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HomeMy WebLinkAbout020-1304-60-000 Q ° ° c ~ I tr p a ° a 0. 0 C -a rN 9) c° N w 3 N> n O a~ lr'V L OY LO O N N 5 C'' I'.. N L O ' X C O L N W O C O O 01 C -O S d Y D C co N (~c0 ao) CL m U T O C U O C -.0.0 a> O Lo .O. O) c y O N -0 M 5 .5 Q) 7 O Q 3 o . Z 0-2 c ~ 'a C 0) 3 (tl N O c Q U. c 75 0. N 0'a U 0) M N CO co U .O N f6 Q n N c 3 = o 3 ~ z rn w E z 4.; o z m ~~U) am c o o z dt m Z v ° c o m H r m N Z C hh a ° M N co co N ca. N • Wawl d L 0 Q o N Q O 0 m z co z o U Z a~ m E Y N N _ *Its W (1) m - m g U') LO N •GI i O c O O O C LO O C a -O O ( N N c _ Ico rn ~ Fes- ~ IN- ~ ~ 0 0 hi c ° 0 0 ~i O O O O z •rv 0 CL CL CL IL L LO LO N o N ° 7 01 Oi } to J V 0 O O _ LO N O S O O O > M LO N N O O E C3) h N m~ d ~ CO N N a~ 76 ~w Q ~j p o p rn N c O 7 c O o ao It co cl, o- 3 N 0 n 0) °O °O \ ° N N V ~ ~ aj ~ O C E CL E O c fn M C ° w M 7 (5 (Y) C ty~' H C N -ONp ~ CD c L ) y N 7 N CT tt1 O E U ~~~111111 i„n O 2 N O N Z -J Cn l"~ R I i E N CA # Q II d a. 7 • C3 O. W .V d y C C c°) a 03 in U STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SA M 4414,44F.' ADDRESS- 10(,el /1/IV yh y S D R /VE 1) D Al u~ 'rVe iy SUBDIVISION / CSMf 7,41VIpf /2/f _F LOT V SECTION TAN-R / I Town of .f/c !y f6,y ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I Lol 9 :),Sc) N~. DQiY~WAy I - ~ r WELL --i A H o') SE a.$ z So' ~y8 o n ix 3 _ moo, -7:1{ 40 ALTEF NA-r- AREA i 13M Tod' of r "PIKE 1- lam' °p INDICATE NOR`1'H ARROW J Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole coves c ~ BENCHMARK: TOP of 1PE AT -~jv. (-oeAl-r/E)• _ p~7 = 16) U ALTERNATE BM: Tai of //adfE 1470uN17A1-1oJY ,E i ^ 1 = (6 S S EPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: / 2- Setback from: Well 41<5 House !o Other Pump: Manufacturer - Model# Size Float seperation,_-- Gallons/cycle:- - Alarm Location SOIL ABSORPTION SYSTEM Width: $ Length Number o f trenches Distance & Direction to nearest prop. line: (moo To SovlH LaT Z/i►'E Setback from: well: (as" House 3 (o Other 'Id TO waS"C Lo7 L/wc= ELEVATIONS _ q1,11 Building Sewer _ ST Inlet. ~S ST outlet mo PC inlet - PC bottom Pump Off Fg i0,19 Header/Manifold RN Il,oy,9111 Bottom of system I 1, 0 c/4 7d Existing Grade `7•~0~~ Final grade-2,65- 01, 10 DATE OF INSTALLATION: yJ~ PLUMBER ON JOB: LICENSE NUMBER: ARRS-63s-00 INSPECTOR: 3/93:jt rvisconern Department of industry, PRIVATE SEWAGE SYSTEM County: : L h00, and Human Relations Safety and Buildings TDivision INSPECTION REPORT S`' • C'ROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City Village ❑ Town o : State Pla 3 MILLER, SAM X CST BM Elev.: Insp. BM Elev.: BM Description: ~t Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ojj e5/ LorlC , p~~ Benchmark V76 1,6, a Dosing , ~Yyt Aeration Bldg. Sewer Ing St/Inlet EF_ TANK SETBACK INFORMATION St/,~K outlet Verit TANK TO P/ L WELL BLDG. Airito ntake ROAD Dt Inlet Ar Septic DSO y NA Dt Bottom Dosin NA Headers Aeration Dist. Pipe J/ dSL Holdi Bot. System PUMP/ SIPHON INFORMATION Final Grade 79a~ D/, fib' Manu r mand ~ S,/G 0 Model Numb*ength PM TDH Lift System TDH Ft Forcemain Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH width , Length i No. Of Tr riches T No. Of Pits :nu e Dia. Liquid Depth DIMENSIONS -v DIM facturer. SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION Type Of `e~, r / I Mo e System: ecp 6C8 ~v 19 OR UNIT DISTRIBUTION SYSTEM Header 1rAAa r4vlld Distribution Piip/e(-s7) Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Y / Dia _~L Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of Fxx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION; Hudson-11.29.19W, SE, NE, Lot9i Mound Tve, Plan revision required? ❑ Yes 0"N'o / Use other side for additional information. 15J/7 SBD-6710(R 05/91) Date Inspector 'sSignature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i i i I SANITARY PERMIT APPLICATION COUNTY v'~■_nn In accord with ILHR 83.05, Wis. Adm. Code C/ Ca . STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than t4 C~v O 2 a3 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 S S T J$, N, R f E( PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # X 7- if, a-- 9 ' CITY, ~A O V ZIPCODE / P NENU?BER~ SUBDIVISION ~ NAME CS NUMB # Li k II. TYPE OF BUILDING: (Check one) 7 CI / NEAREST ROAD El State Owned ❑ VILLAGE I DS Y "0 D S D ~ (~+E ❑ Public j 1 or 2 Fam. Dwelling- #,of bedrooms PARCEL TAX NUMBER(5) III. BUILDING USE: (If building type is public, check T11 that apply) Lo /_3 O4l 1 ❑ 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 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line Bit 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 30 ❑ 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 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (s q. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION d g rg ~00 7 9 7 04eet /0400 Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks Concrete structed glass App. Tanks Tanks ZSO W F1 F] F1 I El F-1 -4-+ Septic Tank or Holding Tank e/ -,C/Z- 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): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: All /~IP,e s - ©3 s~io 38~ 869E- /x P ld Al _ ~z~L lumber's Address (Street, City, State, Zip Code): #/P -ufN 14li-4- LAA/A!57 ,01 wi SY01 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater [Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Approved El Owner Given Initial Advers Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: 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 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. ll. 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 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 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) • • r.______ ~o~NOS vnwc WEJf CDT` (/NE 26 n t7 D 3 i- Vi TT, Q ~ r O p Sion \ _ p! - - fry D c~ ( 7%* 'yam kA I~ 00 m 'n , r 2 r-O v t , ~ 1`t 0 g b ~ rt m n 2 a rn kj- ° $ 4 3 ~ G BAST for e /#,e rt l3d' tCi► Q O O II µ O I I I I I I y I I 1 I 'n 01 I I .p I ~ Z 1 I ' I "o 'O i o h I m 0 I I O ~ ~ ~ I z I I I I m 1 1 I m I , • I ~ I I I 1 I I I 1n I w rn rn w I O I I I •'~p I r- I I I 1 a; I I ( r r (f ~ 1 O 1 I 1 ~ ~y t~ I I 1 I I 1 I ~~Q I I I e7 I ~ ~ . O 1 z i i m i t pr LA I Z .~n I I I 02 1 I I `v C. I _ • -d I I I ~ I I l Z - m cn s u m ~ V m p m N Ilk N O~ ~ ' a rl 9-l' 0 -*j -n < c> o N ~'s Z rr7 4 ^wE~ Safety and Buildings Division v~■a.r■r. SANITARY PERMIT APPLICATION Bureau Building Water Systems 201 E. Wa ashington 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 Co than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sa itary Permit Number ~83a3 The information you provide may be used by other government agency programs ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Property Owner Name Property Location S/ A-N M ~L L- E2 SE 114 1/4. S// T 0'7 , N, R 19 E ( W Property Owner's Mailing Address Lot Number Block Number O ?-.y 2- 17 City, State Zip Code Phone Number Subdivision Name or CSM Number DSo S o/ ( Z'7G 7 N/VEY RIDGe II. TYPE F BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road E] ❑ age Public 1 or 2 Family Dwelling - No. of bedrooms 3 Town of S D R~VF J V O III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 Zc - 130 y HOC 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..X 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 Number 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 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc- Rate 6. System Elev. 7. Final Grade 7 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 7 (p g -72,40 d, Feet /0 Feet VII. TANK Capacity Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank oo 5 P, ❑ ❑ ❑ ❑ ❑ -1 1 Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans- Plumber's Name: (Print) Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: K~ -1- o ELL 1ijP/?S- 3-5-0 0 3g6-84092 Plumber's Address (Street, City, State, Zip Code): 4*1 Re M GL I -ANA va soN UJI S-D/ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue Issuing Ag t Sig ture (No amps Surcharge Fee) Approved ❑ Owner Given Initial` Adverse Determination V X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit 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. 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. IL 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 lime 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 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, rump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of !,oldinq tank(s), septic tank(:) o .>th ~r treatment tanks; building sewers; wells; water mains/water, ser, ce; stre ~r s ~:1 lakes; puma or siphon tanks, disc i'bution boxes, soil absorption systems; replacement system areas, v J the loc,~l[or ( f the building served; 3) horizontal and vertical elevaJon reference points; Q complete specification, fo- pumps anc ront-ols; dose volume; elevation di fferences, friction loss; pump performance curve; pump model and I::ump manufac firer, D) cross section of the soil absorption system if required by the county; soil test data on a 1 15 form; arid F) .,I sizirg information- - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practicer, which can effect groundwater The monies collected, through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. f t Q ~ h N~ ` Q \ W o J l 2 v in p N ? ~ ~ u.~ W ~ o 0 M ' I- ul ~ W In ~ a ~ i , o ~ ~ 0 '44 v U o W d' 9 9 W ~ Q i!1 r?~ h72 .a~°3~/l~jll~rY/ U~ NP w F ad, L.Lf =3 CL 0 I 0.. w p Y O _ ~ZY LLJ P- > x rn m _ T-O l R* 0 X o~ LLI tM no Z 1 M 1 w `qt I O n. V ~ I z I I Ma i ik CL MC 1 a U w F I I I (S. Q tit j n- j j z u.r I ee} ~ I I I J a~ Lij 0~ I I I ~ ~ I ~ 4 nl O I Q~( I I I a I j I I 1 Ld x v M io ZD i~ V I w I 4 I rL a y I I I O m v~ I ~ I I F > I 1 tw: \ ~ I 1 I f/1 ~ 3 I C9 V I a~ I I Z I I I $f I ~ ~ I I I > ems, I OZ ~l I I I ~ L z 4 kit Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches ' ust include, but Cko iX not limited to vertical and horizontal reference point (BM), dire o ah o f e ale or PARCEL I.D. # dimensioned, north arrow, and location and distance to no APPLICANT INFORMATION-PLEASE PRINT AL j~ RM~ / REVIEWED BY DATE lirn PROPERTY OWNER: PER W TION 7 N,R E (or) W ~>4 f~h I r] 1 LL C 1Z CaOTrl.A ,~LOT 1/4 /j~ 1/4,S 11 T 1Q ti PROPERTY OWNER':S MAILING ADDRESS L # SUBD. NAME OR CSM Q A , CITY, STATE ZIP CODE PHONE Nr-, R, Pt, C LAGS OWN NEAREST ROAD 14U ~ -rA iij pi ZY, LA wr [iQ New Construction Use [bQ Residential / Number of bedrooms K [ J Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations V ALts A: /Q)'> tjr,N~ PQ )tT ~Ct i0PP'6 Vi4 L Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MO ND IN-GROUND PRESSURE T-GRADE SY TEM IN FILL HOLDING TANK U= Unsuitable fors stem S❑ U W S ❑ U Qrs [I U S❑ U S❑ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourtclaly Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch A ®--I6 /b44 3 I S K Al ,r C 1-J h « 0.4 025- I/o-To /oYie, 4 3 SC ~bV- w Z-~ 0.4 a Ground -l Z/ /UY 4 7 0 elev. 9` •a j ft. Depth to limiting factor Remarks: Boring # 131 16VR4~:~ ic ri sk C- LA) o,-z:,o,3 LIE*` Ground g~ 2~ ft. Depth to limiting factor Remarks: CST Name:-Please Print Phone: F 6 - 400 Address: fa 6dx 9 ok's6pi L'A S r 6 Signature: Date: I CST Number:~~ PROPERTYOWNER S)"'h M)LL0Z SOIL DESCRIPTION REPORT Page? of PAMEL I.D. JLo-r 1 `TmNV&.Y gtlsC;t Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bound ry Bed Trench 3 k $ 1 lq-53 16YR4 14 S ~ C. 1 /h 5WK r, ~i C S 1 ~ 0,2- 3 cio 1 Ground qVift. Depth to limiting factor > ID.ZS Remarks: Boring # _ ftifr C w p 4 fl 67 b% Ground elev. / QI,S"5ft. Depth to limiting ~ factor Remarks: Boring # - i 3-Z~ fib'/r24 - 5 x r= s6K ~'h c r~ a z d :3 Ground elev. 7- f2 0* 4 3 - S Yt, 7 CS 97-k0-ft- Depth to limiting factor y L Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) r7l ~ ~ o x ..p t ib 0` o(~c~ N u T a.. N 1 V _ v -0 i l QbU J ` ~s N ( t O !p-1J I 1 all &Z pe l ~ p~ g~f ~ 1 1 d C7 ' . N 77 ` Bill n I fill 1-17 ~ N a v ~S 1 s~W a j g ~ J ~ S wwi ~ e beset°s •s8$ aIo I I ~rrp j' , n I I e A •v~ M ~ ~ - i -I- i- a r\ ~ N Fs ~ y G 1 >s y= J ~ W 3! ~I W 0 F O s ~ a ;1 = y,~F~ % In r mac., O p d R J Z V I_I yi 0p1111 NI Q Q F - t\ ~JI cil TI ~i k / Q(~~~ ~ . y C 6`l yl / NI ~ CJ oz Arm min to w ~ F , uvt % al Q CD, a w ^ 1 /b / / ~I 61 # ~ srtn n w ♦A U. 3 YO YY YOS V•O p /1 w' 21 N rl r 1 r O'- 1 O Z it (D - ~ IYNI y~ - ~ \ Q-HLIIOS OVOL- Q f1OWT- Y \ ` \ # \ ZP Ot, off` tib~, _I :z G Z? p ILL e In g JO=;G k ~"t \ \ ■ •01191•'Mi1 >1LL O Mla !IL A M•1 lW 031Sd1dHf1 Y y A C E e ~ ag•:d s ~ W • • ::i.Y4N•~ e 1(11Qn3 iiaa2 ~M esa3.w.e .•{{•i~,i [{si aoo~-uii m1olRlr 11 • wM ~ o.~i" ~ f su oa oalala anR Hpp • i • • w o.~ s a i STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNEWBUYER 5 A /M /VI LL IF(L MAILING ADDRESS BO)( 2S/ L H V a.S o N w I S' 510 "C PROPERTY ADDRESS to ~9 M0L)N D 5 Q (Z ~ y F (location of septic system) Please obtain from the Planning Dept. CITY/STATE HL) A S O /V w i Syo I b PROPERTY LOCATION 5 1/4, N E 1/4, Section "1'_? TOWN OF HU 17 50 N ST. CROIX COUNTY, WI SUBDIVISION I-,q YN y ~Jl~ly LOT NUMBER CERTIFIEDSURVEY MAPS ZS S~, VOLUME (el , 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 year expiration date d SIGNED: DATE: a - aoS St. Croix County Zoning Office Government Center 1101 Carmichael lZoad Hudson, AVI 54016 1 193 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 SAM M ILLF-4 Location of property SE 1/41/4, Section T Zy7 N-R / W Township 1jyUSo1V Mailing address 13oX-* ZX Z-- AUDSoM I,JL Syo/6 Address of site /0&9 MOuN D S D A I VF #&)0 SoN r -u( 5-3;1014 Subdivision name -T-AN AI `lam R/D6E Lot no. 9 Other homes on property? -Yes No Previous owner of property RAND A I-L S YNA N Total size of property 2_so AC, Total size of parcel _ 2•so 4C Date parcel was created 1- 9-? Are all corners and lot lines identifiable? Y Yes No Is this property being developed for (spec house)? X Yes No Volume /031 and Page Number SC as recorded with the Register of Deeds. I 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. :S-0 el8 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. S-0 5/8 sr < 0 U~' Signature of Applicant Co-Applicant Date of Signature Date of Signature DOCUMENT NO. STATE BA F WISCONSI ORM 1-1983 *NU avac[ R[a[RV[D FOR RIECOODING DATA ARRANTY D D 504855 rot 1031►AGE 4% - - n_CJST"4'S OffiCE: Y This Deed, made between I . X CO.. ty9 Randall-_ W. -Synan and- Patricia. E. Synan,,~.' 1brReukd _ husband and wife - - _ .---------,..Grantor. SAP i1 1993 kn. d ....Sam E' _i_er, a sang..... person...... - - at 10:4 p ~A m 1 lc"~ Grantee, I Desdn t Witliesseth, That the said Grantor, f r a valuable consideration...... l_ Randall W. Synan and Patr~cia E. Synan _ NATURN TO conveys to Grantee the following described real estate in St . CroiX . County, State of Wisconsin: - - - - L r The SE1/4 of NE1/4 of Section 11; the SW1/4 of NW1/4, the N1/2 of SW1/4, and the South 53 rods (874.5 feet) of the SE1/4 of k. NW1/4 except the East 74 feet thereof, all in Section 12; all in Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin. FF,E _ Al AND C l ~~W got A parcel of land located in part of the NE1/4 of SE1/4 of Section 11, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin further described as follows: Commencing at the E1/4 corner of said Section 11; thence S89 3010011W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point of _.eginning; thence continuing S89 3010011W, along said North line, 66.00 feet; thence SOO 28103"E, 500.00 feet; thence N89 30100"E, along the North line of Certified Survey Map filed in Vol. "3", Page 722, 38.08 feet; thence N00 1113311W, 150.00 feet; thence N03 58134"E, 351.07 feet to the point of beginning. I' This A_.AQ.t---- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; warrants that at the title is good, , indefeasible in fee ample and free and clear of encumbrances except And..... hetdal~.. W- Synan.................. and ftrichtsEofSwaanof record, if any. easements, restrictions and g y and will warrant and defend the same. Dated this day of August..................................... 19..9.1. t GvYld'~ LtJ, G?L!!'~ (SEAL) .lG'IQ~tF.~! ~.G~.~ 4112✓....---------------------- -(SEAL) • Randall W. Synan Patricia Synan - 6 a (SEAL) (SEAL) i ~ . AUTHENTICATION ACHNOWLBDOMBNT = Signature (a) STATE OF WISCONSIN lv i a& S_ t . Croix Coon 'i y tY authenticated this day of--------------------------- 19 Pe ashy came before me day of August 19. . the above named Randall W. Synan, Patricia E. TITLE: MEMBER STATE BAR OF WISCONSIN Synan A (If not, C,Y authorized by 708.06, Wis. States) to me known to be the person . V N4MY 949 e " I~ going instru nt and a n w1e&dit-* &COARII THIS INSTRUMENT WAS DRAFTED BY 1 r Rristina Ogland Alice Joy o ors At Forney a t..i;a`r - Notary Public • County, Wis. ryl (Signatures may be authenticated or acknowledged. Both My Commission is permanent. f not, state exp' ation are not necessary.) date: 1Q.) •Name of persons signing in any capacity should be typed or printed below their signature. - - - - - WARRANTY DRED STATE BAR OF WISCONSIN Wi--in Deal Blank Co. Ine. FORM Ne. 1- 1982 Milwaukee. Wis.