Loading...
HomeMy WebLinkAbout040-1248-60-000 C a) °o, ."y 0 e°9 j a) 0 C o I 0 N I M i I s I I I I I 0 z LL C 3 :O I a I ~ I ~ ill a3i I ° z o O z `m m 00 H N Z a m c o c O Z I c c°) v ° o J(D z ' m '0 0) m N N a U) I c ~y U a L c 0 v O N z~z z I N m E lE O) _N o H cu > LO B a) ` 2 _ C N U) 'n E (0 co "Z+ 0000 zC) ti is 'a a a in ~'~i 3~ N~ rn rn N ay m U U rn_ rn } ~V L (0 c U) 4 _0 00 m 0 0 l N ~ - 03 3 j 00 ` c CL zr O Y tv O ;S) M d Q N Fa N • ° N C 60 (.10 10 0 3 (8, co O N ° Q) O U a p °o J L 0p 3 y u1 E B N N w N o H I E- c m y c co 00 (D a N a a) co 0 CD C CD 00 O ,{may' O N E Of N O Z N Z 2 Cn R w J (M I i E _ii ma N +m E c d 3 A va~;',Oinv AS BUILT SANSITC TARY 104 SYSTEM REPOR$q:. ~ OWNER ADDRESS CX H r / T SUBDIVISION / CSM# SECTION ~I' # - W, Town of r-QV ST. CROIX COUNTY, WISCONSIN 640 I aµ8 - (POD PLAN VIEW 7. q g• R6. Ia-$g SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S kp e t INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. a BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House 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 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: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt f C N O s- C d 3 ' ro o _ W. 1 o CD ' w C/ 4 o I&T N a o~ c o A C • w co CD N o n m W :3 ODD CD Ei 90 oD rn CD 7 CD g _ 00 N N a F g N fD ,.I N O m CD 0 0 CD N I O O O c- O e-~ W O 3 a 0 N 7 O O ~1 C v O G Cnt C CD d O 7 IN 3 = b 3 N O N j z l\r O C)- 1 0 n r N (JO 6 !r 0007', ~ytJ~ c6n 0 O N N to :1 CD lA 0) m CD N I N 3 ~ CL z O ° z -+z D m ° tr w O CD h~i11 • 0 CD CD :3 U) l~l CD CD M C 'Op N N CD co C1 w 3 CD Z CD c6 A z 7 p z O ° W m A -0 00 M CD CL z 0 3 A m O " m o z A CD I ~ a T O T co 3 z G O CD II ~ S a, I •c N I ~ qb O V S` ~ O O O O C) O_ - Page _ j_, of ~ vWiscorm' Department of Industry. SOIL AND SITE EVALUATION R E P O R T Labo; aM Human Relations Wis. Adm. Code COUNTY Division of Safety S Buildings in accord with ILHR 83.05. sr c~o~x a per not less than 8 1 /2 x 11 inches in size. Plan must include, but PARCEL I.D. # Attach complete site plan on p p din slope, scale or not limited to vertical and horizontal reference point (BM), f REVIEWED BY DA -2 QQ -1 dimensioned, north arrow, and location and distance ton f\ kaa N~ APPLICANT INFO AMATION-PLEASE PRINT OR AT ID { SZj -r ZS nl !9i~w O L OCATION 2' S 19 tT ZS' N.R 1PROPERTY OWNER:tl4 W~/A. ANN d ~,~gAKpr 71'►AS q LOCK # SUED. NAME OR M# PROPERTY OWNE`i (LING ADDRESS CT CROI ~%9 OT T - TKo`1 VI Lt. a IL GE CUOWN NEAREST ROAD 2100 .14.17 ZlP 000E E U I Z C.T, 01 G CITY, STATE 1 1 1b 1 H u L)S aN VSL S 6 [ ] Addition to existing building New Construction Use ] Residential I Number of lot L 1 Replacement (j Public or commercial describe ft2 p trench, gpolft2 Recommended design loading rate a , b bed, trench, gpolft2 .63 trench. Code derived daily flow 9Pd gpol - trench, 9 bed Maximum design loading rate O ~ -1 bed, gP~ft2 referred to site plan benchmark) required (pOC EEfCMtNEf~ EY.~ Las Recommended infiltration surface elevation' 10 3 N Additional design 1 site considerations Rood plain elevation, if applicable ft Parent material l~ IN GROUf~D P~ ESSURE AT-GDE S U SYSTEM ❑ S IN FmU RLL TANK c MOUND I aSN~' stem U S =Suitable for sy U =Unsuitable for s stem S OU WS OU SOIL DESCRIPTION REPORT GPD/ft Structure Consistence 8ourtdary I Roots Bed T:ft Depth Dominant Color~~ Texture Gr Sz. Sh. Boring # Horizon in Munsell 4u• Cow- Color 0.31 "S9< sf~ I mSbl r -5 10 -4 K ~ S ~rn Sb J~r ~ Ground 3 1 3-2b I o V 3/L4 I CS 10."~ ~ 0. elev. 3~ _ 5 e Qr O5 t,,~ - I Rff.S ft. 4 Zo -30 ~ s Y - S Osq t^" Depth to limiting factor ~ Z ~ Il oC• 0, O, Jr Remarks: s Boring # 1 _ Z O• 10 Y ZI Z k ;R~Fic.<S 3 I$ OYK m 3I`f ` CS Ground S E Y elev. 4 1S-Z ~r,s v s t 0, Ot $ qp3, ft. - 5 S 24-g(o to 41 b Depth to limiting factor Remarks: Phone: (-)r$ yZS_yl T N `:-Please Print I y 02 ,q,~, z~, ress: CST Number: tw C>✓ J Date: ~v 0 1%4 n3 Sign I11C A W). 2-7 14a . fo Page ? of 3 , PERTY.OWNER fLUEMM~t E .'1nlt~ SOIL DESCRIPTION REPORT CEL:i:D. 8 GPD/ft Depth Dominant Color Mottles (Texture Structure Consistencelf?anr~ry Roots Bed iTrendi ,ing # Horizon in Munsell I ()u. Sz. Cont Color Gr. Sz. Sh. _ 1 0\4 Z >Z~ _ 1 Z m sb J-F .S . O.b w Z 5- I0\ z Z s i t m ft 0.5 ~ 0.,6 I ound 3 8- N 10 as 1_I ft. 4 14-Z5 IO YK-31 S Z m 0 -0:7 0. spth to 5 25'3\ ~tiSY IN - 0.7 03 niting S 0 S ml ctor (0 31-90 10\1 4 ~gp'1 ~-T -r Y►~ r pMLI N~.S oM EL AND A% lt~ TO Remarks: oring # I 4 p_ 10 Y R =~Z I r rn C S - `O,S Ms K zn g - 0 .S 0, -0 10 y ~y 3 10-2.0 -7. 'f around _ S C~ Sq rn 1 7° D elev. `I Z()✓QZ 1otiK~l Depth to limiting I factor Remarks: I _ I Boring # 1 10 YK 7) I qv" rrr C 01 / is rn.S r~ 0-7 03 3 < Z ,0 3 «52 s - 04 3 t zx- o ~R ~l a Ground a 0' elev. 0 . ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to I limiting factor Remarks: SBD-8330(R.05192) Page 3 0z ,3 PLOT PLANT Property Owner 1U1~~ Legend: Legal Description ?Koy BM =0-.d-Z7-,5P/X6 JAI A/ S)IOFOF V► ctA&E t,clCATrO 0v-tHr: r- z S20 Cr norQ ixEE -Fuca. ED '/i SO, y'1tN, ►e 19 W ~ ~LtV~rrlOnl 911.3~ w -r2vj, ►'.zav ~ W TOWN LIP-r0X) S1;Cgolx COUArry) U2, Q = soil boring w/backho( S;E sa-mv Im-° AN &L-E L•oT C~• Q 1 Q52o BIZ rcd.910.1 D 40 3.9' a L \Ijoamm 190 052-2 EL 4o6.-T' GA #Z7 ~n 3 EL 41®3 ej- qo 9.4' t3 5~►9 EL 498•5~ Signed CST /103 70 7 Date N6V.27 )99~o County: ✓visl►onsin Department of industry, PRIVATE SEWAGE SYSTEM OIX _abor and Human Relations INSPECTION REPORT iafety and Buildings Division (ATTACH TO PERMIT) o.: GENERAL INFORMATION 5 : Permit Holder's Name: ❑ City ❑ village Town of: RUEMMELE, JOHN & BARB TROY CST BM ElevIns p. BM Elev.: BM Description: 248-60-000 r TANK INFORMATION ELEVATION DATA ELEV. TYPE MANUFACTURER CAPACITY STATION BS HI FS Benchmark Y Septic Dosing Bldg. Sewer 11V 90`l. G Aeration St/ Ht inlet 41 Holding TANK SETBACK INFORMATION St/ Ht outlet ventto ROAD Dt Inlet TANK TO P / L WELL BLDG. Air Intake Septic ~ 7 0 f NA Dt Bottom NA Header / Man. Dosing ~y,54: crnz'a'o . 3 S' oG S' Aeration NA Dist. Pipe o` 0 4os.S Bot. System Q Holding PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Lengt Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH 1 No. Of Pits Inside Dia. Liquid Depth Length 15-0 No.O`f Trenches IT Width / pIMEN I N DIMEN 1 N LEACHING Manufacturer: SYSTEM TO P / L BLDG WELL LAKE /STREAM CHAMBER Mode Number: SETBACK d ?S~ i OR UNIT INFORMATION Type o System: l DISTRIBUTION SYSTEM x Hole Size x Hole Spacing Vent To Air Intake Header / Manifold Distribution Pipe(s) Length Dia- Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only hed Depth Over xx Depth Of xx Seeded Sulc Topsoil ❑ Yes Yes ❑ No Bed !Trench Center " Bed /Trench Edges 0, oZ u COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 24.28.20,NE,NE 273 TURNBERRY COURT LOT 46 Plan revision required? ❑ Yes No 7 $ Use other side for additional information. Cert. No. Date ss Signature SBD-6710 (R 05/91) ADDITIONAL COMMENTS AND SKETCH r ? SANITARY PERMIT NUMBER: SafetY3o{guilding pve- gurea Washin9to 2p1E. 7969 -7969 PP1.1CAT1O`v Madison W) 53707 A m-C.ode r,~ 1 Y p fIlk At Ad 1~N1TpR thIlNR8305,w~s tleSS County 1 N mb r SA 10 accord Nr on paper no Sanitar P(e~rrn only) e System, State appficatio° n h w t. • ~n {pr t V isn to Prevwus copy vn ,f rev%o ~ Plan 1 D .Number S (to the county 1I ation ~he`k Plans e- th i5 app State ttach comp 1 lete inches fn 5iz tons {or cpmple1109 L ams r Nr • han g 112 Y. r I -rUCttO ent agency Progr side vernm TION cation T r See S Block Numbe ve 'nsA re rse {o may be used by other g° INT All INIF pfo 4erty ~O 114 • u Pr1 vide SE PR The info ` a %°n y5o04 0) 1- A•~IOI`I " PI-Ep' t.ot Number Ir /L/ M m ad NN, N 1NFOR r CSM Nu r (privacy p~T10 restRo Subdivision Nam e ~ 1. APp1.1 Owner Name r Address Num yy p(opesi phone 'sMailin9 Code l Z~') ~ Vd la9epF proPeJ OWner G t 7 1P O State Brooms P tote TaXNumbe(l0 / Y C nal Facility State kcheclc one) No o{ d rooms 0 tdoor gecreat%O r pining cat F g ,,.DING amll Ov'iellin c, check all that aPP y 110 Q Restaur Sti Pe a B nl Car W ash 11. TYPE 1 or t is PUb1i e vice do publ'Ic vSE: 0tfbU%Iding y Set 1Nursing ecify Medical Facility . 12 ~ Other: sP VI~pIN Repa'rs { an 111. B Condo 6 Me and15e: Sales 13 Repair °SYstet ment I Merch a park licable) o{ 5. :.A% nq 1 0 Apa OV "al 8 Q MO . Fac ory box on line Br l{ aPP %econne5y tem 2 .3 Campgrou pol 9 0 Office line A- Check et o{ 4. Exist~n_g_ _ Date Issued 3 urch l Sch one box on a lacer, 4 O Hotel 1 Motel Check only onent 3• R a k pn Y_-- Other 5 OF PERMIT: Replacem -erm~t%umber Ao\ding'an TYPE 2. Systert! ed- P ental 4113 privy 1V A) 1 4 Systtem _ - ~t W as previously issu Experi pacify -Type 442 3 O~ ault Prtvy ,.Sanitary per i heck only one) ution 30 rued Distrib ~ Pressu B) SYSTEM V • TYPE OF Distribution 1 ~MoGro nd Pressure S stem Elev Elevate Non pressurized 6. 4 J e Bed c Rate of• t Se Page ch 5-Per hl b5'`I Fee 1 SeepageT a N• Loadinggate 0M.100 ' 9 r P1a e age P MpT10 rea 4 day►sq- F;be - alsl p Site 1 glass 13OSe P In_Fil\ In►FOR bsorp.,. ft.) lG Stee stem- YSTEM a 3. d lsq' a b. C p,re 140SyBsoRPT10N5 Nam i. Abirerd- ftJ Prof fl 00 r 5 e Concaete strutted VI• per Day Requ # o{ Manufacture Gallons P t.-t ()p Capallons Galons Tanks v in g Existin e attached pl. VII. 1NF0RMP`TION Ta"ks Ta©s ZB p c Stem shovwr` °nB h-nes5Phone Num e Y e onsite 5e\Nag nk o er p{ th Mp1DC"' SePticTan Y S' fA.IE~AEN rasp ta~latN°StamPsl {prlns k ~ n rtj Illt ~i RSPONSIBI~1 ons'b m is ,,at re' nedr assume P C Hato, VIII., h unders►g Agent 519 ►ssuin9 print) ~ ate ssue, mbersNarne.0 Q- Zip Code)'. .tee dWacer P C rt State 1 (1ncWdes Groue St- et, C y NAY ere ) Plu er'sAddressl RTMEN,TVSEO perrn;tFee gurchar9 nitarY P OVp~1.: pEPP► pISAP LINTY roved R INtial IX• CO OD'w~er Give rmination ON5 FOR ,.,Proved 00 dverse P e AL I REP' °W~er.PWm~r uilalin9s prv~sion, 10%5 OF AP To: fetY sit pl sa CON untY.01 ng coPY X. mad to`o _...u• O l~STRUCT1 pNS 2l osanitaryperrnitisva NiscOnsn~tarY permit lid for two (2)Years. 3- All re '4dministrati may v be renewe visi e code will be efore 4 coUn ges;° °swn 'his permit must be apps able expiration date, a n S- On un Sewaor to rnstal atiopl rnber r quires approved by the permit iss . and at a time Of renewal an 6 If necessary u gallyseVrnust be a Sanitary permit TrW ng authority. Y new criteria I. the YOU ccons ~ questionse Y eo I Yar~per/yrnaintained The ansfer/Renevval Form (S W s Safety and oncl Buil Wing your onsi septic tank(s) must be BD 639g) t° be su be complete and orate dings Division, 608-266-38 e system, co pumped b bm'tted to the To Y a l i tem per/ y ovvnopS this sanitaryPermit /S, contact your local code administrator ceased pumper Whenever I ro ver be ..,sta X to me• , application Type Of 'nl! 4 1 or the State of g building be. /led €Iss. pro must include: ng served. vide the legal de IV T Building din9 use. If building eck IV , type is Public, only one and complete pti°n and par - Check Vl. gbpe of system. heck only one on bnie check all approplate # of bedr°Oms; ce/ tax number(s) of wh vll. Tank i poion System info ma appropriate box plete line g if Permit that apply f I Or 2 Family Dvvellin ere the ma coati on. Provide depending On mgt is f 9. h ldi g tans 's ~ Fill the ty Of all inf On eem type. for tank repla cement, rec tanks for his , in e paci ver orrr,a requested onn system prefab Ynew/pr tE'd f ecti°n D/ ng tang to or rs 1 t , or repair- Responsibility X r si to COWS ti statement perimentaltructed existin and tank, list th numbe address and phon check e through enernP~ning plumb approval total onlynf t m anteia .cOrnplll°ns, nu Coun mb _ounty/Departrnen t use Only. tuber must's 9n applican0 me, livens received experiMentaseper of ti entaseptip mp~snd iph ~mplete t Ilse Only n form. t number with appropria pod uct approval fr and Plans an to prefix (e. g- top kn) o Ofth ol/o and specificati0 etc.), s; oer w/ 9• /1) p ion pla n, not small k distri treatmen dr er th i an ori2pntalut an n boxes soil s, buildi~wn to scale orl /2 X 1j inch 3tion differed vertical S e/ev OH absorption 9 sewers; well with Coco les must be s 'soil absorption syrictio nos opur erencepointspl a emen s aenS/watersiobs I mItte caditO the count equired b Perf Poi n~ C) comp/et stem areas service; str a Of hold; y The Plans by the countyeCurve. pure specification and the IOeatms and lake tank(s) Sp ust f, s, pu soil test da pu c p a on model a tS urnp ma pufa and cOntrojs din9 erne hon d, n Act m, and F) all sizing D) osse volume; voter 4l g included the creation GROUNOWgTFR SUR ng information°n nt ed tan ugh theses of surcharges (fees) for aHgRGE lards. urcharges are used for number of regulated - monitoring ground Practices which can water contamination investigations Page --l- REPORT SITE EVALUATION. SOIL AND Wis. Adm. Code COUNTY Kok X rttnent of industry. with _,fl ILHR 83.05. ~ ` C ►Jisoo and Homan Relations in accord a but & Bwidings PARCELI.D. # Division of Safety 8 112 x 11 inches in size. Plan must i nclu DATc direction and % of slope, scale or ED By Ian on Paper not less than REVIEW point BM Attach complete site p 2O ical and horizontal reference p° ,'r z8 not limited to , vertnorth arrow, and location and distance to nearest road. ATiON E 2 Zy ,R 19 W T 2-Y l N dimensioned LEASf? pRINT ALL PROPEATY LOCATION t 114 vd~~01 ppp_ICANT INFORMATION-p e"I Me LL # BLOC,, SUSO.NAMEORCSM# PROPEAN OWNER: # ?H.pMAS RA LOT TK°y VI N EST ROAD ~y~rZBAK~ QCr ~ ILIAGE SOWN C T PA FED OW NF R.... ILING ADDRESS PHONE NUMBER T 2b 0 C,T ZIP CODE ti 79 0 Z Addition to existing building CITY, STATE S I b - f-1 DS 011 rooms 2 Use Residen6a11 Number of bed b ed, Oft trench, gP~ft Construction ,n rate -1-b-1 o trench, New 9P~ft2 Public or commeraa► df Recommended design loading Repla . gpolft2 j) cement Rec 1 bed gPd n loading rate ~ I~ benchmark) daftY flow Maximum desig Code derived 2 ~ trench, tt2 (as referred to site p Uired S9QD-bed, ft ElCnnrNEO rGNER nl _tt applicable Absorption area re4 elevation( s) if Recommended infiltration surface i nood p►aln elevation, IN FILL I C PING T UK sQT ~d S Additional design 1 site considerations A S p o U Parent material f-'4 t IN S U o UESSURE III LSD ❑U c S U REPORT GPDIft S=Suitable tot system ❑ OESCR1PT10N onsiste „~ylRoots Bed Tte> nce U =Unsuitable fors stem SOIL Structure C Moores Texture Gr. Sz. S11. as - O.S Depth Dominant Color Qu SZ. Corn Color ~r . _ 0,3 2 Munsell Boring # Horizon in. mSbl 1 Q. 1 o y 2 L 1 l s9 Z 13 lo,) K 3~c m Sb I - 0.~ O. 'v 4- 1 S C5 13- b l Y 3 t4 5 ar OS _ 4 2 Ground 3~y S OSQ elev. y 20 _-y) 7.51 Depth to ~ 3o-g 1 ~ y limiting factor lo.d Remary,s z I m K - b.~ `:a Boring # Y ~ Z Wm 3 1sE r 0, - ~ Ground S A ~1 5 S elev. 4 1S'2 q1 tt. S zy -g(o t o y ( to Depth to limiting fade` ~1^ l~ phone: ~71$)yZS' I Remarks: VST Number: z~ 3 nNarne:-ease P ~ni.Ll S x { 02 Oate: ' Z.7 Iq l (a ~A ~ ress: ATM fi Page ? of 3 ,E pyyN fLu'E M A ~nrtnl SOIL DESCRIPTION REPORT RTJ D. # GPO/ft ,ELI Mottles Structure Consistence lBourclaly Roots Bed ITrendi Depth Dominant Color I (Texture Du Gr. Sz. Sh. _ ing # Horizon in Munse11 .Sz.Cont Color err - O.y 4 5 v»<: >x 1 0-15 ION L- t Z M Sb J-F .S O. b 2- 2- r21 s;1 m fr i O.L Z ~r I al,S g-14 j0` ~ ound 3 4 14 -ZS 10 YIC3~ (a S - ~,'i s 0 . y 2pth to $ 25'31 7.SY 3~ y m~ - 0,7 O•`L niting S d s tctor l0 31-90 I 0 Y 4 Ef_ ~,un To r►~ r ~rtt NHS M OT Remarks: V~ S 3oring # I Y- M 1 0- 10 Y =/z 5 p .S 0. 22 Z - 0 ° K ZI yv\ I C S 0.7 3 10-2A '7. y 3/y S C)Sa Ground elev. `i 20~9Z I oyK41 Depth to I limiting factor Remarks: Boring # 1 v~r C 040 10 YIc 2l - D-7 0-7 ~.::L}hhrrw.. Z (0-13 10 03~ .5 3 3 13- o `lR 0.7 Ground u elev. ft. 4A3. Depth to limiting factor Remarks: Boring # :i• fn.w Ground elev. ft. I Depth to limiting factor I Remarks: sso-8330(a.05r92) Page 3 0- PLOT PLAN N M~t~ i gY APT "1064= ?roperty Owner (,OT- Legend:/ ,~O6r'EQ Legal Description LAI +6 TKoy VILA-A-GE BM A4).Z7- SPIK,4 IN Al $jDFoF cr nAR iy-eE - aAGb ED V I A&E L.1r-ATEO IN-tH E,Z , S2q, C V~'TI0~1 Cm.33 Yi 514, -r AI) k-T9 W --Zgni, ,Z.a►N ~ W ► i Q soil boring w/backhoe TF,wq 01="1 aY► ST c-R COUNTY, U/=, Sn~E svfulm`I ~ fO?-- IIrm I..JN AN 6LIE -S L-OT y D 1 !3520 tiJoc>~a 8% x 000 ZZ EL 9ob.s' i✓523 G/4 #27 ~AQD EL9f 1.33 ~D 498•S~ Et 4C Signed CST M~~ ,03767 Date NbV, Z7 IQg1s 1 } STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County / OWNER/BUYER MAILING ADDRESS ~ Co C~ C,ncc n/y ~ A44J5 j , PROPERTY ADDRESS ~ ~ u :trm &rr CDr~ (location of septic system) Please obtain t e Planning Dept. CITY/STATE &A IBS PROPERTY LOCATION /*Vff 1/49 1/4, Section T_f, ~N-R r O W TOWN OF -T_ro y ST. CROIX COUNTY, WI SUBDIVISION -7-r6~" LOT NUMBER 01 V 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 y ex i tion A*. SIGNED: DATE:6!_ q- q7 St. Croix County Zoning Office Government Center 1101 Carmichael Road 11/93 Hudson, WI 54016 • 8 T O - 10 0 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. -------------__-ff------------------------------------------ Owner of property joh n lJ, 47nd 2~6 rbu m 14, ?Fuc M Ana A Location of property__N_g-_1/41/4, Section F-A , T 48 N-R~!O-W Township j roe, Mailing address(oa W -77 Address of site Subdivision name f Lot no. -A,:~Z_ other homes on property? Yes 1/ No Previous owner of property Total size of property •7( Total size of parcel 4,'730 2c.rv-- Date parcel was created 7_9-7 Are all corners and lot lines identifiable? 1✓ Yes No Is this property being developed for (spec house) ? Yes No Volume LLAq:-and Page Number _5Lr,-7 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. _a~,p rePO , 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. gna re of Applicant Co-Applicant Date of Signature Date of Signature qty" s STATE BAR OF WISCONSIN FORM 1 - 1982 56068vVA TYDEEED DOCUMENT NO. VOL "1M PAcE,1CV _ FtrlCd is pooora ~ This Deed, made between John J. Ruetmele and Thanas J. Ruemtele JUN g 1997 Grantor, 'led ; 1'• M and John J Ruermele and Barbara ~k R+te+mlele,J,,,~... +t 1'-~^ hushand and wife Rw,l,t t.edas Grantee, Witnesseth, That the said Grantor, for a valuable consideradar THIS SPACE RESERVED FOR RECORDING DATA ,I conveys to Grantee the following described real estate in _ St amix !NAME AND RETURN ADDRESS 'I County, State of Wisconsin' S.C. 1 b CART, Lot 46 of the Plat of Troy Villages 204 Locust Street H udson, 14 54016 j' i! II PARCEL IDENTIFICATION NUMBER This is not homestead property. ` (is) (is not) ~i Together with all and singular the hereditaments and appurtenances thereunto belonging; And John J. Rimmele arid M=& J- 11immelp warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except I'. { I! l i1 and will warrant and defend the same. it Dated this 6th day of ,19 97 (SEAL) (SEAL) ~i tohn Rueamtel (SEAL) (SEAL) ass j Rttetmele 11 AUTHENTICATION ACKNOWLEDGMENT I~ State of Wisconsin, . { Signature(s) Tnhn T rawnTn1a SS. ~I rnatiias J. Ruettatele County. Jt . 19-97 _ Personally came before me this day of authenticated/! day of , 19 . the above named I 4- '� q I obi `1 I I L -1— 0 N po ▪ .� h q VI -i -J ' Cry o J 0 c: V) 4 / QY o v va ct (1-o w O 6` 0 o i• v w 0 m 3• a 30 y l' . �v v