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HomeMy WebLinkAbout042-1033-80-000 � . .. ... . I ¥ ! w K 0 � L ( � � b KE &CL k +/� A 7 - C J . 2 -ƒ 7/c 2 S°�« W © =a §k§= ®o =Nc z $_ Ln n i % z C' . LL ca — 217 � ga2b/ � 74+2 . � 2 2 § I Z § % a § \ 1 a m \ b . k § ) � z e E \ o E Cl) E 5 . b 4 ± \ Q }zz ) , z . , § \ 2 g 0 § . W e _ a §kJ k\ )0 c g ■ ■ / D co EL z ) \ 2 a a t a k o B � u k $ � D « } 3 , ; 2 cc � , a � k § % 2 I = E f \ 7 f » E c ) § § 5 , = e n .; m k§ k /\ o z/ i / ;7 2 a 0 C4 CL. $ ) B % / J a 2 o k 2 I Parcel #: 042 - 1033 -80 -000 01/03/2006 04:34 PM P 1 OF 1 Alt. Parcel M 13.29.18.199A 042 - TOWN OF WARREN 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 F J & DELORES M TRUST SCHULTE O - SCHULTE, F J & DELORES M TRUST 969 140TH ST ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description * 959 140TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC ? /, J 6 6 / Legal Description: Acres: 19.980 Plat: N/A -NOT AVAILABLE SEC 13 T29N R18W SW NW EXC PT TO CSM Block/Condo Bldg: 10/2732 & EXC PT TO CSM 13� Tract(s): (Sec- Twn -Rng 401/4 1601/4) � 13- 29N -18W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1171/414 QC 07/23/1997 406/615 WD 07/23/1997 406/615 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 79136 Use Value Assessment Valuations Last Changed: 07/11/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 37,500 226,700 264,200 NO AGRICULTURAL G4 17.980 3,200 0 3,200 NO Totals for 2005: General Property 19.980 40,700 226,700 267,400 Woodland 0.000 0 0 Totals for 2004: General Property 19.980 40,700 226,700 267,400 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 206 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY ZONING DEPARTMENT ' AS BUILT SANITARY REPORT I rA� Owne r Q S G Property Address �1 5"' 9 City /State (01 Legal Description: 3 Q © f Lot 4w& Block Subdivision/CSM # '/4 ul '/a Sec. T �N -R Town of at ti PIN 2 ` L lam, � � SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMA► Tank manufacturer Odic: Size ST/PC A00 Setback from: House Well ! 03 P/I. 2 4;k' Pump manufacturer Model `r' S Alarm location 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 5 Length 7;; Number of Trenches Setback from: House Well fyS P/L �QZ Vent to fresh air intake 100 ELEVATIONS Description of benchmark 1 A - -1 /P PUL P ` P� � Elevation Z , 0 6, 019 Description of alternate benchmark a Elevation l 3 B 4/ 3 Lot 0 Building Sewer 1 63- 8 S ST/HT Inlet /o '; 1 , 3 S ! ST Outlet t O f �' ! PC Inlet PC Bottom Header/Manifold / 3 Top of ST/PC Manhole Cover E' g Distribution Lines Bottom of System (} 16:2, 6 O ( ) Final Grade Date of installation / / Permit number 3N State plan number / 90?2 O Plumber's signature License number Date/ Inspector ,� Complete plot plan or I I 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 a C� ! d3 O � INDICATE NORTH ARROW ` S � I Wi,�corAn Department of Commerce PRIVATE SEWAGE SYSTEM County Saltty and Buildings Division 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)]. 353230 Permit Holder's Name: ❑ City ❑ Village l3 Town of: State Plan ID No.: Schulte, Fred Town of Warren CST BM Elev.: Insp. BM Elev.: B Description: Parcel Tax No.: Z 042- 1033 -80 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic G�GR ] L ��d Benchmark _ . 0,0 (OD, d Dosing `� �� Sv Alt. BM 3_ e Aera i Bldg. Sewer 4 Pq l 44 Holdin Ht Inlet ANK SETBACK INFORMATION y Ht Outlet a Z o 0 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 13, 2 ,5e Septic > L/0 r ^/,+ �J NA Dt Bottom la f Dosing r NA Header / Man. d �, - 3 Aera ' A Dist. Pipe Holdin Bot. System (a - PUMP / SIPHON INFORMATION ` Final Grade Manufacturer 1 Demand St cover 3 9 0�: Y Model Number �� Z�GPM czp Z. 00 TDH Lift Friction System . TDH Z Ft r Ih-if ea Forcemain Length Dia. Z Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Len No. Of Trench PIT No. Of Pits Inside Dia. Depth DIMENS 7` DIM N SYSTEM TO P/ L BLDG WELL LAKE nufacture /STREAM LE r. SETBACK CHAMB INFORMATION Type O Mo ber: System: 3 z /v /V OR T DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size FSPacing Vent To Air Intake Length Dia. Z Length f Dia. / Spacing L� (� �� ��� �� 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] ;N COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: iI /17-/gq Inspection #2: j/ Location: 959 140th Street, Roberts, W1 (SW1 /4. NW1/4, Section 13 T2 N -R18W) - 13.29.18.199 i- Cv 1.) Alt BM Description = � �,,, ; � (� '�P .�' a , Y ._, �-- (o rtad ��• � r 5 ec�a�r� Wa �h �� l.�r�.a� 2.) Bldg sewer length = �7 ' (o rfs� A ivew4 - amount of cover (,,� iac 6� j �,C� ll I„ s c ol e,,,( ` 3.) Con r = �G c i, 9 t urf 11� = (/o • �� `� loo well arr & sa ai r,( ° =� -/ Plan revision required? []Yes ❑ No l f Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. i Safety and Buildings Division �• ■�rir,. SANITARY PERMIT ►iiON '` - Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR $3. Wjs :Adm Coo P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the s stem, on paperrlot less Cours."y than 8 112 x 11 inches in size. -- " } • See reverse side for instructions for completing this appllation state ni ary Permit umber :. ST ;t you provide may be used b other g overnment agency ro ipms MiG0 U y p y y g g y p q ��+G , ❑ Check i revision t� The information gErous application [Privacy Law, s. 15.04 (1) (m)1. 11 !`" State Plan I.D. Number I. APPLICATION INFORMATION - P LEASE PRINT ALL IN R MATION Property Owner Name --erope tion � [ 0 5 e T ;1Z P , N, R JA E (or Property Owner's Mailing Addres �� Lot Numbers / Block Num �� City, Itate Zip Code Phone Number Subdivision 4 me o CSM u tuber IL TYPE OF BUILDING: (check one) ❑ State Owned nit Nearest Road Ci Public or 2 Family Dwelling - No. of bedrooms own of KJGLG` r ni. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo G 4 ;L — 10 3 3 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. w 2. ❑ Replacement 3_ ❑ Replacement of 4_ E] Reconnection of 5_ E] Repair of an _ __,System ________ System ___________ __ Tank - nly-------------- 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 Pressun d Distribution Experimental Other 11 [:]Seepage Bed 21 [ ound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy Vault Privy 43 au t 13 E] Seepage Pit ❑ Y 14 ❑ System -In -Fill u S — ID I- 6 VI. ABSORPTIONS STEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 1 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation IS 37 7S_ 10 ;% 6 %eet /OV -W Feet Capacit VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank lope ` t /►� Lift Pump Tank /Siphon Chamber VI11. RESPONSIBILITY STATEMENT )P I, the undersigned, assume responsibility for installation of the onsite sewage s stem shown on the attached plans. Plumber's Name: (Print) Plumb 's Signature: (No Stamps) MP PRSW N : Business Phone Number: c � - 791 —7f9 — 3 Plumber's Ad ress (Str et, City, State, Zip Code): k9 - 7 ZAJY 4!�P Sr "0 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved 0SItary Permit Fee (includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) �A roved Surcharge Fee) Ap proved ❑Owner Given Initial � Adverse Determination X X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. OS /94) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Diw ion, Owner, Plumber Safety and Buildings , . PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 www.commerce.state.wi.us Visconsin Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 22, 1999 CUST ID No.226375 ATTN. POWTS INSPECTOR ZONING OFFICE ROBERT W ULBRICHT ST CROIX COUNTY SPIA 655 ONEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identification Numbers APPROVAL EXPIRES: 09!22/2001 Transaction ID No. 248096 Site ID No. 180920 SITE: Please refer to both identification numbers, Site ID: 180920 above, in all correspondence with the agency. ST CROIX County, Town of WARREN SW 1/4, NW 1/4, S13, T29N, R 1 8W Facility: FRED SCHULTE 969 140TH ST, ROBERTS 54023 FOR: Object Type: POWT System Regulated Object ID No.: 491503 MOUND / DWELLING 450 GPD The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • 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 cons truction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address P• q g P y � on this letterhead. C O llCdttlf ➢i �1 cerel , DATE RECEIVED 09/13/1999 t FEE REQUIRED $ 180.00 F o EE RECEIVED $ 180.00 �IAMES B QUINLAN, POWTS PLAN REVIEWER BALANCE DUE $ 0.00 _ Integrated Services SEE I ' (608)266 -3937 , WiSMART code ::7633': JQUINLAN @COMMERCE.STATE. WI.US cc: FRED SCHULTE ORIG INAL JULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems Private Sewn 71 5 - 3 86 -8 - 185 REGENE g D a Consultants S EP 13 1999 PROJECT I NDAFETY & BLDGS DIV 01lHR Plan I.D. # Date Sept. 8,1999 Owner Fred Schulte Phone 715- 749 -3366 Address 969 140th St. Roberts, Wis. 54023 Legal Description Part of a 300 plus acre farm. PIN 042 - 1033 -80. SW 1/4, NW 114, Sec-13, T29N, R18W. Town of Warren County St. Croix C.S.T. Robert Ulbricht 226375 Installer Local Authority/ Supervision St. Croix County Zoning Dept. PROJECT DESCRIPTION New construction, for a proposed 2 bedroom home. System will be designed for a loading rate of 450 gals. wasteflow per day (up to 3 bedroom home). Soils are fairly permiable in upper 12" (.4/.5 GPD /Ft.2) but seasonally saturated at 24" with active HGW seepage observed at 48 ". A long narrow mound system using 12" sand fill is proposed. .S. . pally i3 a` ` . ......... or,� yr�os 'ROBW W. "'• __ (� ULOnICH7 �"` hh D1160 HUDSON. WI . V 4tS '* �\ \ puunupl��u� P9.1 PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS &SYSTEM PLAN VIEWS �l � P9.3 PIPE LATERAL LAYOUT PgA DOSING CHAMBER CROSS SECTION Z� Pg.5 PUMP PERFORMANCE SPECS Ill 1,9 design for instal.lat.ion ig }� ta'�'lsr'ape cc�nditl��ns (S1nE,eS etc.) Sandesoilesuitabiliturements, elevations, accuracy of hi.s specs, as re y provided by CSTM of the CSTM, t�urted, shall remain the sole responsibility Any use of this POWTS design ty any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the workmanship, construction, placement, substitution or selection of any components not specified, or any assumptions by the plumber that any unspecified components are state approved or proper, or the effects of poor judgement if working under adverse damaging weather conditions (wet /frozen soils) by any such parties or persons. 30 r p `J ! Pf _�� /X p Pk /32- 16 !. Q3 I _ ol S7' O -- 55 - • ,�1,pco�s��i iJ P,f'etif S % � �a O 3� To — � L of vG {�iF �f�fiN �� � � •-Z. f f�.�t E S %7'� )30 - -- - - - - .f 36,3 r c p 01 3oo Yo —47— c? fhb 1✓ L o '(' I [__ CPOSS SECT 1 00 of M OUk-) D w i r P4 13 eD BED F % ro 1 ?.� A33et - 5AT6• T)iSTRi(3uT1o,v 6 P 6- s Ys; rEM so L e IevA rioo L.i "E Us.) i FORM - % 5 F ORCE7 E1EVATkOO UNoEI� BEE / o 1G l" E, 11 5 - ' F 1m vF-RT of )ATERMS y F T T op o f Roc 16 7 H 1'5 F Top of I A T E R A I S _._. 10 3, 32 PLAN VIEW OF Mou. -- wi T'VA 13E D FvRcE MAbJ 3 FT 1 - - - - - - -- •, C3 �� Fr K �J F r ---------- F1' w ` - ---- _____- - -- -- 1 --- FT k - >� T F r- �� W r W 3o F T - 1 To PVc. cAppep �- df35E RVh rio.0 A 99RE5i4TE Pipes PERM,,) EuT M AR kE'RS REirqumeD BASAL PcRCA -_ 'D Ai�y �RSre'Fr /�o l /ZS C A 'PAC i Ty Sq Fr, PRoposeV f3ASAI AReA _ B + 7 5 5 /P - S + s q, F T. PUMP CHAMM -R CROSS SECTION AND SPECIFICATIONS -VENT CAP `i "r-1, VoiT PIPE WEATHER PROOF APPROVED LOCKIAIG JUNCTION BOX MANHOLE OVER 1.5' FP,OM DOOR, (.� /�vlv(� WMDOUJ OR FRESH 12 "Mill. I ! AIR INTAKE U-11 "rij GRADE I — `i" MIN. r7 18" M11J. COIJDUiT -- --- .- - - - - -- fIt Vln v 7 PRovIDE I -� I"LE T ... AIRTIGHT SEAL 1 III V / I I I �!.FPR OVE D JOINT A h DG K I I (I APPROVED JOINTS I N /AID I / W/C.I. PIPE W/C.T. FIFE I EXTEN VJTO SOLID SOIL 3' _ 0� Q I (I ALARM EXTEE1011JG 3' 0 /_ ► I I I1 ONTO SOLID SOIL I I o f_LEV FT. - __1 PUMP usE7 3 -o -� OFF re �10�PE' eF ,fAN k T f ��� �' etocu Si},v� ( c Ij v !1 (;o d RISI'R EXIT PERMITTED OHL9 IF TANK MAWUFACTURER HAS SUCH APPROVAL SEPTIC f SPEC DOSE NI /1� �yES 7fr�iV � TA"AS MAAIUFACTURER: IJUMBER DOSES: PER DA y TAWK SIZE : / 7 � So GALLOMS DOSV VOLUME /D ALARM MAWUFACTURER: U L r INCLUDING BACKFLOW: GALLONS MODEL HUMBER: / y, V' L /(o • CAPACITIES: A= � IAICNESOR - GALLONS SWITCH TYPE: r1o'4 7 560 Z -4 t ' B= y INCHES OR 5 GALLONS PUMP MANUFACTURER: ��� � (�(� C= �� IA)CHES OR ! GALLOIJS MODEL IJUMBER:fJ CI� //� tf it D= /3 IMC14ESOR GAttONS SWITCH TYPE: p /�z�� f 7 -- MOTE: PUMP AUD ALARM ARE TO BE MINIMUM DISCHARGE RATE Zrj GPM INSTALLED ON SEPARATE CIRCUITS ( v, 3 �" VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE., FEET • MIXAMUM NETWORK SUPPLY PRESSURE , . 2.5 FEET EAC(A O� �� P • 35 FEET OF FORCE MAIN X /� /� F j TFRICTION FACTOR.. �� FEET q If 75 j IOOF. ��(UrIS �IJ TOTAL 09MAMIC. HEAD = 9 ' ' FEET INTERNAL DIMENSIONS OF TA►JK: LENGTH UJ ;WIDTH iLIQUID DEPTH I I ZOLLER EFFLUENT PUMP MODEL 98 11EAb CAPAC11Y Cunvi -F Z >tQ I J 5/e m - 1e — ` + �` 44 e 2 e- 1 1/1 NPt � OJ 10 10 __ -_ �o — 5 - 0 so To IW N0 i 110 ftOw PEn MINUTE tetu eY1UYq pl/uNleW /lrl Innvtl lrrrulNf AND exw.rrrywl lot" lalAtlly �� ., �___ _ tlMlitlMrN a � rlt/ Mtltpt Ut{ tllla ~ �t �ts it a13 If e► ,1 z 1 ! 10 1 I � t! Lack Vale 3 6/14 CONSULT FACTORY FOR SPECIAL APPLICATIONS 1 ItIT eet ewh em la duPlex eyslemx, ers ev Alable end s eiTpesd with en claim. Mercury It oal awhches are available for controlling t►Ingls and Mtchal*d sllsrnelae, t& d,rPlex Iyeleme, ere evellebis with a • 1hrss Phase systems. * ""A Mean Iwgches. oubls Piggyback mercury Iloal ewllches ars available for vallebls Isvel tong cycis controls. _ 81 111dard all mode - Ws1 hl 90 Ibe. - '/ (( ,p, t Mrleerallloateperaled2 ttMCh ION GUIDE AM lelbe �.. t. eln la t D°� anlealawhch, no oxbmalcon4ollaadrad. Control sel�ellon e P tiler t o maeury coal switch of doubts Plawbaek mereury, lod Alodd ih h pl Amt - rwheh. It.br to fM0 471, e lmel•� __ T bup M 1. Mochankalamale/ 100012 or 10001' ' -- -- P j - 1 - 1, t -` 1. toe f M0111, la correct medar d Ebclrlcai Aharnalor, • E Pak ". tiff 230 1 _H __f, _t.rl3lL —14th e. Mercury e.n" hoaf swItch 100221 to 1M1 t t 1 Auto / _ _ d N • control aedvalof Hon --r 1 1 1 f P I l�l of (1) NoN system +001h. • 1 1 - r p 1 { 301198 .(1 Pak ". Iurtetlorl box, fa --- - —_ pp11 a dup4x epaador% to 0". � � �►ntNbn or wired h /Yn• Pl hak "J Pak ", la nNwdVN acts. —, at SO". New r«krttl W@# b e.taky en ce �Nn,.son Duna bell; OAUTtoM i ■II`,.� • 1 i1bi11I tMc4kd /l Ma�uor /tbsM; 1'„ch.�kd lllbrn.ta, AM Intionalloa sl eenUel., Prel.Nlen �.{Iaa ant w4 utl>i �e1 tf to^Me,..tr Ms1ns tlbssl; u,e D Trl. C« ad 11.1 ecsnraJ rl►drla4n AN *"61 rn1 e.t kM shs,N w Iens a va e.3 1^1 M.a neat roar.& Nallreal ttealou Cea. t'h eed.e a rso ►" 0061 W late ' Hrrxh Ad p tNA1. M C) end the C aarpalbwrt ar /rly rr� RESERVE POWFOR) DESIGN _ For tmllstlrll condillons A reserve zafely faclot la dnglneered into the design of 04' ry Zoeller pump. t' MAIL 1Q r.U. etlX 163N p z al_ / ror,►rv;rt.,Ky ro7ss 0347 Manufacturers of... CHIP ?0: 3 eo 01' Arllen tape ,r 100! JI,, Xr 10;401 M v /ow 7»► :• I,t1fjS021171 3621 Quad rAas swnr larif Labor t?epartme l i Industry SOIL AND SITE EVALUATION Labor t?i�id Human Relations Page � of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County .� Include, but not limited to: vertical and horizontal reference point (BM), direction and �� ' C0 . percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ag/2 - J 33 - a APPLICANT INFORMATION - Please print all information Re 'ew by 0 let Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). I` Property Owner Property Location �/�EJ� •�C A U L. TE Govt. Lot SN 114 N&) 1 /4,S 13 T 2 f ,N,R E (or)( Property Owner's Mailing Address Lot If Block# Subd. Name or CSM# 9t'o 9 t y� s i. Poi o r 30d � - Y�VA l City State Zip Code Phone Number ,—, Nearest Road 2a /3Fi� r5 Gt✓ /• YW 2.3 (7!S �7yf • ?3G ❑ City v'lia e D � Town [9' w Construction Use: residential / Number of bedrooms Addition to existing building ❑ Replacement �/�✓' El Public or commercial - Describe: Code derived daily flow 77 a gpd Recommended desi n p1 rate bed, gpd/ft s trench, gpd/ft2 Absorption area required 3 7 s bed, ft 3 ? trench, f7t Ma>tlfi,6 d ding rate bed, gpd/fi gpd /ft Recommended infiltration surface elevation(s) S'� • J ft (as referred to site plan benchmark) Additional design /site considerations u sE GD Parent material JGtiE S AUE DE.ys'G� L L Flood plain elevation, if applicable -V / * — tt S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S C9 u li3 < ❑ U p S p'6" ❑ S [�i-tf ❑ S 211 ❑ s SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 In. Munsell Qu. Sz. Cont. Color Texture Gr, Sz. Sh. Consistence Boundary Roots Bed ,Trench .. J 0-1 /D J/h' 3 1 L Jf . y . S Ground .34 loY/? Y/& s/e- Lew, s44_- I�M 7i elev. 10 ��i ft. �a m s/4 c z Atof r U�S / f Y11 191 Depth to ' -S YX limiting factor 3LI in. , Remarks: Boring # 13 3 .3 /0 Y / /-/S / 4 /M fe cs . s •G Ground w %d�• vt7p �' . elev ' 7•1 YR 51 cZ 4 hots G /f ' Jl �,., s cw • S •G L Depth to d . 4 limiting !o y/Z 4/ clet A1A1 0 - 5 sr CG S /r►� , factor 3�In. Remarks: CST Name (Please Print) ��� RT Signature Telephone No. is � Q � T_ - 7 ls• 3Z. J 0 4? ,F Address Date CST Number Ulbricht & Associates • !/ . 2 2. ll3 S 655 O'Neil Rd. Hudson, Wis. 54016 ORIGINAL v as a /Vo V . ; PROPERTY OWNER SGT 7 SOIL DESCRIPTION REPORT Z Page of W PARCEL I.D.11 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench a.3 / • I /a 0 331 /�'J,,e �S w / - . q: /C . S Ground I !� ^m 3 1N 0'tS S1 t- 2�h D/C /h;i 7'/ C Slev. i ,3 / Depth to 7 -S Yk ` c r/'vE G s /�1+� �+►r !/f - . S ; . Co limiting (actor >q—in. Remarks: Boring # Ground elev. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. -Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting l factor In ' Remarks: Boring # Ground elev. ft. Depth to limiting factor in ' Remarks: s , SBOW -8330 (R. 08/95) III r � � V ' � 1 p 77-5 F \`I in Poe p'k-p- /oo, o tt 1 -vim c Q3 • - yd e5 a� by { -- - /30 - - - - - - ' c � 3G3 50 �IPb�O• Gi,vE �C /' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer R �.r S C X Mailing Address Property Address C 16-q -- 14/a t t- (Verification required from Planning Department for new construction) City/State Parcel Identification Number o `/ LEGAL DESCRIPTION Property Location SW %a, ' /4, Sec. T_2,9 N -R Town of CCFa w j- Subdivision . Lot # Certified Survey Map # Volume , Page # Warranty Deed # �� `CI . Volume ���� , Page It Spec house ❑ yes 2"n Lot lines identifiable R yes Ito 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 threegear expiration date. 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 prope des ibed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE ****** Any s mis -re resented may result in the sanity permit being revoked by the Zoning Department. * * information that r sanit P P Y ** 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 "VOL 1469PAGE 341 STATE BAR OF WISCONSIN FORM 7 - 1998 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number TRUSTEE'S DEED ST. CROIX CO., WI RECEIVED FOR RECORD Frederick J. Schulte and Delores M. Schulte as Co- Trustees of Frederick J. and Delores M. Schulte 11 -09 -1999 10:15 AM Revocable Trust dated February 27 1995, TRUSTEES DEED for a valuable consideration conveys without warranty to EXEMPT # Thomas C Jambor and Jane E Jambor, husband and wife, CERT COPY FEE: COPY FEE: TRANSFER FEE: 648.00 RECORDING FEE: 10.00 PAGES: 1 Grantee, the following describeld real estate in St. Croix County, State of Wisconsin (hereinafter call the "Property "): Recording Area Lit -, v A I J J ES 30 -- 'l' S 1" . Tt10SUIN, W! 540 ; 042 -1033- 80-000 Parcel Identification Number (PIN) That part of SW 1 /4 NW 1/4, Sec. 13- T29N -R 18W described as follows: Lot 1 of Certified Survey Map recorded in Vol. 13 of Certified Survey Maps, page 3757, as Doc. No. 612813. Dated this day of November, 1999. Frederick J. and Delores M. Schulte Revocable Trust dated February 27, 1995 * * Frederick J. Schulte * * Delores M. Schulte AUTHENTICATION ACKNOWLEDGMENT Signature(s) Frederick J. and Delores M. Schulte Revocable Trust STATE OF WISCONSIN ) dated February 27 1995 by Frederick J. Schulte and Delores M. ) ss. Schulte Co-Trustees COUNTY ) authenticated this ay of November, 1999 Personally came before me this day of 1999, the above named *Krishna Ogland to me known to be the person(s) TITLE: MEMBER STATE BAR OF WISCONSIN who executed the foregoing instrument and acknowledge the (If not, same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 Notary Public , State of Wisconsin My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not .) necessary.) *Names of persons signing in any capacity should be typed or printed below their Signatures TRUSTEE'S DEED STATE BAR OF WISCONSIN FORM No. 7 -1998 INFORMATION PROFESSIONALS COMPANY FOND OU LAC, WI 800-6" ,' �� �I C� QUIT CLAIM OEEU Fred-erick J, S010:e and D.elOr"es `1....SchUlte 1 husband and wife _ - } APR 1 � (: quit- elLinla to rrederi J. ?, Delores -. �1. Sc.hylcF Revocable Trust, dated 2- 27 -.95, �rederic:c J. A. Schulte and Delozes.:M. Schulte, Co-- Tru.stcez J` I they fuxb,%vm-, described real estate in S t . Ct'f' 1 l'o�nty, State of W;sconsin: •E _.n a C. L Gaylord the SW� cf the NE-4- Attorrey at Law P.O Box 46 The SW- of the NW-` EXCEPT part described in _L; £=1;s_ �Alt 5'1022 " C.S.M. 10/2732; The SEA of the NW4; The `iE`� of the SW4; Tax Parcel No: The NW4 of the SW4 EXCEPT S 150 feet of th_ 133 Feet and EXCEP! part described in C.S.M. 10/2732; The SE4 of the S1.7t EXCEPT S 484.5 feet of the E 4�1 feet and F.XCF:P1 part described in C.S.M. Vol. 4/983; `The NWk of tF.e : c'4; The SW, of the SW -'t; 'The SW of the SE4 EXCEPT S 484.5 feet. All located in Section 13, Township 29, Ranee 13, !own of t� �t /S EXE This i S homestead property. lis) lis not) Dated this 10th day of April 19 -96 - (SEAL) -' Cc :L �_i� 1, -z' �c , - (SEAL) . .. Frederick..). Schulte �C� `r•_� -: -, -J ll Z�_ (SEAL1 (SEAL) • _ _ _. Delores `t. Schulte AUTHENTICATION ACKNOWLEDGMENT Sigratu:c(s) STATE OF WhCO�SIV _ .- ._._. -_ ._..... r ss. .......... .. . - . . ......... ..------- -........ - - -- ---- ---- -- - ----- • -• - -- Pierce - ----- --__-- -- --- -- --- ---- -- -Countp. authenticated this ._.._ Jay of ...... ..------- ..... . ... 19 Personally came before me this .."l.Oth. day of ................ - C11..._ - - -+ 1s---95. the above named - _ -- Frederick J. Schulte and - _ . _. -. .. .... .... Sc to TITLE: MEMBER STATE BAR OF WISCONSIN . -- ." . "__.. (If not, ------ ... " authorized by § 706.06, Wis. Stats.) ec me kn -'.:;. is be the arson 5 ... -who executed the foregoing 1n_ - raiment and acknowledge the same. THIS INSrRUMENT WAS DRAFTED BY C. _t�.._G.ay.l.or -d, ". A.t.t.orney_ ......- • - -- _ _ _ --- ';' C��cn `1. Engel River Fa11s,..W1.. - 54022 _ v „ca P u!ic - Pierce County, Wis. (Sigwitnre., may be authenticated or acknowledged. Both Nlv Conm i-s,c.n is permanent. Iif not, ;tote expiration are not i.ce;sary.) date: - - -.- .. b -Z.9.. 19 7 " "a...) gUIT CLAIM DEED yr 1I } It V2 14 'A ISI U.A:1A N x - „ -..n { • -c a! n'.ck fa. inr if) NM %•. 1 -- 19+t3 'W­­ ., K.• r s APPROVED ST. CROIX COUNTY 'S UP 9 Planning Zonim r yL � . 19 gg fp OCT 2 8 1999 ° ° o If not recorded within 30 days of !! approval date approval shall be ti null and void M-0 v Az _ UNP LATTED LANDS WEST LINE NWI /4 SEC. 13 Z-n S 01 °52'06'E 2659.11' >:v ... ..... .................. . ............................ �. 0_V N01° 52_•_06 "W..660.00:... (32 Cn7C 9.55' 0 C+ • • • .... 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