HomeMy WebLinkAbout018-1072-50-000 r
ST. CROIX COUNTY ZONING DE"#TMNT
AS BUILT SANITARY REPORT
Owner C r `e ®R�
Property Address
City /State
Legal Description:
Y Block Subdivision/CSM # - '/4, Sec. , TAN -R W, Town of ,�� PIN #
SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION:
Tank manufacturer lt/ 5 2c- .e Size ST/PC f ��� Setback from: House Well PAL
Pump manufacturer Model
Alarm location
(HOLDING TANKS Y)
Setbacks: Service roa Vent to fresh air intake Water Line
Meter location
Alarm location
location
SOIL ABSORPTION SYSTEM
Type of system: C- o'I v" / 4idth f Length Number of Trenches 3
Setback from: House Well PAL to fresh air intake
ELEVATIONS
Description of benchmark Elevation ere-
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet " 6 7 ST Outlet �' ;1 Inlet
PC Bottom Header/Manifold Top of ST/PC Manhole Cover + ?�
Distribution Lines () () ( )
Bottom of System
Final Grade () () ( )
Date of installation") /�'c.4/ !` !Permit number 33 State plan number _
t�
Plumber's signature �� � ,-� �se number 7A.9 7 Date
Inspector / ' / _ f `
Complete plot plan Q
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. cv?d'&d
PLAN VIEW
l
l
CP
G � �
INDICATE NORTH ARROW
I
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y:
Safety and Buildings Division Count
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit 9 : IX
Personal information you rovice may be used for seconds purposes [Privacy La s.15.04 (1)(m) 3 38899
Y p Y secondary p p I Y
Perrrut.l-kblgh r ebEORGE El Cit y_[1�1ill�q� Town of: State Plan ID No.:
CST BbbMAAEKKIellv11VV ttii Insp. BM Elev.: BM Doscription: t1AN1MUIV Parce! Tax No.:
/Oo' /D0, 0 �� 018- 1072 -50 -000 'A I'll'190158
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic fie` } Benchmark
Dosing'
Aeration Bldg. Sewer
Holding St/ Ht Inlet w0 142
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P/ L WELL BLDG. Air ir I ntake ROAD Dt Inlet
Septic S NA Dt Bottom
Dosin NA Header /Man.
g
4. 3 � s.8�•
Aeration NA Dist. Pipe 93 •
92. J-'
Holding Bot. System �. a 93.e•� `,
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand
Model Number GPM
TDH I Lift Fri ion I System TDH Ft
ss
ss Forcemain Len th Dia. Fi Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH width r Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 D IMENSION S
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O Model Number:
System: ' /y A10 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 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed/ Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No []Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: HAMMOND 33.29.17.504,NE,NW 1747 COUNTY ROAD J S
,6 e j.. �,
4 r
Y 5. .., ,
!� q
/0,63!
Plan revision required? ❑ Yes L] No
Use other side for additional information.
SBD -6710 (R.3/97) Date nspe or's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
VA
T - 24-0—
e
"
3
T-1 1.4—nd i.-I A I .-V
�. _.
E
_.. EE O!
i
a f I ,, iwa. m
lit
9
j
� � F
,.,,,... ..".". z , .".... m , , . wm _
ae
"
Z
+1 , F J -
4 ,..,
-ttt
knd
1 a
t ffi
,e 33
< i
B
7 2
m e v
f T.
c
r 3
,.,...
e
e
aw e
d>
e
:
4 ..,. .... . ... . ......� .rye_ .. ,., ,..", , m .. .. .. ..... .. ,.,. ._ ,,.. � ,
E
e
g
C [ a P
.... .. ,.,....
#
_�.,,...._ p,_.. .............� ,_ __.. ..., ,,, ,_A.._ .,..,. ,., ,L ,... ..... _ _ .,...,
F
f �
:
g f
}
.,,...,v_ ,.. ♦.e" .e ." ".�.. a ... e... ».. + e® .... ,.....
8
! s
a
. :
S � a
a s i g
{ t
e ...e .¢... .. ,. t,.. e w ,t .by®... ,g .d�.... g.
3
11- ' F
x4$
a � � f
a s
—
i
SANITARY PERMIT APPLICATION 20 Safety and dings D
1E.W shingtonAve sion
Viscons In accord with ILHR 83.05 Wis. Adm. Code P.O. Box 7969
Department of Commerce Madison, WI 53707 -7969
• Attach complete plans (to the county copy only) for the system, on paper not less County .S
than 8 1/2 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
y ou p rovide may be used b other government agency programs �� of
The information
y p y y g g y p g Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION
Propert Owner Name ,, pr9Perty�o � tion
ell /�R h Y /? a A/ / 1 ia, S T 2, N, R E (or
Property Owner's K11ailing Addres ; Lot Number Block Nu mber
/ '7 , ;z 7 V -\
City, State Zip Code Phone Number Subdivision Name or CSM Number
. TYPE F BUILDING: (check one) E] State Owned iti uutGr»�?a Nearest Road
C] Vil age
Public a 1 or 2 Family Dwelling - No_ of bedrooms _� Town OF Cc U
111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 14 r10 11 'ja
1 ❑ Apartment/ Condo 6 _ / O ;2
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1 &New 2. ❑ Replacement 3. ❑ Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an
System 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 Pressu zr ed Distribution Experimental Other
11 []Seepage Bed 21 ❑ Mound 30 E] Specify Type 41 []Holding Tank
12 JEFSeepage Trench —AC& 22 ❑ In- Ground Pressure , k r 42 C] Pit Privy
13 E] Seepage Pit C 3 S S 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
/ S z' gJ��et Feet
VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete strutted Steel glass Plastic App
Tanks Tanks
epticTan k —^ �!''G9 ( fffa� -2— ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 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 ignature: ( Stam PRSW No.: Business Phone Number
L. ss �}� "� Z �� 6'� •.3 ��
Pll er�A `d r!(S e it a, e,Zig
!! �rS ®fa
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater I Z A ; Issued Issuing t Signature (No Stamps)
�.
Approved E] Owner Given Initial Surcharge Fee) ` r �
Adve rse Determination J
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD -6398 (R.11/96) DISTRIBUTION: Original to County. One copy To: Safety b Buildings Division. Owner, F+lu nber
I
INSTRUCTIONS F
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
Yp Y
P
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; 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.
/�. cdf
r 3.6
i
� 1
/h 2
/Vag 1 �
i n
46 J
C0 h`To o
t I
I r
v
-6
9
r-h
�PVSS �CC1 O� J�S�t',s�'1
F /016A AN IM06 And Ob6moollM tMi
Awl-of Yri! Go
�giwt iZ' A?w�
i rfi� •
t0- ti' AMr� ryM + 4' ft d m M
to fiyl irN�
.r. 01 a C—i i
A�w•f.h
ova
' �' A�Mflili !Loom ftI FIA adrw
/�piM Ji1i� -
CwMM� TNiMi/!1K A� .
0"100 of srafM
q6.7
1'4i� -
"',—•MJITERlM oR q' of S-ritAw
OR MARSIA HA`j
1
TAEV OF_ lEiiT -S Z ,.
Q!sT4A* TJORI rICULi ?"L4 A!C T LG1L5'S -- - lvc4s $ ,$-Cjw QltIG1w3m. " #In I*3 P&,40W EL
p* D&prt{ of v-XG/bVAT%oO FIGH A MAK WILL BE _ , � �t�sc►��
or �7 �I(s1N4L E3� WILL 6E iWCNE5
I -
sl�,avco
LIGCUSC 1,10MBER:
G c
VAT It : `� . rG- �•-- -+
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page ) of 3
Labor and Human Relations
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 L°.0 V
not limited to vertical and horizontal reference int BM direction and % of slope, scale or PARCEL I.D. #
Po ( )� P e
dimensioned, north arrow, and location and distance to nearest road. 01g_ J b _) Z - S 17 1)
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R IEWEDBY D
1 TE
PROPERTY OWNER: PROPERTY LOCATION
GPIa Z 6 E: G `P'{R elz 691fF -E6T N.F 11"W 1/4,S 33 T Z(j ,N,R 1Z E ( W
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
\ Z
0_
\ " S,
CITY STATE ZIP CODE PHONE NUMBER [:]CITY []VILLAGE QTOWN NEAREST ROAD ti y
`1�r�o,., w sV ol S ( fS) -)q6 - ZZ�L9 l_lUlm 7:S'
R New Construction Use [,� Residential / Number of bedrooms Z [ J Addition to existing building
j J Replacement [ J Public or commercial describe
Code derived daily flow 300 gpd Recommended design loading rate — bed, gpd /ft •4 trench, gpolft
Absorption area required S o bed, ft 6 , o o trench, ft Maximum design loading rate • 3 bed, gpd/ft L4 trench, gpo1ft
Recommended infiltration surface elevation(s) °k_ 0 - " t S It (as referred to site plan benchmark)
Additional design / site considerations Z. S . -)e-,
X . --) S ' Lax G .
Parent material - _U S S QNNC_ \S e S `n L\_ Flood plain elevation, if applicable ty fa , It
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem IRS o U 0S ❑ U OS ❑ U 5a S ❑ U ❑ S W U ❑ S J�IU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Boundary Roots
In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed T mnch
n> .. D -q 1p�� j !2 — SL1 Zwt 3bk S� �S _ •^� •(,
..,.,..,,..> Z q - l0`1 R 3I(, -- S t ( Z`�Sb1c � C-S
Ground 3 LS - S L t CZ ly l S 1 e Sbk cS rvP N�
elev. /
Depth to
limiting
factor /
T y
Remarks:
Boring #
Zm Sbk oA
; -4o. t 0`1 R- 311 — Gar a • i 1 Z TS � s � cS , 'S
.<>
3 16 -yo S'� (z 31 � G� � g �. esbk o�� CS — •, • g
Ground
elev. ft. `-/ 12. VA — S O S `NL •�
Depth to
limiting
fact r c
Remarks: Sr r 99
T Name: — Please Print Phone: Z Q� 1y r
Arthur L. We e r e r 715 2 U 1'oF,r F,
Add ress: Soil Testing & Design Service -P.O. Box 74 River Fal ,,
Signature: a _ 20 U Date: ,
M00576
i 1
PROPERTY OWNER GN SOIL DESCRIPTION REPORT Page- of 3 '
PARCEL I.D. ft bi b - Lp'1 Z - 54
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell 11u. Sz. Cont. Color Gr, Sz. Sh. Bed Trench
; 0 -9 — s' z,rnsb
2 ° i -Z6 . Lb ti iZ 3 / S . S . L
Ground :s l w m v' y — S) 0-s — • �l • S
elev.
oLq. ft. 14 Sb-83 1'3'fr yN '1MV�- •� •$
Depth to
limiting
factor
Remarks:
Boring # ,
Ut z — s� ZK sb1a- ��� e_- S s .�
Z $ –tiS ) e - trz y/3 — s,1 Zm sbtir 1n ��- � • s
3 1 S Z` 10 `i 2 3 /L — s I • C.S yn- i LS • Z -' 3
Ground
elev. ?-6 43 !Sl — G�- 1 1esb mfg e s _ L-L .
°t Lft 9 -
Depth to
S yb-$z - 1-S , Z Y! S1 als w,v-� - - .y
limiting c s 1
factor
- 2 Z
Remarks:
Boring #
S. Z,
3
Ground
elev. '4
a.6=) ft.
Depth to
limiting
factor
Remarks:
Boring #
13
Ground
elev:
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
MAY -03 -99 MON 12:02 PM NELSEN WEBER SURVEYING,M 1 715 425 6864 P.02
PROPERTY OWNER �` � � SOIL DESCRIPTION REPORT
Page G- of
PARCEL IA
De D
th ominantcol Mottles or Structure Roots
Boring # Horizon (3PD�ft
P Texture Consistence BaYdary
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trade
C) 1O"1it
M]MR vi u� Li p-- 3 J
1 �. ��k vin { l- • y 5
Ground � 21 S AP ►b`-1iZ S// y �. s � -- -.
el ev, g Q� Ss - M
gy.oft.
Depth to
limiting
factor -
Remarks:
Boring # s t 1 Z M 5b ►''ti ��^ S
Z
� ":. �: ^ --
y Z $ -�s s,1 -S
3 �s to �zrz 3 1 L �, I • csbk YYt .s
—
Ground s
elev. �_yn Z•S 't f� 3 y G�- s } � SbI�C m 'f >• _
1t. - o - -3
s qls . y
Depth to �- --
Ilmilling c s 1
factor
-Z " Zti
Remarks: - - ---
Boring # S . S
.;# ) o - `b tU�1 Cz � 1 z sit Z wt..S'M, 1 5
S Z Rs - lam tz st Z*nS
3e Iz-- VIL \j TV- ew
Ground
elev. t} U A S cf V- 3 1 r► LS 1 e-S h tiz ►n \ ` L -` • `� ' �"
-
Depth to —
limiting
factor - ----�- -
> t 3
Remarks'
Boring #
Ground -- - —
elev,
—
Depth to -
limiting
factor - - --
Remarks: r_ .
seo- e330(R.05/92)
MAY -03 -99 MON 12:02 PM NEL EN WEBER SURVEYING,M 1 715 425 6864 P.01
WEGERER s o z
L 'TESTING and DESIGN SERVICE'
sozL TESTz
NG - SEWER SYSTEM DESIGN
ATTN.
DATE S
CC.
SUBJECT: C-,ezi 1Z 6c (s
.TllE FOLLOWING ITEMS ARE ENCLOSED
N0. OF DESCRIPTION
COPIES
SENT TO YOU FOR THE FOLLOWING REASONS
L-- YOUR USE FOR REVIEW AND COMMENT INFORMATION DESIRED
WEGERER SOIL TESTING
AND
DESIGN SERVICE
1�
P.O.BOX 74 421 N.MAIN ST. RIVER FALLS,WI 54022 PHONE 715 -0165
PLOT PLAN Pa of 3
SCALE 1 "= 30 '
` 0 '' .0 ( � p�J �Z" rcpt 6!4 � 31y -bTA �1Z�_PIPE..
3SV�
5i
Qrt OL3 �
C;7, J;
/\
L'"L a►{ z o
B. S
L-L Ot ✓
O
0 b -
—3
I
O
�tovS� ZO 6E fN'" � -�1s1� ZS �t�l `11Z- �vett�s
(715 ) 425 -01 _ I4 00576
CST Signature Date Signed Telephone No. CST #
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page ti of 3
labor and Human Relations
• Division of Safety & Buiklings in accord with ILHR 83.05, Wi Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S�I'.
not limited to vertical and horizontal reference point (BA), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 01g_ ) d l Z - S Z)
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R IEWEDBY DATE
PROPERTY OWNER: PROPERTY LOCATION
G O 1Z 6 E G Y'CR,bN kM G0VF - T N3 E 11"W 1/4,S 3 T V1 ,N,R V1 E( W
PROPERTY OWNER' :S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM #
CITY STATE ZIP CODE PHONE NUMBER CITY []VILLAGE ►MOWN NEAREST ROAD ti
`�r�►o►.,O w S'Vol s (_)IS) �6- zzb�9 -
K New Construction Use[ >j Residential /Number of bedrooms [) Addition to existing building
I Replacement [ I Public or commercial describe
Code derived daily flow 300 gpd Recommended design loading rate — bed, gpolft •4 trench, gpol(t
Absorption area required `15 0 bed, ft 613 o trench, ft Maximum design loading rate • 3 bed, gpd/ft . y trench, gpd/ft
Recommended infiltration surface elevation(s) 0.7- O ft (as referred to site plan benchmark)
Additional design / site considerations . Z.. S `.X , '-) S , t-b)vt; ,
Parent material Lt= S e S Flood plain elevation, if applicable ty L . ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem OS ❑ IJ S❑ U W S ❑ U S❑ U EIS O U [IS ICU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Boundary Roots
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Ground 3 L$ -3 S Li R ly _ s \ e sbk ,� cg rvP NP
elev.
0i . ft. y 2--bY S `I R- YA - .FS o S5 M
Depth to
limiting
factor
> elf
Remarks:
Boring # -'—
< t o VL :5 -
Z Z -1 b. 10`1 R- 31 L
\a \1'::1411':'
S 3wvc
Ground
ft
Depth to
limiting
factq 6 ,
7T
Remarks:
CST Name: — Please Print Phone
Arthur L. We erer 715- 425 -0165
egerer Soil„Testing & Design Service -P.O. Box 74 River Falls,WI 54022
Signature: ! 4 a — O Date: L _ CST Number.
2 _ J 3 �� M00576
PROPERTY OWNER G' .OIJ Z SOIL DESCRIPTION REPORT Paw of
PARCEL I.D. # O
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerh
3 O -9 1o� -ttZ �!z — s' Zr►1 b rn r �S , 5 .�
IA- R 31 — si 1 Z- S
Ground 3 ZL -Sb 1 U` 12 V/y — S) 1 c -3 bk v -( C - • �l • S
elev.
Oft 56 S`�fZ y/ — �s u s9 'r-►V�� •� $
Depth to
gmitlng
factor
Remarks:
Boring # ,
Nano= l z — s 1 2 rn Sb\,L ►� F� s - s
113—i z y/3 — s, i Zm sbk )v,
3 1S Z` 1b`t2 3/L — s) I 1 Yn' ; • Z `.
Ground
elev. 16 -qa Z.S K Iz 31 y — Gi- s l
L-fr - 1 Sblc mfg e s
Depth to S . 4D-$2 � V/v
limiting c s
factor
Remarks:
Boring #
S. Z,
3
Ground
elev. �
a6-) ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
PLOT PLAN g
Pa e of 3
SCALE 1
Ll.'• Gam- �• _LY• U, k K 4L h K _ lT • -
3Sp�
2
M
la 7 X4
I
/ fit, b�
EZ. �►y z 0
8.5
O
ti
�ov9� 10 6E Rfi �- Ef1s1' �-S �l�i �i1Z- �vett2� • -
w\ZL-L ti ti so ,
%-
(715 425 -01155 M00576 CST Signature Date Signed Telephone No. CST #
• ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Q (Yt
Property Address
(Verification required front' P Dcpartrncat for ne astructioa) G
City/State Parcel Identification Number
LEGAL DESCRXPTXON
Property LocationLE %., AU W %, Sec. 3 1. T -N -R Town of
Subdivision Lot #
Certified Survey Map # Volume _ . Wage #
Warranty Deed # _ R , 9 2 G Volume �I —' Page # L fir:
Spot house (] yes t;l� no Lot lines idcnfrfiableA yes ❑. no
8XS1F.11�I- A4�API ENANCE
Imqvoperusc dmamftaaaocofyuarscpticsytOcmcoaldr esaltmitsper_a tirfaTia�etoIun &cw&stes.Pn4=nui�b==oe
ooasists of pmmping oat tic septic tank curry a= y� or sooner; if nec&d by a Iiceasedp=43m What you pat.into the system
cam u affect 6c - fimdioa of tic septic tankaas.a ftatmcat stsge is tie vaste di;posal_eysbem.
Tlae p roPaty' owrLa agrees to submit to St. aroix Toning Dot oatifi on. four, signed by the aar= and by a
;M i plumber. restdctedpt= bcroraliccasedpmmpervrafyingtfat (I) theca _citeiaastewabar&sposalspstem
is is proper operating condition andlor (2) after inspection and paagft,Clf necessary), the scp&tmk-is less than Ili 6U of 'sludge.
Uwe. &e tm icakwd have.rmd the above mgcuccm=ft and sgme to maintain the pavite sewage disposal syst= Wr ft standards
set fork burin.'as set by the Department of Commeme and &c Dq=tment of IdaCmml R=mrucs; State of Wisconsin_ Oatific ahka
that Your septic system has bear maintained must be coatplded and roamed to $bc St. Qroix County Zoning Office within 30
da of the am= year tier date.
9
SIGMA O PLiCANT DA — �
OWNER• CER'dT UCAITON
I (we) ce tify that all status on this foam are true to the best of my (oar) I mowledgo. I (wc) am (arm) the owncr(s) of
tic Ptgx:cty described above, by virtue of a warranty deed recoriled in pegister of Doods Office.
slGru PM NT �
DACE
ssa « «s Any information. that is mis- c+cpresentcd may result in the sanitary permit being revoked by the Zoning Department-""
a� Include With th[s application; a ctarnpod wammty deed from the Register of Dwds office
a copy of the cafft►ed curvcy map if rcfcrcace is made in the warranty deed
DOCUMENT NO.
BOOK 441 P:4 [ �l f� WARRARTY DEED
I STATE OF WISCONSIN —FORM I
THIS SPACE RESERVED FOR RECORDING DATA
291993
THIS INDENTURE, Made this. IT - -.. -- ._..day of. _ A.I?r -l. _ .- --- ---- _ -... . Hr- GISTt_RS 01- FICE
ST. CROIX CO., WIS.
A. D.,19._�I ..-, be[ wcen__._. �i�. Z- E'�i�iE L2' �;_ 11 ..E:_I'.. -_ - -- --..-- ._....
-- - - _ - -- Recd for Record this -22nd_
- -- -- -. _ . -- -- day of--- PTJL1 ---- A.D.19 68
part.,,'_ of the first part and
( ..uf)L ( ,t'.. J.__�_ttl2 !1l_Sl_r e1''!_�- -.iS( f,_t�y tj..__ -� ilJ'_�it_i_O.1'� _hltslm.T10
......
_ -_ - Reg t of eeda
i
part- A. (..S of the second part, RETURN TO
W i t n e s s e t h, That the said part-- of the first part, for and in consideration
of the sum of TI I t 1'- 17 V SL 1 ,1) O u ,) tt _ ,I 1 11 o I G U d o I l 17 S
_to_ l(.'_.- __in hand paid by the aid part 1 C of the second part, the receipt whereof is hereby
confessed and acknowledged, ha_ V_(, __given, granted, bargained, sold, runi,ed, released, aliened, conve} cd and confirmed, and by these presents
do ( I Vi g
_ glue, grant, bargain, sell, remise, release, alien, convey and contlnn unto the said rlrt_l_I'_ -_ o[ the second xtrt,t �rs and assigns
,I f_'
E,
forever, the following described real estate situated in the County of_ �- L . S - S �l l_,`:_ .._ and State of Wis(onsin, to �
N0rtl ".( -t ..11o1 1 ��'..1, (:1 I) I - tII ltlr 'rteSt
i. (,1'( T.`. l { ) i.4('Ol1�7ii s111)) ('0 ( . t
I
ls( I, IF•ift T e 1oi)' t r'( E,nr t,t v "I ric O '
"!I L 31 [I T ('f*I'rtl))I
�cn' F, i tlrl I e j I .. 1 t �l n l r('c(Ii. Jul l i11
t'(,l. '2C '13 i -Tl r
ro \
(. (!li i� {i'� 1 +1 .`: ('CJ 5 I1, ,'1 '1.1Cn .` <CI' ('('� 1t. I,�,'. 1. (`( TIC o O' 1 -IC
li 1 - ':A. �)ll I'�;t� (,, 1 �� l.l'cl - �.t� ,I11.�'� rl;l (:( ", .,n ('r I I _`( I 1 : 'I(, 11 ! 1'( I-' of
�0v('r ( r :'_'i , 1 ( 11 i CO1 �'_>7 „1 r 1 '"; i n e a
C. t'i 1 1. I.t ",'� r,l c('U ..`=1 tI Fli { U ;I r)1 ;� ('r
E',)�('r:,( r 1T ,.1 ��� tt�l (''tt�oIe L`.'f ii < *I t: ( ,: -I�� { ; I. t,
rp(-ordI -I i t ;)1 :'f�Z
�1I.' i! iir•c r'. .�(' r '1(,( „�� .t r(,f•(,� -,i,
I
(Ir NGCE?SSARY, CONTINUE DtiSCRUIETON ON REVERSE; SIDE)
Together with all and singular the hereditaments and appurtenances th,reuuto belonging or in am ,vise appertaining; and all the c-tlte
right, title, interest, claim nr demand ,vhatsoeyer, of the staid part- Y _ of the fie t part, either in lte, or equit%, either in possession or e\pcc[toicv,
of, in and to the above bargained premises, told their hereditaments and appurtenance.
To have and To Hold the said premix, as above dc,crihed with the here_dit.mlcnt, ,tad appurtenances, unto the s.<id part I (' Sof the
second part, and to {,It(`7 i' heir, and a „igns FORE), FR.
And the said _ 1 I ' <' ( 1 1' , I I (,I,
for I �ll.: c ( 1 hs ] heil,, executors and tdioini,li.rtor,, dof ” covenant, }r:uat I irgaut, and agree to and
with the said p tit I ( '_`:'of the second part, LI', (' T' heirs and ts,ign,, tint at the time of the enscaling :anal dcli,en of these presents
I I ( ` 1 `• i
well s,i/cd of the premises al,ove described, as of it peed. ,tire, perf<rt, al—Ilute ;md indcica -ihlc estate of inheritance
in the LM, in fee simple, and that the s,uue arc flee and clear from all incunhrance, whate,cr
and that the above bargained premises in the 'luict and peaceable po„c,sion (If the , ail part _1 S.'_`:d the ,et and p.a(t,_j_� ( 'I #ks .tad t
against .ill and every_ person or persons hwfull, claiming tha whole or any part thereof, _{:!iC,),' will forever 1 \_lkl\ :ANI) I)EFFNI).
In Witness Whereof, the said part , }'.__of the first part ha__ .. .hereunto set I1.1.`_ _ h;md. _ .old a:al lhi�
day of - s�'. A. I)„ 19 �).e`,`
SIGNED AND SEALEI V PRESENCE OF )! ��` �� �� r��2�� of :ALE
rrlrl�'r
i Ir' n t 1•�I
(SFALI
LoreTle 'Ot'T) snr,
(SF.11,1
I
STATE OF WISCONSIN,
ss.
Personally came before mc. this �. "_ _ - - -. day of -- -.- _ _t ;)1' l) -- 1. 1)., 1 _
the above named_- _ � 1 T 1 t' �:. t, 'l t'rI (' 1'
to me known to he the per—ii who I tcuted the foregoing instrument and acknoty ed the �� tryc.
'
NOT
ARY 1
SEAL S =, /( ��� -
hh , instrument drafted b, r { ( 1' U I \ Co t�! \l
t ..
Notary E ubhc__ _�'..: -
-
-- - ----- - °- - ---- M} Commission (Expires) (Is)_ t� - TH:
ISection 59.51 (1) of the Wisconsin Ste{tutes provides that all instruments to be recorded shall have plainly printed or typewritten thereon the names
of the grantors, grantees, witnesses and notary).
WARRANTY DEED —STATE OF WISCONSIN, FORM NO. 1 s. C. MI, L EII co . .11 -Urr