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Box 526 Colfax, Wisconsin 54730 715- 962 -3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST. CROIX ZONING REPORT NO.S 40554/01 PAGE L ST, CROIX COUNTY REPORT DATE: 5/ 1 03/93 COURTHOUSE DATE RECEIVED 4/29/93 HUDSON, WI 54016 ATTNS THOMAS C. NELSON i OWNERS Thomas P. Ohr LOCATIONS 881 Trout Brook Rd., Hudson COLLECTORS M. Jenkins DATE COLLECTED: 4 -28 -93 TIME COLLECTED. 2S15pm SOURCE OF SAMPLES Outside faucet DATE AlW..YZED S 4 - 29 - 93 TIME ANALYZEDS2SO0pm COLIFORMS 0 /100ml INTERPRETATIONS Bacteriologically SAFE NITRATE -NS 3 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. - Coliform Bacteria /100 ml Nitrate- Nitrogen, mg /L 9 4i 1 O A s i N C'� C', O + r Owl oE.E� LAB TECHNICIAN: Pam Ganz y4�r Z .OF• \N OpMT - 3 ; WI Approved Lab No. 19 zs A "+� t Means "LESS THAN" Detectable Level Approved by: PROFESSIONAL LABORATORY SERVICES SINCE 1952 T. CROIX COUNTY , k RECEIVED WISCONSIN " ZONING OFFICE APR 2 X993 utii:t CROIX COUNTY COURTHOUSE � ' ►1 " COUNTY URTH STREET • HUDSON, WI 54016 J <` 4QYINGOFFIC (715) 386 -4680 1 k SEPTIC INSPECTION / WATER TEST REQUEST FORM Specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. 0 Water (VOC's) $185.00 Septic $25.00 Water (Nitrate & Bacteria) $35.00 (Visual inspection Owner: ' rNo&A.6.5 P uhf R Requested by: �I I U ., L Address : 85 'TROUT $ R17 Address: -� t / l _s-t . S City & State: Nup5c , Wz City & St. , Zip Code: S4©j(d Zip Code: 6 Telephone N°: ( ' - 7j , 5 ) 38/..- -z989 Telephone N°: ( 38 316 i Property address (Fire N & Street) 881 ' -r &QvoK Rr- Location: NW , , NE l-,, Sec. 19 , T 2`3 N, R i 9 W, Town of j- Iur> -%0 J St. Croix Co., WI. Tax ID N Parcel ID N 1444 "� T�7 � House color:Ce a r Realty firm: �Z /� Lock Box Combo /' Water sample tap location: 8- FRONT � +� TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Is the dwelling currently occupied? Yes 0 No If vacant, date last occupied: ►J /a* Septic system installed by: sa►-i MILLffR Year: 1 98�a Septic tank last serviced by: j3%� r-1aQG4,ti► Date: -uLlr i "z Previous Owner's Name(s) : jJ /, Have any of the following been observed? ❑Y 9N Slow drainage from house. ;QY ON Sewage Back -up into dwelling.— L-jarz- FRO-'\ HOVSE WAS PL%164fiVn ❑Y fiTN Sewage discharge to ground surface, road ditch or body of water. ❑Y Slow drainage from the dwelling. OY 1�N Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. P, n OWNERS SIGNATURE: ®-kv+ DATE: 4 ')3 i l OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION TO BE COMPLETED BY INSP E CTION AGENCY System design & /or permit on file? L'Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system I elow grd ❑At -Grd ❑Mound Approx. size /,P X XU ' �ravity ❑Dose ❑Pressurized �d ft. 2 Zed ❑Trench ❑Dry Well ❑Holding Tank ❑Outfall pipe OBSERVED DE�IES ❑Other ❑Unknown Septic tank Setbacks: ❑House ❑Weller ❑Prop. line 4 9 1 ❑Other Dose tank Setbacks: ❑House ❑Well ❑Prop. line ❑Other ❑Locking cover ❑Warning label ❑Pump /Floats ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: ❑House - 70 ❑Wellg5 " ❑Prop. line ❑Other ❑Ponding: -_ ❑Discharge: Win' General comments INSPECTORS SKETCH OF SYSTEM LOCATION N ti Inspecto it e O Z T 1 s ST. CROIX COUNTY .,�t �. WISCONSIN ......::: ; .. ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - _ (715) 386 -4680 April 29, 1993 Joel A. Vindel 310 - 10th St. S Hudson, WI 54016 Dear Mr. Vincel: An inspection of the septic system on the property of Thomas P. Ohrt, located at 881 Trout Brook Rd. Hudson, WI was conducted on April 28, 1993. At the same time a water sample was obtained for testing. The results of that test will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. S ' ncerely, __ Mary J. Jenkins Assistant Zoning Administrator cj Parcel #: 020 - 1040 -50 -000 08125/2006 11:04 AM PAGE 1 OF 1 Alt. Parcel M. 19.29.19.172A 020 - TOWN OF HUDSON Current [x I ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner JOEL A & PAMELA J VINDAL O - VINDAL, JOEL A & PAMELA J 881 TROUT BROOK RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ' 881 TROUT BROOK RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 1.980 Plat: N/A -NOT AVAILABLE SEC 19 T29N R19W NW NE LOT 1 OF C.S.M. Block/Condo Bldg: 6/1608 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 19- 29N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 JU341,61 WD 07/23/1997 741/89 014 � - 07/23/1997 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.980 76,500 153,000 229,500 NO Totals for 2006: General Property 1.980 76,500 153,000 229,500 Woodland 0.000 0 0 Totals for 2005: General Property 1.980 76,500 153,000 229,500 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 134 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner 3040 f m) W J A Property Address s� S +" City /State '#��,n� oU W') 5 L � N " Legal Description: p ' Lot _�_ Block Subdivision/CSM # N t /a N L ' /a, Sec. Jam, T a 9 N -R 1 9 W, Town of V�uo f- t � PIN # -% SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: us i u) �E )hl St Tank manufacturer e fR Size ST/PC Ow / $cu Setback from: House Well 0 P/L U Pump manufacturer Zo c e f- Model _ Alarm location A, �� 1 (HOLDING TANKS ONLY) Setbacks: Service ater me Meter loca 'on Alarm location SOIL ABSORPTION SYSTEM Type of system: T � � KbA uo Width 3 Length 1 - 5 G- Number of Trenches 3 Setback from: House Well 15Q' PAL a Vent to fresh air intake 5 0' ELEVATIONS Description of benchmark Elevation 0 U Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet 7 PC Inlet 8 7 S PC Bottom 3 r?y� Header/Manifold �- 5U Top of ST/PC Manhole Cover Distribution Lines () () 5 3 4 ( ) 9 $ ) � Bottom of System Final Grade Date of installation / / Permit number 33 dP f-5 6 State plan number Plumber's signature License number ��� Date / / Inspector so N ° N jtD j J Complete plot plan ar I� I NOTICE Please provide the following: • 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 r -,s� �o T r' -� C �"" t:' l ��ItUUh � to 1 Ubb q I INDICATE ORTH OW I i Wisc County Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: ST. CRO X Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ Village 10 Town of: State Plan ID No.: VINDAL, JOEL & PAMELA HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: (Od U ,N-/ TANK INFORMATION ELEVATION DATA A9900209 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic WC- 6,e k enchmark z. /G Dosi ng 'PQU Aeration Bldg. Sewer huri�A' Holding St/ Ht Inlet TANK SETBACK INFORMATION St Ht Outlet TANKTO P/L WELL BLDG. A i r lpl% a ROAD !y r1(J 0 9 Septic of > U� ��l(7 sl NA Bottom fO 3 Dosing 7(3 'I >5'(� �� NA Header /Man. Aeration NA Dist. Pipe ,� fi: ;or 15' y Holding Bot. System ? ply , I o - P P / SIPHON INFORMATION Final Grade I T3-T 4 'q Q�? Manufacturer fee Demand L 3 Model Number s 3 Z(,'9GPM .00 Z Il•A TDH Liftff, Friction Syestem_ TDH �( ivew Forcemain Length f? Dia. z v Dist. To Well SOIL ABSORPTION SYSTEM BED / Width Length t 3 No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 7f DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING uf�ct rr r: r INFORMATION TypeO ,> r 7$0 ( ) M del umber: System: /- r K gel DISTRIBUTION SYSTEM /bc,� I IF S Header/Manifold Distribution Pipe() x Hole Size x Hole Spacing Vent To Air Intake Length P Dia. Length G t r Dia. AA Spacing SOIL 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 ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) L � o-' a r / LO -' ON: HUDSON / 1 9.29.19. / 172 , L NW, NE 881 TROUT BROOK ROAD f /o, yU bi'6rr� &UV k s twee like S Id roe ak -�e P 'f o•�' S�o��y< 0 \.eadsv s atfkA( /y 5 .4 ,,sty.. V Plan revision required? ❑ Yes V] No Use other side for additional information. SBD -6710 (R.3197) Dat Inspector' , na ure Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i i t a e 4 e E c y I s j Y 3 S � t 3 i m 0 x t f 6 2 f 3 , t s t ,..,. . .... W , ..« .— s { We _� a rts _ .. .., m., ,m ee , ... ..2 G F i r r � $ ... ........# ....... ....... ... ........ � ..... SSW I # t t F .. ,� a � 3 5 e r + $ e x + mss � Y a 4 E i I s c 4 SANITARY PERMIT APPLICATION Safety E and Was hington sion Vi P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 33 SIS0 The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RM TION Pr y Owner Name Property Location 1/4 va, S T , N, R /I E (or) W Propert Owner's Mailin Addre Lot Number Block Number mok City S to Zip Cod�e Phone Number Subdivision Name or CSM Number II. TY PE OF BUILDING: (check one) ❑ State Owned it� Nearest Road ❑ vil age Public 1 or 2 Family Dwelling - No. of bedrooms own OF 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 19 . _2A - AL IA 1 ❑ Apartment / Condo 00 r 16 �o 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, ❑ New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an _____Syrstem ------ ------------- 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-14 I IlLA' oxy 22 ❑ In- Ground Pressure r _ 42 [] Pit Privy 13 ❑ Seepage Pit !fir f�vaw ` X `�� x, 43 ❑ Vault Privy 14 ❑ System-In-Fi I I - , O C� VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grad _ Re rr d sq. ft.) Pro ed (s ft. (Galsld sq. ftJ (Minch) 44; L n EI�voi.Vj� 1,. (3 Feet 7161 .) V av it 40 Feet Ca aclt VII. NFORMATION in gallon Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper- Gallons Tanks Concr to lass A . New. Existin structed g pp T nks Tanks Septic Tank or Holding Tank _ ) 0 O Ig e ) 11 11 ❑ ❑ ❑ PumpTan r 1 01 ❑ 11 El VII . ESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. P lumber 's Na int) Plumber's Sig ture: (No S mps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Sty et, City, State, Zip Code): ` �.,Pj 2 � _ j )z IX. COUNTY / DEPARTMENT USE ONLY � ❑ Disapproved Sanitary Permit F e (includes Groundwater ate issued Issuing gent ignature (No Stamps) 1tt H roved �^�- / Surcharge Fee) pp ❑ Owner Given Initial J Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD4MI (8.11/96) DISTRIBUTION: Original to county, one copy To: Safety R Mridngs Diwision, Owner. Pknt or INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2-' Your sanitary permit maybe 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. 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: Property owner's nacre and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. Il. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Buiiding.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. Vli. 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_mains/water 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. II L f i + C I L.OD Ao- B� o NQti 1 N Or, Q` 04w-L OS Jx U $f 1- Tito 11 3x s s D /6' a k A H BM c kn , � � rG21 - lev o/ �vr� gdd�d gOu jn l l, bml�n, E o oo O e t � c 0 kL E C N r (q _ co: N (/) I a �C X .n � nc�om ~ aEi E c°rn c cy ui ca j V O.O o C O Q N Q «+ SOON O► 'v 3 a •- a. � o � ura CL C V J ,Wo _ �o'ov _� o :DU- O Z n N o m CL o "i 82 PRIVATE SEWAGE SYSTEMS - II PAGE OF PUMP CHAMBER CROSS SECTION AMO 5PECIFICATIONS VENT CAP - T 4 "C.I. vE�JT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 3. Z4 FRCM ODOR, r F `diMCC`rl OR FRESH I AIR '.NTAKE GRADE I 4" MIM. AL I B" MI11. COWOUIT -- - -- -- - - -- 18 "M I N. --- \ 1- _ PROVIDE INLET AIRTIGHT SEAL APPROVLD DINTS APPROVED JOINT A I III . I I I W /C.I. PIPE w /C.I. PIPE I II ALARM EXTENDING 3 EXTENDIAIG 3' I II ONTO SOLID SOIL ONTO SOLID SOIL iF3 I I I I o C ELEV. FT PUMPS - -� ^~ FF r 0 CONCRETE BLOCK RISER EXIT PERMITTED GAIL`! IF TAUK MAAMLIFACTUR6R HAS SUCH APPROVAL SEPTIC SPEGIFICATIOUS E II � , " DOSE TAAIKS MAIJUFACTURER: `iIA& NUMBER OF DOSES: — PER DAU TANK GIZE: �C) GALLONS DOSE VOLUME f - -T � C I Af � 115 INCLUDING BACKFLOW: ��L� GALLONS R ALARM MANUFACTUER: O lJ CAPACITIES: A= INCHES OR �b 'S GALLCUS MODEL ►DUMBER: Q SWITCH TYPE: M -q n'tL1nNA B= INCHES OR �_ _GALLONS PUMP MANUFACTURER: Z C 2 IQ� - C= ILICHES OR S v :,A .L0A15 ,H !!tl OOEL NUMBER: D= I :R GALLONS 5WITCH TYPE: Un MOTE: PUMP AND ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE � � GPM VERTICAL DIFFERENCE DETWEEN PUMP OFF AAIO DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . - FEET 11�}` FT. 1.41 + p FEET OF FORCE MAIN X( FRICTION FACTOR.. FEET TOTAL DYNAMIC. HLAD iir± FE£T l • l l If OF lA1JK: LENGTH k ) WIDTH ;LIQUID DEP H IAITERNAL DIMEAl510N5 SIGI,,�EC: �6L LICEUSE UUMBER: / DATE: 4 i Of M TOTAL DYNAMIC HEADICAPACITY PER MINUTE ■ mn���mmmm Ems MEN C3= m" Emm �����=NKMWMMEM=3EK3 Ewa �����mmwmnwmm cim mm owlsoom smommmim i l■■■■■■■■■■■■ 1 , \� \� 1 \0000■■■■■■■ :, `\ \dill \\ ► \ \ ■ ■ ■ ■ ■ ■ ■■ 10 SEE, ► -W 0 IRV I I il 1 \ ■ (\0 000■■ • orkhmm, li lil No K!"PIENNENVISEN ■■ ■■■ ■I ► RI liklokimmkil 0111111111111 NEI 1 -M -W I 10 WN N Ill 0 0 0 Xl ►� I h Q§ ME \ \`\ ■ ■ 0 N W 0 0 0 ILI &L % 11"imim, 1 w Nh, ki 01 0 Ill Ill W IS 0 0 H Kim i 9.4, 111 h q,- i ►RZI, IN Ill Ill 0 0 1 1 Q 70 loo]110 120 1--o ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving n the �b�� a I'4j-VV9)A Wnj"J residence located at: MW ', - � ; , , q _ Sec. 4 , T R _W, Town of NUp sw-j St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced 3 (, 9 Did flow back occur from absorption system? Yesl No (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: /O u U Construction: Pref b Concrete Steel Other Manufacturer ( if known) : Age of Tank (if known): (Si to ej - (Name) Please Print (Title) (License Number) ) �)--? 1 (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). n Name Tp�s W P4'QMkkA Signature Ca W� �dL cA MP /MPRS V Qua 9U9 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety s Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St. Croix 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. 020- 1040 -50 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R BY DATE Ik'- t I PROPERTY OWNER: PROPERTY LOCATION Joe Vindal GOVT. LOT NE 1/4 NE 1/4,S 19T 29 ,N,R 19 [kor) W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 881 Trout Brook Rd. 1 na csm vol.6 pg. 1608 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD Hudson, WI. 54016 (715)386 -3169 [ ] New Construction Use [ A Residential / Number of bedrooms 4 [ ] Addition to existing building �] Replacement - 1 1 Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Absorption area required 1500 bed, ft 1200 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Recommended infiltration surface elevation(s) 95.60 starting ft (as referred to site plan benchmark) Additional design /site considerations trenches spaced to code 3.00' below surface Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem 1 [3 S ❑ U IS S ❑ U CRS ❑ U as ❑ U ❑ S R] U ❑ S C$U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tmr& .................. 1 0 -16 10yr3 /3 none sl 2mgr mvfr gw 2m .5 .6 2 16 -54 10yr4 /4 none lfs Osg mvfr yw if .5 .6 Ground 3 144-84 10yr4 /4 none sl /lfs lcsbk mfr na na .4 .5 elev. 97.3 ft. Depth to limiting factor +84" Remarks: Boring # 1 -30 10yr3 /3 none sl 2mgr. mvfr gw 2m .5 �.6 2 2 0 -61 10yr4 /4 none fs Osg mvfr gw if .5 .6 3 1 -88 10yr4/4 none sl /fs lcsbk mfr na na .4 .5 Ground elev. ; r 9 8.6 ft. Depth to limiting factor ; +88 " — s r q 1 1 Remarks: 7 "f ° FFi CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6200 Address: 1554 200th. Ave. /New Rich and WI 54017 Signature: Date: 8_12_98 CST Number: m02298 Joe Vindal PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # 020 - 1040 -50 s Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 - 10yr3/3 none sl 2mgr mvfr gw 2f .5 .6 2 30 -61 10yr4 /4 none fs Osg mvfr gw if .5 .6 Ground 3 61 -84 10yr4 /4 none sl/fs lcsbk mfr na na .4 .5 elev. 9 6.1 ft. Depth to limiting factor �r + Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) . - 1 r STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Joe Vindal New Richmond, WI 54017 MPRSW -3254 NE4NE4 S19- t29N -R19w (715) 246 -6200 town of Hudson lot #1 -CSM vol. 6- pg. 1608 N 1 " =40' BM. =nail in Elm tree @ el. 100' Alt. BM.= nail in Cherry tree C el. 96.55' Y Gary L. Steel 8 -12 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address e 8 1 `� o �� �o� \� 91 14, Z u , u,, : S 4 ui & Property Address g 1 ► J�✓'c Qf ►C (t, / 6 (Verification required from Planning Department for new construction) City /State fl 'j 'Q50' I \_K.� , . Parcel Identification Number ©Zo - to 1 1u -s o LEGAL DESCRIPTION Property Location VII '1 NI 1. � y,, Sec. T_J�q N -R-13-W, Town of H u ASo n Subdivision , Lot #— Certified Survey Map # 3 , Volume , Page # Warranty Deed # S0 d 7 G , Volume ! 3 , Page # Spec house ❑ yes W no Lot lines identifiable ❑ yes N- 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 master 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 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 a e w e year e ' tion date. �,' NATURE 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 the property described ab virtue of a warranty deed recorded in Register of Deeds Office. S9 ATURE OF AP CANT 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 DOCUMENT NO. w1RRA r TWIG SPACE RESERVED FOR AECOROIN6 DATA STATE BAS OF WISCONSIN FORS[ R--1W 5O W76 � . i iOi REGISTER'S E ST. C RW Co., W1 P. Chrt and Stern E. Chrt Reed fbr P4K* d ........ ........... . .. . ...................._...__..... ----------------------- - - - - -- _.------------- I ....... JUN 2 1993 ............ ... ....... * --------- . ...... •-- - - - - -- � - - -- - -- 7 * ------ coinveys and warrants to ...TOel.l4.. * .......... �3 13aP_lri t ]._ w! 1p ----- - - - - -- f ...................................................... ---- •• - - - - -- ............................................. .............. ........................................... ..................................... ... RETURN TO . ... ........................................................ ..--- - _ ----------------- the following described real estate in ................ .. ........—____-- __--- -- .-- Wonty. State of Wisconsin: Tea Pared No: 02L- 1040 -50 Part of the NNk of NE% of Section 19, Tow ship 29 North, Fange 19 West, St. Croix Musty, Wisoonsin described aP follow: Ivt 1 of clertified Survey Mp filed Novenfber 6, 1985 in Vbl. "6 Page 1608, Doc. No. 406835. rR4V S FEH - This ------ .i3 ................. homestead property. (is) OCIMM e- Exception to warranties: TUCETHER WITH AND SUBJE TO any other easiements, covenants, ants, reservations or restrictions of reamd, if arty, but this shall not be deemed to extend any such other recorded encultbrances beyond the term established by law therefor. Datedthia ... ....... 2 $ti _ ---------- ---------- day of .-- -•--.. --- -- -- -- - --- ---•------- ---- ------- ------- -- 19.9 .. � 4 P - --- .._(SEAL) -- -- --- - --• -• -- -- ----- -- -.._ (SEAL) : Thomas P. Chrt -- - -- ` _-- ..... .._...(SEAL: - --- .. (SEAL) Sharon E. Chrt ' - - -- ------- - - - - -- ----------------------- - - - - -- -- ------ - - - -- -- AII+THNN�TICCATIONA,�o ACKNOWLEDGMENT I- Sienat ulre(,) --1�CN4t� �{ --lMw. - -- ------- STATE OF WISCONSIN I ) 7fk1[1_ . -- -49t1C __ St. Croix 's' 1 *� Q — ------------------------------------ County. aufbentiested day of.._ . _ 19-1 came before me thi Z8 - -- -_day of ............ __________ _ _ _ - -_, 19 ..._. ...the above named W _ - --------- A. - : -- - --- ----- - IIFIQnaS -- �i rt - ai - . -- - -�t TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ... ----•--•--------------------------------•---•--- authorized by 1706.06. Wis. State.) to me known to be the persons --- _....... who executed the f foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS GRAFTED BY At Pabert A. We�dhe ----------------- •-- .__.. _ .. ........................................... . I ' - -•- --- - ----•------ei --- - 430 2nd St., Hudson, WI 54016 `- - - - - -- -- • - - - - - . • - - - - -- - - - - St....ix (q ........................... .... ........................... Notary Public .. -------------------------------------- County, Wis. (Signatures may be authenticated or a^knowledged. Both My Commission is Permanent. (If not, state wrpiration 1 are not necessary.) l i date- -- --- ------- -•- •-------- --• -- - -- - ----- •--- --•- ---_ 19 - - -•) a *Names of persons signing is any capacity should be typed or printed bet . their signatures. WARRANTY DEED STATE BAH QY W LSCONSM Wisconsin legal Btank Co. Inc` FORK Ate. 2 — 1932 Miiwaucee, Wisconsin n 61985 *%Bob wow CERTIFIED SURVEY MAP Wkmmm& 44 LOCATED IN PART OF THE NW 1/4 OF THE NE 1/4 OF SECTION 19, T29N, R19W, 8 TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. OWNER LEGEND Clair V. Fry et al • IRON PIPE FOUND. TRUSTEES 10229 N 106 Ave 1" x 24 IRON PIPE WEIGHING Sun City, Az. 85351 O rd�11/0�018@p ! � 1.68 LBS /LINEAR FOOT, SET. Go ALLEN C. l�,. N S NYHAGEN. °° S -1407 /��`V IP is 2.36' V HUDSON, north of com- WIS. r o ° w� puted position. ' .01 SCALE IN FEET ti 100 50 0 100 h o'� Q . o bearings referenced to the west line of the NE 1/4 assumed to � 0Q �,�*' - INC �, � bear S00 0 15 oo o , ., /„ �p coo m r oo� - h IP is 0.94' ;° 71,215 sq. ft.) EX. R/W south of 1.63 ac. ) "' _ computed position N 86,110 sq. ft.) IN. R/W N 1.98 ac. ) m r W A PPR 0V — C r: N89 °52'27 "W 295.30' 0 140.30' 155.00' N 1/4 corner NOV iQQ o O 1985 r O section 19 w 47,476 sq. ft. 44,957 sq. ft. z county monument `-' 1.09 ac. 1.03 ac. ST. CROIX COUNTY 0 COMPRtHENSVE PARKS ►LAMWMNG AND ZONk4G COMAME I rt N N I0 r o 1 c+ W W W 1 N 4- D W N CM WO LLID W �� - 3 0 N TOTAL CURVE DATA - C) '^ 0 o R- 2135.87' - ecisting W n - 6 0 53 1 19" house CD C2 rt w • C- 256.64' Re 2135.87 R- 2135.87' �+ M = C' CB= N86 ° 10'56.5 "W n - 4 33'42" n - 2 0 19 1 37 11 — L- 256.79' C- 170.00' 20 1 20 Ca 86.74' ° CB- N87 - �8= N83 0 54 1 05.5 "W h 1 A T N88 L- 170.05' O Ll 86.74' (D 989.83 m SW corner of joint N7300311611W the NW 1/4 Of ac cess 4 � NE 1/4 3.051 C.T.H. "All Vol. 6 Page 1608 S 1/4 corner section 19 this instrument drafted by Douglas Zahler job no. 85 -53 county monument 1 }� '. ✓ Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT I OWNER TOWNSHIP �d �� r� SEC. l ? T c;9 N -R JQ W i. ADDRESS fJS� anS l ST. CROIX COUNTY, WISCONSIN I-11A 16 D c-.J U'/r, SUBDIVISION yN¢ ✓ �/ ( rf LOT LOT SIZE �• 9 Xe_ Q,✓ S �a 4 �� y PLAN VIEW Distances and dimensions to meet requirements of ILIiM 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SysrtQVti Lib• I Sc�� Id le W �,4 �:�,4 !. l�ous a �� aF�xSo I ' r � I 0 7 A INDICATE NORI ARROW BENCHMARK: Describe the vertical reference point used �bf b"T� 2� F re w SW• !(s✓ a d " Elevation of vertical reference point: Proposed slope at site: 3 Al ll, SEPTIC TANK: Manufacturer: .�1�'� �� Liquid Capacity: Number of rings used: _ Tank manhole cover elevation: - 160 Tank Inlet Elevation: 9�-3 0 ` Tank Outlet Elevation: I 1.60 Number of feet from ;nearest - Road.: Front O Side,® Rear, ��Q feet = From ' nearest -property line Ftont 1 0 Side,ORear,0 y� feet Number of feet from: well 7 , building: a" L for- S I✓ cor,%" o� N o uS C�i '(Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 0 PUMP CHAMBER 'U 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, O Side, O Rear Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM G 6, SS Bed: Z o ,n v a ( Trench: i Width: ( Z Length: Number of Lines: Area Built: 9 FT. Fill depth to top of pipe: y Number of feet from nearest property line: Front, O Side, ® Rear,0 Ft. 7 Number of feet from well: 5 r Number of feet from building: - 71) (Include distances on plot plan). SEEPAGE PIT Size: / 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). HOLDING 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, OFt. Number of feet from well: Number of feet from building: Number of.feet from nearest road: Alarm Manufacturer: Inspector: // �/ ` mil �• ( Dated: Plumber on Sob: License Number: l 3/84:mj r DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION Fro. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 CONVENTIONAL ❑ALTERNATIVE State Plan 1. D. Number: ❑ Holding Tank ❑ In- Ground Pressure El Mound (If assigned ) NA ME OF PERMIT HOLDER Miller / � ADD R. PE 1 . Box 282 Hudson WI INSPECTION D TE: {- � , � BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV. J C51 REF, PL ELEV.. NW NE, Section 19, T29N -R19W, Town of Hudson, LOT #I , Former Frye prop Name of Plumber: I MPIMPRSW No County Sanitary Permit Number: Douglas Strohbeen 5432 St. Croix 75022 SEPTIC TANK /HOLDING TANK: MANUF CTUR ER LIQUID CAPACITY. TANK INLET ELEV. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER ✓ D 9 71 0 PROVIDED. PROVIDED. YES ONO DYES ❑NO BEDDING: VENT DI VENT MATT HIGH WA EH NUMBE O . F ROAD. PROPERTY WELL BUILDING. VENT TO FRESH L ALARM FEET FROMI I LINE AIR I YES ONO C]! DYES ONO NEAREST DOS G CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY JPUMP MODEL J PUNIP SIPHON MANUI ACTUHEH IWARNING LABEL LOCKING COVER PROV IDED. ❑YES ONO ❑ PROVIDED: YES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF `. PROPERTY WELL J BUILDING JVENTTOFRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I I N(,TTf J IMArm TER J IIATI RIAI_ AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH NO OF UISTH PIPE PACING COVEEJ INSIDE UTA -PITS LIQUID BED/TRENCH / THE S / jj�Fil L: PIT DEPTH DIMENSIONS Ov ( /!/� T GRAVEL DEPTH FILL DEPTH UIST Fi PIPF UISTH PIPE DISTR. PIPE MATERIAL NO MISER NUMBER OF PROPERTY WELL. BUILDING: VENT TO FRESH BELOW PIP 0� ABOVE COVER E V. INLF f ELEV. ENU PIPES LINE ( AI INL / /� / �/ FEET FROM NEARES -- -# w MOU 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- meets the criteria for medium sand. TIONS MEASURED. ❑YES NO SOIL COVER TEXTURE PFHMANFNI MARK I'HS (7FiSEH VATI(7N WELLS DYES 1:1 NO _ ❑YES 1:1 NO DEPTH OVER TRENCH BED DEPTH OVFH TRENCH HF,U DEPTH OF T111 SOUDF 11 SEEUFD MULCHED CENTER EDGES DYES. 1:1 NO ❑YES 1:1 NO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO OF LATERAL SPACING [HAVE I DEPTH HE LOW PIPE FILL DEPTH ABOVE COVER BED /TRENCH TRENCHES. DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE I MAN11OLDMATIRIAL NO DISTR _DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ?'. ELEVATION AND ELEV.. ELEV. CIA. ELEV. J PIPES I DEA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS DYES ❑NO ❑Y ES ❑NO COMMENTS: PERMANENT MARKERS: J OBSERVATION WELLS. NUMBER OF 1PROPERTY WELL: BUILDING: FEET FRLTM LINE ❑YES ❑ NO [:]YES ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNAT RE. TITLE. DILHR SBD 6710 (R. 01/82) wisconsin APPLICATION FOR SANITARY PERMIT LJ D ILHR (PLB 67) OUNTY DEPRRTmEnT OF UNIFORM SANITARY PERMIT # In0WSTR V, LR60R G HurnRn RELRTIons X7`5'0 oZ � — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /2x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS Ali, 'f Z`6Z PROPER Y LOCATION 1GI1/4 ,r'1 /4, S/ , E(or TOWN 1 � sw. s .5 ycr� LOT NUMBER I BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER 1 4 ) V✓i TYPE OF BUILDING OR USE SERVED 0 d0 —J40 elQ— 50— 1 or 2 Family Number of Bedrooms: E ❑ Public (Specify): THIS PERMIT IS FOR A: X New System ❑ Tank Replacement ❑ Repair ll Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. 54 Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity j -y Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic / / Gallons Tanks Concrete Constructed Septic Tank,Capacity A Lift Pump Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ❑ Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: 11 MP /MPRSW No.: Phone Number: Ids _ . Plumber's Address: Name of Designer: A¢ ° / M, rv<s - 4 0 t ;� C A .I ( COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved �� ry �p[ ❑ Owner Given Initial 0 V Approved Adverse Determination j y Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. 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 inadequaoies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractpr,( "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 Location of Property �� Sectio T , N - R Township a Mailing Address AC,- Subdivision Name Lot Numbe Previous Owner of Property �/ �,- Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable ? Yes No Is this property being developed for re // sale (spec house) ? �_ Yes No Volume �+ and Page Number I as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING C, 1. Warranty Deed Z. "Land - Con tract •r . 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION 1 (We) eeA.ti,6y that aft a.tatemente on #hia 6oAm axe xAue. to the beat o6 my (ouA) knowtedge; that I (we) am (ate) the owner (a) o 6 the pAopeAt y dea cA i.bed in thiA in6oAmati.on 6oAm, by vi tue o6 a walutanty deed�n con in the 066ice o6 the County Reg.e,a teA o 6 Deeda as Do cument No. _ ; and that I (we) phew entty own the pnopoa ed & to bon .the a ewage d iApo eta. - d yd.tem (on I (we) have obtained an easement, to h.un with the above deben.i,bed pnopeAty, bon the con - uacti.on o6 aa.id &ptem, and the dame has been duty AeeoAded in the 066.iee o6 the County RegiA teA o6 Deeds, as Document No. _c 2.'; SIGNATURE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ! !� •.,. Nc, QUIT CLhki= D Recorueu at the request oft trAlK OF w>MOptwrfy:I i* y 3�ybJ�l waltz, hayt and 14 u11, P.C. iwslrw�wws�sl a� ' R a j P.O. sox 727, Sun City, A2.85351 r . k THU IN1IN'1'1"Merle tbie _ day e! - October • w REGI8TY4" s A. M. 19 Z . bets —.FLAIR y . FRY and hJA1lnTtr . r2y r � I� ht.nhanA and wi fa ST. C ROtx CO.. I Rec•4 f&• air ar, Part iea of w Am p.,% ..d AL__u ; � p V , CLAIR _ FRV ti + w MijinTr r FRV r n r. RWTS Pay a CABAL VIR.TNI . TrLCtpe -a +inAor tt, j, in s revn��le tz LSL�QZBpmPnt • dated ]: ++ li&t 26 tl11&A0'tb'M adpart. at 10229 -106th Ave., City, Ari e"ess is W 1 t•• a a e t b. That the said '! yatt 1P.S Or the first panr% for end L antnhloww M/M Clair V . !ry tYeewn —TEN DOLLARS ($10.00) an 10229 -106th AVe. ftn CA Arizona to them —is hand pain by ti sate PM -AdW w aoaid PM% tie wd�c.rMNt rlUg� 4"howd and ttdtaowledp � g. d. b nK .ea. woad. barPiaad. sold. oa Mnd. and faeit.41"6d. end by tMee NwotMg safe post. hatpins, .d1. tewai«. thaw .nd tttritel.iat unto w aid " Sea of w tnattd Pnt. end % .thall�ii ' feYNiod dnw" wal eaoaM eland in w clasty or St- c rn i .. -- oed �Itle d Nlleoelelg t�wt Property description typed on reverse side of deed, a Said property 'is emmpt from transfer fee and forty beoaU" of exemption #9, Section 77.25, Misconsin Code. , 4 x. --Ira. h X ip'� �6 I � r 3 t # f 5 � To Ilnva and To hold the same, together with all and singular the apperansam OW privilepty tbeteyaoo �,w a y e thrreunM arrrrtnining. and all the estate, right, title, interest and daim wbataoewet o1 w said peel is" w lest "M either equity. either in po.re.ron or expectancy or. to the on) { r wopa* stns. benefit e.d bebeat 1 w "M Part issue_ of w aaeand �- ..the .trust` h1fiM]ItYtPfistigns ( orever. /K— •;'.� ' 10 Wltnea Whw*W. the aid part irXd the first part be 2 to so - .tfiai i aay el Cc tobez._— , A. 0..19-75. �- 81G 1) AND S lL(11.R1SJ[t1 PR>I$ii�CB OF , 4L, CLAI V. FRY .-- - ralukor { f ~ :_ k L f �� MAtIDI� . op koxamcuz PXM4 p sTATZ OF M � county. Personally awe beiare nit. this.- /A day Of _ oc tnbe r twewsw named Ci.ATR V_ FRV and MA1inTF T. FRY h Ad W.fe N » sets knntw a be Ne imtrttoatt and eeloatiwMdged w care. :*� __ Mariorie C. , arnmil _^ 1: Thia instntnom dnited by , a Notary Peblie mar i Cna PMts H a d 1 E} c 85351 iizonti _;l : •.... �, My Cetttultiniolt SB*kO 04 Box.. �7 p'A __. __. Mr!tlaa se.N M N stns MMrwMNt 1NMtNN Pr«MMt t taK � InNSeIlreMe M M tae111Md �� . - . ' �'� ..' y ,. ' sue '� rr ^„�� r':' • a y Y. ' � .J F , x y .s VU see"` is as P. u01 ' she Ifor#i • �R i�►��.�t M �! I { ' f � yyy( of Newg ses a e t • �' � eol�thsaa'o: d���N�Ai �T =7_ La Sim ed'lieo t 9684 64"1 it. Cry ` oewa . �L, L Ma . . �' Rio oM PO . taoN asfte" peroo" 00 " idea fir. in mm deeds of rose" is oaid deltaic - 09 Asodbe ottloo. Is YoZus. an es page " aN is V0191604" ' � Mai � th fte1Mroos %alter of the Northeast quarter (I ot , iMfiwt NisOteOM `19 0 Towmakip Twenty -nlve � } Nisos (19 WNt ozoep t B .twe M F ¢ Y `. ?bur (4) of 1Yhal addition to Nri�oa " to the .pXat thereof. sedating prior -to . as v"AtIma of said p4t, and also eacoepting that asp** oz %als of land deseribed in that oertain deed of r*O offioe o! the Register of DNd for it Or*!s ftuft U WIVAe a46 on Pap 460= 3 . We** Wf of the Southeast quarter (W' of 8]4) of +I sitptj. (1 Township Twenty -nine (89) t �g ;! uetee�r (19 S wilt, except that certain p issorihed in that oertain deed of record in so of Wis Rooster of Deeds for 8%. Croix Oounty 9* oo Page 4d; ' Tsob 0!" of tie Northeast quarter of the Southeast tar ( of 8 , and of the .North Twenty -six and titter ,(! 6 8js rods of thR'aouthonot �bierrnr of tloU"oi+a1 Au lartor (SIC o f U'WA:) of Jootlon Xtrhtoen (lt1), 'lb ash , ,Twoxtj- nine(89) North, of ltunra 141notoon (19) Nt W North and West of tho 1'ublio hij;hwoy as the i to ]paid out and traveled through and across sold " 1486 sMopt the$ certain parcel of land described in 1 r Milt it .deed of record - in the offioo of the izsgists�f 1. ' for 449 Croix County in Volume 838 on Pee bib A ° 1 +"a `ye x of l bad in the Southeast 4uarter of the t Nor a nor ter (SIO of bWU of Section Nineteen =° � (it) 6'. ip .1%venty -nino (w) North, of N(m(! *o Iiine- ' too n 440 =Nest d es oribud an fol,lown; Co menotng,, at the Holt ' oOri+o Of said Southeast t4marter of the I4o ` rats' U6~ (bloc,'• of NW' ) of said sootion • thence n 1g goo on the 'dust line of said Southeost 'quarter *meet - quarter (S74 of NVOJ) a distance of k } Misoty -four (994) feet to tits North line ` •.� ink Highway "t1 "; thence Northeasterly alOW', i 'sill, thirty -five and ' S /lo (30 © /lo) feet; thsrar ee (33) . feet last of and, parrallel to ate of said Southeast qu arter of the Northrros' f y4 of W, to a point whioh is Thirty -thrso Met of the NorthWest Oorl r of the Souttreul Of the Northwest quarter (SF of NM;) of sand ' ' 0001001 lamoo west Thirty-three (u3) ;sot to t� t r g t " J 1 CERTIFIED SURVEY MAP o -JI LOCATED IN PART OF THE NW 1/4 OF THE NE 1/4 OF SECTION 19 T29N R At , 19W TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSI OWNER LEGEND Clair y.' Fry st al • IRON PIPE FOUND. RUSTEES` ._. 10229 N 106 Ave 1 x 24 IRON PIPE NEIGHING Sun City, Az. 85351 rt O�lL'� 1.68 LOS /LINEAR FOOT, SET. ALLEN �'• / NYHAGEN. S -1407 IP is 2.36 HUDSON, r wy north of con- �� yra `y w P position. N, Ato su o�w i SCALE IN FEET 100 50 O ti 100 b .� h bearings referenced to the west line of the NE 1/4 assumed to /o bear S00 `� �0Q °��•� r CD O to n I P is 0.941 71,215 sq. f south of 1.63 ac EX. R/W m o computed position °C N1 66,110 ' - ) 1. ac. �)IN. R/W o 98 - r 1 t y H89 295.30 c m N 1/4 corner 140.301 155.00 j T N section 19 ✓`�- 1 ,� Ln county monument 1 N � - ' AI - 47,476 s ft. q• 44,951 sq. ft. ,1.09 ac. 1.03 ac. 0 1� N y ° N IA w c - t , y W tW0 W N W ' CM o _ �- W TOTAL C URVE DATA _4 Co r n ° 0 ►. ft- <3�.67 rocasiin9 6 J house w C- 256.641 R- 2135.87 R. 2135.87 r+ CO- N86010156.511W O . 4 3314211 6. 2 " L• 256.791 C- 170.00 C. 86.74 20' 20 i ~' CO- N87 � - 0 1 z N88 05010011E , o CBa N83 54 05.5 co L- 170.05 O Ll 86.74 ' SW corner of - the joint 1/4 Of access N7300311611W NE 1/4 4 43.051 C_ T'. H. ILA ti ` S 1/4 corner section 19 county monument this instrument drafted by Douglas Zahler job no. 85 -53 F / H • z v� .a r STC - 105 r r y SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z c7 9 OWNER /BUYER Sc�`r� /`�I�'1� ROUTE /BOX NUMBER �3d u 2_ ct" Z. Fire Number CITY /STATE �����o r� 1� ZIP C PROPERTY LOCATION: Nu�) I- " Section �� T 2, N, R Town of {-� t.t� O V1 St. Croix County, Subdivision number 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, I if needed, by a licensed septic tank pumper What you put 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 operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. Ho E I /WE, the undersigned, have read the above requirements and agree Ln to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart - v 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. c.: SIGN DATE 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. • ".. ..y..... ,_ ... .♦... , n..:x. i. w' /a0i6R«e.:i ".. .v"2ffiYWw ®.... ia, .... ..:...... ._.a.+.+a _ . __. ....x..a .. N r a I co " -. N N Al =r C C O O N Al � � p � � 11,C) p � .► ►� ' � � ° a 'cam 0 0 -w' � Q O m m A p D 7 fD N CD O n 0 n p ^. N � - O N N d ° m r ti o mn c0�uoo�'' w ° p o ,� c w N aw c� v3 8' 10 _ W fv N 0 °. w c� gi p n ° � 7 XN QAn moo° -wo�c e to c~D � O O 0 Co N �,m��wN Z CA am 0 3 NCO N n D A > Q N 0. N N S n co (A y n C 111 S L1o_ ° , oc� oQ�CD SU ° ,o. CO Q W 7 Q W N = �1 a So �,o c D ° c = CL 111 o in c W ap; aaa° ° ao Qa� a�a o G) '<v; mo g m M o CL c c �c m w o vl� ° n a a , w ? m o 3 ?.� N o _ , c ,, a 1 INDUSTRY, OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSRY, DIVISION J LABOR AND PERCOLATION TESTS (115) P.O. MADISON WI 79 HI ,IMAN OELATIONS (H63.090) & Chapter 145.045) LOCATION: hj SECTION: TOWNSHIP LOT NO.: BLK. NO.: SSJB VISION NAME� /a 19 / ♦' N /R /91P(or -, &,u COUNTY: OWNER'S BUYER'S NAME: M AILING ADDRESS: USE DATES OBSERVAT-rbNS MADE , NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFI DESCRIPTIONS: DILATION TESTS: Residence ,New F-1 Replace / RATING: S= Site suitable for system U= Site unsu itable for system S 7 t r Q*l n v J /ul d CONVENTIONAL: MO IN- GROUND - PRESSURE: SYSTEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) 19S ❑U ,®S ❑U IBS ❑U [IS 9 ❑S ©U o . w ea If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: I Floodplain, ind ica t e Fl elevation: AJA PR FIL DESCRIPTIONS BORING TOTALI ELEVATION D PTH TO GROUNDWATER- CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER D EE PTH4M- � OBBSERV A ED EST. HIGHEST TO BEDR OBSERVED (SEE ABBRV. ON BACK.) B- Is AAAjv / .O r . V / 7 l L i / s 1 B -,2 .d . ` e > 7.r-) -r B- zd' r ' .e— > r d ' / S s y Is B- r 00. 3' .,�' ,.�.,� S Jr'r 3 q A B- PERCOLATION TESTS TEST DEPTH+ WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER 4"GlalE8' AFTERSWELLING INTERVAL -MIN. PERIOD PERiOD2 PER PERINCH P_ or AiD O .7 ar L .2 / .7- P- r 0 0 3 `L .2 0 P- 0 3 _3 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 r- - 3 . i r E N 3 z 1 � ...L. V J A tN _ r c,� K r P CBI 8Y r� f - ' f t� I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified 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): TESTS WERE COMPLETED ON: °s r ki O sc v 4) ;L -� ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): CST TUBE: c 4_42t-t DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) - OVER - 1 t � a INSTRUCTIONS FOR COMPLETING; FORM 116 - SBD - 6396 � 1 Y t To be a complete and accurate soil test, your report must ir= .dude: � 1. Complete legal description; 2, The use section must clearly indicate, whether this is a residence or commercial pro ject; 3 MAX 1MUN number of bodrooms or corr?ra Ncial use planned; 1. Is this a new or replacement system; S. Comfidece the suitability gating boxes. A SITE IS SUITABLE FOR A HOLDING TANS ONLY IF ALL OTHER SYSTEMS ARE BULEQ OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the ab it avRatrtmis shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A supar. m sheet maybe used if desired; S. kljo e. sure your benr P,ialark and vertical elevation reference rxont are clearly shown, and we oei rnanent; S. Comptete all approrwiate boxes as to dates, hams, addinves, flood plain data, percolation test exernp- tiorn if rarpropria =e; 10 11 ow Ador nathn ( ;aaCla as flood plain, elevation) does not apply, place N,A. in tho appropi iat:e box; 11. Syn fhe fami and place your curr No adclrms and yraur certification iraamtaer; 1 2. Make legible coijes out distribute as rimgirE =ct. ALL SOIL TESTS MUST BE FILED lk!ITH THE LOCAL AW T HORITY WITHIN 30 GAYS OF COMPLETION_ ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Sep crates. and Textcrces Other Symbols t - "3 hom -, (over 10 ") OR EsKkmk Ez Couble (e3 . 10") SS San d00!"e Carat (t der 3 LS Lint= mone is Scared HGVV - Hiyh Cara; a c cA C ,< . « f„ = ?r P my R nndAhn Rate m .l uir Sym, t,a - t == I ve T"Id l"!3Wg B oH ncr - Lo ny f-mi rh"'ol sl Srtrld,i L aii Les rl?ar, Loan BA B rr: s�i - gilt Lrazrrr B1 EsWk w S; ;[ .... i),1nd}/ C,l it l_L.,:,a. r ^'. 11 ._.. i trip 4 — . y ( hay Lown mot - Kl ... _. vu TOPQ (lay Q " k - n o — So Coy f — tf t't, l[rTS� 1cA.nT t I Cif conmiotr c o,'g .� P1 mm — My, nv huin, ,. - + cl< d — Whut p __ i7FomiYten Six L[(:n "s € ?il lexulm's S m `;ar 0 1`'s; , t for hquid wow disE:sEW BP0 - R ch Mark V RP - Vertical Refior , ,m r Point r. To THE OWNER !f lood t nt ry'E)r rs m e ihit s lop Al <,.;rrrrng i sanitar'y pf"'I f mt. T h£ or tnio D partmeni may r0..(jLWSt sm dy c U .1.; Sol ms in Wa Amd Ptim to �4?rrni_ U3..,..,, A t,x�.r? tr gi. of � � t ! a_, ;�t ,7 €��s l: 1 €)," tI`7'��' pri Vi� L" t ` V" $ _''n s "nd a p , tlh WaWN100 pa:;. by Idt m fwd to we ayn"h WWm , dLom o v in £a9 (lip- to OMOO ywraht. 10 <s3 c m . t . Fa i, €,,,, A ami posted `xim { °t� err r F , t ir3 � _ _ 4'.p �in`y' t }rt�i$'l3ftii)ra. z s � • P , y N ` I I i I I t I 1 1 ( it II i ^ P �j w ° � N Q 0 Jr ( Sun LA p v► � � r s' 4 J a � , i h o r. - a3� d Q d o� a ' 'o Z N / i �i •��Mi?wr.M.�w�i»r r .�' oy1pw.. w.... .iM+ �» Ts.�Mr...w•f..�.M+w«.wNwr -Jmsw. f#hl r t f s; of 1 of C*rtIfI *d Sarv*y * a .` 6 r 1 S'� ltd ♦O1. �� � P 1�. �r t i;j ji Y � = i ,... ......... of ....... .......................................... i \ I tr i �� ....1......... ............. «..... flow �111M��i /. ..T... e �q ... ;,..... .: ».... .; ........<........ ...... ..Sam ..E!...MIfit........ .. . .. 4 .....x .........., ...ZtiALI ........ ................. •............. a. . «... .. ... ........... ............................... f ! r ats�taesoss r ♦olxow"*. ........ .�t..,�..d� »« ..... ...................... �::::.,, ,,,;...:..... � .).... ».............. ............. °..................... ». «..,..,«r,e d too k�wol� d . It Yv Y �, '�'`�/!' �Mi 0/11 • ...,.,. +',� >. � �} C.. ". ii o r �M 8bWW W,'Wo -*A" wwiMMt rte. ' s "-�:_ sue^ .:s.° � _.:..� • . = ... .z ,ems+ 'j !�� i� z / H a S T C - 105 c�- :< SEPTIC TANK MAINTENANCE AGREEMENT ' _ ` � `C "'9 a St. Croix County 1 ' �� z OWNER /BUYER r 1 M D W1 - _.�,_.�- th ROUTS /BOX NUMBER h Fire Number Qf' .CITY /STATE - kCs� �J ZIP > PROPERTY LOCATION: , �, Section T R__� Town of �wd�d�. , St . Croix County, . G Subdivision - 'orma-'✓ : ) - V s4 a _ Lot numbe 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 pUt 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 operating condition and (2) after inspection and pumping (if nec- e-saary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 E I /WE, the undersigned, have read the above requirements and agree z „ to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart - w ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offkpe within 30 days of the three year expiration date. T SIGNED U LP DATE 3 -`� g`7 0 L St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715- 796 -2239 or 715- 425 -8363 Slan_ dAtP and ratitrn to nl�nva n dAvaee x) 1 � APPLICATION FOR SANITARY TARP � i 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 ' - t h f� r Location of Property _ (W 1 % b� h, Section , T j N -R W Township Nailing Address S A_ Address of Site 13 0 -2 S�/� Subdivision Name ✓ /Q, �. Lot Number Previous Owner of Property Total Size of Parcel ��c� ✓S Date Parcel was Created 3/ 1 �t f Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume - 2 �(/' and Page Number Q7 as recorded with the Register of Deeds. 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 I (We) ce tt. that dtt stat on thi.6 an true to the best o6 my (oun) hnowCedge; that 1 (we) am (cute) -the owneA(sf the pnopehty desehi.bed in th.iA .in6oltmati.on 6onm, by vi)ttue o6 a wa Aanty deed heeonded in the 066.iee o6 the County RegiAten o6 Veeds as Document No. and that I (We) pnesentty own th phopobed d.i to 6 o4 the sewage di6 po sat s y em (o I (we) have obtained an eaeement, to nun with the above deacA bed pnopenty, box the construction o6 eaid d ydtem, and the tame hae been duty recorded in the 066.ice o6 the County Regi4teh o6 fleedd, ae Uoemnent No. SIGNATURE 0I OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED r H N H STC - 105 r H SEPTIC TANK MAINTENANCE AGREEMENT Ho St. Croix County x c7 a H OWNER /BUYER 5ck ,\ ''^^ M ROUTS /BOX NUMBER s go x, 3 Trt" Fire Number =eY /STATE 4L 5 9 ,.,, ZIP __5 / & OPERTY LOCATION: Al Wi6, 3 6, Section T ;?-9 N, R Town of tdLe,� , St. Croix County, Subdivision �V V 4 _ Lot number 3 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 put 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 Cor 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 operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 I /WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart - v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offi within 30 days of the three year expiration date. SIGNED DATE ,'5 k 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.