HomeMy WebLinkAbout040-1135-55-000
4• STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Tier,
IP /9
ADDRESS_ 37 sw+rr'ewor'
0.~~ ..thy A-0,0• 9v4/do
N / CSM f ye f 7 ! 7r -x LOT f
SECTION 3~ T Z61 W, Town of Tk py
ST. CROIX COUNTY, WISCONSIN ~v - 13 S - 5506 0
2i`7. 2g. l . S S (o u
PLAN. VIEW .
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
-sunv,ew aa>`,yre,
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wrdt e t #
T- tcp! i'c f,4 r /C 3-3 j7 60 l'i
a S'a f't
septa" td-k 30 43
~ 1 Q
nt di o 9 7
/0 4
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o flaw '9~dl) 1 pi ~r a !
of ex
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d/w,eas, ayi~ ~J
3-tkesc4r eA" J-x 80711~
P}c1
" Prod, INDICATE NORTH ARROW
Q h
~tPoV~
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
'BENCHMARK: a O
ALTERNATE BM: C~h ~;2' •1 e 7" ~`0 00 L Cy
% :SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION /
! d fJ R ` GCs /~so« h / I- TO
Manufacturer: Liquid Capacity: i Z o~d /
Setback from: Well House s8 Other N-
Pump: Manufacturer &7f :Modelf /Y ?b Size
Float seperation Gallons/cycle: IV
Alarm Location A-,4-
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line: 4 ? J'-t,
Setback from: well: ?/,('-,';--House ~lav~t Other Nth
ELEVATIONS =
Building Sewer 41-r ST In'l'et:"" " ST outlet: •CjLsJ4 h
PC inlet ivy PC bottom N!4 Pump Off
5'.3e-27.r Y, -f/ 4s.
6- 9
Header/Manifold 7 bottom of system 9 70 uo
1y.o4
7. 1^ -~aa.la f:.6 /a/_ua
Existing Grade 7-a 9 q. 9o Final grade ; ao
DATE OF INSTALLATION: /s-/7 7
PLUMBER ON JOB: C~~kles Gye4r4aV - 4.4
4141
LICENSE NUMBER: 11P
6'S J
INSPECTOR: -e f~n s
3/93:jt
j?, `I 7-70
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Y
Safety and Buildings Division Count ST . CROIX
_ INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar~PFgnjtg:
Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)].
Permit Holder's Nam Village Town of: State Plan ID No.:
DOUGHERTY, ~1'IM Qfwp
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel _hb:L1135-55-000
TANK INFORMATION ELEVATION DATA A9700236
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic
Benchmark j
f All Z, 1r,
o /6a~
Aeration Bldg. Sewer
F olding St/ Ht Inlet ' loo, 5.-Z-'
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. VentAirto Intake ROAD 0,j D"nkl~~ G. 6 U .
Septic , 4 > NA Dt Bottom
8.38;
Dosing NA Header / Man. r. ?e 4 S 9-~'
Aeration NA Dist. Pipe g :813 ; qQg 9
9, ~r li'8, a 9 '
[!!i~ng Bot. System
PUMP/ SIPHON INFORMATION Final Grade
~r•9'
5.1a•J~ rr/r~~~
-...s. ~d~ X03.3
Manufacturer DejFt
Model Number
/ G/rP..~uJ#a.vk+ .8/ c9l-~~J~
TDH Lift Friction System TDH oss mead
Forcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ur d 1- DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION TypeO CHAMBER Model Num er:
System: ,V,, ' /0,0 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 'v Bed /Trench Edges Topsoil E] Yes ❑ No E] Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TROY 35.28.19.556U,NE,SE 37 SUNVIEW DRIVE LOT 2
/ n
hJ/f` 1-r 1 p v Q J
AL4
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. g L5 n Z
SBD-6710 (R.3/97) Date sp 4r's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Safety and Buildings Division
^•;`nR SANITARY PERMIT APPLICATION Bureau of Building water systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County y
than 8 112 x 11 inches in size. C/ro/111(
See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs El Check revision to previous application
(Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION PLEASE PRINT ALL INFORMATION
Property Owner Name ,,ropertt Location
/->otz 6aer~ * 1/4 S4' 1/4, S 3,r T 2-91, No R /,Pffer) W
Property Owner's Mailing Address Lot Number Block Number
37
Cit , State Zip Cod Phone Numbg,r Subdivision Name or CSM Number
11. TYPE F BUILDING: (check one) ❑ State Owned ❑ ity nyarest R_gad pr,rQ
❑ Village ~rav~
of ~d®
❑ Public 1 or 2 Family Dwelling - No. of bedrooms fgrTown
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 of 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. ❑ New 2_;M~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;9 Seepage Trench w..r 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) lev Ion
47 p~'_ Feet Feet
VII. TANK Capacit Site
in gallons Total # of Prefab. Fiber- Exper.
INFORMATION g ' Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existi ~►e.~~"~hX strutted
Tanks Tanks
Septic Tank or Holding Tank / 14EJZa .Z.Z C7 +P~~'t'y ❑ ' ❑ ❑ ❑ ❑
Lift Pump Tank (Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT V er'dA!"d't 00 to
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: oStamps) MP/MPRSWool"do.: Bu mess P one Number:
:01 4>
Plumber's Address (Street, City, State, Zip Code):
IV -77eO
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps)
Approved Surcharge Fee)
❑ Owner Given Initial
Adverse Determination d L/ ~02 *41
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: 10
SBD-639$ (R. 05/94) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Divr 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 ma_ iling..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.
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ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the A, pd c,3,1,I A- 7L residence located at:
1/4, syr 1/4, Sec., TZO N, R-L?-W, Town of
T~d f Upon inspection, I certify that I have found the
tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced 7
Did flow back occur from absorption system? Yes No ~<(if no, skip
next line)
Approximate volume or length of time: !/A gallons minutes
Capacity:
Construction: Prefab Concrete_1< Steel Other
Manufacurer (if known):
Age of Tank (if known):
G`~ C'~dr~1 Gt/e d Ile
(Signature) (Name) Please fPrint
14 /
'I ,a (Title) (License Number)
(Date)
Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR-83, Wis. Adm. Code (except for
inspection opening over outlet baffle).
N a m e c r .1s--1P.,r s qtr S i g n a t u r e L~GG /~i~~'Uy M P f~~ 47
5/168
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Wiscosasin Department of Industry, SOIL AND SITE EVALUATION.--R.E.P O RT Page ~ of ~
,Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, I
UNTY
~a ST C2~.i ~X
Attach complete site plan on paper not less than 81/2 x 11 inches in siz . m gi~ut
not limited to vertical and horizontal reference point (BM), direction and o lope, L I.D. #
dimensioned, north arrow, and location and distance to nearest road. r 'ecib
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMA DBY DATE
~~o►x
PROPERTY OWNER: OPERTYCWIV"
`S-1 F.1 -D Ov e N EN`T t/a ,s 3 S T Z N,R 19 EKW)
PROPERTY OWNER':S MAILING ADDRESS T S` AME OR CSM #
31 :sum vti-SI-v D1'1UE
CITY STATE ZIP CODE PHONE NUMBER CITY ( (3E SOWN NEAREST ROAD
tLL.S fJ1 sYoL2 (pis) Zs -Oie_69 'fi cU`t ~L oz-
' f
P, lztiN
[ ] New Construction Use [,XJ Residential / Number of bedrooms L/ [ J Addition to existing building
[4 Replacement [ J Public or commercial describe
Code derived dairy flow 6 Op gpd ,uS,, t,Noeb Recommended design loading rate - bed, gpd/ft2 • 5 trench, gpolfi2
Absorption area required V L,00 bed, ft2 NZOb trench, ft2 Maximum design loading rate S bed, gpd$ -trench, gpd/ft2
Recommended infiltration surface elevation(s)118.3 - 98.0 1t1- 7 It (as referred to site plan benchmark)
Additional design/ site considerations 3 ~12ch S - isR C 1 f S ' x b Z~ L L*J G .
Parent material L.OzS 3 ex l Z-r- a sJ 31-JrJ Flood plain elevation, if applicable N, fa . ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for s tem ®S ❑ U ZS O U OS O U ® S [I U El S E[ U I] S 0)
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tuck
Z 1 -Z. 1 O `'i t'~ 3 !y - ! Z S ~lz m C 1 c w - S
Ground 3 Z4 3 Z. 10 `i 2 3l~ - S l y Z S b>z `F l~ C - S
elev. . 5 ,
X19-y ft '32_L16 ti r,16 - 1 ~s c~ btiL vn U -
Depth to
limiting
factor
8
Remarks:
Boring #
e_~3 1~`1~L Z L Z - 511 Z i?Sbl2 my ~w c~lv S
Z Z ti3 Zl. 13 `i 1Z 31 y - S 1 1 , Sb!r~ n1 ~ . s r
3 ZI-3q lo~R 3/~ - s11 2m Ab
Ground l
elev. 3°l-SO 13`12 ~y S
1ob.o ft
S se 69 lo~>Z 6/6 - 1 ~S ~~5~~ mU
Depth to
limiting L L9 Z 10`? 2. 6l l S iZ 3 I lS `J`am wi u~ - -
factor
69"
Remarks:
CST Name:-Please Print Arthur L. W e e r e r Phone. 715-425-0165
1
e~gerer_Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: b Date: CST Number:
F
PROPERTYOWNER ~oU C ti~l2~~f SOIL DESCRIPTION REPORT Page Z of '
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. MV.nsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed
Trends
o-tTm UciLj O Ground Z.o 3to`t`em, 3/6 s i Z s~~ yn {~1~ C S S
elev.
roe. b ft. 38-70 l 0`t 2 6(~ ` c~sh~rt `m U`F • S • 6
Depth to
limiting `
factor
7 1
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
l
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
f Boring #
ax
aT;:
Ground
etev.
j ft.
Depth to
` limiting
factor
Remarks:
nnn nnnn/f'r nrrnn,
PLOT PLAN Page 3 of 3
SCALE 1"= 10 '
s' S , S
6
r S ~'P~'l C b
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Ut G~1 lp` (715 ? 42.5-0165 1400576
CST Signature Date Signed . Telephone No. CST #
LED
4358"78 APR 4180 co
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CERTIFIED SURVEY MAP Kek OL Cook GL.
DON D. KRUGER AND DONNA M. KRUGER
8 4
Part of the Northeast 1/4 of the Southeast 1/4 of Section 35, Township 28 , ange
19 West, Town of Troy, St. Croix County, Wisconsin.
CITY OF RIVER FALLS
E I14 COR. SfC.33, T 28 N,
R/9 W, /COUNTY
APPROVED SURVEYOR'S MON.)
TITLE ``~~~•+t ~ O OWNER'S ADDRESS :
O DA T £ D N cam. 3 n / Ff 7 M Route 3, Sunview Dr.
~I I River Falls, WI 54022
N~ N C. S. M. LOT / I C.S.M. L_OT/ I N =
OIM~~ VOL. - - VOL.2.0
h y
~I 1:4. N 89. 48' 381" W 339.98'
41 ! W E S T ,1 . 3 6 00'
I 328.00' 3/.98 p
ttA~I 33 33' , F y G i R/ 3.00'
v ~ pl -
h~:a3 ► a r. 9 693
° T
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0 o L07'1
1.054 d, ` 7 O y ti ti
--7--
ACRES 2 1 QI O
I I I O O
43, 919 SDI. FT. 4 y
w
JI S 89. 48' 381£ 328.00' I Q 2 y
O ~ C
O O O O
l I Q ~ W
LOT 2 M W Q o
M
y, 1.43/ ACRES w
a 62, 319 S0. FT. 3 1 = w
h I R
0 '0 W)
OI"J
O O!D W ELING I THIATT. O^ I q
~~M o *AIAGE °
t I V I o o I II Zj 2
Q OI66 I MONUMEN71ED W LINE APOLL,O'RD. 2 1. 66' v
2 N
U~ O I 33' 33' ' I I 33' 33' I
_
_ I Qh
S 89. 48' 38 "E 328.00' wm M
Rf EAST)
-j v
W
UNPLA TTED LANDS Q y
a
SCALE I / 00'
0 30' /00' 200' 300' w
y
w
x
SE COR. SEC. 33, T28H, R 19 W,
Dated: October 7, 1987 w (COUNTY SURVEYOR'S MON.)
O Indicates 1" x 241, iron pipe weighing 1.13 lbs./lin.
ft. set.
• Indicates 1" iron pipe found.
NW ~ NE
C. T. H. "MM " ```t%%J111/111"t'fit
S G0N
~/A .
T -,P,11 If) Mn ate`
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- ,Oowf 41e,.
Location of property_4LZ-1_1/4 1/4, Section ,Tc-1-0N-R~W
Township Mailing address -?7 d7i y tv
Address of site
Subdivision name Lot no. o~
Other homes on property? Yes X No
Previous owner of property ~d IIIak*-y e,v
Total size of property 6..~ Y, 3d
Total size of parcel 6 3> 9
Date parcel was created _ /Ve, y. 3 a / ?e ?
a
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes
Volume ~sf 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. 14 ?0 , 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.
(Z7
Signature o Appl cant Co-Appli nt
Date of Signature Date of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER R C41 e ky Z ~d wyh/eo- ff~
MAILING ADDRESS 3 .~u ,,F e ,dr•'l' ~i /f'%~r e-/ Gv '.D 1-~
.7 'S~~~• cw ,b~, 2~/~ e--
PROPERTY ADDRESS ~ ~1 /ls
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE AQ~ Y cr ~d .
PROPERTY LOCATION Jy 1/4, S 1/4, Section T d& N-R//9 W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISIONa LOT NUMBER
CERTIFIED SURVEY MAP ,~VOLUME6%SePAGE 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 fora 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 y ex tion dat
/h e
f L alit
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
- -
ooeUMENT NO. STATE BAR OF WISCONSIN FOGY 1- ISO ?"d space 1°e"1i° eO" aseae+~e o.ra
WARRANTY DEED
! w3' rice Q~~ REGISTEwS OFFICE
454100
Kru er a/k/a St. C" M, VA
T aD, De r made between Don D. ~ d for REOOId
!I
Donald juger and gonna M. lcruger, hurmbanl R
and wife and each. in their own r.•£•ght DEC 0 81,9 I
Grantor,
y
and _Timcthy, J- DOugherty..and-.Ch*ry-1..1t•...4.!AVh9r. 10:40
husband. and wife. with right..AV*urV.iw4r*h p-
I.
_
Grantee,
i
Witnesseth, That the said Grantor, for a valuable consideration.o .
r tioln--- - - i
;'►.7.uab s...ca1?~~iida i asTU M To
on:-.doll az. a>nd other good and...
conveys to Grantee the following described real estate in .....St...CX0iX..-••-- "
~t
County, State of Wisconsin:
Tax Parcel No
Lot 2 of Certified Survey Map filed April 4, 1988
in Vol. 070, page 1952.
This Deed is given in satisfaction of a Land
Contract dated May 26, 1988 and recorded May
31, 1988 in Vol. 812 at page 174 as Document
#437822.
This iW homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And.. DOn.. D.-..Kruger-. and..Donna.- Kruger _ .
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
and will warrant and defend the same.
Dated this . ../l. day of ...November 1989...
.(SEAL)
........(SEAL)
Doh D•. Kruger .
(SEAL) ,yc~ C~'✓{SEAL)
• Donna_M.. Kruger
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
s
4
St~_-Craix................ County. a&
1
authenticated this ........day of 19 Personally came before me this of
~[AYy x 191.9.. the above named
U4i1 Dt_..K u3er..a/.~S/. ..AS?)1dld..A.
.......K?F>a4g
TITLE: MEMBER STATE BAR OF WISCONSIN T1fiOttly.•..-Dougherty
Cher 1 A. Dou. herty.-•
(If not -------------------Y.. g_.......
authorized by 4 706.06, Wis. State.) to me known to be thqi,per~n 8 who executed the
fo g instru' AA an aalt~i~edge the same.
I, ru.n INCTRMAFNT WAS DRAFTED BY \ _ ♦bc