Loading...
HomeMy WebLinkAbout020-1321-80-000 ° o °o 4. p 6 O a y N ~ I I co CL O N Y U O O III O U Z a) O o Z z - -2e LL C R U- O Q c Z Q I M co z E E rn z c v £ ° z ~ ' m m I a m m ~n d F z c c C7 v I ° z d c w d 2 a C c CC: Z fn F ~ O N E '2 C of d a M N N C a) O • IV d t ~ N p -C 00 Q 0 Q - N it z~-z ~ =Z z I I ~ ~ E Y m ~ Y N - R N 0. Cc CL m Q) 0 CD W N` R G O a 0- (DI .0 d 0N N 0 C 0 0) -0 ca N fn tl1 E C) !n fn N E N .v H H H v • N c7 co H H H U.)_ a a a a a a n o w a o ai tq N V) J U N rn ° 0) a) N _ f 0 C) Co O O O O N W d m d Q z u? T a d Q~ UJ~ m 'D - p d c C7 d R _ fD 7 U) co O 7 O I C N C y O O li ! M_ O C 'O C O RZ O M O U O c I m N C y 40> d p O LO 3 Q co E .2 ) C,) S O p r~ La co Sri O N U Cl) of m `t `a) FL- a m N o I- ° C) E CC) "0 0 L6 00 _ N O N Z Z N O - Z (A • iii y' O - d (D a ~*k all, La T Lam CL Z 4) 0) r STC - 104 AS BUILT SANITARY SYSTEM REPORT X31'. )i+ii OWNER DON M6R Q y 61" , ADDRESS (o t 3 CX-4 'c -f RG+AD ,r, NuD5o11~+' WP , ~ yard R • P ".S(3 pTVIS1ON f CSM# 644&r,E t/ALCEf' LOT,. n SECTION IC T27 N-R /9 W, Town of 11W4-1,0 4S4o IV -'r-ST. CROIX COUNTY, WISCONSIN , SHOW PLAN VIEW EVERYTHING WITHIN 100 FEET OF'SYSTEM r i E ' w r~ ILI^ c ~ S'Z l' A R T ~C' r -10 0 I14DI CATE VORTH ARROW Provide setback and elevation information on revere;( of this form. f Provide 2 dimensions to center of septic tanl-. r;i,)nhole cover. At BENCHMARK: ToP of I••~Ron Nw G~K crt?NE 2 / v /coca r.± y ~7 ALTERNATE BM: ~FGyrL EPTIC` TANK /'"PUMP CHAMBER HOLDING TANK INFORMATION Manufacturer: WE 15 C,x.. Liquid Capacity: (pc C E,11L Setback from: Well ioT' House 38 Other y0~ Pump: Manufacturer 2OF i- L EIZ Modell 99 Size 1/Z ~ D Float seperation Gallons/cycle: Alarm? LocationAM-2A Z-C L 7 U V L~ . (j SOIL ABSORPTION SYSTEM Width: d .5 Length 170' Number of trenches - Distance "i' Direction to nearest prop, line: re lya,grH eeT" 'LiNe Setback from: well : S a House Other ELEVATIONS Building Sewer - ST Inlet. ST outlet PC inlet PC bottom- Pump Off `Hd'ader/Manifold Bottom of system_ t0,~ 44 1-f ~ ~ r i Existing ,Grade Final grade ;L,(00 lei DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: ti n"t 0C"> i INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division Sanitary Permit No.: GENERAL INFORMATION (ATTACH TO PERMIT) 289347 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: NERBY, DONALD HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax 0- /~o . cj' ~ 020-1321-80-000.. TANK INFORMATION ELEVATION DATA r7 TYPE MANUFACTURER CAPACITY STATION B5 HI FS ELEV. Benchmark Septic GU- `'i*f ~G1) Cif / GJvc; Dosing ~Gv f}(f U', iY~ O. 33 /dam r Aera Ion Bldg. Sewer Holdin St/ ' Inlet ~Jzr Yf ,J, Holding - TANK SETBACK INFORMATION St / I Outlet 9 3~~ 93 TANK TO P/L WELL BLDG. ventto ROAD Dt Inlet Air intake Septic y ' stj' YI NA Dt Bottom 51 Dosing ' >50" u ~ NA Header. i Aeration NA Dist. Pipe 97, 71 Q / Holding Bot. System PUMP / INFORMATION Final Grade 1 33 Manufacturer t: , Demand 'Xet _ ~~,r 5.55 9Z r r1 O v' `rn Model Number # / GPM g / TDH Lift g E Friction s System ,nl TDH /j,~gFt s~ ~J. car P'46 { 9X 7Loss Forcemain Length-V /j Dia. 02 " Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length- No. Of Trenches PIT No. Of Pits linside Dia. Liquid Depth DIMENSIONS 5 acturer. SYSTEM TO P / L BLDG WELL ~LAKE/STREAM L ~rer' SETBACK CH R Mode Number: INFORMATION Type O n R UNIT System: DISTRIBUTION SYSTEM ~7 5e 7/ Distribution Pipe(s) x Hole Size x Hole Spacin it Intake Header Length _LL Dia. Length Y7 Dia. A, Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gra ystems j Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Edges Topsoil ❑ Yes C] No ❑ Yes ❑ No Bed /Trench Center COMMENTS: (Include code discrepancies, per ons esent, etc) CZ 6~- LAT ON : HUDSON .1 . 2 9. 19W , NW , 613/ GRANGE ROAD LOT 8 ' ~ pig/ '-`a~:' ~ / t"`• _ I n revision required? E] Yes Use other side for additional information. Date Inspector's Signature Cert No. S-6710(R 05/91)4,, ~ ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: nom- r ~~2. E w o x 0 PC, m Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems ri'■L.■7R 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 ~Q l than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Nurtbe ~37 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)]- . a yl-P State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location D20 AL R. E K B CJ A /1( GU 1/4, S J S T~ N, R /9 E( W Pro pert Owner's Mailing Address Lot Number Block Number ~ 3y ~le>4u ~ ,eo City, State Zip Code sfVhone Number Subdivision Name or CSM Number 4 L) J so r SY0 ra (3*) l 3 N . LZ II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ city Nearest Road Town of V ~Se ~12A~ teE 20 W Public E] 1 or 2 Family Dwelling - No. of bedrooms 3 [:1 Village III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) is. /lo5f © 2-0 Z SO I- 1 ❑ Apartment/ Condo 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. lsfi 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 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 fin-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) Elevation, L` s S O 0 0 197-00 Feet / 0 0.0 Feet Co VII. TANK Capacity Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper INFORMATION Gallons Tanks Concrete glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank 000 x (.{)>E~SE~ ® ❑ ❑ ❑ n Lift Pump Tank /Siphon Chamber OoQ S r=~_ ❑ ❑ ❑ D VIII. RESPONSIBILITY STATEMENT [,the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. No.: Business Phone Number: 1IPRSW Plumber's Name: (Print) Plumber's Signature ( Stamp MPIIN Plumber's Address (Street, City, State, Zip Code): 6 d U P,1J jr- D!t 14b .oSo kJi s' IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved San t ry Permit Fee (Includes Groundwater ate Issue Issuing A nt Sign'a / Surcharge fee) y / pproved [:]Owner Given Initial /pr) 6021 (p/~7 ~ d5l Adverse Determination l0 C/ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SRD-6398 (R. 0b/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber i INSTRUCTIONS 1 A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be 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. 11. 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 (urve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data ona 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. sAAn 8s0T:~~ 613 s`7' <rt r-lV, z ?7,Cie 5e, ,ef ~fy =Av' iD I~ Fd W E 1 ~~1 N ice uJ6G~- fV ICU WE LL tai I ~ T J FI` f ~ ~ ~j'~!§C' 1 IppGa SAL yl i V x V~ \ b ~ 0 V~ ~ a lqz_ n~ 31 f Q r Page Of COMBINATION SEPTIC TANK/PUMP CHAMBER (No Scale) 4" CI Vent Pipe with .Approved Locking Manhole Cover Approved Cap, +25' With Warning Label Attached From Buildings ~ Weatherproof Approved _ Warning Label Junction Box Vent Cap 12" Minimum Final Grade 6" Mini um 4" Minimum 6" Maximum ' 4" C.I Quick . ' 18" Minimum } Insp. Pipe Disconnect I 1/4" Weep ' Hole Baffles n ' * i 4 A Alarm B On C i *APPROVED Off JOINTS WITH APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL 3" of Bedding Under Tank-/ Note: Pump and Alarm Are On Separate Circuits Number of Doses: Per Day Gallons Per Day/ of Doses :11 Z - S Gallons Volume of Backflow:....... + S Gallons Tank Manufacturer: LJJr S.E1, Total Dose Volume.........= A~Gallons Tank Size-Septic/Pump: 1~o Gallons Alarm Manufacturer: Z T E/r Model Number: Capacities: A1Y inches or ,'/Gallons Switch Type: ~ Q t., + B z-, inches or C -1,yiGal l ons Pump Manufacturer: `Z_oe LLER.• + C~~D inches of Gallons + D~y~i nches or_gE! t Gallons Model Number: q j, Minimum Discharge Rate: ^/p GPR Total inches or Gallons Vertical Difference Between Pump Off and Distribution Pipe:144 Feet Minimum Required Supply Pressure:....... Feet 140 Feet of Force Main x Friction Factor/lOOFeet: + Feet Inch Diameter Force Main Total Dynamic Head: ...=1©1la Feet Internal Tank Dimensions: Length Width Liquid Depth 37 Cf, c~ 7 I HEAD/CAPACITY CURVE :v HEAD CAPACITY CURVE EFFLUENT MODELS I s4 TOTAL DYNAMIC HEAD/CAPACITYPER MINUTE 11 EFFLUENT AND DEWATERING 05 32 i 6 SERIES 67-w q N 137.139 161 163 1N ,46 100 1N 1N IN 30- R. LL Ud Ut' A.1 La4 Ci4L U9. (34L 4Y CtLL Lt4 t341 Ltrs Gd LK dr lK G4L Lta. Gd lK Gd Uis:' 95 6 1.62 43 163 66 2I2 T2 273 101 J94 106 bl 61 231 91 'Z71 N f66 H7 166..617. 28 90 10 306- 34 120 4 171 61 231 79 300 100 :474 41 231 /t 231 60 226 14 660 161 672 16 167.. l0 72 36 133 4 ..170. 64 242 91 344 60 27J 40 227 69 220 142 11 146 649 26 85 20 110... 16 67. 25 95 36 130 42 310 59 223 40 221 64 220 136 816 140 630. 26 ip2 24 B0 b 114. 0 30. 74 260 67 210. 60 .223 64 220 126 '494 131 6W 4 24 I6 ..206 4 220 tq J40. 64 . 111 121 4" 127 ' 41 75 40 .12.19 4 174 48 In 66 200.. 76 2!3 68 2W 1% 397 114 .431. 22 186 60 16?A 70 21 w 33 126 61 191 58 -.219 64 220 90 311 100 379. 60 1129.. 16 67 43 161' 36 .130 N no 71 2M 46 422 63 20 70 21.34 30 114 10 34 62 197 61 :193 70 266. 163 W 2{„36,. 18 60 00 17.43, 14 6J 4 170 2. 106 64 - 20t 32 .121 2 6 37 140 55 100 3x46 16 163 110 444 14 N 21 W 79 Lock VOW: 19.26• 23761 23' 21 64' N' or 7Y 11s•.. 91• 112' 14 4s EFFLUENT & DEWATERING 10 35 I°S Warning: Model 185 should not be subjected to less than 30 feet TDH. 9 25 189 Note: For Head Capacity on Model 112, industrial 6 L0_ I column-explosion proof pump, see FM 219. 15 161 8,~7t].A 4 97 188 2 98 5 5-55, 7,59 13 139 SEWAGE & DEWATERING GALLONS 20 30 40 0 70 90 90 00111012011 ,0 ,40 130160 WARNING: Model 293 should not be subjected LITERS 80 160 40 320 400 480 360 640 0 to less than 15 feet TDH. -5-9c. pm, t W ~ ~ W 24 80 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE 7S SEWAGE AND DEWATERING 22 70 FT. M Gal. Lim. Gat. Lln. Cal. Ltn. Gal. Lets.- Lets. Lets. Lets. Gal. lln. Gal. Llrs. SERIES 262 21141 267 2" %3360158 &461655 294 295 20 5 1.62 $0341 128 481 128 481 128 484 Got 140 98 712 223 852 65 10 3.% W 227 89 337 89 337 89 337 81 685 2% 776 15 4.57 22.5 95 so 189 50 189 50 189 5 625 185 700 16 60 20 6.10 10 38 10 38 10 38 50 568 168 636 25 7.82 76 288 68 257 106 101 136 515 153 590 30 9.14 55- b 12.14 43 163 47 178 90 310 121 458 140 530 16 5 19 50 169 94 356 115 435 50 15.21 50 3° 220 59 337 60 18.29 13 /9 59 223 70 14 21.34 25 % 45 Lock 'el". 18' 21.5' 21.5' 21.5' 26' 35' 42' S0' 62' 7T 12 40 35 10 30 8 293 25 6 20 15 1 282 10 292 2 5 262 266, 267, 268 264 294 295 0 GALLONS 10 20 30 40 I 50 60 I 70 80 I 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 1 I II I I I LITERS 0 ~ I I 60 160 240 320 400 480 560 640 720 - - i eoo Soo Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of 3 Labor and Human Relations Division L-if Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but }X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWAll-a'k : PROPERTY LOCATION c~ Q ~A/I I GOVT. LOT W 1/4 NL.J 1/4,S /S T 2 / N,R / r E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAMAOR CSM # C.i+P. RNG C r~tc cY CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLuAGGE OWN NEAREST ROAD y ( ) 4L)% sU 0 N A [Dtj New Construction Use [*I Residential / Number of bedrooms [ ] Addition to existing building j j Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate ®-7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 -~~Uench, ft2 Maximum design loading rate 0.`7 bed, gpd/ft2 A V trench, gpd/ft2 Recommended infiltration surface elevation(s) ~7 /.®d It (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ❑S ❑U ❑S ❑U EIS ❑U ❑S ❑U ❑S ❑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 Q /0 l L ! /h sb< A~r I ~.4 0.1 -8, -24 16YA 3 S L 1 M ~bK w 1 Ground -$C 16Y14 5A _ 5 fGf r` 61 C L') 0,7 0 elev. ioDaft. 1 d YrQ 4 3 5 ev, r !bt((~~~ C W (3 Depth to B -9g '7.YR 4 4 m T'r > limiting factor 3 7.3 Remarks: Boring # 0.1I love l ` / rh sbK A v G L') 1 jr D 6.5 r' 11-2 ` .16ye, 4Z3 S, L M sbK M-r G S l ,2 10.3 Ground $ 4-31 16Y44-A r, r M c 5 7 d.% el„Q a It TS 16'14413 s e t d. ~7 ~ Depth to C 7<411 ?.s R s a.s 946v.gs s sn 5 -Cr /h r t4 F N limiting factor Remarks: CST Name: Please Print Phone: 461n I Address: Q Li Signature: l~ Date: CST Number: -3 PROPERTY OWNER 'SAM MILLED SOIL DESCRIPTION REPORT Page 7- of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Ba.nclary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench . 3 4 (3-0 IO Yr? ~ L j /1,7 5b>< >'r, r CS 1 8, /9-33 y - S: Z f sb>; ni CS 0.2 ~.5 Ground Y 4 S 0.7 0 elev. I Depth to limiting factor 7, Z Remarks: Boring # _ w Yt. Q Q -/5 16w V1 L ~ rh sbK k" v - C,w 1 ~ D 4, €0.S Ground elev. $z 33-4Y Ili`/,C 4 s M v 0 .7 S ca t t. Depth to Q3 4g-7Z 16Y4 4-h' V S rh r /h limiting 7Z-/OZ 414, Eos -FS 0--F 9 r wr 1 /old N P factor 7,67 Remarks: Boring # . A 0-fit /Lay/>Q I L Y,4 sbK rho ~Y / 6,4€6.S oYp, 4 Ground elc v. ~ -'~0 7. XP IFS ~ or N '/01 n ft Depth to limiting factor S,S~4 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: con 01)wV0 ncioo~ C, RAN6C -R644 j~ tuwo4mot- I"ikoPJ AT Lo'T C4,bJL*- I , r 3z , r '71 I N ^ I B-4 oRYN Sc.aL;✓ 'ZOO i II w Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page l of Labor and HVmnan Relations Di*ion'of Slafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but )X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWN R: PROPERTY LOCATION !IL.C E)~z GOVT. LOT W 1/4 NW 1/4,S /S T Z N,R / E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAM~~OR CSM # C.if:RNGC ~t~y ,r CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VIL E OWN NEAREST ROAD ~4tj% so v4 A [AQ New Construction Use [ Residential / Number of bedrooms [ j Addition to existing building j j Replacement [ j Public or commercial describe Code derived daily flow gpd Recommended design loading rate 0-7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 0.`7 bed, gpd/ft2 tS ,T trench, gpd/ft2 Recommended infiltration surface elevation(s) 7.0CS ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem [3S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench w o x% Q -ta v J - L 1 A h~ r4 r I (5,4 o.s -24 /Z)YA 3 _ S • L / sbK ~r w I Q,Z 6.~! Ground $ 4 -SC lb Y4 S/4 5 r ✓f'1 Gw 02 D S elev. Do, Ir A C 1-1 &7 e3 1% joDa. ft. 8a 66-V Depth to 8 -9~ 7s YR 414 S n ► r limiting factor 3 Remarks: Boring # A C)-/t IOYP 3/ L sL A vfr G Li 1~ 6.4 6.5 • I~, /I --Z .16yk 4 _ 5 L 1 M s br-- (11-P G S l i~r .Z O 3 - 7 0.% $ ? -3L /b Y4 414- S Ai r M r-5 7- I Ground D el" ev ft D3 3~- 75 /6y44 3 S n~t r r►, e L3 Depth to C S-i 1~ ';1b"1'9" ~ ~.sy+z 940-k's c S P<17S 5 r rh~r t4 p tip limiting factor &,ZS Remarks:,$~ CST Name: Please Print / A &y 64gSok) Phone: b_ 46,n Address: D p 1 LO) Lit ..yA Signature: O Date: CST Number: 5'T PROPERTYOWNER SAM 1111LUK SOIL DESCRIPTION REPORT Page--4-Of 0` PARCEL I.D. # S Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Barry Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mr& A a-(9 /4 Y►Q / L. f /h sS >K th r CS 1 0 ~ p.S U." 8 /9-33 y SAC 1 ~6~ r►, cs Ground Y 5 r+, I 0 7 O ,a 944 elev. JoD--~ ft. Depth to limiting factor 7 Z- Remarks: Boring # n^ _ O ICS I L 1 a E yQ f A N a IS /Dy23 / L /m-s6< rHv~r Cw 1 O A -S> L / M SLK n,v-~Y- CS Ground zoo ~e ft. $z 33-4Y 4 -7-L 16W 3 5 n, /,h l C- LA) $ 4 4-1 Depth to Q3 9 limiting 72-/OZ 4 T ST "Y-5 d r r►~ / /V/ AI P . factor 7.67 Remarks: Boring # OY 4 3 _ S.L / sbK ,wv-~r CS / 0.2:0,3 A $ ZC-4s `/e-4 S r~ l cw _ 0:7 og Ground elev. $ S -~Sd 7.sYP IFS A F S ft. Depth to limiting factor S.SN~ Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: ~ co^n.D nc•M~ PROPERTY OWNER 75011 MILL& SOIL DESCRIPTION REPORT Page 3 of PARCEL I.D. # 'ZZ17 b e~ Y JAt Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BaxrJW Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rends } Ground elev. ft Depth to limiting factor Remarks: Boring # n: A 4-116Y,01i L ^sL< ml, r as - 6-410,s ~:a 6 19, A -Z 3 S. L f bK P'ir GS _ 0.2.6-3 } Ground 7 5- / Y 4 M 4.7 -Z elev. ids ft. Depth to limiting factor Remarks: Boring # _ TILL MAI NP S:vdCJjY4 2/-42. 16-11R4,13 ( n, $ K n, h es 4§ Ground Depth to limiting fact Remarks: Boring # Ground elev. ft. NCIunj Depth to P x r SnN limiting 9 factor Remarks: CO n_OOOf1/D /1S /091 1~,EUCRMOV.- I„ItorJ AT Lo'T CAttJU I ELE~►4'SIc~N= 10~ i I 3z i 7, I ! 1 nI N L° a- ,cry ' roe Ems, ~ /67 $ 7 B-4 t~ oR'rN Sc►~Lt~ I 'ZO 1 r R n ~ SCE I L 'Y~F) LES SvlL~ - l l F~UT ~ w p, .O J J ~ G S c L 6?~ w ~ O -P N A ~ -fl W I p - D CIA w r ~ STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Jo N A L D lVf e _,e MAELING ADDRESS 3 58,e,4 Al rp£ 2© rf-D PROPERTY ADDRESS lp / 3 Co a A ~So~E 2p low (location of septic system) Please obtain from the Planning Dept. CITY/STATE H J PS O Ni W 1 S` O ((o PROPERTY LOCATION N V I/4, hl uJ 1/4, Section I S_ T zq N-R W TOWN OF 4 L) DS O N ST. CROIX COUNTY, WI SUBDI -ISIONG414 u (oL i IALLF_ ' LOT NUMBER S CERTIFIED SURVEY MAPS So Z V VOLUME Cam, 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. UWe, 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. , SIGNLD: i St. Croix County Zoning Office Government Center 1101 Carmichael Load Hudson. AVI 54016 11/93 8TC-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 ifcsuance. Should this development be intended For resale by owner/contractor, (spec house) , then a second form should - rel:ained and completed when the property is sold and submit ed to this office with the appropriate deed recording. . Owner of property be) N A L Location of property&l/4 41W 1/4, 3e( t5 on IS T Z`I N-R 19' W Township NODS5D Mail; ii address_f2/_ Addressof site (.tj C;2~I PnAD Subdivision dame _<gee,4 A(09 UlF}G~ E Lot no. g other homes on property? Yes Iio Previous owner of property f~ IL 6C12,_ Total size of property Z_ f5 S I+<- Total size of parcel Z, $ S r¢ Date parcel- was created Are all corners and lot lines identifiable? _%e Yes No Is this property being developed for (spec house) ? _It," Yes No Volume and Page Number -5-S$ is recorded with the Register of Deeds. IflCLUDE WITH THIS APPLICATCON THE FOLLOWING: A WARRANTY DEED which includes a DOCJfMENT 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 M; p, 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 offi,f2 of thc, County Register of Deeds as Document No. s(pdZ~e~, 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 Registej of Deeds as Document No. oZ ~ _ Signature of ~Appl~ican~t~ C,)-Applicant - ;7 _ Date of Signature Date ()f Signature 560266 STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED DOCUMENT NO. Val REGISTER'S OF=FICE Sam E. Miller ST CROIX CTY., Wl kx RroolE J U N 2, 1997. conveys and warrants to Donald R. Nerby and Mary L Nerbv, 8:30 A. 'M husband and wife, a trvi yorshi = marital Property flegisterof Deeds THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St. Croix County, - State of Wisconsin: - 020-1321-80 PARCEL IDENTIFICATION NUMBER Lot 8, Grange Valley in the Town of Hudson 'AVSo f R F is not ~ This homestead property. X (is not) Exception to warranties: Existing highways, easements and rights of way of record. Dated this 30th day of Iv1aY A.D., 19 l (SEAL) (SEAL) * Sam E. Miller (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, ~ Signature(s) ss. St. Croix County authenticated this day of 19 "/b_ Personally ramp hefnre me this nth Aav of STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SA 41 tP7 /C L Ftt, a ADDRESS_(i / 3 G W 04 ,V6 C SUBDIVISION / CSM# (2 seON 4 e U04 L G. LOT SECTION / 5 T Z N-R , Town of ({v p Cy ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SEEM Alr- !oS 6 y it W DL jr 01 4V WD 1 L k T Y INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ?oP of / ~ /ROM /Y,E`ot'NE~/ 97 9,!.9 S ALTERNATE BM: Tv p ~F 11 n Few tm g~ otT / a e4 / SEPTIC TANK.'/ PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: W C/ 3 C Liquid Capacity: /-00 0 gg41L, ' s Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: s Length l o r Number of trenches Distance & Direction to nearest prop. line: 1y' 4, F A S~ [mil/~l Setback from: well: l0 S House 3 If Other - ELEVATIONS 4k oZ /2/,V6 5 = S. /V_ qg,7~ Building Sewer ST Inlet. 11.32=9S s3 ST outlet ~f(6Z =9S, Z3 PC inlet PC bottom Pump Off T}I II.gZ_ °iS.o3 Rte 12,Dvz eW7 Header/Manifold Bottom of system 13 .O~ = 93 ,gS Existing Grade 95Z---7q 7'7~inal grade DATE OF INSTALLATION: r, PLUMBER ON JOB:`i,G~tA LICENSE NUMBER: INSPECTOR: 3/93:jt low- - Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX rCafety and Buildings Division (ATTACH TO PERMIT) SanitaryPermitNo.: GENERAL INFORMATION 284243 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: MILLER SAM HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 97 0 q7 'OA S~ 020-1321-80-000 TANK INFORMATION ELEVATION DATA 612E-197 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic/-PS,/ (L,~ / O Benchmark 7 9 v-~ Dosi g ~i~~tivt.r3,wt, r.Z~~ Aeration Bldg. Sewer Holding- St/ Inlet TANK SETBACK INFORMATION St/~K Outlet Verit TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet Ar Septic NA Dt Bottom Dosing NA Header- Aeration NA Dist. Pipe /a, i4 5 Holdin Bot. - System 22 ~ 1Y~ /O ~ 90? Cog PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ST r Mo el Number TDH Lift `ricti System mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS IMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEAC Manufacturer: SETBACK C BER INFORMATION Type O mw Y? Moe Num System: -U-¢.t?,cj, OR UNIT DISTRIBUTION SYSTEM Header/ ulo%mw 1) Distribution Pipe(s) x Hole Size x pacing Vent r Intake Length Dia. Length Dia. _JL Spacing rade System my SOIL COVER x Pressure Systems Only xx Mound Or A Depth Over Depth Over xx Depth Of,.s' xx Seeded/ Sodded x Mulchecll~ Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON. NW . NW .15.2 9.19W 613 GRANGE ROAD 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 , SANITARY PERMIT NUMBER: 5~~~1 7 - C1 t,C~ pz w c~ , CcJ, ~Cl/I? ~.j 1~ ;"C Zo 4-:(Ci l~Cl~ /CC%~W'~ GciC e% iT1'vJfc C-tomOE!/GL' .n 2L ESQ. w Safety and Buildings Division XESANITARY 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 _-5W_ than 8 112 x 11 inches in size. ~ • See reverse side for instructions for completing this application State Sanitary Permit Nluumbber The information you provide may be used by other government agency programs E] Check if~isionopreviO s application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location 5,4 ILLL~ 14 1/4,S sT Z9 N, R/,? E(or W Property Owner's Mailing Address Lot Number Block Number M' Z L r City, State Zip Code Phone Number Subdivision Name or CSM Number D D Lt j/ S D 0 (j f(p) Z74 (5Ieid/f1 eJ~LG E 14 L-) Al 11. TYPE OF BUILDIN : (check one) ❑ State Owned !t~ Nearest Road Public 21 1 or 2 Family Dwelling - No- of bedrooms ❑ Town OF SD Al G/01IA6 X0.94 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo V Z Z/ - $ O 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. E] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. E] 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 0 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 1 ❑ 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) - y Elevation quo goo S Z Feet 49, Feet -1 1760 VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel Plastic p glass App. New Existing structed Tanks Tanks Septic Tank or Holding Tank ❑ 1:1 1:1 1:1 1:1 Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No Stamps MP/MPRSW No.: Business Phone Number: (1 ,-03,~~ 3 -80 2 Plumber's Address (Street, City, State, Zip Code):" 0q o~® vN-r vv,5o~v w y IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa tary Permit Fee Fee 0ndudesGroundwater ate Issued issuing ent Sig ature o S mps) roved Surcharge Fee) Pp roved Owner Given Initial. ~ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Ruildings 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 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. 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 11 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. S /n /Y) v, L f' L~-r - S 13 URGE Opo D C ~r Z r S C4 L E- 1~4- ~ 6M ►~~~Roti►~ h/E C.o2 At f 2 E I = too, 2x7 4-iv~c /V q G ~Y~ I A- ~ b ~ ~~F A 4 j ayxz 11V L, 1% \ t ~ t~ 5 I B- 3 ~ 1 1 i W q ~ ~ v 1 1 0 ~Z T LCT' $ got ~ ~9s, ~o LO, ~Y o h g I ~ ~ I a. t M ! t 0 Ti z I ~ ~ cry J M f v I I I f N EL I m L~ *a- Lo Wisconsin Department of Industry, S O LL AND SITE EVALUATION REPORT Page I of l !bor ane, Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 'ST 6RO x not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or [PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION p p `SAA M/LL4 e GOVT. LOT NW 1/4N W 1/4,S /S T -29 N,R E (or) W PROPERTY OWNER':S MAILING ADDRESS LO # 1 1# SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VIL GE OWN NEAREST ROAD ( ) 140 &SC,) CT 14 /Q New Construction Use [oCJ Residential / Number of bedrooms UN [ j Addition to existing building j ] Replacement [ J Public or commercial describe Code derived daily flow gpd Recommended design loading rate 0 bed, gpd/ft2 d 6 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate Q-bed, gpd/ft2 Q • 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations So'L L A UA , iow W jr- % R,4--7~ A.RPR6\(,4 L Parent material Flood plain elevation, if applicable ft S = Suitable for system CggNVENTIONAL M LIND IN-,GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING K S U U=Unsuitable fors stem Id) S❑ U S 1:1 U ®S El U Cj S❑ U 1~ S❑ U El SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Botxtcary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground -4 L1Ye,4 3 - L l S Gw 0:2 0.3 elev. 44j3o SAY w p Depth to Jf 7.s,/P-4/A`, limiting factor Remarks: Boring # C~ j- 5 l~ K nor w - 0 4 sd .S 8z ZZA7 ye 414 Ground ev g - I 4- r' j O 10 Z ft. Depth to fnfaLy:; iar~ s limiting ?.s Yee ¢ '6 - ? C ► ~,'t i' factor 5 Remarks: CST Name:-Please Print Phone: Aao Address: X (j&aV0 Signature: Date: f62 49/ CST Number: ~Ac,( PROPERTY OWNER SA'h Mlktb2 SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. # Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bortlay Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch p-1 oy~e3 1 L 5~9 rh 7- es / of 6s 19-4Z ,S(P, 4 - Sts m r C~ ,4 0.`~ Ground /6yP f 3 - S;L t' of -s r~r S Q.2 elev. nn '6L ft. $3 '73 /bye 3 _ S•L M SDK n~~r C5 O.Z 0.3 Depth to $q 7343( /d Y 4 ~ s ri, r n; 0:7 d limiting facto Remarks: Boring # •x. ozz 16\14 3//- t! it r~, sa'o I'h r r_ S 1 D.S 4 -3-7 1dyf- 4 ~z 137-74 10ye, 4+ S r- M Cv 02 d g Ground elev. g3 Ar/Z Syr24 ft S 470, n~ l O.S 6. ~ Depth to limiting factor } /p.d7 Remarks: Boring # ~..:v.,~:, A o -a 16W311 4r cs l ©,4 o S g ~7-~ 3 4 rf b;b ~r C Q .2.~ o s Ground gz 3-75 I~ 4 A S r CS C3, -elev. i ft $ =2S syz4 4 Depth to limiting ~ facts Remarks: Boring # vry•:;. Yvvi::•: •~i iWy:~~~tis~\titr Ground elev. ft. Depth to limiting factor Remarks: 130(R.05/92) C $~~cN~M n2 K- I "i~Po~ A r L -r C-&2. E LEJ A-r~ o~ = 9 7.4 i q All tih 1 h~ 1 \ i 4b' STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 4M 4 r2 MAILING ADDRESS P ® PROPERTY ADDRESS (012, a 4-04 A/ (~-k rc 0 /4 (location of septic system) Please obtain from the Planning Dept. CITY/STATE M V 4~) :S o k W / VO / PROPERTY LOCATION 1/4, 1/4, Section T__?,_7 N-RW~ TOWN OF Pte" U O y ST. CROIX COUNTY, WI SUBDIVISION t.j L. LOT NUMBER - CERTIFIED SURVEY MAPS-6 Z 3, VOLUME ~ ,PAGE (P' , LOT NUMBER d 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. 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 expiration date. -7) e SIGNED: p DATE: 02 F7 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application fora 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 property S ,4 M /h L 9 rQ- Location of property AA14 ,t (t)1/4, Section /v TAN-R Z W Township 14 L).N Sa Al Mailing address ROX-2f-z'F 2--___ Address of site tom, ~ ro-,41 G , oi4 subdivision name oe #4r c/ 4' Lot no. Other homes on property? Yes. No Previous owner of property JDQ U C L a-r T A/,C4. Total size of property 2 , 9 S' H c... Total size of parcel . 8 '6- e_. Date parcel was created - - 5; a~ Are all corners and lot lines identifiable? A, Yes No Is this property being developed for (spec house) ? Yes No Volume t/- Zand Page Number 102-4 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. yit ~Al- , 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. t S ature f Applicant Co-Applicant Date of Signature Date of Signature ^ ~ / / ~ $latr fiat c f Wiu:nn in Foma 2 1982 / r WAIt2A°c'CY DEED .y DOCOkiENT NO vto~ Cfi,t}(n Co, V1! Douglas C. Kutner, Bernard J. Nen.,!ian, --and Chris-_P.--Neuman SEf Z 1990' - - - 12:30 P.&I _ +a'~.x~_~~. Sam E. Millet conveys and warrants to li - - •M$ SPA"r PESER < n rk)H Hd rOHIAN- DATA HAVE AND K TURN ADr1HESS I I+ the following described real estate in St. Croix— County, State of Wuco,rsin: ~I B:Z (Pa,ccl Identification Number) s I~ NW1/4N1,11/4, Sec. 15-T29N-R1914, except Certified Survey Map recorded in Vol. 5, P-ge 1418 as Doc. NO. 393288, and except Certified Survey Map recorded in Vol. 6, Page 1761 as Doc. No. 420627. Ii ,r ij a ii I I This---- is not homestead property. (is) (is not) ~i 34 Exception to warranties: easements, restrictions and rights-of-way of i, record, if any, i~ Dated this September 95 day of (SEAL) (SEAL) • Douglas C. Ratner Bernard J. Neuman (SEAL) (SEAL) ;i • Chefs P. Neuman ; ~ •1 AUTHENTICATION ACKNOWLEDGMENT i i Signature(s) Bermd NeumdnSTATE Of= WWW15f, r Chris P. Neuman Count y.authenticated this"-_ day of _5ePteMbeX__ , 19.95. re me this day of I VU.g a3 C Katfle[' 19p~aAc ve nam d Kristin gland - ]Q ~ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) , to me known to be the person tv exccu:e~t Tr foregoing, in;iru m cnt and acknowled~~tftc' t (i y THIS INS MUMENT WAS DRAFTED 13Y 7 + ` Kristina Ogland _ ------q _ .:'oi- 11 ~Y ~ 9 fr i i 36, i I s~ v r ec, ST. CROIX COUNTY WISCONSIN ---~_'t ZONING OFFICE M r r""""" M~•~~ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 June 10, 1997 First Federal Savings Bank LaCrosse-Madison Attn: John Sais Hudson, WI 54016 RE: Septic Inspection for Don Nerby Dear Mr. Sais: An inspection of the septic system for Don Nerby's property was conducted on June 5, 1997. This property is located in the NWY4 of the NW4 of Section 15, T29N-R19W, Lot 8 of Grange Valley, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 386-4680. Sincerely, ~mesK. Thompson ssistant Zoning Administrator sm