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ST. CROIX COUNTY ZONING DEPARTMENT RE ~X/E
AS BUILT SANITARY REPORT
Owner -SAM M } t 4 f 4, - ~
r- ur CRCI~x
Address -737 will f'*k"v COuNr,'
ZONINGOFrICC-
City/State N o D-c, gym, t
Legal Description:
Lot 3 Block Subdivision/CSM # B4 DLA N DS 4 (f-
'/4 SE '/4 NK) Sec. z 7 , Tz7 N-R If , Town of H0Dz~oKt PIN # -0ZO-[33S•zj0-(~
SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION:
Tank manufacturer LvEl,S9A - Size ST/PC IdQO / Setback from: House Z- Well SS P/L `IrlaE
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: rtKc N` N Width S Length Number of Trenches
Setback from: House Y S Well '86' P/L Vent to fresh air intake (OD
ELEVATIONS:
Description of benchmark Z.~ U~ S' SO = 9~.5 S Elevation
.Description of alternate benchmark 5 I L L n N MOCK b ,00 ri` ?,If=/0347 Elevation
Building Sewer _ ST/HT Inlet 5-4 ST Outlet SAL - 101' PC Inlet
PC Bottom Header/Manifold `It 51 0'- ~S Top of ST/PC Manhole Cover 3, I = 16 3, 7
N' pow
Distribution Lines O -7,70 = 9 3 O ~i • 0 17, 3 t ( )
Bottom of System ( ) ~0,1 ' '~41, 3 S ( ) lD 7 = l74-3 S" ( )
Final Grade ( ) (Q ,7 ! = 160, 3 O 7 S e lot, 3 ( )
Date of installation I / xr/9 Permit number '2116 (o State plan number
Plumber's si nature License number &W-035700 Date f /21
Inspector IS 7 3
Complete plot plan
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
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INDICATE NORTH ARROW'
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: c
Safety and, Buildings Division INSPECTION REPORT csi Cro1A
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)]. 30 7
Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
~,3' a8• 2" 020 - /33s-3p-oa
IQ- 42
TANK INFORMATION ELEVATION DATA fJ g7Gi~~2~
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Sep ti Wzsew- 00D Benchm r ~~r
Dosing Alt b -2 /03.77
Aeration Bldg. Sewer
Holding St / Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANKTO P/L L BLDG. Ventto ROAD Dt Inlet
Air intake
Septic q j) f ?,(p NA Dt Bottom
Dosing NA Header / Man. Gf ~S^ 7s1
Aeration Dist. Pipe Gj(p3 ~7?j(o
Holding Bot. System `A ~~•3
06-
PUMP/ SIPHON INFORMATION Final Grade 5
Manufacturer Demand .~I~ 4V%ko G
Model Numb GPM
TDH Ift Friction ystem TDH Ft oss
Forcem Dia. H
Dist. To well
SOIL ABSORPTION SYSTEM
BED C Width I Length G b No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMERWQIVt~ Z. DIMENSIONS
ACHING Ma cturer:
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM
INFORMATION Type O ~~jlc 5 C AMB_E~R~ m er:
Syste v ( 6r ~4V , UV r OR UNIT
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pi a s) x Hole Size x Hole Spacing Vent To Air Intake
i !
Length Dia. Length Dia. Spacing / STwl S !T• Z?zq 6c)
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx ed / Sodded xx Mulched
Bed /Trench Center Bed / Ed es Top ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) 737 W, I I?
I' I /tif, I&K- Tv? D~ dooral -ioacKQ~i►~` ~03.771~
flu
Pit'
Plan revision required? ❑ Yes Co No
Use other side for additional information. ( Z(
SBD 6710 (R.3/97) Date Inspector's Sig ature C-Ce-Ft o.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Safety and Buildings Division
SANITARY PERMIT APPLICATION Bureau of Building Water System:
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 y
than 8 112 x 11 inches in size. •5T• Cro; X
• See reverse side for instructions for completing this application State Sanitary Permit Number
,0'70001
The information you provide may be used by other government agency programs ❑ Check if revision to previous pplication
(Privacy Law, s. 15.04 (1) (m)]. -7 37 W1 c n/ Rol State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
/Yl L 5F 1 /4 Lp 1/4, S Z T Z9 , N, R /9 E (o W
Property Owner's Mailing Address Lot Number Block tuber
gQ/3 _3.3
City, State Zip Code Phone Number Subdivision Name or CSM Number
o !o w w 1 S- o r (3ti.) 7-7 LA N D P-64 X21 f-
. TYPE F BUILDING: (check one) ❑ State Owned Vi llllyage Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms _Ali Town of P L) O 411L4-F2 E D ~D.
III. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) A 7 SO?. /9- 177
1 ❑ Apartment/ Condo (9~ /3_30 7
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.~ew 2. ❑ Replacement 3. ❑ Replacement of 4- ❑ Reconnection of 5- ❑ Repair of an
__System System Tank OnlyExisting 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 410 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. 7- Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
5-4„ ~p Feet tOO C J Feet
VII. TANK Capacity gallons Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing structed
Tanks Tanks
ticTa ppt+J ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATE-MENT
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 Stamp) MP/MPRSW No.: Business Phone Number:
0, 10
Plumber's Address (Street, City, State, Zip Code)-.'
07o Ho A- jee.>,,+jQ v0 44W WI
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps)
KApproved ❑OwnerGiven Initial ha Surcharge Fee)
18'0 ~/oo 112-'30 "17
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05194) 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.
I
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-
11 . 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 13 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.
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 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 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.
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SOIL DESCRIPTION REPORT c'
PF OPEPWIY-OWNER Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench
A Ord i c / mof cs lF ~Y
Ground
e ev i
ft.
Depth to
limiting ;
f ctor -
Remarks:
Boring #
7, Aj,
7 -e-
Ground
`elev.
QQ
Depth to' -
limiting
factor
9~in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # - 7, .S /P,i .S / --gip ,rJ e
~ lftah Ft,- 5 .C-7 2 F
Ground
elev.
I6~St.
Depth to - - -
limiting r
factor
Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
__.-in' Remarks:
SBDW-8330 (R. 08/95)
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.Wiscon-1in l5epartmentof Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Sarety and"Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 299061
Permit Holder's Name: ❑ Ciyt ❑ Village'El Town o : State P No.:
MILLER, SAM HUDSON
CST BM Elev.: Insp. BM Elev.: BM Description: rcel Tax No.:
020-1335-30-000
TANK INFORMA ON ELEVATION D ;/A A9700378
TYPE MA UFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmar
Dosing
Aeration Bid . Sewer
Holding / Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. t ke ROAD Ai ta Dt Inlet
Septic Dt Bottom
Dosing A Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH Lift Lriction Sy em TDH Ft
Forcemain Length Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTE
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMEN 1 N DIMEN 1
LEACHING Manufacturer:
SETBACK SYSTE TO P/L BLDG WELL LAKE/STR
INFORMATION Typeo CHAMBER Model Number:
Syste OR UNIT
DISTRIBUTIONS TEM
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 S ems Only
Depth Over Depth Over xx Depth Of xx Seede Sodded xx Mulched
Bed /Trench Ce er Bed /Trench Edges Topsoil E] Yes No E] Yes E] No
COMME S: (Include code discrepancies, persons present, etc.)
LOCATI0 HUDSON 27.29.19,SE,NW 737 WILFRED RD LOT 39
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
•
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
.Labdf.and Human Relations Page 1 of 3
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. #
000 - lU? S 00
APPLICANT INFORMATION -Please print all information. Zizd y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
RichARD Stout Govt. Lot SE 1/4NW 1/4,S 27 T29 N,R 1 9 XEX(or) W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
1353 Awatukee Trail 33 Badlands Prairie
City State Zip Code Phone Number ❑ City ❑ Village FC] Town Nearest Road
Hudson WI 54016 (715)549-6731 Hudson Badlands
New Construction Use: Residential / Number of bedrooms 3 4 Addition to existing building
Replacement H Public or commercial - Describe:
Code derived daily flow 6 0 0 gpd Recommended design loading rate ' 7 bed, gpd/ft2 - 8 trench, gpd/ft2
Absorption area required A S 8 bed, ft2 7 (1 trench, ft2 Maximum design loading rate -7 bed, gpwft2 • 8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 97 i ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material Glacial deposit _ Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
❑ U 1 S ❑ U OS ❑ U (j, S ❑ U ❑ S [3d U ❑ S J] U
U = Unsuitable for system ® S [5
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
1 1 0-15 7.5 r2.5/1 none L 2mabk mfr Cs 2f .5 .6
2 15-36 10yr4/4 none sl 1mabk vfr Cs if .4 .5
Ground 3 36-90 10 r4/6 none ms s 1 Cs .7 -.8
elev.
99.8 ft.
Depth to
limiting
factor
min.
Remarks:
Boring #
1 -10 7.5yr2.5-Zl none L mabk -afr CS ?f -1; 6
2 2 10-3 10yr4/4 none sl 1mabk vfr s if .4 .5
3 36-8 10 r4 none ms s 1 s .7 -8
Ground
elev.
1 03-0t.
Depth to
limiting
factor
89 in. Remarks:
CST Name (Please Print) Signature Telephone No.
7.,
Address Date CST Number
r a 9
Q'7d c c ~ G~ a c ci` .2 2 / 37
..~.RoptATY OWNER Richard Stout SAIL DESCRIPTION REPORT Pagel of 3
PARCEL I.D.#
3oring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench
3 1 0-1 7.5yr2.5 1 none L 2mabk mfr cs 2f .5 .6
2 15-36 10yr4/4 none sl 1mabk mvfr cs if .4 ..5
around 3 36- 2 10yr4/ none ms osg ml cs .7 .8
alev.
Q'
p Depth to 01
niting
actor
9 2 -in,
Remarks:
3oring #
1 -14 7.5 r2.5 1 none L 2mabk mfr cs 2m .5 ,.6
4 2 14-3 10yr3/4 none sil 2mabk mfr cs if .5 _6
3 6-9 10yr4/6 none ms sg sg cs .7 ..8
around
3lev.
100.5 ft.
Depth to
imiting
actor
9 2 in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring # 0-10 7.5 r2 .5 1 non L 2mabk
5 2 10-36 10 r4 4 none sl 1mabk -mvfr CS if -4 _c;
3 36-90 10yr4/6 none ms osg ml cs .7 ..8
Ground
elev.
9 8 .2-0--ft.
Depth to
limiting
factor
g~ in. Remarks:
Boring If
Ground
Nev.
ft.
Depth to
limiting
factor
in. Remarks:
SBDW-8330 (R. 08/95)
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
Yk
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench
/ 0 _ C.4 r2F S
a ono ~ ,e- ~
Ground C
e ev ;
ft.
Depth to
limiting ;
f ctor
--in.
Remarks:
Boring #
e -g S R c *766 k P7 j1:1- c s F
I W, e- OJC
Ground
elev.
iQ
Depth to'
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture . Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench
Boring #
3 .3,Z -9 e ~F' y G 1n s' s C -T
-
Ground
elev. - - - - -
~2,!rft .
Depth to - -
limiting
factor
M-'n. Remarks:
Boring #
Ground
elev.
n.
Depth to
limiting
factor
in. Remarks: - - `2 - 3 U - cjj
SBDW-8330 (R. 08/95) lf6
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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 _S N /21 f ~ ( 1 LC f-,
Location of property / 1/4 Nt-C-/1/4, Section T 7 N-R / r W
Township N L) Mailing address l3 c_)V 1 T
L L) rr may. Yb1 (G'
Address of site 3 'Zj,&)( L jrQt O tZOA 17
Subdivision name # A 1) l o4 CD 4 k A! k f[ Lot no. _3
Other homes on property? Yes X No
Previous owner of property R 1 h a/ S f o u "
Total size of property ' - a A e-
Total size of parcel Z. ®
Date parcel was created 47 - / 19 - 9 7
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Y Yes No
Volume /Z' and Page Number S 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. ~ S , 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.
ture of Applicant Co-Applicant
9-2 3°97
Date of Signature Date of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER f1 I/ / /t L f'.t._
MAILING ADDRESS -l 1.5 /
PROPERTY ADDRESS 3'7 W1 L F I
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE 11 a D s o r/ w/ S y0 / 6
PROPERTY LOCATION SC 1/4, r/ L4J 1/4, Section Z 7 , T Z 7 N-R IF W
TOWN OF 14 0j),Z0 W , ST. CROIX COUNTY, WI
SUBDIVISION B4V I- p ffZ) I R l.£_ LOT NUMBER ,_J..3
CERTIFIED SURVEY MAP SAO /01(c , VOLUME, PAGE LOT NUMBER 3 3
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:
DATE: Z c~'
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
565615 STATE BAR OF WISCOt SIN FORM 2 - 1982
V V WARRANTY DEED
DOCUMENT NO. VOL ?f 5PAn053
RF91STER?S OFFICE
Richard 0. Stout ST. CROIX CQ„ WI
Rec'd for Record
SEP 1 9 1997
conveys and warrants to ..Sam E. Miller 2:30 P M
--fk 0.j~
j Re Isfor of Deeds
THIS SPACE RESERVED FOR RECORDING DATA
NAME AND RETURN ADDRESS
I,
the following described real estate in St. Croix County,
State of Wisconsin:
T~t jL
Lots, ,33, 26, 41 and 43, Plat of Badlands
Prairie, Town of Hudson, St. Croix County, _lr
Wisconsin.
I
PARCEL IDENTIFICATION NUMBER
I
i
T ARC
P
-FE
i•
II
l
ii This is not homestead property.
li (is) (is not)
Exception to warranties:
easements, restrictions, rights-of-way and covenants of record, if any.
Raced this 19th day of September , A.D., 19_.
j'I F:~-~'-~ (SEAL) - (SEAL)
II Richard 0. Stout ■
(SEAL) (SEAL)
i
I!
I~
i AUTHENTICATION ACKNOWLEDGMENT
I
Ii Signature(s) State of Wisconsin,
I ss.
St. Croix Count
y
authenticated this day of 19 Personally came before me this 1 9t-h day of