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HomeMy WebLinkAbout038-1116-30-000 • ~ 4 1 0 O d G - 0 0. H. M '.C+ d (D ^ cn 2 Z ° 0 cNO w . w,•i n O N p) O coo 01 j 00 CD 3 ~m CL CD a N ~ 1 C) UJ C/) co ~J W 7 N N ! - CO p rZ O W O ' d O N a 3 0 m CD G' O Q m o C) C (oD m o O0 m 6 w C r t~rJ (D ~d n 7 3 ° N 'c III * °p p r• H rt Q F o Q H. ~ x w U) -G D F a rt d m (o m N a w W N C7\ H 4- H C c a V Cb a CD M~~ U) 0 m 4- H (D 00 00 CD 00 p o In O C y C CD a (D (D o o - trey ~ ° O v 2 'II 3 ry~ C7 rt f c co Cl) N CD v m Q. ~ O G~ N O O N (D N O 4- . CnN I ~ d Q 77 y O o~o N ' 3 a CD N 00 U1 H H o O O w D CD o a c Z 0 (n h co a O ,d : CD y !1 F -h N 00 C7 00 C!] i (p Nci • w :EE! (D C 0 F4 rt a b W et w m Q n r• fl 3 (£p ~-d 0 I z CD c° A Z cn Cn W N o N a A Z O r• ~o m G) O r• N z --I O W :-5 j p a z 3 o " z CD 0 .O A i (D CL O 0 f a (D 3 cD 3 ~ a CD F DI N Z) T (n N C com spa oZ a CD 0 m o m o 0•`CD a m 3(0 mm m oaa S ~v 3 0 too Ell- 3 W 0- o N m A "O 7 S m 3 ~CD crm Za=c CD p E a b m -0 Q (n nai °o Fl CDco~a v _ A o c v CD 21, ° CD ° b p i . y Parcel 038-1116-30-000 01/29/2007 12:52 PM PAGE 1 OF 1 Alt. Parcel 29.31.18.488E 038 - TOWN OF STAR PRAIRIE Current X 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 - ASMUS, ROBIN W ROBIN W ASMUS 1990 93RD ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1990 93RD ST SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 29 T31N R1 8W PT NW NW COM 427 1/2 FT Block/Condo Bldg: N OF SE COR TH N 91 FT, W TO APPLE RIVER SLY ALG RIVER TO PT W OF POB TH E TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 29-31 N-1 8W Notes: Parcel History: Date Doc # Vol/Page Type 10/11/2006 836394 QC 07/23/1997 1197/184 WD 07/23/1997 846/490 07/23/1997 724/558 more... 2006 SUMMARY Bill Fair Market Value: Assessed with: 175667 106,200 Valuations: Last Changed: 10/15/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 58,700 35,200 93,900 NO Totals for 2006: General Property 0.000 58,700 35,200 93,900 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 58,700 35,200 93,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 131 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form- S T C - 104 , AS BUILT SANITARY SYSTEM REPORT = TOWNSHIP SEC. T_.:~LN-R W OWNER iz~ ADDRESS t ST. CROIX COUNTY, WISCONSIN dz SUBDIVISION ,11 LOT LOT SIZE I ZA, PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM G 60 ~-~o- i _a 3 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ; ' Elevation of vertical reference point:, Proposed slope at site: SEPTIC TANK: Manufacturer: d Capacity: Number of rings used: ^ ~ Tank manhole cover elevation: Tank Inlet Elevation: G Tank Outlet Elevation:, Number of feet from nearest Road: Front,O Side 0 Rear, 3 ; feet From nearest property line Front,O Side, Rear, O _~=2_ feet Number of feet from: well y building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE 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, 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: Fill depth to top of piper Number of feet from nearest property line: Front, Side, O Rear, Ft Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: y - / Plumber on job: License Number: Z 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 , BUREAU OF PLUMBING MADISON, *1 53707 [CONVENTIONAL ❑ALTERNATIVE [1,1, PI,, I.D N-be1 ❑ Holding Tank F11 In-Ground Pressure ❑ Mound l f assigned) NAME OF PERMIT HOLDER. 7AD;DRESS OF PERMIT HOLDER. INSPECTION DATE. Pat Gogerty 1 , Box 144A, Somerset, WI BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF, PT. ELEV. NW NW, Section 29, T31N-R18W, Town of Star Prairie Name of Plumne' MP/MPRSW No. County Sanitary Permit Number. Cal Powers 1563 St. Croix 64848 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY. TANK INLET ELE V.. TANK OUTLET ELEV.. WARNING LABEL JLOCKING COVER Z C PROVIDED PROVIDED C 1 YES LINO EYES O BEDDING. VENT IA.: VENT MATL_ HIGH WATER NUMBER OF ROAD. PROP RTV WELL. BUILDING. VENT TO FRESH -T j G / ALARM FEET FROM LI I AIR INLET ❑ YES ~ANO f lC^ EYES LINO NEAREST DOSING CHAMBER: MANUFACTURER IBEDDING. JLIQUID CAP ACITV PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOOCKVIING COVER PROVIDED: PH DED. EYES LINO EYES LINO EYES LINO GALLONS PER CYCLE: PUMP ANDCONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL 1BUILDING,. I VENTTO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET' PUMP ON AND OFF) EYES LINO NEAREST lo- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LFNGTH JDIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/TRENCH WIDTH. JLNOOF DISTRPIPE SPACING COVER JINSIDE CIA-PITS LIQUID TRENCHES MA~£ AL' PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. ISTR NUMBER OF PROPERTY WELL. BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER EL V INLET ELEV. END PIP IS FEET FROM LINE AIR INLET. NEAR EST-r ~c7I 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- E YES LI NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS EYES LINO DYES LINO DEPTH OVER TRENCH BED DEPTH OVER TRENCH :BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED. CENTER EDGES EYES LINO EYES LINO DYES LINO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH. NO -OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL. NO. DISTR. IDIA IS TRPIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEVELEVCIAELEV. PIPES.; DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS OYES LINO EYES LINO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY JWELL: BUILDING: FEET FROM __~LINE: L~ EYES LINO EYES LINO NEAREST a Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) Wisconsin APPLICATION FOR SANITARY PERMIT COUNTY DILHR OEPRRTTEn (PLB 67 T OF inousTRYtLRBORSnumRnRELRTIOns UNIFORM SANITARY PERMIT # I J / d -Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAIIyG ADDRESS PROPERTY LOCATIO j ` N, R (orybll~ Towv o l 1/4 '1/4, 33'A T LOT NUNJBER ]BL OCK NyJMBER SUBDIYISION N NAME NEAREST ROAD, LAKE O LANDMARK STATE PLAN I.D. NUMBER TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms: ❑ Public (Specify): THIS PERMIT IS FOR A: ❑ New System Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity 42 I Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: A, IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound EJ In-Ground Pressure Total #of Prefab. Site Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of he pri to sev age system shown on the attached plans. Name of Plumber (Print)' J Sig Si tur MP/MPRSW one - ~ ~ o Ph Number Plumbers^ddress: f - \ a me of Designer- N COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: pproved El Disa [L~ / El Owner Given Initial N T Approved Adverse Determination Reason for Disapproval: a Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISP.O. BOX ON WI 7969 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATI ON: SECTION: TC~JpID1SHIP/MUNI'et -LITY: LOT NP.: BLK. I SUB IVISION NAME: /a, /a T7/ N/R/, I!(or) W ~ % / COUNTY: OWNER'S/BUYER'S NAME: MAI INU ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: CDESCRIPTION: IPRO E DESCRIPTIONS: PERCOLATION TESTS: [Residence ) ❑New Replace -a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE:SYSTE -IN-FILLHOLDINGTANK:RECOMMENDEDSYSTEM(optional) ZS Ou CIS Du ©S ❑U FIS au ❑S U 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: ci Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL =ELEVATION TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, RVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) y r Z-1 Zf 7-,;' 14-'rrill r~ r 3 24 s' B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IWG-H-ES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- /lli J 1 P- f I 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 a~ - - - - - r , A ~ C - p / y,~ 1 , ~~~yyy yt I p/ "'mac.. 1 - . ° _..m._ ~J r. 6 ~ _ . _ 4 ? I , 1 i 9 IE r 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: K , ✓ ADDRESS: CERTIFICATION NYMBER: PHONE NUMBER (optional): CST- IGNTUR i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - _U.j RULn 1,. NS Oz"a LjW.aTL§ ~~IG l lb - SL3f. use section 321.1.;£; Clearl p C?C'~kot whets ti, is a resi~YG`ncc o ;canr i-,. .;2~1 project; ec'%; lvl ~Xii':;?um t- urn'ber of bvdr<,orns «t" c€:7777.Y1t.'!-ci a'l us c,, planned; Is %tis a sum; Ui m l ,t„ Fg t sy='sw€q CJ i-}€. the biiE„ ~ay k.gyp tE, boxes. A EITE yib~f-lisl SUITABLE y~"C?,~- A - CA- IINIG TANK ONLY IF ALL r. -a v~ PLEASE t1., W abla.f wiC €i.s shm=1 here for vv,-it .ti[t P .ti!P des ,3 tp dons m W cam O:=thq We plot plan; ',iA F tC 3 siE i„ dls3f3 nm :acs#,t,€ tal}' €:.aC=Vg you te.t locations, D ixl:flmt, tC scale, is ,lt e, ffeC,xCa a A €-a7 ,na Ono: nT;ax, be w dubso, ;y. 4. k e sac r°, .tr f=t.,.. In =1€ Val Js:?€ € € .,..a,.;3a, won ~'t,r, taC'.'€'_". r€ C,.. t , ~l":€ . ~#2~i .~8'e p7e:E7t r3 riGtit; : to , r n , te Wows as V) Owe, €iwnes m£ tnno f WA p3=a : daian p ercola on 'test' AEiI7p- er 4 o i lv~ £ c, -€F r, ina::,Fr, as d(,:ad ,.asr=, Mesta an) does rte,t apo place N.rL. , . No aqwvGaAm box; Ow is-no and pioop you coa ! a skv "d you a r., l On t?t.tt2A r; a , At tf'af M SIR °'-'Y" cit s NIT;! 'Alt !IF SS Wdmme GNMA WWI M, LS Loveamw - „€''Ci ra f,.t dpt _u i"'€ L'a i"C9u„a(7k4'ai£3I- (Nose f Sts£a _t i'4"£: ~ d3.;[ € €a,!ttgC F 1 S- cj Skin 8"Idmg iii L «o, < - Lys :i, - 4 € _xi Hl Wi S£t a ° aF Chy ,r SwAyCNy Lo vs-i R Fees SWAY clv,-~ W/ with CA ay C',; - 1; a wan; n High wan kno o C . , rE`: ~f PAGE OF I ,I rC)SS Sz~4luC"I o~ ~ i3e~~ Jy5 r Fnth Air InIsI6 And OlItgetwullon Pipe Approved Vint Cop Minimum 12° Above Finul Grads '0- 42" Above Pipe _ 4" Cast Iron To Final Grade Vani Pipe Mi0 Pipe Morin Moy Or SyAAggrogats Distribution Pip• - Taa 6Perforated Pipe Below 8-Coupling Terminating At bottom 01 S1e10M SOIL FILL DISTRI BUTIOVI PIPE APPROVED S1ItlTNETIC COVER ° MATERII~~ OP, 9" OF STRAW 2"OFAGG9E6, AlE. OR MARSH HA`:J 0 FAGGREGATE V-LEV. Ot FEF.T-,.. DISTRIB1-1TIC)K1 PIPE To BE AT LFAS -T IIJCHES BELOW ORIGIIJAL GRADE AkIL AT LEAS-T-20 IUCHE' BUT AIO MORE THAK. H2 WCHES BELOW FINAL C PKADE MAXIMUM ®F-PTH OF EXCAVATIm►j FROM OW10JAL 6KADF- WILL BE I►~c_HEs MIKIMUM ®F-PrVi OF EACAVATIOW FROM 1*I6IbAL GRAOf- WILL BE itvcHEs ~ I L.IG E"SE 00MBE R: _ _ t DAT E : ~~o I ~ i t 'f t 2 4 14117 I s i APPLICATION FOR SANITARY PERMIT ST C- 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property ?,.-i r p f Location of Property JZ~A)_14 114, Section 2, T N - R `lJ W Township -.S"t yea ly-j~Q Mailing Address , ~ ~ ~ 3~ A Se e r 5,j;t J, ~ S C- S `f Subdivision Name Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes _ No Volume S and Page Number a,::) as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2 Land~~ • 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROPERTV OWNER CERTIFICATION I (We) eeAti6y that ate statements on this 6o,m ane txue to the best o6 my (oun) knowledge; that I (we) am (ah.e) the ownen(s) o6 the ptopenty desc i.bed in . kis in6o4mati,on 6o4m, by viAtue o6 a wavmnty deed %eco4ded in the 066ice o6 the County Regis teA o6 Deeds as Document No. ,5 and that I (we) pnesentey own the proposed site 6oh the sewage d Apoe dyb.tem (on I (we) have obtained an easement, to nun with the above ducAi.bed ptopeAty, bot the condt.ucti.on o~ said system, and the same had been duty xeconded in the 066ice o6 the County Regis.ten. o6 Deeds, as Document No. ) . SIGNATURE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) ' ~y f T DATE ,SrIGNED DATE SIGNED H H a S T C- 105 r r . - a H SEPTIC TANK MAINTENANCE AGREEMENT H St. Croix County z d a OWNER/BUYER V-1 C, G ROUTE/BOX NUMBER jay Fire Number CITY/STATE S5rrrcr"7' ZIP Sfy/7 PROPERTY LOCATION:N1A 4, Section, T~N, R le)-W, Town of St. Croix County, Subdivision Lot number I 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. H 0 E I/WE, the undersigned, have read the above requirements and agree Cn to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart- w 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 'o 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. ci z ~w Q rn > o c cu 0c cc cncu 3fra it p i p C a O p p p L p G C ~ 0)2 C O-0 ill p = p p C O a) U i to O C O p U •CD U N) N L 'LOO ~ 2.0 co 010 'ro W 3 o 3 0-0 (n 6 c ca 7 =03 = ~ 0 O ) (n 0 :3 CD a ~oCoCo V °2L W m 3: cc a U) 3 C C LUN p a) _ L cq p t .r LC W cNCD `o ~~m ~ 3 4 s.~C E U CD c H ctf =~Cro - Z Q o,3 mo 3~ ~F-cn 10, Q Z N ai 0 to cn N c cn vi o 3040)~00 `°~rn 7 CL r- :3 0 O D U Lu = O U p 0 L7W O .a ~ a N U C= a) 00 w C Q Q d 00 a) w M = CO c0 C C a) O r O (D O C ` _ N L p 03cn>~ C)z.c \ N rO '2 » >>1 o o E o co C C L L C - ~N O c0 O ~ 0 0 O O a. N p O E U co w U N N a) d _ v 'coo 03avi c 76 co a) 0 cu 00-0 13 k - :t 7~5 .2 3 a) ~ o a C O c z 0 >~c N v>rn j 0 - O~ MOLL ~d L O !A co 3 C A C O i Y 0 0 a) C O a) C cO N m p O E CM U) CO ~ (D m c = N J O