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Home My WebLink About020-1330-70-000 Sh. CROIX COUNTY ZONING DEPAi Y EP AS BUILT SANITARY RE1'010' Owner 1 far) _.. r_G 6f Z a a SS e Address �, �As (��tlr Cit y/State ' F IL" 7 /Slate Y � Legal Description: Lot Block Su bd' v' i si on/ CSM G� i t c a /, S 4f _ /, z6W, Sec. , T9 N -RZY W, Town of 0 PIN # 0; ?0 SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer 1y1.'�we�t�•,. Size ST/PCA /G Setback from: House a6 Well .f//G+ P/L Pump manufacturer Zsaa , s Model a Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Meter location Water Line Alarm location SOIL ABSORPTION SYSTEM: Type of system: ,�6D,v Width Z�L Length / � Number of Trenches Setback from: House s�a>�- Well , A P/L e7- Vent to fresh air intake ELEVATIONS: Description of benchmark 4 d % Description of alternate benchmark Elevation / Elevation 1 0a, �P Building Sewer ST/HT Inlet - 4 4" ST Outlet PC Inlet PC Bottom ?7 7& Header/Manifold . f� Top of ST/PC Manhole Cover Distribution Lines ( ) �4/,_ ( ) ( ) Bottom of System Final Grade ( ) ) ( ) Date of installation Z ?! / /Permit number State plan number Plumber's signature L.,l_ License number Inspector Complcic plot plan .� 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 � h ` o b b p � INDICATE NORTH ARROW Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count 9 . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitayk26% Personal information you provice may be used for secondary purposes [Privacy w, s.15.04 (1)(m)j. Permit Holder's Name: ►- L_Citb R_Village Town of: State Plan ID No.: ACASSE, RICHARD HU ON CST BM Elev.:- 67., 1 Insp. BM Elev.: BM Description: Parcel 6169-i330 11 lb4 TANK INFORMATION ELEVATION DATA A9800453 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e Ic I h4 r ✓c c.�a �— 10"' Bench S ,S• $ Dosi �5z> 6 m i 7 ' `-7 Aeration Bldg. Sewer ,Ion /3. �Z. d Hold i S / Ot Inlet 1 3•Y TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake eptic f 'Z NA Dt Bottom 1 7, 571 �Z NA Header /Man. 3Z / OU• / S Aeration NA Dist. Pipe 16 C/-/ Z Holding Bot. System pt` L�. ¢B 16 3. PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand M— 0 5, 05' ?5 100 Model Number O ?e,4GPM 41 8 � TDH Liftl6 . Friction2 0 1 Systeml,.� TDHIV. *Ft S(� :5 99 S [ Forcemain Length ! a S� 1 Dia. ?, I Dist. To Well SOIL ABSORPTION SYSTEM B RENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM ENSIONS S DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM EMB HI M SETBACK ER I NFORMATION Type O _� M umber: System: 1 00 DISTRIBUTION SYSTEM Header /�ifold II Distribution Pipe's 1 ' ' _ x Hole Size x Hole S sing Vent To Air Intake Length / Dia- �_ Length,: , Dia. Spacing J � SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over I xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges ,2'' Topsoil , [ y es ❑ No �] Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) 3 0� i'-f •3 � a� i• z S �6x�o S LOCATION: HUDSON 23. 732 WALDROFF FARM ROAD Plan revision Oluired? ❑ Yes If No Use other side for additional information. SBD -6710 (R.3/97) Date Inspecto s igna ure Cert. r Safety and Buildings Division 2 01 W. Washington Avenue - SANITARY PERMIT APPLICATION Visconsin P O Box 7302 In accord with ILHR 83.05, Wis. Adm. Code Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. S'7�4 t,& • See reverse side for instructions for completing this application State Sanitary Permit ` Number � Personal information you provide may be used for secondary purposes E] Check if revvisionevio pl"ication [Privacy Law, s. 15.04 (1) (m)]. - 73 A W ald rof'F r Q r m Rd • State Plan I.D. ^W mber I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION 70 w�Z� Property Owner Name Pr perty Location 4 , 4)1/4, S Z 3 T 0 2 4 7 , N, R E (orlo Property Owner's Mailing Address Lot Number Block Number , 9 �R0 el .a Cit ,State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F LDING: (check one) ❑ State Owned ❑ Ic ge Nearest Road Public 1 or 2 Family Dwelling I C] Villa - No. of bedrooms _� Town OF r/ / v`r1 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1.1.9 9 . �7 n • /73 1 ❑ Apartment/ Condo 01-713 - lS "0 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 ______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 QMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation �Y47 2 E �'$r Z Q,3. S Feet Feet Capacit VII. TANK in Ca allo s Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Ex istin strutted Tanks T nks pti rank or . ding T nk 13 ❑ ❑ ❑ ❑ ❑ ( Lift Pump T /Si hamber El ❑ ❑ El El MA". ESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (N a ps) P PRSW No.: Business Phone Number: Plumber's Address (Street, City, State ip de): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) (JApproved ❑ Owner Given Initial Surcharge Fee) 9 n Adverse Determination �� 4 0 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber J . SAFETY AND BUILDINGS DMSION 2226 Rose Street La Crosse, WI 54603 ISCOIISin. Department of Commerce Tommy G. Thompson, Governor 27- Mar -98 lit William J. McCoshen, Secretary IN Soir' ti C.sl Wegerer Soil Testing & Desig RICHARD LA CASSE 421 N Main St N" ✓ 96 PO Box 74 River Falls WI 54022 EVERGREEN ESTATES LOT 7 Plan ID 9820425 SW,NW,23,29,19W inspector: Leroy G. Jans Municipality of HUDSON p Y kY County of St Croix (715) 726 -2544 Private Sewage plans including the following element(s): MOUND 450 GPD The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for compliance with all code requirements. This plan action is subject to the conditions listed on the following page(s). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department. All permits required by the state or local municipality shall be obtained prior to commencement of construction /installation /operation. This project is under the supervision of a state inspector. As inspection concerns arise feel free to contact the state inspector at the number listed. The inspector for this project is listed above. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when making an inquiry or submitting additional information. Sincerely, Gerard M. Swim POWTS Plan Reviewer (608) 785 -9348 SAFETY AND BUILDINGS DIVISION 2226 Rose Street LaCrosse, Wisconsin 54603 /sconsiI � • T«raW G. Mwmpson, Gomm Department of Commerce William J. McCoshen, Secretary Page 2 98 2 ®425 - A Sanitary Permit must be obtained from the County where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Ws. Stats, prior to installation. - Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Slats. • SBD-5524{ (R. 2W) File Ref: H:ISTANDARD PARAGRAPHS APPROVAL LETTER.DOC Page 1 of b MOUND SYSTEM 98 FOR A 3 BEDROOM RESIDENCE LOCATED IN THE SE" 1/4 OF THE "w 1/4 OF SECTION Z3 , T Z " L N, R L9 W , TOWN OF VNjsot,J , sr. COUNTY, WISCONSIN. :LOT 7 O F E V E RG ReL E L31 INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR ��t� -2D L W CRSSE RECEIVED S q o t I, MAR 2 R 1 998 SAFETY & BLDGS. DIV PREPARED BY WEGEE�ER SC3 I L TESTING a E�+se�a►�ee , AND 6 DES = Ghi S>ERV I CE 4 y`i+� ��••..��.�+�,. 4 P.U. BOX 74 421 K. SAIK ST. ti MgrxtraL. • WEGERER P.O.W.T S. RIVQ? U LS. V1 W22 ` s GER OfiTH. ELLSri Conditionally �` 4 _ i APPROVED �� ` � DEPARTMENT OF COMMERCE 4� ypry` ! v� DWISION OF SAFETY AN ILDINGS ``gEG5G8' 3 -1 - -9F1 1`4 1 141K EE CORFISSZ JOB NO. 3 Page Ur b Approved Synthetic Covering 19STM C 33 Distribution Pipe Medium Sand _ Topsoil F Ele *. O 3 . S p \ - 3 b y %Slope - . (Force Main Plowed - Trench of - From Pump Layer Aggregate Undisturbed D - Ft. Soil E X. L Ft. Cross Section Of A Mound System Using F b.S Ft. 1 Trench For The Absorption Area G 1•a Ft. A S Ft. H i- S Ft. B - 1 S Ft. I \S Ft. Linear Loading Rate= 6.Q GPD /LN FT J a Ft. Design Loading Rate= 0.3 GPD /SQ FT K 10 Ft. L c15 Ft. orce W 2- Ft. L Force F . B K Main 4 — ----- - - - - -- W i� Distribution Trench O f 2 2 Pipe Aggregate l Observation Permanent J Markers Pipe s ()Lnchor securely) f Mound Using Trench For Absorption Area 9 P Page Of b Perforated Pipe Detoll 0 End View Perforated End Cop) e�e� PVG Pipe 1 _ ��a aoce Install permanent at end of each lateral Holes located On 8ottom, Are Equally Spaced s it Q End Cap * PVC Force Main Distribution Pipe Lost Hole Should Be Next To End Cop Distr Pip La P 34.5 Ft. X 3 O o Inches Y 3 Inches Hole Diameter ��( Inch Lateral AL/ Inch (es ) Manifold Inches Force Main Z Inches # of holes /pipe \Z Invert Elevation of Laterals Ft. Place lst hole 1g from tee with succeeding holes at 3 6 intervals. Last hole to be next to the end cap_ " Combination Sept4ic;Tank and PUMP CHAMBER CROSS SECTION. AMD SPECIFICATIOUS ' PAGE S OF -.VEIJT CAP ' - WEATHER PROOF Ju1JCTI0IJ BOX i -(C.I. VEuT PIPC APPROVED LOCKING -" - -- MAUHOLE COYER tNlV 10 _.. FRO M 000 R. 4 wAtitultJ6 L.14gEt.. FRESH i OW OR R d UD A!K IUTAKE Dul MI s I _ • L — _ -- - - - - -- y�luS��17a►J AIPt PROVIDE -- . 1/JLE T TAIRTIGHT SEAL I I I 1 I I I I APPROVED JOIAIT: APPROVED JOIUT A I i l I W /C.I. ?iPEcitR'c W /C.T. PIPCOV'm Tank construction I i l ALARM shall comply with ILHR (83.15 and 33.20 a I I OIJ C CLEV. � FT. PUMP - -� OFF 0 LOAJCRETE tZ 8°►. O o BLOCK 5 3" AGPRo+�. RISER EXIT PE.RMITfCD OtJLy IF TAIJ M HAS SUCH APPROVAL 6EDOtN4 SEPTIC SPECIFICATIOMS f DOSE M1flVQE:J? l�1 pR_QP,� U UMbER OF DOSES: 3. S3 PER DAB TL1JK MA►IUFACTURCR: TA IJK 5IZC : 1oDo L 6SO GALLOW DOSE VOLUME r S • Zt�l1 S� S 11JCLUDi&JG 6ACKFLOW: 52) GALLONS ALARM MAIJUFACTURCR. MODEL ►DUMBER: �w CAPACITIES: A= �a IUCHES OR 30 GALLOIJ5 5WITCH TAPE: 8= IUCHES OR "I G( LLO{JS PUMP MANUFACTURCK: GOV L-Q S C = 9 IUCHE$ OR S GALLOIJS MODEL ►JUMBER: 38 � } t 05 0- INCHES OR � S 3 GALLOms SWITCH TUPE: W��1Z --1 MOTE: PUMP AUO ALARM ARC TO 6E 6 MIN IMUM DISCHARGE RATE Z g' GPM INSTALLED OIJ 5EPARATE CIRCUITS VEF DIFFERENCE DETWCEU PUMP Off A1,10.015TRIBUTIOU PIPE.. 1q FEET t MI I.IETWORK SUPPLY PRESSURE , .. . . 2.50 FCET + ASS FEET OF FORCE MAIN X Y F � FRICTIOM FACTOR -. Z. SD FEET 100 FC TOTAL OyIJAMIC. HEAD — 1\0I. FEET DIAMETER II Pump chamber IJJTERLIAL. DIMEIJSIOLI i Of TAIJK: LENGTH — ;WIDTH LIQUID DEPTH 3 $ _ BOTTOM AREA 231= GAL /INCH AS PER MANUFACTURER = ' 1' GAL /INCH Goulds Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • =erged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. ne oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems . dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms manual operation. Automatic Motor: and float switch attachment • EPO4 Single phase: 0.4 HP or , models include Mechanical points. •Heavy duty sump 115 230 V, 60 Hz, • Water transfer Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- Solids handling capability: automatic reset plastic Semi -open design 3 /; maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: u to 55 GPM. standard length 16/3 SJTO T P P � mechanical seal protection. SP• Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding - • ■ EP05 Discharge size: 1 1 /2' NPT. plug. Optional 20 foot (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic ennclosclos ed d Thermo- design for end in "F' or "AC ".) rotary/ceramic - stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. o I • Capable of running dry without damage to s 30 components. Pump: EP05 s i - • Solids handling capability: o z 2s i Y/' maximum. W -- — - - -- • Capacities: up to 60 GPM. x s 20 • Total heads: up to 31 feet. • Discharge size: 1IN NPT. Z s -- - -_ • Mechanical seal: carbon- rotary/ceramic- stationary, ° 4 1 s BUNA -N elastomers. o • Temperature: 3 10 104 °F (40°C) continuous j 140-F (60°C) intermittent. 2 5 1 F� 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m'/h CAPACITY 0 1995 Goulds Pumps. kr Effecdve May. 1995 I • y oo - - -�_ � .� ! � � � .� � zr o� � z r � /� � p �L SoGG�STL'> >c �! ►'J�2.1. �rJeRT�J � -� ' J � /� m i � � -� I . Bw1 - EL V3 . D aN Top ptPZ riv .Sb � i , b13�1R.8 `fY1'1S �-�A -L i i CM / �\ CL\ol \ / / \ S S' OF z PVC F-111. t Sir �I�AVC s . j l C�, } ,�- </ �o NOTES - 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each. lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. -Septic tank to be i 000 /6so gallon capacity, manufactured by 5. Bench Mark S2E tuVe G. Divert surface water around system to prevent .ponding at the uphill side. . s • Wisconsin Department-of industry SOIL AND SITE EVALUATION pa of `3 Labor and Human�Relaflons Division of Safety and Buildings in accordance with S. ILHR 83.09, Wis. Attach complete site plan on paper not less than 81/2 x 11 Inches in size. Plan must County n Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. pane! I. D. # PE.VD/a (T• - APPLICANT INFORMATION - Please print all information. Reviewed by Data Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ,I q f f (fi�'f1314/> `�N� l'p/t° Govt. Lot SOW 114 1/4,S 23 T 2 ,N,R / E (or)O Property Owner's Mailing Address E S T Lot # Block# SRbd. Name or CSM# 33Z N NN�soT h Sr h,�'K L�I/ERIriPEEiv EST TE'S City State Zip Code Phone Number Nearest Road //IV ! /L ST PAU L �1 Iti1�1 � 5101 � � 1 Z) 222 ' S S ss [I Itiu ❑Village Toe a r t /�E"GL y R D . UT' New Construction Use: Residential / Number of bedrooms 3 - L4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: 4Sv - �•- Code derived daily flow 6900 gpd Recommended design loading rate • 1 J � bed, gpd/ft ' •� trench, gpd/ft Absorption area required 50 d bed, ft 2 Sdt) - trench, ft 2 Maximum design loading rate T bed, gpd/tt - s trench, gpd/ft Recommended Infiltration surface elevation(s) ✓`' E Pi ' 3 ft (as referred to site plan benchmark) Additional design /site con ations/� /'- - o t,.0 v T YPE - S YS T - . Parent material :5C-3 O " / /�//o T S� 1 PA ; �elf' Flood plain elevation, if applicable / ft S = Suitable for system Conventional Mound I In -Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ s g'G [� S ❑ u [is C9 u ❑ s e El y-G ❑ s SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench �- x- 30 /o ,e SL 12` A(✓ 1W � Ground 3 - �3 / Y 7 • S slew. — /0 Z ; p Depth to i . / YR S�� 7 5 Vie y��t S . Q 5 /hit C 5 i • ? ' 'O r cttorg S 6- 7 /0 Y/e �/ z 3� 5 L l f ? In. 6✓E�I�Gy G�•�s T �it'�tb /p Remarks: Boring # I -i /a YR 31 - 2-- /fskt- ,,,,, s 2 Z IY-4 o VA 31 3 SL 17 3 . /,Y s o/ S. d e Ground J l0 6 A o S. f a 5 N elev. /oi. ft. / V/- SL d a s ;N Depth to limiting factor ZgIn. Remarks: CST Name (Please Print) Signature Telephone No. RO BERT - 24f:(3Ri C(T 7/.5 396 P 185 Address Date CST Number Nb /Z -/ Assoc iates � CSTW z y�Z Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 NA L PROPERTY OWNER y SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D.t G O Boring # [ 2— Depth Dominant Color Mottles Structure 2 2 in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots 0- /2 /O yw /3 LD s Bed ,Trench Ground •.� 60 elev. ,v Depth to CvE M { limiting factor Remarks: Boring # Ground elev. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # o , Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) r l3M Fd v.�p : T ogo v /" • P �f` N �. L o r co�PN ,v • L o r G- • /D 0, j 0 Low Ig - 7 s3 J • y� � 0 126 'yam a f / f a 1 G/ - 13, 30 EAST LOT- A rz �,:� E 6 E V A-T1 0115 0 C3 z , ►01.0 , B3 X0!•08 'p • 3 o f 3 — l � ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM r Owner/Buyer lC. g. Mailing Address _1 2. 7, c) 0 u ^� Property Address 7J (Verification requited from Planning Department for new construction) City/State 11 Parcel Identification Number LEGAL DESCRIPTION Property Loca t''" ' ?� 3 _ p rly n � � +, _�J�9 � +, Sec. , T�N R--LLW, Town of , fj -��a -•�✓ Subdivision -e A.5 i d Lot # 7 Certified Survey Map # Volume , Page # _. Warranty Deed # _3' d PVC 3 Volume 18s — , Page # Spec house ❑ yes B no Lot lines identifiable U ❑ 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. Fwe, 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 d the three ye p' 'on date. SIGNATURE O 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 perry describe bove, by virtue of a warranty deed recorded in Register of Deeds Office. l /Q SI NATURE c4KAPILICANT bATE * * * * ** 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 587453 VOL11,58 Phu 4.96 DOCUMENT rvo. WARRANTY DEED STATE BAR OF WISCONSIN FORM 2-1982 i� Humbird Land Corporation, a Minnesota Corporation i FE......... .......... ... ....................... .. .... . CROIX CO,, W1 • �ac'J c, ;r Ryrrr� ... ............... ..... � 98 119 cunvo,ys alld warr:ults to .. ..Ri allaxd.. W... LaCas.S.2 a =3 C) _ P .............. - . ....................... ......... ...... .. ... ... ... .. .. ... .... RETURN TO -- v Ga �caZx a 17 -e- the following described re:ll estate in .........$ x...C.rA1X ..................... ...County, — State of Wisconsin: Tax Parcel No: ... . ....... . .................. � C of , Evergrgen Estates, Town of Hudson, St. Croix County, Wisconsin TR F This .... s not .. homestead property. (XsKy( (is not) Exception to warranties: Easements, restrictions and rights-of -way of record, if any" Dated this .. ...... 8 th . .............................. day of ........... .. Se p tember ......_... .............................., 199$., ,.. ..... • - ..(SEAL) HUMBIRD LAND CORPORATION (SEAL) ................................... . ............................. * By- i.._...... - ........_......_.........._.... Austin J. Baillon, Its President ................ ............................... .....................(SEAL) .... I . ........................................................... (SEAL) * . . AUTHENTICATION ACKNOWLEDGMENT Signature(s) ..................... . .. ............................... ..... STATE OF RDpxEOfJlNSM MINNESOT ss. Y • ... ......... .. .............County. audienticated this ........day of ........................... 19...... Personally came before me this .... $tb ....... day of September ___._ . 19.98... the above named Au sti of ".............. - •.• ................... . ....._.._ Humbi.rd._Land Corporation TITLE: MEMBER STATE BAR OF WISCONSIN .......................................... .............................•-----..__.......... ...•- --- -•........_............ (If not, ....................................................... authorized by § 706.06, Wis. Stats.) to me known to be the person ............ who executed the fore / oink instrum e en n j t j PAULA. THIS INSTRUMENT WAS DRAFTED BY / / O S SAIL�.ON t o (i(�f11^, �Y v1i��{ PuiJ ✓.:. �+i'_'j r ��T.. '> .. . Humbi rd Land Corporation "-"""'-'• "" °-••-•- ............•------ •- •• - -••• p 11' ASHII *rM1J ' ..... i ._;ybj. Cosner ..:xa::ws.l�t:t,•3�,::'��:vy•.. .....•.._.......- -••- •-•--- ........................ Notary Public ..Wa. *h .. t 1!�ilCi .MN (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) Januar 31 *Names of persons signing in nny cnpncity should be typed or printed below lhrir sirnatures. L i IN VOL. 10 _ PG 2807 62'2 I S01 °3102 "E - -- -- - 07 14-22' W AY "12" Y -- N89 ° 26' 40 "W 262.36' M 660-Cd - N PUBLIC M 384.84 0 v 0 0 .................. ................................... ............................... LEC ALUM FOUNC 3 LOT 5 � I" I R( 3.20 ACRES ry a 139,295 SQ. FT, 0 LINER co P NOTE o rOh ~ I O �` 0 5� ,��°� • J - - 12 W N LOT V ROAD) DRAM LOT 6 ti - rHL l OENO' `. 3.06 ACRES U PRO 133,103 SO. 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