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HomeMy WebLinkAbout040-1245-20-000 ST. CROIX COUNTY ZONING DEPARTM ` i � ' o AS BUILT SAMTARY REPORT Owner Property Addres� 7 City/State r ��C6' it: Legal Descr COUNTY NINGOFFICE Lot 1 Block Subdivision/CSM # Q��!S ��� Sw VI -&b t /4, Sec. _ 11, T -VN-lZ.t�W, Town of ,?'T PIN 6: � SEPTIC TANK —DO E CRAM gER BOLDING TANK INFORMATIb1V Tank manufacturer G✓Pc 4-t� Size ST/PC X20 Setback from: House ' 2 - P 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 SYSTlI<1M: Type of system: rC�„� � i a . YP Y Width 3 Length Number of Trenches 2 Setback from: House -90 ` Well r P/L AI& Vert to fresh air intake ELEVATIONS Description of benchmar ° ''„` Elevation 1 Description of alternate benchmark Flevatio4j Building Sewer STlHT Inlet 10 Q -0 ST Outlet 1U3 -6 PC Inlet PC Bottom Header1Manifold � �2,�/ -G - y Top of ST/PC Manhole Cover IGS.,fX Distribution Lines Bottom of System O /©A .,.2 -7 Final Grade {) /0(; - 7 3 Date of installation 2:' -q 'eranit number 3 2!/ G State plan number Plumber's signature License number Date Inspector Complete plot plan w Ga 4e, sw� K /y Se (9tT.�j �9w Z 61"f Gv - B dsc � �•�• L 7aal -jq ti`s Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count'k. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary�e�rpitND.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. Permit Holder's Name: Village i Town of: State Plan ID No.: KLEWICKI, JOSEPH A. �'88 CST BM Elev.: Insp. BM Elev.: BM Descri tion: Parcel 100 � � '9�CeC b 1245 -20 -000 TANK INFORMATION ELEVATION DATA A9800475 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic f Z S7� Ben"ft 27 Dosi ng Aeration Bldg. Sewer �j" q.6 , 2 Holding St /W Inlet cr3:4 laq TANK SETBACK INF MATION St /Of Outlet ��S" q 1c3� TANK TO P/ L WELL BLDG. Air I to ROAD Dt Inlet irntake Septic S� /U 3 5 - ' NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System —Zv' PUMP/ SIPHON INFORMATION Final Grade /f( j /. 104_7 Manufacturer Demand Ji Model Number GPM TDH Li L Ft Forcemain id. T D — ,s To — We IT SOIL ABSORPTION SYSTEM BED DIM CH Width �I Length No .O Trenches PIT No. Of Pits Inside Dia. Li uid Depth DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / T AM LEACHING Manufacturer: INFORMATION Type CHAMBER Syst�t7� a7 G OR UNIT Model Number. DISTRIBUTION SYSTEM lac j, i Header / old ! r Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length S Dia. Length ?� - 'J� Spacing 1Zu,,, 6 Wy � 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.) LOCA : TROY'j1�9p. 2 8 . i 9 , SW , NW 2 5 � TRO� URG'Lc.( ROY VILLAGE LOT 12 Plan revision required? ❑ Yes [0 No Use other side for additional information. I L 1 7,1 7 RS 7 S �l I i SBD -6710 (R.3/�7) Date Inspe or's Signature Cert. No. Safety and Buildings Division �v : SANITARY PERMIT APPLICATION 201 W. Washington Avenue *sconsin In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. e- • See reverse side for instructions for completing this application State sanitary Permit Number :3Zo Z8(o Personal information you provide may be used for secondary purposes ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N Property Owner Name 5( Prope rt ( &,1/4, S 1 T �, N, R` ( E (or19 Property Ow is M fling A ress Lot Numbe Block Numb!�__ w l Ci ty'), tae Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned o qt Nearest Road p village Public 1 or 2 Family Dwelling - No. of bedrooms aL Town OF 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Nu m er(s) V � 15 O , M45 1 ❑ Apartment/ Condo `7 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 ff New 2_ ❑ Replacement 3. ❑ 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,ffSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit - -,7 5 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 (s . ftt (Gals/day /sq. ft.) (Min. /inch) lOS tin U G ��� - 3 Feet Feet Capacity VII. TANK in g all o ns Total # of Prefab. Site Fiber- Exper INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks _ Septic Tank or Holding Tank �(! / r�� El El 1:1 11 Lift Pump Tank /Siphon Chamber ❑ 1 13 El ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) I Plumber' Sig ture: (No m MP /MPRSW No.: Business Phone Number: Plumber's Address (Stniet, City, State Zi Co e G( l IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial /O- a, Surcharge Fee) Adverse Determination ` V U / ` X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber : 1 - I _ I I _ ; f 11 i i t i i Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1— of 4: Labor and Human Relations Divisioh ofSafet; & Buildings in accord with ILHR 83.05, Wis. Adm. Code '` COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM) ' tni4yo of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance n e t rda`g.? 7`' 040- 1076 -80 -T 9. -_, , v APPLICANT INFORMATION- PLEASE PRI yA�f.r INFWORMATIA�" RE WED BY D TE �a PROPERTY OWNER: ERN LOCATION John, Barbara & Thomas Ru c1-. r le LOT SW 1/4 NW 1/4,S 1 2 8 N,R 19 FC (or) W PROPERTY OWNER':S MAILING ADDRESS �` "I f''� BLOCK # SUBD. NAME OR CSM # 260 C.T.H.F. ' CRp fi� �`ro Villa e CITY, STATE ZIP CODE R1 NE NUMBf tCE C [:]VILLAGE ®TOWN NEAREST ROAD Hudson, WI. 54016 X IT Troy C.T.H. F [ New Construction Use [x] Residential / Num f o rr Z 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gp d Recommended design loading rate • 7 bed, gpd /ft - 8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate . 7 bed, gpd /ft . 8 trench, gpd /ft Recommended infiltration surface elevation(s) 101 .3 area B= 99. #N referred to site plan benchmark) Additional design/ site considerations trenches spaced to code 3.0' below surface grade Parent material outwa sh Flood plain elevation, if applicable n a ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem ®S ❑ U ❑ S ®U] S ❑ U EIS ®U ®S E3 U El S 2 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bar>Cary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench l 1 0-8 10 r 4/4 none fill material na np n 2 8 -78 7.5yr 4/6 none ms osg ml na na .7 .8 Ground elev. 1 Depth to limiting factor +78" Remarks: Boring # 1 0 -7 10 r 4/4 none 1 2c 1 mfr cs na n .2 2 2 7 -25 10 r 4/4 none cos os mvfr na .7 .8 Ground 3 25 -32 10 r 4/4 none sl lcsbk mfi na .4 .5 e . 4 L32 -7 1 02 2 .6 ft. Depth to limiting factor +78" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. ,AqV, New Rictnovd WI 54017 Signature: Date: 7_17 -97 CST Number: m02298 . STEEL'S SOIL SERVICE Gary L. Steel John Ruemmele 1554 200th Ave. CSTM2298 WIWI S19- T28N -R19w New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246 -6200 lot #12 -Troy Village N 1 " =40' BM.= top of SE lot stake C el. 100' Alt. BM.= top of NE lot stake @ el. 97.60' 'h K� N �S Gary L. Steel 7 -17 -97 Wisc Department of Industry, SOIL AND SITE EVALUATION REPORT Page C. � -,1 r and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1 t 1 40 ,s� . Plan must include, but 5r' cXoI x not limited to vertical and horizontal reference po (�I1 ,dire' "on an6 °° slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and di o ne es*pad. ' APPLICANT INFORMATION PLEASE A T10. REVIEWED BY D., c PROPERTY OWNER: 3 19 _ PEATY LOCATION rl Z ) 5 zq Tzj Al g2a w �oftl Z,44 4KA d T1�OM &S /Ng F y� 1 / S (q T Z$ N,A IQ � W PROPERTY OWNER ".S MAILING AODAESS , COUNTY �# BLOCK # SUB0. NAME OR CSM # m3p GT. N.I+ ZO NINGOFFICF vilLLAl- CITY, STATE ZIP CODE UMBER CITY QVILLAGE ®TOWN NEAREST OAD J+ IA 050N WZ 6401(o " TAD GT. . >_ Pq New Construction Use Residential / Number of bedrooms () Addition to existing building ) Replacement ( ) Public or commercial describe Code derived daily flow 4 60 gpd Recommended design loading rate O, (e bed, gpd/ft 0''7 trench, gpc/ft Absorption area required J alon bed, ft 159 trench, 111: Maximum design loading rate Q. - 7 ed, gpd /ft 0 trench, gpol;t Recommended infiltration surface elevations) iD 5E DErEKA tpEp OY DEA (as rE rred to site plan benchmark) Additional design / site considerations — X11 , C Parent material 49LA-r f_ t I L.L Flood plain elevation, if applicable NA ft S = Suitable for system VENTIONAV MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL I 7ANK U- Unsuitable for s st S O U ®S O U XI S O U � S O U O S � U I O S 1 Z U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Rcots c =D Tfe Io z z — s. l 2 m M41 0 I— ! 0.y I o. T L I o y 3 — r l z sb r►� -err k5 — 0•Lc 'O's I Ground 3 94-30 7 S Y 3 1 — S C- r, 051 d 1 0-5 — 0.7 :Q-T- elev. 401.O y - 81 0 14 / t , r S d — . - 7 0. Depth to limiting fact� I Remarks: Boring # i I 0- 4 d W — I s :a I ��: 50 Z - to 2 31 — s l 1 c w r o Ground 3 q -t 1 Y f, V — 511 Zff'S tr Y aw -' 10.5 0. elev. t- 0 — S r. a W "' i 1 ADS ft. ' Depth to 1 q r ti S 0 d _ J d •"] 10 limiting factor >qo'r I I Remarks: C6fLk Z4A6&4 10 . T Name: — Please Print Phone: 7 15 1 ILLS � IW re GSO""N ST . R t 19 T-ALLIS WZ 74 Sign Date: 7 CST Nwnber: aw 4. 27 Iq9 3 70 7 PROF= RTYOWNER RUI�LE .TOOAJ SOIL ,; PARC£1.I.0. # . Depth I Dominant Color Mottles I Texture Structure I Consistence Roots ��j/ft;-,' GP ' Boring # Horizon in Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed Trerxh I _ r M y C S , y 1614 -5144 s1 I ;L rn sbK ev4r CS Ground 3 3 1tt rnSbK (w4f' elev. — �.Zft s s rn� w 10.7 OX Depth to S I -An q7I )Fh Xa ,41S i S s m► — ,'7 limiting factor Remarks: fjznM 2- P,4rp5 70 (� Boring # I 10 z — I s� I m rn -P C S I r4 P 0, 50� q Z _ 15 t o z S)1 z rn m �� es 3 Is * � �1 Z eK I — , S 0. Ground I elev. 4 _ I - it r, t ms I -� GS 0.1. �•g ft. J r _ I6 y � 5 O '_ Depth t0 limiting fac tor 1 Remarks: 14 (VV? `I P '*5 7D n Sa "oetzp>y S HAS ScLv►E 3 1CANaL- Boring # Z 4- )5 I i�Z 5 r I Z r,. ,nn-�t S ! — 5 0•b 3 I5-3 10V 51 '. 5 rn' ( C 5 — 0.5 A(0 Ground _ elev.y -4z io r *4 I ' r. In"Shr rylgr s I — 10.4 0.7 V6.0 ft Depth to z" -4 — S rn I — 0 . 0. limiting factor Remarks: oGl IM TO 96 Boring # i Ground elev. ft Depth to limiting factor Remarks: SSD- 8330(R.0"2) Page 3 0 ° j PLOT PLAN Property Owner KU EAMGUL Legend NOTED Legal Description _U71?,tjQpy VILLAg�, BM /A/ W SSE of 4bCATE D IN Ttt15 %Z SZy, T2YAi !; ZDW WY2 S Iq, Tz9nl� K l4W � , 7bWA1 OFT VA 869, 51.-' sT,CCooX CouAiTY wISCONSIA1. Q = soil boring w /backho C SEE 34 ~ F8r— OKYZCT L LINE *A1 C-LES. LD T I Dasos � � FL qoi.3' ZC3 !� I y EL OSSo -7 EL S9'5.3 LoT�s � 0 0- Signed CS )"03707 Date Aj DU- Z7 lgg6 ,e��; Z-7,097 t and Hum ^ge Of De partment Industry, SOIL AND SITE EVALUATION REPORT Page — L 3 Division of Safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 57� i X0i x not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.O. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL LDWV REVIEWED BY D:;7- 9 r PROPERTY OWNER: RTY LOCATION jM 1 Z 5 Z TZ j g Zt) H/ f{ _ r _0004 $Af,6AKA a'r +OM &S R L.E . p:. W `/ S 19 T Zg N,. IQ � W PROPERTY OWNER':S MAILING ADDRESS LO BLOCK # SUBD. NAME OR CSM # C.T. N, F A I — T1KUY viuJM� CITY, STATE DP CODE 14KINE NUMBER 7 9 ;]CI ILLAGE QWOWN NEAREST OAD If 1A 0 111 tAm 540 t V 386 �14Ce3�c C- , r— Pq New Construction Use Residential! Nu V -' DBE Addition to existing building Replacement (] Public or comm Code derived daily flow (6410 gpd esign loading rate 0.6 bed, gpd/tt O'7 trench, gptrft Absorption area required I OM bed, ft 159 trench, ft Maximum design loading rate __Q,Z bed, gpd/ft 0. trench, gpd/;tZ Recommended infiltration surface elevabon(s) - M BE DIEM" wEp l3Y DQA fas - re fe rred to site plan benchmark) Additional design / site considerations — QW .< Parent material a1- 4CIA L- - r ILL Rood plain elevation, if applicable Na ft F U = Suitable for system VENTIONAL` MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN PILL 1 ;�0:; :0 7ANK =Unsuitablefors s S 0u ®S 0 I Z 0U 10 0U CIS R I CS ' Z U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary I Roots l G = D /ft in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh. G _c Tv F z m .� �.� s (— ! 0.y I o. s - 7 I 0Y a 3 — 1 L ^% M-�V- 415 — I 0•t4 ' Q S Ground 3 Z1 7..SY 3 / — 5 r, o5l 10.7 '0.T elev. gDLD ft. y : g 1 4/ t , S d [ — _7 0. Depth to limiting facto Remarks: Boring # l 0-4 Sill -� 1 I my Of s { 2 4-9 10 3 � Std j GW I A,11 0 Ground 3 q-1 i O YK 3 / S' — Z ekS f 4 A - 10.5 O. elev. f _ — 5 r. Q W _ i R'o� ft. ' q f Depth to ti - s o o d l — 0 :7 ! limiting I factor >go I I Remarks: C*Gk 2 4AS SOFA 1-r- t0 , M Name : — Please Print Phone: 7 1 1 4Z!5 -- q 1 re LSO 9.% rrALLS WZ 740 2 Sign - Date: 7 - 7 .$M7 CST Number: 4. 27 199 37 0 7 PROP =3TY OWNER M SOIL D 'dye �L u1 -� PARCEL LO. # Depth Dominant Color Mottles Texture Structure Consistence Bouncbry Roots GPu /ft Boring # Horizon in I Munsell Qu. Sz- Cont Color I Gr. Sz. Sh. I B ed iTrE" 2 m A S 0. (0 Ground 3 3 SI I msbK (w4v 5 7S in XiKc ggi.ift Depth to , 5 -AD - 7 l hva q1 set limiting factor Remarks: /J L 70 a Boris # r< v9:: m jr C S l m P 0. ) Z rn qr m f11 3 �/ 1 Z Ground elev. 4 - 10Y 51 r. L nns 1 GS 0, Qg-s.B ft. J� Ib 41(_ 5 O Depth to limiting fac tor 1 Remarks: 1412110 PAI- 70 40kl7-nr,► Boring # s � z Z fr CS �> F I Z� - : 1 1 2 m ,r4 3 IS -3 I OV 3 Sr 1 3 sbk marl 5 — 0.5 Ground elev. `I - Y �4 r 1►�^.s 0.7 _ 4 S „� 1 b .7 0.9 Depth to Z limiting fac Remarks: 44 rA is PALM TO OSq Boring # I Ground elev. ft. Depth to limiting factor Remarks: S8D- 8330(R.05M2) Page 3 o c L 3 PLOT PLAN Property Owner KQ EAMGUL� ii i Legend: �� FYC6'1 hl//tjC Legal Description 1- rrl? 1 /ILLA8e� ^�OTEP BM = #23 - SPI I N W S1Df O 4kVM D W - Trt e 9 Ym, 3zU, 77�N� ZD t^! 8W ELb119k Tx GL A"rO wy S W, - r2.M < 14a1, TDw,.I oFTXDv VCy *TrorU 831.341" ST.CCDix COUNTy wISC0MSIA1. Q = soil boring w /backho SEE SU KYEY M" For. CIKXECT 1�T L.IN ig AA1 G Lr LOr F 1 —� D 6SO� �k Le" *V � aasos � � � qoi.3' z Cr-31 1 P 3 2 3 ` � EL 'M - 0850 EL 893.5 �oTti3 � CC Signed CST Mo3707 Date OU• Z7 JIQ g4P, A1j.t9, Z7, /997 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer � . Iri. / - I 4' � I IG K Mailing Address - d�TOQ m u mv, Property Address V 19Sc.EJI3 M , 1,rDGVK , (Verification required from Planning Department for new construction) yQ City /State &V9LI Parcel Identification Number LEGAL DESCRIPTION / Property Location !2 S ec. 20 - To p rty `1(� 7((' S ,�, T N R W, o of Subdivision ��Y ' Vu�•a� , Lot # Certified Survey Map # Volume , Page # Warranty Deed 4 5 �D ' ? / ✓C , Volume 1 Z,5'0 , Page # 57 Spec house ❑ yes 9 no Lot lines identifiable Byes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as y the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your se ' stem as been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o the three a e p ati n date. t /2�/ o SIGN TURF OF PL ANT DATE OWNER CERTI ICATION I (we) ce tha all tatements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr erty desc a o e, virtue of a warranty deed recorded in Register of Deeds Office. AA /2 t /1 o SIGNJ,hJlff OF P CANT DATE * * * * ** Any info n 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 O (y O° O, e IV cn ✓ �. D 20 O I v, C7 r ASSUMED BEARINGS REFERENCED TO THE 1 O D m NORTH —SOUTH 1/4 SECTION LINE OF SECTION 19, C I I r • • T28N, R 19W, WHICH BEARS N 00-19'39" E. --- / 1 Z 1 (� O .o W - Tl I ' I m N 10 I O i 00 M 1 ,00 ,00.9 N I 05l O ti N I I .......... ... .,......... O_ I 1 2ps I — p) (11 I 1n i \ J O \ I 000 o Z N I I o m „G� '90ee Z N ,I-� X92 n\ ,�`� I 0 7 f N N M g0 cr I, a� m m „5 b ul \ ° \cn O$ M cn \ I o N m 6000 � '� 5 9 ° ' cP ti' � � s F �Z9 8 .7 ' OD o N I o�oo s ir. ,t8' �`'��i, °y 20 8 �8. ' 0 6 c�ZZ' o OD n 11 cn \ CNn c0 Z L N °_ Cn �" , 1 1 0 y 0 0 _� (JicO :q N 0 '� ' UJ of Di I i U N o o m' ..;` D Ln 0) ti D C1� 1 1 I 0 cog S `� ? O3 V S "f1' i N� /� �v iO o m 1 1 n 3 - .rO 6'i cp s O� g3 � S �^ L+ ' toq O O �. cn o �� 2ez 6 3 , j I° N -P` I O �, A V p cc N p p N 0, U II __ I � S 2 4 ° \ I v' O I 27 1 c o ,ss'a�z p 8 „£01S$OS0 S O 1 - -too - -too 4 �` X4 8 3 00 ,, c o F v I ���0/E,/ � � , ' 3 y o 4440 4 24. \trQ \�CS4 _. ' V /� t_ N Ln N _..a C4 j D 46 �1 O p• � .8 rn cn p ,, T j co j cm cn tD N(!J O W 14 0 \��$ 11 °0 cc 0 :A n to Cn cn ° '' rn _a 8 DO 189,87, m o N � po cb ° O N 42 � ' �� 710 ,0, 0 'y '�_� 0 00" W ; m 4 N . - 18g _ � cn N 1 e ti ?�� , N e , N rn 89 ,0 , � F �� % � cb $ j t° 97 � N . '' z tic, O z rn y �Q 1 Dcn w� C °° _ 2:-n N w , ° '' n 0 o v A- oc„ o g S N rp. co I o v 03 E �? n� D cr0 0 s �-° w 248.85 �� E 1 0 o I 273.78' ny I 0o OV Q f te a. I o V) cn ' N o cil @ L-0 w v � p , 00 , 00 °Z N�� >Nw N° M D N r I m 7+1 ' :car m cu IZ 03 00 E °�0� N Z`i I ca ' z 275.00' Z O to to N 03 °00' 0" E g IIT1 I 0D w O ° i 218.82' (n Ii„ o I 00 cn N� O tom L o f ���° S I 0 0� Na° O ts� cD�N o � I a D ,p 0 � 70'n `� rn cn I m I r I m ST. CROIX COUNTY WISCONSIN ZONING OFFICE 9 N RUN g Run ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 March 1, 1999 First Federal Attn: Tammy 201 S. 2nd Street Hudson, WI 54016 RE: Septic Inspection for Joseph A. Klewicki located at 257 Troon Court, Lot 12 of Troy Village, Town of Troy, St. Croix County, Wisconsin Dear Tammy: A septic inspection of the above referenced property was conducted on December 9, 1998. This property is located in the SW %4 of the NW' /a of Section 19, T28N -R19W, Lot 12 of Troy Village, Town of Troy, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. If you have any questions regarding this, please contact our office at (715) 386 -4680. Sincerely, i o d dE i anger Assistant Zonin Administrator /sm FAX ST. CROIX COUNTY ZONING OFFICE 1101 Carmichael Road Hudson, WI 54016 (715) 386 DATE: - /- TO: Fax Number. Name: �- FROM: Fax Number. //�� ,� 3864=6 Name: S�`AwxFi-- Number of Pages Including Cover Sheet IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE CONTACT: NAME: / � g U , TELEPHONE NUMBER: `� J