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HomeMy WebLinkAbout040-1260-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division V INSPECTION REPORT Sanitary Permit No: 405124 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: city Village X Township Parcel Tax o: Erdman, June I Troy Township 040 - 1260 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: CID -_0 I I eb.a` a Re- TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark t 2 IZ •+ IZ• OD 0 Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet �Y Cu .OR TANK SETBACK INFORMATION St/Ht outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 2 5 '+ 3 I ! Dt Bottom Dosing Header /Man. Aeration Dist. Pipe 1 1 a Holding Bot. System 13 . g 19t O n PUMP /SIPHON inal Grade ON INFORMATION �J Man acturer Demand St Cover ( 3 f GPM o(o Model Nu r TDH Lift ction Loss System Hea / TDH Ft Forcemai Length Di to Well / SOIL ABSORPTION SYSTEM 15" BEO RENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN I NS 3 93• �fi n� C2 SETBACK SYSTEM TO P/L BLDG IWELL LAKE/STREAM LEACHING Manufact rer: INFORMATION Type Of System: CHAMBER OR tr. 1 I ( UNIT l 1 -2.0 '�• �.� Model Number. tZit , DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Pipe(s) — -1 Length Dia I Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over IDepth Over xx Depth of eeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil xx S L � Yes j__] No Flo] Yes Fig] No N MEN��S: (Inc``uud�de cpdde di re envies, persop,s res nL ) Inspection #1: / / -� Z-- Inspection #2: Location: 373 Whitetail Lane Hudson, W 54 (SW 1/4 NE 1/4 8 TN 2)19W) Deer Valley Lot 19 Parcel No: 18.28.19.1398 1.) Alt BM Description= 2.) Bldg sewer length = M 3 t - amount of cover = Plan revision Required? [ ; Yes <'No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. Safety and DivWM cowry 201 w. w Ave., PA. Box 7162 7Z L-K itisin Madison• VVI 33707 - 7162 Departme of Commerce Ss D 373 �'`'� `"`� v� Sanitary Permit Application <(o S7 in accord with Comm 8311. wit. Adm. code, peasold bhcmsdm you Eroww1c 0 Chwwk RevWw t Voss far Lrnr s15. 1 L Ap dcldw )6atarBtatlen - Please Piet AR Information pared Pion Number MOW Number property owner's Name Prepeaty Owntes RECEIV property Laaation Wu 5f'S T .R e'ur, asses Zip code ► 2002 La Number Brock isbn Name CSM Number C ST. CR II. Type of (do* VII dud apps � 1 or 2 Family DweUft - Number of Bedr owns pQW��Describe Use o 01 S ale owned stat itio.d III. Type of (Check en(y sae Laos an Rae A (am®baimg at*me for iotKWU mm). Campleoe Rue B B a�italaie) A 3 0 Rsplaoeasear 111:111 6 01 AdMon to Far Casesty use 1 Now 2 � R Teak Only Duo Issued B. © Check i S.nitary Permit Ptevim* blued Perndt Naaaber� IV. Type of reneft (Cbwk aR tiles v j4*)(maasberlO9 acheaae is for brtwwat on) � 44 Nan - ptasaa*aed I>►Gt�atmd - 2101 Mound 47 D Sand Fiber so O Co acted waisna °t �� 22 Pr QQ +essmiaod la- ound 410 Holding Tank 48 0 Some 1'aas sl 0 Drip Line � 1O, IS 43 0 At-cirade 46 ❑ Amot is T=@U eor U nit 49 O 30 O Omer V. Area �alma�c rarcattaioa itme Design Flow' (gpd) Dfspend Area Dbpersal Ara Applkntioa Elevation Reqabvd Proposed Rae(t skJDiYvS9- ) ° pQ 14a k7 tea 8s 7 y( 433 N Prefab Sled Fiber Plastic VL Tank Info Chin teas otT beer Coucrosn Co�roceed Blass New 8sist;.es larks talk Doft CM*W VII. IN Oft Staftomat Unisex4poc assures sn d the POW'i5 -bows as toe slows 8 P s Name pbmtber's WIMM Number Business Phone Number nm*v 's Address CO. MRIP• Zip code) VIII. U On y Due Issued UsuJug Agent Sigasarr0 (No Stamps) Approved ❑ Dia�ovW dw Fee ( Pee) r 01 Owner siren }meal Adverse I%. of of D Rt' Lh 4 for (� S .�/ a te, , ...p,. o. Ah w . �t' „_ ��^No 'Lk y� rots.° a.- u� c.• F .. c�p RVR (R (15/(11) P o1- V3Lthe- Ct'Qmar /(7¢ D. a4hPrS �.?� I fV �`ly s1gT�N Qig w (oo PA Q i- Vab'D Lor 1 c� �/ �aSc7 «.QS�e a �� 1 #� ).ao - 3 c B� top aK c� et I� m — 't�o Ck AIT d d �g3 S� 3'� P a1- IL e ������ � , prs :Sw '1k f N E `l s tg TJL�; N R 9 w a� IQp ( ,� eer V Loy' 1 aJ 5�2��;�ZQb�2 lUG IJUi eS �rS 3 o (2,"40 #� aa s 1 d C K am. r. d d VO O � t ok A/T i �g3 0► g � rrNI 1 -10 -1996 4 : 53PM FROM ^) �� �Q.vt - ' P- 2 r+ac san"OF"r- OR 0"na"", SOIL AND SITE EVALUATION RE 1 of 3 farard.Hunhan Ralsdas siw, or safety s Bulldrrw In accord with ILHR 83.05, Wis. Adm. Code COUNTY k W .Attach complete site plan on paper not leas than a 112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (WA), direction and % of slope, scale or PARCEL I.D. 0 dimensioned, north arrow, and location and d chance to naarest road, APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION IEYYO BY DATE PROPERTY OWNER;' PROPERTY LOCATION Det GOVT. LOT - sw 1N NE 1/0 IS 7 2 8 ,N,R W PROPERLY OWNERS MAILING ADORESS WT A BLOCK a SUW. NAIVE OR CSM s 1505 ft 465 "14 na am vallox CITY, STATE ZIP CODE PHONE NUMBER ITV LI.V ILLAGE UOWN NEARW ROAD New Richnond WI. 54017 b15)24 -2320 N New Cwisflttction Use (x 1 Residential i Number of bedrooins . �_ 4 () Addition to e* Mg building I 1 Replacement (1 Pubic or commercial drAfte code derived dally low 600 _ MW Recorrorooded design loading ►ale — ...z bed, 9P" 9pol(tg Absorpt at•aree required bed, 1`1 '7,W french, 11 Maxdmun design loading rate _a bed, gpd4t @,_ bench. gpdm Recommended iMitrauon surface elevjMr(s) _ 99.10 It (as referred M site plan berO mark Additional de* I stills owv iderelm trcmt;,}aes spaced to code 3.: 50' - bezov grade Parent material 011tyash Flood plain elevation, N applf * na fl S S(riible for s" Ism CONVENTIONAL MOUND F EDU NO PitEMURE 0 -GRADE YSTFJN IN Fig L l� DI10 TANK u= unsuftable for ®S D u ®S D u ® S D U F S. D U U S ctu SOIL DESCRIPTION REPORT Depth Dominant Color N100es Texture Structure Roos jed i3orirlg +� Horizon in. Munsell Qu. Sz. Conk Color Texture Sz. Sh. 1 0-16 10 3 3 now s wvf >r 2•. 7 Ground 16-4 .,,01 10 wy L. lei urlev. 9$,7— fl. Depth lo littidng factor , f +84 '" o Remarks Boring # 2 2 2 - 7 ft Cora M1 Ground � • 9 8 .7 tL l factor L L + 84 n Remwks• CST Name: -- Please Print Gary L. Steel Phone: 715- 246-6200 Address: 1554 200th. New RiEftMqM& WI 1V 17 sig"tum: butt: 6 - - CST Number m02298 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division 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. rrpix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to.n9arest4c4,d. 040- 1071 -20 APPLICANT INFORMATION- PLEASE PRJXf ALL 1k F' R' N R VIEWED BY DATE ;• -i CD PROPERTY OWNER: ' ROPERTY LOCATION Derrick Construction inc —t- `! �, r�- -� VT. LOT �1W 1/4 NE 1/4,S 18 T 2 N,R or) W PROPERTY OWNER':S MAILING ADDRESS # BLOCK # SUBD. NAME OR CSM # 1505 Hwy #65 na Deer Valle CITY, STATE ZIP COD ` 1 PHON CITY ❑VILLAGE {]TOWN NEAREST ROAD New Richmond, WI. 54017 ` / 20 Tro Cove Rd. r ` [ x] New Construction Use (x ] Residential ='_S=i , � °�,F ` 4 (] Addition to existin 9 buildin 9 Replacement ( ] Public or com Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /1`11 Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft _,_a__ Recommended infiltration surface elevation(s) 99.10 ft Additional design / site considerations trenches sp aced to cod 50' below grade Parent material Outwash ood plain elevation, if applicable na r S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S El ®S ❑U I ®S El ®S El ®S ❑U ❑S CRU 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 ITiunch ................. .................. ................. ....1...< 1 0 -16 10 r 3/3 none sl 2m r mvfr cs 2f .5 I .6 2 16 -84 7.5 r 4/4 none cos osa ml na na Ground I elev. 98 ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -12 10 r 3/3 none sl 2m r mvfr cs 2f .5 .6 2 ................. 2 12 -84 7.5 r 4/4 none cos osa ml na na .7 .8 Ground elev. 9 8.7 ft. Depth to limiting factor +84 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. ,4V9 New RichrnQW, WI 54017 Signature: Date: 6 -10 -99 CST Number: m02298 — C "=� 2f 4L�f4 I PROPERTY OWNER Derrick Constructi DESCRIPTION REPORT Paget of 3 PARCEL I.D. # 040 - 1071 -20 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP T re ` in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Li 1 0 -17 10 r 3/3 none sl 2m r mvfr cs 2m .5 .6 2 17 -25 10 r 4/4 none sl lmsbk mvfr gw if .4 .5 Ground 3 25 -84 7.5 r 4/6 none cos 0SCI ml na na .7 .8 elev. 1 Depth to limiting factor +84 Remarks: Boring # 1 0 -14 10 r 3/3 none 1 2msbk mfr gw 2c .5 .6 4 ' 2 14 -31 10 r 4/4 none sil lcsbk mfr g w 2m .2 .3 Ground 3 31 -48 10 r 4/4 none sl lmsbk mvfr c1w if .4 .5 elev. 102 ft. 4 48 -84 7.5 r 4/6 none cos Osg ml na na .7 .8 — Depth to -- limiting �/ Q factor +84 S 2.a tt2,�0 Remarks: Boring # 10 -12— 1 2msbk mfr Qw 2c .5 .6 S 2 12 -30 10yr 4/4 none sil lcsbk mfr gw 2m .2; .3 Ground 3 30 -36 10 r 4 4 none sl lmsbk mvfr gw if .4 .5 elev. 4 36 -84 7.5 r 4/6 none cos 0sq ml na na .7 .8 1 03. l ft. Depth to limiting factor +84 Remarks: Boring # Ground elev. j ft. i Depth to limiting factor Remarks: SBD- 8330(8.05/92) r - 4 STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc.' 1554 200th Ave. CSTM2298 .Bw4NE4 S18- T 28N -R19w New Richmond, WI 54017 MPRSW -3254 town of Troy (715) 246 -6200 lot #19 -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 - =40' B�= top of 2" pvc pipe C el. 100.00' Atl. BM.= top of 2 pvc pipe @ el. 104.40' 'I P 10 9� �y f Gary L. Steel 6 -10 -99 �,� • •""r i nere Is q Better r / Uck Y i�q�� y LoT t q �� �� (iQ tl10 ' SIODIffuSer� Units. x 34w x,..34 �6» _ F 1� JIM or ter S torw ve1u., OPen bott n or w e + L°u Protect , f opt Sidcwan open; surfi2m and Mast h3Mt MtaiV, t + Proved u uu nL dFect ' &nuance + Very Monomicw s: Maxim�� unmasked lea The �oDif�r,�, lea ching sur�aCe of unmasked Provides the optimum a objective is to �� leach' mount mg surface. Its design unmasked P °vide an open bottom and sidewall to allow capillary action in all direci ons ent to flow via SPECIFICAj $: achieved by combining This has been t)rigl� s Unit ' bottom with a g the t raditional L am.... •....76" LOw Priory Unit Effluent series of louvers along Open Wialttt.. Length ,.._ 76" inside the chamber g the sides. -. ' 34 " oil along lows to uncom Height ......... 14" width ............34" 1 � the full l ength to eac Patted H I 9" eight ...........11 " ; re designed to allow ch side. The lo uvers ncompa effluent to SIOD U.Sers Invert...........6.5" fluent w Pass into the TM of eithe gating into the chamberrle preventing it from Q� graded and cow S '' w hen installed +th 2" or 17 '. withstand H 1 Q SO�S ' to �pry1S o over respectively. H-201 factors 3t, taM',- r - - POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of z FILE INFORMATION SYSTEM SPECIFICATIONS Owne Septic Tank Capacity Z) ga l ❑ NA r- Permit # Septic Tank Manufacturer 13 NA Z DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Effluent Filter Model ❑ NA Number of Bedrooms ❑ NA loo Number of Public Facility Units NA Pump Tank Capacity Gal ❑ NA Estimated flow (average) 0 gal /day Estim g / Y Pump Tank Manufacturer D NA Design flow (peak), !Estimated x 1.51 C-) al /da Pump Manufacturer ❑ NA Soil Application Rate � al /da /ft2 Pump Model E3 NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit ❑ NA 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 (BODd 530 mg /L *In- Ground (gravity) ❑ In -Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform Igeometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other. ❑ NA Other: ❑ NA Other: O NA 'Values typical for domestic wastewater and septic tank effluent. Other: 13 NA MAINTENANCE SCHEDULE Service Event Service Frequency 2 months) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: J ear {s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: 181 yearls) ❑ month(s) p NA Clean effluent filter At least once every: I — Z R year(s) ❑ monthis) A Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) �NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) 0 year(s)NA Other: 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 tanks) 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. GMW (4/01) I 'START UP AND OPERATION page o`, of 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 wM be discharged to the dispersal cellfs) 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; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly 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 inart solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption 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. < <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 6 r\ Qr­3 Name Phone ( 5 _ a (� S�� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ` c Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f► and 83.54(1), (2) & (3), Wisconsin Administrative Code. r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND . OWNERSHIP CERTIFICATION FORM OwnerBuyer �v b�lr; �� ��h.- �t_ `-t r Mailing Address es `� a-l� , t�u O 5-.0 Property Address �/`«� t L= �- ✓ (Verification required from Planning Department for new construction) City/State ®> o Parcel Identification Number LEGAL DESCRIPTION Property Location 5 � '/4, W '/4, Sec. l� . T Z`�b N -R W, Town of Subdivision . Lot # a Certified Survey Map # . Volume T` Page # Warranty Deed # I Z S t C, Volume 4 . Page # Spec house Oyes El no Lot lines identifiable 4es O 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 muster plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 . statin that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 s of ee year ex date ( ILORkTURE OF APPLICANT DATE OWNER CERTIFICATION ) 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 ir tue of a warranty deed recorded in Register of Deeds Office. TURF 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 WAIMANTY DF.F.D (F'onner Statutory Form). STAIR OF wisn NSIN Miller -Davis Co., Minneapolis, Mann. -• i Form Na 9 W. 259154 M41S Enbie turt, Made by Archie J. Waxon and Lois Waxon, his wife,. grantors , of St. Croix County, Wisconsin, hereby convey and warrant to' i Jack J. Erdman and June M. Erdman, husband and wife as joint tenants granter, , of St. Croix County, Wisconsin, for the sunt of One dollar and other good and valuable consideration the following tract of land in St. Croix County, State of "Iflisconsinr Northeast quarter of Section Eighteen (18), Township Twenty -eight (28) North, Range Nineteen (19) West, (NEI 18- 28 -19) . REGISTLRro OFFICE ST. CROIX CO.. WIS. Recd ft�r Record thi -i. - -17th day of __ Au�,nst _ - . r1. ;59 at__9t}0- �'...._ 0), iVid Hope Deputy In Witnraa Wflrreaf, The said � S haVChereunto set their hood Sarrrt . r wt S thi:; 10th dqy of August .�. 1). 19 59 SIGNED AND SEALED IN PRESENCE OF Hugh F. Gw in _ - . Lois Waxon Harold Walbrandt � #fx�r of isrnnsin, St. Croix �•ru,rr, /1 amlouors qa a iqun awoN alrJmad6 ,�• 0 9 61 Z —. ��S s;).ttd :ra uorss►iuruo� r � ., r JT1 tU) Yt �7rO),I Sul y`'u 70 `Ad0 )r IJ )l JJ.I'J o .n woRa.4 .)7 )) t) umou. ,)ru O 177 7�1 7 P ? 7 y f; 111 1 1 11 1 1" '1 1 OSTM STq ' UOXrM STO'j Pur UOXt'M !jsn JnV 10 /Ivn lillollmua,r I DEER VALLEY 4 OF THE I LOCATED IN THE NE 1/4 OF THE NE 1/4. PART OF THE SE 1 OF THE IN T AND PPART OF THE NAA''1 /4 OF THE NEf /4, OF SECTION 1 s I y ST. CROIX COUNTY, wISCONSIN. - watot v1 arms � I ' Z W I =� I J 0 I I I UNPLATTED LANDS OWNED BY OTHER o � o. aTJ{ITM ut a M ■artnr sas' a xIt wwN > a,[ Iml /• Na9'19 1322.74' Tor Ts f!t - � •tt. Ww m halm/ n 7, n3AW ML I .a r ' i sa1. • L r i 1 1 A rt. 1 r rr 11t.B1 I � 1 ,m► pg ce um acm 1 8j •� I C 1 Mj.t SC FT. ��( I 1 � r j i 1n I ' m,..m mM.M6L mm ...t . • x p W = Q i .�1m com rt. _ 17j I Z iJM 0 I U" W Y I 1N *so man 1AwFT. .. 0 � �� Opyt/=11MN110[,� =t�� r�jr• a I Wzr4 i vim"" maw ,ow I i 51a.7Y ' N89'2 1191ST 295. ' I i prral'�p j 1 1 (tit I 1 I ; LOT 1 PARCEL I I I PARCEL �N 1 ; C.S.M. IN V. 460 I I 1122 V 633. PC. 36 � V. 4, PC. ' I 1 � i I , I AN ammo SCALE IN FEET 1' • 100' MCI= to 100 0 . 100 p0 ]00 ogpwj 1T onw= W Lmma 0 .c mm Jo Na was DA10 V AIN Co RD F a Z ww � N 0 0 16 Z 0 -b tJ A G W G w, N r4 > D� a a v ON D 6 co to o mQ ;Ls to l