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040-1017-40-000 (2)
Wisconsin Departmentof -Commerpe PRIVATE SEWAGE SYSTEM Coun Safety and Buildings Division INSPECTION REPORT �'t. Croix GENERAL INFORMATION (ATTACH TO PERMIT) SanitjJ3S /yy SNo.: Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. ratit Permit Holder's Name: ❑City ❑ !(illa e. d Towp.of: State Plan ID No.: ailey, Charles & Amy ro� wns tp CST BM Elev. Insp. BM Elev.: BM Description: « I - ParcelTc Nq 17 -40 -000 ��'�' ��•� r 1ev� �S wt� �I P "� ) 114V 1tl TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1W L h 1ZCO Benchmark .}O 166 UD , ' Dosing Alt.79 (. LJp `jZ. fo r Aeration Bldg. Sewer e Cvgj Holding St / Ht Inlet , sv' l °1.6a r TANK SETBACK INFORMATION St /Ht Outlet G.88 �`�. ZZ TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic 552 �, p' NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe C . ro Holding Bot. SysterTf PUMP/ SIPHON INFORMATION Final Grade 5, ( caner L4t.— Manufa er nd St cover Model Number GPM TDH Lift Fric 5 stem TDH Ft For 'n Length Dia. Dist. ell SOIL A S PTION SYSTEM (t,) C ,�,., "t" 3z TR CH Width / Length N Trenches PIT o. Of Pits Inside Dia. Liquid Depth DIM 3 dD r �� DIMENSI \� SETBACK SYSTEM TO P / L BLDG LEACHING Ma nyf ctur WELL LAKE /STREAM INFORMATION TypeO r _ CHAMBER Model Number: System: CPIIV. 2 fi OR UNIT DISTRIBUTION SYSTE ' Header/Manifold %A Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length � Dia. gth pacing I SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over (0 'D Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present etc.) Inspection #1:� /Zfi vo spection Location: 527 Francis Avenue, Hudson, D WI 54016 (NE 1j4 SE 1/4 4 T28N R19W) - 04.28.19.61I 1.) Alt BM Description= 641- . 2.) Bldg sewer length= 12-.0 - amount of cover= y 3G q) Plan re ision required? % No �++Tl Use other side for additiona In or tion. 06 Z Q 415261 Date Inspector's Signature JJ Cert No SBD 6710 (R.3/97) �,�— ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t a } 3 a � r ....._ .. ., _�eq t } i } .. .... ._mmP ......,, ... _ ,a. .... .. ., ... t —t t r E a E ®mm .. ......., .........P m�- .e m° °... .. .. ... E . a ` f s i E i mp .. _ ° er ° s .. .. ,.....« �J w € _ € .> 5..�..... u 1 M g P € B � a . . E a ' 1 r a _.,._ v ° ®_. _.. .. °........ �...,,. .. a m... _...... mw ., .. ... m # h � f t r e a i a ' ; E a ° (✓I Safety and Buildings Division Visconsin �J S ANITARY PERM LIGATION 201 W. Washington Avenue � P O Box 7162 Department of Commerce ! In accord with 3 0$. a Madison, WI 53707 -7162 • Attach complete plans (to the county copy only) e s step'�pap less County than 81/z x 11 inches in size. [17 J,— • See reverse side for instructions for completin application G-. State sanitary Permit Number JUN ? - 3 �3 3 Personal information you provide may be used for secondary p r0a es ? COX , Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. 3 / , 0"Ty �J7 State Plan Review Transaction Number 1. APPLICATION INFORMATION - PLEASE PR Uq Property Owner Name / ; 6 a(r6y Location �t' T aF , N, R/t? E (or)�O Property Owner's Mailing Address tOt Number Block Number E 7 e City, State Zip Code Phone Number Subdivision Name or CSM Number •Ls'c� 60 c` 5 -/�fG ( ) II. TYPE OF—BUILDING: (check one) ❑ State Owned It Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms _ Sj Sj Town of 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ 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 box on line A. Check box on line B, if applicable) A) 1 r&L 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 Number 35 3 '�-, Date Issued_Ty_4_Z,4- uto 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 5LSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit T„c v rA 4- ! 43 ❑ Vault Privy 14 ❑ System -In -Fill e_fu . 3a r, VI. ABSORPTION SYSTEM INFORMATION: 7. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade 1 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation � C�'U d /coo j - qL - �� Feet /d v,. Feet Cap VII TANK in Ga gallo s Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks M anufacturer's Name Concrete Con Steel glass App. New Exist in strutted Tank Tanks Septic Tank or Holding Tank ac 1 e 6; f/' ❑ 1:1 El E] 1:1 Lift Pump Tank /Siphon Chamber I I I ❑ I ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sew ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: 441 o' ,z J .& , /re v r ..,. ? 7 -6 Plumber's Address (Stre Cit , State, Zi Code): n. IX. COUNTY / DEPARTMENT USE ONLY C] Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issui g gentSignature(NoStamps) A roved Surcharge Fee) pp ❑Owner Given Initial Adverse Determination $ 1 50. X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: _ `(,< < S Ur rte - I "( oo SBD -6398 (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS � Y 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 - Wisconsin,Safetyand Buildings Division, 608- 266 -3151. 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 oe 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 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 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. 17 'lo gg e7 Pt vi 0 www4wj Livpttmndnt of kornmerce SOIL AND SITE EVALUATION p Dosion of Safety e Burtmu of integrate irdance with s. ILHR 83.09, Wis. Adm. Code • , County inches in s ize, Plan must Attach complete sit C e include, but not limt point (BM), direction and ✓ percent slope, scab n and distance to nearest road. parcel LD. # r APPLICANT IN Reviewed by Date Personal information y -- -- .- s (Privacy Law, s. 16.04 (1) (m )). Property owner Property Location 61l,tY,4G' _ ` Govt. Lot 1/4 /'1/4,S 4� T N,R Property 0wrrer's M ailill i ng Address lo-t# Block# I Subd. Name or CSM# I City State Zip Code Ph u str -' - / City ❑ Village Town Nearest Road 1 16 Me "a New Conuction Use: ❑ Reside Number of bedroortl Addition to existing btAlding [I AeptacemeM ❑ Public rP nmera� € k)40dbe�- 6 Code derived daily flow gpd r. O.WT'¢Rscom�henc�bd design loading rate .._. . bed, gpolff? c�_ trench, gpd/tt� ri, C'' (' Absorption area required 1 bed, ft a tra :Maximum design loading rate _ bed, gpd/RZ gpd/Itz r T ��>. - _. • , �'� h (as referred to site plan benchmark) Additional design/eite considerations Parent materiel Flood plain elevation, If applicable ft S Suitable for system Co nventional M ound 7n-Ground Pressure A ystem rn o ng ank U unsuitable for system ®S 0 u [ s❑ u E s C u O s El u ❑ S E U ❑ s Z u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots In. Munsell 4u. SZ, Cont. Color Of, SZ. Sh. Bed Trench 13 7-77 - 2 & L e a) Ground , 3 /� S -- t 5 a m -5 . . , L Z. ev. 7 4 q Dow to limiting . factor min. •G oS. � Remarks: Boring # ; ft. /a 1 ,Y2 b . 2Y 32 Depth to limitlnp factor j 2,�—. Remarks: CST Name (Pima Print) Signature Telephone No. eas l 71f—M l� `� �'" CST Dumber AMU . Date s ?D g cge�ca •tip oes�aes ., BugEuiU 00 4� •n'te Pu�jO # 5upoe :s�aBwey •ul Bumwo q %O&C 'A4p Pump IM # Bupog 4s Is to joi°'J 'iuo0 tg 1110 peCUtsVr V uouesl ' peg sto kvpunog SOUK U013 of at somoyy �olo� sueulwoa 0 uo H emaon4s t out) I '9l�1@LUld •ui MOD) bumwll of 4090 7l 'A!1® Punoa>? ' C 3 # Blipo8 :"Jewpld •ul ;� JO#�l Cq BUM uo � S •A" d Puaap 4S . , jot °O iuo� zg np ~V4 da UQ2;JO # BUIiGs 4oua�� P�9 wooly tivpunog eouo3sisuo'J al e�nixel selAO;ry iolop iu4ulcuoa 4i 4 t N'0'I 130d1fd W3NMO AlWgdOad 4 0 ®Bsd 1liOd3d N011dldMa -1105 � 1 � 17 tsLl 2 � Q� u y h I `w a Safety and Buildings Division Vs SANITARY P k"APLI`1V 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord wit �`Qr�rr 4t jltM Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) f r e system, Rn,�aot leS9 t County than 8112 x 11 inches in size. �6 t $` • See reverse side for instructions for completing thi � licatio -1 COCA State Sanitary Permit Number Ic=_ :35 3 �► Personal information you provide may be used for secondary purposes r'' ❑Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. \ �.r r _ ,. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL MIF RilotbN Property Owner Name X1 / 4e.5 Location S T , N, R Q E 0060 Property Owner's Mailing Address Lot Number Bloc Numbe /4'/ S`7" r i x Sfi City, State Zip Code Phone Number Subdivi,t�n Name or CSM Number s dN �t1 SY AA I. TYPE OF B ILDING: (check one) ❑ State Owned ❑ Cil Nearest Road Public N 1 or 2 Family Dwelling - No. of bedrooms E] vil To wn OF III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) �. 14 1 1 9 . (G ( 17— 1 ❑ Apartment/ Condo �` 6 r 7" 464. ^d a 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 Outdoor Recreational Facility 3 ❑ Campground 7 E] Merchandise: Sales/ Repairs ❑ Restaurant /Bar /Dining 4 C] Church/ School 8 ❑ Mobile Home Park 2 ❑ Service Station / Car Wash 5 ❑Hotel /Motel 9 ❑ Office/ Factory 13 ❑Other: specify IV. TYPE OF PERMIT: (Check ly one box on line A. Check box on line If applicable) A) 1, pff New 2 ❑ Repla ent 3. ❑ Replacement of 4. E] Reconnection of 5. ❑ Repair of an ------ System -------- System __ Tank Only Existing System Existing System B) [] A Sanitary Permit was previous issued. Permit Num r Dar! Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurize istrCon Exp I er 11 [] Seepage Bed 21 ❑ Mound pecify Type 1 olding Tank 12 ❑ Seepage Trench 22 ❑ In -Grou I r 42 I vy 13 ❑ Seepage Pit k 4 1 rivy 14 ❑ System -In -Fill TA VI ABSO SY STE NFORMATI 1. Gallons Per Day 2. Absorp. Area 3 bsorp. Area 4. Loadi Rate S. Perc. Rate 6. Lte Xv. 7. Final Grade Required (sq. ft.) oposed (sq. ft.) (Gals/day /s ft.) (Min. /inch) Elevation G� 75'Q 7 , 1 7 Feet /jf Feet VII. TANK Capacit in gall Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer s Na Concrete Con- Steel glass Plastic App New istin structed Tanks anks Septic Tank or Holding Tank �QQ , ' e $ e 1/"c/ ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ I ❑ I ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Z Code): l &? C a O'er e c IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D atelssUed - Issuing Agent Signature (No Stamps) ,Approved ❑ Owner Given Initial surcharge Fee) Adverse Determi a� " X. CONDITIO S OF APPRO / RS N DISAPPROVAL cam- '�' EA S FOR , ,M¢ �. �Z� mw^_ &s SAWED— r SBD -8398 (R. 4/99) DISTRIBUTI rigm 1 o County, One copy To: Safety &Buildings vision, Own r, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at 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 tanks) 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,-608-266-31 I 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 on line A. Complete line B if permit is for tank replacertfent, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Abs ption system information. Provide all information requested for numbers 1 through 7. VII. Tank tion.. Fill in the capac of every new /or existing tank, list the total gallons, number of tanks and manu act is name, i%icat pr r site Constructed and tank material. Complete for all septic, pump /siphon and holding to or his system. e x erime$tal approval only if tanks received experimental product approval from DILHR. VIII. RespQility s at�n t. InstaI� ng plu ber in to fill in name, l number with appropriate prefix (e.g. MP, etc.), ad c ens d hone nu r. 16M ber m r, t sign application form. IX. Co�rnty pa refit Us ly - X. County / De en� Use O Complete plans and specifications not smaller than 8 112 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 umps and controls; dose volume; elevation differences; friction4bss; pump performance curve; pump model and pumNmanufacturer; 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 practiceswhich can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. r ,3 l Ido, Sp � o a 1 r rr Misaonsiri Department of Gommeme SOIL AND SITE EVALUATION Page 1 of 3 Division of Saleiy.and Buildings in accord with Comm 83.05, Wis. Adm. Code Envuorunentat By Design Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal refe point (BM), direction and percent al Wape, scale or dim , ernam north s� Ti o� r "&0 S dislance to nearest road_ St. Croix Parcel LU.# APPLICANT INFORMATION - use' print I infnrrinaon. R Dabs Peasuriai idrrrrraScn You povide my be i j rrR+acy L4rr,'1L '15.64 (1) (m)). f 3 t- Property Owner .' Prope Location Bailey Charles And Am Lot NE 1/4 SE 1/4 S 4 T 28 KR 19 W yr Property Owner's Mailing Address + Lot # ! Block # I Subd: dame or CSM# 1011 St Croix N Street r1 G Gry State'�o�e`�PN6� ®wey�ier I,] Vila4e I`�Town Nearest Road Hudson W1 4 381 -81$3 Tray g Frances Ave M, New Co nstructi on Use. E,\j Resl' of bedrooms 3 FlAddition to existing building [] Replacement [] Public or commercial describe Code Derived daily Row 450 gpd Recommended design loading rate .7 bed, gpolll- .8 trench, M Xff Absorption area required 6 43 bed, fly 562 trench, fla design loading rate •7 bed, WW .8 tr ends, WW Recommended ini'iltrabon surface elevabon(s) Po• 101.70 & 100.00 ft (as referred to site plan be� r Additions! design ! site consideration T � s� k � - /°T' ✓ I Parent material loess Over Glacial OutWash i r���j� • Flood plain elevation, I applicable Na it S Suitable for system I Conventional i Mound /dam Ground Pressure I AT Grade l S I Fill I Holding Tank U= Unsuitable for system) ® S® u ®s e u ® S❑ u I® S® u l a S M U I❑ S® u SOIL DESCRIPTION REPORT Boring# Horizon Depth Domnant M Qu. Sz Coat Color Texture (s S Boundary Roots M ill! Trench 1 1 0 10yr3/1 - sil 2msbk mfr cW 2f .5 .6 2 8 -18 1Oyr4 /4 - sill 2msbk mfr cW if .5 ? .6 Ground 3 18 -34 7.5yr4/4 - gls 2msbk mvfr cW - 7 .8 elev 102.70 it 4 1 34-30 I 7.5yr4/4 I - ' gsi I i csbk I mfi I - I _ I 4 .5 Depth to I I I I ! I I limiting factor >90 Remarks: Z l 0-5 10yr3 /1 - sill 2msbk mfr cW 2f .5 .6 2 5 -20 10yr4/4 - sil 2msbk mfr cW if .5 .6 Ground 3 20-44 7.5yr4/4 - sl lcsbk mfi cW - 4 5 elev 102.50 ft 4 l 44-90 7.5yr6/6 - I s Osg I ml - - I .7 .8 Depth m limiting - -� factor I I I I I I I I I >90 L 1 Remarks CST Name (Please Print) Signature: Telephone No. Thomas, C.. Nei," 715 -2461 -2454 Address Environmental By Design Date CST Number Ref # / /,� / 1432 120th Street, New Richmond, Wr 54017 lq 227387 278 f PROPERTY i3MER ta;tg (jgq* and Amy SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL IAA Environmental Des; GPDM HOdZDn i Munsell Qu. Sz CDnt. Color Texture Gr. S�z Sh Boundary Roots Bed ?Trench 3 1 0 10yr3 /1 - sil 2msbk mfr cw 2f . 5 .6 2 6-38 10yr4/4 - sit 2msbk mfr cw if .5 .6 Ground elev 3 38-48 7.5yr4/4 - A I csbk mfi cw - .4 5 105,90 ft 4 1 48 -90 7.5yr5/8 1 - 1 8 1 0sg 1 Ud { - 1 - { ,7 .8 Depth to I I I I { I I I I limiting factor >90 o I I I { I I Remarks: 4 l 0-8 IOyr3 /1 - sil 2msbk mfr cw 2f .5 .6 2 8-18 10yr4 /4 - sit 2msbk mfr cw if .5 .6 Ground elm 3 18-56 7.5yr4 /4 - sl lcsbk mfi cw - .4 5 106.50 ft 4 5 6-94 7.5yr5/8 - s Osg ml - - .7 8 Depth limit�g © � fatter >88 (o I I I I I { I I Remarks: 5 I 0-8 1Oyr3 /I - sil 2msbk mfr cw 2f .5 .6 2 8 -20 10yr4 /4 - Sit 2msbk Mfr cw if .5 ? .6 Ground elev 3 20-54 7.5yr4/4 - sl l csbk mfi cw - .4 .5 104.60 ft 4 IL4 75yr5 /8 I - I s I 0% I m1 I - I - I 7 .8 Depth to limiting I I I I I I I I factor >94 �. i I5 2- q .ZI I I I Remarks: Ground elev FT Depth to I I I I I I I I I limiting factor I I I I I I I I I I I I I I I I I Remarks: [AViROMAENTAL �Y 0[5j�M 1432 120 STREET, NEW RICHMOND, WISCONSIN 715 -246 -2454 Tom Nelson Certified Soil Tester 227387 -- Registered Sanitarian SR00713 is N a 10a.70 �o�-s 42 laa Q3 �oS,So Li h E V , S C V Sy `C LZ r 0 1 CD y `SCALE 1" Tom Nelson Pic P I P-e Cleo I'a o ✓bM 2 -"o P j 1'� Pic Pipe e1io g9.�� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /� Mailing Address %4 ST Al, S �' Property Address (Verification required from Planning Department for new construction) City/State ' GW ©A" Parcel Identification Number LEGAL DESCRIPTION Property Location " Y., , ,5F — Y., Sec. _ , T _N - R_L W, Town of Subdivision Z�UA--C 9�wT d'A & S C AJ A ze R ✓ AEX -- / L g Lot # Certified Survey Map # P Volume _. Page # i 7l Warranty Deed # i���9i . Volume . Page # Spec house ❑ yes )K no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 masterplumber, joumeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. L,2 2- CD 5� /'3 / &70 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 f - - .� VOL 1471 STATE BAR OF WISCONSIN FORM 2 — 1982 613951 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT N0. ST. CROIX CO., WI _ „_..... RECEIVED FOR RECORD Corinne K. Greenhalgh and Jill C. Greenhalgh 11 -I6-1999 12:34 PM WARRANTY DEED EXENPT D CERT COPY FEE: conveys and warrants to Charles R. Bail ey, Jr. and Arty N. COPY FEE: Bailey, husband and wife p NF� 12 PAGES: a THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, State of Wisconsin: l� 040- 1017 -40 PARCEL IDENTIFICATION NUMBER (See Attached) i This is not homestead property. )= (is not) Exceptiontowarranties: Existing highways, easements and rights of way of record. Dated this .� / h day of Noyemhv -r (� , A.D., 19 - (SEAL) ` �i � . o , F� �/�� �l�Jld Jy (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, County. authntticated this day of 19_ Personally came before me this 3— day of November 199, the above named n innt K reenhalgh and Jill C. Cr Penh a1gb TITLE: MEMBER STATE BAR OF WISCONSI G k (If not, Wis. W p authorized by §706.06, b1is. Stais.) w ONotaryFublic, be the person A who ex used the foregoing Attorney David 304 Trnust St-, Hilidson WT U cknowledge the sam .. , THIS INSTRUMENT WAS DRAFTED BY g. N� L��rist County, Wis. (Sig natures may be authenticated or acknowledged. Both are not My commission is permanent. (If not state expiration date: necessary.) Names of PCfYle5 vdning in any - apathy should by typed or pnmed below Ihrir sixnamres STATE PAR OF WISCONSIN wiawnsln Legal Bank Co.. Inc. WARRANTY DEED Form No. 2 — 1982 Milwalkee. Wis. w L f VOL 1471?kGf299 part o f NEV, of SEV4 of Section 4 -28 -19 described as follows: Commencing at E'Js comer of said Section 4 thence SI'04'48M on E line of said Section 4, 741.22 feet; thence N85 °30'00 "W 362.35 feet to place of beginning; thence S1 °04'48 "E 618.01 feet; thence N89 °56 274.44 feet; thence N4 °00'00 "W 13.18 feet; thence NW[y 104 -46 feet, on arc of curve, concave SWIy, long chord N26 °30'00'W 101.79 feet, thence NVAy 104.46 feet, on arc of 133 foot radius curve, concave NEly, long chord N26 °30'00 "w 101.79 feet; thence N4 °00 "W 268.0 feet; thence NEly 104.46 feet on arc of 133 feet radius curve, concave SEly, long chord, N18 °30'30 101.79 feet; thence NEly 96.08 feet on are of 303.13 radius curve concave NWIy, long chord N31 °55'12 "$ 95.68 feet; thence S85 °30'00'3✓ 291.55 feet to place of Beginning. St. Croix County, Wisconsin.