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VOL PAGE 5241
REGISTER H. DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
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BEARINGS ARE REFERENCED TO THE NORTH LINE OF
° 1 a a THE NE 1 /4 OF SECTION 13, TOWNSHIP 31 N., RANGE
1D 16 W. WH:CH IS ASSUMED TO BEAR N89'30'02"E.
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1 oi2 Vol 21 Page 5241
Parcel 006-1027-10-050 02/23/2007 10:31
PAGE 1 OF 1
F 1
Alt. Parcel 13.31.16.182A-20 006 - TOWN OF CYLON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
07/14/2006 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - SOLBERG, ERIC W & KRISTIE K
ERIC W & KRISTIE K SOLBERG
2192 HWY 63
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 2192 HWY 63
SC 1127 CLEAR LAKE
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 9.600 Plat: 5241-CSM 21-5241 006-06
SEC 13 T31N R1 6W PT NE NE CSM 21-5241 Block/Condo Bldg: LOT 02
LOT 2 (9.6 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
13-31N-16W NE NE
Notes: Parcel History:
Date Doc # Vol/Page Type
07/14/2006 829671 21/5241 CSM
07/23/1997 1186/431 WD
07/23/1997 1141/271 LC
07/23/1997 950/550
2007 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 09/14/2006
Description Class Acres Land Improve Total State Reason
Totals for 2007:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner
Address h("-;O" 6 .
City/State C IrA k .tL-,E W,2 ,
Legal Description:
Lot Block Subdivision/CSM #
14 NE 14.E9 Sec. tj-, T-ILN-R-W, Town of G PIN #
SEPTIC TANK - DOSE CHAMBER HOLDING TANK INFO TION:
Tank manufacturer Size ST/PC Joz~Q/k) Setback from: House aZWell,EZ P/L
Pump manufacturer _ Model Fa
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: Width 8 Length Number of Trenches
Setback from: House /D) Well 11 P/L Vent to fresh air intake
ELEVATIONS:
Description of benchmark a ,E ~~-~-~L.. Elevation
Description of alternate benchmark Elevation
Building Sewer ST/HT Inlet 7, 25- ST Outlet o~..s PC Inlet 2S /
PC Bottom Header/Manifold S/ / Top of ST/PC Manhole Cover
Distribution Lines ' ( }
Bottom of System { ) .S; { ) ( }
Final Grade { } ( } ( }
Date of insta[tation 8 I WI Permit number s~ State plan number to a d 7,57/
Plumber's signature at~.x t~ License number I . 7yS"~ Date / I
Inspector
U Complete plot plan or
r
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 covei~a, v;} f
• Show alternate benchmark, if applicable.
PLAN VIEW
Iv
1
1
INDICATE NORTH ARROW
N_
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the sysitem.
D/ o
• Two horizontal reference points to center of septic tank manholie .cbveh,, ~ T,k ~G
Qc~/cF
• Show alternate benchmark, if applicable.
q ~i5~
PLAN VIEW
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INDICATE NORTH ARROW
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
aty nd Human Relations
Safety and Buildings Division INSPECTION REPORT ST. CROIX
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 299014
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
SOLBERG, ERIC CYLON
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
006-1027-10-000
TANK INFORMATION ELEVATION DATA A9700332
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 1(j, yS IDIj o
4,1
c I
Dosing D
Aeration ✓ Bldg. Sewer
Holding St/Ht Inlet -y5 ja S'
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Air
Septic 7 NA Dt Bottom 11,7 g~ 7
Dosing '5-7, 3 NA Header/Man.
Aeration NA Dist. Pipe
Holding Bot. System 5_ql Gz./,
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer ^ Demand
Model Number ld'; GPM
ra ( System 1. _ TDH Q Ft
TDH Lift 5,_o F
Loss riction
Head
FForcemain I I Length / Dia. Dist. To Well r
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION TypeO CHAMBER Moe Number:
System: A 6 , /0 7 ~2 v /U OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
r.
Length Dia. Length Dia. Spacing 14
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
PB epth Over Depth Over xx Depth Of xx Seed /Sedded- I xx Mulched
e d /Trench Center Bed /Trench Edges Topsoil 6 ~ EkYes ❑ No O Yes ❑ No
I
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: CYLON 13.31.16.182A,NE,NE 2192 HWY 63
GG /f,; ~7Gt} 6/ /
LL
of J , _Yh ( f
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's signature Cert No.
ADDITIONAL COMMENTS AND SKETCH r
SANITARY PERMIT NUMBER:
Aa .i
N*6consin SANITARY PERMIT APPLICATION 01 E w shnilgtonAve sion
P.O. Box 7969
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. !A I X
• See reverse side for instructions for completing this application State Sanittary_Peer mit plumber
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 INF RMATION 5cl - )D-151
Property Owner Name ujPrroperty Location
r 10 1 r E/4 E 114, S 3 T N, R (Or)/
Property Owner's Mailing ddr Lot Number Block Number
Qty, State Zip Code Phone Number Subdivision Name or CSM Number
W(Lk 5`4W5
II. TYPE F B I DING: (check one) ❑ State Owned !ty Nearest Road
3 Village CL~ /0
Public 1 or 2 Family Dwelling - No. of bedrooms Town OF
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Nu/,mber(
1 ❑ Apartment/ Condo ~~Q 10 2"_7 ^ ) D
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. ❑ 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 21Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12E] Seepage Trench 22-[:] In-Ground Pressure 42 ❑ Pit Privy
13E] Seepage Pit 43E] Vault Privy
14E] 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
/~D Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) _ Elevation
Feet Feet
VII. TANK Capacity gallons Total # Of r Prefab. Site Fiber- Exper
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Exist in structed
Tanks Tanks 0. Eft -
Septic Tank or Holding Tank Jle)A - ❑ ❑ ❑ ❑ ❑
- ni .600 -
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑
Vill. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum 's Signatur : (No Stamp P PRSW No.: Business Phone Number:
d
Plumber's A ess (St t, City, State, Zip Code):
P b • x 22
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sytary Permit Fee (includes Groundwater ate ssue Issuing Agent Signature (No Stamps)
(CAD ~
Approved ❑ Owner Given Initial Surcharge Fee)
L
Adverse Determination -el
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
880-6398 (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
t
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, 608-266-3151.
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.
II. 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 1/2x 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.
GROUNDWATEIR 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.
•Oc-31-00 03:09P P.Ol
Private Sewage System Plan Index/Checklist
All plan sets should be legible and pcmanent copies, organized into sa4, by an index sheet such as this sample. No other bounds staples and covered
paw
set is signed Your cooperation expedites your plan review need and signed shortens as plan long en n thetun83 tryindex sheet for each
e.
IMan r
Le~at Desonptton • C 10ty Ell u~ 1 1' N Q/ (o E 0- p S! . L
~-Ifox CO
CYLON Croy
moos
Contcnb Cowmen
j~eC1>t<1 d1t1'OCttODs
Pate s included Two copies amded for all
plans
I Plot Platt
2 Plan View/Lateral Return by Mail
3 Cross Section
4 Tank & Pump/
Siphon Information 0 Fax to (County) (Subtnitter)
Circle One and Provide Fax ( )
System siz;n (Public)
6 [D Gall for Pick-UP: ( )
7
Q Other
i, the undersigned, hereby certify that the Seal (if applicable)
plans and specifications submitted
herewith were prepared under my
dir ction and control.
~~it,'~ Liistrtetos► r
tom' LL a.rCJ MP-11456
Address City stun
~.o. ('~x ~a 1 ~1f►~t''~ (A?Z
Sittsa0nt
Attach PRIVA~Q9lWAGW36YSTEM
Soil a site evaluation
Ate`""'°n Conditionally
Fee
Needed for NnWiag Took Submittal: APPROVED
one cc" of nolarumd holding sank
apeement. (Originals to County) DEPT. of inu=TIIY, LAW i NVMMi MAMW
Needed for At-Grade Submittal: DIVISION OF SAFETY AM
OrWoal signed and notarized
ApOiration lot "Use of as At-
Grade"
SEE COR S NDENCE
County ov-site
One additiaa ul set of plans SOD-10264 (N.01M)
AUG 1 2196
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PUMP CHAMBER CROSS SECTION AN10 s~ECIFICATIOI►I, 0,f~ e
2 u iv,
VCWT CAP
i C.Z. VENT PIPC WEATHER PROOF APPROVED LOCKING
- . F JUNCTION BOX lKAMMOLC COVER
LSD FROM ODOR, ' ~(C
wIWDOW OR FRESH IL MIU. I
AIR IWTAKC I ~vl
GRADE i y' MIIJ.
pow 10
IR'Mlu.
CONDUIT-,/
•11'KOVIDE I
IIJ .E T AIRTIGHT SEAL
7 I I v
APPROVED JOIIJ
APPROVED JOINT A I III APC.I. PIPE
w/C.z. PIPE r ,r P e O I III ExTEUDIUG 3'
EXTENDING 3' J~-LC ( II Al/1RM ONTO SOLID 60
OIJTO 601.10 &O1 L B I i
i I ON
~ I I
sr T LLEV. _QQ~~: L`SFT. PUMP- __J
orf
o CONCRETE BLOCK
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APPA
RISER EXIT PERMITTED ONLY IF TANK MAWLIFACTUitCR HAS SUCH APPROVAL. ggppl~
5 PECIFICAT10kis
SEPTIC E mmxm~
-
DOSE NUMBER Of DOSES: --PER OAS
TAWK MANUFACTURER:
TAWK 51ZE : 600 400 o GALLONS DOSE VOLUME GALLON
/ ZdAl INCLUDING 6ACKFLOW:1
ALARM MAIJUFACTUR[R: L DL y']/ ~~~~j, t/
MODEL NUMBER: LI/ CAPACITIES: Aa~l¢~.0.1._IWCHES UR GALLCU;
SWITCH TUPE: da - -HJCHCS ORa '641 GALLOW
C. -IUCHES OR L2317F W►LLOU
PUMP /KAWUFACTURER: ~y gy
MODEL NUMBER: 0- - IMCHES OR GALLOW
SWITCH TYPE: -MOT' PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RAT 3~GPM NSTAlLEO ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWECN PUMP OFF ANO OISTRIBUTIOM PI E.. FEET
+ MINIMUM NETWORK SUPPLY PRE3 SURE . . . . . . . 2-5 FLET
20 FEET OF FORCE MAIN X If* fyortFRICTION FACTOR- FEET
TOTAL DYNAMIC. HEAD FEET
INTERNAL. DIMENSIONL OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH
91GNE 0: L.ICEWSE WUMDEK: DATE:
S96-20751
gobw
OW f.Ea P. Or"
. ~ P~6E L~ OF 6
HEAD CAPACITY CURVE 3 7/8 6 1/4 -
MODEL "98"
30 4 s/e
•
8 9
25 3 5/8
6 20 } +
O
z 4 3/16
is-
4- pip
to
1 1/2-11 1/2 NPT
2
5-
0 isa-as as
J.S. GALLONS 10 20 30 40 50 60 70 80
fTERS
so 160 240
0 FLOW PER MINUTE
TOTAL DYNAMIC NEADIFIAW PER NORM
EFFLUENT AND DEWATEieNG
CAPACITY 12
HEAD UufTSAMlm
FEET METERS GALS LTRS
5 1.52 72 273 -T
10 3.05 61 231 T
15 4.57 45 170 3 5/16
20 6.10 25 95
Lock VaWe 23'
CONSULT FACTORY FOR SPECIAL APPLICATIONS
Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and
supplied with an alarm. three phase systems.
Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for
without alarm switches. variable level long cycle controls.
SELECTION GUIDE
1. Integral float operated 2 pole mechanical switch, no external control required.
Standard all models - Weight 39 lbs. - 1/2 H.P. 2 Single piggyback mercury float switch or double piggyback mercury, float
98 Series Control selection switch. Refer to FMO477.
Model Volts-Ph Mode Am simplex Duplext 3. Mechanical alternator 10-0072 or 104)075.
M98 115 1 Auto 9.0 1 or 1 & 7 - 4. See FM0712. for correct model of Electrical Alternator. "E-Pak".
N98 115 1 Non 9.0 2 or A 6 3 or 4 91, 5 5. Mercury sensor float switch 704725 used as a control activator, specify
098 230 1 Auto 4.5 1 or i & 7 - duplex (3) or (4) float system.
8. Four (4) hob ••J-Pak'•, junction box. for watertight connection or wired-in Sim-
E98 230 1 Non 4.5 2 or 2 6 6 3 or 4 6 5 piex or duplex operation, 10-0002-
7. Two (2) hob "J-Pak". for watertight connection or splice.
CAUTION
4 information on additlorW Zoeller Products rota to catalog on Combination Startar, FM0514; AN installation of controls. Protection devices and wiring should be done by a quali-
:apyback Mercury %vitchas. FM0477; Electrical Allertabr, FMO486: Medtartic it AMrmOor, tied licensed electrician. All electrical and safety codes should be followed includ-
40495; Alarm Package, FM0513; Sumprkwage Basins, FM0467; and Simplex Control SM Ing the most recent National Electric Cods (NEC) and the Occupational Safety and
A0732. Health Act (OSHA).
. RESERVE POWERED DESIGN S96-20751
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
A/AfL TO. P.O. f= 191347
Z
Lm inft XY 402W 4W Manufacturers of .
Z jt'M f spar tLoTO: 3260 dW ref KY 40216 ~.fe. VAAW fAInr /.9.7.9
779-2731 • 1 (MM 928-Ptrfi4P
Department of lnckrtry, SOIL A N D' S IT E EVALUATION REPORT Page Of :sir HumP►s Relations
4~n otSafev a Buir*9S In accord with ILHR 83.05, Wis. Adm. Code
COUNTY
ach complote site plan on paper not less than 8 1/2x 1I inches in size, Plan must include, but
4 limited to yordcal,ank1 horizontal reference point j8M); direction and % of slope, scale or PARCEL I.D. # _
LSO(
nensloned, north arrow, and location and distance to.nearest road. le 07 IV
- ~REVIEWED BY DATEa
tPLICANT INFORMATION-PLEASE PRINT,ALL INFORMATION
ROPERTY OWNER PROPERTY LOCATION
C GOVT. OT No 114 X)I' 1/0 10 T 3 f _~R Ft ~(e~,w
RGPERTY.OWNI'sR' MAILING ADDRESS A LO'f # BLOCK # SUED. NAME OR CSM #
6107":D~sK ST. Q 0 Avx 933 V/A N/X _ y
TY, STA7E 21P CODE PHONE NUMBER []CITY []VILLAGE EJfOWN NEAREST ROAD ,
Clete' I~kx. o~S (7a) 943 - 87
J New Comtruction : ,Use [Yl Residential / Number of bedrooms Addition to existing building
J Replacement (J Public or commercial describe _ _
ode derived day how_ gpd Recommended design loading rate '.✓lr bed, gpolft ^ e trench. gpolft`
.trzorption area required bed, 1112 trench, ft2 Maximum design loading rate N1,,f bed, gpd/It2L/ _trench, gpdIR2
,
ec*mrwded infiltration surface elevation(s) _f&"dlos'.~.. tGRIt (as referred to site plan benchmark) f
ldition8l design /site tAnslderndats~,e4 t '01 st 2&-Y
arent material QcZiA 7-gyje Flood plain elevation, if applicable It
Suitable fix system CONVENTIONAL MOUND IN-GROUND PREssURE AT•GRADC SYSTEM IN PILL HOLDING TANK
a Unsuitable, to CIS M U RI S❑ U [IS ®U ❑ S Q U Q S 0 U ❑ S ® U
SOIL DESCRIPTION REPORT
epth Dominant Color Mottles Structure GPD/rt
Ig # Hertz in. Munsell Qu. Sz. Copt Color Texture Gr. Sz. Sh. Corsistence Boundary Ronts BedJiTTr'd, -7 rf
CZd
.nd
It J - -T
Ig
Remarks•
,
fff
.R yf --10 sl zC~ sdK Aft'
W14 W
id % 491401, S/
AJ AtC3d w/S lyd - -11.
,g
I.& ±12-11
•r
Remarks:
Nacre:---Pia#sePlinf Phone:
,
,'reps: - i~zM.~ •~re ,nr, ~.f•~i-~ ,.~v, ~.3"f~~•Q
` Date~
AP "'L4
• f ~ fir`' 'd;~..:.
~ (,~bt..t:. .4.'Vo , u..s.r,..r.ar..+..aM-+►'r...rna.w.. b
k;;~. SleR4 SOIL DESCRIPTION REPORT Pao
F r,. + J Sn t,
nng "Horizon Depth Dominant Color Motues Texture Structure BAY Roots GPD
? Consistence
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed (Txy& LL 3
1 oro o sx ~r w .S
y /a=as y~ o S ~i/aft e~
s
i.N, CAA77
GroundA gat3 :y y , y l64 a6/C X14
Depth t0 14
firniting
factor \~r r• ,
'ReM sa
GrouW,
elev.
It
Depth to
actor.
--17
Remarks:
Borind # i
i
Grouts '
elev.
fti f
Depth to
ftiiing
facto i
Remark;;:
k
Y
Ground
elev.
Depth b .1~
limiting
%
Re:
# WOO w4d + R~~ Fes-.
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Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of :3
` - Labor and Human Relations
Division of Safety & Buildings in accprd..w...ith ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 112 x 11 inches i'asizp. Plan must include, but
not limited to vertical and horizontal refereAce, point (BM), direction and"%I f slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nsaies4toad. b OG~(e -1eX7-10
APPLICANT INFORMATION-PLEA'$E'PRINT A,LL INFQR1NATi'-#~ REVIEWED BY DATE
PROPERTY OWNER: t r` PROPERTY LOCATION
i e .So e R # GOVT. LOT ^/E 1/4 1/4,S 13 T 3 ~ N,R r(w) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
a1o? 04K ST , o Box 333..
CITY, STATE ZIP CODE '-PHONE NIJM(3 ❑CITY 0VILLAGE KJiOWN fit REST ROAD
Cl e- L4K~ w ` o dS /87 Cyj-oAl 6 3 "
PC] New Construction Use [X] Residential / Number of bedrooms [ ] Addition to existing building
I ] Replacement [ ] Public or commercial describe
Code derived daily flow .lo gpd Recommended design loading rate _ A40 bed, gpd/ft2 t)/ trench, gpd/ft2
Absorption area required *04 bed, ft2 VIA trench, ft2 Maximum design loading rate N/l/ bed, gpd/0&Z trench, gpd/ft2
Recommended infiltration surface elevation(s) 9~! o ft (as referred to site plan benchmark)
r
Additional design/ site considerations O #AP Mffl,,A13 c I .So. %s 6eAdi- opus ' STAY ";v
Parent material &c,: jL T;G.L. Flood plain elevation, if applicable ,✓14 ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ❑ S ®U ®S ❑ U ❑ S ®U ❑ S ®U ❑ S W U ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
c w
/o- Z6f)S1,r( Mv{'l-, e~ 2Sy' .C
Ground la-so syx y~ C 6~ 4 /6 4Ae MA, - N/A WIA
elev.
3, o ft.
Depth to
limiting
factor „
Remarks:
Boring # 2" Af
7 ,q y/ -o-- sl z.(~,) sdK ',rvF2 e w . G
Ground
elev. ft. Jr3 $ Y/(. C3d A N/A
Depth to
limiting
factor
Remarks:
CST Name:-Please Print Phone: C71,111~ 8-53/8
Address:
Signature: Date: CST Number:
dt®rr.,,c e;a,✓ A9 YS- v-o 7
I- Ay
PROPERTYOWNER So11~rKa SOIL DESCRIPTION REPORT Page Z a
PARCEL I.D. K BOG - /O~ /O
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
/0 y~ - o - S K MVO' r w . S , G
Ground I ✓l ~i SC / 6ti0a4k m c,' v ///4 A1.4
elev.
D ft.
Depth to
limiting
factor ~ II
Remarks:
Boring #
}\vtyyty '::'v
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
f
4r'4
F?V `
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
of
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
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STC - loo
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
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 property4!:-21e- A) a.-,d
Location of property_,tfZ__1/4_" 1/4, Section ~ ,T_,3LN-R w
Township_ Mailing address
Address of site a / c 7a
ff/,c(
Subdivision name Lot no.
Other homes on property? Yes No A
Previous owner of property 4j,/1 as /e
Total size of property 76 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)? X Yes No
Volume t_ and Page Number L7.:iL as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified 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 required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. 400-2!267:
0-2!2 S , and that I (we) presently
own the proposed site for the sewage disposal system or I (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.
ignature of Applicant Co-Applicant
Dat of . ianaturP na+ o .,f c;
r.
STC- 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
O WNER/I3 UYER L (.l a.z r.~ ►''s `St•'~. ~O l~ e.- 4
MAILING ADDRESS t1--96 &%,r ~ 3 G~~ L.✓~ `~GIOS'
PROPERTY ADDRESS a l9~~
(location of septic system) Please Obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION iV,_ NE' 1/4, Section T N-R_ _W
TOWN OF C V6dyt ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME 6, PAGE 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 a 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.
UNkle, 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 expiration date.
SIGNCD: 45t~~~
DATE: rz
o - -
St. Croix County Zoning Office
Government Center
1101 Cann ichacl lWad
Hudson, \\'I 54016 1
T
s
DOCUMENT NO. S T 4TE BAR Of- WISCONSIN - FORM 2
WARRANTY DEED
545930 I-,P'kCE AESE~VED F^R RECORDING DATA
- -
i REC GTcn G- riCE
William J. Ar:;dt a/k%.a WI11isr, '
- ST. CROIX CTY•, WI
A n ci _2 h e r pc P _Z2.-~r.IlLI Poe" 1~r Feoc•~
JUN 2 6 96
conveys and warrants to F _Q_W So 1 br r !j _
Kr i S i 5b nd and . At 9:30 A. M
.
- - - - . tJAk
- Ruyis:erofDsels
RETURN TO
the following described real estate in STROI X County, i
State of Wisconsin: I _
oc_d_w Lt:- qyC1-
Lf
Tax Key No.
The North One-Half (NIJ of the one-quarter (NE;) of
Section 13-31-16, EXCEPT Lot 1 Surrey Map filed
? December 15, 1986 in Volume "6", =756, Doc. No. 420295.
N
C
i
This deed is in satisfaction of contract dated May 26, 1995
recorded September 25, 1995, Vol--:-;-.e ..Yl, Page 271, Document No. 420295.
I
a
a
This is not homestead property.
(is) (is not)
Exception to warranties:
i
Dated this 21St day of -__June-, ,9
(SEAL)~.~ (SEAL)
-William J' Arndt a/k/a erese M. rndt
William J. Arndt, Jr.
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGEMENT
Signatures authenticated this Jay of S-A r CW WISCONSIN
19 ss.
_r o i x _ county.
21st
}x~ 7-a y came before me, this day of
91
- - e- t9
TITLE: MEMBER STATE BAR OF WISCONSIN
the above named _
(If not,
authorized by 6706.06,Wis. Stats.) __Arndt-a,lk/-a__William J.
- Jr. & Therese M. Arndt
This instrument was drafted by 0OM46w4
__D.OAR* DR1LL_AND SKOW _ + O
- ' - - -
- c-&a^ b~tTi rs4 JA _V_ who executed the foregoi% in-
s^_L. n _Q d,he same.