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HomeMy WebLinkAbout040-1090-20-000 n Cl) Q C n rw O pp C O M (D v v -o 4t v 3 v ^ (D 3 M a CO CO W° `C • M o m w o ' o c o rn ° < CD 3 - CO 7 r- z E (D 90 CO c W 0' O co DD 0 O N CL N N 7 W N O p : CD N O A O ^ O CD CD Q ) N p O k N O N N v .7 E; c cc U) C a > CD n N W a U C CD O O ry CO N (D (~1 CL CO \ w CD O O N 00 CC) (n O r- .4. A O c7 IT N c h• z OOO ~i Cj (/Ij TJ f/1 (A fR CD c R cam, c,• o ° In o v v v N 0 (D CF A D b 3 u y N o ~ c W d CL CYI N = - n z 41 A L ZWz ON O TJ HN G7 v O D a~ Oi • CD CD H v ? 7 CD v lv CD -i c m N r° w m a r A a (D - I !R Z I ~ Z O t-ri 1 C1 o0 ~ A I Z ~ N Ob ca _0 -i Z W (DD m N ° ° w A cy' ~ rn a ~ ~ A cf) y CD CO C CL CD R °'"o ~ IS E; X (Z N ( CC CD D N - c O ~ w wx ~ o a v A~ ` O7 00 CD C d N CD IZZ d ao CD ~C) cn CC C' 3 n. N A "0 CD - •a 5 CL <S CD ON O O _ 0• A h O N < O a A 69 Q ti p O (D yb O CL ti y Parcel 040-1090-20-000 01/04/2006 04:41 PM PAGE 1 OF 2 Alt. Parcel 23.28. 9.364C 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): O = Current Owner, C = Current Co-Owner MARK R & ERIC BJERSTEDI`~ O - BJERSTEDT, MARK R & ERIC 1524 60TH AVE ~ ROBERTS WI 54023 der Districts: SC = School SP = Special Prope s(es): Primary Type Dist # Description 359 CTY RD U n 2 _ SC 4893 SCH D OF RIVER FALLS - 1 ~V l /v J SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.620 Plat: N/A-NOT VAILABLE SEC 23 T28N R19W 1.62 AC NE SE BEG INTR. Block/Condo Bldg: NR/WHWY 35&WLNNE_SENU951 F 160 FT S 493.3 FT WSTLY ALG N R/W TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 23-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 05/12/2005 794749 2801/382 EZ-U 12/27/2001 666549 1801/609 LC 02/19/2001 638751 1588/257 QC 07/23/1997 '1686/437 CI~/ more... 2005 SUMMARY Bill M Fair Market Value: A i'- cl_ 102737 183,900 Valuations: Last Changed: 11/06/2002 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 1.620 35,400 141,600 177,000 NO Totals for 2005: General Property 1.620 35,400 141,600 177,000 Woodland 0.000 0 0 Totals for 2004: General Property 1.620 35,400 141,600 177,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1090-20-000 01/04/2006 04:41 PM PAGE 2OF2 Parcel History: cont. 1135/574 EZ AS BUILT SANITARY SYSTEM REPORT .~`T N-R W OWNER WNSHIP SEC ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LO`T LOT SIZE PLAN VIEW Distances and dime.nsions to meet requ•ireme.nt +t.t SHOW EVERYTHING WITHIN 100 I 2 r i e1ndidat N r h rr w BENCHMARK: (Permanent reference 00int) Describe: ~~~~~__~~w Elevation of vertical reference point: 6"Okslope at site: SEPTIC 'L'ANK: Manufacturer: Liquid Capacity: 0 Number of rings on cover : Tank manhole cover elevation: Tank Lulet Elevation: Tank Outlet Elevation: PUMP CHAMBER Manufacturer: Number of gallons Number of gal. pump set for a cycle _ gallons; Total capacity of distribution lines gallon: size of pump- head; gallon per minute horsepower_ brand name of pump and. model number Type of warning device__ HOLDING TANK: Manufacturer Number of gallons Elevation of manhole cover Type of warning device SEEPAGE PIT SIZE; Number of pits _ feet diameter feet liquid depth seepage pit inlet pipe-elevation bottom of seepage pit elevation _ feet. SEEPAGE BED SIZE: number of lines- width _ length _tile depth SEEPAGE TRENCH: width- length- PERCOLATION RATE AREA REQUIRED AREA AS BUILT INSPECTOR DATED PLUMBER ON JOB LICENSE NUMBER_ DEPAR'MENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING XI CONVENTIONAL ❑ALTERNATIVE State Plan ID Ncmbe, ❑ Holding Tank El 80" nedl In-Ground Pressure L1 Mound "840166-200 NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Bo and Dicks s Cottage Highway 35, Rive& EaM , WT 54022 30 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV. . CST REF. PT. ELEV. NE SE, Section 23, T28N-R19W, Town a6 T&oy Name of Plumber. MP/MPRSW No. County' Sanitary Permit Number: Thomas A. Clang 3231 St. C&oix 49467 SEPTIC TANK/HOLDING TANK: MANUFACTURER. y LIQUID CAPACITY. TANK INLET LEY.. TANK OUTLET ELEV WARNING LABEL 1 _ LOCKING COVER IJ 1 Y` 9"1+ / 7 C*J `f t PROVIDED. PROVIDED. BEDDING: VENT DIA.. VENT MATL. HIGH WA ER L' y & EYES ENO EYES ENO ALARM. NUMBER OF ROAD. 1PROPERTY WELL. BUILDI NG. VENT TO FRESH FEET FROM I AIR INLET EYES ENO EYES ENO NEAREST L"Vf DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL P UMPiSIPH ON MANUFACTURER "WARNING LABEL LOCKING COVER EYES ENO PROVIDED PROVIDED GALLONS PER CYCLE: PUMPANOCONTHOLSOPERATONAL EYES ENO EYES ENO (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BuILOING I VENT LET FRESH, LINE AIR INLET PUMP ON AND OFF) FEET FROM EYES ENO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENISrH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH BED/TRENCH LENGTH NO OF DISTR PI PfrSPA CIN(, COVEFk INSIDE CIA -PITS LIQUID . IL TRENCHES / MAT E'yl; DIMENSIONS G! p1T DEPTH GRAVEL DEPTH FILL DEPTH UISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO DETR BELOW PIPES A VECOVER E V. IfVI LTV .E~D. NUMBER OF PROPERTY WELL: BUILDING. VENT TO FRESH ;EEE L/ PIP E / FEET FROM LINE{ AIR INLET: NEAREST- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- E YES NO meets the criteria for medium sand. TIONS MEASURED. E SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS. DEPTH OVER TRENCH BED DEPTH OVER TRENCH BED EYES ENO EYES ENO CENTER DEPTH OF TOPSOIL SODDED SEEDED MULCHED EDGES EYES ENO EYES ENO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRE&OF NCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE C TRENCHES OVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DIS FHIBU IIUN PIPE MBA TERIAL & MARKING ELEVATION AND ELEV ELEV DIA ELEV.' PIPES CIA DISTRIBUI ION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROV EO PLANS COMMENTS: PERMANENTMARKERS~YES ENO EYES ENO OBSERVATION WELLS: NUMBER I PROPEERTY J WELL: BUILDING: FEET FROM LI"' e% c T EYES ENO EYES ENO NEAREST i { ~ f Sketch System on (p r Reverse Side. lain in counAfile for audit. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) 'DEPARTMENT OF APPLICATION SAFETY & BUILDINGS 'INDUSTRY, FOR SANITARY DIVISION LABOR AND PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/Z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be included. Property Owner: Mailin Address: Lick's q Il e 7 35,/1l /c' uer FI/S tS. Property Location: City, V' lage own County: g:' 1/4 .S Et/aS 05 /TO? NCR is E (orxif;> j~',~ ~cfarX Lot Number: Blk No.: Subdivision Name: earest a Lake or Landmark: State Plan I.D. Number: (I assigned TYPE OF BUILDING Number of ❑ Public* ❑ Variance* E Other (specify)* Q 11 44 Bedrooms: Q 1 or 2 Family *State Approval Required. J TOTAL NUMBER PREFAB POURED-IN NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE STEEL FIBERGLASS INSTALLATION MENT (Specify, SEPTIC TANK CAPACITY 1 I/ e HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER i MANUFACTURER: EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): ❑ New Replacement ❑ Experimental Seepage Bed ❑ Seepage Pit ~a 4 U • y, ❑ Alternative (specify) ❑ Seepage Trench !hater Supply: Cj Owner's Name as Listed on Soil Test Report (If other than present owner): Private ❑ Joint ❑ Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name o Plumber: Signatu MP/MPRSW No.: Phone Number: conk. C;n~ 0, / (Y'I/S)~S=9yS , Plumber's Address: Name of, Designer: COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: APPROVED Sanitary Permit Number: , •j16 ~YV Al y/ c , y ~ 7 v / ❑ DISAPPROVED '7 T f'p / Reason for Disapproval: I Alternate course(s) of Action Available: i Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (N.03/81) P.l.. w:~~ ~enc.C X x x lCX X X aG X X k k K n k K x k K 7c AK kXX mac Prop0Se-a add. r'Lfi itU.) on Care ;oF e n ~3P, xY6 Bed Yy ff 5iop Pr ese►~* _ j5 R-r S L) (~i•esent ( i n Qa I + seiner Neu i~pO~ ~al 5e~~+~ i S~~r Beni. fork Eleu. loo.ee, Pa~ntmAl-C5 itl~ ~e,,vev Wrote nexfi to thwi Ave . • •0008 s CO J p i.. It ~y S7a~~ f Day G~%~wet~ ~.onc>l'e~`~ SEp?`!C fQ~~J rap P%~e o? New Shoff to S,e 1- /easy On7o itndisIkebec svi/ eo r i S e f1 Ski.-~ CDrn e0- D ~ F.C VVED ~~~e ~ end" S hU~ tow JAN 16 1984 AFE-T,y e, E,LL)G5. [)IV. QQ p ~ r ss ~~'z~~ few 66 q ~'a e _ - - - - - fi;na1 race. w;rh s Iv fe for rtim 4 -11dnct)(, to0ew y"Pei , pUL So;i ~:I~ a"Rk, vier OUP 1^ ireS rod S ' K mAfev),6L Mid s k Na Q U` g' v`~ ~ t aaJ o r ~Eleu, 9~:as 1iul,fl' d e - ~ rk) ftrtarate4 P;1 f D v rte✓ri of ' d f J-/ "Per -47 a~ 3~ A / C' 1r~ f~ From Se- , Ol tO fV~ C11 Jeas~ '9y,~ /L Cm ~ ctt s '20 LIT n0 ti Orc #4 Be)OU) Chu l ~~~t e S 't vi P, et T- e ( al Se f aO ~ls per emp/o ec x ✓U eeerloeeS ~ct a'~ ~a 95o Ise~c re ui~'e~ lcieeS 41 /1a C t6r pe r e m to e E P- C, C^P- U(CeA For' Pa 6 li c 641' N I n RECEIVED p JAN 16 1984 SHAD P~ e t a 3 ~'7 u to 6l E l r a c L P C ,s o c4 Sec. , 72e 1V i / 0 7-o iooL o'~ 7r-o L-olx ~ouvzr~ lk)~S- Sr~eX PQ 3 5Xeet f6l e ~2 PIC /1/6 14 rot rl~n 0 e Sl I Vl frepar 7~ 0 Iq L)a ej b-) Po - 3424 r'P'~P7 E ~ . j r JAN 16 1984 6 SAFETY ax B' nG Wisconsin Department of industry, PLB-1 INSPECTION REPORT Labor & Human Relations Safety & Buildings Division Bureau of Plumbing Name o remises Date -PTa-n o. St-ee y oun y Sanitary Permit Master Plumber irm Name dress t Journeyman Plumber ress Owner ess w - y 14 w Discussed with 1gna ure r ( )See Attached. f ~ DILHR-SBD-6192 (R.10/82) Signature o' is um 1ng up., n- ite WAt is is, Inspector Local Inspector Plumber or Respons,tle Part, ri Owner Department of Indu r and Human Relations ~ws~0,,S.. ro Safety & Buildings DILHR nF ~c9 ureau of Plumbing P.O. Box 7969 0EFKiRTT71Ef1T F~ ~~Fa d i s o n, W I 53707 - inouSTRY,LRBOR&HUTRnRELRTions ' (608) 266-3815 L CORRESPONDENCE REFER TO PLAN DENTIFICATION NO. r zc) 0 NAME OF PROJE T i VATE SE A E ONL - GENERAL PLUMBING PLANS Fee Received: LOCATION Priority Plan Review Only CITY OR TO t}fV ,.Y Examin ion of plumbing plans and `~pesificat s r this project has been comple ed. In accord with Chapter 145, Wiscaas-U tatutes and the Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon compliance with the stipulations shown on the plans. Please review your code for the requirements of each code section noted. The licensed plumber responsible for this installation shall keep at the construction site one set of plans bearing the department's stamp of approval. The installer shall also notify the appropriate inspector of wher required inspections are to be made. to 4. hin o him -be-gin. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions or examination oversight, and reserves the right to order changes or additions if necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit requirements of the c:, village, township or county in which this installation is to be made. Failu; to obtain local permits will automatically void this approval. For Private Sewage Syste. Sincerely, yeThis approval ars or it will be valid urge the expiration date of the James Sarg~it~ sanitary peffnit. Bureau Dire or PLANS REVIEWED BY: DATE: A ;2 cc: DWS Owner H & R & Rec. San. Sect --L Plumber Bur. of Health Fac. & Services oun y Other DILHR SBD-6099 (R. 05/82) d ' z, ST. CROI X COUNTY WI SC O N S I N ZONING OFFICE - - 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 December 17, 1984 Mt. Thomas Wang 10094 W. Maple Ri,veA FaUs, WI 54022 Dean Tom, As o6 today, thus o66ice has not received the AS-BUILT on Bob 9 Dick'z Garage aseptic system. This ,cis the th td request 4ot same. The system was installed on May 29, 1984. Until this .us completed and 4i ted with the Zoning 066ice, this is not con6ideAed a code complying system in te6eAence to Section 10.1 A 2(b), St. Cuix County Zoning Undinance. As it is not a code comp.E'ying zystem, the phemi6es .6haU not be occupied untie such time as the AS-BUILT cz necei.ved by the Zoning 066ice. No 6uAthen peAmi A .shah be -issued to the instaUi.ng p.eumben, of any inspec- tions made by this o66ice untie att past due AS-GUILTS are 6ited. Shoutd you have any questions, ptease 6ee.e 6nee to contact this o66ice. Sin etce.ey, Thomas C. Nelson kszistant Zoning Admi.ni6tnaton TCN:mj cc: Bob 9 Dick'z Garage ST. CROI X COUNTY WI SC O N S I N z14~of r 4 T n;'`~ ZONING OFFICE 796-2239 HAMMOND, WI 54015 May 30, 1984 Tom Wang 1009 W. Maple Raver Falls, WI 54022 Dear Tom: We have been holding the Sanitary Inspection Sheet for the following system(s): Bob & Dick°s Garage Leslie Paulson NEB of SEA of Section 23 SEA of SW-4 of Section 32 T28N-R19W, Town of Troy T28N-R18W, Town of Kinnickinnic Please turn the As-Built into this office as soon as possible, so that we may complete our file. If you have any questions, please feel free to contact this office. Yours trul Thomas C. Nelson Assistant Zoning Administrator s.l DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR-AND PERCOLATION TESTS (115) MADISON 0153909 HUMAN RELATIONS 3.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSH MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: O NTY: O E 'S/BUYER'S N ME: MA LING ADDRESS: . L Y'flr 0 S Gag'aqe 1. A/zj 3s, jet u e r > ~y7 USE DATES OBSERVATIONS MADE NO. BEDRMS.: C MMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: IPERCOLATIONTEST'Z. i ence ,~_~u ' A ❑ New X Replace Q / q ffff7777 s A 7 r",, RATING: S= Site suitable for system U= Site unsuitable for system _ NX ENTIONAL: UNSLi TIfV-GROUND PRESSURE:SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑U &S ❑U ❑S U ❑S ®U enA so 161 eeS If Percolation Tests are NOT required DESIGN RATE: quired / If any portion of the tested area is in the under s.H63.09(5)(b), indicate: L C 3,-) Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ~d j/ PIA 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- ~ Db B- ~ ,.DU J~S,❑ ~ ''ri'.4© ~.DU,~1~Si 3,`>v itS~l 5-10 9117 S I' 3, ~0 '&-l S' B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D 3 PER INCH P G a P- k /0 6 P- o O Y~ ~o 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 11 1 r J~ W re rente, 1 fs>~DS~c~ 4jd x x h a x >c x k X n~,,~~.i►•a5~ ~reS~nf ~3 JJ Seer d E \-IP4 sl.v~►' PG_AJ T N M ~ .~i~` o Pe r'Z N~l~ s 1 I ~r~sen o wv' Bl PI well f SAP _100 4 = ref. tlet). J PG,h fi Darks rj,r1i ~e . I, 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. NAME (prin TESTS WERE COMPLETED ON: ADDRESS: CERTIFICATION N LIMBER: PHONE NUMBER (optional): CST SI RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DIL.HR-SBD-6395 (R. 02/82) - n•. - NOAH W. P a . s a..r a.,. Y . e r L Y HS U . WD Q. . , be ; : , , oile a : ac.wrW. ,wi , your a pp, t rnmt n "%W: 2. E 3 4 . . -haly 5UnAvion „c w ._htp nunq = AI ATE IS SUl AT WHEN E _ sR-_RULED Lrt BASED ON SOIL CONDITION R._. z1_ tro Ai_ =SUE m. E:_., t. We '({7, .7 int = d=c uQ~„c t s='q ~.'~tit"t> t.;i dC,t ti o i~?t r ?V~t1s. a Lan, it. r ....it does n i'`'v, p...' ? K ayprtAt _E: Q < k.mot as WYA _ t; re nn is i` :y ~L1,',a5 « _ vAH, E: !il i Ase erg ~r~' s ~3t 'ezl j4 c i E73 r r ra: 5 , r. i r..-_,. Lmwq, - ' .Y' I "NON - H i.th h PC! Lanny f Won Rn am El; , c",,.Or Loevil not S"v -thy f> a IC s ti8£~ 91 Ndr !00 in nE f0d PIP F in t hp .t t,tWa H U7 r-{ y S `l' C - 105 r ;y H SEPTIC TANK MAINTENANCE AGREEMENT 0 St. Croix County U I r 7" UWNI':lt/fiUYI:R ROUTE/13UX NUMBER ~ Eire Number I'I C1TY/STATl: /Thy - P- , W SecCiun '1' 0U N It PROPERTY LOCAT ION: E- _ --Q - 1-/ Town of Tr St. Crojx County, , Subdivision ti Loo cumber Improper use-and maintenance of your septic system could resuLt it.t it_b premature failure to hand-le wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed sul,tl-c tank pumper. What you put into I the system can affect the function of the septic tank an a treat went stage in the waste disposal system. St. Croix County residents ply be eligible to recuivc a ghat fora maximum of 60% of Chu cost of replacement of a tailing system, which was in operation prior to July 1, 1918. St. Croix County accepted this program in August of 19130, with Chu roquireme"t. 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 veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumpinf, (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. 0 1_/WE, the undersigned, have read the above reduiremunLs and agree c„ Lo maintain the private sewage disposal system in accordance with x r-i the standards set forth, herein, as set by the Wisconsin Depart- ~i meat of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiraL ion date. ~ SIGNED- - UA1 E St. Croix County Zoning Ul'lice P.O. Box 96 Hammond, WL 54015 715-796-2299 or 715-425-13363 Sign, date and return to above address. t APPLICATION FOR SANITARY PERMIT S 'f 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/contractgv,("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 L - S Location of Property ' S{ _ Section , T N - R W Township Mailing Address Subdivision Name Lot Number Previous Owner of Property ~J 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 No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION 1 (We) eeAti6y that aU statementz on thin 6onm ahe tAue to the best oA my (ould k.nowtedge; that I (we) am (ane) the owneh(4) ob the pnopehty dacnibed in thi,6 injonmatian Jonm, by v i4tue oj a wa4vianty deed neeonde to the 066iee o6 the County Reg %a ten o6 Deeds as Document Na. (~Z and that I (we) pkmentey oun the pnopobed site bon the sewage dis o system Ion I (we) have obtained an easement, to hun with the above deeehibed pnopeAty, 6o.CL the con,stAuct%o►,. o6 .said 6ystem, and the name has been duty h.eeo&ded in the 06jice o6 the County Registers o6 Deeds, " Document No. 00, r' ~ ZZ SIGNATURE OF ER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED Parcel 040-1090-30-000 01/04/2006 04:37 PM PAGE 1 OF 1 Alt. Parcel 23.28.19.364D 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): O = Current Owner, C = Current Co-Owner JOHN A & DEBRA R CARSON O - LARSON, JOHN A & DEBRA R 232 HWY 35 N RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 232 HWY 35 SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.450 Plat: N/A-NOT AVAILABLE SEC 23 T28N R19W PT NE SE 417/411 COM ON Block/Condo Bldg: W LN AT SLY R/W OF RR, TH S 52 DEG E 293.8 FT, SWLY AT RT>153.2 FT TH W 140 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) FT TO W LN, N 300 FT TO POB: ALSO 100 FT 23-28N-19W RR R/W ADJ ABV PARCEL INCLUDES P367F EXC PT TO HWY PROJECT 7200-04-21 HWY 35 Notes: Parcel History: Date Doc # Vol/Page Type 05/21/2003 722309 2248/471 QC 1149/433 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 102738 221,700 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.450 44,000 169,400 213,400 NO Totals for 2005: General Property 1.450 44,000 169,400 213,400 Woodland 0.000 0 0 Totals for 2004: General Property 1.450 44,000 169,400 213,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 502 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1090-10-000 01/04/2006 04:38 PM PAGE 1 OF 1 Alt. Parcel 23.28.19.364B 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): O = Current Owner, C = Current Co-Owner O - ST CROIX COUNTY ST CROIX COUNTY 1101 CARMICHAEL RD HUDSON WI 54016-7710 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.380 Plat: N/A-NOT AVAILABLE SEC 23 T28N R19W 2.38A PT NE SE HWY Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/24/1995 Description Class Acres Land Improve Total State Reason COUNTY X3 2.380 0 0 0 NO Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 040-1090-30-100 01/04/2006 04:40 PM PAGE 1 OF 1 Alt. Parcel 23.28.19.364E 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): O = Current Owner, C = Current Co-Owner DONALD & JEANNETTE JENSEN O - JENSEN, DONALD & JEANNETTE 212 HWY35N RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 23 T28N R19W PT E1/2 SE1/4 CSM Block/Condo Bldg: 6/1717 ASS'D WITH P367E EXC PT TO HWY PROJECT 7200-04-21 HWY 35 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 23-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1157/41 WD 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00