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Home My WebLink About020-1334-30-000 ST. CROIX COUNTY ZONING DEPARTMENT RTMLN AS BUILT SANITARY REPORT Owner -Sift W1 11,i I L- L /L Address L teF- L &t 1`'L � t../9N City /State U D3 a q Legal Description: Lot 2 _ Block — subdivision/ # 4Z L - S PQ,4 ► / '/, ' - 5 0 ) %. ,Sec. �, T L/ N - R�own of 14 ,� ,b d �/ PIN # 3t!- -'" SEPTIC TANK DOSE CHAMBER -- HOLD . Y _ � Y ING TANK INFORMATION. Tank manufacturer (A- F Size ST/PC IWO/ Setback from: House 17 Well 01 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: B b Width r Len Y'� � Number of Trenches Setback from: House � ' gth — Well q', P/L z5 Vent to fresh air intake IF ELEVATIONS Description of benchmark IF, $ Qmc� tA ca )u► T 41: r- r / �► ' 3 � S � Elevation ( 0 0#0 0 ' Description of alternate benchmark /'' S E -en(e,41- OC.41.:r rDS' 4 1 /Stlevation 9-f s Building Sewer ST/HT Inlet g� Z I �� S •�q ST Outlet V n gf �� g , (v6 PC Inlet PC Bottom Header/Manifold � C� f % r 1 " T p of ST/PC Manhole Cover `{ ` `� = `, r f Distribution Lines Bottom of System () Final Grade () e , L/ 0 Date of installation S t y Permit number 3 7 State plan number '^ Plumber's signature -14 t titi l�a cu License number P P- � "C Z tOD Datel' /2479 Inspector ,I - complete plot plan •� � c 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 3•' S C A LE) 25 f L_oT - 4 Z - 3 V V } w INDICATE NORTH ARROW i J Asconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County:ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary?U71fp®: Personal information you provice may be used for secondary purposes [Privacy Lap[, s.15.04 (1)(m)]. 1 rmit E er s ALame. ❑0i t E] Town of: State Plan ID No.: CST BM Elev.: SAM Insp. BM Elev.: BM Description: Parcel T&MI. 13 34 - 30 - 000 TANK INFORMATION EL VATION DATA A9800160 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3.50 / OrOU Dosing 7, �,S Aeration Bldg. Sewer Holding St/ Ht Inlet S TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet Air Septic S$' y 6 ' Z ' 'o75,' NA Dt Bottom Dosing NA Header/ Man. / 0, 7!3 qa•. S Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 12, 94,0 Manufacturer Demand Model Number GPM TDH Lift Lrictio System TDH Ft Forcemain Len Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED /TRENCH TREN H Width r Length No. Of Tenches PIT No. of Pits Inside Dia. Liquid Depth DI DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of a , b CHAMBER m od el Number: System: y= OR UNIT DISTRIBUTION SYSTEM Header/Manifold 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 67) Bed /Trench Edges l'. - ��` Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 27.29.19,SW,NE 669 RED MAPLE LANE J '6 Plan revision required? ❑ Yes [�f Use other side for additional information.( SBD -6710 (R.3/97) Date alr4 ecVr's Signature Cert No. • r Safety and Buildings Division V` \LRR SANITARY PERMIT APPLICATION Bureau of Building water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 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. .5 4. -Crd 1 • See reverse side for instructions for completing this application State Sanitary Permit Numbe 3077(70 The information you provide may be used by other overnment agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)1. / _ / n on y ]Q („Q (.�' 7 Rod �WU �YIwa �/'��v�SJ �`^? ," �`✓ State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name � Location _9A Al (ll -��L �'W 1/4 Nr 1/4, S T 2 , N, R /19 E (°<.:.:-) Property Owner's Mailing Address Lot Number B lock Num ber o " :- / z-3 City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ V ❑ Cit illage Nearest Road �(� P ublic 1 or 2 Family Dwelling 1',JS - No. of bedrooms � Town of � C E!7 l dt fe Z}1 III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) /� 7 � q . 2, 1 ❑ Apartment/ Condo ®10 _ 133 QaC 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 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 1 1 Seepage Bed 21 Mound 30 E] Specify Type 41 ❑ Holding Tank 12 11 E] 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 S� Required (sq. ft.) Proposed sq. ft.) (Gals/y /sq. ft.) (Min. /inch) 91 Elevation `�/3 7 r— � Feet qSk Feet VII. TANK Capacity in allons Total # of Prefab. Site Fiber- Exper. g Manufacturer's Name Con- Plastic INFORMATION Gallons Tanks Concrete steel lass A New Existin strutted g PP Tanks Tanks Septic Tank or Holding Tank Y IC00 F 11-S F_ $Z-- D? ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ ❑ ❑ ❑ 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: (No Stamps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): Ill 0 70 9 Q 0 T g 0 R LObS O N WI ,S" l IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa "tary Permit Fee (ndudes Groundwater ate Issued Issuing Ag nt Sig Surcharge Fee) 7/7 Approved ❑ Owner Given Initial Adverse Determination OIs X.. C ON S APPROVAL/ 5 ��.C¢d/ O Gt�( /!/I dZJ�- SBD -6398 (R. 0 DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber f7� o ^ �► `. Z t CN IN 4 i t _._-, --- e ^lf m I ------------------ o; I I I 1 o ( T lu m I I I I w 0) rn w I � I . I � �- � �v I 1 ch L v 1 0 w { Z °d to i m 1 f� x o �, O 0 co 0 F m x g J 0 cn 7 O m Z � 0 �� 4. E Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page -L— of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and .54, percent slope, scale or dimensions, north arrow, and I 3 e to nearest road. Parcel I.D. # b APPLICANT INFORMATION - P/ p nt aH i�Qrma " Reviewed J by Date q Personal infomration you provide may be used for ry pur law, ,ts.. (t) (m)). Property Owner S J MA 7 1 t_ vt Lot S 1/4 /UE1 /4,S a Td I N,R (Dor) W Property Owner's Mailing Address S T CROIX t # I Block# Subd. Name or CSM# n s UNTY ?QNI . 3 1 1 BaciforI&S " City State Tip Code le Number ❑ City ❑ Village Town Nearest Road N New Construction Use: Residential /Number of bedrooms 3 Addition to existing building Replacement / ❑ Public or commercial - Describe: Code derived daily flow lOd y gpd Recommended design loading rate ° 7 bed, gpd* -- trench, gpd/ft Absorption area required bed, ft 7,1 U trench, ft Maximum design loading rate / - 7 bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) q/1 7 ft (as referred to site plan benchmark) Additional design/site considerations Parent material / Flood plain elevation, if applicable it S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system s❑ u Ef s❑ u ® s❑ u 0 s ❑ u ❑ s 5a u EIS P U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/112 13 1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 0- 3 /0 S/-. ma,b f— L S I 'r., 3-I'{ 16 r /& 5 1 mc l ' CS I — ,7 ;, Ground 3 N //) l0 r 4 1 �- (Yl CJ S � Yrl � II a e��ft. Depth to limiting Q�pr (U in. Remarks: Boring # 0 - /o l� 5 makk v- r" S l 2 vi f ma b< rr uTr1 CS 6 -11 to r q4o ---- -- rn S vn Ground elev. 7IL -y�• Depth to limiting factor Remarks: CST Name (Please Print) Signaboi Telephone No. Ado y r, S iKoc ker .5 - 3 �zi Address Date CST Number Gr/ S j 1: 7� �� r _ SOIL DESCRIPTION REPORT PROPERTY OWNER Page 4— of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GVptft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 0 -G Iv r SL Im L m-Cr Ground elev.� Depth to limiting factor �[Qin. Remarks: Boring # fS� to �' /( W✓ t CS _ w Ground elev. 9 S'l fi Depth to limiting facto �in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. n Bed ,Trench Boring V# f 0 to� r CM � 2 L ►�'t -� � � l -I- 3o C_S 7 = f Ground elev. k,7Un Depth to limiting M n. i Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) 2 a. _ sw F11,V 5 - -A za — rkwor k GeV /OV` Oe vy�s �r y/i I� ,G I ! aq d3 G � , a�- (yn� Wisconsin Department of Commerce ' Safety and Buildings Division PRIVATE SEWAGE SYSTEM County CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarMecfr t-h-: Personal information you provice may be used for secondary purposes (Privacy IT, s.15.04 (1)(m)]. ,WE t�*er's [kftA#Ilage ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T(?L"13 34 -30 - 000 CST BM Elev-: Insp. BM Elev.: _ T TANK INFORMATION ELEVATION DATA A9800061 TYPE MANUFACTURER CAPACITY STATION BS Hi FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht O t TANK TO P/ L WELL BLDG. Ventto ROAD Dt I Air Intake Septic NA Bottom Dosing NA /.Header / Man. Aeration N Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Sys rn TDH Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYST BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTO TO I P/L I BLDG I WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type CHAMBER model Number: Syste OR UNIT DISTRIBUTION S STEM Header / Manifold Distribution Pipes) 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 Ce r Bed /Trench Edges Topsoil [] Yes []No ❑ Yes E] No COMMEN S: (Include code discrepancies, persons present, etc.) LOCATION: UDSON 27.29.19,SW,NE 669 RED MAPLE LANE Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3197) Date Inspector's Signature Cert. No. Safety and Buildings Division V•is.'■'■ SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County r A than 81/2 x 11 inches in size. Cfb • See reverse side for instructions for completing this application State Sanitary Permit Number (072, 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 I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location A"A k/1 /4 1/4, S T , N, R 1 E (0 jVD Property Owner's Mailing Address Lot Number Block Number 23 City, State Zip Code I Phone Number Subdivision Name or CSM Numb . TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cit llage Nearest Road ,! ,� Public 1 or2Famil Dwelling E3 Vi - No.ofbedrooms own of iJI��N E�MAQILE 1 III BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo 0 t.3 3 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 Ip1 New 2, ❑ Replacement 3_ E] Replacementof 4_ E] Reconnection of 5 E] 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 E] Specify Type 41 ❑ Holding Tank 1 Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 1 ❑ 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. Pert. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation "1 s-o o , - 1' 74,00 Feet 100 Feet VII TANK Capacit INFORMATION in gall0 S Total # of Prefab. Site Fiber- Plastic Exper. Gallons Tanks Manufacturer's Name concrete Con Steel glass App. New Existing strutted Tanks Tanks ptic Tan n I a (OO 0 E 1 ❑ ❑ 1 ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ 1 ❑ 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) Plumber's Signature: (No Sta ps) MP /MPRSW No.: Business Phone Number: ®CJ N1 IM %. °r l2 5-03 fQ a S'- kG °F1 (09 Plumber's Address (Street, City, State, Zip Code): " 0 7 0 li ^rt,CM1 k1bGe R v O IX. COUNTY / DEPARTMENT USE ONLY E] Disapproved Sanitary Perm Fee (IndudesGroundwater ate Issue Issuing Agent Signature (No Stamps) Approved ❑ surcharge Fee) L� 9 Owner Given Initial � �/I1 �� 8 4xio Adverse Dete rmination oV X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: �' SBD -6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety 9 Ruil,lings Dive ion, Owner, Plumber I ��p G � ,�, t.�' fi ► 2 E 1a-? - rA x p ?,q - s y .sTENI F- 5c. .00 /11 _' jJ n-i ,#; /2 -- - Q3 S , bcp G Asr" lwr •LEA E z yG. r . I 1 +0 LJ S E sg' s , 2; �y �52� 14 1 T NA '^ Go 72.3 n � v 0 h IV r 0 O tl. , H s +� w i z i N LL Rk Z I i I ' I Q C}- Z ' n. I o I � � W `f V) LLJ tu I I cm �, I V) LL -� • WisconAn Department of Industry SOIL AND SITE EVALUATION I- aboreand Human Relations Page 1 of 3 I Divisibn of Safety and Buildings 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. # 0a — /U ? y— '10 APPLICANT INFORMATION - Please prin 71 �►P Reviewed by Date Personal information you provide may be used for seco Property Owner �+ (� perty Location Richard Stout �� . Lot SW 1/4 NE 1/4,S27 T 29 N.R 19 X (or) W Property Owner's Mailing Address c. ; ��9 LoT Block# Subd. Name or CSM# 1353 Awatukee Trai j 'r, ? � lX '� Badlands Prairie City State Zip Code Phone Nuc GBVN F�C� City ❑Village Town Nearest Road Hudson WI 5401 ` (%71, 5 ��13 7' /Hudson i Hill Farm Rd -t ® New Construction Use: ® Residential / N 1 + 'PrDf' d ce 3-4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 0 0 gpd Recommended design loading rate 9 9 `'L — bed, gpd/ft . 8 trench, gpd/11 Absorption area required 858 bed, ft 5 0 trench, ft2 Maximum design loading rate - 7 _bed, gpd/ft� - 8 trench, gpd /11 Recommended infiltration surface elevation(s) 96-4 ft (as referred to site plan benchmark) Additional design/site considerations Parent material Glacial de Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system US ❑ U U s ❑ U f7 S❑ U I W S ❑ U ❑ S ®U ❑ S E] U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structur e 9 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots GPD /ft2 Bed ,Trench 1 1 0 -10 10 r3 2 none sil 2mabk mf r cs 2f .5�.6 2 10 -36 10yr3/4 none sl 1mabk mvfr cs if .4 Ground 3 36 -88 10yr4/6 none ms osg ml cs -- .7 ; .8 elev. 98.8 ft. Depth to limiting factor – 118 in. Remarks: Boring # 1 0 -6 10 r3 2 n one _ sil 2ma bk mgr cs 2f .5 .6 2 2 6-1 10yr3/ none — sl 1mabk mvfr cs if .4;.5 3 18- 10yr 4/6 no ms osg ml cs -- .7..8 Ground elev. — - - - -- 99.8 ft. Depth to – - - -- - - - - - -– - - -- - -- — limiting factor 9 0 in. Remarks: CST Name (Please Print) Signature Telephone No. m c�`l� _ 7l S� 7 pe Address Date CST Number r r IROPE OWNER _Richard Stout SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# 30ring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 1 0 -8 10yr3/2 none sil 2mabk mfr Cs 2f .5,.6 2 8 -48 10 r3/4 none sl 1mabk mvfr Cs if .4'.5 around 3 48 -89 1 0yr4 /6 none MS osg ml Cs dev. -- .7 , . 8 10 0 off. )epth to miting actor 8 9 in. Remarks: 3oring # 1 -1 1 r3 2 none sil 2mabk mfr Is 2f :_6 4`. 2 10-48 10yr3/4 none sl 1mabk mvfr Cs if .4 ..5 3 48- 1 10yr4/E none HIS osq ml Cs -- .7 '.8 ;round lev. 10 0_4 ft. )epth 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 -6 1 0yr3 /2 none sil 2mabk mfr Cs 2f .5 ' . 6 5 2 6-18 10yr3/4 none sl lmabk mvfr Cs if .4 .5 3 . 18-84 10yr4/6 none ms osg ml Cs -- .7 ;.8 Ground elev. 103.5 ft. Depth to _ limiting factor R 4 in. Remarks: Boring # Ground elev. h. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) I vc aT a � Ai n ' 0. a 'Ya y T F ^` � GT�a c ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer IM t LE Mailing Address X I ! Property Address q , k' . i /- N (Verification required from Planning Department for new construction) City/State JQ Wb N W Parcel Identification Number LEGAL DESCRIPTION Property Location w ' /4, 0 ,Vf. '/4, Sec. Z T Z & -R ±W, Town of ojDz 0/y 'Subdivision .& AD L A YD Lot # 2 ._. Certified Survey Map # Volume , Page # Warranty Deed It 'S 4 I , Volume `�'� r Page # Spec house yes ❑ no Lot lines identifiable l yes ❑ no SYSTEM MAINTENANCE Imptloper 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. W hat 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, sig aed 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 disposz 1 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 St. Croix Co ty Zoning Office within 30 days of the three year expiration date. 3 7 ATURE OF APPLICANT DATE ",. 0WNER CERTIFICATION certify that all statements on this form are true to the best of my (our) knowledge. I (w-.) am (are) the owner(s) of the propbhy described above, virtue of a warranty deed recorded in Register of Deeds Office. (� IG TURF Oh ` ' LICANT DATE * * * * ** Any information that is mi5- 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 _fF STATE BA DOCUMENT NO WARRANTY DEED I i lj RICHARD 0. STOUT ktrRT "FFICE SAM E. MILLER ST, ix CID W1 conveys and warrants to FEB 0 V 1998 8:00 A M Sk 0� R!&tw ad 15"018 St. Croix ft following described real estate in State of Wisconsin: RIETUR TO Lot 23 Plat of Badlands Prairies Ile, Town of Hudson, St. Croix County, 24; Wisconsin. ��'C /fr Parcel Identification Number (PIN): TRANSFER $103 rEE This is not homestead property. (is) (is not) Exception to Warranties: easements, restrictions, rights -of -way and covenants of record, i any. Dated this day ut 98 (SEAL) (SEAL) &I Richard 0. Stout (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN St. Croix Count' . ss. I 5110L – e �� authenticated this — day of Persona came before me this day of ! Lf � 19 9 28 i the abov - named RILcliara U. bLout - TITLE: MEMBER STATE BAR OF WISCONSIN (if not, to me krKpvn to ue the person who exenuted th, authorized by § 706.06, Wis. Stats.) rK 1 r the same. !'. 1- THIS INSTRUMENT WAS DRAFTED BY ... Janet P. Stout NOt'ARY 11MAX QF VV14CDO . who 1353 AwaE_uTe__e_T_r. Hudson, Wi. 54016 Notary IfI_ Cour ity, Wis. tS_1gnatures may he authenticated or acki,owledged- Both are not MY Ca m I is permanent. (It not, state expiration necessary) cafe; =qning — inan y — cap—ity sh—; ed pr gated bea� T -f signatures S82 NTF 00:"A ,ould be � WARRANT ')qED STATE BAR OF WtSCO#gS^ Nelco Inc_ PO Bcx 10208. Green Bay. W, 54307-0208 Form No. 2 -- 19W, � 9 , owl E _ I