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HomeMy WebLinkAbout018-1032-40-000 M ti O °va v o N d a' I ° I o N i N (Ud O~ O ti Q ozs U O N d C Z O N N N H a N Z C LL C U O O O C C w - M O 'O N MO Q N U O M C z o - o I ~ v L CL" m c C7 O Z a l c N aoi Z a ! ° ~ I C5 P r N a~ E N O O O O LO 7 m N - C (n C (D N O O O O N • N ~ - M ° U-) M d U 2 N N z~Z z° N Z o w N O CO U) m Q = 0 H _ I w d N m u i O ~ a v u) (n to n` w~J c ~i a Z _ Cj a a a o O ° O rn rn } m J U Cb rn rn Y N O tO O O N 0 CD O M n o co c d cD N N ~ 'O N N Cl) N Q to cb Ca O Iii, C 7 O 0 O C m y C 00 co 3 O O+ M~ N N C C U d °O co:) U j N U Y Y C N N O C m C C C C N 4.i M O M O N 7 r- (0 M 1..1 M' N N m a0.+ 7 Z' •N O r_ O N O Z N (n V] y is CD a • o v ,2 `m y c rr`~~v E ~ c c ~ ~1 A Ua~ ',0 n0 ST. CROIX COUNTY WISCONSIN ZONING OFFICE INN rr p e a r a~.■i ST. CROIX COUN Y GOVERNMENT CENTER r,,• 1101 Carmichael Road - Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test (s) x remit appropriate fee with w application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $185.00 Septic $50.00 0 Water (Nitrate & Bacteria) 45.00 4/Nitrate & Bacteria J Water (Lead Concentration) 21.00 retest $15.00 0"- Owner: ~'Ihl 01,561I Requested by: ~r c~ rs~ Address: Address: rq Ji.ZIP l,J; ZIP/(1 Telephone N4: (Zi Z - Telephone N4: 44 Property address (Fire W & Street) : s? Co X Location: ALP Sec. , Ta`) N, R /7 W, Town of Ham.-"ol? ~61 14 Realty firm: 6wotrS LOClBox Combo: Closing Date: is. z 9. a3ia 019-103A-410-0400 TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: 11o A 42 Is the dwelling currently occupied? Yes ❑ No If vacant, date last occupied: Age of septic system: Septic tank last pumped by: Date: `7-a.-4o~, Previous Owner's Name (s) : _ epber+ - Bonnie i/6Z12p-er5 Have any of the following been observed? ❑Yr & Slow drainage from house. ❑Y ON Sewage Back-up into dwelling. ❑Y (RN Sewage discharge to ground surface or road ditch. ❑Y 19N Foul odors. Other comments relative to system operation: r e dIL .filth 0,&E I certify that the above information is complete and true to the best of my knowledge. ~ 7 OWNERS SIGNATURE: J~~f1I 1 DATE: 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN a~ Aa ' TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ❑No Soil series per SCS Soil Survey: sheet # Type of soil absorption system: ❑Below grd ❑At-Grd ❑Mound Approx. size 'X ❑Gravity ❑Dose ❑Pressurized Ft .2 ❑Bed ❑Trench ❑Dry Well ❑Holding Tank ❑Outfall pipe OBSERVED DEFICIENCIES ❑Other ❑Unknown Septic tank Setbacks: ❑House ❑We11 ❑Prop. line ❑Other Dose tank Setbacks: ❑House ❑Well ❑Prop. line ❑Other ❑Locking cover ❑Warning label ❑Pump/Floats ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: ❑House ❑Well ❑Prop. line ❑Other ❑Ponding: ❑Discharge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector Title s yes i iNS~•¢~~~ l ASO- AS BUILT S STC - 104 ANITARY SYSTEM REPORT ~p- 2,3,P/ ~~~1~✓~ OWNER Ae//fAl 6900N Silt l S 7 C ADDRESS Zr A 0Aiv his, s~ SUBDIVISION / CSM# 411ti- SECTION1 5_T-j WTTownof~ LOT# y--- ~rov~ ST. CROIX COUNTY, WISCONSIN PLAN IIIVIEW SHOW EVERYTHING W 100 FEET OF SYSTEM N oTES 2 vCX t 5 7_1A.)6- jGQ T~'~4-~' "I ,07- T4,~,,s ~i ~ S~,vi '~1' a►,~. Ala f3.6 'S ^ R c ~ivEO INDICATE NORT to RRI~ ~ ~W Q 7 1997 Provide setback Y C~ C an elevation information on reverse of 2c Provide 2 dimens' this ions to center of septic- tank manhole cover. S 136 TI-ol-f BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBERHOLDING TANK INFORMATION Manufacturer:' Liquid Capacity: 4Ide - Setback from: Well 200 House ! Other Pump: Manufacturer ~ Model# Size Float seperation Gallons/cycle: Alarm Location / SOIL ABSORPTION SYSTEM Width: S I Length 60 Z Number of trenches c i Distance & Direction to nearest prop. line: ,70 C/~ • ~T Gii~21 Setback from: well:?2-00 House 32` Other i ELEVATIONS Building Sewer ST Inlet: ST outlet:-f6-37/ PC inlet / PC bottom -f Pump Off s' ~y - P5 . Header/Manifold 3 Bottom of system y~ ~vG Existing Grade 5'G . Sd Final grade Y~ 7% DATE OF INSTALLATION: PLUMBER ON JOB: P613 r ?Y 33 0 LICENSE NUMBER: • ~ ~ INSPECTOR: • P'~,/V S~ ~j ~✓~l.tTlr-~ ` 3/93:jt m 0% o TU rn C ~ Z a \n n n o v. '~-70 lei N~ p o H IN, o I ~ , y Z5 ~ b .K A ~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safes an~Buildings Division INSPECTION REPORT ST . CROIX T GENERAL INFORMATION (ATTACH TO PERMIT) SanitarMt1VY: Personal information you provice maybe used for secondary purposes [Privacy L s.15.04 (1)(m)), y 3i OLSO w, eBR A i/BONNY JO HEII*EMA qIAPIMUI~117age Town of: State Plan ID No.: CS BM Elev.: Insp. BM Elev.: BM Description: Parcel TaIBlo_:1032-40-000 loo TANK INFORMATION ELEVATION DATA A970020,8 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 2y~,✓ Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet , 76 6 / ' TANK SETBACK INFORMATION St/ Ht Outlet ,d J ' 6,3 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. D S~ 2. -7 q5 . ' Aeration NA Dist. Pipe ^ 1,/ Holding Bot. System U~ 96 PUMP/ SIPHON INFORMATION Final Grade Manufacturer -Demand Model Number GPM TDH Lift Friction System TDH Ft oss Head Forcemain Len Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / _2 ' DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O model Numer: System: 'c5D OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. 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 L,!'l Topsoil C] Yes E] No C] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HAMMOND 15.29.17.231B,SW,NW 957 CTY RD T u d- [vf, Plan revision required? ❑ Yes Co Use other side for additional information. - L G_ SBD-6710 (R.3/97) Date I pe or' gnature Cert. No. ADDITIONAL COMMENTS AND SKETCH r s i SANITARY PERMIT NUMBER: Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. Visionsin' In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County y~ L~1DfJ/- than 81/2 x 11 inches in size. • 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 ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number L APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION A,//~- Property Owner Name f~ Property Location (or W I,3 emA I OI S'6 v 3 1 /4 (dJl /4, S 15 T 21f , N, R /71E Proprty0wner's Mailing Address Lot Numb Block Number 'ii S 7 GT ~LL//+ //d-- Cit , State Zip Code 01-5 one Num r Subdivision Name or CSM Number WAMfto.u 6) wS - p )?v'2Vj S 1300--av_5 II. TYPE F BUILDING: (check one) ❑ State Owned o it rr Nearest Road 3 e 44 Public or 2 Family Dwelling - No_ of bedrooms Vown of tIA 4mOAJ D wy . T~ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) o~~-lo3z-fa 1s.2~. 17 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. 14 placement 3_ E] Replacement of 4_ ❑ Reconnection of 5. E] Repair of an System System Tank Only Exi sting 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 ❑ Se age Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 eepage Trench 22 ❑ In-Ground Pressure r- 42 ❑ Pit Privy 13 ❑ Seepage Pit 2 .rftw-44es, S/X(;o 43 Q Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: fj. „$'p , -z-.p f7, 5"o 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) F3,o , Elevation ~~d S~ &60 ti 7`f Fee F7.0 Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper- INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank OO~ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber / c-C.t~+ ❑ ❑ ❑ ❑ ❑ ❑ VI11. 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 Signat re: (No Stamps /MPRSW No.: Business Phone Num er: P_0 e)tjer -UL8~( cell. 330 7 1-7t5-30R110 -9195 Plumber's Ac dress (Street, City, State, Zip Code): Cos b' 'O.Qt'G , ,~so-J Gv/ S• s~~l IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signa r (No Stamps) >(JApproved Q Owner Given Initial Surcharge Fee) G ¢14 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R.11/96) 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 maybe 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, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. 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 iif 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. r , IX. County/ Department Use Only. X. County / Department Use Only. Complete+plans and specificationsnot smaller than 8 112 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. 4 ? a / AAIPv6,v i13OV011o-F S y.S`r . pasocts~ss 3 I oIdl SLt~PTtc T / ~avvD olbrlcht a cousuhav% i $eWt9 10 L7E.~l761~/~~i- 5 O~Netl ad 54o18 Hudson" Wls. co j~ir/o,, i SPif Wo' ~a I v ° .vow - R o ~ 30 /3 131 52Fp 1y' c 32, l3~RN ~ ? 2- P). eq Wisconsin'Department of Industry, SOIL AND SITE EVALUATION ! 3 Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 6 1/2 x 11 inches in size. Plan must County -5` y include, but not limited to: vertical and horizontal reference point (BM), direction and '~~C/~~l/~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # D~8 -103 2- y'D APPLICANT, INFORMATION - Please print all information. Reviewed by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 13,141,V1;5 G/S e ,v ~ Govt. Lot -5& 1/4 AJ 1/4,S T N,R /7 E (o W Property Owner's Mailing Address ©^f~ Lot # Block# Subd. Name or CSM# 3 ?s I`j CcCS• City State Zip Code Phone Numbeer/ Nearest Road L ~/~ND ~fl~• sy (~/S ) 7lC~ ~38~ ❑ City ❑ Village awn 7- ❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building 'Replacement ❑ Public or commercial - Describe: 0 T ti Code derived daily flow gpd Recommended design loading rate gibed, gpd/ft2 ' p trench, gpd/ftz Absorption area required bed, ft2 .5 3 trench, ft2 Maximum design loading rate NIA bed, gpd/ft2~trench, gpd/ft2 Recommended infiltration surface elevation(s) 's'ue P5 •3 ft (as referred to site plan benchmark) Additional design/site considerations ~AV~A&) J Parent material 5"fV,9l o c S 67 Flood plain elevation, if applicable it S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ~S ❑ U O-S ❑ U D-T- ❑ u C'- ❑ U aS'❑ U ❑ S C SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 31SL 2fshe S ~s 3f s;. 2 2,3- 45S /ten C S - . 7 : $ Ground 3 S G ^elev. Depth to limiting , factor rn. lpf Remarks: Boring # . ~ D i to - S~- ~fS~ S CS 3 f •S -G .5,1 _WA Ground elev. Depth to limiting factor in. Remarks: CST Name (Please Print) f-%._ Signature Tele hone No. K~ Bpi Zl~l3iP~47 _ 715 • 3 POPS Address Date CST Number 2 - ~ST~ 2 Z7 a Z ~ T e SOIL DESCRIPTION REPORT PROPERTY OWNER Page Z of PARCEL I.D.ff 0/~r ~0 3 2 Y~ Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots vp/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 / 0 -17 /0 3/3 IAt Cs z , z ; 3 Z i0 LIP .s<< z shy Ground 7 S L~ 1,441 ~j elev. 3c 7- ft. _AK Z~e 4"41 _10 49 Depth to limiting ; factor Remarks: Boring # Ground elev. ff. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Structure PD~ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground i~ elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: ~Ty, T 130VO,l o-F SYS-r . 97.o pasoclstes ~ 3 ~ oidl S~PT~c T• ~bvvD l tjoh co,gultante vj Jo e tgewsp y~,r>,~N6t~rJ o!> .t'T~6I+~~.~G prWsts 685 O Ne1W sa 54018 / Hudson, 1 3 - 106 - 13~D~M5 - ~ I 30' 13~,~~,,~y k 1 rl 3Z 2 v i t BARN r~ 3. ~S A~es x !7) c•-, Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12" Above Final Grade yF- S0 3& , Above Pipe - 4" Cast Iron 'To Final Grade Vent 'Pipe' Synthetic Covering min. 2" Aggr:i-T te Over Pipe Distribution Tee Pipe 0 0 0 0 , Aggregate o Pertbraled Pipe Below Beneath Pipe 0 Coupling Terminating At Bottom Of System y I3•5-b' G6 1 Fresh Air Inlets And Observation Pipe - Approved Vent Cap Minimum 12" Above Final Grade /fv j .0 4" Cast Iron 6 T C - 100 "Phis 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. ~ iP%4,tl So xlv %so,v (;eeVA1 j l,/fG 4~~ -o owner of property / IJ A) Ldcation of property 5w 1/4 yw 1/4, Section l-s ,T~7-/ N-R /7 W Township /riGJl 1galyQ Mailing address Address of site 5-a-ve- Subdivision name 44e- fS Lot no. Other homes on property? Yes No Prgviousowner of property Total size of property 3 .15 146V S 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 22- and Page Number ZZS 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. . and that I (we) presently own the proposed site Po-f~ t ewage 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. Signa re of Applicant Co-Applica Date of Signature Date o. ignature STC-105 14e%' SEPTIC TANK MAINTENANCE AGREEMENT p,vN Y r ~~foa n St. Croix County OWNERBUYER 13iPl~. /3 DtiA-1 Y 6/sQ•`J ~7 ! E MAILING ADDRESS 61' . A-d. ~f 'Af i PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~r- PROPERTY LOCATION Sc✓ 1/4, S&) 1/4, Section ~J T_2-Y N-R /7 W TOWN OF #,f yA'7l~ ST. CROIX COUNTY, WI SUBDIVISION /Y f4- LOT NUMBER ti A CERTIFIED SURVEY MAP VOLUME , PAGE , LOT NUMBER y/ 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 mater 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 year expiration date. ~11 SIGNED: B~7zx&~ eD,~ Q ~Uy DATE: c__1?6 7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 State Bar of Wisconsin Foam 2 - ~ WARRANTY ID- YOl~~VpArw i'L`J . REGIS?ERS DOCUMENT NO. ST CRG,X Robert A. zappers and Donnie T. zappers. MAY ~,T 1995 nuaband and rile - at t t : t S AM.. PC, Coe" and warMM to pomW Jo HiRlkema ; ^t THIS SPACE PIEE`SSSAVED FOR IIECOADING DATA NAME A Y. i MI C" VM of. so I the tolbwiy, dewn'6ed red emu it St Croix CaDaty, Stare at Wtreareic (Parcel ideaWwdioa Number) I North', 300 feet of South 493 feet of West 542 feet of S 1/2 of NW 1/4 of section 15. Townshi& 19 North. Rnage 17 West, t. Croix County. Wisconsin. srQ s. i. ~ y i F hl ~.a} - Btooepttos eo ~nrr~rties: subject to easements, reservations and restrictions of record. ~y -.19_251 C)aled dds 12 dry of (SEAL) (SEAL) =RMZRTAP S (SEAL) (SEAL) BOMIB P. XAPPERS AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN S) IL St. Croix t. CorMy. allavoticased this - , dry at Nreorafty came before me this 12 - dry of M" --z , 1915_ the above mmed ^ jkMbej t A Uq;Ve m AnA Ronnie F MIA MEMM STATE BAR OF wiscONSM (ram s who esecueed the a boriaed by 1706AC Wis. Soft) a► ~ Icaowr to be the person iestrumeat aebaowledSe the same ~O TWS MTRtMrEtr1T ssAS DRAFTED BY i .