HomeMy WebLinkAbout026-1100-40-000
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ,d
ADDRESS
r art , lA)T ,,y 017
SUBDIVISION / CSM9
LOT
SECTION , T_3 6_N_R Z W, Town of lc` 6n~
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
40
c
r
r
r
x
4
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
y~
BENCHMARK: C
~IC.►
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:... Liquid Capacity: 1673-b
Setback from: Well /O House /,7 Other
Pump: Manufacturer A/dyv_- Model# Size
Float seperation N Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: 1 Length Number of 4=s o~
Distance & Direction to nearest prop. line:
.11 Z
Setback from: well: / -~-House_-3 S Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
PC inlet 0/ PC bottom Pump Offer
Header/Manifold 9 (o.~ Bottom of system 9S. S
Existing Grade Final grade
DATE OF INSTALLATION: /2
PLUMBER ON JOB:
LICENSE NUMBER: 153
INSPECTOR: 3/93:jt
Wiscchisin 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
Per~jt~{ g6 arpPAV20 E] City ❑ Village Town of: State Plan D o.:
CST BVVtM11Ellev: UU Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA /7AyS
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Z01.e-,~ee- ~e Benchmark
Dosing
Aeration Bldg. Sewer:
-FIX St /.Of Inlet
TANK SETBACK INFORMATION St/yrf Outlet s 97.17
'
TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet
Air I
Septic Spy f~' G f NA Dt Bottom =M! i
Dosing NA Heade _ Z/ 9,y-1 ~
Aeration A Dist. Pipe `lY- 91a
Holding Bot. System
~,93~ 9~ tea`
PUMP/ SIPHON INFORMATION Final Grade S,US'
, 00 -
aF
Manufa turer Demand e_610 5. 7 , 3.7V ,P,49
Model Number G M
TDH Li Lnction Fie System TDH Ft
Forcemai n Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Leng No. Of T enches No. Of Pits Liquid Depth
DIMENSIONS /ao IM N
NG Manufacturer:
SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STR
INFORMATION Type O 5~p /'gy~ml CHAMBER Mode Num er:
System: 0%kd,Qt aa1 3& OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. `t Length _ Dia. Spacing ~p
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys s On y
Depth Over `a- Depth Over xx Depth Of x Seeded / Sodded xx Mulched
Bed / Center Bed /ift=a&6 Edges Topsoil E] Yes El No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOC TION:: Richmond.35, 30.f178W, NW, SW Lot 1, ',lghw 65
. a::t't, ~ v,' /~"'":,.t,+.~,:.r~' , ~-~~~...zZ!! Q. ~II'~'~~~..
U
) L7LCY~•t k _ ,:DG ` ~P '-c r, ir1 cG1n"~ l D i '1 ` ~iR5:~7~""
Plan revision required? ❑ Yes No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No
SANITARY PERMIT APPLICATION
51,
~~I`IllrelA In accord with ILHR 83.05, Wis. Adm. Code -COUNTY
' S~ C r'o 1X
STATE SANITARY PE~M~ #
-Attach complete plans (to the county copy only) for the system, on paper not less than av(3
8% x 11 inches in size. ❑ Check if revision to previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
So NAJ1/a 14'/4,S 35 T36,N,R r)W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
5 6
CITY, &ATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
u!J 53'b/ AJA
E3 CITY
VI AGE R NEAREST ROAD
II. TYPE OF BUILDI G: (Check one) ❑ State Owned ❑
❑ Public ►1 or 2 Fam. Dwelling- # of bedrooms-!L PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) t7 al ~o 100 - 410
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 Mobile Home Park 120 Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1.E1 New 2./X 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 # Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 8 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
130 Seepage Pit Pressure 430 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) ELEVATION
&.215 e N 9 S ~5 Feet Feet
VII. TANK CAPACITY Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New xistin Gallons Tanks Concrete stCon glass App.
Tans Tanks
Septic Tank or Holdin Tank Ze' AA _
Lift Pump Tank/Si hon Chamber .7x~ Ej Ej I El I El n n
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Pr' Plumber's Sign lure: ( Stamps) 49P/MPRSW No.: Business Phone Number:
uI n 7'~w~.~ I C JlQ3 ;5
Plumber's Address (Street, City, tate, Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sani ry Permit Fee (Includes Groundwater ate ssue Issuing Agent Sign
pproved El Owner Given Initial urcharge Fee)
' ~ ~ j~ .
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 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 the 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.
r 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 & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in 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 in #1-7.
VII. Tank information. Fill in the capacity of every new and/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% 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
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C, r o s S
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Fee►A Alf Inlelt And ODtefrollon PIP•
""%lmw-n ~ADP~e.I~ Venl Cep
12• ALOre
/Inel C.eAe
20. 42' Abe.. PIPP -I' Cost Iron
To Flnel 0feee Vent PIPe
Mer Hey Of Sfn1M1k Cautny .
LU 2• A401e0e1e
Oeef PIPe
DIU.Itvllon
PIPe o ° 0 Tee ►
Alljo ele
eeneel~ PIPe ° Perlo.elee PIPe deleer
° C"lnl Ts""IAelinl At
eollem 01 system
'ill, J, Iof)
SOIL FILL
DISTRIBUTIOI.I PIPE
w , Y e APPROVED SwTV4ETIC cove
2 OF 1~GGR~6llTE ~'`MATEFtI~L OR 9" OF sTRAb.
OR ARSte
LLEV, oF95,~ FF.r ~bY•, L"•OP'1t-21/Z AGGRCGATE ~Pwv
0IS'rRIB~JTIC)W PIPE TC) GE AT LEA5 T _ D•
AIJU AT LCASTLO INCHES BUT 1.10•MORC THAN 47 I1J BELOW ORIGINAL GRADE
CNES OELOW FINAL GRgpC
tIAXIMUM DSPrH OF F,X(-/AvA'r11)0 FK011 OR16NAL 6gAD~ WILL. BE
.nt"VM DEFn1 OF ExCAVATION INCHES
rROM 0~I6NAI. ~R4DF_ WILL BC INCHES
SIGIJCD:
LICCUSC LJUMBCIi:
DATE: 110
t , y `rr~
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
I..abor and Human Relations
DiAsion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St' Ctmix
not limited to vertical and horizontal reference point (BM), n o slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance t 026-1100110
REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT tWF1QRN~ATION
PROPERTY OWNER: co PR 0 LOCATION
David Jcb= GOVT;_` Nw 1/4 sw 1/4,S 35 T 30 N,R 18 X k (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT BLOCK # SUBD. NAME OR CSM #
1004 Carl Dr. k" na~ na na
CITY, STATE ZIP CODE P NE NUMBER 00rN/ ❑VILLAGE MOWN NEAREST ROAD
Mahomet, IL. 61853 ( na
st- RV- :L1:69
Richmona
[ ] New Construction Use [xk Residential / Number of b6drooms:... Addition to existing building
P4 Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .4 bed, gpd/ft2 .5 trench, gpd/ft2
Absorption area required 1500 bed, ft2 1200 INch, ft2 Maximum design loading rate • 4 bed, gpd/ft2 - 5 trench, gpoltt2
Recommended infiltration surface elevation(s) 95.50 It (as referred to site plan benchmark)
Additional design / site considerations na
Parent material pitted glacial drift Flood plain elevation, if applicable na ft
OF I
S = Suitable for system CONVENTIONAL MOUND IN•GROUND PRESSURE AT GRADE SYSTEM IN ALL HOLDING TANK
U = Unsuitable for svstem I ®S ❑ U ®S ❑ U ®S O U )GS ❑ U ❑ S ®U ❑ S O U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed
Trerxtt
1 0-11 10 r2 2 none 1 2mqbk mfr 9W 2m .5 .6
2 11-44 10yr4/4 none sil lfsbk mfr gw lm .2 .3
Ground 3 4-84 7.5yr4/6 none 1 of s Osg mvfr na na .4 .5
elev.
99.1Qt.
Depth to
limiting
factor
+411
Remarks:
Boring #
1 0-12 10yr2/2 none 1 2msbk mfi w 2m .5 .6
2 12-30 10yr4/4 none sil lfsbk mfr 9w
2 if .2 €.3
3 0-84 7.5yr4/6 none 1 of s Osg mfr na na .4 .5
Ground
98 00 ft,
Depth to
limiting
factor
+84"
Remarks:
CST Name:-Please Print Gary L. Steel Phone: 715-246-6200
Address:
1554 200th e wRichmond Wt. 54017
Signature: Date: CST Number:
1-23-95 cstm 02298
PROPERTY OWNER David Johnson SOIL DESCRIPTION REPORT Page2• of 3_
PARCEL I.D. S 026-1100-40
Depth Dominant Color Mottles (Texture Structure Consistence I Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boundary
Bed iTrench
1 0-25 10yr2/2 none 1 2msbk mfi gw if .5 .6
3
2 25-44 10yr4/4 none sil lfsbk mfr gw if .2 .3
Ground 3 44-94 7.5yr4/6 none 1 of s Osg mfr na na .4 .5
elev.
100 ft.
Depth to
limiting
factor
+94"
Remarks:
Boring #
t}t;.
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
i
Remarks:
SBD-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel David Johnson 1554 200th Ave.
CSTM2298 NW4SW4 S35-T30N-R18W New Richmond, WI 54017
MP4RSW 3254 Richmond, township (715) 246-6200
N
1"=40'
BM= top of cement footing f outside stairway to basement @ el. 100"
60 '7k
f~
C00 B -
So' f~- U-S E
O"~
v0 ~
Gary L. STeel
1-23-95
h'IF11' VJ VL L.~
C' 21 PREM. URP. HUUSUN rax ris~~isn-nn~a
• % ~
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER c
~I ~ I~ Y1 S ~ lr~ .
ROUT&/84X NUMBER A/ FIRE NO. -
-12 3 CITY/STATE, lflc~Ar) r'r,.._ ZIP S</a/
PROPERTY LOCATION! /IW 1/4 ~1•p 1/41 section T _a 6 Nj R-LA-W,
Town of at. Croix County,
Subdivision Lot No, N 44 ,
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 a LICSNSED SsFTIC TANK PUKPSR.
What you put into the system can affect the function of the septic tank as a
treatment stage in the waste disposal system.
9t. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of
$3000 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
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
fora, signed by the owner and by a master 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. Certification form will be sent approximately 30 days prior to
three year expiration.
I/WB, 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 Department of Natural Resources. Certification
form must be completed and returned to the st.Croix County Zoning Office within
30 days of the thtee year expiration date.
SIGNER
DATE - r
St. Croix County Zoning office
P.O. Box 98
Hammond, WI 54015
(715) 795-2239 or (715) 425-8363
Sign, Date, and Return to above address '
I'd 3 jI-djO ':~--,Hain(D Wd92:bU S6, SO dda
_C-21 PREM. GRP. HUDSON Fax : 715-386-6551 Apr 05 02:29
' APPLICATION FOR SANITARY PERMIT
STC-100
This application form is to be completed In lull and signed by the ownst1s) of
the property being developed. Any Inadequacies will only result In delays of
the permit lssusncla Should this development be Intended got tesali, by
owner/contractor,jspee house), than a second form should be tetalne4 and
completed when the property Is sold and submitted to this ofllee with the
appropriate deed recording.
eww--ww-------r~•M--wr-- --1■--------- 6 ----r------------w-----Trw/Wfoaoft
owner ,of property
Location of property l/4 section s_; TAN-R l ~x
Tewnehip Rich mim
Ma:ling address 22
r.r M4! r.~■rr r . .w I ■I -ir■
Address of alto
S+tbdivision name
Wt number
Previous owner of property y'C IC-A 4,4
Total site of parcel 3'`i /
7"
Date parcel was greeted 0i2 r.
Are all cornets and lot dines Identifiable? eyes _~to
to thlo property being developed lot resale Opea house)?_,,r,~-Yes es ,,,,Ro
Volume grand Page !lumber ~ as recorded with the Register of Deeds.
000-w-w---------------•-----Y-~--'~~~-ti-1■-F-.1r.---r-r--r-----------------r-i---•
INCLUDE WITH TNI$ APPLICATION Tilt POLLOWINGt
A WARRANTY DBSD which Includes a DOCUMENT NU1(BERt vOLUXI AND PAQ10 N(MBSRi ~ and
the SEAL OF THS RSflIBTER 01 03208. in addltlont s cattilied survey, It/
avallable, would be helpful so as to avoid delays of the reviewing process. If
the deed description references to a Certified survey Nap, the Certified Survey
map shall also be requited.
~~~--w- ------------------rllr-- ----w---N_,.----- - r------------w---------- l
PROPERTY OWNER CERTIFICATION 1
IlWal cattily that all statements an this form are true to the host e! •y (our)
knoviedge) that I (we) art (are) the owner(s) of the property described in
this lnlormnatlen term, by virtue of a warranty deed recorded in the Office of
the County Register of Deeds as Document No. - 4-S 7 4 S,c-72- .1 and that I (Ye)
ptesently own the proposed sits for the sewage disposal system for I (we) have
obtained an eassmomt, .to gun with the above described property, let the
construction of sold system# and the same has been duly recorded In the 9111ae
of Cou R 7'2 of Deedsf as Document No. 1.
Ai \ C), Qa"D
ghature o In Signature of Co- nor {It Applicable)
Atkzz I I lam. r I 1 I I~u ul Ire. ■I 11■■ ur I ~rrr-.-rr rr~. 1 nu■n I■ u• I I I
Date of 8110(stuto Date of 8lgnaturo
G-
SO ' d 3~:1I d3~ ? .I~It!~31f10 Wd1.~.: bpi 5. cidH
DOCUMENT NO. ;J1'dir, bNtc UP' W1JUUN6Li4 r'URA 1-pl64
" ^~>°^•,v o,~~
• i M WARRANTY DEEP
` cry c ,9
4J~! 48ti j '~P: SV (PACE Ul. 'I
J
REGisu"S OFFICE
i
phis Deed, made between ..R....ichard Loren Der.ri.....ck.> .I $T. CROIX CO., W1
~ Rec'dfor Record
. APR 17 1390
. Grantor,
Of 10.00 A. M
husband and wife,
I i
Grantee,
Witnesseth, That the said Grantor, for a valuable consideration...... I
cFirst B3* cE
onveys to Grantee the following described real estate in $.t C taaTURN ro l j l 1~tiV '
r.Qix..... 109 E 2nd St 133K C
County, State of Wisconsin:
Rw Ridmcr-d,VR 54017 ; j
Lot 1 of the Certified Survey Map recorded Ta:Parcel No:
in Volume 2 of Certified Survey Maps on
Page 488 as Document No. 344070, being a
part of the West 1/2 of the Southwest 1/4
of Section 35, Township 30 North, Range
18 West.
• O
FED
This warranty deed is given in satisfaction of that land contract
between Grantor and Grantee dated October 29, 1977, and recorded in
the St. Croix County Register of Deeds office on November 7, 1977,
in Volume 564 of Records on Page 05 as Document No. 344437.
This i S no t homestead property. j
(is) (is not)
Together with all and singular the hereditamenta and appurtenances thereunto belonging;
And...... q ran to r
warrants that the title is
good, indefeasible in fee simple and free and clear of encumbrances except
municipal zoning ordinances and easements of record.
and will warrant and defend the same.
Dated this ............~~oT/ . day of April. , 19.9.x...
Ji.L.tic ....L"_0 . ..............(SEAL) (SEAL)
Richard Loren Derrick
.....................................................................(SEAL) ...................--•-•••--..................................(SEAL)
• '
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ST. CROIX County.
authenticated this' :y'r.~-day of 19...... Pergonally came before me this ....J~.% day of
April
._.....19 9 0.._ the above named
: 1Zicliard...Loren berric7i
y •
T:NP E: MEMBER STATE BAR OF WISCONSIN
-(If not............................................................. t: ant orized by 1 706.06, Wis. Stats.)
. ~r ~ to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY '
BAKKE, NORMAN 6 SCHUMACHER, S.C. : -l-_•-
.
New Richmond, Wi 54017 • _Cr.:. •9
Notary Public .St.....C.ro.Lx............... County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (EE not.-state-exp4ation.-
are not necessary.)
•Names of persons sixnin[ in any capacity should he typed or printed below their siQnet,,res.
WARRANTY nxxn STATF IIAR OF WISCONSIN %vi-eon-in I,eesl ninnit Co. Inc.
r ,ns, lt.t...w,.4r Wis
J
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
r r r r r p s x■ rorei ST. CROIX COUNTY GOVERNMENT CENTER
F„ . 1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680
April 18, 1995
Century 21
706 19th Street
Hudson, WI 54016
Attn: Jenny Olson
Dear Ms. Olson:
An inspection of the recently installed septic system which serves
the David Johnson dwelling, located in the SE1/4 of the NW1/4 of
Section 23, T30N-R19W, Town of St. Joseph, was conducted on April
17, 1995. This system was designed and installed for a three
bedroom home. Enclosed is a copy of the inspection report should
you need one.
At the time of the inspection this septic system was found to have
been installed in accordance with the requirements set forth by
chapter ILHR 83 of the Wisconsin Administrative Code.
Should you have any questions, please feel free to contact this
office.
/gincerely,
Jayne s K. Thompson
-'Assi.stant Zoning Administrator
cc: file