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HomeMy WebLinkAbout020-1334-10-000 A ST. CROIX COUNTY ZONING DEPARTME AS BUILT SANITARY REPORT RECEIVE& Owner S �4 /11 1' (L Fr'L C 1 � - ! sr c 199 Addr e ss (� 10� ,e y / � � � L F L lF1 IV � aotx City /State d L2.n -SnA( w 1 - - y f o ( 4IN OF Fne Legal Description: £� �2� Lot d 1 Block - Subdivision/CSM # ,? /1Ly L,4 AlJ) 5 PeA41 Ie l E '/4 U/' /a , Sec. - .-- - ? ,TAN -RAW, Town of Hu'�:�.. C+ N PIN # - 2 -/3 �I -14) - S'ErTIC TA -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer W Lf (L. Size ST/PC ( ' / Setback from: House 3 Well 75 P /L - -::� S Pump manufacturer Model Alarm location -- (HOLDING TANKS ONLY) Setbacks: Service road - Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: F ( r;T P igo, , z .Width 3 / Length S7,, 2 5 Number of Trenches Z- Setback from: House Well �. 0' P/L e- - 7 ' Vent to fresh air intake ELEVATIONS Description of benchmark 7-6 P 0 l aC � &uo b - T o +1a Elevation 10 010 i Description of alternate be nchmark - 1"0 P 144 )1 H-61 -E 4r ✓f fZ_ '/, 2 Elevation a Building Sewer ST/HT Inlet 3 S Outlet lO. PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover y 2 Z ' Distribution Lines ( ) $ Z = y �() �`6 , 8 2 _ Bottom of System ( ) d • SS� ',� 7 O �n = 3' ( ) Final Grade Date of installation 1 SI Ik Permit number ZD 2 S State plan number Plumber's si nature 1. .e ,�_ License number S •O Z,Sva Date Pa //7 /9 � Inspector khfj-�(& Complete plot plan Or 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 i S R LF ) If f o Q =A ( r c 7 fej476 R i Ll �eRGE. i — 'r► T 3q , 1 A L vT To a • tTF4.t T,e 1 INDICATE NORTH ARROW I i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count ' Safety and buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Pers(mal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 320256 Permit Holder's Name: ❑ El Village Town of: State Plan ID No.: MILLER, SAM H UD SON CST BM Elev.: Insp. BM Elev.: BM Desch do : Parcel Tax No.: - e , 1 � 020- 1334 -10 -000 TANK INFORMATION ELEVATION DATA A9800445 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Bench ark - Z_ (p3 I to Dosing ,__-_ _ ---� 3 Aeration -- - ----- Bldg. Sewer Holding �___ Wit / Ifx Inlet �� 9 .Z2 TANK SETBACK INFORMATION W)tt Outlet 3 -72 TANK TO P/ L WELL BLDG. Air ir l to ntake ROAD Dt Inlet ----- Septic - _7S_ _34 NA Dt Bottom Dosing NA Header / Man. •� Aeration NA Dist. Pipe �f �7 t�• 72- Holding Bot. System (p, jS r'J V'7 PUMP/ SIPHON INFORMATION Final Grade ��. 2— Manufacturer — Demand � jy] 7Z- Model Number �"7 GPM TDH L H Ft ead Forcemain Len Dist. To we SOIL ABSORPTION SYSTEM BED / TR NC Width 1 Length No_ Of Trenches PIT No. Of Pits In ep DIME ' t Z DIMEN 1 N E CHIN rer. SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM CHAMBER ` �- , ® 7 n ' INFORMATION Type O r Model u ber: System • 3 ! L Lt4l"I' C DISTRIBUTION SYSTEM Header/Manifold rr Distribution Pipes) 0 x Hole Size x Hole Spacing Vent To Air Intake e l Length _ Dia. Length �l�' � ) r3+eC Spacing �., SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over De th - - -- xx Depth Of x /Sodded xx u c e Bed /Trench Center - Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 27.29.19,SW,NE 665 RED MAPLE LN– BADLANDS PR LOT 21 Alf. ► (O 6tb I/l,46 -w (,mrtA_ r� (Z'Ib•`l Plan revision required? ❑ Yes M No - I+ Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Ce o. SANITARY PERMIT APPLICATION Safety and Avenuen Vi sconsin 2Q1 W. Washington In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • 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. • See reverse side for instructions for completing this application State Sanitary y Perrmit O Number Personal information you provide may be used for secondary purposes cneck if revlsTon co ap ccacion (Privacy Law, s. 15.04 (1) (m)]. /_ (.(l Ki — P 5 pf4 lA "/ mcwi p h p (I( �/ f 5 tate Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATI N Pr e y Owner a ropert Location �� /� I-L -F& I t /4 114, S 7_7 T Z41 r N, R 19 E( W P ,L�sQ�p erty Owner's Mailing Address Lot Number Block Number Q �T * /' L Ci State Zip Code Phone Number Subdivision Name or CSM Number 11. TYPE OF BUILDIN : (check one) ❑ State Owned o Ity Nearest Road Public 1 or 2 Famil Dwellin - No. of bedroom o T ow a g OF 1� SQ w/L F SP III. BUILDIN SE: (If building type is public, check all that apply) Parcel Tax Numbers) A ^�. ��• , -7&1 1 C] Apartment/ Condo ®Z O _ /33 9/—/o OC 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 _______ ExistingSystem B) A Sanitary Permit was previously issued. Permit Number Date Issued _ ?i 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 l216seepage Trench :S joe lu) ID 22 ❑ In- Ground Pressure A 1 42 ❑ Pit Privy 1 ff❑ Seepage Pit 56 /NFILT*ATo& i 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 f 5 ,,� Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation `j SG0� S 7 � q 3 d Feet 99 1,0 Feet VIVII. Cap act TANK in lions g Total # Of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank 0040 Wr I to ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1131 1:11 ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: oStam s) MP /MPRSWNo -: Business Phone Number: Plumber's Address (Street, City, State, Zi Code): O C3 l0,11F ROA0 t4 u"oN w' � ,r Gil IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Iss ng A t Si n ture (No Stamps) Surcharge Fee) P Approved I n Owner Given Initial ( � Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398(R.1U97) DISTRIBUTION: Ori final to County, One co PY To: Safety &Buildings Division, Owner, Plumber II I 9 Y L Safety and Buildings Division � �• - SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue �v�scons�n I n accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 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. 9 Cvd • See reverse side for instructions for completing this application State Sanitary Permit Number 32C� Personal information you provide may be used for secondary purposes ❑ 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 RMATI N Property Owner Name Property Location �I 1 ! t L j 0 /a ffi 1/4,S Z.7 T2C/ ,N,R E( W Pro erty Owne 's Mailin Address Lot Number Block Number 4D r/ / City State Zip Code Phone Number Subdivision Name or CSM Num r G 11. TYPE OF BUILDING: (check one) ❑ State Owned 3 It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms o viollag OF#u S0A/ r III BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo a Za ~ / 3 1 /U 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. E] Replacement [3 Replacement 3_ Replacement of 4. Reconnection of S. Repair of an ,_�ystem ________System - __ Tank Only______________ ExlstingSyst - E --- -- - stem 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 TZSeepage Trench 22 ❑ In- Ground Pressure , / 42 E] Pit Privy /� st 3 7 43 Vault P 13 E] Seepage Pit L7' / NF 'RCS T' S ❑ Y 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. 1 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) , Elevation { ISO - 7� 3 - 4 9 Feet � S Feet VII. TANK Capaclt in gall Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks I 1 , ==F - pticTan rRflid4wg C>O i W ❑ 1:1 0 1 : 1 1 : 1 Lift ' Pump /Siphon Chamber El ❑ ❑ El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: o Sta s MP /MPRSW No.: Business Phone Number: Plumber's Address ( treet, City, State, Zip Code): 04n 0 v a� u � �t r. ( �J W IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Agent Signature (No Stamps) Id A roved Surcharge Fee) , pp ❑ Owner Given Initial l QED �� Adve Determina O ZW !�E/ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: V e SBD- 6398 (11.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber �,� N - - -�� �t��11 IY� rL.� �i2 13AD��N�S t'RA►� �� I LOT' 2-1 X 57 2EQ fi?#ejf 1,441,r f 7 X a 2 v- 13 fi-) SCALE lly_io' ID ay 5 *f F— L �. a3 % CP O oL S� J �. _z�` R► �. yo � 4 N i LoT At ? J N.1. �k N n t, Q t , h 55� 4 v w GIs L , J� �1 w ri - ?IJ 7 7 VI w :3 iN rn Y $ CD 0 a m O 0 0 te /��' �j T in N +G \V .� s O a V �� 00 8 " '`� 0 �� n O � Q CO n . CD � V t0 p � „ o f _ 0,w �' z • Q, mz S Q < ^ . zi N on 00 w l JJJ ' rn $ 3 a� m 0) N ^ CD tA I? ] T \ 5 J ` rr • Y 8 �{ 1 1 i l YYY � / V v co rn cx QL H S ]� 0 N •� °-0 1903 c. C: o ': CD o< N 0 (Q d C = Q C 0 (p w CD CD 3 to rn N `c _. O (JA _ � n � o CD w m � m r (7 3 n (D = C . « Cn x ` w E < a?0 � ti r b X CD cflo�mO° -0� a c CL CD °' ° CD ° i 3 _ N P. . N 'p W 'p CD N W x (D CD < `�G 1 N v 0 N Q W � -�Ul O G .� Q N _ 6 rn ' x .� y w j a 3 m w ° a CD ° °� a r,, Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page _�_ of Bureau'of Infegrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 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. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 114 , &C 1/4,SV? 7 T q ,N,R /,�r E (or Property Owner's Mailing Address Lot #/ Block# Subd. Name or CSM# / / City State Zip Code Phone Number ❑ city El Village [y Town Nearest Road New Construction Use: Residential / Number of bedrooms 3A Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: / r gp 6 66 Code derived daily flow dd Recommended design loading rate ' bed, gpd /fi , � trench, gpd /ft Absorption area required ft trench, ft Maximum design loading rate bed, gpd /ft 9 trench, gpd /ft Recommended infiltration surface elevation(s) � � ? eT ft (as referred to site plan benchmark) Additional design /site considerations Parent material �_. Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U I 9s ❑ U ® S ❑ U Os ❑ U ❑ S 5� U [Is �4 U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 2 - d Vf V-1 r` S l / . 3_� Ground / / 5 �- ta 41 r/ - elev. C 5 I? Z l . Depth to limiting factor (� ® in. Remarks: Boring # G S !n W-/ i ?4_ - ' ' 6 G S Ground fi f e Depth to limiting factor in. Remarks: CST Name (Please Print) - Signature Telephone No. Address Date CST Number /s2c� S c� I✓ a7v SOIL DESCRIPTION REPORT PROPERTY OWNER Page :� of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench C / / �i' Ma A k In /i' C S Jn . S - ti /� �' �S 1 hi Ground elev. ' Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # i ........................... Ground elev. ft. 1 Depth to limiting factor +n ' Remarks: Boring # Ground elev. ft, Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) 0 AesT, N ea.vsTpw � % 133 ,,� /-I ow D d� Wisconsin Department of Industry SOIL AND SITE EVALUATION fLaMor afid Human Relations Page - 4 - of -3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference int BM direction and � ( ). St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # OJ O- 10 o APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for seconds cy Law, S. 15.04 (1) (m)). Property Owner \ Property Location Richard Stout Govt. Lot SW 1/4 NE 1 /4,S 27 T29 N ,Rl g Xk(or) W Property Owners Mailing Address Lot # Block# Subd. Name or CSM# 1353 Awatukee Tra 21 Badlands P rairie City State Zip ng rb m r Nearest Road [. �.� ❑ City ❑ Village Ej Town i Hudson WI 5 0-1 (7 �$kt9- 7 "T Hudson jHill Farm Rd 'o i ER New Construction Use; ®Re 'rltihl Number Qf s 3=4 Addition to existing building ❑ Replacement ❑Public cner a I e: Code derived daily flow _ gpd Recommended design loading rate bed, gpd/ft gpd/ft Absorption area required $ $ bed, ft2 7 54 8 trench, ft2 Maximum design loading rate —7—bed, d/ft g g 7 gp .$_ trench, gpd /fi Recommended infiltration surface elevations) ft (as referred to site plan benchmark) Additional design/site considerations Parent material _ r 1 1 -a-c i a d p S i t Flood plain elevation, if applicable ft S = Suitable for system Conventional I Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system [Is ❑ U [ks ❑ U [X s❑ u [� S❑ U EIS U U EIS g U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots Bed ,Trench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 1 0-12 10 r3/4 none sil 2mabk mfr Cs 2m .5 :.6 2 12 10yr4/3 none fs lfgr ml Cs if .5 '.6 Ground 3 52- 8 10yr4/6 none ms osg ml Cs -- .7 .8 elev. 92 .07-- -tt. Depth to limiting ; factor - - -- - - - -- 9 8 in. Remarks: Boring # 1 0 -14 10 r3 4 none sil 2mabk mfr Cs 12m 2 2 14 -43 10yr4/3 none fs lfgr ml Cs if .5 .6 3 43 -91 10yr4/6 none ms osg ml Cs -- .7 .8 Ground efev. 9 4 Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number Z '9 92 ?99e .� ?ROPERTY OWNER R i Cha rr3 Stnttt SOIL DESCRIPTION REPORT 2 Page of 3 PARCEL I.D.# 3oring # Horizon Depth Dominant Color Mottles Structure 2 Djft in. Munsell Qu. Sz. Cont, Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed .Trench 3 1 -11 10yr3/4 none sil 2mabk mfr s m .5 .6 2 11 -4 9 10yr4/3 none fS lfgr 1 CS 1f .5 -.6 around 3 49-931 10yr4/6 none ms osg M 1 C s - .7 .8 'ev. 9 5.9.0- it. )epth to imiting actor Remarks: 3oring # 1 0-16 10yr3/4 none Sil 2mabk mfr Cs 2m .5'.6 2 16 -45 10yr4/3 none fS 1f9r ml Cs if .5,.6 4 3 45-96 10yr4/6 none ms osg tol Cs -- . 7 ' . 8 ;round alev. 97 Depth to imiting actor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 1 0-14 10yr3/4 none sil 2mabk mfr Cs 2m .5 .6 5 2 14-43 10yr4/3 none fS lfgr ml Cs if .5 .6 3 43-91 10yr4/6 none ms osg nil Cs -- .7 ..8 Ground 9 3el'et ft. Depth to limiting factor 91 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) ., �� � a foGCP.p , ��t/,�..c�� P9a v � � �� �� � �� �� d � �� �� Sr o � �� d .. . ,�' � � �� � j , �-' � ��� � r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A M I L.LS %, Mailing Address _ e /.r J Property Address rO ( 0 S R I M (Verification required from Planning Department for new construction) City/State H V O,?o N L Parcel Identification Number 24 - 3 LEGAL DESCRIPTION Property Location J U) '/4, NE ' / a, Sec. —*� '? , T -�- ? N -R / W own of / 4,)P V W Subdivision $1x17 L A RD 3 -'� k ok 1 (t «.., Lot # �- Certified Survey Map # S" Cn 10 t Ce , Volume , Page # t Warranty Deed # -45"S 0 / / ( , Volume 3 2 " , Page # 44 Spec house yes ❑ no Lot lines identifiabl y yes ❑ 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 wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. A F A LICANT 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. SIGNATURE & AP1 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 ' pp STATE BAR OF WISCONSIN FORM 2 — 1982 Sov11 WARRANTY DEED DOCUMENT NO RICHARD n STOUT JUN 02 1998 j 8:30 A I conveys and warrants to SAM F ptlTr r >~ u It, j � ; � Re t>thr al DNds �i ii I I , !' THIS SPACE RESERVED FOR RECORDING DATA j� NAME AND RETURN ADDRESS !! the following described real estate in Sf County, Z5 m if State of Wisconsin: t oo 40 11— Lots 18 and 21, Plat of Badlands Prairie, I NvOsow Town of Hudson, St. Croix County, Wisconsin. if - 1 i t PARCEL IDENTIFICATION NUMBER i . I it TR J lSFER $ �r7 li FEE l l I .I i �i This ; S not homestead property. (is) (is not) ! '.I Exception to warranties: easements, restrictions, rights -of -way and covenants is of record, i f any. if 'I I : Dated this 211th day of May , A.D., 19�$_. : I f Richard O. Stout (SEAL) (SEAL) s Q r • I� j (SEAL) (SEAL) it �I AUTHENTICATION ACKNOWLEDGMENT if II Ij Signature(s) State of Wisconsin, (i SS. li St. Croix County authenticated this day of , 19 Personally came before me this 20 day of Maw 19 9 8 , the above named $i r_ha rr9 n S.t TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) ��► • <Y * .: to me known to be the person who executed the foregoing `�► •`; # instru nt and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ..1 rJ/ AAn „, ;„- Janet P. Stout v��""�` 1353 Awatukee 7' A �. Virginia R. Gartman Hudson, Wi. " 0 Notary Public, St. Croix County, Wis (Signatures may be authenticated or acknowle : BBtl" ggr� 4 t�$a,_ My commission is permanent. (If not, state expiration date" necessary.) , ,�.r ►*''`` January 30, 2000 2t4t ) Names of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED Form No. 2 — 1982 Milwaukee, Wis. II _I ST. CROIX COUNTY �- WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715 ) 386 -4680 January 5, 1999 First Federal Attn: Tammie Hudson, WI 54016 RE: Septic Inspection for Sam Miller located at 665 Red Maple Lane, Lot 21 of Badlands Prairie, Town of Hudson, St. Croix County, Wisconsin Dear Tammie: A septic inspection of the above referenced property was conducted on October 15, 1998. This property is located in the SW' /a of the NEI /a of Section 27, T29N -R19W, Lot 21 of Badlands Prairie, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sin rely, Plod Esiinger Assistant Zoning Administrator /sm i v � a x a �E41tR 'w� I I ` � $ X f. a 4 EIS E$ a ( I �4URYM[e 4. Pfi 862.J a 1.. T T o f�° LOT 6 "!I L 7 x I LOT , �1 LOT 3 I LO 2 d LOT ._ � o - o �� °� � y —o F L1— o � � ! 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