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040-1117-60-200
C) I m o ti O EA p u> m I I 0 4 d c I I 0 o I I N I ~ I 0 3 y c I ~ r Q) m U) c y c t Cl. Q) y O y 7 tC O N C 16 Z a) C Z T N C C C LL C L LL 0 O 0 co a 'a a~ a N Q C Q I II Cl) N Z z rn = O I „ O O d m I N N I M 04 a m I a m o c (9 a ~ I v O Z :!t c c t. 7 y O 2 y ai Z rn cm aci m F- Z N I IL E c E '2 v I ~ rn I N m N N O N c N aai (n • I ID in ID o (~D c p c I c c O z zF- z Q z°m ° N z Y N C C N O N A E N N N la N N N }~~yy d LO C l r ` C I j N Y ~ c o a N 95 a) ~i o y N c r c o a E Z N vi m (n N rn I yr N N 0 3 n LL z ILL 3 3 ° LL • ~aaa I~aaa a I~ in J V 0) m co co 0) I rn z m 00 0 o ca v 0 :z p N O CD N N ~ O O Q p N d 0 I C m C 7 .6 ml N tT N 00 y Q U a Q} cn is U 9 z fn (V M I M U) O) 01 N N N N co V) C °o M y) c `o E O p i co co O p a) O I P y w N V il a) 00 I F= y c c ~ T7 n a a c a c; C o o c o o c o o a) l o c a) N 7 N_ p) In ° fD C iC> ,NN co ~ N FL- H C (D N o 0 °v o 2 ca o y E E v I 0) o j • f. o M I- ! 2 o Z g co z z 0 ~ = I ~J ~ d ~o E a a I EL L: 0- r`1v o m 3 o 1 3 r c r A c~a O Ow v) L) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER/,w, ADDRESS_r,/Qd SUBDIVISION / CSM# LOT SECTION. 3a T Z8 N-RW, Town of Z"Pj oy ST. CROIX COUNTY, WISCONSIN ~M PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~yX 3 Z INDIC TE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ' sAgZe 1&0e ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: l/l leA5- Liquid Capacity:/4mv Setback from: Well Sa House 1A Other Pump: Manufacturer Modell GvFpsii14 Size so ~a/ 4¢3p' Float separation y Gallons/cycle: 1,7,6 Alarm Location :SOIL ABSORPTION SYSTEM Width: Length z Number of trenches Distance & Direction to nearest prop. line: /s' wvW Setback from: well: > /ao ' House > loo Other ~oa S,II t,ti ELEVATIONS Building e ST Inlet. u Iet d f!' PC inlet ottom Qs , s- 6 Off rl, r6 o.~ Bot system Pf, o Existing G S'El.o Final grade DATE OF INSTALLATION: 3 PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt L part` e~Fr„~~tty28.19.SE"$% EiEAGE%%T% County: Labor and Human Relations INSPECTION REPORT Safety, and Bhildings Division - I (ATTACH TO PERMIT) sanitary er it ,'GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State Plan o.: TROY ev.: ~ Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300173/b ~ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic A nG . Benchmark lG~ Dosing G7 Aeratiori- Bldg. Sewer Holding St/* Inlet ~ ry TANK SETBACK INFORMATION St/ I# Outlet 7 " TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet / ' Air Intake Septic 1>l NA Dt Bottom 2 gyp` Dosing NA Header,p!" 9d•l5 Aeration Dist. Pipe ~D, D 5 Holding - Bot. System, OS PUMP /'INFORMATION Final Grade 6 Manufacturer Gc Demand °cj - , j ` l a~^ Model Number GPM 7g TDH Lift Friction System TDH Ft Loss H c " !v ,10 Forcemai n Length Di a. " Dist. To Well (D x r ZC; / , 97 SOIL ABSORPTION SYSTEM BED / TR9QCW Width i Length No.Of Trenches PIT No. Of PitsgA, Liquid Depth ~Zl DIMENSION -3~ DIMEN I N ~f LEACH[ Manufactur SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type Of /l~ CHA M0 tuber: R UNIT System: Cyn DISTRIBUTION SYSTEM Header /Rllarri b - Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing (P SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Depth Over Depth Over xx Depth Of xx Seeded / S x- ched Bed/Flko'thCenter Bed/T"Edges Topsoil es ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.30.28.19.SE,SE,LOT 2, CO. RD. MM aZ%~ v l Plan revision required? Yes No Use other side for additional inform❑ ation. 9 93 a` SBD-6710 (R 05/91) Date Inspedor's5ignatur Cert. NO. ADDITIONAL COMMENTS AND:SKETCH t , . SANITARY PERMIT NUMBER: aIL!-'IR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITA~Y} TK -Attach complete plans (to the county copy only) for the system, on paper not less than Y 7 8% x 11 inches in size. LJ check revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNE PROPERTY LOCATION %a S To T XA N, R / E (or PROPERTY OWNER'S MAIL ADDRESS LOT # BLOCK # Z lo? Of CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~y a !j w 12 830 CITY NEAREST ROAD 13 II. TYPE OF BUILDING: Check one ( ) ❑ State Owned 5 VILLAGE : ❑ public 1Z 1 or 2 Fam. Dwellings of bedrooms 3 AR L TAX . UM III. BUILDING USE: (if building type is public, check all that apply) Q - / 7a~O _ ZB~ 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ -Off ice/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.0 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 # If 3S/3 Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 2 Seepage Bed 21 ❑ 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. GALLQNS 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 20 7W , j .D Feet f2.b Feet CAPACITY VII. TANK Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New )Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank on Chamber Dv lv~ Lit Pump Tank/Sipt Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite wage system shown on the attached plans. Plu bar's Name (Print): Plumber's Signature: to s) idP/MPRSW No.: Business Phone Number: I -p is Address (Street,-City, S Zip Code) luIO : ro^~ ~ WS D Z3 IX. COUNTY/ PARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ssuing Age Sign a (No pproved F-1 Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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. 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 & 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. IL 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. VIII. 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 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; (Jose 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) LH SANITARY PERMIT APPLICATION COUNTY v In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT. , -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNE PROPERTY LOCATION 4 4,S N R E (or) PROPERTY OWNER'S MAILI G ADDRESS LOT # BLOCK # ly-7 Z_ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER f ~'•."t,°rv r•/!f t~,£ <~~2 ~ X305" - u _/fs..! CITY NEAREST ROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE~~^ / ❑ Public ©1 or 2 Fam. Dwelling4 of bedrooms S AR L UM IIL BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 20 Assembly Hall 60 Medical Facility/Nursing"Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground` 7 ❑ 'Merchandise: Sales/Repairs 11 ❑ RestaurantlBar/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 in line A. Check line B if applicable) A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of S. E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # i ZL ~s Date Issued -7/` 2n3 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 42, ❑ Pit Privy 130 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 (sqA.) PROPOSED (sq. ft.) (Gals/day/sq. ft.)- (Min./inch) ELEVATION % 7,-70 7l f" I 'Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic :New xistin Gallons Tanks - Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber dp VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite wage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: to s) rMWMPRSW No.: Business Phone Number: u"er's Address ( treet, ity, SW , lp Code): 1 . r tea. r_.~~ ys IX. COU TY/ P RTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued ssuing Agent Signa re (No S P-W pproved ' Surcharge Fee) ` ❑ Owner Given Initial - Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) 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. 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 & 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. VIII. 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. - - - I 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) 77D,LHR SANITARY PERMIT APPLICATION COU TY In accord with ILHR 83.05, Wis. Adm. Code ST TE ANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8% x 11 inches in size. c eck f revisi to prey esapplicatlon -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 41 s^r'i `I tti % S o T f , N, R E (orb PROPERTY OWNER'S MAILINO(ADDRESS/ LOT # BLOCK # C. z CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER v II. TYPE OF BUILDING: (Check one) El State Owned 1:1 VILLLLAGE NEAREST ROAD D l1i1 ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms 3 PE&NUREPTARNUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo /9 117 -0 - >0 0 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 in line A. Check line B if applicable) A) 1.0 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) Z A Sanitary Permit was previously issued. Permit # 9.35'/5 Date Issued 7-,Zl IF -3 V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 71 Seepage Bed 21 ❑ 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 01 2 O 7Z0 ( 7 ~9 6 r Feet 92. v Feet CAPACITY VII. TANK Site in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank D Lift Pump Tank/Si hon Chamber f ~O VIII. 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 Stamp MP/MPRSW No.: Business Phone Number: Z27 C., / 1W 4 9 7Y;P 3GSi~ Plumber's Address (Street, City, State, p Code): o 3004-r f- _r S~ .z 3 IX. OUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date) Issued Issuing ent Sign pproved ❑ Owner Given initial urcharge Fee) / Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS , 1. A sanitary permit is valid for two (2) years. 2.1. Your sanitary, permit may be renewed before the expiration date, and at the time of rene'Nal 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. On-site sewage systems must be properiy rna ntained. The s,~Fptic tank(s) must be pumped by a licensed pumper wherever necessary, usually every 2 to '1~ years. 6. If you have questions concerning your onsite sewage system, contact your local code aciminisirator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: c- I. 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 onlyr one and complete # of bedrooms if 1 or 2 Famiiy 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 cf system. Check appropriate box depending cn system type VI. Absorption system information. Provide ail information regsesttad in #1.7. VI1. Tank information F iii in the capacity of every :le~v and/or ext Coy , tank, '«tt'ie t1t~r! gallons, number of tankb and manutactsirer's nan*te. Indicate pref~lb or site constructed and tank, i7}atu,-ial. Conplete fcr all septic, pump/sipl ;.lr and holding tanks far this system. Check expPnmt a ,owoval only if tanks received u. ,=er;rnental produ;- t approval from DII-_F4q VIII Fie > n5ibility statemVnf. installing piu nber :s to fill in, name, license !,timber with approp,i~te prefix (e.g. SAP, + address ano" phone number. Plumber must sign application form IX. Cour ty/Department Use Only. X. County/department Use Only. Com!)'ete plan- °:nd sciecif cations not smalistr Inan 81/z x -11 sr-,,,h Frt.,:st be submitted to lire cou ity. The plans in6ucly -re fo.;, giving: A) plot plan, drawn to .-c-J,_ or with complete c . e:s,si err>. ?0,-,&`ibn of hoAing t<<<~ -~ic tars ,)r oiher treat!nl tanks; 'it '-ding sewe-; v.-s, we,,ter I %,vE;t;Iir service, st=P80-15 e'21) z urnp o! ~zi,;han tanks, soyi aIb!zo'ooorl system,, repi&cen,snt system area 7~ nu of °hE i)ui!ding served izonta' ,ertic ' .lf:, stir p6-)t3; G) complete specifications for pumps and contr cis, close ,,Dlurne, ele, tiori differer,ces; 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 inciuded the creation of surcharges for a numbE r of regulates' practices Which can effect groundwater- The morirs collected through these surcharges used for monitor r;r(,). ndwater, ground- water contamination investigations and establishn-orit of stan; arils - SBD-6398 (R.11/88) Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of Labs; 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 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 OWN PROPERTY LOCATION lr,"/i `r GOVT. LOT Se1/4 1/4,S 3aT N,R E (orJlp PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE GOWN NEAREST ROAD ~ Gv' a ( ) T O rl'1 [A] New Construction Use [x] Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow So gpd Recommended design loading rate _,7 ed, gpd/ft2- .s-trench, gpd/ft2 Absorption area required 7.2-o bed, ft2 S'dS trench, ft2 Maximum design loading rate 2_bed, gpd/ft2 . f trench, gpd/ft2 Recommended infiltration surface elevation( ft (as referred to site plan benchmark) Additional design / site considerations 'J~~ c Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ElS ❑U ❑S OU OS ❑U mS ❑U ❑S 0U ❑S [Z I.) SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench PA 4r 41 S fA, Z /z Sc m Sd/~ cc v4~ Ground elev. 3 z S Y S b e , S / ft. 6 S O vir s Depth to S" r S limiting factor # Remarks: _g _q is u fem. Clore so% r Boring # 1.... Z d 3 C AV r G 2 u T c . ~ s z2 y s 6~ S _ 6 Ground elev. 2-7 2. S 3 S C S /V P y _L ft. Depth to r y s S _ , limiting factor Remarks: CST Nam . Pleqs Print r--- J Phone: 7 Loowj2l -e P_ T - S- Address: 70 /Ta Art- CIO Xr, Signature: Date: CST Number: o L~ L lip / A PROPERTY OWNER iy SOIL DESCRIPTION REPORT Page z of z PARCEL I.D. # l4?X?eS- Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 4 vv nv.v m a h,~ 4t . > /3 Ground y y v r w elev. y 7.2 ft. ` /o - ~ S I - .7 jv Depth to limiting factor Remarks:` Boring # 3 d S p td, G k Ground elev. Y s - j 6/~ t~ ~r s _ v ,Oft. Depth to 39 ° S - limiting factor i I Remarks: Boring # r S z0 S y 5/ ft, Ground elev. sc s k r s - A) /v ft. Depth to r S 6 5 ©s I c w - limiting factor Remarks: Boring # vv Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) J 1 ,rte T~ I ~ ~G SCa~~ $ml fNrv`7 X ~dvrr i~ C T'NNl/ J GI Y V ~ c 7s, _ ooa r o ~ K G. S , ~ spa f z y l 77 • • 11- 1 c w T 'M ~vr~`Hr ~ 167. a ~•t3 lB 63 AYE FOURTY PLUMBING Licensed Perk Fester & Plumber c#3233 #13289 ROBE RTS W1 N3 No5402 Phone 749.3656 t l hi M a k'SSl.~ttr /G+~O~ X = 6o r%H~ II'' ,J 5•r . r, pmo,,i L.s. goy fed N_ X Alf 0 i o• # s rrlH y 74 NG 7 y9-?GS6 11 F- '63 i i x, ss h, ~ ~I s•7: lD ~~33 ~ - I r Cj7~/ lt~rH~/r.~uv~ f~l~C{S QCIONH n// f r M CD" n z 1 °O PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP I"C.I. VENT PIPE frT WEATHER PROOF APPROVED LOCKING 7 JUNCTION BOX MANHOLE COVER 25' FRCM DOOR, 12"MIU. WINCOW OR FRESH I AIR INTAKE I GRADE I `I" MIIJ. Alp, CONDUIT 16"MIN.\ - IAIi._F_ l" PROVIDE I I AIRTIGHT SEAL I I.II ~ J/ I I APPF.O'JEC JOINT A I III APPROVED JOINTS nl/C.I. PIPE. I I) I W/C.I. PIPE I II EXTENDING 3' EXTENDIM& 3' ALARM B I ONTO SOLID OIL .)NTO SOLID SCt:. I 1 I ON C •i I " PUMP ~ OFF D CONCRETE BLOCK RISER EXIT PEWMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL /~dyk ~63~ SPECIFICATIOA.IS C TIC AND TANKS MANUFACTURER: 1- 00 " 1~ 5 NUMBER OF DOSES: PER DAy TAWK :IZE: r'~lD GALLONS DOSE VOLUME _-j * 1-7 r ` ALARM MANUFACTURER: ~L U INCLUDING GACKFLOW: ?G f yS0 y7GGALLONS MODEL NUMBER: CAPACITIES: A= 2 1-1 INCHES OR GALLONS SWITCH TYPE: 'Gdd a/= B = INCHES ORGALLOWS PUMP MANUFACTURER: ( Or~ / G INCHES OR GALLONS MODEL NUMBER:pp~~10~~~ Dw INCHES OR GALLONS SWITCH TYPE: NOTE: PUMP AND ALARM ARE TO BE PUMP DISCHARf.E RATE 3Z GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKENC[ Bi9'NJEEW PUMP OFF AND DISTRIBUTJON PIPE.. /Z FEET + MINIMUM NETWORK SUPPLY PR~~ESSURTE/.. "Wi"g' FEET + U.0- FEET OF FORCE MAIN X ~~L_.__~~F/ooFxFRICTION FACTOR..s, 2' 44 FEET `L D FEET TOTAL DYNAMIC HEAD = INTERNAL DIMEWSIONZ OFT UK: LENGTH _ ;WIDTH ~-...;LIQUID DEPTH SIGNED: LICENSE 1JUMBER: 3 9 _ DATE: -117- 9 111 10 i..vr~ t~.G ; ~ o , 6 luau M F HEAVI W 11$ 110 CAPACITY z15 CURVE 301 95 28 90- 26 85 24 80 MODELI EFFLUENT and a 75 MODEL 189 DEWATER/NG = 70 165 V 20 _65-- z 18 60 55 ODEL F 16 50 F 0 163 MODEL H 14 45 188 1y _40- 35- 10 MODEL ~ MODEL 137, 139 185 SEWAGE and 6 25 DEWATER/NG 6 20- MODEL MODEL 16 15 • 4 97 10 u~i 2 MODEL _ f LL 5 53, 55, w 57.59 0 GALLONS 10 2' 0 30 40 50 60 70 80 90 100 110 24 LITERS 0 80 160 240 320 400 75 22 FLOW PER MINUTE 70- 20 a 18 fi0- MODEL Q 295 W_ 55 16 U 5o Q 14 45 MODEL Z 294 y p. 12 40_ J MODEL 35 F- 10 293 O MODEL 30 284 8 1 25 MODEL 6 20- 282 - 15 4 ' OELLE/~ O. 10 MODEL 2 5 267, 268 ° 3280 Old Millers Lane GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 X130 140 150 160 170 180 190 P .O. Box 16347 Louisville, Kentucky 40216 LITERS 0 80 160 240 320 400 480 560 640 720 (502) 7782731 FLOW PER MINUTE eUo Z OR 3 01993 N~tt A991019t ofCONOft CER`>:I 1W' SURVEY MAP LOCAt ed in pert of the SEh of the SE4 bf Sedtion 80T28N,' RIM, TOWn of Troy, St. Crct~x COUrity, 'WiSc6nein. Cbrve Radlus .j . Central Chdrd Chord, 10 ;Arc tangent tangent r Ler~gth Angle Bearing Length length Be.e. ring h . ; dearin ~d5,96 !b 1!! $5S$4 0~ 211,$ l~=2$+S1i4~1„~2S~1t181 °.•=f~~~l°5510~~IE_'`sl$6°1S16T"E 1~ir J~ $05.961 2201316911 653002101.511E 233.661 235.141 1'605.961 244156'1 S6501112911E 22:021 22,021' E 14 CORNEIt N OF SECTION 30; o ~ UNPLATTED LANDS , A PPR eD , , CROIX C0W0 o ' m ~proh~nsivJi I~r>~Aij \ 6/1, z F' \'v zonkv ena C g p Parks Con*iitAil N o n Ir Q \'9~- . Y o 1D ~ • 57~~ ~ ~ 11 not rbtiSrdl+ia . ; . ~ - ;a W111111`1 30 a{•r dr t1 t;•' t r `tT r''' spprbvl~t'of • ~ ~C 8 Jl,`vok! jb o LOT 2 QL ' IZ 2;01 ACRES INC. R/W I~ IV 87,726 SOFA 2.0 ACRES EXC. R/W 87,165 tij (rn Q SOFT, • \ L Imo, t~ ACC1E89 EASEMENT voL.731 00. S.00°04'21''W Yfl . N60°dl'da"E I' 500°04'27"W ® + X23.51 417.34' 2. 9 Nee ae 4t E t119.Is' S89°51'53°W 437.34' °SOUTH LINE OF THE SE44 20.Qd tt Laa' S~ CORNER OF SECttON 30 1 Sk CORNED. t $kb 6ORNER OF SECTION iSO~ ;OFD SECTION 29 R Q-3.-M. IN .t LEGEND _G 2 P 1wER AI'u' I inua County Section Paul Johnson I~ Monument Found 382 C.T.H. 11MM11 O 111 x 2411 Iron Pipe Set, iver Falls, Mi. weighing 1.88 lbs. per 54022 'w: , I linear foot 1.l,i~l1l C , 1001 Roadway Setback , 4-A- Fence Line Si, r,• ` < SCALE IN FEET M .Y• •t. f 1 q9•'' .,4. i'' g,~~ ~;.'••Ir • fit, } ► 0 50 10 0 VOLUME 9 PAGE 2612 SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify that by the direction of Paul Johnson, I have surveyed, mapped and described the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the SE1/4 of the SE1/4 of Section 30, T28N, R19W, Town of Troy, St. Croix County, Wisconsin; further described as follows: - - D e g+rrrri' n g1_. a t: t h e.-E D-e e r e x - - a S o a k o a» S89°51'53"W, along the south line of SE1/4 of said section, 437.34 feet; thence N00a04'27"E, 430.62 feet to the southwesterly right-of-way of County Trunk Highway "MM", thence S41o55'02"E, along said right-of-way, 344.47 feet to the point of curvature of a 605.96 foot radius curve, concave northeasterly, whose central angle measures 24018'55", whose chord bears S54004'29.5"E and measures 255.23 feet; thence southeasterly, along the arc of said curve and said right-of-way, 257.16 feet; thence S00o04'27"W, along the east line of the SE1/4 of said section, 23.51 feet to the point of beginning. Above described parcel is subject to access easement as shown on this map and all other easements of record. I, also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. Each parcel shown on this map (plat) is subject to State and County laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.) Before purchasing or developing any parcel contact the St. Croix County Zoning Office for advice. VOLUME 9 PACE 2612 p~Q b t i , S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County y 9WNE /BUYER ADDRESS FIRE NUMBER 3 9- ZIP J T d . CITY/STATE PROPERTY LOCATION: L-F,-1/4,S_!E~-1/4, SECTION_ 0 T $N-R W TOWN OF , St. Croix County, SUBDIVISION - , 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 a 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 as been maintained must be completed and returned to the St. Croi Co. Z n ng Officer within 30 days of the three year expiration te. SIGNED: -10 DATE: ! r St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 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), thenia 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 _ Location of pro-pertySZ-1/4 -`ter 1/4, SectionlS , T N-R W -3 Township Mailing address C 7W dlra Address of site subdivision name_ e Lot no. L~ Other homes on property? _ /-yes Previous owner of property Total size of parcels Date parcel-was created ~r~► 3 r Are all corners and lot lines identifiable. Yes No Is this property being developed for (spec house)? Yes,)LNo Volume ID/F and Page Number / ~O 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 & 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 ~inr the g. fice of the County Register of Deeds as Document No. V y)j , 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 re co d in t V office of County Register of deeds as Document No. N Signat a of applicant Co-applicant 7- / Y-- - q3 Date of Signature Date of Signature - - - " STATE THIS SPACg REBERVED fOR R[COROING DATA ; BAR OF WISCONSIN FGRA 1 -~.t988 DOCUMENT NO. i i WARRANTY DEED I pp A .Sd1.'48 -4 lI_ VOL 1018PAGE 6 [WGGISTER'S OFFICE This Deed, made between Ja11nS.an...and......... ST. CROIX CO., WI , A.elphi.ne...R._.Jo.hn.son,..-hu.s.band... and..wif.e Rec'dfor Recard Grantor, JI~N 2 9 1993 ;I and D.eI ta..Con-st.r.uc.tion...Co.•.,.••-a.. Nir ime. Q;ta 0:45 A.,rM at ii 11~ ....cor.por.ation . ~ i~ Remsber of Deeds _ Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... .....p... RZTURN TO conveys to Grantee the following described real estate in ..St.....C.roix........... I County, State of Wisconsin: Lot 2 of C.S.M., recorded in Volume Nine (9), Page 2612, as Doc. No. 498305, Register of Tax Parcel Deeds' office, St. Croix County, Wisconsin being located in part of the SEk of the SEk I' of Section 30, T28N, R19W, Town of Troy. Also granting to Grantee an access easement as shown on the above described C.S.M. and subject also to all other easements of record. I~ i y :'~v i' I' This • i s_ ri-• homestead property. not (is) (is nnt) j Together with all and singular the hereditaments and appurtenances thereunto belonging; And......Paul.. H.._..J.oklns. n..and.._Re.lphi.ne. R...._J~o.hn.aon warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and rights-of-way of record, and will warrant and defend the same. ~.th day of M.a Dated this y Y•• 19.E-3... I (SEAL) . . (SEAL) * ..PaLIl ...H.:... .ah.ns~on............................ (SEAL) De.lphine..R._. Johns.on................. AUTHENTICATION ACK,IIOWLEDGMENT Signature(s) STATE OF WISCONSIN Pierce County. i authenticated this ........day of 19...... Personally came before me this th......day of Ma.}!..............., 19...83. the above named Pala.l...HA....inhn.s.on..and JDelplAne.Ap...Johns-an TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06. Wis. Stats.) to me known to be the person s.......... who exeoqf$_c they areg ng instrument and acknow dge the;'e e . THIS INSTRUMENT WAS DRAFTED BY A L , s C! ; C. L. Gaylord Attorne -'.j Y K.a en..I....Elage.l. N River. Fall.s WI 54...022 . Notary Public - Pi erc-e.._.... CQUA*, ~ My Commission is permanent. (If not, st t~acpira'hion~,.•',,;"'. (Signatures may be authenticated or acknowledged. Both are not necessary.) 7 - 4 date: .............................................•-•-•--.:t.;~ *Names of persons signing in any capacity should be typed or printed below their signatures. STATE FORM No. tWISCONSIN 4lIL.mMr !8 Stock NO. 1300 SANITARY PERMIT APPLICATION UtLHR COUNTY ~ In accord with ILHR 83.05, Wis. Adm. Code ` STATES ITARY PERJ,T # -Attach complete plans (to the county copy only) for the system, on paper not less than El / 8% x 11 inches in size. c(ac If revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION l ~1 '7 rle 5wE '/4 S~ '/4, S mod' N, R E (O PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # (ea 44 2 Ad- IV1 C7ITY, STATE ZIP CODE PHONE NUMBER 14 E OR CSM NUMBER / / -a ` Gj . p3G' S , Ile C 6~ P4 II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD rnrn ) ❑ State Owned VILLAGE nn 99 =N OF: ❑ Public LJ 1 or 2 Fam. Dwelling- # of bedrooms PAR EL TAX NUMBERR( ) III. BUILDING USE: (If building type is public, check all that apply) 1 Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandiser Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ 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. Z New 2. ❑ Replacement 3. ❑ Replacement of 4.0 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 300 Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43H 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 ELVi. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Al / /G'D• S ELEVATION f ,o . G L s~ O Feet /O Y-0 Feet VII. TANK CAPACITY Site in allons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xistin Gallons Tanks Concrete glass App. Tanks Tanks structed Septic Tank or Holdin Tank p bw S Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage ystem shown on the attached plans. Z 9WP/MPRSW No.: Business Phone Number: 77/1 ber's Name (Print): Plumber's Signature: (No StamDal - ..2 re? / 3 )3 4 _rig i r PI urnber's Address (Stree ,City, State, Zi ode): I IX. COUNTY/D PARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date sue Issuing Age t Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial 'P I~6 Adversee Determination 3 k4 `yt X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: t~ l SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber I 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. 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 yotAr.AnSltQ,.5QwAge system, contact your local code administrator br 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. Ill. 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 13% 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) L ' Ts; rtrT8W un3try28.19 . SE il 'E lEVU7Q6E ST 1 County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ' (ATTACH TO PERMIT) Sanitar mit II ` GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State PI ev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300173 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer [Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Ar I Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Moe Number: System: 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 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.30,28.19,SE,SE,LOT , CO. RD. MM Plan revision required? ❑ Yes ❑ No Use other side for additional information. SOD-6710(R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS.AND SKETCH. SANITARY PERMIT NUMBER: I ILH Mill SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY ....M.,_.,,e. EK STATE SA T H ER I # -Attach complete plans (to the county copy only) for the'system, on paper not less than / PifFvlYntoprevious 8% x 11 inches in size. CReapplication -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY -0WNER PROPERTY LOCATION - %a S O T N,R E(o ZP O ERTY OWNE S AILING A R SS LOT # BLOCK # CITY, STATE' ZIP CODE PHONE NUMBER W891W610111 NAME OR CSM NUMBER carl OXJL .yC v P1, 0 C".4 el I ' ✓ 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned VILLAGE : 0 44 ❑ Public 01 or 2 Fam. Dwelling of bedrooms Z PAR L RO III. BUILDING USE: (If building type is public, check all that apply) wjo 144 7 -/00 1 E:1 Apt/Condo 20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40. Church/School 80 Mobile Home Park 12 ❑ Service station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 E seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 Seepage Pit Pressure 43 ❑ , Vault Privy 14 ❑ System-ln-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEVj 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) A(/ /OJij ELEVATION SO 'r D Z I/ AU_ " .,VFeet D .e Feet CAPACITY VII. TANK # of Prefab. Site Fiber- Exper. in allons Total Manufacturer's Name Con- Steel Plastic INFORMATION New istin Gallons Tanks Concrete glass App. Tanks ranks structed Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage stem shown on the attached plans. PI tier's Name (Print): Plumber's Signature: (No Stam 101r/MPRSW No.: Business Phone Number: r s. ~9 6S'L lu is Address (Street, City, State, Zi de): O Gv O,~L I OUNTY/D ARTMENT T USE O Y ❑ Disapproved SanitaF Permit Fee (includes Groundwater a e sue Issuing Agent Signature (No Stamps) Approved El Owner Given initial Surcharge Fee) r Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety s 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 courUy prior is installation. 5. 4nsite sewage systems` ?husNN propert)MaintS9rted. The septic tank(s) must be pum,pe'd- t y 64 nsed pumper whenever necessary, usually every 2 to 3 years. ~ 6. If you have questions concerning your•onsite sewage system, contact your local code administr"atbr'or the Stataof Wisconsin, Safety. S BuiloirTs Division, 608-266-3815. To be complete and accurate this sapitar* 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. 11. Type of buildi'hg"bt'1ng s pl'e'd. C1*eolc0n1y onb 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. VIII. 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) c@mplete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump perforrt"Mc&7curA pump model and pump manufacturer; D) cross section of the soil absorption system if .;?'?s-,required b)r1he ooitlJty; E) "I test data on at1'1b form; and F) aft,sizing information. Q *6*AJ1T*SUR'CHARG' E ti4 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater'. The monies co ected throug~,.toesesurcharges are used for_tgfl{litoring groundwater grounds e cam ♦ n wader c~n`famin tibn investigations and establishmef 'Wf ign rds. ' SBD-6398 (R.11/88) 1-7 PIN * y~ DAVE FOGOM. PLUMON6 UcUmd PWk TGSW & Pkanber / tna #32U AL f 1~IN 54023 ~w a 749.3656 1po~ so T10" Hy ro N y3o Sca~ ~ „ _yo . ~ Ll 8~ I ! re+~• asra~t /00v x = 6® ri i~ e r. ~Cr~ O < road pa/,. ~T. Q will ~ s° 5•% d- ~itt r40L ,s~1~-~ wiry D~~ ~~d~-- ~ ;Ff `7 64 A-P i . i I I i ~ ~ ~ ~ 1 i i i ~ _ I 4 - Dave Fogerty Plumbing SEWER SYSTEMS & PERK TESTING ' FOGERTY HEIGHTS ROAD ROBERTS, WISCONSIN` 54023 t~(715) 749-3656 r C /7 Y rWr~ .ls i 7 / ya r_. - - elev. 77, ~O . s/oPc ; P 7e `t 1F APR 2 019930. AM s a I JAMES 0'Ct~ 498 , Islet 01 , , tlrodc saa, WI , CERTA ' ~D SURVEY MAP 'LocAied in pert of the 5Ek of the SA bf Secftion `30,' T28N1. R19W,` TbWn of Troy, 8t. Crd~x County, 1,WieC(5h:ein. ;Garvey :Central Chdrd ' Chord :Are tangent Z' Tangent A gle Bearing Length ;lingth Bee- .ring . a~. ~l.earin r l •'1 bb3,96I 1146109991 ' 534000 Hi Silk 1 6,1~~!~ X86601315 fit 605.961 , 22013' 59'1. S53002101.511E 233.661. 235.141 , ► r r t , -3 r' 605.961 200415611 S6501112911E 22:021 22.02' Y E ~4 CORNED if OF. SECTION 30. N: O UNPLATTED LANDS -APPROVED. I t d- f ~~D Ajo n I , 1 4A C)(i i \ '1 is CROIX COW, t`- kr' rt it IC ~•\C~ Znndnd 869 • _ p A \\Gj~~ Petki CwttWtAiNoe m All it not ° d13 jr"sf ti ' s re' ' y j r r . t. , i t f --1- 'v ' : ~►r, I Wllhili 30 ~ rh \ ~hPC ` tfalt ° ~ . Q ~D o LOT 2 t IZ 2:01 ACRES `INC. R/W ♦ ` 1D 87,ri:6 Sf2ET 2,OOACRES EXC.R/W Mj ~rn Q 87,165 SOFT, t Id. ACCESS EASEMENT I L • VOL;731 00. 67 SVO°04'27"W Na0°el'ea"E 1' S00°04' 7"W 023.51 41234' 2.7 Nee 4941 E 419.1e' S89°51'53"w 437.34' °cOftWER SOUTH LINE OF THE SE~4o.QO'' 2f t,ls9' OR' , SF CORNE14: $r4,8ORNER SCtb30 OF SECTION S6. ;Of SEC1`ION'29 D Z LEGEND ~ I P 1 s • I Ivy Aluminum County Section Paul Johneon A Monument Found 1q~,•y~, 382 C.T.H. 0MR11 0 In x 2411 Iron Pipe Set, ~'•'e1 ~,V fiver Falls, Ni. ~~Y . weighing 1.68 lbs. per ti~ $4022 linear foot I.l.C-N C 100' Roadway-Setback 1 Fence Line ~ cep ~ .,L, t• ~lI'p, ~dt'•i, SCALE, IN FEEt ".4 0 100 0 17 VOLUME 9 PAGE 2612 X, S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County SP BUYER_~~~ ADDRESS f[~ FIRE NUMBER CITY/STATE ~~,~,.,.-c-.-~f~-~~. 1.~/" ZIP J T d PROPERTY LOCATIONS SECTION_ o T Z- N-R W TOWN OF , St. Croix County, SUBDIVISION , 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 a 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 a set by the Wisconsin DNR. Certification stating that your septic as been maintained must be completed and returned to the St. Croi Co. Zon ng Officer within 30 days of the three year expiration te. SIGNED: --J t/ DATE: l' l r St. Croix.co. Zoning office 911 4th St. Hudson, WI 54016 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), thenia 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 _ e Location of* property-5-S--1/4 S0 1/4, SectionD , TN-R I W Township Mailing address Address of site l Subdivision name //~DNC Lot no. • L- other homes on property? - yes Previous owner of property Total size of parcel Date parcel-was created 3 O / 3 Are all corners and lot lines identifiable? -,X-Yes No Is this property being develtoyped for (spec house)? Yes,-No Volume ~a13 and Page Number / as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & 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 t1je q fice of the County Register of Deeds as Document No. `r ~ )j 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 recd dl in IV office of County Register of deeds as Document No4ie Signat of applicant, t, Co-applicant Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FuRA 1-.t Beg THIS •rACt R!5[RVZO FOR R[COROINO DATA f WARRANTY bEED qq , 501478 VOL 101SPAGE.406 REGISTER'S OFFICE This Deed, made between P.au.1Ji,... JQhns.an...and......... ST. CROIX CO.P VNI Delphi.ne...R.... T.obitson,-bu.s.band...and....if.e Rec'd for Record i .........................................................................--..................:;..Grantor, J 2 a 1993 it and Delta ...Constr.uction...Gsa.•.,...a.. M 0. ne.SQ.t.a----•--•--•-----!-• 10:.45 _ A-,M i~ cor.por.ation. at jl . . R90mr of Deeds _ , Grantee, Witnesseth, That the said Grantor, for a valuable consideration...... RICTURN TO conveys to Grantee the following described real estate in .,st.....uOix........... 1 County, State of Wisconsin: j! Lot 2 of C.S.M., recorded in Volume Nine (9), Ii Page 2612, as Doc. No. 498305, Register of Tax Parcel No: ..4.fo._^...lle? Deeds' office, St. Croix County Wisconsin] being located in part of the SEk of the SEk of Section 30, T28N, R19W, Town of Troy. I~ Also granting to Grantee an access easement as shown on the above II described C.S.M. and subject also to all other easements of record. I' I~ i~ II This ....15... n.o t.......... homestead property. I' (is) (is not) i, Together with all and singular the hereditaments and appurtenances thereunto belonging; And...... PAU!.. H.:...J.Q.h7.1.SO.n...nd...Delphi.ne. R.....John.s.on warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and rights-of-way of record, I~ and will warrant and defend the same. Dated this 7.th day of .........Kay......... 19.x.3... (SEAL) . . (SEAL) " • ..Paul...h.r....oh.nsan.................. (SEAL) ../..d..,..9-_e .....%t. EAL) ...Delphine.• R.. John.$,on AUTHENTICATION ACIifOWLEDGMENT Signature (a) STATE OF WISCONSIN Pierce ...........county. authenticated this ........day of 19...... Personally came before me this t h ......day of ...................Ma y. . , 19 ...93. the above named a1t]...J1 A....iDhns.on..and................ Delph.i.ne. K,-Johns.an TITLE: MEMBER STATE BAR OF WISCONSIN (If not . authorized by $ 706.06. Wis. Stats.) . to me known to be the person r$........... who exeau%4_theV '•.,,I oreg ng instrument and ac now dge thq'ls al.. ~ ~ THIS INSTRUMENT WAS DRAFTED BY tj C. L. Ga ld Att n.. .i ..Y.....o...r.._s ............o...r..n...eY........................ en..lla...Pngel. River...Falls,._WI.....54022 ?votary Public Pi. .e.rce. . .!.Coin g~n s is ermancntf' (Sifinatures may be authenticated or acknowledged. Both My Commission p (if not, st~+e~x,,pira`i;io are not necessary date: 7.4 .....9.X 1 •Names of persona signing in any capacity should be typed or printed below their signatures; 041- 8TATE BAR OF TFORM No. I WISCONSIN 1082 Stock No. 13001 I DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION ImABOR-AND PERCOLATION TESTS (115) MADISOP.O. BOX N W153969 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: /~r MUyN~ICIPALITY: ILOT NO.: BLK. NO.: SUBDIVISION NAME: 1/~), E'4 So /T r/"/p~11POE (or6# 3t COUNTY: OWNER BUYER'S NAME: MAILIN ADDRESS: -CU v' a o~ So 3ga C~"~' !`~1 1"I C 0e 2-~ T~S ZJi 5~lor?o? USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR FI E DE~ TIONS: PER CO ATIO TESTS: Residence >New ❑Replace 3 3 p'2 0 Q~ RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TAN: K RECOMMENDED SYSTEM:(o tional) ❑U ©S ❑U ®S ❑U I DU ❑S ®U 2-75` ~renC~es If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevatio . PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- II 4Al n ~oarse S B- a 8 /Da ► a Y /s l 1 a y va ~n ya 8~, me d S 13- -3 a PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PER OD3 PEER INCH P- D o~ ~O7rv~ P- a( d o° -7 LI) P- at 0 ~~✓6 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference p ints a show their atio 2 the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 405 - S (r SYSTEM ELEVATION 3- R? o a' /QO a . S Ca f~ / ' ' ~ ~ I I d P. L_ (r .e►^ )e> o -fe-f-c G~ se ~r e._ ~e~.~t►^e~~~~es -9g.oo - 99 o 4t 1- /61" 06 #9- /o). ~ 3 *1 B 1 F 5 ~ C ~5 # #a . 12 lt, l oeAt oij 0 . PQ > fi Al limp 5.1 1, the undersigned, hereby certify that the soil tests repo this foo ad in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the loc n ~ h~ sts are c c he best of my knowledge and belief. 5 NAME (pri t): TESTS WERE COMPLETE /~ON: A /A~ s ~ ~6 7 ADDRESS: CERTIFIC TIO NUM ER: PHONE NUMBER(o tional): ~ CST SI RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - FORM 115 - ° L ALL A aia~1s? i I ~ T° . i E TO THE OWNER, This soil test report is the first step in securing a sanitary mit. The county or the Department may request verification of this soil test in the field prior to pr n ; complete s,~t of plans for the private sewage systerrr and a permit application must be subm, 1 >c;' authority in order to obtain a permit. The sanitary permit must be obtained and _ ~ %F any construction. CCU/' f ~r. ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE _ 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 April 29, 1993 Paul Johnson 382 C. T. H. "MM" River Falls, WI 54022 Dear Mr. Johnson: At the April 27 meeting of the St. Croix County Planning & Development Committee, your minor subdivision was given conditional approval. The conditions are that the driveway be 75 ft. from the NW corner of the lot (per St. Croix County Highway Department), and that the Surveyor make some minor additions and/or corrections to the map. The driveway permit should be obtained through the Highway Department, and I have notified S & N Surveying of the required map changes. When these conditions have been met, the map may be presented to the Zoning Office for final approval. Should you have any questions, please contact me. Sincerely, Mary J. Jenkins Assistant Zoning Administrator cc: Clerk, Town of Troy