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036-1024-50-100 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)], Permit Holder's Name: City Village Township Joe Ailts TOWN OF STANTON CST BM Elev: Insp. BM Elev: BM Description: .�2 r �3u' S S -%�e� t K TANK INFORMATION V ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic F. Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Friction Loss System Hea , TDH Ft Model Number TDH Lift Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: 651305 State Plan ID No: Parcel Tax No: 036-1024-50-100 Section/Town/Range/Map No: 11.31.17.160A-10 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet I St/Ht Outlet Dt Inlet Dt Bottom Header/Man; � �� -ern I � �� W-e2 r 1 Dist. Pipe Bot. System Final Grade �f St CoverA4 C,r(2!!E!�44-v 3 o 01 a T-(42- BED/TRENCH Width Length r No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2� Irog C3� / SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: T f m: Type O System- �, J ~ 5 �D 1 D UNIT Model Number: 9 - DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole S acing Vent to Air Intake Pipe(s) � l S-D Length Dia Lengtri Dia Spa& SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems 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 discrepencies, persons present, etc.) Inspection #1: 1202 3 Location: 2226 CTY RD T 1.) Alt BM Description = _17Mcnc.,k 2.) Bldg sewer length = �� - amount of cover = 633 +(,r- e4pzo 3) p r Sri -{-a o ri eYesXNPlan rzuer?o T3 �� /20q- Use other side for additional information. 2 SBD-6710 (R.3/97) Date Insepctor's Signature Inspection #2: �3.Z2 o _ Cl Y. 22- T-1 C) I _L Cert. No' Deparmient of Safety & Professional Services,, SEP 2 Services Di -vision P Industr-N sanitary ft Application L tb SPS 38121(2),P'Wi , A�=- C�)�t!. su-b of --h-s ior=.. -o app,,oprir.c goN-c= k requLred prior to obtaining a sanitary pe t- Not--- A�p'icatioz: fo,7ns fo- t;-La-e-ow-n-ed �OWTS are �uo=-L xc �o 'the epa rt t Of &Lfem and ?Mfessional S-t:rvii;ps. Personal infonnation you p:o�:d.- ,nay be use fog sec putposcs In accoridarCc with the Privacy Law, s. 15,.04(l )(m), State. I. Application Information — Please Print -AH Information F�Q-cryA-:ac-':s Name r,-,]' g Address rM 22Z(' Late Zip cads &�Jz� IaY el C-,- T�?e of Buflding (check A that ipp 1y) v DwelLiz-g - NumbeT. o!-Bedrooms 2 Famil. --I-- -2 Public.,Co=eTcial - Descn-be U-se S t ate Owned — Describe Use T3/ N R Z E oQ Subdivision Name © City of CSM N'Umher L-i To sAn a f znw X (0 T51D% J-U- Type of POWTS Permit: (Check either "New" or "Replacement" and other apphcable on tine A. Check one box on line B. CDMPLete line C if #pphcable.) -7 R e Other Modificatioia -jo Exi Syste= (expjain) Adc�toiaal PL,-enT-aixn=t Umt t exp ,A, r— StLn8 am " Ne%;,, SVV= pLacemenr System HoIcUmg Tank M -74 At -Grade (cozven6onai) awal Before D Change of ?lumber IV% Fier eatwent Axta and Tank Wormation; Dr-sigr, Flow mod) Design Soil Applicatlion Rives'gp&sf) 7 capacx:y M Tani, Jafom-Lat-jcm L Gallons New Tanks Tamki Cowy -7 513 O *�`ate -rranmc-Li on Number k,, •-c= Ad & es s cif d 'ermt thaa nlaihng add- s I "a.-ccl + Location Lct Phome. :umber 47 /4, trot C, MoL=d Indv,, --dual Site: Design cfter Tvp e , ex Baia) Transfer tO NeW 0W...List Previous Pel-rmi: N-L=ber end Dam lss-ue-� 3 x (400 sperrUl Area Req,;,rrd (S-1141; 6 Y L. rotL = of CTZKOMS -1: -5 I -�pc " A a Pro pose'd i- s f) S stem Eltv a hon t rsa o z 6w E I ur Ho Tic [:DosL1gC ----------- le)ev e7 IStc aij--bcr: the unde V. RespansibWty Statetnent- I -r-signecL "Sgum responsibffity for ins talLation of the POWTS sbowm on the attached pbms- 1i Tn. h5 Narn e t I i FuILIbeT's S1' Nimbe- Business Phone Number V,7,1, 71j--OOK Plunalm"s address (SLrett, C;6�y, Mate, Zip Code) — -----.._.._._.3S' - V L I Co cotun MDepartment Use Only ed: Appmve. D, P- 0, ed 1)-S-1P permit Fee Date Issued ls�L:112,g Agezrir Sig=nL-t- - i�,e : n for S ,— -, i 4t) � I D 1 �23 C o ndition P 70. Qisa515 O , C i:kal 3� U'a-Cve cI4� LkL- --moAcPOffi��4 yl Se.pfi.fa. �,1 Itrandds9ersaIx nkFffUFII �r WC cx1. f e C4%EQ must be se;,viced i maintained as pei- I Jan by r 6P,��eC managenier,,� proviCed fr-1jmN.-r. 2. A i setback re ij . reFCLI-;Is must be a-i;�'inlained a S Pe r a p F.-:ii r-,F, ID Ale , ",-j orn a r) -:7 f I'. S 6 -knatcb 1-0 complete plan% for the s-v9ttm si-od:SubMIE EO thil CoUnty oaly 00 PZPMF 00t IUS thatl 8 ' ".) X 11 WC-be.1 Ln SiM �— (-,o / f7 "..-/ 0/7 X t�a �o 1V15�,�7 �u"�% � ?h Peg!( 71d l� ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) located at: 1/a, 1/a, Section ,Town N, Range W, Town of , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? (if no, skip next line.) Approximate volume or length of time: Tank Capacity: Construction: Prefab Concrete Manufacturer (if known): Age of Tank (if known): Permit number (if known) (Licensed Plumber Signature) (Title) (Date) Yes No gallons Steel Other (Print Name) minutes (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 .� •e��. .ram �. •w +u _ a i ��_' ��� +�F y �.-� �.yr-'a:..�'aunr., _ _ L, a y, •a � -- aa4. w �^ ' +-h - •tit •Fi a rY rt• r - r•u,_ru^'_•,_ _ � J a • - �a s^ 1 tia � --r - r'i � `.. a_wy + rt f_ _ �° - K,-,� ' ..r M �•a� w 'uJ +ad �. � � � Y �. 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F.'a r� r a �' � '�L " ,d`. • * „_ i1 t � . , 'w . cz- W% � 1 40%L 1 '1 �'•tr• + ,� +r.n r 1e �'r• r a-' _ �l�a,wr "' �'�. �= a4 .. •� - +-, •� _ ] e �,;Y'�.'te 'r+�`�t4�'j�����"I���+d� C�•.tii �5.:•+t -r,-�= .�I� � i: I goo i+, lo 2M, Is 3 6FLA 60MI mmo: M /3 H F $0- PJW v! m PF6od Pr(wim "A IN Der Du#x K- 062rkm) Aw VKAK rf wmrl Dvo or prosw a s WV6 monual IrA&6) (kin 3Z, 1v iFofl D6c6fvk Sue 1 1012- (31 t, rmml 2" � 54 Imm,tl sows NrAnil Pr -cord 10'' &"rice Faftl r� * Corbft-lf 0mg Nix 71 moc4rao'l p Di Ned owtoF w/whook r &$Md. smite proiovn 0 Upw o4d kww w* ros W', boorvq 04 ow A 6C GPM (3 7 vil ""6 Ic 75 6 fr) I 5,FLA 60HA 1750 RPIA SirmA% - it R*2 r 30- vown) Dja* OQ m pf r.w-t swm-c� nw;g Akowak (ano uo, o Acrvzi krocize I m POW C�W me NovD! li-onit ofu Pmen, mra ng Fr, rr: Pew v (ood v sj,,A A Sowfo Few W-ih 0 No vc I �f C. I., N 'L W-tv, ufux �0; (or r mam rtuimn 6 cwbQrvct' -ami, �nx 71 mw_�AWKW Sw q* od hW F410- **nW 6 mu"m Aral t-fto •Uw W4 6w wo mm ba *rq onhow now n■on\ice\■in wommumommommomap mom Mon. MEMO mom mom r, Lm- 20 30 40 50 60 '-'APACITY-US G-PM. F�^r 10 YoUr &Ut�konZ&o 'o"' HyOrMale I�NVAAAX, 140Pf0Wt8TFVlP Or &W tocory ky 041�41 APP4"t*n! 0 Septic -Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer. a Pump Manufacturer Tank Model Number - Pump Model Nurnber C3 S Total. Tailk Capacioy Alarm -Manufacturer Bury Depth Alarm Model Number [Filter Manufacturer LFilter Model Number Joo Inlet Minimum Pump Performance RequirLcd 5`s7 GPM I Ccv Ft TDH Outlet Manhole Min, 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Grade Sealed Watertijzht Ic Switch Type Tota"I -Dynamic Head (TRH) - Feet Elevation Head. Distal Pressure Network, Loss Force Main Loss Taal Manhole Nfin. 4" Above Grade With Locking Devict n Disconnect Means -C e, - elrk Mole C? -C B < 1 i Off Elevation C Ft -C it Ar IL Bottom D Elevation Ft I -C I t I -C < < < 7-7 > > > 3. :> 4 > I D -L > 4 A -t -t :0 4 >. -C 1 4 < c 5 q 2 1 1 > c 2. 1 -c Switch Settings and Reserve Capacity Tank Volume — GPI Dimension Inches Volume Gal. (reserve) A � �3 � (alarrn} B 2 J. (dose) C /,vF 2 3 —(dead) D Total 4 GENERAL INS TALLATTON: The septic/dose tank- is bedded and back filled in accordance vAth the manuf�r's product approval specificafions. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approvaJ. Manhole covers exposed to grade have an effective looking device (padlock) ins Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and. laid cm stable soil to prevent settling or sagging. The force main is sleeved Nkith 4" ch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight Electrical service complies with NEC 300 and Co= 16.28 WAC. 02/0 5 LJ Page 0 f To TZ�VAl) 6, i77 ��'IST�+•1 /J-�n 7�/ / l��i,c<� X inoiK C���tij 0 f]ZW,?7�s� I�r ,ZZIY71 ST. E2o rv1Y.Tv SANITARY SYSTEM Filer: OWNERSHIP/ADDRESS FORM Oiea�� ece �zoz�in'y I- .--- Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. Owner/Buyer r<-% 04 Z1.4 OWNER/BUYER INFORMATION Mailing AddresU '2Z Z Ci - - -- ------------------- ------------------ City/State/Zip 4.,�tsr. Z0, af&V.� '!rCfVo Phone Number (required) ! - OZ7.V - `7V Email Address (required) Parcel Identification Number_ el 3 G /v (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location 1I4 15-4/ 114 , Sec. // , T 3 / N R / ? w, Town of S*p7,a Subdivision Plat: ,Lot # _ Certified Survey Map # S'Z or G Volume �� ,Page # E/�7Y Warranty Deed # (oZ% (before 2006)Volurrie Page # 72 g 7 Number of bedrooms. Spec house ❑ yes 0 no Lot lines identifiable 0 yes ❑ no OFFICE USE ONLY New Property Address (Verification of new address required from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warrant deed from the Register of feeds Office and a copy of the certified survey map if reference is made in the warrant deed. Community Development Department — Lard Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd2sccwi.gov 1101 Carmichael Road, Hudson, W1 54016 www.sccwi.Qov SEPTIC TANK MAIN 1 ! ; 'ANC : AGRF,1.M .NT ANU € WNERSH P CERTIFICATION FORM OrrwWyer joc '} /4 Mailing Ad&m &q2 6L-- K ',V51 Propaty Address tVeritication required irwn Planning Llegartment t'or new construction) cilyiStatc_ Psi ldentlficuUon Nuntbour zz2f i ♦ ■ 'If I Eiji Ili Pmperty Location v., sec. T_ - R . -_ w Town o */V /V `v Cerdfiedd Survey Ma # 0502106 Volume q4? 7 ......, _..^,. , „ ,,,.....,,_ ,....., Pale # Warrwty Deed # -_ tol 1121 pag.-Volume +.........�.�.www...n....�...r, e N Spec house 13 yes • no Irnproper use and maintenance of dour septic system could result in its premature fallurc to handle waucs, PmM maintcnwicc consists of pumping our the septic tank e;cry three years or sooner, if needed by a licensed pumper, what you put into the system can affact the funetion of the :optic tank as a trcatment Wage in the waste disposal system. T je property owner agrees to subinil to St. Croix Ioijiug C�:partaw-ut a ccrt.ification form. signed by the owner and by .a amster plumber. journevrtan plumbcr. rwrictcd alurmbcr or aE licensed pumper vcrifving thal ( I) the on -site wastewater disposal system is in MOW operating condition and/or ( 2) after 1ngwction and pumping 4 if ncccssary), the septic tank is toss than 113 full of sludge. Uwe, the undersigned have rrad the above requirements and agree to maintain the private sewage + Usposal system witb the ataudards M forth, herein, as set by the nt of Commeme and the Departmnt of Natural Resourcts, Stand of Wiwon.ain. Certification sting that }our scptic systcm has been mainwncd must be compl tcd and returned to 6hc St. Croix County 7zning Office within 30 days of /th dwft car expiration date. SI ATUU OF APPLICANT ?ATE t (we) certify that all stalenwnls can this tans are urue to the best of my tour) knowledge. I (we) am (art) the owner(s) of the prope described above, by virtue of a warranty deed recorded in Register of Lids Office. St ATURE OF APPLICANT DATE * *'� • Any information that is mis-represrntcd may result in the sanitary permit being revoked by the Zoning Departwnr. talk wkb thb app*mdm- a starnped warranty deed frorn the Reester of Creeds office a copy of the cenIf ed survey nup if reference 1s made 1n the ►varrenty deed WARUAN"11Y DEI,."D Dor-Ljr-wot Numt�et Wayiw, Al' Ct* i (L -Mi f,l Af C, ta r', k, 'ho Cp rib F It j)f. �Or a Vd I 04ble U-0T-1%kd'Pr lt�Or-t- C F L V PY (71 r;i r1 P C'*j dvwr L1,jed real e5l,ilt- LTO ij t , ,,,r 4; C i ) r I S L I I ' ) 6 1.oc-ated in part of the 'S'OL11hoast Quarter of the S4c) u I I ) wast I of 1, Tbwn of z,3Canton ('SM Vol 16 Paqe 4214 Doc ff 6/`5206) 1 C-� 1 1 ;:�'-7 XAPHILEEN 1H. WALSH REGISTER OF DEEDS T. CROI X CO. , W I RECEIVED FOR NEGORL) 06 - 07 2002 9 - `74 t-3 AM WRRANTY DEED F." x EIMP 1 0 e REC. FEE: 13.00 TRANS FEE: 14. 40 COPY FEE CERT Cbj,"'Y FEE: P A G E IS : 2 Name ztewj Reluvr, Afjclre-s% A-, -Z -�u -J, C) Parcel oeniifpuation r,,4w7`jaw 1r11N) ThIN properly t-% I L0t) (LS) C' I 1F,1 %*.-j-, �j all 2[jptwunant ]-ighL13, , t I I 10 --1 rl d i.nt Pi est five.it,.d Cxal vXCAIJ�l t3tJIL, to CVI,p ProPQTtY VS go ]di, jj-. r.UTIJAC L -ind GILWIC %,k-marv% Ehai 11-c DE-ited 011% day Of (SEAL) /9 A I jTH E N"I'l C AT 10 N ACKN0Wj,.FDGMENT State of Wisconsin, I ht"s did y Or L y r a r-Tic bvioct! Tnl' IN% c alc I IdI7.1ed tic .1 Y ee-1 *P T I H, E E H A R C)F W [SC. 0 N ST N t�",c lhf- •put-stirif.) S"' '4�-] tile N", 9- egOl r) k' (If not. auLhurl.-i-vid by '7nb.()fi. Wis, Sxat5) L'�,• 4L L INSTRLjmpNr WAS URAFTED BY . . . . .............. . C-1 *p N Ncl,aPut) hc St-Itit. f '"14 I ait: *,eN rcu m r 1 (1al May Itc. -awhentIvAted. or bri�?-,-Acdgvd, Btitli To rkf 31 zr� it r-1 I tin, Lj r,; r 4r N!, % I(, &k k, 11$. r a p.Ac I yy I -Lk Lst Ppr I y 1,.ird i i r pi i n ted hr'1 cl R--�p tir. WISCONsIN VV WARRANTY DEED -1k:v ci e%iti t=^=1U&jV AA I Pt_JRPC3SE ACKNOWLIE-00MENT c;,,a Califomia C, 0 ij 1 V 0 1, 0range CD form —MqYWAME, TF-LE Or- tDF-FJUJ�H E F,'DTA Y bee e' IATE personally appeared .:s f\j kDe sic_ personally known to me OR proved to me on the basis of satistactory evic',nce & � I to be the pe(s) wtiuse nam rsone(s I are subscribed to the within instrument and ac- knowledged to me that hey ofl nth ey executed the same in hisj)or@y/tK6ir authorized capacity(ies), and that by his/y'e'r their T NJ A vvEISENBERG signature(s) on the instrument the O&son(s), COMM 3360 2 -1 or the entity upon behalf of which the PijL3j_tG-G_AL1CnRWA P4 person(s) acted, executed the instrument- WITNES,S my hand and official seal. -5JGNAT1JF;9:7 Opfql!�7ky OPTIONAL I I - �, r-C�!y1r'Iq ('�7E Vnl+:� d cc-k ime n I anci cou 14.E pro- vent PCF! ) P%0 the dala bOlOw Js not re(juired by law, it may pr •VC% V�ILJZJ)�f� 10 -j f 'ol fraudule, of this form- aw, it /ma,, ",,r CAPA CLAIMED BY SIGNER DESCRIPTION OF ATTACKED DOCUMENT INDIVIDUAL CC)RPORATI F_. 6 F F i CL_ R A ii-rLE(S) PARTNER(S) GENERAL A _FT0Rr4EY-1N-FA('-.T TRUSTEE(S) GUAR DIAN/CONSE ATOR OTHER" SIGNER 15 RE ESENTINCI. T' i i I L-E OR TYPRIA DOCUMENT - - ___-- - -- - - - Nil BER (JF F"AGE-Q., DATE CF Df,)CLJMENT SIGNER( a) OTHER THANNkMEn ABOVE l 1,?93 NATJONAL NOTARY ASSOCIATION - 8.2:36 vv.. P.0- Box 71 F-1 - Canngk' Pars. C" A !1 1309 7-R4 do WLoocimlan DeParttwit of CQmffef oe SOIL EVALUATION REPORT pme of Divisk)o of Salety and SwAkiigs to Banc*,- md,-, axTw-n 65 WLS A4m Code Aftw*� oo"to !� te p4an On Pam. DO 10" th a I 2 ". 1 1 n �-be s i -i I%- lZ 111CW9, but rict IIm tod w - vwtcal aM horizonta re f ora4 i cc ix> i d (B F.I. J;reCton and Pamm 1, D, Pwomt sk". Sca cor di menalms, rKwM a rrow, aoj k"(xi a lid d I sta r iog to nearI rcW, I Poesso print all IN mTotion. Re . owed by Date PwwnW 0. ,, *0 111111OW1 YOu PMvW@ qwy be usad ko imil 7.'.'- Pmp" Owor A4 Its Ptop" CWW a Mailing Kiinm c4y state ZO C** Nub 5 qV 0 4 1 v •Locat. on 4 %7) LiL T I N R E.� 1A S I BIC" N.,o-ne a CS" 7 N&W C01$WLiC*r NLJFDbef Of bedrjcwns C-00t. c; or vr'�qj fje�w� kw rate GP0 j . . . ...... Flcg)d Plan alevaV if aWicable A; Gorwo conyrionts am mcol1v1er"jakvt3 OA C, J) Ck, -t- pit Gfoursd 5urfam etev- 27. Z 5' fL Depth to lin*bnq faclo > m &A bm Rim Hc((zov [*P th in. Occ-Nrya pm Gc" r GGu, RWux Descnpbw Sz Coo I C"(x Tex tum -err ------ - ---- ShA2ure Cron sistencz Sz Soho 6 8OX)dafy, RootB QFIDIF "Ettol -7-1 Effore jL 74- 4,k �47 7 ffff [.? 4 7q, �3.3a 3 L Pit Gmund swfac* elev. 0 ft. Depthlo I wn bnq fa cl 7 tn S<* Aff4wxm Rare HbAzon Depth Domnant Coor Radcw Nsoription Toxbot Struclure UrmsW"! Bourry, RoM GPCM in, Qu. sz. C401- cokw Gr St sh I -*E"1 "'EM .-2 Y 2 .5y 00 /-s:tc<'A ELL" oc ink, 4r� ct T. e 47Ck 11.u__ 71 a - --7 9 1 A00r6ft 00 VakoWn C'on&X=d tS-4 -rzq 51716 7 PAN pow Property U~ Borlog 0 Pit Grouna surface Blev, -9&LY tt Depth to lirnog f�ictcx Honzon De pth IA laO t C4J4V R*dcx-De3wPbM Texts SLrumre Czr%j3*noe Bcourld!ry a Roots on Munsell Caw . Sz. CW L GOkx Gr Sz, Sh -L7 2 BWng 7 in of L�e LL� II:)C J. g Y'8 4 75'f ILI ir Q'rr fA jf E &xing c2round Surface ewy. 0 pit Depth to firrvtr)g faCW Effuent #1 1- 10 -r. 220 mVL and T SS >30 � 150 n-VL E"nt 02 = SM S < 3D mg& ano T SS -K 30 nig�L The Department ofConimcfce is art rqual oppuritamty scrvicc pro-, ider and employcr if yua nced asstslancc jo jCCCSs %erviccs or -TY 608-264-8777 raced ced maleal in an altcrnatc fOnrnat, PlMe COn"cl �jc d c parlmen i. -, t 6 11 S - 26,0 15 1 or T SOD. 1 t)4 f It &MO) Rtf av-.�%f #I O'e -� -A�acJx, Sol ' S4 C4 r-p rr+� ZIL f AS I Lec.eKc) A R� Pt, c_ L ,.wr- k ; sya O/X r►�ar ne rc. 13 Cot I prop". -U-%f JI f-I � s►r CERTIFIED SURVEY MAP Located In port t of the Southeast Quarter of the Southwest Township 31 North, Range 17 West, Town of varier of Section i, Stanton, St. Croix Count �. Prepared far and of the r �►. [scans!n. request of: JCW Alta 1 881 220t h Avenue 1w�Pf1-� 114 C�N�R Geer park, VA 5400 ? OWNM iMo jlne Altus Et Al (�Df1�Vf) �S[l�' V "Y MAAW AtAll,) Dra#ted by. T � p, Doge v This parcel is created persuont to Section 17. �(1)(b), County Zonint� Ordinance, and ►ne � Sl. Croix � � • l } except In y not � e reconvedy inital grantee j ,14ON�.,, wl t h 801d section, rn UNPLATTED LANDS 40 AND 114 Jam' J L� FOP\MER CHtCAGC �. �s.w.r ..1• .r / -.r ! SW I/ ROAD TERN - "E N OR w 488.86 41.34 � 447.46 : + ;C: 46 - z r► -� L 0 T TOTAL AREA: rn c. ; I z 157,416 SO. FT. } I i 1 4 R3.8t CR�5 C r i AREA EXC. R--O-- *. I two o 3,28 ACRES► TI/PtCAt, --- If/ — -. 4 43. S89'48'33*W 484.754 � ,UNPLATTED _LANDS NOTE: The .. parcel shown on this map is sub jecl to State, Count an Township haws, rules and reg�tlatic�ns (i.�!. wetlond5Y d to parcel! etc-), Before pcirrhoslnq or de�Nn In ' tnlnirnt,�tnel. int sloe, nrc:es� Croix County Zoning Ct#+ce and the approprioiTow iny pnrrrd r:nntdvi lie St, r i 11?� ScOlon Corner Monument ! of Reenrr! SOUIH 1/4f f.nPAI P �j CERTIFIED SURVEY MAP Located In pant of the Southeost Quarter of the Southwest Quarter of Section 11, Township .31 North, Ronge 17 West, Town of Ston ton, St. Croix County, Wisconsin. SURVEYOR'S CERTIFICATE: 1, 'Fy R. Dodge, a Registered Wisconsin Land Surveyor, do hereby certify that by the direction of Joe A i l t s, I have surveyed, divided and mapped a parcc l of land located in part of the Southeast Quarter of the .Southwest Quarter of Section 11, Township 31 North, Rank: 17 West, 'Fown of Stanton, St. Croix County, Wisconsin, described as follows: Commencing at 1he South Quarter corner of'.& it1 -Section 11; the:rick,, on an assunwd hearing ak)ng the rwrtli-south Quarter linc of said Scetion 11, North oo de rem 02 rnincites 54 scc:c�ndti _ • g Vest a distance of 913.11 feet to the point of heginnl"ng of the parcel to be dmribcd; then a South 89 demos 46 minutes 33 sc1conds West a distance of 484.75 feet; thence Ncirt h oo degrees 02 mi mites 54 seconds 'west a list ` ncc of 294.11 feet to the right of way of the former Chicago and Northwestern Railro • thence along said former right v f via � g y, North g2 degrees 34 mincites 33 seconds East a distance of 488-80 feet to said north -south Quarter line; thence, along last said north -South Quarter line, South oo degrees 02 minutes 54 seconds 11ast a distance of 355.37 feet to the point of beginning. Containing 157,416 square feet (3-61 acres). Subject to County Trunk Highway "I" Also subject to all easements, restrictions, and covenants of record. 1 also certify that this map is a correct representation to scale of the exterior boundaries surveyed and described, that I have complied with the previsions cif Chapter 236.34 of theWisconsin State Statutes and the Subdivision Ordinance of the Count of St. Croix and the 'Town cif � � � . y tantc n n surveying and mapping thc saw. Y . Dodge Registered WLwonsin Land Surveyor No. 2484 onsuh inGroup, Inc. P.O. Box 325 New Richwnd, W1 54017 Date 0 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Quilding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1 )(m)}. 'ermit Holder's Name: City Village X Township Ailts, Joe Stanton Township ,,ST BM Elev: ( insp. BM Elev: BM Description: t�� I 00•i) I ev- la M I TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO PIL WELL I BLDG. I Vent to Air Intake I ROAD I Septic t >I r0D � 44W Dosing t L Aeration Holding d - ... ) PUMP/SIPHON INFORMATION Manufacturer ��ti1►l 1�1[,,..r Demand GPM Model Number Porcem Lift '06 Friction Loss System Head TDH Ft ain Length j Dia. Dist. to Well " rjr Well W11:1--161 Z129 [elk, &-Y&I 9:4 J4 1 �-T WARP 19 ELEVATION DATA County: St. Croix Sanitary Permit No: 405177 0 State Plan ID No: Parcel Tax No: 036-1024-50-000 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer 2� # � Cytt / St/Ht Inlet fit (q o 741 ef- Et 4 19VHt Outlet1. Dt Inlet ❑t Bottom Header/Man. t I 3Y 'Fist. Pipe j t It �., �' 0 Bot. System ZS 87-3 �• yZ-1 Final Grade ij (loo St Cover �d BED/TRENCH DIMENSIONS Width Length &% No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO Type Of System: Pik. BLDG j I � WELL � LAKE/STREAM ��..� LEACHING CHAMBER OR UNIT Manufa Model Number: � it.. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x HoleSpacing Vent to Air Intake Pip s) � (ro t Length Dia Lengt Dia Spacing SOIL COVER x Pressure Rvsterns Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No jxx I� Yes N❑ CO IIt�I E NTS: l nclu3iscrepencies, persons present, etc.) I nspection #'I : � � 2-C�L7� Inspection #2: r L90 ion. 2226 County Rd T New Richmond, Wl 54017 (SE 114 SW 11411 T31N R17W) NA Lot 1 Parcel No. 11.31.17.1E 1.) Alt BM Description 2.) Bldg sewer length .�. t amount of cover Plan revision Required? Yes <No •� 70 �. Use other side for additional information."4 Dat Insepctor's Signature SBD-6719 (R.3197) i q - Cert. No. . . . ....... J)C I �f No. 6s13aS CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval.. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: 1f you wish to renew the permit, or transfer ownership of # ca authority. t e erm�t lease contact he uu h permit, P ty AUTHkJRIZ'--JEI"j ISSUING ul"FFICEIR — DATE. /131 z - ------------ ------------- I I ZDIZ T-j A T I"! "NL'SS RIEN'WED -ur-j-PuRE THAT V FS RMI X"IRIES P c U .. .. ....... . . . . . . . . . .. . SBD-06499 (RI 1/20)