The URL can be used to link to this page

Home My WebLink About030-1096-10-100 G .. p 3 N p d �1 c 3 C ° 3 r* W ' !TD 7! S1 ID I c m O ( O O CA) W z z y Z o CO W �^ N W O• =r L p » 0 O O C O p L 4) Q ICI W W fl. O Rl Ill ro H N N N N O O .a C 4f Vl j W C CD CD N C A CD 7 W 0 N c m m a 'm m' o ' o CD o co o 3 p a a o CD fNl—I �N H y N C ° CD v ° D z CD � a - i I v> D � c m cn W a a m D W a CL o o co a = 0 co I� 0 �. c\ x g w I CL CO CO Z 3 CD ccoo CO O CD d cn o c N CO o o, -4 Q � .. Q z I z' v z 0 0 0= 0 0 0 � Y e o Z S S S S C SS c 4 5 c < Z CO) cn O 0 O3D N y O � N y y O D v �vv� 3 CD CD I D CD CD CD to CD N CD CD A - CD N 3 C- N 3 N M rn z ° z, z z pz 0 v o m ST E `° m ! r • M CD c CD CD CD m W m 0 co C a n 3 m 3 Z m C CD C 6 v� 3 CD in c CL a A (A -i W a CD a CD N 3 a x ° m y z y z CD CD W W a I I m Q. 2 y CL a v3 o -n co o ago o a Q 5 a a S CD O N N m oZ �d w CD n c n n y a0 I n � A N <0 I � c CD cn cc N o I I a I I o o qb fD m oro w p tA o CD °o ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner A A N-R R-o1�► Address.k 1 City /State o s �., � 00UNY 1 ^ti 1 !QNiNG0FF1U Legal Description: Lot �_ Block Subdivision/CSM # a V d I • ` ( 3 �O J ' '/. '/, 51,1, Sec.L, T b N - I $ W, Town of 5T. aSA PIN # 030 - Oci� - Ib - ID SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC 1 000 / Setback from: House y 3' Well Sa t P/I, U ' Pump manufacture_ r- � Model _ Alarm location —� (HOLDING TANKS ONLY) Setbacks: Service road o es air m Meter location --° Alarm location SOIL ABSORPTION SYSTEM: Type of system:—TtA't Itc ( Width Length Number of Trenches — Setback from: House 1 Well 7 5• I P/L S ' Vent to fresh air intake 7 $ ELEVATIONS Description of benchmark �o Q 3 � Qp Description of alternate benchmark Elevation Elevation Building Sewer ` ST/HT Inlet �9 ST Outlet -8S PC Inlet PC Bottom -- Header/Manifold Top of ST/PC Manhole Cover U Distribution Lines (�) 1 � - ) I S . 0 $ ( ) Bottom of System (A) 5 �v (L) Final Grade Date of installation B /lo/ PPermit number 3 5 1, State plan number Plumber's signatureC1l�Wz icense number Date a la�f Inspector oU �C s` 1 N R � ,•�"V` (�/GtiiGt S(,L °mil �� (, complete plot plan Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: Safety,and Buildings Division Count • 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)]. 315963 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: B ROWN, WAYNE ST. JOSEPH CST BM Elev. Insp. BM Elev.: L Description: Parcel Tax No.: 030- 1096 -10 -100 TANK INFORMATION ELEVATION DATA A9800352 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e Ic .Ge. - ([fib Benchr;I Sv� W y 6 Dosing Aeration Bldg. Sewer Holding 0I t Inlet s Sa 2 1 TANK SETBACK INFORMATION �y p ; St iK Outlet 5 17 qR TANK TO P/ L WELL BLDG. Air ROAD Dt Inlet tic s �� c/' NA Dt Bottom Dosi A Header /Man. Ae tion Dist. Pipe iZ Holding Bot. System T) `f-� PUMP/ SIPHON INFORMATION Final Grade (1.'5 j Manufacturer Demand � fl� 4 Z.Z,, /C.1:1. T7 Model Num GPM TDH Li Friction S e m TDH Ft oss Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED Width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid D h DIM N •7S DIMENSI N SYSTEM TO P/ L BLDG WELL LAKE / STR M LEACHING Manu SETBACK CHAMBER INFORMATION •t- �lG7 I`f(7� O Mod tuber: y �t/Ctt�► DISTRIBUTION SYSTEM Y, la,. ^ . Header /Manifold / Distribution P�ip s) x Hole Size x Hole Spacing Vent To Ai Intake Length Dia Length ( 7 5_ 46rd. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 32.30.19,SW,SW 1214 N. TROUT BROOK ROAD Plan revision required? ❑ Yes (� No Use other side for additional information. SBD -6710 (R.3/97) Date Insp ctor's Signature C�i� V i SANITARY PERMIT APPLICATION 20 Safety and s 1 E. WashinlgtonAve sion sconsin In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County �� , than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary /y Permit Number The information you provide may be used by other government agency programs [] Check it revision to pYevio�pplication (Privacy Law, s. 15.04 (1) (m)). Me State Plan I.D. Number 1. APPLICATION INF RMATI - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location (Z W 1/45 U 1/4, S T a d, N, R� g E (or) Property Owner's M ilin Add s • Lot Number Block Number a 0 U RIo Cit tate Zi ( n ) mb bdivics Name or CSM Number )� �/& 3 koa 9a9 II. YPE s BUILDING: (check one) E] State Owned it Nearest Road Public 1 or 2 F amil Dwelling - No. of bedrooms Town OF 19-OLL F brl III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(.; 1 ❑ Apartment/ Condo A 2 .30-1 9.3508 0 - l U I u 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. m New 2 ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an , ___ystem ___ System _____________ Tank Only Existing System Existing System B) 5(A Sanitary Permit was previously issued. Permit Number a 4 g 0 6 Q Date Issued 3 g V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed J1 []Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 KSeepage Trench k&" "I � �� ❑ In- Ground Pressure r / 42 ❑ Pit Privy 13 ❑ Seepage Pit St &T• 7S 43 ❑ Vault Privy 14 E] System-In-Fill S VI. ABSORPTION SYSTE INFORMATION: 1. Gallons Per Day 2. Absorp_ Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. S stem Elev. 7. Final Grade \14 S O Required (sq. ft.) Proposed edd (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) �- 4 �.So (u ((,e s L. ?3.S(_Feet p Feet Capacit VII. TANK in gallons Total # of site INFORMATION Gallons Tanks Manufacturer's Name co�c Prefab Con steel g ass Plastic xr- pp New Existing strutted T nks Tanks Septic Tan r Holding Tank 1 0QU 4 Q El )(f 1:1 1:1 E] Lift Pump Tank /Siphon Chamber ❑ 1 ❑ ❑ ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Sig ture: (No Stamps) MP /MPRSW No.: Business Phone Number: T� o� �n a a Is -3 L - v.� o Plumber's Address (Str et, City, State, Zip Code): `n ) I OU gv IV e3a ►- W) f tad 1 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit F (Includes Groundwater D ate I ssue j lssu�in Surcharge Fee) A Igneture (No Stamps) r Approved ❑Owner Given initial r (r rfilr/1 e ll Adverse Determination 6UV �V �° X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: St38 (R t 1196) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Owner, Plumber 1 : O.1_ o r I L, �� I n 1-1 ► 1 ! U :� ;� it l� I I 1 ICI f EC • Jr I: A ` ._ �t • ( I 1 f 5-e • rk... s rj2.u 4- -5 � yo S ��ti C, C7 w S. 1 '...•.. � U� �ICoi� p •' r • ' p`h' f J 7 u Ile FRESH AIR INLETS AND OBSERVATION YI.PB CROSS SE CTION y Approved Vent Cap �; . �. � - — _ _.� _ ^-•4: N ��1.. �.�«�`. � ?dew Inc( r Minimum 12" Above �_Ci 4,�� I,ers .. �� nal Gr a de n yu A v e pe `� j To Fin & Grades Wisconsin Department of Industry I�SITE EVALUATION Labor and Human Relations �a , , Page of Division of Safety and Buildings nce wlihs. ILHR 83.09 Wis. f ' •' �• Attach complete site plan on paper not less tha f3J/2 x 1 County 1 it A qq Plan mu' include, but not limited to: vertical and horizon I Teference point (�Ai�); �irection'and� S C Off' percent slope, scale or dimensions, north arrow, "and I #egen tance to nearest�oad. °� Parcel LD. # 03 62 / 4�o ' /�� 8 ^" ST CROIX '�- APPLICANT INFORMATION - P/ease,priht all ir0onlll Nion. R ' wed Da Personal information you provide maybe used for.second pu'rppses ;14-04j (m)). t Property Clvvner /'' �� roperty Location t siV ?L K/ ) Govt. Lot Sk) 114 1/4,S ,7 T .30 ,N,R /f E (o W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# i,?Z s _r:,vP0s7 f //f/ S l go/ // /',f . 3�G City State Zip Code Phone Number Nearest Road t10SD,✓ �/. SyprC� (3�(� 2 ❑ city F vino Town New Construction Use: esidential / Number of bedrooms Addition to existing building ❑ Replacement //'' El Public or commercial - Describe: ,�/ /Q - �(! D 7 ElQ�yiy L c—,y fJE� Code derived daily flow X P gpd Recommended design loading rate N-W bed, gpd /ft trench, gpd /f1 Absorption area required &Zoe bed, ft trench, ft Maximum design loading rate0A bed, gpd/ft2 ? trench, gpd /ft Recommended infiltration surface elevation(s) S� G 3 ft (as referred to site plan benchmark) Additional design /site considerations L Parent material _51f4f p Y *lV7 - W 4 Flood plain elevation, if applicable ft S = Suitable for system e t Convonal Mound In- Ground Pressure S AT , - Gradg System in Fill Holding Tank , U = unsuitable for system s El CC'S ❑ u [�❑ LA 5' U 'S ra LD u ❑ S 9-CI ❑ s SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ig -& AMe 31 - L_ Z s�,C S Ground V G -2 _ 5 / Y SL Z�.S "Wwl w �- . S • �O e �99. p p ft. 7.Sy/� Depth to limiting factor ll Remarks: Boring # Z z �• z /Ow /ash c� y ;. s 3 zz 3 -7.S!IR 0 4r,) . - 7 : . Ground 7• -Sy �l( S d, S a �, •7 ll elev. _D Ire S d. � � -- . � ; Depth to limiting factor 7 , ILl in. Remarks: CST Name (Please Print) Signature Telephone No. ,P r - .. Signature ?�s -34 -PIPS' Address /b. I Date h CST Number `s to O -— yob to 7' L' �lc,S sE a p o f 3/y 1 1 120 a3 Z., . Tor 3 1y 20% l P) 0 S �` & P9so coosa O AS gs ws 0 so -- - -- 1670 Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM C ty: Labor and Human Relations INSPECTION REPORT ST. CROI? 'Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Pe No.: GENERAL INFORMATION "299060 Permit Holder's Name: ❑ City ❑ Village t Town of: 7tate Plan ID No.: BROWN, WAYNE ST. JOSEPH / CST BM Elev.: Insp. BM Elev.: BM Description: ' Parcel Tax No.: 030 - 1096 -10 -100 TANK INFORMATION ELEVATION DATA A9700377 TYPE MANUFACTURER CAPACITY STATION HI FS V. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System I TDH Ft L oss H ead Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST. JOSEPH 32.30.19,SW,SW 1214 N. TROUT BROOK ROAD Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. C r ` • See reverse side for instructions for completing this application State sanitary Permit Number c�?99Ob d The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Pro e y Owner Nam Property Location 14 Lo Trip 113 a 1/4 1/4, .�� T 30 , N, R /q E (or )OV Pro a ner's ailin ddress Lot Number Block Number AIR Cil S ate Zip Code Phone Number Subdivision Name r CSM Numbe II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ qt Nea rest Road [] VII age r E] Public ja 1 or 2 Family Dwelling - No. of bedrooms � Town of Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax , Nuumber(s) G 1 ❑Apartment /Condo (0v / &V _ 16 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.%;;rNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an -__ System -------- System ------------- Tank Only System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Pq Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 4 n� Elevation_ 1-1 /h� V 5 (Q s7 3 5 l O $ - 8 83•w Feet 735 Feet act VII. TANK in Ca allo g Total # of r Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel Plastic p New Existin strutted glass App. Tanks Tanks Septic Tank or Holding Tank /00 0 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. t ber' me: (Print) Plumber's Signature: (No Stamps) MP /MPRSW No.: Business Phone Number: o e. 1 Plumber's Addre s (Street, City, State, Zip Code): tt// T® IX. COUNTY / [DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) XA pp roved E] Owner Given Initial Surcharge Fee) ` � Adverse Determination 1 q_Z19 7 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber (� - ..P. B. L 6 P �.• N A M E WAL N Bg _. NA ► I3 -ot-r� L O CAT I 0 .� .T 4. fi. � a _. __ - �_ - i E C E E :/ - O q _ �..__...._... �.:� n T _.... g � �..- CT Ali . By t h' .3 �QDRUOM _ S� c • Nar^Q lo co �1. o� 0 8 • 8� 6�= io n o� s �' N o� N ' �IJn )J5 z k ►00.0 .) fg rm S►p �"! c �� r t� fi U :,kJ h L r bll, ENO is �0o'f 31 38h .FRESH AIR INLETS AND OBSERVATION PI.PB .. ...... CI;QSS SE CTION Approved Vent Cap Minimum 12" Above 1►`hPl G Ei nal , ra SjG' - - -� - R •• �I �'' Marc A" Cast Iron Above Pipe Vent Pipe To Final Gradr. Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page i of -;I Labor and Human Relations Did sign of Safety & Buildings in accord with ILHR 83.05. Yft - -Ado gode / ��.;, COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in sizo. 'PJ'4ti mustio but ST. Croix not limited to vertical and horizontal reference point (BM), direction and�%ot`slope, shaf bs° " RCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. pending r' IEWED BY DATE APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION i PROPERTY OWNER: 'PROPERTY, , ATION Claire H. Dilts GOL(Dr�gprF;ti v4 T 1/4,S 32 T 30 N,R 19 for) W PROPERTY OWNERS MAILING ADDRESS \ :LOT BLQ S NAME OR CSM # 1218 Trout Brook N. ' r I rli ` oendina csm CITY, STATE ZIP CODE PHONE NUMBER []CITY E YOWN NEAREST ROAD Hudson ( ) r;4Q_&d St. Joseoh Trout Brook Rd. NJ [x] New Construction Use k ] Residential / Number of bedrooms 3 [ ] Addition to existing building ] Replacement [ j Public or commercial describe Code derived daily flow 450 g pd Recommended design loading rate • 7 bed, gpd /ft . 8 trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate _gi bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) 84.60 ft (as referred to site plan benchmark) Additional design/ site considerations alt area sytem el . = 83.05' 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 K7 S ❑ U :91 S ❑ U ® S ❑ U EIS ❑ U [IS ® U 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 Trench 1 1 0 -7 10 r4 4 none sil 2msbk mf 2 7 -31 10 r5 4 none sicl 2msbk mfr CrW I if .4 .5 Ground 3 31 -36 7.5yr4/6 none sl lcsbk mfr gw na .4 .5 elev. 87. ft. 4 36 -84 7.5yr4/6 none cos 0SQ mvfr na na .7 .8 Depth to limiting factor +84" Remarks: Boring # 1 0 -8 1 4 4 none Sil 2msbk mfr cs lm .5 ' .6 ? 2 8 -31 10 r5/4 none sicl 2msbk mfr CrW if .4 .5 3 31 -84 7.5yr4/6 none ms osq MV na na .7 .8 Ground elev. 88. ft. Depth to limiting factor __T + 84" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave., New Richmon WI 54017 Signature: SD Date: 9 - 5 - 96 CST Number: mO2298 STEEL'S SOIL SERVICE Gary L. Steel Shire 1554 200th Ave. � CSTM2298 1 4�4 S32 T30N - R19w New Richmond, WI 54017 MPRSW 3254 Diets town of St. Joseph (715) 246 -6200 lot #1 - csm 1 =40' Ern. = top of SE lot stake el. 100' �19 G v 19 A60 Q Gary L. Steel 9 -5 -96 °f. CERTIFIED SURVEY MAP Located in part of the "SW} of the SWi of Section 32, T30N, R19W, Town of St. Joseph', St. Croix County, Wisconsin. NC O� WI< Corner of Claire Di1tis Section 32, 1218 Troutbrook Road Hudson, WI 54016 c M • ID .. L. O UNPLATTED LANDS _ +' #0 N _ A M N .° 9.5' N88 489.86' 'v 240.58' 249.28' aiw �o 0 LOT i I:OT '_ 2 3•.22 Acres Inc. R/W 3.19 Acres Inc. R/W 4 , in 140,272 Sq. ft. u; 139,078 sq. ft. o � s - $ 3.00 acres Exc. R/W m 3.00 Acres Exc. R/W C' NI '". 130,855 Sq. Ft. 130,853 Sq. Ft. r �M„ Q o� 00 JI I %n -.. S JI o+ S cp Q pt N In V W� N Q ti .... S88 13"W" 318.58' .. M 249.28' 1 � - 69.30' ` 3 ° 68.74' 249.28' .— ./ 1 S88 57'13 "W 318.02' 8 T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will. only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ---------------------------=--------------------------------------- owner of property Local ion cif property �! 1/4 = 5;,�) 1/4, Section _ ,T .J N -R Township 1.,� T sPPA Mailing address /rwj z(`Q4� Address of site Subd i vision name Lot no. Other homes on property? Yes No Previous owner of property ) op, ; l Total size of property Total size of parcel e"s Date parcel was created Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house) ? Yes ✓ No Volume 'q� and Page Number [ as recorded with the Register of Deeds. --- - - - - -- ---------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRA111'Y DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description referen to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge' that I (we) am (are) the owner(4) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. ! Y , and-that I (we) presently own the proposed site for the sewage disposal .system or'q (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register o.E. Deeds as Document No. Signa re of - App scant Co- Applicant 0.1fi• tit .,i1jila ilre Data. of signature ST(' - Ills SETTIC TANK 1N1AINTE'NANCE. A(:ItEFIMENT S1. Croix Counf)' OWNERMI)YEIt MAJI,ING ADDRESS PROPERTY ADDRESS ZA1 A ),,, (location of septic system) Please obtain fion, the I'lanning, Dept. CITY /STA'1'E PRO PE,,R TY LOCATION �113_ 1/4, s5 1/4, Section ,� I' � N - It �_ «• TOWN OF �� T ,Pn� ST. CROIX COUNTY, %% SUBDIVISION LOT NUMBEIR CERTIFIEDSURVEY MAI' , VOLUME, PACT 3&- -; LOT NUMBER ' Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out (lie septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic lank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July I, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. 'Ilse propetiy owner agrees to submit to St. Croix Zoning a certification fo,m, signed by the owner and by a neater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) file an -site wastewater disposal system is in proper operating condition amt (2) afler inspection and Pumping, (if necessary), the septic lank is less than 1/3 full of sludge and tic11m I /We, file undersigned have read the above requirements and agree to nlainlait, the private sewage disposal system in accordance will, the standards set forth, herein, as scl by the Wisconsin DNR Cetiification slating that your septic has been maintained nmst be colmpletctl and tetunlrd to the St Croix ('nunl� % Officer within 10 days of the three year expiration dale SII;NIa T �G� A, uA n . `I ('tots l't1un1� l.11ning; (Mict. ( illvl'It1111C111 (�l'llll'1 1 101 1'atnlu I,acl Road 111111.,,11. W1 '14016 1I /'1