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HomeMy WebLinkAbout020-1120-30-000` W ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT ~ Owner ~/~-nl~D,(~~ f ~~Y ~Eiss LEA Property Address y~o ~R~~w~~ ,DPI vg" City/State 1y~c~s~-/ c.~~ S~vs~ _ Legal Description: Lot ~~ Block - Subdivision/CSM # /V c~ '/4 5~ 1/4, Sec. l? , T,~N-R/4 W, Town of PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer l~ ~{- Size ST/PC / Setback from: House Well P2 Pump manufacturer Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Meter location Alarm location SOIL ABSORPTION SYSTEM: ~~ic-~~~ Type of system:~i~~NcH Width ~• Length lv~ ~~ r Number of Trenches ~ Setback from: House ~_ Well //~' P/L /~~ Vent to fresh air intake $'~~ ELEVATIONS: Description of benchmark( 'a..,cR~ ~~~ ~®O~P Elevation l Oo. o a' Description of alternate benchmark Elevation Building Sewer ~~ ST/HT Inlet N ~' ST Outlet g~ • ~~ PC Inlet PC Bottom `'- Header/Manifold ~~• U ~ ~ Top of ST/PC Manhole Cover ~~ Sa Distribution Lines (f~) `~• ~~/ / (~) ~~ ~'~ ~ ( ) Bottom of System (~) ~5~ - ~~ ( (~3) S~ ~S ~ ( ) Final Grade (~}) /QO, oe7~ (rS) /~ ODD Date of installation l l r l l ~" l Permi num er State plan number Plumber's signature ` ~~~~~ =~cense number Inspector Model Vent to fresh air intake Water Line ~~ ~,/r/~~ Date / /© Complete plot plan a .; 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. • Show alternate benchmark, if applicable. PLAN VIEW _ - -- Q ~ 9s ao' G~ /8' r ~ d~,~ _ _ ~c w Svc. 3a3~ ~tJ~t a~vr L,.va - ' - ~ ~.c%s~~1 Tom? 'V~tL/€ O w ~-+ ~,o ~ SwszrM - - - - - 1 ~ ~,~ ~t~,, ,~~E~-f t ~t coo ~ icr~? AFS5u2PT~m.~ fi~iIAEA ~xisT~nlr. `JEOT~c T/bvK nvea? S~ /~-~p~,~ rJl~vfkc~ ~s ouch cx~-r1,~- ,J~~T ~°~ / \ .~ L,~.J~ ' ~ ' ~ ,. ~lcl~fi~lh? K - \ /%N i5 ffi ~LAa2 `i~•4~E ~ ~x ~ 5 ~~t/f~ 3 ~i'C2hro[ /,~ooR ~ /3cr~?opt /r~s,Qc~c~ ~~ ~ ~ .: iDd. oo' I ~_.__ Ex -s'ri ~ GrJ~ INDICATE NORTH Wisconsin Department of Commerce Safety and Buildings Division a GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) county: S . Cr ix Sanit~~Pg~it No.: State Plan ID No.: Parcel~~x l~)'20-30-000 Personal information you provice may t>e used for secondary purposes (Privacy Law,,ts.15.04 (1)(m)]. eiss~er Kando~pmlie~ ^ City ^~iu~Oi~o°wns~iip CST BM Elev.: Insp. BM Elev.: BMBM Den: n 6•D . O r 019 . ~ ` a~ = CS( `J~~ J-- TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ~ ~p~ ~(op' ^-25' -- NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer De nd Mode ber G M TDH Lift ridion System Ff TDH Ft Fort ain Length ~ist.To SOIL ABSORPTION SYSTEM ~ 1 ~ ~ ~~,,,,,~,~~s ,,~~ ..(~,~_ NC Width ~ Length No Of Trenches PIT No.Of Pits Inside Dia. Liquid Depth I EN I N 8~ DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manu ctu er: i ~ -S~~ SETBACK INFORMATION TypeO / i ~ CHAMBER Mo a Num er• System: ~~ "' ~© ~ 1010 OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipes x Hole Size x Hole Spa ing o Air intake Vent T a h Di L f~ I D S I / ~ ~ engt a. ia. paung engt l0 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 co a discre a~~ies, persons Lesent, etc.} ~/ ~____~= Inspection #1: DI/ ~(P/ ~ Inspection #2: Location: 410 Brookwood Drive, Hudson, WI 54016 (NW 1/4 SE 1/4 17 T29N R19W) - 172919520 Trout Brook Woods - Lot 17 1.) Alt BM Description = ~W ~~-b`-"`~~' 2.) Bldg sewer length = a- ~,6,p~~ I -a ount of c er = ~.~~'~' ~ P~ b~/t~ ~-~--~° ~ ~~ ~~'O`'`~ ~ PI,:Sn~revisi i e~ Yes ®No Use oer sid r ad iti ya1' jnform~on. 11O 'z0° ( ~ Z SBD-6710 (R. ) (~f~~ ~~ e ~ Inspector's Signature Cert. No. ~~ ~6s~N ~~...P~ ~s i-w ~ ~ ~-'`ti ~. ~- ~ mil/ ~-~-~``"' STATION BS HI FS ELEV_ Benchmark ~, ~ ~ fj19 ~. c7 ` t. n/ Bldg. Sewer ~~~, St/ Ht Inlet s St I Ht Outlet ~; ~ , O' Dt Inlet ~• Dt Bottom ------- Header /Man. g. ~'8 c(5-, 2.~ ~ s - ~-s- q -9 3' Bot. System ~ RS ~ ~.{_~.~' Fig~~~y~le ~ vD . I aF r ~j ( C.e~rc~ ` ~ . ~6 , ELEVATION DATA 2F!' ~~~ ' Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, b1'is. Adm. Code 201 W. Washington Ave. ~~C~ns~n See reverse side for instructions for completing this application PO Box 7302 Madison WI 53707-730^ Department of Commerce Personal information you provide may be used for secondan~ purposes , (Submit completed form to cou:uy if r [Privacy Law, s. 15.04(1)(m)] state ow•nec Attach tom lete tans (to the county co • only) for the system, on a er not less than 8-1/2 x 11 inches in size. Court State Sanita P rmit Number ^ Check if revision to previous application State Plan [. D. Number ~.~ I. A lication Information -Please Print all Information Location: Property Owner Name Propert}• Location - b/1/4 E 1/4,S T,~9,N, E o Vv' Property Owner's Mailing Address Lot Number Block Number a ~ - ~~ City, State Zip Code Phone Number Subdivision Name or CS~9 Number II Type of Building: (check one) ~ City ~ 1 or 2 Family Dwelling - No. of Bedrooms:~~ ^ Village ' ^ Public/Commercial (describe use): IH Town of ^ State-owned ~ p,~/ III Type of Permit: (Check or! ~ one box on line A. Check box on line B if applicable) Nearest Road v. /LT /E A) 1. ^ New System 2. ®Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onlv Existin S stem Da0 - O - O - 00 B) Permit Number -wN~e~t1 ^ A Sanita Permit was reviousl issued a . / S~. l IV. Type of POWT System: (Check all that apply) ~ - 1~D ® Non-pressurized In-ground . ^ Mound ^ Sand F!Iter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade t ^ Aerobic Treatment Unit ^ Recirculating ^ Other: ~ 3 ~r~•~ V Dis ersaUT'reatmentRrea Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation ~ p 37S ,~. 3~~ o~ ~rq. FT / ~ - 9% 7S 99. ~s VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete strutted Tanks Tanks ® ^ ^ ^ ^ .('~=~rzc T N~c /ova /ova ~ ~~y fE/Z . ^ ^ ^ ^ ^ VII Responsibility Statement I, the undersi ned, assume res onsibilit fer installation of the POWTS shown on the attached laps. Plumber's Name (print) Plumber's Signature (no stamps): MP/MPRS No. Business Phone Number ~ ~io .p - ~~~ 373 '/s ~ac6 - ~.~5-0 Plumb s Address (Street, City, State, Zip Code) ~ ~ ti, ~~ o,,, ~/~_ s~yU~~ VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Si ature (No stamps) ~Sj Approved ^ Owner Given Initial Adverse Su arge Fee) p. ~ Determination ~~~ ~ a IX. Conditions of Ap royal easons ~or Disapproval: - -~ ~- ~ ~ ~ ~+-N~ S~tc ~° t~ ' -~ ' l 1 1 1 I ~~ f ~ ac.`~unF.r~ evts . / SBD-6398 (R. 07/00) -~ ~E~E~VE~ ~ ~ - ~ ~ 7,E~t11 r;~; R1 ' ' ~:~.. `.' i.7~~ G7 ~ ~ Sj CR ~ -... ,•3 ~ ` ~ ~' r - - - - - .,+s~a. ...,i r .~ .,,.., • ~/3~oRo~.t ~s°~shc. -' /.~ = 3'~S - i7,i~. fir. s~ ~~ _. . ~ °?~ ~i0` t~•~r 0~ ~' f~i~// LA~,~rfc ,Tr ~i-l~,by~IS~{~S ...p d . 'PLOT i~ CROii i6CT10N PN1Ni / ~' =APPA 6ROi. El(CAYAT1Nfi INC QQ ~ i!LUJ~INO UI~T .. 4 IJ~tir~~i~~ ~~ul'E ~R~~rr~2 n T~~~ ~o ~V `~ fw` ~, `~ ~IQ' /b 30 ~ ~,~ , ' ~'~ , ` ~~ ~- _ r ~~ •~ ~'/ ~~ ~ -~ ~x,STi~-a ~r.~,1 e.N>M S a-sXs~' L.~~^.vc R ~r~ ~a-~~-~ ~~ ~+ ~ e~ ~\ JOE ~., ~ ~~OV C ~t'FuL E~vT'~~r ~ ~~,~., Cv.~,cR~rE ~c.r~?Grl~~~ c.,~~T/~ QiQE~Tic~•.~ Url~~ ..\~ , /c~c..~ ~'~ ~itff~o ~f!'c~dLl LR`/~f .Z , nl f ~ v ~ ~n r 5T"i^t,~. looc~ IvAC ~jcJ~ic ~~.rlc I C iST I /~~~~ 3 ~~42mcar~( [TESrgf~c~ 'Y,E~ m~ ~,~an~e - o~s~2~~r,~N.P~ ~F ~----- ~ih('E.:gp6Q C~B~~i'Vt1`f~iv~u ~F,°. oR Fti,sH ~R~~E ~/" A(c sc N yo PPE MAx/ Mu^'. dI~°' Above .L~+ivnRrR To Fi N, 5 H ~4/FOE 81~t~Dt `~ ~i~~ ~ _,/c,5~i.~u. w~~~ N V~ f ~ E. i5 ~~ C~ UCENlsE: ~~ tJ rl S'7 DATE: /~ - a?~ • °O ;sa~TEe~lq er: ~~ ~? S'? Side View Ft,E~g4"ia.J TE~I<H Bon-on TEQ So,c TEST T End View _t6 • 0 . ~ _. ~• - - "=G' - ~ _ c ~ -- ~4 7S"' --'wl Y SIDL~"C,.~i.JD~IQ ~~GN ~APAC/T~ 15° f ~_ ` E~~ 34' ---~ SUE t .. PiW~lECT .. d ~ fE ~E/5 C ~P~.a c~.yl~../r~J7'~.vc S ~+oT ~rJ `~c7uT C7 ua~K W'v~,CJ~ ~/O v® ~.acoo ~2i v~ ST d! C dHNT ti • i Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ' of m accoraance w¢n t,omm aa, vv~s. ream. ~.oae Plan must lete site er not less than 8 1/2 x 11 inches in size lan on a Attach com County ~ 1 _ ~ ~~ i k p p p . p include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel l.D. 5 Z ~l ~ ~ ! 7 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~ • i • Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z~ Property Owner Property Location ~ (~ ~,~,~ ~ ~ ~ ~' `a (~ Y ) SS 1_.~ ~ Govt. Lot -~ +,,~ 114 ~ 114 S 17 7 ~g N R ~ 7 E (or) W Property er's Mailing Address ~ ~ Lpot # ~ Block # Subd. Name or ~ ' ~ ~CyC~~Ia~.X.~~, 1 ~J ~U~C~~ l.~.JQ ~ Oily/ State Zip Code Phone Number ^ City ^ ~Ilage Town Nearest Road ^ New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD Replacement ^ Public or commeraal -Describe: ___~ _______. Parent material ~) (1141_ ) j LL Flood Plain//elevation if applicable ~~ ft. General comments 'Sc~+1rS k- C: Ste' - ~~^~~ ~>!?lh~T L~x~S ' OU~~NA.Zd: SINS - ~~'i'TR~ and recommendations: p~~ j SYS~~Elsz ~i~v~l r'IC2~ Y~ ~ ~~,~4~~ t~~. L1;Cr1E~ Boring ~ Boring # s~ti L' _ '~I~ tr L=! {~! Pit vrouna surrace elev. r r • v n. uepm w uneuny mciur • .~ "'• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color h. Gr. Sz. S `Eff#1 'Eff# 2 • ~` ~ ~" ~ 1 ~~ C5 r~ c .--- Z 9 Z 7 `"' Boring # ~ Boring ~ Pit Ground surface elev.~__ ft. Depth to limiting factor >~ :7~c in. Soil lica6on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ~ .~ ~ ~~~,k ryj'~r C5 .~ O~~ r - ~ ~ - s l~. i >dn ~~ ~ ~ ~~.~ -- .2 ~ :3 - -i ,rte 4- Q /'~S -~ - :7 ~ ,Z . 2 r3U . `Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL ` Emuent #z = tsw < 3u mg/t_ ana t ~ < su mgitr CST Name (Please ~nnt) i atu CST Number Address Date Evaluation Conducted Telephone Number I~'t_~ ~x~K ~ l ~~~~v ~~~rnr3~'E i 3 2 clt~~ ~~, ~~t5 Property Owner ~ ~ 1 ~s ~ ~ Parcel ID # / ~' ~ ~ ' ~ ~' J ~~ Page ~ of a Boring # ^ Boring ~ r~. 7 Pit Ground surface elev. ft. Depth to limiting fador~ ~~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 4~-I~~ ~ ~ te4 ~• -- nos 5l-~ 1 - , ~. (, (•8 .8 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor ~n• Soil licatron Rate Horizon Depth Dominant Color Redox Descxiptron Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 'Eff#2 a Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil icatron Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 'Effluent #1 = BODb > 30 < 220 mglL and TSS >30 < 150 mg/L • Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sso-esso ec.6roo~ Y' ~'. i ~f I~ r .. __ ___~.., t,-_....~ .. y.... _._.,..._.~ ., . ~~ ~- w ,~ y ~ M J ~ ~~~'~ ~ ~) W iI ,~~ ~ \ - NI '- ~I '- 1„ ~, ~ ~ ' - - o- ~a , r I ~ ~ ' ~ ~ i ~i ~~' ~ ~~~ ' ~ ~ r~ v ,,,d, .~' GIB a ~~~; ~ ,~~. ,.~. I ~~ ~ ~~ 4, Q III ~ ~. ~. .~ ~, a ~ T / d o~ D~.l~ ~ t ~~\~~©~ ~ ~ I \ ~ W ~ ~ ~ -~~ p J ~ ~ ,~ ~ J' I` I f v~ ~. ' i~ ~~ 1~ d ±; ~ I! ~; ~ +.~ ~ i it ~i~ I~ ~~~ ~,~.. iQ ty n ~ 2 ~ ~y ~ ~ r 'y ~ ~~ m .»* Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the tn-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number ~3 O Number of Bedrooms Design Flow -Peak (gpd) -t~ Estimated Flow -Average (gpd) Septic Tank Capacity (gal) - ~S Soil Absorption Component Size (ft2) i _ ~. Type of Wastewater Do estic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) ats'0 z - Qs Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se tic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filte shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the r J eao~~ 1~~~ ~ ~~ F '~ ~ ~ Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason withouf being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer RANDOLPH K. GEISSLER and PEGGY J. GEISSLER Mailing Address 410 BROOKWOOD DRIVE, HUDSON, WISCONSIN 54016 Property Address 410 BROOKWOOD DRIVE, HUDSON, WISCONSIN 54016 City/State (Verification required from Planning Department for new construction) HUDSON, WISCONSIN parcel Identification Number 020-1120-30-000 LEGAL DESCRIPTION Property Loca±ion ,~~ '/4, ~ %4, Sec. 17 / 18 'I' 29 jv.R 19 W, Town of xudson Subdivision TROUT BROOK WOODS ADDITION Lot # 17 . Certified Survey Map # 328288 .Volume 4 ,Page # 11 Warranty Deed # 458790 .Volume 871 ~ ,Page # 237 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 a licensedpumperverifying 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 days of the three year ex ' tion date. SIGN APPLICANT 4- DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best f my our) knowledge. I (we) am (are) the owner(s) of the perty described above, virtue of a wary ty deed re orded in ister Deeds Office. 12 /22/ 00 SIGNA F PLICANT % DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of We certified survey map if reference is made in the warranty deed ,. f - - ~ ~„~ -, : ,-.n.- _ ~ ~.. y ~ ,~., ,. ~, pOCUF.igtJ7 No. ~ $TA'E'$ BA]1` O)1• ~!YI~~+I~l~ )~t3)3~[ 1-!lg91 '~+~ e~~ *v~+ :opt +~+~~e- sw4- ~~ ~`.t, M x _~(~a,.7~~l~1>~.~.~' I~Q~'.~rt~e"t~..~l~l~..~~k'~#} ~:~ ~4?~~1~1!4a_ ~f' d hu.al~a~ad..~d rt~.~'a a~ ~s~~.nt t en~,~lt ~ .... _........ MAY ~ !~ ~D .,+a-.~~.~~~'~:~.~~ ~ ~s>-s~e>"_ and- ~6~t. ~`~ ~e~e-~„e"°,r~' "~ I0~60 1~.: M ~;, _,~Ksba~~~ ~~~ ~~~ ae marital survivorship ... .. ._ .. .. .....M... , : ........ ..............~ Grantea, ' W~tA~89~1, That the said Gri-ntor, for ~ valuable eoaaideratton..._.. eaaveya to Granter tha tollawing de~erihed real estate is ....~~ ~.. CrgiX .,.... .` `County. State of Wisconsin: Teat Psseei Nor ............................. Lot: ?7s Trout Brook Woods in the Town: of Hudson, St. Croix County, Wisconsin. i I~' This _-_-- 19 --Y.I.Ot„•,•-_: homestead property. (ia) (ir not)- Together with aU and singular the hereditamenta and appurtenances thereunto belonging; And-..-.Randolph•and._PeB6Y.._t3eissler ......... ..............................•-.. ........_......... warrants that the title-is Good, indefeasible is fee simple and tree and clear of encumbrances except eaBernents, restrictions and rights-of-way of record, if any. snd wilt warrant and defend the acme. Dated this .........................f ~-~-.-..-_•--- day of .._-._. .._~~l/.l~'~"~""~•_~.-• =-/C~s!!~--''••----..(SEAL) _.....~lliam_F...._Kartum .................. ::--=•----•----•-••-----••--•----..-•-------------------------------- (SEAL) a t/TSBNTICATIO>li B~stnse(a) _..~~~.a.~,.~t__~..._I~QX'.YillJila....------•-- Karsn A..Kortum anther this'/~.;~y.at..~y. ..... _, i>a_90 TIT2.1•: l[El[SER BTATE BAB OF W:SCAIJSIN .-..._ ~~~""•~'~`. - ~~ . ~~~~'~G~!'""`^" .............. (SEAL) • _Karen-.A.---Kortum ..:......................... .....................•--.._...........--- (SEAL) ACBE+tOWLBD4>t![BNT STATE OIP WISCONSIN .._...---•----------------------------County. 1~ Personally came before me this ................dsy of -------_•--...-°_•_-__• ................... 1>i..._.... the above named tr ~ `` rA v ~ ` N ~ Y Q \ ~~~ ~ ~ w 9i biz ~ ~°o 00 °80°6~ s °- v „o£ ~SoQI s 3 ,oo ~ 2 ~ ~~ u'' OS 6~0°6~ S s~ ~ p`0 6'~ ~ 00 , ~ N N c0 1 ~~ 1 ° 11 O m yq°~' 1 .• 1 1 1 1 1 1 1 1 °4 ~ ~~ 1 11 S 0°4 f ~00~~ E 394.46 1 j 356.88 ~' w ~ j 238o A 1 1 X00' 1 1 O _ 1 1 _ O O 1 1 ~_ 1 t0 X60 o364S 1 a 11 ~\~ZurO6\ ~ Z W N ~, O1 Cn,, ~ V _W ~ ~ °41~ 0~~ E ~ S °41~00~~ E W 389.65 ~ 2 363.81 ~ ~ N N ro -O N I ~ N I N w cn .I m N N Q ~ N ~ O - v m • ~ ~ 180°06 X40 ~l I to Go S 0°41~00~~ E S 0°41~00~~ E ~ 359.64 • ~ ~ W 395.39 ~ • o ~ ~' v_ ~ w o~ ~ o ~ -N N Z • N - - ~ I ~ Q ~ a ~ I ~ ~ 9~~10. j I ~ ~69o N N I I~ s,. 00 I I 's'• o S 0°41~00~~ E ~ S 0°41'00" E ~ 333.11 I 424.33 m I ~ I I I I I w I I ~~ - o I I ~- ~ o I I I N_ 01 I I I ~ I I ~ X71 - S 0°41~00~~ E i S 0°41~00~~ E