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HomeMy WebLinkAbout040-1218-20-000 4 a~i 00 1 ~ o M ° w ~ a o o N C N ~L N U (6 C O, v a ~ z c E p;. LL ° a ''o Q L y a Q ° 3 vi e,~ r ~ Cl) Z y C v o 00 4) LO H C d m c O O Z d' c _v m Z tl' ° o fn F- ac) Z E '0 0) N a ~ M ) C L s O o ~ I z z N z Q m £ N ~~y T, U) Q w i O O ° a ~~v^^ CO D o ` n E U ~ I~ H H H = E I `J `n3-k ° o 0 0 0 z ro a a a N a c ONO `O 0 fA J pOj z O M - 3 N p c N O O O _ V C N CU O ii Y O ~V V d Q C Z) ❑ p 7 w r O N C y L O CC O M - N ° C E ao 00 O LO O t c O 0 O O O N O O O N a C U 0- p) O 0 r- -0 0 ttY 42 N 0 N 0 H C L z M N i..l C, M d1 N N CO o • V LO 2 CO N C) y E p m V O L. O O S N O z y H Cn CC r 3k E V r~ L Vl S . Q y a C _ ''{~yj O V_ O d CL C i C C O r~ w `~1 A uCL OtoU Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human nelations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY CPO/~'( Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION YC. R/ e-/ AP12 llllAGEy GOVT. LOT 50 1/4 S4.9 1/4,S T 2X N,R /9 E ( ) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK Ir SUBD. NAME, OR CSM # A~Di T O~ cT ;PP F~ /y C/E ell CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE GROWN NEAREST ROAD vp fm,~ G~J/ , s/o~ro (713T 3 PG - Sz// [ t.} New Construction Use [ Residential / Number'of bedrooms 3 7`0 2 (J Addition to existing building [ J Replacement [ J Public or commercial describe Code derived daily flow y 6 gpd Recommended design loading rate 7 bed, gpddt2 / trench, gpddt2 Absorption area required bed, 112 trench, 112 Maximum design loading rate bed, gpddt2 , P trench, gpd/ft2 Recommended infiltration surface elevation(s) S-PL 3 ft (as referred to site plan benchmark) Additional design / site considerations ~/°1empA> - 4t4 4. ,v,•m'eo W ylwne'AeS timow ealc5 Parent material SCS -,_S,4 77;P lc-- : S11,KS~:s~~vTS Flood plain elevation, if applicable It a S = Suitable for system CONVENTIONAL U MOUND- INN--GROyetD PRESSURE AT-GRADE SYYSTEk IN FLL HOLDING TANK U = Unsuitable fors stem ©"5 a U 9 ❑ U EW 11 U alks ❑ U ❑ S SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munseli Gu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Roots Bed Tench o_ 9 loge 2- s,6.(' 404 fie s s 2- - l -2 f sloe ~,,,-f~P cs l -F , s Ground 3- y a y s/ f' .evf,P Q s elev. Depth to • s . 0, Se:; ' 7 ! d limiting factor Remarks: Boring # ley Q S ,3f 5 -G s -2fs,~,~ 1I1g7,c s , s G Ground elev. /D y x ft. Depth to limiting factor Remarks: CST Name:-Please Prinl ~D Q~RT LB l C T Phone: Address: S S 0 UA (L PO - t~ v .5-YO16 C'STi~I 2 ~~2__ Signature: Date: ~f CST Number: -I/ - wi;vTt=~ TAT rav P/,7, A S ' 3G Q svw-01-11y ~kp 1,900 s T . ~ GlN A~ o? PROPERTY OWNER :DO' Wt& v SOIL DESCRIPTION REPORT page 2- of 3 - PARCEL 1.0. # 4-0 T le V I ~~ZJ Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 -i3 io z s. z s ,C n,►.-f~2 s f, s 6e >t , Z io ► 31z s/ 2- -Fs6,r ,f -e s l-f , s Ground 5/'/ Z 7~5,6~ iJ►~~ie CS /Uf , S elev. ) pD it. 4-1 Depth to ~-7 7•S!~ yl - Is. limiting lac Q, s q. T Remarks: Boring # o -~T 16 2 Z Si~ 1 f Ae -,~-fR T5 ~-~F S i •to Ground... 3 JAk cS Y . S elev. it. Depth to Cs limiting factor,,, . i J Remarks: Boring # / o -io 4410gZ S 3 S G 3 - i3 io 3/~l - s~/ Z f SAIL lie s Ground elev. )-3 " J~ 7•SYie y ~S / C4 7 it. Depth to D ` s✓ 5 0 s 7 limiting factor U_ Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: DoT- I Z clt,t-ruiI~rv _ 3of3 0 I I W 133 ~ %Ts y ~o y Zy , 13 Su(~GES Teo T 9 FN ~ C'fA,, S yS TL=M V I ~V 4 t I'OU S - v/PvE Ti!°t'~G~s 7-0 S- hr~Eti s P $'o IoW Tit' -V 76, o ' iy B3 AO "O 7i . 9S ~y Z S ' ~S' _ Zo Qt y-/r-yy - - G®.t°~✓ ' ' 34? ~i3ov~- yt~r10~ AS BUILT SANSTC - ITARY 104 SYSTEM REPORT OWNER 4~-. ADDRESS V6 / cx' 41 SUBDIVISION / CSMI C~ LOT # / Z SECTION -5 T ZgLl N-R /c1 W, Town of / w ST. CROIX COUNTY, WISCONSIN PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM TP~7 \sG ~ I a - ~ jt4 3 ~ r r tSAX 2 / ° _ - _ _ ~TZ ♦ ~ri5 f ~Xy /fir l/ f7 ~~ihk. /rf C4 S 3I~C"" / 6 2 ~y, z INDICATE NORTH ARROW: I Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cove BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: s aoot Liquid Capacity: /°".bO Setback from: Well House -ZG' Other Pump: Manufacturer 1? 14 Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length S& Number of trenches -Z Distance & Direction to nearest prop. line: bar a~ ` Setback from: well: /s(-- House llS Other 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: L - 30 ~S PLUMBER ON JOB: l,~r -77 LICENSE NUMBER: INSPECTOR: 3/93:jt W scoflsin 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 228390 Pes NaReICHARD C] City E] Village [Town of: State Plan ID No.: AdffCST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: A9500084 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Air I Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System i PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM I Loss Friction System TDH Ft TDH Lift Forcemain Length Dia. H Dist. To Well I F SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: 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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Troy.5.28.19W, SW, SW, Lot 12, County Road FFp~ / bGL - """.t1 Aa Plan revision required? ❑ Yes ❑ No Use other side for additional information. SOD-6710(R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ~r SANITARY PERMIT NUMBER: I, L SANITARY PERMIT APPLICATION (Y In accord with ILHR 83.05, Wis. Adm. Code co~.,<+. STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ check if revision to plevious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPER OWNER PROPERTY LOCATION SW'/a S Y., S T 29, N, R /J! 1K (or PROPERWNER'S MAILING ADDR LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUM ..~Z/~ SUBDIVISION NAME OR CSM NUMBER L:I VILLAGE: I NEAREST ROAD 11 11. TYPE OF BUILDING: (Check one) F] State Owned /yo C L ❑ Public 91 or 2 Fam. Dwelling-# of bedrooms - P10 TOWU 9L ~4~ ARCEL TAX NUMBER S) III. BUILDING USE: (If building type is public, check all that apply) ;1~ _ f 2 Z~ 1 ❑ Apt/Condo l~ 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 100 Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. 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) 9gZ ELEVATION Y7© ® ~y d, Feet OR, 70 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank C" F1 1:1 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' Name (Print): Plumber's Signature: (No Sta ps) MP/MPR.: Business Phone Number: 3 :201- 7!~ 7 2 ~Z /T v Plumber's ddress (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial gV ~flf Adverse Determination aalak&~2 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) 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 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. .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) I JOB /7 Rd 4~' TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 J _~s WILSON, WISCONSIN 54027 CALCULATED BV• DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE E i'^- - . < i i i r, e 5 : .7 qf: 2. a0- . ° . t . l . .m . / - f . NNrt~ fk Ila& L32 Q i. PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1-&DD-225.6080 JOB Il IGRL!s~ ~tu TIMM EXCAVATING SHEET NO. Z OF 2 Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BYE--'- DATE S - - f S (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE . , U.'- . . / Y - . . ~ . ,,/Cry{/, l~ l r i /tJ` ~S 1-0 G L . q~ . 01 a PRODUCT 205-1®Inc, Groton, Mass. 01471. To Order PHONE TOLL FREE 1-800.225.8380 Wisconsin Department of Industry, SOIL AND SITE E V A rAdnj~j Page of .3 Labor and Human Relations J Division of Safety & Buildings in accord with ILHR 83A N T /P X Attach complete site plan on paper not less than 8 1/2 x 11 inches in sizup, but not limited to vertical and horizontal reference point (BM), direction and 9tiP I.D. # dimensioned , north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATII DBY DATE PROPERTY OWNER:/ PROPERTY LOCATION ~le . R1 Gr,4iPP >1/92Gey GOVT. LOT 5/oJ 1/1/4,S S T 2- N,R If E ( ) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME, OR CSM # WD/7- 12- CITY, OS GT ~D F~ STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE GIFOWN NEAREST ROAD vps®, 1 GPI. y016 (71~13 PG - sz// fe 14-95--~ [ Ly New Construction Use [ -j"'t;esidentiai / Number of bedrooms 3 fo i/ 2 [ J Addition to existing building j) Replacement Public or commercial describe Code derived daily flow y" gpd Recommended design loading rate ' / bed, gpd/ft2 / trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate ;7 bed, gpd/ft2 , P trench, gpd/ft2 Recommended infiltration surface elevation(s) 5-z e_ J~ • 3 _ft (as referred to site plan benchmark) Additional design / site considerations ~E~Ohi~tE~y1)Fp - L,~.v4 ~,v/~p~PO W vE.4--.4,4lS w/D~a.D icy gs Parent material 5e!S -SA F: S~/f 52!2w-*2v7:k Flood plain elevation, if applicable. It a I - S = Suitable for system CONVEWIO L MOUt~ ❑ U IN IdN--GRO D PRESSURE AT-GRADE SYYSTEk IN FILL HOLDING TANK U = Unsuitable fors stem (B-8 (L~'f''$$ -S ❑ U ge- ❑ U G ❑ U ❑ S 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 Tmnch 44 C- "e -2 f 4,e 414A0 cs l _F , s Ground 3 -,y2- lo elev. y s/ if .e ~,P Qs y• s J ft. 7s ; lv Depth to limiting ffaactoorri All I Remarks: Boring # o-// Faye z/~•- s,/ 1 fsl.~ ~►ti, fie s ~-F , s ~ -G S G Ground / 2 /L7 3 S~, 1 f S/J.~ ~vt 7Fjt° L~S~ [J f • ~ elev. 3P /D y ~f~ .die S ' S ft. 41 s~' Depth to 14-0 limiting factor Remarks: CST Name:-Please Print 'RO BMI- U LB R t CkT Phone: Address: ,C S` N~ f L 0 ~ U t7siv Gl~/S , S y016 G"STi J 13f J92_.__ Signature: Date: CST Number: 36 a f Sv,r/,v t~ ~lv 00 S T . PROPERTY OWNER D~ f h,? L.O / SOIL DESCRIPTION REPORT Page Z'of 3 PARCEL I.D. / 1-0 T I L- C I t= It le V I 61k.; Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouclary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 9-13 z- S//. S /C nv.-F1° S' 3 f , S G 16 yl 311- z fs,6,r 1e s /f . s . ~ Ground 01 /o yle 31 ~ /U-F , S elev. , ft. 3 /o y s cs - , y i .s Depth to limiting factor Remarks: Boring # A::}. o /6 2 Z s~/ f sb,e -f2 ~s ~-F s Sf- -U,-05e Q GS Ground S elev. 7 _ 7S y ~S CS' 7 ft. Depth to e es d, limiting 01 factor Remarks: Boring # Ground f S`I, At, 'fle elev. J-3 L'S ft Depth to limiting factor_ Remarks: Boring # Ground elev. fl. Depth to limiting factor Remarks: con oeonio ncrn,~, lt,~k ruiC~ w 3"13 2, (7 hCilS ~ ffv,~si TF i o ~ W ~ EV,~►T tvNS t /oz./ 1 0 r3 30' p Z 13 y /o y Z~ v 0 Sur,GES TfD T~ENC~(,~, SyS TEM V 7,-oe NG,Vs To h J ~ l 44- a. cev /i i iy -43 6)o O ~ 7i i 25' 7S~ ZD - Z ~G se. ~mr ~ - o \ I \ SMALL TRACT \ 0~ 0~I LDI SMALL TRACT wi of a1 wi sJ. D1 \ Oi _z I 19 ro ~O 71 h W i OQ w ~O \ S M w 1 Q~~\J D 12 01 W. 94, 308 SO. FT. f-i o 2.17 ACRES \ wI ,c o 2S S3 0 •\y N \F$ a In a I 1 z O 103,750 SO. FT. 2p~ 2. 38 ACRES 20, ` \ w cn 0 3 \ e0 .h Ilk ai ,yam ah w to of LL tiSSo 2 103, 750 SO. of ° - 22.500 2. 38 ACRES J1 w 95,. O OI J WI f' I F O QI w JI 3 Z z1 ~I O S ~ S2 v 250 ' °O 13 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. owner of property Location of property tic/ l/4 54,-) 1/4, Section T- N-R 1 g W Township r Mailing address Address of site 40 Subdivision name Lot no. Other homes on property? Yes__,Y No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? -1,'K-Yes No Is this property being developed for (spec house) ? Yes X No Volume /!d S and Page Number -71 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 i~ the o fice of the County Register of Deeds as Document No. 3( a , 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. 1 n Signature of Applicant Co-Applicant Date of Signature Date of Signature y STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERMUYER `uv MAIIANG ADDRESS Csl az PROPERTY ADDRESS tse - (location of septic system) Please obtain from the Planning Dept. CITY/STATE 5~/Grii Gt/d PROPERTY LOCATION 1/4, S 1/4, Section , T N R. 19 W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER l CERTIIrIED SURVEY MAP , VOLUME----, 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 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. Me, 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 iration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 DOCUMENT NO. WARRANTY DEED n"SPAC. 523G24 STATE BAR OF WISCONSIN FORM 2 -1982 y _ f REGISTER'S OFFlC~ David R. Knighton ST. CROIX ReCdfipr , WI ~ -Record Nov 2 i conveys and warrants to Richard C. Hadley and Arlue T.Hadl 199 tenants in common at -A M OWTua'TO Richard C. Hadley 1409 Cowles Rd, Hudson, WI the tolllowing described real estate in St. Croix Sala of Wisconsin: Tax Parcel Na. Lot No 12, Clearview Addition Subject to Declaration Establishing Protective Covenants and other easements of record., F~L This is not honwft property Pst (is not) ad' Exception to warranties; Dated this / day d ~'lOyJ . t 9 94 (SEAL) (SEAL) Z4d 4R.q_h44:::: (SEAL) ~ (SEAL) s AUTHENTICATION ACKNOWLEDGEMENT Signature(s) STATEOF7519CENM MINNE HENNEPIN 739. County. P authenticated this day d ,19 Personaqy cams before me this ~i day of Novembe , 19 94 the above named David R .Knighton s TITLE: MEMBER STATE BAR OF WISCONSIN autl sized by g 7p8.p8~ Wly Stets) to me be the o~ who executed the foregoing ' a cite w e th THIS INSTRUMENT WAS DRAFTED BY David J. Butler, Attorney at Lav / 6625 Lyndale Ave So, Suite 526 - Richfield, MN 55423 . Davi9 J. Ruth (612) 869-7121 Nola+y public Henne i n cou^N, w& MN (Signatures may be authenticated or acknowledged. Both My Con►m' state ex ~iration are not necessary.) deli.N- of w- so-v in eny 0111) , 3ftM be yew or pr ireed below ,N0 $91aft"s. *Sim CMIM - ) WARRANTY DEED STATE BAR OF WISCONSIN ~O 4W 41101 Heysa R FORM No. 2 -1982 ASSOCIATION IM Me~ison be-rein 53704 ~ y ~ ,~z ~ ~ ~ S~~ ~ ~ 3 o ~ ~ ~~z ~l-2 ~ ~ l L~ /Z f 9 ~ ~Qr v ~l