Loading...
HomeMy WebLinkAbout040-1117-10-002 . j 2 ) e w K 0 NO I �c � E tM k CD ( k §\ 2 k 2/ � . � f 7/ � $ § O G 2 - o £ k LL c 2 #I aa x 7b88 R § % a ■ S � C 2 7 k W ) ± 7 \ 2 ( � $ § 4-: o o / k - ~ " $ : § 2 . Its : 7 $ i ^ ƒ I \ E § f / c . . \ ] § o a ) ° 6 . k \ \ k k k - i a a a IL g o B U) � Q E \ k $ \ § % \ 2 ' » = E g 2 J � k ƒ ■ 3 § 2 ° f ® © c 80 r & kLO 2 § < o \ $ c c S -0 8 � 4 ® .\ ® e a ■ 2 / Via / W 3 � I 2s § , § a m ) z z 2 k / / ) f o 2 ) / k 2 \ o .. l « k ) 2 a , : CL CL : k a § & 0 £ : 0 3 J Parcel #: 040-1117-10-002 03/31/2006 04:34 PM PAGE 1 OF 2 Alt.Parcel#: 30.28.19.475G 040-TOWN OF TROY Current X11 ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner 0-ROESSLER,JOHN E&GAYLE A JOHN E&GAYLE A ROESSLER 335 GLENMONT RD RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *335 GLENMONT RD SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.180 Plat: N/A-NOT AVAILABLE SEC 30 T28N R19W SE 1/4 SW 1/4 COM AT S Block/Condo Bldg: 1/4 COR SEC 30,TH N 0 DEG W 1308.72' ALG E LINE,TH S 89 DEG W 516.57'ALG N Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) LINE TO POB.TH S 89 DEG W 161.14'TH S 30-28N-19W 0 DEG E 463.86'TH S 89 DEG E 277.357H N 0 DEG W 179.55'TH N 89 DEG W 120'TH more... Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 828/185 I I 2005 SUMMARY Bill#: Fair Market Value: Assessed with: 102941 212,200 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.180 51,000 153,200 204,200 NO Totals for 2005: General Property 2.180 51,000 153,200 204,200 Woodland 0.000 0 0 Totals for 2004: General Property 2.180 51,000 153,200 204,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 156 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form - S T C - 104 r AS BUILT SANITARY SYSTEM REPORT OWNER le I -56/eVTOWNSHIP D SEC. 3e T *N-R/ ADDRESS �0 /S ST. CROIX COUNTY, WISCONSIN SUBDIVISION - "LOT LOT SIZE PLAN VIEW /USG Distances and dimensions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM l,ono�a� y' INDICATE NORTH ARROW boo op Pr 6' BENCHMARK: Describe the vertical reference point used lop S.bo. f. k g fq Elevation of vertical reference point: lo0. p Proposed slope at site: a S16 SEPTIC TANK: Manufacturer: �h&dt t%t $Vr_tC,5\ Liquid Capacity: r}�'o U Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: i Number of feet from nearest Road: Front,©Side 0 Rear, O ?/00 feet From nearest property line Front,0 Side,O Rear,O feet Number of feet from: well pr`��t� , building: (Include this information of the above plot plan) ( 2 re— ference 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,0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: V 0 S'e o Width: '� Length: 100 Number of Lines:�^ Area Built: Fill depth to top of pipe: r Number of feet from nearest property line: Front, O Side, O Rear,O Ft .,/d _ Number of feet from well: ? s0 Number of feet from building: Z5&1 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: f Area Built: Has either a drop box O or distribution box been used on any of the above soil O 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, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: n Dated• Plumber on job: 71,mw S !� License Number: a> 1 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.O.BbX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: SE!,jSW%,S30,T28N-R19W © CONVENTIONAL ❑ ALTERATIVE (It assigned) Town o4 Ttoy G2ev� ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound John 9 GayteRRoasteA ADDRESS 548ApaRtto Road, RiveA Fa.P.P�s, W1 54022 INSPECTION DATE: BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: 7homaz A. Wang 3231 St. cuix 119384 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: YES El NO ❑YES 40NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING:I VENT TO F SH I I ALARM: FEET FROM LI E: AIR IN ❑YES 0 `L— ❑YES ❑NO NEAREST—► DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO A ❑Y S NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROP Y ELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF E]YES E]NO NEAREST-� SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAM TER: ATER ARKING: 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 DIMENSIONS / 4-60 TRENCHES: � 1 MATERIAL PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.D R. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BE OW PIPES: ABOVE COVER: E INLET EnLE/V.END, /1 �1 PIPES: LINE: .6G 9�� AIR INLET:FEET rt i/ +�✓ 7�0 �7v c�(� s+ NEAREST ©� V V f 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: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PfOPERTY WELL: BUILDING: FEET FROM ❑YES ❑NO DYES ❑NO NEAREST� r %7 Sketch System on / Retain in county file for audit. Reverse Side. IG URE: TITLE: Zoning Adlnt,ni6Vca oo L SBD-6710(R.06/88) CO." SANITARY PERMIT APPLICATION COU DILHR In accord with ILHR 83.05,Wis.Adm.Code STATE SANITARY PERMIT# "TV —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. [FORIVARIANCE TION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. ❑YES U NO PROPER Y OWNER PROPERTY LOCATION eS5 �° a '/4, S T , N, R f E (0 '10 y /r PROPERTY OW ER'S AILING DDRESS LOT NUMBER IBLOCKNUMBER SUBDIVISION NAME TY,ST . ZIP CODE PHONE NUMBER CITY EST LAK LANDMARK �� [�� ❑ VILLAGE : TIT II. TYPE OF BUILDING OR USE SERVED: / - /Vi. 0V0_///7_/C Number of Bedrooms if 1 or 2 Family OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4,if applicable) 1. a. K New b.❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2) 1. a. PgConventional b. ❑Alternative c. ❑ Experimental 2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b.X1 Seepage Trench c. ❑ See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 14. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPO ED(Square Feet): �� �j Feet Private ❑Joint ❑ Public VI. TANK CAPACITY Site Fiber- Exp in allons Total #of Prefab. p. INFORMATION New Manufacturer Existing Gallons Tanks 's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank I El Lift Pump Tank/Siphon Chamber ❑ VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plum is Name(Print): Plu er Signature:(No St mps) MP/MPRSW No.: Business Phone Npu�mber: �filCc S ?l V 5� �L ? Plum er's Addr as(Stree ity,Stake,Zip Co �): Na esigner:� b ,3 Ce to er s VIII. SOIL TEST INFORMATION Certifie Soil Tester(CST)Name CST#;V s d 000 CST's ADDRE S(Street, 'ty,State Zip e) Phone Number: 69- le 25' IX. COUNTY/DEP A RTMIFNT USE ONLY ❑ Disapproved Smitary Permit Fee Groundwater Date I suing Agent Signature(No Stamps) Approved ❑ Owner Given Initial cc//�� Fee racy Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR'COMPLETING A SANITARY PERMIT APPLICATION TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), deptb of system, or type of system; - 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. Private sewage systems must be properly maintained The septic tank(s) should be pumped by a licensed, pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 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 where the system is to be ` installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair, IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. 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. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. 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; dosing or pumping chambers; 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. ---------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground Ater included the creation of surcharges (fees) for a number of regulated practices which Wisco irltS can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reisur . is used in your building is returned to the groundwater through your soil absorption u system or the disposal site used by your holding tank pumper. a The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD-6398(R.03/86) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY& BUILDINGS INDUSTRY, CC DIVISION 'HUMAN LMORAND, PERCOLATION TESTS (11J) MADISON WI 53707 (H63.09(1)& Chapter 145.045) LOCATION: SECTIO OWNS MUNICIPALITY: LOT NO.:BLK.NO.: SUBDIVISION NAME: 7T 4E�/ 1j9 R gE (or o COUNTY: OWNER BUYER' NA ,p MAILING AD RESSS: F StC'roi A IlDeSS�PI_ SY9- l ��Uel f` USE d DATES OBSERVATIONS MADE NO.BEDRMS.: C MMERCIAL DESCR PTION: PROFIL D SC IP IONS: ER TION TESTS: Residence NINew ❑Replace /� p� ? RATING:S=Site suitable for system U=Site unsuitable for system l 0 J CONVENTIONAL: MOUND: IN_-GROUND-PRESSURE: S STEM-IN-FILL HOLDING TANK:RECOMMENDED SYSTEM-(optional) CAS ❑U ®S ❑U CAS ❑U ❑S NU ❑S CCU s'Xroo '?`rc�► c� If Percolation Tests are NOT required DESIGN RATE: Q If any portion of the tested area is in the under s.H63.09(5)(b),indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS,COLOR,TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) _a, 50' f" In Lest 2 V6r, 3 �d 9.S� 6 ,61 s l5!ao S a. 5,61, eesf e 5/4r B- y '5'0 , 5e s'o .�o �� s; �.oa 612 S 3,5o44 SV('> h B- ZZ .s16 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIADID 1 PERT D 2 P PER INCH P_ Mt P- � 50 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 1� - �D Gh a Ko = 10 ,0 (J°1'. .� ei^� • I IL J0 tK r •T--....--— I E E ►►�� I,the undersign d,�hereby certify that tfia soil tests Yeported 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. NAME( t1: TESTS WERE CT tDqN; D ADD S. i CERTIFICA ON N BER: PHONE NUM R(o Fonal): CST SIG E: DISTRIBUTION: Original and one copy to Local Authority,Property Owner and Soil Tester. DILHR-SBD-6395(R.02/82) —OVER — 1 ' INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test,your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or repIacernent systern; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbrevidtions shown here for writing profile desc€iptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet.may be used if desired; S. Make sure your benchmark and vertical elevation reference point are clearly shown,and are permanent; L'. Cornplete all appropriates boxes as to dates, narnes,addresses, flood Main data, percolation test exemp- tion, if appropriate; 10. If the inforrnaton (such as flood plain,elevation)does not apply, place; N.A. in the appropriate box; 11. Sign file farm and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WI THIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Teastrares Other Symbols 4t - Stone (ovc,( 16") SR Bedrock cola - Cobble (3- 10") SS SatId`.ston,e gf Cfravel (under 3") LS Limestone CS - a nar.a, Sx3,ld perc _ Percolation (;ate rage€` : II F e f ano 31tdg Su te�rrrg s s I o"wty -and ]'hall I - l min r G - Cr<'Y l t i 1y Lo<tn i 3 Ho",- sicl - ` i�t May Loam irat -- [�J ,tics Clay 1t t.� ,t C F,;vjL --- High vt;at€! r v(d, Six etene rc l s""'J tz.x?;meS furl hqu d 21sst°t d ;>posal P sE B3 wnch i,Jla to tat Rp _._. vnrncd 2t r TO THE OWNER: This soil rest report is the first ste.+p it) securirin a sanitary permit. The county or the Deparvment may request ve,ification of this soil test in the field prior to permit issuance. A complete set of piz ns for the private 5evvaq,e sysiern and a permit application must be suhrnitted to rhea appropriatc local at-ohorny it) order to <Tbla�o a ocrinit. The sanil°ary not snit must, be ohtam,7 d and p.?5t8fd 1,,i for to tile, start of any con ti"tiction. I J STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 06 I pe!ss I- K ROUTE/BOX NUMBER P-}, FIRE NO. CITY/STATE &11Qe f' 1,S � Wk ZIP -_-yo�'a PROPERTY LOCATION: 5E 1/4 X1/4, Section T_2&_N, R_L2_W, Town of dun\/ , St. Croix County, Subdivision 'T , 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. Clew 11 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 ST. CROIX COUNTY WISCONSIN ZONING OFFICE I���NNrr• ` ST:`CROIX COUNTY GOVERNMENT CENTER ar , _ ST cRoix 1101 Carmichael Road COUNTY r Hudson, WI 54016-7710 zONINCOFFic (715) 386-4680 SEPTIC INSPECTI TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. ❑ Water (VOC's) $185. 00 % Septic $50. 00 Pk Ll Water (Nitrate & Bacteria) 45. 00 ❑ Nitrate & Bacteria U Water (Lead Concentration) 21 .00 retest $15. 00 Owner: f_ r 1P Requested by: Address: 3 � f,l�h r�� fz d Address: -%Oei Z�ah�, _Z I P ZIP Telephone W: ( _ _q ►� Telephone W: ( ) Property address (Fire If & Street) : M-) f- ; JRd Location:SE ;, Sk) ;, Sec. _, TAN, Rj,�L_W, Town of Realty firm: 11an.e Lock Box Combo- Ac�rLk Closing Date: 54 ® �� 002- muha I Sa Uihc�5 `f,30 PW\ moo, a8. l9, '175-G see pkken ko5� 1 TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: Is the dwelling currently occupied? Yes 0 No If vacant, date last occupied: Age of septic system: �p Septic tank last pumped by: UCCIA\=5 ',Ss cc Date: 4-9 7 Previous Owner's Name(s) : nmye Have any of the following been observed? Sy���w, ❑Y Slow drainage from house. 5`Y100� 5-Do 0Y Sewage Back-up into dwelling. 1000&-/ ❑Y Sewage discharge to ground surface or road ditch. Y Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the y e. best of m knowledge. � g OWNERS SIGNATURE• DATE: 5b j9y'' 1 /94 � s OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION 1N IO TI P k 11- TO BE COMPLETED BY INSUCTION AGENCY 116I3RY System design &/or permit on file? es ONo Soil series per SCS Soil Survey: sheet # Type of soil absorption system: B15elow grd OAt-Grd OMound Approx. size ' X OD , EGravit ODose OPressurized Ft. -' ❑Bed QTrench ❑Dry Well Molding Tank OOutfall pipe OBSERVED DEFICIENCIES OOther OUnknown Septic tank / Setbacks: G ouse OWell_��OProp. line ��DOther Dose tank Setbacks: OHouse OWe11, OProp. line OOther OLocking cover OWarning label OPump/Floats ❑Alarm ❑Elec. wiring Soil Absorption System Setbacks: OHouse OWell OProp. line ❑Other OPonding: ODischarge: General comments: INSPECTORS KETCH OF SYSTEM LOCATI N Inspector Dd tle W r ST. CROIX COUNTY WISCONSIN ZONING OFFICE prxrxxru■ - ----. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 May 20, 1998 John and Gayle Roessler 335 Glenmont Road River Falls, WI 54022 RE: Existing septic system inspection Legal: SE '/4, SW '/4, Sec. 30, T28N-R19W, Town of Troy, St. Croix County Dear Mr. and Mrs. Roessler: On May 20, 1998, in your presence, I conducted an inspection of your septic system located at, 335 Glenmont Road, River Falls, Wisconsin. At the time of the inspection, the septic system appeared to be functioning properly. No ponding of septic effluent was observed in the drain field vent. The septic system serving this property was installed on December 2, 1988, and was sized for a three bedroom house. A Midwest Precast 1000 gallon septic tank discharges to a trench type drain field— 5 ft. by 100 ft. The system was inspected by staff from this office on December 2, 1988, and was installed as a code compliant system. To prolong the life of the system, remember to have the septic tank pumped once every three years or when the tank becomes 1/3 full of sludge and scum. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. This inspection of this sewage disposal system was based on a surface inspection of said system, and did not involve any excavation or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Should you have any questions, please contact this office. Sincerely, Olt e4 Rod Eslinger Assistant Zoning Administrator . C E Y � LCJ9 I 301 >v 16 0-61) r 0 fe s Pd'o�Se� ID d �rn.N 13 t,000��, n8q See ado � � ra=ge. Alrf-k al — —i �a 5 xtoa` Aw,-�-lie /6010 top fir ST i . CRO X COUNTY �.� WISCONSIN ZONING OFFICE Iriy 9 (1, T:,aROIX COUNTY GOVERNMENT CENTER 134$ ST CROIX 1101 Carmichael Road ' = COUNTY Hudson, WI 54016-7710 ZONING OFFICE (715) 386-4680 SEPTIC INSPECTI TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. 0 Water (VOC's) $185. 00 % Septic $50. 00 A 0 Water Nitrate & ( Bacteria) 45. 00 ❑ Nitrate & Bacteria i] Water (Lead Concentration) 21 .00 retest $15.00 ' Owner: ) Requested by: Address:_n� h1o�n ti� 12a Address: ����er �n 115 �Z I P ZIP Telephone W: (ji,; ) yae,-gt�g►I Telephone W: ( ) Property address (Fire W & Street) : 33 r G-) r1mG n+ Rd . Location:96 ;, Sr.J hi, Sec. _, TAN, R_Lq _W, Town of Realty firm: Hone Lock Box Combo: Aon-k Closing Date: 5 - q mufua 15a u,h55 '1;30 p+h 53e pher\ kos� 1. TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORM* Water sample tap location: Is the dwelling currently occupied? Yes 0 No If vacant, date last occupied: Age of septic system: Septic tank last pumped by:: cicclp\\=5 ISPOic Date: 4-9~7 Previous Owner's Name(s) : n Have any of the following been observed? Sy�E' S�-;c.t bArwiS 0Y Slow drainage from house. ��></DO�>• St�O OY M Sewage Back-up into dwelling. G ❑Y Sewage discharge to ground surface or r road r�c.s�s�, ditch. 0Y Foul odors. Other comments relative to system operation: I certify that the above information is complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: 90 1 /94 ST. CROIX COUNTY WISCONSIN <, ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER l N/pNpll�p rtrr4 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 May 20, 1998 John and Gayle Roessler 335 Glenmont Road River Falls, WI 54022 RE: Existing septic system inspection Lam: SE A, SW '/a, Sec. 30, T28N-R19W, Town of Troy, St. Croix County Dear Mr. and Mrs. Roessler: On May 20, 1998, in your presence, I conducted an inspection of your septic system located at, 335 Glenmont Road, River Falls, Wisconsin. At the time of the inspection, the septic system appeared to be functioning properly. No ponding of septic effluent was observed in the drain field vent. The septic system serving this property was installed on December 2, 1988, and was sized for a three bedroom house. A Midwest Precast 1000 gallon septic tank discharges to a trench type drain field— 5 ft. by 100 ft. The system was inspected by staff from this office on December 2, 1988, and was installed as a code compliant system. To prolong the life of the system, remember to have the septic tank pumped once every three years or when the tank becomes 1/3 full of sludge and scum. Other efforts to prolong the life of the system could be as simple as fixing or replacing plumbing fixtures with water conserving fixtures, reducing shower time, washing dishes when the dish washer is full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. This inspection of this sewage disposal system was based on a surface inspection of said system, and did not involve any excavation or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Should you have any questions, please contact this office. Sincerely, U Rod Eslinger Assistant Zoning Administrator 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 s of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------------------- Owner of property -�O�f1Y1 £ (P Location of property J G 1/4 6k) 1/4, Section G , T -10 -LLW Township j ,./o� Mailing address �� , gt (l�r �g1lS, �Y Address of site vy�--e- Subdivision name — Lot number Previous owner of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes 'r No Volume 20 9 and Page Number /gs as recorded with the Register of Deeds. ------------------------------------------------------------------------------- INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER, and the SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. ------------------------------------------------------------------------------- PROPERTY OWNER CERTIFICATION I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document No. and that I (We) presently own the proposed site for the sewage disposal 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 the County Regis er of Deeds, as Document No. ) . 0 U14(f k- Sig u e of Owner Signature of Co-Owner (If Applicable) -a�-� Date of Signature Date of Signature [DOCUMENT Nom. STATE BAR OF WISCONSIN FOR] 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 'I il. /� -r{� i li �cK rc,I,C 1 � � OFFICE Si. CRO, co., wi ; This Deed, Paul. I; Recd for Record made between _H..._Jo.hnson__and Delphine. R. Johnson, husband and wife___-----------------. NOV 31938 - ---- I; of 3:�.5 Y. M ----- ---- - -._, Grantor, I and John_ E.. Roessler _and Ga.yle._A..___Roe.ss_l.er ,.___ husband and wife, as survivor.s_hi.g. marital Registe►ofDeeds property - ------ ----- - II Grantee �1� SSeth, That the said Grantor, for a valuable consideration_ I1E) (i I` ` RETURN TO conveys to Grantee the following described real estate in -St-. -Cr-Q1X-- aunt,, state err Wisconsin: FIRST FEDERAL SAVINGS 8 LOAN ASSOCIATION AF -EAU_CLAIRE ._ . Lot One (1) , Vol . 7 , Certified Survey 2000 CRESTVIEW DR. Maps , page 2045, Doc . No . 443078 , being P.O. BOX 506 a part of the SEk of the SWk of Section 30, Tax Parcel]�1jDspl�I;__yu}-54F}]6--•-------- it Township 28 North, Range 19 West . it I; I! I I I ;I I I � � 1 I I i ii 1 I This __-i s-_no-t-------- homestead property. (is) (is not) i Together with all and singular the hereditaments and appurtenances thereunto belonging; Ana.- Paul H ..--Johnson -and--D.elphine_- R._ Johnson----- --------- - --------- -_ -- ---------- -------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except j easements and rights of way of record , if any , and will warrant and defend the same. Dated this __-_ __._ __. .23rd _ ...- ---- day of ----------November __-- -, 19..88._. - - f SEAL) /.�L-�Z-'` - r=-l� ��' Zf_(SEAL) I * Paul H . John/son - - f-- ----_------ ------ * - - - - - - Delph.i.ne_. R ---Johns.on-------------- AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF WISCONSIN ____ ____ - -fS�R!?1��'.iq I _._____ ss. -- °` � :.Ldih�f, St . Croix ��Y4 --------------------------------- County. authenticated this _____ off. 19-�__. Personally came before me this __23rd......day of .---- �� fj i , ;� November_......... 19.$8.. the above named Pa............................ n-_and * ----- -------- ----------- .' i= , - --- --------- ---- Delphin-----R ...Johnson--------- -- --- TITLE: MEMBER STATE I�1It�©F VVISCONS�N r,"r (If not, °�°►�T91 `•.•...,.,..•'tJil " -------- authorized by § 706.06, Wise�'t�fs.9`;I�� to me known to be the person ---S.------ who executed the tglyy`L3�Y foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Ct L• CaYler � AttQney----- ------------ * Michael L. runner ---- --- -------- ---- - -­------------------------ .. R ver_-Fal_ls,-- WI____54022__----___--__. St . Croix Count Wis. --•--- Notary Public -_------ - -- ------- - Y, (Signatures may be authenticated or acknowledged. Both My Commission ]kkAi�gMgiji"k. (if not, state expiration are not necessary.) date: -__.__--_2X2.1xQS._711A.e._23.................. 19.-91--.) ! •Names of persons signing in any capacity should be typed or printed below their signatures. Ii ;I -i. ...._ . .. ...._ ...... .. .._ ._.. ..._. ......__ STA'rE BAR OF WISCONSIN n�1 � � � FORM No. 1-1982 Stock No. 13001