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HomeMy WebLinkAbout040-1221-50-000 y O N 00, 3 C M 0 tc (1) t~j 4 O C ~ f.. M O O o x N ~ O O G I' C C p (D CJ N O O 0.6 c C N 01 fA fir p O O U O c .V E O C L.2 C _z N (t0 co U. c m co o rn a) N N ~ Q N c 3 v vl ~ z y rn W O U) .r O p z y N w a m N f- (n C Op O O z d a v IX e- N w mz v ~ o N F- e- cn a0i z N 'p O `7 ch `o as CL • N N c ~V -o s O C Q z z N d fA C NI l0 co O 04 U) 4) d .N N Q c 'g b a co co D CL a CD °o °o N N 0 U) U) U) E .9 UU-) yr F- H O w U_- N N Q. U) .O V V lL 0 0 0 z O O • ►v a) a a a g a 7 0 N N O 0 N fA U } rn rn O cli LO co oo 0 C) Z O N O O O O O _ Q- O C N N m Q ~z n m 4) .s> N N a~i m Q m !M~ ❑ m 3 H Q Ai O 0 _ C N C p Om O E Q O U w u> O O C14 u) oo O O O O C c X 0 0 0 y c US V yr _ y :2 O N N N N O O Q c N N _4 O f',y c6 ~ Y N Lf; n p' N T y N ' 7 r • 7> ~ ~ ~ 7 ~p G' tq f6 f6 U Q yy O N F- O N O ? U) zii w M M 0) E m i d7 a. 2- L: CL w • a y m y E i c c r D tea'' Om0 r`'\ y 7Q STC 104 AS BUILT SANITARY SYSTEM REPORT rl''~~X ems`: i.~ S7 OWNER A~ 1 3 ADDRESS uAnAd--A SUBDIVISION / CSM# LOT # SECTION T 'k p N-R l ! W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S e .e s INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. i Fle BENCHMARK: - T640 Of Ata &d- "'C&i ALTERNATE BM: " SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer• (Z'Cda Liquid Capacity: zoo Setback from: Well House ~S Other Pump: Manufacturer_ Avers -Model # ME L16 Size Float seperation ,5z 23 Gallons/cycle: f 72 . Alarm Location SOIL ABSORPTION SYSTEM Width: Length 6 3 Number of trenches- c2- 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: ~P LICENSE NUMBER: CP 7 C INSPECTOR: 3/93:jt a r V~ O v I r, Z S r b rr / 1 Ir (`X )y - 1 b 1 1~1 f~ t; wiscorsinDepartmentofIndustry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT 'T- CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 2 6 2 4 2 7 PbVg0er'sAL ~Itne& BONITA ❑ City ❑ Village IR Town of: State Plan ID No.: TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark A)*?,~7,; , t: Dosing -f.rU Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet 96 f Verit TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic NA Dt Bottom 94 Dosing NA Header'. S~ Aeration NA Dist. Pipe Holding Bot. System 9y Vi a. 6. PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 1Z.4 j Model Number GPM TDH Lift ¢y0~ Friction r, Systema~l TDH Ia"o Ft Forcemain Length 1 Dia. HHU Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 DI SYSTEM TO P / L BLDG WELL LAKE/STREAM LEAC Manufactur SETBACK CHAMBER INFORMATION TypeO ne A_ Q i r Mo ber: System: J~~, 90 > so Y I OR DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe {s)~ zz x H le Sizee x Hole Spacing Vent To Air Intake Length Di m \ Length Dia. A* Spacing A y (Q 3 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.) _X AS VA-3 LOCATION: TROY 21.28.19W. SE. SE. COUNTRY OAKS Plan revision required? ❑ Yes ❑ No / Z Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION COUNT v~~-nlff~ In accord with ILHR 83.05, Wis. Adm. Code St a'OlX STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 ~Aif 8'/z x 11 inches in size. Chec -See reverse side for instructions for completing this application' STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S96-40238 PROPERTY OWNER PROPERTY LOCATION Al & Bonita Dusek SE '/4 SE '/4, S 21 T 28 , N, R 19 C) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 1103 Sunset Lane 5 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER River Falls 54022 1(715 426-0595 Count Oaks II. TYPE OF BUILDING: (Check one) 1:1 State Owned EXMICKNINIK. NEAREST ROAD Tr0v Count Oaks ❑ Public ® 1 or 2 Fam. Dwelling of bedrooms PARCELTAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 040-1221-50000 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4E] Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E1 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 0 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 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 600 500 500 .6 94.4 Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App Tanks Tanks structed _T7_ 7_7 M I F] Septic Tank 1200 1200 1 Wieser Lift Pump Tank/jbdCKp0UqKW 1000 1000 1 Wieser Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): PI is Signn'atur : (No Stamps) MP/AN? No.: Business Phone Number: Paul C. J. Steiner( 6780 715 425-5544 Plumber's Address (Street, City, State, Zip Co N8230 945th Street; River Falls WI 54022 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S!Vary Permit Fee (includes Groundwater a e issued Issuing Agent 44:9~~ Approved El Owner Given Initial Surcharge Fee) Adverse Determination 16U Xgi;~~ . CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety a 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 the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 4 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 (S8D 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumper; 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 & 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 in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new arid/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. Vlll. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. a MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. 3 X. County/Department Use Only. Complete plans and specifications not smaller than 8% 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; ffi streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system r 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 1 SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations April 26, 1996 2226 Rose Street La Crosse WI 54603 STEINER PLUMBING N8230 945 ST RIVER FALLS WI 54022 RE: PLAN S96-40238 FEE RECEIVED: 180.00 DUSEK, ALLEN & BONITA SE,SE,21,28,19W TOWN OF TROY COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, i and M. S m Plan Reviewer Section of Private Sewage (608) 785-9348 I I SHUA-7997 (R.10/84) O' ~ 0 MOUND SYSTEM FOR 5~~~ Allen & Bonita Dusek PGE S 1143 Sunset Lane River Falls WI 54022 of g "N INDEX V:1 1 of 7 ...........................Index Page 2 of 7 .Calculations Page 3 of 7.... ..................Plot Plan Page 4 of 7 ...........L,ateral Layout Wage 5 of 7 ...........................Cross Section Page S of 7 ........................Plan View Page 6 of 7 ...........................Pump Chamber Pace 7 of 7 ...........................Pump,.Curve Located in the SE ~ of the SE '4, Sec. 2r.---~---~ T 28 N, R 19 11, Town of Troy St Croix Co., Wisconsin. I Prepared by Paul C.J. Steiner Steiner Plumbing and Electric, Inc. N8230 945th street River Falls, Wisconsin 54022 Master Plumber: ~ #x6780 Date: April 15, 1996 CALCULATIONS STEP 1: Absorption area: 150 gpd/bedroom X 4 - 600 gpd. Table 4: 600 + 1,2 500 square feet required. Use ft X ft bed f Use 2 ~-trenches, 4 ft wide X 63 ft long] • i ' laterals, each ft long, manifold, Spacing between laterals. STEP 2: -Table 5:1 1/2 diameter laterals, 1/4 diameter' holes at 63 •r8- spacing between holes. STEP 3: Table 6: 12 holes/lateral, 15 gprt: discharge rate peer lateral. 15 gpm X 2 30 gpm total discharge. STEP 4: Table 7: N/A diam, manifold, inlet at of foot long manifold. ` I STEP 5: Design dose volume is 150 gal/dose at a rate o;f~times per-day. Min. dose volume must be at least 10 X distribution pipe volume. b00/4 0z"7W1 X 1~4~ = IG~j •6'~ &AL Mik, Table 10:1 112 diam. pipe= .064 gal/ft X100 = 6.40 X 10= 64 gal. STEP 6: Table 8: Dosing rate = 30 gpm, STEP 7: Table 9: Friction loss in 2 diam. force main, 12A _long,' 30 gpm= 1 in 100 feet. ELEVATION DIFFERENCE 8 FRICTION LOSS 1.85 f HEAR 2.50 " 12.35 TDH page 2 of_7_ i i i STEINEF: i , It i 0 o_ Pc~c:P• • LATERAL LAYOUT P~r~Orclt.G--d,~ F'1.F~~ ~PtaZ a. Perforated / End Viaw PVC Pipe Holes located on bottom, End Cap a.ce equally spaced,' Variable-y" ~ Ditanc PVC Force Main From Pump / 15t i-IC O~ 144CNI ~:M F Z L~ist2 ibutian Pipe i Last Hole Should be tll:.t to and ca,). ANO 3'fzPLOM Ei'bt E cF TkeNCH p 63 X '6~ y ebb Hole Diameter -1/4 Inch Lateral " 1 1/2 Inch(es) ( Manifold Inches Force Main 2' Inche§ CR:OSS SECTION Page t)f 7 -238 Straw, Mush Noy, Or Synthetic Covering AST&I 6322 Distribution Pip9 Medium Sand ' H K.G Topsoil ~_l F yst6nt Elev. c4.4' % Slopa Bad Of 2 % Force Main Plowed Aggregate From Pump Loyar D1 Cross Section Of A Mound Syslam Using 1'2 .,A Bad For The Absorption Arco F A4 Ft, G1.0 $t 132 Ft. H -1.5 PLAN VIEW B91 63 Ft. I 20 Ft. J 8 Ft. K 10 Ft. i! L 152 Ft. f Force Main N 32 Ft. ' t L Observation Pipe 8, K A L----,_-_------._~--- ~Disirlbution Bed Of 2 Pipe 2 a i Aggregate Observation Pipe Plan View Of Mound Using A Red For The Absorption Area i , VUHP CHANAFR CrtoSS SECTION AND SPECIFICATIONS Sir Vent Cap Approved Locking Weather Proof ` JuhCtion BOX Manhole CQvcC 4" C. I.------- 12 " H i n Vent pipe ; Final 4" Hin Crade 18" H i n Conduit 18" ?fin - •r ~Ij Approved Inlet Join Cs W/ C-1. Pipe A R,r* rove all Extehdiag +l 3' Onto Jo'i n C W/ . Solid C.I. Pipe t " i Extendiitb A (3roun t ~<< 3' Onto Alarm Solid t ;b Crvund k C .Pump 0f f Concrete Block p S PT:C TV I C A T I ONS Th14}: PUM), Ha-nufacturer: _ Wieser Mnnufacturer: Myers Tank Material: ConcrPtp Itoaa1 14uuit,L! r: - M1.1 Tank Si'za: 1,000 Gallons Switch' Type E1cat; Total Dynamic Head: 12.35 Ft. CANACITIFS 1'uin ji 0iachar1.e Rate: 10 GPM Total, Daily Eff lucnt: tinn Gallons A 14-;," or 401.94 Callons Humber of Uoueo : 4 _--...--Per Day 8 or 2 ;;7-4-? Cal lolls Dose Volume t~'l2 Z~ -Gallons C ^z:-Aq" orC_6r' 1 y~ V72- 1(a Galaans 11ota1. See pump curve for D - " orD-=115.1546 4$ `sr?=a CA IIon s addicional pc:rfortn,znce Total ni nk information. Ca;incity Required + 1,076 0 n110 n0 2. Pump and alarm are t,~ be inatalled on oeparat" citcuil Ate AttM au ve r 1L11R 16.17 ;WAC. ltnncsf nc;turar: LeVP_1_Alarm. Modc1 V,tkInwL•r _ D ru t t cl~ }1y1'~---- -Flom. - - Inge 6 01 7; i PAGE 7 of 7 w 100 so ME Series MYMS 1/3 through 1-1/2 HP Effluent Pumps Performance Curve S96-40238 I. + CAPACITY LITERS PER MINUTE ,i 0 50 100 150 200 250 300 350 400 450 100, 90 28 ©0 f M~~SD 24 tr ' 70 w M ~ w E/OO 2:0 u, w Z 60 - ? O w 50 16 hQ- 40 A/FSo 12 p O H 30 8 4 20 MF 3 \ Is 10 4 0 0 0 10 20 30 0 50 60 70 80 90 100 110 120 130 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company -1101 Myers Parkway, Ashland, Ohio 44805-1923 419/289-1144 FAX 419/289-6658 Telex 98-7443 i K3327 7/91 j Printed in U.S A. Wisconsin Department Industry, SOIL AND SITE EVALUATION REPORT Page L of 3 Labor 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 oho/ not limited 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. vas OV .07.U~~iFi'~?riav APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION f3 REVIEWED BY DATE sv~v 2~° 3 f~o~~ 7- rko-, SoA.) Illy 1 PROPERTY OWNER: //W/v /'/PROPERTY LOCATION ~A GOVT. LOT .SE 1/4 5,---1/4,S L/T L, N,R E (or) W PR PERh3 ER':S IL~ G DRESS LOT # BLOCK # SUED. NAME OR CSM # y f~ ,j HhSDP COU-QTR d~-~S C TY, STATE ZIP CODE PHONE NUMBER ❑CITY (]VILLAGE WrOWN NEAREST ROAD &/O/, S yo~z ( //s) 4.1S - YO 3,2 '20 New Construction Use [X] Residential / Number of bedrooms 4•- Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate bed 2 2 gpd/ft trench, gpd/ft Absorption area required bed, ft2 s9 trench, ft2 Maximum design loading rate N~ bed, gpd/ft2 / 3 trench, gpol112 Recommended infiltration surface elevation(s) 5-4C ('l;, - 3 ft (as referred to site plan benchmark or- Additional design / site considerations TPE.iJ 7Y ~i4avp CJ vG y. - c/dfE 7ZD ~c 3 3 / Parent material SCS o'2 - $dL1 .SfD,,:,y f Flood plain elevation, if applicable It A-Z 7-1" i S = Suitable for system CONVENTIONAL MOUND 11 U IN ❑ -GS UND U ESSURE AT-GRADE ❑SYSTEM IN RU. HOLDING TANK U= Unsuitable fors stem O S W U U OS U EIS U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft Texture Consistence Bourtdaly Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench lo ye y12 s, i z, AIM sb,r s s fi4: xty ~ <.::.::r S~ / ~►vi , C d- Z /0 2, 6. ~v, fie s /f - S Ground ~y 3 /O t/e Olt F r C S i f , Z 3 elev. 7ft. Depth to C (o~ Yie SHIP j 0'W, M, 7 limiting factor " 17,ke, -.2 go - y~- 7 s Ye Remarks: Boring # Z 3 2 ri E )0-13 /d Ve z/2- S, / 1, f, fiP c s If 13 3_11 `2 ye y~ s,/ h,~ 4,,1</' CS rf Ground ' ele . t.3Z y- yo 1o ye Sb~ S /of 9~. ~o ft. Depth to C ~~O J 7 f YX y~ 1 S/U~ ~vLi ~Vp .v limiting factor N NA Remarks: E- CST Name:-Please Print Z81TE SEPTIC BI ~i Lam. I-Pli ne: ~6_ ~10-l t Address: " ROBERT ULB Z cFZ ,(70 "liS. M" Signature: j~ Li Date: CST Number: 11,1N It-l TALLER & DESIGNER LI PROPERTYOWNER G-~U/p ~ SOIL DESCRIPTION REPORT Page L of PARCELI.D. LO~ #✓r ~U-fJTJ~f~ 0,j A<$ /41,4T0, Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft ` in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench -37-7 , , s1k -M -1-4 G S /of , Z- •3 odd /ay,.e 33 .k KO-If /o%e 4113 si f shy ~r.f2 c.s /vf- , S ,6, Ground I9' 1-f /D y/e y 7 JV 'f S~& /W V74-At 5 / V F y S elev. 93 ft. G -7'V1. -s ye s/~ s f sh /W Depth to limiting fact y Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # nw~ Ground elev. ft. Depth to limiting factor Remarks: Boring # kip- iv Ground elev. ft. Depth to limiting factor Remarks: con 0~nn,o ArInrn e Y ~ri-OO~m M A o - rr, IIN E n n a, Q ` gin N 1n 0 y cs ~ ~ °c o 0 NL~ w ~ N CA O ~ 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 Alfe~ ~ Au~~~ Location of property __S C- 1/4__S - 1/4, Section , T N-R~ W Township o, Mailing address ( f ~3 1 h se { tr) Address of site. of r y_ Ks R l U~~ TG4 //5 Subdivision name Lot no. Other homes on property. Yes No Previous owner of property Total size of property , ~W RCS Total size of parcel n~o3 ac Date parcel was created Are all corners and lot lines identiffiiable? V Yes No Is this property being developed for (spec house`)'?? Yes _4No Volume _Z~15 and Page Number - 7/ 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. _syn , 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. /.C~ Signature f Applicant, Co-Applicant Date of ignature Date of gnature . ti s STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 1-411je J :I- ~us~'-/< '60w ' I 4juse h MAILING ADDRESS 1103 JC !Z-e Z A/PROPERTY ADDRESS o~. I h"~ 5 5 (location of septic system Please obtain from the Planning Dept. CITY/STATE gV rSL~ S ~°Z PROPERTY LOCATION _ 1/4, =S 1/4, Sections T_ 2 ZN-R-jTW TOWN OF 111,1C4 ST. CROIX COUNTY, WI SUBDIVISION ,~CC~t1 ii ~~~SS' LOT NUMBER CERTIFIED SURVEY MAP , VOLUME/16,-f PAGE /'7/ , 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 die Wisconsin DNIk. Certification stating that your septic has been maintained must be completed d returned to the St. Croix County Zoning Officer within 30 days of the three year expiration ate. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 . S r . riPR-- 1 r_-, FR 1 03 : 39 FM P LlRPH`i' LAF41-1 =:URV E`]' I SIG 71 ~ 4'2 E• 9 7_1 1 _ 01 • Z. !J* ] T - r- b 4 ' ~ 4F m r / 44 :14 YA ' y C W N T 4 ti h 4 p' Ir 4 4 O N ~ y / 1 # N n l q 4 w a w a,~/ stn ~brk at ~i t4 M / N r- I~ t n qp / Y r it Ch of UP , I - -y / f / / ]t- 10 23, P.P, t. 4 a llo' 04 wC- -w [!~ti r N DO• aa' 00'lw 2o1.a1 / 't / l pf f ti ~i h 1 /go ~lc 'i ~4 } ' Y~~d Y v~ (a A~ ` 1 I t~ 9%s O o ♦ y 1 '4 x, kl~ y y A f ~ til y ~ \ U^ ^v cz, ~ s~ ~ nl y ui Q d Obti p C ' j 1 ~7 ~ q~y "1 CA bo 74- of t f 220- 4 1 0 •°~Tq o 2 10 `l9 E a SOS' TOI. 14 L' Ai PAGE 1157 it b ~I uea!L ~"tla' U') u;41im 'riuiuuui:xl na,l auo tsc~l a:wap!sai Cjrwud sr. jaseyajnd ,Cy patdnaao ay Ilp^A pue svun jnoj of auo say Suiplutg I M t. . ~d 1 M 1 - t t; 508 [nil Irv i STATE DAR OF VVISCUNMIV, rvi.:n WARRANTY DEED DOCUMENT NO. V I 11600, PAGE 171 - rEGGISTER'S 0FI-ICE ST. CROIX Ray Galep, Robert L. Mackey, Laurence mu r y and Recd for Ro;,, , Norwood Ecklund, as partnership property, MAR 5 1996 r at 9:30 conveys and warrants to Allen J. Dusek and Bonita Marie c<e4alDusek, husband and wife, as survivorship marital= property, Register of Duds t~. THIS SPACE RESERVED FOR RECORDING DATA NAME AND R RN ADDRES) I the following described real estate in St. Croix County, State of Wisconsin: First National Bank of River Falls P.O. Box 166 f. River Falls, Wisconsin 54022 f 040-1221-50 PARCEL IDENTIFICATION NUMBER 1 i I II Lot 5, Country Oaks in the Town of Troy. I~ li TRI A g'FER Ii ~ I ~I ~I is not This homestead property. (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this I day of A.D., 19 96 (SEAL) (SEAL) Norwood Ecklund urence Muf "Pry (SEAL) (SEAL) I; AUTHENTICATION A.rKNOW FDGAA Signature(s) Laurence Murphy State of ~ Wisconsin Norwood Ecklund 5s. ' r 0 f /b 1 ` ' l.e C'