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HomeMy WebLinkAbout018-1075-20-000 ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT ��° r (1EO'', Owner 2 6 i f G' f, M P rtY 0 ,4 ;_ __ Proper Address - o !�' 1 `a q o S ,, 1. KAx City /State &.4 /VI hi C;OUrur+ Legal Description: Lot Block Subdivision/CSM # '/a ' / a , Sec W , TAN -R-LLW, Town of &A M M m iy PIN # &A SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer Nl� (kAeste. AW Size ST/PC /DDD / ��o Setback from: House 5 Well PAL Pump manufacturer 6� e L d Model 46 Po ..S'' Alarm location RA X P NI f� N (HOLDING TANKS ONLY) —' Setbacks: Se ,� Ti a intake Water Line Meter locatio ------ ' Al cation SOIL ABSORPTION SYSTEM Type of system: M 0 N N d Width _ Length 9 y , Number of Trenches Setback from: House Well /Ii P/L Vent to fresh air intake /!J y ELEVATIONS Description of benchmark LOC ' )e P o F w o ed SfA K e Elevation Description of alternate benchmark fe P o &I. Elevation ` 9, Building Sewer Y! ST/HT Inlet ^ , �, � ST Outlet PC Inlet + - PC Bottom L//-- Header/Manifold 9 ��� Top of ST/PC Manhole Cover r Distribution Lines , () ( ) Bottom of System( I f/ Final Grade 0 r. Date of installation /" / Permit number State plan number 2, O Plumber's signature h�� License number J 3 Date 90 T Inspector AW Complete plot plan 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 0 3Sf z L —L L- M -3.z� 3 Na r�S f/ al pti rA K iz 3 i 4 e t� h V6 INDICATE NORTH ARROW r Wiscon`si Count rf Department of Commerce PRIVATE SEWAGE SYSTEM r Saf3ty and Buildings Division ST. CROIX INSPECTION REPO GENERAL INFORMATION (ATTACH TO PERMIT), Sanitary 92_: Personal information you provice may be used for secondary purposes [Privacy L , sA5.04 (1)(m)]. G ``�t �i i GG ftbtit Holjr tdtLw: Ej&# ❑ Town State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: I N � ; / Parcel T r > ��� dl -: 1075 -20 -000 f TANK INFORMATION ELEVATION DATA A9800623 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �Nl ;o(I�D�, .. lUD Benchmark Z8 /. y / /0L21 166 1 1 Dosing �: 'if fir . �ZS A - 14 9M 3.z Co /o / 3. 7.7`11 Aeration Bldg. Sevver iZ - 5�; $ . U Holding Ow Inlet /U ,z -7 1 $ �, TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet Air e ti �j�a 1 0 ^�) A NA Dt Bottom /0Z I L - 131 c p osing ,?j; k ":�!> f;' NA Header /Man. Aeration ,._ NA Dist. Pipe ✓ �. od S/ , Holding Bot. System , -� z� , Iz 9 oa- PUMP/ SIPHON INFORMATION , , �� �, y Final Grade 1 - 1 -F Manufacturer � Demand `�vuf c 5 �Gwlt Model Number ��'GPM �/ / c� CAS �.r TDH I Lift /q,q Lriction 3 7� System TDH 2,v.5jt Head /, Forcemain Lengthy Dia. Dist. To Well I F F SOIL ABSORPTION SYSTEM ! s c BE TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Li uid Depth 9 i IM N DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Man u acturer: CHAMBER INFORMATION System p vt� 35 �� / � /_�- OR UNIT Mode tvum er. S: l� � DISTRIBUTION SYSTEM Header Manifol Distribution Pi e(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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.) LOCATION: HAMMOND 34.29.17.5 A, SE, SW -1-8 �'6 / '�60TH AVENUE -,� ��, c �v'✓ 3 C� 3 _�7.f L (rq � �I8,�0 �ofG' !f' /atClc �1 e4Ai - 1t! 4�) A a, - 1 o C ecc K a� �c G1 luc/ Plan revision required? ❑ Yes No Use other side for additional information. Z� / SBD -6710 (R.3/97) Date Inspector's ignature Cert. No V isconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. j p • See reverse side for instructions for completing this application State Sanitary Permit Number Nuuumb Personal information you provide may be used for secondary purposes ❑ Check it rv..ion to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION a2 O © .3 Prop y wner Name Property Location M P ,C ,L t t /4, S T d ? 7, N, R /7 6w W Pr p rty O ner's M fling Address Lot Number Block Number 77T7 Cit , State jZipCode Phone Number Subdivision Name or CSM Number A 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ C it y Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 o Tow o f Illflq 40;41 111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo C ! �% 1# 1 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. D( New 2 ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an ------ System System Tank Only Existing System Existinq 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) q Elevation Feet /,$,O/, " Feet VII. TANK Capacit g allons Total # of Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer s Name Concrete st noted Steel glass Plastic App Tanks - Tanks I ` eptic Tank or ng a �'] /pG tv e /I/ ® 1 El ❑ ❑ ❑ ift Pump Tank er /QC ® 1:1 13 El ❑ ❑ 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 Signature: (No tamps) MP /kOMMVNo.: Business Phone Number: (54-� e Plumber's Address (Street, Ci y, State�Zi Code): /L IX. COUNTY/ DEPARTMEN SE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groun ate (No Stamps) Approved ❑OwnerGivenInitial .,TD urchargeF ) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber ' Safety and Buildings 15837 USH 63 HAYWARD WI 54843 -8107 N *hsconsin Philip G. Thompson, Governor lip Edw. Albert, Acting Secretary Dep of Comme December 16, 1998 CUST ID No.640767 ATTN.• POWTS INSPECTOR ZONING OFFICE ROBERT J TUTTLE ST CROIX COUNTY 316 E WALNUT ST 1101 CARMICHAEL RD GLENWOOD CITY WI 54013 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identification Numbers APPROVAL EXPIRES: 12/16/2000 Transaction ID No. 200973 Site ID No. 165253 P SITE• Please refer to both identification numbers, ' fl, Site ID: 165253 above, in all correspondence with the agency. ST CROIX County, Town of HAMMOND; 1651 60TH AVE, HAMMOND 54015 Facility: BRUCE MOLL RESIDENCE SEPTIC SYSTEM 1651 60TH AVE, HAMMOND 54015 00 " "t ME FOR: S orrr.FS� /� =�- Description: MOUND SYSTEM, 450 GPD Object Type: POWT System Regulated Object ID No.: 442645 SEE CC RFC 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: 1. This plan action is subject to designer comments on the plan. 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. 3. The area 25' below the downslope edge of the mound must remain undisturbed. 4. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 12/11/1998 i FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 PATRICIA SHANDORF , POWYS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WSMART code: 7633 cc: GALE W SMITH Page L Of .5 Strow, Marsh Hoy, Or Synthetic Covering Distribution Pipe Medium Sand G Topsoil b % Slope Ded Of 2 2 z ( Force Moin flowed Aggregate From [lump L.aycr D • E /..2� Cross Section Of A Mound System Using i F A Red i - or [tie l+t, sorption Arco t G ,O A _ Ft. H qA1 Ft. License flumbcr: A 'fp 2- -�?.�� t 1,;2— Ft. bate: /� /9/9�' J Y-� Ft K V, Y Ft . 0,9 of on Pipe � � K G Force Main W ' .� ._._ ._._ .__ _ __ _____..._ _.. J From Pump i Distribution Ded Of » — 2 ! I Pipe /Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A tied For The Absorption Area 4 Page Of .� Perforated Pipe Detail End View peA FORAM:!, pVC P %Pe a � F crce Main PVC P '� * -:ioles located on bottom of force ;gain are equally spaced End cap — Last hole should be next to end cap Distributation pipe layout P�Ft. Invert Elevation of Laterals Ft Inches S Inches Signeds XInches License f �. �Z �� rInches Date: �- Hole Diameter Inches —T_ Lateral It a Inches Manifold it o`Z Inches Force Main �� a Inches # of holes /Pipe. PAGE . ^? OF PUMP CHAMBER CROSS `• s �TI IJ • SP SEC 0 AIUO ECIfiCATIOAIS VENT CAP " 4 C.I, VENT PIPE WCATNER PROOF APPROVED LOCKING �: 25' FROM DOOR, JUNCTIOW BOX ` MANHOLE COVER , WINDOW OR FRESH IL "MIU. P.IR INTAKE � GRADE I `I" MIN. IB "MIU. CONDUIT V-- 18 "MIN. �� -- - - - - -- —�. N � 11 , IIUL_ET PROVIDE I - - -- -. - T AIRTIGHT SEAL I I APPROVED JOINT A I I APPROVED _: 1' '•�; C. 1. PI FE I III W /C•I. PIFE EXTENDIAIG 3' _ _ ( II ALARM EXTENOiN'. .' ONTO SOLID SOIL_ B I I I ONTO SOLID 5 A _ C I I O Al CLEV. / FT. - - -J PUMP ,f f r> OFF l �- D CONCRETE BLOCK y''s14 tid RISER EXIT FERM GULIJ IF TANK MANUFACTURER HAS SUCH APPROVAL ded r'4 N/t SEPTIC E SPEGIFICATIOUS {- '7ANKS MAAIUFACTURER: /►'I�GIrC����/Q1�1 �C� C/�IS/ CUMBER OF DOSES: PER DAB TANK :,IZE: 0e7 L7 GALLOUS DOSE VOLUME ALARM MANUFACTURER: INCLUDING BACKFLOW: GALLOP S MODEL NUMBER: - -10_1 CAPACITIES: A = / INCHES OR GALLOk; i SWITCH TYPE: /�/ INCHES OR __�_�.:L�__ GAIIO►.' S PUMP MANUFACTURER: �" OL1 ,�, _ C =�LL.INCHES OR .�.,. GAL,LOX: S MODEL NUMDER: - Pd Do � INCHES OR _AdfL GALL01•IS SWITCH TklPE: l' - 'r - �4 e d )'l?0 �/ 0 E: PUMP AUD ALARM ARE TO IDE Mi DISCHARGE RATE A 0 GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL. DIFFERENCE BETWEW PUMP OFF Au0 OISTRIBUTIONpIPE.. 1, FEET + MINIMUM NETWORK SUPPL9. PRESSUR ✓ � � � � � � � ; .�' � ��F.EET + LrG_= FEET OF FORCE MAIN Y ' % L..2.L oo rt FA TdR. ' b FEET TOTAL 0�11JAMtG HEAD t,242 FEET IWTERNAL. DIMILMSIONS OF TAUK: LEMOTH �.l;WIDTN 7!� IL DE � ` o ' eq LICEMSE �,�� WEST URI'�E SUPPLY INC. °F 12 DUSYRIAL RD. Goulds ON, WI 54016 Submersible Effluent Pump 38 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor: and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, manual operation. Automatic points. • Water transfer 115 or 230 V, 60 Hz, 1550 models include Mechanical RPM, built in overload with Float Switch assembled and ■ power Cable: Severe duty • Dewatering automatic reset. preset al the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP. ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM. FEATURES heavy duty ball bearing Pump: EPO4 t.uilt in overload with construction. • Solids handling capability: automatic reset. a EPO4 Impeller: Thermo - 1 /4" maximum. • Power cord: 10 foot plastic Semi -open design AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for • Total heads: u p g to 24 feet. r,ith three pion grounding mechanical seal protection. SP Canadian Standards Association • Discharge size: l NPT. p'ug. Optional 20 foot ■ EP05 Impeller: Thermo- • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for (C„ A listed model numbers rotary/ceramic - stationary, three prong grounding plug improved performance. erJ in "F" or "AC ".) BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104'F (40 'C) cortnuous superior strength and 1401 (60'C) intermittent. corrosion resistance. • Fasteners: 300 series h1ETERS FEET stainless steel. 10 I - • Capable of running dry without damage to s 30' j �� -- - -- I compon - t—SGPM Pump: EP05 B FT j • Solids handling capability: 0 25i - -- - 3 /4" maximum. w z • Capacities: up to 60 GPM. s 20 - -- • Total heads: up to 31 feet. — -�-- - - - • Discharge size: 1'h" NPT. z 5 . 7 • Mechanical seal: carbon-0 15 1 i rotary/ceramic- stationary, -- BUNA -N elastomers. 4 I EPOS • Temperature: a 10 104 °F (40'C) continuous 1401 (WC) intermittent. 2 EPOa I _ I 0 00 10 J 20 30 40 50 GPM 0 2 4 6 8 f 0 12 ml/h CAPAWY 0 1995 Goulds Pumps, Inc. EflecWe May. 1995 83871 1 Jf o0 o I - 1 - - - - -- -- - -- -- rJ - - - - -- - 14 t a _ t o - -- - -- - -,- - -- - -1- - -- --, -� - -� -� ec i ice✓ �_ . � - --43 — — — — — { -- — a _ -- — -- �• _ � - -- rT0 J - p4 ^'ice* 5 i Z v � , z ,• _ - - - - ( - -- - -i -- -- - ! - - -- _ I .- - • - - . - .� - NEE - A ys- L �I � �1 - -- - - - -{--,- . - I - -- - - -- - - - - - - -' -- �- -� . - - -- - -� -'- - -- -- i -- - -- - -� -- -i - i - - I -.- i i I �- - -i - -- -- -- Y-- -- - -- - -- - --,- - - Jr fl- 3 - - Wisconsrm Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s-ILFIR&3.09, Wis. Adm. Code r Attach complete site plan on paper not less than 8 1/2 x 11 inches'in size. Plan ryust County include, but not limited to: vertical and horizontal reference point (BM), direFtiorfiidr n percent slope, scale or dimensions, north arrow, and location and distance ;© Rea[t j�ad Parcel I.D. # APPLICANT INFORMATION - Please print all irlformat�bn F ` I v' wed b Date Personal information you provide may be used for secondary purposes (Privai y Law, s. 15.04 Property Owner ZCA 60WFOCAP13 J O _ _ Govt. Lot �'` 1/4s� 1/4,S T ,N,R `� .OM W Property Owner's Mailing Address V Lot.# k# Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road 16 0R O'CiAl b'' ( ) 11-4 i 6v fh Ax'46 New Construction Use: ,MResidential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow r0 gpd Recommended design loading rate bed, gpd/fF -3 trench, gpd/11 Absorption area required bed, ft trench, ft Maximum design loading rate,_J/_bed, gpd/ft .r trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material 6:1 C i A L t Flood plain elevation, if applicable N ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system EIS M U ®S ❑ U ❑ s Lou I ❑ s 0 u I ❑ S R U ❑ s 9? U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 0- /a VZ S" M y 4 1,3 ,44 6 F 13 Q -- /- Al Ai . r G Lv Ground - , zrhP .S' / 4 k Al V Y'� — 2 .� elev. Depth to limiting factor Remarks:- Boring # 5 7 1 4 I v " 3M ", 6 �- o- a a L , Ground ° elev. 9 �q pry Depth to limiting // VON factor � p � � ^`� � o3,�_ Remarks: ' ' CST Name (Please Print) Signature I P� 4�—'A ) e L) S A4 �t �ece, Address 0. Date CST Number 22 e 6,1 e tv AP Po zi( 6 / r_'"L D/3 I l/� y� [ OIL DESCRIPTION REPORT ' PROPERTY OWNER n> R, ON /V/Ai( Page 2 of ' 3 PARCEL I.D.# ©/ O "' �fl 7-5 oz 4 ­d Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench am Ground 3 1 M X N v� tip 3 elev. 9ft- Depth to limiting , factor 2y.5 in. Remarks: S jL t 6 Boring # ......................... . Ground elev. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda ry Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to limiting factor in ' Remarks: Boring # Ground elev. ft Depth to limiting factor in ' Remarks: SBD -8330 (R. 07/96) �1 - - -__ _ _ A I_ : I ' f E I I I - - - - - D- - -1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Soper Al d�L Mailing Address _ / � O 7`� 1¢ Ve, Property Address 0 taN A ye- (Verification required from Planing Department for new construction) Cit3atate AA A M m h/ o fv / Parcel Identification Number O / 6?- /40 75'- r �2 O - v O p LEGAL DESCRIPTION Property Location %, Sto 4, Sec. T v RZ7—W, Town of Subdivision Lot # Certified Survey Map # Volume Page # Warranty Deed # .1�.3 /' 6 . Volume . Page #� Spec house - I4 yes ❑ no Lot lines identifiable .❑ yes Of no SY MANTENANCE - ��ofy'��asy�emoonldtesQItiaitsp � ". toLandiewastGS .Pr�perar�beaa:doe _ consists of pumping out &Csq)tietM*Cvay9=yc=orsoone4 if headed by x licensed ptmnper— What ymt put.into 6c system can affoct�e .fim�on of �e sepac taatc ireatmcntstage is Eye vrasdedisposalsysoem, - - - 11be PWPerY ow = agree to submit - to St Croix Zoning Department* certi5cation f0cw,' by the vwrnw and by a n=wp l ph ber,rest[ictodplmndaor&Uc a.9odp=pavc fyingtbat(1)1 e it *aAMatW&sPo lsystem is is PrOPer OPCWM condition and/or (Z) after inspection and pumpmg.(rf accessary), the septr taakis I=than w fie of sludge. ywr. the M&Mk mod have =d the above requkcmcats and agree to main&;. too private sewage disposal set with the staa,dards set &A herein. 'as set by the Department of Commerce and the Dc�attmeat of Natraal Resounoes,;�State of Wisconsin.. Cerdficahoa statiug that Your septic system has bom maintained mint be completed and returned to the St. Croix .County Zoning Office vBbin. 30 days- of the three year expiration date. SIGNATURE OF APPLICANT X DATE OWNER CERTIFICATION I (we) oatify that all statements on this form are hue to tine best of my (our) knowledge. I (we) am (are) the owner(s) of the PAY described above, ly virtue of a warranty dood r000rdkd in register of Deeds Office. z Z 4 A SIGNATURE OF APPLICANT E �' DATE « « « « «« Any information that is mis4g=sentod may r=& in the sanitary permit being revoked by the Zoning Department. «« «« «« «« Include with this application: a stamped warranty deed firm the Register of Deeds ofrice a copy of the cerWicd survey map if reference is made in the warranty deed VOL 1386PAGE5'2 593 ©6 WARRANTY DEED RKA GISTER O H. WALSH F DEE Document Number REGISTER O DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD John D. Ronningen and Jo Ann Ronningen, husband and wife, as joint tenants, conveys and warrants to Bruce J. Moll 12 - 14 - 1998 i o: 45 An and JoAnn Moll, husband and wife, holding as survivorship WARRANTY DEED marital property, the following described real estate in St. EERT FEE: Croix County, State of Wisconsin: COPY FEE: TRANSFER FEE: 312.90 RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address Thomas A. McCormack 740 Main St. Baldwin, WI 54002 018- 1075- 20/018- 1074 -90 (Parcel Identification Number) The East One -half of the Southwest Quarter (E'/ of SW %) of Section Thirty -four (34), Township Twenty -nine (29) North, Range Seventeen (17) West, St. Croix County, Wisconsin. S Excepting therefrom the East 195 feet of the South 1214 feet of the Southeast Quarter of the Southwest Quarter (SE% of SW %) of said Section Thirty -four (34). 1 1 I Exception to warranties: all easements and restrictions of record. This is not homestead property. Dated this day of 1998. * hn D. Ronningen *Jo ; 'nn Ronningen AUTHENTICATION ACKNOWLEDGMENT Signature(s) — STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this day of bea4 18CK. 1998, the above named John D. Ronningen and Jo Ann authenticated this day of Ronningen to me known to be the person(s) who executed the foregoin instrument and acknoow the sam,, signature � signature IT�A jtil 5 type or print name type or print name - �.. V i TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St. Croix County, Wisconsin. (If not, My commission is permanent. (If not, s fte e4pir4tionZidate: R authorized by §706.06, Wis. Stats.) ) � �v THIS INSTRUMENT WAS DRAFTED BY *Names of persons signing in any capacity shoiNti , t;r� Thomas A. McCormack printed below their signatures. rafr.M Baldwin, WI 54002 Information Professionals Company Fond du Lac, Wisconsin 800.655 -2021 irlsw4in Department of Commerce SOIL AND SITE EVALUATION , Givision f Int g Integrated Services Building in acc rat wv to . � . Page of Bureau of 3 s. IL 83.09, Wis. Adm Attach complete site plan on paper not less than 8 1/2 41')hches �11 P musi . ' County include, but not limited to: vertical and horizontal ref + once point (Bf�y��t and percent slope, scale or dimensions, north arrow, and s 1a*ion and distance to nearest road.', Parcel I.D. # (39 4 Sr- � � 4999 a /e- A6 7.5' 0 2 o d o d APPLICANT INFORMATION - Please riht all infort fiaw p UNTY Reviewed by Date Personal information you provide may be used for secondary purposes (Pt0pS0X#a (1) (rn)p Property Owner . 'op Location J_v G r� `G Lot s`, 1/4_5- ,01/4,S � Tg d ,N,R /�7 4M W Property Owner's Mailing Address V Lot # Block# Subd. Name or CSM# Ro V City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road o do k I 6V 7eh APe Qg New Construction Use: XResidential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow k-r_0 gpd Recommended design loading rate bed, gpd/ft — trench, gpd/ft Absorption area required aE bed, ft ?'>i rench, ft Maximum design loading rate — gpd/ft ., trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material GA A C /"A L f /.L L Flood plain elevation, if applicable 4 ft S = Suitable for system I Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S E4 U ®S ❑ U EIS Ex U I EIS IN U ❑ s A U ❑ S [$ U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots . h in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench . £ 1 v- /a 2 S • r M v s 3 Al I 6 9 Al 3� a A6 1 49- t4,1 Ground - e ft• ' Depth to limiting fcIctor ,in. Remarks: S/L t #0R # .3 Boring # o -© /a 31 a V F A 3M ', 6 G v — 3 Ground elev. Depth to limiting ,,c. f 1 5_'_ In. Remarks: / 60 / O #0 CST Name (Please Print) Signature Telephone No. 4:—�_ A ,e S A/I i rA 42 7/� :2 X-5 i'3o"' Address Date CST Number 9 .2 ; 3 OIL DESCRIPTION REPORT PROPERTY OWNER -•/fin n✓ /�Q/yA/ /AI �n4p Page 2 of PARCEL I.D.# O / Boring # Horizon Depth Dominant Color Mottles - Structure 2 Texture Consistence Boundary Roots r; I N K in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 3 � o- S /� �Ms6 F A 3M '5 g Ground 6 Inch M y 3 elev. Depth to limiting factor n. Remarks: _ SjL ;v4 7 %/�/ g O A/ h�o — Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ........_.. . Ground elev. ft. Depth to limiting factor in. Remarks: Boring # '.......... y.......... is ' Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) f ► D I i ' 006 i I I , I I { j I I I I ri - 4 - LJ 1 I I I - I Y i I I I _ I j I -- - - -� _ -- - - +t - tl - -1 , JI r � ° xk '. ` CERTIFIED SURVEY MAP LOCATED 1 N THE SE 114 OF THE SW 114 OF SECTION 34, T29N, R 17W, TOWN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN PREPARED FOR BRUCE MOLL SOUTHWEST .CORNER 11l.OTP: BEARINGS ARE REFERENCED SECTION 34 —FOUND TO THE SOUTH LINE OF THE SW SURVEY NAIL 114 OF SECTION 34. (ST. CROIX COUNTY COORDINATE SYSTEM). OD jvzc l UNPLATTED LANDS 1 -7-7 I _ .................... WEST LINE OF SE —SW I m N00 ° 54 Ol " W 660. 00' l 626. 99' ` 6 3. 01 y LOT I co I goo N IN ao :1 3.97 ACRES to tp N ro ; y 1 3, 077 SO. FT. !� N 77 ACRES EXC. R1W ry 3. NN A I N IN 164, 422 SO. FT. - {y U R1 NOW 54' 01 ' W 660. 00' 626.99' 1 + 33.0 LOT 2 N tn N NI N �, 3. 97 ACRES N N p HOUSE 173, 076 S0. FT. N : Z Z to 3.77 ACRES EXC. R1W a? D I °f • 164,421 SO. FT. 0 N I 33. 01 626.99' ` 02 E 660. 00 :. S00 54' " ' :10 k 33. 66.0 / N00° 54' 02" W 660. 00' : D r� 626.99' 01 ' : o Z I� LOT 3 � v N o ' y ;C o (I0, N co : m 3 . 9 7 ACRES N N :Rl I N N 173,082 SO. FT. N N N I N {, 3. 77 ACRES EXC. R./W a? co I ni 164,426 SO. FT. m ;k 33.01': N00 54' 04" W 660. 00' I 100' : 626.99' 333 a LOT 4 N Cn I N O IN .o. 4.00 ACRES 174, 148 SO. FT. • a ao 3.80 ACRES EXC. R1W ^? O 165,489 SO. FT. 33. 00': 626.95' I S00° 37' WE 659. 95' UNPLATTED LANDS of —I ,• I AI , ' SOUTH QUARTER CORNER i SECTION 34 — FOUND RAILROAD SPIKE LEGEND O = SET I" X 24' IRON PIPE WEIGHING 1" `200' 1.13 LBS PER LINEAR FOOT. JAMES M. WEBER S -1804 O 100 200 400 NEL SEN3 BBE LAND SURVEYING • " FD. 518" REBAR W /CAP DATED 983 106 THIS INSTRUMENT DRAFTED BY JIM WEBER SHEET I OF 2 DESCRIPTION A parcel of land located in the Southeast' /4 of the Southwest' /4 of Section 34, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin, more fully described as follows: Commencing at the Southwest corner of said Section 34; thence, South 89 °52'45" East, along the south line of said Southwest 1 /4, 1310.04 feet to the southwest comer of said Southeast' /4 of the Southwest' /4 and the POINT OF BEGINNING, thence, North 00 °54'01" West, along the west line of said Southeast '/4 of the Southwest 1 /4, 660.00 feet; thence, South 89 °52'45" East, 524.56 feet; thence, South 00 °54'02" East, 660.00 feet to the south line of said Southeast '/4 of the Southwest '/4; thence, South 89 °52'45" East, along said south line, 66.01 feet; thence, North 00 °54'02" West, 660.00 feet; thence, South 89 °52'45" East, 527.80 feet; thence, South 00'37 East, 659.95 feet to said south line; thence, North 89 °52'45" West, along said south line, 1115.15 feet to the point of beginning. Contains 15.91 acres or 693,383 square feet. Subject to right of way for W Avenue as shown. Also subject to any and all additional easements, right of ways or conveyances of record. SURVEYOR'S CERTIFICATE I, James M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St. Croix County Subdivision Ordinance and under the direction of Bruce Moll, I have surveyed, divided and mapped the above described parcel of land and that this is a correct representation thereof. Dated this fK"%'� day of 1999. James M. Weber S -1804 NELSEN -WEBER LAND SURVEYING, INC. NOTE The parcels shown on this map are subject to State, County, and Town laws, rules and regulation (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. SHEET 2 OF 2 98310BThis instrument drafted by Jim Weber