HomeMy WebLinkAbout034-1032-90-000
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AS BUILT SANITARY SYSTEM REPORT
OWNER jZ r a ~
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ADDRESS \GS
syo
SUBDIVISION / CSMJ LOT
SECTION T R9 N-R~ W, Town of ST0
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
a ►A'1
Joe
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wed ~Ar,
t 3
INDICATE NO H ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
,
BENCHMARK: d O
ALTERNATE BM: Q I
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Liquid Capacity: 1000 - CoSo
P
Setback from: Well House Other
Pump: Manufacturer_ d ~fi L Model#StA)3 3 Size 7
Float se eration
P l S Gallons/cycle: 1
Alarm Location a o~~ 0
SOIL ABSORPTION SYSTEM
Width: Length S Number of trenches I
Distance & Direction to nearest prop, line: 10F'~w
Setback from: well: o~60+ House ISO Other
ELEVATIONS
Building Sewer
l ST Inlet: - ~ ST outlet: -
PC inlet PC bottom Pump Off
Header/Manifold_O 3 'Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB:
LICENSE NUMBER: -AP 7-?a V
INSPECTOR:
3 / 9 3 : j t
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
Y t . (ATTACH TO PERMIT) Sanitary PermitNo.:
GENERAL INFORMATION 299058
Permit Holder's Name: ❑ City ❑ Village'Ej Town of: State Plan ID No.:
BRANDT, JOEL SPRINGFIELD
CST BM Elev.: Insp. BM Elev : BM Description: Parcel Tax No.:
c 034-1032-90-000
TANK INFORMATION ELEVATION DATA A9700374
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 2kZ4,11:4 &&2 94Z, Benchmark
Dosing >2~ P/tvY,,
Aeration - - Bldg. Sewer
Holding St/*f Inlet y~ jj'
TA SETBACK INFORMATION St/ M Outlet 1,2 ' %24,3
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet r n
Air Intake 7r~•6'~
Septic S~ NA Dt Bottom j' 9 8
Dosing NA Header / Man. 3 Q
Aera ion NA Dist. Pipe
Holding Bot. System 3,0 /6 a.~2
PU P / SIPHON INFORMATION Final Grade
Manufacturer Demand 61Y7 bt 5..1/ 00,
Model Number 55 P GPM
TDH Lift Friction,4~ Syster> S' TDH 104 Ft
Loss
Head
[Forcemain Length Dia. n Dist. To Well 7 7S '
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Lengt}, / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS !s DIMENSIONS-.
SYSTEM TO P/L BLDG WELL LAKE/STREAM HING Manufacturer:
SETBACK CRAM
INFORMATION Type O //C; q , ode Num er:
System: .d >6 r2-a .(/A OR IT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Z1g Length Dia-00 Length 06 Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ 5eddVd xx Mulched
Bed /Trench Center ~p u Bed /Trench Edges lo?-/e" Topsoil _y_1 s ❑ No 2"Ye s ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SPRINGFIELD 15.29.15.228C,SE,NE 966 RUSTIC ROAD #3 (310TH)
I ,
ol_
"0- T
G~
Lao
Plan revision required? ❑ Yes LJ No
Use other side for additional information. ZQ -30 62 1
(G
SBD-6710 (R 05/91) Date In e€*'s Signature Cert. No
ADDITIONAL COMMENTS AND SKETCH t
SANITARY PERMIT NUMBER: `
Ic-~1 ~i
r
SANITARY PERMIT APPLICATION Bureau and Buil ingWater reau o off Buildin Water System!
r 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, en
• See reverse side for instructions for completing this application State Sanitary Permit Number
0905-6
The information you provide may be used by other government agency programs ❑ Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. Q /Y //1„ ® ,
~.J(7~~ ~ ~-C../ State Plan I.D. Number
1. APPLICATION' INFORMATION - PLEASE PRINT ALL INFORMATION
Prope rty Owne ame roperty Location
Jib e, I sl 114I 114, 5 6 T'19 , N, R 6
Pr erty Own 's Mailing A dress Lot Number Block Number
IlLeU " I
umber SubdivGisio~nJN or umber
City, State lip Code ~ t Phone
11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ it Nearest Roaedrt,
_3 ❑ Villa s Pn~, -7 1~ Y -
Public 1 or 2 Family Dwelling - No. of bedrooms -To OF
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
C -3
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. ❑ New 2. W 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 a 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
"790 -75o o 0P Feet Feet
VII. TANK Capacity gallons Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete con- steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank beG ~e~ ( ( l Q jt ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber (P SO I CG 0 ( ® ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumbers Name: (Print) Plumber's Sigrjature: (N tamps) P/ PRSW No.: Business Phone Number:
Plumb is Address (Street, City, State, Zip Code):
sl- eKX_ t ,,y76n 1,J7, s y 7 S"/
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee OncludesGroundwater Date Issue Issuing Agent Signature (No Stamps)
~
WApproved ❑ Owner Given Initial 0 Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
9B (R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
• i
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:
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
11. 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 numb6rlwith 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.
SAFETY AND BUILDINGS DIVISION
2226 Rose Street
Nviscons'in La Crosse, WI 54603
Department of Commerce Tommy G. Thompson, Governor
12-Sep-97 William J. McCoshen, Secretary
RED CEDAR PLUMBING JOEL BRANDT
KEVIN LANNON
N 4676 471 ST ST
MENOMONIE WI 54751
BRANDT, JOEL Plan ID 9720087
SE,NE,15,29,15W
Municipality of SPRINGFIELD Inspector: Leroy G. Jansky
County of ST Croix (715) 726-2544
Private Sewage plans including the following element(s):
MOUND 450 GPD
The submittal described above has been reviewed for conformance with applicable Wisconsin
Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY
APPROVED. The owner, as defined in chapter 101.01(2)(e), Wisconsin Statutes, is responsible for
compliance with all code requirements.
This plan action is subject to the conditions listed on the following page(s).
A copy of the approved plans, specifications and this letter shall be on-site during construction and open
to inspection by authorized representatives of the Department. All permits required by the state or local
municipality shall be obtained prior to commencement of construction/installation/operation.
This project is under the supervision of a state inspector. As inspection concerns arise feel free to
contact the state inspector at the number listed. The inspector for this project is listed above.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or
at the address on this letterhead. Please refer to Plan ID number listed at the top of this page when
making an inquiry or submitting additional information.
E. Sincgerely,
/ iSwim~
rd M. POWTS Plan Reviewer
(608) 785-9348
SAFETY AND BUILDINGS DIVISION
2226 Rose Street
Al LaCrosse, Wisconsin 54603
MF
Department of Commerce Tommy G. Thompson, Governor
William J. McCoshen, Secretary
RED CEDAR PLUMBING
Page 2
September 12, 1997
Plan 9720087
- A Sanitary Permit must be obtained from the County where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats, prior to installation.
- Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats.
SBD-5524-E (R.07/96) File Ref:
20087
Joel Brandt - Mound
597-41121
Location: SE 1/4, NE 1/4, Sec. 15, T 29 N, R 15 W
Town: Springfield
County: St. Croix
Date: September 12, 1997
Owner: Joel Brandt
Address: 966 Rustic Road # 3 (310th St.)
Glenwood City, WI 54013
Plumber: K7/in La on
Signature:
7320
License # P
A- '
Attachments: 6748-Plan Review Application
SBD 8330
page 1: cover
2: calculations
3: plot plan
4: system cross section-.
5: plan view, lateral detail
6: pump tank exit detail
7: pump curve
page 1 of 7
Conan w 1.S
A,PpQ ~°na jy
VIDEPgRTIyERo
St F ~T OF CD~r ,
ETA RCE
UI~DING$
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System Calculations
One family residence 3 bedrooms
Loading rate ~`3b gallons/sq ft per day
Depth to ground water in
Depth to bedrock in
Cross slope Z %
Force main length ~O } ft of Z in
Manifold/header length N ft of in
Drainback gallons
Lateral length @ ~•o ft of Z in
Lateral elevation I's ~•OS ft (bottom of pipe)
Lateral hole size V' f- in @ 6-0-0 in ( S-' 0 ft) spacing
v<- holes/lateral, \!ir holes total
Lateral volume gallons
Total lateral discharge rate gpm @ ft head
Elevation difference ft
Friction loss 0.66 ft @ gpm
Total dynamic head ft
-L C>
Pump/sVhon gpm @ ft of head
Manufacturer Model # Sw 33
Dose volume , 3 3 gallons
Lift/siphon tank ~ ~ ~`'`TO•b`'`~ C•O,"1'O o-o gallons
Septic tank gallons
Measurement pump on & off in
Height alarm from tank bottom in
Reserve capacity } gallons
talcs page 0 f
oA %01
0 F-
a
y
1
1 96
C,A
C11 CA
s ~
a d
C2
Y
# C4
vdl O{ J ' J
Q N N q
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~1oSrr: ~a•~.•»: ~S 2.~' S ~ o•r. o.~ o~ ro~~
ate.
:
O 1,4 K 0 1 O h ~T a►~ CA.r. ~Y X00 1'~O yr. 1: ~J d • 0 ~ N-~ t S' ,
Z.s
L X i ~J Q w: 1 z FORL-it
Mmsr4
WEATHERPROOF
LOCKIMG COVER .T<JNCTION
B%C
~(AB~C .
4/A~N E
pvlcK a~corv~cT--~
4N C.T. IM>•AitkNMM~~Mb T
w~t7t7 ~ s~ 12
'.I. PIPG 3'
p NDIbTURIND
24" %.D. 1 4 G.L .
SOIL.
VENT
aklaw M4~tKOLE
IN
/II)LiT
a WCAP
• ~ NO:G
OPPAOVLQ A 22.2
C.Z.Pw
KET abwa &VF43 1 AL 3' t o
PI/i 4 2" tM+D~s11iR6.
ECTtOMi ON
(~RONMO
o
PUMP
D ,6
towtitETE .
v • c7 6co CSC
SEPTIC f (CATIOUS ZSQ
DOSE q
TAWKS MAWUFACTURCR. IJUMOER OF DOSES: PER DAY
TANK SIZE: aALLOIJ& DOSE VOLUME
S L~`c `-s 3
ALARM PIAACTVQCR: IWCLUDIAIG DACKFLOW: GALLONS
MODCL NUMBER: , OI 1A CAPACITIES: A= Z~ Z WCNE5 OR GALLONS
>3WITCN Ty/E: 5 = INCHES OR Z4 GALLOWS
PUMP MAMUFACTURER: C. INCHES OR GALLOWS
MODEL NUMOCR: s~ 3 D• INCHES OR ~O Z GALLOWS
SWITCH TdPE: NOTE: PUMP AND ALARM ARE TO bE
MINIMUM DISCKAst" RAT 6PIA INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFCRE'UU OCTW[GJ PUTAW OFF AND OISTRIOUTION PIPE.. FEET
+ MIAIIMUM NETWORK SUPPLY PRESSURE 2.5 FLET
+ FEET OF FORCC MAIM X ,/VponFRICTIOLI FACT01t.0 FEET
a~
TOTAL DYNAMIC HEAD x , FEET
Ili " , g
IIJTERAIAL DIMEIJ6106Ja OF TAWK: LEWOrTN ;WIDTH ; LIQUID DEPTH 3
6 0~
c
I 1 I
- Performance Data
32
Pump Characteristics
Puns /Motor Unit Submersible
Manual Models SW25M1 SW33M1 W 24
U.
Automatic Models SW25A1 SW33A1 64 1/3 HP
W
S
Horsepower 1 /4 1 /3 a 16
Full Load Amps 8.0 10.0 ; 1/4 HP
Motor Type Shaded Pole (4 pole)
a
R.P.M. 1550 $
Phase 0 1
Voltage 115
Hertz 60 0 0 10 20 30 40 50 60
CAPACITY-U.S. G.P.M.
Operation Intermittent
Temperature 120" F Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24
NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0
Insulation Class A GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10
Discharge Size 1-1/2" NPT
Solids Handling 1/2" Dimensional Data
Unit Weight 30 lbs. 1. All dimensions in inches
Power Cord 18/3, SJTW,101 std. 3-1/2 - 5.7/8 - 2. Component dimensions may
4-1/2 vary ± 1/8 inch
(2D~ optional) 3. Not for construction purpose
1-1 2 NPT unless certified
3.1/2 DISCHARGE 4 Dimensions and weights are
Materials of Construction approximate
S On/Off level adjustable
Handle Steel 6 We reserve the right to
3.1/2 make ievniom to our
lubricating Oil DIBI@Ctrlf Oil products and their
Motor Housing Cast Iron specilications without notice
Puns Casing Cast Iron I
Shaft Steel '
Mechanical Seal Faces: Carbon/Ceramic r -
Shaft Seal Seal Body: Anodized Steel
Spring: Stainless Steel r"r
PUMP tt t.a
Bellows• Buaa-N ON
10.1/8 9-1;2 1
Ins eller Thermoplastic
Upper Bearing Bronze Sleeve Bearing DISCHARGE
_ HEIG~
Lower Bearin Single Row Ball Bearing
31/2
Strainer/Base Plastic 3 PUMP
OFF
Fasteners Stainless Steel
AURORA/HYDROMATIC Pumps, Inc.
1840 Baney Road, Ashland, Ohio 44805
(419) 289-3042
Wisconsai Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3
r with Comm 83.05, Wis. Adm. Code
.Division of Sajety and Buildings X',
Attach complete site plan on paper not leah ' size. Plan must FCounty
include, but not limited to: vertical and horizontal refer qi ' ection and St. Croix
percent slope, scale or dimensions, north arrow, a _...8f1. ste' nearest road. 034-1032-90
APPLICANT INFORMATION - PI Tint allifo , .1 Reviewed By Date
Personal information you provide may be used f dary rle~my Law :p4 (1) (m)).
Property Owner Fro" Location
Brandt Joel L0 'ovt. Lot SE 14 NE 1/4 S 15 T 29 N,R 15 W
Property Owner's Mailing Address r Lot Bloc~#SbdName u. or CSM#
966 Rustic Road # 3 310th St.
City State Zip a hb er ❑ City ❑ Village ®Town Nearest Road
Glenwood City WI 5401 S rin field 310Th St.
❑ New Construction Use: ® Residential / edrooms 3 ❑Addition to existing building
® Replacement ❑ Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/fF .6 trench, gpd/fF
Absorption area required 900 bed, fts 750 trench, f? Maximum design loading rate .5 bed, gpd/ft' 6 trench, gpolft:
Recommended infiltration surface elevation(s) 102.55 ft (as referred to site plan benchmark)
Additional design / site consideratio4nstall 5'x 75' rock bed mound on nominal 100.8 as upslope edge of rock w/ 1.75' sand fill
Parent material loess Flood lain elevation, if applicable NA ft
S=Suitable for system Conventional Mound In-Ground Pressure AT Grade System in Fill Holding Tank
U=Unsuitable for system ❑ S® U ® S0 U ❑ S ®U ❑ S I ❑ S ®U I ❑ SE U
. SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
Boring# Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
„1.. 1 0-4 10YR 3/3 - sil 2 m cr mvfr cs 2flm .5 .6
2 4-11 lOYR 3/3 - sil 2 f sbk mvfr cs if .5 .6
Ground 3 11-14 10YR 4/3 - sil 2 m sbk mvfr cs if .5 .6
elev
100.8 ft 4 14-24 10YR 4/6 - sill 2 m sbk mvfr cs if .5 .6
5 24-28 l OYR 4/6 i'pyg 6 2 sil 2 m sbk mvfr es
Depth to - 5 6
limiting 6 28-34 1 OYR 4/6 m2p l OYR 6/2 scl 0 m mfi - - NP .2
factor
24"
Remarks: occasional Gy si coats on peds 14-24"
2 1 0-5 10YR 3/3 - sil 2 m cr mvfr cs 2flm 5 6
2 5-11 10YR 3/3 - sil 2 f sbk mvfr cs lm .5 .6
Ground 3 11-15 10YR 4/3 - sil 2 m sbk mvf- cs if .5 .6
elev f2 10YR 6/2
100.7 ft 4 15-24 10YR 4/6 T5YR 4/6 sil 2 m sbk mvfr cs lm .5 .6
Depth to 5 24-28 10YR 4/4 m2p IOYR 6/2 cl 0 m mfi - - NP .2
limiting
factor
15"
Remarks:
CST Name (Please Print) Signature: Telephone No.
Henry F. Grote 715-665-2681
Address P.O. Box 57, Knapp, WI 54749 Date CST Number Ref #
8/7/97 222774 149
PROPERTY OWNER: Br-dt Joel SOIL DESCRIPTION REPORT tae Page 2 of 3
PARCEL I.D.# 034-1032-90
Depth Dominant Color Mottles structure GPDif? ,
Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots q
Bed :Trench
3 1 0-5 10YR 3/3 - sil 2 f sbk mv& cs 2f1m 5 6
2 5-11 10YR 3/3 - sil 2 m sbk mv& cs if .5 .6
Ground
elev 3 11-17 10YR 4/3 - sil 2 m sbk mv& cs if 5 .6
100.3 ft f2p 7.5YR 4/6 sil 2 m sbk mvfr cs - .5 .6
4 17-27 l OYR 4/6 l OYR 6/2
Depth to 5 27-34 10YR 4/4 m2p IOYR 6/2 cl 0 m mfi - - NP .2
limiting
factor
17"
Remarks: one vertically oriented 7.5 YR 5/8.5/3 root mot w/ classic dark center 11-17
Ground
elev
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
J 0 O
? C J t d H
~l
r 3
0 _9 r s a n
J ! r! 4
4- .d M V
d s J
11
(~J. ~ c y o
~ ~ a a ~p r
CIA~
Q( dd r~ ° ~ ~
g C r'
P4 pip
S
~ Q
3
' J
S 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, (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- k er-PvncJ
Location of property 1/41/4, Section, Ta?g_N-RI_W
Township Mailing address g(j(Q r obf c (@f?
Address of site
Subdivision name Lot no.
other homes on property? Yes No
Previous owner of property ~i Lj
~rC> /e, J( Total size of property
Total size of parcel
Date parcel was created' r 7:2
Are all corners and lot lines identifiable? _ i Yes No
Is this property being developed for (spec house)? Yes --A"' No
f Volume and Page Number V17,V 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 f r 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.
Sig- ture of Applicant Co-Applicant
9 -/7-97
Date of Signature Date of Signature
STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER U
MAILING ADDRESS 1 CG ~Q / O
Sao t Z
PROPERTY ADDRESS ( Le-A1o00 C L
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE GIQ.ALA'200d 0:-j IAA' s` Q) 1
PROPERTY LOCATION,5E_ 1/4, E 1/4, Section TAN-R 1 S w
TOWN OF t t ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER
CERTIFIEDSURVEY MAP 3(o VOLUMT _,q AGE ' LOT NUNII3ER~--
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, it 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 I, 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.
Ilse property owner agrees to submit to S1. 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.
lAkle, the undersigned have read the above requirements and agree to maintain the pr ivatc sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNK
Cert ification stating that your septic has been maintained must be completed and retu11l'1 to the St Cron
County /.oning Officer within 30 days of the three year irat n No
SIGNED:
DATE 9 7-_97_
St. Cron County Zoning Office
Government Center
1101 Carmichael (toad
lludy,n_ AV'1 54016 11i`)3
II : j
COCUMENT NO WARRANTY TNif SPACE R[fCRV(O FOR w[COw- INO DATA
DEED
STATE BAR OF WISCONSIN FORD 2 -19" , >
504264 VOL 1029P+ ~O
F:rG)$TER S OFFlCE x t+, ,
ii ST. CROIX CU.. VYI =
Doroth M RorrLee, a • single person.-- j id4AxReao:d #
x
j
AUG 2 0 1993
- -
• 3:3p . P M
. k
-
conveys and warral.ta to ...._JOel-►.- ,Braridi< and Dianne
G,,D•..,BraLndtL..huahand.._an_d_.vlf-a I~ aV13te:aoese. s ~F
...........holding..ns_.auryivarship..ISaxital ij r~. t -
pxopertY.............................................. ;
:
.
. use
oix_. -
G ~R
the following described real estate in County,
State of Wisconsin: o
Tax Parcel No:
Part of the Southeast Quarter (SE's) of the Northeast
Quarter (NEkl, Section Fifteen (15), Township Twenty-nine
(29) North, Range Fifteen (15) hest, described as follows:
lot 1 of Certified Survey Map filed August 16, 1977,
in Volume "2", Page 434, office of the Register of Deeds
for St. Croix County, Wisconsin.
it .
# A
I I:
k
This i_s homestead property. y
(is)
Exception to warranties: Easements and restrictions of record.
1
G~ n
Augus~. . 93
Dated this day of - - - - • . ~
r
- --------..(SEAL) ..--11/- ~,•-~~(l-F-'•• . (SEAL)
• ..Dorothy.-- Ro?~Lee
~ } w
.................(SEAL) (SEAL)
's .
o { ~
AUTHENTICATION ACHNOWLBDGURNT
Signature (a) STATE OF WISCONSIN '
St. Croix
County.
< 3
=
sotto ntigted this day of_.......................... 19 ftmonaliy came before me d,, ..of
August 19. . Up #ve gamed * .
- - -
Row>;ee, s
Dorothy
-
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, - . ) G... :.A..r. 1~
by 706.06. Wis State.) -
to sx yno" to the person -c-_--.••W f the
INgtoolng ent nd acknowledge. ems' r
THIS INSTRUMENT WAS DRATTED BY I R` ~S-~.'-~.:
s •
CERTIFIED SURVEY NO. 113),
342363
Part of the SE4 of the NE4 of Section 15, T29N, R15W, Town of Springfield, County of
St. Croix, State of Wisconsin, being a part of Lot 1, Certified Survey No. 290, as
recorded in said Register of Deeds office in Volume 1 of Certified Survey Maps, page
290.
'6600'
N
• LOT I CERTIFIED SURVEY NO. 290 I I ~ 8
-o
O• • • ••.q.• • i•e.. q.. 0.. 0••.• 0.. 0 O
O
0)• Z Z.
(U N 890 14' 04• W Q • _
m
ea. 435.60' Z:
9 .
1 1 10 I
• r
a
W • LOT I EXISTING 3
: W BUILDINGS m I • W 3
n
• _
87,120 SO. FT. S ( W : = a
g 2.00 ACRES -1 g 8
• Qp0 1 I M I. 0 OZI
• ` Q • U: W E
I
I 1
1 J. W
W: L-a L-_1
a.:
Z: W
ai0 435.60'
U : S 890 14' 04• E
LOT I CERTIFIED SURVEY NO. 290 N
I LEGEND
S I /4° z 30" ROUND IRON ROD
SCALE 0 i6 WEIGHING 1.502 LBS/L.F.
c
I"= 100 FEET z
F9 33.00' '
300
0 25 50 75 100 150 200 i
EAST 1/4 COR. OF SEC. 15, T29N, RISW
N 890 14' 04 W I 11/4" ROUND IRON ROD
I, Thomas G. Kuester, Registered Land Surveyor, hereby certify:
That I have surveyed, divided, and mapped a part of Lot 1, Certified Survey Map
recorded in Volume.l,. page 290, being a part of the SE)-, of the NE4 of Section 15,
T29N, R15W, Town of Springfield, County of St. Croix, State of Wisconsin., more
particularly described as follows: 1.
Commencing at the East 4 corner of said Section 15; }y~~'~Gj~+oyti
Thence N 89° 14' 04" W 33.00 feet;
Thence N 00° 00' 58" W 808.12 feet to the point of begir-ring.; $ 1lI t
Thence continuing N 00° 00' 58" W 200.00 feet; RlESi
Thence N 89° 14' 04" W 435.60 feet; . 41 S-I345
Thence S 00° 00' 58" E 200.00 feet; Meoomorft VA
Thence S 89° 14' 04" E 435.60 feet to the point of beginning.,;
Said parcel contains 2.0 acres more or less. Su
That I have made such survey, land division, and plat by the direction of Frank
Kirchheiner.
That such plat is a correct representation of all exterior boundaries of the land
surveyed and the subdivision thereof made.
That I have fully complied with the provisions of Chapter 236 of the Wisconsin
Statutes and the subdivision regulations of the County of St. Croix and the Town of