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HomeMy WebLinkAbout040-1044-20-000 V G, p 3: O eo O e» Ui 4 q C r. 0 O ' N o ' ' I C �4 I I O m z _o 0 O C z - LL c O Q 3 co w Z z • o 7t . 9 c z `m a o N Z a m 0 O z c T � el• U O fA F- e'• O p_ N z C m E 'Q N Of N � N I N C N tU • O q ►•rl d iu s O V o 4- Q �i z S z Q c O N N l0 N W d m A w d ct O O O O O o G G m E E N N .- _w O O tv Q O y z � p H F H O E N N *a� O O O d H z o 0 •r.a • @aaa c N 0) 0) (A J U rn rn O O z N (D A� N N O N N 7 N N LO f` d Q c+3 7 O . O O N C O CC O� O Oq C 7 Ccs O O O LO O N � O N r a N N N N t+�y - 7 H ' �I N >+ O O In 4i E v� `w (D a t n L a w 2 c c Zb 9 f ST. CROIX COUNTY ZONING DEPARTME r AS BUILT SANITARY REPORT Owner / d 4 4 �9° Property Address A 7el c /ar U; ;`�, ST � ROX TY City /State COU114 ,Y ZONINGOFFPfax Legal Description: �� - .� ,� �. VL - 1�4 A�9 Block Subdivision/CSM # 4, Sec. T Z&N -RAW, Town of 7 MV PIN # © SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION OrNn ,4:o 41AW Z,Q6c/ ' % ki P lGa Z� Tank manufacturer c��e� C, _ Size ST/PC � Setback from: House `� Z Well PAL Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road en h air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: - 7�hG4ch Width 3 Length Number of Trenches 3 Setback from: House � 6 Well 9 , 5 P/L Vent to fresh air intake toe Sides tar��i r`�J! �, ELEVATIONS Description of benchmark /vt� %sue _emu rt' J;K -/ Elevation Description of alternate benchmark Elevation Building Sewer ST/HT Inlet V5, 70 ST Outlet 2/0 PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lmes J ( ) Bottom of System Final Grade Date of installation ?1 /� Permit number State plan number Plumber's signature 1 A nk. License number 7� �i Z �/ Date y/ 2l c l Inspector L Complete plot plan � r 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 t N O M O a t tA / f . { 1� ' 1 INDICATE NORTH ARROW Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT SY 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)]. � 1 515 Permit Holder's Name: r ❑ City ❑ Village Town of: State Plan ID No.: %rte CST BM Elev.:- Insp. BM Elev.: BM Descrption: Parcel Tax No Qo • o' 1 00- w t Z" .�,.Qrar t 1 64 1 o q ZD —Od o TANK INFORMATION U SO"A "' EVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - Benchmark b r8 toe, q. 9 Dosing �< < ` `}-�E . Bwt (. o Aeratio Bldg. Sewer Holding St /Ht Inlet b�lo ::V TANK SETBACK INFORMATION St/ Ht Outlet �Z- , /�- 45 S O Ventto TANKTO P/L WELL BLDG. Airintake ROAD Dt Septic �� aq s 32 . NA Dosing > t V�D p NA Header / Man. Aeration NA Dist. Pipe s . 3 �'33r . up ct v " o Holding Bot. System 92. PUMP/ SIPHON INFORMATION Final Grade 3.92 3 98 , 66 — Manuf urer Dem nd TC 3 �s� / 3 . y6 9 ot. / Model Numb GPM TDH Lift n System e In . HH II stem TDH Ft Forc Length Dia SOIL ABSORPTION SYSTEM, Ska(CI RENCH . ) Width Len No. Pf T ches PIT No. Of Pits Inside Dia. Liquid Depth DIME 3 •SO 3 j I DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING M -i �t ctyr r: INFORMATION TypeO CHAMBER ModelNuGmber: System: C,l �!'� C r F5 �� OR UNIT � DISTRIBUTION SYSTEM Header / Manifold y Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Lengt 4� Dia Length paung 1 (5 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 E] Yes [] No COMMENTS (Include code discrepancies, persons present, etc.) LAIL Plan revision required? Yes No M � � � L 1 2- 9 Use other side for additional information. Q 1 23 11] SBD -6710 (R.3/97) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ° ! ° t F a € F ; r z S i r ° i r e �. ,....�... _ -- �".... ... ........ .....�,.., E^-- ,� .,.. .. ... ..,-�. y..m m �:° ..tea` � 1 i } i t ,>....° .gym .m .,°.� °° as ..-� � ,, ,.,. _ „° _. .. f } E i e £ } � 7 ; i E r ° m i 3 e !. i E "i i i .e.... e a 3 f w t �. ., _..w.. °.,.rte °w °�. � °,,...eem °� ® n ,.® 3 � ®��.?� m e4-. �, _, a• .em., ...� S { r ° F t t ,- € t � d} i e 3 } } i P i t µ E 4 3 i { d E S a E E N...... , w, .... e. ... _ . .�...., a . . < e._ ... < �, < . ........... .... ................. . .. .... ry ... . ,.� . e... ....,..,L , ..... , ,.d.,.e . ....W.._ ------ ,. , ,..._._ , _ , a ._,d ....- ,._d.,,�....a °.e..... ..........«. gym. V i sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 B 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 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Number Personal information ou p rovide may be used for seconds y p y second purposes El if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property ner ame P operty ocation l�t /a V A, S /0 T 28 , N, R j (orQV Property Owner's Mailing Address Lot Number Block Number az�c, -- -- City, St a Zip Code Phone Number Subdivision ame or CSM Number S ( 7 — .6 'v re fJ II. TYPE OF BUILDING: (check one) ❑ State Owned it Nearest Road ❑ Village �— Public R 1 or 2 Family Dwelling - No. of bedrooms Town OF Ler T/a c_a 111 BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) f 1 O, 28 . 1 ILAc A 1 ❑ Apartment/ Condo 0 VO - l S" �- z<� 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. Q New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an - _____System ________ System _ __ Tank Onl�r______________ 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 121K Seepage Trench 22 In- Ground Pressure � 3X / 42 ❑ Pit Privy 13 ❑ Seepage Pit �,,. .��,►c ,' 43 ❑ Vault P ivy 14 ❑System -In -Fill 111' // A 3 VI. ABSORPTION SYSTEM INFORMATION: IF 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. ? El 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft_) (Min. /inch) r evation UiG 7 3.'— Z 3 Feet 08, $ Feet VII TANK Capacit INFORMATION in all0 S Total # of Prefab. Site Fiber- Exper. New Existing Gallons Tanks Manufacturer s Name Concrete st noted Steel glass Plastic App eptic r Ing Tank T Tanks El 11 1:1 1:1 1-1 Lift Pump Tank /Siphon Chamber 7 U v(f J El ❑ El ❑ El ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Name: (Print) Plumber's Signature: (N)Omps) MP /M P RSW moo.: Business Phone Number: '214— 7 7 2 — 321S4 Plumbe s Ad ess (Street, City, d C State, Ip Code) � IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved I Permit Fee (includes Groundwater D ate I ssued Issuing Agen Pgnature o Stamps) Approved ❑ Owner Given Initial r Surcharge Fee) Adverse Determination S 6 L X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 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 may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. _ If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, 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 bui ►ding 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 *mber is to fill in name, license number with appropriate prefix (e.g. MP, etc), address and phone number. Plumbermust 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. JOB TIMM EXCAVATING S HEET NO. OF Z Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY ✓ ��� DATE Z / (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE _ po i SCALE ..... ... .... .... ..... .... ..... .... .... .................. <.... . ....................... >. ..... ... ..... ......... <................. .... .... I .... ..... .. ...... ... <. $ ........... .. ... ........................ ..... .... ........... y% ...... . ... ........ :... .... ..... , ...... .. ... �, ..... ..... ........... . ... I...� .. .... T ........... ....... F. ....... ... ..... ... 0 ..... ......... 0 ...... .. . ................. . .... ... ..... ... ..... ............ .......... . ..... t ........ �ec. PRODUCT 205-1 Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1- 800 -225 -M JOB TIMM EXCAVATING SHEET NO.- OF Z Route 1 Box 192 � WILSON, WISCONSIN 54027 CALCULATED BY �/ r-- DATE (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE Fl f t 11 t .......... I . ........ ........... ...... . .......... ........... .......... ...... ... .......... .......... I ............ ........... ........... .......... .......... . ........ .......... ;n! ..... 1 .. :.... : ....... 14 ............... 7 Alln._ r L .. ... L fi , _ L, 4 t 3 . kv- . ......... ............ 17777 I - tn - t PRODUCT 205-1 Inc., Groton, Mass, 01471. To Order PHONE TOLL FREE 1 -800- 225 -M Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildngs 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. APPLICANT INFORMATION PLEASE PRINT ALL INF TION R EWEP BY DATE PROPERTY OWNER: � VJeD �T�A �� -U`R+ ►� �rcT'6 ; ERTY LOCATION %01-1 LZ P,Qz) I lU 1/4 N E 1/4,S 10 T Z8 N,R l R E ( W� PROPERTY OWNER':S MAILING ADDRESS LOTS# BLOCK # SUBD. NAME OR CSM # L°SM CITY LST TE k� l 5 4 u � E PHONE N EA _ ILLAGE ®TOWN NEAREST ROAD � , ( ors) 3a6 -_ ,�'� S g C IT '.. IY Cov �L htl}i L- [�Q New Construction' Use [ac] Residential ! Number ofbWWM" ` y [) AdditiQn to existing building [) Replacement [ ] Public or comm0oal.deWibe Code derived dairy flow 60o god `' "omre Ign loading rate bed, god /ft trench, gpd/ft Absorption area required 8 S S bed, 1 - 15 0 trench, ft Maximum design loading rate '"I bed, gpd /ft2 6 trench, gpd/ft Recommended infiltration surface elevation(s) 9 O � It (as referred to site plan benchmark) Additional design/ site considerations 3 'TUk)1JoAt15 - Nytetf 3 "x sue" w/ Ytl Gt� if-I l LZfVQJ4 CH 12 R s Parent material L 4e s ov N S F �. g G t y t5 - Flood plain elevation, if applicable N R ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U= Unsuitable fors stem 0S ❑ U I 9S ❑ U MS ❑ U ®S ❑ U EIS ®U [i s ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bour>dary Roots Bed jTw& {^ [ -9 I o `12 Z L 2 - s i l z�F s�1� '�h aS - s b <Y: J. Ground S s� h1 1 C S — •� `� 9 ft )0 -m S it 61- 0 S9 Depth to limiting factor T �o. { loG Remarks: Boring # ) o, -q ���� - i✓! Z — s i 1 z -F��>t v,-A, Z 1 � K 2 31 6 S I) Z`E' S �k Yvl`�1,- GS - 3 z, S 'I k 31 y — G � Fs b S 4 I cs Ground - b elev. 4 Zo'. �Iz t o �-1 R V/G - S �t Gl_ d S5 t, ° ) - qq.S It Depth to limiting factor ,< < > �Z o Remarks: TName:— Please Print Arthur L. W e e r e r Phone: 715-425-0165 Add ress: egerer Soi Testing & Design Service -P.O. Box 74 River Falls,WI.540 22 Signature: 6 7- - �(S Date: 3 _ : �, - L ,j CST Number: I 220254 PROPERTY OWNER R►� IIQG SOIL DESCRIPTION REPORT Page? of 3 PARCELLD.# Oy,o - 1(3y,4 - ZO Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bo Roots Bed Trench 1 0 -9 ztz s it Z�7bk r1`fr �S .s .6 Z R_ b ltwi 2 316 Ground 3 6o - Z S`t2 31Y -- S ai6► Sq M� CS elev. 9 • l ft. L/ p _ �Zp 10 Y1 0 S 9 Depth to limiting factor } L - Z.Z , v Remarks: Boring # y Z 1D -q s i J Z� s ►vL`FL 0 -S -- • S 1 l � 0 `1 R 3/( ` s i 1 Z'� sbk y ,•, �, cs . s . l 3 41 -80 SLi 3r y — s�Gl C) S 0 wt) — •� -� Ground el�v: y go -\zo 10 L/ v- VA - S asF o s9 1 — •� i - g q S ft. { Depth to limiting I factor I > l'Z-O t wit Remarks: Boring # U - O`-t lZ - 2- S Z I I_ S 3 l v R. 3l6 � i t Z'F S b k yy1'fs c_S ._ • S - 6 3 S3 _ � 3 =t • S �1 R 3J y : S p S g yn Ground elev. Lf - 7 3 - 9L. 6 ft. Depth to limiting factor IJ3. Remarks: Boring # i Ground i elk ft. ' Depth to limiting factor Remarks: PLOT PLAN Pa 3 of SCALE 1 PR- opos�p lA'T l.)�u� �i 0E > S ' Fv2p w.l •� 8.1 SO' B •.r �w1tfZ r N) � V. f'lR w12 IK)rl HL f'r A Ltri,F}TE `� f�1 C ltS__ s.s r*ti. 9 8 6 6 S , 3' Lwc I �-�W-X4 CC'1y�1�3�ZS . 13o1'TOY"� N N a F= 's1�t,'sUG.f� 't0 BC ttT' I g:3 ei Re 3rliN ia-Ib o" oh, �z "'�fi16�, �ly"Dlt1. fi 13 QL. °1a.q' a-t - ) " "I (SH, 3 /v 0 �ZC- -aer►z w /LF�TN _ -- o 't-bvSE Z0 8E AT UatiST Z FP-6H i12��►CP,S WEL N 4 k + So K � o•$ �i Tti � - 7 � (715 ) 42.5 - � 5—_ 1400576 CST Signature Date Signed Telephone No. CST # Wisonsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor V Human Relations Dnnswn of safety 8 BuikSngs in accord with ILHR 83.05, Ws. Adm. Code COUNTY c, R.o 1 X 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. If dimensioned, north arrow, and location and distance to nearest road. (3 LID - Wq4 _Z0. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVI DBY DATE I PROPERTY OWNER: 'F-1?2D �'Y q XR-L'r � N►vts tAj 6 PROPERTY LOCATION QV`1 LZ -_ Zf �1 4 fNlup 1 IU G GAV. 1Jw 1/4 N t; 1 /4,S 10 T Z8 ,N,R I o t E (o W� PROPERTY OWNER - .S MAILING ADDRESS LOT If I BLOCK # SUBD. NAME OR CSM # 4 33 t-4rvY 3 S — — w�v s CS" CITY STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ®TOWN NEAREST ROAD L I sgedL ('715).38L- S66 S Tito Cqv LLZ -ntPti L_ [>4 New Construction Use Residential / Number of bedrooms y [ J Addition to existing building J Replacement [ J Public or commercial describe Code derived daily flow 6 0o gpd Recommended design loading rate — bed, gpd/ft ' _ % trench, gpd/ft Absorption area required 8 S g bed, ft -15 0 trench, ft Maximum design loading rate '� bed, gpd/ft g trench, gpd/it Recommended infiltration surface elevation(s) °I .O ' it (as referred to site plan benchmark) Additional design/ site considerations 3 `rtt C - Lf 3'KsU" w/ m Gt4 C-0�RU7`l LAY Qtt C"" Takms Parent material Lo e ss ovttt Sf�i� tl G%'�_A y Lit- Flood plain elevation, if applicable N,R • it S = Suitable for System CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDMIG TANK U= Unsuitable fors stem 0S 11U 0S ❑U NS ❑U SS ❑LI ❑S NU ❑S NU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Boots Bed terx� z a- 9 t o-I 2 Z! zT sb wt'�h S Z R -3 y 10 �i tz 3 ! ` — s ► I Z`Fsbk h1 �1 - cS — . S J. 1 Ground S`lZ •3Ltf — �,t- �S o g� Yv1 J C S — •, '�' elev. ; -g .9 It if 60-Na ,10 '1 fL LIA d S9 6►t Depth to limiting factor Remarks: Boring # I - 0_9 1.o�t� z,lZ - s i 1 z-F��>t w1`�. c$ _ , g ' •� toLt fL31C _ s ►J Z'�S�k 1v,`fj- CS . 1 • 5 i •� 1 3 31 Y 1 G�- •Fs S `� Yvt CS Ground elev. y 1 lo VA, - S O s g I _ • -� q9.S fL Depth to limiting - factor�,� Remarks: TName:- Please Print Arthur L. We erer P 715- 425 -0165 egerer Soi Testing & Design Service -P.O. Box 74 River.Falls,WI. -54022 Signadxe: ��+ 9 q_ S Date: 3 2 q c CST Number: h2,' �Z 220254 PROPERTY OWNER ��1.IVG SOIL DESCRIPTION REPORT Page Z of 3 PAR EL I.D. # O q O - * \U q - ZO Boring Horizon Depth Dominant -Color Mottles Structure GPD /ft 9 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Baxid�y Roots Bed Trench 3 1 0 - 9 2 4 z — S i 1 Z. `¢7 mfr �-S — -S . 6 Z 4 - b LO`-t tt.. 316 - S 1 1 1 w►,S� tiz m'Ft• cS •� . Z . 3 Ground 3 60 4g0 - 1 S`i2 3 I — S Ec& O S4 elev. ft. L/ p _ �Z.p l f� � R Vl ( - S' d Ci l- O S 9 Yv►� . "7 . �3 Depth to ; limiting factor i > l ?1J Remarks: Boring # 1 o -to 10��z zcZ 55 1 Z� s1,� ► s S y z to -u43 l o�►rz 3/6 — s!� Z� bk mfr cs -S' -L 3 Ground u$ -go �.S�rZ �y _ 5 d61� O S9 rn) �°S 1 •�' -� i eleV y gp_�7A ft. t b Lip- VA - S ash O S9 i Depth to limiting factor > l?-0 Remarks: Boring # 1 O- ► I L0m6Z 2 (L 'e, 1X l•,.ti'�1- �s � , S � - b 5 Z l I- S 3 1 v` R. 3l6 i t Z'F S i Ground 3 S3 , � 3 � • S �f R 3l y -_ 5 $ 6 �. � s � y 1 cS — . -t ; , E� elev. y � - t 6 L v 2 U 16 - S it G}- G S rvr I •'Z . ft. Depth to limiting factor j >'ctb" ___ I Remarks: Boring # t3 ti Ground I elev. ft. Depth to 4imiting factor Remarks: PLOT PLAN Pa 3 of SCALE 1 P�wnoseq �T �.t�u�`3 >U 6� > S - PtiZ01..i o- q$ r NI a Pp..7�) A �-�►uA TE TCt-�► �' -11�s_ . g.s t*�. 9 8 � 6 'r� uv g•v S _ �- �hfiUiv S StfpUti 3!"1#FI i1.l0U.ti OrV l6ti, 3lcj ° Dlti- _ 2E -�3+� R w / LrifiH ''ttlGH, 3 /y`D Iii . NvvS E lU @E AT U-- "LS FiU H - M& - v - M , ,� o • 8 � i lv (715 ) 495 - 01 69 i4 00 5 7 6 CST Signature Date Signed Telephone No. CST # I w ` ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address t9�✓` „son ®c ;� Property Address (Verification required from Planning Department for new construction)_ V T City /State Parcel Identification Number LEGAL DESCRIPTION _. Property Location WwJ 1 /4, A/ l /4, Sec. ILA , T RN -R W, Town of Subdivision Lot # Certified Survey Map # , Volume . Page # Warranty Deed # S 5� 1 , Volume ,C/d S _, Page # a �� Spec house ❑ yes P* no Lot lines identifiable M 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 masterplumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, 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. SIGNATU 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 bove, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA7 F 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 IL - - yy �., r.- :u:ar�:s ._.v „ sau . .rs., - ._�si�.= .._.. _arses- -r_z— .'�::..rn'.: ss= �_:ra:.__«--- � :.-.•. —_ ;-. _ - a.- ..:- :�:s... -..ti. � -:... - �.- ...�v ^�_r }b DOCtitdEtlT STATE EAR of wisCONSM -FORM 2 WAM NTY DEED , ` JAIS SPACE MEAVE 9_ Y Wl ' XfCtWt)1hG bATAI - 1 52 — REGW R S OFFI Raymor:d F. Andin , a/k /a Ra�_F.. 4id ing s and ST.CRC�XCA..VN -- �. 3 i�ng, us anc a nd wife. - - R w'd1wReca D p -- - _ _EC 9 1994 k conveys and warrants to Frederic E. Md in,g_ 8nd 8:30 A - Ruth M And in$ husband and wif_e_ aG cur AY- r shit) marital oroDery� or uard TO •-•- the following described real estate in St Croix _ County, s State of Wisconsin: 1 The NWk of NEk of Section 10 -28 -19 EXCEPT - Commencin at the Nk corner of Section 10- 28 -19; Tax Key No. thence SO 10'E, 660.10 feet; thence N89 °50'E 33 feet to point of beginning; thence N89 °50 E, 330 feet, thence SO °10'E 660 feet; thence S89 °50'W, 330 feet; thence NO °10'W, 660 feet to point of beginning. AND EXCEPi a parcel of land located in NWk of NEk of. Section 10- 28 -19, Town of Troy, more fully described as follows: Commencin„ at the Nk corner of said Section 10, thence go SO °10'E along the W line of said NWk of NEk a distance of 660.10 feet; thence N89 °50' E a distance of 33.00; feet to the point of beginning of the parcel to be herein conveyed; thenc continue N89 °50'E a distance of 330.00 feet; thence SO °10'E a distance of 660.00 feet; thence S89'50'W a distance of 330.00 feet; thence NO °10'W 01 a distance of 660.00 feet to point of beginning. (This being the same r. exception as above.) AND EXCEPT that part of the NWk of NEk of Section 10- 28 -19, located in Lot 1 of Certified Survey Map filed 5/26/76, in Vol. 1, page 240. The SEC of NWk, W� of SEk, the West 5 acres of SWk of NEk, all in Section 10 28 - 19. All of the SW} of Section 10 -28 -19 EXCEPT Lot 1 of CSM filed 8/22/78, in This _,_not homestead property. Volume 3, page 656. is ( ) (is not) , Excep isrrant. (This deed is given in satisfaction of a Land Contract dated 1/29/79, recorded 1/30/79, in Vol. 589, page 30, as Doc. :'..;. 354809.) December < rr 6th da Of— . 19 94. I"t LN':)r 1 ” Dated this 1� nX4 1 [ (SEAL ,. 244 LX . ,. d .. ±' � s (SL.+i.) R F. Ading _ Edna G. Anding- — (SEAL). _ (SEAL) AUTHENTICATION ACKi' OWLEDGMENT ! Signatures authenticated thi 6th A n y of STATE OF WISCONSIN December 94 as. County. Personally came before me, this — day of y C. L. Ga lord _ _ - the above named TITLE: MEMBER STATE BAR OF WISCONSIN aut horised by li 706.06, Wis. Stats.) This instrument was drafted by -- C L. Gaylord Atty . to me known robe the person_. rho executed the fore - 9 R iver Falls, WI 54022 going instrument and acknowledged the same. 1 ( Signatures may be authenticated or acknowledged. Both are not necessary.) Notary Public — County, Wis. My Comm: io,::s pe:,nanent. (If not, state expiration date: ' 19 — ..) p, --- WAR-.^?NTY DRLD -•'r ATS BAR OF WISCONSIN. 'FORM XOU 2 —r4T7 `