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AS BUILT SANITARY SYSTEM REPORT
OWNER ~!tNt~ ®N V R,9,4 /V ZNeA?
ADDRESS 7 7h 4 V
M df.R A4~~ri
SUBDIVISION / CSM# LOT
SECTION_ _T _;?o N-R-1,5- W, Town of
~~t-°lI/4.1 D Ocs~
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
l i 1sr/
/OVV
a
r
~'y i
1
Z'
t~
/ 70 /-X A ~e INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: /
ALTERNATE BM:
PUMP CHAMBER / INFORMATION
Manufacturer: G(j e- e Liquid Capacity: p
Setback from: Well House p Other
Pump: Manufacturer_AVdAQ /14 4;tl C Model# sws7 Size L
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length 1 Number of trenches
Distance & Direction to nearest prop. line:
Setback from: well: House Other
ELEVATIONS
Building Sewer ST Inlet.
ST outlet
PC inlet PC bottom qD, Pump Off
Header/Manifold Bottom of system
Existing Grade ag ~ 6
Final grade D ,
DATE OF INSTALLATION:
PLUMBER ON JOB: 1
LICENSE NUMBER:
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, • PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division CROTY
(ATTACH TO PERMIT) SanitaryPermit No.:
GENERAL INFORMATION 262389
Permit Holder's Name: ❑ City ❑ Village [R Town of: State Plan ID No.:
BRANI'NER ANTHONY GLENWOOD
CST BM Elev.: Insp. BM Elev.: BM Description: s Parcel Tax No.:
jav. (h, 1 /dD. a), 0 s •t 0 4 A9600201
TANK INFORMATION ELEVATION DATA 7/are/,9G - f
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. t
Septic ~CX/`J ilGr _ ~a,r - (=ti Benchmark 3~a' 3 ' /G2, GD
Dosing GCS (Zeno-, r1o 0.10
Aeratiefi- Bldg. Sewer 04-6 w --F /2.
Holding St/,W Inlet It TA SETBACK INFORMATION St/~K Outlet Z 9& KO
'
TANKTO P/L WELL BLDG. Aenttake ROAD Dt Inlet
Septic _75- NA Dt Bottom a 96,911
Dosing ~S~'02 7a5' NA Headert
Aeration A Dist. Pipe
Holding Bot. System
PUMP / WINFORMATION Final Grade
Manufacturer Demand
t
Model Number SW 3.3 30- PM
f
ction I uq' System TDH~5, ~7Ft
TDH Lift Fri
oss mead ;51
Forcemain Length Dia. Dist. To Well >c~
SOIL ABSORPTION SYSTEM
No. Of Pits Insi a. Liquid De th
BED/TRENCH Width Length i No. Of Trenches PIT p
irk S3~ DIMEN 1 N 9v DIM
t. Manufacturer.
ti• SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LFIA/~dHBER
jo INFORMATION Type O / Model Number:
System: .1 /v y(a 44 UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) r r x Hole Size x Hole Spacing Vent To Air Intake
Length Di Length ~ Dia. ~ Spacing /1/4- >
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 GL&%WMD. 7.3Jd,15W NE 170TH AVE
f ' v , ' rJ l a/, ~
ol~
Plan revision required? ❑ Yes No p
Use other side for additional information. Inv G 1/01
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
~ITIONAL COMMENTS AND SKETCH •
SANITARY PERMIT NUMBER:
Safety and Buildings Division
~~■~r■r. 4ANITARY PERMIT APPLICATIA 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. r 7"c'? • See reverse side for instructions for completing this application State Sanitary Permit Number
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION .S' d _ ;2,0 2.:
Propert Owner Name Property Location
,4 e NE 114 Id 1/4,S 7 T 3O , N, R & fir) W
Property Owner's Ma King Address Lot Number Block Number
2 212 / 70 7`! A ve -
City, State Zip Code Phone Number Subdivision Name or CSM Number
L 14- o /;z ( 714').2
p~
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road
Villae
E] Public 1 or 2 Family Dwelling - No. of bedrooms Eoff ] Town OF (5;Ie woo eo/ 70 ve
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) /
1 ❑ Apartment/ Condo 0 /d ! /0 / b
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. EK 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 Z Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ® Seepage Trench 22 ❑ In-Ground Pressure 42E] Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14E] 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
11J~~ A 02 Feet p Feet
Ca acit
VII. TANK jn all0 S Total # Of r Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank O7~fJ //W Q ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber Do 1v ® ❑ ❑ ❑ ❑ ❑
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: (N~ Stamps) MRF}i! -ko.: Business Phone Number:
G A 0 7fS'-~ 6.s
Plumber's Address (Street, City, State, Zip Code):
3 w /?o G etv v ta/ zf ol3
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Issuing ent Sign ture (No S s)
roved Surcharge fee)
A 1
App ❑ Owner Given initial ;r
Adverse Determination l®
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Di-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
1!
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, r(;c:,)nnect on, or repair.
V. Type of system. Check appropriate box depending on system type.
Vl. Absorption system information. Provide all informatior requested for numbers 1 throuoh .
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, nc m';e r of tanks and
manufacturer's name, indicate prefab or site constructeJ and tank material. Complete fc,r .11 ? Aic, pump/siphon and
holding tanks for this system. Check experimental approval only if tanks received experiment,,' oroduct approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropr at,_- 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/ x 11 inches must be suc;rnitted t ; t':(? c inty. --he plans must
include the following: A) plot plan, drawn to scale or vvith complete dimensions, locatiGh lic Iding tank(s), septic
tank(s) o, other treatment tanks; building sewers; welk,; water main,,/w4t: r ser°v;ce, stfc: i lakes pump or siphon
tanks; dis,triilution boxes; soil absorption systems; replacement sy tc-m areas; a ',h If the building served;
B) horlZCLnial and vertical elevation reference points; Q complete oeci hcatio-s for pur-i,,r i -~I -ontrols; dose volume;
elevatior differences; friction loss; pump performance ::urve, pump mode; and pump man; firer; C) cross section
of the so i absorption system if required by the county; soil test data on a 1 15 .`arm; and : ,i sizing information.
GROUNDWATiER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regelated practi(_e, which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contaminaticn investi Rations
and establishment of standards.
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Page z Of
Straw, Marsh Hoy, Or
Synthetic Covering
Distribution Pipe
Medium Sand
G
Topsoil F
3 ' E /b
% Slope
Bed Of 2--21. (Force Moin l'IuY.ed
From llump t-aYc;r
Aggregate
Cross Section Of A N!ound Sysfern Usirld ,
F' , •
A Bed For the Absorption Arcc
.
It
Signed: ~ i;
90 I t .lo,q
License Number:
[;ate: - -
I t . /!$•a
ri
d
l orce Moin
J From Pump
Distribution E3ed Of 1 2
' Pipe ecr/rnfionenj egote__ .
Observation Pipe Morkers
Pion View of Mound Using A Bed For Ttie Absorption Arco
6_2025 4
S9
• Page- Of J
Perforated Pipe Detail
el~
End View
FoR A
peR
PV3
a
91
-es located on bottoms of crce
~r. are equall -Hated
i
T -i cap --w. ~ 1,Gst ole sho-Id be
next to end cap
Distributation piL;e lay out
P14~_F t
/0 R~Inches
Invert Elevation of Laterals t
S Inches
X--Inches
Signed:
_ Y Inches
License 1 /0 94
Hole Diameter Inches
Dates
Lateral Inches
Manifold " Inches
Force Main Inches
lr' JX # of holes/pipe
6'202c
S9
. • • PAGE OF
Pl1MP CHAMBER CROSS SECTION AND SPECIFICATIONS
VEWT CAP
4"C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
JUWCTIOW BOX MANHOLE COVER
~ 25' FROM DOOR,
WINDOW OR FRESH 12"MIU.
AIR INTAKE
GRADE
I 4" MIN.
COWDUIT
18"MI1~i. -
PRovIDE _ I -
IAILET
AIRTIGHT SEAL I III V
I ~I)
__T
AFFROVED JOINT A I III AFFZDVED
C. I. FIFE i I I w/C.I. P I F E
LXTLPJD IJC, 3' _ I II ALARM EXTEQDIU'.
C►JTO SOLID SDIL I I I OrJ'C SOLID -)I
B I I
I ON
C I I
I '
[LEV. FT__ - PUMF-~
OFF
D
CONCRETE BLOCK
RISER EXIT FERMITrED GkJLJ IF TAIJK MAIJUFACTURER HqS SUCH APPROVAL
r E 5PEGIFICATI0 PJS
COSE l
"A►JKS MAUUFACTURER: zo:&e~ eI - (.LUMBER OF DOSES: PEP, DAy
TAWK :,IZE: Fee GALLOMS DOSE VOLUME 7
ALARM_ MAAIUFACTURER: SJ /FLeetRe INCLUDIMG BACKFLOW: F, / GAILL01' S
MODEL DUMBER: ZO! y CAPACITIES: A= - INCHES OR GALLOI; i
SWITCH TYPE: Me)ea u/:?/ = INCHES OR GALLO'. S
PUMP MAMUFACTURER: / • Z_INCHES OR 16 e l O GALLO$_'S
MODEL WUMBER: S w 3 l ^/lSp. D=INCHES OR 6 GALLOPS
SWITCH TYPE: _ ST ELec) Rd DFL NOTE: PUMP AMD ALARM ARE TO BE
MINIMUM DISCHARGE RATE Z. O GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE OETWEEIJ PUMP OFF AIJO DISTRIBUTIOU'PIPE.. FEET
+ M~II[U,Ir,MUM NETWORK SUPPLY P~REES~SLIKIE . ?;5 F.E.ET
♦ FEET OF FORCE_ MAIIJ X /76 F/ooFtFRICTIOU F4rOR. Y' FEET
TOTAL OyIUAMIC. HEAD FEET
„ j 9 6 0 2 Q 2m-b
IWTERNAL DIMENSIONS OF TA►JK. LENGTH ;WIDTHLIQUID SIGNED: LICEMSE NUMBER: Mlo`LdU DATE:`~°2~ a
`rif~ ~i Y v f-,S
TYPE • SUMPOEFFLUENT
MODEL SW25 & 33 SD25 & 33
MAX. SOLIDS 1/2" SPHERE MAX. SOLIDS 1/2" SPHERE
1 /4 AND 1 /3 HP 1 /4 AND 1 /3 HP
1550 RPM 1550 RPM
PRODUCT
~y
Q
2
FEATURES 0 For sump and effluent use • For sump and effluent use
• Automatic models available with • Automatic models available with
wide-angle piggyback float switch. diaphragm piggyback type switch
Also available in manual • 1 /4 HP (SD25) or 1 /3 HP (SD33),
• 1 /4 HP (SW25) or 1 /3 HP (SW33), heavy-duty, 115V oil-filled motor
heavy-duty, 115V oil-filled motor with thermal overload protection
with thermal overload protection • Rugged cast iron construction
• Rugged cast iron construction • Non-clog vortex thermoplastic
• Non-clog vortex thermoplastic impeller
impeller • Long life lower ball bearing
• Long life lower ball bearing Sintered top sleeve bearing
Sintered top sleeve bearing 0 Carbon and ceramic mechanical
• Carbon/ceramic mech. shaft seal shaft seal
• 1-1 /2" NPT discharge • 1-1 /2" NPT discharge
• 10' replaceable power cord. (20' • 10' replaceable power cord. (20'
optional) optional)
• UL listed sump pump • UL listed sump pump
• 1/4 HP, 1o115V-1/3HP1o • 1/4 HP, 1o115V-1/3HP1o
115V 115V
-
PERFORMANCE 32- - 32-- --T---
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0 0 10 20 40 ~50~ ~60 00 10 20 30 40 50 60
CAPACITY- .S. G.P.M. CAPACITY-U.S. G.P.M.
3 S96720254
Wisconsin Department of Industry, *OIL AND SITE EVALUATION J&P O R T Page 1 of 3
Labor and Human Relations
Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code
' - COUNTY
Croix
St. Attach complete site plan on paper not less than 8112 x 11 incheh i e. Plan must include, but
not limited to vertical and horizontal reference point (BM), directU f slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 016-1014-60
" REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT,ALL INF'iiMATI
PROPERTY OWNER: OPERTY LOCATION
OVT. LOT NE 114 NW 1/4,S 7 T 30 N,R 15 for) W
Anthony Brantner
PROPERTY OWNER':S MA!I.ING ADDRESS ev-':~ kM OT # BLOCK # SUBD. NAME OR CSM #
na na na
I
2737 170th. Aye.
CITY, STATE ZIP CODE P NUMBER []CITY []VILLAGE MOWN NEAREST ROAD
Emerald, WI. 54012 Glenwood 170th. Ave.
[ j New Construction Use [x] Residential /Number of bedrooms 3 [ ] Addition to existing building
bc] Replacement [ ] Public or commercial describe
Code derived daily flow 450 God Recommended design loading rate • 2 bed, gpdm2 ' 3 trench, gpd/ft2
Absorption area required np bed, ft2 375 trench, ft2 Maximum design loading rate • 2 bed, gpd/ft2 ' 3 trench, gpd/ft2
Recommended infiltration surface elevation(s) 102.12 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material glacial drift Flood plain elevation, if applicable na It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem O S tau I)MS ❑ U El S 12U ❑ S]OU ❑ S ®U ❑ S EIU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trerdt
rl 1 0-9 10 r3/3 none 1 2msbk mfr 2f .5 .6
2 9-20 10yr4/4 none sicl lfsbk mfr 9w if .2 .3
Ground 3 20-40 7.5yr4/4 c2p7.5yr5/8 scl lmsbk mfr na na .2 .3
elev.
100.45ft.
Depth to
limiting
factor
20"
Remarks:
Boring #
1 0-8 10 r3/3 none 1 2msbk mfr 2f .5.6
2 8-18 7.5yr4/4 none sicl lfsbk mfr gw if .2.3
3 18-22 10yr4/4 none scl 2msbk mfr na na .4.5
Ground
elev.
100.45tt.
Depth to
limiting
factor
22"
Remarks: B-2 was du b han due to power ble
CST Name _Please Print Phone:
Gary L. Steel 715-246-6200
Address: 1554 200th. Ave.
New Richmond, wi- i4n1:7 y 10-M-gr,
Signature: Date: CST Number: 298
PROPERTY OWNER Anthony Brantner SOIL DESCRIPTION REPORT • Page 2
_ of 3
PARCEL I.D. # 016-1014-60
Depth Dominant Color Mottles I I I
Boring # Horizon Texture StructureConsistence Boundary Roots GPD2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh Bed iTrench
.
t
s? 3 1 0-8 10 r3/3 none 1 2msbk mfr gw 2f .5;' .6
2 8-14 10 r4/4 none sicl lfsbk mfr gw if .2j.3
Ground 3 14-30 7.5yr4/4 c2p7.5yr5/8 sicl lfsbk mfr gw na .21 elev.
99.8-9t. 4 30-50 7.5 r4/4 c2p7.5yr5/8 sicl lmsbk mfr na na .4 .5
Depth to
limiting
factor
14"
Remarks: _
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Anthony Brantner 1554 200th Ave.
CSTM2298 NE k N W11 S7-T30N-R15w New Richmond, WI 54017
MPRSW 3254 town of Glenwood (715) 246-6200
4
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1"=40'
BM.= top of cement pad by garage entrance door C el. 100,
)76
8
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ZI . SSG
C9 U v- b\6-
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0-3 ( mss, 5
1;vj~NS10P
=.b d Pyp,
u n d.s,~v,
Gary L. Steel
10-30-95
Wisconsin Department of Industry, SOIL AND SITE EVALUAT~
Labor and Human Relations Page of
Division of Safety and Buildings in accordance with s. ILHR 83.09, Is.
-
Attach complete site plan on paper not less than 8 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. #
APPLICANT INFORMATION - Please 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
67/Y Govt. Lot 5_:~ 1/4 A) 1/4,S Tao N,R )por) W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
2 717
City State Zip Code Phone Number Nearest Road
r 114 f-L 1-37-4VIZ ` p ❑ City ❑ Village. Town
❑ New Construction Use: Residential / Number of bedrooms 3 Addition to existing building
Replacement Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate 1,4L bed, gpd/ft2~trench, gpd/ft2
Absorption area required bed, ft2 trench, ft2 Maximum design loading rate _&,ej bed, gpd/ft2_,d~A_trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/site considerations mac.
Parent material rI-A- G /At 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 ®S ❑ u ❑ S ®U ❑ S ® U ❑ S 19 U ❑ s IN U
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
/ O- B 3 2M AfR W A F
Ground i p SG' L- s~
elev.
ft, 11ft.
Depth to
limiting
fact r ;
~in.
Remarks: Al
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
CST Name (Please Print) Si nature Telephone No.
GA 4V .151A, /0 ?f.S ;-ks- . e3rr
Address Date CST Number
7 A4 -irv 1/7P
CIF
PROPERTY OWNER SOIL DESCRIPTION REPORT •
Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G=ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
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Depth to
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Remarks:
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Depth to
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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 #
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SBDW-8330 (R. 08/95)
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/»R N tk O Al y g q ft 1 r/V e ,,q
MAILING ADDRESS a 7.7 7- 1,20 A y e-
PROPERTY ADDRESS SSh Af -
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE ~-2
PROPERTY LOCATION A1,F 1/4, 414V 1/4, Section T_,?O_N-R /4_W
TOWN OF 91 ekwa a' d( 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 year expiration date.
SIGNED:
DATE: C' l
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
. . 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 i N zI ®/V v RA y /y 7'`/V eR
Location of property_Ugf 1/4A1411/4, section 7 T_,~a N-RW
Township G1 eN4J0 0 d Mailing address
2 73 7 - /70 0-,4 .4 v4e ,G-`M C V ,41 4&Z : ' o / 2
Address of site 5]d AA
Subdivision name - Lot no.
Other homes on property? Yes No
Previous owner of property J~~-try~~
Total size of property , -
6-Total size of parcel C g e,
Date parcel was created 7 41,
Are all corners and lot lines identifiable? Yes X- No
Is this property being developed for (spec house) ? Yes No
Volume of6 X and Page Number .5-7e 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. Ggzrs-Z ~19 and that I (we) presently
own the proposed site or 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 of ice of the County Register of Deeds as Document No.
Signa ure of Applicant Co-Applicant
& - a q - qb - aF- -
Date of Signature Date of Signature
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 `j 0 / e residence located at: IV W s ,
Sec. T p N, R _j_5- W, Town of 4~eNwado~ , St. Croix
County, Wisconsin. Upon inspection, I certify that I have found the tank and
baffles to be in good condition, and it appears to be functioning properly.
Last time serviced
Did flow back occur from absorption system? Yes No X (if no, skip next
line.
Approximate volume or length of time: gallons minutes
Capacity:
Construction: P efab Concrete X Steel Other
Manufacturer (if known): -
Age of Tank (if known) : d yR 6'
(Signature) (Name) Please Print
P1 uM d M P .3-Z 90
(Title) (License Number)
~f~6~96
(Date)
Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or
licensed disposer (NR 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 64/- e /,o-Cm i^7 Signature MP/.lid p
DOC:UME1dl- 1140. JVT AR OF WISCONSIN PORN 1-~ SPACE RESCl?VEU FOR RCCURUING UATA
WA11RANTY DEED
455643 8621"AGE578
REGISTER
OFFICE
Th.is Deed, made het«r(!en . J.._--.ame.s - A Au-ne---a---nd Je-oy.....ce I ST. / CROIX S CO., WI
Aune, husband and wife, as joint tenants, and each
Recd for Record
individual-l. -y. i n. his/her-.own right
- _ Giaiitor, FEB 0 5 1390
Anthony-.M-.,arantner and Anita J.. arantner-, husband- Of 10:40 A. M
.and wlfe,- as survi.vorship..marital .property -
----4s.,QQ
- Grantee, Regi~terofDeeds
Witnessetll, That the said Grantor, for a valuable consideration Qf
..One,._Dol_l.ar_-t$1,_00),_and._other valuable__consideration-_-._-.--
conveys to Grantee the following dcscribed ical estate in St CC.07 X------...... RETURN 10
County, State of Wisconsin:
Tvx Parcel No:
Part of Northeast Quarter of Northwest Quarter (NE4 of NWO of Section Seven
(7), Township Thirty (30) North, of Range Fifteen (15) West, St. Croix County,
Wisconsin, described as follows: Lot One (1) of Certified Survey Map recorded
April 29, 1977 in Volume 2 of Certified Survey Maps, page 359, Document No.
339691 in the office of the Register of Deeds for St. Croix County, Wisconsin.
TRANS
$_L3 3-S O
FM
This 5 homestead property.
(is) AK.X"x
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And..... James--A, Aune and Joyce. Aune, his wife .
warrants that the title, is good, indefeasible in fee simple and free and clear of encumbrances except
easements, reservations and restrictions of record, and except applicable municipal
and zoning ordinances
and will warrant and defend the same.
bated this 31st day of - January..- 1a-90
. (SEAL) v -----....(SEAL)
?404anes A. Anne
- .(SEAL) (SEAL)
I.
Joyce.-A-une-........
AUTHENTICATION ACKNOWLEDGMENT
S;'I nlaire(s) - - STATE OF WISCONSIN
SS.
Po73C
---------County. 31St
antheni:ieated this rlav n'f 19 1 nrcnnnlly r•:nnn hnfnrn 1110 this day nr