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HomeMy WebLinkAbout020-1324-30-000 AS kK- STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER lk7 I L c. f~ r ADDRESS /YJpe n O ffU S a Ar L.y i SyG7 / L SUBDIVISION / CSM# //q M/yE 5'1 y ~C LOT # ~6 SECTION / Z T ?-'T N-R ! W Town of /~fcJ D S p N ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM kM- loIP El- /AD.ta0 ~Ae►~c~ NATE ,yavsE W i L $o X12. AA as'xso ~ LIP T, a t7 / 3L s -C to - o ~ I11DI CATF. NORTH ARROW Provide setback and elevation information on rever,;e of this form. Provide 2 dimensions to center of septic tank. m;~nhe~I(- cover. BENCHMARK: TOP O l I P I pc C6rWj A_ 41=. G, M, /E~00 ~ ALTERNATE BM: TOE' O elee-& Fovmo"47/v / - C~ 1 • SEPTIC TANK / UMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: k.) Liquid Capacity: l ooo C 4L, Setback from: Well -(_^O House Other $s' ~Tc 4 Pump: Manufacturer _ Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: s" Length G o Number of trenches L Distance & Direction to nearest prop. line: '70 -/a 4 /07~1AlAt Setback from: well: House 3 2 Other rk6w k a I r Z RINL S ~f, ~8= 1~2, 1 ELEVATIONS Building Sewer ST Inlet. 0►~3 ST outlet PC inlet PC bottom Pump Off rN I JR3 =94'Ir RN ~41610S: 19,1-93 Header/Manifold Bottom of system I_. 'pC Existing Grade7, ~_S . f f-13 Final gradel . 4 ,4~' DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: M oOO n S ' D S" INSPECTOR: 3/93:jt Wisconsin Dbpartmentof Industry, PRIVATE SEWAGE SYSTEM County: Lal~or`aKd,HumanRelations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284276 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: MILLER SAM HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 020-1324-30-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _ Benchmark Z0 y" /JU. Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet ?,q 0 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 85' 6b 1'2 NA Dt Bottom NA Header! Man. iU~ 7 9" 4/1 Dosing 6 eF s.9 6 r Aeration NA Dist. Pipe S, /0,09, ystem- /ago q.' 86 , Bot. System- Holding PUMP/ SIPHON INFORMATION Final Grade 7 0 , / $ Manufacturer Demand v ~x 3' Model Number GPM TDH Lift Friction System TDH Ft Loss d -I Forcemain Lengt Dia. I f Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width _ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 O DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O /Y(," CHAMBER Mode Number: System: 7b a 90 AI 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 Seed:ed So dded xx Mulched No 10 1 ° Bed /Trench Edges ° Topsoil ❑ Yes C] No C] Yes E] Bed /Trench Center COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.12.29.19,SE,NW 1056 MOON GLOW RD LOT 46 Y3 al 1 fr~ Plan revision required? ❑ Yes [/No Use other side for additional information. ' 7l SBD-6710 (R 05/91) Date I p or's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH t SANITARY PERMIT NUMBER: Safety and Buildings Division vp`ri ; SANITARY PERMIT APPLICATION 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 n~1 than 81/2 x 11 inches in size. lam/' • See reverse side for instructions for completing this application State Sanitary Permit Number .28' The information you provide mil'y be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. ,Q-/n 41,904 G149 riw ♦ Rd State Plan I.D. Number 1. APPLICATION INFORMATION-' PLEASE PRINT ALL IINFORMATI( Property Owner Name Property Location ,..+°Al LLS (L St 1/4 N~1/4, S ~ Z T L'f , N, R19 E (or Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number 4n I< U e o)4 4 (3 >z 10 4F r l (C4 11. TYPE F BUILDING: (check one) ❑ State Owned ity Nearest Road ❑ To age HL--'Dly MOON GL4W Public 1 or 2 Family Dwelling - No. of bedrooms Town OF 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) • /9. /b 915 tiJ ©z r~- 1-3 zY -30 1 E] Apartment/ Condo r 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. Iff New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ----System ________System_____________TankOnly______________ 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12)g 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, T Sib 5-4.3 ~r7 $ 'FS-, 166 Feet 91, f 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 strutted Tanks Tanks Septic Tank or Holding Tank I x 1000 1 WE' / R.. ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ 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 Signature: (No mps) MP/MPRSW No.: Business Phone Number: l,~ o1VCt-L / .S -~S~C~ 8'b-PL' z..e Plumber's Address (Street, City, State, Zip Code): IX. C UNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa Itary Permit Fee (InciudesGroundwater ate ssue Issuing Ag nt Sign ps) roved Surcharge Fee) pp E] Owner Given Initial /~1 cz,, Adverse Determination lov / 1570 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) - DISTRIBUTION: Original to County, One copy To: Safety a 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 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: 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. 111. 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. V1. 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. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smallerthan 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. SAM MILI.r=R TTAxu~~ fD6E Lv1''J A/6 tt 5lo 95, 6C) ' 7r"r-t' 026 n i 1 0 i ~ Moent aEANt WXS - O f s" i ,4 ' Y L, _ Caq"x3~ vEW~ 1 LbT q -s z, dV r t1 wt a- -To MA ~p-F R Q~ iRi?1'tE11 S % 41 • L 43 Vi LJ O oIL - ro \ 0 0 ~C O p f1 o F- LLI v LLJ CL I M' I Z I O Z I N I w , I a. i n- o I Z I L li I Cl) I w i n. o v"t I 4 I m 14 I - J I ~D Q W <G v , ' I VI V1 t~ Q i o I w 1 N 14il V- Wisconsin De rtment of Industry, SOIL AND SITE E V A L U ATIO U7.Q R T Page 1 of Labor and Human Relations) h . Divonbf Safety & Buildings in accord with ILHR 83.05; Adm. OffoO • `'-49 COUNTY St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size, Plan m. . t, 460e but not limited to vertical and horizontal reference point (BM), direction anti % of slope, scale or ; PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATTTON ~_ry VIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Sam Miller GOVT. LOT'" - 1/4 ,Lty/4,S 12 T Z9 N,R 19 E (or) W PROPERTY OWNER':S MAILING ADDRESS L T BLOCK # ,S D. NAME OR CSM # Trout Brook Rd. Znd Addn to Tanne Ridge CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE EjfOWN NEAREST ROAD Hudson Wi. 54016 ( ) Hudson Tanne Lane [ ] New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate D . S bed, gpd/ft2 6 trench, gpd/ft2 Absorption area required bed, 1`12 trench, ft2 Maximum design loading rate A,3 bed, gpd/ft2o.Z trench, gpd/ft2 Recommended infiltration surface elevation(s) - - - - - ft (as referred to site plan benchmark) Additional design/ site considerations Soil evaluation done for plat approval. Parent material Flood plain elevation, if applicable It S = Suitable for system 9,QNVENTIONAL M UND IN-.GROUND PRESSURE AT GRADE 7 SY TEM IN FILL HOLDING JANK U= Unsuitable fors stem Id l S ❑ U 2 S ❑ U S❑ U MS El U S❑ U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bardary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench x -zo 23 / - s 6< fh r- w Z d Q ~d-~ ~iz4 - SQL 1 ►r-►sbe- m~" C'W ,Z 6.3 Ground ~z 6-!Z1 P- 4 S r m - Cs -'7 1 elev. ~4 ft. Depth to limiting factor ? ILA Remarks: Boring # lo-15- 1 YOIZ ° I M -5 tP Frr 1. lo e 1 -1 1Q` 4 - S Y41 r ri, d 0 Ground eIPa,y. ,Lot Depth to limiting factor > lb. 6-7 Remarks: CST Name:-Pleasppnnt Phone: 386-4080 Harve G. Johnson Address: P.O. Box 91 Signature: Date: Oct. 96 CST Number: 3484 PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z_of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft 3 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ranch E = = - -4 Q o-/6 a'/ 3 / / sb A-rr Cw 1 O. /6-44 /by 4 4 - S►< Irk5~K A-f' Cw 6.7 0.3 Ground 8 14 -►Z4 16'y P, 3 S el v. ^~ft. Depth to limiting factor 0 .3 Remarks: Boring # /D9 L I C w I 6A6:.5 Ground 37-I2/b YPU 4 S M r- - 0,7 elev. Depth to limiting factor '7 Remarks: Boring # Cw oz Ground ,elev.. Depth to limiting factor 7 M Remarks: Boring # rall Ground elev. ft. Depth to limiting factor Remarks: con_ovanio nrioo) { t s6 d' 3 z O \ L I` m d7 \ 3 La Y- 1t O f a~~ Iy v2s.7 i 2]tl ac \ ( •JL1~f~ t -"-....IV]u•: n2, 52r w rr ~ ~ ~ ' ~ 66 - 19r 19'-- - 3$ Nw • _ _ tl> 2 2+ Ac E.c ES.T 1S~ V44 w _ _ M -PUBLIC -WE 97,]29 50. ir, Iv _ t -E3EAM a, T E w ad' \L^ sF~y~s Lyw~r.I 31 - 99:_..,-.----' - 1f1 I - 240. 46' \'J l •a+ \ - \ ~~._~c~ 'r _ NB9.23'SI_E._ 773.42'-_._.•..i•_-_.! M 45 N ti. O7 59 LOT 60 1 T? 99,b69 so FT. 3 I Y ^ 1 ti O y~ 'l 2 .0 AC 2.00 AC. 1.62 Ac. E.C. EsMT \ \ \ 9,i )2 40. rt. I - I 81.119 eJ. rT. 70.00. t4.lT h t NS `I r ^ 1 YI K. EXC. ESUT. 35 Y1.655 so FT r VVV r~ _ rf N ~I q ~ ~ \ 'ILA up t~ E NWL 3 • K b \ ~ ~ ~ N 910.2 a LOT 46 q~r1 \ 2 22 1C. p . +.J.I 4°\ 7P.O~~y~* 96.793 30 rL \+i` X` -?0 , ~ e \ •q L 2.01 A[. [.C. 13YT. \4093' 2+022' { u 97.719 50. 7T. R V //LE~~ ,ti '7 52126, $ Zo- / (ss D~ se9.24*02•w e 3~ - PLOT 47 •-T LOT ' ll? " / f 2.00 AC. LOT \ , 'T or q0 SQ Ft e (-yI L!1 Ac. E.C. . [stilt. ~ C ~ 1 p`hi' X701• 2 NWL • V 67,060 40ri 48 v Ga• Y Ali Y I b iQ p3,w N 2.06 AC. I NWL , 939.00' I r 1 1 I • .9.7C' S4 rt > ` I t 1 1 LOT 51 Ep, t ~ '~1►L! 1.3: AC. Ell[ E MI r r r , ~ I r r ! 2 11 Ac \ ET\ l7, LEGEND 499 30 11 ! / •rf; / r' ii / 1o+,93t w.rr. it/ J.Z ALUNINIIM :(h'NIY kC710N CIMNEN\ ►A r ~ C MVNVMt rtl 1 )f ~ 2'-1NUft FIrFU 4NL LOT. 49 ~1 7 ~49•~ N 7./ 376•+plr"t • 1° WJN NYt I(1"W. 2 93 Ac. \ 124,)95 bo.FT. / E? •`Y% 0 2", !J• IN.^ Ylrt SET. wlWNl,w )6, ttl5 •`CV,, O / LOT 56 rtN .Ihl 4N CWT t\ 1 01 rW IE Au U1NlM l0T CyRhf NS MrrwMt r. TLQ j•' !52 Ac N~1N • 21` NJh Y~Yr ..L 14uihV yy • 11' I till tIIS Ylh 1.INt aN If•ll •1 Q, I O I 19),197 sU E1 jL 2 tlU .C. l:}C CSMf -Y-~rry Wt, b r• .,Na.h M:L t.•,t Mehl - 509•+U lS-E IV6.71' 1 .2.,613 SV rT 1 / .r fhAC• l.hl NVrn. waY i ' I Jc) yq L__ If' wIUl. ~i M1. .1. I4tit ML UI O 59 E 1 21 ^C .6w w.rr. V f~'~•~1. ~~~I L` • ~1 ' N1wJ'. _ W,.:,... w ~w .r. . .Nt .IV 4.. rn: N -16.11h.N~N I r \ 1]9 A[ F..C ESMT \ Is)`/•~L;,+• ~ 1 .nll 'm, NWL fb1~\ 11S,.rvb sy. Ft S / \ ri ~ IM. `lN , 1 Yh,n•.stu n.lvl l1maL uNwt l.:rAn„N 31 y16.5 ;11 r I~ InN ut :I Ir•t O.:C wt I.J. W ME - V, / <V ' t•'`, I),'; _ L o.l T 1 ,\.L/ , \ Nwl • `I/ - L1 1 2 62 AC L- 1.1,111 t ~ 34 ,,l I I7, I ` , fl lj !j6-19.11-M- 4-1 1 , I 1 / ay LOT 51 - ; IF ~ - 2 u] AC sJ. rT S ff ' ' I ,,11,•111, IF 1 if7 L ~/y T 1 I I IbL.W AI UMININA\` U) b," )l' 4' N--l-~ .-QtNCI1M11R9' TAM IF far (ILVAiIUN• .19.w E1 1~1 11 L. A SS l,L0 1'..LVAl1UN N6Y•IM'12.1 1 1t1 ~.,yE I E"" Sby, Itl'1:•w :~l~TwN .2 LOT 52 o, y ! ' ~ J LOT ' C V ' ••i1( 9 C r 2+ . C b dy ' m m ' ',e. s u., ac V \ flu, 676 SV. FT . v `rl r. TI ~ N A r%'~ ,y 1 2.•.tl AL. ur r+.llS r II I V ~fj_3, r, ~ 6.1 nY:1.vyN. « N~9"IN'4~"E . ~+VI.. ~'•,b,Ri '.U'lIN 4111 J IM 111/, INL i'NI1M 1l MV./Na.,Y ~JL'~E 11?!11'_,91 i r v AND 5 1 l.t 1• a. rv M1Ae . ,.Jr4h SHEET I OF 3 SHEET'- S T C - 100 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 =A W 11j 14 t. Location of property's 1/4w 1/4, Section I Z. T'zy N-R~ Q W Township Mailing address L) -S 0 N ~'o v yo Address of site 10 S(o M o Q N Co Lo Subdivision name `fit AIAG_ V P t Cy c.6 Lot no. 416 Other homes on property? YesX No Previous owner of property *?A L w /V, ,V Total size of property - , 2 7 A. Total size of parcel . 7 Date parcel was created , M ! S' Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? ~o Yes No Volume 10.11 and Page Number WS(b 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. ~56 11$ ter; , 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. S x ature of Applicant Co-Applicant C. I Date of Signature Date of Signature ti 1 ti STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER -E:' ,y W lc..t~ r e-_ MAILING ADDRESS E' r K :r z # L ter;-, to PROPERTY ADDRESS I 4 f C C > c tom'- ' r Y1~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 114, h 1/4, SectionT *0. ` N-R~r'w TOWN OF R U 0 5 ©llL ST. CROIX COUNTY, WI SUBDIVISION T/4 A(H C y , I U , a, LOT NUMBER _Lf - - (o CERTIFIED SURVEY MAP G51 (.3 r, VOLUME (o , PAGE 7 S , LOT NUMBER q(.' 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. SIGNED: ~e~Q DATE: - Z O _ cI St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 11/93 r TN1• /OACL Ne•saveD ION NtCOND1NO 7ATA DOCUMENT NO. STATE HA F WISCONSI ORM 1-1963 ` ARRANTY D D ' 504855_ YOL 10 3J►AGE 456 . f CJSTER'S OF ICE y This Deed, made between 1 1 andall_.W. Synan and Patricia E. Syttan, 00.'~~tP husband-..and wife , c=antor. SEP 1993 . ..E.....Hi_l::.er.t...a s~n P............................... Ct 1.0• :45 - pA,:'M and ...S 3m 7 ! R-~s~e. a Dews Grantee. Witile Seth, 'I hat the said Grantor, f ra, valuable consideration...... Randall W. SYnan and Patr~cla E. S nan . . to . Grantee . - conveys . . . the . following described rsa . l estate in St . CZO..x NatuNN To S County, State of Wisconsin: f 1 Tax Past No: The SE1/4 of NE1/4 of Section 11; the SW1/4 of NW1/4, the N1/2 < of SW1/4, and the South 53 rods (874.5 feet) of the SE1/4 of NW1/4 except the East 74 feet thereof, allin Section 12; all in Y1 Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. FF~ AND ._.i- A parcel of land located in part of the NE1/4 of SE1/4 of Secti ntn 11, Township 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the E1/4 corner of said Section 11; thence S89 30100"W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point j of :.eginning; thence continuing S89 30100"W, along said North line, 66.00 feet; thence SOO 28103"E, 500.00 feet; thence N8c) 30100"E, along the North line of Certified Survey Map filed in Vol. "3", Page 722, 38.08 feet; thence NOO 11'33"W, 150.00 feet; thence N03 58134"E, 351.07 feet to the point of beginning. This ..........A.$-.AQ-t... homestead property. (is) (m not) Together with all and singular the hereditaments.and appurtenances tuereuato belonging; And. ..RAMAL11- If ....$Y-nan-. An. d_.Patr-icia.. E....Synan.....-•-------... warrants that the title is good, indefeasible in fee simple and free and dear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. i Dated this ................1..1 day of UgAs.t....................................... it..9.1. Gs!Ytd~'-~"r..A114(SEAL) .1zlOlrtL~44:!i..'!4~ !~ie~ .........................(SEAL) Randall W. S..nan Patricia Synan . e~ ...(SEAL) .............................................................._.....(SEAL) 1i ' • A AUTHENTICATION ACSXOWL=DGtg'NT Sl tares STATZ OF WISCONSIN ~I St-.- Croix.....:..........Coasb• mr ...._.day of authenticated this ........day of 19 Pasonaft came before . a i August - 19_....... the above named ltaniiall..--'S nan~...patricia-•2 TITLE: MEMBER STATE BAR OF WISCONSIN S nan _ . (If not authorized by 4 706.06. Wis. State.) I~ to me known to be the person