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HomeMy WebLinkAbout020-1311-50-000 Q o ~ ° 0 °u3 M y O 0.' O C. p I O I ~ I a -°o I Ili I I z° c 3 U. c C Q 3 I M N z 1I! O a T p 04 a co N z c I O O z d c N 2 a 2 C O to F- c z E a v M N a) 7 Q N Q Q pea CO .2 < co O as Z co z w N z cq c a m Y O) N a! }~yl C ~1 O N d .Q C O _O ~ co Z • rrv a a a ~a a 7 O O 0) 0 N tq U rn rn } M = N 7 O ftftw N O O C p N m O _ N m d N O O ~ O N C ~ E Oo (o p O N C 0 0 O r' Qj (D E C 0 C a) N N CJ _ Zr" M Oj C L "7 CO • O r 2 N O z y in n m a • ~ o. d '2 a m c I E L C O 7 O L) a 0 v) 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~ ADDRESS zee SUBDIVISION / CSM# LOT SECTION_/~_T ~S N-R_Z_f I, Town of /7'LJ,y'f?>hl ST. CROIX COUNT-Y-, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM T,+,vAt= y L ANA EST DoT ~iIV E of b5 1~9 ?'Pipf-wrl/:/tv r SCALE iy'_ /o S' CW/ ~.NpJSE 1 ?d -I a6 ~x.S~ I ~ V e25~ ~q ~ \ ~ a - - I I ~ yob ~ I I 1 ~ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK : --rep o c 2, pyPT 5, r SLcJ 65W009- E 74 0 0. ew, ALTERNATE BM: oPmF CCWOA7 ?*10 ceT W1111DU7r,_,6bDR_ 44% 6-', ZZ SEPTIC T / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: /UOA C,4Z. Setback from: Well -7.5" House /f other o2F 7,,>- _54J (~pE,~~/fFgjsic Pump: Manufacturer - Model" Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Ye Number of trenches Distance & Direction to nearest prop. line: 7.3 " ro /000# Setback from: well: House (61' n / ' Other 2S ' To S F PT/C TX N ELEVATIONS Building Sewer ST Inlet,/"I"/- sg ST outlet Z4. PC inlet _ PC bottom Pump Off - TN . ag Rtt t -.3 =8?.y(. Header/Manifold Bottom of system (S,yZ = 04,351 Z Existing Grade Final grade r1. S1y DATE OF INSTALLATION:/ PLUMBER ON JOB: l/ LICENSE NUMBER: INSPECTOR: 3/93:jt Wifcons:n Departfnent of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations ST. CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village a Town of: State Pla o.: MILLER, SAM E. X CST BM Elev.: Insp. BM Elev.: __[BM Description: Parcel Tax No.: /oo a /b r ;a€w% TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ' Dosi ng Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet / go- Vent TANK TO P/ L WELL BLDG. AiI to ntake ROAD Dt Inlet irl Septic /1 5- 1 1q * , NA Dt Bottom Dosing NA Header/Man. Aeration NA Dist. Pipe 9 ' Holding 1-71 Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Lricti System TDH Ft Forcemain Le Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r o r I-, DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manua acturer: SETBACK INFORMATION Type O CHAMBER Mode Number: System: '13 / /3C7 1U/4 OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over It Depth Over q,36 xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges 3 Topsoil Yes ❑ ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson.12.29.19W, NW, SW, Lot 32, Tanney Lane Plan revision required? ❑ Yes ENo t~ Use other side for additional information. / ! 6 SBD-6710 (R 05/91) Date I pe r sSignature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ' SANITARY PERMIT APPLICATION v ~ri R . In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a T~ -7 -7 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 14-L- -"14- S / Ti T N, R E (o W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 30 J( 28' 2_ CITY, STATE ZIP CODE 10 PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER JD 50 I rvo 1940 ) Z 741 TA- AINF-Y R I04,E II. TYPE OF BUILDING: (Check one CITY NEAREST ROAIG ) El State Owned ❑ VILLAGE UA S O -MYNOP /-/f /Y'g TOWN OF: N/ CEL TAX NUMBER( 5) ❑ Public ~0 1 or 2 Fam. Dwelling- # of bedrooms 3 PAR III. BUILDING USE: (If building type is public, check all that apply) Z CJ _ .3 SO 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 B if applicable) A) 1. ® New 2. ❑ Replacement 3.E] Replacement of 4. ❑ Reconnection of 5.0 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 M Seepage Bed 21 El 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. ABSQRP. 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) ELEVATION ~f 0 6 413 7 Z O .7 - g5', S Feet $ q,10 Feet 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 strutted Septic Tank or Holdin Tank X /000 WE .515 Ile, F~ F-1 [71 1 El FT 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) /MPRSW No.: Business Phone Number: M I K F, M .Do A/ F LL Pf a f%-j 3e?(- 9 Z- Plumber's Address (Street, City, State, Zip Code): Y(-l 6 EN/!'t I[L L4 NE Hu,ASoN W f 5510/ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing A m Signa No ramps Approved F-1 Owner Given Initial a ,Pb Surcharge Fee) J Adverse Determination 'v X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety a 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. Vll. 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'/z 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 5AM MILLER F1iZST AbDIT►om -TO Tfl""Y RIDgE LoT43Z l`l►LE # Io9O S ~ TEM ,s' S(fA1 z" /RoAlplip.E ~lT ' S W ~ oT Cod ~/E•e c / = /oo. ov ~ ~1-~-~e r~/l ~ ~If~ ,D ~S D.~SQ O 7-A AIIVEY r L f/NE wF-ST Lc3/ L/NE 2SU•o0 13,M•Top of z'~r2or~ ' AT SW LoT CCANE 2 / /od,oo~ V "t VJ LL W I A ' goose ; avX,~bt ' 30zo R-3 1 I ios' o /Co i y0 i ~ 65 f3-4 a1 v U 0 v v 0 v ,--,45T Z o7 t/NE 2.f), 3y ~I/o Srt~E Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page i of 3 y 'Labor and Human Relations Divi;,~ of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/ 1 i e. Plan must include, but ST Ceo f not limited to vertical and horizontal reference (Q f slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and di neagest roa . APPLICANT INFORMATION-PLEASE T A MATT REVIEWED BY DATE PROP RTY OWN R: PERTY LOCATION p Arh 1LLk i~ ao . LOT Nw 1/4SW 1/41S 12 T V N,R E (or) W PROPERTY OWN9':S R41LINWDR ST ~t # BLOCK # SU ME OR CSM # T t~~ Q-4y x Ar 4NntCY -Kih6; CI TAE ZIP CODE CITY V LAGE OWN N EST ROAD / t4 A ~ y ~9` U S dIJ N AMY LkNe ( New Construction Use [(7(] Residential / Number of bedrooms L4AJK [ j Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate 6 bed, gpd/ft2 6 77 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate .bed, gpd/ft2 O$trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations EV)4LUAr)b>J Q0~.1iE goy2 LAI i4 PP kZyAZ, Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tiench {::>4 A a_iz Ids R L m sb Y- c w I o.4 Fs t• f " -Z 71 Ground ~z - ~ayf24 tl r Q7 elev. 93.39 ft. Depth to limiting factor Remarks: Boring # F'i+j `'4.'y.;-G'i`:z A -~3 ~~~+23 t, I >-r, sbx p.,r- ~w 1 04~.s $6 -/i9 MR-4-14 s r D r - 0 1 o.g Ground elev. 90'a ft. Depth to limiting > f~tq(,~ Remarks: CST Name:-Please Print Phone: 4o Address: 1 U)SSO-v Signature LX~ Date: 7 2~ ~S CST Number:+VN i PROPERTY OWNER rnSOIL DESCRIPTION REPORT Page? of PARCEL I.D. # L-V-t 3:2- ~ ~ t ✓ 2 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench :>:<:>::>::>:<n:::>:<:: 2 -4 S~~ jsb /~v ~w 1 O,Z 3 1& 46 7. s'Y~2 4 4 s r 6,7 101 Ground 140/7 y2.4- 4- elev. ,U 98 ft. Depth to limiting ,kctor ~ ~7S Remarks: Boring # A Q-r1 /6A3 / sb~; 1h~r Cw $z IaY~~ s 5 ,r" 02 8 Ground elev. ft. Depth to limiting f ctor Remarks: Boring # 0-1 .'....5>< I K-S9 7,S/P-4/4 ~.J 1 .Z .3 Ground... v2 I! elev. .31 dTft. Depth to limiting factor „ 7 G Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: c,nr1-P~'211~R ncrno~ • ~U $L i L T>~prQ~ m cv r ~ r% r f*~ l 1 8 b I o l ~ I t 2 33 4 Y 8 11! U_J?LA TT ED LANDS lY ?j ssr u°t a rwt "W114 or roc save, sarwu 1s Soos43'04'E 131Uo5..0086' 240. 249.83 03 30000 409.20 = .S ` ~ N ~ ~ ~ O O g^ a T, ~ ~ 1 ~•f NOS 4 o_p Qe _ u _ O u 01 u W p0 1n O ` ° "0 W J^ w p NO N> \ O J. -'1 2 Q W W OJ p. Q ~m Q V o ' wa au r to orn N o N o 0 'A 'A L4 ~o .-4 W o .r. y c 0 t0 M a- N O, w N O M p fn V i N ` O^ i 03 r) b v1 .,1n 0 f ~~433c di\ O P; be. or HUNT ti~ /c~ i ER OC VL 100. l71 N A . t ~•re. O \ tl -IT O N o- N 74 -j z m O N c 1` gym„ O z4\090 Z¢`' : O~ C3 m N OQ O a 0~ / \ CA W _ D co 505.x' 350,46' n r N (3) 3960, 645. i6. ~ 8 - 70 NO6.5<, •42.W ' O 1 v / . .f,'A O Q z94 '0O; o oo$ N /~y ,~r1d.. Syr;, 9,wo 0 1~ y e m -1 - Y~ $ ~~0~, / :-yea. N O i 1o rDi : tiro 235. f• 0~, D \ \Sa 1o N r n , / o u Q o r.. N ® J y. O N w m f 1 N_ 0 cF u a it t• ,p. 0 u ~ o n 9 y\' / Co i p O 'A f" 74 Uw Ll .4 r Ja -IL P 4. 0 500-41' 19'E- 70 94- / s.~t9 d' =NrO 04 ~r O J Oy On W O. --229.27 4L57 C N S00'41'18'E 27084 - T N a 9yjTi ~1 _ N a W 4 a s o N -i~ O m N O m m N r O ~~O D L'J N V O LZ fLV CA) 0 1- 'A _0 0-0 El 0 0 ` 1n n m , W \ OD N N ~W ~L` r N v " l0 (^l Q ~i•p J< c1~ y / 90` M 0 / ~ .nom U 0 ru / 1 ZS Z° ,C 92 622 Zt 04, ,0000b M,90,91LZON 'r~ f rc~ r IV) 1~ IS ~L 1S2 I~ ly iU I-1 t~ Li LCD N O Ir, IT I_ ~ ~ x am amf T 0 90' sir ...4 m1 o 66 0,r Z O v mss' e 7C~~ U O 00 N 4 Z°~ f n, mod. 0 0 A Z p c N r ~ uT -100 (1- ~ TT ,s a W ~s m JJ • 1J 4E \ N W O O Z CO x \o ` vNOO.20o0•E p g g n O IZ> W u -1 , _ . OEOt N a~i a Z - i u, ^ S MOON 1C4 rE0 O N i _ L4 CIO - / _ BF _ ^ L.J N V\ '14f rlj brs u , • Bt g[£ 3QyGZ.90 [Nil Z r -n 6p\ J V N n V r f m N V 'n 'fry 4 D M (A y W m '1 O [11 i rri cA` a 0 `n (0 J u m~ b 1 u4 _4 V N 10 -N03.42'59"E Sp.64' 3.42'S9'E Y u D O ~S a a; ~f F Z ~~O 234.25 26589' \ 9 ' f G O O t / rim 28, N03'429"E N/•E l b- 31.64 N Z 4 a 317.06. 0 M 21" _ Z X IIA Un '~?tl m (A `,ti'L4~ W O C5 c \r' $ N 1 m G rn A n O N00008'09"w 453.12' m EAJT LINE of THE SAV4 Of THE NW114. SECTION 12 T m ~If cn =s~Z [ w r D v i a « ; r ~ ~ c~ 141 r v Z 8 U) N n r O O r ►+Tl Z E[.AINOS 4~IC NEt U[NUD ro r..E tAsr -.[sT Z w .1. LINE Of SECTION II, ♦31..So rO f[N ~V Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page --Lof S Labor and Human Relations Divisiod aNSafety & 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 in size. Plan must include, but 'ST ~Q0 i not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROP RTY OWNER: PROPERTY LOCATION p /Qn1 ~YJ jLZg_R GOVT. LOT NW 1/4S~ 1/4,S II T 7--7 N,R E (or) W PROPERTY OWN ':S MAILINQMDRE # BLOCK # SU ME OR CSM # 7 to i(24 K6AA NNEY 1 dt, l: CITY, TAE ZIP CODE PHONE NUMBER ❑CITY 171VILLAGE IATOWN NEST ROAD Ub50~ l ) 14LA9 I AfJ>u~Y l.iarvl ( New Construction Use [~l Residential / Number of bedrooms U ti1,4 ( J Addition to existing building j J Replacement (J Public or commercial describe Code derived daily flow gpd Recommended design loading rate o , 6 bed, gpd/ft2 7 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 3".7 bed, gpd/ft2_ trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations EVALUAT-)6xj LQ)'JC -0-R PL A-) APP2e-)VA2~ Parent material Flood plain elevation, if applicable ft S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U Unsuitable fors stem ❑ S 13 U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U El S ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bourxi~vy Roots GPD/ft Boring # Horizon in. Munsell Chu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends q 6-11 L. m shy, c W II I©•4 ,S El 'g> "S ZSIP-4- S)L 1 mSbK MY r GW Z 03 11 Ground $Z -12 /ayr24 Q S f n'' j 10,-7 , elev. 93.39 ft. Depth to limiting factor Remarks: Boring # 04, :6 . -13 /L) Q3 L, sbK r Lw Q m Z.w 13 7SYt?4 4 S)c, ~n,sLK J r CW - ,Z O. D 1 o .g $i -//9 b~ O 4 S r ©,r Ground elev. %jZ ft. Depth to limiting >f c Z Remarks: CST Name:-Please Print Phone: 6_ t a Q Q LY ~ NSo~ O Address: . O ` 1 V~~l~l e Date: 7 21 CST Number: Signatur "5~~~ PROPERTYOWNER S4M WhCkt k SOIL DESCRIPTION REPORT Page of PARCEL I.D. # L O-t 32- GPD/ft Boring # Horizon in. Depth MuDominantnsell Color Mottles Texture GrStructu Szreh Consistence Botx~lary Roots Bed Trench au. Sz. Cont Color . . S. sb / cw 1 p, a. 7.4 S~Z /fisb /~v cw r a.Z 3 Ground elev. 12% ft. Depth to limiting Remarks: Boring # ;ti 44 my cw 1 ~~Z 0,3 $z dy.24 5 r v b~7 0,~ Ground elev. )9 ft. Depth to limiting f ctor Remarks: Boring # { w'.N{r{, A 0-16 6Y L /h sbK cw o.~ 0.5 { 7, S-yk 4/4 3 s r 14 Ground l~2 s~ II 16YP24 elev. E Depth to limiting t~C,' 7 G Remarks: Boring # w: "ZZ Ground elev. ft. Depth to limiting factor Remarks: ¢on.ocon/q nclnn, low M m' aF ~ ~ N D I 'b t 1 1 N 8 w b 1 ~ W z • z I ~ ~ j I I ~ 1 ~ I I 1 I .p~ 1 I ~ I b I ~ Z I I I m ~ 1 a rn h I I -o I I I ~ i Q~ z, , I I rn I 1 1 rn I w I O I I I I O` O f;. I I I I I I ~ p I I I ~ ~ ' I I I V/ I . m ~ I I I ~ 4. I m I I n I z I I ~ 2 I ~1 rn 1 z I I I 0 2 1 I I 'v ~i I a► ~ v I I -o I -v I I N W m { z ~ o J cc, I rn z R° X 0 AY N C 0 \ O Y -100 I{ ° Fn -n s < r\ 7C 0 -q -4 v z X -o 0 -u rri ° N N rn ° z N STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER MAILING ADDRESS PROPERTY ADDRESS a D ` ~ Y (location of septic system) Please obtain from the Planning Dept. CITY/STATE .S O X !"4j ( S Sao/(" PROPERTY LOCATION 1/4, s Ze,~ 1/4, Section T 2-% N-R TOWN OF ~UD 50 /y ST. CROIX COUNTY, WI SUBDIVISION 7X Al A/,~47 Y P 10 LOT NUMBER 3 2- CERTIFIED SURVEY MAP 5319 q?-- , VOLUME G, PAGE 3L_, LOT NUMBER 3 Z Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. ~ lk J~~ ICI SIGNED: DATE: O Z~' S St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property -,54411 16l/LL E2 Location of property lVzcl_1/4 SW 1/4, Section / 2 , T 9 N-R Township //vDSON Mailing address Igor ' -2 f 2- 0 /SoN u) r 5-- 00 /4 Address of site /c9570 TA NniE Y L/fib£ f/L~)D So nl u-' i _7W/C. Subdivision name 7",9iv/V,Ey'Lot no. Other homes on property? Yes X No Previous owner of property Total size of property z,&7- AC Total size of parcel z. (o z At Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? X_Yes No Volume /0 31 and Page Number `s 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. Sp $/Y r S , 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. so y~ sr MA S ature f A licant Co-Applicant 9-zo 95-- Date of Signature Date of Signature . y DOCUMENT NO. _TSTATE BA F WISCONSI ORM 1-198! T"I• a+acs ORISCHV[D POOR agco"DI"D 9ATA ARRANTY 0 D 504855 - v" ffliPME 456 f- ' ~._CIS7".,4,S OF1CE This Deed, made between Randall W. Synan_.and_ Patricia E. Synan,..__....___ oc }br Reow>d ___.husband-_•and -wife 1 Grantor, SEf_ it 1993 and ..Sam-t- ...M~...ler,...a single person 10:45 - A.-M ii Grantee. I R-*s~P,lOsed witd~llesseth That the said Grantor, f r a valuable consideration...... t- s,. Rana-all W. Sy. .nan and Patr cia_ E. SYnan CPO conveys to Grantee the following described real estate in ...St • x RAT it" TO - County, State of Wisconsin: z .s 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 NW1/4 except the East 74 feet thereof, all in Section 12; all in Township 29 North, Range 19 West, Torn of Hudson, St. Croix County, Wisconsin. FEB. wj AND r 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 30100"W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point of --eginning; thence continuing S89 30100"W, along said North line, 66.00 feet; thence S00 28103"E, 500.00 feet; thence N8q 30100"E, ~s along the North line of Certified Survey Map filed in Vol. "3", Page 722, 38.08 feet; thence N00 11133"W, 150.00 feet; thence N03 58134"E, 351.07 feet to the point of beginning. This -.------.-i.s..nt2t.... homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And..... Ra.rldall..if!...Synan•and•-P -tr.ic.i.a---E.,_..Synan warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any. and will warrant and defend the same. Dated this 11 day of - Auguust_.... 19..9.3.. GPM T•. el (SEAL) _~GlafilF-ecAi.G~. !hx✓....-• ...................(SEAL) Randall W. Synan a Patricia Synan er.; .--------•--•---•-••---------------•---•----••--••-------------.....(SEAL) --.........................---......(SEAL) a i AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN St. Croix County. l authenticated this day of 19 Pe~wreally cams before me 31........ day of August 19........ the above named Randall W. SYnan, iiiFr-fa' E*'. TITLE: MEMBER STATE BAR OF WISCONSIN Synan y... LaOM41's . (If not, . authorized by 708.06, Wis. State.) to me known to be the person NxCtBR't e i I~ ing instru nt ;and n wleftf Co THIS INSTRUMENT WAS DRAFTED BY / &6, L r Kristina Ogland At'ccsrnep--a-t-- -aW---•-••--------------•------•-- Alice Jo o .rs Croix Notary Public County, Wis. r (Signatures may be authenticated or acknowledged. Both My commission is permanent. f not, state exp. ation are not necessary.) date: 61 1A.. *Name* of persons signing in any caparity should be t pad or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wie-min Leval Blank Co. Inc FORM Na. I - 1le2 !Milwaukee. Wis.