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HomeMy WebLinkAbout020-1317-70-000 ^ (D °o a 0 s°e h c o c Q N N ° a -.o (o . o o ICI m,IS,co. ~.2ooc c~ao~N,N o> D 7 N c6 O f C C .C.N C O N p - o m 3 N -0 L I a~ c ^ o o o m 0 3 c N~ aNi~'O ~cp orn~ co -o c N "O C N C U .d z > O E a 7 (0 C N O ~ N C~ N LL p ~O O O m C) O -C of CO > C N N E v Z N ui E Z O a co N I- O Z : c U O N m Z a m aci U I- ~ I'; ~ E I N O O C 0 N •M J (D d Wi Z a) Z Q w E c ca N - m (D L ~ d CL M w Y (n o o a a E ~ N V) N N E =3 U _~V O ~ dl U) o 0 0 0 0 a a a a 3 0 l rn rn Z ~1i C N N B O N N m n E ~ c` 3j ~5 O O U O W W 00 O 0 O O Q Z Cro, O O N N C 00 C CO C C O) N (D O Q) in cn y r O 4~ O. O. N N N V O c L o o N L: O w O N I- I- (n 00 O •o N N E E U O N= N N O N U) •O « .-t4 ✓N l(S ~ a O L C.L _ C~ U a O (n U llr7 ~S r ry ST. OIX COUNTY WISCONSIN ZONING OFFICE r .`~a _ / ST. CROIX COUNTY COURTHOUSE /o/ ~Qtin C~Qe/ • ON, W154016 y - - (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, Plc` making access to the home necessary. Please make arrangements with this office to insure a time when entry can be gained. Its' ❑ Water (VOC's) $185.00 ❑ Septic $25.00 ❑ Water (Nitrate & Bacteria) $35.00 (Visual inspection) Owner "G Requested by: Addres-4 Address: City & State: City & St. , Zip Code: Zip Code: Telephone N°: ( ) Telephone N4: ( ) Property address (Fire N2 & Street)- f viJn t~ 016 7 Location: Sec. , St. Croix Co., WI. Tax ID N4 Parcel ID N2 House color: Realty firm: Lock Box Combo: Water sample tap location: TO BE COMPLETED BY PROPERTY OWNER. 'PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Is the dwelling currently occupied? ❑ Yes ONO If vacant, date last.occupied: Septic system installed.by: Year: Septic tank last serviced by: Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y ❑N Slow drainage from house. ❑Y ❑N Sewage Back-up into dwelling. ❑Y ❑N Sewage discharge to ground surface, road ditch or body of water. ❑Y ❑N Slow drainage from the dwelling. ❑Y ❑N Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: OWNERS DRAWING OF HOUSE & SEPTIC-SYSTEM LOCATION t IN TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ONo sheet # Soil series per SCS Soil Survey: Type of soil absorption system: ❑Below grd ❑At-Grd Mound Approx. size- 'X OGravity ❑Dose ❑Pressurized Ft . 2 ❑Bed . OTrench ODry -Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES OOther OUnknown Septic tank Setbacks: OHouse--- OWell OProp:-Tine 00ther Dose tank Setbacks-: OHouse:.OWell ` OProp. =line _ ❑Other .OLocking cover OWarhing label OPump/Floats " OAlarm OElec. wiring Soil Absorption System Setbacks; --0House- 0Well ❑Prop. line 00ther OPonding: ODischarge: General comments: INSPECTORS SKETCH OF-SYSTEM LOCATION N Inspector Title Safety and Buildings Division IIIr~Iilllii ie+ Bureau of Building Water System: r.•■`■■rt SANITARY PERMIT APPLICATION 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 81/2 x 11 inches in size. . `%V" 1 • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs heck it revision to previous application [Privacy Law, s. 15.04 (1) (m)I_ State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location =e~ GY 5?,j1/4 A? 1/4,S T ,NR E(or)1/ Z Property Owner's Mailing Address Lot Number Block Number 02 City, State Zip Code Phone Number Subdivision Name or CSM Number O ( _ ) TYPE F BUILDING: (check one) [j State Owned C] ity Nearest Road . sc d-W, a t Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Town Village of Ill. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment / Condo 2 n 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. pt NeV 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 Zb 2 Date Issued 2 V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 5a 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 S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation G Gd /,Zoo 0 d r 5- "Vu- 11" G 2• Feet dS, S Feet TANK Ca aclt VII. in gallons To of Prefab. Site Fiber- Exper. INFORMATION ons Manufacturer's Name Concrete Con- Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank ,r ® ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ! 1 ( r r~ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMEN I, the undersigned, assume responsibilit r instal on /of the onsite sew Age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P PRSW No.: 1_~usiness Phone Number: 9112- s Address (Street, City, State, Zip Code): Plumber's 14 IX. COUNTY / DEPARTMENT USE ONLY E] Disapproved Sanitary Perm t Fee (includes Groundwater ate sane ssuin2AgeiAt nature ( to s) Surcharge Fee) Approved ❑ Owner Given Initial 9 Adverse Determination / f/1 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: ~r SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS j.... 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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. 111. 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 narne, 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. tv.;tor)sin-Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT S1. i:i ix Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Wr_ Permit Holder's Name: 11 City El village pTown of: State PIA ff Zi+WIEFELHOPER. BRENT R X CST BM Elev.: Insp. BM Elev.: M Description, Parcel Tax No.: 7 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic + c/`tn eC4~ 2 Benchmark ➢ C~~ Dosing 7Sd 3)/4 ~ Aeratianr- Bldg. Sewer (0 69' Holdi St/kg inlet /7 TANK SETBACK INFORMATION St/ 10 Outlet e0 TANK TO P / L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing ~99~, S NA Headert-tifiarr- / Aerati NA Dist. Pipe Hol.d+rrg"' Bot. System -7, 3a PUMP /-AI--INFORMATION Final Grade Manufacturer. Demand Model Number GPM TDH Lift Friction Head DH Ft I oss Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width ' Length/ No. Of Trenches PIT No. Of Pits i e Dia. Liq epth DIMENSIONS DIMEN rtu, SYSTEM TO P / L BLDG WELL LAKE/STREAM LE H r SETBACK ' INFORMATION Type O y)q,,, oar AMBER + iO Moe Number: System: ~G.~, S I`~ OR UNIT DISTRIBUTION SYSTEM Header , Distribution Pipe(sj Hole Size x Hole Spacing V In_ take Length Length /a Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade e Depth Over o Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil C] Yes C] No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSQN.24 29 19W, SW. NE, JANE CIRCLE n S, L, r « qo' - f t Ca~c ~CS- e' Y1~? ^ ~;r, r !.1~11'l a hG1~ tic " P . Plan revision required? es E] No Use other side for additional information. SBD-6710 05/91) Date Inspector's Signature Cert. No. ,ucn~ ✓ 5,t.J. ADDITIONAL COMMENTS AND SKETCH t ` SANITARY PERMIT NUMBER: l %(f J p~ c u[O X~~',v ~uGl~, a..,!/-''•'~ IJk1 j 4J r lras°E°m., w via.l9l~rF'i SANITARY PERMIT APPLICATION Bureasafetyu o oand ff BuilBuildinWater System: ing Water ~ 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 5 than 8 1/2 x 11 inches in size. . C''& • See reverse side for instructions for completing this application State Sanitary Permit Number .-24~CQ 00's- 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 Property Location ;i F 4)114 "1/4, S _iY T2Q , N, R E (orrlo P operty Owner's Mailing Address Lot Number Block Number Gol City, State Zip Code Phone Number Subdivision Name or CSM Number ,S-y ( ) .54 II. TYPE F BUILDING: (check one) ❑ State Owned ❑ qty Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No- of bedrooms --l-t Town of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo D°z o, 121-7,7e 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. jZ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System SystemTank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 J.Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 114E] 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) .O . p c Elevation lo," 4; ,it ed d6d ad' S /a/ . so Feet /°6 5G Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ~Q lL~} ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans- Plumber's Name: (Print) Plumber's Signature: (No Stamps P PRSW No.: Business Phone Number: `r 1 l3 d'r2 I?S--,3P - 316t l Plumber's Address (Street, City, State, Zip Code): 14 7,6 S" IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sani ary Permit Flee (Includes Groundwater ate Issued Issuing A ent Sig ture ( to s) e~eJ/ Surcharge Fee) pp roved ❑ Owner Given Initial dverse Determination A2L X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety a 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. 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. Z-, Cp A h 1 ^ N, 0 0 N o ~ G1~ ~ ~ ~ 4 v d ~ - o 13 vY e-5 13,46 W7- 4 41s ,r z w~'ES~L 4~Eti° ~/.Ly 5 -24ees- ~ 9~~7 Ui4~/~!/ J~Gk°~~ Gift, /t/I/~~~E ~~OU~' /Ll/~f/~t1, •~3 ~t f r Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pap/ of 3 Labor and Human Relations Division of Safety s Buildings imaccord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 ' ches in size. Plan must include, but not limited to vertical and horizontal reference noise ije9t i~nd % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and a APPLICANT INFORMATION-PLEAS P4R T ALL!1FQRINATIA REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION I µ USG 90VT. LOT 5W 1/4 NF 1/41S ly T Ly N,R E ( W PROP OW R':S MAILING ADDRESS t OT # BLOCK # SUBD. NAME OR CSM # 1219 :57- t ysvJ CQZ suA.)(RI•nGff' CITY, STATE ZIP C04 - PH E NUMBER OCITY OVILLAGE [GOWN NEAREST ROAD t.pso~ Gt~l 5yol~ Uls)3d'G-3G7 lJ12SOAoO [p New Construction Use Residential / Numbkn[.b6~s~ [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe = AJoT (?6'0A j^ Code derived daily flow gpd ReoRmmertded e`sign loading rate N /e bed, gpd/ft2 U trench, gpd/tt2 Absorption area required bed, ft2 iooo trench, ft2 Maximum design loading rate bed, gpd/ft2 •4/ trench, gpd1ft2 Recommended infiltration surface elevation(s) Sze-- P5 - 3 ft (as referred to site plan benchmark) Additional design /site consid ations 2(SE ~r4 O uJ 7";PE.v6Ae S Parent material .`'C $ S ~3yiP~i SOT Flood plain elevation, if applicable ft S = Suitable ter system CO1`1ENTiO MOUt,IB 11 U 0.- IN-GROUND U ESSURE A 0-s- D~ SYSTEM IN FILE Q DING TANK = Unsuitable for system S ❑ U U as L~ 0 U ❑ S Tt7 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Btxindaly Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rench / 0-// oY,e 2-/3 2 Z O /D y~e 31el 141F , S Ground 3 Q S pQ 7 elev. pt/, ZO ft. Depth to ' limiting factor Remarks: Boring # 0-/ EO ill S/'l Z f S S Zew .rr1 $ /0 a 21 44Y' i'Mi4K r33 Ground elev. ft. -1 7.5 Yiie S~ 7e-- le~S CS ; y - os GPs - - ,s ~ 7.5 yts y ~F --t Depth to limiting factor it Remarks: CST Name:-Please Print 'ROWRT 74L~3 t'GG~T- Phone: 7/S- 386 ' e5 Address: ; l/-/5=F3- CS7-v z YT Z n..t..• f'-QT Nitmhcr- PROPERTY OWNER P056~& SOIL DESCRIPTION REPORT Page 2- 2 of 3 PARCELI.D.I Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench '3..' 9 92 Aoye 3 0 ,y 7757 7 S Z ,s Ground 3 2 ' 1 7~ srie S/ jie- C's . y , S elev G Depth to limiting factor Remarks: Boring # ~ o _ 3~i- si~ 2•f S,~,C n~-F 5 ' , ~ L Ground -?4 y/Q % - s ~~R Q S . 5 Depth to limiting factor # --T- Remarks: Boring # 0 lP /0 y 3lL Sr / f S~~ /F,e S 5 -f P_ 41A Ground 7 3 v JA elev. ~.s CS S `5-19 >oL 101w y ©S ~/L ft. Depth to _Y /0 VjC S14 S oil limiting factor it 77 Remarks: Boring # Ground elev. ft. Depth to limiting factor ' C O / r r ~ r H ~ a ~ N Q i O I ! I rz 0 Q O s O ~ • 6 6 SOLD. i WIN \ v.. 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LL bT6 3„60.46.00 S z; A 00 I x I I o Z , i I II3~6imNns ~ I ,9 N u N 4j 3 W W~ 3 W W W W 3 3 W W 1'3 3~ W 3 3 W r-l O' c3 I~OOONOO u Z y~ N 00 0 M 0 0 0 O_ O O O O O Ln c, O f ~ 0 C O - O - O C> -Ln d' v' d' tli •'1 ON OCO ~ G f~N~1 NOO V' X00 c) 0 0 0 CD OC' OMM O O Lli W 9 W N M (D l!1 C~ N N ul M d' V' r N M CO O 10~~ co N Y y ZZ Zzcn U)(nz 2 Z z((A22Z (~i~ tni~ Q 0 W?3 _Wk!W W3G:W W333 13 Wr33 W W 3 W O O O O M 1~ 0 0 0 0 0 0 O O O O O O O O N O N ~ yJ ~ O O N O O O M M O 0 0 0 O O O O O u) O O rQJ' OO O~ OOOin O V' V' cl~ -,D O 0 0 0 -wom O N O O O N N O O V' O O O 0 ~ ~ c W ~ Mo ° Q o 0 000d'M p Z z C C N~lO[,& g)?.,& Q) I- N V NMNO O t!) u) ~o 2 V' co l!) l!1 ^ 00 O~ 1 W E En (A Z2ZZZZ(n2inmrj) Z((n~ (Onzz z c~ 4-09-1996 6:40AM FROM CUDD BROTHERS CONST 715 425 8053 P.2 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER L SIP z Gt1; e~C e MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITYISTATE zc l t G PROPERTY LOCATION sk1 1/4, ZJ I~ 1/4, Section 2 c/ T_,/ ,7 N-R__ZL_W TOWN OF Y, , I _ _ , ST. CROIX COUNTY, WI SUBDIVISION w al LOT NUMBER CERTIFIED SURVEY MAP , VOLUME11!~TAGE 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 Counry 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 expiration date. SIGNED:,. DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson; WI 54016 11/93 4-09-1996 G:AOAM FROM CUDD BROTHERS CONST 715 d25 8053 P.3 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 ~9 Y 2,r17- L-F a er Location of property,SAl 1/4 Al 1/4, Section g,11 TZf N-R_ZjP_W Township fQ,el.Se J Mailing address Address of site _Z2,6; e- C-t een A- -e- Subdivision name Lot no. Z"Z Other homes on property? Yes___.Z=,_No Previous owner of property .T fn /c~~ sit Total size of property Total size of parcel eL c e • s Date parcel was created ''Q'd Are all corners and lot lines identifiable? 9- Yes No Is this property being developed for (spec house) ? Yes J~.--No volume 4F/ls9 and Page Number -QoMW as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified survey Map, the certified survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No.and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. natur f pli nt Co-Ap scan STAFF BAR OF \\IsCONSIN FORM 1 WARR:\NTY DEED t CJCUMENT NO. 7 JAN 1 G 1996 This Deed, m reenwe9d Enterprises: I^c x 11:00 A. - adebelRetn a Wisconsin corporation, - - Brent R. Zwiefelhofer and Lisa M. Zwiefelhote*, an-! - husband and wife with right of survivorship______ r- AE- Of on 7 F4$ WlineSSelh, That the said',; ran tor for a saluable consideration - r '.Al+c AND RETJON ADCRE~? / I - doll rand other good and valuable consi era >_o Greenwood Enterprises, Inc. - - copse}s to Grantee the following described real estate it. St. Croix - - 1416 Third Street ('ounp. State of Wisconsin: Hudson, WI 54016 T AN~~N (Parcel Identification Number) O Lot 62 of the Plat of SunRidge III, filed in thelgffi e Vof the olume Reg6ister of Deeds in of Plats for St. Croix County, Wisconsin on January 2 . at Page 46 , as Document Number 538046. Grantee by acceptance of this deed agrees and binds eie grantee and all of his/her heirs, allow representatives, successors and assigns Enterprises, Inc., and and their agents agents for the purpose of drawing water samples from the well located on the property. This unrestricted access shall continue through Decetmber 31, 2002. Sampling and testing will be at no cost to grantee. is not This homestead property. (is) (is not) Toeether with all and singular the hereditaments and appurtenances thereunto belonging: \nd .Greenwood_Eatergrises.-Inc_.-_._--_.--------- %sarrants that the title is good, indefeasible in fee simple and free and clear of e curn^ ances except easements, restrici*ons and reservations, if any, of record and will warrant and defend the same. 19 9(z Dated this ------.8th- _ - day of GRE -nuENWOODar}t ENTER e INC. GREENWOOD ENTERPR S, INC By: (SEAL) BY ~ ~ (SEAL) Rus.ch, secretary- - mes E. Rusch, its president r (SEAL) ACKNOWLEDGMENT AUTHENTICATION STATE OF WISCONSIN ss. Signature(s) ST. CR!OIX Counn. - - 8th - day of l9-_ Per-. nalhv came before me this authenticated this - - day i~( 19 96 the abose named James- E. usch, it-president and `lark--- g_ R=szhr--i-ts_secretary ~ ~ -t+ a