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HomeMy WebLinkAbout020-1334-50-000 ST. CROIX COUNTY ZONING DEPARTME T, AS BUILT SANITARY REPORT Owner SW /" /yf lL G 44— JC? �1 19gg Address G7 �,6� �'!t E" Li¢ N� 1`� � � sr CROX COUNTY City/State },F ✓DSO r► Ll I S"y0/ ZONING OFFICE f . Legal Description: Lot Block — Subdivision/CSM # B A D A N 0 %. , Sec. ,, T1 -R1 Town of tJ D S O hC' PIN ' # IC TANK SE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer W P 15 JF it– Size ST/PC Of Setback from: House Z z � Well P/L r ' Pump manufacturer Model —" Alarm location (HOLDIN ANKS ONLY) F ice road Vent to fresh air intake Water Line r location arm location, SOIL ABSORPTION SYSTEM Type of system: L N C 4 Width S / Length �� Number of Trenches 2 - Setback from: mouse 4 $ Well f Zo P_ Vent to fresh air intak ELEVATIONS Description of benchmark 2 V G � Elevation �• Description of alternate benchmark G Elevation Building Sewer ST/HT Inlet `� `r ST Outlet Z Co PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of Syste ` 7" ' m Y () s Final Grade Date of installation Permit number State plan number f, Plumber' si ure ° J 1<0 License number Date - 7 / 1 / 9 � Inspect Complete plot plan NOTICE Pilo $e provide the following: • A plan view skl6tch 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 M. '* j " Plie ji �r 01 l ' 2 ,� a Z2 G�e ods�, " SP� If `. 76 INDICATE NORTH W 1&lisconsin Department of Commerce PRIVATE SEWAGE SYSTEM C ounty Safety and Buildings Division ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarspil rr 416: Personal information you provice may be used for secondary purposes [Privacy Laiv, s.15.04 (1)(m)j. Permit Holder's Name: Ej ftkY llage E] Town of: State Plan ID No.: MILLER, SAM 1V CST BM Elev.: Insp. BM Elev.: BMescript n: Parcel TB 1334 -50 -000 1� le TANK INFORMATION ELEVATION DATA A9800133 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 0�0 Bench & 5o& i U � Dosing + ', Aeration Bldg. Sewer 7 Holding St/ Ht Inlet '? -Cf , a, TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ai rr Intake ROAD Dt Inlet • 7 & 27 3S" NA Dt Bottom Dosing NA Header / Man. $ •$�� , 57 Aeration NA Dist. Pipe O Holding Bot. System g 7/ S� PUMP/ SIPHON INFORMATION Final Grade Manufacturer Deman Model Numb GPM TDH Lift Friction System TDH Ft oss Forcemain Leng a. Ff Dist. To Well SOIL AUGRPTION SYSTEM BEDV Width n Length �� No. Of Trenches PIT No. Of Pits Inside Dia. Liquid D pth DIM N DIMENSI SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu acturer: CHAMBER INFORMATION Sype a r �]U �.� OR UNIT o e Num er Y 11 DISTRIBUTION SYSTEM Header/Manifold Distribution Pipes f �� x Hole Size x Hole Spacing Vent To Air I take Length 12.E Dia. Length Dia. � Spacing�(�J pk 9 g 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.) t `► LOCATION: HUDSON 27.29.19,SW,NE 673 RED MAPLE LANE G �Z e � I Plan revision required? ' ❑ Yes No Use other side for additional infor tion. 1 - 7 1 SBD -6710 (R.3/97) Date Inspector ignature ert. No Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue N4 .4consin to 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. S / �(,�ii�l • See reverse side for instructions for completing this application State Sanitary Permit Number 3o T ? q4., Personal information you provide may be used for secondary purposes Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. 1015 RN A C /6 "1111I State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name P operty Location Jr ` - ld1 /4 N 1/4, 5'Z. T ,�, , N, R ` E( W Property Owngr's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Na a or CSM Numb r TYPE BUILDING: (check one) ❑ State Owned ❑ !tia Nearest Road Vile Public ja 1 or 2 Family Dwelling - No. of bedrooms 0 Town OF 1 gE list A -PLE. III. BUILDIN USE: (If building type is public, check a.. that apply) Parcel Tax Number(s) 01 aq. 1 ❑ Apartment/ Condo Z 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.of New 2. ❑ [:j Replacement 3. Replacement of 4_ E] Reconnection of 5. ❑ Repair of an __ __System ________System Tank Onl�f______________ xis Eting 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 5eepage Trench 22 [] In- Ground Pressure _ 42 ❑ Pit Privy 13 ESeepage Pit c s x �� 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) G� Elevation Feet 1� Feet VII. TANK in g Ca city Total # of Prefab. Site fiber- Exper. INFORMATION gallons Gallons Tanks M anufacturer's Name Concrete Con- Steel glass Plastic App N ew Existin structed Tanks Tanks El 1:1 O 1:1 11 Septic Ta g an Lift Pump Tank /Siphon Chamber ❑ I Ej 1 11 1 11 1 0 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: KE, 11 aft 7 r �� Plumber's Address (Street, Ctt , State, Zip Code): ° gyp �,! 2 o► F# �.�' .S ! o IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Issui, g Ag t Si ture (No Stamps) Surcharge Fee) .� ) (Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings Division 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 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 301 4-t(v The information you provide may be used by other government agency programs El 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 Proper Owner Name Property Location Sim m WILLF-0, SLA)1/4 F, 1/4,52 T 7.4 ,N, R /f E( Property Ow er's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number 4 (jo -50rC W) ot(, I (3V ( )z'7 co I-At" 5 0f ! tC. 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms own OF t10 50 W P IE 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo d 2-0 — 1-3 _ Sd 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. E) Repair of an System System Tank Only 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 S pecify T y p e 41 Hol Tank ❑ a p9 ❑ ❑ p Y YP ❑ 9 12 taSeepage 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 Ll T 0 1 T (03 -40 7! , t r 0 . ( o 9 7 Z a ¢ Feet 4 /, Ga Feet VII. TANK Ca acit in g all0 5 Total # Of Prefab. Site Fiber- Exper INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank Q Q / S ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ I ❑ 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: If + f Lo?X0C1 P umber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY Disapproved Sani ary Permit Fee (Includes Groundwater Date Issued Issuing A ent Sign ture (No Sta Approved surcharge Fee) /O / ❑ pp ❑Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divi. ion, Owner, Plumber INSTRUCTIONS t 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 -3815. 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 is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 o• 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 tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only_ X. County/ Department Use Only. Complete plans and specifications not smaller than 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 tanks) 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 fir pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater cantamnation investigations and establishment of standards. e b n n bo r� n U Z0 C � W k p W t F r N � O r o to I Lp i r IN ©v -4* aN r .I 10 o rl -U m ' 4-A F9 i Cu m Q t v I =5 I ' rrl TI Z 1 --�- m L r — - Wisconsin bepartment of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services e,' s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less 1/2 x 11 in siz must County include, but not limited to: vertical and ho ' oft6 referi4w M), CH and percent slope, scale or dimensions, north and location and distance est road. Parcel I.D. # APPLICANT INFORMATION - P/ print a#ipWtr►ation r ° Rev ed by Date Personal information you provide may be used for ry purpoi5. (1) (m)). 67 ( Property Owner ,` ., _- `� Property Location �C.11c� f�f .S 1��� r �1 i Govt. Lot SW 1/4 ��1 /4,S '7 T 4? .N,R / C7 (9(or) W Property Owners Mailing Address Lot # Block# Subd. Name or CSM# City State Tip Code Phone Number y� ❑City ❑ Village Town Nearest Road 4 ac(Sc' r\ G✓C .S�YoI(P (7i� c/ o Cd , �-�'r e 14 ICJ New Construction Use: Residential / Number of bedrooms L Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: �y Code derived daily flow 0 gpd Recommended design loading rate bed, gpdHt , trench, gpd/ft Absorption area required - 8�§g bed, ft 7�y trench, ft Maximum design loading rate - L - 7 bed, gpd/ft 2 trench, gpd/ft Recommended infiltration surface elevation(s) ��� ft (as referred to site plan benchmark) Additional design/site considerations 1 Parent material CY /CtG l GLC l�CJ S i' T 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 0 S❑ u PS U YS u (� s❑ u ❑ s R1 u ❑ s o u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f12 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench _S Ground elev. - Depth to limiting factor / Z6 in. Remarks ` rb ei O ✓\ 6 c) t'/t Boring # i'- S r- c-_S - 2 -/o CIS — Ground elev. /GJ�oft. Depth to limiting factor /&3_1n. Remarks: -2U } CST Name (Please Print) Signature Telephone No. am Sc-k v / 1� y7- `7G Address Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER �`� � Page ' of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Geptft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 'al 1 -.1 . ----------- 1> Ground H7 -�j —� CS lo ft. ; Depth to limiting fa r /Min. Remarks: V% !3 C) Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # [3 Ground elev. ft. , Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) P '%,Ic 3I'3 v s r 131#1 4 t k N V 1'8.0 '� "P�c. i Pt IN ef-C V. tit L .na A . + eat S o l s ee o c;,34: p-d6 k C o p y r 1 X1 well �eE� M Wisconsin Department of Industry SOIL AND SITE EVALUATION LabcZ and Human Relations Page 1 of 3 Divisiori 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 St. C r o i x percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. b. # ((,, APPLICANT INFORMATION - Please prin rrfRrm ion Reviewed by Date Personal information you provide may be used for seco pot ;ses (Pnvkcy Leyy,� 15.04 (1) (m)). Property Owner n� roperty Location Richard Stout ;:�`,'';.� Vt. SW 1/4NE 1 / 4, s27 T29 N,R 19 (or) Property Owner's Mailing Address R ,.. -� # Block# Subd. Name or CSM# 1353 Awatukee Trai n Badlands Prairie City State Zip C P' e r Ci Nearest Road ty ❑ Village �] Town Hudson WI 1 540 ,(71 5 ) 4` 673.,1 Hudson gill Farm Rd jI .7Y /. ER New Construction Use: [2 Residentia mbgt �f beii6ortls 3 4 Addition to existing building ❑ Replacement ❑ Public or commercial = TSescribe: Code derived daily flow 6 0 0 gpd Recommended design loading rate -. 7 bed, gpd/fF trench, gpd/ft Absorption area required 8 5 8 bed, ft 2 77 5 00 _trench, ft 2 Maximum design loading rate 7 _ bed, gpd/ft gpd/ft Recommended infiltration surface elevation(s) 96-40 ft (as referred to site plan benchmark) Additional design /site considerations Parent material G l a c i a l de Flood plain elevation, if applicable ft S = Suitable for system I Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system I [j S U q S❑ U [� S❑ U g S ❑ U ❑ S U U ❑ S W U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 1 1 0-14 10 r3 2 none L 2mabk mfr cs 2m .5 :6 2 14-52 10yr3/4 none sil 2mabk mfr cs 1f ".5 ;6 Ground 3 52-96 10yr4/6 none ms ml ml cs -- elev. .7 .8 -- 101 ft. Depth to limiting factor 4 Remarks: Boring # 1 0 -16 10 r3 2 none L 2mabk mfr 2 2 16 -48 10yr3/4 none sil 2mabk mfr cs if .5 -.6 3 48 -89 10yr4/6 none Ms M1 ml cs -- .7 .8 Ground elev. 101 .70 ft. Depth to limiting factor .8 9 in. Remarks: CST Name (Please Print) Signature Telephone No. a 4 - .SG X Z N Address Date CST Number Zd7d 5e �, o < `' g 7 Yr7 O �ROPR�Y owNER Ri hard Stout SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 3 1 0 -12 10 r3 2 none L 2 mabk 2 12 -44 10yr3/4 none sil 2mabk mfr cs if .5;.6 around 3 44 -88 10yr4/6 non ns knl M1 cs -- .7 .8 flev. 101 .50t )epth to imiting actor 8-8—in. Remarks: 3oring # 1 0-10 1 r 4 2 10-44 10yr3/4 none Sil 2mabk mfr cs if .5 .6 3 44-89 10yr4/6 none TIS M1 CS - .7 .8 around 'Iev. 101�.2Qt, )epth to imiting actor 8 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 # 1 1 0-14 1 0yr3 /2 none 2mabk mfr cs 2m .5 .6 5 2 14-48 10yr3/4 none sil 2mabk mfr cs if .5;.6 - 3 48-96 10yr4 /b none MS Mi M1 cs -- .7,.8 Ground el ev. 100 Depth to limiting factor 9 in. Remarks: Boring # around alev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08195) CAF ,3 61n7.22 ycp,pc,t�(a�l. � rfd ,AA t j �.aT ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer — Iv Al (t Mailing Address Property Address (o 7 f 4) fi f p I E L A/ /V e (Verification required from Planning Department for new construction) City /State u e N Le,' f Parcel Identification Number LEGAL DESCRIPTION _ Property Location U) 1 /4, AL- 1 / a, Sec. - 'Z '7 , T Z 9 N -R Town of Subdivision 'RA D L A RD 'S + R A ,Lot Certified Survey Map # (� , Volume , Page # Warranty Deed # 0 , Volume 3 , Page # y Spec house' yes ❑ no Lot lines identifiable 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. I/we, the undersigned have read the above requirements and agree to maintain die 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 St. Croix County Zoning Office within 30 days of the three year expir tion date. 0 ') v I q /30/ 9 A APPLICANT DATE ... R.S WNER CERTIFICATION P(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 rap* ty described above, by virtue of a warranty deed recorded in Register of Deeds Office. K . . < y Sal y AGW ATLJI � E ' O XPkICANT 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 STATE BAR OF WISCONSIN FORM 2 - 1982 57 804 8 OU'O TY DOCUMENT NO. rNW465 RICHARD C) 4TnljT RE�11J I LK "�r ICE ST. CROIX CO., WI Rsa'd for Renard conveys and warrants to SAM P. _ MTT,T,FR APR 2 8 1998 11:30 A M Re hr of 0"do THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St r1l C) i x County, State of Wisconsin: 1) I u l t (I k Lot 25, Plat of Badlands Prairie, Town of Hudson, St. Croix County, Wisconsin. _ qj UCdSj FS PARCEL IDENTIFICATION NUMBER AIV FER F E This i s not homestead property. (is) (is not) Exception to warranties: easements, restrictions, rights -of -way and covenants of record, if any. Dated this 2 7 t- h day of Apr i 1 A.D., 19 Ii (SEAL) (SEAL) f ON r (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Si g natures State of Wisconsin, St. Croix ss. County authenticated this day of , 19 Personally came before me this day of A n r i 1 19 g 8 the above named Ri. _hard -0 Stoaat TITLE: MEMBER STATE BAR OF WISCONSIN (If not, `><.� • Ilk authorized by §706.06, Wis. Stars.) �. f to me known to be the person who executed the foregoing n' nY instru nt and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout PUt3� -� ,� ` Virginia R. Gartman w u Hudson , W i _ 54016 F _ ..t � Notary Public, St . Croix County, Wis. (Signatures may be authenticated or acknowledged. Bothi o My commission is permanent. (If not, state expiration date: necessary.) January 30, 2000 XM .) ' 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. m B1'94 M jr l , N \ r �I� • ' �� I + 1 OOTl m ' • r �1, f Y ` l • 1` 11 r o ' 1• .1 �„ t�7 �° 1 , r � ° LL. f �, rn" ) 1, I nn•oa w ) �' I,` • fi,I� I ii ` �. ,\\, \� ,�• �' II I �,;I! in I• %•� MAPLI -•� ' ,. n Li Ja II 1 Vii. in• a� I ~ v' •j r 4' d. f r n /'' � O � I'i � ,u 6 � `y'r t_r• .mil +r.t a / r 5:.• .D W , U'.� ^. D q l' l r t ` (S ` \ • • 0'. `i l ;. 1 p P ty r J IA SO 109.77' o' IV ,, - Ln LA :U I rJ �. 204 96' 2.17' . - --- .e.. .»._ -- -- tie 24b 51' �rB r N oa °oo`2a' r '.a. r SW1 . C AST �.F itfE. �V1 "1 OF 1HE , a Dr 'HF Nf..l; •t f LOTV LOT 7 �I i HUMBIRD\ HILLS 11> HWY 12 !I RYAN bR tA rn I I _ I I AL• -' 1 r 1 + ' N HILL FARM HIS. rri v Orlrp_ 1 `�' III . _ I GI `•- I, { _ i J �. / rn �.m WLD at I I Ito �xruss>wc, .