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HomeMy WebLinkAbout018-1033-10-200 ~ ti ~ 03 I _ p q 0. O C O p ~ N N O G y ~ I m I' a C m I y o y c Y U J O Z C LL f0 N C C O O C I Q f0 N ~ O z E r- w Z _ o Z d d a m U) o O z a c o N m Z a c o m H m 4) Zz 0 Cl) N O N C U WI o ~l o m L o 0 Q Z co z z 04 dc Cl) y E N d C N O y w Y C C~ ~l In y m a~ E p CD 'ooo{ya~~ .Q ' Z m > > O ~WAWA t6 d d d y a o V E co rn aNi L 'O y y rn ~ ~ 'O d Q fn f0 C3) 4) p o m o C- O 0 C .r O C C C U d 0 O C r C V 0 M04 C I 0 ` E C) 1~ 7 r 0 N E w 7~ Z c~ O T co m cco o E m m U O O N O Z N In a E A ciao '',o U) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS Z10-7'A a P,, SUBDIVISION / CSM# S jM LOT SECTION N-R W, Town of- ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM (j - as e_ ►6 h`p ti ~w In n 94 rh INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: Sa Grp C- S' / lS ALTERNATE BM: ~G,FJ d F QO/.sc.!( ll i SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:_/,,h7, lj&)eS're .4.1 Liquid Capacity: 1,Tod Setback from: Well 611 fi- House /S Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: ,S Length Number of trenches .17, Distance & Direction to nearest prop. line:,Sow7"AL 3d Setback from: well: SrU House ,2o-' Other ELEVATIONS Building Sewer ST Inlet: ST outlet: PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: ZC ,0T PLUMBER ON JOB: LICENSE NUMBER: j'~ 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 (ATTACH TO PERMIT) Sanitary268650 . ,GENERAL INFORMATION Permit HoldWs Name: Ci Village Town of: State Plan ID No.: DALTON, JOHN 0flR%4OND t CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: DD . Q r' -i TANK INFORMATION ELEVATION DATA A9600355 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark a3-~ ' l0 ~ Dosing .0' Aeration Bldg. Sewer Holding St/ Ht Inlet s - 91<. v TANK SETBACK INFORMATION St/ Ht Outlet y7, gg a I Verit TANK TO P/ L WELL BLDG. A irl to ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header/Man. Aeration NA Dist. Pipe -2 Vol 78' Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift T Fricti System TDH Ft Forcemain I I Len Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r -)S DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of 7jFZ~~ CHAMBER Model Number: System: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 ffii Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center b! { Bed/ Trench Edges 'b'b Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HAMMOND.15.29.17W, SE, SW, 90TH AVE h- OA,;t 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 t SANITARY PERMIT NUMBER: ,r r A SANITARY PERMIT APPLICATION Safety and ve. In P.O. Box 7969 Department of Commerce accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County C V,& X than 8 1/2 x 11 inches in size. • 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 if revision to previous application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name Property Location X® 10- s'G` 1/4 SA-I,11 i4, S -S~- T , N, R/ 2 E (or) .2 lp Property Owner's Mailing Address Lot Number Block Number 7?a / 74% All City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F B ILDING: (check one) ❑ State Owned ity Nearest Road Village s Public 1 or 2 Family Dwelling - No. of bedrooms -7L TOWn.OF 0,--4 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo 6 l r- le 33 - -2 ad 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. Kx New 2_ ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an ____`_'C_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 110 Seepage Bed 210 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 36 0 , ,,I 44 G 4 176- 16441 Feet lj~fd, a Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ( ~0d L El ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (N Stamps) MPRSW NO.: Business Phone Number: l,'asn ~~du a e.- 3~z - 3F~ *-3l2 Plumber's Address (Street, City, State Zip ode): G d s, IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Is Agent Sign ~tur Stamps) *Approved ❑ Surcharge Fee) c Owner Given Initial ~ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 11/96) DISTRIBUTION: Original to County, One copy To: Safety & Buildmo Division, Owner, Pkwdw INSTRUCTIONS R 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 system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. 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. It. 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 a!1 septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimenta 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 manufa(tLirer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) ail 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. LHR SANITARY PERMIT TRANSFER/RENEWAL COUNTY UNIFORM PERMIT # (PLB 67-T) I GS I PERMIT RENEWAL DATE: PERMIT TRANSFER DATE: p ORIGINAL PERMIT ISSUANCE DATE: STATE PLAN LD. NUMBER: PROPERTY LOCATION: .S %a -56d t CITY: LOT NUMBER: BLOCK4NUM R: SUBDIVIISiON 17 NAMEOr VILLAGE: TOWN OF: ? N 3 NEAREST ROAD, LAKE OR LANDMARK: esm ti X03 94' r~v~ PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED): NAME: SIGNATURE: NAME: SANITARY PERMIT TRANSFERRED TO: v r~ •t~ ~Gt- ! Td,~✓ ADDRESS: PHONE NUMBER: 1,19'-4 //0 7'/ a Lt PHONE NUMBER: ADDRESS: the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been property. PLUMBERS SIGNATURE- REV Y een approved for this ~ P` US PWMBER' NAM IF CHAN PLUMBER'S ADDRESS: Sc ~ J~/ / PREVIOUS PLUMBER'S Aq S^ P PRSW NUMBER: cl leG, 44 / X 7 sZ :3 ~/-5'T ~ / ~ r' PHONE NUMBER: ~-a' 4~: MP/MPRSW NUMBER: (?/S ~G , 3l2 ! PHONE NUMBER: r V/ (21Y-) 37 ~a SI TURE OF ISSUIN ENT: DATE APPROVED: DISTRIBUTION: Original - County a' /0 COPY - Bureau of Plumbing 11 SBD-8399 (R. 5/82) p Copy -Owner Copy - Plumber y . t~ 4 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 1 , C than 8 112 x 11 inches in size. • 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 if revision to previous application (Privacy Law, s. 15.04 (1) (m)). State Plan LD: Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Pro~POrty Owner n rLM jqe~ 1/4, 5 T 2,9 , N, R E (or) ation Property Owner's Mailing Address Lot Number Block Number 4073 City, State Zip Code Phone Number Subdivision Name or CSM Number o aL Sti 4 / 3- ( 71S) 7116 -,14 y.>- II. TYPE OF BUILDI : (check one) ❑ State Owned ❑ Ityy # r aresstt Road E] Public 1 or 2 Family Dwelling - No. of bedrooms Town of e 911. BUILDING USE: (If building type is public, check allthat apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo © / r^ /©33 /tq -°Z6P 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. 0 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 E[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 3 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation Feet /©p Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel lass Plastic ANew Existing strutted g pp Tanks Tanks Septic Tank or Holding Tank 1:1 ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ 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: o Stam ) MP/MPRSW No.: Business Phone Number: Plum is Address (Street, Cit State, Zip Code): 9P, 2 ~ of IX. UNTY /DEPARTMENT USE ONLY E] Disapproved Sa tary Per it Fee (Includes Groundwater ate Issued Issuing A ent Sig tore (No amps A j surcharge Fee) ,Approved ❑ Owner Given Initial Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: .-6398 (R. 05/94) DISTRIBUTION: original to County, One copy To: Safety & Buildings Divr ion, Owner, Plumber 1 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 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 numb,~r(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, roconnection, 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, nurr r) ~r of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Cc.,r~-,plete for ::jfl sE ptic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks receiv?d exper1m(-nt l product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number v.r!th approp is prefix ;e.g. MP, etc.), address and phone number. Plumber must sign application form. IX County/ Department Use Only X. County/ Department Use Only •`i fixations not smail>_. P 1.2 x 11 inchE:. rrt:st be su nii l i ,F _inty_ he plans must olot_ plan, draw's 0, -vlth cofn Yt(_risjo I J~.'t idinq _ank(s), septic b, jr)~ ✓e!i>, 1aI pump or siphon cif o pi ion 'pr3:er ,r . f the i:.>ilding served; >I ) < _ co-^t-cls; dose vo!ume, n C , !re. ) cr05) Se C' on E) SO, _ c.. ~ ) q SiZlnc: Information- GROUNDWA "ER SURCHARGE 1~P , `v r~ir c. 1113 included the creation of surcharges ifees) fora numbk~ro° r f<,i:e:f pry •:.t whicl- can effe:t rrot;r'ti,r:,,C r s <a~.. thru., c ::_sc su~chi.irges arc used f`or monit r~ng grc t ~ cr!arri 1 t :r investigations Labor °ar Htea eiarus"' SOIL AND SITE EVALUATION REPORT Page of rHvLsion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but f ~3 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P E4 . dimensioned, north arrow, and location and distance to nearest road. r, f>. Afo EWED BY ; APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION , j _.r PROPERTY OWNER: PROPERTY LOCATION. ; f ~ r t CM -:7b 1} N3 I~ Lro N 86W.tfff S E 1/4 (4 S 1 S T t~ PROPERTY OWNERS MAILING ADDRESS LOT If BLOCK # SUBD. OR CSgIF•, ; ` CITY STATE ZIPCODE PHONE NUMBER ❑CITY ❑VILIAGE MOWN NEAREST >✓)o~b (NI S4o~S (~lS)~96_ Z~9Z Yr~°c~tMd~v r' `..6 New Construction Use Residential / Number of bedrooms Z A" to existing building j ] Replacement [ j Public or commercial describe Code derived daily flow 30 a gpd Recommended design loading rate 13, S bed, gpd/lt2 0. 6 trench, gpd/ft2 Absorption area required lo to bed, ft2 - trench, ft2 Maximum design loading rate O. S bed, gpd/ft2 p. 6 trench, gpd Recommended infiltration surface elevation(s) q`1 O ' ft (as referred to site plan benchmark) Additional design / site considerations `2 ' X Sp' Ct~1V U ~v`n urvi~ 8 tD Parent material Sf y- o' Jll jfls N Flood plain elevation, if applicable N1 -ft S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system aS El U INS ❑ U LAS U ED S ❑ U ®S ❑U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rend 't..' _ t 1 0-9 ~o`-t2 z-cz - s,) Z ~I"bVT as 3 o.S o.b Z q-l9 Lo"tsL 31 - s!) s~Vf m'f1 eS o-S o.~ Ground 3 1Q -Z3 S Y IZ 31- S 1 \ ~s b k wt v C S S elev. 100. I ft 23-yZ 7• S vk V4 S o -S 1M~ C S - o.~ a Depth to 5 L{2_~D 10`12 S/~ o Sg w!) a. S c,. L limiting factor , 7 80' Remarks: Boring # o -~l L13\l 2 Z-LZ St I Z'~ S~k YOTI- C_ S 3 o_S v. L, k>: Z. Z ~Z-32 0 `11Z 1 S1 Z S~Ir L`FY ~S Z 0-% o. s>m. I 3 37-35 ~S~tIZ3l s~ l~Sbk v~4 Ground elev. 5--).L to~R s16 - ~S o sg yn 1 - Q--S n-b a9.9ft Depth to limiting j factor ?7(,s Remarks: ; TName:-Please Print Arthur L. We erer Phone: 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: °1~-81~ f-~Z-`'~ M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourclary Roots GPDlft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 0-l 0 lp `-t L Z.LZ S Z s1~lz wr. V -S o. S o• Z 1~-~3 Lo ~~z 3~y s1 2 `F sb►~ ~,'F~. cS z~ o,s o, 6 Ground 3 23-32 7•S`t1Z Sly SI B LSbh MU`-k cs o ~I o S elev. ll~l•2ft. (3 \1 Q- S IL - c7 gg r'1 O. S O. I, Depth to limiting factor > F~ IA Remarks: Boring # 1 o-~Z 1Dti`Z: z.d Z - S 1, S~ `M `F b' es 3 o, S s o. 6 Z 2 I \-It L 3~~ - S I Z `F S~~ r~ c S Z~ o S i o. 6 [,,3 3 32-3? -)-SyIZSly S~ 1 ~Sbl~ Yn V~1 cS o•Y o.S Ground tt elev. y 3$-$y JO `72 SA - -0 Sg 1 o•s 10-L 4U ft. Depth to limiting factor y Y~ Remarks: Boring # _z 5 Z $ ~ 10 `-t iZ 3 Y S y Z 5 b k Yv<'F~- GS Z o. S n• ~ 3 Z~-32 -S y2 3/y S } 1 CS ~h YYt U o. V o, S Ground `el v. ft L/ 14a I~`?e S/L - o s~ m) o, s o, L Depth to limiting factor 88 i F Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Inn noontr ncrnn~ PLOT PLAN Page 3 of 3 SCALE 1"= 40 ' 603,11' J 3 J ~ SL.op~TS V P~t2.Y bv!`TZi'1JV `Itis`r~ H'iZ~TA 1"10- fo a ause `lb 8L PrT C.",T-r ZS' t=-~,ZOx~ BADS. N l-X-IS'T)YUG J-JETL( IS Zdo' Nw of 5 )re. B~cP_N 2 J tU i- i' 'St-~-Vrt0*, LINe Mt". \ 3 3 ' 1-RO ~y 9-~ ri 1 tit L C l iYI ~ ,-^F I 1 SO i sc. Or- BNoS I I co) & Z ~ ~-g.-1 ~.loU t 1. W o,SfK' To O T}4 n , - - - ~t_~oo•o'or~ q''r}t sH, 3!y'` Di>g P~ c PIPE w/~.~`ll 1`'~kQ. wuo~~ fro s7~. D q6- 81- ~ (715 ) 42,5-0169 1400576 CST Signature Date Signed Telephone No. CST # to TILED - AUG 1 5 1996 ~j 4 82 03 z KATHLEEN H. WALSH F4!stu of weft ~ WI CERTIFIED SURVEY MAP SL Croix Co., Located in Part of the Southeast Quarter of the Southwest Quarter of Section 15, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin. Prepared for and at the request of: OWNER: John & Carolyn Dalton BEARINGS ARE REFERENCED TO THE SOUTH LINE 1794 110th Avenue OF SW 1/4 SECTION 15, TOWNSHIP 29 N., RANGE 17 W. Hammond, WI 54015 WHICH IS ASSUMED TO BEAR N 89'42'12" W Drafted by. Kristi A. Eyiandt County Section Corner Monument NORTH 1 /4 CORNER of Record, or as shown SEC. 15-29-17 1 • Set 1" x 24" Iron Pipe weighing (RAILROAD SPIKE a minimum of 1.13 pounds per TO BE RECORDED) 11 ~I linear foot. NORTH/SOUTH 1/4 LINE- * Found Iron Pipe SEC. 15-29-17 REC = RECORDED AS NOTE: The parcel shown on this map is subject to State, County and Township 0) laws, rules and regulations ( i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel, contact the St. Croix County , j Zoning Office and the appropriate Town Board for advice. I I 1 i (REC=N 00'49'05" E UNPLATTED LANDS N 89'49'58" E 1 ,"31.55') N 89'49'58" E 601.31' REC. = S 89'47'33" E 603.11') it N F~~*-~-(REC=N!90-00'0V'W 200.45' 200.43' 200.43' 225w =WEST T 225') ~i ► 0 11 t l I i. I r7 N 0 r- WELL oM 0) E13 a I• 0 Inl o r-,r" r- ® LOT 3 370 ZI MN _ _QUSE N N M N I Z Olt LOT 1 'I a, o LOT 2 o Mo HWY SETBACK 0) 00 a I iM0 N r7 IIO M N O I (0 04 ~IN U Q .Q . .O ~j N zib Cr EXISTING DRIVE .ry0i~ +I ° -J a' O. . °o 0 ~I~v II0wIIZ II Z I CO N (n .1 I 00 O QVW O 0 p w I i I 1 1 i IO of N 1 1 I I M j 0. Y 0) 1 1 r l I 1 rll I--N 89'42'12" E-. -N 89'42'12" E ' 1 I r N - - - -1~~1 0 11i i~r-N 89'42'12" E-201.4 Q\ r - - 201_43' - - 201.43- 11 - - 1 r 11 , - - WY R.O.W. Y i ---(REC = N 90'Ou'00" 1l 380')---- o 201.56' 201.55' - - - 201.55' Z I -----S 89'42'12" W 604.66'----- M o _ _ S 89'42'12" W 2623.87'------ g I 90TH AVE. o I SOUTHWEST CORNER 90TH AVENUE D SEC. 15-29-17 SOUTH 1/4 CORNER (MONUMENT) COUNTY SOUTH LINE OF SW 1 /4 OF SEC. 15 SEC. 15-29-17 OUT UNPLATTED-LANDS (PERN94 3ED TOTAL AREA LOT 1: TOTAL AREA LOT 2: TOTAL AREA LOT 3: 61,126 SQ. FT. 61,031 SQ. FT. 60,940 SQ. FT. AJG 15 ~ ZhI£ H9Vd II SWn'I0A o~Nians off, ~i '51PA b~ 'NOsonH ~ SVIZ-s ~ Z b31HVZ -r svionoo y OOS~M •uoajagq uoTutdo aTgTq a apTAojd pup aTgTg pooh JOJ sTgg MaTAal oq paau Aew AauIogge UV •sauTT Agjadoid aqq JOJ pTaq pup puno3 ajaM adtd uOJT papjooajun qnq 'ATIPOTgewaggPw sauTT awes aqq aneq qou pip uzaaagq suozgdTj osap spunoq pup sagaw Z aqq gegq puno,I seM qT 'V6T abed 9T6 awnlOA UT uTSUODsTM 'AqunoD xToaO •qs Joj pup UT aoTjjo spaaa jo .zagsT6ag aqq UT papaoaRJ paaQ AgUPJJ eM aqq UT suotgdTi osap aqq 'Taojed stgq BuTAaAans uI :IMUns SO 1HOd2H LTOVS IM 'puowga tg MaN SZ£ XOg •O •d 6T£V-9VZ ( STL ) # auogdaiay BuTAaAans pup g 1 ageQ SVTZ 'ON •Bag ja •r eTBnoa i / V-Jrj-~~ •awps aqq BuTddew PUP BUTAaAans uT puowweg 3o uMOy aqq pup XT010 •qs jo AqunoO aqq 3o 90UUUTPJO uoTSTATpgns aqq pup sagngegs uTSUODsTM aqg Jo y£'9£Z ,zagdeg0 3o suoTsTAO.ad aqg ggTM paTTdwoo aAPg I gpgq !pagTaosap pup paAaAans saTippunoq joTjagxa aqq jo aTpos og uotgequasaidea goaa.zoa P ST dew KaAjns paTjTgJ@o sTgg gPgq A3Tgjao ogle I •p.zoa ax JO squeuanoa pup suoTgoTjgsai Isquawaspa TIP oq goa[gns pup Agjadoid pagTjosap anoge aqq jo auTT Aljaggnos aqq BuoTe anuaAv gg06 Jo APM-3o -ggBTJ oq goaCgns •(sajoe OZ-V) gaaj ajenbs L60'£8T BuTuTPguOD •BuTUUTBaq 3o quTod aqq oq gaaJ L6'ZO£ Jo aauegszp a gseg spuooas TZ sagnuzw VT saRJBap 00 gqnos 'auTT jaq.zenb pies gseT 6uOTP 'aouagq :ST uoTgoas pTPs Jo auTT .zagj enb gqnos/ggjou aqq oq gaa3 T£'T09 3o aouegsrp P gseg spuooas 8S sagnuTw 6V 89916ap 68 ggaoN 'auTT ggjou pTPs gsPT BuOTe 'aouagq !Agjadoid pies gsPI 3O auTT gq.zou aqq oq gaa3 S£'VO£ jo aouegsip a gseg spuooas 0£ sagnuzw £Z saaisap 00 44JON 'auTT gsaM pees gseT BuoTe 'aouagq :V6T aged 9T6 awnTOA paaQ UT Agjadoid pips 3O auTT gsaM aqq oq 499J 99'fi09 3o aouPgsTp e gsaM spuoa as ZT sagnuzw ZV s9aa69p 68 gqnos 'ST UOT400S pTPS 3o auTT gqnos aqq BuoTp BuTj eaq pawnsse up uo 'aouagq :ST uoTgDaS pTPS jo aauao0 jagjunb gqnos aqq qP BuTuuTBag STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER L MAILING ADDRESS /0 .T 14 z./ PROPERTY ADDRESS / C/ 0 T~ (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~//9'//7 0 /1 d to i "5~ PROPERTY LOCATION _ 1/4, S A) 1/4, Section , T__2i.~ __N-R~~_W TOWN OF t} eft a ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER 3 CERTIFIED SURVEY MAP Spy ~,~VOLUME Y_/, PAGE 3 OT NUMBER 3 3/yam. 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: yam/ /I St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 8 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 `J /J n IDA Location of property_,5 1/4 5 1/4, Section T~-R W Township Mailing address /'7 5e-1 - //0 Address of site / ty' `gyp T/ .d J Subdivision name 1~oG % j cf~ Lot no. Other homes on property? Yes/_No ©3 Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house) ? Yes _No Volume M/ and Page Number 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 iji the office of the County Register of Deeds as Document No. ~J 7 `3 Q , 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. Si ature of Applicant Co-Applicant x/13 1.9- Date of Signature Date of Signature I 'i ' ' ~ vo. 915 1.4 rNls 3PAC[ RESERVED FOR RECORDING DATA !F " F` JCIJMENT NO. WARRANTY DEED l . STATE BAR OF WISCONSIN FORM 2 -1993 ' _ 47356} EVELYN C. DUDLEY, a%ingle person, Grantor REGISTER'S OFFICE . • . ST. CROIX CO., Mn j Rec'd for Record S 3P3 61991 at P. M conveys and warrants to . -,JOHN DALTON and• .~ARQLYN. D~ITOIV, usband..and._wife-..as..survivor.ship.-marital praperty,.,. ~ C I .....grmaee& W4.0 ot0aet~ RETURN TO . the following described real estate in $ts.SK91 5 ...................County, State of Wisconsin: Tax Parcel No: f o (SEE ATTACHED LEGAL DESCRIPTIOP') , - FIT 010- . TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and rights-of-way of record, if any. This _.._....iS..IIOt homestead property. Gid (is not) Exception to warranties- - Dated this 4th................... day of September (SEAL) ~r~Is-iC C1 01 /.G~ .k'11 ?c-~ fi-(SEAL) ----..(SEAL) (SEAL.) e AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. St. Croix . • County. authenticated this day of 19 Personally came before me this -11th day of September 19.. 91. the above named - Ev-etyn C._-Dudley----------------•--••-- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, - authorized by 1 706.06, Wis. Stats.; to me known to be the person who executed the foregoing instrument and ack nowli f d a the same. THIS INSTRtIMFNT WAS nRAV - Gv 1 4 - IF /f ♦ ~ a ~ ~ ~ ~ f . 915PAGE 195 A parcel of land located in the SE'k of SWk of Section 15-29-17, described as follows: Beginning at a point on the S line of said Section 15 a distance of 380 feet W of the SE corner of said SEk of SWk, thence N parallel with the E line of said SEk of SWk a distance of 274 feet, thence W a distance of 225 feet, thence S a dis- tance of 274 feet, thence E along the centerline of the Town road a distance of 225 feet to the point of beginn- ing; ALSO all right, title, inite-cst and benefits given by that certain Agreement b Laurence H. Vrieze and Magdalene H. Vrieze, husbaza and wife, as joint tenants, with Clifford Spooner and Rosella Spooner, husband and wife, as joint tenants, dated Aug. 12, 1965 and recorded Nov. 12, 1965,'in Vol. "418", page 578 (No. 32) in Office of Register of Deeds. A parcel of land..located in SE4 of SWk of Section 15-29- 17, Town of Hammond, more fully described as follows: Commencing at the S'k of said Section,15, the Point of Beginning of the parcel to be herein described; thence N90°00'00"W 3801eet (all bearings referenced to the S line of the SWk of-said Section 15, assumed N90°00'00"W); thence N00°49'05"E 274 feet; thence N90°00'00"W 225 feet; thence N00°49'05"E 31.55 feet; thence S89°47'33"E 603.11 feet; thence SO0°28'03"W 303.34 feet to the Point of Beginning of the parcel herein described. 1 ! • ~ . r. f ^ . f