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HomeMy WebLinkAbout040-1059-40-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER e j ADDRESS. ~ fo? C A y V' SUBDIVISIOqN / CSMf LOT SECTION / T~ b N-RzW, Town of- ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM -3 S'o t //I Ty, a ~ ' 190 100 11) INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. DENCNMARK: ~6 D 16 ALTERNATE DM: TANR / P[JMP CHAMII HOLD ING TANK INFORMATION Manufacturer: Liquid CaPacity:A5W 5'6 Setback from: Well-z//~~1 House Y(~ Other Pump: Manufacturer e %4 Modell 4 LL Size 6l7` Float seperation d Gallons cycle: Alarm Location SOIL ADSORPTION SYSTEM Width: y Length SAD Number of trenches Distance Direction to nearest prop, line: LJ Setback from: wells :-"16 U House ~l60 Other - /Old 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 16 O?b PLUMBER ON JOB: LICENSE NUMBER:— INSPECTOR: 3/93:jt Wisconun Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanita 99127 GENERAL INFORMATION Permit Holder's Name: p Cit ❑ Village Town of: State Plan ID No.: LACKEY, DAVID & FAYE TROY CST BM Elev.: / Insp. BM Elev.: BM Description: Parcel ab48o-.: r'L , ~L lCJ . lf~ J~ m~~ c is 1059-40-000 TANK INFORMATION ELEVATION DATA A9700444 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark g7 /CJ C1~ f Dosing Aerati Bldg. Sewer Holdin St/ byK Inlet (os ANK SETBACK INFORMATION St/ I Outlet Vent TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet 97 Septic 3 NA Dt Bottom Dosing NA Header 31' Aeration NA Dist. Pipe Holdi Bot. System 4, PUMP/ SIPHON INFORMATION Final Grade S ' n 'e Manufacturer Demand , /Yt"- _ ~YQ re t.~ S ' Model Number GPM TDH Lift Friction System TDH Ft oss Head Forcemain Length X30' Dia.02 ` Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width i/ Length No. Of Trenches No. Of Pits Inside Dia. Liquid Depth -PIT DIMENSIONS 3 'D MEN SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING INFORMATION Type O CHAMB Model Num er: System: 0R.NKIIT DISTRIBUTION SYSTE r({J,~9,,r` p-,-L,-t,,cp 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 E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 15.28.19.227C,SE,NE 692 GLOVER ROAD 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: SANITARY PERMIT APPLICATION 2018E.Wand shnlgtonAve sion N%#&ConSin _ P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm Code Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less county , Cr© , than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State sani0?taryy PPermit Nuumb/e~/r The information you provide may be used by other government agency programs E] Check it revision to v`ious application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Nam Fa v pert Location UL~'J-0 l Q C , 1/4, S Tc , N, R E (o 0 Property Owner's h gAd a Lot Numbed Block Number of D~~IF ar tate t . Zip Oide P e lUum er , Subdivision Name or CSM Number % ~XIAIK A) v l 5) 5' 1. TYPE F BUR DING: (check one) ❑ State Owned ❑ it~ Nea st oad Public 1 or 2 Family Dwelling - No. of bedrooms E] VIIage Town F 7P yep Ad, III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number( 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 online B, if applicable) A) 1. ❑ 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 Trench1~t~u IU7"j 22 E] 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 Requ'rQ~l q. ft.) Pro17V q. ft.) (Gal day/sq. ft.) (M' /in h) El,e~,.v, T Feet Feet le) .1 VII. TANK Capaaty Site Fiber INFORMATION in gallons G lions a ks Manufacturer's Name cone e e Con- Steel g ass Plastic AExper. pp. New Existin strutted Tanks Tanks p Septic Tank or Holding Tank b0 LdcS 1~ ~S bi ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ . ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility f 9r installation of the onsite sews shown on the attached plans. P er's Name: (Print Plu a Signature: ( a Ps) Business Phone Nu b r* 04 26M AwA Plumber's Ac dress (Street, Cit , Sta de): IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing Afient!,;ignature mps) Surcharge Fee) Approved ❑ Owner Given Initial el ~I~tJ~ ~1-42Z_ Adverse Determination <J~/ 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. 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. Ik' t ~br JA't (tis /f l.J~ y tT, Top Yn►n, 4ia't p-pep ~a w e r 'S PUMP CHAMBER CROSS SEC IOIJ AMD SPECIFICA-rIOkJS rnc,F c;F VEUT CAP 4"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIAIG 25' FROM DOOR, JUNCTION BOX MAMHOLE COVER WINDOW OR FRESH I2"MIU. AIR INTAKE GRADE I I 4" MIN. ~ l-_ COKIOUIT 18"MIU. _ _ _ 11~ IMLET PROVIDE I AIRTIGHT SEAL A I' ~ I I I I ALARM B ~ I I I C *APPROVED i i ON JOINTS WITH ELEV. FT APPROVED PIPE g 3' ONTO PUMP- OFF D SOLID SOIL CONCRETE BLOCK RISER EXIT PERMITTED OWLy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E S ECIFICATIOUS DOSE ~a TANKS MANUFACTURER: - ~wLt V ~WMBER OF DOSES: PER OAy -ze TANK SIZE: GALLOKIS DOSE VOLUME ALARM MANUFACTURER: IMCLUDING BACKFLOW: ! 0/ GALLONS .4.5 MODEL KIUMBER: CAPACITIES: A= Ale_9MCAIS OR C ° AALLOU5 i ! SWITCH TyP¢; C/ B = INCHES OR Y,D GALLONS 5~ PUMP MANUFACTURER: r) 13 14 IUCHE$ OR /20 GALLONS I MODEL NUMBER: l / D=lO~ INCHES OR! ) GALLONS SWITCH TYPE: 14 IrMOTE: PUMP AND ALARM ARE TO BE MIKIIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEREIJCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MIAJIMUM NETWORK SUPPLY PRF_SSURT.E/. _ , 2.5 FEET + FEET OF FORCE MAIN X i=F/ooFtFRICTIOU FACYOR__ I~! FEET TOTAL 0HUAMIC HEAD = ` FEET IMTERMAL, DIMEMSIONt OF TANK: LEKIGTH ;WIDTH ;LIQUID DEPTH SIGKIED: LICEMSE NUMBER: _ naTr, Goulds Submersible Effluent Pump 3871 EP04 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas- • Homes components. Available for automatic and tic cover with integral handle Motor. and float switch attachment • Farms manual operation. Automatic • EP04 Single phase: 0.4 HP, points. • Heavy duty sump 115 or 230 V, 60 Hz, 1550 models include Mechanical • Water transfer Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, 115 V. 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing , construction. Pump: EP04 built in overload with ■ EP04 Impeller Thermo- • Solids handling capability: automatic reset. plastic Semi-open design 3/4 maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SP• Cana"StandardsAssociation • Total heads: up to 24 feet. with three prong grounding - • Discharge size: 11/2" NPT. plug. Optional 20 foot ■ EP05 Impeller Thermo- • listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F' or "AC°.) rotary/ceramic-stationary, three prong grounding plug improved performance. BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104°F (40°C) continuous superior strength and 140°F (600C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 _ • Capable of running dry without damage to s 30 ` sGPM components. Pump: EP05 $ 251'r. " • Solids handling capability: 0 25 1/a maximum. a z i • Capacities: up to 60 GPM. _ i i • Total heads: up to 31 feet. 6 20 • Discharge size:1 W NPT. z 5 • Mechanical seal: carbon- } _ T a 4 15 ; E rotary/ceramic-stationary, ° BUNA-N elastomers. _ o • Temperature: 3 10 104OF (400C) continuous 140OF (600C) intermittent. 2 5 1 I ( i 0 00 10 20 30 40 1 50 GPM 0 2 4 6 8 1o 12 ' m'/h L -L -L -L L CAPACrTY 0 1995 Goulds Pumps, W. Effective May. 1995 Wisconsin flepartment of Industry, SOIL AND SITE EVALUATION REPORT I'age ~ of Di.vision of Safety & Buildings in accord with ILHR 83.05, Wis. Adrn. Code COUNTY Attach complete site plan on paper not less than 8 1/2:x `1 T`inches in Plan must include, but ST, C KO t not limited to vertical and horizontal reference poO'(BM), direction an ° slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to neare,a road. 011D - /0J ~1-'S O APPLICANT INFORMATION-PLEASE RIND' ALL INFOkQATIO REVIEWED BY DATE PtR~OPPERTY OWNER: Q PR PERTY LOCATION Am m FANS LAC.KEy 14 . 69; $6 1/4 &19' 1/4,S ~S T Z g N,R EW PROPERTY OWNERS MAILING ADDRESS 411,CX, y1 LOT # BLOCK # SUED. NAME OR CSM # 1092 COL.uvEM~ Ra• ONINGOPFICE - - CITY, STATE ZIP CODE NUMBER - ❑CITY ❑VILLAGE MOWN NEAREST ROAD u sly] s sy o t to. M&I ~r ~o c ovi - New Construction Use.X Residential / Number of bedrooms -5 (J Addition to existing building ~Q Replacement ( ] Public or commercial describe Code derived daily flow 1450 gpd Recommended design loading rate Q. bed, gpd/ft2 d,7 trench, gpd/112 Absorption area required 750 bed, ft2 4 3 trench, ft2 Maximum design loading rate Dj bed, gpd/ft2 tl' g trench, gpd/f12 Recommended infiltration surface elevation(s) Tb Be DeT-eft)AI0 Zb at__ft (as referred to site plan benchmark) Additional design/ site considerations Parent material .SAi4D Keu r Flood plain elevation, if applicable MIS It Fu = Suitable for system CO VENDO NAL MOUND IN ROUND PRESSURE T-GRADE SYSTEM IN FILL HOLDING TANK = Unsuitable for s ste S U 11 U S❑ U V ❑ U ❑ S ,~U El S 06U 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 TMrK:h 1 I s i rn r Mjr 5 0.5 O. (o > : 2 (~-Ito a. - st 1 2.msb -fr Q-W r D.S 0.~ 10 VP' 1 Ground 3 I -2 f2 66 - st 1 ';2 rn zbl mf r CW o.s o. elev. Ib' StL 24-35 I 3j3 - S I 1 m-sK M \j -`r CN► Co, 0,S Depth to S - 2 I0 3~y S OS 1 b."7 !rj.7 limiting fac7orq,Ltt Remarks: H alt 5 D . Boring # 10 yr 2-1 - ( rn r rnV~r C5 0,5 ` U b 2' z 6-15 10 2 1 1 m bbK ryNi CvJ 0 S 08 , i 3 )S 10 y 313 'SI 1 2 msb CvJ O.S o. b Ground IO elev. 214-29 y S l 1 2 r~'►sb Mfr 0.vJ - O.S 0.(0 Depth to 2q-36 I0Y 3/ _ CI m b n1Tr limiting c2 facto fi 36-y2-I o` e- it y ioto ~ l cl 3 ms K ry\fr CL-\,j 0.4 0.5 ' L~ 7 y2~9o IbY 3J~, s 0S I 0.7 0•S Remarks: HKIZON Z 5? O rr r. CS Name: PI se Pint Pi;une: Addr ss 220 8 0-1~^ AVEi _ R vEK T% VZ S1 402Z. Sign t re' ` Date: CST Number: j(L SEPT. 22 199 03107 PROPERTYOWNER IifiCKE~ _ SOIL DESCRIPTION REPORT Page Z-of 3 PARCEL I.D. DD I OS9~ ya Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourclary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxfi El ( -`l D YKZ 51) Z m y- 5 - C),51 wo 2 7 -1'7 10 Yle, Z, I 511 2 m 5b1 Ground 3 1'7- 's/ Z 2 m5b) _/A S Q_ S Q b elev. _ IO `f yit. -A I0 `I R* CI 2msbK _ YYNt,- Qs _ 0, (A 1 0.5 Depth to s' Z 10 y 31 I s 1 M&K_ yn 1( 0.W _ 0.7 9 limiting factor 3,~ ~e 24-1 1o'l 3/ s D S _,ml _ - .7 Remarks: - - - Boring # KIM-. y''F Ground - elev. ft. Depth to limiting factor Remarks: Boring # ~x ~~.~~+lt*%fli'~ Ground i elev. Depth to limiting factor 'Remarks: Boring # Ground 818V ' ft. Depth to a0ting b Page 3 of 3 PLOT PLAN Property Owner;QAVIj) 'FAFyt L*c.KEy Legend: /II 4OI EXcE-F wt'E-jes AWT ED , Legal Description A- PAMELLCCA'TED BM =(R) NW CO"F-ve- OP CU.NcKE-r'F--PA-rID IN THE SEY4 OF -Ttie tIF-V4, 5EC, If, /{,S,SUnnE~ /D0.0 -t2j Q x19W~"1"OWN Or-'TROY, 6?•CkD1X = soil boring w/backhoe Co uNTy~ w ~scaNS► N . NO cb-mm 83 sl~~ bgelC PROBI A►s SITE I A Cof-A 55 eL~ . /FPPKaX. n D L32 . Z5~ -rp st f'iaPzt y I~iUE 75 FL- /0 - 8I n7 EL I oil. w J rr- ~L W auRFAcv-. CL 107-5D/ Q ~WEU.. coNCt~te ~ , SLAB 1 U * 3 n'~OIGOOM HouaE. c ~Rp Y- '12- M% le- AO 5X.. l+. -55' VII s` Signed CST M03707 Date DEPT, ZZ~ I q~I now- 6 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. t Owner of property GL, l j 15"-, e Aa,' c eL Location of property 1/41/4, Section } ,T N-RZy W Township b Mailing address Address of site Ja,~y -e subdivision name Lot no. Other homes on property? Yes ~CNo Previous owner of property hec T ~ , Total "sire of -property n a a&PLp-C T'otal'site'ofparcel, / Da fps Date-parcel vas created. Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume,5'7/ and Page Number`io 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 n 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. 9-3 S nature f Applica Co-Applicant Date f Si nature Date of gj"nat>>rn STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County k ` OWNER/BUYER eko MAILING ADDRESS 6 PROPERTY ADDRESS ' (location of septic system) Please obtain from the Planning Dept. CITY/STATE L~`~ Gr r ~ I U" PROPERTY LOCATION 1/4, 1/4, Section --6--`'-+ T c O N-RW TOWN OF TN LA ST. CROIX COUNTY, WI SUBDIVISION:. LOT NUMBER CERTIFIED SURVEY MAP , VOLUME PAGE , LOT NU1449R 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 i tion date: SIGNED: DATE: ~D C) a St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 DOCUMENT NO. ` STATE BAR OF WISCONSIN-FORM I Q WARRANTY DEED 4~ 347383 V., ~ A6. MIS SPACE. RESERVED FOR RECORDING DATA 1 IX CO,, OFFICE ' THIS DEED, made between Charles J. Smith and Sally E. Smites RE~i OSTER$ husband and wife and each in their c_va r_ ight ST. -RtX WiS. Recd. for Record 06 27 and - David J. Lackey and - FSv--L--. Lac ke- y-, - husband and wife day of March A. D. 193a e as jo3,GZ-tenants - - - ' tt -8:_30( {AA K ~f ii Witnesseth, That tae said Grantor for a valuable consideration J conveys to Grantee the followingdescribedrealestateIn at-Croix _____Gunt71. RETURN TO State of Wisconsin: j A parcel of land located in the So,itheast Quarter (SEA) of the Northeast Quarter (NEk) of Section Fifteen (15), Township Twenty-eight (28) North, Range Nineteen (19) T..Key■ j , West, Town of Troy, St. Croix County, Wisconsin, described This is - homestead property. as follows: Commencing at the East Quarter corner of said Section 15; thence South 89016'55" West (true bearing) 422.50 feet along the South line of said Northeast Quarter (NEit); thence North 0026' West 184.49 feet (recorded as North 0043' West 183.00 feet) to the point of beginning; thence North West 259.01 feet; thence South 89016'55" West 100.00 feet; thence South 0026' Eas 258.66 feet; thence North 89029' East (recorded as North 89017' East) 100.00 feet the point of beginning. Also, part of SEk of W4 of Section 15-28-19 described a= follows: Commencing on S line of said SE~t of NEit at a Point S 89017'W 422.5rD fe_t from El, corner of said Section 15; thence N 0043'W 183 feet; thence S 89017' . =='0 feet; thence S 0043' E 183 feet to S line of said SE`s of NE-11,; thence N 89t'17' E on said S line 100 feet to place of beginning. Together with all and singular the heredicaments and appurtenances thereunto be..cgzng or in any wise appertaining; And_(har'Pg T. Smith and _Sal]y___Sntith_ warrants that the title is good, indefeasible in fee simple and free and clear of exusiaances except restrictions and easements of record FEM and will warrant and defend the same. Executed of _ River Falls, Wisconsin this -23rd day of __March 19 SIGNED AND SEALED IN PRESENCE OF 61 (SEAL) C!--_-rles J. Smith f~ ^~_LG~ Y .in yif i (SEAL) _ Saliv E.--Smith ' - t SE A L) (SEAL) Signatures of authenticated this day of 19 Title: 1We+ai.rr State Bar of Wisconsin or Other Party Auttsorssed seder Sec. 706.06 viz. STATE OF WISCONSIN -.P1E3C~------ County. ss. Personally came before me, this day at ---_Mf~rCtL 191 , the above named _ClIarle-S-Ts_Smith and. Sally q_ith to me know.l to be the person _9__ who executed the foregoing instrument wed ackmx ledged the same. i~ ~ i ~ r