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HomeMy WebLinkAbout040-1260-30-000 F ST. CROIX COUNTY ZONING DEPARTMENT i � 19 AS BUILT SANITARY REPORT Owner R I .A-1CLA =� t Property Addre s 3 U` 0 - City /State l �� sT CPOlx \ lF cou%Ty =. ' �FACE Legal Description: .5 ,� •'' Lot_ Block — Subdivision/CSM # 1 1kl E' /a LR '/4, Sec , TAN -R C LW, Town of r PIN # 0 O -O ° c7 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer W ese rs Size ST/PC (OD!)/_ Setback from: House /4 Well T MA P/L Pump manufacturer Model Alarm location (HOLDING TANKS O Setbacks: Service road t to fresh air intak Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: T 5 Width - Length Number of Trenches o2 Setback from: House l(. Well PT ZO ' Vent to fresh air intake ELEVATIONS � Description of benchmark CJJ f Elevation — Description of alternate benchmark Elevation /0 6 Building Sewer �� ST/HT Inlet . -ST Outlet D PC Inlet c�,oS PC Bottom T Header/Manifold Top of ST/PC Manhole Cover Distribution Lines (2) 9 �O Bottom of System (1 ) '? S ' l ? Final Grade (�) �� (A4 ( ) Date of installation /L/ 0DPer number 3 53a tD , State plan number Plumber's signature Li ense number �o1a- 7 Date l I1/ o a Inspector ..^-' Complete plot plan � l l f f 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 plicable. N PL VIEW i 7 - o IV CQ e INDICATE NORTH ARROW }yis*,n "*Department of Commerce PRIVATE SEWAGE SYSTEM County: Sa eiy and Buildings Division INSPECTION REPORT St. Cro ix 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)]. 353200 Permit Holder's Name: []City ❑ Village ['Town of: State Plan ID No.: Town of Tro E ev.:- Insp. BM El 7v.: BM Description: Parcel Tax No.: (031D•r)` f City Sea ndin TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �� alf, Benchmark aD a Dosing Alt. BM :aa B on Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet Air Septic r NA Dt Bottom Dosing NA Header / M . Aeration NA Dist. Pip • oa _ o ' Holding Bot. Syste . ZZ S 051 PUMP/ SIPHON INFORMATION Final Grade 6. /o g,z3 Manufacturer Demand cove Z v 9 Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H Dist. To Well SOIL ABS PTION SYSTEM ct ,t,is G SW f TRENCH , ) Width [ Length. // t No. f nches PIT No. Of Pits Inside Dia. Liquid Depth DIM N 3 (O DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/ STREAM LEACHING Manu acturer: SETBACK CHAMBER INFORMATION Typeo mod Number: System: > /r 3 � OR UNIT DISTRIBUTION SYSTEM Header/ ifold f� Distribution Pipe(s) x Hole Size x Hoe Spacing Vent To Air Intake Length I Dia. � Length Dia. Spacing SQ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over 7Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / 1/ ! oOInspection #2: / Location: 392 Deer Valley Drive, Hudson, WI (NEIA, NEIA Section 18 T28N -R19W) - 18.28.19. 1.) Alt BM Description= Wl#f 2.) Bldg sewer length= � - amount of cover Plan revision required? ❑ Yes 9 No ' `� &0 z 6 Use other side for additional information. R: R SBD -6710 (R.3I97) Date Inspector's Signature Cert No. ., Safety and Buildings Division SANITARY PERMIT AP ATION 201 W. Washington Avenue isconsin P O Box 7302 Department of Commerce In accord with Comm 93.05,4 ladm2tode Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the s�, on gapeirlot less County than 8 vi x 11 inches in size. • See reverse side for instructions for completing this app tt itation F R ,. State Sanitary Permit Numb !, 35 Ze Personal information you provide may be used for secondary purposes heck if revisi to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALLfNF i fA" N Prope Owner Name Property Locatioai �/ % r S NI 114 , r VA, S� O T � N R�C r W Property Owner's Mailing Address Lott4umbet' Block Number 9 r 3 City, State Zip Code Phone Number Subdivision Name or CS umber II. TYPE OF BU ILDING: (check one) ❑ State Owned 't Nearest Road Vill Public 1 or 2 Family Dwelling ❑ age OF No. of bedrooms 3 Town OF r III BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo — —1 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. ❑ Replacement of 4 E] Reconnection of 5. C] Repair of an - ___System System Tank Only Existing System Existing System B) W A Sanitary Permit was previously issued. Permit Number 353210 Date Issued f I- 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 ❑ Pit Privy 13 ❑ Seepage Pit , ZS 43 E] Vault Privy 14 E] System -In -Fill oZ - 3 X 6 , ¢y e 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. .) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) © Elevation S 0 S /3 ( Feet ��' Feet Capacit VII. TANK Ca in gallo Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existing structed T iks Tanks Septic Tank orMQ44iwg-*ank-- x 6Z3'U �, rS El 1:1 1:1 E] 1:1 Lift Pump Tank /Siphon Chamber ❑ ❑ I ❑ ❑ I ❑ 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 er's Signa ure. (No Stamps) r MPRSW No.: Business Phone Number: rs ( fit 3 _7 al[/( S'l Plumb is Address (Street, City, State, Zi ode): 1 5��. .Q %'e IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Agent Signature (No Stamps) PApproved E] Owner Owner Given Initial % Surcharge Fee) Adverse Determination Jr�. � /r :7—oo X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber LOS' � 3 5 ?e- M N fift`rc>>^s y aaos3? x- l6 ,�- L3 o _()NiNGCPFIC l� Wis; nsin,Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page j— of 3 Bureau oflntegrated Services in accordance witFj 4LHR 8:1.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inche in size. Plan must County include, but not limited to: vertical and horizontal reference poi r (BM), direction,'eind ST G /`O percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # D qQ - 10 70 -t D APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1),(m)). Property Owner Property Location Govt. Lot N51 1/4 &)C1/4,S I& T ,N,R 1 5Ir) W Property Owner's Mailing Address Lot # Biock# Subd. Name or CSM# 7 s 1;3 ph 1 ae,2 UCAC City State Zip Code Phone Number Nearest Road ❑ City ❑Village X Town 0QCL rVr New Construction Use: WResidential / Number of bedrooms Addition to existing building Replacement �� �,� El Public or commercial - Describe: t� Code derived daily flow T- 0 t _ gpd Recommended design loading rate bed, gpd /f trench, gpd /ft Absorption area required — " 3 bed, ft S63 trench, ft Maximum design loading rate 1 bed, gpd /ft i? trench, gpd /ft Recommended infiltration surface elevation(s) 9 +j Ql ft (as referred to site plan benchmark) Additional design /site considerations Parent material () �A_l Q3 Qs q_ (N Flood plain elevation, if applicable pI ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 00 S ❑ U 91 S ❑ U [A S ❑ U I Q(S ❑ U ❑ S J91 U EIS JJ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench o :t ►� k L Z a ) 5 6 51 1 3k LAD c2 S Ground elev. ft D� 6 S 05 Depth to limiting S' factor ,>%in. Remarks: Boring # r N Ce m M5r C'Z -11 , 5 q , Ground elev. Depth to limiting factor 50in. Remarks: CST Name (Please t) Signat Telephone No. Address ` Date CST Number r � O 5 -qO PROPERTY OWNER h S,,Y% SOIL DESCRIPTION REPORT Page ,of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GepIft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench sW rn+v L f S , 6 jol r Ground elev. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. S2. Sh. Bed ,Trench Boring # i3 Ground elev. ft. Depth to limiting factor in. Remarks: Boring # .......................... Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) S o [ Cge S Ja �'► 3 - 3 I ��c � �rd m 4 �•- �' Uca _ o2 fd� Ca ws Ro� I F- A ) E 11 Sec ,97o - )9 L43 f06 Y o� F - Lot 13 a D I' r � m a Y� 1 wj a) m 0 C3 o � � T W A, C) go 3 r Q I�d�tJ (D H ° �-, 1 ° 0 - 0 0 0 —0 ct)� y N g • L � m co co N o O m � 20 C a w �p T3 co C (D , , d X S ? (D �- (D O• ID X 0 N C or co c p m O N (D C `< O (D co O n 0 � 3 2 `D v suL- wr. o�ca�D p N ' 0 7� v o co Ln. CO CL ( j •A ::r Q ( ¢ a v 3 m o ��— c CD °= n a cn o 3 zw`w W ° ° P� — Invert 11 — m • cD s OQ V1 �• 7 Q/ 9)\ 1 ;, - % Safety and Buildings Division SANITARY PERMIT APP TI J! ' 201 W. Washin Avenue �scons�n P o Box 7302 Department of Commerce In accord with Comm 83.05, Wis. dm. Code 1'* !Tq \lo a Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, cl 1 paper not legs, -, than 8 1/2 x 11 inches in size. Y. ;. • See reverse side for instructions for completing this application ST to San it` ermit Number ,'��' 'ZOO Personal information you provide may be used for secondary purposes 11 C f r ision to previous application [Privacy Law, s. 15.04 (1) (m)]. - I.D. Number S,�PPU ATION INFORMATI N - PLEASE PRINT ALL INF RMATI wrier Name �C 1 Pro ert Location E'C- t._. R1 C. rh ` l £ 1/4 E' 1/4, 5 g T g , N, R E, W Ptpperty 0mm r's l�lddress 6 Lot Number Block Number C r'�a pllp l� Ci ^/ V . pp ,t Zip Code Phone Number Subd Sion Name or CSM Nu ber 11. TYPE F BUILDING. (check one) ❑ State Owned !tr Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 O V own of I cou -Q III BUILDIN USE: (if building type is public, check all that apply) arceI Tax Numbers) 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. [ (New 2 E] Replacement 3_ ❑ Replacement of 4 E] Reconnection of 5_ [] Repair of an SystemSystemTank Only Existing S stem E -------- ---- -- -- - --- - -------------- 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 E] In-Ground Pressure 42 C] Pit Privy 13 Seepage Pit , 43 C] Vault Privy 14 ❑System -In -Fill �C g VI. A SY STEM ORMATION: 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) Q EI vati ` Feet /MlY Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Ta I bO U Q/„$ 0 ❑ ❑ ❑ ❑ ❑ LI Pump Tank /Siphon Chamber El ❑ El 11 El El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Si a (N Stamp MP /MPRSW No.: Business Phone Number: as O 5 3 - 7 Plumber's Ad dress (Street ,Zip lode): � Or IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa�titary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Ip Approved ❑ Owner Given Initial e�l� Surcharge fee) c Adverse Determination �� l� t —�� 140AA, ,V,� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Ffiftx4Zrl� SBD -8398 (R. 4/99) 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'pufnped by a licensed pumper wbehd '- 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; 609-266 -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. tor4we 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, 1`06tion 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 SU9CI ARGE 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. tF�rc�Say. 5 Y ° `� F a m N SSI ..' C 1 ` 0 l eer> O �r A el L,,, L ofi 13 pr y Y � �D 3 X" 5 � �o a G kl-ez� -4 ,� d,4 ?02J Wisconsin -Department of Industry SOIL AND SITE EVALUATION REPORT Page I of :3 Labor and Human Relations Diysion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direct' and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to r gf r " 040- 1070 -10 .- - I `, REVIEWED BY DATE APPLICANT INFORMATION- PLEASE PRIN FORMATION l ve PROPERTY OWNER: 1v ! r!'f(� � PROPERTY LOCATION Derr' `I GOVT, OT NE 1/4 NE 1 /4,S T N,R 19 I(or) W PROPERTY OWNER':S MAILING ADDRESS J uf ` a q LOT # BLOCK # SUBD. NAME OR CSM # 1505 Hyy #65 '' na Deer Valle CITY, STATE ZIP CODE P E NUMB -, []Gl7 VILLAGE E]fOWN NEAREST ROAD New Richmond, WI. 54017 11$)2 u+ iE Troy E...:Cove.Rd ( New Construction Use [ Residential / Numbef odt�4r4o'T � ' � [ ] Addition to existing building ] Replacement [ ] Public or commercial descc Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) A= 97.50 -B =95.90 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material Outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U ®S ❑ U ®S C] U Ca S El U [2 S ❑ U El CRU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tre & °> 1 -23 10 r 2/2 none 1 2msbk mfr Cfw 2f .5 ( .6 2 23 -41 10 r 4/4 none sil 2csbk mfr QW 2f .5 .6 Ground 3 1 -96 7.5 r 4/4 non Cos osa ml na na .7 1 .8 elev. 10 ft. Depth to limiting g factor +96 Remarks: Boring # 1 -16 10 r 2/2 none 1 2msbk mfr w 2f .5 .6 2 2 16 -29 10 r 4/4 none sil 2csbk mfr qW 2f .5:: .6 Ground 3 9 -96 7.5 r 4/4 none Cos osa ml na na .7 � .8 elev. 10 ft. Depth to ' limiting factor +96 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 246 - 6200 Address: 1554 200th. Mo. New Richm nd 5 017 Signature: Date: 6 -4 -99 CST Number: m02298 PROPERTYOWNER Derrick Constructio SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # 040 - 1070 -10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed jTrench 3 - mfr f .5 .6 2 15 -29 10 r 4/ none sil 2csbk mfr qw 2f .5 .6 Ground 3 29 ` na na .7 .8 elev. 9 9.9 ft. Depth to limiting factor + 84 11 Remarks: Boring # 1 0 -17 10yr 3 3 none 1 2msbk mfr qw 2c .5 .6 2 17 -29 10 r 4/4 none sil lcsbk mfr g w lm .2 .3 Ground 3 29 -84 7.5 r 4/4 none cos osq ml na na .7 .8 elev. — Depth to limiting factor +R4 Remarks: Boring # 1 0 -10 10 r 3/3 none 1 2msbk mfr gw 2c .5 .6 2 10 -15 10 r 4/4 none is osg mfr gw lm .7 .8 Ground — ml na na .7 .8 elev. 9 9.2 ft. Depth to limiting factor +84 Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) A i STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 NE4NE4 S18- T28N -R19w New Richmond, WI 54017 MPRSW -3254 town of Troy (715) 246 -6200 lot #13 -Deer Valley This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown P � as permanent lot lines were not established at the time the test was conducted. 111 - ; = nail in pine tree @ el. 100.00' t. BM.= top of 1" pvc pipe @ el. 97.90 Qs 1 . 3 + - 3 S t z 7- q Gary L. Steel 6 -4 -99 I m t6 n A N k44 \p = G5 Z C3 C3 _0 cr M r � o r (D ■ s 4 — o ,� o w 3 co U J (D a z® � 01 $= w N v N O 3 N $ a Y � c cn �, r r- o m w m a1 oco c CD =r JCDL S K 9r = a -om -, o m cn o o -� o 2 co U �U� C r p N O p 7 to m o co CO Go 1\ Co C ID j� x 3 C D g 9 3 � 0 ` W CD w w C o_ _ �— Invert 11'—� J ;, I N r pq,� } 0 D a V) � f- �' P ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Tacit, �' e, OMA " V-tc vi P.-a. C, S" %Tµ 2c�r. &.O v;c 12o b-0 1 "1 S Dtza k-e Mailing Address " 4S c N, Ord t 540 lK. N� rw ►� S s i 7-7.- Property Address �q Z � cEll— �At,L OI�'►v c (Verification required from Planning Department for new construction) City /State J - *, Parcel Identification Number O doe - lo'I I - 10 - oo LEGAL DESCRIPTION Property Location %a, �c ' / Sec. . T 14 N -R �� W, Town of Subdivision Lot # . Certified Survey Map # . Volume . Page # Warranty Deed # ZS9 1 'S 4 , Volume � . Page # (0 t Spec house ❑ yesXno Lot lines identifiable / Kyes ❑ 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 plomber, 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. I/we, 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 ee ye ti date. NA PLICANT 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 roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. to /20/ o q c l 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 RARRANTY DF.F.D (Farmer Stntutury Form). STATE OF NYISC6NS1N Mil ier -Dnviv Co., Minmat +,I �.;, Aanu. Form No. 9 W. 259154 M4is fnbentitre, .Made by Archie J. Waxon and Lois Waxon, his wife, grantors , of St. Croix County, TYisconsin, hereby convey and warrant to' Jack J. Erdman and June M. Erdman, husband and wife as ,joint tenants trantee,S , of St. Croix County, TVisconsin. for the suns of One dollar and other good and valuable consideration the follozrin.s tract of land in St, Croix County, State of Wisconsin Northeast quarter of Section Eighteen (18), Township Twenty -eight (28) North, Range Nineteen (19) West, (NEJ 18- 28 -19). i r n g w i REGI %TeRS OFFICE S T. CROIX CO.. WIS. kec'd f(x Recor -t it: 17th (!ey of- _.Aui�ust �.;:. , � 59 at_ 9 :00. ArM. i).3iiid Hope 7z, Deputy In Witnras U114errof, The soul S ltaVeltrrrrurtn .ert the it h i Sqo' 1.1 th l -,r „j Aul;ust 1. I). 1' 59 SIGNED AND SEALED IN PRESENCE OF lIugh F. twin i j Luis Waxon Harold 'Nalbrandt - i i *fate of Wisronsin, St. Croix ('orrntrt I'crsonarlhr rurnr lr jurr mr, thiti 1Jth Arty Of August .4. 1). 19 59 tier orb -,tc n,rnrrd Archie J. Waxon and Lois Waxon, his wife, to nrc A•nrrrrrr ter lrr thr Irrrson if Ito c.rrcntrrl 11w jore�oin insirnment (Ind ueknotc•lal e thr nmrrr. Hugh J l j Yotary Public. - -fit- �II�X— -- -- - -- - -- County, 11"i, try commission expires Sept. 1 2 ----- - - - - -- 1. 1). ! 1 60 "7 ypewrite Name under each Siqnature ,L Pao 360 r, "631 r DEER VALLEY Located in the NE1 /4 of the NE1 /4, Part of the SE1 /4 of the NE1 /4,.Part of the SW1 /4 of the NE1 /4, and part of the NW1 /4 of the NE of Section 18, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN LOT 12 2.3 Acres LOT 11 2.7 Acres LOT 13 dl 4.8 Acres Q 2 J LOT 10 pul 2.7 Acres LOT 14 3.2 Acres tL LOT 9 3.3 Acres Z LOT 15 UNPLATTED LANDS LOT .3 Acores LOT 8 a Acres 3.4 Acres W J z LOT 17 2.4 Acres LOT 18 LOT 23 LOT 7 2.6 4.7 Acres LOT 28 2.5 Acres Aces LOT 22 2.9 Acres 2.7 LOT 29 Acres LL 6.8 Acres LOT LOT 6 � LOT 19 2.4 2.7 Acres 0 2.3 Acres Acres LOT LOT 24 Z 3.4 Acres 3.4 3 Acres LOT 5 0 2.7 Acres U LOT 4 4.8 Acres LOT 25 2.3 Acres LOT 3 LOT 2 3.7 Acres 2.8 Acres LOT 26 3.3 Acres LOT 27 2.7 Acres LOT 1 2.3 Acres Existing House East Cove Road Oct, ?,O 99 1O:13a S.O.S Players 715 - 386 -7447 p.5 N►-" MCOO N m� -4 co X $ md� s' z mom ' m = w- ;D". 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