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HomeMy WebLinkAbout040-1004-40-100 ST. CROIX COUNTY ZONING DEPARTMENT,' AS BUILT SANITARY REPORT �'` �•, -�', Owner Property Address a 34 3. `Src1 City/State � 1 ycr Rills a u)= 54 O z-Z :G Legal Description: , Lot �_ Block --" Subdivision/CSM # I '/a S W ' /a, Sec. T_alN - RLW, Town of 'i�i�t��► _ PIN # o VO %oor/ yo - /aa - /4. 2 C SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Wels�r Size ST/PC /25' / Setback from: House, Well 60 P/I, � Pump manufacturer /Avers Model At ryo Alarm location Aa • g <^ (HOLDIN T :M o NLY) Setbacks: Sad Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: - t e a c k Width 3 Length 75 Number of Trenches 3 Setback from: House I g 7 Well /s"o P/L --a Vent to fresh air intake � 40' ELEVATIONS Description of benchmark k ici A Nx Rd C- V Elevation IX, 6 Description of alternate benchmark & flo" Elevation Building Sewer SJ, ST/HT Inlet N-81 ST Outlet 6 / PC Inlet PC Bottom U, J Header/Manifold 9G • DG Top of ST/PC Manhole Cover Distribution Lines ( ) 4 G i oZ a ( ) 76 . , e) 4 ( ) 91 -1l Bottom of System O 7 8 O `7'1 73 O �`�• 75 Final Grade () () ( ) Date of installation 1 I lPermit number .553 16') State plan number Plumber's signature C License number Date Inspector Complete plot plan � �H. NOTICE Please pro 'de the fol � � q It '1�" q ;• • A plan view sketc i showing a er�.hi 4hrn 100 feet oft system. • Two horizontal re ere e p cen�qr Q p ,cr; ,rp ole cover. � � �acNo4 3 tren�l.s • Show alternate be chm , if applicable. s' eve LAN VIEW 1 X ti d 3 toeis<+ lX6V71b 5, Ts.k v i ti V N /lousc u a 3 .V C Q BuN�icup c ou.r n INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division . 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)]. 353151 Permit Holder's Name: ❑ City ❑ Village IR Town of: State Plan ID No.: Chicchese James & Robyn Town of Troy CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: go . O' 1 100. C , 3 mA pending TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmar 1 d roe i Dosing �5 Alt. BM Q/, Aeration Bldg. Sewer tAl) 9 13"S� 90 Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet o $' 4 TANK TO P / L WELL BLDG. Air i to ntake ROAD - Dt Inlet / � O O T j ,r Air � Septic asp' 32% - NA Dt Bottom I ° �� 0 2� /1_ /.Sy Dosing SO r 3 r 3 NA Header / Ma . t `� •`( S Aeration NA Dist. Pipe Holding Bot. System c 2 �;q2 PUMP / SIPHON INFORMATION Final Grade Manufacturer M Demand St cover ��y� Model Number /) 0 GPM lo. 3a �(� •3� 1 =3 F DH Lift �. Friction 3 ( System TDH IS IFt ead main Length / Dia. H it Dist. To Well S`� SOIL AB RPTION SYSTEM ��p " (Z. - PT' 21 f/ \� Width r ten th I N O Trenches PIT No. O Pits Inside Dia. Liquid Depth DIM I N � ] DIMENSION S SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Typeof CHAMBER Model Number: System: tow, 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 Mu c ed �6 Bed /Trench Center Bed /Trench Edges Topsoil []Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: /Z/ 7/ rl Inspection #2: Location: 700 Buttercup Court, Hudson, WI (NWl /4, SWl /4, S ction 2 T28N -R19W) - 2.28.19. 33.0' 36 c vine, 7' - - - t #�` ,,/ n ,2� Z ®T.�`o u, 2 9f; . o G 3 to Z 6!9' Plan revision required? []Yes ONo Use other side for additional information. 3 Z � I I SBD -6710 (R.3/97) ( _ ate �� _Inspector's Signature Cert. No. U Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue Asconsin P O Box 7302 In accord with ILHR 83.05, Wis. Adm. Code Department of Commerce _. _ Madison, WI 53707 - 7302 • Attach complete plans (to the county copy only) for the system, on pa-�e si; 3 7pu than 8 112 x 11 inches in size. ` ',/ r w ; • See reverse side for instructions for completing this application , Vt�tl S It ry Permit Number Personal information you provide may be used for secondary purposes r. r ❑ Check 4 ion to previous application [Privacy Law, s. 15.04 (1) (m)). i f pl Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF R ATI GRQIX Propel Owner Name Pro i n , — J ame s 4 RO�J I C - < t/4 ,($ Q Ff , N, R / 9 E (o W Property Owner's Mailing Additfs Lj Block Number .5 , � h ( z City, State Zip Code Phone Number Subdivision Name or CSM Number a 1 ag 6g0 - .?a 1 ( 715 ) a(�- II. TYPE OF BUILDING: (check one) ❑ State Owned Neearest Road Public 1 or 2 Family Dwelling - No. of bedrooms I Town OF l rL) Bu C Ill BUILDING USE (If building type is public, check all that apply) Parcel Tax e N ,( umber( 1 E] Apartment/ Condo 070 160 — 3 0 - 000 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. E] Reconnection of 5. E3 Repair of an I_'_`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 1 " Seepage - Tnflitr4fer 5 ;d1Q ;J 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 §aSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit + n � 43 ❑ Vault Privy 14 ❑ System -In -Fill 3 { Z CrS 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 �.1 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) �3. �t Elevation QO oZ / • 5 ;L a. Feet Feet VII TANK Cap aclt in gallo Total # Of Prefab. Site Fiber- plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass App. New Existin strutted Tanks Tanks ��}} Septic Tank er++ek io+Z*ak— X, db ��20p �,(fPl St I!1 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank�rx 76 ip I ^ I ZrOW I k ® 1 ❑ 1 ❑ 1 07 ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plurplw5s Signatur : ( o Stamps) MP /MPftSVeNS: Business Phone Number: PAuL. C.T. ner Plumber's Address (Street, City, State, Zip Code): 3u wz- ` �a1� 4o IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued Issuing Agent Signature (No Stamps) Surcharge Fee) )4Approved ❑ Owner Given Initial Adverse Determination X25. to -It-9q 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. t To be complete and accurate this sanitary permit application must include: 1. 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. 9 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. Plan o f su s 1, 54ewiod -err In 4 trafor For fache, f 3 s . S —1 � l %�Ib Se Y • r i 0 N /7 °° v Vv ts 3 �v L 1 LtH frCup C ourt �J J x s y ,17 �. �v � ,fir ME40 Series �® 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 to 30 f bZ 25 9 Z 20 6 15 4 4 p 10 ~ 2 5 0 0 0 10 20 0 40 50 60 70 60 90 100 CA ACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289-1144 FAX 419/289 -WSB Telex 98 -7443 K3326 7/91 Printed in U.S.A. vVi.sconsin Department of Industry, SOIL AND SITE EV A L U A REPORT Page of 3 Labor and Human Relations Division of safety 8 Buildings in accord with 1LHR 811 Sio COUNTY Cb s7 C Qci� x Attach complete site plan on paper not less than 81/2 x 11 inche e. Pi e, not limited to vertical and horizontal reference point (13M), dire of r N PARCEL 1.0. # dimensioned, north arrow, and location and distance to nearest APPLICANT INFORMATION - PLEASE PRINT ALL INFO TI0ON Z W IEWED Y DATE sr PROPERTYOWNER: C:o'�tbpty q MPrTt_ \- r-Mo TT TIO r� �� 't(g W va,S Z T Z.% ,N,R 1° 1 E( PROPERTY OWNER':S MAILINVDDRESS• LqT # BLOCK WUBD. NAME OR CSM # Z3 S. 3'^ S P�PUS� Csi� CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®TOWN ' NEAREST ROAD 2�v �2 etc s, i.l I s � � zz (� cs� � zb - 03 o z - nz o � Bv ��-. �9 New Construction Use QC) Residential / Number of bedrooms 3 [ [ Addition to existing building j) Replacement [) Public or commercial describe Code derived daily flow LlS 0 gpd Recommended design loading rate — bed, gpd/ft • L\S trench, gpdtft Absorption area required 't 0'3 bed, ft _ t 5 O trench, 11 Maximum design loading rate • S bed, gpd /ft - b trench, gpd/ft Recommended infiltration surface elevation(s) S Fj�' Pf� (S EF' 3 ft (as referred to site plan benchmark) Additional design / site considerations SQEe IQCT _TD W Sw ,LzR, oN 'P AGE 3 , ' Parent material \_ r) QsS 4z \j k S2 0\3 Flood plain elevation, if applicable t - • It S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem 0S ❑ U ®S ❑ U RI S ❑ U I I$S ❑ U JO S ❑ U EIS ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Bourxfa�y Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mmnch I a - 8 -S`/tZ 3[3 _ si l Z`Fsbk m' �-S 1v� •5 -6 >.���� _ s � cZ 31 _ s • y 5 Ground SyR yf� C-' 'S M \j i Cw q -4 tL 54=16 - - ).S 4R V& - S O S Depth to ` op It limiting + �; factor >, a IS ss f Remarks: Boring # S ' S --10- l j st t Z'F 5bk �� 1 V`� -t R - i's -1 R 3 L (f wi C S � � `� • S • � 3 y -3Z S`1R 3l/f lg o Ground elev. 3z- • S Lt 2 V1G Depth to limiting factor�� Remarks: CS T Name: Please Print Arthur L. We erer Phone: 715- 425 -0165 r ress: „egerer Soil Testing & Design Service -P.O. Box 74 River Yalls,WI.54022 Sgnature: Date: CST Number:: ��1 iii �5� �� IL, 99 220254 PROPERTYC4VfNR S %PCRIPTION REPORT - Page? of 3 PARCEL I.D.# QVQ - LOZA -30 Boring # Horizon Depth Dominant Color es Structure GPD /ft in. Munsell Texture Consistence Roots Qu. S :Coat. Color - Gr. Sz. Sh. Y Rt Bed Trench --ta L 3 � s y Ground `ttL 3/tf 5 elev, 9 4 .O ft. L4 30$3 7 -Sk V4 S � S — Depth to 1 limiting tg 3N Remarks: Boring # Z 4 -ZZ � S K �. k cs 1 v •F • s . Z R SIC) `7 -S Y 3Ly — i S 0 Ground 3 h'1 � L`bv � � • � elev. c{ 30 -80 S �t 2 y/6 1 S C� S g 8. - I ft. 9 ►� I ,-� I .g Depth to limiting factor j } Remarks: a s: Boring # 5 •• #' Z 7 -� 7 • S vi- 31 _..:. y s� 1 sbk � r ka:•:ss,. S> _ � 1 � Ground 3 -33 -S `Z R 3l �S CJ S °� r►'t ei.v •� ,� elev, Da ft Depth to limitin factor i Remarks: Boring # ii" i Ground I elev. ft. Depth to limiting factor Remarks: _ PLOT PLAN Page 3 of 3 SCALE 1 V `mow QVL \Z l3 f Q ,ti' 4— _� 0.g. �Y Eugg ZA' v b3 co fl - G i � awt�i - fit. Iua. o' cum 6`�H1GN, Sly "'�1q. Pve l��PE w��n7�I a < 3r�tiL eL, 0 11.9` 2 +a HvjsF`ty w� A'r LLZ " Zs' ski' tzTE T4 1 Iv Z 'zlosm 7v-sewc es SCE; - ]S LO"G 1 EHGN CA 1''-/ S t lJ`t.-jlN L l Ctf'�j1Q 1 S ~ I W1lN 1r'1U Rfi�C�1 lam Cdvl'L� R9 -13Z / t Z z o Z. S'i C� �� ��" �• �� 'l�j ( 715 ) 425 -0 69 _ CST Signature !� Ye Date Signed Telephone No. CST # OCT -06 -1999 TUE 10:19 ID:STEINER PLUMB & ELEC TEL:716 426 SS1S P :01 � ax�es � Robb h C I «hest • r ►nrt c:F PUMP CHAMBER CROSS SECTION AND SPECIFIC " f - IOLJS - VCWT CAP W VENT PIPE - WrAT'NEKFK00F APPROVED LOCKIRIG ?-5' FROr1 DOOR, .JULICTIOAI SOX MANHOLE COVEF, WIM00W OR FRESH 12 "Mlll. AIR INTAKE I GRADE 16 "m1 COAIDUIT IMLET PROVIDE 9 AIRTIGHT SEAL, A I 1 ALARM c *APPROVED ow JOINTS WITH 1 ELEV. FT APPROVED PIPE 3' ONTO PUMP �� J OFF o SOLID SOIL COMCRETE DLOCK RISER EXIT PERPIIIrKD OLJLH IF TALJ MAMUFACTURER HAS SUCH APPROVAL SEPTIC E SPE IFIGArIQAIS DOSE /�� y TA►IK$ MAUUFACTURBR; La . Lc C fr WUMBER OF DOSES: / PER DAS TAWK SIZE; 7 .T:Q GALLO DOSE VOLUME ALARM P4AWUFACTUR,CR; LP:/Gl Alomp ,L INCLUOIN SACK f[.P & GALLONS 1 AODCL 1JUM6EK: rr�, CAPACITIES: A-L 4 McFjrS OR 7 ,GGALLOIJ.S 3WITC14 TyPt: �[�sT IB a 3 INCHES OR _ 9 .2 GALLOWS i PUMP M AMUFACTURER: M WiPle.S CC „&41 GALI-01J5 MODEL LIUMDCR. _ ,= yo D-11L_INGHEs OR ail _, CALLOW: SWITCH TWPE; MOTE: PUMP A►ID ALARM ARE TO pE MILIIMUMI DISCHARGE RATE -3 6Ph INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEILEUCE dETWEELI PUr%P OFF ALTO 0137RIDUTIOM PIPE.. 1 1 2 - FEET + MIMIKILIA 1JETWOKK SUPPL.y PRESSUR / . . . . . . . . _ . . Z•5 FEET ♦ 4&& — FEET OF FORCE miN X - �AocFrFRICTIOy FAcirm. FEET TGTAL D�INA HEAD = ,. FEET l G. 13 rl 1,01f IMTERLIAL, 1J 61001: OF TAMK: LEkl&TH ;WIDTH LIQUID DEFY DATE: S IGIQE D. LICEAISE AWMBER: � y� l I . wisc nsin m ur o use, SOIL AND E EVALUATIO REPORT _- - Page - _ of -- S1T- Division. of salary s Buildings in accord with :ILHFI 83.05, Wis, Adm. Code .:. COUNTY • 9 , •�. Attach complete site plan on paper not less than 81/2 x 11 inches in size. include, but not limited to vertical and horizontal reference point (BM), direction and ° e, scal�r WCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMA 0 B DATE PROPERTYOWNER: C Ql \cYJo -T �U`•l1r12 : �1N1� R �0 3y tv Cl�` e S PR t/4 S 10 Z T T% ,N,R 1 0 1 E (oro PROPERTY OWNER':S MAILIN � ADDRESS• T BD. OR CSM # v` ST. --� •�? v9� cst� CITY, STATE ZIP CODE PHONE NUMBER N ' NEAREST ROAD 21U�Z Pus L•]! s�c,zz (acs} 44.6 =o3oz T B�� e [� New Construction Use pCJ Residential / Number of bedrooms 3 [) AdditiQn to existing building [) Replacement [ j Public or commercial describe Code derived daily flow 0 gpd Recommended design loading rate - bed, gpdtft • ` S trench, gpdtft Absorption area required `l WO bed, ft `150 trench, 11: Maximum design loading rate S bed, gpd/6 - E' trench, gpdtft Recommended infiltration surface elevation(s) S �>" e- 3 It (as referred to site plan benchmark) Additional design/ site considerations SEE L' 1 D IAJ s1`F1'S..IzYt.. dtf P ATGE 3 .. . Parent material ass o\l k-_\2 ov Flood plain elevation, it applicable t - a . V ft S = Suitable for system CONVBJnONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM W FILL HOLDWG TANK U= Unsuitable fors stem 14 S❑ U ®S ❑ U 0 S ❑ U I$S ❑ U ms O U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed I x >.<-k Z Ground 3 4-39 - ).SYR 4//6 M U Fl- C"i - • 5 • - elev. g i f S4 8 - 1.S 4R V& S O Sg Depth to limiting factor Remarks: Boring # S'4 R 3 t - Z Sbk yn C -5 .� 3 U -32 S4 )_ 3)1} kn` Ground elev. S Y R_ VI(, 6 I S -S fL !. Depth to limiting factor Remarks: T Name.- Please Print Phone: Arthur L. We erer 715- 425 -0165 i ,egerer Soil Testing & Design Service. -P.O. Box 74 River.Falls,WI. 5402L . 1 Sgnadae: Date: CST Number.-: cn -13Z 6 -16 -9 220254 PROPERTYOVWJ�sR SOIL DESCRIPTION REPORT ?—of PARCEL I.D.# C`E`O tOpVr - Page "' M �r tl Boring # Horizon „Depth Dominant C i v 0 St GPD /ft Texture ructure Consistence In. Munsell CoptColor Gr. Sz. Sh.Y Roots . :`� •' °` Bed Trer& sit z�l -sbk mom• �S \� .s .b - �. s � icy si Z`Fsb� wr�F� e s 1v� •s .b Ground elev. wt U '�t- Cw - •S ado ft. Depth to limiting N f Remarks: Boring # >. ro 9 S�t�JL3 st 1 Z`�'sblz wL`� �S lv� •S •� Z 4 -ZZ - 7 •S `iIZ31y sl�l Z�'s�k ri 3 zz3 — 7 .SY.(Z3ly �S D3 Ground 9 elev. Cf 3o —8D .S Le z VA � S Depth to limiting factor i Remarks: Boring # 5 o -� 1.S ��Z 3I3 s11 Z`� ��r �S 1v� , S `• 6 -z0 - I •S'-ttZ 3! Zb Ground 3 -33 `1 -$ SI R 3!5( �S Cj S °� h1 QW — • . e lev , ft. j•8 Depth to f limiting factor ° L 11 Remarks: Boring # i Ground' elev. ft. Depth to limiting factor Remarks: _ __ p LOT P LA1 Page 3 of -3 A ' SCALE 1 '= `1p' rj ati LniT L�NL: ;� 4YAq'� O f � g�Z O 51- S J �., G C3►`1 tt i - a. ! 1o. O' ON 6''HI6N, 3Iy'�t q, PV e_ �P PE W! LA T'} , 3r1t�Z LL, 0 17 -9' h l0" 2 Pfl- Lv - is F 1 , clf� S. W ELL Ste' UOSm IV-k JC At E�tC-N -IS' LprJG Wl H'!G CAIN , K-I Ytf S tJ 1 ! R ► �'� L � � ' FJ Q '� NS ~ Cl{E ►mil I AJ ) M uw( Cav�'t; Q 9 13Z 71 ) _ z z 5 4 2. s n 1 5 CST Signature i Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OW NERSHIP CERTIFICATION FORM Owner/Buyer — J A ry t5 Ci Mailing Address a Property Address 00 -e re - U (Verification required from Planning lepartment for new construction) City/State Parcel Identification Number o `/ o - I DO y - 30 - & - t LEGAL DESCRIPTION Property Location l�i _ %,, ESQ %., Sec. , T ,2►L N -R Town of Subdivision , Lot # Certified Survey Map # (a t [ a`a , Volume � . Page # 3 9 Warranty Deed # fp I L a 3 , Volume _ 140 O . Page # IX Spec house ❑ yes ❑ no Lot lines identifiable GY'Y es ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating 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, b virtue of a warranty deed recorded in Register of Deeds Office. GNATURE 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 nce is made in the warran deed a copy of the certified survey snap if refere ty • STATE BAR OF WISCONSIN FORM 1 - 1998 61 1233 WARR DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number VOI. 1460PAGE 12 ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between 7 @Tr. G 6N -mNb 09 -29 -1999 3:45 PM - c -�_ s T WARRANTY DEED EXEMPT N _ Grantor, CERT COPY FEE: and MP, W f S �tND �R COPY FEE: 2.00 n g �t N e- iC-�' �S f TRANSFER FEE: 54.00 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuab, a consideration, conveys to Grantee the following described real estate in ST. (XGD t Y County, State of Wisconsin (the "Property "): Recording Area Name and Return Address X4 cn= t+� �wr tFw>rsT J 1>h E S be-c- _-S t-. 5 a;t1 O A , MA-) t3 s-k k- �L`� `fir G4. ICI L,D�, T'otAD 11) � SOY X �vF �wt�s. W t S4oaa. dh5 I-OT 1, OT C 5 r �� Cd����9 4S \) 0L -(, ,3 r C d'� ou0- 10 - 30 _ 0 00 P,& ` �� 3� ^ 4 ^ ' 1 , nn ��� 11 �� I Parcel Identification Number (PIN) C� 1 lJU Yr` This l5 "0_� homestead property. V-Jjv-yp El 's eTT V11 0i Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, Indefeasible in fee simple and free and clear of encumbrances except Dated this �_ 1 day of Jf ,OR Tt.I/Vl'R - `1 q (SEAL) (SEAL) * Ga� -N kN © y% CCi tC ��i�Z2L� (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (s) State of Wisconsin, • - ss. County authenticated this day of Personally came before me this o�9 — day of �QJ1i3c7L the above named Ga K.00N 6V,9# TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person who executed the foregoing - authorized by §706.06, Wis. Stats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Notary Pub ate of Wisconsin My comma st is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not ' 0 3 ) necessary.) Names of persons signing In any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. `rARRANTY DEED FORM No. 1 - 1998 Milwaukee, Wis. -, ----------- -- -------------------------------- -------- ------ -------------------------------- -- let ----- ----------- CI zo CD ry ui LL SP U) Z.J7 < 90 C Y ) I - ------- ---------- ui cr ------------- U-) CL -gym, Co (D co 9,0, V, 00 co C) ------------------ --------------- ----------­----------- ------------------------------- t i W (D S. 4- up 1-10 r co -9 ;9 FiL�D * 10 Sip 2 9 1999 11 KpmIEEN H.WAt R� Cr0ljX , St.CrorxCo. �? y Certified Survey Map Gordon and Marie Knott Trust Part of the Northwest 1/4 of the Southwest 1/4 of Section 2, Township 29 North, Range 19 West, Town of Troy, Croix County, Y� Y� w 114 coR. s 2,' r.-O N, R 19W, LEGEND: /BERNrsEN NA /L/ R (10.0') Indicates previously LA T `T ED LANDS recorded data. N 0 Indicates 2" dia. iron pipe O a found. �I M) � Indicates fence. v N 28 P' o Indicates 1" x 24" iron pipe �I ao w sEPr /c vENrs Weighing 1.13 lbs. /lin. ft. set. I J t7 $89'10'52 "E 209,.20• ; W -j j l 4 I N r ' o Owner's Address: o z 743 Tower Road LOT Hudson, WI 54016 Z o J Q Dated: July 9, 1999 h o "Revised this 21st day PRE Q a of Sept. 1999." SE ptt� 2 3 APPROX. TOWER DECK m FALL LINE a � DI O H W 1 Z APPROVEMI b ° a " N O �o N J W ST. CROIX COUNTY W h h �• % h Planning Zoning and Parks Co Vee q 3.000 ACRES 2 N /30, 684 SO. Fr. O , Q O I 2.683 AC. EXC. ROAD R/W S E P 2 9 1999 O O Ili //6, 878 so. Fr. h OI O ROAD SErBACK LINE This instrument drafted by It not recorded within 30 days or i 3 ...... " " "" " " " "" "" Laurence W. Murphy approval date approval shall be y SCALE / " : /001 null and void ' hl 2 O 50' /00' /50' 200' 250' J 3 1001 O C1 1 N 89 209./8' The applicant has decided to build J DRIVEWAY a new home within 500 feet of an W r LOcAr /ON existing transmission tower. BUTT ERCUP COI RT b e e b -- I. ATEDRIVEWAY EASEMENT 11. N B9 52'31 W 209./8 TEMP.OV/L - DE - SACJ 1� /RESERVED FOR FUTURE PLIaL /C SrREErI o UNP LANDS ,`��••�•a�•ui��h �'' ���.• C SC O /v q SW CDR. SEC. 2, T 281, R19 W, L : AU ••• •• KICE '; •�� /COUNTY SURVEYOR'S NON./ • I RPHY °C I BERNTSEN ALUM /NUM MONUMENT/ SHEET 1 OF 2 S 1713 i ?. RIVER FALLS,: • �I WISC. Q`, ,•• c I Nr,�� LAND' v I Vol. 13 Page 3739 Certified Survey Map Gordon and Marie Knott Trust Part of the Northwest 1/4 of the Southwest 1/4o€ Section 2, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. Description: That certain parcel of land located in the Northwest 1/4- of the Southwest 1/4 of Section 2, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin, more fully described as follows; Commencing at the Southwest corner of said Section 2, thence N 00° 0729" E (recorded bearing on the West line of the Southwest 1/4 of said Section 2 a distance of 1736.17' to the POINT OF BEGINNING, of the parcel to be herein described; thence continue N 04° 07'29" E 626.01' on said line; thence S 89 10'5-2" I, 209.20'; thence S 00 0729" W 623.48'; thence N 89* 52'31 " W 209.18' to the POINT OF BEGINNING, containing 3.000 acres or 130,684 square feet; being subject to a private driveway easement as shown on this map and all other easements of record. This instrument drafted by Laurence W. Murphy Dated: July 9, 1999 "Revised this 21st day of Sept. 1999." Note: Each parcel shown on this map is subject to State, County and Township rules and regulations (i.e_, wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning (thee and the appropriate Town Board for advice. State of Wisconsin) County of Pier; e) 1, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owners, Gore and Marie Knott Trust, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County and that this r1U. and description are a true and correct representation thereof. N ot I�IIIIttltf��NVA- S • LA URE 2T W MU Y �� S 1 �. RIV ALLS, i .,W1C..' Q` ........... •• LAND S ��•. Sheet 2 of 2 Vol. 13 Page 3739