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HomeMy WebLinkAbout042-1078-40-000 Q c ' v ° Fr 0 ° N ~G O p O Cl) h. X aJ a3 a) 0 3 ~ © Y ~ 'O C a7 ~ y ~6 ,p N C O C O N 0 O 0 N co 6 00 C - O vl cu •u N 3 _N d _6 y O V) C j cu 7 6 O LL O 0 ~a 0 C) > j O N Q Q E 3 ~ z rn z . c o w a co N H z O z :!t p s m z ? C E N N C CL p O d ~ -C a5 N . O U N O z m z Z N co ,M m E _ N i N 7 01 al a w w LO zVT ° ~ c a` n u~ z co ~ = w? •N a a a n U) r~l a) Cj ° v> rn rn to U > O rn } 04 t O N O O O d N O m N O T "O ~ Q ~ N -ci C. C 7 w Q _ N N 'y^ O O d N C O O Q 7 30 O C C O L f- a3 N Y Y "O N c c a) U-) +~y - C 1~ C N a) 3 N O N 00 E -5 N Q) O (y~~ r.l N fD 11 L- L L l I'> rY p~ > 7 Vi f0 f0 N00 O y O > O N a. tV o CC Q) M E L 7 # a d T • LL y Uy w C rr.~ w E i •s C 7 1 A 0 y c0 a O fn STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM# LOT SECTION_j:2_2_Ta?N-R W, Town of aere i J~ ~n ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM al'Q in / /e!A 72 / s0c) o9 90 twe f ,.Z knee alk I ` 4INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. Cl~ u /ao. BENCHMARK: _ D S~0l~~ ~ 06 ro 2~"o a~rD Ivy fJi)Pd ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Wnv--kg' Liquid Capacity: X6 Setback from: Well House o?g, Other Pump: Manufacturer /vl +,p,rt Model#-55 N Y Size K ~ Float seperation Gallons/cycle: (o Alarm Location l h 5 ,~p H611i s4- SOIL ABSORPTION SYSTEM Width: LengthNumber of trenches Distance & Direction to nearest prop. line: y i 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: LICENSE NUMBER: ~p 7 p INSPECTOR: 3/93:jt ,:ATi£ON: AR 2E29.29.18.4451V A ' ~GE SYSTEMH AVE. n/isconsinD}}~epart m nt o In ustry, PR County: man Sa`e y an6lu d ngs D viision INSPECTION REPORT (ATTACH TO PERMIT) Sanitary er it GENERAL INFORMATION 1 '71 A Q'7 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan I o.: BUTLER, GARY D & PENNY D WARREN CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9200251 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t~! y 0 ,00 Benchmark /06-0 Dosing lLt S $0 D Aeration Bldg. Sewer Holding St/ Ht Inlet 6r,ff8 1/ TANK SETBACK INFORMATION St/ Ht Outlet ~n.1z 4 TANKTO P/L WELL BLDG. Airl to ,take ROAD Dt Inlet Air l Septic 1A -rar NA Dt Bottom Dosing NA Header / Man. (0 7a ga'3v Aeration NA Dist. Pipe 6410 g~{„3 Holding Bot. System 7, y Cf ~Ug PUMP/ SIPHON INFORMATION Final Grade S-u~ Manufacturer Demand Q.L.✓~ /q 0.01 Model Number GPM Q0 xfiiv TDH Lift Friction System TDH Ft Loss ead -1 Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width z r Length_73 No- Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO ` yl CHAMBER Moe Number: System: 3 ~ OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) Tx 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 c5j63 Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No 'G~? .rr " Ir 5 COMMENTS: (Include code discrepa i 'persons present-etc) r- 04 lay= - <f-73.19 Plan revision required? ❑ Yes ❑ No Use other side for additional information. -i,-c'' SBD-6710 (R 05/91) Date nspecto'r's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH 4 r SANITARY PERMIT NUMBER: s I i HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 171 z197 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. PROP OWNER PROPERTY LOCATION k F_ %a A/ r Y4,S T,19, N, R Zg? G it? elea PROPERTY O NER'S MAILING ADD ESS LOT # BLOCK # w 176i~ Cow-11- IF Tr CITY, STATE Z CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned NEAREST ROAD rV( W l~ " v c ❑ Pubiic L~J 1 or 2 Fam. Dwelling-#of bedrooms / PARCEL TAX NUMBER() 111. BUILDING USE: (If building type is public, check all that apply) 74? ~yD 1 ❑ Apt/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 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. [ANew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 220 In-Ground 420 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. SYSTE LEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 0 eet Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks oncret strutted glass App. Tanks Tanks Septic Tank or 0 - 4 I C C Lift Pump Tan ^ ,e VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. P mber's Na e (Print): Plumb ign ur : o to ) MP/b01421O *No.: Business Phone Number: l Set e A!? d 7~ 1%21:~` 15_"l Plum is Address (Street, City, State, Zip Code): IX. C LINTY/D RTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date) lakued Issu' Agent Signature (No Stamps) 1114proved Owner Given Initial Surcharge Fee) Adverse D termin lion a X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: 398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS far' V 1. A sanitary permit is valid for two (2) years. 2. Four 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 sugmitted.to the county prior to installation. ,ya 5. dnsite sewage systems must 6e properl'y'maintained. The septic tank(s)must 6e pumped b' licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact'your local `codi;administratof-or'the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary perrri1l:•appTdation 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. 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 tbercaunty; E) soif test data on a 11§ form; and F) af[ si;itlg informatiom - GROUNDVVXAR 86RCHAROE 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) =Lni LHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY .a St. Croix STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ ro 8% x 11 inches in size. Check N revis p wous 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 Gary and Penn Butler NE Y4 NE %4, S 2 T29 , N, R 18 FMM W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1706 Count Trunk TT 3 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Haignond, 154015 11. TYPE OF BUILDING: (Check one) El State Owned NEAREST ROAD ❑ Public ❑ 1 or 2 Fam. Dwelling - 80th Avenue - # of bedrooms -4-- PAR L AX NU III. BUILDING USE: (If building type is public, check all that apply) 042-1078-40 1 ❑ Apt/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 in line A. Check line B if applicable) A) 1. N New 2.E1 Replacement 3.E1 Replacement of 4. ❑ 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 2. ABSORP. AREA 3, ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTE EV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 600 864 864 -7 1 10 6 r'--5 ~l Feet Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete structed glass App' Tanks Tanks Septic Tank o _~F Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum Sign lure: (N s MP/fq.: Business Phone Number: Paul C.J. Steiner 6780 715 425-5544 Plumber's Address (Street, City, State, Zip Code): 65 East Woodridge Drive; River Fal s, WI 54022 IX. COUNTY/DEPARTMENT USE ONLY I E] Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Signal a (No Sta pal 0 Approved F-] Owner Given Initial Surcharge Fee) Adverse Determination In X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: L_03978(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. 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. V a SBD-6398 (R.11/88) .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 2 GNN ck R, Location of propertyl/4 _NC 1/4, Section T~q N-RW Township kfArwe GPI Mailing address 1_ Q^ ,aim I e L I Ly~D 1~ oAKeD Address of site _10ni 80+~ Avg. Subdivision name Lot no. J Other homes on property? -yes No Previous owner of property g mac. ~.'7 3 a_e_ Total size of parcel Date parcel-was created > >+L Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes ✓/No Volume 2 and Page Number 5 '37 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 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 in the of,#ice of the County Register of Deeds as Document No.4~ 5,' 3 J , 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 recorde in the office of county Register of deeds as Document No. P,,O_~A Signatur of applicant Co-appli nt Date of Signature Date of Signature } ~a 6 - ~W& lei In i. I" R[t111MI to MAD C a = IDMDwMtO do@t:rt~D~ r eel estate in St ' Soft q$ WWoarln. TDII nno 4. Peet of the northeast ON* Quarter of the Northeast Ose spy (NE 1/6) of Section Twenty Mine (29); Township 'I t"ise lortha range Eighteen (18) West, Town of Warren. St. Croix Consty, z. Visconeig further described in Volume 2 of Certified Survey Maps on ~ ti Page 537 as certified Survey No. 537 as lots 2 and 3. r 1 This is Wt homestead property. J; Its) (to not) Exception to Warranties: ;rat day of y Dated this CAL X .:rrairw A- Butler sairtY (SEAL) y. AUTHENTICATION ACKNAVEOOM 1 f X 4 5 Signatun{s► - _ STATE OF VM MM MStM So. r auHlentk aNd this day of Personally came before me 19AQ theaheftwo s TITLE: MEMBER STATE BAR OF WISCONSIN (it flOt to me known to be the person IN" el f authorizedcy470e.06.Wis Statal foregoing instrument and acknowiedOetMsaff* THIS IN$TRUM ENT WAS DRAFTED BY Notary Public_ (Signatures may be authenticated or acknowledged Both My Commission is permanent. (1101' Zile are not necessary -i date's . ION of parsons s.gnang in any capac-ty should be lyt+ad or printed pttow thou signatures WAAAANTr DUO STATE DAR OF WISCONe1N °y- - Form NO 2 - 11162 s ,:r-: 3461"10 -1 Part of the Northeast One Quarter.(NBJ) of the Northeast One Quarter (M4) of Section Twenty Nine (29); Township Twenty-nine (29) North, Range Eighteen (18)! West, Town of Warren, St. Croix County, Wisconsin described•in Volume 2 of Certified Survey Maps on Page as Certified Survey No. 557 1. r FILED 041 23 JE. 1978 (mil ,Jt. c rra C~~nty, N Q ~ttatgtlrra__ ~n L z J. UT 7 r Jj 'Aa 3 0£ Zbo00 S 6Z '03S ,01,00Z 0/13N 3H11 1SV3 WON 0~ II c `~70 N , a N PQQ~ Sys r m Ql N P ~~5 C ~ f u~.~0 " I'M eO r~ AX P"000 S Z r C qX* I,RF tt o M t+: Nf r. M roo off.?ia 1O~ N 0 M rr^^ r~ WW po vJ do N Q V) 0C h W N Q; N N 3 J W - bI Ob.Z' W m g aa Q v: % I ,•0£ .OIDOO S' N N W z. o1Z h. LL. `V WZm L) C~ N Q m j: OD J 1- -J: N p M M O D 1 O t7u Q Z in G v W Z • W Z O N :Q 01,00Z = 3,P2 Zt, oOO S ~ a ~ q v = Z Z M ill • . f _ t~ Q M c'j z - M 00 80 ON - M/M A-W31SV3 \ rl Ile _ ---91'10£--- - a'''•, M„OZ,Obo00 N -6Z'33S - 3N-3N 3NIl 1S3M 0/11it~r W Z. W Q. 2: z Sheet 1 of'2 sheets J: ~I~ Paxt of the Northeast One Quarter•(NMJ) of the Northeast One Quarter (NDJ) of Section Twenty Nine (29); Township Twenty-nine (29) North, Range Eighteen (18) West, Town of Warren, St. Croix County, Wisconsin described-in Volume of Certified Survey Maps on Page as Certified Survey No. 557 1. •t • t- FILED 23 Jp '1978 J..." o' C eV Q r Roe#., W: ~RRtttlt ~ ~ ~ ~ z V • .j h LAI z N N J 5a 3 0£ Zbo00 S 6Z '03S 3 ~ 1 £ a~ ,bl'obZ 0/13N 3NIl 1SV3 N 006W `UF \T'P c~Q~~ N b P ~ v U (j O -\O v~Ji eQ A,0£,Zba00 S ~ Qe . s Q p ro co h: S 5 v m r~ O~Q o ~,O N v) l0 M G r~ W (r 3 a W St = N Q 0) - bl'ObZ' _J qq N 04 ' o: 4. N 2: z ~ V W 3 U' ~l'r ~•r IM t~ ~ Z W W (N~ Q C1 QW j: to az Q fA M b, y W M o V z o m W N fa Z z p = - J - bl'ObZ a 3 „0£ Zb 000 S z LL: ' lid z ~ - MOO 80 0ION MM A-W31SV3 ' . _ _ - 9L' 106 - _ _ .d.••.•~MM a M„OZ,Obo00 N -6Z '03S - 3N-3N 3N1'1 1S3M W QRRIi'~~1~ ' ~ z 1 ~ W Q Z. z z Sheet 1 of '2 sheets J: { r r~ 9 S T C - 105 r a a H SEPTIC TANK MAINTENANCE AGREEMENT a St. Croix County z d _ a OWNER/BUYER ~1 l.TAa% Y t1~ LEIZ 1 ROUTE/BOX NUMBER 80+h /RUC Fire Number 10 d23 CITY/STATEk~LgEk) r6WN5~~ ZIP PROPERTY LOCATION:~k, N E k, Section 'O T 7.9 N, R_18 W, Town of WAULEiV , St. Croix County, Vol. MAPS AN PA6eeB 5,5 -1 C 61ET „S 141"It # 5 3 7 3 Subdivision Lot number 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 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. Ho I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- rv ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE 7- ~Z 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. CrO55 IYIOX c aC " fin c , -1, ~ 4 ~ } To or- 0 ti G o G G c. Y" ID C r4~. ter-~x. ~~t~~~'c • f 6791) Garry f Penn Y Bartl rw REPT131 WARREN. ST. CROIX COUNTY ZONING PAGE 1 09/21/92 10:20 REQUESTS FOR INSPECTION WORK SHEETS FOR: 9/22/92 AREA: MJ .-A~tivity: A9200251 9/22/92 Type: CONVSEPT Status: PENDING Constr: e Address: WARREN 29.29.18.445D,NE,NE,LOT 3, 80TH AVE. Parcel: 042-1078-40-000 Occ: Use: Description: 171487 Applicant: BUTLER, GARY D & PENNY D Phone: Owner: BUTLER, GARY D & PENNY D Phone: Contractor: STEINER, PAUL CJ Phone: Inspection Request Information..... Requestor: STEINER, PAUL Phone: Req Time: 11:09 Comments : l CJa ~ Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION Inspection History..... 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