HomeMy WebLinkAbout040-1235-20-000 (2)
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1 A U a 0 N V
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pagel of 3
Labowand Human Relations
Divisibn of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ri S 1
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or ~}4 F;EC I D. #
dimensioned, north arrow, and location and distance to nearest road. y Z3
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION f, " REVIEWEDf3Y DATE
~a ~ d
PROPERTY OWNER: PROPERTY LOCATI fa Y I
Richard Stout GOVT. LOT N, /4 SW 1/0 3 T 28 N,R 9 g(or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK# ${i~D. NAME.MQ$M #
1353 Awatukee Trl. 41 na
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE 09MMOWAQ NEAR ST AD
Hudson, WI. 54016 (715) 549-6731 Tro v Rd.
[xj New Construction Use [ Residential ! Number of bedrooms 3 [ j Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate ' 5 bed, gpolft2 ' 6 trench, gpd/ft2
Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 •6 trench, gpd/ft2
Recommended infiltration surface elevation(s) 95.92 ft (as referred to site plan benchmark)
Additional design / site considerations alt site= 94.86' el.
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem ®S ❑U ®S ❑U ®S ❑U ®S ❑U ®S ❑U ❑S $7U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
k` 1 0-22 10yr2/2 none 1 2msbk mfr crw If .51.6
1
2 22-28 10yr4/4 none sicl lfsbk mfr if .2 .3
Ground 3 128-38 7.5 r4 4 none
elev.
97.36 ft. 4 138-82 7.5 r4 6 none 1s o
Depth to
limiting
factor
+82"
Remarks:
Boring #
1 k-17 10 r2 2 none 2ms]ok mfr if r,
'X`
2 17-30 10 r4 4 none sicl 2msbk mfr if .2::.3
3 0-82 7.5 r4 6 none fls os mfr na n
Ground
elev.
99.9Io
Depth to
limiting
factor
+82"
Remarks:
CST Name:-Please Print Phone:
Gary L. Steel 715-246-6200
Address: 1554 200th Ave. New Richmond WI. 54017 m02298
Signature: Date: CST Number:
Q 4-23-96
PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # Mending Lot#41
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boarrky Roots GPD/ft
in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
.
3 1 0-9 10 r2/2 none 1 2c P1 mfr if n .2
~tiifitiv^ii
2 9-16 10 r4 4 none Ski if mfr if .2 .1
Ground 3 16-27 7.5 r4/4 none sl 2csbk mfr na .4 .5
elev.
98.9 ft. 4 27-85 7.5 r4 6 none IS mfr na na -7: .8
Depth to
limiting
factor
+85"
Remarks:
Boring #
i!;' ~g4 1 -10 10 r2 2 none rnfr cm if np! .2
t\. :v41
4 2 10-18 10 r4 4 none
slcl Ifsbk rnfr if .2i.3
Ground 3 18-32 10 r4 6 none sl 2csbk mfr n
elev. 4 2-84 7.5 r4 6 none 1S oscr mfr
99.0 ft. na na .7! Ft
Depth to
limiting
factor
+84"
Remarks:
Boring #
..«:•4...::: 1 k-10 10 r2/2 none 1 2c 1 mfr
Q[w if n .2
::k = 2 0-19 10 r4/4 none sici lfsbk mfr if .2i.3
Ground 3 9-30 7.5 r4/4 none sl 2csbk mvfr na .5::.6
elev. 4 0-80 7.5 r4 6 none is o
98.35ft.
Depth to
limiting
factor
+80"
Remarks:
Boring #
'k'"t vv vvry
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(R.05/92)
w
r STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
Richard stout New Richmond, WI 54017
S -R19W (715) 246-6200
MP SW 3254 ton of Troy roy
town
lot #41-Country Wood
N
1"=40'
Bm.= top of 11'steel pipe C el. 100'
15
k5 0,
I0
Gary L. Steel
4-23-96
ST. CROIX COUNTY ZONING DEPARTMENT `
AS BUILT SANITARY REPORT R 'Ec"s V E D
Owner A sA U i e ? 1
Address CU u ti ti o U0 ST CROIx 1
City/State ~t~asuN s a") couOF
Legal Description:
Lot.41_ Block Subdivision/CSM # Couwt~~kj
'/4 Mf- '/45l~ , Sec. 3 , Ta N-R 1 1 W, Town of iz-o PIN # Oy0 l33S-a10-0
SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION:
Tank manufacturer WIZ-e.t-5 Size ST/PClVW / Setback from: House 161 Wellade(P p/I,aUQ~ SV
Pump manufacturer Model
Alarm location ~'i
(HOLDING TANKS ONLY)
Setbacks: Service ro Vent to fresh air intake er`T;irie
Meter locatio° "
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: Z>,► fi~ a Width 3 Length S 0 Number of Trenches -3
Setback from: House 05- Well ;77S' P/L aS` Vent to fresh air intake
ELEVATIONS:
Description of benchmark T v oN I -,rr- (i ti I I m Elevation 100,C)
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet r v'a ST Outlet T7 8o PC Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover
Distribution Lines 7,-Z7 ( )
Bottom of System ( ) 1 ( ) 9 S . 9
Final Grade O_ 1~ o~ O 9 .9d O 79
Date of installation / 7/ *ermit number q9 I~ State plan number
Plumber's signature . License number a~ T Date
Inspector '6d (Ai
Complete plot plan 4
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
~ le~►N~afi
3 BQ DfLuv m • O 38 31'
Orv'R '
105, _
INDICATE NORTH ARROW
,Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division INSPECTION REPORT x;/. 6,0;x
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 24t?/<7
Permit Hold L'-~ Name: ❑ City ❑ Village [9 Town of: State Plan ID No.:
d l`~ -
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
`~~'7~`i 8' rovr~.~ G~~va~i?lh ~ ~a p, .Zp-ood
TANK INFORMATION ELEVATION DATA q 7o0 5D4,z
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Se Ic Benchmar OW92 •V9 'L
1/T'2 t1~5•
Dosing All, 6A4
Aeration Bldg. Sewer ,0 l ob xzi
Holding - / lik Inlet ~•Z( ~D~ • (i/
TANK SETBACK INFORMATION (D/ PR Outlet 161 a z,
TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet ✓~i~
Air Intake d
Septic 57c f* I I 12~ NA Dt Bottom a-
Dosing NA Header / Man.
Aerati Dist. Pipe .~3 96-
Holding Bot. System of • ~~~91i
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand 2-•02- 102;5"
Mod m er GPM
T H Lift Friction Syste Ft
Forcemal ength Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
BED/ RENC Width Length t No. Of Trenches PIT No. Of Pits :ins:ide Dia. Liquid Depth
DIMEN 3 So DIMEN SID-N-5-
LE Manufactur
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM CHAMBER
t f, J- Number:
INFORMATION Type Of -
Syste tr(M~` _tU t~ tOD OR U
DISTRIBUTION SYSTEM
Header / Manifold , „ 5 Wj x Hole Size x Hole Spacing Vent To Air Intake
Spacing 1So
Length Dia. ~tL'_' Lengthy Dia. ~"1 it
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
f xx Seeded /Sodded xx Mulched
Depth Over Depth Over xx ;etc.)
Bed /Trench Center Bed /Trench Edges To❑ Yes ❑ No / ❑ Yes ❑ No /
CovNYvl W64 1
COMMENTS: (Include code discrepancies, persons present, Sr t~a,~~rt
Cl~ 6MOE4^444L &add 14~ V* tj ~6~ .
Pan revision required? ❑ Yes ® No feet ~ cc t~
Use other side for additional information. ?7 l~ Iq ` a f DISA
Date Inspectis Signature ert
SBD-6710 (R.3/97)
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
T '
^:„E•~~ Safety and Buildings Division
v■■..■■■~ SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County ,
than 8 1/2 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property O 9er N me Property Location
girl ~.~tC~ ~E1/4 S l 1/4,53 Tab ,N,R/g E(or)W
ProPertYwner's Mailing Addre s Lot Number y Block Number
` NL~US h]P+ Roan /
City, State Zip Code Phone Number Subdivision Name or CSM Num er ?
unSOH ~►-I iSL ()j ( Caw vit II W000 +
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ cityage Nearest Road
VIl f
~ Town of ~(.~;-Q c~.ll
Public 1 or 2 Family Dwelling - No. of bedrooms ❑
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
Q` 1 a 3S`
1 ❑ Apartment/ Condo ^ ~q a Q
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. E] Replacement 3. E] Replacement of 4. ❑ Reconnection of 5. E] Repair of an
-____-ystem System Tank Only Existing System _________Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30E] Specify Type 41 ❑ Holding Tank
12'~Seepage Trench - 5,rDeW,"Djt2. 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit Z4" Iffil.40r, ;der- 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
450 IMM Y's C) -IS6 . ~ - IGy 9.S, (i Ta Feet 00-)DI, Feet
VII. TANK Ca
in galloacitns Total # of Prefab. Site Fiber Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank ILS ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's Si ature: (No Stamps) MP/MPRSW No.: Business Phone Number:
.7 YO I IS- 386- 9o.~v
Plumbe , Address (Street, City, State, Zip Code
1610 )A W , _5 kDSUn1 1riJts'L
IX. UNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing A ent
A roved Surcharge Fee)
pp ❑ Owner Given Initial ~ yQ c,T,
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 1-11
SBD-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumtoer ,
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 a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) 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 and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on 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.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or 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. MP, 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 8 112 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, locattan of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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' I— PL 0 -I- M A P
x 54c( )tit'
. 3% S)
• . (al.)er IN PIA It.k
;4., . : I Iry ------I
• SI �y B°1
5 vV
i i 35' * o' 3 ( opRoOM
f Is.—. `, /_ VIO OA
---- `-
L 50' 3 r p
.
6S CIB3 a , .
• $
•
s fi� !,= B•0U(1, martk P In 9.441 Pipes
•
3C BE • Notf. . Adjpctil lofs Weil 1 s fPrtt ,
11,,oN IOW filom. Stei c t Sster,
<----- Va ---.?' N ott : We)) i s IAA-NE ii,p w 5&'
• i •
y•
g ft= ohn Sr't►C i S ,�tow"
1 Bolu1,u)es NI
LU�Curt..Nip.
, 'N _
, FRESH Ail: INLETS AND OBSERVATION PIPE
_ CROSS SECTION •
gs)Nc Si(2., LI wpev‘. 1.H-rr iinhr012 Sj_tt- -, _rTh- -
Approved Vent: Cap
Minimum 12" Above tw ��
Final Gracie
is
4 " Cast Iron
Above Pipe : Vent Pipe
To Final Grade
• ni C_i-) : --inn .c_— Tee--
•
-� I1
n4144 + e- --- r
�7 �j c l'..�.nt a at:i ng-�1'
- • ' .r U~bor and Human Relations %9%04 a- r%' • u bwl • Ivl~ mrv n t raye 1 ui _j
Division of Safety & Buildings In acco I ~ Wis. Ad . Code
6 COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
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. pending
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Richard Stout GOVT. LOT NE 1/4 SW 1/4,S 3 T 28 N,R 19 Ck(or) W
PROPERTY OWNERS MAILING ADDRESS LOT # LOCK # SUBD. NAME OR CSM #
1353 Awatukee Trl.
CITY, STATE ZIP CODE PHONE NUMBER ITY []VILLAGE 291-OWN NEAREST ROAD
Hudson, WI. 54016 (715)549-6731 Troy Tower Rd.
[xJ New Construction Use [ Residential / Number of bedrooms 3 [ J Addition to existing building
[ J Replacement (J Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate - 5 bed, gpd/ft2 -6 trench, gpd/ft2
Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate • 5 bed, gpd/ft2 .6 trench, gpd/112
Recommended infiltration surface elevation(s) 95.92 it (as referred to site plan benchmark)
Additional design /site considerations alt site= 94.86' el.
Parent material outwash Flood plain elevation, if applicable na It
F able for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
uitable fors stem ®S ❑U ®S ❑U ®S ❑U ®S ❑U ®S ❑U ❑S $7U
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch
1 0-22 10 r2/2 none
1 X.- Z Zmsbk mfr CIW if .5 .6
2 22-28 10yr4/4 none sici lfsbk mfr if ,2 ,3
Ground 3 28-38 7.5 r4 4 none
elev.
97.36 fl. 4 38-82 7.5 r4 6 none is
Depth to
limiting
factor
+82"
Remarks:
Boring #
"a
1 -17 10y-r2/2
x 2
2 7-30 10 r4 4
none
Ground 3 0-82 7.5 r4 6 none f1s os mfr
elev.
99.91!5
Depth to
limiting
factor
+82„ I J
Remarks:
T Name. Please Print Phone:
Ga L. Steel 715--246-6200
Address:
1 200th Ave. New Richmond WI. 54017 m02298
Signature:
c Q _ Date: CST Number:
4-23-9
PI0P$kfYOWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 c
VARCEL I.D. # pending Wt#41
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consisfience Boundary Roots GPD/ft
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Twrk.
F - 3, 1 0-9 10 r2/2 none 1 2c P1 mfr if n .2
2 9-16 10 r4 4 none sici Ifsbk mfr aw if .2 .3
Ground 3 16-27 7.5 r4/4 none sl 2csbk mfr na .4 .5
elev.
98.9 ft 4 27-85 7.5 6 none is O-qc[ Mfr
Depth to
limiting
factor
+85"
Remarks:
Boring #
1 -10 10r22 none mfr wi if n
pe -2
2 10-18 10 r4 4 none i
Ground 3 18-32 l r4 6 none sl 2csbk mfr
elev.
99.0 ft. 4 2-84 7.5 r4 6
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 -10 10 r2/2 none 1 2 1 mfr 99 if npi.2
5 2 0-19 10 r4/4 none sicl lfsbk mfr if .2.3
Ground 3 9-30 7.5 r4/4 none sl 2csbk mvfr nor .5.6
elev. 4 0-80 7.5 r4 6 none is os
98.35tt
Depth to
limiting
factor
+80"
Remarks:
Boring #
Ground
elev.
ft
Depth to
limiting
factor
Remarks:
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Richard stout
MPRSW 3254 NE4SW S3-T28N-R19W New Richmond, WI 54017
town of Troy (715) 246-6200
lot #41-Country Wood
N
1"=40'
Bm.= top of 11'steel pipe @ el. 100'
J-v
~'Y !b X1'1
1ri
\ ~y
5 0,
f
74,
Gary L. Steel
4-23-96
S '1' 1115
SEI1'TIC TANK MAINTE-NANC , AGREI?t\1F.N.1.
St. Croix County
OWNER/ISUYE,It •J.:_ ~ ~ci~~~
MAlLINC ADDRESS Ji~q P1dln~ t"I6
PROPERTY ADDRESS C,DC~. u1`~ ~
(location of septic system) Please obtain from the 1'lamaing Dee.
CITY/,STATE,
1 ROI E;RT LOCATION ILIZ 114 1/4, Section r
TOWN OF ST. CROIX COUN'T'Y, N%,I
SUBDIVISION L, )j_~04i x,19 I,()'l' NUMItEIlt
CERTIFIED SURVEY MAI' , VOLUME; , PACE; , LOT NUMBER
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 licensed septic tank pumper. What you put into the system can affect the function of the septic lank
as a treatment 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'systcm, 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 system properly maintained.
'llac propetiy owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition a►►d (2) :►tler inspection and
pumping; (if necessary), the septic lank is less than 1/3 full of sludge and st:una
Me, the undersigned have read the above requirements and al, ;rce to maintain the private scwagc
disposal system in accordance with the standards set foatlt, herein, as sct by the Wisconsin DNIt
Certification stating that your septic has been maintained Dross be completed and tetunacd to the St Croix
County Zoning 011icer within 10 days of the three year t,:xpiration daw
I)AI1~. la _ O
tit ('toax 1'ounly %.oninl; I )Ilir.t1 iovetnmrnl 1'rnlet
1 101 1'atmn•harl lWad
1111d.,1111. WI 14016 I I/'r ~
8 T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will.
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Dwner of property
Local ion of propertyAjl-:-_l/4 ~ 1/4, Section-3 ,T52ILN-R / W
r
Township rro~4 _ Mailing address T-/"L 4no
t d wi
Addressofsite CGt,r'1 SyS Cam' ~nr.'1
Subd i vision name \A (y,4 Lot no.
Other- homes on property? Yes No
Previous owner of property
Total size of property
Total size of parcel . ~3 t AC: •i
Date parcel was created l~ly-r 1 Gt 0G{~Q/,
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? ',y( ,--Yes No
Volume /401 and Page Number as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Surrey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on, this form are true to the
best of my (our) knowledge' that I (we) am (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. 5~ ,<,Qyr , and•that I (we) presently
own the proposed site for the sewage disposal system orlI (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register o.ia Deeds as Document No.
Signature of Applicant Co-Applicant ,
I~.rt < I irrr:rt rrrc~ Ikrt.C, c,f Signature
DOCUMENT NO WARRANTY DEED beA(.[ RCXfW lD fOR RE ;iN
STATE BAR OF WISCONSIN F13" 5-1982
REGSTER'S OFFICE
ST. CROIX CTY M
DSi.~T L. S and ~ R. Ste, pka ar l~ood~
husband and wife, and each in their own inch rid-.al
right and capacity _ _
- is
JUN 3 1996
2.15 P.
conveys and warrants to
at 1
--Kau..., `k LIsa,
i
RICMRD O. SUM, a resident of the Town of St_ Joseph, Reqtet9rdD"
St._ Croix-County, Wisconsin
I
i
for $1.0 and,other-
good-and valuable consideration
- RETURN i0 j
•
Richard 0. Stout
1353 Awatukee Trail
the following described real estate to St •..-~>'Q R County, Hudson WI 54016 - jj
State of Wisconsin: i
i Tax Parcel No-
~i
Lots 16, 17, 19, 22, 25, 27 and Outlot. 1, Plat of
Country Wood, ~n the Town of Troy, St. Croix County, Wisconsin.
AND ALSO
I ,
Lots 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 43, 44, 45, 46, 47, 48, 49, 50,
52, 53, 54, 55, 36, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70 and 71,
Plat of Country -Wood First Addition, in the Town of Troy, St. Croix County, Wisconsin. AND ALSO
Any other lots, outlots and other lands described in that Land Contract dated June 2,
1995, recorded June 5, 1995, in Vol. 1124, Page 496, Doc. No. 529718, in the office
of the Register of Deeds for St. Croix County, Wisconsin, EXLI PT those lots, outlots
and other lands previously conveyed by deeds frn~ grantors to grantee A EXLTM
public roads and any other portions dedicated to the Town of Troy by said plats of
Country Wood and Country Wood First Addition. ~I
Together with and subject to easements, covenants, reservations and restrictions
shown on said Plats or otherwise of record, if any.
j
fl
This deed is given in full and final performance and satisfaction of that Land I!
This is not - homestead property. Contract recorded in Vol. 1124, Page 496, q
- -
(is) (is not) Doc. No. 529718. Transfer fee prepaid. j~
Exception to warranties:
i~
a ,
Dated this day of I A-1 96
19. j~
a (SEAL)
(SEAL) jI
Delbert L. Singerhouse it
i
_ - /
..(SEAL) r iv
--Ijtisc-mac L'r-/E,L`'c,REAL► ~I
Bernie H. Singerhouse~'! I'
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