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HomeMy WebLinkAbout032-1016-20-000 o a ' ° Ci h p vi � I c c z LL C h O Q 3 � v N c I Z y Z w O ° c O f�\ L \ Z y y a) c; w a m co U) U O z :!t O O O N Z CO F- E N N N E O N Cl) N O Q N • N N O d L a) O N N N � 9) 0 o a) a N z m z ° z z c m c a — co O a @ f o p C d a N �J Z U) F U) U) _OI o 0 0 0 a s • ►v ;• a a a ►� o m rn N U rn } co 0 0 0 0 N M N N N N 04 a O O Y E M_ m r r r m Q m r O M N N O C N N C 0 " ° 0 N a co w O N U N as O U N m H E Q) C a) U a 0 0 0 0 1 y CO @ N O c D N N N N O M O N c N c N N M � _ 'rl r0 r - OD - ' N 3 M L"i N . CO N "6 w N r r • „'� M CO O 1 O N CP y O O @ U O O O (n d (M O z N Z Q� Cn � r i a � a .� a U 'c c y c Q 0 d '', 0 (%1 U ST. CROIX COUNTY ZONING DEPARTMEN b 9 AS BUILT SANITARY REPORT .� Owner :� r"-5 5 1'o �,t i Property Address 3 CD Q 19 City /State O ST CROIX �s COUNTY ZOININO OFFICE\�, Legal Description: Lot /oZ Block Subdivision/CSM # 5'P t /4 - UC—,t /4, Sec. -- t� , T�lN -R�W, Town of PIN # r) 0 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer W lPN5 Size ST/PC A l Setback from: House Weller P/L 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: 6- Width Length 7 O Number of Trenches A Setback from: House aQ Well P/L Vent to fresh air intake //D ELEVATIONS Description of benchmark /y 7 &r--xe-t art .Sfi& Elevation Description of alternate benchmark Elevation Building Sewer /00 ST/HT Inlet 9 T S ST Outlet 9 PC Inlet PC Bottom 95. --), Header/Manifold `�� ' 3 Top of ST/PC Manhole Cover S Distribution Lines ( i) 2 1 (z) F` -- 3 ) 9 - Bottom of System O c) 5 ; 1 O 9' r Z O 9 Z Final Grade ( ) 9, Z O 7 ,9, 2— ( ) 9 9. Date of installation /o Permit number 3 a L/6 9 '" State plan number Plumber's signature License number a2D 5 3 7 Date Inspector o Complete plot plan Witiconsin Department ofCommerce PRIVATE SEWAGE SYSTEM Count Safel and Buildings Division INSPECTION REPORT ST CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 324698 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: PONTUTI, JAMES SOMERSET CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ADD l� T ,tJG 032 - 1016 -20 TANK INFORMATION ELEVATION DATA 4q 0 1 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 612 �a Ben o pog y Dosing Z• ��jJ Aeration Bldg. Sewer 5 D D Holding St Inlet TANK SETBACK INFORMATION St W Outlet 7, S&o TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Sept U ' 4 NA Dt Bottom Dosing NA Header/ Man. 7 -v4 Aeration NA Dist. Pipe $.00 7 ,Ql9 `•O� X9(0 Holding Bot. System 9� GAS PUMP/ SIPHON INFORMATION Final Grade q-7 5'_ �' �; Manufacturer emand 5 f13 Gj �• j°I Model N er GPM TD Lift Friction stem TDH Ft Forc Dia. Dist. To Well SOIL ABSORPTION SYSTEM BENCH Width Length � No. Of Trenches PIT No. Of Pits si a Dia. D IMENSIONS p I DIMENSION SETBACK SYSTEM TO P/L BLDG I WELL LAKE /STREAM LE CHING Manufacturer: INFORMATION I systw Type G� o CH ER a Number: / 60 OR UNIT DISTRIBUTION SYSTEM Header/ Marli old Distribution Pipe(s) If x Hole Size x Hole Spacing Vent To Air Intake j Length 1- Dia. 7 Length Dia. __�L Spacing ?r 3q 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: SOMERSET 6.31.19,SE,NE 2358 DELONG ROAD — LOT 12 0 Ali •b YA- T" PMVA Cimw4e . "4 m cv� t 40&' � ,--f) � - Plan rfvision required. ❑Yes S Use other side for additional information. d SBD -6710 (R.3/97) Date Inspector's Sign ure o. NV SANITARY PER Safety and Buildings Division o ns i n SANIT MIT APPLICATION 201 W. Was hington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 • Attach complete plans (to the county copy only) for the Z system, on paper not less County Madison WI 53707 -7302 than 8 v2 x 11 inches in size. �+ , • See reverse side for instructions for completing this application State San itatar ryerm i it t Number Personal information you provide may be used for secondary purposes 3� ` 4 Q/ r [Privacy Law, s. 15.04 (1) (m)]. ^ „ ' � Check if revision to previous application APPLICATION INFORMATI N - PLEAS ALL INFORMATION State Plan I.D. Number Prope Owner Name O Property Location Property Owner'sMailingAddres S� 1/4 ti� tl4r S G T 3 � , N R /9 Or) W / 00 L �N um er B lock Number CW, State a J.N ip Code Phone Number Subdivision Name or CSM Number a It $-) va t g 3 II. F BUILDING: (check one) ❑State Own 6 ❑ It S{ Public 1 or 2 Family Dwelling - No. of bedrooms El village Nearest Road III BUILDING U S E Town OF 54 M>h @ II.- Rot : (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo � - 3/ M• b 5 r3l n 3.� - 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 3 ❑ Campground 10 El Outdoor Recreational Facility 7 ❑Merchandise: Sales/ Repairs 11 4 El Church/School 8 El Mobile Home Park El Restaurant Bar/ Dining 5 ❑ Hotel/ Motel 9 ❑ Offi 12 E] Service Station/ Car Wash ce / Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 g New stem 2. E] Replacement 3_ E] Replacement of 4 Reconnection of ❑ 5. ❑ Repair of ______ ________ System _________ _y ____TankOnly___ Exl sting 5 stem _____ _______________y___ __ __E_x Sy _____ B) A Sanitary Permit was previously issued. Permit Number V. TYPE OF SYSTEM: (Check only one) — '3� y 69 8 Date Issued /a / • 9 s Non -P essurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed •. 21 El Mound 12 ❑ Seepage Trench 30 El Specify Type 41 ❑Holding Tank 22 C] In- Ground Pressure 13 ❑ Seepage Pit /u x , D 42 El Pit Privy 14 El System -In -Fill - 43 ❑ Vault Privy 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 (CEO Required (sq. ft.) P (sq. ft.) (Gals/day /sq. ft.) (Min. /inch /A00 ) Elevation VII. TANK Capacity -S 9 5 ' 2 Feet Feet INFORMATION in gallons TotaIt( f site Galloks Manufacturer's Name Prefab. Fiber- Ex per- New Existin n Concrete Con- Steel lass Plastic P Tanks Tanks structed g APR c an ��Sa ❑ ❑ ❑ L Pump Tank /Siphon Chamber ~ ❑ ❑ VIII. RESPONSIBILITY STATEMENT ❑ ❑ ❑ ❑ ❑ ❑ I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plber's Name rent) Plumber's Signa ure. No St m s / ' „ P) /MPRSW No.: Business Phone Number: Code) P u tuber's Addres (Street; Citv.State Zip : s 3 7, s Ph y �� / A IX. COUNTY / DEPARTMENT USE ONLY 0� ❑ Disapproved Sanitary Permit Fee (includesGroundwater ate SSUe Issuing ent Signature (No Stamps) }Approved ❑ Owner Given Initial _ surcharge Fee) C Adverse Determination f •'l.�i� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber Sh� S v� v e rs 5..11 UJ m �ns � r �? p a 11 S7 ,�Ori. AJ Sp a, �� /oa' CUS &A _ Rd 04.1 e (; 2..2 9f o No�l� /n, 76 / 9s 2 ' 75 n -tQ o cam) K ..� C,rvSS Jec lo�� p � 2 1 r 1 VCI� SYS s _N� 5G -T 3 _ 17&j �� _ S 0 �u2PTrJ4" V `? > �� fr�lA AIr tnlel� And Obierrollp4 Pipe .. r '41 4I�nlm,,,� 12•Aeora ADDro•ld V.nl Cop final Grad. 20. 42' Aber, plpf _ 4' Call Iron To final Oreda, V.nI Pipe wr rn It* Or S ntMik Co•.rin 0 4r2Plp,prapole OIUNbvllon _ tips , 0 0 0 —.. Tee r 4• AOQreyale Oanaelik Pipe a Parlorol.d Plpa 11.1or o Co Ina T.rednollnp Al Oollom Or Sr'.lam P 1\uP05tD 11 gCi cl{ �gqe Ion .' gag SOIL FILL D ISTRIBUTIO1.1 PIPE ' 2"O Fh GGREWIF ---/� _ r ` :•APPROVED S�I�/Tf1E71C COVCR �i MAT1=R ,% OR 9" OF STRA4! E o f •S 2 •b (:• -2' /t AGGREGATE DISTa PIFE TO BE A7 ! AUU AT LEA S7 L0 IIJCNEG 6UTLI,IOSMOR U 42 ADE E BC B ORIGIIJAL OR FLOW FIkIAL GRADE !'wcIMuM DaP.rH OF EX-AVATIOP FXoM OR AL 1'UNIr1vM p�Prl� of �xcAv 691�0� WILL BE sd " _ IucHEs �tTImN F�o� �161f1gL C�R4D� WILL BE � INCNEs SIGI,IED: —r42� LICEUSC ►.JUMBEIi: � DATE: I10 r f Ali SANITARY PERMIT APPLICATION Safety and Buildings Division 20 1 E. Washington Ave. Department of Commerce 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 8112 x 11 inches in size. S • See reverse side for instructions for completing this application State sanitary Permit Number The information you provide may be used by other government agency programs c36 l &1 ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATI N - PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location � 1/4 E 1/4, S T , N, R E46;) W Property Owner's Mailing Ad ress �t�— Lot Number Block Number 0 � V City, State I Zip Code Phone Number Subdivision Name or CSM Number jai 11. TYPE F BUILDING: (check one ) ❑ State Owned ❑ It Nearest Road El ❑ Village Public 1 or 2 Family Dwelling - No_ of bedrooms Town OF III. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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 Re lacement of System System ❑ p __ - - 4� ❑Reconnection of 5_ E] Repair of an _ Tank Only Existing xisting System _________Exis_ting 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 11/6Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure i 42 ❑ Pit Privy 13 ❑ Seepage Pit 1� X 1 �� 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/da /sq. ft.) (Min. /inch) Elevation (0 r�0 a 14o C) 7 1��� s�, Feet 9¢ce6 Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Ex per. New Existin Gallons Tanks Concrete Con- Steel glass Plastic A p p Tanks Tanks strutted Septic Tank or Holding Tank ( v W It - a I ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inslaR of the gnsite sewage system shown on the attached plans. Plu ber's Name: (Print) Plu ber's Sign ture No am MP /MPRSW No.: Business Phone Number: c S 13 Ch . 2.0 Plumber's Address (Street, rty, State, ip Code): qki2 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitar y Permit Fee (Includes Groundwater ate Issued Issuin _ Surcharge Fee) �� gent Sign ture(NOStamps) Approved [ Given Initial Q Q ( � / � Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: �e SBD4M (8.11/96) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Humber Play- A -st 1 4 ti li� Y s C, --t 3 1 - v A 19 %,j 1900 _ s k" P S 'homQ,-sJ"' Ldp l M O a L X57 a 3 5 `co ' ein NE la Dom% k\ �. qS" A N n 3> a l ei _ ... =� N` r - i SEPTIC TANK 8 " PUMP CHAMBE CROSS SECTION AND SPECIFICATIONS Mom SK! s cty I5� 4" CI VENT PIPE 12" MIN. ABOVE GRADE E `L�� XE >_ 25' FROM •DOOR, WINDOW OR OOF' FRESH AIR INTAKE- JUNCTION BOX APPROVED` WITH CONDUIT MANHOLE COVER FINISHED GRADE 4 CI RISER W/ PADLOCK 8 6 MIN. WARNING LABEL ABOVE GRADE �.�____.4" MIN. 18" IN. 6" MAX. It INLET , WATER TIGHT SEALS GAS. ' i 4 �� TIGHT i , BAFFLE A SEAL 1 APPROVED CI PIPE -�-- , ALM JOINTS W/ CI 3' ONTO B PIPE 3' ONTO SOLID SOIL C ON SOLID SOIL PUMP OFF ELEV . FT. - 4 — OfF RISER EXIT D PERMITTED ONLY IF.TANK MANUFACTURER 3" APPROVED BEDDING UNDER TANK HAS APPROVAL SPECIFICATIONS CONCRETE PAD SEPTIC / DOSE %aU �°75c� Cc�w�Ioz� TANK MANUFACTURER: ��s;,�� p,,� NUMBER DOSES PER DAY: TANK SIZES SEPTIC �a SD GAL. DOSE VOLUME INCLUDING DOSE '7=_ GAL. FLOWBACK: GAL. I ALARM MANUFACTURER: ,IS �j�c�.�,c� CAPACITIES: A =7 INCHES = .�/�,J, GAL. MODEL NUMBER: SWITCH TYPE: B = 2 INCHES = GAL. PUMP MANUFACTURER: s C = /-� INCHES = Ida GAL. MODEL NUMBER: ��• � �,E � it L• SWITCH TYPE: Ao - 7r D = _( INCHES = gFt Z GAL. REQUIRED DISCHARGE RATE_ GPM PUMP 8 ALARM WIRING AS PER ILHR 16.23�WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE $ FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . ... . . . .� FEET + � FEET FORCEMAIN X l k/ FT /100 FT. FRICTION FACTOR . -6 FEET T.OTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH; WIDTH oZ ; DIAMETER LIQUID DEPTH J SIGNED: LICENSE NUMBER: DATE: 1/88 S J` C 1 U '1 io SK; p Q�a� c Fresh AU IAIII And ODertrpttpn Plpa �S�m;� �n � ��s/ `. h� ^ utntm 12' Anoro APP /orbd Vanl Goo SI~ Ig Y s LO FIn01 Glade L off• Sorfvors " 20. 42 Abe., PIPj _ 4 Gaol Icon TO FIne1 Oroda, vonl PIP, u-th Ito Of S nlMtta Gallo 0.u 2 Plp 9p1opalo - Dloulbvlton • . PIPa "' 0 0 0 - -Too 0 Do 0a1% PIP' ° Porlo1olod Plpo below ° �Ce,pinp 7010 11116IIA9 AI D O"o 01 111:614m P rupnseD PIFlal g 99. 4 ON SOIL FILL DISTRIBUTIOI.1 PIPE 2 "pFAGGRE6 ATF _�� _ ` R _'APPOVED Z%j)j HETIC COVER / OR 4 " OF STRAW OR JAARSN HAy �:Y t:'OFr KIEV. O - 2 1 / F FEET z AGGILCGATE U ^, —� . DISTRIBUTIOU PIPE T(} INC AT AUU AT LEASTLO IfJCHES F1UT`I,IOyMORC THAW y2EUCNES OW ORIGIQAL GRADE BELOW FIIJAL GRADE 1UlXIMUM DaRrvi OF EXCAVATIOIJ F!(otl OiWI NAL 69ADF- WILL BE, Ebb 7'UNIr� 05 F n 1 of EACAVATIm1J ��o e ,t,IEtgL — IUCHES �RnD WILL B E INCHES SIG1.7E0: LIGEL-ISE IJUMBER: � 7 DATE: Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division 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 x 11 inches in size. Plan must include, but St. Croix 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. 032 - 1016 -20 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION RE EWED BY DATE PROPERTY OWNER: PROPERTY LOCATION James A. Pantuti GOVT. LOT SE 1/4 NE 1/4,S 6 T 31 AR lg * (or) W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 1505 H 65 12 na csm vol 553 — pg45 #339574 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD New Richmond, WI. 54017 (71-9 246 -2320 1 Somerset I DeLon Rd. [x] New Construction Use [ x] Residential / Number of bedrooms 4 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 1200 bed, ft 1000 trench, ft Maximum design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Recommended infiltration surface elevation(s) 95.20 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material stream terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I 13 ❑ U KI S ❑ U I CA ❑ U CA ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trerch .................. ................. .................. ................. .................. ................. 1 1 0 -10 10 r3/3 none 1 2csbk mfr 2f .5 .6 2 10 -23 10 r4/4 none sil lcsbk mfr gw if .2 .3 Ground 3 23 -39 10yr4 /4 none silc lcsbk mfr gw if .2 .3 elev. 9 9.5 ft. 4 39 -88 7.5yr4/4 none sl 2mgr mvfr na na .5 .6 Depth to limiting factor +88" , Remarks: Boring # 1 0 -9 10yr3 /3 none 1 2msbk mfr gw 2f .5 .6 2' 2 9 -22 10yr4 /4 none sil lcsbk mfr gw if .2 i .3 3 22 -35 7.5yr4/4 none sl lcsbk mfr gw if .4 .5 Ground elev. 4 35 -82 7.5yr4/4 none sl 2mgr mvfr na, .5 .6 98.9 ft. Depth to D limiting factor +82 rn.. - ST CROIX i Remarks: C G OFFr-E .' CST Name: -- Please Print G L. Steel Phone: 715 -246 -6 0';. ` Address: 1554 200th. Me., New Richni6arl, W 54017 Signature: Date: 9 -23 -98 m02298 ,� , f STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 James A . Pantuti New Richmond, WI 54017 MPRSW - 3254 SE4NE4 S6- T31N -R19w (715) 246 -6200 4- town of Somerset I' lot #12 -CSM vol. 553- prg.45 i N 1 "=40' BM.= tof NE lot stake @ el. 100 Alt. BM.= top of mid -lot survey stake C el. 99.50' 75 f r pft4) &41b Al W �l U GAry L. St 1 9 -24 -98 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND , OWNERSHIP CERTIFICATION FORM Owner/Buyer -� P-M ES -{� . �� N►Z Mailing Address l N, p S A S ; M Q 21, 5 - 1 a�.s8 Property Address Xv, ,% Le bk T (Verification required from Planning Department for new construction) City/State �1 ©ni+crt�SET, \ Na' Parcel Identification Number ' - 10 11%a - Z.0 LEGAL DESCRIPTION Property Location !�c '/ WI '/,, Sec. , T X 1 1 N -R J� W, Town of Subdivision L q tj�-- ce X01> I Lot # Q— Certified Survey Map # j Volume , Page # Warranty Deed # 9 5-14- Volume '� . Page # S Spec house 0 yes' no Lot lines identifiable yes O 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*nber, 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 J f th ree year exp�n dat w " I N " ATUR u E OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of e pro rty describe bove v' tuee of a warranty deed recorded in Register of Deeds Office. JYt NATURE OF APPLICANT 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 I 3 'o M' r SOUTH 135,59' c J z o�(,�'� Qb+pb�uolaa 00 J , Oy . SL 1 M „ 06,9S " 80S �i off. W / y � � A � z a — / N / w � J I o ` 0 LO n w w >1 -C O Q 4. +., o :. i O N +' ODD U +, U Z oj N L � i i C1 C C U N C�1 s N O �' w u ►� > ,a w ) £ i Ul W (� s