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HomeMy WebLinkAbout030-1017-95-120 FORM - STC - 104 V AS BUILT SANITARY SYSTEM REPORT OWNER ~/,/A.4,o ~r A,,cs TOWNSHIP-'!5r JoSEPH SECTION S T_q:l N-R 7 W ADDRESS L/9'J Coan,TY /fp- _ST. CROIX COUNTY, WISCONSIN ~rt,US~ G✓~ S~/tJ/G SUBDIVISION I~JA LOT .LOT SIZE AIA PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM tJoT~rz, AgsofA~-lDj Aye--A r Ic A& /n ewrc /oc>n &AL S~:ar/c Tr~K ~,5~Pi3u-r > TFE s, ~rNCm _ /Ss~• ~0 1Po.40 - ARe sod Sc 303'/ P/c --vs ASa • To /}LZI i C~"57 i P'fu&enr- 4"A"55 -'!54007le 77 K 5 "5e A-10 4r faP,P~ /RTE ~i, me QEE,vc//M.tIK - ~OuTI't 6~Lf'~Q~rr f/NL ~ Cw~ Oc 0 INDICATE NORTH ARROW A/c ScrIGE BEHCHMARK: Elevation and description: ~O or Qw ~ ' E4 Alternate benchmark /✓A SEPTIC TANK: Manufacturer: t<,116ScfLiquid Cap. /ono 6rf4. Rings used:.e2-Manhole cover elev: //9.0s• Final grade elev: Tank inlet elev.:/3-v-5' Tank outlet elev.: /3.S No. of feet from nearest road:Front , Side , Rear ✓Ft. From nearest prop. line:Front , Side' Rear Ft. '115" No. of feet from: Well Building: aq (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE 1 K PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.: Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front-, Side_, Rear_Ft. Distance from: Well Building i SOIL ABSORPTION SYSTEM A Bed: Trench: 5 //o --o-Seepage Pit: Width: Length S/ ' Number of Lines: I Area Built Exist. Grade Elev. 6 /i,? .9o Proposed Final Grade Elev. 6 //3-so Fill depth to top of pipe: a~ No. feet from nearest prop. line:Front , Side , Rear 'Ft._(eT' No. feet from well: No. feet from building 4-1S" HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well , building , nearest road Alarm Manufacturer: INSPECTOR: ~j DATE: 9/ PLUMBER ON JOB: LICENSE NUMBER: Oli'S ~-gs 6/90:cj 1 SAFETY & BUILDING LyEPARTMJENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number SW4,NF.4,Sec. 5,T29-R19 CONVENTIONAL D ALTERATIVE (If assigned) Town of St. Joseph[~ot ❑ Mound Holding Tank ❑ In-Ground Pressure NAME OF PE IT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Rnnald Thopnnes -497 Co. Rd. E. Hud-son. WT BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELE!ll 5D;/ //9. ~ i ors, 09 ~ Permit Number: Name of Plumber: MP/MPRSW No.: County Sanitary r^~ EPTIC TANK/HOLDING TANK: 6© cD4 /Y(a Co'k = z T,0 ,2,3 z. 6. MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: [ANKOUTIE W LOCOF.~ /J PROVIDED: PROOD S NO ❑ BEDDING: VENT DIAHIGH WATE NUMBER OF ROAD: PROPERTY WEL BUILDING: ALARM: FEET FROM LINE: ' ❑ YES ❑ NO ❑ YES ❑ NO NEAREST IS DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: YES E NO ❑ YES ED NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPE AL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO REST 111111- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENG DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SP CING: COVER INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHES: MAT IAL: DEPTH: DIMENSIONS 1 sa G',- GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIP MATERIAL: NO I TR. NUMBER OF PROPERTY WEL BUILDING: VENT TO FRESH BELOW IP S: CO W. F~ T: PIPES: LINE: / A1RINLET: ABgyE FEET FROM - ~ iq / a NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW EYES ❑ NO s the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑ YES E NO ❑ YES ❑ NO DEPTH OVER TRENCH/BED PTH OVER TRENCH/BED DEPTHS OF TOP IL: SODDED: SEEDED: MULCHED: CENTER: A EDGES: ❑ YES ❑ NO ❑ YES E NO ❑ YES ❑ NO PRESSURIZE ISTRIBUTION SYSTEM: BEDITRENCH WIDTH: LENGTH: NO.OF TRENCHES: LATERAL SPACING: RAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIO MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERI 0. DISTR. DISTR. PIPE DISTRIBUTION PIPE MAT MARKING: ELEV.: ELEV.: DIA.: ELEV.: PI DIA.: , ~ET VA ON AND UTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO FO TION APPROVED PLANS ❑ YES E NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL, BUILDING: COMMENTS: FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAREST . 1J Q 2 flB.~=// '4 I i i ~(,~~.~CY /nCT'~~'~,4"7.4%,iL~-L,~~~ ~i cZ~ ~-l,yy-~~' /~~-r~ yc~'r~'.--~~,~y-•`.~ Reta in county file for audit. Sketch System on Reverse Side. SIGNAT E: rl SBD-6710 (R. 06/88) ?C7 r~~ ur PLOT & CROSS SECTION PLANS ZAPPA BROS. EXCAVATING INC NO(T~~ ~iPuPEPTY /1 /N~ PLUMBING UNIT I PROJECT I CtJ c l ✓--A;r/o.Vlfl VS rL' O/✓ ~i`~OFruNEs ~TO~oSfD 5'r CiPUR ~ouNTY }}~~CCjjJJ QoPoSty as P~oo~~o DPVEw.FY V% IQ~Si4L.Utd I q A BY APoP 8~j`' 5~/P 3S So3/OVC L8 \ SE....--q ►..vq EGFu4cvr Al r. /.vcs y3 - J`srE N so. I ~s% a3 s< /000 CsA~ Score c TirvK ,w S/o A-r ~NL Gr A"o 0-T-X Er ~/(3 T ~Qo.v ~j O ~fEIEA/OUTl'.~.V$PG[T/Wt/ t1Ji TN A7~1Y/ R 65 it o-...... v.:. L f~-2ri r~ P~ u o Bi NO I SCALE FRESH AIR INLET AND OBSERVATION PIPE Pen Ar S G I. or APPROVED VENT CAP MAXIMUM 12' ABOVE FINAL GRADE 4' CAST IRON VENT PIPE MAXIMUM OF 42' ABOVE PIPE TO FINAL GRADE SIGNED: MARSH HAY OR SYNTHETIC COVERING LICENSE: G6P5 33 rS" MINIMUM 2' AGGREGATE DATE: '91x.? AV OVER PIPE I DISTRIBUTION PIPE TEE SOIL TESTING BY: r .r r► _ 1 A4,f ✓a Y ~J ~ Sg cr ELEVATION BED b" AGGREGATE • BOTTOM PER;SOIL., BENEATH PIPE PERFORATED PIPE BELOW TEST IS • COUPLING TERMINATING A = ira • s-o' FT. - AT BOTTOM OFSYSTEM B=/io.so' ZEE ]ILHR SANITARY PERMIT APPLICATION . In accord with ILHR 83.05, Wis. Adm. Code couN C:! STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ~paQ 8% x 11 inches in size. ❑ Check if revision top vious 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 ,v U of Es St..) Y4AI e Y4, S S T 4, N, R Al E (or PROP TY OWNER'S MAILING ADDRESS LOT # BLOCK # /A C'oc„vr p e[ 4 e, W A CIITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER KurJ3o.~/ Gv, 54/c9/~ '7/s 0 _F II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE : ST ~ dos EPA S D ❑ Public N 1 or 2 Fam. Dwelling-#~ of bedrooms ~ PARCEL AX NUMBER(b) 76A _ 30 III. BUILDING USE: (If building type is public, check all that apply) D 3 Q I O 9 q,s_~ O 1— 11 1 ❑ Apt/Condo 2 El Assembly Hall 6 El Medical Facility/Nursing Home 10 El 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.New 2.E] 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 30 ❑ Specify Type 41 ❑ Holding Tank 12 18 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 12. 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) a=: //ELEVATION 4,1 90 . sz. 93 3 r3 -i/o.SaFeet qc /?geet O SAS /S s~.yr S Fr: VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New F-xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank /Gb0 iooo / DES 9,f Ll Lift Pump Tank/Si hon Chamber Fj F1 I El LL_ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsits sewage system shown on the attached plans. MPRSW No.: Business Phone Number: Plumber's Name (-_Print): Plumb 's Si ature: (No Stamps PPWS 5 ~/S SS' ~aB~So ,eAAAJ &,95 339 Plumber's Address (Street, City, State,, Zip Code): ,?/S- S /V ~0 S c9~J ~i S4/t?/ IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) XApproved [I Owner Given Initial Surcharge Fee) A vers D rmination X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety S Buildings Division, Owner, Plumber y + DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, W1 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATI N: SECTION: TOWNSHIP/MUNICIPALITY: LOT'NO.:BLK.NO.:SUBDIVISIONNAME: 5w 1/ Nc 1/ rs /TZ9 N/Ro9 E (or) W S, Joss?N C J C UNTY: OWNER'VUYER'S NAME: MAILIN ADDRESS: , CA l ,j j, T s ~9? C,- ~dsc~l `F ~1 LV - ,a USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCI-AL DESCRIPTION: R FI I TIONS: E ATION TESTS: P,5 C [*R.siidence 4NV New ❑Replace Z-C)/ 9 U~ SOJL-. V_ S L, ~ a(1Z . , 34 6-TIE K RATING: S- Site suitable for system U- Site unsuitable for system ON E_ T~NAL: M U D: ❑U IN- O ND- URE: S STEM-IN-FILL HO❑LDING T NK: R~cN J~E~~E~D~atT SYSTEM: IoPt~alEs S U S U S S ests are NOT required QESI N RATE: If any portion of the tested area is in the If Percolation T under s. ILHR 83.09(5)(b), indicate: LAss ' Floodplain, indicate Floodplain elevation: ~Zr PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH* ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 9.33 j0&.&6 do 1, B- Z ~.S /07.14 > 19'ALLTS 23~~>BRN SI `19R j MS B=-3 °67 ►~►,9/ > ig.6 ,3~+~t.c.TS 20"Ba~►~►IS r 6Co ~o °'Ba.~l~s B- 4 /o.2S lkS.l I JIVIE > /b.2S Ir-9I.t_TS 40 "Bah n~S~G+P CdbCor,?o "LT$e~ S B- S 9•so 114 .-il A/oNc > T so STS S4- &Q &L Al' un A<.... B- PERCOLATION TESTS I TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER i"=VS AFTER SWELLING INTERVAL-MIN. PERIOD 1 PER10 2 P~ PER INCH 3 P_ z.zo owC /0-7. ' 3 >2 G j P_ .zo rs6Ac c -m '4 >Z >2 <3 P_ i . So 1►Z.c~ >Z > > Z P_ A'~lo A L 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 points and show their ~oca`ion on the lot plan. Show thhesurface elevation at all borings and the direction and percent of land slope. 9 SYSTEM ELEVATION /N ti % i P } TN _ d , .3 - ( t -4- i 11 Kk I /,oR Ozt a I, the undersigned, hereby certify that the soil tests reported on this form were e by meeiin1 ccord with~the~procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAM print : TESTS WERE COMPLETED ON: A , Sohi ~Ua Ev 1vc. a /991 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): P. a $ox i ktoN IA/ I S of ~ ~4t~~ o CST SIG URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHRSBD-6395 (R. 10/83) - OVER - DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION P.O. BOX 7969 LABOR AND PERCOLATION TESTS (115) MADISON, WI 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.: BLK- NO.: SUBDIVISION NAME: Sw 1/ Ng 1/ 5 /T29 N/R i9 E (or) W ST ~s~ P1J Z - C_ S C UNITY: OWNER'S UYER'S NAME: MAILING ADDRESS: ~T C i2 is 74T& I Es 49? CT '4 #1Sc~i ) s4o r ,j I USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: 1PROFI 5E RIPTIONS: ER ATION TESTS: Residence i/~ / New ❑Replace 1 77 Q/ 9 / 13 11-6- RATING: S- Site suitable for system U= Site unsuitable for system I ST❑u IONAL: M U XS. ou IN- RO D-PE]RESSUU RE: SYSaTEM-IN-F LLHOElLDING T NK: RCN~4L;'ti~'"IOi"+►4tT R& N SYSTEM: a lLES If Percolation Tests are NOT required UESI N RATE: I If any portion of the tested area is in the j : under s. ILHR 83.09(5)(b), indicate: ~~QS~ f Floodplain, indicate Floodplain elevation 4 PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER (DBE ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) B 7 ' 66 o IS~Q4.LTS to"8PNSIL S4"62,j1M~ g'Y82Nl~IeS B- ~.S /07.19 > 19'ALLTS I1"Eew Si C 61 "aRN ~'t s B=3 e,67 rrr,9~ > 19.6 13"I1kI-TS z6°190_,J AS CObCO#h ~r "&P js B- /C1.ZS /151 C3NL 7 /x.25 18t1.TS 4L1 gQhMS4 6 Q[6bCO1M70'L r&tii~ <a B- S 9•s6 114.-71 doNc > 9.Sa 0"al-.07S S4" 8Q,, I'll 4144,4:1~c6, b g3* 9. k),, ih S B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER -MgUIdES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P. T"10 oWC r14,1 3 >2 >Z 72 43 701 >Z >2 >Z <3 P_ 'Z zo 1,3,_ P 3 I.SO 1Q.06 >Z ~Z. > P- P_ f ~1/AT)t~ L 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 points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. O- - - III - Z 11111111I to SYSTEM ELEVATION /N E 3 rs%t 1 i d I V ~PGR~QcFNC. !!Z 5 z ~3 LoW 1 ~ I I I N y 10 I~ op 0_1 , I, the undersigned, hereby certify that the soil tests reported on this form werre mCe b 1mee n acctodwlithh the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAM (print): TESTS WERE COMPLETED ON: a42 v L~Nsovl ' ' Uk EYrNC.. T AA /94 ADDRESS: W1 CERTIFICATION NUMBER: PHONE NUMBER (optional): v Kok 1 N S dot ~4f34- 3.6-4 0 CST SIGV FT URE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - 1 CERTIFIED SURVEY MAP Located In part of the SW; of the NE} of Section 5, T29N, R19W, Town of St. Joseph, St. Croix County, Wisconsin. OWNER David Waldroff SCALE I" = 150 398 River Rged P-M I- Houlton+ WI. 54082` 150 100 50 0 ISO 300 I CSM vol. 2, pg• 585 I to S890 12 118"E 540.78' I" IC 505.24' 35.54' m 1- ( + I I at Bearings are referenced Im 0 130,680 sq. ft.) EXCLUDING R/W NI N to the east d west one- w 3.00 acres 1 u 0 quarter Ilna assumed to ;W beer N890371 4711W. 140,046 sq. ft.) AI = I 3.22 acres )INCLUDING R/W 0 S89°45'18"E z 91.2 24J.3R: I- I 1= Z - 633.55' - 66' R/W ~a 130,700 sq. ft.) 14 3.00 acres )EXCLUDING R/W N ~a A I Iv is 140,134 sq. ft.) 0 ~m a INCLUDING R/W .4 ° o In m 3.22 acres 1 o o f I m w I CL 0 0 W 1 N89°45' 18"W I w I 4 oO I a I I to i:. N 171 7 %A A t0 ININ S89°45'18"E I~ 18.63' 2 329.59' 38.46' k0 1 j N 4b. 3 A~ N sk. 1- W IO I (N~ Z II3 to I O ° 110 V' ~O V~ ( ID w N W O_ A in+ s rn 130,682 sq. it•)EXC. R/W z 130,680 sq. ft•)EXC. R/W vl= I 3.00 acres ) 3.00 acres ) - z ~ i` A o 1 0 I? 138,088 sq. ft.) 156,304 sq. It.) o, INC. R/W INC. R/W I I tCD 3.17 acres 1 3.59 acres I N A N , `0 p, 00 6 3.50' - II 283.91 ' a . M 81:W X 29 •g2' -b - 3267.23~ 28.8' 370.48' 1322.22' South .Ine of the. NE N89037047"W 654.26' 1153b_Ase: - W; corner REC. AS 1976.95' E} corner• ~66' R/W Section 5-29-19 unplatted lands Sectl n 5-29-19 LEGEND _ e 1" Iron pipe found. ''•o L[.rj• 15 . , 1" x 24" Iron pipe weighing 1.68 LBS/linear foot, set. c ESr~ t f9 County Section corner monument, aluminum cep In concrete. APPRoyE Nov g. 2 8 1990 C this Instrument was drafted by Douglas Zahler St 'Eif~VEPAQXSPLAN 4 AND Na C~TIEE a STC - 105 _ a~ SEPTIC TANK MAINTENANCE AGREEMENT rt St. Croix County r (c N. l-foE LAiE'5 r OWNER/BUYER 6 iJ~ rt t t~ o ROUTE/BOX NUMBER `T'1~ 6ltJ►~~ Fire Number 4q7 d CITY/STATE. NIUD sot~j tS C0 Nsl Q ZIP 16 rt r B M PROPERTY LOCATION:.S( k, VE34, Section 7 T2.1 N, R_Ij_W, Town of Gf. 713S!gh, St. Croix County, Subdivision Lot number 7- , Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, b a licensed 'septic tank ~pumper. What you put into the system can affect tth function f thee-septic tank as a treat- ment stage in the waste disposal system. r; St. Croix County residents ma be eligible to recieve 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 County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a_licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H I/WE, the undersigned have read the above requirements and agree o to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ::r ment of Natural Resources. Certification form must be completed •b and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNEc~ DATE IC St. Croix County Zoning Office 911 4th St. Hudson, WI 54016, 386-4680 Sign, date and return to the above address. j f APPLICATION FOR BANITART PERMIT aTC-100 This application totm is to be completed in full and signed by the ownet(s) of the pcopecty being developed. Any Inadequacies will only result In delays of - the polmit Issuance. should this development be Intended got tesale by owner/conttactot,lopee' house), then a second form should be retained and completed when the pcopecty Is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - r-- - r--- - - r - - - - - - r - - -.r - r - - r - - r- r - -r - - rr rr-r - Ovnet of acopally onlA~ N- 11{0E-4114 : S AFL T ~r"1~c4 AA'' Location of property S w 1/4 Me Bection T -zq _R v Township Mailing aadceas 4~1 G\i 78, E HLtasoN W t S cosiswS0t/. Adages of alto `1~TN Sf N4c~SotiJ ~JLS~ONS11►~ lubdivision name Lot number -two Previous owner of property ,i AYID W swlA Pr- Total also of pascal Data parcel was created av 7-6 141,1 Are all cotners and lot lines Identifiable? ties __.110 If this property being developed got resale tepee house)T_Tes _ VoIv"4 and Page Number- as recorded with the Register of Deeds. -76 L..i~.► . -t-------------------- INCLUDE WITH THIB APPLICATION THE FOLLOWINGS A VAIIRANTY DEED which Includes a DOCUMENT NUMBER, VOLUME AND PAGt NUNStR, and the BEAL OF THE REGISTER OF DEEDS. in addition, a certified survey, it ; available, would be helpful so as to avoid delays of the reviewing process. it the deed description tolerances to a Cestifled survey Nap, the Castifled Survey Map shall also be required. . PROPERTY OWNER CERTIFICATION IlVe) cattily that all statements on this form are true to the best of my tout) knowledge) that t (1-3) saw (ate) the ownetCn of the property described In this information form, by virtue of a warranty doe recorded In the, office of the County Register of Deeds as Document No.~ S~~L 1 and that r IWeI Presently own the proposed site for the sewage disposal system (or I (wel have obtalneit an easement, to tun with the above described pcopecty, tot the construction of sold system, and the same has been 4 c•eeotdsd n th} Office the county 4119 a of Deeds, as DocumenTlinatutee /v i - Owner 111' Apps icablA 1. oo,f7) . signature of Avnat o;90 i n Date 09 Bignetute - Date of 819natuti DOPYMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1982 465716 1 PAGE 76" REGISTER'S OFFICE ..........De:~~d--J'--- W~.~._~rof f _and .--Jull.e...A-.,... [^11_,drof f, ST. CROIX CO. WI .___..._..hl~st~and__axe_..wfe Recd for Record JAN 161991 a► 11:10 AA conveys and warrants to -onald..N_..-.Thoe_nnes_and................... Ric-hae•1--J-,---Ka-_n.ig..... as..t_enant.s..in_.c.ommon.......... ReglowofDews RETURN TO III the following described real estate in _._._.St . Cr0 X County, - - - - - State of Wisconsin: Tax Parcel No:.............................. Part of SWk of-NE?' of-Section 5-29-19 described as follows: , Lot 2 of Certified Survey Map filed December 3, 1990 in Vol. 11811 Page 2297. 33.00 j Lam i I I I This As-_-not........ homestead property. (is) (is not) Exception to warranties: easements, restrictions and rights-of-way of record, if any. l January 991 day of . ------------------------1 Dated this 7U 4iZ~ ...(SEAL) . (SEAL) . . _ . * David...J....Waldroff . q4tujjjle~..A.._.Waldroff. ........:.......•.....---.....--••••-•-----•-••--------•---.(SEAL) ..(SEAL) s AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St_ . Croix County. authenticated this day of-------------------------- 19 Personally came before me h's -------,day of January , 19__. the above named I)avid i Waldrof` Tulle ---A * - TITLE: MEMBER STATO $AR OF WISC SIN L7aYdro `f . (If not, ` `~--Y•~ authorized by § 706.06, Wis. State.) - ' to me known to be the per w ~ ed the for W. instru n and TlSg A~ ijS INSTRUMENT WAS DRAFTED BY ff Kristina Oland Lundeen I.------------------ Alice Joy o . Q Attorney at Law - - . . Notary Public -c---- Y, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanen nIMIS piration are not necessary.) date. . July_ 19.93 - ~ *Names of persona signing in any capacity should be typed or printed below their Signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No. 2- 1982 610waukee. Nis. ST. CROIX COUNTY WISCONSIN 1~ - iE' l ZONING OFFICE d~ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road - - = - Hudson, WI 54016-7710 (715) 386-4680 July 21, 1994 Ms. Jean Utecht 1168 Rolling Hills Trail Hudson, Wisconsin 54016 RE: Septic System Dear Ms. Utecht: Per your recent request, enclosed is a copy of the Inspection Report for On-Site Sewage Systems, Plot Plan and As Built for your septic system. If there is anything else that you need, please do not hesitate in contacting our office. Very sincerely, Marilyn Zais Administrative Secretary mz Enclosures II it 1117 ' f " I