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HomeMy WebLinkAbout020-1082-90-000,,.OM4MERCIAL TESTING LABORATORY, INC. 514 Main Street, P.O. Box 526 Cvifax, Wisconsin 54730 715 -962 -3121 800 - 962 - 5227 ST. CROIX ZONING REPOT N041 25936/01 ST. CRDIX COUNTY REPORT DATE! 7/17/92 C�THOU KJDSON WI 54416 DATE RECEIVED! 7/15/92 ATTN! DOW C. NELSON OWNER## Mi'ichaet b Martha Breard LOCATION! 421 Deer Haven Dr., Hudson, WI COLLECTOR! Mf. Jenkins DATE COLLECTED! 7 -14-92 TIME COLLECTED! 3l30ps SOURCE OF SAMMPLEf Laundry faucet DATE ANALYZED17 -15-92 TIME,ANALYZED /2100 pS,,, . COLIFW,Mfi 0 /100 sl INTERPRETATION! Bacteriologically SAFE NITRATE-N! < i pps Above 10 PPS exceeds the recomeended Public Drinking Water Standard. Colifore Bacteria /100;x1'' { +. Nitrate- Nitrogen,.sg/L g LAB TECHNICIAN! Pas Gane s+ �s�'` WI Approved Lab No. 19 ' Means "LESS THANE Detectable Level Approved by! S A ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 PAGE 1 14 j, `� _g ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386 -4680 The St. Croix County and water inspections private individuals. 1-T Zoning Office offers the service of septic to Lending Institutions, Realty Firms, and Completion of this for is essential so that the property calr be located Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------------------- - - - - -- -FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION---------- - - - - -- -FEE: $25.00 (Determines if system is properly functioning at time of inspection) PROPERTY OWNER'S NAME : " PROP. ADDRESS: 4-1 /IFS �% CITY f7GI SC}/� Legal Desc ption (ge /4 of the 1/4 of Section , T _N -R IS Town of ! 1XhN Lot NumbL r _ Subdivision: _ Z 6 � S ll 02 1 -qa 0� FIRE NUMBER 2 OCR BOX Color of house BK1914JAI Realty sign by house? f so, d ist firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A NAP,i.e, Y OF PLAW BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING thEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requestin se r ices: Telephone Number Awo REPORT TO BE SENT TO: " IL? 1 - . '/1 CLOSING DATE: Signature Edina Realty Hudson Qffice 700 Si Hudso (715) PRICE: $ 229,900 # BEDROOMS: 4+ # BATHS: 3 MB n WT n BBXn .TERMS: ZN:RES ADDRESS: 11.21 DEER HAVEN DRIVE CITY: HUDSON ZIP: 54016 MJKM: ST. CROIX LT SZ:5.97 ACRES DI ST: O1 SCHOOLS/ F -LFM: E P ROCK MID:. HUDSON IuCll: HUDSON PAR: ST. PAT' S LFCAL: PART OF Sw 114, NW 1/4, SEC 29.29.19_ CSM. VOL 1. PC. 299 LOT #1 STYLF• RAMRI.FR td A1.K h11T FXTERIOR: ,E-DAR. /BRICK YEAR BUILT: 1980 TAMS: 1 '1677 RR • YR: 19 91 SQ FT MAIN LEVEL: 2059 TOTAL FIN FT: 3500 ROOM DIMENSIONS L I W F FQUIP-M / MISC LR: 21 X 27 M B C REFRIC: X C. WFR: DR: 10 X 14 M B C OVEN: X- 2 C. SWR: WELL: X KT: 13 X 13 M B I TILE P,ANGE: X FR: 21 x 26 L V C X SEPTIC: x MR: 12 X 22 M B C _DWSHR: D I S P: X DEC!',: X BR2: 10 X 13 M B C WS: X PATIO: BR3: 12 X 13 11 B C A /C: X BASMT _ BM: 10 X 13 L B c CAR CDO DEN: 13 X 14 M B W nWLC• X- 2 FOSS rATE: AMUSE: 12 X 13 L B C HCAT: CAS/F.A. LAUNDRY: 10 X 13 M C TILE NSP TOP QUALITY THROUGHOUT! WELL DESIGNED WALK -OUT RAMBLER ON 6 WOODED ACRES WITH ADDITIONAL 2 + CAR GARAGE /SHOP AND 3 STALL HORSE SHED AND TWO HORSE PASTURES. HOME HAS 4 BEDROOMS, 2 FIREPLACES, AND MAIN FLOOR LAUNDRY, AND DEN /OFFICE. DINING ROOM HAS WOOD PLANK VAULT CEILING. DEN HAS PARQUET FLOOR. JUST ONE MILE FROM HIGH SCHOOL ON PRIVATE BLACKTOP ROAD. VERY PRIVATE! NEW PROPANE CAS F.A. FURNACE AND AIR CONDITIONER IN JAN. 92. LISTMuCARRIE JOHNSON Pt 1# 549 -6130 LISTER: P1 lit ' S/II C 2.4 Brkr: EDINA REALTY #260 PRONG 715- .386 -8236 612- 436 -7072 f Q CERTIFIED SURVEY MAP PART OF THE S. W. 1/4 OF THE N. W 1/4 SECT. 29 r . T29N R 19 W S 89 11 W 9 0° 554.40' A 0 O N N u� V' \ N.E. COR OF THE S.W. I/q OF THE N. W. I14 0 M rn M U-) o� 0 9 o , CD o 6 6' O 0� �L rn r� l() V Q `9 N1 1 O' 50' 100' 200' I I ° �O g' 9; I ' 565.0' �S�,, BEARING ARE ASSUMED NORTH _ t 1 N � O ON THE WEST LINE OF SECT. 29 N N I V) "' ENLARGEMENT 5.79 ACRES VOL 10.25' 35 - IIW: _ 1 LOT 2 0 , rn O � I 4 9" o � � • t W O 0 :. o O WI ro N 0. O v, p 9 0 S 89 -45 -361 N ° N 89 36"E o �o ° 1 565.0' 1312.17') N 1 09, o t � 1 I 66 ROAD EASEMENT I � Lo • O = 2" X 30" �9G� 5.79 ACRES 5 -1325 = �� v LOT HUDSON Y WI S. I S, r THIS INSTRUMENENT DRAFTED BY AC.NY_ HAGEN •`� SU Rig 15 51'J� t 09 A 0 O N N u� V' \ N.E. COR OF THE S.W. I/q OF THE N. W. I14 0 M rn M U-) o� 0 9 o , CD o 6 6' O 0� �L rn r� l() V Q `9 N1 1 O' 50' 100' 200' I I ° �O g' 1 0 9, I 565.0' �S�,, BEARING ARE ASSUMED NORTH SCALE 1= 200' . f t 1 N89 '- 45 -36 E ON THE WEST LINE OF SECT. 29 I CERTIFIED •SURVEY MAP rn SECT 29 T 29 N -R 19 W ST VOL 1 PAGE' 138 j T vi o C4 CROIX COUNTY MON. o � WEST 1/4 COR. ! I O \ o rGQ' ',. ' 1311.14' ° N 89 36"E \ S. E. COR OF THE S.W. 1/4 C�• :y (RECORDED AS 1312.17') OF THE N. W, I/4 r G N C. • = 11/4" X 24" IRON PIPE WEIGHING ' F ER O = 2" X 30" 2.27 LB. PER. LIN. FOOT IRON PIPE 5 -1325 = �� WEIGHING 3.65 LB. PER. LIN FOOL' HUDSON Y WI S. I S, r THIS INSTRUMENENT DRAFTED BY AC.NY_ HAGEN •`� SU Rig � C) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: Ellefson, Charles R. II ❑ City ❑ Village ❑ T6Wn of: Hudson Township CST BM Elev.:- Insp. BM Elev.: BM Description: vo o' 1 IUD .o' I " ? c. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Air Air I to ntake Od Dosing '> So r > (op r Aeration -- NA Holding 7 (o 9 9. (t r TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Air Air I to ntake ROAD Septi . '> So r > (op r D r -- NA Dosing 7 (o 9 9. (t r Bldg. Sewer NA Aeration V St/ Ht Inlet BLDG WELL NA Holding St / Ht Outlet SETBACK INFORMATION S - ZO $� r PUMP/ SIPHON INFORMATION Manufactu 0 ts mand Model Number GPM TDH Lift L rlction System H Ft H ead F ma ein Length Dia. Dist. To well SOIL ABSORPTION SYSTEM /I - 21, Q ELEVATION DATA County: St. Croix Sanitary 70239 State Plan ID No.: Parcel Tax No.: 020 - 1082 -90 -000 1 71, C2 9, t q, 332 STATION BS HI FS ELEV. Benchmark 5. OD 1o5 j Liquid Depth 20 -a Alt. BM 51 1 7 (o 9 9. (t r Bldg. Sewer V St/ Ht Inlet BLDG WELL LAKE/STREAM LEACHING St / Ht Outlet SETBACK INFORMATION S - ZO $� r Dt Inlet CHAMBER Type O Dt Bottom � r y M el Num beer Header / Man. r (� Dist. Pipe ,Zo Bot. System ((; 3.25 Final Grade St cover 3•� o �� C ems �. ls' T_7 li I _ ro. I e 1f . BED/TRENCH Width r Lengt _ No. f T enches v PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS T DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manuf, ctu er: e�e� SETBACK INFORMATION CHAMBER Type O � r y M el Num beer System: r (� OR UN T DISTRIBUTION SYSTEM Header! Manifold u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 7 Length fie— Dia. acing Topsoil ❑ Yes ❑ No ❑ Yes ❑ No SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Tr nch Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No C Q MMENTS: I code Iscre es, p s e t,c l 111 �r`'�`i"1` ~���.�.. Locahon: 42 T lleer Haven r��ve son, wlo�4�r1 � 1I4 NW 1/4 29 T2�1�T R19W) - 29.29.19.3326 -Lot 1 l.) Alt BM Description= t,� v`V �- 4 dl ✓� �.oX -mss 2.) Bldg sewer length = z - amount of cover = Plan revision required? ❑ Yes KNo Use other side for additional information. SBD - 6710 (R.3/97) 0r , 0 Date .— Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: go o ...... p „. em L _ ,... { € t t F € t I S 3 go o Safety and Buildings Division enue Visconsin S ANITARY ; r A I�P�.`I:TION 2 01 W. WashiPgO Boxv7162 Department of Commerce In accord w pr 3 05 Wis dm Code A Madison, WI 53707 -7162 • Attach complete plans (to the county copy only)�i the systo i }m }� ri'Q1 flpss County r than 8 v2 x 11 inches in size. �, .. .j 7 State Sanitary Permit Number • See reverse side for instructions for completing f4i` pplicatiO r `�� f' Si ;� t 3 }c7�39 Personal information you provide may be used for secondary pu , X3(}07 - [Privacy Law, 15.04 r ❑ Check if revision to previous application I State Plan Review Transaction Number s. (1) (m)]. !} r :Vk 1. APPLICATION INFORMATION - PLEASE PRIN Propert y Owner ame pErty Location 1 /4pf4.,(114, S a T q , N, R y,I?r(or) Property Owner's ailing Address Lot Number Block Number Cit , tat Zip Code Phone Number Subdivision Name or CSM Nu ber s o(o ( G II. TYPE OF BUILDING: (check one) ❑ State Owned It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ❑Village Town of III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) Z 1, Z �.� P 3 3 Z © / 7 0( Do 1 ❑ Apartment/ Condo a 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 on line B, if applicable) A) 1. ❑ New 2 Vr Replacement 3_ ❑ Replacement of 4_ E] Reconnection of 5. ❑ Repair of an System System Tank Only System -------- Existing 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 ❑ Specify Type 41 ❑ Holding Tank ,1 120 Seepage Trench �/0 _� 22 E] In-Ground Pressure 42 ❑ Pit Privy 13 Seepage Pit - 43 ❑ Vault Privy 14 ❑ System -In -Fill p7 = 3 Z 9 7 3 , VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. S Elev. 7. Final Grade Required (s ft.) oposed (sq. ft.) ( als/d sq. ft.) ( n. /inch) Elevation 6 0 '—" fl i eet Feet VII TANK INFORMATION Ca aclt in g Total Gallons # Of Tanks r Manufacturers Name Prefab. concrete Site con Steel Fiber- glass plastic Exper. App. New Existin structed Tanks Tanks S tic Tan nk 1_7 ❑ ❑ ❑ ❑ ❑ Li ber ❑ I ❑ 1 ❑ 1 ❑ ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite s pkage system shown on the attached plans. Plum er's ame: (Print) Plumber' gnatu : (No p PRSW No.: Business Phone Number: 71v a68 Sy -6 Plumb is Address (Street, Ci tate, ZI Code): IX. COUNTY / DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Issuing Agent Signature (No Stamps) A Approved E] Owner Given Initial surcnar j D atelssued Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: s c�� � �►._ �� f 6� > y" 6e(/ 9r � >b x = SBD -6398 (R.12199) DISTIGBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 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 Code will be applicable. 3. All revisions to this permit must be approved by the permit issui ig authority. 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. 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 systeri, co itact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151: To be complete and accurate this sanitary permit application must include: ry I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to oe 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 poxes that apply. IV. Type of permit. Check only one on line A. Complete line B if aermit 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 reqL ested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed anc tank material Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Irstalling plumber is to fill in namE, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application f )rm. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must bE submitted to the county. The plans must include the folIowing:.A) plot plan, drawn to scale or with c )mplete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacemE nt system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) conplete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance (urve; pump model and pump manufacturer; D) cross section of the soil absorption system if r6quired by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) `or 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. E 1z To-uw. C� cs/k / /d%9 1" y° o. I - ) � Jt, ,Q/n= l� t l - g m 0 ` 1 �3�yo 0 �p 54 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT WLabnr and Human Relations n:, t _f c -sew, x Page 1 of 3 ' III CL"VIU VV I COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz must} aMde',hu� St. Croix P RCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and slope, scale br ' ` dimensioned, north arrow, and location and distance to nearest road " `' J j r .. 020- 1082 -90 -000 RE I EDDY DATE APPLICANT INFORMATION PLEASE PRINT ALL INFORMA . P." Bed Tmr& PROPERTY OWNER: ' PRCEI,TION Charles R. F.11Pf-,Pn TT X C?V'T. LOT SW 1 /4* 1 1/4,S 29 T 29 N,R 19 f*r) W PROPERTY OWNERS MAILING ADDRESS 2mgr � #� �SU . NAME OR CSM # 421 Deer Haven Dr. 1 f c sm 1/299 CITY, STATE ZIP CODE PHONE NUMBER [E]CITY ❑VILLAGE MOWN NEAREST ROAD I Hudson, WI. 54016 (715 386 -8585 Hudson Deer Haven gw if .7 [ } New Construction Use [ Residential / Number of bedrooms 4 [ ] Addition to existing building [x] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate _ bed, gpd /ft gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 93.50 ft (as referred to site plan benchmark) Additional design /site considerations trenches spaced to code 4,00 below grade Parent material autwasb Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL S [I U MOUND CAS [I U IN- GROUND PRESSURE CAS El I AT -GRADE R1 S El SYSTEM IN FILL is S ❑ U HOLDING TANK EIS F-1 U U = Unsuitable fors stem :E] SOIL DESCRIPTION REPORT Boring # 1 Ground elev. 9 5.6 ft. Depth to limiting factor +8411 Boring # Ground elev. 9 3.9 ft. Depth to limiting factor 9011 Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD /ft Bed Tmr& 1 0 -9 10yr3 /3 none sl 2mgr mvfr gw 2f .5 .6 2 9 -16 10yr4 /4 none is Osg mvfr gw if .7 .8 3 16 -84 7.5yr4/6 none m s Osg ml na na .7 .8 71 Remarks: 1 0 -10 - 10yr3 /3 none sl 2mgr mvfr gw 2f .5 .6 2 10 -22 10yr4 /4 none sl 2msbk mvfr gw if .5 .6 3 22 -90 7.5yr4/6 none co s Osg ml na na .7 .8 Remarks: PROPERTY OWNER Charles Ellefsen SOIL DESCRIPTION REPORT Page 22 of 3. PARCEL I.D. # 02 1082 -90 -000 { Boring # ............... Ground elev. 9 7.5 ft. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Bmrbary Roots GPD /ft Bed Tw& 1 0 -7 10yr3 /3 none sl 2mgr mvfr gw 2f .5 .6 ✓ 2 7 -14 10yr4 /4 none is Osg mvfr gw if .7 .8 3 14 -10 7.5yr4/6 none co s Osg ml na na .7 .8 Remarks: Remarks: Remarks: Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Charles R Ellefsen II 1554 200th Ave. CSTM2298 Sw4NW4 S29- T29N -R19W New Richmond, WI 54017 MPRSW -3254 town of Hudson (715) 246 -6200 lot #1 -csm 1/299 N BM.= top of 1" pvc pipe C el. 100.00' BM.= top of 1" pvc pipe @ el. 93.50' li 13 rel V� " Gary L. Steel 6 -2 -2000 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT O'�/NERSHIP CERTIFICATION FORM�� Owner/Buyer Oyrle. 13� Mailing Address VA I Afe. 4" Property Address (Verification required from Planning Department for new construction) City/State L1 t4� Parcel Identification Number O rQ d — AO 0 <5 c; — �o — Dvc) LEGAL DESCRIPTION Property Location ` 0--t ` / 4, P ' /4, Sec. , TQ -R/7 W, Town of Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # S 6,2 (� (P Volume /O S 7 , Page # Spec house ❑ yes it no Lot lines identifiable ❑ yes 0 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 / days of the three year piration date. - SfGNATURE OF LICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. roperty desc ' ab , by , vii / tue of a warranty deed recorded in Register of Deeds Office. � SIGNATURE OF APPLIr I (we) am (are) the owner(s) of 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 ii .I DOCUMENT NO. I� nja I)R` ef, m p bat`+►o -m ... • ..................... .... ..— ....._................_. M - ICP�� 1 B>re7ard and Martha _..huabanQ. and„ wife - ................---------- ..,.......,.......... ......,.. (3r �, Chx�*st Y�a«aeri �Z aiid �cw�.�"�. klle a< ser.r hu 5attd an3 wi' ' .... ....... . __.......I .............. ..-1—.....I........._.. -, . --.- I...._............. .G?ar," Vtlitnegaet 1, That thl ;m&A Graf.47r, for a wwimaMe nonglderw' o,e....,, ........................ ... ......... ....... .................................. ....... _. ...... Je c veyn to Gr404t tho. following deseriktd road toWie in S� ` �. Cnaoty, $t+a+i of Wismom : T2!,♦ gPM:R p�:.t�R41{J ➢V01 i`.X�'OXA iri"J SEP 1093 8.30 a Pd. Wk" TO 85t1IC . $C. Cc l'%tx 2212 Cteatviov Dr. i H udeq'n, W1 5.4416 T" pnr,:r1 Nl�: - - - - - -• ............... ........... Part of the Sw1/4 of NW1 /4 Section 29,29 -19 cd as f0liovq: i + Lot I of Certified Svc-fey file$ Sept, 20, 1976 in.. Val. 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