HomeMy WebLinkAbout020-1355-04-000 ST. CROIX COUNTY ZONING DEPARTMEN / - -,
AS BUILT SANITARY REPORT
Owner
Property Address i30
City /State /`fy.OSD Al t ,)� i : 2 - �6 Z _ ,� C
�
Legal Description:
Lot � Block Subdivision/CSM # A
t /4 t /4, Sec. LE T 7-9 N -Rl?ff, Town of Y6U4_5 9)._' PIN # O 7,0 - /3SS- 012 a
PTIC TANK -- OSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer l'' _ Size ST/PC p / Setback from: House 3s Well 85 t P/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: Gy- Width 3 / Length SG,ZS Number of Trenches �-
Setback from: House It S ?� Well P/I, !ao Vent to fresh air intake
ELEVATIONS
Description of benchmark 1 LiT STA K (:F— M 0 e S , _B3 Elevation
Description of alternate benchmark'To P o F 'R 1 04 r- RUMPI /OA) l44' Elevation •
S
Building Sewer ��� ST/HT Inlet 3 ` ST Outlet �� 3 ' O PC Inlet
PC Bottom Header/Manifold Z, D s Z `�op of ST/PC Manhole Cover gay' 9 7. 21
Distribution Lines Z �� S r ?.5�' ( ) j 2.73"`g Z ( )
Bottom of System ( ) '/ � �� - r `� 3 O 10, to = c f 1.3 )
Final Grade () () /• '� ° 7 ✓� ( )
Date of installation/ / / S/ 9 hermit number State plan number
Plumber's si nature License number 2 �O Date /L /I ,
Inspector
Complete plot plan �
�J
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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INDICATE NORTH ARR
A
af ,a n Department Commerce
Set afe Buildings Division PRIVATE SEWAGE SYSTEM Count INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 6T CRU I X
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344578
Permit Holder's Name: ❑ Cit ❑ Village Town of: State Plan ID No.:
MILLER, SAM HUDSON
CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.:
p' I I ot , 0' 11 (eke_ Nw (� Cdr 020 - 1355 -04 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark , 33 � f
Dosing , g4,t 6 1,
Aeratio Bldg. Sewer
Holding St /Ht Inlet �( 3(o 133!t
TANK SETBACK INFORMATION St/ Ht Outlet ft iq 3
TANK TO P/ L WELL BLDG. Air I ntake ROAD
ir
Septic ' ( 35 NA
Dosing NA Header /Man. 1Z ' ga.63
Aeration NA Dist. Pipe
/ ,/O •Z3
Holding Bot. System Lo 9(•
PUMP/ SIPHON INFORMATION Final Grade
't. g, Z) � Q? . 33
Manufa turer Dema 1 �,0 C 1 9 - .a.q
Model Number GPM
TDH Lift Fricti S stem TDH Ft
Forcema Length Dia. Dist. To
SOIL ABiQRPTION SYSTEM
TRENCH Width t Len th / No. f Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIM ? J �Z DIMENSION
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacture
INFORMATION Type Of 0 gC� OR UNIT CHAM odel Number:` C
System: i
DISTRIBUTION SYSTEM
Header/ anifold GI I Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Lengt Dia- Length Dia. 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 ❑Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HU ON 21.29.19.2070,SE,SE 809 GRANT AVE — HOMEPLACE LOT 4
3qY �W� 7 Ift czl�
A �Wlj. V ��a a
Plan revision required? ❑ Yes R No ,
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert- No.
i
ADDITIONAL COMMENTS AND SKETCH ,
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
•
Vi scons - SANITARY PERMIT APP ION 2 01 W. Washington Avenue
�n P 0 Box 7302
Department of Commerce In accord with ILHR 83.05, W �p e j
�-- Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the systq� pap r* S Cotin�y
than 8112 x 11 inches in size. - >° ts_ \ . LP 1
• See reverse side for instructions for completing this applici i6 161 State - S nitary Permit Number
":_
Personal information you provide may be used for secondary purposes — ST GHOIX if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. COUNTY r S &t Ian I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL I' b(fiFIGE
Property Owner Na '. Propert _LDCation' E (o W
'E1/4 ',,'/4" Z / T ' N, V al
Pr rty wrier's ailing A dress Lot Nu Block Number
Q ^V Mm--"
Cit , State Zip Co a Pho a Number Su ivision Name SM umber
D Phgge L G
. TYPE BUILDING: (check one) E] State Owned ❑ It Nearest Road
vil
❑ (age � 1 �1
Public 1 or 2 Family Dwelling - No. of bedrooms own OF V Al
111 BUILDIN SE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 E] Apartment/ Condo Zv - I Z Z) �- R 00 Q
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 rSiNew 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
________ System _____________ Tank On l�r______________ Existing System ________ Existing System
B) A Sanitary Permit was previously issued. Permit Number '3c6(f S Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non- Pressurized Distribution Pressurized Distribution Experimental Other
11 0 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12�Seepage Trench LE 14 22 ❑ In- Ground Pre sure / 42 E] Pit Privy
13 r_ Seepage Pit 0 IN;-) LT TtI 7), - x 3 j/ � 43 ❑ Vault Privy
14 ❑System -In -Fill 1 1,2s 454 ` ")
VI. ABSORPT 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/da /sq. ft.) (Min. /inch) Elevation
Is b Z- v Feet �c DO Feet
Ca acit
VII. TANK in g ns Total # of Site
r Prefab. Fiber- Ex astc i
INFORMATION ga Ions Manufacturers Name Con- Steel Pl
New Existin Gallons Tanks concrete strutted glass App.
Tanksl Tanks
Septic Tank or Holding Tank Od W e i sr le_ ❑ ❑ ❑ ❑ ❑
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.
Plumber's Name: (Print) Plumb's ignature: ( mps) MP /MPRSW No.: Bu es Phone Nu b
� � ���.
Plumber'sAddre Stree tate Zi p e
IX. COUNTY/ DEPARTMEN USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Agent Signature (No Stamps)
Approved I n Owner Given Initial Surcharge Fee) -
Adverse Determination V&0�
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 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.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on fine 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
201 W. Washington Avenue
Vi scons i n SANITARY PERMIT APPLICATION P O Box 7302
Department of Commerce accord with ILHR 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. sr
• See reverse side for instructions for completing this application State Sanitary Permit Number
Personal information you provide may be used for secondary pures ❑ Check if revision to previous application
e S
[Privacy Law, s. 15.04 (1) (m)]. 61
0 (i�ta4A State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
,`j/- /j " k M / L-1 F 6-- SF 1/4 g L 1/4, S 2l T sC1 , N, R / E (oQ W
Property Owner's Mailing Address Lot Number Block Number
Cit State Zip Code Phone Number Sub ivision ame or C M Nu ber
v o W ( g ) z7 off/
. TYPE F MIL DING: (check one) State Owned It Nearest Road
❑Village t , O c p A_� .4 ME
Public 1 or 2 Family D welling - No. of bedrooms 3 rows o (f `�l`Il
III. BUILDIN USE (If building type is public, check all that apply) Parcel Tax Number(s) .mil 297 _ — 2... - 1 a
40 zo 3S15'- W4 - Oop
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 _W New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
ystem ________ System____ _________TankOnly______________ 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 / � 6 !� 21 E] Mound 30 E] Specify Type 41 ❑ Holding Tank
12 Seepage Trench A 04 22 E] In-Ground Pressure k ## 42 ❑ Pit Privy
13 Seepage Pit a /NP 1LtkATO 9- a !14 3 X SG, 2s 43 ❑ Vault Privy
14 ❑ System -In -Fill 3 h t s Q F t �T -stbew1Njbrw& r /Y1 g /$ —"T pT1i} L,,.
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 (s q. ft.) (Gals/clay/sq. /sq. ft.) (Min. /inch) Elevation
,� Z- :• 9 S �UFeet 9�l, Feet
aclt
VII. TANK Cap site
in Ca
INFORMATION g Total # of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper.
New Existin Gallons Tanks Concrete glass App.
alsommomw T nks Tanks strutted
Septic Tank1eld;,rg'ftk v ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 1 1 ❑ 11:11 ❑ I ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plu ber" Signature: W Stamps MP /MPRSW No.: Business Phone Number:
tyz,64014
Plumber's Address (Street, City, State, Zip Cod():
07 0 140MXL P-i 46 HoASO UA *3
IX. COUNTY / DEPARTMENT USE ONLY
(Includes Groundwater D ate Issued Issuin A ent i ature NoStam s )
❑Disapproved Sanitary Permit Fee t g ( p
urcharge Fee)
Adverse Determination /
Approved []Owner Given Initial v�5 v a /�
' l
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
l
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 permitissuirg 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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Wi9R onsin Department ofCommerce SOIL AND SITE EVALUATION Page - -_1- of - 3
Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code
A.C.E. Soil &Site Evaluations
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must Coun
include, but not limited to: vertical and horizontal reference point (BM), direction and
cent sl scale , , nd a ce to nearest road. St. Croix
Pte' slope, l or dimemsions north arrow , a Parcel 1.D.# _ -
APPLICANT INFORMATION - Pie -p))fi4t"all information. 020- 1056- 90-000
Personal information you provide maybe used for n ary pur sesrivacy laws 15.04 (1) (m)). R iewe By Dat e�
— --
Property Owner «vt Property Location
Miller Sam r'_'r Go . Lot SE 1/4 SE 1/4 S 21 T 29 N,R 19 W
_._.
Property Owner's Mailing Address "' ' *� -Lot Block # Subd. Name or CSM#
Box 151 Trout Brook Road ?+
- t_ -- `_ _ 4 -__ -1 N - -__ - - Home Place - - -- --
City State 2(ISCoOe -R.149, r { City Village Town Nearest Road
Hudson WI 5016 715 6169`,, Hudson I Grant Avenue
Re placem ent lion Use: Public or commerce describe ms 3 [ (Addition to existing building
'- P �_J
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' It (as referred to site plan benchmark)
Additional design / site considerations
Parent material Outwash s & gr. Flood plain elevation, if applicable NA It
S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank
U= Unsuitable for system ® S❑ U Z] S❑ U N S U E, S U ❑ s ®U S E U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD / ft 2
Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consisten Boundary Roots Bed Trench
1 0 -8 l OR /2 N one sl 1 thin pi mv fr as 2f 0.4 0.5
2 8 -12 IOYR3 /3 None sl 1 thin pl mvfr cs 2 Im 0.4 0.5
Grou 3 12 -23 IOYR4 /4 None sl i 2msbk mfr cw 2f, Inn 0.5 0.6
elev
-- - - -- -- - - --
99.71'ft 4 23 -32 7.5Y None _i gr. Is 0 s ml cw if 0.7 0.8
Depth to 5 32 10YR5/4 None s & gr. ( o sg ml - - 0.7 _ 0.8
limiting /�ro� �etdo.^ -- �`E i i / Q C6WO
factor J`or'/ a-
�-
Remarks:
Z 1 0 -8 l ORY /2 None sl 1 thin pl mv fr as 217 0.4 0.5
2 8 -14 IOYR3 /3 None sl I thin pl mvfr cs 2f, l m 0.4 0.5
Ground 3 14 -25 10YR4 /4 None sl 2msbk m fr cw 2f, Ina 0.5 0.6
elev -- - - -- - - -- - - - -- - -- - - --
99.82'ft 4 25 -31 7.5YR4/6 None gr. is 0 s ml cw If 0.7 0.8
s & r. � - - - -- - --
None -
Depth to 5 31 - -- 10YR5/4 o sg ml - - 0.7 0.8
limiting I• `f / l'3� `>`
factor
I
Remarks: - -- — - -- - -- — - -
CST Name (Please Print) Signature: Telephone No.
James K Thompson 715- 248 -7767
_
Address A.C.E. Soil & Site Evaluations Date CST Number Ref #
340 Paulson Lake Lane, Osceola, W1 4020 5/6/99 3602 1016
� I
PROMWOVIINER: _Miller, Sam SOIL DESCRIPTION REPORT ,o,s paged 2 3
PARCEL LD .# 020 -_1 -056- 90-000 ____ ___ A.C.E. Soil 4 Site Evaluations
Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots - GPDlftz
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Eled Trench
3 1 0 -9 IORY2 /2 None sl 1 thin pl mvfr as 2f CA 0.5
2 9 -14 1OYR3 /3 None sl I thin pl mvfr cs 2f, lm q 4 0.5
Ground- - - -- - - -- -- - - -- -- -- -- i _ -- _ - -- - _ - -- - - - .1 -- -- -- -- -
elev 3 14 -24 1 OYR4 /4 None gr. sl 2msbk mfr cw 2f, 1 m 0.5 0.6
99.50'ft 4 24 -31 7.5YR4/6 None gr. sl I 2msbk mfr cw if P.5 0.6
Depth to 5 314+9- 10YR5 /4 None s & gr. o sg ml - - 0.7 0.8
limiting --
factor
Remarks: —
1 0 -10 I /2 No ne sl 1 thi pl mvfr as 2f 6.4 0.5
2 10 -24 1OYR4 /2 None sl 2msbk mvfr cs 2f, Im 9.5 0.6
Ground - - - -- - -- - - -- -
elev 3 24 -38 1 /4 None gr. sl 2msbk mfr cw 2f, lm li 0.6
99.64' ft 4 38 -119 7.5 YR4/6 None s & gr 0 sg ml - 6.7 0.8
Depth to
limiting
factor
>11 9" - -- - - -- - -- - - -
i
Remarks: -
1 0 -11 I ORY2 / 2 Non sl 1 thin pl mvfr as 2f 9.4 0.5
2 11 -15 10YR3 /3 None sl 1 thin pl mvfr cs 2f, lm 0.4 0.5
Ground I -- -- --
elev 3 15 -29 10YR4 /4 None sl 2msbk mfr cw 2f, lm 0.5 0.6
99. ft 4 29 -36 7.5YR4/6 None gr. sl 2msb mfr cw if 0.5 0.6
- - - - - - -- - -- - - -- — —
Depth to 5 36 -121 10 /4 None s & gr. o sg ml - if 7 0.8
limiting - - -- - -- _ - - -- -
factor
>121"
Remarks:
Ground -_ -_
elev
I
Depth to i
limiting { -
factor
Remarks:
I
�I
I
305 // 07 3
P2 To/0 oa/o•� Sh e.
/t s5li -rn-td e.leth = /Co. eo' AC- fe/'r+a -�c b.r►t. ' T
of I
C D. pel
Pe,pi. Area
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63
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ScaJl t l s 7 o,
p- P; rr
Owntr:•
Say, y✓l; [.(L
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer S t Ykj & j L..4_--f A..r
Mailing Address Bd X
Property Address 8a r+ A NT
(Verification required from Planning Department for new construction)
City /State ,k U ,D_'�Q k lit) Parcel Identification Number
LEGAL DESCRIPTION
Property Location '/4, '/4, Sec. 2, , T�N -R/ —�, Town of #Ub O A/
'Subdivision f �til E1•� L l�° , Lot #
Certified Survey Map # &OS 22 Z--- , Volume Page # SS
Warranty Deed # $ $ , Volume 1O 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, 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 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 St. Croix County Zoning Office within 30
days of the three year expiration te.
- 7 /►9/�
ATURE OF APPLIC DATE
'.: ±?WNER CERTIFICATION
i; V(we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the roptiEty,.de 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office.
ATURE 0 ,
' I' NT ATE
* * * * ** 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
0 C,J K
SS it G4 VOL •x:36:3 pw 114
� Dstunwnt Number WARRANTY DEED '•'
This Deed, made between.
Robert L Rohl
Grantor. ►
p cent•
a ` d ' E Miller REGISTE 1: FICt * f '
a single person Grantee. ST. CROIX Co.. WI
Witnesseth That the said Grantor, for a valuable copse ah ga r on of one do n �K la seee•r
a
other valuable consideration conveys to Grantee the below below 3escrbed real estate in OCT Q 6 19 98
St. Croix County, State of Wrsv
This is rant homestead p 9' j 44 M •
Together with all and singular hereddaments arse appurtenances thereunto b for of oeerae
belonging; r
And Grantor
warrants that the title is good. indefeasible in fee sarpie and free and clear of encumbrances except Recording Area
easessents, covenants, and restrictions cf record, one and Return Address ,
r and will warrant and defend the same. sae E. ML11•r
R
Mae fentificabon Number) tO Box 151
i 020 056 -90
� Hudson iiR 54016
A parcel of land located in the SE '/4 of the SE '4 of Section 21. T29N, R 19W, Town of I Judson, St. Croix
j County, Wisconsin, described as follows: beginning at the SF corner of said Section 21; thence N 89 °23'51 "V6'
1319.10 feet to the monumented West line of the SE of the SE !'4 of said Section 11; thence N00 °5 1'33 "W
980.09 feet along said monumented West line of the SE 'h of the SE 'A to the North line of the South 3040ths of ,
x the E' /2 of the SE 'A of said Se. ion 21 as caliee out in that documentation found in Volume 838. Page 252 of
the St. Croix County Register of Deeds. thence S99 "T1 9"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 Surve% Map tiled in Volume 2. Page
484 and the said North line of the South 30 80ths of said E ',1 of the SE '/.; thence S89 °23' 10"E 31.88 feet to a
found I" iron pipe being the SW Comer of said Certified Survey Map. thence continuing S89'23'101: 660.24 .i
feet to the East line of the SE 'A of said Section = I : thence S00 1'50"E 982.41 feet to the point of beginning.
containing 29.725 acres including rigl.. of % 1 29.006 acres excluding right of %%a% ).
a ' Dated this _ day of 199_ T AI�
Robert L Rohl
AUTHENTICATION ACKNOWLEDGMENT
+ Signature(s) STATE OF WISCONSIN �► k
COUNTY ST. CROIX
w
Personally cart�b� fore me this 2 day of C- r?f the + +
authenticated this _ day of above named %o ert L. Rohl
to
me known to be the person(s) who executed the foregoing
L signature ins t and acknowledge the
type or print name
type or print name v1/14 k.+
TITLE MEMBER STATE 8 OF WISCONSIN Cary public County.
(if not. .l+1i► Y PV om is s,an is permanent (H nix. stall expvaoon date
9 authorized byg706 06. Wis Stets.) O
y THIS INSTRUMENT WAS DRAFTED BY r 'N a ens signing in any capacity should be typed or
Robert F. Wall Ylt KEEN IIJtn their signatures
! (Signatures may be authenticated acknowledged So are 1d y
necessary.) y2► i `•
It {
LOT 4 OF PLAT OF PRAIRIE VISTA
• CERTIFIED SURVEY MAP LOT 6
• VOLUME 6, PAGE 1768.
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W ( R S 00 51'49 "E N 00 51'33" W 980.09
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a $ EAST LINE OF THE SE 114 OF SECTION 21
'° UNPLATTED LANDS