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Home My WebLink About030-2087-30-000 I* rWisconsion Department of Commerce PRIVATE SEWAGE SYSTEM Y' Count Safety and Buildings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary�P� Tejlo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. 3 //1111Lb644 Permit Holder's Name: ❑ City ❑ Villag ❑ Town of: State Plan ID No.: Erlitz, Kevin St. e Joseph Township CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel T1 C� •a l dD, ►" S = CSJ $w I 2087 -30 -000 TANK INFORMATION ELEVATION DATA ,- TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic w e.2, L s 1Z*0 .r -�' I Zip Benchmark �('�Z Iogf.5 m i Dosing Alt. BM Za' u I03 (. Y t Aeration Bldg. Sewer 3.1 0 3R 11• Holding St/ Ht Inlet TANK SETBACK INFORMATION St /Ht Outlet q1 �j.S 9.58 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet ------- Air Intake Septic > 19 ' 1 4 0 ` NA Dt Bottom ^ Dosing NA Header /Man. Aeration NA Dist. Pipe Z* Holdi Bot. System .Eo `� 5 POMP / SIPHON INFORMATION Final Grade Manufac r mand St cover �oZ . 5 Model Number GPM = TDH Lift L oss ction em TDH Ft For main Length Dia. Dist. To well SOIL SORPTION SY STEM s� ENCH ) Width { Length No f T nches PIT No. Of Pits Inside Dia. Liquid Dep D IMENSIONS 3 1 EN I N SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufa t rer SETBACK CHAMBER INFORMATION Type of r V> { r Moe Number: C System: , (o — 1 0 b ^' ► Di0 —` OR UNIT DISTRIBUTION SYSTEM -I-• Header/Manifold ,� (( u Distribution Pipe(s) Hole Size I x Hole Spacing Vent To Air Intake Length-vo Dia. T Le t 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 ❑ Yes , [] No CO MENTS' ( I lu� dis ancies p o e pt ns ec ion : nspec ton 7�12: =1=j Location: 68S North ay P Roa�, r %orners& % ?V8 T ( 019 NE 1J4 22 T30N R19W) - 22.30.19.737 North Bass Lake Estates -Lot 3 l.) Alt BM Description 2.) Bldg sewer length= 2-o.0 - amount of cover = 18 " + $,i tAr 3� A- - to-o ke,r w-1 Imo: t� �,�,,�Jtr�he•v. /,,+ c,�.�, o,,,Q.�th (►F6� '�►�~' �-� Plan revision required? �] Yes N No Use other side for additional information. D1 1 7 - 1 - 1 0 0 ] SBD -6710 (R.3197) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: s f 3 's i C N ; 1 i i }j /vorzTI+ "_� Cc- Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Vsconsin P O Box 7302 Department of Commerce In accord with Comm 83.05, Wi n T10Nk ' *r. " Ad Cd Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system than 8 vi x 11 inches in size. r; � See reverse side for instructions for completing this application Stnita Permit Number 3 T O Personal information you provide may be used for secondary purposes heck it tavi `on to previous application [Privacy Law, s. 15.04 (1) (m)]. Pla N: :Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF Property Owner Name p op -- L ! 74 — 1/4 30 , N, R f E (o W Property Owner's Mailing Address Lot be ' + Block Number S Cit Sate Zip Code Phone Number Subdivision Name or CSM Number 44 WY 59 lix-:!r 9 5455 ZAICL—: A16,? r� 0 L7 11. T P OF BUILDING: (check one) ❑ State Owned Itia Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms j Town OF -57, 7654P W 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) A,a. 30, /Q. �37 1 ❑ Apartment/ Condo d 3 — ,Z097 - 30 - 0 , 00 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. Eg New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ System Sntem_____________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 0 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit �� X �� I(h� 43 ❑ Va t Privy 14 ❑ System -in -Fill 315 L 2 ro VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. S stem Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch)(,, Elevation 4, 60 1160 111-3 6 , VL6 -_ Feet 00. ` Feet VII TANK Capaclt in gallo Total # Of r Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existing structed Tanks Tank Septic Tank or Holding Tank Z2 60 H4- 5 a El E] 1:1 11 1:1 Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans. Plumber's Name: (Print) PI ber's Signature: (No StampA Business Phone Number: G /Y t - - S Q Plumber's Address (Street, City, State, Zip Code): ' Z_Z IX. COUNTY / DEPARTMEN USE O NLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps) C Approved ❑ surcharge Fee) Owner Given Initial la:)-5, t / Adverse Determination M �-tZ 2 0 t�� X. CONDITIOONS�OF PROVAL / REASO S FOq DISAPPR VAL: _ - - A Cv a as C50U,5 , SBD -6398 (R. 4/99) 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 may 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 (SBD -6399) to be submitted to the county prior to installation ' 5. Onsi"te sewage systems must be properly maintained" •The septic tank(s) must be pumped by a licensed pLidiphrWhOinever necessary, usually every 2 to 3 years. 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 1hissanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system into 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. 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. VII. Tank information. Fill 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 DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (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 must be submitted to the county. The plans must include the foTlo "wing:` A) plot plan, drawn to scale or with complete dimensions, locatidn'of holding tankls); 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 loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system ii required by the counTy; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation c f 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. Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue Visconsin P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. S C flfl y i. • ; See reverse side for instructionsfor completing this application State Sanitary Permit Number -' Personal information you provide may be used for secondary purposes ❑ check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RM TION Property Owner Name Property Location -1 /a . 1/4, S T , N, R E (or Property Owner's Willing Address Lot Number Block'Number City, S ate zipE6de Phone Number Subdivision Name or CSM Number A ll. T YPE OF tL0 : (check one) ❑ State Owned It� Nearest Road Vil Public 1 or 2 Family Dwelling - No. of bedrooms c3 Town OF ` III BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) 1 ❑ Apartment/ Condo -- — 042a 2, 0 AV. embly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational FacArty 3 ❑ Campgrounds 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 Hotel / MoteL- 9 r ❑ Office /Factory Facto,ry 13 ❑Other. speAify IV. TYPE OF (Check only one box on Kne A. Check box on line B, if applicable) ` A) 1 ( New 2. ❑ Replacement 3, ❑ Replacement of 4, ❑ Reconnection of _❑ Repair bi an ........ ------- - - - - -- Tank Only -------- - Existing St S tem ---- - ------- - xisng ysem - _ -_ -_- Exlstln� - - - -- B) ❑,A Sanitary Permit was previously issued. Per_ i"umber Date Issued V. TYPE OF SYSTEIII+I: (Check only oney - Non- Pressurized Distribute Pressurized Distribution Experimental Other 11 ❑ Seepage Bed . `_ ❑Mound 30 E] Specify Type 41 ❑.Holding Tank 12 [5 C] Seepage Trench 22 In =Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit {} y (Y le ) = 1 43 ❑ Va t Privy . 14 ❑ System-In-Fill 35 ' 7- ,,)4 VI. ABSOIUION SYSTEM INFORMATION: 1. Gallons Per Day 2. "Absorp. Area - 3. Absoi Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq..ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) `��,'�y Elevation Feet , Feet Capacity VtI. TANK in gallo Total # of r Prefab. Site Fiber=' Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. Ni2w Existih strutted Tanksl Tanks ; Septic Tank oe Hcllcling Tank ❑ ❑ ❑' ` ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ ❑ ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Prot) PI er's Signature: (No Stamp MP RSW No.: Business Phone Number: - _ um er's Address (Street, City, State zip Code): s _ IX. COUNTY/ DEPARTMENT USE NLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued I Agent Signature (No Stamps) (Approved u wner Given Initial surcharge Fee) Adver a Determination -,� "`� fe- IZ --- X. CON DITI ( OF A PROVAL / REASONS F OR DISAPPROVA j,y , t]�N\f�►'�NJ�.�5 CIiJ' t� �t�1y,�;t/vcr' 3• I �j,.yf� • i �w�A �� LV W` tug: t� ", r t r . - SBD -6398 (R. 4199) DISTRIBUTION: Original to county. One copy Tq;,WeTV &Buildings Division, Owner, Plumber , I INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 1 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 (SBD -6399) to be submitted to the county prior to installation 5. Onsi"te sewage systerM must be 15toperly maintained: The septic tank(s) must be pum'ped a iicerised purliptrwhenever necessary, usually every 2 to 3 years. 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 66- 3151.• -- - J� - * • � • � • . To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel taxnumber(s) of where the syste+M +`s to be ihi talled 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. 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. VII. Tank information. Fill 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 DILHR. VIII. Responsibility statement. Installing plumber isto fill in name, license number with appropriate prefix (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 must be submitted to the county. The plans must include the folfil g:` A) plot plan, drawn to s7ale f with comprete dimensions, locaticlKof 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 loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil teft data ort a 115 form; arr►d F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 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. - a i , i I _ - - - i - - - - -- -. .. .t -- r - ' -- ' - �' - -- - - - - -- - - -- - - -- -' -- c A I . /o Aw _ . • t , , i � ! lf I I A - _ , 1 , , i i - �W I _T I ACT. I _ , , ' l � I , I : , , , '_,�A�•r.�•�t. __ �� -_ � ._ ___ 1Q_�- - ca - -- -�� ;/�� ._�.��- -- - � -�_- �- T -____ , -- A 44' - / %w 40- -1- 21 y/ 1 p 1 I 1 1 � 1 E g s : t i , J � i t t ; i 1 i , ' r f , —— — -- — Ll rt J+ , I r . 1 i 1 , i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR HUMAN REDLATIONS PERCOLATION TESTS 115, MADISON WI 3707 (H63.090) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP /M TY: LOT NO.: BLK. NO._SU BDIVISION NAME: NE � /ar1E/ 22 /T 30 N/R 19Lor) W St. Jose h 3 n/a jBass lake North COUNTY: OWNER'S NAME: MAILING ADDRESS: St. Croix Richard Stout 1 1353 Awautkee Trl., Hudson, Ldi. 54016 USE DATES OBSERVATIONS MADE NO.BEDRMS.: COMMERCIAL DESCRIP TION: k1 j�L PROFILE PERCOLATION TESTS: esidence 3 n/a pNew ❑Replace L 4 -26 -92 n/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND•PRESSUR_E: SYSTEM -IN -FILL OLD)NG TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U 1 9S ❑U ® SEA ❑ S �U ❑ S E1U conventional If Percolation Tests are NOT required DESIGN RATE: q If any portion of the tested area is in the under s.H63.09(5)(b), indicate: aaS-s -2 Fl oodp l ain, ind Floodplain elevation: n/a deciaml' PROFILE DESCRIPTIONS page 34 OnC2 BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH2X ELEVATION OBSERVED / EST. I HEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B 6.66 99.90 none ` I3gV >6.66 .83, 10yr3 /2, s.l., 1.00, 10yr4 /4, s.l., 4.83- ` 1 4/4 co. S. 2 7.08 99.45 none ��Vv >7,08 •83,10yr3/2 s.l., 1.25, 10yr4/4 sil., 5.00,- B- 10yr4 /4, s. B _3 7.17 100.33 none �9;� �, >7.17 .92, 10yr3 /2, s.l., .75, 10yr4 /4, s.l., 5.50 - ti 1 r5 4 s. B _4 6.58 99.70 none >6.58 •83, 10yr3 /2, s.1., .75, 10yr4 /4, sil., 5.00,- 1 5 4 s. B -5 6.58 100.10 none 2.75 less 1.00, 10yr3 /2, s.l., 1.00, 10yr4. /4 sil., .75,- ' B- 10yr4 /4, co.s. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PER PER INCH P- P- P- P -_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 96.70 ji _ 06 L' l( s 4 .... -. i � I E i t s t L. � ., ..... _ ..�, - .......�.. -... _ 5 •........, ..,.. ..__ i _ �� ..;.,.._... _ �,...... �. _ .-F .. _ 4 I II I � ., _.,- ......._ _ .._.. S ,. _...y........ .. 1.. . ......... ... �...... .. .,.....�.. ...._. .... -I EE I` 3 y s 3 3 1 t Y _.. — 3 3 A. 7 _ _-4 .. _- g S t _ _._.1._.. . S_ _. _.,.._L._.... _.,� _...-1--l' 1 _.. ,� ? a _ .....,._..._.._ ..___.(.,._. _- .,..,�.. ............. ,....._......._.... _ti..U, w �. ._. .._ ___.,�.. I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 4 -26 -92 ADDRESS: CERTIFICATION NUMBER: PHO NUMBER (optional): 1 554 200th. Ave., New Richmond wi. 54017 2298 71 246 -6200 CST SIGNA 'STRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. LHR -SBD -6395 (R. 02/82) — OVER — � � � � � INSTRUCTIONS FOR COMPLETING FORM 115 ' SB[l 6395 � � To bre complete and accurate soil test, your report must include: � 1. Complete legal description; � 2. The use section mat daar|v indicate whether this be residence orcommercial project; � 1 MAXIMUM number of bedrooms n, commercial use planned; � 4. b this m new cv replacement system; 5� Complete the Suitability rating boxes. AS|TE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED 0N SOIL CONDITIONS; 8. PLEASE use the abbreviations shown here for v"rilinn profile descriptions and completing the plot plan; 7, MAKE A LEGIBLE diagram accurately locating Your tom locations. Drawing to scale is preferred. A seFmram sheet muy he used if desired; 8. Make sure your benchmark and vertical elevation referrnon point are clearly shown, and are permanent; 9� Comp|e/o all appropriate boxes as to dates, names, addresses, Vnud plain data, percolation test exemp- tion, if appropriate; lD� If the information (such as flood plain, elevation) does riot apply, place N.A,in the appropriate box; 11. Sign thotorm and place your current address and your oort|fimoioo number; 12. Make legible copies and distribute as required. ALL SOIL. TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS 0FCOMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (ov l0[') BR — Bedrock con — Cobble 10") S3 — Sandstone 0/ — Gravel (under 3") LS — Limestone °o — Sand HGVV — HiyhG,00ndwaor os — Coarse Sand Pc,c — Porco\azivn Rata med» — Medium Sand VV — YVo|| fo — Fine Sand 8|dg — 8uUclinQ Is — LonmySand > — G/ra/orThun � °s| — Sandy Loam / — LessThun ' °| — Loam Bit — Brown ~sit — Silt Loam B( — Black � si —Gi|| Gy—Gmy °cl —OoyLomm Y — Yellow sd — Sandy Clay Loam R — Red nicl — Silty Clay Loam mnt — K8cuUco nc— Sandy Clay vv/—vvith � sic — Silty Clay fff — fma fine, fmi^t ~o —Ooy /c —xninmon.coaou Pt — Peat mm — Many, medium ' � m — Mock d — distincii p — prominent HVVL — High vvoz rlevel, ° Six general *,i| te^u'n: surface water ' for liquid waste disposal 8K8 — Bench K8m,k ^ ! VRP — Vertical Reference Point ' , ` � ` TO THE OWNER: � Thivsoi)tmu report is the f\nt stop insecx,ingamxohary permit, The nu"ntyo, the Departmen may ,e(xms � verification of this u,i| test in tire field n,iv, to pert-nit issuance. A complete ,et of plans for the private uowas" ovnmm and a permit application mum be submitted to the opp,op,iate |ncx| a uth o rity i or t � obtain permit. The sanitary permit mou he obtained and posted n,iorto tho start of any construction. � ' � . ' � ��U ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM E / � Own er/Buyer ��/ �nI 4�L T Mailing Address _ � t Property Address �`�� (Verification required from Planning Department for new construction) am C- City/State S ) vim SST all' • Parcel Identification Number Q-30-A,09 LEGAL DESCRIPTION Property Location V6 %4, -A6�L %4, Sec. z 2 , T20N- R_ Town of .S ?, r%s�.®y Subdivision RASS 4 4rg 422 7rA/ . Lot # - 3 Certified Survey Map # r . Volume ` ; Page # Warranty Deed # . Volume / 3 /A Page # X60 Spec house ❑ yes 0 no Lot lines identifiable JR yes ❑ no SYSTEM MAINTENANCE 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 systemr 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, journeymanplumber, restrictedplumber or a licensedpumper 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 of a I'iree r piration date. GNATURE OF 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 owners) of the prope scri ove, by virtue of a warranty deed recorded in Register of Deeds Office. 4 / GIC? GNA APPLI 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 in the warran deed a copy of the certified survey map if reference is made ty STATE BAR OF WISCONSIN FORM 2 - 1998 624258 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between - - -- 06 -06 -2000 9:25 AM - -- RICHARD -O, - -- STOUT - and -JANET P STOUT, - - - - - --husband and -- wife, - - -- - - -- - - - - - -- -. EXEMPTT DEED 17 �. _ _- __- - --_- Grantor, CERT COPY FEE: and KEVIN C..__.ERLITZ_- and. -- ANN-- M.--- ERLITZ, -- husband - -- COPY FEE: and- wife., - - - -- - - - -. _ _ _. --- __ -. -- _-- _-- -__._- -- ______ - - -. -.. TRANSFER FEE: --- -- RECORDING FEE: 10.00 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in — S _t.. -.Cr�i __— County, Stale of Wisconsin: ✓Lot 3, Plat of Bass Lake North, Town of Name and eturnAddress St. Joseph, St. Croix County, Wisconsin. This deed is g iven in full and final satisfac- / � g sf tion of that land contract between Richard (3 O. Stout and Janet P. Stout and Kevin C. / � , Erlitz and Ann M. Erlitz dated April 22, 1998, J 7 recorded in the office of the Register of Deeds of St. Croix County on April 28, 1998, in Vol. 1318, page 460, as Doc. No. 578044. 030 - 2087 -30 -000 _ Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 5th day of Ju — __ - -_- , - 2Q..00 1 ` __ ' - - -- (SEAL) - -- � — - - - - - -- -- * Richard 0. Stout - -- - - - - -- (SEAL) - --- - - - - -- - (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT - - -- State of Wisconsin, SS. . -- - -- -.. -.. -- - County authenticated this ---- -___ -_ clay of- _- __ --_.. , _ -._ -- Personally carne before me his - - - _.- 5th day of V , -2 � the above named TITLE: MEMBER STATE BAR OF WISCONSIN — - - - - to (If riot, me known to be Ur(! person .� who executed the loo -going authorized by §706.06, Wis. Slats.) Ins Irnent and ackl wledge the nl THIS INSTRUMENT WAS DRAFTED BY - -- - ,X Janet P. Stout * _( __ E OY ( in 1 353__AWatukee- Tr .- -- -- - - -- - - - - - -- N iSCp� Hudson, WI 54016 Notary Public, State of Wisconsin W My commission is ptrnrt'letIt. (If rlgtcttAll explwlion date: (SiF,natutes may be authenticated or acknowledged. Both are not n1•I rSSary.) IJ IwISans %tgu.1Ig in Ally apal ity must be typed or printed below thvit sign,ome STATE I3AR OP WISCONSIN W'scons.n t .19,11 lifaf* Co , 111c. \1ARRANTTY DEED FORM No 2 - 1998 661 a w141, WIS. t W , 81119 1 z rt s I . rypz ao 1 Im — I LL I ' O �) J 1 0 i N CY zSt 1- 21 o $ Cl NI o � ` -' M M � ti A 9 z'oss M e ,; o �o c k � (I p 11 M i (G M OD 1 M N Qq 0 99 CD I 090 INS , zsiY N O OD NI Mp O [ I MA j — N NO N 2 Q \ N OD' Q , Z9 In 4 a ~ O mO In p . N J ti N 3 VI � VI ti q- 3 Z4 9f►>i ag-090 ui I OD ao J . • .� a 'a LL1 CY M