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HomeMy WebLinkAbout026-1096-20-000 m c n 0 O~ o 0 o C E 1`L N 0 3 °6 (D N Y ti C N N q E p N Si x O N O O - e' U ~ O a 3 C L O N C U N n > Z 3 Z N C LL 6 N E S] c ro ro _ 0 U N N N a O Q N ill CL U M N ~ N U) O V 2 Z ~ y ° a co M H co O Z a c r O N avi 2 d o W P r N E N a 3 WJ O ~ N Cn C CO • N Q 2 p L L (0 N C U O ® O Q 1 N Z; o N z E z c° O E C 7 V > O L ro N Q y- w N (D 6 N d 'L a v E O FN- H H 2 O • 2 0 0 0 d d of a a a a (D o cn z rn rn to _5 U LU rn a) ~ _0 7- 7- w c 7 N O N N co 0 _0 C) 0 a) :3 0 P- © p 7 N U C O O O N y O~~ W m ~ N N II w O O C N 'N <D CO E N j:7 Lli N U c a • y, N M L N N O O L) r L. O M Q' U N O Z 0' UI w d ro a ~ *k C2, d a Y 0 CL rlwV E i C C r A U V a 0 in K 1 ST. CROIX COUNTY J WISCONSIN ~ ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER _ 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with C application. Outside water lines are often turned off during i~ winter months, making access to the home necessary. Please make ~p4 arrangements with this office to insure that entry can be gained. ❑ Water V ( OC's) $185.00 Septic $50.00 0 Water (Nitrate & Bacteria) 45.00 ❑ Nitrate & Bacteria Water (Lead Concentration) 21.00 retest $15.00 Owner: Requested by: &ftu_ Address: - Address: Telephone NQ: (j -Z T ZIP _V4e T~ elephone N°: ( ) Property address (Fire If & Street) X Location-,9w sec. T N R1 WW Town of_~<<j~ry~~~r Realty firm: Lock Box Combo: Closing Date: '02 le -1091 - 2,0 - CV-0 3- go . 1g. 5/9C3 1 TO BE COMPLETED BY PROPERTY OWNER *PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: Is the dwelling currently occupied? es ❑ No If vacant, date last occupied: Age of septic system: Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? ❑Y CSR Slow drainage from house. ❑ Qf Sewage Back-up into dwelling. ❑N Sewage discharge to ground surface or road ditch. ❑N Foul odors. Other comments relative to system operation: I certify that the above information-,is complete and true to the best of my knowledge. OWNERS S IGNATU~ V~ " ..-G DATE : f~~~~~7 1 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION IN 1 ~~~IV►c 6 6) TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? OYes ONo soil series per SCS Soil Survey: sheet # Type of soil absorption system: OBelow grd ❑At-Grd OMound Approx. size 'X OGravity ❑Dose OPressurized Ft.2 OBed OTrench ❑Dry Well ❑Holding Tank OOutfall pipe OBSERVED DEFICIENCIES OOther OUnknown Septic tank Setbacks: OHouse OWell OProp. line 00ther Dose tank Setbacks: ❑House OWe11. OProp. line ❑Other OLocking cover OWarning label OPump/Floats OAlarm ❑Elec. wiring Soil Absorption System Setbacks: OHouse OWell OProp. line 00ther OPonding: ODischarge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N i Inspector - Title 1 YVUsonJonss • Cn4enNa • 8165+-NCR oupxew • siesm-L r~ncw. o I I I I ~ I i C>'3 ° A A O n z vcc ZZ < n zD p D I - n n a p I O ~ ~ I z I ~ I 1 I I I A; I D I v I i i T I ~I I I I "O . I • ~I I I I 01 CD I QO I ~ O~ I O p CO) *c Q a O -4 O Q a T 4 O 1 y T v T) n _ E o N A -Di O n :d w n O$ o_ m a rn P. n a 3 c 0:3 G C Z is p 7D fD fD m m o rt n ~ an a ~ <O N (ND H a o m o rt tli ~3 0 0 0 (DD ~ ID w n Q m am 0 o y n a 0 ~ v 0 D N CD m a z n CAI m0 O ft W G \ ~ H O V N o 3 40 m o to Ul c E cn o o ~ 7d cD 1D o 0 o r 0 c 0 0 ~ n FJ- r• c 0 En H c CL rt (10 78 a w Voucher IV COUNTY OF ST. CROIX Stag of Wisconsin Check a TO: James Carver Vendor # I Address 1108 Cty Rd E New Richmond WI 54017 (Complete for vendors without numbers) Account Name _ Zoninq.nFees Description Zoning Fees II Invoice H Fund Dept Acct Obi Amt 100-47480 s 50.-00- r f • TOTAL s 50.00 Filed , Iq ST. CROIX COUNT v 1 WISCONSIN Y l DONNE" - ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST-REQUEST FORM Please specify desired test(s) & remit appropriate application. Outside water lines are often turned off fee with during winter months, making access to the home necessary. arrangements with this office to insure that entry canPbeage make gained. 0 Water (VOC's) 0 Water (Nitrate & Bacteria $185.00 (8 Septic $50.00 D Water (Lead Concentration) 21.000 O Nitrate & Bacteria retest $15.00 Owner: - E Requested by: Ile- Address: Telephone W: ( ZIP syqZ ZIP T' Telephone W: ( ) Property address (Fire W & Street) : Locationt&J h;, Sec. 33 E T~(ZN . RJW, Town o fC11Gh Realty firm: Lock Box Combo: Closing Date• ,y TO BE COMPLETED BY PROPERTY OWNER . PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: Is the dwelling currently occupied? Vies If vacant, date last occupied: No Age of septic system: Septic tank last pumped by: Previous Owner's Name(s): Date: Have any of the following been observed? OY W4. Slow drainage from house. R Q1I Sewage Back-up into dwelling. VON Sewage discharge to ground surface or road ditch. ON Foul odors. Other comments relative to system operation: I certify that the above informatiori-,is complete and true to the best of my knowledge. OWNERS SIGNATUL ~ V IF DATE : t~~1~;"~/,/ t 1194 r OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION v TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? OYes ONo Soil series per SCS Soil Survey: sheet Type of soil absorption system: OBelow grd OAt-Grd Mound Approx. size 'X OGravity ODose OPressurized Ft•= OBed OTrench ODry Well ❑Holding Tank 00utfall pipe OBSERVED DEFICIENCIES OOther OUnknown Septic tank Setbacks: OHouse OWell OPsop. line OOther Dose tank Setbacks: OHouse OWe OProp. line OOther Mocking cover OWarning label., OPump/Floats OAlarm OElec. wiring Soil Absorption System Setbacks: OHouse OWell OProp. line 00ther ❑Ponding: ODischarge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION N Inspector _ Title 0 a, T W n 1 00 a c -4p $ Q m _y a 0 1 N W In C fD (D fA o SL n _ E o N 0 *4 02 n Z 0 (D 7d 00 CJ p m D W" N (7 N c 0 i ~ 0' 0 3 c c C Z ac (D a ~ ~ (D w N rn 0 rt• K D an a x L" ( H a (D (D o ~ o c rr tai o b P. cn :3' 0 O o ((D 0 (D N m a(D _ ~rt ' < S T ,o N n O a m ~o 2 O CL Z n -A, 9 o to ~ o r (D L cn y, O C) 0 21 O y N (D 0 6 H- 0 N ~ 0 H 0 N 3 A 9 N O N N rt W cp 73 a w .1 i + Voucher # COUNTY OF ST. CROIX State of Wisconsin ll Check N 1 TO: James Carver Vendor # I Address 1108 Cty Rd E New Richmond, WI 54017 (Complete for vendors without numbers) Account Name ZOnitlgnFees Description Zoning Fees j Invoice H Fund Dept Acct Obi Amt ! 100-474-__• 50-.00 i s s TOTAL. 5 0.00 Filed , 19 t VI( STC - 10 4- AS BUILT SANITARY SYSTEM REPORT ,r RGi~~~D OWNER ouHbiaf ' ADDRESS b ?ONINGOFFICE 85 Crd 14A SUBDIVISION--/ CSM J'1", - SECTION T y Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET _OF_.SYSTEM A A4. &A s~ fog ISM INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: Bv SEPTIC TANK PUMP CHAMBER p G K IFapRMATiON Manufacturer: I A) l9k-1 Liquid Capacit .w. , ~ : . Setback-f4rtsm:~ ~euse O erg, Pump: Vanufactu'mr Model # Size Float seperation N /Gallop /cycle. Alarm Location- ~1t ! ~a # . SOIL ABSORPTION SYSTEM Width: > Length Number.of trenches C Distance & Direction to nearest prop, line: sa . Setback.from: well: 70House Other ELEVATIONS Building Sewer 017.95 ST Inlet: ! 4i ~ST outlet: w PC inlet 1J J~-- PC bottom Pump Off He Bottom of system Existing Grade ~j 7~ Final grade 9. DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 157- 3/93:jt Wiscorisio Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryRe,CrAiM Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)]. Pgrmjt_yQlsie,'s NaCnR;.,S ❑ki1xvyCjM6s Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: l:nrtV1Y1J Parcel T hg_1096-20-000 l Oro (6U t'1 s ; , 'f, TANK INFORMATION ELEVATION DATA A9700513 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic VV tegve~ /0017 Benchmark 3 2 0~. ov Dosi ng A 0, /`t t W -2 Aeration Bldg. Sewer 5`.2, q?.T Holding 046 Inlet o P Qto , C/ TANK SETBACK INFORMATION V'4*4 outlet 7 /4 9'/s-&P 6 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic gvY -a' 27 r NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade qG .5-Manufacturer Demand 67- Me it ho(t (o S V c? 7.7 Model Number _ GPM TDH Lift ri yStem TDH Ft [Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED RENO Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENStOMS- S /32 DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREA LEACHIN nufacturer: SETBACK INFORMATION Type O ER Mode Number: System YO' 767- OR UNIT DISTRIBUTION SYSTEM Header/Manifold r, Distribution Pipe(s) r x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 10Z ' Dia. Spacing 2 trsv\ S 14 Z 7Zai' SOIL COVER x Presswre.Systems.Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx_SegdQd.lSoddes4 xx Mulched Bed /Trench Center Bed/ Trench Edges Topf6il ' } E] Yes No E] Yes E] No I r `7 COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 33.30.18.514B.SW,SW 1108 COUNTY ROAD E -roe 61,foc Toviybt' lm 001.Z5- 1) © lcl~ ~CVIC-V aM el 11/1 s In 5- L/ 44 4 4::::/ . ~1'fIGII l1. 1b-q Plan revision required. ❑ Yes No Use other side for additional information. 1'L (o 17 0~ I W4 SBD-6710 (R.3/97) Date Inspector's Signat e ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Safety and Buildings Division ~~■~r■■,t 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. (2- (In Ilk 4 • See reverse side for instructions for completing this application State Sanitary Permit Number 2991?C The information you provide may be used by other government agency programs E] Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert Owner Name Property Location Q ~j /4 C jU 0 A, S T , N, R ~ fir) W Property Owner's~Vlailin A ress Lot Number Bloc} N ber kz_ [N4 City, State 45~j Zip Code Phone Number Subdivision Name or SM Number /V No -j lp, r L" VIA k,~ I S~v o1 lQv(d-S 37 A II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms Town OF e Ill. BUILDING E: (If building type is public, check all that apply) t e//~ Parcel Tax Number(s) ! _ 1 ❑ Apartment/ Condo 33. 30' /g' J/7" cx~4 1.0 to 2 n 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 130 Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. X Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an C~SystemSystem 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 O Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq: ft.) (Min./inch) a 4 93.2 Elevation 11.2-5 A6 I :y Feet 977 Feet VII. TANK In Capafity IF gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. New Existing strutted Tanks Tanks Septic Tank or Holding Tank d27~ % ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber El I ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Pri Plumber's Si natur : (N Stamps) MP/MPRSW No.: Business Phone Number: ~s /S G t S Plumber's Address (Street, City, State, Zip Code): Ne "-D "Olk r )IMnaA. IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issue Issuing A ent Signature (No Stamps) ~f Approved ❑ownerGiven Initial Surcharge Fee) Q~//► Adverse Determination "Zr` X. CONDITIONS OF APPROVAL / REASONS OR DISAPPROVAL: - abov4donrt ekrejftn1 ----frZ p r dl G®A. M 83 1f`Tl r6*rA+s . SBD-6398 (R. 05/94) DISTRIBUTION: Original to Counl y, One ropy To: Safety & Ruildino 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 pe'rmit 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- " ll. 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 surchatges (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. -7& ryas C4r-. SLs . 3- 730 1~' //®r AL"j _Rrem o-r\ci cv Z A _ PCC COAA AA V3 ~ ~6Q 3 10 10 3 ~ i ; ~ i i I i I I I I t - ' I I I i I i : i I I ~ I ll I ~ I I f PAGE OF Dr\ `.FUSS J~C~IUr'1 O~ /n~ ZCI7 Jy Sk!n ~l '1 &v3 R(Jir" LOil- F11611 Air Iniele And Observation Pipe nn ~.QyJ KI c1+~V~c7 h ~ LAD--L' 0 i ~ Approrisd Vent Cap 1611AIMUM 12* Above 7 final Orede .1/ ly ec3 3 T'3 ouPJ9'w Q _C U\W\O (4 20- 42- Above Plpp ~ 1° Cost Iran To Final Orade Vanl Pipe sl«en Noy Or Srmnertc Coverlny win 2' Ayyrayalo Over Plpe 01e1r10vllon Pipe 0 0 0 Teo : 6- ApyreeoU i Beneath Plpa ° Perl«eled Pipe Belo, o '-Covpllno T«inollnp AS on Balloon Or System P~ppo5c pine-1 9r1%Clt SOIL FILL DISTRIBUTIOI.i PIPE APPROVED SIMTHETIC COVER- -9 n0ji. "-ll1ATERlN- OR 9" OF STREW 2.OFAGG9E4AlE OR MARSH I•lAy ELEV. OF-13_0 -EEY_~ (•~r0 PlL-21~2 AGGREGATE S DISrRIPj'JTIrJ1J PIPE TCU BE AT LEAST cao _ INCHES BELOW ORIGIMAL GRADE AMU AT LEAST ZO INCHES BUT 1.10 MOP C THAI) tit IMCHES BELOW FINAL GRADE MAXIMUM DEPTH OF F-XC/IVATIOIJ FROM OKIbWgL 6KAo. WILL BE / IIJCHES MIKIMUll 9£Frtt of EACAVATION rAOM 001k►4 IWAL GRADF- WILL BE INCHES SIGAIEO: LICEUSC IJUMBER: _ [Sle ° DATE: Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor anct Human Relations Page of 3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. ajie' flan must County ` Attach complete site plan on paper not less than 8 1/2 x east include, but not limited to: vertical and horizontal referedire*n and S1 C t-CO percent slope, scale or dimensions, north arrow, and loca~ertp,~~a(~st roadParcel I .D. # I~CLtiVCLf ab oAPPLICANT INFORMATION - Please print Reviewed by Date Personal information you provide may be used for secondary purLave f.1) (m)). 1'L Property Owner 20NlNG Location Govt. Lot 1/4 5(b/4,s 3 3T 3O N,R /9 40r) W Property Owner's Mailing Add ess t lock# Subd. Name or CSM# Q g 6,A4 `l , tip 1 A /V14 City State Zip Code Phone Number Nearest Road "A I Wt I S p t'j ( 71S) ay6 ^5376 El city illage Town 1 )7k' ❑ New Construction Use: Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow ~ gpd Recommended design loading rate bed, gpd/ft2-,-,Y-trench, gpd/f12 Absorption area required 1500 bed, ft2_Z(2.2trench, ft2 Maximum design loading rate _,_~bed, gpd/ff i I trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations f re r'C kjz'V A-, P A 104p K Parent material '?i_ )C"I_ Flood plain elevation, if applicable. It S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system S❑ U [9 S ❑ U KS Ea U ❑ S ~KU ❑ S ;R U ❑ s N6 U SOIL DESCRIPTION REPORT 5.11 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench -l] /o 2 bk M-~r a W 3 .3 y -2 17- loo Vt- Al ft S S e K r C ~J z .3 ; 9 Ground y d S V v C L. ( -3 elev. g eft . Y6- A C w - 7 Depth to limiting factor ; in. Remarks: Boring # AD A $ 3k th r e La ~ , ~ > p bk r?) r -5 3 2311 Iva 5 Ground elev. / , ft. 'C 0 Sir Depth to limiting factor >_A4(_in. Remarks: CST Name (Please Print) Si nature 9 Telephone No. c w eV Jf -4 y(p r~I-3--s 1J1 t~ Address Date CST Number 5~4 Alg4j PROPERTY OWNER ~~n. L~6N Ue f SOIL DESCRIPTION REPORT Page 6f PARCEL I.D.# 0 g 6 C~ a Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench f~ l _3A A) S r Ground `6 ,0 a a in 7,9 elev. DR5 /~s 4 3 iy 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 GP /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) Io n. C ~v r- sa TI 5c 7~ t~~ 1~,. ► ,Sk~Lj "IAJs w c~ c,-33 -3 o A) 1 = e -1-/ /6v, n : , : i i a i ~ i : i i I _ - ~ - _ ! _ 1 _ _ i_ ~ _ _ ~ _ _ - a~ - _ , J. _ - I i I t ~ i _ i y - . i _ _ _ _ ' - _ ~ _ _ I _ i i - - - I _ - . I I i _ _ - - - - _ _ _ _ , ~ i I . I _ _ - - I ~ i ~ i ~ _ i i--- _ - - i. _ _ i ~ i i - _ _ - - _ ~ I - r - - - i I ~ i 1 ~ ~ - - i ' I - - i~ ~ ~ ~ i_ ' ~ i i ~ I ~ ! r ~ i ~ ~ ~ ~ - i _ - - - - ~ ~ - - ~ I r-- , - f- - _ i ~ r- I ~ I ~ ~ ~ ~ i r _ ~ T _ - - - I` I I - I ~ i i i r ~ _ _ r _ _ - i i i _ _ i i_ ~ ~ ~ f rt ~ ~ _ _ I I - _ - _ ~ _ _ _ _ _ - ! i _ _ _ ~ ! ! i I ~ - _ . ~ _ _ ~ ~ _ - i _ _ ~ I II ~ i i i ~1. _ _ l - ~ ~ ~ ~ I _ . i _ - i i ~ ' _ i _ - i i j ~ _ I I ' i 1 i ~ ---1---- - ~ STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBb1flER 1'1~-- MAILING ADDRESS / 11%fl ~y l 116/ PROPERTY ADDRESS c 1P (location of septic system) Please obtain from the Planning Dept. CITY/STATE 7 PROPERTY LOCATION ~Cy 1/4, SO 1/4, Section 3 T _,3j,-)-N-R_/,_W TOWN OF ST. CROIX COUNTY, WI 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. 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 t y expiration dqte. SIG DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 T C - 100 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, (rpec 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 .~C~~ Z &5"- Location of propert - 1/4 36o 1/4, Section -3,3 T N-R /e W Township Mailing address G} ?v --7 A zl-oj / Address of site Subdivision name Lot no. Other homes on property? Yes--A-No Previous owner of property c~L Total size of property Total size of parcel ZZ9 GGCi Date parcel was created I Are all corners and lot li s identifi ble? -(_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. S' nature Applicant Co-Applicant Da a of ignature Date of S-lqrfature' e £ . DOCU~fg"T PIQ - V~ J ( p~ ~E V `O i~ BTATE 0/ WI>1GONAIN • roRM 11 VOL vaia wr►aa saswao non nsooaaNe patA y 354352 REGISTERS Office U. HL Jon & Kag, lurts St, CROIX Gp a WI& a Corporation duly organized and existing under and 13711 R/C'jj. for RSe"d *b_1 Y v#ttut et tLt brws of dw stile of Wisconsin, located at udaon i' do OfJBA. AQ t a+.~a A Carver anc~ Y - 1 d w of the Am part. and ;F vnda L. swr. =art>terly kn4MA g~_Lygda AILOwen of o• ~ - pant. lot, d the stoned'ate. That dw add party of the bat prt, for and is coasiderationof the sum II 1 gasg'1a(}1,0Q) and other good and valuable conaiderat ! - - am vo i M it /dd by dw add pant a of the second part, the receipt whereof :s hereby confessed and .3; -c&M*M@4W ku VW*n, pwa@d, bargained, sold, remised, released, aliened, conveyed and con-, liae*4 sari by that pre eats does site, grant, bargain. sell, rwise, alien, convey, and confirm ucto t _ *am - of the second past-. itBheirs ana assigns forever, the following described real estate, situated is k O'CANDO gt= CrOilt State of Wisconsin, to The M1% of SYX of SO, Section 33, T30N, W N, according to the recorded plat thereof on file. TRMSM y 3 ~F''.0 D FM _ (r! NNUIBMARY, CON`MNL-N DESCRIPTION ON RAVER11M QDR) TOguber with an and singular the hereditaments and appurtenances thereunto belonging or In say wise appertsisins; "A an 62 interest. claim or demand. whatsoever, of the said party of the first part, either is law or equity, either in p° ' Mrtfe si^ dde, . < t . ltaee; at, In and to the above bargained ,remises, and their hereditaments and appurtenances. 'T,s' , bm Md to Wd the said premises as above described with the hereditaments and appurtenances, unto the said patt.. - I a d Cis Meoad park sad to- their heirs and assigns FOREVER. 1I ~Ltti dte wd - John & Kam Zac. I a1 IM itat pmt, for itself and its successors, does covenant, grant, bargain and agree to and with the said part_j&p-- Of dW of these presenb it is wilt p 1 their heirs and assigns, that at the time of the unsealing and delivery OPP" Rid of dw pteoisa bove described, w of a good, +ure, perfect, absolute and indefeasible estate of inheritance in the bow. I* fee siaWk tie saw an fine and dear from all iacumbr.nces ~ the dtat the above barssioed premises in the quiet and peaceable possession of the said part-_iea of the second part, i awd sm4pts, swine all sad every person or persons lawfully claiming the whole or any part thereof, it will forever WAR=ANT and' W70ess Vured, the said John & Ka Inc . of ilia feat past, has used thaw presents to be signed by John L..CCurrell ,Caod its corporate sest to be WOOD= .446 den of December A. D., tA-.._2 I'A . AAI" xx VRxamcm O ~__.tl s_+tss! D AM Ago John L. ;Cltrrel COtrNTERat N1CD: i ASri~~~ - - _ryn i ! - "kk7f Of '!>9Gt7i M MIN= T_ 's f...-December A6 D Ig t day o ' 4. ce'~1 l M Kates }4. Currell v. - president, aad......._..__ Secrets"