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HomeMy WebLinkAbout032-2093-80-000 o co 0 a d o d C/1 C ~ o 3 H. (D 3 # to I g " ~ chi m o a, o ~co~ o a w C (D `z d CD A < N ~ Q Q - L (D L3 N (D N m m m cD = U) 0 -0 S* O O N C@i -I v O O O O 3 A. fl. O 7 N D 00 1~~1 C O 0 d 0 '7 .`.1•l~r•~a P. co N V m N w ~a v C: V N 3 C 0 CD CD CL 5~ O co O(D O C7 O C U) J -I a j CO) Q CD - ;a z 0 0 0 fD. . 0 0 0 i13 O -q -.-I 2< ~ 0 N N N A 7 ZJ 0 0 0 CD rn cn 0 d CD m d co a 3 z N zco Z o Ell, D CD o aa) O a ter • CD CD CD CD m N N OIQ E (D CD Lo m Q z CD o A Z C* o ~ z o v a t* O R o z C-~ a ao v ::E a z 0 3 a ~ I o I cn ~ y z 41 a I Q ~ m n w c 'i cQo a CD CL cn 0 CD S D N Cr 7 S A ~ O a I N I °o v A I I A O CD cfl O O (D o O O Q- Wisconsin Department of Industry, Labor and Human Relations SOIL AND SITE EVALUATION Page of Division of Safety and Buildings ltll , ance with s. ILHR 83.09, Wis. Adm. Code 1 Attach complete site plan on a p p ss than*IV2 x 11 in a size. Plan must County include, but not limited to: verti a horiz I OrAce poi direction and ~-t, l.. r D t percent slope, scale or dimensi orth ar o fbcation an i nce to nearest road. Parcel I. D. # 4-~.' PCY1(~; h APPLICANT INFORMA - Please p~ .all info ion. Reviewed by Date Personal information you provide ma d for sec0~Ilffpurposes (P ~y aW, s. 15.o4 (1) (m)). r _ i Property Owner Property Location Govt. Lot N\~1/4 Cj\0j1/4,S ay T 3 N,R 9 E(or)(g) Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# Mr; 11anSen`s tvt~\t L*.1t4f„ 1~;\IS 1~5~ 0010. City State Zip Code Phone Number [:1 City El Village ® Town Nearest Road ~ If New Construction Use: ® Residential / Number of bedrooms- Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: p Code derived daily flow 5 C gpd Recommended design loading rate • 7 bed, gpd/fl2 7 trench, gpd/ft2 Absorption area required (O t 3 bed, ft2 !5 (V 2'5 trench, ft2 \ Maximum design loading rate 7 bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) IT2t S 4 + S 91. a5~ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U 19S ❑ U ®S ❑ U ® s ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 g Texture Consistence Boundary Roots - in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0- OK p31;t. - 1- F r r Z1 F -5 . a -I I• pal Y 1 SL I F s 6k, rnv1: r w 1 F Ground ~j ov P,'1 3 I- - Sc► vh L W V elev. g9Lft. 4 3n- ie e. '4 S -s L Cw - , 7 .8 Depth to 7; limiting factor Remarks r Boring # r mv~r Qt AE ~5 - I-, FCO 3 -~4 41 I-S - mL_ ~w 10F , Ground 1 H .S 1^'11-- C Lj elev. 95 3~ft. 5 qs-so I b R s I S - 5 tr1 L - ' 7, Depth to limiting factor Win. Remarks: a h r i Rj \j CST Name (Please Print) Signature Telephone No. T a IN v% ik Z', 1G 1 S -;I $ - 3S g Address IT 6+dt V. Pray V ; V w* Date CST Number D Do 1 . 11- 1 O- 9 I Sy l> a i PROPERTY OWNER~ar n. r.jwAv►r, SOIL DESCRIPTION REPORT Page ~of~ PARCEL I.D.# Borin # Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench p`C 3/ - F Car 1hvFr 15 C_ :1 I V< 4 13 L F 5 k m y f c. v) 1 F , S Ground 3 I -.15 to< y I3 L5 p • c~ L L I~ elev. a5• eft q s D - w, L c , $ Depth to 5 O 5~ - 5 - S Iti► r . 4l limiting ; factor in. Remarks: 3 r o r a v1 Boring # 1% A, Vz b- 1w 310 F 6r my r Q F y -ly oY y SL- FS vrv r GvJ 3 ►y-3 to 90 LS - 5 w,L ew 1vF , Ground y 33.1 A -SK Q'4) 5 0 - L GuJ ? , elev. 4;i-lo wn"6111 Depth to limiting fa for in. _qD 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 # 1 d- I blC 31 L F Ca r v F r• a a F S It-It IWCpy1 5L 1F -vre r C W 1F ; WA, I t >K 1_S o- s Vv%L C-w 1,, I? Ground 4 3D-S `S q1_6 .5 t> - s L C. W elev. Depth to limiting factor Qin. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: 7 330 (R. 08/95) W D - I Y4. r6, q I; ,r s j l i I!! i l l I!!~ i j Sr4l I I! l i t I I l I( ~ ~ i ~ I -T- i -1 I I t ~ ~ ~ 1 f ' I -T- 1 4c %Olt% C-1- i u i i i - - 63 99. B 4 - - - 19 - - 0,401 i r mo 1."N C- C~ z15 44 t ~7~ ' I - - - - - - - - - - I- ' i I I i L-7-1 I i , i : : ' I I w , i i L I , I ' , I I i I , I - : i I L , STC - 104 AS BUILT SANITARY SYSTEM REPORT r r OWNER - ADDRESS SUBDIVISION / CSM# _ LOT SECTION_T~/N-,,2/ Town of ST. CROIX OUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET SYSTEM 'Jr s 1i INDICATE NORTH ARROW Provide setba and elevation information on reverse of this form. Prov' e 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM:f SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity:4~~,,l Setback from: Well ,N 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: Setback from: well: House_2,,,~_ Other ELEVATIONS Building Sewer E?S 7 ST Inlet: qG,,?C ST outlet: PC inlet PC bottom Pump Off Header/Manifold a Bottom of system Existing Grade Final grade DATE OF INSTALLATION: s- PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin, Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division ST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita2§jr4itNp.: Personal information you provice may be used for secondary purposes [Privacy LRw, s.15.04 (1)(m)]. P~rmi3NQ J!ejpamft , RTY [96 SVVijge ❑ Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel "21x:2093-80-000 r a,, 11A, /M. 1 109 .t~Y7 %1ii 7 TANK INFORMATION ELEVATION DATA A9700278 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic i G Benchmark 9 Dosing / 3' Aeration Bldg. Sewer o y / ?go 171 Holding St/ W Inlet TANK SETBACK INFORMATION St/W Outlet 59' TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header/ Man. / qy_ 120 ' 1 11 Aeration NA Dist. Pipe 112, 2 9,65 Holding Bot. System 13-7 931 79/ PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Lrictio System TDH Ft oss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length , No. Of Tyenches PIT No. Of Pits inside Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION TypeO CHAMBER Moe Number: System: f 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 Bed /Trench Center Bed /Trench Edges -;?p a Topsoil E] Yes E] No E] Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 24.31.19.917,NW,SW 2028 77TH STREET LOT 1 6 r Plan revision required? ❑ Yes ❑ No Use other side for additional information. p <p SBD-6710 (R.3/97) Date In or's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH , SANITARY PERMIT NUMBER: 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 J 11 ,v 41y, than 8 112 x'11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number *57 The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (ril c.)W( , State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prope yo ner N e Proper cation NAI 1 /4 J 1/4, S T 51 & , N, R 71(or Property wner's Mailing Address ~ Lot Number Block Numbe/ / 11319& 77 `7 It tate Zip Code Phone Number SubdivName or CSM tuber s- ( > dNearrest II. TY PE F BUILDING: (check one) ❑ State Owned ❑ Ctad ❑ Vilage ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Town oF~G/yi III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 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 online B, if applicable) A) 1. 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 1 1 0 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 Requiredsq. ft.) -Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./ ch) Elevation O Feet 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 Existing strutted Tanks Tanks Septic Tank or Holding Tank - ,C _Z ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the u)hdersigned, assume responsibility for ins lation oft a onsite sewage system shown on the attached plans. Plumb r ' ame: rP Plumber' Si atu S m ) MP/MPRSW No.: Business Phone Number. Plumber's ddress (Street City, Stat Zip Code . IX. COUNTY f DEPARTMENT USE ONLY ❑ Disapproved Sagitary Permit Fee Surcharge Groundwater ate Issue Issuing Agent Signature (No Stamps) (X Approved E] Owner Given Initial 7610 /~~y 9 Adverse Determination /d X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SHD-6398 (R. 05194) DISTRIBUTION: original to County, One cnpy To: Safety & Buildings Divr ion, 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 systern, 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: I_ 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 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. IV/ hz!P v,0scor sin-flepartment of Commerce ND SITE EVALUATION Division of Safety and Buildings Page 4- of 3 Bureau of Integrated Services i . ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less x ize. an ust County include, but not limited to: vertical and hori referen dire d percent slope, scale or dimensions, north r and location and distance to a st road. Parcel I.D. # / _►l' 1997 _ APPLICANT INFORMATION - Pie a sprint afl ation. A Reviewed by Date 10 Personal information you provide may be used for s P N(R0W%j ' (1) (m)). s Property Owne _ Property Location f f Z Govt. Lot 1/4 J 1/4,S T N,Ror / _/17 'ue~e - _ Pr perty Ow s Mailing Address Block# Subd Name or CS K4# Lot # 1 2A 1 City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road ® New Construction Use: ~ Residential / Number of bedrooms Addition to existing building ❑ Replacement Public or commercial - Describe: Code derived daily flow /,,1~0 gpd Recommended design loading rate _ bed, gpd/ft2_ A~__trench, gpd/ft2 Absorption area required bed, ft2 7_:5 trench, ft2 Maximum design loading rate _„-/bed, gpd/ft2T trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system COS ❑ U 0S ❑ U (22 S0 U ❑ S ❑ U ❑ S U ❑ s O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft2 Consistence Boundary Roots in. Munsell Gu. Sz. Con . Color Gr. Sz. Sh. Bed , Trench 9 l < ' Ground ~eleev. / Depth to limiting factor ; _Z~2_in. Remarks: Boring # a- . 41, All Al)n Ground QIev. ft. , Depth to limiting factor in. Remarks: CST Nam (P ease Print) ) igna a Telephone No. Address Date CST Number l~d U - - n r PROPERTY OWNER AA la 4211,!EV4Ztae SOIL DESCRIPTION REPORT r Page ~ of PARCEL LD.# Boring # Horizon Depth Dominant Color Mottles Structure Dtft2 in. Texture Consistence Boundary Rooms • Munseil Qu. Sz. Cunt Color Gr. Sz. Sh. Bed , Trench sy" , c yv= Ground 3 e~d A114 lev. /42-s-ft. S _ Depth to limiting factor Remarks: Boring # rs r . Ground elev. - - /4~.Lft. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD/fl2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Boring # o- < s U Ground _ elev./ s /~,claft. ' Depth to limiting ; factor 7,Z ~Jn. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor 'n' Remarks: SBD-8330 (R. 07/96) 441 ,~.30 >C3 ~ ~ .~~•X I ass ov,e i1)0,0/ U~x~y 7X 7,,~ 7 ``!~D Sly ~ 9=97 ~dJ ~al i ys gr 4yy 3 j f Wisconsin Department of I(zdustry, (/V\ 40N labor *d Human Relations Page ~ of D;visim of Safety an i dings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County G include, but not limited to:'vertical and horizontal reference point (BM), direction and J -t• C r D t pf>rcent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - ?lease 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 ~~a f n p Govt. Lot N Vf 1/4 S W 1/4,S y T.3 N,R 19 E (or)t A Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# a 14•in,o~ 5 Ir 1t L.KL ~f S~' 9.~ Mc~-{av • C;ty State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Qr~"~- SSIr ~(b~~. )7? -7y.0 So aost~ e- ttE New Construction Use: ® Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow 5 C gpd Recommended design loading rate • 7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required (o L(3 bed, ft` 5 (a trench, ft2 Maximum design loading rate 7 bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) .3k 5 Y 5 7.) O L, y + S r! 9a . AS )ft (as referred to site plan benchmark) Additional design/site considerations Parent material r.% D, L 't' Flood plain elevation, if applicable ft Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank Suitable for system I 1 Unsuitable for system F4 S ❑ U 15~S ❑ U ®S ❑ U R S El U ❑ S 5 F-1 S ® U SOIL DESCRIPTION REPORT 'oring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench - o< e.3! :1. L ;:r, O's r F -S a -►I• U"(e y~ 5L I F s6►< rnvFr W ( F -S t, around 3 f3~~:r~~ t -So rnL ~VF , p ~yerlev. To{Tft. 4 ?Il- -7,5~ L- ~.IIJ , 1 Depth to ,riling ictor q' 5_ in. Remarks: nr2 U..nr,. 31 mg # O-c• Iw O/' F r MVGr 415 A ~5 13 1 o< N13 l.- vvvF LW I~ 15 , g 3 -a y/ LS or try L L Lv 1U P ground 9It s C W , , ev. , ' 5, 313_. -ft. S Ib~~s~- S b- S M L ; epth to rating dolor $Qin. Remarks: a tr, n ST Name (Please Print) Signature Telephone No. _~!1 1C 1 S -,Ali? • 3S $ {!dress Date CST Number -r ~ 5'f'q r {~~a • r ~ ~t lJ~ ?I- Ada S-F. • II-lo-9V 4011 PROPS "TY OWNER~CIr r. r, wav` r SOIL DESCRIPTION REPORT Page -,L of >ARCEL l.D.# 3oring # HORZOn Depth Dominant Color Mottles Structure 2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench - 3 F Co Pnv v lq~' 'S 14 1 V't 13 S 1- I F sb ~C M y C. c.v> t F , 5 around 3 I .~y P. L5 O-S c"' 1. IMF , , lev. 1j -)epth to S P ® 51 _ S - $ 1'ti+ 1... C' inviting actor Remarks: 3r 3oring # d- t b~( 3! L F r, r "v r q !F -7-Iy by y SI- FS V' vFr C. 1F ,S 3 )y -3 10 Q,4 LS v, C. W 1 v 5 around y 3;-q l W4 S p- rv't- C. vj flew. eft. S y~- ►o s/ S - t. t7 depth to miting !ctor t RnLin. Remarks: Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Boring # 1 b_ t aK 31 L F G, r v F r F S tp.rg 1D`CQ`I SL 1F r^-j Fr C.w 14- '41 L-5 O- 5 L. GW ~.3 ~1 Ground 30-S 21 y I.. Gw Ile vv% elev. Depth to , limiting factor _jain. 1 Remarks: Boring # Ground 'lev. ft. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) Lo-r 1! j 'rll ~1y SW 'q_ 5 ~ ? Ir' !!~klI I ! CS+-M- LtQt h 1 ! j I I I ~ I ~ i j T j , f i i I I j { - 9 0 r G c2' - - - ~ j I ~ I I ~ j t r \ ! i_ I rek - - - - - j ~..h - a B4 s.38' r Q ~1 - .-10 ' !h i i Fr q M I q• . 1-~ 1' r. e I- i I { i7 . LS AI - t--- ~j viii j !il I ij~ i j i i I i I ~ i I I{ w 44 -71 9211 ~ r t c AI h-t Jt Jt ^~..1J ~ ~ Ql C)! J ..t O N 4J 0 L O N" •o L,9t-~00L 3„hZ,lSoLON, to 4-4 c4' ,00'00£ ' jilt •C~J ~.a n w~ [Vt ° m m- mw U-4 C4 O C7 X, a > . DI 3„hZ, ZS LON r~ W o gene s ~ _...►t .••1 t~ a; Ni ^ 3 O co to CL. y ! O y~ tit Oi 01 V) 1 !1 --1! X99 x o W V ~ ' i L1 g N e-I ~ ~i C et• .n ~ u W LL.1 t^ii p W W n^ G^. V) •I•t o U i N 0 I ' Cn 41 41 U 2e 4) 0 HuC wI w w x - 4 a I x p rq W ,...tt ~ ~ o a° U E-1 (u .a V ~ O LLJI rq 01 Cpl 41 ~j c. L nS Z ZON ® w ' N ~ N _ ~zzsna ~x~ of- 4 O Z! 400'04h M,,SS,ZOoZOS I / r-t C~~C~77S W W ~I 99 - 11 , E O. O W. 19 UN u ~ 3 sC r F-t Mt r. :e c x l~ m lit -w e v , q O.(u t S s rA E-4 s-4 C)l CJ 3 'plc, a ¢ 26 9g' ac O •iJ r-1 S 1 I. C )1 Q !o rah. p ` w 44 E-4 e.. -AC O R~ H Q? .o~~ ,s , zt S r-• / m tl1 N Vl N v i •r~ N C~, a t~•~ o 4- C~ c a' sr n~MN z t-~D vj V v7 +3 u 'MuhZ, ZSo LOS a i JQOq of pounss4 441Z uopooS io VL3S 044 ;o ou L 4990 04; oq poauoJOIoJ oJO TBuEJeog `r NI W Ai 09-96 'ON •roJd >f00o>f46L9 uttJ,A Xq PoqioJp quawnJ3truJ 9441 DFILED EC 2 3 1996 ► KATHLEEN H. WALSH 553639 Re,;isterof0eeds ~ Crcbc Co., W~ This instrument drafted by Fran Bleskacek Proj. 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IC/) c n yo co p10 tri t F-- pr, '+a ~ pr~^v'~ Ct m rt 177 W 1--q r Ct O 300 00' DEC 2 39b1 IN01°52'24"E 1004.16' - 0 m. 0 a 201 R. PHONE 1-10. May. 14 1997 11:42AM P2 STC-105 SEPTIC TANK h'XA[riTENANCE AGFaENfFNT St. Croix County 0''r`IYERM1.1Yl1: R "I V 0 0- _7G_-2-027 R2~:LNG ADDRESS !-?1 L11+ )i f } : _ l ~~p f ! ADDRESS (location of septic system) Piease obtain from the Planning Dept `.SrAE e-a PROPERTY LOCATION _L\1_6 314p 1 1 114, Section 1W_,~ ~ _.-N-R_--~ y TW ~-utei'Yr_t-P"t' _ , ST. CROIX COUNTY, W1 emu? Y'i IOi I f~ LS l~ t l ~.1 `r.; n , LOT NUMBER s`E I ' 1 i3St RVEY MAC' VOLUME 1 PACE _'2Z,1 L4TNUMfii It r;ksoper use and maintenance of your septic system could result in its premature failure to hand., aa_Fs t : per iriaintcnance consists of pumping out the septic tank every three years or sooner, ;f net-d -r t_3 septic tank pumper. What you put into the system can affect the function. of the Serif n kat stage in the waste disposal system. St. ~'roix County residents may be eligible to receive a grant for a maximum of E,0°io of the re, to cen-nt of a tading system, which was in operation prix, July 1. 19`~1 St. Croix County acccpte-d this program in August of 080, with (he requireincrtt th::. -mers of all new systems agree to i,ecp their ystva:_ properly maintained. he property owner agrees to submit to St. Croix >ning a Lcrtification form, signed by the owner slid by a inaier ptumbcr, journeyman plumber, restricted plumber or a licensed pumper ver;'ving that (1) the on-site wasmwater disposal system is in proper operating condition and (2) after inf ection and punip:rib (it necessary), the septic tank is less than 113 full of sludbc and scum. li We, the undersigned have read the above rquirements and agree to maintain the private sewage oisposal system in accordance with the standards set forth, herein, as set by the Wisconsin UNR. Car; '_ttior~ stating that your septic has been maintained mu t be completed and returned to the St. Croix Yount-y Loring Officer within 30 days of the three year iration da NED, CATL: I _,Q x t„i lint' Lonin'g 'tttc 1°ludsLr:,'`dv"i 4t31 b 11/93 FROM R PHONE HO. May. 14 1997 11:42HM F1 T C ]-00 This appl.i.oation form is to be (,ornpleted in full and signed by owner(s) of the property being developed. Any inadequacies w only t-es~..~lt in delays of t1je per-snit issuance. Should t? j development be intended for rn-sale by owner/ contractor, (s) house) , then a scc-.cind forme should be retained and completed wi the property is sold and submitted to this offio(~ with rop: i ate decd recording. ,-f,rpzoperty l' i,o. Tocation of propertyl/9_S~_ Section T ~I N-R~ ` I to Subd vision name ~1tot no. -It_r, r.omes on property? Xes ~--No Pt'avious owner of property *~r'`•~- ~wct~Sca~ c: t<3 L s e of property, p _ - - tt. w,J.- _°reated Are all corn and lot lines identifiable? Yes No T~; this propa~Cy being developed for (spec nouse) ? _ _Yes Vo a kImC~ r l and Wage Number! 7 ( as recorded with the Regis INCLUDE WITH THIS APL : '-:TION THE FOLLOWING: A WINFRAN'.VY DERD which includes a CC3ME13T NUMBER, VOL13ME AND 1', NOMBER ANC THE SEAT OF THE REGISTER OF DEI'DS. In addition, ^ertitled survey, if available, would be heiptul so as to av, delays of the reviewing process. It the cieed descri.pt ,:eperences to a Certified survey Map, the Certified Survey Tna l also b : required. PROPERTY OWNER CERTIFICATION I (we-) certify that all statement: on this torn are true to best of my (our) knowledge- that I (we) am (ire) the ownoz(s) of property described in this information form, by virtue of warranty deed recorded ~n the office of the Coozity Register Deeds as Document No. and that l (we) presen own the proposed site for the sewage disposal system or I { .)bta i ned ain easement, to run the above ' described property, for construction of said system, and the scimo has been duly recorded c l ficl- of thee, County Register of Deeds as Document JS "g ature of Appi icant Co-Applicant WARTUT 'tY DEED SSA Fi~GiSt Dccwwft NWer• ST MWvO.,m JAN 6 1"7 at 11:35 A. at Dews PieW Ilk Numb : itwfusas aiw" heAm so or b d and and WW, COMIS md vJO"mb WWjs j. to A. ~ ' jrrraid p*'h►+ < Soft Of mcoat+a: fosowifvg d =Ad teal as in may. min, aMM6,s To* Labe 0% Fsst Addition to to Tom of Somafut described put of ou" )F Sled it Vd. 11', Pop 3196, Dm No.553639- MW ororx l# I of Ca&rM + y~ TTris is not fir. ~ y may' Haaooptiog ► B restictlons tmd ngbtr'°f-'fir if dry of Dovanb , 1996. w (SEAL) (SEAL) ~JoMk xwdogg« AQ 'ICATM Sionsaae(s) and JM1►ns Hardegga', buAwd snd w* mOmmmamd *is $Q%A-, &y of Dwanber, 1996. y Oilind TITLE: DER STATE BAR OF W;SSiOO SIN TEAS INS'T'RUMENT WAS DRAFTED BY: Attorney Kristin Oglmd Hudson, 9VT 34016 5-i4-1997 12=16PM FROM ALLEGIANCE G12 323 0644 P.2 ~ OZ 110e70a$ do vLn ~4a 3o Out( alga A 4AZ 1 ZSe t0$ All ill , So l0$ 41. 100' £OS ----o ~ c L ,92' Ztl ` o ms ° L ~ 6 N W N A V o c c N U u u ~ ~ y~, e w H Z! cc V O $ SDI ^I V vi y wj .71 1ri t•-i F+1 0 L n O.. c QI 9 w QI 0 c' . 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