Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
040-1103-60-110
o° I 0 m o ca)@ ?� 0 7 rn @ m r - r 0 a) 0 Co rn a cLL E E_ @ 0 E EQ m - flr °- U V N Co e �m -' U O O R E L @ � c 7 O N Z r` N @ p. O L 0-0 c z acc C Z o� 7 @ p_ O 3 N 0 N - E @ LL O 5@ a) LL p Q oz} y a'o ° 3 Q) @� m E << o@ E ¢ 3 CO @ d CL a) O E E O .. 0 ` O ` O Z ao C U m a) m 04 w a) a m a CO N F- Z I C C9 O O Z !t c c CD Z C m 0 a7 c c rn E 0 O 7 O CL N N 1 N O O O *� a) - i a) Q) •1V a fn CL 6 C 3 N 9 O fl z co z z Z z o N � y a) o (U E N 7 N N @ O m L O V G . In Z U) Ln Lo �J Q) N 13 a a 5 o a O N E cn (n =3 E F 1- M- 7I 75 N d Z +n I- @ O O O • a 0 a 0 a LL a a a "a a o vii ii o co O II rn C) a V) J U � , O) O Z @ - - a) o �•v N E N O O O O C o M E N @ -, 7 a M N co N a - rn N a) co N a) >- 6-5 D :3 c0 N C fA N C py� ol O 0 E N O � - T m 0 a o 0 -e c cn O N (� _ F- o n o Z d r~i a w c c m rn 0) 00 • y ° v co V� O o `° � N o ai v C N @ L O N N N S I- > Cl) O z N �' Y U1 w i'' •E c xt a' a w L a CL w • c� w .� d c a) y c I 3 @ 7 0 A v a g O� v O V Parcel #: 040 - 1103 -60 -110 11/25/2009 11:23 AM PA GE 1 OF 1 Alt. Parcel #: 26.28.19.404A10 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - WARREN, CARL MICAH & SUE NANETTE CARL MICAH & SUE NANETTE WARREN 188 RADIO RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 188 RADIO RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 16.000 Plat: N/A -NOT AVAILABLE SEC 26 T28N R19W NE NW EXC N 637' AND Block/Condo Bldg: EXC P404B Tract(s): (Sec- Twn -Rng 401/4 1601/4) 26- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1157/639 07/23/1997 961/493 07/23/1997 877/636 2009 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.000 80,000 342,500 422,500 NO 10 MFL BEFORE '05 CLOSED W8 12.000 96,000 0 96,000 NO 00 Totals for 2009: General Property 4.000 80,000 342,500 422,500 Woodland 12.000 96,000 96,000 Totals for 2008: General Property 2.000 50,800 365,000 415,800 Woodland 12.000 63,000 63,000 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 135 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 E ' COMM ERCIAL TESTING LABORATORY; INC. I ' 514 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715 - 962 -3121 r 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.S 07480/01 PAGE 1 ST. CROIX COL14TY REPORT DATE: 7/13/90 COURTHOUSE DATE RECEIVED« 7/11/90 HNIDSON, WI 54016 ATTNS THOMAS C. NELSON 2(v. Z� 04R�R2 Tom G i ere LOCATIONS Rt. 3, Radio Rd., River Falls COLLECTOR: M. Jerkins SOURCE OF SAMPLE: Kitchen faucet COLIFORMS 0 /100 ml. INTERPRETATIONS Bacteriologically SAFE NITRATE• -N: 3 ppm Under 10 ppm is safe for human consumption. Coliform Bacteria /100 ml Nitrate- Nitrogen, mg /L LAB TECHNICIAN. Pam Gane i WI Approved Lab No. 19 I I I .OF \NDEPENO A u A Means "LESS THAN" Detectable Level Approved byt PROFESSIONAL LABORATORY SERVICES SINCE 1952 4 -\ ST. CROIX COUNTY ZONING OFFICE �U l St. Croix County Courthouse 911 4 th stree 1 Hudson, WI 54016 Vj r Telephone - (715)386 -468 _ P he water inspections tooLending e service of septic and P Institutionsh Rea Firme and private individuals. a-- form is essential so that the vroRaxty can be Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. WATER TESTING--------------------- - - - - -- -FEE: $ 25.00 (For nitrates and coliform bacteria) FEE: $175.00 '`p WATER TESTING N" �16 (For VOC'S) - -FEE• $25 00 � '� t�q,P SEPTIC SYSTEM INSPECTION - - - • (Determines if system is properly functioning at t ms of inspection) Property owner's name ��► °� Property owner's add ess < Legal Description 1/4 of the Avg j 1/4 of Section _( T N -R Town of r otw a _Subdivision Name Color of house f Realty sign by house? If o, list firm: Cr Cep Z PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP, .e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requesting services: h'I �� r Telephone Number r 3 REPORT TO BE SENT TO: Closing dat -- Signature I re� ►�.s in � ©usc? h ever �o�� 4e /< 4, 4i e S T 6 a 1 z��r� �m . ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE WN It ` - 911 FOURTH STREET • HUDSON, WI 54016 (715) 386 -4680 July 11, 1990 Jim Claycomb Century 21 706 19th St. S Hudson, WI 54016 Dear Mr. Claycomb: �,(���� • An inspection of the septic system of the Tom Giere property, located at Rt.3, Radio Rd., Troy Township was conducted on July 10, 1990. At the same time I also obtained a water sample for testing. The results of that test will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspections. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system is totally dependent upon proper maintenance of the system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cj ' EAST � -O 1 5 T PART R Y 28 N. - R. 19 W. SEE PAGE 27 Wayne - NG. f Er7 /oB Tr• rB 4B � N/a,xine • ,V o ro9 Wil a�X �C �� . �`4 5'9.6 5ri.>t -:t y7 : I.SC/ /�erl \ �W 90.34 ���� �Si ✓O /7kR,Inc TRacra •C F� M �.Pon.S W a :v0 /YS. za.¢B7 I: /96.77 p a la,a'r Hand /os 4 « h � � e ee § :::::::... ...... ...... • d M nd � How- D s. � •9s5..1 :�: De /bB�Yf Bein/a '0 p U p b �f'r/of i i�t�Iii CBs/ .Snye. /rouse / -'�eff q l C� /os .:•• sro 270 7s9 \ \ Q�� • g0 Rich¢r - +d �+ � Tricbo /cs yr %mar^e • Fr¢ cis O fo Leana d J C % / 6E /✓ iz2 cSo /ba. 7tisor7 .Dcs L¢u�rb. \ D .�eiss 40 /iy 43 BD FF • . etux zoo • • �90 doh •p 9,x�y /� OE \\ 9 /ss 90 � p Troy fir /e C / /rrs b U /`9acfha. •.Qo.4/ 9a f /90 a4o yew s .3s.gs Ly /e ss /Po/% h/7 7Je✓ ,.7 Ano f N/a /ioq /zo ah I'loeIA- L /ZS.z1. 'Big'' lJ¢!e Make //Q 0 i rwhrV 3zo dC6randf g an o Q /70 w � barf �� a 7g�e7- s,Led>` -� olio /4/ • klwfe� 3797s 793 07ve�s f%a�o/ H ©Pe�� � ,� �J. �Pobcrf e i6o E '/o Tiin P V �tGS /fb fo ED cv Jr3 BO e� .0 /Cvo • /60 �4C) S N�, g o ®o E�UX P {N ,B.o wry �Odru`` /Ed 26 j J� clohi7 so/7 • • 24D 40 \� , C � • con • /oo 80 se" • s :Ya// ,F;verFa //s /e /tzfe 8an/c 4O so c /e1/ I�GZ vo � � /o� �icfrpr 79sz O %'�Jo /% Duane f• //8.20 CP�/lO • LervriSE� LuX /SS .G¢c.. %nC ' ous. -- M•A• /) POU /Sor7 OrJadey �e • 65 C'pr /son o Fa _ Inc. G'o / %cs Orin E `/o Dwar%n 7is /6o Car /son 2903 fhnsa�7 c / /.� /96.7/ /97 yi/ 7Ttr. I c. nneffj• 95 • • • /71 AfAf Sumner- ' � fl•a-7/ � C � •yVune F e'T� e� • . : :Qi�E : :: �.,: .Mn• 9 Sh Ye w • ZP q' 'Ge%re'oy .6MALL: . - . / .✓6a � tl tl /,ro7� � ,9 Dan: / LQ w � ce j �J� efvA �✓E/so�7 G'er'm ous �e noilc�us �i :i�iEi: tFi�i+''Fi ©E:; i :iii. is ®/97.2 oe� o�d Moo P /ERCE COUNTY c5f oix Ca / KINNIC` IMPLEMENT RIVER FALLS COMPANY MEDICAL CLINIC, LTD. J ALLIS- CHALMERS a9 PHONE: 425 -2711 PHONE: 425 -5322 GENERAL CONTRACTOR River F alls, RIVER FA 54022 W ISCONSIN RIVER FALLS, WISCONSIN - 425 -5956 3 3 '* t I v rD c py I co 3 7 Z Z O C < O N O O N A 1.) CD `C • ? O t9 N 3 O C W fD a N Q M"I c 1 CD rt O N W lD Z p N O y l D �N 7 CD m ? S W 7 I N i;3 a sy m N n 0 C17 N p A N 7 CD 3 O O? O CO N C A C CD 0 3 C L ° QD O 00 0 0 C CD O v> D CD °_, a to GD a° CD (D CD N 4 O tL] CD N 6 W CD CD CD N CD c .Z7 CL CL O CD 0 .. O. O.' O N { co Co d Z co co t N v y m co CL l O co OD d CA O C N CD I y 3 p Z O O O v O O O of y N a4 N p v O G O '�0 O G N m j 7 CD �i A O W 9 90 N (D N CD O A !D N CL o O D > ? O D a CD 0 m ?� � n+• X to CA cn v m ° C m m C m I w cc a a a 3 ° 3 Z CD ccy CD C6 - � N BE � z c ° I �• I Z - I N CD ( a (D m 0) Z I c c z �2 C C m I y y A < < I Cl) I to = o m o o m'_ 3 CDs' m c I �c o a ID o a CD I y � y Z fDmO N C1 O �• N 01 = , y I = 0 � N 7 N n •• y I N A O 'O CD CD O 3 TO I co 0 m ;° A I co N (D a o CD O co v I I i o o b ° ° ac ,'4 o 0 c w I ° o a. I ° o a ,., parcel #: 040 - 1103 -60 -110 01/04/2007 05:05 PM PAGE 1 OF 1 Alt. Parcel #: 26.28.19.404A10 040 - TOWN OF TROY Current X, ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - WARREN, CARL MICAH & SUE NANETTE CARL MICAH & SUE NANETTE WARREN 188 RADIO RD RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 188 RADIO RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 16.000 Plat: N/A -NOT AVAILABLE SEC 26 T28N R19W NE NW EXC N 637' AND Block/Condo Bldg: EXC P404B Tract(s): (Sec- Twn -Rng 401/4 1601/4) 26- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1157/639 07/23/1997 961/493 07/23/1997 877/636 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 158507 455,800 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 50,800 365,000 415,800 NO MFL BEFORE '05 CLOSED W8 12.000 63,000 0 63,000 NO Totals for 2006: General Property 2.000 50,800 365,000 415,800 Woodland 12.000 63,000 63,000 Totals for 2005: General Property 2.000 50,800 365,000 415,800 Woodland 12.000 63,000 63,000 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 135 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 �— li► L ♦ STATE OF WISCONSIN %i,EPAAt'ME:4T OF NATURAL RESOURCES WISCONSIN FUND PRIVATE SEWAGE SYSTEM BOX 1921 REPLACEMENT OR REHABILITATION MAOISON,WISCONSIN $1707 INDIVIDUAL SYSTEM COSTS - ITEMIZED BID ESTIMATE SHEET (Pursuant to Sections 144.24110), Wis. Slats.. and NR 1 28.30, Wis. Adlr►ul. Chile) FORM 47 -12 7A 10 MII OUNTV -- TO BE COMPLETED_ BY DNR i•RO OWNER NAME APPLICATION NUM0 n G� L e 10DOERANSTALLER NAME DATE RECEIVED MODER'S ADDRESS—ST J T g R ROUTE -'ITV. STATE. ZIP CODE MP/MPRSW NUMBER i I ELEPHONE NUMBER (INCLUDE AREA CODE) BID ESTIMATE. DATE A. The following items are required for the rehabilitated or replacement system to meet only the minimum requirements of H 63, Wis. Admin. Code: cost OR kti11MAi 1:0 INSTALL e.USI El Septic Tank Replacement . . . . . . . . . . . . . . . . . $ — - . ' L1 $ Meteiial Type ('� W-4 h Opac ity Gallons A)6- - -- 0 Pump Chamber . . . . . . . . . . . . . . . . . . . - -- - Material Type Capacity Gallons 0 Lift Pump . . . . . . . . . . . . . . . . . . . . — 9 7 ® Drain Field (Convention I Replacement . . . . . . . . . . . . . _ / _ Square Feet yVl 0 Pressurized fin Ground) . . . . . . . . . . . . . . . . . ` R 1 Square Feet 9 i 0 Alternate Mound Absorption Area Basal Area Package _ (Square Feet) - -- - - - - -- - - -- jp , !, / - 0 System in Fill . . . . . . . . . . . . . . . . . . . . . .. . ... . • ti Square Feet — w Sewer Line or Fora Main (From Septic Tank to Z 1 ® Absorption Area Only) . . . . . . . . . . . -. - --- - - Lineal Feet Type Pi C3 Hydrogen Peroxide Treatment . . . . . . . . . . . . . . . . ._ . _ .. 0 Holding Tank . . . . . . . . . . . . . . . . . . . . . 'C� ' ► �a Material Type Gallons tO Soil Te ;-;&N & i� . . . . . . . . • . _ � , Name ���1 -� CST Number _ - -_— -- - -- - E�0 Permit . . . . . . . . . . . . . . . . . . . O * 0 Design and Plan Approval . . . . . . . . . . . . . . SUBTOTAL ALLOWAGE COST $ J( 0 " $ STATE OF WISCONSIN WISCONSIN FUND PRIVATE SEWAGE SYSTEM DEPARTMENT OF NATURAL RESOURCES BOX 7921 REPLACEMENT OR REHABILITATION MADISON, WISCONSIN 53707 INDIVIDUAL SYSTEM INFORMATION Complete and send one copy for each system included (Pursuant to Sections 144.24(l 0), Wis. Stats., and in the application to the Department of Natural Resour 9 NR 128.30, Wis. Admin. Code) Bureau of Water Grants, under cover of a Wisconsin F �O7 ORM 8700 -127 REV. ]0 -80 Septic System Replacement or Rehabilitation Cou Application, Form 8700 -117. Also attach a comp TO BE COMPLETED BY DNR EcE�vEO R f✓ copy of the itemized bid estimate, Form 8700.1 EC C U APPLICATION NUMBER MAR 3 1982 PLEASE PRINT OR TYPE Z ONING DATE RECEIVED COUNTY SUBMITTING APPLICATION UMU NAME OF PROPERTY OWNER ME OF OCCUPANT (I NOT PROPERTY OWNER) STREET OR ROUTE STREET OR ROUTE go x ?a CITY, STATE, ZIP CODE CITY, STATE, ZIP CODE Gv .S Rlve g «s TE EPHO NU BER ( AREA CODE) TELEPHONE NUMBER (INCLUDE AREA CODE) 1. LEGAL DESCRIPTION OF PROPERTY -� ' /•, �� '/4, Section 1Z 6 , T N, R —� OR— Township or Municipality T X_ o Y _ Lot Number Block Number Subdivision Name 2. BUILDING USAGE (Check One) CD Commercial, brief description Residential, Number of Bedrooms: ED Other, brief description 3. SEPTIC SYSTEM FAILURE DUE TO: O Failure to accept sewage discharges and back up of sewage into the structure served by the private sewage system. Discharge of sewage to the surface of the ground or to a drain tile. C3 Introduction of sewage into zones of saturation which adversely affects the operation of a private sewage system. C3 Discharge of sewage to any waters of the state. O Other (explain) 4. APPROXIMATE AGE OF - FAILING SYSTEM: —2-4 — Years 6. PROPOSED REPLACEMENT SYSTEM Conventional Sewage Disposal O Holding Tank O Alternate Mound ED Cluster System 0 System -in -Fill o Other (describe) _ 6. Yes E3 No Has the replacement system or rehabilitation work been completed? If yes, date work completed: 7. ELIGIBILITY CRITERIA �r Yes O No Has a written enforcement order been issued against the failing system? (Note: Enforcement orders must be issued in writing prior to construction. Work must be completed and application must be submitted within one year from date of order.) Date of Order Or t n h e r 5, 1981 XYes C3 No Does the failing system serve a residence or small commercial establishment constructed prior to and inhabited on July 1, 1978? Yes 0 No If residential, is it occupied at least 51% of the year? O Yes M No If commercial, is total average sewage flow less than 2,100 gallons per day? 0 Yes )q No Is a public sewer available to the property? 0 Yes �1 No Has this residence or commercial establishment received a previous grant under this program? 8. JOINT OWNERSHIP ASSURANCE (This question applies only to systems serving more than one principal residence or small commercial establishment.) 0 Yes JRkNo Do you certify that the system is and will continue to be owned jointly by the owners 0 N/A of the properties served? 9. GRANT FUNDS FROM OTHER SOURCES C3 Yes No Are grant funds from other sources (i.e., HUD, FHA, etc.) to be applied to any portion of the total cost for this project? If yes, please identify: Source Amount % of Eligible Cost (Note: Under state statute, the property owner must pay at least 25% of the total eligible project cost. Therefore, if grants from other sources are for more than 15 %, the Wisconsin Fund grant share may be reduced accordingly. This condition does not apply to loans.) 10. ESTIMATED COST OF REPAIR OR REPLACEMENT OF FAILING SYSTEM: $ 3,1 (Note: The amount shown above should be the lowest bid to allow the rehabilitated or replaced system to meet minimum requirements of ss. 145.13 and 144.24(10) (g): W is. Stats.) 11. PLAN APPROVAL .. _ ... .0 Yes 0 No Have plans for the proposed sysf ?m been arpr' -wed? yes. !Oeas, ;de—Jv Permit Number 4 ',r - TV 12. PROPERTY OWNER CERTIFICATION 1 (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded i the Office of the County Register of Deeds as Document No. � ; and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. •Z.S"L�� 7`� ). 1 J � SIGNATURE OF OWNER / L SIGNATURE OF CO -OWNER (IF APPLICABLE) � g � g. /„9 O DATE SIGNED DATE SIGNED 13. COUNTY REPRESENTATIVE CERTIFICATION I certify that a preliminary inspection of the failing private sewage system described in this application was made on S e n t emb g r 27, 19 81 that it is a failing system as defined ins. 144.24(10), Wis. Stats., that the repair or replacement proposed has been approved in accordance with the State of Wisconsin codes, and that all statements on this form are true to the st of my knowledge. ,^,A e." W", /. j Ze Zoning Administrator SIGNATURE OF COUNTY REPRESENTATIVE TITLE Harold C. Barber Azaz -e'l g, PRINTED OR TYPED NAME DATE SIGNED s ST. CROI X COUNTY WA SC 0 N S I N ZONING OFFICE 796 -2239 HAMMOND, WI 54015 February 24, 1982 Thomas Giere Box 33 Minnetonka Beach, MN 55361 Dear Mr. Gierre: We are enclosing the form that is needed to apply for the Wisconsin Fund Grant Program. We have the estimate sheet from the plumber. If you are interested in the program, please fill out the application and return it to us, with a check for $150 to cover St. Croix County Administra- tive costs. The funding is expected to be exhausted early this year, so you must apply early. If you have any questions, please contact this office. Your truly, y Harold C. Barber sl Enclosure `• .. +31 �.lh 50 :Ibt. t', UtN G(1 :1 r1 11,a a '• }� t, •ap 4 + y ./.►oar � .. 1 f Y.IRI l� J' I A tOHL & TIMM EXCAVATING 310 Arch Street Z. HUDSON, WISCONSIN 54016 Np 1378 Phone 386 -8664 GATE V P __— it r t CUSTOMER ORDER NO. -- —' SALESMAN VIA TERMS: IT ITY Iap(!{5•.,.w: w-.. PtA 33w .. r , v .t, f /D��PTIV,^w>egs(Mnr aloR4a9P" 11 4r ! C . ` xyU9,; SS�^a"a..t ,.� i ,, .r (a e:v�. 43 i.IR:, h ". • ,G,,. V � L t L-la. GINAL 1 ..�F �� � � yw.lY.r IIW YwM1MMf 1 \1 11:.: (, - .{. �� ✓ /M gI1V 1. n, .��. iii 47'I ,�✓ _ �� M�• i AS BUILT SANITARY SYSTEM REPORT �.. TOWNSHIP % � �� SEC. 1 N - - 'W OWNER ZD/'�"l 6 /G'r�_' � .-.� LZ ADDRESS ,, �c �c' Lf ST. CROIX COUNTY) WISCONSIN. 11/ e, SUBDIVISION LOT _ LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of h63 �uE$YTHING WITHIN 100 FEET 01 SYSTE I IV / / _ d r I di a e n th Arrow I 4 :Lj BENCHMARK: (Permanent reference Point) Describe: L.�MC se _ ,I / o " „�,�„ f`j , ✓ Elevation of vertical reference point: at site: SEPTIC TANK: Manufacturer: 1J�r�er5 Liquid Capacity: Number of rings on cover :- Tank manhole cover elevation: Tank Inlet Elevation: S Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle gallons; Lot T - c:apa-ci�y -- distribution lines gallon: size of pump____________ _ bead ; gallon per minute horsepower_ brand name of pump and model number Type of warning device HOLDING TANK: Manufacturer Number of gallons_ Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE: Num Uer of pits feet diameter feet liquid dept seepage pit inlet pipe - elevation___ bottom of seepage pit elevation feet. , SEEPAGE BED SIZE: number of lines width lY ` lettgth > the depth SEEPAGE TRENCH: width len Lh PERCOLATION RATE C, /us; -� __ REQUIREDAF.EA AS BUILT INSPECTOR _ DATED PLUMBER Off LICENSE NUMB R - ' 0 j,y�Y 7 ` REPORT OF INSPLCTION - INDIVIDUAL SIWAUL SVSIIM ti(Iil1 (11'111 V( I III I ( p?6 S IaI v S 1 1.) t (c o ?Y43c , NAME / - Town -.- �� - - - - - -St. CA k (' ,g un (r( I tor(Ition — Section Lot N Subdi.vi.eion SI.PTIC TANK Size ga f -one Numbe.A o6 compaAtme.nt,6 Dietanve 640m: We.tt Building 12s eKope Highwaten P CHAMBER size oat.tona _ Pump Manu6ae.tu4e4 -__ __ Mode.K Numbe.A H OLDI NG TANK S.i ze gattone NumbeA u6 CompaAtmern fe Pumpers Atahm S ye tem D.ia tanee 64om: Weft Buil!dting— __.___- --- .. -. -- H.ighwateA ABSQRPTI SI TE Bed TA.eneh D.i a tanee 6hom: W ett Buitd.ing �_ t 2 % e 4'a pe - Highwate ABSORPT SITE DIMENSION 6 6t RcGui ct v S Wi dth o tKe n ch S Length o6 each ti ne ;�(, At Depth o6 A.ock beeow ti Ye ?J� �n NumbeA o6 fine.e_ ";� _ _ Depth o6 noeh oveA (( Irrtaf Length o6 tines 6.t Depth o6 tife below yAUde L, +n D.i a tance between P.i_nea _ At St upe o 6 t neh _- < n . pe h 1 0 A t Io 4,4( a .t.i aAeu -� p `I S 6 t Ty v 6 C u v e n: (' a f;�.i� -h'" �u h e t A aiU ` PIT DIMFNSIONS Numbers o6 pitc GAavef aAournd pi to yve kill Oute.ide. d,i.ameteh 6 e th b efow knfe.t 6 TotaE abeon.ption a4ea 6 AAea he �:` , 6t INSPECTED BV T11 Ll APPROVED DAIt 198 RE JI CTED VATf 1 REASON FOR REJECTION i >a APPLICATION SAFETY & BUILDINGS ) OF FOR SANITARY NDUSTRYUSTRY, DIVISION -ABOR AND PERMIT P.O. BOX 7969 1UMAN RELATIONS. (PLB 67) MADISON, WI 53707 I Attach plans for the system on paper not less than 0% x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal tnd vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H -63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Prop9ciy Owner: Mailing Address: L Pro erty Location: City, Village or ownship;, J County; '/o N4-A/4 :>aL rT 2 N/R /Y E (or) 40 'Tc)' r' 1 �v / Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: III assigned) TYPE OF BUILDING Number of ' ❑ Public' ❑ Variance ❑ Other (specify)' Bedrooms: �$ 1 or 2 Family 'State Approval Required. —' TOTAL NUMBER PREFAB POURED - IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY A HOLDING TANK CAPACITY LIFT PUMP TANK /SIPHON CHAMBER MANUFACTURER: L / EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New Replacement El 0 Seepage Bed 0 Seepage Pit S ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Na of Plumber: Signature: _ MP /MPRSW No.: Phone Number: 3 (7i5 ) -f,G Sly Plu ba Address: Name of Designer: COUNTY /DEPARTMENT USE ONLY Signatu of Issuin Agent: Fee: / Date: / gppROVED Sanitary Permit Number: at o ? ` '�/ ❑DISAPPROVED � v0 30 Rat n for Disapproval: Alternate course(s) of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White- County, Canary - Bureau of Plumbing, Pink- Owner, Goldenrod - Plumber DILHR- SBD-6398 (N.03/81) r • INDUS DEPARTMENT Y, OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, DIVISION LABOR AND HUMAN RELATIONS PERCOLATION TESTS (115 MADISON WI 3707 jLC I N: SECTIO N: T OWNSH IP /MUNICIPALITY: LOT O..BLKNO.:SUBDIVISIONNAME: y �/ 2& /T /R/ nP0 el o� 7_S Y OWNER BUYES NAME: MAI IN ADDR S : iao /� R' dM GIFR� lion 3 3 Ali v•vt ro,c>�t'q / 6464 , tifi "v s, 553 USE DATES OBSERVATIONS MADE �NO, D RMS.: COMM R A DES R TION: EST®Residence j ❑New Replace �dU. l��� E - ! RATING: S= Sita ui = ! r.* - {' N07 s table for system U Site unsuitable for system Sc $ O 9 v / k CO© ENTIO ❑ NAL: EISMU IN -('' ® ❑URE:S0 STEM- INa FFILLHODLDINGQU TAN • AO UF.cIi�,V�j�YS �� .Pb V S S U U S IILwJI S S C' � F.nders.H6'3.09(5')t(b), ton Tes are NOT required DESIGN RATE: If any portion of the lot is in the indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH T R UNDWAT NUMBER DEPTH IN, ELEVATION ER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH OBSERVED EST.HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- I /Q Y 7. Q Fr. /Z0 , SiL� 1r� ��. f z G� /3.t1. SL d wilyi 5"t 44 7 �M O c,re T S 7 6 11OUJ 5' - G 77 r,& B- 5 „ � � y „ Pax _ 'e'j . 11,4 .sa„_2 w I^ QR - FT. 8 RAJ. S,'� L " G� /3A; Si L / '' L� /3,J • 9-o1 B- L 7Y ��� /o " N p4- /3,j . S L 6 36 „ P� Hm B- l �, / Tr % /d" S,'�rL• 7"13 SiL 3�7 0 -R IJ .S i 4 - /9 " CW /3 a Si- B. �p 13t�j�Z&i W - /3 e` w4 - B - ev� " � ocXI-rS OF SitT -40AAI CovTA /J aw f�w y 7 aT S - N C /0" ,V4Ah AgNy i5 5EASa0.4i4y PERCOLATION TESTS v EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. P I D 1 PERT 2 P R PER INCH P. (O , j P- P. LO P- P- �P O fro Co P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. y1 0 r R /N fie, cc 446 4 0 rToM © 13ev ,VaZt /icy SYSTEM ELEVATION pig rly //. o FT i__ F _.. .y `Y _ x /3alPE rb "� Will, 4'ie o FT 13 I e' 9 x Bekw ` vE 064L �Ef F.�rE �p�,J j N J y F Tv ° 15E Gv r - - i �600 `eA5e OF P AIIQ Fier_ , F Si ' o 0 1 , a� 1 a 3 3� 1 ;Is! F ? r� v r r f �F Jo c 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedur- rr�ethodsed in the I onsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belie . ' ` NAME (print TESTS WERE COMPLETED O ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER optional): ?T• 3 0 ve-; L 2 . ve- /s If- DISTRIBUTION: Original -Local Authority, 2nd page- Bureau of Plumbing, 3rd page - Property Owner, 4th page -Soil Tester. DILHR -SBD -6395 (N. 03/81) N \ Az Q h L ST. CROIX COUNTY ZONING DEPARTMEN , �. AS BUILT SANITARY REPORT Owner 60 e E Property Address City /State ate- Legal Description: Lot Block Subdivision/CSM # 1 /4 Nu) '/4, Sec. , Tq?&N -Rj�-W, Town of - n/) PIN # — /b SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: E X 15044 & /Vtry ° y,� >,SO Tank manufacturer ld� .c Size ST/W (20D/ ° Setback from: House 7Z Well P/L 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 Type of system: Width r Length — Number of Trenches Setback from: House 710D Well '7 /W P/L 5 Vent to fresh air intake 2 /&22 ELEVATIONS Elevation �� .uG6 POSE Description of benchmark - 41 Lv&vy - Description of alternate benchmark Fo uV d 4- --) n/ /.}.;- 14( ",4f(-4 W4- LL o A) Elevation I/ F, .3 Building Sewer t ST/HT Inlet « /0 2! Outlet l Lev /0 '0, 27 PE - fiflet� /av 113 Pe-Bottom Header/Manifold Top of ST/PC Manhole Cover 17o-y- Id 9 o p � Distribution Lines (!) f 0 , Q g (2 S (7) V7 L b, 76 Bottom of System (�) �� (Z) gy� Z u ) 8 6 5 ® 8 7. Final Grade Date of installation/ 60 Permit nu ber 3 State plan number Plumber's signature License number Ap Date /ZJ& S Inspector Complete plot plan Or r 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. f '30 PLAN VIEW g2 b b b b �0 0 g �3 � INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353237 Permit Holder's Name: []City ❑ Village [ of: State Plan ID No.: Warren Carl & Sue I Town of Troy CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: aD 0 00 .0 Kk*_(-,,e.,,,1 — J 00 040 - 1103 -60 -110 TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I +�s w �, Benchmark ©, 0 r ob. 0 -Imp l 4 Alt. BM A oZ •qb 1(3. 81 Aeration Bldg. Sewer (o, 75 Ito. 1 C) Holding St/ Ht Inlet d :?- 32 CR. S3 TANK SETBACK INFORMATION St/ Ht Outlet 7.510 o4. TANKTO P/L WELL BLDG. Ventto ROAD Air Intake Septic y ' >Sp /5' NA D+ Betterm Dosing > Sc >roo ZS' NA Header / Man. S• � 9 t• 6 Aeration NA Dist. Pipe Holding Bot. System (,� PUMP/ SIPHON INFORMATION Final Grade t't•�o qs.3• , Manufacturer Demand St cove A- 1 3.85 ((7,. O Model Number GPM �„� Z,q �pZ,�( TDH Lift Friction System TDH Ft ST 1L Z oss H ead Forcemain Length Dia. Dist. To well —+� Z ,�,,,,,� It-96 )04.10' SOIL ABSORPTIONSYSTEM32� {,aI.Q 6r` Q 15`S 101•2a� N& TRENCH j Width r Len r No. f enches PIT No. Of Pits Inside Dia. Liquid Dept DIMEN I N 3 b IMEN I N SETBACK SYSTEM TO P/ L BLDG WELL I LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of r CHAMBER � a Number: f System: Cerif, „ 5� >Zoo -"Z,5-0 OR UNIT DISTRIBUTION SYSTEM Header/Manifold a� Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Ai Intake Length L;A�_ Dia. Length Dia. Spacing 7 ZtfD 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.) Inspection #1: 1 /2. /91 Inspection #2: Location: 188 Radio Road, River Falls, WI (NE1 /4, NW1 /4, Section 26 T28N- R19W_) - 2 8.19.404A10 1.) Alt BM Description = T�•��.,,.�a#,a�. « S vJ 6+ao.-can„4r W, �kC we12Q . I. 011C 2.) Bldg sewer length = ap, o If 0_q6 s 8q SS: 10.25 - amount of cover = > qZ. S er*Q. n q.Y2 4=6r. qo, og 10.$0 8q. zo . q•2`� t qo.?-G S � 1(.� =88r6� A LL �� - 4g 61.w 7` "" 'E .•. to,,,Qc� '¢ lz. t o = 8.90 Wt Plan re iJ sion 1quir d? ❑ Yes N p( 03 UU ✓r 2 6 Us �j other sid r additional informatio a S8 97) CI � t ` 1 Date Inspector's Signature Cert No Wisconsin Department of Commerce ' Safety and Buildings Division PRIVATE SEWAGE SYSTEM county: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 353237 Permit Holder's Name: ❑ City ❑ Village EINTown of: State Plan ID No.: Warren, Carl & Sue Town of Troy CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 040 - 1103 -60 -110 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 Benchmark O ngZ 2DO Alt. BM 1 07.9(0 3 Aeration Bldg. Sewer (0175 Q, (p Holding / Ht Inlet ::V 0el TANK SETBACK INFORMATION US/ Ht Outlet I!a •v� tsQ • Zq TANK TO P/ L WELL BLDG. Ventto ROAD DA 1 13 , 02 Air Intake Septic 5D t -> 5a I — NA Dosing >0 � > lop' � �� NA Header /Man. �.'� q/, 9 • `I� Aeration NA Dist. Pipe S3 .9 Holding Bot. System 4eC- PUMP / SIPHON INFORMATION Final Grade r Manufaclh<rer Demand Stcovet4l' 3•�� 3.0 Model Number GPM M 4-2-c ) O C• ZO TDH i Lift Fr' Ss ' S stem TDH Ft 2 ` • 9 O Z. b - 6 Forc n Length Dia. Dist. I•S j o 2 •a- SOIL ABSORPTION SYSTEM 3� C✓S `� �-- ' I'� �a5� = (� .�a 9GB TRENCH Width f Length , No O renches PIT No. Of Pits Inside Dia. Liquid Depth DIME 3 O DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufa ure SETBACK INFORMATION Type O CHAMBER Mode Number System: CA", �' Zvp > Z OR UNIT ZIL DISTRIBUTION SYSTEM OF Header / anifold u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length \&h7 Dia. Len ia. Spa > ZQp SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only , 2 Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched ' 6 Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ N g� 0 COMMENTS: (Include code discrepancies, ersons resent, etc.) Inspection #1: // /3o /qq Inspection #2: Location: 188 Radio Road ver Fal �NE1/4, 1/4, Section 26 T28N -R19 - 2 AA 1.) Alt BM Description = ', b��S 2.) Bldg sewer length = 20, U v d 0 = ` q Cz) - amount of cover = `f 2 6 4 11 1 0 vt- r- 200 VWJ� Plan revision required? ❑ Yes E] No set of side fora di o nal inf�n a ' n �. BD -6�0 (R 7) �� at t Inspector's Signature Cert. No. 1 Safety and Buildings Division Nvisconsin SANITARY PERMIT APP ION Po6 o WshingtonAvenue Department of Commerce In accord with Comm 83.0 .11�► e ! -7 '4, Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the sstrri onpeiot less' County than 8 112 x 11 inches in size. Vr (fe 0 N F ry Permit Number • See reverse side for instructions for completing this aplilicatiort State Sanita information ma ou p rovide be used for second Z y p y ry purposes , ST C] , � heck if revision to previous application IPrivacy Law s. 15.04 (1) (m)]. �+ �te Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT AL H �, Property Owner Name �l GA'2l. N c a, S Z6 TZ8 , N, R E (or) V Property Owner's Mailing Address L Block Number 2 9 DI D PU40 Cit , State Zip Cod Phone Number Subdivision Name or CSM Number vt 1`4CC3 W( 5 ' T YPE Or (check one) ❑ State Owned 0 It� Nearest Road ef Vil age Public M 1 or 2 Family Dwelling - No. of bedrooms Town OF J1 /O k0/q III 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) A) 1 ❑ New 2 p& Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------ System -------- System ______'______ Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 []Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 XSeepage Trench 22 ❑ In- Ground Pressure _ 42 ❑ Pit Privy 13 ❑ Seepage Pit 3 X S U 43 ❑ Vault Privy 14 ❑ System -In -Fill � Z C A) h- .. 4 - 026 !� VI. ABSORPTION STEM INFORMATION: -Ke .ley y deea / , - s `_ U 1. Gallons Per Day : Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade b&o ' Required (sq. ft.) op s d (s . ft.) als/day sq. ft.) in. /inch) 4-o 1 17 s Elgvn Feet Capacit VII. TANK in Ca allo g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks tit Tan � t� - �� �� s ❑ ❑ ❑ ❑ ❑ L ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' ame: (Print) Plumber's Signature: (No ps) MP /MNo.: Business Phone Number: D6cr� 63 � GSoi� 27 Plumber's Address (Street, City, State, Zip Code): -L Z f (4 l A;_ I IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) A roved Surcharge Fee) pp ❑ Owner Given Initial � � ��--�� I VA-Z/11 < �f Adverse Determination J X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: �- oar �, �« �?�,, e ff h e,-el bC � l e br i ^e o`� .l f U d I n S,,pi` L 1 ICJ V Pi�i �-y e 3, 5r'/J�✓ k ti - t e,cCe /Z Ur/ a a SBD - 6398 (R. 4109 ) DISTRIBUTION: Original to Cou y. One copy To: Safety & Buildings Division, Owner, Plumber �4- r- I Cpr inl ; Z f oo� GF�y b ti (0 1 1-1 R� D►o l I � B i g l►t I C O W c) JJOAUI Ca ca C `+ C E a) p O E CZ i - - - i I c N > C p ±' �. O C T— C� T �o�o = �I I T ---:- -0 L � I a o E r� x 0) I 1.1 m (Lf = U C7 r co O a O !, O 0- E T ca U p j . I o a) O j, a3 a) _ U) :�-- U)-Jn— 0 T 1- O U CL I as - r �� E�_ 8) -0 c� CO J O V O i x a) = 1 1 U L a) _ cu 0 O 0 � a) — — +� c � O O Q) - N JJ2 — +� - j � O (n Cn LO CL • • • • g a) I� o 7T 's Tim z. i ff E - f 4T Y - ` ~ Y � E om , D o F�m ,� �� ! _�I_- _ LL (° CO , 0 0 v CD 11� W W � C m -. C O W Y m $ Z � _ '�� m a CO —� Cv 3 L CO m �a m c m c V � - l0 = J Wisco andHum nRentof Industry, SOIL AND SITE EVALUATION REPORT Page � of Division of Safety 8 Buildings 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, and location and distance to nearest road. D APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R D Y DATE IZ, 2j PROPERTY OWNER: PROPERTY LOCATION fu- ' S V'�- 'OQ�) CfMl , L`� Z -ZJ GeVfitOT fJ E 114 N W 1/4,S ? - 6 T 2-8 ,N,R 19 E (or) W PROPERTY OWNER':S MAILING ADDRESS. LOT # BLOCK # SUBD. NAME OR CSM # 1 X25 '�t_ f��� o 1 D CITY, STATE _ ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ®TOWN ' NEAREST ROAD �z Lv Z `rfltlS !�) S kfD't _ S2AS Z e) Tom) o �Z ' [ I New Construction Use [>I Residential / Number of bedrooms [ ] AdditiQn to existing building (� Replacement [ ] Public or commercial describe Code derived daily flow b OD gpd Recommended design loading rate s bed, gpd/ft ' b trench, gpd1ft 2 �o�� 9 gpd/ft trench, gpd/ft Absorption area required \,� bed, ft trenCh,.f�? - loadin rate ^ S bed, 2 ' ' 2 Recommended infiltration surface elevation(g) � = titJ`f� t "'desi gn It (as referred to site plan benchmark) Additional design / site considerations l�STP�'L�'2 3 Parent material Flood plain elevation, if applicable N IN ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE I AT -GRADE SYSTEM IN RLL HOLDING TANK U= Unsuitable fors stem OS ❑U ®S ❑U ErS ❑U OS ❑U ❑S OU ❑S ®U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourJary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITtench A ^:<€ n - t2 l>J�-t — s i 1 z �r sb �- - • s z �Lz Z �z 3] toy �z 3l� — sly Zmsbk m cw — , S Ground 3 a� -6y ,.S�I��� - sl -sal �('-'sb�z m�� es •Z .3 elev. c 6 .Z ft. S i• b Depth to limiting factor ��5 -- eO l ?Il9•`' lz Remarks: Boring # p _L C) V03 ' 1_ 3LZ SL� z 4' P] VVl' aZW * IJP •' . 3 3 Z6_e -2 Yyp- Y — s � wr�1 -- �S 174 .� Ground elev. {� 4L 1(� lU� 2 l� `� o S5 wt r Depth to limiting �' S ? U 1.�� O _ r factor 2 LL$ L> S Otic? Remarks: r �CrNI �fTY CST Name Print Phone: Arthur L. We erer 715 425 - egerer Soil T ting & Design Service -P.O. Box 74 River.Falls,WI 54 Signature: Date: CST Number: 4' -� 9 4 ` 4� 220254 I PROPERTY OWNER W f y-(Z" SOIL DESCRIPTION REPORT Page ? 3 � PARCEL I.D.# ty0 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /tt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. — rB 10 tZ 3 Bed Trerxh 3 ?- Sb ►t wi `f ��-v Z 1o=z� 10`t 3l6 si J �unSbk w� �`l- C.w -s Ground 3 2�-$l� S`fR �/ S CS I�i� m U`FF- L° �0 , . S elev. gy -S lt. so-) S �t 31Z — s l v>� ►��1- �S - • � _� Depth to R y/6 �s cT S 9 wl 1 _ , s ` b limiting fac for "A f - r S31 ., i Remarks: Boring # L l 1 t ' E Ground i elev. ft. tt Depth to t limiting factor i Remarks: Boring # Ground elev. i ft. I Depth to I limiting j factor, Remarks: 3oring # around ;lev. ft. )epth to imiling actor Li Remarks: _ PLOT PLAN Page 3 of 3 SCALE 1 "= 30 ' - wooer Hof ZSO' T T T �) Or— at gLi b �LD1fnAjt'� C V LF ( BEEP i ; a-0hJ5?�C�710lV) O.0 dJ `f DP OF q' -i l_, V, `` b!n • LUoD no %T- w'�Z - E toy - Z' Ow`lvp of ivoTC, 10 _ tfv sTPCI..c� � ►N 3`t�cl.<. y }�,�, - E} 3 ` wl pF 137 SO' LSSyvG w 1M � G � � �e.l`r`r S i D�11�v►� LwiZ >_L e.�f l���s • `nZs,�,� -� �v _ pz 1 tv - , jjLe�1 eI EIZ UPMW X r T)�4(!�- OF a9 -Z�9 zzozsy ( 715 ) 42 -0169 CST Signature Date Signed Telephone No. CST # NOV -22 -99 MON 02:14 PM NELSEN WEBER SURVEYING,M 1 715 425 6864 P.01 WEGERER SOIL TESTING and DESIGN SERVICE SOIL TESTING - SEWER SYSTEM DESIGN ATTN : DATE CC: SUBJECT: Mv� nZ_�, THE FOLLOWING ITEMS ARE LOCI G r£D' 0. OF DESCRIPTION COPIES Sa S 1•� BLS ��S SL . SENT TO YOU FOR THE FOLLOWING : R ASON E S i,-" FOR YOUR USE FOR REVIEW AND COMMENT INFORMATION DESIRED WEGERER SOIL TESTING AND DESIGN SERVICE P.0 -BOX 74 421 N.MAIN ST. RIVER FALLS,WI 54022 PHONE 715- 425 -0165 NO.V -22 -99 MON 02:14 PM NELSEN WEBER SURVEYING,M 1 715 425 6864 P.02 PLOT PLAN Pape of SCALE �r � s A LIJI o. H P �I s Zso' +K T Lo tw of a8 jvua � 13w1 t4-1 tM— 100.0 o4J 1vP of L I MtL, 6 bf�. vx)oD pe_ce Po or - t- ,sac» - me... Tz? .57- pt z7 50' ls►+vG w 1771 W, r ki _ Z 2." D el'_' fw� �-A k1 &. qty U X1 a bhp. iZ v�seu zzoisy CST Sin tore o. ! h 5 9 Date Signed Telephon No. CST # 10/21/98 WED 07:25 FAX 715 386 4686 ST CRX CO ZONING ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspect the septic tarl% presently serving the C�AW&�,�4WRE-AJ residence located at: k, MA/ I section T'70N - : t-� f R I? W, Town ((Z0 Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears t be functioning properly. Last time serviced. Did flow back occur f om absorption system? — Yes -�NO (If no, skip next line) Approximate volume or length of time, .-.— gallons zainutes, Capacity: Construction: Pref concrete Steel Other Manufacturer: (it known) W16-57�s� Age of Tank (If known); ? A� {Sig tore) {Name} Please prin (License - Ku — mber) Date Form to be completed by licensed plumber (-c,1A5.06 Wisconsin Statutes) or Licensed Disposer (NR 113 Wiscon=sin Administxativp Code) Plumber (appl f sanitary permit) Cez7t,f i , cation: In accepting the above statement regarding existing s�J)tic tank, condition, I certify that the tank to the best Of my knowledge wjj* "OnfOral the requirements of ILHR 83, wis. Ad C ode a m e —Signature - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuycr ( ✓�'��� `'�''1 Mailing Address - f � � ` Iozz Property Address �_ ((� -- -- _ _ __ (Ver required from Planrung Department for new City/State �1 d 4 �� '�/� Parcel Identification Number - I.. I,GAL DESCRIPTION p Property Locationn - ' ;, n LQ %, Sec. (A ( Ta 8 N -R 1 / _W, "Town of 7 Subdivision - - Lot # -- - - - - -_ -__ Certified Survey Map # Volume , Page # O `"J -) � �t Volume I I S Page ii (0 _ / Warranty Decd # � ______ Spec house O yes O no Lot lines identifiable 0 yes L no SYSTEM MAINTENANCE Improper use and ma intenanceof 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 I nto 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 cemfication form, signed by the owner and by a master plumber, journeymanpltmlber, restrietedplumber or a licensedptrnper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and primping (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 standard 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 as been mauttained must be completed and returned to the St. Croix County Zoning Office within W days of the e y expi on date. SIGNATURL' OF APPLICANT DATE OWNER CERTIFICATION I (w certify that all statements on this form are true to the best of my (our) knowledge I (we) am (arej the owners) of the pr de cribed ab c, by virtue of a warranty deed recorded in Register of Deeds Office 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 cemfred survey map if reference is made in the warranty deed d c J fiQ { ST \rr. B \R OF WISCOWN FORM 1982 x ,� V It WARRANTI DEED DOC,2 N— r�_ 1 4 This Deed made bet,seen Thomas A. Giere Family JAN 1 6 1996 Trust dated `larch 20, 1992, Thomas A. Giere and } 11:00 A;,j Shirley F. Giere, Trustees Grantor. 1 . + Carl Micah Warri-n and Sue Nanette Warren, husband and wife as survivorship marital property Grantee. Witnesseth, That the , aid Granter, for a caluabie consideration - One dollar or other good_ and valuable consideration �� rr..rt> to Grantee the folloo(Ine described re31 estate to St Croix C "inty. State of Wisconsin: The N% of NW- of Section 26, except a triangular piece of land in S14 corner thereof, commencing at a point 10 rods North of said corner; thence S 10 rods; thence E 16 rods; thence NWly to point of beginning, containing i acre, all in T29N, R 19W, and also excepting a parcel of 4.59 acres located in the Parcxl Idenufi atom \ mtrr NE', of NA, of Section 26, T28N, R19W, further described as follows: Beginning at the SE corner of said NE- of Nw4 thence IT along E lire of said N'W4 a distance of 400.0',. thence W parallel with the S line of said NE- of N101 a distance of 500.0', thence S parallel with said E line a distance of 400.0'; thence E along said S line a distance of 500.0' to the point of beginning. St. Croix County, Wisconsin. This Warranty Deed is given in full satisfacation of that Land Contract between the parties hereto recorded August 6, 1990, in Volume 877, page 636, as Document 'o. 461154, and also in satisfaction of the Amended Land Contract recorded July 31, 1992, in Volume 961, at page 493, as Document No. 486600. Grantor also known as Thomas Giere Family Trust dated *larch 20, 1992. rnls is not homI proprrt,. TRANSFER S `fi1C xis putt .. Together Nsith ail and angular the hereditaments and appurtenances thereunto briongine: \nd grantor �sarrant- that the title is rood. +ndefea,iNe In fee imple and free and dear of encwnhrances except easements, restrictions, reservations, and covenants, if any of record, and highway rights of way, and liens or encumbrances created by acts or defaults of the grantees .end will %arrant end defend the ,ame. Dated this 9 da} of January 1996 z ' (SEAL) � s ISE \1 Thomas A. Giere, / stee Thom Shirr. Giere Trustee �'. -._ _. __ I_ AUTHENTICATION ACKNOWLEDGMENT FICRIDA Sienature(st -- -- STATE OF r ` Count\- _. authenticated this dal of _ 19 Perss�nAli. came hctore me this _ das A 1 the abate named 0 A Cieee, ,1�7, eg TITLE: \IE\IBER ST: \TE BAR OF \\ IS( PAMELA A MY =dMISSION / CC 340M + if not. _ EXMIM jawry 9.1M _. authonied he §?06.06. Wis. Stats) 1 �.d � ���yP !�, n to he the pet�ori_4 sh rse.utcc the torrgu+ne ins mint 1 3. o'.t i ' - 'e the ate THIS !NS-aU'.!ENT V.AS DRAFTED By Edward F. F. Vlack, Davison & Vlack 200 East Elm St., River Falls, WI ' ( 715) 425 -1525 Notary Pubs: /I�e`fQ Counn. \\t•. t ttitgnatures may hr authenticated of ae6nomledgcd. Both are not \ts :ornrni i l +rim nr t tit ma. 'tare esplrat ;.r.t "ate: necessary.) t �� %RR \t\ IM 1) NyR (1F wl�C (, \a♦ .. _ -. ..