Loading...
HomeMy WebLinkAbout020-1187-50-025Parcel #: 020-1187-50-025 02/27/2oos 03:32 PM PAGE 1 OF 1 Alt. Parcel #: 28.29.19.1177A 020 -TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/07/2006 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -MBH ENTERPRISES LLC MBH ENTERPRISES LLC 587 LENERTZ RD HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ` 583 LENERTZ RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.159 Plat: 5328-CSM 22-5328 020-06 SEC 28 T29N R19W PT NE SE FKA LOT 4 BlocklCondo Bldg: LOT 06 LENERTZ ADDITION (3.894 AC) BEING CSM 22-5328 LOT 6 (2.159 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 28-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 01/10/2008 867068 AFF 12/22/2006 841200 QC 12/07/2006 840238 22/5328 CSM 11 /23/2005 812792 2933/327 EZ more... 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06!05/2007 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 2.159 101,500 240,300 341,800 NO Totals for 2008: General Property 2.159 101,500 240,300 341,800 Woodland 0.000 0 0 Totals for 2007: General Property 2.159 101,500 240,300 341,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Section 111-Zoning Board Decision Process C. A specified number of copies of site plans, accurately drawn to a scale of not less than one inch to _ feet, showing and labeling: a. Landowner's name b. Preparer, date of preparation and revisions c. Scale and directional arrow d. Boundaries and dimensions of property for which the permit is sought, and all other lands within a specified distance of the boundaries of the property _= ~ "~ e. Location and dimensions of all existing and proposed ~ '_ structures on the property in question and adjacent ~ ~ properties, including: ~' ~ ~ i. Building elevations ~~,. ii. Dimensions, colors, and materials used on all exterior -- sides of buildings -- iii. Distances between multiple structures iv. Distance between structures and the ordinary high water mark v. Distances between structures and lot lines vi. Distances between structures and the centerlines of abutting streets and highways f. Soils information g. Topographical contour lines: _ foot intervals h. Wetlands, 100-year floodplain, shoreland zone and ordinary high water mark for any adjacent watercourses i. Easement labels and locations j. Adjacent public streets, centerlines, and rights-of--way k. Auto ingress and egress 1. Visual clearance triangles m. Parking and loading areas n. Utilities: existing and proposed locations and types of private well and onsite waste treatment systems, or connections to public sanitary sewer, water, and/or storm sewer. o. Grading and drainage plan, showing existing and proposed surface elevations p. Proposed erosion control and stormwater management provisions q. Any outdoor storage or dumpster areas r. Existing and proposed landscaping on the site, including the location, species, size at time of planting, and mature size of all new plantings s. Signs: location, height, dimensions, colors, materials, lighting, and copy area of all signage t. Lighting: location, height, type, orientation, and power of 54 all proposed exterior lighting Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM ~"~. Safety and Building Divsion ' INSPECTION REPORT `; ~~~ GENERAL INFORte1ATION (ATTACH TO PERMIT) ~~ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Howland, Michael Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: i~ gin ~ cs ~ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER / ~~ CAPACITY Septic E ~ 32. 5 Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic > ~ ~ 3 ~ ~ /5 i > /~• i J ---_. Dosing Aeration Holding PUMP/RIPHAN INiORMATION Manufacturer Demand GPM Model N er TDH Li Friction Loss System H TDH t Forcemain Length Dia. Dist. to Well Cf111 ARC(1RPT1(1N SYSTEM county: St. Croix anitary Permit No: 488025 0 tate Plan ID No: Parcel Tax No: 020-1187-40-000 Section/Town/Range/Map No: 28.29.19.1 6 STATION BS HI FS ELE . Benchmark ~ ~~j,$~ I~J~•$I ~~~ Alt. BM~ i , ~/7 • ~ Bldg. Sewer St/Ht Inlet 2.z ~I3.5 St/Ht Outlet Z •.7z ~~ ~ b~ Dt Inlet Dt Bottom 1 ~ Header/Man. * ~. 5 9 ~ • °~3 Dist. Pipe t3.3$ Ja2.a ~ 5. 97 •9 3 3 Bot. System ~~ ` Final Grade ~ ~ •' 9 ~ ~ ..~ 2 St Cover: ~~ ~cJ +~. $ ~ ~ `1 . (p ~ 5.S 9,93 ~ ~' b ~7 95 .? 3 BED/TRENCH DIMENSIONS Width ~ Length / ~ No. Of Trenches ( PIT DIMENSIONS No. Of Pits _ Inside Dia. Liquid Depth \ ~ 7U~}- „5 Z ~~ ~V ~ _ SETBACK P/L BLDG WELL SYSTEM TO LAKE/STREAM LEACHING CHAMBER OR Manufacturer. r • ! ~ / J INFORMATION f~yste r n Type O r~} ~~ / "~ ~ /l~ I ~ /~ UNIT Model Numb :~ ` a I ~ r\ICTDIRI ITIa'1N CVCTFM G_ , 1 J~ f- ~ 3 = ~Z 7 caw „~cc ~.~.."__"_.' _' Header/Manifold ~~ v Distribution x Hol Size x Hole Spacing Vent to Air ntalie q / ~ Pipe(s) ~ ~ ~ in S a h Di ~ ~ Z Ova.` Length t Dia _ g p c a Lengt ~~n nr'\\/CD __ .,____...._ ~.._a_~_ ~_~.. .... ee.......~ n. Ar_Gr~rin SveTame r7nly Depth Over ~ C~ Bed/Trench Center ~ ~ ~ ~ji Depth Over Bed/Trench Edges\ xx Depth of Topsoil xx Seeded/Sodded Yes No xx Mulched Yes No COMMENTS: (Include code cfiscrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 587 Lenertz Road Hu son, WI 54016 (NE 1/4 SE 1/4 28 T29N R19W) Lenertz Addition Lo 4 Parcel No: 28.29.19.1176 MM~' 1 ~ •~ 1.) Alt BM Description = v 2.) Bldg sewer length = ~ ~ ~~~"•' a v~ D~ ~~ ~ ~ ~~ ~' 1 5A ~ ~ •~.gs - amount of cover =Z 1 t~ ~ 1 G~„~ ~-- ~, o e~,a p~~ C. ' __/_~ __ Plan revision Required? 'Yes , i No ~ ~ ~ _ _ (0~,3i7 71~ Use other side for additional information. _ _. ` '°'_ _ -- - --- - Date hisepcto s SignaLre <- (~ /~ 11 Cert. No. '''SB''D__-6710 (R.3/9 IR Csint~ ~ a ~,4,~~ ba,s)ti ~~' ~t b0a'4S Cam. Qrut2 ~G'1~tw 1 1 C~'~o~dViAt~t~ ~ t`..:~ t,Jo.~w ~~WS ~.~ ~e~`~,ta,~e~ ~~ ~ 5id1.e.J ~~,.rt,~' ~?w.e.. q~ das~a./'gR~D Sav~nA/l~e J S and uildi 20 eV C unty ~ ~ ~ . ashi on Ave., P.O. Box 7162 ~~O~~,~ Ma 6 I 5 7 266=3~'Y " ~ 2~0~ S itary Permit Num (Io be filled in by Co.) De ar ( y~~O2 J ,. Sanitary Permit App ~C 1 T• CROIX COUNTY ~ Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal fo may be used for secondary purposes Privacy La 15 . )(m) oject Address (if different than mailing address) I. Application Information -Please Print 11 Information ~~ Property Owner's Name ~ Parcel # # Block # 540- ~ \ Property Owner's Mailing Address Property Lo ~ ~~_ % S i ~ ~' ~ Ci S h', } Zip Code Phone Number <, ect on _ , [~~ ~ ~ ~ ,~j -'7/,, r c o e) ~ (~ / U/ ~~ N R II. Type of Building (check all that apply) ~ , ~ ^ 1 0 2FamilyDwelling-NumberofBedrooms Subdivision Name CSM Number is/Commercial -Describe Use ~, '"~ ~~ ~G ~~ ~~ ^ State Owned -Describe Use - ^City Vill wnship o III. Type o Permit: (Check poly one box on line A. Complete line B if applicable) O b ~ _ c~~ A. System "~~-~ ^ Replacement System ^ TreatmentlHolding Tank Replacement Only ^ Other Modification to Existing System B_ ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. a of POWTS S stem: Check all that a 1 ssurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In- nd ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ ReGjr~ating Sand Filter ^ Recirculating Synthetic Media Filt Leachin Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) G ~ V. Dis ersal/I'reatment A nformation: DesignFlow (gpd) Design Soil Applic t t/e(gpdsf) Dispersal Area Required (sf) Dispersal Ar opos Syste levation VI. Tank Info Capacity in Total Number Manufacturer /~ Prefab Site Fib Plastic Gallons Gallons of Units b 7 Concrete Constructed Glass New Tanks Existing Tanks ~ //~~ ~~-- ~"LJ t'-~~ Septic or Holding Tank rp1 titer Aerobic TreafireM Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, a responsibility for installation of the POWTS shown on the attached plans. Plumber's N e (Print) Plumber's ~ MP/MPRS Numbe Business Phone Num 2~~~~ J ,~ .umber's Address Street, City, State, Zip C w / t~f~ VIII. oun /De artment Use Onl ./lpproved ^ prove ~ Sanitary Permit Fee (includes Groundwater Da Issu Issui gent Sign o S ps) ~ ^ Surcharge Fee) ~j ~ ' ~ ~ Z q S ~ Ohai Reason ial ~J t 1X. Conditions of ApprovaUReasons for Disapproval SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must all be services / mehttairtad as Per management plan Provided by Pkarnbe-• 2 AN talbardc nquir~rlenls mtatt be mairtlaNNd se Par apploable code / ardirwtoat. -- Attach complete plans (to the County only) for the system on paper not leas than 81/2 x 11 iuchea in sine SBD-6398 (R. O 1 /03) PLOT PLAN $ROJECT Mick Howland ADDRESS 698 Ctv Rd E Hudson Wi 54016 NE 1/4 SE 1/4S 28 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 103.0/101.5 GPD 335 CONVENTIONAL XXXX AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 800 gallons LIFT TANK SIZE DOSE TANK~~,S~~IZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA~~~~ of chambersy~2.7 BENCHMARK V.R.P. TOp Of 1/2" pipe ASSUME ELEVATION 100' Filter .Z~a~b--elA-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Lenertz Road The Dry Dock 3000 ft^2 retail area 6 employees 3 floor drains Holding Tank The catch basin in the repair area is to discharge into the DNR approved holding tank 320' I uffcutt 800 Gallon ST Ca1cs: 6 employees X 13 gpd/employee = 78 gpd 3 floor drains X 25 gpd/drain = 75 gpd 3000ft^2 X 70%/30ft^2/patron X 1 gpd/patron= 70gpd ~,, Total gpd= 223 X 1.5 for peak flow = 335 gpd ~~` 335 gpd X 2.088(magick tank number= 700 gallons ~, ~,~ using a Huffcutt 800 gallon tank 335 gpd X .5ft^2/gpd = 670 ft^2/31.1 ft^2/chamber = ~.~~ 21.5 or 22 chambers! ~~~ ~„~"' B - 3 106' `y`_`` r ~„ ' -~-~ 104' .~ -1 ^ B-2 B.M. * ec~ 102' ~It.B.M. 16% Slope Scale = 1 /4" = 10' 541' Property Line FROM :THE DRY DQCK LLC, FAX NO. :7155496267 Apr. 19 2006 03:59PM P2 ~ r sty o~m ~ oEPaanur~rr of ~u-ru~-t. ~souac~s wr s~oa Scott ~' Tdphotte- 71'.R4if~14 t1~OF1U111RALl~SOtIRt2l6 FAX 715~p4.~W '~"""" T7'i/ Aaaeaaas vM oat~pry - T11 AprH ]9, 2006 Mc Mick Hamad, Pieaidaat The; Dry Dock, LLC 589'[.e~ertz Road Hadaon. WI 54016 Subject: ~1-PD&R Cesetel Paid 11a WI AOSIiSi,Z, Wa~ewa~a~i+kr~ Warii~ Vd~kk~ Pro jed I~ 'Y'be Dry Uoc#, II.G Dbdsatge Lees~Oet: Qeassod Ater Santb and Ead odBuad~ng Dear intr. Haw~and: I am phatsed to inform you that the tug~e at the wash aster generated Brota your bout a~asbitg opetatto~ is e~fe tar the etrobaed gmaat permit. 't'lte waaatea-atar ®eaaa0ed by the insoYrle sed wide boot aw~tmg operaoiori wi8 Aow by gravity M a grassed area sotHh and east of the Dry Dods bu~rtg 7'bew araeb aq~er vtrwme is estimated at 150 gallons daily and wdl cot any detesgeals or aalt~eiva~ Please ~ tbatt the ww>~eaarater diacbarge is autboriaoed under ibis permit Soon the date of this letter unto Mar+cb 3I, Z009. >f ibe scope of the project is altered oar op~iotas rroaa tha>se dastaribod in the request Tor vow order ibis peemll, mtiii- me y m deoermiine if the project can aomirate ttoder the genewl permit tasgtmeaoeds. Additiooat a~ormasion it~rdietg the Departaaeae's legal aothnrity in this outer. sad year tigigt of appal ate sbatrn am dte attstabed aLeet. If yott have soy qs '~6 ~ Pte, er.riiea Dexw~mteet eofi6eadioa is requited. plewe ooetact ate art (7l5) 684-2St1~ eat, lOt. ter, Peter W. Slooosetb, P.E. Frniroaarpengl Bn~eer Amtd~ats: i~d Amboriieies Goatxal Permit wl•OOS91sZ-a C: Daaidle Fug - elecetonic Dopy for SWAMP emry tlnrvri.gov Qrra~lylVaasal Rem Mara FROM :THE DRY DOCK LLC FAX hl0. :7155496267 Apr. 19 2006 03:59PM P3 LFGAC. A[TTHOR1TlES and APPEAL BIGHTS Suction 283.35, Stater`, antlwriaes the DepaRmeat to iaaiu a gpreral pernpt flar tt~ ~ dosses o~Ppoint sources. The DepaTppeat miay withdraw a + from coverage u~ a general Peet fit is debe~oed that a di'chug~e is s for of pp1lutan~ to waters of Rr>scausin, ifthe: source is sot ie campi~spe l1 P~ rf you request ir, or m cerriin other oases set out m :2$1.35, State, m &o of ~Y tr.~r ~Y viad>lion o~oVPDFS Pelmet No R-I OWG558-3 to tie ~ of Iusfice for eNbr~oemeat under s 283.89, Stars, If you beli~v~e coverage of this ~ udder this perttdt is noR appropriate, y~ae mry Petidcn tha Uepertmemt 8or withdrawal of oovdr~e amdy whoa appropriate; spP}1- for iaauaac~e of as indnridwl WPbtr'S. permit prssosait W 9erdiprr 283.35(2), . lsruattoe of such as permet will provide Sur s puh8c oormheat period sod, pY, a public i~ormgttioeal hesrirrgrg and/or an adjo~ory !raring Nom. ~ ~Y regtreR l or adrraaistrat:ve review of the DepartmaaNs deriaiaa do cover your discharge under the enclosed geoearyd pattdt. F,,t4evr toquest mu:t be submitted m timer thst 30 drgrs atiDer this !error was maned To rs~quest judica~I tevrcw of ttsis deciaian purauarrt m seotivns 22'1.52 and ?27.53, Stars., s petition SRS ~ of Na~ral Resouroea ss respondeet moat 6e filed with the appropriate cinadt court sdf served car the Dot. To request a and case herring dr t3ria deosiora prrraumt m soc~on 277.+tld, Sots., a petitiwn far heating terrier be saved oa the Seaetaty of the Depertmerrt of Natural Rxaoutoe=. Tlaa trntioe i3 provided ptasuaat to s. 227.48(2 Stars. cornmerce.wi.gov ^ ^ isconsin Department of Commerce December 07, 2005 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING,INC 1008 192 ND AVE NEW RICHMOND WI ATl1V.• POlFT5lnspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin:gov Jim Doyle, Governor Mary P. Burke, Secretary CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/07/2007 Identification Numbers SITE: Transaction ID No. 1220776 Mick Howland Site ID No. 708082 Lenertz Road Please refer to both'identifcation numbers,.. Town of Hudson above; in ali corres ondence with the a enc. . St Croix County NE1/4, SE1/4, S28, T29N, R19W .Subdivision: Lenertz Addition; lot 4 °" FOR: Description: Proposed Commercial Non-pressurized In-ground POWYS Object Type: POWYS Component Manual .'Regulated Object ID No.: 1054461 Maintenance required; 335 GPD Flow rate; 100 in Soil minimum depth to limiting factor from original grade .:System: In-ground-POWYS Component Manual, SBD-10705-P (N.0.1/O1); Biodiffuser Leaching Cliambers; Biofilter 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. . No person may engage in or work at plumbing in the state unless: licensed. to do so by the Department per s:14S.06, stats. _ The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved glans and with the "In-ground Soil Absorption Component Manual for Private Onsite Wastewater.Treatment: Systems -Version. ?.o", SBD-loos-P (N.ol/ol)._ • The leaching. chambers rnust be installed in accordance with the manufacturer's printed uistructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135-and 145.19, Wis: Stats. + Inspection of the POWYS installation is required: Arrangements for insgection shall be made-with the designated county official. in accordance with theprovsions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance- information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • 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. P.O.t~'d.T.S. Car~c~itFOnc~lh,~ ~Q~E~ ' SHAUN R BIRD Page 2 12/7/2005 • This approval covers only domestic/sanitary wastes directed into this system. The Department of Natural Resources must be contacted regarding the treatment and disposal of all industrial wastes; including those combined with domestic/sanitary wastes. • Comm 83.22(7) - A copy of the an roved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the D~artment which may include local ins ectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(x) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption . system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow-the contingency plan as described in the approved plans. • The'owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes.. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed Below, or at the address on this letterhead. The. above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ ' .0.00 Gerard M. $wim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. =Fri. 7:30 am to 4:15 pm WiSMART code:.7633 jswim@commercestate.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 12/4/05 Owner: Mick Howland Location: NE1/4 SE1/4 S28 T29 N,R19W Lot 4 Lenertz Road Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. System Plot Plan 3.Chamber Cross 5-6. maintance and 7-9. Soil Test Signature ' License num RECEIVED OEC - G 2005 plan SAFETY ~ BUILDINGS SAFE? u ttU-~'1NGS p1'J-S~u~+~f NDENC;E SEE C%GRRES Gross Section of Standard Biodiffuser Leaching Chamber Typical cross section for 2 of 2 cells Standard Biodiffuser Leaching Chamber with-~.~-ft2 of Area z. ~-.~ Typical Installation Vent ~ Grade 4' 4" ~~30/34 Septic Tank `-- 1 " 5' !~ ong 34" Grade at System Elevation Spacing 5' System elevations: A_103.0 B_101.5 To be >1' above grade Finish grade elevation 106.0'/104.5' >Vent 4 Long 1 ~~ Grade at System Elevation 2-3' X 69' Cells Same on other end Observation tubeNent 9.5' -~~ A B ~'4,chambers per cell ~ i~{ -~ -3 Page of n ..,~. Vstues HPtm ~ domestic (noc~oomme~n wasterratar optic tack erlruent. ter. Yatues tYP~ ~ ptitrtated ~~ ova licenses or one of the #e(towin9 tamer, Septa9e ~yFiTENANCB lt+iSTRUCTiON~i cells shaft be made by Sn ind-"tvidual carrying ~~ POWTS tt1[atn in or broken of tanks and di'ispe Restricted Sewer. POWTS inspe $ ,~ identify anY miss 9 Inspec6oc'~ .Master plumber: Mater Plumber pn of the tank( edc fvr any back up aEKtifi~~'. ns must indude a visual inspe~ ed sludge and scum and ~~ rite emuent levels Servidng flP~r• Tank ins flp~ks~ rrteasure the volume oflco s~ [I ~ visuaitY inspected of eftiuent on the nding ha~m• ~~ anY ~~ round surface- The dispersal tx t ~ round surface. Tt~e Pp at,t}tority. or pond'inq Of etf(uent on the g for any ponding of effluent on file 9 Option of the local regutat>Dry in the observation PrP~ and to check urres me immedrate nob or more Of the tattle volumt:, the ~ NR indreate a failing cond'riion and r~ Is one-bird (~ wirh groom ~~ meY a and scorn in any tank aqua of in accordance rrtulation of sluff ~ a $eptage Servicing Operator and dispoS~ when the combined acs ~ and anY entire corrteMs of the tank shall be rem ~ retreatt~ent cornPonents; in pdministra~e Code. onents, p 5ed pOWTS Maintainer. 113, Wisaons nicai or pressurized POtA(tS comp ~prmed by a ~ . of effluent filters. metxta of ~mpietion of any service event The SeMCin9 at intervals of 12 months or less shall be p? other maintenance or mocirt0 a 9~ to ~e local regulatory authority within 1 Q d~ A sere report shag be Pn~ nce of painting products ar other treatment tanicts) fir the P~ trabons are START t1P AA10 OPERATION pO,~S check. ersal ~(I(s). If high concen For ttt~w c7onstruction, prior fro use of the s and/or damage the dispo rator prior to use- chemicals that may;mpedeof U~ee~k(~ e~ ed ~` a septage servicing pe detected have the contents ENS PLAN Nt,ANL1AL $~ MANAGEM QOWTg pY1lNER S SYSTEM SPEG[F[CATiONS • ~ _ Page of_,^._ /~` conditions are frozen at the infiltrative su-iace- is ~ ~ r3XCes5 . gysl~em startup shalt not occur men ~~ 8bova nomtal hcghwater levels- >~en P~ s ~ may result in the mpg pump tanks rr`;sY ~ ~ petits) ~ one large dose. oves[~ ~nof the pump tank removed by a ,fir ~nrr~ ~ d~hatge of a uecitPTO aYO~ th ~ ~e effluent pump ~ ntad a P{ttt°~ ~ POYYTS Maintainer to e~Secvi~' s 0~!~ ~~D•~~ toriPStote normal levels wiff~in the gumP ~-. dl~ ~r 00[111paCt, asscst in tnanuaaY oPeral~ng ~ p~'P ~~ cells. Oo not drive or pack overt or otherwise . rk vehicles over Tanks and dispersal po not drive or pa moernd or at-grade sat? absorption at>ea- ~~~ and prolong tfte the the area r~tthin 15 feet down slope °f anY ter stream may improve the pe nation of ttre fol(o"lvin9 f!'i0m the ~ cotton swabs; deg: denfa(8oss; diapers: Reduction or.eGmi ~ dgarette butts; condoms; eftn s, asoline; grease:- herbicides; treat ~ ~ POWYS: antibiotics; ~y ~lJe' vrater, fruit and vegetable pe 9 " g tida~on dia(n (sump P~p3 na Eons: tampons:'and ~~ softene< bcine_ . d-~~rtts; fat; fou n raduc~: pesttudes; sanitary P ~ _ soaps: ~' oa ~b g P steps shoo l~ taken to insure that the ggpNDOt~MENT andfor is l~ tatCen out of service the following Code: anently sin Administrative When the t'OWTS fats ~( in compliance with ~-- Comm 133.33, 1Afrscon s sealed system is ptoperlY ~d safeh ~~ disconnected and the abandoned Pipe opening in to tanks and pits shall ~be _ . disposed of by a SePta9e Servicing Opetato~ All PEP 9 rt,, shall be removed and P~Pefi' The ,QOntents of air ffinks and P rs removecr and tfie void spare cmp~,q, al[ tanks and pits shalt be excavated and removed or mein cove After P revel or another inert solid material. fitted veittt soil, $ CONTiNGFNCY PL-~ the foitowing n'-easures have been. ar must be taken. to Provide a code if the POWYS falls and cannot be repaired cement soil o~mp nt ~~nent system n evaluated and may lye utilized for the location of a ~n and should not A suitable rep{acernent~area has bee rotected from disturbance and comps %bsorption system- T~ replacement area should be P sect structure. tot Fines and wetfs_ Failure to be infringed upon t>y requrr~d setbacks from existing artd propo the re lacernent arEa will result in the need for a new soil and siteevaluation to establish a sttttab e protect P R Cement Systems must comply with the rules in effect at that time- advances in POWYS replacement area- eP , p A suitable replacement area ~ ~tm~il~ as a las resort o rep;arce the failed POWT'Sn9 . technology a holding tantc may n tailurie of The POWYS a soa.and _ tb identify a sortable replacement area. Upo iacernent area is available a. p The site has not been evaluated th locate a' suitable replacement area_ if no rep site evacuation must be pe~~ removal ~ the biomat at twtdng tank maY ~ ~stalied as a last resort to replace The failed pOVYI"S_ n systems may be reconstructed i! pig ~ [Iowl~ngn e~ at that time. p Mound and at-grade sorT abso ~~ of such systems must comp Y the fnfiftradve surface. Reoonstru ~cyilARNtNC~~ .1-ME~ T,4NKS MAY' GOl~r7'ALN LETHAL- GASSES ANDIOR INSUFFtCiFaIT OXYGEN. SEPTIC, PUMP AIdD OTHER Tt3F'A' TMENT TANK UNDER ANY CLRCUMSTANCES. DEATH MAY DO NOT' ENTER A SEPTIC, PUMP OR OTHER TREA RESULT. _ RESCUE OF A PERSON FROM THE INTERlOt2 O~ A TANK MAY BE QtFFICULT OR (MPOSSlB anQmonlA~ coMiKerrrs , ~ . POWYS 1NSTAL[.ER ` Name ~-~ , J~ ~ Phone J ~„ ~ ~ J.- POWI"S MAiNTA[NER Name ~ ~ /'/~ Phone ~ 1 y'or ~ ! '1J ~ e~ I_ocal._ iz.EGUtATORY AUtNORiT1f -~ SEPTAGE SERY(C(NG OPERATOR PUMPER ~- Ll Agency ~~. ,,/- c Name ~ r~ ;~ ~-''J Phone j j~~. ~ U E~ / Phone r- '"" This docrrrnent meets ._-. The smlfs of the teen lake. ty(anTcrette and Waushan County Zoning and Sar+it2tion 2PEf1ciPS- nOt This Qoa was kkattgd by ! and 83.56(1}. (2t 8. (31. Wisconsin A~6minisYatna Cade. Use of this d~rrnent does g,e minimum regw~ements of dt. Comm 83.22(2)(h)t X~(>7 - ~tW lyiDt) guarantee the performance of the f~C7V4tTS_ ~, .Wisconsin Department of Com rce SOllj -EY~LUATIO PORT Page of Division of Safety and Buildings ; , , , . +.a e, m acwrpanc~ ~n ~-ornm ao, vvis. ram. ~,ooe County ~ ~,0 , Attach complete site plan on a er not less than 8 1/2 x 11 inchs in size Plan must p . indude, but not limited to: ve 'cal a-Sdh6rRb114~Kt~l-~oe poin '(BM), diredion and _ _ Parcel LD. d ~j ,,. ~~ $ 7 yU O percent slope, scale or dime ions, n3~IttSnQ~-b~ation ar'd distance to nearest road. O p Please print all information. Review by Date Personal iMormation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~Z 9 0 S Property Owner ~ ~ Property Location l ~/ G Govt. Lot ~ 1 /4 5~ 1 /4 Z T p~~ N R' E (o W Property Owner's Mailing Address o # L.. Block # ... Subd. Name or CSM# h-~~ AX ~/" City Stat Zip Code Phone Number ity ^ V'Ilage Town Nearest Road f ~ ti ~sl 1 ~~s) sy9-Ga .e,,,er ~ s ~ew Construction Use: Residential /Number of bedrooms Cod derived design flow rate GPD ^ Replacement ubl•ic~~or co~mmeraal -Describe: U~M. ____,_________.__ __- Parent material _ ©L[if':"~t ~cL1~ Flood Plain elevation if applicable ~~,~- ft. General comments and recommendations: 1 J~ ~ ~ / j ~~--~ ~~~'Ci l ~V CJC,~~ / s / I sing # LJ Boring i tel. `7_ 3 X95 i M ~ t r r ~ pjt vrouno surrace erev. i v • r n. veprn io ummng raaor r v ~ ~r~~ ~jl lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft= in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. `Eff#1 `Eff#2 o ly v 3~~. ~ ~- m~ ~~-- ~ - ~, , a ~-- 4~ ov ~ ~-~ ~'S- 6 /n f ~/lr4- ) - ~' l- !~ ® Ong # ^ Boring ~j 3 ~ 5 ,/ ~..Eit Ground surface elev. ~OC' J ff. Depth t~ limiting fador,~~ in. Soii lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ~-/ ..~- ~--- O~ rn ~ ~t4 - S- l~ f It • Effluent #1 =BOO > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent fY2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~~--~~~--~,-~-- 715-246-4516 Property Owner Parcel ID # Page of ~~ # Boring , ~ / .~ 3 it Ground surface elev. L ~ ft. Depth to limiting factor l ~~ in. Soil lication 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 ~ ~1 ~- -~~ ~ .~ ~ ~~ Z ~ L-) ;T ~r ~ /~ l'~ f 3.~ '' ~ a ring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EffiY2 ^ Bonng Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODE > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 mglL and TSS < 30 mglL 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. SB0.8330 (8.6/00) ~.. Property Owner Parcel ID # Page of Boring # Boring / /'1/I_' ~ .~-~ it Ground surface elev. ~ ft. Depth to limiting factor l ~r7 in. ~1 iced ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f1? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 1Z- -___, ,~ ~, -, / ~~ 1 3.0 'r ~ a ring # ^ Boring ^ Pit Ground surface elev. ft. Deptfi to limiting factor in. Soil ication Rate Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~~ # ^ Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soli ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/ft: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 rngA. and TSS < 30 mglL 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. seo-e~~o nt.~oo~ r a Soil Test Plot Plan r Project Name Mick Howland Sha i Address 698 Cty Rd E Hudson Wi 54016 M #226900 Lot 4 Subdivision Lenertz Addition Date 10/20/05 NE 1/4 SE 1/4S 28 T 29 N/R19 W Townshi Hudson Boring ~ Well PL Property Line BM or VRP Assume Elevation 100 ft. System Elevation 103.0/101.5 Alter Sc. un: no~ p County ST. CROIX Top of 1 /2" pipe * H R PSame as Benchmark W~i::or~sin~Department of Commerce Division of Safety and Buildings -_ [~ New Construction Use: (~ Residential / Number of bedrooms 3 _ ~ Code derived design flow rate ~ G d GPD ^ Replacement ^ Public orcommercial -Describe: ~ -`-"' Parent material UU'F-w'a-S t^ Flood Plain elevation if applicable '~ ~ ft. General comments S~s~C vn e l e J • >~~ Q(). Sp Low ~ -^ 89 SO \ ~. .%~ and recommendations: ~ , !H- ~...~. ~1 t V . ~rQ 9.~ d~ tro w a tr 9 Z • v0 ' ;~ RECE~ ;~. _~ ~- I ` ring , •, GOlrl'T`/ ;.~; Borin # g [~ pit Ground surface elev. 9Z•U d ft. Depth to limiting factor ~~~ 4t1~' ._ ZOP1~GaFEiGE ~'' Soil n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boun ~' Foots ~ ~ /fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~'~-'--..,...: ..,,-'Cif~1 *Eff#2 Z . z _ao l~~(r 3 ~ ~-S /~S yr -~~ C S - . `7 Z Boring # ~Ing Pit Ground surface elev. 9~ ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / /,~ ~ * Effluent #1 = BODS > 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) tore ~~ CST Number ,pct arc ~S ~~,,, ~n ~ ~ ~ ~ ~S.~3a ~' Address Date Evaluation Conducted Telephone Number z// ~U '~ S~ ~~~~-~- cv( S-yozs- 9'-z y - oa 7/,S'=zy~ -yam SOIL EVALUATION REPORT Page ~ of ,. m accoraance wim ~,omm aa, vvis. Ham. ~,oae County S r elf Plan must lete site lan on er not less than 8 1/2 x 11 inches in size Attach com a p p p p . include, but not limited to: vertical and horizontal reference point (BM), direction and Patel i.p. Z 0 ' ~/~~ ' ~ ~~v percent slope, scale or dimensions, north arrow, and location and distance to nearest road. G Please print all information. ~ b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). `~,(/j/1/4~'~ J Property Owner ~ ~ ~~ ~ ~Cy ~ Property Location E ~l N R r0 Govt. Lot ~ 1 /4 1 /4 S (or ~ T Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ^ City ^ ~Ilage ~] Town Nearest Road //` ~ ~- / ~ /l Property Owner ~ d ~ n .5° -~ Parcel ID # ~. Page ~ of ~ _ Boring # Ing Wi Pit Ground surface elev. • (D d ft. Depth to limiting factor ~ in. Soil lication Rate Horizon ~ Depth Dominant Color Redox Description Textun: Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 O-!Z /0 ( Z L Zrn ~~ ~ ~ ~ ,~ ,~ 3 ~~- ~ ,o. ~ ~ m c~ s ~ ~ ~ ~- - 7 i ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft? in. Munself a, Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L 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. SBD-8330 (R.07/00) PAGE .3 OF 3 NAME ~ o l~ n co ~ LOT# ~7 LEGAL DESCRIPTION ~ F '~45 ~Y4 S 25t T 1q ,N,R (a E (or) SCALE: I"= ~~ BM 1 ELEVATION /00 • d BM 1 DESCRIPTION 11U ~(; n /~ •~ L°ecQ1 r~re -C BM 2 ELEVATION Q 1.00 Z $ Sec. BM 2 DESCRIPTION- ~p o~ I .,~o~ P•Pe SYSTEM ELEVATION ~b P `f 0.5'p Gtxv e ~`(. Sa' _. ~`x -- ALTERNATE ELEVATION•1ap43 ov l.•o,,JCr'42.o0 CONTOUR ELEVATIONgZ• oo, q ~. o a, 9(~ •OD ~- ~~ ti. \(~ f3MZ . a,.r t ~~ 1~I-~-+' . ~ t'f'~'rn~ . _ QZ' D 1 3-t DATE .~ - /~ ' 2-3 80.00 335.10° 138.56' N 30°22'14" W X40 00'00' 4 80.00' 156.49' 132.71' S 85°40'05' N 112 04'x" 5 80.00' !78.61' 143.76' N 25°40'0'3' E iZ7 ~',~` TILLS ESTATES II ~-- 329.48' 5 3.404 ACRES 148,.276 S.F. n 0 v u~ (+'! W d' cn. O~ O O 50.00' 2 b A I CEDAR HILLS ESTATE8 ~ EAST-NE ~ S 89°37'46" W 1301.48' ' 110.30' 84.05' 510.35' y ~~ , 3 ~ ~ LENERTZ y y , - \ - ! \ i 1 \ \ ,e!---~---- ------ i - .Ot 1 ~ ~ ~ u~i ~ ,~ ` 2 '~ -- --- - - ~ ~ ; BUILDING ~ / a ~`~, 9 ~ ~i ~ ~ c Il1 ' i ~_-- o is n o~ N O aD N m d 3 M1 . -. - ~ N N ~ N 3 • " 3..297 ACRES O ~ 1.619 S.F. Z 3.894 ACRES w 169,:601 S.F. a e O O Z n v m u'1 N N _ 0 N 3 N N e O O Z N ;' O IA , O e O ... O 363,86' 248.10' N 89°34'48 E 7 1.96' UNPLATTED LANDS ~. ~l ~~~5 P 3?~ State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Number ~~ Document Name THIS DEED, made between Michael R Kranz. ("Grantor," whether one or more), and Michael Howland and Barbara Howland. h >> G ha n rl a n r4 ~ ; t A as SLrti,i c~n~i ~ mari tal ~ rc_ nTart~ ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lots 4 and 5, Plat of Lenertz Addition to the Town of Hudson, St. Croix County, Wisconsin. 8 1 1 673 REGISTER OF DEE S ST. CROI% CO. , IiI RECEIVED FOR RECORD 1i~09~2005 10:00AM NARRAATY DEED EffENpT # REC FEE: 11.00 t'RAKS FEE: 1160.70 COPY FEE: CC FEE: PAGES: i Recording Area Name and Retum Address RVAT 2685623 o2o-Ilse-ao-ooo & o2o-Ilse-so-0oo Parcel Identification Number (PIN) This _ homestead property. (jp~ (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, itany. Dated October 27, 2005 R Kranz (SEAL) (SEAL) * r AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on Wisconsin STATE OF St. Croix ss. COUNTY ) TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on October 27, 2005 ([f not, uuu+t the above-named Michael R. Kranz. authorized by Wis. Stat. § 706~Q~,G I,~S ~,,~~ ~.~ ~~ , ~ ' ' ' ' ~ , 0,`% to me kit6tvn to be the person(s) who exe d the foregoing THIS INSTRUMENT DRAFTED B~2 ,' ~•(ARY '. ~ ~s ent and acknowledged the s e. =o:z ~ '2= Attorne Kristina O land = U - - = G~ ~ l Y_ a Hudson. WI 54016 S-~r P A ?y? onnie M. G lixson '~is'p~' ~ .. • • SG~~~~~Notary Public, State of Wisconsin ~'~igTEtOFt,~p~~` My Commission (is permanent) (expires: - 1 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY [DENTiFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM N0.2-2003 * Type name below signatures. INFO-PRO"" Legal Forms 800-655-2021 www.infoproforms.oom ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT OwnerBuyer Mailing Address Property Address City/State AND HIP CERTIFICATION FORM Parcel Identification Number G.Z C7 "liG d ~~'~(~ j~ LEGAL DESCRIPTION ~~rr Property Locatior/~i '/~/ - 1/a , Sec. ~ , T ~/ N R W, Town of Subdivision ~e'~~%!.%l~s, c"~l/`I/ij~`~f ,Lot # Certified Survey Map # ^_ ,Volume ~- ,Page # '~"/ `~~ Warranty Deed # ~! I~ ~ ~ ,Volume ~ , Page ~ ~/ Spec house yes /fio ~ Lot lines identifiabl yes o SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all stat ents on this form are true to the best of my/our knowledge. Uwe am/are the pwner(s) of the property descri above, by ue of a warranty deed recorded in Register of Deeds Office. J n \ /t~ NA ICANT(S) DATE *** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.*** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. rf ,D S ~ ~ L~ C.^Qiy~ lam. ~X1 (Verification required from mng & Zoning Department for new construction.) (REV. 08/05)