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HomeMy WebLinkAbout040-1221-70-000 a o -0 o 0 0 Gr, i 0 0 Ui o -o v O d 0 E O 0 x t-I 'b c C f6 L Z U C 7 m O U. c UO O I~ L Q z w w rn z o w E z - 0) d co 3 m N a N F- U7 'Q C N C O ~ N O z C U U r ~9 N fA F- r- N Z E 72 O Cl) E N Q O ~ ~ N O • U 'O p -C c in D U U O z z O z L LL ~ -O N d N O d C O (D (0 O v CD C O C O O C O G a L O M N N O Y N N fA O N w N N U z Z O O O d z o 0 Iy i a a a a N co co C) N U y ►ii ul J U p rn rn N } .O N LO CJ o E 0 0 M N 0 N N (0 O O ~ CO L U .d N U ~ G l6 °6 O N C O a) E C11 LO 00 O O i" F p C <L (a C C_ x 0 0 0 L to VOi y ~ N N N O O C N C w N w Z (D Q -Op e- ~.i 00 C r1 O N ` = N N E U • O y?„' O N N O N F- u) CQ r (D CL • cis a m 2 `m a r *saoand Humart Relations Industry, SOIL AND SITE EVALUATION REPORT Page / of 3 Labor Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code sr, COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 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. /,3elo1;0(6-5 4A.,' S,'T~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE 2- ",oS T T rk .Ypsa v PROPERTY OWNER` ~~RP` PROPERTY LOCATION GOVT. LOT SA=- 1/4.5 1/4,S 1/ T A? N,R 9 E (or) W PROPERTY OWNER':S MAILING AD PRESS LOT # BLOCK # SUBD. NAME OR CSM # W 302- boor 4v'eF 7 M9T0,0 y C TY, STA E ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD 54,102-2-- (7/s) yZS ' 9a3 L T/ .o ~O0,,,7A y 101W-V k~ [Al New Construction Use [)d Residential / Number of bedrooms y [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow 6/00 gpd Recommended design loading rate bed, gpd/ft2 3 trench, gpd/ft2 Absorption area required bed, ft2 x'270 trench, ft2 Maximum design loading rate bed, gpd/ft2 3 trench, gpd/ft2 Recommended infiltration surface elevation(s) S~ 3 ft (as referred to site plan benchmark) L}/ Additional design / site considerations z- fiYj~~` ~10U~o .Sf/SF~I 0&1 Parent material 5GS ~'L ,Sa 1 - 51:e-' T 5~~-~*t~TS Flood plain elevation, if applicable N~ ft v , S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM 1 FILL HOLDING TANK U= Unsuitable fors stem ❑ S [3U CK S❑ U ❑ S ®U ❑ S O u ❑ S ❑ S KU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell C lu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench /7 /0 yle 51-1 2-, 5 . Ground , 7 l(Q /D y/p y~~ Sit 3, 40, dk luf. lie. fr S v( 2 ft. Depth to limiting fact All Remarks: Boring # 0-/)- /0 }/,e 313 5-/./ ft sh& ow-ye/p, js i f - Z . 3 xii 12-2-0 /0 YA 3 .5-V 12- Ground elev. ye y~~ , ~iCfi' C'S /u , S , G IFY, 70 ft. G -G5 7 5 Y,e f` 5C L ~~SS/vim "41 U{, i .,W . 2_ Depth to limiting factor 32~ Remarks: CST Name: Please Print Phone: n tb5 O'NEiL RD., HUDSON, WIS. 5401 71✓~ Address: US. M~ "TEA PLUMBER LIC. NO, Signature: 1," ,LLER ZI DES04ER LICC NO. I Date: CSTNumber: L '4- "A, I' PROPERTY OWNER G' ~1v,PP/f~ SOIL DESCRIPTION REPORT Page2-of-!? 3 PARCEL I.D. # Go T 7 - Gov-Tay D"9'eS Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 12-10, f2- Ground 13, 2 - Z/ 10 Ye- Sk 75 elev. )-l-32- 4" Depth to 1- G$ 7 5 Ye Z s Sc/ 3, bx 2 3 limiting factor a 3Z Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # w Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) G G `r R p „ LIN 46 NI Q w 0 _u R~ c W N r j 00 ~C-0 m w STC - 10 4 1 . AS BUILT SANITARY SYSTEM REPORT OWNER ~,l11L~/AM CH►( A_M/ ADDRESS AJ ..1, ~ ~F-19-C~s W. u 0-K SUBDIVISION / CSM# Z09( C0Q A.J4-A.K p S LOT SECTION- I T Z 9N-R_ZI_W, Town of (f o y ST. CROIX COUNTY, WISCONSIN q0 PLAN VIEW r SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N o "J 'L L,. goo, z„ o D C P 0 4 t 0 INDICATE NORTH ARROW Provide setback and elevation {information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~j d~ O /3 L I ni 1- 2 ALTERNATE BM: F09?,V0 hJA. LL. ck eem 6'A-M.,Cer /Q Z , 7.3 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: C,,~~ ~S~1Z_ Liquid Capacity:/ Z,,!5D Setback from: Well House Other `3+ !3 Pump: Manufacturer yG-~ Model# ~~C$ize Float seperation 0 Gallons/cycle: V Alarm Location- 13/i~~w ,:SOIL ABSORPTION SYSTEM Width: Length Number of trenches -94- Distance & Direction to nearest prop. line: ~A> Setback from: well: House', Other ELEVATIONS Building Sewer ST Inlet: 9 ST outlet ?wKP PAID PC inlet PC bottom , /Pump Off Header/Manifold ZS ~ Bottom of system 7 Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: P ~3 INSPECTOR:- 3/93:jt Wisconsin 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 PermitNo.: 262480 ❑ City E] Village Town of: State Plan ID No.: PerSmtHl ~NN,arr .ILL/GUENTHER, SHER T TROY _ CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: /670, CJ, ao CLI , ,,r_,r , A9600140 TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark r s~ ~3 ~ao.va Dosing . Aeration Bldg. Sewer 1'~,dg 9l e Holding St/ Ht Inlet 3.d 1. ?0o 0 TANK SETBACK INFORMATION St/ Ht Outlet Vent TANKTO P/L WELL BLDG. A irito ntake ROAD Dt Inlet Ar Septic 10, ///1 e S ' NA Dt Bottom 75 ~3<- , 3 Dosing NA Header/Man. Aeration NA Dist. Pipe 5.~f s' 9 ,01 Holding Bot, System Sy' $ / PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 751 3 Model Number GPM /a 0/ /g TDH Lift Friction System2S TDH nj~ Ft oss Head Forcemain Length® Dia. ~G Dist. To Well T SOIL ABSORPTION SYSTEM DIMENSIONS RNH Width ( Lengt~4, No. Of Trenches PIT No Of Pits inside Dia. id Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/ STREAM ""LE"HINNAG_~ anufacturer INFORMATION Type O CHAIBER'°- 1mad i Number: System: /bGfl)L" -.q :S-` d R 6R UNIT DISTRIBUTION SYSTEM HEa4efi/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. ~B Length OL Dia. El Spacing y( "/LI t SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of / xx Seeded / SDdded-- xx Mulched Bed /Trench Center g it Bed /Trench Edges I 1 t Topsoil Ee~es ❑ No R<es ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.21.28.19W, SW, SE, NORTH 8TH ST 44t,/_6, 2 Plan reJ on required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date 1 Inspector's Signature Cert No SANITARY PERMIT APPLICATION ~•=`A~ • In accord with ILHR 83.05, Wis. Adm. Code COUNTY ~ C ©/X STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ l / 8% x 11 inches in size. Check b 4~ll . application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUM ER f~S 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 5 29 0 P PERTY OWNER PROPERTY LOCATION L t4,nM - 5#e7Z 6U e-A14 k1r-R 4 SC/a, S2_1 T Z. $N, R E (or PROPERTY WNER' MAIL ttAf1DRESS, LOT # BLOCK # C STATE ZIP CODE-' ~PHONENUMBER, SUBDIVISION NAME OR68%"4bVSER k1tR 11. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) State Owned V ILLAGE tA, N ~ O ref TOWN (0) ❑ Public 29-ror 2 Fam. Dwelling-## of bedrooms PARCEL AX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) Z -7c) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 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 in line A. Check line B if applicable) A) 1. 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 Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABS)= 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) LEVATION Feet SO 7,-5-Feet '.5 VII. TANK CAPACITY Site in allons Total of Prefab. Fiber Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank 25 f F Lift Pump Tank/Si hon Chamber r I El ~ =E1 - F Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb s Name (Print): Plumber's Signs e: (No Stamps MP/lf6No.: Business Phone Number: 6 ue 3 7 Z r3 U6 Plu ber's Address (Street, City, State, Zip Code): ~G L S'ccJGrj2~ ~ S ~ ~ IX. OUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing gents, mps) pproved F-1 Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS F R DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS Y 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the 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 i 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 & 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. Ill. Building use. If building type is Public, check all appropriate boxes that apply. r IV. Type of permit. Check only one in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/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% 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 i r i 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) Wisconsin Department of lndustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations DWW'Won of safety & suldings in accord with IL HR 83.05, Wis. Adm. Code COUNTY ~ ~o Ix . Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (Blue, direction and % of slope, scale or P L dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION If • 6a.` l PROPERTY OWNER: PROPERTY LOCATION W\ 0- l16" SC-" Z-pt my-, -GOVT-•~ S W 1/4 1/4,ild T 8 ,N,R I WA (0ow) PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # S OR CSMv 1"I 1 p 7 Iv. ca 7V ST'. fl - Nom. CITY, STATE _ ZIP CODE PHONE NUMBER OCITY FWILLAGE ®f < > ` ST R 1 um. 1`~LIS W 1 S q 0 ZZ (7 f ~ Ll ZS _ S8 7 O f ; kS RD . [4 New Construction Use [,k] Residential / Number of bedrooms [ ] Add kn to existing built R I ] Replacement [ ] Public or commercial describe Code derived daily flow 60~ gpd Recommended design loading rate O.3 bed, gpolft2 - trench, gpolfl2 Absorption area required SOD bed, 1112 5Dp trench, ft2 Maximum design loading rate 0 S bed, gpd/ft2 t]- b trench, gpd/R2 Recommended infiltration surface elevation(s) q-) - S It (as referred to site plan benchmark) Additional design/ site considerations "161 jr-% ►^j A' x 8V ',Bm - Mir - Cur- SAuvt t=t LL. Parent material %I LY4 S lot wtQwY ov~St GAL ftA- `nLL Flood plain elevation, if applicable - ft S = Suitable for System CONVENTIONAL MOUND "ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK u= unsuitable for loam a s Eru IRS o u ❑ S ®U [Is O U ❑ s ®u [is ® u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou nary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed wick y;? o_ 5 \o-t. R. Z /I _ s Z M AR wi'F~ a.S I o -S oA Z S-30 O`tIZyl3 - SI) Z T Ab r yn'f4- GS o S o_ Ground 3 Po _.S5 -)-SVVL 31 Sy2 5!s S'C' C) W.\ elev. a,.s Depth to limiting factor 3 O4 Remarks: Boring # ' o -y Lp`~2 Z f I s 1 ` Zvi Sbk ~h a- S 1 wt 0-S o. Z U Zf; ~a ~c~z Yf 3 - S11 't 'F Sbh wt'F'1- e s 1 o• S o. 6 3 Z$So ~_S'?►2 31~ `Ft .S~rR s1~, SC) Ground elev. 9s-s ft Depth tD limiting factor Remarks: TName:-Please Print Phone. Arthur L. We erer 715-425-0165 egerer S41 Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: 6_ Z Date: J]/ CST Number: 0 0 5 7 6 PROPERTY OWNER Se~nzAMM SOIL DESCRIPTION REPORT Page? of 6 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 Inch 3 1 o - b \.o-tQ Z!/ - %l. ZW, Fel, vn ~Ft. ci, s o. t, 2 6-Z-1 Lo `I P- vj 3 s t 1 Z `F s ~>T cS l r~, d. S o. Ground Z-a_uy >•S`r2 31y 1tR 5/t; Scj O >n fit. - elev, q ft. Depth to limiting factor Remarks: Boring # , 4 Z -t~ \b\- m Lill - st l - - - Ground 3 Z~-~0 > S `lR 3!Y S jR s!g Se` - elev. q0.0 ft. ti G V~TX- u L Depth to limiting 8 Z d Q l factor Remarks: Boring # f~ 2. U S l! d L ~ W1 LL1 S WRIT (~46 Ground v-J S lrv Sul elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: -nn n'"Mn nrln M PLOT PLAN Page 3 of 3 SCALE 1"=4p ' N? S IE "Vb $F flT L-".S"r 2-S' FT4 M M Dv,.,D . ~t=LL << u SO" << « LoT l..l ►v xiSvG6E3~'1~ bv~Tt,l `.O N~'11t'ni 1 4 ab `cNo v s E e n 3 0 s-~ ,etig~9 2S MIN. 1 ~o rimer chmtV-A--cT (S1Z p0j,i ~ aS~ . \ \ b \ S lti►\z-B -ftii'!S ~TTiti'A `y ,l) V7 0 0 3 a- tuo.n oN a.~ 'a Z sPthE z' arao~e ~~,.as S~ q " ~ ~ ~ . 'CSt~sB ado ~y ~ 7 ~ v' c L~~ of a, 4 s oTfion ~ , ct-~ _ 5 o pF Z~# - 3 } SOT 96-uZ l ► l~°I (715 42q-0165 M00576 CSTSignature Date Signed Telephone No. CST # Wisconsin Department oflr y, SOIL AND SITE EVALUATION REPORT Page of 3 Labgt and Human Relations Division of Safety a Buuldngs in accord with IL HR 83.05, Wis. Adm. Code COUNTY ' ~.0 1x Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but sr. C_ not limited to vertical and horizontal reference point (BM), drection and % of slope, scale or PARCEL ID. # dimensioned, north arrow. and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY -DATE PROPERTY OWNER: PROPERTY LOCATION W\ 0-11) M-1 SCE} f} M'1 " -GGVF. E@fi S W t/4 S!_ 1/4,S 2 I T 2.8 NA 1 cl E PROPERTY OWNER'-.S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # IOZ tv. $ -Tif S7'- JI - Cuvr.~`~t.y 0"-S CITY, STATE DP CODE PHONE NUMBER ❑CITY []VILLAGE ®fOWN NEAREST ROAD ~ 1 Z t~->t t ts,1ti 1 S q o zz (-),I t4 is _ S8-)r) cants 1i.a . New Cons#uction Use [,k] Residential / Number of bedrooms Aden to e*1ing bttWq j) Replacement Public or commercial desrn'be code derived daily flow Edo gpd Remmmended design loading rate • 3 bed, gpN2 - trends, Absorption area required SOD bed, ft2 sDO trends, ft2 Mabmum design baling rate O - 5 bed, gpd* p. 6 Irerxil, gpolft2 Recommended infiltration surface elevation(s) S It (as referred tD site plan berldtrnark) Adcfitional design/ site concideratiorts h'lburv~ w /6' x 8v ',Bm . M ►N. 1' or- SR>vD t=t Lk. Parent material S i L~T`t S dot m 'r oviffTi G fP_ `f l Flood plan elevation, ti applicable - It S = Stfi We for system CONVEIMOkk MOUND Nl_GROUND PRESSURE AT-GRNDE SYSTEM IN RLL HOLDM TAW U=Unsuitable for systiern ❑S ®'U IRS ❑U ❑S MU ❑S ®U ❑S MU ❑S ®U SOIL DESCRIPTION RERORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Cwsistence Bwxfaty Roots GPD/ft in. Munsell tau. Sz. Cora Color Gr. Sz. Sh. Bull mach h o_ S 1o~t, L Z/ I - s Z Yy~ A a-s I 0-S DA - S-30 l0 `t tZ y f 3 - S I,) Z, ~ Ad r yn `F~_ C-.3 o • S 0A Ground 3 -SS -)-stm 36 Sylt elev. q,-t. 5 fL Depth to limiting factor Remarks: Boring # s L Zen S~k ►vE a S ~ 0.% :0A7 1 0 -y io~2 Z t l Z U ~e`t1Z Yf3 - Si l Z~ Sbk w►T►- eg 1 o•S €0.6 13 3 ZR so --)_SL1lz 31y ~t s~R S153 sC_ l Q)I-n VKfv Ground elev. ctS-S ft Depth ID limiting factor Remarks: T Name:-Please Print Phone: Arthur L. We erer 715-425-0165 eV g rer So'1 Testing & Design Service-P.O. Box 74 River Fa11s,WI 54022 Signature: 0/6_ g z Date: I, )11 ~ CST Number: M0057-6 PROPERTY OWNER Se.\t'l2_A MM SOIL DESCRIPTION REPORT Page? of_ 'L 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. Trerxh 3 0-~ ~.o~-ccZ z,li - S' ~.w► S~k vn'F~. a,s : o;s ;c.l 2 6-Z-1 Lo~~ ~!!3 ~ s rl Z `~S1~h ~I- cS l ~ d•5 a. Ground 3 Z~_yy ~•S`t2 31y yR s/EL scj Oti•, - elev. 9~3 ft. Depth to limiting factor " i Remarks: Boring # , 1 0.1 » ~.1Z z-! 1 st 1 - _ - - 4 z 3 21_~O S`fIZ 3!y ~.S\-fft S/8 sCl - E Ground i elev. q,7.0 ft. ti G U ~TX v L'- Depth to limiting 6 Z d Q s factor I Remarks: Boring # ,Z U S At 1~ ! ~j V"n ~~I S ARIL (246 Ground S `v S 1 elev. ft. Depth to limiting factor i i Remarks: Boring # { E3 Ground elev. ft. Depth to limiting factor Remarks: curl O~~nIC1 nc .r PLOT PLAN Page 3 of 3 SCALE 1"=4p ' rvo`~; uSt lv bF flT L"s'r ZS' PRc" MOvr.,D. w~ L u << Sp' << « Lp~ LIME x~s~~s e~'resa w~.~ ~.o atTcr~ j I ~ 8 A R-►"I . ' Vrov 9E 1 e J 0 6. 2S'm w, ~ ~ \ ~ bo Yvdr Ce~~ t~T p1Z 0► v. o~sT►~~ ins ~u~~ sPlhE Z' po'oliF Z L-L AS 5~~ CaxLovhiO 1 N \ t1..lt~. use ~ ~ > a a ~ tis,, O' of ae° VIN-rim" OT -u- 1715 ) 4L-0165 M00576 CSTSignature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE E V A L N . RT Page of 3 labor and Human Relations - Divisiilli of Safety Buildirx#s in accord with ILHR ` is. A~1m. 1 Attach complete site plan on paper not less than 81/2 x 11 inches' Plan"mdse Iriblude, but not limited to vertical and horizontal reference point (BM), directio % of *,pe, xcwe p( PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest ro 4n 4~.. APPLICANT INFORMATION-PLEASE PRINT ALL INFOR A 0 REVIEWED BY DATE PROPERTY OWNER: j Aft, wt LL l t~ `M S C.M Z-A lt w'1 51.~•;)9 SE 1/4,S 21 T 2.8 N,R 1 R E O(cn PROPERTY OWNER'.-S MAILING ADDRESS tf3T -6 SUBD. NAME OR CSM 1 O Z tv- 8 -M ST• 01tFz5 CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE DOWN NEAREST ROAD t . ~-f~l ~S,1ti 1 S q 0 Lz 01 -2) t4 LS _ S8 O 1-ZA` f covnrc~ y ohs S Izz. New Construction Use D4 Residential / Number of bertrooms [ I Addibt n to existing building j) Replacement Public or commercial describe Code derived daily flow 6 tg~3 and Recorrwnended design loading rate o • 3 bed, gpd/ft2 - trench, gpd/ft2 Absorption area required SOD bed, ft2 SDO trench, 1112 Maximum design loading rate C3 . S bed, gpd/ft2 tJ- b trench, glA* Recommended infiltration surface elevation(s) S ft (as referred to site plan benchmark) Additional design / site considerations Y'lbv►.-sL, ►ti A ' x 8%j' BCD M Irv . I' or- S h►v,b r=t. LA- Parent material %I t_'N S fot my'r ov m GAL A-L LL Flood plain elevation, if applicable - It S = Suitable for system CONVENTIONAL MOUND TIN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK U= Unsuitable for stem ❑ S RU [2S E ]U ❑ S O U ❑ S ® U ❑ S ®U ❑ S 2111 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rends I p_ S ID`t R Z, /I _ S Z M Sbk `^'1 `F q-S I o . S o • ~ Z S-30 SI - ` Avg yn'~I_ CS ° S o_ Ground 3 0 _ SS S y R 31 ~l S `12 S/9' SC )i o wN elev. a,. s tc Depth to limiting fact ti Remarks: Boring # 1 0 _y toy ltZ z t I s t \ Z~ sbh g 0-S ' o. I. Z 2 U-z.p, tgy\Z Yf3 - Si l 2~' sbk col~'~ eS 1 o.S 0.6 3 zgZ) S l 31 Y ~t SCR sJ~, sal Ground elev. `1S-S It. Depth ID limiting factor Remarks: T Name:-Please Print Phone. 715-425-0165 Arthur L. We erer egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: c16 _ Z Date: CST Number: F~L C1 7j" M00576 PROPERTY OWNER SC`crZZ., MM SOIL DESCRIPTION REPORT Page Z -V PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend `t ~!L 3 S 1 I Z 5 ~k rn ~I- CS l v, d. S o. Ground Z~_yy ~•S`~2 3/y ~1 yR s/(; Sc~ O~, - _ elev. qq.~ ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Inn 001nin 1)""N PLOT PLAN Page 3 of 3 SCALE 1"= v S E I -L3 bz flT L-"-5"r -5"r Z S' F Iu " 1 h ~~l l ~ << a << SO" LoT _ L l h1 i 0 j A,,3 e-~- ay 9 ~ q 1 M \ ~1Z ~o r~~t COr~ P I-T O A-1 S \ SP~1z~ Z~ °VF y. B eLgSS GLZOVrvD ~ N ,y~` ~ '1 ' a v 3a 1 i eov~z ( . 46. S I `30l'~►~ OF aklD of z~ N ~ ST nJ 3 SO } ~pZ 96-BIZ H9 6 ( 715 ) 4L-01 65 M00576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page N of 3 Lib6rand Hunan Relations - Dmsion of Safety a Buikir,ys in accord with ILHR 83.05, Wis. Adm. Code COUNTY S'n C zu lx Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must irxiude, but not limited to vertical and horizontal reference pant (BIA). dhrection and % of slope, scale or PARCEL I.D. t dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION W\ LLI1)" SCH Z^ mW► -GAtfF-tff 5W 1/4 SE 1/4,S 21 T Z-8 N,R 19 E( PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM 8 1oL Iv. 8 -m sr. -1 - c k)U?'J'Xjwy otrt-s CITY, STATE _ ZIP CODE PHONE NUMBER []CITY []VILLAGE OrOWN NEAREST ROAD ~t Z 1-M ~s, W 1 S tE o Li (7)11 t4u _ 58~ 0 1~?A~f conkS RD . New Construction Use [,kJ Residential / Number of bedrooms [ ] A" to existing building [ [ Replacement Public or commercial describe Code derived daily flow 6 6a gpd Recommended design loading rate o • 3 bed, gpolft2 - trench, gp W Absorption area required _ S o0 bed, 9 SDO trench, 112 Maximum design loading rate O 5 bed, 9VW b trench, gpdAt2 Recommended infiltration surface elevation(s) S It (as referred to site plan benchmark) Additional design/ site considerations t'1byr.-% w A 'x 8Y 'd3M . M I by . 1' 01= S ht b h L L. - Parent material I L YJ 5 ft 1 M &,-r oy t--Tt Gvket Rt T LL flood plain elevation, if applicable - It S = Suitable for system CONVENTIONAL MOUND W-GROUND PRESSURE AT-GRADE SYSTEM IN ILL HOLDING TANK U = Unsuitable for term [I S Eru (g s ❑ U ❑ S O U ❑ S ®U ❑ S ®U ❑ S IOU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell QU. SZ Con t. Cola Gr. Sz. Sh. BW rt tdn U S X0,-tR. Z!I - s Z M A~ x `M'FG 0-S 1 o.S DA Z S-3o 10 `t 2 Y 13 - s)) Z`Qsbk Ynf- C S 0-S o. 1, Ground 3 -SS --)-SyR 3l ~1syR S/S SCI elev. CV1. S It. Depth to limiting factor 3 O" Remarks: Boring # o-\4 CL- \M 0. t. 13 Z \4 --?-b 14`t1Z Y~3 - StS 2~ sbh mT eS 1 o•S 0.6 3 Zgso ~.Sk1z 31y ~t~ S4R sly SC.1 Ground elev. Depth b limiting factor Remarks: T Name:-Please Print Phone: Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: ~l 16 _ q Z Date: n~ zi L I' I Ct 7j, CST Num M00576 L- C494L PROPERTY OWNER SC.~t2flMK, SOIL DESCRIPTION REPORT Page? of PARCEL I.D. #f Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench O-b 1Cootiz Ll/ - SL Z-M F~1t a-.S ,-l 3 • .<s Z 6-z o -t V. y! 3 ~ 5 i I Z 'F s 6Yn -FCS i o_ L Ground Z-~_uy ~•S`r2 Sly 1t2 s/t; scl O~, yn't- elev. c1 q.~ ft. Depth to limiting ' factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor ' i Remarks: Boring # Y Ground elev. ft. Depth to limiting factor Remarks: rnn no~nin ncm^ PLOT PLAN Page 3 of 3 SCALE 1"= yp ' vS>` lv $F f)T L-"ST 2.5' f'VU" ►''~Ov~D. Lp~ 1.1 N I a n3 ` 9 I q 1 M ~ C%r -T (I)- o d i J°y . o t S T -TIM Pt ifh 3 3r'1 ~oo.o cN B.I \ ST-0-e Z"► ~~F y' $Z LSL qS5 G LZ ovnip I N tip, ~ I' ` a ~ 3a Q (411%n or- aQb 4 S ' N~~1sT L~ n.t ~ 350 3 \JST 46-uZ a~VL 'fMVLL~ L4~2 6 (715 42q-0165 M00576 CST # CST Signature Date Signed Telephone No. f SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations May 13, 1996 2226 Rose S t 10 11 La Crosse 460 WEGERER SOIL TESTING c~• °'3` f 7 Ir`_~ 421 N MAIN STREET s1- cRofx PO BOX 74 COUNTY RIVER FALLS WI 54022 0 ZONINGOFFICE i RE: PLAN S96-40345 FEE RECEIVED: 180.00 SCHRAMM, WILLIAM SW,SE,21,28,19W TOWN OF TROY 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 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, 1 G and M. Swi Plan Reviewer Section of Private Sewage (608) 785-9348 SBDA-7997(8. 10/94) s Page of 6 r MOUND SYSTEM S96-40345 FOR A BEDROOM RESIDENCE LOCATED IN THE Sw 1/4 OF THE SE 1/4 OF SECTION Z ! , T z 4?N, R l 9 W, TOWN OF }Zp`( ST• C"!g COUNTY, WISCONSIN. INDEX PAGE I'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN .PAGE 3 of.. 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR w~tl..l ~'r-t S C ~R f~l 1~ u Z N. $ `R+ ST. RECEIVED ~tuQZ s1roZz MAY , 6 1996 S~► t rv & BLDGS. DIV. PREPARED BY 0~ f1c d 7@015 WEGEFZER SO = L TESTING AM. 'b I3E~ N SEF?V = CE v F R t 4=M ,H, SEWAGE SYSTE Pf~1WA'1 E .U. B01 74 421 K. KAIK ST. nditiOT RIVET FALLS. VI 54022 s ~lMtsea Don. OF ;~;STRY, LAB I 4au F k ~ Dl F AF SSE COB Et JOB NO. 6 - Z PLOT PLAN Page Z of Scale 1"= L413' S96-40345 L,oT 1.1 x~-SvG6 ES`i1'D ~vl'Ll LO ~/}T101'v ~1 8 A ti"1 • ~}ov 8g o o 03 r A \Gf i 2$`MIN. V 1 ao o F Z lov Q Q i y 0 3a \ bo rvvT Cor-~ ~T dlZ °v \ o 191ti►~u~ Tttn i wu~ A \ 0 0 2 ~ n.q, s \ 3NI - \oo.o orv 5.1 ~0 \ \ \ S P►1t-E 2. ►~ovF ~ \ \ o' a tisi i S oT'To.-t of B ems- Ct~_ eta- of Z-+t $`MIN N U~3T U. Jt' SO • } LOT ~~~(VRJc NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( q required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be "LSO /-)SO gallon capacity manufactured by L%3"S IER tL\A-JeZ~Z lzapv e~-s 5. Bench Mark S P~BoyE_ 6. Divert surface water around mound to prevent ponding at the uphill side. Page 3 Of b r Approved Synthetic Covering FrsT" C.3; Distribution Pipe Medium Sand _ H G , Topsoil F Elev. 9'1.5 1 D E " 1" - b y % Slope Bed Of 2~- 2 %2 (Force Main Plowed Aggregate From Pump Layer D o Ft. Cross Section Of A Mound System Using E 1. Z Ft. A Bed For The Absorption Area F a B Ft. G 1. o Ft. A 6 Ft. H l• 5 Ft. Linear Loading Rate= GPD/LN FT B Sy Ft. Design Loading Rate= 0.3GPD/SQ FT j 1`8 Ft. J i; Ft. K ~O Ft. n L_ oI Ft. W 34 Ft. L d Observation Pipe-,," 8 K A -----.i Force Main Distribution \,,,Bed Of 2~- 2 2 Pipe Aggregate Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page ' Of Perforated Pipe Detail /1" 0 End View )Perforated End Cop PVC Pipe Install permanent marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S PVC Force Main i Q PVC Manifold Pipe Distn ution Pipe Last Hole Should Be I Next To End Cap End Cap P 39.6'Ft. Distribution Pipe- Layout S _V Ft. X 5c, Inches Y SD Inches Hole Diameter 11c/ Inch Lateral 111Y Inch(es) Manifold Z- Inches Force Main Z Inches # of holes/pipe 10 Invert Elevation of Laterals 98.o Ft. lt4Y,I x%.= L16.80 GP" Place 1st hole Zs~tfrom center of manifold with succeeding holes at Sd intervals. Last hole to be next to the end cap. - Combination Septc;Tank and S OF PUMP CHAMBER CROSS SECTIOW ARID SPECIFICATIOMS ' PAGE f -NEWT CAP WEATHER PROOF JUWCTIOW 60K 4'c.I. VENT PIPC APPROVED LOCKING lO' f ROAM 6606 MAIJNOLE COVER ou1`M .ii1JDOW OR FRESH wAiLaJIWG Lt4gEL. ALP, tuTAKE caaDu\ CTL 't s , s I K+RA 4 AIM. 18: MILL PROVIDE. I LME: AIRT16HT SEAL I I I I `A, . ~ I ICI v 3 gFTrL~S APPROVED JOIAiT A I I I APPROVED JOINTS I I I W/C.I.lIPE~C W/C.I. PIPE oR Tank construction I . I I I "I 11 shall comply with ALARM ILHR <3.15 and 33.20 D I I I I ow C I CLEV. FL PUMP1 y OFF D CONCRETE L 8-7•00 DLOCK CL 3" APPROVE i RISER EXIT PERMITTED OWL! IF TAIJK MAUUFACTURCIt HAS SUCH APPROVAL. gEDpI SEPTIC E S"PE GIFICAT10JS DOSE WlE`11Z cz ~rj_`~g TANK MANUFACTURER: jJDER OF DOSES: 3'$y PER OAy TANK SIZE: \Z'S0 SO GALLOWS DOSE VOLUME I S . Z, lsl.l?'- TW S~'4 INCLUDING DACKFLOW: y GAIrLONS ALARM MANUFACTURER: MODEL NUMBER' 1 \Z~ CAPACITIES: A= 2.S IMCHES OR ub3.3 GALLOUs SWITCH TYPE: F~1F-M(yiR.lf 5= Z IIJCIIES'OR 32-3 G~LLOUS PUMP MANUFACTURER: In"'ILz_S C= Y-' I UCHES OR ~69'q CALLOUS MODEL WUMDER: µ'l.1` 4Q D- 2 I Z 1NCRES OR 1S3 - -L GALLOWS -759 I`'1 CU~L',( MOTE: PUMP AND ALARM R TO DE SWITCH TYPE: _ JAIWIMUM DISCHARGE RATE ~6'8o GPM INSTALLED OW 5EPARAT6 CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AIJO.DISTRIbUTIOIJ PIPE.. "ZI'1 FEET + MINIMUM NETWORK SUPPLY PRESSURE . ; . . . . . . . 2•S1 FEET + FEET OF FORCE MAIN X y~FjoFLFKICTION FACTOR__3.31 FEET TOTAL Ot JAMIC HEAD = ~~'b Z FEET Pump chamber DIAMETER INTERLIAL. DIMLWSIOLJ i OF TAWK: LENGTH ;WIDTH --.;LIQUID DEPTH -7~ BOTTOM AREA 231-- GAL/INCH AS PER MANUFACTURER = ~~•~3 GAL/INCH • 4 P`GE 6 OF M E40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve Ma)EL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 N W 30 t W N 25 6 E Z QQ M = 20 6 J = H 15 l6.oZ ..J lam-- 4 p 10 46-80 5 2 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLOMS PER MINUTE 1101 Myers Parkway, Ashland, Ohio 44805-1923 419/289-1144 FAX 419/289-6658 Telex 98-7443 K3326 7/91 Printed in U.S.A. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER t~ RAj,,, ,r. - S kp12; C yjghj 4 iia, MAILING ADDRESS 10a. 1q, 8* S4 Ga. i 1 S cam' .S~to 2Z PROPERTY ADDRESS o)09 (!,>,r42tj bhKS ~R R;.r~tZcA/lS L J, S'y-_Z2 (location of septic system) Please obtain from the Planning Dept. CITY/STATE S 0 2 72- <W PROPERTY LOCATION 1/4, 1/4, Section '21 . T L 8 N-R f 9 W TOWN OF 'n2~y ST. CROIX COUNTY, WI SUBDIVISION Cog NA2Zti OAKS LOT NUMBER 7 CERTIFIED SURVEY MAP , VOLUME (7i, PAGE 635 , LOT NUMBER__:j_ 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 ex 'ration date. SIGNED: DATE: I. 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 8:11 ScAM l+~ - C ~;_(,%y~N1'flclZ Location of property 1/4 56 1/4, Section 2-1,T ZO N-R/9 _W Township TRoy S Mailing address hod N. e"s+. Ri ER Cals $yo2Z Address of site c~p9 0-oun4iRv BAKS lp 4)► &FAA Subdivision name CoowlNy Lot no. 7_ Other homes on property? Yes ---A-- No / Previous owner of property LAUpe'dc - molphy ( bey-102CF Z l Total size of property 2 4cRes Total size of parcel Z Acs- S Date parcel was created Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house) ? Yes v/ No Volume _U36 and Page Number as recorded with the Register of Deeds.-- 1c -7C) 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. 5 V 3 34 , 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. ignature of Applicant c6--Applicant s 12C, Dat of Signature Date of ignature WARRANTY DEED •0/1-1 jL- Document Number 543392 •rc~ 1176PAG:635 Freed for eturn ddress Attorney Kristina Ogland MAY 8 1996 _ P 0 Box 359 9:30 Hudson WI 54016 + Parcel I.D. Number. 040-1221-70 Ray Galep, Robert L. Mackey, Laurence Murphy and Norwood Ecklund conveys and warrants to Sheri A. Guenther the following described real estate in St. Croix C ounty, St to of Wisconsin: Lot 7, Plat of Country Oaks in the Town of Troy. This is not homestead property. ' T NSFER Pe1'tY- $~e ~ ' Exception to warranties: Easements, restrictions and rights-of-way of record, if any, n~ r'~ v 'sated this day of May, 1996. (SEAL) a nce Murphy ) o r L AUTHENTICATION Signature(s) Laurence Murphy and Norwood Eeklund - authenticated this day of May, 1996. Kristina Ogl d fit; c TITLE: MEMBER STATE BAR OF WISCONSIN $Y i , THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristina Ogland" Hudson, WI 54016 r s, c