HomeMy WebLinkAbout030-2036-30-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
399521
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:
Weiss, Tom I St. Joseph Township 030 - 2036 -30 -100
CST BM Elev: Insp. BM Elev: BM Description:
L5�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic i / O s Benchmark Z, vZ.
wt,P _
Dosing Alt. BM ( s
7, I r
on Bldg. Sewer
I a 7- 3 y
_t ding S Ht Inlet / r yrr`
(�'
S t Outlet ,
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet n ,
f �^ zv 4
Septic Dt Bottom
Dosing / Header /Man.
Dist. Pipe.23 9 Ay -b
Holding Bot. System UA 4. "' 43.aI�
! 9. y 93 3
PUMP /SIPHON INFORMATION Final Grade
Manufacturer /_ Demand St Cover I2 3
Model Number lJ O
v
TDH Li G Fnctign Loss System Head T i H - Ft
II �
Forcemain Length Dia. Dist. to Well +
Zh S�
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 / Z. s /
SETBACK SYSTEM TO (S � P/L JBLDG IWELL LAKE/STREAM SING Manufactu .
INFORMATION Type Of System: + f 2 H-- A--MtltlBBW OR
' r > i IT Mode umber:
d o > �O
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
L Length Dia Spacing _L 'a
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of eded/Sodded xx Mulched
T
Bed/Trench Center Bed/Trench Edges Topsoil Yes [W No ® Yes [W No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_�/ Z / O L Inspection #2:
Location: 1394County Road V Houlton, WI 54082 (SE 1/4 SE 1/4 24 T30N R20w, NA L9t A Parcel No: 24.30.20.476B
1.) Alt BM Description b�a/�c�. 5
2.) Bldg sewer length
- amou t of cover =
Plan revision Required? ❑ Yes t No
Use other side for additional information.
SBD -6710 (R.3197) Date Insepctor's Sin ure Cart. No.
- Yd
Sanitary Permit Application - Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing thi application PO Box 7302
14 sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x I I inches in size.
County State Sanitary Permit Number ❑ Check if revision to previous application State Plan (. D. Number
ST•cRa�x g5�-t 1S IP►
I. Application Information - Please Print all Information Location:
Property Owner Name Property Location
E 1/4 E /4, S T,30 ,N, R.ZV(or)®
Property Owner's Mailing Address Lot Number Block Number
0 o, Jos 1,4 8 qOU 16 A /V
City, State Zip Code Phone Nuthber 08 Subdivision Name or CSM Number
V �—
/� .S C ) -
II. Type of Building: (check one) ❑ city
1 or 2 Family Dwelling - No. of Bedrooms: 3 / " a ❑ Village
❑ Public /Commercial (describe use):_ ti , `` A Town of
❑ State -Owned
w / Nearest Road
n!
Parcel Tax umbers)
III. Type of Permit: (Check e box on line A , Check bo B if applic le)
A) 1. ❑ New Replacement 3. ❑ R 0lacerQqtl0fR(V*rtX ,� 5. 6. ❑ Addition to
System S stem Tank Existing System
$ Pdrmit r Date Issued
❑ A Sanitary Permit was previously issued
IV. T e T�Syste • heck all that apply)
on- ress uri n_ero and ❑Mound ❑Sand Filter ❑Constructed Wetland
Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
3 - ' 61S
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
7
Required Proposed Rat Ials. /day /sq. ft.) (Min. /inch) Elevation
' /N1ci`L
,.5 3.
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
lI ❑ ❑ ❑ ❑
E / 000 '
B a 11 0 ❑ ❑
G E AS
VIII. Responsibility Statement
I, the under signed, assume responsibility for installation of the POWTS shown on th ched plans.
Plumber's Name (print) Plu a 's Signature (no stamps): RS No. Business Phone Number
9 4kYl
1-5
P lumber's Address (Street, City, State, Zip Code)
S
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued g Agent Signature (No stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee) oo _
Determination 2.2_.S � top �� � -3
X. Conditions of Approval /Reasons for Disa
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FROM :,SCHMTT & SONS EXC PHONE NO. 715 549 6651 Oct. 30 2001 03:42PM P2
0,;"l: , PI'.C:IF' 1"/ 'I 'Ii��
i - - vE Q� CAP
WEATWERPRCoF I i AFFRD'JEO LOC.it h1 C..
l0 I JIIAI CTIOIJ BOX r1A�JHOLE COVEi�.
DOOR, 71 Lpd[E
WIUJ CW OR FRESH 12 "MiLl.
AIR INTAKE
GItAOC I
{
COWDUIT
IAILET PROVIDE { II
AIRTIGHT SERI„
APPROVED JOIWT A I {II °�I j� APPROVED J01NTS
W /C.T. PIPE I I I W/C.X. PIPE
EXTENDING 3' I { (I ALARM EXTENDING 3'
01�1T0 SOLID SOIL, B I I { . ONTO SOLID SOIL
I I
I I ON. G
E LEV_ FT,
Pu►1P
w OPT
COUCKETE BLOCK
KISCI't EXIT PEKA11TED OAILy IF TANK M ALIUFACTURCR, HAs SUC14 APPROVAL.
SEPTIC E 3PECIFI'CATIOKIS
DOSE
TAUIts IMA►IUFACTIJRElt: WgE k C IJUM90R OF DOSES: PER DA:i
TANK SIZE: 8Qd GALLOWS DOSE VOLUME
A LARM MALIUFACTVIZ£R: _S 'jEPT/loA!/C_ INCLUDIIJ6 DACKFLOW: 1 GALLONS
r "
MODEL WU MBM CAPACITIES: A. _ IUCRES OR % /6.Z �,ALLONS
SWITCH TyPC:
6 =- � INCHES OR �• 6ALLOUS
PUMP MAMUFAF �n� O (L�/� C =INLNES OR GALLOWS
MODEL AWUMBER: - 7S Do INCHES OR J .GALLONt
SWITCH TSIPE: Aff"0 JfQ .. � Al OTE; PUMP A►J�ALARM ARE TO BE. par lv!�
MIM IMUM DISCHARGE RATE Q GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE dCTWEEU PUMP OFF A41D C15TRIBUTIOIJ PIPE._ FEET j, I/
+ n1A11MUM NETWORK SUPPLY PKESSUKE - _ _ ` - A - / FEET
♦ O F
FEET OF FORCE MAIM X 3 "a /aarr,FRICTIo1J FAGTOt. ` �L CC L! FEET
TOTAL Dy1J11 WEAO FEET
IIJTERrJAL. DIMEWSIO►JE OF TAQK: LEl ;WIbTH - ;LIQUID DEPTH
51GUED LICEtiISE LIUr16ER: .Z1.�7Y/ DATE Vie O`O
FROM :,SCHMTT & SONS EXC PHONE NO. 715 549 6651 Oct. 30 2001 03:43PM P3
FA
8–
25—
0 � 1 N
Zv-
S2
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0
0
LON5 10 2 G 3o so 59 t>C 70 80
6C tEC 240
FLOW PER WMJT:
MODEL 98 60
M-LE
i..l
rti
F 9 It Gallons hiMer's Ott–.
7 7
L 23,
G" I cis i I T 2
F-
4 3/16
CONSULT FACTORY FOR SPECIAL APPLICATIONS
E!wctrical altemazars, for duplex systems, are available and - Variable level ffoat switches are available for corittAling single
supplitrd with an alarm. and three phase systems.
• Mechanical alternators, for duplex systems, are available . Double piggyback variable level Boat switches are available
with or vAt"ut alarm Switches. for variable level long cycle controls.
SILECTIOlid GViVE
I • Intagmi Roe aperilwi 2 Pole rriecharll"I switch, no extemal control required.
Standard all models - Weight 39 lbs. � 1 /2 KIP- 2, Single pjqqybdl* variable fouel float switch or double plgMFbai* vaAable level,
96 we$ Control Soleaffam floillit SM61). Roller to FIV10477.
Made: _' volis-pil Made Am pt simplex Duplex 3. Mechanical aMmsft( 10-0072 or 100075.
MIX 115 1 Au§z -9.4 1 4- Sm FMO712, for correct modal of P—lecWcal AKgrnallaf,
rm i15 1 ►on 94 2 a 2 6 3 or 4 ri 3• Cortrol switch 10-0225 used ac a oDnirot . activator, specify duplex (3) or (4)
ON 230 1 Atiic .7 1 or i & 7 float tyswrn,
k Four (4) halo JuPak, junction box, for w4ftrught connection or wtracwn
EBB 23U 1 i Non 4�7 1 2 7— 1 — aimpleX or duplex aperaition, i 0-00Q.
7, Two (2) helm J-Psk, for watertight annnocItion or splice,
CAUTJOR
For idx Pr. wid ZW!w prwae new 5o =a" an PWARck Variable Love! 8w.k.*.46, Ail installation of contpols, protection devices and wiring snouki be done by a qualiflea
lice nzed dectriclan, All Occtrical " siatety codes should be followed Fnc(udi" the.no2t
recent National fl*ctric Code INECI, and ft Occupational sir" and Health Act (OSHA;.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered info the design of every Zoeller pump.
U4fL M; a ,o, 60X 18347
Lo wlii 3
SW TO. 3649cairlopuft 47
Pow
LM&WO, XY 4021 MW
FAX(6G4 7743624
POWTS OWNER MANUAL 8L !I"1HIrh�L� aci�r� r�r�i.
r
INFORMATION Septic SPECIFICATIONS
Owner Septic Tank Capacity - /040 gal ❑ NA
Permit # qq S Septic Tank Manufacturer t- c� G�2�_ C3 NA
DESIGN PARAMETERS Effluent Filter Manufacturer ,p ❑ NA
Number of Bedrooms
C3 NA. Effluent Filter Model r 41 pp ❑ NA
Number of Commercial Units )23 NA Pump Tank Capacity g ov gal ❑ NA
Estimated Bow (average) O gal /day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer qghej[Z,_ ❑ NA
Soil Application Rate 4 Cum— gaVday/ft Pump Model ❑ NA
Monthly average* Pretreatment Unit ❑ NA
Influent/Effluent Quality ❑ Sand /Gravel Filter ❑ Peat Filter
Fats, Oil lT Grease (FOG) :_30 mg/L ❑ Mechanical Aeration ❑ Wetland
Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Disinfection ❑ Other:
Total Suspended Solids ( TSS) x150 mg /L Manufacturer
Pretreated Effluent Quality ❑ NA Monthly average* * Dispersal Cell(s)
Biochemical Oxygen Demand (BODs) :530 mg/L ❑ In- ;round (gravity) a1fi ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ At -grade ❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100m1 1 ❑ Drip -line ❑ Other:
Maximum Effluent Particle Size inch diameter
* Values typical for domestic (non - commercial) wastewater and septic
tank effluent.
* * Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s)
At least once every ❑ months years) (Maximum 3 yrs.)
Pump out contents of tank(s) When combined sludge and scum equals one -third (31) of tank volume
Inspect dispersal cell(s)
At least once every ( ❑ months year(s) (Maximum 3 yrs.)
Clean effluent filter At least once every ❑ months year(s)
y ear(s) ❑ NA
y
Inspect pump, pump controls at.alarm At least once every ❑ months A
Flush laterals and pressure test At least once every
❑ months ❑ year(s)
Other: At least once every ❑ months ❑ year(s) ❑ NA
Other: At least once every ❑ months ❑ year(s) ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Mas
Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintalner; Septage Servicing Operator. Tank inspectio
ken hardwaredentify any cracks or leaks, measure t
must include a visual inspection of the tank(s) to identify n n missing � �t on the grou d surface. The dispersal
volume of combined sludge and scum and to check for y
cell(s) shall be visually inspected to check the effluent levels m indi a a and requir immedi te
the ground surface. The ponding of effluent on the gr ound surface may
notification of the local regulatory authority.
When the combined accumulation of sludge and scum In any tank equals on
(Ys) or more of the tank volume, the Wiscon
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113,
Administrative Code. ts ment components, and
The servicing of effluent filters, mechanical or pressurized e POWTS be performed by a certified POWTS Maintainer. ny other
maintenance or monitoring at intervals of 12 mon ths
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment ce11(s) s I high concentrations are detected have the Conte
that may impede the treatment process and /or damage the dispersal
o% t rhn ranlr(sl rpmovpd by i sentag servicing operator prior to use.
Pace .,. —Of.._
System start up shall not occur when soil conditions are frozen at On Inflltradve surface.
During power outages pump tanks may fill above normal hlghwater levels. When power Is restored the excess wastewater will be
discharged to the dispersal cells) 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 Maintalner to assist in manually operating the pump controb to
restore ncrmal 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-trade sod absorption area.
Reduction or elimination of the following from the wastewater Wearn may improve the performance and prolong the lift of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs, degreasers; dental floss; diapers; disinfectants; (at;
foundation draln (sump pump) water; fruit and vegetable peelings, gasoline; grease; herbicides; meat scraps; medications; oil;
painting croducu: pesticides; sanitary napkins: tampons; and water softener brine.
ASANDOMEMENT
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 ch. Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings scaled,
• 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, g:-avel or another Inert solid material.
CONTINGENCY PLAN
If the POWTS falls and cannot be repaired the (ollowing measures have been, or must be taken, to provide a code Compliant
replacement system:
O A soluble replacement area has been evaluated and may be utilized for the loadon 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 ernes 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 rnust
comply with the rules In effect at that time.
O A suitable replacement area is not available due to setback and /or sod limitations. barring advanos 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 of the POWTS a soli and site
evaivadon must be performed to locate a suitable replacefanent area. If no replacement area is available a holding tank may
be installed as a last resort to replace the failed POWTS,
O Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat at the
Inf itrative 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 TKE INTERIOR OF A TANK MAY BE DIFFICULT OR
INPMURI F.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone 7 ! S"- S — C-ES 1 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) WCAL REGULATORY AUTHORITY
F—t4lame-L Ageney 5A •C i
Phon•
' 1068
SOIL EVALUATION REPORT
Wisconsin Department of Commerce Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.
Please print al • .
1 ; Reviewed §Y Date
Personal intbrmation you provide may siQr Law, s. 15.04 (1) (m)).
�• to 3a Of
Property Owner ,, �' 7 Property Location
Weiss, Tom & Donna \�, Govt. Lot na SE 1/4 SE 1/4 S 24 T 30 N R 20 W
Property Owner's Mailing Add i Y ` Lot # Block # I Subd. Name or CSM#
P.O. Box 168' i f r 7nn4 ua na na CSM
City Stag Zip CoV er 1 : � City Village 0 Town Nearest Road
Lake Elmo 55042 - 549 St.J oseph Cty. Rd. V
New Construction Use: I h / Num ooms 3 Code derived design flow rate 450 GPD
Replacement c�or�c�r 5i scribe:
Parent material Pitted glacial drift Flood plain elevation, if applicable na
General comments
and recommendations: Area suitable for a conventional system with a 0.5 gpd /sgft rating. Three trenches recommended, with a
possible elevation of 93.3'.
Boring # J Boring
jo Pit Ground Surface elev. 99.31 ft. Depth to limiting factor >115 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fN
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -8 1Oyr3 /3 none I 2fsbk mfr cs 1f .5 .8
2 8-30 10yr5 /4 none Is 1msbk mfr gw 1f .7 1.2
3 3 39 10yr5/6 none cos Osg mfr gw --- - -- .7 1.6
4 31- 61 5yr4/4 none scl 3fsbk mfr cnr - ----- .4 .6
5 67-115 1Oyr5/6 none ms Osg ml - --- -- .7 1.2
?L
3�3
Boring # ..J Boring
if Pit Ground Surface elev. 99.08 ft. Depth to limiting factor >112 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f1
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -10 10yr3/3 none sil 2fsbk mfr gw 1f .5 .8
2 10 -26 10yr4/6 none scl 3fsbk mfr gw 1f .4 .6
3 215 7.5yr4/4 none sl 2msbk mfr gw 1 f .5 .9
4 4W1 12 1Oyr5/4 none ms Osg mfr -- ----- .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 J. Schmitt .,,�Ltorvcoe , 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
586 Valley View Trail, Somerset, WI 54025 7/21/01 715- 549 -6651
Property Owner Weiss, Tom & Donna Parcel ID # Page 2 of 3
F3 ] Boring # =j Boring
A Pit Ground Surface elev. 97.03 ft. Depth to limiting factor > 100 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots UP
In. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh, " Eff#1 'Eff#2
1 0 -6 10yr3/3 none I 2fsbk mfr CS 1 f .5 .8
2 6-11 10yr4/4 none grsl 2msbk mfr gw 1f .5 .9
F 11 -33 7.5yr4/4 none SI 2msbk mfr gw - ---- .5 .9
3
4 3 -100 10yr5/4 none SI 2msbk mvfr -- -- -- .5 .9
R33`
❑ Boring # Boring
� f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil 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
F-1 Boring # j Boring
j Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate
Ro Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
" Effluent #1 = BOD 5 > 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
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 1,01-7
Mailing Address /p A ) �o x' 16-8 L AIC257 -1 - rya ZZI V SSo y
Property Address c u - '- 62
(Verification required from Planning Department for new construction)
030 „2036 - 30_ /00
City /State gwt-raaz LU/ - Parcel Identification Number 10A- 03 - 1D - 1496
LEGAL DESCRIPTION
Property Location 5 L V4, S , ' V4, Sec. - q . T _ N- R Town of 5T 7--s =a s/ .
Subdivision Lot #
Certified Survey Map # . Volume , Page #
warranty Deed # _ g 2l . Volume :21!2 . Page # 7 S
Spec house ❑ yes 93 no Lot lines identifiable 01 yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic syst nance
em could result in its premature failure to handle wastes. Proper mainte
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
mastorplumber, joumeymanplumber, 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.
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- c�e�thm 30
stating that your septic system has been maintained must be completed and returned to the St. Croix Cr ; , ,y Z
da of th year expiration date.
IW-M OF APPLICANT
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 property described above, b
,viriue of a warranty deed recorded in Register of Deeds Office. ZI rl a
OF APPLICANT
« « « « «« 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
WARRANTY_ DEED
DOCUMENT NO. TWIG $ 11-Act R<sERVto FOR R[COR01N4
STATE BAR OF WISCONSIN FORM Y —im
�6 .Yk 719PAGE17
0013TM OFFKX
Keith E. Warlin and Linda C. Warlin , $1. COX CO. W tS,,
........... . . -. ......- ...............� . -.... _.......... ......................9... . -. . . ,
. ....... - ..Wxfe.. - ued.1fw Rowd fibs 23rd
.... . . ... . .. ...............................
...... - -• . . .... .......... ........... . ... .............................................................. Y of ugma_ 19 85
... ..... ........ .. .......... - --• ............... ...... • .............. ...... ...........................• - -- :25 P
conveys and warrants to ...... Thomas. J.... Weis B- ..and._.... ..................
Donn J...weass- .- ..lausba�:.: ..and..wa fe, as
........... "
. ..... 19. int.. ten. ant -s.- and_ riot ... as..- Lenante..i 'n ...................
_.... common.._- ................ . -• - - -• .. .. ..................... ...•-- ...............- •........
................. . . . . .. ...-- .............- • - - - - -- ••---- ....---- - - - -•- - - -- - - -. -- --.--- ......... _
. -- -. ..... ... ................ ... ......... •-- ......... .......... - .......... ..... ....... RETURN TO
. ... .. . ...... ............... ........ ............... ........ . '-- ........ - -- ........ ........ . .
the following described .eal estate in ... ...... . . .. a.- cr4iX- ...... ....... county,
State of Wisconfin:
Tax Parcel No: ..............................
Part of the Southeast Quarter of the Southeast Quarter (SEk of SE'h) of
Section Twenty -four (24) and part of the Northeast Quarter of the
Northeast Quarter (NEk of NEh) of Section Twanty -five (25), all in
Township Thirty (30), Range Twenty (20), described as follows:
Commencing at the SE corner of said Section 24, said corner being
the point of beginning of this description; thence N00 0 38 1 20 "E along
E line of SEh, 338.3 feet; thence S89 °21 11 W 1287.86 feet to W line
of SE4 of SEk; thence S00 0 39 1 55 "W along said line 338.3 feet to NW
corner of NEC of NEh of Section 25; thence S00 0 36 1 39 "W along the W
line of said NEh of AEh 338.18 feet; thence N89 °21 "E 1288.58 feet
to E line of NEh of Section 25; thence N00 0 30 1 53 "E along said line
338.17 feet to the point of beginning.
>, r
This ... ....... ... ..... ...... homestead property. f
(is) (is not)
Exception to warranties:
Dated this .. ... --- rX �'�f�- .... day of ......... ! _ .......... ... •.
- - (SEAL) ......... . .... . ...... -• �.. (SEAL)
• .. Ke -' W
i
-- - -- - -- .- -------- ............................ .. .... ..(SEAL) r.. (SEAL)
t
• Linda C. Watling
AUTHENTICATION ACKNOWLEDGMENT
Signature (s) STATE OF
MINNESOTA
----•--------------------------------•----._.....--- ...----------- •--- •--- -• - - -- Washin ton - - -- �
-- - - - - -•
.-.. - �3.. - - County.
authenticated this ........ day of ..................... ...... 19 ...... Personally came before me this .--- . - - -. -- _.- -day of
.......... . ...................... .......... 19 -$5.. the above named
.................................. -- --- --•----------------- -----------
- --•- --
__..... _ E.__ Watling __and - _ L nd_a,_
TITLE: MEMBER STATE BAR OF WISCONSIN ° _Warling_,___husband__and_ • Wlfe- ,- __- _••- • -. -__
........................................... .....................................
(If not ................................. --
authorized by § 406.06. Wis. StateJ •---•-•- •--- •- - - ---• •--- --••-- • - -• -- to me known to be the person *- ---- - -_. -- who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
T� 1a.- J,.__Eckber ---- •----------------- - - - - -- -- -- ••-------- - - - - -- ------ ..............
g----------------------- •---- - - - - -- '
1 3J Northwestern Av nue •- .?- C:Tu?. -�11.- �
--- .S -tx. _l water'...V"-�'_ ..... .. Washin_ o
tn
Data *y Public -•--- • -•- --.- ... �-- - -• --- • -- -- County. 1'15. Minn.
(Signatures may be. authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration
..are not necessary.)
d ate: ................. .. ��, w....La;.- ...:.:.. �A&'VIM1MAMil,
" T": 1 1
li. IIIARWY
�NAm�A of Verson..igning in Any CAP&eltY Should be tYVed or,printed below their SicnAtur".
IICYNS.rGSrgAny RTATR BAR OF WISCONSIN •7;r:r;�, Sf ® 'SPC A, 13002 FORA( No. t — 1942