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HomeMy WebLinkAbout020-1077-60-000ST. CROIX COUNTY ZONING DEPARTMENT Owner ~DS~~I ~~ ~ cc~0 ~sN Address - Po Bah ~ rj~ City/State ~, os o~ ~ , ~yd ~ 6 Legal Description: Lot - Block ~-- Subdivision/CSM # ~' '/, rSL '/, ~- ~ Sec. ~ ~ , Tag N-RAW, Town of /-~~ 5 o.t.1 PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer _Gv, ~ S ~./~ Size ST/PCY~oo / Setback from: House /q ~ Pump manufacturer - Model -- Alarm location ~- (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system:T~n1 ~ ~ Width ~ • Length ~-? . 5'-a' Number of Trenches 1 Setback from: House Y r7 ` Well `~a' P2 a ' Vent to fresh air intake ,~ S~ . ELEVATIONS: Description of benchmark ~`~ ~'o~piy~C ~~~awc?~ Tc ~~,,,~ y,~p Elevation ~n~• oa Description of alternate benchmark Elevation '~ Building Sewer ~"7 ~~ ~ ST/HT Inlet g2• gs ~ ST Outlet ~ ./~ ` PC Inlet "- PC Bottom r-- Header/Manifold ~ Top ofST/PC Manhole. Cover ~~ ~~ ~ '~ Distribution Lines JBottom of System AS QUILT SANITARY REPORT () () Final Grade () 7' Sa '~ Well !r a ~p/I, 4So , () Date of installation ~ / /ao Permit number State plan number ~~ Plumber's signature ~ " License number Inspector ,- 2~y~S'I Date G/~/oo ('omplete plot plan ~ 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 3yo~ ~~~~~ ~~~ -- ~~~T~P•F~Q-~iD~ w~N Oa1Q /P'2'~a. l a~ c~/" SOP SS ftxu~n// ~„~~ try' ~o . /OOb ~ti G~tG3c77t'/T/( TrtxlK ~ // \ ~ L~ yS~ N ~ ,ti,~o~03e/ ~(/e f~.Cr h~n,6 INDICATE NORTH ARROW s 2 ~' La.JCPar~ ~aw~P ~E~ w~t~ Co c k~iao.u Wisconsin Department of Commerce ' Safety af~d Btnldings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Personal intormatlon you provice may oe usea ror seconaary purposes Irnvacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ down of: Iudson Soccer Association Hudson Township CST BMElev.:- Insp. BM Elev.: BM Descr tion: l~ .b /U~..a ~-,-~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~~ e.~.~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic ?,Zcsp ~c.(,~' ~ NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manuf. Model Number GPM I TDH I Lift ~iction stem I TDH Ft I ForC'~main I Length I Dia. I Dist. To~tte,l` SOIL~SORPTION SYSTEM (I-pl~~~„N,,,~,~ ELEVATION DATA County: St. Croix Sanitary Permit No.: 370205 State Plan ID No.: Parcel Tax No.: 020-1077-60-000 STATION BS HI FS ELEV. Benchmark ~. ~~. ~ 3 ~7 ~} , (~ Alt. BM Bldg. Sewer j ~ Cj ~• 3~ St/ Ht Inlet (o, (pjj ~ 7. ~ I St/ Ht Outlet ~--~-.~ v Dt Inlet ' Dt Bottom --- ---- Header! Man. Dist. Pipe ~-~ Gj ~ ~ ~ l Bot. System ~O. t~ l'J~3, ~^ j Final Grad St cover ~-_ 8a 9~ TRENC Width ( Lengt ~ ~Z No. f renches p1T No- Of Pits Inside Dia. Liquid Depth DIME - DIMENSI N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING ~ urer ~~~u SETBACK INFORMATION Type O ~ Z~ , ~~ ~ ~~ D CHAMBER Model N tuber: System: ~ D OR UNIT 4 C.t DISTRIBUTION SYSTEM r ~ Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length ~~ Dia. in ~ $~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded 1 Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: (p / /(X) Inspection #2: / / Location: 541 County Road LTU, Hudson, WI 54016 (NE 1/4 NW 1/4 28 T29N R19W) -~~ 19.314 1.) Alt BM Description = .57. ~~~ ~ ~ j/yl~ G 2.) Bldg sewer length = (~'' ~2~~ ~ ~i~ -amount of cover =~ ~ ~~, ,~p~ ~_ /`` ` ~ ~~~ Plan revision required? ^ Yes No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No ~r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ,•IsC~ns~ SANITARY PERMIT A n Department of Commerce ~ In accord with Comm 83.05, Yyj • Attach complete plans (to the county copy only) for the than 81/2 x 11 inches in size. • See reverse side for instructions for completing this appl Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)]. 1 ~l .~, ~ ~j~ ~1, l vl "1 t"`"`Safety and Buildings Division f~l ~N ~ 201 W. Washington Avenue P O Box 7302 ~~~ ,d~~ r ,. `=t, Madison, WI 53707-7302 y~,,,,,_ t~;n pap~~arlless~~ Cc ~. rIs tS y t } ~,, .~Ui xfc~n ~,. i t ~=~ n :~, ~4. ~~~ State`~anitary Permit Number '' 3~z~.~ p~k if revision to previous application ~h LD. Number I. APPLI ATI N INF RMATION -PLEASE PRINT ALL id - ~'r ~ ~ ~'` Property Owner Name ~u~oSc~J ~a~~ ~SS~I, r` ,. Property L f n ~ '~ .- ~ia aS T ~°! r N, R /9 E (or~ Property Owner's Mailing Address ~ Lo Block Number o. g ~ Cit~yy State G Zip Code ' - Phone Number Subdivision Name or CSM Number tr, +~fOsta.~ s yn~~ ( > I1. TYPE F B IL ING: (check one) ^ State Owned ~ !tr ~ ~ Nearest Road TH ~~ Public 1 or 2 Famil Dwellin - No. of bedrooms inDS~) own of / 4 uu III. BUILDING USE: (If building type is public, check all that apply) m er(s) 29 ,!r{. U~o -/o,~ - 6a- Ot~o (3q.2f t9.c~.cr 1r1~ Z'8• 1 ^ Apartment /Condo o °-/O~~_ o - o ~ ~ ~s'`~~""'~P ~ ~ 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~New 2. ^ Replacement 3_ ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an _______ystem --------System ------------- Tank Only--___--_-_---- Existing System ___--_^_ Existin~System 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 Spe ify Type 41 ^ Holding Tank 12~Seepage Trench 22 ^ In-Ground Pressure 'I Z/S 42 ^ Pit Privy T 13 ^ Seepage Pit 43 ^ Vault Privy 14 ^ System-In-Fill ~~j~~~,(-ro,P 0 S --~9 3 ! x ~p 2 ~ s~ VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade /O~ Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 4 ~ ~sq~,~-. 3/~s~ ~r ~ .3 ~S Feet ~~ Feet VII. TANK INFORMATION Ca acct In gall0 S TOtal # Of Manufacturer s Name Prefab. Site n- C Fiber- plastic Exper. N E i ti Gallons Tanks Concrete o Steel glass App. ew x n s strutted Tanks Tanks Septic Tank or Holding Tank Do0 /pOt~ / tr.JIcSER ~ ^ ^ ^ ^ ^ 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) Plumber's S~ ature: (No Stamps) MP/MPRSW No.: Business Phone Number: .~~, 3?~ ,s -~~ a Plumbe Address (Street, City, State, Zip Code): IX. COUNTY /DEPARTMENT USE ONLY ^ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue I su~ g Agent Sig toe (No Stamps) Approved ^ Owner Given Initial Surcharge ree) 2~~ ~ ~ Zf Adverse Determination - ?-7.. jsCO~IDITIOW~N,~QFAnPPR„QVAL/REASONS FORDISAPPROV ~L~~~_ ~e,~n~ ^~~`~-- ~~J ~s ~ f-t-C®+n~~~c.2 6'"`"`;"` aft" f `~ ' ~ r z~ A~,L S.e~'~ ~ v~ww~-~~.Q._ -nn a'~.tn-~a~t..,~ ~ a.S nom, r A.Q.Q___ _ ' u SBD-6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, INSTRt~CTIONS ~ ' • r 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 lode 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. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. r~ To be complete and accurate this sanitary permit application must include: ' ` 1. 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 online A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or e:~cisting 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 i f 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 applicai~:ion form. IX. County /Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/7 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to sca-e 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 takes; 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; ~) 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; !=) soil test data on a 115 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. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. f ~ ~ ~scons~n Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www.commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 09, 2000 CUST ID No.692428 MARK STAHNKE 715 6TH ST N HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: OS/fi9/2002 ATTN: POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Site ID: 191027, HUDSON SOCCER ASSOCIATION L ST CROIX County, Town of HUDSON; CTH UU, HUDSON 54016 NE1/4, NW1/4, S28, T29N, R19W FOR: CONVENTIONAL SYSTEM, 100 GPD Object Type: POWT System Regulated Object ID No.: 660508 P.C Identification Numbers C~n~ Transaction ID No. 312351 l• Site ID No. 191027 Please refer to both identification numbers, above. in all correspondence with the aaencv. ~~?"^. SEE G(%~ - This approval is for a conventional system to serve aconcession/storage building with 10 employees, no toilet room, no showers and no food prepared on site. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section COMM 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. 3. The replacement area shall not be disturbed per COMM $3.09(1)(c). 4. The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and COMM 83 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. The designer proposes to install 10 High Capacity Sidewinder Infiltrators®. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. MARK STAHNKE Page 2 5/9/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. r'-- Sincerely, ~~ ~ ; PATRICIA L SHANDORF ,POW S PLAN REVIEWER Integrated Services (715) 634-7810, FAX: (715) 634-5150 , M-F 7:45 AM - 4:30 PM PSHANDORF@COMMERCE. STATE. WLUS DATE RECEIVED 04/24/2000 FEE REQUIRED $ 110.00 FEE RECEIVED $ 110.00 BALANCE DUE $ 0.00 WiSMART code: 7633 cc: KELLY DUNK HUDSON SOCCER ASSN ~2~~ ~cT ~r7G/t'feonl • ~,~Po~oSED ~.c/fi~~/~~fTo/'t ~RA~l~rY //~~n!<tl ~Y`~''' v~ m ~' % nl w / S ~~ ~-- ~ v N C ~ o m C7 v j~o /'rc ~Lr SO G G ~ R ~U++'I ~~ £.~s T ~~ T~ G, r~ orc ~ Orel ~d~ n,~~ /~~j~ (~ (,{ /C/.a-~< !w~ ~~~?ESS ~ d 5 0~l P. 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Plan must Couniy include, but not limited to: vertical and horizontal reference point (BM), direction and ~,~ i ~~ IX percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION -Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ ,~ ~~ Pro erft~yCO,w~ner Property Location C~ y /~ ~U~1J"-~1~ L~ ~~ ~55/~ Govt. Lot ~'/~= 1/4 ill; ,~1/4,S ~4 T ~ 7 ~N~R ~/ E (°r)lV Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number ty ^ Village Town Nearest Road ^ Ci ~tAs~.~ ic.~r , ~'yof~ i ( > /.~r-~~aN I CTN "U~1 %, ^ New Construction Use: ^ Residential /Number of bedrooms Addition to existiny building ^ ReplacementPublic or commercial -Describe: Code derived daily flow gpd Recommended design loading rate Q ,~ bed, gpd/ft2 ~ ,~ trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum desi n loadin rated • bed, d/fl2 C~ g g ~ gp n. trench, gpd/ft2 Recommended infiltration surface elevation(s)~~~~~ r~ ~ ~Ah- ~ ~~ , ® ft (as referred to site plan benchmark) Additional design/site considerations Parent material. (J L,r4GJ d L ~Jt,~'I~(..JY.1~ t~ Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ~ S ^ U ^ S ~ U ~ S ^ U ^ S ~ U ^ S ~ U ^ S [~ U SOIL DESCRIPTION REPORT Boring # Ground lev. 9~1• d ft. Depth to limiting factor ~f~7 in. Boring # Z Ground elev. -1 / . L ft. Depth to limiting factor 5~in. Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench --~~ , 4 -~ ~ s 5G n.,1 - a ~ ~ 3, , ~1 S ' Remarks: p z I -- L 1 r~ cr >~ r Ck S Z 4 ,~ _~' & -rl ~ a v~2 4 - ~ S S~ 1 -- o . .g Remarks: SST Name (Please Print) tur Tele hone No. y ~t~r~~(s~N ~ ~~s6~ ~ A ress at CST Number o ~~ 9 i ~u s~ ~ ~ ~o Qo Z 7 I~l UJS~~ JQ~-~~~ ~~'~-"V SOIL DESCRIPTION REPORT PROPERTY OWNER PARCEL I.D.# Boring # Ground e ev tt. Depth to limiting factor >!23 in. Boring # Ground elev., 9`c ,'~ ft. Depth to limiting factor 7 ~Z / in. E . ~~ Page ~ of Horizon Depth Dominant Color Mottles re Text Structure Consistence Bo nda Roots 2 in. Munsell Qu. Sz. Cont. Color u Gr. Sz. Sh. u ry Bed ~ Trench 8 -z v~.~ ~ - s~t 2.~o,bK ~ es - o~;o.~ 8 :qs fcav 3 -- ~~ 5~, M ~ cs .7 ~o.~ B s ~ ~ 4 -- ~s s~ ~, ~ `" .7~a.8 ~~- ~s-' s3• ~i.Y ' Remarks: a U-~ 1av+22 t -- L Z,~t ~~ /h~r r S 2-~ p ,S ;0 ,~ -ZI ~ '} SQL ~ /h (~~~ M~r ~S - ~0~ ~-4~ y 3 4 - ~'d 5 SG 1 c s `' ~ -t2• 4 4 -- fns 5~ n~ ~ y Remarks: Horizon Depth Dominant Color Mottles T t Structure i nce C t Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ons s e ry Bed ,Trench Qi O-$ /D ~ 2 f -~ ~ Z ,~h r. ~ r~r ~5 Z~ b.S 0.6 ~23 0~/~ 3 3 - /~ 5 r-~ ~ ~-~ - O-7 ~ ~ - ~~ ~ ~ Q 4 ~" ~ ~ - Boring # Ground ev. 9 tt. Depth to limiting factor >' f/~ in. Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Remarks: SBD-8330 (R.9/98) : .r' 30~~ T~ P~oed~ZY~iN~ r J_qj- g. ~ _ ..~'~ . .. ~ _ S- ~" ~ ~z ,_ ~ ti 6cD, ~o cr~`1 I ~, .. v v ~$tac~fhn~x•Tc~P aF ~caA~ ~ SET 1 N CG1I~I f 1 .~ 1 EtE~ ~g.6 ~ 7 ~ ~ i ~-- - t gip..,-„~,..~~~„~.:. ,.,,. ~ e ,.._ _ :.. _.,. +' T. ~ ~ / 3 cL pZ N I ~ ~, J t l' ~ r q8• I ~ 1 ~~ ~ 1 ;~ N f ~ ' ~ • ~~1 1. . g4~ -~~~ ...~ ~~~~ ~ €u.~ 9. I ~ I ~,~~~ 4 ~' $asE~~-~ - I,JES~ ~rnc~ ~ 6R Co-~c~ss~ou Inc, ~ .1_.. Pac.E3oc'3~ B~~c~irodPK • 5w co~~-ta~.o~ . CSTA L E~~.v = /oo.oy .~ z u 4 a s m .r :,. ' I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 4 So,1/ ~o cc ~ ~2 Mailing Address p0 - ~o,,~ CQ rj ~ /~.~ S o~1 ~ ~ S ~oi~ Property Address SCI G"T' ~ ~~u u " ' / (Verification required from Planning Department for new construction) City/State ~C c~So~- GJ ~ Parcel Identification Number ~ ? O , _ (~ ~'3- -- / ~ ' ~ 3q '~'~ ~ oZD, /o~P - 3a - o~ -~5 4s-q-, LEGAL DESCRIPTION Property Location ~~ '/., N ~ '/4, Sec. ~X , T a~N-R ~ `~ W, Town of /~,D Soil Subdivision Certified Survey Map # Lot # Volume ,Page # Warranty Deed # !Z~ 32~ ,Volume ©~~ ,Page # ~~ 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 a three year expiration date. SIGNA OF APPLICANT 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 the property described above, by virtue f a warranty deed recorded in Register of Deeds Office. ~. ~ `tom-, L~~ S/~~ ~ SIGNATURE OF APPLICANT 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 the certified survey map if reference is made in the warranty deed DOCUMENT NO. ,~f _ ~~~salso`als°cxeir ~~f~rantn,• ~ s fr nery ~ .. WARRHrv ~ . _ .. Eder for the ~°..? !hc rclur,~ N Ur t cV f~c~ci ~3 3~~~ 1 n~j~j ~ °i• ngthela This Deed, made between .____.John..M...&aushn,ot- ---....-.--.-.-... ~ r ~_ ~~ ,~ ~"-',j ~:. ----------------------------------------------------------------------------------------------------------------- FE B 2 3 1994 -•--•--•--------------••--•-•-------••-------•-•-----...--•-•--•--•------•-••--------..._.._._...., Grantor, and.iiudscu~--Sa~~r---AssoEiation,---~no.-------------------------------•-•-------.... ~~ 10:00 ~, A•,; .; ---• ...........................•-•--•---•--------•------....-------•------•--•----•----......_._._, Grantee, Witnesseth, That the said Grantor, for a valuable consideration__._.. conveys to Grantee the following described real estate in _._St..__Crni.x ............. County, State of Wisconsin; ~ NE 1/4 of NW 1/4 and N "IO acres o.f SE 1/4 of NW l/4 of .Section 28-29-19, EXCEPT Lot 1 of Certified Survey Map in Vol. "8", page 2378. RETURN TO M. Finn i 30~/ 2-iic~sSTNa~u~son l~nk54016 Tas Parcel No : ................................... ~~~_ ~~ I This _._._.._d.s__zl.At_._.__.. homestead property. •(•is)- (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And .............IS?hA_.M....~s3u&11riSJt._..................--•-••--•-----•--------........_................._....-------••--•--••---•--...........--- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants and restrictions of record. and will warrant and defend the same. Dated this ......-----•----21~t-----•-- ................ day of -------February.._.-----.._.... _..._......---.._.......__, 19._94... •-----•-----...----•--•-----•--•---•-(SEAL) _ ..__.......~.J.---••-•----•-•-••----•---....----•---•-•---....(SEAL) * ..............•-•----..._...---------•--.._--•-•-------•----•----. :_,TQ)lIl_.~...X11.C~1JOA.C--•---•-----•----............_.. • ........................•--•-----._...------•-•-•-•-----•-•----•- --(SEAL) ---•--...._--••--•---...--•-•-•--•--.._.....---•---•--•--••-•--•--_-(SEAL) * * AUTIiEI~TTIC.a,TION Signature(s) ..............•-----•-•-----•-----...-._.._..._ authenticated this ___...._day of.._._._____________________ 19._..._ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, -----•---•-------•------------•----------------------------- ACKNOWLEDGMENT STATE OF WISCONSIN 1 sa. ST.__CROIX ___________________County. Personally came before me this ___.21st.._day of __ February________________________ 1994.._. the above named __John_ M. 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