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002-1087-30-000
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'J Tg N -RJ�W, Town of ��l �.J u SEPTIC TANK - DOSE CHAMBER - HOLDING TANK INFORMATION Tank manufacturer /2Z, dive s Size ST/PC /" / 5a Setback from: House Well P/L Pump manufacturer s Model zf Alarm location /Y a ti. s e-- (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width - �?3 Length / /� Number of Trenches r Setback from: House Well PAL Vent to fresh air intake ELEVATIONS Description of benchmark n, 5 Elevation 11,5 Description of alternate benchmark Elevation Building Sewer 1 1 �2 . ST/HT Inlet ST Outlet PC Inlet PC Bottom & Header/Manifold 4/, 7� Top of ST/PC Manhole Cover Distribution Lines () /,#/,, 7, - () ( ) Bottom of System( l d t . /d () ( ) Final Grade () () ( ) 20 0 ) Date of installation 10/a9 Permit number 3S 14 4 State plan numbe Plumber's signature CJ - e,& L icense number - � 7 2 7 `�,�_ Date Inspector v `� Complete plot plan * NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW J V a o 3 o v Z n � 7 INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: .Safety and Buildings Division Count I 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)]. 353144 Permit Holder's Name: ❑ City []Village R) Town of: State Plan ID No.: Town of Baldwin a q 9 ( (o O CST BM Elev.. Insp. BM Elev.: BM Description: Parcel Tax No.: 0 002 - 1087 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( &`0 6 Benchmark 3 tS0 Dosi n 9 Al t. BM o� • © / 5fl . 3 a Aeration Bldg. Sewer Holding St/ Ht Inlet '39 TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto ROAD 04 _IAI@4 Air Intake Septic f�' �L ?Zi NA Dt Bottom Dosing f << �8 r A Header /Man. Aeration NA Dist. Pipe D( Z Holding Bot. System �•�� e1• tD PUMP/ SIPHON INFORMATION Final Grade 5 . Manufacturer Demand St cover Model Number A GPM TDH Lift �,�V Friction ;Lai System 2, TDH L oss I Head Forcemain Length 50 , Dia. 2 u Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width / Length S / No. r f renches PIT No. Of its Inside Dia. Li uid Depth DIMENSIONS DIMENSION O` SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACH G ufacturer: SETBACK CHAMBE INFORMATION TypeO i 't, f .✓ odelNumber: System: d T� 'rrC OR UNIT DISTRIBUTION SYSTEM �� _ C -, �Q Header/Manifold a Distribution ipe(s u x Hole Size x Hole Spring I Vent To Air Intake Length Dia- Z Length 3 V Dia. PY Spacing U 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 E] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 1 ° /a- 9 1 Inspection #2: Location: 243 " 6 County Road BB, Woodville, WI (NE1 /4, SW1 /4, Section 34 T29N - R16W) - 34.29.16.504A "OZ ? °° Plan revision required? ❑ Yes A No Use other side for additional information. 1 631 1� 0 �p SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: t .. �a _. e s t S ..em.e,.i w s 3 r $ t Y i m�em.=.., 3 I } e z . a e � e e 1 §$ s s ` k t ..$,,, _ R F r a s . F a i $ $ a t .. 1 g 1 t ¢ E $ Y .... $ Z d v E � t Safety and Buildings Division 14sconsin SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis $ti,d r . ` ,• Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syste �P pa emit less t ourtty than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this applic StateSnitary Permit Number Personal information you provide may be used for secondary purposes -- t ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. S T i✓:alX GUN t r State - , an I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL I KtillI 1 FIGS 2. 9 j (po Propetly Owner Name Property Locafi�o r riz Sr� / fi T N, R/ E (orxy Property Owner's Mailing Address Lo a Block Number n D Gic� City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned !ty Nearest Road Public 1 or 2 Family Dwelling -No. of bedrooms __2_ village own OF " ...tJ 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 3L4. 2—q , 1 .5o4 /� 1 [] Apartment / Condo 0 61 ` �� 7 `� r �'` 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: (Che ox on line A. Check box on line B, if applicable) A) 1. E] New 2 Replacement 3, ❑ Replacement of 4_ E] Reconnection of 5 E] Repair of an ------ System - _______System ______ - _Tank Only_ ______ _ __ _ ___ Existing System -------- ExistingSyrstem 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 gMound 30 ❑ Specify Type 41 []Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressu 42 [] Pit Privy 13 E] Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill C 1 C 1. VI. A BSORPTION SVWEM INFORMATION: 1. Gallons Per Day 12.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 " 7 .� � ��� . f Feet fe, i:� Feet cap acity VII TANK in Ca gallo s Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber X : 5Z I ! I•e •° re v t1 ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (N taamps) / PRSW No.: ;Business Phone Number: Plumber's Address (Street, City, State, Zip Code IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved nary Permit Fee (Includes Groundwater ate I ssued Issui Agent Signat a (No Stamps) roved A r- OD surcharge Fee) pp ❑Owner Given Initial 5 / — "1 Adverse Determination X. CONDITI r OF _APPROVAL / REASONS FOR DISAPPROVAL: r4 `DUB 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 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 and 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 be- installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for 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; ah 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. Safety and Buildings 2226 ROSE ST LA CROSSE WI 54603 -1905 TDD #: (608) 264 -8777 Visconsin www•commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 29, 1999 CUST ID No.267341 ATTN.• POWTSINSPEC -& �-, `'` �. WEGERER SOIL TESTING & DESIGN ZONING OFFIC > ` 421 N MAIN ST ST CROIX COLKTY SPIA PO BOX 74 1101 CARMI I!AEL RIVER FALLS WI 54022 HUDSON WI `16 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 09/29/2001 n ers Transact .g ED SITE: Site ID No.. . P. Site ID: 181378 Please refer to n ' on numbers, St. Croix County, Town of Baldwin above, in all correspondence with.the agency!. ' NE1 /4, SW1 /4, S34, T29N, R16W Facility: Robert & Mary Sell Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 492828 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The existing privy must be inspected for structural soundness, size and baffles where required, and must be brought into conformance with the requirements of ch. Comm 83, Wis. Adm. Code. If it does not conform a state approved tank must 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. Sincerely, DATE RECEIVED 09/20/1999 l E . FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM jswim@commerce.state.wi.us TITLE. Page of b MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE NE 1/4 OF THE SW 1/4 OF SECTION 3 4 , T 1q N, R 1 6 W, TOWN OF �{�Lpw lIy ST- e H2O lX COUNTY, WISCONSIN. INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION: PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT .PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR RECEIVED w OO"b I , w 1 S V Q Z� SEP 2 01999 SAFETY& BLDGS DIV, PREPARED BY WE XIV GEF:ZEF:Z SO I L TEST I P4 C-3 COQ go AND. �, ®...... ».....;�.�.+'� DES = Gh! S�F�� I CE ,�.•' ARTHUR L P.O. BOX 74 421 N. MAIN ST. W _ gib p R RIVER FALLS. YI 54022 ELLSWGFTH, wrs. 715'4Li-0 P.® , ConditlOna��y ��b► 8 I00' • of CONIM UI EjjE E Cj ct OEFAR�M p LDINGS S F SO � . 41U1S�QN PPP � c G G 4RESP DENSE JOB NO 4g —Z23 PLOT PLAN Page Z of 6 Scale 1"= ►v ?-c) L W o DoT Cow4prr-- OiZ o \ S`ZJR13 T S Pri2'rA 425' 3.3 I I I � 310 of z I,-„C�>�.— dew`(. 34 - - go pw1 of 7'c_&jtM 10 �D � B_2 • �1.10p 3 Sv G G LS \L'Q h1 ru IAC, I LO QNTJ J G Vn rc�j �Lz c0 ULR, Q7 wl r�tz�•hz to�E eov-I, P U n')v T FdTC 5 7tCc uw, c.ttQ use. - 44 0 0 m 0.0 NOTES -1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( 2 required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. - Septic tank to be �%3ou L bS 0 gallon capacity manufactured by 5. Bench Marks-_ SSE Pn3o 6. Divert surface water around system to prevent.ponding at the uphill side. Page 3 0f Approved Synthetic Covering rysTM c 3 3 Distribution Pipe Medium Sand ti — , Topsoil F Elev'. 1O 1 \ 3 E „ , All Z % Slope b ( Force Main Plowed - Trench of k"-2k" From Pump Layer Aggregate Undisturbed D Z ,o Ft. Soil E - ?-.I Ft. Cross Section Of A Mound System Using F o.'5 Ft. I Trench For The Absorption Area G 1•p Ft. A S Ft. H I- S Ft. 6 - )S Ft. I 1S Ft. Linear Loading Rate= 6 .OGPD /LN FT J Ft. Design Loading Rate= 0.3GPD /SQ FT K \3 Ft. L 101 Ft. A lterrtpr , F, ,r�� -any►, ��`i. W 3 I Ft. Force —13 K Mahn Distribution \\, Trench Of 2 - 2 2 Pipe Aggregate 1 Observation Permanent Pipes Markers (Anchor securely) Mound Using 1 Trench For Absorption Area r Page Of Perforated Pipe Detail 0 End View ) Perforated End Cap) ' PVC Pipe lY � ot`o `` as Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cap * ti PVC Force Main Distribution Pipe Last Hole Should Be Next To End Cap Distribution Pipe Layout P 3 � 4 S Ft. X Zb Inches Y 36 Inches Hole Diameter '/V Inch Lateral 1 Inches) Force Main " Z Inches # of holes /pipe 1 �- Invert Elevation of Laterals Ft. `ZjLt,l.7= L�E.U�f >c Z � Zh o$ G PwJ Place lst hole 1 g4 from tee with succeeding holes at intervals. Last hole to be next to the end cap. c omOlnatlon Sep ana PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE 5 OF 6 VEIJT CAP WEATHER PROOF JUWCTIOAJ 80X 4 VENT PIPC , APPROVED LOCKING 1.10' FROM DOOR, MAIJHOLE COVER kV •.ituoow OR FRESH u''AR►JIW4r. L.NSEL AIR INTAKE cot�Du�r I TLMI ►J y lNS1iCTcl PIPS PROVIDE I - - - -- I/JLE T AIRTIGHT SEAL I I I V _ I I APPROVED JOINT wIC.I. PIPE �AFFLCS A I I; I APPROVED JOI►J%- W /C.T. PIPE Tank Co I III �p 1 with ALARM shall comply Y �I II ILH' 13.15 and 33.20 o I I oN C I `` 2L CLEY. F PUMPS - -� OFF D CONCRETE Ll. �. Z1 , DLOCK APPRa+AD R15ER EXIT PERMITTED OIJLtJ IF TAW MANUFACTURCR HAS SUCH APPROVAL 1 3#' SEDOINE SEPTIC f SPECIFICATIOKJS DO $ E \�,� TANKC MAIJ FACT URCR: , = F'I�yw 1��Z� gT MUMBER OF DOSES: 3 . ZZ PER DAy TAWK SIZE: VOlM 1650 GALLOAIS DOSE VOLUME r ALARM MANUFACTURER: 2Lk�?' • .C) S' jS INCLUDIN(P OACKIFLOW: S GALLON: MODEL QUMDER: l Nw CAPACITIES: A= INCHES OK 3 0 GALLOIJS SWITCH TAPE: F� ZCOIZL( B = I W CHES''OR 3 G( LLOLJS PUMP MANUFACTURER: G V L.D S C r — _ IWCHES OR S GALLOWS MODEL NUMBER: 3 '11 4 D- MCHES OR S 3 GALLOWS SWITCH TYPE: C1Z( IJOTE: PUMP AND ALARM RE TO 5L MIMIMUM D15CKAROE RATE ZOO. OS GPM INSTALLED OM 5EPARATE CIRCUITS V EKTICAL DIFFEKENCE CETWEEIJ PUMP OFF AUD.DISTRIBUTION PIPE... q' b� FEET t MIIJ IMLIM METWORK SUPPLY PRESSURE 2 . 5 n FEET � FEET OF FORCE MAIN X � -- fXofr.FRICTIOLI FACTOR.. �' FEET .— TOTAL OtIMAMIC HEAD — 13.L�3 FEET DIAMETER Pump chamber ILITERAIAL DIMLWSIOW� OF TANK: LEKIGTH _ ;WIDTH - ;LIQUID DEPTH BOTTOM AREA - 231= - GAL /INCH AS PER MANUFACTURER -- �-I •O. - GAL /INCH Goulds Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specificall y designed ned for the stainless steel. grade turbine oil for for efficient heat transfer, • Capable of running lubrication and efficient strength, and durability. following uses: dry without damage to heat transfer. •Effluent systems ■Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor: manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■Bearings: Upper and lower R 115 V, 60 Hz, 1550 RP SPECIFICATIONS • EP05 Single phase: P M, , FEATURES heavy duty ball bearing Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plastic Semi -open design 3 /4" maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. CO. Canadian Standards Association �J1 • Total heads: up to 24 feet. with three prong grounding ■ EP05 Impeller: Thermo - o Discharge size: 1 NPT. plug. Optional 20 foot (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in " or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. " BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 ! I •Capable of running dry without damage to s 30' �f- 5GPM components. ( i Pump: EP05 s _. zsFr • Solids handling capability: a° z 25 I i /4" maximum. W • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. • Discharge size: l' /z" NPT. Z 5 • Mechanical seal Garb } rotary/ceramic -stati ary 15 EP BUNA -N elastomer 13 j • Temperature: 10 104 °F (40 °C) continuo i^ ' o EPO4 140 °F (60 °C) intermitten . 2 5 1 ; i i 0 00 10 20 30 40 50 GPM L , L 0 2 4 6 S 10 12 m /h CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 Wtsonsi"Departmentoftndustry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations g Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches 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 and distance to nearest road. ' �OZ. -• l O a7 - 3 O APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Wt ps �Lq S LLL GGW -60T NE7 1/4 St O 1 /4,S 34 T 1a) ,N,R 16 E (acc PROPERTY OWNER':S MAILING ADDRESS • LOT # BLOCK # I SUBD. NAME OR CSM If 1\ 1 1 9 eov Sr6 — CITY, STATE ZIP CODE PHONE NUMBER C]CITY C]VILLAGE ®TOWN NEAREST ROAD b� 1 o ubV1l.\_JZ ,Iit SgUlf (7tS) 4914 36A wtAj [� New Construction Use Residential / Number of bedrooms 3 [ J AdditiQn to existing building [ } Replacement [ J Public or commercial describe Code derived daily flow ykSo gpd Recommended design loading rate — bed, gpd$ ` 3 trench, gpd/ft Absorption area required 3'l S bed, ft 3 -) S trench, ft Maximum design loading rate 5 bed, gpd /ft b trench, gpd/ft Recommended infiltration surface elevation(s) 1 1 1) \ • 1 It (as referred to site plan benchmark) Additional design / site considerations 1" V3 VIw W 5 �c TR�C`1i - mo, j , 14 4 OF- S fP" F/ L_L_. Parent material CGLP�L Pr 4_ 'R `L . Flood plain elevation, if applicable t`1 A . ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT GRADE SYSTEM IN 11U. HOLDING TANK U= Unsuitable for stem 11 S aU RI S ❑ U 0 S ®.0 ❑ S Ea U D S 21U ❑ S T U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rEr>dt ��� o -$ 1 312 — L j �� rz si 1 � -`Fsbk vvt`�h � s 1� • 5 •6 Z 8 - 14 1o`ivL V 13 - sit 2- y,.i`F►- a,s ,5 .b 3 �y — $ 10 `I 2 31 �l C1 OV%l Ground � - I.S `-f R S1Q, elev. oal ft Depth to limiting factor AM Remarks: Boring # , Joy Tz- 3! z - sl 1 Z yn' t- aS l 5 • I z3 Z 8 -L3 Kv y /3 SO If5bIL wfI R. I 3 �3 30 l0`� 2 3! y C ; S y tZ S/ S C 1 0 `h ln'� - I.'� • Z Ground elev. 10 ft Depth to limiting factor Remarks: S T Name: - Please Print Phone: Arthur L. We erer 715 -4 -0165 Add ress: egerer Sol . Testing & Design Service -P.O.s Box: 74 River :Fa11s 54022 Sgnature: - �Z3 Date: CST Number. Ci 220254 PROPERTY OWNER SiCL\- SOIL DESCRIPTION REPORT Page ? of 3 PARCEL I.D.# OOZ l08 - Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots "y> " °'? Bed ITmnch ,6 � s ,6 ..: 3. O `n bk Z�sbVL vn a. s 5 . Ground 3 l3 3Z lU` 31 cl — �.Sy2 S�� C 1 O YV elev. Ol e . - I ft. Depth to limiting facto I i r Remarks: 5 " Boring # li •'i iS2L�:�Gi Ground r elev. ft. _ r Depth to limiting factor i : Remarks: Boring # Ground elev. ft. I Depth to limiting factor' I. I Remarks: Boring # r '1 w n , '} i Ground elev: it. Depth to limiting factor' Remarks: PLOT PLAN Page 3 of 3 SCALE 1"= ' � o JOT Cur1���T OrZ I 3�3 I 125 I 1 3l' ol, Z o aw l G . • �.�o0 9 3�z k Sv G G �T1�'P O O m �k.pS� LR�E zZ.oZSy (715 ) 42.5 —n A — CST Signature Date Signed Telephone No. CST # • - udli -lu- 1.7CU I uLVrmI OVIILUULII1U "�•"" „ 10 -8 -99 St Croix County Zoning Office ATTENTION' Kevin Gravau This letter is to serve as our intent to build a three - bedroom house_ We know the floor plan appears to look like four bedrooms, but we intend to use one groom exclusively for an office. Si e1 Bob and Se �Y 2439 County Rd BB WoodviUc, Wl 54028 l i Zd W8VT :0Z 666T L0 '1- 'ON 3NOHd WMJA i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer //Ve 16 c'• V 7' ,� a • y .� Mailing Address .2q3g Property Address a/2 Kr e (Vc"fffica(ioa requircd from Pkaniag Depatt;neat for new construction) Cttjatate Parcel Identification Humber 0 02 - D 8 — 30 - C9 D LEGAL DESCRIPTION C ; SOH) Property Location %, S'fi� V Sce. __�, T 9 N R !G W, Town of & Subdivision iC Lot # - Certified Survey Map # -- Volume . Page # Warranty Deed Volume Qy . Page # Spec house 0 yes no Lot limes identifiable ❑ yes ( no SYSTEM lm p w p erv= = 4 =ai&==ocofy=scpdcsy*m ooddtrsaItmitspc satac:hff etobaadlewastci.Propermainomamoe consists of pampiag out the tanY caaaffact.Zlx a of tibc CVMYthnx yC= orsooner. if acodcd &tH=sedp=4= Wftt ym pxtt.itrto the sysbcm s�ietanlc -ss_rt�aLmcat�mS��- sysbcai, .. - _ . P?oPcrtY oar agrees to sabmrt to St Crone T•caii g Dcpattmcat 3i ceWficado loan. signed by the genet nerd by a p 7 y aplwnbcr tesVidodplumberorafiecasedparnperve fyimgdut( I) Meonaitcw is is proper condition ansor (2) after mspcctioa and p= p n.Cif acccssaty), the scpti,ctanti is Icss $era W £all of "sludge. Vw. the =&=kwd hm read the abort tvq k=zts an d to to � tier pdvatc a disposal syst«a wilt �e standards suting su by of Oommuce and Dot of Nat�aal R.csout ors; Stale of Wboonsin OecOcxtiva your uP bas'bocamakUkcdmastbe complctodand reWamd to the St. Crob, County Zoning Office within 30 day%. thYOF date. i SI TURE DATE OWN ER. CN (we Ce'* that all stag cats on this form are trmc to the best of my (our) knowledge, I (we) am (arc) the owner(s) of the abo virtue of a wamaaty deed reoor+ cd in PxgisW of Deeds Officc. OF APP CANT DAT « « « « «« �, ino� oa that is mis . «ssss sod may =& in the sanitary permit being tevoked by the Zoning Dgmtment. " indude With this applieWon: a cumpod wa nmy deed fmm the Register of Doe& office a copy of the owylod twcy map if mfcreaoe is made in the warranty deed Stock No. 13001 t STATE ISAR OF WISCONSIN -FORM t a DOCUMENT NO. . A 4 - WARRANTY DEED ` VOL b5 to "t j J 5 THIS SPACE RESERVED FOR RECONDING DATA — P - r 'G 15 M.6I OFFICE THIS DEED, made between J ��n A °i and Ra�e?1 37• CROIX Co Weiss, t:ua;�' an' i A R - - - -_ -- _. ac'd for Rbaord this ' 4 th — day of Na ___ v___. A.D. 198 Grantor A 2 and _R e11, LI - _.t _ Sel : ,h nJ of 2:25 P a 11 i i Re � a � o i''t' t e„Z:., 7t __— —` _ - - -- Grantee, or of 0604 z Wi t n e s s e t h, That the said Grantor, for a valuable consideration r e tlr h" P .on^.3yra - __- } RETURN TO 1 conveys to Grantee the following described real estate in S`. Or'�i x County, State of Wisconsin: :' ^.e Souti, east quarter (SE 1jh) of he Sct,thwest - quarter (SW 1,14) of Section 3 - -` and pert of the PTortheast quarter (fir. 1/4) Tax Key No. _ of the Southwest Quarter (3k l /. %) of Section 34 -2n -1 , lytn�f South of Cou -ty 2,-ad B ALSC, that part of the ;T. theast quarter (':E 1 /��) :)_° tne Sout ^. *~rest quarter (SW 1j4) ly ing :Tort~ of County Road B3 EXC.�:r' the :Torte I- acre +.hereof; ALSO, all trat part of ± -_e iTor`.h Half ( :, 1/2") of the Southeas' quarter (SE 1/4) lying Tortherly of 'he Railroad 3i -h+ of Wait except t' e 'North 30 rods tt^ereof, all in 34 ? -lc. T . +Sr EH p,00 1J This _._homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And — 3T---_ tcT' — ._— .. - - - - -- - -- - -- warrants thai the true is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated ^° --_—. - - - -- � —. __.dayo . -- - 19 (SEAL) 0 (SEAL) J W (SEAL) (SEAL) i . a ,e.fl: .. ciss AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this_.___. ____ _day of STATE OF WISCONSIN 19 ± ss. 5t, Croix County. • da i Personally came before me, this �__ y of 'Y •_ C,Ct OI7 ° l am e the above named_ _ TITLE: MEMBER STATE BAR OF WISCONSIN Jo A. 1o,_, .s a ' 'i .in:,'E `i. , — — — -- -- (If not -- - -- — — r f'�'iSS authorized by 1 706.06, Wis, Stats.) This instrument was drafted by - ••••••r•.,,,� Robert G • Wa to me noh b�et a pe sot wlZei wted tlt',. goin t ment ack , w the s • e r� '• Attorney at La -- - ��: c , (Signatures may be authenticated or acknowledged. Both a. are not necessary.) Not'ry Public- — Cour�y, 1Y SJ; My Commi :sion ;s permanent. (If noP,,Z;jlt�•e!r� x date - - -- a •Nsmes of persons signing in any capacity must be typed or printed below their ^ignatures. w *ARAAYTY DEED- STATE BAR OF WISCONSIN, FOP.4 v0. Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety 8 Buildings in accord with ILHR 83.05, Wis,,Admr._ Code . r COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plah must include, T by , not limited to vertical and horizontal reference point (BM), direction and % of tslopal sc kd pr ARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION - �` D& DATE ! Q� PROPERTY OWNER: PROPERTY L w 1 1`'1' -y S �TL L s91r N1y�` t�4 5 T 1c) N R 16 E (aW PROPERTY ��WNER':�MAILING ADDRE�S� LOT # :BLOCK #- SW OR CSM # t a CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD wouZjv\L � S�[�� ( bey - 36 "k] tly is Qg [� New Construction Use ( Residential / Number of bedrooms 3 (J AdditiQn to existing building j J Replacement [ J Public or commercial describe Code derived daily flow qSC� gpd Recommended design loading rate — bed, gpd/ft 3 trench, gpd/ft Absorption area required 3"1 S bed, ft 3 - 1 S trench, ft Maximum design loading rate • 5 bed, gpd$ 6 trench, gpd/ft Recommended infiltration surface elevation(s) \ \_3 \ • N It (as referred to site plan benchmark) Additional design / site considerations Y`'bo ylw W/ S � S Cc 1JC`ti - tkA VL j , Zq OF- S" Fr LL_ _ Parent material GL PcCL r,-L. 'R " Flood plain elevation, if applicable 1`1 f� , It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem ❑ S au ®S [1U [IS ®.0 ❑ S FU ❑ S OU EIS O U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rw& �ti? •i ?i 1 a, S 1� • 5 ` 6 Z 8 -t� 1�`ttZ �l3 Z'Fs1�1� m'�►- a.s l�� • 5 \U �$ l0 `Z 2 3) Ground yr 1 -S -1 R sip, e 1 c) wI elev. qaa It Depth to limiting factor ktl" Remarks: � Boring # o Ion >Z 3 I Z - sl 1 Z'� sbk wt�t- aS 1 5 • L/ l3 s Z 'Fs bt M S- cc.. s 1 of 3 l3 30 Ml-i IZ 3 1 y -s Ground elev. \0 It Depth to limiting factor t3 M Remarks: S TName:— Please Print Arthur L. We erer Pine 715 =4 -0165 Add ress: egerer Soi -Testing & Design Service - P.O Box, 74 River. :Falls;, WI. 54022 S` nature: 1L �� ( Date: CST Number: . - W7.; � o1 =2Z 3, �-} - 1`�:q. 220254 { PROPERTY OWNER S'-U- SOIL DESCRIPTION REPORT Page Z•of 3° PARCEL I.D.# OOZ. 108`7 - Boring # Horizon Depth Dominant Color Mottles <; Texture Structure GPD /ft >�> in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Consistence Boundary Roots �:akY Bed Trench h :> \-t \L y 11 36Z wt f�� ar s - . 1, Ground 3 l3 3Z \0`t1Z_ 31 ct - r.S�t2 S�� C 1 0 vv elev. g •� ft. Depth to limiting factor v- s Remarks: Boring # . a;•ittt+c`�RY Ground ' elev. ft. Depth to limiting factor Remarks: Boring # i �4, Z j Ground ` elev. ft. Depth to limiting i factor' Remarks: Boring # Ground elev. ft. Depth to j limiting factor' Remarks: — PROPERTY OWNER S1 SOIL DESCRIPTION REPORT Page? of 3' PARCEL I.D.# OOZ 1081 - Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots �`` � � �'� `'lR- •3 L'L Bed ITrench Ground 3 l3 3Z \U`�12. 3/ cl - Z�S`12 S/?, C1 v►^ yn �� _ Np Z elev. q 9- - 1 ft. Depth to limiting factor V3" Remarks: A� S Boring # ' vti4 Ground elev. ' ft. Depth to limiting factor i Remarks: Boring # Ground i elev. ft. Depth to r limiting factor' i• t i Remarks: 3oring # ... i ,round _ aev: ft. )epth to miting adtor Remarks: 'n n• :•,nor „r ,. -- PLOT PLAN Page 3 of 3 SCALE 1 "= 4O ' O \ S�2i Tlii S �°r12.LrA � B.3 � I25' � at ` �> LoL.� of "Dj*1 )�6, '17 Z o • �1.L00 3 k 44 0 v m i ° 1 4 1 — Z'L•3 zzoZSy ctl'A n 1 1-)- I ( 715 ) 42 -n1 65 r CST Signature Date Signed Telephone No. CST # Wiswnon Department of Industry, P of 3 • Labor and Human Relations SOIL AND SITE EVALUATION REPORT age_ Derision of safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. (3 C)z — 10 88 - ' APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE ' PROPERTY OWNER: PROPERTY LOCATION 20 3 �lZ �Iym S 60V N►J 1/4 SL 1/4,S 3y T Z ,N,R t 6 E ( W PROPERTY OWNER•:S MAILING ADDRESS• LOT # I BLOCK # D. NAME OR CSM # Z q 3 cuj►J - M B.3 — —1 — CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE EgOWN NEAREST ROAD w0(%N)jL`� l.vt SgozZ ( 68 t�t,Dw i ra B [xJ New Construcction Use [nt] Residential / Number of bedrooms 3 (J AddibQn to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow yS0 gpd Recommended design loading rate — bed, gpd/ft2 _ trench, gpd/ft Absorption area required -_ bed, 11 trench, ft Maximum design loading rate bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) _ It (as referred to site plan benchmark) Additional design/ site considerations 1 ;�'-Zczy - IMF WMA Parent material _ G LAN Ctify�. `C1 LL Flood plain elevation, if applicable ty it It k U = Suitable for system CONVENTIONAL MOUND KGROUND PRESSURE AT -GRADE SYSTEM IN R HOLDING TANK = Unsuitable for stem ❑ S (IU ❑ S RI U E N U [I ®U ❑ S ®U EI S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rendx o — 1 3 1 Z. Sbh wi r = S 1 4 •S •� :__, ST 1 v►1 S 1U� • S •` I I c S 1 1 7� u 3 R S/� � 4 2 ! � S `� 1 � Ground H -� S m f c� ° -s tt 4 -�� .�.S`1R 31y �t� -S 1fzsit S> 6� o Sg r, _ '� •� Depth to L) v w s S limiting factor 14 r Remarks: Boring # VL 3 �y , v -LSHIZ 31 - 1 SLIQ S s cl \as �,�� L 7 . • 3 Ground A q 4.� ft T7F E� Depth to 6ml�rng �r� 19 factor - L� 4 ,� UN ••+ i 6� Remarks: T Name: — Please Print Phone : At-t: -hur L. We ever 7:15- 4'25 ,egerer Soji :Testing: & De.s.ign Service P 0, Box : 74 ;Rlvex Fa11,s,WI 54022. Date: ? j .[(� J 9 CST Number = PROPERTY OWNER Spa_, _ SOIL DESCRIPTION REPORT Page Z PARCEL (.D.# ©U Z — V3H - - 10 Boring# Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Consistence Botmdary Roots C, _F5 Bed Trend cg Ground 3 LZ —Z2 1n — 1 I1_ YI j — s f elev. \.'F 5 ��h l h1h a. S L . L 9 , O ft. Z 2 30 .5 f't 5 / 7 •S `d 2 ViS SCI L-.S Depth to limiting factor i Remarks: Boring # Ground elev. ft: Depth to limiting r factor i t Remarks: Boring # r •< t afi•; €S Ground elev. ft. Depth to limiting factor Remarks: Boring # k£ b' • ?Mn i i { 1 4 Ground i elev. ft. Depth to limiting factor Remarks:.__..._ PLOT PLAN Page 3 of 3 SCALE 1"= i i N � 6w►tM Z • � � ° � �� �'►� Loc.q'noN 0 M t V,MWI — fit, tOU.O' orv'2" W , 3)V' VA 44 -f03- Z S. (715 ) 425 -nj 6s CST Signature Date Signed Telephone No. CST # Parcel #: 002 - 1088 -70 -000 05/03/2005 03:30 PM • PAGE 1 OF 1 Alt. Parcel #: 34.29.16.509B 002 - TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` = Current Owner " SELL, ROBERT K & MARY K ROBERT K & MARY K SELL 2439 CTY RD BB WOODVILLE WI 54028 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 0231 BALDWIN - WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 21.000 Plat: N/A -NOT AVAILABLE SEC 34 T29N R1 6W S 21/40 NW SE & PARCEL Block/Condo Bldg: IN VOL 4111549 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 29N -16W NW SE Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill M Fair Market Value: Assessed with: 42713 25,000 Valuations: Last Changed: 06/28/2004 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANC G6 21.000 16,800 0 16,800 NO Totals for 2004: General Property 21.000 16,800 0 16,800 Woodland 0.000 0 0 Totals for 2003: General Property 21.000 16,800 0 16,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/1712001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address d AK Ve Property Address o CT (Verification required from Planning Department for new construction) City /State 4,jw- ><//�`%e Parcel Identification Number 3q. 24. 110 . SoLf A LEGAL DESCRIPTION Property Location y 4 ,< ,d2 i /4, Sec. If . T2 ? N -RL4�—W, Town of Subdivision . Lot # Certified Survey Map # , Volume Page # �- Warranty Deed # � 70 j?-j � , Volume 4'5 . Page # 7 Spec house ❑yes 0 n Lot lines identifiable El 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. 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. A CA:&SAA V / / -'-1 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. 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 Parcel #: 002 - 1087 -30 -000 12/27/2007 10:28 AM PAGE 1 OF 1 Alt. Parcel #: 34.29.16.504A 002 - TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - SELL, ROBERT K & MARY K ROBERT K & MARY K SELL 2439 CTY RD BB WOODVILLE WI 54028 Districts: SC = School SP = Special P perty Address(es); ` = Primary Type Dist # Description " 2439 CTY RD BB SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 15.000 Plat: N/A -NOT AVAILABLE SEC 34 T29N R1 6W NE SW EXC RR R/W & N 8 Block/Condo Bldg: RIDS & EXC PT LYING S OF CO HWY BB Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 29N -16W NE SW Notes: Parcel History: Date Doc # Vol /Page Type 2007 SUMMARY Bill M Fair Market Value: Assessed with: 230589 Use Value Assessment Changed: 04/16/2007 Last Chan Valuations: g Description Class Acres Land r' Improve Total State Reason RESIDENTIAL G1 3.000 29,200 I 231,700 j / 260,900 NO AGRICULTURAL G4 11.000 1,900 0 1,900 NO 00 UNDEVELOPED G5 1.000 100 100 NO Totals for 2007: General Property 15.000 31,200 231,700 262,900 Woodland 0.000 0 0 Totals for 2006: General Property 15.000 31,100 231,700 262,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount 010- GARBAGE SPECIAL ASSESSMENT 45.00 Special Assessments Special Charges Delinquent Charges Total 45.00 0.00 0.00 MAP OF LOCATED IN PART OF THE, SE 1 /4 OF THE SW'tA IN PART OF THE NE1 /4 OF 1 SW1 IN PART OF THE NW1 /4 OF THE SEt /4, IN P w OF N E7/ OF TIME SE1 � PART OF THE SE1 /4 OF THE SE1 /4, AND IN PART OF 71-* SW7 /4 or THE 8E1 /4, SECTION 34, T29N, RI OW, TOWN OF B�4LDWIN, ST. CROIX COUNW, WISCOIV N 114 CORNER SECTION 34 b .... p � - Oi NORTH 4 ACRES EXCLUDED — EAST- WESrT�L"E_ _ f 5 0 � ry x N$' °31 CLUDED FROM DESCRIP710N r N $ FENCE i .719 66 r ' ° EAST CORNER FENCE IS 2.B' - ---- -- - SOUTH LINE OF THE NORTH 4 ACRES EAST OF LOT CORNER. ' � QD A T NE OF THE NE 714 OF 14 OF SE ION FE 7 EAST OF L NORTH -SOUTH 114 NORTH LINE SE( TiON 34 ¢ (466:(466:00) : / 30 RODS R EXCLUDED FROM NE1 /4 - SW1 /4 USE DESC�PriON f ER Fk FENCE IS 2.7' « OR I FENCE is 8 a x SOUTH LINE OF THE NO" 30 F EAST OF LOT DORNER NTH OF LOr 110 10 FORMFg•.y y /`/�° .. Ngg /Cg qb � ✓ w � � q Z 4 r 9 41�� $ a PAPCEL B g r & 56,19 ACRES a a �. 2447,749 SO. FT NW1 14 - $E1 14 A E'M B'� L O "EO 1 r T m S"FQ Z FENCE IS 2.8 :* ° EAST OF LOT CORNER` �! g .... SOUTH LINE OF TH '� ggti�O,�9F.,.,� . �p� 6e _ E NE 1 4 OF THE SN/r4 0 NORTH LINE OF T HE SE1 SOUTH I DY /8 �O 4 OF tHE SW 1 i4 / l NE F THE Ni✓ OF �, THE 3E7/4 F AV Z P/�4CEL E O 2.29 ACRES w PARCEL A 99,U6S FT, PARCE a ,� 55.62 ACRES INC. 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AMH V998 BZ049 IM'31IIA000M 3NI'9NlGA8ns0NV1Hi80N •S(JUAio690Z. WnNVId O NIM03 - n3s i43866f ` aoAanans ds Wisconsin Depart Zt of lnausuy- SOIL AND SITE EVALUATION REPORT Page � of 3 Labor avid Human Relabo s DWW*ntf Safety & 8dkin in accord with ILHR 83.05, Wis. Adm. Code r COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST ' -0lx not limited to vertical and horizontal reference int direction and % of slope, PARCEL I.D. # po B (fib, pe, scale or -Z y Z '?, / G.3 'b9 6 dimensioned, north arrow, and location and distance to nearest road. b OZ. - I 0 88 -- 0 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE � 2 z �9 PROPERTY OWNER: PROPERTY LOCATION klr�� S E L L fieW.LOT t ► 1/4 Se 1 /4,S3y T Z ,N,R L6 ( W PROPERTY OWNER' :S MAILING ADDRESS • LOT # BLOCK # SUBD. NAME OR M # z Iq 3 g CwIjT ( B-8 — /4T CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE LWOWN NEAREST ROAD WvUDVILL.'' t...11 S� ozX, (BLS) �8�(_36 - 1 f'�L.�W1 C1�4 �3B [xj New Construction Use [k] Residential / Number of bedrooms 3 [ J Addition to existing building � ] Replacement [ J Public or commercial describe Code derived daily flow 'AS0 gpd Recommended design loading rate - bed, gpd/9 j bench, gpd/9 Absorption area required - bed, ft trench, ft Maximum design loading rate - bed, gpd/ft - trench, gpd1ft Recommended infiltration surface elevation(s) , - ft (as referred to site plan benchmark) Additional design/ site considerations - "ov>v0 Parent material GL1P C1P%A__ _n LL Flood plain elevation, if applicable ry fl ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem ❑ S W U CIS ®U CIS R U ❑ S RU ❑ S O U EIS ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Cois Roots GPFl�t in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed S 1 •5 IcmTZ a/L S,1 Z't Y., a,S 1v • Ground 3 14 __LL I ul 2 3�� l i•S `1R S tc) vn Sh - ht ak' • 7- ' elev. 9 It -�� .�s�a StiRSit Depth to limiting factor \4 Remarks: fy C, Boring # Z`F 5101 -r �, �S ��' • S ) \A 3 tiU 6v -L R 3! SL1Z S S et � aS�k le1 `� - f 1p� •3 Ground elev. \. .�► 9 it rlm� g - 2 4 1999 factor 4 L ` Remarks: T Name: - Please Print Phone: i ° Arthur L. W e ever 715 - 42 5 -61 - 5- y- egerer Soil ;Te.sting & Design Service -P.O Box, 74 River ..Fa11s,WI 54022 Sgnature: Date:. f 9 CST Number:. 220251, 1 PROPERTY OWNER SOIL DESCRIPTION REPORT Page ?of 3 PARCEL ED; # O 0 - L Boring # Horizon Depth Dominant Color Mottles Texture Structure GPDlft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots n; a• «� Bed Trer t ^.. :: \::ti %n S J +5 ��Z vy I 111 '(2�— C- S 1%j . S ♦ f Ground elev. 0 `3 f t. if 2 2 34 1. S ` 1 R S / -) •$ L12 5A 3 C) Ls 10 � C Depth to limiting i factor z Z ti i Remarks: Boring # i Ground i elev: � ft. Depth to limiting t factor _ Remarks: Boring # �'•: • k•riv:J: �; Vii. . h Ground ! elev. ft. - - - -- - ._�_ Depth to limiting i factor 1 Remarks: Boring # XX E Ground elev. ft. Depth to limiting factor Remarks: — -- - - -- -- - -- I PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of PARCEL W. 4 Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft i Qu. Sz. Cont. Color Texture Consistence Boundary n. Munsell Roots s >• Gr. Sz. Sh. Bed Trend 3 < ° f3 wy si Z +sbYz m-( c S I _ s .b Z 1 Ground 3 N2-Z 2 1 D`11Z- Y/ 3 _ �zoq v h1 F1 - 0..S `Z _ 3 elev. •° q �3 •e ft. Z 2 3a . S -f 4 fL Sl8 Depth to limiting factor Z Z .. ti Remarks: Boring # Ground dev. ft. ' Depth to limiting i factor ` Remarks: Boring # Ground elev. ft. Depth to . limiting i factor Remarks: Boring # Ground elev. f t. Depth to limiting factor Remarks: — - - - - - -- - -- — PLOT PLAN Page 3 of 3 SCALE 1 "= yQ ' / / N \ /7/ \ j 6 \ \ -4'/ - W O Nor adr-1ipfiGT oF- ��� / -i ° Z tt laMW_ - tOU0' otv 8 "tAIGII, 31y "D►A Lff' I+. 44 -1p3- 2 7 z,zo 715 ) 425 -016 9 CST Signature Date Signed Telephone No. CST # wisconsib Dej artment of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 344691 At Perr§ifitver s�1�&RT & MARY ❑ Cit� ❑ Villa Town of: State Plan ID No.: CST BM Elev.- t t1 Insp. BM Elev.: BM Description: AL 1 Parcel Tax No.: bO A �► �A j " 002 - 1087 -30 -000 TANK INFORMATION y'— ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 'u 1 J l /�° G�� Benchmark Z 03, Z OCJ Aeration Bldg. Sewer Hol St Ht Inlet t ; v Z TANK SETBACK INFORMATION utle TANK TO P/ L WELL BLDG. Air l to ntake ROAD ir Septic / N N +� NA Dt Bottom Dos A Header /Man. Aera NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade _ Manufacturer d ✓ s 9 Model Number GP TDH Lift L ric System TDH t cemain Length Dia. H SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of its Inside Dia. Liquid Depth DIMENSIONS '� DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER f ,� OR OMIT Model Number: Sys : m { v 7 00 1 4 DISTRIBUTIONS M 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 Depth Over xx Depth Of xx Seeded Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes E] No [I Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: BALDWIN 34.29.16.504A 2436 COUNTY ROAD BB O S�rw rtir< rva5 xW `O(,e,1 yPf c 1 Sf",' TUire W6L6 a /oz Plan revision required? ❑ Yes ❑ No Use other side for additional information. 1 F 111 6 SBD -6710 (R.3/97) Da nspectar's Signat a Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ... .. . . ....... ............. ... . ...... -- --- ---- ---- - . .. ........ J J .. .... .... . T ... . ....... 1 . .. ..... . ......... - - ------ --- ........ . . .. .......... i - - ....... . ... . ........ l�__-_1.4_111___ - --- -- . ........... ------ ---- I - ----- I Safety and Buildings Division SANITARY PERMIT APP"C 2 01 W. Washington Avenue NVIsc6asin ,o P O Box 7302 Department of Commerce In accord with Comm 83.01 Wis. A o�e � t fs Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, per nptle* coucty than 8112 x 11 inches in size. ll �� C�`IV E '� $ % y d J 5ni ry permi hi • See reverse side for instructions for completing this applicatio 1 State 5 mber i (Oct Personal information you provide may be used for secondary purposes ST C{X� C rir vision to previous ap4ication [Privacy Law, s. 15.04 (1) (m)]. State�.,-� .D. Number I. APPLICATION INF RMATION - PL ASE PR A TI rC/C Property Owner Name yr Location's S' e 1 ,� `if* T o7 , N, R %� E (or)0 Property Owner's Mailing Address Z1 Lot Num Block Number a City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) E] State Owned It� Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Town OF u Go III. BUILDING USE (If building type is public, check all that apply)p4I Parcel Tax Number(s) IVview b o a- / 8"7- 3 d 1 ❑ Apartment/ Condo -'• • IL- 5 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 ❑ Hoteh/ 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. 5 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 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 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade �� Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation Feet Feet Ca acit VII. TANK in g allon s Total # of Con Site Steel INFORMATION Manufacturer's Name Prefab. Fiber- Exper. New Existin Gallons Tanks Concrete strutted glass Plastic App Tanks Tanks Septic Tank o*+4eid�g Tank I( A�v I I Av, koe s ev 9L ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ I ❑ 1 ❑ 1 ❑ 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's Signature: (No Stamps M PAAPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, ip Code): C me�.Qs t . IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing nt Signature (No Stamps) [proved ❑ Owner Given Initial / Surcharge Fee) Adverse Determination 9 //S X. CONDITIONS OF APPROVAL / REASONS FO DISAPPROVAL: Vb w, P(u�12 % t�� �. lu- 511wIL&d A 4t pv os-r -s e-r SBD -6398 (R. 4/99) sy S s DISTRIBUTION riginal to County, One copyT0#Safety& Buildings Division, Owner, Plum INSTRUCTIONS • • . 1. A sanitary permit is valid for two (2) years. l 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the WisconsinAdministrative 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 and 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 be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for 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. STC - 106 VOL 1453PAGE 541 PRIVY INSTALLATION AGREEMENT St. Croix County, Wisconsin PRIVY INSTALLATION AGREEMENT -COPY TO BE ATTACHED TO THE SANITARY PERMIT APPLICATION. Property Owner(s): Reserved For Recording Oata Mailing Address: 4 - 1 4,2s q 1 1wNT c l3 B Location: N(� }.Sw }, S 3 TL9 N R I.in, E or City. Vdlag ownshrp (: Parcel Tax Number: 00Z - L(�0`2 - Legal Description: .P O tiL t�cF— SPlily SQC.3N,7 RR N 19 9.s yl�� s o w 1. No lumbing will be installed in the privy. 1 2. No plumbing will be installed in the premises served by the privy unless a code compliant soil absorption system or holding tank exists, or a valid sanitary permit to install such a system has been issued. 3. A privy vault/ pit shall maintain minimum setbacks as specified in Table 1. Table 1 Well Building Lake / Stream Additional County Setbacks Open Pit SO Ft 25 Ft Min: 75 Ft Sealed Vault 25 Ft 25 Ft Min. 75 Ft 4. Privies for public buildings shall comply with ILHR 52.63, Wis Adm. Code. S. Privies used for one- and two - family purposes shall be constructed in such a manner so as to exclude flies, rats and other vermin. Doors should be self - closing and vault ventilators should terminate at least one foot above the roof. 6. A privy vault shall be constructed of watertight plastic, fiberglass, coated steel or monolithic concrete. Materials shall comply the intent with ILHR 83.20, Wis. Adm. Code. Counties may, by ordinance, establish minimum sealed vault sizes and type or construction within the guidelines of ILHR 83.20, Wis. Adm. Code. 7. The privy shall be kept clean and sanitary. The contents of the pit or vault shall be disposed in accordance with NR 113, Wis. Adm. Code. I 8. This agreement shall be binding on the owner, their heirs and assignees. This document shall be recorded by the register of deeds in a manner which allows its existence to be determined by reference to the property where the privy is installed. I Pnnte wrier s Name s Subscribed and sworn to before me on this date: Rob Sell and Mary Sell wrier WN Deputy Register of . D ds Notary Pub).c . My commission expires on: Jan.2, 2Qp� V ument wa s drafted by the State Department of Industry. Labor and HuNbo ttelatl Bureau of Building Water Systems. • -. i c" _ 4 L •• 9p X O N.s 1 ra 1453P 540 63 0966.8 KATHLE M H. WALSH Doeume:u Numbar Docum Gnu REGIST R OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09-01 -1999 1:00 PR ALIT EXEMPT N CRT COPY FEE; COPY FEE: 3.00 TRANS U FEE: RECORDING FEE: 12.00 . Recording Airs Name and Retm Address Su Robert hu 24 39 (- � Z &g WOO dU Il, ws Sg02 -8 Parcel Identification Nmnber O? M "THIS PAGE IS PART OF THIS LEGAL DOCUMENT -- DO NOT REMOVE" Thi: information mu A U compietad by aebmiut . AWo cnr tdrde. dame & return addrut. end f(N Of r,q dred). Odur Jerfonnmton Awk ar a%c s re clans, 4ro1 d edpdar, ea: Wray be placed on #di fnt Page of the doreoneru or may be p&ced on add Amd puaa of die doe a -'& NO At-" Ute of Ards wwr pare odds one page to your doeranarr and X2.00 ro rfec c r&m ec rise mm Smears, AS17. WMA 2196 tftw1 n'ftRII/ SQ, Owner's name San. Permit No. H63.0 5 PLOT PLAN Show: l .LSE Location of building served NA Dosing chamber Q Septic tank © Vertical/horizontal reference point NA Building sewer N System elevation is Effluent system ® Well FRI Replacement system area Nq Property lines w /in 50' of system ►YA -Distribution boxes Scale = 1 Llb ' , or dimensioned Pump and controls: Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal..per Min. Gal. per Cycle Place check mark in appropriate box, indicating item is shown on plot plan below: �1, 1 C, 0' ON q "b }�61f , 31V "1� - P2PElzA'T?}:; —_. Ar I 3 0 7 F I • Br1 YJ�T�,L LDCi�10►J r �v L�`m 3003 By the granting or approving of the above plan, or upon the event of a subsequent permit being issued,St.CroixCounty and theSt.CroixCounty Zoning Administrator, does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any damage that may result in or after installation. P um r s.signa ure License No. Uate VVisconsin Department of Industry SOIL AND S'IT E EVALUATION REPORT Page \ of 3 Labor and Human Relations .D ' ' ' f.Safety & Buntings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY ach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but - Ste• cS2.01)C 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. OOZ l APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION W sir u- 6AV;-1=9T N� 1/4 S W 114,9'3V T Zq ,N,R L (� E (or(w) PROPER MAILING ADDRESS • LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER EICITY CIVILLAGE ®TOWN NEAREST ROAD W0nDV1.L\,�,L SqU2L (Ifs) 4 ey =3 Wt tsCs Re / Number of r ms 3 Ad i' o b uil d in g P4 New Construction Use [.�. b [ J d tiQn t existing b ki g j J Replacement (J Public or commercial describe Code derived daily flow y Sb gpd Recommended design loading rate "- bed, gpd/ft2 , trench, gpd19 Absorption area required — bed, 1`1 — trench, 1`1 Maximum design loading rate bed, gpd/ft ^ trench, gpd/ft Recommended infiltration surface elevation(s) -- ft (as referred to site plan benchmark) Additional design/ site considerations RV-COM"\► N ANt --T w 1,`n..1 ensr . Parent material Flood plain elevation, if applicable !J A , ft �S= Su itale for system CONVENTIONAL MMOUND IN-GROUND - GROUND PRESSURE AT GRADE SYSTEM W FILL HHOLDING TANK Unsuita ble for stem S U ❑ S ®U S [� U ❑ S Q U ❑ S O U O S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourdwy Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmnch 0.,S 1 S 10 Z Ground ty 7 $ K0 31y -i's -I R elev. ° tom ft Depth to limiting factor tA " Remarks: Boring # 5 6 . Z Z a -k 10`1R yJ3 si 1 zfsbl Z Ground elev. EIVE I 1p ft JON Depth to ;,,, , limiting ST ROIX \ -_\ C N factor F O F Remarks: t' S ! - Z TName: -- Please Print Phone: 71 "4,2 - 0165 Arthur L. We erer 5 5 � ress: - egerer Soil Testing & Design Service =P P.O. Box 74 River :Fail -s,WI. 54022 ' Sgnature: Date: J _ `�� -_ � CST Number �� �ti2� 99-1 -1 , 220254 PROPERTY OWNER tL\. SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D.# ooZ- 100`] 30 Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Consistence Boundary Roots ' Bed Trench �z s b k wt �Fr� a, s t • s 6 `F t o 4v- Ground 3 13 )z vU` - w y elev. q 1 ft. Depth to limiting factor ti 3 i Remarks: Boring # I 24 j I Ground j elev. ft. Depth to limiting r $ factor t S I E Remarks: Boring # l Ground elev. E i i Depth to t y • a limiting I factor Remarks: Boring # k l Ground elev. ft. Depth to limiting factor' F Remarks: _ — PLOT PLAN Pa 3 of 3 SCALE 1 "= k40 ' P R�t� OR bislv„i8 r ~— I I N S • to \� D M �3r1t I — EL. 1D0,p' ON ° l'IlY1G!} �!�` PVC PIPE ul Lrt34_ OAJ 1�t �2Q3T P��P� -'C`f t_1 nr� � i �P. t0�' F-�ZVwI w��►�D 1._ocn'�7uN x.35,, q9 -lo3 -I z zo Z Sy (715 4 2 5 -0 - 1 6 5 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 tabor and Human Relations Division of safety a Buikintp in accord with ILHR 83.05, Wis. Adm. Code COUNTY • Attach complete site plan on paper not less than 81/2 x 1 i inches 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 and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION "'PC q s lzr C. G --LOT NE 1/4 SW 1 /4,S 34 T 2.q ,NR 16 E (orCW3 PROPERTY OWNER' - S MAILING ADDRESS • LOT # BLOCK # SUBD. NAME OR CSM it 1\4 cw g — CITY, STATE ZIP CODE PHONE NUMBER EICITY O1/ILLAGE ®TOWN NEAREST ROAD Won�jV�l ,fit SqU7f ( ley -36 1 [ New Construction Use Residential / Number of bedrooms 3 [ ] Addition to existing building (j Replacement [) Public or commercial describe Code denied daily flow qSo gpd Recommended design loading rate _ bed, gpd/9 french, gpd19 Absorption area required - bed, f1 — Wench, 11 Maximum design loading rate bed, gpd/9 trench, gpd/ft Recommended infiltration surface elevation(s) '-' ft (as referred to site plan benchmark) Additional design / site considerations ft'vt-T PRI VAf e*JT Y-1 DUK-iz�) , Parent material fr Tt Flood plain elevation, if applicable u A , ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN RLL HOLDING TANK U = Unsuitable for system ❑ S V,U EIS O U 1 ❑ S [AU I cis ZIU [IS ou I EIS O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bo undar y Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerz� ou S 1'�' S • 6 8 -14 Ground 3/v -� .S ti R s18 e 1 c�K, - vv, T - - >,►Q Z elev. ° tq • fL Depth to limiting factor Remarks: Boring # a,s Z $ -�3 )o`[(Z y/3 - s� 1 Z'FSb►i �n`ff- �s lv� ,s .� 3 V3 30 l0` R- 31 y c � S `12 S./ B 0-1 CJ • Z Ground elev. 10 3 ft I LIAO 1_ a ice? Depth to :--`�:� �2 4 1999 limiting _ factor Remarks: 'l' S T Name.- Please Print Phone. Arthur L. We erer 715 - 4.25 -01 ress: ,egerer Soil.- Testing & Design Service =P.O. Box1 River. .Falls;, WI 54022 S&ature: / /L''rf YL? j - Date: - (� - CST Ntmtber: . l � y �' -I , 220254 PROPERTYOWNER S tL SOIL DESCRIPTION REPORT page Z of 3 PARCEL Lb.# QOZ 106 3p - Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground 3 t3 3Z \U`112 3/ c � elev. 't -SLt2 S/$ C C� 9•") ft. ; Depth to limiting factor i Remarks: A � S =J Boring # Ground ' elev. i ft. Depth to limiting factor i Remarks: Boring # Ground i elev. ft. Depth to limiting factor; Remarks: Boring # gg \? Ground t eley. f t. Depth to limiting factor' Remarks: �_ 77 - P L OT • r LAi. Page 3 of 3 SCALE 1 "= 4) ' i . Prey p(Z DlS1v,Z8 1 � N I(A 1 1 m • �o Fv Ivy zeoA Ceti em O� aX4* z J D W I '&I ( - ( 1 U , 0.p' ON �I'� \11u!�, � /y" D!A P I PIPE u! LrffP QN R U Z_ LVI k 1 t 4 h1``t��L>35'S" �'��- c1�?�"R•X`/ �I n�k I i � �4�' F-�'� -cix� w�pv►�O Loc- f�TOry I p o.3s - -" �9 -1o3 -i 15 47.5 n76s CST Signature Date Signed Telephone No. CST # Stock No. 13001 U()CUWftT No STATE BAR OF WISCONSIN —FORM I WARRANTY DEE3 654 r riAb THtS SPACE RESEAVE0 IFOR RECOR0414C DATA RECISTEk, 0FclCe A. T1fIS I)Etr), made between CROIX Co wl 11 * 1 c'd. for Rtbwrd thi 3th day of Nov Grontor 1982 nod at 2.'25 P ft of Deeds Nitne. -seth. 7• liat the soic Grantor, for a valuable consideration C.-t. -.3 RETURN TO conveys !o Grantee the following described teat estate in County, State of Wi%L,nsin� e 2a a er (,SE i ,' 1 = cf tie r� , !.rter (SW 1/ C)f Section I a! -,)rrt uf % )iia - ter (XE I Tax Key No. Qw `te (,;W 1/14) •of Sertlon C� - t , , , Road z"'14 7f t Quartir (:4 1/�,) )f t Quarter Y Road B3 t! :T-rtl L- acres t' AL opr. �f -alf (i. !,'2) of' +' Soutlieast. Qizarter 1 1-1. , Way except t--- North (3E 1., of 't'-,e Railroad R! cf r1 -ere f a' Ka •A. "'14 iion!0stead property. (is) (is not) ToVether 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 o A dt+.Ind the Fame. Dated t 19 (SE AL) —(SEAL,) ' —(SEAL) 4 (SEAL) W AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this --day of STATE OF WISCONSIN 19 SS. County. Personally came before me, this day of the above named TITLE: MENITFIER STATE BAR OF WISCONSIN V (If not, We 0 authoriz"d !jy j 706,06, Wis. Stats.) This instrument war drafted b Robert 3. Walter o me - now to b_& me U ��Lyie �Mqt� t pe goin ment an i k at LaA A (Sig-iatures may be aul. vacated or acknowledged. Both are not necessary.) Notary Cou*y, wi�-b Comm*4,on :s perma ent. date: ff * N*�.esofper$� Xy .gust Le typed urpr their tgna! G_WAPVANTY D' -ED -SPATE 8A.1 nP WJSCOVS,": . NO, i-t971 5 J 9, r ! au a � 4 v RZ x µ