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HomeMy WebLinkAbout020-1316-90-000 U ~ -0 0 °0 7 O N \ C N O a N w n• \C ~p Vo v c C C N 01 =3 N Q 1S N C A 7 ~ O , I N ~ O ~ "O Z ~ ~ N I O E C Z C N C LL C O N -0 Q N 73 N ~ Q .L.. N M Z a+ 0 It O 7 N LL1 a m N H U) C O C C9 O U O Z d C U ~ - in H O ro z c E 'o p M N N ,s N w 4) C: _ co C U III 0 Z co z N ° a 0 04 N ~ m d 13 r Y C O m .0 D a 3 _ N Z o LO O O O •N aaa ~ n o N N .j U o°i rn rn a~ 'co m tV = ~ N a~ ov o ~ ~ ^ d ri III U N N ~ • Q c C) 04 ' N C ~V O O O I O O O C W 0 _0 3 O O C O CC) p 30 N E C Q. y GG+ N E Y Z3 co V M w M C Q• M(3) O N r N N N 00 j > N O U N co O N Z ^2 • y?,~' O N S > d 10 I''~ a ` a w CL •U N "~1 A 0 a~ I O y V r : 9 x t~ A. WIN ROO( at STC - 10 4 GOOE AS BUILT SANITARY SYSTEM REPORT OWNER IA,2 .e s~ T 6LI ADDRESS SUBDIVISION / CSM# ✓G1t//Crd~ LOT # SECTION y Ta 17 N-R_W, Town of cc ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM p 6 X i~N O 1 f N4 G_ F h INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r r BENCHMARK: ALTERNATE BM: _r, ¢ p, i`~ ~n SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:- -r Liquid Capacity: Setback from: Well House ZZ Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length ~lJ Number of trenches 2- Distance & Direction to nearest prop. line: Setback from: well: S p House 7d' Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: y ?G PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: yam' - 3/93:jt Y Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: ALabor an^,AHumanRelations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284283 Permit Holder's Name: ❑ City ❑ Village j] Town of: State Plan ID No.: WOLF, ROBERT HUDSON CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: ~+t- 0204316-90-0 00 16ej a 54 1.4 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Q 7 l;0 O Dosing Aeration Bldg. Sewer Holding St/Ht Inlet ~•a5 `~~{,8~ TANK SETBACK INFORMATION St/ Ht Outlet ' TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic , ~ ~ ~ ~ NA Dt Bottom Dosing NA Header / Man. 9 5 13i' Q/c7,/Aeration NA Dist. Pipe q, a 9' Holding Bot. System /0. J_ 91 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Fri ' n Syestem TDH Ft Forcemain ngth Dia. FFii Dist.Toweu 7 T SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits inside Dia. Liquid Depth DIMENSIONS J`y DIMENSIONS LEACHING Manufacturer: SYSTEM TO P / L BLDG WELL LAKE /STREAM SETBACK INFORMATION Type O 1 CHAMBER Mode Number: System: `-k o O OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched 11 Bed /Trench Center Bed/ Trench Edges 36 -40 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON.24.27.19,SE,NE DAISY CIRCLE LOT 54 l' ~7 yy~~ 7 x f ! if 1 t . .o: , _ 1 ,f'~ L.~ (ti,~-rf.(,..~ r-`°'! ~rz r.. "3 ' j- • x-~' E,.g~--(. -e, s_ -V. Plan revision required? ❑ Yes ❑ No Use other side for additional information. Lq 1,7 f (o 1.2, 1 I SBD-6710 (R 05/91) Date Insp or's Signature Cert. No. ~ t ADDITIONAL COMMENTS AND SKETCH er t SANITARY PERMIT NUMBER: s 'm ~:a µo Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. r Q.. YD r' • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide may be used by other government agency programs heck it revision to previous 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 ab~~ Ter 1/41/4, S T g Cl , N, R E (or) Property Owner's Mailing Address Lot Number Block Number S y I C 5-/ City, State A,,#p r t, Y! $o~ j'j Zip Coder, j i2. J Phone Number Subdivision Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road - Public 1 or 2 Family Dwelling - No. of bedrooms E] Village - z_ Town of A2 d III. BUILDING USE: (If building type is public, check all thatapply) Parcel Tax Number(s) -170 - 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. 54 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 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) / Elevation 4< q_? 6 Feet z, .S_ Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks{ Septic Tank or Holding Tank , ~Li7`S 7"~ f.,~f ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite e Wage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (N Stamps) P/ PRSW No.: 71Business Phone Number: A4 Wt',OL All -,it I 06,0C '77' rill, _~31 a Plumber's Address (Street, City, State, Zip Code): a 5c.0Z= _d IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Ffff222e (Induces Groundwater Date )Issued Issuing Agent Signature (No Stamps) t Owner Given Initial / Approved ❑ / / o4J Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 0 S80-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber = f 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 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 1/2 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. fi:PAe- IY2 P s .x t ld®d a 'Wisconsin Department of Industry, SOIL AND SITE EVALUATION f Latweand Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and STC Yet X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ©,Za -t3/~ O APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location /V dh e., r Govt. Lot s' 1/4~i 1/4,S T2 Q N,R E (ora Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# Citylole,., 40'd.14,~ testate Zip Code Phone Number 3~l~U ❑ City ❑ Village [v~ Town Nearest Road New Construction Use: ❑ Residential / Number of bedrooms -3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 4K5_d gpd S -70 Recommended design loading rate bed, gpd/fl2 n trench, gpd/ft2 Absorption area required Xj zYS bed, ft2 trench, ft2 Maximum design loading rate Ij gybed, gpd/fl2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ~[r ft (as referred to site plan benchmark) Additional design/site considerations Parent material S' S y Y SA t74- !r' G S= 7-4 a a At Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system S ❑ U [X s ❑ U [as ❑ U ®S ❑ U ❑ S iz U ❑ S [R U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench mim 7' 2 -1 5' /,0 jef 3 l= FQ C!5 Ground 3 l6- R flJ ,(PD ft. 1 q.Z Z Sl R YI , r- .4 s' /,in b- d+' ! L S r 7 Depth to '/2- 1 7, 4 'Vl Q u G~ l limiting factor % L7 -in. Remarks: 43 0a- 5 d'e- e4 etd 7o ir.0.d~=~'vrr+ S ck ;'Llbh -e 5;5n:'/G a7~ _4,:o ec~ OeR Boring # S S' Ground Ll 7 G ~G s elev. Depth to limiting factor 0 in. Remarks: 5- c S eo es~< o v„v- 6' , 'fa t a $c>' o-T a +Co tP A9-4 4, CST Name (Please Print) Signature Telephone No. Address Date CST Number y~iD 7D GL w G.~r` G, + .7a7 7771_777-7-) / l SOIL DESCRIPTION REPORT page ot~ PROPERTY OWNER PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground elev. ft. Depth to limiting ; factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) s ! ww1w Safety and Buildings Division ~•~~rG SANITARY PERMIT APPLICATION Bureau of Building water systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, Wl 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. C • See reverse side for instructions for completing this application State Sanitary QPermit Number o2W~2K3 The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFO TION Property Owner Name rlop4erty Location 1/4 $ T N, /l/~ - a y R E (or ~V Properly Owner's Mailing Address / FubdiLoLvision mber u I Block Number ,&i L or SO C JYf 7 City, State Zip Code Phone Number Name or CSM Number II. TYPE OF BUILDING: (check one) ❑ State Owned n ❑ ity Nearest Road d ❑ Village ❑ Public 1-or 2 Family Dwelling - No. of bedrooms Town of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)/3JG aad- --ell 0? 1 F-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. K New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existinq ExlstingSystem __-__ExlstingSystem 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 aSeepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev_ 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 49s'•.SG Elevaatoon SO .5'63 d U Feet « Feet TANK Capacity VII. in gallo Total # of Prefab. Site Fiber- Exper. NFORMATION Gallons Tanks Manufacturer's Name Concrete Con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank /60 G / &weS7- ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ in, ❑ Ej El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (N Stamps) PRSW No.: Business Phone Number: 4t A-- Plumber's Address (Street, City, St e, ip Code): ~S' r ~41C IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuing A ent Si nature (N XApproved E] Owner Given Initial ~ ph surcharge fee) Adverse Determination Ie U y 7 X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original w County, One copy To: Safety & Buildings Dive ion, Owner, Plumber t 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 Divi;ion, 608-.266-381 S. 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. Vl. 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 isto 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,- Q soil test data on a 115 form; and F) all sizing information. GROUNDWATI=R 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 2 Q Vljq~ TSf su Sc &4 ~e- , Y ~v N J'' i ~ JOA( 5 v~ R i l C . Wisconsin Department of Industry, W110,1 and Human Relations SOIL AND SITE EVALUATION REPORT Page _ of Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less thacr~ 1/2 yr tfi mcftt3s-lri size; Plan must include, but CPO/.x not limited to vertical and horizontal referen*e nt f6M), direction anti, °~."o4bpe, scale or PARCEL I.D. # dimensioned, north arrow, and location and Asta~ce to neari# T.ood. APPLICANT INFORMATION-PLEASE PRINT ALOWFORMATION ~ REVIEWED BY DATE PROPERTY OWNER: P PERTY LOCATION c7i iH 3 /14/)P 7 eos& Lt ' VT. LOT ,S 114 NFt/4,S2 y T z9 N,R /1r E (°"!~n/ PROPERTY OWNER':S MAILING ADDRESS T If BLOCK # SUBD. NAME OR CSM # /,Y/ 3RO S r- y su,.~ R O&G CITY, STATE ZIP CODE NEMUM []CITY []VILLAGE [TIFOWN NEAREST ROAD Ffup.S 0') W 1, 5110 1 Co 1'3, /tvOso.v YoUA-1 6-- e22 14'New Construction Use [,"esidenfial I Number of b6drooms 3 -t'o Addition to existing building [ J Replacement [ J Public or commercial describe ysa - Code derived daily flow <e p 0 gpd / Recommended design loading rate g _bed, gpdAt2 L trench, gpolft2 Absorption area required _!N/A bed, 11112 trench, tt2 Maximum design loading rate */R bed, gpd/Fl2 , 61 trench, gpd1ft2 Recommended infiltration surface elevation(s) 5--e P - 3 it (as referred to site plan benchmark) Additional design / site considerations Z-5'!57- ui'' 7i s c~'- s/%-e Parent material C$ 5 4-rT*E , si/fr /o,~,ys Flood plain elevation, if applicable NA- It 0 S =Suitable for system CONS[] U L MOU ow- INN--G ND PRESSURE AT--GRW SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem If~'SS CC'S U C-S U 919 0 U O S ft94s- S gAr SOIL DESCRIPTION REPORT Vlf = ,voT ,PELd.~/~tF.vp~~ Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence eounfty Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed fertctl 0-•7 ,oYIe 3/z /o~,-r / fsd~ .►M fie s vf- Y s - /l /o y,2 j,/,y /o,~,r► / f s6,r f e 05 fe , s Ground 3 30 /O yid y S~ ~x~/' Cw "s elev. Depth to . S SD p /O / ✓r C' S D S . 7 , c~ limiting factor i i l Remarks: Boring # loyle z z i6 Ground 3 elev. 0 7 5 yt, LO y - , S, O S JQ - ; 7 ' 1y Depth to limiting tact Remarks: CST Name:-Please Print Q-oi3ERT Z 4-13 P_ 'cln7-- Phone: 71-5-- Address: ~7_yJ~ C'STiy 2y~,Z Signature: t od..afu Rawaee consultants Date: CST Number: PROPERTY OWNER S, 3 M RU 5C'('%, SOIL DESCRIPTION REPORT Page 2,01 3 PARCEL I.D. GOT SU.v2 /DG Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxlary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. tied ranch X J& &K r~e CS, Ground 3 Av r; S 5 • G elev. Depth to 10 f limiting I t factor i 1 Remarks: Boring # o-11 io yje 31;1-- 2 /-1 -7 /o ,2 y/ Ground' Z7-~ 7S re Vf' /7s~~ ~t S y 5 elev. _ O 7,,5- /e Y1 C s ©S 1,7 /o 0,5 tt. i Depth to ' limiting factor Remarks: Boring # Ground elev. 7,5 - S /T IQ d' S' a S , S ' G Depth to - lO y tr/ Cs 0 S limiting factor ,r } Remarks: Boring # Ground elev. ft. Depth to limiting factor ()Pill S~D~ ypv v U- iPl7 • ,vo T C 1. ~oa~S7,evcTE'~ yET GoT sy All rbr of 3,y • = 4,44"o E c~~ /l HRH /ao.O' 2~ 0 V C i3 z sy 35 yf a'o /oo ~ fay /0.1 ~ s yyo~, 3 0 ~iLl ~ Z SET p,~ . ~iEV, = 97, y5 y ~ C5 SOLD G ZoN ; bti DW 0 O `t' . ~7 0 CO) CA) 11-- ~ r y CA) ~ W A I _ N Q i,,vJ y t 0 Alf, CA) 6 w co -i 'C. t ►a r- Cl) . Eg yQS D A . s 1 i 4416 M. 4 Q r; 4 a / n GJ ?Xtf" V.- vwt 1 2 Vl Rtin7}i4~i~ Tt7' w~~~a4~tF~1{ji /•~•,j ; 4 ~f . rr + may. >0 -V f a{~ty(,t~ 1}i'rYr\^fip 'M„it >rr' h t•n er' x 13 \ v q y(51O r i 9. `TS O~ ooOO V. 29 o P26 cr N, ~ -1 Z 11 \ OVNr ~ g3 45 ~ o v 0 1 R A0 - 0 35\ 0 oQe \ \ \ S8304 5 - X2000, .l'~ 3 ~r1Q8,~ ~ ~ 0 0 GO /~1~. N69,9~ 99 /Zd ~T (0 n 50, z U.S.G.S. 0 ~0`~10 54 o' 18 (q ~ S 273,518 Sq Ft / I SEE 9~o~~P55 1? 6.28 AG o / o 21 I MARK JOE N ~p g_3 1051.98 G~ ~ ~ 20 ~l N ~ Lis S 850 36'00" E - I 1 O/~ I O ~10 v~ I 1 EXCLUDING EASEMENT 165,727 Sq. Ft. or 3.80 Ac. \ p 2 NO ~ Ag6 2A ~9 00 a~ tu 55 56 ~ Z 0 D 135,379 Sq. Ft. p o 97, 347 Sq. Ft. \ 3311 W \34.15' 3.11 Ac. 00 2.23 Ac. N v co 3 Z t` O N Ft. 0 N O m O 5,581 Sq. Ft. or 2.19 Ac. N 0 1795.17' Z 417. 00' 364.0 ' 0' SHEET I THIS INSTRUMENT DRAFTED BY J.E.RUSCH 0'R vv 9e :80 L6-97-£0 lnQ4L9 Vqo Nd g of C - 100 s 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 Location of property 1/4 1/4, Section _ X~'.T_g,~_N-R 13P' W Township Mailing address .2 0 do / , G e al a o- -t~ g~ &.2 b2iSy C;~c Ce Address of site _ subdivision name SGT .rJ/~-`~ `Lot no. Other homes on property? yes,__ _No Previous owner of property Total size of property G Total size of parcel. G Date parcel was created Ada. Are all corners and lot lines identifiable? JQ Yes No Is this property being developed for (spec`house)? Yes C1Z No Volume L& 7 and Page Number ayf as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION TAM 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 Cettified 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. SS/7®r~' . Signature of Applican Co-Applicant 3/ ~7/~7 Date of- Signature Date of Signature lOd WH SE 80 L6-9Z-E0 y 5 STC - 10S SI::I'TIC TANK MAINTENANCE AGREF~NC>r`~NT St. Crf.ix County OWNER/BUYER Rl><!,ss ~s'S v~~~C.~~. rte. T ~ " MAILING ADD -J his' Circ [ e, ' 0 ' I'ROI'TRTY ADDRESS itic. sy..tel11) Please obtain from the plasaiing e {lucat.on cif } . CITY/STATE pROpERTY r,OCA'1CION ST. CROIX COUNTY, W1 TOWN OF LOT NUN FR J _ SUDDMSION IJX2 VEY 1Vii~I` ti OLL'-IF ~ ,1'.A( 'L yG , LOT NIYI~~ER ~ CERTIFIERS - t` il,hdl:., rem'M N* f ;;lr se.1t;<; ;.yst~'r11 .j result ill ;t5 p ery three ycfirs or SWIM "e de-' llrpropYyr use and e ° "t`'Y11)i1Si + tf?P.e}?tiG 5~Y {i Y fun;.;ar. of the septic tin Nvasies. P'toPV rS1t":i.11tevaPcF9 C'~.+l l'+Lv'Y Ut. iflt!: the syst,-si can affect: 4110 ~m r~r, ~'4.<<•.:. , A ' by licensed septic- tank I'+ } l system. as a treatment stage in the waste diSpo.;a of 601/6 of the cast St.. Croix County r a YnsutiYru+,: rr•.:~:cic1Y{s ;,.,:~,i•~: eli~i.l`•le if) rc~Y:ei~~e a graut fa o,• ?8. St. Crni1 Count•~- 1,; .~;as in O~~CTSitQr. nriot' t%, July 1, 10178- 7& t: grce of replacement of a failir►g.. :;stern. ; ~~r,~a~itlY t'sw s•e,k+iirerr!Ytit that cawtleis of :3l! . yts'ti" Sy'S!v accepted this program M. Of keep their system properly maintain:r<, celtification four:, Signed b'v the owner The rorty Y' owner e~l'F,r:a : '!Il tl r,"il1XUt11n~i ! d p1171F~ r v:.rif'~ ing that (I~ P F ,tr;cted tLt?it}ter or a I:ccrYs ~tion 8l1d and by a rxaater IY.►ntiber, ~Cl!•"1Zr`'v:1i~'S'' I' !.'•.1 Y~!k'=s ~ 1 )ni 0pel:{t!iig condition mid Z' Zge, inspec ~ astF~rater di.ar-a:~i! lan 113 full ~7f ,,l+sdge znd scum. etl~ rin-si+ .e v t(. le_s CSS$ the scE-tio .:,til, i; trumping, (if nc: +ry), 'k,uire111ell_s and agr4, to ma;t~tain Jprivat tl se-wage r;''V'e, the -andersi~t ed i1:tr4 ;o t:l° a c r: the ~~1soonS. D disposal) SySt.am in aCCOrllr'1' CE: wi:'.. :1+,;° Aan.~atd," Set f01' i , hereby, as Set by Certification stating that your septic has been maintained must be com lted and returned to the St, Certification County Zoning Officer within 30 days of the three year expiration date, SIGNED: _ St. Croix County Zoning Office Government Center t i/93 1 } OI C;annichaet Road Hudson, VVt. 54016 Lg 66:80 L661/9c•/Ey 10 3ridd kidnL VOL 170-jpAr[?4j WARRANTY DEED F=G:~ i Document Number: i:H CFFiCE ST. CHOIX CTY., W1 NOV 5 iQ96 Return Address: Greenwood Enterprises, Inc., 1416 Third Street, Hudson, WI 54016 at 10:45 A. M P w ; 3r of Deeea ' Parcel I.D. Number: ;r Z THIS DEED, made between Greenwood Enterprises, Inc, a Wisconsin corporation, Grantor and Robert W. Wolf and Jennifer L. Wolf, husband and wife as survivorship marital property, Grantee. s WITNESSETH, that the said Grantor, for a valuable consideration of one dollar and other good and valuable consideration conveys to Grantee the following descriW real estate in St. Croix County, State of Wisconsin: . r Lot 54, of the Plat of Sunltidgerlll, filed in the Offde of the Register of Deeds for St. Croik County, Wisconsin, on January 2, 1996 in Volume 6 of „Plats, at Page 46, as Document Number 538046. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; and Greenwood Enterprises, Inc. warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any, of record and will warrant and defend the same. j Dated this f,Z,hday of October, 19%. TokA SIFER GRE OOD ENTERP SES, INC. GREENWOOD ENTERPRISES, INC. I. By: By: E. Rusch, its president ary R I AUTHENTICATION ACI-IOWLEDGEMENT Signature James E. Rusch, its president > STATE QF WISCONSIN R ) a ent• ted 's day of October, 1996 ss• T ST. CROIX C6t NTY ) Lo' A. Murray Personally came before me s 2/444- TITLE: MEMBE TA AR OF WISCONSIN day of tuber, 1996 the ve named Mary R. Rusch, its secretary to me to be the who executed the foregoing instrument :;I ac w edge` ~he i, THIS INSTRUMENT WAS DRAFTED BY: Lois A. Murray Zilz, Estreen & Ogland No Public, State of Wiscon n / h 304 Locust Street My commission expires a W S (n P.O. Box 359 Hudson, WI 54016 ,9. Brenda Poulin Notary Public State of Wisconsin s ' a,