■ § k o o o ; E. 0 0 0 g 2 ¥ \ m \ \ j_ 7 I f m ° \ CL I 2 7 / z \ z \ a =;, n S C. g [ g ; $ �. / \� G & \ CD } \ t m 3 o f \ CD \ k / / Co 0 § \ ƒ { \ » � � > \ § z / \ ( 0 \ � ƒ . � � � � w � \ 9 . 0 « A § \ \ } \ :� 4 852P 4 64 6-7332 KATHLEEN H. VALSH REGISTER OF DEEDS ST. CROIX CO., VI Document Number Document Title RECEIVED FOR RECORD 03 - 12 -2002 9:00 AM St. Croix County ZONINS AFFIDAVIT EXEMPT # Occupancy Affidavit REC FEE: 11.00 TRANS FEE: ( �1 COPY FEE .J A Son J a '\S � CERT COPY FEE: Name — (Owner) Typed or printed PAGES 1 being duly sworn, states, under oath, that: 1. He /she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume /`E99 Page _(, Document Ntunberb2o 6 St. Croix County Register of Deeds Office: Recording Area Name and Return Address A parcel of land located in the Mc- '/, of the NN %4 of Section _ , -� S T )MS 0� T N - R j! W, Town of S4. - T, c � !` , St. Croix ` ` °� 30 County, Wisconsin, being duly described as follows (includ a lot no. and I ( (ey N bA subdivision/CSM or detailed legal description): 63 — — 1 7O - Parcel Identification Number (PIN) As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a 3 bedroom home, or a design flow of 5 gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently occupants living in this residence; - (2 - occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and /or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this properly. Dated this �-� day of J AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. authenttcated this day of St. Croix County. ) /� Personally came before me this a day of the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledge the same. THIS , II ST UMENT WAS DRAFTED BY Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. If not, state a ration date: necessary.) Date: //- 5-0 5 REND M. CAL "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" Pustle STATE OF WkW NdS:K This information must be completed by submitter: document title. name & return address. and PIN (if required). Other information such as the granting clauses, leagal description, etc. may be placed on this first page of the document or maybe placed on additional pages of the document. Note: Use of this cover page adds one page to your document and $2.00 to the recording fee. Wisconsin Statutes, 59.517. Wis sin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division Coun�� Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar 5trit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1, b41 Permit Holder's Name: ❑ City ❑ Villa e ❑ n of: State Plan ID No -: ohnson, Jason St. �osephownship CST BM Elev - - - Insp. BM Elev -: BM Description: Parce�T r�Jq 95 -000 U 1'Wit TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r' Benchmark (o. Z' 06 .0 6L�. r Dosing Lsj Alt. BM (o .hod q (Z- Aeration - -- Bldg. Sewer l( 3 .5 6� Holding / Ht Inlet IZ I 43. $fir TANK SETBACK INFORMATION St/ Ht Outlet r--- -- TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet ir Septic ) /� 0 r NA Dt Bottom Dosing c 'yo NA Header/ Man. ----" Aeration NA Dist. Pipe Holding Bot. System . s 3 76 • y ' PUMP/ SIPHON INFORMATION Final Grade �, o o ( 2' Manufacturer Demand St cover (off q$ •q2 r �b Model Number 1 GPM � TDH Lift Friction ( Syetem TDH �,Sy Ft oss Fi Forcemain Length, Dia. z Dist. To Well SOIL ABSORPTION SYSTEM BED / ENC Width Length No Of renches PIT No. Of Pits Inside Dia. Liquid Depth IM 3 S6 Z� L DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM ELECHING Man id tur r: INFORMATION Type O g� r IT R Mo el u er: System: C DISTRIBUTION SYSTEM Header/ ifolcl }, Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length y Dia. Length — Dia. _ Spacing ,� /U� 0:M 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 E] Yes El No COMMENTS: (Include code discrepancies, persons resent, etc.) Inspection #1: oss /IS/ eo Inspection : Location: 119064th Street Hudsor� WI 540 6 (NE 1/4 NW 1/4 3 T29 R 9W) 03.29.19.901 Buck Hill -Lot II 1.) Alt BM Description = If. o ' I1.q(n L'1� "'�L'"' ( °`�''� r T Y I -�,, 2.) Bldg sewer length= 3 ' 3 s L y - amount of cover = 24 - �`� 7 Plan revision required? []Yes ® No Use other side for additional information. D S '� ` 1 1: 4 4 t q1 SBD -6710 (R.3/97) Date Inspector's Signature Cert No. Safety and Buildings Division Vi sconsin SANITARY PERMIT APPLICATION 201 W Washington Avenue P O Box 7162 Department of Commerce In accord with Comm 83.05, Wi o ` s � " \ I I Madison, WI 53707 -7162 • Attach complete plans (to the county copy only) for the Sys �grrpaper4Ot less unty • than 8 vi x 11 inches in size. � T (�,,� -�•.G • See reverse side for instructions for completing this appli att¢n r `FCE1Vf Stat Sanitary Permit Number Personal information you provide may be used for secondary purposes __ f pCh@ckitrevision to previous application (Privacy aw, s. 15.04 (1) (m)]. c- , y � T Clgpf State ,Plan Review Transaction Number I. APPLICATION INFORMATISN - ( PLEASE PRINT AL ' Prope Owner Name `. Prop ato q 1 T OZ L ,N,R or Property Owner's Mailing Address T w ' b r Block Number 4/ • 'v Cit , St at Zip C Phonelmber Subdivi 'on Name o CSM Nu ber «d S O�G 13) Q • IL TYPE OF I DING: (check one) ❑ State Owned Itr Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 6 III. BUILDING E: (If building type is public, check all that apply) Parcel Tax Numbers) 2 /9.901 d ;o- 1 ❑ Apartment/ Condo 0 /dam .9 2 ❑ Assembly Hall 6 [],Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 VNew 2 Q Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ____System ________System __ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 []Seepage Bed ��, �� 21 [] Mound 30 Q Specify Type 41 E] Holding Tank 12 RSeepage Trench 22 F1 In- Ground Pressure 42 Q Pit Privy 13 ❑Seepage Pit c5 .�c�►•••�� 43 ❑Vault Pfivy [] 14 System -In -Fill 01-19 C-X� VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate I S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) als/da /sq. ft.) Min. /inch) levation �7 D .S�,Z • 7JFeet Feet Ca ctt VII. TANK in g allons Total # Of Prefab. xper. Site Fiber- E INFORMATION g allons Tanks Manufacturers Name concrete Con- steel glass Plastic App New Existin structed Tanks Tanks eptic ank ZO QP I • ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins llation of the onsite sewage system shown on the attached plans. PI � nt) Plum 's Sig ure: wo & mps) V7MPRSW No.: Business Phone Number: 0 3 Plumber's Address (Street, t , S t Ip Code V. IX. COUNTY/ DEPARTMENT USE ONLY Q Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issuin gent Signature (No Stamps) Approved ❑ Owner Given Initial . Surcharge Fee) P Adverse Determination 2 O Ov X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: es Sk �� o O J C C - 4 6QC oLff b(ff bite f pere .SBD -6398 (8.12/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit mlay be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBb -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. i 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151; To be complete and - accurate this sanitary permit application must include: P y p pp I. Property owner's narr,.e and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. i IV. Type of permit- Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. V11. Tank information- Fil! in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material- Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from D1LHR. VIII. Responsibility statem(,nt. Installing plumber is to fill in name, license number with appropriate (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use-,Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches mustbe submitted to the county. The plans must include the followi4g A) plot plan, drawn to scAle er with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks, distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction less; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system iflrequired by the Bounty; E) soil testdata'bri a 115 form; an'd �)- all sizing information. -- - - -- - - -- -- - - --- - - -- - - - -- - - - - ---- - --- - - - -- -- - ---- - --- - - -- - - - - - -- - - - - - ------- - --- -- ----- ----- - ----- --- GROUNDWATER SUR4HARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Im f f 1 )3 t)k -:- -rcf l -`o i% h 1 qg` -,2, s q0 1° yb ' 10 0 3v 1 31 All ), Y J -sue X 9G• �s AND SPECIFICATIONS 4 " CI VENT PIPE 22" MIN. ABOVE GRADE S !2S' FROM DOOR, WINDOW OR WEATHER PROOF FRESH AIR INTAKE JUNC'l70N BOX WITH CONDUIT APPROVED FINISHED GRADE 4" CI RISER MANHOLE t 6" MIN. W/ PADLOC ABOVE G ADE WARNING 1 28" IN. 6" MAX. � -y" MI? INLET 0 0 , I; WATER TIGHT SEALS GAS_ 4" TIGHT] Cr PIP BAFFLE ---_/ A SEAL E � 3' ONTO J.... I f APPROVED B ' LM JOINTS W/ SOLID SOIL -T-- ON PIPE 3' 0 � PUMP OFF ELLV . FT. C C SOLID SOI ' D OFF ** RISER PERMITTED IF TANX 3" APPROVED BEDDING UNDER TANK HAS S APPRPPRA AU? HO'. SPECIFICATIONS CONCRETE PAD ;EPTIC ! DOSE TANK MANUFACTURER NUMBER DOSES PER DAY: TANK SI2CS: SEPTIC GAL. DOSE VOLUME DOSE -c7) GAL. INCLUDING 7 D ALARM MANUFACTURER: FLOWBACK: 71. �pGAL, MODEL NUMBER: CAPACITIES: A = (INCHES SWITCH TYPE: B = 2 INCHES =� PUMP MANUFACTURER: MODEL NUMBER: C = 0 ��INCHES = 73.��r_ SWITCH TYPE: _ D f INCHES L, ?_5F KEOUIRED DISCHARGE RATE GPt'I PUMP F. ALARM WIRING AS PER I LHR 16 , 23 VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE + MINIMUM NETWORK SUPPLY PRESSURE , + - .,� -�, FEET FORCEMAIN X �FT/ I00 FT. FRICTION � � � - FEET FACTOR . - FEET TOTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGT ____; WIDTH FEET DIAMETER LIQUID DEPTH rGNED: . ilg�� LICENSE NUMBER: M/9, 0?R0� r�•w.._ Goulds Submersible Effluent Pump 3 871 EPO4 EP05 APPLICATIONS • Faste ally submerged in high 11 Motor Housing: Cast iron Specifically designed for the stain:. rade turbine oil for for efficient heat transfer, following uses: • Capa' , brication and efficient strength, and durability. • Effluent systems dr y w' cat transfer. • Homes comp ■Motor Cover: Thermoplas- • Farms Motor: ilable for automatic and tic cover with integral handle • Heavy duty sump • EPO4 ' nual operation. Automatic and float switch attachment • Water transfer 115(_ als include Mechanical points. • Dewatering RPM, t Switch assembled and r Power Cable: Severe duty auton, A at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 ` ■ Bearings: Upper and lower 115 V, 'ORES heavy duty ball bearing Pump: EPO4 construction. • Solids handling capability: autor, r g4 Impeller: Thermo - 3 /4" maximum. . Pow. Semi -open design AGENCY LISTING • Capacities: up to 55 GPM. stand )ump out vanes for • Total heads: up to 24 feet. with ti ..apical seal protection. Canadian standanlsAssociation • Discharge size: 1 "NPT. plug. r 05 Impeller: Thermo- • Mechanical seal: carbon- length, i enclosed design for (CSA listed model numbers rotary/ceramic - stationary, three ved performance, end in "I'" or "AC ".) BUNA•N elastomers. (slam ing and Base: Rugged • Temperature: oplastic design provides 104 °F (40 °C) continuous or strength and 140 °F (60 °C) intermittent. „ion resistance. • Fasteners: 300 series METER: stainless steel. • Capable of running dry without damage to + components. CIPM Pump: EP05 • Solids handling capability: c 3 /a" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1!6" NPT. z • Mechanical seal: carbon- > rotary/ceramic- stationary, BUNA -N elastomers. I EPOS • Temperature: 104 °F (40 continuous 140 °F (60 °C) intermittent. rv ., EPO4 c 2 30 40 50 GPM 6 a 10 12 math CAPACITY 1995 Gouids Pumps �i J % Effective May, 1995 B3 A Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Fluman Relations Division of, $afety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 030- 1008 -95 -000 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION nED BY DATE PROPERTY OWNER: PROPERTY LOCATION Steve Henning GOVT. LOT NE 1/4 NW 1/4,S 3 T 29 ,N,R 19 kor) W PROPERTY OWNER'-S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1182 61st. St. 11 na Buck Hill CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE KFOWN NEAREST ROAD Hudson, WI. 54016 (715)549 -6094 St. Joseph C.T.H. " E " Ic ] New Construction Use [x] Residential / Number of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 857 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 96.45 ft (as referred to site plan benchmark) Additional design / site considerations na-_ Parent material outwash Flood plain elevation, if applicablr3 na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRE SSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U ®S ❑U ®S ❑U 11 ERU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -11 10yr3 /3 none 1 2csbk mfr gw 2f .5 .6 2 11 -30 10yr4 /4 none sil lcsbk mfr gW if .2 .3 Ground 3 30 -84 7.5yr4/4 none co s Osg muff na na .7 .8 elev. 9 9.9 ft. Depth to " To o limiting factor Remarks: Boring # 1 0 -11 10yr3 /3 none 1 lcsbk mfi gw 2f .2 .3 2 11 -29 10yr5 /4 none sil lcsbk mfi gw if .2 .3 3 29 -84 7.5yr4/4 none co s sOg mvfr,,. na: na` .7 .8 Ground r elev. Ili P miting factor ; r~ , +8411 Remarks: >' N, CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6200 Address: 1554 200th ,,Ave., New Ricjimond, WI 54017 Signature: Date: 7 -10 -98 CST Number: m02298 PROPERTY OWNER Steve Henni -6j3 SOIL DESCRIPTION REPORT Page 2 A of 3 PARCEL I.D.#M non- In()R_AS ^ ( nn Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounck3y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 -11 10yr3 /2 none 1 2msbk mfr gw 2f .5 .6 2 11 -25 10yr4/4 none scil lcsbk mfr gw if .2 .3 Ground 3 5 -84 7.5yr4/4 none co s Osg mvfr na na .7 .8 elev. 10 ft. Depth to N3. limiting factor +84" Remarks: Boring # 1 -12 10yr3 /3 none 1 lcsbk mfi gw 2f .2 .3 4 2 2 -28 10yr5 /4 none sil lcsbk mfi gw if .2 .3 3 8 -82 7.5yr4/4 none ms Osg mvfr na na .7 .8 Ground elev. 9 9.7 ft. Depth to limiting factor + Remarks: Boring # 1 -8 10yr3 /3 none 1 lcsbk mfi gw 2f .2 .3 5 2 -22 10yr4 /4 none sit lcsbk mfi gw 1f .2 .3 3 2 -80 7.5yr4/4 none co s Osg mvfr na na .7 .8 Ground elev. 99 ft. Depth to limiting factor + 80 1, Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Steve Henning New Richmond, WI 54017 MPRSW -3254 NE4NW4 S3- T29N -R19W (715) 246 -6200 town of St. Joseph lot #11 -Buck Hill N 1 =40' BM.= top of 1 pvc pipe C el. 100 Alt. BM.= top of 1" pvc pipe @ el. 100.90' This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines had not been established at the time of this test. '` me 2p f6 1g . Gary L. Steel 7- 10 - vC ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Addres Property Address S (Verification required from Planning Department for new construction) City/State .�BAf timi Parcel Identification Number LEGAL DESCRIPTION Properly Location ^ ' /,, A(� Sec. , T y N -R_Z!I_W, Town of Subdivision Lot # Certified Survey Map # , Volume . Page # Warranty Deed # Volume , Page # Spec house ❑ yes I* no Lot lines identifiable VL yes ❑ no SYSTEM MAINTENANCE Improper use a 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. 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 wastewaterdisposal 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. I/we, 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 Zoning Office within 30 days ofiffie three xp' lion date. y SIG TURF OF APPLICANT DATE OWNER CERTIFICATION I (we) certify tha all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the t desc ' ove, by virtue of a warranty deed recorded in Register of Deeds Office. ��rFlw STOATUROF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I � WIL 1499PRGE 96 6.20406 STATE BAR OF WISCONSIN FORM 2 • 1998 KATHLEEN H. WALSH REGISTER OF DEEDS D urn entNumber W ARRANTY DEED ST. CROIX CO., WI This Deed, made between LaG se Custom Homes Inc„ a RECEIVED FOR RECORD Wisconsin Coruoration 03-31 -2000 4:00 An Grantor, and Jason R. Johnson and Daum Wells M. WARRANTY DEED Grantee. EXEMPT M CERT COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE- the following described real estate in St. Croix County, State of Wisconsin TRANSFER FEE- 134.70 RECORDING FEE: 10.00 (The "Property"): PAGES: I Record' Area Name and Return Address i 030.210&70 Parcel Identification Number (PIN) This is not homestead property. Lot 11, Plat of Buck HUI in the Town of St. Joseph, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any Dated this o?7 day of March, 2000. LaCasse Custom Homes, Inc. �t1 * '" Richard W. LaCasse, PresidenT s AUTHENTICATION ACKNOWLEDGMENT Signatwe(s) STATE OF WISCONSIN ) ss. authenticated this _ day of Cot County ) pNMaM9N S• NE&v Personally came before me this � day of * ,• .� i �It'- Larch, 2000, the above named I aCasse Custom Ho nres ` �Y c. Richa W. LaC 1 A TITLE: MEMBER STATE BAR OF WISCON f [N t�0� = to me known to be the person(s) (If not, T C o executed the foregoing instrument and acknowledge the authorized by § 706.06, Wis. Stats-) `�, y °' THIS INSTRUMENT WAS DRAFTED BY� at q Attorney Krishna Oglartd p "trM" 1� Hudson, WI 54016 No tic, ate of Wisconsin My C ion is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not ) necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 -19" INFORMATION PROFESSIONALS COMPANY FOND DU LAC. VII BOO-655 -2021 r 3.021 ACRES S ° '� �,c�U ~• . 131 , SQ. 'FT. i 8 S - 26 . ' ,� E 498.51' it Q R- 80 . 1 ' . � _ kl , , _- ;;�1�' / � ' � _` .,fit � � �• 10 ., s p s 3.200 S89 '43 212.42' 139 M 30454 ACRES to a� 150 SQ. FT. •. 4;200 .-ACRES -'= g 1$2 ` FT. 447:1 346:05 2 SQUTH LINE - 'OF' THE All l4 OF THE NW1/4 ATTED . LANDS, c^r% n i r M r r f - r* r n