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HomeMy WebLinkAbout030-1029-40-000 0., o -0 ° I ^qn 03 60!3~ o"o m can 0. 0 ~ I o c N m ,o c i O ~ = cn I > C) ,me 0 o m ov LO c o m I o i- do 00 Z a o ~6 a Z m v m c -C'4 Li c y ~ ° 0 c 3 mo m '0 a) a Q 0~ E Cc ~ m H z o z '0 W a m z I c C9 O z c (D Z c N rn c ww a~ m N N N J a vi CO C o 0 •N O a L L V .V N 1~ O c C O 4= w N O LO 0 '6 O Z H z Z z o N Cl) c c LO " e a = Q, - w I to c N d N o m O 0 a v -j E VN z > 0 3 a 5 • a a a IL v o o ai (D ~ ti } tq J U Cl) rn rn iz z -T 00 0 0 m CD, 0 N N c O a v ti~ C, c ~ a' v co - _ Q n N c v Q ~ to m I p N ~i H ~V O C. C p y C O O W O U Qf 0 0 rr ° 0) ~ U m a~ a~ a o 0 0 l L C V/ C C m N N N CL (D E CN U) U) p 0 N m c. W W C N I~ ' N '0 -0 w 7 'p V L~ O _ p • N O r CD N O z a' U) O I w Q a a • ea a 'm m r A 0 at 0 aiv 4if - 00 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER C~AI~~~ ~~N G(lO/~~/GJ~/t~ 3 • ~Opf~ ` DEC 1g7 yrT~ ADDRESS /a l~ 7 (Jt~/ O,¢`~s 4N • ST CROIX ; COUNTY ' /UPY-D ZONINGOFRCE SUBDIVISION / CSM# LOT SECTION 7 T LIr N-R W, Town of J bS~ I ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ALL NON-CONFORMING TREATMENT TANKS SHALL BE ABANDONED PROPERLY r f FOR ILHR 83.03(2). P 0 ' ~Oi5 7b INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ,rp / p of ~lo-r,t BENCHMARK: ALTERNATE BM: f6 "o Ej~ CU ~L~ e~f S/,v G" D ' N~ZU ~%G T,vlc ?SO ~ 'of ~-s' tiCLv P ('i~ 6e e-"f S % . SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION "w5T/4-Manufacturer: 4/&/L__S11,!:;X Liquid Capacity: l ~l S/ Setback from: Well >75 House DSO / Other 0,y/ - /i N Pump: Manufacturer GdyLDf Model# 3371 Size Float seperation / Gallons/cycle: 2'2 S . Nei- Alarm Location f(okT SOIL ABSORPTION SYSTEM Q / V Width: Length O Number of trenches Eq~ Distance & Direction to nearest prop. line: g, 40 ST, Rlw Setback from: well: 51 House 3o Other 22 '~v Poop. Ci.u ~,4ST-) ELEVATIONS (5,c;snNlr' 87. z o Building Sewer ST Inlet: 2 ST outlet: PC inlet (?i • 5? ' PC bottom Q3 • Sy Pump Off SO S ,4~' Header/Manifold 17-60 Bottom of system P~Q,w Existing Grade Final grade 4U t►.~LET- ~97.0 DATE OF INSTALLATION: PLUMBER ON JOB: Al//I • COU,(ti LICENSE NUMBER: 3.30 INSPECTOR: Fob, 3/93: jt INLC'TT TO lsT OiLOp F-'Dk ~77 Cm O f3o qom 5 0 i ~Q u ~ r!~ -v ' 11 ~ I' N Q T ^y ~ ~ Q y C'l e o ~ ~I ~ I I\ I I~ ~ y I r r ~ (l n ~ yII .I \ I it it ~ h ~ I I r l of I z l Z I t I I I-n N I w I I I I I w Iril U1 ~ I I~ i IOO I~IX ~ ~ I 1 I I hI I I ~ I I I ~ ~ II I~~ I I 6` I I i ~ _I I. _I I I r II I a- I of loi - lol r I I I I ~I I~~ 1 o y IMo Wisconsin De pgrtmentof Industry, PRIVATE SEWAGE SYSTEM County: .Lab,-,ranc)Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 299142 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: WORKMAN, ANNE & CHARLES ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: ae Parcel Tax No.: loo' loo' v +cle uric eel calls 030-1028-90-100 TANK INFORMATION ELEVATION DATA A9700458 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic M V✓ T 75-0 Benchmark loq-,~~ U. 1 -7 osin ('y`~"~ 2- so9 Mato /060 5M 1-1,47 /02. e 67 C @~1 /tilk-~N Aeration r 1 42 7 Z Holding fT Inlet 1~p g•7 TANK SETBACK INFORMATION (94* Outlet 7 S~ TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet -7 Air ~ / 7 5 d' 3•S Septic 170 sg' (po ' NA Dt Bottom 209-2' Dosing ~~j~ 17o r S~~ (pD~ NA Header/Man. 5.09 q?. Aeration NA Dist. Pipe 5-.4 (a -CIO (o .2.¢ 9 25 qy Holding Bot. System 1.00 ' Z 31 7. 7_2' a~3 4s V7 PUMP/ SIPHON INFORMA ION 37 rtiaX. Final Grade 3. (oG 3 S 99a3 99.0y Manufacturer 0 v S Demand Duo F,V> uZ I,~ S (,p~ 9-7,01 Model Number :j`67/ Za GPM TDH Li ft q , Friction5'5 " System_ TDHty,63-Ft Loss 1 F Forcemain Length 7 Y' I Dia. !e Dist. To Well /u SOIL ABSORPTION SYSTEM 100 of 4CSe, BED RENCH Width Length No. Of Trenches PIT No. Of Pits Inside Ilia. Liquid Depth DIMEN 3 DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufa rer: SETBACK CHAMBER INFORMATION TypeO Mod Nu be r: System&vewi > f 22 1U SO OR UNIT DISTRIBUTION SYSTEM Rev- g4-tvIc1^ Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length ` Dia. Length Dia. Spacing 3o' SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc. t LOCATION: ST. JOSEPH 7.29.19.107I,NE,NE 109,3 GOLDEN OAKS LADE 6e,~ SfOir- fanK 35' 4o F.QO), 2~ ItiS~~tl~✓ f-e-Vista +p6f- )0/A.✓! 4o oNow 4-' -he. joj,5 c, Uc,-N-6,7 of -~Oe Side"J1,1der In ;t'(ru e/ GHawi 6-e✓' . 3) lk) Sfzlte,r- placed 4y-par (0VCriAl Ove*''+Inec" be✓5 Plan revision required? Yes ❑ No (I (01 / Use other side for additio a information. Off{ SBD-6710 (R 05/91) Date Inspector's Si ature Cert No. • Safety and Buildings Division ~•p`~R 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 ST. CAI)( than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit tNNumber The information you provide may be used by other government agency programs ❑ Chl ck it"revi ~o~ilfpmvious application [Privacy Law, s. 15.04 (1) (m)]. so , l State Plan LD. N tuber 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property wner Nam_e A roperty Location ITAIPAI 4,d G~ NI 1/4 N'G 1/4,5 7 T Z , N, R ! E (or) W Property Owneer's~P, iling A d ?..e C G~ Lot Number / Block Number s er IZOC / Cit tate~~D J / a!, Z~ 4O~` J (hone Number ~ Su ~me or CSM N b W , W l izSg II. YPEOF BUILDI G: (check one) State Owned ity ?G f Nearest Road S El VIl age ?Z~Qk, ~~.s ~s'~1 Public or 2 Famil Dwelling - No. of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 7.:R q. I q-1o7% 03 d -/Dz?- y0•16_Z2 ~T L_ 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 12E] Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. .Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an System System Tank OnlyExisting 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 ❑ Se page Bed 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank 12 [ epage Trench 22 ❑ In-Ground Pressure 01 42E] Pit Privy 13 ❑ Seepage Pit 3 5•' 43 ❑ Vault Privy 14 ❑ System-In-Fill 5 If ff. so VI. ABSORPTION SYSTEM INFORMATION: = 7 1. Gallons Per Day 2. Absorp. Area 3. Absorp: Area 4. Loading Rate 5. Perc. Rate 6. S stem Elev. 7. Final Grade -75 v Required (sq. ft.) Proposed (sq. ft.) (Gals/ ay/sq. ft.) (Min./inch) y 0q::, j E00"t& liSO ! _6 O v/ A 4-1 7 • Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Exist in strutted Tanks Tannfk~s Septic Tank or Holding Tank 750 l(wv 1750 Z ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber larD /VM ❑ ❑ ❑ ❑ ❑ 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) r,MPRSW No.: Business Phone Numbe ?b ge*r ~eld~'lGLll 33 0 7/S• 31'~ ' ~ Plumber's Address (Street, City, State, Zip Code):~55 /A~~j I~IV 19,AA11 401-S IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee (Includes Groundwater Date Issue Issuing Agent Signature (No Stamps) NApproved Surcharge Fee) n A~ ❑ Owner Given Initial ~D ~(p~.ff Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SLID-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 maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- 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. 111. 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? Dopartmerrt Use Only. Complete'plans-and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must -.includethe followi•ng.: 'tA) 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. OLRRICHT & ASSOCIATES CO. 655,0'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants R+~~ i. S'~dl PROJECT INDEX p la.Vl 9V Z2 . If -Y7 DILHR Plan I.D. # y _ Date Owner dAl S Phone 3 f6 Address /D y3 6~6 /,QQ, IIV PS ''v Legal Description iv~C_. Town of //IV ps County s T r~Gepi' C. S. T. I ns to 11 0jr Local Authority/ Supervision PROJECT DESCRIPTION .e-rcr~s f~y~ S i~ , S S7 lp/1,~1.P . mss' l ~ 4? 5~,~ ~'~rr '7S a Gov SYS i w 106- .6 ~ , a spot w set v,'.~ G-- ~i• ~ ; s6. -F,~ . ~ : • y 3 t ~C 0-3 ~N Sco - * R r UIL Pg .1 PLOT PLAN VIEWS l.. H UIRN P9.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS ~a MIT .3 -Plr.* DOSING CHAMBER CROSS SECTION C/ 4T-S PUMP PERFORMANCE SPECS m O r two C 'I ~ o m ~ d It's 0 -'77N0 0 13 =om---~ O J m r Z p ~ c> N Ii ; 1 N Q o '_1 zzl ~ ~ - _ o on, ~y^o JS 1 I I I I I u~ z y d Z j~ ~ ~ z ~I I III I I r xl I`'yl Iw1 O ao Ixl Ihl J~ o ~t ~ I I Ih►I I W, v. I I ON ll~ cZh I I I 101 I °A • -C tp Dt> (AP 1 IAN -A ~I 7- a~ ~NS~J~c T/ov Iff M 'sue. Qo 9iP~f~~= c17.~s ~ s ysT~M 75 CAo SS SEC TIOv a~ ~NS~J~c T/ov I ff 1 v~~ #16 A9 1,70 19 CAa 5 5 SEC TioA,) o/5- Ti CA)6i~s 11604&tP I/zt-;v 7- C-4/10 „Z.._ FiNi S QED ~ Opt I(e.sa 3y PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS P,41C `f of S VENT CAP 4"C.I. VEPJT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER ?I 25' FROM DOOR, w/ (vA(A)l )6- iAgEl WINDOW OR FRESH 12"MID. AIR INTAKE ^7/ON GRADE I 4"MIM. F 9G'~ CONDUIT-- /0 IV gG.D PROVIDE I I - INLET AIRTIGHT SEAL I I ~v ~ I ~ I APPROVED JOINTS APPROVED JOINT/ A W/C.I. PIPE w/C.I. PIPE y~~ ~UM I I EXTENDING 3' ZXTENDIIJG 31 ALARM ONTO SOLID SOIL ONTO SOLID SOIL B ~1 N I I II 0 3, 3~ ELEV. FT. 1 PUMP OFF vsE 3 Ow g ~10~f'E sly o NK BLOCK SnNI~~~!'_ ~N /e v~l f io,J t _ n~ RISER EXIT PERMITTED OIJLH IF TANK MANUFACTURER HAS SUCH APPROVAL SEPTIC E SPEC.IFICATIOUS- DOSE (y%D(vESjL)P,t~ ~i1-«IIST DUMBER P TANKS F DOSES: PER DA4 TANK SIZE : CALLOUS DOSE VOLUME /a IMCLUDING BACKFLOW: 20 - GALLONS ALARM MAIJUFACTURER: MODEL MUMBERRu' ~,OVA/ L CAPACITIES: A= 2O INCHES OR 5~ GALLONS SWITCH TYPE: 1Irk(me 2- INCHES OR S~ GALLOAIS PUMP MANUFACTURER: UV Lv S C - INCHES OR GALLONS ~JV1I - CPO u 7 D= Zo INCHES OR Zsb GALLONS MODEL NUMBER: SWITCH TYPE: ~~J S~~A ~ r 7 NOTE: PUMP AND ALARM ARE TO BE INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE GPM 33 fiANk SECS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. - • FEET - " 4- MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . FEET EAC(A-p + FEET OF FORCE MAIN ' 7~ F 00nFRICTIOU FACTOR..' S FEET ~Ur f S ZS /S• TOTAL 09 JAMIC HEAD = /3,7 S FEET I INTERIJAL DIMENSIOMS OF TA►JK: LEM&T' H Z .-;WIDT)4 .;LIQUID DEPTH f6.7 S If - .11 Submersible Effluent Pumps 3871 APPLICATIONS Motor: FEATURES S ecificall designed for the • Single phase: 0.4 HP 115 p y or 230 V, 60 Hz, 1550 RPM, Impeller: Thermoplastic following uses: Semi-Vortex design with pump • Effluent systems built in overload with out vanes for mechanical seal • Homes automatic reset. protection. 6 Farms • Power cord: 10 foot • Heavy duty sump standard length, 16/3 SJTO Casing and Base: Rugged • with NEMA 5-15P 3-prong thermoplastic design provides Water transfer • grounding plug. Optional 20 superior strength and Dewatering foot length, 16/3 SJTW with corrosion resistance. SPECIFICATIONS NEMA 5-15 P 3-prong Motor Cover: Thermoplastic grounding plug. cover with integral handle and Pump: • Fully submerged in high grade float switch attachment points. • Solids handling capability: turbine oil for lubrication and Power Cable: Severe duty 3/4" Maximum efficient heat transfer. rated oil and water resistant. - • Capacities: up to 55 GPM. 0-Ring: Provides positive • Total heads: up to 24 feet. Available for automatic and Discharge size: 1'/2" NPT. manual operation. Automatic sealing. gaskets . replace • models include Mercury maintenance. Float rotary/ceramic-stationary, Switch assembled and preset Stainless steel fasteners. BUNA-N elastomers. at the factory. • Temperature: 1400 F (60° C) maximum. • Fasteners: 300 series stainless steel. METERS FEET + Capable of running dry without damage to cotnponents. 8- 7- 5 _5 GPM + C3 _ W 2. F = 6 20 - - - U_ I 5 - a Z 4 0 15 Tp p 3 10 - - - - - . 5 1 0 00 - 10 _ 20 30 1 40 50 i 1 c + + 4 + + + 0 2 4 6 8 10 12& CAPACITY 6 Wisconsin, Department of Industry, SOIL AND SITE EVALUATION / ,3 Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 9 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 0 3O /O Z~ • 9D • lo-a APPLICANT INFORMATION!. Please print all information. Re sewed y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). //-3-47.7 Property Owner . Property Location q Govt. Lot N`G 1/4 /Ve 1/4,S / T ~,..F,N,R lq 1 E (or) W. Property Owner's Mailing Address Lot # BZ4 ubd. Name of CSM# /©93 Go~O•v ~•S L~ 'as Hof /3 City State Zip Code Phone Number Nearest Road I UVPYDA--) 601, ft~plC~ (7!S ) 3500 ' 10gV8 ❑ City ❑ villa a Town 0'fk'$' 44" ❑ New Construction Use: esidential / Number of bedrooms ✓ Addition to existing building Ei]- replacement ❑ Public or commercial - Describe: N~/1 = NOT E~p~~ Code derived daily flow 1~0 gpd Recommended design loading rate ~N~~' bed, gpd/W ` L trench, gpd/ft2 Absorption area required bed, ft2 12,50 trench, ft 2 Maximum design loading rate ' bed, gpd/ft2 • 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 5Q . 3 ft (as referred to site plan benchmark) Additional design/site considerations s ex-- A"ai'eS ~Z 16Z-2 ptj Q _ p Z Parent material S14T Oll~ LOh•Ot Y 0&74Vy4!Y1- • Flood plain elevation, if applicable ft S = Suitable for system conventional Mound In-Grou ressure AT-Gra~~Ui System in Fill Holding Tank '90P I U = Unsuitable for system U'S ❑ U ❑ S 21-U ~'S ❑ U ❑ S ❑ S [ ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. C091. Color Gr. Sz. Sh. Bed , Trench 51L r IX4Uf i' acs /Of tap P /O y~ s/(n ~i// SQL /.urf s .t» Gfi' 4 S /u7~ N ; N Ground 3 ly Y A0 Vie SL. ZTS AC /YV1`T/~ CS ~i elev. 16 5 YS• /7-- W Depth to limiting ; factor Remarks: Boring # / d•F /ay~ 2!Z%/! S!L MiUi Q S 10-F N ;N 2. /0 YX 516 \1 Elcl;V '51& 4V 1141- P Aj to 3 36 7• S Y/? 5-Z- z -f She /;o 7'X CS _ . S . Ground 7 S ~l%X`{ D L S /hl a.L / • D ~.el^'• n ,r ~L.. 2~tr~t ~bt Tie Q,t• - . S ' • ~o Depth to limiting ,(actor y 6 in. Remarks: CST Name (Please Print) Signature Telephone N Rnimpi 74 1, 8 R71S• 3gG•g~£S Address Date CST Number q Zy ~o - ~s • q csT•'`l PBvate Sewage Consultants Reif; A'Nail Rd. If PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2-" of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench / ©•S /d z/3 e n,, ~S if N rJ 2 io Y~! SQL/ / s ,C 4S i~ N Ground ~o /~l s~ C- / / l • ~s • Z el v. &a w- I L G .5" • , Depth to limiting factor in. Remarks: Boring # Ground elev. n. ; Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in.' Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. n. Depth to limiting factor in. Remarks: Boring # Ground elev, n. Depth to limiting factor in. Remarks:. SBDW-8330 (R. 08/95) ; TMpnPTAMT Mnmr mn nT.TATLVDO f TLT[ M- r _ . C fi ti I I y0.1 o~ G ~ I I I I I y yy I I I I I I ° 1 ~ I I I I I I ~ 1 ~i I I I b', ~ I~ i hi i xl f1"1 ~ ~ I i I I C I ~ `N ul v ~ I I I I I 1 O` O, ~ ~ al i ~ I I I , ~ I I I I I I y W N c m 1 420023 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NE} OF THE NE} OF SECTION 7, T29N, R19W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN ALSO BEING PART OF THAT PARCEL KNOWN AS LOT 9 OF TROUT BROOK HILLS. NJ CORNER NE CORNER SECTION 7 SECTION 7 T29N R19W T29N R19W o i ?A1 north line of the NEI 11310.521 V ' o rn r 0 0 r m rt, ru ? U) m 00 to tD 2 N \ o o sy-• -3 co co o \ N -H N GD N CD f1 f7 ct fD • d 7 O \t~EN N rt 0 =r Tp OAKS CD C A NE C D0 \ y WN RpAQ o , a o a M N I S o r R_ 851 DEC 41986 ,p. SCALE IN FEET am" 0'of vemb 40 20 0 40 d~~ R cNis C=ft# G OWNERS e o O Rudolph E Kathleen Blakeman AREA OF LOT 1 G o0 1 `~\o~\ 1222 Golden Oaks Lane 2;400 square feet Hudson, Wi. 54016 eK 0.06 acres ~e~ Vs ~ m LEGEND o ? d J County Section Corner Monument 04. LOT 1 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the '-Y residence locatid wt: N~ 9, N 1/94, Sec. -7 , T 2/ N, R W, Town of • :~b Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. / G Last time serviced - *4 Did flow back occur from absorption system? Yes No ~ (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacurer (if known): LU/z~SZ° Age of Tank (if known) : tS Ye'f'~e5 - blzw~ 7-- (Signature) (Name) Please Print lolkS 330 7 (Title) (License Number) (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer OR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for Inspection opening over outlet baffle). Name iw EPr- Wlhkt e~'Ar Signature . MPS hPFS 33 t} ` 5/88 S T C - 100 y 'Phis 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 4,v. G Ldcation of property 1/4 /U 1/4, Section 7 ,TN-R /7 W Township Mailing address 49 f -3 6, Address of site Subdivision name /U Lot no. Other homes on property? Yes No Previous owner of property Total size of property...,. /1W X- S 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 16FIl and Page Number 3210 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 ffice of the County Register of Deeds as Document No. 41107 , 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. Signature of Applicant Co-Applican Date of Signature Date o. Signature STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER AXIAI MAILING ADDRESS 3 PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION / 1/4, N~- 1/4, Section 7 T 24 N-R_/f W TOWN OF cJ / S~ ST. CROIX COUNTY, WI SUBDIVISION (y 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 canaffect 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 a iration date. r ,1 SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 , TMIe cantor RaatatlfC !'.K RLGJRG:NG QA~♦ ` pC1C'~MENT NO. STATIC EAR OF WISCONSIN FORM 1-IM i WARRANTY HEED i~ ofKCE Iaubl J. Blakeman auxi ST. CROIX al* WI& This made betwom . F)'1 ife it'd for Record ft 29,h 1ceein.A,..H?..!?°~'~_s?'c~ ' aec.A.D~19-6 day of ~tw' " 8:30 A um y,TQr]aii l..... 'I~l: l e wcus'fii. P __.i>;ar tal Pi'aperw.... ; - wind vrife surxi moo' Gri ...............~1~i..---- Va.l~----..... t .~..._.1a_.considerattiiron~ t~ . l- ---5t: Raruaw ro con"Ya to Grantee the following described real estate in Coonty, state of Wisconsin: Jot i13 - A parcel of land located in the NE 1/4 of Q3 / 6 - yd Section 7, T29N, Rl", Towns of St. Joseph and Hudson, Tax Parcel No: St. a oix Mmty, Wisconsin described as follows : S 3 xjrees 39 minutes Oem>nenlaing at the NE corner of said Section 7; thence degrees 46 minutes W 50 seconds W (true bearing) 330.46 feet; thence S 0 S 88 degrees the centerline of an existing Town Ibad; thence 1174.86 feet along point of beginning; thence S 88 I 55 minutes 30 seconds W 1011.05 feet to the ~ N d9grees 46 minutes E I degrees 55 minutes 30 seoocds W 533.78 feet; W feet; thence 193.36 I 284.09 feet; t2senee N 58 degrees 07 minutes 40 seconds Southerly right- N 31 degrees 52 minutes 20 seconds E 107.21 feet along the right-of-way ofrway line of the T:'wn wad; thence Northeasterly along Southeasterly said eedy whose lEAr19M line 186.90 feet on a 145.83 foot radius curve concave Bence s 74 chord bears N 68 degrees 35 minutes 20 seconds E 174.37 feet; thence $ E 30.00 feet along said right-cif-waY line; degrees 41 minutes 40 seconds E 132.95 feet along said r'Ot- FEE thence S 54 degrees 10 minutes 20 seconds said right-of-way line on an of-way line; theme Southerly 96.64 feet along S 86 degrees 85.00 foot radius curve concave Northerly whose chord bears mutes F. 504.49 44 Minutes 40 seconds E 91.52 feet; thence S 29 degrees feet to the point of beginning- And; 4 of NE 1/4 of Sections 7-29-19 being a nortien A parcel of land located in the NE 1/ filed der 4, J986 in of lot 9 desgribed as follows: Lot 1 of Certified Surve17 as document *420023. i This 11----------------- homestead property. Volume 06", page (is) (is not) Together with all and si ~1arr the beredi ettt,! rid appurtg~+► ereunto belonging; Iu1do1 J. BTakemaul el - - And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except, protective covenant:; and recorded easements of record as of this date, if anv, and will warrant and defend the same. December Dated this - rd day of 19 86 (SEAL) _ fSEaL A- BlakeUM 94 . . N SEAL) - -•----•------(SEAL) W ]Kathleen A. Blakeman AUTHENTICATION ACHNOWLBDCiMENT STATE OF WISCONSIN S' (a)udQt County. ` 71!! «IA._ 41yi11AK---------- st. Croix L_W_/ 23rd 6 of QWIdBay of.... . - 4!'{4.._, 19 en Per my came before me8this d~~' sathr ~f 19__-•---- the above names • I~ix3olPh J. and Kathleen Blakeman U4.0 r - - - TITLE: MEMBER STATE BAR OF WISCONSIN - - • - - - (If not, --_a_-:-- is tho nnrRnn tsnn es"-.ite t,e