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DAM WHILE ypU WERE M O ERE OUT Of phon Nu s C)ffi d 5 _ R: honed : le ase �C�neil�_ FAX Returned your call Pager ❑ Called to am yam Mob 0 Wants to see yo e- mail ❑ Will call assn Me ssage ""`-- ❑ AGENT ? If .AF- AMPAD EEFRMNCYO operates, Reot*r #'�'i wo 0 3 !� u 1 0 T/-o y .. ST. CROIX COUNTY ZONING DEPARTMENT h � AS BUILT SANITARY REPORT . Owner ? ( Property Address ubo rids City /State i A t4- I , Legal Description: Lot I aL Block 0 fi Subdivision/CSM # �e � '/4 QJ t /4, Sec. �p, T -R,�W, Town of ( PIN SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer i PSph c,-.,_ Size ST/PC L0etback from: House �� We11 Z o Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road A) it Vent to fresh air intake pU A Water Line A" Meter location Alarm location N SOIL ABSORPTION SYSTEM Type of system: idth 7 _ Length Number of Trenches 3 Setback from: House `370 Well P/L 6n._ Vent to fresh air intake > z - 5 ELEVATIONS Description of benchmark C 5'+ � Elevation V Description of alternate benchmark ^^ Elevation Building Sewer ST/HT Inlet ST Outlet O i6 Z PC Inlet PC Bottom Header/Manifold 1. Top of ST/PC Manhole Cover �3 Distribution Lines ( ) 555 4 () 4. 0 1 1 ( ) Bottom of System () �F ' 5 -� () 8a. 5 ( ) S I - � a Final Grade O � 1 . 4 tp O ' �`� ( ) g5, Date of installation 10 / hermit number 3 `� 4 State plan number Plumber's signature 4"icense number M(63 Date I Inspector Complete plot plan Q NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW ‘te { o GC f 3y SLA\,;(;' ' ,7L f-f-/o a. I V W� i N /�.+ �.�sit.S • - 2 p'.) I1 V INDICATE NORTH ARROW E- I ' Z� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Counttl CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita1N'll Personal information you provice may be used for secondary purposes [Privacy , s.15.04 (1)(m)). Permit Holder's Name: K� Village ❑ Town of: State Plan ID No.: M URPHY, WILLIAM 1 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel &46 lOb p g o aia J2 51 r TANK INFORMATION ELEVATION DATA A9800506 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. % Septic ,IL><c [ dV Bencg •� �S ?D� Dosing Aeration Bldg. Sewer Holding Inlet TANK SETBACK INFORMATION h4E Outlet S I/ 0 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake S ptict NA Dt Bottom Dosing NA Header / Man. q •'�`� �� - / 9 ro• 8S Aeration NA Dist. Pipe Holding g Bot. System ' z • y PUMP/ SIPHON INFORMATION Final Grade 14 3 86.7 Manufacturer Dem_ d 1, Model tuber PM TDH Lift Friction d TDH Ft Forcemain eng Did. Dist. To Well SOIL ABSORPTION SYSTEM BED EN Width �/ Leng PIT No. Of Pits Inside Dia. Liquid Depth DIME DIMENSION LEACHI 'Manufacturer: SETBACK SYSTEM TO LAKE / STREAM CHAM ER Model INFORMATI ON TYp �� OR UNI Sy e DISTRIBUTION SYSTEM Header /Manifold � Distribution Pipe(s) x Hole Size W e Spacing Vent To Air Intake Length Dia. Length Dia. Spacin g ( r % C oo } SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded [ �Eo]Yes Mulched Bed /Trench Center Bed /Trench Edges Topsoil [I Yes ❑ No ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 36.28.19.765,SW,NW 69 EAST WOODRIDGE DRIVE y '�.cM.tl�.a w� 4� dit•2 � ��� . 5 - . �v w� Plan revision required? ❑ Yes 0 No � Use other side for additional information. Date Inspector's ignature C ert N o. SBD -6710 (R.3/97) SANITARY PERMIT APPLICATION Safety and Buildings Division Vi scons i n 201 W. Washington Avenue 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. .5 C(ZO I y( • See reverse side for instructions for completing this application State Sanitary Number Personal information you provide may be used for secondary purposes E] Check if revision to p mus application [Privacy Law, s. 15.04 (1) (m)]: State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property Owner Name Property Location co / U 114 u-2 ff w1 /4 U/1i4,S 3 T Ze,Nr E (OA Property Owner's Mailing Address Lot Number Block Number wl0a m� D 1 rZ City, tat Zip Code hone Number Subdivision Name or CSM Number L { W ( --) D Z CA- II. TYPE BUILDING: (check one) E] State Owned it Nearest Road ❑ Village El Public 1 or 2 Family Dwelling - No. of bedrooms wn OF LOftV 0-F06e D i21 VT — 111. BUILDING USE (If building type is public, check all that apply) Parcel T ) 1 E] Apartment/ Condo 0 T D '" / / 1 ��— ✓�D — O fl 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 [:] New 2. k Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5 ❑ Repair of an System ------ System ________System _____________ Tank Only______________ Exist 9 --- -- ____ -___ Existing System - B) ®, A Sanitary Permit was previously issued. Permit Number 6 a(00 - 6 Date Issued V. TYPE OF SYSTEM: (Check only one) rn ✓ee "- S Non - Pressurized Distribution Pressurized Distribution (� Exper ental Other, 11 []Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 JRSeepage Trench 22 ❑ In- Ground Pressure (1) 3 x 3 i .zT' ;c. k -s 42 ❑ Pit Privy 13 ❑ Seepage Pit 3g. STO• vs q cLuift " 43 ❑ Vault Privy 14 ❑ System -In -Fill 62 -5' VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. S stem Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/clay/sq. ft.) (Min. /inch Elevation 57 !Zu -7 a �0 C L � 4 Feet Feet Cap acit y VII. TANK in allon Total # of. r Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer Name Concrete Con- Steel glace Plastic App New Existin strutted Tanks I Tanks Septic Tan �ti lea 1� `!(;�r2- s ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ ❑ I ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum er's Name: (Print) PlumbeAZ'.= 'e MPH tNO.: Business Phone Number: 0 a Z 7 Plumber's Address (Street, City, SS atte Zip Code): D IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fe (Includes Groundwater ate Issue Issuin gent Signature (No Stamps) Ap p roved `� surcharge Fee) / ❑ Owner Given Initial t D �' �D /q �8 ' Adverse Determination X. CONDITIONS APPROVAL / REAS NS FOR DISAPPROVAL: Cep lob I� D� n ,in LA ; n G it Jf� �;I 1 r 6- i .S 6398 (R.11/97) V DISTRIBUTION: Orig nal to County. One copy To: 5 fety & Buildings Division, Owner, Plornber P/of PI4N Scal VV�l�ion� AA ur'�by 0 G� well 3 B� dteO M Ne►�� G aYeo�• pA Mare $o Nor of 5 1 1 d -q 100.0' �O0 N d� Jel 1 , v` 3 y Z h i rce CS) Iv. 7, y "U IS" x 5 3' Dr j�ra �Y' �Qr6� w vtiaconsitepartment of Industry SOIL AND SITE EVALUATION REPORT Page _ of Labor arxi Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY _ Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARC I.D. # dimensioned, north arrow, and location and distance to nearest road. 6, V� APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION RE W DB DATE PROPERTY OWNER: PROPERTY LOCATION W illiam mur h GOVT. LOT S E 1/4 NW 1I4,S 36T28 N,R 19 E(or)W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 69 E 14 Dr. - -- Oak Rid.ne .Acres CITY, STATE ZIP CODE PHONE NUMBER 2e" OWN NEAREST ROAD River Falls. WT ) _ Troy County M ( ] New Construction Use [ ] Residential / Number of bedrooms 3 [ ] Addition to existing building LX] Replacement [ ] Public or commercial describe Code derived daily flow 4 5 0 gpd Recommended design loading rate • 4 bed, gpd$ • 5 trench, gpd/ft Absorption area required 1.1 ?_ 5 bed, ft 9 0 0 tr ? aximt� design loading rate • 5 bed, gpd /ft • 6 trench, gpd/ft Recommended infiltration surface elevation (s�� __ �3 ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system NVENTIONAL OUND GROUND PRESSURE T GRADE SYSTEM FILL HOLDIN TANK U= Unsuitable fors stem �7 S❑ U S ❑ U C S O U S D U ❑ S � J U 0S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITi N k =` 1 0 -9 10Y?�2 1 None SIL `2MSBK MFR 9 .4 .5 L amm J 2 9 - 10YR3 3 None SICL 2MSBK MFR c .4 .5 Ground 3 13 - 10YR4 3 None SICL 1MSBK MFI C .4 .5 elev. 3 7 _' A 9 ft. 4 23-3E 10YR4 6 None LFS 1 1MSBK MFVR G .5 1 .6 Depth to limiting factor 6 0 -10 10YR4 6 None LFS OMGR MFVR -- .5 .5 Remarks: Boring # wz NOTE: IJORT7T N 1 0 -9BACK FILL FROM EXCAVATING 1 4HERE HOt F jAS OPICINA.L LY BjjT T Ground In� elev. ft. y LcE] ED y Depth to _. limiting C r T © 199 factor x COUNlY Remarks: TName:— Please Print Phone: PAUL C.J. STF'INF'R 715 C+ . Ad dress: 4 2.30 945T # 9 STREET RT_VFR FAL TqI 5402.2 Signature: j /J Date: / 5/ 9 8 CF umber. . Plot Ala„ 1. pf (p �' O i 7 t well 3 13 eetroom Pom e I Ber c Ma r k �` 1 13o Nor of 5 ;,y ((�� fICJ 104.61 UO0 1 D0 0 �a1 see 7Aii Sy; . � 81 l rc e �Iv, $,7• ys ® i � EX�slrhq Droll; I �fld A53' rQS GtJao•lt�,��.c Ur fly s Labor Depa HumanRef a bons In dustry , SOIL AND SITE EVALUATION REPORT P a g e Labr and n Reltions g _ of Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code FPA Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but x not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION R �Q TE PROPERTY OWNER: PROPERTY LOCATION Wi lliam mtirl2hy GOVT. LOT S E 1/4 NW 1 /4,S 3 6 T 2 8 ,N,R 19 E (or) W PROPERTY OWNER':S MAILING ADDRESS LO # BLOCK # SUBD. NAME OR CSM # 69 E r Dr. 1 - -- Oak Ride Acres CITY, STATE ZIP CODE PHONE NUMBER QeR•4' a OWN NEAREST ROAD I River Falls, WT 54022 115)425-2210 1 Troy l Cotinty M (] New Construction Use [ ] Residential / Number of bedrooms 3 [ ] Addition to existing building jx] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd /1`1: • 5 trench, gpd /ft Absorption area required 11 bed, ft 900 trench, ft Maximum design loading rate • 5 bed, gpd/ft •6 trench, gpd/ft Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system ��oo NVENTIONAL OUND GROUND PRESSURE T -GRADE SYSTEM FILL HOLDI U U= Unsuitable fors stem f�l S❑ U S O U S El U S ❑ U ❑ S U O S 1 EJ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. ' Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Ttench 1 1 0 - 9 10YR2 1 None SIL 2MSBK MFR 9 •4 .5 2 9 - 13 10YR3 3 None SICL 2MSBK MFR c .4 .5 Ground 3 13 -2 10YR4 3 None SICL 1MSBK MFI C .4 .5 elev. 7 .45 ft. 4 23-3E 10YR4 6 None LFS 1MSBK MFVR G • S .6 Depth to 5 36- limiting C factor 6 0 - 10YR4 6 None LFS OMGR MFVR -- .5 .5 Remarks: Boring # ,.. NOTE: FORT7,T N 1 0 - 9RACK FILL FROM EXCAVATING Ground ljol aP � dAS OPIC I NA L LY RTITI � elev. ft. Depth to limiting ST 4R factor c 1NG FFICE S f - Remarks: CST Name: — Please Print Phone: Ta T 715 425-5544 A ddress: rTR2 945TH STR_RFT RIVER FALLS, 1 54022 Signature: _. _....._.__ Date: 10/5/98 CST Number- PIo P/a 1, W / 1�lA n Mu rphy ,a Wep 3 Be ctroah , }Tarot led C>0 G6 re. �o Nor• a{ S +d�"� Flev loo-o' POO /QQ O�ai Seei,c 1 3 8 Elv, 87, y4 f r froe �yis��nq f�rs,n I��fld x 53' ra s 1 Gtl a a <ll �l. Ur �),,�,,,,► icy /��,�( <�t sf�,A�,� Vlf Gt1/ 1 77:J Vo. yl f 1 J f J f f JJ IVrL- UN rL.ui•u0li1u ►'Hlat 171 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ` 1 ( OWNERSHIP CERTIFICATION FORM Owrta/Buycr W , ` 1 ` V" 1. N\O R P L4 Y Mailing Address � C! -(-- ` �dQ/Z SA G E �<Z • „ � ��l� -�� W b 400 2 Property Address .5 rr (Verification required from Planning Department for new construction) City /State 1 ��� S Parcel Identification Number y �� �� g�� Sy -0 0 1 LEGAL DTSCRIPTION Property Location L"" ' /,, N W Y., Sec. 3_L p / / q T — — W, Town of c) Subdivision P —AL : C f2 S , Lot # I � . Certified Survey Map # , Volrune , Page # Warranty Deed # y - 3 D , Voltune , Page # _• Spec house 0 yes X no Lot lines identifiable 0 yes 0 no SYSTEM MAINTENANCE Improper use and maiatenanceof 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 it 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, restrictedplumber or a licensedpumper 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 113 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 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 yen expiration M,,& A,7A I- C l / `?/ 1 I t SIGNATURE OF APPLIC DATE OMMR CERIEMATION 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 property described above, by a of a warranty deed recorded in Register of Deeds Office. q q SIGNATURE OF APPLIC DATE 000000 Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. 0000 •• Include with this application: a stamped warranty deed front the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 40T21 ''l0 M I L6 PAGE 105 PIEOISTFRS OFFICE Rolling Hills Development-- Corporat_ion,_ €T. CRcJIX CO., WIS. a Wisconsin Corporation, R�c`d for Record this 10th . - -- .... .. - - -- -- - - - - -- - - -- - - - - -- - -- - -- -- - - - - -- -- - - - - -- day of July A.D. 19 85 ----- - -- -- - - -- -- - - - - -- --------- - - - - - - --------------------------- conveys and warrants to - Wi T . -- Mug -p1�y _. a- 17d- ._Ks� -thxyri ._M.. t 1:45 P , M. --- mux_pb.y,.._huskzand. -arid - _�aif.e..as._j_Oint --- tenants ............. -- pMUr of Diode - ----- -- --------- ---------------- .. ----- ___ ------- _ _____ _ _____ __ __ __ RETURN TO .. _ "- ...... . ......................................... ..... .................... . . . . .. _ -------- the foaowirng descrihed real estate in --- �t..._�rQ1X----- .------------------ County, State of Wisconsin: Tax Parcel No- ---------------- .------------- Lot Twelve (12), Oak Ridge Acres in the Town of Troy 3o, o o.. This - 1S_ -nOt- ----- .- homestead property. OU1 (is not) Exception to warranties: easements and restrictions of record. )ated this _ _ l.Oth- - -- - day of - July. - - 1,19. §5 ROLLING HILL DEV OPNL�T4�R�PORATION: t / /,� - (SEAL) i Z G 1%C - ".._ (SEAL) - - - -------------- - - - - -- " BY_: ..R_ichar N. - F_ox, P.resident - - -- - - (SEAL) h- _ �� - C X . - (SEAL) -- - _ BY: J. Frances Fox, Secretary AUTHENTICATION ACKNOWLEDGMENT Signature (s) ------------------------------------------------------ - - - - - - STATE OF WISCONSIN 1 ss. - -- - - -- -- . Pd- er.ce---------- -- ----------- County. ,thenticated this ---- --- day of ...... .-------------------- 19. - - - -- Personally came before me this ---- 1 - 0t ... day of Form - S T C - 10 AS BUILT SANITARY SYSTEM REPORT OWNER , , i. TOWNSHIP -i y , , SEC. to T - , N-R '' W ADDRESS `3D , ..c.v ,, ST. CROIX COUNTY, WISCONSIN V.7 ,/Tha SUBDIVISION s� LOT I , LOT SIZE ,� `---C/1i _�__- PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM r 1r fa 1 =y r I _ 5,_ , ; F J\ fitr i a i r l ' -_ - INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used L Y,,• ' , Elevation of vertical reference point: t('t\U Proposed slope at site: SEPTIC TANK: Manufacturer: `, ,?c' Liquid Capacity: Number of rings used: < Tank manhole cover elevation: 7,`: . Tank Inlet Elevation: ' :; ,T<1- Tank Outlet Elevation: *< , Number of feet from nearest Road: Front,O Side,O Rear,, C-7' (fl feet From nearest property line : Front,OSide,ORear,(g) ` ``W %-` C; feet Number of feet from: well - C" , building: - 'r''' (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan) . SOIL ABSORPTION SYSTEM Bed: Trench: Width: I9'. ''' Length: ~.! �: Number of Lines: 3 Area Built: 67-5. Fill depth to top of pipe: 2 _`j' Number of feet from nearest property line: Front, O Side, O Rear,e ht . !o -' Number of feet from well: - Number of feet from building: FZ_I ;, " (Include distances on plot plan) . SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, (2)Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: ge/1-A ✓ — �Lt_�� Dated: /� � Plumber on job: /1/5ake License Number: Age/ P"� 07i37 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING `LABOR &HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISIO P.O. BOX 7969 BUREAU OF PLUMBINI MADISON, WI 53707 C�kONVENTIONAL 1:1 ALTERNATIVE slate Plan Ttl.Namber - ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPE 10 ATE. William Murphy 308 E. Division St. River Falls 1 27',254 BENCH MARK (Permanent reference po-ntl DESCRIBE IF DIFFERENT FROM PLAN 7 r AEF. FIT. ELEV.. CST REF. PT. ELEV. SW NW, Section 36, T28N —R19W, Town of Troy, Lot#12, Oak Ridge Acres Name of Plumber MP /MPRSW No County Sanitary Permit Number: Paul Cudd 2739 St. Croix 135- 69600 SEPTIC TANK /HOLDING TANK: MANUFACTURER LIOUID CAPACITY. TA F11 INLET ELEV TANK OUTLET ELEV. LOCKING COVER .. . WARNING LABEL LO _ PROV ING PROVIDED (� 'j YES ❑NO ❑YES ONO BEDDING. VENT DIA.. VENT MAT L.. HIGH WA ER NUMBER OF ROAD: ROPERTV WELL: 11 ILDING: VENT TO FRESF ALARM ,/ DD LINE AI //�� Q FEET FROM {4 / A 7 YES ❑NO l., r- DYES ❑NO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING LIQUID CAPACITY PUMP MODEL PUMP /SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO DYES ONO I ❑YES ONO GALLONSPER CYCLE: 7NC CONTROLS OPERATIONAL: NUMBER OF PROPERTY I WILL BUILDING VENT TO FREST (DIFFERENCE BETWEEN FEET FROM LI AIR INLET PUMP ON AND OFF) ❑YES ONO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH I DIAMFTER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH I LENGTH N O. OF DISTR. PIPE SPACING. tv R INSIUE DIA #PITS LIQUID BED/TRENCH < TF ENC�s b Y NI SQ. IAL. PIT DEPTH: DIMENSIONS CJ GRAVEL DEPTH FILL DEPTH DIS7H. PI FEET FROM / P DISTR. PIPE DISTR. PIPE MATERIAL. NUMBER OF PROPER V WELL: y BU ING: VENT TO FRESF BELOW PIPES ABOVE COVER EL INLET ELE D LINE: / AI T / •1 - NEAREST L/ OL MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- DYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE " OB ERMANENT MARKERS SERVATION WELLS OYES ONO DYES ONO DEPTH OVER TRENCHIBED DEPTH OVER TRENCHiBED DEPTH OF TOPSOIL SODDED SEEDED MULCHED CENTER J EDGES OYES ❑NO I DYES ONO DYES 1:1 NO PRESSURIZED DISTRIBUTION SYSTEM: - WIDTH. LENGTH. NO. OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER: BED /TRENCH' TRENCHES: DIMENSIONS MANIFOLD. PUMP MANIFOLD Of PIPE MANIFOLD MATERIAL: N PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND ELEV.. ELEV. DIA. ELEV. PIPA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO DYES 1:1 NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LI NE. ❑YES ONO I DYES ONO I NEAREST ­ Sketch System on Retain in county file for audit. Reverse Side. T DILHR SBD 6710 (R. 01/82) TUBE. C / TA APPLICATION FOR SANITARY PERMIT S t. Cro C OUNTY +arYrs rp (PLB 67) UNIFORM SANITARY PERMIT # ac r�rtwn•�aau.nona itt$uHl aorlel'ins in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /zx 11 inches in size. - x5aI9• t @rse,.Klf`ttrus jons`for,rompleting this application. PLEASE PRINT 4. ; f�' MAILING `ADDRESS �, ••,> , "' ` 308 E. Division, River Falls, WI 54022 q 9� x Y, s w x Troy I N .?!s " ry �,;tt7S �V R g IX� W TOWN OF: tO ^ J t3 tri t ' f ii 11 s DIVISI N'NAMF NEAREST ROAD, LAKE OR LANDMARK STATE PLAN LD. NUMBER Rid e. Acres Scenic Drive Nuttlber pf bedrooms: 3 M P ublic ( Specify): 6, THIS PERM1? R A IVew $, r :: ,r't' F-1 Tank Replacement ❑ Repair ❑ iepi tt I t�SoI Ab$Orptib 'System El Revision Privy `' ;Sl #erxiate m'' ❑ Reconnection ❑ Petition for Modification tE (COMPLETE THIS BL CK. , , u t ❑ Holding Tank T yiMr ❑ SSeepage "Pit + � { ''; s p ❑ 1n i0ond Pressure ❑ ;Vault Privy ❑ Pit " �''rwPtrtnills On file Permit # issued � r r I asl en �tpected Arid Is Compliant As Far As Soil 'Conditions {, h Total of. 'Prefab. Site, , 'a , ,�,. t �, F 1 •`,ty, {k M ' r T r Gallons Tanks' Concrete Constritcted�. Steel "Fiperglasa - .Plastic A 3, $LOCK: ❑`Mound❑ In Grxuind`Pr�ssure ^ j �I ;+of Pi ref,ab. ..Site r T Sti3e1 Fiberglass Plastic s G:flIOns � Tanks'' ' Concrete , . Constructed y 4 ft - r .L ilW. k P t l rt , r y lye r µ c, r' i Alf PT1 N R ABSORPTION AREA P� 0 WATEFISUPPLY: ih 4 lil0 ($qu{el=eet) PROPOSED (Square Peet): R e r :v Priv at e ixl .❑ Joint ❑Public 95 1 th ¢filclers elay' es me tssp0 Obili#yfoir installation of the private sewage system shown on the attached plans. + IVa PtumE�C Si ra=- MPRSW No.: " l ql5)425-2049 Phone Number: «w tdd 2739 ' Plumbbr's Adtlrdss3' Name of Designer: R, ► 364, . River Falls. Wl 54022 Art Wegerer (576 COUNTY /DEPARTMENT USE ONLY Si o1 l�n� t, F Date: ❑ Disapproved I u Q' El Owner Given Initial ^ "fJ� Approved Adverse Determination t r , Attire �aurlle I `:�A+ipi191�a11#et 0IkHt0$0IiB ;`}t/82) p1STRIBUTION: Originat to County, One Copy To; Bureau of Plumbing, Owner, Plumber �:.C S?,CTI0N OF A _,ED S FACE OF "ILI "i F'V i 4" Cast Iron Vent Pipe 12" Above Finished Grade 4" PVC Distribution Pipe �— S of 1 F 11 -__"7' - -- 2" Of A gg-re €a t e Approved Synthetic "over Material or 0 of Uncompacte 6�.Of ' IT -21 „ Ag - o , date Or Mlarsh Eay. No Feet ;lev. . r � Perforated Pipe To Bottom Of Bed. 'DISTRIBUTION' PIPE TO BE AT LEAST - 1 INCHES BELOW ORIGINAL GRADE AND AT LEAST 20 BUT NO go THAN 42 INCHES BELOW FINAL GRADE. MAj_I2, ,VUI1 .DEFTt! OF EXCAVATION FROM ORIGINAL GRADE WILL BE SY 1NCT—jpS . MINII•NM. DEPTH OF EXCAVATION FROM ORIGINAL GRADE WILL BE Z7 INCFES. PLAN VIEW OF .BED 53 4 Perforated PVC Di stributi on Pipe. 4 11 PVC From Septic Cast Iron Vent Pipe Tank 1111 - - -- - - - -- — — — — — _� 4" Solid :':all PVC -- — - -- Header Pipe � a Ow:1 name Sari. Permit Nc,. H63.05 PLOT PLAN Sho EA Location of building served N -A Dosing chamber Septic tank Vertical/horizortal reference point Building sewer System elevation is — 98• ID Effluent system U1 Well Replacement system area � Property lines w /in 50' of system N R Distribution boxes Scale = —30 , or dimensioned �A Pump and controls: Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal. per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan , below: I R-O'u Pj PL i Lp cwT10N SAP- G s1 S4 W 7 f s 4S -F 4'rirc 2S .o - — -- -- - c1 1 w�FSeR cOtic. W I v 3E v i 1 tA 1 I R ��r unit t ` loo. o' o ,,, ' TP By the granting or approving of the above plan, or upon the event of a subsequent permit being issued,St.Croix County and the St.CroixCounty Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction,. or any damage that may result in or a installation. 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Yow �_, a n r, �r• c Yi �' ��� R ! n � 1 �, > r ' 4N KbFa$ s dyJ tw r a i s f ;P ¢ il 5.1 o c ,�.^` �`. k �i +§ s � r }° 'S yzan "t� �►" s �.h ri ly. �, �1 '[ r ' y w, 4'v` .3 Y "ilk 1�k � �� � »er, ,bds.'sw��✓."��1a. w� . , ' � r � .. Y.t�.. �' '�S ;iY t�„i. � c�. r r.. � �.�. � ��.:,� �it�'� � ":' Y } r 1 1. d ",. Si: ',.` .� ..;�:•�r�l ���'h:; Furor - t' C loo Owner of Property �!V ��- .►,��v� \ _— ._�`iT�2"�l� t ►\ . V .Location of Property �W_� 1,� :i�0 ,'1' Z8 tv k l�j w Township 7 Mailing Address Subdivision Name (PAK 12 �OGE � G �S Lot Number i Z Previous Owner of Property „�C.1:2� A(S Total Size of Parcel x Zpp Data Parcel Was Created Are all corners identifiable? Nu Include with this app lication one of the full .Certified Survey Map .Dead .Land Contract, or .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION 4 - (We) certify that all statements on this form dre true to the best ofs" (our) knowledge; thatA"(we)JWf(are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 4 406 ; and that presently own the proposed site for the sewage disposal system or r(we) ) obtained an easement, to run with the above described property` for the have construction of said system, and the same has been (ply recorded in the Office Of the County Register of Deeds, as Document No. 0 Ac 6 ) W SIGNATURE OF OWNER - - - -_ SIGNATURE OF CO wNER qIF APPL CABLE) DATE SIGNED - - - - DATE SIGNED - -- H y ST C- 105 r ;Y SEPTIC TANK MAINTENANCE ACREEMENT St. Croix County .° 1 d O W N E R /�- V V L-t k w t ? R" iZ`i I l" \ v ZP 6 j y ROUTE /BOX NUMBER T S Fire Number CITY /STATE t \\ 2 `LS �Jt _ 'LIP '54e - PROPERTY LOCATION: � '�, �, Section ZG , T - Z'b N, R V9 — W, Town of , St. Croix County, Subdivision CAY­ Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, f if needed, by a lic se tic t ank pum What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of al l new systems agree to keep their systems properly maintained The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. h(R the undersigned, have read the above requirements and agree 1 to maintain the private sewage disposal system in accordance with x the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED W D AT St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715 - 796 -2239 or 715 -425 -8363 Sign, date and return to above address. v t. N 7 d N M CD 1� 0 O QO coww�`�w C p •p C (D •O 'Q (D (D O Z A. os mN m Fg N �f OL w O =-' w co 'F cn c° o 3 a O O o m ' m CC) -A vr " > > c o w o(° w -. = o Al 0 0 � w e wwZ' cl< vmao c Co _ N w N w y o �o oaf O O w A N C� n < tD 0 Q • (O O '' C) (D 0 C N Q 6 A "N' o o D � � m L7 In o (O � W 0 O- a= O O OCL w O(p O ^. aQ0 W O 0 5D Om jNN N�vwwu, C In D Z ° OCD0 O—O (DW27 1 • �� ; 3 D D w C a o IW ?o =o m �a -c w -< O ui m. a O w CO �v 3w u, 0ww_. C M �.� 0 c 0 CL (D �! °`•• �(D m N w Zvi n o 0 0 . FM w — CD = c• w = �- m v, yoo (A 0T -c N 1 7 (D % 0 to y L/ Q O f (C C C C 3'w aaa(D W R1 a0 M a.. • 0 (D E 0 p c p a 0 W 7% 0(D O �_ r? O OL O (o C 1 Co 1 C CL C -4 w -� (D (D C tD s OL 3 O j 0 0 0 0 O aw X03 o�N. 0 3a 0< 0 a ? .�..`, cp .. •� (D 4'? DOCU N o. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 403 ,106 w 11 IIV VOL / 1-6 PA SE REGISTERS OFFICE Rol . ling Hi lls Dey...lopment_ _Corporation,- .___ - _ ST. CROIX CO., WIS. a Wiscons Corporation - , .. .............................. Rcc'cL for Re=d this 10th ... -- • - - -- - - -- - -- - - - - -- y df my A.D. 19A comes and warrants to .wlllldm- T, -- . nd...Ka.thr.yrI..M.. , K . Mur.p arid.. .if_e..as._ joint. ..tenants.,...._...... I � ---------•------------------------- - - - - -. - -.. I r i - --- ------ ---- wY1� M �d• ............................ _ _ ................ -•• I RETURN TO .... ... .. ......................................................... .................... ......... .. .... - .. .... ... .. ........... -- ................ — - -. the following described real estate in ... St... ._Cxo1,X...,,•....- ..- .,__•__ -- .Count State of Wisconsin: Tax Parcel No: .............................. Lot Twelve (12), Oak Ridge Acres in the Town of Troy 30, 0 0 _ FEE This ..... S__AQt- -------- homestead property. OW (is not) Exception to warranties: easements and restrictions of record. Datedthis ... ....... 1.0th ....... -........ -- - - ---- •.. day of .......... July ....................... ... - - -- .................., 5 .. ROLLING HILL DEVE OP T RPORATION: . ................ . .. (SEAL) .... ........ (SEAL) • .N.....Fo President -- ...---------- ------------------------------------------------- (SEAL) T.... (�}G.._... ...(SEAL) . ----- -..... BY J. Frances Fox,....Sec retary AUTHENTICATION ACKNOWLEDGMENT Signature(s) .......................................... STATE OF WISCONSIN as. . P .i.er-ce ----------------------- County. authenticated this ........ day of ........................... 19...... Personally came before me this ... 1.0th ... day of ( Date 7 g o — — " > TOWN BOARD RESOLUTION ';_ " Resolved that the plat o O Ri ak dge Acres, es O J. Francis a Richard Fox May Beth 6 Elwood Cleosby, o 8 owners, is hereby approved by the Town Board of the 16 o g o _ P6 _ 0 °D M O Date I! I hereby certify that the foregoing is a c 90° 0 '° °o 8 Town Board of the Town of Troy, Wis. °_ 15 o� 0 ° o ° o �i Date 9 M D] .W o _W ,� °I SURVEYORS CERTIFICATE 0 o ti "o N�i I Howard R. Kruse, Surveyor,hery certify: — 0 o g o _ divided and m ghat 1 have surveyed, 0 0 o IL�. 0 w Acres to the Town of Troy County of St. Croy and z I ° 0 — ti That I have mace such. land divisi 0 J. Francis 8 Richard Fox, May Beth S Elwood Cleasby, 0 owners of said land which i� described as follows: C ° �r 0 N 0-05 a distance of 33 from the West 1/4 corne o to z being on the West line of said Sec.36.and the point of 0 0 thence N60 738.03` thence 3 89° 53`E 39 c $ 13 0 thence S 89 5SE 266.00;'thence N00 °07 E 175. a) 0 ° 0 thence S00° 07�W 175.Od thence S 8.9 °53f 20 Q °— — thence S 36 1 V E 234.00; thence S00°07W 5 thence N 00°0TE 50 0-0 0d, thence N 48 I thence N 89°5�W 594.52`, thence S60 2 7�W 4 .. thence S 89 2 00. 00' thence SOO °05 E 9 Pls o o to the point of beginning.Soid land being all contoi ss °_ 0 12 0 �I /� SW1 /4 -NW I/4 a S E I/4 -N W.I /4 of Se.p.36 °,T.28 N.,R.19 W. ° Iv '/' That such pbt is a correct representatio land surveyed and the subdivision thereof made. That I have fully complied with the prov _ , Wisconsin Statutes and the subdivi.sion reggulatibns � 0 _° of River FaI Is,.Wis, in surveying, divi ding ' and .mapping CD 0 ° o_ II ° 0 0 ° o 9 0° — — 3, 30 , 1966 Date i e 8 (D 1 ° 0 10 ° Revised 6, 2, 1966 9 0 _ 0_ A/ OD 0 ' 9 °� 200.00, 90° N CD66.00' S89 E N W ti O 0 O O z 1'31 "0., Wis. There are no objections to this plat with respect to Sec ,ad e,k '� 4 rN '? 236.16, 236.20 and 236.21 (1) and (2), Wis. Stats., an the Wis. Admin. Cod ed by Sec. 236.12 (b), Certified this oy of .. l 4 t C..� 1 10/21 WED 07:25 FAX 715 386 4686 ST r..R1 CO ZONING ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the W t(- C /�}-�! - A� residence located at: - -.Ld k N� section 31— TZN, R_/�' W, Town of Upon ins action, p R I certify that I have .:our,d the tank and baffles to be in good condition, and it appears S:sj be functioning properly. Last time serviced: Z Did flow back occur from absorption system? Yes _ - No (If no, skip next line) Approximate volume or length of time: gallons _ minutes Capacity: I. Construction: Prefab Concrete ___,e-<—Steel Other Manufacturer: (If known) : Age of Tank (If known): 13,W �5 (Signs re) (Name) Please print (Title) (License Number) O -Zg -� Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will , ^onform to the requirements of ILHR 83, was. Adm. ode (ei e) . )name Of Signature p �3�g 11 • Form - S T C - 10 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T N-R W ADDRESS ADg' ,;( ;<ea.7 , ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE Z PLAN VIEW Distances and dimensions to meet requirements of ILH.R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM • $ U v rh • S, • Cv P Z I INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,Rear, 3 feet From nearest property line : Front,O Side,O Rear,0 feet Number of feet from: well , building: (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, cSide, °Rear, Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: 3 Area Built: Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear,O Ft . " Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box() or distribution box O been used on any of the above soil absorbtion sytems? (Check one) . HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: /614,/ Dated: Plumber on job: g)11.-:.4-c.4211012, License Number: /"' q9 2 7 3/84:mj DEPARTMENT OF INDUSTRY, '•LABOR & RELA-TIONS INSPECTION REPORT FOR SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING LP'CONVENTIONAL ❑ALTERNATIVE State - Plan -rD- Number: - — (If assigned) ❑Holding Tank El In-Ground Pressure El Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: William Murphy INSPE 10 ATE: P y 308 E. Division St. River Falls BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: - SW NW, Section 36, T28N —R19W, Town of Troy, Lot #12, Oak Ridge Acres EF .ELEV.: CST REF. PT. ELEV Name of Plumber: MP /MPRSW No.: County Sanitary Permit Number: Paul Cudd 2739 St. Croix 135- 69600 SEPTIC TANK /HOLDING TANK: MANUFACTURER: � LIQUID CAPACITY: TA K INLET ELEV.. TANK OUTLET ELEV.: WARNEL LOCKING COVER �' /f^ PROV DE ING DLAB: PROVIDED : BEDDING : VENTDIA.: VENTMATL.. HIGH WA ER /` / NUMBER ��, ` YES ❑NO DYES ONO ALARM: ROAD: ROPERTV WELL BUILDING: VENT TO FRESH FEET FROM LINE AI {, fir: YES ONO ❑YES ❑NO NEAREST � DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER El YES ❑ PROVIDED: PROVIDED GALLONS PER CYCLE: PUMP AND coruTROLS OPERATIONAL ❑ NUMBER OF PROPERTY WELL YES ❑ NO ❑ BUILDING YES ❑ V NO : . (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST' SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORGE the soil is dry enough to continue.) MAIN' CONVENTIONAL SYSTEM: WIDTH O SPACING /�++,' LENGTH. NO. F DISTR. PIPE P. C VER BED /TRENCH v TRENC S INSIDE DIA #PITS LIQUID DIMENSIONS a t) ,vL� M E IAL' PIT DEPTH GRAVEL DEPTH FH DISTR. PIP R V DISTR. PIPE DISTR. PIPE MATERIAL: N ISTR BELOW PIPES. VER. EL I NLET ELEq D. NUMBER OF PROPE WELL: ,y BU ING: VENT TO FRESH P s FEET FROM LINE: / r" NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- OYES NO meets the criteria for medium sand. TIONS MEASURED. ❑ SOIL COVER I TEXTURE PERMANENT MARKERS OBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCH /BED DYES ❑NO ❑YES ❑NO EDGES CENTER DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED: . DYES F No ❑YES ❑NO ❑YES ONO PRESSURIZED DISTRIBUTION SYSTEM: BEQ /TRENC.II WIDTH LENGTH NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE [DIS L DEPTH ABOVE M COVER: TRENCHES: aIMENSIQNS MANIFOLD. PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE TR ELELEVATION ELEVATION AND ELE V, ELEV.: DIA. ELEV. PIPES DIA IBUTION ATERIAL & MARKING. : OISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: COMMENTS: PERMANENT MARKERSE YES E1 NO ❑YES O NO OBSERVATION WELLS: NUMBER OF "PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ONO DYES El NO NEAREST Sketch System on Reverse Side. Retain in county file for audit. TURF: TITL DILHR SBD 6710 (R. 01/82) � , q 4 „ APPLICATION FOR SANITARY PERMIT St. Croix ' OUNTY ' (PLB 67) rri+rioits UNIFORM SANITARY PERMIT # �arteCq tktns in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /2x 11 inches in size, • r , `"�e e # irtstttt ions four pompleting this application. PLEASE PRINT y MAILING ADDRESS 308 E. Division, River Falls, �WI 54022 728 N R i9 1101a) W TOWN Troy C B U OLVlSI N"'NAME NEAREST ROAD, LAKE OR LAND K STATE PLAN 1.0, NUMBER ©Sk Ridge Acres Scenic Drive T O r;, ' or Falrtifl�i Number of f3edroums: 3 Public (Specify): THtS ,ER MtT IS" FOR Ac ,f tew System ❑ T ank Replacement ❑ Repair q ❑ ep4ar ert i t foil ,Absorption System ❑ Revision ❑_ Privy, c llterrteta" m ' 1-J Reconnection ❑ Petition for Modification �* t I""�`F+Ct!�Vfl EM CCMPLE fE THIS BL CK. ❑ See pa9 a Trench p g ❑ Holding Tank ❑ See a e'Pit �� 0 � 1n4round Pressure El 1/ault Privy � y ❑ Pit4Prty Y + F y +tins Permit is Qn File, Perrrti #_# issueq ��s t -0IV � � s , Oeoni to ected And is Compliant As Far, As Soil Conditions. r F a7F } � srss $ t y i v , • ` i Tt ''Prefab. Ite ,, ar Cialions Tanks Concrete' Constructed Steel Fikferglass �Plestic x al�fir�.'7;an)a � wren �;+` ' e r G� re$r 1"� G` • SYSTEM COMPLETE THIS BLOCK: El M ound ❑ ln- Ground Pressure T tal # Of Pr efab. Site Gallons Tanks Concrete> Constructed Steel Fiberglass Plastic r ift tbl$i lAiY � 1 r F AS PTIflNAREA ION AREA WATER SUPPLY: ' FtEtlttRE[f tSwupe Feet): PROPOSED (Square Feet): + 954 Private ❑ Joint ❑ Public t tt.dttderstr eby astt�e rstponsibility-Fot installation of the private sewage system shown on the attached plans. �� mod` lurr�#sr r t x �' Si ure IMPRSW No,: Phone Number: x R lid s Ad re 2 739 (715 )4 25 -2049 � itrmbpr'tfss„ r � � Name of Designer: 5, R 3. RiVer Fails, W2 54022 Art Wegener (5?6 COUNTY /DEPARTMENT USE ONLY o Issuing t F Date: ❑ Disapproved �1� � ❑Owner Given Initial S Approv r P Adverse Determination .l. r Al slf?kt t' Aotwill A il+skttet� ' ��i�tk.tafl4* 84 � S tI !i{82l DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, ,Plumber' ti r �rrf�++ Yl r+ h` nv+ pm +mc�7^kth41+ �: (;SS S �CTIOii CFA =ED SYSTE'✓ PACE - CF 411 Cast Iron Vent Pipe 12 Above Finished Grade 4" PVC Distribution Pipe_ - �— Soil Fl i - -- - - - 2 of Ag�regate �s4 Approved Synthetic ^over Material or uf UncomFacted E Of 111 _2 1 " A ate .:St -r aw Or N,arsh Eay. Elev. 1O Feet - Perforated Pipe To Bottom Of Bed. 'DISTRIBUTION PIPE TO BE AT LEAST - 1 INCRES BELOW ORIGINAL GRADE AND AT LEAST 20 BUT NO MORE THAN 42 INCHES BELOW FINAL GRADE. MA CRT EXCAVATION FROItf ORIGINAL GRADE WILL BE S� IP:CT�S. IVIINII•9jJM DEPTH OF EXCAVATION FRM ORIGINAL GRADE WILL BE Z1 INCHES. PLAN VIEW OF .BED 1 53 4 Perforated PVC Distribution D Pipe. m �- - - - -- - - - - -- T 4 Cast 'Iron Vent Pipe 4 "PVC From Septic Tank Solid 1 1 :a11 PVC Header Pipe Pl.v"1U = S1C�7JR�'tZ -� L.1,C�r.)SE 1J0. �A. -i-E San. Permit No. Jw er's name. IV H63.05 PLOT PLAN S how: N A Dosing chamber �✓� Location of building served horizontal reference point Vertical/ Septic tank Q System elevation is 9�• � Building sewer Well Effluent system Property lines w /in 50' of system Replacement system area _ "N _ or dimensioned Scale - N•A Distribution boxes ✓ �A] Pump and controls: Vertical Lift Size Force Main Pump & Model No. - - - -- -- Vol. Dist. Pi pe Gal. per MLin. Gal. per Cycle Friction Loss `r• D. H. Place check mark in appropriate box, indicating item is shown on plot plan below: I IZON P PL La G�'fION �PcRPcGE S1 SH 4S'CF 4`'PJC -- —� 20' o► y'CI yvv 3E W , 97 ' I 'n I L- e T' 4- N e t:. lov•o' W yep � of 1" �Rc>►J �, P� . n the event of a subsequent B y the granting or approving of the above plan, or upo does Zoning Administrator, permit being issued,St.Croixcounty and thQ2fects1inoplans or specifications, plain not assume or hold itself liable for any that m omission, examination overs ay result in or o ight, construction, r any damage a-f 7 installation. >, PTiun is signa fuuie - -- — icense o. a e � ra'r a .� r k � y'Y '. r .✓ , ,�> r rt �: "� 3 R5 .i S? ���.�,. 1 3 � � oft IIi y F �� , !' 't �F 'n,I�; r �k PE } ,. f �? t �.. � k , �'Y ny �+t, 1• ? I v e h� a ! + >< i I «� ������fr �:.� � r. • ' t su+ t.. b „y� � �P �'�` ct , l tY t�' � � N I 1 ME er ,. r ,,,(��� :✓ y�,,,_, r 1¢�., z 1,��,,,ti�k�ry l x 5; Y w ! ?'4"Fa: aft W1M'*�fi;�!!., , a �•��/M�iRyli)�y� "�!1T�M �', '{ ! ,./I, £ui. n �M'i) \�y �. tai Y y F' `� T�IOFI�Y �a; � �a � .�: y � _ '� , srry ! Yt � - .P,a em u • " t . �'�� 'h �' t 1 !71 av t ill yy `� f ' {FS � pt • .+ ` A"�>�' .. a,"�?� '✓I � � !r , "�� . "�"i,' P , :s` 3,��, -mo , '.Ft. h t- s ! r x r '� t,� u� +i � 4. � a i z• ,� � 'I ' V✓ t�K �t r w �k > r � t � ,r r � ! , ���C , �t n a � C �y !•a k 1 t y +`� � �`� t .`sly" - d��' ��''..�+(rM,�t'"'�Mf�i7����'k�' ' `� >!`! ��� ��q'� RS' r�•� '��,, `''• " 8► a+ t y,� �� i at7d'i t�2.,.'W"'� L. n�. .�� � r t�lt �+ E: >,•��,' ,J ►�, '1 #1r at1i rM ?�r► owl ab� Iwir H is seio; n .. N ". r $ sant�i + �srt(cr�etev�dC 4farsns ` x P41n #bnd Ft Afwf tpc� tt�r M 1�t i ea�ME � ti'S { 5 s j t S L f e uF .. i S R 5 ��� x � ✓ i ti 4 L X Al q if. 1 tl r A ., v. Sf w r r4 ', �, _ s. - k i`rv" t tx . + X `�'d # ��C x . z ro r r ° � ' � `i •': � 1 ,r� ' �' �.l ti i � �, t-0�� ., y 1 tj Furw - S 1' C 100 Owner of Property-N ��. L��}w, ' �` �4 I t2�/� Y ►� . QOc4 .Location of Property ��_� (� erection a 6 ,T 2. N R 19 W Township (Ie- i Mailing Address 3 © �- Ls 't. 1 ` l_A1Tt& W . Subdivision Name ( PAK I`%o(j c- Lot Number Z Previous Owner of Property ` 'C-k4 - L � r Total Size of Parcel__ R X ? Date Parcel Was Created Are all corners identifiable? _ YEy_ No Include with thi.s ion one of the fullowi .Certified Survey Map .Dead .Land Contract, or .Other Legal Document which describes the property PROPERTY OWNER CERTIFICATION -41We) certify that all statements on this form are true to the best ofd (our) knowledge; thatAIwe)paf (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. 44 03A0(=' ; and that (we) presently own the proposed site for the sewage disposal system (or e) have obtained an easement, to run with the above described property, for the construction of said system, and the carne has been d _ lyrecorded in the Office of the County Register of Deeds, as Document No. `f. 4c 6 ). W Su�N Ual OF oWNfR SIGNATURE OF CO WNER (IF APPL CABLE) DATE SIGNED _ DATE S IGP4ED SJl H ST C- 105 r H SEPTIC TANK MAINTENANCE AGREEMENT c St. Croix County z d �—, 9 OWNER /*0 HVER- ��- a w. I ? A -p, lZp t4 j m ROUTE /BOX NUMBER — Fire Number 7T'� s , CITY /STATE "\ 42 1 c S , W Z I 5/} pZ 2 - PROPERTY LOCATION: S '4, � 1 4, Section , T Z S N, R V9 W, Town of 72- , St. Croix County, Subdivision dAX 2� A�;, � S , Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- p sists of pumping out the septic tank every three years or sooner, I if needed, by a licensed septic tank up mpe r. What you put into I the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 s. the undersigned., have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart - ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. t � A- SIGNED l- , DATE - ( Q) - g5 St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715- 796 -2239 or 715- 425 -8363 Sign, date and return to above address. v y r � m =r fA N N N a � n fD O M O 3 v � n 0= PC s 0 `< 3 c co co y 7r P ' °cam' vamm °off. CMD N m CD N cD F ~ (j) $ ap 6 0 o (D � cc w v cl) :00 gr CO •+ N (D :: . ? cp n °3a o0 m m co 0 CD co w 0 _3 °c `<� O A Z c 0 CA CC) o �° w T c� v m N Dc ° j' a C ° =w��o =cD CL Q�w O ANN � v?;�yN C N (a =r NF (B 0 D ID m .mo = - aM o 3 cD M m ?a 1 CA W .-. a C A� m f y C =r a� m CD co Opp Nm =4 co °oo y °� = �o y "� A N O ' ^^� 3 CL CL 0 :E M C C c 0 "-w m M, 0) a - aCDN� RI cD a cr (n v 0 � r. = vi c -• �cc Q;sm 3 m n C �(p G N A O p a° a C Q a "> ac a �c °:..o ° 3 0 O o 3 : 0 a 3 a m o O 3 f.,, `.. O CD X <:,: �, m . . ' onouwswrwo i| ^ � WARRANTY DEED � r"/s op^�s RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2--1982 ' �� � °������� ~� � �� \0 |i '=^^~"��^�~~ VOL ������ K�� ' | REG ISTERS OFFICE - ---ll�Ili��Qi�]Bill/�'D���l���t�\t../�C0�D���t��Qn" U ST. ��N%�|X CO., WIS. ----.a.VVis/cog��io C������tio�l, --- �i lU�� Rei Ns ---�����----��---------------''--'- ---------- i ����^�� � 'wve'p and warrants u`.yKil][���i'��^'��JJP�� �J��l 'a1�----'--' �p��bv ���bau� aod i�e '- -- -' '��~'^~ { ' '~�' ..»« ..a��-if-tenaoto°--_-- --- ------- -------------- ------------------------------------------------------------------------------------- 1"MW of ---------''--------------'`------------ � -----'----'-'--'--'--'--- --------------------------------------------------- ! ---------- RETURN TO || | !� ---- ---- -------------------------------- ----------------------------------------------------------------------- i / | ' ------------------------------- ---------------------------------------------- - - � .| tho following described real estate in ... st....C-roiX �--------'Ooont» ' ------------------ --- � State of Wisconsin: '| || � Tax Parcel Nn; | ^ --'---'--'---'---' ' /! | | ! | . Lot Twelve (13), Oak Ridge Acres in the Town of Troy !' ``'^'~.° / LV ` ��p ! ^��^ V | / !| | |! This ----- i-s'n-ot --------- homestead property. (is not) |' |' U Exception to warranties: . ^ easements and `restrictions of record. | Dated this ---I0 th---------------------------- d»xvf -- Jiz]Ln 9 --__-- : _------ ---------------------------------------------------- ------ (8QAL) �� | . ~_________.________________ ~-BY.; Riolzar-d D[ n~ 'dent " | � ------------ ------ ------------------------------ ------------------ (GEAL) �� - ---(8EAL) | _-// / --------- -------------------- ~��� /-��-Fr-anq.es']7oxx'S�!���t��� .� AUTHENTICATION ACKNOWLEDGMENT ! / Signature (s) ------------------- Q� ��GO0�Ql]� ^ � ---------------------�-------- ' ' --____________________________ m� . �| ------------' 'P��'zz;��-----------Onnot� � ow QQ 0 2 3 'O 0 d O O CD 3 K C .d. A A 5 4t c CD 3 '•� 1 S oa a O o N c rn? `< m m m i -o ° M-0 rl • N C n O O O d N N N v K CC CO N N N C1 3 CO • < 7 -4 O O O n O 0 A O0 � O N O � O � 3 m 3 0 H N C tD CD o m D a s p oo m CD O C N O O p L co N CO a !� C co co a n r CO) CD cn co co coo coo m co o c tv O 3 Q <. 0 0 0 0 X CD ° C O C N N CD d 5i V N ¢ CD CD d < D a o N Z -1 Z O D m O N !1 Z1 CD N O CD C 0 :3. C CD N w m m a n � � Z CD Cp -4 CO) O =5 A Z CD cn A Z O a G 3 0 W I c �a Z 3 P ;o m +, 0 v O Q m CL Q :3 - vV C ° T Er v c o Z a , 1 � o �J CD Z N N O QO W y Z CD O A d tC y O ? -O A N � n S CD � O 4 CA N W O A Q A CD CD C7 O < A O 0 ~ O C 0 i � Parcel #: 040 - 1185 -50 -001 03/01/2005 04:49 PM PAGE 1 OF 1 Alt. Parcel #: 36.28.19.765 Current X' 040 - TOWN OF TROY ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owners () * = Current Owner WILLIAM T & KATHRYN M MURPHY * MURPHY, WILLIAM T & KATHRYN M 69 E WOODRIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 69 E WOODRIDGE DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: 2237 -OAK RIDGE ACRES SEC 36 T28N R19W LOTS 12 & 13 OF OAK Block/Condo Bldg: LOT 12 RIDGE ACRES INC 040 - 1185 -50 -002 (766) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 36- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 716/105 2004 SUMMARY Bill M Fair Market Value: Assessed with: 27564 275,100 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 68,000 207,700 275,700 NO Totals for 2004: General Property 0.000 68,000 207,700 275,700 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 50,600 170,000 220,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 213 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 040 - 1185 -50 -002 03/01/2005 04:52 PM PAGE 1 OF 1 Alt. Parcel #: 36.28.19.766 Current 1 X 040 - TOWN OF TROY ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owners () " = Current Owner WILLIAM T & KATHRYN M MURPHY ' MURPHY, WILLIAM T & KATHRYN M 69 E WOODRIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: 2237 -OAK RIDGE ACRES LOT 13 OAK RIDGE ACRES ASS'D Block/Condo Bldg: LOT 13 W /040- 1185 -50 -001 (765) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 36- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1027/429 WD 07/23/1997 842/248 07/23/1997 808/152 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/1995 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00