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HomeMy WebLinkAbout012-1011-40-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT 1A Owner c Property Ad ess City /State rk m (j wz 54 0 ! - 7 Legal Description: Lot — Block — Subdivision/CSM # '/4 ' /a, Sec., TAN -RAW, Town of -`' # 3?� 129 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK} TION 1200 Tank manufacturer W 2 P Size STS' / Setback from: House 12, Well P/L /oo Pump manufacturer - --- Model Alarm location — - G TANKS ONLY) Setbacks: ice road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: TPenc, L Width 3 Length 00 Number of Trenches Setback from: House I yo Well /ti O P/L ? I5 Vent to fresh air intake S /0 ELEVATIONS Description of benchmark 8 14 5 3 w • D QUC Yl e - e W1 lad k - Elevation 1 60, Description of alternate ben mark s'a- c Elevation `27.0 ' Building Sewer D y, q ( ST/HT Inlet /0 3, 7 7 ST Outlet 76 3. 57 PC Inlet PC Bottom Header/Manifold- Top of ST/PC Manhole Cover l, 2 7 Distribution Lines O 97, 6 Bottom of System () 97 ' 6 S () ��' ��� () � Final Grade () J0 /, 5 () ( ) Date of installation lI /2'3 9 Permit number 3 State plan number Plumber's si g nature pe��z ! ti License numbe r .2'2:E y.5 I Date Inspector L4 ,� lvt Complete plot plan � NOTICE Please provide the following: 1 • A plan view sketch showing everything within 100 feet" of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW i t4 . k qP rF G - Qcil V vl /cm ►d d ?Ad ' -r0A/a j wp ,026; nil3 L' W g 4d 'Ad reti ? :avN . vc,000I n'13 T W $ i �1 "•1 „1011c• smaarn Cott i sg 1 INDICATE -NORTH ARRC) to 's rWQ -°c oR a;- I 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Persona inf you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 353199 Permit Holder's Name: []City ❑ Village ❑ own of: State Plan ID No.: Dunn, Sherry Town of Erin Prairie CST BM Elev.:- Insp. BM Elev.: BM Description: \ Parcel Tax No.: 0 r 60.0 Ta K PV t w��etx� (t l 012 - 1011 -40 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic OJ (2w Benchmar 1) Dosing Alt. BM —4 Aeration Bldg. Sewer 3 yi .. 1 /o cf, y Holding 5/ Ht Inlet TANK SETBACK INFORMATION St Ht Outlet 13 j o 3.5T TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic rte 5 r -- NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe,,, +_' �-Z- CA Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade �. tS Ion • Sb� Manufa er Deman St cover Model Number GPM TDH Lift Fri m TDH Ft ss ea For rn Length Dia. Dist. To We SOIL ABSORPTION SYSTEM BED / EN Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME N I N 3 1 dul DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufa rer: SETBACK INFORMATION Type Of CHAMBER Model Numbe System: CohV. 11Qb ' 150 OR UNIT << DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. '_ Length Dia. Spacing 1 150 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over ` Depth Over xx Depth Of T x Seeded /Sodded xx Mulched Bed /Trench Center l� Bed /Trench Edges Topsoil E] Yes [:I No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 11 /,23/99 Inspection #2: Location: 1866 170th Street, New Ric on WI (SW1 /4, SE1 /4, Section 3 T30N -R17W) - 3.30.17.47A 1. p Alt BM Description To ��y� _���n �- p 1;40 = 101.00 P �°'."`°• I e �� 2.) Bldg sewer length= �- 2 , at 16 �C•v i - 1.�0 . mount of cover = .,�T % CZ. //``,, _nn ..�`,,�- F''° t-�°�" sue► � � t Z� 3) 11. Plan revision required? ❑ Yes No Use other side for additional information. 1 3 1 - 3 [ 1 CD SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. X ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 4 - - - - -------- I a E q g a� i i a 1 a a I _ Safety and Buildings Division V isconsin SANITARY PERMIT APPLICATION 201 W. Washington Avenue P o Box 7302 In accord with ILHR 83.05, Wis. A Code , Department of Commerce 1. ? t, Madison, WI 53707 -7302 . • Attach complete plans to the count co o for the s st �_&` a r no less tot:lnty than 8112 x 11 inches in size. p p ( Y c Y) Y _ p p � • r .r ��,�o, • See reverse side for instructions for completing this applic hsfl „„ 1 ` r fF, State anitary Permit Number 19 ry 3x3 , 9 Personal information you provide may be used for secondary purposes ; .. ! r: ❑ Check it revision to previous' application [Privacy Law, s. 15.04 (1) (m)]. 'i Co Uh State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL FbA 0/, I o l 1- ,qv _ 000 Property Owner Name \ r Prope cation, �_��';� n \ -1L4_. �j 114; S`r T 30 17 ` — Rs"�vv Property Owner's Ma4gng Address L tuber ` Block Number 17 q/ et City, spate I Zip Code Phone Number Subdivision Name or CSM Number eW 9tch m an.d 5y01 ( > II. TYPE OF (check one) ❑ State Owned _ Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms � Town OF Eo 170 - f' Ave, 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 3- - n L + - A 1 C] Apartment/ Condo ©1 2-- / O r —V D r c� t' 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. , g New 2 ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5. ❑ Repair of an System ________ System __ Tank Only_____________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 []Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pre sure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fi 11 j ) I &D VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2 Absorp Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev., 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/da q. ft.) (Min. /inch) `�9 i 94. a Elevation 6 - X Q 4 99. Feet Feet VII Capacit TANK in allo g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons an Manufacturer s Name concrete con Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank - s� rD W eise r ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI er's Signatur : 'Stamps) MPURRS1 140-: Business Phone Number: - We 0a LL e z . �eArwe - C aas�5 71 � a ss Plumber's Address (Street, City, State, Zip Code): N ?A �)o 9 &+. - Rue-ir FaA ,kJ17 5CID 2Z IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sa Surcharge fee) OD itary Permit Fee (Includes Groundwater ate I ssued Issuing Agent Signature (No Stamps) ` 'Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS ' a 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. I 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) 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 mainstwater service; streams and lakes; pump or siphon tanks; 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; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE~ 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. �l . 1y \ � M2. ,3� 8 • gy 3 1 S ys few. Ele 4 9.8' ae 990' 3 . 4r - Q1 Ch P V c P.t wl j-Q 1 i g A El u . '97,6' c h 8"' l-� a j4 �/y ram► �. - -- PUC P,�e W14,otk '70 e i Wiisc6nsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations 9 — DMsion of Safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code r P 3 - COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. PI fu e, �ut'. S`r • cc�-� l� not limited to vertical and horizontal reference point (BM), direction and % , scale�gr PA{ CEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ' `e.''+�� APPLICANT INFORMATION PLEASE PRINT ALL INFORMAT 0�.% 4 ,. ` lTI7 R IEWEiDBY DATE PROPERTY OWNER: )Pic.. - ;,PROPER$* ATIQI , 4 1/0 PNU\- \ - V VJ�S&J Q T 3 p ,N,R E (dR PROPERTY OWNER':S MAILING ADDRESS • 'C(}T,# SUBD: NAM5 OR CSM # Z 6 SP'XlDL� CITY, STATE ZIP CODE PHONE NUMBER [QTY E� NEAREST ROAD R \ 3e2L Ffvus WI S y o i 2 ( q� _ o 'Z8 I ��" t _LL �1D `�+ Pj New Construction Use pG] Residential / Number of bedrooms [ j AdditiQn to existing building [ j Replacement [ I Public or commercial describe Code derived daily flow b —Q gpd Recommended design loading rate - bed, gpd/ft __�j trench, gpd/ft Absorption area required bed, ft Sa O trench, 11 Maximum design loading rate , - �t, bed, gpd /ft - 14 trench, gpd/ft Recommended infiltration surface elevation(s) s� )v u'r'-- ` - a ft (as referred to site plan benchmark) Additional design / site considerations 1ti %TIt - LL L-4� 0'j 3 Parent material otJ%_-� G ft @L.11_ nLL Flood plain elevation, if applicable 'N R It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FlLL HOLDING TANK U= Unsuitable fors stem O S ❑ U U ❑ U 0 S ❑ U OS ❑ U EIS O U [:] Mi l SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trelxh hntiiv}ih \vt�p > ) o - - Lm Sb Z 7 - 2. I - 7 • sy R fl S> I e-Sb12 >v1�H C S L .3 Ground 3 Z1-32 S li p - 31 y elev. _ q a _1 ft 3Z -kv fL 3 /Y - L 4 S 0 VIA wI vFa �y Depth to limiting factor 34. A) Remarks: Boring # l O`' z_ 31 Z 5 t 'Z m S b �t wt �I a. S - • 5 . z 2 k—ug lo`•t Vz-31L si( Z+nsb� mfg- � S . S . L Z6 - t S -I 23Cy — Gr L l eSbY� �,.► , c,,�, _ wig Ground elev. y ZC, -� G -� •r �l i d q� It Depth to limiting factor X86" Remarks: CST Name:- Please Print Phone: Arthur L. We erer 715 - 425 -0165 egerer Soil Testing &'Design Service -P.O. Box 74 River.Falls,WI 54022 Signature: - - Z 6 5 Date: CST Number:. ��' 6'9 9 220254 PROPERTY OWNER - OU►Jtl SOIL DESCRIPTION REPORT Page Z-of 3� PARCELI.D. # O\ Z- LU11 - OHO l Depth Dominant Color Mottles Boring # Horizon Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer>ch z q -z,) -S �lIZ 3/v — s i I zrnSbk tr�'F s � Ground S Li RJly L CSbF� c 0 elev. ° e ft, y 3y -87 -)- J' kfZ ov" T Depth to limiting factor Remarks: Boring # o`t (Z 31 S € 6 <•T Lj $ 1 -S`iR 3l Zvnsl,lz w, F'h c9,► — . S 1 .t, N>> f tip Ground elev. 1 01-0 ft. w►v�� - Depth to limiting factor 9 ,� Remarks: ' Boring # r: >::< >. .. »:::::: >; ) o - 9 ► oti >Z 3l Z — s i 1 _LM Sb 12 yvlit - CX S S Ztn 'I 2 3 — L tes1,1� wok I Ground a �1RR.� CS _ Ijp E flilp elev. 4 Z6 -e v 7 .S �/ R �l y 1_ � S I 0�,, m u Pt- - lb3 ft. I Depth to limiting . Z i factor Remarks: 3oring # 1 around .lev. f t. )eplh to inviting actor Remarks: .h ri •, •i r,rn .r n PLOT PLAN N Page 3 of 3 SCALE 1 "= L10 ' 5 '� __ � 1 n��1ZpR. }�y� "A 1=02 � ,, �� ..3• ��� i o L p O3, 0 y *I - L=L. 100 pN 8'L -VIG4- �r� - -- PUC V�VPE wlL� } - in PVC P LPE w ! LM , Be A7 L3T ? 5 • Przo►ti `fi�zact r . c 35 m l � ST, Q9 -Zbs CAL — jnj,., zzoZSy ( 715 ) 425 - 6S _ CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3 Labor and Human Relations 9 DiviS of Safety 8 Builc5ngs in accord with ILHR 83.05, Wis. Adm. Code f COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 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 nearest road. ' O l2_ �z� l- Lj 0 - Ob O APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION - REVIEWED BY DATE PROPERTY OWNER: O`itV N F t i I ►v C , PROPERTY LOCATION C to Pfl1��- �?f�SO� - Y`i17,1 1 LO>vSTQ t� c (7 0JV GeW -LGT S 1/4 S �F 1/4,S 3 T 3 p ,N,R �--) E ( W PROPERTY OWNER'.S MAILING ADDRESS • LOT # I BLOCK # SUBD. NAME OR CSM # Z 6 S s D CLC.� 2a — — CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®TOWN ' NEAREST ROAD R�U lz'2 Ffil_CS WI Sy02-Z (11-9 y-zS_ azz, C�21tJ P�R'L(ZtL X10 ``N f�UL . [� New Construction Use [>GJ Residential / Number of bedrooms `I j J AdditiQn to existing building j J Replacement [ J Public or commercial describe Code derived daily flow bb gpd Recommended design loading rate — bed, gpd/ft gpd/ft Absorption area required — bed, ft \ Sop trench, 11 Maximum design loading rate 1 bed, gpd /ft • trench, gpd/ft Recommended infiltration surface elevation(s) is )v u t 't p ft (as referred to site plan benchmark) Additional design / site considerations \ti STAB Li aJ 3 Parent material 1.- of --s3 ou V Z Cwt @LR L, n LL t Flood plain elevation, if applicable Ty A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ,I S ❑ U [RS ❑ U ®S ❑ U ®S ❑ U [I S O U ❑ S ®'U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed rhw& o -7 C Ground •S `1 rZ 3 I y elev. _ Y✓I V i Depth to limiting factor Remarks: Boring # ' S lo`L \Z L L Z(o •$`1 w t`RF`C-`t 231 — 6� - L l eSbl� c.►� c w - N� r"p Ground CL 1y Depth to limiting factor ?86" Remarks: CST Name: — Please Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI 54022 Signature: ....// 5 Date• CST Number:. d, °i� -Z(, 1�• 6 -� 220254 PROPERTY OWNER SOIL DESCRIPTION REPORT Z. ` Page _ of PARCEL 1.1). # O�Z lUll — Ot)O Boring Horizon Depth Dominant Color Mottles Structure g Texture Consistence Roots G P D /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Y Bed Tn & SO I Znrn sb tin r- �S " S . b ............... Z q_Z1 � -S Utz 3/y — s i I ZrnSbk ►n�`t es - Ground 3 21-3y S`" L 1 e Sb� co C S �P elev. 1)2.0 ft. y aq -e- - )- J - vy - � sl o w► �' - _ w► vTf - 3 •4 Depth to limiting factor > 8z Remarks: Boring # s t 1 ZMs b k ►� �Fl a , S -S b L Zvnsb►z w, F� c�:►.v - , S �.� l• r `4R.31 y L C �y�0✓iti'D C°S Mi. Ijp Ground elev. y 3S-$9 • -1 cZ 3l y — LaS� O►ti, � � — l 1 •Y l -0 ft. wiv pv Depth to — limiting faclo�r ,, I t Remarks: ' Boring # <:::..:.... ) o - 9 10`1 iL 3 1 - Z — s t 1 Zr► <<{ s Z 9 -LS - 1-S (7- icy Ztn Sbk- m :: tesl�lc y Ground '►t tt.� CS _ IUP 0 elev. 26 -8y S yR �Jy — 1A S 1 py�., U �� - - � •� lb3 ft. ' i Depth to limiting factor Remarks: 3oring # around ?Iev. it. )epth to imiting actor Remarks: _ •n n•, I PLOT PLAN Pa 3 of • SCALE 1 "= y0 ' 1 o B's / t�w1`4 1 ! � o � EL t00 p' Oti 8 "tom G l a Rh1�I' - Z - �Z. X17.0' o►a �3 m nV C P LPE u! a • 3 S wl, I TU 1►vSTPR.<.-- 3- 1�2��.i�°1�5,. �-N: s Skloo�. LUiJG 1 n1�`[�} _ '3 -TC�� - 'T'12.s��v C� lU \3� 36 �` O Z'\' Wr-T ``� 1�U Wh1 S ls� P� ..��Gt" • _ -. - - - -- a l u - M - N Qli t (3 niS )h-T 01c 1ws s LV o iIU a9 -z.bs zzazsy ( 715 ) 425 -01 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND l OWNERSHIP ' CERTIFICATION FORM OwnerBuyer Mailing Address ��e/ /e0 % C a �dzv Of Property Address l a /h /J��t� 0/ (Verification required from Planning Department for new construction) City /State Parcel Identification Number 0 /6 / J ' 1 /0 ' 00 o LEGAL DESCRIPTION Property Location 5 W ' /., S ' /,, Sec. -3 , T 30 N -R 7 W, Town of If Y I h P Subdivision • Lot # Certified Survey Map # . Volume , Page # Warranty Deed # 4 J12 & 14 . Volume 9 if y Page # Spec house O yes P0 no Lot lines identifiable 0 yes D no SYSTEM MAIRMANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, joumeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE j7WNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descn above, by virtue of a warranty deed recorded in Register of Deeds Office. /O// / S1GNATtJRV0F 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 r l I 1218 M' Mau WAUStwhTy DrtD .aaravw sow accowo...a ea,a ' ( I ppC(JµEtiY NC` 1� s{�,aYi 4r WIFCONTIN. f0a►{ Y 492(;14 I ii t �! a �, REGISTER'S OFFICE Thi indencure,}r.d� of d. CROiX CO. Wt °'g""4 2 SS (i�R�d LION arkJa S � rpy� , ST. . � Corporatina dull A. D. tp.. __ . between __ ______... «._ ..___....... __ . _ ayi{dd or gtio n ` Reed for Record (�'� w6ania�i=0tl arms under and by 1 r�r T R vitro* of the law of the state of Wiscont K Ott H ►� •g � (�"�� pt DEC 0 R 1992 Viscerwo, party of the first part and .. _.._ _ __ 11:30 A. M husband and w f as survivo hi rata ro w: _.... _. w .w._...._.._ .... . _ �..�, �� part...,�•6:a ____._ of the sccond pat'. �r(/a\ Wit , That the aid party of the first part, for and is conridCratiOuOf the sum �teattir T1eo Hu ndred Dugfirldt go d. sal]1D11- 1$ZAa,000,0(i�•-0o,H++s -- a++ 9- 0 '•j by the aid pafjM__ ». of the ftcond pact, the receipt whereof is hereby confeeted and to h paid adu,ewledged, has given, granted, barpintd, sold, remised, released, aliened, conveyed and con• it 11 ir'eed. sad by ;hue presents dots Siva Stoat, barpin, set 1, remise: ditty. convey, and confirm unto , nr= • • ''' ' j! the said of the strand past ...,....theix_ .... ......_... heirs and uslgM forever, the following daaeribed real{titaa, situated in ... State of wisconsin, to - Nit: t the Snooty of_.......»».. n�. r-.. �.. Lli�. X.._.......... ._.._... ........_....., ......_. ii Part:* A: Ii The Southwest 1/4 of the Southwest 1/4 of Saction 2, Township 30 North, Range 17 West; !� all of the Southeast 1/4 of Section 3, Township 30 North, Range 17 West EXCEPT the Certified Survey Map recorded in Volume "4't of Certified Survey Maps on Page 948 as i Document No. 364369; all chat part of the Southwest 1/4 of the Northeast 1/4 of Section 3, Township 30 North, Range 17 West lying Soucharly Of the Soo Line Railroad. 1i Parcel _$_ a 17 West and it The North 1/2 of the Southwest 1/4 of Section 2, Totdnstlp 30 North. �n8 a 17 West. '•; the Southwest 1/4 of the Northeast 1/4 of Section 11, 'ownehip 30 North, Range ur NscuesAas. cotn"Mat Daaoramax ON aaysass FEE or in arty win appettaioiaif sad all the 1. ToSaher with all and siagulac the hereatasatats and aPPttrtssaoees there'a't° belva5lai res of eitlle. right, title, intattst. claim or demand whatsoever. of the aid party 44 the first past. tither IO law of *q{sity, tr dw fit, atpattatuy e(, Is and to the above bargained premiset. and their hereditam ou and app+rreeaalwa. to the said t •rt -- To have land to hold the said premises as above dnrribad w!N t h e htraditsmeate and aPP►"c� of the **rood part God ta.._...« .Sst3liF_ .__..._. « haia and asAps FORSVE& And the said aft -SuTQ � to and with the said paet�as - -. aE she patty of the tint part. for itself sad its s�cesson, dos rore =rase, bargtiia es it is Mali strand PALM _..» ...'c�- �- +.^^ —.^ -- ^ heirs and uaigns, ctiat at the time of the enaaiing and det(.ca7 d these P Is Ea dmPla ti ached of the pntoltn.above.Assedbtd, a of a good, lure, Perfect, abaelu14 and indefeasible estate of inheritance III kv+, _...«�� and that the am are five sad clear from all encumbrances wt,ate.er, -_¢KSJ +�•� ��' N � • 1, saats„f.,�cions, aad�ri�httrof- aay- „�cor�,��if }ivy,, � ., � ..� � � � .��., of tae second pert ... Ab+lt�,.L.. and that Wa above bargained premises in the quiet and pacnbic possession of the utd part in�ll ---» ' heirs, sad aaaigfu, egataat all and every person or P41110111 tawfully cl■imin6 the whole of say part thereo L wiU fo!*v*r'�Ai«'r +'d DEPEND. the aid _�� � .��..A�.ILL.a..�l.,�t.LG�G� ---_ ^'— �.- -• - --- 1 party of the first part, hu noted thew praeaa to be signal r.1•• its Sec tuft, 1� is Pnsident. and "unurslgMd d. by- - _ _ " - Oylscanri0. sad In coepOrate seat w la hereunto a8iw this' ..TAW day December ,... _... ». _.� A D., ►'_ 11 etONSD AND NZALDD IN TRUNN” OT _$•at. +�'�"° � � r�'ae �) u ri � a rdL31 I STATE OF WIKONSIN • i rs. County . . ..._....._... _ Dacatabet .. r... A. D. A; _ day of...... « Personally came before me, this - �,,,,,.,.,,._.., and .G4.) w r sit hao.m to be web .i of r1,e akeW a.,ed corporatloa to me known to be the par"" who VAcuted the futasoi ....� r p ''y n as tla dad of 7 president find Secnary o r vAA cano.ati.n, and aakaowledstd that they execuYVA-lHe !o T �' % aid COMMON by its authority. » '! L�►arr �7�a -. Via.:: Ro et: W. ••u�.eMAt way NtoTt. -T Motar7 Tub(ie. ••- i. L�1DGE 1 PORTER & LUNDBEN r S . C . i`ty tom :so Iet�ph�,W ?�*r,,..,....• N+wiwAwrtaa + wsia'e•1V t[7L ( tea H. t (t1 el Me pi,taadw ,re.cM tbN .an' 'l .at> a I t t - 1 thr a e� dx ac' xwr. Uamaw. �.. seed �: v n, x .. K:. .,'� .. .•..•c+r av �tyw.a{a that VAgkk �". ERIN PRAIRIE T•30N -R.17W 45 0 SEE PAGE rmSEE PAGE 89 n K PO • AVr/ /,am r/ n i 1 I LL r7osgoh p ly r Caro/ 14477 ' 7/`mbcr 1A�ET::: D ;trrraan Cao AN Ida � Mar• � � .� •.•. EN . L BO ,run3 d � o T/rerrras . R j h a 4J/< ar rn °// < /PS Shery G� ` LarYle T lion a Cough/ i7 Nf'Po/dt .Eoy/und Dun zoo Quan7 ZQ s • �, /sa rMarrc =.�y .eo pit// /eo M R //N Pe3 (1 /r /eh A g • . �o rr►r $ �` F'�� � • fie • M /io � O y •� Ceuyh/rn n Remmet/J E C IQ U 77�rps CV /.reC6 .Drvreen u+a . u � � o • h,��R. elZ1/ rbai Sch ,Udf �' � ti S / /eb • Gy /c T NPPo /dr �\ / ee7 ALU qU hd s o row C6 /W. "T �� nn ass r ` 40 mon • 4e 7e / -hbe o f�icrson E /ca.roro M. 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Le/o W es. 1 4 C B /2o Stoddard rzo Farms et WStJksr d! /bo T Y L. n dl9J 3 ,4�4/7C °' ^• /2o IIRs/ !'c°nne v p' `I'� �70� Qt+v/n J C _ • d y y � `y rt F voan y ji y K Wa /sh, 9 grmu� / " O 5 F Ric /ion U v U b ° N tae C < ct serf • err/c/C �l g ` E E SEE PAGE 9/ c5!!Crnix rrfyyl✓i /9s3rt�a E MaP o6rf♦ Irra 1300 1800 1700 1800 1900 2000 2100 DEER'S FOOD LOCKER, INC. 41 Years in Business f� A ' 1952-1993 CUSTOM PROCESSING A FAMILY CURING, SMOKING, SAUSAGE MAKING AFFAIR RETAIL MEAT & CHEESE - SAUSAGE ON FARM SLAUGHTER LOCKER RENTALS THE WAIDELICN'S * (715) 269 -5118 �b DEER PARK, WISCONSIN