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HomeMy WebLinkAbout040-1224-40-000 STC - 10 4.. `a . . AS BUILT SANITARY SYSTEM REPORT OWNER Don C ~cA T~ ) \ ~p ADDRESS -ql_X (l c~d.~ ova, l~J t d ! SUBDIVISION / CSM# e` (QQ/L G(L~~ LOT # SECTION ~T -?O N-R~W,' Town of L ST. CROIX COUNTY, WISCONSIN of PLAN VIEW Jr. SHOW "tVERYTIJING WITHIN 1,0 ~F 3 A, _ ~ Y:.!:.`~. ..tom yrs... I 1 ~g 0 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK : rs.% La-1- a I .S ftt~ t 1 Q b ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: (,j 9,. Jkl. Liquid Capacity: Setback from: Well /1J~K House Other Pump: Manufacturer Model# Size -r Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length 7S Number of trenches Distance & Direction to nearest prop. line: t4 0 Setback from: well: House $ Other ELEVATIONS"" Building Sewer ST Inlet: ST outlet: PC inlet - - PC bottom Pump Off Header/Manifold /0i Bottom of system q 7, Existing Grade . Final grade . DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: leb INSPECTOR: - J 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284256 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: KINDOM DONALD TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 040-1224-40-000 TANK INFORMATION ELEVATION DATA A9700023 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent irl to ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER Model Number: System: OR UNIT 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 Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.7.28.19 SW SE CEDAR VIEW ROAD Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: f Safety and Buildings Division =~r■■z 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 Count-„r than 81/2 x 11 inches in size. io % • See reverse side for instructions for completing this application State SaanniitaryPqrmC~bber The information you provide may be used by other government agency programs ❑ Check ii reevvision co previoub application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Own ame Property Lo ation V'\ 0 r", _)l /4 $ ff 1/4, S T N, R E W Property Owner's Mailing A ress Lot Number Block Number ♦ "04~ Si c) 6 0%0.^ Pol /V City, State Zip Code Phone Number Subdjision ame or CS N. ber p II. TYPE F BUILDING: (check one) ❑ State Owned ❑ city Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ❑ vii age n Town OF CexiL.", L7y.e 1'G 111. BUILDING USE: (If building type is public, check all that apply) ]Parcel Tax Number(s) 1 ❑ Apartment/ Condo 4f Q O 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.j New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an ______System System Tank Only- Existing System Exlstln9 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 210 Mound 30 ❑ Specify Type 410 Holding Tank 12 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./ nch) Elevation to b 17.56 T7 .S~ I ~ fN Feet o o :8 Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel Plastic p New Existing strutted glass App. T nks Tanks / Septic Tank or Holding Tank 1315z t 4~ ers ❑ ❑ ❑ ❑ ❑ 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: nnt) Plumber's Signatu : (N St ps) MP/MPRSW No.: Business Phone Number: t s (q3 715 - oZ.~lo ~ l,3S Plumber's Address (Street, City, State, Zip Code): I o IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanita y Permit Fee (includes Groundwater U e ssue Issuing Agent Signature (No Stamps) OfApproved I ❑Owner Given Initial 9 Surcharge Fee) Adverse Determination, db 41' X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05194) DISTRIBUTION: Original to County, One ropy 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. 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. il. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dweliing. 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 13 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, purTip/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIIL 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. ~Q.,r.~,\~\ lit n do PAGE OF Zito SYJ(!0-) Fre►A Air 1111611- And OD►ervatlon pipe L1t-Approvid Yenl Cap Minimum 12' Above flnol Grade 20- 42' AOova Plpp _ 4" Cost Iron To Final Grade Venl Pipe - Moen Hay Or Syninark Covering Min 2' Aggregate • . Over Plpe Oleirl1-ullon Pipe 0 0 0 To6 a S' Aggregate eenoola Pipe a Pe(loraled Pipe bolor o -"Covplino Twinlnoling AS 6ouom Or Sy►lem ~L~cJ•.~ ion SOIL FILL DISTRIBUT101.1 PIPE • APPROVED $1WT(HETIC COVER 2"OFAGG9E4AlE t1AT1=R1JV- OR 9" OF STRAW Oil MARSH HAY A LEV. O !,fn ,fn lerOFl2-2i/z AGGREGAT E DISTRMUTIrON PIPE TU BE AT LEAST INCHES BELOW ORIGIMAL GRADE AMU AT LEAST LO INCHES BUT 1.10 MORE THAN tit IKICHES BELOW FINAL r.RADE M AmuM DaprH OF F-XCAVATIOW) FKOM ORIGINAL 6KAvF- WILL BE - _ INCHES MlFlir'1UM C)vf" OF EXCAVATION f-RorA. 0~14INAL GRADE WILL ICE St: INCHES SIGIJEO: ' LICEUSE DUMBER: 151-6 DATE. t l ~ j f i } ~ID~. k- i~~ t duo ~ j _ i ( j- t , +w -~s'~ ~s.~.~-7► _ _~"a~ ~1~ c..~.)- I I 1 ` it I it - 5 I _ - i j - I I I , I I i( I I~ ~ I ~ ~ I I I t r - I - o I 0 4c I 1 '1* I ~ I CII ~ ~ I ~l I I ~ ~2 1~ ~ I U - ! r i l l ! i i j ~ j i I I ~ 1 1 I , i , I I i I I , I I ' I ! I ~ I I I- t- r - - ! 1 I , ~ i i I I ! ~ I I , I I ~ I i ` l - I I ! I I I I j I ' I i I I _I_ I ~ ~ ~ i___~• ice- ~ - r ~ - i - I-- , , + j 1 I I I 1 ~ ! ~ I I I ' I ' i L-. 1\ I I i I j I ' I i I I ! ! I j i. _I ! ! I , 1 I I 1- ' ' I ~ ` I j r - ; - I - I I ~ i i ; i ' 1 I 1 ~ ~ I I I I I i I ! I ~ I I ' j i ' I I ! I i I ( ~ ' I I _ 1 I I- r 1 1-- - I -i -t- 1 , I I I I : I 1 rL ti f j- - j - r f C I I I j I I I I ~ ~ , , I ~ i i I I I 1 I I ~ I~ I i f I I I I I I I I ~ I ~ I I I I i I I - r r r-- ~ ~ I ! I ' ~ I I I , ~ I i I I~ I I ~ i l l ' I I L' I I ~ I I 1 ! ~ I 1 r i i ' I i i j 4 1 i I I I I I I I t , ; I I I ~ I f I i I I 4 ! I I I ! ~ , I + I I 1 _ - - - T . - + - - - I I I i I i II i I t! I i I I G ~ , I 'I I I I I ~ II -t I j I I f r I I I C I I I ~ : ~ r Y r t , I I I 'I I I I I I I I I I _ _ Y _ Y . I I : , I I ` ' I'I I ' I I I I ~I ,1 1I , I ' i i ~ I I I ` I I i I I I ! I I I I I I I , I I I , I I I L i i I e I I I i I I I I , I I I I I i I l I I I I r I, I ~ I I I I , I± 1 ~ I I I I i t I I I I ; I i 4- All I ~ i I ~ ~ Wisconsin Departrnent of Industry, J Labor and HumanROIations SOIL AND SITE EVALUATION REPORT page_ot Division of Safety 6 Buildings in'; accotd with ILHR 83.05, Wis. Adm. Code COUNTY T: GR0I X il< Wllplete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but of led to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dims ;sioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER; PROPERTY LOCATION XAm ES 3 GIO R I•,4 WA HME 3 B ROG k GOVT. LOT SAI • 1/4 SE 1/4,S T 2 N,R 11 E (or o PROPERTY OWNERS MAILING ADDRESS LOT I BLOCK If ;SUB6TNAME OR IC.SM If q0] So. FORK o (R c t_ e _ -C IEPA 12i X)G- r CITY, STATE : ZIP CODE PHONE NUMBER []CITY []VILLAGE WN NEAREST ROAD i vPS a a' C61- ' S 4 0 l c. ('715) 3 18 5 T R o Ir-C1004le vow XV, New Conglrtrctlon Use ( Residential I Number of bedrooms (J Addition to eilsling building "y Replaaemenl (J Public or commercial describe Code derived daily flow b od gpd Recommended design loading rate . 7 bed, gpd/fl . 7 trench, gpdA02 Absorption area required . ed, tt2 750 bench,1112 Maximum design loading rate . ' bed, gpd/ft bench, gpoltt2 Recommended infiltration surface elevation(s) K (as referred to site plan benchmark) Additional design ! site consideratlorts us!t E~Gf~ lS Paren material ! $CS 13 o r Si i . sit. o e s S Flood plain elevation, it applicable f/,4= f! S =Suitable tot system o ENfIDNAI I~t)11f1B O U IC`bL7 5 ~ PRESSURE E 1 U YST O U L 0 StNO TANK U.5 insuilable fors stem f3S ❑U L~$ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxftry Roots GPD/ft In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed '13 A9 V/? 312- Ground 3 :7 /0 y/f y/3 s /~S 'ts+~ie f ' 40 Depth to S yd / Yee f GQ.Q- I(mlling _ (actor I Remarks: - Boring # yle Zll plow 'y 'S • s ' G 3 -z7 o - 5'► 1. 2f sbX A--~ F~'_ 4L,5 Grog ;J elev. e S O S csP~' of , 1 •8 '611411 A9 gle 10, toe -s o sq -SO Depth to - tlr~ tlng 5 n,. factor , y - Remarks: f TName:-Please Print Phone: tRoaERr ZAc l5 386 x(85 ~ddrass:. Co55 0'.. ei L.. Tp-D.- j ,.Rv O.S e W 1. S y 0 1(# f- /1 ~.Si" c S rM z y ~Z i PROPERTY OWNER pHR£►.~13Rack _ 'SOIL DESCRIPTION REPORT I Page i PARCELI.D. a Lo G eum 1 DG-iF- Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/tt Boring lr ! Iorizon In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Ttrich 0-11 / O YR 2-1(_.- 50. 5 6~ S • `f ,5 /0 YR /Z- _5(1. Ifs bK -f oe s • y . S 3 y-3 `O yK' Y3 sit. lfSb~ ~F~e o rt. y /o 1112 Y13 Depth to 5 1- y' /o roe _ smiting Remarks: Boring q ~/O w SI ! .f s.b~ M1 ~F/2 Is t-F- . c j . S I a-t_, /0~//2 2~ ~ ; II !oy12 ,3/L S; I-fsbk . "4,-Fie s • `I •S 0 Salk fi2 S . S 3 / / YR 31 3 Ground.. C S Q s GQ ~ C„$ • ~ elev. ~y 7.5 YR y a o n. o 5 l. /d YR S/z~ S 4 s d~2 Deppth to limiting lacior - 1 nemarks: ! _ T Boring # D- Q O - /dw Sj ~,,,,,fR 1-~Sbk S t" f . 4 • S / Yoe -n S; 2-1 Sb& -,If A Is - /3 ro yie 3/ - `Ground elev. Jr - f/ 7 •S YIQ y C • S ° CS • 7 •0 /40 /o /,I Depth to - / o s _ ~.~2 - s - - ` ~Lftg to nemarks Boring tr. i z Gi c i - _ elev it. Depth to - _ - timilin - 9 ,r 'c �' N m 1 n 7 1 c>� ITT rn ^'D r Z Q o o ° Q 4- T. o 1' ft! 0 o Q . 7 k N ,' o . 'N b o z �' 1, k .__. . 1 • „ r // _____\ C 'I, - ------ a rt d °. O a r O 7t. 'h • N o W - ul o ..i P V- G -1 In N Us) G G v� -. �' W • • - O GN rn N -4 m In = o t n J r v / 0 Wisconsin Department ofIndustry, SOIL AND SITE EVALUATION REPORT Page'of 3 Labor and Human Relations Division of Safety&Buildings in accord with ILHR 83.05,Wis.Adm. Code COUNTY ,., ST C R O I )( Attach complete site plan on paper not less than 8 1/2 x 11 inches i• Si.:. + •ut - not limited to vertical and horizontal reference point(BM),directio .".r of sl••e sca "+' PARCEL I.D.# 9 dimensioned, north arrow,and location and distance to nearest o.p. > APPLICANT INFORMATION-PLEASE PRINT ALL INF. : ATIONiA-�"']� Et� REVIEWED BY DATE PROPERTY OWNER: , - 1'.t i °PROP RT dCATI z J./AN ES 7 GI O(2 I•,4 WA tie N B Q,r'7: 930 t4.0-r5p) . , 5E 1/4,S 7 T 2? ,N,R let E(or PROPERTY OWNER':S MAILING ADDRESS _ der,tTrYf t B OCIf p•UBD.NAME OR CSM# 1 01 50. FcRK cf RcLE • , ,1 ��DAR RIDGE CITY,STATE ZIP CODE PHONE NUMBER lid,.ITY. VIE_. •E [�I OWN NEAREST ROAD Kt�LScP 01. 5401(c' ((id) 3k • Ie: • > ► j =oy cEa1 ' &"ecJ ,�v. [ ew Construction Use [Residential/Number of bedrooms [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 6Od gpd Recommended design loading rate • 7 bed,gpd/ft2 •7 trench,gpd/ft2 Absorption area required -bed,ft2 /50 trench,ft2 Maximum design loading rate ' e bed,gpd/ft2 'g trench,gpd/ft2 Recommended infiltration surface elevation(s) S-e-f.. 0_C . •3 ft (as referred to site plan benchmark) Additional design/site considerations Use-- T1 E4-' i-€$ Parent material SGS 13 i'i I oT S[\. 5i If. I o E SS Flood plain elevation,if applicable N/�¢- ft /�� auC SANDY GIhCiAL Dtz f j S=Suitable for system CONVENTIONAL MOU ❑U IN-S ❑D U ESSURE AT____G DE❑U SYSTEM FILL HOLDING TANK U=Unsuitable for system C�iS ❑U EI'$ ❑U ❑S SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Barclay Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench I 6'-9 /0 yR•Wt 37 5/7. /f 5 ,P 'lc 1-4- • V .s >M_ _ ; 2 9-/3 /O V/P 3/Z- S"// /fs6k .44.1-74-,P cs - y .5 Ground 3 /3'-7-7 /O y' V/3 S/ /fS6e 4*i' ' 5' — . LI • S ele : t o o.2-T ft. q i9 /0 y, 3/1/ es ©s� �-2 cs . Depth to S M -fT /o Y1 y/�/ -S . 6 Sq , 6e,� — . 7 limiting d factor i/ Remarks: Boring # / 0-11 /O l/iP Z/I P�ocy s'� / . I f Sbe iw►-ce ,S Pf 'y .5 ` 2 ° z //- /V /6 Y/P 3/2__ 5,/ i-fsd M^`r ' 47s If • LI . s 3 / --2-7 io yid Y/3 si I I . z f s 6- 4,,,,-F,e_ cts -- . 5 Ground elev. LI /�/.).7-%7 7- 7•S tV P Yf l es O sa d Q c5 _ . -1 . .8 /0A0 ft. // Depth to s r -16 /c9 fie 1/7 — S S . 0 Sq dI.2 - 7 .P limiting factor ( . � ' Remarks: CST Name:-Please Print R o B E R 1- Lt L f3 li 1 c k T Phone: -715_ 3 s'(. fi?[ 8S Address: 665 0' )JELL_ 'RD. ]-4V0, 0,3 4.01 . 5Yot(, f-/2-75 cSTMaya'2_._ Signature: 24 Date: CST Number: ORIGINAL PROPERTY OWNER tA-1AH f2E° BIZ°Ck SOIL DESCRIPTION REPORT Page 2• .of 3 PARCEL I.D.tt LD T y G EDh Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouciary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench o-1 1 /a YR z( ( 5(1 . l-F 5 bit µ►Cae s l-F • s IR! 3 I P�w - • �t 2 *II /o yR / 511. I f sbK f g •4/ . Ground .3 if-3.-- to '/P Y/3 511. if Sb Amfe c5 . '{ ..s elev. coo. 70 ft. 4 3).- ' /o tIlq y/3 SI 2,-,44 se& _ . 5 . Depth to 5 6/2- /o ye i/V - 'h,,-i S. D Scl — • ) •6' limiting factor ,( Remarks: _C Boring # d-(2 /O ��g 2I l P/Ow Sf'l ) r S�e� MN-F/2 S t"r-- .11 Z (0 11 / 0 OR 3/L St'i l-Fsbk ,„„-fie s • L( S 3 /i'J /0 y/e 3/3 - 5)7. 2,s, shk 1, S . S Ground n n elev. 4 Zy-z6.- 7•S Y Y/! C S Q S CX e� • 7 •dr 100.30 ft. 5 ul -i3 /° YE S/t( -- n .s. 0 sq dk — •P Depth to Q limiting factor i, > 3 Remarks: Boring # I O- P /()1/,e )(I /d w 5( 1 . I f-Skt 1 f • q • S 15 2- 9- /3 /°Vg 3/2-- S,l . z-fsb,e g S _ •s • Ground 3 0 -Zy lorg3/3 — 3 /• 2fsb1- 44.►`f,e z5 Cn — .s • elev. t f �1-j/G 7•S. Yie Y/� c•s. O Sg dQ� C$ /00.1 z- ft. nn Depth to 5 go 12- /°/A S`W/ S . D S dr Z. . •e9 limiting factor > ir _ Remarks: Boring # - .................. ................. .................. Ground elev. ft. Depth to limiting factor Remarks: con OOOn/o nc,nn\ I .• • I �,, ,S - y • i 4 , L 0 .090 3„ 6 S , Z0 . C•s%-\\ 1 — . ____...._, co d O O > k. lb ti e} O Q N J 3 .y a h O Q J ' --7 I o et , c oW ~ '\ 3 �' I. a n • , �L o rn .�,A > W a V N h C:)\ 0 ' w' CO Th 1 tA 2 w j I � ` 04 0.? ---7(:)3\\ — - I oco I or, • rr ,IS - - -- r r; N •; r----_________ N.. (� t o .J I v) tk• 'et/ I ? ri cb 2 �_ — _ — co � 1" '11 142 i • O o ' Q. `� O O W ! cfN 0 ( �- t n i a c\i (7) 0 : N ,,tP` . P , o q .4, 1 c...) ,„ ...._) . ,„ v. , ) Fes. I h v 0 O Ni h J r Zf 0p 09/ '7, eb, 92.g0 • •I •y8 6 0 0 .0l 9 d , ° ` > elk SON el ko ail t 2 z CI' 0 N. O O M v 2O0[ O 1.)'•‘ o ti toO Q 3 .so A or 3 O N �� W O • ., 3 0 0 , f0 •b6f 2 `N , b/ S Z6 • • M „ OD , bO . /ON 092 30 dd ' c * 70 /1 ` •w *s *0 ' i i 07 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~Unc~1U 1 N o rn MAILING ADDRESS PROPERTY ADDRESS Xk A. 1 y ~fromm (location of septic system) Please obtain the Planning Dep CITY/STATE ~td5 S ~a PROPERTY LOCATION 5-4-~ X1/4, 5f 114, Section 7 , T 2 N -R/ W TOWN OF ST. CROIX COUNTY, WI I~ o 11 SUBDIVISION LOT NUMBER 7 CERTHUD SURVEY MAP____----,, VOLUME 9 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) condition and and scum(2) der inspection and the on-site wastewater disposal system in thproper an /3 full operating pumping (if necessary), the septic tank is le I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards gained set must be completed and returned to the St. Croix herein, as set by the, Wisconsin Certification stating that your septic has been County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: (S/ - St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, WI 54016 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 Location offp opertyg 1/4 -SE 1/4, Section 7 ,T,~ k N-R W`` Township 'rNo Mailing address S i ` cad Address,of site Subdivision name Lot no. Other homes on property? Yes_No Previous owner of property ~c n 0_"S -J c-C 0 4 p_S Total size of property A , QCr Total size of parcel 01 Date parcel was created to -to - q ~0 Are all corners and lot lines identifiable? Yes No Is this property being developed for ('spec house) ? Yes _ No Volume 3 and Page Number 3 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. _5 4 50Co f , 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. 7 Signature of Applicant - pp icant ' Date o Signature Date of Signature 02,'l 9.97 16: 11 $715 386 9281 1st FED-LaX*HUD 2002 V C ^ ~~c~ i~ SI'~['fE BAR WARRANTYIDEED I,2 - 1982 JY V DOCUMENT NO. ~ VII. 118PAGr 3t e79 7 REGISTER'S OFFICE . - _ I t ST. CROIX CTY., WI j~ Francis N. Jacques, Jr. and Sandra I,. 'fa sues, husband and wife SUN 0 1996 at 10:30 A.M convcys and warrants to Donald L. Kindom and Linda p- `KAuu.~ * J.4t, Kindom, husband and wife• holding a, RoaftrofDeeds _survivorship marital property I i THIS SPACE RESERVED FOR RECORDING DATA J _ NAMC AND RETURN ADDRESS _ the following described real cstatc in St. Croix County, Gary ka r Statc of Wisconsin: Krugr Estate ~j 214 No ain Street River , Wl 540 22 PARCEL IDENTIFICATION NUMBER I Lot 4, Cedar Ridge in the Town of Troy, St. Croix County, Wisconsin. i I Ii *"R NSF~R 43 i ,i This _ i S -no t homestead property. XXX (is not) ~i Excrptlon to warranties: it Easements, restrictions and rights of way of record, if any. I Dated thLq . day of June !I , a,n„ 19,x_• I L L~ - * F.r, nCis N. efT16%q, Jr c (SEAL) (SEAL) i Sandra L. ac qu AUTHENTICATION ACKNOWLEDGMENT l~ ~ w J•5"3 - `7t (~3 G~ .01 7e, r O I I