Loading...
HomeMy WebLinkAbout040-1253-60-000 ., Wisconsin Department of Commerce PRIVATE S EWAGE S YSTEM y:. Safety and Buildings Division S G S S Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353340 Permit Holder's Name: ❑ City ❑ Village ❑ Xown of; State Plan ID No.: T roy Development, Troy Township CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 6 CS7`� 040- 1253 -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic s 1 250 Benchmar1 , Dosing Alt. BM Aeration Bldg. Sewer ti Hold St! Ht Inlet ,(o 9 p z TANK SETBACK INFORMATION St/ Ht Outlet (,, �$ , -(Z' TANK TO L WELL BLDG, Ventto ROAD Dt Inlet Air Intake Septic (�(� r �2 3' NA Dt Bottom Dosing A Header / Man. Aeration A Dist. Pipe c- 3Z ` . S$ Holding Bot. System L /1 g o g5 .2o , PUMP/ SIPHON INFORMATION Final Grade Ma Demand St cover Model Number GPM TDH Li Lrictio S stem TDH Ft F emain I Length Dia. Dist. u SOIL ABSORPTION SYSTEM -ff-0q- TkENQj Width Len th N O Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manu ct rer: SETBACK 'r- CHAMBER t ` INFORMATION Type O / r M del Number: System: c o y w �5 OR UNIT DISTRIBUTION SYSTEM zoo Header /Manifold u Distribution Pipe(s) x Hole-Size. x Hole Spacing Vent To Air Intake Length fe- Dia. otr Spacing - 7 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 /Trench Center Bed /Trench Edges Topsoil ❑Yes [] No E] Yes [] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #l: O 'B V /00 Inspection #2: - i i Location: 320 Birkdale Court , H dso �I 54016 (NW 1/4 SE 1/4 19 T28N R19W) - 19.28.19.1337 Troy Village -Lot 86 1.) Alt BM Description = TiT ° r`� sow (3) 1 - I y 2.) Bldg sewer length= 2.5 ecjt to-;r % y 3 - amount of cover = ? Plan revision required? ❑ Yes b�No Use other side for additional inforny6tion. O (o SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: c * sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 22011 B Wa ington Avenue Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Number 35 Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Pr2w N e Property Location k y4 S r 1/4, S T , N, R t Ear) W Property O er's ailin Address C) Lot Nu Block Number t , State Zip Code Phone Number Subdivis 1l Naame or CSM ber S5 An ( > re) V L) II. YP F ILDING: (check one) ❑ State Owned E Ci Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms o Village o B � � III. BUILDING SE: (if building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo l 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 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 ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an ........ System------------- Tank Only -------------- Exi sting 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 12 (Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 0 Seepage Pit / 43 V Irivy 14 ❑System -In -Fill 2 3 x T7 —�i" VI. ABSORPTION S YSTM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. SV5teM Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 0 1 att• Elevation (0 9'4'S Feet 1 7,5 Feet Capacit VII. TANK in Ca allon Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks epti Tan ocJ QWiwg rtlt rS C3 El 11 E] Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ I ❑ 1 ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Pri PI tier's Sign ur (No Stamps) MP /MPRSW No.: Business Phone Number: 0 j-, � L I � ,, Psi k Ap 1 PIurrl is A ress (Street, Cit State, Code): / L C.t� l O 6 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater ate Issued issuing Agent Signature (No Stamps) t_ roved Surcharge Fee) pp ❑ Owner Given Initial CD Adverse Determination X. CONDITIONS OF APPROV �j� E / A �Q FOR D _I APPR VAL: 1 S wu l �'�� i 1� S�� C cDAGu,,.. co L / a - __ u.t'`�i � cQ¢ a c-+ c`� eaQ SBD -6398 (R. 4/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber I 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 5. Onsite sewage system" 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 - BWdings Division, -608- 266 -3151. - To be complee..and accurate thissanitary 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. -C lete plans; ir1Q' pecificatiorrmat smaller thaw8 1/2 x 11 inches.0aust,be submitted d�he county. The plans must include the following: A) plot plan, drawn to scale 6r 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 curvw; pumR model and pump manufacturer; D) cross section of the soil absorption system ifrequired by the county; E) soittest data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURC 0i& :-X�: 1 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 - I -t , f C46 Tro �11-111 co l.-P N wY, SE s n -t a%-. N R�9 1` P o ^ c-& - © O - l a. S 3 _(p c� 3aD E/ Tai 7 Djq Grp kti 4fw 3 !o s Wissconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page _L of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY C.�UC Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S--. not limited to vertical and horizontal reference int BM , direction and % of slope, scale or PARCEL I.D. # Po ( ) P dimensioned, north arrow, and location and distance to nearest road. O�[0 - \15 _ 60 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION R IEWED BY I t ATE PROPERTY OWNER: \ ft\_ G ftVUZ L %fR PROPERTY LOCATION C` `f1 C. * '�ZptV O 1 I Geff.-LOT- Nw 1/4 SE 1/4,S \ T Z$ ,N,R 1 E PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 6 C) tS C-I1 Ki L_t_ 'AV Z . 8 G — TTtO 1 Z h & CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD HNwR \Mue- vier- tt) - s ' W (w) Liss. :Slgz CT- (� New Construction Use Residential / Number of bedrooms [ J Addition to existing building (J Replacement (] Public or commercial describe Code derived daily flow bah gpd Recommended design loading rate bed, gpd/ft • trench, gpd/ft Absorption area required S S!iti bed, ft -- I'S O trench, ft Maximum design loading rate bed, gpd /ft trench, gpd1ft Recommended infiltration surface elevation(s) S L� ?k6 s 3 ft (as referred to site plan benchmark) Additional design / site considerations ?- Zcz"m..Q 'TN � 1_ elf CH I ►-t (Qt? Rs - SE P n (S 3 Parent material S by OV ,-)r Rood plain elevation, if applicable ft ! i S = Suitable for system CONVENTIONAL I MOUND IN GROUND PRESSURE I AT - GRADE SYSTEM IN FILL HOLDING TANK i U= Unsuitable for s stem S❑ U Q S ❑ U 9J S ❑ U R) S ❑ U ❑ S 21 U ❑ S I$l1 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Z q - Zg c� g� ew •1 -S� Ground 3 F -8-� vb4 R y/b — S O % Vn ] _ ; •�3 elev. `12 -L ft Depth to limiting factor > Ba Remarks: Boring # � o —t0. Lod Q. Z[Z � si 1 Z-�sb ��c� cs — • S - b i Z z [Z_ V& , g Ground I elev. t Depth to limiting` factor r , . S T ROrX Remarks: r^rGOFFr j CST Name: — Please Print Phone: ;°- Arthur L. We erer 715- 425 -01 F h eg�rer Soi Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 Signature: Date: CST Number. l� -Z�- Moo5i6 PROPERTY OWNER SOIL DESCRIPTION REPORT Page ?of PARCEL I.D 0g1 - .# n 60 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr C. zLL — SL � Z b `M &S • , 1, L " J i �I � s U ) 1 s g w► Ground 3 -9 0 D `I tZ y _ S O g 1-n •'� . $ elev. , B2-�L - ft. f Depth to limiting i factor ! i } Remarks: Boring # I M -1-Z -.- S `TR 31 St 1 ZM 1M 'V - ea 3 ZZ z -s �R NY — s 1 1 sb► r n w, ci , Ground = �3 . ft. Lf zt -9b to�-f Depth to I limiting factor > 4 Remarks: Boring # tw-i z c z -- s i l z�'s b� vn `F� • s -� E z Iq --z Z - 1 - S R- 31 y — s; Zen sek ,���- S — • s { . Ground elev. 3Z 9� tO` S cs g9 In1 I _ •7 i .fib 1 r-t�lq_ ft. Depth to limiting j factor > Remarks: Boring # I .......... . Ground elev. � ft. Depth to limiting factor Remarks: cnn nnnntn nrnn� PLOT PLAN Pa 3 of 3 SCALE 1 30 ' w7�4 i1. R9.6 Oni 'tnP of %4 sTim :FEz t-ieT Posh^. l yyt4 Z�L31-,gs pN p or Gz t:lGL�fi PoaT^: 0 �I STR -E.L'T � pQD�21�?SS � 3zo B1R�brsL�. CovRT f$.3 y ..D N 1 9/ 4 / t o" 6 ' OU I ' b/ b o a� i o• a AT LQfVsN Z5 F-uf 1 TTL ±JCws. 50� 4 1 i . ( I �� � �►u�_� 3' w�uE 1��� ctFt3 ►hS S1h - v�vav wtTrl QA , A C t'ry Stocakjw\(A 1 Z1_c�' _(_715 ) 42 -0 1400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & BuikSngs in accord with ILHR 83.05, Wi Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST. not limited to vertical and horizontal reference point (BK, direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION BY D ATE q PRO V}f"0__ G�t3'L.� PROPERTY LOCATION C-/ y'1 yl e7.3 GeVF -W� NW 1/4 SVZ 1 /4,S 1 T Z8 ,N,R I E PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 6 b t,S C-F {-t L L by �. 8 G - '�Tts 4 \)I L_l-t\ G E Z n � f`N'D CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN MK�bw" ROAD 1N�1t'R '12�ULCS 4eQtT'S r*a SSo7C6(6S1) S . T1ZO c -T• pq New Construction - Use [Jq Residential / Number of bedrooms [ J AdditiT to existing building j J Replacement [ J Public or commercial describe Code derived daily flow boo gpd Recommended design loading rate bed, 9pd/ft . � tom, gPd& Absorption area required 8 Sb bed, ft - IS O trench, ft Maximum design loading rate bed, gpd/ft - g trench, gpd/ft Recommended infiltration surface elevation(s) S t!:� PkG S 3 ft (as referred to site plan benchmark) Additional design / site considerations RZc-zm 1 % `i Cr .rc 3 W Lk' CC_y - CH i'1 M t31? lzS - SEti ' P n G k? 3 Parent material Flood plain elevation, if applicable "A it i I S = Suitable for system CONVIKIIONAL MOUND W- GROUND PRESSURE AT -GRADE SYSTEM IN FILL FOLDING TANK U= Unsuitable for stem Q S ❑ U Ga ❑ U ®S O U ®S ❑ U [IS 21 U ❑ S Ru SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. B Ground Lt'`9 R �/� — S S yr) j _ ; 7 -$ elev. Depth to limiting factor Remarks: Boring # � o -to. tio`�tz z[2. sir Z`�'sb ►�lfh e.S — • S � � Z X0 Zoo - I S `1 R 31y � S O S9 yvl Cw -1 -8 3 6r8�i 10 ti R_ V/6 - S O s ►,,� 1 _ , g Ground - elev. = M: qL_p ft. Depth to limiting fac >$, I Remarks: CS T Name Print R10ne Arthur L. We erer 715 - 425 -0165 eg Soi Testing & Design Service -P.O. Box 74 River Falls,•WI 54022 Signahxe �� �l _ CST Number Date =z ??I p (, : 11 -Z1 _9 g M00576 . PROPERTY OWNER 9'P* -E i- elc SOIL DESCRIPTION REPORT Page . PARCELI.D.# O'tO kZ.53 6b ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Roots GPD /ft. In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Twich o. ►� i p-t VL Z to - �• S �l2 Sly � � S U "�3 Yr� 1 • � , � Ground 3 -4 o t O `t ►Z y �, _ S O s -t . g elev. X52--H-ft Depth to limiting factor Remarks: Boring # , 1 0 ��� 1u�t R- it t ._ s i f Z•Qsbk wt•Fy. c.S -- • S , E 2 ,o -ZZ z- s tia 3L 9 1 1 - 1My1) w0 e—l' I- % s Ground , mom , �\4 :s elev ft L{ �8'_9g tort 2 Yn •`� •8 ! Depth to limiting factor > Remarks: Boring # o-14 tio\ tL z c Z E rz 31 y T;1 Zwl sbk tine- el — • s 3 LZ 3 2 �- S �t R 3 l � O S `3 YVI � L -_. ` •� Ground elev. y 3z 9� I p� Yob S d g9 Wl _ •� . 4'y 1 -� ft. Depth to limiting factor > Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: cnn aurora nr,nn� PLOT PLAN Pa 3 of 3 SCALE 1 tL . a9.6 oN Wib a t Q3.p' pN}� off' ► ° `b1R• G LLG*r A r in, g,-)4 7A BtWcb�st_� Cv�,RT tali � 1 d! N t t _v t e S a i• o gy o f f h BE PIT I.Q097 - LS' F� — Zte s . ' 1 la,S OL 1 � r � 1 � /� �, ��sl�.l 3'ti..�tpE llZl'1.JC�3 ►�S Sl`�kioV W1`n•} _ 1 � , � - L.t �, t �, rc2, � � �'� lv a'c ►�-f w�+� u�"1 3 � �` ` � , _ _ - -- $•1 °1- B I • ti�go 00' —"14�1 ( 715 } 425 -n, 65 19 00576 CST Signature Date Signed Telephone No. CST # r • !Z Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code ' Environmental By Design Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow,,and;toca6oTr and distance to nearest road. t Parcel I.D.# APPLICANT INFORMATION - ease print all information. Reviewed By Date Personal information you provide may be tnr "`seconda urps4s (Privacy Law; s. 15.04 (1) (m)). Property Owner ` > $` Property Location Continental Development ..' Vt. Lot - NW 1/4 NW 1/4 S 19 T 28 N,R 19 W Property Owner's Mailing Address ; �8 Lot # Block # Subd. Name or CSM# 12301 Central Avenue NE, Wte 230 ' CRCIx h 86 j - Troy Village Second Addition City Stat `Zip CMdlryVi �ber ,t ❑ City ❑ Village ZTown Nearest Road Minneap MNN" :` Troy Birkdale Court ❑ New Construction Use: 7� R fti drooms 4 [:]Addition to existing building Replacement Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ftz .8 trench, gpd/W Absorption area required 857 bed, ftz 750 trench, ft' Maximum design loading rate .7 bed, gpdM .8 tr ench, gpdffl Recommended infiltration surface elevation(s) By Designer ft (as referred to site plan benchmar Additional design / site consideration Parent material Loess Over Glacial Outwash Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ® S❑ V f ® S❑ u ® S U ® 8 E U ❑ S ®u ❑ S N U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistent Boundary Roots GPD/ftz Boring# in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 1 0 -10 10yr3/2 - sl 2msbk mfr cw 2f .5 .6 2 10 -15 1Oyr4/4 - s1 2mskb mfr cw if .5 .6 Ground 3 15 -31 7.5yr4/4 - gs osg ml cw - 7 j 8 elev 9 ft 4 31 -100 7.5yr5/4 I gs osg ml - - 7 ; 8 Depth to limiting factor >100 Remarks: Z 1 0 -14 10yr3/2 - sl 2msbk mfr cw 2f .5 .6 2 14 -48 10yr4 /4 - s osg ml cw if .7 i .8 Ground 3 48 -66 7.Syr4/4 - gs osg ml cvv - .7 .8 elev 92.22 ft 4 66 - 100 7.5yr5/4 - gs osg rnl - - 7 8 Depth to limiting factor >100" Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 2/3/98 MO2605 11 PROPERTY OWNERS Development SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Environmental By Design Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPDr in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ! Trench 3 1 0 -11 10yr3/2 - sl 2msbk mfr cw 2f .5 ! .6 2 11 -32 10yr4/4 - s osg ml cw if .7 .8 Ground elev 3 32 -49 7.5yr4/4 - gs osg ml cw - 7 .8 94.64 ft 4 49 -100 7.5yr5/4 - gs osg ml - - 7 8 Depth to limiting factor Remarks: 0 -12 10yr3/2 - sl 2msbk mfr cw 2f .5 i .6 2 12 -27 10yr4/4 - s osg ml cw 1 f .7 .8 1 8 Ground elev 3 27 -51 7.5yr4/4 - gs osg ml cw - .7 ; .8 96.22ft 4 51 -100 7.5yr5/4 - gs osg ml - - .7 .8 Depth to limiting factor >100 Remarks: ,r 1 0 -10 10yr3/2 - sl 2msbk mfr cw 2f .5 .6 2 10 -27 10yr4/4 - is lmgr mvfr cw if Ground elev 3 27 -47 7.5yr4/4 - s osg ml cw - .7 .8 93.2 ft 4 47 -100 7.5yr5/4 I s osg ml - - .7 .8 Depth to limiting factor >100" Remarks: Ground elev Depth to limiting factor Remarks: r.. E BY DE 1432 120 STREET, NEW RICHMOND, WISCONSIN 715- 246 -2454 PROJECT NAME TROY VILLAGE 2nd ADDITION DESCRIPTION: Nf Y., NWI, SECTION 19 „T 28 N, R19W TOWNSHIP: TROY COUNTY: ST.CROIX LOT: 86 SUBDIVISION: TROY VILLAGE 2 ADDITION 4, \ 1. 1,b5� acre s �° SCALE I Tom Nelson BM i Nail in tree elev. 100' cstmo2605 BM 2 i c 0 > C .l 4 Uanul ' I c E � c� CL O�c�� E N p E 3 c� c0 c n 7. 0 0 q: >, Z) 5 T O p O L d - -- -- _ 0)CCJ O 0) p F- co O . CL - to , O — O n U) N �- OQ� Q _ t U'�� U J --�- O_� - 0 C X LL p V -0 - � C: ( L s m U 0) Q N O (D 3 --- o J O S vJ s j. � z o ex� T N ` .�' •� � z h F-- ,w. C.) = L t , , ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM � J Owner/Buyer pir�' . Mailing Address 1230.1 Oe�o Ae-. , &Ame 14A 56;k:� Property Address (Verification required from Planning Department for new construction) City/State a Parcel Identification Number f J ' /5j ~ (OCR LEGAL DESCRIPTION Property Location6LV l ' /,, 5C '/., Sec. , , T � N -RJW, Town of C) Subdivision — ro q t (ctq e, . Lot # 9(0 Certified Survey Map # , Volume �— . Page # _ Warranty Deed # ' ( 7q (3 . Volume 1 _ _, Page # Spec house ❑ yes )`no Lot lines identifiable )< yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanpl�tuber, 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 expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Vu 6 --r � 3 / 3 / d o SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed • 'iMe tttoda Dttwr111 st wm C w 1a ' IatMSrt!~rw 1taa�eale aad AWI t_ •....,..r a...2 . — • [ omy. 2 T is? tlnrta Daft . t7raetw� Wftws etb Tbu du said Gtaw". k r a vtltattbN ooltNdtxatioa �,_ n ..........� ei �,�. a . wsroauatur� eoavayo to Grantee dw folbwk* dtsatnd rat aim it SL Craim County. stme or wbCOMIG.. rum 10taaftaka Dlrwwj Lots I thmlh 43, Lots 47 fto* 63 &W tots 66 bo%t 7o ordw PM of Troy Vilble. 9- Croi: CotaaY Wieearrsin ad dw Portion of OtAW t of the Plat of Tvov VtA pp B7thtbit A attacind hereto. aad oathms I and l to the vat of Troy Vulage, S• Cmk Commy. wbew* S A Peraoa •f Ab a!a• r wind psgwl ► _& _ t+Mond pWW a< GMM&A 1o6g 1. RVWO * ad I A bommoY (m)(swo T"law w4a IN od fil f11r 1M Me Y al[ Mplaneq 11wewO 6lkejieR Aad t:•�ee .r�rw ttw �M ir• : w.L i3Od••r1Me is fir MPk wd e.• r�r afacw�k..�w •.ap . easenaeats, ooveAMM resUietiorte and highway rivet dwtsy otrecord aid wdl arena a" 4464 OW SIM o.r4,t�• 2a ,,, •r Awe 0 t •• i gic • Eneetoerls � ! 1 AUTHEnICATION ACINOWLEMMWr S�{nwarMi) STATE Of WSJ , tartttmticated d!b of 19�_ Coraey . Pertoneily cater bdore atle due _ . day of 40ppwr W — y dw above asataasad TI17.& W ATE BM Of WISCONSIN % WML mud by SmIc era,, St k) w axle ken m be the Paaott who a ombd dw Acgpuw iitetrttttllt nt atd admowlay to mL 21 p 1'HH /.'f71lUI#l� MAZ t7RM*1!» 1Y lialeeoad � Gri. st:.. SaaeJ R ... • _ . _ notary hm* Cowly. WIL X*www •wf M =&wAl W o mw my eaomitaioa io Ptessateent. (lf act se wtolrad" dim 7M��MMg1 wtri � �� rM•.�rM�d•..ir •U�M. M�� an�.p i c N b N 3 �3 `'* CY) Ld „A„ AVMHOIH AiNnoo v 3 v ►- N NOSMH gg O c CD ' :t 6 o 0 V z 0) .� N U) 112 _I Z " '� X O odoa ,� W ; N 0 � a �SON W •5 2 I I o 0 W (/1 W I OS M 3 O > I = J o rn b V 3 I H I_ +o W Y N 6'£6 J I � -' O &D I I n N 3 ' Oy< hNn N •+-' -� ��S 9ry I � I N 1 c ar 30g.is, � N< N y< N pl woe ui �< a, ,Ot C-4 N .`,° W $h 8 Q Uv fin+ N O mh �hRN gLJn�N�rn w �U .[s'[41 yQ o N< nQ $�o h n �° n *° n ��O n I 4' ' ��m 00- a C14 0 V I �, Q , 3APJG SMMMY r h �� N �. � w mil^ \�6 0 Q N Is ,98'ri �L} 1 p Lnw + LL- 12 .73' �' 1 3N21 SM3NONV • = " o y < rd.-» U R'i g . e- < ae- N - ag N t ' 1- �rn� p o - U . co N o >- N ,9� L L, U m i� V! <. � " N �Mp '° ��o ,0 '4 Z � Q �< �n�n rn I hl I c01 X� $ o�� zaszl c � C4 N � ,� 3 na z- m COI 1' I I 154 1 • ! * ,y6 � cl �.- + <1 � �� o �° .,.� v �a I N < i i CO Mn _ ' ^ N< ^� vi< �p� .` ' � ^ a A N vi� co �+' N NU 6�9� 8 17�N U)U �C n �:: �Q N �• 10 -N - g �NQ 2 46' `° to r Na_ tto ro , . 1�°N�io 20�Z0 p�� 201 O ro U + n d o , n m r. Q + ro cO o h< ' �w� 'SSce `� oM w� o' r �^ c+� 00 Con .09'zl£ , N , �U —. N :;n m • ss� Q to a r 'W ^^N < � \ la IN 'r p N < 'Z O � 4 U ICJ N '• Vi` < H < Y . o ; ki - N r. ,,� np 1 1 � - •A �, t "- • V /� Q r O • f�Aq tp� w T It n Z F- +- 3 Q Ln� 1�(0 ^ ; 242 g• LO D 00 Z 14 e y U ^ In U ^ •. 1 - A V) II I r +� lV < U; I N L4 n I— Nm ��0 (QN NY/ 4• F . I r U � O pJ , •_+ P , � '� nom. +� ry ! O W U d 6' ! W � a+ I O� � �. fn < • ;� � � W ! � \ h W 0 co 52' \ O n LL- o W W X O 150.54 F � - Lai U �' D w z U� C4 ° N 4 � 'Ot Z O O Li M F-- J I.1.1 ::D U) �� 29, 0 -1 osso� y< h /�° Q ul �\ fir° n L4 U U W p .inn „ / 0152 -t 4 y6 U) to ryS U l o h N��g . •� , - N O a- M LO •8 ' 01 N 6l s Qvo,j bSQNI7 �� [ ZV .•+ / ap n �*� Z M � ' 121n0� e � U' �=' g 8 ' ��— ' 0 0w ,I �� �° N ►��� g o0' , $` —�. n ,9 04 r� 0 0Q�°a, 1 0 091 0- N 'ice F0 \`I ` - OC OO ��� N� 8 NU r> �N< ,ty' yi ti N 6 N v v1� ^MM N � \ N� N< n N< Na SSic - N a N , w ��.- i:�C, rylnn � efJ +.n a �9 w� ♦ rt — — — - - ��� O 4 N �Q O + ^ N a r- Sr At SZ,9zz o� •---m < \ \ ! N Mho ph �� h o o y n Nm N ,kVM)WVd S3NNV •1S o° � `� �• � in < - 9 a: F— O M �� d'n� �� � ^ N O LL. }Q J h �v, ` �` z Q I� ` M w irw O w W �•,� tp +.� 9 W 'Zi � 8' • O S rn R' sy I t� 9 o o 4 h Qw=) Ot' N �" ti