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HomeMy WebLinkAbout040-1205-50-000 a o ~ ~p I I h ~ m I O n 0 I a w I C c N E N C I b I I ~ ~ I I c> I c I aNi d I a`~i c I v Z c Z o I U. c T U. c ado _ O co o rn 3 ? E € c 3 Q w a E `e) I -aai M I ~ y 11! Z I O~i Z = O a+ 0 O c w C, H z o I I I _ E z I c c w o I NFL 4' z c E aEi 2 r) :3 c m N vii a U) CO *a '0 1 o~iQ E I Q zoz o zco z z I 4i 4i N d N E N I 'a E o I Cf) CL _ d CD o m CL m d a o a 20 (D iocoa cca. E ~a O o N H N E G y N > _ 0Lo co dZol IF • Iaaa 3daa u, a Ic o I N ) o N I o 0( rn ayi I V1 J V = 01 01 Z = 0 }~j D a N O O N 0 c~ v = I c0 cc _ E I L p m C L p p co y C a. E QI E O m co m O C o I LO N C ` Ln H c p 'fl E d O o 0) o c c c a 0 I LO z yy p y N W w N C is d 0 1 V w 0 Qj W C m y LLI n C N d:3 N 'a to CO~ N m w o z ~ co e o V I o Z Z g fn • ' C o Z r_yi = H CE N 04 EL L: IL Z~ I L: IL 0 co CL 0 rr`%~4 .r E c~ c! c :1 c 2 vat vsv ~ yv ' y `w 4 AS-"BUILT SANITARY SYSTEM REPORT. SN . 0 N' 1, U'W N S 11, 1 P `;1: C • l aZ It ~Fz-~ Q p. ADDRESS; ee- .i'f. C1:0 iX COUNTY, WISCONS.1N, S'UB'DIVIS1Uk,u'1' _ PLAN VIEW D s,tanees and dlui0.nyiuUb to tl►'i~ct reyu-irciuei1LS of 1163 $11O4 E:VE:RY,rlifNG WITHIN 100 1'i-,E'1' OF SYSTEM - 1 •M • y Y i - ; _ - it ti.c aC N r h r I W Ii EN .:HMAKK: (Permanent rei ur rtl►c v Po i.itt) wuc:,c• r:,i 1) Elevation of vertical rerero-W(,v puiLit : :;lope t i,tc SEPT1,C 'T'ANK: Mranufac:tur,ex 1, iyuid Capacity: /DOD Number Uf rings on cover 02. 'I'ait k iii. ait liola cove[ e.lev,Ii- '1a-nk lalet Elevatl'uat T,3.11 k OULlet Elevat.toti: _ _ IN~ET'A 7© Ae~'>4i~v~~~ ~D' 9ff•~~ PUMP CHAMBER Maiiufacturtr: Nunchc~r „I c11~,u: NU1:,ber r,l gal. primp set for it cycle , ni p ~„•.,cl , ctL:.Crit,aLlr.,n IlII VS gaflou I z e. i nup bricauiI I'u~u gI Iqn 1)cI litiicuLc: 11orh(IweI LAWd UludeI it uitilic.r - ry,pe of wurnicig' device HOLDING TANK. °Manulactui:ur Nu,ul,c+t Elevation of manlfole cover 'T'ype of warning device cIlk , t , lcret Ii SEEPAGE PIT SIZE; Number of pi ts_ feel liquid :ept h_ ,ee1) agc 1,11 ►n1.CL k,ipc.-elev.,( It bottom of seepage pit elevation feet. t 5E1 E' _ I l II ~ I PAGE BED 5 ` I` G number of 1 ins~ wid t: I I l I 1, I, b - leugtt► S~?LAAGE '1'It };'NL:H: widthW - PERCOLA'1'iuN RATIO/ AREA EA,- ARIA AS HU11,4d /r9l~.C . .(BUD PLUM1iE R ON J-(.) III DAI ~D _ _ 1 1 C EN'S F, N 1.1 M B 1,. h JJ,i;S W fy DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING ' MADt~SON, WI +53707 . EX CONVENTIONAL ❑ALTERNATIVE State Plan I.D. Number: ❑ Holding Tank 1:1 In-Ground Pressure 1:1 Mound IT assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER INSP CT ION DATE: Edmund Smith 949 Fa2can 1Jtrive, Rivetc FaM, GII ,l -8.7 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NW NF, Section 16, T28N-R19W, Lax 5, G2aveA Station,Tawn a6 Tnay Name of Plumber: MP/MPRSW No.: Coumy: Sanitary Permit Number: Paut Cudd 2739 St. cuix 43727 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY. TANK INLET ELEV.. TANK OUTLET ELEV.: WARNING LABEL LOCKING VE t P VI ED: PROVIDE D~. YES ❑NO ❑YE O BEDDING: =VENT DIA VENT MATLHIGH WATER NUMBER OF ROADPROPERTY WELL BUILDING: VENT TO FRESH ALARM FEET FROM LIN~f AIR INLET❑YES ❑YES ❑NO NEAREST V .1~V DOSING CHAMBER: MANUFACTURER BEDDING. JLIQUID CAPACITY. PUMP MODEL. 1PUMPfSIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL. NUMBER OF PROPERTY WELL BUILDING.( VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) ❑YES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing ILENI,TH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH NO. OF DISTR. PIPE SPACING. COVE INSIDE DIA.: #PITS: LIQUID BED/TRENCH TRENCHES / nnryF IAL: PIT DEPTH. DIMENSIONS GRAVEL DEPTH / FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. P PE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL BUILDING: VENT TO FRE~~~FNNI BELOW PIP / 7 VER. ELEV. INLET E V~„,`ENQ. PIPES FEET FROM LINE / ^ AI~NL 2f. 15 42 CJ 2 1), NEAREST-► Jvt1{' C}l[ C/~/ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- ❑ meets the criteria for medium sand. TIONS MEASURED. YES ❑NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL. SODDED SEEDED MULCHED. CENTER. EDGES. ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH TRENCHES: LATERAL SPACING: GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER. DIMENSIONS MANIFOLD PUMP MANIFOLD Of PIPE MANIFOLD MATERIAL. JNPIPE DISTRIBUTION PIPE MATERIAL & MARKINGELEV.: ELEVDIA.ELEV.PIPA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS. ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: ❑YES ❑NO ❑YES ❑NO N 01 00 rt Sketch System on Retain in county file for audit. Reverse Side. v " ^ r® SI E: TITLE: DILHR SBD 6710 (R. 01/82) DEPARTMENT OF APPLICATION SAFETY & BUILDINGS INDUSTRY, FOR SANITARY DIVISION LABOR AND , PERMIT P.O. BOX 7969 HUMAN RELATIONS (PLB 67) MADISON, WI 53707 Attach plans for the system on paper not less than 8'/2 x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be included. Property Owner: Mailing Address: Edmund Smith 949 Falcon Drive, River Falls, WI 54022 Property Location: )Ki~3lXliiiXr Township: County: NW '/o NE 1/4s 16 /T 28 NCR 19 E (or) W Troy St. Croix Lot Number: IBIkNo.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number: 5 Glover Station Omaha Road (if assigned) TYPE OF BUILDING Number of ❑ Public* El Variance* El Other (specify)* WildX6 Bedrooms: © 1 or 2 Family *State Approval Required. 3 TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY HOLDING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: Wieser onCre a ro e EFFLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA (Minutes per inch): PROPOSED (Square feet): KI New ❑ Replacement ❑ Experimental 9 Seepage Bed ❑ Seepage Pit Less than 2 624 ❑ Alternative (specify) ❑ Seepage Trench Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): ® Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber: IS: ign r MP/MPRSW No.: Phone Number: Paul R. Cudd 2739 1715 425-2049 Plumber's Address: Name of Designer: Rt. 5,'Box 364, River Falls, WI 54022 James Rusch (568) COUNTY/DEPARTMENT USE ONLY Sign ture of Issuing Agent: Feee:O Date: J APPROVED Saaniit rxy PPe7rmit N/u]mber: 146 V3 ❑ DISAPPROVED `I✓ / ~L / Reason for Disapproval: Alternate coursels) of Action Available: ,Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in- stallation. Failure to comply will void the sanitary permit. DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber DILHR-SBD-6398 (R.07/81) I v"tz) S" l-TIi - San. Permit No. pr's name H63.05 PLOT PLAN Show: F posinc chamber V Location of building served Q Septic tank Vertical reference point Horizontal reference point Q sewer Fa Building Effluent system Q Well Replacement system area Property lines w/in 50' of system Scale = k_ 410' , or dimensioned Distribution boxes _ N p~ Pump and controls: Mfr. & Model No. Vertical 1-_f t Size Force Main T. D. H. Vol. Dist. Pipe Gal. -per F-In. Gal. per Cycle Friction Loss Place check mark in appropriate box, indicating item is shown on plot plan below: w j ~ GAR J F- w'3 9 "4 ib, Sv N D y Q~ looo G'K L wt SEA 0 VENT ~ 9T C TPcti~. ~16 p~ f~ Q ` a cNI Bz/~~~ yC \ B r~ I IN, a ~1}RP )63.5$` So' l~ zao co, ?U~CtO S a %\O '~2aCHT- nt=- I~~f U N Oh 1x, By the granting or approving of the above plan, or upon the event of a subsequent permit being issued, sT.cQO+x County and the sTCRo1X County Zoning Administrator,. does not assume or hold itself liable for any defects in plans or specifications, plan omission, examination oversight, construction, or any da:--sage that may result in or after installation. ~ Dl.,ci-+~r~ c ci nnatnYP i 4--PAR r T OF EPORT ON SOIL BOf 1:lfbAP3 RELATIONS PER° OLA 100 ` S i) P.O. QUX 7969 (1-163.090) & Chapter 145.045) D{SUN,1'J! 53707 LC%CATION: SECTION _ 9 O'PJNSH" MLINICIPAI_11 Y: OT I, I_K ~I IOr "N P.IE: ,'\f Y}} C~# COUNTY: C)J/ERA DYER S NAME: MAILIN ADDRESS: w LI _ ✓ ~~IE-_t'~..C.-5 X17_ L-C. _~f t aF _ DATES OSS LADE Y` NO. EiE[TFiIVIS: COMMcR IAL pESCRIPTION: , PROFI E Df S(Rlr~6IONS r f~Z`~L M N TES-iS: llResidenca 1 J E Jew ❑Replace L ~ _M~ { c c Z- s IL- S, r to t-4 f t~ C" RATING: S- Site suitable for system U° Site unsuitable for system ON EN'TIQ~r~Lc ItUUNO: IN-GROUNCIPR[ UR SYSTE,`d-IN--FILL iOL01ldG TANK' RECOh1MENDED SYSTEIvl:(apiionel) t _[AS ❑ l D S ~ lu-~~• ❑ EIS /A 0 S [OU °t l'`, U>, _ C I it Pemolation Tests are NOT required DESIGN RATE: LFloodplain, an r / any portion of the tested area is in the i'll't!er s.f163.09(5)(b), indicate: y inclicate Floocsplain elevation: ~i ;lPROFILE DESCRIPTIONS I; ER TOTAL EPTH TO GROUNDbVATER-INC HES CHAT{ACTER OF SOIL WITH T>iICD;I,IESS, COLOR, TEXTURE. AND DEPTH i,.;1cI 3ER DEPTH w. ELEVATION !2r. IGFiES' 7 P S c f2 V,-.D tS O BEDROCK IF OBSERVED (SEE ABBRV ON !JACK.) U 9,52 , r ~ C, %~/1.'.~-• - j 3. Z./ l~'J _ +~-.J:i ~ i/ L.'~ l-:Mi~ 4 _ 5-0 i n i PERCOLATION TESTS N©.: !v' ; . - n~_ C 2 I L ~ l ! N t DEPTH WATER IN HOLE TEST TIME DROP IN MATER LEVEL•i ' NCHES ' RATE MINUTES ES~d3ER NWHES AFTER SWELLING INTERVAL-MIN. p Al D t pF-~ti~.p 2 pr qT c PER INCH 1 4, < Z i' r_ t 'i.Or PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- c.ntal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings antf the direction and percent landslope. t ~3ID ram. j='`C'., tJ t'Y~*p3 c_ - Y TES'! .ELEVATION ~ I-= ~ ~ X-, H a j O P acv t_ tj r - s--A h 1 - 0 - ,sr -ZaT t GN G H M1~'R.k-: S W C.CiR... ?'IC /aN~~Spp I~I~iL/ the undersigned, hereby certify that the soil tests reported on this form were made by mein accord with the procedures nd met6ods sdcifrOe(li~~n the Wisconsin ' c:ministrarive Code, and that the data recorded and the location of the tests nre correct to the bast of my knowledge and belief. E Iprin[ TESTS WERE COMPLETED ON: J A M E la. tr y J V (.~1C~', • /9 L 3 _ z SS: CERTIFIC;\TIUA1 VU,Vt$rR: i'41MC iNJ!.19EratoUtinn~ll ~Z-~ ..~`~.Z..T - r~-~_~/v ~ra~v ~....J~ .SC,,~ ~ =~~3G-~-- rlt,,<~C~ , i a) C IGNAEURE: .-)!ST RISJTION: Original an.' nn. r-oPy to 1-rear Math,)rj;v, Proper ty Own+r anti Soil Testar. 1 ei.;J',t :i,'. it •i x,11/ j.t _ PARTMEN Ur I t 1 f~:11 1 t7•.~ iii + Iffvl,tv:'r 13T,l~ ,r•_ ,,TS'~ t- P.O. Box 7969 '3C)LL HFLAT10lVS PERCQ~ i IOC ON TES (1'-53) " MADISON, W153707 (1-163.090) & Chapter 145.045) OWNS WVVI__ _LINI--CI-PALH-- . -u~ Ir,o. DI-V-isl^J Aa~.li:: I zi-IM /IR1~ ~ Ia :UN1 Y: UNER Uhf NAME:AUUH(Itoml-IN _ t i ' f ~3 l' (fir \ G',P-,D / . t~ eft J N r~ ' _ . /l I / / - - _ - UAIFS UNSkNVAT10NSMADE - - 1'1lUFII.E I]kSCfil{aT10?JS Pr 11000ti(T N cSTS: j31:),f1F.C1N1S.: COMAAEHAL^DE°iCRIPTION I UHeVEace New f ING: S- Site suitable for system U- Site unsuitable for system - A lNTIaNAL: h10UN7: INCsI ND•PHL-SSUFl SYSTEM IN f ILI. HOl-OIhJG TANK .iECOa_li-vlENE)ED SYSTUvI:luptiunall S U~ ❑ S U S ClU0 S_ ~U~ S otolation Tests era NOT required OESI GNJ N^Tc: 1 If any port.on of Ow --d :.tea is in the r. s.Hfi3.09(5)Ib), indicate: Fluu.!;:! ;...LCata f EoudpEa.n elevation: r`- -Lou ]~{_'r. PROFILE DESCRIPTIONS _ I' TOTAL nFpTH To r.A UN WATER-i:t~FS CHANACTEl: OF SOIL JITH TllICf.NE5S, COLOR, TEXTURE. AND DEPTH r.aaEH DEPTH fa. ELEVATION ftVF 111 ,~+F r; TO BEDROCK IF ObSEHVLO (SEE AtltIfj',).ON IIACK.I 1 -al C lye t4w- l - z r i a !V';1'r•"..+ : r VI ' I~:~ Iy rY . .,l ~ ~ a.: r ~•..,;,r plGl 1J /t PERCOLATION TESTS 1 147 tr. 0-- It DEPTH WA E INMOLE TEST TIME D OP IN VIATER LEVEL•INCHES FIATS MINUTES PER„ E^ NCH '~..lER ►NIP. AfTERSN kLLING INTERVAL-001N. P RlSZO tt9'!^_ T L •r' ' .rte Or PLAN: Show locations of percolation Lasts, soil borings and tht dimensions of suitable soil areas. Indicate scale or distances. D•tscriba what en the h ,at;l and vertical elewtion ref0ene0 points and show their location on the plot plan. Show the surface elevation at all Wirings anO the direction and per Eared slope. -j.`'~ 7 p-~'T. 1 1 Sr4<~,, c_ L~G~ p ;YSTEWELEVATtON 1-~ O P t..- Il* Tic /,.1 -tom le I J1 -r - - 10 - fi _ 3 , le>p' Lj CA- J 1 d - -Ao the undersillnedr haralW eartily than the soil tests reported on this form ware made by me in accord vvith the procr.(lurj Fmet(tods 1p ciltedits the V lsco cministrativo Code, tllld Chas the data recorded and dsa location of tho tarts ere correct to the, bast of my knoroledge and beliet. t ! J tr! ;AMF pent - TESTS YVERE CO C ETEO ON: tJr~t :t•1- Ste( ~\/G~ I r../r:>/ /trZ. /O / j _ _S$: (,ERTIFI(a1T1U~INlI1,IHEii:~.~F1.l~lE~•EU•'•IK+'riropt.ral C;-1) 7 r\!r7 ti/ J/ 5G ` L ;~tC~- 'U~~U ~~r.. -r t--- ' IGNA f UHc: +1SI RIHUTION: Orrrlinal trro* nrs► rrspy to t_r.tat Auth7riiv. Prnpe. ty Owner .tart Soil Tester. PA( ,E O p w ~ 'S tJ A h E CROSS SECTIOA] OF A BED 53STEM - t ~~~~~'v~ JRCL2-C?vc~E 2' OF AGGREGATE SOIL FILL 2 DISTRIBUTIOQ PIPE APPROVED 59UTHETIC COVE o MATERIAL OR 9° OF 57RA OR MARSH HAS • os~r~oo o° ` eorF 2-Z~/ oAG&REGNTE ELEV. OF S~•SO FEET Z7 INCHES BELON^✓ ORIGIUAL GRADE DISTRIBUTIOU PIPE TU BE AT LEAST AQD AT LEASTZO WCHES BUT MO MORE THAQ 4Z IUC14CS BELOW FIRIAL GRADE I>JCHEs PIAYIMUN% DEPI-F{ OF 1 XCAVATIOU FROM ORIGIQAL GRADE WILL BE INCHES ` MINIMUM DEPTH OF EXCAVATIOIJ FROM ORIGIUAL GRADE,. WILL BC SIG/JED:.. . LIGC►.15C DUMBER: .~~Ar/ 3 8 9'7'7 0 CERTIFIED SURVEY MAP' Located in the SE 1 /4 of the SW 1 /4 of Section 9, T 30N, R 16w, Town of Emerald, St. Croix County, Wisconsin Surveyed for: Mary Schmit DESCRIPTION A parcel of land located in the SE1/4 of the SW 1/4 of Section 9, T30N, R16W, Town of Emerald, St. Croix County, Wisconsin, described as follows: Commencing at the S1/4 corner of said Section 9; thence WEST (assumed bearing referenced to the monumented South line of SW 1/4, bearing assumed due WEST) 555.831 along said South line to the point of beginning; thence continuing WEST 496.381 along said line; thence NORTH 375.031; thence EAST 496.381; thence SOUTH 375.031 to the point of beginning; containing 186, 157 sq. ft. (4.274 acres), and being subject to all easements, restrictions and covenants of record. N N _UNPLATTED _LAN DS _ N C M EAST 496.38 v 900 0 00 ao 00, 90 I c D I Z C IZ O C ID z -0 N I D = I-1 ~ m I° N N 0 W DEC B 193 w Ln 0 ST. CICIX Cool ~"t Y CA Ir W COMP^c11ENSiYE: FA IKS N;0 : t';.; HOUSE D AND ZONING GO"!'IklF Ir 2 Ip IN POINT OF BEGINNING IU) 0 00 900 90 00' WEST 496.38 T 01 WEST 496.38' 555.83 C-Ly, w EXISTING TOWN ROAD CAL S.W. CORNER S 1/4 CORNER SECTION 9 UNPLATTED LANDS T30N, R16W '011~lltltt0l~1 .•`~~~Se0Nsh''4 .++'r~ 'SCALE IN FEET I°= 100' JAMES E. RUSCH = 0 100, 200 400 s-I376 LEGEND 'ss►~ trls, ~o,,~+ COUNTY SECTION CORNER MONUMENT Y • IX 24° IRON PIPE WEIGHING 1.68 LBS./LIN. FT. SET to ease I, James E. Rusch, registered Wisconsin Land Surveyor, do hereby certify that I have sur- veyed and mapped the above described property; that such plat is a true and correct repre- sentation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes an4 the St. Croix County Subdi- y ioon^Ordi ~n the be t of my professional knowledge, understanding, and belief. 'James E. Rusc Vol. 5 ,Page 1378 Wisconsin Land Surveyor S-1376 421 Second Street, Hudson, WI 54016 November 9, 1983 483-601 f 1 € e Jill loll zxo/ oool. I fly P III .q. 'eke NZ~ '•a y.~ 4f~ ~r 1 ,111 NIO 'p )i! Y s 4 `i ~~1`~ppryyy111 I 8'p6 ~ i .f6'CK ).9[,8,.fN '•72'1 I .x•'W► )•al,•MN 1 i try '~i V'y 7 1 a [ t~ a I 1 •R•r.y ;0§ry ./a^'~ $ $ n- ~ ~ '~7yJ ~ .1 wX~ "i 8 pQ W b' A Y! ~ _ ~L~ a ~ I~ ~.x $ Na " (rir/~.~ NM ~z ~ s• e • 3 51 . I C I « / "Y Z 1 wow 3.90.22.11 .pus E N 4e «•fr) d awl f« $ A w 4 R YY~ jw- -Oft I i."~. +a WWI, s I '°'I I»- $ ~ y$ ty '4~4 ~ 3 SRI .IN ~y mom /18 ^ ,=09•[ ).tq•f.IN t gym .M Nd t4r Q uq•e.lN ,x•ss), ,urola n1.wFf•a'- . Zei 1 . .00'm P0 .0-a I .•e L ^ ° C Q .'1• i ,.1 I M1 .fx9Ef 7„•0, -sorox)~ - pa .09 --ooosz-- --,ooc►:~- - -A• ua ' 'MG )••0,•fJV i ~qy, ►n INI A0 x/1) A 31111 LM • Form - 5 T C 100 ,.k 1 owner of Property-- l~:Xc, ~•_r./~. c, - Location of Property-~ 0/ ME Sectiun__I(V_ ,'FN R-ly W Township Mailing Address Subdivision Name Lot Number L5 Previous Owner of Property Total, .Size of Parcel X12--/6 S Date Parcel Was Created Are 41-1 corners identifiable? Yes_ No Include with this application one of the following: •Certified Survey Map Deed Land Contract, or Other hegal Document which describes the property PROPERTY OWNER CERTIFICATION I (We) certify that all statementmn this form are true to the best of my (our) knowledge: that l (we) am (are) the owner(s) of the property`described in this informetionform, by virtue of a warranty d recorded in the Office of the Crulnty.Reg6ur of Deeds as Document No. E ~2~.-9-4' ; and that i (we) presently own the proposed site for the sewage disposal system (or 'I (we) have obtained an ossament, to run with the above described property, for the construction of sold system, and. the some has been duly r Md~ed in the Office of the County R of D s, as 0 ment No.~Q OWaiEA Y SIGNATURE OF CO-OWNER (IF APPLICABLE) 1 / RATE 510 o DATE SIGNED Stock NO. 13001 "rQaipnr~ DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 1 WARRANTY DEED VOL PACE ~J9 THIS SPACE RESERVED FOR RECORDING DATA 3803 5 H REGISTERS OFFL beerMartin F. Shuster and CE Car HJS REED,gwd n ST. CROIX CO., WIS. RPC'd• for Record fhis 20th Grantor dray Of Oct_ M 19 82 „ d un Smith, r. an E en Smith, 07 8•30 A Iius an an ~wife, as point tenants, Grantee, Roww of Deeds Wi t n e s s e t h, That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate is St. Croix RETWIN TO County, State of Wisconsin: Tax Key No. Lot 5, Glover Station Subdivision, located in the NW-1/4 of the NE-1/4 of Section 16, Township 28 North, Range 19 West. vz ~c Q c L,L This is not homestead property. (Mac (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Martin F. Shuster and Carol Sue Shuster warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except for easements and restrictions of record and will warrant and defend the same. Dated this day of October .19 82 (SEAL) (SEAL) * * fAa~tin Shuster (SEAL) (SEAL) * * Carol Sue Shuster AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day Of STATE OF WISCONSIN 19 ss. St. Croix County. Personally came before me, this day of * October, 1982 the above named ( TITLE: MEMBER STATE BAR OF WISCONSIN Martin F. Shuster if (If not, Carol Sue Shuster authorized by § 706.06, Wis. Stats.) ~j or- This instrument was drafted by C. M. Bye, Attorney at Law to me known to be the person S who executed the. fore- 710 North Main, P. O. BOX 167 going instrument and acknowledged the same. River Falls. Wisconsin 54022 Ai, i± (Signatures may be authenticated or acknowledged.. Both are not necessary.) Notary Public County, Wis. My Commission i, permanent. (If not, state expiration 1 date: 0 19$3 *Names of persons signing in any capacity must be typed or printed below their signatur ii CMB:dc Ii WARRANTY DEED-STATE BAR OF WISCONSIN, FORM NO. 1-1977 L Satisfaction of Real Estate Mortgage - By Bank ,,Stock No. 11063 THIS SPACE RESERVED FOR RECORDING DATA + 387854 673 SATISFACTION OF REAL ESTATE MORTGAGE - BY BANK ,,;E ,IMRS OFFICE The undersigned Bank certifies that the following is fully paid and satisfied: ST. i_1Z 1X L'O., WIS• Mortgage executed by Edmund A Smith Jr. & Ellen T Smith . Recd. for Record this .__19th day of Sept A. D. 1 c;,_83 husband and wife at 8:30 - A , M. James O'Connell _ Deputy - - to Bank and recorded in the office of the Register of Deeds County, Doc. Of St. Croix Wis., as No. 380456 , obw (Records) ft") RETURN TO: (ATTN: 1 g in (Vol.) 653 oflN on (page) 550 Z*gff Main Estate River Falls, Wi. 54022 [Corporate seal not required. Sec. 706030, Wis. Stats.] Dated September 15 t9 83 River Falls State Bank NAME ANK By [K PRESIDENT • Donald W Larson COUNTERSIGNE By C OFFICER • David A. Gilles Cashier STATE OF WISCONSIN, as. Pierce County. On the above date, the foregoing instrument was acknowledged before me by the above named officers. 7 NOTARY SEAL it, ;:`l~.,,. < Sharon C. Wilson pt A It This instrument was drafted by >r c Notary Public, State of Wisconsin . U n XCCY'laxlllC~14 River Falls State Bank .q•• U C' My Commission (Expires) May 18 , 19_A6 (TYPE OR PRINT) `Type or print name signed above. 0C FlQMillo'Compuri l F~nst~b R~yw LAMY c, VeO rl TyP#4 +3" crus h ~a RocK CL 97.8' \ pp~ - Ge i2i x s2 seP~~~ 7-An K-/00)OCIP ~sE A C-t- loo 00, ` ~ si rnPRsw /5'63 too. , f AS BUILT SANSTC - ITARY 104 SYSTEM REPORT OWNER l6N Srn~~1 ADDRESS 'S rj Om~l p~ ?1UU10N ~~)SC. 1\ Sy )ICo SUBDIVISION / CSMJ ~y }r 0jJ LOT ~ SECTION I_T QQ N-R ( W, Town of jgo~j ST. CROIX COUNTY, WISCONSIN SHOW EVERYTHING WITHIN I 100 FEET OF SYSTEM 5~')t co-ov- F C'o(L 13M =l~u,0 .3 &D12wrVr { a" l~orr~ -VQ I fx4~ Voly-( TN 9y a3 6A1~,KuN I` 9y.ao X01ri ►6 =5slf o~ ~BkS'U~U lU INDICATE NORTH I~I.1ZOt' Provide setback and elevation information on reverse of this Corm. Provide 2 dimensions to center of septic tank manhole covet BENCHMARK: S~511 (Y) -7n lJ )0010 ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: quad Capa ity: ~IJIJ Setback from: Well y se Oth r i Pump: Manufacturer Modelt Size Float seperation-- Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: a 31 Setback from: well: O~Q'KS0 House S 'l i Other ~}cr e fz, ~a. 0 - 9a. (~"q ~N~ 9a 53 - g-)•53 ELEVATIONS 1 Building Sewer ST Inlet. ST outlet 45~ PC inlet PC bottom Pump Off p Header/Manifold Bottom of system 8 Existing Grade 97-96 Final grade G,88 DATE OF INSTALLATION: C 95 PLUMBER ON JOB: ~,1!? _IJuu'~~ LICENSE NUMBER: INSPECTOR: 3/93: )C Wisconsin. dDepartment Industry, Labor and Human n Relations PRIVATE SEWAGE SYSTEM County: ST. CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town of: State PI SMITH, EDMUND/ELLEN Troy CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ~oa,6y 6 J , Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK.SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. AirIto ROAD Dt Inlet Aintake Septic NA Dt Bottom Dosing NA Header / Man. y Aeration NA Dist. Pipe Holding :::j:::Z~ Bot. System / 1 d , PUMP/ SIPHON INFORMATION Final Grade j. Ito ~!4 -t l Manufacturer Model Number TDH Lift Friction *jA Forcemain Length DSOIL ABSORPTION SYSTEM BED /TRENCH Width Y Length J~D No. Of T ches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type0 / CHAMBER System: ~ cj' OR UNIT Model Number: 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 e ,4 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.), l ~ LOCATION: Troy,16.28.16W, NW, NE, Lot 5, Omaha Road v U Plan revision required? ❑ Yes No , Use other side for additional information. ? c) ~j (n { SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTS CRC; STATE SAATARY PERMIT -Attach complete plans to the county copy only) for the system, on paper not less than 3~ 41/p1 8% x 11 incheisNaSize. ❑ 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 1 c l PROPERTY LOCATION ~11O-N > 1/4N~ 1/4,S ~p T ~$N,R E((?r) PROPERTY OWN,Ej 'S MAILING DRESS LOT # BLOCK # 57 _ 0I'v-, PJ,m 5 CA- CITY STATE ZIP CODE PHONE NUMBER SUBDIVISION NAJE OR CSM NU E 1A 0561-J W1 S 1( NA 'Zir- P ;~oU -171 CITY NEARES OAD II. TYPE OF BUILDING: (Check one) State Owned ❑ VILLAGE : ~ M P P 1~ ❑ Public ~~I`41or 2 Fam. Dwelling- # of bedrooms PARCEL AX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) /J~ 1 ❑ Apt/Condo O 0 / v 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.0 New 2. Replacement 3. ❑ Replacement of 4.E] 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.) PROP SED (sq.ft.) (Gals/day/sq. ft.) (Min./inch) Q1 ~7 Q LEpV~ATION 7b 4 0 V J«) S8 Feet Feet VII. TANK CAPACITY Site in alIons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New xistin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holding Tank Lift Pump Tank/Si hon Chamber V [I I El F] F] 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: 1 rVN 36 U T,, r 71.5 38(,- gbh Plumber's Address (Street, ity, State, Zip Code i 106' 8 I n ~ )sv 1W 51- 0 ago s' c- IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee (Includes Groundwater a e ssue issuing Age ignat r / I'du.Approved Owner Given Initial rcharge Fee) e., Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: r SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety s Buildings Division, Owner, Plumber q < ti. 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 Saniitary 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 8 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 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) i Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page,/ Labor and Human Relations Of 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, but51 a ► ' 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 4.1 r,.rl4 GOVT. LOT I/[/ &J 1/4 /V40/4,S 4 T ?-p,N,R 14 E (o& PROPERTY O 5,54 WN ':S WILING ADORE LOT~ BLOCK # SUBDE OR CSM M to A ~ /udt'., rS~ f~ 2r, CI ST JTE N fc ZIP CO E (HONE U R []CITY []VILLAGE A9rOWN [NEAREST ROAD So 0"I i IiII [ ] New Construction Use,[ Residential I Number of bedrooms 3 [ ] Addition to existing building XReplacement [ ] Public or commercial describe_ et/ A Code derived daily flow L// rd gpd Recommended design loading rate .S bed, gpd/ft2 4C trench, gpd/ft2 Absorption area required ~J'GbD bed, ft2 S~~ trench, ft2 Maximum design loading rate S bed, gpd/ft2 G trench, gpd/ft2 Recommended infiltration surface elevation(s) 2. 51" ft (as referred to site plan %Thmark) Additional design / site considerations 6r be- lwe,_ 04,1W11&1 4, i~ c e -,l !ne S' c✓s fl Parent material Qur~~~ Flood plain elevation, if applicable X)IAL It S =Suitable for system ~~CG~OyyVENTIONAL MOUND IN-GROUND PRESSURE gT-GRADE❑ U ❑ SYSTEM VUFILL HO SINCLT UK U = Unsuitable fors stem 4'S El U US ❑U 9S ❑U [S SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 2 of At Ground 3 71-"55r- ,e I v.9 SS T V//l f'f1 - - 7 Depth to limiting f or Remarks: Boring # o -,15" A0 Z12- s 7=~1' O~~ C /S s6~ Nfi►~ c s G Ground Depth to s D S ©a, S limiting factor~ ILA Remarks: CST Name:-Please Print Phone: A4 C, 4a a►17 G~ 3S6 ~p 20 Address: 'VI SS/o/ O o Signature: ~f Date: CST Number: PROPERTY OWNER SOIL DESCRIPTION REPORT Page ?of # PARCEL IA Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench ie 1 S C .,4 % Ground j D ye 1 s' s~~ !z► IF 7' 17: Depth to limiting fact? Remarks: Boring # y~:S Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # F Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) 3W3 ~l1 sl z mo'o' _ . ( rl~.,, IV^ ~y _10'ss Sl-(' I it.. PLOTA m I I I \ .0 I \1 -7~ 7) T Pl\oi L..J~~~- ` N A M E SM; NAM J i X3014 Y n E iL& AT 10 I C E N S E://. 310 &W rv►pF'k cl-o: 100,E t~ ~s~iti5 (,Jel1 Ru>> RuN !-10..1 4 y KvxiP~ $U Vply e two, RtiM ~t Jl1fDy►, P 30' RNP c' ° A 1.1.x. FRESH All' INLETS AND ODSERVATION`YI.Pr C120SS SECTION Approved Vent Can Minimum 12" Above I Fi nal Gra i ~ I Cast Iron Above Pipe To Final Gractr- venj Pipe Marsh clay Or Synthetic Covcri.ng i Min. 2" Aggr.co 1I , . Over Pipe Dis tribu tio~ Tee Pipe I Aggregate Ver•f.orated Pipe QeloW Beneath Pipe --Coupling Terminating r Rot•tom. of• System.. ':,JtlJT ~r ` err 'a.+...s Vi4 a w,ir 'J v1+rd~.. u-i, l..a ►a~ •r r a n UIVI~i V+'! PERCOLATIO "1, ~T '9 ' . P.O. BOX 7969 {U~1 N RELATIONS TESTS (11 QG DISON,1VI53707 (H63.09(1) & Chapter 145.045) LOCATION: ~ErrT N: 0 1PJ, ,MUNICIPALITY: O-I I.K. IM ~1 tOP MIE: t x/41 i ~w - zsn/R ► 6 ) y 01) COUNTY: y`/NER'S U . R S NAME: MAIL,IN AUD ~-ESS: S.r. cz 01X, c M;;/t L1nJ r-) LA tTF'{ ISE DATES 08S BADE NO.REDRMS: COMMERCIAL DESCRIPTION: PR15~TC ~SC~Tr~t! N G:[ION tSTS: Residence r / I,L:INew ❑Replace Pz J / r • o,/C ! s~rc~.s r ~v 2/ 1JbTING: S- Site suitable for system U- Site unsuitable for system :OiV ENTITI0N`AL BtUUNO: 1tV-GF7(9 1`6PRGSS'UR SS STEM-IN•FILL iOLDING TANK' RECOMMENDEO SYSTEtvl:(uptiuna0 F71 SET S Cl.U El S W-U S Q _1S U C❑ U It Pe,colation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ,nufer s,H63.09(5)(b), indicate , ~ . .~s Floodplain, indicate Flaoctplain elevation: ~t Via, PROFILE DESCRIPTIONS E-:' f ' "rE21NG TOTAL PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE. AND DEPTH t`iJh1BER DEPTH W. ELEVATION UBSERVf D E ' Si'-HI-C TIES' TO BEDROCK IF OBSERVED ISEE AEiBRV• ON [JACK.) :oi. = to 3 N1 ° s J. 4- ~l ~~c~,, r 7, J tit ; 7 ' • ' BILL IE ~.~1!~.•- E3 = c, 7y' !3 3,zJ' f:~•,~ v J' raV AA ate $ n_ n- flE>:1 t✓`,6•: t» PERCOLATION TESTS PEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL•iPJCHES RATE MINUTES _ .:V3ER hieht.SS 'AFTERSWELLING INTERVAL-MIN. p'" _pE"Aib PER INCH . AF P. 3 t7 t 1 y -c or ( = P- &,Z./ P- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- :ntal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings ano the direction and percent f land slope. S P`Y , t.1 tTfe tea , . WSTEM, ELEVATION 9 7, ID ` o sr -_i 71 4- 5 J a o a h -:4 D • ~ ~ ~ A, JV t - r. 99 iz l 1'i F:- Y ► - - S~NGH M,r}R.K. SW cexc.. 1~/uv5 h~o~MEt~.~P`.., the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures a~me f oJs 5p ctlAlin the Wisconsin dministrative Coder, and that the data recorded and the location of thn testsr:ue eorrecnttt, the bust:uf'nny knowlaiige:and Gelinf; ;.sdE fprirtt : 7EST54YERC.COMP4ETED ON*, A M 10i P/ AG Z' N CERTIFICATION NUMBER: 0i%jE; NU'.19ER(optionk:1 d 7 f ro S0, GcJ~ 5G _ Cam-- ,lc~ C~ i L GNAfURE: :STRI8tjTION: Original eM' nor copy to l.nr,r Authority, Propel ty Owner ;)nd Snit Tester. .w.JO ti; ,rS s .4. a p 's Y / 1 e - •r 1 l ,)..c' r ~.1^w'y+, 1~.Yic a~ U 14T SANITARY SYSTEM RETORT Ci)WNSIIl.I' SEC' . '1 N h/9 lY 0WNIR Alll)ltE5S /Ue~....ALt,S__...._ Gi:OLX GOUN'1'Y, W1SCONSJN. _ L, OT S1'L.E_)_ _ - - SUB'll'LV,iSlUNOE_._ST!4Tlp.nJ 1,1)'1'. PLAN VIE p tatte'es acid dl;,ut0ny4iuas to t(1'e`'r L re.qu-iremciiLs of Hb3 ~HUWI` EVLR.Y'1`11tN(" W1.'1'111N 100 Fl,- O SYSTEM GL i 77- . ,M t ,r It is aL N r It , , , w. ~ r 131:1KCHM°AR,;K•r (Permanent ref crutt~:u fu 1Ut-•;c1.1 bL:: /DO /"4 n L1eva•tion ot.• vprtieal' re i:'ere- tic v., puttit _ LLyutd Capac..1Cy /DOQ ' : attk manitul.Q ci,v~:r u.luvlt. it Ntimb of, rings on cover act : !'t! E/:SE {yE,P1 ~'G / LANK• Manua' k O u l L e t Llt:v.lC.iuu: .a.tr ldtt 1 11 1 1:11:va')t'L~~n r - PUme CHA-M13"Ill' R ~~,:clJttn~. r u l Manufac.turt:x N u ut b . r t r Nuu,ber01` gaI putrll~.^seC :fut..a cyc'Ct_,.. ),ull'1.0111 c•a1,1, tt tie pLi wl) t.•.,.I , c~Lrit-rlbuti i0n 11:,it s 1,aJ..Curt I.to I's trp,1wct r., t n,,m, t 1 u 10 n .per III l.ntrL L: a it d @l u d 3:1 t1 u ttt e r .r_ lyape`of ~war'n1it1;`'devi.Ce lillLllLNG LANK.: Marttllact"arcs u•ub El.c:vaLiun of •matiltole cover Tyi,e or wartlitig device t 1 tw, t , t t • t• l i . SEEPAGE .11 IT S1LLe Number of 1' i !,vepagu pit t:l.el ) i pt e t' fe e t lL.quld ac.p• ~ v'11"'~ ~lt ~ . S-~ t t i 1 cl 1:,0ttom of seepage pit elevat tort f - I t numiitrr of 1 inc 5 f wLdr.i) c,n} 11, SLEPAGE 13 ED SIZE: SFFPAGE TRENCH: hC 11 L it 1rK C 0 itL1)_ AIt1:A AS 13U t l,'I'~~~ AIt15A It t;l~U L Y L A'1' J;.C1N R AT ( 1. N i P l l `I' O It r9G~G . (~C~ D p: 1) A'1 E 1) 117, 1 M 13 L 1tu N .1 O B L.CE NSF. N1.1MBKh S_W -Z N~.h,~ 7-119 ,Y1v~~b S~'1 _ San. Permit No. ^.r s name H63.05 PLOT PLAN Show: F! Location of building served Dosinc chamber Q Septic tank Vertical reference point Q Building sewer Horizontal reference point Effluent system © Well Replacement system area Property lines w/in 50' of system Distribution boxes Scale = L{0, or dimensioned Up, Pump and controls: _ t - Mfr. & Model No. Vertical L_f t Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal. -per Y--in. Gal. per Cycle Place check mark in appropriate box, indicating item is shiown on plot plan below: J S-+66 = S~TL'D \{o'aSE ® w~L f Leo crt-. o1J TH v nl 00 ry~j Q\ IOOO 611L W I = ~e 0 V elwr 9 EST C_ TPc~t. 47 a` 93 ~ a s~ Z )bt3.58 50' LL 1017.W' o~ q3 ~crlT_ r,F_ U„~y will S~ ta'yt'z Or'\ 1~ 1~ A ~'~O fr0 ~ ~b Tz+4uS\'O~~N~ ~'AA By the granting or approving of the above plan, or upon the event of a subsequent permit being issued, sT.cROIx County and the STCROIX County Zoning Administrator,. does not assume or hold itself liable for any detects in!plan_ or specifications, plan omission, examination oversight, construction, or any dar-age that may result in or after installation. N I u) W 00 I W O O O A ego 47 O G o O G0 +C 1?. 0 _ _ 0) - 225.02' N 1°3506"E 155.00 D N I°35'06"E 380.02 o~O 14o cn 06 z 00 X0'0° w 0 ` c 0 N N (O Ut N - O m P o m m O N (o O Ln t.i~ o- C7. 1 380.02 N 1°35'06 "E 400.02' 0,'1' 6 6~ I 9;&, N N z O N O W Un N w OD O o W D W ° v o cD - m I .47 O_ 20--l { 400.02' o OD N A' o (D OIC O rr lz (D i r I 4 W !u O_ D N ITI I ~ 0) N I i-4 O 0 n-4 N IM r 0_ O m b I _ I • CID ~ A i 9 CD_ CD o cn_ Dv w cF p o 400.R2' 'I 150.00 o_o_ 133.66 116.36 ! ' m m rn Ir- N) W N O O_ (n m p N I z N Z .rri r N m (Dn G N) O- '0 O Z p O M /T9o5 ' s pM N-S 1/4 6 6 m SECTION. LINE Z c~'o SI°50W m NI°35'06"E 399.86' 0 _ 330.03' O m0 m z CD Zz 0 I (0 Z~ W (0 z o co co N N I p 5; 0 N ~ mz co O O N W j ff W z 0~ n Ul 0 1 W~ p ~ \ O I M Oz0 `v /63033 2S" 1 m 0~ Z D W I /96026"3S" m CD Z N6045 !z 17E 406.02' I Ir- 0 3325' i 14 Im ti A Om /9 2d--~ X Z sot N ir to s35.. C iz n _m 0~ ~I Opp o m C O Ln 01 N Z ,tea o~ti a3 g3 0 1 CD _ 30 ~F I cD Cn O_ O 56,8. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT A FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify thaSt} I have inspected the septic tank presently serving the O t residence located at: _N 1/4,_1/4, Sec. TQV N, R~_W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes~No (if no, skip next line) Approximate volume or length of time: ..allon_a-- minutes Capacity: 1000 GA1 Construction: Prefab Concrete j_Steel Other Manufacurer (if known): Age of Tank (if known): j. Bo kAr.\ -e e 1 t (SigBature) (Name) Please Print . fy)A'Jteiz~Iu~,~eiZ MPKSU 3goy (Title) (License Number) to l4 (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). ,I Namej_i~r\Qs L~ LtOvV ~r - Signatur +ntagL&t~rn.Q~ P/MPRS 'Foy 5/88 { STC- 105 j SEPTIC'rANK MAINTENANCE AGREEMEINT f St. Croix County OWNEWBUYER ~ c~ _ ~r_~.------------- - MAILING ADDRESS PROPERTY ADDRESS (location of septic system) Please obtain from the Planning ept. CITY/STATE i PROPERTY LOCATION 4~ 114, 1/4, Section T~ IN-IZ_ W t TOWN OF ST'. CROIX COUNTY, WI SUBDIVISION LOT NIJM13ER _ _ 3 CERTIFIEDSURVEY MAP , VOLUME , PAGE , LOT NUN13ER 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 j 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. Tile 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 (I) 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. UWe, 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: . St. Croix County Zoning Office Government Center 1101 Carmichael (toad Hudson, \VI 54016 11193 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 cN- Location of property 1/4_1/4, Section ,T N-R W Township Mailing addre s vz' Qtra\rc~~cj Address of site subdivision name Lot no. other homes on property? Yes No 1,revious owner of property Total size of property_ a.c 4e 4a Total size of parcel Date parcel was created Are atl corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes _A_No Volume and Page Number ~ as recorded with the Register of Deeds. - INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WgATZR114TY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certifie(i 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 bast of my (our) knowledge that I (we) am (are) the owner(s) of the property described, in this information form, by virtue of a ~.:rranty deed recorded in he office of the County Register of L ds as Document No. 3:1"yo~ j' and that I (we) presently o,: n 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. riatu e f Awl icant Co-App-l icant Da~/ 0 f-._ iure Date of -Signature er t NI:WN, Crn^Y~ry M Stock 'No. 1300 EiAR OF 71lSCONSIN-FORM S1 „ • Ya -Yt. - . - ATE ,NpRR aNTy DEED ` FOR RECORDING DATA COCUIttfNT NO. rAQ THIS SPACE RESERVED , ~ 653 - - - CIS. Shuster and___ Martin 20th Q T}{y~ eer, Oct us~ _ - Grantor 8.30 r. an~--- - a Itlun~~' w_ It Dint tenantsrQhtar ci D.odr iu s- a - Grantee, _ or a valuable ronsideratlon RETURN To - Grantor, That the said Nttnesseth, Croix - llowitte described real estate ie S-- t' eonv,eys to Grantee the o Cownty. Stye Y'tILonsw Tax Key No- located in the 'lover Station Subdivision, n 16, Township 28 jot 5, of the NE-1/4 of Sectio North, Range 19 West. i r r 0 not, homestead property* • This 1S urtenances thereunto belonging: (ttaC (is not) Sue Shuster Carol aPP Together with all andsrnyuuStereranan'ents an And Martin F. _ S~t1 le and free and clear of encumbrances except indefeasible in fee limp record warrants that the title and 'restrictions of for easement. ,19 82. and will warrant and defend the same. October q _ day of Dated this - j ~r (SEAL) (SEAL) f tin r = /Shuster • - t (SEAL) (SEAL) Carol Sue Shuster ACKNOWLEDGMENT AUT14ENTICATI014 day of STATE OF WISCONSIN ' SS. 1''1 l Signatures authenticated this---- St. Croix County. day of - before me, this - Personally came ame October, 1932 the above named ' Martin F. Shuster ste Car01 Sue Shuster TITLE: MEMBER S: ATE BAR OF WISCONSIN (I{ not. authorized by as drafted by a rson S - Xho executed the fore This instrument w to me known to be the p' Attorney at Law acknowledged the same. C. M. Bye, 167 going tnstrument and iii Main, P. 0' Box - rlK 710 Nor - Wisconsin 54022 « County. 'y Rver-F=-11s- c~ Is. 1 state e..tpiration ged. Both Votary Publ,ion t. perm if not anent. (Signatures may be authenticated or acknowled Wv Co t` nmi - 19 d3- ) _ are not necessary.) date. an -epac itY must be typed °f Printed below the' ;,4n,o Names of persons s,gn,nB a Y CMB:dc i M 9O t-19~~ ARRANTY DEED-STATE BAR OF yISCONSIN. FOR