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HomeMy WebLinkAbout030-1095-70-400 0 N O o N O! 3 n C7 C `o1 l0 T.zv, z oa)cn Bo N 0 0 r— co 1 �±• � <° c 4 w 3 3 3 c tO s w CD O N N CT O ri O N CD N Z N o , N O O r tAl Q (O CD M N N N 3 co N Y Cr �, 1 N N Q Cr w -0 � CD `G i I A p O v W f3 C a m C) O T 3 a o 3 N go N o p p m C a) I m A rn o p CL cr ' Z D m a W N'. N N > C @ u N O. D p W p < O CD CD �IK O Fz� N S PO CD ° o ° o D N m a N o c N < 0 3 a CD C A o d n c N N N o 1 o w D N d ' 3 v ai N 3 v 3 0) Q O G v� G O o h °° o m m 'm N N fT d N O 3 W a a (D � (D am z ^* hh 0 z z z ._.{ oZ V D -�- ° D 0 ^ @ '9 zr IN o m o m �• tol (DD ? m C. =r CD m m w io n CL m a a 3 .0 � CD O O n • O N p A Z n 7 : p z o m a a O 0 �C W N W W CD < O a o. z 0 3 0 3 a 0 3 3 !� !� z a a o = w 0 ?1 D _M n a C a C N O D) CD C N C X Z a p d . O O O CO CD C O CD n N O 'O N N CD 0 3 - ro O F 7 Z s '. CD V N N O I ' p V I w 0 0 A O 3 Q A CD CD D'0 Oo O N fA 0 EA 0 �+ W Q G CD `0 O O CL S z 0C E 'a n d o o O " n N u O W `� N W `� • N 7 �. N j p L 41 F�1 O O O N N Q= ? W V Cl 0 0 N < A C O (n W C 3 fD = N a � - n O �• O I m C cn m N a ° T O N W A C o CD C A 0 W 1, O O O W O L _ C O O > N CD 0 0 cn w a p z 0 0 0 Z I tr cn a o y ! < W Z w N co 0 o �' D N = I -0 O v Q o O D N J 2 y CO A A O1. N tT N a 0) `' N Z J o O D I o. 0 d � m ° u) N c (C N C CD I W n a d 3 N = m — `4 fA O O 0 0 A Z CD _ C O N I a CD O '' Z y D L o o' F) 9. y O 7 d C CD Z x O_ CD Z O N O 7 �7 O w 0' m N I O FF O ~ b O A r N O 0 . ~ �y C> a Al Parcel #: 030 - 1095 -70 -400 02/28/2005 04:29 PM PAGE 1 OF 1 Alt. Parcel #: 32.30.19.347F 030 - TOWN OF SAINT JOSEPH 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 DAVID F & SANDRA L SIMONS * SIMONS, DAVID F & SANDRA L 440 126TH AVE HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 440 126TH AVE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.080 Plat: 0417 -CSM 09/2696 SEC 32 T30N R19W PT SE NW BEING LOT 3 OF Block/Condo Bldg: LOT 3 CSM 9/2696 EXC PT TO 126TH AVE & EXC AS DESC 1462/149 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 32- 30N -19W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1087/184 RD 611803 1462/149 W 2004 SUMMARY Bill #: Fair Market Value: Assesse 5604 285,800 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.210 84,300 196,900 281,200 NO Totals for 2004: General Property 3.210 84,300 196,900 281,200 Woodland 0.000 0 0 Totals for 2003: General Property 3.210 49,400 160,900 210,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 129 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 S MAY No v 0 8 1996 ► i , , ��r n Deeds O N f -- ° Cn Bearings are referenced to the ti west line of the NWk of Section 0 ° m 0 0 32, assumed to bear N01 ° 48'04 "E. o _ ° Z �`" 1 Iron Pipe Found UNPLA I T ED LANDS S20 ° 37 1 35 11 W, 0.49' N' M (So1 0 48'23 "w) - -- of computed position. N01 0 4$'04 "E West line of the NW > ° Q N01 0 48 1 04 11 E 531.04' N01 048104 11E c ; 773.29' °oN - z o 1304.33' a 4 Z j I r 0 0 ;� Icy 0 < r . ! z 01 0 o c 11 m 0 X 0° S01 048104 11W iS "C w N cr . 265.02' H fi il+ � Ian a' .. CO = IC P_ O S // .•,. `/ y° m m o IC) IJ' n ro O r t Iv Z A ` C+ IN � �' h ' y - I O Rt N � f'I' � w P a H IGl NO , O a o °, �} �1 c0 cr o %c C r 1( �I 0 ::r — I a �, 0o o �I— h-hM I< Ic�l I 1 F� N ; o a CO c� ICJ rJ 1 w a cr rt Ir rn Ln M0 0 x I G1 i 'r :E a °D z O t'7 i , 1 �� / / .�f W t c.� v K I� I� F (D —n O N ' Z 9 v cr i) 1 D I--' M a C= C1 J r 1 - 4 p' 1 N W < � +� ��t F .� ti Q I I IL 0 n m C/1 11 0 ( 0 t rrf �� �v �' y��` --i I Gl I••- Ir i o 4 9 '?3 i �OV �'C' 1(4) N I 1q co � WR EE I 3S> N °' ° m OP. t U, a z O or C/� -3 � art t:Clt�i\i i \/ I y / Sbi a , 2�. O o_ C f0M a i M $ N �./ , /� 0 C+ f C M ~ " H Parks Com ttoo x I— O o °o r Cb o ff not recorded ' �n' ° . � O �' ��'' 0 a rii:hll 30 days i7i ya N C —� o� ��� rt• ?SO ?� O� ORD CO '.,ppro:�a! S f1 f +OQ;�''F "� i ��� \ y \ . M r r 0 0 R C+ C+ ;Q Sp 03, `� o m .�, V to N -00, ' 0 i a +.Y /i4 M (D o - I. I _ `�` 0 00 o a a N �N n I G) I A \� Q m fi O l0 10 1S (W \' 2 o v -n c fi N U7 Z 0 This instrument drafte y Ed Flanum Job No. 96 -13 i VOL. 11 PAGE 3180 FAX ST. CROIX COUNTY ZONING OFFICE 1101 Carmichael Road Hudson, WI 54016 (715) 386 -4680 DATE: TO: Fax Number: Name: FROM: Fax Number. 386 -4686 Name: �LUJ Number of Pages Including Cover Sheet IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE CONTACT: NAME: TELEPHONE NUMBER: C '- P fd � s4L,-\j C f FORM - STC - 104 AS BUILT SANITARY SYS TEM REPORT . OWNER - X�W� / �cffs TOWNSHIP SECTION f,e2 _ w ADDRESS e �'Olv vI SST ST. CROIX COUNTY, WISCONSIN Ll SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM O YE: OPoQ Box I,oAc ,�Fo,(aE ,1��oPPiti/G o T�ne.I B /VOlP7t� ��ooE P - rY.� /.t/f — S c N S/ S .P � /,v6 — /ooc G,ac 5'ePr�c �i�n)K L­? / r.fiPo.v C 4,eA1Q0M /.;v50rrr�acl CJ/7 AP oU" r rPTi7F 1 J31- ST GcJ c c t C , i"r�Crf opck�y p s .. � SL,vP� a / r ICU - 00 SOuT/a � //vim BENCHMARK: Elevation and description: /00. 00 Alternate benchmark 6>4 �'wT )PI N do Manufacturer: iES� Liquid Cap. /ooa �4. SEPTIC TANK. • Rings used: Manhole cover elev: 2:,49" Final grade elev: /OD•S� Tank inlet elev. Tank outlet elev.: ' 975 Z ' �� Rear Ft. No. of feet from nearest road:Front____, Side , _ From nearest prop. line:Front�, Side v"" Rear Ft. No. of feet from: Well Sy' , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE I ?_1_.,_ ST. CROIX COUNTY ZONING DEPARTM AS BUILT SANITARY REPORT,- ,� , Owner _ hu ) ��rORA /� v.y s `'� Address 41 y� City /State 1jins dJi �9_yolo Legal Description: Lot Block Subdivision/CSM # e_ S1W Sa<G ' /•S %, �, Sec. 3�, T_ N -RAW, Town of *Jo-ogM PIN # o a - 10 -/m SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC — Setback from: House - Well 1 7a' P/L, "s Pump manufacture_ ' r — Model Alarm location (HOLDING TANKS ONLY) ) Setbacks: Service road Vent to fresh air intake ® Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: fiaN«f Width 3 " Length lr•2 �' Number of Trenches - 4. ' 7 & , o A0,9,r,,Aus Setback from: House Gy Well 95' PAL o's Vent to fresh air intake _ �' ELEVATIONS Description of benchmark i "T?o.) i0 0f A-r Sw ), GT Elevation /O° • 04 Description of alternate benchmark _ �ew,--n . 4yrk )Clyne Elevation Building Sewer ST/HT Inlet '5 2 ST Outlet' PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover G�.' Distribution Lines () () ( ) Bottom of System q f) �' - o a (f,�) p • Sv' (C) �r-f . �a Final Grade (4) SS. a 0 ` (g) c j /• �ka Date of installation -S r/ ooPermit number 3�- 3 S' 1 State plan number Plumber's signature License number �� �l tl Date ! Inspector K U. , • i Complete plot plan * NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW C�E rlNV � � N cW �.�1f7c17Prf � TRd� , -- -- � 1V�v N" 5cri� vr0itil� �rsTi•v` As w LIK s o 351 PVL PIyLOI^rL 4 � Snw•rtf OQ o OAR •rri 1, ,.•� � INDICATE NORTH ARROW �� A i con , sin Department of Commerce ,Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. 363817 Permit Holder's Name: ❑ City ❑ Village ❑ Mwn of: State Plan ID No.: Simons, David & Sandra I St. Joseph Township CST BM Elev -:- Insp. BM Elev -: BM Description: tr i r � 4 Parcel Tax No.: 1 0 1 Gb• 0 r C5 xMi:64_ sw 1.1 030 - 1095 -70 -400 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �� S Benchmark BZ r ' O-D - v ` o . S2 l Dosing Alt. BM Y, loo . 28 Aeration Bldg. Sewerc►s Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet g 6 cj( u TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet irl Septic NA Dt Bottom - -- Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manuf turer nd St cover /9.50 I cj Model Number GPM TDH Lift Lrictlo System TDH Ft Forcemain I Le Dia. Dist. To SOIL ORPTION SYSTEM �z " 5 i,L I•G BED / TRENCH Width , Length No. O Tren es PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS s DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING M- a— nu�f�tt`� SETBACK — St CHAMBER Number INFORMATION Type O �p_ � Dp' S OR UNIT del Nue System: 11� D DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole S acing Vent To Air Intake I Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only r Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil I ❑ Yes ❑ No I ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: 5_ 169 /a0 Inspection n #2: Location: 440 126th Avenu Hudson, 54016 (SW 1/4 NW 1/4 32 T30N R19W) - 32.39.19.3477V - ' V l ,I 1.) Alt BM Description= Q 660f 5 2.) Bldg sewer length= ((p ` (� ► LiL��Sf� = 13. $0 8 3� - amount of cover = (�6 ' U J Z C��s� 1 ` , 3c> 3) Sq �0`- r ew�cue cQ, ��1_`"""� w`7►, °� 1565 3 C) t5.20 Lo.3/o`h �(2X -6-S Plan revisi `requires Yes E] No Use other side for additional information. av SBD -6710 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r 1 E b 3 � r d ..«...».... .. ... t � c ede r m.em, S f �n .... e S { 3 4 b � f { n { 2 v9 ..,. i � } ..,..:.. , { � 3 e { t _ em i 3 , c s e 3 h E e e..w e i a.. ya„ 3 i x e t n t t E "8 ,m ,.5... .c i ° 3 i 3 y 3 ! I , 9b '£b z 9fbg° f �m. �. x x x e 3 } £ e E 14 sconsin Safety and Buildings Division SANITARY PERMIT APPLICATIO 201 E. Washington Ave. , ( . f' P.O. Box 7969 Department of Commerce n acco with ILHR 83.05, W IS. �d tQdg # r p z r,� Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, Pt ess t than 8 1/2 x 11 inches in size. it 1 Stat a itar Permit Number • See reverse side for instructions for completing this applicavonj 'r 3 8' The information you provide may be used by other government agency programs„ t? t revision to previous application (Privacy Law, s. 15.04 (1) (m)]. t n I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF AT �. Property Owner Name rt Lo "/ / ") iv •4 '�/ �? DNS ' i f -`; W, � T 346 , N,11 E (ortfp Property Owner's Mailing Addresj Lot Nu Block Number 7 ^VLC 3 City, tate Zip Code Phone Number Subdivision Name or CSM Nu b� 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Roa ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms own OF r Ill. BUILDING USE (If building type is public, check all that apply) Parcel TaxNumber(s) 32. 3 0 • /`3. 3 1 ❑ Apartment/ Condo O 1 0 15 - - _ 1` 0— LI 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� on line A. Check box on line B, if applicable) New x Artist �� Replacement of Reconnection of Repair of an A) 1.❑ �I 3.❑ P 4.❑ 5.❑ P. - _____System ____ __System --- --- -------- -------------- ----- TankOnly Existing5ystem ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number 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 XSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ' El Seepage Pit C� �� ® SZ7 43 ❑ Vault Privy 14 ❑System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4_ Loading Rate S. Perc. Rate ste lev' Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) 0 evation �S0 .? - S tA, eet Feet Capacit VII. TANK in Ca g a llons Total # of r Prefab. ite Fiber- Plastic Exper INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existin structed Tanks Tanks �} Septic Tank or Holding Tank /� GS / (� 14E - jZf 1��'. El ❑ 11 E] Lift Pump Tank /Siphon Chamber �� ❑ 1 ❑ 1 ❑ ❑ 1 ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu tier's Name: (Print) Plumber's Si nat : (N St mps) MP /MPRSW No.: Business Phone Number: �K t<tr i c. Plumber's Address (Street, City, State, Zip ode): 7. . S 4 Sr ^ /7 '40 S 0 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee (includes Groundwater D ate Issued ssuing Agent Signature (No Stamps) A roved 4f�� pp ❑Owner Given Initial Surcharge Fee) Adverse Determination • l q-20 -2" X. �QNDITIONS OF AP ROVAL / EASONS FOR DISAPPRQVAL: � �r SBD -63W (R t 1196) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber i INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative, Code will be applicable. 3. All revisions to this permit must be approved,by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wiscqnsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on 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 for numbersl through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete far 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 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; 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 contamination investigations and establishment of standards. i A10 rs r�N�, /PFS.QE.�c� o r'xP�r�v��,� T� b&aaom spa ,v 5"x 1160 = 9S Gqt_ _ - 8 = 93"1. sp r moo s I~r , Q Le, $,,'-J(, ••PLe e PLOT & CROSS SECTION PLANS ZAPPA 91108. EXCAVATRA INC �2 A aIEQ / co' numo dG UNIT .. . i EAST PQ, A . PROACT av - riE.u� Ex /ST /AJL. . I' AAJ A,00 as ! iz C /�kv,4 � S.�h.4eA S / -•,ous :50 ss �i 0� T �w,e!��s�? � y di SO ' To �� LX /ST,�1G �iQEnit G3 `�, Q�KOix Lc�uNTt/ Ar ;vA or EAt H 7 ?2 -c/cH , - e 3 A 3 rs4 pkoP B ox 4 lJfEOM /440 -jWle -j�?EnlC9 Gm. SEPT /e `j K T ��P��tcE D,4,O i000 G.tc �/c T K 4 A vg Ar sW i-or o Ef ,C.,E �rtF Qq O Y ., i�41 �iEv� m� �iI/�•i�EP — �/E,vr f �B sIW 4 AriaU P,O� SIGNED: L APO� uVELi VENT LAP LICENSE: Y '� DATE: _ attic, ►� /�" Ae� \jF f,4,sH 6 i SOIL TSBTI" 9Y: Side View FI � �q�,onl -qf J c N Ba 1tv" �FQ Sa Ttsr End View i4 ll 15° _- - r , I 34'— 78" / 'S nE t.,, / .� o� ,(' �,GN 4 A�'fI CITE /��,UE t _ - Wisconsin Department of Commerce SOIL AND SITE EVALUATION f Division of Safety and Buildings Page ! of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and - 5 - 1 ( f %eQ lk percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 0 9S ) 4 oo 347 APPLICANT INFORMATION - Please print all information Reiewe by Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner Property Location - �SA A 5 / M� Govt. Lot St 1/4 jW l /4,S 32 T ,N,R f ! E (or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number ❑ City 44 village Town Nearest Road sy 7N c �Jis >q .� A vr New Construction Use: Residential / Number of bedrooms Addition to existing building V Replacement LJ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd /ft trench, gpd /ft Absorption area required bed, ft ft Maximum design loading rate bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevations N414 W .3,4-4a, - -� ft (as referred to site plan benchmark) Additional design /site considerations & TWE£►1 9 13- Parent material 6 LAen d L. C /Q 5 N Flood plain elevation, if applicable ft S = Suitable for system I Conventional Mound In-Ground Pressure AT -Grade System riinnfFill Holding Tank U = Unsuitable for system S❑ U N S ❑ U N S ❑ U Ws El ❑ S ,mil U ❑ S X U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 A -- SL f rl -Cr nr CS f 0 -z 3 G S(� n, 1 0.7:6 Ground Q /� M5 6.7 :o.S © ellev� ra`a ft. Depth to limiting factor Remarks: Boring # q 34 j ZS Y X, 4 - j lo K 0 .Z 62 Ground /.¢ Depth to limiting factor 7j in. Remarks: CST Name (Please Print) Si re Telephone No. dAI NIL Y J �6 Ad l Date CST Number / ro g1 c) Ns(l (-J1 4- /9-o6 ZZZ >1�'7 PROPERTY OWNER Page of ���� S Q�� SOIL DESCRIPTION REPORT Z 3. } PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft Depth to limiting factor in. Remarks: Boring # ,1 ZSVO M5 SCE m w .7 0.8 Ground CJ - %2 I Y 4 �S SC rh Q e ev. , f&ft. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft p Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # - '�P/ L L C. N .4" /6y, 3 -- S L j t h sbtt n ,, -Cir w — 0 2 0 , Ground 1 %19 y 3 — S L ! A SL K A L S — v .A, 6 Y 4 2 M SC n^ -- 6.7 Depth to 3 limiting oZ 131' 1 factop, '> 0 I in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) .0 v 4 Pcz. c 3 ov 3 z W 43 4 2 £ <ao Q 1— v N 2 IJ z CA C N / L"Ovyc/ i I I ..___. ._..... .._.._ .. ....:,..... ,; ....�. -�.. ..` .._...._.....,.. ......... .j.__.._�..� .. Aar.- ,�...i. �,.LLu�k�,,...�.. Q � co � Z r � U,. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer V) d �. ti j Mailing Address L / , Li n 6� Vil" _ n �, Property Address V 6 (Verification required from Planning Department for new construction) City/S Parcel Identification Number D 3 O -- 7 V q S — 7 LEGAL DESCRIPTION Property Location Sw '/4, A u-) '/4, Sec. 3- . T 30 N -R /`l W, Town of h - �o5,6 Subdivision Lot # .3 Certified Survey Map # > 6 7 SG , Volume 9 , Page # A- Qi G Warranty Deed # — f; - 09 -/ 1 7 9 Volume /0 `/a , Page # 3 S3 Spec house ❑ yes JX no Lot lines identifiable K yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature.fadure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the fimction of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department 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/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned -have- read -the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stj�the t your septic system been maintained must be completed and returned to the St. Croix County Zoning Office within 30 d e year expira ' n date. SU OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro desc bed above, virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed OOCUMEPNO. wARRaWtY OUD TM Is a►Ac 1119"01vto PDIII R[CDA0046 DATA STATE BAR OF WISCONSIN FORK Y -190 s) 50'74'77 1 .4Xj y.�i�hc,.Ochs,. a. a .-_ ......................... e person .................. d for ...... ....................••-•--•-_-.. ......................... . �) ------------------------------ --•-----•---- - -.... OCIA 9 M3 ........................................................ ........................................................ til 11: A. conveys and warrants to .. t��id-. r Siams..and. - _ it ........ ...... Simons,_ buaband.. and..wife,..as., surgivor-Ailp-imital ........ MW Q ro r Y---•----•-• ..................... ............................... • ------ ..._.. byllMtslO�llb > --•--• .......................---••---....._.......--- ..I.............•.............. --- - - - -•• ................ z ---•-•--• ................... .....•......................... . ....................._..-----._....--•...._............---........... .............._..----- ......... _............. wn URM TO i -- ------ ----- ---- - - - - -- ------- • -• - -- .._.... ... the following describe: real estate in ........ St— CraiY ------------------- County. - -- - State of Wisconsin: Tax P" NO: ........................... – I) ; Fart of the rrAwk, :�. 32 T3ONf -R19W described as follows: Lot 3 of Certi fied &jvey Map recorded October 5, 1993 in Vol. 9 of Certified &xvey maps, page 2696 as Doc. No. 506756. SfE�+ 7a I , I• . Tbis -...... Ja ---- :.......... homestead property. L Exception to warranties; bcisting higtl>ay8, easements and rights of way of I': ! record. I , Dated this --------------------------------- day of ............ --------- . October ......................... - ...... 18.93.- _ - °.. ...( SEAL) ....... (SEAL) I - ----- Q ....... ................................... --Kathy- • -- Kaathy -.Am.- Ochs_....._.. :._ - --- • -_ - - -- - -.... r ..................... (SEAL) ----• .................. ......................... .. ...... (SEAL) ' a ....................... .........._.............••.... ......... • AUTHANTICATIOI! ACHNOW LBDtiFlIiBNT AR Signature(s) STATE OF 541 1" -----•---------------- -------- •-------- - - - - -- ------------------------------ -- AA ......... co, oCunty. � -- _. authenticated this _- -day of__._._ --- - -- -_---__- 19- - -___ Personally came before me this ... authenticated of I - -- - .ptpbe 19 _ .L.," above named -- ---- -- ----- __- ------ --- -- --- t s f 8 8 a ...... • p s — •ir 'Sc,�' '. ..................... ^-- -- °----------- ------ ------ ---------- ------------------------- ---- -- TITLE: MEMBER STATE BAR or WISCONSIN �_ av --- j-- " .4:r... _ authorised by 708.08. Wia. Slats) to me known to be the person r .: _.. �' wl I Is lit4g1he foregoing instrument and ackn4;!0ed9e THIS INSTRUMENT WAS DRAFTED BY • ; - j 1 � ,`�,.�• Attorney_ David J. Estreer, - ' �., 7 �f 1 -.... _ 1 - Notmry blic _.. ....... Y C"-ntp, WW. AZ �. My Commission is permanence ri not - state expiration '�• (1?Ignatnr�.. TMay be authenticated or acknow3edeed. Both /� uS �. -- --• - •- °--•-- - --._. 19.9�J ( are not necessary.) dais: -- _ -AwG3I _._�-__. -. - -- 1 ' siq&mas of pesaons afy! .-.=. in Any capacit sbrould be t3'ptid oe prinUtJ elow their sltnaturm. ;? Ii Wisconsin L :igal Siank Co., Inc. WARPLUM D"D STATIC BAS OF WISCONSIN Milwaukee Wisconsin FORM NqL 2— 1988 h - ... FORM - STC -'104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP �T J os CAW I SECTIONT N -R W ADDRES // 06 ST. CROIX COUNTY, WISCONSIN uL GJ / SSAc7 /� SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM py-E; w-'o 6-,x T '4 A D -7 4"C /4 A N ©�rN AfoPEPTr' (i�/f — J006 C.4L SE�T/l T)U , ;( L'/rb CAs 7" ��o �[,/4NO4tT /�vS�£� /acJ w /TA ,goo�o Uc o /k,kT TL' PAtA PVC Er�Na,c•vT 41AJC' 00 �o L ST GcJ [ J L C'� rrie s QRi vEi..� A </ ice?" 3-3 S DuT N I�oPEPT'/L,�N� /\/o 15,fAA- BENCHMARK: Elevation and description: � :��N t 44V. / 00,00 ' Alternate benchmark �s�.nT t �nbP �ccd 10I S� SEPTIC TANK: Manufacturer: Liquid Cap. /ooa�. Rings used: O . Manhole cover elev: 9?_ ,/ �r Final grade elev: /00• S� Tank inlet elev.: 3 Tank outlet elev.: No. of feet from nearest road:Front , Side L- Ft. From nearest prop. line:Front , Side Rear Ft. No. of feet from: Well Sy" , Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE 1 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 Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: rench: d 9-? • yo' - Seepage Pit: Width: S' Length .50' Number of Lines: i Area Built SoO� t.FT (TT,a�� Exist. Grade Elev, L&'.qo — Proposed - Final Grade Elev. �� o o 0 ' Fill depth to top of pipe: �•S No. feet from nearest prop. line:Front Side , Rear Ft.j� No. feet from well: ��' No. feet from building 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: DATE: D 9'1 PLUMBER ON JOB: LICENSE NUMBER: 1 616 0 !5 6 /90:cj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDING LABOR & HUMAN RELATIONS DIVISION P.O. BOX 7969 ON -SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION W ISO _1y 1 ,Sec . 3 2 , T 3 0 - R 19 State Plan I.D. Number: v CONVENTIONAL El (It assigned) Town of St. Joseph 1 h Holding Tank El In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: •� s Kathy Ochs 206 2nd St. Hudson WI 54016 dS BENCH ARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: •� REF. PT. ELEV CTr R PT.. EL .. ,, Name of Plumber: MP /MPRSW No.: 5 7 County: Sanitary Permit Number: Gary Zappa 3395 St. Croix SEPTIC TANK/ = .5 MANUFACTURER: LIQUID CAPAOM ANK INLET EL TANK OUTLET ELEV.: WARNING LABEL LOCKING COV PROM ES ❑ NO P ROVIDED: BEDDING: DIA. \fE1dT ATL.: HIGH WATER UMBER OF ROAD: PROPERTY WELL: BUILDING r VENT TO FRESH C -` ' /1 b ^ • ^r ALARM: FEET FROM �..� --- LINE' / AIR INL T: El YES NO �- -*�t�� ❑ YES O NEAREST DOSING CHAMBER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP /SIPHON MANUFACTURER: WARNING LABEL KING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO I ❑ YES ❑ NO I ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATION : MBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEE LINE: AIR INLET: PUMP ON AND OFF ❑ YES El NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: RIAL 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 SPACING: COVER INSIDE DIA.: LIQUID BED /TRENCH / SO ( TRENCHES ( MA7ERI DIMENSIONS /j GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. P PE M T I�jL O. I R. NUMBER OF PROPERTY WELL: Bi G: VENT TO FRESH BELOW PJFE,$, // ABOVE COVER: ELEV. NLET: ELEGD: y/ �� i PIPE�S�. FEET FROM LINE: � �1p AIR INLET: Y U "-IIf l0 NEAREST �� �O / 0 �� MO UND SYSTEM: P Q gk 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 TOPSO SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED /TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: I GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTIO MATERIAL & MARKING ELEVATION AND : ELEV.: ELEV: DIA.: ELEV: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS T I INFORMATION APPROVED PLANS /a,qU ❑ YES [__1 NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: [:]YES ❑ NO ❑ YES ❑ NO NEAREST — eA L+ ,D. �/' �3•GP X095, eon ��.� - ►.a�br = 9a Sketch System on n in county file for audit. Reverse Side. SIGNA RE: TIT SBD -6710 (R. 06/88) SANITARY PERMIT APPLICATION � �T ILHR In accord with ILHR 83.05, Wis. Adm. Code r STATE SANITARY PERMIT # — Attach complete plans (to the county copy only) for the system, on paper not less than 1-q 9 00 6 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this app lication. STATE PLAN I.D. NUMBER P 9 PP I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION t /4 Al" t /4, S 3 T 3b, N, R/ E (o� PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # T CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER I. TYPE OF BUILDING (Check one) CITY NEAREST ROAD Ill. Owned ❑VILLAGE ❑ Public R 1 or 2 Fam. Dwel ling -# of bedrooms g PA L TAX h U M � ?_ - Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 Outdoor Recreational Facility 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. IR 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 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12,KSeepage Trench 22 El In-Ground 4 El Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) /} qa. go• A ELE jASJON 9W.-10 Feet 4 ?e • 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 Holdin Tank /000 /odo Lift Pump Tank/Siphon Chamber 1 0 1 ER 0 Ej I El I Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's igna ure: (No Stamps) MP /MPRSW No.: Business Phone Number: �As°�•¢ /,X�os ��c . L�L4��.<c -- � ��s .4395 des' S8'� ^d 8•Sc� Plumber's Address (Street, City, State, Zip Code): 7i� G S7 Al A44OSc. ) w f SS/ IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin gent Signature (No Stamps) Approved ❑ Owner Given Initial _Surcharge Fee) / Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety S Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and w the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /F;enewal 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 number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for &// 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 contarnination investigations and establishment of standards. SBD -6398 (R.11/88) APPLICATION FOR SANITARY PERMIT STC -100 This appllcatlon form is to be C01AVIStOd in full and signed by the ovnet(s) of the ptopetty being davelopcd. Any inadequacies Will only result In delays of thz patmlt Issuance, Should ttila development be intended got resale by co sletedttwhant�theeCptopetty /l stsold second should retained this officevlth the appropriate deed recording. ----•-------•--------•--- ------------------- ------------------------------ Owner of property 2±:� '►- a- ' 0 Location of property , /4 ,Q(,�. Section -� Township Melling address „ "�` / tT Address of alts fa(.ot*- Sabdlvlslon name . Lot number Previous owner owner of property - r�r � / ' /C' ✓�T..�..�r+w Total else of parcel Date parcel was create Are all cornets and lot lines Identifiable? (� . Yas N o is this property being developed lot resale topec housa)T__Yas �z j N e Volume and Page Number as recorded vlth the Register of Deeds. -------------------------- - ------------------------------------------- ft-ft ------ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WAARANTY DECD which Includes a DOCUMItNT NUNSRR, VOLUMa AND PAOt NUMBRA, and the 8ZAL OF THR REGISTER OF DEiDB. In addition, a certified survey, It available, would be helpful so as to avoid delays of the reviewing process. It the deed description references to a Certllled Survey Map, the Cattilled SutveY Nap shall also be required, --------------------------------------------------------- --------------- -• - -- PROPERTY OWNER CERTIFICATION I(Ve) cattily that all statements on this form ate true to the best of my (out) knowledge; that I (we) am (ate) the ownet(s) of the property described in this intormation form, by vlttue of a wartanty.daed recorded In the Office of the county Register of Deeds as Document No. ) and that I (Ve) presently own the proposed site Lot the sewage die s 1 system (or i (we) have obtained an easement, to tun with the above described ptopettY, tot the construction of said system, and the same has been duly recorded In the Office of the county Register of Deeds, as Document Ho. 1. a 01- sign tuts dj owner 819natute of Co -Owner (if Applicable) Date ' of slgnatute —�� Date of Signature DOCUMENT NO . WARRANTY DEED THIS s►AC9 RtaCRVW FOR RZCORDINO DATA STATE B44 OF ONS F RM 2-191812 4 5 9 9'79 rvo! �PaGE REGISTER'S OFFICE , " - -- - -- ST. CROIX CO., WI Recd for Record .......... JUN 2 71990 .......hzs..irz E,~.. and ...i n.. hax-m yn.. xxghx ................ ............................... of 3:45 P. M ........... .... ........ ......................................::................... ............................... .,., . conveys and warrants to ...K?thy.. Ann.. Qgh.* .............. ............................... ROQ11t0I0f0ef "i` ................................ ............................... ............ ............................... ................................................................................. ............................... RtTURN TO ................................................................................. ............................... I ....... ........................................................................... ............................... the following described - real 'estate in St.. -...Croix .......... „County, ............... ................ State of Wisconsin: Tax Parcel NO: ... Q1Q .1994.40..... That part of the NE }NW} lying South and West of Old Highway "E" except Lot 1 of Certified Survey Map recorded in Vol. 6, page 1661; also except Lot 1 of Certified Survey Map recorded in Vol. 6, page 1639; Sec..32- T30N -R19W. Subject to an easement as described in a deed recorded in Vol. page as Doc. No. j � � +' a • 1 �"I This ........ is-not ........ homestead property. kixk (is not) Exception to warranties: Existing highways, easements and rights of way of record. Dated this .......... �/ ..................... day of .......... ......aTu71 ....., 199.... ............. ............................... .........................(SEAL) X.... �.. .: :... .........................(SEAL) . Wil 'am N. McKinnon ................. ............................... ... ..... .. . . f f . o�f f f J / / ...... . ........... ..................................... ............................... (SEAL) �.. � � .... . !! ... .lJl••C� "•: .•.. (SEAL) * ................................... ............................... w . Thy. J. �. �. a........................... AUTHENTICATION ACKNOWLEDGMENT Signatures) ... nliam and STATE OF WISCONSIN P . s M. cKin on a'• ..................... ............................... -• .............. ........................County. a hentic ted of ...... June ,...._..__.I 199.. Personally came before me this ................day of ............ .............. ................. 19........ the above named .David J :.....• s t r een ............ ............ ................... ........-•..... ................................. ............................... TITLE. MEMBER STATE BAR OF WISCONSIN (If not, ............................................................ ................................................. ............................... authorized by 1706.06, Wis. State.) to me known to be the person ............ who executed the ' foregoing instrument and acknowledge the same THIS INSTRUMENT WAS DRAFTED BY ......................................... ............................... Attorney David J. .. ... .............. . . .. .. .......... 621 2ndSt :., Hudson, WI 54016 • ............................... ...... ...... .. .... . .. ... ........... ............... Notary Public ............. County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: ........................ 19.........) •Names of persons signing in any capacity should be typed or printed below their signatures. j l � STAT ow FORM No. i 1983 Sto No. 13002 N TANK MAINTENANCE AGREEMENT w� SEPTIC T St. Croix County ►� a c� OWNER / BUYER 0 �- Fire t O N ROUTE BOX NUMBER d CITY /STATE ZIP PROPERTY LOCATION: k', , Section_, • T_ R l_ , Town of _' - `--);� ��!� St. Croix County, Subdivision Lot number__ - Improper use and maintenance of your septic system could result in its premature failure to handle wastes.' Prover maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a lic'en's'ed 's'ept'ic tank pumper What you put into the system can aftect tfiie unct on of cne s eptic tank as a treat - ment•stage in the waste disposal system. • St. Croix Count yy residents - maybe eligible to recieve a grant for a maximum of 60% of the cost.of replacement of a failing system, wh c was in operation prior to 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all hew a 1 s tem`+ QQ agree to keep their system properly maintained. LL�i�� 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 nee C Certif three year-expiration. y I /WE, the undersigned have read the above requirements and agree to maintain the private sewage disposal sYs the Wisconsin the standar set forth, her Y w ment of Natural Resources. Certification form must be completed b and returned to the St. Croix County Zoning Office within 30 days year of the three y expiration-date. p SIGNED DATE d l G I St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386 -4680 Sign, date and return to the above address. DEPARTMENT OF RE PORT ON SOIL BORINGS AN D SAFETY &BUILDINGS DIVISION INDUST'RYg 1 C LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.09(1) &Chapter 145) LOCATION: SE CT ION: TOWNSHIP/ Y: LOT NO.:BLK. NO.: SUBDIVISION NAME: w 1 /4 4w 32 /Tgo N /11 E (or)W wST)C)srp)j COUNTY: OWNER'S ' MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS : COMMER IAL DESCRIPTION: PROFILE I ONS: R A ION TEESY Residence �N� New El Replace �� ' MdQC�t � f4,�Qca /S)/97/ sm_% v , ,4,z Z ce-_ S�tNT� a4o RATING: S= Site suitable for system U= Site unsuitable for system `�� A �/ co NV NTIO�NAL: M D: �� IN -G NDP� URE: SYSTEM- IN R 06N\j c� SYSTEM: (optional) S U S S U PS U S U �) IOlv4L N If Percolation Tests are NOT required DES GN RATE ( If any portion of the tested area is in the under s. ILHR 83.09 indicate: L dS5 1 Floodplain, indicate Floodp elevation: qA PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEW6. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B Q.;b q6,$8 404 8• so i3' «Ts 19 /D " fist- 66 e ^S 60, B- Z O 96.I9 pj6iV [ 9. 6,9 9'18Ltn l7 ~ Y S,1 i3 Y& A5i 76"8a+V/die B- 3 l�.�o _�8 0 > /0.Ob g "�c1S I / *1 32KSc +GIP S* " leg ✓ S B- 4 , %3 93•S N O > ,Z "8uTS W N& ,MGR 4'&9f4 hS - 1&e 66�$�'�7S1K� B- 5 6.7s' 92 9g nla > 6.75 illLc -s z,'&,JS,c 49'J84 , 4MS¢ 4 I?1 B- L�r PERCOLATION TESTS TEST WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES EPTH NUMBER S I AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 P RI PER INCH P - A , 00 1 N 6N E 6.80 > ? > Z > 2 < 3 P- z 3,QQ INkNE IC16 3 > > 2 >2 <3 P- 3 S•3o o>n11E qB• 1 > Z > 2 >Z <3 P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate s �alb or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show�thl sjifac'e elevatid a af1-porings and the direc 'on and percent of land slope. / Q SYSTEM ELEVATION i kamep-A a 9 �•$o ' g S ' bo re 14 4 7 j 3 -- I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures a d methods specified in the Wis Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belie NAM : TESTS WERE COMP D ON: 14, p �Y J O►�ISau Jo+�N Sa>ti 6 /r+L I�l4ficN �� /99 ADD CERTIFI ATION NUMBER: PHONE UMBER (optional): 9 / U&Sa� W s� l 6 349 3 o$a CST SIG TURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 10/83) — OVER — - t PLB 97 PLOT & CROSS SECTION PLANS I ZAPPA BROS. EXCAVATING INC t• _ /000 l'.rc. Scvric -7AAle PLUMBING UNIT w, r.� C, r. C,�E,k,Vour /�ads�c -rwJ 14 , oP roadr P uG PROJECT cca� L cLt/ A,ToNrfL 7 c yo Pile- sc .� - SDI 9S Pvc ��tac�.ur t,,.�� t d oic Sr. o v.✓ l-Jc« �f�biO�,vcFj • � � Y i A Qs SR oof ev NO SCALE FRESH AIR INLET AND OBSERVATION PIPE _. -- -- ' ~~ APPROVED VENT CAP MAXIMUM 12' ABOVE FINAL GRADE i W CAST IRON VENT PIPE MAXIMUM OF 42' ABOVE PIPE TO FINAL GRADE SIGNED: MARSH MAY OR SYNTHETIC COVERING LICENSE: 335 MINIMUM 2' AGGREGATE -�7 DATE: j / " OVER PIPE DISTRIBUTION PIPE � TEE SQL STING BY: ELEVATION BED b° AGGREGATE • BOTTOM PER SOIL BENEATH PIPE t l�- -� PERFORATED PIPE BELOW TEST IS ; COUPLING TERMINATING A %2- 8'a FT. AT BOTTOM OFSYSTEM