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HomeMy WebLinkAbout034-1000-20-000 c Q) °o 3 0~ O ~ Cr 54 O a c ~O O y C r~ C O O y ~E o co i = x o Cn c E o v o Y E ~ Q O `C 4 i p Y' U E✓ 3 o 'Z~ LO CC O N O ~ L Z O • y G U ~ ~ 7 U. c C O. N E O y -p O 8_ n O Q Z v M w E Z Z O w V O Z y (N a m F- z cj o O Z d a v Z = C O N ♦-'I O cn E z O Cl) E ~ O 4J • N C O N O Q Z Z w N p C 6 O N f0 E C C. . . CL LO U y d i N C O° ~n O o ° CL .O ~ N LO - to U) W C U r ^ 0 0 0 a J Z o •rv i a a a a o !wi a 0 g 0 c0 r- 0 C) o zI Cl) O N m O N O « N_ d' O h T ° E :3 0) 0 c cn d N U N y N ~ ~ y y 3 N C E o co 0 Q~ 3 api c N d o° °o o V N N Ty -p y Y O• 'D N N N L O 0~ N LLJ C C E O O~~ i W O y L .00 M O c N W F- r M _N fl. E y co E • L' O O Cn N o N U)j O ~ E m ✓a # a a a 0 C~ O. a W .U d ' STC - 104 A BUILT SANITARY SYSTEM REPORT OWNER- ADDRESS Di5L,,CJA. in~ fA~ 3y SUBDIVISION / CSM# LOT # 49 SECTION ~T N-R_L~_W, Town f- fj f ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM O rrn will , e~be~ I' ~i°rnK INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ?mot d BENCHMARK: Icao ~Z in FI/Y\ inve ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid capacity: 1006 (p Setback from: Well 5y`0, House. L5 F1_ Other Pump: Manufacturer UTAC 6✓AA+( Model#,SZc4_~~. Size Float seperation Gallons/cycle: Alarm Location "kha2-e_ o2Lr,-n 0 ~4 /qalm~ SOIL ABSORPTION SYSTEM Width: Length 0 Number of trenches I & F4 Distance & Direction to nearest prop. line: Setback from: well House Other q ELEVATIONS Building Sewer ! ST Inlet: ,5• T~ ST outlet: PC inlet PC bottom Pump Off Header/Manifold 21 of Bottom of system Existing Grade Final grade DATE OF INSTALLATION: - -7✓ 7 cJ PLUMBER ON JOB: /~W/! vl r' ~ LICENSE NUMBER: ~cJ C INSPECTOR: 3/93:jt Wisconsin Department of industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations Safety and Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 284157 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: JAMES, EDWIN SPRINGFIELD CST BM Elev.: Insp. BM Elev.: r BM Description: Parcel Tax No.: ) TANK INFORMATION ELEVATION DATA AQAnnAnQ ~7_ TYPE MANUFACTURER CAPACITY STATION BS HI FS E . Septic Q/Sc Benchmark Dosing y 3 s Aerallkamn- Bldg. Sewer 9 p'r Hol St/ I Inlet%j 9S. 7?" TANK SETBACK INFORMATION St/$ Outlet TANK TO P/ L WELL BLDG. ventto ROAD Dt Inlet Air Intake Septic Qtr c~2~ 4~5 yt NA Dt Bottom Dosing 20 NA ice/ Man. o~z" 9 9.9Z Aeration NA Dist. Pipe 99.9,?, Holding Bot. System % 9~), P P /SIPHON INFORMATION Final Grade Manufacturer Demand -ell Model Number GPM TDH Lift F Loss riction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O A CHMBER Model Number: System: f J`~ OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing r' 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 E] N ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 4S Ark ,C✓W LOCATION: SPRINGFIELD.1.29.15W, NW, NE, COUNT ROAD W / I--~ r°r>Ce r~T l nGL Syr tti t, ,c2": ( l'J~ C>>7 ~1/ r'~ 11a y J' C . l'r k c ;I N~eJ 0~~. /J ";V_~an vision re ired?~ ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION Bureau and uildildirg Waater Systems Building 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 Sani ar Permit Number q1 5'1 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 wner Name Propert Vocation kf% 1i4 I 1/4,S T , N, R 1QW Pelty ner s M fling Address Lot Number Block Number Qty, State V Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned icy Nearest Road ❑ le C12 village elD Public 1 or 2 Family Dwelling - No. of bedrooms Town of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo d 3y /coo C;~(:) 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- K New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of S. ❑ Repair of an System System Tank OnlyExisting 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 X 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 Requir d (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation • ~w Feet Feet -Is -7.5 0-9 VII. TANK Capacity acitns Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank 000 (bbd Q 'f E3 El El ❑ 11 Lift Pump Tank /Siphon Chamber 0 I ",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) Plumb is Signature: (No St ps) PRSW No.: Business Phone Number: 31;~o `71S X35 - Plumber's Address (Street Cit , Sta e, Zip Code): A) q(2-1W IX. COUNTY / DEPARTMENT USE ONLY r~- ❑ Disapproved sani ary Permit Fee (Includes Groundwater ate Issued Issu ng Agent Signature (No Stamps) Approved Surcharge Fee) ❑ Owner Given Initial 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 nevv 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 Dw(-l' 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 13 if permit is for tank replacement, rec-innection, 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 sewtic, 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. SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations October 7, 1996 2226 Rose Street. La. Crosse WI 54603 RED CEDAR. PLUMBING N 4676 471ST ST. MENOMONIE WI 54751 RE: PLAN S96-41283 FEE RECEIVED: 180.00 JAMES, EDWIN NW,NE,1,29,15W TOWN OF SPRINGFIELD COUNTY: ST. CR.OIX 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 ILHR 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 ILHR 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. Sincerely, -yard M. S im lan Reviewer Section of Private Sewage (608) 785-9348 SBDA-7987(8. 10184) Edwin James - Mound 596-41283 RECEIVED SEP 3 0 1996 SAFETY & BLDGS. DIV, Location: NW 1/4, NE 1/4, Sec. 1, T 29 N, R 15 W Town: Springfield County: St. Croix Date: October 8, 1996 3`96-41283 Owner: Edwin James Address: N 9602 CTHW Q Downing, WI 54734 Plumber: Kevin Lannon Signature: License # MP 7320 Attachments: 6748-Plan Review Application SBD 8330 page 1: cover 2: calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve SSW p,~E S~sT~M T -~~bnally Page 1 of 7 VI) Ep gptl VVq of p1V c v System Calculations One family residence bedrooms i Loading rate S gallons/sq ft per day Depth to ground water 3 3 in Depth to bedrock in Cross slope % Force main length ° ft of Z- in Manifold/header length Ka ft of in Drainback 3'2 g gallons Lateral length @ ft of Z in Lateral elevation ft (bottom of pipe) Lateral hole size in @ in ft) spacing holes/lateral, holes total Lateral volume gallons Total lateral discharge rate gpm @ 'Z~ ft head Elevation difference ft Friction loss ft @ gpm Total dynamic head + ft Pump/si~fion I5 gpm @ ft of head wr p a ~,w 1.~. w -Z,~~ Manufacturer , Model # Dose volume gallons Lift/si}yhon tank to , G `T`om gallons Septic tank gallons Measurement pump on & off in Height alarm from tank bottom in Reserve capacity gallons calcs page Z of _ F1 6 Y A-. -i I G "I pp I I ~ sloPC i U i • I I•il 'r 0 CL- Q "1 I L. ~ O ' •.2.L~ U UII ow Q a$. 2 ~.0..+.. i i I I o I xo , c s~ i. fill 4m.. h'~ 6 "A6ove .:Rid. 1 guy. I I ' I I I ~ 1 ~ ~ I' I ' I S s 4L %0%% c. v~o S 4. a•. t: cv, / e y1 / r_5 \ 3 NS, , 9.4, 2 ( ti~ry ~ l.o' l ,4, c.13 \ h w.aSt ~ b i..~co:~ 11 Sa.~ ~ R Q, e %Jc z.S` 4•~ S'am` ~•3~3 g, Ott 0. P 14L M v ; Ark. 2-S, A0 slo' 2.S' I z.%, -4. t o.: ' 'k- 1o.S N X: `'L S~L~ QY~pry (or °0~..:V~ 1 tiT W~ ~ yrN~`~O~`l- ollh:va.C•. To 1}:.`.~ ~v O; Pvt ob':obV.L~:o •.i...~`~ 01 \`0 01 h.G1~ A o ivo~: `a+tLb.JC 1r~..r.: ~S ~ • ~ r ow. O..l~{ o ~ v o~~ Ago , ~ 1ovC S~ i . . 1~9. I~ el ~•t, o 1 ,.t Q-~►~ e,,o.» ~ Qv- BOO 1►~ o w. 1: w e a~ a. C ` _o~ 9-s ~o~ 04 K Mg1N1 WEATHERPROOF LOCKIuCs COVER 1UNLTION 8 4/,"NMX AX&---,C, 0ot pyleK a~vac~'---~ .I. PIPL 3' 0 ND16TURBED sat. Za" VD a c.t. YENT ~ MA" QM MIW. A "Ir 4 WLLD A z'i • o ' I+at AI►tovJLQ t.z. vI►- KCT 3b1dP3 WFLES 3' ono AL PIM 4 ECTIOIi>< ~ TC , •1 Leu , O ow P444P D ba CoaCJtE'nE . L.~v• 6toGK V SEPTIC t 11CATIOkIS U OOSC M TAWKS MAnlUFACTURER. IJUMOER OF DOSES: PER DAU TAIJK SIZE: - ~'v'~"~ GALLOWS DOSE VOLUME S~ Ll~ Itq ALA" MNJUiACTYKGR: IAICLNOIAICs BACK/LOW: GALLONS AODEL NUMOER: CAPACITIES: A= z~'O WC1I15 OR Sot 1G GALLOUS SWITCH Tura: g = INCHES OR 3 t GALLOWS PUMP MAAJUFAGTURCR: ~"w`'• C IULHE5 OR I `C( CALLOUS MODEL NUMpCR: 0~ ~ INCHES OR ~O Z GALLOWS SWITCH TWPE: MOTE: PUMP AWO ALARM ARE TO OE MINIMUM DISCHARGE RAT 1 g 6PM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEMICE DETWECty PUAF OFF ANO DISTRIOUTIOIJ PIPE.. FEET + MINIMUM NETWORK SUPPLY PRCtiURE 2.S FLET + 20 FEET OF FORCC MAIN X F~00VxFRICTIOU FACTOR. O FEET 2 U~ TOTAL DyWAMIC. HEAD = I S'`S'~- FEET 1 4 1 ~N . MITERNAL. DIM[W610Nt OF TANK: LEW&TH~._;WIDTH .6 ;LIQUID DEPTH 39 ~Au.l 6 pF ~ r( Performance Data Pump Characteristics 32 Pump/Motor Unit Submersible Manual Models SW25M1 SW33M1 W za LL Automatic Models SW25A1 SW33A1 W 1/3 HP s Horsepower 1 /4 1 /3 f 16 Full Load Amps 8.0 10.0 z 1/4 HP Motor Type Shaded Pole (4 pole) ° a R.P.M. 1550 o e Phase 0 1 Voltage 115 ELL #-...N# - Hertz 60 0 0 10 20 30 40 50 60 CAPACITY-U.S. G.P.M. Operation Intermittent Temperature 120" F Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24 NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0 Insulation Class A GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10 Discharge Size 1-1/2" NPT Solids Handling 1/2" Dimensional Data Unit Weight 30 lbs. 1. All dimensions in inches Power Cord 18/3, S1TW,10, std. 3-1/2 5-7/8 2. Component dimensions may (20' optional) 4-1/2 vary ±l/8 inch T 3. Not for construction purpose 1-1 2 NPT unless certified 3-1/2 DISCHARGE 4. Dimensions and weights are Materials of Construction approximate 5 OWN level adjustable Handle Steel 3-1/2 6 We reserve the right io Lubricating Oil Dielectric Oil nukerevisionstoaw products and then Motor Housing Cast Iron specifications without notice Pump Cosin Cast Iron Shaft Steel - - - Mechanical Seal Faces: Carbon/Ceromic Shaft Seal Seal Body: Anodized Steel Spring. Stainless Steel 11_,,a Bellows: Bum-N PUMP 10-1/8 ON Impeller Thermoplastic 9-112 Upper Bearing Bronze Sleeve Bearing DISCHARGE HEIGHT Lower Bearing Single Row Boll Bearing 3 3-1/2 Strainer/Base Plastic PUMP 1 OFF 1 t r Fasteners Stainless Steel AURORA/HYDROMATIC Pumps, Inc. } 1840 Baney Road, Ashland, Ohio 44805 OT _ (419) 289-3042 Wisconsin Department of Industry, SOIL AND SITE EVALUATION Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR $3,09,_Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size I'st include, but not limited to: vertical and horizontal reference point (BM), rqc and o;.r percent slope, scale or dimensions, north arrow, and location and dis nearest Parel.t.Q. # APPLICANT INFORMATION - Please print all inform ReviAVVecby Date Personal information you provide maybe used for secondary purposes (Privacy w„c~ 15.04 (1),~rrr)).. °'1 Property Owner ~ro Location y ~~N 13 t 1%4, 1/4,S / T~9 N,R )W Property Owner's Mailing Address t.pf # JI Efiock# 8Lbd. Name or CSM# qll~ OG2 Cc Rol 0- City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road w/V/N bu a ( 7/,4')26,5" a 41o SP IN F G~Ld de" fTd GrJ New Construction Use: [ Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow IV 3-0 gpd Recommended design loading rate !Y bed, gpd/ft2_ r trench, gpd/ft2 Absorption area required IYA_bed, ft2 2Z5- trench, ft2 Maximum design loading rate / bed, gpd/ft2_,_trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred t/o site plan benchmark) Additional design/site considerations ,f Parent material ~4 14 e i,4 / 12 Flood plain elevation, if applicable A 4 ft S = Suitable for system Conventional Mound In Ground Pressure AT Grade System in Fill Holding Tank U = Unsuitable for system ❑ S 0 U ~ S ❑ U ❑ S ® U ❑ S ® U ❑ S W U ❑ S 1B U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Consistence Boundary Roots in. / Munsell Qu. Sz. Cont. Color Texture Grp.. SLz. Sh. Bed Trench o" 0 / D 3 Y14 2 4,G AK6R C J M ® C ),4,h Ire M VAS C S ✓F 4/ Ground 3 S M S elev. ' NA4 Depth to limiting factor 11,4 in. Remarks: Boring # 0-.20 /0 3 Si,L 46 -M F -C5- 2 tit ,37 6 YZI a 3~ io c ~ 6A 41 M vrr eZ s -VF . s Ground elev. Depth to limiting factor ,?.~_in. Remarks: CST Name (Please Print) Si nature _ Telephone No. (!2A X e S l 1-h Address Date CST Number 1 PROPERTY OWNER 6dWiN "-TAM eS SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D.# Horizon Depth Dominant Color Mottles Structure 2 Boring # Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench a :2 /O 3iL .2 46,4'M lv1 FX Gr .S 2 ,S" 2 zs 6i 3 C G A6~"C /►-VJZ% G'S v Ground IVA- ; IVA elev ft. Depth to limiting ; factor in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to , limiting factor in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: SBDW-8330 (R. 08/95) ! I i (U 1- - stpAv, / ,L - P-1 - ! i ~ - 1 I I I z 1_4 _ - - - I I ! I A %Y f" c/ 49 R S g boa S ,0 ed I - I ! i : ' i i I I I ! I I I ~ ~ i C I I I ~ I ~ I i I I I I II I II I I I I I I I ; I T-L I - - - _ - - - - - - 1 - - - - - I I , r ~ I ! ~ i I l l~ l l I 1 ! I , : I ' r i a - - I.- AL : L l I i I - ~ I; - - it - ~ - _ - i I i I I ~ ~ ~ STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Ur d cd ce \ c-w. P G w rc c MAILING ADDRESS N q r- 0 C4 c. \&I V . PROPERTY ADDRESS _ (v C v y.', \ a S n e \d (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4,/1/0) 1/4, Section TN-R1~W TOWN OF S r c, e ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY MRP , VOLUME 33 , 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. t 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: X DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 i/ 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 Location of property 1/4 1/4, Section ,T N-R W Township _ G Mailing address t~l q ~d a C~ T Address of site Subdivision name Lot no. other homes on property? Yes__.X__No Previous owner of property C\„Ae A a ,e s Total size of property \ y C e s Total size of parcel ~ y o c' c Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes K No Volume :~L 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 in the office of the County Register of Deeds as Document No. 2-Cy 9F? , 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 Applicant Co-Applic nt /'417 / y /Ul -7 / Date of Signature Date of Signature rl' . t r., DOCUMENT NO. 26496 U n' This Indenture, Made by Clyde M,~m .s and Leora R.s.ames~ H>.1`ghanft and Wife, as Joint Tenants grantor 3 of Dunn County, Wisconsin, hereby conveys and warrants to Edwin James and Ardyce James, Husband and Wife, As Joint Tenants rantee S of Dunn Count Wisconsin for the sum of Eighty-five Hundred (8500 00) the following tract of land in D11nn~3c St,. Craix County, State of Wisconsin; ,IN ~T'GQUNTY: North West Quarter (NW4) of North East Quarter (NE); cept the North_ 32-6 thereof; Also etc6pt that, part of said Forty North and West of County Highway Q as located on Jamie 11, 1947. ALSO The East Half (EJ) of North East Quarter (NE4) ; ALSO The South West Quarter (SW4) of North East Quarter (NE4); All in Section six (6)-'.::Township twenty-nine (29) North, Range Fourteen (14) West, Dunn i County, Wisconsin. IN ST. CROIX COUNTY: North West Quarter (NW4) of North East Quarter (NE4) !I except N 83 feet thereof; North East Quarter (NE4) of North West Quarter (NW4) except N $3 feet there- of and North Half (NJ) of South East Quarter (SE4) of North West Quarter ~i (NWT), All in Section 1, Township 29 North, Range 15 West. Continued from October 30, 1935 at 3:00 otclock P. M. .I South East Quarter (SE4) of South West Quarter (SW4) of Section 36, `town- ship 30 North of Range 15 West. Continued from May 26, 1950 at 2:45 otclock P. M~ (SEE REVEt1UL STA1,TS ATTACHED TO REVERSE SIDE) I I IN WITNESS WHEREOF, the said grantor A ha_ Ve hereunto set their hand $ and seals this day of April A. D., 19: 61 . (SEAL) N D AND S L-E .~Ai'pItESENC OFlyde M. James ~176 (SEAL) i~ Richard P. Rivard I,eora R. James (SEAL) ~I Velma Mouw _ I' A' M ti 'L1 • c~: a ~ ~ a r z s o N a a• n 0% w n U) C41 C '-1 M C w d n C7 ~ ~ f7 ~ CD i 1 I xl~ r o c_I D --~~n= c r~ - ~ c7