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HomeMy WebLinkAbout004-1085-20-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT f '^J pp~ OWNER Ora ~0 I e ADDRESS 319 7 .5 P a ~ I ~ r..y ~ ST OROi)( COUNT`( t l~ Sb v~ LtJ S!O c -7 ZONN3OFFICE SUBDIVISION / CSMJ LOT SECTION S T--)3 N-R-Z-5---W, Town of_ Ca~ v ST. CROIX COUNTY, WISCONSIN PLAN VIEW _ SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ® by 3 a 2. ~u~sr u. . F~1) D ~ 600RTH ARROW l Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: l00 l0P Or W6\~ ~a a q /Z, ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: _uyFF Gu lvc. Liquid Capacity: /000- co Setback from: Well f- /00" House 7 Other Pump: Manufacturer F'd Modell S W 33 Size Float seperation I C " Gallons/cycle: I (4 3 . Alarm Location x_ 19d,AX r ! o,c .'A/ !3.►s c~T o l= S SOIL ABSORPTION SYSTEM Width: S Length 7 S' Number of trenches t' Distance & Direction to nearest prop. line: o?.aS~ Setback from: well: /U0 ~f House (o g Other L )0" ELEVATIONS Building Sewer ST Inlet: 7' 7 ST outlet: 7 - /pYyIj, PC inlet - PC bottom - Pump of f =0'Header/Mani fold- 5-0" Bottom of system 5=/0 %L" Existing Grade Final grade 3 -Q" Co. r F01I044 DATE OF INSTALLATION: PLUMBER ON JOB: CL 4,,'s /3Aver LICENSE NUMBER: S h 001 (o q B INSPECTOR: nn T~~ M Soh 3/93:jt i i t Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299090 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: CRAWLEY, ROY CADY CST BM Elev.: , Insp. BM Elev.: BM Description: Parcel Tax No.: 004-1085-20-0002_ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV! Septic Benchmark Dosing ri {)c Ae Bldg. Sewer Holding St/ 1-14 Inlet 7 t? ' S i ' TAN TBACK INFORMATION St /,pit Outlet = 4 Vent TANKTO P/L WELL BLDG. Air Ito ntake ROAD Dt Inlet Septic NA Dt Bottom (03 frp Dosing NA /Man. r .13 Aerat' NA Dist. Pipe Holding Bot. System PUMP 44046N INFORMATION Final Grade Manufacturer Demand Model (Number GPM ~I'! TDH Lift Friction System TDH Ft ` Forcemain Length 31 Dia. Dist. To Well SOIL ABSORPTION SYSTEM j BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DI o~ L NG Man !Fe~r: -AGW cSETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM CHA TypeO MBER„ INFORMATION er: OR UNIT " System: DISTRIBUTION SYSTEM i~r / Manifold r~ Distribution Pipe(s) x Hole Si Ze x Hole Spacing Vent To Air Intake Length Dia- Length Dia. l,) Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: CADY 35.28.15.546B,NE,NE 3197 HWY 29 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05191) Date Inspector's Signature Cert. No. t ~ ADDITIONAL COMMENTS AND SKETCH f SANITARY PERMIT NUMBER: a Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County 11 C than 8 112 x 11 inches in size. ~TL - e-0 • See reverse side for instructions for completing this application State Sanitary Permit Number .2 99096 The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property-49 ner Name Property Location U 'l (f a A W 1/4 NC 1/4, S 3' T 2$ , N, R 1,5 (or) W Property Owner's Mailing Ad ress Lot Number Block Number 'A' I C1 51 City, Stat Zip Code Phon Number Subdivision Name or CSM Number (At 1L56V 5 a27 (1l )17Z'3314 II. TYPE OF BUILDING: (check one) ❑ State Owned ° city Nearest Road E] Public 1 or 2 Famil DwelIin - No- of bedrooms a- ° Towg of C A w 2 SSAS4 111. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Numberr(s) 1 ❑ Apartment/ Condo 604, 0915--d-0 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. ❑ New 2. X Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only 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 21 W1 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 2 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ' EI ion 1 395 S' S 1 Z 16--l Feet Feet VII_ TANK Capaci - INFORMATION in allons Total # of Prefab. Site Fiber- Exper g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank / 0 &IV b V ' V - I G1, 1,C. ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 6 cV VO ~J a ~ wfi NL ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Name: (Print) Plumber's at e: St s) MP/MPRSW No.: Business Phone Number: Plumber's Address (Stree City, State, Zip Code): fC_ STA'TG 1O , 25 fJ,~~r~ 1,. IX. C UNTY / DEPARTMENT USE ONL Permit Fee (includes Groundwater ate ssue Issuing Ag t S e) 5%Approved ❑ Owner Given InitiaSurcharge Fe ❑ Disapproved Feo~Z515/5~_ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 0' 5/94) DISTRIBUTION: Original to county, One copy To: Safety 8 Ruildings Divi ion, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a 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 and Buildings Division, 608-266-3815. 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 number(s) of where the system is to be installed. fl. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on 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 for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/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. VIII. 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 8 112 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 performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; 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 contamination investigations and establishment of standards. SAFETY AND BUILDINGS DIVISION 15837 USH 63 of Hayward, WI 54843 Nytisc Department of Commerce Tommy G. Thompson, Governor 26-Sep-97 William J. McCoshen, Secretary Pelke Plbg Herb Pelke N6298 State Hwy 25 Durand WI 54736 Roy Crawley Plan ID 9710406 NE,NE,35,28,15W Municipality of Cady Inspector: Leroy G. Jansky County of St Croix (715) 726-2544 Private Sewage plans including the following element(s): MOUND 450 gpd 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(2)(e), Wisconsin Statutes, is responsible for compliance with all code requirements. This plan action is subject to no additional conditions. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department. All permits required by the state or local municipality shall be obtained prior to commencement of construction/installation/operation. This project is under the supervision of a state inspector. As inspection concerns arise feel free to contact the state inspector at, the number listed. The inspector for this project is listed above. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Please refer to Plan ID number listed at the top of -this page when making an inquiry or submitting additional information. Sincerely, cam) F Carl Lippert Wastewater Specialist (715) 634-3484 4 ni • Page.L aft PRIVATE SEWAGE SYSTEM MEX AND TITLE SHEET Property Owner(s): ProjectName: Koy C~•vc✓~e*y sp7; - Project Location: J1197 Sr . / r 19 Strout Addross 4 AAC S ,?8 os ' tson O of ounarMsmicapatity / _ _ J 3-' ~/leir Cow Contents: Page 1: ~~x v~ rir S.~E~ r Page Z: l 'd o 7" !~"L.r.✓ Page 3: L/lo.rs .~EaTio•✓ of /%~.✓D Page 4: l/~E.~/ /rift Gib r/'A•/L L.oYe4 Page S: .~~ATic I. i1.✓~~~~i~ ~.O~Dtc G/ldrs - .~Ec 7'ie.! Page 6: /''Uivo ~,r,~ e,y,.✓~' ~~d~ Page 7: 17 Name: Sighed: ` P.O.W.T.S. Credential Nubber: /1!l `.?.?7 Date: - Address: on t Iona _ y u r ~5-"Y7.~G Phone Number: >X-s- .7.z - RCE DI N OF SAFETY ND BUILDINGS SEE C R SPONDENCE S97w211 '5 ~ 320 ~ 97 3 9or I N G = /SAe-ewoze Pirf PA'I AnA,TT of X7 /f6Ar .4~RIIL LAS Ali Lo.~.N, 83,io trr,Q" wd4NtA0 ~irc t~.c ~ ~ Q Pjlo,~t - t.~! T.t✓ne ~ AOf ~X/Si'/✓G .j-,~t. /yOTE: EK/ST/✓L L-A~Kf ,t6A ~Ilpl~tS mss: Yo .QE G'.~r,~Bso~ A~A../OOr~D 1AA14 ~`oAOI~s Fictt4 A s /00 Tod y ~i~oG of '~6'dt G./P ~ yl .QO'Ley L.e.N RFt~a le' .e4rf4Akre Ay AVIV SNEG El /ooo Leo • SNEp s~~~~"'~ co '-raK `Auk 00% fArA fiEci ,ce,eo S y 7S' ll.c.r ,6E0 ay'X Ae 9 043. f~-`" y sq s`3 Corfnally AP pR®V~~ DEPARTMENT OF COMMER IP14y f,E~Q *DIONOFSAFEI AND BUIL NGS L CO SPONDE TY o ~ a ro V11 W ch a o ~ L n~ 03 ~o 00 co 0 0 rr x M 0 1 c' .f I cr*. RO W.T.S. Conditr.onally APPROVED DEPARTMENT OF COMMERCE DIV N OF SAFET AND BUILDINGS SEE CO ESPONDENCE o I~ k b oro H :z r C4 H bd ro w w w ~ rt N h IcjD W rt I ~ ~ 1 old • n rr , ~ a . y w -r b ~ k a yJ w of \ w ~ I \ N , I'd ti. I N p r• I td r+ , rn I ~ o la. ti- y ftl 0 CT ti IL 0 ~ a a ? w a~ I a txj 0 K I ^ ~d ~n r• I n k n b J I z , k C \ ti n 03 ' i y I I t J~ w0t v w ~ k O I (D H (D x o0 p,01 K ~ C t-I y w n L to 9 o p rt 0 ~d ate' (D 0 r D :j .b ,b• N ti m ( n a s a (o X m K a \ r x w ~ w w cew r-+ b (D 0 T M z (D rr :j 0 jai ry 31 1 w h x a APPROVED ro ~ ai DEPARTMENT OF COMMER bye DIV N OF SAFETY NO BUILDINGS n U SEE COR PONDENCE 02, Page S Of~_ SEPTIC TANK &'PUMP CHAMBER CROSS SECTION'AND SPECIFICATIONS o.t Scr• yo 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHERPROOF lo#* FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK & FINISHED GRADE 7 . WARNING LABEL .4" CI RISER y _Z._ 4 MIN* 18 IN. 6" MAX. INLET ~t WATER TIGHT SEALS GAS- TIGHT i \)APPROVED A SEAL 1 JOINTS WITH APPROVED i a ALM APPROVED PIPE PIPE 3' ON 3' ONTO ONTO SOLID SOLID SOIL C I SOIL PUMP OFF ELEV . 89.6 FT. OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD-- SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER : vfFau rr ,dc. NUMBER DOSES PER DAY : TANK SIZES: SEPTIC Ingo GAL. DOSE VOLUME INCLUDING ~s°•8+/.~ DOSE Loo GAL. FLOWBACK: d f GAL. ALARM MANUFACTURER: f ~iECrico_ CAPACITIES: A' INCHES = .?78 GAL. MODEL NUMBER: /o/ SWITCH TYPE: ilE•~c' 4Ar B = 2 INCHES = a?98 GAL. PUMP MANUFACTURER : n i rew C = 1L INCHES = AL. MODEL NUMBER : sA/ SWITCH TYPE: D 7 INCHES = 16-13 GAL. REQUIRED DISCHARGE RATE ".o8 GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . 154EET + 8o _ FEET FORCEMAIN X FT/100 FT. FRICTION FACTOR C0i r l ~ldtT T.OTAL DYNAMIC HEAD- F INTERNAL DIMENSIONS OF PUMP TANK: LENGTH. S/ ; WIDTH 74 DEPihR r Fn%%UJ V Lb ATBRMERCE-" LIQUID DEPTH ye? DIVI OF SAFETY ND BUILDINGS 0 SEE COR SPONDENCE Sump/EFFLUENT PUMPS - Features and Performance WS/DS25 WS25A1 • Completely submersible DSIWS25 - 114 HP - MAX. SOLIDS 112" - 3300 RPM automatic sump/effluent pump. 28 • Available with wide-angle "piggyback" float switch 24 (WS25A1) or diaphragm type "piggyback" switch (DS25A1). • Cast iron constuction with non- tu- 20 corroding ABS volute/base.. U.1 U_ I • 1/4 HP, 115V oil-filled motor. Z 16 with thermal overload °a protection. i 12 • Anti-clog thermoplastic X FULL LOAD Impeller. AMPS AT • Can be used without switch for 0 8 -.16,115V. portable dewatering pump. DS25A1 . 1 1/4" NPT discharge with adaptor included for 1 1/2" NPT 4 discharge. • 10' replaceable power cord. 0 • Weighs 14 lbs. 5 10 15 20 25 . 30 35 • UL listed sump pump. U.S. GALLONS PER MINUTE SW SD25 33 • For sump and effluent use. 28 SWISD25 - 114 HP - MAX. SOLIDS 1/2" - 1550 RPM • Automatic models available SW25/33 with wide-angle "piggyback" 24 float switch (SW models) or FULL LOAD AMPS AT diaphragm type switch (SD 20 so 115V. models). Also available in U. 16 manual models. • 1/4 HP (SW%SD25) or 1/3 HP :12 (SW/SD33), heavy-duty. 115V F oil-filled motor with thermal overload protection. • Rugged cast iron construction. 4 • Non-clog vortex impeller. • Long life lower ball bearing. ° 5 10 15 20 25 30 35 40 45 50 Sintered top sleeve bearing. U.S. GALLONS PER MINUTE • Carbon and ceramic mechanical shaft seal. SI'~-113 HP - MAX. SOLIDS 112" - 1550 RPM + 11/2"NPTdischarge. 26 • 10' replaceable power cord. (20' 24 SD25/33 optional). • UL listed sump pump. 20 W ? 16 0 FULL LOAD 12 AMPS AT r 10, 115V. O 10.0 F 8 4 05 10 15 20 25 30 35 40 45 50 4 U.S. GALLONS PER MINUTE Wisconsin bepartment of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page _L of -3 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 Y- Da percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location o Govt. Lot 4/-,c- 114yE 1/4,S 3,5' T .78 'N'R /S S(00 Property Owner's Mailing Address Lot # Block# Se M. Name or CSM# J~ 97 r. r. .z 9 City State Zip Code Phone Number ❑-6ih ~e ® Town Nearest Road All, ra _r o.27 ( 71S ) 772 -3546 r..T 9 f 3.u r l r. ❑ New Construction Use: ® Residential / Number of bedrooms_ Addition to existing building © Replacement ❑ Public or commercial - Describe: Code derived daily flow -SO gpd 2,V-11Fr. a Recommended design loading rate _-_W-bed, gpd/ft2~.~trench, gpd/ft2 Absorption area required s'7S bed, ft2 a7s' trench, ft2 Maximum design loading rate S~ bed, gpdfft2. . G trench, gpd/ft2 Recommended infiltration surface elevation(s) 9G. 1S. 9 Le.✓ roc/.a It (as referred to site plan benchmark) Additional design/site considerations Pjw *,'OY Fl'n'a EASY QLGrf r 6'o uP.raoN! SIDE 'iA Lilio 1011,10 Parent material Flood plain elevation, if applicable 41,4 It S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ S © U ®S El u ❑ S ® U El S ®U El S ® U ❑ S 21U 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 f o-i ors - / ,t S' Ground ,y o y - s/ s6 1" elev. 9~ 3 ft. -.r4 Ye oy t y 2 R a s~ -r ,F r - - Y ' Depth to limiting factor -zo Nin. Remarks: Soi4. S dd'sit4e.&4 1 w/ rN w/040-0 1'"110er .0y4rs Cf//7r/~A r .y" s' '00~' rs Boring # p / o Yet d L ~ ✓ v - S' , d~. p~ /pJ Q /.o YA e, 13 Ground l? o 4 ,T ,s Xf 101, elev. 9x6 ft. Depth to limiting factor 3 fin. Remarks: CST Name (Please Print) i Telephone No. Address / Date CST Number .503 .4i~r./•sY ~r: ~,~u Gi iD GI yam/ 8-.77-7 .?.T `~S7 PROPERTYOWNER floY C/lgtJLlY SOIL DESCRIPTION REPORT f 3 Page o? of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G~ptft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 / -/o o Y.t ✓ Z O-l Ort 3 S/ v -s V S; Ground elev. -3 e .c y - . / a` S .7 5 Depth to limiting factor in. Remarks: Boring # f , Ground elev. ft. ; Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor ' in. Remarks: SBD-8330 (R. 07/96) 3 0 cn n ro ro ~o, 3 of 3 T H ~cn~ o o' ~ /u ~ C n H H / yo . ~ z r z o .70' yD ~n O .agC.C/Ioad Pars .40 44 r of 37'` ~Gn! ~AAClL p y Cr1 Q.H ~'/OOH tio/ oI Xa 6A.I0! savors Z ils'ac LAP T7f Ets (1 . O ° ~o 3/s~ Op ~ ~LL• GeNN 83. /O L . /~FyL//RErllnl7s ~/A r' t ``1 * V V ~ n IANd EL Ec rR~c~a ~ ~ R ovoak~A® y ~ QUMd~ 1 b 4A ro vc i ~N.•r~f r 0 H A4" of t Ejvrr..+~ 3 ,ck. /f/oFE: ,1 Pirs w/R! `AAA ~`bp~ A/6 r /~/s` ,ONE /nl D'n41 NAY F/66.0 ~ S ~Sf G°A 06vdAt1.16 rorr4oo So~~t `fi/J fi nl /rin'roi.r rl~Y .flfoo.✓ r'.+~r ~~SfN !.~/Y /oo ToP of x'P,s,. \ LAYl~L llE'LL cAP P 001..' ,T o Sift ° 4 I~Al 0 0 farts ,pop iaa s!A~D wl~ d cAT7l~lp ~AAOM 0 s~E AnrA f/FGrO ~oAO r] 3 . yy Awy `/ELD F- Q~ > m1?p0 W 'ELI E FU.IMBII-43 F- _ _ This application form is to bt>_ complete^d in full and signed by the. owner(:;) of the property being developed. Any inadequacies wi. 1 only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. owner of property-L0t- IJ---P. 011441e-V rIe- /tf ' orzz~ l -e(, Location of property 1/4 14, Section 3-5 ~p / , T ~L1--N-R ~S W Township C a_~ Mailing address,3 Address of site7-!Lw~_-~i_(.5m~ (uZ subdivision name Lot no. Other homes on property? _ -Yes No Previous owner of property G-i~ ~'~YL p L , Klt /V E_~ Total size of property ~/1®(~'!/~fLYG'CIfS _ Total size of parcel Date parcel. was created _ Are all corners and lot lines identifiable? X _Yes No Is this property being developed for (spec house) ? Yes ~ No Volume H- 011 and Page Number 4-30 as recorded with the Register of Deeds_ INCLUDE WITH THIS APPLICATION THE VOLL40WING: A WAP.R"TY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a cer_t.ified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a certified Survey Map, the Certified Survey Map shall also be r, ecpair?d . PROPERTY OWNER CERTIFICATION I we certify that all statements on this form are true to the best of my knowledge that I & am (4j the own of the property described in this information form, by virtue of a warranty deed recorded in th Office of the County Register of Deeds as Document No.(~~ and that I d(S~presently own the proposed site for the sewage disposal system or z (we) obtained an easement, to run the above described property, for the construction of said system, and the same.has been duly recorded in the office of the County Register of Deeds as Document No. *ature of Ap icant Co- pplicant Date of Signature Date of Signature F'ELI':E PLIJh1EIIII-~ F.1.::.::: 15-672-5 245,7 Sep ± ''_i7 U F. 1-12 STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O'WNER/13 Y ER L-5,,q 41 0) MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE: PROPERTY LOCATION _ I_i~- 1/4, L 1/4, Section T-JZ_N-R ' S W TOWN OF ST. CROLX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as s treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of. 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 St. Croix zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal System is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than. 1 /3 full of sludge and scum. 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 stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expirati date. ~i SIGNED: DATE.' 7=~~~~ St. Croix County Zoning ntTice Government Center 1101 G>; mlehael Road Eludson, WI 54016 11/93 •J ! • C STATE BAR OF WISCOtiSiNi FORM I 5~f'72V WARRANTY DEED KICIE ' DOCUMENT NO VOL Fj ol;X i, y W Gerald Karnes a/12 1v9L This Ueed, m he:ween Gerald _L Karnes, a _single person- 9:30 A.M. _ . Carrnc~:r. _ and Roy B.. Crawley and Catherine M Craw y. ___husband. and wife as survivorship marita! - property.. _ THIS SPACE PE SERVED FOR HE.C✓a DING OA-A Witnesseth, That :he said Grantor, for a valuable cce.~.Sera.EOa NAME ANO HErUHN AooaESi conveys to Grantee the following deu.ibed real estate in Croix-, Richardson Law Office County, State of Vo+xonsin: P.O. Bob( 399 Spring Valley, WI 54767 The Northeast Quarter of the Northeast Quarter (NEk of NE}) of Section Thirty-five (35), TownsMp Twenty-eight (28) North, Range 004-10E5-10;004-1085-20 - - Fifteen (15) West, EXCEPT land awarded to (Parcel Identification Number) the State of Wisconsin in Volume 535, page 443, as document number 332286. s TRA This ____is -not--- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtc-ces ttcrc-"o belonging; And _-Grantor__ warrants that the title is good, indefeasible in fee ample and fret and dear +4 enc-tsbrances except all easements, restrictions and rights of way of record. and will warrant and defend he same. 19 96 Dated this (SEAL1 (SF AI ~CiYll - G;erald _L.-"rne5__ - I SE Al-) AUTHENTICATION ACKNOWLEDGMENT S7.;TE OF WISCONSIN Signature(s) --Gerald L.-_Karne, ~S. - County. day o i 96 /~,onally came before me this authentic d thi- d of 19 _ 19 the abo a named - - n(f ardsrn_ - - - / - - - - - TITLE: MEMBER STATE BAR OF WISCONSIN - - (If not, - an an: Yra )w n to be the person who evecuteo the authorized by §706.06 Wis. Stzts.) tfc instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY , ,