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HomeMy WebLinkAbout040-1217-20-000 $ 0 2 # � 2 £\ / k a _ I . \ \§\ { t ;® 0 / \\\ � m cu j ¢ \ � $ ° E \ �/) ) z E , 2 , 0 LL \k \ �- E > 8) pf ! � � \ j E g \ { § z2 � a I-- § $ S I k z :!T _C: £) � 2 � ) z \ & e Cl) \ ( a 7 ' CL ) \ / / / © � _ .. ) � � f � lot _ # E ~ / \ ƒ / ) ƒ § § _ a o a ) & \ S g 0 k k k z G) \ G a a a a_ \ / ] q j \ \ ° } 7 U') / ) \ \ _ © E § j j j , J \ / co # / / ] - 9 0 � - • , £ 8 § ® k « C'4 / ° f \ \ k % \ / \ o ® a \ B £ $ @ (D a a 4 % C'4 \ ^ I Q . § § 3 - a ® 2 § ° § e \ R / } { o z $ z z 2 \ \ J CD \ § a. - S » •• I » ( ] § a § / j a E ) J 3 Parcel #: 040-1217-20-000 01/18/2005 09:04 AM PAGE 1 OF 1 Alt. Parcel#: 7.28.19.1044 040-TOWN OF TROY Current X' ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): '=Current Owner * THOMAS W&HELYN S ZARFOS ZARFOS,THOMAS W&HELYN S 430 S FORK CIR HUDSON WI 54016 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description 430 S FORK DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.000 Plat: 2478-SOUTH FORK ADDITION SEC 7 T28N R19W PT SE SE 2AC LOT 7 SOUTH Block/Condo Bldg: LOT 07 FORK ADDITION Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1247/629 WD 07/23/1997 832/230 2004 SUMMARY Bill M Fair Market Value: Assessed with: 27827 452,100 Valuations: Last Changed: 07/22/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 84,000 369,000 453,000 NO Totals for 2004: General Property 2.000 84,000 369,000 453,000 Woodland 0.000 0 0 Totals for 2003: General Property 2.000 80,000 340,300 420,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 217 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER/fW- Z2Z! #If TOWNSHIP O Y SEC. T N-R �� W ADDRESS V30 Sa r?/tI)g&e CiC,jEST. CROIX COUNTY, WISCONSIN Auo 50,0 GJ I s SUBDIVISION Sour�/�wPK LOT # LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM p�TN �2oP£KT Y L iNE P,(o100 sEp /40"-Ocl S eio )D V/Vdf t`J tJEL� A0?0' etrer I iN� 9 / sin 200 38" I �_uJrit INDICATE NOR H ARROW A/ s� E BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: /00 ' Proposed slope at site: 9y SEPTIC TANK: Manufacturer: bj"' Sc j Liquid Capacity: ate. Number of rings used: �_ Tank manhole cover elevation: Tank Inlet Elevation: Q7.a 7� Tank Outlet Elevation: C3,17' r Number of feet from nearest Road: Front,O Side, Rear, /l�` feet From nearest property line Front,0 Side,(Dlear,0 //0` feet Number of feet from: well Sr9, building: /y` (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE_ _ PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,© Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 25�4tV VC-90' Trench: Width: /07 Lendth: 20 Number of Lines: % Area Built: s9'-4' Fill depth to top of pipe: 3 SET Number of feet from nearest property line: Front, 0 Side, O Rear,(aft . 3�� Number of feet from well: 99 Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: , Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: -l �S sly 9�6— 3/84:mj DEPAR-rMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION ► PX).BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 S ate SE y,SE 4,S7,T28N-R19W (If assigned) D.Number: Town of Troy � CONVENTIONAL ALTERATIVE ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDE : ADDRESS OF PERMIT HOLDER: INSPECTION T Ron & Kathi Mi.ckelson 430 South Fork Circle, Hudson, WI 54016 BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: JCST REF.P7.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Zappa Bros Exc. Inc. 3395 St. Croix 119451 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: AIR INLET: ❑YES ❑NO ❑YES LINO NEAREST---*1 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: P PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF F-1 YES ED NO NEAREST---* SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: 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: BED/TRENCH WIDTH: LENGTH: NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV.INLET: ELEV.END: PIPES: FEET FROM LINE: AIR INLET: 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 ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; [--]YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV: PIPES: DA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO NEAREST—* I Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: SBD-6710(R.06/88) Zoning Administrator -- SANITARY PERMIT APPLICATION T DILHR In accord with ILHR 83.05,Wis.Adm.Code COUNTY — �...�. 7. STATE SANITARY PERMIT# -Attach complete plans(to the county copy only)for the system,on paper not less than 119,1161 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 OWNER / PROPERTY LOCATION o�! f Ttf� �lGKFZL ON '/a '/a, S `J T Zg, N, R Iq 19(or)W PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# 4130 0u7N AoRK 7 CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER u-r14 FoKK II. TYPE OF BUILDING: Check one) CITY NEAREST ROAD ( ❑State Owned VILLAGE ❑ Public ®1 or 2 Fam.Dwelling-#of bedrooms P R EL TAX NUMBER(S) 111. BUILDING USE: (If building type is public,check all that apply) 04/0— 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 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. lin�j 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 9 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 j 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 6,00 SZo 85/0 71 3 8s.9 Feet 89.4/0 Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdina Tank /ZOO F-1 El Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumbe Sig ture:(No Stamps) MP/MPRSW No.: Business Phone Number: ZAPPA -Bp_c>j tzxC I/JC. . I/'� war ?IS 38(0-2860 Plumber's Address(Street,City,State,Zip Code): AA4.6 o<J V✓( Sri/ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee(includes Groundwater Date Issued ssuin Agent Signature(No Stamps) fQ -n J ` p Approved ❑ Owner Given Initial Surcharge Fee) [jf S � s �0 ahh 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 Sanutary 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: I. Property owner's name and mailing address. Provide the legal description and parcel tax numbers) of where the system is to be installed. 11. 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. 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. SBD4M(R.11/88) " APPLICATION FOR SANITARY PERMIT STC - 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. --------------------n-----------------------------------------------------------A Owner of property tkkh-r ct t-k[-" a Location of property J�� 1/4 51 1/4, Section - , T _N-R W Township T✓o Mailing address - j_t 5 -7p Address of site "F 30 ( ��L Subdivision name :S L4 ,, Lot number Previous owner of property 's''-IL=�J�� S �oR ,e_,� Jew Total size of parcel �. Q CIL� Date parcel was created - l3 � � 87 Are all corners and lot lines identifiable? _Yes No Is this property being developed for resale (spec house)? Yes )4- No Volume 332:::,ffnd 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, 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 warrant deed -r�e/c/orded in the Office of the County Register of Deeds as Document No. --,-`7 9 "( . ; and that I (We) presently own the proposed site for the sewage disposalY system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of Ahe County Register of Deeds, as Document No. ) . F 0114 J. M�� g, ty) Signature of Owner Signature of Co-Owner (If Applicable) vla�/ ?� J-/ - d-7 - 9 0/ Date of Signature Date of Signature i i " DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED ' REGISTER'S OFFICE� � eoo� s� ST. CROIX CO., WI i CharZe Died de�jetween -_ ___ - ..._• Recd for Record . 'E��le sen alk/a Charles E`llef sen a/kla-----CFiarles �llef-seri IT and NficFielle---E-:---- JAN 3 1989 ___.E1lef s n aria roger Ruelin alk/a Roge-r._.M.G }� in a 11 :15 A.M and____Roriald- D:.___M ckelsor- and_=:Ifat�ileen R. Nickelson, a husband and wife as marital survivorship_ --------- keptere►ofDe - --------- -------- --------- -------- --------- --------- --------- property ----•--------------------••---------------............------......------ --------------- --------, Grantee, W-tnesseth That the said Grantor for a valuable consideration-_____ ChMes and 'Michelle Ellefsen and Roger Ruelin ---------------------------------------------------------------------------------------------------------------- conveys to Grantee the following described real estate in .-._St . Croix RETURN TO _-_--_ _ _ ____________ County, State of Wisconsin: Lot Of SO F A Tag Parcel No_ ----------------------------------- i 7 South Fork Addition located in part the SEk of the SEk of Section 7, T28N, R19W, Town of Troy, St . Croix County, Wisconsin. 1 Together with a nonexclusive easement appurtenant to the above I lot to use the private road as shown on the Certified Survey Maps filed in the Office of the Register of Deeds for St . Croix County in Vol. 7, page 1930 and in Vol . 7 , page 1870 as an access road and for the installation of utilities to reach the Public Road shown on the plat of South Fork Addition. ?'PJWSE R FEE This . 1 S not •---- ------- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And.......Charles anc Michelle Ellefsen and Roger Ruelin warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend thQe same. Dated this .11 -------------- day of January ----------------------------------------- 1989----- (SEAL) V—'C,-••-----------------•--------•---(SEAL) *Charles R•.___Ellefsen-_ask/a__Charles * _-Ro•ger_-Ruelin..a/k/a_-Roger-.M. l� - Ellefse /k/ Cha llefsen II Ruelin (SEAL) I (SEAL) --------•------- ---------------------------- * -_Michel. e-.-E-•---E1-1e-f s.en---------------- i AUTHENTICATION ACKNOWLEDGMENT Signature(s) ------------------------------------------------------------- STATE OF WISCONSIN as. ------------•--•-----------------•---------------------------------------------- St . Croix ....................... ..............County. authenticated this --------day of___________________________ 19------ Personally came before me this !____day of ii January • ----- - --------__- .19 89__ the above named -------------------------------------------------------------------------------- Charles R. Ellefsen a/k/a Charles ------------------------------------------------------------------------------- * Ellefsen a/k/a Charles Ellefsen II li TITLE: MEMBER STATE BAR OF WISCONSIN Michelle E. Ellefsen, Roger Ruelin --------------------------------------------------- ---------- (If not, a/k/a- Roger M' Ruelin -------------------------- p - •-•----------------------------- authorized by § 706.06, Wis. Stats.) S to me known to be the erson __._________ who executed the j going instr t and wledge t same. i' THIS INSTRUMENT WAS DRAFTED BY J L C --- - ----- •---____- -- -............ -Eri.s t_n.a__Oglan d_.Lun de e n----------------------- *Ali c e J. F is c haL Pe of Wisconsin Attorneyat Law . ---------•---- -------•----------•-----•----•-•-•-••-•-• ----------•----- -------- ------------------•-------------------------------------------------- Notary r Public _________St . Croix------------County, Wis. __ ______- _ (Signatures may be authenticated or acknowledged. Both My Commission is permanent. ([f not, state expiration are not necessary.) date: ....June__11------------------------------------ 19.8. __.) *Names of persons signing in any capacity should be typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. WARRANTY DEED FORM No. 1—1982 Milwaukee, Wis. t u 0 1 [ r < x I t o t, 0 M� ou 10 -q a:cl + 2 A < T A u 0 C\j 2 Z� ui > -i cr 0 75 L) o figg to z 0 LO V) fi < 0 U- Z F, Z 0 u LLJ U) 4r -, w A "" 't'l- I >: 3•1c.00.10S Woos C) w Xw 0 U) O cr co x 0: 0 0 lz < 0 of = :- 1338IS-- D118nci— r is Z 00 a 1144. Z < 00 Z. 0 & 40 ZO -0 WI Cl IV 1. 0 611 CQl' lo: w 0 n o ILVI tj LJ wt Lo Ills part of the road is to be left unimproved until such time it is deemed nerce'.,tiary to extend the road to serve the adjoining property the north. At. ',u,h time responsibility for the cost of construction o the road will belong to the developer who benefits from said road extension. Neither the Town of Troy or adjoining land owners will be liable for any construction costs. UNPLATTED LANDS OWNED BY OTHERS - NORTH LINE OF THE SE 1/4 OF THE SEI/4 OF SECTI S89 021' 15"E 770.46' 349.98' 166.03' 354.45 I 33' 33' w t-' zlw w � v i-- w p 7 rn N< l0 a; a N 80, 328 � N N 87,212 S0. FT , nl -1 1.84 A 2.00 ACRES Crr \W ( -I / N89° <1 354 CL I N89°15'56"W 0 350.00' \ to >-I 0 r t3l NOTE: ANY BUILDING OR FILLING N N TEMPORARY BELOW THE ELEVATION OF 866 00 00 REMOVED U T` IS PROHIBITE4 ON LOTS 6 AND 7; (SEE DETAI _ o f EXCEPT FOR -THE CONSTRUCTION 30o W1 OF DRIVEWAY . ZI II 3 I -LLJ N 1 87,382 O U of W 2.01 i of ZI H Q I I Z JI 3 W sR W 3 Io 0 rn a LIJi 0 -0 6 w 0 w 00 0 = 1 ° Qr O 185 , 412 So. FT. U-1 J1 Z 4.26 ACRES 0 1 0 � I o 0 ZI 0 O M I z (n �o W to C 87 , 3 Z N Q 2 .01 tY 1 U IC N I t C ~ 350.00 r I 0 (� N 89°15' 56 W I - NOI°00�51" W �� a 87, 1 I 47.93' ' ,' 2.0 LOT 5 OF CERTIFIED SURVEY ' I -- - - -------- - - - - - S89°1556"E MAP IN VOL . 7 , PG . 19_30 25.40 I - -- -- --- - -- -- S00°44'04 W 7.00' I / S89015' 56"E 0 250.27 0 Kl 0 - - ---- — - E E T-- ----- - �o --- ;., 0 IT rn � N89°15'56"W 250.26' S00°44 04"W � 2 N00°44'04°E 7.00' p 80 00' N89015'56 W 3 , 7 79 . 02 Z 24 9 . 02 ' O m t� m Z r o � � :E N CD:r C c ~ r CD rn ° w \� - — t�1 Q 0 o a . , n . `••. r O Ml ,- 0 Z rT, urns \ CD D '` o o r 0 -- -� Z r -� o cn 0 � / N / -- r-- D OD _ m Z 0) 0 O / :� m 0 ' 249. 57 ' 827 . 50 • - w m w rn (SEE NOTE 0) W ABOVE ) rn W O w 8 25 . 58 ' 226 . 45 ' 0 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER D n d �j�;A")4, ROUTE/BOX NUMBER 213 j 9 C1 rJ c— FIRE NO. Y 3 y CITY/STATE �� _S3n_ %� } ZIP J 1-/O PROPERTY LOCATION: SE 1/4 S E 1/4, Section , T__(aN, R_lg_W, Town of 7✓n N , St. Croix County, Subdivision �OCc�t'h , Lot No. 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 $3000 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification form will be sent approximately 30 days prior to three year expiration. 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 Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address 'INDUS T"..'!��!�F ' REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS `INDUSTRY, DIVISION LABOR HUMAN RELATIONS PERCOLATION TESTS (115) MADISON WI 53707 (1-163.090)&Chapter 145.045) LOCATION;-S SECTION: TOWNSHIP [OT NO.:BLK.NO.: SUBDIVISION NAME: S& 1/4 F'/4 `7 /T2e 0194(a►)W -TAO 7 k COUNTY: OW E ' MAILING ADDRESS: E DATES OBSERVATIONS MADE ,,,yy O R PTIO TESTS: PIlResidence uw , New ❑Replace - ILS 4 ((y RATING:Soo Site suitable for system U-Site unsuitable for system rNEiTIONAL:U M +•aU N S oU F�L a�G TANK:RE�OMMENDE�Y T M:(o��nal) I if Percolation Tests are NOT r wired DE61GN RATE: X�.1 V � If any portion of the tested area is in the w�� under s.1-163.01)(5)(b),indicate: L / )LASS / Floodplain,indicate Floodplain elevation: DCr-.1 PROFILE DESCRIPTIONS BORING TOTAL R N ATER-INCHES HARACTER OF SOIL WITH THICKNESS,COLOR, TEXTURE, AND DEPTH NUMBER Rm:w. ELEVATION V TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) B' 7,SO 90 E > ?.S O 1-21 i s /fr3"$>2NStL (D� LT QN�M5 B- Z I 3 qZ %9. > T4Z k�"Bt-LTS R c rhS B. .17 1 u-90 NNE >6. /7 S,„ LT. c r C-075 B- S" 9AZ 9?-V _NOML > ?4Z 1A"ALLT-_ 99"Cl- e�kl 1> tH PERCOLATION TESTS I TEST A 1 HOLE TEST TIME L V -I S RATE MINUTES NUMBER AFTERS ELLIN INTERVAL-MIN. t D PER INC P. 1 ,4c �9n 3 >2 >P- A79d 3 >a ? > <? 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 points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION �s �� 31. z ►�N �,�� �....._ , C LeJar►o,v ,pU•oU 7 has? Aaue(4ATe aler c M X30' slid t°-I / , i 6 �csf Aje _.... ° mJ _.,.._ .._..- -- 1Qpnl F'11�t try ii Mr��,,.ttRY 1,the undersigned,hereby certify that the soil tests reported on this form were made by me in accord 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. C t,t_ts k. A<- NAME print TESTS WERE COMPLETED ON fi e�^.t??'t 1` e t t 1 iy _r'.r 1 •- c,:y el Ca �-• .... ...� Lls Y t�t :�a.t.. 'a .J ADDRESS: CERTIFICATION NUMBER: PHONE NUMB ER(opt ional): 467 S��otvt� S- u N ► �4-v7., T �, !<.a 4c)k C,, CST SIGN TUBE: DISTRIBUTION:Original and one copy to Local Authority,Property Owner and Soil Tester. OfL MR-SBD-6395(R.02/02) -OVER -- iye Al9` PLB 67 PLOT&CROSS SECTION PLANS ZAPPA BROS. EXCAVATING INC PLUMBING UNIT J34NC,� MARK )s a•• � ' (SELL t-" AAA AT Al/04r7r PROJECT G,f��6 SAO E,43 T AKw OeRT Y CooTAJC)� T / ,CIS Miele- VA ELEVATIoAl - /00 ' � k T. 51 TE IS d BS cro d Lc> c_ S'yo Q INSo aik �/�w Sto'r�c S Tc t A63 %?• A a► o a � g /a N � �veq N SOut�F 400• To Coesr t��K a:. E nn NO A 60u-r/4 oloee 4.1EVE' SCALE FRESH AIR INLET AND OBSERVATION PIPE 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: -P/f'-s �3 9S- MINIMUM 2'AGGREGATE DATE: OVER PIPE DISTRIBUTION PIPE TEE SOIL STING BY: ELEVATION BED 6' AGGREGATE • BOTTOM PER SOIL BENEATH PIPE PERFORATED PIPE BELOW TEST IS • COUPLING TERMINATING g'S- 90' FT. AT BOTTOM OF SYSTEM