The URL can be used to link to this page

Home My WebLink About040-1245-40-000 i C i •. • r x ST. CROIX COUNTY ZONING DI TM E AS BUILT SANITARY REVORT " °��, �► r /,,�; � t Owner - f - d �' ln� at, sr,..� � Property Address .2 ry Tnot7At Cr `. +� City /State h��clsa S a/ v� Legal Description: / �� t Lot � Block Subdivision/CSM # T � .��n -. � 4 t /a, Sec. 2, TAN -R - M, Town of PIN # G SOU SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer flue Size ST/PC 0 — ` /�J Setback from: House 30 Well ZC2 P/L Z Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM L f Type of system: Width 33 Length Number of Trenches Setback from: House Well 70 P/L Cd Vent to fresh air intake 5� ELEVATIONS Description of benchmark &A, o-� 6w,,, e,0 Elevation 6 Description of alternate benchmark -5" f Ihg,Xa a Go v' Elevation ldL'/- Building Sewer / �° �� ST/HT Inlet ST Outlet 3 PC Inlet PC Bottom Header/Manifold 7- y Top of ST/PC Manhole Cover / 9Y Distribution Lines Bottom of System Final Grade () g () ( ) Date of installation S_ Permit number 3-2- ` V Y State plan number Plumber's signature License number L/ Date F Inspector f �t — Complete plot plan NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW i I INDICATE NORTH ARROW /iW c ack S� 39 ti S� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division bT . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) San itanfNj�r$iD.: Personal information you provice may be used for secondary purposes [Privacy , s.15.04 (1)(m)). Permit Holder's Name: T RIK7 Village Town of: State Plan ID No.: KOOTENIA HOMES CST BM Elev.: Insp. BM Elev.: BM Description: Parcel b�:1245- 40-000 t. Iwo 6& A� 5row, TANK INFORMATION ELEVATION DATA A9900003 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (,J B 75 107. l0 6 Dosing 9 16 rn Aeration Bldg. Sewer Holding t/ Inlet TANK SETBACK INFORMATION (g Outlet TANK TO P/ L WELL BLDG. Vent Ito Air Intake ROAD Dt Inlet Septic NA Dt Bottom Dosing VA Header / Man. 'IS - 7 Aeration NA Dist. Pipe g,9 7 Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer De ? (�. Model Number GPM �� le- 4•5 TDH I Li Friction System TDH Ft Loss Forcema a. Fi Dist. To Well SOIL ABSORPTION SYSTEM B THEN Width Length .lic No. O�enches PIT No. Of Pits Inside Dia. Liquid Depth O DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREAM ACHIN Man f c _.- Z. SETBACK MBER Lq INFORMATION Type / / el N m er: Sys lm -0 6 70 OR UN A It c S DISTRIBUTION SYSTEM PF Header /Mani old + f Distribution Pipes) r x Hole Size x Hole Spacing Vent To Air Intake f ,! Length � Dia. Length �� 3`T Spacing �O �! /� / E(,�, 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.) 10 '7 • SL If •C/o LOCATION: TROY 24.28.20 254 TROON COURT - TROY VILLAGE LOT 14 q . A 1 db _104 NWzI J k z� Plan revision required? ❑ Yes [j Use other side for additional information. 2� SBD -6710 (R.3/97) Date Inspector's Signature o r Safety and Buildings Division VA sconsin SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue I n accord with ILHR 83.05 Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -73Q2 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. 5 ID b I X • See reverse side for instructions for completing this application State sanitary Permit Nu r 3Z� Personal information you provide may be used for secondary purposes 123'G if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Ovyner Name Property cation 10+_ u+, S T 2 r N, R.90—/ E (or) W Gci Property Owner's Mailing Address Lot Numbifir Block Number City, State Zip Coe Phone Number Subdivision Name or CSM Number 7 -2 3 Vi /lu II. TYPE OF BUILDING: (check one) State Owned 't Nearest Road Public 1 or 2 Famil Dwelling - No. of bedrooms r Town of ray • GPI C t 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 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) - New Re lacement Re lacement of 4. Reconnec i9i 6 /1 ? Re f an A) 1 E] 2.❑ p 3.❑ P ❑ 5 -❑ p ------ System -------- System ------ _ ------ Tank Only ------ m Existing Syste______ Existrn -- y__m B) A Sanitary Permit was previously issued. Permit Number 3.7— U 7 3 Date Issued S 9 f � 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 RSeepage Trench 22 ❑ In- Ground Pressure /, 42 ❑ Pit Privy 13 [] Seepage Pit 49 c 5 /~ 43 ❑ Vault Privy 14 ❑ System -In -Fill f ,;, 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 Re uired (s q . ft.) Proposed (s q . ft.) (Gais/da /sq. ft.) (Min. /inch) Elevation q p Y � �7 :y 0 5 Y Y(6 Feet IV Feet Ca a acct VII. TANK in ltos Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name concrete Con- steel glass Plastic App New Existin structed Tank Tanks e tic Tank r Holding Tank` (,� t �! > ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's ame: (Print) Plumber's Sire: {No Stamps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code /., 1, Cs / c(a IX. COUNTY / DEPARTMENT USE ONLY ❑Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing Signature (No Stamps) A roved Surcharge Fee) 1 2 / A p p roved ❑Owner -Given Ini#ial S CE �� A( Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: safety & Buildings Division, Owner, Plumber i �n e. /oo' if 63 / y r�,�, , 1 i , r f i 1 tj 5 i 11 I 0 �ca nsin Department of Industry. SOIL AND SITE EVALUATION REPORT page ._L_ ol � Labor and Human Relations _ Division of Safety A Buildings in accord with ILHR 83.05, Wis. Ad ' COUNTY Attach complete site plan on paper not less than B 112 x 11 inches >, an must *ude, but 57 cgol not (united to vertical and horizontal reference point , directio14 f sbFR;`VE PARCEL 1.0. r f BM ) ° dimensioned, north arrow, and location and distance to nearest ro 4 (-?� APPLICANT INFORMATION- PLEASE PRINT ALL INFO N �yP"r y . kWED Y t? Lie PROPERTY OWNER:, PRO ATION Kt rt A}A 1 k OWE S �>J C • ' � �, :: _ V4 114.S 2 } T 29 N A 20 E PROPERTY OWNER' :S MAILING ADDRESS LOT r BLOCK rr NAME OR CSM r CITY, STATE 21P CODE PHONE NUMBER n . ILLAGIE MOWN ?NEA H EST ROAD WOOD I&JP ss c i -rRD F N ew Construction Use Residential / Number of bedrooms ( ) Addition to existing building I I Replacement () Public or commercial describe Code derived daily flow !a 00 gpd Recommended design loading rate 0• bed, gpdM 0• g trench, gpd/tt Absorption area required q _ bed, 111 7 trench, 11 Maximum design loading rate _ 0 jLj _ bed, gpd 1ft O , g trench, gpd11t Recommended infiltration surface elevatiort(s) 9 . Z ft (as refened to site plan benchmark) Additional design / site considerations Parent material 5Mr Flood plain elevation, it applicable ft S ■ S Uitat)1e fOr S NVENT&thL MOUND IN•GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U• Unsuitable for s stem !� S O U S O U S ❑ U S O U O S U O S �U SOI L DESCRIPTION REPORT Boring * Horizon Depth Dominant Color Mottles Texture Structure Consistence 8wiclary Roots GPD /ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Tt nch / 0 1 z -- s r►1 — 0.� s.. ,. Z -2l tp y�3 S m G 5 0.7 (�B Ground 3 21 -53 y S ►' Q C S 7 0• elev. S C 5 0 -7 g. fc. y 53-(00 1 0 -1 4 4 /LI Depth to 5 O 4 limiting fac Remarks: Boring # Z,msb iYt r Q -.° 5 C16 I 0-12 (o z -- 51 u l Z 12- a s lilt l� Ground /off it. X c Depth to 00 limiting 7 301W-11 factor Remarks: T N e: ease Print Prwne. o f5 L4ZI - 1 7S less: E Z -111 EA I 51022 Date: CST &N 03`7 C 7 l99 PfiSPERTYOWNER 1000 V9Art& SOIL DESCRI REPORT rage ,' or ,5 PAR tL I.D.1 Depth Dominant Color Mowes Text Structure Consistenoe gam Roots Bed r ead► , G P D /rt Boring # Horizon in Munselt Ou. Sz. Cont. Color ure Gr. Sz. Sh. ! 0 -b rb Y 1 2 m5lo 0 s a S a,lo 3 - s m Qs o.7 O�g Z ro -f?S /0 N Ground tE E elev. V S CS Depth to 6 • 1 4 IWong � - 80 �, rrt l . - 2 -- rj g Remarks: Boring ri ! 0 3 ION ,y 2 - p y S Ground elev. Depth to limiting fa ac ct to or c� � = l Remarks: - -- +- Boring # & ;a ! 0— y 3 Ground _ elev. Depth 1 y limiting 3 g. lact�, 7 Remarks: Boring # Ground elev. It. Depth to limiting factor Remarks: 5BD•8330(R.05/92) , a ' Page 3 of 3 " PLOT PLAN Property Owner 1000 40WES, --WC. Legend: J Legal Description 4,oTiy, 'TKO NJILL�E HM = l — Q OF,51DIAJ& Onl —EF See. 2q, T29', Rao Vj� - TO A) OF TfZO COKAJEle OF HWSE ST, C Kul X MU M 1 1 1 SCANS I M _ 02- - G QD UAJ-0 St A FACE r-0e EP, LUr PTACE Pd Tr 104 ❑ = soil boring w /backhoe NO C.a A ga serSACK PRD4L6^s x�sTING A8 WME tNOT To --,CA A-,'5',U,*IEb 10OA, ❑ 83 ex►sT FL gt.gl' s�K , �o �E � pgz. EL. 103.89' Signed CST A10 3707 Date IAAN 3. (q Vft1o0n Oepartrnent o f Indusvy. SOIL AND SITE EVALUATION REPORT Page I - Libor and Human Retatwrrs . Divrsiot) of SatetY rs Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 5T, C.►e01 Attach complete site plan on paper not less than B 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. I not limited to vertical and horizontal reference point (8M), direction and % of slope, scale or Q _ 1 ZL-1 5 y 0 dmerWoned, north arrow, and location and distance to nearest road. RE D Y DATE APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION !� 1 1 PROPERTY OWNER: PROPERTY LOCATSON I �" KOOTj K A 0 M;7— �:, 'I_K) C 114 114 2 i T 29 N,R 20 E>K W PROPERTY OWNER':S muNG ADD ESS LOT r BLOCK aI SUBD. NAME OR CSM x - 79 - 76 A F`ib>,J Rb. Iy T �i 1L1. CITY, STATE 2►P CODE PHONE NUMBER OC►TY OVILLAGE WOWN NEAREST ROAD W OaL. 3 R y �S 1 New Construction Use Residential I Number of bedrooms ( j Addition to existing building (j Replacement ( Public or commercial describe Code derived daily flow (0 00 gpd Recommended design loading rate 0. bed, gpd/ft 0. g trench, gpolft AbsorpDOn area required _ bed, 1`1 - 7 5 D trench, 11 - laximum design loading rate 0_ _ bed, gpolR trench, gpd1h Reoommended infiltrafion surface elevations) 9�, ZO ' It (as referred to site plan benchmark) Additional design ! site considerations -- Parent material 1t)S'CQ1A� Flood plain elevation, it applicable f ft $ : $unable for S yst @ m �E MOUNO IN•GROUND PRESSURE AT•GRADE SYSTEM IN FILL HOLDING TANK U. Unsuitable torSys tem 1$ S❑ U $ M U cg s ❑ U X S ❑ U Cl S 1 ZU ❑ S `$U SOIL DESCRIPTION REPORT Mottles Structure GPD /ft depth Dominant Color Mot Boring ft Horixon Texture Cortsistenoe BoLrtd�ry Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trt3rdl y 2 0. $ 1 09 Qj Ground 3 2f -53 y Witt. P63 LA s C s _' 0,� C1•g Depth to O limiting factor , czV Frrrd t 4l 61 t Remarks: Boring f Q—fZ (o a.5a6, .,, Z l2- Q,_7 `03 `I Ground elev. S +e 4ev 1 call t .l .e v Depth to l Wiling e c::1 ' factor I � sl it Remarks: (� Pnunu / T Name: ease Print �7 15 t_}Z�` 1 S" reds: � �Zlf � 5�! t.7 Z Z �// Date: CST Number: n signatu 194 Mt rage PFZpPEpTyOWNEA Y00illufl HONrt s SOIL DESCRIPTION REPORT PApCEL V.D. tl t74 ! Structure Roots Motlies Texture GPDIit Depth Dominant Color Consistence Ba Y Bed Tmxh Boring M Horizon in, MU se t]u. Sz. Cont. Color G Sz. S h. µx y si 1 2 vns� V r 0 s 4 , S a (o Ld Z 10 -!3 r0 N " _ s Os ml es .7 0•g Ground I -J D L, cs — ,� ,g qM it. ml a � S r Q M1 CS Depth to 6 Sln o a K tvniu S rr►1 , cr A x 01' 1 1 Remarks: Boring N I 0-3 10 V 1 — 5 i 1 2 5 s a 2 Ground elev. giL1 t It. Depth to limiting factor Remarks: - -- Boring p ). ±.5r ' Ground - elev. Depth to limiting factor Remarks: Boring # Ground elev. it. Depth to timidng factor Remarks: S8D- E330tR.05iV2) r - Page 3 of 3 PLOT PLAN Property Owner X06 40ME�S, Legend- )1- 4A1 Legal Description IM4 V I LLAGE BM = gcjTd OF5101 Uti1 � see. 2q,T2 , R?ZW - TOWA) OF T(LO , COR1NE1e OF HWSF s max cduna W I §gAC ZirJ . #z - �'EbU,ID �� CVA),e a LOO PPAcE rd Sr 10 Q = soil boring w /backhoe- NO CoAv% 85 I :SET �CK 0 K06X^ - S Ex,sT ING W3U -'5E (.uar To 5CAI-r-) R' -SsUMIE!b 100 13 63 1 Sear ►e aa► �y EL-g1,&14 DE'S EL 103.84 ' C113q �L49.lS+` 13N1 #2 Signed CST Al 0 3707 Date Safety and Buildings Division V cOnS %n S ANITARY PERMIT APPLICATION 201 Box Washington Avenue Department of Commerce In accord with ILHR E3.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County /' than 8 112 x 11 inches in size. _ • (, rO • See reverse side for instructions for completing this application State Sanit�ary�Perrmitt Number Personal information you provide may be used for secondary purposes E] Check it revlsion4o previougapplication [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLI ATiON INFORMATION - PLEASE PRINT ALL INF RMATION Prop ert Own r Name Property Location -w4 ! a4 S - ,) - y T _�! N, R.20 E (ork�F Property Owner's Mailing Ad' s Lot Number Block Number L� 25 ZS7 City, State Zip Code Phone Number Subdivision Name or CSM Number j(1 7' - B r /M II. TYPE F BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road E] Village Public 1 or 2 Famil Dwellin - No. of bedrooms _� Town OF o C� III BUILDINGUSE (If building type is public, check all that apply) Parcel TaxNumber(s) Iq• Iq laStP 1 ❑ Apartment/ Condo G 4 /0 - 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. F2 2. ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an - _____S�rstem ^ ____,__ 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 ❑ Specif Type 41 ❑ Holding Tank 120 Seepage Trench 22 ❑ In- Ground Pressure AO,pk 42 ❑ Pit Privy 13 ❑ Seepage Pit r///V c 43 ❑ Vault Privy 14 ❑ System -In -Fill / 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. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min. /inch) Elevation of 00- feet Q03• S'Feet Capacity VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks r SepTan k e f S ,'- f�l ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ ❑ 1 ❑ 1 ❑ Vlll. 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 Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued Issui Age t Signature (No Stamps) Approved E] Owner Given Initial Surcharge Fee) �" q Adverse Determination �v //v ✓ 5 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber P6 2 Property Owner eA Legal !)ascription LIT1S110Y VILtAf-c LWA'MCI Iltl7jg r,- Yz,,, T-2s A 7 kf i c l W Y z, 519, rises K 14 W 7bwrnl of rY, j o� �oa) Jasc) L gs LOT 1y N Cit. �� qb3• .•' 6614 F E� L Flo rte 13 o' O' I --T -- . I I L , 1 I i i , i i L4 _ I _ 1 t 4 F -- I � I i I I I Wisconsin Department of Industry, SOIL AND S IT E EVALUATION REPORT Page of abor artC Hwttan Relations Division of Safety 8 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. f not limited to vertical and horizontal reference point (BM), direction and % of slgpe, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest ad. APPLICANT INFORMATION PLEASE PRINT _ , Milli REVIEWED BY DATE PROPERTY OWNER: OPERTY LOCATION g t r S Z' X12�,A�RA' T-ko/' ps AA EO T �4"W % l9 T Z Y ,N,R 1 4 tW IN PROPERV OWNER':S MAILING ADDRESS (.01 BLOCK # SUBD. NAME OR CSM # 2J.6 CT. 4. F APP 1 -1 4, 1 TKON V 1u,A6C CITY, STATE ZIP CODE ONE NU QVILLAGE f$I OWN NEAREST ROAD uQSON tJS S401.(a 5 ) 'r" "; zrwiiun QW4-r. - )4 New Construction Use Residential / bedrooms ( I Addition to existing building I Replacement 1 1 Public or commer d Code derived daily flow (off_ gpd Recommended design loading rate 0-k- bed, gpd/ft 0 trench, gpd/ft Absorption area required I ODD bed, ft 59 trench, ft Maximum design loading rate 0.1 bed, gpd /ft 0!J trench, gpd/ft Recommended infiltration surface elevation(s) -M RE 0e7e um nleD R y I� ,AJ9er�ed to site plan benchmark) Additional design / site considerations - A CC.. Parent material GL AC 1.4(- - TILL- Flood plain elevation, if applicable N A- ft S - Suitable for system IONAL MOUND IN- GROUND PRESSURE 7A�l -GRACE SYSTEM IN FILL BOLDING AN rIt U- Unsuitable fors stem S 0 U S❑ U CZ S [3 U a S❑ U ❑ S IR , CIS L' SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistent) I Roots GFD /fte Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. N Bed Trerdt -11 It 4 K 4 b 5i< 2 11-24 1 10 Y K : '1 1 4 — ► a m K r 5 0. b Ground Zy -40 joy 0 3 i(o S Q >nn 1 0 elev. Qt13.5 ft. Depth to limiting factor � Remarks: 1-t kl7 of ! RA_ 5aM'E Z m Boring # t >,: 10 Z /1 _ m, 1 Z rn r m4r as 0. to .S15'} Z l I_ z ►oY 3 ly — st I 3 ►�sb m +fr s — ,S o.ta Ground elev. !% t3 ft. Depth to r limiting fac Remarks: L PAIC7S 10 2 m r, CST Name: - Please Print Phone: C j 5.` 4z5-i; ( gg l J A ddress: YW _ R - A Signa - Date: CST Number: NVI. Z"7 i9 q(, /'W43707 PROPERTY OWNER 1ZUEMMC- �,E.?tN��I SOIL DESCRIPTION REPORT Page z ofd PARCEL I.Q. fl Depth Dominant Color I Mottles Texture Structure (Consistence 8our>vary Roots GPD /ft Boring # Horizon in Munsell C lu. Sz. Cont Color Gr. Sz. Sh. Bed 'Trey v 10- x + o - -5 o Y zl -- s I z rh <v >: S I i M 1 r 3 Z 3 roy�C Ground 3 Io -3o I o 3/4 S r l Z rn sbK mFy 5 _ 015 0. S go4.1 ft. Lf 0 -33 0 1 4/( # Y' m I = 1 0� Depth to S -g 4y )t S �'►'� I — i. `� limiting factol 4 .. F Remarks: (�t�C1ZON PAK� z mfr Boring # 1 0 -5 10J& 3 -- s• -� C5 M9 0.3 10 3 — 5') I Z m r CS 015 0.V 3 -Z4 l0 3 F5 0 1 QS 7 D. Ground M II elev. — 10. o. � Q 03 ft. _ Depth to J 7 -q 0 v 3� 5 m Q, - 7 limiting factor Z� Remarks: Boring # 1 Z rn S O.S 0• b 5►S�n Z 10 1OV, m S .... i o Y U — � I a 5 Ground I elev. zb— i o "A 403.? ft. Depth to limiting factor Remarks: � ► n,,� 1 x o Zm q r Boring # FT- Ground i elev. ft~ Depth to limiting factor Remarks: f SSO- 8330(8.05192) Page 3 0 = 3 PLOT PL=,V Property Owner KUEMMEIc NOD Wff� Legend: � � � � Legal Description J4Tj% - WjY V►L6A6F BM = 0 4) -b,o OF 60 NHy LW I A/ Tb'V C- Yz� S Z q T ZB N � IC Za W IVAHL - F,�.6-a iE 0 W Yz� 519, TZgA), K i4 �+/, Taw of Txo Y o eL.MV.4-rlUN QO-3 0 ST L'OLIAMY VJ15CONSIN • �� (� = soil boring w /backhc C5r=E 50 MfhP FOY, TRIE' L6T U N E AyY a)L S ., Lo-r 15 Lp'T �3 LOT lt1 L ,, , q o 35}, y, �qo3- 0 5w �51b �8 i EL qo4 . 1 130 (65114 0 EL 4o'S•� � (351:5 D 6104. of _ Signed CST Z�u M o 3767 Date NOVA Z7. 1990 • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer, Mailing Address Property Address 2� :IY-921,1 CaLE-1-; &D!��. Vj (Verification required from Planning Department for new construction) City/State .A1V_-ZK1T, Parcel Identification Number LEGAL DESCRIPTION 1 Property Location C' X Sec., T 28 N -R '�O W, Town of Subdivision _ IF!Q"1 Lot #. Certified Survey Map # . Volume , Page # Warranty Deed # 5� 4 3 / , Volume 9a Page # X36 Spec house ❑ yes no Lot lines identifiable ^yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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, here' as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating a s tic ystem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o ee ar xpiration date. n n,, VVVUZ 1/ 7 / SIGN F AP LICANT ATE OWNER GERTIWICATION I f c rtif that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro s 'be above, by virtue of a warranty deed recorded in Register of Deeds Office. la / M g SIGNA' 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 �a VOL 1390mc[036 594431 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document nde ST. CROIX CO., WI RECEIVED FOR RECORD 12 -23 -1998 12:30 PM QUIT CLAIM DEED EXEMPT # CERT COPY FEE: COPY FEE: TRANSFER FEE: 210.00 RECORDING FEE: 12.00 PAGES: 2 Recording Area Name and Retarn Address K w-kni a- Inc . A/ Parcel Identification Nmnber (PIN) "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This information mustbe complctod by submitter document tide, name & return address, and PIN ff rc ' cd). Oder " otmadon such q:ar ?tf as du granting clause, legal description, etc. may yc placed on ddr f—t page of des doeeumemt or may tic pfaccd on addidonal pages of dee document Norc: Use of deft cover page adds one page to your document and $2.00 to the recording' fee Wisconsin Stanaes, 59.Sl7. WRD l 2196 • VOL 1390PA037 • DOCUMENT NU. STATE BAR OF WISCONSIN FORM 3 TNIB BRACE REBCRVED fbR R[cORDINO DATA I QUIT CLAIM DEED I •- ••Rodney.A. Brown: ... an Yoriai�'eRortiiri's = rowii; . °.. ... .. quit- claims to .. .KAl.1tP.J.'i;LaJ1Qme,9.,..�51!~ .......... ............................... ............................ .. ................................. ............................... .......................... • . • Via following described realcatnte in ...St .....C.rA7 -�.... .... ••• .. State of Wisconsin: County, ....... _..._......_..... ...._ _. ••.:.•. :.,. RCTVRN TO KOOTENIA HOMES, INC. Lot 14 of the Plat of Troy Village in the 7975 Afton Road Town of Troy, St. Croix , County, Wisconsin Subject to Declarations of Covenants, TaxParcel No; .............................. Conditions and Restrictions for Troy Village, recorded in Vol. 1241, Page 256, as Doc. No, 559964, and the Declaration of Golf Course Covenants, Conditions and Easements, recorded in Vol, 1241, Page 301, as Doc. No. 559969, all as appearing in the office of the Register of Deeds for St. Croix County, Wisconsin, and such other easements, reservations, restrictions and reservations of record, or in use, and obligations contained in the Purchase Agreement for this lot. This ..... z —axa ut) ..... homestead property. Dated this ..... 10th of December gg ... ............................... day ..................... ............................. , 19......... ........ - .......................................... (SEAL) ..... ....(SEAL) 11 Rodney A Brown • °• GREGORY W. JOHNSON . ` ... ..............:................ • . r .....IIO�RY`P LWMINNWTA- - -- .. . (SEAL) 4 RAMSEY COUNTY ;.... .. .. • •;lYlyCosMlRblpiresl •31 . ... .2000...... .... (SEAL) FlorianeRobins'trown .......... ........_.,.................... ............................. ..................................: ............................... AUTHENTICATION ACKNOWIt UDGMENT Signature(s) ............................. ............................... STATE OF WISCONSIN ................................................. ............................... AS. ...... ....... ....County. . before me this .......... authenticated this ........day of ............... :.......... . 19...... Personally ame 10th • .. ... emb .... day of er ................... 19.. 8.. the above named ................................................. ............................... ... Dec . RocneY.. A._.. Brown and .............................. TITLE: MEMBER STATE BAR O WISCONSIN Floriane • Ro1ii =Br ns own (If not, .. .... ... ................ . ........ ... ... .. ......................... authorized by § 706,00,Wis Stats.j ................... .. ................................................. ............................... to me k w to be the person ... ... who executed the r o iatrument and nowle ge to same. THIS INSTRUMENT WAS ORAFTEO BY K ootenia Homes,....Inc ............. .......... ..... ......... .. ... ............................... +...GTeRo Joh s n ....................... .. ... : .. . ......... ............:............ ............................... Notary Pulp a Rams eY ..Count ,i� Ir or acknowledged. (Signatures may be authenticated kledged. Both My Commission' ls/permanent. (If - st Y ate expiration necessary •) are not / 3 .. date: .............. r ....... hQ rn o do 1 i F U)!� e rn �� L4 W ms s' �,n � � N � :o V' a ° �s M N 1 14. C-4 � 00 O N °° o 7 '` 0 3M ' o0 r 20� 6pOp ccl ° rI a 2 Z °Op �-- O a _ 3 IA, W 2p, M o O� N a, �aoi, .° _J z � ro � co O 010 M r' �� 1�0 NcrZ Ln oo W "�• a0 2 O �� NU N � WN �. 3 •90 6 8t N 1*° - �0v~i° � tq t `� cn _ - V) OO Z 8` 11) r- ,, 3 z a — L - N W ,�o, N h 0� YQWZ u,V r ° O 0 J_lWJ � Q ;-- O h� n j� W U- 0 Z ! 4;V 11 O �WU' — IV) 7 \ `� 00 p PO N a � ° O W W V) LL `n r--G `c u' w N W � W Nom' C44 d3 \ �^ �w s 05 045 03"+ E '� O •- .,� 00 24 . 8 N •. Or r . h O - O r. N �D - ' O L4 tn— r 01 ° \ �� O �NQ UJr� ' �� pN \ - N rap m W = i �cn Q ° I �.1� , ^ y Q U M l V J 01 M 0 C Jf, 0 N .d. ,^ • iap p • �� do (� 001 Z •. Z �y ry°` w z: 3 ° •• 2 96 W 5 8044 0� °° °9Z = g N 0 N O LO d'