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HomeMy WebLinkAbout030-2034-60-000 Wisconsin Department of CornQ,4rce w PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430530 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: Carlson, Val J. & Mar aret St. Joseph Township 030- 2034 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: e, 24.30.20.465B TANK INFORMATION ALEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I Benchmark b 0 C 3. � D A03 /0 loo. a Dosing Alt. BM le Aeration Bldg. S ?� /0, Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i 7 i O Dt Bottom A Dosing Header /Man. `� 7j �,1�1 Aeration i i 2. L 7 t Dis P ! ? O �2 Holding Bot. System ,/ rP P',�J {o e PUMP /SIPHON INFORMATION Final Grade q q / $ � Z q Manufacturer Demand St Cover GPM <- o ( V ` 57 IL Mod umber TDH Li Friction Loss System Head TDH Ft r Z '1� )i /fl For main Length ia. Dist. to Well SOIL ABSORPTION SYSTEM t BED/TRENCH Width 7 Length No. Of Trenches L -fy �.µ�, PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '� zl'� IS 'n aL SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: u CHAMBER OR - 2 Sr� / UNIT Model Number: DISTRIBUTION SYSTEM C� ` Header /Manifold Distribution ` x Hole Size x Hole Spacing Vent to Air Intake / Length Dia Length is Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Mulched Bed/Trenc en er es -- Topsei+- No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: ll / d/ r•- Location: 1497 23rd St. Houlton, WI 54082 (NE 1/4 NW 1/4 24 T30N R20W) NA Lot � No: 24.30.20.4656 1.) Alt BM Description= l Z, 2. Bldg ewer length 9 9 I , - amount of cover = 6 q nnah W e, f►W —/ No Plan Use other de for additional information. ! I -- L — - - -- —_L✓ ` -- - - - - -- -- - ... — -J _ je r SBD - 6710 (R.3/97) Date Insepctor's Signature No. I RECEIVED as I fety Buildings Division County 201 Was ington Ave., P.O. Box 7082 C' VA s"evn /�T. C I N X F I Nl�' adi � WI 53707 — 7082 Sanitary Permit Number (to be filled in by Co.) ■� ZONIN OFFICE 8)261 -6546 � 3 D Department of Com !' Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide - -� may be used for secondary purposes Privacy Law, x15.04(1 xm) Project Address (if different than mailing address) I. Application Information — Please Print All Information Sa—Ae— Owner's Name Parcel # Lot # Block # �� I . ' ryl�ke�.keE� ✓� . L.� �ec,so,J 030 —a 03V 4o -ooh .`f65 - 6 Property Owner's Mailing Address Property Location /Y a3 "-esk-, City State Zip Code Phone Number a N W Y, Section ;TOKL.'�O� wl. S�d 1 7 1 5 - S G}l7� T ..3O N; R�E lael IL Type of Building (check all that apply) X 1 or 2 Family Dwelling — Number of Bedrooms �� T!� EF Subdivision Name CSM Number ❑ Public/Commercial — Describe Use AJ A ❑ State Owned — Describe Use 2 ` ?c R 3 • ❑City! ❑village o ro o 0 IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) - A. ❑ New System Replacement System ❑ Treatment/HokGng Tank Replacement Only ❑ Other Modification to Existing System B • ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. of POWTS S stem: Check all that a 1 K Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ COnsMsOled Wetland ❑ Pressurized in -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pi ❑ Other (explain) V. Dix al/Treatment Area Information: Design ow (gpd) Design Soil A plication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tarts Septic err Holding Teak � l�'O ! �E �tf Aerobic Treatment Unit Dosing Chamber VII. Responsibility Sta tement - I, the undersigned, assume mspom bility for installation of the POWTS shown on the attached plans. Pl 's Name (Print) Plum Si MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zi Code) VQI. Court /D artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued uin gent Signature o Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial 25D IX. Conditions of Approval/Reasons for Disapproval 3) SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced ! maintained v"o�Ci t - �o S as per management plan provided by plumber. aQ 2. All setback requirements must be maintained as per applicable code /ordinances. 4) UIIA � 01 x - �e�s "_4 8• c� / Attach complete plans (to the County only) for the system on paper mot less than 81/2 x I1 Inc In sift 7 , V � SBD -6398 (R. 08/02) �3 s•r - ...P 1 7. Exl bT�NG PLOT & CRO" 86CTMM PLANE L1PPA oRW. ExCAYAIWO m � — oclTiaJ z / " PROJECT V L ertQ�S4OJ ex isTiv - Jr. 1 �/ Poi �4 ss v -r�Juc Ef s �a adsx o.v M 13 — 8o�rro•►+ of a S� iN4. EVK 4 qe PIA M 3*eoFkAelSr:Q �go.rc E�KIf ENO �T AI- CWh000 eokt.. LJrt-S � � .r� g _ _ Sic. T•aooc ��rN ,��rBt� S A /400 • ' o tJ: • <gene- 38' ---� q'3 . �S A #JJ JLJiY � - s - C Ak A T N COPY 4 w E r Peop A-voF •T�Q�o��o c�85�t'vr� Chi uceNSe: �22 4/ t7 S!Z DATE: /� CJ y o F N iSl1 IvPAgL Arc i5, N yo Pot plLTeePNq By: M ^Jr) � my ..... M � A T o A i ' AJ J 5 M GF hpE Side View 64VA'T 1 014 1 � 9 AJC N 6i ro.v% rt4 Cv,& TLST Lt • Fwd View T tSO t _ S i - 9s s,• � D / Ac f T"hr' Mo oc L S I DfW.� �Q � GN C.� • �3 5� --� ...PUS �xt 4TiNG PLOT k CROee SECTION PLANS IAPPA OROe. EKCAVAWA IM WEU PWMam UMT / ` / " PROJECT V t �i�E4d s GG ,P .dlr�uf -S LX15 T�it1(� N 8otrom or ��,,,•�- ��gs6eJ.tr Prot • f44# ENO + / AIFW /noo ev4L- U1lE59? th V00 lcli-n6c _ I - tt 13.75 �x � sT.,�� S �" T AIF /Es to Ca pE PQoP -4 810t�D• Ti4+�F.r10c,0 C�BSE�t'Vt�1'i�ru,� LICENSE: r7 S DATE: • � Mk�ci mNM I.?' i4$oJF ��tSH �Qh4£ F..u,sN �oR,ogE Ac 5c N yo 801 0Y: TEBTIIdq To � /NOSH G4hpE Side View &gVATIjA I�EAc Bovw so,,, TcsT I / End View T / ` ` 15 .z SI �£W �•�l ��R ��GH efMACiT1r' MvDEL f' - RECEIVED 1739 Wisconsin Department of Commerce SOIL EVALUATION REPORT page NOV 05 Z,003 1 of 3 Division of Safety and Buildings in accordanc omm t;5, is. Adm. Code A.C.E. Soil &Site Evaluations County Attach complete site plan on paper not 43 thafl% Cfl(i UW(@Wbff )Plan in t St. Croix include, but not limited to: vertical and ontal rai®300)6Il'WEjirection percent slope, scale or dimemsions, n rest road. Parcel I. D. 030 - 52034 -60 -000 Please print all infsormabon. R= By Date Personal information you provide may be used for secondary pxposes (Privacy Law, s. 15.04 (1) (m)). �aV Il ZG7 Property Owner Property Location Val J. & Margaret Calrson Govt. Lot NE 1/4 NW 1/4 S 24 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1497 23rd Street na na Na City State Zip Code Phone Number J City J Village r/ Town Nearest Road Stillwater I MN 1 55082 715 - 594 - 6776 5T• 23Rd Street J New Construction Use: Y' Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD V1 Replacement I Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at elev. 89.00' using 30 leaching chambers. Boring # J Boring Pit Ground Surface elev. 98.22 ft. Depth to limiting factor >171" in• Sal 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 1 0 10yr3/4 none tfs lfsbk ds cs 2fmc 0.4 0.6 Jo 2 8-19 10yr4/3 none Ifs 1 msbk ds cs 2fm,1 c 0.4 0.6 3 19-26 7.5yr4/6 none sI 2msbk dsh cw 2f,1m 0.5 0.9 4 26 -56 10yr5/4 none sl 2fsbk ds cw lfm 0.5 0.9 5 56-95 10yr5/4 none strat s 0 sg dl gw - 0.5 0.9 6 95 -171 1 Oyr5/6 none strat. s 0 sg dl - - 0.5 0.9 H's #5 & 6 contain 1 /8" -1 /2" bands of 10yr414 Om Is at 9" -16" intervals. Loading rate reduced to reflect reduced permiability of horizon associated with banding. Boring # J Ong 0 Pit Ground Surface elev. 95.09 ft. Depth to limiting factor >135" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 * ff#2 1 0 -8 10yr3/4 none Ifs lfsbk ds cs 2f,lm 0.4 0.6 2 8-22 10yr4/3 none Ifs 1 msbk ds cs 2f,1 m 0.4 0.6 3 22 -40 7.5yr4/6 none sl 2msbk dsh cw 1fm 0.5 0.9 4 40-78 10yr5/4 none strat s&Is 2msbk ds cw - 0.5 0.9 5 78-135 10yr5/6 none s 0 ag dl - - 0.7 1.2 H#4 contains several bands of 1 Om Is too numerous to differentiate. Loading rate reduced to reflect reduced permiability of horizon associated with banding. * Effluent #1 = BOD ? 30 < 220 T i and TSS >30 < 50 mg/L * Effluent #2 = BOD <30 mg/L and TSS <30 mg/L CST Name (Please Print) Sig re: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, , WI 54020 10/282003 715 - 248 -7767 Property Owner Val 1. & Margaret Calrson Parcel ID # 030 - 52034 - 60-000 Page 2 of 3 a Boring # - Boring 96.38 ft. Depth to limiting factor > 148" in. Pit Ground Surface elev. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr3/4 none Ifs 1fsbk ds cs 2fmc 0.4 0.6 2 6 -16 10yr4/3 none Ifs 1 msbk ds cs 2fm,1 c 0.4 0.6 3 16-22 7.5yr4/6 none sl 2msbk dsh cw 20m 0.5 0.9 4 22 -50 10yr5/4 none sil 2fsbk ds cvv 1fm 0.5 0.8 5 50-54 10yr5/4 f1f 7.5yr5/8 sil 1fsbk ds aw 1f 0.2 0.3 6 54 -148 10yr5/6 none strat s 0 sg dl F - - 0.5 0.9 Gomm.85.30(3)2 appplied to discount Rdox. features found in H#5 as indicator of seasonally saturated soil. Many sift coats on ped fads in H#4 & 5. H#6 contains 119' -1 /2" bands of 10yr4/4 0m Is at S' - 20° intervals. Loading rate reduced. ❑ Boring # I Boring Pit _J Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring #ng J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary I Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff ll *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. 1f 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. r �i SOi /¢[�G /ua�on � leda -won /aca - �c cl �orq�- .gEak'c 73f ,C o. a E itli e /,e a f too oPbu.'/d, 9 " 6mde aE (�' wrdeiti� Gtaaea SyStcm a, e.A: 97SC''- 3 �- W ert hole AI4--.&M. Top of /SOS 51'" 4 lvo/ of E?'is�in �b t c L` 5u viCk olc v t ? ) 3 b�droon Assn ++calo /ev Vic AV 01C ,0/n /iC�Elon of Olt ,6anbandon a5 o , ��- •O dZ /6',� S / cyoe Aba.,obtf aS�cacic. �. 3o4'.3 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page —/—of o� FILE INFORMATION SYSTEM SPECIFICATIONS Owner 4_ ,1 vo1` r^ o'j -Septic Tank Capacity 02 o a gal ❑ NA Permit # 4 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model 04 ❑ NA Number of Public Facility Units ® NA Pump Tank Capacity a l Cl NA Estimated flow (average) p p gal/day Pump Tank Manufacturer ® NA Design flow (peak), (Estimated x 1.5) 'IS p g al/day Pump Manufacturer 0 NA Soil Application Rate , S gal/day/ft 2 Pump Model ® NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ® NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L 19 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ® NA Other: ® NA Other: ® NA "Values typical for domestic wastewater and septic tank effluent. Other: ® NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ® ea�(s)(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 13 month(s) (Maximum 3 years) 13 NA A M year(s) Clean effluent filter At least once every: 4x ❑ NA yearls) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ® NA ❑ yearls) Flush laterals and p ressure test At least once eve ❑ y mon Ed NA P ever 13 yearls) Other: At least once every: ❑ month(s) ® NA ❑ yearls) Other: 19 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for, any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. I When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed'by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) i - Page A of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 0 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure df the POWTS a soil and site evaluation must be performed to locate a suitable . replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone _ Phone _ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name - Phone / _ coZ/ Phone _ c This document was drafted in compliance with chapter Comm 83.22(2I(bl0)(d) &(f► and 83.54(1), (2) & (31, Wisconsin Administrative Code. I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address A F 7' WL,i — o.,i ! �y U�� - �/ /.� Property Address % 9 ? - ��it d S i .�i�u c�v� �✓ . .�`y y�oL - (Verification required required from Planning Department for new construction) City /State t> �c Parcel Identification Number O.?o . ko y- KO - o a o LEGAL DESCRIPTION EE- Property Location /� ' /4, Sec. �, TAN -R a20 W, Town of Subdivision A/A • , Lot # -vv . Certified Survey Map # , Volume , Page # Warranty Deed # - ,Volume %sl , Page # Spec house ❑ yes W no Lot lines identifiable N 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 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. 0 / o X I E OF PLIC T DATE CERTIFIC e) 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. A SI F A 51C Ti DATE �j * * ** y information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I N U M B E R 90 ABS TRAC - T OF TITLE Vo the following described `!Zeal Estate situated in ST. CROIX COUNTY, WISCONSIN N 200 feet of W 200 feet of NEk of NW's' of Seetion 24- 30 -20. PREPARED FOR • V R #1 Sti1lv�ater, Minnesota ST. CROIX COUNTY ABSTRACT CO. 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W.-Ca" O (a 0 e • CU 4 to 5 cu fu - Att.i•- a 611 ° tii:3 r u p x Olt �' yq O O oe w m y 0 Y>• w 1 ma Z " V N — Z CU _i . C � , 3 yy � ♦♦ �r (/ J �� J W o z Y LL ►•� la ai.ii'd ` �Y7 YIV Y�1 = Z Q y"W cIIp w a F Y OQ r ad W < Wce F W d W O W 3 n n Z Eacl cozz t 1 4915 1 VOL 981PACE 45 REG16 OFFICE SY. � C�•+ «Loan Nt�er : 30- 1- 133535 R Record " NOVI 3 at 10:00 pl1A Reglafer`o� SATISFACTION OF MORTGAGE Legal Description: The North 200.feet of the West 200 feet of the Northeast Quarter of the Northwest Quarter (NE 1/4 of NW 1/4) of Section Twenty -four (24), Township Thirty (30) North, Range Twenty (20) West. Tag Rey Number: 030 - 2034 - 60 I HEREBY CERTIFY, that the mortgage executed by VAL J CARLSON and MARGARET A. CARLSON, Hi -s Wife,, to, .is Administrator of Veterans ,Affairs, an Officer of the United States of America, dated the 12th clay of May , A.D., 1969 , and recorded in the Office of the Register of Deeds for St. Croix County State of Winconsin, in Volume 451 of Mortgages on Page 332 -335 , as N)cument No 296261 is fully paid and satisfied. IN WITNESS WHEREOF I have hereunto set my hand and seal this 1st day of September A.D., 19 92 . Adminiotrator of Veterans Affairs By Loan Guaranty Officer THOMAS M. MALTA. Loan Guaranty Officer pursuant to the delegation of authority S TA TE O F WISCONSIN ) contained in 38 CFR 36.4342 & 36.4520. SS COUNTY OF MILWAUKEE) Personally came before me, this 1st day of September ,A.D, 19 92 0 the ;II)OVe Thomas M. Malta , Loan Guaranty Officer of the Veterans Adminiatratlun, an .1gency of the United Staten Government, known to me to be thr person whose name in subocribed to the foregoing instrument as attorney -in- f.jct f ur EDWARD J. DERWINSKI, Secretary � of Veteran"if.fairs, .111d acknowledged that he executed the same au the act of his principa,k4W ;flge' purpose therein contained. s' +• � `� � A THE TITLE "SECRETARY OF VETERAN" A1 Alliti" a' SHALL BE SUBSTITUTED FOR THAT OF "ADMINISTRATOR TOM G. I31'I "I'tsRS / �' � a •` • OF VETI>3WIS AFFAIRS" EACH TIME THAT IT APPEARS Notary hibtic, Milwaukee CouAty,r IN THIS DOCUMENT PURSUANT TO THI: PROVISIONS OF M conYninsion is permanent. P� SECTION 2, PUB. L. NO. 100 -527, TIi.I•; DEPARTMENT OF VETERANS AFFAIIiS ACT. This instrument drafted h TOM G. BITTER,, ATTORNEY THIS INSTRUMENT DRAFTED BY ATTORNEY VA Fore 02 -466r (330) State of Wisconsin County of St. Croix ss THE ST. CROIX COUNTY ABSTRACT COMPANY hereby certifies that the foregoing abstract consisting of entries No. _ _ _ 60 _ _ to _ _ 6-5 _ _ _, both inclusive, is a correct abstract of title since ------- Eeb - nary_ 28, _ - 196 - 9--- at --- 10---00 _ - o'clock. in the _ _ _ -A_ M. of the lands described in ----- he_ _Caption_ _.t _ Ro.._ 60----- hereof, to -wit: i N 200 feet of W 200 feet of NEB of NW4 of Section 24- 30 -20. That, for the period covered by this certificate, said abstract correctly shows all matters affecting or relating to the said title which are recorded or filed for record in the office of the Register of Deeds of said County, including Federal Tax Liens and Old Age Assistance Liens filed therein against the parties listed below. This abstract does not include Financing Statements filed in Register of Deeds office for St. Croix County. For the period covered by this certificate, except as shown by this abstract, there are no unsatis- fied mechanic or material liens affecting title to such lands docketed in the office of the Clerk of the Cir- cuit Court in said county for the past two years. That, except as shown in this abstract, there are no unsatisfied judgments, including delinquent In- come Taxes, docketed in the office of the Clerk of the Circuit Court in said County within the past ten years, as and against the following named persons which affects the title to the real estate above described, to -wit: John J. Rogalla Marilyn Rogalla Val J. Carlson or Margaret A. Carlson. That for the period covered by this certificate, all instruments appearing in this abstract contain the necessary number of witnesses and acknowledgments unless otherwise noted. We further certify that for the period covered by this certificate that we have carefully examined the records in the office of the County Treasurer for St. Croix County, Wisconsin, and find no record of un- paid taxes or assessments standing as a lien on the real estate described in this abstract, except as shown herein. Such examination covers up to and including the taxes for the year 1968----. That this certificate and annexed abstract and also any prior certificates, if any, made by the un- dersigned, covering the same land, are furnished for the use and benefit of any and all owners of the land described in said caption and their successors in title, including mortgagees and guarantors of title. Dated at Hudson, Wisconsin, this ___ - l5 ----- day of __.May_ A.D. 19_69_ at ---- l0__-00__ o'clock in the --- A.M. ST. C I T T COMPAN B Y- - -- - - - -- - Secr ry SEAL +,;�► ++ Form 3 — 1956