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CROIX COUNTY WISCONSIN ZONING OFFICE ;. I u u r r u r r ST. CROIX COUNTY GOVERNMENT CENTER -- - 1101 Carmichael Road -- _— Hudson, WI 54016 -7710 (715) 386 -4680 Fax (715) 386 -4686 NOTICE OF VIOLATION March 17, 2000 STEVE SIMMON 1156 CTH D GLENWOOD CITY, WI 54013 RE: Failing septic system at 1156 CTH D Town of Baldwin - St. Croix County, WI Computer # 002 - 1000 -40 -100 Parcel # 1.29.16.4B Dear Mr./Mrs. Simmon: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and Article 15.04 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(b) Wisconsin Statutes (Category I). This violation was first noted on 3/16/00. The violation noted is septic effluent discharging to a zone of soil saturation. An on -site inspection on March 16, 2000 did reveal the septic effluent discharging to the zone of saturated soil. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of March 16, 2000 in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING SANITARY SYSTEM ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION. REQUIRED ACTION: You have already contracted with Gale Smith, a certified soil tester to have a soil evaluation conducted. The soil evaluation has determined the type of septic system needed and it's location. You will now need to contract with a licensed plumber, who will design the septic system and obtain a sanitary permit through this office. The septic system must be installed no later than December 1, 2000. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me at the St. Croix County Zoning office at 715- 386 -4680. I look forward to working together to resolve this matter. Sincerely, Kevin Grabau Zoning Technician cc: file /* Wisconsir' Department of Commerce y' Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count §t. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. S Permit Holder's Name: ❑ City ❑ Villa e E] T wn of: State Plan ID No.: Simmon, Steve Baldwin Township T ,s to * - : aT'e � CST BM Elev. - . Insp. BM Elev.: BM Description: arcel Tax No.: in . o ( ec� . o' CST P� �- A C 002 - 1000 - 40 -1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic vvo `� Benchmark S •� Dosing Alt. BM Aeration 131 �AVed dCct]�-c Bldg. Sewer S�.Sro 3.23 9`{.2�` Holding St/ Ht Inlet 7•5v t(v 90.2` TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic >(Cv` go , -L 3� f -- NA Dt Bottom Dosing > 4M r �5 NA Header /Man. Aeration NA Dist. Pipe 5 2.L 51A N 2. � �`F• Holding Bot. System 5 3 • �u 9�{e( PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand St cover 7 ,rp qz -`1Z r A Model Number `f (( �� A�PM 2 - 117.4(1 T l cn9 D ti H Lift Friction l•q.+ Systera, ,6 TDH tt,g Fii Forcemain Len gt Dia. Dist. To Well g� SOIL ABSORPTION SYSTEM BED/TRENCH Width Length r N f Tre PIT No. O Inside Dia. Liquid De DIMENSIONS nches DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING INFORMATION Type Of , SO , t3 � t � } , O AM T Moe Number: System: Nle DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) r p x Hole Size x Hole Spacing Vent To Air Intake Length r Dia. Length 12. Dia. .2 Spacing —' I/ 4+ 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 ` COMMENTS: (Include code discre ancies, per ons s ntt, tc i nspection : o a ns ec io _ f \ Location: 1156 County oad D, enwood City, ff %1 (�E 1/4 NE 1/4 1 T29N 1(W) 01.29.16.041 -I,o 1 1. Alt BM Description = 5` °OVCr �, aS _ t ?� " c.F F 2.) Bldg sewer length = S2.0' j 4 - amount of cover = ' n 3.) contour = � 2 5 r -� a S 3S'c.:�� �( •`�� d�eX ,lcs 5 Y$ 4) E s� b�r. Pu�..pa� / - �"�- K„(P(v,b� /�ST� Plan revision required? ❑ Yes CK No Use other side for additional information. Ifl 116 1 20C TOI ,, F ( d SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. I ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E a � �a E q g d Safety and Buildings Division Vi scons i SANITARY PERMIT APPLICATION 201 W. Washington Avenue n In accord with ILHR 83.05, Wis. P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) forth sys tit paper no �K county , than 8 12 x 11 inches in size. //''�� Q • See reverse side for instructions for completing this appI on R �"��VE© a Sanitary Permit Number Personal information you provide may be used for secondary purposes ° JU Q � 2� /S p C eck if revision to previous �� ation [Privacy Law, s. 15.04 (1) (m)]. ST X o u Tta* Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT AL N =S Q Propert Owner Name � oc ' Ve // , v4 T t7 7, N R )W Property Owner's Mailing Address u�n a Block Number / a d — City, State Zip Code Phone Number Subdivision Na a or CSM N m er G1 e/V 4.uiood G I`c �/ -1 (7C')� - tS"SP II. TYPE BUILDING: (check one) E] State Owned 11 1 Nearest Road ❑ VII age Public 1 or 2 Family Dwelling - No. of bedrooms Town OF cal O. a/ III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ' 6� L 4 15 1 ❑ Apartment/ Condo d 0 a /0 ae r /D 0 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 S ❑ 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. D( Replacement 3. ❑ Replacement of 4_ ❑ 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 QQ Mound XO ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 [] In-Ground Pr ssure X 9 , ! =�1 42 ❑ Pit Privy 13 E] Seepage Pit Q / 43 E] Vault Privy 14 E] System -In -Fill l 3 20 VI. ABSORPTION EM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Re uired (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 6 1 D /, 9 2 Feet Feet Capacity VII. TANK in g allon s Total # of r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer Name Concrete Con- Steel glass Plastic App New Existin structed Tank Tanks Septic Tank or Holding Tank X 600 ) K/QS ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ,X Q 00A4 i 0 1 ® 1 ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) r Plumber's Signature: (No Stamps) MP /IMAXMNo.: Business Phone Number: Plumber's Address (St reet City, State Zip Code): � eevwDO4/ IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (includes Groundwater D ate Issued Issuing Agent Sign ure (No Stamps) [j] Approved E] Owner Given Initial Surcharge fee) l< Adverse Determination 3as. 6 - � X. C ND IONS OF APPROVAL / REASONS FOR DISAPPROVAL: �A 4�2>1 _S SBD- 6398 (R.11197) DISTRIBUTION: 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 may be 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 issuing 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 a, 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. To be complete and accurate this sanitary permit application must include: I. 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 on line 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 existing 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 if 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 application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; 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; C) complete specifications for pumps and controls; dose volume; elevation differences; friction Foss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- �GRQUNDWATER 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. I Safety and Buildings • 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 22, 1999 CUST ID No.222234 ATTN: POWTS INSPECTOR ZONING OFFICE GALE W SMITH ST CROIX COUNTY SPIA 3228 HWY 170 1101 CARMICHAEL RD GLENWOOD CITY WI 54013 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 11/22/2001 Identi tion be Transaction ID ko. 278793 Site ID No. 18443 SITE• Please refer to both identification numbers, Site ID: 184432 above, in all correspondence with the agency. ST CROIX County, Town of BALDWIN; 1156 CTH D, GLENWOOD CITY 54013 SETA, NEIA, S1, T29N, R16W Facility: STEVE SIMMON 1156 CO RD D, GLENWOOD CITY 54013 FOR: MOUND, 450 GPD, REPLACEMENT SYSTEM Object Type: POWT System Regulated Object ID No.: 638069 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. The orientation of the mound system must be such that the mound's longest dimension is perpendicular P.O .% to the direction of maximum slope. nditi 3. The area 25' below the downslope edge of the mound must remain undisturbed. Co 4. Abandon failing system per COMM 83.03(2). APPR o A copy of the approved plans, specifications and this letter shall be on-site during construction and p en to 1300tENt inspection by authorized representatives of the Department, which may include local inspectors. All permits tpN of AF required by the state or the local municipality shall be obtained prior to commencement of ' construction /installation/operation. SF Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 11/15/1999 ---- FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 ATRICIA L SHANDORF , PO PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633 "ism ENOS Ammim M !� - -' ■ ■■■ ■ ■ ■■ ■ IN ■ ■ ■t ■ ■■ ■■ MONSOON ■ _CGS L�]■ ■■■■ ■■■■ _ ■ ■ ■ N■■ AV so � r a r � r 'r ■ r . � r / r Page i� Of ,S Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand G Topsoll F E � 3 o j� %Slope Red Of z 2 1 Force Moin f'lovred Aggregate From Pump I. ayCr D ;?, O Cross SeCli; Uf A Mound System Using � F � A Bed for 'f he Absorption Arc c , G L fL / ' D A �/ Ft. H Signed 7 — q a ft. � - License Ilwp.ber: I;a to : rc Ft. V rt . AdSer v pipe — �-- a I I I I ' force Main W ' .._ .�..__._._.._ ._ -_ -_ - - - -- ---. J From Pump �[)istribution E3ed Ot ��- 2'2 Pipe Aggregate . 1 Observation Pipe Permanent M0r ers pion View Of Mound Using A Bed For The Absuiption Area Page_ Of �— Perforated Pipe Detail End View peR poR Ated a pve PiN;e, s a Q� , Force iiain PVC Holes located on bottom of force main are equally spaced End cap --,, Last hole should be next to end cap Distributation pipe layout P�Ft. R — Inches Invert Elevation of Laterals 9 Ft S Inches � p X -Inches Signed: 'C�i �li,�i Y Inches Licenses Hole Diameter a Inches Date: — �" — Lateral " o `Z. Inches rlanifold " Inches Force Main " 0 Inches # of holes pipe 241 Page Of COMBINATION SEPTIC TANK /PUMP CHAMBE (No Scale) 4 Cl Vent Pipe with Approved Locking Manhole Cover Approved Cap, +25' With Warning Label Attached From Buildings Weatherproof Approved I _ Warning Label Junction Box Vent Cap M 12" mum Final Grade 6" Minimum 4" Minimum 6" Maximum 4 C. Quick 18" Minimum Insp. Pipe _ _ Disconnect 1/4" Weep ' Hole Baffles n ' i A Alarm B On C ' *APPROVED Off 6 JOINTS WITH ' APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL , 3 of Bedding Under Tank-/ ' Note: Pump and Alarm Are On Separate Circuits Number of Doses:Per Day ' Gallons Per Day/ of Gallons Volume of Backflow: ........ 2� Gallons Tank Manufacturer: Jo�l� e G�f1 Total Dose Volume: ........ =Gallons Tank Size - Septic /Pump: Go D -- G allons Alarm Manufacturer: S e Model Number: / o / H w Capacities : A L, i nches or ons Switch Type: melgc CYR + B .2 inches or Zy_ Gallons Pump Manufacturer: G o Gf /.o/ + C o, inches or allons Model Number: ' 5 PC a // + D inches or Gallons Minimum Discharge ate: , p Total ..... = inches or Gallons Vertical Difference Between Pump Off and Distribution Pipe: 9, o Feet Minimum Required Supply Pressure: ............... .+ Feet 1 L o Feet of Force Main x,3 Friction Factor /100�Feet:� + eet Inch Diameter Force Main Total Dynamic Head: ... ja�2 Feet Internal Tank Dimensions: Length — Width V Liquid Depth Signature License Number Date / 4 ouSrRIAI. - Goulds p e '+ ON WI 54016 Submersible * Effluent -Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel, grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. • Homes components. ■ Motor Cover: Thermoplas- • Farms (dolor: Available for automatic and tic cover with integral handle • Heavy duty sump • EPO4 Single phase: 0.4 HP, manual operation, Automatic and float switch attachment • Water transfer 115 or 230V 60 Hz, 1550 models include Mechanical points. • Dewalering RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty automatic reset. preset at the factory. rated oil and water resistant SPECIFICATIONS • EP05 Single phase: 0.5 HP. N Bearings: Upper and lower 115V, 60 Ili, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 tuilt in overload with - Cons!iuction. • Solids handling cap ability zutomatic reset. N EPO4 Impeller: Thermo - 3 /4" maximum. • Power cord: 10 foot Plastic Semi -open design, AGENCY LISTING • Capacities: up to :5 GPM. standard Irngth, 16/3 SJTO w'th Pump out vanes for • Total heads: up to 21 feet. ';;ith three prong grounding mechanical seal protection. SA Canadian Standards Association • Discharge size: 1 ,,' NP(. plug. Optional 20 foot ■ EP05 Impeller: Thermo- • Mechanical seal: carbon- I.?ngth, 16/3 SJTW with plastic enclosed design for (CSA listed model numbers rotary/ceramic - stationary, twee prong grounding plug improved performance end in "F" or "AC ".) BUNA -N elastomers (standard on E P05) 0 Casing and Base: Rugged • Temperature: thermoplast c design provides 104T (40 , C) contTuous su erior strength and 1404 (60'C) intermittent corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 1p I • Capable of runnirg dry without damaga to o 30' Components. I i —►� —s Gam, -- — - Pump: EP05 e • Solids handling capability: o l 25 FT '/4" maximum. Q 7 • Capacities: up to 60 GPM. s • Total heads: up to 31 feet. 2 s 20 • Discharge size: l Vi NPT. i 5 • Mechanical seal: carbon- o rotary /ceramic- stationary, t s BUNA -N elastomers. 4 _ • Temperature: ° EPOS 1041(40T) continuous s 14 1401(60" C) Intermittent. 2 . E PO4 1 t] 0 0 10 GPM 0 2 4 6 8 10 t2 mi ®1995 Goulds Pumps, kic. CAPACRY Effective May. l s 9S 03011 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page / of Bureau of Integrated Services in accordance with S. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and , , (� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # ®O - A©Dd ' O -�O 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)). Property Owner Property Location & / �%7 ALPAL Govt. Lot s 1/4NL.1/4,S / T,,7 N,R /O 10w W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# lLs� go City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road y , e11/k�0 /v / .S O (7F ) �'J�O /� �i f O al ❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building Q Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd/ft trench, gpd/it Absorption area required bed, ft % trench, ft Maximum design loading rate _,5- - bed, gpolfl gpd/f1 Recommended infiltration surface elevation(s) 9 i ft (as referred to site plan benchmark) Additional design /site considerations o # / O rA /Near Ne 4 4 ed" a iv E de /?&Ai e Parent material A d / A 1. ,t / L !2 _- Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Ik U = Unsuitable for system EIS U X S ❑ U ❑ s IN U [Is ®U ❑ S 21 U ❑ s SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench fr A S -_f • h.. V -11 o L 2AJ h Al A4 .� 6= S I W F ' d Ground j Jr x I MP SC A 2 6 e A r X � t eA S Depth to � �_ Vt limiting ' factor F m, a 'y Z� CRQ X �< Remarks: Boring # e WWI F.nfs;;F..n ?1" Ground $ s° oo elev. eft• Depth to limiting 4 r in. Remarks: C T Name (Please Print) Signature Telephone No. p� L--e t4j J M Address Date CST Number o Cr e PROPERTY OWNER S� e ,,�/!V/ NJ e d( SOIL DESCRIPTION REPORT Page Y g of� PARCEL I.D.# .7 1 ® 0 O 4/a /D O Boren # Horizon Depth Dominant Color Mottles Structure 2 Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .....:..................... /v VA 3A. S f M � AS A 6 Ground a ?,J S Zyy1f SC A ~ 6C p ellev � . L .L f e ft• Depth to limiting , factor 1_in. Remarks: Boring # .s" , S ahj M y �3 Ground �el 7 L� -�- , Depth to limiting factor / (n . Remarks: _'d/ L P o ,�D �/1 P_ a e_f No ;y /else, f X ge r4f/ ll Me/j%f' jv Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ........................... , Ground elev. Depth to , limiting factor in ' Remarks: Boring # Ground elev. ft. Depth to limiting factor in ' Remarks. SBD -8330 (R. 07/96) 1 o i JA Yo 17 r _ 6A e' —�- _ x� i 0 - I I _ I I f , _ - _ -- - -+ -- -- _ -- - - -- -_ �- -_i- - - -I - - - -- - -- _- -_ - _ -- - - _ - i � _I I. I I I III _ I I , I I I r l I ! I i I ' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner .S �� V e SI M A-f D Al Mailing Address EZ G 9-/ D Property Address —!�ZA e (Verification required from Planning Department for new construction) , .S�'o l,? City /State 15�� e& k,-) D ,0d Parcel Identification Number LEGAL DESCRIPTION Property Location 5�� ' /a, N25 V,, Sec. T�N -R /� W, Town of Lc/L� Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Y �� , Volume �� Page # Spec house ❑ yes % no Lot lines identifiable 14 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, 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 t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 e three ye# date. / ' Co TURE PLICANT 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 t of a warranty deed recorded in Register of Deeds Office. / S C3: SIGN LICANT 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 I 0 Ire *1 ii it IF - - - - - - - - -- i I t - - - FF I I I i I i I I 1 I I � I I : I_ 1_4 ! i ' � I I T l : r- I � I , I I I i r- : I i I I C I I I : ' I : L I I I I ! � ! ! I �* •I TNIt 1•IAC[ PESLRVID 1011 RCCOROINO DATA 00 - UMENT NO. WARRANTY DEED STATE BAR OF WISCONSIN' FORM Z -1983 t :} IRE+61STERS OFFICE Grant I. Simmon and Mildred Simmon, _- ( ST. CROIX CO., WIS. ..... husband and wife as point tenants -- p�c'd. for Record Kris 26th ��A.% 19i 86 45 AL conveys and warrants to - .Stephe -. R •Har-- ara.•..- it- n L....3immon,..husband_.and .t,<i..a -. as ...... ... suzvivars. maz.i*..al...pr.up.e_rt.y_.... .._. ......... = , .r •- -..... .... . ........... ..... ....._ ..__.... •• ._- . -•,.•- - -, .- RETURN TO - enomonie Farmers Credit Unio _ .. ......... ox ... . the following described real estate in ..... ...... .•- CrOiX ..... -,,, - -- County, State of Wisconsin. T ax Parcel No: ............ .. .......... ...... t Part of the South`ast Quarter of the Northeast Quarter (SEA of NEB) of Section One (1), Township Twenty -nine North (T29N), West (R16W), more particularly described as Range Sixteen Lot 1 of Certified Survey Map dated July 23, 1986, and recorded August 14, 1986, in Vol. 6 of Certified Survey Maps, Page 1694, as Document No. 415805, Office of the Register of Deeds for St. Croix County, Wisconsin. i 1 r i� 4 i �i 4 This _ _J's ...... - - -, homestead property. (is) Aix ctc�7? t i - Exception to warranties: easements and restrictions of record 3 19- 86 Dated this _ day of �.. - ...... (SEAL)' ✓.(SEAL: Grant-- .I_. -- Simm n ..... -------- - . { _ (SEAL) .eeQ2� "� �e- +,a, .(SEAL) - -- _. Mildred- Simmon i AUTHENTICATION ACKNOWLEDGMENT �) STATE OF WISCONSIN Signature(s) u ss. --- ----- I� •-- ---- -- - - -- -day of S.rr.r...CCO County. authenticated this __... day of..------ ..._. .._...., 19 _ .. Personally came before me this _..��� 86_ the above named - -•- -------------------------------- ------- - - - - -- -• - -- Grant I' Simmon and Mildred_ y Simmon ,. - -.• - -- - - -- i , TITLE: 3fEMBER STATE BAR OF WISCONSIN -- - - -- - - - ---- - - - -- -------- •: (tf not• _ ------ - - - - -- ... ..... - 4 1 . c l &."thorized by 3 706.08, Wis. Stats.) to me known RFit, �_. a�1 xe� ta�,the . t for roi insHowl e �_ 1 ` F r T41$ INSTRUMENT WAS CRA PIED DY i /> _ Thomas A. McCormack-- -- - -_- -- - - - -- rwalder Baldwin, W1. 54vO2 B n nt s t a l e n - - a -•-i , N�t.l - p, hhc t Crvi S u Vii ion,aTis; ion s .tertr?ae .(IP not, tat. expirati t ag (Signatures may he authenticated or ackno vledned. Bo *h ary not neeeszo.y.) �_ll�, 1. y7.. ) 4 �,, � date __ - - - _ -- -- -- '� � 1 - £ 1 _ *NAM' of A _one sirn"nQ u in any ca6aty Vr.nt d "'Ao v th�•ir iR•a... rad. ak yl 1( •e; •F VIAP.R "..vTY DEF,D STATF 9A4 OF WISCONSIV ,r: .n L r l Hlar„ C". In; �,,...,. ,- ,.�.r... �•�. ••w- e..axxs. - ..:�.� ,..;.. -;�. �:. ,�7' <'r::.... " ^,a"x�?m3�`�'�S,'... �,;, C �, `�: tb v'.� :.., � o •�". :a �� x- ._ , r _ 4J a n 4�1�L� ►S CERTIFIED SURVEY MAP NO. 169 Sh cmx `�' VOLUME 6 ,PAGE 169 Z LOCATED IN THE SOUTHEAST QUARTER .OF THE NORTHEAST QUARTER OF SECTION 1, TOWNSHIP 29 NORTH, RANGE 16 WEST, TOWN OF BALDWIN, ST. CROIX COUNTY, WI. VARIABLE RIGHT -OF -WAY CENIERL /N£ OF C. LH. D' AND EAST LINE OF NE NE1 14 S 00 0338" W 480.00' o O » „ c h C. T. H. �, cs S 00'0 '38 "" W 478.78' Io,�\ W � CN z i ►- V k^' X 0.2 U �DY o \Z `+ a Q. 2 'j ° Qy o 90 o C lr- Q APPR VED N Q �_� W e o AU G 0> 1986 cram sr. CROIY. OUNIY O COMPREHENSIVE I RX3 PLANMNG BARN O AND ZONWG py�Tg s N O O O ,gyp Q V �� ; JER `E , i1� Lu O Q E � • - 47 O o s` � i S T�Sf0F � s O )-Z �V' WIS. • Q v A 00 co w Ll Ltj x� J � ' LL 0 O p L �o ^ w 0 w � w w Z QN V h cn Zoo ewc�i ca v V1 x N 00 W 457.31 UNPLAIr.2 LANDS CEDAR CORPORATION 604 WILSON AVENUE MENOMONIE. WI 54751 / PAGE -L OF Z.