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HomeMy WebLinkAbout040-1244-70-000 S = ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner d Address /Q-.go/ as City /State Legal Description: Lot - � Block — Subdivision/CSM # 7e,6y Ui �, %, '/, Sec. , T N -R W, Town of PIN # � � 7 SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFO ItMAT ON 1 Tank manufacturer I,J(a4-a-ti Size ST/PC Setback from: House Q.3 ' Well 0 P/L 30 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: eaAJ Width ol , Len 7 S Len Number of Trenches Setback from: House • Well 82 , p/L g0 Vent to fresh air intake //S ELEVAI�QNS a , Description of benchmark I71 �cQ l,,,i( IUd („si, , Description of alternate benchmark Elevation. Elevation Building Sewer ST/HT Inlet S� ST Outlet 2S, 0 ' PC Inlet PC Bottom Header/Manifold 9 �� $ Top of ST/PC Manhole Cover ° l 7. 7 Distribution Lines Bottom of System O 9` 3. Final Grade () �8, ,2 ( ) ( ) Date of installation //S /9h number State plan number Plumber's signature License number a'1L Date G 1 5' Inspector yr� �,,,,, �� Complete plot plan �+ 1 L Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count §afety and Buildings Division y :ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar y PD(0.: Personal information you provice may be used for secondary purposes [Privacy La �rp?ii , s.15.04 (1)(m)]. .ii / bb LG y 0� t t PMENT /DERRICK CC `�� village ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel T 690 1 ��� Nt- 1244 -70 -000 a, � ,? J TANK INFORMATION EVATION DATA A9800016 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /D J Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Airintake Dt Inlet Septic r _�25 3' NA Dt Bottom Dosing NA Header/ Man. q• �, 9 �1.��� Aeration NA Dist. Pipe Holding Bot. System 1 19 ,311 93_� PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand S glS 57� r4, Model Number GPM TDH I Lift L ricti System TDH Ft Forcemain Le h Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /o'(� 17 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type of A_4 < CHAMBER Mod Number: System: '3�� 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 xx Seeded/ Sodded xx Mulched Depth Over Depth Over xx Depth Of Bed /Trench Center /�a " Bed /Trench Edges �— Topsoil ❑ Yes ❑ No ❑ Yes E] W. COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 19.29.19,SW,NW 268 ST. ANDREWS DRIVE i Plan revision required? ❑ Yes 15 / r' Use other side for additional information. i! %j t i'J e z SBD -6710 (R.3/97) Date (;ins eiUr's Signature Cert. No SANITARY PERMIT APPLICATION 20 eE w shnilgtonAve lion Visconsin 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 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Numb 3o7 &Z ?. The information you provide may be used by other government agency programs ❑ Check if revision to previo application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION I -'� Proepy Owner Nam Property Location �or 5W1/4 lltW 1/4 S T A7 , N, R ? r) W Property Ow er' Mailin b' Lot Number Block Number 3 +� ` 1 `r , - t ( a 7 St ate Phone Number Subdivision ame or CSM N ber �R"h Zi�Coodde N (W) II. TYPE OF BUILDING: (check one) ❑ State Owned [j it Nearest Road E] Village t Public M 1 or 2 Family Dwelling - No. of bedrooms Town OF f`O St 1� III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) `` 4 �Tf� 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 online B, if applicable) A) 1 [k New 2_ ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an " S 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 Dist 'bution Pressurized Distribution Experimental Other 11 f� Seepage Bed �2�7� 72, r � 21 E] Mound 30 E] Specify Type 41 [] Holding Tank 12 ❑" Seepage Tren 22 ❑ In- Ground Pressure 42 E] 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 5. Perc. Rate 6. System Elev. 7. Final Grade (� Required (sq. ft.) Propose (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation Feet S 8 7 "'_' 93.43 Feet 7. J ct VII. TANK Capa t in allon Total # of Prefab. Site Fiber- Exper INFORMATION g Gallons Tanks Manufacturer s Name Concrete con- steel glass Plastic App New Exist in strutted Tanks Tanks t{� epticT Ing t sz C� PS `el^ ❑ ❑ ❑ El ❑ Lift Pump Tank /Siphon Chamber El ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans_ Plumber's Name: t) Plu ber's Sig atu : (N Stamps) /MPRSW No.: Business Phone Number: �S _` k I p e^. Plumber's Ac dress (Street, City, State, Zip Code)`. ` C IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date I Issuing Agent Signature (No Stamps) Surcharge Fee) a J Approved []Owner Given Initial �7100 �. • "1 8 4d 6g��� X. Adverse Determination P � IrtNilac� -A.wt APPROVA Owt.G� RE ASON S �G�t4ISAPFR OVAL: SBD -6398 (R.11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber 5 t s. 4 Q l e rb rb LA 1. w' _ J� w 1 t Wisconsin Department of Industry SOIL AND SITE EVALUATION tabor and. Hmnan Relations Page of Divi §ion of Safety and Buildings in a:orcnce with s. ILHR.83.09, Wis. Adm. Code Attach complete site plan on paper not less an $,b2 x 11 'nches in,siie \Plan must County /+ include, but not limited to: vertical and ho ' pntat refe ncel 41ptM); direN-on and S 1 Y` 6 ► percent slope, scale or dimensions, nort arr / ow, and 1 istance tobearest road. Parcel I. D. # •' 0 ` APPLICANT INFORMATION - ( se A&t alb &AWti'ot). � Reviewed by Date Personal information you provide may be used rikndary pAJodeeF04&aacy Law, s: 1504 (1) (m)). �. /�•,?j Property Owner /� 1 I s ONINGOFFICE Property Location i I� r-.- I k CO n S f Ir w c h n c / Z Govt. Lot SQ 1/4 rl LJ 1/4,S 1 T 'Z$ ,N,R I �j -re W Property Owner's Mailing Address C Z Lot # Block# Subd. N ame o r CSM# 1 14 Y (05 7 t1 C, 1 oy HilI -e- city State Zip Code Phone Number Nearest Road Y1 u►) R l c. m o n W I S 4 0 f 7 1 3 2 0 ❑City ❑ Village � Town r ( )2�10� Z ro ti � S} (�n.dl.�eas �ew Construction Use: „Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow l000 gpd Recommended design loading rate • 7 bed, gpd/fi2 S trench, gpd/ft Absorption area required ��_ bed, ft2 -7!50 trench, ft Maximum design loading rate • _7 bed, gpd/ft ' a trench, gpd /ft Recommended infiltration surface elevation(s) q 3 , 6 3 ft (as referred to site plan benchmark) Additional design /site considerations rations 94 V'L G fn`rAL 02t � -C— 02 Parent material Q L o C 1 & b 1 J 0. � S Flood plain elevation, if applicable t'1 C ._ ft r= u— = Suitable for system Conventional MMound In- Ground Pressure AT -Grade System in Fill Holding Tank Unsuitable for system Lry S ❑ M U S ❑ U Ns ❑ U ® S ❑ U ❑ S `0 U ❑ S & U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure, Consistence Boundary Roots GPD /112 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench { 6 - `3 1 0 Y (� 3 2 r� u r. t L 2 m s 6 k F ;t- a - 31 101 5 A . M 0 n St C S b 1-< m t I-J I Ground 3 31-80 T S 5 / y YA o n f r-t S o 5 T"1 1 h 2- n a . $ elev. Z 2— ft• Depth to limiting factor ` 0 in. Remarks: Boring # I 0 -1v 1 y o- 3 12. n one 3k a rls 6 k r , Pr 0, W 2 2, 2 -►� Toy t2 5 \lone S9- I CIS b K rnP 3 I7 -32 7•S R S n 0 - e 1 3 o s 1 L3 Ground y 32-4 7, 2 SI Y10 n 2 cS 059 r,rt t,S C, 1 v80 ft. 5 1 � , S R S �1 o n ¢ c s c7 S t^'1 h� n . Depth to limiting factor T t o o in. Remarks: CST Name (Please Print) Signature - �_ Telep / honeN o. -_ I YZ Or`14 LIS a '1 2 ` ( -. 2 -/ ( Address Date CST Number 11 1 3 - C51 2 !0 05 �7e%S r c—Tt ' gLi /-� Y - iwtfy S19 - T29 N RVq� r 'Tro s �- A n w 6 1, r If o 0� °n -� G 2 w 1ti�f'\ ca, 3 r W I sconsin Osoart— of Ind-is", SOIL AND SITE EVALUATION REPORT Page I of 3 Labor and Human Reiauons mviswn ot 3 Bwtdngs in accord with I LHR 83.05. Wis. Adm. Code .-- COUNTY Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but ST. CROIX PARCEL I.O. not limited to vertical and horizontal reference point an and 9'v of slope, scale or dimensioned, north arrow, and location and di $� r APPLICANT INFORMATION -PLEAS AL INF�1i1 ON REVIEWED BY OATS PROPERTY OWNER: KtUENtU PROPFATY LOCATION E 1/2S 247 28 NR 20 W TOM RUEMMELE &JOHN AND RUEMME `� — GOVT. LOT 114W 1/2S 19T 29 NR 19 - 640 W PROPERTY OWNER ".S MAILING ADDRE _ LOT x -8t6('Itye SUfjO. NAME OR CSM is 260 COUNTY ROAD F cT CROIX 1 7 TROY VILLAGE CITY, STATE ZIP PHOfyR11 PA*.R CITY aILLAGE UOWN NEAREST ROAD HUDSON WISCONSIN 54 (y ) F TROY ,sr, A►us c��l�tt: bQ New Constnxtion Use j Resident ut o 4 ( [ Addition to exis*q building L I Replacement [ ] Public or comet Code derived daily flow 600 gpd Recommended design loading rate D. ¢ bed. gpd/tt trench. gpd/9 Absorption area required SDO bed. 9 Seto MCt. ft Maximum design loading rate bed. gpd1tt 0.6 trench, 00 Recommended infiltration surface elevations) BY DESIGNER ft (as referred to site plan benchmark) Additional design I site considerations E A107 V5 V/V' Parent material 4645 1 Z Ov'Ga/'F5 Flood plain elevation, if applicable N/A tit S Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U . Unsuitable for system I ❑ S ®'U I (B"S ❑ U ❑ S �(U I ❑ S f8'U I f] S Wu I ❑ S KU No SOIL DESCRIPTION REPORT Boring # Honzoni Depth (Dominant Color I tvtottles ('!" (Texture I Structure ICawliancel8ou.�Y I Roots GPOltt I I in. Munsell Qu. Sz M Odor Gr. Sz. Sh. I Bed ITrarx7t ^� Al 0 -14 110YR 2/2 - -- sil 2msbk Imfr gw 12vf -q 0.5 1 0. 287;4 A2 14 -22 10YR 3/3 - -- sil 2msbk mfr gw 2vf-f 0.51 0.6 Ground B 1 22 -40 10YR 4/4 - -- sil 2msbk mfr gw lvf 0.5 10.6 elev. I 8 B2 40 -44 10YR 4/6 - -- sil 3mabk mfi gw lvf 0.5. 0.6 Depth to B3 1 44-59110YR 5/4 mld 5YR 5/8 sicl 2f -csbk mfi cw lvf - -- - -- limiting f�, C 59 -79 10YR 4/6 - -- is lcsbk mvfr - -- lvf -- - -- Remarks: Horizon C has pockets of 10YR 6/6 g s, Osg, ml Boring # A 0 -21 1 10YR 3/1 - -- Isil 2f -msbk mfr cw 2vf- 0.5° 0.6 ^A360 B1 21 -38 10YR 4/3 - -- sil (2msbk mfr gw 2vf- 0.5' 0.6 10YR 7/2 B2 1 38-50 10YR 5/6 jc2f 5YR 5/8 sil 2msbk mfr cw (2vf- - -- - -- Ground C - 7 1 50-70 10YR 5/6 - -- s Os ml - -- lvf -- - -- 8 98 . 9 ft. Depth to limiting factor 1 Remarks: Names -�.w Print JAMES 0. FUp,S RfOn'� (715) 425 -7831 OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS, WI 54022 S'gnature: 0aw CST Numbr: /o CSTM03988 PROPEMOWNER SOIL. OESCRIPTION REPORT Page Z af 3_ PARCEL I.O. A ` Depth Dominant Color Motnes Texture Structure �� Roots GPOitt and Horizon in Munsell • Sh• Boring # A 0 -13 IIOYR 3/2 _ -- 1 12f —msbk ( mfr I cw 2vf —f 0.5 0.6 +... B1 13 -23 lOYR 4/3 - -- I sicl 2msbk mfr I gw 2vf —� 0.4_ 0.5 B2 23 - lOYR 4/6 - -- sil 2msbk Icnfr lcs 2vf 0.5 0.6 Ground elev. Cl 43 -48 110YR 5/6 f if 5YR 5/8 fs Osg ml I cs lvf - -- --- 8 98.6 ft. C 2 48 -72 10YR 6/6 - -- s Osg ml I - -- lvf I - -- - -- Depth to fronting fac tor 43 Remarks: Boring Ground it. Oepth to li miting factor Remarks: Boring I L Ground elev. Depth to limiting j factor Remarks: Boring # Ground elev. ft Depth to lim" factor I Remarks: Sao- @=R.otr= t PAGE 3OF3 SITE PLAN SCALE: 1 " = 40' GoT 9 Z / ,E,gS��Mr Q W f E S � w o s 360 e� 0 G ©T l , � �vr� NOTES: PROVIDE MINIMUM OF I' SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50' FROM WELL; 5' FROM LOT LINE. OGDEN ENGINEERING CO. JAME ILKINS, CSTM03988 Civil Engineers & Land Surveyors DATE: 0 % 113 W. Walnut 425 - 76315 WI 54022 w�scorts�n oe panment or ind�� say, SOIL AND SITE E V A L U A T I O N REPORT Page L of 3 Labor and'Human Reianons civ,san of Satery S Bwldngs in accord with ILHR 83.05, Wis. Adm. Code COUN iY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST. CROIX not limited to vertical and horizontal reference point (8M slope, scale or PARCEL I.D. x dimensioned, north arrow, and location and distance to $$ APPLICANT INFORMATION— PLEASE PRINT µ JI N RE VIEWED BY DATE 6' PROPERTY OWNER: o - PRO LOCATION E 1/2S 24T 28 NR 20 W TOM RUEMMELE & JOHN AND BARB R L G 114W 1/2S 19T 29 NR 19 - 64" W PROPERTY OWNER':S MAILING ADDRESS OT SUBO. NAME OR CSM 8 260 COUNTY ROAD F ST CROi: 7 TROY VILLAGE CITY, STATE 71P CODE P U I OFFI ILLAGE OWN NEAREST ROAD HUDSON WISCONSIN 54016 (71 Llr Aituems Qlaj bQ New Constnxxion Use (X ] Residential/ Number o s ( ] Addition to existing building L I Replacement ( ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate ¢ bed. gpdM trees• 9pd/tt Absorption area required .SOD bed, tt Smo trench, 9 Maximum design loading rate 2 S bed gVn D• 9 trench, gpdM Recommended infiltration surface elevation(s) BY DESIGNER 4 (as referred to site plan benchmark) Additional design / site considerations 5Z .6F46 4 7V 5 rvN f 16 3 Parent matenai Flood plain elevation. if applicable N/A ft S = Suitable fair system CONVENTIONAL MOUND IN4MUNO PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= unsuitable for system I❑ S ®'U I Irs 0 U p S FEU D S ®'u I ❑ S Eli I S Iffu SOIL DESCRIPTION REPORT 311 1 Depth I DominantColor I Mottles I I Structure I Bourmy G PD /tt Bon # Horizon in Munsell Qu, Sz C,om cow Texture Gr. Sz. Sh. I RO ° � I Se ITnenc 287.1 Al 0 -14 lOYR 2/2 - -- sil 2msbk mfr gw 2vf —q 0.5 0. A2 1 14-22 10YR 3/3 - -- sil 2msbk mfr gw 2vf—f 0.5� 0.6 Ground B1 22 -40 10YR 4/4 - -- sil 2msbk mfr gw lvf 0.5I 0.6 elev. 8q B2 40 - 10YR 4/6 - -- sil 3mabk mfi gw lvf 0.5 0.6 Depth to B3 44 -59 I10YR 5/4 mud 5YR 5/8 sicl 2f —csbk mfi cw lvf - -- - -- limiting f�, C 59 -79 10YR 4/6 - -- 1S lcsbk mvfr - -- lvf -- - -- I Remarks: Horizon C has pockets of lOYR 6/ gs, Osg, ml Boring # A 0 -21 10YR 3/1 - -- I sil 1 2f —msbk mfr cw 2vf — 0.5 0.6 M360:< B1 1 21-38 10YR 4/3 - -- sil 2msbk mfr gw 2vf —> 0.5 0.6 ate 10YR 7/2 Grou B2 1 38-50 1 10YR 5/6 c2f 5YR 5/8 sil 2msbk mfr cw 2vf— - -- - -- 8 C 50 -70 10YR 5/6 - -- s Os ml - -- lvf -- - -- Depth to limiting factor Remarks: FNam Print jAmES b. Fuws P'wc (715) 425 -7631 OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS, WI 54022 oar: / CST Number / /a < CSTM03988 PRCPERTYlOWNER SOIL D E S C R I P T I O N REPORT Page 2 at 3_ PARCM I.D. S Hanzon Oepm Dominant Color Mottles Structure GPOift in. Munsell Texture . Sh Cor>srstence Bastyary Roots Boring # A 0 -13 I10YR 3/2 - -- 1 12f —msbk I mfr I cw 2vf —� 0.5 0.6 B1 13 -23 10YR 4/3 - -- sicl 2msbk mfr Igw 2vf— 0.4 0.5 B2 23 -43 10YR 4/6 - -- sil 2msbk Imfr lcs 2vf 0.5: 0.6 Ground elev. C1 43 -48 I1 0YR 5/6 f 1 f 5YR 5/8 I fs Os g ml I c s lvf I - -- - -- 8 98.6 ft. C2 48- 72I10YR 6/6 - -- I s Osg Iml I - -- lvf I -- - -- Deptn to limning I I ! ta= Remarks: Boring Al Ground elev. it 080 to fitting factor I I I ( I I Remarks: Boring # I I Ground elev. ft. D eom to fimning factor Remarks: Boring # X U MM Ground elev. it Dam to fronting factor Remarks: - S80-Q=F%.0W= PAGE 3OF3 SITE PLAN SCALE: 1 " = 40' Z' oT �❑ B -Z87 J �N w � 0 � o � e $ 360 G ©' 7 B� ��r��2 �c, NFL /� i.✓ ' t' z- °T G NOTES: PROVIDE MINIMUM OF 1' SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50' FROM WELL; 5' FROM LOT LINE. OGDEN ENGINEERING CO. JAMES . FI KINS, CSTM03988 Civil Engineers & Land Surveyors /l ° 113 W. Walnut St. River Falls, WI 54022 DATE: (715) 425 -7631 SAFETY & BUILDINGS DIVISION State of Wi Departmen ' + T ce January 26, 199 =3 'Field Operations Bureau East Spruce Street x��111 C ippewa Falls, WI 54729 THOMAS C. NELSON ENVIRONMENTAL BY DESIGN 1432 120TH STREET NEW RICHMOND WI 54017 RE: PLAN ID 3649 FEE RECEIVED: 80.00 TROY VILLAGE LOT 7 SW, NW, 19, 29, 19W TOWN OF TROY COUNTY OF ST CROIX MOUND RESTRICTION WAIVER The Department has reviewed the above - referenced submittal. The Department has reviewed the request to waive the restriction on the above referenced property. This request is supported with information that indicates this property is acceptable for development with a below grade soil absorption type private sewage system. Therefore, the Department waives the above mentioned restriction and has no objection to the development of this property provided that the private sewage system is constructed in accordance with the applicable requirements of Chapter Comm 83, Wisconsin Administrative Code. Conditional approval is hereby granted to waive the mound system restriction provided the following condition(s) are met: 1. That the release and waiver of this lot restriction be incorporated into a correction instrument under s. 236.295, Wis. Stats. This should eliminate future questions regarding the restriction on the recorded plat. 2. That land surface area for both an initial and replacement below grade soil absorption system be set aside for use. Said areas shall be at least 50 feet from any well, 25 feet from any habitable building or dwelling or building with a below grade foundation., and 5 feet from any lot line. This approval does not include review of the design for the proposed private sewage system. All other applicable criteria, as contained in chapter Comm 83, Wisconsin Administrative Code, must be met prior to issuance of the sanitary permit for a project at this site. All permits required by the city, village, township or county shall be obtained prior to installation. SBD -7997 (8.11/96) I r SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce January 26, 1998 Lot 7, Troy Village Page 2 of 2 Inquiries should be directed to me at the telephone number listed below. Please refer to the plan number shown above. Sincerely, jroy ansky Wastewater Specialist, Senior Ijansky @commerce.state.wi.us E -mail (715) 726 -2549 Fax (715) 726 -2544 Voice CC: DOA - Plat Review St. Croix County Planning and Zoning SBD -7997 (8.11/96) ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Thy 1- %.on Nv p4T C cx,•p -�c o� �G- �.�AtL�'S Coo r. , pnc'; Mailing Address Z101 Cc t- ►I�p.t,. Y�� 'Z'Lp aU 1 . MN '55; 5 jo 4 Property Address A104atic 2tk'14°C (Verification required from Planning Department for new construction) City /State 1050 ►.i f k1- Parcel Identification Number Qy o — / 2Y 7 0 LEGAL DESCRIPTION Property Location ' /a, %,, Sec. _�I' , T ft N -R OW W, Town of Subdivision "�1 �/ �/L 1.�. l.a�C Lot # Certified Survey Map # . Volume , Page # Warranty Deed # r l 9 9 of to -J 7 , Volume I 1 , Page # - 2.5 4 Spec house N yes 0 no Lot lines identifiable Xlyes 0 no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman pltimber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro erty described above, y virtue of a warranty deed recorded in Register of Deeds Office. S. � q SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 1 it -Fc -=r'T = a. 366-7E64 ian 13 J�>f`.jy'rS WARRANTY nEFD Document No. , veL T ?'4J Aa? J � This Deed, mods between b7 :Vrrii:t . '.. Vil John 1. Rmsmmelt end R A Rueenmele hit wife and Thomu d. � ~�"• Buarr mime act Nell L R uernMete ' MAY, 2 7 J99 Grantor. and 4iL 3:15 FM _ -Trov De�eioomeeet Golporation ` hlat� f jd l► _ . tiYMars d cloaca Grantee, W itnssseth That the sold Gramor, for a valuable consideration .F, our• ....ea.a.etraan� ww a Mo UTM 400at n conveys to Grantee die following described real estate in SL Croix Counly County, State of Wisconsin: (pataN Weab(katlon Nambah Lots I through 45, Lots 47 through 55 and tots Elf through 70 of the Plat of Troy Village. 4. Croix County, Wisconsin and that portion of (Nstlol B of cite Plat of Troy Village deaaibed on Exhibit A attached hereto. and V IER 4 tunas l and 3 to the Plat of Troy Village, St. Croix County, Wisconsin A portion of the abort dw4ibsd prgrrty JL — howataad Petopatyofthe Orattaee, John J. RWATC19 aid Barbara A Asammele (is) (a toot) Toaeeuer wits all and s6easta the haeddaneeu and apunaetaeq theme= beloogsilli And ('� uwreau this the haw is 6rr4 inddeasible is tee simple ad on and elan of eawmbr>oros eeow . easements, covenants, muictiona end hijhway rights ofway of record +std will wanntt and defend the same, Usted'this_ driof (SPAL) (sue, e e mmele 7 '. Ba rbarla A. Ruemmale Nadi— Ruemmele ALTHENTICATION ACKNOWLEDGMENT Synagrde) - wife and _ STATE OF WIKXM.IN 1 Jl�[t Rueelll[le er1D Nd L ttutl"whi h• mife 1 A. authenticated this r & of 19 County ) !f TIC I ,* Personally came before me djs _ _ day of Oppwp w — .19 the above named Till F, HF. RLM ATF BAR OF WISCONSIN (tfa•L wdhonaed by 4706.06. Wit. $eels.) to me known to be the person who exeeuled the fnregoins instrument and aeknotvedge the Satre. THIS INSTRUM" WAS DRA TIM BY F1e%w od & W, S.C.. SL K Qjj _ • St.. P.O. Box 125, Hudson. W1540 Notary Public_ County, Wia. ,Sianwto may he ■dhenneated or aeknowiedyed Oath we nnr My coinmisaion is Derminent. (If not, swe expiration date: yt,r, t/suxw yrie w our eo„ty rM a type w 1�•.ri erw �� M,rw fa111 lib I•INi atetat��l