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Home My WebLink About020-1017-90-150 n @ o ■ -V n c k (D 2 g - � ® ƒ / [ ° e 2 8 , } ( o ƒ \ � ƒ (D \ i�3 CL {( // ~ n \00 ¢ o w CD 0 CA \ � \ f _ I to = a § E 7 ® 0 � t § 3 / � ~ w \ \ t o )(% CO) E a 00 OD � E rr cr CL � \ 0 0 0 3 ` / 2 2) �i / ^ § / cD 2 / f / 7 ° \� § E ; I & M � g § \ i 6 f .. > t 0 / CL \ a § m ` \ d ] f z k a / /CL CA) % g 2 / < (D E \ k / CO) : \ « CL 7 G) .. ■ i § CD 0 k k $ © ® @ q z \ $ ® � F3 0" §0 2§ § a < -aE $ \'a 2 0 : — , 3 � 0 R m o . cr. < ! ) M C D » D:E ! § ( ' �« -a ; §k�k0 � CD CL � ° k7E 07 m Goo _@ a . < m � E a�§ 2 �4 2 { �0) CD� \ ) \ DCD CD = 4 Safety and Buildings Division A s i ionsin SANITARY PERMIT APPLICATION 2 01 E. Washington Ave. In accord with ILH R 83.05, 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 Corr ' ,: than 81/2 x 11 inches in size.` • 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) State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N Property wner Nance --. Property Location va 1 /4,S /j TA 9P ,N,R E( roperty Owner' (ling A dress Lo umb r Block Number GRlN/1' City fate Zip Code Phone Number bdi Sion me or CSM Number II. TYPE OF BU ILDING: (check one) ❑ State Owned i It Nearest Ro d Village Public 1 or 2 Famil Dwellin - No_ of bedrooms •� Town OF 111. BUILDIN USE: (if building type is public, check all that apply) arcel Tax Ni m er(s) � OF 01 1 O / V 1 ❑ Apartment/ Condo 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. J9 New 2 ❑ Replacement 3, E:] Replacementof 4 E] Reconnection of 5 E] Repair.of an _____System ______System __ Tank Onl�r______________ Existing System stem ExistingSystem B) E] 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 [ Tank 12 p(Seepage Trench 22 ❑ In- Ground Pressure, * 42 ❑ Pit Privy 1 Yo Seepage Pit SY �� k 6145*__ �� Z_ 43 E] Vault Privy 14 ❑ System -In -Fill c,r .j' . 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 15 P 4 ��►. Feet . 9' Feet VII. TANK Capaclty in gallons Total # of r Prefab. Site Fiber- Ex er- INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel Plastic p New Existin struded glass App. Tanks Tanks Septic Tank 0 1 aid* v ftp Ilk r 0 ❑ � ❑ El El FM Q El Lift Pump Tank /Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of ty9onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Sta MP /MPRSW No.: Business Phone Number: lumber's Address Street, City, State, Zip ode): .-. IX. COUNTY/ DEPARTMENT USE ONL ❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) []Approved ❑ Owner Given Initial Surcharge reel Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: gep. g fR- tt�9s1 DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, plumber 1Xrtment of Industry Sol 1 I L U AT I O N REPORT Page of _ man Relations Unnsion of Safety & Buildings `in acco%yvith IL 5, Wis. Adm. Code COUNTY Attach complete site plan on paper not I s9 than 8 1 MC7E inches in si an must include, but not limited to vertical and horizontal refe en poi M . 0 nd f slope, scale or PARCEL I.D. # dimensioned, north arrow, and location ad ista a oad. APPLICANT INFORMATION -PLEA INT A A REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION C GOVT. LOT �.4 V14 Sw 1/4,S T ,N,R E PROPERTY OWNER':S MAILING A Df E LOT # BLOC # SUBD. NAME OR CSM # 932- i a 2 *.Z2' *.Z2' � CITY, STATE ZIP CODE PHONE NUMBER 2Sy []CITY :]VILLAGE OWN EAREST ROAD V) New Construction Use Residential / Number of bedrooms 3 [ J Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow � *0 gpd Recommended design loading rate _ bed, gpd$ . P trench, gpd/ft Absorption area required bed, ft 7 43 trench, ft Maximum design loading rate -- bed, gpd /ft ---- trench, gpd /ft Recommended infiltration surface elevation(s) Qs.s/ It (as referred to site plan benchmark) Additional design / site considerations • A!1110 s Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE 7 AT -GRADE SYSTEM IN FILL HOLDING TANK U Unsuitable fors stem 4 S ❑ U ❑ S O U 121 S El ❑ S O U ❑ S U ❑ S I;J U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ITrench r. t G —, P 7 S 3 s Ground elev. NZ c s zc O .7 1. S' /WUL ft. 3 8- 7•.� - LS f 0 /�.t — Depth to limiting ' "� ° �- • . factor Remarks: S� Ar Boring # 2 . fs•r Ground °_ S elev. y7 ft. Depth to X - 1-2 yk — — • ? .e limiting factor > 76 I J / y Remarks: ( CST Name: — Please Print Phone: Address: 02 jg2a ' Signature: T Date: l _ ^ _ CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page _Z of 3 PARCEL I.D. # Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Baxxia�y Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITwch } L S Ground Z _ elev. f ft. 8- L S 1 Depth to . 7 ,0 - 1,42 15 -- V o' limiting factor Remarks: t rl Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # r"m 5: Ground elev. ft. Depth to limiting factor Remarks: Boring # + }4{ h`irX ~v Ground elev. DATE: Now* ft. JOB Depth to Wiling factor FOGERTY PLUMBING DAVE F0cERTY PLUMBING Ucerwo Perk T Plumber DATE: _0� 13233 o� R� ROBERTSWIS NSIN 54023 JOB PT : S 22 Phone 749 -3656 y // ��p 7 I JOB SP: �rle-e T�,,rp„ GS I I X I i X�y ' I r rJ4r d tl = 1 W } r airs- of 1 Li'n c Fence QiAK T/P�E �¢STUSS+E ioo.O _ f446�EU I i 4 tvu O/ IVySL .47- firs'!= , adrr �Lf E e I T_itF�' �� F�.+✓ct Lz'ivE � �SScr,1.r,� �G�.l7 �rioT --: r�rTif��` --� rs r�i�' 1 L v 7 p tf C TdYC/vi � F. I I frrc D V L FILED a JUL 2 5 1997 ► - Q� KA1tnMV It WALE 562900 s CERTIFIED SURVEY MAP 0 M LOCATED IN I�W.4•ft�y �C Sh7 ah5W1 /4 OF SECTION 13, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN ASS ck C-3 U N P Z A F T � Ef✓ BE'q�PI r''EST LINE _TE L Np1 lECTI LAST L REF ` OE SW A N D 1 S6..E 13 471X 4' Tk HC ED '3gg.4y. 8 1/y Op SE Ip _S Cy BE RS 1''1 /y 4p-63'Npl lip - N I3 � T ?9N, 81 W •°^ d S23_ 63 1 -.26 3 � M v 00 o r 1 p O o H `1439 r-• o0 n.+ 0 c c" to v \ y °= 1 +I+ cj W W a �t ('] 1C) W N M _ M y '.F.' CA O a N19 ° 14'37 "W r ° o N 473.63' y m 66. ' 4-- w v H C> w t1 a iw. y H W , r �v ry a .� 66 r n y � y A 9 CD Up I Z .d 1 °' 4CHIPPEWA PATH�,� . . IM � -'472.87 -�_ �-66.00 �_ 48 1 T o Id l �b 857.35' N15 °54'18 "W Ln N O H y U N P L A T T E D L A r.. v. - - N D S ....-... - ,i�t. - - - -- - - - - - Area of Lot 4 includin ' a. N g 66 easement r. a >ti o n so 423,092 s N ye+ q ft. 9.7,13 Ac. y a ,+ Area of Lot 4 excluding 66' easement 401,099 sq. ft. 9.208 Ac. c- S '97 y n m y q lb V D PA O .l ai iEC ✓f Jed ON ., _, 1� 30 c`rgs of - THIS INSTRUMENT DRAFTED BY BARTON AHRENS ar.Q oval date ,pp-oval shall be VOLUME null shd void 12 PAGE 3310 /01 f AL STATE,9AR OF WISCONSIN FORM 2 - 1982 58 3324 WARRANTY DEED DOCUMENT NO. Kenneth C. Tennan and Da D. Tennant, T. CROIX Co WI h usband an w e, % -� Rsc�J tut 3ec rd JUL 2 X1 3:10 P r conveys and w arrants to -Steven W. Ten nan t and Andrea L. Tennant, husband and wife, �^ Register el Deeds = '3 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS f ( { the following described real estate in St. Croi _ G until; �t 40 SON ASS r State of Wisconsin: V p a 3 i A Pt 020- 1017 -90 & 020_t017_80 -100 �, PARCEL IDENTIFICATION NUMBER That part of `the W1 /2 SW1 /4 Sec. 13- T29N -R19W described as follo 'ws: %t Lot 4 of Certified Survey Map'- in Vol. 12 of Certified Survey Maps, page 3310, as Doc. No 562900. $Q�TRANSFER A FEE, is not This _ homestead property. XXsX (Is nut) Exception to warranties: Easements, restrictions and rights -of -way of record, : +.'• if any.E.• Dated this Q�O day of July A.D., 19 98 . ti (SEAL) ��j t.� • �` y`i»� (SEAL) 4 Kenneth C. Tennant Darlene D. Tennant `} (SEAL) —_ (SEAL) f AUTHENTICATION ACKNOWLEDGMENT -- — Signature(s) State of Wisconsin, • is St. Croix counts 9� ±• authenticated this dap of 19— Persunbefore - came before me this — �—�" day of .� July 19__, the above named - -- -- Kenneth C. Tennant and Darlene D . Tenna � • _ - �.husba.nd -.And w ife, - II fLE: f%IEkIBER S 13,1R or �%ISCONSIN 4 (If not, authori :ed by §706,06, Wis. Scats.) a n e known to be the person S who executed the ,fokegu trument and acknowledge the same.