HomeMy WebLinkAbout040-1237-10-000
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W&onsin Department of Industry, SOIL AND SITE EVALUATION REPORT 9 10 1 of 3
Labor and Human Relations
.f Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
C ~ r
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or EL I.D. #
dimensioned, north arrow, and location and distance to nearest road. JOK&O 1995
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION !D EWED a sT CRCk~1. DA E✓
PROPERTY OWNER: PROPERTY LOCATION f►V6OF"CE ti
Richard Stout VT. LOT SE 1/4 SE 1/ , , 28 (or) W
PROPERTY OWNER':S MA!i_ING ADDRESS LOT # OCK # SUBD. NAME 0 t! f
1353 Awatukee Trl. 60 a -Cpuntry
CITY, STATE ZIP CODE PHONE NU VILLAGE [3rOWN NEAREST ROAD
Hudson, W'. 54016
( it New Construction Use [x l Residential / Number of bedrooms 3 (J Addition to existing building
j J Replacement ( J Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate ' 4 bed, gpd/ft2 ' S trench, gpd/ft2
Absorption area required 375 bed, ft2 375 trench, ft2 Maximum design loading rate -4 bed, gpd/ft2.5 trench, gpd/ft2
Recommended infiltration surface elevation(s) 104.62 ft (as referred to site plan benchmark)
Additional design/ site considerations system el. based on contour line of el. 103.62'
Parent material limestone highlands Flood plain elevation, if applicable na It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for svstem ❑ S 13 U ® S ❑ u ❑ S EL ❑ S ® U ❑ S ®U ❑ S [!3U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bouldary Roots GPD/ft
Boring # Horizon in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. I Bed Trench
1 0-13 10 r3 3 none mfr aw 2f •6
1
2 13-21 10 r4 4 none sicl 2msbk mfr (TW 11"1 .4 .51
Ground 3 21-29 7.5 r4 4 none scl 2msbk mfr aw nJ .4 • 5
105e104 ft 4 29-50 2.5y7/2 none Fractured Lime tone
Depth to
limiting
factor
29"
Remarks:
Boring #
1 0-11. 10 r3/2 none 1 2msbk Mfr 2f .5 .6
3 2
2 11-27 10 r4/4 none sicl 2msbk Mfr •4' .5
3 27-50 2.5y5/6 none cl m n na na n p: n
Ground
el
105T4
105.04 ft.
Depth to
limiting
Remarks:
CST Name _Please PrinGar L. Steel Phone. 715-246-6200
Address: 1554 200th Av New Ric n
Signature: Date: CST Number:
10-27-95
{
PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page.J of-,,.3
PARCEL I.D. x pendincf
D/ft
Boring # Horizon Depth Dominant Color I Mottles I Texture Structure Consistence lBotix:13y I Roots B ~ 2
_ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
3 1 0-17 10yr3/2 none 1 2msbk mfr Cfw 2f .5' .6
2 17-27 10 r4/4 none sicl 2msbk m r 1f .4 .5
Ground 3 27-60 2.5y6/4 none cl m na na na n ! n
elev.
101.42 ft.
Depth to
limiting
factor
7-1
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
~ y
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 SE4SE4 S3-T28N-R19W New Richmond, WI 54017
MPRSW 3254 town of Troy (715) 246-6200
t lot #60-Country Wood
N
1"=40'
BM.= top of 1" steel pipe C el. 100'
Alt. BM.= top of marker pipe C el. 102.45'
~ 7-5
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3
4-0~
N
6- A
90
o[ . ~~~Z.X-~1xY
Gary L. Steel
10-27-95
f
r
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS.
~~~y GX~ IP
SUBDIVISION / CSM# /`7
SECTION r 2 LOT #
T2-5 5 N-R~W, Town of %rc y
ST. CROIX COUNTY, WISCONSIN
G - Ia3-1 -
PLAN VIEW ~ _ ZF. - lI ~
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
r
r,
INDICATE NORTH ARROW
Provide setback and elevation information on reverse
Provide 2 dimensions to of this form.
center of septic tank manhole cover.
s
w
yr .
BENCHMARK: Ar
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Gl /1-1i4/-/~ Liquid Capacity: cad
Setback from: Well House o?3' Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length aa~ Number of trenches
Distance & Direction to nearest prop. line: ~j
Setback from: well: 0'2-' House a~J Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: A)
PLUMBER ON JOB: A:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wi§convin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryL89387 .
Personal information you provice may be used for secondary purposes (Privacy L .9t, S. 15.04 (1)(m)].
Eggolde fi*TIRD 7'KUY- Village Town o : State Plan ID No.:
C BM Elev.: Insp. BM Elev.: BM Description: Parcel ba o.id-:
~Yr,~as~~~ 1237-10-000
TANK INFORMATION ELEVATION DATA A9700202 /a -2
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark i f
711
Dosi r►t / r
Aeration Bldg. Sewer P r
HoIdincf` St/ Inlet p'~ 9~, 25r
TANK SETBACK INFORMATION St//,4t Outlet Coot%r q,9
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet i
Air Intake
Septic NA Dt Bottom ? -
Dosing NA Heaclezl aw-
Aeration NA Dist. Pipe 0 jrf ~ &3 r
Hjo,tt ring Bot. System 96. y5
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demands ° S ~~a ~,SO
(t'-"
Mod umber GPM 9i 79
TDH Lift Frictio m b u
Ft d- el. r i0a 9/36
1 Lo Head
Forcemain L th Did. Dist. To Well
SOIL ORPTION SYSTEM
BED/TRENCH Width r Length , No. Of Trenches PIT No. Of Pits inside Liquid Depth
DIMENSIONS DIMEN
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEA M acturer.
SETBACK MBE
INFORMATION Type Of -Coat n CHA Model Number:
System: -6r ere-(ws i ►e.0 026 1 fORUNI
DISTRIBUTION SYSTEM
Header/Manifold / r Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Ir Dia. ~ Length/ 00 41'J Dia. Spacing
I
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys
x
Mu
Depth Over Depth Over xx Depth Of x) .-S,eded / Sodded x lched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes E] No E] Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TROY 3.28.19,SW,SW 613 OAKLEY CIRC E LOT 60
~~-SCR-.,naafi ~ ~~``-~1- i►!"I,or ~,,P( ~~a~ ~f:7~
Plan revision required? ❑ Yes [INo
Use other side for additional information. /.0 12-
1 pf
SBD 6710 (R.3/97) Date Inspector's Sig ature Cert. No.
C),? r_
ADDITIONAL COMMENTS AND SKETCH -
SANITARY PERMIT NUMBER:
/U
6 4-,
F
t
3
s
1
S %
1
a ,
Safety and Buildings Division
` r~~■i..r■■,. 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
L
• Attach complete plans (to the county copy only)-for the system, on paper not less County
than 8 112 x 11 inches in size. J O I'
• See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used b other government agency
c3 ':5
Y Y Y programs ❑ Check i re is on to previous application
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property vane Name Propert L cation
1 /a 1/4,S "3 T Zj) , N, R (o . W
Property Owner's Mailing Addres Lot Number Block Numb r
City, State Zip Code [Phone Number Subdivision Name or CSM Num er
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ it Nearest Road
Public _ 1 or 2 Family Dwelling - No. of bedrooms Z 2 Iowan OF _7;
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 040-
2 Z !O 116- ❑ 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. g New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
------System SystemTank OnlyExisting System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank
12jj Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area ,4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
~~d //.;x 5 7 Feet 9867 Feet
VII. TANK Ca
in gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App-
xi sti nstructed
Tanks Tanks
Septic Tank or Holding Tank /pdQ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATE-MENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans-
Plumber' ame: (Print) Plumber's Signature: (No tamps) MP/MPRSW No : Business Phone Number:
-7115 77Z X.X15Z
Plumber's ~ficlress (Street, City, State, Zip Code):
2! V-? av 0s4,7 -
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate slue Issuing Agent Signa e N amps)
Approved Surcharge Fee) /
❑ Owner Given Initial G. 7 -r-~
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber
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.
1 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.
Il. 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 1/2 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, location 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.
' /l ii~/l4id ~t ~CJ
TIMM EXCAVATING JOB SHEET NO. OF 2
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY DATE 2~- S7
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN C %ECKED BV DATE
sLE
?.ra y...... .d...... ......r.. l........................
p' ~.+e r f
gym..;
. . rs /
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xs......... .............f................:............................
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C ./h(1V / /
(.y/.~.
.
~C. ice..:
Bi?r 2 / ii /!c/L aJ w£ Ea f <a~n er
= 88.2s
3
.
.
i
.
PRODUCT 205-1 Inc., Groton, Mau. 01471, To Order PHONE TOLL FREE 1-800.225.6380
JOB /G d i Gt~GS
TIMM EXCAVATING SHEET NO. OF Z
Route 1 Box 192
WILSON, WISCONSIN 54027 CALCULATED BY DATE
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
.
Xx
I I-10
4 -
- - - - - - - - - - - -
I
- - - - - - - - - - - - -
PRODUCT 205-1 1 nc., Groton, Mass. 01071. To Order PHONE TOLL FREE 1.800225.6380
Wisponsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must incl bwt ro ix
not limited to vertical and horizontal reference point (BI VI), direction and % of slope, scald PARCEL I D #
dimensioned, north arrow, and location and distance to nearest road. pendXxi
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION , REVIEWED BY , DATE
PROPERTY OWNER: PROPER tC ATION
Richard Stout GOVT. LOT 1/4 11;5 T~ N,R E(or)W
PROPERTY OWNER':S MAILING ADDRESS LOT # BL C)k# „SU8lJX NAME OR M•#`
1353 Awatukee Trl. 60 na J? ood
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAG i NEAREST ROAD
Hudson, WI. 54016 (715 549-6731 Troy Tower Rd,
New Construction Use [x] Residential / Number of bedrooms 3 [ J Addition to existing building
Replacement [ ] 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/ft2
Recommended infiltration surface elevation(s) 94.67 ft (as referred to site plan benchmark)
Additional design / site considerations alt site = 93.67, system el.
Parent material pitted outwash plain 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 for s stem ®S ❑ U ® S ❑ U ®S ❑ U KI S ❑ U MS ❑ U ❑ S 91U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bourxiary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-8 10 r 3 3 non 1 2c 1 mfr cs if n .2
1
2 18-24 10 r4/6 none sil 2msbk mfr aw I if .5
Ground 3 24-8 7 . 5 r4 6 none i f
elev.
98.97 ft.
Depth to
Iimifing
factor
+84"
Remarks:
Boring #
;<<•.::.; 1 0-13 10 r 3 3 none 1 1
Y` 2 2 13-3 10 r4/4 none sil 2msbk mfr aw .5 .6
3 32-8 7.5 r4 4 mvfr na na .5 .6
Ground
elev.
99.2 ft.
Depth to
limiting
factor
+84"
Remarks:
CST Name:-Please Print Phone:
Gar L. Steel 715-246-6200
Address: 554 200th. Ave. , New Richmond, WI. 54017 m02298
Signature: Date: CST Number:
4-22-96
I- 1_~~ A~
PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 0' .3
PARCELI.D.# pending
Lot#60
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxl y Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3
1 0-10 10 r3 3 none 1 2c 1 mfr cs if .6
2 10-84 7.5yr4/4 none lfs lcsbk mvfr na na .6
Ground
elev.
97.67 ft.
Depth to
limiting
factor
Remarks:
Boring #
?:<<f'1 0-23 10 r2 2 none 1 lfsbk mfr cs 1f .2 .3
2 23-37 10 r4/4 none sil lfsbk mfr w if .2 .3
Ground 3 37-80 7.5 r4 6 none lfs lcsbk mvfr na na .5 .6
elev.
96.38 ft.
Depth to
limiting
factor
+80
Remarks:
Boring #
1 -10 10 r3 3 none 1 2msbk mfr cs if .5 .6
5
2 0-21 l 0yr4/4 none s i 1 2msbk mfr w if .5 .6
Ground 3 1-84 7.5yr4/6 none lfs lcsbk mvfr na na .5 .6
elev.
96. 28t.
Depth to
limiting
factor
+84"
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
s
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 NW4SW4 S3-T28N-R19W New Richmond, WI 54017
MPRSW 3254 town of Troy (715) 246-6200
lot #60-Country Wood
N
1 ii=40'
BM.= top of 1" steel pipe @ el. 100'
Si
/ G11,
b,t
ti`
22' f 2i ` 2,`
- G7
GaRY L. Steel
4-22-96
a 47 . i.UU »-14 )J' A 4 J4 60.�'D 191.J) 09.7)
' tia. WI/4 COR.
SEC. 3
LOT 2
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--- -1 7 z 31
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V, LLE ( i`.''I 2.40 AC.
_---—_ wwp 91,700 SQ. FT.
\ C" a vo • S60° 104,483 SO. FT.
✓IL �I °b'sz,, p
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HEIGHTS I J NZLL N p,
.56.
- .. --_._ 0 6 2
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N�' 2 IRON PIP �'" �n
S84°43' E F0UN0 _.,
23"E, 5.00' FROM _ en2.33 AC.
FOUND I" IRON PIPE
GI . I 101,687 SO. FT. i/ �
inI / /�
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u_ I N84°15'30°E
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W I 2.12 AC.
jn 00 92,414 S0. FT.
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y0 2.09 AC. �O 2.01 A C.
Na 0 87,555 SO.FT.
cv 90,972 SO. FT. 0�
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S 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.
Owner of property t~z~~ k3
Location of property'1~--1/4 5/ 1/4, Section T a-$N-RAW
Township 7✓v-~ Mailing address
Address of site ® { &A it A.1
subdivision name Lot no. -Ir26
other homes on property? YesX No
Previous owner of property , crud'
Total size of property
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house) ? Yes _.2L_No
Volume 11,3 and Page Number 3 6 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 Survey 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. and that I (we) presently
own the proposed site for the sewage disposal system or I (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 of Deeds as Document No.
S nature of Af(plic-ant Co-Applicant
Date of Signature Date of Signature
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Z4AA-eul, lk~lP5
MAILING ADDRESS
PROPERTY ADDRESS 41-3
(location of septic system) lease obtain from the Planning Dept.
CITY/STATE A4
PROPERTY LOCATION 1/4,l 1/4, Section T o21~ N-R_Zl__W
TOWN OF ST. CROIX COUNTY, WI
SUBDIVISION Ca~iwt s k~r,F~ol LOT NUMBER 46
CERTIFIED SURVEY MAP , VOLUME PAGE , 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 tank
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 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 system properly maintained.
The property 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 and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
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 DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year ex iration date.
SIGNED:
DATE: (~'~ifl -~rI
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
X59268 STATE BAR OF WISCONSIN FORM I - 1982
WARRANTY DEED(
DOCUMENT NO. V1L I < PArc'~~) Y
ST. Co., VA ,
This Deed, made between Richard O Stout
k.cOtut HrIW
Gramor. • MAY, 12 1997
and Ric'. and G Miles and Kathleen M. Miles. Iat 2:30 PM
husband and wife it f.~aJ.t~
~A. Hryusun ui U~rOt{
Granwe. :
Witnesseth, Tbat the said Grantor, for a valuable cormderatur
Y•
conveys to Grantee the following described real estate in St. Croix THIS SPACE RESERVED FOR RECORDING DATA
• County State of Wisconsin: GAME AND RETUAt ADDRESS
~tCaN~~F~~O
w Lot 60, Plat of Country Wood First
' Addition, Town of Troy, St. Croix FC . neX t3lG'
County, Wisconsin.
v:~'S~e'~I`, S `
PARCEL IDENTIFICATION NUMBER
~ b•
This is not homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging:
And Richard O Stout -
warrants that the title is good, indefeasible in fee simple and free and clear of enc-umbnnces except
easements, restrictions, rights-of-way and covenants of record, if
and, p
and will warrant and defend the same.
/Dated this 1st day of May 1997
` y (SEAL) (SEAL)
Richard O. Stout
f'
(SEAL) (SEAL)
• • V
w a
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State .,f Wisconsin, .
ss.
St. Croix County
authenticated this day of 19_ Personally c2me before me this 1st day of
May 194, the above named
i Richard O_ Stout
TITLE: MEMBER STATE BAR OF WISCONSIN ' ~~•4
1 (If not,
authorized by $706.06, Wis. Stats.) to me known w be the person w}Ld recutel~! the. foregoing; r
instru aid aimowledge the e 4
c _ '1
~ ~
•i` THIS INSTRUMENT WAS DRAFTED BY
r Tanpt P_ StMtt ~ .n / ~l b , •,5 lk. ~".•S