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036-2000-10-000
Wisconsin Department of Commerce County: St. Croix Safety and Building Division • Sanitary Permit No: 430178 0 (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 Township Parcel Tax No: Barnhart, Lynn H. I Stanton Township 036 - 2000 -10 -000 CST BM Elev: ( Insp. BM Elev: BM Description: Section/Town /Range /Map No: . p tee #0 r_C'T 31.31.17.608 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic `Z �� Benchmark / � �• o2 S' 00 .© Dosing r ♦ Alt. BM Aeration Bldg. Sewer 1 Holding St/Ht Inlet �I �Q Q /• D y J St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' 1D 5b' Dt Bottom a tog Dosing Header /Man. • �S 12 • � Aeration Dist. Pipe Holding Bot. System 10• i •sL I �o. sy z •� 3 Final Grade t� Manufacturer Demand St Cover lf_ GPM T Model N ber weo 3 a L F e6t -�• l �?• 10 TDH f . fiction Lo$s System Head TDH t ---- -- S •'91 Forcem L gt4 Width Length " o. Of Trenches No. Of Pits Inside Dia. Liquid Depth 3 bo' A 1 ON SYSTEM TO P/L IBLDG IWELL LAKE /STREAM EMan r: _ � Type f System: i v — -9 �s � l umber O D ( IJMA* Header /Manifold fj Distribution x Hole Size x Hole Spacing Vent to Air Intake Q Pipe(s) � �l Length e Dia Length Dia Spacing Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [,] No I [_,�] Yes [:] No J elude Code discr person present, etc.) Inspection # ?ioo3 Inspection #2: 1823 143rd St reef New Richmond, WI 54017 (SE 1/4 SW 1/4 31'h1N R17W) Hooks Addition Lot 11 31.31.17.608 1.) Alt BM Description = 2.) Bldg sewer length = > - amount of cover = • ""� ��rl�! Plan revision Required? Yes � No �•��� — U o er 'de f r additional infor � __ Insepctor's Signature Cent. safetey sur Bu d Buildings Division l Viscon 20l W. f et y n din Ave —, P.O. $ou TO$2 Sin a Madison, WI 53707 — 7082 Sudwy Permit Number o be filled in by Co.) Department of Commerce ( Sanitary Permit Application State P lea I.D. Number In accord with Comm 8321, Wis. Adm. Code, personal infomution you provide may be used for secondary purposes Privacy Law, sl5.04(i xm) P Address (if diffamt th rail' address I. Application Information - Please Print All Information PAID Property Owner's Name € V l tr Lot « Bloc # Property Mailing Address Property Location 0 sT. b.__.r 3 city, state -� "�+, Vi i,, Section _ Zip Code Phone Nuiaw LL Type of $trilrNiag (cbetk all that apply) (O (0 T `� t N; It W Subdivision or 2 Family Dwelling - Number of Bedrooms tI ublicr-ounnercial Name CSM Numbe r - Desanbe Use —_� l" ❑ State Owned - Describe Use ❑City ❑Village tryo—hip On I III, Type of Permit; (Chec use A. Complete use $ if applicable) A. ❑ New System Replsadaamt §!W ❑ Tr t/Hokting Tank Replacement Only ❑ Other Modification to Existing system B. ❑ Permit Renewal ❑ Permit Revision ❑ Chaoee of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Be€ore Expiration Plumber Owner IV. of POWTS Systent. Check all that a pply) ,WNon - Pressurized ia- (hound ❑ Maud > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Walead ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ RecuculatingSymbeticMedwFiber OLewAmSChamber ❑ Drip vd-less Pipe QOdwrfmp V. DISPersonmatusent Area Information: Design Flow (gPd) Desi sal APPS RaD�s* Ara Required (sO Dim Ares (sf) Elevation , �Coo i -1 7 - VI. Tank Info Capacity in TOW Nunmber ManOwturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Exisda Tanks Tub HoWingTmk K ldsa ' W i Q'--S Z Ibe Jr Ambic Treannaat Unit Dosing Mamba ' VII. Respo nsHoUlty Statement - i, the sttderalgred, a regmWbftky for is of tbt POWTS si mva oa the attacked plans. P 'a Plumber's Si JMPRS ber Business Phone Number Plumber's Addrei a (Street, City, State, Zip Code) AA'' Z 4, VIII. Coup rtreent Use On Approved ❑ Disapproval Sanitary Permit Fee (includes Gtoundwata Date la� in t Signature (N tamps) Surcharge Fee) rn ❑ Owner Given Reason for Denial Z V �- IX. Co Baas of Approval/Reasons for Disapproval F N ,cal m c9owbaa Pb - t» am Ca" iar at syps� w paper as lea Ilan a172 :1 r t■cMa Mr wise SBD -6398 (R.. 08/02) i I ' _'_� � _L➢ctn� -- ;. -_ � ! ±___; � - - -! !- ti �_`l� S c31_�3f__N.' 12!1.2i� '. '_ _ 1 C{ � _ 3, ter - ! I I } g �000a -!ol owl i I i I I I C i 1 -- h �. I I t , I i 1 I _ i k I ! I I ! I ! I 3 t ` i I I I I I 1 , i I , , N. c� I I " 9 . , i ' I I I i . I i I --- - - - -- - - - -- - i - i ' I I flot ! (-- �Y n � mot- N `� S �� S 3! 73 ! N R t 7 w 14 3'� sr �d s a " Cad � � � �,., l � r 11 N. R;Av -,a4 wa S c7 c7 a►1 v v� �srt`' TSC) qo-Q- r IIZC) -, pce • +C��,� D �3(v ��o 00 - to - �'�'% BSc 1Cs E1 /d __ i W ' m , D 'panmm i at C SOIL EVALUATION REPORT pop / or 0 1 1 1 6 on orod*wd 8us*vs in ==WARM *ow cmmn asp wts. mw +cod. ANcA aonp,�„r.pM a, CMN*f S - r C roper wpt i.s. rrw t tax t1 irJ�s in dww Arw wwe Id ui.iutasEi�id�occMw/uoiaAdNOwrM p*d Pwo�t RD. P MiR�. aI1mKavd1oRrOM r*Wbo"Now by + ► p.wnMw.r.,. w,1M � n„ �s....r*�+....r.,rrn .moo ` ` t /2310 o�wwr Pi*WvW"n_ r 11 v` f &A U* A) T 3 1 N It JD c It � tetr I�tf �!i■waro� u�.cP�.Ap ftM? �M.ra.re+re.dr�e.�s _ _ caod.dwM.ua.an+aa# am � ' � nwRwwA � ii d ---r-� � �� - Aw�ic i�aodPY�.�rir+wita�pb wh .. F V 67L Team ilaw�+ m Mau + s� oat t L RL ilk 's6wt Noma 'eo S)k w+ J' f r i S S I rn S� rr CLo I ry\ r Els e * * ow.twr: 7 R 71�b � o.pw�a.r4lr�or a std► its ft Cut odor +Dr ,irk 'fit Lo 3 s /d S © m S h11 CID 2 A ' twntfis sa0Silid=VLwndTSSj10,<„160wall Qe 000 <!0 40 wndT"<M 1iM11t cw r and / gp i l P i i�■ m w�m- � mm�� =i, M m MMMT MEN a P/�Jt a C7 n h N Y +� t a3 /1 t3 `�'S W�: _ SY Is?` C Ib �>C 13 4 �3 Pf1 �Q� t ?203H 7 7s► .L � � 777 ►li 24M !7• 7 7!• 77♦ * r* 7 s7 1 7 W 12tt 77 77! 7 7s 7s ♦• � 7s♦ j + *R 7fi It y/� 7 77 !r4 M9 ► ! 7• 7 .7 77 77777.7 1!!•7!•f�7��� �!• ►! 7• 7 • 24 12-1,2*, DIA. f 'V ) f r A grvep u ST. 4lt,, � ,f O.U. of4 p,p - 4 r A, V °d .e b. "��c pes lrf� g e 3 r� •�.- --•_._ $'�wa }} (? �'*r+lrlsj � 12i�lA j 0*0 of ry/u Bottom !tt J J b pb wig � Too! Sai ? f , l Interface Arq UC �t2irtt t ° 3 is -1 -..]iS1� i �! O,}?.orO...k { lXnr 'J7a 4 5 . 14 St?.F7 (tt P2 rocs 8 r' 22 ft woy or+tttdt / cY► crs ?.a.:�! i-2-.. � �.sra , 901 tr Fr°lec" Trench Area w Void voice a bpnpm bcr.,� �rh _ 2Ei. ' watt Hri01 -- 12 m_ •2 2 F�tR a2wr0 � - � 3, rat -�..� 361n ( , t Ewa v o 1 Wt![ at t - r -2; 3 ft ! ?e; Pr $Q.Ft. 3 oat void oo�ett Mrw„ [1:? of vow vuo� Prolectc� Ti e+t6 Are, " S Oi ,kyoc 0.1 17 r 0 .422 w 0, *C" cylote�l 0 13 , T a 4slf°tts Per f ' 1.T6J X ?.4$ � 9pf « oz S . 0, !Oa = 176I �c h f ft fl !01{ w �i r a � f r J , y f AV EIS Aggregate Trench Ysten, Z1 203H R 'ng Ind 65 vsco Group Mdu s#r+u! land, p Ovk TAt 48060 �Efz tt-X� -pt t � . , w. w.. .+ w. u.♦ v ♦ vlli 1.11f ?IIN Vl ♦\JJJ JL1r A ViV f11'IL J1 L� +• A il 4" Cl VENT PIPE 12" MIN. ABOVE GRADE S WEATHER PROOF • 25' FROM.DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER 4" Cl RISER W/ PADLOCK & 6" MIN. --, I WARNING LABEL ABOVE GRADE - -- �- _ 4" MIN. 18" IN _ 'r I,JLET °WATER TIGHT SEALS GAS- i 9D`5 TIGHT i 4' ° F�j 4, A SEAL ; APPROVED CI PIPE 4ALM JOINTS W/ CI 3' ONTO B r PIPE 3' ONTO SOLID �' r , ON SOLID SOIL � SOIL C PUMP OFF ELEV . 99 FT. -- - t �' Off. '� RISER EXIT D PERMITTED ONL� IF . TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS , SEPTIC I DOSE TANK MANUFACTURER: NUMBER 'DOSES PER DAY: J TANK SIZES SEPTIC GAL. DOSE VOLUME INCLUDING DOSE _2L9D GAL. FLOWBACK:, GAL. ALARM MANUFACTURER: T\. v z CAPACITIES: A = INCHES = '� ,S GAL. MODEL NUMBER: `0 SWITCH TYPE: B = 2 INCHES = GAL. PUMP MANUFACTURER: � v�m�s _ C = INCHES = GAL. MODEL NUMBER: SWITCH TYPE: D = JIB INCHES = GAL, REQUIRED DISCHARGE RATE �.=. GPM PUMP B ALARM WIRING AS PER ILHR 16. 23 WA( VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE -S FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . ... . . . . . . k * 2.5 FEET + -� FEET FORCEMAIN X 3_ D FT /200 FT.'FRICTION FACOR I FEET TATAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER 3 6 -3 LIQUID DEPTH L_ • l 5�. �` � � 5 3 r Goulds LYk! 7 n SU�►�I. - i ,>l�e Effluent . pump 3885 APPLICATIONS A' • Overload protection must smooth operation Silicrut can be operated continuously Specifically designed for the be provided in starter unit, bronze Impeller available as without damage. following uses: • Shaft: threaded, 400 series an option, • Homes stainless steel. ` '' ■ 8earin s. Upper and • Farms • Bearings: ball bearings ■ mod¢ t',ast iron volute lower heavy duty bap bearing • Trailer courts upper and lower, type for maximum efficiency. construction. • Motels • Power cord: 20 foot 2' NPT dtdwp adaptable Power Cable: Severe duty • Schools standard length (optional for slide rag systems. rated, oil and water resistant. • Hospitals lengths available). ■r M&J anlcat Seal: SMXON Epoxy seal on motor and Industry Single phase: CARBIDE VS. SIUCON provides secondary moisture Effluent systems % and % HP —16/3 SJTp CARBIDE seating faces. barrier In case of outer jacket with 115 V or 230 V three Stainless steel metal parts, damage and to prevent oil SPECIFICATIONS prong plug. BUM- N elaStomers. Wk ft. Pu mp • 'Y• -7 % HP —1413 STO with III Shag: Corroslon- resistant ■ O- ring: Assures positive barn leads. • Solids handling capabilities: Three !rase: stainless sled Threaded seating against contaminants ,Y4* maximum. p design, Lockout on three and oil leakage. %-1 h HP —14/4 STO phase models to guard • olscharge size: 2' NPT. with bare leads, o n GSA against component damage ' Capacities: up to 128 GPM. rTstad modals — 20 foot on accldental reverse rotatio AGENCY LISTINGS n. • Total hems: up to 123 feet length WW and STtiN TDH. are standard. In Motor �y submerged in caveman sra»� Avisdaum Mechanical seal: silicon high turbine on for carbide -rotary seatlstlkon FEATURES lubrication and efficient heat UL � tabmalorkm carbide- stationary seat, 300 transfer. series stainless steel metal IN iMpeller: Cast iron, semi- • Designed for Continuous Parts, BUNA -N eiastorners. open, non -clog with pump. Operation; Pump ratings are • Temperature: out vanes for mechankai seal within the m tar manukturer's 1O4°F (400C) continuous pmteofion. Balanced for recommended working limits, 14O0F (60°C) Intermittent. - Fasteners: 300 series 619TOs FMT stainless steet. so • Capable of running dry 2 s sr�: 38M s without damage to &t wet SQE W SOLIDS components., m � Motor 20 si=r Single phase: _ s4 • 9 HP- 115 V. 200 V, 230 V, so 60 H4 1750 RPM- % HP, 1$ 115 V, 60 }� 3500 RPM, XHP -114 HP, 230 V, < 40 60 t lz, 3500 RPM. 14 30 • Built overload with automatic resat. • Class B insulation. s Three phase: '14 • HP —1 % HP 200/230/ 460 V, tit} H z, 3540 RPM ° ° • Class B Insulation. ° 10 20 30 �o ! � 9a 100 114 124 130GPM 0 14 1995 GCUiQ$ Pumps CAPAG[TY 30 m Effective May, t995 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page —L of D�' ALE tt VOff�IIlATif?N SYSTEM gpEC�iCAn2n ow Tank Marwfacttsrer (� �s a v^ S DNA E a ter\ Pecrrut 3p r Sdpt�c C3 Dose 0 Holding vol. � a 5 � gat Tank Manufacturer ❑ NA tl PARAf1METERS Number of Bedrooms RNA O Septic }Dose ❑ Holding Vol. gal Nhw*w of Public Facility Units Effluent Filter ; 21A—Wp D NA Estimated (overage) flow e7 Effluent F Model p 0 Design {peak} flaw - (Estimated x 1.51 aVd pump Manwfacturw DNA Sod Appkcartior► Rafe f /ft' Pump Model 11 L 5tendard Infkesnt/Efltusnt Quality Monthly hly average' pretreaMtefst unit A Fats. OR &Grease (FOG) 00 mgiL ❑ Sartd/(s`ravaa Filter [I Pee Fifer Biochemical Oxygen Demand IBODJ 6220 mg/L DNA ❑ Mechanical Aeration D Wetland Total Suspended Souls (TSS} sl 60 mg/L O Disinfection D Otter. Pretrcated Effluent Quality Month average Manufacturer Biochemical Oxygen Demand (BOD,} s30 mg/1- Dispersal Collis) Total Suspended Solids (M) S3 mgd- ❑ NA tt y} � h� Cirownd tad} Fecal Comm {geometric ) .10 cfu/lo(WW At- Gracie D Mourn Maximum Effluent Particle Size Yin die, NA n kw ,, vuw-- D O NA t?chec': DNA •values typical for domestic wastewater and septic tank effluent. D NA '� MA iTEWANGE SCHEDULE Frequency Service Event Sarcrlex month(s) (Maxknum 3 ye ws) 0 NA Inspect condition of tank(s) At least once every= 3 s} When combined sludge and scum equals one - third (Y}) of tank volume D NA Of out contents o tardtis} 11te water alum is activated Pump out Y1fl� higt► D monthts} tlNexktarrf► 3 years) DNA Inspect dispersal Collis) At West once every: s) At last ants every: 4 / O morttt} �{s} DNA Glean effluent fitter t ❑ monthlsl O NA Inspect pump, purnp controls & alarm At least once every: at D montlo) D NA Fib laterals and pressure test At least once every- D ar(s) rnarsthts} D NA At Est once every: ❑ sy D NA MAWTENANCE INSTRUCTIONS certifications: inspections of tank one of the following licenses of Units and dispersal cells shall be made by an individual carrying Operator 1pumon Master inumber: Master Plumber Restricted Sewer. POWTS inspector: POWTS Maintainer; Septa S h y Cracks or Tank inspections must include a visual inspection of the tw*is) to identify any missing of broken hardware, teaks, measure the volume of combined sludge and scum and a check for any back UP Or P Ondinil of effluent on the ground surface. The dispersal Collis) shall be visuaily inspected to check the effluent levels in the observation pipes and to Check for any and ponding of effluent on the ground surface. The porsfing of effluent on the ground surface may indicate >1 fat'ing condition requires the imunedwu notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third tYs} or more of the tank volume. the entire contents of the tank shell 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 fitters, mechanical of pressurized comp s _ '. nrntrreatrr "" units, and any servicing at intervals of 512 months, shalt be performed by a certified POWTS Maintainer. A service report shy be Proms to the local regulatory authority wittan 10 days of canplet+on of any service event. GMW 12 /O2i START UP AND OPERATION Page - Of For new construction, prior to use of the POWYS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and/or damage the son dispersal calls). ff high concentrations are detected have the contents of the tank(s) removed by a sepGrge servickv operator prior to use. System start up shal not occur when sod conditions we frozen at the infiltrative surface. During extended power outages pump tmks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal callls) in one large dose and may overload therm resulting in the backup or surface discharge of effluent. To avoid this motion 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 Maintairw 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 sod absorption area. Reduction or efimination of the following from the wastewater strewn may improve the performance and prolong the We of the POWTS: antibiotics; baby wipes; cigarette butts; condome; cotton sue; dam: dental fires; diapers; disinfectants; fat, formation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; most scraps; medications; oil; Painting products; Pesticides; sanitary napkins; tampons; and water so brine. ABANDONMENT When the POWTS fads and/or is permanently taken out of service the following steps shad be taken to insure that the system is Pro and safely abandoned in compliance with chapter 1C 85.33, Wisconsin Administ Cade: • 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 property 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 POINTS fads and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: E3 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area mould be protected from disturbance and compaction and should not be irrfringed upon by required setbacks from existing and proposed structure, lot firms 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. 13 A suitable replacement area Is not available due to setback and/or soil limit Barring advances in POWTS technology a holding tank may be instdW as a last resort to replace the faded POWTS. The site has not been evaluated to identify a suitable replacement area. upon failure of the POWTS a soil and site evaluation must be perfonraad 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 sod absorption systems may be reconstructed in place following removal of the bwrnat at the infiltrative surface. istructions of such systems must comer with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR VjSUFRCjENT OXYGEN. DO NOT EIItTER A SAC. 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 OSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAiER Narme C V i ✓� O W .Q � Name Ph t S 9 ! Pie SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORfTY Name Marne � i � \ � Phone ` 3 Co (o This document was drafted by the staffs of the Green Lake Marque Marttue and Wacsshara County Zoning and Sanitatiors agencies its compliance with chapter Comm 83.22(2)(b)(t)(d) &if) and 83.54(7). (2) & (3). Wisconsin Administrative Code. r - <0_ c J • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM L �s Owner/Buyer O-r 1111n :A- 4A Mailing Address Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number ©_ —ac)c> o -- /a — Oo c7 LEGAL DESCRIPTION Property Location �1 E %,, ) y,, Ste. T 3_[— N -R-i-7 W, Town of e� Subdivision � mks QLt Qo , Lot # Certified Survey Map # Volume , Page # Warranty Deed # 3 s q( c t a, Volume S 9 . Page # Spec house O yes X no Lot tines identifiable 10 yes 0 no SYSTEM NIAI_N'rENANCF Improper use and maintenanceof 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 masterplumber, journeyman plumber, restricted plumber or 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 in within 30 iaya of the three xpiration date. - 7//,5/0 - 3 A OF APPLICANT DATE 3 WNER CERTIFICATION I (we) certify that all statements on this form are true t he best of my (our) knowledge. I (we) am (are) the owner(s) of he pro rty describe ve, by v' a of o t a warranty deed recorded in Register of Deeds Office. ,I TURF OF APPLICANT A / 03 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 I • S & N LAND SURVEYING • HUDSON , WISCONSIN 54016 (715) 366 -2007 Name First Federal of LaCrosse Address 201 South Second St. Hudson, Wi. 54016 Description Lot 11, Hook's 2nd. Addn. to the Town of Stanton, St. Croix County, Wi. Barnhart PLAT DRAWING N This is not a complete Land Survey I I MAR OR / � VE S 4- % O /S ��',- 0 1 1 v t ti I C� O, .r r I I The location of improvements on This draw=ing: are approximate, and-are based on a visual inspection of the premises. The lot dimensions are taken from recorded plats and deeds of county records. This drawing is for informational purposes only and should NOT be used as a'Comple Land Survey I I First Federal of LaCrosse has agreed to-waive the minimum standards of AE -7 S� i y Ma No. 90 -01 -127 1 „ p R t� r Drawn By A.N. r. 4:,, 4/18/90 Scale 1 =40 1 11 � r•` .£7� '4x