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HomeMy WebLinkAbout028-1045-60-000 ST. CROIX COUNTY ZONING DEP NT AS BUILT SANITARY REPO Owner r D� e Property Address .2 Oc) C' f k x City /State P YS/ IC 1 J 1 0() i Legal Description: 'ONINGUPFJC�E 't Lot , Block Subdivision/CSM # L %a ' /a, Sec t, TaLN -RAW, Town of - 'lam t SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer ROLy4.s� Size ST/PC /222/ o Setback from: House /`i Well a- P2 4�_ Pump manufacture Model n5j. " Alarm location 1(- �" c P (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width </ Length _ Number of Trenches - 3 l Tv-e IV- Setback from: House _ Well ©/ eP/L 9 / Vent to fresh air intake ELEVATIONS Description of benchmark 'ro p a c�` f' t � R � �, ��K� Elevation s Description of alternate benchmark Elevation Building Sewer y7 ST/HT Inlet 9' ST Outlet PC Inlet PC Bottom 1� /� Header/Manifold Top of ST/PC Manhole Cover f� Distribution Lines ( ) &2a !V 3 O ( ) Bottom of System ( ) Final Grade ( ) / l -2 O ( ) Date of installation x)11Q19§ Permit number ,3 VS� State plan number / :Z Plumber's signature 1cense number Date Inspector o Complete plot plan � 7. I 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 co r. • Show alternate benchmark, if applicable. PLAN ca A/ �a o V Mom 4� 8a -ro,p op j � " P1) c a°,/ CL INDICATE NORTH ARROW ,l�ex f f° ►' °sF ti f I . Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y- Safety and Buildings Division INSPECTION REPORT i 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)]. 344573 Permit Holder's Name: ❑ City ❑ Village ❑ of: State Plan ID No.: Kro elnicki Bill I Town of Rush River oZ 3 CST BM Elev.; / Insp. BM Elev.: BM Description: Parcel Tax No.: efl g . ? S'Ts ".1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic f p N Benchmar�. 3.30 e2, Ze Dosing Alt. BM D,l��• / Q 2 • t3 Aeration Bldg. Sewer 5 D q� ( g Holding St /Ht Inlet ! �jG ,9IG TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Ventto ROAD Air Intake Septic >5-0 r ' ~" NA Dt Bottom O g 340 e Dosing >To r t / �-} NA Header / ManCA . `a I arlb•" Aeration NA Dist. Pipe �� ' }Z 1 06' Sa Holding Bot. System ' �a 4 ' PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover -7 (. Model Number �S 33 Ail * I G P M # oZ �'� ( laS.L2 Q$. $2 TDH Lift , 4; 1 t friction .q% Syestenry1, TDH i�.A Ft L oss Forcemain Length Dia. Fia " Dist. To well SOIL ABSORPTION SYSTEM H Width r Length r No-.Of T nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /e 3 ;L DIMENSION SETBACK CHAMBER SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O � i �� model Number: System: 30 OR UNIT DISTRIBUTION SYSTEM Header/Manifold v Distribution Pipe(s u / x HoI Size x Hole Spacing Vent To Air Intake / S i f rr n Length Dia. Length O Dia. A Spacing Y �p SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over 78ed th Over xx Depth Of xx Seeded /Sodded xx Mulched I Bed/ Trench Center / T rench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: /0/8 /991nspection #2: /0 1/2/99 Location: 20 1 C.T.H. "YY ", Baldwin, WI (NW1 /4, SW1 /4, Section 36 T28N -R17W) - 36.28.17.283A v od- 3 (mac. lg Plan r lslon required? ❑ Yes 9No Use other side for additional information. iZ u li I 1��, _Vokm I 1 I SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. l ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ax --v .. . } i F { F s e i : y s e e q .. ° ... v m e E € E a F i 3 � e j 3 < F <` t F - . m. r 3 r w. mf m E.. ... m. « <_. <u,m ... ° ..... -g <<.,i•..... # 6..._. ®_.a»..,.�i F F c 1 I Fj € I t s 3 t 1 t i S i i # 3 $ m � B c f tj < m., " S T i < #w k ; P M [ k . € J. ^ . ..m. F °a e s° f i dms << P k .. s F Q F 1 { 4 S } 7 , 1 E fi i F � �.. re , ; N d } # Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. ST CROIX • See reverse side for instructions for completing this application State Sanit Perm�ber Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number SITE ID #175993 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATI N TRANS ID # 234837 Property Owner Name Property Location BILL KROPELNICKI NW 114 SW 1/4,5 36 T28 , N, R 17 YNO W Property Owner's Mailing Address Lot Number Block Number 14335 15TH STREET N City, State Zip Code Phone Number Subdivision Name or CSM Number STILLWATER MN 55082 1 (651 )436 -1671 II. TYPE OF B ILDING: (check one) ❑ State Owned o it� Nearest Road Pu blic x 1 or 2 Family Dwelling - No. of bedrooms _ ° "own of RUSH RIVER CO TRUNK YY III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers). se , i� 3 1 ❑ Apartment/ Condo " � W? - i 6 , 4S v^D 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 Pressurized Distribution Experimental Other 11 []Seepage Bed 21 [a 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 13. Absorp. Area 4. Loading Rate 5_ Perc. Rate 6. System Elev. 7. Final Grade 450 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 375 "' 1.2 N/A 99.6 Feet 101.9 Feet VII. TANK I # Of r Prefab. Site Fiber- plastic Exper. INFORMA i Tanks Manufacturers Name Concrete Con- Steel glass App. strutted Septic Tank or Holding 1 MIDWESTERN PRECAc T Q ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon 1 I MIDWESTERN PRECA T ❑ 1 ❑ 10 ❑ 1 ❑ ❑ VIII. RESPONSIB \ I, the undersigns illation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) ..r s Signature: (No Stam MP /MPRSW No.: Business Phone Number: BENNIE HELGESON 92 715/772 -3278 Plumber's Address (Street, City, State, Zip Code): W1229 770TH AVENUE SPRING VALLEY WI 54767 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued Issuin ent Signature (No Stamps) Approved C] Owner Given Initial /� surcharge fee) 7I1 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: i SBD- 6398 (R.11/97) 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 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 isto 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. j Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 TDD #: (608) 264 -8777 *isconsin www.commercestate.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary July 08, 1999 CUST ID No.268093 ATTN: POWTS INSPECTOR ZONING OFFICE HELGESON EXCAVATION INC ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identification Numbers APPROVAL EXPIRES: 07/08/2001 Transaction ID No. 234837 SITE: Site ID No. 175993 Site ID: 175993 Please refer to both identification numbers, St. Croix County, Town of Rush River above, 'in all correspondence' with the agency: NW1 /4, SWIA, S36, T28N, R17W Facility: Bill Kropelnicki Residence FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 478276 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 mound area must be deep chisel plowed to help break up the platy soil structure that was reported at the site. • The changes made to this plan on 7/8/99 by this reviewer were acknowledge and approved by the plumber in charge of the project. 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 06/29/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 erard M. swim BALANCE DUE $ 0.00 POWTS Plan reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us WiSMAl2T Code;f3; INDEX SHEET RE CEIVED 35 PROPERTY OWNER: BILL I 15I'H STREET N JAN 2 9 1998 STILLWATER MN 55082 SAFETY 8Lp PROJECT NAME: BILL KROPELNICKI PROJECT LOCATION: NW 1/4, SW 1/4, S 36, T 28 N, R, 17 W MUNICIPALITY: TOWNSHIP OF RUSH RIVER COUNTY: ST CROIX CONTENTS: Page 1: Plot Plan Page 2: Cross Section & Plan View of Mound Page 3: Distribution Pipe Detail Page 4: Cross Section & Specifications of Septic Tank & Pump Chamber Page 5: Pump Specifications Name: Bennie Helgeson Sign e Address: W1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: June 25, 1999 p,Q,W.T.S. Coll i OVER OE F'0.R1 h1ENT Of COMMERC �NGS S�0 AF _ bp N 6 A �ORKE . ()N �fCE p ao- I E; l Krn .0 c-I � S cube_ (� 5 d1o co►t 4 -Y rv rCi"-� 0 9.:' •14. P I00.00 'Top C4 pi (-e- S C B� -----------� - �A a 8 3 _____ — _ i /'Ala 4 er.- 46 / �-, � e o - F PL c_ P �t� ►o��l.a. rv�D�nt�_k� Page_ Of _ i Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H ===_zz yisr_ss= V / q Topsoil P p t 6 l i 3 u Slope Trench Of %- 2 %N Force Main Plowed i 2 From Pump Layer Aggregate Undisturbed D —L-- Soil E Cross Section Of A Mound System Using F 2- Trenches For The Absorption Area G /• Q A 3 Ft. H B 6,3 _ Ft. Signed: I J'7' $ Ft. License Number: J_ Ft. K jo.� Ft. Date: L g3,V Ft. Alternate Position of Force Main --`+ W Y_ Ft. L C /5' F� J � � C Force — Main From W Observation Permanent Pump Pipes Markers Distribution Trench Of Pipe Aggregate 1 Mound Using 2 Trenches For Absorption Area i r LL- � Perforoled Pipe Oeloll 0 End view )Porfo(aled End Cap � o,\oboc `: PVC Pipe j Permanent End Markers m Holes Located on Bottom are Equally Spaced n p Ir PVC Force Alain From Pump / Q PVC [N0 / Monllold Pipe CAY j Distribution... Pipe Loft Hole Should Oe Neal To End Cop Distribution Pipe La yout P 30 R -- S .s 4 i X Y � - Signed: Hole Diameter Inch License Number: Lateral " Inch (es) Date: Manifold " elf Inches Force Main " I g H o les der �Gteva� �N�i��r �l�u. rocs• � L I / L • Page - COMBINATION SEPTIC TANK /PUMP CRAM ER 4" CI Vent Pipe with (No Scale) Approved Cap, +25' ,Approved Locking Manhole Cover From Buildings With Warning Label Attac ed Weatherproof Approved 1 _. .Warning Label Junction Box Vent Cap 12 Minimum 6" Minimum 4' Minimum Final Grade - ; + + 6" Maximum 4" C.I. , Quick Disconnect 18" Minimum Insp. Pipe - -- 1 Weep Hole F 11 Baffles r ' I Approved Joint A w /C,I. Pipe + Extending 3' Alarm B Approved Joint Onto Solid Soil On 6; w /C.I. Pipe I C Extending 3' Onto Solid Soi Off D Conc. Block 3" of Bedding Under Tank Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Daffy /fo`FDoses: / /.�.5' Gallons Volume of Backflow: ... ..•• = 6 Gallons j - eCccr "t Total Dose Volume: .... .... 1 37.1 Tank Manufacturer. N�+ ��� �� r a ons Tank Size - Septic /Pump : - Alarm Manufacturer: Capacities: A inches or fl .?s' aIIons Model Number: + B inches or Z y Gallons Switch Type : M�rs�r + C inches or - gal 1 ons Pump Manufacturer: w - + D p inches or /7 2s Gallons Model Number: Total....._ inches or 5 �•�S�allons Minimum Discharge atie: � 7 S/ - - Vertical Difference Between Pump Off and Distribution Pipe: ,f• S Feet „+ F eet Minimum Required Supply Pres��rFriction 'Factor /100'Feet• + �.e. feet //Ec) Feet of Force Main x _ • Inch Diameter Force Main Total Dyn amic Head: ... = /S,66 - Feet " Li uid Depth 3$ Y 17 6.d. P``- t'c� Internal Tank Dimensions: Length 78 ; Width SS , q p - Y Signature / License Number Date __________ M ODEL: OSP33 SUBMERSIBLE SUMP PUMP MAX. SOLID ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ - MOTOR ■f������� �� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■■■■■ ■ ■ ■■ ■■■■■■ ■■■■■o:.- . ■ ■ ..................... ■■■■■■■■■■. OEM � ....................... ■■■■■■■■■ ■■■■■.i. .................. ■.... MEN ■■■■■■■ ■■■■�I■■■■ ■■■■■■■■ ■■■■■■■■■■■■■ ■■ ■■■■■■■■■■.i■■■■■ ■om■■■■■■■■■■■■ ■ ■ ■■ ...............i.. ■.�.... ... ■■■■■■■■ ■■■■■■■■■■■■■■.i■■■■ ■■■■ - ■....... ■■■■■■■■_■■■■■.i■■■■■■■■■. ■ ■ ■ ■ ■ ■ ■■ M ODEL: . 1 STD. .�. O lid ► � I %\ ■�- '�■��, 25/ ir, P IPE THD. —: c— -. — N Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page — of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code r COUNTY Attach complete site plan on paper not Tess than 81/2 x 11 inches in size. Plan must include, but s (f 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. DO — o94 APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION R D BY 1 �2S� PROPERTY OWNER: ll PROPERTY LOCATION o� c�n�l�r a2 GOVT. LOT 1145 1 14,S T AR 40D) W PROPERTY OWNER':S ILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # //-/9 VS . 1414V 6 3 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD A Z I-11A/ WI- re_ c02-- 0j5 - ) 0' 1 /-3930 �U . 72?A ] New Construction Use [X} Residential / Number of bedrooms (3) j ] Addition to e xisting building j ] Replacement [ ] Public or commercial describe Code derived daily flow : 6eQ_ gpd Recommended design loading rate N bed, gpd/ft . trench, gpd/ft Absorption area required A/P _ bed, ft S "0O trends, ft Ma)dmum design loading rate _hlP bed, gpd/ft .3 trench, gpd/ft Recommended infiltration surface elevation(s) '79. ft (as referred to site plan benchmark) Additional design I site considerations him A kn ,k vP.T Parent material 6; la c: 4 �i /� Flood plain elevation, if applicable 4A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT.-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S RU cg s ❑ U ❑ S ®'U ❑ S Eau ❑ S au ❑ S 2 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 rersdi rkw„ 1 0 - 10 jo P 31 st I .� m sbk m G s m 5 0 sb M Ae C z 4 $ Ground m b k /� sC 5 ' . - �o elev. ft. - N 2 6 0 y ' x © m 171 ) AS -F Depth to 5 �� 313 limiting factor 1r co 6 S o E .8 17fZUG�. Remarks: / S cz err ° .S' Boring # z %h)n 17)'F C'S .Z !y) . 3 a /0 30 Alyx y C1 2 m 56k M f Ground 3 _3 313 z elev. f _ \ v Depth to limiting Z �. a j factor Remarks: CST Name:— Please Print / Phone: � T Se 2 - A ddress: Y Ca ,S -_ ,'neP7,- l 1A1 /S 9q 75 / Signature: Date: CST Number: PROPERTYOWNER / � sm 2:SOIL DESCRIPTION REPORT Pa ge _of t �� � � onto w �/• PARCEL I.D. # Depth Dominant Color Mottles exture Structure Consistence B«� . v Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends s .,. s l -F ,4k -1 M FR -- t� io �e :hex> a �o a o sl r m F2 cs zF' s Ground 3 -2? 1 3 s 1 1 sbk F A 1 .5 el3 ft. -� 1 Q I C9 ! g 5 ►"� /�s I of 7 Depth to ,5� -50 IdyP- �t8 C C� 'ms s► )�) F ` — -- P z limiting fact L 42 L Remarks: Boring # Ground elev. _ Depth to limiting factor Remarks: Boring # _ Ground elev. ft Depth to limiting factor Remarks: Boring # Ground elev. ft . - Depth to limiting factor Remarks: JUN-24-99 01:33 PM P.�a r ST CROIX COUNTY SEPTIC TANK MAtN MANCE AGREEMENT AM OWNS G'!�!!lCA►'lf0��t Ft�t OwncrBuyer .` Mailing Address ?� 5 _ _ I SA s-t J Jor-Lh 4t) 5 age �. 2L Property Address a® .r. (Verification required from Planning Department for now City /State Parcel Identification Nut ft LEGAL DESCRIP'T'ION f Property Location W 1 /4, 1.161_ '!a, Sec. 3ld , T N -R 1 - 7 - W, �� ),d t � Subdivision Lot # Certified Survey Map # 51 15 l g -3 , Volume Warranty Deed # � b S 7i 6 . Volume L 4 3 Z . Page # 2 Spec house d yes Z no Lot lines identifiable P yes C7 no SYSIFrd H6R= Improper use and maintenance of your septic system could result In its premature failure to Handle wastes. Proper raalateasaoe atnsists of pumping out the septic tank every three yeah or sooner, if aaeded by a licensed pumper. What you put into the system can affect the Amotioa of the septic tam* as a treauneat stags In the waste disposal system. T'he property owner &&roes to submit to St. Croix Toning Department a certification forth, signed by the owner and by a masterplumber, journeyman pl=ber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in prpper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank Is lass than 1/3 full of sludge. Uwe, the and igaed ve read the above requirements and agree to amintaiatte private sewage disposal system with the standards set fa , jkere as set the Departws at of Coati n=c and the Depart r at of Natural Aetouft", State of Wisaoraai*n. Carttlo. itioa scat ha your S s tear has been nuintained me be Narhlsd rill sshMd to the St. Croix County Zoning Office within 30 d y three are d data. D Sl ATVRE I.IC 0 I e) cc that all tements on this form are true to the best of my (our) knowledge. I (we) am (are) dw owner(:) of t e describ above, by virtue of a warranty deed recorded in Register of Deeds QfRce. �q SIG APPLICANT DATE • + +• • • At.y f=4wrmat/on that Is Hug- roprasanted, may n atift le the dialtsri' pelslltt bttstt tswlaed by tba Za"hw VeParl,r,eal. ooa're• •• r„Clude w1el, till• applleatlaq: a etfikm 4 -91 wOrrani deed froin for Assists of Pooda offloe 6 Gppy or the oortt3ted auwey map It ro[brenae a Made In /lee warranty deed N � � l I11'K' ;. 'r ':' r M i✓X � ICI .,w..w r .� FROM HALLE BUILDERS INC FAX NO. : 1 715 463 1341 Jul. 13 1999 03:42PM Pl 1V11:lI1WWW 1b::I:i ll'5 k*NA?.!6CM-')&Ii.fV: PAL+. U! U7111/99 MI 11:10 FAX 919 310 $$pj NwI9TEn v Dabs Lap wt �4t37►,��60 'Ad Tx LO N. OffA nW std Sofa K. A undeaon, husWW4 wW *, oonv" I FIR 1111W1 and skrt-11 Wipiam J. KMpothi0i, a #� nom, to N04,i rp , aFfllislf fa�0a rr dtsaoo WW rw **We In et Croft Etuta orwimnsn, vM no lit a.ar ttRt jO.N +nw of m Yf111 " 012 PART CIF THE MOR'f HM8 QUARTER OF THE SOUTkWUT QUARTF4 (Nw it or sw Y.) OF Sa:C MH THI Y SIX (If9). YOMINIF TIND Y.CGHT (2W, RAN4E SYVEN'TleEN (17) WEST, TOWN OF RUSH RIVER. COUNTY OF 37. CROIX, STATE OF WISICONVIN, AND OB�R M RESPWTIN MY, AS FOLLOWS' LOT ONE OF COt'fW%D SURVEY MARK FILW NOVEMBER W 1 00, IN VVOWME It 00 WATIFIED SAJAVEY WAPIL PAC! MT. AS OQ LW"T no• 44141M. OFFIM OF THE 8116111 IVIR Cw t>tiE1 Q FOR W. CROIX COUNTY tMl1110566SW Eva km b worranow as 0090IMM ena r•etlletiats of hoard. This Is not fn(atteetraeprvperW. Qededdt y low. Ra!t nv9Rwrits wotUu�vnaalawlRrer i 7Erufun( 9TA1V OP sNtAWIMI ST. CROIX OWNTr 4% O -- — s 19oD absvaeemw �f wAraW ruR►/nlfaleeR alit T tlry M _ _.� _. e s w GwdMw m air mom 10 of the pomw4s) wow au SM0 *4 Itsfrtntent ass faertgtAW i!r eem arpr nrw �y TIhZ: MOMER f)T'ATE GM OF W1300NOW w of net, Noshc R. GrtiK t,�runsy, lNllpoltl n. }dart ig wMrisdano4sm rataMoa dills•. q*w Itid'f11sM11kf Wa bfrsF GY d/ J ( & ` T*nm A. MaCavock 9wnw r wwr.y+y w w y w«4+r.uw y. rrHe a. n.Idw:w M 5490 A P] DIP nIl�,/..Mr 4"Aw.l rwdl„1: W.,9r11T WO'6i5'1'J!1 ROM ,: _ _ FAX N0. May. 13. 1999 11: 06AM P6 L,+" &U4 J cutwa+, KL r nuu5�,w wla�urvbarv; rope v C21- BRLDWIN Fax 715 -6£4 --2615 30 '99 12:23 P05 r CERTIFIED SURVEY MAP LOCATtD IN PART OF THE IVW1 OF TftN Slffe4 OF SsCTI01Y 36, TW, A f ?W, 7 OF RUSH grVFJ?, S7: CI;OIX COuN7'Y, A'lSCONSIN. OWNER LEGEND LYLE GUNDERSON • 1' IRON PIPE FOUND 149 HWY. 0 63' BALIMN, WI 5*4= 0 V X z4 IRON PIPE SST WEIGMINQ 1540d'Z' 1.66 LBS. PER LINEAR FWT ATE ROADWAY SETBACK LINE (AS SHOVN) I IRON PIPE f'(Mt) W46017100 X STEC(, SU RVEY KARKER SET 0,65 FEET FROM CCWQTEb POSITIQN FROM SECTION COIRNER TICS 0 11AI1_{70AD SPIKE FOUND a t� WI /4 CUR, A SOIL TEST SEC. 36 �° G V 4 CUR r r S9 n SEC. 36 Sq2 iB' EAST - WEST 1/4 LINE 90 0 00 00`E 413.37 e © 1 .- ' YY' " LINE DATA TABLE .. o cs "BER DIRECT DISTANCE ` 590.OQ'00'E 66.00' l ilt LOT 1 "�' S90.00 66. 4.)01 AC. S00.33 01 W 33.00' 174,26& 90. PT. %a Sg0'00'b0'E 65.00` . 164 AC. EXC. RW .a. S90 66.00' 164,911 SO. F7- N00 "E 33.00' ; S00 33.!10' 0 UNFLATTE40 LANDS S90 `00'00 "E 904.04' r. a • 9u 3a5 • u • LOT 3 R1 r m 664 3711 O. P T. Z LOT 13.2 AC. EXC. RV QD 10A00 AG• `r 662,133 S6. FT, `. 433500 bCt, FTC f � V 9.950 AC. EXC. RV 439.422 SO. FT. • 767.87` 52y.b4' SOLITN L1NE OF THE N89 "W 1314.91' uu1 is r1r tur tut iA r i s t w / ps K b c co - o A y i o �n I ..o F �1 # a b 0 cn l I IJ I QL rt i t'► i t I i i i 9 t i r . i { r r