Loading...
HomeMy WebLinkAbout020-1294-30-000 ti 10 ~ R9 11 STC - 104 AS BUILT SANITARY SYSTEM REPORT /CO iJ p o OWNER ,~~~g'(G GEC ADDRESS 14 A) T L rT ti SUBDIVISION / CSM#,} LOT # SECTION I~ T~_N-R_ _W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WIT T OF SYS M i36 s ~ 1 i sa f~ ~a lvt J I7.,~ 5i~;t Z: C9fi.G1Glc" c~c~~ INDICAT NORTH ARROW Provide setback and el v tion inf rmation on revers of this form. Provide 2 dimension cente of septic tank m nhole cover. r BENCHMARK: ALTERNATE BM: SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: 40 Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: ;1,12 Setback from: well: House- ZZ,!~_ Other ELEVATIONS Building Sewer - ST Inlet: 22 C ST outlet: i 7.s2 PC inlet PC bottom 9-L 7 Pump Off Cis %D, GO Header/Manifold- p, y Bottom of system Existing Grade 7 Final grade 7 DATE OF INSTALLATION: _C 7 PLUMBER ON JOB: LICENSE NUMBER: 1-2 ~j INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor d 1lumcan Rgyations INSPECTION REPORT ST. CROIX Salet nd Btrl*ngs Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284259 Permit Holder's Name: ❑ City ❑ Village Town o : State Plan ID No.: S ~'I - -'7~D0 NELSON GARY HUDSON oT 5u.µ ~ e- Prcel Tax No.: CST BM Elev.: Insp. BM E ev.: BM Description: a 020-1294-30-000 ELEVATION DATA TANK INFORMATION _A97 9 9-0 2 7. TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing z S Aeration Bldg. Sewer Holding St / Ht Inlet 8/ . 79 TANK SETBACK INFORMATION St/ Ht outlet 5x TANK TO P/L WELL BLDG. v A e ltto ROAD Dt Inlet p' G. ?'1' ir Intake NA Dt Bottom ' Septic >aS • - 70' _ Dosing ,a 5 • > NA Header / Man. 166 NA Dist. Pipe 0 Aeration Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 8.5 ' a Manufacturer Demand Model Number _0 GPM TDH Lift ~0,43' 1:6ction ( `s. Systn,61 TDH II,Sg'Ft Forcemain Length , Dia.a Dist. To Well - SOIL ABSORPTION SYSTEM BED /TRENCH Width ( LenN No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth / DIMEN 1 N DIMENSIONS- LEACHING manufacturer: SETBACK SYSTEM TO BLDG WELL LAKE/STREAM CHAMBER Moe Number: INFORMATION Type of Ike"i OR UNIT System: DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length --116 o Dia. Ala. Spacing / to (7 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only xx De th Of xx Seeded/ Seeded- xx Mulched Depth Over Depth Over I e_ p Bed /Trench Edges ' Topsoil Q'S es ❑ No [Yes El No Bed !Trench Center ~~'l ~ COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.24.29.19 SE NW 868 MCDIARMID CIRCLE .O V3 qh, 0 _11~ /00. Plan revision required? ❑ Yes Q/No Use other side for additional information. Date In veeagnature Cert. No. SBD-6710 (R 05/91) ADDITIONAL COMMENTS AND SKETCH t lk 4L SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION Safety and Buildings Division 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 than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permit Number a 8el~5) The information you provide may be used by other government agency programs ,n ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. A C D /1 tr 1 d Q/ , State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prope Owner Name Property Location 1/4, S T , N, R E (oro 1 /4 1W ~ ;2 9 Prope O er's ing ress Lot Number Block Num er city, S e Zip Code Phone Number Subdivision me or C Number A 1A D ( ) II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ ity Nearest Roa ❑ VIIIage Public 1 or 2 Family Dwelling - No. of bedrooms Eir Town of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) fie- 6c#` Oo1 .2.. i9. i (51 ❑ 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. 0 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 11E] Seepage Bed 21 2,Mound 30E] Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22E] In-Ground Pressure 42E] Pit Privy 13 ❑ 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. ate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./' ch) Elevation eet Feet VII. TANK Capacity In a110 S Total # Of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- steel glass Plastic App New Existin structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber - / ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATE-MENT sewage system shown on the attached plans. I, the ndersigned, assume responsibility for insta ation of t" sit Plu b Name: Pri Plumbe sSi u t ps) MP/MPRSW No.: Business Phone Number: I Nu ber's Ad ress ( ~e~et, State, 7un Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sa ary Permit Fee (includes Groundwater ate Issue Issuing A nt Sign ture (NOS ps) Surcharge Fee) XApproved ❑ Owner Given Initial `.a Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: ,Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 5 r 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 / Renevval 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 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 into 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 1/2 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. ` r4 ) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations February 18, 1997 222E Rose Street. La. Crosse WI 54603 K 0 CONSTRUCTION KIM 0 CONNELL 504 THIRD AVE OSCEOLA WI 54020 RE: PLAN 597-40051 FEE RECEIVED: 180.00 NELSON, GARY SE,NW,24,29,19W TOWN OF HUDSON COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number 'Listed below. Please refer to the plan number shown above. Sincerely, and M. 11 MM Plan Reviewer Section of Private Sewage (608) 785-9348 SBDA-7997 (8. 10/84) t y Private Sewage System Plan Index/Checklist All plan sets should be legible and permanent copies, organized into sets, bound with staples and covered by an index sheet such as this sample. No other pages need be signed as long as the index sheet for each set is signed. Your cooperation expedites your plan review and shortens plan entry time. I Plan ID N~ -1~qa U" Legal Description Address , d city/Vil own ounty A, Y Contents comments/Special Instructions Page N Included Two copies needed for all plans l Plot Plan 2 Plan ViewP ® Return by Mail 3; 4 C>~'D~ s '';a,~l 0 Fax Letter to (County) (Submitter) Circle One and Provide Fax ( ) S a+' J 6 C:] Call for Pick-Up: ( ) 7 Other I, the undersigned, bereby certify that the R , &ble) platy; and specifications submitted hers with were prepared under my FE B 1 4 199a dirt ,don and control oonm/Reeiser«ioaN SAFETY & BLDG`. PIu►rr;;:r a 's MW s CRY St s~ ,ostir- -1 IN Attachments: co10-r0 $ Sail Ac site evaluation dos Fen Needed for Holding Tank Submittal: one copy of notarized holding tank WwMeat. (Originals to County) , ~v~S~pl1 DtJC7 ~ Needed for At-Grade Submittal: O~ Otigisel signed and nouvized 5~E G Application for "Use of an At- Grade" County oo-alte One additional set of plans SBD-10268 (N.01/96) I { /rXl 1 ~ f r t-- It - -I T I I ;gs4 I I I j j _ I I /4cy I I ' ~ ~ I 1 .11 I 1 I ~ I ~ , dL--- : I i ~ I I i ~ I ~ I I, 1 ~ 1 ~ I I i I j i ~f I I I I _i I i j~l I I I , i ~ i ~ ~ 1 I 1 ~ I l s4e } i I i. ,pus ; I ' I ~ I i i i 1 ~ j I ' _I I I I I ~ ~FT • Y E D~signer~ D`clysa Non-Woven Filter Fabric 4" Observation Pipe Distribution Pipe ASTM- C 33 Sand 1 M G Alter. Pas. of " Topsoil Force Main t E b D= . r ♦ \ 1 G, % Slope Bed Ot 2 t Force Main Plowe d Drain Rock From Pump Layer D • Cross Section Of A Mound System Using E A Bed For The Absorpiion Areo F BA<,AL LCA0 kAr& = 3 G A Ft. H „ ,5 <~5c1: • j - i SCC st= B IZZYT t. t~.r r - l Ft . i 2- J Ft. K ?S Ft. Alternate Position L ~J /SS-Ft. of Force Main w Ft. •2-3.1 J 4"Observotion Pipe .B - K i ; Force Moin W From Pump c - 3 o Distribution Bed Of I/2[- 2 %Z Pipe Drain Rock 1 a 4 Observation Pipe Permanent Morker Pipe or Rods. Pion View Of Mound Using A W For The Absorption Areo PAGE,_Or~ ♦ y ` PERFORATED PIPE DETAIL and DISTRIBUTION PIPE LAYOUT Perforated Schedule 40 PVC Pipe End Cap-- C, e 4 Holes Located On Bottom Are Equally k \ Spaced ,,,III \ End Cap 4 / Schedule 40 \ PVC Force Main \ k Last Hole \ Should Be Next To End Cap Owner's Name: / feet Plumber/designer's Signature: x inches Y 4,2 inches Date$ License No.: Hole Diameter inch Lateral Diameter inch (c 3) Force Main Diameter inches _ Holes per Lateral w ~L feet. Invert Elevation of Laterals Page " of 4! ~d m p w x U ~ A A 41 44 a~ 9: o - _ $4 4J G! to W > W O _ A W _ ~yR •1' 0. O r~ jJ LF 41 N >1 a N O N 4! N a w O r : O v •d 4J U 0J N N N 4 41 0 N v` W 9F 4) b N ~ A d ~ tT U b' to a a • PA6E OF PUMP CHAMBER C9055 SECTION AND SPECIFICATIONS VE NT CAP " . '1 VENT PIPE WEATHERPROOF APPROVED LOCKING JUMCTIOW 80% MANHOLE COVER WITH 25' FROM DOOR, WAIWING LABEL WINDOW OR FRESH I2'MIU. AIR INTAKE I GRADE I y" MIAJ. I COAIDUIT - - 19"MIDI. ~ IULET PROVIDE ( T 1 (I I / I II APPROVED JOINT A AIRTIGHT SEAL I I APPROVED JOINTS W/ PIPE I III W/ : PIPE EXTENDIMG I 3 II ALARM EXTEUDIU6 3' OWTO SOLID SOIL B I II ONTO SOLID SOIL ( I I ow c I z I CLEV. lcL> FT PUMP b ~ OFF D COUCKETE BLOCK RISER EXIT PERMUTED OWL`J IF TAIJK MAMUFACTURE:R HAS SUCH APPROVAL ptPPAOVED BECpIWG Undcr TIitSK SEPTIC E SPECIFI'CATIOAIS DOSE TAIJKS /v,AMUFACTUREK: IJUMBER OF DOSES: PER DAy TAWK SIZE: GALL S DOSE VOLUME ALARM MAUUFACTURER' INCLUDING BACKFLOW: GALLONS MODEL WUMbEK: / CAPACITIES: A=4UJCNES oit GAlLLOU5 SWITCH TYPE: B=-yy IIJCHESOR -r?8 GALLOWS PUMP MAUUFACTURCR: C -_LIUCHES OR CALLOUS MODEL UUMBER: - 6 L On INCHES OR GALLONS SWITCH TYPE: DOTE' PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE KATE_ LaL~GPM~6-) pINSTALLED OIJ SEPARATE CIRCUITS VERTICAL DIFFEKEIJCE DETWEEU PUMP OFF AIJD 015TRI8UTIOM PIPE..FEET + MIUIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . 2.5 FEET 7T,,~/ FEET OF FORCE MAIN X ~F/porT.FRlGTIOU FAGrOR.. FEET - TOTAL Oy MIC HEAD - FEEr IWTERAIAL. DIMEWSIOME OF TAIJK: LENGTH iWIDTH ;LIQUID DEPTH - 5IGIJE0: _ LICEWSE NUMBER: DATE: Performance 1 u e n t comes Pumps METERS FEET MODEL 3885 25 so SIZE 3/4' Solids WE,SH 70 20 WE/OH 80 - WE07H 15 50 W E06H 40 10 . 30 E03M- WE03L IN S 10 0 0 0 10 20 30 40 w 80 70 80 90 100 110 12o GPM i i I 0 10 20 30 m,/A CAPACITY nGOULDS PUMPS, INC, S&L-CA F*US WW VM METERS FEET 120 MODEL 3885 35- SIZE 3/4" Solids 110 wE15HH 100 30 90 25 70 20- w WEOSHH 15 50 40 10 30 20 S 10 0 0 0 10 20 30 40 50 •80 70 80 90 100 110 120 GPM 0 10 20 30 m-As CAPACITY • 1996 Oow" PWnm Inc. "mom jwy, 19" CxSe~ 130YC'S: C,PisTy /I SMVS , 220 f I/ 1fitv/ey Ad- 0-,F Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page/ of 3 Labor and Human Relations Division of Safety & Buildings in ac 1 .05, Wis. Adm. Code COUNTY s ST cAol' X Attach complete site plan on paper not less th x 11 inch in siz P must include, but PARCEL I.D. # not limited to vertical and horizontal reference BM ire % e, scale or dimensioned, north arrow, and location and a to n Est r REVIEWED BY DATE ALfP,1Nt'~tM TION APPLICANT INFORMATION-PLEASE Ti, PROPERTY OWNER: ERTY LOCATION Tl M -41 /LIAR ~ Rq5 G LOT S£ 1 /4 N411l4,S .1' 'T 2. 9 N.R /q E (or) W SUED. NAME OR CSM # BLOCK # PROPERTY OWNER':S MAILING ADDRESS rEICITY 3Ak - T . Svc CITY, STATE ZIP CODE PHON [-]VILLAGE [ffOWN NEAREST ROAD uDSo,J C4-5i. s(4014V (7/S)3 '3G7 uDSoo--) 114fc lpl*emiD [-J'New Construction Use [ 'Residential / Number of bedrooms y [ ] Addition to existing building j J Replacement ] Public or commercial describe Code derived daily flow (oD 0 god Recommended design loading rate bed, gpolft2 trench, gpd/112 Absorption area required 500 bed, ft2 -56 0 trench, ft2 Maximum design loading rate bed, gpd/ft2 ~trench, gpd/ft2 Recommended infiltration surface elevation(s) S-9A- 11 q :.3 gq•15 ' ft (as referred to site plambenchmark) Additional design/ site considerations V S5 /f' I~RAK 40N 6- 090W o 0-u0 .44 Parent material SC5 5*? 4V : • Si/f- liJ/ Flood plain elevation, if applicable ti ft LAO, tb== Suitable for syeCONVENTIONAL M~OUr~D IN•GROUNDPkiSSURE ACT]-GS DE S ❑ YST I NRL L ❑S HOLDING ANK Unsuitable fors stem ❑ S O -U C~3'S ❑ U ❑ S 2- ~J M M SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bounchy Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mrich l 0-7 /o yR 3/ - 5// 2.f Skk ,w.fR ~S 2f . S tY c._:< N.;.: _ x 2. 7- 13 io yip y/4/ 4 54e .w, f•P os / of . . s y v~,vy a z. 3 Ground -3 /3-3 7•SYR yl`/ ~.i.>./10 f'/• s elev. j ft. Z /o ye y~G S l M+ fip Q w N n,+ of i' Depth'to limiting factor O.M R t7c E' Si'S lip C) P T Remarks: Boring # / O-Co / R 3/y S~ 2 f 4& .►,Af R Cs 2f . S . G 41 Z Z -/J0 /O Y/? 2sAe 4 f A CS I U f • s , G p=ry.,......{ s~ z,►~ s6~ -fie ~s s Ground A- fA9 ? elev. G 2 cQ / / f r ~ • '1 s ft. /d VA k~' . S Vle S5_1V -It gp.~~ • . Depth to limiting fact j., SSS Remarks: CST Name:-Please Print R ©~R i uLd R t G ~t.~- Phone: 715^ 3,96 • SOIF3- Address: 5^~r^ p 1,V4a& /eD • ff~vsD,~ 49%. syo/~ y• 2.3 y5- C5 7,A12 VP 7 n~~o• CST Number: ~ T PROPERTY OWNER SOIL DESCRIPTION REPORT Page L of 3 PARCEL I.D. I LO f 0 3 40 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tends 3 0- 0 3l S,/ 2- -F 56,r fie rs z .5 . Z. Ground 3 1-2-324 I-SYR V/19 9~ G iy //w Z • 3 elev. 9 3 . V- ft. 1 ~ SS !O VR J13 oE~a r~ os~o S / f s6'~ /kv,, -F 0- A ~ .2- Depth to Z Gfri7E - - limiting factor a % S VA S/ S $S • ~l-T' f G .,&fESTa.v 6- Qdld fF ,V cov T Remarks: Boring # 4-fR cs f . y 5 :.t Ground Sh ~v►-f/e CS r--- . S . Co elev. If 31. J97 7•.5 YR t~ / -S/ Z iM+ J-44 Av► fR 4,< .5* ~o D 1-50 7.5 YR y/ z ` 51 Af /MuFi a,~ N eL.b pth to limiting factor " - .v Oo ~~•t~'T ~.v U.~ SSS . 4 Remarks: Boring # v / 16-7 /o YR 151 -2 Xi& 4-1 A. cs ! f I.s .6 Ground , 3 - ye Yl ~ U, f R CS • S elev. . G %Y/? y! p cGy If 5'Ak 4"Z7C/' 4,,e* As M 9~. 54 ft. M u 7.SY,2 y oCe,47`s Depth to M• S~ ,iw► 4.,C' , y S limiting factor pE~+it/~//~tY R~cry~p/GTIov Remarks: lO~L°i ZD.c> 7 Ur 4:pE7- - ~q/~.IOST -s-Ty~TE`f> Boring # 104e 31z .~vfi? Of 3,k,, . s . f~ its ~f . So Z.r„► h 11" •G 27 7.S YR S /.>rr, '~Ufie 2 S - • 7 Ground elev. ~ ft. b-76 7'SY8 3 c Z AZ. s~ l,~ ~►ri U7C1 ' N l0 V9 s!e Depth to Pa limiting S factor 7.5 S! t 2,yK sAe i►r► ~ie . S . Co 121r 7•S Y!¢. Sll~ - - `S /.rri ~•Y► fR . ? i SCALE: I yp ' I ~ . 3of 3 - • ~i44rCka2 P ~ T5 5U55ESTtp M ovoD SySTTEM E l ~vhT i "I SA ND Fi I l 2 Al 4o T CoA-;E#C o 369 - >_or 30 y5 - 1 co~_7ovk i Nv~foR'N. ~8•~57z G ~o ..33_ 30' /3,44= Top of 07 ~ (e U ATE 00 Cox f r sw Z 9P. -7g • a& Sid ~iEV, = ioo.p' f3 3 ?3.78 ' SUNRIDGE VOL. 5-OF-PLATS PAGE TI 1 0 IN j I N 00'56'l0"W 390.00' T r N IA N p D ~ cp \ a1 C) ,p sF Z Tj \ d~ ` -U w ° O ~ W ~ Ivy \ ~ i N P ~I W ~ n W -n \ \ \p ~n \ \ t,P 9 \ 0 517 AA. O \ \L 9 moo, 215• , 13 W o(D ~~~~iQ 1g• AA N cn o o \ \ \ F / \ \ \N to -n m ° ° •o H \ ° o - \ o A o o \ \ o - \ ow C) ul.p W \ ( D N m S 006004000E 396.00' L4 w c; U) I \ w I w cn -1 I \ O I O O m 1 Z I 32l ' 12 51 W I U) 0 N 12 A3 I O l< I 0 1 p 'r- I~ it 1 c \ 1 ~O 1 I 1-4 IG) Im W , IN m I0 m 1- ~C) S ~1 O , A I- I_u Im 9 g 0 Cl) r~ can I r- • STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County i OWNEWBUYER MAILING ADDRESS /J PROPERTY ADDRESS Ryc~ 11/ (location of septic system) Please obtain from the Planning Dept. CITY/STATE Zan - I Js - PROPERTY LOCATION - 1/4, )1AJ 1/4, Section T N-R~C W TOWN OF ST. CROIX COUNTY, WI -&/a~) Y SUBDIVISION LOT NUMBER_ CERTIFIED SURVEY MAP , VOLUME 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. 1/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, its 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. SIGNED: DATE: a 5 9 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 R. ~ ~ . ,'"•v 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 property - Agea Y, C""/ Location of pro erty !F 1/4_1/4, Section ,T_N-RW Township mail in address Address of site cs Subdivision name Lot no. Other homes on property? Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume and Page Number 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. , 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. 01 Sign-tur of Applicant o-Applican - 17 5-- -5;;~ 7 r -0?"5 92 Date of Signature Date of Signature Tr &W K 4- /a ° ot.X VOL 1'10n09?:;"2' F'e-k 042 WARRANTY 552 DEED N~G!~T~; ~ G~~~Cc DOCUMENT No. ~ ST. CRCIX CO.. WI at-d'0' R"o NOV 2 2 1996 at 8:30 A. M This Deed made between WILLIAM C. ASMUS and amass..- -R 0.4 0, KRISTY J. ASMUS, husband and wife, Grantors and GARY AeT°Swt of ceeda NELSON and JILLIENNE I NELSON, husband and wife as survivorship marital property, Grantees, Wiinesseth, That the said Grantors convey to Grantees the followirg described real estate in St. Croix County, State of Wisconsin: Lot 30, Sunridge II, St. Croix County, Wisconsin. RETURN TO: This is not homestead property. tt Tax parcel No. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantors warrant that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. 4f ~ Dated this day of November, 19%. = T ANaSFER FEE ~i,..• (SEAL) - William C. Asmus (SEAL) us STATE OF WISCONSIN )SS ST. CROIX COUNTY fi Personally cane before me this day of November, 1996, the above named William C. Asmus and Kristy J. Asmus, to me known to be the persons wbo a uted the fore g instrument and acknowledged the sane. ' Brenda PoulinNotary Public, State of Wisconsin My Commission expires: November 19, 2000 Brenda Poulin THIS INSTRUMENT DRAFTED BY: NOta of Publonsin Robert W. Mudge State o MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street, P.O. Box 469 Hudson, Wisconsin 54016 74 ST. CROIX COUNTY WISCONSIN ZONING OFFICE I I a g o I■ N r _ r~■~i ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road _ _ _ Hudson, WI 54016-7710 (715) 386-4680 July 25, 1997 Gary Nelson 868 McDiarmid Circle Hudson, WI 54016 RE: Septic Inspection for Gary Nelson Dear Mr. Nelson: An inspection of the septic system for your property was conducted on June 23, 1997. This property is located in the SE'/, of the NW1/, of Section 24, T29N-R19W, Lot 30 of Sunridge II, 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, Mary J6 Jenkins Assistant Zoning Administrator sm