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HomeMy WebLinkAbout042-1091-50-100 Q o a� °• I o o � w c e I 0 N � I i I Q I '� II I I Z a a) ) 0 Z LL m Q > 0 _ 0 0) a m 04 N M f- U) = I O � o Z d o a�i Z a) Z H E �E Cl) z z w N_0I Zo E N .. 4) .. N @ LL CL w U = L N O G a O == E a) @ N ` U_ s 3 E - L LL z o • �aaa Z; �i a g C a �D co 0) N O O_ ... Q r a0 E O = O CL O m N = p (n a) O 0) Q O Y O O O N C .a O p '2 N r O \ o m 3 '. r r u a C, V 00 ~ _ _ _ Y (4 _ • ~ N @ N Q a) O p O o co > ! m M O Z N Z 0 (n \ at w . • m � a �t a L: a a • a �I m A 0 a2 'i0 U)u ST. CROIX COUNTY ZONING DEPARTME j 11, AS BUILT SANITARY REPORT Owner //,4,/z ApS.r �lZ Property Address 1 p9 /dpY_� -.r ingtg_ City /State Legal Description: Lot — Block -- Subdivision/CSM # Y15 J/4 ' /4, Sec. ,�, T gy N -RJW, Town of tw.*Ae e.o P # • �y1- iogf_ a �� SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: z1f Tank manufacturer _ / 'BSc R Size ST/PC /`?V / /1Sd Setback from: House 114 Well P/L _ Pump manufacturer ('o k G D Model Alarm location S; *1 (HOLDING TANKS ONLY) Setbacks: Service road Ven'to fre air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: /*O"/P Width z � '''/ Length /3d Number of Tees /�,a Setback from: House > Oa' Well >ioo P/L -D ' Vent to fresh air intake ELEVATIONS Description of benchmark . Elevation Description of alternate benc ark Elevation Building Sewer /O2 � ST/HT Inlet /o ST Outlet /o% iJ PC Inlet 9G P2 PC Bottom _Z s ' Header/Manifold Top of ST/PC Manhole Cover o A. 9y Distribution Lines Bottom of System () /e /, y Final Grade ( ) ( ) ( ) Date of installation r7011W, Permit nu er �.? V 6.S"'/ State plan number Plumber's signature License number -? ii 8o Date Inspector Complete plot plan ,70 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 4 �7, Sc/4Ge: / Yoe r ep IX/4' 372 , k w 77r 7 Pere{ x --� -- -----� t INDICATE NORTH ARROW F� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary ggi: Personal information you provice may be used for secondary purposes [Privacy L s.15.04 (1)(m)]. f AY NO*er "PtftARD f7-Gi Y�llage Town o : State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tdtf!?_.1091 -50 -100 TANK INFORMATION ELEVATION DATA A9800541 TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic W� l 5 Lv Bencp -7-0(a 1 ,17-0 6, /vr� Dosing GtJc l s(a J ,9/</7 2.oa /oS•o�,. Aeration Bldg. Sewer �Z /oa•S'f Holding - -- St /A Inlet 57.y� /o /.SSG TANK SETBACK INFORMATION St Outlet g /al -a3 TANKTO P/L WELL BLDG. Ve ntto ROAD Dt Inlet / /•d Septic -i f �TQ 2 NA Dt Bottom r}- Dosing ( /�j a .) `Z d NA Header/ Man. Aeration Dist. Pipe A •S� 10j, Holdin Bot. System p Z Z.. ! o / PUMP/ SIPHON INFORMATION I p Final Grade Manufacturer 6atH.( Demand 51/wAl (c 411., / 03 Model Number v j 15 ' DG PM aE/ (g - 5 - 4� /ou TDH Lift p, Friction/ ' System- TDH I t Forcemain Length q-5-111 Dia.L " Dist. To Well ,L o ff. Z 16 p SOIL ABSORPTION SYSTEM BED/TRENCH Wicl Length No. Of Tr nches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /b Z A 'ji DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type O / CHAMBER mod Numb System: l��,j /2v f 7/ a!J OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. tl Length Dia. 7 Spacing —I— 1 1 4 � S� 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.) j. - 7 6 1 LOCATION: WARREN °/ .29.18.502B,SW,SW 609 100TH ' ST s f • I�U� „ ( t�0 �r�'"� tt���l�i�t�l '�� Q 9 o ® P� lane revlslon require ? ❑ Yes ❑ No use othe side for additiorkaI information. ( dL ego jwtt, d*API 64, FIS'-cm t Inspector' tire C�errt..NNo��y� ® S BD 6710(R.3/97) "1`�w hGwd C�t , .NQuJ?,"v�'PCaAAA1Q)6'_ V /p -� SANITARY PERMIT APPLICATION 201 WashinlgtonA ero sion Vi scons i n In accord with ILHR 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 County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information y ou p rovide may be used b other g overnment agency programs Check it revisor` n to �ious'a Y P Y Y 9 9 Y P 9 ❑ P PP lication (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location 1 rop 1ia 1/4, S 2 T� N, R1 E (or Owner's M it g Address Lot Number Block Number e S Cit State Zip Code Phone Number or CSM Number R. II. TYPE F LDI : (check one) ❑ State Owned ❑ it f Nearest Roa Public 1 or 2 Family Dwelling - No. of bedrooms S o rof Town of / OD D III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo ey _10 f l --J — 00 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, 0 New 2. E] Replacement 3. ❑ Replacement of 4. E] Reconnection of 5. E] Repair of an System System Tank 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 21OMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 01 s 42 ❑ Pit Privy 13 [] Seepage Pit 0 AD 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) , y—'C Elevation 7-5 1 Z,S" /, Z p. Feet Feet Capacit VII. TANK in Ca allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer Name Concrete con- Steel glass Plastic App New Existin strutted Tanksl Tanks t leliv 1 Eli ❑ ❑ I ❑ I p Ta ipba"4kan+" —"' ❑ ❑ El El 11 III. RESPONSIBILITY S ATEMENT I, the undersigned, assume responsibility for installation o he onsite sewage system shown on the attached plans. Plumber's Name: (Print) PI ber's Signat - No S ps) NfPMPRSW No.: Business Phone Number: AT tier's Address (Street, City, Stat ' K, Zip Code): O o L IX. COUNTY/ DEPARTMIFUT USE ONL ❑ Disapproved Sanitary Permit ee (Includes Groundwater L ate ssue Issuing Ag Signature (No Stamps) Surcharge Fee) V A / pproved ❑ Owner Given Initial Adverse Determination V I � U'� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.11/96) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings 15837 USH 63 f, HAYWARD WI 54843 -8107 *isconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary September 22, 1998 CUST ID No.259518 ULBRICHT & ASSOCIATES 655 O'NEIL RD HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identification Numbers' APPROVAL EXPIRES: 09/22/2000 Transaction ID No. 138641 Site ID No. 160075 Please refer to both identification numbers, SITE: above, in all correspondence with the agenc Site ID: 160075 ST CROIX County, Town of WARREN SW1 /4, SW1 /4, S32, T29N, R18W RICHARD BUSKER RESIDENCE MOUND FOR: Description: NEW MOUND SYSTEM, 750 GPD Object Type: POWT System Regulated Object ID No.: 424432 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 area 25' below the downslope edge of the mound must remain undisturbed. 1) The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. 2) Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a). 3) The elevation at Boring 1 is 99.58' and at Boring 3 is 96.4 4) If a Zabel® filter is used: a) Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the Zabel filter will be required. b) The Zabel filter shall be installed per product approval stipulations, which may require a manhole rJ extending to grade over the filter. -w''t. vim A copy of the approved plans, specifications and this letter shall be on -site during construction and open to Q �dltl.0 inspection by authorized representatives of the Department, which may include local inspectors. All permits coot required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. 0i p 0� 01 OR 0 j • ULBRICHT & ASSOCIATES Page 2 9/22/98 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 09/04/1998 ° � � � � FEE REQUIRED $ 190.00 PATRICIA SHANDORF , POW PLAN REVIEWER FEE RECEIVED $ 190.00 Integrated Services BALANCE DUE $ 0.00 (715)634-7810, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE. STATE. W I.US F 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. # / 35��/ Date 52� A� , �y Owner A?talrXV / Phone /5- Address &0�7 /::�D V%�- ST 5 4 3 Legal Descri ption Q/V d y�- /D� / -,�Q - /p"D �'Q �¢GiI / j - sw iy 7� . AP ev Town of County C.S.T. 32 3 Installer Local Authority/ Supervision PROJECT DESCRIPTION 4140 130 5����y 5,�7' �-� � jam' " 3 C � I Pg .1 PLOT PLAN VIEWS 01V �W.Y yyrrrr 1 Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEN ROl�#RV 1 L t Pg .3 PIPE LATERAL LAYOUT �/ �py�j� co HITDSON, WI Pg.4 DOSING CHAMBER CROSS SECTION !(►6i , �'.,�� ' d.•.._ $a P .5 PUMP PERF RMAN ' S I G 0 CE S PECS �� "rr�drnuan A m >7. v 0 x ! w a O o �b � ►► u n 1b � a TA Z ti ,... t 6) 1 N� L ,w .: 0 IN- ), CC <IC 011 �- � � Wo �U "( c? cn ¢ M Q • c� c`+ 4. CD ¢ FQ- van , b Q cD -i--. \\ k1- ac Oar. d = T 1\ 1116 V O11 0.. UanO ( 0 kiN Yl i ---, \,..., \ - _ _ �� 1 — — 4 O Ag 1 I �O Gov -/ NI I \I, oAlX �-,,tal . _ _ _ _ o, q.\ L. elo tie I ,,N, 4 \\,.. // N) ,-N'- Nt- '!s '71.0 QQ/ CROSS SEcTioki of NI 000 D - to i r ti BED . BED OF ro I 'i,` A59es-5ATE G , Tl t•CA-- s ES 5 pip �N �- sYSrEM or Topsoil E IEvA rlo►j Uoi FORM TOE u /Oo .0 q, ►i M u Li" E F I� f f RATIO ,' MEii v. e' . 1-3) : • II ' SAND . • • I /// /////% IN Plowt7 TopSoi L /// /// uuiFd M __,..c R g % SIopE FoRoE Ei t>/vPO,0 uovER ?INK) Rep 7 9.So .1) /' 0 Fr. — E.LEvArio►) S .__. fi E 79g Fr. • INvE.Rr of 7- 'ATERA ( 5 / O/- O ez/ FT. • Top of Rock /O/ 3 �! G /0 Fr. H /,5 FT • Top or '2-- I ATER A IS /0/, /8 I PLAN VIEW OF Mow0D - wirtt 13ED For) / - F'Rc . MAikl A C FT, /d(p Fr f K /2 FT \ , Fr w � ° J V _ - - _ _ -- -- - - -j' i_ F -r K -,1 i T /, Fr a o w N. Fr IIEr el /2�� PVG (Appel, To I i1.t► df3sErz ATioo A 9gRE ?4±E PnpEs ,¢ PERMA,JEuT M hR kERS RC(Vi12t o BASAL hReA = 'AAiLy k.)hsrE- riow _ 7cO - /,"av sc,+L 1,J-c irpATnuE CAPAcry , S 54, Fr, PRopoSEv BAsA-I AReA = (3 x ( A + z /6'(.0 x Co + /g 2 S c/ s az. FT, DISTRIf3orIok3 pipE 1iETwoRk LAyour TO j,f G VOL/ -1-e 6f N67-4)0er 3 sus N U 1,-)°*-T \5r F \ Z , R Fr X (P0 , FcRcE MAW � Fr. Y � of- PVC VARI.M3LE ToTAL VOID UoIu1AE 33 GALS . 'PisrAacft H olE D►AMETER % I1uc1-1Es Lh�ER/!L " 2 _ INc t{ES MhotFvLn 2 �� r,.)cf{ s Fo1'cE MAIN " Z I uct1ES Op- of flolE5/ pi iovERT ELEVATIo•.)' o f LATE► t TETAi L E 'D cAP PER Fog hTED Pi co .�--J • RE iouE- 411 DRi1l BuRR5 y • HolEs IOCATEt) OK) BoTToM Ec.QVAlly SpACED Tali STRi Burlo DISchAR c-E RATE' FoR LAT'ER/i L N, 57 DER o-t"i 5 2 GAL TOTAL 1Di5TRiB( TIorJ IiSct1ARCE FATE FOR NET wOR K y`1'./Y GAL/ MI'to . e a MCWMOAA Il EA D . PAGE GF 1 PUMP CHAMBER CROSS SECT IOU AND SPECIFI 0k!S VENT CAP 4 "C.I. VEMT PIPE ' WEATHERPROOF PFROVED IAIG - T 25' =ROM DOOR, JLJUCTION BOX MAWHOLE COVEF S WIUDOW OR FRESH 12 MIU. AIR INTAKE GR I `I M I IJ. 15 M'1 AI. O UIT � -- 18 "MIN. `� ---- - - - - -- 11� MILE PROVIDE AIRTIGHT S AL i I *� A ALAR� I II II I i *APPRO I I o JO TS I H I I ELEV. FT. R AP O D PIP (� O rump—, --� D LID SOIL OFF CONCRETE BLOCK RISER E PERMITTED OIJLy _IF TANK MANUFACTURE HAS SUCH APPROVAL SEPTIC E SPEGIFI.CATIONS DOSE KS MAN UFACTURER: • /�t�, IJUMBER OF DOSES: Z ' PER DAy ANK SIZE . S O GALA OkiS DOSE VOLUME �•J G .� ye ALARM MANUF R; E ..L �'� INCLUDING 5ACKFLOW K GALLONS MODEL ►D UMBER: Dy� CAPACITIES: A = IAICHESOR i> /9 GALLOWS SWITCH TYPE: _1�?/r' cGr/Zy , FLQ�¢T g = 2 INCHES OR 7 2.5 GALL01J5 PUMP MANUFACTURCR: _6Q&I-6 C= fD,S IN LHES OR - - GALLOWS MODEL A1UM8ER: D- INCHES INCHES OR 141E GALI_bA15 SWITCH TYPE: = _ NOTE: PUMP AND ALARM ARE TO BE MWIMUM DISCHARGE ATE __ S� GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. "'401 FEET + MINIMUM NETWORK SUPPLY PRESSURE • • • • 2.5 FEET +' � X FEET OF FORCE MAIN T ' pp ��FRICTIOIJ FACTOR.. , / / . � 6 —FEET TO L D'J JAMIC HEAD = J FEET /2 !An IMTERNAL DIMENSION& of TAUK: LENGTH / ;WIDTH ,. ;LIQUID DEPTH SIGI�IED: �� '7 LICEIUSE NUMBER' ti r j +. MODEL 3871 • ' • ■ 04 EP Su bmersible Pump GOULDS x ;r Pump Specifi cations Y. �, � € / P 3 METERS FEET UpFto,40 GPM ` 0 1 Disdharge "size 1'I•" NPT p� 9 30 MODEL: 3871 Solids: �s maximum + M otor 6 2s Single phase: 115V o Materials of Construction ' = 6 20 Brass/thermoprptic 5 ,5 Features and Benefits > 4 *Top suction eliminates 3 10 . impeller clogging. 2 L W __ • Corrosion resistant , 5 construction. • Float actuated switch. ° 70 20 30 w 50 U.S. GPM 0 2 4 6 8 10 12 rt 1 /hr 7 METERS FEET CAPACITY 25 MODEL DVP03 Pump Specifications Features and Benefits 6- 4 h0 and /2 HP • EPO4 impeller- semi -open design = 5 Up to 60 GPM with pump out vanes to protect 4- 'S Maximum head to 32' mechanical seal. 0 3-10 Discharge size 1 NPT • EP05 impeller - enclosed design 2 Solids: 3 /4° maximum for improved performance. 5 Motor • Rugged glass - filled thermoplastic All motors feature ball casing and base design provides ° 0 0 5 10 15 20 25 30 35 40 U.S. GPM bearing construction. superior strength and corrosion 0 2 Single phase: 115V resistance. CAPACITY 8 e 10 Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. *Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. ,.a PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P, 1E- I o S —VEUT CAP , 4 "C. I. VEAIT PIPE WEATHER PROOF APPROVED LOCKIU6 JUIJCTIQU BOX MAIJHOLE COVER 25� FROM DOOR, &71 E If}/(,t1/NC- Ii9ISEI WIIJDOW OR FRESH 12 "MIU. AIR IIJTAKE I T/0 nl GRADE I 4 " MIN. IB "MIU. —L � IFV14P eV \ 111 PROVIDE I — ` - - - -' INLET AIRTIGHT SEAL 1 yl pE I II APPROVED JOIWTS APPROVED JO NT K I C I. P w/C.I. PIPE I� (U► I II EXT IJG 3' EXTENDIIJG 3' �O 4 0 ALARM ON SOLID SOIL OLITO SOLID SOIL I II I I ON / - -' F usE 3 ELEV. . T. 1 PUMP OFF y �lO�t'E eF 0 Nk ' ) t ppl A) BLOCK Ito f RIStR EXIT PERMITTED kJL-4 IF TAUK MAIJUFACT ER HAS SUCH APPROVAL SEPTIC E PE G I F I'CATI S DOSE TAIJKS MAAIUFACTURER:������� f�WMBER F DOSES: PER DAS TAUK SIZE: GAL O 5 DOSE VOLUME 35- y FACTURER: L'2lJee " /O GAIL O1J5 ALARM MAUU IMCLUDIMG BACKFLOW: MODEL HUMBER: / / 1 CAPACITIES: A= IMC14ESOR 7 � GALLOUS ITCH TYPE: `vl !� /� B=- 4 3 INCHES OR GALLOUS SW C= / IIJCHES OR GALLO PUMP SW IJUFACTURER: : '� — D = '� IE1"ES OR GALLOUS MODEL NUMBER SWITCH TYPE: P� S ( MtVC /��r MO E: PUMP AMD ALARM ARE TO BE ' �� INSTALLED OU SEPARATE CIRCUITS MIUIMUM DISCHA E RATE GPM fiAA)k S . VERTICAL DIFFEREMCE WEEAI PUMP OFF AMD DISTRIBUTIOM PIPE.. FEET 4- MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET c �' Of' 2U� FEET OF FORCE MAIN X �' /9 F ovtFRICTIOU FACTOR. EET � 3&- Z S / YAls. TOTAL 09UAMIC. HEAD = 3 S FE- IUTERUAL DIMEIJSIOUS of TAUK: LENGTH ;WIDTH ID DEPTH ME Series M YON 1/3 through 1 -1/2 HP Effluent Pumps Performance Curve CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 400 450 100 1 90 28 80 MF 24 0 SO °; M W F �00 20 2 LL 60 Z Z 50 M F >S 1.6 w T- 1 < 40 12 3: MF S o 0 0 O 30 ,y� e 2J 10 4 0 Ti j 0 10 20 30 40 50 60 70 80 90 100 110 120 130 0 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 Wiccorkn-Department of Commerce SOIL AND SITE EVALUATION Page of_ •Division of Safety and Buildings Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include,but not limited to: vertical and horizontal reference point(BM),direction and eKteZXC percent slope,scale or dimensions,north arrow,a ,f0cation and'dist,,ance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Plus ¢rinta((►flformationi:\ Reviewed by Date Personal information you provide may be used tier segondary pufdeses(Pdvacy Laws 15. (1)(m)). S. (I I 3 t 31 \ CI Property Owner property Location /t('61f0 i) .SWSkr-/Z .- ,' i(') 1998 ,— povt.Lot s-w 1/4540 1/4,S .2.2_ T.19 .N.R /f E(orep _; T CR(31 / of# Block# Subd.Name or CSM# Property Owner's Mailing Address --- COUNTY f` City State Zip Code,,c `Phone Number ', *``' ❑ City ❑ Village ❑ Town Nearest Road ./ZT3- I cam- I ryo z3 'I'( z'9)i ...00'T 'Mice.B.r/ I /ov�- S Qf New Construction Use: Z Residential/Number of bedrooms S Addition to existing building ❑ Replacement ❑Public or commercial-Describe: Code derived daily flow 7S0 gpd Recommended design loading rate . S bed,gpd/ft2 . to trench,gpd/ft2 Absorption area required bed,ft2 ‘2 S- trench,ft2 Maximum design loading rate — bed,gpd/ft2 — trench,gpd/ft2 Recommended infiltration surface elevation(s) -`-Q a I ft(as referred to site plan benchmark) Additional design/site considerations tY/fitle. ift/3'uK/) .41-5 LDA' /✓4Sz'Or�C'e• 4/o zifZ• S Parent material Flood plain elevation,if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ S IZ1 U IZI S ❑ U ❑ S ❑ U ❑ S ❑ U El S ❑ U ❑ S gl U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed , Trench / D/2. l0—.3/2_ / 2 F SdiC /YI v fR RS /F • S . 6 L /.2 2V 7.5- —/3 _ ,.s,;;L .3c sd.0 rti,c/e c.s /F .s! . 4 Ground 3 .741.5{(2.r— 3�� s s 1: .2 Sd.0 p.F r ft s — S 6 elan, Ne .r'n;P .+ 9?.,5�rt. ST4 G. .7- -- ,Z/‘ SC L /.1-$-' x G.ssoa/EL _ io , - D Depth to limiting factor C/ in. Remarks: `Boring # - / d—// /0--7/2, -- �7-/ 1 F J(c' tit YEA RS / F . S-. . G z : .2.- //-20 /0 -.2/y -�jsrL2M 5&x MFJ- cs /F . 5-; . Maga 3 O_29 7S—y// — ss,.rL1 _2G s8K MFr G$ ` ; 5-' . 6 Ground 'i .2p-57 a7.J sc.L .?Fs3R Ao v FT Y • s y� _ elev. f ft. , Depth to limiting factor yot j 7 in. Remarks: CST Name (Please Print) Signature Telephone No. 4A gr,/) , iRCZ.-/Z Ty 1717*(--4"/ / --------- 74/0"--.1‘5-g Address Date CST Number /4)(<r / w. i yo.2 r ...-7de/fE-- ..2zil.7a PROPERTY OWNER i c l+r...11 11 � SOIL DESCRIPTION REPORT Page %Z' of 3 • PARCEL I.D.# /.)—•-/0 Q/ ' ,y 6 /&D Boring# Horizon Depth Dominant Color Mottles Structure in. Munsell Qu.Sz.Cont.Color Texture Consistence Boundary Roots GeD/ft2 ` Gr.Sz.Sh. Bed ,Trench 3 � / o-f - arL FRvC m v FR /7s i f= . ; . L z Q-,ta ?..S'-/y srL 3< 5 c s ii-� f', . Ground 20 — 6 elev. 7 y Ls fit=S3k /241 -7- — . 7 .9 fl l f.t. s/ ys-ss 7.� - 9/ .s rfiiz.4?�D Ls c"s. X .o nl Fr hcs -- �, . Depth to S rS-6/ ••s-rJ�6 �c .1 F s&it m✓Fr — — nry limiting factor 65 Vs in. • Remarks: Boring# Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Consistence Boundary Roots Bed ,Trench Boring # tv3 Ground elev. ft. Depth to limiting factor in. Remarks: Boring# Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330(R.07/96) d p i • N o� b x I � o i i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner / ? P- &egLa QAtX Z Mailing Address 405P &V Property Address X 0 ,4? 44T, Sq©I 3 (Verification required from Planning Department for new construction) pya City /State J * As fi= Parcel Identification Number LEGAL DESCRIPTION Property Location,S J '/4, S W % 4, Sec. 3:1 , T - N- R -a Town of Subdivision , Lot # Certified Survey Map # q/ 5",0'D z , Volume , Page # � /ems Warranty Deed # S y� , Volume J��D , Page* 4 1 1F Spec house ❑ yes no Lot lines identifiable C� yes ❑ 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, restrictedplumber 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 exviratiQ0 date. SIGNATURE OV APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the rope rty described a ve, 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 � ♦ S70 na 497 DOCi MENT NO. STATE BAR OF WISCONSIN FORM 11.1982 THIS SPACE RESERVED FOA RECOAdNf3 DATA Lmo , �ONTUCT Indlvidaa and Corporate USED FOR ALL TNSACTIONS WHERE i 458MIL j2 o IS F,NAN ., RAND IN V HER NON - CONSUME AC TRANSACTIONS) _ REGI OFFICE C ontract, by and between.......... ROCsER.. M.... JEdE T. T ....... ............................... St. CROIX M M ....... ... .M IAG& T..CO....- A ... ±�.?al�e��t ±�. - -��. - �er�. t, �, � .... ............................... Reed for Rec d ............................... _ ................................................. ................ ....... ..................... _ -... ("V endor" , M 5 Lae 1 4 P of whether one or more) and .. RICHARD.. A.....°. USIA.. AND ............. ............................... ..... .......L�ItIM..p.t!aI�FR....h!a .ar►d... ...'+�.te...A . ..Ault!ivp.rPhip ............... ...............1T Arita.l— prop .. arty.......... ....... _....... ( "Purchaser', whether one or more). Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- P__ formance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interests (all called the "Property"), FETURN ...............................S t... Crn1a[._.......... ............................... County, State of Wisconsin: TO Tax Parcel No . ............................... _._. _ A parcel of land located in the bW 1/4 of the SW 1/4 of Section 12. T294. RIN. Totrn of Warren decribed as follows: Lot 1 of Certified Survey Map recorded in Certified Surveys Volume 6. Page 1691 as Document No. 415802 in the Office of the Register of Deeds of St. Croix County. Wisconsin. Together with a non-exclusive easement for ingress and egress to the above described property over an existing driveway direct to the South f of the above described property. This .... _..i,3...T1lQ . ............ homestead property. (ttit (is not) Purchaser agrees to purchase the Property and to pay to Vendor at . t$e place of his choo .................. the sum of i 4.� L10.,.- .�.- R- R:.�.��,T���. -,. -. in the following manner. (a) at the execution of this Contract; and (b) the balance of E ?FO..QO O..OQ. - - -- - - - - -- , together with interest from date hereof on the balance outstanding from time to time at the rate of ..... ten .... UOQ .................... I................... per cent per annum until paid in full, as follows: Payments of $528,61 per month commencing June 1. 1990 and continuing each month until the complete principal and interest are paid. Provided, howe - er, the entire outstanding balance shall be paid in full on or before the ......... .....1At....................... day of ............. vay: _. 2CQQ .................. .3:1x .... (the maturity date). Following any default in payment, interest shall accrue at the rate of ...........% per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser shall furnish Vendor a paid receipt indicating that the annual taxes have been paid when due„ - Pore he by su fr , ; r., p _ y r r oannahl�on - paled enrwal taxes special- assessmen ta,- Cireand-requi red irtsurancepremiums when d,te. -Tb tfieexterrtreceiwed-by Vendor appl i�endat agrees to pay+cents-te-bhese obligMiens when ts- reeeived by- tones, aseeeeme"be a - d insers"ce- will -be- deposited into -an escrow -fund or trustee-- eeceunt, 'tenet hearrinierestl An4eee44herwise required by low Payments shall be applied first to interest on the unpaid balance at the rate specified and then to princippal. Any amount may be prepaid without premium or fee upon principal at any time after .... Jut► e ... I . ....... ......... ... ............ . 19._Y..0 ... tE" 6here may he no prepayment of prineipal without permission eF Vendor.' In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. Pvrchaser states that Purchaser is satisfied with the title as shown by the title evidence submitte3 to Purchaser for examination except None ACA S' Purchaser prott(isea to pay when duo all t a�is sled to wvw as tit limperly et rrti Vet►d4t's 611114" • in Itand to deliver to Vendor oa demand receipts showing a ooyuw#' Purchaser shall less the improvements on a h alnet ex elama bx tt+rr, w tended coverage perils an+ �l► ' l'� y t! tea, w�tont oa asurrance. thrn ugh ivaar no apisro ' by Vendor, in the sum of $ n Vsaxpx shsl! ot:agaity h • ��3�C r c t premeume w QL hat;' t an the balanc� owed under - tits contrast. �rchasar; �,�y , contain the standard clause in favor of the Vendor'; Beador Gains Yes o gr%lase in tip of all policies covering the Property_ shall be deposi ttdor. PvrehesK snail goat y give�swt7g4 �' M itNisrBntx swa►psaias and Vendor. Unless Purchaser and otherwise agree wasting, insursrhos �estsae3a . w d be applied to restoration or repair of the Property damaged. provided the Vendor deems the restoration or npw to } economically t)C"bl y purchaser covenants not to commit waste nee allow waste to be emmitted on the Property, to kaop the p r000ft in good tenantable condition and repair, to keep the pert free from liens superior to the lien of this Conti tact; a" to comply with all laws, ordinances and regulations alle I rhg the Property. Vendor agrees that in Base the purchase price with Interest and oth - oneys shall fully paid and all t: shall be fully performed at the limes and in the m*nper above specified,�t. doe will on and, etteate the Purchaser, a Warranty Deed, in fee simple, of the Property her and clear of all liens and eaatunManeey � any liens or encumbrances created by the act or default of Purchaser, mad except _ .. .. _ .. ._ _ ............_ . ... ___ ..... ............................ _. _ F J ...... _............ . ....................... ............................... .._ ...-.. .___..........................� _.. � Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any prineipal of interest which continues for a period of..._..3Q._ ---- .....days "Owing the specified due data or (b) in the evesd of a detault in (ormance of any other obligation of Purchaser which continues for at.. �. _ .... da ys following dU notion thereof by Vendor (delivered Personally or railed b certilled mail Ve�* az outstan ding balaaex under end hall become immediate) due and payable in fall. at Vor s a without notice (which �waives), and Vendor shall also have the followin rights and rem(subject to any limitations low) is addition to those provided by law or in equity; (i) Vendor may, at his option, terminate this Contract and Purehsasr'tt ri his, title and interest in the Property and the proprty back through strict foreclosure with any q Wes ' of tion to be conditioned upon Purchaser's fu payment of it►e entire outstanding balance, with interest thereon the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts K by Purchaser shall be forfeited as liquidated damages for Mare to fulfill this Contract and as renal for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to ewmp4 immediate and full payment of the entire outstanding balance with interest thereon at the rate is offset on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (Wi Vendor may so* at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this ontract at an end and remove this Contract as a cloud on tide in a quiet -title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from poeseesioa of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any ectioa under {t), ii) or (tv) above. Notwithbtanding any oral or written statements or actions of Vendor an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all casts and expenses including reasonable attorneys fees of Vendor incurred to enforce any reinedyy hereunder (whether abated or not to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser. as in- curred, and &hall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, lemurs, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer sell or convey any legal or equitable interest in the Property (by assignment of any of Purchaser's rights under this Contract orb option, long -term lease or in any other way) without the prior written content of Veudur unless either the outstanding belanee payauie under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract soley as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property an the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely pa ment of the amounts then due under this Contract Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall he binding upon and inure to the benefits of the heirs legal revvisentatives. successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein W release homestead rights in the subject Property and agrees to loin in the execution of the deeds to be made in fulfillment hereof) Q Da is ....___._....... n .... ........................... day of._. ........ - -..... . . .. ... ...................•....._ .19.9,6 r s. h tu, �.._- �_._ ... ............ ...... (SEAL) _ ...�. __ __ EAL) ' .Ri c tax.. A.... Pusker ......................... •. Roger M. �.....:`�.....J.....tt.. ��'1;...�o........_ dent _.._._ J ett, Presi _ .......... ..................... (SEAL) __.-... .... _.......................................................... (SEAIJ • .. .................... 11LdEl..Ht1SjC£tl ... .._............................ • ....... _ ..................................................................... ._ ..... _ AUTHENTICATION ACKNOWLEDGMENT Signature( s) .............. _...................................................................... STATE Or_ SCOtJSIN .............................................................. _ ................ .............................. __..... .....County. _ Personally before me this - of authenticated this ............ day of....• ...................... . 19 ............ .. .............._................ ..... 19... �i.the iwed.,. " .... , ....................,.. ;c f ..._ .......... _ .......................... _ ...... .............. ! y :............... — 1 ; .... 'Al! q...- .�.-- -K.... • ............................................ ............................... __ .�Gr...�l::...n1!?.e. :'� TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person ......................vii led. i itf one_ ........................ foregoing instrument and acknowledge the ° "�" „...• G ............................. 8 8 m FILED 1842 A UG141986 �, Of ° st CERTIFIED SURVEY MAP� Located in the SW 1 /4 of the SW 1 /4 of Section 32, T29N, R 18W, Z Town of Warren, St. Croix County, Wisconsin Surveyed for; Roger M. Jewett 341 Herman Terrace APPROVED Hopkins, MN 55343 AUG 14 1986 SI. -: Olx courm W 1/4 CORNER COMP tN:NSIVE PARKS PtANN" I SECTION 32, AND ZONING COMMME T29N, R18W I I SCALE IN FEET (1 =200') N LEGEND 8 6 ( 0 200 — 400 600 w SECTION CORNER MONUMENT UNPLATTED LANDS WEST 660.00 ° o I ° X24 ° ROUND IRON PIPE I as 627.00' v�� ' 0 O WEIGHING 1.68 LBS/ ° z LIN. FT. SET. O $ Cl 1 ; W I 7 C! M LOT I M F j ir I I 217,800 SO. FT. MOD ACRES) L] INCLUDING RIGHT- OF-WAY g ~ M 206,910 SO. FT. (4.75 ACRES) EXCLUDING RIGHT-OF-WAY z I W 5 FILED W N I° 62700' y o AUG -W986 EAST 660.00' z a OOMNN (6 6 UNPLATTED LANDS ,� H POINT OF BEGINNING I IA 2 � Z I. S.W. CORNER SECTION 32 DESCRIPTION A parcel of land located in the SW 1/4 of the SW 1/4 of Section 32, T29N, R 18W, Town of Warren, St. Croix County, Wisconsin, described as follows: Commencing at the SW corner of said Section 32; thence NORTH (assumed bearing referenced to the west line of said SW 1 /4, bearing N0 "E) 508.43' along the west line of said SW 1/4 to the point of beginning; thence EAST 660.00'; thence NORTH 330.00'; thence WEST 660.00'; thence SOUTH 330.00' along said west line to the point of beginning, containing 217, 800 square feet (5.00 acres), and being subject to town road right -of -way as shown, and also being subject to all other easements, restrictions and covenants of record. I, James E. Rusch, registered Wisconsin Land Surveyor, do hereby certify that I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Section 236.34 of the Wisconsin Statutes, the St. Croix County Subdivision Ordinance, and the Town of Warren Subdivision Ordinance to the best of my professional knowledge, understanding and y f ?. ", E 4 y,S ` y �," ✓ a � r � } �' • � �. �''. } �'> 3 Y�x � �v, mo ,`�S Fm " ^ t# �.:a S x v Az Ify �s �s a 4 i t f 1 ' �� i . t� .: �.' � r ': y�s fi�. f•Sl ''�;3n,° z a`,�re�ktgY �_ ... 3�'�.'�'1� �` � � �, It It 7 f ,.f �' 8� '� - =�gz . ,+ a �" ri���°^I' `�:. �iq.. � �, `� «. 1 � } x� t� , ems, . ` �7� �.• �'. ' �,,a : -r f "' �• r 4 95 y% of L ` a5'n Yk `+ �` a x ,v, ♦ii ,� ' 1 �'. ; �� irw i € •�, '� ` 1 ><� w , J , � r�ZX Jtira4e ay �• n s o r s i t%t'