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HomeMy WebLinkAbout022-1086-40-000 C o ° I o Q. j ' ~ I ~ I o I 0 N I r, ti I I I h I ~ I a z c LL c Q I Cl) ~ 3 I w z N Z w o o L W a m Z m C z o I O z d c v Y o m Z d' c N F- ° ° z E -o m N N ~ 7 co c CL • ) ° o N d f6 O O Z m z N z I ~l N y c V c t0 E N ° L °1 `6 I N a ~a L a = U) 00 0 N O N d a) 2 O Q) 't o o n. -0 C Q U') E ►~iJ O O O Z ° • rv ~ it ~ a a a I S; a 0 U) N N U) J 0 > a) a) o o a~V Z ii) m !n v E a L !n N N 00 CA -p N Q } a`) N ° r"" C i~' y N y c \y O o 3 cy, (a ►~+i o ° O `v° 0) o N a o o V'T c a) n C1 C cy) N 00 ~ c i Y c S o a rn o I ° N M a> F Z c CD v CO c • yy,' o r°i Y 2 ° N cn 51 E V1 m a M EL L: CL E v E c c `~J A 0 a O m 00 Eff -1-15 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION -N NW /4, Section 30 ,T?8 N,R18 155)(6r) W Township or Municipality Kinnickinnic Lot No. , Block No. County St. Croix Subdivision Name Owner'siOwfert-Name: Keith Hansen Mailing Address: 218 W. Charolette, River Falls, WI 54022 TYPE OF OCCUPANCY: Residence X No. of Bedrooms 3 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW X REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS Aug. 27, 1979 PERCOLATION TESTS Aug. 28, 1979 SOIL MAP SHEET No. 91 NAME OF SOIL MAP UNIT Boone sandy loam PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTE INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- l 36 4" dkbrn Tssl, 32" brn sand 22 no 30 3 1/2 3 1/8 3 1/8 9.6 P-2 30 6" dkbrn Tssl, 24" brn sand 22 no 30 2 7/8 3 2 15/1 10 P-3 24 5" k rn Tssl 19" brn sand 22 no 30 3 3/4 3 1/2 3 1/2 8.6 P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B-1 72 none > 72 4" dkbrn Tssl, 46" brn sand, 22" white sand B-2 66 none -Mw 66 6" dkbrn Tssl 41" brn sand 19" white sand B-3 60 none > 60 5" dkbrn Tssl, 41" brn sand, 14" white sand B-4 72 none } 72 5" dkbrn Tssl, 43" brn sand, 24" white sand B-5 66 none > 66 6" dkbrn Tssl, 41" brn sand, 19" white sand B-6 60 none > 60 6" dkbrn Tssl 42" brn sand, 12" white sand PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the.location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy 750 ft trench Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 945 ft bed e _ a Approx. 150_ ft. to existg _3~uilding f well,. ~ e rt . 1 w ' r 9 o slope" € 4- #a -Telephone pol~e_. i _ I F--- 340' ref. elev I- i (;tv 48 J bore holes N roposgd • perc tests elevation reference " , edroorr) Sca-fe ..iR~. 40, Owner has 3 acres for ome 1PF s , building site ~'.9 O proposed ; Se~ctibn~30 w t will t 1, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) Roger A. Swanson Certification No. 55-606 Address RR 5, Box 124, River Falls, WI 54022 .Name of installer if known Unknown Copy A -Local Authority CST Signature STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_& JA glpns z>h ADDRESS SUBDIVISION / CSM LOT SECTION 36 T Town of l a h~ ~ n~ ~c ST. CROIX COUNTY, WISCONSIN PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM M Cl,, /oo.o' ova fro /7 Oil / ~hewC ~rA,.d /asQ~ ' Y Brd^ a~ Pole yq ~ o~JtY' ~ l 1 t c I~Jnr t ` G Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: Ab(ytts gro"ad j`t IV WS;A ALTERNATE BM:. b J n(~ ~Pr~'~ 1 ~P SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 1.5 ew Liquid Capacity: Setback from: Well House Other Pum . AMafacturer Model# Size Float sepe tion Gallons/cycle: Alarm Location / SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: 3y~ Setback from: well: House 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: PLUMBER ON JOB: Ad.1 LICENSE NUMBER: Cp l~~ INSPECTOR: 3/93:jt LOCATION: KINNICKINNIC 30.28.18.466C,NW,NE,HWY.65 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: -1 Labor aod Human Relations INSPECTION REPORT ST. CROIX Safeky and Buildings Division (ATTACH TO PERMIT) SanitaryPerm itNo.: GENERAL INFORMATION 149331 Permit Holder's Name: ❑ City ❑ Village X] Town of: State Plan ID No.: HANSEN, KEITH O & JULIE R KINNICKINNIC CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /0U~ "W i~~ - 022108640000 178 TANK INFORMATION " ELEVATION DATA A9200178 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic q~ Benchmark 00' Dosing Aeration Bldg. Sewer Holding St/Ht Inlet 7,90 4Y,7-V TANK SETBACK INFORMATION St/ Ht Outlet 9q5-3 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic ~~`j a Sal > S NA Dt Bottom Dosing NA Header / Man. q 3: yg Aeration NA Dist. Pipe 6 q3S g Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 13 Manufacturer Demand & / j=,C ao ~S 3 l S Model Number GPM Lrictio System TDH Ft TDH Lift I oss ead-- I F__ Forcemain Length Dia. Fi Dist. To Well SOIL ABSORP ON SYSTEM BED/TRENCH Width Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~a / ~6 / DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type Of - CHAMBER Model Number: System: 3 3 y~ - P wt. 60- 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 E] Yes I-] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.).~~ f ~ a~ ~c a c e Plan revision required? ❑ Yes Ek/No i1 Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: f ap SANITARY PERMIT APPLICATION I.~.HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY St Croix STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 8% X 11 inches in size. Check f .7"P.0 pr vious 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 Keith and Julie Hansen NW '/4 NE '/4, S 30 T 28 , N, R 18 )5j$IW PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 191 Hi hwa 65 North CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER River Falls WI 54022 II. TYPE OF BUILDING: (Check one) ❑ State Owned NEAREST ROAD Higbway 6_5 ❑ Public ®1 or 2 Fam. Dwelling- # of bedrooms 'A PARCEL AX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 022-1086-40 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 1100 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 in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 M 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 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 450 648 648 .7 N/A 93 Feet Feet VII. TANK CAPACITY Site in alIons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App' Tanks Tanks Septic Tank or VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): PI is Signature: Stamps) MPAMPRSW P o.: Business Phone Number: / 17.11 Paul C.J. Steiner C 6780 715 425-5544 Plumber's Address (Street, City, State, Zip Code): 65 East Woodridge Drive; Rive Falls WI 54022 IX. COUNTY DEPARTMENT USE ONLY ❑ Disapproved Sa 'tary Permit Fee (Includes Groundwater Date ssu Age Signs S pa) Approved ❑ Owner Given Initial urcharge Fee) /t Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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. 11. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. 111. 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. Vill. 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) • APPLICATION FOR SANITARY PERMIT • 8TC-100 This application form Is to be completed in full and signed by the ownet(s) of the property being developed. Any Inadequacies will only result In delays of the petmlt Issuance. •ehould this development be intended tot tesele by owner/contcactot,(spec house), then a second form should be retained and completed when the property is sold and submitted to this affiee with the appropriate deed recording. w - - r- - - - - - - - w- -rwww r-r- rrrwwrrww-rwwrr wrr rwwwr~---~~~-~~rw~-~ Ovnet *01 property . k/E i T*74 © • c+ TLt L 1 E ~"Id'T~ S~ 1J Location of property N W 1/4 11/1, 8ectlon T zb.l di? V Township K 1 N M I C IC 1 &J 1 C • Melling address 1? 1 1= i'Z.1 4G 212 1 OC 4.. PA W =1~ S~ O Z Z Address of site ) q ( wH (o5 tj IQ 1 JG✓L FA "S SLIOZZ Subdivision name MIA Lot number Previous owner of property _GeoaGe C °f G LAp~(-S Total wise of parcel 2-S A Gas Date Pstcel was created Are all corners and lot lines Identifiable? Yen Is this property being developed for resale (spec house)T___-Yss ~_tto Volume g~_and Page Number -(o G as recorded with the Register of Deeds. -------------------------------------wrw-rw-rw-wr-----------ww-wrrr-~r--~~~~~-~ INCLUDE WITH THIS APPLICATION T112 POLLOWINCt A VARRAHTY DYED which Includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMAZRt and the BIIAL OF THS RE018TER OF DEEDS. In addition, a certlfled survey, it available, would be helpful so as to avoid delays of the reviewing process. it the deed description references to a CeitIliad Survey Map, the Certified survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(ve) certify that all statements on this form ate true to the best of my (out) Rnovledgel that I (we) am (ace) the ownst(s) of the property described In this Infocn+allon form, by virtue of a warranty deed t rr,ordad In the allies of the County Reglstet of Dead$ an Document No. '1•;&0 - otf* l and that t (Ye) presently own the proposed alto for the sewage disposal system (at I (we) have obtained an easement, to run with the above described property, got the of thcuctlon of said s tome and the same has been d 1 recorded In the allies of the ount Re at of Deeds, so Document No. _36 f AA A 0- "6 l G ~G-Xlslt_ 1~. s gn uce of Owner ~ atuts o[ C -Ownet III Applicable) ate o[ signature - Date o[ s gnature DOCUMENT NO. -J STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA II WARRANTY DEED I - i .465026 i.._ - ~$~~~.--~iF---------~_ REGISTER'S OFFICE Y-- ! Geor a C. Kind This Deed .made between and ~ .ST. CR{~IX .0 WI Glad s..R....Kind husband and wife ReCrd for ReCO ! rd OEC191990 i ,Grantor at and_...K.e.i.th..Q...Jians.en..and..Tu13.e.R...Hansen,...hushand..and...... 9:35 A.M ii _._.wife._as..suryivorahlp_.maxi tal..propert3t w RsOhfer Of peels . Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... RETURN TO is conveys to Grantee the following described real estate in SA..... C. 9ix......._.... County, State of Wisconsin: I A strip of fast and unflowed land 2 rods wide on the h--~== i; north bank of the Kinnickinnic River including the stream bed, all bays, bayous and backwaters as it flows Tax Parcel No: through the following described lands: T28N, R18W, St. Croix County, Wisconsin. Section Thirty (30) that part of the NWk NEk more particularly described as follows: Commencing at the NE corner of the NWNE; thence West along the north line of said NWNE a distance of 230.5 feet; thence due South a distance of 66 feet to the point of beginning; thence continuing South a distance of 351.9 feet; thence South 71°02' West 94.4 feet; thence South 65°21' West 77.6 feet; thence South 47°10' West 65.8 feet; i thence South 24°20' West 128 feet; thence North 36°40' West 121.3 feet; thence North 40°14' East 490.3 feet; thence due North 105 feet; thence East 16.5 feet to the point of beginning. ALSO, a parcel of land located in the NWNE described as follows: Commencing at the most southerly portion of the above described parcel described in Vol. 349 Deeds, Pages 348 and 349; thence North 36°40' West 121.3 feet; thence South 40°14' West 15 feet; thence South 36°40' East 139'4" to the Kinnickinnic River; thence Northeasterly 24'2" along the Kinnickinnic River to the place of beginning. ALSO, a strip 1 rod wide along the East line of the above described land for ingress and egress purposes beginning at the private drive and terminating at the easement area. It is understood the access will be used by the Department of Natural Resources, its employee officers and agents for development, maintenance and managing the property and not for pubLic use. t is i.s....._.no_...... homestead property. (is) (is not) A~ Together with all and singular the hereditaments and appurtenances thereunto belonging; .10 Geor e C And . Kind and Gladys R. _ Kind--' i ........g...----'.......---......._......--•--•--.. warrants that the title is good,._ indefeasib.le in fee..simple a.... nd f ree and clear, of encumbrances except r 1:111 subject to easement J granted to State of Wisconsin, Department of Natural Resources, dated 3/13/86, and recorded 5/8/86, as Doc. No. 411691, Vol. 739, Pgs. 163-165, Registe an8 wipewars•antfan,Fadfe~atthe samex County, Wisconsin Dated this .9.th day of November , 19.90.... ................................................................(SEAL) .f.......... ....-..Cts ....(SEAL) ii y i * .George. C.._Kind/.......... ............................•-_...........................(SEAL), !t....................... (SEAL) I' Gladys R. DKin - Ii AUTHENTICATION ACKNOWLEDGMENT Signature(s) . STATE OF WISCONSIN as. Pierce ..............County. , 'I authenticated this day of 19 Personally came before me this day of ._.......Noverber 19.9Q... the above named I Geor e..C:..Kind.. .and Gladys R. Kind ~.1:..~.._.._. TITLE: MEI'ABER STATE BAR OF WISCONSIN I (If not, authorized b Y Y § 706.06, Wis. Stats.) - to me known to be the person vrbp e.-Qc ited the a. foreegoi g ' trument and ac owledge, the -sanL j II TH:S INSTRUMENT WAS DRAFTED BY ° ~.:..L....Gaylord, Attorney a. Q. River Fall s'..WI 54022 ..d...... II Notary Public ierce........... i.:God'AltyoI ,}g ~~v`• (Signatures may be authenticated or acknowledged. Both My Commission is permanent.-ftf-m.., xtatc- I ~xprrarr are not necessary.) «~,,,r ! &St€ ~ --nt; ! - i •Names of Persons sirnins in any capacity should be typed or printed below their signatures. t 1 ~tKCRrer STATE BAR OF WISCONSIN FORM No. I - i982 Stock No. 13001 IL DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 THIS SPACE RESERVED FOR RECORDING DATA QUIT CLAIM DEED t 480214 von 938 PAeE 557 Ernest James Hebert and Linda J. Hebert, REGISTER'S OFFICE husband and wife. ST. CROIXCO.ir WI Recd for Record quit-claims to Keith 0. Hansen and Julie R Hansen- • MAR 0 61992 husband and wife a survivorship marital pip erty at 2:50 P. M Regfafer of Deeds the following described real estate in St. Croix County, State of Wisconsin: RETURN TO A strip of land located in the NW% of the NE4 of Section 30, Township 28 North, Range 18 West, Township of Kinnickinnic, Tax Parcel No: St. Croix County, Wisconsin, more fully described as follows: Commencing at the N 1/4 corner of said Section 30; thence East along the North line of the NE4 a distance of 1099.48 feet; thence South 66.00 feet; thence West 16.50 feet to the point of beginning; thence continuing West 13.59 feet; thence SO°11'59"W 110.24 feet; thence S40°28'33"W 504.49 feet; thence S36°22'08"E 9.69 feet; thence N40°14'00"E 519.75 feet; thence North 105.00 feet to the point of beginning. Contains 0.13 acres of land. (This deed is given to correct the boundary line between the parties.) EXEMPT This is not homestead property. (is) (is not) Dated this 6th day of March. ,1s 92 (SEAL) (SEAL) Ernest James Hebert (SEAL) c:.. v, -C~ r✓ ~i''~ (SEAL) Linda J. Hebert AUTHENTICATION ACKNOWLEDGMENT MAI Signature(s) STATE OF SIN SS. County. authenticated this day of , 19 Pars nally came before me this S'O day of 7 /VeQ/~' , 1 s 92 the above named Ernest James Hebert and Linda J. Hebert TITLE: MEMBER STATE BAR OF WISCONSIN ' (If not, to ilwn (,ow", U Y s who executed the authorized by § 706.06, Wis. Slats.) fo H-0611;1466( ial ~ ~t aS w the same. THIS INSTRUMENT WAS DRAFTED BY V\&VV 9VVVVVV`C. L. Gaylord, Attorney River Fills, WI 54022 ~ No ry Public- County, (Signatures may be authenticated or acknowledged. Both commis ion is n nt. (If not, state expiration are not necessary.) 19~ ) date: Names of persons signing in any capacity should be typed or printed below their signatures. S133 NTF 7776 OU1T CLAIM DEED STATE BAR OF WISCONSIN I FORM No. 3-1982 Nelco Tax Forms, P.O. Box 10208, Green Be-,,, WI 54307-0208 r~ z cn STC - 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d S Ny OWNER BUYER IvG( A444~ ROUTE/BOX NUMBER loll (Q$- Fire Number CITY/STATE P1Q(EV, W-L ZIP 5~f'UZ.Z I PROPERTY LOCATION: NW k, Me _14, Section 20 , T 21 N, R 12 W, Town of V-1 Wtj 1 C_V_J A M t r , St. Croix County, Subdivision tgliq , Lot number. I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into I! the system can affect the function of the septic tank as a treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), 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. H 0 E I/WE, the undersigned, have read the above requirements and agree M to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- ~d ment of Natural Resources. Certification form must be completed and returned to the St. Croix County 7.onin Office wit in 30 days of the three year expiration date. SIGNED 0 4 r ~C~..rl~ DATE S/ /10 I q Y St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. N n y~ ° J 00- 0 0 0 ,n ;N cm Co 10 c en a LA w Or 30% a a ~m N f c t WO N O 4.- m ~na2 o o ~c o as = pJ 0 2 00 t J dJ 0 mc d LL %n I l'l oa, q v -a V7 r = P in r 7 a7 Q + O > J m ° a. V~ v ~Z a a fl. Y p O r Y F °v{/ N !n a - O A y Q. Q ra m c O > d a G. C ro o 0 a a ~ Ain s d~ c s 8, z 4) 04 -0 (n m '0 O_ , ~r 1 N y aEi aE, N k, C3. 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