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Parcel #: 040 - 1097 -40 -000 08/19/2005 09:33 AM
PAGE 1 OF 2
Alt. Parcel #: 25.28.19.386E 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
JOHN & CAROL FEYEREISEN H & F INC O - H & F INC, JOHN & CAROL FEYEREISEN
155 HWY 35
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): " = Primary
Type Dist # Description ' 155 HWY 35
SC 4893 SCH D OF RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.000 Plat: N/A -NOT AVAILABLE
SEC 25 T28N R19W COM NW COR SEC 25, E ON Block/Condo Bldg:
N LN 1086.5' TO CL ST HWY 35, S 52 DEG E
2175.8' TO N LN, S 1/2 NE1 /4, N 89 DEG E Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
387.4'S 29 DEG E 488.1', S 57 DEG W 25- 28N -19W
POBS57 DEG W217.8FTTONR/W
7
more...
Notes: Parcel History:
Date Doc # Vol /Page Type
04/01/2003 715481 2190/545 EZ -U
826/582
761/252
756/281
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/06/2002
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 2.000 40,000 399,900 439,900 NO
Totals for 2005:
General Property 2.000 40,000 399,900 439,900
Woodland 0.000 0 0
Totals for 2004:
General Property 2.000 40,000 399,900 439,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Total Special Assessments Special Charges Delinquent Charges
0.00 0.00 0.00
Parcel #: 040 - 1097 -40 -000 08/19/2005 09:33 AM
PAGE 2 OF 2
Legal Description: cont.
217.8', N 32 DEG W 200' -POB. ALSO COM NW COR SEC 25, E ON N LN 1086.5' TO CL
HWY 35, S 52 DEG E 2175.8' TO N LINE S1 /2 NE1 /4 N 89 DEG E 387.4' S 29 DEG E
488.1 S 57 DEG W 56.2 S 32 DEG E 200' -POB S 57 DEG W 217.8', S 32 DEG E
400 N 57 DEG E 217.8' N 32 DEG W 400' -POB
ST. CROIX COUNTY ZONING DEPARTMENT / 4 3 �,.':..! ..;! /
AS BUILT SANITARY REPORT
Owner Al G
Addres
City /State ,` �, , �, ; S _ I .. ST CROIX
COUNTY
ZONING OFFICE
Legal Description:
Lot Block Subdivision/CSM #
'/, c '/. -A& , . Sec. , T.LN -R, Town of Tv„ ✓J PIN # , 7. ' Y
SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: ' sp
Tank manufacturer » i,`,t aw es fpew size ST/PC /iod / Setback from: House moo' Well P/L �
Pump manufacture_ r. 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 3 Length 2-� Number of Trenches r
Setback from: mouse Well PAL Vent to fresh air intake
ELEVATIONS
Description of benchmark 0l Elevation z
Description of alternate benchmark
Elevation
Building Sewer ST/HT Inlet ST Outlet q `� -� PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover 9. -?
Distribution Lines 7 2 () ( )
Bottom of System () 93• 4 1 () ( )
Final Grade () - 2 - L, 5 - 2 () ( )
Date of installation 5 fPermit number �47�5/ State plan number fl 114
Plumber's signature 44�t , 1 License number 22 7y Date /s /$
Inspector 6 '
Complete plot plan +
,
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Twc horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
N.
A
h a h
1 .
INDICATE NORTH ARROW
M�ss��... Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety*dnd Buildings Division
INSPECTION REPORT S�, CrviK
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)). ?
Permit Holder's Name: ❑ City ❑ Village IQ Town of: State Plan ID No.:
GV\ t/v
CST BM Elev.: Insp. BM Elev.: BM Description: II Parcel Tax No.:
Top 0 CCwich 4 05/0 - 4>97 - vO — or
TANK INFORMATION ELEVATION DATA 13 (o
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
e ti �'V►;dwGS' �tcctiai'f 1�p Benchmar 2.77 ioZT7 ! ��
Dosing
Aeration Bldg. Sewer 7.7— 95
Holding Inlet - 7 -114 9S. c 3
TANK SETBACK INFORMATION &)40 Outlet
TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet
Air
epti 1 5 7 D , 17V If NA Dt Bottom
Dosing NA Header/ Man.
Aeratio NA Dist. Pipe ZCS W72
Holding Bot. System 9.32- i
PUMP / SIPHON INFORMATION Final Grade Y.2S dy r. Si
Manufacturer emand ;� 3.3$ CM-
Model Number GPM
TDH Ift Friction ystem TDH Ft ead
Forc Length Dia. hi Dist. To well
SOIL ABSORPTION SYSTEM
BED / Width Length No. O Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS � �315� � DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA
C nufa er:
SETBACK CHA BER
INFORMATION Type Of
Mo el Num er:
SystemCvft& IS 'L?,i OR UNIT
DISTRIBUTION SYSTEM /,ScA&,
Header / Mani old � Distribution Pipe(s) „ x Hole Size x �.le Spacing Vent To Air Intake
Length -- Dia. Length 1 �•'7 -Bia. Spacing sidr: �it�il�j/pr�r 2.3 ,
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over ,/J Depth Over Seeled/Sodded xx Depth Of xx xx Mulched
Bed /Trench Center �D " 1� a Bed /Trench dges Topsoil ❑ Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.) / 5T -2
�) i�sftw - WA4 i#t yfJeW A,t e voWj' a/p�0 P/0
Plan revision required? ❑ Yes ® No
Use other side for additional information. - (p 1 1
SBD -6710 (R.3/97) Date In is Signature < ert. No.
V 6' SANITARY PERMIT APPLICATION Safety E �ng Division
consin In d with ILHR accord Wis. Adm. Code P.O. Box 7969
Department of Commerce 83 05, 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. -5'7
• See reverse side for instructions for completing this application State sanitary Permit Number
3077..E
The information you provide may be used by other government agency programs ❑ Check if revision to previous a lication
IPrivacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLI ATI N INFORMATION -PLEASE PRINT ALL INF RMATION f C — ; z o l
Property Owner Name Property Location
-f , e_'1 /4W t/4, S X!s T 2,' , N, R/ F E (�
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
11. TYPE OF B ILDING: (check one) ❑ State Owned ity Nearest Road
EL Public 1 or 2 Family Dwelling - No. of bedrooms o ig Tow OF - t S 7` 7el 3. i
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 0 el &_ l to
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 Q 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 14 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 ® Seepage Trench 22 ❑ In- Ground Pressure r I 42 ❑ Pit Privy
13 ❑ Seepage Pit �3 7� 43 ❑ Vault Privy
14 ❑ System- In -FiII
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. 5,�(s3eeev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) `� J Elevation
19 2 G� 7 - 7 Feet . Feet
Ca acit
VII. TANK in allons Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name concrete con Steel glass Plastic App
New Existin structed
T nks Tanks
eptic Ta ng ink i GLl[s' �„ ' I`:~ y r/ Q ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber El El 11 1:1 ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite ey
ypige system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code):
4 r
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitar i Permit Fee (Includes Groundwater ate ssu Issui g ent Si tune (No Stamps)
)6 Approved E] Owner Given Initial I � / �S argeFee) � V
Adverse Determination cJ c �
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6.= (R 1 tom) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
031211998 13:51 608- 785 -9330 SAFETY AND BUILDINGS PAGE 01
SAFETY AND BUILDINGS DIVISION
2224 Rose Street
LaCrosse, wecaIsln 54603
V A
sconsin ?amWG.Tkngnm,covens
Department of Commerce v Irom J. MoCoehen, Secretary
March 23, �.9 9 8 post -Ir Fax Note 7671
T °S`T
coJDept. co.
G
Phones apfir
WEGERER SOIL TESTING & DESIGN Fex>r L Fax
P.O. BOX 74
RIVER FALLS WI 54022
RE: PLAN 9820410 FEE RECEIVED: $335.00
H & F INC.
SW,NE,25,29,19W
TOWN OF TROY COUNTY OF ST. CROIX
NON- PRESSURIZED IN- GROUND SYSTEM
PETITION FOR VARIANCE TO CODE SECTION(S): Comm 83.12(4)(b)
83.15(3)02.
The Department has reviewed „the above- referenced submittal..
Conditional approval is hereby granted for. the system plan submittal.
All noted items must be corrected. The review and approval of the
system is based on chapter 145, Wisconsin Statutes, and chapters
Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon
compliance with any stipulations shown on the plans. This system has
not been reviewed for the code requirements set forth in chapter
Comm 82 or in chapters Comm.50 -64, Wisconsin Administrative Code.
This plan submittal approval, will expire two years from the approval
date, or if a sanitary permit is obtained, plan approval will expire
on the day the initial sanitary permit expires. The licensed plumber
responsible for this installation shall keep one set of plans with the
Department's stamp of approval at the construction site. The
installer shall notify the appropriate inspector when inspections can
be made.
All of the statements and supporting documentation included with the
Petition were considered. Since your request is similar to other
petitions approved by the Department (e.g.S93 -00586 & S92- 51057), the
petition is conditionally approved. The conditions are:
1. The system is to be constructed and located in accordance with
the enclosed approved.plans.
13D5524•E (R. RA” Re Rst; HA93.12(4)8 a 83.15M(C)Z_D0C
M 03/23/1998 13:51 608 -785 -9330 SAFETY AND BUILDINGS PAGE 02
SAFETY AND BUILDINGS DIVISION
2226 Rose Street
` LaCrosse, Wlaoon9in 54603
,sc0nsin
T=M1V G. Thompson. GloveMW
Department of Commerce I William J. Mccostien, Secretary
WEGERER SOIL TESTING & DESIGN
PLAN 9820410
MARCH 23, 1998
PAGE 2
2. In the event this soil absorption system or any of its component
Parts malfunctions so as to create a health hazard by discharge
of partially treated or untreated liquid waste to ground surface
or into surface waters or groundwaters of the state, the owner
will employ a properly licensed plumber to repair, modify or
replace this system (including the possibility of installing a
holding tank with proper disposal) with such action approved by
the Division and appropriate local officials.
The variance requested was to allow an .existing retail store to install
a replacement non - pressurized in- ground soil absorption system that
would be undersized. The size reduction is based on the actual daily
customer count records that are approximately 70 percent less than
code specified figures.
This petition approval is granted conditionally with the understanding
that all of the petitioner's statements included on the variance
application form and any other documents submitted to the Department
will be carried out. This variance is specific to the subject petition
and cannot be used for any additional modifications.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please
refer to the plan number shown above.
Sincerely,
Gerard M. Swim
POWTS Plan Reviewer
(608) 785 -9348
cc: St. Croix Co.
sBD4=4E (R. 2") Fib Rd: H;M.12(4)1k & a9.15(S)(0)Z.00C
SAFETY AND BUILDINGS DIVISION
2226 Rose Street
LaCrosse, Wisconsin 54603
N visconsin Tammy G. Thompson, Governor
Department of Commerce William J. McCoshen, Secretary
March 23, 1998
WEGERER SOIL TESTING & DESIGN y '
P.O. BOX 74
RIVER FALLS WI 54022
G � Q FPJc
/f 4 {i
+
RE: PLAN 9820410 -.. � RECEIVED: $335.00
H & F INC.
SW,NE,25,28,19W
TOWN OF TROY COUNTY OF ST. CROIX
NON- PRESSURIZED IN- GROUND SYSTEM
PETITION FOR VARIANCE TO CODE SECTION(S): Comm 83.12(4)(b)
83.15(3) 02.
The Department has reviewed the above - referenced submittal.
Conditional approval is hereby granted for the system plan submittal.
All noted items must be corrected. The review and approval of the
system is based on chapter 145, Wisconsin Statutes, and chapters
Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon
compliance with any stipulations shown on the plans. This system has
not been reviewed for the code requirements set forth in chapter
Comm 82 or in chapters Comm 50 -64, Wisconsin Administrative Code.
This plan submittal approval will expire two years from the approval
date, or if a sanitary permit is obtained, plan approval will expire
on the day the initial sanitary permit expires. The licensed plumber
responsible for this installation shall keep one set of plans with the
Department's stamp of approval at the construction site. The
installer shall notify the appropriate inspector when inspections can
be made.
All of the statements and supporting documentation included with the
Petition were considered. Since your request is similar to other
petitions approved by the Department (e.g.S93 -00586 & S92- 51057), the
petition is conditionally approved. The conditions are:
1. The system is to be constructed and located in accordance with
the enclosed approved plans.
BD- 5524 -E (R. 2198) File Ref: HA83.12(4)B & 83.15(3)(C)2..DOC
SAFETY AND BUILDINGS DIVISION
2226 Rose Street
OjV LaCrosse, Wisconsin 54603
1*isconsin Tommy G. Thompson, Govemor
Department of Commerce William J. McCoshen, Secretary
WEGERER SOIL TESTING & DESIGN
PLAN 9820410
MARCH 23, 1998
PAGE 2
2. In the event this soil absorption system or any of its component
Parts malfunctions so as to create a health hazard by discharge
of partially treated or untreated liquid waste to ground surface
or into surface waters or groundwaters of the state, the owner
will employ a properly licensed plumber to repair, modify or
replace this system (including the possibility of installing a
holding tank with proper disposal) with such action approved by
the Division and appropriate local officials.
The variance requested was to allow an existing retail store to install
a replacement non - pressurized in- ground soil absorption system that
would be undersized. The size reduction is based on the actual daily
customer count records that are approximately 70 percent less than
code specified figures.
This petition approval is granted conditionally with the understanding
that all of the petitioner's statements included on the variance
application form and any other documents submitted to the Department
will be carried out. This variance is specific to the subject petition
and cannot be used for any additional modifications.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please
refer to the plan number shown above.
Sincerely,
Gerard M. Swim
POWTS Plan Reviewer
(608) 785 -9348
cc: St. Croix Co.
SBD5524 -E (R. 2198) File Ref: HA83.12(4)B & 83.15(3)(C)2..DOC
CONVENTIONAL SCIL ABSORPTION SYSTEM
` FOR ..�
Page of
LOCATED IN THE SW 1/4 OF THE NE 1/4 OF SECTION Z 5 , T ZS N, R 1 4 W,
TOWN OF COUNTY, WISCONSIN.
RECEIVED
MAR 1 2 1998
INDEg SAFETY & BLDGS. DIV.
Page 1 of 4 TITLE SHEET
Page 2 of 4 PROJECT DATA
Page 3 of 4 PLOT PLAN
Page 4 of 4 SIDE VIEW -CROSS SECTION - L�Cb4 CbHw1g�R
C
PREPARED FOR �O �pING
�o�11J F o-0 N S Np��.1GE
4 F i ) ti.► C .
C�IUL�2 t= y� -l.ls, W 1 S 4o s
PREPARED BY
4 l9 , Pip
Ja-
WEGEF:ZEF�Z SO I L TEST I P4CD
`,T D na AATHr.'A L.
A ND w -ER
_ : 11' p
ELLtiA RTM,
DES I Gh1 SIEFZZ V ICE w.
F.O. BU 74 421 K. KAIK ST. 4
RIM FXLS_ KI 54022 �8?n � $ T
715 - 425-416)
JOB NO.
PROJECT DATA Page Z of
This conventional gravity flow soil absorption system will serve
a furniture and home furnishings store with 6 employees and an
anticipated maximum of 50 customers per day.
ANTICIPATED WASTEWATER
6 employees X 20 gpd = 120 gpd
50 customers X 1.5 gpd = 75 g pd
Total = 195 gpd
ABSORPTION AREA
196 - .5 loading rate = 390 sq.ft. minimum required.
15 units of the HIGH CAPACITY SIDEWINDER LEACH CHAMBERS by
INFILTRATOR SYSTEMS, INC. will be installed providing 477 sq.ft.
of absorption area.
This area will allow up to 238.5 gal /day of wastewater and up to
79 customers per day.
SEPTIC TANK
Maximum 238.5 gal /day + 750 = 988.5 gal. minimum capacity required.
A 1000 gallon Wieser Concrete Products septic tank will be installed.
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Wisconsin Hum Relations Industry SOIL AND SITE EVALUATION REPORT ,
Labor and tiurnan Relti Page of 3
Dh"n of Safety & Buildrxts in accord with ILHR 83.05, Wi Adm. Code
COUNTY
Attach complete site an on
mpl plan paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), dir - Wa`ri % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to i t `toad. p L 4 0 _ 1%39 7 _ L O
APPLICANT INFORMATION PLEASE PRINT FORIWION REVIEWED BY DATE
PROPERTY OWNER: K1 t C � L ' � - ' r- PROPER OCATION ������
F, I N C. t ;..t 1/4 N E 1 /4,S ZS T Z S ,N,R t ° I E ("C J AAA n. PROPERTY OWNER'.S MAILING ADDRESS T # BOCK # SUBD. NAME OR CSM #
k S S �Z-� ST CROIX — — --
CITY STATE ZIP CODE P E )UMBE + FI CI7Y, ILLAGE ®TOWN NEAREST ROAD
1U � �J� S`! U ZZ (1111'4 _ ; r y; ST- 2D. - s S
[ j New Construction Use[ j Residential / Number o ! 1 j
[ J Addition to existing building
D9 Replacement Public or commercial describe »tu - Sly
Code derived daily flow I gpd Recommended design batting rate ±_ bed, gpd/ft , S trench, gpd/ft2
Absorption area required y86 bed, ft 3°I 0 trench, ft Maximum design loading rate __ bed, gpd/ft S trench, gPdfit
Recommended infiltration surface elevation(s) °I y ft (as referred to site plan benchmark)
Additional design /site considerations C� y L'ch CI Cn 2s
Parent material S � L S Mt" e)VT O,I•q Flood plain elevation, if applicable M ft
S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL
HOLDING TANK
U= Unsuitable for sy stem S❑ U ®S D U ®S O U ® S El U ®. 11 U EIS Q U
SOIL DESCRIPTION REPORT Se K.)Z i� OI\1 p/tGE Z>
Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Consistence Botrxiary Roots
Be
z 3 / Z Bed rend,
Z o"I tz 31 y — s 1 Z r►- sbk m �� i=ce , s . L
Ground 3 2'0 2 - 1. S `t R 31 Y — S 6>^ S 9 wt o> .. • -� . $
elev.
ft. y zc) —9 16 X0'-1 R S e _ �S
i ow, u fit- . `l F. 5
Depth to
limiting
factor
>
Remarks:
Boring #
o - 1 O`l R 3! z St Z `�5�� L• S 1� , S •' •1.
Ground 3 1q-yy -s `iR 31 y — S� 1 ►n Sb>� I, U `Ft- ek, •�[ € • S
elev. 4 qtr - ►o 1 b712 sIL _ ' o,� v►�v — • ` •5
9 -o ft
Depth to
limiting
factor
> I�b"
Remarks:
T Name: — Please Print Phone:
Arthur L. We erer 715- 425 -0165
eg %rer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 '
Signature. �./�
Date: l��h1TZ 2_, ly°JF j CST N 00576
•
PROPERTY OWNER 1- $ 1= , IN SOIL DESCRIPTION REPORT Page l'of 3
PARCEL I.D.# D`ID- �D11 - �D
•
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench
10`1 a_ 3 / sb1T w\ e-S 1 v S -L
Z. 1l_9 v 1 c y 2 3/y — S; Z >n S Yn H C°S - s . t.
Ground 3 40-S1 S ylz \ 1 m S bA•T m J`- Ck) .4 . S
elev.
c7V.o ft. y SL_a3 S 16 \c_s dti"� v� — '1/44 .3
Depth to
limiting
factor
1 01.1"
Remarks:
Boring #
REM MC5TE = R NQ`n`n urJ FoNZ. Pc-Tc j PM/ Qt.l2�
c�C�xkw1,3wr OF so Cs-ugtvt S/ ter 'Hks--ict
Ground CC�E S1�,� G � R c1L- -S Ott- 8f'�L7 oN t .-2.L AVf3t
elev. ft. wS�Jt••'10R.S w oU �? `3t✓ 3 S O Cv s� r'► S i D H'l.Cl� l
Depth to 0r cLf�'n C
limiting
factor
Remarks:
Boring #
1,81191
fi l<
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
PLOT PLAN Page J of a
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CST Signature Date Signed • Telephone No. CST #
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address Lt ff Q I L S4 2- 2
(Verification required from Planning Department or new construction)
Cit3 / tate lv ►� Ca I,(� 1,t (� parcel Identification Number — y
LEGAL DESCRIPTION
Property Location S ! ;, Sec. ZS - , T N R
�W, Town of _T KOV
Subdivision
Lot #
Certified SwTe Map # Volume
. Page #
Warranty Deed # Q� Volume G Page # S'�'2—
Spec horse 0 yes O no Lot fines identifiable Q yes 0 no
MUM 14Laf NANCE
Impmperuseandmamtwa= ofymwseptic systemcouldres*initsprematcue uretoCandlewastes.Properm&ftia=
consists of pang out the septic task every gaee years or if needed by a liocnsed
can affect-the
fim�ion of the septic tank a try stage is the wage disposal: system P=Pa what Y into
T
WON ItY owner agmes to submit to St. Croix Zaaiag Department a certification f
p �° P :�ictedplumberara licensed °�• by owner and by a
is is proper operating condition and/or (2) after inspection � ymg that ( the site wastewaterdispwal system
P�Pm$.Cuf aeassar3►), the septictanlcis Less than 1/3 full of sludge.
. �• � mod have read the above requireincnts agree to mai�aia � private sewage
set &A berm. as set by the Department of Cie and the system with the standards
stati ° tW your septic year CTiration date. em been maintained must be completed dro wned to S (� oix uatq Zoning Office wittun 30
days f the three
LURE OF APPLICANT
DATE
OWNER. 7-RR1IFICATION
I (we) certify that all statements on this form are true to the best of m
Pmi�Y dcscnW above. by virtue of a warranty deed recorded in Y ( ° knowledge. I (we) am (are) the owner(s) of
Register of De eds Office.
SIGNATURE P ICANT
DATE
« « « « «« Ar ty iafomration that is mis- representod may result in the sanitary perimt bewg 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
DOCUMENT NO, STATE BAR OF WISCONSIN FORD[ 3 -19891
TN'. [PAC[ R[f[RV[D roe R[CORD,NQ DATA
QUIT CLAIM DEED
-- 44296* - - - -- eooK 826 ?A �:t 582 1 11 REGISTER'S QFFIC2
-- - - - -- - ST. CROIX CO., iM
Theodore Howard and Connie Howard, husband and wife Reed fw Rai'
---...- --- -- •--- ---- ---- ---------------------------.................................
as survi vors • hip marital
property
NOV 071986
--------- - - - - -- ............................... _ ....... .......... - - d 8:30 A JA
to .. John W. Feyereisen and Carol • e1. - Feyereisen, a
husband wfe as survivorship marital ro ert
P...P . _Y I
------------------------------ -- - - - -.. .......
�plMaelDaed�
...............
the following described real estate in ...St. Croix
--------------------------- - - - - County. -- - -- A State of Wisconsin: '1 R[TVRN TO
Tax Parcel NoZ
See attached sheet for legal description.
�I
Grantors hereby also convey to Grantees all their right, title and interest in
J b T Real Estate Properties Partnership. fl
r
FEB
This is.
_pot . ......
_. homestead property.
kid (is not)
Dated the =. _..- .....4th
---- - -- - -- - -- day of .......... .
November_.
-.. . -., 19.8$....
re Ho d
--- _.._..(SEAL) _. .....(SEAL)
eodowar
.:'41�c�Ft!� - .. . . . . .. .........(SEAL)
- - - ..... ...... _ _ - - .
. Connie Howard
AIITHBNTICATION ACKNOWLEDGMENT
Signature(s) .of -. Theodore -- Howard.- n.. -•- STATE OF WISCONSIN
Connie Howard '
authenticated ttis 4th NOV November
....... .... ....................County.
19 . 8 $ Personally came before me this ..
/ -- -- - -----day of
........................
--- ---- --------- --- 19.... the above named
e h D. •-- -•-- •- --- --- •• - - - -- ------- ........................
P Boles --
__
TITLE: MEMBER STATE BAR OF WISCONSIN
- ----- - - --- ......-- ----.... --- .
(if not, -- --..._. --- -
_ _ _ - ------•-- -• - --- -- -- ------
authorized by 1 706.06, Wis. Stats.)
to me known to be the person .... .- who executed the
TM!S INSTRUMENT WAS DRAFTED BY foregoing instrument and acknowledge the same.
JoQenh Ti_ Rntoe D-Al j
.' Part of SVj of NES4 of Section 25- 28 -19, s -
�QOi
r
Com,encin at NW corner of Section 25; thence E on N line.of
said Section 25,'1086.5 feet to centerline of State Trunk
Highway 11 35 "; thence S 52 E on said centerline and exten-
sion thereof 2175.8 feet to N line of 51,E of NES$; thence N 89
33 E on said N line 387.4:-feet; thence S 29 E 488.1
thence S 57 W 56.2 feet; thence S 32 E 200 feet to
place of beginning; thence S 57 N 217.8 feet to N right -
way line of State Trunk Highway "35 "1 thence ' S 32 E on said
right -of -way line 400 feet; thence N 57 E 217.8 feet; thence
N 32 W 400 feet to place of beginning:
too, 826 PA
M A parcel of 1 acre located in south half of the northeast quarter of
'Section 25, T 28 N, R 19 W, described as follows: from the northwest corner
of said Section 25, go east along the north line of said Section 25 a distan
11 of 1086.5 feet to the centerline of S.T.H. 35, thence South 52 East
along the centerline of said highway and an extension of said centerline a
'distance of 2175.8 feet to the north line of the south half of the northeast
quarter of said Section 25, thence North 89 East along said north line
of the south half of the northeast quarter of Section 25 a distance 9f 387.4
feet, thence South 29 Easta distance of 488.1 feet, thence South b7 41'
'West a distance of 56.2 feet to point of beginning for parcel to be conveyed
herein: thence continuing South 57 West along the southeast line of a
parcel previously sold to Dick Fox a distance of 217.8 feet to the north
, right -of -way of S.T.H. 35, thence South 32019' East along said right -of -way
line a distance of 200.0 feet, thence North 57 East a distance of 217.8
feet, then.,e North 32 West a distance of 200.0 feet to place of beginnin
Vi scons i SANITARY PERMIT APPLICATION Safety and Buildings Division
n 201 E. Washington Ave.
Department of Commerce 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 8112 x 11 inches in size.
• See reverse side for instructions for completing this application y Pe m
State Sanitar it Number
The information you provide may be used by other government agency programs 3o777-s1
❑Check it revision to previous a cation
li
IPrivacy Law, s. 15.04 (1) (m)).
State Plan I.D. Number
L APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N �! d" - a Q Z/ /Q
Prop rt Owner Name Property Location
I f' .� a ti e e Y a,v S 114,v6 va, S .2S T ,� , N, R Q E (0&
Property Owner's Mailing Address Lot Number Block Number
S _ 6_7 ' a r iV _'F -
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. TYPE F B ILDING: (check one)
❑ State Owned ❑ It y Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ❑ village � 3S
Town OF �Y`rJ- � 7`
Ill BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall f' dical Facility/ Nursing Home c 5 �'; 10 ❑ Outc!02 PLftpational Facility
3 ❑ Campground 7 M Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash
r 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. id Replacement 3. ❑ Replacement of 4 Reconnection of
- - - - -- System System ❑ . 5- E] Re s
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 ff) Seepage Trench 22 ❑ In- Ground Pressure o I 42 Pit Privy
13 [] Seepage Pit 3 1 3.7I 43 ❑ Vault Privy
14 E] 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
/1715 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
'� zY --7 s "C/ et- Feet 9 Jr Feet
VII. TANK Capacity
INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Ex per-
New Existing Gallons Tanks Concrete Con- Steel g la ze Plastic A p p
Tanks Tanks ! strutted
epticT ingTank K IJ ®, ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsit ge system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No Stamps) PRSW No.: Business Phone Number:
LfJ /l; a nt .Sofia makev l�l 27��
Plumber's Address tr City, I S Zip Co e�
IX. COUNTY/ DEPARTMENT USE ONLY
❑Disapproved Sanitar Permit Fee (i ncludes G, ate ssu Issui g entSi ture(NoStamps)
I] Approved El Owner Given Initial 00 Surcharge Fee) ( J
Adverse Determination �(> I ;
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
.— - - -- "' nIMIRIITInN• nrininal to rmmty now chow To: Safety A Ruildinns niwision. nwner. Piumh r