Loading...
HomeMy WebLinkAbout040-1191-40-000 (2)St. Cro"" County Planning and Zoning Detail Sanitary Information 4 ffediresdcry, October 31, 200: at 5: f1f:1 D PM Page 1 ��}'1 Computer #: 040-1191-40-000 Sub/Plat: Croix Ridge Section: 24 Parcel #: 24.28.20.850 Lot: 4 TN/RNC: T28N R20W Municipality: Troy, Town of CSM: 114 114: SE 114 SW 114 Owner: Abuhejleh, Ahmad 238 Plainview Drive River Falls, W 154022 State Permit: 149271 Issued: 02/24/1992 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 06/01/1992 POWTS Detail: Trench - Seepage Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Note- Issuer/Inspector As Built Plumber Other Reguirements Additional Notes lonq�Owed Jim Thompson Yes Fogerty, Dave 1000 gal. Weeks tank to 2 5' x 57' trenches $0.00 Jim Thompson :w{ :..... Yes 41 int ,#f x.: s 4 -ion Scheduled Pump Date Pumped Notification 6/1/1995 04/20/2006 6/1/2007 0 r � 5 r Parcel #: 040-1 1 9 1-40-000 04/05/2005 05:05 PM PAGE 1of1 Alt. Parcel #: 24.28.20.850 040 - TOWN OF TROY Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owners): * = Current Owner AHMAD J & GWEN J ABUHEJLEH * ABUHEJLEH, AHMAD J & GWEN J 238 PLAINVIEW DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 238 PLAINVIEW DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.600 Plat: 0234-CROIXRIDGE SEC 24 T28N R20W PLAT OF CROIXRIDGE LOT Block/Condo Bldg: LOT 04 4 Tract(s): (Sec-Twn-Rng 40 114 160 1 /4) 24-28N-20W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 914/168 07/23/1997 699173 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 27640 284,200 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.600 72,600 212,200 284,800 NO Totals for 2004: General Property 1.600 72,600 212,200 2840800 Woodland 0.000 0 ❑ Totals for 2003: General Property 1.600 669000 196,000 262,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 136 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • • AS BUILT SANITARY SYSTEM REPORT OWNER 2�7ditaA0 t Z � TOWNSHIP SECTION-2 7 T N — R _e7 �O ADDRESS -e- -ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ?All,? 74. s - T. V 011 r�q IINDICATE NORTH ARROW I .0 BENCHMARK: Elevation and description:— �-Z'kifew-e V Alternate benchmark-. Zllc SEPTIC TANK: Manufacturer: Liquid cap. Je Rings used Manhole cover elev :/,--.",� Final grade elev: Tank inlet elev.: 77-Y Tank outlet elev.: No. of feet from nearest road :Front , Side—, Rear / Ft. From nearest prop. line:Front , Side Rear Ft. -> 5-0 No. of feet from: Well Building,,___, P74 - (Include this information7 in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE a *' PUMP CH2,1Bffit Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.. Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.:Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side , Rear -Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: 1/"' Seepage Pit: Width: 5-- Length, 5-,Z Number of Lines: Z Area Built, Exist. Grade Elev, Proposed Final Grade Elev. 4,7, J- r, Fill depth to top of pipe : e-LD _. No. feet from nearest y rop . 1 ine : Front,, Side' Rear_Ft . _____ No. feet from well: elf/ No. feet from building N yP HOLDING TANK Manufacturer Capacity: No. of rings used:. -Elevation of bottom tank: Elevation of inlet: No, feet from nearest prop. line : Front, Side,,, RearFt. No. feet- from: Well , building , nearest road .� Alarm Manufacturer: INSPECTOR: DATE: Z PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj LOCATION: TROY 24.28,20,850,SE,SW,24,PLAINVIEW DRIVE Wiscoilsin Department of industry, PRIVATE SEWAGE SYSTEM La�or and Human Relations INSPECTION REPORT Safety and buildings Division f (ATTACH TO PERMIT) GENERAL INFORMATION Permit Holder's Name: [] City E] Village )U Town of: ABUHEJLEH, AHMAD J & GIVEN J TROY CST BM Elev.: Insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosi ng Aeration Holding TANK SETBACK INFORMATION TANK TO PI L WELL BLDG. vent to Air Intake ROAD Septic NA D ojsfn"g""' NA Aeration NA Holding PUMP/ SIPHON INFORMATION Manufacturer Demand . . . . . . ................. Model Number GPM TDH Lift Friction 5- stem TDH Ft I LQss . �4ad"I­..,_ I Forcemai n Length Dia. Dist_ T:0_-_-!� FLFVATION DATA County: ST, CROIX Sanitary Permit No-: 149271 State Plan ID No.. Parcel Tax No.: 040119140000 A920011'/ � /, / A?, STATION BS HI FS ELEV_ Benchmark /"` .:fir, /` s Bldg. Sewer st//t Inlet or St Outlet Dt Inlet Dt Bottom Header / Man. Dist. Pipe Y, Bot. System Final Grade SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of TrenchesPIT No. Of Pits inside Dia. Liquid Depth DIMENSIONS l DIMENSI NS LEACHING manufacturer: SETBACK L i SYSTEM TO P/L BLDG WELL LAKE / STREAM peOf INFORMATION —TyCHAMBER Model Number: F Type OR UNIT I T-C DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded Sodded xx Mulched No Bed /Trench Center Bed Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ COMMENTS: (Include code'discrepancies, persons present, etc.r. Ll ZZ _1 "00 9 ell, Plan revision required? 0 Yes 0 Use other side for additional information. 0( SBD-6710(R 05/91) A 1" Date Inspector's Signature Cert. No- SANITARY PERMIT APPLICATION COUNTY Ir DILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT —Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. 1:1 9� iqfe previous application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 9.�AfejZ XV&e 0/ e i'le, '/4 3-iv 1/4, S ..2 y-00 T.,Z 9 N 9 R oz� E (or (o PROPERTY OW ER'S MAILING AD LOT # BLOCK # 404/ 11 4/0p - 6 7" w"w, 74SS W-C CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME" %'-%,SM NUMBER IS 11. TYPE OF BUILDING: (Check one) StO0 CITY NEAREST ROAD 0 ate Owned VILLAGE: 01 "TOWN OF: 7�00 401 im z&eZeA-IJ El Public [21 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(S) 111111. BUILDING USE: (If building type is public, check all, that apply) 1 LJ Apt/Condo 2 0 Assembly Hall 6 El Medical Facility/Nursing Home 3 EJ campground 7 0 Merchandise: Sales/Repairs 4 Church/School 8 ❑ Mobile Home Park 5 ❑ Hotel/Motel 9 ❑ Office/Factory 10 ❑Outdoor Recreational Facility 11 El Restaurant/Bar/Dining 12 ❑Service Station/Car Wash 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. Eg New 2. El Replacement 3. El Replacement of 4. El Reconnection of 5. El Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 El SeeDage Bed 21 El Mound 30 1:1 Specify Type 41 El Holding Tank 12 2Seepage Trench 22 0 In -Ground 42 El Pit Privy 13 El Seepage Pit Pressure 43 El Vault Privy 14 0 System -In -Fill V1. ABSORPTION SYSTEM INFORMATION: *- / oe - - 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION L/ Jr-7 5` 1 7 7 1 1 Feet vdgl"pm* -mom I low Feet. V11. TANK CAPACITY in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION ew New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App. Tanks Tanks strutted Septic Tank or Holdina Tank I it Lift PumE TankJSiphon Chamber, L� Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu 71�)r's Signature: Sta MF4MPRSW No.: Business Phone Number: er �tf 2- el q 3 Z Plumber's Address (Street -,City, Statd� Zip CodeT- �/. / 10 -'COUNfY/D&_A7RTM ENT US t ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued suing Agen ignat Approved VZharge Fee) rp pproved Owner Given Initial 1----Adverse Determination #1V1 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber T INSTRUCTIONS 1 A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing author-ly. 4 je. / le, Changes in owneirship or p!umber requires a Sanitary, Permit �Transf r P n ewa! Form (S8D to be submitted to the county prior to installation, 5. Onsite sewage systems must'be properly maintained. The septic tank(s)-must be pumped by a licensed pumper whenever necessary, usually .every 2 to 3 years. 6. If you have questions concerning -your onsite sewage system, contact your local code administrator'or the - State of Wisconsin, Safety & Buildings Division, 608-266-38.15. To be complete and .accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide thelegaldescription and parcel tax numt)er(s) of where the system is to be installed. 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VL Absorption system information. Provide all information requested in #41-7. VIL Tank information. Fill in the capacity of every new ar-Aft- existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete, for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. NIP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than W;2' 11 inches must be subripitted to the. county T,,_, plans rnust irclude, the folllowlng: A' plot pjan. drawn to scak.Ej. of, with cottoplete dim �1_ _-Q tank(s' or other treatment tanks i i d i n (j .,, e - v e, nk;" + -.e m vzi �Ysle ■strearns and `.ike-s; plump or siphon Ianks; boxes k�cil agho'w"�� Fr Po; -eas and the 11ocation the bi_,oi1dn9 se-ved M hc•jr�zGnlal' end v e r I a levafioi -c,-ference CA I C' complete specifications for pumps and controls; dost", vcfluirne�- elevat'.,n differ fance---�' frj<-t--gin pul 1p -np rn a. n u f a c t (7 r c r c, ss s e c IL f S Y S T EI, ormance'curve; purnp model and- pw equired by the county. soi l. �t test data on a 1.15 form; and F) a I Il S'i z in g i 0, f 0 nril a ti o r. L E) ' GROUNDWATER SURCHARGE 1983 Wis :)_.` -sMn Act 41C included the creation of surcharges x O: 0. L' regulated practices which can effect groundwater. t,-rd s.:ichargSae con'tamination investiga t I I tions arid establishment of stemolm, 58 D-6398 (R. 11/88) AVPLI CATI ON FOR GAI{IT►RY P9RHI T 9TC-100 appliclHon form la to bo complotad In Full And algnad by thr ovnir(j) of the prop!rty being davelopEd. any InAdoquactea gill only re3ult In deli s o( lilt pi u l t 1 s 1uonCB r ' 311ould t1115 Gave o pment ba Intended for 1e1alt by avnsrlcontractort I epaa houct) , cvmplitcd vt,a t1)a property thcn A tacond L o r m a h o u I d I►■ sold and ecubmitt+rd Lo th1A btt tttit Ined and o L f I c I t h ■ppropr w r wi w w •_ r s w w w w wr #+ w w .•r w w w w.+�..r it 1r. w w. r . a v the M M M Ovnir of property fy ins .� M �► M Fr IM wa �+ ■y r M �/ *0M A en w/ M r M M M M M Iw IM M M MM LLe .rr, w. ! l M M M s w w w r s •r w Location of property 1/4 • 1/� �tCtlo � r n ....r......... �...► 4� T - R v T v vn s h i • KA I I Inq -' �.' C �ut7d [YI,r I nn ns�t �" Lot nuzber Pfty1cua ov'ntr of propirty "Y ti 7vta1 star o patctl ', . date parcel was rr+tat�d Ar• aall Corners and lat IInIx IdrntIfIAb I r thlo ptopatty be in dly +� q tYtp d for rw't14 ;aptC how:a j 7 Yts �. Ivrw and pagr Uumber ■s recorded vlth the X0 A47I5 tar Of Drads. w ! r •r w r r w! w r f~ M A mob N ffw ! w w +y r w 1r w q 1 w"" A r 1r• wy *. r. W fA !! w m w M Mr soon" +► w go r M y A as ! 1w w w M r w I I I C L U D 9 VI T I I TIII 5 h P P L I CATI 011 TII� F0L1,0WI HC T)It aS0I VXARKYTT DRID vhIc11 1ncIudaP a bOCUHgjir �,WinY r nY�i, a�" �r ���U"NQ J�NND phC]i �tt1�{�t�, and GT$R 07 DUDg , I n Add i t i an, a c e >r t ays 1 I sbI uvula be helpful ea arc tv ova ld l Z led autvty, I f the cittd detCtlptivn te[+~renctx to delays Of the ttvlevinq proct:�t. If ��sp ahtl1 it ISO k�e xe u Cettliltd �8urveY }�sp� the CettiiZed �urYe q Ired, y . � 11* ! M .� w r y Y w w �. w F� w r •e• w r .. w _. ` �. /� w �• w. w w w r..... w f•. �. .•. w y u. ._ r. w r .s w i (ye ) 00ER CERT I Y I CXT 1011 e�rt.l Cy ki,st sl1 �ktrtiemenEd on thisknovlydc�� ���:t I f va) I'm form art true. to the best of t~y l0uc (Ara) tl7a owner (a) dC the ro perk d i lr,I: ln(c�trna�tton itirmr by virtut © u p G y eser Ibtd in Lhe County' �tgl,Eet vC bee�4r AR Documait rrsnty deed rsc0rdrd to the or t ic,� of pt t t t nt 1 ovn k �e px a ® �] e t I(o, .. I a nd kha !, [ �` p lka for rho newage dle1❑xeI a aten f i outs lntc� sn et�rrncnk., td xur� ulkit ti Y (orhAY: evnettuc"On a( bald nyatem� and Itie abova ditcrit�ed pt'opsrtY� tvr t.)s at the Cavh�y As lskttr C bdtc�n ht1 r11 has baan duly rscordtd in the v[ r a■ Document I{o, � t t c r 4 r 1 9n■ tot r OE Own* 819n tune oL Co -ova .. �� � +� �ppcabYs j dyke e! n lgnskuz■ V f D�ttt t]C fAIgnaturn r-117 1 --111'-11 M, k "A "77 77 n— a 4. Folta 2 OVA" re v�T rR ST. CRW CD VOL 47=wyk Ree'd for % day 0 Made this-th� s t. p 0 4 1991 This irldenmm .a under Sa at 11:30 A* A. D.* 19 91 betweeft zed a . na existi MN a rorpor j ....... . ation duly Or"n" 14pIgpota Detroit.JAis-t� oca at ... . ............... i16 Gwen J - lames of the State Of eh and..._ ----;--- le virtue of the it paan�dnwife ► surv:; ��rsh�.�.._..rital__- QW1P&rtY Ofthe6" Abuhle-i-leho husband ................. pax'L ies, •of the second ps p - arty of the 6rst Putt for and ja Considerati0t%of 'he sum a �On Ite-ruaw TO Vjtnesse*4 That the ""a ralUable conside�� 0, ........ .1fessed and j..and other on receipt whereof is hereby c ........ of the q, f:ond part. the et,lsed, sliened, conveTea and con - paid by ffie slid WL d' scilj� situated in to it ed bargained, remise, alien, convey, and confirm unto abed real est,&W acknowled8ed, has giveN granted, give, grant, bsrg*'n, seli'lem a assigns forever, the following descr fir, led,, and by thew presetits does, ....... heirs an to -wit" th of the second PAM-- State of Wisconsin, C said part;It' S.... . .......... ................. the county of ....... own of Troy, Lot Crolxridge Addition in the T. Wisconsin* St. Croix County. ?4VCZ88A1:tY' CONTINVIC DF'qCR1MI0N ov gm 91DM) BEVER appertaining; the ftF the 2"a appurtenances thereunto bclongtng r)r in any wise either in possession or Tooether with all and singular party (if the first Part, either in law of eclu'ty' or demand whatsoever s Of the "'a and 3PPurtcnances. *d estate, ri6ht, title, interest, ClAir" and t1wir hereditarritnts ances, unto the said Par above bargained premises, ments and &PPuften CqKvuncy of, in and to the gibed vsth the befed1ta to hold the Said prernists as above &%� r FOREVER. To have and the i r. ...... hclr! 3A assiSns of the ...... ­ ......... . ....... — a corF2r.atlonr ....... part. jit, and to .................. *-*---'-*' Inc.._.# ........ . ... ....... ...... C said of the secul" D,vnaml ... Horne s to and with the esents it is well c ....... ........ .. sad does covenant, grant, bargain And 39ree f these Pr And the Ciling and dclivery 0 part, for its(:jf and its successors at the time of the ens e in the 13w, in fee simple, 1"'irs an g that party of the first I their ........ estate of inhcritanc r+eservat i ns. and ........ ......... -- ...... Perfect, absolute and inclefessible second Part, as (if a good, Sur, t....e.a Ssl�a �.- mises r .. .. ..... ,bove described, what"er, ........ e.xcel) seized of the pre and clear from all encumbran%,t .. ........ ...... * ................... .a that the $AMC are f rm rceord ............ ............................. . ...... . .......... . ................ c t i o n s ................ ............................. ......... I ............... .. - ----- ------ .. . ............................ .. .... .... -- ..................... ....... . ......... . ....... ........... . . ............part,.......... thgU ..... ....................... . ............................. ......... .... ....... ..................... ies .......... of the second . . ...... Sion of the said Part-1- ......... orever 'WARRANT aftd 1'eable "w�';Cs I .......................... ed premises in the quit ar, ! P(, I hole Of any part thereof, it will f at the above b3,g-,in 4; 1. , �lalming tile w and th all and eVLry Person Of per�lon L against norat'L)n ..................................... heirs, and Viomes # Inc cor ......................... .......... ....... DynaMic ...... -, ...... .. .......... .... ........ DEFEND. reof, the said . ..... ................. its ecretaly, Whe caised these presents ,, 1,e bY ...... ........ ......... ere-.jntO affixed' this St part. has . ........... 41 ....... j,.- -4�-nn-aS�7�,�,,I to be h C t" Corprate se Pao, of the fir gned by--.- lJoward Lund A 'l I its president, and countersi, rait-LAKC 5 ................... ....... .............. .. ..... .. I A. ust J 0 at ................... .................... .... , ......... AM I C H �'�)ME te Narne of.—, C�) cvor IL DYN CE OF ID14 ...... ... ..... ............. E)AVID KNU')SON---- ........... . . . ....... "Crewy .... /AsSt ......... ... .. Iowa r(I jAind If. �-..10006 0 MINNEOMA I SS. 19.91-.1 1Z ......... I A, D County. Secretary B e.c k- ....... IRth.- - of .............. "U be such t this ... ................... G.. 110vard o me kiown to Pcr-;onallY ...... - ...... ................. ........ pre,,'Hlent, and ............... tile 'nstr11MC'rt- a" t C of ..K11- msons who elec"t" nstru'nent as Such 0111ccrs as th the ftlrc.K(olng 1 ve (70T""t" to r11C tO be the executed of the abo 3(kilu'Alletiged that the Sc ry of president anal 16 7 MN said Corporation, � by its authority. I V, -1 1 -i - Ck. County. .ry 7 - - ----------- - WAS DRAFTED 193 OT A�� ..j T141S INSTRUMENT (15 DtJNLAP__,_ n the STEPHEN J tinted ()f c)fdcd , -,sin have P14i Is 01 21, instruments to be that thgo name the PCf Htld sono W It I" � Pr tv "ion 59,sj� sitnilleflif re"T'st'"eft thiplew in a lei of the W;"Von%in Stan*, witne5ws and notary. t' "I, XTIr of the glantors. W,,nteto '0 the nati h, ditaflicel such in.Arumcn -14 N' mental asiency WhIc ViASA 4XVY By cn S T C 105 SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County OWNER/BUYER—, Fire Number _U;L4_c__q7-c:4 ROUTE/BOX NUMBER Section T R W z I P CITY/ STATE- _ ; 2 PROPERTY LOCATION:`)1z: .14,.o 1-4 Town of St. Croix County, L Subdivision o t 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, if needed, by a licensed se tic tank. pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the was-te disposal system. St. CroixCountyresidents m� 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. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St IL Croix County Zoning Of ic w t in 30 days of the three year expiration date. 'Pill K, Li SIGNED J., St. Croix County Zoning office P.O. Box 98- Hammond, W1 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address* Safety &Buildings Division Wisconsin Department of industry, SOIL DESCRIPTION REPORT P.O. i�x 7969 Labor and Human Relations Madison, W1 53707 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Page of M pA n a Pit No Elevation r,-.) kN fr\ 'o ;= x 'I =N -t- R U � . cl C1 , Lq soli Survey Page No. cml clee ion Date d Use or Vegetative Cover Parent Materials ­701 Evaluat-1 Current Lan Horizon Depth. In, S Dominant Color Munsell S 11 R_ 3 Additional Remarks: Mottles Sz, Cont. Color VV %I I IV r­%., I- — - - -m ......... nw� 1�� L wNwomn-mm s;.) L -T- other Site Features: Limiting Factors/Depth: L4 tD CST Signature Date . Signed Telephone No. CST # Wisconsin Department of Industry, Labor and Human Relations 7 Pi-t No 0 L- Elevation _Zs\__� � K � I C. x Horizon Depth Additional Remarks: SOIL ���CRIPTION REPORT Safet & Buildings Division P.O. i�x 7969 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, W1 53707 Page --7 0 f --i soil survey Page No. mapped as �- �, � � � _ � .ateF_ �17 valuation Date Current Land Use or Vegetative Cover —parent Materials other Site Features: I Ll C CST CST Sig - nature Date Signed Telephone No. 9 Li-mi.ting Factors/Depth: LAJ • i Safety & Buiidings Division .R��oRTP.O.8ox�'9�9 Wisconsin De artment of industry, SOIL DESCRIPTIONf man Relations Signed Sheet) Madison, W1 53707 Labor and Hu (Attach Soil Profile Location Neap - To Scale - On A Separate, g , _ram, ��..�� Page of 4�1 Pi t No. Elevation •Z . soil Survey Page No . appe Parent Materials of Eva uation [late I Current Land Use or Vegetative Cover Z.SubS� V�'� 1137tLR ST S 6s� E �`Z' • l X Lot -Le -gal Discription Additional Remarks. ,t,. --> t r T'7Q?mil. r':> ?[l!'L \---� 13) --. t..oj tEj1S7tE\RL-r Other Site Features: tS L4 71 S�-9) �1e �7a CST # Date Signed Telephone No. E the CST Signature g Limiting Factors/Depth: 01 ) � 1 �3' 9 r nr1 01'•n ; k � ON Fnn1 t Safe &Buildings Division Wisconsin Department of Industry, SOIL DESCRIPTION REPORT P.O. ldox 7969 Labor and Human Relations (Attach Soil Profile Location Mai -Tv Scale, On A Separate, Signed Sheet) Madison, W1 53707 Page of t mn neq as Pit No 0 ��, _�_] N � ; C_ <S`7- x Lot_Legal Description Elevation 1 �5ojj Survey Page lAo. ____� Evaluation Date Current Land Use or Vegetative Cover Parent Materiais Additional Remarks: Other Site Features. - --% # . -I— ---v c I t. x r"5 --> ?,\ I , . Date Signed Telephone No. CST # Limiting Factors/Depth, CST Signature 9 . SOIL DESCRIPTION .REPORT safetiy &Buildings Division Wisconsin Department of Industry, P.O. Box 7969 Labor and Human Relations Madison, WI 53707 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) — - r�..,..,-. �T,-, G � Marir�orl aG-PL�!iJ��L\�1—�i�F�`1 ��Fl►.,O Page S Of � Pit No . Elevation - Soil Surveyr page o Evaluation Date Current Land Use or Vegetative Cover Parent Materials 1 C1 S Customer Address S 1 x L©t -Legal Destriptaon r- I-z-r. '-5 t f T 7 Q , 71? r? [ 1 I 1 3 Additional Remarks: Other Site Features: C� / CST #� . � Limiting Factors/Depth. CST Signature g � Date Signed Telephone No. cjt ) - Ip 9 PLOT PLAN L z T �-4 t'''C • ai: 5e t1v_ SLu IN Sez. z.4.Tz$f.3, RZa L..-; Page G of K-�. S T �] G C�� ZU►a� �— P[ �01 i�v yL 91 V m C.n L� �l �'1 `i-iz� �-1� �' S , LAJ LSL L `ri7 0Jj 1 1 p� S. .v 0 a' cr rr 1 p-4 I � � 1 l-r7 �s r� 5, $►� -.. �a�. o p �' luau I NE 4 F z V `% o Pt\t IS' -) 3. b-7 0 Date 5i ne Ye�ephone No. CST # CST Signature g AS jr Wisconsin Department 9f Industry, Labor and Human Relations Pit No. \ Elevation I C- Additional Remarks: Safety& Buildings Division SOIL DESCRIPTION REPORT P.O. ix 7969 (Attach Soil Profile Location Map - To Scale - On A Separate, Signed Sheet) Madison, W1 53707 'P�--� +F� � ��.�� �_�.�`f `� �� .��Page of c,i 9, L4 soil survey Page No. mapped as Parent Materials -I goil Evaluation Date Current Land Use or Vegetative Cover � F other Site Features: Limiting Factors/Depth: LJjw 411 I w r 0 P, -- I] f 0 �j 1Y S ;10 CST # Date Signed Telephone No. CST Signature Witconsin Department of Industry, Labor and Human Relations Pit No, �. Elevation ��'•�x Horizon Depth Additional Remarks: Safet��x &Buildings Division ��. DESCRIPTIONREPORT P.0. 7969 rt A Separate, Signed Sheen Madison, W! 53707 (Attach Soil Profile Location Map � To kale - � p � � �� Page � of v Page No . � ! Mapped a s -V�N-to � eL-\� Lei V)K-)� g .. Z -. -- lp, 3 Soil survey g Soil Evaluation Date Current Land Use or vegetative Cover Parent Materials e LAJ tii�s7taRL-( Other Site Features, -- Telephone No. CST # CST Signature Date Signed Limiting Factors/Depth. g -- 1 o 9 r nn 0�7n '�' ^' 'e)r` f t Wisconsin Department of Industry, Labor and Human Relations Elevation r­� k.ft c% c- % t",-,% -rl PtUF Additional Remarks: Other Site Features: SOIL DESCRIPTIO Safet&Buildings Division P.O.R�P`C3RT O ��x7969 E . c,fnninrl S►hPet) Madison,= 53707 Soil Map - To Scale OnASeparat , (Attach So page � of � , o soil SurveyPage No . Mapped as p- � e�\-) L -)I f . —T-�n1d rv� ujatinn Date Current Lan use or vegetatsve Cover Parent Mater a s l `r � K'rr-e 5 1 " rQ -7 u . T 2-54 1- 3 , R_ 2-0 IUD p c L4ZS�- C�) �S �a . � • � • � `� Telephone No. SST � CST Signature Date S� g ned Li m,iti ng Factors/Depth: g o 9 Wisconsin Department of Industry, Labor and Human Relations Pit Na, H Elevation Sa#ety & Buildings Division SOIL DESCRIPTION .R ��RT P.O. Box 7969 • � Separate, *�� Cte[� Sheet) Madison, Wl 53707 Sv�l Pr�f�le �otat�vn Map - To kale on A Sepa g(AttachJ Page of � � �- `7 soi 1 survey gage No . � Ma�� .""... - - nll cation Date Current Lan Use or vegetative Cover Parent Materials r-% t., T 0 C % %=N -r, ph u t - JA ©lt VY7 �—I ` L,, a t k'1 + V Lot Lega De c_ril tion �- Q,F �;C_ Horizon T Depth Additional Remarks. Other Site Features. u . T?A�13) R__Lt]LA-_1 r L -�' S%" V CST # Date Signed �`--� •- Telephone No. CST Signature Sied [ m fi ng Fact-ors/Depth: g ) -- 1 Q 9 W'I'Sconsin Departmentaf industry, Labor and Human Relations Pit No. Elevation x Additional Remarks; Other Site Features: SOILSafet& buildings Division DESCRIPTION .REPORT P,O. ��x7969 • A ��? c�r��e,Psl Signed Sheet) Madison, INI 53707 Soil Profale l.ocat�vn �'1ap � Tt� Sole - �n P g(Attach % � �. Page S of � - � soil survey Page No. 3 Mapped as t_. try �. �� � -. RI ©f Eva uat vn Date Current Land Use or Vegetative Cover Parent Materials Ts b5C i\377 \ 3 LI) r�, L.4J Sim^ -L`7 C� 4 CST � • - Telephone No. . .. CST Signature Date Signed Limiting Factors/Depth. - o r n n 0��n IN PLOT PLAN Page G of 'SL T I I SIAJ ly 9 -7)),3 Cb, C-t\rjrw Iz VI 2s 1 (n CST Signature Date Signed Telephone No. CST # rn Ln F -r k) AG�-< r letvti �loZs V ` ` f ♦ )e aSS GrOf / p91r O ol .Val�r e* i r ';''-- U i CS In Q r _ M z (n �' rn C)* =rn (;a lid cn �0( C) •� U) \tp Q Q° r--r m� av "' Ua rn in 0 z U) C] W Q� ke r Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN 54023 (715) 7 6 L � ly # 7yf 0 r 9114 REPT131 TROY ST. CROIX COUNTY ZONING PAGE 2 06/01/92 10:09 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 1/92 AREA: JT Activity: A9200117 6/ 1/92 Type: CONVSEPT Status: PENDING Cons tr: Address: TROY 24.28.20.850,SE,SW,24,PLAINVIEW DRIVE Parcel: 040-1191-40-000 Occ: Use: Description: 149271 Applicant: ABUHEJLEH, AHMAD J & GLEN J Phone: Owner: ABUHEJLEHI AHMAD J & GWEN J Phone: Contractor: FOGERTY, DAVID B. Phone: 749-3656 ----------- ------------------ ........ ................. ......... Inspection Request Information..... Requestor: DAVID FOGERTY Phone: Req Time: 15:06 Comments: Items requested to be Inspected... Action Comments Ti Epp 00012 FINAL INSPECTION Inspection History..... Item: 00012 FINAL INSPECTION REPT131 TROY ST. CROIX COUNTY ZONING PAGE 06/Gl/9 10:09 REQUESTS FOR INSPECTION WORK SHEETS FOR: 6/ 1/92 AREA: JT SELECTION CRITERIA INSPECTION DATE 6/ 1/92 INSPECTOR AREA JT REQUESTS SELECTED 2