Loading...
HomeMy WebLinkAbout038-1174-50-000 :a ^-c3 o I 0 3 0 o 0 y3 m 0. 0 n; ~ I a I i o I N li O LO x N N ty O ~ Y C N U - C Z N 7 LL c C co O O i - O -0 O Q O CO z 00 E o z d m am I c o o z c f GLI r N - o m zz z 0 v~ rn 0 z 'a CY) °Y z N M m N (n N t. C • ~ ~ CV p L .C a ~ I c O C0 O o Q w z F- z r a z N c o m L E N LO c " v d ~ a~ o a~ - - I °o n c G C a E N 0 CL N N m r ~ I Q 3 3 o 0- U) o z o •ti c 3 a a a g z (0 (D to J U c rn rn n`l > M o co A N_ 1- CY) ~ O O = n N O N C CL CO 9 N N N s> O r~ o m Q Q } is M w d q o p O 3c: r- yNNC O O CC O' F- O O o O N N O m 0) O 00 Q) - ~ C C CL O O Er- LO 00 00 -(6 C c C C QJ U) P 0 Q) a) ~r r d N V '7 ~ 61 a i..l O' c+') f0 ~ t cy) ~2 (0 C, cn co cu V L CC I 54 E V w EL 1 L: o CK CL Z .V d d rrww E I' c _1 A 0 a a 1 O y ci o m mo a~i °o h 03 °cfl h M ~ I o 0. Ili o ~ ~ I I o °o h ~ c s i •Q I d _ c p~ I C t~ 8m r co 0) E S 0) C N E m _3 $ z a~i m O to O c O z € -0 Z N 7 t6 7 N O U. O N LL O m O 70 Q C N Q vOi a) c 3 M 0 o v m N r z H W E E v E ° E ° a m a co to z c I o o c C7 '0 O z I c c 'V ~ c- 00 m o ~ , C/ Z ~ C C O to F- e- d) ~ ~ ~ ~ i C .O O N -O N M N CL O N Q/ O N N N C d ° 0 d L - c O O ~ O y Z F- Z Z co Z o N z m E m ea E E N c n N is Y (D 0 2 CL CL 2'l+ -0 to d i N c O \1 a~ c 0 o a 0 E 'c o a c CL LO U) U) (n _r_ u < C,4 0- 0 CL U) -r- I 2 0 0 0 0 0 0 0 z° •►v a 3 a a a I E a a a y a I,Z I ° I co 00 o N a) (0 CD o N J U rn rn y rn rn z Q 0) o _ 0 rn rn - 0 o Aw_ r c E - I C > O 3 2 N 04 'O m N Q L V) O ~~p N Q N •p _d Q Z ca N 7 C) 3 w e M a c ►~i °o o ~ o~ c o E 00 O CQ O O co O 0 1 C) a ~ 5 w (D a`) U a 0 0 l C n c E 0) 0) w 7 N CL :E 05 c N as v H a~ w a~ c a~i Fri M f6 3 p~ W 7 'O C L • m` 3 a0 p w O E N 0 N 0 0 0 y O cn cn N O - Z= M O Z- Z Cn V C° E d E d c a m a 3 a a • a m .2 `w c m c ` c c c "~1 D U a 2 O N 00 O in 00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~QI---- ADDRESS _1Z-3 h Tk SUBDIVISION / CSM~/~/lL~- LOT SECTION_ j 1- _T_,3 / N-R_L8 W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1v `L Ilk- ~ scrag / yo ~ ~aus~ c9~ 6 - ~X 57 ifTENc ass INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: GUCEr Liquid Capacity: 10ogo Setback from: Well House Other t Model# S Float seperation cyc e. Ala ion SOIL ABSORPTION SYSTEM Width: Length - 7 Number of trenches Distance & Direction to nearest prop, line: s Setback from: well: House_,j~_' Other CGUELL /V'67" /A/ ELEVATIONS Building Sewer ST Inlet. ST outlet s PC inlet PC bottom Pump Off -NA Header/Manifold 9399 q.?/G 9/,yG Bottom of system Existing Grade 9;7 7b, 9Y-C3 Final grade DATE OF INSTALLATION. 9 6 PLUMBER ON JOB: LICENSE NUMBER:3 S INSPECTOR: 3/93:jt Wiscorisin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division' (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 268547 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: SWANSON, ROBERT STAR PRAIRIE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: o r ,.J TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 8 Benchmark 16 3.6? 00- Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet 7,09` ~.SFt TANK SETBACK INFORMATION St/ Ht Outlet 4,39' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header/Man. ~8 g3;y 9~ Aeration NA Dist. Pipe ~jj Holding Bot. System /0,.5 r 13,16 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Lricti System TDH Ft Forcemain Le Dia. If Dist.Toweli SOIL AB RPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5_2__1 DIMEN I N LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION _Type O CHAMBER Model Number: System:VPJ) 5 5(0 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 tp Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Star Prairie.15.31.18W, SE, SW, Hwy CC Gl" 80 Plan revision required? ❑ Yes Q' No Use other side for additional information. S b ,1C't,~u SBD-6710 (R 05/91) Date In a rs,Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: ` r x I DILHR ' SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code C~ Cr0 x o.°...M,.,..~ J STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than o!~ & f 5-q -7 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION C Y4,549 %4, S /S T , N, R lo4 E (o W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # rN U~ - , 14 aZl; 3 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER L - 4" AA04F R1 II. TYPE OF BUILDING: (Check one) El State Owned VILLLL.AGE : r NEAREST ROAD CEL TAX NUMUItK(b) M a= ❑ Public YN 1 or 2 Fam. Dwelling-# of bedrooms PARNg. III. BUILDING USE: (If building type is public, check all that apply) - 70 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 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 in line A. Check line Bit applicable) A) 1. 9 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 # - 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 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12.ABSORP.AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE TO REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) cep, to 6- ELEVATION TO '570 8 86,0 Feet III- ?y, Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 000 S Lift Pump Tank/Si hon Chamber F1 LJ 1 11 El I El E3__ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumb Signature: (No Stamps Business Phone Number: - - 3205- sy -66s Plum er's Address (Street, City, State, Zip Code): S8C c NEW 7-9. L r a IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date slue Issuing Agent Signa a (No Stamps) Approved ❑ Owner Given initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & 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 th.~ time of reni ii al any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisiorfs to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Fo-:t i_ 6399) to be submitted to the county prior to installation. 5. O rlsite sewcagr, ;systems must be properly maintainned. The s,?ptic tank(s) m. t be -f t:y a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local coclf: ao - wiistrator or the- State of Wisconsin, Safety & 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 omplete of bedrooms if 1 or 2 Fami'y Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank repiacei(len:, •(.connection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption systern information. Provide all information request4d in ##1-7. Vii. Tanti :reformation. Fill in 1^s :a..parJty of every new and/or exis ,-l tank, list tt'e total u Ior ; mimb(ir of yanks and manufacturer's !,;r)icate prefab or site coast, ur_lod and tank nate(iai !!i >te to, all sep? p^_imp/siphon and nc;(lirg tanks for this 1y::.iem. Check uxperimentcl : apn~va~ p ` _;:inks received experi l;; ,Jal product apps 1 fr(.m DILHR. Vile. Responsibility statement. inslalling piurn~Ier is to fill in name, iwerlse nwnbe~ with -i,~ ,!ctp, prefix (e.g. MP, etc,), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Ccinpiefe r:k; m:: and specification- not smaller than ~3xs x 11 inches m.~vf hr < ubmittec t) i cowlty. The c!'IS Z;: de the foliow'-g: ~);(it o!an, drawn to scale or with l,: dimeil';i'." it F,;tl, tar !f f_ fheF t ? ? 3':{'.rit tanks; biiildln S84' p s g f wale,* ctte r : a.vice- . iphoo ta.iik ,iic,7i t o ikon boxes; so4i i „;i~~ri iy8te~ri`:•, i ,i.in-F.,n( system It ;d 4 G'. 'he bu ding se ~_o ) nOflZUnta• a.,,~ Vv;, f;a. `~levritic^ i'+fe;r i,.; ~intS: e mpiete specifications for pumps and controls; lose volume; elevation difterei ce fri(i loss. pump performance curve; pump model and pump manufacturer; D) cross section of the soil absc:,lition 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 ci-eation of surcharges (fees) for a number of rec?ui-Je,+4 P,,'io aces which car, ~groundwater. Cohecte through Jl-,ale surcharges are s, c,, monitoring r, ,.r ~ .,v,, tee. - waIer contaryi,nation investiuations and establishmierit of standards. SBD-6398 (R.11/88) % N82020'15"W (V 392.00. • a rules and regulations (i.e., vetlands, 33 !1 contact the St. Croix County Zoning NE 1/4 OF THE SW I/4 SEI/4 OF THE SWI/4 TI i LOT-19 / 1 1.62 AC. 70,419 S0. FT. , survey stake,. or obstruct vision along i monsin Statutes. Utility lasesents as , the right to serve the area. 3.1.9 1 A h' ~ ~ / N6go •W 44S •5° "p LOT do 1 S16'S8'46 DEDIC I AT~ %00. 1.62 AC. p0 Z F 70,608 SO. FT. ' - / 85° LOT 's ~41.'S~ a, 17 MG R 5A G ~rt~o - LOT 16 1.48 AC. 19 64,685 SO. FT , - - N~ LOT, 15 $ 1.48 AC. 64,638 SO. FT 3 A , \6 2 4 1.70 AC, v►~ 2 e" . cjZ _T bcJ, 29~ " o 4a LOT 14 * 73,944 SO. FT. >a~- w 1. 76 AC. N62 . v~ 76.850 S0. FT. Nom, \ OQ 2C) \6 pF ,oa <1 Mc~ Aa \06~ 5t / tNREAO 00 i 6°2 22A °O 3 `G I v 03 7 7 0 SHEE T 2 OF 3 SHEETS ~,r S'c/1 y0 PUC Ut=h r P floe- ' f4P/~ltov~~a cbu~2 3 F~, 9y 63 GF /lDc r AF < G dno DOHA- ° (ILK G" L L, 90.63 -xxr 15a' p ~P~ vim' PRDpaSEi' ~L ® J Pf?0 pOSCD GARAGL W /~OUSL J ~ /OCb G L 81~J --K- f°lc ~ ,2-5jc~7' TR~ivc~ES = 12~~ D _ L7...-- l 86- LT s f r~:F- p j i sy o 83 ToP ~f %#11V WAGL E4, /00,0 D/~Acv~iv~ FoR ` L:::- 7-56-Y6 D RAWIru ~Y p33 ;?/,Z T/' 4 UL S-86 Oil L L iFr v/LC--GV 72 ,A C!1 ©/~r~~s~ri GUS` _ syo,2 S- w+onsin Department of Industry, SOIL AND SITE EVALUATION REPORT' Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. e ~ UNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Pla u includeiit c R o rx fVC5L # not limited to vertical and horizontal reference point (BM), direction and % of , scat I.D. dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATIO`? Jf RE DBY DATE PROPERTY OWNER: ERTY L a#4041,' kl'c h,4 f?D 577-o v T . 114 SW 5 T 3/ NCR / E (00 Vic 4 V4 , PROPERTY OWNER':S MAILING ADDRESS L SUBW alE 35'3 14 w.4 T 0 ~Et~ 7-R. f ~ . CITY, STATE ZIP CODE PHONE NUMBER [[0A:]]6:" _ _ N N REST ROAD I+v SopJ 5yol(V (7i5)W-(v731 $ PRAgZie- wy. Cc l ,t ew Construction Use I q--fiesidential / Number of b6drooms 3 +0 4 Addition to existing building ( I Replacement ( I Public or commercial describe Code derived daily flow y°oy gpd Recommended design loading rate - bed, gpd/ft2 trench, gpo1ft2 Absorption area required d 3/ bed, ft2 73O trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 ' trench, gptf ? Recommended infiltration surface elevation(s) SE_W t~ • 3 ft (as referred to site plan benchmark) Additional design / site cons rations Parent material 9CS I t d ylPKli/IIVp 7-" Flood plain elevation, if applicable ft S = Suitable for system CONWIO AL MOUND, IN-GROUND PRESSURE 7 AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem [Lys 11 U B-9, O U 9-6- O U 0-87 0 U 83-0 U O S 04- SOIL DESCRIPTION REPORT N1/? = Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/f{ in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. Bed Trench 0_0 10 fie 31~1 140 5- .2- F .7 2 17-0b lo y/P Y ~s / cs 'f 7 • E Ground 3 o 00 75 yk S. 4 S 7 f! elev. y~ . f--L- ft. Depth to limiting tact a i Z Remarks: Boring # 0.20 /o YR 31~S /40 S /IC 7^; • ~ 714 Ground'. 3 °1-J`O 7. • S. - -7 S' 5v' 7.6, ft. Depth to limiting factor If Remarks: T Name:-Please Print R d (3 E R r 21 L (3 R I C L\T' Phone. 715= 3&_ S 1 8 JC Address: -f- CSTA 1 Signature: Ulbricht s Date: CST Number: na...#e a-an Cnnauttanta PROPEWYOWNER R~ ,pD S-fr~~T SOIL DESCRIPTION REPORT Page Z of PARCEL I.D. ! AYIE if 111Ere Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourd3y Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rerxh 0 to Y 3,i S sh S cS 2--F --7 .8 -~0 -75YRY/e - S. O s - - 7 •6' Ground elev. si. a~ ft. ~ Depth to limiting factor t Remarks: Boring # $ / o 31 le' s o s d1 k - _ Ground elev. ~ft. 3 Depth to i limiting factor (~p l Remarks: Boring # p -1 ~o yR 3/ 5 z /0 Ye Ground:. 3 7-5 YP, t S 4dX11- 1- • ? elev. 5"/.-( z. ft. } Depth to limiting = i" factor It Remarks: Boring # { 4 i Ground elev. (t. Depth to limiting factor W o. fi U1 h 4oT w 91._ _ N _ . • - w ~ W _ c~ppCD N fQ s L N W o C~ G ro G N - - n_1 0 (tr m Q . • o ----r . r--~ T 70 ° rn I 01 Ri rn - / r d nedustry, Labor and Humenumen Relations SOIL AND SITE EVALUATION REPORT age -z. of Labor ' P 3 Qivielor4or Safety A 8utlding4 in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but ST. c R O 1• K not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. A dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION ;Vi'G h A RD 577-o u 7- GOVT. LOT -5F 1/4 SW 1/4,S T 91 N,R /9 E (oo PROPERTY OWN~R':S MAILING ADDRESS LOT t4k~ W-# SUBD. NAME OR CSM A 135"3 W.4 7-0,e,~5C TiP • -,4& /5r 18e-,vX> CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE N NEAREST ROAD tfU So.,3 5y0f6v (;715)5q,?-(0731 5rh PRAwler- cc Ipt" ew Construction Use ( 4-0esidential / Number of b6drooms 3 4 ()Addition to existing building I ) Replacement ) Public or commercial describe Code derived daily Now y °o(~ w Recommended design loading rate 9 bed, gpd/ft2 ' 001rench, 9pd/ft2 Absorption area required ASE, 112 75 0 trench, 112 Maximum design loading rate bed, gpolft2 • trench, gp"2 Recommended Infiltration surface elevation(s) S&;a 1~A • 3 ft` (as referred to site plan benchmark) Additional design I site cons rations Parent material SCS t t A6VX&1j1f Qp 7- Rood plain elevation, if applicable ft S =Suitable for system CONWIO UL MOl1N~Q U IN19--r 11 .rMMDD U PRESSURE AT•rRA SYSTEM IN FILL HOLDMIO TAM( U- Unsuitable for stem rM'$ L c4e o U 91r- U O S SOIL DESCRIPTION REPORT 4/R::: IvOTI ~PEcoN/r~NfJED Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou rd3y Roots GPD/ft In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. Bed Mench 0-17 10YW31~1 2- .7 Z yo lo yx y /s / C.57 'f . 7 .61 Ground 3 Q•~ 75YR / S. O S dt 7 elev. it. Depth to limiting factor~ Remarks: Boring # 0-20 10YR 3/ /S 140 S 7^ • t7 17e .7 -74-0eqsa '7 Ground S7•!Z it. Depth to limiting factor ,r Remarks: TName:-Please Print R d 8 ~ R r ~ L ~ R I.C ~ T phone. 7~S ~ . ~ ~ p 5 Address: CST -f Signature: Ulbricht ~ ~ _ J. Private Sewage Consultants Date: CST Number: PROPERTY OWNER R~c~iq~D S-f~ ~T y 301E DESCRIPTION REPORT pageZ Of 3 PARCEL I.b.! 611 T~ PIE- R/Vak 8&-AJP Boring # Horizon Depth Dominant Color Mottles Texture Structure wfttence Barby Roots GPD/ft In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. tied Mordi 0-6, 10 Y 31~1 AM 3 ,f& cS Z .T .8 (,p- fo 75 YR y/e . s. a .5- - • e Ground elev. / Aj ft. Depth to Nmiting factor f Remarks: Boring # p . 8 ! O y 31 z ' fig' 7•,S ,p % . S S - • ? Ground elev. Depth to limiting factor Remarks: Boring # 0 -fj- l0 YR 3/y 5 14o g 16 '(0 YR Ground 3 - D 7.5 YR elev. 5'y~ rt. Depth to timilIrV factor it Remarks: Boring # 13 Ground elev. It. Depth to limiting factor O_ C2 I- ~ OIL ~ ~J 3 fi _ A UJ N 10 of u M m ~ O C6 fill C)CE) Ca C CC) W Q- rn 15-3 'o ~ri7 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS a,.I,- / 7 F~"mac rs ~J PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE J i rc PROPERTY LOCATION 1/4, 1/4, Section T N-R W TOWN OF ~TGi /G~/r ? ST. CROIX COUNTY, WI SUBDIVISION ✓ w~S~ LOT NUMBER 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 year expiration date. SIGNED: 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 ~r Location of property 1/4 1/4, Section ,T N-R W Township mailing address; :2 jP~Sp~ Address of site y / Z subdivision name Lot no. other homes on property? Yes.9e' No Previous owner of property,- Total size of property ZU Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume/ y Z and Page Number Q4-1-- 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. - 5y7 3 ~y , 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. 557 Ny Signature of Applicant Co-Applicant Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 547344 VOL REGiSTER'SOFFlCE ST. CROIX CTY., WI Richard O. Stout ReedbrRe=d This Deed, made between J U L 2 6 1996 . Grantor, at 4 :15 P. and Robert W. Swanson Register of Deeds Grantee, Witnesseth, That the said Grantor, for a valuable consideration RETURN TO IO~OD conveys to Grantee the following described real estate inSt. Croix ~~be~,r. ~ , S (,~QI'1$0 County, State of Wisconsin: I n^ Lot 15, Plat of Apple River Bend, Town of rVl j~ / Star Prairie, St. Croix County, Wisconsin. Tax Parcel No: This is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And_ Richard O. Stout warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, rights-of-way and covenants of record, if any. and will warrant and defend the same. Dated this yy3 rO day of July 1996_. (SEAL) J_0_~ (SEAL) Richard O. Stout -(SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN 1 es