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HomeMy WebLinkAbout030-1027-90-000 r °o Q 3 0 O N V « 5~ p C O U) 00) X N U p 0 O N 70 N V CL (n 0) LO Q O1 C p co O ~ C 'B ~ ~ C N O C aO U O W } c can a cmi 3 in N=od, s N ;E N L co CSU O C O T n w Y N Z C) X > o Y m 3 MM LL C N ~ ~ >a C, mmm 7 m ma~ a Of U m ~ Q N ~ II! O V) 0 Z N N W a m O H U) c' 0 o z v ~c - (n Z o o fp F- O m Z c m E 72 _0 0) 2 co _ N a y U) N C O L L _ d U c ON m F~ C U N Z I- Z o N Z c c V V > N N R E V) m C (D _ O a O W d c 0 CD CD 0 O C a L O G N N N N~ Z N> H H H 3 U N FL U) ►i X 0 0 0 Z o O o a a CL N g o = rn rn v1 . i U - - rn rn 'm !z 7- N O O co C) m CSI O O 0) Y N N m o o a _rn o a o Ln o 5 V) a) o d Q Q ~ O p C C N C N In O O C0 0 0 ~ a c v m o0 oo 0o m -C -0 C14 N N r/ O N a~i o c m a in rn_ o 0 =1 0 o '0 LO cc) c Z m 04 (,0 ~p 200 c in E co m y O O (n U N O= ME U) CJ r. w . a 0 a U w c E c c _1 Q 0 a O N 0 AS BUILT SANSTC - ITARY l04 SYSTEM REPORT OWNER ~.4R !?Dw~c i a ADDRESS 3~ j T~IDUT /3Ann,r T-~ SUBDIVISION / CSM$ p LOT ~ SECTION--,-6_T -,Z_~ N-R__,LLW, Town of S o , ~u ST. CROIX COUNTY, WISCONSIN SHOW EVERYTHING WITHIN I 100 FEET OF SYSTEM ~xI S~lN4 /too G Al- 5/7-- 3 ~5X8o 7 /yeHEs 1069► 1 NDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center .,r r G • BENCHMARK: ~jp !'oiyC/Jy9 Don A~ DNT ~ ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /?O© S ck from: well House Other Pump: Manufac Modelf Size Float sepera Gal o 1e• Location ':SOIL ABSORPTION SYSTEM Width: Length Q Number of trenches--3. Distance & Direction t/ 100 7' o nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold j Bottom of system--?-Z,,3 2 Existing Grade 9 Final grade DATE OF INSTALLATION - PLUMBER PLUMBER ON JOB: /Ii4,9 LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor aAd Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings'Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 268607 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: CRONICK, GARY ST JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION LEVATION DATA A9600305 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Benchmark , Septic O. 9-4-9 awA Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St / Ht Outlet Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header/ Man. Ys gs.s8 ; W a•3~ Aeration NA Dist. Pipe 9 o' /3 Holding Bot. System gse Js G9' a /s/' PUMP/ SIPHON INFORMATION Final Grade 43s, 4,0 ' Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Head Force-main Lengt Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 0 DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Mode Number: System: a..,(I d' OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST J/O`SEPH.6.29.19W, SE, SE, TROUT BROOK RD .c L Plan revision required? ❑ Yes E(No Use other side for additional information. 6" 9/. 6 SBD-6710 (R 05/91) Date s dolls Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e p~~ o Safety and Buildings Division v~L=17~n 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 n than 8 112 x 11 inches in size. - Cr6 I • See reverse side for instructions for completing this application State Sanitary Permit Number &,ff6o The information you provide may be used by other government agency programs E] Check if revision to pre sous 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 5+e 1/4 Sir 1/4, S G T , N, R E (or Property Owner' Mailing Address Lot Number Block Number 3_79 419Q= 7-R- 't I City, State Zip Code Phone Number Subdivision Name or CSM Number a4g-779A I o 1(7,16-) 90,05,6"y W1 t, TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ village Public 1 or 2 Family Dwelling - No. of bedrooms A/ Iff Town of o III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 6 30 - 12 - 2,6 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 online B, if applicable) A) 1. ❑ New 2. jg 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 ['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 O® /1 fvl 5- 9:2, *31 O Feet Feet VII. TANK Ca in 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 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sews e s stem shown on the attached plans. PRSW Business Phone Number: MP Plumber's Name: (Print) Plu er Signature: (=Sta) Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Ag nt Sign ture (No St ps Approved ❑OwnerGivenInitial OV/ Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Courtly. One copy To: Safety & Buildings Divi ion, 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. a 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 vvith completedimensions, looatioaof 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 creati6n of surcharges (fees) for a numberof regulated practices which can - effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SC//I(O v~Mr Oapzeo .0 cod 61 SCALD I y0 ~ QI"/ _ %oP pF .SLU C0rPN'~/1 G~RABP G~,T /4P,~~N EL, /DO.O color Q~~g tp i _ v ~ t-1(YST~NG t 4 sC- *09 4ACA $ti ~ ~ f/DcrS~ 3 6-X 80 71'?2&4#e37 \ DP1~ iv i33 Q ORAWIA' p- foR: /9-S'G' 9RA13 y: GAf CIMNACK 3 7 9/Y TRauT 1719ooA' TX. ~BG U c ~ y /eu~ T% . 1&0 sOAr 401` S yo16 ~d~`7~/1 s~ T CUi' Sro? r /7/>iPl'u~ 3~20~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor .d Human Relations Divisiao df Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUh Cro•x Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or y. , LLD. # dimensioned, north arrow, and location and distance to nearest road. ~ B VIEW '~X APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION `I > PROPERTY OWNER: PROPERTY LOCATION Gar Cronick GOVT. LOT 1/49 N,R or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. N C~SM 379 Trout Brook CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN St. Joseph Trout Brook Rd. [ ] New Construction Use [ ] Residential ! Number of bedrooms 4 ( ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .4 bed, gpd/ft2 .5 trench, gpd/ft2 Absorption area required 1500 bed, ft2 1200 trench, ft2 Maximum design loading rate • 4 bed, gpd/ft2 •5 trench, gpd/ft2 Recommended inniuation surface elevation(s) 92.32 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material pitted glacial drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ®S ❑U ®S ❑U (US ❑U 97S ❑U ❑S KU ❑S FU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botidary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmr& 1 0-10 10 r2 2 none mfr cs 2m .5 .6 2 10-24 10 r4 4 none sil lfsbk mfr 9w if .2 .3 Ground 3 24-36 4 4 none sicl lfsbk mfr if .2 .3 elev. 95.32t. 4 36-74 7.5 r4 4 none sl 2m r mvfr na na .5 .6 Depth to limiting factor +74" 7-1 Remarks: Boring # 1 0-12 10 r2 2 none 1 2msbk mfr cs 2m .5 .6 2 4 4 none sicl lfsbk mfr 9W if .2 .3 2 12-33 3 33-49 7.5yr4 4 none sl 2msbk mfr 9w na .5 .6 Ground elev. 4 4 none sl 2m r mvfr na na .5 .6 - 96. Olt. Depth to limiting factor +82" Remarks: CST Name:-Please Print Phone: Gar L. Steel 715-246-6200 Address: 1554 200t ve. , iV chmond, WI. 54017 m02298 Signature: Date: CST Number: 7-11-96 PROPERTYOWNER Gary Cronick SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # 030-1027-90 Depth Dominant Color Mottles Texture Structure Consistence Bourclary Roots GPD/ft~ Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 2 Ground 3 31-49 7.5 r4 4 none elev. 95.77 ft. 4 49-84 Depth to limiting factor 84 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Gary Cronick 1554 200th Ave. CSTM2298 SE4SE4 S6-T29N-R19w New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246-6200 1 N 1"=40' BM-- top of sw corner of garage cement apron C el. 100' I. LaCS~S 1,~,v SySfC►`~ 4)OM~ 14 of A Ito, Gary L. St el 7-11-96 if? accord with ILHR 83.05. Wis. Adm. Code... COUNTY Attach complete site plan on paper not lass than 8 1/2 x 11 inches in size. Plan must include, but St. cmix RCEL I.D. 4 not linmted 10 vertical and horizontal reference pant (BM), direction and % of slope, scale or [RE dinwnsioned, north arrow, and location and distance to nearest road. _ EWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION VI PROPERTY OWNER: qC ROPERTY LOCATION Gary Cronick OVT. LOT Sp 1 29 19 14 114.S T ,N,R AO) w PROPERTY OWNER':S MAILING ADDRESS OT s BLOCK 0 SUED. NAME OR CSM # 379 TrOut Brook Trl- Vol 1 249 CITY, STATE ZIP CODE PHONE NUMBER CIT Y ILLAGE JUCROWN NEAREST ROAD St. Joseph Trout Brook Rd. r*c*,. New Corwtruc ian Use { Residenlial Number of bedrooms Addition to existing building Public or commwd daMbe derived daily flow 600 gpd ROWINIlef>ded desgn loading rate . 4 bed, gpolft2 .5 ,ranch, gpd*2 Absa don area required 1500 bed. ft2 1200 trench, f!2 Ma*tlrMn det* ba*V rale .4 bed, gXW . 5 VWlch, qXUR2 Reoottunanded wIlwm sufte elevmbxs) 92.32 ft (a$ referred b site Plan benchmark) Additional design / silo txmsideratiorts na Pawlt materW pitted glacial drift flood ptaindevation, if apocable na R S - & ft* br system CONVENTOOL MOUND N+ 41il"D PRESSURE AT-GRADE SYSTEM IN FILL NO-DING TAW u®S 13U ®S ou ®S ou XIS oU ❑S :K] U ©S 12U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Cow Bounday Roots GPD/ft in. Munsell Ou. Sz. Cant Color Gr. Sz. Sh. Bed 7*01 1 0-10 1 r2 cs --2m .5 .6 1 LX1wa" 2 10-24 1 r4 4 none oil lfsbk mfr Sir if .2 .3 Ground 24-36 10yr4/4 none sicl ifsbk mfr if .2 .3 elev. 95.32i 36-74 7.5 4 4 none sl 2 mgr mvfr na na .5 ' .6 Depth to twrlitirlq bw +74^ Remarks: Boring # 1 0-12 1 r2 2 none 1 2msbk mfr cs 2m .5 6 f2; 12- icl lfsbk mfr if .2 ` .3 Gn>tatd 33- 5 4 4 none sl 2msbk mfr na .5 .6 elev. 96.071 49- sl 2 mgr mvfr na na .5 .6 Deptih to *mpg facbr +82" Remarks: T Nsmr.-Pleas Print P}~: Gary L. Steel 715-246-6200 1554 200t ve. , New cbmond, WI. 54017 ta02298 Dab. CST Number: 7-11-96 r r.w. ....~a..~._... vv~~ vr.vvner • wn m6rVn 1 P8pe L of 3 PARcEuA.t 030:-1027-90 Depth Dominant Color Mottles Structure GPD/tt Boring Horizon In. Munsell tarn. Sz. Cont Color Texture Gr. Sz. Sh. Cor>6rWerroe ~ Roots Bed Trends Grourd 3 31-49 7. 4 4 elev. .77 ft 4 49-84 1 Dep11 b tiff" + 8411 F1 Remarks: Boring s Ground eNv It. Deplh b f~Gor Remarks: Boring 0 win" Ground elev. Oepth b wring taclDr Remarks: Boring #I OWN! elev. n Depth b bft Remarks: Z S STEEL'S SOIL SERVICE Gory L. Steel Gary Cronick 1554 200th Ave. CSTM2298 SE%SE'k S6-729N-R19W New Richmond. W! 54017 MP4RSW-3254 town of St. Joseph (715) 246-6200 I N 1"=40' HW top of sW corner of garage cement apron ! el. 100 SJpMr, 4RI L~lS~Si,+~Ei SySt~►'+ o ~ sG 3 ask 14 a m Sk ~Z) V Ito, 6,3 4 AAGaaLUry S 1 7-11-96 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the _GAkst C R QAUCA1 residence located at: S~ _1/4, 5:C-7 1/4, Sec. 4::~ T_2,? N, R-? W, Town of ~Tit,L:n,r~ Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: !g©p Construction: Prefab Concrete- Steel Other Manufacurer (if known): Age of Tank (if known): APIX 0K /7 ~IpS ~t?~([~_U/ref ~)r irT (Signature) (Name) Please Print Pz my 13jFFA ~'7P,Prcv 37 0 tr- (Title) (License Number) 9-10 96 (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tan}' condition, I certify that the tank to the best of my knowledge wil' conform to the requirements of IL HR- 3, Wis. Adm. Code (except for inspection opening over outlet baffle) Name aiv J' j / T Signature MP~_-320 r 5/88 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ti/C~cLI / t~~~rrc 1-c~t>~c.\L MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE jA c "A<_C' , u.m PROPERTY LOCATION S 1/4,_ 1/4, Section, T 2~N-RAW TOWN OF SA . 12~1 ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 2 CERTIFIED SURVEY MAP ;~3i Qom, VOLUME PAGE 2 LOT NUMBER Z 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 expiration date. SIGNED: d'-Z Aoa-'C~ DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 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 ,rr n, ~ e==, CIL- Location of property 1/4 _ 1/4, Section ,T N-R W Township Mailing address Address of site 37 q rzy,, } pct, L ca Subdivision name N Lot no. Z Other homes on property? Yes No Previous owner of property r< L,,- I / h, , nr\e-4 Total size of property Total size of parcel Date parcel was created r. !T9r/~n Are all corners and lot lines identifiable? __,,,Yes No Is this property being developed for (spec house) ? Yes _,ZNo Volume ! and Page Number 44.2 - 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-oLfice of the County Register of Deeds as Document No. 33iq 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. Sign ure of Applicant Co-Ap icant yj 6 Y-1,5 Date of Signature Date of Sianature 33.31:5 1' Ep cr.: MA Y q , s 197; APPROVAL OF THIS nni'rJOR SUBDIVISION JaM,s °Phi old, .~'Y_ Phi., DOES NOT MEAN APPROVAL FOR SEPTIC 54 r.~,~ 1, SYSTEM. REFER TO H62.20 -7 CERTIFIED SURVEY MAP . DANIEL BAU6 Part of the SE 1/4 of the SE 1/4 of Section ,ERTownship 29 North, Range 19 West, Town of St. Joseph, St. Croix Co ty, Wisconsin E ;tiy APPROVED cw 19 'gas SO•• N88 /B'35 ,~C A¢90o ,y 1 -.ve2~e3 s E ~4 ST. CROIX COUNTY PoNC coMPREHENW- PARKS PLANNING $ 3231 m 00 AND ZOMNG COMMITTEE 00 i• 589°55'00"E 475.00 ~ s ~ 442.00 c '~t• 3 O 2 p0 1 LO? 2• 4 ;'t ti X 3.3 Acevs p h v~j $ h Loy 3 AGREs M Z c a S 88.07 b0iE q H h _ 3?b. b7 • ~67os R 5 /3.04 a Q Furust_ p • o G•K4dN~~ON N Sa 33~„ ~ M N88' 07 00"W 549.02 b 5884 '07b0",E ~8. • Q+ SCALES I"= ZOO' o Z o ti Loy 1 a n 3.3 AfRES h n1 C. S. M. E•L~Nt ~ sc y ssa ~ Yot./,Pg6d ~ A $3 A wa.ro ' y pu~isTN hb 9i~ 0~. b b 377. 07 .33 0•. Q• 5g0.005E Cox. Sec • 6 -Z9- /9 k iNa Sire. 4p. 88. 26 •40W • Indicates 1" x 24" iron pipe stake weighing 1.13 #/ft. Description: That certain parcel of land located in the SE 1/4 of the SE 1/4 of Section 6, T 29 N, R 19 W, Town of ST. Joseph, St. Croix County, Wisconsin, more fully.described as follows; Commencing at the Southeast corner of said Section 6, thence gonS 880 26' 40" W along the South line of said Section 6 a distance of 550.00 feet to the Point of Beginning of the parcel to be herein described; thence. continue S 880 26' 40" W 377.07 feet; thence N 000 31' 35" W 959.38 feet; thence N 880 18' 35" E 249.00 feet; thence S 000 31' 35" E 55.17 feet; thence N 880 18' 35" E 211.31 feet; thence due South 169.85 feet; thence S 890 55' 00" E 475.00 feet to the East line of said Section 6; thence due South along said East line 352.40 feet; thence along the centerline of a 66 feet wide roadway N 880 07' 00" W 549.02 feet; thence S 010 53' 00" W 33.00 feet; thence due South along the West line of parcel described in Vol. 1 on Page 127 of Certified Surveys a distance of 370.00 feed to the Point of Beginning, the above described parcel subject to roadways as shown. State of Wisconsin) • J S 8 N LAND SURVEYING • HUDSON t WISCONSIN 54016 (715) 386-2007 NAME River Valley Abstract & Title Inc. ADDRESS PO Box 149 - 220 Locust St. Hudson, WI 54016 DESCRIPTION Lot SE 4 of SE4 of Section 6, Township 29 North, Range 19 West St. Croix County, Wisconsin described as follows: Lot 2 of Certified Survey in Vol. 111", Page 249 (91-2524 Gary F. Cronick and Lynean M. Cronick) PLAT DRAWING This is not a complete Land Survey N88 0- 181-3511E::"-. 249.01 M' IA In M O O O N 10 foot R/W easement to St. Crol~ vcljnty Electric, Vol. 489, P&12 -4 1 0 -W d Lo M 7 S M ~ O OI M 1 O O p O O 1/ O 1 M lA i N 1 ~ 1 5 0 R 12 GAR 1 HOUSE 24 1 281 ~ o- -o d 0 L O - 326.671 1 S88o07100 E Private Drive Tk- 1-14-;- „f 1TflPnl.-+e nn th;e drauinn are annroximate and are based on a visual inspection of the DOCUMENT NO WARRANTY DEED THIS SPA' c RE'-rVEO FOR RrCnR[ANp DATA STATE BAR OF WISCONSIN FORM 2-1982 470194 Jl1JPA'U611 REGISTER'S OFFICE .Marshall F. Sinnett and Roberta L. Si,~nett, ST. CROIXCO., WI tx'sbanc and wife Recd for Record JUN171991 conveys and w.irrants to Gary F. Cro a(;X and Lynean M, 11:30 A. M Cronick,. husband. and wife . as )Marital .survivorship...... pxoPehty.. RGV of ON& FrTVPN TO the following described real estate in Cour.t5, State of Wisconsin: Tax Parcel No: . . Part of the SE% of SEC of Section 6, Township 29 North, Range 19 West, St. GYoix County, Wisconsin described as follows: Lot 2 of Certified Survey Map filed May 27, 1976 in vol. "1", P"-- 249, Doc. No. 333195. TOGETHER WITH .'>,ND SUBJECT TO a non-exclusive easement for roadway purposes over and across the existi.-- private road as shown on said Certified Survey Map. litA.,'v5t' is This .-is homest-ad property. (is) (is not) Exception to warranties: ease:'lents, restrictions and rights-of-way of record, if any. Faced this June 01 day or ls' N~l Y~cs Cdr (SEAL) t, ` a t Marshall F. Sinnett Roberta L. Sinnett (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) .Marshall. F__Zinnett - STATE OF WISCONSIN Roberta L. Sinnett -------------------------------------ss. - County. authenticated this ........day of ,;=die.. 19..91 Personally carve before me this day o+ ~f! lr w : r lc 19.. the ab--e named tins.--Ogland,limieea--..-- - TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authorized by § 706.0 Wis. Stats.) to me known to be the person wl'o execoted the DOCUMENT NO. 1141`_: SPA(:E RESERVED FOR RECORDING DATA WARRANTY DEED i. i L STATE BAR OF WISCONSIN FORDl 2-1982 Marshall F. Sinnett and Roberta L. Sinnett, husband and wife conveys and warrants to QcVy.F,_Cronick-and-Lynean-M,------_- .........Cronick,.- husband. and. wife - as, marital ..surv.1VOrshi------- pmpex°ty------------------------------------------.....------------.-.. RETURN TO . t CT'o1.X the following described real estate in . ......-..........County, State of Wisconsin: Tax Parcel No: Part of the SE% of SE's of Section 6, Township 29 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lot 2 of Certified Survey Map filed May 27, 1976 in Vol. 111", Page 249, Doc. No. 333195. TOGETfEJR WITH AND SUBJECT TO a non-exclusive easement for roadway purposes over and across the existing private road as shown on said Certified Survey Map. ~J .t I I (I ~I This is homestead property. (is) (is not) ~i ~I Exception to warranties: easements, restrictions and rights-of-way of record, l if any. June 91 i Dated this / day of - - - - - - 19..---.... II (SEAL) L) Marshall F. Sinnett *Ro to L. Sinnett (SEAL) ------(SEAL) * i AUTHENTICATION ACKNOWLEDGMENT Signature(s) YbrShall-.F---Sinnett.,...------------ STATE OF WISCONSIN Roberta L. Sinnett ss. II County. i COMMERCIAL TESTING LABORATORY, INC. Y ,C14 Main Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 ST. CROIX ZONING REPORT NO.: 04655/01 PAGE 1 ST. CROIX COUNTY REPORT DATE! 5/03/91 COURTHOUSE DATE RECEIVED! 5/02/91 HUDSON, WI 54016 ATTN: THOMAS C. NELSON lqR( Cr6 n OWNER: Marshall Si nnett LOCATION', 379 Trout Brook Trail, Hudson COLLECTOR: N. Jenkins SOURCE OF SAMPLE'# Outside faucet COLIFORM'0 /100 ml INTERPRETATION! Bacteriologically SAFE .NITRATE-N: < 1ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L LAB TECHNICIAN. Pam Gane WI Approved Lab No. 19 oF.NDEDENpE~r o' 6$ ~ s < cleans "LESS THAN" Detectable Level Approved by. o PROFESSIONAL LABORATORY SERVICES SINCE 1952 ~l ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion of this form is essential so that the property can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received. OG WATER TESTING----------------------------FEE: $ 25.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $175.00 (For VOC' S ) . vv SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 Z 5 (Determines if system is properly,fun tioning at time of inspection) m Property owner's name''' Property owner's address J1" 0L, Yov a i Legal Description e 1/4 of the S 1/4 of Section T N-R-zy Town of Sf„ns eT Lot Number Subdivision Name FIRE NUMBER -7 cI LOCK BOX NUMBER S~ P Color of house Q)ro W-7) Realty sign by house? es If so, list firm: Q ~e Cv. PLEASE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry maybe gained. Firm or individual requesting services: Telephone Number 8Z 3 REPORT TO BE SENT TO: U Closing date Signature (tom , ~ ~ r 1.. 1 APPROVAL OF THIS 1,,%ifJ012 SUBDIVISION M R SEPTIC c O . t APPROVAL F4 I)OES .1 J aYSTErY1. 1.I:,:hf~ 'ro 162.20 CEIMFIEn' SMEY 11M, DAN I LL BAUER Part of the SE 1/4 of the SE 1/4r of Sect.1on 6, Town:sh-. p 29 North, Range 19 West, Town of St. {Joseph, St, Croix CWn'ty, Wisconsin uy • t ~ ; ti`' ~ 6'' f;, ; er t. ~ tt! IZ'~ 1 9 1976 b V 849.00 114'h.~ N86'/B 33' ~1~ ~.l i . t ; l ~•,t POND ~ ~ /t~3t COMPIZE: ;aJIi"I'LA DUNG 3234 pp AND CO.'AMITTEG 00 \ q0 b 440 a Sag"s 'no`,E +75.00' 0 h n ++Z 100 o h O ? p0 t!1 koT 41 c4 h .i ' Loy 3 ~h a r~ AA- Asss 616 Nq 4 08.0706 X. O Q VI Q ` o~os 5 / 9.04 pu ~ I o RRif ~ N V ~ . .5¢~'•°58610"rY _ ~A ~3. ~a: ! M N6l3• OTD O'Y✓ S4 .-J..• : 5S$~D7p0",F; 902 u 3;1A I" s ZOO O• o JA. ✓0a-./,Pgbtf /27 39 33 s uMdo. } D~.c N~.crN 7 ` <'o•. Q 550.00 3907 5• I- INC. SEa. 4p. s 6 -z9- i9 ~;':3 $ 88' 2G, 40" ~ Indicates) 11' x 241r iron pipe stake weighing 1.13 la/ft. Descripti.on:I That certain parcel of land located in the 5E 1/4 of the SE 1/4 of Section 6, T', 29 No R 19 W, `Poem f 'ST. Flo^>eph, St. Croix County, Wisconsin, more Dilly described as-follows; CommenQing at the Southeast corner of said Section 6, thence gonS 080 26' 40rr W along the` Sou.tli line of said Section 6 a distance of 550.00 feet to the Point of Beginning of the parcel !:•o be herein described; thence cor1tinue S 830 261 4.0rr W 377.07; feet; thenco N 000 311 35" W 959.38 feet; thence N 880 181 35I" E 249.00`feet; thencq S 000, 311 35" E feet; thence N 880 18' 351r E 211.31 feet;lthence due South'16905 feet; thence S 690 551 00" E 475.00 feet to the East lin of said 'Section '6;;thence due South along; said East line 352.40 feet; thenco along the centerline of a~66 feet wide roadway N 880 07' 00" W 549.02 feet; thence S 010 531 00"'W'33-00 feel ; sthence due South along the West line of parcel described in Vol'. 1 0" :Page'127.0f Certified"Surveys a distance of 370.00 fee.t to the Point of Beginnin ,'the above described, parcel subject to roadways as shown. State of Wisconsin) County of Pierce ) F , . JOSEPH:-, -[-29-30N - 3 R.20 19 W. . 150 SEE PAGE 53 a oone o sR was. ar/_ M0171, C tl crn ce ® / n • We v :iii~=~' $~S/ t ee U~ K/Q ~ gg /ke ~ f. L 9e 73.s tl / e v "FMgg U 4o J • Err~esl Errzcst (i I J C V Uk / .7 :Sr'7P1:L'L y a( 4l TC $ 00 Ern~C7. K/ue-c1f.Ee f EVGy ExR.ct;g: o U- • %/1,e9 lip m. ✓f~ ~rZ ® We99e 160 K/ucdf.Ee TR D~£~ ..z s 40 0 J U N /ISTN • /eo /60 4. . • v ^ VE. • uo - O sr. c. onxe/pct fj % y bu ao ~b / E ~U :::3 rhea ~s-i o - Qpc~ 0 /I2N o Cpp `C N •:TRXIGTB::::: • / ~7a.r ear Lcnt l °m p \ D. t /9o tl r A /`oif i tl b i v^ie e y ar/lny yC~ roti 97 O/so7 p~ ^ /ae.s9 4 59 /9nd ron 0~ r// yCV ®Edl(ward 77 98 G N /20 T ttR /00 s O , rO DYN/C 4 al'Ce //a. - r. 7--.04 . 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LL..a--- - . r' ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE nU s 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 May 1, 1991 Shirley Nelson Edina Realty 700 Second Street Hudson, WI 54016 Dear Shirley Nelson, An inspection of the septic system on the property of Marshall Sinnett at 379 Trout Brook Trail, Hudson, WI was conducted on May 1, 1991. At the time of the inspections a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them back from the laboratory. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Sincerely, Mary Joh Assisi ant Zdhing Administrator js