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008-1037-80-100
Form- S T C - 104 ` AS BUILT SANITARY SYSTEM REPORT OWNER 90QA 1L3 1?Yj C1ersGn TOWNSHIP jo k ! A !l f- SEC. J T �� N -R 16 W ADDRESS I�'. J ST. CROIX COUNTY, WISCONSIN S "yG � SUBDIVISION Nll LOT N/� LOT SIZE S PLAN VIEW Distances and dimensions to meet requirements of I•IHR, 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM A n ePr�C 1q ? / 7¢ ho INDIC NORTH ARROW 1s3 BENCHMARK: Describe the vertical reference point used f oP u 7F G on Li tc. �{ �✓t �l 14 (114 f� Elevation of vertical reference point: / b G Proposed slope at site: SEPTIC TANK: Manufacturer: Vie IS G le Liquid Capacity: ) 00 b Number of rings used: 0— Tank manhole cover elevation: �0. 3 Tank Inlet Elevation: O. Z5" Tank Outlet Elevation: Number of feet from nearest Road: Front , Side, Rear, O v feet From nearest property line Front,OSide, ®Rear,0 3 (p b feet Number of feet from: wel building: 7 (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER i Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench:- ✓ Width: s Lenjth: 3 U Number of Lines : Area Built: s U U Fill depth to top of pipe: Number of feet from nearest property line: Front, Side, Rear,O Ft. Vy Number of feet from well: 1 o C/ 0 Number of feet from building: 1 3 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O O or distribution box been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: I ° Plumber on job: c License Number: (i !o 4 1(p 3/84:mj , DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 LVCONVENTIONAL 1 ALTERNATIVE State Plan l.D.Number: El Holding Tank ❑ In- Ground Pressure El Mound 111 assigned) NA OF ADOR�E . 1, , WI 54028 INSPECTION DATE: � • Od BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. NW NW, Section 13, T28N -R16W, Town of Eau Galle Name of Plumber: J MPIMPRSW No Cnumy. Sanitary Permit Number: Joe Stang 6646 St. Croix 79177 SEPTIC TANK /HOLDING TANK: MANUFACTURER. LI UID CAPACITY TANK INLET ELEV TANK OUTLET ELEV WARNING LABEL LOCKING COVER IRVVIDED . PROVIDED: r L , YES ONO ❑YES YNO BEDDING'. VENT OIA. VENT MATE HIGH WATER I N UMBER F ROAD PROPERT WELL . BUILDING: VENT TO FRESH ALARM LINE AIR INLET - FEET FROM OYES NO �\ I ❑YES NO NEAREST -----)'H DOSING C AMBER: MANUFACTURER REDOING- J LIOUIO CAPACI(Y PUMP P 11111 WAR NING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ON O ❑YES ONO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PHOPEHTV WELL BUILDING VENTTO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET PUMP ON AND OFF) 1 OYES ❑NO NEARI ST -�-�► SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I I N TH 111A1,11 T11+ 1 11ATIRIA1 AND MARKING; or excavation. (If soil can be rolled into a wire, construction shall cease until FORGE the soil is dry enough to continue.) MAIN'' CONVENTIONAL SYSTEM: WIDTH LENGTH I NO OF 1 1DISTR PIPE SPAC N(. COVER INSIDE DIA -PITS LIQUID BED /TRENCH THE NIZ- S MA +IAL: PIT DEPTH DIMENSIONS S Z �- RAVEL DEPTH FILL DEPTH DISTR PIP, DISTH PIPE DISTR. PIPE MATERIAL NO DI + NUMBER O F '. PROP VEN ERTY WELL BUILDING: T TO FRESH BELOW P ES ABG VE COVER V�INL,.I EL �yN VIPFS FE FROM LINE AIR INLET: -' i' 2 ��7 'L NE AREST --1► �(vt? i`J J �S.T MOUND SYSTEM: L J G Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. 1:1 YES NO SOIL COVER TEXTURE [ IIIIIA111 N1 MAItX1HS OIiSEHVATION WELLS El YES NO El YES 1:1 NO DEPTH OVER TRENC7`7 EPTH OVER TRENCH BED DEPTH OF TOPSOIL SOODF I) SFE 1 D'U YES F ULCHED CENTER DGES DYES ONO ONO YES 0 N PRESS DISTRIBUTION SYSTEM: B ED('BENCH WIDTH. LENGTH TRENCHES.. LATEHAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL NO UISTR UISTR. PIPE DISTHIBUTION PIPE MATERIAL & MARKING ELEVATION ANt3 ELEV.. ELEV. CIA ELEV. PIPES DIA.. ' DISTRI BUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED COH HECT LY COVER MA TEHIAL VERTICAL LIFT CORRESPONDS TO APPROVED �+ PLANS [:]YES NO ❑Y ES ONO COMMENTS: PERMANENT MARKERS: J OIISLFIVATION WELLS: NUMBER O PROPERTY WELL- BUILDING: FEET LINE. OYES ❑NO ❑YES O I NEARES T t l� 0 � X7.7 Sketch System o Re n in county file for audit. Reverse Side. " rle SIGNAT w 717LE') DILHR SBD 6710 (R. 01/82) r —onsm APPLICATION FOR SANITARY PERMIT DILHR PLB 67) C OUNTY �� oEacvaTrnenTOV ( UNIFORM SANITARY PERMIT # 00 InOUSTRY. LRBOR 6 HUMArl RELRTIOnS f�► /� / }�, — Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /2x 11 inches in size. —See reverse side for instructions for completing this application. PLEASE PRINT PRO ERTY OWNER MAILING ADDRESS � /U n �. a R So _,Q- Lt�vvdv� 1/e �/�s �1. PROPERTY LOCATION etTy: 1 /4AIRA /4, S 1 3 , T 9, N, R >t (or) W TO 1,9 L4 R fl LOT NUMBER I BLOCK NUMBER I SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER NIA N q /� C o f�w B 01A TYPE OF BUILDING OR USE SERVED '�� j0 go -,1e) X 1 or 2 Family Number of Bedrooms: 3 LJ Public (Specify): N /,q �`" THIS PERMIT IS FOR A: ❑ New System ❑ Tank Replacement ❑ Repair % Replacement Soil Absorption System ❑_ Revision ❑ Privy ❑ Alternate System Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed Seepage Trench ❑ Seepage Pit ❑ Holding Tank System -In -Fill ❑ In- Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity 1 0 Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: ❑ Mound ❑ In- Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch) REQUIRED (Square Feet): PROPOSED (Square Feet): 2 yrli h M•r1 2� - L�C� S s 00 Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for install tion of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: MP /AIG.: Phone Number: 0 S fi ` l is 1 4k - zy 0 Plumber's Address: Name of Designer: 2 k .' S tA/6 o d v. `� �" a 2 rJu e S-ir R h COUNTY /DEPARTMENT USE ONLY Disapproved Signature of Issuing Agent: Fee: Date: `���d'� J �/ 71:1 Owner Given Initial &V4 � / (� b Adverse Determination Reason for . Approved a ro . Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber r I 1' d v ao 2 a O N M i10 d0 0 1 f I v I � C 3 � r� • O � I Pa r t� J o I .___�.. e O ' e a � �. � i► OVA � O d Z C Jo v o J J d J d CD V ,.?� Lo Qp O v APPLICATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contracWt ,( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -• - - - - - - - Owner of Property �'o F' A L� -� - X-� G A rJS) � ° iJ Location of Property / ', Section 3 , T N - R 6 W Township F a Q G L L E Mailing Address �- Q- Go 0 0 V zip C ti �.J '-�✓S , S P?� •. Subdivision Name Lot Number Previous Owner of Propert 0- g Total Size of Parcel S C (ZC Date Parcel was Created - e ri ) ) 9 (a Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes ✓ No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING 1. Warranty Deed 2. Land Contract 3.• Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. --------- ----------------------------- - - - - -- PROPERTy OWNER CFRTIFTCATION I (We) cehti6y that aQ,E statement6 on this 6 ah tru to the b efit o6 my (oun) knowledge; that 1 (we) am (ake) the ownen o6 the pnopenty de6cAibed in this .in6o4mation 6o4m, by vi tae of a wa4xanty deed neconded in the 066ice o6 the County RegiAten o6 Deeds a6 Document No. L � ' and that I (we) pnebentty own the proposed z to bon the sewage poaaa..6yatem (on I (we) have obtained an easement, to nun with the above desn bed pnopehty, bon the con.6tnuction o6 said syst and the same h as been duty eco&ded in the 066ice the County Reg"ten o6 Deedb, a6 Document No. 410 S Aga ) SIGNATURE OF OWNER S ATURE OF CO- ER (IF APPLICABLE) DATE SIGNED DATE SIGNED t-+ z H 9 ST C- 105 r . H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d a OWNER / • ROUTE /BOX NUMBER �Q''t I Fire Number CITY/ STATE l,-- LC ZIP -5 Lfan & PROPERTY LOCATION: tl' !%, Z, Section T ,;� 9 N, R / ro W, Town of pr" C r LE St. Croix County, Subdivision Lot number I I Improper use and maintenance of your septic system could result in I its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. 0 E I /WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with x r the standards set forth, herein, as set by the Wisconsin Depart - 'U ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED '` / DATE /V\ � y `7 �b St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715-796-2239 or 715 - 425 -8363 Sign, date and return to above address. DOCUMENT NO. �' W ARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA ! STATE "it OF WISCONSIN FORM 2-1982 i REGISTERS OFFICE, I Clarence Frederick and Barbara T. CROIX Co. g h "t Frederic WIC a I k.'. RQC'd. for Record this 10th e n d " " "i n - "7i e "r - "own r i " � 1 ...........•••--- •------ • - -.... ` A.D. IPL6 ----------------------------"-"-.:.--------------"-•---------------------" •-- "- "-------- .--- .•-- •-- - - - - -- .. - - -- day pfTanuary ..-- •----- •- •- •---- •- ••--- •-- - - - - -- ---•----•-•-------•-••-------•-----•--••-- •------------- •-------- •- - - - - -- - P conveys and warrants to .... o n a l •• L ... - A ri d e r s op and _____ Janice_ J ._ _Agderson_, wife., ... as 1oint tenants .. ._- J ........ ......... ......... ............... .... ........ ......... .............. ...................................._.......•...................................... ............................... I RETURN TO Ronald L. A n d e r s o -- - - - - -- --- • - - - - -- -------------------- •------ •------- ....._- - - - - -- •• -- Route 1 !' . -• - -- ..... ... •- •- ••......• - - -•- -- 4Tood- villa, WI 54028 +� the following described real estate in ... ,S.t. ... Cx91.X ................. ......County, State of Wisconsin: I i Tax Parcel No 1 ` j NON 1� Lot 1 of Certified Survey Map recorded in Vol. 6, page 3, i% 1619 of Certified Survey Maps in the Office of the Register of needs, St. Croix County, Wisconsin. i i I !i i This ...... is .. . n.o.1~-------- homestead property. )(5k (is not) Exception to warranties Existing highways, easements and rights of way of record j 4A ' Dated this -"---••---------- /P•- •- -- ••- -•- • . ............ day of ............ J_anu. ..y ........................................ 19.$ -6... ------ -- ---•-- (SEAL) ------ ---- - - - -- EAL) I ' Cla _ * ------------------------------------------------------------ - - - - -- - • - - -Frederick - ---...---...------ • -- -•-- •---- ....- •---- ••--- - -- - -- -(SEAL) .- "----•- -• - ------ (SEAL) i * . Barbara Frederick ----- •......•• - - - -•• ........................................................ --- - - - - -- (� AUTHENTICATION ACKNOWLEDGMENT i Signature(s) ------C_l.ax ail_ Ex -e.d_e r i.rak.....- . -.. -- STATE OF WISCONSIN (' it Barbara ederick ss. I - ------ •----------------------- - - - - -• - - - - -- County. ! : au Mica d his ._ _ __day f._._ .T a n u a r y -_.... l 6,_ Personally came before me this ............. ...day of c _ .._.. ----------- - - - - -- 19 ........ the above named i ---------------------------------------------- ----------- -------- • - -• -• II 'j ■ Dav_id J. streen ------- - - - -•- ----------•------------------------------------ - - - - -- ----------•---------•---------.._._...------••--•----------- ••--- •-- ......._.... TITLE: MEMBER TATE BAR OF WISCONSIN ...................................... ............. •------ ..--- - - - - -• . (If not, ---------------------------------------•......-----•------•---•-.._...---••---•- j j authorized by $ 706.06, Wis. State.) to me known to be the person ............ who executed the l j foregoing instrument and acknowledge the same. 'j THIS INSTRUMENT WAS DRAFTED BY ....Attorney... David .......Estreen ................ ............................................... ..................------ ....... I 4 621 2nd St., , Hudson , WI 54016 _ _ _- Notary Public ------------------------------------------ County Wis. � ) I (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) I date: ----- --- -- ---- --- -- --- -- ---- 19 --------- I! •Names of persona signing in any capacity should be typed or printed below their signatures. nn -- ......_.. �' ilGMillarConipaly® STAT FORM No. 8 -1 82 Stock N O. 13002 YIh.WM. MMLM.111 CERTIFIED SURVEY MAP Located in part of the NW 1/4 of the NW 1/4 of Section 13, T28N, R16W, Town of Eau Galle, St. Croix County, Wisconsin. NV ,���9LP1rSrR�', e corn section 13 ALIEN C. 3/4 re -bar x NYHAGEN �'• v v. S -1407 HUDSON, 2 f ' �► WIS.✓ Q� ae - I .9 -�0 LO a .. I - uss ° j�► NO Lx= et4► ti . o I ° -* unplatted lands owned by platter .-. M I - - ` L i� O O .-. O b O H N88 355.03 e ti 1 6.0, 32.91 322.12 4 .. A d = .N I I ( LOT 1 S a� LEGEND AREA INCLUDING R/W si O 1 "x24" iron pipe o M 217,804 Sg. Ft. of weighing 1.68 lbs./ 5.00 Acres lin. ft., set. I O O M N z .- �° In " AREA EXCLUDING R /W� I 198,654 Sq. Ft. Ai 4.56 Acres Ci I angle pt OWNER 0 Clarence Frederick I RR #1, Box 188 Woodville, Wi. 54028 I o W r, barn house 0 0 �• N m 4 ' • .I = 31.07 = I 364.50 a 6 0' I S88 06'41. 401.57 I unplatted lands owned by platter SCALE IN FEET 100 75 50 0 100 2DO Mest 1/4 corner section 13 County monument job # 85 -62 drafted by Darrell Nelson 1 SURVEYOR'S CERTIFICATE: I, 'Allen C. Nyhagen, registered Wiscinsin Land Survevor, hereby certify that by the direction of Clarence and Barbara Frederick, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the NW 1/4 of the NW 1/4 of Section 13, T28N, R16W, Town of Eau Galle, St. Croix County, Wisconsin, further described as follows: Commencing at the NW corner of said Section 13; thence S00 10' -00 "W, along the West line of said NW 1/4, 434.77 feet to the point of beginning of this description; thence continuing S00 10'-00 "W, along said West line, 576.00 feet; thence S88 06' - "E, 401.57 feet; thence N04 26' -20 "W, 579.27 feet; thence N88 06' -47 "W, 355.03 feet to the point of beginning. Above described parcel is subject to a easement for C.T.H. "B" and all other easement of record. That this Certified Survey Map is a correct representation of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 Wisconsin Revised Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. SGO�►S��� ALLEN C. �i. NYHAGEN 0 8.1407 _ HUDSON, WI& 4 + -�� Allen C. Nyhagen �� SV a` ��$ S & N Land Surveying #11144 108 walnut St. Hudson, Wi. 54016 .. _ . w ■ ]O ° 0 ® m Sr Sr q - # \ a ■ - /� m 3 k cc o o 5 - CL 7 § g m m ° 0 P' Q. \ f k § 7 7 § / | CD § 2 �_ m § \ |R Cl) $ o 7 k ' n]a Ga�o | \ \ 7 3 0 ■ o _ ■o_G / /K\F | ƒ2® t %k : o � �k ¢/0 /spa \ / CD r.1,, q /_ c / 00 @ Cc § � K 0 k , E n � � o 2 a � � � � ) cn ,g l) Z > E ®�■ 7 3 k a q _Z m § m $ £ a = $ � a ],mm- D cn � _ - o � � 0) 2 0 / ° c =r --o � ato M . cn ■ a c n * m f m m ° � - 2U) f \ 0 . ��. f\/ \f /� ƒ( a/k ��omoi k/� CAC :a0) w= 6 a a CL � 0.E &E_g� \ k/ 0 Q 2¢ \ 0 m 2 2 �0� oc� w�\0 a c J■ £ 20)_ n \ \ a E \ ° - o ° \ «$ƒ �� q_7 e \ q .m 0 �§ » » ° E m , S 0 . DEPARTMENT OF REPORT ON SOIL BORINGS AND S AFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115 MADISON W 7 I-(UMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP /MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION AME: �/ '/4 /T AN /R 161 (or) W p M 6,4 14& 1 /V COUNTY: OWNER'S BUY / MAILING ADDRESS. 1 r / p SG �� a 0.7/,/ L L-. - ,& st USE DATES OBSERVATIONS MADE Residence NO. BEDRM ❑New Replace S.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: ER A ON TESTS: � RATING: S= Site suitable for system U= Site unsuitable for system 6 J CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: S STEM -IN -FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) � ❑U ❑S OU �S ❑U ❑SOU ❑S�[ll If Percolation Tests are NOT required DESIGN RATE: Q If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floo indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. IGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 90- Q' Al o A C_ � . O .. I . i, 0' 6 Z , 1 P 3', 7 M B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TESTTIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD PEF3100 3 PER INCH P_ 3. ® a Miki < T P - A 3 _ < " P- a. �;M 3 w•;K P -_ P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION ia. 7x e k G g IV o XV r!L " G A- e w m - -- ___ ------ - _. _ T i _ T _ _ _ F _. _ 3 i 3 ._ 3 I ' I t i E F r , I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: f ® d CERTIFICATION NUMBER: PHONE NUMBER (optional): `� J?1�'�� T• Gvo�alvrLL� GU, �yG Z6 y4 6 ?/ - `t' - yd1 CST SIGNAT RE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) —OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SRQ - 6395 To be a complete and accurate soil test, ynur report must include: 1. Complete legal description; 2� The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used it desired; 3. (Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9_ Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10, If the informal ion (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11 . Sign the forma and place your current address and your certification number; 12. Make legible copies and distribute as rer:luire.d. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION, ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10 ") BR Bedrock cob - Cobble (3 - 10 11 I SS - Sandstone gr - Gravel (under 3 ") LS - Limestone s - Sand HGtjtl - High Gr_oundwatcr cs - Coarse Sand Perc - Percolation Rate oled s - Medium Sand W Well s .__ Fine Sand Bldg - Building Is - Loamy Sand > - Greater Than "sl - Sandy Loam < ... Less Thai) `l - Loam Bn - Broviin sil - Silt Loarn BI Black si - -- Sift G - Gray cl - Clay Loarn Y - Yellow scl - Sandy Clay Loam R --- Red sic! - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ with sic - Silty Clay ffl fevv fine, faint r . Clay a �; -- Clay <;c _- common, coarse PI - Peat rnrn - Many, nlediulil rn - Mu {.k d - distinct p — prominent HWL - High vvata = level, µ SIX geocNil Soil U'XtUres sur{ace wwcr for liquid waste. disposal BM - Bonch Mark VRP - Vertical Reference PoinT TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Departmorr may request verifivaticn of this soil test in the firs it Prior to P�?rrrlit is suance. A corriplete scat of plans for the private wF rlaq {P system and a }.7 =ii ;'rt4 {: ajxpltc'r',3tion must be to the appiopri alt local au l:hority In order to ok }taro .i pei mit. The sa iar r Irotmit rm t he o[it,ainctl and posted prior to tr > start of gray c'w'tr uction i,� t3� Nauss i g , — r o F (� ALL 1��uS ® f3o R-IL 1�aGr� I \ s 190 ' S - �p�°" adq p3 ST. CROIX COUNTY ZONING DE4 PARTMEN AS BUILT SANITARY REPORT. . Owner l ,- Address :3 2 7 City /State 1c 1<<_�� �; , 1. Legal Description: Lot Block Subdivision/CSM # E C_ /�h _ L � d �l� ,� J Sec. }j, TAN -R . W, Town of ', t , C. ,c� r N # SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION: Tank manufacturer f r h Size ST/PC 1 r> Setback from: House / Well 76 01L le6 Pump manufacturer _ tV ,:y, -e_ Model Alarm location d��/ (HOLDING TANKS ONLY) Setbacks: Service road Vent h air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: I R -e /c c /L Width j Length / 12 Number of Trenches Setback from: House 2 W 5 C� P/L 6 0 Vent to fresh air intake ELEVATIONS Description of benchmark pi l ev t. Elevation z� Description of alternate benchmark �' s :v, zG %, f -�� Elevation ? Building Sewer 1 f 2 , /-/,k ST/HT Inlet r j �`? `1 i ST Outlet- D : 6 PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover / Z Distribution Lines Bottom of System Final Grade ( ) �� �; " ' s - ( ) 16 s Date of installation / '` ermit number j j 5' State plan number Plumber's signature �� ��� - {''�"�� y-•- .License number � - Date / Inspector complctc plot plan K 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 V1 r ` 7 I� .r J N 6� " s INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM .Safety and Buildings Division County: INSPECTION REPORT 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)]. 3+ s of 6 <a Permit Holder's Name: ❑ City ❑ Village ® Town of: State Plan ID No.: C, i hda Wl� �oc�ci l Eti � Gu /lF CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ICO lop' q" hr ti 3 / y" PVC p7p.a &c:�'S -103- - ev -rev TANK INFORMATION ELEVATION DATA A 'Io 0o n3 7 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic > \ icScr t2So Benc r 1.5 2. 101 100 Dosin "3M pm IS Ae tion Bldg. Sewer I , Z•54 1 l 2. Y(. Holding St Ht Inlet I q -0q 1 10.91 TANK SETBACK INFORMATION St Ht Outlet Its 4•µ lit). 6 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic l oo' gp IS' �/ NA Dt Bottom Dosing NA Header/ Man. 1 15 - I5 99.04 T.1 re1.5'a .i1 23 Aeratio NA Dist. Pipe r.z roe M •aw3 `N� G9 r•. 101. s1 &.Oq 9SV8 Holding Bot. System -r � 1 0449.. 5155 9s�g r PUMP/ SIPHON INFORMATION Final Grade o9.r T•i 101.6'Z 1 97•si Manufacturer mand St. vnct tkol-e C „i 1 IS d - f I Z• Zg Model tuber GPM �� � �Lcv/ 11 17-95- 97c� TDH ft Friction S TDH Ft 4 0.w r-A 11� 1.7J 1 17. L5 Forcemain Length Dia. Dist. To well SOIL AASQRPTION SYSTEM BE idth Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid D th DIMENSIONS 5 1 00 DIMEN I N SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEA HING Manufa INFORMATION Type �} r -t' OR BER Moe Nu r: Syst�4c� �� l30 17, -� OR UN DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) I �! x Hole Size x Hole Spacing Vent To Air Intake ! Length D Dia. — f Length 10 0 ' / Dia. `7 Spacing ASTI� 212 c ( 7 1 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 E] Yes [] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 38 &M1 (?� 1 he- •e_m% -V SCf}Ce, 4V V k wag (c fIk Ce � �a;v./ �ZSD �/c5cr. �pcca ✓sue �� Was OV 'io ik t eS 'A"_M - �X e k6,1'5 ,. , C �3r i 5 r jv rC_4 -' ffi u 5 f s W ln/ v1 ew - tavl C f✓` c, lacevnLK� 'T kf,, V - 1 I L'� k ✓tJACl k wu Ir L (CA-GM 1 bel.v 1 � cA wi c -� it, e 3 --Gcd ru(e_ -lz> r�., -� l�l ��O av� v►�►o Tfl I vnU - Plan revision required? 0 Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspectors Signature t� 600 • Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM y: • Safety-arid Buildings Division Count 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)]. 315986 Permit Holder's Name: ❑ City ❑ Village n Town of: State Plan ID No.: MCDOUGAL, LINDA I EAU GALLE CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: g w f�✓G G 008- 1037 -80 -100 TANK INFORMATION ELEVATION DATA A9800374 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I Benchm 1 S i Jp(, (bb Dosing rV\ Js /bp Aeration Bldg. Sewer a 5q t/.a , Holding St/ Ht Inlet 9 .0 //Q , TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. A ir ir I ntake ROAD Dt Inlet Septic J U(jt" Id 1,�_ ZD NA Dt Bottom QI 00 4 -4 Dosing NA Header/ Man. 15 Pi C Aeration NA Dist. Pi e� 7 r% Vs` 4 ro If 4-1 Holding - Bot. System •gg PUMP/ SIPHON INFORMATION Final Grade 3 3 !•`s Manufacturer D and 4. t Model Number GPM c)-?;L 112 2� TDH Lift Loss Syestem TDH Ft f " i o Forcemain Length H Dist. To Well f Y r SOIL ABSORPTION SYSTEM ( 'src. ete IV.& X 0 0 3 BED/TRENCH Width Length No. Of T nches PIT No. Of Pits Inside Dia. Liq pth DIMENSIONS J 1 161D I I DIMENSION SETBACK SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING CHAMBER M urer: INFORMATION Type �� odes Nu r: Syste sp�f 1- 3 0' OR UNIT DISTRIBUTION SYSTEM Header / Manifold ( Distribution Pipe(s) , `� x Hole Size x Hole Spacing Vent To Air Intake Length (�ia Length l t9p Dia. Y Spacing � �7�jM sc 27 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.) Z'���/ z `/ I' LOC CA ( ATION: EAU GALLE 13.28.16.190C,NW,NW 387 COUNTY ROAD B , scf4; e- 4c K --- D h I J 2: b 'i i<_ ► S f-rG VYl 0 s4 — f V 0/�O/�B Plan revision required? es m No Use other side for additional information. rMl I SBD -6710 (R.3/97) Date Inspector's Signature Cert No. SANITARY PERMIT APPLICATION Sa fety E. WashnggtonAev *60nsin In d with ILHR accord Wis. Adm. Code P.O. Box 7969 Department of Commerce 83 05, Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 81/2 x 11 inches in size. J� y • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs ❑ 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 Pro rtyOwner ame Prope Lo ation � 1/4 1/4, S/ 3 T �2P , N, R 16 E (or) Property Owner's Maili Address Lot Number Block Number -7 v A t o s t ia .- �/i 46- Zi ode Phone Number Subdivision Name r CSM Num r . TE OF BUILDING: (check one) ❑ State Owned 0 Cit Nearest Road ❑ Village .Public 0 1 or 2 Family Dwelling - No. of bedrooms own of III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo o� --10 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 g4Seepage Trench 22 ❑ In- Ground Pressure / 42 ❑ Pit Privy 13 ❑ Seepage Pit �'— S X ��® 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 Re uired (so- ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) !7 6 Elevation Q co i �� 9 - �lj Feet 1D4 -- Feet VII Capacity TANK in allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tns T eptic Tank or (t' -e ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ I ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signatur • (No Sta mps) MP /MPRSW No.: Business Phone Number: Api Plumber's A dress (Stree , City, State, Zip Code IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued lllssuing AnAntSignature (No Stamps) N A roved Surcharge pp ❑Owner Given Initial e Fee) Adverse Determination Q� Iro/ O 6 `1 C6 F APPR P X. CONDITIONS O OVAL /REASONS FOR DISAPPROVAL: GV1gi •f ,e VGI/IGtS Cu'' _ 1 6'W(4d SBD-6M (R 1.1/96) DISTB T)ON: Original to County. One copy To: Safety 6 Buildings Division, Owner, Plumber PLOT PLAN SCALE Q i .�.+ :�•. CCLs�iJ x.11 k, T R ino ti tis .\.:,.�.a orgy i 1 { �I i PLC v pqs CYF Yvp S C�L� __ - - -- top V. 6• y °PvC ot5TR.1g��ON p!p<. Put ��� 6 v�JT P►O� w�r►PPRO� G}p ^ 5 trvv�' Ft, loo t�vul- E,. CZ O S S S �o sCAN-Q� gluEvjT PlP6 U /pf�pp"UfD C" p�T. SOt F t FT wPPC�.ou� syrrn�e y Y ov L`0 a 6, S I I . !, "or- i "� 2, I z Pr6 pem ST% Qt-i n ��S1�1 a�i10►J �tP�S pfp-)p Z B OF - TjtAh/CEF �lpe-s. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the /1z /&z C: in41 residence located at: Section / -3 T _ 2,,,V N, R W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: l DO CD Construction: Prefab Concrete Steel Other Manufacturer: (If known) : Lv l it - ce--2 Age of Tank (If known): f� (Signature) (Name) Please print (Title) (License Number) P / // - - Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Wis. Adm. Code (except for . insp ection enin er outlet baffle P P g ) Name r gnature MP /MPRS Wisconsin Department of Industry SOIL AND SITE EVALUATI R Page \ of 3 N and Human Relations r Division of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 - �1ri�caes in size. Plan must include, but not limited to vertical and horizontal reference I t �, � irbogn % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location a ig o n Dii 3t ioa�d G O 8 - - Wn - g0 lb l3 APPLICANT INFORMATION -PLE `DINT A RMA,NO �BY 7P3 PROPERTY OWNER: �j�r - ROPERTY LOCATION L_ 1, tib `p, M C bU V , < tiw 1/4 NW 1/4S �3 T Z-8 ,N,R V. E (or ,r �.J PROPERTY WNER�S MAILING ADDR EA rI -- f,' zqy` ti X �� ► l OT BLOCK # I S s" E V CSM# 1619 CITY, STATE ZIP C f ?', ' •. PH R ; . " CITY []VILLAGE ®TOWN NEAREST ROAD L3 f���w t� , W V S lS) 6ti G�'� 6fL °C� 9 [ j New Construction Use W Residential / Nu ms 2S [ j Addit'kn to existing building N Replacement [ j Public or commercial describe Code derived daily flow y SO g pd Recommended design loading rate - bed, glxW ' 3 trench, gpd1ft Absorption area required - bed, ft `Soo trench, ft fvla�dmum design loading rate • q bed, gpd$ S trencrco') d1ft2 Recommended infiltration surface elevation(s) SEq rJU`� au P9 3 ft (as referred to site plan benchmark) � "laN �- Additional design/ site considerations 3 c ES- LRet# S' x you LuKj G - \Z� �UD� vk5 Z Parent material a t t-T-t out_7c G vN "C Lft L T'Lt. Rood plain elevation, ifaPplicable N- q ft r su = S uitable for system CONVENTIONAL MOU D IWGROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK _ Unsuitable fors stem ® S ❑ U @S ❑ U ®S ❑ U ['S [1U p S IRU ❑ S lZU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Bouxiaiy Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tench 1 o _ of w 7- 31z c S - LU 4 Z °► -3 5 y s� 1 Z.`FS vn cg S Ground wf�v iI- elev. t� 1 ft c y,., M \) Depth to limiting factor 4 � 6$ Remarks: Boring # o �o`tcZ 3l2 — s 1 z shirt >q�>- zu (' -S Z . S ktZ 3/y — s L ( Z`F sbk Wi f C W — • s. L :. 3 26-63 1wHIzY /y - �s s( �csbk wtv�V� es _ •q I .S Ground elev. I 6312 10 `'1 1 - S /6 �i�S`12�t; s te_\ o� �y _ Nt�`.z lo z ft. IXpth to limiting factor 63� ' Remarks: T Name: — Please Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O,. Box 74 River Fa11s,WI 54022' Signature: Date: , Number � ��' n $4 - 7- Z- Z-Iz'S CST Num M00.576 PROPERTY OWNER Y` -A( 2- (YJGPti. SOIL DESCRIPTION REPORT Page?- of PARCELI.D. # OOS L��7- �p- X00 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxxiary Roots GPD /ft In, Munsell Qu. Sz, Cont. Color Gr, Sz, Sh. Bed Trench Z C - -I. S lip- 31y — sL MIR cS — • S . L Ground 3 Z1 -3t3 S `i (Z 3L y — s 1 c s�k Yvj U '4 . 5 elev. 31 - Gti- s 1 \ e LL . S Depth to limiting factor Remarks: _ Boring # 13 'w S c St hJ 1 r 8 3 Ground elev. ft. Depth to limiting ` factor Remarks: Boring # Ground elev. ft. Depth to limitng factor ' Remarks: Boring # Ground elev. ft. Depth to limiting . factor Remarks: SBD- 8330(8.05/92) PLOT P LAN , Pa 3 of 3 SCALE 1 "= L10 ' L�► s�.L 3 TRk� C!}�� �rcGb1 S X X00 � �N G � 'Zy, ►`��� � `�� �- ~fl� u_ \ 8.3 J oao \ � 8v �'Th�3L�' Pt1tLA — al b PVC PIPI? ;J lLfy'T}.l, I \ , Jc w--LL c 715 ) 425 -0 1100576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALU AT10 R PORT Page \ of laborand:Human Relations , - -DiV*n of Safety & Buildings in accord., with ILHR 83.05; Ws Adm: Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but Z Y' C � not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. IJ O8 - 1b37 -g0_ -LO APPLICANT INFORMATION- PLEASE PRINT ALL- INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION M C, N)o U G p 66Yf- t9T- I'aW 1/4 NLU 1/4,S t3 T _L8 ,N,R V. E (04�6 PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM 3 8� e�1vNr4 `� Ott 1: — Cs" V01 b PSG 1619 CITY STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD t�F'T�- , W I S4t MS) 6bV 3z-6L , lit r. eu 14 a" [ ] New Construction Use D4 Residential / Number of bedrooms 3 [ ] Addition to existing bdkfing jQ Replacement [ ] Public or commercial describe Code derived dirty flow 4 SO gpd Recommended design loading rate bed, gpd/ft ' 3 tip, gPd1ft tlenC 2 `Sua trench, ft Maximum design loading rate • y bed, gpol(t Absorption area required - bed, it2 S Recommended infiltration surface elevation(s) s ►.xu`cC au P9 3 ft (as referred to site plan bendimark) Additional design / site considerations 3 C *es - a" S k u)o L0ti G ?_mz eIJD� Parent material 31 t..Tj 000_V T'L LL Rood plain elevation, lf a pplicable N- A' ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM W FILL HOLDING TANK U = Unsuitable fors stem ® S 1:1 U ®S ❑ U 7@S ❑ U IR S O U [IS ($U ❑ S O U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in.. Munsell QU. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bottxdaly Roots Bed ITrench L o -9 w`t� -31� si z'�sbh Yh'�h eS Lug .s .� Z Ground 3 � "t.$� �- 3 / _ sl gq1 er w `� u E ew - _ z , 3 elev. q9 ft 67-6S Lw-1"Z a Depth to limiting factor Remarks: Boring # , 1 0- �o�c2 3x2 — sLl z`Fshn mfr e-S z„4 .s .6 E l z B z6. 1.S�R 31y — st( Z�sbk y-A e� L 3 U- i IwiP__V /y - �s s1 �csblt M iv - 0- _ . q .S Gr o u nd 1 0 42 s � s ic.\ la -Z- fL . Depth to limiting faC6 y . Remarks: TName:— Please Print Phone Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 ' Signature: 9 $ —! $ O Date: _- ZZ ^ CST Ntxnber t�� -Ql� M00576 - 1 � h PROP ERTYOWNER SOIL DESCRIPTIO14 REPORT Page? of PARCEL I.D. #t 008 - 161-) - $ o - Nw Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tnench 3 z 1 si 1 Z `Fsd wt`Fr �s �.� • s Z q -Z, Z. S `� R 3! y - � t l 2'� s�k Y►1`R. c5 - • S . L Ground 3 Z1 3H S `1 R 3L y s 1 c ��� Yvt U f h c� - 1 -S elev. .� ft. t} 38 70 �• S `� R �L G�- s 1 e g 1�k 1►� U (^ _ • LL :,S Depth to limiting factor ? �ON Remarks: Boring # is •w S St =I Ai 4S Ground i eleV. ft. Depth to limiting factor ` i Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor j Remarks: Boring # 13 Ground l elev. ft. Depth to limiting . factor Remarks: SBD- 8330(R.05/92) PLOT P LAN , Page of 3 SCALE 1 "= 4 ` ti Ki t-'T on 3 TTZ-e , cm-'s, "Mm 5' X ` oo ' 4)N G l Z\A t, . • e.3 o�Z `ct1s�J elt� Z PUC PIPS, WI�R�N, i 380Qv� scene � Jc ►/�LL (715 ) ?S -DIES 14 00576 CST Signature It Date Signed Telephone No. CST # f ST CROIX COUNTY • • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM I Owner/Buyer L n I o U � � Mailing Address r=-- Property Address (Vcrifrcatioa required froar Pknaiiig Department for new construction) tY Parcel Identification Numbs _ D ©� L EGAL DESCRrMON , Property Location ea %, � /, Sec. J T 2 � N_R�W, Town of Subdivision. Lot # _. Certified Suzvey Map # Volume Page # �! 1,1 Warranty Deed it D L 3 3 Volume D Page # D , Spec house 0 Yes Zino Lot lines identifiable 0 yes ❑. no ANC IM PR WM =dmu m=nceofy=aqpcsyso=coddms*mztspremau=i a & = t o h =u M wad= p Loper=lmt== = of P oat &C =Ptic task cvcrY throe y,= or somc4 if needed by a lic=cd p �Phat nn y pat into d= system cavn a��od�e .fimetioa of the . tmlcas -a tcr+sbmemt:bge in the ate disposal - system, - TU PAY owner agrees to r a r R to St. Quix Zoning Departima t t ecctff=tioa form, signed by tine - ow.nes and by a p P dpinmberoralk=w dpmapavccifyingthat (I) dlconaike . msteavatrdisposdsysbcm is in Pml= oP=tfWg o00dition and oc (2) aft= inspection and pumping.(if =r=ay). gm scp&tankis less Bran Ira Roll of smzdge.. Yy4t. the mod hm -bead &e :borne tugaic==& sad agar to maiirt:in flue pervate sewage disposal system w,&. the suab ds ' fadk od by dae t of C=wc c sad 6rc Dqur memt of Isabmal Reso=c:s State of W mmsia.. Octti aticn &ftdAS that Y= mptic system has bcca maimtamod mast be completed and days f the three returned to the St Croix - County Zoning Office witiun 30 datz. l�SI TURK OF APP CUNT DAZE OWNER.0 MERCAITQN I (vre) oatify that all oa this fonn are true to the best of my (our) knowledge. I (we) am (arc) the owner(s) of the qwpaty desetrbcd abo virtu of a avamtnty decd rcwr M in Register of Deeds Office. SIGNATURE OF APP A DATE ssssss AnY infoomatton drat is mis OdmaY T=k in the sanitary permit being revoked by the Zoning Deparftn a ssssss s * Indude with this appiication: a tumpod wanaaty decd from the Register of Deeds office a copy of the certified curvcy map if mfcmnoc is made in the warranty decd • POCUMENT NO. STATE BAR OF WISCONSIN FORK i --1M ? TMI• SIACS RS;EAYPD IOM RSCOWIMO DATA WARi1i589 f S i�.�wY REGISTER � co wt This Deed made between .tvnald--L.•Arx�e�so�3 �a1d -... Rec'dtixR�.d .... Janine.- •J- . ... A•nderson - ... husband. • and- w•i €e-•a- s-----•-------- CE ... AUG 3 0 1993 joint tenants _ -• -- -- - -- - -•- ----•-•----•-----•------•------------------_.•..-•-- __.. Grantor, at 8:30 A. M a nd Gerald -- L.� - -- McDougal,_ -_Jr aid- _Linda_- McDougal . m hushar�s3._ ana. . ... imr, ---- - - - - -- ....px_ agar_ kX .... ..... ................... ....... ...................................... -------- - - -• -- R. " s'e •,' xeos ................................................................... ..............................y Gran Witne88eth, That the said Grantor, fora valuable eonai nation__ �'1 cne_ :dallax..l1_.Q92._ar___30«3 and valuable oassidera t4 �nm _ - - -_ ... -- .._.- -• - -.. conveys to Grantee the following described real estate in .St,.. mix _- _-- _- - - - - -- ! IMri''Katlonai Bank Of R iver fat County, State of Wisconsin: P.O. Box 166 fiver Falls, Wisconsin . Tax Parcel No: ........................... ....... Lot 1 of Certified Survey Map recorded in Vol. 6, page 1619 of Certified Survey Maps in the Office of the Register of Deeds, St. Croix County, Wisconsin. rRAN This ....... is ................ bemestead property. (is) (is not) Together with a ll and singular the hereditaments and appuc.�nanees thereunto belonging; I And ------- gz'al S} O XI S........... ........................ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except I II l and will warrant and defend the same. ail •. --- ..... - -•- day of -.... Augusts - 93 Dated this ......... . .... 27TH .... y ................... ............_........., 19......... I l !I (SEAL) ......_.. SEAL) - - -- - -- I (SEAL) /! 'e— • .. . ..... ....... EAL) �) Janice J. 4nderson ............................. ..................... t AQTEBNTICATION ACHNOWLBDGMENT Signature(s) ------------------------------------ ----------------------- STATE OF WISCONSIN ss. -----------•-------•---•------•---------- • ...... .............. ....._._._.._..._ ---------- PIERCE ------------ - - - - -- ------County. authenticated this -------- day of- ------ --- --------------- - 19 ------ Pe k)rWly came before me this .......... day of -- AUGUST - ------ - . 19- - - - - --- the above named --- Andex o TITLE: MEMBER STATE BAR OF WISCONSIN - -_ JaIIi._J_AI1t Sex .Balx-- _----- •••- _---- _ - - - - -. (Ii Sot, _._ ......................... --------- •-- .......... ............................................... authorized by $ 706.08, Wis. Stats.) to a to be Lh petsoa .., who executed the f u and.yckncs ledge the same. THIS INSTRUMENT WAS DRAFTED BY r 3 Dian e L. Gavic, Attorney ; Boot .--•-------•-------------•-•--•-- •-- •-- •----- ••-- •--- •- •-- • - -... a (_ yIIaEY_ � 'Spr 9 in -54- 7 6 7- --- ----------- ....... ------------ •---- •-- •---- - - - - -. Notary Pnbl3e' PIE eY�.. Wl Wis. (Signatures may be authenticated or acknowledged. Both My Commission j (if not, state expiration are not necessary.) ^_ date: _ __ _ A (!_Ciil,9Z._27.............. .... ....... 19.43 -. -•) l ��. *Names of yeaeons signing in any uPAt3b should be tYDed or printed blow SDe3t si:a.!tam. WARRANTY DEED STATE BAR OF WISCONMX Wisconsin Leval Bkrk Co. Ina � "I&M Nw 1 —Im Milwaukee, Wis. r 4OS422 FILED %6 JAN g OAMN of �W� 6 , ft w CERTIFIED SURVEY MAP s L 4ocated in part of the NW 1/4 of the NW 1/4 of Section 13, T28N, R16W, Town of Eau Galle, St. Croix County, Wisconsin. NW corner A ALLEN C. Y~ off✓ section 13 6. o NYHAGEN �, H 3/4" re -bar % S -1407 41 y HUDSON, {' 5ii►� Wis. d a A 4 _ = - o M I unplatted lands owned platter 1 \� ` ;' ° O C- a o } O L O O CO O N88 "W 355.03' U) r- Cn 6 `0 32.91' 322.12 A N d d O .O 3 +1 LOT 1 I s 4J cc LEGEND AREA INCLUDING R/W = i O 1 "x24" iron pipe ' 217,804 Sg. Ft. Oi weighing 1.68 lbs./ I .0 � 5.00 Acres _ �� lin. ft., set. N A I O O M � ~' CO CD LO AREA EXCLUDING R/W 198,654 Sq. Ft. bi 4.56 Acres o.1 I angle pt N OWNER Clarence Frederick I RR #1, Box 188 Z Woodville, Wi. �I 54028 3 I 41 barn o house APPROVED r, W o c .-+ � N y JAN 0 6 1986 I z 37, 07' = I 364.50' ST. CROIX COUNTY 6 0' I S88 415'47"E 401.57' COMPON U LNG AND ZOMNG COAUMTEE I unplatted lands owned by platter SCALE IN FEET 100 75 50 0 100 200 West 1/4 corner section 13 qty monument Volume 6 Page 1619 job # 85 -62 drafted by Darrell Nelson