HomeMy WebLinkAbout032-2077-90-000 N O CD CD
O `�
M c c
GO a 0 0
rn
C C.
N y
tm C
w N E
y o N
N La
CL
cc
Its
T
C r M
N O
�3 I L I
C m N O
N c �� Z a��i '
C Z d° N I C Z O.
LL C N `� LL c • m
O N ° 0 0
3 a m ° 3o E ¢w
'f6 M @ O
d y aai
o w E E
N ° !' O
a m
f
0 0
co oC o
a� Z o o
m z Z
-°
M` ci
y a
cn c
y c I I
•►y L 01 t o ° t °
15 N c
Q N Z co Z O o N 2 Z z O o
N z Z
G I 'S
c C
�o E Q) N �o E E N
N m O L O d ` N C O O
C G C a Q v 0 G G a a c N
z � j irntnm ja = Nmm >)U o
q ttrr al5 - v ao
tv 033 Z o3 Zo
• _ naaa y naaa
IL E E
cc u
rn rn ° V ° o o a�i
V O Z O N N O} I, �V CJ _ O O N Z 0 N CD
C E
aa 9 E cop — o� M
^ L ml C CL m� O C d 0
N N O LT y _m cu
C 'C Q Z fn @ c d Q A l4 f0
cl lo t
O IA C Y! c
o; '' :- o E o v E
Q o ° P ° u a. ° ° m a
rv\ rn �~ a a C NN
cc
f0 V) 10 M
N
co Cc
Ci N O 47', G d' N C N a$ ao C N
• ~ Cl) v o o o @ o 1` c o v im, o a�i �+ v
O ' o U) o Z �' Z 0) M o Z �' Z Y 2 U') w — I _ —
a; a 4) a y a
tr `I � V a y d aa+ d (L o
�1 A tia2 'oa,t l0U)u
o
DEP,''VRTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707 XX�,
NW 4, SE 4, S 14, T30N —R20W CONVENTIONAL El ALTERNATIVE State Plan l.D. Number:
(if aasfgned)
Town of Somerset ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound
Scout Camp Road
NAME OF PERMIT HOLDER: J ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
David Corbo Route 1 Scout Camp Road, St. Joseph, W 54082
BENCH MARK (Permanent reference pomm) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.
Name of Plumber MP /MPR SW No.: County: Sanitary Permit Number:
Robert Ulbricht 3707 St. Croix 102838
SEPTIC TANK /HOLDING TANK:
MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER
PROVIDED. PROVIDED.
❑YES ❑NO [ ONO
BEDDING: VENT DIA. VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL. BUILDING. IV ENT TO FRESH
ALARM FEET FROM LINE. AIR INLET
❑YES ONO DYES ONO NEAREST
DOSING CHAMBER:
MANUFACTURER BEDDING' LIQUID CAPACITY J PUMP MODEL. PUMP /SIPHON M ANUFACTIIRER WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
DYES ❑NO ❑YES ❑NO ❑YES ONO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET
PUMP ON AND OFF) 1:1 YES El NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING,
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH. LENGTH N . PIPE SPACING COVER INSIDE CIA -PITS LIQUID
BED /TRENCH TRENCHES MATERIAL' PIT DEPTH
DIMENSIONS
GRAVEL DEPTH FILL DEPTH UISTR PIPF DISTR. PIPE DISTR. PIPE MATERIAL. NO DISTR NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH
BELOW PIPES ABOVE COVER ELEV INLET ELEV. END PIPES FEET FROM LINE AIR INLET
NEAREST --*-
MOUND SYSTEM:
Mound site plowed perpendicular to 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-
meets the criteria for medium sand. TIONS MEASURED.
❑YES 1:1 NO
SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS
El YES 1:1 NO ❑YES 1:1 NO
DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL SODDED SEEDED MULCHED
CENTER EDGES. .
El YES El NO ❑YES El NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH. LENGTH. NO.OF LATERAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER
BED /TRENCH TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO DISTR j D:ST R R PIPE DISTRIBUTION PIPE MATERIAL & MAHKIN6
ELEV. ELEV. DIA. ELE V.. PIPES DA..
ELEVATION AND
DISTRIBUTION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED
INFORMATION PLANS
DYES El NO 1:1 YES NO
COMMENTS: PERMANENT MARKERS: J OBSIERVATION WELLS: NUMBER OF PROPERTY WELL. BUILDING.
FEET FROM LINE
L1 YES 1:1 NO El YES ❑ NO NEAREST
Z�v 6 - / .
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATORE. TITLE Zoning Administrator
DILHR SBD 6710 (R. 01/82) I
I
DILHR SANITARY PERMIT APPLICATION C.7"— TYCIG��
In accord with ILHR 83.05, Wis. Adm. Code
1--w�.* STATE SANITARY PERMIT #
A( 'Z p G
–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. PETITION
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION FOR VARIANCE ❑ YES ❑X NO
PROP RTY OWNER n PROPERTY LOCATION
9 % S 6' 1 %,, SK T 30, N, R 10 E (o W
PROPERTY D OWNER'S MAILING AD ESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
,I s V ��MP gip.
CI Y, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, ♦ BMA RK
�dS rJ yQQ2 W / s . .6� ❑VILLAGE: S Q•��p, SPT SGD U 7 C 1 OR
II. TYPE OF BUILDING OR USE SERVED:
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) o V+ LET' O r= 1r/1NK R rt= /E &2%
Ta Be - RRoKEw cK clp s'Sarv.
1. a. ❑ New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. Re6air 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. � Conventional b. El Alternative c. El 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) A/.
1. a. El seepage Bed b. El Seepage Trench c. El Seepage Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
41 • Feet Private ❑ Joint ❑ Public
CAPACITY
VI. TANK in all 2n, Total # of Prefab. Site Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass • Plastic App
E 0/1 Tanks Tanks structed
Septic Tank or Holding Tank 2 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.
Plumber's Name (Print): Plumber's Signature: (No Stamps) 4APFMPRSW No.: Business Phone Number:
2ogar MW IC 3,20 745
Plumber's Address (Street, City, ;;� Zip Code): Name of Designer:
!v SS 0 /•�VI . a V pSoA I 49 1J
Vlll. SOIL TEST INFORMATION
Certified Soil Tester (CST) Name E:, i O'NEIL RD., HUDSON, WIS. 54016. CST # 6
ROBERT ULBRIGHT 2 a 2—
CST's ADDRESS (Street City, State, Zip Code) NIS. MASTER PLUMBER LIC. NO. 3307 .. . . Phone Number:
4N. INSTALLER & DESIGNER LIC. NO. 00663 7
IX. COUNTY /DEPARTMENT USE ONLY
❑ Disapproved Sa tary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps)
%Approved ❑ Owner Given Initial rcchharrg^e �Fee J Q �/
Adverse Determination � � "' 011J • �J(� 1 3— r 1— c� / I2 - &
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. i\ new permit may be needed
if there is a change in your building plans, system location, estimated wastewater flow (number of bed-
rooms, etc.), depth of system, or type of system;
4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renew, a Form (SBD 6399) to be
submitted to the county prior to installation;
5. Private sewage systems must be properly maintained The septic tank(s) shout 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 expi:,rimental approval only if
tanks received experimental product approval from DILHR;
VI1. Responsibility statement: Installing plumber is to fill in name, license number ith appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form. Fil in designer name if
applicable;
VIII. Soil test information: Certified soil tester's name, certification number, addrese 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 8'h 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.
---------------------------------------------------------------------------------------------------------- - - - - -- - ----------------------------------------
GROUlIOWATFR- .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 .jri statutes was tre
result of over 2 years of steady negotiation and public 'dObae:: The..,groundwater bill Ground Ater
included the creation of surcharges (fees) for a number of regulated practices which Wisco
e
can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried r :aauCB'
is used in your building is returned to the groundwater through your soil absorption a
system or the disposal site used by your holding tank pumper.
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)
z
oc� rio J 7 yP� of 7 r
E
1f R SOR ?Tto a s y sT� S ZINKNow
DU E,�P f/0 a', G—
`J zx I'S r %v c
5E,0 T1C . I - 2/w"010-mv SilF
I'
r'
i
z
1 . HOMESITE SEPTIC PLUMBING CO.
655 O'NEIL RD., HUDSON, WIS. 54016
ROBERT ULBRIGHT +
WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S.
MINN. INSTALLER & DESIGNER LIC. NO. 00W3
} Q�
i
i
5 4o v r e �(I
ti
T Y oA of T.f'�'.t T,•,,�,,, �—
If ASOPP O s ys�7e�+ s Zlw�cvaW
1
rv�°F�ow•ti �—
A&EzisrING- 3 v ye-
5 4 - ,o r1c • iVit�.vow.v Siy�
� ldvl�i�iow -
- 3
t
HOMESITE SEPTIC PLUMBING CO.
655 O'NEIL RD., HUDSON, MS. 54016
ROBERT ULBRIGHT
WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S.
MINN. INS & DESIGNER LIC. NO. 00663
i
f
a
4
i
5 C,9 Ac = / " :2 e
4
's
iNisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division
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. 363814
Permit Holder's Name: ❑ City ❑ Village ❑ Fown of: State Plan ID No.:
Corbo, David St. Joseph Township S 1A*
CST BM Elev.: Insp. BM Elev.: BM Description: - Parcel Tax No.:
1.06 1,06 S 032 - 2077 -90 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Q IZ," Benchmark
Dosing Q p Alt. BM `D g am'
on Bldg. ewer s
g� �
Ht Inlet l0 o a , 35 6q.6$ - �
TANK SETBACK INFORMATION St/ Ht Outlet 2 -Go
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet off• ° D
Air Intake
Septic (OD '> 7-S7' 'i, 0 1 NA Dt Bottom �0•(0 g�'
Dosing >+ 77 /tsb' ( p p ' NA Header /Man. Z 30 CM - 916�
Z•3a r
Aeration NA Dist. Pipe _
Holding Bot. System $.9D'
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand St cover . Z Z� D , 13
Model Number 3 L lkt ( y r-¢.ts }_O 0 10D.0
NO '
H Lift �.bb Friction 1.t`i System., TDH ``'' �` t 4L ?.O p2.o �p .p
/ Fi ,
Forcemain Length 30 Dia. 2 " 1 Dist. To Well > /
SOIL ABSORPTION SYSTEM
E A N H width t Len th, of
MEN I e+t PIT No. Of Pits Inside Dia. Liquid Depth
to � I ou�.J� D
SYSTEM TO P / L BLDG WELL LAKE / STREAM �AMBER Manufacturer:
SETBACK
INF ORMATION TypeO M INumber:
System:&n 1}� (c7D � (L OR UNIT
DISTRIBUTION SYSTEM
Header /Manifold Distribution Pipe(s) L4 x Hole Size x Hole Spacing Vent To Air Intake
Length 3 -ID Dia 2 Length 8 I .(o ff- Dia. 2 Spacing 3.c> f7 ! �9 _
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over 5 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes o
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 1d / I f / or Inspection : 1 /1.2 / °''
Location: 1517 Anderson Scout Camp Road, Houlton, WI 54082 (SW 1/4 SE 1/4 14 T30N R20W) - 14.30.20.794B1 -Lot 1
1.) Alt BM Description= `A Co r - ,
2.) Bldg sewer length= —
-- 4 —*
amount of cover = **, '( 3L
�j 3.) contour= �.yN = �, °I � 4�A;t 4tt 1o1.34 � ,
Plan revision ❑ required? Yes XN o q Us e other side for additional infor n. oL 1 1 3 1 0
l L
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
--------
7 S
.......
.,., ...«
-- $ e.e e.e., m , . �e eg.a m e e eee ..,�
JL
e t
i w
.a_ .. . ......
Y 3
_..� ,�e,� m� ...dm .> - - ----
e
E
i
i
fl
e I
3
0
P h
3
E
r
m
t E
e
?. _ — .
E
E
F
e
s
e
7
I
_
e �.e
a
} a
m_
E r
s
c
i z
eee
me e } a
e e
s }
.e.. ,.,
m -
_..:.� mmm�a ,. .�. _ ed ,w. ...
a®
..e
w.
q m P
5
i
W isconsin Safety and Buildings Division W. SANITARY PERMIT APP r 1 2 1 Box Washington Avenue
Department of Commerce in accord with Comm 83.0s, Adfrt► Cbdi' - -f < Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the sy eFn on p' t less C ty
than 81/2 x 11 inches in size.
• See reverse side for instructions for completing this applla#ipn s anitary Permit Num
Personal information y ou p rovide may be used for second 3 (r
y p y ry purposes h k if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. k i v
to Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL M 3a X816
Prop" Owner Name /iP Ltic�tl
T14; ' 1 t� , S T , N, E (or)g
1q, Q Property Owner's Malting Address Lot Num er Block Number
City, Sta zip Code Phone Number Su division Name or CSM�Lu
( )
ITTYPE OF BUILDING: (check one) ❑ State Owned [] !t Ne est Road
Public 1 or 2 Family Dwelling - No. of bedrooms � 0 Tow OF
111. BUILDING USE (if building type is public, check all that apply) Parcel Tax Number(s) f
� , 30 , 2.0. 79 �Z
1 C] Apartment/ Condo 03 _ll CUD
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 box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2 ® Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5 _ ❑ Repair of an
System ________ Syr em _____________ Tank Only______________ Existing System _________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 fo Mound ❑ Specify Type 41 []Holding Tank
12 E] Seepage Trench 22 ❑ In- Ground Pressure x 8y f 42 ❑ Pit Privy
13 El Seepage Pit i �� 43 ❑ Vault Privy
14 C] �..B+� System -In -Fill / V"V_ �
VI. ABSORPTION SY M 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. /' ch) Elevation
Feet Feet
capacit
VII. TANK in Ca allo
g Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanksl Tanks
Septic Tank or Holding Tank — s' 0 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 14 — " oksl ❑ 1 ❑ 1 ❑ I ❑ I ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for in allation of the onsite sewage system shown on the attached plans.
Plumber's e: tint Plumb is S at r (No 5 ps) MP /MPRSW No.: Business Phone Number:
Plumber's dress t t, Ci , State, Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved itary Permit Fee (Includes Groundwater ate I ssued Issuing Agent Signature (No Stamps)
22 Surcharge Fee)
[KApproved ❑ Owner Given Initial
Adverse Determination s ZD 24 D I " _A�
X. CONDITIONS OF APPROVAL I REASONS FOR DISAPPROVAL:
i SBD -6398 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber -
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administralive 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 most be properly rri ntained 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 and buildings Division, 266 -3151.
To be complete 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.
IL 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.
Vl. Absorption system information. Provide all information requested for numbers 1 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 for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. ;Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 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 Fj'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.
Safety and Buildings
PO BOX 7162
MADISON WI 53707 -7162
TDD #: (608) 264 -8777
Visconsirn www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
April 12, 2000
CUST ID No.224263 ATTN. POWTS INSPECTOR
ZONING OFFICE
KIM A O'CONNELL ST CROIX COUNTY SPIA
504 3RD AVE 1101 CARMICHAEL RD
OSCEOLA WI 54020 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 04/12/2002 Identifica ' rs
Transaction ID No.
SITE: Site ID No. 189577
ST CROIX County, Town of SOMERSET Please refer to both identification numbers,
SWl /4, SEl/4, S14, T30N, R20W above, in all correspondence with the agency.
1517 ANDERSON SCOUT CAMP RD, HOULTON 54082
i
DAVID CORBO RESIDENCE
FOR:
Description: MOUND SYSTEM
Object Type: POWT System Regulated Object ID No.: 656565
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
+ The existing septic tank must be inspected for structural soundness, size and baffles, and must be brought
into conformance with the requirements of chapter Comm 83, Wis. Adm. Code. If it does not comply, a
state - approved septic tank shall be installed.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
A
Sincerely,, / DATE RECEIVED 04/04/2000
FEE REQUIRED $ 180.00
�' y FEE RECEIVED $ 180.00
P�TER E PAGEL , WTS PLAN REVIEWER II BALANCE DUE $ 0.00
Integrated Services)
(608)266-2889, M - F, 0745 - 1630 HRS
PEPAGEL @COMMERCE.STATE.WI.US WI IYI code op
cc: DAVID CORBO
WOUND SYSTEM DESIGN
Residential Application
INDEX AND TITLE SHEET
Project DAVID CORBO
Owner DAVID CORBO
Address 1517 ANDERSON SCOUT CAMP ROAD
HOULTON WI 54082
Legal Description SW- SE- SEC14- T30N -R20W
Township SOMERSET County ST. CROIX
Subdivision Name Lot No. ##t!#
Parcel ID Number
Plan Transaction Number
RO.W.T S• Index and title sheet Page 1
Conditionally Mound calculations Page 2
AP R ® Pres. d sts. calcs and laterals Page 4
DEP MEN OF CO ERC TDH and pump tank drawing Page 5 CORRECTION NEEDED
D1V1 y� SA TY a Bu► INCS PUMP CURVES Page 6 SEE CORRESPONDENCE
PLOT PLAN Pa e 7
SEE CORRESPO ENCE
Designer KIM A ON ELL License Number 224263
Signature Phone No. 715 - 755 -3145 4 Z
Date 3 -25-00
Notice: Tampering with this file by unauthorized persons is prohibited.
Deliberate modification will result In disciplinary action under s. 145.10, Wis. Stats.
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
l
SEOL 10462 -E (8.MM) Page 1 of 7
I
I
MOUND SYSTEM DESIGN
Complete red boxes as necessary. 1000 gpd maximum design flow.
Inch - founds Metric
Residential or commercial? R (r or c) (y or n) Y Replacement system?
Creviced bedrock site? n (y or n)
Slope 6 %
Wastewater flow rate 600 gpd 2271 Lpd
Depth to limiting factor 28 in 71.1 cm
In situ sal infiltration rate 0.5 gpd/ft 20.4 Lpd/m
Contour line elevation 97.9 ft 28.84 m
Use standard fill depths? x OR Design depth? in cm
Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth.
I
Center or end manifold fc or e► Hole diameter 0 0.125, 0.156, 0.188, 0.218.0.25, .25 in 0.281 or 0.313 inch only.
Lateral Spacling 3.00 ft Use 0 lateral spacing for trenches.
Estimated hole space 4.00 ft Not a final calculation.
Number of laterals 2 Pump tank elevation 90.5 ft Outside bottom of tank
Forcemain length +lQ.O ft Forcemain diameter 2.0 in 1.5, 2 3 or 4 inch only.
2.067 in Actual I. D.
HOLE DiAMETER CONVERSIONS
IM =0125 1/4=0.250
SYSTEM SOLUTIONS Inch ou�ids Metric SM = 0.156 lW = 0.281
Estimated daily flow �go 2271 Lpd 3H8 =0.188 5H6 =0.313
7x32 =0219
Absorption cell
Design load rate & area 1.2 gpdrft 500.0 ft 43.45 m
Linear loading rate (LLR) 7.14 gpd/ft 88.5 Lpd/m
Design width (A) 6.00 ft 1.83 m
Cell length (B) 84.0 ft 25.60 m
Depth of cell (F) 10.0 in L 25.4 cm
Sand filter
Upslope fill depth (D) Zfe in 30.5 cm
Downsiope fill depth (E) in 41.4 cm
Basal area required (gpolrnfiltration rate) 111.48 m`
Supporting components
Topsoil depth 6.0 in 15.2 cm
Subsoil depth at center 12.0 in 30.5 cm
Subsoil depth at cell wall 6.0 in 15.2 cm
End slope toe length (K) 10.54 ft 3.21 m
Up slope toe length (J) 7.20 ft 2.19 m
Down slope toe length (1) a 11.70 ft 3.57 m
Total mound length (L) 105.08 ft 32.03 m
Total mound width (W) 24.90 ft 7.59 m
Project: DAVID CORBO
Transaction Number: Page 2 of 7
MOUND PLAN VIEW
observation pipes (typical)
J
E; N B ft A A= 6.00 ft 1.83 m
m B = 84.0 ft 25.60 m
W J= 7.20 ft 2.19 m
K f = 11.70 ft 3.57 m
I j K = 10.54 ft LMm
_ 1 105.08 ft
32.03 m typ. obS. pipe
(anchored securely)
I = down slope dimension = absorption cell (AxB)
J = up slope dimension �J = plowed area (LxW)
K = end slope dimension 6' (152 mm)
MOUND CROSS SECTION
D = "''f in, 30.5 cm
lateral
topsoil G H subsoil cap E= 16.3 in 41.4 cm
invert 99.40 ft F = 10.0 in 25.4 cm
elev. 30.30 I m ''! ;; i F G = 12.0 in 30.5 cm
ASTM C33 H = 18.0 i I 45.7 cm
D Sand Fill E
SYS. 98.90 ft
elev. 30.14 m 97.90 contour
29.84 m elev. 6 % -�
slope
D = upslope fill depth plowed layer
E = dowrlslope fill depth Note: Absorption cell media will consist
F = absorption cell depth of aggregate and pipe with laterals
G = subsoil + topsoil depth at cell V N centered across AxB media. The cell
H = subsoil + topsoil depth at cell center media is covered with geotextile fabric.
Designer notes:
Project: DAVID CORSO
Transaction Number: Page 3 of 7
PRESSURE DISTRIBUTION CALCULATIONS
Absorption cell Inch Metric
Width (A) 6 ft 1 1.83 Im
Length (B) 84.0 ft 25.6 m
Lateral specifications
Number laterals 2
Holes/lateral 21 holes
Lateral length (P) 81.67 ft 24.89 m
Hole diameter 0.250 in 6.35 mm
Lat. dis. rate 24.47 gpm 1.54 Us
Sys. dis. rate .94 gpm 3.09 Us
Hole spacing (X) 49 in 124.5 cm
Lateral diameter Pipe diameter Design option. D esi g n choice
Designer must 1 in (25 mm) Place X in red
"X" one choice 1 1/4 in (32 mm) box of chosen
from the options T - 1 in (40 mm) diameter.
provided. 2 in (50 mm) X X
3 in (75 mm) X
Manifold diameter Pipe diameter oesign oaoons Design choice
Designer must 1 in (25 mm)
NXw one choice 1 1/4 in (32 mm) Place X in red
from the options 1 12 in (40 mm) box of chosen
provided. 2 in (51) mm) X X diameter
3 in (75 mm) X
4 in (100 mm) X +---d
Distribution system contains: 2 Lateral(s)
LATERAL DIAGRAM - &ND CONNECTION
Place correct lateral diagram by clicking in one of the drawings' at right and dragging the diagram into this area.
Laterals ceruer overt sion Last hole drilled next to end cap a .l oap
f P
AN laterals are identical IF X — ) I Holes drilled on the bottom of the lateral
equally spaced S
•
Faroe main commotion via tee of cross to manifold at any point. Laterals & foroe main of PVC Soh 40
• . permanent end marker (per C )MM Table 84.30 -5)
Inch - pounds Metric
Lateral length (P) 81.67 ft 24.89 m
Lateral spacing (S) 3.00 ft 0.91 m
Hole spacing (X) 49 in 124.5 cm
Manifold length 3.00 ft 0.91 m
Hole diameter in 6.4 mm
Lateral diameter in 50 mm
Forcemain diameter l , in 50 mm
Project: DAVID CORBO
Traiisixtion Number: Page 4 of 7
TDH and Pump Tank Drawing
Total Dynamic Head
Operational head 2.50 ft 0
Vertical lift 8.00 ft m Are laterals the highest point in the
Friction loss >3 i fi''� 4 Ia do m system? Yes "x' here. F x i
Total dynamic head 12.03 m If no, what is the highest elevation
Dose Volume downstream of pump? L....�
Dose is > 10 times lateral volume Forcemain drain
Lateral void volume 28.5 gal 107.9 L back to tank? (')e' one)
Minimum dose 285.0 gal 1078.8 L x Yes
Drain back 7.0 gal 26.5 L No
Dose volume 292.0 at 1105.3 L
Typical Pump Chamber Layout
In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC.
approved manhole cover with
weether proof warning label and locking device
grade levels junction box ! � rade levels
disconnect g
alternate
4' vent pipe electric as per NEC 300 and < outlet
Comm 16.26 WAC location 18" (4 1 cm) min.
wall of pump L�—' approved
chamber or outlet joint
combination tank
A Provide 1!4 weep hole or arti-
alarm on siphon device as necessary
pump on B
Grade levels
pump 91.4 ft C I - pump tank manhole = 4 (10 cm)
Off elev. 27.9 tri minimum above finished grade
D - vent =12' (30 5 cm) minimum
above finished grade
90.5 ft Pump tank elevation
3 " (75 mm) of bedding under tank 27.6 m bottom of tank
Tank manufacturer WEEKS CONCRETE PRODUCTS
Pump tank capacity ig.41galAn
Pump tank volume 1000 gal
Pump manufacturer 1GOULDS Inches Gallons
Pump model number IV
#E031 1 L o A 26.5 514.0
.5 B 2 38.8
Alarm manufacturer S.J. ELECTO SYSTEMS E C 15.1 292.0
Alarm model number JHW 101 i5 D 8 155.2
ProjeCt: DAVID CORBO
Trahsaction Number: Page 5 of 7
Pumps
MMAS F1 cT
—�� 1 I ' r �r�I�Dt: �J�JtJ J
I
-, � ---,#� _7 70 I
ZU WE10H —
ti 1 1 7
wEOIH-
to WtwM
WEOJI _
10 70 90 40 ) 0 W W 1 w 110 I .V GP M
0 10 R Ll ;x7 m'/h
CAPACITY
�., r ,, ,,,. . ;�, , ., •,,,,, -? •► A; :, ..� . . ;.: j.. �. u L D :i PUM
METERS M f
u D E 3305
S rE ',' Solids
� ' t i• I II —I•-
WEolHm
+H r r -r�
10
oL 0
0 10 ?0 00
0 10 :J :r0 m
C r
• 1 WO OvuW� IvmP�, Ino. C4Grn .�.ry. t r.a
C)1�`
c � xs ( Z O
-- i'v_
r" O �\
n `
_t 0 C) Q Q
rT
u
v
Wiscoo Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with s. ILHR 63.09, 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
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
/ Govt. Lot �� 1/4 — 1/4,S T N,R . /(or) W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
City State Zip Coe Phone Number ❑ City ❑ Village 21 Town Nearest Road
❑ New Construction Use: [Residential / Number of bedrooms _ Addition to existing building
Replacement ❑ Public or commercial - Describe:
Code derived daily flow Zel5i gpd Recommended design loading rate /,? bed, gpd/ft /.- - trench, gpd /ft
Absorption area required ,; _ bed, ft trench, ft2 Maximum design loading rate bed, gpd /ft /.;. trench, gpd /ft
Recommended infiltration surface elevation(s) _____ 1 9,,Y , % It (as referred to site plan benchmark)
Additional design /site considerations
Parent material �(� Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ❑ S U S El U ❑ S U ❑ S ®U ❑ g ® U ❑ S .® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
J
Ground ;,
elev.
Depth to
limiting
factor
,.min.
Remarks:
� Boring #
l
Ground 1� ' �� - — -
elev. AY
k f t.
Depth to
limiting
factor
;�in. Remarks:
CST Name (P ease Print) Signatur _l , ` Telephone No.
Address / ate CST Number
SOIL DESCRIPTION REPORT `
PROPERTY OWNER �1�/� Page of
PARCEL I.D.#
Boring Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munseil Qu. Sz, Cont. Color Gr. Sz. Sh. Bed Trench
�
f el
Ground
elev.
2, 7 r r f
I 4 Ablo
Depth to
limiting
factor
,2,4 in.
Remarks:
Boring #
Ground
elev.
ft.
Depth to —
limiting
factor
I in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /f1
in. Munseil Qu. Sz. Cont. Color Gr. Sz, Sh. Bed Trench
Boring #
i
Ground
elev.
n.
Depth to
limiting
factor
in. Remarks:
i
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R. 07/96)
� n
1 1 r
lzs
I
It
A a
0
• Wiscon'§in Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page --L of
Bureau of Integrated Services in accordance with s. ILHR 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 r
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # i �, 3� Zp �gc� (3�
- -9 D -�
APPLICANT INFORMATION - Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). - clt _Zo — o-D
Property Owner Property Location
Govt. Lot 1/4 � 1 /4,S l T N,R /(or) W
Property Owner's Mailing Address Lot # Block# Subd. Name or
/- - J
LL State Zip Coe Phone Number ❑ Ci ty El Village �] Town Nea est Road
/� - J
❑ New Construction Use: C Residential / Number of bedrooms `✓ Addition to existing building
9 Replacement ❑ Public or commercial - Describe:
Code derived daily flow ff4 gpd Recommended design loading rate - bed, gpd /ft /,.2 trench, gpd /ft
Absorption area required bed, ft 5!�Z trench, ft Maximum design loading rate
g g ,_ bed, gpd /ft J-2 trench, gpd /ft
Recommended infiltration surface elevation(s) -j ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system I ❑ S DO U f S ❑ U ❑ S [�] U I ❑ S ® U ❑ S ,®U ❑ S 0 U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
J in. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
r r > >
Ground
elev.
eft.
Depth to
limiting
factor
Remarks:
Boring #
Ad
Ground 7 ' y
elev.
�ft.
Depth to
limiting
factor
in. Remarks:
CST Name (Pease Print) Signatur , " Telephone No.
Address I ate CST Number
I
PROPERTY OWNER 20-4 Ik )Q SOIL DESCRIPTION REPORT
Page of J
PARCEL I.D.#
Boren # Horizon Depth Dominant Color Mottles Structure 2
Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed .Trench
'41 1A
3 � ;
Ground �Y
elev.
r
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R. 07/96)
J
h
M �
IZ
� o
o ,�
v ( N -
8 �
\ � M
• ST CROIX COUNTY
i SEPTIC "TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
'Owner/Buyer b✓a y to G- • Cog (3 a
Mailing Address /S /7 ANQeRSrN Sca �- Coln ?12^,
Property Address S A
(Verification required from Planning Department for new construction)
City /State _ �-� o 14oti Parcel Identification Number Q3a - 20}x-- 40 -�
LE DESCRIPTION 30 20 7WBl
Property Location S r /,, S !E �/4, Sec. 14 , T dIV N -R 10W W, Town of S'tw *�t�
Subdivision , Lot #
Certitied Survey Map # 3 4 j U 3 °7 , Volume oZ , Page #
Warranty Deed # 3 (62 Oa , Volume ' ?o , Page # g
Spec house ❑ yes IK no Lot lines identifiable 14 yes ❑ no
SYSTEM MAINTENANCE
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 pumper. What you put into the system
can affect the function 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.
I/we, 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
stating that your septic system has been maintained must he completed and returned to the St. Croix County Zoning Office within 30
day f the three year expiration date.
7�L �t� --
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are tnre to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
6 4 IGNATURE 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
DOCUMENT NO. STATE UAR OF WISCONSIN -FORM I
WARRANTY DEED
__ R ,• r , j � (7� !HIS SPACE RESERVED FOR RECORDING DATA
1/(?` �� r1 _ REGS1 _RS OFFICE
Wilbur F._Hamm and Pat C. ST. CEOi;( W IS. q
BY THIS DEED. — _____ Co.,
Hanunon, husban . and wife _ iec'd. icr Reword figs 1st
day of Ma.-ch A. 1�
Grantor conveys and warrants to _tea- V-i-d - _ C a ba - -an t J-
1 Q� 8 : ��J
corhn, hu a-- wife as Joint tenants -, \ 1l ��� t>�PYN�I
149111rof of Dow q
Grantee
for a valuable consideration _mil_ �LJ - 3. y.y_Q.SL . - . 0 t0 RETURN TO 6J JA l0 rW i T i! iE� I: rZ
Set ,, A. 1 t /.c AA ti f r
C I i l. I r f T.
the (u 11ow..:R described real estate to - County, State of Wtscunsrn: �,.� T F I , r , Si•,- J,•.1
Part of the SW; of SE; of Section 14, T30N, R20W, This is -- homestead property.
being Lot 1 of Certified Survey Map filed
October 24, 1977, in Volume 2, paqe 432, in the office of the
Register of Deeds for St. Croix County, Wisconsin.
Tr A1 ; ER w
53
FEE
s
i
Exception to warranties: Any highways, easements and other restrictions of record.
a_
E> e,ut.•dac Stillwater Min ne:,o ta thi�_2-8-t -( _-F- 19-72— y y
SIGNED AND SEALED, IN PRESENCE OF �� G { � � _ ��n -" '' `' �� J (SEAL)
Wilbur F. Hammon
(SEAL) Pte#
Patricia C. Hammon
(SEAL)
+iKa:
- -- - - - -- (SEAL) ., .
i1
v
�1'611vh.IK"l Ot�.. - - -- �_ �--- �f-. �_ �—. wta. aa� _...raaaw.s— a��aa��aa�_�x.a. —�— -- •-- - - - - -- _
---------------- -. - - -- ----- -- ------- - --��a —w —u. — - -- - - - - -
• F i+ti
an0lent C It —4ay J(.- Ewa .aa�.�a�� a��aaatia^1— �9•a.�. I �4,.
--------------------------- - - - - -- $'
•��i!yulfl"
T[t•it -Me mber-&tsCe -Bare!- Wtscons i*r•or-0MrerPurt y
Aauhariaad_ QG- atz�������.� -ate_— dr6n.i
Minnesota
STATE OF,*kWf�X!! (;t
W,i c ;hinq ton "s a
Personally came before me, this ___ - .- _.2.8.th. �.._ day of -- Febr uary—
the above named___ -klilbur L _Hanunon- and — Patricia _C —Hammon,-- husbazid- -and _ wifcr -
Jf'i Y r
to me known to be. the pers �riuMrai+#rvv.4r�.ayiytiumaot and ackno the - b
�.� SCOTT F. C0Oi`dE3 aa--ee { � � �� •1 _
'f NOIARI tvPlk. - WNF:ISo-A
P`, t HENNEPIN COUNTY
Thu :nar•v ^ant was drafted by �� •
J My Cootm.ilwt Dipires Feb. 26,198 —
N+a:: rN?�N1sPAl iJ ?JdVJJIJHalrM7
William J. Gilbert.,, Att-oxney Notary Public —Ala-s n_ n an County,` }y.t nn *'
Hudson, Wisconsin
The use or witnesses is optional. My Commission (F,tpues)
ria nr. s of 'son] ., m ca paci t y should be or ruffed b+',.- their sl atures.
a1a pr.. yn ,n{ .ay D Y •YV"'- t D t/T 71
f OARN"TY DStn_j ?A *.y PAR OF 'S'SSCOrIStTi, POUR :10. 7 — tall �•� • - -_. }
7011
CERTIFIED SURVEY MAP co FILED
OCT 241977
,A&" 0 CoNNIII t..
lf� IS &w of D*ft% N
�q C k Comfyi
wbogum
�
ED 6 6 NORTH LINE OF THE SW 1/4
I UNPLATT LANDS N F THE SE I/4
1 1 N 89 0 33'40 "E
I 661.71' d
j h .► 9 63i7I' h 8 W
3.00 2S 2 �� V) 30.00 °'S w
33.00' 1 - 3 � o a
I 3
LL
1 ao 6.50 ACRES INCLUDING ROAD o 0
W
a o 6.21 AC EXCLUDING ROAD
IC0 Z HOUSE a , U- N cr:
M O W:
I �t / �FSHED w =
N _.__- W
u): p 1 �p �RIVEWAY z o:
W �I J LL
}:
f ort z 363.66 268.16 w o m:
3 1 631.82' 10 3
}: O 13 661.82' W:
m.f-lo N 89 °33'40 "E °�_LO z:
b 'M 3 WI/2-SW-SE v o 0
W: (.9 •O DIti _o
Z ' (D (D° a - (f): 3 :_ �, o °•,� 2 z o
z �°� a
v): - I 30.00 9.04 ACRES _ Z: W I INCLUDING ROAD
a 1 64.00 8.76 ACRES w: BEARING \`
POINT OF �; 1 234.00 XCLUDING ROAD ~
BEGINNING o . I I 9 °33 42 E ti Q:
Wy j6 6' UNPLATTED O r , S w.
LANDS 3_ z:
a ;• - 9 �:
1 3.00 0 C
z: 1 o OWNED p�
1 Sri B Y z M , D,, 0°
1 OTHERS ° '►� D `
W °� S 89 °33 42 SCALE IN FEET
I 0
3 �' ' 14
1 3 - - - - - .-- ,x; .-- .. —.�-.
W I
o o 2 00' 0' 200'
i °
W i o UNPLATTED LANDS
J OWNED BY OTHERS
............ ..
W SECTION 14 S 89"33'42"W
3 T30N,R20W 2648.08 SE CORNER
SECTION 14
T3ON,R2OW
LEGEND
9 COUNTY SECTIOA CORNER MONUMENT, FOUND. OWNERS $ SUBDIVIDERS
0 1 ".x-,24" IRON PIPE WEIGHING 1.68 # /LINEAL FOOT, SET Wilbur F. & Patricia C. Hammon
" R. R. #1, B 137
APPROVED
-,�-r- EXISTING FENCES Stillwater, Minnesota 55082
M EXISTING BUILDINGS OCT 19 1977 APPROVAL Of THIS M114
OR S
UB
DOES NOT MEAN APPROVAL FIOR
ST. CROIX COU; I1UIL01NG SITE OR R
CWItEHENsm PARKS PLAWOO � TO SEPTIC $Y,TEM,
AND ZOWNG Cp#JWTK hlb�2•y�
his instrument drafted by James T. Swanson.
Volume. 2 pare L82
i