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HomeMy WebLinkAbout040-1224-60-000 kr) 0., o I ~ I o ~ I m 0 cc 0 00 06 ~ I N N O Z a 7 (6 U LL C L° O_ p V co oB Q N O I Cl) ~ N z N w E w « o E L v Z `m d a m c 0 o z °c aVi z d ° c z H E ' o m N n ° a N U) N ~ • N ~ fll c c O 0 o o Q N Z~Z z I W N O O d - d 0) w LLO d R O Lo N (n v) E U tD J 0 0 0 d N CL IL CL N v _ Lo Lo o _ y J U l', rn rn } o co Lo a o Q' N O .4"'... O p 3 co E 0 0 ° CL I 'a N m w~ ~ ° '1V -o° a Q > 675 m rr,~ q U H H p O r+rl V N - OU') V O $3 O 00 W (v\ O N O (n C N E Lo n :.w 17 F- aCOO a - N 7 "t z CD 00 ~o ~ O N 2 m to N O E U r- z • 7a O O F- I LL N O N Z=i U) O I', a I d a • d m .0 a c 7 °r c 40 o E° E 0 L A 0 a~ 0 in V CERTIFIED SURVEY MAP v'!J.>•'D /,.z ' JAMES AND GLORIA WAHRENBROCK i Part of the Southeast 114 of the Southeast 114 and the Southwest 114 of the Southeast 114 of Section 7, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. -e e. Indicates fence. •Indicates 1" iron pipe found. O Indicates 1" x 241' iron pipe weighing 1.13 lbs./ ~OIndicates 2" iron pipe found. lin. ft. set. NORTH LINE OF sours 11z SE 114 UNPLATTED LANDS 4. rs, S 89.21'/5"E 1166. /9' R/ //66.7/'/ _ 2 66. ~ J65. 08' _ O 734. 88' y 1 p 800.91' S01000100"E7z~61 ~ NO/•00'00"W, 1 ~I 75.66, @Cr 6' O • ~ ZI OT _ / 1 ~gp2:' O CRE Ij C TEMPORARY CUL •OE- SAC TO ae W 11 J WI REMOVED UPON ROAD EXTENSION O' 1 I It /SEE DETA/L FOR PLACEMENT DOS 8.0/1 SO. C -41 QI h) O 1 3 Q~ N ` I 1 6' N 89. 2/'/3"W 40t.` Q 0 ~J 2 3 ^ y CA p 'O , / j •a LOT 6 - o o°• ,LO 8 N se • / / ' o o " w 201. s7' ° 0 O /T, 331 ACRES 0 .0 ° 0 / .33J ACRES Q ~V!► b q 1 W A Q: b 733, 996 S0. FT. I /02,390 s0. FT. k, •I O Q 15. 8/8 ACRES EXC. lI n' / t h Z 411 66'W/DE ROAD EASEMEN , l y / W ~I N 89 • '15"W 482. 77' : 0 y H ° 689,040 SO. FT. bbl V ~ Q 1~ ' 1 ~ I a a 4 Q a h o I~ ! 6 Pf~/ VA T E ROB IT~ J Q~ EASEMENT a h S LINE E114 z I J1 k ? 1 I II' I b a ~T/2.52' 1933.80' 3 V OO /0 I C N c W I 3 1 I ti 3 589•/5'56"£2648.3? a I~ I ?t N89•/8'3J"W105.33 / O• I SE• COR. SEC. 7, T28N, M ~0 66' ° q I q a R/N 89. 13'56"W 203.46'1 R19 W, / COUNTY MONUMENTI ° I q I N t O • _ N 40r5 S C.S.M. W L i 4' $ 'ieST o : VOL. 7L m 292. 81 ' 16603I' 202.9z, J h Q pA q_1930 Z b N 89.16'24"W 65/. 7.6I ~ b RJN a9• /5's6"W es/: 55J5, 1 90 6f F FORK DRIVE J q6 III -f444 4tZ- j L0 T2 LOT 3 LOT 4 Owner's Address: C. k. M. Vol.. 7. PAGE 1930 401 South Fork Circle Hudson, WI 54016 W Dated: April 11 4 r v scats / " s 200' ti/{I~1lq ? Z O O 50' 100! 200' 300' 400' 300' ~ A % v 1y b } Q Q ?zLAUR CE "m E. M PH p: 4ft 13 = This instrument drafted by Laurence W. Murphy ER•~ALLS,i Xb; F WISC.....•~~~'~'~ r~i 9 ''48,~o LAND 811486660014 Laurence W. Murphy egistered Land Surveyor SHEET 1 OF 3 f e STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ,S lye jr:r, ADDRESS 0 SUBDIVISION / CSM# LOT # SECTION T~N-R ,g W, Town of T~Q i ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM wvi~ , >l~ 4,,,k T2V as 0 ~4 1 f a ~ a INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. i BENCHMARK: f La CD~~r re,e / Ire ,(-I ALTERNATE •BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: (,J-"41 t4,-1 Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location ,SOIL ABSORPTION SYSTEM Width: 5 Length 5-8 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: ~7~5 2`1 INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: ~ Pef ft o rs N!P E ❑ City ❑ Village Town of: State Plan Trnu CST BM Elev.: Insp. BM Elev.: BM Description: } Parcel Tax No.: TANK INFORMATION ELEVATION DATA s TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Q%z 7GL.6[1 Aeration Bldg. Sewer Ing St/~f Inlet (may © Ste' TANK SETBACK INFORMATION St/dE Outlet 9 3S~ TANK TO P / L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic >2S , NA Dt Bottom Dosing NA Header 3 98, 2s" Aeration NA Dist. Pipe Holcfl-ng Bot. System PUMP/ SIPHON INFORMATION Final Grade s" 2" 161,17" Ma rer Demand ~O a~_s. % y Model Number M TDH Lift Fric Syste Forc n Length Dia. Head Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length I No. Of Trenches PIT No. Of Pits Inside Dia. th DIMENSIONS 57 (9- DIMEN 1 N nufacturer. SYSTEM TO P / L BLDG WELL LAKE/STREAM LE H' SETBACK INFORMATION Type O /iP.•rCovt~ p A NIT R Model Number. System: ~eoc.i. s DISTRIBUTION SYSTEM Headerflb'I'3rtifv v Distribution Pipe(s) it ` Size x Hole Spacing Vent To Air Intake Length / ' D,,,. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade S m ly Depth Over y t Depth Over ~,f a xx Depth Of xx Seeded/ Sodded ---Mulched Bed /Trench Center co ' 3a Bed /Trench Edges 3a Topsoil El Yes E] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) CJ!~/~' iy LOCATION: Troy.7.28.19W SW, SE, Cedar View Gzti'► ~~Q-C•~-CS'1 L?~ s . ~ a!~ dLL; ;Y!f . i ~i„ r,.~, a Plan revision required? ❑ Yes [-Co PT/ Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert.No - SANITARY PERMIT APPLICATION Bureau ofBu lding WaterlSystems 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 than 8 112 x 11 inches in size. _5/ eko / X • See reverse side for instructions for completing this application State Sanitary Permit Number 033 tN [ U The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)1. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Proper3y Owner Nam Property Location e 1i45 1i4, S `7 T Z8, N, R JCt (o Property Owner's Mailing Address < Lot Number Block Nurpb r O IV City, St to Zip Code Phone Number Subdivision Name or SM Number o A& ( > V hL II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t Village Nearest Road l Public 1 or 2 Famil Dwellin - No. of bedrooms El Town of P,.j III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 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. P4 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 0 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ZSeepage 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 J Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 'r/ cl'7,66 Elevation O '70 670 d-O Feet /66r4RAFeet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App strutted Tanks Tanks Septic Tank or Holding Tank X Loan I ?,)-ee S 6, AY ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumbe ' Name: (Print) ` Plumbe 's Signature: (No amps) MPLMPRSKYl Business Phone Number: 3a ~ - 77 z ,3~zi Plumber' Add ss (Street, City, State, Zip Code) / 1-99 1_126 //Z v-e A'ji ' r C/ icy d !Z IX. COUNTY/ DEPARTMENT USE ONLY f E' Owner Given Sani ry Permit Fee (includes Groundwater Date Issue Issuing Ag t Si ture (No amps) tpproved ❑ Given Initial ~l 5r`narge`ee) Adverse Determination /COGt✓ X. CONDIT NS OF APPROVAL / REASONS FO DJSAPPROYAL SBO-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber I l 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 purnped 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 ovi~ner's narne 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. q% IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, r=econnection, or repair. V. Type of system. Check appropriate box depending on system type. VI_ Absorption system information_ Provide all information requested for numbers ; throw h t_ Vil. -1 ank information. r, the capacity of every new/or existing tank, list, the tota:' Gallons -.-m r of tacks and manufacturers nan3 ,2 ~n0,ic.tte prefab or sit'-, constructed and tank materiai Cc-#ete f :~r' df eptic, pump/siphon and holding tanks for (his yst:ern. Check experirr,ental approval only if tanks receive, experiment,,l product approval from DILHR VIII_ Responsibility statement Installing plumber is to fill in name, license number v.,i h apor. r ,refix (e-g. NIP, etc.), address and phone numher PI. rnber must. sign applica Lion form IBC. Count; Department Use Only X. _iJntr i"DeParlf-nent' se Vrlf'y is ;15 ri: ~t Oh( pl nsrnuo. _ :'.0t A s I V,/ tI o e. ,in ani sEOtl C., r n I''s_ c. - infrrrnatior. h,: ea+ c. -vh;~h can i!-J"WGVV'11er thr; ,;i ;,_.E ..ir(I..fgN3i ; _;SCd (ti( !~1Jv'. TIMM EXCAVATING JOB Route 1 Box 192 SHEET NO. OF WILSON, WISCONSIN 54027 CALCULATED BV^ - G ' 2-2 DATE (715) 772.3214 (715) 386-5443 r MPRS #3224 WI MPCA 0696 MN CHECKED BY DATE SCALE r : . -r- e 0 VN Q / E. .......-q-....................... - , .......................c' _ l X . l . t% ,F l (r y , ti r ;p.........` . a I . ' . i E -4 N N a' L.... . r y - PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1 5-M JOB J~4!/ P TIMM EXCAVATING SHEET NO. z OF Z Route 1 Box 192 G ~S WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE $N` 11~/ . . . . ~pp lr~:._ r 7 ._._.._...J u r /J...~,d 1. G bi a ) o 6L K a £L.Y Su - _ b - £'G~1T; o 0 ; PRODUCT 205-1 ~ Inc, Groton, Mass. 01471. To Order PHONE TOLL FREE 1-800-225-6380 L Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT,' Page of Labor and Human Relations 'Division of Safety & Buildings in accord with "tt jS;6 W Adm. Code COUNTY ST. c R o l X Attach complete site plan on paper not less than 8 1/2 x 1 iri#a #s in si Plan4mu de, but PARCEL I.D. # tk, not limited to vertical and horizontal reference point (BM , tion~j~, q'QfITPpe, dimensioned, north arrow, and location and distance to st road APPLICANT INFO RMATION-PLEASE PRINT A FOt.,tII i REVIEWED BY DATE PROPERTY OWNER: tp S OPER TION TAN ES GI O J2 I'A WAH EN . L 1/4 5E 1/4,S 7 T 2 N,R I I E (oro PROPERTY OWNER':S MAILING ADDRESS L K# SUBD. NAME OR CSM # qo 5e. FoR K C (R c L C4'DAR 'Ri D&' CITY, STATE ZIP CODE PHONE NUMBER (]VILLAGE OWN NEAREST ROAD F} u t~ s o ,J I . S 4 0 l c. (71S) 3 P . • l fsk9 T R o r-EVA iP V/e kJ AV, ( New Construction Use [ Residential / Number of bedrooms T (J Addition to existing building I J Replacement I I Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate - 7 bed, gpd/n2 • e trench, gpd/tr2 Absorption area required ~ed, ft2 '7.510 trench, h2 Maximum design loading rate 7 bed, gpolft2 • IV trench, gpolft2 Recommended infiltration surface elevation(s) S~ p S • 3 B (as referred to site plan benchmark) Additional design I site considerations uSE S Paren material $C5 '13 ' 11 oT SO. 5i I. 1 o E SS Flood plain elevation, if applicable N ft CAP u S = Suitable for system CONVMIONAL MOUND / IN-G D PRESSURE AT-G SYST 11 U L ~ SING T U=Unsuitable for s stem S❑ U C S -U 15-S O U V1U BUF SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bot/rtdaly Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 2-/t ~~T_ ~tip~rc~~v ~'i~ Z f r~► i c s /f n, (e-17 I d ~l 3 / -t0 S6& lwlcp . Ground 17-1V /o Ye Y// ~S ~.1,~ GAS e 5- elev. • ~.e /o/.~ ft. ) / /O Vip Yee 675' 0S Depth to -.S ~ limiting factor Remarks: Boring # o - 9 IOU t - St' . I -F 56k ~,,,~,,F (Z S • `f S z - az love 311- s; ( 2-F Sbk f R CS t-f- .5 3 2 - Z5 o y~ y ~s y,~ Ile Ground el S'- ! d p Wet - CS U s d:2 /vo • f1 ft. Depth to limiting factor Remarks: CST Name: Please Print R o la E R -I- 2A L(3 Q 1 C Li T Phone: 715_ 3 ?6 185 Address: Co55 O' X-Ne1L. Pt7. ~0Qja,J WI. 5L4Of3- IS- -5 CSTM Signature: , A Date: CST Number: ORIGINAL PROPERTYOWNER WPtHR£I~(3ROCk SOIL DESCRIPTION REPORT PN'e 2 Qf PARCEL I.D. # 40+*(-- G EDh P. 1~r DG-e- ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxlary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed nench if sbk 16 yk f S* 10 Yle 312 SI'~ . 2tSbk nN. k s !f • S .6 Ground 3 1y-L~ o Yp 3/3 S1 Zt- sbk wf/2 4 s if , s , c, elev. ft. zy-y /o 'e f cs v S d'C Depth to 5 yo,y lo vies` S O s ~~Q - •'1 •Sr limiting factor Remarks: Boring # 0-// to YR 211 PA c~ C $ i 2 1L ,►N, f i c f -f ,/V N 2 If /0 ye 3 s I. 145b k -F Q s lvf . s v /o y y s es .1 . S~ Ground /02-09 ft. !6q p 5!4 - S 0 S d1~ Depth to limiting factor , Remarks: Boring # l a-G 1 o Y k z I Si' I 2f Sb,~ ,►N►-FR S /-f S. F~ G- iy /C YR 3/ 2- 2f Sbk VP 313 - S I -E; 5 bk R c s . y . S Ground elev. 6- -7. S yk y y - - s ~s _ • ' . > S" Y Go l 0 Y y/ CS d S a(.~ CS - , Depth to limiting factor /o / 5~~e - CS U s GQ~Q .1 a Remarks: Boring # Ground elev. ft. - - Depth to limiting factor Remarks: 0011 ee0L10 ACIA- c C c ln Uj cN 1 m \ \ > r Z rh d o N _33 V1 15 O i cE~~q R V1~w ~ I' r~ 0 J H 333 . OCR W N 1 O • O N ~ o as 9~f5T aT . .7-2o' a p Z w 0~~ r ~ ~ ' b ti w m c >j Lo 0) e m w o o b ti O Ep ~ANpS V n z~ z - 'v oe - P A T. R 60 00 W Ell 22 325.85 N lO. 3 2 285 37 I ~ o m~ 1 2 1 m o e ti 4 ~I 1 m l I w ti \ 01, I ~ I ~ ~ O + w b N D r.~ A A ; b N I b I~ nV1 2, 44 V A m 0 4 a O ~ Irv Qt O Cb I f ~ p~ ,Oti I - OC - - '00 \ - r 288. .99' P, ~ o C m I ~ ~ \ Q b'~ I ~ rl c ~ r I N A ~ e r~ r A 25 k 22 C' OC' 2 v b ti °44C4W/ ~ I O O m 100 ~ I y u, ~ , Cif ~ G czo w 2 S 0/ 02 ' S 9 "E 260. 2 7 - I W ~ S_ 5/ 'E 1 ~;r i 6 SOU rH FORK ADD. JUN-21-1995" 11:18 TERRY TRAYNOR STATE FARM 71F =125. &_20 F'.01 V CEDAR RIDGE 52979 LOCH TEO IN ?EKE 50UJ'HEAS7" I14 OF THE SDUTNEAS T 114 AND TH! Awlsal's 0111cl, 114 OF THE SOUTHEAST 114 OF SEG PION 7, TOWNSHIP 28 NOR sf,e,rolYeo.~nt /9 WEST, TOWN OF TROY, Sr. CROIX COUNTY, WISCONSIN. Nomew IN Iwo rX M~ilL MMMIwIr rirw d Now Iff Orly UNPLATTED LANDS NLINE !I/rY[Old I • r r. of 1 of. e3 • - ; gap, b rrf. O 17;. lI' I roI'00'00 T3. 7;- a 1 11 1 l~ r r' 0 2 ;.rrf AcRrl v N* 019 $0, OPP. [_0 r 7 A'6 I~FemOvPA t ~ G t~/ 1 \ r fr* IM.O!-SAJ I r,nRox Lee; rioN ,Ors 4 II 4 r. A ACR[; Jf w rrf, lQ7r0.RY. I JoINYORrr[vArA.lp P ` 4o r / MI•t r c Orr4r ® CVL -O[ • SAC ~yl wl 0 rM£ rORN Or 19p►y ; I1•;r' - SGr Jl rArL CI ORIV[r'Ar O#arNARCr rj` Oe"£-1Tf p• , Iw N r;• oe•r tri ti 3 !a°°' 4 o r. rsr AcRrr ' Q ~J a es.4,4 so. Ar r1 } ~t 1 srr•oe•00'w Lora .0 Nff•rr'PO-w' adi.ff' s )J. r' • ~ ~ r I lQ 00' r aO Ir t .A( t w . r or. 1 i I JI 1 ! Qa~ r s ss • rr' l3'r .la. r: 4D1 ` ~I j I f' 1 f J r0' N ~ N 1 J 4 I 4 l M 'Af i,rOr ACRrr 1 ! 11! ,~v1G~ h e lr, 10 0 Sax r. t t j 1 f 7 W I 1• ?.412 ALR[S a 0 a 1 y 0 " fr.oo 1~~ +r•o ti o 4 ee as- me 40. 10 \1 _4 y 1 UNr lG /I; a' q! NA,•//'3!'w rOl. Jl r00' I q /P°• Rrh.!•rJ'!6"w ROM. 1i7_r fl. M ~ i r h 1 1 s go. h ,.033 Acar, • p I ` 17.0!! AeR£! h I Ire. 7, or cOR.:[i• P. fJIM, I/t coR. ?0oM, b , W lo. OF. aI i }rl,AdO SO./r. s LOT 5, C.S_M., V r.lfr d I l a. - IlN,IIrRNrlrMcAP/ Rr!w,II[RNTS[MrAP/ 'a too' hC PAGE 1930 ' rrr ti r t 1 " L I on' o i pQ• I o 1 o rlr.er l z LEOENO: r!' flax-lo 'O•Ir Ill. rr' wrNl!•r!'!r"w tll. !!'I ;"IRON PrRr JOUN. 0 ,'IRON rrlr fOUNC - r 0 r' r JQ'• IRON P/Pr ALL ormeR cOPNro `•I T^ Arl.00l rNOI[APIS PPrw ALL 4rN£AL MrASU ALL 4N4;U4AR M[Ar Lo r cOMPUrr° re rrrr nq - --lNCOCA r£r ROAD #of 8 esk /N P r[ A rrs U r r L rr Post-It'" brand fax transmittal memo 7671 pages NOrcA FES OPrvt TO From Norr: rrrr IARcr4 imp" ON ,Mrs MAP IF sUrVrc wrrLANOr MrwrAIUA+ 40r rrdr, ACC#Sl, ra /rRe CO. rNr l.T. eROfx COUN rr 20NINa Orrret ANO rN! kud 'r Dept• Phone Fax N~ Fax TOTAL P . 01 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER JET /l~ . (J L M41LING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE Zi (z ,DSO l'l 6015-C, PROPERTY LOCATION S641 1/4, 1/4, Section 7 , T a0 N-R / TOWN OF 'FO ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEEDSURVEY MAP , VOLUME PAGE, LOT NUMBER Ja X1645 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, Wl 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 '~~4z' Location of property,56c) 1/4 1/4, Section 7 T a8'N-R__L7' W Township Mailing address .4/0 9 Address of site ro-1111~ Subdivision name Lot no. other homes on property? Yes/ No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes _,-Y No Volume ff'o* and Page Number ~3y 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 Co~ty Register of Deeds as Document No. 1.30 -34 and that I (we) presently own the proposed site for the sewage disposal system or 0 (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 Deed? as Document No. Signature of Applicant Co-Applicant N3- /F 5 Date of Signature Date of Signature