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AS BUILT SANITARY SYSTEM REPORT
OWNER _ 460= do
ADDRESS ,~&,Cgjl2,rV
SUBDIVISION / CSM# LOT #
SECTION T N-R W, Town of X /~`p gy
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
pr. u~w0-j
~e
lad B
.sc~ c
yo.
?So Pc
- Ca f
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: rn Q~S' /!5
ALTERNATE BM:
SEPTIC TANK /PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: Z99' GJes7` rr~ Liquid Capacity:
/Op►y
Setback from: Weller'-. House S ' Other
Pump: Manufacturer S6G r &1a)A d /0~, Model# Size
Float seperation Gallons/cycle:
Alarm Location
-.SOIL ABSORPTION SYSTEM
Width: Length 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 Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: -7'111
~
-PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:
3/93:jt
j# +
\ftisconsin,pepartmentofIndustry, PRIVATE SEWAGE SYSTEM County:\~, a.iav V.Ln
Labor and Human Relations
Safety and Buildings Division INSPECTION REPORT
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION
Peugi g!r's.6ta~rp,~RIC ❑ City ❑ Village Cl Town of: State Plan ID No.:
CST BBMYY Elev.: Y ~~tt~~ Insp. BM Elev.: BM Description: 3i Parcel Tax No.:
o 0 /00,00, 1_1:5Y4 11
f
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing
Aeration Bldg. Sewer - / s, r;, >
Holding St/Ht Inlet 6V..
TANK SETBACK INFORMATION St/ Ht outlet /6 y > 3
, / d
TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet ~b
Air Inta16,2, Septic 710` '50' ._2S' NA Dt Bottom ~ _75 o, F, Dosing U NA Header / Man. 1
Aeration NA Dist. Pipe 7/ X03- `r `
Holding Bot. System , 3~f U~.Df
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand o °
Model Number, GPM
TDH Lift ~+V Friction Syestem, TDH Ft
55 1 Dia. !Hd " Dist. To Well
Forcemain Length_
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSIONS-
LEACHING
SETBACK Manufacturer:
SYSTEM TO P / L BLDG WELL LAKE / STREAM
INFORMATION Typed CHAMBER Model Number:
OR UNIT
System:
DISTRIBUTION SYSTEM
Hie4-4er /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia ` Length Dia. Spacing Ob
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over _ I Depth Over Ct + xx Depth Of xx Seeded / Sedderf- xx ;ulched
es ❑ No
Bed /Trench Center 1, i U Bed /Trench Edges ~D Topsoil V ' [ Yes ❑ No VY/
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: RUSH RIVER.27.28.17W, SW, NE 185TH S`1'
Plan revision required? ❑ Yes &No
Use other side for additional information.
SBD-6710 (R 05191) Date Inspector's Signature Cert. No.
Safety and Buildings Division
0:LH s SANITARY PERMIT APPLICATION Bureau of Building Water System:
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.C). Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
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
Y Y Y programs ❑ Check if revision to previous a plication
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Propert Location
'7" .Q 5- 1i4 1/ 4, S Tap' , N, R E (or)~
'9 a, ot'. A' t 140- V Property Owner's Mailing Address Lot Number Block Number
0.2q G7X s?-
City, State Zip Code Phone Number Subdivision Name orCSM Number
a/ G ( ) Q V to
II. TYPE F BUILDING: (check one) ❑ State Owned !ty Nearest Road
❑ Village
Public 1 or 2 Family Dwelling - No. of bedrooms Town 00^:4 X'
'
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
1. ❑ Apartment/ Condo 0 V, r _ fee J ~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. ruNew 2. E] Replacement 3. E] Replacement of 4. Reconnection of 5. ❑ Repair of an
-___ystem-------- 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) Elevation
11.2 S S
X '416- X31 0 5r Feet d y, o~'Feet
VII. TANK Capacity
in gallons Total # of Site
INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Apex.
New Existin Gallons Tanks concrete structed glass App.
Tanks Tanks
Septic Tank or Holding Tank 0~, ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber 7SD / ` S LY- ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite se ge system shown on the attached plans.
Plumber's Name: (Print) Plumber'sSignatur NoSta ps) MP/ P R S W No.: Business Phone Number:
Plumber's Address (Street, City, State, Zi d
rfD~~ c .A),- 6 B ~G
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved anitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) '
*pproved E] Owner Given Initial Surcharge Fee)
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: I/ V
SBD-6398 (R. 05614) DISTRIBUTION: Original to county, One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS „
F'
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.
'E 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
r 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.
f SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
May 26, 1995 201 East Washington Avenue
0. Box 7969
n WI 53707
FIVE3 A~
ULBRICHT & ASSOCIATES REC~
n
ROBERT ULBRICHT J U ti
U
655 O'NEILL ROAD
HUDSON WI 54016 LP ST CROiX
CC*NTY
~KJPtiN~~!'P~IC~
RE: PLAN S95-01428 ECEIVED: 180.00
HAYES, PAT
SW,NE,27,28,17W
TOWN OF RUSHRIVER COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items must be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters II-HR 83 and 84, Wisconsin
Administrative Code, and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter I1-HR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify -the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
7 Si rely,
ames Quinlan Plan Reviewer ORIGINAL
Section of Private Sewage
(608) 266-3937
SUDA-7997 (R. 10/94)
ULBRICHT & ASSOCIATES CO.
655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems
715-386-8185 Private Sewage Consultants
PROJECT INDEX
DILHR Plan I.D. # S95-01428 Date may 2r,, jqq-A
owner Patrick & Donna Hayes Phone 715-386-1825
Address 329 6th St. Hudson, Wis. 54016
r -
Legal Description Tax parcel # 028-1037-30. Part of a 40 acre parcel
SW 1/4, NE 1/4, Sec. 27, T 28,N, R 17 W.
Town of Rush River/ Pleasant Valley County St. Croix
C.S.T. Gary L. Steel CSTM2298 Installer
Local Authority/ Supervision
St. Croix County Zoning Dept .
PROJECT DESCRIPTION
New Construction, for a proposed 3 bedroom home. Estimated
daily wastewater flow: 450 gals.
Soils are fairly permiable (.4 GPD/ft2) but seasonally
saturated at 27". A long narrow conventional type mound system
is proposed.
REcommended: install zybol filter in septic tank.
RECEIVED
MAY 2 6 1995
SAFETY & BLDGS. DIV.
Pg.1 PLOT PLAN VIEWS 0N.~"`~
0,7 tiSC ~NSl
Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS.:''
ROBERT W.
Pg.3 PIPE LATERAL LAYOUT = LBR~CNT `
= D116O
HUDSON. W1
Pg.4 DOSING CHAMBER CROSS SECTION 'y
a,,~ I G Ct
Pg .5 PUMP PERFORMANCE SPECS S
rirn►►1unua►nu►aa~
This design for installation is based entirely on measurements, elevations,
landscape conditions (slopes etc.) and soil suitability provided by CSTM 27-?60
The accuracy of his specs, as reported, shall remain the sole responsibility
nF f•lhc ria"A
IS rk AvR- .
CS Tq1 s /3Ms
Ai # / =
/3.y Z = To o z-
N
D SG,}LE: 30 'r
H /
J~ p
FPO 0569 o r:.ids SYSTEM
M itionally
popo5E0 p!
R14 k
APPROVED-
1A S DEPT. OF MOUSM, LAW 1
f MvtSO1K OF MIU
0
of grI4 W
00
yl~ TOf'~~{-oR~ ~r
i0
e(,Ay~ y,, PSG p,
O - 71
(3Z
ZIN/ FflipM ~flv Td v~Q ~ , ~ '
`CE►JTP.AL, MAA)i Fnt_p D►srPo'BOTIOA-) PIPE UErwoR k
TOTAL NkT-Wo(2k udlunrz:- ~S
1
-P
9►STR►QUTIaN3
PVC CENTRAL- = LATERAIS i
M AN %Fo 1-t>
ENlD SAP 5
I Y~ X X i [BUG FoRCE
MAW
LAST' ►AO l e "All Be
NEXT TO LAND CAP FT.
VOID VoluMt FOR 2 5
0 F 2 Fo RcE M lei U ~ ~ gA IS,
XaueRr G IRVA'noA3
103, 55
SAFETY
F
D
p 4q ~fiq O~NWWE D E TA L
Holes l(gcATED
Q Go-rroM sHAtl BE
I -I VAPlAaLE y t c uhlly SNhcED.
Y DtSrgNCE
F1- Hole DiAKa=Te R 'N•
P 3~ ,1
~ is .
i LATERAL, I/
R 3• °
MA01 FOLD " '2- IN
x 3 Cv ~~~hES
FoRcE MAI~U IN.
Y 44= of I+o►E5/ p i p E 13
INC,1.Es
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P,4 <E of j
-VEUT CAP
4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING
JUNCTIOU BOX MANHOLE COVER
25' FROM DOOR, t1l (V fXp1,0(1 /J113E~
WIIJDOW OR FRESH 12"MIU. I
AIR IAITAKE
1r^nE ~~F ~q~/p n/ GRADE I 4"M10.
l I IB" MI U.
~ /C 1/4 ri r 1
PROVIDE I -
iNLE r AIRTIGHT SEAL I I (
h DE I I APPROVED JOINTS
P,PFROVEO JOINT A W/C,=, PIPE
1J~C.I. PIPE ~ r~~Ur, i ~ EXTENDIAIG 3'
2XTENDIFIG 3' 0 ''nn a ALARM
~ ONTO SOLID SOIL
0gT0 SOLID SOIL. Q1 I v N 1( I-,k
B . ✓ 1 ~~ia 'L '''c t7i it IV 3°~YiD
Q M9 '
yq. a
ELEV. FT.-~...
i _E C a OFF
,S
(fit Dv!)" BLOCK
0 god
-x- RISER EXIT PERMITTED O►JLY IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E SPECIFICATIOU -S
DOSE H(VWESTERN P12e(ASr ~o.
TANKS MANUFACTURER: (DUMBER OF DOSES: ~ PER DAy
ii2-•5
TAMK `,IZE : -lS GALLOIJS DOSE VOLUME 411 /!7
S .S. Et~cT(Zd INCLUDING BACKFLOW: GALLOt15
ALARM MANUFACTURER:
MODEL MUMBER:` -rAok kiser- /dI Hr~ CAPACITIES: A= INCHES OR 3b0 GALLONS
SWITCH TYPE: M.'RCl0/Qy ~YO'4T B = Z' INCHES OR 37'5 GALLOWS
PUMP MANUFACTURER: GGV Ll~f 3 ~d5_ C= 4'3 IAILHES OR I17 CALLOUS -415*5 MODEL NUMBER: WCO 3 1!L Y3 H pl D= [S'7 INCHES OR GALLOWS
SWITCH TYPE: P(l CiH(-K )4MOR FloAr NOTE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE 3w (p P INSTALLED OM SEPARATE, CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTIOM PIPE.. FEET S~lu
-t- MIUIMUM NETWORK SUPPLY PRESSURE . . • . . . . . . 2.5 FEET EACH Pitt.
+ FEET /~Un (Q• 5 !C
~ FEET OF FORCE MAIN X Z•b~ FTT/Ui1FRIC7101J FACTOR.. '52-
A i n `1 `7~ I.>
Submersible
Effluent Pumps
3885
AVAILABLE CERTIFICATIONS
ETL LISTED SUBMERSIBLE PUMP
CLASS I AND 71 DIV. 2 AND
CLASS III DIV 1 AND 2
ETL TESTING LABORATORIES, INC.
CORTLAND, NEW YORK 13045 G1086131480
CANADIAN STANDARD ASSOCIATION sf t
PERP RMO ANCE RATINGS (gallons per minute) MODELS
WED511H WE0511HH Series HP Volls Phase Max. Amp. RPM Solids Wt. fibs.)
series WE0512H WE0712H WE1012H WE1512H WE0512HH WE1512HH WE0311L 115 9.4
No. WE0311L WE0311M WE0532H WE0732H WE1032H WE1532H WED532HH WE1532HH WE0312L 230 4.7 1750 56
_ WE0312L WE0312M WED534H WE0734H WE1034H WE1534H WE0534HH WE1534HH
WE0311M 115 9.4
HP Vi V3 '/2 % 1 1'/z '/2 1 Vz WE0312M 230 1 4.7
pPm 1750 1750 3500 3500 3500 3500 3500 3500 WE0511H 115 13.0
~5 100 70 80 90 106 - 60 - WE0512H 230 6.5
10 80 65 76 87 102 112 56 84 WE053211 208/230 3.4
15 60 57 72 84 100 108 53 82 WE0534H 460 3 1.7 60
a 20 36 45 65 79 95 105 48 77 WE0511HH /2 115 13.0
25 25 59 74 91 100 45 75 1
WE0512HH 230 6.5
w 30 50 67 85 96 40 72 WE0532HH 208/230 3.3
35 40 61 79 92 35 70 3
5 40 26 52 72 86 30 67 WE0534HH 460 1.65 %11
-45 10 43 64 80 25 64 WE0712H 230 1 10.0
WE0732H % 208/230 5.4 3500
"50 30 54 73 18 60 WE0734H 460 3 2.7
55 17 42 65 12 58 70
WE1012H 230 1 12.5
60 6 30 54 3 54 WE1032H 1 208/230 7.0
~65 5 26 47 WE1034H 460 3 3.5
! ~70 WE1512H 230 1 15.0
75 14 43 WE1532H 208/230 9.2
80 4 40 WE1534H 460 3 4.6 80
90 24 WE1512HH 1 /2 230 1 15.0
100 WE1532HH 20230 9.2
110 15 WE1534HH 460 3 4.6
120 5
metal parts, BLINA-N
elastomers. METERS FEET
• Temperature: 1600 F (71° C) 90,
maximum. MODEL 3885
80 i ; SIZE Y4" Solids
• Fasteners: 300 series 25-
stainless steel.
WE1--
• Capable of running dry 70
j
without damage to 20 WE1ort 1 ;
components. 60 i SGPM
Motor: w WE07H I 5 FT
X _ ; -
• Single phase: 1/3 HP, 115 or a 15 50 f
230 V, 60 Hz, 1750 RPM; 0 4o wgO H
'2 HP, 115 V, 60 Hz, 1
3500 RPM; '/2 HP through 10
E"M
1'/2 HP,230 V, 60 Hz, 3 !
3500 RPM. ~n WE _ , I i i
Wisconsin Departmenf of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
' bor and Human Relations
D~yision of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. #
not limited to vertical and horizontal reference point (B lion and % of slope, scale or
dimensioned, north arrow, and location and list, 1 ~ >sest 028-1037-30
REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE,PRI~Nf°ALL INF N
PROPERTY OWNER: -*art PROPERTY LOCATION
)FE
atrick Hayes GOVT. LOT SW 1/4 NE 1/4,S27 T 28 N,R 17 (or) W
P
PROPERTY OWNERS MAD_ING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
329 6th. St. a.~' na na 40 ACRES
CITY, STATE zip C .A PRONE OCITY OVILLAGE &OWN NEAREST ROAD
Hudson, WI. 54016 f %,715) 3 82,5,"".' Rush River 185th. St.
( New Construction Use# j Resident 3 ( ]Addition to existing building
Replacement [ ] Public or commerp l
Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd/ft2.5 trench, gpd/ft2
Absorption area required 375 bed, ft2 375 trench, ft2 Maximum design loading rate . 4 bed, gpd/ft2 .5 trench, gpd/ft2
Recommended infiltration surface elevation(s) 103.05 It (as referred to site plan benchmark)
Additional design/ site considerations el. based on contour of 102.05
Parent material pitted 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 for svstem ❑ S ou I as El U ❑ S ou I ❑ S Bu ❑ S a ❑ S au
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Gu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tferch
+1 y 1 0-11 10 r 4/3 none s l 2.msbk infr w .5 .6
2 11-2 10 r 4/4 none scl 2msbk mfr cw if .4 .5
Ground 3 27-6 10yr 4/6 c2p 7.5yr5/ .2 .3
7.5 r5 scl lmsbk mvfr na na
elev.
102.5fp
Depth to
limiting
factor I
2
Remarks:
Boring #
:M 1 10-13 10 r4 2 none S1 2msbk mfr Cjw 1 .51 .6
2 2 113-21 10 r 4/3 none siCl 2msbk mfr w .4 .5
3 21-3 10yr 4/4 none sicl 2msbk mfr gw na .4€.5
Ground c2p 7.5yr5 j
elev. 4 32-5 10yr 4/6 7.5 r5 scl lmsbk mvfr na .2" .3
102.55ft.
F
Depth to
limiting
factor
32"
Remarks:
CST Name:-Please Print Gar L. Steel Phone: 715-246-6200
Address: 1554 200th Ave. New ichmond, Wi. 54017
Signature: Date: CST Number:
4-22-95 cstm 2298
PROPERTYOWNER Patrick Hayes SOIL DESCRIPTION REPORT Page_2 dr
PARCELI.D.# 028-1037-30
I I GPD/ft
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Batr ry Roots
in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh.
Bed iTrerxf~
<....3. 1 -14 10 r 3/4 none sl 2msbk
w if .5 .6
mfr
X-X
2 14-32 10 r 4/4 none sicl 2msbk mfr w if .5
Ground 3 2-48 10 r 4/6 c2p 7.5 r5/ sci lmsbk mvfr w na .2;1 .3
elev. c2p 7.5yr5/ i
100.85 ft. 4 48-55 10 r 3/4 7. 5 r 5/ s i c i m na na na na na
Depth to
limiting
factor
32"
i
Remarks:
Boring #
Ground
elev.
ft.
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SBD-8330(R.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Patrick Hayes 1554 200th Ave.
CSTM2298 SW4NE4 S27-T28N-R17W New Richmond, WI 54017
MPRSW 3254 town of Rush River (715) 246-6200
1
N
1"=40'
BM.=top of 1" pipe C el. 100'
Alt. Bm.= top of 1" steel pipe at el. 98.40
U, ~F~C J
~l
N-
6A 71 ~tA
~'o
40
Gary L. Steel
4-22-95
i
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER AALLP, 1Y1 1)O nA ►4
MAHJNG ADDRESS 231Z { ~vle Dreg h x S~lvi Co
PROPERTY ADDRESS Z 9S 7-;4 S
(location of septic system) Please obtain from the Planning Dept.
CIT WATE
PROPERTY LOCATION) 1/4, 1/4, Section W
TOWN OF 1 c 5 I~ ~!1 ST. CROIX. COUNTY, VVY
T
SUBDIVISION i _ ----93 LOT N' N BER
CERTC>EMSURVE'Y'MAP VOLUME PAGE ;LOTNumBER
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 609io of the cost
of replaeetneat 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 'W'isconsin 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 imtion date.
SIGNED: !tl .
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
Z0 39Gd vd9 L5 86:L0 9661/9Z/b0
STC-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-
Location of roperty 50 1/4 /VF 1/4, Section Z -F , T ZT N-R_Ly _W
Township 0,56L ~fNrzr/ Mailingaddress 231Z 4 6re!e
YU
Address of site . ~C
Subdivision name Lot no.
Other homes on property? Yes_X~No
Previous owner of property t,y E= ~r P w~ fly v w
Total size of property yp -C, p1Z
Total size of parcel yp
Date parcel was created
Are all corners and lot lines identifiable? xl Yes No
Is this property being developed for (spec house) ? Yes >C No
Volume 1;2? and Page Number to Q6_ as recorded with the Register
of Deeds _
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that.all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature of Applicant Co-Applicant
I kYai i ~Ntl 4e w«_ e: wd„ .x ar a. .nu .o I I alr till l'N
Date of Signature Da a of signatu e
TO 39Vd Vd9f L9 86 =LO 9661/97,``
t a 7 a S.
State Bar of Wisconsin Form 2 - 1982
53058 WARRANTY 7 DOCUMENT NO. ypt
12 1 PAGE UUc3 F-a~~ ~r f
Seed tax F-o.:.:: J
Roger C Wiff and Timothy C. Wiff, d/b/a JUN 2 8 1995
RTW Enterprises
Ety 10:45 A.N
I conveys and warrants to Patrick M. Hayes and Donna M.
Hayes, husband and wife
poo HIS SPACE RESERVED FOR RECORDING DATA
NAWE AND RETURN ADDRESS
-A
k ~ •
St. Croix
the following described real estate in
County, State of Wisconsin:
028-1037-30
(Parcel Identification Number)
The Southwest Quarter of the Northeast Quarter (SW 1/4 of NE 1/4)
of Section Twenty Seven (27), Township Twenty Eight (28) North,
Range Seventeen (17) West..
a 1~st+
is' not bomesteadproperty.
This
' 2W~ (is not).. .
Exception to warranties: easements, restrictions and rights-of-way of record,
if any.
May . 199 5
Dated this 3rd day of
RTW En rprises
Y. _ (SEAL} - B C (SEAL)
Roger Wiff
•
(SEAL) B (SEAL)
Timothy C Wiff -
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSINi
Signature(s) SIL
St. Croix County.
authenticated this day of .19 Personally came before me this 3rd day of
May , 1995 the above named
Roger C. Wiff and Timothy C.
Wiff - d/b/a RTIt nterp*f ses
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
I authorized by §706.16, Wis. Stats.) to me knD who executed the
for Il An_
ABSTRACT Order No. 17603
HERITAGE TITLE COMPANY
CONTINUATION OF ABSTRACT
78
I
From the 27th day of March ,1995 at 8:00 o' clock in the _A_. M. of the
land described as: SW} of NE} of Section 27-28-17. t
79
Roger C. Wiff and Timothy C. Warranty Deed.
Wiff, d/b/a RTW Enterprises, Con. none shown.
Dated May 3, 1995.
-to- Ack. May 3, 1995.
Rec. June 28, 1995.
Patrick M. Hayes and Donna M. In "1125'', page 605, X1530586.
Hayes, husband and wife.
The Southwest Quarter of the Northeast Quarter (SW} of NE}) of Section Twenty
Seven (27), Township Twenty Eight (28) North, Range Seventeen (17) West.
Recites: This is not homestead property.
Except easements, restrictions and rights-of-way of record, if any.
80
Patrick M. Hayes and Donna Mortgage.
M. Hayes, husband and wife, Con. $24,000.00.
Dated May 3, 1995.
-to- Ack. May 3, 1995.
Rec. June 28, 1995 @ 10:45 A.M.
First Federal Savings Bank In "1127", page 606, 11530587.
LaCrosse - Madison.
SW} NEk, Sec. 27-T28N-R17W. St. Croix County, Wisconsin.
(Adjustable Rate Rider Attached, see Records)
81
Taxes for the year 1994, due and payable in 1995, in the original amount of $541.36,
have been paid in full. (Tax Parcel No. 028-1037-30)
HERITAGE TITLE COMPANY
* * A Pogey 6auingAgent For OId Repubfie National Title
Ineumnce Company
HTC 10076/93
t
, Cdunty of S=. Croix APoIiq I..Weg Agent Fa OW Republic National Title y.
~ * , * ,,,,uYeneaComp.J, i
. r { M
HERITAGE TITLE COMPANY f:
AFoJp WWgA,mt FmWld gepublk N.UmWTJe hereby certifies that the foregoing abstract, consisting of Entries
Innnrce C.np.ny
No. 78 to 81 , both inclusive, is a correct abstract of title since March 27, 1995 @ 8:00 A.M.
of lands described in the Caption at No. 78 hereof.
THAT, FOR THE PERIOD COVERED BY THIS CERTIFICATE, SAID ABSTRACT CORRECTLY SHOWS:
1. All matters affecting or relating to the said title which are recorded orfiled for record in the Office of the Register
of Deeds for said County, including Federal Tax Liens (for the past 10 years and 30 days) filed therein against
the parties listed below.
2. EXCEPT as shown in this abstract, there are no unsatisfied construction liens affecting title to such lands
docketed in the Office of the Clerk of Courts in said County for the past 2 years. .
3. EXCEPT as shown in this abstract, there are no unsatisfied judgments, including delinquent Income Taxes,
docketed in the Office of the Clerk of Courts in said Countywithin the past 10 years, as and against the following
named persons which affects the title to the real estate above described to wit:
Roger C. Wiff Patrick M. Hayes
Timothy C. Wiff or
RTW Enterprises Donna M. Hayes
4. EXCEPT as shown below, we certify that according to the tax records in the office of the County Treasurer
for said County, there are no delinquent taxes or special assessments affecting said land:
(Such examination as to real estate taxes and special assessments covers up to and including the year 1994
Tax Parcel No. 028-1037-30
5. This examination does not include the following:
(a) Special assessments against the premises above described for public improvements instituted or
completed, or deferred payments thereon, not shown on the County Treasurer's records.
(b) Laws, zoning and other ordinances unrecorded, regulating and restricting use of said land.
(c) Insanity and guardianship proceedings impounded by the State of Wisconsin.
(d) Checking of maps for any proposed road shown on any city, village or town map or official map.
(e) Circuit Court and County Court proceedings unless a lis pendens or other notice has been filed in the
Register of Deeds office calling attention to the proceedings.
THIS PARAGRAPH APPLIES ONLY IF THIS IS A 60 YEAR ABSTRACT.
This abstract shows all interest of Railroad Corporations and Public Service Corporations, as defined by s. 184.01
or any trustees or receivers of either, and all interest of the State or any Political Subdivision or Municipal
Corporation thereof, and there are no further easements than those shown on the abstract.
We assume no liability to any part other than this continuation containing the original signatures of an officer of this
company.
That for the period covered by this certificate, all instruments appearing in this abstract contain the necessary
numbers of witnesses and acknowledgements unless otherwise noted.
That this certificate and annexed abstract and also any prior certificates, if any, made by the undersigned, covering
the same land, are furnished for the use and benefit of any and all owners of the land described in said caption and
their successors in title, including mortgagees and guarantors of title.
Dated at Hudson, Wisconsin this 5th day of July 1995 at
8:00 o'clock in the A.M.
HERITAGE TITLE COMPANY
A-qk MA,w.F MMp.Wk N.Jeul M.
Innn.ncnmwnY
BY I a-v\C
Nancy K. fathisrud Authorized Signature
Abstracter
HTC 1006 6193