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HomeMy WebLinkAbout040-1259-50-000 YNisconsin c-epartmentUf Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildino Division 7 INSPECTION REPORT Sanitary Permit N o: (ATTACH TO PERMIT) 399668 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Erdman, June I Troy Township 040- 1259 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: 4 /00 oa - / TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sep tic ti Benchmark U St✓2 ZSn • 3S (I►N. • 00 •D Dosing + � � Alt. BM 'T+ Aeration - ". Bldg. Sewer , r Holding y St/Ht Inlet e /v;� . 7/ St/Ht Outlet . 4f TANK SETBACK INFORMATION D 1 02.3 1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' 35'1 3 �t Dt Bottom Dosing t ► Header /Man. -d p/. 3 Aeration Dist. Pipe 5 IOU 7 Holding Bot. System Final Grade PUMP /SIPHON INFORMATIO ' ib � Manufa urer Demand Co GPM 'D•�i8 Q .d Model Num TDH Lift Fric i S stem TDH Ft Forcem n Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM fJ¢ BED /TRENCH Width Length No. Of Trenches rPITIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 3 all SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM EACHING Manufa to INFORMATION CHAMBER O Type Of System: / UNIT M umber: v . I ^ 4 DISTRIBUTION SYSTEM 01 " Header /Manifold u Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 17 [ / >'3 Length Dia Lengt Dia Spacing IL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes gj No jj.j Yes No NI (Include, code discrepencies, persons present, etc.) Inspection # 41;Aj- 6 2Ac Inspection #2: Location: 369 Deer Valley Drive Hudson, WI 54016 (S 1/2 NE 1/4 4 T28N R1 9W) Deer Valley Lot 5 e No: 18 28.19. 1.) Alt BM Description = �+� �— r 2.) Bldg sewer length = 34 - amount of cover = > 240 Use others de for additional information. _ - I Yes'_, No !o Q tJ -- – Date pctors Si ature ert. No. SBD -6710 (R.3/97) r J l � Saitjr md B C1a�atq� Whim � 201 W. Wad6itr = Ave.. P.O. Sm 7162 Gr. K W! . Wi S3a0"1' - 7162 �e w�li�aa vvisc DODWtMnt of Cottttttett+e Pennft q .0000a sa�r rw*i°c tmk ow Ds sad lrr L A#pbomit Librtmrlta - ?Mre Trutt AN LNiitt�s prawly t kmws Ness n Pmoei Nt�er v �o r) A. 11) -I a-5 Fmaly owmr-t tends PtaPeeq L°w"i°° o s�--' 'A s s R c:61. Ler zip Cody 7 pbomea, I.at Btock SdW*vido* Nave csm romw IL T of BdMbg Obook A dot "W Oda r or 2 � DwGWW - rl Ml Ot o l ltsoan Doscrft Un (I sm o+.aea 1ro.d � �er wsr� UL I%" eii � a* >� m ire A d�••+�we =bon for jt�Ittraal wq. A. 1 New z 0 Este s+rwean 3 0 R of d 6 0 A M im o >!lr CST fete s. D CIO* V a :a ftwim* bmwd Prsanit Nsstiter Dsae Itraed - IV. Tye of Psesit: 2Oft al Utz — h o t s ar3st�e 4 fir l id on) Ia �m -p weised teammd 21D tweed 47 0 Smd PRsor so 0 c oororeaed Walwd 22 /-,+ ft- ', d ykkowd 410 Holft To* 48 D Nlt Pan St D Drip Lim 45 © At Qm* 46 D Aermaie llwt MM XhW 49 ❑ Ro==kft 30 0 Odw D odp nm to � A Am Sol A"Nmdm pei�aiatio� RMt Sr�Men BinNdoa Plapaed Raw+IId& Dn%mlj.13 -) A - 7 Cl a3 tip R4. q o a. 9 VI. Tsak bdo TOW PesiYtt oft S raw phsfic OtdAm fil,0oas dYfstoe Ooocnw careaated i s Mob TM" twr dillies VQ. >, trinree trr Itrdsisliss► dde 1*aiPlS dlwwa aMeelted mmmbm. } tQA@R4 } tla d=n Place Number i 77 c 1.3 �s37 rs -a b � s A &Sft tstneet. +cad. surx. z1p code W 5 V ' um Dan tstaed z +taint ASUK S� MIM (No S"W) ash ❑ wpprawa © Deed S«iarr P�ssl Ere r°�'d°s Oroaede�ater Sate 1%*) D O.mK Otsa bmW Atm a 7 Deotsisdoe ; r ML Ggalidm at spp wd/Q� ter DbappwW D Imo'"' sue' ,w.ea ew*Mr ph.la sto t' A• trst l) the NO= «�.r..e +..tr..stn :a t ar. >e rare eur"Am m nS ) er 1/ .. � Sett �J,�,� E�� �� ay L - 0 r s 4 WW 34" 76•_ Y�" .. + o pen err �atrs r ♦ V e rr . **ft �k T Qf u proVJ svr n eed the opti )blective is eve leactUn wn amount , nmask � to provide an © s -Its desig h lelar �dewall to allow effluent to pen bottom and SP -- ved b n In a ! 1 ire+ctlons. This r'' via �CIF� S . Y sen�nS the has been mat tft at with a traditio Ruent ,ns louvers alo nal, open LegM ....... ....7s. i ' tow pm ft Unit I aloes the he �nbe� flows t alo he sides. WkSh .............34~ ;' Length ........76 desi length of �'ncolnPacted N rt .........14• ........ ..34 °pact to allow efflu side T he lo uvers invert .............g- Height. .......11" bacicfilt while preto Pass into he Biopj �,� In ......._._.6.5' � 8 into the chamber tang it fro flt graded aW efti� see, when I T. wi thstand H - 1 p �h factors 3l, I ` P 4� J`d rr. ar��Q�2F UA 7 'PC r� �o 1 SF y� N F' Yy 513 T a& A) R /9 a ca� kooc-� ���,� vc'WQ L-Ort W -S la r s o Ito y ?ca r 0 /O ! a S m os A BM Tcf 0 Ov 4ti Safety and Buildings Division CO i 201 W. Washington Ave., P.O. Box 7162 - S��r�S�t� Madison, WI 53707 - 7162 SiNj s La( Department of Commerce D Aff Ss _ �" Sanitary Permit Nutttber A Sanitary Permit Application 3� � g ' r f � a, r In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number ' Property Owner's Name Parcel Number .' Property Owner's Mailing ss Prope Location " °:7 '•� \ Q Lon u c I4 �*4; S/ T' N, R 1 1 1� City, State Zip Code Phone Number Lc. Number Block u jar Subdivision Name CSM Number il U 6 II. Type of Building (check all that apply) ✓ ��� S '""` ❑City or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public/Commercial - Describe Use Vownship t-0 ❑ state � Nearest Road V ! r_ Q S 13 -s 04_v III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to S stem I I Tank Only Existing System B. [I Check if Sanitary Permit Previously Issued Permit Number -- [ 5a - te Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44(V Non - Pressurized In -Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Disp ent Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate tem Elevation Final Grade Required Proposed Rate(Gals./Days /Sq.Ft.) (Min./Inch) Elevation Lo Y ( 55 . 7 kA- VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ` Dosing Chamber -+ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. lumber's Name ) Plumber's Sq&bq MP/MPRS Number Business Phone Number P C aa, 7is S! Plumber's Address (Street, City, State, Zip Code) V i O VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse �{ Determination }� L J 1X. Conditions of Approval/Reaso - for Disapproval CA Q6 1! -rv�1� �l�V1AUl 1" 1`2CJb�^•• ` U Vw t s.t a complete plans (to the County od S qS y) for the syst per on pa not less than 81/2 x .1 inches in size SBD -6398 (R. 05101) ty c,/d. -pe r' f u0.l c pcvi n w 1---S J (� Y tj E Y 5 13 T a �j /Q /9 Lo Cnv .2 1`o GkQ / J 2 r^ U L T W C"- 0 1.2 s I Y �a�cD- d �o ras - o�u c t 3.15 t / 3D 4 aaos A Bi� Tcf � IUa', l ; r, el m lr-q s eA /CSC . ,) 42 y �r ce ati Phlu�+� Wire bonsla, Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 tabor and Human Relations gi-Oon of Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix x not limited to vertical and horizontal reference point (BPB -,, direU*m.agd % of slope, scale or PARCEL # dimensioned, north arrow, and location and distanQe to g_ - .,. ;t "road %' - "' ® T 0 ' z -� D APPLICANT INFORMATION PLEASE P 1 alL INFjkRMA'FION` -, REV WED BY DATE PROPERTY OWNER: `J' r`. ° > !I - PAOPERTY LOCATION f QpVT. LOT SE 1/4 NE 1/4,S18 T 28 N,R 19 Ikor) W PROPERTY OWNER':S MAILING ADDRESS �� LO! # BLOCK # SUBD. NAME OR CSM # 1505 H #65 sT CROrx 5 na Deer Valle CITY, STATE ZIP CODE 0 CITY [:]VILLAGE J9OWN NEAREST ROAD New Richmon WI. 54017 M )24 M Troy E. Cove Rd. ( New Construction Use (x] Residential / Nu Addition to existing building Replacement [ j Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate __,L bed, gpd /ft gpd /ft Absorption area required 858 bed, ft 7517 trench, ft Maximum design loading rate gy bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) area A= 99.90 -B =98.20 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE 7 IN FILL HOLDING TANK U= Unsuitable fors stem >� S O U [a ❑ U CA ❑ U R] S❑ U S ❑ U EIS @ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench <. >.` 1 0 -8 10 r 2/2 none 2 8 -18 Ground 7.5 r 4/6 none MR nqrf rnl Nnn na .71 .8 elev. 1 02.9 ft. Depth to l � limiting c (� o Remarks: Boring # 1 0 -12 10 r none 2 12 -20 10 r 4/4 none 3 20 -30 10 r 4/4 none Ground 10 ele ft. 4 0 -96 7. n 1 Depth to limiting factor + 96" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. ve. New Ric and WI 54017 Signature: y Date: 6 -2 -99 CST Number: m02298 f PROPERTY OWNER Derrick Construction SOIL DESCRIPTION REPORT Page 2' Of ' PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft ................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends .................. ................. .................. 3 ` ' 10-10 1 2 10 -15 10 r 4 lfs 2 bk mfr aw Ground 3 15 -84 7.5 r 4/6 none cos 0sq mi na na .7 .8 elev. 102. Depth to limiting factor +84" r��•4 4 3• l: � /8�F Remarks: Boring # 1 0 -14 10 r 3/3 none sl lcsbk mfr cs if .4 .5 ................. 2 14 -84 7.5 r 4 6 none cos os ml na na .7 .8 Ground elev. 1 Q1 -ef — Depth to limiting factor • (e ° • ° +84" Remarks: Boring # 1 0 -10 10yr3 /3 none s1 lcsbk mfr cs 2m .4 .5 ?; 5 <` 2 10 -22 10yr4 /4 none sil 2msbk mfr gw if .5 .6 3 22 -84 7.5yr4/6 none co s Osg ml na na .7 .8 Ground elev. 10 ft. Depth to limiting factor 3•L° +84" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, INC. 1554 200th Ave. CSTM2298 SE4NE4 S18- T28N -R19w New Richmond, WI 54017 MPRSW -3254 town of Troy (715) 246 -6200 lot #5 -Deer VAlley This soil evaluation was conducted to satisfy.a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N r1 =40' - BM.= top of nail in Elm tree @ el. 100.00' Alt. BM.= nail in Elm tree C el. 107.10' -� 0 Gary L. Steel 6 -2 -99 i - _ z - c am cr m 1 , K' CD t• 7 b ; .Y i 6 f ; a � t. IC ' T ca ca �.. a 3: r d rn ti7 G UM r-• Q C L1 �• �ra� »N�rQ r) to v� x' ° E= -` 4 "° u , to g' 3• �-- Mve�! t 1' '1 G POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner �'" E GMT Septic Tank Capacity Z Sfl al ❑ NA Permit # �9 Septic Tank Manufacturer W.e rws ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Ata_ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model -- (LrD ❑ NA Number of Public Facility Units NNA Pump Tank Capacity a l NNA Estimated flow (average) bfl gal /day Pump Tank Manufacturer IR NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer N Soil Application Rate 0 . 7 gal /day /ft2 Pump Model NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NNA Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD :_30 mg /L KIn Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :_10 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 5r Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: � Kyea�� )(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA � � 3 �ityear(s) Inspect pump, pump controls & alarm At least once every ❑ month(s) NA ❑yearlsl pressure test At least once ever ❑ month(s) P y= ❑yearlsl I�NA Flush laterals and Other: ❑ month(s) c1 NA At least once every: ❑ year(s) 7 C Other: R NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. r Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; panting products; pesticides; sanitary napkins; tampons; and water softener brine. ABA "4DONMENT W an the POWTS fails and /or is P ermanently taken out of service the following steps shall be taken to insure that the system is pr erly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. C !- 4TINGENCY PLAN the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant ,iacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. • Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. I c < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name.v (N PBU1 E2 S Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST, C'" ()( Qbkj1 Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �� 'Eta-) AA Mailing Address C C - , OVC P-c a 6, O ia 5c tom., W f 4 c t to 3 l,0 9 Property Address D� �-- vA- t- Du �< LW Q S o u 54 1 b (Verification required from Planning Department for new construction) City /State Parcel Identification Number 4 0 _ � 'Z c9 ` So <) LEGAL DESCRIPTION Property Location %{, i /,, Sec. � . T 2b N -R 11 W, Town of Subdivision �� �dL� �/ Lot # Certified Survey Map # . Volume . Page # Warranty Deed # O Z S 4 Volume — �6 c - , Page # Spec house Dyes ❑ no Lot lines identifiableXyes ❑ 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 masterPlumber, journeymanpl*nber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 g e three year a iration te. SIG 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 e pro described above, by virtue of a warranty deed recorded in Register of Deeds Office. / SIG OF 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 t QQ ZW 11 e^ 0 a = N a' 1 u o n $c ar, 44 U. N vo to a a a N N � N N c4 4�1 g 1 CM 9 tl% ~ C4 z 0 a 44 o tU z CO) 0 I��w�4�A�w�Y1��1 Y i�l��l I I THE NE 1/4, PART OF THE SW I14 'CTION 18, T28N, R1811, TOWN OF TROY N _ �FS u •_ O I MAT C4 7� l �M N i a or g 8 W Z 2.737 ACRES ►� / (. AtT, IWII SO. FT. Jill . M 1 ` n - 1 • -$ 4.030 ACRES ,t M � .•••r�J �t \t EXCLUDING EASEMEMS t ; �• t a7Mp AcaEs 4 .1 t 16L323 m FT. In I N o ; t . �; ` J co 3782 ACRES -j: W i 4 O Y ', '\ ;. '� .` 164.707 Sa a FT. Z M5 ACRES C) 11 1' - 1 122.6]O J J \ EXCLUBM EASEMENTS I 1 'ay. 2333 ACRES 1 ?')I Wi EASEMENTS M� ULM Sa FT. } I 2334 ACRES bit 110.999 SO. FT. .1 j I z ;a i Roe„ � - - -�•• `,s, .,erg v ��. I io 1 z N1 1 1 2.363 ACRES 4 E 0 . FT. .............. I L 48 SG � u M................. d CSM IN : 8/2387 8 >3 9 _._ - -- - — -------- - - - - -- _ 300.19• "E1 /4 CORNER S89'13'41"E 856.29' soon+ LINE OF TMME NEI /4 SM3'41'e SEclwN 18 D UNPLATTED LANDS OWNED BY OTHER I SHEET 3 OF 3 SHEETS i WARRANTY DF.F.D {Former Stntutory Form). STATE OF WISCONSIN Miller_Davis Co., Minneamlia, H:Inn. Form Na P W. 259154 Whiz Enbe nture, hladc by Archie J. Waxon and Lois Waxon, his wife,. h grantors , of St. Croix County, Irisconain, hereby convey and warrant to* ' Jack J. Erdman and June M. Erdman, husband and wife as ,joint tenants grantees , of St. CroiX County, Wisconsin. for the cunt of One dollar and other good and valuable consideration the followin.6 tract of land in St. Croix County, State of irisconsin: 1 Northeast quarter of Section Eighteen (18), Township Twenty -eight (28) North, Range Nineteen (19) West, (NEI 18- 28 -19). I I i t rt 6'il I I REGI%Tf!R.% OFFICE ST. CROIX CO.. VVIS. Pec'd fLf Rocord thii. .17th day of- _ j nsL__ .,1. x..59 _ A * d Hope Deputy En Uldnran 1I111rrraf, They sail �;roiitlor S luaveherewdo wt their h and Sl. ! s lhi r 14th day of August' `' .i. 1i. 19 59 SIGNED AND SEALED IM VHESENCE OF rlrc Hugh - l � . Ow in (.� 1:'. ! 1,., Lois Waxon Harold_ lValbrandt ]otaty of Ulioronsin, St. Croix (�uur�lyj Personally ea)ne beforr• mr, this 14th day of August ✓1. D. 19 59 , the above named Archie J. Waxon and Lois Waxon, his wife, to n,c known fu he t1se t,er•son trho c.teeutcd the fore oing' instrianent and acknotvlcd�cd the sa me. - \ , • T .Notary Public,- _ ___Sf..__.Crnix County, Iris. IXy c)rrunissiun canires S hpt. 1_2 , .1. 1). !rI 60 {. . •T ypeturite Name under each Signature t R��K 360 PA "E631