Loading...
HomeMy WebLinkAbout040-1186-60-000A A&'t AS BUILT SANITARY SYSTEM REPORT' lb OWNER Z t,, 4- & 6 be 71_� JOWNSHIP SECTION T JP' _N - R_j J_W ADDRESS. ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I INDICATE NORTH ARROW I BENCHMARK: Elevation and description: Zn_'A3'1- '/ SEPTIC TANK: Manufacturer: Liquid Cap. Rings used: Manhole cover elev: r39 Final grade elev: 9 S, 0 Tank inlet elev.: Tank outlet elev.: No. of feet from nearest road :Front Side Rear � Ft. From nearest prop. line:Front Side Rear Ft. > No. of feet from: Well_' Building: (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pum /Siphon Manufact.: Pump Size Elevation of inlet: B tom of tank elevation Pump on elev.: Pump o elev.: Gallons/cycle: Alarm: Man.: witch Type: Location Distance from nearest prop. 1� e: Front Side_, Rear Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: -r Length Number of Lines: 2 Area Built Exist. Grade Elev. y',,3 _Proposed Final Grade Elev._ .4 ._. Fill depth to top of pipe: 3 No. feet from nearest prop. 1 ine : Front , Side , Rear ,--- Ft . S- No . feet from well : > 7.r' No . feet from building HOLDING TANK Manufacturer: Capacity: No. of rings used: lev ion of bottom tank: Elevation of inlet: No. feet from nearest prop.\kine:Front , Side Rear Ft. No, feet from: Well , building nearest road Alarm Manufacturer: INSPECTOR: - DATE: f PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj WOODR LOQ26;91 QZ�; rt rWAPX I n �A py? 8 . 19 7 4 'y'h -Labor and Human Relations INSPECTION SNW�VH�f INSPECTION REPORT .5 U%fety and Buildings Division J. 10 (ATTACH TO PERMIT) GENERAL INFORMATION F Permit Holder's Name: ❑ city [] Village iTown ;le A K ::A1 Jim I II.L".Lx Insp- BM EIev_- BM Description-. ELEVATION DATA TANK INFORMATION TANK SETBACK INFORMATION PUMP / SIPHON INFORMATION A93%00020 //14 SOIL ABSORPTION SYSTEM --:I:::: PIT Inside Dia. H Width i Length No. Of Trenches T� BED/TRENC EgS104—S SIO S DIM SIO IEN Manufacturer. D I M05LO �NS SYSTEM TO P L BLDG WELL LAKE STREAM LEACHING SETBACK CHAMBER Mod� . I Numoer'. INFORMATION Type Of OR UNIT System. DISTRIBUTION SYSTEM Hole Size x Hole Spacing Very Liquid Depth take Header /'A;, "*& Distribution Pipe(s) . I i Length Dia. Length 43— Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only =h xx Depth Of xx Seeded Sodded xx Mulched ;F N 0 Y No Depth Over Depth fiver No Yes No E] Yes &@zL/ Trench Center 9-ee Trench Edge IF COMMENTS: (include code discrepancies, persons present, etc.) Y NW L T 83%, E./WOODRIDGE D OR. 28.19.784.785,SE, LOCATION: TR ck C-7 r or ..... woe If ,eAel z p or- i Pl'a"nrevision required? NO Use other side for additional Information. Cert No. D t Inspector's Signature SBD-6710Af 05/`!) (,12 cd SANITARY PERMIT APPLICATION COUNTY 1�DILHR In accord with ILHR 83.05, Wis. Adm. Code 1 -010 —Attach complete plans (to the county copy only) for the system, on paper not less than 81/2x 11 inches in size. —See reverse side for instructions for completing this application. I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 1/4 4 S. I,XROPERTY OWNER'S MAILING ADD ESQS LOT # _3 STATE SA RY PERMIT # Checkck i re5 s application he ksio t0q STATE PLAN I.D. NUMBER T 2J IN, R E (o I BLOCK # CITY, STATE f ZIP CODE PHONE NUMBER SUBDIVISION NANE OR CSM NUMBER ZL40 &( klo_- aika x -e- ,�L az2r- - =n kvmE CITY : NEAREST ROAD El II. TYPE OF BUILDING: (Check one) State Owned 0 VILLAGE: Iols-jow 0 - F]Public l or 2 Fam. Dwelling—# of bedrooms -­2 PARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 1 El Apt/Condo 111111111111:2 2 El Assembly Hall 6 ElMedical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 0 campground 7 El Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 El Church/School 8 1:1 Mobile Home Park 12 El Service Station/Car Wash 50 Hotel/Motel 9 0 Off ice/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ew 2. El Replacement 3. El Replacement of System System Tank Only B) F-1 A Sanitary Permit was previously issued. Permit# 4. 0 Reconnection of Existing System - Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental 11 El Seepage Bed 21 El Mound 30 0 Specify Type 12 Seepage Trench 220 In -Ground 13 Seepage Pit Pressure 14 ❑ System -In -Fill V1. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) VII. TANK CAPACITY in gallons Total # of Manufacturer's Name INFORMATION New xisting Gallons Tanks Tanks Tanks 5.PERC.RATE (Min./inch) 5. 0 Repair of an Existing System Other 41 El Holding Tank 42 0 Pit Privy 43 El Vault Privy SYSTEM fLEV. 7. FINAL GRADE ELEVATION 2z.>-2. -Y Feet 'Feet � Site Prefab. ' Fiber- Plastic Exper. % Con- Steel foncrete strutted glass App. j Septic Tank or Holding Tank Lift PumE Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PK"er's Name (Print): Plumb isSignature: (No Starnns) IMPRSW No.: Business Phone Number: .7 dA: Plumber's Add resv(Street,4City, State,,ip Co <-;- / - - 0j'7t. - IX. COUNTY EPARTMENT USE ONLY ture (No m -ts-s—ued issuing gent Sig Issuing gentSig(No Disapproved Sanit Permit Fee (includes Groundwater Date Surcharge Fee) 100, A pprovedLE Owner Given Initial yZ Adverse Determination /14. X. ONDITIONS OF APPROVAL/ ASdN FOR ISAP=PRVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: 0 -1 riginal to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. ' 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be -.§ubmitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank{sy must be' pumped & ra Il Y censed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code'adrniini' traitor 'or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number�)o s f where the system is to be installed. P II. Type of building being sorved: Check%onty'one and complete ## of bedrooms if 1 or 2 FamilyDwelling. ng• Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and fakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; 8 }horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; .pump model and pump manufacturer; D) cross section of the soil- absorption system if required by th.a county; E) soilsteet data on a..,.115 form; and F) a I I si4ing information. , GROUNDWATIE SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. t r � SB D-6398 (R.11 /88) �p #ts �S1'��c /�o•D ea �t d -14 �� % If.e- 41 r/"vim - SANITARY PERMIT APPLICATION COUNTYJ/ LI C'�HR In accord with ILHR 83.05, Wis. Adm. Code A Ad .d —Attach complete plans (to the county copy only) for the system, on paper not less than 81/2x 11 inches in size. —See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 46 J let '/4 S _z�n?/PPRTV nWNFR-.q MAILING ADDRESS LOT # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME Xc­ 0 A 11. TYPE OF BUILDING: (Check one) State Owned 0 VILCITGE: TQWN QF: El Public [Ji or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NIMBI Ill. BUILDING USE: (if building type is public, check all that apply) 1 0 Apt/Condo 2 El Assembly Hall 6 1:1 Medical Facility/Nursing Home 3 ❑ Campground 7 El Merchandise: Sales/Repairs 4 ❑ Church/School 80 Mobile Home Park 5 F-1 Hotel/Motel 9 0 Office/Factory IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) �s STATE SANITAERMIT # ❑ Chk ire son 3t oK'Op�r us application ic( STATE PLAN I.D. NUMBER T Y I N I R E (or W IBLOCK # M NUM OEM NEAREST ROAD ,='~� ,: ir 0 "Offpm 0=0 10 ❑Outdoor Recreational Facility 11 El Restaurant/Bar/Dining 12 ❑Service Station/Car Wash 13 ❑Other: Specify A) 1 - .New 2. ElpRelacement 3. ❑El Replacement of 4. EJ Reconnection of System System Tank Only Existing System 13) E]A Sanitary Permit was previously issued. Permit# Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental 11 El Seepage Bed 21 0 Mound 30 F] Specify Type 12 [R Seepage Trench 22 El In -Ground 13 El seepage Pit Pressure 14 El System -in -Fill 5. El Repair of an Existing System Other 41 0 Holding Tank 42 El Pit Privy 43 0 Vault Privy V1. 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) ?Z, 7� ELEVATION age r Feed Feet CAPACITY Site VII. TANK in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xisting Gallons Tanks Concrete structed glass App. Tanks Tanks 1_L] L] Septic Tank or Holding Tan LME2.m .2 Tank/Siphon Chamber Vill. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. $ Pl,u is Name (Print): Plumbe"s ignature: (No St MPIMPRSW No.: Business Phone Number: Plumber's Address (8freet, city, StALte, Z Code):--- -Y a�s IX. COUNTY/DEPARTMENT US t ONLY Issuing Agent Sign Lu*e_-,kNb Stamps) F-1 Disapproved Sanitary Permit Fee (includes Groundwater Date Issue Surcharge Fee) Approved F-1 owner Given initial I.. _;V 3 I -Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber j f r• r INSTRUCTIONS ' r • r 1. A sanitary permit is valid for two (2) years. 2. Ydur sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s)must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-265-3815. To be complete and accurate this sanitary permit application must include.- 1. Property owner's name and mailing address. Provide the legal description and parcel tax numbers of where the -sy4tem is to be installeo. Il. Type of building beirig'served. Check vary orid'"and complete ## of bedrooms if 1 or 2 Family Dwelling. 9 Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. V11. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use only. X. County/Department Use only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump -or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B} horizontal and vertical elevation reference points; C} complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performan66 curve; pump model and pump manufacturer; D} cross section of the soil absorption system if . -required by(-tft&bunty; E) soil test data on a 115 ,farm; and F} all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment'of standards. SBD-6398 (R.11 /88) SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ��U � n r ebb r ���r_�: ADDRESS: �FIRE NO: LOCATION: 1/4, fVtk) 114, SEC, T N-R Icy W, TOWN OF: ST* CRC] IX COUNTY SUBDIVISION: e— LOT NO@ 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 septic tank pumper. What you put into the system can affect the function of ' the septic tank as a treatment stage in the waste disposal system: St. Croix County residents may be eligible to receive a grant to help with the cost of the replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the St. Croix County Zoning 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 wastewater disposal system is in prop(ier operating condition and (2) after inspection and pumping f necessary)r the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration* I/WE, the undersigned have read the above requirements and agree , to maintain the private sewage disposal system in accordance with the standards set forth,, herein, as set by the Wisconsin DNR. Certification form must be completed and returned to the St. Croix County Zoning officer within 30 days of the three year expiration date. a. � SIGNED: DATE St. Croix County Zoning office 911 4th St, Hudson, WI 54016 • I APPLICATION FOR 8AI(ITART MMIT n T V - 100 Tula application form 1a to bi conpinted in full and algned by the ovntr(r) oC the property belnq developed. Any lnadnquacles WLII only result I delays of i]tie pzitAlt Isivancg- • Bhould U115 daveloPment be Intended for I I I a I a by ownet/ContraaIotI(apac houne)I U1r.n A second [otn should be t i t a I m v d and ce0plIIId vhon L I i a pxaperty la sold and submitted to this 0 L L I c a vtth the ■pptopcIatit detd ttcordInq. - - - - - -- - ------ - - -r.r --wrr--Y..rwrrr w.�rrrYr+•r ..•rawrar Yw rr r.rw wr w�.Y.w�wrr r.rr r.rrr rr rwrrr w --r.. . ovnir of property D n - ve Location of property 1/4 1/4r BectIon _ �� T "` -R �V Tovnahlp (- K-aIIIng addttset Adele of aIte subd lyl s i on nawq Lot nuxber Prtvloua ovntc of proptxty Total tlis of parcel Date parcel was created - — �r Ara all, cornais and lot lima identiflxbls? k� Yts H o Is this ptopatty being dtviloptd for rtre■le (spec hours)? Yea _ ,�'Ko and Pal• Humber�as recorded with the Ra9 lsteo t of Dods. . rr•+Y..+..wMloft" rwrrrwrto" wrr..wri•w.rrrrw`rMr—rrYr..rw 111CLUOg VI TH Tit 1 Q t\PPU1 CATI 011 TII2 FOLLOW] HC i P VKAaKNTT DptD which InclLido s a b0c:UXI}iT tiU)tl ,jR, VOL"M 1U1D PA02 ULrr(eIA and th* 0v KL Or T I I X RZOIGTRR OP DRKDI9, in addItIon, a eertlfild suIva Y, 1 [ AyaIIabIt, could be hclplul ao as to avald delays 01 the ttvlaving proce:a. I[ the dt'd aeet:tIptlon reierenca■ to a C•t'LILlad survey Nap, the Certified iurvt)r asap shall slty be required, - - w - - - - - r r r - r - - - r - w r - - r - - - - - - - - - - •,. - w r r - - w - - - - - r - - - 7 --------------------- PROPERTY MIER CERTI pICAT10H I (Ya } c+ttl fy that all statiemeriLs on thle form are true to the best of my {our y knovltdthat I (ue) am (Are) the owners) of the property dtscrIbId I t1115 lniatrnatlon (orr-�, by virtue of a urirrenty deed t@corded In t h a C) Ilca o[ the County Righter oC DetdS A Dacumaht )(o. "�©�q6,r IC J4C and that ( ive l rcesently o v n the proponed alto for thn neuage dlepostl systen (or I (vt� hey: ot�talntd an eeetment, to ruri WIU1 Lha above daacrIbid property,, for t.ha canitcucIIon o[ timid nyatetn, and the aame him bean dui recorded In the 0CLlca oI the Ccyhty Rwglattr v[ DO 'ION as DoCumeht Noi�c sOnature oL owner Signature oL Co-O%mor (IL Applicable) l - -f Date 0L algnatuta Date 0L signature DOCUMENT NO. VOL 411 E514 V i y WARRANTY DEED .� STATE OF WISCANSIN— F0RM 1 THIS SPACE "SERVED FOR RFC =DING DATA to THIS INDENTURE, Made this ..__.. �,S s.............day of---------•-----•--tc-•----•-----••ber ....................... REGISTERS OFFICE D., 19..:...., between...._.._JQ.S!R `11...H...."2C N. LZ' I .--wi _.-A2 i.q q...Up... aQh.v I t z ... ST CROIX CO. WIS ..,..Ala.,. Iid..iand--.xi ff?.......-•----.................-..- ...........................................................•------------•------........ Rec'd for Record this._ 8th-- ..............................----_....----------•--•----------------•------------....................................................... ...._.... day Of QQtQh_Qr.._A.D.19b5 ................................................................... parti-�.;...... of the first part and at. _00 ..----=A'" Me ........... ; �_.. ! .s ?; ...c3. '�4�_. .J, t n ,. i- r ? :.• s t e.............................. t coNmon ............ .................. egl/eit Veeds part...I.e&S..of the second part, Witnesseth That the said i, s RETURN TO - part__..'_...._.of the first part, for and in consideration of the sum of- ...... rn. � `fir ..(..�.1.00_)...�.7id other considerations._...-.-- ................................................. _. •-----••------------•........................................ ............... ..............................................................to---•tTiem ... in hand aid b the said 1 P S par:. "S' _.of the second part, the receipt whereof is hereby confessed and acknowledged, ha_'4_�_......given, granted, bargained, sold, remised, released aliened, conveyed and confirmed_ nd b these presents do ............ give, grant, bargain, sell, remise, release, alien, convey and confirm unto the i aid part !' S...of the second part;:_ eirs and assigns forever, the following described real estate situated in the County of --- t ....� roi ............. •........... and State of Wisconsin, to -wit: Fart of Of ;",, of `section 30-29--19 described as fo?101,7S. Co'Mencinci at z. ' corner of said Section 36; thence E on Aline 1487.20 f et to ,r.lace of beginninn; thence IT rar.ai lel with .°T. linp of said Section 36, 233.00 ~4 feet; thence E. rarallel with said I ine 100.00 feet; thence S. raral Zel with said W. line 233.00 foet to said fi line; thence W Dn srid Line 1.00.00 feet to Place oz heinnin. (Ir NECESSARY, CONTINUE DESCRIPTION Ok REVERSE SIDE) Together with all and singular the hereditarnents and appurtenances thereunto belonging or in any wise appertaining; and all the estate right, title, interest, claim or demand whatsoever, of the said part __lof the first part, ither in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditarients and appurtenances, unto the said part-.i"' -of the second part, and to_.th(ai r.... heirs and assigns FOREVER. And the said............?C: _---............. .. ------ ------ -• .....-----•-.---.--.....---••.......................................................................•--.....---------,.. for------------------- �' r - _ _ -----' ------...,._...---'-. ;---...< - --- } .�hei-r--•----- -- -- ---•--•---`.------_ y heirs, executor-, and administrators do..__.___•• -_.---covenant, grant, bargain, and agree to and with the said art..1...8_of the second part,.... _-,--- - : r.............hers and .assigns, that at the time of the ensealing and delivery of these presents T^'asp.....................well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance { in the law, in fee simple, and that the same are free and clear from all encumbrances hatever. .................. ............................... _ -------- ....... .......................................................... ........ .................. .................................................................................................. ..................... .-----•---------•......................................................................... .................................................. -----.•.__.... and that the above bargained premises in the quiet and peaceable possession of the sad �} .............................. ! q P P part..,..?_:1.of the second part,.....___...heirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereo ,.11 P"......will forever WARRANT AND DEFEND. In Witness Whereof, the said part:.�A ..__of the first part ha." , ...-----hereunto set:-�!� �.._.._ 5hand___hr,-._..and seal.... this....... �.�:�...... g day of ... C?px .. , A. D., 19._ y�... SIGNED AND SEALED IN PRESENCE OF -%/,. ,� �' - (SEAL) ............ �.� (SEAL) •-------- ----- ?---- —----- •------------ -. ..,._.,.. ...._.... C ...1 r Cat 1 L rr, .... ..................... _Z (SEAL) .............. ................................................__.................. (SEAL) STATEOF WISCONSIN,............................................ ,........ ..................... ......................Pierce ......................... ........ Count SS. . Personally came before me, this .............. .... . �............................dad' of ................. - Q!-'f'...................................................6 the above named__.....C1r+.1� TT� "'�.1���� �...��,... .,? .S...ry:.� i ..�. �, C inl� , A. D., 19......... ... - and . Ali c O � � i ..� }. :l c?and. f _". �. _ .1.. f n......................................................... • . I ------ . to me known to be the person_ `:.__,..__who executed the foregointnment�andacknowledged�---- ------ --- -- - - .........._.......... wledged the me. o, r ry NOTARY '--• .. .......... ........................... .......... SEAL _ - This instrument drafted b y Notary Public ............ F1 rC.......................... ........ County, Wis. River Falls T.r= - --- •----- y.'- s•., My Commission (E� (Is) p��rman�nt: ..x.sconsin .� .. ------ •-------------- (Section 59.51 (1) of the Wisconsin Statutes Peovides tha of the grantors6 grantees, witnesses and notary). recorded shall have plainly printed or typewritten thereon the names WARRANTY DEED —STATE OF WISCONSIN. FOR41-NO. 1 N. C. Ml6LEk CO.. MILWAUKE zf fi L --------------- z eg 1, .► r DAVE FOGERTY PLUMBING Perk Tester & piumber ,5- ca /, / e�-- "?.& " #3233 #3289 Fogerty VVISHejg�ts Road Z t4SIN 54023 ROBS So CO Phone 749-3656 Visconsin DaparuTient of Industry, tabor arvi Hurilan Rotations DIVI�10i'l Of SLIfelly & Buildings SOIL AND SITE EVALUATION REPORT in accord with ILHR 83.05, Wis. Adm. Code COUNTY • LD 0 Attach cuiplotO site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. ll not 1111)11ed to vertical and horizontal reference poInt (BM), direction and % of slope, scale or d►rnun::,i,nud, north arrow, and location and distance to nearest road. REViEWED BY APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATION 1111 - U) - PROPIE.-HTY 0IIIIIIIi. —Dick Fox (John Parsons Pe'__,L)p-�-jy 0,v'V,,NER'-S MAILING ADDRESS L 84 West woodrjdqe Drive CITY, IST A 7 ZiP CODE PHONE NUMBER E P i VC-1-r Fat IS WI 54022 (71� 425-2100 Page— I PROPERTY LOCATION GOVT. LOT SE 114 NW 1/4,S 36T28 lt�'R 19 LOT # BLOCK# SUBD. NAME OR CSt� III; 83 oak Rid e Acres [:)CITY [3VILLAGE JU, OWN NEAt�EST RCekj Tr2y _.CQtjni7 y M% I exist+ng building ��._____.. _ Nevi Consuuction Use V, Residential / Number of bedrooms Addition V Puolilc or commercial descfiW Recommended design loading rate Pd/tt _ . $ trer�c�', 9Fr , ct•. ,&,ta d�;'rivE:d duly flow 450 gpd bed, ft2 563 vench, ft2 NUtimum design loading rate ---bed, gpd/ft2__VenCn' gpa �Lsorjjljon area r&quirc 643 ft (as referred to site plan benchmark} li,coriinionded infiltration surlace clevation(s) �ucltioiial deslgil / site consl cable NONE Flood plain elevation, 't ap pliI :1ar-:nt material ri GROUNDAT-GFjADE SYSTEM 1N CONVENTIONAL 7MOUND IN_PRESSURE M I I 0S UL11 SUI[LibiO for system 1%2 e% r­1 I I r"19 L% r-111 r3T (Z KI S D U t')'L)ring .if Ground 97.3-0- It [_'i�!Ptn to 11111iting Uclor None 'Jourid t."!c V. 96.25 ft. PJptll to 1.1111ting I4 toter SOIL DESCRIPTION REPORT Depot Dominant Color mowes Texture Structure Consistence Bak" Rom Horizon Gr. Viz. Sh. Qu. Sz. Cont. Color i n. Munsell 2 m sbk m fr as 2-m .5 0-10 1 OYR 2/ 1 NONE sit I ­_­ ­__ , - 1 4/2 NONE sil 2 m sbk m fr as if _. ` r� 2 10-14 1 OYR 3 14-24 1 OYR 4/6 NONE S', gr 0 - gr Rd as 1 of - � _ 4 24-47 1 OYR 6/6 NONE s 0 r as .7 47-51 1 OYR, 6 6 NONE • `� 6 51-106 1 OYR 6/6 NONE S 0 r nil —..-7.- 07 ___ I @I S.rpjLLjju._P1o.,st) Print i n ra r Addfu-lj 1\18230 Hi hway 65 South; River F 11a,_ CST NwrnLo PROPERTY OWNER Dick Fax SOIL DESCRIPTION REPORT PARCEL I.D. Boring # Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. cont Color Texture Structure Gr. Sz. Sh. C�onsjstence Ebuncbry Routs 1 0-17 10 YR_ 211 None sil 2 m sbk m fr as 2m 2 17-23 1 OYR 4/2 -None sil 2 m sbk m fr as 2f C,',,ound 3 23-65 1_0YR_ 416--- None S 0 M Mi as if 6�v. .7 96.. 50 It. 4 65-1 OE 10YR 6/6 None S 0 M Mi .7 lj,�Plh to i c to r Rt.,,,marks: -ig 1 0-10 1 OYR 2/1 None sil 2 m sbk m fr as tam 2 10-24 10YR 4/2 None sil 2 m sbk m fr as 2f 105 0 G1,0und 3 24-37 10YR 4/6 None s,,gr 0 M MIL as 1 f .7 8 97,­80 4 .37-10 10YR 6/6 None S 0 M Mi .7 to Depth to Ifflilling 7 [lictor Ground dev. 96.35ft, Upth to Remarks: 1 0-10 10YR 2Z1 None sil 2 m sbk m fr as 2m 5 6' 2 10-21 10YR 4/4- None sil 2 m sbk m fr as if 5 6' 3 .21-52 10 5 3 none M. S crr 0 M M1 as if .7 8 4 32-106 10YR 6Z4 none S 0 M - M1 Remarks: Boring # . ............ .............. . ....... .... ......... Ground L -,I(:V. ....,,.......... ft. Gopth to R By 5 N % I ;-A- i ( I _ Y... ......�_ — r ...E -5 . �. T fN P`.`t t % .� . 1' I 1 'i 1 P7 /"� L T T hT " L' i'�.i iJ - -�- L !' . ClJ11i id IN i i ��i� i�r v % '; _e �y _ _ f1 w /'1 !d %fl h n Tf ri i TTT-1 MCC ":{! lT"1 Tl�T f�: i7l!wtTT!'�1T F.Z /'�T17T TTTl T-1ITfQ � LL i f 3 ARi1C� � � � � 10 0 3 rcL1� u � - a rc .� n L-P l �. �i v��� 1ri z .=, r �R . / _ "l ! 1 w / +1 / f i F P�1 is T Y T ' 1 ' ' J �JU �,r' i9 9 J 1 % ' N V � .3 licti V it� . �"+ L .. L e . ,. T1 T� A T1 T l T /`4 !Y .� �.. .-. r . .� Ud U+�x3 : r %i'�L%1.i`�� L.t�Il a t�. T'� r+ y .a .. __ n- - m T'1 S 7 r n! n w ■-�7r }ns r_ r^�.� r�-5 s dT1�f r f 1-4 AU :� rn r% 0 � -% G . . i . f . I V : r ,J L1 , • *'v , �.., s. n --� �--+ r.7 r 1 � . Ov arc I i' L r[ Pai c 1: O-lg8E-60-000 iJ Use elm Descr-LPi93i6OU _ �'_... l i c ant ; P �.� S OM ki i� � _ _ P i i t L T I-* Owner. . PAR.�iV� , JOHN `' Phone: -err_ 1-0 C"m RT Y DAV I. D B �V _ � rd rilone 7 6 -- — — .r---:---...r—rr r. rr--- rr—��r i 3 � iL,.1. C� i 1 R C,1 L1� 3- T i l l V' t 'l a �, i o n..... Requestor Dave Fogerty PIitJn 1Z.eq T i1[[ s T-irie X J teens requesLed tobe --Enspected-me Action coitiii[eii �. :-=i U U li 2 r i- -INSPECTION Z) . i i V - ---------------------------------------------------------------------- 1.. TT-0 A— ..._�_ _ It1spec �..iofi1 nis for �i • • • • • %l .�— .r ..._.. ., I'd 0 -% q � % -r 1 -V 1 T 7 Ir T A T r" % Ti E C f'TF T' !'" � X � .L L.� i[l : U s.i U i r _Lapt LIL �i'�i >VMk, 1 -LUlAN