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Home My WebLink About038-1066-70-000 /k? o e , m (D ¢ ) g CD a \ � � 0 2= E A \& S Ln �qCL �0 \� \/ k /kk \� 7 m ) co I M § / 2 CD QQ a § , ! § 8 to a # ® m z > E § ' (D 3 >/ 3 \ $ 2 4 $\\ ® § § e n r ■ � a � ■' 7 2 'a T 'a e ' , z 0 0 0 o j 23 / A § A % § 0 K) § 0 J 7 R k § E7V�� 3 \jd CL § S E 7 � r! \ 0 ° \ § j m CD A m } } I CL ■ i o � o » CL 1:k m T CD ] 2 \ � CL � ƒ� . gD § a ƒ0 % §aq ƒ £m i k/ � 7 �/ a §§ CD ) \/ � � k � e � . 2 § 69 ~ � a � C) , \ � � nisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division I INSPECTION REPORT Sanitary Permit No: 405090 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: Ziegler, Paul & Barbara I Star Prairie TownShi 038 - 1066 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: or 1 1 3. N W os - pgq khors -� TANK INFORMATION ELEvATiON DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , / / �9Q (n! �d V /1 Benchmart M41•e.� Dosing VlJ v Alt. BM O < < Aeration Bldg. Sewer 0D.0,_1 y•s s. - 7 Holding &t Inlet / , y �i y•7 S•S TANK SETBACK INFORMATION ( S)Pt — outlet �•d S, 1 TANK TO P/L WELL EB L DG] V ROAD Dt Inlet Septic y r.! / Dt B ottom Dosing Header /Man. Aeration / Dint. Pipe • 61 v ` . Holding f o Bot. System 1. t S PUMP /SIPHON INFORMATION Final Grade - , Manufacturer Demand St Cover G Model Numbe TDH Lift Frictio ss ISystem Head TDH Ft Forcemain lLgpgfh Dia. 11 _� I I r I L SOIL ABSORPTION SYSTEM -TyS(�j.� BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1114 ,cr i tz ^� d� SETBACK SYSTEM TO P/L JkLDG WEL L LAKE /STREA LEACHING Ma fait rer: INFORMATION T f System: CHAMBER O /1.000,11' (� yP y -t/ 1 Model Number: l /_ V Ir/ DISTRIBUTION SYSTEM • d f_ Header /Manifold Distribution x Hole Size I x Hole Spacing Vent to it Intake_ h P�Pe(s) It�� _ I Length Dia_ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil -i Yes E,i No La Yes ( No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: k_ / V I d 2.� Inspection #2: Location: 2111 100th Street Somset, WI 540 ?5 (SW 1/4 SW 1/4 16 T31 N R18W) NA Lot 2 Parcel No: 16.31.18. off ?Alb Ate- ) 0y_ �PCf- 1.) Alt BM Description = h<) — o k r S / 2.) Bldg sewer length �� Z 3 �a r�'�" I' ` - amount of cover = w f -� �a 3? Plan Use other i s de for additional information SBD -6710 (R.3/97) Date InsepcVsSi�g�nature Cert. No. r �S . -is AI jl �...• �. ' �Q fLll 7� J- 1110 W M-za -% 7 7 4 1 9 A•r2 esm /6/`/ VOL 4286 KATHLEEN H. WALSH O38 I al It 7, V 6 jW y,4 REGISTER OF DEEDS ,C,r,t 8, fm 1 41 '�04 ST. CROI X CO., VI Q / o a/ 4 v /}'00 7A -ya RECEIVED FOR RECORD k t 1� am // 04 -26 -2002 12 :10 P f Y REC FEE: 13.00 • ?CAGESFEE: 3.00 ►� y REFERENCED TO THE SOUTH LINE OTHE SW1 /4 OF SECTION 16. PREVIOUSLY RECORDED AS AND ASSUMED TO BEAR. o �m W>C N89 o < �, M v IC N r � Z ..N ' c v q Qr1f.. N� I z < zm r- -ol CERTIFIED SUR1/EY MAP H a I o VOLUME 13, PAGE 3fi51. 'fl v o - l0 82 LOT 4 LOT 3 .. � n '^� i • i WEST LINE 0� THE SW1j4 I � ��.. I I_— — — — — — — LOdTH I STREET _ _I — -� 1978.55' I . — —' SOpo09'16'E it 269.01' 0 8 LOT l OF 8� 100 BUILDING 8 � g I CERTIFIED SURVEY MAP SETBACK LINE -I r p , M AG VOLUE 2, PE 423. 9 W L � p � � z � ss� M I II I PARCEL DESCRIBED O n "' -n 0 Q) .r { I IN DOC. NO.676476 Mu 0 _ Q I 396.04' SOOo 0� � i � � ^� -a Z I 363.04' 7 - — — — 1 33.00' In ❑ Noo 00'30"E 268.97' > :1) I s� I 6 I� y C3 0 w N°M Inis C,, CA) Z p ❑ 8 � A-- 8 632.02' ( Igh a I I133.00' NOOo00'55'E 665.02' �. - � �p � I � I � : v ' � ID w o r• I 6 ' �� O Zcn I�I I is -� -- s j -n o I A �► 50 I , �� A I I P <> I I sgts� OO - V ";nj N N O CL 0 tO bb CD LJ CL w o U Z 'Z I i',tw O 1] Cl CL M I { 33.00' 492.75' 8 ^ i T NOOO 00 WE 525. • rA � r 0 �n 1 75 40.0 133 NOOR 01'4 R NOdo00'55 "E ) • I I EAST LIME OF THE SWi /4 OF THE SW! /4 A LOT 1 OF ,• . tin -b CERTIFIED SURVEY MAP �, ; 1 • cl 8 VOLUME 11, PAGE 3443. Q rn 4 rd cn I Vol.16 Page 4286 2 t l 1CO �+- 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 this application PO Box 7302 Nviscons 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 r ® �� J state owned.) Attach complete plans (to the county copy only) for the s ste /2 x 1 I inches in size. County I State Sanitary Permit Number ❑ Check il revisi a ion tate Plan I. D. Number • l/J`D a I. Application Information - Please Print all Information ocation: , 2$7A - Property Owner Name IVIAl I operty Location r� /'ej GCr�GQI"GL � �� IX COUNTY / 1/4, V Co l , 7- E( W Property Owner's Mailing Address ZONING OFFICE otNumber Block Number er City, State �' ,/ ` Zip Code Phone Number Subdivision Name or CSM Number Pr l�/ f ��Of ( S�YJ`��,5o� /J` Csw. I v. Ib /.. � II. Type uilding: (check one) ❑ City 0 1 or Family Dwelling - No. of Bedrooms: ❑Village Public /Commercial (describe use):_ XTown of ❑ State -Owned 3 ;7) s f J' GP r n e n 4 ��ncn!/ CEO Nearest Roa e 3� h e X e E1� +� �' k 2 -�re.,t a r� Parcel Tax Number( III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) b 3 g _16 6 76 --O d U A) 1, ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) ❑ Permit Number Date Issued A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) "Ak A —Iao WNon- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Informat 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal ea 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed 1 `�� Rate (Gals. /day /sq. ft.) (Min. /inch) — (� Elevation VII. Tank l apacay in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks de ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume respo nsibility for installation of the POWTS shown on the attached plans. Plum is Name (print) ` Plumber' gnature (no stamps): ` MP/MPRS No. Business Phone Number lu is Address (Street, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge ee) Qp Determination 22 S. fA 1 2"2- X. Conditions of Approval /Reasons for Disapproval: L a•L S�uita7flsy►S �" . SBD -6398 (R. 07/00) PLOT PLAN PROJECT Paul & Barbara Ziealer ADDRESS PO Box 274 Amery Wi. 54001 SW 114 SW 1 /4S 16 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX 5 -6 -02 3 MFRS Byron Bird Jr. 220529 - - ` ?= --"'T� -- DATE BEDROOM CONVENTIONAL XXX At -Grade ` CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK S E HOLDING TANK SIZE G LOAD RATE •4 ABSORPTION AREA 1,125 # of chambe s 37 ,► BENCHMARK V.A.P top of steel fence post v ASSUME ELEVATION 100' ❑ BOREHOLE O WELL sH.R.P same as BM Vent SYSTEM ELEVATION > 12" T- 1= 92.6T- 2= 92.4T -3 =92.2 of Sidewinder High Cove Capacity Leaching Chamber with 17.2 6 � tA chamber Long 34" Elevation 100th 269' 180' PL � b 3 bed house Driveway BM B4 2 40' B► ' ST �r 7 ' 4' 81' 332' PL 20' 1 , B I ��u� -- ��► --� l , 2 3 B3 PLOT PLAN PROJECT Paul & Barbara Ziegler ADDRESS PO Box 274 Amery Wi. 54001 SW 1/4 SW 1 /4S 16 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Byron Bird Jr. 22052 - — z C ,. DATE 5 -6 -02 BEDROOM 3 CONVENTIONAL XXX At -Grade G CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .4 ABSORPTION AREA 1 ,125 # of chambers 37 kk BENCHMARK V.R.P. top of steel fence post ASSUME ELEVATION 100' D BOREHOLE (DWELL 1H.R.P. same as BM Vent SYSTEM ELEVATION T- 1= 92.6T- 2 =92.4T - =92.2 AT' Sidewinder High Of Capacity Leaching Chamber with 17.2 „ t ^2 per chamber -Gradent System Long 345' Elevation 100th S 269' 180' PL 3 bed house Driveway BM j ` i �r 7 5 9 6 C' 7. , 4 815 � 332' B B B 1 PL 0 , 1 ® , -o v� B3 II t Wisconsn Department of Commerce SOIL EVALUATION REPORT Page of Yivisio4 of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code / d Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County 7 include, but not limited to: vertical and horizontal referen_Ce po irectlon and Parcel I.D. percent slope, scale or dimensions, north arrow, an ocatioh arf� a o nearest road. Please print all i rtion. Reviewed by Date Personal information you provide may be used for a ary pur{e�' Law, s', k (1) (m)). Property Owner _ Pr Location 1 6 Go L 1 /4SL /4 SIZi T 1/ N R E(oO ,qnp Property Owner's Mailing Address ST cF"x L / Block # Subd. Name or CSM# couwry City State Zip Code Ptjo umber „� City ❑ Village Town Nearest Road New Construction Use: L3 Residential !Number of bedrooms Code derived design flow rate `7 T U GPD ❑ Replacement / ❑.9 Public or� mercial - Describe: Parent material 1 f <2.��. Flood Pain elevation if applicable /;'J� ft. General comments n and recommendations: t '�� *N � Boring # ❑ Boring r 9 pit Ground surface elev. r• ft. Depth to limiting factor 2 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l / (/ (� V llll // CC / `1 w1' ° JZ • reD - 3 S l— (ao Boring #❑�y9 Boring � Lq Pit Ground surface elev.�ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 J , . — .�1Z ,r-- -- , .� j r r ,.s 4'2 /� J 5l * 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 Nam/ee (Please Print) 1 re __�ST Number Address I � Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) a - r Property Owner Parcel ID # Page of ffl B oring # Boring Pit Ground surface elev. ft. Depth to limiting factor r in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Sl 11- X A Id sa Y . Boring # E] Boring ® a pit Ground surface elev. �' ' � ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft P P ►Y in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 7 ❑Boring FT— Boring # 3 Pit Ground surface elev. / �' ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 r ,3 4.4 - Y * 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. SBD -8330 (R.07 /00) 4 Soil Test Plot Plan 'Project Name James Raboin Shaun Bird Address 1008 210th Ave Somerset 54025 CST 226900 Lot Subdivision - - - ---- Date 1/3/02 SW 1/4 SW 1/4S 16 T 31 N /R18 W Township Star Prairie Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 92.6 *HRPSame as Benchmark Alt. BM Base of Steel Fence Post @ 93.6' CIO g B -1 97' 15' B -4 40' _ 2 g 3 96 ' 40' 20' 6% B -5 Slope 95' B.M. 180' POWTS OWNER'S MANUAL 8T MANAGEMENT PLAN Page of FiLE iNFORMAT ON SYSTEM SPECIFICATIONS Owner c Septic Tank Capacity g a l ❑ NA Permit # O!�_o O Septic Tank Manufacturer. , e ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ,2 ❑ NA Number of Bedrooms ❑ NA, Effluent Fliter.Model ''` l ❑ NA Number of Commercial Units A Pump Tank Capacity i gal q(NA Estimated flow (average) gal /day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) ob gal /day Pump Manufacturer kNA Soil Application Rate gal/day/ft' Pump Model i;�NA Influent/Effluent Quality Monthly average* Pretreatment Unit "A Fats, Oil Bt Grease (FOG) 530 mg/L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L [3 Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 mg/L ❑Disinfection ❑Other: Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg/L P.In- ground (gravity) ❑ in- ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At- grade ❑ Mound Fecal Coliform (geometric mean) s10 cfu /100m1 ❑ 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 Frequen Inspect condition of tank(s) At least once every ❑ months years) (Maxim yrs. Pump out contents of tank(s) When combined sludge and scum equals one - this .(Ys) of tatikvolum inspect dispersal cell(s) At least once every ❑ months y ar(s)< (lriax 3 yrs.) Clean effluent fllter At least once every , _ ❑ months years) Inspect pump, pump controls Bt:alarm At least once every ❑ months ❑ year(s) ., NA Flush laterals and pressure test At least once every. , , ❑ months ❑ year(s) ' A Other At least once every ❑ months. ❑ year(s)..,1%NA Other At least once every ❑ months ❑ year(s) :4 MAINTENANCE iNSTRUCTiONS inspections of tanks and dispersal cells shall be made by an individual carrying one"of the followings licenses or certiflcations. Master Plumber; Master Plumber Restricted Sewer, POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank insi dons must include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify '4ny`c'ra&or leaks, meal the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for'amr"patiding of efflue&.Ibn the ground surface. The ponding of effluent on the ground surface may indicate a falling condition and requires the immediate nodflcadon of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (%) or more of the tank olurne,'the eittit'e contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent fliters, mechanical or pressurized POWTS components, pretreatement com p onenih d any other ,? ` maintenance or monitoring at intervals of 12 months or less 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. START UP AND For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting prodttcts or other clieimicaIs that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents . System start up shall not occur when soil conditions are frozen at the infiltrative. surface. Page of During power outages pump tanks. may fill above normal highwater levels. When powers 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 effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operation prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating ttie'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 ones, 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. ABANDONEMENT When the POWTS fails and /or is pennanently taken out of service the'foilowir% steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsh 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 removerd or their covers removed and the void space Oiled 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: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systems. 11e replacement area should be protected from disturt. 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 to POWTS technology a holding Clink may be Installed as a last resort to replace the failed POWTS. 92� The site has not been evaluated to identify a suitable replacement area. Upon failure of the 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 1�NSUFFiCiEN"F OXYGEN. DO NOT ENTER A SEPTIC PUMP OR OTHER TREATMENT-TANK .UNDER ANY AIt IiMSTAN II ' _ CAS DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY RE WFICULT Old rntvnc.AIRIT. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name , Name c e Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY` Name 6/� a , �� l Agency Z 0 hs . I :�iS- b ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer g f - 44 Z/ Mailing Address cow `yr e ~� O o / Property Address all (Verification required from Planning Department for new construction) City/State 60 1 2' Sew Parcel Identification Number LEGAL DESCRIPTION Property Location ' /., ' /a, Sec. . T -�r/N -R /� W, Town of err! �— , � Subdivision - Lot # Certified Survey Map # !a 2 -7 �l Volume /,C . Page # Warranty Deed # Y (1� ( LL , Volume $ Page # 3 �' Spec house ❑ yes ,% no Lot lines identifiable X 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 da f the three ypr expiration date. C l0�/0Z SIGNATURE OF APPLI&ANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPL T 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 V 1888P 317 • 678655 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. WI This Deed, made between James Raboin and Louise Raboin, RECEIVED FOR RECORD husband and wife, 05 -10 -2002 11:30 AN WARRANTY DEED Grantor, and Paul A. Ziegler and Barbara M. Ziegler, husband and EXEMPT # g wife, REC FEE: 11.00 TRA COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Part of SW 1/4 of SWIM of Section 16, Township 31 North, Range 18 West, Recording Area St. Croix County, Wisconsin, described as follows: Lot f Certified Name and Return Address Survey Map filed April 26, 2002, in Vol. 16 , Page 42 86, Doc. No. 677419. POWL ' �I e (� Po. box a�I Prm , LA� SLIoa 1 Part of 038 - 1068 -70 -000 Parcel Identification Number (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this LQ� day of May 2002 * t537mes Raboin Al AJAI, * * Louise aboin AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. S , T County ) authenticated this day of Personally came before me this pd,?y of May 2002 ' rj j - ti b a a named James Raboin and Louise Raboin, husba, d'and wife, ' e% TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) whd 0Xe yted oregpang instrument and acknowledged the s4ir e'' C ' authorized by § 706.06, Wis. Stats.) O" ' THIS INSTRUMENT WAS DRAFTED BY * F Attorney Kristina Ogland Notary tic, State My - Wisconsin Hudson, WI 54016 2:mmission is permanent. (If not, state expiration d9te: (Signatures may be authenticated or acknowledged. Both are not necessary.) I * Names of persons signing in any capacity must be typed or printed below their sig re. information Professionals company, Fora du Lac, wl STATE BAR OF WISCONSIN aoo 2021 WARRANTY DEED FORM No. 2 - 1999 �677Z+ 1 9 • h� 0 VOL 4286 aa, L�G "�✓'� KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO., VI RECEIVED FOR RECORD 04 -26 -2002 12:10 P rulis bm REC FEE: 13.00 Z FEE: 3.00 N PAGES: 2 q BEARINGS REFERENCED TO THE SOUTH LINE lA OF THE SWi /4 OF SECTION 16. PREVIOUSLY ^ , RECOROEO AS AND ASSUMED TO BEAR. p ' Z N89 °30'00 "E. 0 M Iu IC m Dcci► O �N> ° Z �Z p� p.< I m r CERTIFIED SURVEY MAP ` a I D' VOLUME_ 13, PAGE 3551 - o O c a -n� H o H I I to LOT 4 LOT 3 ° n - I I 4 I rn I I STRE _I_ U) '�' �, I 4- - - - - -- 1 -- M . - '30"w NN bf r — — I , 5�0�00_30"W 396.00' — 1978 55' m i -- a Al swom 1. � LOT 1 OF — 8s � 1oo•�BUILO NG � �' PO 8 SETBACK LINE 1 D C M CERTIFIED SURVEY MAP 0 0 1 8I I �/OLUME 2. PAGE 423. W r s��o Z n I rA W O � om PARCEL DESCRIBE w4 ...� �� 7O IN DOC. 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