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HomeMy WebLinkAbout026-1117-40-000 ST. CROIX COUNTY ZONING DEPARTMI+jN AS BUILT SANITARY REPORT Rc = t�C Owner .� r Address ° rcJ,Nry City /State W ► D ZONINGOFFIC[ Legal Description: Lot Block Subdivjsion/CSM # Gk" Sec. �, T�N R W Town of PIN # ,LYE/ .L� c� 7 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Size - SX4 456- 0 Setback from: House L7A Well N 8- P/L 5P • w'''� 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: 12?P& Width / a Length 9� Number of Trenches Setback from: House 36 Well ��P - PAL ,7g Vent to fresh air intake 1-5' ELEVATIONS Description of benchmark ,8 ,,., - Elevation �E Description of alternate benchmark - Elevation Building Sewer Da • ST/HT Inlet Je, -S ST Outlet/ 41, f PC Inlet AMA PC Bottom &0, Header/Manifold 10 •d Top of ST/PC Manhole Cover •'1 e Distribution Lines O 9`'9.2• O ( ) Bottom of System Final Grade Date of installation A q /1V/? 15` Permit number 31 - State plan number Plumber's signature License number o)AO53) Date dJ /9 Inspector • 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, it applicable. PLAN VIEW L 3° IND ICAT TH ARROW �v ALA GG . Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Salty and Buildings Division Count INSPECTION REPORT CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanita�yPr�itl�lo.: Personal information you provice may be used for secondary purposes [Privacy w, s.15.04 (1)(m)]. .ii 11 2tii 44 Permit Holder's Name: pp Cit �pp� Village Town of: State Plan ID No.: ILLOW RIVER JOINT VENTURE RI&MOND CST BM Elev.:- Insp. BM Elev. BM Descriptio : Parcel o r � d4`9— . 1 ' 117 -40 -000 TANK INFORMATION oLJ ELEV ION DATA A9800234 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic `�� �S 6S Bench b 8%�rl 0?,w Dosing CI,g c Z p Aeration Bldg. Sewer L /U 3• o B' Holding t Inlet 711 TANK SETBACK INFORMATION (, O St Rt Outlet �•/9 1p /. G TANK TO P/ L WELL BLDG. Air In ROAD Dt Inlet Septic 5 % �/ 17 �z Zg NA Dt Bottom Dosing NA Header / Man. g•�i6 Jul fi Aeration A Dist. Pipe g•S'j �p� 3� Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 3Z loS $ Model Nu er GPM TDH Lift Friction System TDH Ft ead Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM t Width I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN IONS 2 DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACH G Manufacturer: SETBACK CHAD INFORMATION Typ mber: Sys �j(�, (�� i(� OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) v x Hole,Size c x Hole Spacing Vent To Air Intake Length � Dia. 'l Length � ' Dia. / Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 01.30.18.684,NE,NW 1440 COUNTY ROAD GG Plan revision required? ❑ Yes MN Use other side for additional informa ion. SBD -6710 (R.3/97) Date Inspe or's Signature ert. r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E P s e. am . E 3 i e E . P e Safety and Buildings Division Vi SANITARY PERMIT APPLICATION 201 E. Washington Ave. acco r d with I R 83 O5, Wi s . A d m. Code P.O. Box 7969 t IL HR Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less Count than 8 112 x 11 inches in size. Cf\ • See reverse side for instructions for completing this application State Sanitary Permit Number 3 /5 The information you provide may be used by other government agency pr rams � C] Check it revision to as application N 1 1 0 — 7 [Privacy Law, s. 15.04 (1) (m)1. 1 10 Vi y • - VI State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Pro erty Ow r Name Property Location F1/4 N� T 30, N,R � r)W P r perty Owner Is Mailing Address Lot Number Block Number P City, State �, Zip Code Phone Number Subdivis Name or C�NbNumber H. TYPE OF BUILDING: (check one) ❑ State Owned it� Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms gTown OF Q_ 111. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo l • 3 0. 18 . & 94 1 04:Zb — f) 1 —1 4 a —a°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 r gNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 11 ❑ Seepage Bed 21 ❑ Mound 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 7.50 1 140 16 9`0 10V,,3 Feetj Feet Ca at VII. TANK in altos Total # of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete st acted Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 1 ❑ 1 ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for install of the onsite sewage system shown on the attached plans. Plumber's Name rint) Plu er's Signatu e: (No amps) MP /MPRSW No.: Business Phone Number: i 5 Plumber's Address (Street, City, Zip Code): jQt S o IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) A Surcharge Fee) Approved E] Owner Given Initial �l Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: S®D -6398 to t 1/86) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installaticn 5. Onsite sewage systems must be properly maintained:. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin., Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: L Property owner's reame and mGiiing address. Provide the legal descrioticn and parcel tax numbe -',$) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. Vil. 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.), P Y address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section 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 contamination investigations and establishment of standards. i :AOU." Ri` vv r 110 �P o Stf ID M LA I - _ ce 5 X$65 J T W I �- I- _ a I I I I I I I I ! _ I I ; 1 I I I � I i �I I _ i l - t. Z► : I i I i i _ i I , • I i I i I ' I I , ; : : ' i , I I I ' I j i- I I l I I , I i J� E ro s ZitoZitoS 1c'n V 114- fre6A Air Intel& And Obwwatio0 pip �1 Appror:d Va (.I Cap ®� 3 �.( M fift el 12 Above - C f / RQ CG final Geode 1 1 (�© / 20- ♦2 Above Plpp 4 Cael Iron To final owed@ Von1 Pipe ►1or.n Noy Or SymM1k Co •wine Lin 2• ApOr@po14 I Plpa 014111boloo Or@ Pipe 0 0 0 -- Too - 6• Apar@yota 06064111 Plp$ ° P@rlowalsd Pip@ below o — Co.pllnp T@ronlnallnp Al Galloon Of Sy.I@m o e p Ptne - rs %c.< �fe► , i SOIL FILL DISTRIBLITIOM PIPE ' APPROVED Sy)Jpr_TIC cOVCR 2 " o>>= G6 EGAlE —�� — • 11ATER ^l OR 9" OF STRAW *'K'w O R M A R S I•w I-1 A °Y feOPlt - 2 i /z AGGREGATE � % \. ELEV. oFl�ftJFEET. • N � DIS PIPE TO BE AT LEAST ,�_ IIJCHES BELOW ORIGIIJAL GRADE AIJU AT LEASTLO INCHES BUT 1.10 MORC THA►J 42. IIJCNES 13ELOW FIIJAL GRADE MAXIMUM OEPrH OF FXCAVAT FR OM OR I &WAL 6RADF- WILL BE IIJCHES nNIMV CKPn1 OF EACAVATIOIJ FP 0,1� 160AL GRADE WILL BE INCHES 1 SIGIJCD: LiG E►J SC 1.JUMBE R: _ daQ Ste_ DATE:-- - -• - -- - • - - -_.. � to .. .. .. r U1 ° ^onsin Department of Industr SOIL AND SITE EVALUATION REPORT Page 1 of 3 or arid Human Relations vi sion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2,�"flinches in s ik:.,Plan must include, but not limited to vertical and horizontal reference point,�6"Atl), direction and % 0f -4ope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest,�iad. +� 026- 1117 -40 ti R kk�V_1(4 VIEWED BY DATE APPLICANT INFORMATION PLEASE PRfNT ALL fl4Wd iWrION 12 [ � PROPERTY OWNER: 1 5 11 7 PAA PITY LOCATION Derrick Constructicm, Inc. GbiT. OT NE 1/4 NW 1/4,S 1 T 30 N,R 18 : R(or) W PROPERTY OWNER':S MAILING ADDRESS ^�UUNTY T. ` BLOCK # SUBD. NAME OR CSM # 1505 Hy. 65 ZONINGOFE na Willow River Meadows CITY, STATE ZIP CODE PHQNENUMBER ITY []VILLAGE MOWN NEAREST ROAD New Richmond, WI. 54017 (7 '246�L3 ' � `' i " [34 New Construction Use [ )j Residential / Number of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 g pd Recommended design loading rate • 7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) area P -Area 13 - ft (as referred to site plan benchmark) Additional design / site considerations none G✓f wta,y be JCVV6'V f pear 4Zl i.6k6s o tm Parent material outwash Flood plain elevation, if applicat* ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem 91 ❑ U E k S ❑ U EIS ❑ U ® S 1:1 U ® S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 1 2 12 - 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 30 -88 7.5yr4/6 none cos Osg ml na na .7 .8 elev. 10 ft. Depth to limiting factor +88" Remarks: Boring # 1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 2 12 -28 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 La 3 28 -86 7.5yr4/6 none co s Osg ml na na .7 .8 Ground 10 ft. Depth to limiting factor Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. AyedNew Ricbmorfi, WI 540 Signature: Date: 12 -12 -97 CST Number: m02298 f ' PROPERTYOWNER Derrick Const..Inc. SOIL DESCRIPTION REPORT Page? bf 3 PARCEL I.D. # 026- 1117 -40 ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends 1 0 -14 10yr3 3 none 1 2msbk mfr gw 2f .5 .6 {; 3 2 14 -33 10yr4 /4 none scil lcsbk mfr gw if .2 .3 Ground 3 33 -88 7.5yr4/6 none ms sOg mvfr gw na .7 .8 elev. 1 Depth to limiting factor + $8 Remarks: Boring # 1 0 -11 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 4 2 11 -26 10yr4 /4 none scil 2msbk mfr gw if .4 1.5 3 26 -80 7.5yr4/6 none ms sOg mvfr na na .7 1.8 Ground elev. 10 2.00 ft. Depth to limiting factor +80 Remarks: Boring # 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f 5 2 9 -20 10yr4 /4 none sicl 2msbk mfr gw if .5 3 20 -80 7.5yr4/6 none ms Osg ml na na .7 1.8 Ground elev. 1 02.0 ft. Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Derrick Construction, Inc. New Richmond, W( 54017 MPRSW 3254 NE4Nw4 S1- T30N -R18W town of Richmond: (715) 246-5200 T lot #32- Willow River Meadows N 1 =40' BM.= top of SW lot survey stake @ e1.100' �ZB� Gary L. Steel 12 -12 -97 oisco Department of Industry, 1 3 rrandHurnanRelations SOIL AND SITE EVALUATION REPORT P age�of Division of safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 026 - 1117 -40 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Derrick Constructi Inc. GOVT. LOT NE 1/4 NW 1/4,S 1 T 30 AR 18 ft(°r)W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 1505 Hy. 65 32 na Willow River Meado CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD Nev Richmond, WI. 54017 (715 246 --2320 +1 1:4 New Construction Use I it Residential / Number of bedrooms 4 [ I Addition to existing building I I Replacement [ I Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpolft .8 trench, gpdgt Absorption area required 858 bed, ft 750 trench, 112 Maximum design loading rate .7 bed, gpd/ltt .8 trench, gpolft Recommended infiltration surface elevations) area 1=100.3 -Area B=%.Oa It (as referred to site plan benchmark) Additional design / site considerations none Parent material outwash Flood plain elevation, if applicabR ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE 7AT SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ® S [] U CkS ❑ U ] S O U S ❑ U 91 S❑ U ❑ S IN U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounty Roots GPD /ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch 1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 sk 2 12 -30 10yr4 /4 none sic 2msbk mfr gw if .4 .5 Ground 3 30 -88 7.5yr4/6 none cos 0sg ml na na .7 .8 edev, 10 ft, Depth to limiting factor +88" Remarks: y Boring # 1 0 -12 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 4 ' 2 12 -28 10yr4/4 none sicl icsbk mfr gw if .2 .3 3 28 -86 7.5yr4/6 none co s Osg ml na na .7 .8 Ground 1a ft. Depth to limiting factor t Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Aye //New RicbrnoA W1 540 Signature: Date: 12 -12 -97 CST Number: mO2298 mop�rOWNER Derrick Const..Inc. SOIL DESCRIPTION REPORT Page 2 , f 3 PARCEL I.D. a 026 - 1117 - 40 ,�► Boring # Horizon Depth Dominant Color Mottles Texture Structure Consisterice Bouxfty Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed jThiW 1 U-14 1 yr 3 none 1 2msbk mfr gw 2f .5 .6 :.3 2 14 -33 10yr4 /4 none scil lcsbk mfr gw if .2 .3 Ground 3 33 -88 7.5yr4/6 none ms sOg mvfr gw na .7 .8 elev. 1 03.3 ft. Depth to Limiting factor +88 Remarks: Boring # 1 0 -11 10yr3 /3 none 1 2msbk mfr gw 2f .5 i.6 2 11 -26 10 r4/4 none scil 2msbk mfr 4 Y gw If .4 .5 3 26 -80 7.5yr4/6 none ms sOg mvfr na na .7 :8 Ground elev. 10 2.00 ft. Depth to limiting factor +80" Remarks: Boring # 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 ; .6 5 2 9 -20 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 3 20 -80 7.5yr4/6 none ms Osg mi na na .7 .8 Ground elev. 1 02.0 it Depth to limiting factor +80 Remarks: Boring # `f • .. Ground elev. ft. Depth to limiting factor Dmm�.Le.• STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Derrick Construction, Inc. New Richmond, WI 54017 MPRSIfIF -325a NE�Nw� sl -T3oN -Blew town of Richmond. (715) 24M200 t lot #32- Willow River Meadows N 1 "=40' BM.= top of SW lot survey stake el.100' o� ni Gary L. Steel 12 -12 -97 rc : F �77 23 <M. zz— 0 M —j r — -4 (7 -4" 5 —; X- Lr; M X z (D z 3007 M z It Lp. Lr! 11 cr fr. Z r a P= > -0 CD m Ill Q io. CL Lr, - 0 z U m > :A Of r. st X C 0 C� z M 0 CD --4z F: z 0 -t- o • 0� z a . s ' WNW TWCBWM ftV%OVWUMG'%%.LCW "GOM ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer / M%CA4AM%.- �• 5 Ns Mailing Address x �'- N �. (?.t c r•1 o e.t _ �!Z 5 401 - 1 Property Address t - oy tLU rlao'o 6 (--A (Verification required from Planning Department for new construction) ` City /State — R- <<- E+�t�ta0, VC Parcel Identification Number b Zto - 1 11 ° 4 0 - 0 0 LEGAL DESCRIPTION Property Location v %,, NYV '/,, Sec. , T 4 13 N -RJ9W, Town of R4 allo Subdivision \pJ l� -�.ow �.cy��{ �A cD <- w , Lot # Z Certified Survey Map # , Volume . Page # _ Warranty Deed # 9 j Volume Page # Spec house X yes ❑ no Lot lines identifiable Xyes ❑ 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, journeymanpl�mber, 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 'v w' a standards gn q nts and agree to maintain the private sewage disposal system with th set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o the three ye 4ex (o 4 SJKNATURE OF APPLICA 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 pro rty de " ed virtue of a warranty deed recorded in Register of Deeds Office. q 6 / / SI ATURE OF APPLIC 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 GUA RI AN S DEED D ' REGISTER'S OFFICE This Deed, made between ........................... ........................ . ST. CROIX CO., WI .... .. Ge.r.tru.de ... E...-.Sc.hm.i.t...by...Bev.er. .. �.C� Recd for Record .... . ...... .... .... ...... .... . . . .. .... ...... .. ............................................................................................... .., Grantor, ........... ...... OG''1211989 ------ - - - - -- � ...............................................................................s and .....M qbAg!j_ R *."' St ' ey * e ' ns l�i.l.l.i.am..H.....D.er.r.i.k . . a .c ........... 8.00 A M .......... William M....- Der E..... D.er.rAc.k.. and -- .... ....... . .. ........... Derrick a .. t ........... ............. Re .................................................................................................. , Grantee, Witnesseth, That the said Grantor, for a valuable consideration .....Gertrude ... E.....S.0m.i.t ... by ... Beverl Buckner ........... ... ntaun,t to conveys to Grantee the following described real estate in ...... .t. rq iA . . . County, State of Wisconsin: Southeast Quarter of Northwest Quarter and Northeast Quarter of Southwest Quarter of Tax Parcel No: ................................... Section 1, Township 30 North, Range 18 West. This deed is given pursuant to the Order to Sell, dated October 16, 1989, and the Confirmation of Agreement and Order, dated October 19, 1989, both duly authorized by Order of the Court and whereas the undersigned, Beverly Buckner, is authorized to sell the same by Letters of Guardianship certified on October 22, 1989. i�thri��F� O . This ........ not homestead property. is (is no ( i .. :­­ .... Together with all and singular the hereditaments and appurtenances thereunto belonging; And ..... Ge-r.tr.ud.e .. E.....S.chmit...by..Be.v.er.1y..Buc.kn.er .................................. ............ ....... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. Dated this ............... ................... day of ......... October ............ ......................... - - -- .......... ..................................................................... (SEAL) ......... ................. .... I Ic- /-- -, K�A- / .(SEAL) Gertrude'E. Schmit by Beverly .................................................................. .................... ..................................................................... (SEAL) .................................................................... (SEAL) .................................................................. .................................................................. AUTHENTICATION ACKNOWLEDGMENT Signature (a) ............................................................ STATE OF WISCONSIN Reverly Ruckner � ss• II ........................................................................ n ....... . County. authentic t d this' --__ ..... day of .. October ........................ 1 19_. Personally came before me this ................ of .................................. ....... 19 ........ the above named &/ ................................. Kristina Ogland Lundeen ................................................................................ ---------- TITLE: MEMBER STA i " ........... * --------- ** ------ *­ ---------- **** ------ * ....... ................................................................................ E BAR OF WISCONSIN (If not ................................................... : ........ ........................................................................ ....... authorized by § 706-06, Wis. State.) to me known to be the person ............ who executed the foregoing instrument and acknowledge the same. KN9 tTAW"'6W'1'AffcP'f ................................................................................ ..... Attarnay ... at._,La.v ....................................... .............................................................................. ................................................................................ Notnry Public ........... ............................... County, Wis. (Signatures may he authenticated or acknowledged. Both 'My Commission is permanent. (If not, state expiration are not necessary.) date: ......................................................... 19......... -Names of persons. signin in any earnelty should be t or printed below their signature!. 1­%"",A•7TV TIrr•r) a*%Tr trot nr