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Home My WebLink About040-1227-90-000J� ST. CROIX COUNTY ZONING DEPARTMENT 0, I 'n AS BUILT SANITARY REPORT rw Owner Address oI cl(z� City/State Legal Description: Lot 9 Block — Subdivision/CSM '/4 /4 , Sec. _, T N-R W. Town of PIN # 'ry SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer UjI' 4-s �e f, Size STW/2o*-(-�/ Setback from: House /2- Well P/L >'Oi (N Pump manufacturer Model Alarm location DING TANKS ONLY) ic Setbac service road io Meter loc�atio Alarm location Vent to fresh air intake Water Line SOIL ABSORPTION SYSTEM: Width 3 Length Number of Trenches Type of system: (-enL IA- Setback from: House Well 0 P/L � 2 5' -- Vent to fresh air intake ELEVATIONS: 314� 11 1 a 1-v Elevation Siv, b?, Description of benchmark UJI� Elevation Description of alternate benchmark ----------- Building Sewer . ST/HT Inlet ST Outlet PC Bottom Header/Manifold Distribution Lines ( ) Bottom of System ( ) Final Grade ( ) PC Inlet Top of STIPC Manhole Cover 3 State plan number Date of installation Permit numberL31 iWA, License number C� I Date 3 12 0/ as Plumber's signatures-i - ).e Inspector Complete plot plan Or I ■ Wiscon.-Jin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes (Privacy Law, s. 15.04 (1)(m)]. Permit Holder's Name: [:] City D Village N Town of: NEUENSCHWANDER, ROBB & LAURA TROY CST BM EleT. I insp. BIVI Elev.: I BIVI Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosi ng Aeration Holding TANK SETBACK INFORMATION TANK TO I P / L WELL BLDG. Ventto Air Intake ROAD Septic A 1q, I NA Dosing Aeratio A Holding PUMP/ SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft I I Loss We a d Forcemain Length Dia. I I Dist. To Well SOIL ABSQFLP,,,,,TION SYSTEM ELEVATION DATA County: Sanitary Permit No.: ST. CRO 338951 State Plan ID No-: Parcel Tax No.: 040-1227-90-000 L7__j .7 U U dn U U IN, �PdION BS HI FS ELEV. P) VeUmark 01 q. 121 61 l g ,9� y2, 7 � �' 3 Bldg. Sewer , Z� Ht Inlet Ht Outlet . d U (�3 `�, �O Header / Man. S � 7 Dist. Pipe Ti � 3" I q? Bot. System -t 1/1, A-? 3s: so Final Grade '0011t aw_ BED NCH Widt No. 0 rench—es PIT No. Of Pits inside Dia. Liquid Depth l=_S"��, DIME DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu�fctur r'. INFORMATION ce�� Type Of �.Ir 11 6 � Model Number: L System.-r0y-.,Q I 0 DISTRIBUTION SYSTEM 12- Header / Manifold Distribution Pipe(s) I x Hole Size x Hole Spacing Length 2,0 Dia. Length _?�!5 Dia, —3 Spacing Aj� 6j+ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Vent To Air Intake Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil El Yes [I No ❑ Yes No COMMENTS: (Include code discrepancies, persons present, etc.) P 1 LOCATION: TROY 13,28.20,1117 296 SALISHAN DRIVE — SALISHAN LOT 9 > eA* 0' 4 0 o 044k &ek ivcl� -(ovaay(&),N r to of'l or 'Of h0p 4,*,depr Yre Je&.�A000' Plan revision required? Z Yes 0 No' -7 Use other side for additior a, information. f SBD-6710 (R-3/97) Date Inspector's Sig5FU'_"e_ Cert No IX I Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. 'Washington Avenue Nvils,consin Wis. Adm_ Code P 0 Box 7302 In accord with ILHR 83.05, Department of Commerce Madison, WI 53707-7302 * Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. - "` State Sanitary Permit Number 9 See reverse side for instructions for completing this application 33 Check it revision to previous application Personal information you provide may be used for secondary purposes 1'y [Privacy Law, s. 15-04 (1) (m)]. I State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Location Prope owner Name 1/4 S T. N A? R �Z 4L adro i PropJty Owner's Mailing Address Lot Number Block Number City, State Zip Code hone Number Subdivision Name or CSM Number 9 hL_ Ye i t c Nearest Road II.- TYPE OF BUIL13ING: (check one) E] State Owned --..A - 05=*4 L..Ej Public kS- 1 or 2 Family Dwelling - o. of bedrooms own OF ow� 111. BUILDING USE: If building type is public, check all that apply) Parcel Tax Number(s) 1 Apartment/ Condo 641 1,24 2 7 - 70 2 ❑Assembly Hall 6 F-1 Medical Facility/ Nursing Home 10 [] Outdoor Recreational Facility 3 Campground 7 n Merchandise: Sales/ Repairs 11 E] Restaurant/ Bar/ Dining ❑4 Church / School 8 F1 Mobile Home Park 12 E] Service Station / Car Wash 5 F] 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) New 2. 0 Replacement 3- E] Replacement of 4, E] Reconnection of 5. [:j Repair of an A) 1 System System ❑ Tank Only Existing System Existing System --- ----------------------------------------------- --------- -------------- Date Issued Permit Number B) A Sanitary Permit was previously issued. V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 [:] Seepage Bed 210 Mound 30 [-] Specify Type 41 L] Holding Tank 12;& Seepage Trench 22 F] In -Ground Pressure 42 [] Pit Privy 13❑Seepage Pit 43 Ej Vault Privy 14 ❑ System -In -Fill - V1. ABSORPTION SYSTEM INFORMATION: 1. Gal 1 0 ons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5- Perc. Rate F. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq- ft-) (Min./inch) Elevation. Feet we /000 TF jb=a 157�4 Feet s4yl. 6 Vil. TANCapacity K in gallons Total # of Prefab. site Fiber- Plastic Exper. INFORMATION ' I Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New strutted Tanks Tanks El El El ❑ Septic Tank or-noidingaT-snk /,2-u ep J.X r. Si El El ID Lift Pump lank /S'ubon Ch I amber ❑ ❑ ❑ 0009000� Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. 's Name: (Print) Plum PI s S ignat i (No Stamps) Business Phone Number: * C 22 Y 410- 1- Plumb 's Address (Street, city, State, Zip Code): C4 eL 2 41 '1 IX. COUNTY / DEPARTMENT USE ONLY E] Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin nt Signature (No Stamps) Surcharge Fee) ffApproved 0 owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL l REASONS FOR DISAPPROVAL: r s �' � t 7 or SBD- 6398 (R-11197) DISTRIBUTION: Original to county, One copy To. Safety& BuiltiingsDivi�ion,owvner,lumber Witsconsin Department of Industry, SOIL AND SITE EVALUATION, REP-ORT Page of Labor and Human Relabons OV*.;Jown of Safety & 1361dNs in accord with ILHR 83.051 Wis.. Adm. Cade COLT NrTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in si'ze.,�" Pla'n �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. \Zz _C)Q _000 REVIEWED Y DATE APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION PROPERTY OWNER: F17 PROPERTY LOGAT-PN, LP�JraA K�V_70EN'� C. A GOVT. LOT 1/4 1/4,S IT N R E 'OU C N PARCEL L R R 0 V REVIEWED 0Q) PROPERTY OWNER':S MAILING ADDRESS • LOT BLOCK# SUBD., NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE GOWN NEAREST ROAD New Construction Use N Residential / Number of bedrooms Addibqn to existing building Replacement Public or commercial describe Code derived daily flow C� t3 gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorpton area required 6 G Vz bed, ft2 � S 13 _ trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Rewmmended infiltration surface elevation's) fi=-Ss S::) ft (as referred to site plan benchmark) Additional design / site considerations 13-ni%j � `' l G 1� PST --) S Parent material SZ;bNv1QVT- OVA S 4- G�- Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE I SYSTEM IN FILL HaD ING TANK U = Unsuitable for system21 S El U 21S[] UES E1U RS Elu 2S EILI I El S [RU Ground elev. 3qL11fL Depth to limiting factor > k �2s Boring # Ground elev. fL Depth to limiting factor SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Texture Consistence Barcby Roots GPD/ft2 B ed rFb-& in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. c� 2, L Z_ L z��b� \Yvv ckj S -3 .� 3 Zq sz - Y�y e.-C-5 C) A NcsTF= - g tUt��u�fi �S � �E -r 13Vt�C 1::-*,1 soy L � 3` w 1S a jkl)Aj NJ B� � p\j 11L�i� 1ki Remarks: 3\__�Q NZJFPO��_r AiLl Mc_,_ :m'z 4-r��uJLLW CU do 0 L S L4'1S 1Z-U leJ j Remarks: CST Name. --Please Print Phone'. 715-425-0165 ArthurL. Weg_erer Soil Te,,sting & Design Servi ce—P.0'. Box 74 River .Falls WI 54022 g'e`e�erer Signature: Date: CST Number-. Yaogii_4A�_ a — zt-4 00 2 2 022 54 Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue sconsin In accord with ILHR 83.05, Wis. Adm. Code P 0 Box 7302 Department of Commerce Madison, W1 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less than 8 112 x 11 inches in size. Count • See reverse side for instructions for completing this application State Sanitary Permit Number 3 05 FC� 53 Personal information you provide may be used for secondary purposes 0 Check it revision to previous application lPrivacy Law, s. 15.04 (1) (m)]- State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop ejAy Owner Name b Property Location 1/4 1/41S TA F N, R ;?6 b �. A I �" . i� +�. ' _ k Property Owner's Mailing Address Lot Number Block Number �IA.Ckkdf CIA 57',o City, State Zip Code Phone Number Subdivision Name or CSM Number m N 11. TYPE OF B ILDING: (check one) El State Owned r`4 Nearest Road f(feve [_1 Public amily Dwellin No. of bedrooms 1a 1 or 2 F g I Town OF /T eO V 0:(:: Ill. BUILDING USE: (If building type is public, check all that apply) 1,22. va .0 SOO . 1116001 Parcel Tax Number(sf 1 [] Apartment/ Condo 2 F-1 Assembly Hall 6 [] Medical Facility/ Nursing Home 17 [-] Outdoor Recreational Facility 3 E] Campground 7 n Merchandise: Sales/ Repairs 11 E] Restaurant/ Bar/ Dining 4 ❑ Church I School 8 E] Mobile Home Park 12 El Service Station Car Wash 5 Hotel / Motel 9 [] office / Factory 13 Ej 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. E] Reconnection of 5. 0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 F1 Seepage Bed 21 F1 Mound 30 El Specify Type 41 E] Holding Tank 12P9 Seepage Trench 22 El In -Ground Pressure 7 1�7 42 [:] Pit Privy 13 [:] Seepage Pit 43 E] Vault Privy 14E] System -In -Fill 4 !L� VI. ABSORPTION SYc*,YFM INFORPAATION: 1. Gallons Pe7rDay 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5- Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) G Is/day/sq. ft.) (Min./inch) Elevation * 'oo 060 1 F3 7,50 Feet i 8 4/ /. 0 Feet VI I. TANK INFORMATION Capacity in q-11ons Total Gallons # of Tanks Manufacturer's Name Prefab. Concrete Cone- Steel Fiber- glass Plastic Exper. App. New Existing strutted Tanks Tanks 0 1:1 1:1 1:1 1:1 Ehgmt� r El El El Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. tuber's Name: (Print) ?4Vr : Plo-ni*r'sSignatu e (No stamps) MPS o--..- Business Phone Number: I Ar ra 4 V, C/ Plumber's Address (Street, City State, Zip Wel: &V-16 1 .5 1- L) t:, P, R IVI IX. COUNTY / DEPARTMENT USE ONLY 0 Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Age!15k Signature (No Stamps) I60_0_Surcharge Fee) dApproved E] Owner Given Initial 01c�)_ Rime Adverse Determination CP,0:)3- too R X. CONDITIO OF APPROVAL / REASONS FOR, DISAPPROVAL: 67 4. L 6 SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To. Safety & Buildings Division, Owner, Plumber tj et q q VIP, YVI- Ala r' 1 k F A` 8 ly 22 P/o !S c. c? / c / , ft--, ,- t C) 000" CPUs e Gtp�a a� 1 il /C;zr 4Y4 IC 7a �, pr�v�ulu� Wv-,op.-isin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of t-L - r and Human Relations Divisiori,of Safety & Buildings in accord with ILHR 83-05, Wis. Adm. Code COUNTY NZAD IX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point {BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: \-\K�ZV �3T3Q I q rQ> PROPERTY LOCATION -S -vt—'— 0--3 C. t> GOVT. LOT 1/4 1/4,S 13 T Z t-S N,R E (oCW,)_ PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# SUBD. NAME OR CSM # e Cl Sty 'Isiihw CITY, STATE ZIP CODE PHONE NUMBER [:]CITY []VILLAGE KFOWN NEAREST ROAD ,a Lj k��7Nz' 716V k--� C'- -S q o 1-Z n J.5) 41 Z. S'. Z:1 S 0 U g yqz Pt o New Construction Use Residential / Number of bedrooms L4 I Aft6Qn to existing building Replacement Public or commercial describe 4 Code derived daily flow 6 o 0 gpd Recommended design loading rate 0 -bed, gpd/ft2 0 - � -trench, gpd/ft2 Absorption area required �zu p _ bed, ft2 k)o 0 trench, ft2 Maximum design loading rate C), S bed, gpd/ft2 0. (a _trench, gpd/ft2 Recommended infiltration surface elevation(s) -S � r- 73 ft (as referred to site plan benchmark) Additional design / site considerations EZ'D �` s P'-s R� 0 " *1 (1::) . Parent material sk�-n Set) 1v4ilxjr o L sN)%j't> 4 Flood plain elevation, if applicable N - � ft S = Suitable for system I GONVEN71ONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TAW U =,Unsuitable for system I M S 1:1 U 10 S El U 1 19 S 1:1 U I NS El U I EIS Elu 0 S [OU I Boring # Ground elev. � - 0 ft. Depth to limiting factor 0 y Q 4'k Boring # Ground elev. qa -.e7 ft Depth to limiting factor ti . 9n SOIL DESCRIPTION REPORT Horizon in. in. Dominant Color Mansell MottlesTexture Qu. Sz. Cont Color Structure Gr. Sz. Sh. Consistence Bounday Roots G P D/ft2 Bed Trierch 4A _S 32-S-1 V i ('1)y Remarks: -k Z Z- cus --Z S c" Q's c'N 4, Ic �jp > P Remarks: TName:---Please '\U CST Name: —Please Print Phone: Arthur L. We A-e'> 715 -4 2 5 -0 16 5 egerer s Soil Testing & De ign Service-P.O. Box 74 River Falls,WI 54022 SS�Signature: ignature: Date: CST Number: M00576 PROPERTY OWNER CA-A)1*--) SOIL DESCRIPTION REPORT PARCEL I.D. # Page. of -3 Ground elevr q cj ft. Depth to limiting factor %-.. r% r*-. Boring .:� J Ground elev. ,$(Ak -I ft. Depth to limiting factor - 7 9" Z� Ground elev. �,-A � -") ft. Depth to limiting factor -7SS Boring # Ground elevr ft. Depth to limiting factor - Horizon Depth in. Dominant Color Munsell Motdes Cu. Sz. Cont. Color Texture Structure Gr, Sz. Sh. Consistence Bourbary Roots G P D/ft2 Bed Tmr& \Z L S bk OL, iZ- 3 )6 5 J y Z. Y C- q/y M 0,1 0 fda 10 Remarks- kv L -Li -S rz, %I o,s lo,6 A A tv9 Remarks: %a�a �a� z �. — s`n '�- C4, L -Z ZZ L) S Y R- Ll Liz .86 • U, Remarks: 0 U 4 C ok.� �-n Kj ttj ou NY) S Vhj*Q -#U f- T)i es -3� E711 Remarks: SBD-8330(R.05/92) L,6zz�- �7NZt`lJ S mD . G5T Signature PLOT PLAN SCALE 1 Lod" 1� Z lti.1'E Page :2S of L-- Qj Gam.. sq t = 2 Oki.00, C13-0 3 - Ot Date Signed Telephone No. CST # Phone: 715-684-28 74 May 13, 1999 Mary Jenkins Zoning Department 1101 Carmichael Rd. Hudson, Wisc. 54016 1960 81h Ave St. Croix County Land and Water P.O. Box 95 Conservation Department Baldwin WI 54002 Fax: 715-684-2666 Re: Erosion Control Plan . Lot #9 of Salishan Subdivision Mary; I have reviewed the revised erosion control plan for Lot # 9 of the Salishan Subdivision. I was also onsite with Bruce Lenzen on May 13, 1999 to get better acquainted with the entire layout. The erosion control plan submitted to me is satisfactory for this site . The only comment I would make is that the rock fill basin shall be constructed on the south side of the setback line and proposed silt fence and that all exposed areas shall be seeded and mulched immediately after construction. I would recommend that a sanitation permit could be issued for Lot # 9. Respectfully; Robert Heise Cc: Bruce Lenzen L 'CEI VEti 1999 ST pok CO(J#Vry OFFPCE N� ;> 145tC;t May 7, 1999 Mary Jenkins St. Croix Valley Zoning 1101 Carmichael Hudson, W1 54016 Re: Erosion Control Calculations — Lot 9 Salishan Drive,, Hudson, Wisconsin Enclosed are calculations for lot 9. Salishan Drive, in Hudson, Wisconsin for your records. A copy has been forwarded to Bob Heise. If you have any questions, please let me know. Sincerel ,nc rei Bruce G. Lenzen President BGL:Iwc Enc. LOT 9 SALISHAN, HUDSON, WI AREA "A" CALCULATIONS Area "A" = 615892 Sq. Ft. of Lot Area x 30% I + 110722 Sq. Ft. Roof Surface Impervious -100% + 642 Sq. Ft. Driveway Area Total Area - Square Feet X 10 year event 4.2 " per Sq. Foot or X .3 5":=Total Amount of Water from 10-year Event May 7, 1999 2,,067.60 sq. ft. + 11 722. 00 sq. ft. + 642.00 sq. ft. 4,431.60 sq. ft. 1,551.06. cu. Ft. AREA "B" CALCULATIONS Area "B" = Lot area 11410 sq. ft. x 30% 423.00 sq. ft. I + Roof Area 100% +792.00s Total Area 1,215.00 sq. ft. 10 Year Event x .35 cu. ft. 425.25. cu. ft. AREA "C" CALCULATIONS This water is flowing away from the St. Croix River per development drainage plan. Area "B" = Lot area 3.,553 sq. ft. x 30% 1,066.00 sq. ft. + Roof Surface 100% 480.00 sq. ft. + Driveway Area 100% 742.00 sq• ft. Total Area 2,288.00 sq. ft. 10 Year Event x .35 cu. ft. 800.80 cu. ft. BRI-j(-"E LENZEN IN TEL : - 1 '5 - 8 ('� I q C) C) E L ,) - - - - ST CO M COUNTY SEPTTC TAM�-, MA1N7.rNANCZ,- AGREEME',NT AND OWNERSHIP CFRT17TCATION FOB a- ONNMCT�Buyer Mailing Address Property Address a n n - (Verification requued frara plnnt Dtpar#mt�nt for new cnnArmction) 9 (0 Ck V1 by ve., City/state Az..'< -r Parcel Identification Number 0410 LEEAJ:�5fW N Property Location N�V114., IU i�'l 114; Sec. T N-R c")V W, Town of Subdivision A-1 Lot # Certifled Survey Map # Volume Page 4 ;L jum1.3 Page 4 Warranty Deedw.Vo e Spec housc, Cl Yes r no Lot lines identifiable X yes 0 110 5=Nf MMMHANLE Trapmpmune and mointoriii-Occ of Your its prenja=i: fafluri�tn handle wastes. Proper mauateriance cczjjzw of pumping out the sciatic =k every tbrrc years or sooner, i-f ceded by ti licensed pumper. What you put ftita the SYStOra cvm affect the f4nctiart of the septic tank as a treatment stagc in the waste disposal 9y%= ne property owner agrees to submit to St. Croix Zo=g Department 4 cerdficafina fog,, Biped by the owner and by a inasterpluraborJoumeynian plumber, .resm'ictin d plumber or a lice wtdpv=per vG�s that (1) the on -site wUtCWi4WTdiNPm141 oystem is in proper operating conditioa and/or (2) after inspection and pumping if ner-r,559ZY). the Septic tank is less 1/3 full ofsludge, I/we, the undersigned have read the above requdro,-mcnts acid agree to maj�tain the pvivatr, Scw;jgc disposal system with the s=dar& set forth, herein, as set by the DepaMent of Commerce and the Deputme-at of Natural Resaumes , State of Wiscon-siu. Ct!rkficaticn C ty sta that your septic system bAs betu maintainco roust be completed and returned to the fit. roIx CounZoning Office within 30 day f dic three ym- X-TU36on date. �L//5/ 23 NATTIRE OF A,?PLICA-NT ID ATE 0W"fl CERIMCAIJON I (we) certify that all statementn an this form = true to the best of my (our) knawlodgc. I (we) am (arc) the OVYmcr(N) Of the prope�descrfbed above, by virtue a a warranty deed recorded in Register of DeC4.5 Office. 41L, A- SIGNXTURk-OF A.PPLICANT DATE * 0 * 19, 1"* Aay informa-don fat is nu'q -represented may result in the sanitary permit being revoked by t�e Zoning Department. 100 Include with this applicattan; a st=ped warranty deed from the Register Qf Deeds office a copy of the certified survey map if reference is amde in the wiry deed