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HomeMy WebLinkAbout038-1067-80-000 n y 0 3 y n C v1 _ C 'r (D 9 ID n 3 O- O 4i O O o Q) W O• W °• N Ul 0 v Et f0 tD a 7 � CD 7 N 0 �. Oo v O N N a 7 CD N 3 O O 7 (D O O ? O C C N Cl) n -I W 0 3 n o m o C -. IA I A N C 0071 CD c0 I G N 3 O O O C3) O_ N CCD O C n c D m v i ° 000°, 01 '0 A O 1/Q O o X co Q D N C- C7 -0 o o" CD Ln =R c o o e e .dr N N 3 O1 N OD CD C11 V CL rt W z OO D = lY CD 0 N N • y X CD 2 c C 3' N W fD n n 01 j z C A fb A Z m O C r w v a A 0 �.o * CD =° — z 0 3 70 C CD W y I Goo A m a m CD JID y o o s o v, my n m ?5. 3 7CD co 0 V O C y 'CAD I' mr CD � (A A n CD 0 C1 � ' C A D o I �; mmo o N 3 m a 7 A I CL ti I ti co b 0 �t m do " C�. o m r W l i •^�- s FILED MAR - 8 Im JQN 2 S 19 95 ► KATHLEEN H i NT ... H. WA)� ST. CRO X COU . Y 52.5'' A�'� Register ofDeeds H ,j SURVEYOR'S RECORD SL Croix Co., WI _ L CERTIFIED SURVEY MAP Located in part of the SWJ of the SEJ and in part of the SEJ of the SWJ, all in Section 16, T31N, R18W, Town of Star Prairie, St. Croix County, Wisconsin. OWNER NOTE Warren Beckstrom ®3/4" Iron Pipe Found NO2 ° 04 1 13 "E, 2.21 feet from 1052 210th Avenue computed position. Somerset, Wi. 54025 U N PLA LA North line of the SEk of the SWk - - - N89 ° 45' 33"W North line of the SWk of the SEk, N 25.50' N89 0 26'24 "W 663.09' It N � o, C o, " I , G, S C H tG 3 J O . C •N I L r 13.08 Acres Inc. R/W I L n co a O • • 569,871 Sq. Ft. C , °,` O `t I m w 12.80 Acres Exc. R/W _ o v e'31, �• ° o N k _ 3 557,627 Sq. Ft. i - �+� ' Irn cns c'c o°, c r 'o ' 3 I C7 W o. a , n N89 0 32'03 11 W t a we ct Z d1 N o O p o m e p ° 330.00' I r- T o 1< N ? LOT 3 0 �' ��; m� m c(o Cr o m c a m I IN 10 o CD ti I F Ct CA fl_ r C r w "h I �J7 z fD _ N Z X 3 LOT 2 t. kD o / Ln O J O N 7.49 Acres Inc. R/W ~ l� J c ° 0 326,370 Sq. Ft. r 1 r 7.21 Acres Exc. R/W ti co � �' co �; 314,215 Sq. Ft. e wo S w l rt �� 0 \. l�Jt 1�J1 .tl M • w o s L 1 I B I W � ` \`^, � ARN --- I D rri r I (t'Iry J' J1(� ✓EY SHEDS ? GARAGE L 1 I M a � ° - c�;R I I F I `U IJRVE'r V 4 , o � --- - - - - -- - - - - -- G 5 � I HousE� I PVI A? /� P v� i; J- / � SEPTIC -- VOL. _7 N 9 °49'39 "E F-" _ 20'5 SW Corner Uj .... .25.50' ..................... �....................... �........� Section 16 o S89 0 58 1 29 11 E zn 662.64' c N89 2648.4 "E ° 33 i 330 589 ° 32'03 "E 2648.44' ' m 332.61' 330.00' w 1987.83' _ �+ _ • S89 "E A 62.61' �! N89 5.50' "E South l i ne of the SEk ----/ SE Corner 25.50' Sk Corner E Section 16 /South line of the SWk Section 1.6 G 17 I H AVE i J U Rr T. LOT I 'JiN 1= LkjTEu LANDS rERTIFIED SURVEY MAC ` ✓7L 9 , PG. 209.E 1 '44, x' i its - SCALE � � :4° SCALE I N TEIr1 ¢ . 100 50 0 100 200 300 �n ia g�3 0 7 03 0 E J % k [ k T© 0 m @ Cl) ■ C- z z z o W _' m- o U g E ; o ®© I o m om$ _ CD E E K i m 7 2 C , , E # i m § o / [ ; ; } G g \ Q = ] k k k \ / 2 co � � g 0 © 2 « v > 2 (�' E £�( f § _ _ 3 \ \ § Z » 7 @ § $; > E r f § M M k z 0 0 0 - S § S < z / / R § ■ CO) @ § % > CD C) OD § ± Cn� w Z / o > 0 E / / a } k � % m \ 3 o \ . � 3 ` f j 0 § k\ � « § � ■ � f CL ¥ z 9 . � g m � 2 2 CL z z § \ � � i�/ . � G §E@± 2 a \ 0 � a f /E ECD 0 E . §(\A {3% E§< Ewa W /7ƒ © k . [ fCD Cc 2) §k 2 gCD £ � ƒ�§ ■ � \ 0 ? } � W'sconsin Departmerri of commerce PRIVATE SEWAGE SYSTEM County: Safetya0d Bwklings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law s.15.04 (1)(m)). 384252 P rmit Holder's Name: ❑City ❑ vi lag Town of: State Plan ID No.: ctrom, Warren Star Prairie Township CST SM Elev.: Insp. BM E ev.: BM Description: Parcel Tax No.: 038 - 1067 -80 -000 TANK INFORMATION ELE ATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 / Benchmark Dosiiiiill W j L it. BM Aera ' Bldg. Sewer Holding �/ Ht Inlet 6, qd TANK SETBACK INFORMATION (St Ht outlet TANKTO P/L WELL BLDG. Airi to ROAD Air Intake Septic NA Header / Man. �(' 1 I NA Dist. Pipe �` L �• a 9 3• z o Aeratio NA 3 olding Bot. System �` �� Z Q PUMP / SIPHON INFORMATION Final Grade j _ " -- emand S Cover b G d Friction tem TDH Ft Loss Length Dia. oist.To e SOIL ABSORPTION SYSTEM / BED/TRENCH width / Lenjh S � No. O Trenches P M N I N No. Of Pits Inside Dia. Liquid Depth D IMENSIONS Mater u i ur SYSTEM TO P / L BLDG WELL LAKE / STREAM LEA IN SETBACK A BE Moe Num er: INFORMATION Type O �' O IT i System: - fib to DISTRIBUTION SYSTEM Header / Man t /I Distribution Pipes) „ , x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length . S Dia. Spacing ' SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ii Feed Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched IT Center Bed /Trench Edges Topsoil ❑ Yes ❑ No (03 Yes ❑ No COMMENTS: (Include code discrepancies, persons present, #1: ` /!Q /a ( Inspection #2: / Location: 1052 210th Avenue, Somerset, WI 54025 (SW 1/4 SE 1/416 T31N R18W) - 163118291B -Lot 2 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = (;(� �� y2 \ w�6I b e y 3. )O�S� ✓vti�r`o�. (/GwL�� ii�S�a�G(Cef .�. Z ✓ � Ca.l.� �7�01 Plan revision required? ❑ Yes R No Use other side for additional information. V / / S80 -6710 (R.3/97) Date Inspector's Si ure Cert No 55 c a O a �_ �0 � I„�,5� ` o �y' i Sanitary Permit Application 201 W Ad � �,r Safety & Bindings Divisigt 15.. S �076;p In accord with Comm 8321 ., Wis. m. Code Cif s 0 W. W g Ave. V sons f� See reverse side for instructions for completing this application PO Box 7302 Oep rtment &CaeiniereE� Personal information you provide may be used for secondary purposes Madison, WI 53707.7302 (Privacy Law, L lS.04(IXm)j (Submit completed form to county if mot Attach complete plans to the county co for the state a�� m, on a not less than 8 -lR x 11 inches is size. County State San* Permit Number o Check if revision to previous application State Plan.. D. Number ST C RoI-k z L Application Information - Please Print aII Information Location: Property Owner Name Property Location St /4 • SE114,41 o T� ..N 1 of y Owoeta� eat Number Block Number A11 E_ 2 city, State Zi Co Phone Number Subdivision Name or CSM Number �DMERS T V1/( .5q Q2 '7 Ira= r 7 VOL 10 1'15 II, Type of Building: (check one) O City 1 or 2 Family Dwelling - No. of Bedrooms �' r ' O Village, . ❑ PubHcC= m=W (describe use):_ / z { $Town of d PRWQ I c (3 State .Owned 1 >a,.' "--! `' (�) �' x is S"' -� •y�s, ,� �, ` `� ®1 ;i- carat Road 4;ty , P� T`. • oral Tax Numbet(s)�,3� /� / 111 T e of Permit: (Checle only one box on line A. Check bo 'ne B if a 114-31, / A) 1. ONew Z lacematt 3, gapia« meat 6. ❑ Addition to S em Tank Only � .r;, � Z� r�� �• ti �� Existing System B) O A Sanitary Permit was previously issued Pencil Number ` �, i Date Issued IV. Type of POWT System: (Check all that apply) �Nott- presstaiud In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized la-grourid O Holding Tank ❑ Single Pass ❑ Drip Line ❑ ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other. V.D ersalrrreatment Area Info rmation: lblf W hd.iT`• SIOEVV/nlr0E12 /AIFILTAMWS 1 • Design Flow Upd) 2. 3 . 1 ? 4. Soil Application S. Percolation Rate 6. ystem Elevation 7. Final Grade Pro Rare (Ga1sJday/sq. !t.) (Mm /inch) Elevation 2 y5© 2 c gram 2Z CHt�mC3EE�s Qc2S , `7 / 1. Z VM Tank Capacity in Total # of . Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass Tanks N �g Crete ' stntcted St"PrtL Iba[n iL / rIvEKS 0 ,a 7 , 57 ❑ ❑ o 0 VIII. Responsibility Statement the unde:si assume re=nsibility for installation of the POWTS shown an ttached plariL Pa>mbWs Name (Pr) P : Si (no ur RS o Basiews Phone Number F� Fox 1 , �32H2 - 715 - 29 '-1 -S1y1 Plumb eta Adders (Street, City, Stair, Zip Code) gt�x Z�5 Q C__2 vV 1 S y021 DL County/Department Use Only ❑ Disapproved Suritaty Permit Fee (Includes Groundwater Date Issued g Agent Si (No stamps) Approved O Owner Given Initial. Adverse FaL etJ Determination Z?J5 �, X Conditions of Approval /Reasons for Disa Pro �Xi 5 S �+�w. ter,A_ '_ _!{ od PQ' LeeQQ— , ce si���► c.res rvi c� v�nu.�� { ht c� sn IfkUer t.s &44� at„ t wee pus , W'Vy SE I cy S i T 3 ( iJ. 1B 1n/ 10SZ Z) u - t A kvc Sv"�- 1�1�{Z\ E TvJS P � S b1.11t�_t2S �`^� v✓ B AiZti GARAt�.G I WE LL I 3 (3E.DiZG1bNL i ✓Q AMES 1SF -Lor / d %S OIL 3oR i ti/�.S e►� SCALC l = Llb' i /JOTS t- US M i b D O G AL E K-S SE P T I C, TA N K- A - t 0 D T A B L E FI LTER- 2 - rRCA3c-RC-- 'WITH l l H (& H CAPAo i1 `/ SiOr W))u862 ) Nnn kATORS F.Ae A 3 - EX ISTi N 6 ?Riv KS T 09 I - mrti .b, i C-� �f vv�, We LL�Z. 5 r4 1 SE /V S I I� T 3 ( )v, R 1,8 M/ Iosz z o -r +k Avr- S`cASZ Pi g \ E Twsp S a� Rs VV I esAn A� -IfIrLN WELL -9 Lk DRACbNL Oausr� ✓Q . AMS IStLDkl i3 ktH m PR k & mom, l a t Y t�� S1DIIJL� 5 :�. p o n(ZNC -,Z Ao0sl= � o r SLALC 1 LI b 0 l 21�Yti AJ'E NOTE ibbD GAL VVF KS SEPTiG TANK- PS -IDD rABLE FLTE z 2 TRCtie±Tics WITH i t HlLN CAPAOilk/ S►OcW))UG62 ►Nf7LTkATORS jC-ACN - 2k ISTi N LG — MlO K-S TC) ?�- Re rnroi cb, Wisconsin Department of Commerce SOIL EVALUATION REPORT Page J— of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 5 -r C Q ` Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. -to •- d C? Q C Please print all Information. r b Date Z2 Ztf) Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). .1.+A•w 1 Property Owner Property Location G t r' - - Pit e l l ' r Govt. Lot 5 W 1/4 S F_ 1/4 S T 3 N R E (or Property Owner Mailing Address Lot # Block # I Subd. Name or CSM# I o 5:L 1 u'rt^ h J e- . a. Vol. 10 P st 7 3 City State Zip Code Phone Number ❑ City ❑ Village JA Town Barest Road oom -. LJ% 1 5YWIS 0 1 5 5 +&f- PrA.ir I `` Av e. ❑ New Construction Use: % Residential/ Number of bedrooms Code derived design flow rate GPD JW R e Public or commercial - Describe: Replacement ❑ Parentmaterial A ` t-1 C., ` C� Vfi lam) A. $ Flood Plain elevation if applicable ft• General comments ay sa e s 5�-• J - S '-t bS ' I'1t`l K4-k 'cS . - - and recommendations: 6 0 , fi. tj • rie �+►° t_ n Boring # ❑ Boring ® pit Ground surface elev. _ S• O ft. Depth to limiting factor Q_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 -1 y 31 _- 5 L - 4 R- I 7, s yP y f k.a•� I I$. M r G W I M • 1 Z) -s w1 L 1. �. a -110 7, yR. ©- s � t.._ -- •-- �, q(.s0 FEZ - 1? Boring # I ❑ Boring Q Pit Ground surface elev. _ r �• 77 ft. Depth to limiting factor I I b_ !n. cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary GPDIf!'• In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Efffff *E 1 - ;L,3 7.5 Vwfy ..---- __...— �7 a rYt S b k vin ' ► F _: A3- 76 JXyly Sri ML C `- I R, 0, 77 2 DA f4&OFFl Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L C Nrlme (Pl"" P� Signature CST Number YN V) 1k +a- V- a a I Lo �Ad�irpes a 0 0 •t h e Date Evaluation Conducted Telephone Number '^ bav 19 ',a a !� l Property Owner G Parcel ID # �� ' (e 7 p� Page of Boring # p Boring y' ss Pit Ground surface elev. _ 7 — ft. Depth to limiting factor /00 in. Soil iption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I 'Eff#2 -� roy2 SL 62F4P- mF CY 5 aF •s « - ay 7.5 `!k Y11 aim 6b14 , C w I of . y- 93 761 5 D - CRk M L c LA- IvF , 7 /. E Boring # ❑ Boring — ❑ 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F-1 Boring # E] Boring 11 pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 5 150 mg/L Effluent #2 = BOD 130 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. SOD4330 (0..610)) 'Cpaw;y + 90,r, tom [)e r Sw j /�� sec•Ib, 31 N, RIVw IV lo 1 ~r ow qj \ y as �' J 1 k an rTM Q8 - SE Cenc�. oFtip t �00. 95. 83 94,55 Sep+`% 5.7 7 TAPL V — s a• h F: t1�1 A S +. rt I t u 6,w4 i s v� V IP % /e.v%+ : P C. p; P c F r o r•, ho o S C . . 9(40.60 1 05/01/01 TUE 10:39 FAX 71` �T cj�,7 (:( Ooo' Private Onsito Wr� -3+f1isrjf or Treatment System Management Plan Septic Tank Amr) !n-Grounel Soil Absorption Component Pursuant to Comm 8`;.5 Adm.. Code each Private Onsite Wastewater Treatment System (POWTS) shall inclu­P; irfOl and procedures for maintaining the system within the parameters of Comm 8, , m-z and the conditions of approval by the department, agent, or governmental unit. The approqud plans and permits for system are on file at the county zoning or health department. This management plan rcompfl� with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Mal ulal for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6199). Tab], 1: System Design Specifications Sanitary Pei 2 12- Number of _3 Design Flow - R7-s (gp!", L15D Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Comperwni I-zi-7e (ft ,i Type of W.nstawatar Domestic Table 2: Soil Component - Limits of Reliable Operation I_ Septic Tank Component Soil Absorption Co ponent Design Flow Peak 0j) Maximum Influent Particle I f 118 Maximum BOD, ( 220 Maximum TSS (m 1L) 150 Tab;o 5: Mlaintanance Schedule Septic Tank pect and lor service once every 3 years _LQs� Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Ta The septic tank shall be main by an individual certified to service septic tanks under s. 281,48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Ms. Adm. Code ( & Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, See;:-age Pits, Seepage Trenches, Privies, or Portable Restrooms). 1 Oep+ ,� T h e o perating condition - f the ­ ' )zpikand )utlet filter shall be assessed at least I ­ ; ' Th cleaned as n once every 3 years E' c '!et Ofte) - shall be n e ce ssary to ensure proper ofl=tion. The fiUvj should in not removed unless provisions are made to retain solids in the tank that W, ay :: off the filter vi i)en removed from its enclosure. If the 10: 34 RE17EIVED FROM:715 326 4686 p•02 05/01/01 TUE 10:37 F., 15 , - _ 0h s.. - a1 ► - AbsoTp lion Component tinuously is actrv2ted con e st IVi ,ued if the atg oontinuous alarm The filler shalt b �ndin9 e in the tank d with �It ,1 .. surg fla,�+s cis' an imp - and slud9 filter is e quippe 1 „c-ite su• 9 lntertrlAtent -niter alarms n,. Y r F me v+-rt when ttre volume of rum the next rvice l have is C,+�ISt'3rs e = if the c+antents of the ten ner o se f when Deed at th septic tank steal t � of the iar'k e accu mulation to th exceeds j13 the liquid ro.rrnme, ,w,sonnel s,nal! advise nd sludg rrFt s c i than mdxirr;urrr sc time of an assedormf�?d t, � needs to be Pe tank ec ted for water tig htness and Upon "J covers should be insp M a nh ole nsef�s. ac ce`s ris ' ervice and asse$sment shall be seale t fat u m st Marsh can rtrr e i tor soundness. Acces. r , p ,,,,,,,� deemed unsound, "he's to d amee� $ha secured by ll be the completion of snlv�r � ` ' rt�ater- thart 8' inches in into the tank. be replaced- _xCPC� t :� . : r;rr .s g r utllL�rized entry an effective iock�np clyti� e tx frn vers acric3E rrtkt r, is tank for o o ne ont sh ould a septic or athefiance #with ()SHAT #ar+dards for N any r ea -sore With h4 grn _,, at,,Sphere within #fie septic or othe a en #erinq a confined sp contain lethal gases, and rescue etg of a treatment of hc�tcli #ank rnaY be dlcult or impossible. person from Me anterior of fife tank may 1lVis. Adm. Code when the Tank abandonrnent shall be in accord Ce With Comm tank is no longer used as qC - - � cormpone Bail AbV 1ti+on Q- 0-TROOP - 9 11t nent serving this st" Icture is designed to accept domestic Tire soil a13S rt PTit >�� ,R; Ti - li mits of operation Qt this component are shown In wastewater from a rr�side'rlia! facility. Table 2. c depends greattY on proper and fim�Y The longevity' of a s0il absorpf the limits pf reliable operation. Gad water maintenance, and system use within or below plumbing conservation practices by a ll �zlpant5 arxi the installation of water conserving p+ fixtures are key faCtrrrs in extending the ixSelui life of this c�orriponenk The soil n bc,orp , Or..,01ripment's operation must be ass sled by inspection at least once every thre=e YO r s- 71 ;e ansper ion shall include recording tfie levels of ponding, if arty, in the Observation piped, and a visual i p ng s fo arvy evidence of surface areas of erosion should be s eepage dentif'Bd and disch arge from the component. Un steeply slo ing reported to the Owner fO�r repair. The surface discharge of domestic wastewater Or sewage from the system = tr_�l i :ifs i arl(t r.c�nsid? red a human health hazard. Traffic around or over the lead soil absorption component should be avoided particularly during winter months. The compactrvn or removal of snow cover over the component may to hydraulic failure by freezing- This type of failure ie uln {e temporary, but is d Of l e this impossible to repair until ws,athe!' conditions rn�pro g ene r al , component will red' it :.r; diffusitX) of oxygen into the soil and dispersal cell, which may lead to more intense, and ea5lier, c:rYanic clogging of the soil. I 2 05 - 01 - 00 10:32 RECEIVED FRO14 :715 386 4686 P•03 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer GAU WCUE1Z. Mailing Address )as L Z ib AVC Sr) Ny RSA W( -5 LAD 29 Property Address fkS AV-Y) � (F- (Verification required from Planning Department for new construction) City /State :5 o(` eg a W1 Parcel Identification Number 63A - I nL 7 - Btu - e0nD LEGAL DESCRIPTION Property Location SW %., S ,, Sec. 1 , T 3 ) N -R 1A W, Town of 57AR, ft lt . Subdivision Lot # Certified Survey Map # , Volume Page # Warranty Deed # , Volume , Page # Spec house ❑ yes ;. no Lot lines identifiable ❑ 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 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 Office within 30 days of the three year expiration date. SIGNAPM OF APPLICANT 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 the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. S GNA F APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed OOCUAWNT NO. ` STATE BAR OP WISCONSEN -FORM 2 (� WARRANTY WARRANTY NTI DEED 7� / F'A E N 1 THIS SPACE RESERVED FOR RECORDING DA VOL l Pe terina Coo a /k /a Pe trina Coo a widow, fi6iTECtS Of"FiCE sT. atoix cc., WI& -- — Recd, ;'-jr 7 :�-nrd Mtis 5th -- day of Dec A.D. 19 84 conveys warrants to War ren_ - E - , - Rc- e cst r� _�d 1 2:30 P &4. µ.. _ — j t enan ts, ` RETURN TO WRrL k t �'l I ,ki - 1 AA I) c, the following described real estate in rO — Count f-•� • f ay State of Wisconsin: / n1: Mc�Nv . ed Tax Key No. _ East Half of the Southeast Quarter of the Southwest Quarter (F�SE�SWh) and the West half of the Southwest Quarter of the Southeast Duarter Nr SWkSE�) all in Section 6- 31 -18. r This deed is Riven in satisfaction of the land contract dated September 4, 1969, recorded September 9, 196 in volume 455 of Deeds on page 40 and 41, as document number 297771. This homeste.d property. r (is) (is not) Exception to warranties: Dated this day of. (SEAL) (SEAL) Peterina Cook a /k /a Petrina Cook (SEAL) (SEAL) y AUTNENTICATIOiI -L ACKNOWLEDGMENT Signatures authenticated th s t � - l a of Y STATE OF WISCONSIN 19b ss. _ r S C roix .--County, � -e_- -- Persor•a!ly came before me, this _day of .?t �-- - -- —� - -- - - - - - -- - - - - - -.. - -- -_ —._ the above named , TITLE MEMBER STATE BAR OF WISCONSIN P eteri na Cook a /k /a P Cook (If not, - - - - - -- -- - -- authorized by 1 706.06, Wis. Stats.) This instrument was drafted by _ - -__ - -- - - - - -- - - -- - ____ W arre n W. W Ltd. - to me known to he the person executed !he fore- P.O. BOX 99 going instrument and acknowledged the same. (Signatures may be authenticated or acknowledged. Both are riot necessary.) Votary Public —rO County, Wis. My Commission is permanect. (If not, state expiration date ---- - - - - -- _ 19 WARRANTY DEED- $TAT_. BAR OF WISCONSIN, FORM NO 2 —:977 ' r ti 1 FILE© JAN 2 5 1995 ► KATHLEEN H. WALSH S isiDeods 3 SL Croix erol Co., W► L CERTIFIED SURVEY MAP Located in part of the SWj of the SEJ and in part of the SEJ of the SWJ, all in Section 16, T31N, R18W, Town of Star Prairie, St. Croix County, Wiscor:sin. OWNER NOTE Warren Beckstrom ®3/4" Iron Pipe Found NO2 ° 04'13 "E, 2.21 feet from 1052 210th Avenue computed position. Somerset, Wi. 54025 UN PLAI LANDS North l i n e of the SEk of the ;SWk y N89 1 33"W North l i n e of the SWk of the SEk � 3 25.50' N89 0 26 1 24 "W 663.09' M � d Ct 3• 3 CA C r• N 3 1L 37 &. r 13.08 Acres Inc. R/W Iz O • • 0 569,871 Sq. Ft. irv- r -h `'° Ct rn w a 12.80 Acres Exc. R/W m m e a I — I �, ., o y F c 557,627 Sq. Ft. I -1 '+ CA� �c M X ° a � -i n 'c i I� W° n, a t° a ' ° - a N N89 ° 32'03 "W !' a W a cr t 5 o ° ° c o ° 330.00' . Iz fi I r c C ; CA 1b 0 o s LOT 3 0 — Iv Wo 0 o . ° fp r °' 0 � c I w °n I r� cr I x ct C a Ct 00 c N tV cf . Z 7 T w '� 3 LOT 2 �; fr 7 1 O m ti 7.49 Acres Inc. R/W ~' . Ct a f0 ° 0 326,370 Sq. Ft. I t41 O o <C o 7.21 Acres Exc. R/W m a w N 314,215 Sq. Ft. w o Lo C s` r O Lo r. O O 1 .0 t0 N W C Ln 7 V L,'-) I I W 0 BARN _ _C R T IFIEV S:�RVE`r SHEDS n GARAG5 LOT i - -- - MAP -- - � O � ,�`�� o g CERT IFIEv SURVEY - - HDUSE� A P PG. 1152 SEPTIC VOL. 7 N89 °49' 911 G. 9 Q - 75 SW Corner •25.50' .................... w . .............................. --- - - -- w v+ o° Section 16 'wo S89 °58'29 "E m 662.64' .o N89 °49'39 "E 33 1 330.01' 1 _ S89 °32'03 "E 2648.44' _ m 332.61' 33W00' 00' w 1987.83' N89 °49'39 "E °�-- 3--Q "E 6 62.61' _ _ - - 25.50 South l i n e of the SEk = -- SE Corner 4 T Sk Corner 4 A` ✓c iJUE Section 16 South line of the SWk, Section 16• — — UN- LANDS LOT I r r SU \ ' 7 4 " Y• ., f� I I F I � V ✓1 A •� � , . , PG. 2599 hc�L�4�i, -- - - -- ;e+y "SCARE IN TE51 . U t WIS.��t1 rte: ��9 ; �G y +' *0 50 0 100 200 300 +e