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HomeMy WebLinkAbout030-2101-20-000 stsconsin Department of Commerce PRIVATE SEWAGE SYSTEM County - Safety and Eiuildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarv.PermltNo.: �Pensonal information you provice may be used for secondary purposes (Privacy Law, x.15.04 (1)(m)]. Permit Holder s Name: ❑City ❑ Village ri TFwrlo State Plan ID No.: St. Joseph Township Parcel Tax Nn Insp. BM Elev.: BM Description: — ;�_ 0 co W •a� QO . ' �d� s� c - - - TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION 85 HI FS ELEV. Septic Benchmark 5 (., o` Dosing Alt. BM Aeration Bldg. Sewer 8-10 10 -ZO r Holdin St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet b S- ofv. 3` TANKTO P/L WELL BLDG. Airi to ntake ROAD Dt Inlet --- Air I Septic > p I NA Dt Bottom Dosing NA Header / Mans � Z 0S. 3$ Jos'. o Aeration NA Dist. Pipe p , Jp 10 , (° l o $-, Zo Holdi g Bot. System PUMP/ SIPHON INFORMATION Final Grade jf Man urer mand St ro Model Number G TDH Lift friction S stem TDH Ft Forc ain Length Dia. Dist. ell SOIL ABSORPTION SYSTEM Z. �e 8 • o SW TRENCH Width , Length No. f renches PIT inside Dia. Liquid Depth DIM 0 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM EA M HING anu acturer. INFORMATION Type Of (` ,p B E Moe r: System: " oZ DISTRIBUTION SYSTEM %` o Header /Mani old r � Distribution Pipe(s) , « x Hole Size x Hole Spacing Vent To Ai' Inta Length 'I Dia. Length 5,0 Dia. ' Spacing -> 4f 0 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over 1 ; Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes [] No ❑ Yes C] No COMMENTS: clude code discrepancies, persons present, etc.) Inspection #1: 1 f S // Inspection #2: Location: 450 Hhighland View, Tjoulton, WI 54082 (NW 1/4 SE 1/4 29 T30N 19W) - 293019821 Highland Hills H -Lot 21 1.) Alt BM Description 2.) Bldg sewer length= Z3 V - amount of cover — 3),�- i 4- (6D Plat revision r quired? A Yes (D No - Use other side for additional information. SBD -6710 (R.3/�7� n n ^ � � Inspector's Signature _ �� ems' N o '50a Ir Sanitary P i Safety & Buildings Divbion In accord with Co is. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 N VIsconsto Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Oepertmant at•CoMirieree (Privacy Law, a. 15.04(Ixm)) (Submit completed form to county if not state owned. Attach complete plans to the county copy o2W for the system, on paper not less than 8 -1R x l 1 inches in size. CC r State San Pemrit Number Check if revision to previous application State Plan 1. D. Number L Application Information - Please Print all Information Location: Property Owner Name Property Location BRE I T ci- L nJ K l 01 �i /4 1/4, S T-�DN Rt or Property Owners Mailing Address Lot Number Block Number 15ZO 1AL)TR fi'r' ZI City, State Zip Code Phone Number Subdivision Name or CS Number i mj 12 A wl II. Type of Building: (check one) .� 13 City y jit 1 or 2 Family Dwelling - No. of Bedrooms :_ _ $Town of ��� }� H S ❑ Public/Commercial (describe use) :_ ❑ State -Owned Nearest Road Parcel Tax Number(s) -ZO -DD IM ype of ermit: Check only one box on line A. Check box on line B if applicable A) 1. XNcw 2. qLRcplaccmcnt 3. ❑ Replacement of 4. S. 6. ❑ Addition to ' system System Tank Only Existing System B) Permit Number Date Issued X A Sanitary Permit was previously issued 3 Fr 3 J IV. Type of POWT System: (Check all that apply) Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In - ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other. V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Race 6. System Elevation 7. Final Grade Required Propo Rate (GalsJday /sq. R) (Min /mch) 7&wH )4Z Elevation �1Sn %'DO /mO I Is TPCA)eH 3 JOS._�s VII. Tank Capacity in Total # of . Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks - Con - Con- glass New I Fig crete strutted Tanks Tanks 5E PT t c /ooa 11060 I hf � I � S ❑ ❑ ❑ ❑ 0 1 I T-T 0 1 110 VIII. Responsibility Statement I the undersigne4 assume responsibility for installation of the POWTS shown on cheer plans. Plumber's Name (print) I Plumbees S' lure (no st ps)• Business Phone Number �£f' F f6x 1 7 Z232- L17 `715 S 1 �I Plumbees Address (Street, City, State, Zip Code)( �Rnx Z7S rx'LSsr \JI S�IDD� IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iging Agent Signa (No stamps) Approved 13 Owner Given Initial Adverse Surcharge F 12- , Determination X. Conditions of Approval /Reasons for Disapproval: 1 `� I3R e2AERI E L i mK. Al W ) Iy Sr I/y 5 - Zq T- A iz 9 W 1SZl l8b TH ST ?DES t K rt6�t/,uSµ I t� C�NTUR 1 I� 1111'( 5y £32K /\APizS 223242 3 3E D r2DD)VL lftf) GAL 1WWEr-KS SgPTivriNi�)Y- /jbUSp Wjr7 l A mh nLTU- G -R1Z►� o . �z $3 DR�uEw'Fly SHARm WITH r, �— Nei Zu RS LOT J SLDPie STAKE ELE1' ldv' --__� II S ale L�bR 1�9 LAS N00 -22 -2000 08:0 -RA FROPthA=RTH COUITRY' LO) H11 71c 44 T0:294;138 P:4/4 STEEL'S SOIL SERVICE GarV L. Cxsry Steel 1 L. S JOWaae Persico 1564 200th Ave. MPRSW 3254 NWkSE4 S2q-T30Ai -R19W New Richmond, WI 54017 town Of St. Josaph (715) 246 -6200 10t #71- WI.ghland Hills Second Addn. N 1"=40 BM-= 'top of SE lot stake el. 100 v ' 1 MY 3 :...:..... -S' el a P.04 11 -30 -99 0 :08 :.F:'" :�?EL� FROM:715 294 2030 1Y .# `G'° (-" -Awfl V iEw Sanitary Permit Application Safety do Buildings Division In accord with Comm 8311, Wis. Adm. Code 201 W. Washington Ave See reverse side for instructions for completing this application PO Box 7302 i StCO ersona Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Codiirieree (Privacy Law, s. 15.04(Ixm)] (Submit completed form to county if not state owned. Attach complete plans to the county copy only) for the system-aniLapa not less than 8 -12 x 11 inches in size. County 57 R01 s 3� 3 (3 Permit Number ❑ QW. «� / satiort State Plan I. D. Number I. Application Information - Please Print all Information I Location: Property Owner Name , f ir Y -' ' Property foation EkL TT (a; OkkE LI NK r F', �I x \; ia SE lia,s7`J T� }c � B or N Rr / Property Owner's Mailing Addut ss ` v L Lot Number Block Number 152_ iBa 7 City, State tip Code Phone Numb}+ i nG"r Subdivision Name or CSM Number I'�kyrU2)A YU/ 54h'2y zo "i� "' °` ':''� �lll �/1.A)tir� // /[LS - aAhb, IL Type of Building: (check one) ✓ I4"� s.�b D City jt 1 or 2 Family Dwelling - No. of Bedrooms ❑ village O Public/Commercial describe use)-_ $Town of S"r SE PM O State -Owned Nearest Road 3 3 r X 62.5`(7 - -►��� C3a Parcel Taxxumber(s)d,W _2010 -ZD •.01 IM e of Permit: Check only one box on fine A. Check box on line B if a livable dj- , 1 ° I . a j A) 1. ❑ New 2. lacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System system Tank Only Existing System $) Permit Number Date Issued O A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) l ` ONon- pressurized In- ground ❑ Mound ❑ Sand Filter O Constructed Wetland • Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other V. Dispersal/Treatment Area Information: 5ex" 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. S m Ele 7. Final Grade Req ' Proposed ( Jda /sq. (Minlmch) Elevation �� )dq. s y5� 75D 30�;J 3a J►��Il.. "�� — � //D VII. Tank Capacity in Total # of . Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks - Con - Con- glass New I Existing crete structed Tanks Tanks S�t�T l � /OOn /tom 1 in�EEkS ❑ ❑ ❑ ` ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I the undersigned, assume responsibility for fintallation of the POWTS shown on giSattached plans. Plumbers Name (print) �ZW�s�lam o. Business Phone Number �C_FF Tb � = ZyZ �► Z�LI-31' -11 Plumber's Address (Street, City, State, Zip e) snb c Z`75 DRE ssLi�_ 1 5�1�b IX. County/Department Use Only O Disapproved Sanitary Permit Foe (Includes Groundwater Date Issued ing Agent Si (No stamps) p Approved ❑ Owner Given Initial Adverse Stkarge Fee) Determination S -� X. Conditions of Approval /Reasons n r Di_ sappXo 5 T� t 1 o wJQ S_ ,(q �c.KQH...w{ `y(.°"QE� Z- tt ` r�V JJ��� Ban -f et4 E12.IE LJNk ��y 5E ( N S- z9 - T30, Al, R 1 /SZD /B ,0' ST ST 30 -nFt N - M'5? G-E.'TUO)A, W) SKBZq 1 130' M PP-S 27-3ZL12 IN 3 B,DROOM NcUS€ ✓lBVb 6AL vxk-'EK.S SEPT /e. 7A Al is ioy A - ICU f - .IIZ 2 GM A &E ' �.3 TREAle- ES VI I - T t1 30 JhGIJ CA- PAOLITY s� ow, ►J1�EK /NFILPRAT ©RS a M SLUPE b SEND, MAR K - r6Y OF 5�5, LOT STAKE afV (D6' • Wisconsin Department of commerce SOIL EVALUATION REPORT Page —/— of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County :Z Attach complete site plan on paper not less than 81/2 x 11 Inches In size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. R viewed by Date Personal infomrafion you provide may be used for secondary purposes (Privacy Law. a. 15.04 (1) (m)). Zo - Property Owner Property Location Govt. Lot ) 1/4 1/4 T N R ( W Property Owner's Mailing Address lot # lock # Subd. or CSKW city Ste Zip Code Phone Number ❑ city [I vllage Town Nearest Road ' ( ) New Construction User' Residential /Number of bedrooms -3 Code derived design flow rate GPD ❑ Replacement ❑ Public commercial - Describe: _ -• Parent material 5a �a � !�F� Flood Plain elevation if applicable 41 / / IL General comments -5 �,�s // l7 ^ 9Ve and recommendations: 41-3 , <°r�s- / 3 .!,�k���°- lee", F—/1 Boring # ®Boring �� ❑ pit Ground surface elev. ft. Depth to limiting fa z z� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRf In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F71 Bori Boring # _ ❑Pit Ground surface elev. , Dj �� ft. Depth to limiting factor � f1� in. � Rate Horizon Depth Dominant Color Redox Description Texture g Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz Color •Eff#1 •Eff#2 All es f�- �i Effluent #1 = BOD > 30 220 mg& and TSS >30 150 mg& EM #2 = BOD _5 30 mg& and TSS 1 30 mg& CST ) l Signature CST Number r Address ,. Date Eva uation Conducted Telephone Number Property Owner Parcel ID # Page of Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz Cont. Color Gr. Sz Sh. •Eff#1 •Eff#2 F Boring ° Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz Cont. Color Gr. Sz Sh. •Eff#1 •Eff#2 El Boring # ° Boring ❑ Pit Ground surface eiev, ft Depth to Gnrting factor in. Sa Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/(F In. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. •Eff#1 •Etf#2 • Effluent #1 = BOO, > 30 <_ 220 mg& and MS >30 1150 mg& • Effluent #2 = BOD < 30 mg/L and TSS 5 30 mg& 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. saoa3wMM) I ' Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & 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 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or r� n&�ind_­A dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION YI ED B DA - o - PROPERTY OWNER: PROPERTY LOCATION =1 4 �' P GOVT. LOT NW 1/4 SE 4 9 J oanne ersico PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NA _ S � 400 S. Second 21 n' Yi&h Se co CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ❑TOWN VILL Hudson WI. 5401 - E [� New Construction Use k ] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ J Public or commercial describe Code derived daily flow 450 g pd Recommended design loading rate • 5 bed, gpd /ft •6 trench, gpd /ft Absorption area required 900 bed, ft trench, Maximum desig oading rate __5_ bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s Qo106.4-104 jiL104.0-101 .2)t (as referred to site plan benchmark) Additional design / site considerations Parent material pitted glacial drift Flood plain elevation, if applicable na ft � SU tabe for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK able fors stem ®S ❑ U ®S ❑ U ®S ❑ U ®S El U ❑ S C U El [ U SOIL DESCRIPTION REPORT( - Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxlary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 +0 10r33 •� 2 10 -20 4 nnntm 2 .`� Gr ound 3 20-82 7.5 r4 4 none S1 2msbk mvfr C1W na -9 .S elev. 109,24_ ft. Depth to limiting factor +82 f �� 12,g9 Remarks: Boring # 1 0 -9 1 mfr cs if .5 .6 - S } 2 2 - 27 10yr4 /4 none sici 2msbk mfr gw if .4 .5 �{ Ground 3 27 -82 7.5 r4/4 none sl 2msbk mvfr na na .5 i.6 S� elev. 10 ft. Depth to limiting — factor 0. $ +82 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 20M. New Ri2tmond, WI 54017 Signature: Date: CST Number: m02298 11 -14 -96 PROPERTY OWNER Joanne Persico SOIL DESCRIPTION REPORT Page 2 of 3 ' PARCEL I.D. # Lot #21 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench _<...3.... 1 0 -10 10 r3 3 none sil 2msbk mfr cs if .5 ..6 -S' 2 10 -30 7.5 r4/4 none sicl 2msbk mfr qw if .4 .5 .� Ground 3 30 -80 7.5yr4/4 none sl 2m r mvfr na na .5 .6 • S elev. 10 ft. Depth to limiting factor +80" Remarks: Boring # -- -- if np n ..4... 2 14 -23 10 r4/4 none sicl 2msbk mfr gw if .4 .5 , L{ ................. Ground 3 23 -80 7.5yr4/4 none sl I 2msbk mvfr na na .5 .6 ,S elev. 1 0 - 4,Z ft. Depth to limiting factor +80" Remarks: Boring # none 1 2msbk mfr 2f .5 .6 >'...5..< 2 8 -18 10 r4/4 none sicl 2msbk mfr gw if .4 .5 .•� Ground 3 18 - 7.5yr4/4 none sl 2msbk mmvfr na na .5 .6 , elev. 10 _ ft. Depth to limiting fa Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05192) STEEL'S SOIL SERVICE Gary L. Steel Joanne Persico 1554 200th Ave. CSTM2298 N ISE4 S29- T30N -R19w New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 lot #21- Highland Hills Second Addn. /'1" =40' ✓BM.= top of SE lot stake C el. 100' 43o o� 0 r 22 2 V� 5 V Zti g� t 2A l � �5. 20 I �y Gary L. Steel 11 -14 -96 ICI Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or overnmental unit. The approved plans and permits for stem are on file at the county 9 PP P P Y zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number S Number of Bedrooms 3 Design Flow - Peak (gpd) 'o Estimated Flow - Average (gpd) 300 Septic Tank Capacity (gal) esap Soil Absorption Component Size (ft) " Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 118 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se tic tank and outlet filter shall be assessed at least once eve 3 ears b inspection. Th outlet filte s hall be cleaned as nec -ssa to ensure every Y Y P ry — roper operation. The filter cartridge shou not be removed unless provisions are made to re ain so i s in the tank that may slough off the filter when removed from its enclosure. If the j Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 i Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address U / Ol M P Property Address k,1-1T 4/ (Verification required from Planning Department for new construction) City/State N U1A'f 4 W T Parcel Identification Number 6/0 - '2Q - LEGAL DESCRIPTION Property Location %., $ ` y., Sec._, T-.�Q N -Rjq__W, Town of • J� Subdivision Lot # J Certified Survey Map # 5 586PI& Volume Page # _ �a Warranty Deed # 01 O 9 7 Volume rage # / Spec house ❑ yes V..no Lot lines identifiable Oyes ❑ 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 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, journeymanplumber, restrictedplumberor 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. 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 Zoning Office within 30 days of ' ofthe three year expiratio LM I Al (A SIGNATURE OF APPLICANT / DAT 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 d psdribed above, by virtue of a warranty deed recorded in Register of Deeds Office. ob SIGNATURE OF AP LICANT 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 1510PAcE 140 6r2-258-7 STATE BAR OF WISCONSIN FORM 7 .1999 KATHLEEN H. WALSH TRUSTEE'S DEED REGISTER OF DEEDS Document Number I ST. CROIX CO., WI John V Persic and JoAnn Persico — _. —. —_ _. —_ -- RECEIVED FOR RECORD -- - - 05-12 -2000 9:30 RM as Trustee of the Job. V. and J.A.. Persico Revocable Trust — TRUSTEES DEED EXEMPT 1 CERT COPY FEE: for a valuable consideration conveys without warranty to Brett Allen Li nk and COPY FEE: TRANSFER FEE: 174.00 Cherie Rose Link, busband and wife, - -� —. -- RECORDING FEE: 10.00 PABES: I Grantee, the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): RecordurgArta Name and Return Address Lot , lat of Highland Hills Second Addition to Town of St. Joseph, St. Croix KRISHNA MLAND ounty, Wisconsin. ATTORNEY AT LAW P.O. Box 5 9 HUDSON, 030- 2010 - 20-000 Parcel Identification Number (PIN) Dated this _ � day of �T — • JoAnn Persico • Job n V. Persico — Trustce Trustee • AUTHENTICATION ACKNOWLEDGMENT Signature(s) John V. Persico and JoAnn Persico, Trustee or the STATE OF WISCONSIN ) John. V . and JoAnn Persico Revo cable Trust — ) ss• - -- County ) authenticated this I ( day of _ May 2000 ' Personally came before me this day of — - - -� — the above named • KristinaOgland — TITLE: MEMBER STATE BAR OF WISCONSIN -- (If not, _ - - -_ to me known to be the person(s) who executed the foregoing authorized by C 706.06, W is. Stats.) instrument and acknowledged the sagte. THIS INSTRUMENT WAS DRAFTED BY _.. —. — • - -- -- Atto K ristias Ogland _ _ —, _.., —__ .___ —_. • __ ___ _ __ _ - H_u Wf 54016 — _ — _ ___.— _..__. _ Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: (Signarures may be authenticated or acknowledged. Both are not necessary.) _ _ — - , -- _ -- _ --) wormmum protessorwa compvv. Farad du Lao, wt • Namcs of persons signing in any capacity must be typed or printed below their signature. aao- 65S.M1 STATE BAR OF WISCONSIN TRUSTEE'S DEED FORM No.7 - 1999 t .9. 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