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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER Kevin & Duane Krueger/Holz Laden Cabinets
ADDRESS 375 Main Street North
Deer Park, WI 54007
SUBDIVISION CSM# N/A LOT N/A
#
SECTION 7 T 31 N-R 16 W Town of Deer Park
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW 14 P
SHOW EVERYTHIN WITHIN 100 F~ET OF SYSTEM
t~ t GI
c y,
5
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer Model# Size
Float sePeration Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
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
i
Existing Grade Final grade
DATE OF INSTALLATION: 1178794
I
PLUMBER ON JOB: Byron R. Bird
LICENSE NUMBER: 1309
INSPECTOR:
3/93:jt
i
'to~borz,ncl HHuman Relationsdustry, PRIVATE SEWAGE SYSTEM County-
Safety and Buildings Division INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
PT, Jp 8 ' Na ,EVIN & DUANE ❑ City ❑ village Town of: State PI,n D o.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
"iAnci
TANK INFORMATION 'ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic S~ Benchmark /03 S /001
Dosing
Aeration Bldg. Sewer 15,-7 q q 7.7 S
Holding St / Ht Inlet 5, g 97,(-7
TANK SETBACK INFORMATION St/ Ht Outlet ~.b X7,5- V
Vent
irIto ntake ROAD Dt Inlet
TANK TO P/ L WELL BLDG. A
Air
Septic NA Dt Bottom
Dosing NA Header / Man. 7, a-
Aeration NA Dist. Pipe ~.a3 q~ 3 1
Holding Bot. System 7, a 3
PUMP/ SIPHON INFORMATION Final Grade of"
Manufacturer Demand
Model Number GPM
TDH Lift Friction System TDH Ft
oss Forcemain Length Dia. H Dist. To Well
SOIL ABSORPTION SYSTEM
1 No. OTrenches PIT No. Of Pits Inside Dia. Liquid Depth
BED /TRENCH Width ` Length
DIMENSIONS DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER Model Number:
System: Iq 7' 2 01 ~ 50 AJ OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over -,(f. i i xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed / Trench Edges ' U Topsoil ❑ Yes ❑ No ❑ Yes ❑
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: Deer Park.7.31.16W, NE, NE, Main St. No. Z `f l
12-
31 il
Plan revision required? ❑ Yes ❑ No
T2-T~]-
Use other side for additional information. 0 Ig~
SBD-6710 (R 05/91) Date I sp ctor's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: '
I
I
• SANITARY PERMIT APPLICATION
' In accord with ILHR 83.05, Wis. Adm. Code COUNTY
St. Croix
STATE SA I RY PE MIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ~ryI0 ,
8% x 11 inches in size. ❑ Check if revision previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION -PLEAS PRINT ALL INFORMATION. S94-,04350
PROPERTY OWNER e V / N w-. PROPERTY LOCATION
Holz Laden Cabinets NE Y4 NE '/4, S 7 T 31, N, R 16 E (or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
75 Main St. North N/A N/A
CITY, STATE ZIP COD PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
Deer Park,.WT 5407 1(715 269-545
11. TYPE OF BUILDING: (Check one) ❑ State Owned ® viLL AGE : Deer Park NEAREST ROAD
Hwy. 46 & Cty. H
K ]Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms - PAR EL TAX NUMBER( )
III. BUILDING USE: (If building type is public, check T11 that apply) C~IJ I Q
1 ❑ Apt/Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campgrou d 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
40 Church/School 80 Mobile Home. Park 12 ❑ Service Station/Car Wash
5E] Hotel/Motel 90 Office/Factory 130 Other: Specify Cab? net Sho
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. ❑ 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy
13 ❑ Seepage Pit Pressure 430 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 ftJ PROPOSED (sq. ft.) (Gals/ccl~ay/sq. ft.) (Min./inch) V TION
110 250 252 .6 96.5 l~~
Feet Feet
VII. TANK CAPACITY Site
in allons Total of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
__7 R -7- 1-1 El F1
Septic Tank or Holdin Tank X 1000 1 Weeks Conc. Pr
Lift Pump Tank/Si hon Chamber
Vill. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Signature: (No,Stam MP/MPRSW No.: Business Phone Number:
Byron R. Bird f /17 i 1309 715 26878317
Plumber's Address (Street, City, State, Zip Co day.
1359 100 St. Amery,' I 54001
IX. C UNTY/DEPARTMENT USE ONLY
Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing ent 71m, tamps
~ Surcharge Fee) /
Approved ❑ Owner, iven Initial (,~'J
Adverse Determination ~ i~
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & 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.
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. --9nsite 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 & 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 and/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.
Vill. Responsibility statement. Installing plumber is to 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% 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, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
,OCTOBER 10, 1994
EIV / .
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bE HOLZ LADEN CABINETS
O r ' 375 Main Street N.
P v ll~Deer Park, WI 54007
r~
NE4, NE4, S 7, T 31 N, R 16W
Village of Deer Park
St. Croix County WI
RECEIVED Retail Office 16' x 16'
OCT 2 s 19~ 6 Customers f~
3 Employees 894-04350
SAFETY & BLOW orv, Q. 4^_ 0 A q- K 0
ii
2
y
y
t
` Qctobzr 22, '1994 PAGE OF
HOLZ LADEN CABINETS
375 Main Street N. ~r
Deer Park, WI 54007
NE4, NE-14, S 7, T 31 N, R 16
Village of Deer Park
St. Croix County WI
• ~~MA
GS r/0
Oa~~FS Q
p~N
cF
CROSS SECTION OF A BED SYSTEM
SOIL FILL Z" OF AGGREGATE
DIS'I~KIBUTIOAf PIPE APPROVED SUMTHETIC COVER
MATERIAL OR 9" OF STRAW
OR MARSH HAy
ogP
EET 41o OFAGGREGATE
ELEV. OF
DISTRIBUTIOW PIPE TO BE AT LEAST IKICHES BELOW ORIGIWAL GRADE
AWD AT LEAST20 IkJCHES BUT WO MORE THAM 42 INCHES 6ELOW FIWAL GRADE
MAXIMUM DEPTH OF EXCAVATIOU FROM ORIGIWAL GRADE WILL BE IKICHES
MINIMUM DEPTH OF EXCAVATIOW FROM ORIGIWAL GRADE WILL BE INCHES
,e
i
S94-04350
SlGlJED:
RECEIVED
LICEAISE AIUMBER: / OCT 2 6
~n~ c October 22, 1994 SAFETY & BLDGS. DIV.
PTb. r 60
1/78
PROJECT. DETAIL DATA SHEET.
NAME OF BUSINESS HOLZ LADEN CABINETS
LEGAL DESCRIPTION NE4, NE4, S 7, 'T 31 N, R 16 w
OWNER K. Krueger MAILING ADDRESS 375 Main Street N.
Deer Park ZIP 54007
ARCHITECT, ENGINEER, Byron R. Bird ADDRESS 1359 100 St.
PLUMBER OR DESIGNER
A m e r y Z I P 54001
TELEPHONE NUMBER 715 268-8317
1. Check appropriate building usage(s) and fill in the information requested opposite
each usage listed. Please consult Section H 62.20.
Existing building New building X Addition
( ) Apartments and condominiums . Number of bedrooms
( ) Assembly hall . . . Seating capacity
( ) Bar Seating capacity # of meals served
( ) Bowling alley . . Number of lanes ( ) With bar
( ) Campground and camping resorts Number of,sewered sites RECEIVED
Number of unsewered sites
Total number of sites
( ) Camps . . . . . . . . . . ( ) Day use only Number of persons O CT 2 s 199~F
( ) Day and night Number of person.§AFETV
( ) Catchbasin . . . . . . . . . . . . Number BLDGS.DIV
( ) Church ( ) No kitchen. Number of persons.
( ) Dance hall ( ) With kitchen Number of persons
( ) Dining hall ~ Number of persons
g . . . . Number of meals served daily
( ) Dog kennels . . . . . . . . . . . . Number of enclosures
( ) Drive-in restaurant . . . . . . . . Inside seating capacity
Car-service Number of car spaces
( ) Dump station Number of dump stations
(X) Employees ( total of all shifts) Number of employees 3
( ) Hotel ( ) Motel ( ) Cottages . . . . Number of units with -2 persons per unit
Number of units with 4 persons per unit
( ) Medical and dental office bldgs, Number of doctors, nurses, medical staff
Number of office personnel
Number of patients
( ) Mobile home parks . . . . . . . . . Number of sites
( ) Nursing homes Number of beds
( ) Parks ~ Number of persons ( ) Toilets
Restaurant : . . . . . . Seating capacity ( ) Showers
( ) Dishwasher and/or disposal?
( ) 24-Hour service
(x) Retail store . . . . . . . . . . . . Total number of customers 6
( ) Schools ,l , . . . . . . . . Number of classrooms _FT Meals ( ) Showers
( ) Self service laundry . . . . . . . . Total number of machines
( ) Service station . . . . Number of cars served daily
( ) Swimming pool bathhouse . . . . . . Number of persons
( ) OTHER (Specify) . . . . . . . ' R% J 4 04 35 0
P91 614 3 50
2. Indicate whether the following facilities are present.
Floor drain yes no x Number of drains
Food waste grinder` yes no x
no x
Dishwasher yes
Automatic clothes washer yes no X Number of clothes washers
3. Septic tank capacity 1000
Holding tank capacity
Septic or holding tank manufacturer leeks Concrete Products New Richmond, WI
4. SEEPAGE TRENCHES: total square feet width of trenches
length of trenches depth
number of trenches
SEEPAGE BEDS: total square feet 252 width 12'
length of bed 21, depth - 4.4
SEEPAGE PITS: total square feet outside diameter
depth below inlet
total depth from top to bottom of pit
Signat e of person completing orm: FOR DEPARTMENTAL USE ONLY
Address 1359 100 St.
Amery WI Zip 54001
~\JTeIeph~ne Number._ 715 268-,8317
Date 10710-,94
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
November 2, 1994 201 East Washington Avenue
P. 0. Box 7969
Madison WI 53707
BRYON BIRD PLUMBING
BRYON BIRD SR
1359 100TH ST
AMERY WI 54001
RE: PLAN S94-04350 FEE RECEIVED: 110.00
HOLTZ LAIDEN CABINETS
NE,NE,7,31,16W
VILLAGE OF DEER PARK COUNTY OF ST CROIX
NON-PRESSURIZED IN-GROUND 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.
kEeter ly,
. . Pa
g
Plan Review
Section of Private Sewage
(608) 266-2889
SUD-6423 (R. 0"1)
O%JIL IYIrL, OIIC CVHL-VMIIVIV nGrVnI raye_Lui~s
L:abo(~a7k{flurr~an Relations ,
Divisio?v*ofSafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan,on,paper not less than 8 1/2x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCELI.D. #
dimensioned, north arrow; and locatiori and distance to nearest road:
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROP RTY OWNER: PROPERTY LOCATION
di rl GOVT. LOT N~ 1 /4 1/4,S 7 T 3 N,R E (or)
400'eA C.',
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
J 7 ':51 S ~
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ®VILLAGE ❑TOWN NEAREST ROAD
&d ,r l' WE -SVW7 - SV.S'3 D-e -e k. a, X 1/6. -f CT N
[p4 New Construction Use [ ] Residential / Number of bedrooms (J Addition to existing building ^
j j Replacement [ed Public or commercial describe_ Qo eJnc7 Nu •'10Aq Sl0
Code derived daily flow 7t'"" gpd Recommended design loading rate bed, gpd/ft2. 7 trench, gpd/ft2
Absorption area required ,2SD bed, ft2/4! trench, ft2 Maximum design loading rate _,_4 _bed, gpd/ft2 , mil' trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design / site consi erations
Parent material I0- ku%JA Flood plain elevation, if appltcable - ft .
I
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ® S ❑ U ®S ❑ U as ❑ U ❑ S ®U ❑ S Q U ❑ S ®'U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench
Ground . 9s On 7/y ~ S ~ COS pe
elev
ft.
Depth to
limiting
f5tor i
Remarks:
Boring #
tq~~ \nA4 v+... 1
41
Ground 3 jr- 3 D%R7 y d S*
elev.
/049 ft.
Depth to OCT
limiting
factor
SA ETY & B S. IV.
Remarks:
CST Name: ase h nPrint1' Pho e: , ` Z Y 3 T
ddress:. &'ex-
Signature:Jf►1 A RI Date:_ _CST Number:
• vv~ v...vv. v• ~~r vn ~f"dt~tY 4 UI
PARCEL I.D. #
Depth ; Dominant Color Mottles Structure GPD/ft
Boring # Horizon Texture Consistence xtvy Roots
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ranch
7SY)eV/I
Ground 3 X96 /Oy/~l/~1 $ fC `Ij~ 1
elev.
Im• ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground ' .3 o-9L /W 71y
elev.
9F• att.
Depth to
limiting
factor
Remarks:
Boring #
4 Mat- 6 :.17
Ground 3 6-73 (7 S/ - MZ
elev. ,2f ft.
Depth to
limiting .
factor
i
Remarks:
Boring #
Ground
elev,
ft.
Depth to
limiting
factor
Remarks:
STn+ 3 yo 5
s7t~ CIF _ 4~,5"
a, f~ - TP T a~ T,.r% off
l~vr~nq ~ w~Lt ®,B,m,
QTy /-E
fife 4v7S%De
33`
~ora~la/1 153
Y
N~ N ' s 77-3
~ t~ ~I~ ~i yL~ S D
9 ` fir ` /S'o
JhbP
RECEIVED
OCT 2 61994
SAFETY & BLDGS. DIY.
S9z-04350 8.94-04350
Wisconsin-Departmernt of Industry, SOIL AND SITE EVALUATION REPORT Page L of
Labor e:d Human Relations
Ovisidn orSafety & 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 _ C t
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.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
JO/ &f." c T GOVT. LOT N~ 1 /4 ~1/4,S -7 T3 N,R E (or)
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR GSM #
C/IIT~Y, STATE ZIP CODE PHONE NUMBER ❑CITY 29VILLAGE ❑TOWN NEAREST ROAD
r Ga.Z syyP7 (7/3-).249- S'YS'3 J0t-c N aid'' ~yL f 0- 14
New Construction Use [ ] Residential / Number of bedrooms [ ] Addition to existing building ^
Replacement Public or commercial describe CadlncY JTa. 1a d1's ~
ST a
i 1 [e4
Code derived daily flow //D gpd Recommended design loading rate lbed, gpd/ft2 . trench, gpd/ft2
Absorption area required .2SD bed, ft2G? y trench, ft2 Maximum design loading rate bed, gpd/ft2 , ~ trench, gpd/ft2
Recommended infiltration surface elevation(s) 45L, S+ ft (as referred to site plan benchmark)
Additional design / site consi erations
Parent material Flood plain elevation, if applicable - fir
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trer&
Ground . 9s MIT 7/y ~ S + Cos Jnl 1.7
elev
IdB.G ft.
Depth to ,
limiting
factor r
Remarks: cA
Boring #
st 41
Ground 3 A?
elev.
Joe ft.
Depth to
limiting
factor
i
X7.75
Remarks:
CST Name:- ase Print Phone:
0' ?/S-- 2
hn
(1 V_ 6 4
Address: 3 ~ Z yo 7L ST Cl~r~+e G✓,~ ~
Signature: ~Date9 y 3C T N~umber:
PROPERTY OWNER SOIL DESCRIPTION REPORT Page Z of y;
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends
:M.-RIE i~
x:43.:::: p. S 2s// - m[ 6t
701? %A/ rW',t 4 MAY M&Ae 4 S -77
Ground 3 f'9` /0 yR7/y S tC4 /IL
elev.
A 3rft.
Depth to
limiting
factor
Remarks:
Boring # OF
-
o -~zrwo/f L .r ~ Ar4 as e
7
L70-9L S ¢
3 ~
R Al-
Ground
elev.
94•
Depth to
limiting
factor
Remarks:
Boring #
6- Ct 114"
04
r2- D -20
Ground
elev.
99.2E ft.
Depth to
limiting
factor
? 7, ?S
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
asTot 3 yo g►
• TV ,~71aa,5tA o~ T,in oA
_!'i.~✓, Cow.,.", •00 ~
CTY 14
Tappe
l~~e 4afs~0e
3.3" 'S3~ D
!g`
D s
9 !Y /50 `
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER Kevin W. Krueger & Duane D. Krueger
MAILING ADDRESS 375 Main St. North Deer Park, WI 54007
PROPERTY ADDRESS - 375 Mai -n St. Nnrth pegr_
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE Deer Park, WI 54007
PROPERTY LOCATION NE 1/4, NE 1/4, Section 7 T 31 N-R 16 W
TOWN OF Deer Park ST. CROIX COUNTY, WI
SUBDIVISION 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, journevman plumber, restricted plumber or a licensed pumper verifying that (I)
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.
UWe, 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.
12,--
SIGNED:
-6 - y
DATE: L(
St. Croix County Zoning Office
Govemment 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.
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Owner of property 'Kevin W. Krueger & Duane D. Krueger
Location of property NE 1/4 NE 1/4, Section 7 IT 31 N-R 16 W
Township Village of Deer ParkMailing address375 Main St. North
Peer Park; WT 54007
Address of site375 Main St. North Deer Bark, WI 54007
Subdivision name Lot no.
other homes on property. Yes xxxxx No
Previous owner of property Donald Krueger
Total size of property 2 acres
Total size of parcel 2 acres
Date parcel was created June 5, 1989
Are all corners and lot lines identifiable? xxx Yes No
Is this property being developed for (spec house)? Yes xxx No
Volume 842 and Page Number 542 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. 448.562 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
th448f ce of the County Register of Deeds as Document No.
xy
Signature of Applicant Co-Applicant
1a
Date of Signature Date of Signature
DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 2
{ a WARRANTY DEED
F Ji ■q) [ ~
1, / ME54 . THIS SPACE RESERVED FOR RECORDING DATA
/_-R~._44L-_-_//-~~
REGISTER'S OFFICE
________Don_ald__W Krueger and. B_ernic_e T: Krueger, ST. CRDIX CO., WI
his i
fe
w----------- Rec,d for Record
-
jurn 071989 conveys and warrants to QYin-_. at
8.30 A.M
----pe F_s o-n--.e.nd D.u,an-e.--D Kr_ueg.e r.....a---m.axx.iQ d-------------
p•ex_sa-n*---as---t e_na-nts---in._cammnn~----------------------- of DEddS
---•-----------------------•-------I----------------------------------------------------------
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RETURN TO
the following described real estate in .__5_t_._... 0. r_9_ix ........................County,
State of Wisconsin:
ii
Tax Key No.
iI
The North 309 feet of East 309 feet of the NE 1/4 of NE 1/4
of Section 7, Township 31 North, Range 16 West, Village of
Deer Park.
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This is not homestead property.
(is) (is not)
Exception to warranties: Zoning regulations and easements of record.
Dated this 5-t-h------------------------------ day of ---------June 19__89__.
- -
i
--------(SEAL) - -
Kl.. ---(SEAL)
Donald W. Krueger
(SEAL)
(SEAL)
P1>nn ~Q. 1
-----------------------------------------------•-------------------SEAL)
Bernice T. Krueger
- - -
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this 19 day of STATE OF WISCONSIN 1 ss-
l
St. Croix.
Personally County. f
y came before me, this S-tb........ day of ,
._jy4_na...... I_gL8.9.... the above named .Do_na-Ld.--tn-_
TITLE: MEMBER STATE BAR OF WISCONSIN _.Kr_ue_&e_r__.and...$ex_na-_c_e___T..... Kx_ue.gQx,_._.. i'
(If not- --h i-s----w-if-e
outhorized by 8 706-06, Wis. Stats.)
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THIS INSTRUMENT WAS DRAFTED BY to me known to be t•he1-person'-14i_--------- who executed the
orego' o instr lI`Att. and.acAww* ledge the same.
Donald W. Krueger
Q a-------------------
Lois 'M. Cs~nn,?A
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(Signatures may be authenticated or acknowled.-ed. Both Notary Publ;;-i ~ ~ l x County,
c- Wis.
are not necessary.) My Commission'is 'PrmgWent. (If not, state expiration
date: --------N-x4'52.-2: • 19._$_9__.)
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'Names of persons signing in any capacity should be type:! or printed below their signatures.
is
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WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc.
FORM No. 2 - 1977 Milwaukee, Wis. (.Iob33638 )