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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS:
SUBDIVISION / CSM# LOT # q
SECTION zt T N-R W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
i
I
j {
1~ j 1
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: Sly t e c'! 5'
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: yljrC~~ vf,/ Liquid Capacity: 40 1~ce t~
Setback from: Well ( House i S 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: _!~S_ '
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: 5 k
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Oisconsin bepartment of industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Btsildings Division ST. ROIX
R (ATTACH TO PERMIT) Sanitary Permit No.,
GENERAL INFORMATION 262356
Permit Holder's Name: ❑ City ❑ Village [:R Town of: State Plan ID No.:
P C. COLLOVA BUILDERS HUDSON A9600166
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION E EVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic, Benchmark a 7 00,
Dosing
w
Aeration Bldg. Sewer
Holding St / Ht Inlet 6. /
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Air n ~
Septic - 5 NA Dt Bottom a(0.0 y d. bG
i, 7 77777 q,o l : 9.t. i.9
Dosing NA Header / Man. q/4 y • 9'. '
Aeration NA Dist. Pipe
94
Holding Bot. System ~o• a 9aX
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer A;Lttlfid Demand
Model Number GPM
TDH Lift ibe Friction I S 4) System TDH 10 Ft
Forcemain Length Dia. Head Dist. 5
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length i No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 5 DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type Of CHAMBER Model Number:
System: 5~ gy'p' 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
No Yes ❑ No
Bed /Trench Center Bed /Trench Edges Topsoil Yes El
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION; HUDSON.24.29.19W, LOT 43, MCDIARMID RD
Plan revision required? ❑ Yes YNO /
Use other side for additional information. I &I f
SBD-6710 (R 05/91) Date nspector's Signature Cert No
SANITARY PERMIT ST- C,Qy " COUNTY
DILHR TRANSFER/RENEWAL U IFORM PERMIT #
~am- -E -,b„s (PLB 67-1) aG-'l 35(;
PERMIT RENEWAL DATE: PERMIT TRANSFER DATE: ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN I.D. NUMBER:
C6 7-9 / - C, -o7-9G
PROPERTY LOCATION: CITY:
'/4,S ,T a2 N, VILLAGE:
R E (orKVP F:
LOT NU BERN BLOCK NUM ER: SUBDIVISION NAME: NEAREST ROAD, LAKE OR LANDMARK: ZZE 9 3 L' 0/,f
PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED): SANITARY PERMIT TRANSFERRED TO:
NAME: SIGNATURE: NAME: PHONE NUMBER:
ADDRESS: PHONE NUMBER: ADDRESS:
I, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this
property.
PL MBER'S SIGNATUREt PREVIOUS VLUMBER'S NAME (IF CHANGED):
/Wr
PL MBER'S ADDRESS: PREVIOUS PLUMBER'S ADDRESS:
r~ t( - fL - /17i9~ CA I '41-7- o< cc
MP/MPRSW NUMBER: PHONE NUMBER: MP/MPRSW NUMBER: PHONE NUMBER:
SIGNATURE OF ISSUING AGENT: DATE APPROVED: DISTRIBUTION: Original - County j
Copy - Bureau of Plumbing
Copy - Owner
DILHR-SBD-6399 (R. 5/82) Copy - Plumber
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i
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.w ciM°"x*x
Safety and Buildings Division
~~i~ii~ii SANITARY PERMIT APPLICATION Bureau of Building Water.System:
, 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 1L
than 8112 x 11 inches in size. 5T--. 6- re /
• See reverse side for instructions for completing this application state sanitary Permit Number
a4a135-b
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name C Property Location
114W 1/4,5 Zy TpZ ,N,R/f E(or
Property Owner's Mailing Address Lot Number Block Number
/.7 6- - Zr 1fc //ee K?
City, State Zip Code Phone Number Subdivision Name or CSM Number
( )
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it~ Nearest Road
❑ V II age
r
Public 1 or 2 Family Dwelling - No. of bedrooms Town of
Rif
III. 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. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
----'-System System Tank Only______________ Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 RSeepage Trench 22 ❑ In-Ground Pressure Y g 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14.❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION: r
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
61 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 4j/r 70 gyd' Elevaati?n Qz.
~Vl rS Feet 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 structed glass App.
Tanks Tanks
Septic Tank or Holding Tank A El El ❑ E] 1:1
Lift Pump Tank /Siphon Chamber El El ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
1, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: o Stamps) MP PRSW NO.: Business Phone Number:
7l~ -38C -3l~ ~
Plumber's Address (Street, City, State, Zi Code):
/ 1 i17d o AIL 4
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved s Itary Permit Fee (includes Groundwater ate ssu Issuing Agent Signature (No Stamp)
Surcharge fee)
Approved ❑ Owner Given Initial IF 11
X 01 L4
Adverse Determination 7
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & &dldings 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.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system- Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 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.
~_,~n,~~. Oyu_.- „ ~~~P~S ~'~~~i~ -~`,z y ~ q /Pl✓ ~7`~r'.3 Swaa~d ~~y~
DoT K3
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3
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as
k7
14 Gdy'v~~ ~'.ip
n
PAGt GF
PUMP CHAMBER CR055 SEC IOU AM SPECIFICATIOus
VCUT CAP
4"C.Z. VEKIT PIPE
WEATHERPROOF APPROVED LOCKIKIG
25' FROM DOOR, JUKJCTIOU BOX MAMHOLE COVEF
WINDOW OR FRESH 12"MIU.
AIR IAITAKE I
GRADE
1
I Y"MIN. J
COIJDUIT _
INLET PROVIDE I _
AIRTIGHT SEAL I (i I ` *Ile
I
I I I
I I I ALARM
B I II
I I
*APPROVED I I ON
JOINTS WITH ( I
ELEV. FT. APPROVED PIPE 1
3' ONTO PUMP OFF
D SOLID SOIL
GOKICRETE BLOCK
RISER EXIT PERMITTED OIJLy IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E SPECIFICATIOUS
DOSE
TANKS MAMUFACTURER: X11«='~ jc' <"'T v~ LIUMBER OF DOSES:._.N
PER DAy
TAKMK SIZE: ZZ~ GALLOKIS DOSE VOLUME
ALARM MAUUFACTURER: ~Cr slc:lIUCLUDING 15ACKFLOW: GALLOP
MODEL AIUMBEK: CAPACITIES: A= 2 INCHES OR C~/5 GALLOA
SWITCH TYPE; _ J2~rc~ 3 INCHES OR Jv : CJGALLOA
6=
PUMP MANUFACTURER:
C= ~FG.S IAlCHES ORi~~GALLOA
MODEL NUMBER:
D- ~ INCHES OR JtnL~~GALLOI
SWITCH TYPE; NOTE: PUMP AMD ALARM ARE TO BE
MIMIMUM DISCHARGE RATE- GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEU PUMP OFF ARID DISTRIBUTION PIPE.. FEET
+ MIKJIMUM METWORK SUPPLY PRESSURE . • -
• - FEET
+ FEET OF FORCE MAIM X FT,,~~
j ~oOFLFRICTIO&J FACTOR__Z_--, FEET
_ TOTAL DtIUAMIC HEAD /~t{
FEET
I
IMTERKIAL DIMEMSIOMfb OF TAUK: LEKIGTH ;WIDTH
;LIQUID DEPTH
51 G IJ E D'
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. of :3
Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size. Plan must County
Include, but not limited to: vertical and horizontal reference point (BM), direction and J!~O/ x T
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Parcel I.D. # i +
APPLICANT INFORMATION - Please print all Information. Reviewed b
y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). r.
Property Owner ~Lt900D-V7'~4~/SES Property Location"~
~l~fjQ/K T r '-t f2 V S C G_ Govt. Lot SE 1 /4 X 1/4,S Z 7 T a g N,R E (oil W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
sue. y,3 sv)/e/*oGrE
City State Zip Code Phone Number
UI~SO 6U/ 15 00/6 ( 7/~) 38~ - 7X El City ❑ village Nearest Road
Gown /me oilf P/W/D e3e
B New Construction Use: [Residential / Number of bedrooms 3 Addition to existing building
❑ Replacement j ❑ Public or commercial - Describe: 1(//,p = No'r PEcDr irr E~ DL~D
Code derived daily flow ~OV d gpd Recommended design loading rate P
. bed, gpd/ft2 trench, gpd/ft2
Absorption area required bed, tt2 l~ trench, ft2 Maximum design loading rate N14 bed, gpd/fl2 1 G trench, gpd/ft2
Recommended infiltration surface elevation(s) s 1- 3 ft (as referred to site plan benchmark)
Additional design/site cons rations /Vi} ,44~ MEiy~4es - GrI~QiQ0~1 QOyES " O^~ S ~D~.Q
Parent material s .54TTrPE• J~/Gf ~v£S GU~fi' Flood plain elevation, if applicable ft
S = Suitable for system rConventional ~Mou~nd In-Grrownressure ,ART rr de System in Fill Holding Tank
U = Unsuitable for system U S ❑ U L~J 5❑ U 3's ❑ U 2S ❑ U ❑ S Eru--- ❑ S U?q
SOIL DESCRIPTION REPORT
Boring # FHorlzon Depth Dominant Color Mottles Texture Structure ry GPD/ft2
Consistence Bounds Roots
rr " - in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
fs 41
1- /0 yip 511 Z_n s 4 ikIf s ` G
Ground -
elev. S R S S - y ; , S
/I'--ft
Depth to
limiting
factor
Y,~ in. ;
03` Remarks: _/*Cof Of M lk-Y REG? U i Pi=g A- M OuNy /A
G-)PAA5` svsT
Boring #
0.~1 le yip L s// heslk M4 ~ie cs If , y ; , s
r ; Z Z /0 R f CS /v-f N
3 - /o Y -3/3 5W z f At f R es S ,
Ground D ioy A s~/ Z4m J,-,A
,,e e s s f . S ; .
elev. ve
9y, O's ft
Depth to
limiting
factor
7 1~;_ln. Remarks:
CST Name (Please Print) Signature Telephone No.
-R O >ep_T -ML(3R i Ctx"r ors- 38Co, 8185
Address Date CST Number
tes q - 2- 3 - 96, C'STi'f 2 S/ SO
.,.r..~•.. cwmena nnnsuitan s
PROPERTY OWNER SOIL DESCRIPTION REPORT p
U Page Zrof 3 `
PARCELI.D.11 Lor 7 3 S(J.(//D(~~"
Boring # Horizon Depth Dominant Color Mottles Texture
In. Munsell Qu. Sz. Cont. Color GrtrSzt Sh. Consistence Boundary Roots 2
Bed Trench
I D-9 Il~ YX -513 ~ 2,f eL,+ .
o Sd~ R CS
Z d k nom-/'!' GS /U7C
elev. nd 3 7. S
1i ft.
7, 75 YX A,
Depth to -
limiting
factor
77' in.
Remarks:
Boring #
/ o-G io r4 3/3 If '5 ' .G
3 -1 S~ z rlr,v c w . S ; ,!o
Ground /
elev. /~1I► . ; ,
~~ft. ,
Depth to
limiting
factor
in, °
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # i y
a- /o ,C 3/3 ~D~M Z f S be /w'R C5 If
S : G
~Iff ,ws4t I'm -k /Dr 3/ 2
Ground
~iX/2~c S ~i11n Q 7
elev. r 25Y
y~ ' 7Qft. ,
Depth to ;
limiting
factor
Remarks:
Boring #
- / 0 313
- /o Zf s h,~ i►,., -f2 e s / f . S ; . G
z w, /0 31y 21w h.~ 41"6e e iv /v f , s ; '61
3 s - s 2 fXY& IW* - - -S Ground 1/'F R
elev.
73 - c ft.
Depth to
limiting
factor
f,2_in. Remarks:
SBDW-8330 (R. 08/95)
M~ ~iP~QM
0
LdT
Zoa
~o y3
a
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good ~ ~ \
5 tTM ~E w
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McAlAoe P" TS
,~g3rju(s6E5T~0 ,TQsa
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low TREKS ~'y'~
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
44.4j P.C. COLLOVA BUILDERS, INC.
OWNER/BUYER ep i.v v~ 12575 Keller Ave.
WITHROW, MN 55038
PH. (612) 439-9547 ID. #1073
MAILING ADDRESS n
PROPERTY ADDRESS ~V 3 x ZJ4
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE TIU ~ SO N
PROPERTY LOCATION~ 1/4, 1/4, Section _g Y_, T_Z ~?_N-Rj_?r_W
TOWN OF Nu S o N , ST. CROIX COUNTY, WI
SUBDIVISION S v n~ Q LOT NUMBER 4 3
, LOT NUMBER
11 _
CERTIFIEDSURVEY MAP f 7,Z9','VOLUME je,~'_, PAGE
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 irattion cl4te.
SIGNED:
DATE: - Z J St. Croix County Zoning Office
Government Center
1101 Carmichael Road 11/93
Hudson, WI 54016
SoNti `rvL_
- 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 P. FDy► L1O kFVl1, ~N
Location of property.S 1/41/4, Section 2,T~N-R W
Township y t) s c >,-i Mailing address
Address of site
Z
1,J ~Subdivision name j0 A.1 IQk C-, `c -T Lot no. _
Other homes on property? -Yes No
Previous owner of property 124-r. A,woofl /ccSff~ a7~
Total size of property --'2 Q et'4 ,e
Total size of parcel 2 ,t a.c J-e
Date parcel was created A u!~, uS 4-
Are
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? X -Yes No
Volume 1111 and Page Number 5 3 vZ 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. _'5-4414 S , 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.
s44 / 4S
S gnature of Appli ant Co-Applicant
-5-- 2y- Date of Signature Date of Signature
STATE DAR OF WISCONSIN FOftM 1 - 1982
'544145 WARRANTY DICED
DOCUMENT NO. VOL 117V pA',,,
E53~ REGISTER'S OFFICE r• f
- ► ST. CROIX CO., WI
flood fpr Record
Greenwood Enterprises, Inc
a Wisconsin corporation KAi This Deed, made between 4 1996
at
f Grantor, ~~t~/►_ I
and P. C. Collova Builders, Inc., a Minnesota df7ura4..~, .
corporation Regleter~f Deeds I••rf
Grantee,
Wxtnesseth, That the said Grantor, for a valuable consideration o f °ne THIS SPACE RESERVED FOR RECORDING DATA
dollar and other good and valuable consideration NAME AND ACTU ADDRESS
conveys to Grantee the following described real estutc in St. Croix Gre0nw d Enterprises, Inc.
County, State of Wisconsin: 1416 hird Street
H. son, WI 54016
Il
(Parse! Identification Number)
;Lot 43, of the Plat of SunRidge 11, filed in the Office of the Register of Deeds
i for St. Croix County, Wisconsin on August 1, 1994 in Volume 6 of Plats,
at Page 17, as Document Number 51.9728.
(I
I
1 This 7 S not homestead property.
(.4k (r5 not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And Greenwood Enterprises, Inc,
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions and reservations, if any, of record
4nd will warrant and defend the same.
Dated this
day of -MaY 19 6.
GREE D ENTERPR S, INCGREENWOOD NTERPRI j
$y. (SEAT.) By' / ;;;00,
}
Tames E. Ruschr its president y ;tar R. h, r s se ary
;h, its se
(SEAL) (SEAL)
AUTHENTICA'flON ACKNOWLEDGMENT
i Signaturt James E. Rusch, its STATE OF WISCONSIN
President ss.
~I ST. CROIX County. _ n
scups„ U AF161 of Industry, SOIL. AND SITE EVALUATION S.vivf•
t.akor and ErurrtaM Relations .
' Dlvlsiore of solely and buildings in ,accordance with s. ILHR 83.09. Wis. Page / tlf
Alloch complete $119 plan on paper not less than s 112 x t 1 Inches in slze. Plan must Carnty '
Include, bill not limited to: vertlcel and horizontal reference point (BM), direction and S7. e-A&Ix
percent slope, Scale or d rnenelona, north arrow, and location and dellihoe to nearest road.
Parcel L6.7-
APPLICANT INFORMATION - Please prlnf all Inlormbtloti.
Personal Infomretia+ Reviewed by bate
you P►ovkle ntwy be used for woendsry prnpeses (Privary Lew, s. 19.04 (1) (n+)1. ,
Property Owner
3 -_o,f' 1 cvooD -u7*6;?~V0P1S&_X Property Location
f~7iC~ Ti H R tJ SC Gti, Govt. Lot t l4 /v~ t l4 3 7 T Z 9 N 4
Property Owner's ailing Addrbsa 'R E ( .
~ Lot R tjlackll Spbd. Nerve or CSMtt
City state Zip Code phone Number
j. PS o a 64)1 57yp/6( 7/F) 38(p -X 7f/ ❑ City Vtliege [Tom Nearest Road
0 &A
lJ New Construction Use, Wesidential / Number of bedrooms 3 Addition to existing building
❑ Roptacement . ❑ Pubtic or commercial • Describe: PST, Q eta NN E ~7~j~
910,91i
Code derived daily pow ~ gild Recommended design loedfng rate ~&t
Ahsorplion ores required N bed, It z ~ trench, gpd/ifZ C
_01renbh, It 2 Maximum design loading fate N/4 bed, gdtocommmnded infiltration surface elevellon(s) $At ~ G
Trnch' gpd/f12
it (as retorted to site plan benchmark)
Addilloha) dgslgn/slte cons retorts 46- N/pteDw 7~t'/ ~1V40f%eS QoysrS O.a! S /10Vt_
Perent mAterialS ,S 7TH ~~Lf . ~vES O(~ Flood plain elevation tf applicable
n
3 a SWlable for system Conventional Molind In•Oroun . ressure AT•Orede System o FlII Hording Tank .
U Unsuitable for system g o U S C] U S U. (d S U S S
SOIL, DESCRIPTION REPORT
Bgtlhg N horizon Depth Dominant Color Mottles Structure
In.' Mun"sell 'ou. Sz. Cont. Color Texture Conalslerrce Boundary Pivots t3 R
Or. Sz. 5h. Bed Trench
0.17 wYQ ~Iy S./.. /fs le ~►~►+~i~ S r . :.S
~ y
/a y~ s./ z.4" sl& I", t,, - le, s icy . s .6
i around
elev. _757
YR
,
Depth to ,
f rrtNing
factor
0-In.
0 Wemarks: ~P fi o~ R M 00W R
CIO U l' I~~`- M Ov,uD ~r
• S
Baring N
Id Yle
/U-f NP
_
Dsv 0 0~ 3 CS ~ S .
fin.
Depth to
Nmlling '
factor
n, Remarks:
CST Name (Plemso Print) Signature
O ft T -74 Telephone No.
f3'715- 8&- 9 18
5
ArMross
Ogre CST Numbe►
ibtirhtl A t s - 3 - 9G CST•y Z S/ P2 -
Prlvals Sewage Consuilen e
iwr crtt r uYlltal ' ' 1"UHI
Pop 2 of 3
Y
PAIWEL I.a.U Lo r V3 SU.v k'ipd: -
Boring A 14011Z O11 Depgl Dominant Color Mottles
-M In. Munsell Ou. Sz. Coni. Color Texture a►1tSz 9h Conelslence Bottndety pools'
Bed , Trench
led
Gratnd 3
~ujw
cloy
r
71 IT
Ar-
DAr1h to _ '
Ilntlling ,
lector
7 pemarks;
boring N
-14
Z0 f Cut
3 Am
Ground
!°4 - •
Depth to
Lj _
lImIling
factor .
In, '
TFiemArks:
1 fortiori Depth Donifnnnt•Color M011195 Texture Structure Consistence Bowwary pool'
In. M11nse11 Ov. S:. Cont. Color Or. Sz. Sh. Bed arwe
Trench
Boring N Of
' G
313 f .5,b& -2 54L 4SIS,
we L
-f she
Ground r 7~..Y.LY,~ ~ix/i~,t ~s /.~r, .~n~d'_ d ~ - ~ 7 •
l1C~n
Depth to
Hndtlnq ,
taclor '
y ~in, Remarks: '
boring N
/ rldhox 313 204µ n,, -2
O 3 y si/, ~.f►+ h~ nM 1,e 4C w of . $ ,
Ground' R
ploy
Depth to
Hntlltnp
factor •
5 In,
pamark8:
SBOW-8330 (R. WMS)
• y
L a T
_0 y
D
v .
r. , lito JP~lr ~ ~ • `
y ~ rrM3 ~
W
S(ALE: yo
ti 1AV
Q A) dA. , .
y~$'~ y11~s 6~"5t'~C7 ~r ~ 1.70
pAja is
d ! V70
TO M hTl.~ 5 /D
8yj _ • f3 5 ~l~
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