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HomeMy WebLinkAbout026-1070-60-200 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER _ .6t,V ADDRESS , OP, G y SUBDIVISION / CSM# LOT SECTION a¢ T 3- N-R` 5~ W ,'Town of 1 G~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW VERYTHING WITHIN 100 FEET OF SYSTEM ID V r. !'-rff~6 i Z& Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. e BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: _I A) Lw- e- Liquid Capacity: lean Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: IQL Length 9 Number of trenches Distance & Direction to nearest prop. line: .Sa, $.✓r Setback from: well: House ~7 Other ELEVATIONS Building Sewer ST Inlet: 9~ ST outlet: PC inlet PC bottom - - Pump Off Header/Manifold-(` , (o Bottom of system 96,7 Existing Grade , Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: 1-5,63 INSPECTOR: 3/93:jt BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:- /,JLiquid Capacity: len Setback from: Well House oZt Other Pump: Manufacturer ModelI Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: /6211 Length 9 Number of trenches Distance & Direction to nearest prop. line: -56, .5..5 i Setback from: well: House .5;7 Other - l ELEVATIcONNS q Building Sewer ST Inlet: ~v• ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system 96,7 Existing Grade /fiber Final grade DATE OF INSTALLATION: d oZ PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt _ Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems r~7L■'■■'1 201 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. • See reverse side for instructions for completing this application State Sanitary Permit Number 4 Ail q91/) & 8 The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert 44wrier Name ` Property Location ` Cl, S tQ S© 1~ N Lit /4 fjo 1/4, S T 30, N, R l C' ) W Property Owner's Mai Iin Address Vill i~ Lot Number Block N ber ; City, State Zip Code Phone Number Subdivision me or CSM Nuln~ier Ai _5~jo(7 II. TYPE OF BUILDING: (check one) State Owned ❑ Near PL@ad ❑ Vllcityage ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town of III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo l~o- I o l o - la? - Q-0 3 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) 19 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 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. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation ^ 6. 10S Feet 115 Feet VII. TANK Capacity in gallons Total # of Manufacturer's Name Prefab Site . Con- LIE: el Fiber- Plastic per INFORMATION Gallons Tanks Concrete glass App- New Existin strutted Tanks Tanks h Septic Tank or Holding Tank IQ r- n El M Lift Pump Tank /Siphon Chamber ❑ ❑ r VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins tion of the onsite sewage system shown on the attached plans. PI ber's Name: (Prin Plu er's Sign ture: amps) /MPRSW NO.: Business Phone Number ~ IS (03 -7[s Q, V k J(\ d r Plu is Address (Str eet, Cit St; , Z Code): C Q 1 IX. COUNTY / DEPARTMENT USE ONLY Disa roved S ary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signa a (No Stamps) ❑ pp ~ ~\Approvecl El Owner Given Initial Surcharge Fee) Adverse Determination 119~ 4h X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBO-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Divi ion, 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. 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. 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 8 112 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 (urve; pump model and pump manufacturer; D) cross section of the soil absorption system if'required by the county; E) soil test data on a-1 15 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. Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LaborandHuman Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarq 990680 Permit Holder's Name: IiiINMONDe Town of: State Plan ID No.: ESPERSEN, HOWARD CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Ta o.: /tip' 6V /zv .Cb SGTm a,S 0~~_1070-60-200 TANK INFORMATION ELEVATION DATA A9700383 16121197 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic w Benchmark 5.351 1'/f6-66 Dosing _ d P". "'T, /f'I, 01.(3/ Aeration Bldg. Sewer Holdi,09 St/ Inlet TANK SETBACK INFORMATION St/ Outlet ~7~ TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic CD o ~ - NA Dt Bottom Dosing NA Headerf~ 7 7f1~ Aeration NA Dist. Pipe 7, 74 Z Z 5-6 Holdin Bot. System 9,7,-?' 91,63 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Mod r1Nu`mb-e-r+_.--_ GPM TDH Lift Loss Ion S stem T Ft Force In Length Did. Dist. To Well SOIL ABSORPTION SYSTEM PIT No. Of Pits Inside Dia. Liquid Depth BED/TRENCH Width Length No. Of Trenches I DIMENSIONS ~=1 Q< / DIMENSIONS-- SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA G Manufact SETBACK CHAMBER INFORMATION Type Of /)ee~t<r.~l of tuber. System: 1,,,--L -55~ 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 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 24.30.18,NW,NW 1411 CTY ~'D G OT 3 v c~ i! / d ct a_ ~ G e -1 tx D U~; n,~ 4/~-~'~ ~ l ~-+e ~ ,~Z~-. rte:>. _ • ' ~ 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: Vic Ow (n V-.- A) to 1 _ 3mon orb I'~`~ ~I Co asp , ~ ~ ~ IE( i _SD A p I _ _ _ ~ , ~ _ - _ . _ _ _ i - . - - -J ~ j - - - - - -r-- - - I ! I'~ I i j I I ~ - - L.. I ? - ~ ' i i { I a : a ~ `-i { I - _ - I-- ,~-'-~-i--- - - , _ _ _ _ _ - - - - _ _ J i ' .rte I _ ,i d _ _ I . - a ~ ~ t. P I 1' __i____ ~ ` yL , ,I ` 1 - j . i ...t-, i _ _ - - t r ,5 tsr. PAGE OF C.roSS S~c~lVf, p~ 3eq S~ AQ~ 4- s FtdiA Alt InIo16 And OD6atvollon Pipe ApprovDd Veal Cop Minimum 12' Above Final Grade 20- 42' Above Popp _ Coral Iron To final Gtade Vaal Pipe WtaD Hoy Ot SlmMlk Covuln uin 2' AYOtepole Ovet Plpe _ DIa1rlDvllOn Pipe O o o Tao j 4' AYOtepato . 8eoeal, Pipe ° Perforated Pipe (°elar ° 'Covpfln0 Twmlaollny AI 6oliom Of Sy►Iam T.Ic )J Ion SOIL FILL DISTRIBUTIOM PIPE APPROVED +S4MPETIC COVCR 2"OFAGGR~GATE " MATERIM. OR 4" OF STRAW ~y~ R MARSH HAy NEV. oFE~T loOP'JL -21/2 AGGRCGATE ~p 3 ~ DISTRI15UTIOU PIPE TO BE AT LEA5T AUU AT LEASTLO 11JCHES BUT {.10 MORE W 42EMCNES BELOW FINAL GRADE tWIMUM Writ OF F-XcIIVAT10)J FKOM OR16NAL 6XADF. WILL BE _ lUilmuM OEPTH ofEACAVAT10N IucHes rAo1M q'41WAL rjgApf. WILL BE INCHES SIGIJEO: LIC EAISC IJUMBE.R: Cat DATE: 110 s Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 3 Labor aind Human Relations _ Of Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code 1CXM Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S ix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or f i CEL I.D.4. dimensioned, north arrow, and location and distance to nearest road. -,Jpenca 23 . APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION [r. ° EVIEWE 13Y I' PROPERTY OWNER: PROPERTY LOCATION r; C tit Howard Es person GOVT. LOT Nye] 1/4 NW,, 114;6 24`~ AR f(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OFT # 1445 Co. Rd. "G" na na csm pMdingi CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN -rVEARESTROAD New Richmond WI. 54017 (71J 246-4772 Richmond Co. "G" [X] New Construction Use [ :4 Residential / Number of bedrooms 3 [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 450 god Recommended design loading rate _ • 4 bed, gpd/ft2 •5 trench, gpd/ft2 Absorption area required 1125 bed, ft2 900 trench, ft2 Maximum design loading rate • 4 bed, gpd/ft2 . 5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 96.65 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S ❑U :97S ❑U EkS ❑U ®S ❑U ❑S ®U ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tterch 1 1 0-11 10 r3 2 none 1 2msbk mfr 2f .5 .6 2 11-31 10 r4/4 none sicl 2msbk mfr if .4 .5 Ground 3 131-84 7.5 r4 4 none sl lcsbk mfr na na .4 .5 elev. 100.1{ Depth to limiting factor +84" Remarks: Boring # 1 0-9 10 r3 2 none 1 2c 1 mfr cS 2f .5 .6 2 2 9-27 10 r4 4 none sicl 2msbk mfr aw if .4 .5 Ground 3 27-50 7.5 r4 6 none sl 2 elev. 99.65 ft 4 50-80 5 r4 4 none . Depth to limiting factor +80" Remarks: CST Name:-Please Print Phone: Gar L. Steel 715-246-6200 Address: 1554 200 ve. New Ri and WI. 54017 m02298 Signature: Date: CST Number: 7-11-96 PROPERTY OWNER Howard Esperson SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # Pending Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerch 1 0-11 10 r3 3 none 1 2msbk mfr V 2f .5 .6 2 11-25 10 r4 4 none sici 2msbk mfr if .4 .5 Ground 3 25-38 7.5 r4 4 none is os mvfr w if .7 .8 elev. 99.95 ft. 4 38-69 5 r4 4 none sl lcsbk mvfr na .4 5 Depth to 5 69-72 7.5 r4 6 none vfs lc bk mvfr w na .4 .5 limiting a .4 `•..5 +f8acor 6 72-82 5 r4 4 none sl lcsbk mvfr na n T_-F Remartz: Boring # 1 0-12 10 2msbk mfr 2f .5 .6 4 2 12-28 10 r4 4 none sicl 2m f .4 .5 LU 3 28-84 7.5 r4 4 none sl lcs k m n na .4 .5 Ground elev. 99.95 ft. Depth to limiting factor +84" Remarks: Boring # 1 0-9 10 r3 2 none 1 2msbk mfr Crw 2f .5 .6 L5 2 9-28 10 r4 4 none Ground 3 28-82 7.5 r4 4 none elev. 100.05 ft. Depth to limiting factor +82" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Howard Esperson 1554 200th Ave. CSTM2298 NW%NW4 S24-T30N-R18W New Richmond, WI 54017 MPRSW 3254 town of Richmond (715) 246-6200 N 1"=40' BM= top of mid lot survey stake C el. 100' N. Od /orz' 43' 3o' nQ Gary L. Steel 7-11-96 FILED 5p AUG 1996 ~ 575+~ KAiNIE'!Ff tYALSH SL Claw C~., ~t7 CERTIFIED SURVEY MAP Located in Part of the Northwest Quarter of the Northwest Quarter of Section 24, Township 30'Nbrh, Range 18 West, Town of Richmond, St. Croix County, Wisconsin. Prepared for and at the request of: OWNER: ~ County Section Corner Monument Howard end Sue E. Espersen of Record 1445 C.T.H. "G" New Richmond, WI 54017 • Set 1" x 24" Iron Pipe weighing Drafted by. Ty R. Dodge a minimum of 1.13 pounds per linear foot. O Found Iron Pipe R= Recorded as UNPLATTED LANDS NORTHWEST CORNER, SECTION 24 S 89'08'15" E 2622.28' NORTH QUARTER CORNER, ALUMINUM CAP MONUMENT SECTION 24 R=2622.20' ALUMINUM CAP MONUMENT T.17. NORTH LINE OF THE 32.52' S 89'08'15" E 459.19' 1830.57' \ rn rn~ Ln CENTERLINE C.T.H. LO S 88'59'52" E ^458_38' _ S 89'00'21" E to 0 RIGHT-OF-WAY 80.00' a V) F- .6 1v 0 Ljr) - I~i I rn 0; V) Olrl HIGHWAY SETBACK....... d' 01 W O I (~I~I M ZI Li 1,01 O (mil O Q mipi I I o LOT 3 o, I Of Area.- 00 00 F- 1 z 159,819 Sq. Ft N <1 I It z ~i o zlcnl -0 Z II 3.67 Acres dI .1 ~IUI 1 °i Area Excluding R-O-W o° ~i I ;oi iaol EAST LINE OF 136, 656 Sq. Ft cv Io 1 UNNUMBERED LOT -T 1,3 Acres I1-- i~ 1-j IN --U 1510-: C jj ! N 89'05'00" W 267.01' N 89'15'17" W 186.49' =N 89'08'15" W S 89'07'44" E NORTH LINE 0 LOT 1 I 80.00' OV W/ C' 0 APPRO7 ED ,`'`r DOUGIASI LOT 1 UNPLATTED LANDS co ZAHIER Z CSM DOC.414068 S21 VO_L_ 6L_ AUG Z 8' PG 1675 ST. CROIX CPUNT`t $ Comprehensive) Pfafu* NO TH CERTIFIED SURVEY MAP Located in Part of the Northwest Quarter of the Northwest Quarter of Section 24, Township 30 North, Range 18 West, Town of Richmond, St. Croix County. Wisconsin. sunvr,yon I s CERTT[TCA'VP I, Douglas J. Zahler, a Registered Wisconsin 1,and Surveyor, hereby certify that by the direction or Howard and Such 13. Esper.sen, I have surveyed, dividerl aril map1:)ed a party of t:he Northwest Quarter of the Northwest Qt.,arter of. Section 24, Township 30 North, Range 18 West, Town of Richmond, SL.. Croix County, Wisconsin, described as follows: Commencing at the Nort=hwest Corner of said Section 24; 1 hnnr.p, on an assumed bearing along the north, line of said Section 24, Sc►rlt:ht 89 degrees 08 minutes 1.5 seconds East a distance of 332.52 feet to the Point of Beginning of the parcel to be describe-cl',' :thd's' being the nort=heast corner of a Certified Survey Map record-PrI-In Volume 3 page 607 with Document number. 3491.48; thence~niil;:i'ntair,c3 along last said north line, South 89 degrees 08 minut=es 1i1 seconds East a distance of 459.19 feet; thence South 00 degrees 51 minutes 45 seconds West a distance of 349.99 feel; thence North 89 degrees 15 minutes 17 seconds West: a dist=ance of 1.06.4() feet to the northeast corner of Lot 1. of a Certified Stirvey Map recorded in Volume 6 page 1675 as Document number 41.4O68;,t:hence, along the north line of last said Lot 1, North 89 degrees;; (15'' minutes 00 seconds West a distance of 267.01 feet to the`Pa`st-: line of said map in Volume 3 page 607; thence, along last said east line, North 00 degrees 04 minutes 07 seconds West a di.stanco of 350.16 feet to the point of beginning. Containing 159,81.9 square feet (3.67 acres). Subject: to right:-of-way for existing County Trunk Highway "G", along the northerly line of the above described propert=y and subject to all easement=s, restrictions and covenants of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundaries surveyed and described; that I have complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the Subdivision ordinance of the County of St. Croix and the Town of Richmond in surveying and mapping the same. Dough J. er Reg. No. 2145 Qal r_ A & E and Surveying Telephone # (715) 246-4319 Kevtudl $ 231y~' P. 0. Box 325 New Richmond, W1 54017 Ate, 0V w,SCO h. ,DO UU LASS J. y2 ZAHLR S-2145. l H WIS N' STC-105 SEPTIC TANK MAINTENANCE AGREEMENT' St. Croix County OWNER/BUYER K \ MAILING ADDRESS /4,44S Oa -Wl/ PROPERTY ADDRESS (location o septic system) Please obtain from the Plaruti*g Dept. CITY/STATE J OF C VSNn AA -S'V 0 ~1•'~ PROPERTY"LOCATION 1/4, wJ 1/4, Section T~N-R~ W ~ 11 TO . OF k &~A c~. ST. CROIX COUNTY, WI SUBDIVISION LOT NUM 3ER _ CERTIFIED SURVEY MAP (f VOLUME , PAGE 3t~OT 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 orzooner, 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 QWty accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. A 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: d4l DATE: 2 A r St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 s 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 n A,-)a y- ~ fl Location of o erty lO 1/4 N;;J 1/4, Section ,T~N-R W Township r-t( Mailing add ess 14 4L Op ~ ~t7 .S l7 Address of site Subdivision name Lot no. Other homes on property? Yes__X_No Previous owner of property '~`~c~~,r~.•~ ~8~~,,,o~~ Total size of property Total size of parcel _ 3, 6 7 a4AA2~ Date parcel was created 1? ,4. Are all corners and lot lirgs identifiable? Yes No Is this property being developed for ('spec house)? Yes ___X_No Volume and Page Number 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 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. Signature of Applicant / Co-Applicant 1-a-2-97 9-a--) -97 Date of Signature Date of Signature DOCUMENT NO. VOL 392 FAVE-396 WARRANTY DEED , STATE OF WISCONSIN-FORM 1 2 7 1 6 9 9 THIS SPACE RESERVED FOR RECORDING DATA THIS INDENTURE, Made this 1'8th.... ...day of..... . Feb~ary ST. CRCrIX CO., WIS. A. D.,19._.63 , between--.-.Fred-.-R tsenau. ._and---Le.ttle. -Park.......... Recd for Record tr~is_ lst__ ..Rosenau.._-h-is.-wife., and---in---her---Qwn.._right-,.-..._... day of__?jarch A.D:19_43 _ at___..2s!1.~---- T',, A - part ie~ of the, first part and _ Howard. Espersen _ and- Sue E Esgersen, -s_ Jo.in.--_--- _ Regl er f eds tenants I part ...ies-of the second part, RETURN TO W i t n e s s e t h, That the said part.! QS.--of the first part, for and in consideration of the sum of.... ne.--Dollar (.$l.A.0)---- .and othe.r....Yaluable...... - , - .-c-ons_ide.raton------------ - ..-_-__....__..__-_..-_._to...._._ -helTl._.__._in hand paid by the said parties.-of the second part, the receipt whereof is hereby confessed and acknowledged, ha...X-e._given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell,-remise, release, alien, convey and confirm unto the said part__ies)f the second part#1.dXheirs and assigns forever, the following described real estate situated in the County of St_~_--C-r01 _ ......and State of Wisconsin, to-wi' The Northwest Quarter (NWj) of Section 24, Township 30 North, Range 18 West. (IF NECESSe1RY, CONTINUE DESCRIPTION ON REVLASL an L, Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate right, title, interest, claim or demand whatsoever, of-the said part_ie.sof the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said par4eS_of the second part, and to_tbei.x ..heirs and assigns FOREVER. And the said--- Fr-e-d- R._..Rose-nau---and_.Lettie-_Pa-rk---R-ose.na-u-,---.parties .n.£.--.the... _ first.-.-part . . _ _ - - . for_._._....._-their-__-__.------------------ heirs, executors and administrators, do_...... .._-covenant, grant, bargain, and agree to and with the said partIBS..-of the second part _..their .__heirs and assigns, that at the time of the ensealing and delivery of these presents they. are_.._------- well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever....._ . - - and that the above bargained premises in the quiet and peaceable possession of the said partiee.of the second part)-be.1 Theirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof they _..will forever WARRANT AND DEFEND. In Witness Whereof, the said partle.S.of the first part ha.Ve....hereunto set..their.hand..._S.._and sea[.S_-_thi, 18th '~bruar day of - A. D., 19...3... ~S N DA S IN P ENCE OF 4r i (SEA[.) FRED__R..- OS U-._.._-... dAAtAA.SFAL) .....JOHHN F.... DO/WDJ - ..LETTIE__PARK_ R-0SE_NAU.. (SEAL) CULVER ANDERSON _(SEAL) STATE OF WISCONSIN, ss. - County. Personally came before me, this. Ifth_ ..............._...---day a.............. 'ebiuary.__..-..---------------------------- A. I)., 19._-63. the above named F.re_d---R_.Ras.enau...and--.Lettis-- Est r .-Rasana-u----------------------------- - . - . to me known to be the person..._...._..who executed the foreg~ng'@q,Vy tnt and acknowledges the same,