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Home My WebLink About040-1237-70-000 ST. CROIX COUNTY ZONING DEPARTMEN AS BUILT SANITARY REPORT RECErVEQ - � IG� Owner ' LC 1 f Address t ST c 19 ,98 City /State : �, -�S . _ , rar G_____ _ zorucota� Legal escription: Lot Block Subdivision/CSM # PIN # Sec. 3 , T -R �W, Town of ♦ r- � � - RMATIO G 4 b` SEPT TANK DOSE CHAMBER BOLD IN TA IN 5 � �(� , Tank manufacturer �� _ Size ST/pc / Setback from: House . 'Well P/L Pump manufacturer 2a �w' Model 67 Alarm location A (HOLDING TANKS ONLY) Water Line Setbacks: Service road _ Vent to fresh air intake Meter location Alarm location SOIL ARS TION SYSTEIVI i Type of system: - t Width 3�� Length . 26 Number of Trend Setback from: House'. Welt 26 I � Vent to fresh air intake s? �(_ _. -- ELEVA't`XONS . Elevation '"Elevation Description of benchmark _ _ _ , Description of alternate benchmark Building Sewer _ ST/HT Inlet e22?Y -- ST Outlet' L7. q PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Coves Distribution Lines 4) Bottom of system (�) _ T • f. S> Final Grade Date of installation IlAaepermit number 3 0 776Y State plan number t' _ � �f� 1�J l 4Sl _ Plumber's signatur License number Date Inspector � ��`�" C.ompkle pl plan 3 _ I t I L - -- -- I. . ... _� C - - TNd f ' _. ► ' I " I I -_ fit. C I " Y t - , I f �_•_. t � T �- - I " " I , t I 4 �. i s N ~ HEAD CAPACITY CURVE UJ U w MODELS 53- 55 -57 -59 Model "53/55/57/59" 25 Ft. Meters Gal. Ltrs. g 20 5 1.52 43 163 0 w 10 3.05 34 129 15 15 4.57 19 72 a z o Lock Valve: 19.25 ft. (5.9m) 4 a 10 0 ~ 2 3 1 5/ 16 �--- 6 5/32 5 � 4 5/8 1 1/2 –11 112 NPT 0 3 15/16 U.S. GALLONS 10 20 30 40 50 i LITERS p 80 160 4 1/16 FLOW PER MINUTE OM97 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Variable level Float Switches available. • Variable level long cycle systems available. • Available with special cord lengths of 15', 25', 35' and 50'. • Alarm systems available. 10 1/1 —� • Duplex systems available. 3 3/32 I SKa59 SELECTION GUIDE Single seal Control Sokcdon us8ngs 1. Integral float operated mechanical switch, no external control required. Model volts -Ph Mode Amps Simplex Duplex CSA UL 2. Single piggyback variable level float switch or double piggyback variable level MSY55 & M57/59 115 1 Auto 8.0 1 or 1 & 7 — Y Y float switch. Refer to FM0477. N53/55 & N57/59 115 1 Non 8.0 – 2 - or 2 — &6 --S or 4 — &5 Y Y 3. Mechanical altemator "M -Pak" 10 -0072 or 10-0075. • BN53 115 1 Auto 8.0 Y Y 4. See FM0712 for correct model of Electrical Alternator. • BN57 115 1 Auto 8.0 — N Y 5. variable level control switch 10-0225 used as a control activator, with Electrical • BE53157 230 1 Auto 4.0 — Y Y Alternator (3) or (4) float system. D53155 & D57/59 230 1 Auto 4.0 1 or 1 & 7 — Y Y 6. Four (4) hole J - Pak, junction box, for watertight connection or wired - in simplex or E53/55&E57159 230 1 Non 4.0 2 or 2 & 6 3 or 4 & 5 Y Y 2 pump operation, P/N 10 - 0002. • Single piggyback switch included. 7. Two (2) hole J -Pak, junction box for watertight connection or splice, P/N 10 -0003. D CAUTION For information on additional Zoeller products refer to catalog on Piggyback variable Level Float Switches,FM0477; All installation of controls, protection devices and wiring should be done by a qualified Electrical Alternator, FMO486; Mechanical AJtemator, FMO495; Sump/Sewage Basins, FMO487; and Single Phase licensed electrician. All electrical and safety codes should be followed including the most Simplex Pump Control /Alarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisvrfle, KY 40256-0347 Manufacturersof. . Q SHIP TO: 3649 Cane Run Road " ® (502) 778-2 K 1(800) 928 -PUMP Q M IT' Pa,Nas �NCE �9�9� httpztAvww.zoellercom PUMP !O. FAX(502)774 -3624 0 Copyright 1998 Zoeller Co. All rights reserved. Wisconsin Department of Commerce Y Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count ST CROIX INSPECTION REPORT GENtRAL INFORMATION (ATTACH TO PERMIT) Sanitary 998 Persona �inffo you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)]. P ALV a ARADO a C] C� Village [] Town of: State Plan ID No.: CST BM Elev.: , Insp. BM Elev.: B!apescription: Parcel Ta64gj- 1237 - 70-000 (vv t oo, q I M ; TANK INFORMATION ELEVATION DATA A9800157 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se ti C IM 6-0 Bench /.fly 101•4� Dosing �/�JiC�iG/ �Db tM ?• Aeration Bldg. Sewer ( - i.of5 9,8 - Holding ®/v Inlet 13.75 q 7 TANK SETBACK INFORMATION Q& Outlet 7. 3— TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet �;[�/� 7'7. Air Intake Se ti sp a�� Q ''yw NA Dt Bottom /7.27 y 2 Z o Ing - NA Header/ Man. ci *2 �� •6 7 Aeration NA Dist. Pipe $.CYV -72. 5 IP- [ Holding Bot. System /0.2/ 46 GIJ• /3 9/• SL' PUMP/ SIPHON INFORMATION 3--7 Final Grade - 7 q / 7 Manufacturer V1 �, Demand y } � /D•S �d 9°f Model Number rte- - Zo GPM TDH Lift g %y5 Friction/ . ,< < Systems TDHr�� Ft Head Forcemain Length I 5' I Dia. ;�' I Dist.ToWell SOIL ABSORPTION SYSTEM ,4 �5 - BED Width 1 Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -'S DIMEN I N SYSTEM TO P/ L BLD+GWELL LAKE / STREAM LEACHING Manufacturer: SETBACK CHA ER INFORMATION Type ' Z_0 OR U T Mode Numb Syst DISTRIBUTION SYSTEM /!; k -C& e& c-:ff S;e/Cwi�►d (nE:� /f+�-�� Header /Manifold `/ � Distribution Pipe(s) ' L s x Hole Size x Hole Spacing Vent To Air Intake Length /0-5 Dia. l Length �. �T Spacing / �� Cha �n ,r Z 00 + SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx 7ed/Sodded xx Mulched Bed/ Trench Center Z 'N • Bed /Trench Edges Topsoil s [] No E] Yes E] No COMMENTS: (Include code discrepancies, p ersons resent, etc.) ' r-o& P p p C7. Z-.) LOCATION: TROY 3.28.19,NW,SW 618 OAKLEY CIRCLE — COUNTRYWOOD I LOT 66 A�-(•�� ' 4�o h�a� c1lJ 11,v�,,, �i dfn.�.�,bav -t bl s��t� � (3), U4.e, �?ae_irer 53 �s a�— s`e�p�y /'v P w �� -ti�,lf GQ Plan rev slon required? ❑ Yes E[ No Use other side for additional information. (Lr ZZ g SBD -6710 (R.3/97) Date Inspector's Signature Cert. Safety and Buildings Division • Visconsin SANITARY PERMIT APPLICATION 2 1 B Washington Avenue Department of Commerce In accord with ILHR 83.05, 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 1/2 x 11 inches in size. 5 • See reverse side for instructions for completing this application State Sanitary Permit Number 3o e Personal information you provide may be used for secondary purposes W he ck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Propert Location r4r`(' ,1 o�G ( / 3,_114, S 3 T _2� N, R � � E (or)V Property Owner's Mailing Address Lot Number Block Number fmFo City a Zip Code Pone Number Subdivision Na or CSM Number 76fr -91 cam-►^ cc . II. TYPE - OF BUILDING: (check one) ❑ State Owned ❑ Cit Nearest Road E] Village �^ / Public 1 or 2 Family Dwelling - No. of bedrooms Town OF % l` o' dtvQr' /r01 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) pLIA 1sZ37 —'7C:) 1❑ Apartment/ Condo 3 2 te O 3 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. 5a- New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an ___ _r System -------- System Tank Only Existing System - -------- - Existing System B) '$J�A Sanitary Permit was previously issued. Permit Number 7 -7 a Date Issued --�r V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed� 21 [] Mound 30 C] Specify Type 41 [:]Holding Tank 12 Seepage Trench 22 E] In-Ground Pressure I t 42 C] Pit Privy 13 [] Seepage Pit C k 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals75 q. / ft.) (Min. /inch) G� Elevation 5 p e22Feet 4 c7Le, Feet Ca acit VII. TANK in allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Co" steel glass Plastic App New Existing structed T nks Tanks Se is Tan k (,� �- 9 ❑ ❑ ❑ ❑ ❑ ift Pump Tan w- ipheEMrember �Q� c ❑ El ❑ E] ❑ ONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PI is Name: (Print) Plumber's Signature: (No tam _s) MP /MPRSW No.: Business Phone Number: '144W) P if ly P lumber's Address (Street City, State, Zip Cod l7✓ J `t �l IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issue Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial surcharge Fee) 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 Safety and Buildings Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. V isbons i n P.O. Box 7969 Department of'Commerce In accord with ILHR 83.05, Wis. Ad m. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. 5' . • See reverse side for instructions for completing this application State Sanit Permit Nuu The information you provide may be used by other government agency programs ❑ Check if revision p eviousation [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Propert Location I, • /0k #( /4 4i 1/4, S 3 T -2S�', N, R � � E (or)(�D Property Owner's Mailing A dr Lot Number Block Number 5 City t / Zip Code Phone Number Subdivision Name or CSM Numbe II. T PE F BUILDING: (check one) ❑ State Owned ❑ Village !t Neare oad Public 1 or 2 Family Dwelling No_ of bedrooms Town OF: �� 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 A. Check box on line B, if applicable) A) 1. Tfi New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an System System Tank Only ____ ___y __ _________ __ y Existing System Existing -------------- g y ________ B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank 12 Seepage Trenc 6 /) .5 22 ❑ In- Ground Pressure ' .� 42 ❑ Pit Privy 13 ❑ Seepage Pit 5' I w'� Lcp 3 x 75 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min/inch) Elleeav�a�io 5-� 7M ro �� Feet /`7•J Feet VII. TANK Cap acit in gallo s Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existin structed Tanks Tanks Septic T orMotd mi Gr ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamberl I ❑ I ❑ I ❑ I ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (P nt) Plumber's Signature: (No Stamps) MMP/MPRSW No.: Business Phone Number: e�3 q � S - - Plumber's Address (Street, City, State, Zip Coder IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate I ssued I ature (No Stamps) A roved surcharge Fee) pp []Owner Given Initial /� p D0 Adverse Determination ! �CO ` X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Seo -62198 (FLI IM) DnTmatmoFt: origimt to county. one cony To. safegr a BLmldinp Dom.. Ckwner, Pkwbw yw - l(ICV� -G°'V roc G21 fib-. 1 11 r. F PUrf\P CHAMBER CROSS SECTIOIJ AND SPECIFICArlwn - -VCA1T CAP `I" C.I. VEMT PIPE WEATHERPROOF APPROVED LOCKIAIG 25' FROM DOOR, JUAICTIOAI BOX MAIJHOLE COVEF, WIMDOW OR FRESH 12 "M AIR IMTAKE GRADE I Y "MIN. I / L - _ 18" /°CI A1. CONDUIT 18 "MIN.v ---- - - - - -- IAILET PROVIDE I - - - -- AIRTIGHT SEAL i I I III I ALARM 1 1. *APPROVED I oN JOINTS WITH I I ELEV. FT. APPROVED PIPE I - Uy 3' ONTO PUMP --� OFF �I SOLID SOIL lP ff3, 71 CONCRETE BLOCK 3 ' 3 RISER EXIT PERMITTED OULy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPE_GIFICATIOUS DOSE e TANKS MANUFACTURER: L , t//2(s2/^ IJUMBER OF DOSES: 3 PER DAy TAAIK SIZE: 1(20'0' GALLONS DOSE VOLUME IS - O ,L,/' d �/t- 16 -1f ALARM MANUFACTURER: _ pt.e & INCLUDING BACKFLOW: `76-> GALLONS MODEL IJUMBER: CAPACITIES: A= I ( 44 `� .30a INCHES OR GALLONS SWITCH TYPE; /`c -�- B= INCHES OR -> GALLONS PUMP MANUFACTURER: C=- mr-HES OR � GALL01J5 MODEL NUMBER: F D- INCHES OR 3 C C' GALLONS SWITCH TYPE: r G MOTE: PUMP AND ALARM ARE TO pE MIAIIMUM DISCHARGE RATE ao GpM INSTALLED OU SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWt<EN PUMP OFF AND DISTRIBUTION PII�P//��..1 FEET + MIMIMUM NETWORK SUPPLY PRESSURE , . + L62 � // �� T✓ 77 FEET - FEET OF FORCE MAIN X �?`'r F lo o f x FRICTION FACTOR.. j' 2 FEET —" TOTAL D9 JAMIC. HEAD = 12' 7 FE I ti IMTERKIAL DIMEMSIOUS OF TANK: LENGTH ;W IDTH e ;LIQUID DEPTH 3o SIGIJED: LICEAISE NUMBER: - 21�fi Y DATE: / C c h q V�j Walk l u N� 3 � W 1 O V O � a tl d rr" L �h HEAD CAPACITY CURVE 3 7/8 6 1/4 MODEL "98" 0 4 5/B g 25 I 3 5/6 = m 8 O 15 4 3/18 e 4 10 1 1/2-111/2 NPT 2 5 0 1 1 1 U.S. GALLONS 1D 20 30 4O 50 fib 70 80 LrIEFtS SO 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAWFLOW PER MUTE EFFLUENT ANO DEWATERINO CAPACITY 12 HEAD UNITS/MIN FEET METERS O LT 5 1 72 .52 72 273 3 10 101 61 231 15 4.51 45 170 3 5/16 20 8.10 1 25 95 Lock verve 23' CONSULT O SULT FACTORY FOR SPECIAL APPLICATIONS e Electrical alternators, for duplex systems, are available and a Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. e Mechanical alternators, for duplex systems, are available with a Double piggyback variable level float switches are available or without alarm switches. for variable level long cycle controls. SELECTION GUIDE Standard all models - Weight 39 lbs. - i/2 H.P. 1. Integral float operated 2 pole mechanical switch, no external control required. 2. Single piggyback variable level float switch or double piggyback variable Control Selection level, That Model volts-Ph Mods Amps simplex Duplex switch. Refer to FMO477. M98 115 1 Auto 9.4 1 or 1 &7 — 3. Mechanical alternator 10 -0072 or 10 -0075. N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 4. See FM0712, for correct model of Electrical Alternator, "E- Pak ". 096 230 1 Auto 4.7 1 or 1 &7 — 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4) float system. E98 230 1 Non 4,7 2 or 2 & 6 3 or 4 & 5 6. Four (4) hole ". -Pak ", junction box, for watertight connection or wired -in simplex or duplex operation, 10 -0002. T. Two (2) hole "J- Pak ", for watertight connection or splice. CAUTION For infonnation on additional Zoeller products refer to catalog on Combination Starter, FMC514; All Installation of controls, protection dwloes and wiring should be done by a qualified PiggybackvariableLevelSwilci , FM ElectricalAlternator ,FM0486;Mechanical Alternator, licensed electrician. AN electrical and safety codes should be tollowedlneluding the moat FMO495; Alarm Package. FM0513; SUMP/Sewage Basins, FMC487; and Simplex Control Box, recent National Electric Code (NEC) and the Occupational safety and Health Act( OSHA), FMO732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. _ U41L r0: P.O. sox 16347 Lcusvi9e, KY 402560347 Manuracfurersof. . SMP70: 3280 00M*mLane LouisvAte, KY 40216 P i/IY /� IO. (502) 778 - 2731.1( 928-PUMP FAX(502) 774 -3624 Wisconsin Department Industry Labor and Human Relations g SOIL AND SITE EVALUATION REPORT P 1 of 3 Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must inclu` _ n.FARCELV. ix not limited to vertical and horizontal reference point (BM), direction and % of slope, scales ';r dimensioned, north arrow, and location and distance to nearest road. "° F , APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION ' ~' DATE PROPERTY OWNER: PROPER - WATION " ''� I Richard Stout GOVT. LOI� `` 1/4 1/4'S 3 T N,R 1 9X (or) W PROPERTY OWNERS MAILING ADDRESS LOT # B C -6ti}8{11� OR C 1353 Awatukee Trl. 66 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY EIVILL416 OTP _ EAREST ROAD Hudson WI. 54016 ( ) _ - Tower Rd. [x] New Construction Use [x ] Residential/ Number of bedrooms 3 [ ] Addition to existing building L ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd /ft •6 trench, gpd/ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate • 5 bed, gpd /ft •6 trench, gpd /ft Recommended infiltration surface elevation(s) 91.22 ft (as referred to site plan benchmark) Additional design / site considerations alt. sites stem el.= 90.54' Parent material pitted outwash plain 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 I ®S 0 ®S ❑U ®S ❑U 13S ❑U ®S ❑U El g]U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots Bed Trench in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '.....1 r 1 0 -15 10 r2 2 none 1 2 15 -21 10 r4/4 none sicl 2msbk mfr CTW if .4 .5 Ground 3 21 -36 10 r4/6 none sicl lfsbk mfr aw na .2 elev. 9 4 36 -84 10 r4 6 none if 0sa Mfr na na .6 Depth to limiting factor +84" Remarks: Boring # 1 -16 10 r2 2 none 1 2msbk mf ,:.._..2...::' 2 16 -29 10 r4 4 none sicl 2msbk mf Ground 3 9 -38 10 r4 4 none 4 8 1 na .5 .6 95. 2 8ft. Depth to limiting factor +84" Remarks: CST Name: — Please Print Phone: Gary L. Steel 715 - 246 -6200 Address: 1,5 54 200th. AXe., New Richmond, WI. 54017 m00298 Signature: Date: CST Number: 4 -19 -96 STEEL'S SOIL SERVICE Gary L. Steel Richard Stout 1554 200th Ave. CSTM2 3254 NW 4 SW4 S3 T28N - R19W New Richmond, WI 54017 town of Troy (715) 246 -6200 lot #66- Country Wood 1 " =40' BM.= top of 1 11 steel pipe C el. 100 Y la 11-� �.v A(C Gary L. Steel 4 -19 -96 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM _ O I`� Ow er/Euysr f n p . - -- Mai ,ng Ac d .s ��(a�_�Q� AO2 c a4 o a; QirbL 'vW, Pr .rty A,J(�t ;Ss 29E Qk� fCl W� - -- TWIC -` (Verific ition required from Planning Department for new construction) — Cit) State - .. + Usor1 wy Parce} Identification Number 3, i9. UM LE! A T ., D j . ; RIPTIO} 4 Prc} arty U •c a, on N W %,, W ' /,, Sec. 3 , T-a(O N -R] —IW, Town of �O Sul) ivisior . _.. u» "" U`�� , Lot # Q ,1 Cer. ified S u r t y Map L700 Volume � ,Page # W Wst, ranty 0 : it # _ S Y �� . Volume O Page # Spct house [ J yes no Lot lines identifiable 0 yes ❑ no SY ITEM 1 j 4 ; NTENAr ICE Impr.jr ea• use and mai itenanceof your septic. system could result in its premature failure to handle wastes. Proper m:. i : tenance consi is of pu, -q a.a gg out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into t : system can r feet the 3 r i Lion of the : peptic tank as a treatment stage in the waste disposal system. The - fr )p xty owner : grees to submit to St. Croix Zoning Department a certification form, signed by the owner t id by a mas.- -phtmbr-,.j itmeymanpiumber, restrictedpiumberoralicensedpumperverifymgthat (1)theon -site wastewaterdispo, ! system is in roper of : jag conditio n and/or (2) after inspection and pumping (if necessary), the septic tank is less than V3 fall c f :fudge. I/we, b,- undo rs ii! ted have res d the above requirements and agree to maintain the private sewage disposal system with the st mdards set R th, here :a set by the )epartment of Commerce and the Department of Natural Resources, State of Wisconsin. Cc 1i :cation static that ya �.0 s i ptic system has been maintained must be completed and returned to the St. Croix County Zoning Office , thin 30 day Lf e th z , ;, ear expirati in date. � "a 0 , 9V SIG: V.11JRE f I o,PPLICAN I' DATE OMI MF C ';E 1 [IFTCAT [ON I (we i - :e i tify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the o - i ;r(s) of the A ►perry d - bed above, >y virtue of a warranty deed recorded in Register of Deeds Office. A it SIGI 01JRE �PPLICAN f DATE Any: m i:):: iaation that s mis- represented may result in the sanitary permit being revoked by the Zoning Departmer ** Ii trade wilt its applicat on: 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 p '► V _w c H rn o 0 .P w w o al 1 N � O C / \ ZZS 33� ° I it 33' o ~„ `( b6 bib ►► I 1 1 kD o0 oa 1 � V r r A- - It v H 1 I f o� 8 482.45' 1 1 SO4 2' E 33' 33' 1 _ � N I — C I CD p 1 LR b OD CA Jv I y y 50' 50' I 518 , Z ~ S08 °21' 13 "E .06 0 1 l0 I I b Gi r Z I I w LA f w 1 a vl L E I i o I o — 1 $ g l o 1 w -► w I m N i— c l• m P H N CA M IV CA -4 1 ? I pl 1 w A 5? 2.15' 1 1 N i I I I 6 6' 1 I 514°43 51 „E I 1 I 616' to cn 1' N � OD p o 6 5A9 0 I N I 3a `V -� W wo i � N O I oD w tr I M+ r I DEDICATE L.Z." je,5.'Z � �. / - bL .,r'lL ✓� �J �� "K ��4 � �� _} - 9 p 4 1A _� � r ,� ! ,�� 1 �- � �� c ,��' � 1'��C�