HomeMy WebLinkAbout040-1224-50-000 r
ST. CROIX COUNTY ZONING DEPARTMENT \
AS BUILT SANITARY REPORT
RF
Owner
rtY Address Jil � 0 6
Property p 1999
City /State S I T GPM
ZOM
Legal Description:
S 0
Lot Block — Subdivision/CSM #
� SU) t /4S2L t /4, Sec. :�2_, T2LN -R -W, Town of PIN # �-
SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION:
Tank manufacturer Size ST/PC / Setback from: House Q Well P/L
Pwn manufacturer Model
p �i�
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:( Width 6 - 1 Length �7 Number of Trenches
Setback from: House �(/ Well 2 , 1,� P/L _� Vent to fresh air intake
ELEVATIONS
Description of benchmark o j ck �A Ccw /I Elevation ZCO- 19 v
Description of alternate benchmark Elevation
9y �3
�-
Building Sewer. ST/HT Inlet 29 ST Outlet PC In let
PC Bottom —�- Header/Manifold Top of ST/P"anhole Cover �- S
Distribution Lines Z3 .) a ( )
I
Bottom of System
Final Grade (1)
Date of installation / / Permit number State plan number
Plumber's signatur , ' ense number Date 9
Inspector h
Complete plot plan �
T
NOTICE: Please provide mg:
J
• plan view sketch shovg everything within 100 feet of the system.
• —i Two horizontal refer er*ints to center of septic tank manhole cover.
0
-r
• p Show alternate bent ark if applicable. r%
C- I m
P1Q VIEW ' �\ a
4-0 - � r�
Z)
a
� , mo t.
L l
1
r
� J
INDICATE NORTH ARROW
n
6
L��
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count
INSPECTION REPORT IX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarype,�r�i6b
Personal information you provice may be used for secondary purposes [Privacy La I s.15.04 (1)(m)].
BI
VI LghN TTH El City [] Town of: State Plan ID No.:
CST i B ' M l{ Elle lv v.:. Insp. BM Elev.: D(,scription: t�C�V xx Parcel Tate �Ic� -50 -000
loo I 4 C7 0'( Corner U 4 l/
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY 119 a TATION BS HI FS ELEV.
Septic Gl�s PeCQ Id 0& Benchmark 6Q
Dosing ��t z,Z
Aeration Bldg. Sewer Z ,3 'l Y_
Holding St/ Ht Inlet &0
TANK SETBACK INFORMATION Ht Outlet 9
TANK TO P/ L WELL BLDG. Vent - to ROAD D s,� �,,�,,�
Air i�4affCe �'m =`-�
Septic ��06) � f ZG l NA D r
Dosing NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System $ Z S
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand S� , Z Z 9 5_
Model Number GPM
TDH Lift Friction System TDH Ft
m ead
Forcemain Length Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED REN Width Le th / No_ f Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIM N -5 DIMENSION
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION TypeO M o elNum Number:
G OR UNIT
System:
DISTRIBUTION SYSTEM
Header /Manifold /I Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake
Length JL Dia - Length _EJ Dia. _ �� Spacing Z - 4z Z 3 Z 1 4 /0 4"
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 ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TROY 7.28.19,SW,SE 410 CEDAR VIEW ROAD - CEDAR RIDGE LOT 5
(� rtiv t e ( / a, 't M
Plan revision required? W Yes ❑ No q q
Use other side for additional information. / 1 1,
SBD 6710 (R.3/97) Date Inspector's SA9n ure Cert. No
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
. .. .0 . ,._. _. -- - ,,, _ . . 9
,
f
E
€ I
°
1
F P
{
j
a
a ,
,
°
r
e
,
s
`
a
< e
e
......._ ,...— e r m m ,m
e.me
s €
3 ,
,
E i
,
„
{
s'
y m_p
a
i
,
i
x 3
j
m g.
I
t �
mm
( t
e
w ..
e
,
E
,
. F
S €
3
e . E
S 4
„
5
e
e °
Y
'. .,......,., .. y..... mm,e,: _ ,+° .
E � x
P
B
r `
e m..
f
s
d
E
,
. 3 e... . .... ..: d . ............�. ., .... ., ..,,,:e... � _�.. .,..,...:.... , u.. —. .,,,......,, .,.m.,. __.. ».,... ,,.., .,«...
w a. .
Safety and Buildings Division
Vi scons i SANITARY PERMIT APPLICATION 201 W. Washington Avenue
n
P O Box 7302
Department of Commerce In 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 81/2 x 11 inches in size. ST. CROIX COUNTY
• See reverse side for instructions for completing this application State Sanitary Permit Number
338917
Personal information you provide may be used for secondary purposes W Gheck if revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
KEITH FRENCH sw va 1/4, S 7 T 28 , N, R W
Property Owner's Mailing Address Lot Number Block Number
101 GRAHAM STREET 5
City, State Zip Code Phone Number Subdivision Name or CSM Number
ROBERTS WI 54016 ( ) CEDAR RIDGE
II. TYPE OF B LDING: (check one) ❑ State Owned ❑ Cit Nearest Road
Villae
Public 1 or 2 Family Dwelling - No. of bedrooms 3 E] oa Town OF TROY CEDAR VIEW ROAD
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 040- 1224 -50 -0000
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: sp ecif y
❑ ❑ cto y ❑ p v
IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable)
A) 1. N New 2_ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
System System Tank Only 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 E] Pit Privy
13 El Seepage Pit (2 5 ' x 57 43 ❑ Vault Privy
14 ❑ System -In -Fill ''rock"
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
450 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
562.5 570 .8 1 N/A 9 2.8 Feet 95 Feet
Capacity
VII. TANK in Ca allo
g Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete con- Steel glass Plastic App
New Exist in structed
Tanks Tanks
O 1-Inl i^; -za nk 1000 1000 1 MIDWESTERN PRECAS ® El El El ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ El 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) Signature: (No St MP /MPRSW No.: Business Phone Number:
Plu
BENNIE HELGESON E 2 715/772 -3278
Plumber's Address (Street, City, State, Zip Co
W1229 770TH AVENUE, SPRING VALLEY WI 54767
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue M ent Signature (No Stamps)
Approved E] Owner Given Initial Surcharge Fee) / (
r Adverse Determination I �,
X. CONDITIONS O / APPROVAL / REASONS FOR DISAPPROVAL: p
S ( , C® 4-,—
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 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 81/2 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 si phon
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.
I
SANITARY PERMIT APPLICATION Safety and Buildings Avenue
Division
201 W. Washington
Vi sconsin In r with ILHR i . P O Box 7302
Department of Commerce acco d t 83 O5, W s Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 81/2 x 11 inches in size. ST CROIX CO
• See reverse side for instructions for completing this application State Sanitary Permit Number
3 Ii
Personal information you provide may be used for secondary purposes ❑Check if revision to previo s application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property p d
Loc o ) W
KEITH FRENCH SW SE $ 7 T 28 N, R 19 V'q
Property Owner's Mailin Address Lot Number Block Number
101 GRAHAM S�REET 5
City, State Zip Code Phone Number Subdivision Name or CSM Number
ROBERTS WI 54016 ( > CEDAR RIDGE jp
I. YPE F B ILDING: (check one) ❑ State Owned i Nearest Road
VII age
Cj
Public 1 or 2 Family Dwelling - No. of bedrooms 3 v 2 Town OF T CEDAR VIEW AOAD
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) . s $,'aq - 1 D9
1 ❑ Apartment/ Condo 040- 1224 -50 -0000
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. M New 2 ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5 '❑ Repair of an
------ -------- ____ -___ 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 M Seepage Trench 22 ❑ In- Ground Pressure X 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM I ATION:
1. Gallons Per Day 2. Absorp: r 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) Elevation
450 570 570 .8 N/A 92.8 Feetj 95.8 Feet
Capacit VII TANK in gallo Total # of Prefab. Site Fiber- Exper
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App
New Existin strutted
Tanks Tanks
eptic tank I 1000 1000 1 IWIESER CONCRETE ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber El El 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' � nature: (No ) MP /MPRSW No.: Business Phone Number:
BENNIE HELGESON 1 220292 1 715/772-3278
Plumber's Address (Street, City, State, Zip Code):
W1229 770TH AVENUE SPRING VALLEY WI 54767
IX. COUN TY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Issuing A e t Signature ( Stamps)
[3'Approved ❑ Owner Given Initial
Surcharge Fee)
Adverse Determination i « H
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 betubmitted 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 81/2 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.
� J
� �t n
a T
Im
Ll
I r -
p
� I k
P
cr _
n
m
n
I,
'J
�p S�._.____S � CT/ c� h c�_!T .. ( - -f-tn �!l.__ �y s"� t!�✓�—
/ a
co�tir
r.
rA
S� sfc �n
L
4"
p c .
e
n,tn
0uJY r ' �e,t� �� e►4c�
L
MlisVons4 Human Relations Department of Industry
L SOIL AND SITE EVALUATION REPORT Page of 3
abor
• oivision of safety a Buildings in accord with is. Adm. Code
2 COUNTY
Attach complete site plan on paper not less than 81/2 es ins_l� s. Pla ude, but ST. c I? or y,
not limited to vertical and horizontal reference point (B ' ectioRp 0 slo or PARCEL I.D. #
dimensioned, north arrow, and location and distance ,`wrest r W I�
Ifs' R EWE B DATE
APPLICANT INFORMATION- PLEASE PRINT L' INFOHM;ATIQN.s,•,;� to
lit
PROPERTY OWNER:
K PROPE eTION _
J M w g HQ E )13 R ock ,� � �L '� tla St - va,s 7 T 2 ,N,R � y E ( w
PROPERTY OWNER':S MAILING ADDRESS c "' ii ` ` ` ' .' LOCK #t SUED. NAME OR CSM #
yo Sa. fob K cipc /E` '* ��� c s.� p�apf� Cam••
CITY, STATE ZIP CODE PHONE NU f9 ❑VILLAGE OWN M-5 EST ROAD
YVPSca G� /• 5yot(o ( '7l5)3K1 -1 - r'Ro froQk �R .
[ New Construction Use [ Residential / Number of bedrooms [ J Addition to existing building
L J Replacement [ J Public or commercial describe
Code derived daily flow mo gpd Recommended design loading rate bed, gpolft • ? trench, gpol(t
Absorption area required F 5 p bed, 9 7 50 trench, ft Maximum design loading rate 7 bed, gpd0 trench, gW.e-
Recommended infiltration surface elevations) S �4 v • 3 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material 5C-5 1 3 Pi / o 7 3,,' . 3v% o'&p ;114& ;f / Flood plain elevation, if applicable A ft
i RA04VA0 Okl
S = Suitable for system CONVENTIONAL MOUND / IN- GROUND PRESSURE I AT-GRADE SY IN FILL I HOLDING TANK
U = Unsuitable for system CC'S` ❑ U C Liu 9-S ❑ U 0-S In ETT ❑ U ❑ S Lfl"
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Toxh
13 4P 0 16V ,11? 2— s,/ 2,w. 6e Q2
A, v-13 /a ,e 2- 311 / - e 95 of I " u
Ground t3 3 - .3 /o W y 3 s/� / J ,�, c�s- _ ` y . .S
elev. .1 yo 7 5' yR '114e s. 0, 5
De thlo
limiting -•
factor &
t
Remarks:
Boring #
y e Yz s,/ 2,�. .e ,,m fl 41. 2 t
C 2 �1 13 V zz- /6VA 7 3 S,/ ,,„ s6K �-6e 05
zc ,2 -1, 7 SyRylepe 56, dt _ — 7 •50
Ground
elev
ys f)ep th to to
limiting
factor,i .
Remarks:
CST Name : — Please Print ROPIER Z(LQ 1' f C f1-[-- Phone: 7 /
S 3�'G - � (pS'
Ad dress: (m s s O' AJ e 0 'RC)- RVDSO cv /• S3 CSrIerZ %PL
Signature: _ Date: CST Number:
1
T,IS to � VW ORI GINAL
for a conventional septic system.
PROPERTY OWNER SOIL DESCRIPTION REPORT Page of 3
PARCEL IA.#
CQ - / c)T
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
Bed
rerxh
V3 i 3 /o %R y3 S/ •/ Z,
Ground S Ye 0, S q - 7
elev.
`IS Depth to i
limiting
factor �� I
Remarks:
Boring # o /o le 2/2-- v ' N
El OZ - iL 10YR L /•z... s ', 2 • f, , c S
Ground
-/,P 16) yR 3/3 f sd,� 4-,, ft?
elev. o f..q /o ye y 6e s — • `� S
G y_ �, S P- Y to S
�G Depth to �o r /
limiting
factor q
Remarks:
Boring #
S i3 /6 ye z s %/ 2 40 f,
3 13 Si% �`ShK fie oq 10' • k • S
Ground
elev. /o ye y1 S /. / 7�s6,� C S i , y . S
.
17 O - J2 7 S y 6 S. a. S �.Q — — •�
Depth to
limiting
factor
Remarks:
Boring #
Li
Ground
elev.
ft
Depth to
limiting
factor
Remarks:
con 60 ACM11%
s - a
' L a r Co
5 CA Lt= :
• = /3gCKl2oE �,•T - s
131q= tleW y 7 o�
y kv oo P
C ��.✓£J� -FE NCE
s 6-6 es T E n pbsi
S y S - rE'�1 I e r oa 5 � T
7
CO
w
0
a
a
CL-
64, 83
/36 �
uo
t3 jr
!G3
c
(P 1
i
2y' 6 2
AM
74'
FoRk
33
/. P ,4 5 w DoT Co
S s
s c A Le : � "— 1 /0
Oil"� = /3,¢C 1 A . TS
Ulbcicht S Associates
private SewaOe Consultants T
655 O'Neil Rd. 13/y v�R / O/ D OF
Hudson, Wis.
4v oOP
f E.uCE \
Pbsi
s
6-6 Es - r v 6' 1EvA- 7
Sys t�� � l EVh Troas � oo•o' v
a o 3
l c� • p �
cc
h
P,O h �� S loes
/f GcUS S T e4--
w
0
c..
a
nc
o..
$3
/3b �
/G3 —
IV '
o AM
70
tv .4 0 7 - lo4°.v&;I'
C L
50. FORK i�D G�"
ST CROIx COUNTY
SEPTfC ;'ANK MAINTENANCE AGREEME?NT
AM)
OWb ERSHIP CE.RTIFICAUON FORM
0 /Buyer
Mailing Address — - .� I � C ►'� bet � W � � D �3 —
Property Address _ 1 f Oar V ico I�oa�► `_ 0 (�_ — -
(Verif3catiou required fron i Planning DoparUnent for new construction)„_ f C —
City /State (iJ M _ o�,b Parcel Identit!'icadon Number _ � D -- a — 50 -0
L EGAL DESCRIPTION
Property Location _$_Uj- 1�4, V,, Sr C. � T ,�� �- �...r�W, Town of
Subdivision - e k ,__ Lot
Certified Survey Map ##� Volume Page #
- -- g
Warranty Reed # S O U
Volume 3D S Page # S
Spec house 0 yes: 19 no Lot litres identifiable El"'Y 0 no
SYSTEM MAMENANCE
Improper use and maintenanceof your sel pc systetn could result in its premature failure to handle wastes. Proper maiuten=
consists of pumping out the septic tank every tbrc a years or sooner, if neddod by a licensed pumper. What you put into the rystem
caa affect the f mcdon of the septic tank as a trey anent stage it tho waste disposal system.
The property owner agrees to submit to Ste Croix Zoning Deputricut a certiftoatium form, signed by the, owner and by a
masterplurnber, joumeymanplttmber, restrictedpt Irnber or a licenarodptu raper verifying that (1) the on -site wastewaterdisposal system
is in proper operating coud.iticm and/or (2) after in: ection kod Pumping (if necessary), the selptie to k is less than 1/3 full of sludge.
Ilwe, th,o undersigned have read dte above requi ei hents and agxao to maintain. the private sewage disposal systern with the standards
set forth.. herein, as set by the Department of Com !tee and the Department of Natural ResouroaA, Stato of Wisconsin. CePtifioation
stating that your septic system has been maintainer I must be completed anti returned to the St. (;m& County Zoning Office within 30
days of the three year expiralion date.
SIGNATUPI OF APPLICANT D ATE
OW NER CERTLU TA ION
I (we) certify that all s.tatoments on this ; irm are true to tho best of my (our) I mowledge. I (we) am (are) the owner(s) of
the pn}perty described above, by virtue of a warm zty deed recorded irk Rtgirtrr of needs Office.
SIGN OF APPLICANT r � 1
DA TE
"4,'." Amy formation that is mis- represented u ay result in the sanitary permit being revoked by the Zoniz,g Department. w"""•
Include with this application: a stamped wan itty deed from the Register of Deeds office
a copy of the G rtified sw vay inap if reference is ttiade sn the warrwty deed
RIVER VALLEY ABSTRACT Fax :715- 386 -7664 Apr 28 '99 131: 3 4 P. 02
J k
15 -TE x' v
♦�'te` i$ rt
Ip
1, 1000MENT NO.
737sa:;o I VOL . 1305Mr;
mn D Wahrenbrock and Clovie K. Mahrenbrook, husbsrd and rile so
ivivarehip marital property, ('rantort oownys end warrants to Reath
FYenoh and Lynn 04 French, husband and wife v survivorship mantel
oparty, Grantee, th0 following desoribsd real estate to pt, oreiR
vnty, State of WisoonslAt a
t 5 Cedar Ridge in the TCAM of Ttoy REGIST 'S OrFit►1r
J7.FAV W1
MAR 1 1998
1 too AU
- +.... -0c
oNSFER
wiia'�io � i�saa
is is not hnew rtaaA pKeporty. 040 - 1224 -50 -0000
ar a C'T3�IZTaa�►�iiF"Ri� — '
aaptioh to Varrantlase
1 easements, restrictions and rights- cf -var of r000rd, if any.
tsd this f day of wareh, 1996.
0S7d') (SUL)
a U. vahzenbroax
.gnature(s) _ -- -- aTATi or KSioplriTN )
so,
CCIJp" )
,thonticated this day of , ls_ Parse" top ae th n day of
/r �r� y lft_i�ar aear�
James ren oa ia alorla s alsrodt
to M known to* be the.peraoq (s) who a =ecnted the
forogO1Ag 1pstr$i00nt %eA d the seals. .
c2tE: rtS►1A£R STATE BAR OF WISCONSIN
[ r not ,
ethorized by §706.06, Wis. atata.! �
119 rK6TRV)4L•NT WAS nawrxea Sr: ootacy' a q is ? >`•� ']g ' if s county, win.
acismissipb��, s —eftr ., set, esp ratieo date•
ao A. seeKnr
Al i, Backer, Bolas i Kruegar, S.C.
Box 130 ' �� �-�� - /Peg
O. t ,�. ••
!ver P6116, WI 54022 !� «,• $�
�• • • r��i�jr1>i
• OpOM.�N 4•
4•a�a�.AW>
I y
D) p0� "�,q M.rNAj
L it — � ' �I ��� :i�i'•tr�p:�
Z �
e%ki . r4W
�.sc.ro.ios �I <<• s�ir
W OOn O
h
n
"���.• .;
.. V• h 1 � Q 141 •• ` •. • f 1 t V
0 \ N.
I h h
' 1 ` • - �� D �r� �-'•' w i N : t .00'0rr Al. $9. 10.00 •
J Q
co 001
w I
ft g - J
I M ! A � q \ • p w S•\ � v f q
N i . � .. �7 �.. •IIi 1.00. ID h O
In •�, ,ss d
-asp
CA
o. Z \ v l
NJ
•� N r; 1� � r 0 ! � bl 1 >t
ly ; * • tv w � \ N • Oi � C I
Q • 1 •
CIO .1�.i11 FBI
w
a " I " � ,•x• /N °I
ZI - 1 .f 1 p0.0111 tl. / N v
It
oz
• ►.lr.fo,r .i N
�� SQ
� N•d Co � �W
O u t o at
W 1 • w N 11 ! " r V w
i w A • •
Y
M•O ►. ►O. /ON A W
W,
09.13 Jdd '£'7011 ''W 'S '0 'l 1 07 w o
4
♦ 1
N ! •
1