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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER
ADDRESS
t .
SUBDIVISION / CSM# ~DIt.v 4 LOT #
SECTION T N-R W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
qr v
d J
0
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
r
BENCHMARK: SP GLZ~ S
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: ,`~Gt e5'7B ,t^~/ Liquid Capacity:
Qd d
Setback from: Well czp ` House Other
Pump: Manufacturer 5e /06 Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length ? Number of trenches
Distance & Direction to nearest prop. line:
T'
Setback from: well: ODv~ House led-e- 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: Z
PLUMBER ON JOB:
LICENSE NUMBER: ~ 7
INSPECTOR:
3/93:jt
Y i
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
aand Human Relations
S INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION 268674
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
KELLY, WILLIAM C. ST. JOSEPH
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic d_" Benchmark ' /00
Dosing a
Aeration Bldg. Sewer
'
Holding St/ Ht Inlet 58• 96
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANK TO P / L WELL BLDG. Airito ntake ROAD Dt Inlet
Septic >Z-' NA Dt Bottom /y, 3o' 4'
61 S;.3 *
Dosing 5-+ ,yo + r S` 0 NA Header / Man. 6'st' g9.o~ '
G, e- 5, 4 ?I r9'
Aeration NA Dist. Pipe L - Ib' 99•34'
7,58'/ 4 7, 9G'
Holding Bot. System 7s ' ag'SS'
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand G~ Q~r 4~. 6
Model Number Jr~_S cf 30 GPM
TDH Lift$.5`~ Lrictionl S`i System TDH ID:Z'Ft
Forcemain Length /00 Dia. 02 Dist. To Well r /U0
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS Jr / S DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
SETBACK
INFORMATION Type O CHAMBER Model Number:
System: r v' (f 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: ST. JOSEPH.31.30.19W, SW, SW, COUNTY ROAD U
Plan revision required? ❑ Xes Q No
Use other side for additional information. 1/0 p~
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
E 1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
d
l
Safety o and Butildin g Water Division Systems
■~~r,r,t SANITARY PERMIT APPLICATION Bureau
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. n
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
Aug b-Irq
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]- State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
Property Owner Name Property Location
r l 1/4Se-J 1/4,ST,~d ,N,RE(o W
Property Owner's Mailing Address-' Lot Number Block Number
A -7 e a
City, State Zip Code Phone Number Subdivision Name or CSM Number
. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road
❑ Village
Public 1 or 2 Family Dwelling - No. of bedrooms gown OF ase
III. BUILDING USE: (If building type is public, checkallthatapply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 n 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. WReplacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
_____System________System_----- __TankOnly 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 [LSeepage 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) D ElevatioClO
Ae T- 61' 9Q B S Feet
lZf-5. lOl. A / eet TANK Capacity
VII. in gallons Total # of Prefab. Site Fiber- Exper
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- steel glass Plastic App
New Existing strutted
Tanks Tanks l r7~
1
Septic Tank or Holding Tank Q~d l l=T El El El 1:1 1-1
Lift Pump Tank /Siphon Chamber ~ l ~ ,u637~ ~ ~ ~ ❑ 1:1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite s ge system shown on the attached plans.
Plumber's Name: (Print) Plumber's Signature: (No tamps) MP/ PRSW No.: TBusiness Phone Number:
2~s-3aG
Plumber's Address (Street, City, State, Z C de):
P d 7 Zr-/AZ
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Agent Signature (NO Stam s)
Surchargeree)
(Approved ❑ Owner Given Initial _
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to CuurJy, One copy To: Safety 8 Buildings Divi ion, Owner, Plumber
C ~
INSTRUCTIONS
l
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:
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 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.
V1. 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.
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PAGE GF
PUMP CHAMBER CROSS SECTION AND SPECIFICATIMS
a
VENT CAP
4"C.I. VENT PIPE
WEATHERPROOF APPROVED LOCKIAIG
JUKICTIOKI BOX MANHOLE COVER
25' FROM DOOR,
WINDOW OR FRESH 12"MIU.
AIR INTAKE I it
GRADE I i
4" MIN.
I
18" P11 AI.
COUDUIT
INLET PROVIDE (
AIRTIGHT SEAL
* A I III
I I I ALARM
6 ( ~I
0 *APPROVED i ow
JOINTS WITH I
ELEV. FT. APPROV D PIPE
3' ONT PUMP-~ ` OFF
D SOLID OIL
CONCRETE BLOCK
RISER EXIT PERMITTED OMLy IF TAWK MANUFACTURER HAS SUCH APPROVAL_
SPEC. IF ICATIOUS
j SEPTIC E
DOSE ,y
j TAWKS MANUFACTURER: ` w~s'~~°y-✓ {JUMBER OF DOSES: PER DAS - 171 TANK SIZE: 7Dl GALLONS DOSE VOLUME
~ IMCLUDIKIG BACKFLOW:~~aO GALLONS
~~deti
ALARM MAUUFACTUItER: ~
MODEL IJUMBEK: CAPACITIES: A= C IAlCAFS OR .a GALLOWS
SWITCH TSPE: h72~bC g = INCHES OR ~ZS GALLOWS
PUMP MANUFACTURER: ~D ~Ld,V r-= iWCHES OR as d GALLOWS
MODEL MUMBER: D - j(/ INCHES OR 2614e;* GALLOWS
SWITCH TYPE: 107 e-i-c- MOTE: PUMP AIJD ALARM ARE TO BE
MINIMUM DISCHARGE RATE Ild GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFEREKICE BETWEEW PUMP OFF AUO DISTRIBUTIOW PIPE..1.lL_ FEET
+ MIK 1MUM NETWORK SUPPLY PRESSURE
, , , . , ~ FEET
+ 160 FEET OF FORCE MAIN X ,'u; F/IoortFRICTIOW FACTOR..tj" / FEET
TOTAL D`.liJAMIC. HEAD = /O Gl FEET
IKITERMAL DIMEIJSIOWS: OF TAUK: LEM&TH ;WIDTH ;LIQUID DEPTH
SIGU ED' - LICEKMSE NUMBER. 15' DATE: ,Y- ir
~
r 4% 61/4
co f- HEAD CAPACITY CURVE 45/8 _
W W "57" - "59" SERIES
45/,
U ° x
25 • l _ _
_11h-11'hNPT
4316
6 20 I
a
W
x
U
~ 15-
4 915/16
J
Ia-'
o to--
33/32
9.56
L Z8. b$
5 TOTAL DYNAMIC HEAD/
FLOW PER MINUTE
EFFLUENT AND DEWATERING
HEAD CAPACITY..-
UNITS/MIN
0 FEET METERS GAL LTRS
US 10 20 30 40 50 5 1.52 43 163
GALLONS
10 3.05 34 129
LITERS 0 80 160 15 4.57 19 72
FLOW PER MINUTE 19.25 5.87 0 0
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Piggyback Mercury Float Switches • Available with special cord lengths of 15',
available. 25', 35'-and 50'.
• Variable-level long cycle systems • Alarm systems available.
availablei--- • Duplex systems available.
Standard cord length - automatic 9 ft. SELECTION GUIDE
Standard cord length - non-automatic 15 ft.
1. Integral float operated mechanical switch, no external control required.
2. Single F'g: txck wide eagle mercury 11cet sw t,:h or double o goyhack merc•:my
57/59 SERIES Control Selection float switcn. Refer to FM0477.
Model Volts-Ph Mode Am Simplex Duplex 3. Mechanical alternator 10-0072 or 10-0075.
/ :AA57/59 115 1 Auto 8.0 1 or l &7 - 4. See FM0712 for correct model of Electrical Alternator, "E-Pak".
N57/59 115 1 Non 8.0 2 or 2 & 6 3 or 4 & 5 5. Sensor mercury float switch 10-0225 used as a control activator, with "E-Pak"
D57/59 230 1 Auto 4.0 1 or 1 & 7 - duplex (3) or (4) float system.
E57/59 230 1 Non 4.0 2or2&6 3or4&5 6. Four (4) hole"J-Pak", junction tax, for watertight connection orwired-in simplex or
s 2 pump operation, 10-0002.
7. Two (2) hole "J-Pak", for watertight connection or splice,10-0003. J
5TSeries - Wt. 27 -.3 H.P. 59 Series - Wt. 29 -.3 H.P.
CAUTION
For information on additional Zoeller products refer to catalog on Combination Starter, All installation of controls. Protection devices andwldnpshould bedone byagmdifled
FM0514; Piggyback Mercury Float Switches, FMO477; Exectrical Alternator, FM0486; Mechani- , licensed electrician. All electrical and safety codes should be followed Including
the
cal Alternator, FM0495; Alarm Package. FMO513; Sump/Sewage Basins, FMO487; and Simplex most recent National Electric Code (NEC) and the Oeanpedonial Safety and Health Act
Control Box, FM0732. (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO. P.O. BOX 16347
Louisville, KY 40256-0347 Manufacturers of...
SNIP TO. 3280 Old Millers Lane
° ZZELLE/P 0i Louisville, KY 40216 N
(502) 778-2731.1(800) 928-PUMP QUALITY /4itI f
FAX (502) 774-3624
Wisconsin Department of Industry, SOIL AND SITE E O RT Page --!-of 3
Lacot and Human Relations
Division of Safety & Buikfngs in accord with 1 .05,10, Adm. e
• y COUNTY
E N 0 S-r. C,o~X-
Attach complete site plan on paper not less than 81/2 x 11 i n size. Plan must include,
not limited to vertical and horizontal reference point (Blu), dir and AL4011p,6 sc~@i 6r PARCEL I.D. #
dimensioned, north arrow, and location and distance to neare d. O 30 - l~ g J - $ 0 _ Op J
ST CF~)1X
APPLICANT INFORMATION-PLEASE PRINT ALL IN TION GC REVIEWED BY DATE 41t4 'q.
PROPERTY OWNER: PROPER IJw-sw 'aKX> _
1~~ l Ll 1 L, S~ 1/4 S W 1/4,S73 ~ T 3 N,R l 0( E or W
PROPERTY OWNER':/WS~ M~AILIING~ ADDRESS LOCK # SUBD. NAME OR CSM #
`2 Z, UIt/ " v -
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®fOWN NEAREST ROAD
~vDSOr..~, I.v1 St{p1.6 (71~ S~I9-69t0 ~S~ H ~vti,~ V t(J New Construction Use [kj Residential / Number of bedrooms 3 [ J Addition to existing
building
Replacement [ J Public or commercial describe
Code derived daily flow qSO gpd Recommended design loading rate - bed, gpd/fI? o•`t5trench, gpd/tt2
Absorption area required , `VZ S bed, 11:2 _q; 0 O trends, 112 Maximum design loading rate _ o. ~_bed, gpd/ft2 0 - Stench, gpolft2
Recommended infiltration surface elevation(s) S: ZIEl- jJ t i3 E OF 3 ft (as referred to site plan benchmark)
Additional design / site considerations t4 oo S f_A 1Z t 0-ttle S - t cH S 'x So' Lo'VG.
Parent material s ti c" SlA>M *jr wuv_--I S G), Flood plain elevation, if applicable ti it
S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for system QS ❑ U ® S ❑ U ®S ❑ U ® S ❑ U ❑ S Eau ❑ S I U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Mottles Texture Structure Consistence Bour>vary Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trend
'atih<S ~ } x_10 1.0`.1,R31 Z ~ s i z~,. sb~C ~s • S ' ~
nY N z to _s I ~O`~ tZ 3!~ - s i t Z ~.Sb` c~ S e
Ground 3 Sl-$b 7.S`1[Z31y
elev.
VW~A3 ft.
Depth to
limitirrg
factor ,
>86'
Remarks:
Boring
IN
Ground
elev.
tiot•S 1L°
Depth ID
limiting
factx
Remarks: -
CST tw►e:-Please Print Phone:
Arthur L. We erer 715-425-0165
eg rer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signait~ne_ - Date: r CST Num o
= L 83 S -5_ b
6 1400576
PROPEM OWNER SOIL DESCRIPTION REPORT Page ? of 3
PARCEL I.D.# 030 leg - SO- OQ0
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench,
1 0-b ~k-)-.~Z- 3!Z sl Z sblz cs - .s
Z %-Z9 10`1 R 3/( _ S,1 Zw) sb
rm`F c s • s
Ground 3 z9-o 7. S `/R 3/ - 31 Alr~ b 1a1 U `~t-, Z GV l ' • S
elev.
W3•± ft. Li 1--13-s • S y R 3/ s q- G,, o s g ~ e w _ • 8
Depth to S Su=~1 ~ _S 23L - S :i 6,), g 3 - • 3+ -y -
limiting
factor 4 S CO?.~ t~S p~= 1p~tC1- V v
>
Remarks:
Boring #
Ground '
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev,
ft.
Depth to
limiting
factor
Remarks:
Boring #
r4
s
l
" Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-A330(R.05/92)
r ,
PLOT PLAN Page 3 of 3
SCALE 1"= 301
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,~.,pp 6-183
d - b' r 5-96 (715 ) 42.5'-0169 _ M00576
CST Signature Date Signed Telephone No. CST #
list onsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Build* 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 S-r' C `X
not limited to vertical and horizontal reference point (81M), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 01(3- l~)91 Op (
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
~Nu
PROPERTY OWNER: PROPERTY LOCATION Q%A 'SW
WlL`~faE'I L G61F-1: S11,31/4 SW1/4,S3~ T 3O N,R LO( E(or W
PROPERTY OWNER`-.S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
\2 Z,1 Covty v " - -
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST ROAD
Y~vDSkiv, I.vl S~{pl6 n 1s) Sq9-&9,10 S`. ~pS N e-AVtivy'f Vd
[ ] New Construction Use [DQ Residential / Number of bedrooms 3 (j Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow q S13 gpd Recommended design loading rate - bed, gpd/9o•qLStrench, gpo1ft2
Absorption area required %1'L S bed, ft2 0 4 trench, f12 Maximum design loading rate S.- tied, gpd/ft2 0 - Strench, gpd/9
Recommended infiltration surface elevation(s) S e-E!- _FD N1 E 3 0~ 3 ft (as referred to site plan benchmark)
Addrtiortal design / site considerations 14 bo S C'O TZ ettE S - N S 'X s o L oN6 ,
Parent material SW'T4 Stp~I*JT Ouv_--k S ~ GI, Flood plain elevation, if applicable ti ft
S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for system l$ S ❑ U ®S ❑ U In ❑ U ® S ❑ U ❑ S [qU ❑ S RI U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou nclary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
v 0-10 LO`1R 31 z s~ Zsb~C cS _ • s 6
- Z ti0_S ~O`~,SZ 316 ~ s 1 1 Z~Sblz m O.t~ ~ • S ' ~
Ground 3 SI-$b ~.SY IZ 31y - S C*)
elev.
%orS•O ft.
Depth to
limiting
factor
> 86''
Remarks:
Borirg #
o_l~ 1,o~-tcz 31 z ~ SLl Zit. sbk rn~ r - . S
amid
Ground
elev.
Depth m
fimitirtg
y
faytoL t4
Remarks:
CSTNme:-Please Print Arthur L. We erer Phone. 715-425-0165
e erer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 A 'I
.i
Sig-nab. - Date: g_ J r 6 CST Num b= M067576:
- al[83-
PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2 of
PARCEL I.D.! 030, 117 - $O- OOI
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bw'cbiy Roots' GPD/ft
In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends
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CSTSignatAire Date Signed Telephone No. CST #
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
MAILING ADDRESS la,W7 e~ 17'V rZ
PROPERTY ADDRESS 574"L
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE /.J , -
PROPERTY LOCATION 1/4, -5"z J 1/4, Section J/' Tj~_~N-R_Zy W
TOWN OF S'7- ST. CROIX COUNTY, WI
SUBDIVISION 3~ ;:cg LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We, the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE:
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
10
. b 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 Gd
Location of property4 ~ 1/45' 1/4, Section T 3Q' N-RW
Township _-7- Mailing address 1Z e-l
/~c•-el~a.-tJ W ~~/Ol'~
Address of site S~ /mot e
Subdivision name v Lot no.
Other homes on property? Yes___ -x' No
Previous owner of property Zc
Total size of property
Total size of parcel
Date parcel was created /gyp
Are all corners and lot lines identifiable? Yes >e- No
Is this property being developed for (spec house)? Yes No
Volume F119- and Page Number 121 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. '"11?s , 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.
l~
Signature of A licant Co-Applicant
I M"-l Al
Date o ig ature Date of Signature
7 , 1
• f)OC.UNIEN`: NC.-. STATE BAR OF WISCONSIN FORM 1 1481 - Tx 5 4Pa.F HCS ER VC❑ FJR RC.O ROfN- CA .
WAPMANTY DEED
4GS125 vsi S~"S -4:! 121 REGISTER'S OFFICE
This Deed, made betµeen ..TCF- Finance, ..Inc.,-.a-------- ST. CROIX C0,W1
Texas corporation,. _ Recd for Record
- - - Grantor, C► 12:15 P.M
and William_ C._ Kelly and-.Marianne--S. Kelly,
husband and wife as. s,~or.ship.-rl? ital
property, ReglSfeaofD~ ,
Grantee,
Witnesseth, That the said Grantor, for a valuable consideration
of one..-dollar and other.valuable.consideration
F To
conveys to Grantee the following described real estate in .-St-,_. CTg1X--.
County, State of Wisconsin:
Part of the SW 1/4 of Section 31, Township 30
North, Range 19 West, St, CrAx County, WisconsinT.,, ParcelNo-----------------------------------
described as follows: Commencing at the
SW corner of said Section 31; thence North along the West line of said
SW 1/4, 707.92 feet to the point c` beginning of this description;
thence continuing North along said West line, 874.46 feet; thence
N 89 degrees 07 minutes 40 seconds E, 1388.41 feet (recorded as 1388.60
feet) ; thence S 00 degrees 50 minutes 00 seconds W, 1050.28 feet; thence
N 70 degrees 37 minutes 11 seconds W, 248.47 feet; thence N 64 degrees
16 minutes 27 seconds W, 330.52 feet; thence S 85 degrees 08 minutes
59 seconds W, 843.84 feet to the point of beginning.
FEE
41D
EXF%TT
This ---15 nOt------ homestead property.
(is) (is not)
Together with all and singular the hereditamants and appurtenances thereunto belonging;
And.-. TCF-_ Finance---
warrants that the title is good, indefeasible in fee simple and free and clear o! encurnbr:.nces except
easements, restrictions and covenants of record, if any,
and will warrant and defend the same.
7
Dated this Fourth - - day of April 19- .91..
TCF Finance' dine.
i (SEAL) By:../ L"✓- (SEAL)
Rob rt/T. Griffore,. Vice.. President
- - - - - -
By: .(SEAL)
Stephen W._ Sinner, Asst,. Vice Pres.
AUTHENTICATION ACK4kOii LEDGMENT
Signature(s) STATE OF K+JM; K MINNE OTA
SS.
nt' -
C.-/-v - --eVjO ---County. -14
authenticated this --.day of___- 19-_ Personally carcfe bef-)re me this day of
ApY11 19.91-. the above named
Robe-rt_.T. Gri.ffore-,..-Vice-President
' - and Stephen W. Sinner. As-sistant_
TITLE: MEMBER STATE BAR OF WISCONSIN Vice _.President__o`_TC;F, Finance.,- Inc..
(If not, . . - ' - - a Texas cor.>oration
- . _
authorized by $ 706.06, Wis. G ' tat-.) to me known he t'-e perscnS %`n exec ted tl:e
a-m - , ,*..-*r rt r.,± a, {.nw.vlr-Jge tv .1 110.
i ~ c
•