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HomeMy WebLinkAbout038-1084-90-000 6 r 1h ~ V P STC - 104 RL,l„I~LO AS BUILT SANITARY SYSTEM REPORT Jf:' OWNER t ST CROIX c COUNTY ZONING OFFICE ADDRESS~_~~~~ r SUBDIVISION / CSMJ L40T SECTIONS _TN_R_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW HOW EVERYTHING WITHIN 100 FEET OF SYSTEM c y~ tt G " n =/7~O.Scn,r INDICATE NORT ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: v ALTERNATE BM' SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer. , Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: E~- Length 75 Number of trenches Distance & Direction to nearest prop. line: _L2 sf- Setback from: well. / House Other 44 ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold` Bottom of system Existing Grade 73 Final grade /,c/ 7 DATE OF INSTALLATION: ~ j 7 PLUMBER ON JOB: __x LICENSE NUMBERS INSPECTOR: JQp 3/93:jt Wiisc^,-, in Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299082 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: SKOGLUND, KARL STAR PRAIRIE ry) CST BM Elev.: Insp. BM Elev.: BM Description: ' /VIA GS f 'S Parcel Tax No.: rSE fE~ 038-1084-95 030 00 je..6 0& & CO TANK INFORMATION ELEVATION DATA A97 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. d Septic !,4.t C 5 /Lob Benchmark 27~ 2? /.0 Dosing 1 if. f.`P ~7L /06 .S5-Aeration Bldg. Sewer 9 7$ /-0 y9~ Holding 41>0 Inlet 10.77 "0' TANK SETBACK INFORMATION &5A Outlet iwl /off 37 Vent TANK TO P / L WELL BLDG. Ai r Itontake ROAD Dt Inlet Ai Septic ~(~-r yeah. Ns/ NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe t r ~3 q9 ; / Holding Bot. System ~2. 9g 3 P, PUMP / SIPHON INFORMATION Final Grader's Sy 'ol 7 Manufacturer Demand 61t 01.33 %6 y Model Num er - r• - GPM TDH Lift System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM / TRENCH width i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth 4EW 12 7 DIMEN I N DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING ` facturer: INFORMATION Type O _ CHAMBER Model Number: System ' IZ. 56P 112' OR UNIT DISTRIBUTION SYSTEM AS77Vk SCW Z7ZcY H/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Spacing r 7Z~00, Dia. Length Dia. t~E SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only xx Seeded / Sodded xx Mulched Depth Over Depth Over - ~t~ Bed /Trench Center Bed /Trench Edges op❑ Yes ❑ No El Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOC ION: STAR PRAIRIE 20.31.18,NE,SE 2042A CTY RD C LOT 3 > ~ ' Tv /~fleZ w1xr1ee,_ l e6 7.~ r. ' - a ?o~`e.I~ G, C lrin4t j7--6-q"7 Plan revision required? ❑ Yes V No Use other side for additional information. 112-1 ? q7 0~ d~"P' SBD-6710 (R 05191) Date Inspector's ignature ert. No. ADDITIONAL COMMENTS AND SKETCH, y = SANITARY PERMIT NUMBER: w.w , PERMIT APPLICATION 201eE W and BnlgtonnAve lion SANITARY Visconsin In accord with ILHR 83.05, Wis. Adm. Code Madison, 7969 Department of Commerce Mad, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Num er qq0 The information you provide may be used by other government agency programs E] Check if revision o previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLI ATI N INFORMATION - PLEASE PRINT ALL INF RMATION Prope rtn Name Property Location va 1/a, S T , N, R (or Property Owner's Mailing Ad revs, Lot Num Block Numb r Al 104- rty, State Zip Code Phone Number Su ivisio j umber ( > 57.140 M II. TYPE BUILDING: (check one) ❑ State Owned o via Nearest Road 17-1 Public I or 2 Family Dwelling - No. of bedrooms Tol _97 wn 0 r. / III. BUILDING USE: (If building type is public, check all that apply) jf~ Parcel Tax Number(s) 1 ❑ Apartment/ Condo v 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandiser 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 Q Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. IZ New 2. Q Replacement 3, Q Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _ System_______ System Tank Only ______________ExistingSystem________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 110 Seepage Bed 21 ❑ Mound 30 Q 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 q. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Exist in strutted Tanks Tanks Septic Tank or Holding Tank - ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ - ❑ ❑ ❑ ❑ ❑ Vitt. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for ins Ilation o e onsite sewage system shown on the attached plans. Plum r' am (Pr ( Plum r'sSi at el o a ps) MP/MPRSWNo.: Business Phone Number: Plu er's dress trg~et, Ci y, State, ip e): L IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial LI Surcharge Pee) Adverse Determination vJ ~l 7 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD•6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit 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, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL 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. ,i9~el ~S~© //.~J,a ~i'/~'~~/-s.E ~ s,Ec~ - T~3/h~-n°J~G~J s~y~~ ~~of'~f-s~'.~ -,~/mom' / ~ sct- ~~Pu~oa~•~0 ~,~1~ ~~e~k~ ~lG ~ .~~a~~~y / y~ / M /0 ~ 9.- _ - 3D ,~~-~~~scrti.,~~~ d 1 ~f~ /3a~ ~ ~ le f~.~ILS M DEPAR.TME'NT OF REPORT ON _SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, 1_C _ DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 7969 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: O SHI /MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: All- '/a '/a /T,; NIR14 to ' \ G COUNTY: OWNER'S/BUYER'S NAME: A LING ADDRESS: 5X_ 61--o 4- - I'll,f :-sue o~S P4 44 A, e- r- Z?ja I USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS : PERCOLATION TESTS: WResidence . ~IVew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MO: ~U IN-GRO ND-P❑u RESSURE: SYSTEM-IN-FILL HODLDING TANK: R MME` D ~ SYSTEM:(opti n I) If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate. 3 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPT-fl TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 10 IB- _Vy ow ICY e- r. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- i P-.2 L PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION w~Il to t~~/•7 h ~1®N 12 INSTRUCTIONS FOR COMPLETING FORM 115 • SBD - 6395 To be a c~, J accurate soil test, yaur report rrtrtst: include. ,I. complete , ;,.,cription, 2. The u,e s: _ --Ist clearly indicate whether this is a residence or commercial project: 3. MA)Clly UiV, „ ii per of bedrooms or commercial use planned; Is this a n, -t or v;placernent system; S, Ctarnplete,1 tale Witability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY 'F ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS, 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan, 1. MAKE A LEGIBLE diagram accurately locating your test locations, Drawing to scale: is preferred, A separate sheet rnay`be used if desired; S. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Completer all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exernp- tion, if appropriate, 10. If the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LQCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR Bedrock. cot) Cobble (3 - 10") SS - Sandstone gr - Gravel (;leader 3") LS - Limestone s Sand HGW - High Groundwater cs - Coarse Sand Perc - Percolation Rate rued s - Medium Sand W Well fs Fine Sand Bldg - Building Is - Loarny Sand > Greater Than _ Ksl _ Sandy Loam < - Less Than I - Loam Bn - Brown sil Silt Loam BI - Black. si - Silt Gy - Gray Mr.l Clay Loam Y Yellow scl Sandy Clay Loam R - Red sicl - Silty Clay Loam mot Mottles sc - Sandy Clay w/ - with sic Silty Clay fff few, fine, 'faint *c Clay cc - common, coarse pt - Peat mm - Many, medium m - Muck d - distinct - prominent HWL - High water level, Six gen(.!ral sr:ail textures surface water foa liquid waste disposal BM - Beach Mark VRP - Vertical Reference Point 70 5 2 N '800 I 3 34 ~i Pit O ow mfts o, R 1 19, • u W ' p p N 4N1lat V .00 237(0 o N w ~I .L da N 9 . O 4` 6 •'S moo. O 0110 'o ~k • N 8 ` c-• s 310 V D p y o 6.L ~ I S, fo. `l, y a_ 3 o v g ,1 N 2W l 44 0.8 t n _ w"• \ n O moo ,`1~-~ ~''`c~oe~~fOQOC1~~►O pAli \ C e~' Z r ~ • ITT ~ to ° U' a w 00 Lor) o a \ x ° , N ~ N Oil 038 /aay ~s' cry 5010 s FILED n MAR 2 0 1996 ® 3 541045 KATHLEEN H. WALSH a Register of Deeds SL Croix Co., WI rn ~ \ rt o At A i K At \v rt 00 \ 01k8 °ioN`Jo S.D - rt o ~0 o rh P- (D Y r. "k (015 00,,E rt, o q1 r4 (D c ',fl c,'L~ rn z p t1i Ln 1,71 m P" \ ` i f=+ )b z n ° ` • `'s ~CJ~ 1 h rJ a fi cn W <P o° ° e t=J bi m rn C) ;a 0-, m 1.0 ct c 6 n a j9 O --i v N tzj O n 0 a qd Fh -p i9 coo cc (A -n N 0 o c c c•t• Q to a x V1 a c' \ c ~ a \ ~ ~ ZA 3 ct 00 tv cu ~a x F~ W ` CP -3 ,6 CID 2631A.2C \ Frt,r• 0 £LO£ a2va ii 'ToA •ODTApe ao3 paeog uMoy 9Ile radoadde pue oo-r33o. ButuoZ A-aunoo xioao - IS agl :loe:Iuoo Teoaed Aue buidOTanap ao BuYsegoand eao3ag -(•o:1a 'Teoaed oq sseooe 'azTs joT mtuuT- -rm 'spueT:IaM ' • a • i) suoi-4eTn6aa pue so-Era 'sMeT dzgsuMOs pue Alunoo 'aieIS 03 339Cgns si dem szgl uO uMOgs Teoaed goeg 3o aoueuTpao -awes BUTddem pue BuTAeAins UT XTOao -:tS 3o A:Iunoo aq:l uOTS-rATPgnS PueZ aql Pue salnivIS uisuooSZM aq:l 30 fiE'9EZ as:dego 30 suOiBTAoad auaaano 943 gITA paiTdmoo ATTn3 aneq I jegp :pagiaosap pue PaAetuns Azepunoq xo-raa~xa age 3o aTeos o:j uoi-4ewasaadaa :loaaaoo a s-r dew AaAanS Pat.Maao szq'4 Imp A3z:Iaeo osTe I •paooaa 30 sIuamasea -TTE o:l joelcns ST Taoaed pagiaosap aAogv (-Ia 'bS L8v'ZL) 89a3V 99'T suieluoo Teoaed sigZ •StlTftffiS a qu-F Zi aql 03 1999 99' ZSE 'B,,ZT ,TTOV ZS aouag4 -19,93 L6' 66T 'HUM VITOLM aouag:l :3993 W ELE 'au:rT paquamnuom pees BuoTe 'M„EOILTctyiZN eouag~ eoi33O speed 3o aaIsiba7i Aiunoo xzoao • aS aqp Iv E-cvE abed 'S OML -[OA ut papaooaa dew AetianS POTIaao 30 E :10Z 30 auiT lsea pa:luamnuOm 9t1 Ol -4893 Z6-66T 'AeM-36-:tg5ta pies BuoTe 'MuZT~ZTOT9S Buznui:Iuoo eoueq:t = 9143 03 3993 9T'6SZ 'AeM-30-IgBTa pies BuoTe 'f4uZTiZToT9S aouaqI !AouaBueq 3o quzod aqp o:j .49a3 09-Z6Z 'A-em -30-146Ta pies pue anano pies 30 oae 941 BuoTe 'ATaalsem eouagq !Iaa3 98-T6Z.seanseem pue MnOTA9TO89S saeaq paogo esogM 1119SIL001,T seanseem oTBue Teaauao esogM 'A-Eaag:lnos eAeouoo 'anano snipea goo3 8Z'98TT e 3o oAano uo Jutod a Buiaq uo„ AeMgBig *nuy A:Iunoo 3o AeM-30-IgBza ATaaglaou aqa 03 4993 W i 'uOTIOGS pies 90 V/THS agl 30 auiT ISeg aql BuoTe 'f4uTVtEOoTOS aouagl :OZ uOTI09S 30 aauaoo V/Tg aql Ie . :sMoTTo3 se pegtaosap !uisuoosTm 'Alunoo xtoao *IS 'a-rateag aejS 3o uMoy 'M8T2i INTEL 'OZ uoipoes ui TTe 'V/T$S age 3o 1,/Tam aql 3o gaed ur pue v,/Tan aql 3o fii/THS aql 3o gaed uT paleooq :sMOTTo3.,se pagtaosap sT paddem pue paAanans Taoaed pueT agp 3o Azepunog aozaa:lxa 941 Imp :deW AananS p9i3i:laao stgq Aq pa:juasaadaa ST goigM Tooaed pueT ag-4 peddem pue pegiaosep 1peAenans aAeq i 'uieuuob 9AoIs 3o uoiIoaaip aqn Aq :teq: 'A3t:laao Agaaaq 'aoAeAans pueq utsuoosiM peaalszBea 'ueBegAN -o uaTTv 'I 8 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 recprding. Owner of property Location of property_ &c 1/4 1/4, Section,T N-R_1rW Township ,e P „a, Mailing address Address of site:~~~~~ Subdivision name Lot no. Other homes on property? Yeses-No Previous owner of property v~~e h ~ ~ ! .Artl~J Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? 'Yes No Is this property being developed for (spec house) ? Yes No Volume,~ 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 he 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 gnature of, ica Co-Applicant Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County w OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain' from the Planning Dept. CITY/STATE i„c c ,/Z PROPERTY LOCATION _ iVF 1/4, 1/4, Sections TT_N-RAW ST. CROIX COUNTY, WI TOWN OF 4 SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME 5-, PAGE A113 , 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: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 STATE BAR OF WISCONSIN FORM 2 - I082 99 a` WAA a Y DFFD j • DOCUMENT NO. AL 52W'407 REGiSTER'$ OFFICE Stephen J. Germain and Melanie Germain, $T. CROiX CO.. WI Pius-bancT-andwife,---- Iac•d +ot,•~ SEP 0 8 1997 conveys and warrant- to Ka r, -SJ ogl-and------ s:ofl A M I - - THIS SPACE RESERVED FOR gECOROtNG DATA jl NAME AND RETURN ArORESS r I' the following descrihcd real estate in __~t Cm i x CA-KY• `tate of Wisconsin: I 038-1084-95-03 PARCEL IOENnf W-AtKJIr ytAMER I Part of the NEI/4 of the SE1/4 of Section 20-31-18 described as Ij follows: Lot 3 of Certified Survey Map filed April 17, 1984, in Vol. "511, page 1413. ~I TOGETHER WITH AND SUBJECT TO a Joint Driveway as shown on Lot 4 of Certified Survey Map in Vol. 0110, page 3073 and as located on Lot 3 of Certified Survey Map in Vol_ 'S•, page 1413, St. Croix County, Wisconsin. TRA~~ j~ This iS not _homesteadproperty. l X*kX 6., not) ~j Exccptionto warnnties: Easements, restrictions and rights-of-way of record, if ` any. ~I Dated this 5 day of Sep_- eDher AD, 19 97. ~j ~~1 Q,<<f)taLw- iSEAL) _ (SEAL) I ~ I` Ste h_e J Germain - l4elanie Germain (SEAL) (SEAL) Ip i~ AUTHENTICATION ACKNOWLEDGMENT 11 State of Wisconsin, II Signature(s) - ss. I authenticated this --day 19-- rr-,uviaPy came before me this day of Sep1:embe•r-- 193_-. the ahen-t named i I - - -fit phen- rmain --an~L M-(~i.Ani? - 4 F fi=xer v,^,-.w+cV6-,wu-, v _.JrTs.[o io V % U 11Y1s i-i p dii q .noyi At-2-t., u, X ~u su I, r1 )n s>w~N } y -u. - cssaIau ~ 91 arep uokirgd. a afed '~i iuaueu»aa si u,4-Sl _ xm v .y~ iuu aie ,t,LUJ P.Apal.+.ouIAe Jo pate?iluaylne aq (sw sain,ru8is) ~M :C,unr~ . - 9 t 06S IM TvospH i ~ pielbp A0 (]31jV)JG SVM 1N~W!181SNi SIHl qi alp l.tiwu~~r Ex,s ;raa Sul"Nalol N) pa,nasax3 oNft uosiA aqt N Of uw r aaax Ui (sle,S siM •90 goL3 A4 Pan,uqu,e (E 'IOU )i) li NISNODSIA'1 dO SV9 3 [VIS 111d,13114:3-1111 I' U a C~~ i i - I S/lo i; Cif I' ,f ~ 4 ,'SLR i; I y E/)T2y I-Ay NY y cf'a Fk'ZSt flaGa~ Sob ~ed+2s dow-z s~,Rs i 9 _ i I lb 's 1i ii i i~ _ s j r 1 i; it Till ii is i t.i l 1; ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER n x x u A„x rrr 1101 Carmichael Road r , Hudson, WI 54016-7710 - (715) 386-4680 March 6, 1998 Remax Team 1 Realty Attn: Mike Germain 103 Main Street Somerset, WI 54025 RE: Septic Inspection for Karl Skoglund located at 2042A CTH "C", Lot 3, Town of Star Prairie, St. Croix County, Wisconsin Dear Mr. Germain: A septic inspection of the above referenced property was conducted on December 8, 1997. This property is located in the NE'/4 of the SE'/4 of Section 20, T31 N-R18W, Lot 3, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. If you have any questions regarding this, please contact our office at (715) 386-4680. Sincerely, Rod Eslin9er Assistant Zoning Administrator /sm