Loading...
HomeMy WebLinkAbout020-1267-40-000 Q o -0 ° I O °603 a m I 4 c o ~ I I o I © N O ) q I V X C; m I Q 0 N a z O C _ N 1i c o_ w' m I 4 0 I I 3 Cl) m I z E rn °o I L z N~aii'' am c I 0 c C7 o z a c avi z d ° o (n F- o z c m p "W (D a o N ) N ~ • m ~ c a AJ c c O ~ o Q Z F- Z - N z 'o d ~ I N 7i E _ _ 16 d d QJ ° C b o L cr, 'O C N N i O D 'C N 0 (L N 7 r 'C U) (n U) a E U r (n 7 T- F F- F- d( P w o 0 0 0 z o • m 0 CL IL CL m a o N II! = rn rn rn am } 0 ~V ~2 c o 1 o rn o o N °m m N n f6 ~ N O N ~j O Q N C 1V '~'d O E V C co 00 O ca V N Ct o o ° c _c d rn °o 3" I~ ~ U) N N Y N w O C N N a) c) r C 3 O N t t« ctl • O O O O O N= z N 0 N H U) 4i E 0. ~a • a m a ° •1V E v c c w; c rr~~ L ~1 A 0CT2 Oin0 II STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER '~C-p ADDRESS 90F,rri SUBDIVISION / CSM9- / 7 LOT , SECTION ~y T 2/ N-R W Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 9JtW46A 1 1 _ to , ~ I o _7 z ~3 0- - - v 1,5 i 7'la ~~EGc: 7(0 ~W B Cf./ ~t.. c T ~o z.u IND I TE NOR H hRRO~.' 7 ri 7-2 T -3 f e9 Provide setback and elevation information on reverse of this foam Provide 2 dimensions to center of septic tank manhole cover. 1 / % r r BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: C{/~ is C,?, Liquid Capacity: /0~7-fl Setback from: Well 7(,- House a Other Pump: Manufacturer A//# Modelt Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM ~ I Width: r> Length 76 Number of trenches 3 Distance & Direction to nearest prop. line: Setback from: well: 1162" House K `1 Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existi.nq Grade Final grade DATE OF INSTALLATION: 16- //-9S PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93: )t Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Perq~ Dft' Natry~;.,j,, F] City E] Village Town of: State Plan o.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: D0.r TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ' D$ 8 /00. 11 Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet ,/,75' is 4.19 TANK SETBACK INFORMATION St/ Ht Outlet N 9a' ~a 3.4 ' TANK TO P / L WELL BLDG. Airi to ntake ROAD Dt Inlet Ar I Septic ~:::501 96 r 7 y NA Dt Bottom .5". 9 s~ • lv S Dosing NA Header/Man.-a9' Aeration NA Dist. Pipe G.so /..23,; Holding Bot. System 7.yy~ 1/ 7', 93 PUMP/ SIPHON INFORMATION Final Grade y 3s. w, 3 Manufacturer Demand Model Number GPM TDH Lift Friction Syestem TDH Ft oss Forcemain Lengt Dia. HH Dist. To well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No f Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of Model Number: System: 4412~ '79' CHAMBER (o >100 ,01A 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 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center O~ Bed /Trench Edges c,7- 30 Topsoil ❑ Yes E] No ❑ Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON,24.29.19W, SW, NW, HUTTON HILL -7, 5 Plan revision required? ❑ Yes E° No _ Use other side for additional information. 6 SBD-6710 (R 05/91) Date Inspector's Signature Cert No-, ~iQ.'■•i : SANITARY PERMIT APPLICATION Bureau o oand ff Buil Safety BuildinWater System, ng Water 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 S4, than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number L --T -7p The information you provide may be used by other government agency programs ❑ Check it revision to previou application (Privacy Law, s. 15.04 (1) (m)]. State Plan LD-Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert Owner Name Property Location Z A ~(Or 1/4 A) 01/4,S 2 T 7 N,R Property Owner's Mailing Addr ss Lot Number Block Numjwj R41 AV /Kc, A40-P, JeZ 1'7 City, Sta Zip C cle Phone Number Subdivision Name or $M Number 4 A& II. TYPE F BUILDING: (check one) [j State Owned ❑ City Nearest Ro d Village( E] Public 1 or 2 Family Dwelling - No. of bedrooms Town of 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 0 ~Lo 7 le 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. ~g 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 410 Holding Tank 12;K 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 lev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) `T-j `a Elevation ~~Jr ~~~5 T z c ✓.SFeet Feet VII. TANK Capacity Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks ' I Septic Tank or Holding Tank x /Ozv LJ~4.~S r, s-~ 0 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumbe ~'N me: (Print) Plumber' ignature: (No Sta ps) MP/MPRSW plo.: Business Phone Number: 3aa 7-) Z Plumber's ddress (Stre t, City, State, Zip Code) / ;?Z 17 Wli,l! / K/ ! e IX, COUNTY / DEPARTMENT USE ONLY Disapproved San ypermitFee (,Includes Groundwater ate Issued Is suing Agent Sig r oStamps) S «ha proved ❑ Owner Given initial 1(/%/-) rgefee) Adverse Determination L7✓ . CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 015/94) DISTRIBUTION: Original to county, One copy To: Safety 8 Ruildings Division, Owner, Plumber i 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. 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, irdicate prefab or site constructed and tank material. Complete for all sel.;tic, 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 apprcphate prefix (e.g. MP, etc.), address and phone number. Plumber must sign applicat on form. IX. County / Department Use Only. X. County / Department Use Only. Corplete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the r o.anty. 'he plans must int:!ude the following: fk) plot plan, drawn to scale or with complete dimensions, location of i o ding tank(s), septic other r.reatirrent tank3, building sewers; wells water mains/water servi,_e; stre3rn , lakes; pump or siphon tar'--;; distribution boxe-; soil absorption systems; replacement system areas, ar--l the loc<! .i:)n o the building served; B) horand vertic.d elevation reference points; C) complete specifications `or pumps ar~d :ontrols; dose volume; elev at iif`e~Er friction loss; pump performance (urve; pump model and Frump m,wufo:A,arer; D) cross section of the soil absorption sy,.tern if required by the (ounty; E) soil test data on a 115 form, arc! F) --JI sizin(.,j 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. JOB TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 J~ • WILSON, WISCONSIN 54027 CALCULATED BY ~ I DATE j (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE . . t f i s.... 7! :............................................:r~.z j y c r 01. r ~ X71 ~p/.v g _ erg. ......0.t . _ 0 /tra ' y . i_. . j.... . - I 1. PRODUCT 205-1 ~p Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE I-8*225-M f , JOB / TIMM EXCAVATING Route 1 Box 192 SHEET NO. OF WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE : vy''.. . . . t py 3 >638 Z lb3. s. ~ Y ti w r f G iol.5 . i 6 . PRODUCT 205-1 Inc, Groton, Mass. 01471. To Order PHONE TOLL FREE 1-M226-M Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Divion of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2x 1,1 inchg in "size. PfaA A include, but not limited to vertical and horizontal reference point.( &'~W PARCEL I.D. # ection end % of slaps, ale or dimensioned, north arrow, and location and distant a to,neare4t road. D 7.0 - LZ ~7- LID r y ' APPLICANT INFORMATION-PLEASE PRIALL INFORMATION REVIEWED BY DATE `PROPERTY OWNER: PrROPE RM OCATION S 1,J 1/4 13LJ 1/4,S 7-VT -Z-'I N,R L I E (ore PROPERTY OWNER':S MAILING ADDRESS LOT BLOCK # SUED. NAME OR CSM # c)1z-P1j6- STr. - Svk-) R-tDGEE °i EIVILLAGE MOWN NEAREST ROAD CITY, STATE ZIP CODE PHON r '~Av-b Soy- 31 s q t3 16 n fs) 3 ~ s orv ' TIME l+f LL R-D. (Xj New Construction Use (JQ Residential I Number of bedrooms 3 [ j Addikm to existing building Replacement [ ] Public or commercial describe Code derived daily flow y S O gpd Recommended design loading rate o bed, gpl:W 0 . y trench, gpdt t2 Absorption area required ~ S~10 bed, ft2 11Z S trench, ft2 -Maximum design loading rate O 3 bed, gpd/ft2 0.4 trench, gpd/ft2 Recommended infiltration surface elevation(s) S ffe- 1 3 ft (as referred to site plan benchmark) Additional design / site considerations 3 QTR Gtr LAN S X-1 S' Lo" G . Z y k bSe PT `T} bukAxS WPE UGC?. Parent material w Is ovIEvz s ~ G V. Flood plain elevation, if applicable N • k, ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable I stem 0S ❑U OS ❑U OS ❑U ®S ❑U IRS ❑U ❑S OU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure GPD/ftBoring # Horizon in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. consistence Bcutdary Roots Bed mach kii: 4} o_Io l0 `112 3!3 - 5f] ZvnS~ Z 6-11 tp`(2 31b - Std .S`p~ ~vt`~, cs - o,S n,b Ground 3 n-q, 1644- 3/6 - S Zf o s~ lout cg o-') 0 $ elev. _ ~oZ, ft. 4 q6-76 1r.)`-R yl 5 o~ m `FH - 0.3 ;o.~ Depth to hj 1 ° o 1,1 l-1 t~S'm I -j r G Y-1 T S limiting facto 6 Remarks: Boring # 10`t2313 - sib Zmgb~ 'F~- CU b•S o•~ 2 2 9-L9 tio1-1 1z31L o.S 6 y. 3 19-38 10`123)L SeLGH OS~ yv~~ cS - 01:0$ • Ground elev. 3a43 1 09 R YA f S v S 9 M 'C -S - 0.5 1 b2.8 ft. 5 63 S lb ~1 fZ 31~ - - Gti` s 1 0~, vn `f o- 3 a • ~ Depth to limiting factor 715'. Remarks: TName:-Please Print Arthur L. We erer Phone. 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: a~. ~l~- 1q6 B-Z~1-~ M00576 PROPERTY OWNER IQ LI.SON SOIL DESCRIPTION REPORT Page L of 3 PARCEL I.D. fl ZA- ~Z 6~ • I Depth Dominant Color Mottles 'Structure GPD/ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench -I Z Lb -11Z '313 S l I Z m 3b~Z CL- S 5 0,l Ground 3 z4-63 1b~2 3l6 - S O S9 w~ 1 Gs - ~•8 elev. lo5.1 ft. 63 l O `t 2 31 6 - ~r s 1 w, - o_ 3 o. y Depth to limiting factor I 7 -1'7 i Remarks: Boring # 1 0~~ t'o~R 3t3 s 1, 2ti+,.s~~ w~~h a,S ~ o.S u- 6 y Z -1-~y ~o`-I~Z.316 G~- st 1 2~~dt~~~ cS - o•S b 0.1 o-$ 3 ►4-~y to`~R-3l(~ - SIGH o sg w►1 cS Ground elev. L4 qv--)y l 0 -t7_.- 31 r, - G~ s l p w. vh - o • 3 a• y ti t3~ . 3 ft. Depth to limiting factor 7 -7 F-1 Remarks: Boring # 1 o-g l0`1k-L3L3 - S~ 1 Z Sb1Z M q_ C-4- o 5:0,6 :h.. - -Z(o ZOKIZ31b Gr S, I ~fnSbh ~k c s o•5 0.6 Via,. ~.k,...,,.., 3 2.61b l(3 1.1 tz316 o•~o,y Ground elev. lb~l • 6 ft. Depth to limiting factor 77(x" Remarks: Boring # s Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page 3 of 3 5~~ ~ tiez sow SCALE 1"= SO ' ~Zp moo. ozo, Zzb~- ~Lo ZZ-S.OV' . w3 l" LR Q PIPE - l.oT CoR~t~R, - ~P of wl~i.. t-E3v c~ 1~u 3T ~L tOZ- ~ o•~ tbZ~ t~ t'tl ij-t, '~2@v cHres D L. 61 "W. o O ft, L o s 60 r 0 DOUSE 'n VE nT LUST Z:S' zaa' -ro ZZ2.35 ' M~9lr}~witD 2Q_uTT01v 1~}LLL 420AD a Li- 1° 1 Ct"Vu - 8` - `~Y (715 ) 425-0165M00576 CST Signature Date Signed Telephone No. CST # • Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY S?'. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL LD. # dimensioned, north arrow, and location and distance to nearest road. Dz o - lZ 0- q,3 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION S CA`(T Ps1.1~ l cA IV el S N G81F-t_9T S LJ 1/4 W W 1/4,S Z V T Z-~ N,R L q E (ore PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # ) Z-) (:)2Ar~ 6 - V-) - SUtJ R Ib G I"ZE CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE (MOWN NEAREST ROAD SuY.. W 1 S q 0 1 to (71S) 3$ 6 - O t ->17 S C)" WSI-mm 141 L.tr R.D . (X] New Construction Use [K Residential I Number of bedrooms 3 [ ] AddtWn to epsting buikring (j Replacement [ ] Public or commercial describe Code derived daily flow L1. S O gpd Recommended design loading rate 0--4 bed, gpdV 0.4 trench, gpolft2 Absorption area required .1 Soo bed, tr2 1 \Z S trench, 112 -Makimum design loading rate ° - 3 bed, gpd* ° • 4 trench, 90* Recommended infiltration surface elevation(s) S EIE- t_-A-Me -3 ft (as referred to site plan benchmark) Additional design / site considerations 3 'C~ C,*t~$ , RCN S X-1 S' bUXJ G . 2 4 vbqe PtT `N} 'M JIJS LOPE Eb Ce. Parent material LA Es s oveqz s It (S%- Flood plain elevation, if applicable N • A, It S = Suable for system CONVBJnON& MOUND "ROUND PRESSURE AT-GRADE SYSTEM IN FU HOLDING TANK U = Unsuitable for stem ® S ❑ U [as ❑ U IRS ❑ U ®S ❑ U [as ❑ U ❑ S laU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Barhdary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Consistence Bed IEnch o-~ loH2 313 = si[ ZmS~ aS - o.s o.6 K.. 0 Z 6-11 t`jR_ 3)b StI Z Soh t+'+`~ cs o,S n,b Ground 3 1J_q, to~t~ 3& o Sg elev. _ toZ, ft. X16-76 to y R y! S ~ o m `~H - 0.3 o.~ Depth to C~~ A 1. l U° o l f'1 tS YU E 6 t-1 T S limiting fact Remarks: Boring # ~~X y o-9 10`12313 st j ~-mSbh w,'F~ as o•S€o•~ 2. - Z 949 LoktZ316 - stl Z~sbh'~~ cS o.Sob 3 19 -38 11W 31 L S eL 6H O S ~j tih 1 C S - ° 1 ° $ Ground elev. 84 l bk R V/6 - ~S v S M C -S - o.s 1bZ.6ft S 63-?S lb~-t 2 31l Gas 1 0 wt~~. 0-3 o.y Depth 10 limiting factor ? 1 S" Remarks: CST Name:-PleasePriht Phone: Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Fa11s,WI_:54022 Signature: 6 Date: 8` Z CST Number: 0 0 5 7 6 I , PROPERTY OWNER l\-) lzl-5Q) N SOIL DESCRIPTION REPORT Page of PARCEL I.D. # O 7A- ~Z 67 - O Depth Dominant Color Mottles Texture Structure Consistence Bourg Roots GPD"t Forizo Trench Boring # in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed o -12 1.0 .-t R- 3 L 3 ~ l l Z 3 b tr44 , C o . ~ Ul♦ z i?z%•,' 3 Z ~2-2~ Lb `l R 3/1 `F:F 1^r `F►~ S Ground 3 Z(! -6 3 1 b `12 3L r. S ~c►. u s9 wr 1 cs _ 0,7 v.a elev. o `t 2 3! ~v, s 1 w, t^ - 3 ` y ~bs ft. 63 -7 ~ 6 - Depth to limiting factor i 7'I'7 y 'Remarks: Boring # a s ti o. S 0.1 101 ~L 31-3 1 , Z r,. S hvt vv\"cH U_ y z ,_ty ~p`7\2_3lio Gr. sf I Z`E'sbte `M`FG C o•S i°' 3 ►y-~y lotiQ-31~ StGH o sq 1 cS - Ground ` elev. y H Y -)y l o`-t~ 31 c~ GH s O w. v" - o• 3 ia, y 1 3 ft. i Depth to limiting factor ? 7'7 L/ Remarks: Boring # ti o . S o. 6 0-g lo`1tz 3c3 - sl l Z>,,Sl C,- `F -S - 5 Z g-z(o IOKIZ31b _ Gh sI Z~Sbh ~ c ~ - os 0.6 3 z.6 ~b 1 b4iz 3l6 - 6~s1 d`~ o. o,y Ground ' elev. 1bV,•b ff. I Depth to limiting factor y Remarks: Boring # S Y. I Ground elev. ft., Depth to limiting factor Remarks: SBD-8330(R.05192) PLOT PLAN Page 3 of 3 S Gll`~C 8 ~'R-~ cq Nom- so N SCALE 1"= 50 -PAp r~o, oZO_ ~zre-►- l(o -Z-Zs- o(3 a?'1 - vs- X00.0 NRu►J PIPE - LOT CoR-u~R, - ~P of ~~t Fiau cE Pn ST Sly t'ti R-c- ~ ~s SMW, ~ L L•0 i 6. sl CD B. 'a EL l0% 6 CL, Los 0 1 i0yS lU $F T~r -LIMST ZS=`_ Yob ~ t 14 ZOO#- ZZZ.3S ' (''lC.. ~l~IN1t,D 2p_ ~uT~ ~ 1~-L l.L '~2.ORD cl T715 25 -0169 M005 76 CST Signature. Tate Signed Telephone No. CST # • l0.. ,a - A 14 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OVVNER/BUYER 5: MAILING ADDRESS / PROPERTY ADDRESS iwd (location of septic system) Please obtain m the Planning Dept. CITY/STATE h~' ~ L=)4 -5 V6 l'~- PROPERTY LOCATION .10j 1/41 K 6j 1/4, Section a T~N-R__/ W TOWN OF (&,&J , ST. CROIX COUNTY, WI SUBDIVISION 5 ct'n - LOT NUMBED' CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix. County residents may be eligible to receive a grant for a maximum of 60%. of the cost. of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. 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. SIGNED: L "~~-t J7 / U z ~ DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 • S T C - loo 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 5G01t /y/& Location of property SLJ 1/4 /4, Section _4,T N-R~W Township &W-gal U& Mailing address Address of site Subdivision name syy~ Lot no. other homes on property? Yes__X_No Previous owner of property Total size of property Total size of parcel a, It) - Date parcel was created '2- JS Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes _:k_No Volume /6Y? and Page Number A 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 i t e office of the County Register of Deeds as Document No. 'p/ 7, , 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. Signature of Applicant Co-Applicant 2-- /-5 --1i' S Date of Signature Date of Signature !PR:~ 11 '9'5 03:413 r_4 Iri HEF:THEIM.EF S I 7 7 4 14 03 03' 14 W 41 AID 5 r (t1 672.35 _ ti,~►--~~~. N hU i i 5 86` 3` M _ - t~, , _ -~i• . - -~_rt° 46 -9 74 225 00'- S s. r i ,rn -OZ 4 45 r-t Cf) VW 41 Ut Ut ~ ft1 ~ ' w i ati ~y .S _ ?l`~ 1 i f 0 01 G' ti r ~ /I N _ sv t/i /mop} d O tJ x :0 D a' _ [m~ g I ! I WARRANTY DEED TN19 4►ACL F"S[RV[D >OR RECORDING DATA DOCUMENT NO. ` STATE BAR OF WISCONSIN FORM 2-1982i' 521882 1 t - J L. .rii lA.l Greenwood Ente.rprises.,-•,I_nc,-,•..a, Wiscon...... orporation,,. ~I SEP 2 9 1994 s 12.40 M • conveys and warrants to ..SQQ-tt..,1 e. l~(el.san..and..Er.i~ka". ~---H~l Sqn„ I pe~s9staf peels hu.sba.[~d..aad..wifa. as aurvivar.ship .mar.ital..-RraRP-KtY . . - I~R ETURN TO 1~ Heywood S Cari, S.C. !I P.O. Boa. 229, Hudson, WI St Croix - - _ - - County, the following described real estate in State of Wisconsin: 020-1267-40 To= Parcel No: Lot 17 of the Plat of SunRidge filed in the Office of the Register of Deeds for St. Croix County, Wisconsin on September 22, 1989 in Volume 5 of Plats at Page 71 as Document Number 451750. ~s O This . is not homestead property. (is not) Exception to warranties: easements, convenants, restrictions of record, if any. _ 19. 94 Z~.- day of September Dated this 7q ~ kvemood~ Enterprises, Inc. ...(SEAL) (SEAL) Mar Rusch,_Se -etary /'treasurer James-.E". -Rusch-,_Pres.ident".-_" - - _...(SEAL) ..(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) James E. Rusch, President STATE OF WISCONSIN r, t 41 ST. CROIX Count __st._ ?t!( 19._..._ 7Persg4ially jeame before:mi[ . ~u suthe i ted this ........day of S~1 C.A.b.ev,---------.! 194 1,'3.----- the above dame(i va&i Mary. R~.. Rusch,-•_Secrea1`~~ 1 C . Walter Hodynsky MEMBER STATE BAR OF WISCONSIN '-'.3.. E~••.W :;at (II not. authorized by $ 706.06, Wis. Stats.) to me kno to the erson whd•pxecuted the foregoin nstr en nd a nowledge he same. A/-y-~........... THIS INSTRUMENT WAS DRAFTED BY /4 4eywood S Carl, S.C., by Walter Hodynsky " I • . P.O. Box 229, Hudson, WI 54016 Notary p blic St-..Croix _ - County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) ti date: 19_..._._..) •Narnes of persons signing in any capacity should be typed or printed below their signature,. STATE BAR OF WISCONSIN V•ie,o«sin fxgal Plank C- Inc WARRANT? DEED FORM No. 2- 10+2 tvis. . ' I