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HomeMy WebLinkAbout030-2026-30-000 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386 -4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this for ,lam psgential &Q that j thg property can be located Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received.. WATER TESTING---------------------- - - - - -- -FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) L SEPTIC SYSTEM INSPECTION---------- - - - - -- -FEE: $25.00 (Determines if system is properly functioning at . of inspection) PROPERTY OWNER'S NAME: o PROP. ADDRESS: N's S A V c-- TX E,�ENE CITY � Legal Description 1/4 of the 1/4 of Section �� , T Town of S7_ r7U Lot Number Subdivision: .lf FIRE NUMBER LOCK DDX MMBER 22� I Color of house Realty sign by house? If so, list firm: PLEASE INCLUDE, IF/AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOR, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. i Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. if this is the case, please make proper arrangements with this office to ensure time when entry may be gained. r� Firm or individual requesting services: Telephone Number — lv REPORT TO BE SENT TO: A . , cui CLOSING DATE: —/ - Signature ST. CROIX COUNTY WISCONSIN {t { ' ZONING OFFICE } ST. CROIX COUNTY COURTHOUSE j 911 FOURTH STREET • HUDSON, WI 54016 - _ - (715) 386 -4680 /W January 18, 1993 Diane Hark Edina Realty Dear Ms. Hark: An inspection of the septic system on the property of Blanch Olson, located at 1455 Pine Tree Lane, Houlton, WI was conducted on Jan. 18, 1993. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. Sincerely, 1 Mary J: Jenkins Assistant Zoning Administrator cj s' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildingbivision INSPECTION REPORT Sanitary Permit No: 420529 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)]. dl Permit Holder's Name: City Village X Township Parcel Tax No: Eberline, Ed I St. Joseph Township 030- 2026 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: lon- Q d s` W Cav "4 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � Benchmark ,�.Gs (O / Z. r tj D.o Dosing Alt. BM Aeration Bldg. Sewer Holding St/ t Inlet s� TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic y 2 j - Dt Bottom i Dosing ) Header/ an. �- V. n4-5- / p. o Z Aeration Dist. D ipe C ( 10 L/ / ° 1- Holding Bot. System q 0, O Final Grade 3 PUMP /SIPHON INFORMATION 2 Manufacturer Demand St Cover Q GPM Model Number 'u TDH Lift Friction Lo System Head H Ft Forcemain Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L T e Of System: BLDG WE n LAKE /STREA LEACHING anuffelyrer/ r, f / _ � INFORMATION CHAMBER v�j4 47 4yX V -1 // r �- `Q O .F J Model Number: DISTRIBUTION SYSTEM IV ' 1 J '� / ` Header /Manifold Distribution t x Hole Size x Hole Spacing Ve``n it Intake �S / #/ Pipe(s) `&t ��� / Lengt Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only V Depth Over i Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center I Bed/Trench Edges Topsoil `) � Yes FN] No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / () 3 Inspection #2: Location: 1455 Pine Tree Lane Houlton, WI 54082 (SW 1/4 SE 1/4 22 T30N R20W) NA Lot r Q Parcel No: 22.30.20.4376 1.) Alt BM Description = 57 64Y0 � fJj� 2.) Bldg sewer length = 22 6-M Uy amount of cover is h� „ n - Yc ' 7' � /, O Plan revision Required? Yes o r - r 5 �� X03; 6� Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Sign ture Cert. No. ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner �v �aG�tiE �ddl cas City/ State _t0 4 -/V ,✓ eu /S. S yU Legal Description: _ M - / - s ; �� ' G,v UvV • Lot 'Z Rlock Subdivision/CSM # �- '/A 4 '/4 Sg , Sec. 1"I T N -R W, Town of 5 7 - - To S 4EX PIN # ,0 3 0 - 20 s G • � • � a SEPTIC 'TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: � 12-50 12 , s • >7 5a ► Tank manufacturer 60 • Size ST/PC / Setback from: House Well P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SO ABSORI TION SYSTEM T/r'�•t r,�r� T �s Type of system: T efG` 4n e S 3 2. YI Y Width Length Number of Trenches Setback from: House ' Well P/L /0 ' Vent to fresh air intake > 4; 3 ' ELEVATIONS CS T s T /ao�d Description of benchmark 7 Elevation Description of alternate benchmark _ 7o p of ti EGy S. 7 Elevation Building Sewer N ST/IIT Inlet ' �Z ST Outlet 9 C° ' PC Inlet �^ PC Bottom � Header /Manifold op o PC Manhole Cover Distribution Lines Bottom of System Final Grade O ( O Date of installation / 1 Permit number z )- 0 s L State plan number / Plumber's signature �' G� i ' Lice nse number 2 -�G 3'l s Date Inspector Complete plot plan + Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 NoT J // THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # " Z g J NN W � " t7 r P 0 (n _..� - M�O 1 e � N v D � y *5 ( am OR N Ln 0 CD \ 1 m CO' CO' om� m 7D y N O n os 03 > r � r e� ti C r' �0 3'XS� � •� v1 cn L kilo VA r Safety and Buildings Division County -5 - r- Cle O i X, 201 W. Washington Ave., P.O. Box 7162 NV ISC011s i n Madison, WI '53707 - 7162 She Address. /y ss nl Ne rIZZ& / De artment of Commerce 3 p -1 // / L -UL /`fOVLra.� W/. S-yas, -Z, Sanitary Permit Application Sanitar Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide I Z p r z 9 May be used [or second ses Pdvac Law, sIS. 1 m ❑ Check if Revision I. Application Information - Please Print All Information State Plan I.D. Number N/ Property Owner's Name Parcel Number ZZ. 30 - e . &Jgu� � ' X e5_136Rz -1,V 1 03 6 6 • X30 '�d'a Fropetty Owner's Mailing Address ' Property Location u 5S :s Z) T30 W N . City, State Zip Code Phone Number Lot Number Block Number /V 7_0 Al �/. S l/o� Z s Subdivision Nam CSM Number y y ' 5 3 16 It. Type Type of Building (check all that apply) J []City 1 or 2 Family Dwelling - Number of Bedrooms (]Village U Poblic /Commercial - Describe Use ATownship State Owned Nearest Road 77ZeA AV . III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. For County use 1 d New 2 Replacement System 3 ❑ Replacement of 6 0 Addition to System Tank Only Existing System B• d Check if Sanitary permit Previously issued Permit Number Date Issued I IV. Type of Permit: (Check all that apply)(numbering scheme is for Internal use) 44 Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 U Pressurized In - Gr 0 - 1 2 41 d Holding Tahk 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 3 0 "� g 46 Ll Aerobic Treatment Unit 49 O Recirculating 30 O Other V. Dispersal/Treat ni Area Infor allon: - Design Flow (gpd) Dispersal Area Dispersal Area Soff Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /SgTl.) (Min./Inch) S Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass r t New Existing w^ Tanks Tanks I &/ &,5 e Septic or fielding Tank 1A Oro basing Chamber KJ VII. Responsiblllty Statement- I, the undersigned, assume responsibility for installatlon of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature UWMPRS Number Business Phone Number.' Plumber's Address (Street, City, State, Zip Code) VIII. Count /De artment Use Onl Approved d Disapproved ' Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) r' 0 Owner Given Initial Adverse Determination 42Z5_. 1( O L I.X. Conditions of Approval /Reasons for Disapproval J 1. The existing system shall be abandoned per code requirements (Comm 83.33). 2. Effluent filter to be maintained per manufacturer's recommendations. 3. The excavated trench shall remain open for inspection to verify any occurrence of scl as reported by the soil tester. If the presence is ianificant the s stem design may need to be modified. 4. The system was oversized4HPQ90t Wde t6%* tidWev Nnnat M a 11 Inches in the SBD -6398 (R. 05101) Safety and Buildings Division Couaty r G o i X 201 W. Washington Ave., P.O. Box 7162 IN VIS6'ns in Madison, WI '33707 - 7162 She Address. If SS J� i.tJ.l. T, z- be artment of Commerce Sanitary Peri App lication Sanitary Permit Number PP Zo�z in accord with Comm 83.21, Wit. Adm. Code, personal Information you provide y 9 ❑ Check it Revision ma be used for secoral e! Prira Las s15. 1 m f. Application Information - Please Print All Information State Plan I.D. Number N/ Property Owner's Name Parcel Number ZZ- 30, Zd . y3p Eo1014KP X4 , 5 - /3C= RGi It1 v3 41, o,Z G •30 -Qda Property Owner's Mailing Address V Property Locstlon &55 Pi 7 1— Lev ' S7 5w 'A 5S Lz T 30 N. w City, State Zip Code Phone Number „- Lot Number Block Number lfU kUG7vA-1 �/ S-el.9 s /� Subdivision Name CSMNmnber 4/ y • s3 iv� 11. Type of Building (check all that apply) 0City 9 1 or 2 Family Dwelling - Number of Bedrooms OVfilage U Public /Commercial - Describe Use &ownship sr. 0 State Owned Nearest Road l; VA T 1zeA G/V . W. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if appHeable) A. 1 i7 New 2 XReplacement System 3 0 Replacement of 6 iJ Addition to For County use System I Too Only I Existim System B • 0 Check if Sanitary Permit Previously issued Permit Number Date issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Non - Presntrized In- Ground 210 Mound 47 0 Sand Filter 50 0 Constructed Wetland 22 Pressurized in -Gr outzl 41 Holding To& 48 0 Single Pass 510 Drip Line 45 0 At -Grade 3 �/ 46 0 Aerobic Treatment Unit 49 0 Recirculating 30 0 Other V. Dis ersal/'Treal nt Area Intor alion: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade / JG b Required Proposed Rate(Gals. /bays /Sq.Ft.) (Min./Inch) Elevation 7 J 2- � p��'�� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass t r New Existing Tanks I Tanks Septic or holding Tank of /;L Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWT$ shown on the attached plans. Phrmber's Name (Print) Plumber's Signature 4rtRlMPRS Number Business Phone Number.' � i C�,/ zz 4 3 � S. 7/S . 0 0 1 Plumber's Address (Street, City, State, Zip Code) VIll. County /De artment Use Onl Approved 0 Disapproved ' Sanitary Permit Fee (Includes Groundwater Date !&sued issuing Agent Signature (No Stamps) Surcharge Fee) 0 Owner Given Initial Adverse. Determination 4 Z Z 5 oQ , 11z 64 M. Conditions of Approval/Reasons for Disapproval J 1. The existing system shall be abandoned per code requirements (Comm 83.33). 2. Effluent filter to be maintained per manufacturer's recommendations. 3. The excavated trench shall remain open for inspection to verify any occurrence of scl as reported by the soil tester. If the presence is .signi ficant the system design may need to be modified. 4. The system was oversized4EiPQ9G9'gllde 4Pttp lylletlfmtrttsritiyletsn ad ll1 :11 tnebn Is �e SBD -6398 (R. 05101) UI BFi1CH & AS CO. 655 (YNeII Road • Hudson, WI 54016 Reg..Veslgners of Englneerhig Systems 715 -386 -8 Prfvale Sewage Consuilenls PROJECT INDEX PLAN ID DATE ti0 U• ✓` �-Z- r ow N ra w 1 )C4 tA41 4_ - - PHONE 71S S�y9• S 3 /� A 11155 /) 1_ 7Aee_ Gry . GGj,S . Swp2 LE DESCRIPTION Mxr dwUr - 030 •2 •,3f�•OaZ7 5 . L Z, T a 6,.0 , n i o w TOWN OF J-aS 1_0� ST COUNTY CS'I'M rO LOCAL AUT11ORITy/ SUPERVISION ST • 4 e , , 'X Z vtii ,v G -- PROJECT DESCRIPTION: - 3 ' GUMS 72'- , Vd Ulbricht & Associates Private sewage Consultants ` 655 O'Neil Rd. Hudson, Wis. 54016 THIS POWT SYSTEM SHALL ALL NON - CONFORMING INCORPORATE PER COMM. TREATMENT TANKS SHALL 83 .44(2)c A PROPER ZABEL BE ABANDONED PROPERLY FILTER MODEL # PER COMM. 83.33. s 3 / Pg.l INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. i Pg.4 " if it it to to Pg.S OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS P9•6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG•7 (OPTIONAL) PUMP PERFORMANCE SPECS. I The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment SYstems.' (Version 2.0) SBD- 1075 -P(NO1 O1. �, ► ; fief b illul • N � 0 � N r q�o II I� I I u �s lol i L'P POWT SYSTEM SHALL I I I THIS 3� i 1 P/ ' 3CO( jORATAE PRO PER COMM. PER ZABEL 3 / g FILTER MODEL # f f I r1 I I II � �� II I G M � I 10 I of iD I rod - -to • yo i57107 �o c ON foxMi ,U(--" � i ALL NON- CONFORMING TREATMENT TANKS SHALL BE ABANDONED PROPERLY C PER COMM. 83.33.' 5w Of Gbe (3R lal b p,a PlAA0 �� _ Co Y 0 �, � I� 0A) i ---,. A N C m AEVI (1 AP ► (r' P tp Usti,- M J /f4A q 6 5 SEc TioAJ o,C-� IA) 6- 'OA r - Gv id2� 3/• / S Q, FT - To T l L P-6 t 5 , L -7- i ff el;V AE A9 s� • Qo 9iP�f�1= 1 � .5 ' � . y L y Di v, 90. OWNER'S NAINTAINCE OF SEPTIC S •• M POWTS (landowner) y maintenance of )issrepemsible for proper operation and main serv i c ing 3' Regular periodic inspections and is necessary for the safe healthy operation of.this S ystem. The owner is required b maintenance /inspection re Y code to submit all necessary ports to the controlling ,authorities. SPECIFIC CONTACT AGENTS • �/�ifJ /X C� * Governmental authority/ inspectors: Z m �P Y • Licensed installer, responsible for maintenance "Users', manual: providing an operation/ 396. gig S /�. 2t�G✓� �'� j-- * Licensed serv&ce / inspection agent other t tan installer: * E lectrician, for pump, electric controls wiring units: IMPORTANT OWNER MAINTENANCE RE UIREMENTS 1 • Winter traffic area shall not (sledding, shoveking, etc. permitted, or frost can /willoss the the cell, freezing up the s penetrate into winter.(a vacactfon tri sy stem Discontinuos use in the lead to freeze u p, resulting in no water use ps• ) can also 2 • Water conservation needs to be ex hydrolically overloaded and destroyed. T ! Or system can be designed for a maximum wastewater flow of is sysem was 3 • POWTS �0 � gals. daily. are not designed to disposal unit accomodate wastes from a or any other unnatural sources of waste. Any introduction of such waste materials will overl destroy this system. oad 9• If a power 6ntage occurs, or a In a temporary overload of effl Pum Pf ails, it m may result g pumped into the cell, which may recommended adv ersely pumper empty the dosin the cell (leakage). It is + allowing the um to Consult pump return to dosing tank, your installer immediatei g the correct amounts. Y for advice. 5• Neg lect erosion of the vegetative cover (the cells insulation & traffic p can lead to also can destroy t he s failure. Compactioci or heavy REGULARLY WATER THE VEGETATION OVERmA It IS the s NECESSARY TO ystem beneath IS NOT alone t0 EM'! Effluent in grass cover, sufficient maintain a 6 • Periodic In spections by the owner or his agents, is necessary. Inspection Into the system: on n Pipes and ports have been incorporated Inspection Pipes), mound basal area (effluent level laterals p ), cleanout terminals on , at each tip - for flushing e pressurized 9 and cleaning ground cover the tanks (via a locked above out. The filter system in rals person /manhole). Only a licensed & person should be performing this work wisks. Evidence which Iny quali6ied Y r hint involves health system's treatment cell shall also effluent lso be r n I in the regularly ispected. i lf3 e Wisconsin Department of Commerce SOIL EVALUATION REPORT p 1 or 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix 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. 030- 2,7 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. R by Date Personal information you provide may be used for secondary purp w, s. .04 (1) (m)). 6 Property Owner G G Pro rty Location Ed and Kathy Eber ne �` Govt, of SW 1/4 NE 1/4 S 22 T 30 N R 20 E( )W Property Owner's Mailing Address O Lot # Block # Subd. Name or CSM# 1455 Pine Tree Lan �`J� % N _ Aje&rs _4 13 o vy 9S City State Zip Code P ne Number�y. FF F, � Village own Nearest Road Hudson WI 54016 ( ) 5 tUG Pine Tree Lane t Joseph © New Construction UseE] Residential /Numb of bedrooms 3 Code derived design flow rate GPD E] Replacement Public or commercial - Describe: Parent material L ness over nutwash Flood Plain elevation if applicable XT�4 ft. General comments and r�e(ArllmendatlOnS: /dl Z arL (Jl ,r Gvaswy ntkC 4r vey�� cove,- so 1 1wc11 d��e ,;f is /s, 14e alse *, fdt¢ S c,( (z e{5 W�r� ve, rY 1❑ Boring # 11 Boring Q pit Ground surface elev. 95.95 ft. Depth to limiting factor >92 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQff in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. "Efr#1 "Eff#2 1 0 -4 10yr3/4 is 2msbk mvfr cs 2f .7 ✓ 1.2 2 4-60 7 5 4/6 is 2msbk mvfr cs If ,7 1.2 3 60 -92 7.5yr4/4 Is* 2msbk mvfr - - .7 1.2 ❑ 2 Boring # Boring 93.50 >90 Q pit Ground surface elev. ft Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 I "Eff#2 1 0 -4 10yr3 /4 is 2msbk mvfr cs 2f .7 ✓ 1.2 2 4-58 1 7.5 4/6 is 2msbk mvfr cs if .7 ,,,( 1.2 3 58 -90 7.5yr4/4 Is* 2msbk mvfr - _ .7 1.2 " 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 CST Number Thomas C Nelson —'� 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 10/31/02 715- 246 -2454 E!F,L Property Owner Eberline Parcel ID # Page 2 of 3 Boring — M eing # Q pit Ground surface elev. 94.30 ft Depth to limiting factor >90 in. 17So1�lApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 1 0 -9 10yr3/4 - is 2msbk mvfr cs 2f .7 ✓ 1.2 2 9 -90 7.5 4/6 - is 2msbk mvfr - - .7 ✓ 1.2 a Boring # ppit Boring 92.70 >91 Ground surface elev. ft. Depth to limiting factor in. Soil Application 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 1 0 -9 10yr3/4 - is 2msbk mvfr cs 2f .7 1.2 2 9 -91 is 2msbk mvfr - - .7 J 1.2 a la Boring # BBoring Ground surface elev. ft. Depth to limiting factor in. pit Soil Application 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 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. S13D- 8330Tesc(R.07 /00) y s www.e ?OhNrth tAl6y�lt �1S -t46 -244 D eb I L e S 1 � o � t (J rA v) SW Zaaner6r�0k 914,ker 0 0 sgil Cover BI AS 50 11,10 117 ,3$7 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer bUl Rta U- 1-�Af e a A) E Mailing Address Property Address 14 o u L T o N j UJT , , 11 (Verification required r T om Planning Department for new c nstruction) City /State f, O wl-IJ AI, VIL Parcel Identification Number �/ i.F,GAT. DESC-- RIPTNIN i r r _ I., A 2 �uuFn �� GY to fro' ' 11�t...+�J u1 � St-.cRoy�C cau.n�"y, t�cd�• Property Location '/4, 5 1 /4, Sec. ZZ , T 3 D N -R' W, Town of sr J asz5Pk Subdivision 39U'v"'W , Lot # Certified Survey Map # olume age # Warranty Deed # q `.Z 1 1 a2 4 , Volume 7 22 , Page # � Spec house 0 yes no o P /�v 30 - 2-0)-6 - 30 SXSTFM MAINTF.NANCR 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, 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 the three year expiration date. SIGNATURE OF APPLICANT = DATE t"1WNRR C"FRTMrATION 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 4 warranty } deed r o in Register of Deeds Office. GCS 4-y- fCw'L It ! ca SIGNATURE OF 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 rxx :U14rNT MCI. WAFi1�ANTY UEkD :•1. k M I" "1. Mr:�.m STAT& BAR OF WISCON:11N "M'K ! 19" 4 = - - - -- - REGISTER`S 0MM St aM CO Rac • o d ....................... .... ............. ............................... ....... .. vtctar: ._._.. .... . ................ : :...... - JAN 2 0 )993 e«►vcyo ard • Narren!a is .• F4 a K •........ 1:20 P4M .......Ebexxine.�..hlaaband.ec xtte .... ..... ..... . ... . .... _............ .......... ... .. .... . ......................... ............... ...... . 71do y ... ............................. ... »•....... .... .. ............................... . ........ '.:2'_..: :i' _•Th'�3.�TST.tV.'.'i'.?•.'� ;` y. ................ ...... ....—_............. �IrtYUNN 70 f: . .. ,. .................. ............. ........ - •�.. .::::::::::.::::: .::.:::::::::.:.':.::::........ ...- '- __............. 0 - � Da�o��0 -DO0 j the following described teal estate in ............ . 661i - I.0 X .......... •_ Stato of Wisconslat T ex Par_el No :........ ...................... Fart of Lot 2, Section 22 'lbmiship 30 Math Range 20 West, St. Croix a3 follows: Urmn -acing at, a point 20 rode West Comity Wisconsin described (� aixl lb rods North of the S9 con icr of said Lot 2; thence ?Jbrth 1.0 rods; therAce West 12 rods, thence 5.xit 10 rods; t rierce Fast 12 tM,xls to the place of begirvAng, subject to an eawtpuit r. f i�f��t- .�f -xtIy over the Hest t roes it the pr�ei!dses herein conveyed, together vd Ji grar:l�or's rights in the right of way easeuent describes! in Vol. "320", Fee 91 and the tmt:Pr a8 t described in Vol. "339 ", Page 187 of the records in the Register of Deeds for St. Croix County Wisconsin. 1 ills .t��• ' FEB This ... ..... homestead prepa+rty, i (Is) (is vkA) Excoptioa to warrantiest eanemetits, restrictions ate righter -of -l' of record,. if erq►. k E Dated this . .............. "Y of ........'..ra . ...... .. .. ...... ... .� . . .... ............... ..........(St;As.) Ls AL) �.. ..» .........» ..:....... . Q il9.... .......... l$SA[.) ..... .....(SRAL) ... + - AUTHRI ITICATION {. AORNOWLSI)31llaTir stU .... ... ...... 11tAf!! OF WISCONSIN ' ` r ... ». ............_... SL. _ Crolx ..:. ».. :....Cooney aatAesttJeniei tAM day eC ' .., it ..... �.T�srW-7.. son illy eamo before mo is . M- » --.Alky of ..........« ........... «..» ...._...... ._. "� .......... ......... Lill. tb abueo gained x,. N # TITLS :MEMBER >s'lATi BAIL OF Wt9c:ON13rN ,_.. ..lfE.Ot� - CIS•. EMIs.I » •- me Itrosrn�lo M ely q�uted jillfrrM�t,S�I�RYtM,,C,,N,T �a� ptAFliO OY • � .... � r . «w » :AK�iIOL�.4J� y �gr� .t. . .. d. A-1-1 - I. ""^"` € A 'At4orney atr. tart _ .' Mice Joy �. ....... .. L , ,. �wi,.....► lwN: i. e..«.. w• +.w+ti ;•i.•Y....1........ • N.6=7 ... ... .. . �.. Ow ' j • .� t `r `wet ua !o aateeirnteA es aeMroakAga(. &�eh>r Chernl+aWa M peraa��ent. (tt not, ttah osratlos .. . �lts.wt st' �atdea M IM'r MMNiS• *•nN ti► dw wI rr6N _ ,. punts! . � ; . .437 B 437 F 437 E . I A�,tt � ^ 'n v ' , Iv' 437 A I 438 F SE //4 2 438 C 438 A LOT I 4 2 L .C:s 438 B 490/33 438 G M � q �,p14G9/g�t 438 E 438 D 438-J DR. ! STATE HWY.