HomeMy WebLinkAbout020-1355-02-000 ST. CROIX COUNTY ZONING DEPARTMENT
4 AS BUILT SANITARY REPORT
Owner—SAM M I LLE
Property Address '90S 6 7' A YF-
City /State f(t) W1
Legal Description:
Lot 2, Block Subdivision/CSM # i - } o Ny1 L A C F-
'5 t /4 `E t /4, Sec. �, TAN- R/1—W, Town of 1 U QZ(o N PIN # D � " 3�S - ' 00 0
S9PTIC TANK DOSE CHAMBER — HOLDING TANK INFORMATION
Tank manufacturer Wf- IS � 2. Size ST/P I / Setback from: House S0' Well t P/L 7 L-
Pump manufacturer Model --
Alarm location --
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: L 9C a Width 3 Length Number of Trenches 2 --
Setback from: House loz ` Well old `' - P/L Z3 Vent to fresh air intake 7.s
ELEVATIONS
tg � 60.OD
Description of benchmark /� �u ti`s r w� Elevation
Description of alternate benchmark - rn f' 4 :5 f fOc k' ELL DO L � ^' `�� �d Elevation
Building Sewer 9 s (PO °% ST/HT Inlet q ST Outlet PC Inlet
y �3 9
PC Bottom _ Header/Manifold �� S Z Y 9 . Top of ST/PC Manhole Cover (O" 2d 7
Distribution Lines ( ) d ►� 2 qN, X13 ( ) It3, 5 Z 4, y3 ( )
Bottom of System ( ) 1(, �' ( ) $ ' �" 1 5' ( )
Final Grade () s = ��'- ( ) 5 • ? 1 `' / ► �-� )
Date of installation / d 4 9f Permit number ` P fo o ` State plan number
Plumber's signature m�� � License number Date // /
Inspector
Complete plot plan �
NOTICE Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
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NOTICE Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
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t Wiscopsin Department of Commerce PRIVATE SEWAGE SYSTEM y:
.Safety and-Buildings Division 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)j. 344604
Permit Holder's Name: ❑ City ❑ Village W Town of: State Plan ID No.:
Town of Hudson `
CST B Elev.; ' Insp. BM Elev.i : IBM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � Benchmark 9� .95� ft,a'
Dosing Alt. BM 3 . 5
o 1. 03
Aeratio Bldg. Sewer g16,2$
Holding St/ Ht Inlet $570 95.39
TANK SETBACK INFORMATION St/ Ht Outlet 9 •$�- o g'
TANK TO P/ L WELL BLDG. A ir ir I ntake ROAD
A
Septic NA
Dosing NA Header / Man. �D�ss cfc(, V0
l9,6 Z 9Y- 33
Aeration NA Dist. Pipe ,,, & Z
Holding Bot. System w / .0 9 ,06 ,
PUMP / SIPHON INFORMATION Final Grade ,16 VID
Ma urer mand St cover Zo c o , 3'S
Model Number GPM
TDH Lift L Iction TDH Ft
oss
Force ain I Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
TRENCH Width r Length No. f Tr nches PIT No. Of Pits Inside Dia. Liquid Depth
DIME 1 3 53 DIMENSION
SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING Manuf ctur r:
SETBACK CHAMBER
INFORMATION Type O 6 Z ---�"— Model Number:
System: �3 OR UNIT i
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 /Trench Center Bed /Trench Edges Topsoil E] Yes ❑ No ❑ Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 11 1 2 - /99 Inspection #2:
Location: 805 Grant Avenue Hu on, WI . SE1 /4, SE1 /4, Section 21 T29N -R.19W) - 21.29.19.2068
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Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-671 0 (R.3/97) Date Inspector's Signature Cert No.
W7
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITARY PERMIT AP,_, P5A ' ON 201 W. Washington Avenue
In accord with ILHR 83.0,5 V - s 14 frt1� fotle' P O Box 7302
14 .4466nsifn
Department of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the y3t , o is not less .County
r�
than 81/2 x 11 inches in size. 1 R' ' it
• See reverse side for instructions for completing this a T dtl State Sanitary Permit Num er
� A 3yy4o�'
�rf?
Personal information you provide may be used for secondary purposes ' S7 ° "' Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)). ., AUNTY tate Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT A e N:
Property wner Nam // i grope �oOtion
��G..�' : ._ 1 "/. 1/4, S T, N, R E( W
Property Owns Mailin7 Address r Block Number
City, Sta t O Zip Co, d / P,on ) umber S si Nrtne o CSJVI Ntyn ber
PE F BUILDING: (check one) ❑ State Owned ❑ C it y Neag R oa A - I'
Public 1 or 2 Family Dwelling- No. of bedroo � ro w a n OF e.1 dA/ 4; VT lCI
111 BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo
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, Whew 2. ❑ Replacement 3 ❑ Replacement of 4_ ❑ Reconnection of S. ❑ Repair of an
___ystem -------- ----------------- -- -------- -------------- ----- System Tank Only Existing 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 eepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 eepage Trench. r 22 In -Gr and re s e t 42 ❑ Pit Privy
13 El Seepage Pit I N 14 it o r , max • 43 ❑ Vault Privy
14 ❑ System -In -Fill j1.q 5A+ FTC„ OF ItJ5,1A. e-gA 'T`OT44-
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 93,13 -
E vation
Sa 40 I s Z Y 'r w.. , eet / Feet
Capacit
VII TANK in gallons Total # Of r Prefab. Site Fiber- Exper.
INFORMATION New Existing Gallons Tanks Manufacturer s Name Concrete st tided steel glass Plastic App
Tanks Tanks ,r�
Septic Ta . P — /O r Holding Tank is+ ❑ ❑ El C1 El
Lift Pump Tank /Siphon Chamber 1 ❑ 1 ❑ I ❑ ❑ ❑
VI11. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum bers ignature: ( o stam ) MP /MPRSW No.: Business Phone Number:
k 1V LLSG "fib"
Plumber's Address (Street, City, State, Zip Code):
J 070 Vk( ` O ,-0 Q.,sp
IX. COUNTY / DEPARTMENT USE ONLY
[]Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued issuing Agent Sig (No Stamps)
4pproved ❑ Surcharge Fee)
Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
'i.
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
i valid for w
1. A sanitary permit s va d o two y ears.
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 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.
Ill. 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 8 1/2 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 loss; 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.
---------------------------------------------------------------------------------------
GROUNDWATER 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.
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
Vbeonsin P O Box 7302
Department of Commerce In accord with ILHR 83.05, Wi Madison, WI 53707 - 7302
• Attach complete plans (to the county copy only) forth sy papnot ounty
than 8 vi x 11 inches in size. tb '
• See reverse side for instructions for completing this app on RECEIVED to a Sanitary Permit Number
y ou p rovide may be used for seconds
y p y second purposes_ l3 199
Personal information ec if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. X e Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT AL O
Property Owner N ropert Lo io
S/ LL/L 1/4 "v/ Z/ T Z9 , N, R/9 E (o W
y Owne 's Mailing
Propert Ad ress o fr a Blo ck Number
a W / _.. ..
Zip Co Phone Number Subdiv sion Name or C Number
X VIC IV �,c / (3? v )Z 4 L
I. TYPE OF BUILDING: (check one) ❑ State Owned C it Nearest Road
El Public 1 or 2 Family Dwelling- No. of bedrooms villg of of 0-S 0 � 6i�ANT A 1/Z
111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo
0 Zo- /34S` Z
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 E] Replacement 3 E] Replacement of 4. ❑ Reconnection of 5 F] Repair of an
System System Tank Only Existing 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 k5k N 22 E] In-Ground Pressure i 42 ❑ Pit Privy
13 j Seepage Pit B /NFIZ TX.4 J OtL Z 3 X S&I ZS 43 ❑ Vault Privy
14 ❑ System -In -Fi I I 36'F SEZ Fr SIDEW C144M F' 'r / - ?07,'#4
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Re 914 d (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
Sd S 2 . -- 0-02.0 . 40 Feet 9 9. /.Sleet
VII TANK Capacity in g allons Total # of r Prefab. Site Fiber- Exper.
INFORMATION New Existing Tanks Manufacturers Name Concrete st noted Steel glass Plastic App
Tanks Tanks
eptic Tank r Holding Tank X I wo/ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamberl I I I ❑ I ❑ 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) Plum ber's nature: (No Stamps) MP /MPRSW No.: I Business Phone Number:
N L am ' ZSO 3G 3 6-
Plumber's Address Street, City, State, Zi Code): CC J !!��
In
lit, v �0 F C0 ,1
IX. C UNTY / DEPARTMENT USE ONLY
❑ Disapproved Sa tary Permit Fee (Includes Groundwater D ate Issued Issui=S;*9nature ps)
Ap proved ❑ Owner Given Initial Surcharge Fee) Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) 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 maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit 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 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 8 1/2 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 loss; 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.
----------------------------------------------------------------------------------------------------
GROUNDWATER 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.
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' Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page --- 1-_ of 3 —
Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code
A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal referen M), direction and St. Croix
percent slope, scale or dimernsions, north arrow, r�ti r"� Iistarice to nearest road. -
` Parcel I.D.#
APPLICANT INFORMATION - PI 6. int all itformatio 020- 1056- 90-000
- - - --
Rview, �d By at
Personal information you provide may be used f ^r secondary r (Pr cy Law, s. 15.04 (1) (m)). � ! � ,(,( � j
Property Owner' perty Location
Miller Lot S Sam - - E 1/4 SE 1/4 S 21 T 29 N,R 19 W
.
Property Owner's Mailing Address `t # Block # Subd. Name or CSM#
Box 151 Tr Br Road ',' ��c�ix 2 NA Home Place
-
- - - - - -- -- -- - -- - - - - -- - - - . ;X4 _*T_Y - - - - -- -- - --
City State Zip Code .p@�uTICE r` . J City )Village "Town Nearest Road
Hudson WI 54016 ; (715) 386- Z' Hudson I Grant Avenue
New Construction Reslderftw_ N �r rooms 3 - Addition to existing building
_- Use:
Replacement - I Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate •7 bed, gpd /ft .8 trench, gpd /ft
Absorption area required 643 bed, ft 562 trench, ft Maximum design loading rate .7 bed, gpd/ft .8 trench, gpd /ft
Recommended infiltration surface elevation(s) 95.00' ft (as referred to site plan benchmark)
Additional design I site considerations
Parent material outwash s & gr. 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 E, u ❑ s ❑ u ❑ S ❑ U ❑ S ❑ U ❑ S ®u - ] S ® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft2
Borin Horizon Texture Consistence Boundary Roots
9# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -10 l ORY2 / None sl 1 thin pl mvfr as 2f 0.4 0.5
2 10 - 10YR None sl - 1 thin p l mvfr c s 2f, lm 0.4 0.5
Ground 3 15 -30 10YR4/4 None _ sl 2msbk mfr cw 2f, lm 0.5 0.6
elev — - -- -- —
99.31' ft 4 30 -50 7.5 YR4/6 None I gr. Is o sg _ml cw if 0.7 0.8
Depth to 5 50 -119 10YR5 /4 None s & gr. o sg ml - - 0.7 0
limiting
factor >119"
Remarks:
2 1 0 -9 I ORY2 /2 N one sl 1 thin pl mvfr as 2f 0.4 0.5
2 9 -14 10YR3/3 None sl 1 thin pl mv fr es 2f, lm 0.4 0.5
Ground 3 1 -2 6 10YR4/4 None gr. sl 2 msbk j mfr cw 2f, Im 0.5 0.6
elev -- — - -- _ - - -� -- - -- - -- - -
99.15'ft 4 26 -32 7.5YR4/6 None i gr. Is o sg ml cw if 0.7 0.8
Depth to 5 32 -121 10YR5 /4 None s & gr o sg ml - - 0.7 0.8
limiting
factor - - -- - - -- -
-,-
Remarks: -- -- - - - -- --
CST Name (Please Print) Signature: Telephone No.
James K. Thompson / 04- 7 15- 248 -7767
Address A.C.E. Soil & Site Evaluations Date CST Number Ref #
340 Paulson Lake Lane, Osceola, WI 5 20 5/6/99 3602 1014
PROPrAITY Miller, Sam - SOIL DESCRIPTION REPORT Page _ 2 - . of _3
?WEL LD.# 0.20- 105 - 9 0-000 A.C.E. Soil & Site Evaluations
Depth Dominant Color Mottles Structure GPD /ft
Horizon � Texture nslstence Boundary Roots - - -. - -
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
d / 1 0 -13 10RY2/2 None sl 1 thin pi mvfr as 2f 0.4 0.5
(� 2 13 -18 10YR3 /3 1 None sl 2msbk mvfr cs 2f, Im 0.5 0.6
Ground
elev 3 18 -32 10YR4 /4 None gr. sl 2msbk mfr cw 2f, 1 m 0 5 0.6
- - - - - -1-
98.96'ft 4 i 32 -117 10YR5/44/6 None s & gr. o sg ml - if 0.7 0.8
Depth to
limiting- -- - - -- -- - - -
factor - - - - -- - - - -- � - - -- 1 . t
>117"
Remarks: - - -- - - - - - -- - -- - -- -- — - -
i
i
4 1 0 -12 IORY2 /2 None sl 1 thin pl mv fr as 2f 0.4 0.5
212 -17 10 Y R3 /3 N one sl 2msbk mvfr I cs 2f, lm 0.5 0.6
Ground —
17 -37 10YR4 /4 None gr. sl 2msbk mfr cw 2f, lm 0.5 0.6 -
99 "ft 4 37 -125 10YR5 /4 Non s & gr. o sg ml - if 0.7 0.8
Depth to
limiting _ -� -- -._._. - -- - - -- -
factor
>125" -
- -- o} . 6 - --
Remarks) --
5 1 0 -12 _ 10 RY2/2 None sl 1 thi pt mvfr as 2f 0.4 0 .5
2 12 -20 IOYR3 /3 None sl 1 thin pl mvfr cs 2f, lm 0.4 0.5
Ground - - -- - - -- -- - - - -- - --
elev 3 20 -32 10YR4 /4 None sl 2msbk mfr cw 2f, lm 0.5 0. 6
99.05'ft 4 32 -39 7.5YR4/6 None gr. Is 0 s ml cw if 0.7 0.8
Depth to 5 39 -121 10YR5 /4 None s & gr. o sg ml - - 0.7 0.8
limiting -- - - - - -- - -
factor
Remarks:
i
Ground - _ --- _- - - -� -- - - --
elev
- I - - - - - - - - -- - - - - -- -- --
Depth to
limiting t - -- - -- - -
factor
Remarks: -- _ - - - - --
o. 3 o(3
-n mxter
■ bJx is�
Q -�
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer S A #A
Mailing Address Roy � / .r �
Property Address 15 05 A
(Verification required from Planning Department for new construction)
City/State P441S 9D Parcel Identification Number
LEGAL DESCRIPTION
Property Location :�_' /s, - ' /e, Sec. T ZI N -R!1 Town of 4 U 3�
subdivision C"t , Lot #
Certified Survey Map # 7 --- , Volume Page #
Warranty Deed # 4 % 4 1 to , Volume Page # _ •
Spec house g yes ❑ no Lot lines identifiable Vyes ❑ no
SYSTEM MAINTENANCE
Impr+aiper 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
verifying
1
masterplumber, journeyman plumber, restricted plumber or a licensed pumper that ( ) the on -site wastewater disposal system
inspection and pumping if necessary), the se ptic tank is less than 1/3 full of sludge.
proper operating condition and/or after ' a g ( �y)� P
is in P Pte' Pe g 2 () insl�e P P
Itwe, 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 St. Croix County Zoning Office within 30
days of the three year expiration date.
O
TURE OF ANT DATE
' : 0iYN
ER CERTIFICATION
. we ) cer ' o ' that all statements on this foam are true to the best of my (our) knowledge. I ( we) am ( are) the owne of
described above
the pro
• fY
Re gister of Deeds Office.
by virtue of a warra deed recorded in Re g
. o
30/ 9
SIGNATURE O AnUCANT 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
r
c /00
VOL 1:361 PAC[ 114
Document Number WARRANTY DEED
This Deed. made between. - r
Robert L Rohl f`
Grantor. ►'
!!
and,
Sam E Miller RTGISfiE!' 0 +'
a single person Grantee. $ CROIX C o.. Wl
Witnesseth. That the said Grantor, for a valuable consoera an t of one dollar and EK � flu M'e'w
other valuable consideration conveys to Grantee the below xscnbed real estate in OCT 0 6 1998
St. Croix County, State of Waa.am ,.t
4
This is not homestead property. 9.30 M
Together with all and singular hereddaments arc appurtenances thereunto M fM d
belonging; f.
And Grantor r �.
}� warrants that the title is good, indefeasible in fee sin and free and clear of
encumbrances except Recordm Area y
easements, covenants, and restrictions c,f record, Nams and Return Address +
and will warrant and defend the same. San E . trailer
Marco Jentficabon Number) PO Box 151
020 1 0 56-90 Hudson WI 54016 r .
.f
A parcel of land located in the SE '/4 of the SE '.. of Section 21. T29N, R 19W, Town of I Judson, St. Croix
County, Wisconsin, described as follows: beginning at the SF comer of said Section 21; thence N 89 °23'51 "W.';
1319.10 feet to the monumented West line of the SE ','4 of the SE !'4 of said Section 11; thence N'00 113"W
980.09 feet along said monumented West line of the SE '/4 of the SE ''A to the North line of the South 30. of
the E'' /z of the SE 'A of said SeL ion 21 as calm eta in that documentation found in Volume 838, Page 252 of
the St. Croix County Register of Deeds; thence S99 °37' 19"E 626.85 feet along said North line of the South
30 /80ths to the intersection of the monumented Sc-uth line of the Certified Sure% Map tiled in Volume 2. Page
484 and the said North line of the South 30.80ths of said E ',: of the SE ' /4; thence S89'23'1 OT 31.88 feet to a
found I" iron pipe being the SW Comer of said Certified Survey Map; thence continuing S89'23'1 0 "I: 660.23 %+ {f
feet to the East line of the SE 'A of said Section = I : thence S00 °5 1'50 "E 982.41 feet to the point of beginning.
containing 29.725 acres including rigl.. of wa% t =8.006 acres excluding right of %lea% ).
1
oat this _ da of tgg_ T AtaFER
Robert L Rohl
AUTHENTICATION ACKNOWLEDGMENT 4a
+ Signature(s) STATE OF WISCONSIN "+ k
COUNTY ST. CROIX s
Personally ca�r�gb� fore me this 2 day of C<-'r' ?f the t ,.
authenticated this _ day of above named KVO rt L. Rohl to
me known to be the '
person(s) who executed the foregoing
signature i tns t and acknowledge Via same, r
y y L
rye or prwM name • (. (f ,2� <.. E
tl type or Print name v'j/1Q•u Lt c�i _) I�S:
TITLE MEMBER STATE B %R OF WISCONSIN �tary Public County.
(If not. y PV om issan a Perm arwd (n not. state exprabon date
ti • authorized by §70606. Wis Stats.) O - �' - 9 S ► '
y THIS INSTRUMENT WAS DRAFTED BY 2 •N a rsons signing in any capaoty should be typed or
. Robert F. Wall WW"AW&E1116n their signatures
(Signatures may be authenticated ., acknowledged do awed y„
)� necessary.) .R
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