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HomeMy WebLinkAbout040-1016-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division .. INSPECTION REPORT Sanitary Permit No: 488009 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. i Perrn t Holder's Name: city Village X Township tY 9 P Parcel Tax No: LaLibert , Roger I Troy, Town of 040 - 1016 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /&/) 1YI f GS 1 04.28.19.61A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 3 d-. Benchmark NE Cor 1 6 12. 1 /Z. 4 l /OD Bcs+ng Z PV l � Alt. BM Z. 8a 12-3. Fit Aeration Bldg. Sewer 5,115 17-6.715 Holding St/Ht Inlet lZ•� TANK SETBACK INFORMATION SUHt Outlet I -,K 11 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ S „eU� 7 Q i �' 1 i 5 l/ _ Dt Bottom \ �g U 7 J l � Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade �. Manufacturer De n and St Cover $ 1 i $ , Model Numb TDH ft Friction Loss System Ft Forcemain ngth D' Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth . % DIMENSIONS SETBACK SYSTEM TO BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR 16 - Type Of Syste AA UNIT Model Number. sl s DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) yn Co Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded hed Bed/Trench Center Bed/Trench Edges Topsoil Q Yes E] xx Mulc No E] Yes E] No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 588 Tower Road Hudson, WI 54016 (NE 1/4 SE 1/4 4 T28N R19W) NA Lot 1 Parcel : 04.28.19.61A 1.) Alt BM Description = cce -55� ( J u J vw 2.) Bldg sewer length = �UJ I C-i ��1 V �✓1� . - amount of cover - T Plan revision Required? Yes No Use other side for additional information. "— Date lnsepct s Sig re �et SBD -6710 (R.3/97) Safety and Buildings Division County W. ashin on ib2. St. Cro I isconsin Madison WI 5V E itary Permit Number (to be filled in by Co.) Department of Commerce ( ) 266 -3151 S to Plan I.D. Number Sanitary Perm t lic t.at?in n In accord with Comm 83.21, Wis. Adm. C e, info ou provide may be used for secondary p Privacy Law, 0 CF"' e` ( CQVNT ject Address (if d ifferent than mailing address) ZONING OF - I. Application Information — ?Lease Print All Information Property Owner's Name Parcel # Lot # Block # Roger La Liberty 00-1/ 1 () q)_1 6 -66. Property Owner's Mailing Address Property Location / _ 588 Tower Road • ll/ City, State Zip Code Phone Number NE �� SE y. Section 4 Hudson, Wl 54016 T N; R 28 i Icircle one) r II. Type of Building (check all that apply) t� °� �181/� K!a- b 1 or 2 Family Dwelling — Num $ Subdivision Name CS ber of Bedrooms L g, � �� ) � Public/Commercial — Describe Use Cs m ❑ State Owned - Describe Use []City ❑Village Elrownship of Troy IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ❑ New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System P —,.%, B. ❑Permit Renewal ❑Permit Revision 13 change of 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner '/ / / 7 3 IV. T of POWTS System: Check all that apply) / / 7 � J Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil (3 Mound < 24 in of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter 0 Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber 17 Drip Line ® Gravel -less Pipe Other (explain) V. Dispersalfrrmeat ment Area Information: Q Resign Flow (gpd) Design Soil Application Rate( sf) Dispersal Area Required (sf) Dispersal Area Proposed (so System Elev4ti / _//0 01 S Y 2� g Z S 160.0 .9� VI, Tank Info Capacity in Total Number Manufacturer Prefab Site 9ted Fiber Plastic Gallons Gallons of Units Concrete Constructed CAM New Existing Tanks Tanks septic or '%Ming Tans` 1000 1000 2000 Wieser x Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Mike Nelson MP 225053 715 - 273 -5000 Plumber's Address (Street, City, State, Zip Code) 278TEast Summit Avenue Ellsworth, Wl 54011 VI . Coun /De artment Use Onl Pi / Appoved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Asued Is ng Agwt S S ) Surcharge Fee) ) El Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval 3 SYSTEM OWNER: S¢�e Septic tank, effluent filte and l � dispersal cell must all be serviced / maintained ' as per manageme � nt Ian Provided by plumber. Q.�G�c�✓z -0 j2 2. setback requirements mus a main acne n"t— . (jtt as per applicable code /ordinances. 6 / ho plans the Conyty ody) If rjl� SBD- 36 98 (R. 01/ ) C P Roger La Liberty 588 Tower Road Hudson, WI 54016 NE' /,,SE%, S4,T28N,R19W N Troy Township SL Croix County Scale I"= 40' Weiser 1000 tank n/ JCW TOr P rr�i��/ u se n 6JE4� K y„ Pile 1 oA �r�v,� tra L C,� s ,•�..� '90 •'� i • /1/cr✓ I�.� ;LSer IODD�iII' T � ERS7 P °• L ,�n c .6 7 AP06100 Title Page Roger La Liberty 588 Tower Road Hudson, WI 54016 Property location: NE 1/4, SE 1/4 S 4 T 28 N, R 19 W Town of Troy, St Croix county Parcel I.D. # Design By Mike Nelson Plumbing 278 East Summit Avenue Ellsworth, WI 54011 715- 273 -5000 715- 821 -5275 MP 225053 Date Mike Nelson Page 1 Title Page Page 2 Plot Plan Page 3 Management Page 4 Old As -built Page 1 of 4 Roger La Liberty 588 Tower Road Hudson, WI 54016 NE %,SE %, S4,T28N,R19W 1 Troy Township St. Croix County Scale I " = 40' Weiser 1000 tank use � o� n ® s' GJE« R f y" pvc �i, y,e L�Ey GXSi nry • iJ j 4 Axp s t A o. a S rjr Tau.- 90od C) q� /VOW l..J:esr / /•' T� Ta., ,F y�p ✓G G Y3..f � T /rw el�rt y.�o' Nov 23 05 04:37p Jeanne M. LaLiberty 7153819844 p -1 s Y Co. �� ST. C'ROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /BuyerG G� Mailing Address p w d r,.., `� / � � - -- �,. ,S Property Address SGf/YJti.Q _ (Verification required from Planning & Zoning Do-parimcnt for new contitruction_) City /State S 0 Aa Parcel Identification Number U�I /�! (� — QoU - A l /v r LEGAI, DESCRIPTION Property Location A/ L V., J a� ' /, , Sec. _ t- ( , T 9 S' N R / ?W, Town of Tr T Subdivision — �— _ Lot it / Certifcd Survey Map # y.s S 7 3 , Volume S , Pagc # 2 a 1 3 Warranty Deed # ? / Z / 15-- , Volume 2 776 , Page # 1 3 ? Spec house yes 11 l..ot line. idenliliuble 6 e np SYSTEM MAINTENANCE. AND OWNER (ERTT(FiCATiON Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consist.-, of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. Wbat 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 Ordinanec. The properly owner agrees to submit to St. Croix County Planning & Zoning Department a certification torn', 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 113 frill of sludge. 1 /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as sot by the Department of C:ommcrc a and the Department of Natural Rosources, 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. I /we certify that all statements on this form are true. to the best of my /our knowledge. 1/wc an-dare the owtter(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu ber of bedroom SIGNATURE OF A P`I WANT(S) DATE ***Any information that is misrepresented may result in the sanilary permit being revoked by the Planning & 'Zoning Department_ !, Include with this application a recorded warranty decd from the Register of Deeds Office and a copy of the certified survey map if reference is inadc in the warralty decd, (REV. 08 /0S) n s Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. if the filter is equippedwith an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank, If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Page I of 7 Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. if an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Distribution System No trees or shrubs should be planted on the septic system. Plantings may be made around the septic system's perimeter, and the septic system shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the septic system is not recommended since soil compaction may hinder aeration of the infiltrative surface within the septic system and snow compaction in the winter will promote frost penetration. Cold weather, installations (October- February) dictate that the septic system be heavily mulched for frost protection. Influent quality into the septic system may not exceed 220 mg/L 8005, 150 mg/L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm.'Code, and shall maintained in accordance with its' component manual [SBD- 10705- P(N.01 101)] and local or state rules pertaining to system maintenance and maintenance reporting. a No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidentat or unauthorized entry into a tank or component. Continge cy Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the septic system component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area If toe leakage occurs or by removing biologically dogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: County Zoning Office 715- 386 -4680 Mike Nelson Plumbing 715- 273 -5000 Weiser Concrete 800 - 325 -8456 Zabel Filter 800 - 221 -5742 Zoeller Pump Co. 800 -928 -7867 + 4 11121 05 NON 17 : 03 F 715 388 4888 X 001 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM yo � /, dw r .L -7- a F , .rd �'9t tp • # r �2 a1r1 INDICATE NORTH ARROW A � BSNCHKARK , .Elevation and description: �T — 1. r�+z�.�►c. �, ' d Alternate benchmark ro d. c r 2 � sO SKPTIC TANK: Manufacturer: ._.._��,o Liquid Cap,, 'Z1 Rings used:-(Q—Manhole cover elev: - Final grade elev: Tank inlet elev, : 14,o9;?, T2►nk outlet elev.: /0 7 J i No. of feet from nearest road :Front , Side , Rear From nearest prop. line :Front , Side ✓ , Rear Ft, r ' No. of feet from: Well Building: .2 (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE ' t� U 2776P -381 791218 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 09/04/2005 10:30AN WARRANTY DEED THIS DEED, made between Randy M. Penkwitz and Robin R. Penkwitz, husband EXEMPT # and wife, as survivorship maritalprorerty REC FEE: 11.00 ( "Grantor," whether one or more), TRANS FEE: 1032.00 and Roger D. Laliberty and Jeanne M. Laliberty, husband and wife COPY FEE: CC FEE: ( "Grantee," whether one or more). PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following Recording Area described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space NAME & RETURN ADDRESS is needed, please attach addendum): SCENIC TITLE AND ABSTRACT, INC. Part of Northeast Quarter of Southeast Quarter (NE' /4 SE' /4) of Section Four (4), 220 LOCUST STREET, STE. I Township Twenty -Eight (28) North, Range Nineteen (19) West, described as HUDSON, WI 54016 follows: Lot One (1) of Certified Survey Map filed May 21,1990, in Vol. "8 ", Page FILE # 2213, as Document No. 458731. St. Croix County, Wisconsin. 040 - 1016-60 -000 Parcel Identification Number (PIN) - This is homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, ifany. Dated AM" - (SEAL) t< (SEAL) * *R dyM.P tz (SEAL) �� (SEAL) * * Robin R. Penkwitz AUTHENTICATION ACKNOWLEDGMENT Signature(s) Randy M. Penkwitz and Robin R. Penkwitz, husband and wife, as survivorshiu marital STATE OF ) property ) ss. authenticated on �• w/ r COUNTY ) Personally came before me on i .goo, , * Kristine Ogland the above -named A, , /y ter. A- 4 -y, 04/, 2. TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: .� - """� "' ` Brian Scott E010 Public, State of Attorney Kristina Ogland N ote Pub�I m mmission (is permanent) (expires: Hudson. WI 54016 i State ;�f IBC onSlll (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO -PRO"" Legal Forms 800 - 855 -2021 www.intoprotorms.com C) 0 2 ƒ E £ 0 2 2 2 - « w C: E \ § � ¥ o � k \ ( D \ � / ! 2 2 \ § _« E �; o ■ � ■ 2 E o o CCD E� © @ 2 > E § CO 9 c >0) E ¥' .� C.02 k ? oo�' k3 0 w� § ° § k c CL 2 T / ° E 2 / 000- " - § a / 2 E ) § n K § § & \ 7 q 2 o Ln Q � F —0 2 CD CD � \ r / 0 > > § m � ® 2 § ■ ° ` \ z 9 0 Z # CD CL CD \ a w � §.. M . ƒ � ■ � ± � 0 £ c F % . ( � \ � � $ � ƒ � # Oa Oa Q \ E CD < @? j �§ kCL �2 w t AS BUILT SANITARY SYSTEM REPORT OWNER F /Z TOWNSHIP T/f o {/ SECTION .ZI N -R _ W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE -?•, PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �•el� /sv.f1 IW� #a 4ftl� r� SP 04 / to r %8 - F2 • 8 i A /off • ' Iva oM INDICATE NORTH ARROW ^� BENCHMARK:Elevation and description: / � /��c — Co��i,ec le d a Z Alternate benchmark C.�/od /, �, t.�i•� SEPTIC TANk:Manufacturer: Liquid Cap.__ ^� Rings used:-0--Manhole cover elev: ATY"' Final grade elev: 4 Tank inlet elev.:.zf? .- - Tank outlet elev.: /( 1 3 No. of feet from nearest road:Front , Side , Rear ✓ Ft. ��C From nearest prop. line:Front , Side ✓ , Rear Ft. > lQ0 No. of feet from: Well -�' 2f , Building: .7 3 (Include this information in the above plot,plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE � s �� '/d L�r 6►oG e / i PULP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons /cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front_, Side_, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length --� Number of Lines: jj Area Buil Exist. Grade Elev. — Proposed Final Grade Elev. Fill depth to top of pipe: e / No. feet from nearest prop. line:Front , Side r/ , Rear Ft. i No. feet from well: ?�S`d No. feet from building l� HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road r Alarm Manufacturer: INSPECTOR: DATE : O 1 PLUMBER ON JOB: ~rL / LICENSE NUMBER • 6 /90:cj .,.,....� �..�..�. LUT LOT SIZE 7 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s caf t l z aM f y f. FZ 7 P1, 7 9' 1 4y A INDICATE NORTH ARROW ^ BENCHMARK :Elevation and description: e Alternate benchmark SEPTIC TANK :Manufacturer: Liquid Cap. Rings used:..0 Manhole cover elev: grade elev: Q Tank inlet elev.: 1 025 - e2 Tank outlet elev.: / No. of feet from nearest road:Front , Side , Rear ✓ Ft. ?, W From nearest prop. line:Front side ✓ , Rear Ft. > l ©r7 No. of feet from: Well �:' JS' 1 Building: 3 (Include this information in the above lot p plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE �/ �� I+ 4k Pin m o v v o s N � o � -i w � v �} O A i W t \ � r M tA �w I x y d 4 d 0 I I t " , 0� Ch i . l J r i h w ti h ' A i I a II 1 « j � i 1 'LOGATIQN• TAOY NE SE, LO ]] RD. Wisconsin Department of In ustry ISRIV`ATE SEW�GE S�M Labor and Human Relations, Count Safety' and Buildings Diyision INSPECTION REPORT (ATTACH TO PERMIT) Sanitary ermit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City [] Village ❑Town of: State Plan I o.: PENKWITZ, RANDY M & ROBIN R TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: WD, 0 C — TANK INFORMATION ELEVATION DATA A9200247 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic ekS OOU Benchmark q` q7 Dosing Aeration Bldg. Sewer Holding St /Ht Inlet a,3� Io1.55 TANK SETBACK INFORMATION St/ Ht Outlet a,� y 101, TANKTO P/L WELL BLDG. Air to i ntake ROAD Dt Inlet ir Septic j 1 5 I a 31 NA Dt Bottom $ ",is I001S7_ Dosing NA Header /Man. a ,o.o�. -101 11q y - 9 Aeration NA Dist. Pipe 9� `I g4 g3 3 im 81 q,q7 I0o•05 Holding Bot. System ' U,q-j q %.9 S A cd O PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TD Ft ead Forcemain Length Dia. Fi Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Wi h Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION 8 +6V + °! DIMEN SETBACK SYSTEM TO P / L I BLDG WELL LAKE / STREAM LEACHING Manu acturer: INFORMATION Type of L / i Model Number: System: /-awc -� J �i 3 so CHAMBER OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 V� Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (include code discrepancies, persons prese t, etc 0 °{ i x Plan revision required? ❑ Yes ❑ No I Use other side for additional information. r 54 1 SBD -6710 (R 05/91) Date V Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E K N i SANITARY PERMIT APPLICATION — 7 ■��c �HR In accord with ILHR 83.05, Wis. Adm. Code CouNTY L STATE SANITAR ERMIT # –Attach complete plans (to the county copy only) for the system, on paper not less than 1 8% x 11 inches in size. ❑ Check if revision us application —S reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION /�C 'A_ NF %a Y4, S T p , N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # GGp YY. CITY, STATE ZIP CODE PHONE NUMBER SUBBIVIelION NAME OR CSM NUMBER �. FG 2 Pal P o, Ill. one l. TYPE OF BUILDING CITY NEAREST ROAD �/ ( ) State Owned VILLAGE: e r. w� ❑ Public LJ -# 1 or 2 Fam. Dwelling of bedrooms =K— L AR AX NUMB R( ) III. BUILDING USE: (If building type is public, check all that apply) _ 60 1 ❑ ApVCondo – 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 PERMIT: (Check only one in line A. Check line B if applicable) LJ A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit ## — 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 12 Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORP S YSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) /�` o ��FVATION Feet 1 ZJ 1 °J Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper. INFORMATION New istin Gallons Tanks Concrete glass App. Tanks 1 Tanks structed Sep tic Tank or Holdina Tank — O 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. ber's Name (Print): bar's Si MP /MPRSW No.: Business Phone Number: PI : r Y• A 4 t Plumber's Address ( tre ,City, Stat , Zip Code): IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sa 'tary Permit Fee (Includes Groundwater Date Issued issuing Agen o Stamps) Approved ❑ Owner Given Initial Surcharge Fee) A dverse Determination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber t � ` INSTRUCTIONS 's 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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. 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 & Buildings Division, 608 - 266 -3815. 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 in 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 in ##1 -7. VII. Tank information. Fill in the capacity of every new and /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 8% 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 loss; pump performance curve; pump model and pump manufacturer; D) cross sect�c.m of the soil absorption system if !equired by the county; E) soil test data on a 115 form; and F) all sizing information. I ------ ----- ------------------------- — ---------- - - - --- --- — ----- - --- GROUNDWATER SURCHARGE 1983 ? v scc.'i5irz Act 410 in_!uded the creation of surcharges (fees) for a numb::�r of ( , rvgw' ated practices which can effect groundwater. The monies collected through these surcharges we used for monitoring groui)dvwater, ground- water contamination investigations and establishment of standards. SBD -6398 (8.11/88) S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,(spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property - Location of property_ (J' A/4 ,�.C Section , T zb N -R W Township Mailing address / Address of site S F c Subdivision name Lot no. / Other homes on property? yes Y� No Previous owner of property /_� a/- �ce�s, -,••/ Total size of parcel T. Date parcel was created y Y- Z ,� 0 Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house)? Yes (_No Volume _Igq and Page Number 3 q as recorded with the Register of Deeds. ------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. q 4P O t , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded n the office of County Register of deeds as Document No. 2 !pd Signatu e o applicant Co- applicant 7 -1-- qv Date of Si gnature Date of Signature i i a ,, ''• r VAl,� , A O +, STATE BAIT OF WISCONSI &M.'11 •• 196f This * race Rtes"= row ■K �ro OATA LAND CONTRACT'''. (TO BE USED FOR ALL TRANSACTIONS ' WHERE OVER 11=3,000 1S FINAVCED AND IN OTHER NON - CONSUMER CT TKANSA REGISTER'S C FFI ! OTIONSI l 104TWool Will corporate VOL rA6E ST. CR61X Cd WI r` Francis A. Marson and Reed for Record Cont f by and between .. Frances Marson FamiYy "}i' §t, : Uk� i' 3 U 199 (! 1r�4 Thomas F. Marson - Co 7rustees:, "V ndor° Oi g ��, athar o e - o • more .......... aad R dpi M . Pen wi tz and k�b �n % • ?` , ' ... wl�v ,Pen�cw..tz, husband and wi'�e as 'su'rvivor Iridr�ital`,proparty, „ (" Purchaser", arhether one or more). Repiste t Vendor sells and agrees to convey to Purchaser, upon the prompt and full per. s "' ,, 'iormunce of this contract by Purchaser, the following property, together With the ,'tents, profits, fixtures and other appurtenant interests (all called the "Property"), t . . .` . ........................... County, State of Wisconsin: ecruarr To } t r !li Tax Parcel No. t. Lt f NE -4 of SE 4 of Section 4 -28 -19 described as follows: ti6 of C ertified Survey Map filed May 21, 1990 in Volume 8, page 2213, as document number 458731. I ` REGISTER'S OFFICE ST. CROIX Co., WI Recrd for Record at J 3 01992 n � 5 n 0 A. M Reyissler Of Oe I I I is not This '. + tout ?tr.l ! pro,, r %. (15) (is not) { address to be designated h a Purcsas Vt'r t Hl t. [ I 1 and tU p:s to Vendor at.... . •• ..• .rp0 s� 06 8d "t tty, �t s 03 .. the slum of .$....... .t.., ,n me ;rllµtvtty, it,s�tyfter. (al 8 �', ._ .. 7 lGl1 `,l1 { ` hereof on the bal ance l r ut� nitw t,;: fr on; ti I' t I i:n. ,( w t iiv rate ni....... - 9.0% , t•li l tr'eP wit ivr i nt er, em iler iii f 1 until paid to full, as follows. monthly' payments of $192.00 principal and interest, comm. {� Decemkier 11, 199 and the itirst of each month thereafter t r however, the entire outetaodinwe httlart,c hall be paid in full on or before the .. 1st day of r rovideJ, {� httaxJemb�el; . , 1u...9.4 ; the maturity date). C A tll%i saved - eo 01- mile 7 less at! el a 1 i� C. Ff V. Payments Shull be applied fsr,t to iw vt or: t v; !;,J ! „!a., ,a the r:t:v .pvrifrtd and then to amount may' liv prepaid :vitholit prcnt; ill' ..r `. t• •.. r ;'I - o' ,l? at t ..J.r. ''In 'he evert of any:isrepavinont; tirier.r. Thal, r I... t• ! .. i' defa -l?t w•iti: n•<pact to pa;nrent +m !no.; as the unpaid hulance of pr-ruipal, stud it rcrr >t ta in !:ri err•, ne ...•n It rn m. nth to rwintl. r;.Il Le treated 'as unpaid principal) is ley t' nn tie woont ti-l., ;.: , il , :•dn, :. . , old 'act 1&(n itad C:.- nwrthly nu nsr •its hren i' made'- as;first 4pecifled tiffive; prov,ijv t ,at. r• nl r,t .sera slh:.11 I— vriwinu•d fin the• event of rred:t ni :,,:y pn,reeds ! 1' of` insurance or condenuutt,on, the r prr•mr'••� I,r..n t.ier.•ait••r exrlu hrrrirr.n,. ,.� ! Purcha er sta'es thitt Puri l:, • r i< , .t ,i icitl, +.l "• ur, !.: tJ. t:t'e evidence submitted to I'•lrvhas for examination except: No exceptions. i I t� Purchaser a¢rrr n pet tr! vest i I' an ,. -r.,. " be retained lr V ndor ur.,.i tt r !: i'urcLsrsc•r siail hacnti;i, •Cr,ae. Out ring. - t!. i , . CONTRACT :adJtrldual and TAI 1: It,Ut tsF KIr Ir�•:� � � • •;" it f r re6E � ,�:�' y � T � r a. ,r ^t ,N�n' f, Paschaaesrtp{o d reeeipt�`thowin ancb paten . levied on thtt Property or upon Vendor's inter" tr ' mires to pay trbea" us all taxers• and tl ""am IS .1 t i in it aqd to de toI'Vendor on dems to R - •, ,.. •_ .. . tt 1 . t A. ,1 1 s ' v ti sa Ptrchaser c ^vcnunta not to commit waste nor allow waskr to be committed an the Property, to keep the Property in good tenantable' condition and repair to keep the Propurt >' free from liens superior to the lien of thin Contract, and t to coalply with sU laws, ordinances and regulations affecting the Property. Vendor agrees tbst in case the purchase price with interest and other moneys shat! be frilly paid and all conditions r shall be fully a r ee s t b at the limes and h e manner above specified, Vendor will on demand, execute and deliver to lt� the "Purchaser, a - Warranty Deed, in fee simple, of the Property, free and clear of all encu asements,ovnns r ceat any ltens'or encumbrances created by the a•a or defaaft of date Of this contra t l ... an ....... ePt exc s of ecord • s .......... .,. c........a......... . f .. .. t ..... . rchaser .......... the .. e ndtions, created by ...............,........ l,.cc2. :. ". ... . .................. .... . Purchaser agrees that tinge +s of the e,4�`rnce and (a) in tilt. cver.t of u default in the payment of any principal or bU interest which continues for a period of .......... days following the specifiud due Jatc or tb) in the event ( ,f a default in performance of any other obligation of Purchaser which continuer for x period of ... 60 following written • days notice re thereof by Vendor ( deliveredporsonu : y ormailedbyter ` e 's + out c e n (which h r b shall become immediately due and payable in full, :: ) I:,lb act to any linlitati"as provided :4' law') m waives), and Vendor shall also have the following rights arid rcmed es j addition to those provided by law or in equity: (i) Vendor may, at l 1, option, terns mute this i'ouuuct and J'u 4ui ' rights, title and tnter� tt l ith _te Prop l e fu�l llavw nt of 71n• ont, ndir g hal:aviT, "'it intere. t uny the�eun rom redemption to be cond+ the date of default at 06 rata In ef o liq u te d d ndowhrrf o rc'a iilur et, fullill liiswContructlundau +r rental the Prope by Purchaser shall be forefeiteJ as r li Proper ire ad full p urchas er fa ll s of the entire out+t:,nJ ny t bulur c•e, w ith lntt 1 !.•t t there r, a t the rut it, r f, cl `On th" (late of Ill)h e ;;default and other ant+ ?�eficienc h eor (ill)�Vc d may sue law for ti "lipaaid p it u ;Juicilinn hall be liable for and J !hereof: ur (iv) Vtndor mayst de c Purchaser C o tracsignifu:antr� ul (v I' I c' r nav I urch. •c frurn n, e.cio s n action if the'eyuitatic ,tit I.r•nl tt, p''n , f ,n:. action of the Property and have a receiver appointed to cullect ury rents, d i•'' r i r' under - (!),:Ili) or,:(iv) ubnve.Notwithstundir , g anJ' oral or ycritten �t•:'• n: lit • a u• m of \'t.u n cli 1 n. e any of the foregoing remedies shall only tit hinding ul -il \'end•n• if and wI.. n It'll u,•J :n uttr i yc'utl !r ah:ac.f r includins; reusLnliblu %itU,nlcys fee s of Vendor incurred to enforce lu:> 1, '" d. ! v. n "1 ' 'r extent not pruhihited` °by law and expenses of title evide.uce shall be :•, tit ti to print ip:a. amt raid f.\ !voce r ^per, u= iv curred; °:and shall be included in any judi ; nlrvlt. I n or during the pendeuc'• of anJ• action of fulfC:o:iure of tl:.' Contract suvsh a nd consents Upon the commence , 1 n e t of t t +Prurp oin tdun t the pendency of t he hrc+iction; ine�usduch rents. �ss,l:, nt;' ht } +r ifta + w }�•r. sn be p rtpplicd :I., tilt. rourt shall direct. l'hreha -er ntlnll n"t transfer . sell ol . cunvey any let ui or u inter n',J ccithot t r tiie�prior t w•ritt n of Porch. - is rig': unde,' this i•nntract or npt.un, rl "S: term ica ayable under t "r:t�act Is t paid nr full ur the i consent "of Ven(h4 unlc. +s either the outstanding balance p nten.a conveyed is a pledge or w- Avil-ent of Pure;:arcr�lcirrt'•innvu� :ulcv . t \�, r.d r`n n t, vnt �rreuutst>+andir of "Purcha er. In thy' event t.f +ul uch transfer, balarce payable under this contract shall hccuinc iltimcdiatei 'sue and u.. ::ha full i m i \c 11 opium Ivjthout nnticr no Vendor shall make :ill p: ort•Ci tt ` •rantedthJ under 1 Purchaser) or undt.r nr'!te secured !herehy, provided s r this Contract (except for anJ m 1 t makes tii ch pn)ment of rile amounts then du undt t }.is C"ntrar•t. P +•• br.ser MAY nm � mad c 1 iy u l t't :l'rIt cr ` l e e n• thy' ;fort_aree if Vendor fair to do so :old all f,a.ntert= sn madQ hJ Purchaser sh11,1 this Contract. , "';, , 1 f 1 rv6s >t t. •.. \'endor may .waive any dcr.t:at witno'l1 w•aivi anJ other subin the bene fi t ,; e fi , e'• .. ' Ail terms of his Contract shall he hindin¢ upon and inure to the henefitc of the heirs. legal representatives, succes , s and as h o! Vendor and Purchaser. (Tf not an otcner of the Property the spouse of Vendor for a valuable consideration joina..)lerein to release homestead rights in the subject Pr�Perty and al'rPex u, join in the execution of the deed to be made in fulfillment hereof.) ltr .91. 25th d :a> ,.r . October Francis-A' Marson & Frances K. Ma Marson, Trustee o am�rllTrust �l( �...., �.....!_ ,siAl.� By3x Randy �4. penkwitz r r.,. FJ.:; Thomas F.'Marson`, Trustee Rok ! ?. i'c'n'•:witz KN0),k i.r.nc`tt•,`T r AL•'rifr:v'rICA'rluly I'A"; Cl?01X 25th dayI 1 ;::lth�•ntic'ated ti::� � C1Ct(rhr•r ;,,,. ..I.,ve :;un:ot.� ,7ohn .I . ?it r.it)I1 , Thomas r. Marson R,-ind% �.,, t'enF;t: itz and Rob iII R. Pon kwitz :I l`1 :! '.: n:. • I I.0 � all e. •••� I Robert L WALL b : II LIX R r � r 'S Sec ond , �. Forte tin. 1 ANn 1'OVTRA(T— Ina'•"Ianl and rn•nnrPl. —. ¢1•r. Rn• �( w'Inrnndn, II — i•rtJ _ �ODLI. - BESKAR .& BOLES, TEL N 715- 425 -7586 Oct 25,91 1235 No.001 F . pOCUMENT NU. I ��$1'. E .DAR OF WISCONSIN FORM 3 - 19821,E THIS SPACE 1416.-CRVGD FOR RECORDING OiTA �! QUIT CLAIM DEED {! X29608 i 789PA JE 391 'i i REGISTERS OFFICE ncis A. Marson�_ a1 /a Francis Marson, and j� ST. CROiX CO., WIS►j Fra ......... ..................... . ..................... 11 27t Frances K. Marson, a%k a Frances Marson, • ........ Reed. For Record this � ,husband and wife ... ' �� ay of Aug. , A.D. 1917 quit-claims to J ohn.. �.,...1a;?c11�.. a11Gd.. �'hQ11lS.... :...(`�?z.; A)?.r.... i� 11:30 A Qne as tenaz}t s.,,�.n.;.�Qmmo un v -ha.19 ..... li I �;il$;1R...�.? ............. .................................. i �..�. 1. 1 .................... .... 7w N psi :... ................. ....... ......................... I the following described real estate in �St• CroiX County, Stute,of Wisconsin: _ RCT%I"N To The•NW} of the 'NW} and the NEI of the NWJ of ,'• Section 10,' T28N, R19W lying North of Coulee Road, ALSO The. NEI of the NEI and the NW} of the NE} of Section 9, m28N, R19W lying East of :the easterly right -of -way line of Tax farce► No: ..... ....................... i . S.T.H. "35 and lying North of Coulee Road EXCEPT The parcel recorded, ;in Volume 360, Page 142 and the parcel recorded in Volume 414, Page 5316 and ° the Certified Survey `Map recorded in volume _7 of Certified Surveys,, Page 1840. ALSO The SWj of the SW} of- ;Section 3, T28N, R19W EXCEPT ;The parcel recorded in Volume 764,;Pa a 212 and that p art , of the Certif iod'.Surve y Map recorded in Volume 4 of Certified Survey Maps, Wage 1164 lying m said SW} of the SW}. ;ALSO: That part of SEJ of the SE} of Section 4, T28N, -R19W lying !South o the Certified Survey Map recorded „in Volume of Certified Survey Maps; Page _140 and lying South,.of Certified Survey Map recorded.in Volume -4 of Certfied Survey Maps,. Page 1164 EXCEPT The parcel recorded in Volume ' 613,, •_eag 123 "and "�?4 , f h AL50 .The NEB, of the SE4., of :Section ,.4,. T28N, R19W lying, ;North, of Southerly right -of --way lino of Tower.;Road M. EXCEPT The parcel recorded in Volume 443, Page 332. Gr ant ors }'ierein reser,Ve• unto themselves M a 'Li fe Estate in ' said real tax and reserving the , e real estate es g,. sin a� th e , s to a re to e to y� g g 1? F right to claim homestead credits. T1 r, document is being rerecorded to correct the legal dcxiption, 'This .. homestead property. ,.-•ti A r 1 .$.�, d ............... Bated this .... .�. .... >• (SEAL) � .. Y,IO`s'�.'(SEAT ) .. n�is ..A.•...M�ix.Son....a /.}� /.a u .>~xanci� Marson ...... ........ .. .......(SEAL) R.r.. (S i". AL,) I j �. Mar•son D N T M AUTHENTICATION' ACBNOWLEDCiM " arson a k a S TATE OF WISCONSIN Q 'Francis A. M � / S .,. .. t re(.) F n ]. Marson-' and Frances K. Marson, as !. ira county. `out c i 'ted th` .da f ... . v.1 ....... ., 19. Personally came before me this .... .....day o; ................... 19........ the above named ea A. Beskar : ....:............. ................................ I ................ ............... 1 TITLE: NIEM13ER`STATE BAR OF WISCONSIN ......................... ............................... .. ..l , (if not. .. ......... ........... .......... I ...................................................... ........................... ...... ...1 authorized by "§ 40(;.06, Wis. Stutg.) to mo known to be the person ............ who executed the foregoing instrument and acknowledgo the same. :THISAN STRUM LNT WAS ORAFTED DY .. Leo A..:::Beskar, Attorney . ........................ RODLI , BESKAR & BOLES , S . C . ........ ................. �9 N.Q,tll, Main S.x .. ....... Notary Public .......................................... Q o u n t y. Wist 1 t My Commission is permanent. (If not, state expiratio � a 1 � 022 ............. II �p taros ,Wily h xut]�enticn c or acknuwludt;ed. Both ure not necessary) date:........... ............ ., 19. .} nrT tbrlr sign urw n brl 4t or rl trd �L .wr....... „r ua.... undue fu ally trurettY should be typed p _ � li S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER C ADDRESS I I FIRE NUMBER CITY /STATE ZIP 1 /6 PROPERTY LOCATI N : 4114 , S � 1/4, SECTION , T 1-► N -R�W TOWN OF 1 , St. Croix County, SUBDIVISION . - , LOT NUMBER_. 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 septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and ( 2 ) after inspection and pumping ( if necessary), the septic tank is less than 1/3 full of sludge and SCUM. I /We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: �� 1 St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 SAFETY 1 BUILDINGS .��.`%'�ENT OF REPORT ON S OIL - 1306R4 'NGS AND DIVISION P.O. BOX 7969 LJ R AND PERCOLATION TES qi5) WI 53707 r ;IJMAN RELATIONS (,LHR- 83.090) & Chapter 145) _W�ION _NAM F._ TC: I I. i7A TT !V T O( =A f1l TT - ION: 6V=S;f1_aXiUN , - )DRT TVLIN ADDR SS: sT 1)< - Tom USE DATES OBSERVATION MADE NO. BEORMS. ICON M DE RIFT ION: M M . n - S - I Q� - 9 0 7 [i�iResi_denca_ evv DReplace RATING: S- Site suitable for system U- Site unsuitable for system W�ONVENTIO - N-N5� S P;R-E!-39-u-nr.rgv-STE NS W,.iN.FIL,I.FAOLE)ING-fA-NK:IRE zS [J A( - 0 Elu I F�u I [I S Ell S'x SL _L)"JG It Percolation Tests are NOT required IDESIGN RATE: If any portion of the tested area " in the under s. I LH R 83.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: _ PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO QROU DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELLVATION OBSERVED EST. I-IM TO BEDROCK IF OBSERVf (SEE ABBRV. ON BACK.) ),0z V . 1- 'tJ O)Q F" B q b IQ tj 6c) N) le Ci 25 - 7 Q 8 ci 1 \ \.0 - 7 9 B- b h N. P - 2 - 7 SEE E Ct 6.5 '7 R`1 B- C? �B- PERCOLATION TESTS - ITES" mrPTH. WATER IN HOLE TEST TIME OM IN WATER LMI -IN CHES RATE M INUTES .,S AFTERSWELLING INTEnVAL-MIN. NUMBER I NCHES ­ 7 - Eff i ff 7 P. Ki PERIOD PE PER INCH P_ I P. P I T_ P. PLOT PLAN: Show locations of Percolation tests, soil borings and zhe dimensions of suitable soil areas. Indicate s cale or distances. Describe what are the hori- zontal and vertical elivatioi: ;e,�arence poin u and show their location on the plot plan, Show the surface elevation at all borings and the direction and percent ijiid slopt% I ',_Dvy)�o rZ SYSTEM ELEVATION C D""s' CT `q ( 4 - 7 f CIO T C_ -. lr^ t Y, . b �� ._._ _ ..i. _ . _� i ;~�t� __. t' r-/p.,+3�-t� _- I ;_ I I - __ - T I _ 4- 4 , ! __ .... � .- � -__.. 'r' - - -. I I_,,. 41'. T -- j + Ls' ! �I – T t m� "e6 � WIT cm LJ ) ale !ZN r ' ) 1 Ak �' t T z C_ 0-nxS '3 VMLA" 1, the undersigned, hereby certify that the s oil t reported on this re made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, end that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAW7 print ): EGEfflER WE RE C 0 M P L E T C D ON: AND _31 l y C) ADDRESS CERTIFICATION NUMBLJR: PHONE NUMBER(optional):l T (3 Qj ( CST SIGNATYRE RIVER FALLS. W1 54022 715--425-0165 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Taster. DJLHR-SBD.C M, 10/83) SOIL DESCRIPTION FORM �� _t Attach..So 1 Pro il�lgca iU Ha� a Sgparoto Shoat) - -- LINEAR 10J10ING RA CLL TE: T �� U r S � 11� �R1 V��S4S ;. C7��o / v 0/,a ASP-.CT • ST lZ L �f . 9 O •.,, -. CURRENT LAND USE; - - -- 5 VEGETATI �nVER 2 S ^rZP WS 'Et CS �I DltATNACE C 0P YA LASS tqi OES %RtP tDN: - - II a Q M , 1 ' R + W Pf°i` o � Ll 0 LOCATION o.i� tsF TaVY GALLONTPER S9. T. PER DAY, - _- SOIL SERIESi pAAENT MATERTALTs11I)EPTII• i )lDNl20N Will NATRI% COLORS M0T11E5 fKXTLRE S1fIUCTURE CONSISTENCE CLAYSKINS/ F1+iE5 RL + ^Ti I P ?t ,BJUNDMY RE1tnRK% ;zi 1Nb _. y�6 s �� I l tin s b n �E=►. corers I�� s - 's i 'I 3 3y -i oz to w s 4/6 - s { Sbk `M � L"'O i u>z. 'cl S oC�1 rJG 2 - M lw -m z — " 1 Z m s bfti. an �►-- _ c s Z rn 5 b1� Yl Y- C, 6k-) `3 3y -g ib tiQ$4R ��6 - �S � � '�`Sb '!�I Tl^ w /lo�a�r'z S cl 3 P 7 oI 1106 } 0 - 1) 1a�►fz, -! 7. sj� Zm9bk Z 1 w tz ql(! blt - � - 1 ' Is j I Zm Sbk �m 4� c S )o� RyA, S Zm�brc M h C �o2�� c, S to - Zy lotih yJ6 - S i 1 Zrn s bh �1- _ Cw _ 3 7y Llo s Yrt v/U - -- �1 b -9 )u ` R y ~ g � g S +� I --- �_ o- 9 Z�--r fz- z Z s i Z M 3 bk )Yl ►- c s z y- 7,6 lb'l R V16 I OTHER 11IE FEATURES /NOIES: / �; n-'Ge 0t Date CSI LIMITING FACIORS /UEPTH: s1 n�tura --c r if1lX COLORS MOrTIES TEXTURE 5 luCTuRE C . ONSTSIENCE C:AYSKIN / PORES fi00TS f'11 1,8puNOARY REMf•RK t¢ Rl2htt DEPIII Gr, St $nP. C14I INGS _ _ - � 3 gi - Wl — 5 ps o tiu�t - _'s 1 1 Zr�Sbk_ �n�F - - s � I Zm Ivy P- U /6 – — t -I T cw U /C, _ S 1 9 Z M 3 bh h't ►^ _�S �.SyR 3 /y� - s 1 ) mSb m�►� y J(. LI 17 " i — .- ---- -- 1 �'1 S� S SZZ1l.� W (3 - -- __ OTfiER SITE r'EATURES /NOTES. ,'� G p' - _ 1 - 9 7 C� S—) 6 CST I L 11l1lYIPlC FACiUftS��cPTN: A� ? �1g9� '-10 M _ ry 458 `31 S ti CERTIFIED URVEY MAP LOCATED IN THE NE 114 OF THE SE 114 OF SECTION 4, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN. OWNED BY: FRANCIS A. MARSON AND FRANCES K.MARSON FAMILY TRUST. C/O TOM MARSON 497 H WY. "35" HUDSON, WI 54016 NOTE BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE SE 1/4. ( BASED ON RECORDED PLAT BEARINGS OFVALLEYVIEW HEIGHTS). .... ; �� is ... f • W 1/4 CORNER OF SEC. I r� . . \ �', 1 j : I I.,.•+. tr J'1 f i1. \.. ? :� s ,.1, 1 i 1 •1. E1 /4 CORNER' OF SEC. (�M 28N, R19W.(COUNTY 4, T28N, RI94.(000NTY MON FOUND). NORTH LINE OF THE SE 1/4 MONUMENT FOUND). see note "D" ' ® N.eB!52'44'.' 84 26 444 - 3:53' tsee note "A" 414.96' 3. S' 426.30 ' Z• Z, CO Q. J. Q • °i d O "� • w r` Q O z w R 40 CO Q w, � � �t a LOT 2 � - `r W . zw„ LOT 1 0 �• ~• - n 4.67 ACRES on `° w Q• J• Q 203.384 3 ° 13, a 27 SO. ACRES ( SO. FT.) m J, _ � (213, 8 N Q.• 4,OOAC. EXC. R.O.W. ON 4.26 AC. EXC. R.O.W. a ' w� ( 174,272 SO,FT.) N i 185,564 SO. FT.) 0 Z• Z. Q m M ° N drly woy to be located — driveway to be located •/ �' EXISTING �?, , withlnthlsorea. ON withlnthlsarea. Z/ see oars' B' I i DRIVE 5 1' I zo, I � I LOW AREA (6 200' —� 1 200' .G 1 \ h � OO_'' 3�5' =0O " _ 36 , 150 , ..... .• 8 4b N��•� - -• • - -� -- - -, —_ � O CULVERT _ M � Q N 85 3 1p �_( -A,B' in see note O 00 : IN 3 9 6. 79 30. 1 �, .. 2 1/2 "ROD• FOUND. , c, w -.. to o NOTE: CURVE DATA IS ON SHEET 2 OF2 Z OK CVM CCx)tfr,/ In h�►�Y;°9t4CC:hrivwTfF!t N a LEGEND CON �S��i O =SET 1 "X 24" IRON PIPE WEIGHING 1.13 • LOS. PER LINEAL FOOT. • : I "IRON PIPE FOUND. JAMES M. • WEBER S • 1804 • ■ 2 " IRON PIPE FO U N0. SPRING VALLEY 3: WIS. ' N • ge :. �/ e' a' � .'L� n SCALE I " 150' »' JAMES M. WEBER S- 1804 WEBER LAND SURVEYING 0� 75 150 300 DATED r..a�rC)a \�`1c'3 SE CORNER OF SEC. 4, T28N, R19W.(000- SHEET I OF 2 NTY MONUMENTFOUN 90 -10 THIS INSTRUMENT DRAFTED SY VOLUME 8 PAGE '221:3 CURVE DATA No. Radius Cent. Angle Arc Chord Ch.Brng. 1 -2 1490:71' 16- 16'34" 397.45' 396.27' S86- 51 "W 3 -4 550.17' 7- 59 76.81' 76.75' N81 °30 " 5 -6 484.17' 9- 22 79.15' 79.06' S80 °49'00 "E 7 -8 1424.71' 16- 46 391.64' 390.41' N86- 37'30 "E TANGENT BEARINGS: At 1= S79- 13'26 "W At 2= N85- 30'00 "W At 3= N85- 30'00 "W At 4- N77- 30'04 "W At 6= S76- 08 "E At 6= S85- 30 "E At 7= S86 - 30'00 "E At 8- N78- 45'00 "E DESCRIPTION A parcel of land located in the NE 1/4 of the SE 1/4 of Section 4, T28N, R19W, Town of Troy, St.Croix County, rj Wisconsin, more fully described as follows: Beginning at the E 1/4 corner of said Section 4: Thence SO- 39 "E along the East line of the SE 1 /4La -��y distance' of 485.80' to a point on the lout -,irl; - 1911. -o- line of Tower Road; Thence westerly 397.46' along said line also being the northerly line of Valley View Heights and the arc of a 1490.71' radius curve concave northerly whose long chord bears S86 - 61 "W 396.27 Thence N86- 30 "W along said line 396.79 Thence westerly 76.81' along said line also being the arc of a 550.17' radius curve- concave northerly whose long chord bears N81- 30 "W'76.76'.; Thence N2- 35 "E .(recorded as N2 -39'E) 448.98' along a line that extends along the monumented east line of the parcel described on the warranty deed recorded In Volume 443, Page 332 to a point on the North line of the SE 1/4; Thence N88- 52'44 "E along said line a distance of 841.26' to the point of beginning. Contains 9.58 acres .subject to Tower Road right -of -way over the southerly 66 feet as shown. Also subject to any and all additional easements, right -of - ways or conveyances of record. SURVEYOR'S CERTIFICATE I, James M. Weber, registered land surveyor, hereby certify: That In full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St.Croix County Subdivision Ordinance, I have surveyed, divided and mapped the above described parcel of land and L ' + 1a a cor re presentation thereof. a P �Ildt Su��i p lat, i p ``e ��t��t �oPk Dated this day of 'C��t�RC�.'c . ,1990- % \9 ti, James M. Weber S -1804 2 WEBER LAND SURVEYING WIS. SURVEYOR'S NOTES monumentedaQuarte� Line,N2 35 17 E 3.77 of I10i S U RA "B" : Found i" iron pipe N2- 36 "E 3.89' from right -of -way line. "C" Found 2" iron pipe N79- 09'14 "E 3.36' from monumented East line-of the SE 1/4. w "D" The South line of High Ridge Court does not and did not Intend to abutt the monumented East -West Quarter Section Line. SHEET 2 OF 2 Drafted by Jim Weber VOLUME 8 .PAGE 2213 Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (715) 749 -3656 S kA r t s / ; /1 / G 7• REPT131 troy ST. CROIX COUNTY ZONING PAGE 1,0/26/92 10:18 REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/26/92 AREA: MJ 4 Activit)f; A9200247 10/26/92 Type: CONVSEPT Status: PENDING Constr: Address: TROY 04.28.19.61A,NE,SE, LOT 1, TOWER RD. Parcel: 040 - 1016 -60 -000 Occ: Use: Description: 171483 Applicant: PENKWITZ, RANDY M & ROBIN R Phone: Owner: PENKWITZ, RANDY M & ROBIN R Phone: Contractor: FOGERTY, DAVID Phone: 715- 749 -3656 -------------------------------------------------------------------------------- Inspection Request Information..... Requestor: Dennis Fogerty Phone: Req Time: 15:10 Comments: Items requested to be Inspected... Action Comments Time Exp 00012 FINAL INSPECTION ` -,- . -------------------------------------------------------------------------------- Inspection History..... Item: 00012 FINAL INSPECTION I �o a o° o° CID 0) 4 c c 0 0 I I o p y c in Q Z N > c ti o y t0 •N o C) rn 0. ° m LO y c o v CD a� A . O c y C N N U YO N c a m ° y ° 3 m oy • m CL At E N U °' LL w o N m> 3 0 E 2 CD O O U.0 0 t6 p E C Z f0 N z p __ D1 fj N a m c c 3 m - L - C t � LL C LL •° 3 ° -,4 7 °- N � U C C v > CD '0 0) c o Q a. Q �LON m c o 0 V M 3 Cl) z E 00 = p E z € v c co m m m d v z a m a m o E z :t c ° rn N Cl 4) CID I o y c Q ° i` -z z z w N z ' M II ' y y c N E N N .. td y N I n a Y o c O co N N !U C d N O G o a ° o G G a z j u fn fn N �I u fn y N az 3�3 �3 a S' o tw z •� ;� 3: 00 o aaa co v CL 0 y (A J U 2 0 Z c a) rn LO `\l p N N O O E N ° o F3°• m y Cl) co Z ii) o °D O �i ¢ to a a0 ° `.4 Lr) O u) ~ _ N C C H C E r" co LA C O¢ ° 'l l a ° . c C V d p Qj yy O N D ! J 0 p m p N n O N R U • O QOI W O O F• - ��� J't O z C z d 0 z C r d fn U �% °•� ! ate ::ate • a d as m e d d c r� c .. r A cia2 I 0U)u 0) 0