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HomeMy WebLinkAbout030-1044-20-112 i~ C :E c w O0 CD 1 = O 7 O T v # O 1 (ID fn I N z O oo W ('1 N Cl) O O O Q W Q !r O W• E3 3 ? O oo O C) C- ci O i~S a- co w Z Z N rn? cn ° o R (T A N CD ~ O (D 7 D O~N r~C r `1 N N N O_ O O O N R \ 1 ° °o °o ' m n w 0 0 0 N OD L" 3 CD Q fD O M N N A O N C ID C) w Cn < D ° t 3 N o w N N o C O D N m 3 cn p. 3 C2. 0 C/) N N N q 0 0 CD FIZ O N O= O co ~ O p ty N O N cr (V 0 0 0 A ro !ai c0 r3- fn N z " fD N (D a 7 rw+ N Lrl j m D (D Z ° z W z N ; D O O : O a N n w -b • O ~p ~p N O (D N h~~ill m w CD D C ~i O N = O N 3 7 CD o z c ~ .P a z CL i Z w o co T o z 3 a A z7 o cn 3 m C¢ N Z G CD A w j I I N O d C X O CL G Ul O n? w 7 T O_ z N O fl C N N N N n• fi j p h O e O to j w O V N N N a I F ti w o CL o m oo ON o in * . w °O • Parcel 030-1044-20-100 03/30/2005 09:35 AM PAGE 1 OF 1 Alt. Parcel 20.30.19.160D 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * BIDON, MICHAEL E MICHAEL E BIDON 1430 47TH ST HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1430 47TH ST SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 4.490 Plat: N/A-NOT AVAILABLE SEC 20 T30N R1 9W PT NW SE LOT 2 OF CSM Block/Condo Bldg: VOL 6 PAGE 1556 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 20-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 844/246 07/23/1997 767/382 07/23/1997 753/98 2004 SUMMARY Bill Fair Market Value: Assessed with: 5084 223,500 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.490 74,500 145,400 219,900 NO Totals for 2004: General Property 4.490 74,500 145,400 219,900 Woodland 0.000 0 0 Totals for 2003: General Property 4.490 43,800 117,400 161,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 140 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS P.O. BOX 7989 PRIVATE SEWAGE SYSTEMS DIVISION ' BUREAU OF PLUMBING MADISON, V111 63707' , )MCONVENTIONAL ❑ALTERNATIVE We Ian I.D. Number: (11 ustgnM) Holding Tank ❑ In-Ground Pressure ❑ Mound NAM OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER- INSPECTION DATE: Mike Bidon Rt. 1, St. Joseph, 611 54082 ,;2 9&' -f :-y a BENCH MARK (Permanent reference pomtl DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV NE SE, Section 20, T30N-R19W, Town o4 St.Jo6eph,Lot#2, Stout Sub. Name of Plumber: MP/MPR SW No. 1C. unty Sanitary Permn Number: Donavin Schmitt 3205 St. Choix 83866 SEPTIC TANK/HOLDING TANK: A/ MANUFACTURER l.- ~/C./' LIQUID CAPACITY TANK INLET ELEV. ]TANK OUTLET ELEV. WARNING LABEL LOCKING COVER / > q L~ PROVIDED PROVIDED - / • s' ~3 vZ YES LINO ❑YES ~91NIO BEDDING. VENT DIA.. VENT MAIL NIGN WALEH NUMBE R.OF - ROAD . PROPERTY WELL BUILDING. VENT TO FRESH ALARM FEET FROM LINE/ So AIR. INLET. ❑YES QNO ❑YES SINO NEAREST V s DOSING CHAMBER: MANUFACTURER BEDDING. LIOU ID CAPACI rY POMP MODEL JPOMP,SIPHON MANuI ACTUHEH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED ❑YES LINO ❑YES LINO ❑YES LINO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF.. PROPERTY WELL 8O FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) ❑YES LINO NEAREST _ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE 1 I N(,TII FrOf TF 11 j%IAItHIAt AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue.) MAIN SS CONVENTIONAL SYSTEM: ..BED/TRENCH WIDTH LENGTH NO OF UISTH PIPE SI'A(.INI, COVEH IOIA zPltS LIQUID DIMENSIONS / d S.2 rHEN~cHfs C" M EHIAL PIT DEPTH GRAVEL D FPTH FILL DEPTH OISIIi PIPF UISTN PIPE. DISTR. PIPE MATERIAL NO UI$il0 NUMBER OF PROPERTY WELL BUILDING LV NTTO FRESH BELOW PES ABOVE COVER E 1 E V IPIPF 5 LINE R 11VLET ~j t E 1 C~ 1 Cj$ C~f~ $7 7 2 ~ FEET FROM / [/O o~ d NEAREST-4m- y~ Co 3 3 MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑YES LINO meets the criteria for medium sand. TIONS MEASURED. SOILCOVER rE%TURE PtHMANtNIMANKIIIS OISSEHV❑ ATI YES ONWFLLS DEPTH OVER TRENCH BED DOI PiH OF TOPSOIL SDUUtO ❑YES SEf UFO LI NO MULCHED LI NO CENTER GES ❑YES. LINO ❑YES LINO ❑YES LINO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO.OF LATERAL SPACING (;RAVEL DEPTH HE LOW PIP! FILL DEPTH ABOVE COVER TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD =NI)ES UISTH UISTH PIPE OISTHISUT ION PIPE MATERIAL & MARKING E LEVATION AND ELEVELEVDIA ELEVPIPDIA DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COHHECIt Y COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES LINO ❑YES LINO COMMENTS: PERMANENT MARKERS- OBSERVATION WELLS EN BER OFT FROM ❑ YES ❑ NO ❑YES ❑ NO REST g03 ~ Sketch System on in i ,county file for audit. Reverse Side. - SIGNATU TITLE DILHR SBD 6710 (R. 01/82) ° SANITARY PERMIT APPLICATION T DILHR In accord with ILHR 83.05, Wis. Adm. Code ~y STATE ~SjANIITAARY PERMIT F J a /0 -Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 43% 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 ❑ NO PROPERTY OWNER PROPERTY LOCATION - /VE'/a S 20 T N, R E (Or)( PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME r r z , CITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK 6 YO ED VILLAGE : .r ST, dus~ U _ ris E II. TYPE OF BUILDING OR USE SERVED: fuel G - /a. Q~Q - !D -o'1(J-lD 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. N New b. ❑ 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. 19 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. X Seepage Bed b. ❑ Seepage Trench c. ❑ See a e 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): r ?1, 0 Feet 2 Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in gallons 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 jow [9 ❑ ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumb 's Signature: (No Stamps) MPRSW Business Phone Number: cs;o~ , 3 7f~ SY19 ~G~ Plumber's Address (Street, City, State, Zip Code): Name of Designer: VIII. SOIL TEST INFORMATION Certified Soil Tester (CST) Name CST CST's ADDR SS (Street, City, State, Zip Code) Phone Number: F88 N1, Dg 6W / Gl~ r I715- La YX ogi~AeV X. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fee 9/a ~L Adverse Determination ;O~lee 1 2" - &A~Z;a2 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 k INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT 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; IL 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'/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; 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 Groundwater - included the creation of surcharges (fees) for a number of regulated practices which Wiscor sin's can effect groundwater. The surcharge took effect on july -l, 1984. All of the water that buried tteas jre is used in your building is returned.tQ the groundwater through your soil absorption ! system or the disposal site used by your holding tank purnper. The rnonies collected through these surcharges are credited to the groundwater fund adrr i€;is tered by the Department of Natural Resources, These funds are used for monitoring groun(J water, groundwater contamination investigations and establishment of standards. Groundwat-, itls worth protecting. S zD-6598 1,11.0i:36) Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP i 4a~ SEC . T N-R W ADDRESS ~jY ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N %O0 L ,L n~ ,r. v2j ~v~L~ `N ~ F ~G l 7s. j I. X 5 BED I~ INDICATE NORTH ARROW 04 0 BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: ,':::,Lj; ) Proposed slope at site: -3f17 o SEPTIC TANK: Manufacturer: Liquid Capacity: U Number of rings used: 1YG'niE Tank manhole cover elevation: Tank Inlet Elevation: U. /33 Tank Outlet Elevation: `f Number of feet from nearest Road: Front, Side ,Q Rear, feet From nearest property line Front,0 Side, Rear, O feet Number of feet from: well 7 1 , building: lu i (Include this information of the above lot { P plan)( 2 reference dimensions to septic tank) SEE REVERSF. STnv PUMP CHAMBER Manufacturer: 17A~~- .5 Liquid Capacity: pump Model: /to3 Pump/Siphon Manufacturer: 7_gEl',5~ - Pump Size Elevation of inlet: Z; Z. 2 Bottom of tank elevation: /©i.1;~~ Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: t'C/jkL A1P Z!1 Alarm Switch Type: (5INrLF ~LDA T Rear 0 Ft. Number of feet from nearest property line: Front, O Side W Number of feet from well: T~Z Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: j/ = 5 Trench Width: / Lenth• j oZ Number of Lines , Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, t7NSide, O Rear, 0itt. Number of feet from well: Number of feet from building: 6,3 1 (Include distances on plot plan). EPAGE PIT Si Number of pits: Diameter: Liquid de Bottom of seepage pit elevation: Area Built: Has either a drop box O or tribution box O been us on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capa Number of rings used: Elevation of bottom f tank: Elevation of inlet: Number of feet f nearest property line: Front, O Side, Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: ~,2U5 License Number: 3/84:mj INDUSTRY, T-Y, ENT OF REPORT ON SOIL BORINGS AND S i V S NDUS IV t~ LABOR AND PERCOLATION TESTS (115) p HUMAN RELATIONS MAD 0 (H63.0911) & Chapter 145.045) LOCl~TION: S--E77CTION: TOWNSHIP/Mt}Pd}gtPAt TY: LOT NO.: BLK. NO.: SUBDI N N ~O /T(cN/R ~Jk(or) ~ ~ .C COUNTY: ER'S/'B4*E-R'S NAME: t1 MAILING ADDRE 61 6q-0 g- SS: / l USE DATES OBSERVATIONS MADE IND. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLAT N TESTS: esidence ~lew ❑Replace 3 21) -Z~-gS -ZS -as RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-1 N+1 LL HOLDING TANK: RECOMMENDED SYSTEM: (optional) HIS ❑U EgSDU ( S❑U ❑SCu ❑S2A >9- If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: Q~s mA I PROFILE DESCRIPTIONS C BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER 9€RT+NN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 7 q &7 ~3 n 7 z ? s~ B- ? o-75 o'L 1, NO 7 B- 3 lp~ / ~0 8o N co 8~.~.~i O& 5'0 5° ~1 ©~3~`'° f' 33 7 B- N B- irm4I i PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER I AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERI D 3 PER INCH P- I 2 AJo 0 1' y Y P- A)O 3o t' P- P-- P_ P- PLOT 5 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 1-z \ . - i { of E E h D 4 [ c'C" . 1 0 3 _ A CP TH r F a _ S zo' \ E 3 E 3 , r 1 3 E i ( E _ - ; 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. NAME (print): TESTS WERE COMPLETED ON: _0~ ell, -a J- - S~~- ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 8 Gl~ Z e; 715--Z X (o ( ep<-, CST SIGN E: C2f 11U DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) -OVER - INSTRUCTIONS I. T ETII - 115 a SCE - cnii report YriUl e ~ _ 21s is or corm ;ert; 3. Use plal- 4. SUITA _1 n!-DING TANK NL.Y I ALL ON SCSI S. 7. A ;t exenIp- TH E i -lest p...ate order to Ir)Ct. I i kel LIRA/ !v J~ Roe Al d (~(~s• t pt~P~ Lo 0sap i ~ v . !L ~ 83 ~ ~ 'rv P S~Ep~~~ i L ~ v BOO co N yet S ;j ~~ft APPLICATION FOR SANITARY PERMIT STC-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-__ /%/,TL-7 Ri Qa iv Location of Property Section T_20 N-R % W Township Al Mailing Address Address of Site iS~/y'jG _ Subdivision Name 7- Lot Number Previous Owner of Property a~~.~ ,o p © br- S ~rr~>- ,a... Total Size of Parcel ~a Date Parcel was Created- Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes k' No Volume and Page Number_ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrant 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPFRTy OWNER CERTIFICATION I (We) ceAti6y that att .6tatement6 on this boAm aAe tAue to the best o6 my (ouA) knowledge; that 1 (we) am (aAe) the owneA(.s) o6 the ptopeUrty de~scAi.bed in thi,6 in4oAmati,on 6otm, by vi4tue o6 a waAAanty deed tecottded in the 066ice og the County Reg.isteA o4 Veed6" Document No. E ; and that I (We) pne,6entty own the ptopob ed site 6oA the z ewaq a d.i,6 poi d y.6em (oA I (we) have obtained an easement, to nun with the above ducAibed pAopehty, 6oA the con6tAuct,ion o6 .6aid .6y6tem, and the dame ha6 been duty AecoAded in the 046ice o6 the County RegizteA o6 Veed6, ab Document No. SIGNATURE OV .OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) / C~j ,DATE SIGNED DATE SIGNED Ln .-3 ST C- 105 r r a SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County ° z d OWNER/BUYER j~'L c=r ROUTE/BOX NUMBER Fire Number CITY/STATE .5 ✓cyp~% ZIP,Syd PROPERTY LOCATION:', L ' Section Li T 3,C) N, R_/_W, Town of ST, C-74:11-5 fJ/~ St. Croix County, 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. _ 0 E I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- ro 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 DATE y/ ! Cob 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.