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HomeMy WebLinkAbout040-1264-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division - INSPECTION REPORT sanitary Permit 463011 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal inform -otion 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: Hogberg, Bruce I Troy Township 040 - 1264 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 100.°Q 05.28.19.1432 TANK INFORMATION ELEVATION DATA 29Iq , */Z3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM i Aeration, '` Bldg. Sewer - Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION j ID-f TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ) A Nor t Dt Bottom Dosing Header /Man. G ?3 2 .T 7 - 7 14 -/ Lo^P - Ik w o I qy Aeration Dist. Pipe Holding '" Bot. System W i ® Ij 3 PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM I '`f ( Cf Model Number TDH Lift friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS G� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR I (� ' -�'� q ""'—e Type Of System:: Nor UNIT Model Number: DISTRIBUTION SYSTEM Z Z c h Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) -- -- -> to o 1 1 -engtk — a �_ Dia `'"t Length Dia Spacing ~ -T SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only aaoS. Depth Over Depth Over xx Depth of xx SeededlSodded T Mulched Bed/Trench Center S Bed/Trench Edges Topsoil `� 9 p C� Yes N No J Yes L No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/f Inspection #2: Location: 542 Cambronne Street Hudson, WI 54016 (NW 1/4 SW 1/4 5 T28N R1 9W) Frontier Lot 24 Parcel No: 05.28.19.1432 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover Plan revision Required? j Yes J No Use other side for additional informat _J L _ -___ SBD -6710 (R.3/97) Date insepctor's ignature 4jCeNo • S an uildittgs 'vision County � ,r = 201 W as ve. ox 7162 isconsirn Son 2 Sani Permit Number (to be filled in by Co.) D efl artmbnt of Commerce /.)(608) a 3017 Sanitary Permit p ati�c� State lan LD. Num In accord with Comm 83.21 Wis. A dn- Code N . don � de O ma be used for secondary y' P Privacy t4�lxm) Project Address (f different than mailing address) L Application Information - Please Print All Information C �� Z - • t` OW s N - / Parcel # Block # •s Madu Address Proper (/- Ze < City , State Zip Code Phone Number Z ectio, " IL of Build' T E utg (check all that apply) - ^ � . t4 y Dwelling - Number of Bedrooms aA, �,(,• Subdi�visiion Name CSM Number PublWCommerdal - Describe Use State Owned - Describe Use / City_ Village)� of III. Type of rmit: (Check only one box on line A. Complete line B if applicable) A ew System Replacement System Tteannrnt/Holdt Tank R ag %6=nwnt Only Other Modification to Euis lu ' ng Sys6wn B • Permit Renewal t Revision Change of Permit Transfer to New List Pervious Permit Number and Date is Before Expiration Plumber Owner 11V. Dan of POWTS S Check all that appl -Prtxsudzod In-Ground Mound Z 24 in. of suitable soil Mound < 24 in. of suitable soil At -Grade Single Pass Sand Filter Constructed Wetland Pressurized In G Holding Tank Peat Flier Aerobic Treatment Unit Recircufat Sand Filter R Synthetic Media Filter' Chamber Gravel -less Pi lain) V. D' tment Ar tion: 0 U S S Desi (Zd) Design Soil Applicaaoa te(gpds0 Dis Area R equired (sti .Disposal st) System Elevation in � Total VL Tank Info � a« t3' Nwnber Manufacturer Prefab Site OW Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Sept . Holding Tank Aerobic Treatment Unit Dosing Number n I VII. Responsibility Sta t- I, the ility for lastallatton of the POWTS shown on the attached plum Plumber's Name (Print) Plumber's S• MP/MPRS Number Business Phone Nu rnlW 77 V 7 > CGS /�; —� — �.;i Plumber's Address (Street City. state. ) /�� e / � VIII• Cott artment Use Onl Apr Disapproved Sanitary Permit Fee (includes Grotindwater Date rued Si Staarps) ( Surcharge Fee) h. (f O 10 OZ Owner Given Reason for Denial Ix Conditions of ApprovayReasons for Disapproval Zk � � e 1 Attach complete plarss (to the County only) for the system on paper not ten than un x it Inches is size r • S�� ��,- �- PLO PLAN PROJECT Bruce Hoabera A DRESS. 838 Summer Pines Circle Hudson Wi 54016 NIA 114 SW 1/4S 5 /T 28 / 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/14!04 BEDROOM 3 CONVENTIONAL XXX IN -GROU ; PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of 1/4 rebar ASSUME ELEVATION 100 Filter ZabelA -100 ❑BOREHOLE O WELL •H.R.P. SameasBenchmark Vent SYSTEM ELEVATION 95.0/93.4 5' below qrade >6 „ Standard Biodiffuser of ver Leaching Chamber with 31.1 ft2 of Area B.M. 6' ng 11 " 437' 34" Grade at System Elevati Property 30' Vents 2 -3' X 69' Cells with - Well is to meet all >3' Spacing -2 setbacks required by WDNR 70' 0' B -3 Cambronne 20% Sl a 35' Road 250' k S P ro 3 �.� Bedroom H ouse ' i 209 Property Line New Century Drive PLO PLAN PROJECT Bruce Hoabera A DRESS 838 Summer Pines Circle Hudson Wi 54016 N\&A 1 /4'SW 1 /4S 5 /T 28 / 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/14/04 BEDROOM 3 CONVENTIONAL X0C IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 hk BENCHMARK V.R.P. Top of 1/4" rebar ASSUME ELEVATION 100' Filter ZabelA -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Vent SYSTEM ELEVATION 9 5.0/93.4 5' below qrade > 6,5 Standard Biodiffuser of ver Leaching Chamber with 3 1. 1 ft2 of Area B. M. 6' ong 11 " 437' >6 ade at System Elevati Property 34 Line 30' Vents 2 -3' X 69' Cells with Well is to meet all >3' Spacing B -2 setbacks required by WDNR 35' 70' 0' B -3 20% Cambronne Slope 35' Road 250' - B-1 15 25' Ak ro 3 edroom House 209' Property Line New Century Drive Wisconsin- Department ofCommerce SOI AL REPORT Page , of �J Division of Safety and Buildings 0 in a rda Co 85, A C bou nt� Attach complete site plan on paper not less than 8 1/ 1 ize. Planu / b c include, but not limited to: vertical and horizontal referen it coon n �n Pa4 I.D. D percent slope, scale or dimensions, north arrow, and location arest d d Please print all information. ��NG����N,. t?e ' we - Date Personal information you provide may be used for secondary purposes (Privacy taw, s. t . #QTn)). ` / I D Q Property Owner Property L6h4q9 r A , Govt. Lot 44 4 S T� f N R E (or W Property is ailing Address Lot # Block # I Subd�.�lame or CSM# City State Zip Code Phone Number ❑ City ❑village own Nearest Road ew Construction Us Residential /Number of bedrooms Code derived design flow rate _ J7- 1 GPD ❑ Replacement Public or co m / eraal - Describe: __— Parent material Flood Plain elevation if applicable General cornments !� and ndatio S ��G4 /� �J • z:2 # Bonng Ground surface elev. ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 M # Boring Pit Ground surface elev. ft. Depth to limiting factor ,. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ® —/Z /n" Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Cwducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 r� r / 715- 246 -4516 I Property Owner _ Parcel ID # Page 2 of Boring Boring i # pi Ground surface elev. ft. Depth to limiting factor ` in. Soil Applicatiori 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 rJ 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I `Eff#2 Boring # E] Boring 1:1 Pit Ground surface elev. ft. Depth to limiting factor in. a Soil icati on 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 I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = 801) :< 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. SOD -8330 (R.6/00) Safety and Buildings Division Coun 201 W. Washington Ave., P.O. Box 7162 ' 0'�✓ eft ���O� �n Madison, Wl 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 b 3 0! Department of Commerce Sanitary Permit Application State Plan LD. Number in acct with Comm 83.11, Wu. Adm. Code, personal information you provide Project Address (if different than mailing address) be used for secondary putposes Privacy --i 1. Application Woimad — Please Print All Information — � B��N� �` icy , 1 Lot Sloclr N ". CR0jXC0UI\'T1' PuopeRy Owner's hW ing Address I aONING F I E a c' / __!'SCyK 5f. Section City, State 7Jp a Phone Number ( W IIZor of Building (check all that apply) Subdivision Name CSM Number ling Family Dwe — Numbet of Bedrooms i Pubmw.0 m ercial — Describe Use City Village ownsbip of state Owned — Describe Use QL Type of Perron: (Check only one box on line A. Com to line B if a licatble) Q 0 A. ew System Replacement System Treaww oldiag Rgdwemeat Only Other Modification to Existing System lisc 13. Permit Renewal Permit Revision Change of Permit Transfer to New Before Expiration Plumber Owner 1(V. a of POYYTS S (Check a ll that appl n - P�ndwd 1,-Ground Mound >_ 24 in. of suitable soil Mound 4 is of suitaWo soil At C3rade Single Pass Sand Filter Constructed Wetland Pressurized twGround Holding T . Peat Ful Aerobic Treatment Unit Recirculating Sand Filter g Synthetic Media Filter Chamber Line Gta -leas Odra lain S' 7 earcuiahn8 ynthea K 1J S V. Di tmeat Area Info 0 2 S ffi w ) Desi Applitatioa liate(gpdsf) Dis 4 ( Area Propo (at) "c VI. Tanik Info �P tY in T70f mber Manufacturer Prefab Site feel Fiber Plaistt Gallons Gaunits 4 ,1 New Edsting / C7D COOS CO1 ) Tanks Taub Septea Holding Tank Aerobic Treatment Unit Dosing Chamber VIL onsibili Statement- I, the astume reg ppp ib ty for lestattatio ou�POWIS on the attached Number : Plu a Name (Print) Signature M Business Pbow i Plumber's Address (Suet, City, State ) 1S 0 I ppro: Co rtmeat U Only Date Usued Agent Signature o Stamps) Sanitary Permit Fee utcludes Groundwater � PPm Surcharge Fee) thvnex Given Reason �fo IX. Conditions of ApprovalMeasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. wm pkft Plans (to the County only) for the "Sum on POP" not less than Elf) z It inches to sine 1 ' ' L t * v i � � - ��, g .. .; ��. LOT PLAN PROJECT Bruc Hoaber ADD ESS 838 Summer Pines Circle .Hudson Wi 54016 NW 1/4 SW 114s 5 /T 2 N/ W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8 /31 /04 BEDROOM 3 CONVENTIONAL XXX IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 hk BENCHMARK V.R.P. Top of 1/4 rebar : SPA*( ASSUME ELEVATION 100' Filter Zabel A-100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 96 .0/95.0 5' below qrade setbacks required by WDNR .M. 437' B-4 10' Pro p e l' �� 5 Line 15' B -2 Plans Designed Using Conventional Powts 60' anual Version 2.0 491' -"' Vents Property 40' Line 2 -3' X 69' cells 20' with >3' Spacing �naiin is Top o elm tree @ 95.08' 9 B � 0 - 20' 40' 15' 80' S 15' Pro 3 Um. edroo ouse >6 „ ndard Biodiffuser 127' O of Cover ching Chamber Property h 3 1. 1 ft2 of Area Line G 6, Lon rade at System Elevation 209' Property Line Pro Town Road LOT PLAN PROJECT Bruce Hoabera ADD ESS 838 Summer Pines Circle Hudson Wi 54016 NW , 1/4 SW 1 /4S 5 /T 2 N/ W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/31/04 BEDROOM 3 CONVENTIONAL )00( IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of 1/4" rebar a SmA* ( I= ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 9 6.0/95.0 5 below qrade setbacks required by AL WDNR X5� 437' Property �� 10 Line B -2 Plans Designed Using Conventional Powts 60' anual Version 2.0 491' _�— Property 40' Vents Line 2 -3' X 69' cells 20' with >3' Spacing lis Top elm tre e C 95.08' T15' BL1, 20 B-_5 80' Pro 3 Vent Bedroom House >6 „ Standard Biodiffuser 127' of Cover Leaching Chamber Property with 31.1 ft2 of Area Line 6' Long 11" Grade at System Elevation ia 209' Property Line Pro Town Road wiscom- nDepai'anentofCommerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code AC.E. Soil 8t Site Evaluations Attach complete.site plan on paper not less than 8'/2 x 11 inches in sine. Plan must County include but not limited to: vertical and horizontal reference point (B", direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D.# -- ase ,; �" Prt of 040 1022 -10 APPLICANT INFORMATION - Ple IR Ah`ltOrntatiA. R 'ewed By Date Personal information you provide may be used for purposes Privacy Law, s. I.S. (1) (m)). f - ZOQt7 Property Owner ! ' m l Property Location Miller Sam Govt' of NW 1/4 SW 1/4 S 5 T 28 N,R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 151 ( ` c.� 24 Pla __24 City State Zit Code Phone ❑;�ity E] Village ®Town Nearest Road Hudson WI 5491 6- , . 7 } J � Troy Tower Road. ® New Construction Use: ❑ Residential / NurnbeF Sf s 4 ❑Addition to existing building ❑ Replacement ❑ Public or cortna I Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ftz .8 trench, gpd/ft Absorption area required 857 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd/ft .8 trench, gpd/ft Recommended infiltration surface elevation(s) 96.00'. ft (as referred to site plan benchmark) Additional design / site considerations Install trenches using high capacity infiltrators. Parent material Glacial outwash Flood plain elevation, if applicable NA ft S=Sultable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ( ® S ❑ U ® S ❑ U ® S ❑ U ®S ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring# Horizon in. Munseli Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ; Trench 1 1 0 -14 10yr2/1 None sl 2fcr mvfr as 2f &m 0.5 0.6 2 14 -32 10yr3 /3 None sil lt hinpl mfr aw 2f,lm NP 0.3 we Ground 3 32 -37 10yr4 /6 None Is Osg dl gw if &m 0.7 0.8 elev 102.15 It 4 37 -76 10yr5/4 None gr. s Osg dl gs - 0.7 Depth to 5 76 -125 10yr6/4 None s Osg dl - - 0.7 0.8 limiting , factor 4-116 . Remarks: Z 1 0 -20 1Oyr2/1 None sl 2fcr mvfr as 2f &m 0.5 0.6 2 20 -53 1Oyr3/3 None sil 2fsbk mfr aw 2f &m 0.5 0.6 Ground 3 53 -58 1Oyr4/6 None is Osg dl gw 1f &m 0.7 i 0.8 eiev 100.95 ft 4 58 -10 1 0yr 5/4 None gr. . s Osg dl gs - 0. Depth to 5 106 -123 10yr6 /4 None s Osg dl - - 0.7 0.8 limiting factor >123" Sq Yl 'Y - Remarks: CST Name (Please Print) Signature: Telephone No. James K. Thompson , , U�— 715- 248 -7767 AW�,q A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, W 12/31/1999 3602 1173 pkpp RrjrpVKE- : Maler , Sam SOIL DESCRIPTION REPORT 1173 page 2 of 3 PARCEL LDS M017040-1022-10 AC.E. Soil & Site Evaluations HWM Depth I Dominant Color Mottles ftre ststence Bound Roots C '� 2 in. Munsell Qu. Sz. Cont Color Texture S�t Gr. Sz. Sh. Bed , Trench 3 0 -14 1Oyr2 /1 None sl 2fcr mvfr as Mtn 0.5 0.6 2 14 -39 10yr3/3 None sil lthin mfr aw 2f &m NP 0.3 1 3 Ground elev 3 39 -51 I Oyr4 /6 None Is Osg dl gw 1 f &m 0.7 0.8 100.95 ft 4 51 -103 10yr5/4 None gr. s Osg dl gs - 0.7 0.8 D epth 9 5 n12 10yr6/4 None s Osg dl - - 0.7 0.8 factor >124' Remarks: 4 1 0 -21 10yr3 /2 None sl 2fcr mvfr as 2f &m 0.5 0.6 2 21 -40 1Oyr4/4 None A Ithin I mfr aw 2f,lm NP 0.3l" Ground elev 3 40 -52 7.5yr4/6 None is Osg dl gw I f &m 0.7 0.8 96.25 ft 4 52 -111 10yr5/4 None gr. s Osg di gs - 0.7 0.8 Depth to 5 111 -120 1Oyr6/4 None s Osg dl - - 0.7 0.8 limiting facto >120' Remarks: 5 1 0 -8 10yr2 /1 None sl 2fcr mvfr as 2f &m 0.5 0.6 2 8 -21 IOyr3 /3 None sil 2fsbk mfr aw 2f,lm 0.5 0.6 Ground elev 3 21 -27 10yr4 /6 None Is Osg dl gw if 0.7 0.8 98.58 ft 4 27 -80 10yr5/4 None gr. s Osg dl gs - 0.7 0.8 Deptih 5 80 -122 1 Oyr6 /4 None s Osg dl - - 0.7 0.8 limiting factor >122' Remarks: Ground elev Depth to limiting factor Remarks: ' � ■ 5o ;i C�s�en�6'an O wner. 2>WClk Mo,- &: 7oP OP P; b Sarn /4, /4om XY-1'e-ek, Assurn4d • /acoled p D, 4ax /,v e lev = ioo, rX�.' S Ke syoi� 0 gz vc ■ .4 .10 5; �0/Bp. gtJy�lsr�y� see . 7'z8rt., ,p /9cv, a 4 1 31. 3 93 A 16 in *M � r •ts'�te. E/� �" = 95.08. a ■ BS ■ AZ 71 ,Zo9. co' Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 C Ong y Plan Option #1. If system fails, determine cause of failure, use alternate area and install new s in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 -246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ST CROIX CO C E AGRE EME ` SEPTIC - TANK MANT OWNERSHIP CERTIFICATION FORM owner/Buyer �� r c A . Addr Matlulg .. _ I''1 Address Department for new construction) Property (Verification required from Planning a - parcel Identification Number City /State pE �TION r� LEGAL j V' VV, Town of =�--= ���� � ir., Sec. Location �--= /,, — Lot # �. property / �% A— Subdivision . Page # Volume Certified Survey MaP #`{ Volume Page # Deed # � � � Warranty Lot lines identifiable )jk 0 no Spec house YesXIIO ce � _ � tore failure. to handle wastes. Proper maintenaa stem coul result in its Pn� r What you put into the system �' rTNA N �� o fyour septic sy d if needed by a licensed P� e and m ain or sooner, ImproPa every three years oral system. the septicnta a treatme the waste disposal consists of pum? out ion. of the sep nt stage in s cd by the owner and by a can affect the fun nt a certification foam, ewaterdisposal system - to St. Croix Zoning DePartme that (1) the on site wart , fie property owner agrees . submit lumbet or a licensed pumper venfymg tic teak is lsss than ll3 full of sludge. pluarber, lestrictedp � (� necessary), the sep e r , 'ourne3'� inspe and pump ds is in p rop plumb ,) 2 after iaspe em with the s tandards is is per operating condition se%r () s e to maintain the Private sewage disposal cation eats and afire artmcnt of Natural Resources, State of WisconsOffic�e � 30 ed have read the above reQwrem to the St. Croix County Zoning Uwe, the uadcrs t of Commerce and the Dep set forth, herein, as set by the Department must be completed and return e sept sy st em has been main that our eP y stating Y n d O tzo da three year cxp DAT 'X — DATE SiGNA "lJJRE DF P `�' W NER �F +ICATI N the best of my (o�) Imowledge. I (we) am (arc) the owner(s) of O I (we) certify that all s on this form a deed in Register of Deeds Office. the property described above, by virtue of a warranty i 3 DATE —lz.- PLICANT revoked by the Zoning Department . * « « «« . "'�`� «• SIGNATURE errnit being infornoation that's mis- npTesentedmay result is the sanitary P . Any deed from the Register of Deeds office a warranty decd d in th ap plication: a stamped warranty if reference is made «« Include with this app a copy of the C ertified survey map 620507 STATE BAR OF WISCONSIN FORM 2 - 1982 KATHLEEN H. WALSH WARRANTY DEED _ REGISTER OF DEEDS DOCUMENT NO. _��Jt7PAGE 410 ST- CROIX CD., WI _... RECEIVED FOR RECORD j 04 -03 -2000 9:30 AM Sam E. Miller, a sin le erson WARRANTY DEED EXEMPT N CERT COPY FEE: COPY FEE: conveys and warrants to Bruce T Hogberg a singl - VOX TRANSFER FEE: 162.00 RECORDING FEE: 10.00 PAGES: 1 THOS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, First Federal Savings Bank I State of Wisconsin: I� LaCrosse- Madison !I 201 South Second Street Hudson, Wisconsin 54016 040- 1022 -10 - 000 PARCEL IDENTIFICATION NUMBER I ii Lot 24, Plat of Frontier in the Town of Troy, St. Croix County, { Wisconsin. . i ii ,I j' This is not homestead property. (is) (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. 5� March, 2000 >��.��• Dated this � � day of A.D.. (SEAL) (SEAL) r SAM E. MILLE (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, l Signature(s) } ss. St. Croix Cou s r authenticated this day of 19 Personally came before me this day of March, 2000 the above named Sam E_ Miller y� TITLE: MEMBER STATE BAR OF WISCONSIN (if not, _ w ho by §706.06, Wis. Stats.) S , Q o own to be the person who executed the foregoing s ~•• pLS insl nt and acknowledge the same. TH{S INSTRUMENT WAS GRAFTED BY STEPHEN J. DUNLAP St Hudson, Wisconsin Nota lie, . Croix County, Wis. fission is permanent. (►f not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not MY 19 ) necessary.) below d cir si ,__._. signing an .__..I p .._ .__ ' • Names of rson%sI ca acity should be typed or printed gnatu:cs. >Kaconsrl Lege4 Blank Co., Inc. N STATE BAR OF WISCONSIN Milwaukee. ws WARRANTY DEED Form No. 2 — 1982 I 1p \ �_ 1 d � .,10 M I I � � �• 0� Sr id' \\ o Lei o f co ' xl XXV 3 „OO.tr�• l S 00 I 1 ; ✓ � w i I a 5 110-1133S V, I M V/ l 3N 31111 isaM _ __ — �,S 11oi l�aS €y TIMS -Y /lMN awl Iso3 988151; M „OS.ZO.O SQ cv Pp t L.1 6p 0 cly In o o Ar LZ I cv� 00 SJ., _ CA z l 1- s - - -- - ------- - - - - -v L5'L - -- - - -� ';6S'9lt �� �� I I I 96'W 3 Dffi•O S M , diS.SZ•S s� CSI ; �� s ; 1133ilS,lb 3 „Lb.6V.o s 3NNQ2i8Wd� .sz czl fsr N 1 N 11'7 d - • O 0D 1 co I.�� rn \ cP I O cal o0 lY, N r 1 d 1 W I t916b I - a 1 1 M 1 Cl - I ? 1 z. 3 „80,\0 L S CID m oo �I! 1 1 0 00 ° ' � d.(j) ' vi 1 1 0 i I ' I fPl \ 1 N 1 \ _ t.6 \ f N cu Cn z i •9 1 I S to 1 � s •., , � .-- . 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