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HomeMy WebLinkAbout018-1006-90-100 r ST. CROIX COUNTY TONING DEl'AlZTN1t4NN - 4. AS BUILT SANITARY REPORT � f� � 1 Owner Address l6 79 City /StatC ���J� G Lr f Legal Description: , Lot _� Block Subdivision/CSM # '/, '' / „ , Sec. V—, TAN -R / 7 W, Town of PIN # 9/9 -ism`' -mod SEPTIC TANK —DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer Gr/ S Size ST/PC /gK / DU Setback from: House Well P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: r Type of system: o % ©G«/ /) Width Length Number of Trenches Setback from: House _ -.s 'Wel — PA > so ' Vent to fresh air intake 7 SP ELEVATIONS Description of benchmark �� �/� Elevation / ©d dV Description of alternate bencWnaA Elevation Building Sewer �- , 2- ST/HT Inlet _ 09 ST Outlet ZZ 7` PC Inlet yY, 7 PC Bottom Top of ST/IC- Manhole Cover • l Distribution Lines ( ) ( ) ( ) Bottom of System ( ) Qf . 72- ( ) ( ) Final Grade ( ) ( ) ( ) Date of installation 9 //o/ Permit nu ber 3 l%I& State plan number 11 70r,14 y Plumber's signature License number Date // / Inspector (� Compklc plot plan i I NOTICE Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW 1 --- T 6�k INDICATE NORTH ARROW Wiscopsia Department ofCommerce PRIVATE SEWAGE SYSTEM y: ' Safety and 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)]. 315969 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: ONRAD, FRANCIS HAMMOND CST BM Elev.:. Insp. BM Elev.: BM D scription: Parcel Tax No.: (II) r.� 1' ! �� , G 018- 1006 -90- TANK INFORMATION ELE ATION DATA A9800357 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi Benchm 16 0 osing &V1 „ Z 2 c i g 3 � to 3.� / Aeration Bldg. Sewer Holding t/ Inlet TANK SETBACK ION St/ Outlet I1 SZ �l.�JZ TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet ' �. 55 j 6 Air Intake =Septic �/ NA Dt Bottom ( s 9;1 7 Dosin � �7� ��/ NA Header / Man. 3,9a qoj, Aeration NA Dist. Pipe ?;,-r `77. j� Holding Bot. System 4 1 , s `?,60 ' PUMP/ SIPHON INFORMATION 1� Final Grade Manufacturer II evo�_ Demand AL - 1 .9Z /,P/, 3Z Model Number t) 1 3SGPM TDH Lift ( 15 oss Friction. -12 , System , s TDH� ad Forcemain Length 6-,C) Dia. Farr Dist. To well AB SORPTION SYSTEM • /TRENCH width Length / No. O . renches PIT No. Of Pits Liquid Depth DIMENSIONS t0 DIMENSION SETBACK SYSTEM TO P/ L I BLDG WELL LAKE/STREAM LEA ING Manufacturer: INFORMATION Type of /� CHI` a Number: System:MD(J 3G 35 4c OR UNIT DISTRIBUTION SYSTEM Header / oifolcl Distribution Pipe(s) / r x Hole Size x Hole Spacing Vent To Air Intake Length _�_ Dia. Length Dia. Spacing h 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 v �� Bed /Trench Edges ('Z Topsoil /! J Yes ❑ No ,q Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) . 01 j, aq _ LOCATION: HAMMOND 04.29.17.49A,NE,NE 1775 CTY RD E - LOT 1 -7 , 7' ^44F /6- li+- 1 NS Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date I pector's Signature Cer T o- SANITARY PERMIT APPLICATION 20 Safety and 1 E. Washington Ave'sion `�scons In accord with ILHR 63 .05 Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 in x 11 inches in size. , ic • See reverse side for instructions for completing this application State Sanitary Pe mit Number 3 The information you provide may be used by other government agency programs E] Check if previous'ap�ati'on (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D umber I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION I Pro erty Owner Name Property Location "C=S Ir© 1 /a 1/4, S T , N, R E (or Property Owner's Mailing Address Lot Number Block Number City State Zip Code Phone Number 9.bdo.sia Name or CSM Number /jt ale tux D./ 7 ( J` j r, L . 2 / II. PE F BUILDING: (check one) El State Owned I Nearest Road C] Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) F 1 E] Apartment/ Condo — — r aq • 11' c c oq /� 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Re reational 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 online B, if applicable) A) 1. [A New 2. ❑ Replacement 3. Q 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 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc_ Rate 6. System Elev. 7. Final Grade Required (sq_ ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation A lp Z Feet - _ Feet acit VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App Existin New structed Tanksl Tanks Septic Tank or Holding Tank a - f' ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation oft onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signat - Sta s) 1*WPRSW No.:: Business Phone Number: AA V lu er's Address (Street, City, Stat Code): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) Approved ❑ Surcharge Fee) Owner Given Initial ^n � Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 IRA 1/96) DISTRIBUTION: Original to County. One copy To: Safety 6 Buildings Division, Owner, Plumber I rn� 1 i , r # V W b Oo 1N ® S -4D I t Safety and Buildings 1\ 15837 USH 63 i HAYWARD WI 54843 -8107 isconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary August 05, 1998 CUST ID No.221180 DAVID B FOGERTY BOX 130 ROBERTS WI 54023 RE: CONDITIONAL APPROVAL Ideritificatidn Numbed"" APPROVAL EXPIRES: 08/05/2000 Transaction ID No. 119068 Site ID No. 15663 SITE: Please refer #i both identification numbers, Site ID: 15663 above, in all correspondence with the agency. ST CROIX County, Town of HAMMOND NE1 /4, NEI /4, S4, T29N, R17W FRANCIS CONRAD RES SEPTIC SYSTEM FOR: Description: NEW MOUND SYSTEM Object Type: POWT System Regulated Object ID No.: 34341 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. This plan approval is for a 450gpd mound. The following conditions shall be met during construction or installation and prior to occupancy or use: • This plan action is subject to designer comments on the plan • Correspondence Note: • The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to P.O inspection by authorized representatives of the Department, which may include local inspectors. All permits Con 1 required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. APPF Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address DEPA MEN on this letterhead. DIVIS F SAF' Sincerely SEE CORRI DATE RECEIVED 08/05/1998 FEE REQUIRED $ 180.00 M BRAUN , dAN REVIEWER FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (715)634-3026, M - F 7:45 AM TO 4:30 PM TBRAUN @COMMERCE. STATE. WI.US . s ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants PROJECT INDEX DILHR Plan I .D. # �l 9 Date Owner G / .S' Cd .v, c °,� Phone 71.5 • 7Yy ' S`of� Address /O 7 g0 4 . ' A 7 4/. Z3 Legal Description /-or / vo • 12. � 3q O( ' p• !00 ( %0 - 000 . N9 Yy ,N Lc- % SEc. 7v a yFV,,P /7 Town of �A County S T'. cl-0C X- C.S.T. 0 p- T u Q3 P c-(4 7- Installer Local Authority/ Supervision PROJECT DESCRIPTION f3 �t s 2 tot A.-(. LC7 T- to )4 DA t w4sr��1 AT.S. tionally soils /4 /P� �i�•;�c ; 000ifilg E :9 r AN r- sE -so,�,4 y SA-7-0147-&-D �r 2� 14 LDo C NAG -off `10UAv) S S �� l� d , �/ T . �v �u Pg . l PLOT PLAN VIEWS fa;11UDSOM" . Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS h '' °ii ` I J Pg.3 PIPE LATERAL LAYOUT Pg.4 DOSING CHAMBER CROSS SECTION P9.5 PUMP PERFORMANCE SPECS This design for installation is based entirely on measu rements, . landscape conditions rements, elevations, The accuracy di his s, as reported, shall remain the sole re (slopes etc.) and soil suitability of the csTM. peespdsp n lb it I Y � 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 res onsibilit b the designer for the workmanship, construction, placement, y 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. D�2 �K 6 o w o � � o - l b Qi N ov G � w Nis \, e: o a � w ZZ / o ✓ –7— ICROSS SECT100 OF M OUkJ D -' w i r ti B eD Oev O F % r o 'DiSTRif3uT�o,�) i A33ek- G, Tl� ickaFSS Pip to G- °F T op sort SYSTEM e IEvA rioo r OW FOR M ow c c �G RATiO MEIN. � SAL) D . . �I /I PIewEO Top sot' % SIoPE FORCE" uu� FORM E MAW 1evAT100 vuMR (3ED 9 7. 5' .17 FT• -- ELEVhTiorJ S -- 1.2- Fr. IMVE,Rr of P 2 21 21 • IATERh(S 5'9. / D • Top OF Rack y'1.5& G F T • _ 3 H /.S FT. • T o r l 2• IArE RAIs ��• 9 f'LA N VI Ew vF MOUAJD -- wi rt} T3 p C E 0 r L w-2 FORCE MAW A FT I I- • I (3 F r f -r I g r Fr w 2- 7 F r L B O F 2 PVc. cAPpEp To I . 013 SERVA T100 A 91 PEI Are Pipes PERMA,jE,uT MARKERS RECquiRED BASAL, hREh ` 'A A�'�y w - �✓`�O �l2 S 901t, ra�t1 T'IQ/1TtbE - APAci ry PRoposEV BAStM APej� = B ( A + _ - 76 x s + *w C S Q . F T. : B o ri o Aj PIPC ►JErwoR k T(�Th vol. of waK A� � 1 p PISTRlf3tuTIOO L ATE RA eNO CAP 5 _ '` x X Z pvc :FoRcE ,�-- M AW LAST "Ole S H A II (3E "EVr To LNp CAP VOID Vo iur- t FoR 35 FT'. IuvERT' <✓IEVgt-10&3 dF Z FoRcE MAW 1 q. 2S PERFORAT - ED PIPE DErAi L.. Q Holes IOCATeu OX-3 (- y VARiAf3LrE7 y c��hHy sphcE D p 3t!o f= H o lE Di ,NKtTe R - -� L ATERAL R �a. 3 -- MANS FOLD " 2_tN X ��uch65 -- r-oRcr- MA1'k Z l S 10. Y o 1401 P i p E. 13 DISTRi f3uTl0xJ DiSCHARvE RATE PER LATERAL 1S•2� 6A TOTAU 'D15CkAR. RATE / Ne IC G� L, i PUMP CHAMBER CROSS SECTION A N D SPECIFICATIONS P,4 E OF 5 VENT CAP 4"C.I. VEf PIPE -T WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER W INDOW OR FRESH 25' FROM DOOR, t / 4i,f,co 1 A) � 13 W 12 "MIl1. .. AIR INTAKE qjW - /IT/OAl GRADE r o I 4" MIN. Z - - I Alk q 'o T ll f `4 `__ X 1B "MIIJ. corJDUIT __________ �lEv1+n ()ti 9 3.x' ��� - - - -- INLET PROVIDE J - -"' -- AIRTIGHT SEAL I I APPROVED JoI APPROVED JOIWTS WT A yI� I II I�) ,{M I I 1J�C.I. PIPE ► �` / T�fA I III W /C.I. PIPE ZXTEMMUG 3' �0 ( I II ALARM EXTENOIIJG 3' 01JT0 SOLID SOIL B Yf� // I i I ONTO SOLID SOIL r � I S c q p, 39 (3- oN ''s // ELEV. FT. __� �� PUMP--_ OFF uSE 3 oe D /. 2 IwAi6 OF O BLOCK N S/1.uD c c RISER EXIT PERMIT(ED OIJLIJ IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC.IFfCATIOUS DOSE TANKS MANUFACTURE F��S �' "CJ ' {DUMBER OF DOSES: PER DA-4 /SD TAMK SIZE : D GALLONS DOSE VOLUME /O ALARM MANUFACTURER: 4 V DTI /P IMCLUDIIJG BACKFL / O ' W: / `�/O GALLOMS MODEL AIUMBER: Z U, L CAPACITIES: A= INCHES OR � GALLOWS SWITCH TYPE: J4 E P V R F -10, 4 7— F -10, 4 7- 8 = Z /� INCHES OR W GALLOWS PUMP MANUFACTURER: E���" c C= ! Z g INCHES OR X GALLONS MODEL NUMBER: � I J V D= / r " 4// INCHES OR —L_L_ GALLONS SWITCH TYPE: P o y Fln r NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE - 35 GvM INSTALLED OM SEPARRATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. g• 3 FEET fi AoF 5 P E C S ' I MINIMUM NETWORK SUPPLY PRESSURE . • , , . . • 2.5 FEET ,cAC(A- + 3 S FEET OF FORCE MAIN X 1 100 FI.FRICTION FACTOR.. ' 7 Z FEET — TOTAL DYNAMIC. HEAD = FEET 9, ouvp 3 a INTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTFI - ,;,LIQUtD DEPTH i - 1 r HEAD CAPACITY CURVE MODEL 6188" 7/e i 1/1 e 1 5/a 25 e I J 5/8 m 15 + + 1 • f) 1 3/10 10 2 .. . 5 1 1/2 -11 1/2 NPT ' 0 U.S. GALLONT7t1 1 LITERS 50 BN70ao 0 180 210 FLOW PER MINUTE TOTAL DYNAMIC NEAOyiIOW t'ER nmUT[ , EFFLUENT A=" LC TEgN6 . NEAR CAPACITY 12 YNITS/MIN FEET METEgs GALS Lf e 1.52 72 213 10 3.05 01 271 ti 4-57 to 170 E 20 s10 2e VaW CONSULT N SULT FACTORY FOR SPECIAL APPLICATIONS • Electrical afterrlalors, for duplex systems, are avallable and supplied with an alarm. • Mercury 11081 switches are available for controlling single and }. alternators, for duplex systems, are available with or • Double Ise s hack s. Without. alarm switcheg. Pi ggyback mercu float switches are available for variable level long cycle controls. Standard all mode - Weight 39 Ibs - /, H.P. SELECTION QUIDS 115 8•TI•• _� 1. M11eprN 11oa1 operalad 2 pole ►nechanlcal awlich, no rrull Control f•quhed. Model Control s•I•c— I,o� 2• Slnpls Piggyback mercury Iby •w h or d.,,, p;2oyh mercu ryDa V ke -Ph Mode Am Slm 1•x switch. Baler b FM0477. M90 115 i Zia 9. l i Du 1•x 9. Mechanical alternator 10 -0072 or 10 - 00756 1. Sao FMo712, for 00rrecl mode( of EW&kal AMarnalor, "E-Pa r. 230 1 Auto 5. Mercury sarlsw dDal switch 10-0225 used #4 a control ak". w ,Elio ' 230 1 No 1 w 1 A 7 _ duplex (�) w N) noel system .pecih• 1,5 . 2 Iir.R S 4 32 • f"u P)1191• "J• Pak lurlctlort pox, lof Vi ati "D�x or duplex operDn f 00002' M Donnecllon at wked•in aim• 7. Two'(2) hole "J Pak ". Iw waleNehl caul..__ splice. far Mdamadon on a"do" ado" Zo•N•i f * awllclwo, FM01�IKyrk4 Mlem VV�chanlcil ilMa br AM WlallalW of 661*0N. plot n CAUTION FM077Z �a0a' Fk"13; Gump 3@"&qe B-Wh FMOaa7; and 8ia%oaa CaWd ao; 16 4 11 -now alaolrbbn AN a "t) - al0nd a and wiring aho.,ld M 40 " by a qu&w in s the moat rawnt (Allonal Eloc" Coda odes ahculd a ksowad Inel.rd- ftaaxh Act 10611A� (NEC) C1 ant the C •ouPallonal safely and RESERVE POWFPED DESIGN For unusual conditions a reserve safety factor la dr1 9 ed ineeT into the design of a very Zoeller pump. MAIL ra r.V. sox 16311 ° �ELLL 100$ 1. KY 10256.03,7 Manu/acluiais ol.. . 0 SHIP 70: 3 80 04 "Il e,$ tare N l0ulay e. KY 402 � (502)178-2131: f�. r,soz 771 -362 � 1 9 _Wiscsnsin Department of Industry, w SOIL AND SITE EVALUATION ` of ` P Labor and Human Relations g 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 T ,o include, but not limited to: vertical and horizontal reference point (BM), direction and 57 C/� d/ x percent slope, scale or dimensions, north arrow, and location and di nce to nearest road. parcel 1. D. # .'O .0j APPLICANT INFORMATION - Please pr i orM n. Reviewed by Date Personal information you provide may be used for seconds ses ( 15.04 ) 4 .. 11 . 7, / v I Property gamer Pro �• oc ( NQV ' Q b 1/4 N 1 /4,S � T 2 ( B ,N,R J E (o W Property Owner's Mailing Address ST cRClx Lot Block# Subd. Name or CSM# 2 d U-0- V /07 �4 couNTV ti CS1�1 Ui .. o u- OF. city State Zip Code Ow, lVe I V 1119% Nearest Road ity ❑ Village Town w t/ New Construction Use: Residential /Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 4 �� gpd Recommended design loading rate bed, gpd /ft ' S trench, gpd /ft Absorption area required 37.5 bed, ft 2 3 -73 trench, It Maximu design loading rate bed, gpd/ft ' S trench, gpd /ft r Recommended infiltration surface elevation(s) S�-� 3 0 ft (as referred to site plan benchmark) Additional design /site considerations / - OA)6 - /U ,4 10 U.v P .S S' % /P2EQ V //VZ%!:? Parent material lg�e jhy 5ED 'S O(�,E1t AEUS46 Flood plain elevation, if applicable _ ft S = Suitable for system Conventional MMou / nd In- Ground Pressure AT -Grade System in Fill holding Tank y C� ❑ ©r U = Unsuitable fors stem ❑ S U [B 5❑ U ❑ S ®-U ❑ S U S El S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ,.,., Be;, Trench 19 -q /o .P 5/3 L dS Cs' I f s :. �, �/ 10 Y e / 5 -I Z- Z Sbk c s . s" ; • � elev. Grou 7 S l0 6 5 l� L A op N Depth to limiting factor �J_in. s Remarks: Boring # $ I oYR 3 13 — L z cQS S 2 S ' • G 0 z g' « In yR 3 G'3 lo S ©, s M. Q cs Ground 3 - 7o "1.S / 1 I /-Cfl , o Y S /Cv /0 4 o nMtr n — o .S ;. C, Depth to limiting factor �_In. Remarks: CST Name (Please Print) r Signature Telephone No. R0?) RT 2AL13Rtcc, I 7 /5'38 Address Date CST Number Ulbricht & Associates Private Sewage Consultants 6S5 O'NeN Rd. Hudson, Wis. 54016 ORI SOIL DESCRIPTION REPORT PROPERTY OWNER Page Z of PARCEL I.D.ff Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 In. 'Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench / • /� 16M --- ^tit �S S z y. 20 /OYR X1q SQL 2 f S h't 'w -Fk c l I ,S' (�v Ground d ' �•S 7 ^� L S Me (! 4 f- 5 elev. �N D , Depth to '► n �0 yle ,$�Co C 2 S i� U� " limiting S factor Z in. . Remarks: Boring # Ground elev. n. Depth to limiting factor in. Remarks: Horizon Depth `Dominant Color Mottles Structure D f2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Boring # ; i Ground elev. n. Depth to limiting factor in. Remarks: Boring # F Ground elev. n. Depth to limiting factor ' Remarks: S13DW -8330 (R. 08/95) I C �iPQro�'D 41, r-- o w a MI to 4A � x � z g � W a G h R ' Z w c,, ►� n C , �y i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _\ Mailing Address - 1 ° a fi� A ve— o ,As Property Address 1 ���f. E (Verification required from Planning Department for new construction) City/State _ I �nn.r.oh� , W Parcel Identification Number 8 ^ 1006 , q 0 ^0o 0 LEGAL DESCRIPTION Property Location N 6 '/4, yG '/4, Sec. T W, Town of Subdivision Lot # Certified Survey Map # S - j 4 0 0 ( , Volume 1 Z , Page # 3 4 14 Warranty Deed # S - 7 (p -- 1 L4 a. , Volume i i � 3 , Page # 'A O Spec house 0 yes X no Lot lines identifiable yes 0 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 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 three year piration date. '>� a L A 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 e(tm Qthe owneo of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF 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 I STALE OF WISCONSIN FQ1R1i 1 -1982 (' NL �F wK D � r DOCUMENT NO. This Deed made between RE 1 7 FItE - -70UN AND CA& YU BAT'F - - -- T. CR IX CC W! HLTSRANTI - �►11i` lo TFIE _ Grintor, p �p�p i and RR APR U 8 1998 HUSBAND wipe *3 SuRvf Von x'30 M MARIT P RO P ER T Y � Grantee, I ICI fit 0 Witnesseth, That the said Grantor. for a v. W&va6m - conveys to Grantee the following described real estate in ST CRO THIS S PACE RESERVED FAR tTECtXrOtN(i DATA i County, State of Wisconsin: NAIVE A140 RETURN ADO,'*SS y Qo. ' 3 a�' CSC \, ,..3ct t I*- L"Ik \o*)Q.►►O 2 �.: x V al. 1Z ,. 1 7 tO � &o Av — LOT 1; LOCATED IN PART OF THp Rc���s, FRACTIONAL NORTHEAST QUARTER OF '10 a j THE NORTHEAST QUARTER OF SECTION a 4, TOWNSHIP 29 NORTH, RANGE 17 -- } WEST, TOWN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN. ? tnn _a0 =O0A NT1fICAT10N NUYBf.R TR ANSFER FEE This IS NOT homestead property. (Lc) (is not) ' a , Together with all and singular the herediuments and appurtenances dwreunto belonging; And JOHN AND CAR LYN DALTON warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except EASEMENTS, RESTRICTIONS, AND FIGHTS OF WAY I _' OF RECORD, IF ANY. !. and will warrant and defend the same. p� Dattd this. day of V — .19 — (SEAL) _ (SEAL) (SEAL) (SEAL)4: DALTON c s; — ' AUTHENTICATION ACKNOWLEDGMENT <. Signature(s) State of Wisconsin, ss. Count . authenticated this day of , 19 Perscmall came be(orc me this day of Y 1 9� — , the above named 6, L . _� to +1 �. • � I 17)alfad TITLE: MEMBER S'1 "ATE BAR OF WISCONSIN Cji q (if not, m authorized by $706.06, Wis. Stats.) so„!*-, known to be the p-rson S____ who executed the foregoing ! r _ owinarnent and acknowledge the sat . > THIS INSTRUMENT WAS !)HAFTED BY ,1 • _ FRANC LS A - COUR T1 rya Public, S Canty, Wis. .� 3 S `4 (Signatures may be authenticated or acknowledged. Both�st4C�'na.. commission is per (If n state exp iration ate: necessary) a p ' • Names of rsons st .� in an ca ii -. should d w , nnied bctow their wm � ? Pe Bea' 6 Y P'i' Y by typed � '.; STATE RAC OF wirctnrciN Waco'en Leo fltank Co.. q,c. I ;' WARRANTY DEED Fe— ?40 1 – 1140A Mo•aukee Wis _ { ''.�.. , . •�. a . aak .,. a ",:..•.� �. ,. :.. r ;e'. Tfi �'.:.' .' � ,.._ .. ' ° -i Mw." �R1';�ff' + a �,? »'s:� "�j. ��.1` _ 3 � ;y ..... _ A . t I FILED � 57e1006 1 -) 2 7 1998 o KATHLEEN H, VIALSH L Register of Deeds SL Croix Co., VMW CERTIFIED SURVEY MAP Located in part of the fractional Northeast Quarter of the Northeast Quarter of Section 4, Cn . Prepared for and at the request of: OWNER: John and Carolyn Dalton 1794 110th Avenue Hammond, WI 54015 UNPLATTED LANDS_0_FOWNER Drafted by Krlstl A. Eylondt NORTH LINE OF THE NE 114 — — — — — — RIGHT —OF —WAY �— --- - - - --N 88'52'30' W 2620.30'-- - - - - -- -- iii — 1310.15' - -- - -- — 1310.15= - - - - -- �' -- �' _ _ — CEMERLINE C. T.H. E" R /GHT —OF —WAY O _ UQRWBN ��J�� QUIT CLAIM DEED h 000 POWER CQMPA.NY VOLUME 161 PAGE 312 — — — — — — — — t 88'52'30' W 208.45' DOCUMENT N0. 133482 NORTH 114 CORNER g NORTHEAST CORNER SEC. 4 -29 -17 CENTERLINE (ALUM. CO. UON.) DRIWWAY SEC. 4 -29 -17 .. • ...... .. (ESTABLISHED FROM BUILDING SETBACK LINE 7I£S— SHEET) o D:I z LOT 1 I ,R W �I W z1 3 69.830 SQ. FT. of I n 1.60 ACRES `� z i r O OI n aaI OI �.:` C �98 ai ? cn Z gj �i Q ZI ; �gC 01 Q w_ rr: '.:a;arntte S 88'52'30' E 208.45 � ' ri 7 S�9 RONALD F. �y of a JOHNSON acs;: . >•rI Gate 0 � 3 -1186 a voi ` AMERY. Huff �+nci void g WiS. o < { �� , UNPLATTED LANDS OF OWNER NOTE: The parcel(s) shown on this map is /are subject to State, County and Township laws, rules and regulations ( Le, wetlands, minimum lot site, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. LEGEND: County Section Corner Monument of Record • Set 1" x 24" Iron Pipe weighing N 71-1 a minimum of 1.13 pounds per linear foot. too 0 too JOB #97111 Prepared by. GRAPHIC SCALE A & E SCALE IN FEET: 1 inch = 100 feet LAND SURVEYING k CIVIL ENGINEERING Phone No. (715) 246 -4319 BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE 109 East Third Street, P.O. Box 325 NE 1/4 OF SECTION 4, TOWNSHIP 29 N., RANGE 17 W. New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR N 88'52'30" W. Sheet 1 of 2 Volume 12 Page 3414 CERTIFIED SURVEY MAP Located in part of the fractional Northeast Quarter of the Northeast Quarter of Section 4, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin. SURVEYOR'S CERTIFICATE I, Ronald F. Johnson, a Registered Wisconsin Land Surveyor, hereby certify that by the direction of John and Carolyn Dalton, I have surveyed, divided and mapped a part of the fractional Northeast Quarter of the Northeast Quarter. of Section 4, Township 29 North, Range 1.7 West, Town of Hammond, St. Croix County, Wisconsin, described as follows: Commencing at the Northeast Corner of said Sect:i.on 4; thence, on an assumed bearing along the north line of the Northeast Quarter of said section, North 88 degrees 52 minutes 30 seconds West a distance of 1310.15 feet; thence along the west .line of the fractional Northeast Quarter of the Northeast Quarter of said section, South 01 degrees 38 minutes 45 seconds West a dist=ance of 83.00 feet to the point of beginning of the parcel to be described; thence continuing along said west line, South 01. degrees 38 minutes 45 seconds West a distance of 335.01 feet; thence South 88 degrees 52 minutes 30 seconds East a distance of 208.45 feet; thence, North 01 degrees 38 minutes 45 seconds East a distance of 335.01 feet to the southerly line that land parcel as recorded and described in Quit Claim Deed, Volume 161, Page 312, Document Number 133482 at the St. Croix County Register of Deeds office; thence along said southerly line, North 88 degrees 52 minutes 30 seconds West a distance of 208.45 feet to the point of beginning. Containing 69,830 square feet (1.60 acres). Subject to all easements, restrictions and covenants of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundaries surveyed and described; that I have complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the Subdivision Ordinance of the County of St. Croix and the Town of Hammond in surveying and mapping the same. R nald F//Johnson Reg. No. 1186 Date A & E Telephone # (715) 246 -4319 Land Surveying & Civil Engineering P. O. Box 325 New Richmond, WI 54017 *uWo ti RONALD F. JOHNSON 8--f Ias AMERY. Wis. ° 1 s �o O SU R vE fte got Volume 12 Page 3414 Sheet 2 of 2 L • • .►.. M // �/� > / f /:� f� / ' / �� �, L i r C� --