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HomeMy WebLinkAbout020-1313-50-000 0. 0 ~ a d M o (D 0. O erj N °o i' a3i I M ~ 3 -y0 O Ci E a~ N I N ~ c 00) co a z c o lL c O N O a I 3 ~ a y rn W z E I ~ v E rn a m CN C14 N F- z o I c C9 v O z C y O tq t- ~ O ' ch N O O 7 C O CL = d 0 O Qw ca ¢ o Q) z in z N C C Z N _ E m co c CL m (0 O d i N T O co O G p n. 4 N E a) y~ O -C Lo 0) d In F- FL LL - N 0 0 0 z ° •N ~aaa u c oN 'rnrn N (n -i V o) a) a) w N ° ~ N ~ ~ - -rte E 3 r O ` - -y) U) Q) co N Q 06 C C O O _O _U) O O R C? 00 _ i W O O 00 3: O O of O Ul N O O A O y O. r M O) ~ O C E E O O N V ❑ O N (0 N N E E_ U LO zx~ O N 2 p N 0 • y',~' 41 cO ~ r G # w E Ca I G) w a vita, a4 r`I►i c~ a m .2 d 4) c r A U a 0 m 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS 2-62 6 SUBDIVISION / CSM#_ ~ff.~Ss~~T fZaN LOT # SECTION 2_2 TN-R_W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM s 6y, l~- I q11 41111 I ~o 0 tC~GE 1 ~.a' Nd wECG AX0 '4w4 we 06, ~ Lo O S,T ,2.0® flt/ INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. *Y BENCHMARK: _I g0 ~7 ~~//Xf i• G.9~ ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: "ICS Liquid Capacity: /,Zee Setback from: Well 1~,e_ House Other- Pump: Manufacturer Model# -Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: l8 Length S d Number of trenches Gs Distance & Direction to nearest prop. line: S- Qrvlale , Setback from: well: /l1~ e Other I i ELEVATIONS Building Sewer ST Inlet. Pf 2 ST outlet 98. PC inlet PC bottom - Pump Off Header/Manifold ~Bottom of system `o d Existing Grade 180.E Final grade /BD D DATE OF INSTALLATION: ,4 l^ PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR/ 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Pbr~jtF,~,yker66 ,RUCTION ❑ City ❑ Village C] Town of: State PI n R&ArD 11JJt~'..LL11~-[i U1YD:1~ 2Xi CST BM Elev.: Insp. BM Elev.: M Description: Parcel Tax No.: /Gd, 00 /G0, e t/ / B a~a, rL QS 1211a, A9500411 TANK INFORMATION ELEVATION DATA a G,C TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic s C Benchmark SSA C0 Dosin Aeration Bldg. Sewer 1~a-(- 5~~. Hold' St/ V Inlet, " TANK SETBACK INFORMATION St/ 1~1 Outlet (o sp' g ~ Verit TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Air Septic a~ -7 NA Dt Bottom iP Dosing NA Headert 7 & g(o,93~ 7.B61' Aeration N Dist. Pipe 7 7 gyp olding Bot. System '57 PUMP/ SIPHON INFORMATION Final Grade Sl7fl Ma Demand Model Number G TDH Li Lriction System F Fie Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / jPJjW Width Length No. Of Tfenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHIN Man urer:~ SETBACK CHAMB INFORMATION Type O . e,,~ n Model Num er. System. OR T DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size I x Hole Spacing_TUeat44, ii Intake Length _ Dia. Length Dia. 4/_ Spacing CO SOIL COVER x Pressure Systems Only xx Mound Or At-Grade System Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) hLOCATION: Hudson.22.29.19W, NW, SE, Lot 5, Ross Road a ~ t~e-L (~~~,~.t/C?Gz'r{'~ e~,~, i►`~'d' 3~GLa'° `Ct'~y`_ ' ~Y2 e~ Plan revision required? M--Y*es ❑ No Use other side for additional information. 1,1-:2 Ofl jig SBD-6710 (R 05/91) Date Inspector's Signature Cert No. w Safety and Buildings Division v~~~r■r,. SANITARY PER WT APPLICATION Bureau of Building Water System: 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 County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application sta a sanitary Permit Number ~s 9~! The information you provide may be used by other government agency programs heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number L APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop y Ow r Na a Property Location ~ti4 ;c- 1/4, S T , N, R E (or Property wner's Mailing r ss Lot Number Block Number umber City, State Zip Cot Phone Number Subdlvisiop Name ( II. TYPE BUILDING: (check one) ❑ State Owned ❑ i r Nearest Road ❑ VII age Public 1 or 2 Family Dwelling - No. of bedrooms- Town of III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo } D 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 P New 2. ❑ Replacement 3. (:1 Replacement of 4- ❑ Reconnection of 5. Repair of an -----System System Tank Only_____-________ Existing System fisting 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 110 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 Required (sq- ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 6~ a ,,O~.tq Feet Feet VII. TANK Ca in gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 41 + ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the site sewage system shown on the attached plans. Plum s Name: (Print) Plumber's Signature: N Stam RA?<AIIPRSW No.: Business Phone Number: d l r P k"f Address (Street, rty, Sk5te Zi od ZZ~ IX. C TY/ EPA TMENTUSE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue issuing g t Signatur Stamps) Surcharge fee) Approved ❑ Owner Given Initial Adverse Determination 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 may be 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. 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 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, 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 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 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 contamination investigations and establishment of standards. C n n I' )1 r o1'I `off' T~ yyrr n 0 ~ I h W o c ~ a fi r 3 m ~r 8 b v I~s Z x IL N Ab ~ NN W O W ~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 LaboY 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 in size. Plan must include, but ° C OIL 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 PROPERTY OWNER: PROPERTY LOCATION / C T 60W.,$ T !vc 7 TD/V GOVT. LOTVa) 1/4 S~ 1/4,S2 2 T .2 ,N,R /,I E (o(o PROPERTY OW .S MAILI ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # ( 2 1:57-1 ffFSAwv ,?u/c) CITY, ATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD New Construction Use Residential / Number of bedrooms y Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 490 gpd Recommended design loading rate bed, gpd/ft2o1P trench, gpd/ft2 Absorption area required eMg bed, ft2 75-C2 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 7 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 OS ❑U ❑S QU 0S ❑U ❑S W1 U ❑S OU ❑S mU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .o Ground elev. ft. Z y 6 Z C S F!t w F Depth to limiting factor 3 y ,9o p G 7 Remarks: Boring # NO 961 Z 6_ Ground elev. %Wt ft. Depth to 3 _ S - 3 ~ ~ D SG /yiL ul limiting factor r 57 - Remarks: CST Name:-Please Print Phone: OC~IZT Address: 1,70 2 j a33 0 Signature: / Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page 2- of 3 F PARCEL I.D. # ' Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Ground elev. ft. z _ 8 , s z c /h r2 S T .2 .3 Depth to limiting factor 3_ YA( Remarks: Boring # 3 z L F )Z s^ 0-4 Ground elev. Depth to limiting factor 9 Remarks: Boring # Ground elev. ft. Depth to 3 - S L 8 limiting factor Remarks: Boring # Ground / elev. "a", 94 'F9.7 ft. ri H c ,c ftc v~ - j~.o !n~ cir Depth to limiting factor Remarks: SBD-8330(8.05/92) 1 v L I O `Y U M d ~ I ^1 1 t's,~ ~ ~!l v Cb 4 a ~~a ~.a u b-Z It Imo- N ~ SANITARY PERMIT APPLICATION BuSafetyreau o oand f f B Builuildiing g Water Sy Division stems 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 County than 8 112 x 11 inches in size- d • See reverse side for instructions for completing this application state sanitary Perm Number vrs9514. The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Prop y Owner Name Property Location /4 1/4, S ZZ T .2.1 , N, R E (o~ Property Owner's Mailing Address Lot Number Block Number City, 5 ate •y~ Zip Code Phone Number Subdivision Name or CSM Number - w II.. TYPE F BUILDING: (check one) [j State Owned E] it~r Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms E] Town OF ARIII. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo , 9. O - 3 .mod 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. 17( New 2. ❑ Replacement 3_ ❑ Replacement of 4, ❑ Reconnection of 5. ❑ Repair of an System________System_____________TankOnly- Exist-------- ---------Existing System ❑ 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 [ZSeepage 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 S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 7 fv*' _3 Feet Feet VI1. TANK Cain gallons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or Holding Tank 2B® f 0 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ~ara - 1- 4' f ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY S ATEMENT I, the undersigned, assume responsibility for installation of t onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signa>w-mSta s) 11A?fMPRSW No.: Business Phone Number: 1 er's Address (Street, City, State, ip Co e): m O O ~-2 IX. COUNTY/ DEPARTMENT U E ONLY ❑ Disapproved San tary Permit Fee (Includes Groundwater ate Issued Issuing Age Si ature (N tam Surcharge Fee) AA"'pproved ❑ Owner Given Initial / (j :0 Adverse Determination O X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBO-6398 (R. 05/94) DISTRIBUTION: Original to Counly, One copy To: Safety 8 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 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: I_ Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II_ Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. 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 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, 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 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 dim-ensions, 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 contamination investigations and establishment of standards. x x V ~ Hal 0 b f o r F ^ Iv) ~L O 1 lk W ~I n ~ i o ron y n V I C CL C 'S `C 1 I~ I~ Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of 3 Labor anO, 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 in size. Plan must include, but • C t 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 PROPERTY OWNER: PROPERTY LOCATION L &,oS-7-_ GOVT. LOT W 1/4 1/4,S 2 T ,N,R E (ol® PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # " Z 4~ i -5 #g.1W'Vr ,rti/V CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OTOWN NEAREST ROAD ~ ~ ~ rcpt yp/ ( )~S/-/~66 h<< 2 New Construction Use [ Residential/ Number of bedrooms Y [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate _2 ed, gpd/ft2 trench, gpd/ft2 Absorption area required jnEf bed, ft2 7,T-c, trench, ft2 Maximum design loading rate • ,Zbed, gpd/ft2 -trench, gpd/ft2 Recommended infiltration surface elevation 7 3 ' Z 6 ft (as referred to site plan benchmark) Additional design / site considerations "CA , ' Parent material S4 ,vD 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 mS ❑U ❑S ❑U ❑S ❑U ❑S OU ❑S 0 ❑S ou SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Ba xtdary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench +v 4ti.'': Ground elev. g2,;_ ft. Z /i z o - 31-3 vC s - . s Depth to limiting factor 6 - S V 6- p ' q, f Remarks: 42- `iO i .rev *3 Gli't 7/ sb6%7" ~F 5#A!Y) _ 2*f5Zf X-s' ~rTLZ.r~~ L / Boring # e /0 X 12- C_ Id S/~, Ay I VF {v Ctii\ ~ is 94'y z T1 o- Y c .1i3/c c s - .2 Ground elev. O rft. Depth to FIZ- '9 cr/ limiting factor 6 a - .8 r Remarks: CST Name:-Please PrintPhone: Address: Signature: D te: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page 'of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 .4•:• Ground elev. pj-- 7- ft. 41 c 2 Depth to limiting factor 3 _ c c S - 1, Remarks: Boring # z 32- o - 3 LS A* L cs - B ~tf.2 3 .4 Ili 12 J? Ground elev. Depth to S L - limiting factor 5.~ Remarks: - dE lCtz'~S Boring # 04 kvi S 9S'31 2- S' o - cS - 1,2- -3 Ground elev. ft. 3 - s- 6 Depth to limiting factor 11-17-JA21 *L - Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) r Ir h ~ q ~ W 4{ y y .g ~ o x _ N w v, N a~ '^r O # ~ N o, It-o V A ' W PA (7, f PUMP CHAMBER CROSS SEC T IOIJ AM0 SPECIFICA'rims VCU7 CAP `"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIAIG 25' FROM DOOR, JUNCTIOU BOX MANHOLE COVER 4r WINDOW OR FRESH 12"MIU. AIR IAITAKE I GRADE I I I `i" MIAJ. ~ 18"14111, CO►JDUIT _ _ 18"MIN. - 11~ JAI LET PROVIDE AIRTIGHT SEAL I A I i I ~ III I I ~ ALARM 6 I II I i *APPROVED ( ou JOINTS WITH ) I ELEV. FT, APPROVED PIPE I 3' ONTO PUMP OFF D SOLID SOIL ~ ~COMCRLETE BLOCK RISER EXIT PERMITTED OJLy IF TANK MANUFACTURI`K HAS SUCH APPROVAL SEPTIC E SPECIFICATIOUS DOSE TAMKS MANUFACTURER: kiLVABER OF DOSES: Z -PER DA!j TAIJK SIZE:_ _Oro GALLOMS DOSE VOLUME ALARM MAULIFACTURER: t- i~ / X~i My. INCLUDING 6ACKFLOW: ZAP GALLONS 4 I5-f / MODEL UUMBER: s.►~ L CAPACITIES: A= -INCHES OR 592 CALLOW SWITCH TYPE.: - _o*gf'Ae441?N B= 2 INCHES OR _ 7 GALLONS PUMP MANUFACTURER: _ ZOEGL~~Z C= / 7 INCHES OR 3i y_ GALLONS MODEL NUMBER: S~3 D=yINCHES OR 7- GALLONS Ef/ SWITCH TYPE: -_~.7 v'eNOTE: PUMP AMID ALARM ARE TO BE MINIMUM DISCHARGE RATE- y0 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF ARID DISTRIBUTIOM PIPE.. FEET + MIUIMUM NETWORK SUPPLY PRESSURE , , , , , , FEET + 9fl FEET OF FORCE MAIN X I ~Yo F,FRICTIOU FACTOR. FEET TOTAL 0y3 JAMIC. HEAD = so FEET INTERMAL DIMEWSIOMS OF TAIJK: LEAIGTH ;WIDTH ;LIQUID DEPTH SIGIJED: LICEMSE NUMBER: DATE: HEAPI ~ W 115 CAPACITY 32110 32 105 95 CURVE 30 10° 28 EFFLUENT 24 MODEL 26 T- 2 I I and Q EL 189 DEWATER/NG = 22 ,\I 20 Z 18 6p } 55 _ Q 16 OD EL 50 0 183 MODEL 0 F- 14 45 188 12 40- 35 10 MODEL 30 137, 138 MODEL 165 8 25 SEWAGE and DEWATER/NG 6 20- MODEL 15 MODEL I 161 4 97 10 w H MODEL W W 2 5 53, 55, F LL W 57,59 r: 0 GALLONS 10 20 30 40 50 60 70 80 90 100 110 24 75 LITERS 0 s0 160 240 320 400 22 FLOW PER MINUTE 70 20 65 18 60_ MODEL Q 295 W_ 55 16 U 50 Q 14 45 MODEL Z 294 } 12 40- - J 35 MODEL H 10 293 0 30 MODEL F' 284 8 25 MODEL 6 20- 282 15 4 OfL<f/~ ,0 MODEL 2 5 267,268 0 3280 Old Millers Lane GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 X130 140 150 160 170 180 190 P.O. Box 16347 Louisville, Kentucky 40216 LITERS 0 80 160 240 320 400 480 560 640 720 (502) 778-2731 - FLOW PER MINUTE STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER r :22tiST MAILING ADDRESS X97,6 M'~7• , C64' 1~9_-'WAC PROPERTY ADDRESS jr /ls ss /t (location of septic system) Please obtain from the Planning Dept. CITY/STATE GtJ_ o PROPERTY LOCATION l/!.y 1/4, 5~E 1/4, Section T~N-R. Zf _W TOWN OF ~4CiA, / ST. CROIX COUNTY, WI SUBDIVISION Rfiz S~IV% LOT NUMBER W=V CERTIFIED SURVEY MAP , VOLUME , PAGE ~ 7~,SEOTNUMBER_ 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 xpiration date. SIGNED: DATE: / l 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 /,eez, ¢ l'~,~~`• Location of property_,,e/a/ 1/4 1/4, Section -51- 0, TAN-R_Z4,9_W Township yP;-CA/ Mailing address ';z o 4; -1 ky „gq, S l Address of site r Subdivision name f✓~/lJ% ~y~ Lot no. Other homes on property? Yes ti No Previous owner of property Total size of property ;~v Qv Total size of parcel x.33 Date parcel was created Are all corners and lot lines identifiable? k--,Yes No Is this property being developed for (spec house) ? Yes _V,-l No Volume 4116 and Page Number ~fLZ 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. S^3,Z fje 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. f'~i X30 A J Signatur o Applicant Co-Applicant l0-iq-'7F- Date of Signature Date of Signature r _ • VOL 1136PAG 607 J DOCUMENT No. " STATE BAR OF WISCONSIN FORM 11-1982 THIS SPACE RESERVED FOR RECORDING OATA LAND CONTRACT s-,. IndIvidu.l ■nd Corporate 'I 53%.930 (TO BE USED FOR ALL TRANSACTIONS WHERE OVER r---lr i•. $25,000 IS FINANCED AND IN OTHER NON-CONSUI4ER~ II i ACT TRANSACTIONS) . ~ „ . ,EDWIN single i~ Fln'a1 ALBERG, a s...... COritract by and between C rson ' !I AUG 2 3 1996 j ..5 .'XW~("Vendorj 3:45 P. Ii whether one or more) and_ DELTA CONSTRUCTION r6MP A_ II Minnesota corporation a 7k7' DELTA COVS'1'F~llt'fYblr ;e.I V"{ j w I' V ii - ("Purchaser's, whether one or more). 71,b•-.._.oi era i?►t Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract by Purchaser, the following property, together with the _ rents, profits, fixtures and other appurtenant interests (all called the "Property"), / ' - in S1=..•-CrQiX.............................. County, State of Wisconsin: RETURN TO &0& `SOl~7~►tLW •Ne 'SRO O J Tax Parcel No i 1:. / 1tey __-..`-~:.,,y,;j~~~-'yN. ~arW"-a9nr Ma.1ee l 'ire ~ K-• . Hof s11y of NM and Part of l~Mi of sift of section 22-29-13'- scrlbed-as follows:-Lots---2; 3, - 4- and- 3- - ofC ortified•"se"ey Hip iied August 16, 1995 In Val. "12", Page 2175 NXCMM Certified i' ey Map in Vol. "7", Page 1817 and EXCEPT Commencing at the 11K tsar of Lot 2 of Certified Survey Map in Vol. "11", Page 2975; r hsace S00°16'35"E 500.0'; thence M89e59116"E 355.01; thence Odle 16 `35.W- 590-: Q•.- to- thee- North tlaw ot--said 3Eot 2; tboxbe } ! 459016"M 355.01 along the North line of ' said Lot 2 to th+k fti t 'Beginning rr~ s 777 This :Js not homestead property. (is) (is not) 606 B Sommer Street North Hudson, Wiscons 40 Purchase a ees rbu ass the Property and to pay to Vendor at 5 - ..._O O0. m the followin the sum of $ g NDecemb at the execution of this ont c and (b) the balance of $ 3Bs000: with no interest X *aL~cYOe>lCXps3tx9M907t1C ' Ore until paid in lump full, sum as follows: payment "53~, of~00 on or before 995. Vendee shall have a thirty day default period with respect to this balloon payment. ' xxxxxR>sari~e>t~tima~¢atK~4if1L7ex]dX~cSOCOt1fiYiStE~@421~1'071~~X~t~Sil~~61[Ab7tiC x~c~ocac-xic~cxxxxx~t~catxxxxx~t~otxx~{~axscX~i3oc xxxx~gg~lgacXpsl~ftT~c~~~cc xxx~acx~s~~~ i 7S1txj~4>!dxxti81X1~iCHisH>~ciFltXYilE~rXil~iiDi ~EXe'~a~c>Na~x~xlxYSSx~c~c~c~sat>i~c 14~ffi~~~ Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required 'insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless oCierwise required by law, xxxxxmaai~ci+~ocx~KilStt~47IYxYiLflEB~fiYys4EYY4BXlit~iidi Any amount may be prepaid without premium or fee upon principal at any time.Ofl~tXXY..XX7SR?Sx?i?tx?°3?t?~5)E ~ciEec~~r~alCa4al~¢x~~~wd#hme!r~armmcad~cxY~iemtamc'~c In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made ar R.-.: specified above; provided that monthly payments shall be continued In the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom. xxxx8ti3i:7iY~~'e1E3R:irx1~~XQsi~#7~ScicX~?fdf:i'~t~~tl~~li$fbcy,Y~a1f W#~~Fi~jxb'nK~#~+ex~.d~: scx~axBaxOe~iX~~~YiaE?~ i'dF~X~ib~Fli~tlWLi~tX Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price Is paid. Purchaser shall be entitled to take possession of the Property on_.date of closing: I~Iglgxx -Cross Out One. LAND CONTRACT - IndlTidual &ad STATE. BAR OF WISCONSIN Wisconsin Letal blank Co. Inc. Corporate FOR N1 No. 11-1982 Idll.r.ukee, Wis. t Vol. JJJ0PA'Z t%; J j + Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keg the improvements on the Property insured against loss or damage occasioned by fire, ex- tended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of ;[?P[..reguirEd/vacant la Nut Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of lcas to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, in.,urarce proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property. to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: UO..FwXCERTIQHrS--_-------------- Purchaser agrees that : ime is of the essence and (a) in the event of a default In the payment of any principal or interest abich continues for a period of ._-_10L.. days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of ...d©... days following written notice i thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this Contract and Purchaser's rights, title and interest in tke Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously ppaaird by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to red,em) ; or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchascr shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (I), (ii) or (iv) above. Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce:any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or ignitable interest in the Property (by assignment of any of Purchaser's rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract. Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives , successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable ecrtsideration joins herein to release homestead rights In the subject Property and agrees to join in the execution of the deed to be made in fulfillment h1eejreof.) Dated t is A?'Q~............. day of .........ly.... 95 F A CON R TION COMPQN~ J . ...............(SEAL) (SEAL) •_-EDWIN C. ALBERG BY: Virgil. Fedorenko • ...............•---......-•----................-----..(SEAL) - (SEAL) • • . Virgil a renka AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN St. Croix as. .................County. authenticated this day of 19--.--- Personally came before me this day of i July 19-95 the above named Edwi1L-C_Aabvx and_Virgil Fedoren o TTTLE: MEMBER STATE BAR OF WISCONSIN ••~w (If not, authorized by § 706.06, Wis. Stats.) to person ...T who executed the foregoi ment and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Barry C. Lundeen . HUDGE~ PORTERS L'UNDEEN' SEGUTN;"S:C:"" o ---11-0--Second- -Stzeat,Hudson.,..W-L-5.4(016....... Notary Public ._____.-.County, Wis. ~ (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: . e'Q 19La....) •Naaws of persona signing in any capacity should be .typed or printer below their signatures. LAND CONTRACT - Individual and Corporate - State Bar of Wisconsin, Ferns No. 11 - 1982