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HomeMy WebLinkAbout020-1034-10-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner ~co.T -~.¢f¢~ ~'rJ Address °18 ~ P~ ~ , 1,,4,,, ~ City/State ~,,,~o„~ r.~ , ,s~'~t Legal Description: Lot Block Subdivision/CSM # '/+ '/. ,.Sec. , T N-R W, Town of _ Dso~cl PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer _w,~s~ Size ST/PC/~/ -- Setback from: House ~ Well /o~' P/L /f~' Pump manufacturer Model Alarm location f- (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: ~--,~ F~ ~ mgr-rb~ Type of system: ~a~U ~ ~ Width `3 ~ Length 3 ~ . S ` Number of Trenches 3 Setback from: House ioo~ Well ~~~~ p/j, ~~` Vent to fresh air intake i~3 S' ELEVATIONS: Description of benchmark ~~.c.. ~~ ~.fPGt a.c << ~c~s Elevation /r~o . °~ Description of alternate benchmark ~ti„s~.~ ~`,~ ,c~~`~ ~~ v~L Elevation Building Sewer /o ~- 73 ST/1~iT Inlet /OG ./i ' ST Outlet %f~ ~• 1S'S ~ PC Inlet ~-- PC Bottom Header/Manifold - Top of ST/PC Manhole Cover /D'7• ~! () Distribution Lines () ( ) Bottom of System (,~) °/ 7. ~r~' (~) q.~, o~ r (y g r~ . o~' Final Grade O /off . 6S ` O /oy. ham' O ~ c~ .,~~ Date of installation / -daa'Permit tuber 3S 37 ~ ~ State plan number Plumber's signature License number Inspector ~2 y~ S`7 Date l/1 /ov ('ompletc plot plan R ~' (,J~S'~ O~JO~ ~.,,~~- NOTICE: Please provide the following: A plan view sketch showing everything within 100 feet of the system. Two horizontal reference points to center of septic tank manhole cover. r • Show alternate henrhmark if annlirahlP ~Wisconstri Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)l. Permit Holder's Name: ^ City ^ Village ^ Town o Hudson Township CST BM lev.; Insp. BM Elev.: BM Description: 0 U UV h t- rv TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ S /' 0 06 Dosing Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intak ROAD Septic 7 ~-~~ ~~ gyp' 2 0 ~ Z ~ ~L NA Dosing - N _..~_. A Holding PUMP /SIPHON INFORMATION facturer Demand Model Number _ '- G TDH U#t" Lriction tem TDH Ft ~cemain Length Dia. Dist. To ELEVATION DATA County: St. Croix Sanitary Permit No.: 353289 State Plan ID No.: Parcel Tax No.: 020-1034-10-000 STATION BS HI FS ELEV. Benchmark Z, e L 2, o U p Alt. BM d , Bldg. Sewer 2.9L ~ (e ~./ Ht Inlet ~ ~}/ Ht Outlet ~' ~Z ~ • Z 0 om Header/Man. ~;'~6 Q~• 2 ~ Dist. Pipe ~ T z r? ;~ a 9~" Z Bot. System T r M rZ ~. r .o ~s-•~ , . . ~ / Final Grade r /~~ 9 ~ ~6~- D.~ St cover ~{. 2 /o SOIL ABSQRPTION SYSTEM G ,/. ./_~, o„ ,,.L BED / REN H Width / Len th _ No. C3Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 3 ~ DIMEN I SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manu ctu er: SETBACK ~' M N M INFORMATION TypeO I~ US -f , --~OU .F ~ ~~D ~ um er: o a ' System: (/„~,d S , ~, DISTRIBUTION SYSTEM Header /Manifold ~~ Length ~~ Dia Distribution Pipe(s) Length' r Dia. ~ Spacing 6~ ~ ~ x Hole Size /,~ x Hole Spacing Vent To Air Intake 7 ~ S r 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.) Inspection #1: ~' / ~I /bo Inspection #2: / / Location: 981 Priester Lane, Hudson, WI 54016 (SW 1/4 NW 1/4 17 T29N R19W) - 17.29.19.147A -Lot 1 1.) Alt BM Description = ~h ~ s~ ~~/ c' ~,c~ ~~a ~r 3.~ ~, bey S ~ ~~ ~~" ~ ~' ~, cr 2.) Bldg sewer length = ~ o' -amount of cover = > 3 ' / / c(~¢anu~ u~¢ S ~ r'a Ce~ dccl`sc`cale f~~ c(~•~,.,,,~ -~aus~ Plan revision required? ^ Yes I~-No Use other side for additional inform7at`ion. aQ ~ SBD-6710 (R.3/97) Da a Inspector's nature Cert. No. ~I i ~~ ~'~°"""-~- ~" Cam, ~~K ~~~ g~~~~~e~ /D>J ~. L~J ~- k~6 ~2E ~ sT~~ • 8~ ~ ~~r ~`~ Pei ~o ~ ~`, ~,c~,~ ,, ~ ~ 3R~sra~^'~ 63 ~ ~2~,Posto ~ ~ as ~ ~~. ~ ci3 ~~ s~ ~, • 3~ s ~_ ~oak~ !,1 ,?d • of S~ ~lic/f ~D 'Srw~7 h2 (n/E57 /c?O~C/1'~/L,iNE ~D~ vF~~SOQ 3S 3as5/~/~ _~~ ' 3 ~~/~ (?DOrr I ~CitrlEc /•~So lofc . = - I:' ` ~G.{' • S _ 3/ • $ ~. G ~ oQ /8 I i~ .:. ~/~l>'//~cg1~5 0/~ 3 Q~ c N e5 ' w rT/f li l/~rI~~PS ~~ ~ = 37 • S" .• PLOT ~ CROdd dECT10N PL/1N8 W'i'A 6ROd. EKC/-YATNrh INC PLUM81N0 uMT .. . ~~ .. " PFiQIECT co ~ ~~ r`i5 L^fio~ ~ s~ ~/ ~ L,2a.,-t C~~ ~~w hv~ ~~~ ~+ ~uT+~l PRo~PTr ~~~E E N VT ~/nJ~ . Yr w ~~~ E Y CALK ~~ (iEv..~ of L~.~.~~e - VET r~' C~gSE'QJ,~T~cKI ~i~L~ iAPVRovFa vEN-r C.FO ~rbc, ~~~,M i.?" q,g~,iF ~.~~ SN 6Q,~~o~ FNrSN G•P.agt - ~ " AlC Sc N Yo VENT Pr PE M~~c, M4~ 40" Amv.~ ~~~r~ To f/ N I S H ~4,~DE 810t~D: ucerrde: 22 ~ r7 5 i ~' ' , 8q1 TEBXiNq 0Y: i `' side View FEE ~A7Yo,J T Etc H Ega iro-.•. ~EQ so, c Ttsr End View T! ~s i S1o£w«IDER J-~,aN ~A~Ac~-ry~ 15° _ s4• J t Safety and Buildings Division c c SANITARY PERMIT APPLICATION 20, E. Washington Ave. ` 1S~~~S,~ In accord with ILHR 83.05, W od P.O. Box 7969 Department of Commerce ~ ! ~ ~ Madison, WI 53707 7969 ~ ~.:.-.._.~w. z r ~ ~ Attach complete plans (to the county copy only) for the sy ~~;dn pa&&~~er n~t I~ unty than 8 vi x.11 inches in size. ` l''F`-, ~ S CQ~ 1 '~ rr- • See reverse side for instructions for completing this app ca~on r `~ ~® Sta Sanitary Permit Number ~~ e~ .r _.1 r ~ ~ ~ 3 X81 The information you provide may be used by other government agency pr grains ,5 /. ~~ P ;,~„ ~~ eck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. }. Cn(~ ~',; ~ r^.. ~7(~.h. ~.^f+ Plan 1 rl N,~mhnr I. APPLI ATION INF RMATI N -PLEASE PRINT AL ~~ ' `" ~'I(A"" ON I Property Owner Name , ~ofiT .z Ell ~ Prop ,LOCat~ijn % t[a .~f "• ;,~I ~ / rj T a~J , N, R /Q E (or~ Property Owner's Mailing Address m er j Block Number _._ /F oi.vT /~O ' City, State Zip Code -Phone Number Subdivision Name or SM Number II. TYPE F B ILDING: (check one) ^ State Owned ~ ^ 'ty ^ Village Nearest Roa/d~ Q Public 1 or 2 Famil Dwellin - No. of bedrooms /`~GA~S~CI own of ~?Nrr3,PDO/r nD. Parcel Tax Number(s) III. BUILDING USE: (If building type is public, check allthat apply) 7. ~, / f, f ~~ pay- l03~_ /p,oov 1 ^ Apartment /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 box on line A. Check box online B, if applicable) A) 1. ICY New 2• ^ Replacement 3. ^ Replacement of 4_ ^ Reconnection of 5. ^ Repair of an ______System ________System_____________TankOnly______________ Existing System ________ ExlstingSystem B) ^ A Sanitary Permit was previously issued. Permit Number 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 12~5eepage Trench 22 ^ In-Ground Pressure 42 ^ Pit Privy 13 ^ Seepage Pit 43 ^ Vault;Privy 14 ^ System-In-Fill ~~G'/1,TQ,¢TraPS ~Q~ VI. ABSORPTION SYSTEM INFORMATIO 7. 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) cr~ a,p ~ Elevation ~~'O " ~ Feet /O!. g Feet ~~ , 5 ~7.?. - ~ ~~ ~'agT VII. TANK INFORMATION Capaat in allot s g Total l # of k Manufacturer s Name Prefab. Site Con- l St Fiber- Plastic Exper. N i E i Ga lons Tan s Concrete ee glass App ew st n x strutted Tanks T nks Septic Tank or Holding Tank /cr~t7 /~ ~ I.JiC„-S~ ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plum 's gnat N t ps) MP/MPRSW No.: Business Phone Number: ~ihP/~ ~T~~•nJ/(c= ~~~/~`j5'7 ~liS- 3~sa ~ o?~fSo Plumber's Address (Street, City, State, Zip Code): e~'~ ~ / ~ cJS . SIG . "ST /~ ~SorJ L// S5 l?/S O/ ~~if{ / IX. COUNTY /DEPARTMENT USE ONLY roved ^ Disapproved Gi i S itary Permit Fee (1ncludesGroundwater Surcharge Fee) ate slue Issuin Agent Sign re (No Stamps) pp ^ Owner ven In tial ~s s ~ ~'I(` Adverse Determination X. CONDITI S OF P ROVA ! RE SON F R D SgPPR VAL: , - ~1 ]~ '~'~ UuC/ ~t.r. ,3 a,~y-a., '~ C~~OUM. a~~ao~,ua~~X.. CotJe~ aLQ ~hti G SBD-6398 (8.11/96) DISTRIBUTION: Original to County, One copy To: Safety 6 Buildings Division, Owner, %umber INSTRUCTIONS ~ z' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a 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 priorto 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. . F. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-315f. To be complete and accurate this sanitary permit application must include: I. 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 on 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. V1. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/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 1/2 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 1 15 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. he monies collected through these surcharges are used for monitoring groundwater contamination investigations nd establishment of standards. '~ - _ .. „.,_, .., ~„~ :, . ~. ~-~~~ sti ~ EiS~~R Pa g~ ,~ ~ ~ • ~ ~` ~ ~ r 'PLOT ~ CROSi SECTION FLAWS ' ~R~! f~ `~ />7 ®. oo' ZAPPA BROS. EKCAYATINIi INC ~y~v ~ ~ ~ '~~;L _ F!LUJv~INO UNT .. . b~ 1 ' ~ ~i,,~S ,St,opf ~~~ g3~ ~i r'~ ~o ~~ J' tvfsT" O,p~B~~l rY ~/N~ ~ •,. OS~ ~ Q~51Dt!-1Lf i .. PfiO~CT s "~ ,~7sTZP~/hu` oKr~r Rv s o.e~ w ~ cc.J ~p/W rT'f ~'t>vc H~ SYs'r~ /~•_ ~0~05~ I ~$- ---~ QQ~~ " SN~O rV~ ~WE! ~/Nf -~ ,ooo ~~ , c..~,esc~P s~~/~ . y" Saps 3~, EfFH~£~ ~• c ~~/L~i4'ry~ ~/'t ~ N r s ~ ,; hL F yso~„t~ . . ~ . s~~.s --- 31 ~7. ~9 m~ 18 ~j,E,,.~ mt-~~ih,idtQ - V~~ ~' C~BsE~I^Tro~l ~,o~ ,. ViT E /~o ~ scALE i ucel~e• ~? ~/7 ~~ DATE: ~ ' /~ •~ OO . eaL Tlee~tNq ev: ~/ " ac S~ -+ y~ ~~NT P~ PE n finliSlt ~ o,/pE e View Fr E ~gTiu.J 7~E arc 11 ,Cgo pro-.. >°EQ Sa, c TLS7 End View T 16' ,~ ._ I~ ~ ~~ C t5° r ~ ~ ~' ~ ' E~~ _ ~ oo' ~-: ~ 34. .~ -- 7S" ----~I Sr nE ~•- ~ ~r Usk ~ +'4H ~APAC /T'I /~v f~E t . A..n.. ~- __. vtNT L~tO L. /•cl E N .~ ,^.~ Wiscs~r~in Department of Industry, Labor and Human Relations Division of Safety 8 Buildings SOIL AND SITE EVALUATION REPORT _ Page~of,~ ...J ...:aL ~~ ~ In nn nr \A/:.. AJ..~. f.....1.. . ~~~ NVVV~V ••Illl ~~~ ~~ . VV.V V, •~V. /.V~~~. VVVV but ~ ~, Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must include v. 'r. "~, ,S ~~~~~ ~ ~~ , . ~~ '~ ` ~-' not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or ~ ~ PA CEt_J.D ~#,; ° ~., L... dimensioned, north arrow, and location and distance to nearest road. " ` =T ; ..,: APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION !~ [ ~` ur£WEDBY - ..._ DATE I- ll-~ PROPERTY OWNER: PROPERTY LOCATIO ~:: a t~ ~` .~ fie ..t.. q.",N`L ~ ` ? ~ ~ ~ k ~, ; 6 GOVT. LOT 1/ 1/4;$ ~ ~ ~ , ~ E ( PROPERTY OWNER':S (LING ADDRESS LOT # BLOCK# SUB ;,IV \ l 2 P ~.S-/ CI ,STATE ZIP CODE PHONE NUMB R ^CITY ^VILLAGE MOWN NEAREST ROAD [~j New Construction Use [~] Residential ! Number of bedrooms 3 [ ]Addition to existing building j ]Replacement [ ] Public or commeraal desaibe Code derived daily flow ~,~ gpd Recommended design loading rate 1Zbed, gpd/ft2~~trench, gpd/ft2 Absorption area required 6y3 bed, ft2 ~.3 trench, ft2 Maximum design loading rate ~~bed, gpd/ft2~,~trench, gpd/ft2 Recommended infiltration surface elevation(s) #/~ 5/ -- ~,.5 ft (as referred to site plan benchmark) Additional design /site considerations ~~ EC1~ Grp/$'~G !~ /g3 SArir1L/_fX,t~ r¢S ~/~olSlii'/~~ Parent material -"-"-'"` Flood plain elevation, if applicable --- ft S = SUltable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN -FILL HOLDING TANK U=Unsuitablefors stem ~S ^U ^S ~[7U S ^U ^S f~U ^S (~U ^S U -SOIL DESCRIPTION REPORT Boring # <~ ":~~~ /uti: :::~:+~'• •: /AJi~~~~~~~ Ground elev. ,~ft. Depth to limiting factor Boring # 44,~:~:;}}}~:.:.t}: ~i.• ...- ••.y ~ l- }\~, ~~:~ ;. i%4r-0:::::::::>. ~ .~~:iii: ~~3. Ground elev. ~~ fZft. Depth to limiting factor T1 i H Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft or zon in. Munsell tDu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trench / / / r~ V ! V 2 2. "- '- S' S . ~ 3 -7 S ~ r a. '`~ S 0 ~ - . 8 e~o cfD.t3~ .~ GY: ~ l . f3 Remarks: _c -- S L 8 o. Z .~'- ---- ..._- m . } 0. L Remarks: CST Name:-Please Print Phone: ~~~, o~~. ~ ~ ,c o, ~o ~ ~~o -~3 Signature: 1 r) Date: CST Number: PROPERTY OWNER~pLfC ~'~/Ylh~fs~ SOIL DESCRIPTION REPORT Page~~f~o PARCELLD.# Boring # ~:..: :: 3 ::. / , 7 j. c Ground elev. ~~~ ft. Depth to limiting factor ~ ~. Boring # r.~:::.::.:;:: y :_~':?.. r`~~ Ground elev. /02./ ft. Depth to limiting factq(,, ~~ Boring # :.::.: ;: 4 C Ground elev. ~_ ft. Depth to limiting factor Boring # .4~'..:::: n~j{i: v'~ ..4. ~` Ground elev. ft. Depth to limiting factor Depth Dominant Color Mottles Texture Structure Consistence Boundar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Treridi z- - z >' - 3 -- s ©s'~ L - ~. 6 z • `( S°. ~l~ . S~ Remarks: Z 3- 7 .3 - -- S o s 1Y! L ~' 7~- ~ 2• - 3 "--- s ~ L -'- - ~~• Z .2 Remarks: #'3 Qtl~'Iz. L~ti /3~ S~irlD{ "'/moo ~dI¢/~ i9~-'/~ S~6D~ ~oittf~/~1~1~ I o -- ~ LS © ~ L ' . ~ s •s -- 3 S o ~ L -- - . ~ Remarks: r# ~ Dlf.~'~c~,,~~~1~ s/~i/!~~ ''- /07~ LOrl~iylT,fcvwt'7.~i~i5 ~tv~~i9cT,c.•!~ 9 ~ 3 0 ,E~t/ L~ w ~ ~ I v€ .~ 6tT ~t/ Remarks: SBD-8330(8.05/92) .,, Vv ~ ~ ~a ~ ~ o qr ~~ ~' ~' ~ ~~ ~ ~" ~ q ~ " u ~ rrnv 3 ~ n ~' ~. '\V M ~ ~ ~ 1 y 1 ~~ Z ~. $ ~~ ~~ ~- ~~p ~ ~~ ~ow~ ~,~ ~ l~- ~ ~Z~~~. N ~~ a ~ \~ ~ w ~r~.~~r~ ~- h ~` N ~~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer `~ <n ~1`~ ~i~~~'i E~ Mailing Address /~ ~n. ~T ~4 ~~y~o~ ~•~/ ~'~~ ~ Mgr ~ ' Lq~~ Property Address r 1 ~ S ~°_ (Verification required from Planning Department for new construction) City/State f~ AS ©.J ~J r ~yo~~ Parcel Identification Number ~ 020 - /d 3 ~ - ~~ ` ~ LEGAL DESCRIPTION . / Property Location ~~ '/4, N ~ '/4, Sec. /~7 . T amt N-R /9 W, Town of ~i+a S o~ Subdivision ,Lot # 1 (Certified Survey Map # 3 ~1a Sig ,Volume a ,Page # S i Warranty Deed # ~3 lQ 0.~7 .Volume l/ y~ .Page # a / ~ Spec house ^ yes ~ no Lot lines identifiable ^ yes ~no SYSTEM MAINTENANCE 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 a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da s of the three year expiration date. ,^SIGNATURE~ APPLIC DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of t~property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ^ i / 5 / 0~7 ~~~~~~ -; SIGNATURE OF APPLI~ DATE :%~ _ ** *~•~on that is mi resented may result in the sanitary pem~it being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Stat ~ Bar ~t Wisconsin Form 2 -- 1482 • 5i~6o2"1 wARR.~NTV nF~D DOCUMENT NO. i~ ~~~~ 1148PAG~ 21~ _ _ _ ._ _ ,1 ___ ____ - __. ___ _. __ .._ __ __ _ Paul Kramer a/k/a Paul ,7. xramer - ---- com~eys and warrants to . SCOCt_ A._za}lY'efl __~___~__ -_-__ the following describe) real estate in _ St CL41X __~ County, Mate of Wisconsin: it r. , ., ST ;'. ~.. F' - -;d~ NOV 8 :99;i :C 8:30 A. ' r r-~_ ~ '4~~__.i THiS SvACE 9E SERVEO rOR NfCONrnry6 DAiA -. _. _ - _ . ,. Ni'ME ANO RETURN AODRE S$/~ ~~' b tercel Identification Number) Part of NWl/4, Sec. 17-T29N-R19W described as folltaws: Lot 1 of Certified Survey Map recorded in Vol. 2 of Certified Survey '~.ps, page 451, as Doc. Nc-, 342588. Together with a private road easement for ic~-gress atnd egress as described in Grant of Easement recorded June 18, 1982, in Vol. fY3u8, page 103, as Doc. No. 378192. i t ~{~~ ,, TEis _ 1S nOt `homestead property. (is not) Dated this Exception to warranties: AUTHENTICATION Paul-Kramer Easements, restrictions and ruts-of-way of record, if any. Y~~ -~ day of _-_-- ember ~~. t4.95_ . (SEAL) ---.-- __-- ___. - _-_ ~__ _ EAL) . Paul Kr (SEAL) Signature(s) authenticated this ~~day of NOVP~7tber l9 95 Kristina 0 land T[TLE: MEMBER STATE BAR OF WISCONSIN (If not, ~ _ authorized by §706.06, Wis. Stats.) THIS 1NSTRUMEN7 WAS ORAiTEO 8Y Kristina 0 land -- --.--- Attorney at Law _ _ _ __ (Signatures may be authenticated or acknowledged. Both are not necessary) ACKNOWLEDGMENT STATE OF WECONSlN ss. --~ -------- County. PersonaHa ,came before me this (SEAL) day of 19~ the above named to me know' tw firc the person ~ who executed the foregoing inunrrment and acknowledge the same. Notary Pubiw: ,~__ Counn, Wis. My commis4ass is permanent. (tf not, state expiration date: ~ ~~- ,., ~ ~/' 9 10 ~~ 342~~~~ ~ FILlD ~ m ~s a oo~r~ ~~Mr a ~ ti CERTIFIED SURVEY MAP .~ " ,.,~.~""~ti NW. I/4- SEC. 17, T- 29-N, R- 19-W ~ ~ 109°-57'-21" Nw coR. AppROVED / ~o SEC• 17 " E P~~' " " 104°-16'-10" N T5o 26 '9~ / ~ j ~ P~'' i~PNOS~ AUG 17 1977 ~ a3i~ 'oa ~~ " // @,, o, ~p ST. CROIX COUNTY / ~ ~ ~~ WEST L 1 N ~REHfN51VE P~I(y pLAN~Q ; ~ ~/ 100°-15'-06" ~ D ZONING COMMflTEE \ s NW 1/4 ~' \~ LOT I ~ + ~ o= ' 1.31 A. N P~P~ ~ -os o 'LPN,- o O ` " Z / Grp .` ~ APPROVAL OF THIS MINOR SU8DIV1S1CiN / ~ / Off'. 09 a a" DOES NOT MEAN APPi~GY.+11 fOq ~ BUILDING SITE OR SEPTIC SYSTEM ~ ~ ~h REFER TO H62.2Q EXISTING ROAD M 5 EASEMENT OF M BEARINGS RECORDED RECORD ~"~ NORTH ALONG THE (AS NOW TRAVELED) ~~ WEST LINE - NW l/4 °, SEC . I T a`' EAST 90 0 'O ~ O~ = N ` 0 F- 0'~ ~ ~ ~, O O Z _ 1382.40' LEGEND O- 1"IRON PIPE FOUND ~. - CO. MON.-BERNTSEN CAP W I/4 SEC.17 SURVEYORS CERTIFICATES 10.0' S0' 25' O 100' SCALE ~ I e a 100 THIS INSTRUMENT DRAFTED BY G.C,S. 77 - 50 I, Gene C. Shaffer, Registered Land Surveyor, hereby certify that in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statues and Section ,5.4.2 of the St. Croix County Zoning Ordinance and under the direction of K.B. Priester, owner of said land, I have surveyed, divided and mapped said parcel of land, that such survey correctly represents all exterior boundaries and the subdivision of the land surveyed and that this land is located in the NW 1~4 of Section 17, T-29-N, R-19-W, Town of Hudson, St. Croix County, Wisconsin, further described as follows: Commencing at the W 1~4 corner of said Sec. 17, thence North along the West line of the NW 1~4 of said Sec. 17, 1044.29 feet; thence East, 1382.40 feet to the point of beginning of this description; thence N 00-17-14 W, 313.46 feet; thence N 75-26-36 E', 233.97 feet; thence S 34-30-45 E, 107.67 feet; thence S 45-14-09 W, 402.66 feet to the point of beginning. Above described parcel contains 1.31 acres and subject to easements of record over and through existing roads a.s now open and traveled. `~~~t~~~Nnt~gi t~, `yGQ/yS~I~y~ CERTIFICATE OF TOWN OF HUDSON: ~.j~~ /~y~ I, Lyle A. Baer, being the duly elected, ~~ I n+~al i fiarl nnrl nn+ir+o Tnrm ('l cr.4 .,P +hc