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HomeMy WebLinkAbout040-1157-40-000 AS BUILT SANI ASTC Ry 104 OWNER SYSTEM REPORT Cr ADDRESS SUBDIVISION / CSM# SECTION--C2~L. T~ N_ R ST ~ LOT # CROIX COUNTY 40-W, Town of / WISCONSIN 00 - 1/S~f _VO -0 bfj SHOW EVER PLAN VIEW THING WITH Irt~o IN 1 a FEET OF SYSTEM s' Provide setback INDICATE NO and elevation info 2 rmation dimensions to center °p reverse of of this form. septic tank manhole cover. r I t O;j BENCHMARK' ALTERNATE BM: TION AMBER / HOLDING TANK INFO' PUMP CH Liquid Capacity: d SEPTIC TANK / facturer~ ~ Other Manu House Size from Well Model#- Setback Manufacturer Gallons/cycle: pump: Float seperation Alarm Location SOIL ABSORPTION SYSTEM Of trencheS , Length Number Width: rop. line ' I Direction to nearest p DistanCe & other House JA Setback from well ELEVATIONS 68,58 - $~g ST outlet ST Inlet: Building Sewer / pump Off f pC bottom of system 0~, 'pC inlet Bottom Header/14anifold Final grade,f lS Existing Grade v 3 F INSTALLA`rION : ,DATE O `PLUMBER ON JOB: NUMBER : LICENSE INSPECTOR: 3/93:jt County: CROIX pGE SYSTEM ST . PRIVATE SEW REPORT Sanitary Permit No.: Oww INSPECTION PERn/IITI 289306 Wisconsin Department of Industry, ,CH TO No.: State plan ID uryti,0"Relations PITT Labor jpRdB ildings Division ToWno SafeP anwBuI MATION City ❑ Village 1157-40-000 ❑ Parcel Tax No.: GENERAL IN" TROY 040- Permit HdlderADOLpH Insp BM Description: ?iJ r Name. OPATZ ~ . BM Elev.: TION DATA FS ELEV. CST BM E1ev.:, ' ELEVA BS HI /p0 , STATION v INFORMATION CAPACITY TANK Benchmark MANUFACTURER TYPE Septic Bldg•SeWer / l0g.g$ Dosing St 1 Ht Inlet Aeration Stl Ht Outlet Holding AfION Dt Inlet TANK SETgpCK INFORM Vent to ROAD BLDG. Air Intake NA Dt Bottom bl 0 ' TANK TO P I L ELL „3 r NA Header 1 Man. ~J, d e Septic NA Dist. Pipe 3.10$ Da./~ Dosing got. System Aeration Final Grade Holding TION . c..:~.r° PUMP 1 SIPHON INFOMA Demand GPM Manufacturer Ft Model Number System TDH Frictio H Liquid Dei Lift L Dla' Dist. To Well No. Of its TDH Inside Dia. Length PIT Manufactufer: Forcem in N SYSTEM Trenches pIMEN 1 N LEACHING BSORPTIO NO. of er: SOIL A Len9t~ a I LAKE I STREAM CHAMBER Mode Num BED I TRENCH BLDG WELL OR UNIT Width I DIMEN 1 N SYSTEM TO P IL j~J R Vent To Air 1 r ole Spaci ng SETBACK TYPe xH INFORMATION ~t System: x Hole size p►STRIgUT10N SYSTEM e(s) Spacing istribution Pip Dla rade Systems 01"y A)( Mulched Length xY. Mound Or At-G Header 1 Manifold C3 Yes C Dia ~ StefnS Only xx Seeded /Sodded Length x Pressure Sy xx Depth Of ❑ Yes ❑ No SOIL COVER Depth Over y Topsoil Depth Over .v Bed /Trench Edges e5ent, etC Bed /Trench Center (Include code discrepancies, persons p IL LOT 4 W , SW 228 LONGVIEW T~ COMMENTS 4F,' 28.20.61 LOCATION = TROY 1l ~ND f F~ C3 Yes e Signature aired-) • t1On• Date Plan revision req Use other side for additional ►nform ra OS191) ADDITIONAL SANITARY COMMENTS qNp SKETC PERMIT NUMBER: H a r Safety and Buildings Division 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 than 8 112 x 11 inches in size. 51. G r, 0 X • See reverse side for instructions for completing this application State Sanitary Permit Number a iq 30 The information you provide may be used by other government agency programs - ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)1. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prope y O ner,Na a Propert Location I Lt Aj 1 /4 1/4, S gQ% T ~eY r N, R QC)I*r) W Property Owner Mailing Address Lot Number Block Number N 4 San. ~'o ua.. City Zip de Phone Number Subdivision Name or CSM Number 5s10S ( ) <sM aZ3 ;t, II. TYPE ILDING: (check one) ❑ State Owned ❑ 't~ Nearest Road ❑ Vil age .Loh Ule.~ (1`O~1 Public 01 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax/Number(s) 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. VNew 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 1 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 Re wired (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 1~ a5A9 96 17 X JA /0 or 'L Feet /0- Ye X Feet VII. TANK Capacity gallons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank !,$Z~ ❑ ❑ ❑ 1:1 ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ 13 VIII. RESPONSIBILITY STATEMENT I, the unde'rsigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu er's Nam rent) Plu er's Signa re: (No tamps) omPRSW No.: Business Phone Number: ,Lb ts' I?y 6 S/~J w.c/r 156-3 i T Plumber's Address (Street, City, State Zip Code): t &r 9 4tw el 4L) 61 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Inciude5 Groundwater ate slue Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) 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,41-he 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. Ill. 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+j, . 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 - , swi I I I f I : LA, I L 1 I L_ I ~ 1 1 i : , { Q , ~ I I I I j t 1 I I ~ I r ' : I j ~ I I ~ I , ' i I 1 j I i I I' 1 I , I I 't ~ I I : t r I _ I I i I I I ~ I ! I ~ E ~ ' Illy 1 I- _ I I I, I I 4 I I I t ~ j 1 I - + - I I r - - 1 - it t I ! i i r I , - I-- I I ! l It I I ' ! ! ~ ~ _ i ~ A~ I I ! , I I 1 : t ~ I r ( t a- ' I I { I ' I I ! ~ ~ - - - I I ~ I - r - - I II----- ~ ~ I ! I I r- i i 1 1 I I C 1 I I I ~ ~ ~ I I t I ~ I I ~ ~ r I I _ t I I I r i - I I _ , I C i I I I ~ _ ~ I I 1 r i I I ~ I t- - - - I I I _ I I i - i _ r t - ~ I I I I I ~ - I I r - ~ ~ I I I t- - I , i , I - i -1- ! I I I i I I j I - I I y - I I I I , II~ I I I r i- j ; it-- 1----t i. y- I` f _ - , , -t , I I - I j Wisconsin Departrxient of Industry, Labor aM Hu man Relations Sol M L U AT I O N REPORT Page of ___3 _ Division of Safety & Buildings in aced with IL 05, Wis. Adm. Code COUNTY Attach complete site plan on paper not I ss an 8 '1 x 11 in n si Ian must include, but not limited to vertical and horizontal ref r_,ce point (Be c r %rand pfo o slope, scale or PARCEL I.D. # dimensioned, north arrow, and location distao Broad. 040-1157-40-000 APPLICANT INFORMATION-PLEA ")IINT AL'~c»~`~~R~A~~LO REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION D e r' GOVT. LOT SW 1/4 SW 1/4,S24 T 28 AR 20 f(or) W Construction PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # doc. # 1505 H 65 4 na csm vo12- a e 329 336861 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE KYOWN NEAREST ROAD New Richmond, WT. 54017 (71-9) 246-2320 Troy Cove Ln. [14 New Construction Use [K J Residential / Number of bedrooms 4 [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate -7 ed, gpd/0-8_trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 : 8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 101.97-100.2-99.53-96.70 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U ❑ S U U ®S ❑ U ILl S ❑ U ®S ❑ U ❑ S [Nil SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence eoundaly Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerich 1 - 2 9-19 7.5 r4 6 none sil 2m r mvf if .5 .6 Ground 3 19-84 elev. ' 8 105.3 ft. Depth to limiting factor +84" Remarks: Boring # 1 0-16 10 r3 2 none s 2m mvfr 2m .5 ~.6 2 2 16-82 7.5 r4 6 none cos os ml na na .7 .8 Ground elev. 105.8 ft. Depth to limiting factor +82" Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Am, New chm nd WI 54017 Signature: Date: 5-2-g7 CST Number: m02298 PROPERTYOWNER Derrick construction SOIL DESCRIPTION REPORT Page 2. of i PARCELI.D4 040-1157-40-000 - Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 10 9w 2 :117-80 7.5 r4 4 none cos os ml na n .7 .8 Ground elev. 103.2 ft. Depth to limiting factor ~ Remarks: Boring # 1 L-12 4 2 12-80 7.5 r4 6 none cos os ml na na .7 1.8 Ground elev. 98.8 ft. Depth to limiting factor X11 Remarks: Boring # 3/3 .5 i.6 2 115-7B 7.5yr4/4 none Cos osa Ml na na .7 .8 Ground elev. 99.2 ft. Depth to limiting factor +78" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel DarAck Ctnst. Inc. 1554 200th Ave. CSTM2298 SW4 524- R2W New Richmond, WI 54017 MPRSW 3254 tum of Troy (715) 246-6200 lot #4-can vol. 2-page M29 . # 336861 N 1"=40' BM.= nail in Aspen tree @ el. 100, Alt. min.= nail in oak tree @ el. 108.50' ,~1 i1 2 Ar~vq Gary L. Steel 5-2-97 U 336861 2 ita NOV of X36$61 84 c'ek CERTIFIED SURVEY MAP s . PART OF THE NI/2-SW 1/4-SEC. 241 T-28-N, R- 20-W PATTED 4ANQ_SLC$Oj2j QQVJ, qUB, NQ-.3„ COVE LANL- PUBj,J,CL_ N 890-51'-23" E S 88°-26'-II" E ROAD 3 1169.11' 79.62' co W 1/4 SEC.24 (RECORDED AS S 89°-06' E, 1167.46') N 33.98' ' ST. CROIX BEA~INGS ARE REFERENCED M COUNTY MON. Z n;0 1 N 02 -36'-18" W TO THE too o 'COO WEST LINE OF THE L AXD W ~m 1 SW 1/4 - SEC. 24 z UNPLATIEQ to CO z W40 (ASSUMED BEARING) 330 01 66' PRIVATE ROAD N Se- 51'- 23 E UN PLATTE O X90 598.69' ` 2 ♦ IAN D_ LQT I ~ 3~,♦ s 1 `gym, 'o ~ c 3.51 ACRES wo •o m•m`~,~♦ ` _ Om `tam b~ o ` 220 0 S Be- 51'-23" W 4 ^36~ 764.80' 1 O 25' 50' 100' 200' / rc~. UNPLATTED_ LAND : SCALE 1"- 100 ~iy'q~ I J CURVE LOT RADIUS CHORD CHORD CENTRAL ARC NO. NO. LENGTH LENGTH BEARING ANGLE LENGTH 1-2 ROAD 98.92' 89.24' S39-02'-29"E 53-37'-36"-_ 92.'58' 2-3 ROAD 227.81' 109.24' S 51= 58'- 57" E 270-44'- 38" 1 10.31' 4-5 ROAD 129.53' 176.06' S 04- 42'- 14" W 85 371-44" 193.58' 12 - 13 R/W RD. 131.92' 53.07' N 230-49'- 55" W' 2 St 12'- 27 -53,43' 13- 14 1 131.92' 69.22' S 500-38'- 44" E 300- 25'- 09" ' 70.04' 1 JOB NO. 76- 21 14-15 1 194.81' 93.41' S510 58'-57"E 27 44'-39" 94.33' 16- 17 1 96.53' 24.31' - S 3d-52'-33" E 14t 28'- 10 24.38' Ql r. t ns .~.o . 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'pvo.z 9-4vATad ePTM '4003 99 T 3o euTT Je,,ueo eq1 o1 1ee1 QA-rr ti-07-00 C 8utnutsuon eauouq fuoind-rrno n QTt7.1 TA SittTnT7TQ0/Y I 336$ N CERTIFIED SURVEY MAP PART OF THEN 1/2- SW I/4- SEC. 24,T-28-N', R-20-W BEARINGS ARE REFERENCED N 02°--36'- 18"W TO THE' WEST LIME OF THE UNPLATTED LAND SW 1/4 - SEC. 24 ~ 05 (ASSUMED BEARING) `b-* 0 41.64' 'ol''+~ N 8 90- 51'- 23" E ~sR o ~y/ C % 596.72' co `0b• 222,20 6 / O LOT 2 UNPLATTED LAND N / 2.60 ACRES 66' PRIVATE ROAD 1 i N Be- 51'-23" E / r 439.60' 1 1 SEE REVERSE SIDE FORT 1 CURVE : DATA. AND 1 N O / I SEE REVERSE.'SIDE 'OF 1 N I 1 SHEET I OF 2 FOR I A LOT 3 1 7 X I_ CERTIFICATION N 2.23 ACRES To o N \ N W 1• \ t0 C ~ - N N 890-51'-23"E ® 8 \ 0 443.33' ® Or/ S 77-OI'-37" E M 12.88 Z 9 28'-19' 160' DIA. ~ LOT 4 S 12° 58'-23" II CUL-DE-SAC , UNPLATTED N 3.52 ACRES - - LAND N SST N O ~ Oo c w ,01'631 „b9 -,£b 95 3,,0t,-,6V_ o8t, S ,68'£31 ,8£-0£1 t, 01 -£3 are „Lb-,£2:;S: 0 3 „05-,0£ 81 S ,ZI'8 ,8£'0£1 £ £3-33 , 101 „91 -,IZ ol3 3 „81 -,To-.90 S ,9L-001 ,68'ILZ £ 13-03 ,99'£03 „9t,-,£9 .zv M,,23 -,V0-.9Z S ,t,8'861 ,68'ILZ Z OE-61 ,E9'6£ .,6t,-,60;9Z 3 „99-,6Z ot,Z S ,IZ'9£ ,00.08 t, 11-01 ,8t''301 „ I b -,1I 09 3 „8'17 -,Z9 9b S I 8'L6 ,8£16 GV08 6-8 ,68'L9Z „ZO -,91 0 9 M „9£-,£3 o I S ,L0-t?93 ,68'8£Z avo8 L-9 'ON ON HION31 31ONV ON18V38 HION31 HION31 38V 1VUIN33 ahlOH0 aHOHO St11aVa 10-i 3Aaf10 ipocas 0 Sim NOSaf1H Szel-S vUjVNS Z 'D 3N3D l~ NoO- State of Wisconsin County of St. Croix nt IS a full; I hereby certify that this i the document on true and correct COPY d has beef file and of record in my office an compared by me.. 19-97 MA- Attest KATHLEEN H. :vALSH inter of Deeds Kathleen H. Walsh 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 ©pp,~TZ' Location of property N 1./IV- 5W 1/4, Section T lAb N-R~ W Township I ItiC7 Mailing address 444-q S, Address of site ilk Vt E;W PLAIL 05a0WI S4000 Subdivision name LSM 1 -!11 A],;~, 20 Lot no. Other homes on property? Yes No Previous owner of property brco A, -4 Total size of property '92 oSZ I } Total size of parcel 3 o~Z U Date parcel was created l - Are all corners and lot lines identifiable? X Yes No Is this property being developed for (spec house)? Yes X No Volume 12:14 and Page Number 141- 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) an (are) the owner (s) of the property described in this information form, by virtue of a warranty deed recorded inf the ff}ce of the County Register of `i° and that I (we) presently Deeds as Document No. i ilAo 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. C715 ~Ib qA0 'IV Av,ld a. Signature of Applic nt Co-Applicant Date of Signature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER NO MAILING ADDRESS M N SS 10 C, It SW VW05'ao W1 oo PROPERTY ADDRESS ` (location of septic system) Please ob ain from the Planning Dept. CITY/STATE 1-%A N \N 1 5 401 b PROPERTY LOCATION N 1146 `7W 1/4, Section 24 T 'b N-R 10 W TOWN OF ST. CROIX COUNTY, WI , SUBDIVISION v5 M LOT NUMBER CERTIFIEDSURVEY MAP Z'9-fib, VOLUME 2, PAGE 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 Julv 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 94ULLALa- SI GNED: DATE: S St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 t %A 1?`?~ ~t►f'7~'~ c VOL J5826 I STATE DAR OF WISCONSIN I Git\t 2 - 1982 WARRANTY Du-i) DOCUMENT NO. REGISTER'S OFF; :F ST CROIX C-M, Wt Gena Setzer, as Anciilary Personal R_presenta tweaatttleart tive of the Estate of George F. Setzer. deceased., and Robert J. Setzer APR 211 1991 conveys and warrants to Adn 1 D h (Ana t anr~ t irtda i _ At q' 45 P. M n n a-__et 3, 1 ' t Lish a n r l a n ei Tjife, as s t r„ •*S•L.... `iA W& , 1 3/a G Sll l~l-- 4ey15to of Deeds marit; 1 rr^nnT~t.~t, _ r..~.~....~.~ i. uns sPACE nEsenvto I on neconowo DATA NAME AND RETURN AODnEss the following described real estate in - St. Croix CourE NA REALTY TITLE State of Wisconsin: C 40 SOUTH SECOND STREET H SON, WI 4016 040-1157-40-000 PARCEL IDENTIFICATION NUMBER Lot 4, Certified Survey Map recorded November 29, 1976 in Volume 2, page 329, I document No. 336861 being a part of the North one-half of the Southwest quarter (N 1/2 of SW 1/4), Section twenty-four (24), Township twenty-eight (28) North, Range twenty (20) West, Township of Troy, St. Croix County, Wisconsin. I i FiANSFER This XNA is not homestead property. II 0% not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this a~ day of &rc- A.D.. 19__9 7 , .01 Estate of George F. Setzer, Deceased (SEAL) .Gena Setze P.obert S zer (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss St. Croix . authenticated this clay of 19 ~ _ County. Personally came before me this day of I L~dErC1~. _ 19 the above named G _ena Setzer ai-Tnci LlarY PersonaI Representative o Estate of Geor e TITLE: MEMBER STATE BAR OF WISCONSIN F. Setzer,_ Decease an F o ert J. (if not. Setzer, authorized by $)06.06. Wis. Stats.) to we known to be the person 8 who executed the foregoing inct nunent -A .,rL.......6,t..~ .1.- 1 ~ ✓g PAGE OF CrUSS ~ec~IOn pt- S t'e Fresh Air InletsAnd Observation Plpe Approved Vent Cap Mlnlmwn 12' Above FInOI Grade 20- 42' Above pip. -4- Coil Iron To Final Grade Vent Pipe MortA Hay Or Synlhelle Covering Over2PAjgregate Dlitrlbullon pipe 0 0 0 0 -Toe 4 i 6' Aggregois 8411401h Plpe a Perforated Plpe 0,14. o -•C04010o Terminating At fioUOm Of $ritem n1eD Pinc,1: 119 re,ci< .SOIL. FILL. DISTKIBU'CIOF.1 PIPE APPROVED $~Al'(1•IETIC COVER 2" OF AGGREGATE c✓ .r o "*`14ATER4 OR q" OF STRAW MEV, oF~4a/2FEET-.. R !e'.or AGGREGATE '•v DI•ST11I5UT10ti PIPE TO BE AT LEAST _ It\1•CHES SCLO•W ORIGINAL GRADE AVU AT LEASTLO wCHES BUT,1.10 MORE TNAIJ 42 IuCHES BELOW F1r\lAl GRADE M IMUM ®SPTH OF EXCAVATI P FKoM .oP,%1&Wq.L ragApF-WILL BE INCHES ' MIKIMVM AEPrtt of FnAvAnotj 'F.Ro1A. OlkI41WAL C949f- WILL BE INCHES SIGIJEO: LIGE►JSE ►1UMgER: - -'~6 3 A DATE: i t0 I 8. I I I 1 h .4 COWS f i dor I ~ k M x st