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HomeMy WebLinkAbout040-1225-50-000 -0 0 aa) o N ^ 0 C=; c m M C o c co I 0 N o y 0 V x C N ~ a) L U C m N N O N O C a z c is W c O 0 O a N 3 ~ z rn C v £ o Z co > d m 0 I- Z C O O z C U ~ o N fA F- O N z c E -o C a~ m A O a a~ M (D ,It N C •N a L O C C O U Z ~ Z O O N z E N R CL (D (0 'I O ~ d i a) ~ O O O j O G G a L ~p N N O N y N j 0 0 V,~ U~ _ H H H IL _ N N 0 0 0 z o o • *v c a a a CL ~ N 7 CO CO N V) J U - 60) i OOi } CM _0 N ~~V O 7 0 0 J N O O N ON C O r E t\ M (a CL It 6 d Q co v N ayi GO Ai _ w c o 0 0 Y W c c a- 0 Oo 00 r LO ~ C C Y 12 'O N N N L6 3: a) In c c V _C N 0_ O L C_ a) N O t~ M N O F- O O 'O - CO i..i N T O N L • Yr, OT 0 2 U~ [n (6 N r, y O O H N O c2 n O r~+ w V ~ E c c t A V a O c V I STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Kiln n Al 05 42 i ADDRESS- SUBDIVISION / CSMJ LOT SECTION_ 9 T__Zg _N-R__/ W, Town of Td 1// ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM - -ol 71' 1 -y t i. N INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to centor of ~~r; t BENCHMARK- f ~r C pl ALTERNATE BM: r SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: buJvd kS Liquid Capacity: lZ6- setback from: Well House 171 Other Pump: Manufacturer AJ'A Model# Size Float seperation Gallons/cycle= Alarm Location ':SOIL ABSORPTION SYSTEM width: J Length ~ Number of trenches Z Distance & Direction to nearest prop. line: Setback from: well: / House.__ 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: LICENSE NUMBER: INSPECTOR: /✓j r 3/93:jt Wisconsin Deparfinentof 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 268602 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: MCCOSHEN, KEVIN TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: DD ' r1~ c2~ TANK INFORMATION ELEVATION DATA A9600300 i P- TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Oo Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet qq, S TANK SETBACK INFORMATION St/ Ht Outlet lb. 0 ' 174.331 Vent ir Ito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Air Septic ~a :5 49 '7 / - ' NA Dt Bottom Dosing NA Header / Man. 1717' 9 ? 56 ' 4S. S ' 41 V Aeration NA Dist. Pipe Holding Bot. System 13. x,08 S PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width _ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS off-- DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION TypeO _ ` Moe Number: System: c}~ p OR UNIT 15- 0 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.9.28.19W, NW, SE, BRIANA LANE , Lli-j fl /00. Plan revision required? ❑ Yes ❑ No Use other side for additional information. v,t SBD-6710 (R 05/91) Date AspWctori[sl Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division %Z TV SANITARY PERMIT APPLICATION BureauofBuildingWater 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 Croix than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number A1(/0/_ Q0 P The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop Owner Name Property Location e y V? vv 107r- Ccs AA ot. 14 1/4,5 T -76 , N, R q k(or) Propert Owner's Mailing Address Lot Number Block NurryM r &41 ' City St at Zip Code Phone Number Subdivision Name or CSM Num f J v/ (115 )3 ~ l-3 ~ odor 11.[5 11 . TYPE OF BUILDING: (check one) ❑ State Owned E] ity Nearest Road ❑ Village ❑ Public 1 or 2 Family Dwelling - No. of bedrooms ` Town OF 1 old) /iG nu 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo j)qD _ 2zc; s 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. P~ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System ___System_----- __TankOnly______________ ExlstingSystem _____ExlstingSystem 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 12P 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) T/ 4f. 3 Elevation -7166 12 Feet 1d13 Feet 6 VII. TANK Capacity site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION Gallons Tanks Concrete strutted glass App- New Existing Tank-;I Tanks Septic Tank or Holding Tank ~O W Pe .G ~5 El Lift Pump Tank /Siphon Chamber CH n , ❑ 1:1 11 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber' ame: (Print) Plumber's Signature: (No tamps) MP/MPG W No.: T7/4 siness Phone Number: 3Z2 7'7Z. 321~e' Plumber's A91 ress (Street, City, State, Zip Code): ~Z r~ ' ( IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (IndudesGroundwater Date Issue Issuing Agent Signature (No Stamps) Surcharge Fee) XApproved ❑ Owner Given Initial d~ . - Adverse Determination 4 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Di-ion, Owner, Plumber 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 nurr ber(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 DA-(?Iling. 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, r;,c,.)nnection, 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, r-,uri!.:t r o, - tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for ail,,; pump/siphon and holding tanks for th s s,rstern. Check experimental approval only if tanks received experiment xod:ict approval from DILHR. VIII. Responsibility statement Installing plumber is to fill in name, license number wi h appropricd 3refix (e.g. MP, etc.), address and phone number Plurnber must sign application form. IX. County / Department Use Only. X. County / Department Use Only C ;lets n _~ficatc~s not smaller than 8 112 x 11 !nch>.5 , U:1t IK: sL. el: 1ty_ TT-le plans must rs li "s ~Jd A) plot In t7.' `l'il to scale or With CO(rl ? .~i X51 _ ic),_; ti nkttii, septic Ofiph(,n IdinGservec?; Ir 6t 1 I i _ . . '."a 1!1 ,°fYla 1_ 10^- GROUNDWATER SURCHARGE 1` _V~I C ,<<Ir !fait eC th e ' re a h e n o f su r c h ar y e-, --2 ,J ,t!Ijllf)e-C 7tc.rh. h. c1 can of feet g 0LJ:)d,v l r_ i1c noni " e.011ected n'~:~ yt:.hese vg- rcharges are used for monitoring grc.:indv.)ol and estab!isriment of <_.tandardi JOB L ~~c ~o53~e rt TIMM EXCAVATING i OF z SHEET NO. Route 1 Box 192 ,Q - 19- J WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ' i ...........s............................. rte' k > , r~ . r ''J' , . d• EJ/ /Ci tZGC mac; i . ?ice -,n' ~ p 1/ ~!Y u. r PRODUCT 205-1 Inc.,Groton, Mass .01471. To Order PHONE TOLL FREE 1.800-2258380 - too JOB TIMM EXCAVATING SHEET NO. 'Z__ OF Z Route 1 Box 192 _ WILSON, WISCONSIN 54027 CALCULATED BY r 'e, DATE g L4 (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE 1 1 A-14--t-t- f I- TV-! 1. I e~ Q tf 1... - , i U " .C',,. 3 . / 1 / - / tlj k4+4 . L_ Ad PRODUCT 205.1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE I-800-225-6380 Ulfucorisin Department of Irxfustry, SOIL AND SITE EVALUATION REPORT Pa 1 of 3 Labor and Human Relations Division of Safety & Builcl ngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY a'r- C11" t X Attach complete site plan on paper not less than 81/2 x 11 i . Plan must include, but not limited to vertical and horizontal reference point ( di a lope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dista a roa . & - APPLICANT INFORMATION-PLEASE PR L II!O CATION REVIEWED BY DATE PROPERTY OWNER: SArZB" R , S G v PR RERI LOCATION ' SVVs, ~p►`1 F-~'" V_ Nw t/4 Sts 1/4,S C) T Z8 N,R E ( W PROPERTY OWNER•:S MAILING ADDRESS LOS- BLOCK # SUED- NAME OR CSM # LSD tQ. GUflUE~P_ Nz.t - 6L_OV \ I -}j S CITY, STATE ZIP CODE NUMBER NO ❑VILLAGE MOWN NEAREST ROAD "U D S ON, w 1 5 V 0 l k8 6 t'1.~ ' R 0 ~2t wf>v14 U4i t [k] New Construction Use PQ Residential / Number o t vwr~7 [ ] Add" to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow \.SO gpd/80Dtzo03wl Recommended design loading rate b- 7. bed, gpd/ft~ ll• a trench, gpol Absorption area required - bed, ft2 - trench, ft2 Mabmum design loading rate O 7) bed, gpd/ft2 •8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 5QI!f- t-joTkZ- OQ Pn-se ' 3 , It (as referred to site plan benchmark) Additional design / site considerations Tom, c*Q1., tz ~co~tYt~.x~~ Parent material S f4~~y o vI'-..j ks 1-1 Flood plain elevation, if applicable N- P\. ft S = Suitable for system CONVENTIONAL MOUND J IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem to S ❑ U MS ❑ u E'S ❑ U 1@ ❑ U IRS ❑ U ❑ S O u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxianr Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerxh 0-11 10 iQ z!z - si 5 Z ~s~>z w► cw 3v'~ o. s o, b Z ~z.-Ly toy-tt2 Sty Sil Z'-sdh ra t. cw Zuj o.S u.L Ground 3 Zy-3y !~`te 3!~ - S~ 1r sb~c tinU`f~ cS - °'y S elev. to ft y 314-t9 tio4ft ylb s o Sg w► Depth to limiting Remarks: Boring # MT` - CtAj Zu`~' o-S `o.L Z Z ~Z_ta loy,Vz Sty - sit Z-~~6k i 3 tg-3y 1o~Ie alb - S 1 csb12 WtU`F►~ CS o.y o.S Ground elev. 14 13%4-93 luytz u!6 - S 0 sg Depth to limiting faCtDr >13t Remarks: CST Name. Please Print Phone: Arthur L. We erer 715-425-01.65 ress: - ~egQrer Soi-I Testing & Aes-ign -Service-~P.w0 Box -74 River Fa11s,WI 54022, ` Date- = - -1~IIfk576 s- - PROPERTYOWNER GI~:tSS)lyG~2 - FOiZD SOIL DESCRIPTION REPORT Page -of PARCEL I.D. # w r~~,F t i ; A Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft ill In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bounc4~ry Roots Bed Trench 3 -I0 1D`12 ZLZ - sL Z `(~sbl~ t~ h ct" 3u a• S a. b; Z Lo-t7 Lo`1R 3l stj ZHbh `M.C./-j 1~~ o,S o 6 Ground 3 t1-Z.E3 10`112 311, S 1 ~,S ~lZ wt ~S a y o . i; elev. m"Z ft, Z~ `12 ti~`1R Y~6 S o Sg ~ - 0,7 0. Depth to © Caw ►JS S I-- Gl~ limiting factor Remarks: Boring # 0~8 R zL2 g1 Z`FSbk W\,Cjr Gw 3v~ o.S o>~ ' ii Z F~- 16 L (.1 111?. 31 y - S Z Z`~' S aK Nil M o . S o, ~►ii; 3 ti6-2,7 lpI2 31L - s1 1 C- S)sw w1vft- cs - ay 11031 is Ground elev. v~\-m cAU " s Solo st2.~tv~LS Depth to limiting factor FT i Remarks: Boring # ,j ~o't >z Z1Z 1 s11 Z-~-s1~k cw 3U~ o.s lo., I, 5 4 Z 8-1~ YCY12 3d - si Z~'sbk v~`~w ~S 1 o.S o f?! 3 t6-RO log-fP-V16 S O s9 vvi Ground , * Gv_Aw ots . € ! elev. ft. © co y J n) S VA. Depth to limiting factor Remarks: Boring # Ground elev, ! ~ c. ft. ltd r Depth to limiting factor 0 Remarks: PLOT PLAN Page of 3 SCALE 1"= SO' Luo _ _ _ Y*L'w e-s T - - I I Sv L~L~LrPt FOR I B-3 4 I - - - W4 S ~}ovs E To a ~ Per LLS"T 7-S, F IL01 lmea a"te4 . WLLI. 1O ti Y SOS d~ N N ~G6, 0 ~io1 1 b'i't tih~ E S `i Sl~~'I ~L.sv /}'J7U~vS f~T ~ wl C61US`'c1IAJC-`n 111V, ~iS_IS- 5 j~~S_ _(_715 ) 475--f~1h5 T1Q€?57b_ .CST # , C3TSrgnat~fe Date Signed- TefephoneKo. _ Viscbnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & BuikSngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not lirnited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION rEVIEWED BY DATE PROPERTY OWNER: -SAsQ,g pl f G S S 111 G t? (2 PROPERTY LOCATION T11 F:6 MD NW 1/4 S~ 1/4,S 9 T ~ 8 ,N,R 1 ~ E ( W PROPERTY OWNER'.S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # y S O N. G ub u~ RAPrD - S - G LO U 1'}1 \•l S CITY, STATE ZIP CODE PHONE NUMBER EICITY EIVILLAGE WrOWN NEAREST ROAD DS 0fv, ~J ` S k/ O L C1t S) 38 6_ t3 l'1 TR 4 g2l PSl`1l4 LPcf.f~ New Construction Use M Residential/ Number of bedrooms uwlzl towrJ [ ] AdditiQn to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow ISo gpd/8V9mZU'3 "1 Recommended design loading rate 7 bed, gpolft2 . 8 trench, gpdtft2 Absorption area required bed, ft2 - trench, ft2 Mapmum design loading rate d • 7) bed, gpd/ft2 0 , 8 trench, gp W Recommended infiltration surface elevation(s) 5~ ~-joTIZ OQ Plk6e 3 . ft (as referred to site plan benchmark) Additional design / site considerations T V_elzaMi- IL"b Parent material S v-Tt.\jks 1-1 Flood plain elevation, if applicable N- A ft S = Suitable for System CONVENTIONAL MCUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for stem 14 S O U ®S O U WS E1U ® S El U [RS E )U Ej S oil SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Botxldary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends S Z S iz l~n lit v 3 v o. 51 1 O `Z 2 2,1Z Z ~Z_-Lv lo-lcz- Sty S11 Z'Fs6k 1,il i, to zu~ o.S u.L 3 Zq-3y !~`t2 31C - S, ~dk ynU`~• cS °'y 'S Ground 1" _ft y 3147 LO)4ft 4/j6 S O S3 M Depth to limiting s~y Remarks: Boring # o _LZ t O `t ~Z z (Z S 1 ` Z'~' ~b1T Inn '1t Gnu 3 v o . S o, f Z Z \Z-1.8 1~l`1~Z 31y - S1~ Z F361Z vmT - Cw Zvg o-S 3 ►g_3y 1o~te 3!6 - s1 lcsbk vVlU~►~ cS o.y d.s Ground w► - elev. 3 L) 93 t ~y t2 u 1b - S O s cj luq- Sff. Depth to limiting factor Remarks: CST Name:-Please Print Phone. 715-425-0165 Arthur L. We erer lies r_ oil-,Testing Aes gn Servlce_ P 0 _ Box-74 River Fa11s,WI -4022_ _ F, _ PROPERTYOWNER 61~1SS)JyGE=2 - ~oSZD 301E DESCRIPTION REPORT Pa9a of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend F•:X~ <,.,3•<.tk L 4 `12 Z 1 Z = s 1 Z `~s Yr► h 7. 3 u a. S a, b Z do-~'► ~ll 31 stil Z~Sbh 'M c.Zj 1 u~ o.s 6 e evund 3 t~ -ZH ti~`1 31 b s 1 ~-S bNz 'M v ~S n , y o . 10_Z,v ft Z~ 2 ti~ 2 Y~6 S O sg Y, o. k Depth to ~>u N S S G~ 4 limiting i factor Remarks: Boring # sit I -L Fs bk Y`fH cw 3u,~ C s o; 3 l~-2~ 1p~2 31(, - s~ 1 ~Sb1~ wtv`~I. c.S - ay ia. Ground elev Z~-4~ l~~ R y16 - S O ~3 w►) _ 0.7 10.f Depth to O Cau w'S solo 612..S1 limiting factor 7,q y r Remarks: Boring # z g-~~ ti~~~ 3~ - s; Z~sbtz• v~`~w ~S o.s ylb - S O s 5 w; ~ - b • 7 (n. I Ground elev. © cA, j0S S °10 tiou.3 ft. Depth to 1 la limiting factor i Remarks: 't Boring # ; } j: Ground f t. Depth to limiting factor "I r~ Remarks: PLOT PLAN Page of 3 SCALE l' = SO ' I ON lp~ 314 -71 / I I 1 SU Ll (tpLl 1°►'R FOR I $-3 I . l~l~ ~ ~ 1~t~~R~l.!►j~ ~ ~1.lOL 4 i 1DI 1-- - _ IL Loy5 i ytovSE To a~ )~-r LWT Zs' r--p- ~Z cues. wlstL 1C~ , Y St~<< a` d° N eG6, 1 t..) S`t'°P~ti-l. Zl"~hJ C~-~S ~C Z" ZU s Zy 11 ~1' t~T Tl~~` v ~,3 t..U P LsD 6 ~ . ~~'TC~-'r'11r.~ E S `i 5~~► ~1.~~ ~''1~~~uS f~T 111~I ol= c~1vS`~1~ c-t~ O~V. °tS_1S- S ~ S r= ~t5 )_x+25-r(~1 a~,.5; 140-0576 - - - CSTSignature Date Signed - Telephone No. CST # STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 4y/i2 MAILING ADDRESS L L~ PROPERTY ADDRESS S/ le!'ie-~ (location of septic system) Please obtain from the Planning Dept. 4-s a/S CITY/STATE A/ PROPERTY LOCATION A/C 1/4, 5£ 1/4, Section 9 , T Z r N-R ~y W TOWN OF Oz1 ST. CROIX COUNTY, WI SUBDIVISION G'locr~y / /Vs 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 4V10, / CCGL~ rs- Location of property 11 1/4 5' 1/4, Section T'Z6 N-R W Township Mailing address Address of site subdivision name G'/~-ev fir` / Lot no. Other homes on property? Yes ~G No Previous owner of property Total size of property Total size of parcel - d, od ~:flPS Date parcel was created 8 191-4 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume { and Page Number (a15 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. rn g;14 , and that I (we) presently own the proposed site for the se aw ge 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. SVof Applicant Co-Applicant Da e o S gnature Date of Siqnature i DOCUMENT NO. I WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA TATS BAR OF WISCONSIN FORM 2- 1882 548374 _.II-.. _ VOL 1195 PACER 5 1i REGISTER'S OFFICE ST.CROIXCO.,WI Reed is Ro=d BARBARA A....... GEISSINGER........ . i a n unrr,arriec woman AUG 19 1996 _ Grantor. I at 1:30 App -:KaQ...,. -R JAL conveys and warrants toKP-Vin..F....Mc.Coshen...ano-.- C.o].le.e.n..A- McC©%he-n-,--•husband--a-nd...w-i-fe....................... Register of Deeds ---.......-.--...._G.ran.te_e5-.. . RETURN TO in consideration-••of X1.00 and other good and V~ o~ gog valuable-,c•on-sid~ra c?n............... the following described real estate in St.r_..C.rA.1.X -.........County, State of Wisconsin: Tax Parcel No: .04.0-.1225--30-.. Lot 5 of the Plat of Glover Hills, a rural subdivision located in Section 9, T28N, R19W, Town of Troy, St. Croix County, Wisconsin, according to the plat thereof filed September 1, 1995, in Vol. 6 of Plats, Page 35, as Doc. No. 533327, in the office of the St. Croix County Register of Deeds. I Together with and subject to the rights and obligations set forth in the Declaration of Protective Covenants and Easements dated September 12, 1995, recorded September 13, 1995, in Vol. 1140, Pages 39-46, as Doc. No. 533786, in the office of the St. Croix County Register of Deeds. This i-5-_T1Qt......... homestead property. (is) (is not) Exception to warranties: Dated this Aug t. - . - - . . Is.96. . day of - - - - - - - - . . - -------------13th. u..s. ........................................•-----.....------(SEAL), ........(SEAL) Barbara A. Geissinger ...................................•-•--•-•-..-............(SEAL) - ---...--........-..-...-................(SEAL) * AUTHENT16ATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN SS. ST. CROIX_. 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