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HomeMy WebLinkAbout040-1224-10-000 y °o It p v) I ° c y 0 N 0 ti C N ~S n x i N O U 'Ct N ~ Y c N m _ z a) I IL C co ~j 00 Q ~ I I v v ~ I z N w E O z ~ y y I d m 0 c C7 O z d c co ~t ° o N z N F- O c E -p m "a 0) c a Q) N U) N C ~l 4. U O C c U V Q z F- z 0 E z N C a (D > N 01 16 LO U) co C, 0 ~r•1l co G c a m E o O N N Cf U) cc 0 N 0 0 0 z o o • m = a a a a c y co (D (D N Q W U rn 0) a) rn } 3 r- ( rn O O U m N D O Q iB ~i O O U N ~ ca O O C co C C 2 0 0 0 C:, Q "t L2 N O q y U.) o6 a LO ►.1 O' N T E N 3 r ` •Q O O H U N O N U) v ✓1 w t EL a s '2 E A U a. 0 N U STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER a,,/ c Ga mD~e ADDRESS / rSUBDIVISION / CSM#_ Soco~"~ ~6Sr LOT # SECTION T ~ N_R /Y W Town of f~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM D s t r INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ~ r BENCHMARK: Satm -e- O-14 ~ ALTERNATE BM. SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: a,C_,97r,,. Liquid Capacity: Setback from: Well 5-6 :4- House ~ Other- Pump: Manufacturer Model# Size Float seperation` Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length mss- Number of trenches -2 Distance & Direction to nearest prop. line: l4M Setback from: well: /DO'( House T'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: T PLUMBER ON JOB: LICENSE NUMBER: a-- INSPECTOR: Jr- 3/93 r if Wisconsin a Department of Industry, Labor and Human Relations PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ~1' • t=nUiA GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: CA El City E] Village (Town of: State Plan ID 4N 31.P CAMPBELL, LANCE CST BM Elev.: Insp. BM Elev.: [BM;Description: Parcel Tax No.: ~D' A96001 _539 T ANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic y o7~e Benchmark Dosing , oS. 35 Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet Vent TANK TO P/ L WELL BLDG. Air Intato ke ROAD Dt Inlet Septic 7/0 w d o - >ar NA Dt Bottom Dosing NA Header/ Man- 7' Aeration NA Dist. Pipe 9v Holding Bot. System 7,94 g ' 4s 4 3 ' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Frictio System TDH Ft L Kea Forcemain Le Dia. Dist. To weu SOIL ABSORPTION SYSTEM BED/TRENCH width -1~ Length,7_,. No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS a-1 DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O 7176 CHAMBER Model Number: System /~isref✓ /UU' J`D f ~f 11 OR UNIT DISTRIBUTION SYSTEM Header/ anii o fld 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: HUDSON.7.2£.19W, SW, SE, LOT 1, CEDAR VIEW ROAD 9 ' /G.~ t~w27z eccr / f.';.w f - 35 / ZJ G Plan revision required? Ves ❑ No Use other side for additional information. aC~ qb p+ 1,c .c SBD-6710 (R 05/91) Date Inspector's Signature Cert No ■ ie~ Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water System: 201 E. Washington Ave. " In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County ~1 than 8 112 x 11 inches in size. Q • 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 iKr~Gi3Qprevious cation JPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location S'dJt/4S~^~ 1/4,S ? Tg ' ,N,R/Q E(or)4- Property Owner's Mailing Address Lot Number Block Number S 9 df City, State Zip Code Phone Number Subdivision Name or CSM Number c✓ " (?is-)sue-~'a4° G~i:f~l.v' Id IOF BUILDING: (check one) ❑ State Owned ❑ ItJl Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms W olwn of v-t III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo a y a- Ian 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 RSeepage Trench 22 ❑ In-Ground Pressure 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 _5~6? Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Prefab. Site Fiber Ex per- Gallons Tanks Manufacturer's Name concrete con- steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank or Holding Tank a2 Q [ r ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber, ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans Plumber's Name: (Print) Plumber's Signature: o Stamps) fM!P/PRSW No.: Business Phone Number: ~ 2 ;Pv/-4-' 3 --3/.-.2 1 Plumber's Address (Street, City, State, Zip Code): tl S' ' G~ IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved E;y3 rmit Fee (Includes Groundwater ate Issued Issuing Agent Si nature (No Stamps) Approved ❑ Owner Given Initial Surcharge Fe e) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety & Buildings Division, Owner, Plumber 7 f INSTRUCTIONS 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. 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- V11. 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 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. 1 f t Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites According to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, a soil erosion control plan needs to be submitted and approved prior to the issuance of building permits for 1 & 2 family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Stan- dard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. Site Diagram Scale: 1 inch = 17-0 feet EROSION CONTROL PLAN LEGEND PROPERTY \ LINE EXISTING ' DRAINAGE TD TEMPORARY LL r y ( DIVERSION 7 • • FINISHED ("VIII DRAINAGE LIMITS OF I GRADING SILT 0ge 'I FENCE f £ All t F LI , ' STRAW BALES GRAVEL VEGETATION O SPECIFICATION TREE PRESERVATION ~SI STOCKPILED SOIL Q 1 F F 4 Please indicate north by completing the arrow below. I PROJECT LOCATION LOT I - CEDAR VIEW ROAD BUILDER LANCE CAMPBELL. OWNER LANCE CAMPBELL. WORKSHEET COMPLETED BY LANCE CAMP13ELL DATE y 2 0 quo ,~o a e ql'r, L ° r ti r~ r - r ` Wisconsin Department of Industry, Pa [ Of R^T g@ - SOIL AND SITE EVALUAT ! Labor and Human Relations r Division of Safety & Buildings in accord with ILHR 83.0 ,~•~;R , A COUNTY 12 01 K Attach complete site plan on paper not less than 8 1/2 x 11 inches in si an mud tnctuda;'Wt not limited to vertical and horizontal reference point (BM), direction an a%. slope, Wile 'oir" Y' CEL I.D. # dimensioned, north arrow, and location and distance to nearest road. IEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMA Q PROPERTY OWNER: O1 TAHES ° G/O[ZI*A. WAHPCN BROCt OT (,v 1/4,$ 7 T 2~ N,R (Q E(or0W PROPERTY OWNER':S MAILING ADDRESS L NAME O R R DG qo 50. FORK crRCLt= / CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [EMWN NEAREST ROAD f}uOSoz 01. 54011(. ('7tS) 3P - I PPS TROY cEv"Is° U/fw (-New Construction Use ( Residential / Number of bedrooms [ ] Addition to existing building [ I Replacement [ I Public or commercial describe Code derived daily flow 600 gpd Recomnfended design loading rate • f bed, gpd/fl2 ' trench, gpd/ft2 Absorption area required ed.. ft21MM trench, ft2 Maximum design loading rate S bed, gpdAt2 • ~O trench, gpd1fl2 Recommended infiltration surface elevation(s) _S.e~C. 4 •3 ft (as referred to site plan benchmark) Additional design / site considerations u S E' ~~GG.c f oa S 1 ol..c. Lug p g pSt IBS t• Q U }c o-~ 0 F S5 Flood plain elevation, if applicable N It Paren material 5C5 13 •111,T S 1 _50. 106-55, S = Suitable for system CON IONAL MOU~1a INN--GPUND PRESSURE AT- E SYS IN FILL HOLDING TANK ❑ U C~?'S ❑ U GdS ❑ U S ❑ U ❑ U ❑ S WS 13 U = Unsuitable fors stem SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rends 1 04 1011 P_ ill- Yd. 2+Sbk m, of P, CS t fi . s . ~ 0 U R31 `f' SI' 1. 2--F Sbk m..f R c S ! u+- . S Ground 3 11- 15 1-5 I R q/4 /S 1.w►• p? dA 2 S .1 etev. .S• s• JQ- loo. ft. IS -3k 1-5q R y` Depth to S 9-14,10.412 S!(e , S• f> S aQ,Q • Z I limiting } factor i . Remarks: Boring # b -7 /0 yj2 2/2-- 2 f Slak ntit of p, S (f S ' • 6o xr: 2' ~ Z, y 1 ~ t o ~lR 312-- S(~ :•>oul lu 3 17 - 3y 1 o V R 31 q s 1i fie ci s CS • Z $ Ground /~f • S . d S - • ~ . /Od • el ' ft. X13 &ip- Y6 1 Depth to limiting factor r/ Remarks: CST Name:-Please Print R o 13 E Q T L( L(3 lZ 1 C k T Phone. Address: (055 0' ~Cit_ 7 LD ROQJaz wI- 5y01& ~ --irf cSTM1y8Z Data- CST Number: y c r PROPERTYOWNER WAcHREQ (3ROCk SOIL DESCRIPTION REPORT 'Page of -3 PARCEL I.D. t L d) t '14- t ^ G EDr4 k' IRI DG-t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft M Y in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trey le R I Si I. of 56k *4Of~ s bVf .S .G 4 4 z jq-2 /o the 31 L- S I-F Sbe ~fje CES Ground 3 2- yb s vie y` ` •'fS, OCS ~S . ~o elev. it. Oe vie Depth to limiting factor Remarks: Boring # 1 0-9 10YR 'a'lt S i I, z-f SICK A.-Cf Is C'F . S Ground -3 IS- 14 t o q A 3 / Z 61 I-f S elev. - •S ~l y S. D J` aC/Q i ~o z . i~ rt. Depth to limiting factor > Remarks: Boring # o `t5 l o YR Zit si I. 2~ Sbk n«f R S If . S . I5-2(a 10VR Ra- Sl'I 1 -FS bit f2 S _ . y .S 3 -yo /oqR 314 - 5I l~5be onf~ CS ~ .q .S Ground elev. p - / D v ie A-5 Cf $ , G 1o2,~ft. c' n Depth to > G f R S © S O~ JQ limiting factor t Remarks: Boring # Ground elev. tt. Depth to limiting factor N m -1 m H w Tn Z G m rn IN. rt> N O O 4 a u Of (IN u o u i s w r n o r N L ~ r 0 r I w Y LO T C. S. M., VOL. 3, PAGE 760 NO/' 04 40 " W 925. 14' 394. 03 QI O ~ r ~ R o nj ti c 0 O v n'~ ~ m O O~ r' w'+a O O ~J O SA N .~~D_S T - 6 r v 0 Noe . 26 48 , o 22 325 85 I E /6 00 I IV I Cc e `o 'o ti 1. 4 v LI) v' 0 h ~ ~ 1 I O 0 r b ti U A 1 In O Ll~ A _ " • cp i L 1p `l) ° SN~ G a o` o e ti r Q i O Ln Q) U O y, 2 I O Cb v oti I. o to to 'An rl) o - ~ ~C b O ~ I O r 2 \ I C ~4P*EAjP .A,4 To -0A1d-1v tG P&&o Q r s-Is-crs (71'r, wA +f Rt-x.313RoC 1-r) --T0 iE-N LRRG-E' 50i L TES r i4 PEA ,7'D S0 i T Hdl.'t E5 err= PR~~~7ear a cc Wisconsin Department of industry, SOIL AND SITE EVALUATION ,y-- - / z Labor and Human Relations % ~`9 1 Page of Division of Safety and Buildings in accordance with s. ILHR 83.09 Wis. , 1'e, i Attach complete site plan on paper not less than 8 1/2 x 11 inches In size. Plan must Cou si3L a~ fr! j Include, but not limited to: vertical and horizontal reference point (BM), direction and sGSy~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. i0x APPLICANT INFORMATION - Please print all information. Revi y 0~,;,"41Y ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). e-0M G 0FFfCE Property Owner- T3VyeEFc : Property Location LAoJ Ce- OA-0 P E~~ Govt. Lot J!u/ 1/4 S~ 1/ , r ,N,R If E (or(D Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 7+4 CS 535 13) LEA4 oAJ S r. X~o / cE~it~ ~t ~v6£ <ivAh`rP>~~v,Q~Poc.E-, City State Zip Code Phone ~Number Nearest Road El city Village L'J Town CED/A~ U/~ic~ P. fNO, f" UPIOAJ w IS 5401(0 ( 7/j ) M-511 9 '4 New Construction Use: Residential / Number of bedrooms 3 _ r Addition to existing building ❑ Replacement yJ~d _ ❑ Public or commercial - Describe: /V/P = tit O j a e_d M Al iC~.y L-)&P Code derived daily flow ~~/0~O/~ gpd Recommended design loading rate 7 bed, gpd/fF ' 4f trench, gpdht2 Absorption area required / K bed, ft2 trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 ' 0 trench, gpd/ft2 Recommended Infiltration sTurfaccee elevation(s)l*Q_ p Ll . Z It (as referred to site plan benchmark) Additional design/site considerations RISE LG.u Cr NrF . /~O 7' w~ D u 0 D 1',5 TIC/' ; , Parent material 5 73 I ~O T _ ~oESS G v Flood plain elevation, if applicable it S = Suitable for system Conventional ,Mound In-Ground Pressure AT-Grade System in Fill Holding Tank 1s El U 21El U 2'S'❑ U ❑ S U = Unsuitable for system CS El U Ili 5 El U 21' SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench MCP ; 0-I /'0 !1R 2--F S bk A- -F k G 5 /0+ i 9- /G /O 3 / 5i 1 f Sb& 1w►-FR 415 / U . S ; , G Ground /O A 31q S / f S be, AIA R- Q S . , . 5 ~lev. ft. 2 7 S r eq S S 97 'j ~O L Y IP .S DC. • dp Depth to s Q r- - ' d limiting factor in. ' Remarks: Boring # t P-18 3 5 /01 5 / ~'S6,~ nM f Q-S /~i f `f :,5 Ground D S elev. 5 > - A- Si/ 5 TAEA0 6f T V , 7 Glli/~ Depth to ~rr limiting EQa to 0 //S 14- TO cur 'OF factor TO S/T~ `s,t,yP) * OA.) 3, 5 r ~Et~ 7 -in. Remarks: CST Name (Please Print) Signature Telephone No. 'k Oi-E R'T ?i1 LAI P IG I.IT T t s& ik ~lr 7~5= 3 ~(O - ~ l $ S Address Date CST Number PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 In. Munseli Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground elev. n. ' Depth to limiting factor in. , Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. n. ' Depth to limiting ; factor 'n. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) r m L w N _ G 0 Z a o N Q O a o it ~l kIN °b if c s v ~ y Q 0 - J U 4 i rn m w I z ~N J~~ 3 M o`~ r n qJN LAJ -1, kA o \ \ \ o Uk) n w °O Q) STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Za„ce e ayes. C'afhCrt~~°► M. CaMpbe l) MAILING ADDRESS S 3S - B LemoK Sf. A/. , IV W1 S 4/0/!o PROPERTY ADDRESS 1-ho Caotar View Ro*A, - (location of septic system) Please obtain from the Planning Dept. CITY/STATE H t&a S c m. W Z PROPERTY LOCATIONS 2 1/4, SE 1/4, Section ? T Z 8 N-R_L_l W TOWN OF Tr o y ST. CROIX COUNTY, WI SUBDIVISION C CA & r R i dq e. LOT NUMBER CERTIFIEDSURVEY MAP --1 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: ~DvvLCtG. C. y`~I 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. Ownerof property 6&vie-e. E, aheA Ca7N►eri14e M. C .Wliohs-11 Location of property 5 y 1/4 $E 1/4, Section 7 ,T_i$_N-R -W Township 7-rMailing address 535- 8 Let,ow g N. N. hlJsoh , wT 6N01(0 Addressofsite qZc) Cedar V,'Q.tj Rooot- Subdivision name Ceolar Lot no. Other homes on property? Yes X No Previous owner of property ~S"aw~.es d' G ~e ri a W*Arevt b roc. k Total size of property , Total size of parcel y y Acxr-s Date parcel was created -Xu vt -e. 4e 1 1 17195 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes_ _No Volume and Page Number 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. Signature of Applicant Co-Applicant T 3 Lbiq(e ' Z96 Date of Signature Date of Siqnature A F - Rkbft it DMIL UNPLA rTED LANDS N L/NE S S89' Z/'/1 "E 800.9/ O 765.00' 466.88' I O 7 3 4. 89' .rI N 0/ '0d O 71.6 fW ~TC' r^ ' 2 v 1.ZZB ACRES Q I b 97. 01Z SO.,-r ~ ~ 7T ? /ECU ~I .6B4 ACR S S 83* 45'-001 4 So- t Z o 1 J I Q 6, 9 0 3 O. f T. I O q 1 LO ! M!/S T L OMPLY 1 ~ w/T OWN or TROrb ~_----S BS s3', DRIVEWAYORO///A NCE ^ ~ W I N 22' 'o0'E r^ 3 b 3 50.00, 1 I V /92 AC.4ES t ` 'f O 95,474 SO. 0 f T• 1 • f I ? J, .,E / / f 8T.00' 1 S J iJ 1 ^ 4 ; l'Y11, 0 ?.206 aCR£S I O n Q o ;6. l04 SO.Ft. 1 1 0 1 r j. H o, a 87. 00, of J H S 8916'24„E 340. 9' e 1 1 S L/NE S£ /14 Q 1 J, ; -100' 7/1. J2' 1933. 80, n 1 589'1116 'E ~.I8•=1 1 c~ 2 m. I.OJ3 4CP.E5 ~O 3 / 5114 COR. SEC. 7r r2BN. 5E COR. SEC. 7. T28 N, 88,567 So. FT. m R /9 w, /9ERNTSEN CAP/ R /9 W., 18ERNT5ENCAPl _ 167' N ; /00, 1 -191.8/=-------- 6 ,v 89' / 6'24 'W 65 7 6' R 1 - of Post-it" Fax Note 7671 z-/._ ~pagml; A / 0 5409 18 STATE BAR OF WISCONSIN FORM 2 - 1982 V~~~~ JT ~U DOCUMENT No. REGISTER'S OFFICE FF ST. CROIX CTY., WI James B. Wahrenbrock and Gloria M. Rec'dforRecad Wahrenbrock, husband and wife holding as JUN 7 1996 survivorship marital property at 9:30 AM conveys and warrants to Lance E. Campbell and .a hc~ri nP {s.~.. (,~,~,k, ~i M Campbell, husband and wife, as siirvivnr.hi p Re Der of Deeds marital property THIS SPACE RESERVED FOR RECORDIN DAT NAME AND RETURN ADDRESS the following described real estate in St. Croix County, 22,Z State of Wisconsin: ~J i! !i it PARCEL IDENTIFICATION NUMBER I Lot One (1), Cedar Ridge in the Town of Troy. I T ER FEE I I~ j: This is not homestead property (is) (is not) i' Exception to warranties: All easements, restrictions and rights-of-way of record, if any. Dated this to day of -C , A.D., 19 9 6 i (SEAL) Qvuqnk (SEAL) it ames B. Wahren rock (SEAL) L) Gloria M. Wahrenbrock i AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, Signature(s) James B Wahrenbrock and ss. Gloria M. Wahrenbrock ^ ' Pierce County. `