HomeMy WebLinkAbout040-1233-00-000
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER ,R,,,/
®.O
ADDRESSGu/S
SUBDIVISION / C S M # Cd u,, 6 V!,.Z LOT # 2
SECTION T N-R W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/6-0 ,aao
w..lC
1
i
INDICATE NORTH ARROW
I
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: a,S I
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: 6zQe
Setback from: Well House' Other
Pump: Manufacturer 5 c c d!!~G e:;., -rModel# Size
Float seperation Gallons/cycle:
Alarm Location 14d1
- 5 -I---
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
Distance & Direction to nearest prop. line: 34'!
~ o
Setback from: well: House ~D Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet:
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: s~
LICENSE NUMBER: INSPECTOR:
3/93:jt
in Department of Industry, PRIVATE SEWAGE SYSTEM County:
Lab a d Human Relations INSPECTION REPORT
S§Ifetf and Buildings Division
(ATTACH TO PERMIT) Sa ' rg Pe .
GENERAL INFORMATION 262373
Permit Holder's Name: ❑ City ❑ Village kAlTown o : State Plan ID No.:
KNAPP, RAY TROY
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
b A9600184
TANK INFORMATION LEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ao Benchmark p, O
Dosing ?5
Aeration 61 Bldg. Sewer S/5 ` b b5'
Holding St/ Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet n~
TANK TO P/ L WELL BLDG. Ae Intake ROAD Dt Inlet 16a,V5 '
Septic r r 15 NA Dt Bottom 7D ' g'
NA Header/ Man. FS a
Dosing G, 7 0?. a '
Aeration NA Dist. Pipe _-7 9 -7 Holding Bot. System -7,77 ia( ~
. -7
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number /0 GPM
TDH Lift i ISM Frictions System TDH /d s" 'Ft
Forcemain Length, /5 ' " Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width r Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
LEACHING Manufacturer:
DIMENSIONS S5 DIMENSIONS -I- I SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Type O CHAMBER Model Number:
System: bdw~ 60, "/D }'SU' V114 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: TROY. 3 . 28. 1 9W, l~SS~E~ SW, LOT 20, TOWER ROAD
Plan revision required? ICJ Yes ❑ No
Use other side for additional information. 9 02
SBD-6710 (R 05/91) Date sp o ' Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: t
i
Safety and Buildings Division
r~■~'lr.R SANITARY PERMIT APPLICATION, BureauofBuilding Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, Vbl 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County r D '
than 8 112 x 11 inches in size. /
• 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 ❑ Check if revlsioll T~pr4Gidusplic tion -
[Privacy Law, s. 15.04 (1) (m)}.
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Propert Owner Name Property Location
y 1/4, S T' , N, R fp E (or)~o
jr- 114
Property O ner's ailing A dr ss Lot Numb Block Number
62377 C,'
City, State Zip Code Phone Number Subdivision Name or CSM Number
W& V/
II. PE F BUILDING: (check one) ❑ State Owned It~ Nearest Road
❑ age xw
Public 1 or 2 Family Dwelling - No. of bedrooms o
. own of e,
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo d Y6 1,23 ® d
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10E] 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 onlyone box on line A. Check box online B, if applicable)
A) 1- rWNew 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
11E] Seepage Bed 21E] Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 (-Seepage Trench 22E] In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14E] 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
w 6 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) rGG Ye Elevation
5-09 -7 tJ- d ,lJ dC Feet /D. ;1" Feet
VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks
Septic Tank or Holding Tank rf 1L RL ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: N Stamps) r P PRSW No.: Business Phone Number:
Plumber's Address (Street, City, State, Zip Code)-
cJ !9 m e ;W l sow r),' -_1/62
7
IX. COUNTY / DEPARTMENT USE ONLY
(Includes Groundwater ate Issued IS I Age t $I natur No Stamps)
❑ Disapproved Sanitary Permit Fee Surcharge Fee) g g ( Approved ❑ Owner Given initial 4 ~
Adverse Determination 16
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SOD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
y ~ s r
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 ne-4 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) Lobe 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, numbe:, 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 into 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.
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PAGE (;F
' PUMP CHAMBER CROSS SECTION AA1G SPECIFICATIOU5
VEUT CAP
4"C.I. VENT PIPE
WEATHERPROOF APPROVED LOCKIRIG
JUNCTION BOX MANHOLE COVER
- 25' FROM DOOR,
WINDOW OR FRESH 12"MIU.
AIR IAITAKE
i
GRADE I
- - 18" mi A1.
COWDUIT
IB"MIN.
11~
INLET PROVIDE I -
AIRTIGHT SEAL
A
I
I I I
I ALARM
a I II.
I 1
*APPROVED I oN
C JOINTS WITH I
ELEV_ FT. APPROVED PIPE
3' ONTO PUMP ` OFF
D SOLID SOIL
L CONCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E SPECIFICATIOA.IS
DOSE h/
TANKS MANUFACTURER: IJUMBER OF DOSES: ` PER DAy
TANK SIZE: ~d GALLONS DOSE VOLUME
INCLUDING BACKFLOW: GALLONS
ALARM MANUFACTURER: t ~ 12.--4,g-trrn
MODEL NUMBER: 10/, 42 !CAPACITIES: A = 61UCHE5 OR ~ CALLOUS
SWITCH TSPE:
~ B = IWCHES OR ,2 GALL01J5
PUMP MANUFACTURER: r5D G=IAICHES OR IS7~CALLOUS
MODEL NUMBER: - -?,P 7 / D- IMCHES OR l,Sd GALLOWS
SWITCH TYPE: ~Ge/ MOTE: PUMP AWD ALARM ARE TO BE
MIIJIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. l_ FEET
+ ~~M,,/~IMIIMUM NETWORK SUPPLY PRESSURE , , , . ' . , -AV*-- FEET
+ FEET OF FORCE MAIN X Ll _FYOFZFKICTIOU FACTOR.-It- 2_ FEET
TOTAL DH JAMIC HEAD = 3 ? FEET
INTERNAL DIMEWSIONS OF TAUK: LENGTH ;WIDTH ;LIQUID DEPTH
SIGUE D: LICEMSE MUMBER:nATF*
3871
Submersible MODEL:
SIZE: 3/4" SOLIDS
Effluent Pump RPM: 1550
HP: 0.4
METERS FEET T
25
i
7 I
w 6 20
:E 5
Z 15 , ~
4 -I - - I- - I-- - - -
O 3 10
~ I_
2
5
0 0--
0 10 20 30 40 50 GPM
0 2 4 6 8 10 12 M3 /h
CAPACITY
[qGOULDS PUMPS, INC.
58SEU F4US WW NOW 0$49
O 1988 Goulds Effective October. 19&
Pumps. hc. SPECIFICATIONS ARE SUBJECT TO CHANGE WTTNOUT NOTICE PRINTED W USA
9 of 3
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT
Labor end Human Relations
Division of Safbty & Buildings in accord with ILHR 83.05, Wis. Adm. Code CO i ,D
Croix -r
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 3 ~g95
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P w LLD
dimensioned, north arrow, and location and distance to nearest road. R VfEN(ED BYyx DAT
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION '''arr
PROPERTY LOCATION
PROPERTY OWNER: GOVT. LOT SE 1/4 SW 1/4,S3 T_-~28 for) W
ichard Stout LOT # BLOCK # SUBD. NAME OR CSM #
PROPERTY OWNER':S MA!IING ADDRESS 53 na ` o z d
CITY VILLAGE MOWN NEAREST ROAD
CITY, STATE ZIP CODE PHONE NUMBER ❑ Tower Rd.
TJUA-zrin. _j 4q -31
3 Addition to existing building
F ruction Use Residential Number of bedrooms
nt Public or commeraal desai• 7 bed 2 8 trench, gpolft2
aily flow 450 gpd Recommended design loading rate 9P
. 7 tied, gpolft2 •8 trench, gpdm2
Absorption area required 643 bed, ft2 563 trench, 9 Maximum design loading rate
106.90 ft (as referred to site plan benchmark)
Recommended infiltration surface elevation(s)
na
Additional design / site considerations Flood plain elevation, if applicable na It
EParent material stream terrace
CONVENTIONAL ®S D ❑U IN-GROUND U D U ESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
itable for s ystem m S ❑ I ®S ❑ U ❑ S ®U ❑ S MCI
suitable for s ste
SOIL DESCRIPTION REPORT GPD/ft
Depth Dominant Color Mottles Texture Structure Consistence 1"y Roots Bed Trertcit
Boring # Horizon in Munsell Du. Sz. Cont. Color Gr. Sz. Sh.
l 2msbk mfr 9w 2f .5 .6
1 0-16 10 r2 2 none
mfr 9w If • 2
2 16-30 10 r4/4 none sic l 1 f sbk
5
sl lmsbk mvfr gw na •4 •
Ground 3 30-39 7.5 r4/4 none .
elev. ml na na .7 .8
110.5ft 4 39-84 7.5 r4 6 none s osg
Depth to
limiting
+841'
Remarks:
Boring # l 2msbk mfr gw lm .51: .6
1 0-13 10 r2/2 none
2 > none s icl 1 f sbk mfr
2 13-27 9w •
10yr4/4
3 27-37 7.5yr4/4 none sl lmsbk mfr 9w na •4•5
Ground os mvf r na na • 7 •8
1elev. none s
4 37-82 7.5 r4 6
10. A.
leoth to
;tiling
tactor
+82
Remarks: Phone: 715-246-6200
CST Name:-Please Print Gary L. Steel -
Address: 1554 200th. Ave., New Richmond, Wi. 54017 10-25-95 CST Number:
- Date:
PROPERTY OWNER ' 'Richard Stn„t
- SOIL DESCRIPTION REPORT
PARCEL I.D.. pendin., . Page? of 3
Boring # Horizon Depth'' Dominant Color Mottles
Qu. Sz. Cont Color I Texture Structure Consiste ce
n I GP0/ft
. k Gr. Sz. Sh.Y I Roots
r3 3 none I Bed iTrerch
a
10-21 10 r4 4
none sicl lfsbk
Ground 3 21-31 7.5 r 1 f ' 2 i ' 3
elev. S1 lfsbk mfr na
110.t5 4 31-82 7.5 4 na '4~
Depth to . 7 , g
limiting
factor
+8 "
Remarks:
Boring #
`1 0-14 10 r2 2
ne 2msbk mfr
4 2f .5: .6
2 14-24 10 r4/4 none sicl lfsbk mfr
9w 1f .21 .3
Ground 3 24-34 7.5 r4/4 none sl lmsbk
mvfr na na .4 .5
elev.
109.2 ft. 4 34-80 7.5 r4 6 none
s osg m.l
na na .7~ .8
Depth to
limiting
factor
+80"
Remarks:
Boring #
l 0-13 10yr2/2 none
1 2msbk mfr
5 gw 2f . 5 .6
2 13-24 10 r4/4 none sicl lfsbk mfr
::....;:.::.gw 1f .2 .3
Ground 3 24-36 7.5yr4/4 none sl lmsbk
mvfr na na .4 .5
109e15 ft. 4 36-80 7.5yr4/6 none
s osg ml na n .7 .8
Depth to
limiting
factor
880
Remarks:
Boring #
Ground
elev.
ft.
1
Depth to
limiting
factor
i
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 SE4SW4 S3-T28N-R19W New Richmond, WI 54017
MPRSW 3254 town of Troy (715) 246-6200
I lot #53-Country Wood
N
1"=40'
BM.= top of Sz section county survey marker C el. 100'
r
`r
Y (eo(
P) I
Gary L. Steel
10-25-95
STEEL'S SOIL SERVICE
GarY L. Stgel Richard Stout 1554 200th Ave.
CSTM2298 SEkSW4 S8-T28N-R19W New Richmond, WI 54017
MPRSW 3254 town of Troy (715) 246-6200
lot #53-Country Wood
N
1"=40'
BM.= top of S~ section county survey marker @ el. 100'
~a
DIV
`1n`
io°
LA~'
Gary L. Steel
10-25-95
PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2
PARCELIAI ' pending
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consists Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ~GPD/tt
ed ITMM
10 r 3 3 none 2msbk Mfr cly 2f
.5 • . 6
3
.&M A. j .
2 10-21 10 r4 4 none if .21 .3
Ground 3 21- 1 2.5jr4A none sl lmsbk mfr n na A! .5
i
110.X15
4 31-82 .7 .8
Depth to
limiting
451
Remarks:
Boring #
x 1 0-14 --!Ovr2Z2 none
mfr w 2f .5j .6
2msbk
fg
4 .
:x 2 14-24 10 r4/4 none sicl lfsbk mfr 9w if .2: .3
w$
Ground 3 24-34 7.5 r4 4 none sl lmsbk mvfr na na .4 .5
4 34-80 7.5 r4 6 none s osg ml na na .7~ .8
109.2 ft.
Depth to
ng
Immiitir
+80"
Remarks:
Boring #
l 0-13 10 r2/2 none 1 2msbk mfr 9w 2f .5 .6
Y:~ 5 <Y
" 2 13-24 10 r4/4 none sicl lfsbk gw mfr if .2 .3
Yom:::
3 24-36 7.5yr4/4 none sl lmsbk mvfr na na .41 .5
Ground
109075(t. 4 36-80 7.5 r4/6 none s osg ml na n .7: .8
Depth to
limiting
+80"
Remarks:
Boring #
Ground
elev.
tt. i
Depth to
limiting j
lector
i
Remarks:
ef~-'f ZG x'1(1
wsstscnsm Industry, SOIL AND SITE EVALUATION REPORT P 1 of 3
AAbol•and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. e
dimensioned, north arrow, and location and distance to nearest road. Mndin
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Richard Stout GOVT. LOT SE 114 SW 1/4,S3 T 28 AR 19 -&or) W
PROPERTY OWNERS MAII.ING ADDRESS LOT a BLOCK # SUBD. NAME OR CSM #r
na r_
CITY, STATE ZIP CODE PHONE NUMBER [:]CITY [:]VILLAGE kWOWN NEAREST ROAD
( Toner Rd.
Ix) New Construction Use { aq Residential / Number of bedrooms 3 ( J Addition to existing building
I J Replacement ( J Public or commercial describe
Code derived daily now 450 gpd Recommended design loading rate • 7 bed, gpolK2 . 8 trench, gpolR2
Absorption area required 643 bed, h2 563 trench, h2 Maximum design loading rate • 7 bed, gpdm2 - 8 trench, gpdM12
Recommended infiltration surface elevation(s) 106.90 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material stream terrace flood plain elevation, it applicable na R
rU=2nsguitable ue for system CONVENTIONAL MOUND IN•GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
for stem I us O U I ®S D U ® S D U ®S D U D 5 ®U [Is W -1 1 SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence
Roots GPD/fi
Bound3y El
in. Munself tau. Sz. Cont Color Gr. Sz. Sh. Bed ttmdt
1 0-16 10 r2 2 none 1 2msbk mfr gw 2f .5 .6
I 1
~t: xJYxtJi
2 16-30 10 r4/4 none sicl lfsbk mfr gW if .2 .3
Ground 3 30-39 7.5 r4/4 none sl lmsbk mvfr 5W na .4 .5
elev.
110.5fL 4 39-84 7.5 r4 6 none s os ml na na .7 .8
Depth to `
limiting
+~4" {
Remarks:
Boring #
rte; 1 0-13 10 r2 2 none 1 2msbk mfr gW lm .5 3 .6
IN" 2 2 13-27 10yr4/4 none sicl lfsbk mfr gW If .2': .3
Ground 3 27-37 7.5 r4/4 none sl lmsbk mfr 9W na .4 , .5 11
110. -82 7.5 r 6 none S os mvfr na na .7 .8
')epth to
ailing
iac
g Zr
Remarks:
CST Name.-Please Print Gary L. Steel Phone: 715-246-6200
Address:
1554 200th. Ave. New_Ricbmond, Wi. 54017 10-25-95
C:wwen ww• nets' rAT Nswnhw-
3UH-P4-1996 08:57 P.01
STC»103
SEPTIC TANX MAINTENANCE AGAEEMNT
St. Croix County
OWNER/BUYER
MAILJNG ADDRESS
PROPFAM ADDRESS ~j :~2
(location of septic system) please obtain from the Planning Dept.
CITYISTATF,
PROPERTY LOCATION ><!40 114, Station , T-.. ...N,R...~.,.~w
TOW1i OF _ r v ST, CROIX COUNTY, W1
ao
SUBDIVISION LOT NUMBER : d
CERTIFUDSURVEY A1AP , VOLVME~~ PACE , LOT NUM ER w
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 deeded
by licensed septic tank pumper, What you put into the systcm 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 6o% of the cost
of rep(atccnient of a fuiliog system, which was in operatiou prior to July t, 1978. St. Croix County
accepted this program in August of 1980, with the requireanent that owners of all new systems agree to
keep their system properly maintainod.
111c property owner agms 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•sitc wnstewatcr disposal system Is in proper operating condition and (2) aNt inspection and
pumping (if neccstaryl, the septic tank is less than 1/3 full or'sludga and scunt,
Me, the undersigned have read the above requirements and agree to maintain the private sawap
disposal systcm in occordance with the standards set forth, herein, as art by the Wisconsin DNR-
Certification staring that your septic has been maintained must be completed and returned to the St. Croix
Couwtty Zooiiyg 017iccr + k1win 30 days of the three yeatr expiration date.
SIGNM IL~ /z
DA'Z'E:
St. Croix County Zoning Orrice
Government Center
1101 Coamichnel Road
Hudson, W1 54016 ><I/93
P.02
;JU11;04; 1996 0e:58
6 T C - ~aa
This appi iration for'm is to be completed in full and siqn
tae by the
owner(s) of the property being developed. A"Y
only re ,u).t in delays of the permit issuance. Should this
development bn intended for resale by owner/ contractor t (spec
this not Floe completed it ~the
house), property second f and should be to ined
the prof _rt.y i
^
appropriate dead1 recording.
owner of. Propert W
Location of pronerty„AW -1/4....19&-1/4 c Section
Township Mail inq address 2377 f'"
Addressorsite f` 1 ,`a !r1 l-aN t E~
d ljot no. -=---=-,D
Subdivision name
other homes on property? Yes NO
Previous owner of property
Total size of property 4V-19 _I SC.
Total size of parcel
Date pixcel was created
Ara all cornars and lot lines identifiable? Yes - No
~4-," No
Is this rroparty being developed for (spec house)? Yes
volume ..117®_ ;%rid Page Number as recorded with the Register
of Peeds
INCLUDE WITH THIS hPPLICATXOH TIM TOLLOW180%
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PACE
NUMBER AND THE SEAT, C?F THE REGISTER OF Mos. in addition, a
certified survey, if available, would be helpful so as to avoid
del*Ya of ttiv reviewing process. If tha deed description
referenc,~s to a Certified survey map, the Certified Survey Map
shall also be requirtd.
PROPERTY OWNER CERTIrxCATION
I (we) c-Ort i. Cy that all statements on this form are true to the
hest of n,y (oor) knowledge that I (we) am (are) the owner(s) or the
rroparty described in this information form, by virtue of a
warranty deed recorded in the of f ice or the county Register of
' Deeds its Document No. f and that I (we) presently own the proposed site for the sewage disposal system or I (we)
we)
obtbi.ne4l rn casement, to run the above described Propsrtin
cvnstructiotl of said system, and the hpe beenaduly recorded No.
the o (f t c r' •;r f the County Rag iatc-k • a
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0. ,IN 1-01-d -,982 7.'
Vi. 170 FAr,
31.. r' r~ Y
RTCF ARD O. SICYJP
APR 8 1996
_ 8:00
i v
,onvecs and wan-ants to RAYMOND H. IMPP and RVI41 M. KNAPP,
hushnd and holcin:, as; survivorship marital
troperty
Eor $1.00 and other . . . god anc valuable consideration
. ~ t~
the following described real estate w St. Croi-:
State of Wisconsin: County Not yet assignod
Tax Pancel No:.....__
rY Lot 20, Plat of Country Wood in the Town of Troy,
St. Croix County, Wisconsin
k~4
! TOGETHER WI1TI and SUBJECT TO any recorded easements,
covenants, reservations and restrictions.
j SUP.JECI' TO a nonexclusive easement for driveway and utilities, running with Lot 21 of
said Plat of Country tJood, which easement is more fully described on the back hereof.
The owners of respective Lots 20 and 21 shall equally divide the reasonable costs for
snow removal, routine maintenance and repair, and mutually-approved improvements, in
the entire length of said easement regardless of whether either lot may use less than
the entire length. The owners of any lot causing or allowing damage within said
easement, by installation, repair or removal of utilities serving said lot, or by any
other reason except normal use of the easement for ingress and egress of residential
vehicles, shall be solely responsible for repair thereof. Nothing herein shall
prevent the owners of either lot from undertaking snow removal, maintenance, repair
or improvements which do not unreasonably interfere with the other lu. owners' use,
without contribution from the other lot owners.
TR~4 f R i
This -1S not homestead property.
i (is) (is not) - E
I Exception to warranties;
'I U
~i
~I I)ated this day of
96
ItiEAL) 72; I~F:AI.
L)
. . - Richard 0. Stout
_..(SEAL)
l AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
STATE OF WISCONSIN ~
ss
- - - ST. CROIX llllll
. ..-----County.
it authenticated this ........day of I9...... Personally came before me this - ...day of
,I
I J 96 the above named
"
Richard 0. Stout Z"'._
ji TITLE: NI EMBER STATE BAR OF WIS'ONSIN l
(If not.. .
111
authorized by § 7063.06, Wis. Stats.)
to me known to be the per of d the
f
vrv g~n{ inatrllnnt and ak wleigcjt~ 31 mil
THIS INSTRUMENT WAS DRAFTED BY
U r
F:illiam J. Gilbert„ 1tty. - Ji
I ?l7Fi Carnn~l
V1.1; 11 (Deer,: 325
M S E MMIT D H,' 'R J pTj o
Lec3ted in part of the SW1/4 of the SIIl/4 of Section 3, T28N, R19W, Town of
'Troy, St. Croix County, Wisconsin, being part of Lot 20 of the plat of
Country Wood; further described as follows:
CC*-n n 'nq at the S1/4 Corner of said Section 3; thence N89038'39"S, along
the south line of the SS1/4 of said section, 131.23 feet to the SE corner
of Lot 20 of said plat of Country Wood; thence NOOo21121"W, along the east
line of said lot, 357.12 feet to the point of bQeg
589038'39"W, 66.00 feet to the SS corner of Lot 21 of said plaatnalsotbeing
the point of curvature of a 400.00 foot radius .curve, concave
sc-,theasterly, whose central angle measures 40015102", whose chord bears
N1!4046'1009 and measures .275.26 feet; thence northerly, along the arc of
said curve and the northwest line of said Lot 20, 281.00 feet to the point
of tangency; thence N39053141"E3, along said northwest line, 131.60 feet to
the point of curvature of a 500.00 foot radius curve, concave
northwesterly, whose central angle measurers 12016129 whose chord bears
N33o45'26.5"$ and measL.:es 106.91 feet; thence northerly, along the arc of
said curve and said northwest line, 107.12 feet to the southerly right-of-
.way of a public street; thence S62022148"9, along said right-of-way, 66.00
feec to the NB corner of said Lot 20 being the point of curvature of a
566.00 foot radius curve, concave northwesterly, whose central angle
measures 12016129", whose cord bears S33045126.5"W and measurps 121.02
feet; thence southerly, along the arc of said curve and the southeast line
of said Lot 20, 121.26 feet to the point of tangency; thence S39053141"W,
along said southeast line, 131.60 feet to the point of curvature of a
334.00 foot radius curve, concave southeasterly, whose central angle
measures 40015102", whose chord bears S19046110"W and measures 22!.84 feet;
thence southerly, along the!arc of said curve and said southeast line,
234.64 feet to the mint of gininncrAbove described easement is for ingress and egress of Lot 21 of the Plat of
Country Wood.