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HomeMy WebLinkAbout002-1007-50-130 Q c I ° I 0o p °U3, n y 5G O C b W c~+ C Z O N (D O N p i L - q ± j o y D E N Q to m x ? NOd. t~ O ~O C N G F~ O w N Cl ~ ~ O N N C O O 7 c N CL LL O a N O _ N C L C C N E N D O M O Q z 3 ~ E v I N II'I C Z ~ 'O a m v IN- z o N O i C U' N NU o z v a _ avi 2~ c 0 VJ F- N a3 z 2 -a o v r) `o v C N C C 01 cu O O Q Q z z o N N O ` D N D _ 06 CL (5 LO N c o o a` ° o 3 E o E m co Fes N - F- (D = p z 0 0 0 n z° m 'N R a~~iaaa ►~i, a U) *i► g p N 0) 0) ~1 to J V o rn rn z r! N o '0 c 0 0 0 0 0 0 0 E r O T = d O N m O Q C6 ~w p Q a O O 0 N C f6 C E 00 LO O o N C Q) N N 0 :3 i 0 0 y 7 C Q. 0) p c° N- N V y~ ~ F- N E C M N Lo p L tIk C O Q w O C T (N CD (D co z • m U N N E caa cs ® CCi r i. E v d m a ° a w • m a m a y £ i c C A 0 a 0 U) 6 Doz STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER Irv ADDRESS. SUBDIVISION / CSM9 LOT SECTION___~_T N-R ~ W, Town of / N /a ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i f f 3$ ~ cr. k4 INDICATE NORTH ARROta Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- r 3 BENCHMARK. ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well TD ' House Other-,--*' ,1t60'' 7 7 / Vol, Pump: Manufacturer o4%";- Model#_ Size Float seperation Gallons/cycle: Alarm Location ' t t2c:3~ yyt~-tL SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: 01)'House Other ELEVATIONS r • Building Sewer ST Inlet: ST outlet r, PC inlet PC bottom Pump Off / Header/Manifold 20310 Bottom of system Existing Grade ! 1 Final grade /O 3(Y2 -7 ~r DATE OF INSTALLATION: PLUMBER ON JOB:, LICENSE NUMBER: INSPECTOR:. / 3/93:jt I SANITARY PERMIT APPLICATION CO ■I~Ilnlr~i In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT# -Attach complete plans (to the county copy only) for the system, on paper not less than - ❑ Check re[vQ>isionto previous application 8'h x 11 inches in size. -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER Q~ Ac ROPERTY LOCATION r te. /a-S litch & NW'/4-sw /a,S Tit`T,N,R E(O W LOT # BLOCK # PROPERTY OWNER'S MAILIN G AQDDRE 30 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ®0 2 ~r ~xQ-3y CITY 77~ EAREST ROAD II. TYPE OF BUILDING: (Check one) ❑ State Owned ILLAGE 3 . TOWN OF: -LO ❑ Public LJ 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(S) 1 o ! Q Q III. BUILDING USE: (If building type is public, check all that apply) 00 -140-7- ❑ Apt/Condo 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 130 Other: Specify IV. TYPE OF PERMIT: (Check on y one in line A. Check line B if applicable) r of A) 1. ❑ New 2. [J Replacement 3. ❑ Replacement of 4•E] ExReconnection of isting System 5.E] Ex saing System System System Tank Only Date Issued B) ❑ A Sanitary Permit was previously issued. Permit # V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution pr°'` ea Distribution Experimental Other - 11 El seepage Bed 21 u Mound 30 El Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 0-An-Ground 42 El Pit Privy 43 ❑ Vault Privy 13 ❑ Seepage Pit 14 ❑ S YSTEM INFORMATION: LLONS 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. (Gals/day/sq. ft.) (Min./inch ®O q P v~ ) a ELEVATION Feet Feet VII. TANK CAPACITY -01 Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name ref ab a Con- Steel glass Plastic App Concret structe Tanks Tanks Septic Tank or Holding Tank 10D0 Lift Pump Tank/Si hon Chamber I,- El I Ed VIII. RESPONSIBILITY STATEMENT m g I, the undersigned, assume responsibility for installation of the onsite sewage system shown o e attached plans. Plumber's Name (Print): / Plumber's Signature: (No Stamps) M MPRSW Business Phone Number: ~ ~'c 3 ~ 5~° X 15- 7yp-.33 2 Plumber's Address Address (Stree , C Ci 'ty, G~ State, Zip Codey IX. C LINTY/DEPART ENT USE ONLY ❑ Disapproved Mary Permit Fee (includes Groundwater Date Issued Issuing A nt 3janalUr Approved Owner Surcharge Fee) Given Initial s) L~1i~ O/ j Adverse Determination c~"Q~/ vlJ , X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: ~')-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division. Owner, Plumber INSTRUCTIONS .tea 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 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 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of z where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If buiying 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. Vlll. Responsibility statement. fnsta in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber mus lication form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 'o scale or with comple itted to the county plans must include th@ . The - of holding tank(s), septic tank(s) or other treatment tanks,; building sewers; wells; water mai streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement sy 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 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 Ifor monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) i SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations February 14, 1995 2226 Rose Street La Crosse WI CD- WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 P~ RIVER FALLS WI 54022 RE: PLAN S95-40072 FEE RECEIVED: X9"1 ©d ACKLEY, DOUGLAS & AUDREY NW,SW,4,29,16W TOWN OF BALDWIN 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 i erard M. Swi Plan Reviewer` Section of Private Sewage (608) 785-9348 7574R/1 N7(R.18M) e Page of 6 i MOUND SYSTEM `9"40072 FOR 5 A Z BEDROOM RESIDENCE LOCATED IN THE NW 1/4 OF THE SW 1/4 OF SECTION T Z I N, R 16 W, IN. WISCONS OUNTY , TOWN OF ~p~L,4W LN , C~?~UIX COUNTY,- INDEX PAGE 1'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 RECEIVED a~tzTLt _ VIIU~"_ ST. - Fzo~3rs_,_w~ soz.3 FE610WS SAFETY i BLOGS. ON PREPARED BY ~@~~faz.B4S WEGE~EF? SAO I L TESTING %q0 4,41 nES z (3M sEF:Zv I cE a AM" L P.O. BOX 74 421 K. KAIK ST_ 'cvr~ i~ 2 RIVER FALLS. VI 54022 .ti rvrs 715-4ir-016 i _ 10,SIG14S Fes, H, !ag S JOB NO . S - Zo a f ' PLOT PLAN Page Zof ~O Scale 1"= '41" S95-40072 ~,S -P~c. PtP~ w/avot~ I.ATN . o P C'~ I ROPoS~ Z $DRF1 p 1 DFII~C.E Ln ° /J Z QV R r F. 1 za' ~ l2 Ip4°_ I \ \ o\SlvtZ~ 1tFlS hiZiiq. F- °jo \ eL VOZ S z, N 9'3 Ul L'Z- l0~{ 3 COU`Itll ~L. I17~. S N $o~-, nF 1R~C~ BEM s o s P.Ceti nally cv U1Z' = • w~L 'to 1 rT L21R3T IS j4ou M o J ~ 25 i=RcM TAniK, a v p*~• ~yt~ts t3CJ` pfl GdR NOTES: 1. Elevations shown are existing ground elevat ns unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) Install 4" observation pipes with approved caps. ( Z required) Septic tank to be =01650 gallon capacity manufactured by ~-ItDw 1~wv Pa~C-A-ST. ►~►c. ench Mark S~ t~BoV~ C - vert surface water around mound to prevent ponding at the uphill sidr . S95--40072 Page 3 Of Approved Synthetic Covering r~s~M c 33 Distribution Pipe Medium Sand _ _ H -IG Topsoil F Elev. tv1. S _ _J E D 3 b 3 % Slope Force Main Plowed Trench of k"-2k" From Pump Layer D O Ft. Undisturbed Aggregate Soil E 1 . \Z Ft. Cross Section Of A Mound System Using F b, b Ft. I Trench For The Absorption Area G N.,c~ Ft. A q_ Ft. H I- S Ft. B 63 Ft. I 1Z Ft. Linear Loading Rate= y.')(.GPD/LN FT a Ft. Design Loading Rate= 0.3 GPD/SQ FT K 10 Ft. L S3 Ft. A++t:p ate Position of Force W ZY Ft. L Foree J B K meia - A I;:-- - W Distribution Trench Of 2 - 2 2 Pipe Aggregate 1 IVA F SE- E S ervation PMarkers t ~.e s ~Ptl Jfnchbj securely) r-, OF FROVED tiEpT; OF fNOUSTRY, dlv ilsN LABOR & HUMAN REUT10M= saFtn MLOINGS Wound Using I Trench For Absorption Area co 1'ONDEN~ C- E Page Of 895-40072 Perforated Pipe Detail 0 End View Perforated End Cop) e~6~a PVC Pipe 1 . ~o~.o aoc Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced Q End Cop Q +.t * PVC Force Main J Distribution Pipe Lost Hole Should Be Next To End Cop Distribution Pipe. Layout P Ft. t X 14$ Inches Y 48 Inches Hole Diameters Inch Lateral t~~y Inch(es) } ~Eu~sS Manifold Inches Force Main 2 Inches # of holes/pipe 8 ESPO3N1C~tM Invert Elevation of Laterals 105.0 Ft. 5 -E g x k. = q .36 x Z, z: 15R, z G W-1 `nY -c. Place lst hole from tee with succeeding holes at 'intervals. Last hole to be next to the end cap. Combination Septic;Tank and PUMP CHAMBER CROSS SECTION ARID SPECIFICATIOMS PAGE S OF 6 J S95.- 40072 VE►JT CAP WEATHER. PROOF JUNCTIOQ BOX ti"GI. VENT PIPC APPROVED LOCKING 1O' F ROM DOOR. MAIJHOLE COVER 1NI~ ,pUDOW OR FRESH wA(ZN1►JG LABEL. It Mlu. AIR INTAKE LrL I8' IAILJ. WAN. PROVIDE IMLE T AIRTIGHT SEAL III I III '3RFF~~S A I III APPROVED JOINTS APPROVED JOINT I I I W/C.I. PIPE-~ItP'f I W/C.I.gptf! lank dA construction I 11 ALARM hSaT EXTEUDIUG 3 CXTENDIIJ th 0 iolL EMomply with ONTO 301-1 _ . d I II OUTO 50L QIL A, I i 83.15 and 33.20 ( 1 6~~1 J ( I ON r" C CLEY. f T. DEPT. OF IN Vk: PUMP r.. J OFF OI ION RYS LAI R HUMAN RELATIONS D NILOINGS D COUCKETE BLOCK E RRE NIJENC 13" APPRa RISER EXIT PERMITTED O1JLy IF TAUK MANUFACTURER HAS SUCH APPROVAL. gEpplµS SPEGIFICATIOL.IS SEPTIC F DOSE TANK MANUFACTURER. P~~DwN'3L t.tJ Ptz-~2121' WUMBER OF DOSES: Z 3Z PER DAy TANK SIZE: 1Od0 I bso GALLOWS DOSE VOLUME z L l -C S~t$T~-115 INCLUDIN& BACKFLOW: ~ 53 GALLONS ALARM MANUFACTURER: MODEL NUMBER: `1 SAW CAPACITIES: A= ~Z WCHES OR ZD GALLONS SWITCH TtJPE: "LRCU\2'k{ 5=. Z INCHES"OR GQLLOL15 PUMP t-%ANUFACTURER: ZoE1~Z. C.oI#g0ft-jQ4 C= IAICHES OR ~S3 GALLONS MODEL IJUM9ER: 9',6 D- INCHES OR ZSS GALLONS M Lu.c%U'.~-f MOTE: PUMP AND ALARM RE TO 6C SWITC H T Y PE: i MIMIMUM DISCKARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AUD_015TRIBUTIOIJ PIPE.. 1Ll'-1S FEET t MIiJIMUM METWORK SUPPLY PRESSURE . . . . . . . . . . . 2.50 FEET I S FE E7 OF FORCE MAIN X O'~ID F/0fTFRICTwN FACTOR-- 1' 10 FEET 10 TOTAL Oy1JAMIC HEAD = ~35 FEET Pump chamber DIAMETER 3g`IAITERWAL. DIMEWSIO.IJ~ OF TAWK: LEIJEaTH ;WIDTH ;LIQUID DEPTH -BOTTOM AREA 231= GAL/INCH AS PER MANUFACTURER = x`1.0 GAL/INCH PRG~ 6 0~= b W L HEAD CAPACITY CURVE 3 7/8 6 1/4 30 MODEL "98" 4 5/8 8 6 25 3 5/8 6 20 2 0, 3 S -I- + U Q 15 l8, 4 3/16 p 4- 10- 1 1/2-11 1/2 NPT 5 2 S95 40072. 0 U.S. GALLONS 10 20 30 40 50 60 70 80 LITERS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING CAPACITY 12 HEAD UNITS/MIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 15 4.57 45 170 3 5/16 20 6.10 25 95 ` Lock Valve 23' CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. • Mechanical alternators, for duplex systems, are available with or • Double piggyback mercury float switches are available for without alarm switches. variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - t/2 H.P. 2. Single piggyback mercury float switch or double piggyback mercury, float 98 Series Control Selection switch. Refer to FM0477. Model Volts-Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10.0072 or 10-0075. M98 115 1 Auto 9.0 1 or 1 & 7 - 4. See FM0712, for correct model of Electrical Alternator, "E-Pak". N96 115 1 Non 9.0 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 10-0225 used as a control activator, specify 098 230 1 Auto 4.5 1 or 1 & 7 - duplex (3) or (4) that system. 6. Four (4) hole "J-Pak". junction box, for watertight connection or wired-in sim- E98 230 1 Non 4.5 2 or 2 & 6 3 or 4 & 5 plex or duplex operation, 104002. 7. Two (2) hole "J-Pak", for watertight connection or splice. CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; All installation of controls, protection devices and wiring should be done by a quali- Pimback Mercury Switches. FMO477; Electrical Alternator. FMO486; Mechanical Alternator, fied licensed electricialt All electrical and safety codes should be followed includ- FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FM0487; and Simplex Control Soot, ing the most recent National Electric Code (NEC) and the Occupational Safely and FM0732. Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO. P.O. BOX 16347 LwkvXo, KY 40296.0347 Manufacturers of... 3200 O `o O Z fLLE~4' O. 1(502) ~ svift ~ ~ T7&2731 • 1(800) 928 PUMP QUAL QTY PUMPS ~~~E /939 0 4sconDepartment of Industry, SOIL AND SITE EVALUATION REPORT Page \ of 3 Human Relations ill-if Safety & Buildings in accord with ILHR 83.05 WI,5, AdM Code COUNTY +but ` Attach complete site plan on paper not less than 81/2 x 11 inches in sizg:~PlQtriust include, "4lo @'` a ch CEL 1. D. # not limited to vertical and horizontal reference point (BM), direction ando o pa~I north arrow, and location and distance to nearest road. OZ - t Q07 - S O - t 00 dimensioned, APPLICANT INFORMATION-PLEASE PRINT ALL INFORIV14iit N IEWEDBY DATE PROPERTY OWNER: PR©PEATY,LowsbN ` ~OV 6 S 1~IUQ ~O}Z~{ RGtr`.1.,~~Y ' "...86b'~-t9 1h¢c..` 4,S T Z9. N,R 16 E(or) PROPERTY OWNER':S MAILING ADDRESS J # , :$L # $ ME OR CSM # t~l • V t1.1 - ST• CITY, STATE ZIP CODE PHONE NUMBER I OWN NEAREST ROAD R% 'a tv--1`5L.U I S LLU Z3 (~tS) X49- 3q0 ~3 15W UV Z30`tb4 'ST. pQ New Construction Use. [DQ Residential / Number of bedrooms Z [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 'SUt3 gpd Recommended design loading rate bed, gpolft2 0 3 trench, gpd/ft2 Absorption area required Z SO bed,112 Z S(3 trench, ft2 Maximum design loading rate o • S bed, gpd/ft2 0.6 trench, gpd/ft2 Recommended infiltration surface elevation(s) _ 1 O q- S ft (as referred to site plan benchmark) r Additional design / site considerations R.ZCu11 m C'*+~ V'► t vkA- w / y "x b3 r Y2~v ~1 • y1 IK3. 1 "OF SAfub R LL Parent material S ids 4`i LARM 'Tt. L l Flood plain elevation, if applicable N t\\ • It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FI HOLDING TANK U = Unsuitable for s stem ❑ S NU ®S ❑ U ❑ S NU ❑ S [~U ❑ S ICU ❑ S WU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ftin. Munsell Qu. Sz. Cont. Cobs' Gr. Sz. Sh. Bed ienc I O - % 1 0%-t1Z z..(Z st ZW,Sbk 1'~t'Fi.. 0"S - o.S o.6 Z l~ - Z sbk to a,s _ o.S o,` 8 3 `t 2 Y1 s l l fi- Ground 3u ~•Sc((Z Sly - s 1 Z'FAyc W,' ( C S - o,S o•6 elev. - Z > • S `t Q S/g v - tot .o ft. 30-3~ S `l V_ ! W ti 2 6lZ S n7 - Depth to limiting factor 3 Remarks: Boring # g y v s t l Z'~ sbk 3 14-1'7 I.S` P_ Sly - s~ ~`~Sbk `FN cs - o.s u.b Ground elevS . ft. L f n-38 S L! R 31 2 5113 LoZ. Depth to limiting factor Z'r " Remarks: CST Name.-Please Print Arthur L. We erer Phone. 715-425-0165 ergerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: ~J CJV_ Z11 Date: vZ _ t C) - 9 y CST Number: M00576 a~ PROPERTY OWNER SOIL DESCRIPTION REPORT Page ~of_ PARCEL I.D.ff C~ Ir-N't- LO(a-) - SD- l00 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bowxiary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 0-8 ti~ytZ z 12. - sil zm Sblz VVLT.- 0, s o,S o-6 3 Z 8 -►.3 y ~z v! s ~ 1 Z`~s bh w. cr.-s - s o . 6 Ground 3 13-3 ~~SyQ 3! _ S~ 2'~Sbk wt`fH C$ o-S b•6 elev. 1 1- S y Q S!~ 304-aft. 7.$-y0 S Li R 3 Jy e 1 61 L S O►'~ 1n~t• Depth to limiting factor Z~ Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # wu ..'w.:'22?fiS Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 3 ' Page of PLOT PLAN _ SCALE 1"= Ll0 ' e-. Loop' oN 6"tiLGN, Sly` t, tfl • Pve M~- w/kjut. L-NTH. I Z $DRM ~ I DFiuC.E a Za ti04 ° - ~D• I ~ C~i DO ~iuT ~-lp~}tT Of~ (n n ~vj J i 0- LW N 8.3 ~ 1.11 3 CA~J111tJ~_ ~1.. 1 ll 5 ~ N Bob, of `RZ~+C!{ a y 3 J w~.L 'Co ~T L~tsT so' ~.~ri r~ovuo. 3 O V (715 ) 42A-0169 M00576 CST Signature Date Signed Telephone No. CST # STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ~p u, q le n S 4 1 t~ h E Y A C2~11 F Y y~ o - MAIELING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. 2uj-f~~ 0-j-'E CITY/STATE Q PROPERTY LOCATION V10 1/4, SW 1/4, Section T_~N-R W TOWN OF axnn ~~p ~i 1 a ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. 1/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 1year exp iration d SIGNED: ' DATE: 2-9 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 54016 11/93 S T C - 100 S 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 1 O 14 c, 4a C~ &Z~ Location of property jVUJ 1/4 S'W 1/4, Section ,TN-R Township BQLun~ Mailing address 1 /~f 3 Address of site/ Z °36 -h S - Subdivision name /Gc / /"v Y C' f Lot no. other homes on property? Yes e' No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable? SC Yes No Is this property being developed for (spec house)? Yes No Volume Rb and Page Number 6 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 t e office of the County Register of Deeds as Document No. 6 p00 , 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. ignat re of Applicant Co-Applicant 1-7 0 Date of Signature Date of Signature S[CbCUaENT NO. WARRANTY DEED TNIa Sp^C[ R[t[RV[O FOR R[CORDINO DATA STATE BAR OF WISCONSIN FORM 9 - iflf 449600 vt; 8n►cc0 REGISTER'S OFFICE sr. MIX Co., vin • Eugene Veenendall and Sandra Veenendali. Reed for Record 1.0...VA UeA...4 ._joint..tenants JUL 121989 at 11:00 AAA w . V conveys and warrants to Od_.. udr-qY..._.... $Wlftow 1010Nl~"° ...........11...-Al-kley.,...husband..and..wif a.... ....joi joint............ ............tenants I • I, St-- -•i'Iioiic ~ _ the following described real estate in .................................................County. - ---i; I State of Wisconsin: Tax Parcel No: i Part of Northwest Quarter of Southwest Quarter (NW% of SW'h) of Section Four (4), Township Twenty-nine North (T29N), Range Sixteen West (R16W) described as follows: Beginning at the i. Southwest (SW) corner of the said Northwest Quarter of the Southwest Quarter (NWT of SA) of Section Four (4); thence North (N) along the West (W) line of said Northwest Quarter of Southwest Quarter (NWh of SWh) 920 feet; thence East (E) at right angles to said West (W) line 490 feet; thence South (S) parallel with said West (W) line 258 feet; thence East (E) at right angles 525 feet; thence North (N) parallel with the said West (W) line 258 feet; thence East (E) at right angles to the East (E) line of Northwest Quarter of the Southwest Quarter (NW'k of SW'h); thence South (S) along said East (E) line to the South (S) line of said Northwest Quarter of the Southwest Quarter (NW'h of SWh); thence West (W) along the South (S) line of the Northwest Quarter of the Southwest Quarter (NWh of SW'h) to the point of beginning. This i--s--n-------ot homestead property. 300 (is not) S Exception to warranties: Easements and restricti•ans of record. Fits Dated this . day of July-------- 19...8.... ii ...............•----•-•---•--•--•--......-•-•--•-•----------•-••---(SEAL)---- ------(SEAL) Eu ene Veenen 1 • --_....•-•-•---(SEAL). EAL; Sandra Veenendall AUTHNNTICATION ACHNOWLEDGMENV Ji? Signature(s) STATE OF WISCONSIN ST CROIX authenticated this ........day of 19 Personally came before me this df ,I.uly 19.8.9.- the above named Eugene..Veefie-ada11---and..S?tndra-------- Vey.nendall-------------------------- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, . authorized by 1 706.06, Wis. State.) to me known to be the person S-........ who executed the foregoing instrument and acknowledge the same. Y THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack .-..'9-~R-L4Y.-...,~/./.~b. /.~rCi('~'•rn!e._ - "Awin, WI 5402 S~ c iPv~ r . County, w~ - Nota. v Public _ '1Qnticated or acknowledged. Both My Commission is permanent. (if not, state_ date: -c G:~ 7 -:rated below their eiRnat-je i AFFIDAVIT FOR EXISTING PARCEL (This language is to be placed on deed) The parcel shown on this document is being added to the p~arcel shown on the document, recorded in Vol. Page gd , Document No. q149600 , St. Croix County Register of Deed's Office to create one parcel, and this transaction is thereby exempt from Chapter 18 of the St. Croix County Land Use Regulations pursuant to Section 18.05(A)(3). This affidavit is to be recorded for the existing parcel being added to: AFFIDAVIT STATE OF WISCONSIN ) ) ss. COUNTY OF ST. CROIX) Your affiant, being duly sworn, states under oath that: 1. He/she is the owner/part owner of a parcel of land located in the 11W ; of the S ) , of Section T-P-1? N-R /6 W, shown on the document recorded in Volume Page q(vO , Document No. OW(oLZ , St. Croix County Register of Deed's office, resulting in a single parcel. 2. The above parcel has had added to it the parcel shown on the document recorded in Volume //,s/~ , Page ~J Document No. D~ Z Z- St. Croix County Register of Deed's office, resulting in a single parcel. 3. The addition is transfer exempt from Chapter 18 of the St. Croix County Land 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. 9 Dated this day of 19< . Y Subscr be nd sworn before me thi ~Aay of t 19 . i e Notary Public County, W'sconsin y commission expires This instrument was drafted by: