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HomeMy WebLinkAbout042-1078-50-000 o CD -0 CD a o I CD C', ~r 0 0 I 0 o 4) (D a o 0 I ~ ~ I t N a4) o 0E (D 00 a 4) h a 4) ° Il- 0 ( p 0 z E z m o N C 1 U. 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OD 0 N A I my of S 00° 423d'E. , n o v g t0 f?~ 240.14 - j k 3 b A. n N ro vd mm w m v' 0 _6 y ao r- 07 O~^~St~ 7 L~ c ` 07 w w N N M FIA S 00042' 3dlE w 240.14 F : ,,,qa c6,t*VQS 0, ~q .2~ Sv\ aad to o nog N owl NO m 4 ao. EAST LINE NE I/4 240,14' SEC. 29 c S00°42 N a) -4 z rn F? ~L S,8043ANS [AINnOO 038 zzn X1080z aD Zil Cd a at~~. L 5 •oN ~kaAanS pa'ij gaa[) se ~ afea do sd SaAmis paz~zq o aumTOA ut pagzaosep utsuoOsTA '-4tm p xzoz0 '~S 'UeaalaM Jo ur►os I~saM``(91) U99~49M 9SUVa `uVIoN (6z) auiu-.tqueml d;rclsuMO `(6Z) auTK;SWOMIL UOT109S Jo ( aaqsBn~j aup ~seauqaoN auk `30 Rcm)"aaqaenb aup sea ~xou auk jd Dasa AS BUILT SANITARY SYSTEM REPORT OWNER J ' ( TOWNSHIP ' y SEC.,72~!_ T _2't N, R~[ W P.O. ADDRESS.,,- ~S lL~ c5c°_ , ST X COUNTY, WISCONSIN. SUBDIVISION LOT~L T SIZE P -Distances & dimensions to meet requirements of H62.20 i SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i V ~ r\ 31' I / ~00 ~0 us . a SEPTIC TANK(S) / MFGR. t_,K CONCRETE !/STEEL NO. of rings on cover / Depth DRY WELL TRENCHES NO. of width length area BED no. of lines width Z ' length 5'~? area / ,4- dept~} to top of pipe AGGREGATE y - y`- PERK RATE _ AREA REQUIRED 4 AREA AS BUILT Disclaimer: The inspection of this system by St. Croix County does not imply complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction: St. Croix County assumes no liability for system operation. However, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. '-INSPECTOR-' t DATED A PLUMBER ON JOB t LICENSE NUMBER r n~ ~ a REPORT OF IPISPECTION--I DIVILUAL SEr,IAGE DISPOSAL SYSTEM Sanitary Permit r.. d~ State Septic' 7A! IE.~L~ C. T61,111SHIP t. Croix County SEPTIC TA'?I • Size /c't-t- * gallons. ~ umber Of COMDartments Distance From: Well ft. 127, or greater slope ~ Y fi. f Building ft. Wetlands f Ilighwater ft. DISPOSAL SYST:4 Tile Field or Seepage Pit(s) Distance From: Tlell ft. 12% or greater slope ft Building; ~ ft Wetlands f: FIfLn `r',ighwater ft. Total len~th of lines, ft, Humber Of lines Length of each line ft. Distance between lines <<ft. Width of the trench Total absorption area sq, ft. Depth of rock below tile in. Depth of rock over the in.. Cover .over.rock, w,-:z . Depth of tile below grade in. Slope of trench in ner 1400 ft. Depth to Bedrock` ft. Depth to ground water, PITS Number of pits Out ide -eter ft. Depth below inlet i ft. Gravel a-rqun es no. Total absorption area sq. ft. j Square feet of seepage trench bottom area required `square feet of see _ge- Tyit ea required Inspected hp - - Title': Approved _ Date 197 Rejected. Date 197. EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON~SOIL BORINGS AND PERCOLATION TESTS LOCATIO ection_'2 , T~N, R LQ E' (or) W, Township or Municipality 141 4-7 Lot No. 'e 16 4 y / 61 13 to, County / Subdivision Name Owner's Name:/ Mailing Address: jdef XEQ h,r TYPE OF OCCUPANCY: Residence l/ N/o. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW y ADDITION REPLACEMENT DATES OBSERVATIONS MA/DE: SOIL BORINGS PERCOLATION TES S Lf SOIL MAP SHEET SOIL TYPE /atA-d9t/ A&V,2t~l PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- I z7 P_3 ~jfe N r 3 ~ ~ ~ ,s SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) S 4,*~ - B! Al. lpe_ t4 V 10- J ( / 10 / /0117-5 ,r_ " PLAN VIEW (Locate perco lation tests,soi I bore holes and suitable soil areas.) Indicate on the plan the location and square fet of suitable are Indicate number , quare feet of abs ?ptkkn area needed for building type and occupancy. to tale or distances. Give horizontal and vertical reference poln Indicate slope. L r~ III L l a D N Akk tN I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) ` Certificatibn No. l 7 Address r v Name of installer if known ~I CST Signature Lam., COPY A - LOCAL AUTHORITY r Z PLB-67 State and County State Permit # Permit Application County Per t ~ for Private Domestic Sewage Systems s County *DENOTES STATE APPROVAL REWIRED ~Ca • Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailin Address: .mot B. LOCATION: F Y4 - Section a T N, R E (or) W Lot# City Subdivision Na e, nearest road, lake or landmark Blk# Village ; ,r r W. h he Township ) _ gr9! v C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) *Variance Single family C__~ Duplex No. of Bedrooms ?z No. of Persons _ D. TYPE OF APPLIANCES:, Dishwasher _,e,CYES NO Food Waste Grinder YES 2-140 # of Bathrooms-Zs Automatic Washer L0-_YES NO Other (specify) E. SEPTIC TANK CAPACITY /0" Total gallons No. of tanks B-y%A~ *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) IS 2) . 6~' 3) _J, Total Absorb Area/ sq. ft. New4----Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length f¢ i Width Depth 3&d „ Tile Depth _ZX1/'1 No. of Lines 1- Seepage Pit: Inside diameter & Liquid Depth Tile Size y Percent slope of land Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil T/ester, 9 NAME ;K L It ca• ~~J SC.S.T. and other information obtained from (owner/builder). Plumber's Signature MP/MPRSW# Phone #000- ✓t'y{~%' Plumber's Address ' PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 7- t I~ ry6 _ -7- k Do Not Write in pace Be ow FOR DEPARTMENT USE ONLY Date of Applicatio 0i a~ Fees Paid: State /0,00 Co n y a/4/-00 Date l Permit Issued/ (date) p Issuing Agent Name Inspection Yes No Valid# Date Recd 1. county (whi copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER YAA.IiIA`i,l 6ftg. ADDRESS qo-f/' SUBDIVISION / CSM# LOT # AA- SECTION T_-,'e? N-R g W Town of Z-0jr- ST. CROIX COUNTY, WISCONSIN PLAN VIEW d .u.@. SHOW EVERYTHING WITHIN 100 FEET OF S i Sw ea~~ f CO,-V,- 00 IV144-11 640, 41, 1 4 Cg - AF s W Cyt-'^''`-/ 1 ~ 1 `0 D _ 3? r INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. d l BENCHMARK: /dim e~~ ~JwO.' nu s G19CAB-Lnn :~C~o~/:I0.7,G/ ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:- mA4 6" b4 Liquid Capacity: "'00 Setback from: We11S5/ 7House_/y/ 3~ Other _ Pump: Manufacturer Model# /y Si Float seperation Gallons/cycle: Alarm Location~- :SOIL ABSORPTION SYSTEM Width: S~ Length 7.3 - Number of trenches Distance & Direction toinearest prop. line: Setback from: well: / House -y6~ Other nn np ~c4~O 7 ~ e-~ ELEVATIONS T,4 Building Sewer nn ST Inlet. 93-95 ST outlet 9 3-4G PC inlet X PC bottom 114 Pump Off / Header/Manifold ! X4&7 Bottom of system Existing Grade _ Final grade- _~nl~___ DATE OF INSTALLATION: PLUMBER ON JOB:C U GLICENSE NUMBER: INSPECTOR: < p 04 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Larsora:- -4,luman Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION ❑ City ❑ Village X Town of: State Plan ID No.: PffSSUUe~aLiAIff's Nf ffb~D ~~11~~LLt'iK ~ ttll A I Warren CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: le"O. e& A9500420 a _S TANK INFORMATION ELEVATION DATA 1210 :5 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ee' c l'G~J Benchmark 3 S ~rtC . ;o09 ° a Dosing Aeration _ Bldg. Sewer Holdi St/If Inlet 9 3 y 93, TANK SETBACK INFORMATION St/ FjI'E Outlet 950 93, 66, TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header..- 91° Aeration NA Dist. Pipe 9°. 12- i3l 9a. 33' Holding Bot. System SCE PUMP / SIPHON INFORMATION Final Grade M nu ac Demand Model Number G TDH Friction em Ft Loss ea Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. uid Depth DIMENSION S 75 a DIMEN I N SYSTEM TO P/L BLDG WELL LAKE STREAM LEAC -Manufacturer: SETBACK INFORMATION Type O srr. CH ER Model Number. System: &-40"C/ R UNIT DISTRIBUTION SYSTEM Header/Manifold / Distribution Pipe(s) x Hole Size x Hole Spacin it Intake Length Dia- Length Dia. Spacing 4a, SOIL COVER x Pressure Systems Only xx Mound Or At-Grad yste I Depth Over Depth Over xx Depth Of xx Seeded/Sodded xx Mulc e Bed /Trench Center Bed /Trench Edges Topsoil- ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Warren.29.29.18W, NE, NE, Lot 4 Both Avenue i to 11'7 Plan revision required? ❑ Yes 9-116 Q Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert No. D~t~HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY r~i STATE S'~~YT;M# -Attach complete plans (to the county copy only) for the system, on paper not less than :J 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPE OWNER PROPERTY LOCATION N, Aok,S T N,R E(o W PROPERTY OWNER'S M (LING ADDRESS LOT # I-A BLOCK # P-30 17 1 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ,5,/Vd S,z 6a_ .5-3 11. TYPE OF BUILDING: (Check one) ❑ State Owned O 12LALAGE : NEAREST ROB 1' ❑ Public U 1 or 2 Fam. Dwelling-# of bedrooms ~ PARCEL TAX NUMBER (S) III. BUILDING USE: (If building type is public, check all that apply) Q 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 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 130 Other: Specify IV. TYPE OF PERMIT: (Check on one in line A. Check line B if applicable) A) 1. ❑ New 2. Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued 7 TYPE OF SYSTEM: (Check only one) Alon-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ eepage Bed 21 El Mound 300 Specify Type 41 El Holding Tank 12 Seepage Trench 22 ❑ In-Ground 420 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 14. LOADING RATE 5. PERC. RATE 6. YSTEM LEV. 7. FINAL GRADE R QUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) )9`~`'° ELEVATION \75 0 OWL Feet VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete stCon- glass App' Tank Tanks Septic Tank or Holdin Tank 000 (.t, ccx/ M. ~2w -471 H Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps MP/MPRSW No.: Business Phone Number: -16-4a ~ 90WA- 4_ chi L1` ~ (7157- 7X°9 3-`3 Plumber's Address (Street, Ci , State, Zip Code): l w 441 5- A& IX. UNTY/DEPARTMENT E ONLY ❑ Disapproved Sani ry Permit Fee (includes Groundwater Date Issued Issuing A nt signal No S s) Approved F-1 Owner Given Initial ~`Surcharge Fee) Adverse Determination / W 10 X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. ,A sanitary,permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. - ` 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a llcensed' pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be-complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. " 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) cvmplete_specifcations for pumps and controls; dose volume; elevation differences; friction loss; pump performancedurvd pimp, ek d pump manufacturer; D) cross section of the soil absorption system if require8 by the.co ' to 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) 1 /©7 -r 0 GO ico 00 Uo jp In 'C LAS N o C ^ 4 o w ti~ o ~ rn q o o o- o ~J t----- y le N o ...ow _Nv r l _i Wisconsin Department of Industry, SOIL AND SITE EVALUATION, 1 3 Labor and Human Relations Page Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan miist County include, but not limited to: vertical and horizontal reference point (BM), direction -id percent slope, scale or dimensions, north arrow, and location and distance to, >st road. Parcel I. D. # APPLICANT INFORMATION - Please print aU information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location AR,4✓e- /.S /4. CO. Alw Govt. Lot *,f 1/4 NE 1/4,S 29 T 2`f N,R E (o4D Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 107q go tk AVE • e,5~tf 37ZII177 Ua/ 2 P,-- S37 City State Zip Code Phone Number Nearest Road ROBERT Wt. 5y62_3 (7l5 El city ❑ villa e£ own ❑ New Construction Use: LrfResidential / Number of bedrooms Addition to existing building [a-ffeplacement ❑ Public or commercial - Describe: Code derived daily flow O gpd Recommended design loading rate „ bed, gpde ' 00 trench, gpd/ft2 Absorption area required bpd, ft2 7_15-0 trench, ft2 Maximum design loadino rate bed, gpd/fl2 • e trench, gpd/ft2 Recommended infiltration surface elew 's) S-4u- ! • 3 ft (P red to site plan benchmark) Additional design/site considerations _ ~S"E - En w /~10 Parent material 9--5; 67 - loews S 1 J UIe~y4/pA0T Flood pia ration, if applicable A1~4_ ft .V S = Suitable for system Conventional Mound In-Ground Pressure A rade System in Fill Holding Tank U = Unsuitable for system S 1:1 U ❑ S U U~ ❑ U ! IJ' U ❑ U El S EM SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Rdots - in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 /~v to yR / 511 2.wr 5h& :15.4 S Zf' _5 & Ground 7 C,2 -p elev. Ly /O -7-S Vk / 4"7"/ 09 (OX Y e2 s g y G6 u,~ Depth to C G _ limiting ~7 E!¢54~ Qlk-7- 7~ . 35 factor _ -717 In. S sr~~~ 76 r - VCJVr 555 Remarks: e Boring # loyk y Z 8- /0 Y/f J/.z. /-fs el~s~ cs v 074 • y ' • s zo Ye C zo a 'Ground 41 -7 7s yl ;Vlea S J~~ 1-r 4 elev. '_~ft. - o 10 Y12 S/ lei f Le5p - GS 0 n+, 7 /,0 gS77- ; Depth to MAI _j limiting factor *~Lin. Remarks: 13, .SU1 rj9/E /9)e XOUyD A ~ T CST Name (Please Print) Signature *4- Telephone No. ~a _ Ulbricht & Associates -1/y 13 ~G ` el( .J Address private Date 655 O'Neil Rd. CST Number Hudson, Wig. 540'6 ~NS ~NO 7 ~ff~, Sai/s /O 2 O oZ eOeUAFD (36V r-) 77' NHS ~D of S!/ST~iy ~(~E,vj 'Elf - S aC7 6i- 40 >fYE* c ~o S s7'E 133-43 13(, /'s s•r~~ ~,v s so,~ ilk ~ ' ,f GOa-0a e 5-C 7-2 PROPERTY OWNER - FRAM- 5 L00RAD SOIL DESCRIPTION REPORT Z 3 Page of PARCEL I.D.# Horizon Boring # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 '1 •9 /o yR y l s,/. /f 54e cs f( 4 cam. • &4 co c E nn Ground Z /D / (!G`/~ s 0 S JCS C S S. Co elev. ~3.3a Depth to limiting factor y_ -in. Remarks: Boring # /O VP N ; a Z G 7•5 v YI aQ~ Gs 0 s ~Q X cs • ~l Ground 3 0'/ O S S elev. 9yolo-ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # /D /P S/~• /7~S~Jr~' nMie S 24 Z, -3 57 -64 /0 Vie VV Ground elev. 9~1 G 6 ft. Depth to limiting factor S in. Remarks: ~,pE~JI- dto .a S S U t'T S l E Oy LS/ Fate M a v ? AT y.Pr4 ~ Fs Boring # 0 C-5 ,3 f .5. i 7 V' f sd~ 44 ff• ; Y12 1 5h& Ground 3 7. R S C.S. 0 , S GC CJ elev. .f Depth to limiting factor 7Q_,,-in. Remarks: `SBDW-8330 (R. 08/95) s, - o U~- L7 9 SLn m n y Q ' w r O o o 0 0~ ~ ~ ~ ~ m w ~ o ' s to m o Q3 r y ~ o► to ti NJ L T , y ~ v~ o 9 - I lb K CKZb b~ m W I i (JV I 2YQ 3 4 6, Part of the Nort~east One 1 Quarter••(N*),of the Northeast One Quarter of Section Twenty Nine (29) NTownship Twenty-nine (29) North, Range Eighteen (18),West, Town of Warren, St. Croix County, Wisconsin described in Volume 2 of Ce)rtified Survey Maps on Page as Certified Survey No. 537 t' F I' L E D 08 23 Jt 1978 1,Jrii O' C . O Q r R.r.#...,,+,.~. W . N 91 . Crox Cq'^ty, N h WIS400A Cc Q• c9 w 3 Z V t11ti1 S SD z z J: ....:,,,0.{aJrlr~ 00 Uj UT 7•S zr-m N 3 0£ ZboO0 S 6Z '03S ,0 bl'ObZ 0/13N 3N1'1 1Sti3 t~ S 41D t. f" O~ OJ P , 03 0 o s~ PQe~sys~ m CD CIj cmv 't Pz c'oQ~~G N QQ~O ~Ot \R~ 0- 0 -1 ~~6 S ~b,LLL. 'D d -~O J - bl'00Z - JGp M j,O£,Zbo00 S ; C4 ts G use` z M M N~ M Ll! C OJ Z M + N to C-0 00 9 a ~ y: N_ N J: W N V vFi 3 a a Z'" es bl'ObZ = ill g a o u v yI „O£ ,Zb o00 S z~ ' z ~ W3(D J 'r z N OD Ci W Cr) W~ I~ 3 N Q N Z h) O ~ M O ~ Q cn 8 M J F- J : J ITJ J; W M ti O v ~Ij z o Z z o z 7. 3 „0£ Zb o00 S V 00 Z ~r ~ d' to 1 Gay M ` M w -7 LLJ 7-: Tl ~a e.. W LJ O 0 3~. • Ib o ' ` Je v OLSZ N } w 40 - M"00 80 :ION ot - _M/2! KWISV3 M„OZ Pt, o00 N -6Z'33S - 3N-3N 3NI-I 1SWA ODD1111~ W W: y I. O• Q: 3.w Z: 'z z Q J. Sheet 1 of 2 sheets J: } ` Et f i ~ s 3 4 6j. Part of the Norte east One Quarter•(NF7J),of the Northeast One Quarter O of Section Twenty Nine (29),'~,ownship Twenty-nine (29) North, Range Eighteen (18),West, Town of Warren, St. Croix County, Wisconsin described in Volume 2 of Ce)rtified Survey Maps on Page as Certified Survey No. 537 011 ~A&A~k r ~ FIL~D 23 JA "1978 J";, a4 O' C . O Q C'• R+/.~+n Wit' ~'°M N St. Cr tx Cq wry, N Z O : l9. WltMniM V 3 ~ Q , Q : ' ~iat V _D gg~~ oc ~ 7N yam Lis , '0~~ z m N 3 0£ Zbo00 S 6Z '03S QE 1~ ,bl'ObZ t1/1 3N 3NI1 1Sb3 #J AP V ` Q~ °ay x\S-r' PQQ yst N C4 \ S r` ~ 0F N ro N QQ~ ~Gt O`I P DES G C3 bry.~~ 4,0 -i bl'ObZ - . M 110£,Zb000 S '40 N Li f GOB ZO Z M M N M Ltj S va0 0 J y : , IOa` N N rA to cr 9 Q 1 W N \ 2 -P) I lW 8 Q o p~ .,y. '~I„0£ ,Zbo00S ~J W N N pip W~ ° z : z Q t` LL - Q J W3 v z Kj: r N Ci W W Q N O J' cr Q0 K) 0 J. 8 O J' z ~ m tv W ro = 2 cn o z 0 ~ ~ bi'ObZ = 3 ..02 Zb o00 S 0 v z z ~ } 1 W 9~$ M JONN -n 'tz LIJ 74 0) l M 00 80 1_MM AIN31SV3 s~ - r✓ • '1• ' M„OZ,Obo00 N -6Z'03S - 3N-3N 3N1"I 1S3M , oelt~~e W W: 3.W z : Q t J. Sheet 1 of 2 sheets J: ' ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that have inspected the septic tank presently serving the residence located at: Al - ~ Section T N, R l g 0, Town of &ZaAz -L- 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: 9 c~ Did flow ~aek occur from absorption system? ~ Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer: (If known) : Age of Tank (If known) : /279 (Signatu ) (Name) Please print (Title) (License Number) Da A c3-2_ _ 7s 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). Name 4t'l"~ -Ivek~ Signature <?6/V A P/MPRS © 5 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croy County OWNER/BUYER MAMMG ADDRESS D 7 9 9 A PROPERTY ADDRESS / /9 75 Cl2 S A/0 3 (location of septic system) Please obtain from the Planning Dept. CITY/STATE e)i' PROPERTY LOCATION AZ,4F 1/4, 46e~ 1/4, Section, T-7 ? N-R °-l ~ TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUM13ER CERTIFIEDSURVEY MAP SVOLUME i?, PAGE -<~3%, 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 systern 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:x ' DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, W1 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. L Owner of property 1-d Location of property W-e-l/41/4 , Section -*zg, TN-R l Township' Mailing address C v f6C-~~i~- Address of site 62 79 -3 027LA Subdivision name Ccr c C5~7( a pS Lot no. h cnaes'n property. Yes No Previous owner of property Total size of property Total size of parcel Date parcel was created Are all corners and lot lines identifiable. C,--lYes No Is this property being developed for (spec house) ? Yes L~N0' Volume 3,~S- and Page Number 5 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-thelpful 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 fora 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, 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. X Si4nature of A icant Co-Applicant Date of Signature Date o. Signature r F GUItV Ssl ~~:.RH.IA11 ni;lL1) -10 .1111 V' 1'. Il.:A1'S. 1Srcth- 1311.41WI.roo-ho Statute., „ y5i75 9~' This Indenture, Made Ihi> 16u, (Liv of S_~id,tvi E221, A I> betc,cen I;',. Is11I UI 1111• tll~~ 11.11 I. ;11111iirt, Fut.ler- as joint tenants, 11,1118 of Ihr -,(111,1 11.11(. Wittlesseth, That the `aid Iclrt " of the Ijrst part, for anti in considerali(n1 of ills 11111 id I in ll.llid Itaid ltd Iht -aid Ir,Irti(- of the srtv,nd halt, 1111 rcto-lpt It('[ A-1 i~ h(„h1 (,ntl,• 1 .11111 .It 1,11'm 1, t1,,, t1, v n, r.ulit (1, L:u(l, "intl, n ntircd, Ic1c't-rd, :llicnrd, 1 t,n\ r\ t-tl an,I 11,111,1 till 1, ill, I Its 11to ,r In,,t ni,- it.oi.[ill , 11, 1rnli,t•, it It air, tlicn, conleV ;old ('11111 Ill tint(, 1111 .!1d 1,1; 11, Olt, ~w(,tn(I l,,u;, iu jtliltt Itn.ulo~, their hrir~ ,old ,t-i,;us folrlrl, the fnll(Mini; described teal ,~(.Itt, .ilu.lit,l in tilt Clgll l of old Stair of Wi,consin, to o-1t'it: I es 41 M~ 119 ~ J y `~II RJ 1 ~ to (tr• 1 tl "'It )~>-•i ll "P t,~ I{l;'P~ 1,_ Together, 1cith all and singular the hereditamcnts arld a1111nrtrnauces tht'reunto belonging or in any 1kise at111ertaining; ;Intl all the e,tate, right, title, interest, claim or demand whatsoever, of the said (rut of the hlr t trot, either in I'm ('I elluitc, either in 11o„e,~ioil or exlxrtancy of, in and to tilt' above bargained Incntirr-,, .111(1 their hercditanucnts and 'Ippurten: lwe,. To have and to hold the ,aid premise, as above described kith the hcTt.dit:unent, and appurtrll-lm-, unto the said patties of the ,ecorld Hart, in joint tenancy, and not as tenants in conurlon, and to their rr~llrctilr hei;> .Ind assigns Fl)IZ1-:VE.R. And the said r t I fur heirs, cwcuto]s and admiuistraton-s, do Covenant, }',r,uct, li.ut'.~in :uul nC to and ce~ith the ;aid p;trlivs of the second part, anti their re;lx.e-Iiyc heir; and as5it;ns, Ih,~t it the' tinuof IhC rk~t . o~ y Cte'Caling anti dvIi\t-r)- of tht-;v lcre;Cnts well ht-ized of the l~nmi>x, alnwC dc•'(rilwd. c,f :c ii~cx1, sort-, ln'rferl, alr.olutc and indefeasible e;talC of inht-ritanet- in tilt- lace, in fCe ;imlcle, :uu1 that the ..inie ,ire fire ;uul r,Car fruit all inct nnbranCCS clime er, k: f f~ and 111,11 the 1"tlt;.iined prerlti"e; ill the ctuiei and lx•arcal~le Ian'--c-ion of Ihc• raid p,irtie': of ill( p.11 1, l a; joint ten,nit anti their ir•lu rtivr h~ ire acd i,,n;, at~:~in~t all and ec~erv lx°non or Ix•r=on~ Lt~cfullc c laiiciin:, the nholcor aliv lrirt ihrn d, %tiill tore\rr A\ARRANT :A°:I) I){•TIIN1). In \\itness Whereof, tilt- '.kill {,art of the tint p:crt ha hereunto ;el S and ,t-al Ihi~ day' of A I)., lcl ~ `tlfl 1E a • 1 rl nUnt v- I lt;t.tc d:~~ ..t ~n{,r=t~,Ler t . 1't un,Inf~~ie n tLi :A. I ~ the nlnice uur.~ 3 o nn n t.. I~~ tln• I~~ c-'m cho rvtit( (I Iln' foret;oin;~ in>triuuent and at knO vvIcdgcd the >anu•. 1)ltane F. Caunt i . NM:iiv I'uhlic, Znf'ha70 1 ~~iuiic, AVin. llc c innn~i -iml c•st~in•, July 19, 1 I r t'~ 4. , W7 Z Z ' 0 t