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HomeMy WebLinkAbout020-1289-40-000 - -0 p O 00 z.. p O 3 p H Q 69 0 O a) N I~' d ~O n III', i i a) d y (3) O q N (1) v (a O ZS In 5" to N a) O. a) CL 3 'p O O '06 v Z C Z - c c 3 (0 '7 LL C y cc c 0 LL c m a) - f6 w' O O (6 V "O 7 (nn 'O N O :3 o c Q Y s _ d co 3 co v ~ m z 4i z N W £ E O U) " O = O `O 9 N nom. m (L CD N F- Z c ~ O cc o Z c c w 4) Z d rn c p) Z fA F- r N c -O a) .O N M ,a CD O N CL N W N U) c 4 4) O • N d y ) t - !ri a c m ~i co 2 Q O o 2 Q O Z F- Z Z F- Z o N = Z h r_ 4) C N 3 G Y m Y N Y) R N_ y 0) c H a) a0. Na) O v a) L D O n`. O O 0 a E T- 0 U C) N (n N _O U ~ N _ N N y 2) E N co o cfl Z o • wry LO e m m ° a m m w a c U7 O N 7 O N (0 E 6) O O O N V) J N O) Z O O O O O O M1~~ O r 'NO O O M (a O 7 qy 'O 0 0 O (L to m 0 CO ~ Y 7 d d Z u`?) II ~ N -YOl d~ U) Q _ r p O ° Cr O C `o o Y w c o O c c rn rn 4 °0 00 c c y N c a) N u) A rn o 25 o 0 0. E w n a 0 o N y' ~ O c E a) m c o o t p ro a o U) ,n _ L co in c r a) ao a F- F-_ ai N 'NO N O F- 'O N O _ • 7'> O Vi O - cc C7 y tR U O N 2 > N O =5 Z N O N O CC d M d d A E ~(L > Via.. m A L) a 2 0 U) v o v) V Wiied-risin.DepartmentofIndustry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division sanitary Permit No.: GENERAL INFORMATION _ Permit Holder's Name: ❑ City ❑ Village Q Town of: State PI . MILLER, SAM E./GLEN WAXON X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sew Holding St Wt TANK SETBACK INFORMATION t/ t utlet TANKTO P/L WELL BLDG. Ventto ROAD et Air Intake Septic 9NA ottom IVA Dosing ` eader/ Aeration Dist. Pip Holding Bot. t m PUMP/ SIPHON INFORMATION Fina ade Manufacturer d Model Number PM TDH Lift I Los' Friction System Head TDH Ft Forcemain Length Did. 1 Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM INFORMATION TypeO CHAMBER Moe 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 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: HUDSON.26.29.19W, NW, SE, LOT 31 WAXON ROAD Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. f ADDITIONAL COMMENTS AND SKETCH f SANITARY PERMIT NUMBER: Ik Let, n hr a q..~ s f Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building water systems 201 .0 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P 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. . C-rO j • 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 A5Ws ~ (Privacy Law, s. 15.04 you (o de E] Check it revision to previous application State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Na e L 1 Property Location !4/~ 1L f1Q.._ ~L- ,//1 /45,eC_ 1/4, S T o7-9 , N, R /p E (or W Pro erty Owner's Mailing Address Lot Number Block Number D JC 40 ,Z. City, State Zip Code one Number Subdivision Name or CSM Number Sa &V I Dt (386 ) A7 6'9' /-//6 A4jFA ?Do ws II. TYPE F BUILDING: (check one) ❑ State Owned ❑ 't llage Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 3 ❑ Vi _ Town of IAIP5 o O A/ 010 III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) t 1❑ Apartment/ Condo D Z D Z g9 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. ;4 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 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 0 Elevation '15-0 7 S'~o 7 SO - 8 ii 3 -O Feet Q7, s Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Ex per- New Existing Gallons Tanks Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank ~Qpv L~/ Sf~ I(~ ❑ ❑ ❑ ❑ ❑ 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's Signature: (NoStamps MP/MPRSWNo.: Business Phone Number: A4-` OFA Plumber's Address (Street, City, State, Zip Code): /Lc. "04Av.E /I41tJ 0 ,SD/Ir G.I / O/ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing Ag t Signature (No S ) Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R.05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1 _ A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage 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. 0 = p ~ rn ~c o v fj o ~i/ok r f~ NJE,a 1~oGU ~2 (vE W EST t o r s i iv E 3 00.5's ' b m S ~ Li o q o,~~w N 4 i N 'Ip ~ O D _ ~ ~ t~ii ~ ITM ~ 2 o UT~~6 L ~ w h c~ m i iR r 0 w z ~ t b E~9sT GoT L /1yCF ,JO , yr " 3d Fr so r r. 0 w STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER y0 Nf ` e ADDRESS ,ApX 2- SUBDIVISION / CSM ~p Js t f~ J Q U ! LOT / SECTIONT Z % N-R~, Town of y//jj JQ IV ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM WELL ~'x 3 2 I /05' I I cJG L I/u = 00 lip 2q i, TER Nn7F I A E A D ,~Z N L-6-1 L WE Sir- INDICATE NORTH ARROGq Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- BENCHMARK: P ` o 0 0 ALTERNATE BM: ILL enN WAS K SEPTIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: - Liquid Capacity: Setback from: Well %Q _ House 41= f Other )q' 5L1~ Pump: Manufacturer ModelW Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S Length Number of trenches 2 Distance & Direction to nearest prop. line: Tn A/ LdT /,V~ Setback from: well: 0S/ House_4f 7 Other 2 S<~ To l'- MA N NcL-E- s.oy 9g it ELEVATIONS Building Sewer - ST Inlet. (p.3S_ 96•$ ST outlet PC inlet' PC bottom Pump Off FAR Header/Manifold7'g1 '?S-- Z ~ _ tt~A V~2_ 9,20 9yy'r Bottom of system 9.15= 9`/00' Existing Grade 5,00=qe.~r Final grade S.Oo DATE OF INSTALLATION: PLUMBER ON JOB: ~J1c ~t ~J~ LICENSE NUMBER: rG! /Z- S - 3 J INSPECTOR: 3/93:jt r Wisco nsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: PeWrmAXOoN;r's8114/MILLER, SAM ❑ City ❑ village C7 Town of: State Plan o.: CST BM El v.: L Insp. BM Elev.: BM Description: 7Cn Parcel Tax No.: /d~. A96003 32 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 0CI-1 12 r, Benchmark ,SSA ' Dosi n % ( Aeration Bldg. Sewer Holding St/ Inlet r T K SETBACK INFORMATION St/ ~f Outlet TANK TO P/ L WELL B#D ROAD Dt Inlet Septic / NA Dt Bottom Dosing NA Headers 3~r s~ r Aeration NA Dist. Pipe r ldold 9 Bot. System 6 3. PUMP/ SIPHON INFORMATION Final Grade Ma ufac Demand O<~ r ~ Je Model Number PM TDH Lift F ' Ion System TDH Ft e For In Length Did. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S Co DI SYSTEM TO P/ L BLDG WELL LAKE / STREAM LE Manufac SETBACK INFORMATION Type O CHAMBEI Mo e System: -C-rPrcl OR,U-fflT SYSTEM Header T1G1=6o#eI--- Distribution Pipe(s) „ x Hole Size x Hole Spacing Vent To Air Intake i Length Dia. 4~ Length S7 Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gra ys Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil El Yes E] No E] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) l LOCATION: HUDSON.2 6.Z9.19W, NW, SE, KALY ROAD -~z7 e :.:N,' ~.`l .s"t C ! - * 1~~ ~C-~ t_I •r=" ~y✓F' E' Plan revision required? ❑ Yes a/No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau aBuilding Water Systems `•~L~R 201 E. Washington Ave. In accord with ILHR 83.0 5, Wis. Ad m. 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 -d than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Perml Number 4oa 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 INFORMATION Property Owner Name Property Location 6i(EN b-211KON S6M ///LL-, //G{}'/4 Se7 1/4,S Z(T Z ,N,Rl E(or Property Owner's Mailing Address Lot Number Block Number City, State Zip Code ~);i Number Subdivision Name or CFM Ny~~#J b S a N C.~J ( ~j 11. TYPE OF -BUILDING: (check one) ❑ State Owned ❑ !tyage [NZearesst Road Public J~rl or 2 Family Dwelling - No. of bedrooms ❑ Vill Town of A) Y^ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 New 2- ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an _ System System Tank Only- Exist----ystem _________-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 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation y,5-0 sG 3 1 (0 a © q y 00 Feet Fg-JO Feet VII. TANK . Ca act Site in gallons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New Existing Gallons Tanks Concrete strutted glass App. Tanks Tanks Septic Tank or Holding Tank ~a~ea / WE/ Lam- 0 ❑ ❑ ~ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ E] ❑ E] 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's Signature: (N tam MP/MPRSW No.. Business Phone Number: _ t Plumber's Address (Street, City, State, Zip de): 41 / <oei5EIV IV/ 1- 11, lfv fJSo w i ~/U/~ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A ent nature (N amp ) Approved ❑ Owner Given Initial _1* Surcharge Fee) / Adverse Determination \OF PPRO AL / REASONS FOR PPROVL 7 SBD-6398.(R. 05194) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, 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 ne4% 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- 11. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwe? ing. 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, reccnnection, 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 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 isto fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. y l CN c ~R'p ~ i, c 1 ca Q C 0 O 0 - t - -D 1 HLTEQ A-T E J V~ 1~~ W C ~ o \ O2 m o ; ~ 0 u O r u ~ I I ' C o LL i a. Lv n O W ` ~ Ci O ~`l I -i O O = m o A O 1' ~ p 3 0 Qi I^NC.Ox n Wisconfin Department of Industry , SOIL AND SITE EVALUATION REPORT Page 1 of 3 Lab6c and Human Relations Division 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 S7LfA)Y not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PR P~RTY OWNER: PROPERTY LOCATION Q_'n GOVT. LOT N W 1/4 ' St~ 1/4,SZ6 T 29 N,R 9 E (or) W PR ERTY OW IER':S M KC)- IvIt -AILIN ADDRESS LOT BLOCK # SUB NAME R CSM # W.5 CI TAT ~ ZIP CODE PHONE NUMBER ❑CITY ❑VIL E OWN NEAREST ROAD s t ) ~ g6 ~ ~6 tr ~ w ► ~ j New Construction Usej~(j Residential / Number of bedrooms U N K [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow, gpd Recommended design loading rate 6 bed, gpd/112 •7 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate (1.7 bed, gpd/ft2 O•IS trench, gpd/ft2 Recommended infiltration surface elevation(s) W MA#_y - 94 .off ft (as referred to site plan benchmark) Additional design / site considerations A L-rC f j ATF_ % 'So Parent material Flood plain elevation, if applicable ft rU =Suitable for system Co VE10ONAL ND IN ROUND PRESSURE T-GRADE SY TEM IN FILL HOLDING K = Unsuitable fors stem S❑ U S ❑ U ]S ❑ U S ❑ U ,IeS ❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPI in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench -fZ L Z rvt ab w 1 S k l 12-13 &-lk 3/? Sr; I r. Sl K ~r 5 I 6.4 .S Ground /W414 5 r /h , S O.-7 O.'~ elev. 71 o Depth to limiting for } 7S° Remarks: Boring # A 10-2 16A~11 0, W of 7-19 16A i/) SL I sb~ r w 1 4.S $ 117-37 /DY 4 5 r/1, S I 1 Ground 1ele:T1ft 7-12) 10111 4/4 M r S 1 0,716% Depth to limiting factor Remarks: gO CST Name: Please Print NAB 31JN Sou ~ Phone: 3Sd_a(...1 Address: u)ss6 LJ) cl Signature: Date: S CST Number: Y't~~ PROPERTYOWNER SOIL DESCRIPTION REPORT Page? of .PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tnch L Cr 0. O.~ 2•Ground - 4 +14 r rp) ~ s 0.7 0 elev 94 it ft. 7-I3 (D Yi?4 S r D.7 Depth to limiting fa for } l.83 Remarks: Boring # -7 1b 7-11 Z6Yie4/?= - s 1 r►. sb~~ s /fir D,q b,5 Ground 1. IbY 4 s yy r h~ f~ S - Q. 6 l D,~ d 9Z i ft. 2-111 y rh r A Depth to limiting ~ f~toZr ~ Remarks: Boring # Ground "L ~"'33 L~Y12 4 S L r►, S 1o 'o .3 elev. 3 3 Y S 9k-u- ft. - r11 r rh S 0,7 O 3 -iZ ~y~ 4 4~ s Depth to Y' ►'h j 0. A K, limiting ~~t3 Remarks: Boring # hti Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 'y • M~K cow ~i 2~J~ 0 I c ( ~ u i i a d" La 1 ~ 4, 3oUAz" UNPLATTED LANDS EAST-WEST 1/4 LINE OF SECTION 26 N99.37' ' W 1 1221.08' 440.06' 66.00' 300.02' 415.00' -71s.arr'- 33' 33' 1 I , LOT 36 N ; I 3 108,332 so. FT. f ; LOT 29 2.49 ACRES m LOT 28 p 92,950 SO. FT. g q 128,018 SO. FT. Q z I 2.12 ACRES z 2.94 ACRES 589.37'22•E 440.04' ' 715.02'- L 300.02'- - 415.00' N89.3T22•W 849.37' LOT 35 8 Y N - 93,281 SO. FT. 2.14 N S89.37'22'E 64 848.39' ACRES I I 300.02' 415.00' 715.02'- 0 P DRAINAGE EASEMENT a ' ( fs.•T 389.37'22•E n a................ ............1......... O m 440.03' I I 23o' +~~~o • . . N O.~ in on n g O LO 1 3 DRAINAGE EASEMENT f 8 LOT 34 8 w 90.135 SO. FT. "..&BLOT 30 8 87,999 SO. FT. C; a I 2.07 ACRES N ` r S N ; ♦ 136,318 SC. FT. 2.02 ACRES ` 1 3:13 ACRES 5 s m sl` . 389.37'22•E .'.......12D'...........1 z Io \ III _ \ 7 440.02' Li A N99.37'22-W _ =I C ORAINAG[ 300.02' \ L 195, EASEMENT S89 .37.22"E 415. 0 g ° a Izo' LOT 33 N 67,997 SO. FT. I N 2.02 ACRES I 1p LOT 3 n N LOT 9 C; 87.150 SO. FT. N 3 N 2.00 ACRES a f S89037'22'E 440.01' ( UM Y1 3 UW 32 MUST BE SERVED BY A WOUND TYPE SEPTIC SYSTEM. LOT 2 OF CERTIFIED SURVEY MAP m $ 8 z IN VOLUME 9, PAGE 2420 se9.37'22'E 300.02' I O- r. m 2 M LOT iO W ~ LOT II p LOT 12 Z M~ o co v N / g 1 - - DRIVE - M E ADOW_- 488-0VOWE w 66.03' STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER L L MAILING ADDRESS X Z Z Oa PROPERTY ADDRESS ~O h1 o vec( r~ v~ (location of septic system) Please obtain from the Planning Dept.- CITY/STATE ~4 V D 5 8 V ("01 S ~a PROPERTY LOCATION # W 1/4, 5 L- 1/4, Section . _4 T N-R TOWN OF /4 c) D.5 ® M ST. CROIX COUNTY, WI SUBDIVISION &I 6 k NE A D 0 cy X v~- LOT NUMBER CERTIFIED SURVEY MAP j i , , 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: Alle-4--ldl DATE: 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 !ZAM f~_ r ~ 0,~41V N/ Location of property4 W 1/4$r. 1/4, Section ~G. ,TAN-R Township V DSo P Mailing address boy 2$ Z It~DsoN w i yo IG Address of site L 0 Subdivision name H I C. N MEA pU-J5 7771 Lot o. Other homes on property? Yes No Previous owner of property < L ~C/V A/ W AY40 ~C Total size of property 2 ~o7 4 Total size of parcel Z .og 4c- Date parcel was created //z/Sy Are all corners and lot lines identifiable? k Yes No Is this property being developed for (spec house)? X Yes No Volume 3 and Page Number S/ 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. Signatur o Appli ant Co-Applicant / ( , Date of Signature Date of Signature WARRANTY DB6D ToHWbaudand WUoM7ofn9Tenants FORM 3" (Revised) c .nuieco r .A,u C[ R _ 256764 ' This Indenture, Made this d..;. ............:.day of............. .ia=4.ry-.......................... , in the year J of our Lord, one thousand nine hundred and f (X'111 between ..........H dwig Win~lolffx-•a/k/a--- ' Hattie Windolff l I part.y.........of the first part, i and ....................Glenn Waxon and Vycgl)!a M,_•Waxonl--uaban~.aip~i wife..... of Husi4x ~..Y4!iscaa husband and wife, as joint tenants, parties of the second part. Witnesseth, That the said part.y........ ....of the first part, for and in consideration of the sum of Six Thousand 610 0, ---.Q._..Q92 ----------------.---.--.-----.Dollars, to.... ..i1er_,......... in hand paid by the said parties of the second part, the receipt whereof is hereby confessed and J acknowledged, ha..Ye.._..given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by j these presents do_.......... -give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said parties of j, - the second part, as joint tenants, the following described real estate, situated in the County of ......:.-...S.t.....Craix ..and State of Wisconsin, to-wit: The North One Half (N1/2) of the Southeast Quarter (SE1/4), the Southwest Quarter (SW1/4) of the Southeast Quarter (SE1/4), approximately .54 acres Ii of land located in the northwest corner of the Southeast Quarter (SE1/4) of the Southeast Quarter (SE1/4) described as follows: Commencing at the i northwest corner of said Southeast Quarter (SE1/4) of the Southeast Quarter (SE1/4), thence East along the North line of said Southeast, Quarter (SE1/4) of the Southeast Quarter (SE1/4) a distance of 76 feet; thence South and para- I II lell to the West line of said Southeast Quarter (SE1/4) of the Southeast Quar- ter (SE1/4) a distance of 312 feet; thence West and parallel to the North line of said Southeast Quarter (SE1/4) of the Southeast Quarter (SE1/4) a distance ji of 76 feet; thence North along the West line of said Southeast Quarter (SE1/4) l of the Southeast Quarter (SE1/4) a distance of 312 feet to the point of begin- ning; all of the land described above being in Section Twenty-six (26), Town- ship Twenty-nine (29) North, Range Nineteen (19) West. ~j Also, the Northwest Quarter (NW 1/4) of the Northeast Quarter (NE 1/4) and all that portion of the Northeast Quarter (NE1/4) of the Northeast Quarter (NE1/4) lying West of the re-located town road, all of the above being in Section Thirty-five (35), Township Twenty-nine (29) North, Range Nineteen I' (19) West. i Ii i ii - - --7 - 2C Cv~-~- n .-Tack T _ ~ And the sgid ........................8............ - Hedwi Windolff a/k/a Hattie Windolff part..y....... of the first part, I II _ for...::., her ...heirs, executors and administrators, do..es I --..:.::..covenant, grant, bargain, and agree to and II with the said parties of the second pa"t, and to and with the survivor of them, his or her heirs and assigns, that at I the time of the ensealing and delivery of these presents...- ehe..is...... well seized of the premises above described, as of a good, sure, l,erfeet, absolute and indefeasible estate of inheritance in the law, in fee iiniple, and that II the same are free and clear fronrall incumbrances whatever I ;I and that the above bargained premises in the < uiet and 1 peaceable possession of the said parties of the second part, i as joint tenants, his or her heirs and assigns, against all and every person or persons lawfully claiming the whole or any li jl part thereof,._..... ehe............. will forever WARRANT AND DEFEND. In Witness Whereof, the said part y ......of the first part ha s__-_--hereunto set.... her _.hand..-.and I seal this ._-...44 .day of..... January...... I I li Signed, Sealed and Delivered in Presence of . Wye c (SEAL) ~ t 1 i'~ ' I~ - r ;,..-r ~ W indolff Hed ~Ltrtac9z L -------(ssAL) John W. Davison II f~- ~ C~~~l.Cil ......................(sEAL) II (SEAL) Kathleen Tobias STATE OF WISCONSIN, ss. Personally came before me, this... ...2nd......................... day of..... J.a•nuar the above named ..............Hedwig Windolff, a/k/a Hattie Wi.ndolff . { to me known to be the person...,-who executed the foregoing instrument and acknowledged the same.. Aa A.l ~~i)r I THIS INSTP,UM IT WAS DRAFTED 6'y . ....`-{V 'LQ-OK.............. WHITE, DAVISON $ YJFN( AT LAW, RIVER FACES, WIsco tsln~s John W. Davis `T Notary Public........ i >r q° , V...Cti[It ~ b R.:I • qty Commission expires Dtz~,,,i)< 6►1. (Section 59.51 (1) of the Wisconsin Statutes provides that all Instruments to he recorded *hall have plainly printed pt N Y f names of the grantors, grantees, witnesses and notary) db[if<thalfioh'ths C: IN 'V ~ _ LtJ ~ ~ 1 •~j ~ ~ 1~ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS IND&`'TRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX 7969 'HUMAN RELATIONS N WI 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SE TION: TOWNSHIPhV0bWtetP*t-ffY: OT NO.: BLK NO.: SUBDIVISION NAME: /.oU ~W V S _ V/ 2C0 /T29 N/R 0 E (or) W H u PSOxj H -&-if JgEAZows~1- 000NTY: MAILIN ADDRESS: 5+ CROI' K GZZ_AJ 4/0r9X0.t) 7Z (P C'ova?y 'Ef>• A) , N U b Soo ~c) t S Syd i G> USE 3 -22 S DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: TS: Residence Sop- 4 ti 4 New ❑Replace l5 Iq9 ~ JUo1= IS 3 1G RATING: S- Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: S STEM-IN-FILL OLDING TANK: RECOMMENDED SYSTE (o tional CDS U ES❑U El SIA El SE]U ❑S❑U Mtimes- Foie P&~-~#5 -Q fOR_ £ - I 1- - O.u L 1 . If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.0915)(b), indicate: L~ S S [Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HET TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK..) ' oye, t o 1h y J~T 5 3, y R nY1 ; ~p z J ry 7 3 S, UAN rj Q 1 B- (to "-/,y ✓ //0 Y. /io " /o ye s/y .s 2 CPO ~'`fG~ Puvl~Gf0~1r 0-12"/0 VR 31y on„ y' )Mx; 36'/oYiPS'/y s, B- /fsbK, ~w.~2; 3G-'!~''/t~ YR ~/8 couRsE /S /CS~,n«F~ - o ~ ~ N 17 S u ~i'1 TE0 / Mfg R, B- p r 0-1 Q" /0 YR 2-I s;/, 2 nM Sh,-, r--Pie; 1 F.,-3 5' Y/r 4/Sc .S./ B- I ~Q ~J ~D ~~d 1n+, 3/< -FR; 3Y-SG' /v Y2 S/p lC3R~ --F 1 SG'- lI / v M, 5 n.,1tQ. 7, 0-1 L1, /0 /P\ 2-1I sil 2,»,S/JP AZ i /2- 3G /b VA' 4/4- S-1 E- ~c,0 ! yD >(~O ~30- s. /oYR /,V5/)Ir-99,~fei on- /0 /0(? 0-/0' /oYRZ/ sd 2-,w,sb/ 36' /a VI? f/4 S/ B- J 6 0 0 sbk ~,frz; 3o yU" ye s/RsI 1C5 2 rmrk; P~Rc ElEU,47-10101.1.5PERCOLATION TESTS /fO f~-/O~ /v Y2 S/Z/ AIK-40P• S. EST DEPTH f WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES' AFTERS WELLING NTERVAL-MIN. PERIOD I P RI D 2 PER INCH P- I q9 >le> T70 10 13//Ce / 3//4 Z/ P- 2 G's 9. y 10 Z 2- -Z % 5! 7 P- 6,0 `jam e. 0 I 4 I /4 1 ` /G S, 3 P- P P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope, i ~ 7- QE 3.O Mouvv SYS'TtM = 17.50 SYSTEM ELEVATION. , I j SeE _DT_ P~Ah~j , i f2 t✓U:= S S~ DE tH } I I I i i f j o J J M OL F- I ~ 2 11 a 2 44 sl I oa ~ - I i i _o - CA 1„r3.LS~$ Qrvnv W µ z . t~ ~IA al I y d+ I ' f o R w L` o~ I m m i n I ' u W I ~ ~ h 4 q, I ~o ~ I m o ~ IN m I N- I I Z I Z I - - ~ I - c ro ~ Z ~ µ ~ p 7C~ ~ o L O O O ° A ~ 1- S n