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HomeMy WebLinkAbout036-1073-70-000 j 2 \ ¢ : ( « » { ; A 0 cc a @ - A ]n \ 22 � \% � rr § Q a � =2q k { \ C, E LL_ 0 $ CL Q) 2 � e = E � E J � 8/ k n / \ ; % � ± , c') § % a ■ E E § k 3 \ ) U) § k / E e 2 . r Cl) / 7 $ � or f ) q 0 co k \ k \ k . m : k CL ) / § % 2 D 0 \ § k k. d o o o z a a IL \ 0 U) . Q k \ 7 k $ kk ® _ ° : E _ u / § co 7 % £ J ¥ o © _ ° ; 2 \ ) c = a§% L ma ,Cl) E/ : 2 @ [ & 2 Q o c') L w E _ 12 @ Cl) (D Z 2 f 2 § \ k $ [ 0 2 $ / z \ l $ z ) f $ m : ) � " IL » 0 B k ( § k o u a ■ ; o u Parcel #: 036-1073-70-000 07/05/2006 11:10 AM PAGE 1 OF 1 Alt. Parcel#: 30.31.17.463D 036-TOWN OF STANTON Current IX, ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-MUZZY, DANIEL A&PATRICIA L DANIEL A&PATRICIA L MUZZY 1889 W CTY RD C2 ROSEVILLE MN 55113 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.310 Plat: N/A-NOT AVAILABLE SEC 30 T31N R17W.31A PART SW SW COM Block/Condo Bldg: 1111'E OF SW COR E 85', N 160',W 85', S160'TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 30-31N-17W Notes: Parcel History: Date Doc# Vol/Page Type 01/14/2004 751505 2491/290 WD 12/05/2000 634758 1564/594 WD 07/23/1997 831/633 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.310 10,000 110,900 120,900 NO Totals for 2006: General Property 0.310 10,000 110,900 120,900 Woodland 0.000 0 0 Totals for 2005: General Property 0.310 10,000 110,900 120,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP , ��2,L SEC. T ��N-R� W ADDRESS CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 0 r7 Les t � �f TRDIUATE-NOR BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: (�i Proposed slope at site: SEPTIC TANK: Manufacturer: - Liquid Capacity: / Number of rings used: Tank manhole cover elevation: z o Tank Inlet Elevation:jk'-,'d/- Tank Outlet Elevation: �g --r 1 Number of feet from nearest Road: Front,SideoRear, O / feet From nearest property line Front,0Side,f N�%Rear,O - feet Number of feet from: well - , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) i PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: �_ Trench: Width:— Length: Number of Lines: �- Area Built:.""-Z,� Fill depth to top of pipe: c /I 0 Number of feet from nearest property line: Front, O Side, O Rear, Pt .� Number of feet from well: i Number of feet from building: (, (Include distances on plot plan). SEEPAGE PIT i Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: ��-� �-Q0 Plumber on job: License Number: 3/84:mj \ l C7 9"e MEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUIOAN RELATIONS DIVISION P.O.-BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: SW! ,SGI%,S30,T31N-R17W )ff] CONVENTIONAL ❑ ALTERATIVE If assigned) Town a4 Stanton ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound VNWE CWVERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: WaUen White Route 4 New Richmond wI 54017 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Cabin Poweu Jn. 1563 St. Cna�.x 119372 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES [:1 No ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES ❑NO NEAREST---*I DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST—♦ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: LIQUID BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER PIT INSIDE DIA.: #PITS: DEPTH: TRENCHES: MATERIAL: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE I DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET: NEAREST�� MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER I TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO El YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST—� III Sketch System on Retain in county file for audit. Reverse$ide. SIGNATURE: TITLE: Zav►i ng Adm�wista tan SBD-6710(R.06/88) SANITARY PERMIT APPLICATION COUNTY � DILHR In accord with ILHR 83.05,Wis.Adm.Code ��� x STATE SANITARY PERMIT# ) -Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUM ER 8%x 11 inches in size. -See reverse side for instructions for completing this application. PETITION ((��{{ 1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑YES L/�,I NO PROPERTY O NER PROPERTY LOCATION (,J'lll '/ 5XI 4, S T—?/, N, R / E(orXg PROPERTY OWNER'S MAILING ADDRESS LOT NU ER BLOCK MBER SUBDIV ION NAME CITY, ZIP CODE PHONE NUMBER CITY NEARE ROAD,LAKE R LANDMARK VILLAGE 11. TYPE OF BUIL ING OR USE SERVED: f/ Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. ❑ New b.[0 Replacement c. ❑ Replacement of d.❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## ,Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. 0 Conventional b. ❑Alternative C. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. 9 Seepage Bed b. ❑seepage Trench c. ❑seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Za—t PP Feet ®Private El Joint ❑ Public VI. TANK CAPACITY Site in ga ons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑El Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation oyle ivate sewage system shown on the attached plans. Plumb is ame(Prin Plu er's igna re:( a s) MP/MPRSW No.: Business Phone Number: Plum be Address(St r t,City, Zip Code. Name of Des' ner: VII . SOIL TEST INFORMATION Certifie Soi Tester(CS Name CST# 7 Zx,� J CST s D S(S et,CiZ11,,,1ipCode) Phone Numb: IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature(No Stamps) FV Approved F1 Owner Given Initial S/urchar is.-y�� E-9,—ge � LPL N/y, Adverse Determination �C�Df o^� W X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERM_ IT "! APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. -------------------------------------------------------------------------------------------------------------------------'------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground included the creation of surcharges (fees) for a number of regulated practices which Wisco i61. can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried irfc'3StpQ: ° is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, ' ..:........::. it's worth protecting. SBD-6398(R.03/86) '014 1 r c s'o 6 Occ, L) b L�a c� i i Lj PAGE OF Fre6h Air Inlets And Obcervallon Pipe n Approved Vent Cap Minimum 12"Above Final Grade 20-42"Above Pipe _4"Cast Iron To Final Grade Vent Pipe Marsh May Or Synthetic Covering Yin 2"Aggregate Over Plpe Pips ion —Tee pipe '� 0 0 0 0 0 6"Aggregate o Perforated Pipe Below Beneath Pipe o —Coupling Terminating At Bottom 01 System �ru(�o5e1J ticJ•- ` ton SOIL FILL DISTRIBUTIOF.1 PIPE APPP•OVEO S'jWr4ETIC COVER ° —/IATt+Ftll�t OP. 9" OF S?RAW Z"OF MCAEGATE —�' c OR MARSH NA"J n o a (o OF 12 -21/Z' AGGREGATE 9 �� ELEV OF FEF-T----- " _ t DISTRIBUTION PIPE TO BF: AT LEAST INCHES BELOW ORIGIAIAL GRADE ANU AT LEASTIO INCHES BUT KIO MORE THAfJ H2 IUCNES BELOW FINAL GRADE MAXIMUM WN OF EXCAVATIOP FROM Oil WAL 6KAK WILL BE .-So IAICHES MINIMUM ®rPT-H OF EAEAVATIOW FPOPR 0�16114AL GRADE WILL BE _ INCHES 51GAIE0: LICENSE DUMBER: �S ��// i DATE : ZZ:J � �y' 110 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY,+. DIVISION LABOR AND, PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (H63.0911) &Chapter 145.045) LOCATION:- SECTION: /� TOWNSHIP/MU ICIPALITY: LOT O.:BLK. O.: SUBDIVI ON NAME: SA 1 '/4//4 H ( r CO NTY: OWNER'S/BUYER'S N MAI LI NG ADDRESS: USE DATES OBSERVATION ADE NO.BEDRMS.: COMMERCI L DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 ❑New Replace I ��✓/ "0 /1_ r RATING:S=Site suitable for system U=Site unsuitable for system r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK:RECOMMENDED SYSTEM:(optional) S ou AS ❑u ®$ ❑u ❑S u ❑SK 29 � If Percolation Tests are NOT require DESIGN ATE: If any portion of the tested area is in the under s.H63.09(5)(b),indicate: I I Floodplain,indicate Floodplain elevation: _Id/ PROFILE DESCRIPTIONS BORING TOTAL^ DEPTH TO GROUNDWATER-INCHES CHARACTER OF IL W HICKN SS,COL TEXTURE, AND DEPTH NUMBER DEPTH A ELEVATION OBSERVED ST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B- 7 B-,? B- B- B- _ PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IIUCUE-6 AFTERSWELLING INTERVAL-MIN. PERT D j —PERICID2 PER PER INCH P- P P 7 P P- P- _ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION ,'" I I _. _.3 i z I € € V l' 1 € j J I ! ......[...._..__C_.__,...,s...,_.....L..._......__..,___.1_. ._...a_. ', ...._a . ..._._...i.... I,the undersigned,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 the location of the tests are correct to the best of my knowledge and belief. NAM rint)• TESTS WERE COMPLETED ON: _ for/ AD CERTIFICATION NUMBER: PHONE NUMBER(optional): CST S AT RE: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395 (R.02/82) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - S - 5395 To be a complete and accurate soil test,your report mint irrclude: 1. Complete legal description; 2. The use section.must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; S, Complete the suitability rating boxes, A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; E. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan, re MAKE A LEGIBLE diagram accurately Ioca'tinj your test locations. Drawing to scales is preferred. A separate sheet may be used if desired; B. Make sure your benchmark and vertical elevation reference point are clearly shown,acrd area peirnanent; 3. Complete all apps opriate boxes as to dates,names,addresses, flood plain data, percolation test exemp- lion, if appropriate; 10., If the, information )such as flood plain, elevation)does not apply, place N,A.in the app owiate box; 11, Sian the form and place your current address and your certification number, 12. !Me[<(, legible copies and distribute as re(luired. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY kNITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st -_ Siorir, iovor ?0„) EAR - Bedrock cols, _ Cutrtsle (3 10") SS - Sandstone gr - Gravel (under 3") LS Limestone S Sand tICaVV - High Grounciw ter cs _ Coar,r= Swid Pere, Percolation Rate rned s rt E:;cliurn.. Saran l°d .._ -'!V i IS.---- i ,e Sarrd i,,ilding 1, - Loamy Sand v> - Greater Than »sl __ Sand L y oan, < _. L,eSS TIra1? l Loa Bn - Brow, 'ssI 3i t L-oaffr BI B?ac; Silt G G> a el 'Clay Luan-r ,t, _ Yeilovv sc;l Sandy Clay Loarn R - Red s i ci - :silty Clay Loam mot - Mottles Sa=rdy Clay 'vrv' vv; t S,c -- Silty Clay fif - fs�v. ' litre, faint C, Clay cr _.. (.III-Mir-non, coarse- p Feat mrn - I`4lar-iy, rnediurn rn' -. Muck d - distinct p prormmrnt Ht>`tiL - High water level, Six genera! sail t f:xxures surface water for liquid waste disposal BM - Bench Mark VRP - Vertical Refere.nce Point TO THE OWNER: This soil test report is the first step in securlrrcd a sanitary permit, The county or the Department may request verification of this soil test in the field prior to permit. issuance. A complete set of plans for the private sewage systen, and a permit application must be submitted to the appropriate local authority in order to Blain a permit, Thee sanitary Permit mess'be obtained and pasted prior to the start of any cc>rastructi:r€t. :G N -1 9 r STC - 105 t" a H SEPTIC TANK MAINTENANCE AGREEMENT o St . Croix County z v a OWNER/B U Y E R ( _ 6-„ ROUTE/BOX NUMBER l` Q Fire Number CITY/STATE ZIP PROPERTY LOCATION : 14, 5;014, Section �, T ,�N , R_Z2W, Town of �—f! yll� 3'� , St . Croix County , Subdivision Lot number Improper use and maintenance of your septic system could result in i its premature failure to handle wastes . Proper maintenance con- I sists of pumping out the septic tank every three years or sooner , I 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 H three year expiration . o E I/WE, the undersigned , have read the above requirements and agree C, to maintain the private sewage disposal system in accordance with H the standards set forth , herein , as set by the Wisconsin Depart- 'v 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 . SICNED�.J.� DATE 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 . APPLICATION FOR SAN T I ARY PERMIT STC - 100 his application form is to be completed in full and signdd by the owner(s) of the roperty being developed. Any inadequacies will only result in delays of the permit ssuance. Should this development be intended for resale by owner/contractor, ("spec ouse"), then a second form should be retained and completed when the property is old and submitted to this office with the appropriate deed recording. er of Property Location of Property 5 63 k ��k, Section N-R _L2 W Tovmship Meiling Address BIZ i;,'Yt ,(L1a ­Ivmr�cl Lsr� c Address of Site (Q� Subdivision Name Lot !lumber Previous Amer of property b �' $ Total Site of Parcel .�a Date Parcel was Created q CJ 7 Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) 7 Yes _� No Volume --t.3'__ and 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, 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 refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (WO cvQA6y that at t Statementh on thus 0AM ahe thus es to Vie but o6 my (om) hncwtedge; that 1 (we) am (ahe) the ownen(.5) 06 the pnopehty de�scAi.bed in th a in6olmaLion 6o4m, by viAtue o6 a waAAanty deed neconded in the 066.ice o6 the Cotinty RegiAten o6 DeedS as Document No. $/ / and that I (Gle) p4U ratty c.un I- pRopoaed a-i to bon .tile Sewage di6spo.& a ya em (on I (we) have obtained an sou ement, to kun with ,tile above deA chibed pnopen ty, 6oh the eonathuc t i.on o6 said eyet", and the aa,,,e has been duty neconded to the 066.iee o6 the County Reg.i.atelc o6 Uttde, ae Oocwnen.t No. SIGNATURE Of OWNER SIGNATURE OF Co-0 (IF APPLICABLE) DATE SIGNED DATE SIGNED 3 n P s � e ,tti P.11 r � � IY DtED.Rade Nt�ea Z. 1s15 S'LQ@�d :�;. _j" teffifts. Q ft" pusaff V�7 a 01 Grantee. �iltla ►sth, That the said Creator.for a valuable consideratim e the following dasaAed wd estate is St-_QMZ ' 11�►. ►e�:�b>lccoasia: 1� 'T , j -` Tax Key W 85 filet of the vnt n96 fist of t im South 160 _ * 8t§+dt d* A% of SectLm 30-31-17. � A .maps a gib, r�wtiroft, ri,�loks 7 propeefy. \ � ! * ~a ft bereditamems asd oppatteaaaces tberea sto bohnisd;'. i ° Mr in fee sisiple and free and clear of enessbaaoga awe+pt Al T k Y Y *W"4 4 the antes. &y of } ' (SEAL) (SEAL) .i VTOINTICATIO� ted ACKHON6t @dfltNT irt°ttl stica this _ day of STATE OF W19CONS1lf ' Coasty. Personally case before srs,tbis .�„t — the above son" V, ST710L BAR OF WISCONSIN by 4 M6.06, Wis. Stats.) we*draNsr!by ised me. 3� x 13111iG�""iaSe Of adatcwMd6ed. Imn 211 Not fW t;t ar" * MI111 44 ''k:;� AQ r ST. CROIX COUNTY WISCONSIN ZONING OFFICE 4 4 x x a u e n■ moveb ST. CROIX COUNTY GOVERNMENT CENTER �. _ 1101 Carmichael Road .:;. _— Hudson, WI 54016-7710 (715) 386-4680 October 13 , 1994 Aurora Residential 110 South Green New Richmond, Wisconsin 54017 ATTN: Eric RE: Septic System for Walter White Town of Stanton, St. Croix County, Wisconsin Dear Eric: Per your recent request, enclosed is a copy of the Inspection Report and Plat Plan with regard to Walter White's septic system. This property is located in the SW; of the SW-'4 of Section 30, T31N- R17W, Town of Stanton, St. Croix County, Wisconsin. If there is anything else that you need, please do not hesitate in contacting our office. VeZesK. rely, Ja Thompso A ssistant Zoning Administrator mz Enclosure eF