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HomeMy WebLinkAbout020-1064-00-000 o m f 3 d O �1 M ' ~: c C p CD N O N C A N � • n 3 ;; Vl O. N N ~ OD v¢ 7 CD y OD r- O O N C 3 ) 0 O �O O V ? O CD 0 ? io O O N C 0 7 D O w 3 M d -e O C co r� cn C D a N 00 m (Cl N( a m CD N 3 D (D W` -< CD 3 a a . o o o p d .. !V Z 000 � r c (D a y O O W = O N <• {p W z N , z .. O Z o o O D 0 v H 3 (D O y • N CD = C f0 N C S (D W (D 0 O. 0) j Z CD ai f° Z m Q. o C') a A Q Q . z-�N 0 m CL z z O Z y m D w � m a 3 o' I v c o C' I o I I a y I A N W N p to A O CD Dq O O Hi O Oo a a, ti - 93 ST. CROIX COUNTY WISCONSIN `}M` .F ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - - - (715) 386 -4680 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 �jWater (Nitrate & Bacteria) $35.00 Asual inspection) Owner: ul zA. cc4-; o sv Requested by: Ft i E zjg4 4 1;AsTFr__ Address: Address: oil ev— CS City & State: , City & St. , Zip Code: Zip Code: Telephone N ( ) Telephone W: ( ) Property address ( Fire NO & Street) : ?, 1 2 Pw -1 I Z � Location: 06 h, 1J;, Sec., Tj_l__N, R_W, own of St. Croix Co., WI. Tax ID N r Parcel ID NO Pa,- Q q ?j p16 House color: NLAk -, Realty firm: G 2- Lock Box Colb Water sample tap location:_ TO BE COMPLETED BY PROPERTY OWNER * PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS F Is the dwelling currently occupied? 0 Yes No If vacant, date last occupied: Septic system installed by: Year: C� Septic tank last serviced by: Date• Previous Owner's Name(s): c w Have any of the following been observed? OY ON Slow drainage from house. ❑Y ON Sewage Back -up into dwelling. ❑Y ON Sewage discharge to ground surface, O road ditch or body of water. ❑Y ON Slow drainage from the dwelling. ❑Y ON Foul odors. Other comments relative to system operation:" I certify that the above information is complete aii lr e�b� the best of my knowledge. OWNERS SIGNATURE. • DATE: 4/93 . y OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION t IN TO BE COMPLETED BY INSPECTION AGENCY System design & /or permit on file? ❑Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system ❑Below grd ❑At -Grd ❑Mound Approx. size 'X ❑Gravity ❑Dose ❑Pressurized Ft. ❑Bed ❑Trench ❑Dry Well ❑Holding Tank ❑outfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: ❑House ❑Well ❑Prop. line ❑Other Dose tank Setbacks: ❑House ❑Well ❑Prop. line ❑Other Mocking cover ❑Warning label ❑Pump /Floats ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: ❑House ❑Well ❑Prop. line ❑Other ❑Ponding: ❑Discharge: General comments INSPECTORS SKETCH OF SYSTEM LOCATION N I Inspector Title • ST. CROIX COUNTY n WISCONSIN aw �`-d ZONING OFFICE ST. CROIX COUNTY COURTHOUSE vl" "•' _ 1101 Carmichael Road • Hudson, WI 54016 F: -- — __ - -- - (715) 386 -4680 July 14, 1993 oy co 5S GAS'`` CP Linda Forster LoN1�G 'O► First Federal C 35 N 9 �� River Falls, WI 54022 Dear Ms. Forster: An inspection of the septic system on the property purchased by Prudential Relocation at 892 Hwy 12, Hudson, WI was conducted on July 14, 1993. At the time of inspection, the sanitary system appeared to be functioning properly, however we are unsure of how long the house has been vacant. 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 this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator mij ST. CROIX COUNTY ZONING DEPAR ° L I AS BUILT SANITARY REPORT ���} � �� RECEIUEQ `� Owner Al2 L /2 IVAO S azoR Tiy � Property Address R9L 4: AP&0 V / J I .. 22 19 �r . City /State 944D S ©nr Legal Description: J. Lott Bock Subdivision/CSM # M01 1 S T--`-` C YE '/a & ' / a, Sec. &Y, T - L±W, Town of W elQ fa Al PIN - OD - o00 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION dOo Tank manufacturer t',U t `5 Size ST/PC &w / Setback from: House 4ZQ Well fQQ'`P/L 85 Pump manufacturer ffA Model &A Alarm location A? .A (H DING TANKS ONLY) Setbacks: nt to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Ueiyc rJ Width f Length J60 Number of Trenches 0 Setback from: House //- 0 Well AM PAL 3 0 - Vent to fresh air intake ELEVATIONS Description of benchmark .* r,y F &.vc� &:5 Elevation 100.0 Description of alternate benchmark 7aa Eu U rG 5.1 Elevation ?K,,6 7 .09'1.7 = ^ua) Building Sewer ST/HT Inlet 9 8 ST Outlet y % r . 27 PC Inlet , 6FAysr , 90 PC Bottom &— Header/Manifold Top of ST/PC Manhole Cover Distribution Lines 3 (2) f. 3 3 ( ) Bottom of System (1) 90,00 (y) jD. DD ( ) Final Grade (1) Z , 0 (2) Date of installation :2./ Permit number State plan number Plumber's signature aA,, number :�,2/ 7 !Z / Date � f22/ 9f� Inspector ��� Complete plot plan 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 19 We" p eo ftg�' y o S; � Soy J C,41,C / Y, TAEAC &CS INDICATE NORTH ARROW I Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermi IX Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)]. 3445 81 Per DAVID .' DAVID E] City_ Town of State Plan ID No.: CST BM Elev.: K Insp. BM Elev.: BM Description: tl 5 1V Parcel Tax No.: Q'0 0o n a, l h f " S. 020 - 1064 -00 -000 TANK INFORMATION ELEVATION hATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic ? es �r� Benchmark „ oC,5 Dosing at gW33 Aeration Bldg. Sewer Holding St Inlet t q,?. TANK SETBACK INFORMATION S / t Outlet ) 3`2 TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet Air Septic D >Ieo' > /tap -- NA Dt Bottom Dosing ��p �i.� NA Header /Man. 7. Aeration NA Dist. Pipe rti s S. 2 3 s s••s�- Holding Bot. System V ID. Sb q, PUMP/ SIPHON INFORMATION Final Grade b6 5:0 Manu Demand �� 5 Z '33 Model Number GPM �j'r C�,r./ yL” X cry • /� TDH Lift Fri tern TDH Ft e /f �•t-Z 3.2K Force m <1 n Length Dia. Dist.To SOIL ABSORPTION SYSTEM a) 3 Imp . F ., ru , � S Ito 2A cl - T Width, Length r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �J IdD l Q_ I DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer � n INFORMATION Type OT t �!� CHAMBER Mod Number: t cwt I System: �,J . 3 D OR UNIT DISTRIBUTION SYSTEM Iq Header /Manifold t, Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. 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.) LOCATION: HUDSON 24.29.19.246A,NE,NE 892 HIGHWAY 12 — LOT 4 parrs 6� • sews .� �. sr � a (�.�d � � r �..�� -. A% - Plan revision required? ❑ Yes P 5-No tp J Z Use other side for additional information. �" 2Z 9� SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: € r ° � k i Pv .. 3 3 3 I { ° e � I r e yy en f F r i _...... °.. .... e .. °. �- °.A Sew ,. �....., a...... _ .. ... ... ..... - °. q °°. 9 5 r t S 4 a r i a .,�. ° .. 4- ........... .....�... ... , .� ... � e { � f F i E r. 6 s x a g € j I m °Ae.... ... = d f a ° e r a e _... .... _._ ._.._......_, a..........., _a.._ ,-,e -- - - , m...emm, F .° .. —2— °m s .—L t a € 39 e� n s r ' n . a ° C € IT i ° k ° 3 E Y u 4 t c 14 scons i n Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. , C/0 / • See reverse side for instructions for completing this application State Sanitary er Number The information you provide may be used by other government agency programs ❑ Check if re�on to C Drevious [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property O�r Name Property Location �1/4 Afe 1i4, 5 T , N, R 12 E (or Pro pert Owner's Mailing Address Lot Number Block Number Cit tate Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) E] State Owned It� Nearest Road C] Vil age Public 1 or 2 Family Dwelling - No. of bedrooms _ Town OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) A,,7 . 2�-) - 1 4) Z 1 ❑ Apartment/ Condo ej at 0 ° — O " 2 E] Assembly Hall 6 E] 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 A. Check box on line B, if applicable) A) 1 ❑ New 2. N 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 Pa Seepage Trench 22 ❑ In- Ground Pressure t 42 E] Pit Privy 13 [] Seepage Pit I 3 ❑ a 14 E] System -In -Fill �(�, -� �$c7a Sj ,e ,-� lq VI. ABSORPTION SYSTEM INFORMATION: ir 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 1 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /19,eft.) (Min. /inch) ,/ Elevation Co M oo / 0 • 4 9,0 0 Feet � Feet Capacit VII. TANK in g allons Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks tic Tan o B M �Q� r ❑ ❑ ❑ ❑ 1:1 Lift Pump Tank /Siphon Chamber ❑ 1:1 El E:] ❑ 1 ❑ VIII.- RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum r Signature: (No ps) M Business Phone Number: Plumber's Ac dress (Street, City, State, Zip Code): «, a .,? IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D at I ssued Issuing nt nature (No Stamps) Approved E] Owner Given Initial s r argeFee) Adverse Determination / 9� X. CONDITIONS OF APPROVAL/ REASONS FOR DI APPROVAL: SBD -639@ (R.11196) _ DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 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. 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 isto 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 lank, 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 8 1/2 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 E it test data on a 1 15 form; and F all sizing of the soil absorption system if required by the county, ) so a a ) g 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. , u ' I raw i I 59 - . ' 1 I � 4 ' , i i i y , , Ce y ff Kr' ------ r oT. t t f - _ i ; R r , , : , FS T —�` — - --- -- - - -. V-1,7 foy i � t �L1 , - s z �_ 1 { } t , I I I ° , E 1 _ T , f t , ° y I � ! I I I . I f t I fi I } t � ° I • I , • , : _ I 1 —._4_ f s i i , L Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8' /z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsices, north arrow, and location and distance to nearest road. - _ Parcel I.D.# APPLICANT INFORMATION - P /eas t ! 0` ion. R 020 - 1064- o0 -oDate Personal information you provide may be use es tPiMldy S. 15.04 (1) (m)). Property Owner e'� Property Location E1✓ 4 David P. & L. Chirine Wadswo `'FC vt• Lot NE 1/4 NE 1/4 S 24 T 29 N,R 19 W Property Owner's Mailing Address ���� L�t # Block # Subd. Name or CSM# 892 E Highway 12 `° i 4 CSM Vol. 1, Pg. 193 City State ' Code City [_I Village ❑Town Nearest Road Hudson WI tab U -9179 Hudson U.S. Highway 12 El New Construction Use: ❑ i Num t bed s 4 ❑Addition to existing building ❑ Replacement ❑ Pub rr*lp rEi be Code Derived daily flow 600 gpd Recommended design loading rate -5 bed, gpd/ft .6 trench, gpd /ft Absorption area required 1200 bed, ft 1000 trench, ft Maximum design loading rate .5 bed, gpd/ft .6 trench, gpd1W Recommended infiltration surface elevations) 90.00' ft (as referred to site plan benchmark) Additional design / site considerations Install trenches using high capacity infiltrators. Install Bull run valve to allow future use of existing hydrolically Parent material Outwash s & gr. Fkxxf plain elevation, if applica ble NA ft S= Suitable for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ® S❑ u ®S ❑ u N S❑ u I ® S❑ U ❑ S® u ❑ S® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPDIft Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consisten Boundary Roots Bed Trench 1 1 0 -4 10yr4 /2 None sl 2fcr dfr cs 2f,lm 0.5 0.6 2 4 -19 10yr4 /2 None sl 2 m ed. pl dfr aw 2f,1m 0.5 0.6 Ground 3 19 -39 10yr3 /3 None sl 2m dfi cs 2f &m 0.5 0.6 elev 94.89' ft 4 39 -49 10yr3 /2 None A 1 th pl dfr cw 2f,lm 0.4 0.5 Depth to 5 49 -62 10yr3 /3 None sl 2m mfr as if 0.5 1 0.6 limiting factor 6 62 -119 7.5yr4/6 None i trat.s& O 9 ml - - 0.7 0.8 >119" Remarks: 2 1 0 -9 10yr4 /2 None sl 2 fcr dfr cs Ulm 0.5 0.6 2 9 -20 10yr4 /2 None sl 2 m ed. pl dfr aw 21,1m 0.5 0.6 Ground 3 20 -41 10yr3 /3 None sl 2msbk dfi cs 2f &m 0.5 0.6 elev 95.73' ft 4 41 -52 7.5yr4/6 None Is 0 sg ml cw 2f,lm 0.7 0.8 Depth to 5 52 -91 7.5yr4/6 None at.s &g , 0 sg ml gs - 0.5 0.6 limiting factor 6 91 -127 10yr5 /4 one strat.s4c 0 sg ml - - 0.5 0.6 >127' R emar k s: Horizon #5 & 6 contain ban 3/4 2msbk sl. Loading rate of ho rizons adjusted to reflect peirmiability restriction created by these materials. CST Name (Please Print) Signatur : Telephone No. James K Thompson S w 715 -248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, W1 54020 7/13/99 3602 1068 . PROPERTY OtiYNEIt: David P. & L. Chirim Wadsworth SOIL DESCRIPTION REPORT rose Page 2 of 3 PARCEL LDJ 020- 106400 -000 A.C.E. Soil & Site Evaluations Depth Dominant Color Mottles Structure GPDIft Horizon r Texture Gr. sistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Bed Trench 1 0 -10 1 Oy r4/2 None sl 2fcr Mir cs 2f,lm 0.5 0.6 3 2 10 -22 10yr4 /2 None sl 2 m ed. p l dfr aw 2f,lm 0.5 I 0.6 Ground elev 3 22 -35 10yr3 /3 None sl 2msbk dfi cs 2f &m 0.5 j 0.6 97.20' ft 4 35 -41 7.5yr4/6 None Is 0 sg ml cw 2f,lm 0.7 0.8 Depth to limiting 5 41 -87 7.5yr4/6 None strat.3 0 sg ml gs - 0.5 0.6 factor 6 87 -124 10yr5 /4 None strat.5 0 sg ml - - 0.5 0.6 >124' Remarks: Horizon #5 contains bands of I Oyr3 /4 2msbk sl. Loading rate of horizo adjusted to reflect permiability restriction created by these materials. Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: i �q. 3 a �'3 a z o ra ■ H o0 0 3 Ert• s /Wws R- vent! E. To(�o�`jti'sfi ^ l �f cnce 10CS6. o ltl/,` 26 9`07 /4sf e-cl Est`• e/ac'A. 0-15 6. o{S.T. 160GO� B ■ C.CeanowE� '440"dr„� a boat ffd. ■ $ -3 0 3 � A Own�r'� 0 V 9,2 E A4 12 .Cot 0 &5Af dW. /, �. 193, /I ,FNvWev, Sed..ty Tzgr , le. /9c,; 7 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer � L/i /0 L� LA D �L1,1 02 T ht Mailing Address 9&92 � / �2 Property Address Ca` Gv X / (Verification required from Aanning Department for new construction) City /State # Ar /� • Parcel Identification Number – — 000 LEGAL DESCRIPTION '' // Property Location /s, Sec. H T��N -RW, Town of Gldlanr Subdivision , Lot # Certified Survey Map # 3.3 O &Z 0 S , Volume , Page # / 7 3 Warranty Deed # 5 6 .3 1 `7 `f , Volume Page # 3 `/ Spec house ❑ yes ["no Lot lines identifiable Oyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance f needed b a licensed p ump e r. What you put into the system out the s tank eve three y P Pe consists of pumping p r5' ears or sooner, r Y 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. 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 Zoning Office within 30 has been maintained must be co g Stalin that your tic stem completed and returned to the St. Croix County Zo g Y septic system days of ee year expiration date. ''J kGfj Ah - V ' KE OF PLICANT 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 above, by virtue of a warranty deed recorded in Register of Deeds Office. / S 4 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 07/15, THU 09'' K 715 386 4686 ST CRX CO ZONING ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR TTT1j=,ATTON OF AN EXISTING' SEPTIC TANK Thisi is tocertify_ that I have inspected the septic tank presently erving the Okr L residence located at: Section T R �L _I"" 11 , Town of Upon inspection, I certify that I have found '-.lie tank and baf to be in good condition, and it appears to be uncti?,fiing properly. tic i service t occur from absorption system? No (If no, skip ne ure or length of time: ir, i- n u T- e Concrete Steel Aiet n 2—z- -as 75' (T - (Liven s - e - - Fo be ►pted by licensed plumber (s.145.06, Wisconsin Statu or L; Disposer (NR 113 Wisconsin Administrative P! umber 1-; — Sanitary permit) Certification: -ove st, regarding Ir accept,nq existing s-ptic tank condition, I certify that 'Ehe tank to the best of - my know-Ledge will conform to the requirements of j 8'. Wis- Adm. Code (except for inspection opening over outlet baf V ., "—,e Name'&~ i At _IUr S ignal - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - DO&MENT NO. STATE BAR OF WISCOSM FORK I 1M Tula SPAC4 aesww Pon Attewlab *^?A WARRAW, V 503V4 WM5mst 34 REG TER% _Off" ST. PRUDwT& R�ff& "na1',**'tbff M' ... Wd . ..••..... ..... ..... BY - PROD . U - T - IAL ... ROM --- COMRATION, .. dbfffil - . F ..... AN it 1993 ................................... ... ............. ........ - -• - -. ---------------- ........................................... ..... . ............................... - - - ------- — --------- - ------------- at A. M .. .. ------------- - ------------ ........... ................................... . ......... ........................ — -- --------- ----------- ........................................... . ................. .................. Grant$*, lsasrdDsadi WitaesWth, net the sald Greater, for a valashis coaddenwtion ...... TIN DOLLARS and ottker good and valuable consideration ............................ ............ . ....................................... — -------- ............ wnveys to Grant** do 160owing described real estate In ... ;q.__CR0ik ............ ISTUR04 TO County, State of w1sooftels: Tax Pared No: PART OF THE SE 1/4 OF THE 91 1/4 OF SECTION 13 AND PART OF THE HE 1/4 OF THE NE 1/4 SECTION 24, TOWNSHIP 29 NORTH, RANGE 19 VEST, ST. CROIX COUN WISCONSIN, DESCRIBED AS 'FOLLOWS: PARCELS 4 AND 5 OF C ERTIFIED SURVEY NAP FILED NOVEMBER 11, 1975 IN VOLUME 1% PAGE 193.' TOGETHER WITH AN RASM It I OVER THE ROADWAY EASEMENT RECORDED AUGUST 19, 1974 IN VOLUME 515, PAGE 55, BEING THE EASEMENT S 0 1 Oil SAID CERTIFIED SURVEY MAP AS ADJOINING THE WEST LINES OF PARCELS 4 AND 5. Subject to restrictions of record, conditions, reservations and easements, zoning �� ordinances, if any, and general taxes and assessments, not yet due and payable. This •...... &AC hosoestead property. T49"Or wide all and singular the hereditarnerAft and &W-tesutaces thereinto belonging; A1kL_ .......................... warrants that. the t[Rie is good, indsleasible is fee simple aid fr.x aid elesr of aacimbrancss except and win wa rrant aid do* the Datedtb;s ...... — ------ ....................... day of ...... - --------- . . ............................. /_ — -------------------------- - ---------- ----- - -----_------- (SNAL) -- ­ ------ PR ENTIRE ------------ .................... .... _(SEAL) --------- HO1MES CORPORATION, GENERAL PARTNER ST: - - ----------- ------------------ --------------- ------ . .. ................ AUTRUNTICATION ACKNOWLBDGKZNT ._ ...........-_ -'___.»...•---- ».» STATE OF 44dGWON — - — - - - ---- - - — ----------- - -44 of It-fl. 6. &ws named .... . .... 1 3 - ------------------ ------- TITLE: UMBER STATE ftZ OF WISCONSIN tie _. I 1 1 t _. e E j - -- - — --­---­-- - - -- - ----------- - -- - ------------- - --------- - ----------- ----------- ft as known to be the person ............ who =mvuted tL* feregaing Justruntent and acknowledge the same. T"Ve ING'MUMEW WAS DRAFTRO 10Y it ROBERT WHEELER, ATTORNEY AT LAW -- ---- - - - - -- --------- ............ .... ........ 76M in cated or a*now%dgo& Be* my state eip1 tion a , Ii (Signatures may be authenticated ---------- -- --- ----------- - -------------------- ._ -- -- ------ - - - - -- - : --------- m not necessary.) date: KAALV% J. FEWU ------- 1 19 ........ * NO— M V— 4 *n1ft 'a Saw mv*cft W6�Wd b. tr-4 w wlte4 %air ___ commmwaf DO. MAY 1. 1"4 ti, l WARA&WT DwD NTATU BAR OW E NO" W%"nsln Legal BIwA Cu lx FORM Is@. I I Ad.hoke.. Wk.. 7 7A NO I -P, 4�-" j ju2ub 330205 11 *121 d FILED m NOV 111975 w JAMES O' CONNELL Register of Deeds (P 5R Croix County, 4QA Wisconsin C SE 1/4 - SE 1/4 NE CORNER SECTION 24 SECTION 13 T29N, R19W �--- s o _ PARCEL _3_ 26� fO0 a► T7 ? �9, SpUT Cy � C gGp FNI z ^� 4-�o p 4R c ywFs No NF p i � oO9 � O ti �4 , 52,. TF r R c S - - - - - - - -- N ro 8 G 'yl. F RN /0 s ° pF 3 to 28 "s in co o PARCEL 4 v NF z 2.48 ACRES a 202° 26' v - (D N NEI /4 -NE 1/4 n j N z0 \`\ e o SECTION 24 cU 0 co 0 _ Li.l �� c' •12 N 87 0 15 E 421.30 v PARCEL 6 M o TRUE a - 2.42 ACRES w BEARING s ° 23. to J i 66 0 0 I z N t� I � a 0 I I o 0 PARCEL 5 M I z z O 2.46 ACRES d^ 204S44' M I w- N R. 185 ro Iy 2 o 3 "''o ARC =88.59 N I �� N `��, S 81 01601 N - -- IaNO w POINT OF LINE °� 88 57 loaw BEGINNING Y R1GHT•Of-WAY 161.33 I Irw an d z N pRTHERL - 1 42 556. . � 395 � . $ g2o 38 W N82 , 1 66.0 - to NE S. � CENTERI -1 N 2O0 p! W _ - - - - -- _ _ 216 p� I - - - 8. s E I/4 CORNER SCALE SECTION 24 T29N,R19W LEGEND 100 0 100 2" X 36" Iron Pipe With SURVEYED FOR: WILLIS H. MILLER Brentsen Cap. 1127 4th Street, Hudson, Wi. 54016 Q 1" X 24" Iron Pipe SURVEYED BY: OGDEN ENGINEERING COMPANY Weighing 1.68 # /Lineal Foot. 123 E. Elm St., River Falls, Wi. 54022 � SG0NS //�� FRANCIS H. OGDEN S-882 / Jo No. 7S-S44 FRANCIS H. �y wA OGDEN - APPROVED Z s -sae _ O' RI FALLS, X ♦ � wls. � � ST. CROIX COUNTY O� COMPREHENSIVE PARKS PLANNING iS�U R ; ,��� AND ZONING COMMITTEE - 10 -22 -75 Volume 1 Page 193