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Home My WebLink About030-1054-10-000St. Croix County Planning and Zonin Detail Sanitary Information Computer 0: 030-1054-10-000 SublPlat: metes & bounds Section: 23 Parcel #: 23.30.19.198C Lot: TN/RNG: T30N R19W Municipality: St. Joseph, Town of CSM: 114 114: Gov't Lot 2 Owner: Haag, John 1450 Ridge Run New Richmond, WI 54017 State Permit: 240800 Issued: 09112/1995 POWTS Dispersal: Permit: Replacement County Permit: 0 Installed:995 POWTS Detail: B See je Bedroom s:ic 11 WI Fund: I ( I I L/ I S'POWTS Pretreatment: NA � _/ Notes Inspector As Built Plumber Other Requirements Additional Notes Not d - �0 SO'Connell, Kim Signed if: tyO • Maintenance / Y Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/12/1998 ►vj&j — c4-.� 4- Len - Tuesday, March 11, 2005 at 3:25:15 PM Page I of I Money Owed $0.00 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 • Fax (715) 386-4686 Parcel #: 030-1054-10-000 03122/2005 03:24 PM PAGE 1 OF 1 Alt. Parcel #: 23.30.19.198C 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' = Current Owner ' HAAG, JOHN M & DEBORAH ANNE JOHN M & DEBORAH ANNE HAAG 1450 RIDGE RUN NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ' 1450 RIDGE RUN SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 23 T30N R19W PRT GL 2 COM E SH BASS Block/Condo Bldg: LK 99.5 FT S OF N LN, E 290 FT, S 100 FT, W 290 FT MOL TO LK, NLY ON LK, NLY Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ON LK TO POB 23-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1129/423 WD 07/23/1997 486/451 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 5179 590,200 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 193,600 387,000 580,600 NO Totals for 2004: General Property 0.000 193,600 387,000 580,600 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 90,000 284.100 374,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 210 Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 771.86 Special Assessments Special Charges Delinquent Charges Total 771.86 0.00 0.00 ST. CROIX COUNTY WISCONSIN ZONING OFFICE j� ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 • Fax (715) 386-4686 Parcel #: 030-1054-30-000 03/22/2005 03:24 PM PAGE 1 OF 1 Alt. Parcel M 23.30.19.198E 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ' = Current Owner JOHN M & DEBORAH ANNE HAAG ' HAAG, JOHN M & DEBORAH ANNE 1450 RIDGE RUN NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: 1784-CSM 17-4603 SEC 23 T30N R19W PT GI-2 COM 1300 FT W & Block/Condo Bldg: 199.5 FT S OF E 1/4 COR, TH W 326 FT TO Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) SHORE BASS LK, SLY 70 FT, E 326 FT TH N 70 FT TO POB 23-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 09/04/2003 738845 1714603 CSM 07/23/1997 1140/54 WD 07/23/1997 492/390 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 5181 13,100 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 12,900 0 12.900 NO Totals for 2004: General Property 0.000 12,900 0 12,900 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 20,400 0 20,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount 040-OTHER ASSM'T SPECIAL ASSESSMENT 10.92 Special Assessments Special Charges Delinquent Charges Total 10.92 0.00 0.00 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 r Fax (715) 386-4686 wuo- iuWHapera"elatiordustry, SOIL AND SITE EVALUATION REPORT limbo• ird Human Relation Orvision ,�Safery 8 Buildngs i.. a ......;a a uo Oe nc ur:- wd_ n_A_ Pape / o1 3 Attach complete site plan on paper not lass than 81/2 x 11 inches in . an must include, but CO ARCEL I.D. i not Amited to vertical and horizontal reference point (BM), directio % of slope, scale or dimensioned, north arrow, and location and distance to nearest r ad. f j dAPPLICANT INFORMATION —PLEASE PRINT ALL INF RMATION JU r ev)), DATE PROPERTY OWN R: 7ds11Q tU idA l� PROPERTY LOCATICKII OOVT. LOT Z. VI 1II,S T 36 .N.R 9 E (or) W P OPERTY OWNER'S MAIUNO ADDRESS , 1 LOT • BLOCK s BD. NAME OR CSM s OI WA l CITY, STATE LP CODE PHONE NUMBER Il LA(iE OWN s PN N fors iK New Construction Use IA( Residential I Nunrtber of bedrooms UPJV I J Addition to e>asting building J 1 Replacement (J Public or corralercial describe Code derived daily Ilow gpd Recorrvrtended design loading rate 0 , bed, gpd/"2 .6 trench, gpoltt2 Absorption area required bed, ft2 trench, I1:2 Maximum design loading rate 0.1jbed, gpd/It2 0.6 trenchgpdrn Recommended infiltration surface elevatioR It (as referred to site plan benchmark) ns)2 Additional design / site considerations. E„tCN ES ' •rQ6,1Gt.>R tC0be! j , Nf kA z Parent material Flood plain elevation, it applicable It U :Suitable ntable fora stems ❑ V rN ®S D ❑ U S ❑ URE ❑ U �r ® S ❑ U c ❑ SHOLDCR U Boring ;M Ground elev 10a ft. Depth to Wiling t, Boring # Ll Ground NAI IL Depth to limiting f tor, 6 SOIL DESCRIPTION REPORT =M0 s. .. .. •_ a .. ®® '.. :..: :. ..:. mmmm "m ®4 ®Muzm= a ® ' Is Warm, `..ter \/.��■i`� Remarks: Ulm M, ®® 6 Remarks: T Name:—Plsus Print 9ANLYO un! S ON Plane: nu: ,O. 7 2r 9� SpData: 5-26 - Asr CST Number .34 00 �rJdLk 144A4 SOIL DESCRIPTION REPORT Pape z of 3 n3o -�os4 -16 Ground elev. It Depth to imi6ng Boring # Ground loev zft. Depth to khting Boring # Dammam Ground /oZ s� Depth to limiting fac Boring # 13 Ground elev. _It. Depth to limiting facWr Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Bw-dary Roots GPD/1t Bed re h O-8 Jove, ScrM l 5 JS 0. 4 6.5 -27 lU�124 3 -- SL Q r M r CS 2-7 04 6S $ 7 7 I Y 4 -- S n, �,- w S 0.0 & 697 -gyp, 3 5 m Remarks: S, C .2 b.3 $ 4 -3o 1ov L ) n, s 64 M c5 1 Sr o.z `O r1% TCS 1 0.5 0.6 4. 3 `� S f►1 r IJ N -A /o /Q s 3 — C1,L yh M e-fr c s Remarks: �M • ®®®M®.I • MM Remarks: Hemarks: S8D-9330(R06A2) r woob, Irfricr LlNr fi c-r �, lh Ih EN �E d Svs� n, �L.�JkTID�1S PRn?a2TY LrN� ) 90 �t "fn &-s-s L4 ec —�pfL"Qii ANY �o d g.z ro 3 $ _ - 5 a Bt,x4NA Z K-TaQ of IkW ki r►J 1J W PA4c3t3R3 �� `' S� ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 January 16, 1996 Hartman Homes P.O. Box 326 Somerset, Wisconsin 54025 ATTN: Becky RE: Septic Inspection for John Haag Property Located at 1450 Ridge Run, New Richmond, Wisconsin Dear Becky: An inspection of the septic system for the above address was conducted on November 16, 1995. This property is located in the NEh of the SE' of Section 23, T30N-R19W, Town of St. Joseph, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. Should you have any questions, please do not hesitate in contacting our office. Sinc ely, mes K. T / psdn Assistant Zoning Administrator St. Croix County, Wisconsin mz STC - 104 n� 7 AS BUILT SANITARY SYSTEM REPORT 19 OWNER��j 9l nR ADDRESS /// l3 ,oft j P 1 '\ SUBDIVISION / CSM# LOT # SECTION.23_T, Y�)_N-R_2�Z W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Q INDICATE NORTH A Provide setback and elevation information on reverse of this foz Provide 2 dimensions to center of septic tank manhole cover. 1 BENCHMARK: �"Z „� Zc .c ZZ / ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: i,,- " Liquid Capacity: Setback from: Well��e House Other Pump: Manufacturer Float seperation Alarm Location Model# Size Gallons/cycle: SOIL ABSORPTION SYSTEM Width: �� Length S2 Number of trenches Distance & Direction to nearest prop. line:f�,/ Setback from: well: House-,Z4 _ other ELEVATIONS Building Sewer 9`/(lc7- ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold_ Bottom of system y 3 _' Existing Grade l_,? Final grade 9Z,,? DATE OF INSTALLATION: -� PLUMBER ON JOB:-4.� LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, Labor and Human Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Perth itt Hoolder''sNNa City ❑ Village [1 Town o rOHN X CST BM E ev : Insp BM E ev.: BM Description: St jese�p-- / , 1lGv.�6; Sa„-e Qs %-(; TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto Air Intake ROAD Septic z 30r NA Dosing NA Aeration NA Holdin PUMP / SIPHON INFORMATION Mahb4t.,urer emand Model Num G M TDH , ift I FrictionLoss S stem TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: ST. CROIX Sanitary Permit No State P Parcel Tax No.: STATION BS HI FS ELEV. Benchmark 0.0 /Ll) . 66� Bldg. Sewer US r St / blf Inlet St / k t outlet s ii7 95190' Dt Inlet PO Dt Bottom HeadertkCaa lo, 7' S/53/ Dist. Pipe 61,131951517' Bot. System Final Grade K� Sl s0 BED /TRENCH Width / i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth el SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM ING u aRurer: INFORMATION C HAMM e I N umar.— Type Cc«v System: /Q,caf >7 �5 SQ OR IT DISTRIBUTION SYSTEM Header / Manifold 1 Length ZL Dia Distribution Pipes Length �P Dia � Spacing a Size x Ho a Spacing Vent To Au Inta e - SOIL COVER x Pressure Systems Only xx Mound Or At -Grade S s Only Depth Over Bed FTAwah Center /Q - �fl Depth Over / Bed/ic#AiII 4 .2 xx Depth Of Topsoil x Seeded /Sodded Yes xx Mulched 1 ❑ ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: /St. Joseph.23.30.19W, NE, SE, Ridge Run �C(1� )6114�4L-7( ez Ly(CC.� �rh� Li cars .rJ/6/ / q� Cif a.X.�'+� . •t-f7�-rr'1 u-1s7 Plan revision required? ❑ Yes Vq-#o (J v Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Sig ature Cert No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: nd gs i:•iLHR SANITARY PERMIT APPLICATION Safety ofBuilldmgWaterDivision 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. YZ • See reverse side for instructions for completing this application State Sanitary Permit Number et_o The information you provide may be used by other government agency programs ❑ C d re swn ID previous appl"tion nr> , IPnvacy Law, s 15 04 (1) (m)) State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert Owner Name Property Location 114 - ti4, T N, R or& PropertyOwner's a g ess Lot Number Block Num r 7r Gt State Zip Phone Number 112 Subdivision Name or CSM Number ACode I. YPE OF BUILDING: (check one) ❑ State Owned ❑City Village Neares oad Public 6n 1 or 2 Family Dwelling - No. of bedrooms __:z_ ❑ tj Town OF III. BUILDING USE:(If building type ispublic. check all that apply) Parcel Tax Number(s) 030 — lOS'�- �0 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. M Replacement 3. ❑ Replacement of 4, ❑ Reconnection of S. ❑ Repair of an ------ System --- _-System_-__- ............. Tank Only ExistingSystem _ -_--Existing System B) ElA 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. Final Grade Goa Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Ml /i ch) El7. evation Feet 9r 3 Feet VII. TANK Capacity INFORMATION in galIo S Total Gallons # of Tanks Manufacturer's Name Prefab Concrete Site Con- Steel Fiber- glass Plastic Exper App New Existin Tanks Tanks strutted Septic Tank or Holding Tank - ❑ ❑ ❑ ❑ ❑ I itt Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 'tal!pti9Qojtq I, theiijnclersigne4, assume responsibility for i ons a sewage system shown on the attached plans. Plumber' Nam . (P Plum r' gna am s) MP/MPRSW No . Business Phone Number: P umber" Address (Street ty, St , Zip C ): dl IX. COUNTY / EPARTMENT USE ONLY ❑ Disapproved Sam ry Permit Fee (Infl o"G`ov,,d Mel ate Issuedssumg A nt Signa re (No a Approved ❑ Owner Given Initial / (�j��"`chargerK) O / Adverse Determination V te 9 X. CONDITIONS O/F APP� VAL / REASOfjS FOR DISAPPROVAL: , ' 115. WD-65re m veryai DISTaIaUTmn: Cnsp „i to eouni , 0 a copy To: s.n.rT a xuad.nq, M..:.o.. 0..,,.,. Pr,.mb.r INSTRUCTIONS 1. A sanitary permit isvalid 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 (SOD-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 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. 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. Vill. 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 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 SURdHARGE 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. rPw 7�� oC7 6 of LabdraidHu angel bons Industry, SOIL AND SITE EVALUATION REPORT Lebdr and Human Relations Division of Safety S Buildings in accord with ILHR A4 n5 Wk Arim f%nrin Page _L of f COUNTY . Attach complete site plan on paper not less than 8 1/2 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. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPE OWNER: PROPERTY LOCATION GOVT. L 1/4 1/4 T N,R(a�ffl PROPERTY OWNE ' ILINGA SS LOT # BLOC # SUBO. NAME OR CSM # / CITY STATE ZIP CODE PHONE NUMBER ( 1 ❑CITY ILLA E JUOW NEAREST ROAD [ I New Construction Use J" Residential / Number of bedrooms [ ] Addition to existing building K Replacement I I Public or commercial describe Code derived daily flow 4nn_ gpd Recommended design loading rate —.�bed, gpolft2 / trench, gpdrtt2 _�trertch, Absorption area required bed, 112,I r�o trench, ft2 Ma)dmum design loading rate Lambed, gpdm2TT�, 9Pdlfl2 Recommended infiltration surface elevations) ,�� G� It (as referred to site plan benchmark) Additional design / ' considerations Parent material _ Flood plain elevation, it applicable It S = Suitable for system U= Unsuitable for stem CONvefnONAL IM Srill MOUND 0 S ❑ U IN -GROUND PRESSURE 14S ❑ U AT -GRADE fZ S ❑ U SYSTEM IN FlLL ❑ S LAU HOLDING TANK ❑ S Oil Boring # 13 Ground elev. ,QL-ft. Depth to limiting factor -Z,!?-- Boring # 13 Ground 9� ft. Depth to limiting factor - 422 SOIL DESCRIPTION REPORT =W �MM -W�� PROPERTY OWNER -2 ,12,11AI, SOIL DESCRIPTION REPORT of. PARCEL I.D. # Boring # Ground elev. 3 -zw Depth to limiting factor Boring # Ground eiev. ft. Depth to limiting factor Boring # 13 Ground elev. ft. Depth to limiting factor Boring # U Ground elev. Depth to limiting factor MI'Al MM Qnmnrkq Rpm.qrkq- lomnrkc Remarks: SBD-8330(R.05/92) .�C.cSia Nk'�� S� S/E� �-�j�3Orll�Fi�dJ .� 9-.ev IAe - , /,:, l �: .�ayllgre rs ,rie'+e� leu hoe 4asc v �%kN tau llsr�a3�y y LA s__ fir tf�tr' I � 33' y5l/ i jc�--4 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT i St./Croix County OWNERBUYER MAILING ADDRESS PROPERTY ADDRESS septic systems Please optain from the Planning Dept. CITY/STATE PROPERTY LOCATION & 1/4, ,<,F 1/4, Sectiono�, T__.a�_N-R__A_9_W TOWN OF rlc�i�ifl 9 ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MAP _,VOLUME , PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a matey plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three y expimtA o date. SIGNED: I DATE: 17A5' St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 STC- too This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. -------------------------------------------------------------- ---- owner of property aid Location of property a 1/4,_f�1/4,Sectior.2,TN-R Lq W Township ��fp�/ Mailing address Address of site Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? >< Yes _ No Is this property being developed for (spec house)? Yes No Volume Z422 and Page Number :Z/Z� as recorded with the Register of Deeds. ------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. S73 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. gna ure c5f 4pl5licant bhll/ Date 6f Signature Co -Applicant ' l/WK' Datk or Signature