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HomeMy WebLinkAbout032-1082-30-100 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS n.~e<<<21- SUBDIVISION / CSM# LOT # SECTION,=,,2g T?j N-R_,12_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 5' ~ /qa ~ ~s ~ ' ~/o sc-1h INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: n ~ ALTERNATE BM: ~ y~ n . ~bZ SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: l Setback from: Well House? Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: =2 Length J-/ Number of trenches Distance & Direction to nearest prop. line: Setback from: well: Housed Other ELEVATIONS Building Sewer ST Inlet: - ST outlet: PC inlet PC bottom Pump Off Header/Manifold .Bottom of system ? Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: . INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: LaboranctHuman Relations INSPECTION REPORT ST. CROIX `4afety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 284281 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: HORT, MICHAEL T. SOMERSET CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ~GD. G~ /D%J, GD 5~ cti 5 u 032-1082-30-100 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic GL)? 5 C c~r~Cr . G~ Benchmark 7 T/' AUh,6& Dosing 64`1,z~, 4/,f, S• /20 7,/ Aeration Bldg. Sewer 11 7S' g, Hol g St/$ Inlet TANK SETBACK INFORMATION St/,of Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic;' /1/4- NA Dt Bottom 3 Dosing NA Heade, Aeration NA Dist. Pipe 107 9G, 301 ~ Holdi Bot. System' 5~ 5,,13 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ° `5 OD,~?S' Model Number GPM TDH LiftL Ion m TDH t cemain Length Dia. Dist. To We SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S./ DI EN 1 N LEACHI Manufacturer: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER o eINum System:' loec/ OR U DISTRIBUTION SYSTEM Header /J1~rftjFd- t/ Distribution Pipe(s) Hole Size x Hole Spacing Vent To Air Intake Length ~ Dia. Length Dia. `f Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Syste n y Depth Over Depth Over xx Depth Of eeded / Sodded xx Mulched Bed/ Trench Center YG 'Gad Bed /Trench Edges fpd Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET.208.31.19,SE,SSW 192ND AVE LOT 3 TI (4v7, Plan revision required? ❑ Yes Use other side for additional information. FT I U SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: i Safety and Buildings Division v~~'■•i : 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 Count than 8 112 x 11 inches in size- • See reverse side for instructions for completing this application State Sanitary Permi Number 8 `f ol? 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 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propertwner Na a Property Location _ 1/4 1/4, S T , N, R (o Pro erty a 's ailin AddrLot Number Block Number City Lip Code Phone Number Subdivisio me or CSM Nu e ( > 0 a earest Roams II. TYPE F BUILDING: (check one) ❑ State Owned LTO la Public 1 or 2 Famil Dwellin - No. of bedrooms wn OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) _~~a-3~ goo 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. j New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an - System -------System _____________Tank Only Existing -ystem Existing ----ystem 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 JM 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. ate 6- System Elev. 7. Final Grade Required (sq. ft.) Propose (sq. ft.) (Gals/day/sq. ft.) (Min./ ch) Elevation 813 Feet , Feet 'Capacity TANK in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank r ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the ndersigne , assume responsibility Or in al tion h onsi a sewage system shown on the attached plans. PVme Name' Pr Plumb r" na tam MP/MPRSW No.: Business Phone Number: Plum er's d ress (Strye Cit , Sta e, Zip OW 5 ege IX. COUNTY / DEP RTMENT USE ONLY 1:1 Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A entSi nature (N a ps) pproved ❑ Owner Given Initial Surcharge Fee) A Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: o-,6- 4Z cam. SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Divafon, owner, Plumber INSTRUCTIONS r 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 nevv 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 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. I } i ~ t t , wad ~~i SL. q~; ' ~ 1 ~ ~~/1.:✓iV f~.~ t t I : t , I I T 1 Q~ . j ~ 1 I ~ t t F-- , I • f I i i • I ~ I I i i ~ f I I I I • ~ + } f ~ i I i i T I ~ I ~ I f j 1 f ~ I ' I I ' 1 , I I i~ !III ~i I , + 1 ' 1 1 { I ~ I I i I ~ a l b ; ~ I 1 ~ I I I 1 I I ~ I j I I I I I I C ~ I i ~ 1 ~ 1 I I I I i ' I E I , I 1 ~ 1 I i cfl D3a- /offj -30 M AY ~ 9 1996 9 543452 s~'`°a'w► ~o N 00 Bearings are referenced to the o I south line of the SWk assumed to bear N89°57'52"W. r LO I I O 1-h a s. M. IN a ~j V.8 (D ( West line of the SEk of the SWk of Section 2~ rOj to o --N00°16' 15"W 1332.63' ° 1292.91' 39.72'- y N rr O Z aW 3 ~ 0 o -1 x 10 9 N IN' I S tfG'1' ~ y 7 ~ I'i 0) co y N c'h O W N 7 E' d Co . I ° I O fD 7 N Ln CD Un 0 O ~S 1-h 398.60' 41.16' - I M ~ Cn v Y sK E. t-1 -3 N _ N00°16'15"W 439.76' I On :4 rr t%j o -0 c w s Fi- r. to O o. a v 3 r o 0 O o0, -3 7 o 0 41 CA 'O O N O W N E N O N 7 CD W OD co dr N (ND tq O K p O O I C (A 00 (7 M 1 F m o C+ rr w I;- •I VD a CD 0 42.60' - I 0-4 m 398.60' Na In W T-c m 0 0) a N00°16'15"W 441.20' I m C> t= n Ct I, O Cn 00 e ~ I ~ I> rh C ~ 3 j o ; ST Ia tx UNIT fi C S vCr w w I N CQV,l SQrMwe 1Qlarv* (D -rn< W Nm Wei W CD O l0 j ZQs and 3 M D m I Pis Conuwaset 7i n w n S00°18'57"E m 2~„ -40 0 C:) Ln cN'n cN'n --I tO ICO if not recorded _ 829,481 iv I IN r T+ X lrl W IZ ittiin 30 days of rt Z - c Ip >ixwoval date O' $ rn r W ON \ \ aS I -roval shag be m z O .i W to f I 1>< ? & void irn ~ ; , r" N tO ~ ~ Iz . IC a O rn w I IM u, . ;0 oo rw m ~o ~N a S00°18'57"E 1287.43' ^ ' '0 Q 828.10' I 398.61' N H rt _ I ~ w _827.93' _ .444.27' _ ,n x -n i LOl£ abed LL '10A. . •aotnpt ao3 paeog uMoy ajezadoadde pue goT4jo ButuoZ AqunoD xtoaD ' IS aiii lorluoo Taoaed Aue butdoTanap ao Bu segoand eao3ag •(.•:)ga 'Taoatd og ssanoe 'azis qOT wnwtutw 'spueTlaA '•a'i) suOTIeTn692 put saTna 'sAet dtgsumos put AIuno0 19,4els oq 3391gns • st (:IpTd) deaf stgg uo UKOgs Teoatd goeg *awes Butddew pue BuTAaeans ut xtoa0 -:IS 3o Aquno0 aqg 3o aoueutp20 uOTSTATpgnS puerj aql pue sagngt:jS utsuOOStM aq: 3o 1,E'9EZ .19-4dEgO 3o suOtSTAOad quaaano aqp g:tteb paTTdmoo ATTn3 anew I UMI =Pagtaosap pue paAaeans Aaepunoq aotaa-axa eqi 3O aTeos of uoi-4equaseada1 joaaaoo a sT dew AananS pat3tgaa0 stgq jegj A;Tgaao osTe 'I •paooaa 30 sguawasea TTe pue (399alS gIGV Pue anuOAV PuZ6T) sptoH uAOL 203 ARA-30-I•gBTa 01 1oaCgns si Taoaed '(*:4a*bS L9S'T60'Z) saaov ZO'8v sutequoo Taoaed pagtaosaa . eq-4 of :19a3 Z6'ZEET 'auTT Isea pats buoTP '$ussilzoOOS aouagj !UOtIoas Pees 3o IF/-EMS aqg 3O fi/T$S aqI ,3o OUTT :Isea;.agg o^4 '1993 Z8'SSET 'GUTS glaou Pees BuoTe '$uEEa8S068S aouagl =8Z uOTgPGB pies 3o V/TMS eqq 30 V/T$S aql 30 auzT Thou aqg o: '3993 E9' ZEET '90t33o Pte3 'We E6TZ abed 18 anmToA ut papaooaa dew AananS p9T3tga90 3o T qoZ 3o autT gsea aqg put 8Z not-oas 30 fi/TMS aqI. 90 V/T$S agg 3o autT 1899 aqg bt=OTe 'Mu9T & 9ToOOR 90uaq-4 :Ia93 OV TZE 'auZT Is9m Pees BUOTE 'MuVS&LOoZOK eouaR: !uotpoas pees 3o V/TMN aql 30 t/THIS axlg 30 autT Isar, agg O: '1983 96'TL8 'saaOe OT glaou aqg 3o auTT tPnos pats buOTe 'MuZS&LSOM aouaRI :EE uOt:1398 3O V/TMN e43 30 V/TSN aq:.30 saaoe OT q:lsou aq-1 30 autT gpnos aqp oq .4993 00'9TE 'T IOZ Ptes 30 auTT gsaA aql BuoTe.'8u0EITEOTOS aouaxrl ::1893 59'Z8fi► 'aot330 speea 3o aagstbaa Alunoo xtoa, 'IS aqg le VOTZ aBea 18 awn-[OA WE papaooaa dew AaeanS paTjTgaa0 3o T 30q 3o auTT tPaou GxP Pue UOTI098 pees 3o V/TMN agI 3o OUTT ggxou aqg buoje 'MuZ9iLSo68H aouagI :3993 8Z'S 'EE uOtIOas pees 3o :P/TMN aqg 30 V/-ESN aqg 30 autT Ista 914-4 EMIR 'HUOEgTEOTOS aOUagg =EE uOTIOaS Pies 3o aauaoo v/TH ge bUTuaTj:)UG :sMoTTo3 se pagiaosap aeglan3 !utsuoosTM 'Alunoo xioa0 •jS 'lasaawoS 3o uMOs 'M61H 'ISTEZ uT TTe I EE uoTjoaS 3o V/TMN axgg 3o V/TRN aqg 3o gaed pug '8Z uot309S 30 T,/TMS aqa 30 VASS aqI uz paIeOOT PueT 3o Taoaed v Wisconsin Department of Industry, SOIL AND SITE E V A L U AT I O W E P0sRt Page of ~ Labor and Human Relations Division of,Safety & Buildings in accord with ILHR 83.05, WIS X~M),~Ode f Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan u ~inclucJe,:f iar not limited to vertical and horizontal reference point (BM), direction and % of sl pfd, kale or PF,Rc :D v s i dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ~t REVIE% ^tl Y DATE PROPER OWNER: PRO ,d OCR GOVT. T,; 1/4 1/4 T N,PlE (ord> PRO RTY OW ER':S MAILING ADDRESS LOT # B SLM NAME OR CSM # C STATE q ZI CODE PHONE NUMBER ❑CITY ❑ ILLAGE OWN NEAREST RED 'J New Construction Usep~j Residential / Number of bedrooms [ J Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow, gpd Recommended design loading rate bed, gpd/ft2__,P_trench, gpd/ft2 Absorption area required bed, ft2_ trench, ft2 Maximum design loading rate lambed, gpd/ft2---,L-trench, gpd/ft2 Recommended infiltration surface elevation(s) 21 i14 . ft (as referred to ite plan benchmark) Additional design !site 'd rations - Parent material Flood plain elevation, if applicable , ,mot ft rsu =Suitable for system CONVENTIONAL MOUND INGROUND PRESSURE AT GRADE SYSTEM _II FILL HOLDING TANK = Unsuitable for s stem t-S ❑ U S ❑ U %S ❑ U ® S ❑ U ❑ S VU ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. C t. Color Gr. Sz. Sh. Bed Trertdt IT a5 'Ground elev. XL ft. - Depth to 4,57- 9Q Z,5- 9 r % a> s q r - limiting factor Remarks: Boring # i .4114 Ground elev. J 'le Z ft. V -2 -99 5 Depth to limiting factor Remarks: CST Name:-Please Print Phone: Address: Lif Signature: ~ ~ ~ Date:1- CST Number: W PROPERTYOWNER SOIL DESCRIPTION REPORT Page~of~ PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Trench Ground elev. ft. G / L _ g Depth to s ZZ2 <j- /17 44,Z limiting factor Remarks: Boring # Ground elev. ft. -41 ' Depth to ' c - - S' limiting factor ~9l Remarks: Boring # 4iy L~ Ground L,-- elev. S31-71 Z2k~d f~ ft. Depth to - ZL limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 33; ~1- ~Cc~ t~ I 8 ~ T V ij F - David Bracht raap,,./ Certified Residential Specialist Graduate REALTOR• Institute i92 North line of the S" of Uxc SWA of section 26 ND /~✓ENUE~ - - S89'58'33'E 1355.82'-- - 120.29'---- 328.:9•-_ - - - 699.7,41 i 328.30' I X30' I 656.13 - _ S89°43'30"E 1313.03' , j , r p P u Lot #2 $27,900 N P LOT 4 LOT 3 w M o = o ~ I n N o iJ_i 6.25 Acres x v 21 7.11 Acres Inc. RN 309.732 Sq. ft. P ~ P Wooded 6.01 Acres Em. o; 261,707 Sq. Ft. o S N o0 00 I ~ F- Rolling = Z S89•43'30"E 1028.29' - - ° ° -i 378,30' 656.71' 699.99' 13.25`- ,ten W V' N cc 656.60' 328.44' - .•a • o 371.69' N ~ Lot #3 $26,900 z = " of - 6.01 Acres LEGEND o LOT 2 W N Aluminum County Section Monu"nt Found •o„ <I o Wooded c Iron Pipe Found o W - 0 1^x24^ Iron Pipe set, weighing 1.68 lbs pcr linear foot c I~I-J y Rolling - w MATCH Uz 100• Roaday Setback IT,; o 7.08 Acres Inc.:R/M 1 Tot ^ 308,306 Sq. Ft.: L ~4 $17,500 6.25 Acres Exc.: R/W Yf' ` 272,793 93 Sq Sq. Ft. o t Y 3.00 Acres y 1 Rolling LOT 5 W W W . ,3 H 30.51 Acres Inc. R/1f - 1,328.921 Sq. Ft. 01 a w r p I° :n : 30.11 Acres Exc. R/N o 0 Tn7'~C nOlVlVS r 1 1,312,757 Sq. Ft. $ U ~o r+ 1 ~ . ° W ROD~7+~r... ° 589.57'52^E PI'.~ j j Z 372.40' 43.97 328.43' 60.72' rom Somerset 438-"• 3 482.65' ounty Road I North _ W N89.57' 52'w Ln C> ne mile to 192nd. o ° LOT i ° " Csm IN I O z VF3,1?~2Q-4 David Bracht 412.76' 459.20' -J N89°57'52-W 871.96' Office: 715-247-5900 Q ~~/H~ Home: 800-733-9915 teamlrealty 103 Main St., Box 68 ® Ails Somerset, Wisconsin 54025 © Office: (715) 247-5900, Fax: 247-3622 Residence: (800) 733-9915 Each Office Independently Owned and Operated 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 rn>:C'XiQ'E' l 74-0,0'7.1S 100 Location of property S% 1/4 9kV 1/4, Section 2JP- ,T 3/ N-R W Township S~:rraT Mailing address9 /.74/0 ~ Address of site f91 -~''o AA- Subdivision name kolAfE Lot no. _ Other homes on property? Yes 'l No Previous owner of property h'IrMlz Alw-'f'7-twyt/ Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _ KYes No Is this property being developed for (spec house) ? Yes _I'le No Volume 1I and Page Number 310/ 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.l~ , and that I (we) presently own the proposed site or 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 - -~7 pate of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERIBUYER / / o, -n.4, Ads / MAILING ADDRESS PROPERTY ADDRESS X XX I ya kVr _ a.OMj Zf C, Wz yDAT S (location of septic system) Please obtain from the Planning Dept. CITY/STATE 5u M M5 Es, " L-11) t SC'.nA S Y PROPERTY LOCATION 5E 1/4, S yy 1/4, Section , T3 L_N-R J ~W TOWN OF So n9;Fj2,5',5~ ST. CROJX COUNTY, WI SUBDIVISION A)01V £ LOT NUMBER _ CERTIFIED SURVEY MAP VOLUME I I , PAGE 31° I , LOT 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 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: /l DATE: 3 A, St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 • Voi Y228 POIN 56812 li STATE BAR OF WISCONSIN FORM 2 - 1982 j r WARRANTY DLED DOCUMENT NO. FLE G,STEAZ CiFFI ;E ' ST. CROIX CTY., WI Hartman Homes, Inc., a Wisconsin corporation i+►eabftaa MAR 18 1997 9:30 A. M conveys and warrants to -Miebael T. Hort, a single person 3 geplsteruf Deo~a THIS SPACE RESERVED FOR RECORDING DATA _ NAME AND RETURN ADDRESS li the following described real estate m t. Croix County, ii State of Wisconsin: KRISTINA OGLAND Zilz, Estreen & Ogland P.O. Box 359 i Hudson, WI 54016 PARCEL IDENTIFICATION NUMBER I Part of SE1/4 of SWl/4 of Section 28 and part of NE1/4 of NW1/4 of Section 33, all in Township 31 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lot 3 of Certified Survey Map filed May 9, 1996 in Vol. "11", Page 3101, Doc. No. 543452. This Deed is given to correct the previously recorded Deed, which Deed was ~ recorded in Vol. 1185, Page 295 as Doc. No. 545605 and erroneously conveyed Lot 2 instead of the above described Lot 3. EXEMPT This 13 not homestead property. (is) (is we Exception towatranties: easements, restrictions and rights-of-way of record, if any. Dated this _ tom" day of March A.D., 19 9)`Hartman Homes, I (SEAL) by: (SEAL) 7# V (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Mi t ~ State of Wisconsin, ss. - County. authenticated this Vt' day of March 1g 97 Personally came before me this day of 19 , the above named • Kristin Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authorized by $706.06, Wis. Stats.) ro me known to be the person who executed the foregoing iestrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ,