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! / %, cmDal 0 tz ; $ % k k 2 - 2 E @ .+ M o/ o co E / E 2 7 E B E o; B\ - / w E g z n® 2 ¥ \k \n \� §\ U) C . ■ ■ E 0 E a $ E " , $ 2 7 E 0 CL 2a 0 ~ § §� . § » c; z CD a' 0 r CO ° : c 2 r . . z 0 00 59 .. j 3 m CD . / # ■ CO) ■ 0) K § i M o § C. 2 » � Z e § co o / R f - \ ( C § ` £ _ [ ® k z 2 E _ E 2 § ! k z E / C L � � \ / T q § » r z 0 F z § CD � G ± E g G & z \ n if a \ � *m _ � }_ ) � ¥ � ¢ \ z \ � � ■ � \ _o �� \� i o � � 0 ° 2 � J�\:(k13 g CD 3 0 (� ƒ E 0 / c co .�- ) w } A } / \ ( m ( / / k \/ \ k k 0 CD k / § \ \ S @ ƒ g k § � O _ Fj g TO E E t . � g@ �; ■ C � _E �$ CL ° a �77§ \ D � > a I U) \ \ \ 2 0 c CA I � � � cr \ M V M K 9 00 \ 2 / / \ ) ® ®®+ ~ E 0 Z ° 7 N) E § E C) i { .. � \ \ � CD 2 = m CD ± § \ ° \ } ) / z m � g ' ^ / [ . � ƒ w M $ § « E § / z § : z § q z » % \ 0 \ C . / z $ : CD � \ � � ƒ � ) � ) . � Q � \ ■ . < f § f C @ i 4 1 Form -STC — 104 AS BUILT SANITARY SYSTEM REPORT OWNER _ j ,��,J TOWNSHIP SEC. T o; � ( ' 6 N -R,5cl W A..DDRESS, V [ w ,� St?LL _ ST. CROIX COUNTY, WISCONSIN SUBDIVISION 462 f� LOT Z LOT SIZE PLAN VIEW Distances and dimensions to meet requirements`of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 4 no t(t 0 46 0 V P4 V o cl ;r INDICATE NORTH ARROW J. BENCHMARK: 'Bescribe the vertical reference point used p dg Elevation of vertical reference point: Proposed slope at site. SEPTIC TANK: Manufacturer: ,4- Capacity: Number of rings used: Tank manhole cover elevation: C f Tank Inlet Elevation: ?c; C / O Tank Outlet Elevation: r Number of feet from nearest Roar': Front,O Side, Rear, Q feet From nearest property line Front, OSideRear,Q . feet � f Number of feet from: well � , building: (Include this information of the above plot plan)( ',2 reference limensions to septic. tank) SEE R EVERSE SIDE PUMP HAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, ORear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench:� i Width: Length: Number of Lines: Area Built: Z Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, Rear, OIt. .�! Number of feet from well: �� Q Number of feet from building: (Include distances on plot plan). SEE GE PIT Sizes Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area• Built : Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). H07 NG TANK Manufacturer: Capacity: Number.of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, Ortli„__ Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: ° Inspector • /' ©sue ' ?� S 4 ' Dated: Plumber on job: License Number: i 3/84:mj P7 ARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING 4.1 1oT715'GN, WI 53707 1 � SEk, NWT, S8,T28N -ReMW CONVENTIONAL ❑ALTERNATIVE I State Plan l .D. Number: Town of Troy E] Holding Tank El In-Ground Pressure El Mound (If assigned Lot 12 Red Brick Addition .NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Calvin Burton 314 Pleasant Street, Roberts, WI 540 - d 7 -,y ,7 1,�3 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN'. REF. PT. ELEV.: CST REF. PT. ELEV.'. Name of Plumber : MP /MPRSW No.: County'. Sanitary Permit Number: Lyle J. Myers 6219 St. Croix 99037 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAP V TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER n PROV DED: PROVIDED 73 � -r_a� YES ❑NO OYES ONO BEDDING: I VENTDIA_ - VE NT MATL.: HIGH WATER NUMBER OF ! ROAD: 1 PINE G ROPERTY WELL: BUILDING: VENT TO FRESH NO C ALARM. FEET FROM _ L LAIR INLET: ❑ YES I ❑ YES ❑ NO NEAREST 7l/w 7 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACIT PUMP MODEL. J PUMPISIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: P NUM OF PROPERTY WELL BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET. PUMP ON AND OFF) DYES ❑NO EAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (if soil can be rolled into a wire, construction shall cease until FORGE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH NO. OF DI STR. PIPE SPACING. COVER - INSIUE DIA.. *PITS: LIQUID BED /T.RE i,$ /� TRENCHES: MAT RIAL• DEPTH. DIMENSI ®NS S ( /L7 PIT GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIP DISTR. PIPE MATERIAL: NO. D R NUMBER OF PROPERTY WELL'. BUILDING: VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV. INLET ELEV. END. PIPES. LIN AIR INLET FEET 2_ ° o ` f EST `1 a StS� ,2 l " - L - Z � I1IEARE57! MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- 1:1 YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS DYES ❑NO DYES NO DEPTH OVER TRENCH/BEO DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED SEEDED. MULCHED. CENTER. EDGES'. ❑YES 1:1 NO 1 ❑YES ONO I DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER: MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. JDISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.. ELEV.: PIPES. DIA.: E I EVATION AND HOLE SIZE HOLE SPACING. DRILLED CORRECTLY. COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED N,F,CJRMATION PLANS: DYES ONO DYES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS NUMB PROPERTY WELL: BUILDING: FEET LINE: C OYES El NO DYES ❑NO I NIARM � � r ).9 777 Sketch System on tain in county file for audit. Reverse Side. SIGNATURE'. TITLE: Zoning Administratr DILHR SBD 6710 (R. 01/82) —�— COUNTY SANITARY PERMIT APPLICATION DILHR In accord with ILHR 83.05, Wis. Adm. Code STATE ANITARY PERMIT# • 9j2,'7 —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION FOR VARIANCE ❑ YES �Z NO PROP Y OWNER PROPERTY LOCATION dJ ( !- , ,q-Z , �f S /a/lf &j S g T-28, N, R E (or o PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME T 5' Z = i2 CITY, STATt /' ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK - S of S O23 , —3Z VILLAGE Il. TYPE OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family 902 e OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check ## 2,3 or 4, if applicable) 1. a. New b. ❑ Replacement c. ❑ Replacement of d. El Reconnection of e. El Repair of an X Systern System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a.gConventional b. ❑ Alternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank ,., V. ABSORPTION SYSTEM INFORM N: (Check one) 1. a. ❑ Seepage Bed b. ee a e Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSO AREA 14. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): , A •. 65 1�i � � Feet ZPrivate ❑Joint ❑ Public VI. TANK CAPACITY Site in g allons Total ## of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank `l�0 "'v T + /1F i El 0 Lift Pump Tank/Siphon Chamber ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plum er's Name (Print): Plumber's Signat e: (No Stamps) MP PRSW No.: Business Phone Number: Plumb is Address (Street, City, State, Zip Co e): Name of Designer: Vlll. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST ## CST's ADDRESS (Street, City, State, Zip Code) Phone Number: 2-A � 2,S' is' 2 -z/ 1/ IX. COUNTY/DEPARTMENT USE ONL ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) k4 Approved ❑ Owner Given Initial r u charge Fee 0 ' ,,/ `) Adverse Determination X. COMMENTS /REASONS FOR DISAPPROVAL: SBO -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION - TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary - Hermit Transfer /Renewal Form (SBD 6309) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained: the septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your l9cal code administrator or the State of Wisconsin, Bureau of Plumbing, 608- 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; ll. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8 x 11 inches must be submitted to the county. The plans must include the following plot plan, drawn to scale or with complete dimensions, location . of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ----------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground or included the creation of surcharges (fees) for a number of regulated practices which Wisc, 6 can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried rea5ure' is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. 0 The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground - t I� water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD -6398 (R.03/86) APPLICATION FOR SANITARY PERMIT STC -100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any.inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, ( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - owner of Property L a \ {" Location of Property -_ It Section _ , T Zg N -R W Township Mailing Address J Address of Site Subdivision Name 17k Lot Number 1 2 Previous Owner of Property Total Size of parcel 2 0 Date Parcel was Created Are all corners and,lot lines,identifiable? Yes No Is this property being developed for resale (spec house) ? _ Yes No Volume 7 V7 and Page Number 'I_149 as recorded with the Register of Deeds. I INCLUDE WITH THIS APPLICATION THE FOLLOWING A Warranty Deed which includes a Document number volume and page number and the Seal of the Register of Deeds In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATIO 1 (We) centt6y that att statements on thi4 6onm ace true to the beat o6 my (oun) know.eedg e; that I (we) am (ace) the owner (s) o the pnopent y des cxi,bed i thi s .in6onmation 6 onm, by vi tue o a wavcanty deed neconded in the 0 o the County RegiAteA o6 Deeds as Document Na. G�2 ® , and that I ( pneaentCy own the proposed 6 to bon the sewage di,aposa6i (on I (we) have obtained an easement, to nun with the above deschibed pnopehty, bon the con6ttuW ob said system, and the same has been duty neconded in the 066.ice o6 the County Regi4ten o6 Deeds, as Document No. ). SIGNATURE Olt OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) / 7 DATE SIGNED DATE SIGNED I I DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 -1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 4289 01. i. "78 7PA ,E '470 �ZE ISTERS OFFICE G!P - W]J es &ade between ............ ST. CRAIG (o., OI I& ---•-•-••----•-•---•-••-•----------•--•-----•-••-••--••----•-•-------•--•••••--••----- ••--- •----- •- •--- •-- • - - -• -• --cc d. for Rewrd this 6th ........................................................ ........................................................ du7 of Aug. A.D. 1987 --- ............................ ••-----•••----•--•--•••--•--•---------- •- ••- ••---- ••---- •••- • - - - -., Grantor, 8: 30 — and ..... BurJ;_Qaa__Bui7•de.ra -by .. Calvin _.Bur_ton--------------------------- •---•---•--•••••-•---•-•-•-----------------•-••----...•---•---•---•--••--•-----•••- -•..............-•---- •-• - -•-- Rp[riv N DNi� ............................................. .................................................... , Grantee, WAh iRgsseth, That the said Grantor, for a valuable consideration...... -- - -- ..--_.. ............................................................... ............ ..............:.... ....................................................... RETURN TO conveys to Grantee the following described real estate in ..St,..- cro].x .............. County, State of Wisconsin: Lot l4 Red Brick Addition, Town of Troy, St. Croix County, Wisconsin. Tax Parcel No_ ------------------- z--------------- '..,!` .... ...� This is not homestead property. , (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And...... Girantor •--•----•----••-------•---•---•--•-• ................................................................................................. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights -of -way of record, if any. and will warrant and defend the same. Dated this ............... 1St. day of JLl1y 19...87.. (SEAL) •-- .......... "l..K!r he" . .. (SEAL) Glen M. Wiese ---- •--- •--- .....-- •--- -• - - -. (SEAL) --------------•----- •- ......._•--- ........_... ...................... (SEAL) I i AUTHENTICATION ACKNOWLEDGMENT Signature(s) --------------------------------- •-------------------- - - - - -- STATE OF WISCONSIN ss. --------------------------------------------------------------------- •----- - - - - -- St. Croix -- ------------------------------------ County. authenticated this -------- day of___________________________ 19.__.__' Personally came before me this ----- 2 _..___.. 1 st --- day of July ... ..............................1 19 --- 87. the above named --.------•------------------•••-------•------..........._...---------••--------- -------------- - - -• -- -- •-- ---- Wi --s --------------------------------- Glen M. ese TITLE: MEMBER STATE BAR OF WISCONSIN -- - - - --- ------------------------------------------------------------------------ (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person ............ who executed the egoing ins met n acknow ge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland Lundeen - -_ - -• - - -- -• -------•--••-----•••---- ------ Attorney - at• - Law -------------------------------- - ----------- Alice J. Fleischauer -- •------ -_...- ••• --- • C ---••-.•------ - - - - -- •• - 5t. roix -•--._....--•-----------•------------------------ ------•-•-------- -...---- ----•- Notary Public _.._..--•- ....... Wis. (Signatures may be authenticated or acknowledged. Both My Commission is perm f y��� (ration -ire not necessary i r1�Yt y') date: June 11 ' Np{NyJkm.., 1989.....) State ofVagoonsin *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE. BAR OF R Wisconsin Leval Blank Co. Inc. i fnRm tin. 1 — 1VR2 ern..._.a...., vn. r k STC - 105 r SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County x d V 9 OWNER /BUYER H e ROU TE BOX NUMBER Pk w Fire Number �4 .LLB( CITY /STATE ZIP PROPERTY LOCATION: 1 �N Section, T? _LN, R�_W, p Town of �� y y , St. Croix County, f q Subdivision ar 31I c- , Lot number > . i Improper use and maintenance of your septic system could result in Its premature failure to handle wastes. Proper maintenance con sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you pdt into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, < which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained The property.owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber;' journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper after inspection and pumping in operating condition and (2) p P P g if nec- essary),.the septic 'tank is less 1/3 full of sludge and scum. Certification form will be sent approximately-30 days prior to three year expiration. H o I /WE, the undersigned, have read the above requirements and agree x to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart 'b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE 6 p - X D # St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715- 796 -2239 or 715 - 425 -8363 Sign, date and return to above address. DEPARTMENT OF RE PORT ON SOIL BO RINGS AN D SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 P.O. BOX 7969 HUMAN RELATIONS MADISON, WI 53707 - • . (ILHR 83.0911) & Chapter 145) LO ,/ SECTION: (or TOWNSHIP /MUNICIPALITY: LOT NO.: BLK. NO: SUBDI\/ISION NAME: / �C'G ► �� t36 ck- Aid. C �:� o � OJpLE�R'S �YER'S NAME: �� AILING ADDRESS: USE �cGGJJ / DATES OBSERVATIONS MADE N COMMERCIAL DESCRIPTION: / PROFIL DESCRIPTIONS: FMC-0 LATION TESTS: Il6Residence IU QNew ❑Replace L )/D RATING: S= Site suitable for system U= Si te unsuitable for system 1 VS CONVENTIO�NAL: MO ❑U IN- GR FjE: SYSTEM- IN- FILJ�H S G TAN O�M� ND��Y / T On0 tipnal) U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the /► / /� under s. ILHR 83.09(5)(b), indicate: I Floodplain, indicate Floodplain elevation: jvh PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B/ 7 y, �h f 7� y y Cs -r B- ftv � u� h S -- B- y.5 9 n� 7 C;� 6n b 1 9 15 rnec) -3 '9r 6n C B- 7 R q . 2,5 > 72 e6aJ,9 b a cis 3 q d C B -,5" 9q. v n � > Q r L U 6 (zo 130 B -( 7a 4. no 12 e- 5r) d6 3 9' 6 o C 6 f PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL- INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PER OD 2 PERIOD 3 PER INCH P- r 6. - 3 �/ / P- P- e. P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION • X 15 i I d 70 lU Q n,_.c. a, 35 Z- 100 ' _ �- r I 8 -4 ' TN i D � P - e D I� a -a 0 -5 �o L 6_3 •P 3 8 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the proced s and metho spec ied in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): ITE§TS WERE OMP ETED ON: ADDRESS: CE�IFICATIO NUMBER: P NUMBER(optional) _ CST S UREA LA 7 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 10/83) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SB 7 - 6355 • y To be a complete and accurate soil test, yow report must. include_ 1, Complete lectal description,, 2. - 1 he use section must clearly indicate whether this is a resicjence or commercial project; 3. S IAKINIUM nurnber of bedrooms or commercial use 0a fined; 4. Is this a new or repiacenrent system; r. Complete the Suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY tF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; S. PLEASE use the abbreviations shown here for writing profile descr iptions and completing the plot plan; 1_ MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; S_ Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent, 9, Complete all appropriate boxes as to dates, names, addresses, 'flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, glace N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12� Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL. TESTERS Saar Separates and Textures Other .Symbols st Stone (ov 10 ") BR Bedrock col) _ Cot t.} e (3 - 10 ") SS Sandstone �,,, gr — Graved (sander s f LS -- Limestone s Sand HGW High Groundvvater cs — Coarse Sand Per c -- Percolati Rate aped s Medium Sand N — Well fs Fine Sand Birig -- Building is L;:,arr y Sand > Greater Than sl Sandy Loam < -- Lass Than Loam Bn - Brown siI &'11 Loam BI _... Black si _.._ Sit Gy Gray ci Clay Loan) y Yellow scl ...._ Sar dy Clay Loam R Red c „ sir;. - �3,(. Clay Loam nut .._ Mottle", sc; - 5arttly Clay v��l — with sic — Silty Clay fff few, fine, faint c Clay cc — common, coarse pt Prat mrn — Many, mediurn m __ Mucl d — distinct l'} — pronl? ?lent HWL - High vvater level, Six general soil textures surface wal:er for liquid ovaste disposa% BM Bench Mark VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. 4d -1fj E-�� •�' up,� oil '37 r- z m �3 'I P OO L L) SD ` P -3 Q I LTA c l i T t4 s, z� Wisconsin Department of Commeil;e PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488093 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)]. e--- Permit Holder's Name: City Village X Township Parcel Tax No: Nagel, Daniel I Troy, Town of 040- 1213 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: W. Of 160-42' �ow. r k uee _ W R ` – 08.28..1024 TANK INFORMATION V ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark v�t ��b DSO •Z°l joi-vt 1 csD•a Dosing / Alt. BM Aeration g. Sewer H olding t /Ht Inlet TANK SETBACK INFORMATION 1S /H i b• Sf 1 TANK TO P/L WELL BLDG. V ent o it In ROAD 11111I �•�$ • � f S'T r s eptic r Ct'r-k ( I 5 °—t C'�°..1' �! q 1 •2 r ea er an. 'A eration Dist. Pipe :7-07 071.W .7 o mg o. sys �Zo X3.0 PU Ina ra e /SIPHON INFORMATION �•`f'`� anu ac er Demancl St Cover 7z •+Z— GPM �R•3S o e um er 1. & i i oss ys em ea 1 r & • Ry. ' SOIL AB RPTION SYSTEM 23 `h �•� VZj,s IFED DIM S 3' g x 1 Z INFORMATION CHAMBER OR r UNIT z z cam. pacing " Pip s) Length Dia Leng is Spacing SUIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only epth of Bed /Trench Center Bed/Trench Edges Topsoil Yes 1';' No Yes i j No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 447 Brick Circle Hudson, WI 54016 (SE 1/4 NW 1/4 8 T28N R20W) Red Brick Add Lot 12 Parcel No: 08.28.20.1024 1.) Alt BM Description = r," ST• 'ar�" � r 2.) Bldg sewer length amount of cover 3 -i s-G-���t. revis Plan Req No Use other side for additional information, SBD -6710 (R.3/97) nature-- —` S and Buildings Division County 2 ashi o ve., P.O. Box 7162 St. Croix �sconsin Ma 7 anitary Permit Number (to be filled in by Co.) Department of Commerce (60 3 1V1 j �'$�`�3 Sanitary Permit Applicat m rt MAR 0 9 Ste Plan I.D. Number Z�1Q6 In accord with Com 83.21, Wis. Adm. Code, personal inform on you provide ;47 ject Address (if different than mailing address) maybe used for secondary purposes Privacy Law, s15. (1)(rt$T CRO I. Application Information - Please Print All Information Brick Circle Property Owner's Name Pazcel #: 1 o Z Lot # I Block # Daniel R. & Lisa M. Nag el 040- 1213 -80 -0000 lot 12 Z .--- — Property Owner's Mailing Address Property Location 447 Brick Circle 8E ' /4, N W v4, Section 8 City, State Zip Code Phone Number T 28 N; R 19 W Hudson, WI 54016 715) 381 - 3081 II. Type of Building (check all that apply) 11X1 or 2 Family Dwelling - Number of Bedrooms 4 Subdivision Name ❑ Public/Commercial - Describe Use Red Brick Addition ❑ State Owned - Describe Use ❑City_ ❑village ❑XTownship of Troy III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A- ❑ New System ❑XReplacement System ❑ Treatment/Holding Tank Replacement Only 11 Other Modification to Existing System B. 11 Permit Renewal El Permit Revision ❑Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T ype of POWTS System: Check all that applyj Two 2 trenches, 23 "Quick 4" chambers each 3' X 02"L46 c ambers total Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade 11 Single Pass Sand Filter 11 Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line 11 Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: 46 Infiltrator "Quick 4" Chambers at 19.1 sq. ft. EISA/chamber + 2 r. end caps 90.20 sq. ft. EISA Design Flow (gpd) Design Soil Application Rate( sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) yttem Elevation 600 gpd 0.7 gpd sq. ft. 857.15 sq ft 890.20sq ft EISA 92.75' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 750 750 1,500 1 & 1 Wieser Conc W/ Polylok P1 -525 X effluent filter Aerobic Treatment Unit Dosing Chamber VII. Responsibility State ent- I, the un rsigned, assujuc res st ' ' or installation of the POWTS shown on the attached plan& Plumber's Name (Print) P MP/MPRS Number Business Phone Number James K. Thompson off MPRS #30021 (715) 248 -7767 Plumber's Address (Street, City, State ip Code) 340 Paulson Lake Lane, -Osceola, W1 54020 VIII. Coun /De artment Use On Approved El Disap roved Sanitary Permit Fee (includes Date Issued Is uing gent Signature Stamps) Groundwater charge Fee) ,,,,,,,,,// 11 Reason Denial 09 2vin J IY, Conditions A prov 1 3 \ , r n 1 4Z �T(� t it SYSTEM OWNER: > V m xu 1� 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained U as per management plan provided by Plumber. -�� �� 2. All setback requirements must be maintained Z 1 as per applicable code /ordinances. KWA -uV- J Attach complete plans (to the County only) for the system on paper nc aclift in size SBD -6398 (R. 01/03) ♦ C,Yi;SEIr� e/c da �� � /(�iCLi74 /1 "Ong" /ot iZ y ,Q�d Bry'uf'i4dd,on, -arc. 8, .'t -,25". 00 ' � / u�. T . o�'Tre 5�• cia;,rG ,.�L � �B.O' GwrEecv Cell SCp6c EanR: \ , �r1G/► mW +�1 60116� O{ idin ov„cd , ' St's yoR ✓.e. �9 d, ✓e o� do lve yl6rdre`�, �, BI Towns vQ /�e�. E�ciS�� t i t P�o�s�.d �,�e�•- � t c4m w cp7sa -»t,Q t :5. Po /y/oK ' < ^7 M '�"oPesed dis�t7rr5Q/ C'e /% Two�t) '� t t Ertac ez aE 3'X9,2'423 4-kXq 1 � i opc Isom �. SMa�I CLalar �r2c5 F w � % �t � a G, � s.7 - = 'E.+iSflrrgSysf¢M e/e 93.2s' {�rapastd d,3 ce/ /Q /cv 6e = 9,2. 75' 277,73 r • �,Y /s�� e %da �� N "l-11-�lY, Qd�niae.,e4r, A Pry, Ice 11 y Qad Bri'uf'i4dd, or), C. 8, 7 fJR 00 �! cJ. Tn.oF'Tro 6'.C/nirCe 97 0' 7 s d.'s�r le SC�6c 6zn�t'• \ 1 98, zi' 84neA Ina.re. 1 o+, ✓oJvc + 1 ( 0 il6rd� 7o�vnJ vQIA�y �Ps + Propcsea( t..Jnes�+� 1 ` 1 1 Co» . W tP 750 -MGQ 1 1 6.7-. +i-y Pol /ole ` P� szSa� /u�E 1 1 � o rn -A^OPosed diSFlerSa/ Cc //, c%eS aE 3'y 9,Z '-3' 1 1 1 1 1 + 1 + 1 OPcn faun �, z SMQII C C.d4.r �r'2G3 off• - E'is -6 .5 It el") a %P = 93.2s' / #3CZ�ti .177.73' y-- I 7r , 1969 Wisconsin Department of Commerce SOIL E VALUATION REPORT P age 1 of 3 Division of Safety and Build in accordance fh orREM I AM Courrty 06de A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'/2 x 11 inc size. Plan must St. Croix include, but not limited to: vertical and horizontal reference po it (BM Parcel I.D. percent slope, scale or dimensions, north arrow, and location and dis nce to ne rest f o'�� 6 040 - 1213 -80 -000 Please print all inthnnation ST. CROIX COUNTY ewed By Date Personal information you provide may be used for secondary Privacy Law, s. 15.04 (1) (m)). I Z� zm� Property Owner Property Location Daniel R. & Lisa Nagel Govt. Lot SE 1/4 NW 1/4 S 8 T 28 N R 19 W Property Owner's Mailing Address Lot # Bloc�#Subd. am e or CSM# 447 Brick Circle 12 Red Brick Addition City State Zip Code Phone Number City J Village to Town Nearest Road Hudson WI 1 54016 1 (715) 381 - 3081 Troy 447 Brick Circle J New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD V' Replacement J Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments 111�' and recommendations: Site suitable for replacement conventional POWTS @ 0.7 gpd /sq.ft. Install two trenches at 92.75' using 23 Infiltrator "Quick 4" chambers per trench (46 total). Boring # i Boring Pit Ground Surface elev. 98.22 ft. >112" in. Sal vi Pit to limiting factor Appl ication 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 1 0 - 17 1Oyr32 none sil 2fsbk mvfr cs 2f 0.6 0.8 2 17-46 1Oyr3/6 none Is Osg ml cW 1vf,f 0.7 1.6 3 46 -76 1Oyr5/6 none s Osg ml cW - 0.7 1.6 4 76 -112 1Oyr6/4 none s & gr Osg dl - - 0.7 1.6 _1 r 3.01 s.to Hof b`f W. Fil Boring # _j Boring 1/ Pit Ground Surface elev. 98.85 ft. Depth to limiting factor >116" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz is Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 1Oyr32 none sit 2fsbk mvfr as 2f,vf 0.6 0.8 2 10 -17 10yr5/4 none sil 2msbk mvfr cW 1f,vf 0.6 0.8 3 17 -25 10yr3/6 none Is Osg ml gW - 0.7 1.6 4 25 -80 10yr516 none s 0 sg ml cW - 0.7 6 5 80 -116 1Oyr6/4 none s 0 sg ml - - 0.7 1.6 .y •Z * Effluent #1 = BOD ? 30 < 220 mg/L ankTSS >30 < 1 mg/L * Efflu t #2 = BOD S mg/L and TSS <30 mg/L CST Name (Please Print) Signatur CST Number James K. Thompson �� 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceo�.l 54020 2/102006 715 - 248 -7767 Property Owner Daniel R. & Lisa Nagel Parcel ID # 040- 1213 -80 -000 Page 2 of 3 3� F Boring # Boring 1/ Pit Ground Surface elev. 98.98 ft. Depth to limiting factor > 120" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GE in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 1Oyr3/2 none sil 2fsbk mvfr Cs 21' 0.6 0.8 2 12 -30 10yr3/6 none Is Osg ml Cw 1vf,f 0.7 1.6 3 30 -84 10yr5/6 none s Osg ml Cw - 0.7 1.6 4 84 -120 1 Oyr6 /4 none s & gr Osg di - - 0.7 1.6 F-1 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 GP / in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef1#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 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. • cr�s�� e /cda�� �-.; c.� C'.�•�c% 5 talc: /= s�0 . 8 �J b777A �PQ {'i9�9 ,Oa4ie,1ee,43 /l Proms /oe iz --.c. T. 2 eil., oo " �� w. Tn. o< Tro 6j. cia;XCe 9 o' Con-teu.� 06 x G8 el r/ �cas>< ', e/ev' — 5c/o6c fang � \ t 1 1 ��: �� � ara e • 1 1 I 1 id; , Assumed 1 t t E,c, i l i 1 I 5/b 1 ' 1 I Towns l/ e B� �oQ d y AVknc EitiSf�� t 1 ' � 1 � 1 � 1 m � � 1 � I � 1 t 1 1 t � I 1 1 1 1 � . 1 Shall Ccdc� { d �rc�bs ode. - EXis sys�eM %� = 93.2x.' X77.73' d ,, n r5 „ AV- i Y 3f f v i } 4 , awn rw,. i � d I 0 I I � I. � I w � Li \ P Ism a o i� own v M w GO > own Q T Q - ®■ = I w W U °• Li O0� a L OWN ■ m °O a tm u d � � v � o z 0 Li E� Al � W C +_ d a /Mg o � Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10705 -P (N.01101). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be :5 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations ( October - February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two -year schedule by use of a diversion valve. Valve to be switched diverting effluent from dispersal cell currently in use to resting cell on a two-year cycle coinciding with septic tank inspection and maintenance. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248 -7767 or the St Croix County Zoning Department at (715) 386 -4680. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/�r 9 Zf. � � .L,i Sa In 4a 9e-I Mailing Address `�y 7 B/`� e %��2 � 5�, co� Sod 16 Property Address �e (Verification required from Planning & Zoning Department for new construction.) City/State t-J/. Parcel Identification Number LEGAL DESCRIPTION Property Location SE t /a , /�IJ ' /a , Sec. 8 , T 28 N R 19 W, Town of boy Subdivision �2n/ .�/'i c �dd� 0� , Lot # /,-- Certified Survey Map # /Ia , Volume , Page # 116 Warranty Deed # s `� 3 2 , Volume 13 K _ _ , Page # 3 Y 0 Spec houses no Lot lines identifiable yes t SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 Planning & Zoning Department within 30 days of the three year expiration date. 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 of a warranty deed recorded in Register of Deeds Office. Number of bedrooms `�` r 41, /1 A 40 Aa.'Ow S NA F PPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08M) VOL 1385PAcfr `340 L-59*314z2t -;r ST !A OF WISCONSIN FORM 3 — 1998 KATHLEEN H. WALSH i QUIT CLAIM DEED kEGISTEk OF DEEDS DOC M N l ST. CROIX CO., WI RECEIVED FOR RECORD CAr fP r �� 12- 09-1998 4:20 PH (NIIT MAIN DEED quit - claims to EXEMPT N 3 CERT COPY FEE: SO— COPY FEE: TRANSFER FEE: RECORDING FEE: 10.00 PAGES: 1 the following described real estate in County. State of Wisconsin: st e g y/y TaB'ry / g ry W y� e d �/r f C. � V ��wl �10 • l� AETURN 70 (75 Sc(, / Yo. -,e &/y`7 Br c k el"- /Q filud l?. Z O E ,ter le l (' Parcel Identification Number (PIN) /D 3 40 - 006 This homestead property. (is) (is not) Dated this day of o bRI-I (SEAL) (SEAL) L► s a m. na (SEAL) (SEAL) A c� n AUTHENTICATION ACKNOWLEDGMENT Signature(s) S OF WISCONSIN } 3t Oro CJjG County. J � fAi authenticated this day of - ,19 Persolly na came before me this 3 day of Al DV t4� 7 ter` ,19 t '1 the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known o executed the authorized by § 7013.08, Wis. Stata.) foregoing Inst THIS INSTRUMENT WAS. DRAFTED BY Y Y `I t Q- 1 Notary PubII9/ L County, Wis. (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. (It 661. state expiration necessary.) date: .18 .) ' Names of persons signing In any capacity Should be typed or prMlad below their signatures. S83 NTF 0023A QUIT CLAIM DEED STATE EAR OF WISCONSIN Nebo, Inc., P.O. Box 10208, Green Bag WI 54307 -0206 Form No. 3 — 1996 8 , 12.30' 169,379 SO. FT. 3.80 ACRES ;y in 3 a� Mf 7 bM 5 s 116,073 SO. FT. s TEMPORAft 2.64 ACRES 87, 702 SO. FT u - - AC 2.01 ACRES t TO 8C REMOVED UPON .�� OAD EXTENSION, ro� .QC' �. OW 2ID'Oe �f3:>➢N' m F 6.78' I p R A i 6 � 13 3,811 813 s0. FT It N Q 3.07 ACRES 3 'O 87,139 SQ. FT.` . \ 2.00 ACRES+„�� P - U L IC N�b9, O 14100' C� 10 N FT. , .. �. 2.26 ACRES 98,565 S M 87.170 SQ. FT. r� 2.00 ACRES 47,475 SQ. FT. 2.01 ACRES ®42.68 17. 41' " 8 27-7 ' 1 4.90 31lO.QO M68 37' 41` E 860.09' SOUTH 1.I MS OF T441 SE W4 OR THE NW 1/4 OF SCTION S. k1�M i.ATTfc _LAN S N �[ %raa�► I�r yhrla+tie1 NW. ,r+ar�1 � ' r��: