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Home My WebLink About040-1121-20-000 S'I'• (:ROIX COUN'T'Y %ONIN(; AS I;UII, I' SANI'I'AItY 'REI'OR'I' q wncr cr Address City /State 5 CFd;�A � oar �r �, �rvr. Legal Description: Lot Block Subdivision/CSM 1/ (lF, Sec., TN -RL�tW, Town of ro a PIN 1t SEPTIC TANK — DOSE CHAMBER — BOLDING TANK I NFORMATIO N- A8.� ON: Tank manufacturer Size ST/PC /d5gr Pump manufacturer ? — S� ack from: Ijouse /6b Well P/L > Alarm location Model ffl� C� (HOLDING TANKS ONLY) Setbacks: Service road — Vent to fresh air intake Meter location Water Line A)14 Alarm location /U SOIL ABSORPTION SYSTEM: Type of system: _ -C) /lL Width Setback from: House Well __3_ Length Number of Trenches PAL _____ Vent to fresh air intake ELEVATIONS: Description of benchmark C 5 4- 61VI Description of alternate benchmark Elevation 9- Z �� Elevation /06.5 Building Sewer ST/HT Inlet n ST Outlet- PC Inlet — '�"- -- - PC Bottom -299-9- Header/Manifold �, `7 To of ST/PC Manhole anhole Cover 9, a g Distribution Lines ( ) O O Bottom of System( ) g Final Grade Date of installation/ / / crmit nu >tbcr State plan / number Plumber's sign re VIA License number 1 7 Date ?� Inspector Comploc plot plan K NOTICE: Please provide the following: • . A plan view sketch showing everything within 100 feel of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark,'if applicable. PLAN VIEW / J o a H' cv\P /401_-+F..A-ker2 .5 .e2 ;ifiA . V\ / rli 8 . ,..,.., , A, , i ,k, _ (.,J ' irofif i i r 7 "I, :.,,,, , , ,_ ________----Mt ‘.1-1 ..10-1 lic /6(1,5E3 e \ AM INDICATE NORTH ARROW LL A/isconsin Department of Commerce safe and Buildings Division PRIVATE SEWAGE SYSTEM – coun ty INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar e Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 1 1 � ��g�cs,luVamQ: L flLitx`7 Description: x Village ❑ Town of: State Plan ID No.: CST BM Elev.: r A Insp. BM Elev.: BM DesM � � � Parcel d TANK INFORMATION ELEVATION DATA A9800307 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 2/p Benchm T Z Dosi n Jh rl S A t L7 Aeration Bldg. Sewer $•s ��- 3 Holding Sfq ftklet p 7 9 TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Aeintake ROAD Dt Inlet eptic 7 �� /c f1J� /OZj N NA Dt Bottom Dosing �� f lo NA Header /Man. �7•�, 7.(F, 9• l9� c �6 Aeration NA Dist. Pipe Holding a �• �8 Bot. Syste /v PUMP/ SIPHON INFORMATION - �� Final Grade -7 •Z' m ax 71 (o Manufacturer Demand �a A• Sa c/ 5"2– Model Number 4/0' O 3a GPM S>�. pia S• S7 r-1�i• Z � TDH Lift 7.79 System_, TDH Y.31 Ft Forcemain Len. Dist. To Well SOIL ABSORPTION SYSTEM BED Width r Length r No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIME I N 3 �. DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION Sypeo 7�/ 2 CHAM y � � - OR UNIT DISTRIBUTION SYSTEM Header / Manifo Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake % Length Dia. 14 • Len Length � � " ' / r (a 9 Bia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Bed /Trench Center Bed /Trench Edges To soil P ❑ Yes ❑ No No COMME NTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 3 2.2 8.19.4 9 7 , NW , NE 81 CARLSON LANE w0 `r +Lvo ` - ,o -,ct� SO �>l 1 r C rA ` 10 -ta ilc� �jrh G �j��Ql. iO p /O G liE r c ti {^S - W 4 . C Q¢Aw lrta� ;3 4 u�-� . Wc I S (/ c CIO Plan revision required? ❑ Yes No a/ x Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature / Ce No. Safety and Buildings Division *6 cons i n SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue I n 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 Q than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Number Personal information you provide may be used for seconds 3 ` 5 7 (9 secondary purposes Check if revision t 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 I A C pe Location L � Q AWis /U - 1/4,5 3Z T 7,2,N,R E(o Property Owner's Mailing Acl r � 5 Lot Number Block Number City, St VCI� � Zip�o� � `hon Numbe� �� Subdivision Name Number 1 5 T " -�' 1 2.13 I ll. TYPE F BUILDING: (check one) ❑ State Owned ity � n Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms own of Tea C- Pk02,GA LAPX-i III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo V ` C ( Z 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. kNew 2 ❑ Replacement 3_ ❑ Replacement of 4 E] Reconnection of 5. ❑ Repair of an System - - - - -- _System - - Tank Only ------ -- - - -- -- Existing System - Existing ----- - - - - -- -------- ------ ❑ 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 J&Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 Seepage Pit ' 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade ,c{C1 Required (sq. ft.) Proposed (sq. ft.) (Gals/d y /sq. ft.) (Min. /inch) do Elevation U lJ `6 0 ---ter 7 Feet FY Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex p er. INFORMATION New Existin Gallons Tanks Manufacturer r s Name Concrete Con- Steel glass Plastic A p p structed Tanks Tanks e rFFeldi an tD Lift Pump Tank r c P El VIII. RESMNSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's me: (Print) Plumbe 's Signature: ( amps) MP/ o.: Business Phone Num er: � K 0 S ( Z7 Plumber's Address (Street, City, to Zip ode): �� w IX. COUNTY/ DEPARTMENT USE OffLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuing Acte Signature (No Stamps) A roved Surcharge Fee) t pp ❑Owner Given Initial q /g� 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 V 6con sin SANITARY PERMIT APPLICATION sa fety and Buildings Division 20 1 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. C • See reverse side for instructions for completing this application State sanitary Permit Number The information ou provide may be used b other government agency programs : 3 1 �/ Y P Y Y 9 9 Y P 9 ❑ Check if revision to prevl application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name N6 �I /4 1/4 S 3Z T z8 N R C ? E (Oro AL Property Mailing Address Lot Number Block Number o /74 AA ..._ Ci , St tom_ s Zip Code Phone Number Subdivision Name or CSM Number 5 o Z Z ( 7 e t -3 II. TYPE OF BUMMING: (check one) ❑ State Owned o Cit Nearest Road ,� Public 1 or 2 Family Dwelling - No. of bedrooms D vll�an OF O C fpti L4uC Ill. BUILDING USE (If building type is public, check all that apply) Parcel T Number(s) 1 ❑ Apartment /Condo v7 Z Z0 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, KNew - 2. []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 JA Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure � r f 42 E] Pit Privy 13 [] Seepage Pit / 9 /l &7 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 (s . ft.) Proposed (jq. ft.) (Gals/day /sci. ft.) (Min. /inch) q Elevation 1� / / Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Prefab. Site Fiber- Ex e Steel r Gallons Tanks Manufacturers Name Con- glass Plastic App New Existing Concret strutted P Tanks Tanks /� �7, I or+feidTtitlTaPik ZtTfl W C_ e t �! ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber I ❑ ❑ I ❑ 1 ❑ ❑ Vill..RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' ame: (Print) Plumber's S nature: (No S s) MP/MP. No.: Business Phone Number: 0 L LSo 7 _ Plumbe sAddressS,StrCet,� �ate,Zip � J � � �� L IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Is ui g t Si ature (No Stamps) pP )<A roved ❑ Owner Given Initial urc 1 7 / 1 , harge Fee) /� ¢ � Adverse Determination 8 v � f)U 1 In X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD (R•11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber D6 n A Al 2 G elk, g3��kx c 1 \Lx v g, 5 K a D � �nsw(�� ✓ I , �� L L. 1V 637 PAS F cF A L__6 PUMP HAMBER CROSS SEC IOIJ AND SPECIFICATIONS VENT CAP 4 "C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIAIG Z5' FROM DOOR, JUNCTION BOX MANHOLE COVER WINDOW OR FRESH 12 "MIU. AIR INTAKE I GRADE I I Y" MIM. L - - 18" h111J. CONDUIT _ 18 "MIN. v --- - - - - -- 11� IAILET PROVIDE I __ _- AIRTIGHT SEAL I I III * � *� A I I lil I I ALARM I I Z 0 *APPROVED I i ON JOINTS WITH I I ELEV FT. APPROVED PIPE I 3' ONTO PUMP -� - -� OFF D SOLID SOIL COMCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MAIJUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE �/j TANKS MAIJU FACT URER: `�' '� IJUMBER OF DOSES: PER DAy TAAIK SIZE: �Z�O' / D , _; 0 GALLONS DOSE VOLUME TT ALARM MANUFACTURER: INCLUDING BACKFLOW: �v GALLONS MODEL NUMBER: CAPACITIES: A= `� IIJCHES R GALLOWS SWITCH TYPE: Z PUMP MAN UFACTURCR: 22za `- B - LATCHES % q GALL01J5 C=- • 3 IAICHES OR . GALLOUS MODEL DUMBER: _ ii / � (] Ivy r �, � D= INCHES OR GALLONS eY SWITCH TYPE; �/ �1 NOTE: PUMP AWD ALARM ARE T� E MINIMUM DISCHARGE RATE _ C �o GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKEMCE BETWEEN PUMP OFF ARID DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK AC h SUPPLY PRESSURE . " . E i , _ .. FEET -�- . � �D FEET OF FORCE MAIN X FT `f 1 l00 FLFRICT1011 FACTOR. FEET TOTAL OyNAMIG. HEAD = _ FEET INTERNAL DIMEIJSI NI: OF TAN LENGTH Q DEPTH I SIG►JE O: LICEMSE NUMBER ,F % nATF- / i ME40 Series 4110 HP Effluent and Drain Water Pumps Curve Performance P MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 5 0 100 150 200 250 300 350 40 12 35 W 30 10 L "Z 25 6 Z l 20 15 H a 10 4 O F- 5 2 0 0 10 20 30 40 50 60 70 80 90 100 0 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company -1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. 01/05/1995 16 :02 7152737753 NELSON PLUMBING PAGE 01 CE x Ja) mn m z `� 111 ' i i i • :... - l7 c OL 0 m a �+ o r Q Li W � 1 it # E r t@ 1'j • • • • I I .. X11 LD = C) r- i q ro a 4 r w CL a' CD K ati a�� mq 1 Q (D I 1 (D _LLI -• i� Qi 1 . � � �. � i f ... r i i • i �� _ ° m `� N n a:w N � E- � fl je - v - . , x a sv �.II�.�. ►. 1 '.i ; j $ 02 H C a IIII co - _ Invert y _w Wisconsip DeparbZt of Industry SOIL AND SITE E V A L U I� T Page \ of 3 Labor and.Human Relations Division of Safety a Buildings in accord with ILHR 83 5 �l+ . Adm. CoC�` , ti UNTY - r. Attach complete site plan on paper not less than 81/2 x 11 inches in ' an must not limited to vertical and horizontal reference point (BM), direction a of sl6k scoe or CEL I.D. # dimensioned, north arrow, and location and distance to nearest road i xz" vu APPLICANT INFORMATION- PLEASE PRINT ALL INFORM ( i 'P fo! �. DATE , D Y R PROPERTY OWNER: =q�1pS 4 uS wl YtN Af30PER IOIV �v" l�S 1�L R►JD �L�tr �.On►6SQO�Z �I��?^$fi( 1/4,S32 T Z _ ,N,R t E(orj�y PROPERTY OWNER':S MAILING ADDRESS L BL BD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®TOWN NEAREST ROAD 'i 1 .UtM T-W-Q, W I SY oZZ I C'PcR-urjh1 � E Pq New Construction Use [x] Residential ! Number of bedrooms L { [ ] Addition to existing building [ j Replacement [ ] Public or commercial describe Code derived daily flow I '3b 1 3 gpd Recommended design loading rate S bed, gpcW • 6 trench, gIXW Absorption area required bed, ft2 1 b o trench, ft Maximum design loading rate S bed, gpd/ft • b trench, gpo1ft Recommended infiltration surface elevation(s) ( - - r t4 O It (as referred to site plan benchmark) Additional design / site considerations 3 ��e -Wen -tN\e_ N S 'Y- 6 S' ww6 6R l y'x 61' Parent material Srr.n y Uv1�R )i Flood plain elevation, if applicable `IV , 1� . It S = Suitable for system CONVEWIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 23S ❑U ®S ❑U ®S ❑U ®S ❑U ❑S ®U I ❑S ®U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /fi Boring # Horizon in. Munsell Chu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tfe & `;�1�:° <T o -I tJ �O"t R Z11 — Si. � Z`Fs� `^'1�• c-S Z'� • S • � Z w Si Zm abl z vvl' V 0, Va •S . b Ground 3 �9 -�(�I S `T R 3 S as �k 'M U - C- S ,4 .S elev. C, 8.0 ft -f yl ( S 0S o • s Depth to limiting factor Remarks: Boring # :�- 1 0 - t 6 �,o�l � z [ � s � J z`Fs�k m'�ir• civ z� - s € - 6 � '{ Z 1 36. 1p`l s� Zrr► s1�k'�� es �� • L 3 36-62 g fit) �S — •� •$ Ground elev. y 6 • S Lt 2 Y j — • 5` ot 6• `3 ft. Depth to limiting factor Remarks: CS T Name Print Phone: Arthur L We erer 715- 425 -0165 egerer Soil Testing,:& Design Service -P.O. Box 74 River Falls,WI 54022 Signabue: Date: c� - CST Number: �� _ M00576 ett. PROPERTY OWNER- LOF SOIL DESCRIPTION REPORT Page 7- of PARCEL I.D.# ) Depth Dominant Color Mottles Structure GP D/ft2 Boring # Horizon Texture Consistence Boundary Roots in. Mu nsell • Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trent - \.(), \--L, .21 \ 7.4' S I 2 3/y s )) 3\Ar c s \w+ s • •L Ground S-SS rc, 3/y S 1.6v. S9 CL S •-1 •!) elev. 311-Y ft. Li ss-as is (i/C, c) tYI • Depth to limiting factor > S Remarks: Boring# I 0-VI. 2, 1 I S) ryA- cs 2-4 • -L paing Ot h )y sb `h- c-11 ) \ 40.x.M --)•S 3/y s) c_3131/ e_s - . L4 •5 Ground elev. 30-8`f ft. •S Lfrz. et- s s5 •S •L Depth to limiting factor Remarks: Boring# c?... 24 ) Si Z`f•Sz •-• •S 'L S a I. -3(0 1(3Li 2_ 3/y sifRs 4\-- cs --).sLm. 3/y S G\- s°3 -- • Ground elev. L43..$7 tit (ilL S'c \ ctn.S ft. i . Depth to limiting factor • > Remarks: Boring# Ground elev. ft. • Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT -PLAN Page 3 of s SCALE 1 "= ti �' Ll►v C OF PRx'pu�� 6 ft,-.. lb�- �$1 *Z- _ C% -Z'oN SP Le v6 �Mbve G taou hb titer i m-g49 I � \ tL0.l 5 0� 5� � ► ►J 1rt Prt � � g•' \ 13•Y s Ei.48 °-- t2 98 3 v � v � ri o oxj sP \" ta'�,�,� G 1>v E.S of p ctL pow , LO 1.1 fve AT 1 A57- ZStsT OF S �1 sl�)'L PAR �q . CST SI nature ( 7 15 4 . S -07 f 5 1400576 Signature Date Signed Telephone No. CST # W� D epartr nen t latio ndustry SOIL AND SITE EVALUATION REPORT . . La6ot and Human Relations Page � Of 3 Division of �� t3uildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S�• C�2 �jU( not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 1�- - gyp 11uC APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION PAVIEWED BY DATE PROPERTY OWNER: Mt1M4S at hWRZ{ `rcPMpt{ us r'l n N PROPERTY LOCATION P* U Dom_ ( 4T NW 1/4 Ne 1/4,S32 T 2.i ,N,R 1q E(orQ PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # I - ) 8S 1 YN - ' M — - PR e)pa s� cs►7 CITY, STATE ZIP CODE PHONE NUMBER QCITY QVILLAGE ®TOWN NEAREST ROAD R.IU� �AtIS, WI S��z.z, htS)uZS -$`117 1"ZU�( C'PcR.I�SOh1 ��E F New Construction Use [x) Residential / Number of bedr � Replacement Public or comm [ ] Addition to existing building [ ] ercial describe e derived daily flow X00 gld Recommended design loading rate • S bed, 9Pd$ ' trench, gpd/ft Absorption area required \_U- bed, ft lop o trench, ft Maximum design loading rate • S bed, gpd$ • trench, gped12 Recommended infiltration surface elevations) q q • Q , ft (as referred to site plan benchmark) Additional design / site considerations _t ji S , y 6 S' LLxv6 6R l b Parent material Flood plain elevation, if applicable `t I . ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL FOLDING TANK U= Unsuitable fors stem S Q U ® S Q U ®S Q U I [a ❑ U [IS R) U Q S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Boring # Horizon Texture I Structure Consistence Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.' C: _v:v4aJAdivyi Bed ra U r C: {• v_ 1n -l9 Ground 3 y s I as dk �,., U elev. C s q 0 - 0 ft. yy 88 - 1 S 19 -- V& S0 o Depth to ` limiting factor Remarks: Boring # S)') Z`FS�1r tin'�tr ci v Z`� • S �, 3 1u si 1 Zm s1�k wI'�'1 eS 1 v� • sl L Ground 3 36-6 s�tGz^ V sg 1�t) C°_S — - elev. y 62-86 S `f 2 VA R — �'s SS 6•1 ft Depth to limiting Remarks: F er -- Please Print Arthur L: We erer Phone' 715- 425 -0165 Soil Testing Design Service -P.O. Box 74 River Falls,WI 54022 ! Date: CST Num 00576 PLOT PL AN Page SCALE 1 "= yD NbT LL►v of P�opul�tl 6 rrc.. LbT' `$ �' 1 l4 Z _ q8.2 or+ S P 1h F \g` 6bU� GCabt��vp 1 '._� �t.� � . Stp� OF (�oW�tL 1�ot - E X46 B ' Z e.3 11.914 o, ,� t ►.,, t r\ ttt R�'R - 3 1�7•�ti�'S f}T S x 6 � LON G wow_ 02 i .J � x-48 _ � / B• y eL q8 3 v o � `� aw\+*1 - FR..100.0' aw SP \hk \a`�► - ac,�. lk, F.SltA of Loj LI �vF A l iu • � y sFly QE rv' L-%AsT ZS �3_NWT of 04PL w�.!- •�.._. k... .� � _...__ 4 SO 4 ti , __- ti CSTSi nature ( 715 ) 475 —n1 � 14 00576 g Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENTZ AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Alan S. & Julie K. Longsdorf Mailing Address 485 Count Road MM River Falls WI 54022 Property Address jew Carlson Lane (Verification required from Planning Department for new construction) City /State River Falls WI Parcel Identification Number 040 - 1121 -20 LEGAL DESCRI Property Location NW ' /4, NE ' / Sec. 32 , T 28 N -R 19 W, Town of Troy Subdivision , Lot # 1 Certified Survey Map # 58231 5 ,Volume 12 k� ctt CIa' _ . 'm ,Page # _3479 Vey Deed # ` > 2 �11 , Volume I -- , Page # U Spec house ❑ yes ® no Lot lines identifiable ❑ yes ❑ 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper veiifying 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 set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating t sep days tf 'c system has been maintained must be completed and retuned to the St. C roix County Zoning Office within 30 ' y ar expiration date. SIGN RE APPLICANT /� / C DATE OWNER CERTIFICATION )i (w c i that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p ert i above, by virtue of a warranty deed recorded in Register. of Deeds Office. GN 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 067 �o�d 582701L STATE BAR OF WISCONSIN FORM 3 -11062 � QUIT CLAIM DEED DOCUMENT NO. James J. Kauphusman and Audrey G. Kauphusman, REGISTER'S OFFICE husband and wif - ST, CROlX CO., 'r111 Rse'd fur t'tie(wd quitclaims to Alan S. Long sdorf and Julie R. Longsdorf, husband and wife as survivorship JUL 0 9 1998 marital property eJpp P M Rs is}sr of Dsads the following described real estate in _ St. CIO2Z State of Wisconsin: CO THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS - - !i Edward F. Vlack Davison & Vlack 200 East Elm St. ". River Falls, WI 54022 i 040- 1121 -20 - PARCEI IDEN?IFc — ATION NUMBER PART OF THE NORTHWEST QUARTER OF THE NORTHEAST QUARTER (NW 1/4 of NE 1/4) OF SECTION 32, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN, DESCRIBED AS FOLLOWS: Lot One (1) of Certified Survey Map recorded in Volume 12 of Certified Survey Maps, at Page 3479, as Document No. 582315. This 13 not homestead property. XW (is not) Dated tl.iS 8th day of Jn1y 19 98 (SEAL) • (SEAL) Ja es J. Kauphusman (SEAL) (SEAL) .Audrey G. Kauphusman AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. authenticated this day of Pierce County. I9_ FT-oaally came before me this J day of July 19 9 8 , the above named TITLE: MEMBER STATE BAR OF WISCONSIN James J. K auphusman an Audrey (If not, ---- -____ G , K.a�taptxusma authorized by §706.06, Wis. Scats.) 00 mw loawn tt bs _�_ , ho executed th ' itS INSTRUMENT WAS DRAFTED By acksow d�je t Same s FILED 8 J 0 2 1998 2 ReDist O' D 'LSH L S CroixCo,WT1 582315 � � CERTIFIED SURVEY MAP LOCATED IN THE NW 1/4 OF THE NE 1/4 OF SECTION 32, T28N, R19W, TOWN OF TROY, ST.CROIX COUNTY, WISCONSIN. PREPARED FOR: JAAES AND AUDREY KAUPHUSMAN N 114 CORNER OF SECTION NOTE: BEARINGS ARE 32. (ST.CROIX COUNTY REFERENCED TO THE N-S MONUMENT FOUND). QUARTER LINE. (ASSUMED y BEARING). UNPLATTED LANDS .............................. ( 0 "' N 89 ° 33' 20'E 512. 00' 30.40' 481.60' 33' 33' 100' :r I,� LOT alt' ='`�' :m $ ;y :2 W rn 6.02 ACRES p :� ( 262, 136 SO. FT.) :v :n 5.67 ACRES EXCLUDING RiW :n (247, 003 SO. FT.) :CA I I nl Z j C!I ". 11 i1j c(iCS I (A I I Wtt'hirl W G&yx; o} p 2�fOVill C17Jitl I approval shall the null and void m 33' 2 28. 72' 483.28' I S 89 512. 00' i I SOUTH LINE OF THE NW 1i4 OF THE NE 1i4 2 UNPLATTED LANDS co m O SET l" X 24" IRON PIPE WEIGHING ' n I n. 1. 131 RS PFR I I AIFAD cnnT -110-