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HomeMy WebLinkAbout042-1078-60-141 3 0 _a p e» y a 2 C~ a a N © ~I ~ X N U O O ~ a N :n O O c C z 3 m LL C co O O Q ° i I, M N z 0o w E z w o : z d d CD a Co 0) N N F- z c O O Z d C: V r 70 cn ~ I. m Z c N z c E -2 co 3 ` m m t4 CL N I N C N N • O 1y a 0 r - C C O U O z F- z p N z 'IT c ` E m N N CL a ';c •L°• c O N ° o G 0 a . cn U) U) zv> 333 ° U) z • aaa Q " U) ° N 0 co co w ° fA -j U rn rn O M U) -0 o C) o 0 C) a) (n a0 E N O N 0 0 O O O) N ~•I~`♦ M ~1 ° N O ~i ~ O r+ Q } O O O Q N C 00 y o 0 CY) 0 o o CD 3 0 d n o c o 0 0 0 ,O ~ F- U N O O N N N N N m O Q) N co C M CY) rn v F- F- a°) 10 lfta > 7 ~ N N (6 N N E E U O CQ • • i r n m xt m L a EL L a w • c~ a @ c CD c L w Q li W ° r A U a 2 0 U) U STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER C_ 0 IT t tE/ - ADDRESS /0-~ T/ SUBDIVISION / CSM# LOT SECTION. T-j N-R~W, Town of (.lJAt?/? LEA/ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Iw ~j _ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCH 4ARK: 5 sA LE L 1015-194 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: 5 Liquid Capacity: 1000 Setback from: Well House Other anufacturer Model#__.-- --Size Float seperation- /cycle: A,1 :SOIL ABSORPTION SYSTEM Width: Length 75 Number of trenches Distance & Direction to nearest prop. line: .g' Setback from: well: House. Other ELEVATIONS Building Sewer ST Inlet; /O/, /0 ST outlet Z03, PC inlet PC bottom Pump Off Header/Manifold lo), e3 /Oj" je~21,&3- Bottom of system Existing Grade Final grade /Q Y DATE OF INSTALLATION: PLUMBER ON JOB: / LICENSE NUMBER: -3a20,5'- INSPECTOR: 3/93:jt VVisconlo Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST - f-V TV • Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State Plan o.: HUBERTY, SCOTT A i% WARREX CST BM Elev.: 1 Insp. BM Elev.: BM Description: / Parcel Tax No.: TANK INFORMATION ELEVATION DATA p TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Gc>~!S ~,y r~ aQ Benchmark QD: GC% Dos' i ✓ ~0~ /3 Aeration Bldg. Sewer dam' Holdi St/ Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet K. 319' 7, 7 3/ TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet irl Septic NA Dt Bottom Dosing NA Header/ Man. 9 C6, Aeration A Dist. Pipe Jp.~S Holdin Bot. System 9.~0 9S'~9y,9 ' PUMP/ SIPHON INFORMATION Final Grade Marfi3taEU rer Demand -r 5-6~ py jj; Model Number GPM 'Z~" S. a 39 TDH Lift Lriction Ft Force m Length Dia. Dist. To Well SIL ABSORPTION SYSTEM BED/TRENCH Width I Length / No. Of Trenches PIT No. Of Pits Inside Di Liqui epth DIMENSIONS 5 S D I M E N I SYSTEM TO P / L BLDG WELL LAKE / STREAM LEA nu adurer: SETBACK CHAMB INFORMATION Type , Moe Number: System: (,a.,.~ ^ /Q~ OR LI19 T DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Sp r Intake Length -16L Dia. Length Dia. Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At-Gr 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: WARREN.29.29.38W. NW. NE, 107TH ST Plan revision required? ❑ Yes No J/ Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signa ure Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION COUNTY v~L■'~■'~ In accord with ILHR 83.05, Wis. Adm. Code S4- Croy STATE SANITARY PE'/R -Attach complete plans (to the county copy only) for the system, on paper not less than vA (e o? t~ 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION v Y4 E'/4, S 2 17 T , N, R E (or (@ ,5corz A, PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 796 T S7- CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER A 7S W1 0 8 a4// 13 CITY EAREST ROAD II. TYPE OF BUILDING: (Check one ) ❑ State Owned 13 VILLAGE : ~q 7/0' E ]Public El 1 or 2 Fam. Dwelling-# of bedrooms 3- PARCEL TAX NUMBER(S) ~ III. BUILDING USE: (If building type is public, check all that apply) O'Ll -/0 729 _ O 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 El Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service station/Car. Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. [A 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 30 ❑ Specify Type 41 ❑ Holding Tank 12 N Seepage Trench 22 ❑ In-Ground 420 Pit Privy 13 Seepage Pit Pressure 430 Vault Privy 140 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) 102-,u ELEVATION /OkoO Feet lo -v Feet 7O VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank MOO ` Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plum 's Signature: (No Stamps) Mill PRSW No.: Business Phone Number: r~SGj Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Ag nt Signature (N ps) ~c Approved ❑ Owner G Surcharge Fee) iven Initial Ire 51A1115 j Adverse Determination Ire fo X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: Coln jzl%7ACA~~ f,/-V eL, SBD-6398(R.08/93) 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 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 pumper whenever necessary, usually every 2 to ;I 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. 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 file 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 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) ` L=e 4 o G 131`1; ~o~v Cuav~ 1x2 EL.i04-Q ~L. IOfCU X41-7. 17r l. TeP AF 1-07' P110E E& 9~= ~G NORTI't Lo 7- NE ow s`~~ LET ~`y a~ Ec. 9~. 9c f~ d y n n O w ~ looo 6-L O c (ri Rr OR/06- SCOTT ~SED u~ECL lltffleI~Ty 79,0 7','r 5 T, 86 c t y u«w TSP. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR 'HUMAN REDLATIONS PERCOLATION TESTS (115) MADISOP.O. BOX N WI 53707 (ILHR 83.090) & Chapter 145) LOCATION: SECTION: eQjWL1jNSHIP MUNICIPALITY: J I OT NO.:BLK NO.: SUBDIVISION NAME: Nw N E /4 zq /Ta9 N/R 143 E (or) w Ap- \~k- k~~ - ~ c s r-t COUNTY: MAILING ADDRESS: -7 '1 O t I Z 7jj_ ST, S-T IX 1~01URI`p Z. STAR-T \~.&fi3GRTS , Lj I S40 Z3 USE DATES OBSERVATIONS MADE NO. BEDRMS: COMMER IAL DESCRI ROFILE DESCRIPTIONS: R A I N TESTS: Residence IV , I1~\ 7FCKNew ❑Replace Z6_90 1v- P". I lv o- = y IF N I -CP4L*Jo p ~ s sYST-~f >ti / z Yt ctK'S L-_xhqq L w c RATING: S= Site suitable for system U= Site unsuitable for system ` L" L VD CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLOLDING TANK: RECOMMENDED SYSTEM: (optional) ®S ❑U "S ❑U S ❑U NS ❑U ❑S,®U elPC-H S'x-7S'Lav~ If Percolation Tests are NOT required DESC`hSS If any portion of the tested area is in the N RATE: under s. ILHR 83.0915)Ib), indicate: L Floodplain, indicate Floodplain elevation: ~ - PROFILE DESCRIPTIONS BORING TOTAL P H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION' r. H I OBSERVED HEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 8S i01. 1 M(o,K3C > 3S s~-~ PaGE 3 o F 3 B- z 8 S 100•2 It > es >7 B- 3 \o4 . V It > $ b y B- $ So l 0 S. S a > g 6 ~i B- S %7 B- - PERCOLATION TESTS } TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES f NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 P R PER INCH P- - P- P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. l S SYSTEM ELEVATION S~~' ~~G~ Z o>= 3 1 r• i I 3, ; E , ~ a L~_ 5 Sow j~l ~r^~h ~t~2 5)ETS T\ , _1 Lc, - 3 3 INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 + To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating yourtest locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well is - Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sI - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sil - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point C) -7 L N ~1f = 2~ 1 LET 1 LoT Z rte' `ti oep STh1'tE ~-Rl}1 Z-.n~ 1 Z' Lor uNe 5w►- ~ib,96~ o~ - ~.o T LoT 3 9►q- L!-.100.00 0►~ l~ixZel C • ~ wooD Sl'Rk~ w / L ATE) 9 J SN xlsnti C~ y ,c~ ~ ~ \ ~ cdvTo~nz s i •s \ \ \ )z- L \ vo 6 T1Z ~u aH E S ®81 en - OL OS-96' oN s.3 ~~Y T~~ cue 1 -F Z ~,y ~t S SOIL DESCRIPTION FORM Attach Soil Prot a OCa to map On a Su orate Sheet) CL E T RDIJR~-D lZ' STE1..)f4~ 12T LINEAR L TI1G TE: 3 ' O Sp1l. (~$SORPT1lw SYS1~7"1 SLOPE; 1l "1,3 PURPOSE: E\ U T%?,- DESCRIPTION BY A R~UR•• L. LA-3 E-G GR"E-B ASPrcT t~o~z`T~f L~ s r~sR. ~Y Nv v Z6 9 4 0 CURRENT LAND USE' W O~ S O)-1 t;` ~P ~Z 5 DATE: CICj \X CpVIQ -TIJ LJ J VEGETATIVE COVER: GryJ s S COUNTY/STATE: 1.~T 0, V- ?V-Q, r-) 4Se., dSM ~`ycee`sslu~LY 1RJ~-1] P V- SE?C. TZ9TJ, R IE1tti DRAINAGE CLASS' 'T 'W LOT DESCRIPTION:' - O • Ei O " O 1= (~j~F2 L-~J GALLONS-PER SO. FT. PER DAY:. LOCATION: I SOIL SERIES: E ~l ~Z ` S PARENT MATERIAL s /OEPTII: tIORIZON DEPIII MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS P11 -BOUNDARY REMARKS in, moist Gr. Sz. Sh COATINGS Bo~L.I G ~ s I 1 ~Sbk ~1. ~t- cw Z io --2.3 Lo ,tR 4 lb - S o s g yn cw 3 zg_ss tioyR 6l6 - ~s o sg m OR1 G Z Cw t ~sbk vf~ _ o- 01 to~t~ 13 - S l z 9,gs Mvft- ~ G 3 GRI►v~- s i ( t TSblt Y n Eo z ~_1q vo fP. y!y Si I l.~sbk tin.~E+,- e S 3 X9 -z -1.S`~R Sly - ~ s l ~sbk r, \'3 g s ~I 3z_gb ~o-tRYl6 - S o S m I Bo 4 o- R to~t~ z!Z - L l-~sbk. Yn-~r cs Z 9- FZ 3!3 - s I 1`FSbk r►v~h CS es 3 ~~-46 ~o~R spy - s1 1~sbk _ ~~-h y yb-8b ~oti~- l6 - S D Sg G 5 -e s \ Z _ Zz tio`r~ 3 !6 _ l s Zntsbk 114 v e S to°!e 6RJKJEL., 3 Zz -V) \o~ Cz 4 /6 - S o S M T2~ r'1~'! ~L SS Z Sl NG t s g~ ~S BZ. x3 liz~z SKS ~~T1 INDUSTRY,' bEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION CAB09 P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON WI 53707 OLHR 83.09(1) & Chapter 145) LOCATION: SECTION: NSHI MUNICIPALITY: OT NO.:BLK. NO.: SUBDIVISION NAME: NW ~ 4 N E 1Z4 Zq /Tz9 N/R va E (or) w A~~ - ohs c s r~ COUNTY: MAI LING ADDRESS: -7 L 1 Z T ST. S`T . c C_ ~ lX hZ~lu Lp S' .tu°cRT ~~v~~T S w S 0 Z 3 USE DATES OBSERVATIONS MADE NO. BEDRMS.: 1COMMERCIAL DESCRIPTION: Residence ®New ❑ Replace PROFILE DESCRIPTIONS: PERCOLATION ESTS: F \ \ - Z. 6 - 9 c) oT~ = y ~►~►-G[~ D PR~~Sviz SYSTL~YI >,v /z Z C's ~1~ 5'x~S' Ltvuc RATING: S= Site suS`- itable for system U= Site unsuitable for system (Z LO I L Z=D - CONVENTIONAL: MOUND: IN-GROUND PRESSURE: SY TEM-IN-FILL OLDING TANK: RECOMMENDED SYSTEM: (optional) ZS C7u NS au s au 0 s ou a s .®u Z-~+- ff~CH If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: C S S Z Floodplain, indicate Floodplain elevation: N ' PROFILE DESCRIPTIONS BORING TOTAL PTH T R UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED F.-TUTH-TS TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 8S 101.1 T.~o►.~C--- > $S 5~-~ P~G~ 3 of 3 LI B- Z S S )00-Z > 85 B- 3 g~ \o'A. V > $ 6 B- y $b 1oS-S 4 B- S %7 J, y, > B~ B_ PERCOLATION TESTS } TEST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES r NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 P RI D 2 P PER INCH P- N P- P- P _ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. P G -7 L "M e-rz- T ' S SYSTEM ELEVATION S n~ G of 3 - 4 - I _~F44---f 4.w_. i ' 1 jI -1-4 A/ L I ' ~ I I ~ ? 3 ~ ve I _ _ L! Li fit(-,-LOt LET \ LpT Z VV~ Z37. 1 Z' LoT t_uu~ ~ . Rb,96 ~ or.r - 1.R.wa P 1 PE? l.o T t_u T 3 919- L)-.IOo.(Nc c-i w0o~ STRktz w / L ATN i x J0 i J `bv' \ Sri \ \ ~xlsnN~ \ \ \ \ ~ Co+vTovs S x \ vo 3 BM - e..1o5.9b lu><z°woo~ ~S i toZ 0 6`~ IDS i 2 IN I "N L O s.3 ~oY T~z~~„c1~eS ~ e.q s ~ to S SOIL DESCRIPTION FORM (Attach Soil P of e s On s Su arsto Shoot) cL Ro►~R~-C~ 1Z, STE~f`cfiZ.T t AR-LOADWO T : 3.0 PURPOSE: lAM FUR Soles FTBSpVkT>'P p SKSI M SLOPE: 11 Ott) nEsrpTPT[ON eY ~R.Tl-}UR 1_- WE6G.IER ASPECT ~1o~t`t}) u~'PtSTLsR L~f-- DATE Z6 , Icl4O CURRENT LAND USE- woofl~-D - - SOE~ OPI COUNTY/STA : 1X (2bQM Tt( LI:J I V I'V COV R• I 'C1 S - G S ~T of?V-0, 9tZt> csM CEsS!U~L,~t 1~f="D L 7 ESCRI ION:' • O 1~)-1J T- SAC. -Z 9 TZ9►J. R 18 L-1 DRAINAGE CLASS: LOCATION: o I" L~ I ERR V GALLONS- PER $9. FT. PER DAY: O • 6 PARENT MATERIAL (s)/DEPTH _ SOIL SERIES, Ell C-zStZ' S HORIZON OEPTII MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS PII -BOUNDARY REMARKS in. nio s0 G St. Shp COATINGS SoQ.I G 1 0 - ti0 'wm?_ 3 ~ 3 - S I 1 is bk yqL i- 1S o s% »1 I caw 3 Z8-85 ~o~R 6~6 - ~-s o s m ~ oRi G Z _ 1 0- q ~t~~tR 31~ - s l Y~5br Z 9-gs 1o~c~ 3~ ~s 1'Fsb My o G 3. lb`- tz- 3!3 - S l I `~sd1c ~L~1- c~ S°~o GR/1~~L Z ~omR. Y/y si I l..~sbk s 3 ~q , 3Z -1.5`•[R 3l~! ~ ~ S ~'FSbI~ Y*T. v -~h g 3t . g b ~o~t tz Y !6 - S o s m ~ Bo ws o- 9 Lo 4tz V?- - L 45s k. Y4 c s Z 9- )IrwiR 313 - S I 1`FSbk ~LV F►^ CS 3 ~$-46 toyR s/y - s1 l~s~k w,~h yb-$b .~o R y 16 - s D s m I 8~R1. G 5 Z - ZZ L0`Cti 3 !6 - i s Zwlsbk ltil v s ~o°!s 6 z 3 ii ~lo~r(~ 4 /6 - S o g M I ' 2- )"t t"! Q e SS -Z s1 JJG S S1 ~S `ez STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER -5ev-r~ fit- KEtuz'-e Z • aoszF i MAILING ADDRESS '7th - 1&4T"k 4Qe Nr.J r-tsp . MIJ s53c~'3 PROPERTY ADDRESS J90 - 10-7 ST , RoIS&-MF:~- (location of septic system) Please obtain from the Planning Dept. CITY/STATE (SEA f~J ) PROPERTY LOCATION A W 1/4, A/Z~ 1/4, Section, T91 N-R_1 ?6-w TOWN OF C<'7Aj ST. CROIX COUNTY, WI SUBDIVISION LOT NUM13ER CERTIFIEDSURVEY MAP 474 to , VOLUME 9 , PAGE 2141 4-, 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. LAVe, 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: L ? - DAT[: - St. Crol\ County Zoning Office Gover-nment Center 1101 Cann ichacl Road Hudson. W1 54016 11%`~ 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 Sept 4- 4, -q c2T&4E-9'T-f Location of property NU) 1/4 A/igr 1/4, Section g,9 ,T_igj_N-R__tf~ _W Township &2 ,45-,kJ Mailing address t&4-TK AVc yL,J Rk sit? Mme) 5S3u~ Address of site -7 O --~p"Z'~'~ Subdivision name r- Lot no. Other homes on property? Yes_ No Previous owner of property DgtL R_ `f Nsf~V~y 1'~(Lk2~ Total size of property -y/o 3 Total size of parcel o?,, ¢ 33 QC. -t- 00 -3;L 7 AC. = aZ • 7lnf) ,4c Date parcel was created d67 Zf 4FFiA4Uj 7- &g Are all corners and lot lines identifiable? ?C Yes No Is this property being developed for (spec house)? Yes _,>e, No Volume t t'1✓5-and Page Number 10( 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. _ Z'4.9935 , 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. ~Q Sig ture o Ap icant C -App nt Date of Signature Date of Signature Adffi~ ti„ x 4'7481.8 CERTIFIED SURVEY MAP LOCATED IN THE NW114 OF THE NE114 OF SECTION 29, T29N, 918W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN LEGEND ST. CROIX COUNTY SECTION CORNER MONUMENT, FOUND. • 1" IRON PIPE, FOUND.~~ 0 1"x24" IRON PIPE WEIGHING 1.684/LINEAL FOOT, SET. O CT 1 S ~J91r" LL O a PERCOLATION TEST LOCATION J/tdtg ol L%o Pa of ~ St. Crobt Co., WI ~ NOTE: THE SETBACKS OF MAIN BUILDINGS ON THESE LOTS ARE AS FOLLOWS: SIDE YARD: 10' MINIMUM AND 25' AGGREGATE REAR YARD: 25' HIGHWAY: 100' FROM RIGHT-OF-WAY LINE ORDINARY HIGHWATER MARK: 75' {Y"' N 940 N 00 W w 00 NORTH LINE OF THE NE1/4 N 00 z 00 ozz -'tpZ UN-LATTE- LAND S ~~m ~Um 80TH AVENUE wwN z cn H N88°49'21"E 2604.58' E N 1302.29' z N 1302.29 _ -N87°34'00"E 657.78' 420.66' 237.12 s-- - - w_ -Q y POINT OF No 237.12' 0 377.0 6 3 ri ~o poi i BEGINNING C4 o 0:M CrJ N Nit 1 M04 rl 1 cy) N U-1 2 POND I° Ni ^I a z x -T 'n o N N 3 9. 5' 4N .a w H N N 8z p \41.58 H I 85.40' 151.72' 126.53' 252.7 ' ; cal w 237.12' N87°34'(O E 420. 3~ o zl w It 0 rn l ° g N87°34'00"E p 3 POND i w a l c z Ordinary ml rnl 001 wl w HI •I g 4 ` N rn High o w AI OG ~Iwl = ^ o ` M m Water Mark1NI H wl v~ o W ICI 00 ° z 381.61' 39.38 , 1 HI o HI H z rn ~lal ~ M v g W 420.99 i of z -4I m 1_4 a 61R1 z 284.94' 334.38' 38.83' I a al H 00 00 S87° 0 'W 658.15' ; e+ al o z 1 U) z ov'a' J9 NCO WAY 'EAS EMEN N i 6 ' i z l - - U N P L A T T E D LAND S ; ~I W i of HIAI i ~p P41 a1 i 1 zI 3 1 X39• o: ' o OWNER & SUBDIVIDER 150.00' i., i x fIT*1Z 9$8d 6 'TOA ~J sa.zTdxa uoissTmmoO AN 0I'IgIId IUVION w4 • •amss aql p949TMOMIOS pus quamnalsuT 2uT099zOI aqj painoaxa OqM uosiad pamsu anogs aqq 6T ' IO Asp STgl am a.zolaq amso ATTsuoszad ( 711ZNII00 XI0,90 ' ZS *SS( (NISN00SIM 30 alvis IliyMaZS IN Q'IVNOH 6T ° Io Asp STgl 39uMO pTsS JO Tsas pus pusq aql SSHNZIM •dsm sTgl uo paquasazdaa s8 paddsm pus papTATp 'pafCaAans aq of deN AaAanS P9TITla9D sTg2 uo pagTaOSap pusT aql pasnso I lsgl SITWBO Agaaaq `ZavMHIS '2I Q'IHN02i NOIIVDIQdQ 30 RZv0I3Il'aRD SURNMO '3'S 9T+7`£OT -+0V ~L£'Z '3'S L66`90T ;:Dv ££fI'Z r +7 '3•S £L£`OOT +OV *70£'Z '3'S £SO`TTT +0V 6~9* Z £ '3'S 9T9'T6 +0y TOT'Z '3'S LOL`STT +0V 999'Z Z '3'S £8£`L9 +OV LT£'T '3'S 80Z199 +0V LW T T Ind zxvn s 2[DVH' DV laaa a2Ivn s Hoyalloy *ON XVM 30-ZHDIU ONIQt1'IOXa XVM-dO-ZHDIII 9NIQIl'IONI ZO'I 41 . Zza3 H2IvII S QldV Sa9wau0v 30 Q'IgHZ £ZOVS 'IM Islugg02T Q s laaHIS LIgZTT OVL TIM I'dVMgs$ ' II Q'IVNO'd = 3 HMIAIC IIS QNV 'dHNMO ZZOi S ursuoosTM 'sTTv3 zanzg T6/6/OT LSawvr gaa.zgS gnuTPM 'M £TT :Pasinag • 00 buiaaauTbug uap50 T 6 / T T / L 4i,~~~~~$ £88T-06 *ON qor N8 T-S uosuVMS •y saure :pasTAag "nnm aa~ -7 .066T ZT xaquiaoa(j : agaQ • autps aqq buiddPtu pup buzpTATp ' buTAaAinS uT AgunoO xioaD •gS pup dTgsuMos uaaapM go suOT4PTnbag UOTSTATpgnS agg pup sagngpgg uTsuoosTM agg go 9£Z aagdpg0 Io suoTSTAOad aqg ggTM P9TTduioo ATTnJ 9APq I gPgg 'apPui Joa.zagg uoTSTATpgns aqq PUP PaAaAins PUPT aqq go saTappunoq aOTaagxa aqg TTp 90 uotgPguasaadaz goazzoo sz dEui gons gpgg ' PuPT PTPS go aeuMo aqq go uoTgoaaTp aqq Aq dPW AaAans P9TJT4a9D PUP uoTSTATp puPT 'AaAans gons apPtu 9APq I gagg AJTgzao I •paooa.z go sguawasaa og goaCgnS • ssaT zo aJOui ' gaa3 aapnbs 996' L6£ buTaq 'ssaT aO aaOlu 'sGaDV 9£T' 6 suTPguoo Taoapd sign VOL 1175mA91 i(lel-j ~ •54293G AFFIDAVIT c. State of Wisconsin ) ~ne`x C74,:141 ss. icr Rucc:) County APR 3 0 1996 - £t • Q Your affiant, being duly sworn, states under 11:00 A oath that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 41 ~3 , Page_f, Document No J547.41 St . Croix County Register of Deed's Office: Francis H. Ogden A parcel of land located in the NWi/4 of Ogden Engineering Co. the NE1/4 of Section 29, T29N, R18W, Townof 113 River W. Falls, Walnut WI Street y. Wisconsin, 54022 , ount . Warren St. CroixC Lot 4 of the Certified Survey Map recorded in Volume 9, Page 2414, Document No. 474818. 2. The above parcel has had added to it the following described parcel recorded ,intVolume Parcel I.D. Number page Document No. County Register of Deed's Office, resulting in a single parcel described as follows: A parcel of land located in the NW1/4 of the NE1/4 of Section 29, T29N, R18W, Town of Warren, St. Croix County, Wisconsin, described as follows: Beginning at the SW corner of Lot 4 of the Certified Survey Map recorded in Volume 9, Page 2414, Document Number 474818; thence N87034000"E 284.94' along the South line of said Lot4;N0 ence21"W S00038121"E 50.021; thence S87 34 00 W 284.941; thence 50.02' along the East line of Lot 1 oftheNCertified Survey Mapnt of recorded in Volume 6, Page 1799, Document beginning. This parcel contains 14,247 square feet, more or less, being 0.327 acres, more or less. 3. The addition is a transfer exempt from Chapter 18 of the St. Croix County Land Use Regulations pursuant to Section 18.05 (A) (3). 4. The purpose of this affidavit is to notify the public of the addition and the resulting parcel. day of Subscribed and sworn to befor 19eq me this I to . ..n.a.,,, . _Q ,,f% SINDQUj''•• A~ : I0TAPY Not y Publ c, S cors~n i : P u c xv commission expires: i-~3' ~,sj STATE BAR OF WISCONSIN FOBS/ 1 - 1982 ,I I! WARRANTY DEED j. ' i 5112935 I ;I DOCUMENT NO. I PAG_ jl r t (jFFF VOL 1175 190 E _ - - ii 1, F :y Yr7 f, 1 This Deed, made between APR 3 0 1596 ' K Dale R. Stewart and Nancy M Stewart, husband j! and wife 11:00 1, ! _Grantor, and Scott A Hubertv and Kerry L Huberty, _ _ husband and wife as survivorship marital property p IZ' r., C1 OW3 _ Grantee, i' THIS SPACE RESERVED FOR RECORDi DATA Witnesseth, That the said Grantor, for a valuable consideration receiRt of which is hereby acknowledged NAME AND RETURN ADDRESS conveys to Grantee the following described real estate in St. Croix County, ur State of Wisconsin: Certified Survey Map, recorded in Volume ;j Lot Fo4), 9, Page 2414, Document Number 474818, located in the !i Northwest One Quarter (NW}N of the Northeast One Quarter (NE0 of Section Twenty-Nine (29), Township - - - .Twenty-Nine (29) North, Range Eighteen (18) West, Town of Warren, St. Croix County, Wisconsin. AND (Parcel Identification Number) A parcel of land located in the NW} of the NE} of Section 29, T29N, R18W, Town of Warren, St. Croix County, Wisconsin, described as follows: Beginning at the SW corner of Lot 4 of the Certified Survey Map recorded in Volume 9, Page 2414, Document Number 474818; thence N87°34'00"E 284.94' along the South line of said Lot 4; thence S00°38'21"E 50.02'; thence S87°34'00"W ''.84.94'; thence NO0°38'21"W 50.02' along the East line of Lot I of the Certified Survey Map recorded in Volume 6, Page 1799, Document No. 424641 to the point of beginning. Grantors reserve unto themselves, their heirs, successors and assigns, if any, an easement 'on and across the easterly most 334.38 feet of Lot 4 as described herein, said easement ;parcel being 66.30 feet by 334.38 feet. iNancy M. Stewart, spouse of Dale R. Stewart, joins in this conveyance for purposes of conveying over unto grantees any and all right, title, and/or interest that she may have in ; the properties described and referenced herein pursuant to the Wisconsin Marital Property : Act. This is not homestead property. (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; , And Grantors ` warrants that the tE:: is good, indefeasible in fee simple and free and clrir cf encumbrances except • no exceptions T /1, DER d?iJ and will warrant and defend the same. I FEE day of 1946-. Dated this ;I' ~ (SEAL) (SEAL) ~I • Dal ar (SEAL) (SEAL) j it . cTart - I~ I AUTHENTICATION ACKNOWLEDGMENT I STATE OF WISCONSIN " Signature(s) ss• I~ County. ; authenticated this a of Personally came before me this day of 19_ the above named ~I Dale R. Stewart and Nancy M. Stewart _