HomeMy WebLinkAbout030-1030-60-000 r
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT '
' lllbricht & Associates
Owner 1 " GA eL. V Private sewage consultants
655 O'Neil Rd.
5 j re Address — 1/01 5 Hudson, Wis. 54018
City /State P S y..j w
Legal Description: -- 8d
Lot , B ,I, 1�ck Subdivision/CSM # �/�
'/ '/4 , Sec. �, T�N -RZ( _W, Town of 5T T 05 �=1g PIN # 03D • 2b1 . /4 • oy v
v 30.1 • o • MM
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION ,
Gvi e'S Cp • !10 50 �Q • > J�0 > 7,5
Tank manufacturer Size ST/WC / Setback from: House Well P/L
Pump manufacturer 4 1 Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: Width Length I � Number of Trenches Z
Setback from: House Well P/L Vent to fresh air intake -
ELEVATIONS /10 '
70 � aF � s T s %a �� 5 / / / AZ / � • Description of benchmark Elevation
Description of alternate benchmark 13 0 Elevatio
Building Sewer 0' g ST/W Inlet 1 6 " ST Outlet y� • PC Inlet
PC Bottom --� Header/Manifold —' Top of ST/PC Manhole Cover
Distribution Lines
E• Gd 1�.�}- �
Bottom of System
Final Grade O O ( )
P441,t 2,
P
Date of installation / / Permit num er State plan number
ZC�3"1 ? .x- � /
z
Plumber's signature 1� License number S Date /
Inspector �� M
D ��� Complete plot plan or
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e
ALL NON- CONFORMING
TREATMENT TANKS SHALL
BE ABANDONED PROPERLY
PER COMM. 83.33.
Uibriaht & Associates
Sewage Consultants
ry ; :;` Nail Rd.
Wis. 54016
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THIS powr
8 3 444 2 ORATE SYST R SHALL
FILLER MODEL # pRope R ZABEL
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 399652 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:
Guldan, Michael I St. Joseph Township 030 - 1030 -60 -000
CS BM Elev: r I . BM Elev: BM Description:
TA NK IN FORMA 11UN ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic r "t:,Z)
Dosing Alt. BM
Aeration Bldg. Sewer r
5.�b a6.8�
Holding St/Ht Inlet q&-00
•oe
TANK SETBACK INFORMATION St/Ht Outlet !Z q5- - fZ r
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic r 3S r / � Dt Bottom
Dosing
twy AtA 4r
Aeration Dist. Pi 43
9 . 12 93. }Z►
Holding Bot. System q q2•
Final Grade
PUMP/SIPHON INFORMATION
Manufa urer Demand St Cover „ [
PM CGS
Model Numb
T Lift Fn ' n Loss System Head TDH Ft
For main Length Dia. ist. to Well
SOIL ABSORPTION SYSTE 1$
RENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM S 3 r 1112- Z
SETBACK SYSTEM TO P/L - PLErG IWELL LAKE/STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR Rl
Type Of System: r UNIT Mod mb?F
l.al&v • S 10 5_' ► w I
DISTRIBUTION SYSTEM
lHead Id to Distribution x Hole Size x Hole Spacing Vent to Air Intake
t'_{
Pipe(s
7 b r
h Di a l t ength Dia Spacing
S ER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of eded /Sodded Mulched
r
Bed/Trench Center Bed/Trench Edges Topsoil I IN Yes [# No No ❑Yes
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 / &I / OZ — Inspection #2:
Lo ti n: 1101 Hi hway 5 dtWI 54016 (NW 1/4 NW 1/4 7 T29N R19W) NA Lot Parcel No: 07.29.19.110
1.) Alt BM Description =
2.) Bldg sewer length= tb 1 r n
3 /a t( o �t of � rrd l `
% \ \ ' (see
!� a
P 5evislo R quired [, 810 Yes No r
Use other side for additional information. 2- Z
Date
SBD -6710 (R.3/97) Insepctor's Signature Cert. No.
Safety and Buildings Division County S T
201 W. Washington Ave., P.O. Box 7162
i seonsin Madison, WI '53707 - 7162 Site Address
Department of Commerce C - -c. r r el �oZ S� ���� r /`"!' 3 S
Sanita Permit Number
Sanitary Peanut Application 3 M 92
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision
may be used for second ses Privacy Law, s15. 1 m
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name t Parcel Number
Al G �q �' / ��},v 7 a�� }/eko�tl 03D 103 aav
Property Owner's Mailing Address Property Location • t f - (/O
of i� "W 35 Nk tA 7 T r N.R /! q
t
City, State n < Zip Code Phone Number Lot NumberA// 'T A Block Number
• �U!// �� Subdivision Name CSM Number
a 70 4(At s
U. Type of Building (check all that apply) �� ❑City .
0 1 or 2 Family Dwelling - Number of Bedrooms ❑Village
❑ Public /Commercial - Describe Use g ip S �• T QS
El Owned ti t Nfg(it9�' oad C
III. Type of Permit: only one box on line A (numbering scheme for fnterhatuse). Cortt ete line B if applicable)
A ' 1 11 New 2 X Replacement Syste 3 ❑ Replacement of F2 istding Addition to F01 O�ty use
System Tank Only System
B. El Check if a rmtt Previously Issued
Permit Number Date Issued
IV. Type of Permit (Check all that apply)(numbering scheme is for internal use)
44, Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other
V. Dispersal/Treatment Area Information: 3 $
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed Rate( Gals. /Days /Sq.Ft.) (Min./Inch) ,/ 90 ,Y6 1 Elevation ✓
y o
75 �Z 5 637 ✓ .7�I.Z �r�d��� ��Q:0 � 5 �/
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing kt"j—
' Tanks Tanks /S
Septic or Holding Tank 15 1 54, S / e ,
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, asstmie responsibility for Installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Sig wre - f4P/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
69.5's 0 "tie 6 �Dv�so 4--)
VIII. Count /De artment Use Onl
Approved ❑Disapproved Surchar a F Pe rm it Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
8 )
❑ Owner Given Initial Adverse.
Determination Z Z<S ( ,,j
IX. Conditions of Approval/Reasons for Disapproval
1. Effluent filter to be installed and maintained per manufacturer's recommendations.
2. The septic system is sized for a 5 bdrm. residence. A violation of the state administrative codes would be created if any modifications are made
to the structure that. increase the # of bdrms /design wastewater flow.
3. The existing system shall be abandoned per code requirements (Comm 83.33).
Attach complete plans (to the County only) for the system on papa not less than SW x 11 hwhes In size
SBD -6398 (R. 05101)
Safety and Buildings Division County S T G /
201 W. Washington Ave., P.O. Box 7162
i seonsin Madison, WI '53707 - 7162 Site Address
Department of Commerce / /D/ �y 3 S
Sanitary Permit Number
Sanitary Permit Application 3 9 q
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision
rna be used for secondary purposes Privacy Law, s15.04(1) m
I. Application Information - Please Print All Information State Plan I.D. Number /ll�
Property Owner's Name i Parcel Numbe
/'11464,6 G /1- j D�a�A- 9'/ei�0� 03a 10,30 • aaa
Property Owner's Mailing Address Property Location - L . / Y . //O
Z9
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. 7 /9
Q� %SGL(J �/ R W Sf, S T N. R Lr
City, State n Zip Code Phone Number Lot Number / Block Number
• �U {���� �/ S G/ / ���, 3 Q /_ • ¢ u Subdivision Name N 4 CSM Number
r o 7O / s
H. Type of Building (check all that apply) L< T ❑City 01 or 2 Family Dwelling - Number of Bedrooms ❑Village •�-
❑ Public /Commercial - Describe Use �i'ownship �/ s ] S
�
❑ State Owned " Nearest Road 3 C
ma
III. Type of Permit: only one box on line A (numbering scheme for Internal use). Complete line B if applicable)
A. For use
i ❑New 2 Replacement Syste 3 ❑Replacement of 6 ❑Addition to
S stem Tank Only Existing Sy stem
B. ❑Check if a M t Previously Issued Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(nu rib ering scheme is for Internal use)
44,Q Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 11 Other
V. Dispersal/Treatment Area Information: 3 i3 , '
Design now (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) 90 � _ Ele vation
ys o ✓
750✓ 137 70 o• fsl So
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
N1 Existing A6.-
Tanks r
Septic or Holding Tank 156,5 j
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assaane responsibWtr for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Si Lure - W/MPRS Number Business Phone Number
'• �i�� I'c� T 1 I z z6? 3 r S 7/S. 3 J 116 •�lBs_
Plumber's Address (Street, City, State, Zip Code)
VIII. County /De arttnent Use Onl
Approved ❑Disapproved Surchar F re it Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
rg a )
❑ Owner Given Initial Adverse
Determination 2 ZS Z 3 0i
IR. Conditions of Approval/Reasons for Disapproval
1. Effluent filter to be installed and maintained per manufacturer's recommendations.
2. The septic system is sized for a 5 bdrm residence. A violation of the state administrative codes would be created if any modifications are made
to the structure that. increase the # of bdrms/design wastewater flow.
3. The existing system shall be abandoned per code requirements (Comm 83.33).
Attach complete plans (to the County a*) for the system on paper ad less than Mn s 11 Inches is also
S11D -6398 (R. 05101)
ULB1ilan & ASSOCIATES CO.
655 O'Neil Road • Hudson, WI 54016 Reg..Uesigners of Engineering Systems
715 -386 -8185 Privale Sewage Consultants
PROJECT INDEX
PLAN ID # N�/1� DATE � • �� � �� /
OWNER 1�jG #,¢ &_L . G'� /D PHONE M
S, ADDRESS / /p/ !� y 3S. �� • ����Io,� 4y/. Sr'o/
LEGAL DESCRIPTION ��1�7 Of 70 -t 4 4fes
Ivev, ,vW 54c • 7, / i 1-y /P� �GJ
TOWN OF _ D p 4v _ COUNTY
csni i E • Zl /6 / GL % 2 ZG 3 ?S
LOCAL AUTHORITY/ SUPERVISION ST
PROJECT DESCRIPTION:
pe
cos . �4�
4' ,•� S � s�� �c T.�ti K
1
Ulbrlcht & ASSOC" "" onsultants
THIS POWT SYSTEM SHALL Private
S0 ll Rd
655 O'Neil Rd.
INCORPORATE PER COMM. Hudson 54016�� � C
83.44(2)c A PROPER ZABEL
FILTER MODEL
��fiy 6 gFgTMF OAI C
pF ACO NEON TgNNO
9 M
Pg.l INFILTRATOR SIZING WORKSHEET .63 V,
�q ,
P9.2 SYSTEM PLOT PLAN 3 4
P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS.
Pg . 4 11 11 11 11 11
P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS
P9.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK.
PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS.
The attached plans and specifications are based on "In- Ground
Absorption Component Manudl For Private Onsite Wastewater
Treatment Systems." (Version 2.0) SBD- 1075- P(NO1 /01.
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OVER: See Reverse Side for Vent/ Observation Pipe.Details.
- 1
An observation pipe may serve as a combination observation/vent p p a p roviding it terminates in
the same manner as required for vent pipes. See Figure 6. p g
Venf cap Return bend, cap
12" mbr.
12 min. rbral grade
Aggregate istribution lateral
Vie 'rn• i
System elevation
Figure 6— Vent and combination observation/vent pipes
Leaching chamber tops are at or below the original grade. Leaching chambers are placed directly
on the bottom of the distribution cell. The locations of leaching chambers are in accordance with
Table 3 of this manual.
Observation pipes are installed in the distribution cells and are provided with a means of
; 1 anchoring to prevent them from being lifted up. Observation pipes extend from the infiltrative
surface for stone aggregate systems or from the inside of leaching chambers to a point at or above
finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate
systems is slotted while the portion above the distribution pipe is solid wall. Observation for
pipes I
leaching chamber systems are attached to the chambers in accordance with the chamber
manufacturer's printed instructions, extend from a distance ? 4inches above the infiltrative surface
through the top of the leaching chamber up to or above finish grade and terminate with a
removable watertight cap. All observation piping has a nominal pipe size of 4 inches. See Figure
5. ,
r Water tight cap
f .— 4" min. dia. ` Top of
leaching Repair couplings
I
Slot
6'* Mile. �- 6"
mill.
Infiltrative surface 4" retire.
water closet coil., Bar(3/8" min. dia.)
Figure 5 - Observation pipes
Vent pipes, if installed, connect to the upper half of the gravity flow distribution laterals and
extend up to at least 12 inches above finish grade. Vent pipes terminate with the vent opening
facing downward by the means of a vent cap or fittings. Vent caps must allow a free flow of air
between the distribution lateral and the atmosphere. All vent pipes has a nominal pipe size of 4
inches.
-Ale v 1-i17&D
4P, 1650 7
iff 1 till
K �� sue• Q° 9���� y SD
to
CRo SS Sic TIOA) o TI'E"ti�s
1
� r
i
i
I ! An observation pipe may serve as a combination observation/vent pipe providing it terminates in
the same manner as required for vent pipes. See Figure 6.
- Vent cape Return hand ; /Cap
`PI, 12" min.
12" title). Final grade`
Aggregate Distribution lateral
tip r. typ.
\System elevation
Figure 6— Vent and combination observation/vent pipes
Leaching chamber tops are at or below the original grade. Leaching chambers are placed directly
on the bottom of the distribution cell. The locations of leaching chambers are in accordance with
Table 3 of this manual.
r .
Observation pipes are installed in the distribution cells and are provided with a means of
A anchoring to prevent them from being lifted up. Observation pipes extend from the infiltrative
surface for stone aggregate systems or from the inside of leaching chambers to a point at or above
finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate
systems is slotted while the portion above the distribution pipe is solid wall. Observation pipes for
leaching chamber systems are attached to the chambers in accordance with the chamber
manufacturer's printed instructions, extend from a distance ? 4inches above the infiltrative surface
through the top of the leaching chamber up to or above finish grade and terminate with a
removable watertight cap. All observation piping has a nominal pipe size of 4 inches. See Figure
5.
�• Water tight cap
4" min. dia. 7h)
Repair couplings
r
Slot
6" min.
4" min.
Infiltrative surface
Water Closet Collar Bar (3/8" min. dia.)
Figure 5 - Observation pipes
Vent pipes, if installed, connect to the upper half of the gravity flow distribution laterals and
extend up to at least 12 inches above finish grade. Vent pipes terminate with the vent opening
facing downward by the means of a vent cap or fittings. Vent caps must allow a free flow of air
between the distribution lateral and the atmosphere. All vent pipes has a nominal pipe size of 4
inches.
PAGE 6 REVERSE SIDE
OWNER's MAINTAINCE OF SEPTIC SYSTEM
POWTS (landowner) is reponsible for proper operation and
maintenance of this system. Regular periodic inspections and
servicing is necessary for the safe healthy operation of this
system. The owner is required by code to submit all necessary
maintenance /inspection reports to the controlling authorities.
SPECIFIC CONTACT AGENTS C L
S 7` . Zflv,
,t1 G---
* Governmental authority/ inspectors: 3Y6 7V6
*.Licensed installer, responsible for providing an operation/
maintenance "Users" manual:
R•
�Sr� /vim, .o�/?s z26-1 3 3�� • �'l�
• Licensed service / inspection agent other than installer:
' �rP� � c r�! 5�.�; Tit -rio•� 3�� • -2'� 3 0
• Electrician, for pump, electric controls, wiring units:
IMPORTANT OWNER MAINTENANCE REQUIREMENTS
1. Winter traffic (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 (a vacaction trip, resulting in no water use) can also
lead to freeze ups.
2. Water conservation needs to be exercised! Or system can be
hydrolically overloaded and destroyed. This system was
designed for a maximum wastewater flow of 7 5 D 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.
i 4. If a power outage occurs, or a pump fails, it may result
in a temporary overload of effluent being pumped into the J
'i cell, which may adversely impact the cell (leakhge). 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 &
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 SYST'EM!! Effluent in
the system beneath IS NOT sufficient alone tO maintain a
grass cover.
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 (effluent level
inspection pipes), cleanout terminals on the pressurized
laterals, at each tip - for flushing and cleaning the laterals
out. The filter system in the tanks (via a locked above
ground cover /manhole). Only a licensed properly quali6ied
person should be performing this work which involves health
& severe safety risks. Evidence of effluent ponding in the
system's treatment cell shall also be regularly inspected.
O � i 1-7~ Y
r
'Msconsin Department of Commerce SOIL EVALUATION REPORT 3
livision of Safety and Buildings Page of
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County 5 / • l//�d��
Include, but not limited lo: vertical and horizontal reference point (BM), direction and 030 • 2.01 • 16 .
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
030 - i02 - 6 a • c"
Please print all Information Reviewed.by Date
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (mp. IZ 7- 6 /
Property Owner Property Location I q - I I: C, 64X:� ,
/G`l>QFL 1 (• (T(�L �f}/V f D� Govt. Lot /V&/ 114 i(f&A14 S 7 T 2 -f N R 9 IF (or) W
Property Owner's Mailing Address �. Lot # Bck # ubd. Na me or CSM#
. 3 S I2 of 7 �4
City State Zip Code Phone Number City Village own Nearest Road
/fvf�So,� ltiy. Sya /G (7!S )3 4 - �fY� ❑ ❑ 6r. 7os_ 11tol . 3 S
❑ New Construction Use: K Residential ! Number of bedrooms �_ Code derived design flow rate 7-
GPD
Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable /f/
General comments ,/ n•
and recommendations: l
7�"S �?' � sv�•T - mod /� ftJ� �i'o�: �t1' C S RE gO
5 .a
� s IR 2001
a Boring # ❑ Boring 9 ` Q COX
pth
Pit Ground surface elev. ft, Depth to limiting factor / �a In S�S�(
1 cation
Horizon De Dominant Color Redox Description Texture Structure Consistence Boundary t G
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
/
0- 12- /0 R � — 2 2
L s! v�/P Sri zc • S , 0
2 42 7 /D 1 //P3 L /ASS I- 7W CS at c ,
3 7 •LZ /o y
22 /o S /�- ��,Sh – 2
3
• soy ter/
,S' 4 1441
El Boring # Boring c ,� El Pit Ground surface elev. fo 7 J ft. Depth to limits >/
p limiti (actor _ in,
Horizon Depth DominantColor Redox Description Texture Structure Consistence Boundary Roots Soil Ap Rate
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. :
YR 2 ,6
'Eff#1 'Eff#2
// • i o 3 7 Cs z f- .
•38
. 5 /R G
S
C-5
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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
CST Name (Please Print) Signature 7
R0 3 E/? T Zl/�R/C1 2243 ?r5
Address
Date Evaluation Co ducted Telephone Number
Associates Zb0 WS' •c3d6" I
Private Sewage Consultants
655 O'Neil Rd.
Hudson, Wis. 54019
tN'I - A. , 14 , ova r�s N
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1 4-13,1N PO A..) All
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( 3 ) T� V&,5
� ys V orF
C 9F ALL NON - CONFORMING
ro f4 1(t o r- 'jam -gyp av s '� TREATMENT TANKS SHALL o
1�
V �i�, 9�1�'(� BE ABANDONED PROPERLY
-FT mil" PER COMM. 83.33.
030 - zo y. io o�
Property Owner 1q' A v " L P4 ' ( ' 1 03o - �o�Q ' &p � 2- ✓
C Parcel ID # Page of
&
a Boring # ❑ Boring / 5
Pit Ground surface elev. �`r' fl. 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
M �9Y �3 4 z, s IN L / s c 7` fit S ,3 /� ` .S /� i fs �,� S . Z-,
.3
2 /o GS 1 4M
S '� • S
❑ 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
A
❑ 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 Dots GPD /ft'
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 • Eif#2
i
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.
SDD -8770 (R.6/00)
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►- ST CROIX COUNTY
SEPTIC 'TANK MAINTENANCE AGREEMENT ..�.
AND
OWNERSHIP CERTIFICATION FORM
Owner uyer fo ; c:"a6t fyY au,
Mailing Address _i r n 1�. a1,u.+ j 3
Property Address SAyli6
(Verification required from Planning Department for new construction)
030 zoa- • /O
City /State 14 j Ds"i v Parcel Identification Number 03 0 • 10,3 - 60 ' &r V : `
LEGAL DESCRIPTION a
Property Location Nt ) 114, Nid y, Sec. T ( N -R
, W, Town of
Subdivision _ PIV T 74' /IQ; Lot #
,
Certified Survey Map # r3 0 0")
olutne
Warranty Deed # 7 (o 0 Volume `mod Page # d
s
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no
SYS'T'EM MAINTENANCE
Improper use and maintenanceof 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 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.
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 of
1
f � th A y e three year exp date.
�
d11LLYYlI ? / of -
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) Am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
m Yom, ,
y 1�
SIGNATURE OF APPLICANT /! / t / aj
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
R copy of the certified survey map if reference is made in the warranty deed
.I
?AGE
STATE BAR OF WISCONSN FORM 1 - 1999 651 760
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROIX CO.. WI
This Deed, made between Michael M Guldan a single person RECEIVED FOR RECORD
[Wisconsin antor, and Debora F Barron and Michael A Guldan bo th single
rsons, as ioint tenants. Grantee.
Oi-23 -001 8:30 AM
Grantor, for a va!uable consideration, conveys and warrants to WARRANTY DEED
antee the following described real estate in St. Croix County, State of REMP7 M
(the "Property ") (if more space is needed, please attach RI COPY FEE:
COPY EE-.
addendum): TRANSFER FEE- 186.00
RECORDING FEE: 10.00
A one -half interest in: PAGES: 1
All that part of NE 114 of NE 114 of Section 12 -29 -20 except that lying
Westerly of the centerline of State Trunk Highway "35 ".
Northwest Quarter of Northwest Quarter (NW 114 of NW 114) of Section Recording Area
Seven (7), Township Twenty -nine (29) North of Range Nineteen (19) Name and Return Address
West; except easements and right of ways of record. Kristina Ogland
Attorney at Law
304 Locust Street
Hudson, WI 54016
Together with all appurtenant rights, title and interests. 030 2024'10-M. .030- 1030 -60 -000
Parcel Identification Number (PIN)
This is homestead property
(is)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions and reservations, if any, of record.
Dated this _, d e_p day of '11 r —, 2001
* Michael M. Guldan _ --
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Mich M. Gu ldan, a single person STATE OF .,. _. -_ —___ _.— ___
ss.
County
authenticated this ZS day of TLL.V, _ 2001
Personally came before me this _ _ 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. W is. tats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
K ristin O gland, Esilten and O land '
- -- -- __ - Notary Public, State of I!
304 Locust Street, Hudson, WI 54016 _ _ Y — - -- - - - -- — - --
— - -- - -` "- -' - My Commission is permanent. (if not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) _ I __ -- _ .. •)
Information Professionals Co_ Fad du Lac. W1
" Names of persons signing in any capacity must be typed or printed TATE BAR signature
na SCONSIN 804655 2021
WARRANTY DEED rORh1 No. l • 1999
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