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HomeMy WebLinkAbout034-1059-80-000 -0 0 Q o Q) ° o O °e). 4 ° i c ~ I 0 0 N V I' I ~ I ~ I I I I 'I 0 Z LL c O Q III M Q) Z ~n Z o Z ~ d d a m N F- C O E CD O 2 d O N ~ I N c • ~ o ~l s c O 'v Z Z 0 N Z I £ N 04 LO i CL m r co C ° o d O O N a C O G a 4I .6 (6 co - (n Fes- FN- = E w N en CL U) ° 5 0 0 0 Z'6 4 CL g III'' T OR 001) w O MTV ~9 M co LO 0) E O O 3 h m 3 a y C7) N O C O 3 y C O O O O O 0 c2 F- Cc) r\ co a O c E ~c v N v ~ N 0 C N c- O O_ O N O N r~ N ,C) O M w O V r O D1 cy) O_ N W O N O U y?,' O N Cn O N O Z N Z 2 (n E 4 4) v~ a a CL N r'~ £ i 'O C w 3 (L o C-0 0 Parcel 034-1059-80-000 03/13/2007 11:19 AM PAGE 1 OF 1 Alt. Parcel 27.29.15.413 034 - TOWN OF SPRINGFIELD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - VANDERPAS,VANNESSA M VANNESSA M VANDERPAS 751 HWY 128 WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 27 T29N R1 5W 40A SW NW Block/Condo Bldg: EZ-UT-1348/275 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-29N-15W Notes: Parcel History: Date Doc # Vol/Page Type 11/29/2005 813146 2935/492 QC 05/07/2004 761910 2567/11 WD 1236/62 WD 2007 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/14/2006 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 17.000 2,000 0 2,000 NO UNDEVELOPED G5 1.000 50 0 50 NO AGRICULTURAL FOREST G5M 20.000 18,000 0 18,000 NO OTHER G7 2.000 9,550 212,750 222,300 NO Totals for 2007: General Property 40.000 29,600 212,750 242,350 Woodland 0.000 0 0 Totals for 2006: General Property 40.000 29,600 212,750 242,350 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 119 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisr:onsin ,epartmentofIndustry, PRIVATE SEWAGE SYSTEM County: afet and Human Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 289341 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: OLSON, DONALD SPRINGFIELD CST BM Elev.: Insp. BM Elev.: BM Description: , Parcel Tax No.: /00,0 1d 0 , e' 2sA 034-1059-80-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent ir Ito ntake ROAD Dt Inlet TANK TO P/ L WELL BLDG. A Air v Septic aSy NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System C)s~`7' PUMP/ SIPHON INFORMATION Final Grade Manufacturer incite Demand Model Number c( GPM TDH Lift Friction P 5 System TDH Ft oss Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Len No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 91K ~ DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER ~VA Model Num er: System: y}) 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 Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SPRINGFIELD 27.29.15.413,SW,NW 751 STH 128 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH 4 SANITARY PERMIT NUMBER: r _r Safety and Buildings Division ~~.i_'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 than 8 112 x 11 inches in size. ~ t90 / • See reverse side for instructions for completing this application State Sanitary Permit Number -2 X93 V/ The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15-040)(m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION 0.~0 Property Owner Name Property Location S4" 1 /4 w 1/4, S ' T -2 47 , N, R /&i ;fir) W Property Owner's Mailing Address Lot Number Block Number o - 1-7-o 1-4 .4 Gem City, State . Zip Code Phone Number Subdivision Name or CSM Number !t/Bly MD d fit/i = '0/7 (7/,~' > 6- ~/0 I - II. TYPE OF BUILDING: (check one) ❑ State Owned 'tyy Nearest Road ❑ Public 1 or 2 Family Dwelling - No. of bedrooms Iowan of 5--t. A. 1.2P11 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) q p 1 ❑ Apartment/Condo d~; 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. X New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ------System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued- Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7_ Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation JT~ 1 -7 ;7 7 b /i A - o0,147 Feet , Feet VII. TANK Cag in 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 X /O-VV ' r e_,R .0 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber x vd 40_1~ ® ❑ ❑ ❑ ❑ ❑ 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' Signature: (NoS mps) MP/ o.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 39 ;2- F w / e- M w o0 0~ Ci`7`' 0/3 IX. COUNTY / DE ARTMENT USE ONLY (Includes Groundwater Date Issue ISSuin A t S S ❑ Disapproved sa tary Permit Fee ~ g g ) Approved ❑ Owner Given Initial r/u~ SurchargeFee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SHD-6398 (R. OS/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Divi ion, 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. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. 'County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ":-GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 42 A/ ADDRESS SUBDIVISION / CSM# LOT SECTION_a 7 T ~N-R__ZS-W, Town of - ST. ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM yo A ~ p v 3 ~ o we6~ 3,8RM No,,fse 3T /0o0-Zoo C"t~ L'o~n6o Mo INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: M 7 gee e - ' IJ1h ALTERNATE BM: SEPTIC TANK / PUMP CHAMBE / HOLDING TANK INFORMATION Manufacturer: /,g S-R Liquid Capacity: e lo D Setback from: Well House AA Other Pump: Manufacturer GD kf L Modell~ Size D Float seperation Gallons/cycle: ~p Alarm Location /gA S~° M N L SOIL ABSORPTION SYSTEM Width: Length -Number of trenches / Distance & Direction o nearest prop. line: .2,0// Setback from: well House Other ELEVATIONS Building Sewer ST Inlet. , ST outlet PC inlet PC bottom p Pump Off Header/Manifold v Bottom of system r Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: 2 0 LICENSE NUMBER: A-4 P E6 10 INSPECTOR: 3/93:jt SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce May 23, 1997 15837 USH 63 Route 8, Box 8072 Hayward WI 54843 SMITH PL GALE SMITH 3228 HWY 170 GLENWOOD CITY WI 54013 RE: PLAN S97-20307 FEE RECEIVED: 180.00 OLSON, DONALD SW,NW,27,29,15W TOWN OF SPRINGFIELD COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, roy . Jansky Wastewa er Specialist Senior Section of Private Sewage (715) 726-2544 Friday's 3133RD 1 SBD-7997 (R.11196) 5 ~v 'to' :z c ca a ' - 1.. -I - 1 Y i - i I 41 : J• MAY - - I- i-- - -~i Q 1F y~:~ c Sys j I I C~ - 1 - - wi.. lank m ml - _ i f j fM! NT OF INDUS I r~Y LABOR ANQ_t~UMFk' fE `A? IONS DF P_Ai `r D,(VISION OF SAFETY AND BUII;DiNC S j 2 ~ - ~p /?Gt SE. ORRESP~, -DEN C i - . r5o Vim. , - - . _ ' _ ~ _ ' - - o~iS •2 T-j+-~4 ~'~C - I i i } st~~ si f : , oo, i_ ;ago o i 2 0-10 - n I ~ - - - ~ - -I - Dom., r. _ _ . l- - -j~ - . 60~!~R/} a - So. - - - - - - -r - - _ i 21 - _ Luji Lt 1. Page Of _J Straw, Marsh Hoy, Or Synthetic Covering Distribution Pipe 4441um S a n d G Topsoil - F E _J I D 3 I; W,3 % Slope Bed Of 2- 2 %Z Force Main flowed Aggregate From F'ump L.oyer Cross Section Of A Mound Syslem Using A Bed For fhe Absorption Arco i G /r S T-g n e d. - License Plumber: I Date: 77ftS97-20307 -AA F ~Foce Main From Pump VII - ~ ~ _ _ E3ed I" z 2 i Distribution Of Pipe Aggregate Observation Pipe Perrnanent Markers Pion View Of Mound Using A Bed For The Absorption Area Page - Of I Perforated Pie Detail End View FAAred~ C7 View peR pvC QiNe '11rpb~~ A~ Q~S Force i~iain PVC P Holes located on bottom of force main are equally spaced End cap ---may ~+Last hole should be next to end cap rte, p,~ Z-20-30r' Distributation pipe layout P q Ft 5 ~ R ~ Inches 4 Invert Elevation of Laterals Ft S Inches X Inches S igned t~ CL~ YIM Inches Licenses Dates Hole Diameter Inches Lateral Inches Manifold " Inches Force Hain Inches # of holes pipe -1-Y PAGE 4-1 OF.' PdMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 'i' C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX a MANHOLE COVER 25' FROM DOOR, 12"MIU. , WINDOW OR FRESH ' A.IP, INTAKE I y GRADE 1 4" MIU. CONDUIT 18"MIN. . ,tv IAILET PROVIDE - I AIRTIGHT SEAL I I I V I I I APPROVED JOINT A ~'7~"\ \ I III APPROVED C J' C.T. PIPE Luc) „L I III 141C.I. PIPE EXTENDING 3' _ ~1'~' ( C'\v I I ALARM EXTEL101►JC, C►JTO SOLID SOIL I I UrJTO Solt D )t C I~" < I eel" CQ I- LCV. FT. PUMP-~ OFF r x~~ CONC.RETE BLOCK RISER EXIT PERMITTED GUL'd IF TAUK MANUFACTURER HAS SUCH APPROVAL SEPTIC E G~rL SPECIFICATIONS COSE , bee C.rr6 TAIJKS MANUFACTURER: IJUMBER OF DOSES: YPER DA-4 TAWK SIZE : lC-?lTV'~~G~ G'oMbo GALLOMS DOSE VOLUME ALARM_ MANUFACTURER: S.1" ~LeC• rRt> INCLUDING BACKFLOW: ZZ ' GAL-Or S MODEL UUMBM - /G H k.-I CAPACITIES: A= 12 F INCHES OR GALLOK; 3 SWITCH TYPE: _ M °l1' ak y 6 ~Z INCHES OR 23• d GALLO►_' S PUMP MANUFACTURER: - GO Z/ G C =INCHES OR J&b,~L GALLOI,. i MODEL NUMBER: - 4'- D= INCHES OR GALLO►t5 SWITCH TYPE: -_SJ E~Gt TRQ NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKEWCE DETWEEU PUMP OFF AND DISTRIBUTION PIPE.. FEET trAV OIL, + MINIMUM NETWORK SUPPLY P~~RE~~S~~SLIKTE✓✓ , .6 . ~ 7 ~ 2 U , O rl, + FEET OF FORCE MAIN X 1--.4L ooFtFRICTIOU FgTOR.~L FEET TOTAL DYNAMIC HEAD = ETl~~ INTERNAL. DIMILMSIONS OF TANK: LENGTH -f ;WIDTH .;LIQUID DEPTH D /fry/ 8/L Pe'h' /iVCh 51GUED:--J,~~C~~ LICEMSE NUMBER:~Ff DAT ~y© E: Vii''ESTBU1'iNE SUPPLY INC. e- 12 DUSTRIAL RD. Goulds ON, W1 54016 Submersible Effluent Pump EP04 3871 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle • Farms Motor: Available for automatic and and float switch attachment Heavy duty sump • EP04 Single phase: 0.4 HP, manual operation. Automatic points. • Water transfer 115 or 230 V, 60 Hz, 1550 models include Mechanical RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty • Dewatering preset at the factory. rated oil and water resistant. automatic reset. SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EP04 built in overload with construction. • Solids handling capability: automatic reset. ■ EP04 Impeller: Thermo- 3/4" maximum. • Power cord: 10 foot Plastic Semi-open design AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for • Total heads: up to 24 feet. with three piong grounding mechanical seal protection. SP Canadian Standards Association C • Discharge size: 1112" NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo-(CSA • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" listed model numbers rotary/ceramic-stationary, three prong grounding plug improved performance. end or "AC".) BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 1041F (40"C) continuous superior strength and 140°F (60°C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET, stainless steel. I I I ll • Capable of running 10 dry without damage to s 30; components. I I I -►(~•:-5 GPM ----I Pump: EP05 s 1 -I • Solids handling capability: c 25 '~-2.5Fr- /4' maximum. 7 w • Capacities: up to 60 GPM. S2 - • Total heads: up to 31 feet. 6 20 - _ _ _ • Discharge size: 1 Y2" NPT. a , j I 5 • Mechanical seal: carbon- • rotary/ceramic-stationary, _j 1 s BUNA-N elastomers. 4 ° EPOg' • Temperature: 1040F (400C) continuous 3 10 140°F (600C) intermittent. 2 EP04 1 I _ I ! 0 00 10 , 2030 44. GPM 0 2 4 6 8 10 12 m-/h CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 83871 f - Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Huntan Relatibns Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ~q % jj include, but not limited to: vertical and horizontal reference point (BM), direction and 5 r" p /percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # lSw APPLICANT INFORMATION - Please print all information. Reviews by R Date 7 'u Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). y Property Owner Property Location P(^f Aj 34~ R Govt. Lot h 1/4 1/4,S~ T O 1;y r Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# S rc, y city State Zip Code Phone Number Nearest Road p GL D? 71 (74-f1 12- 6,f'❑ City El Village Town Hw /12 New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: `Q Code derived daily flow - = gpd Recommended design loading rate & bed, gpd/ft2~trench, gpd/ft2 Absorption area required _bed, ft2p'trenfch, 2 Maximum design loading rate IVA" bed, gpd/ft21//trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations / Parent material 6;.4 % A'L Flood plain elevation, if applicable 14 ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ s ® u X S ❑ U ❑ S ®U ❑ S ® U ❑ S 0 U ❑ S ryu SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I l 0-7 m :z 6 /F M_ /U 'r-X G .2M s" '6 / - L. A114 M E: S ~ S 45' Ground *?e S-4 .26LTM 6 .r G' .2- 3 elev. Q ft. 25A K e- FL NA p Depth to limiting factor 2AP _in. Remarks: 3 d Boring # I 0- / p - /,4 a Sd k Af- _G Y 9M a- Q -l8 S L E-r C 1F)9 Ground ( C ✓J l! ne Vhl /V jV/j -elev. ft ' , Depth to limiting factor il-in. Remarks: CST Name (Please Print) Signature Telephone No. ~r I Address Date CST Number .2 a- ~ '7a G~e~tr~•r.ooo/ G f- ~„is 7-a?-9~ /`76~ PROPERTY OWNER C1®661 R~I /)✓S_1y SOIL DESCRIPTION REPORT p Page of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench v 25,6 M R G= S 2 M Ground P .S S ,4O t Z• A , Ilev. ; .Oft. Depth to limiting factor - Remarks: Boring # Ground elev. n. ' Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor 'n. Remarks: Boring # Ground elev. n. Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) 73 )v S c A/ I r9 ' i I , i I - ~ I i N' ;e- P -o t 00, i t---- PIP 'P, e Al i 1 • r y r ' o v' R h e I- i- - --CA_ niess~!- e I i I r - - i- _ i- - 1- 77- r I ! 1 ~ I I i I I i I Ed- I ± } I r i I C i I 1(~ II' ~ i I i I I I I i I I i ! I A -L -i - - - - - - LI - I - - j--- - - - - i 1 I I I- I I I IL ! t- i I I I i, I 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 L/o NA L d 0 L S-ON Location of property,: ~ 1/4 1ti1 1/4, Section ;2 7,T.)-/N-R W Township pi~/ti Mailing address Address of site 75/ S 77H. z a g Subdivision name Lot no. Other homes on property? Yes__/_No Previous owner of property /QD d e g T~' /o/Q~/V SG~/V Total size of property &e /t C /7 e- Total size of parcel at) 'f GR e, Date parcel was created Are all corners and lot lines identifiable? Yes _)(_No Is this property being developed for (spec house) ? Yes_,;!( No Volume and Page Number p oz. 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. Signature of Applicant co-Applicant X ~~1~ 6197 x S Date of Signature Date of Signature 7 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERS t 14'NALW L/_71S_0N MAILING ADDRESS / - 1--7a 7'h ~4 v~ ~ ~OO PROPERTY ADDRESS ` 5-1 ~ T f/ la (location of septic system) Please obtain from the Planning Dept. CITY/STATE L /'1 .Sd Al Au / PROPERTY LOCATION Sia 1/4, 0 1/4, Section , T_2LZ__N-R W TOWN OF Ol 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 three ye xpirat~on- c~te. X SIGNCO. °l X DATE: f~ St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 STATE BAR OF WISCONSIN FORM 2 - 1"U cQ ti 558669 WARRANTY DEED DOCUMENT NO. VOL 1216 PACE 062 REGISTER'S OM SE Robert R. Prinsen and*Myrna J. Prinsen, ST.CROIXCTY..WI husband and wife, survivorship marital property. *said Kann J. Primm a Myrna Ptingm MAY T 1997 i con and warrants to Donald J. Olson and Julie L. at 9:45 A. M Olson, husband and wife, as slaviwsip i} marital pvqmrtv naplals► of o.«b ii ....J THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in S t. C r n i if CbamtX State of Wisconsin: ATTN: Morwip Dept. First National Bank of River Falls PO Box 188 River Feb, WI 5M 034-1,059-80 ~I PARCEL IDENTIFICATION NUMBER ~i Southwest Quarter of Northwest Quarter (SW 1/4 of NW 1/4) of I) Section Twenty-Seven (27), Township Twenty-Nine North (T29N), I' Range Fifteen West (R15W) TRANSFER Ij si.. FEE i i j This is not homestead property. j R*x (is WO Exccptimtowarranties: Easements and restrictions of record. I ii Dated this ' a 9 day of Af A.D.. 19 Q 7 - (SEAL) (SEAL) • Robert ^ P nsen i (SEAL) A'Yyr+~ \`T./~Anwd (SEAL) Myrna a'. Prinsen aka *m Prhmm I i AUTHENTICATION ACKNOWLEDGMENT j State of Wisconsin, ~ Signature(s) ss. PieLrE ¢Coumv authenticated this day of .19- Rs9ooaDy carne before the this 29hh day of 0_. 19 9 Z. the above named Robert 'Q Prinsen and j Myrna j r- alta Mvttta PriryM TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authorized by 1706.06. Wis. Stars.) to ww ' a, to be the person _ a who executed the foregoing ~ scknowkdgc THIS INSTRUMENT WAS DRAFTED BY 111111 Thomas A. McCormack ~Ja~. • • •