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HomeMy WebLinkAbout040-1225-30-000 C-)0 ~ o I 0 Q of wo i''' (D a I 0 o I N i Q' I I N 0 C Z C LL O 3 a I I v ~ z y I o L Z y y C,j W U) a m I o z a c v~ ~ o y I c E I N N O O) CL y y O O O •N d _ •0 U N V c a 0 .2 o O O N Q a+ 0 Z co z z Z V N c E CL (O 20) d N C o p p a Q c O Lo U) FN- IN- U M n. 0 000 •N _ o a a a y a v C r O U) ^ 0) 0) CL) a1 J U rn rn to I- rn ~i co o = ? o °o °o o ° p_I, N N N m I~ O E M (D a) cc O m O d UY O co 'a y O V 'C d Q A Cn f6 ! I': 7 y O O f-yA C O O O) y U d j 0 00 O N A rn o O N `m a~ a °o °o 0 0! r M C -p N N N N d M (O rn N _ t , co ~ y w W r v N L ICI N T 7 d ' .a+ 7-D 'p t a) co a) co I- 0 N O Z A U) •Oki O O 0 ~ v a if a ` a ~`I~i ~ E CL 2 0 U) STC - 104 r~ VVV AS BUILT SANITARY SYSTEM REPORT OWNER I'r.A. l 19 f& ADDRESS sr `47 2~7 r' HGoFFjCE !E 0-n , SUBDIVISION / CSM# LOT SECTION___-~_T _N-R_W, Town of ST. CROIX COUNTY,, _ WISCONSIN Q PLAN..VIEW. SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Z" L ~',~wr`fr* ~ wF~~ r r~ INDICATE NORTH ARROW f Provide setback and elevation in rmation on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 'BENCIiMARR: 3 ALTERNATE BM: :SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer. Liquid Capacity: _ Setback from: Well House A/ Other Pump: Manufacturer ;Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length_~_ Number of trenches Distance & Direction to nearest prop. line: Setback from: well: _ House-9~ Other ELEVATIONS Building Sewer S ST Inlet. ST outlet: 2,2" PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR : 3/93:jt I ` Wisconsin Dgpartment of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) SanitarOmt1t: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). ab5t NaBOSS Village Town o : State Plan ID No.: Insp. Parcel TUAV-'1225-30-000 CST BM Elev.: Ins BM Elev.: B Description: "V 1 TM 0 3/ " UC r e- TANK INFORMATION ELEVATION DATA A9700227 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic/ J Bench ar ,r„ S /dr~• X00 Dosing Aeration Bldg. Sewer 7-/t ~3 3f' Holding Of inlet 7 70 q2 ?V TANK SETBACK INFORMATION 04 Outlet -7-96 9Z !i~ TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic (Opt I DU J I NA Dt Bottom Dosing NA Header / Man. $ Aeration NA Dist. Pipe G 92 Z~ Holding Bot. System q, PUMP/ SIPHON INFORMATION Final Grade SZ CJ/v 02' Manufacturer Demand (ov <7 q 3 Model Number GPM' 1 S.GoS 9'yS~' TDH Lift Loss System Ft Forcemain Length Dia. fi Dist.Toweil SOIL ABSORPTION SYSTEM BE RENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION Z Z DIMEN I LEACI fl nufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM INFORMATION Type O , , ~~-tAMI~ER G Number: SystemCp»ucvJllona J2 Zcj 160 OR UNIT DISTRIBUTION SYSTEM S7--z 72 Header/Manifold Distribution Pipe(s) x Hole Si x Hole Spacing Vent To Air Intake Length Dia. Length _ ~ Dia. Spacing _ 7A 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 El Yes No ❑ Yes E] COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 9.28.19,SE,NW 544 BRIANA LANE LOT 3 l) ~of r ~-N i e vrSi34 lS ~r: K. U rre~l s vac e hbvs~ l = sv~ ~ C ~a e,-t V SCR c3 Gv e~ff' IR1 » f,~' ' ` ice' `r ' /x # 6° 9 ~'~>nL( i~ ~t1-7 Plan revision required? Yes ❑ No D~ 7 Use other side for additio al nformation. I~1 !/fit SBD-6710 (R.3/97) Date Inspector's gnature ert N 4 ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: I Wµq Safety and Buildings Division 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 8 112 x 11 inches in size. • See reverse side for instructions for completing this application state SA anitary,PE r rtNumber The information you provide may be used by other government agency programs El Check if,vision h: previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prop y Owner N e Property Location _ f4l/442 1/4,S T , N, R (orb Property Owner's Mai g Address Lot Num er Block Numb r ! J City, ate Zip Code Phone Number Subdivision Na CSM Num r 17 II. TYPE OF BUILDING: (check one) ❑ State Owned Village Nearest Road p , ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town of Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)" 1 ❑ Apartment/ Condo 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. jK New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank 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 N Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ 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./inch) Elevation 3 Feet Feet 9S., I gel 12 VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Plastic Exper INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ E] Lift Pump Tank /Siphon Chamber ❑ ❑ 1:1 1_1 Vill. RESPONSIBILITY STATEMENT I, th undersigned, assume responsibility for i stallation oft onsite sewage system shown on the attached plans. Plu rbs Na tPlumb "s n e: NaS MP/MPRSW No.: Business Phone Number: 7 61),A) d c:2 i- _ Plumber's Address ~Stre , City, State, Zip Cod 1 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing entSi ature (No S) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One cupy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS T 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 isto 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. pss ~u/7~F 3 y~ lax ` V4wonsin Department of Industry, 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 Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), dire lope, scale or dimensioned, north arrow, and location and distance to o REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ORMATION i . - PROPERTY OWNER: $t~Q$ fl CZ S 1 PRO OCATION v-Sa ~~N R I 'M RD O S a-1/4 !.)W 1/4,S 9 T Z•$ N,R 19 E( W PROPERTY OWNER':S MAILING ADDRESS LOT # K # SUED. NAME OR CSM # 4 SD tQ, GLbvEv_> R..o 3 - GL-o\) CITY, STATE ZIP CODE ilUMBER" - mV ~JC ILLAGE MOWN NEAREST ROAD ADS zj ~ 1 S (I 016 N 6 c 'L, R.o 32t'Pf~R l_P~h►~ IN W Dd New Construction Use N Residential / Number ~r rv [ ] AddifiQn to existing building j ] Replacement [ ] Public or commercial desaibe Code derived daily flow VSo gpd/81Mlio,1w► Recommended design loading rate - bed, gpd/fr- 8 trench, gpolft2 Absorption area required bed, ft2 - trench, ft2 Maximum design loading rate D bed, gpd/ft2 0.8 trench, gpd1ft2 Recommended infiltration surface elevation(s) 5Rla NoTtr o>J Pvt6L3- 3 , ft (as referred to site plan benchmark) Additional design / site considerations Tz - C-`kt7-S. Sz ~M>~E i~ Parent material v71--1 k-3 N Flood plain elevation, if applicable N- A ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem [4 S❑ U RIS ❑ U WS ❑ U ®S El U Lid' S❑ U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Botxx~ry Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rerxh :A z 0-9 10-1~ 3! Z - L Z>hsbl-c ti.~-~►- O ,,J Su, o,s a6 • 2 01-16 W-1 V- 31b - Csblrt wr v~t- e S - o•y 0-S Ground 3 )L-9v I LY It VA. - S O S ` - o .7 0.8 elev. tioo.o fL Depth to limiting factor u ,7 '31 y Remarks. Boring # lo`1,R_ 3 ~ Z L ZmS~1( Y, S o_~ Z Z 11-Z, 1b'(2316 - St Z`F sbk w►`F'I cS - o.S o.b 3 -~o Lo `1 FL V ~ - S O Sg rh I - 0.-x:0.6 Ground elev. °►s.b ft Depth to limiting factor Remarks: CST Name:-Please Print Phone: 715-425-0165 Arthur L. We erer eregss er__Soi1 Testing &_Design Service-P.O. Box 74'River Fa11s,WI 54022 _11_93 Q65 -;-Iqj 5-71 PROPERTYOWNER &nSS)"M - RTLb SOIL DESCRIPTION REPORT Page ?of PARCEL I.D. !t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence GPD/ft In. Munseil Qu. Sz. Cont. Color Gr. Sz. Bourdary Roots Bed T 3 o IA \ b-t V- 3/ 2 - 5 Z ►v~ S b 3 u l i, Z 1048 tik~'\-tZ 2,[Z - sL~ Z`~s~k fir. CLC, e.s Ground 3 -~l3 do ` t ~Z 3 J y - S t Z'F~b1T I4 elev. Yvt ` c S _ o S a ~I' ft. y3 9 lo`tTt L/!r; - Depth to limiting factor 5q a'I Remarks: fry; is Boring # 1 0 -l6 1o~t2 3!Z S) -L"-p w,va•S a vi ors: fa T Z l b -Z to X12 316 Ground 3 ~0 `1 tZ ~{~6 - S O S 9 wt`F~. _ a.~ f o elev. ft. Depth to limiting i ly factor i Remarks: Boring # IIN~, c-l2 1O~t2 ~~2 S ~ Zr+-tsbk Y►~►v'~1~ 4-S 3u~ o. g' ~ ~;J~ S I Z ~z ~zs`1 R 3L6 s 1 "WT wtvJh eg o.Y 5'.i 3 ig-9S l O ~t 1Z ~/6 - S D s g w, I - ; ;,,i Ground I elev. 1ob•2 ft. i, Depth to i ' limiting ; factor Remarks: Boring # Ground elev. t !yi ft. Jill b' Depth to limiting factor t , Remarks: PLOT PLAN Page 3 of 3 SCALE 1"= SO -I S(4 LL Z 3 ~o ~o JrU G '~t:►.uu z t!L 4.6 ISLv -T- i `TD'S S \ -7y 11 Nom, ~ o L uT' 3 ` I B«I ~ e FL, tout • ~i ~ S - 31~-tL, vau.0 ~N ~uItl Of 3JyuD1A. Pl> C BIlpl wl LAJW trAT lu L4 `Di N. P1~vE TiZI'~ }ovsN 10 %F' V°-T LtV ST ZS• RU n'1 ~YS I Z2.LC`4 WNE: L It l~ Ec N S0L4 u 4 9SOrI 1 A~ STIYI.l,~2 - - U STm L TRO.j coves 5 z" Q TtuP Pr' ` rll- U \-Z, s t.-0 P IE ~s0 G F pi Lvz)c P u s s l a _ _ P~-Luw M N*-t"Um pm-eA Fv 12 't'r{-~ t`i°ov s . 'fl~T'Zw►lti~ i1Z~G.~4 ~~:t4T~~~vs `n~'-~~ or= c~~s"fTw-~-luau, cis-Ls- 3 x_715_ ) -425-0.1. T'ID05Z6- CiT:i~~afure DateSignec~ TelephoneNa CST # Wisconsjn Deparbnent of Indusby, 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 Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. If dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: S A~~,B" G ejS S 11V 6 tTT2 PROPERTY LOCATION ►ti~b ~ZJN r'c L-D M . Fo RD GB~06 S e-1/4 MLO 1/4,S 9 T ZS N,R 19 E { W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # SD N, Gl pv 2r fop 3 - 6L_Dv CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN JNEAREST ROAD V~NDSW,x,►NI St(OL PIS) 38&- 131-1 TRp gRlwTyvR L_Kje Pd New Construction Use M Residential /Number of bedrooms l»Jluww" [ ] Addition to e)dsting building j ] Replacement [ ] Public or commercial describe Code derived daily flow VSO gpd/8lEblzola" Recommended design loading rate - bed, gpd/fi2 0.8 trench, gpd/ft2 Absorption area required bed, ft2 - trench, ft2 Maximum design loading rate o..-) bed, gpd/ft2 0.8 trench, gpolft2 Recommended infiltration surface elevation(s) 5mEr ►-aoTIZ- 00 Pk&e- 3 , ft (as referred to site plan benchmark) Additional design / site considerations -v-xz--Q4,j P_)~f_sU Parent material S ~~oy o v"Tl rks N Rood plain elevation, if applicable N- A ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN ALL HOLDING TANK U= Unsuitable for stem [4S ❑ U 10S ❑ U WS ❑ U © S ❑ U IRS ❑ U [Is O U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed mrdi n ) -9 lo`i~ 31 2 - L ZMs~ z Y►1-Fh Gj 3v~ o,S 0-6 Z ci-L6 1o`-1 t_-3 _ s 1 csblz w1 v-fr cS - o'y 0-51 Ground 3 ) 6 -9y 1 b `i 2 VA - S O 31 tin ` - 10--) 0, 8 elev. tiba.o ft Depth tD limiting faCtDr « Remarks: Boring # 0 5 o - Lo`'ItZ-3 Z L Zyn'yn c~ 3v~ wA? .E z Z \1-14 It `s 316 - st ~,`~sbk 1~1'f'4- t<S 0-S,o. 3 wl I - o.~ e.~ 113 -1rLVIL - S O S Ground elev. Depth to limiting factor Q A Remarks: CST Narne:-Please Print Phone: Arthur L. We erer 715-425-01.65 . ress: egereraSoil_ Testing 4 Pesign Service-P-0. __Box.74 River Falls, WI 54022 r - ~ :3 sale ,~7 ~ T`Ntltr, ail 7~6 . PROPERTYOWNER 6ls1SS)1~1G~R - F=01ZD SOIL DESCRIPTION REPORT Page of i PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Alj In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T i. t)l a - LO V3-LV- Z ,k Z to-L8 1.~~t2 2,1t b- S o. 6►r Ground 3 t$ -~l3 to `-t 1Z 31 y - S 1 Zabl~ ln1 c-S S o_ elev. 4~a~ ft. -0kZ. 10`12 L1~6 p g h~ 1 Depth to limiting factor 2u L is Remarks: ? Boring # 1 0 -l6 toy-2 3! ~ ~~i 2 S Z++, b ~n v `F1. a S av C-A~Z V; ui~- Ls v.+. n..f•hfi. 6-9y Lo tZ ~l6 _ s fl s Ground elev. ~Depth to f ` i limiting q~ ; factor Remarks: Boring # s `sc, xc~ b - l2 10`i CZ 12 S. I Z m s dl~ Yn U `FI- C-S 3 uq is. S 5 Z ~z `f tL 3 Cfa - s ` e sbk w►v Fh cg o. V Ground 3 Zg-qS 10 `~>L ~/6 S O S9 rrt elev. I ! Depth to ;i i limiting i u;+ factor si~ Remarks: I is Boring # iV Ground elev. F. Depth to limiting factor Remarks: - PLOT PLAN Page 3 of 3 SCALE 1"= ~SV.~7. ~o' ~~tr t s *or D a o. 0~ .p d3 1hJ c-, tn_ q6 ~ 1I 8-S 3.yo- L -T- -7y" g.3 ~N, Clf.`, ~ ~t-93 q LCr3 I a s tL 4s LIL too vat) ~ro ~14 tfl6lF, 3/yui~1H- PvC PI►~~ w/~-R'rN utrxT ?n y " Di N_ A»vE 'Meld j Ytov s ~p 8 F ~NT L T ZS F-tZ0 ►y sYS J ~ MIM WV--LL << so' L< u lZorl To 1 U STft-LLQ$ Z-_ A )i STty-L Ti c-ties 5 z q pP PrT ` R? vj S l_U P ~ ED G E Fl wk)r-- ` *E czy-l" vz. t ? T12 C1t STS WS r nZ \-QI)U-jNs lb AE 195 1~- U~S!_~!- _ l -~Uw Nagy-lw~UWl Pat--%`R FO12 Dt~7~Zyn Itie - e-xj(Li LtLejhnilxvs \-tT- -nmG- o1= co s`nuz~ou, ~tS-IS- 3 ZL M00576_ CST SJgnaWr,eDate Signed Telephone-No. CST# APP'LICAT'ION FOR SANITARY PERHIT STC - 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 developsent bra intended for resale by owner/contract.Rr.("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 of Property 's 1, 14, section • N - R _ W Township Ma i I. inK Address L Subdivision Name Lot Number Previous Owner of Property 'ibtal. Size of Parcel bale Parcel was Created Are all corners and lot lines identiflabls? Yes No is this.property being developed for resale (apse house) 7 Yes No Volume and Page Humber _ 4s.recor4ed with the Register of Deeds INCLUDE WITH THIS APPLICATIOM•OUR OF THE FOLLOWING.: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey flap shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY MKR CERTIFICATION I (We) cen ti y that aft b tatewentb on A" em one twe to the beet 01 ay faun) hnmodge; that I (we) am (au) the ownu(41 o l the potop&Uy de cA bed in th" indaAunat%on J04M, by v-ilttite of a wrM4K4 deed in the OWC& o6 .the County RegiOeK ob Dee& ae Document No. ~l and that I (wt) Y r' S T C 105 C-. y SEPTLC 'LANK MAINTENANCE At;ltEEMEMT c St. Croix County 0 Y r-i Cam- -f f' , - csl U W ii l•: IC / B U Y L R./ Fire N u ns b u r Ro U'l'I:/BoX NUMBEIt_. 1 C I T Y/ ST AT L' L L 1' _ y~ . I'Itui EA(TY 1.UCAT10N: S- It. t SaecC it) it W I 5t. Croix Cuuisty, '1'uwn of i I Subdiviisiun l:ot number I twl►ruper use a►►d maintenasice of your Sept ic. system could result in fts preusature"tailure to handle wastes. Proper maintc:nan.:e cott- siests of pumping out the septic tank every three years or souuer.,. it needed, by a licensed sit is Cask 1?uuiLr. What you put into I 1.1►e syrsten► can at"I ct the function of Lite septic tank as a treat - mcnt stake in Lite waste disposal System. t . Cruix County reside atrs u►a~r_ be eI19ible to receive a grunt for- ,t maximum of 60% of the cost, of replaceme►st of a failing system, which was in operation prior to .luly 1, 19711. St. Croix County accujiLed this program ill August of 1980, wick the requirement that owners of uLl ucw systems agree to keep their Systems properly. The property owner agrees to submit to St. Croix Cuunty Zoning a ccr.tificatiun 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 nee- essary), the septic rank is less than 1/3 full of sludge and scum. Certification furm will be sent approximately 30 days prior to threw year expiration. 1./WK, the undersigned, have read the above requirements and agree u, ru maintain the private sewage disposal system in accordance with the standards set forth,-herein, as set by the Wisconsin Depart- K► uWnt of Natural Resources. Curtificatiun form must be completed and returned to the St. Croix County Zoning OLfiLce within 30 days of the three year expiration date. DATE__ SL C.•oix County ZonIng 'Off Lee 11.0...tox 9&, llammo'l►d, WI 54015 _ 715-7 +6-2239 or 715-425-8363 Sign, date and return to above address. 400 DOCUMENT NO. I WARRANTY DEED I~'yTATE BAR OF WISCONSIN FORM 2 - 19M ~60S8f II VOL 17 Up '?I. la _ - - - . =1 L 7, ; 1 1 i; C 3., V.I GEISSINGERP ST. CA an un~Rarriec4 Pon .an - J Grantor li JUN 5 1997 conveys and warran4 to RQ S..1~r.-.~ E..4111 10.30 A M KABEI~I.A...GAl1L,SITE,-.huSband..and-,Wi.fe,..with. survivor-ship- 4'0w__ -4 marital property..........._ BANK 111rON M~~„~ in consi_de.ration..of,.•1•..00 and.._other..good and X A val-uable._cons c~~ t.io> Hudla 11M11510'16 the following described real estate in St...... -rolx .....................county, _ State of Wisconsin: 040-1225-30 _ Tarr Parcel No:.... Lot 3 of the Plat of Glover Hills, a rural subdivision located in Section 9, T28N, R19W, Town of Troy, St. Croix County, Wisconsin, according to the plat thereof filed September 1, 1995, in Vol. 6 of r, Plats, Page 35, as Doc. No. 533327, in the office of the St. Croix County Register of Deeds. Together with and subject to the rights and obligations set forth in the I Declaration of Protective Covenants and Easements dated September 12, i 1995, recorded September 13, 1995, in Vol. 1140, Pages 39-46, as Doc. No. 533786, in the office of the St. Croix County Register of Deeds. Subject to a ponding easement in the westerly half of said Lot 3, as shown on the Plat, which may not be filled or altered without the consent of the Town of Troy and County of St. Croix. Also together with and subject to utility easements along lot lines as shown on said Plat, a 100-foot setback line along public roads as shown on said Plat, and a telephone right-of-way recorded in Vol. 410, Page 567, in the office of the Register of Feeds for St. Croix County, Wisconsin. This homestead property. (is) (in not) Exception to warranties: 30th May 97 ` Dated this day of ..............................(SEAL) (SEAL) T s .Barbara A. Geissinger . K .--......(SEAL) .(SEAL) ; • * - fl• ICATION ACKNOWLEDOD9SNT U ' Sign - STATE OF WISCONSIN ~!!►uwlatl!~~_...... ST. CROIX----- County. authenticated this _ 9....-- Personally eerie before me th97 ..30th......day of • 19........ the above named --......a.. . a Barbara__A _Geissi Ne_r TITLE: MEIIBEA sTAT,p 1 (If not . y'!F I authorised by J 706.06. / t* to me known to be tie person who executed the 1 - foregon g instrawrst and =led the same. 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