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R~eESE "a'
AS BUILT SANITARY SYSTEM REPORT
lJ.
OWNER ~C~ ~rt~F/1 srcRa.
ADDRESS
SUBDIVISION / CSM# ~v
LOT
45 SECTION T D~ N-R W, Town of ea /j6j;p~'
ST. CROIX COUNTY, WISCONSIN
PLAN VIER
SHOW EVERYTHING WITHIN 00 FEET OF SYSTEM
1
S✓/
i
~,lm- 1bU,p Spike Aiwe rc!
~G► 1~ 1l B i r` ~ ~1 0` j
/a00'p~ h1 ~ 5.x.1
spp7;(~d PIAAP
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: 'S' tl~ t 9d ''d A 4, l ~ Ir ;Pe i1
r ~
ALTERNATE BM:
~YSEPTIC TANK / PUMCfiAMBE/ HOLDING TANK INFORMATION
Manufacturer: 0, ~ Pa~Cas~ Liquid Capacity: 1C9DQ ~7S~Q
r r
Setback from: Well ?16t) 9 House ~Q Other
Pump: Manufacturer ed'G{(C~ Mode1ibf0Y111- Size
r~ J r /L
Float seperation / Gallons/cycle: A~
~r
Alarm Location bD~e
SOIL ABSORPTION SYSTEM
Width: Length /00 Number of trenches
Distance & Direction to nearest prop. line: /
Setback from: well: `House ~'300' Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
i
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: 9 6
PLUMBER ON JOB: J(
LICENSE NUMBER: 30 3
INSPECTOR:
3/93:jt
Department of Industry, PRIVATE SEWAGE SYSTEM County-
d Human Relations INSPECTION REPORT ST. CROIX
and Buildings Division
(ATTACH TO PERMIT) SanitaryPermitNo.:
GENERAL INFORMATION
P ~~l~attler'sLVT ❑ City ❑ Village 1 l Town of: State P aAIR
CST BM~~Eleev.: SS7 Insp. BM Elev.: , BM Description: X Parcel Tax No.:
/'It 6
TANK INFORMATION ELEVATION DATA / Y
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic K616aes~ &,,-r. Benchmark
Dosing 1g°
Aeration Bldg. Sewer
Hol g St/ Inlet ate' 9~ IVY
TANK SETBACK INFORMATION St/jib Outlet ~o.oG 9~ 'Pv
Ventto
TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet
Septic '-/0' a O` .4 NA Dt Bottom 12, ~7* , 73i
Dosing 7/o / >lpv NA Header/Man. 3-d 3 BOO,
Aeration NA Dist. Pipe q, / 7
H Bot. System
PUMP / INFORMATION 10111 Final Grade
1s = ~
Manufacturer ~Q Demand
Model Number 1VfF U 3// L (/3 GPM
TDH Lift LrictionSystem TDH 4 Ft
oss mead
[Forcemain Length Dia. Dist. To Weli,~X'
SOIL ABSORPTION SYSTEM
BED/TRENCH Width I Length No. Of Trenches PI No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS "~S- aw ' i DIMEN
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LE G Ivlanu acture INFORMATION Type O CHAMBER
o er.
System: rn6" 3~0 -30c)' ',3001 OR UNI
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length U7'5 Dia. Spacing - of
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over n Depth Over ~((y, xx Depth Of r xx Seeded/ Sw~ed-- xx Mulched
Bed /Trench Center Bed /Trench Edges 17D0f Topsoil v [Yes ❑ No ❑.-'Kes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) ,r,(t;
LOCATION: Baldwin.5 29.26114, SE, SW, 220th Street
31,
$ J J~
Plan revision required? ❑ Yes dN0
Use other side for additional information. d(J) U
SBD-671(R 05/91) Date f%spector's Signature Cert. No.
r
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
m
Safety and Buildings Division
r.~■~~r■r~ SANITARY PERMIT APPLICATION Bureau of Building Water Systems
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less Cou9
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
c 3 x-13
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION
ocaon /
Property Owner e Propert L ti
e~ V ~'re e /4 YW1/4, S ~ T ~ , N, R / E (or)Q
Property Owner's i In A dress t Lot Number t.-- Block "
~
Cit State Zip Code Phone Number Subdivision Name or CSM Num e
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ city Nearest Road
❑ vil (age lCl W p/v~Q ~ 5ye
❑ Public a- 1 or 2 Family Dwelling - No. of bedrooms Town of
111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ) n ] ~'J
1 ❑ Apartment/ 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 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. I!KNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
-----System System Tank OnlyExisting System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21^WMound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade
/~a Required (sq. ft.) Propo ed (sq. ft.) (Gals/da A ft.) (Min./inch) oo Elevation
no d ?O 9(. 7 Feet 020 Feet
VII. TANK Capacity gallons Total # of r Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank 019 K l« S ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber V ® ❑ ❑ ❑ ❑ ❑
VI11. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sews shown on the attached plans.
Plum is Name: (Print) Plu =re- (No t mps) MP/ Business ~NumbeT
W Y, 0, 9
Plumber's Address (Street, t , tat Zip ode)`
` t9
a v ly- v
IX. COUNTY/ DEPARTMENT USE ONLY
,,r..{~}~,,E] Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Iss rig Agent Signature (No Star
A roved Surcharge Fee)
pp ❑ Owner Given Initial C ~R1
Adverse Determination v' /2 A
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, one copy To: Safety & Buildings Divi.ion, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
_ 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
4
To be complete and accurate this sanitary permit application must include:
e I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to bd installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for ,-,U _,eptic, 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 8 112 x 11 inches must be suhr, fitted to the c,o.:nty. The plans must
include the following: A) piot plan, drawn to scale or vrith complete dimensic,, !ocaticr i c,f holding tank(s), septic
!.Ink(s) o ;tl,er treatment ranks; building sewers, wells; water mains/watt s r stre. i 3 akcs; pump or siphon
tanks; distribution boxes, soil absorption systems; replacement system areas, the loc~_t on c)'-he 'X.iilding served;
!o i~oi i(a~ and vercicai eir.vcUOn reference points; C) COmp!ete S~rCI f,C. L~: ~.'>f purT'r.'5 an( (ontr`o;sl dose volume;
elevation differences; friction loss; purnp performance curve; pump mod e: and F;:mp rno ,ufa_?. aver; D) cross section
i o(thc soil absorption system if required by the county; E) soil test data on a 1 1'Ji ;rm; ar;d } a.! sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated prat ices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
March 27, 1995 2226 Rose S e Q
La Crosse 603 1D
WEGERER SOIL TESTING
421 N MAIN STREET
PO BOX 74 r.
RIVER FALLS WI 54022
`-1 i
t
RE: PLAN S95-40171 FEE RECEIVED: 180.00
GREEN, SCOTT
SE,SW,5,29,16W
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,
era d M. wim
Plan Reviewer
Section of Private Sewage
(608) 785-9348
7880R/ 1
SBDA-7997 (R. 10/94)
,
S95-40171 Page ~ of 6
MOUND SYSTEM
FOR
A y BEDROOM RESIDENCE
LOCATED IN THE SE 1/4 OF THE SW 1/4 OF SECTION S T Z91 N, R 16 W,
TOWN OF $Lpw►N ST • CIZUIX COUNTY, WISCONSIN.
INDEX
PAGE 1'of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN
PAGE 3 of 6 PLAN VIEW--CROSS SECTION.
PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
sc~ TT G RZ E-E N RECEIVED
~1 o t r.~ . L ~S.v ~ s
MAR 2 4 X95
SAFETY i dLDQ3, MV.
PREPARED BY
LJEGEfER SO I L TEST I NG g~o
AND
I7EE3 I (3V4 SE=-:RV I CE ®
6C, ARTPUP,, L.
~ 4V.'csFr.@R . ~ I
R9 Y r,..i s a Y i m 40
F.O. BOX 74 421 K. SAIK ST.
w.
RIVEF FALLS. KI 54022 b " ?r~ "
715-CM-0165
JOB NO- S ` q 7
Vie . 3 & YT310,2
PLOT PLAN Page Z of b
Scale 1"= CIO S95-40171
cuuYovcz fit. a`~.q' ~a
8llT• O F Y~t~ Rkl N
cam. a e 9 ' m
<zipek--) w~o0~
I
I g
I j
0 0 .3 r~ 1 I rj N1
r 1
r
o ~O ill' eur~ P Rt.T ' j 1 u10
h yj OR O1S}vR6 `
, r
! S
~t r
2 ,
ZS,
`waeFZ~Pvc
C
Z s . E v~ tN LN r
IJ
' !
us raav x EL e -
°p !fig OF 'E~ trn~gT-
SE puc Ci
4' 2p`oF
I
M - ~uU, oU` cyJ Sp11~L U Z t~$ou Gt2-~vwb
~►~1 ~f?5T S1~~ OF h\IZCq `~lT i~l2UPUS~
w~L '~0 8E RT LL%'ttST So" FZ0-1 wlUVlvD Li B DRwI
R auk PtT L e~'k S T Z 5' RO W T A >u h S. T2~5
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install permanent markers at end of each lateral. ( Z required)
3. Install 4" observation pipes with approved caps. ( Z required)
4. Septic tank to be ZZAO gallon capacity manufactured by
M\flw~S 1 ICJ ~Z r'~hSl' 1tic, ~ P -Vv~--)k *U BC 1~ I`'~ 1DwC' ~40L1 GVrc. TP►-►r
5. Bench Mark S ~py~
6. Divert surface water around mound to prevent ponding at the uphill side.
~o
Page 10f"
S95'-40171
Approved Synthetic Covering
1~STM C 3~ Distribution Pipe
Medium Sand _
G
Topsoil _-H F aEiev. X18. q
~I -
3 E p
b
% Slope
Force Main Plowed
Trench of k"-2k" From Pump Layer
Aggregate
Undisturbed D 1.O Ft.
Soil E 1.o5 Ft.
Cross Section Of A Mound System Using F 0•8 Ft.
I Trench For The Absorption Area G N.a Ft.
A S Ft. H I- S Ft.
B too Ft.
I \Z Ft. _
Linear Loading Rate= 6-o GPD/LN FT J g Ft.
Design Loading Rate= p.3S GPD/SQ FT
K ~ O Ft.
L \ 2-O Ft.
A Ltw~&a Position of Force W Z S Ft.
L
B K maim
A
I I"
W Distribution Trench Of 2 - 2'2
Pipe Aggregate
Observation Permanent S.f1510-0
Pipes oE
c
. (Anchor securely) D
P
Mound Using I Trench For Abs 4nrea c:
4`l
Page Lq Of b
S95-41"71
Perforated Pipe Detoll
0
End View
Ptrtoroted
End Cop) e~. PVC Pipe
1 . -40,'N aoGIL
G a
Install permanent-marker
at end of each lateral
Holes Located On Bottom,
Are Equally Spaced
Q End Cop
GS S JST0A
% fr
* 4 PVC Force main
ltW ARt ?,F A,10~1s
TRY, - tg~rt.~
Distribution pfr \ttt+~ AMY A
Pipe ~pt~t~t
Lost Hole Should Be
Next To End Cope
Distribution Pipe Layout
P y.1• S Ft.
X 60 Inches
Y 6D Inches
Hole Diameter j1Y Inch
Lateral Inch(es)
Manifold - Inches
Force Main Z Inches
of holes/pipe 10
Invert Elevation of Laterals 4 9•y Ft.
Place lst hole from tee with succeeding holes at 6D' intervals.
Last hole to be next to the end cap.
a
PUMP CHAMBER CROSS SECTIOM AND SPECIFICATIONS ' PAGE S OF 6
S95-401'71
VE WT CAP
- I
-(C.1.. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE
JUNCTIOIJ BOX COVER WITH WARNING LABEL
10' FROM DOOR, 12'MIU.
wiN00W OR FRESH I
AIR WTAKE i
GRADE I Y0 MIN.
LL 4 ~ ~ - ( I18' MIFJ.
COWDUIT
• PROVIDE I -
IMLET AIRTIGHT SEAL I III
v
APPROVED JOIAIT A ;Tank r8nstructiqu shall comply 1 I ( APPROVED JOINTS
with approved withd ILHR 83.20 1 III
I i 1 ALARM
pipe extending
3 feet onto
8 ''d~ r .A 1 I
solid soil. ON
PiELATE❑ta=
-
Both sides of C LpBOEt HUIRAq,I
t~sTY, c ea a5 I
tank. gS.6Z a a I;w Alto
LLEV. fL ;I'waut P
OFF
~ i
D Det4OE
t' IrE C:U~~'`
COAICRETE BLOCK
T* APPRwf 1>
RISER EXIT PERMITTED OWLy IF TAWK MAWUFACTUR{`.K HAS SUCH APPROVAL ISESPEGIFICATIOAIS DOSE MI.~W~S1~1ZN PAZ-S"3.-
TAM!K MANUFACTURER: IJUMBER OF DOSFS: PER DAy
r
TANK SIZE: ~~00 GALLOWS DOSE VOLUME
ALARM MMMUFACTUFLER' S---LZ1~0213 SL/ S INCLUDING 5ACKIFLOW: GALLONS
MODEL NUMBER: 1S 2$k 14 w CAPACITIES: A= INCHES OR y l 6 GALLONS
SWITCH TyPC' 8= Z II,ICHESOK SZ GrLLOL15
PUMP MANUFACTURER: Gov p 5 PS l~C G= IMCHES OR Z GALLOWS
MODEL NUMBER: 3$-2I D= 131 IZ'IMCHES OR 3 S 1 GALLONS
wl ~ZCU\Z~-( MOTE: PUMP AND ALARM ARE TO OED I
SWITCH TYPE:
MIMIMUM DISCHARGE RATE Z3'~fO GPM INSTALLED ON SEPARATE CIRCUITS
13.8 \
VERTICAL DIFFERENCE OETWEEN PUMP OFF AUD..015TRIBUTIOM PIPE..- _ FEET
f MIAIIMUM NETWORK SUPPLY PRESSURE . . . 2.50 FEET
+ ~ZS FEET OF FORCE MAIN X \,\S FY,,, FRICTiOU FACTOR.- FEET
. = TOTAL OyIJAMIC. HEAD FEET
DIAMETER
'WIDTH - iLIQUID DEPTH 3$ r?
IAITERIJAL DIME►JSIOW~ OF TAWK: LEAIbTH ~ ,
BOTTOM AREA - 231= GAL/INCH
AS PER MANUFACTURER = -L 10 GAL/INCH _
` Sub ~'R 6E 6 aF ~
4017.1MODEL: 3871 -
merSible s 9 5 SIZE: 3/4 SOLIDS
Effluent Pump RPM:1550
HP. 0.4
METERS FEET
8-
25
~ 7
6 20
5
Z 15
4
23.4.0
J
H 3 10
5 j
1
i
0 00 10 20 30 40 50 GPM
I 1 I 1 I I
0 2 4 6 8 10 12 M3 /h
CAPACITY
[QGOULDS PUMPS. INC.
se~ca FALLS PEW YM 13148
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 'i of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
• , COUNTY
Pl"r/ f"~ sT• C~.o yY,
Attach complete site plan on paper not less than 8 ft~;4ksize. Plan must include, but
not limited to vertical and horizontal reference PJV , direction and % of slime, scale or PARCEL I.D. #
s
• ~ oc~z,_ lutO-
. , ,yYA
dimensioned, north arrow, and location and distance to nest d 90
) I f REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PRINT A[f,' MAT IN
..y
PROPERTY OWNER: `m kjRT \`i\_ 10 S P TY LOCATION
C3~~ieR S CUTT G\?-L ~ S X1/4 SW 1/4,S S T "Z01 N,R E (wQ
PE OWNE :S MAILING ADDRESS BLOCK I SUBD. NAME OR CSM #
uu\ rU. L~wtS fir
CITY, STATE ZIP CODE S NUMBER CITY []VILLAGE MOWN NEAREST ROAD
W1 Sg0jZ h1 :So3 LDwI" ZZO`i}f ST•
AS, T
F-ftt
New Construction Use [X( Residential / Number of bedrooms LI [ ] AddifiQn to exisfing building
j ] Replacement [ j Public or commercial describe
Code derived daily flow boo gpd Recommended design loading rate - bed, gpolft` o .3S trench, gpd/ft2
Absorption area required Sou bed, ft2 S'~10 trench, ft2 Maximum design loading rate o S bed, gpdfil 0.6 trench, gpd/(t2
Recommended infiltration surface elevation(s) g' a• 9 ' ft (as referred to site plan benchmark)
Additional design / site considerations ML9-jb VJtYJ-4 w/ s' x tou' . M Iti . ! ` of SRAup R LL.
Parent material stcr,~y UlIvM T0 .L Flood plain elevation, if applicable N -P% ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for s stem ❑ S KU ®S ❑ U ❑ S ®U ❑ S ®U ❑ S ®U ❑ S Will
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Bourdary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cortt. Color Gr. Sz. Sh. Bed IP. &
0-9 toy-ttZ 3t 3 sLl Zm S'iK~H ~s - o-s o.6
9-1 - s~ [ Z `F sbh wtv- euv - u,S u. b
wYr Z b to ~Q 11 /211
Ground 3 16-Z9 -).S `m_ V4 - s Zwt sl~lrc o-3 o. 6
elev. ~Z 2.SyfL V/y
q-I•-7 ft. V/ V a f o f s l o~ `~i -
Depth to 3 Cprv nl S L t
limiting
faZol
Remarks:
Boring #
<;:A..vx I 0-9 ~o`uL_ 3(3 - s11 Zw1 s hk m-FH cS _ u•Ss . o_ b
Z`< Z ►6 to~Q siI k mfr ew
3 16-35 ~•s'iR W(. - S 1 W► s bk tin`f y es _ 0.~1 o_s
Ground
elev. s4fZ y!y ~l`F~•S~tRSig !3 pf,,t Lvr'Fj _ -
9t3.1 ft.
Depth to 3 n~S lU7R..6~Z S~ Co
limiting
~3 5 ~r it
Remarks:
TName:-Please Print Arthur L. We erer Phone. 715-425-0165
ergerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Date: CST Number:
X14- 31'7 tiZ-la-qy M00576
i
PROPERTYOVVi`M SOIL DESCRIPTION REPORT Page? of 3
PARCEL I.D. # Oz~2 _ 10M - 40
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxia~y Roots Bed TM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend
o_ 10yR 313 - S~ 1 Zw, SUk vv~`Fh cS o.S 0.6
V1 St ` 2 ~'Sbh ~n`~►~ cw p.
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SBD-8330(8.05/92)
PLOT PLAN Page 3 of 3
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(715 ) 425-0165 1400576
CST Signature Date Signed Telephone No. CST #
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNERIBUYEa C a I ~r ~z~
MAELING ADDRESS ellD
PROPERTY ADDRESS '1~ / ~~Q ► 07
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE LV j 6~ ~'LJ
PROPERTY LOCATION 1/4, S 1/4, Section , T ( N-R A~) w
TOWN OF & 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.
Me, 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. Croy
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE: -
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, AV'I 54016 I I~~
•
S T C - 100
. This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/ contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property. _ S co CrerI2
Location of pro erty 1/4 ,S,~J1/4, Section c , T_0 9 N-R__ZL_W
Township it PA Mailing address
~ e 1..~ i /Pi's L ✓~~l
Address of site
Subdivision name" Lot no.
Other homes on property? Yes o
Previous owner of property ;C IA U`l ( TU16 4&OS
Total size of property _ ~Xl[) ~rCU ~°S
Total size of parcel
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes No
Volume/- b and Page Number as recorded with the Register
of Deeds / 0
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 qq fice 4 the County Register of
Deeds as Document No. - = 1` '"5-9V,6rNd that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signature of Applicant Co-Applicant
gc5
Date of Sig ature Date of Signature
_ x•
f ' 4, L + 524G92 VOL 1107PA SE
a I DOCUMENT NO. s SR~t:E RESEnY[D ROR REGnRD «O DATA
~i ;1 ~ WARRANTY DEED '
STATE BAR OF WISCONSIN FORK 2-1982 T.. -
-261- REGISTER S OFFICE
Kurt Almos and Eleanor I. Almos, husband and wife, ST. CROIX CO., Wt
. Reed 1br Reoord i '
ii
_ _ . .
.DEC 2 9 1994
i30 A. M jl
conveys and warrants to Scott-Green,...a ....n a person, (I et
.
a Dads
_ ta.Dstr
_
RETURN TO
)Cn8-0 - -wml
St ix DaB 11,6 Jej4e ll-k {IV
' the following described real estate in ....r ....CQ ........................County,
State of Wisconsin:
Tax Parcel No:
I
i
S 1/2 of SW 1/4 of Section 5 and NW 1/4 of NW 1/4 of Section 8, all in 29-16
EXCEPT commencing 2 rods East of the NW corner of SW 1/4 of SW 1/4 of Section
5-29-16; thence South 16 rods; thence East 10 rods; thence North 16 rods; thence i~
West 10 rods to point of beginning and EXCEPT commencing at the SW corner of
said Section 5; thence North 981.64 feet; thence East 33.0 feet to point of
beginning; thence East 347.0 feet; thence South 392.00 feet; thence East 144.0 feet;
thence South 309.0 feet; thence West 491.0 feet; thence North 701.0 feet to point
of beginning.
And EXCEPT Certified Survey Map filed September 30, 1992, in Certified Survey Maps
41 Vol. 9, Page 2545, as Doc. No. 489272. TRANSFER j
(The purpose for re-recording this Warranty Deed is to EED
correct the legal description.)
I
This 13 not-__..._ homestead property.
XWOMOM
Exception to warranties: Easements, restrictions and rights-of-way of record,
if any.
=~I
Dated this C ..Sa day of December 94
REGISTER'S OFFICE
L' I
r - SL.CROIX CO., Wl....... I £ (SEAL) (SEAL)
r Reed for Record h
a Kurt Almos
FE B 2 1 1995
SEAL) (SEAI.p
2:30 P.M Eleanor I. Almos
Reptaber of Deeds
TION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
St. Croix ss.
.County.
authenticated this ........day ot 19....Personally came before me this .._a~ ...day of
DeQetub-c 1994.... the above named
Kurt Almos and Eleanor I. Almoss
---.husband and wife,-.........................................
TITLE: MEMBER STATE BAR OF WISCONSIN
R (If not.
persons authorized by § 706.06. Wis. Stats.)
f to me known to be the who executed the
r
D'QfpgcjAg ftr"t and acknowledge the same.
I1C tY~ i
Y THIS INSTRUMENT WAS DRAFTED BY ublic ,I
Kr_ia nd- Oglnnd----------------------------------• State Of }n~
W -
E111titOlCley at._ W. Tr
Notary Public - ...County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent.(If not, state expiration
are not necessary.) B `
date: - - - rl' 8-- • 1997.....)
Y •Narnes of persons signing in any capacity should be typed or nrinttd hcloar their -signatures.
:I
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leoal Blank Co.. Inc.
FORM No. 2 - Ivs2 td.lwaukee, ~N:sconSm