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HomeMy WebLinkAbout040-1061-80-000 S � � J-- b �§(k � >0 2 $ S� § §$,> _ CL J 'a z z 5 = @£ 2 c 4) 3 &gym -� / � B � � i k E \ ` 0 Z �2 e § a m § � \ $ Lo / A / : $ A § z f § 7 Cl) � \ k § 7 Q z - .. z 2 2 � 4 £ b ~ 0. C-4 & a / § / E < I ■ ■ ■ E t ] t 2 a a a { � LL J k k ƒ � � �� % i = \ E � § � o m § § % £ < z m ] to \ § % ' (D ) a a ) § §// k r k k r 7 7 2 6\ 2 . 2§ ££ LD / 2 2/ z) 2 A Q\ ■ � k k c 2 c l on A J� 2 o U) 2 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 338831 Permit Holder's Name: ❑ City ❑ Village IN Town of: State Plan ID No.: SIRE, TREVER TROY CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: 6i f lco•a S ;1ct.�• = C-sr - S u If 040 - 1061° -80 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark - ' L 03.6 3 f LTD . o Dosing Aeration Bldg. Sewer [ Holding St /Ht Inlet •'I�� .s�S�t /q�.6�� TANK SETBACK INFORMATION St /Ht Outle �fo• °`� 0� f ° )9�•Og Ve Z TANK TO P/ L WELL BLDG. Air I ntake ROAD Air Septic NA Dosing A Header / Man. _ } I 'f��i t 17. 2 Aeration NA Dist. Pipe r b S.tf Holding Bot. System 63 �, Y PUMP/ SIPHON INFORMATION Final Grade,�e*t� Manufacturer ST.K 3�1 �s a -ZC0.0� Model Number GPM 4if-3 O� S a DH Lift L riction System H Ft & .4 ,r bti. fZ - rZ ` e Length Dia. Fi Dist. To Well �` 2M, 0 r .. SOIL ABSORPTION SYSTEM is •ei" 3°•O' Qi°T THE I Length No. Tr nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 S '� a DIMENSION SETBACK SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEACHING Ma actur INFORMATION Type of CHAMBER Mode Numb System: 5 � OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake r � Length Dia- Leny 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 Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOC TION: TROY 5.28.19 34B,SW,S 324 SOUTH LOVER ROAD z4" w +u �G sea fk. Q.6o�-r"}� tY - (/' ""`' �p ` `� • / 6­11dexW. 6K 0— o t -o q- oo : Att o - oY- oa IZ, f .e." R ra eVislo�'n qu �rt�es No ; ��,• Use other Ide fora additional i for motion_ U sr (— Inspector's Signature Cert No S 7i.3 /9 t4r- S-�A L.4 LL LA144. S atavlcl�tiiil,-� _;tv� JWI4 ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: a x € x .� _.... �.., a a a d y a e s i E E 3 i N F r . a . F _.. x ..e , a � 3 i c t 3_m F c { yy I k� � f M B e, m w € 3 5 mm P�.a .,_ t m,. t ) ' 6 � a a = a s { E 3 € 3 ... E 7 a a v E s E ' _, �. g:.... .�__ _ t ,mom., . t . 3 €,.,. 3 � e 3 e r i i� ` r 1 - i • ^� � Safety and Buildings Division C 671 R SANITARY PERMIT APPLICATION Bureau of Building Water System! 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 - • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. p / • See reverse side for instructions for completing this application state 1 anitary Permit Number 33w 31 The information you provide may be used by other government agency programs eck if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prp . e erty Owner Name ' �ro4e 5#j Zia, S ,6 T `t 1 F, N, R E (or) V0 �;" - Propert Owner's Mailing Address Lot Number Block Number th� t. -- Cit , Slate Zip Code. Phone Number Subdivision Name or CSM Number f/ S (6l )y) 03 ( a 6 II. TYPE ILD NG: (check one) [:I State Owned 1t Nearest R� il age Public 1 or 2 Family Dwelling V - No. of bedrooms own OF �. III BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Nu...ber(s) 1 ❑ Apartment/ Condo 6 9 0 — � 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 New 2 E] Replacement 3_ E] Replacement of 4 E] Reconnection of S ❑ Repair of an -__ System ________ System_____________ Tank Only______________ Existing System ________ Existing System 8) ❑ 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 E] Mound 30 E] Specify Type 41 E] Holding Tank 1 Neepage Trench I S 22 ❑ In- Ground Pressure 42 [] Pit Privy 1 eepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill 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 //l� Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 7 j 7SU h (V rS"D . D Feet ?f-1 ,0a Feet Ca pact VII. TANK in allo s Total # of Prefab. Site g Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank OOa Gil ❑ ❑ ❑ ❑ I ❑ l Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ W11111. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of th nsi sewage system shown on the attached plans. Plu er's Name: (Print) el [L�� PI er's Signature: o Stam } MP MPRSW No.: Business Phone Number: — Plumber' dress (Stree , Cit , Stat , Zi C de): I C LINT / DEPARTMENT USE ONLY ❑ Disapproved S dry Permit Fee (Includes Groundwater D ate Issued Issuing Age tSignature dCIS m )� A / p provecl Surchar Fee) ❑Owner Given Initial 3�t3 f Adverse Determination X. CONDITIONS OF APPROVAL � SONS R D16 R �� GU/��►?t AL SBD-6398 (R. 0"4) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber rNSTR y ' 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 -3815. 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. ll. 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 isto 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. .^ c n v' e� M � w 1 V �y � i r Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page ) of 3 Labor and Human Relations Division of Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow , v and location and distance to nearest road. � 0 - kri10 So APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: e-4 B 13 1Z N k7-- PROPERTY LOCATION $U`-1 L1Z; TZEV S 1 E GOVT. t6fi SW 1/4 1 /4,S Y S T Z$ N,R 19 E (okow PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # tq$ -r14 , 1 - CSw1 Von 6 , P9 � S 6q CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ®TOWN NEAREST ROAD 4 S�h16S, M'1N SSo�3 (612) VIV- 303) _7R-0 4 S. 6LbVk�!jt a )tb [�q New Construction Use j<] Residential/ Number of bedrooms 3 [ J AdditiQn to existing building [ j Replacement [ J Public or commercial describe Code derived daily flow L4 S o gpd \ Recommended design loading rate - bed, gpd/ft `i trench, gpd1ft � r • VQ Absorption area required coo bed, ft - ISO trench, ft Maximum design loading rate S bed, gpd /ft trench, gpd1ft Recommended infiltration surface elevation(s) 1 l 1.0 ' (_�rLL (as referred to site plan benchmark) Additional design / site considerations x'11 h 7URw eta w /� Ctt�th9 S `�TR�1 f{ _ h l►u n�� Parent material _ L o esa 0 Q\�Nt G L PrL - n Flood plain elevation, if applicable Q . A It S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem •EIS El U ( S ❑ U as ❑ U 0 S ❑ U ❑ S 01.1 EIS ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tw& 4i ?}; -L Z 12 -Z� lu s Z �'sbtiz yn-ft- cs S ^6 Ground 3 z 1 2 2,) (o - s► 3 w1 ab Yv►'� �S • S . j ° elev. v - s ft R 2- Depth to 3 Co N N S W1 eO J f 10 `t C� 6 1 TL - g limiting factor 3 S" Remarks: Boring # p _LO t•O`t � 3 l Z — s11 Z'FSb1Z 'w►'Fh �S � S • � • 2 3 �1 -3a tC3`ttZ 3h, S11 3�abh ht�� eS S '� Ground elev. Y _Z -- )_S`J R_ 31Y _ ��fS o� � - • 3 _�/ ft - Depth to limiting factor Remarks: CS T Name.--Please Print Arthur L. We erer Pine 715 425 - 0165 ress: egerer Soil Testing &`Design Service -P.O: Box 74 Rive -r Fa11s,WI 5402:2 Date: c� CST Number: Sgnature: • ` 9 9 -3 Z �' tii2 %y'�nZ 2202 .54 PROPERTY OWNER �LlO1�.lE:, SOIL DESCRIPTION REPORT Page Z. -of 3 PARCEL I.D.# O\4 3_ 10 61- c 8b Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch 3 ) o -lZ tp\ -tVZ-312 - sil - , Fs'ty, M �S - -s •� Z tZ_Z9 lr3 4 IZ3L iv L Ground 3 i9 - - I "s - R 31y �i o � � ` t 3 0 o � >n� i �S - 1.►p • Z elev. ,, ft. y V/y Depth to limiting factor Z9` Remarks: Boring # 1 o -ty l lZ � z � �! ,3y 1, o`t iL 3l L - S J 1 Z. w, s b�k yn - F h cs � • S • 6 Ground 3 3�1 Sb - I • S `t IZ Yl6 S I 1 C S b tic Yn `F � °tq a ft. - 7_ SKfzYI` S S m U 'F►- - , S b Depth to 5 6Z -�S � 31 - S o6t � Sg >n I .� •� limiting factor ?'ZS 7_1 Remarks: Boring # 3 Z6 - yo 10 -1 R WL siJ Z s hh m �h e� •S ? .6 Ground el ev. ft. Ue - � S`jR /(, GH �`FS O Ynv�y eS •�( 5 5 �v -S s ,S�rZ 3l _ S 1 0.,, w►�t- 3 ,. Depth to limiting factor Remarks: Boring # a -ls 1O ti.R aLz - S iI ZE'S tilt w► Z `S_�Iz. tort rz WL s � 1 Z'(�s bh ►� �- cS — - S � (� 3 4Q--S 9 - 1.S HR V& 1`FS � YnV pt� C,S .L . S Ground elev 1 00. . ft. 1 S L l � V/ S C�`M m v ., Li ti3 1y is Depth to limiting factor � ry Remarks: PLOT PLAN Pa of SCALE 1 "= qQj ' 4a °- 9. �N ft TR�N eta I_ �Kel4 �° �iY}'1 p'i2 S t7 $ -En. l0 u . p o o S1�lh.EE i S N G 1Zclu )A) S h 5� 6' - r!� - I• l 3 ' T I �. S O 1 =Lh/ C L-_ �R�iP 1i`M w N I Cclhl S'nZ -u �►,l 5 1� d 3 - -` 9 " �� flLl lllp c°0 r a jl I ljvU SP�k -C xS "OVk v1�uVtiW /AV g9,az rfcj (715 ) 425-0 -- 14 00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations INWrion of Safety & Buildings in accord with ILHR 83.05, this. Adm. Code - COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O q 0 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: Tit e-`'f 'S 1313 N V-` PROPERTY LOCATION BU`-t L1Z : - TIZFV S \ `2 E t: 1/4 SW 1/4,S N S T Z$ ,N,R I I E (oO PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # tz��t0 tab T14 . 1 - C.Sy V DL 6 , S 69 CITY, STATE ZIP CODE PHONE NUMBER []CfTY []VILLAGE ®TOWN NEAREST ROAD l S�><tGS, M'tN SSo�3 (b12.) Vty -3r,3} `` S.Gtuv (tz)j%b [>c] New Construction Use (x ] Residential / Number of bedrooms 3 [ ] AdditiQn to existing building ] Replacement (] Public or commercial describe Code derived daily flow L4 S o gpd Recommended design loading rate — bed, gpd/ft ' `/ trench, gpdtl? rcl , 2 So trench, ti Mldmm design Absorption area required a to bed, ft 2 au bading rate • S bed, gpd /ft • 6 trench, gpd/ft Recommended infiltration surface elevation(s) °l1.0 LPrLL'RL&jCTMS (as referred to site plan benchmark) Additional design / site considerations \ iJ 'T2kNJ et n w /LGgcN compw \- A'I h ou h2x Parent material L o ass o Q'z G t✓rKet f11 1 Flood plain elevation, if applicable Q . A It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE I AT GRADE SYSTEM IN Flll HOLDING TANK U = Unsuitable fors stem aS ❑ U RS ❑ U I I&S ❑ U VI S ❑ U ❑ S RU [I ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxfaly Roots GPD /ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed ranch L ; Ground 3 - Z ) 1 S l0 ` f 2 21(0 - st) 3 rrt a b Yvr i, - elev. s ' � �( S � y 7. `t 31 7 S 1 Sei Depth to 3 Co N N S M'1 L( tp `� ti (= 1 s l - g limiting factor 3S Remarks: Boring # nn __ 1 l 0 `t rL 3 l L — So Z __Ts vvc'� ' L- - Z Z to -t'7. c0 ti fZ- �l'13 Si 1 z� sbk ►�.`A- GS � . s ' . � Ground elev. Y _Z - )- s Lr iz 3 1 Y - l F� ow, wlv - • 3 ' �/ SOS. ft 3 s E ti o rE7 Depth to limiting factor Remarks: TName:— Please Print Arthur L. We erer Pine 715- 425 -0165 egerer Soil Testing & Design Service- Box 74 River:Falls,WI 5402:2 ' '� // 9 9 -3 Z Date: Z : Z S -el C) CST S rum F": " nature: L, �� . 'L • ���L -gym 22 PROPERTY OWNER 0qy i p , SOIL DESCRIPTION REPORT Page?. of- i PARCELW.# C)\40 l0 bl- %t) Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consrstenoe Roots Bed Trend 3 ) n -lZ t0 -t 31Z -- Sil Z�s�1t m'�1- cS _S .� Z 1Z -29 10 `-t 2 3 L f Ground 3 19-S) - i's `-t R 3 1 �i o `1 t 3 C o )n� j i.►P • 2 elev. wy,l ft. 4 St -)f3 - 1 -3 1 ­Y R Vly pw, tvi u 'P►. _ . q . S limiting p h to S ND 1� ft'T` pJ factor - Lq Remarks: Boring # s i I Z �s w► `Fi- r°S — s ,b yn.�F►- �s • s ' � Ground 3 3U Sb - I 'S `t IZ Yl6 S 1 C S b 1t m Ic - c S • ` _ . S l� ef2v, so -6 -�_ S V RYl6 m v •Ft- cs — , S ?• b aq' -o ft. Dep 5 (;Z "?S•S 3! — S ��!- t, Sg P -� •8 limiting factor Remarks: Boring # o-lZ l�` -L�2 t Z g l Z �' S �1t ►� Fr �S — . S _ S Z� s bh � •f �- �S • s , l 3 Z6 -(/o m \-I ft W L Ground S t l Z m S hh Yvt'�y �S • S 6 elev. ` Z�R Z ft. Ud -30 �• $�t R Y /L Gr• �`FS ow, `n!U`fj. •�( ,5 Depth to S >�v - s .S L fz 3 / _ s 1 C) "- limiting ' factor Remarks: Boring # • ) a -1S l O H. t2- 3 � Z - s � � Z �'S b1 w► `FH �S 1 , g � . � \.S - \4z. 1 Z 1t. ri 311, — s t 1 ZE bh ►n Fi-- es — • S �� Ground 3 4Z S9 S `IR S( /(, I Oo 3 ft. �l� •sue tt3 IK is Depth to limiting factor Remarks: PLOT PLAN Page of SCALE 1 "= qCJ ' X3.4 W641 0,"INC -M Sxb*- J1Nokes l del+ �° �} 11'1.1 S trt2S rr �� $�'?►�l -Ea. l0 u . ri o n) r H _ @ � 1 S � rS80 c+ C � N s�11zc S' G 17 dU1✓1� J,,1 ^^ �N • yo s te*_ Pow2Q PoU�c . 6' CL 9 a ? js 6 � • � � � - r J� 1 LOv Ce - - CZ Wri �VCRZ•lFM 6l�co�k( -; �`�.'.' i �\ � r° M3P F]"11�.1T C.dtiJ Sl'R-" t� u s \ ` 69/ J\ , n o ,�uoS eawtatr 2 OR a jl �ti`R�tNRT� t�"v S { t SoU`�1 OF S`tsT"-j pv" zjz� _ i 106.0' c) ?j LS " OW V 1� -UVtvD /�.t gq, �� - -I -rtc) (71 5 ) 425_ -n1 65 14 00576 CST Signature Date Signed Telephone No. CST # f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 1Z�la t h s l ��'LS i(`tti�l SSc�33 3 � �- Property Address XY% X Q, Q 1 rl�fe�iZ (Verification required from Planning Department for new construction) City /State W6---, l.y�sc. Parcel Identification Number LEGAL DESCRIPTION ze - Property Location ' /a, c 1Q ' /a, Sec. VS , T �N -RA9,W, Town of Subdivision , Lot # � . Certified Survey Map # tADA 555 , Volume Page # ��lo Warranty Deed # /" T7/ -the A, ( c)CXQ l 2 Z. . Volume Page # S Spec house ❑ yes 0 no Lot lines identifiable 0 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, restrictedplumber 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 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 props // ed above, by virtue of a warranty deed recorded in Register of Deeds Office. L c� �� /iq SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VOL 1413PACE541 X0 0122 STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI This Deed, made between Tracv Boone, a single person, RECEIVED FOR RECORD Grantor, and Trever P. Sire a single person, 03-25-1999 2:45 Ph , Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee NARRANTY DEED described real estate in St. Croix County, State of Wisconsin The EXEMPT N the following ty� ( CERT COPY FEE: "Property "): COPY FEE: TRANSFER FEE: 174.00 RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address `2� 4 - Z T� tc v o o S a. <t J - 7 040- 1061 -80 Parcel Identification Number (PIN) This is not homestead property. Lot 1 of Certified Survey Map filed August 22, 1985, in Volume 6, of Certified Survey Maps, page 1569, as Document No. 404555, located in part of the SW 1/4 of SW1 /4 and the NW1 /4 of SW1 /4 of Section 15, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of March, 1999. * * racy Boone * * AUTHENTICATION ACKNOWLEDGMENT _ Signature(s) Tracy Boone a single person, STATE OF WISCONSIN ) ss. authenticated this7 of March, 1999. County ) Personally came before me this day of the above named *Kristina Ogland to me known to be the person(s) who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN instrument and acknowledge the same. (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney ristina O land Notary Public, State of Wisconsin y g Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 -1998 INFORMATION PROFESSIONALS COMPANY FOND D' n 4015 5 ti CERTIFIED SURVEY MAP a 7, RICHARD 0. ENLOE W 114 COR. Part of the Southwest 1/4 of the Southwest 1/4 and the Northwest 1/4 sfc.15,r2eN, of the Southwest 1/4 of Section 15, Township 28 North, Range 19 West, R/9 W ,rcouNrY • Town of Troy, St. Croix County, Wisconsin. SURVEYOR'S MON.) N • Indicates 1 iron pipe found. o Indicates 1" x 24" iron pipe weighing 1.13 lbs. /lin. ft. set. I � I 3� y / W M _` 4j 2.8e3 ACRES J O `% V' •�........•. l�y Q 2 125,563 SO.Fr. tu •• 4 W * NET ° 2.389 ACRES y ; ;' LAURENCE'; 3 104,078 SO. Fr. 3 y i h -m W RPH 0 rl ��. "\ Q — S 71 R1 ALLS ° D to ''•,F� LAN SV`,•`� _ \ Seuma% U 2 Z °\ Laurence W. Murphy m m Registered Land Surveyor " J y APPROVED h1 V Q O N � q PLAN MN(; h 6 " \ ? ��� 2 0 00 � 48 1 �I N 4 ' 0 0 20 \ E 96. AUG 1 9 19 v 3 63 .A •4 8 Y1 53 3 100, % I n 5 563 I A t E% 6' 12 St CROtX COUNTY RI Ni US 3 e \ S 2 SCALE / " ° 2OO' �011rF BARPAWS NING / y' 00- O 50' /00' 200' AM 206 �� �I 01 62 4 6 g v o 2 1 3 .4 8 . 4 I 1 2 46 ' 8 0 6 5 W 96 q2 , * 5 �,8 4 � 11? q0 6.1200 02 2 5 ''E 0 ' 1 .1 002 1 58 383 2 A li ,; Z 52 26 .12 E l oos . d) 0,0! /0S 1 ' 6 \a R . 8 v1 2 00• A 2 % 1 ' \ '0 3 63 4 3.0 \ �.+► 3 \ \� R 1 16 2 00 1 1 4 o q . Dated: 10 June 1985 ,59 ,9 ,2 00' ,'E 2 01.15 p0 " N r 526 8I6 6 .12 .k 116 2 08' z m\ \a PIS 2 N 63 3 . 48E LO 2 0\ 3 7.425 ACRES p y 0 323,435 SO. FT. N R0 p 4+ O NET = 6.95e ACRES rO� V N �* 6 O 303, OB 4 SO. Fr. 6 y , S 114 COR. SEC. 15, r28N, R 19W, 696. 17' (COUNTY SURVEYOR'S MON.) 36./7' \ 660.00' S87'58'/7 "W S LINE SW 114 SW COR. SEC. 15, T28N, R /9W, UN L ICOUNTYSURVEYOR'S MONd Vol. 6 Page 156 Certified Survey Maps St. Croix County, Wisconsin SHEET / 0F2 CERTIFIED SURVEY MAP RICHARD 0. ENLOE Part of the Southwest 1/4 of the Southwest 1/4 and the Northwest 1/4 of the South- west 1/4 of Section 15, T 28 N, R 19 W, Town of Troy, St. Croix County, Wisconsin. C!lRVE DATA CURVE CHORD BEAR. CHORD ARC RAD /US CENTRAL ANGLE /S7 TAN. BEAR. 2ND TAN. BEAR. $20 "E 146.60' 146.86' 700.04' 12'01'13" S14'/0'47 "E 526•/2'00 "E 3 -4 N24 '25'55"W 43.23' 45.24' 733.04' 03032'/0 N26 "W V22* 39'50"W Description: That certain parcel of land located in the Southwest 1/4 of the Southwest 1/4 and the Northwest 1/4 of the Southwest 1/4 of Section 15, 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 Sec�ion 15, the POINT OF BEGINNING, of the parcel to be herein described; thence N O1 10'35 "W (assumed bearing on the West line of the Southwest 1/4 of said Section 15) (recorded as North) a distance of 1537.81'; thence Southeasterly on the centerline of a Town Road, on a curve concave to the East, having a radius of 700.04', whose chord bears S 20 ° 11'23.5 "E 146.60'; thence S 26 ° 12'00 " 44'00 "W 207. 3 53 E 550.66'; thence S 6 ° ' (recorded as S 63 208.00'); thence S 26 ° 10'02 "E 157.84' (recorded as S 26 158.00'); thence N 63 0 46'40 "E 207.62' (recorded as N 63 208.00') to the centerline of a Town Road; thence S 26 ° 12'00 "E 96.48' on said centerline; thence leaving said centerline S 63 ° 52'52 "W 208.02' (recorded as S 63 208.00 tF;ence S 26 0 16'59 "E 200.22' (recorded as S 26 200.00 thence N 63 ° 49 '16 "E 207.73' (recorded as N 63 208.00 to the centerline of a Town Road; thence S 26 ° 1200 "E on said centerline 27.59' to the South line of the Southwest 1/4 of said Section 15; thence S 87 58 696 .17 on said South line to the POINT OF BEGINNING, containing 10.308 acres, being subject to easement over the Easterly 33.00' of said parcel for Town Road purposes as now laid and traveled and also being subject to easements of record. State of Wisconsin) County of St. Croix) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of ttie Owner, Richard 0. Enloe, I have surveyed and divided the above described lands according to official records, Chapter 236 of the Wisconsin Statutes and the Ordinances of St. Croix County; and that the above map and description are a true and correct representation thereof. ,`,% %J1 `y O NSA 4i,� ��Ep AP %. •i LAURENCE t Dated: 10 June 1985 S 1 W MU P AUG 1 `� X985 - S NJ► s RIVI LLS, • ' SS. GRO►X . WI C. Q. Cp�«+1Y r"Wo �, LAN © �•` j Laurence W. Murphy Registered Land Surveyor Vol. 6 Page 156 Certified Survey Maps St. Croix County, Wisconsin SHEET 2 OF2