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HomeMy WebLinkAbout032-2077-50-000 STC - 10 4 AS BUILT SANITARY SYSTEM ORm"~ 6 A KfaN ~o Y` OWNER In') KIP- d' h'l u 1 p p ADDRESS 1535 I ' m I At)4 i t~ p , . A SUBDIVISION / CSM# T # SECTION IV -ft-T3V N-RJ V W, Town of ~r ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ar 0(tC.RMJC fAJ rvt Chats 00 Sep 3a 33 (a3' 8 , S 31 3 - ebRoorm i ~ l 1 3 -Ti2er~~.,~a S S x ~U N NDICA E NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: SF CUIZJLtQ~L pUNip)~44,10IQ ALTERNATE BM: SEPTIC TANK ~~P11UMP CHAMBER HOLDING TANK INFORMATION Manufacturer' W e-k kS Liquid Capacity: g0c Setback from: Well D_ House 33 Other Pump: Manufacturer ZOel12f, Model# 13~ Size a,,Float seperation Gallons/cycle: 1 `1 V IOn1S q Cu~.c.~QS Alarm Location N dm-g N to 16 Isc. PA/ve SOIL ABSORPTION SYSTEM Width: S Length (0 0 Number of trenches 3 Distance & Direction to nearest prop. line: a00 Setback from: well: lQ House 3 Other CUM ~3.4to (~eFcorc 9,87 ELEVATIONS p Q 1 Building Sewer ST Inlet; ST outlet 8 T 1 t' t,3 C;) PC inlet 89-VV PC bottom 85• 7 Pump off 11 95.5 ~y eader/Manifold Bottom of system •75 Existing Grade 9Y,75 Final grade 71-05- DATE OF INSTALLATION: 4 0~ 3 PLUMBER ON JOB: CJ( LICENSE NUMBER: 3Yoy INSPECTOR' ~r i 3/93:jt i i Wiscorisin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety anrAuildinl Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 21 AR79 Permit H,91 dd ' yae: ❑ City E] Village Town of: State Plan ID No.: KLO1rATI MICHAEL A . CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Alk, Benchmark /LA3,67 DO Dosing Aeration Bldg. Sewer Holding- St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet /3.37 TANK TO P/ L WELL BLDG. VeAirnItto ntake ROAD Dt Inlet J , ~3, 5 / Septic NA Dt Bottom Dosing 1041 ~j ` `~,1~ NA Header/Man. Aeration NA Dist. Pipe Holding Bot. System 7r PUMP/ SIPHON INFORMATION Final Grade Z 94, 0S Manufacturer Demand Model Number GPM /S• g TDH Lift Friction System TDH Ft Forcemain Length Dia. Dist. To Well Head SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N ~U DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O , e Model Number: System: x~, ~2UO 3 / I CHAMBER OR UNIT DISTRIBUTION SYSTEM Header/Manifold I Distribution Pipe(s) I x Hole Size I x Hole Spacing I 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.) L--- LOCATION: Somerset.14.30.20W, Lot 1, Maple Hill Road X47 { - Plan revision required? ❑ Yes ❑ No / +~4 I FR4 Use other side for additional information. SBD-6710 (R 05/91) ~pDate Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ~i'► Gam, Gfi" Vfi l~~ ~ ~ G3-t ~ ~eJ~' ~ oie Ck" ce) i SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm Code STATE SANITA Y PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than c Q) X911 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 lni', C A10,1 Y4 G Y4, S T 3 N, R Q E (Or)dO PROPERTY OWNER'S ILIN DDRE LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER A6 a f) zuff` Y h 11. TYPE OF BUILDING: Check one CITY NEAREST~RO D ) ❑ State Owned O VILLAGE : ❑ Public N 1 or 2 Fam. Dwelling-# of bedrooms 3- PARCEL TAX NUMBER(S) ~n III. BUILDING USE: (If building type is public, check Z11 that apply) 034 o 7n 1 ❑ Apt/Condo O(^ / 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground ❑ Restaurant/Bar/Dining 7 El Merchandise: Sales/Repairs 11 4 ❑ Church/School 8 ❑ Mobile Home Pa rk 12 ❑ Service Station/Car Wash 5 ❑ 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.E] New 2.-N Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 R 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 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROQPOSED (sq. ft.) (Gals/day/sq. ft.) (M* //inch) Q EVATION q~ O v© 900 ~.J 1 Y. I b Feet 9). 66 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncre a Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Od v 2 Lift Pump Tank/Si hon Chamber - OC7 ) VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): J I Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: ~y s s ~~d M _2Iou rr) ke I 1Z Plumber's Address (StAv',) tCity, State, Zip Code): t~ T H-o c- s CSI6 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa 'tary Permit Fee (includes Groundwater a e Issued Issu ng Agent Signature (No Stampp) Approved ❑ Owner Given Initial TT Surcharge Fee) Adverse Determination /~v s.Or/ f ~A~ 91.d~ I.A X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(8.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS a ~ 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. Ill. 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) _ 0 S5, Q, L.- 7 PLOT 1 P I. nJL N :l~ M F an, Iti1 A M E `►G~P~ e ,1~. I.-1 C U!-s L O C A 10 NJ l s35 P A__ P L s ~P2 k.~ Nofi e : W01 2or. Sit C , S SPr` `''T"~ ''DMDP} t(~v.~ F 6m: ,Corw~rc ogNtn 5u, 3 frzeN s ' DN S*60 63 cul t 3'BQbmouh. 8 4 • r z pr 49- 31 30 , 6wlw Rwu l~ra. O-`Qr..P`. ' • 35' vaja~ P Izfi Mkt 18o S . o , (5 Bonn la tNl~~ . ' r 1~0 G 10 r = TIAn+ O`J ~I `hp2 . Gu'~^ X11 pfi J, 5~ FRE 11 All' INLETS AND OBSE1 ATIOR PI.B C1,0-S SECTION Approved Vent Cap minimum 12" Above I 9I' 5 rlw E)Fppp- F na raSle__.___~ i y Mlak . ~ , 4" Cast Iron Above Pip Vend Pipe To Final Gradr.- Marsh 11,1y or ~Synthetic COVCri.ncJ_ Min. 2" Aggrc~J':tI _ Over Pipe Dis tribu tion Tee pipe [~e loan _ Aggregate ~ Pc_x•f.oral:ed Pipe 47S 1)cneath Pipe --CoupUng Terminati.ng' 12ewz~eS _ Bottom. of Sys tem. PLAT DRAWING N This is not a complete Land Survey of 01 a~ 21 W E Hi S 560 0 S9 , R= 80.00' 20 C= 153.49' CB= 577023'40"E. gg6 0 10''easem'ent for underground electric 0 Vol. 523, Page 525 Co Easement to St. Croix County Electric Coop. o Vol. 256, Page 176 o ~ 241 i 22., 261 Ln (0 ah,~ - t-n 24'~ 30 0 L , House o N u' Deck M N 16` Shed 0 Ln N O O O U) N89 33'40"E 504.43' i The location of improvements on this drawing are approximate. and.are based on a visuai inspection of the premises. The lot dimensions are taken from recorded plats and deeds of county records. This drawing is for informational purposes only and should NOT be used as a comple,t'-e Land Survey St. Croix County Abstract Co. has agreed to waive the minimum standards of AE-5 Map No. 88-01-90 Drown By F.B. Scale = 111 = 1001 1 PRIVATE SEWAGE SYSTEMS - II it 82 PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS i VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTIOU BOX MAWHOLE COVER 29' FROM DOOR, 12"MIU. WINDOW OR FRESH AIR INTAKE GRADE I 4" MIN. I IB" MIAI. CONDUIT-- 18"MIN. 11~ MULE T PROVIDE I AIRTIGHT SEAL I T I I►I V APPROVED JOINT/ A I I I W/C.I. PIAPPROVED JOINTS III PE W, C.I. PIPE I XTENDING 3' 111 ALARM EXTEWDIUG 3' ONTO SOLID SOIL E ONTO SOLID SOIL iB I I ON C I i I ELEV. FT. PUMP OFF r D CONCRETE BLOCK RISER EXIT PEP.MIlTED GIULy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC,IFICATIOKIS DOSE TANKS MANUFACTURER. ~a)ee ~S NUMBER OF DOSES: PER DA-4 TANK '-dZE.- _80Q yy GALLONS DOSE VOLUME ALARM MANUFACTURER: pit-C INCLUDING BACKFLOW:~ GALLONS AN h 3 MODEL NUMBER: NA CAPACITIES: A=INCHES OR ~ALLOU5 SWITCH TYPE: + B= Q INCHES OR GALLONS PUMP MANUFACTURER: n~ P C=WCHES OR IS ~,A_LON5 MODEL NUMBER: 137 D= -1NCHES ^.R 0) ` GALLONS 5WITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE_ lace GPM VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE- _:LL FEET + MINIMUM NETWORK SUPPLY PREESSURE , . . . . . . . . . . 2.5 FEET + _ FEET OF FORCE MAIN X F 00FT.FRICTIOU FACTOR.. FEET TOTAL DyAJAMICHIlEAD = FEET INTERNAL DIMENSIONS OF TANK: LENGTH;WIDTH ;LIQUID DEPTH 51GNE C: LICEOSE AIUMBER: M ~L Sb ~ I U~ DATE: r ly 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 k~ot!l!~ k-V-> residence located at: I _'j IVP) 1/4,51/4, Sec. Zj TAN, R Town of 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 AU4 I / T Did flow back occur from absorption system? Yes V/ No (if no, skip xt line) 'bn~ Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete-\/ Steel Other Manufacurer (if known): N Age of Tank (if known): (Si ature) (Name) Please Print (Title)., (License Number) 1,0 r7 Y (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). Name ' Signature MP/MPRS J-f 5/88 Q 1 N ,b0'£zz , 991 B9 106Z W h~ N _o M o M M o M V` 9 0) - ti ti ~ >o , 7 , \ WSJ , E I.9b6 ~ b 3j , Irl2t ~-IIN 96.6` ~V co W QI U R ti 0 LO Q LL. Lo ti 8 a OD - IL' I t,9 122E I L' ~ ~ ~ ~ r= M N ~ N E 1.99 'G8 dkVVO 1 ZZ'822 1n 0S ,z9•sos I CL 1 0) W I 0 O ~ I 2 WI (I (D ?t I U QI °o U) CV l LO iWI NI j LO ~ I ~I ~ >I o W~ a ~i zs m U I S~~ / F~~s t15 00 < L P, fL 6 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page l of - Labor and Human Relations Diyision,of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUP 2 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 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 GOVT. LOT 0 1/4 s 6'1/4,S/ YT 3o N,R ZO 411~or)dO PROPERTY OWNER':S MAILING ADDRESS' LOT # BLOCK # SUBD. NAME OR CSM # CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD [ ] New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building (Replacement [ ] Public or commercial describe Code derived daily flow. Wo gpd Recommended design loading rate bed, gpd/ft2 S trench, gpd/ft2 Absorption area required bed, ft2 40 0 trench, ft2 Maximum design loading rate y_~'_bed, gpd/ft2 • S trench, gpd/ft2 Recommended infiltration surface elevation(s) 9y 75 ` ft (as referred to site plan benchmark) Additional design / site consid ratio Parent material r~ jp ~M j> P 33 C/o.'Jr e-,,,/ Flood plain elevation, if applicable ft S = Suitable for system ONVENTIONAL OUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem S ❑ U 19S El U W~/S ❑ U N'S ❑ U Us ❑ U ❑ S 2M SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0_4 17 q _5'_ /a Yk Ground r yf elev. 33ft. #48K Depth to limiting factor a > Remarks: Boring # 0-/7' 7S 311 0roc mV ~ al ,41 2, /VT 7-29 /0 YX q 9- y' M y ~S 1 r+6K N► r'•- C V.) Ground elev. 5 rt y Adx w► C - y Depth to s 9 - at S yg Y14 46 k' $1 limiting j factor Remarks: CST Name:-Pleas P t ~p Phone: 7/ 3 L _ 3 ) Address: O ~v r114 o~ t/ Signature: ,J Date: 41, ov CST Nu ' gU; r PROPERTY OWNER SOIL DESCRIPTION REPORT Page ?-of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh 44{ 3 o- C . 5 YK 311 ~ sG v ~ w /7v s Ground 3 yy' S yx Y y s/ /n^ A~~ yy+ C S elev. q1) Z, _70f t' Depth to limiting factor 9'. Remarks: Boring # 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 Remarks: SBD-8330(8.05/92) 3 W-3 s J X11 O = doe PAS t 83 ~ B z yoH y ip„ i s 30, ~ i FAIL 18®' ~~s 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 Location of propertyhAJ 1/4 6-114, Section f , T 30 N-R 00 W Township - Mailing address ~S~7SCI( Address of site Subdivision name Lot no. Other homes on property? yes X No Previous owner of property [-t4&rj JQcpbg Total size of parcel s• (,~~e Date parcel was created /(OCT) Are all corners and lot lines identifiable? _Yes ~No Is this property being developed for (spec house)? Yes No Volume-5-01and 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 & 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 the t of my (our) knowledge that I (we) am (are) the owner(s) of 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. O , and that I (we) own the proposed site for the sewage disposal system orrIe(we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly record d in %h e office of County Register of deeds as Document No .3 S`} Signature of 1 c nt Co-appl cant Date f Si nature Date of Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County uYER A l I w - K1 e,* +)-v MAILING ADDRESS (S~ S /~Gt 10 11. 12C PROPERTY ADDRESS i~ I It? UJT VUl,6 (location of septic system) Please obtain from the Planning Dept. CITY/STATE C' I`}pe , U) ) ~Z PROPERTY LOCATION rev 1/4, S L~ 1/4, Section T O N-R a_W TOWN OF ~SU1 ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED 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. 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 expiration date. SIGNED: tz--mix DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 00c:uMLI'll NV WARRANTY DEED a 4 STATE BAR OF WISCONSIN FORM 2- 1982 ` 4:35950 eooK 807 wt 1.it1 - ' • - 1 REGISTER'S OFFICE ' Leland H. Jacobs and Madeline D. Jacobs, ST. CROix CO., W1 Recd for Recei►d husband..ancY.w fe..as..°in.....£enan s APR 51988 i conveys and warraup to .....Micbrael...A....Klongexbo 1:30 PM ' . ~of 090& ftodsr 11 I - I w[7Uwr. ,p ' . . the following described real estate in St.....CrD. X .......................County. State of Wisconsin: Tax Parcel No: Part of the NWk of the SEk of Section 14, Township 30 North, Range 20 West, Town of Somerset, St. Croix County, Wisconsin, described 1 as follows: Commencing at the South Quarter corner of said Section , 14; thence N0001W (true bearing) 1,319.39 feet, along the West line of said SE'k of Section 14; thence N8903314011E, 819.00 feet along t8e South line of said NW'. of the SEk, to the POINT OF BEG;NNING: thence N89 33,401t E, 504.43 feet, along said South line; thence NO p2150oW, 290.00 feet, along the East line of said NW'k of the SEk; thence N60 5912onw, 446.55 feet; thence NWly 205 53 feet along the Sly right of way of Town Road on an 80.00 foot radi8s curve, concave NEly, whose chord bears N77 ?3140t1W, 153.49 feet; thence S3 481E, 545.13 feet to the POINT OF BEGINNING. • 1, ~I'Rp,N~~'ER Q $ f 1 This ..........IS homestead property. (is) (is not) Exception to warranties: EASEMENTS, RESTRICTIONS AND RIGHTS-OF-WAY OF RECORD, IF ANY. , 1 8...... Dated this day of Ur.i1........... 1 I ~Q (SEAL .1.1..' ` .ISEAL) j Leland H~ Madeline D. Scotia........ (SEAL) (SEAL)..................................................... ! 1 1 i AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. 1 $ Croix ...............County- authenticated this ........day of ..........................119 Personally came before me t is .th......day of I pril_.--•-----_._-•-_.---, 198_._ the above named • • I i ••----•-•--1 elamd..Ii.-.-Jac.ob.*.,--. Made1111&......... 1 ' Jacobs. TITLE: MEMBER STATE BAR OF WISCONSIN 1 (If not . I authorized by § 706.06, Wis. Scats.) I to me known to be the person .S. who executed the e I 1 for in instr... namcknjowl a the same. 1 THIS INSTRUMENT WAS DRAFTED BY 1 . St. St.... Croix.qft I . Notary Public St,'ftd- • W1BOOflilkl-- County, Wis. (Signatures may be authenticated or acknowledged. Both bly Commission is permanent.(If riot, state expir lion are not necessary.) date: 6-119