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040-1147-95-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 515189 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holders Name. City Village X Township Parcel Tax No: Weekes, Steven E. & Monica I Troy, Town of 040- 1147 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: �u ` j / 16 F % 66CV CfltAf 13.28.20.576 i TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark !7 . Dosing / Um\ Alt. BtvJ. is , aCly – fjn.4 r 6lc aYi lit Aeration Bldg. Sewer _k: /_/ 1) 6,17 IFII•V Holding t/ t Inlet S TANK SETBACK INFORMATION Ht Outlet /0.76 �S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / F- Dt Bottom _ Dosing L !4I avi Header /Man. Aeration /� Dist. Pipe Holding Bot. Sy tem l� r,�ti,� 7 I Final Gr e , 6 , PUMP /SIPHON INFORMATION �'1I /Ob Manufacturer Demand Sf Cover GPM — Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length I Dia. Dist. to Well SOIL ABSORPTION SYSTEM r s r74f • BED /TRENCH Width Length No. Of Trenc DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S 1- 16 / SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type f System: UNIT Model Number: �N® DISTRIBUTIONS S M 1tiotj 2 0 .5 firtk c_hu Header /Manifold IDistribution Hole x Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed Trench Center Bed Trench Edges Topsoil ❑ Yes [ No [] Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 5 / /0 Inspection #2: / Location: 342 No. Cove Road Hudson, WI 54016 (NW 1/4 SE 1/4 13 T28N R20W) NA Lot 14 Parcel No: 13.28.20.576 i Ok An f 04 rw4AJ 1.) Alt BM Description 2.) Bldg sewer length = (f i i / 1 c. V O! - amount of cover Plan revision Required? � Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. 'AID commerce.wii,gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 �O n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of cotnttterce �l / � �^ Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental forms for state -owned POWTS are Project Address (if different than fling address) unit is required prior to obtaining a sanitary permit. Note: Application o s J submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. Rr 1. Application Information - Please Print All Information Property Owner's Name Parcel # �f� F "��. NOV 122009 1 '16 - ly `�ao� Property Owner's Mailing Address Pro ert Location 5 f 7 Jt I;KViT uVUIVIY P Y / c /a/. pLANNING & ZONING OFFICE Govt. Lot 3 City, State Zip Code Phone Number y., %, Section S - (circle one , T R II. Type of Bui ding (check all that apply) Lot - or 2 Fsmity Dweftmg- Numberof BedrooTns Subdivision Namf Block # ❑ PubliclCommercial - Describe Use / ❑ City of ❑State Owned - Describe Use CSM Number ❑ Village of ® Town of 7e v Ill. Type of Permit: (Check only one box on line A. Complete line B if a plicable) A. ❑ New System p y ® Treatment/HaIding�ank Re Y B (explain) ❑ Replacement System placement Only Other Modification to Existing System ex lain ) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner q ` ,_3 1 �� � 3 IV ype of POWTS S stem /Com onent/Device: Check all that apply) Non - Pressurized In -Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersalfrreatment Area Information: I j t -h V 9 Design Flow (gpd) Design Soil Application Raw4pdso Dispersal Area Required (sf) Dispersal Area Proposed (st) System Elevation Vt. Tank Info Capacity in Total # of Manufacturer d Gallons Gallons Units - Rt V N New Tanks Existing Tanks aU rn y m wC7 a Septic or Holding Tank - - — Jc�3 T Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si ature MP /MPRS Number Business Phone Number 0 2 Plumb /s Address (Street, City, State, Zip Code) 111 Zy /� _ Syv VII County/Department Use Onl Approved $ ❑Disapproved Permit Fee Date Issued Issuing A t S atur . c � j ❑ Fes- Owner Given Reason for Denial Z -�� IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: I Septic tank, efflue fi and. d / maintained dispersal cell mus t all be as per m t com ete pl em and submit to the County only n pa pr not less th 8 t4 x I1 inches in size 2. All setback requirements mush a r>� i ? as per applicable code /ordinances. SBD -6398 (R. 01/07) Valid thru 01/09 2 � \ a / a 1 , CN oll 4 1 b i a � a C6� b ye a i c r '� ®� � 4 �, Q v 3 ji a ' z a th ` r 1 `� STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRE 3 xi Ife c� S G/ .v Syri G SUBDIVISION / CSM# L Siy! - �vt . ,� �� , �•�o LOT I / SECTION. 13 T aV' N -R 00 W, Town of �O . 2.5? - I fib 5'l c, ST. CROIX COUNTY, WIS NSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM y ^ Plc Sc.i 4/0 ':5z 0 - - -- f+t�US�r / g 1000 amt , 5'e tc T�'►.vK STN s4ydo 04c4•W14T�. AL-eroN��v A " C 'f 1607 Oku e /9 y„ p ✓C S0f 3S f td.vr L, c cif B.t X0.41 ���. i�•c�' , c/I I' SpurtH 1'.PJO�+P�r/ �i.�E INDICATE NORTH A W I Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 J BENCHMARK • �oN �� e4if 65A�� &tc L �t` V . /OU oo ALTERNATE BM: I SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: Liquid Capacity: /OUD 644 Setback from: Well / / ' House Other Pump: Manufacturer /l!A Modell AJA Size AIA- Float seperation NA Gallons /cycle: ^/A Alarm Location /V A SOIL ABSORPTION SYSTEM Width: Length y/ Number of trenches / Distance & Direction to nearest prop. line: - Setback from: well: / 7y House cq Other ELEQATIONS Building Sewer W,6 ST Inlet. ST outlet PC inlet AJA PC bottom .AJA Pump of f r/.4 Header /Manifold qg. �O' Bottom of system Existing Grade Z00, Final grade 100.6 DATE OF INSTALLATION: PLUMBER ON JOB: / _ .�i4� �,� NL LICENSE NUMBER: a INSPECTOR: 3/93:jt i LQQMs, E;art`r �f I Ajjry2 8. 1 PRIVATE SEWAGE SYSTEM county: ' Labor and Human Relations INSPECTION REPORT Safety and Buildings Division CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: Permit Holder's Name: ❑ City ❑ Village C7 Town of: State Plan ID No.: lev.: In. B E ev.: z rB Descripti spon: � Parcel Tax No.: , /, L , 6, C � )- ca, o's — 040-11 47-9 TANK INFORMATION ELEVATION DATA A9300335 J: P .�_5 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L��il� / ne i� Benchmark Dosi g Aeration Bldg. Sewer - too ?d "ing St/ t Inlets 7/ TANK SETBACK INFORMATION St/ 4tfoutl et a' TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic 50 ` , NA Dt Bottom sing NA Header. 7 Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ° P a 6 ' T 5-S 7 V 11 Model Number GPM TDH Lift Friction System Ft L oss Forcemain Length Dia. Dist. To wed SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r DIMEN I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHI Manufacturer_._ INFORMATION Type Of 04,,j n' / — 4.. C HAMBER— Model Nu System: - .0 -r r.Z 3 $,W o� 5 �� °. OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) �/ x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length �/ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over it " Depth Over (1 1' Depth Of xx Seeded / Sodded xx Mulched �ecKTrench Center 3 7 .� /Trench Edges �C� ' r Topsoil ❑Yes ❑ Yes E] No COMMENTS (Include code discrepancies, persons present, etc.) LOCATION: TROY 13.28.20.576 -I Plan revision required? ❑ Yes to 1 4;2 Use other side for additional information. SBD -6710 (R 05/91) Date Inspector's Signature Cert. No. .� SANITARY PERMIT APPLICATION 103 1LHR In accord with ILHR 83.05, Wis. Adm. Code CO UNTY STATE SANIj+RY PERMIT - Attach complete plans (to the county copy only) for the system, on paper not less than [ 8% x 11 inches in size. ❑ Chec"k / if reel io�Wious application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION I/ 3' /a, S / 3 T a?$, N, R o?o E (or)® PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 34/ Al. ?o CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER V. 5 4 /�dS 11. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE NEAREST ROAD gg E] Public � 1 or 2 Fam. Dwelling-# of bedrooms TAX NUMBER( 111. BUILDING USE: (If building type is public, check all that apply) _ ya 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. � 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 �K Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. A BSORPTION SYS TEM 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) ELEVATION /(10 �o o ? oo S a? ri I • V 9 � - 9 S � Feet /Ow. So' Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New is Gallons Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdina Tank Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber' Signature: No Stamps) MP /MPRSW No.: Business Phone Number: 4� s. '�.t� S 338 5" ?ts 3'x"4 - ?r-<b Plumber's Address (Street, City, State, Zip Code " - rte d5oAj 4✓ S V IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved tary Permit Fee (includes Groundwater a e ssue Issuing A nt S lure (No mps) Approved I D Owner Given Initial Surcharge Fee) Adverse D e mination �� U X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 11/88) 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 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. 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, 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 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% x 11 inches must be Submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with completa dimensions, location of holding tank(s), septic tank(s) or other ireatrrent tanks; bui'ding :,ewers; well:; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soii absorpt{or >ystems; replacement system ar�l;as, and the location of the building served; B) horizontal and vertical elevMion reference points; C) complete specifications for pumps and controls; dose volume; elevation d'ferences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section cf the soil absorption system if required by the county; E) soil test data on a 115 form; and F) a!i sizing information. GROUNDWATER SURCHARGE 1933 Wisconsin Act 410 included the creation of surcharges (fees) i�?r a r- urni --r O regulated practices which can effect groundwater. The monies coilocted through these Gurcharyes w( s -se for vo.o nitoring grou� �c�w,i2c <r, yrc�ur�d- water contamination investigations and establishment W standards. i SBD -6398 (R.11/88) x.047 32 508538 von PAGE IF TEk'S OFFICE IT. max Co., wr Pj'd for Record NOV 0 81993 so 8:30 n '_ _ A.M &VV.�Q November 6,1993 of D" To whom it may concern- We the undersigned, in order to receive the necessary permits for the construction of the proposed "S.Weekes residential garage and pool house," hereby agree that this structure will not be inhabited as a dwelling unit. The address of this b u i l d i n g s ite is 342 North Cove Road, Hudson, Wisconsin. The legal description of this property location is Lot 14, Government lot 3, Section 13, T28 North, R 20 West, Troy township, St.Croix county, Wisconsin. `i �aasa�ax x �� ��.�• yhA ivy f'�•. Steven E. Weekes, owner N O TA R y'• l o- � .A 1 r � UBLIC N • f Monica J. Weeke , Owner ��'� ��''��•''' e r ti s G Z � 0 RR G Es "l kA cl � a e � ^ Q IA cn % � tm y � oo N � co worA H "C . � Z g - < Z o cn e e �CL�Cr N AV t c� m cs� , CL V cn 0 .�. M tD CL g CX �^ y o c� ;1 It CO CIO ��StR Z b ypE� °� V s�a� of ;:, �E GO hp ,o 'l lj I e Z o '114 '1 0 4 k 0 D \ cc Co o IN Z e M y rte, e '^ o ^� BoR & pp INDUSTRY, � 0� DIVIS N Of y� , SEE C L GJ o Z y h � Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of S 'Labor and Human Relations Division of Safety & Buildings R , .0 „ ILHR 83.05, Wis. Adm. Code S�3 4:1,213 coup Attach com lete site Ian on paper not le T C,RO iJ� p p p p sOrb�n � 1A2 ��3nches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location a,4 istarWE6%geafft road. APPLICANT INFORMATION-PLEASE PR ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: CATION E, A e s GOVT. LOT 1/4 PC 1/4,S/3 T - 2 - & ' N,R 2-0 E (a) W PROPERTY OWNE C INt --A DDRESS L BLOCK # s r R 4Z M S (— CITY, TATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE � NEAREST ROA U 4Sa , u , � q f 6 ( ) Cw Opt b k% New Construction Use Residential / Number of bedrooms [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate �1, `� bed, gpd/ft 0.6 trench, gpo1ft Absorption area required bed, ft trench, ft Maximum design loading rate .7 bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) to WdW 94 .4,4j& 9 7.50 ft' (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S - Suitable for system C MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U- Unsuitable fors stem IN S U as ❑ U i29 S ❑ U S❑ U 4S ❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bcunc Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench O- s K L r I C 0.4 0- Ground elev. 100,6Lft• Depth to limiting fac tor i Remarks: Boring # ^ 2 3 7.S 3 Z C Z 0A ,5 Ground 3 S r ' 7 O 10 ft Depth to limiting > ` fact or � Remarks: CST Name: Pleas ri t �y d J4 ` N Phone: Address: Uok C t 1 ( JQud >) Signature: Date: 16 1 �� CST Number:�� �� PROPSMQWNER ST&VlC WC/i'tLS SOIL DESCRIPTION REPORT Page Z of 5 PARDEL.I:D. # S 9 3 4 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Barxiary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch 31 — L n, c_r !ti►I 'C Z DA 07 Ground 6z 16 4/3 5) a r. n, I 0 .? 0,F elev. 140A ft Depth to limiting factor lb r' S r ' A. I S 0. > i7 1 l' l y RS !N $ iZA%�J Remarks: LAYS * c - 7r Jr. A kA 6*XY %u ref 3 Boring # __.. i - 4 16Y 3 Z3 c 0.4 .5 Gro /O 9 ft Depth to limiting factor � 10,d6 Remarks: Boring # C 0A 4 .S Ground O M >� l �S elev. ft Depth to lim iting Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: SBD- 8330(R.05/92) S 9 3 41213 ov-3 n a v Q - t °` � Lij } - Q � � Sc►4 LE 1 " 2 �� . � J m M A M M ) n i Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor Human Relations Division of Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code COL I complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ZT C i.x not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: CATION j E: E: y (f-'S GOVT. LOT 1/4 (p' 1/4,03 T - ,N,R 2-6 E (or) W PROPERTY OWNER':S MAILINC�ADDRESS LQ BLOCK # SU D. NAME R M # 'Z- Cnf IL us - &- 5 P 1 2z CITY, TATE + ZIP CODE / PHONE NUMBER [:]CITY [:]VILLAGE OWN NEAREST ROA New Construction Use Residential / Number of bedrooms [ J Addition to existing building L J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate Q • "� bed, gpd /ft O. trench, gpd/ft Absorption area required bed, ft trench, ft Maximum design loading rate ©•_7 bed, gpd$ trench, gpd/ft Recommended infiltration surface elevation(s) te i wdW 1 :MK b &jA, 975Q ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S - Suitable for system CQNVENTIONAL MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem 29 S ❑ U MS ❑ U EV S ❑ U k O U PO S❑ U ❑ S Qrt I SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Botaidaty Roots Bed Trench 13 5 L- /3 r C 'Z p.4 0 < Ground >$ 6 i! O.7 (7 elev. kll'iL ft Depth to limiting f�cror Remarks: Boring # 0 AL Ground / Z QVk4l 3 ``— `� r r : 7 1 0% 1® i..O - ft. Depth to limiting factor 7 9.5 Remarks: CST Name: —Pleas ri t ti I N Phone: en c, A ddress: L)t�' z-C) Signature: Date: /d Z 93 CST Number:.�4 PRpPEfiT1rOWNER `� �VtS SOIL DESCRIPTION REPORT Page 7 - of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouictaty Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 A b S j l�' Z 7.sye, � Z SL /1 Cr �r l.. - 0.4 ©.J Ground � Z7_ /6 1 1 4 41 3 5 0 rh I 0 77 0, - 6 elev. Depth to limiting r factor 1 4' r t r 0 - 17 �, y�RS i N $ • ly 1'2,d r.J Remarks: - LAAk's CSC = INr Aj4 o 3 Boring # _ 1d - Z.Z 7• C * Z (0.4 © S -F C 2 Ground • 12.0 X 43 S 0 r+, tY J b /O el Depth to limiting factor Remarks: Boring # El 4 r Ground � t - � /0'`l � 3 � S � i'►, �" 1 ' , � .7 ' Q�S elev. ft Depth to limiting Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) �d 14 r Cr aA z � J U � _ � J a i m D. � � D O-Fll ► I . M ' M I .. r- i sTC -100 This application form is to be completed in full and signed by the owner(s) of the property being developed Any inadequacies Will only result �m delays of the pormit issuance. ,Should this development be intended for resale by owner /cohtractor,(spec house), thenla second form should'be retained and completed when the property' is sold and submitted to this office with the appropriate deed recording. Owner of property Location of property--4�5o, /4 ,zr,. 1/4, Section 12 'T„&_N -R,2.Q_W Township i Mailing address _ , �%� ti <IvE Address of site Subdivision name Lot no. /S' Other homes on property? ✓ yes No Previous owner of property Total size of parcel _2 ma c, rF P Date parcel -was created ! 'Are all corners and lot lines identifiable? ]/_ YeS No Is this property 1)eing developed for (spec house)? Yes './ No Volume and. Page Number —Irl of Deeds. , as recorded with the Register ------------------------------------------------------------------------ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. ,In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description .references to a Certified Survey Map, the Certified Survey a shall also be required. y p PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register`of Deeds as Document No. .39.3, �6i and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document N o. . Signature of applicant Co- applicant c� Date of Signature Date of Signature S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER .I T��,C.✓ �v,,�n ��„���_ ADDRESS 7y� �/. �� FIRE NUMBER_ CITY /STATE PRO LOCATION : Gov. 1 1 4� or 3 1/4, SECTION Z.? , T_&_N -R TOWN OF Ti2v�, , St Croix County, SUBDIVISION r — C/'1 - JloL /�6.'/°1O,S , LOT NUMBER 2-,m Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1). the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and SCUM. I /Ile, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration da e. SIGNED DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 `• DOCUMENT N o. STATE BAR OF WISCONSIN FORM 1 -1982 if THIS ..AC[ R[D[RV[D FOR R[CORDINO DATA WARRANTY DEED _ - - - -- 93 This Deed, made between ....RQt?.� .t..> ............................_..................................................... ............................... 11 x cc: ................................................................. ..............................� G � Grantor, >czr�� :!I',_ . 30th • +i��:'d. '... : ............ ............... ........................................ ............................... and ........ Ste-vea..E....Weekea.. and. - Monica __.I.....Weekes........... ! d of Ma y .A 1984 ............. husband -- and- wife_,_._as_. j .oint..tenants. .............. . i -- • - -• -• ...... - - -- -• - -- I� Qt�45 P �1. ............................................ .................. - -. ............................. ., Grantee, Witnesseth That the said Grantor, for a valuable consideration__... .............................................. ...... ................................ ............ RN TO i } conveys to Grantee the following described real estate in ...... $t_...CrOix. - -. I County, State of Wisconsin: fj Lot Fourteen (14) of the Certified Survey Map filed September 7, 1982, in Volume 5 of Tax Parcel No: . _ ........ _ ............ - ....... Certified Survey Maps on Page 1205, being a part of Government Lot Three (3) in Section Thirteen (13), Township Twenty -eight (28) North, Range Twenty (20) West. i` f This _.. S..Tlpt•........... homestead property. (is) (is not) Together with all and singular the hereditament& and appurtenances thereunto belonging; And..................................... ........................... .................... .... ............................... warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. I Dated this -Ntll . ....... day of .............. Ma 19 84 I � � QQ ......---•----•---•--•----•-••---• .... ................ ............... (SEAL) .... "t% .l. ..:�1 '� ._ ...... (SEAL) f Robert SeegrSr Ahrens, Jr. .............................................................. .................................... ................ •- -• - -•• ............................. .......(SEAL) ................ -- •- ---- - -• -•-- --......-- ---•...... --....(SEAL) I s s I AUTHENTICATION ACKNOWLEDGMENT , Signature(s) - -.of Robei t _Seeger Ahrens,Jr -STATE OF WISCONSIN a& • 30 authenticated this ..... ___da Y of. ------ . Ma County. -_- 19. Personally came before me this ........... ._day of .._.X ---------------- 19_.- ---._ the abo a named G. E. Norman --•--•---•-----•---•--•----- -------------------- - - -• -- -- •- •- • - - - -- ........... - -- . • -- •--- •- - -• - -- .. - - - - -- •. •• -- - - -- -- -- •-- -• - - -• - TITLE: MEMBER STATE BAR OF WISCONSIN (•If- riot ;--- _-- ---------- - - _- -- - - -- anhltsttzet� by ,� X06.98; iR1s �tatsr) to me known to be the person ------------ who executed the foregoing instrument e.nd acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ROAR DRILL & SKOW S . C. ............................................... ............................... . - -- ••_-•_•••,-•-••-- New Richmond, Wisconsin 54017 .. ....... ..... •-----•--••---•-----••-•-----......- • . ............................. 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 type,) or printed below their signatures. WARRANTY DEED STATE. BAR OF WISCONSIN Wiseomin L 1 Blank Co. Ina FORM Mo. 1 — 1982 Milwaukee. Wis. M� X t 1 , R i K t •b. ' M l�� t .1 '1 or qf �. i r _ L C-) to O 0 to O C v n - O y O v F C d O r m 3 (n (D y 3 3 3 m - - _ M 0 � S z 0 j z� 0 -4 o @ ii7 (fl O n 3 CD t✓ CD N CY l co J N O ' ?? �;� (D (D Oz CD N (\ N W O p N O %E . N O O A O O C: < n < p O 0 O p _ (D Cl. O ( D O ch (yn m o (�a, m o v CD d m go rt CD W a s (D oa a co y O N O N V ICJ N N Cil 0 0 t W OD A -�, N N O V N (D (o Z z o z 0 r cn CD co W o° 0 o o c o C-) O O O o O O O N r O N '7 O m n 3 cn i vi o m '0 0 0 X ° a 0 0= o � � w -y a Ul c A ' ? ID CD o N N N o N ? O A p 0 O z� Z Z co Z O D m o °' D a r O n Q Q -0 Q • O N O i (D d C C m (D (DD CD (o a n (D — 3 � 3 ° c D 1 a n J W( Wm SOD a z 0 3 3 a 0 ° ' cn N 3 3 ��m� N z N _ CD D a (D C Q(D ( CD a cnv�g�� 3 o - CD O j CD .< O — �. ID O' — O CL �o nU,�' n� — v � �a� - n v c a x T N 7 (n N(D (D NO — Z N w -.3 Z a ° n� ti° v z n �m n o m anCD c v a D a= o �0 (a v p n CO (D u N =r O 0 p fD pj C) c CD _ (D WN �— N OO < NN I R (p o p r+' o p p S 31 I Vl (D :I- m y oc N `:� (O O1 (D O O O O (D O .< (D CL N (n O O N N OO C O' COO N p O N N 0 (.n N O p (D p ? 7 3 d N d ' x- a c (D ¢ a ) �. N o r C v CD (h (D n C O � a o o > > w m CD o 0 0 0 o p I .� 0 to O 3 v 0 C O d C O n — 1 0 cu OD •• v 3 O C7 O ( < N O Z Cl z ✓: (n CD 0D R (D — I N uo 0 0 O 4) N j (.n I 0 (D O C) < '� SU CD C) 3 N O r m _ a D N a o � � N Z O W W Z A A O N O C •v - 0 CD O O O X * * * o < z -� -� ry� D ` � z �cr CD O D C O ul CD (D 0 N O , 4 � A Z !� A A A p Z (D Z V O O O i, "'"* D a l n O N N N N d w � (n h O O O• Ln 0 cn 0 C == O N In d C O m CL (D (' Z n (P C 7 A z 0 a WA �cc i G s Z o p fn N 3 m !A z (D A W � y C 0 O gip 2 n O N co N T C 7 cr N C (n (D N ? Z G ID O � A W N 4 En a ey O (D N �_ O (D C (O O — I .T N p p 0 CD (D 3 M ? c O cn J CD (D ° o N "a O w (D ti �^ o O ti (v v I Form - STC - 104 AS BUILT SANITARY SYSTEM REPO 1 8i OWNER TOWNSHIP v '� C T N -R�W ' y �c �< ADDRESS f2 _ ^ /1ia, (;� ✓C ST. CROIX COUNTY, CO�'�F . SUBDIVISION . LOT ouT /,, LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM (/vary: R7oPodEO / Noit Pn*,*,mry I-x E 1 WELL JO' Tb l C�vE/l yoo Fn or+► 'rySTEm) .0VbAT1a Or RESrOJFJVC � RES2�rNGE Gi9RAGE 90 To AADPO4ED IAIELL /UO t To �no, oi,E0 W1EU- Sy • 3�. I vrM'STACX. l / yy�YT /'nor�aTY Lz•�� ' l vv,Glt loo hROm SYSTLm) �� i 3' ! y 7' � vo To ,EAST 1 L.re+E Q� � , JVL4 PRO PttZ ?Y Ls�vB S r✓ PlbPER Y COANEa INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used , now azor ON .fvwrrt,+L °T .4 Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: J ,�eE/Z Liquid Capacity: �� (� QA)- Number of rings used: -3 Tank manhole cover elevation: Tank Inlet Elevation: ZZ S Tank Outlet Elevation: 9 /•.�l Number of feet from nearest Road: Front, Side Rear, O + feet From nearest property line Front 10 Side .0 Rear, (a SD feet J � Number of feet from: well 70 Q� , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE e A PUMP CHAMBER ' Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: • Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: I &S Trench • p Width: � 9 Lenjth: / Number of Lines: Area Built: d9� �i Fill depth to top of pipe: U Number of feet from nearest property line: Fron O Side, ® Rear, O P't.� Number of feet from well: 1,90 11- Number of feet from building: (Include distances on plot plan). ,DISTitSl3u�20n� /�ipE /�irv� / ��!'ircH �ctiF.att� Pita.+, J%19Ao9& 7o E/VD ox Lzvzx SEEPAGE PIT r F-D floor ZLEv. 99. 0 ' Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: ` Inspector: Dated: 0 0, 0 Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 03707 • ' ❑CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: (If assigned) ❑ Holding Tank ❑ In- Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: I ADDRESS OF PERMIT HOLDER: INSPECTION Steve Weekes RR #3, N. Cove Rd., Hudson, WI 54016 - I I -d'iy BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN REF. PT. ELEV.: CST REF. PT. ELEV. NW SE Section 13 T28N —R20W, Town of Troy,Lot14 of Govt.Lot 3 Name of Plumber: MP /MPRSW No County Sanitary Permit Number: Gary Zappa 3300 1 St. Croix 58905 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER �� PROVIDED: PROVIDED: /,: 71 DD OYES ONO ❑YES ONO BEDDING: VENT DIA.: VENT MATL.. HIGH WATER NUMBER Of ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET FROM LINE �j � AIR INLET YES ONO 'I ❑YES ONO NEAREST /C/� /O �"B / DOSING CHAMBER: MANUFACTURER . 7E ING. LIQUID CAPACITY PUMP MODEL PUMP /SIPHON MANUFACT URER. WARNING LABEL LOCKING COVER PROVIDED: POVIDED: ES ❑NO DYES ❑NO DYES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL. BUILDING: V (DIFFERENCE BETWEEN FEET' FROM LINE AIR INLET. PUMP ON AND OFF) 1:1 YES ONO 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 FORGE the soil is dry enough to continue.) MAIN' CONVENTIONAL SYSTEM: , n: � yy,,,,ii WIDTH: LE NGTr NO .OF DISTR. PIPE SPACING. COVER INSIUE DIA.. ?i PITS. LIQUID r+G �� TRENC S I if UA.U RIAL: PIT DEPTH: GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: ISTR NU MBE R OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES . ABOVE Cy�VER ELEV. INLET ELEV. END- FEET FROM LINE: , /(/ f� Q 0 .! AIR INLET: fJ /L 1 NEAREST- MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- OYES ONO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER I TEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES ONO DYES ONO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED. SEEDED. MULCHED. CENTER. EDGES. ❑YES ONO I DYES El NO OYES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO.OF LATERAL $PACING: GRAVEL DEPTH BELOW PIPE. FILL DEPTH ABOVE COVER. TRENCHES: ,I MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: •ELEV. ELEV. DIA.. ELEV.: PIPES: DIA.: y01 HOLE SIZE HOLE SPACING: DRILLED CORRECTLY. COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED •??� PLANS: DYES ONO DYES — ]NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NiJUMBRF L NE ERTV WELL: BUILDING: FEET DYES ❑NO ❑YES ❑NO NEA�tEST Sketch System on Retain in county file for audit. Reverse Side.. 7 TITLE: DILHR SBD 6710 (R. 01/82) 77U7FI7 _71 i wmcons,n APPLICATION FOR SANITARY PERMIT S / ` D ILHR (PLB 67) B OUNTY oePawrmenrov UNIFORM SANITARY PERMIT # 11'l�USTRV, LFiHOR 6 HUmfii"1 RELf1r70n5 r /al /��� — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /2x 11 inches in size. — See reverse side for instructions for completing this application. PLEASE PRINT PR OPERTY S-fFVE WNKJE��S ADDRESS PROPERTY LOCATION III ✓ ✓�/ y NA), /4 5 �/4, S / 3 , T�N, R Z �EC40r) W TOWN F: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, L STATE PLAN I.D. NUMBER / 0 Gov' -I. Lo esH Irv/ S i 20 s 4/61 TYPE OF BUILDING OR USE SERVED y�. 1 or 2 Family Number of Bedrooms: Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair iJ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank J System -In -Fill ❑ In- Ground Pressure ❑ ,Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 1b x Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: / QA-)CA IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSE (Square Feet): /3 0-2-0 /0 JC I L ( D � Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP/MPRSW No.: Phone Number: 3oa J/ 394 9SO Plumber' Address: V F Name of Designer: . s COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved a �Q ❑ Owner Given Initial ,kL,A_'U / l�� /� a I(Approved Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber J i INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PL8 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system typq, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; l 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67 -T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tanks) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. L APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property 5r--Vie�IU GyE S + &OIVIc A / —� KE S Location of Property ;4 S 0 'k, Section ' T 2 N - R 2 W Township 796 Y Mailing Address I` t ? j �p� ?� � p v e 5' yo / b Subdivision Name �jp�Mp`}le ��E�(>! t lge,•r ADDITi Lot Number / Previous Owner of Property &0 r �� re S Total Size of Parcel etc V'& Date Parcel was Created Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number IZ 6!> as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed 2. Land Contract 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. -------------------------------------------- PROPFRTy OWNER CERTIFICATION I (We) eenti y that aU statements on this s bosun are tAue to the best o6 my ( our ) knowledge; that 1 (we) am (are) the owne,t ( s ) o b the pro pen ty des eh.i.bed i .tw inbotLma ion bonm, by viAtue ob a wa4Aanzy deed neeonded in the Obbiee ob the County Regis.ten o Deeds as Document No. 3 7 9 5 Y , ; and that I (we) pnesevtty own the proposed site bon the sewage pos system (on I (we) have obtained an easement, to nun with the above dea eh ibed pnopWy, bon the constnucti.on ob said system, and the same has been duty neeonded in the Obb.iee ob the County Register ob Deeds, as Document No. 3 7 VVV- r Y l/ SIGNATURE OF OWNER SIG TU OF 6-OWNER (IF APPLICABLE) � 0 - all al , DATE SIGNED DATE SIGNED THIS SPACE DOCUMENT No. STATE BAR OF WISCONSIN FORM 1- 1982 !I � RESERVED FOR RECORDING DATA WARRANTY DEED '39366 vO [) A�r This Deed made between --- S _ g. _.__, - ee er _ _ ____ _______ __ ____ ____ ___ ______ __ _____ __________ _______________________________ ______ ___________________ - - - ---- -- - - - - -- - - - - -- Grantor, 0th - and -------- StPaven__ Weekes._ -and _ Monica- _.L•__- W_eekes........... May 84 husband- _ and._ Sri .fe- >--- a.a-- J- aint._tenants- ................. CE 1.:45...P ----------------------------------------- - - - - -- ------- - - - - -- ---------------- ----------- • ------- - - - - -- - - - - -- r ----- •----------------- - - - - -- ............... , Grantee, - Witnesseth, That the said Grantor, for a valuable consideration_.__._ --------------------- __ ----------------- _------------------------------------- _.................................. )RE URN TO conveys to Grantee the following described real estate in ....... $.t..---Cr01X ..... County, State of Wisconsin: Lot Fourteen (14) of the Certified Survey Map filed September 7, 1982, in Volume 5 of Tax Parcel No ----------------------------------- Certified Survey Maps on Page 1205, being a part of Government Lot Three (3) in Section Thirteen (13), Township Twenty -eight (28) North, Range Twenty (20) West. This --- is --- 1101........... homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And ---- -- ----------- -- - • - - -•- -• - - -- -------•--•-----•------------ •- •----------------- - - -• -- -------•----------••--------•------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this ------------- N - - - -- - •------ - - -• -- day of ....... .. My - Ma � 1 9 ..... - -' - -•• (SEAL) • • - - -- - - --- rrAhrens, . ....... '.(SEAL) s Robert Seeg Jr. ------ -- - - - - -- -- •--- ••---- •- - - - -•.-- ••• - - - -- ••---- - - -• -- ---------------- _(SEAL) - - -• -- ........................................ ......... (SEAL) ------------•---.-••- I 'i AUTHENTICATION ACKNOWLEDGMENT j ! Signature (s) ... 9 - f . Robert Seeger Ahrens , Jr .STATE OF WISCONSIN -- --------------- - - - - -- -- - ss. ---------------------------------------------- ---------- - - - - -- ----- ------------ .................... _County. authenticated this 30 --- day of ------- )X ........... 19.84 Personally came before me this ________________day of , 19 ........ the above named -,. -- - - - :: - - -- -- - - - -- - - -- - - -- G. E. Norman ---------- -_ - - -- - ------------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN ...................................•...••...... _....___...._._.___..__..._____ (I1`tlot - -_ _ - - anthexYZed- by- ¢706.96; -Wie:'66llt . to me known to be the person ------------ who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ................................. --------------------------------------------- ..... RILL •. &- SK :-- -S.. -- C ................ .................. ... ... ........................ .............................. New Richmond Wisconsin 54017 Notary Public ... . ...................................... County, Wis. - -- ------------------------•---------------•----- --- ---------- --._......_.. ... (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) d ate: - - - - - -, 1 9 . ........ *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leval Blank Co. Inc - FORM No. 1 —1982 Milwaukee, Wis. H G H y ST C- 105 r " 9 SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d 9 OWNER /BUYER f f V FA (t) 7E S ROUTE /BOX NUMBER j<K ?j /f� (fpUr /_ Fire Number CITY /STATE Aub -sou CA 1511 ZIP S S(v I (� PROPERTY LOCATION: 14, 54f '4, Section T 2,3 N, R 20 W, Town of St. Croix County, Subdivision /fly /GN7s Lot numbe Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pu What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with t-he requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. '• 0 0 I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the standards set forth, herein, as set by the Wisconsin Depart - u ment of Natural Resources. Certification form must be completed and returned to.the St. Croix County 'Zoning Office within 30 days of the three year expiration date. SIGNED f DATE St. Croix County Zoning Office P.O. Box 98•. Hammond, WI 54015 715- 796 -2239 or 715- 425 -8363 Sign, date and return to above address. G N r m = 7 a CD =•t� m � w �� � ^'3 O v c N w N (D f�� A N D ° a �sw Q c O�� N 7 . o ? �m v a° ° ° O A y . o m C N (D `" m apo o ^CD a a 3 ohm° �D'c °awl' r =mow.. ��.° 0 3 a O '• (p W MME �> > °og N O O K L C N 30 O ! i ( O a� O -., 0 > Q Q � O o R _ o O O O C= 1 N a 0 Q An CL w � 0 o :aQO y C 0 C p Z N sw '^ m CD m�' °� ?cD s aCD 0 3 �N� �, a cD � o �� o m war: =r 0oow CA V CD v; w n CL r- (D C m e j C O a N N? C4 0 Oro N•o �_�(o b i N O C CD C (p = N W w = m o o 'a0* Nc°awo fll 7 N (D - & (D N ao (D CL f ,'emu; (D0 O f0 ' C N -� N O 7 S (D a 1 1 C V\ w} a cow m ?w =-o 00 i �4 C a S C (D = ° O 'O CL CD w CD to �:.: i DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS INDUSTRY, cc DIVISION BOX LAErOR AND- HUMAN RE ATIONS PERCOLATION TESTS (11J) MADISON W 53707 (H63.090) & Chapter 145.045) Cf tjp-e. S PG•• 12 O S LOCATION: SECTION: TOWNSHIP/ : LOT NO.: BLK. NO. SUBDIVISION NAME: Nw 1 / 1 / /3 / WN /R (or) W J--,P I ly Goo ' /of 3 COUNTY: OWNER'S t"'T C-R=S NAME: MAILING ADDRESS: Y/ s Ea,� GvEE,�s R�•3 G'oUz, l'd . f�v��'ass✓ wis. USE DATES OBSERVATIONS MADE NO. BEDRMS.: ICOMMERCIAL DESCRIPTION: PROcILE DESCRIPTIONS: IFERCOLATION TESTS: Residence CrNew ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM:( ptional) S EA ©S ❑� $ ❑� ❑ $ ©� ❑ S ©U �'ov UF.v Ps o J70. ft. If Percolation Tests are NOT required DESIGN RATE: 265 J IV r If any portion of the tested area is in the under s.H63.09(5)(b), indicate: /��Q,prl Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER - INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BE IF OBSERVED (SEE ABBRV. ON BACK.) B- L 56 iao •a B -3 I /0Z /00- 2te /oz cs•T• 5S-5ST B Y /bP 100. > 10,6 AIo �/ iov s ,PPW ra�UG,✓ B- 7 91- S&Jf1►w E 1,5 /�P�C S PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLIN INTERVAL -MIN. PERIOD I PERIOD 2 PERIOD PER INCH P _ / ' y S P- C P- 1 00-r)- L P -_ P d < . + P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION p F1`. E t t k I T ' E i } E i F 1 E E I 7 3 E I t x t 3 . I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: HOME I E SEPTIC P LUMBING CO. CERTIFICATION NUMBER: PHONE NUMBER (optional): RT. 3O'NEIL RD., HUDSON, WIS. 54016 S 5 p1��.2.�- 3 ��p CST SIGNATURE: WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO. 00663 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — 1 INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2_ The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacernent system; 5, Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be use(] J desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11, Sign the form and place your current address and your certification number; 12, Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st Stone (over 10 ") BR - Bedrock cob - Cobble (3 - 10 ") SS - Sandstone gr - Gravel (under 3 ") LS - Limestone c s - Sand HGVV - High Groundwater cs - Coarse Satin Perc- Percolation Rate reed s - Medium Sand UV - Well fs - Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than " sl - Sandy Loam < - Less Thar? "l - Loan , Bn - Brown * sil - Silt Loam BI Black si - Silt Gy - Gray . cl- Clay Loam Y Yellow scl - Sandy Clay Loam R Red sicl- Silty Gay Loam mot -- Mottles sc - Sandy Clay w! - with sic - Silty Clay fff - few, fine, faint c - Giay cc - common, coarse pt - Peat nun -- Many, medium m - Muck d - distinct. p - prominent HWL - High level, Six general soil textures surface water for liquid waste disposal BM - Bench Mark VFRP - Vertical Reference Point ' I I TO THE OWNER: This soil test toport is the first step in securing a sanitary hermit_ The county or the Departrnent may request verification of this soil test it) the field prior if) Permit issrra ce, A comr)[ute, :;et of plans for the private sewage system and a permit applica' "')n muss he suhriditeri to Me <smi icipriale local at-ir hority in order to obtain a permit. The sanitary pekrrn,t nuw3. €use and pasted prior to Tho. of rsrry construction. r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, , DIVISION BOX HUMAIt RELATIONS PERCOLATION TESTS (11J) MADISON WI 53707 GOVERMMIDIT LOT 3 Job No. 82 -1370 LOCATION: SECTION: TOWNSHIP /MUNICIPALITY: OT N LK. NO.: SUBDIVISION NAME: NW �� �� 13 /T28 N/1120 FM W Troy 14 - Certified Survey Ma COUNTY: OWNER'S BUYER'S NAME: MAILIN ADDR S: St. Croix Robert S. Ahrens R.R. #3, Box 12, Hudson, Wi. 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DES R PTION: PERCOLATION tR esidence 3 ®N ❑Replace 3 F I 7/9/82 NIA RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURET YSTEM -IN -FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) D OU ®S ❑U Ox S ❑U ®U Conventional Bed If Percolation Tests are NOT required DESIGN RATE: S �f any portion of the lot is in the under s.H63.09(5) (b), indicate: 10 9/0, O Floodplain, indicate Floodplain elevation: N/A CLASS 2 PROFILE DESCRIPTIONS P . 81 DaA BORING1 TOTAL DEPTH TO GROU NDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER IDEPTH IN, ELEVATION OBSERVED EST. HIG HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 1 91 99.6 None > 91 28, Bl 1; 63, Bn Cs $ Gr. B - 2 96 100.0 None > 96 24, B1 1; 12 Bn 1; 60 Bn cs. B-3 102 100.1 None > 102 6, B1 sl; 7, Bn s1; 9, Bn is & Gr; 60, Bn Cs $ Gr B -4 108 100.5 None >108 2, B1 sl; 36, Bn s. B-5 94 99.8 None > 94 4, B1 sl; 8, Bn is & Gr; 52, Bn Cs and Gr. B 96 100.0 None > 96 6, B1 sl; 10, Bn Is; 50, Bn s $ Gr. B_7 92 99.7 None > 92 5, B1 1; 9, Bn 1; 12, Bn Is; 56 Bn Cs $ Gr. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PER IOD2 PER INCH P- P- NONI REQUIRED PER H63.09(5) b P- P- P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slop. SYSTEM ELEVATION 96.0 SCALE 1" = E ! .. 1„ P • IRCIN PI R SI ( F U NUA a ` ! F' i W _ G 4 3 LDP 2- ' �I 5 ' E 4 26167' _ T .__._ . _ _ __._..... P BF�.-PE 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures methods specified in the Wisconsin Admimistrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Walter J. Gregory 7/15/82 ADDRESS: 0�den Engineering Co., 123 Edst Elm Street CERTIFICATION NUMBER: IPHONE NUMBER optional): River Falls Wisconsin 54022 ?ASS -588 (715)425 -7631 I C MM A DISTRIBUTION: Original -Local Authority, 2nd page- Bureau of Plumbing, 3rd page - Property Owner, 4th page -Soil Tester, DILHR -SBD -6395 (N. 03/81) rn MY PL E3 (o 7 o • MOT anc3 CR055 y SECTION F IANS -14 -v- w O vo t i �� r a T ro y T ow,v�� . S �'GNED 1k A1Stc -?t- e Fresh Air Inlets And Observation Pipe V\ �- Approved Vent Cap ' o Minimum 12" Above Final Grade All Above Pipe 4" Cast Iron YZ '' — i o Final Grade Vent Pipe Marsh Hay Or Synthetic Covering Min. 2" Aggregate Over Pipe Distribution T 50% / Pipe T 61 Aggregate O Perforated Pipe Below Beneath Pipe o Coupling Terminating At A) F Bottom Of System /�'0 _ W K 00- r SkKk No. 26273 r+it�t err n CERTIFIED SURVEY MAP GOVERNMENT LOT 3 SECTION 13, T2814, R20V'1 LOCATED IN COVE�2 ;,:,• r.� W O •' WIN w V EFERENCED TO j F R ... THE PLAT OF BOMAR HEIGHTS n FIRST ADDITION. LAKC ST. CROIX / m Z f 1z w m is N,L1 1 Y ? mi m I—t NO �/"/ �. FILED Q �� , �" ' o w M�PN c ' S EP x 1982 r + l6 ° %@Mw N D«ai 1> Jb Cnk cmmer, 1z ' N N � _. - W O co ` N OD ' A O Sr 5 0 W > '-I » �' .�.� � o J? w ; w 74C ��' A : Z r Cm ,o 13 LUFFLINE ' 1+ o 0. CS co o , " ". :' O SAD 1+ i .. V1 C o �� O w c► - 1 57-02 0 1 x N Z , X0: ' 0 5J. 34'0 0.34' 51.00' (D • r� 02 m N 6 °58'22' ►E 0.... N g - - - - -- .. •� 0 an O EI uff Setback i so ? ° Line ; ro a ... W N / .* r r-; D—I m �! N o 0 n 0 0 o Z z -n ro 4 / tl*' z —I R ,,. APPROVED ., SEP 11982 -' `No �2 ; SOUTH = j A 1� p ' 1 ST. CROW COUNTY . 121:10' r; N4 COMPUB649VE PAWS PLANWHO AND ZOMHO CO MAUfM oo r fto ` �► yT `\ fi y� S �^,� . m eat 0 Ar `no r, w Z x ti Volume 5 Page 1205 . s