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HomeMy WebLinkAbout002-1065-30-000 r STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER__ o%dy, ADDRESS 7/0 SUBDIVISION / CSM# (/o•P. /Q LOT # 56k,15E`'c~SECTION .26 T aQ N_R W, Town of )8aZp64-)jr7 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM h7ro k. 6;, cd btslwbahe-e- moecnd _ Area Pie stied a~a-- C a+M b,tita.~~ dot ZSO~Q. I Scp~.c. '~n1l~l,-ts~~.a•Q. ._L I 3 3ccleOr Noasc. I INDICATE NORTH ARROW" I~ Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: Length` Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt rscorlinDepartmentofIndustry, PRIVATE SEWAGE SYSTEM County:: Labor and Human Relations INSPECTION REPORT ST. CROIX ,.Safety aRd Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village Town of: State Plan o.: ANDERSON, RONALD / O1 9 al_ Ko 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 Dosing 322 S Aeration Bldg. Sewer N3// StInlet TANK SETBACK INFORMATION St /Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Is All A- NA Dt Bottom ,/3 55 Septic d r Dosing << /1 ? ~>o NA Header / Man. / Aeration A Dist. Pipe 9 Holding Bot. System /T logo INFORMATION Final Grade Manufacturer 0.~clls Demand S~ Model Number X03 ~s-Gp TDH Lift Friction j(' 5ystem~ TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width.3 ! Lengt , No.Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION DIMENSIONS LEACHI acturer: SYSTEM TO P / L BLDG WELL LAKE/STREAM SETBACK AMP INFORMATION Type of CHj Model Number: System: hlC ~tt,d c~0~' 3/~ Q(p OT NIT DISTRIBUTION SYSTEM Header/Manifold ~,r7,J~ Distribution Pipe(s)„ x Hol/e,Siza~, x Hole Spacing Vent To Air Intake Length Dia. Length ji - 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 No Ly ~`eS ❑ No Bed/ Trench Center - ~o Bed / Trench Edges ,y Topsoil & [ El COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: B ldwin.26.29.16W,E, SE, Highway ,plc l( i/ ` J l~~ ! C ry Lc f ~Q,1 f .',.t~ r ~jYrtl J. lv. r J 4. / / ji . ~1 GIL j 4~ r > l r9 c ~~~G~G~ Plan revision required? o Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. 0 J~~ _ ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e SANITARY PERMIT APPLICATION OIL.HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY ....grows. STATE SA^NIT549 MIT# -Attach complete plans (to the county copy only) for the system, on paper not less than d d 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. Q~l~- Z dG S' PROPERTY OWNER PROPERTY LOCATION e or~- f7n~►[~Y' Sd tti 57,C11- SK '/a, S 4 T ZN, R It (or kw PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 325 1-;--2c? /e Sf . IV Ax CITY, STATF, ZIP CODE PHONE NUMBER SUBDIVISION NAME OR C NUMBER W« vi le S-elOZS 71s fa9S--ZZ/ II. TYPE OF BUILDING: (Check one) El State Owned VILLAGE NEAREST ROAD ❑ Public 01 or 2 Fam. Dwelling- # of bedrooms PARCEL TANUMBER(5) III. BUILDING USE: (If building type is public, check all that apply) Z 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 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.,X New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 R 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.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 30f~ 250 2-:50,50 -824 1VX10 /db •O9Feet /O/, .5 ?Feet VII. TANK CAPACITY Site in ailons Total of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank IC0 40 0 Lift Pump Tank/Si hon Chamber 7- 7 19 1 L1 L1 1 11 -7501 F1 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: ,o>e? xc r/0, 45;~~ 7- Plumber's Address (Street, City, State, Zip Code): I . 92-0 17905~. J a ! o~u~ ; n LJ~' , S~dO Z_ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved San ry Permit Fe Includes Groundwater ate Issued Issuing Agent S' f c~ Approved ❑ Owner Given Initial rcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS 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 licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. 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 mairis,'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) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 3, 1994 209 West First Street Route 8, Box 8072 Hayward WI 54843 BOLDTS PLUMBING 820 MAIN ST BALDWIN WI 54002 RE: PLAN S94-20645 FEE RECEIVED: 180.00 ANDERSON,RON SE,SE,26,29,16W TOWN OF BALDWIN COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, I Carl Lippert Wastewater Specialist Sr. Section of Private Sewage (715) 634-3484 Mondays 4148R/ 1 SBD•6423 (R. 01/81) 1, -LJ U 1 ! 11 l In accord with ILHR 83.05. Wis. Adm. Code COUNTY S r Attach.comptoto site plan on paper not less than 8 1/2 x 11 inches in sire. Plan rtwst indude, fwt not Gmitod to vertical and horizontal reference point (84. dreclion and % of slope, scale or PARCEL LD I dimensioned, north arrow, and location and distance to nearest road. • APPLICANT INFO R. I. IATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTYONNER PROPERTYLOCATION n S o r- WW. LOT S. k 1d S 1/4,S.C 6 7 2'? ,N.R //,I w PROPERTY OWNER'S MAILING ADDRESS LOT I BLOCK I SU80. NAME OR ISM I 3 S- a le, /VA 1!4 CITY, STAT ZIP CODE PHONE NUMBER ❑CtTY ❑VILLAGE RTOWN NEAREST ROAD (715) 69 - 22I 0 New Construction Use (A Residential ! Number of bedrooms Replacement ( ] Public or commercial describe Code derived daily flow 3 00 gpd Recommended design loading rate 5 bed, gpolft2 trench. gpdA? Absorption area required ,;~5 nn bed, fit Z 50 trendT, ft? Maximum design loading rate ° 7 bed, gpd/ft2 • $ trench, gpd/ft2 Recommended Infiltration surface elevation(s) X18• C? Z_ It (as referred to site plan benchmark) Addtional design / site considerations Parent material Flood plain elevation, if applicable /✓X fl S = Suitable for system aM94T0NAL (MOUND H QG OUNOPRESSURE AT-GRADE SYSTEM N All HOCDWG TANK U= Unsuitable fa s tem ❑ S 13U OS ❑ U ❑ S C91 ❑ S U ❑ S M U ❑ S_&U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Texture Structure Consistence BOxb3y Roots GPD/It in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrend- `yGtf ,5XR ✓o 15 Z n7Sib l~c~ Qs / Ground 33-~l •.5 fl ~ Z d 5y& 51g Cs r ~ r; ~ a S elev. 9'y 371t_ y -70 7,; %f' S~G e c>l 5Y1'51 Depth to limiting 3 3 Remarks: 1~;r o O wci / e r a~ '7D Boring it - a-/5 ,5Y~c5~ 5~ one .sl zm,6 r~r~~'> CcJ /1 .5 rJ 7- IS-36.75 Y,P Alone, _rs C L.') -51.6 3 31,-4zl Ground $ y SY~P s S CsY r S / .7 • 8 elev. ~y rJ '7.5y,~5 C sy~es 8 ~5~ •'7 98• y3' n. Depth to - limiling (actor - - - 06 5- 36 Remarks:. G'.- • -cif ~cz /t°r n7` iY CST Name:-Please Pint L" Phone: ~a I F ~,A~.so 7~sJ ~•S y 33 7 S Address 1 ~60 2- Si nalure 0310._ CSI Numbe, Tj - 5__ 9 3113 1 07/20/94 _11:11 $ COMM CLERK _ 0002/002 Boring 9. Hotizo Depth pominant Color Wift Structure In. Mun$ If 4v.Sz. Cont Calor Texture Consistence Gr. Sz. Sh: Ba vza soots GP ~d 10-/0 ,5 Y -le s C w 1 6 p z7 al, s eJley- ion 07 ' Depth to idling bck)rr Fiemaft- Boring # Ground elev. Depth to Finning (actor Aernarks: Boring # I Ground etev. tL Depth to knifing War 2 + Remark,• Boring # Ground elev. tt Depth to knifing wor _ - 4 Remarks: Q~..tier: 1\on hrlo/GI`Sp,1, 2)O-awr. 13y; 32 S /~'l aP /C St i P 12 9 71:5 - 69 g Z Z / ~ CST 3y/3 S94- 206 4 5 5, e, s~~ sE i 9 A K lZ Gtr 0 PoSs, b~c NouS~ to~4 f roy.- 4- gl Mound 60 71~ oB. 3°l0 165 Area 50 93 i Zoo st. BM, ~wncr: 7~0n /yr)oIG/`so .lJrawV,- By • 325 Maple Sf e ~ JyP ~GZ 9 71s -6qg ZZ/g CST 3y/3 914 ~ 06 4.5 o N Z3, M, _ 160.0 T~ of o~ r oa~ sFi SEi 79N RI~~J D ~ ~3- lOa•g7~ shed House ~o~af 1" (f 4~ "20' 50 U B 4 /~0 5 3°10 TO spiol 93 63vi - 4IDN'SlON Sp0N t io7 Cross Section Of A Mound Using A Trench For The Absorption Area o - H Medium Sand-Fill ~I F 6" Topsoil 3 E Trench Of '2" - 2~" Aggregate, Plowed Layer 6" Below Pipe, Covered With 0 /0 Ft. Straw, Marsh Hay Or Synthetic Fabric E /-o Ft. G /0 Ft. F 1$5 Ft. H AS Ft. Plan View Of Mound Using A Trench For The Absorption Area Force Main J Distribution Pipe Permanent Maskers Observation Pipe WK LABOR aujtjaiKG$ uav►1OeAO It - 231" Aggregate ZESPCN®ENCE EE CC L L A 3 Ft. I /D Ft. K /D.~ Ft. W Z I Ft. B g3.5 Ft. J S Ft. L /0 Ft. License Signed: Number: ~'lJ~~~Z9 Date: r7 / - 7 -q / 1f ~94m20645 zed' 4 Distribution Pipe Detail For Two Lateral Network Holes Located On Bottom Are Equally Spaced PVC Force Main End Cap ~ IF- 'Y FX-71 ~,X PVC Distribution Pipe P P X * Last Hole Should Be Next To End Cap 7 P '02-5 Ft. Hole Diameter / VI/ Inch X L1 $ Inches Lateral Diameter Inch(es) Y Inches Z Force Main Diameter 2- Inches # Of Holes/Pipe la Invert Elevation Of Laterals loo-5 Ft. Signed: License Number: WZ Date: '7- `7 -9Lf g N UNiRN BUILDINGS TRY k9 .AF 00 e 4 flf INOUs DIVISION OP S no SPOND ,EE _ 2~g45 0 PAGE OF ~ PUMP CHAMBER CROSS SECTIOIJ ANO SPECIFICATIONS VENT CAP Y"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUUCTIOM BOX MANHOLE COVER ~ 25' FROM DOOR, WINDOW OR FRESH - 12"MIU. AIR IAITAKE I GRADE ( Y" MIK1. 18" MIN. COIJDUIT-- 18"MIN. \ PROVIDE I - INLET AIRTIGHT SEAL I I i I V I I APPROVED JOIMT A I I I ( APPROVED JOIWTS W/C.I. PIPE I III W/C.z. PIPE EXTENDING 3' I II ALARM EXTEUDIAIG 3' OMTO SOLID SOIL B I II ONTO SOLID SOIL r " I I ow ;4~ i;Y, LABIIt~ & 1 jJMAW fi i AiIOPI ELEV. FT. tNG. IS101~ OF SAFETY AND BUiLDiNGS PUMP OFF t o SEE CO ESPONDEN'~E OUCKETE FLOCK RISER EXIT PERMITTED ONLY IF TAIJK MAMUFACTUREK HAS SUCH APPROVAL SEPTIC E 5PLECIFItATI0 AIS DOSE- TAKIKS MAKIUFACTURER: NUMBER OF DOSES: PER DAy TAWK SIZE: GALLOUS DOSE VOLUME INCLUDIMG BACKFLOW: 90 GALLONS ALARM MAKIUFACTURER: MODEL AIUMISER: 9 CAPACITIES: A = 2233 IUCHES OR `f1_5"17GALLONS SWITCH TYPE: 5= 2 IMCHES OR yf gg GALLONS PUMP MAUUFACTURFR: C= -5" LIMCHES OR 9192 GALLOIJS MODEL NUMBER: ~~d 3 D=_L_INCHES OR D 'Z GALLONS SWITCH TYPE: I " /eI'',n ar MOTE: PUMP AUD ALARM ARE TO BE I~~>t~* 2.tPM INSTALLED OM SEPARATE CIRCUITS MIUIMUM DISCHARGE RATE Lr~14r VERTICAL DIFFERENCE BETWEEU PUMP OFF AMD DISTRIBUTIOU PIPE.. _/2- FEET -I- MIMIMUM NETWORK SUPPLY PRESSURTT,E/~. . . . . 2.5 FEET O FEET OF FORCE MAIN X i/0 F/po,FRICTIOKI FACTOR.- FEET TOTAL O%JXMiC HEAD = FEET S,94- 2 IAITERKIAL DIMEIJSIOMS OF TAKIK: LEKIGTH ~g -,WIDTH -,'LIQUID DEPTH 61,4 lG SIGIJED: LICEh1SE KIUMBER: ~L ~ DATE-1-1-2y : Submersible Effluent . ,Performance Curves PUMPS w q METERS FEET IS (5) 4 " 645 9° ::HMODEL 3885 25 80 SIZE 3/4" Solids WE15H ° 70 x 20 WE10H J 1Q- 60 O -WEOTH F- 15 50 WE05H 40 10 30 WE03M 20 WE031 5- 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 I L 0 10 20 30 m'/h CAPACITY [4GOULDS PUMPS, INC. SGWC► Hats PEW Niow awe METERS FEET 120 MODEL 3885 35 SIZE 3/4" Solids 110 WE15HH 30 100 90 25- 80 i Q 70 Z 20- 0 P- - 50 WEOSHH 15 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM Li 1 0 10 20 30 m'/h MP~znCAPACITY 7- 7 - 01985 Goulds Pumps, Inc. J % EHecGve July. 004-20643N h-1 ©I L H R in accord with ILHR 83.05. Wis. Adm. Code •~+N~•^~J COUNTY Y . ' Attaj:h Complete site plan on paper not less than 8 112• x 11 inches in size. Plan must include, but snot limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. I dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY ONNER: PROPERTY LOCATION O a .So 'r - GOVT. LOT -5,r t14 S'i I14,S,7(T 29 N.R f~ @ (or W PROPERTY OWNER S MAlUOIG ADDR SS LOT # JBLOCK# JSUBD.NAMEORCSMS 32 s /Vcr /VA /V14 CITY, STAT ZIP CODE PHONE NUMBER OCITY OVILLAGE VOWN NEAREST ROAD tJaa (715) 61 78'- 2271811 0 New Construction Use 1>1 Residential / Number of bedrooms 1 1 Replacement ( ] Public or commercial desrxl ttr Code derived daffy flow 300 gpd eg grate • s bed, gpd/lt2 trench'. gpd/ft2 Absorption area required 25 0 bed, ft2 Z 50 tr Maim deSi rate ° 7 bed. gpdi(t? • $ trench. 9Pd/ft2 Recommended Infiltration surface elevation(s) S It re red to site plan benchmark) Additional design / site considerations Parent material Flood LWJ elevation, N applicable AI b S = Suitable for system CONYENTMAL MC(*: ` 7, % y RE AT-GRADE SYSTt3d RLL HOLDM TANK U= Unsuitable forsystem ❑ S .a U$' U S U ❑ S r Ku ❑ S U ❑ S-RU SOIL DE ,C ORT Boring # Horizo Depth Dominant Color Mottles Texture Structure Roots GPD/ft in. Munsell Qu. Sz. Cont Color , Gr. Sz. Sh. Bed Tmrd ` M a f O-`/ 527 tAKI v0 P /s Z s~ l/Jr/ Qs / s >.:r;:<>.._ Z y-33 r7,5 5~ Gro und 133-91 - F -d 5/8 es - Fr 7 elev. V _U fft32B- Gq-70 sYkSG sus g ~Sr 1-721 •s Depth to limiting factor A/ Remark' : G' u s e r A~ '7D Boring # I a-/5 ,5Yc5~ 5~ onC. sf zm~b n?v~r - C/J •5 I /53Z 75 Y_ ~Z/ o nr✓ ~s G r~ s r..Z A Ground 34 -&Iy 5 y Z 0/ SY~ s S CSQ r S /n 0S ,7 elev. It. ~y 7 '7-S,YR 51,1 c a/ sY>; s 8 ~s r • 7 Depth to - - - limiting factor 36 Remarks: G'r~u o~ r.~Gr~~r a7' CST Name:-Please Print / J~SO Phone: &121 337 S Address. M ) - Signature' Dale: CST Numbo( f'' -s"-9q : 13 Boring Horiio Depth Dominant Color Mottles Texture Structur in. Munsell e GPO ff fl 8otndaryRoo s Qu. Sz. Cont. Colo Gr. Sz. Sh.~~ t •8ed :Trcrir, 7;$y n s~ s/ cw •7' g Z ~o Z7 -7-,5 Yee y o s / c w 5- r~ Ground 3 Z'7~51 7, S y 5 s 8 S r? % , r7 . g Depth to ' irniting , facto BSI . Remark's: Boring # k!3, Ground elev. IL Depth to limiting factor Remarks: Boring # Ground elev. fL Depth to limiting facto Remarks: Boring # IN Ground elev. fL Depth to limiting factor Remarks: III ~ - ~nolGrson, -8 ',v owyl_ • 3Z S Map le st. ee2 9 7 s- 69 8= Z Z/ g CST 3y73 Sec,Z~ S,'fe yw y ~z ST / 7-22 9 N ~ Gv 0 Pa sSl No~AS~ Loco! OY~- ~0 4,. 8r /"found 50 7/~ p B~ 3°10 A~ eQ 550 4133 ~~o st. B M , ez. • 9 - 7 a~ i i ~c. s . y i --I- -twIl f Ff bob- -.d , STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER _ ~o dt a J / o/ ~ ~1~11. e ✓ so Y' MAILING ADDRESS 3 25 Q PROPERTY ADDRESS D O' (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1141-5R' 1/4, SectionG T_Z2_N-R /lo W TOWN OF L~sG1 1014-01 1y1-1 ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER IfI CERTIFIED SURVEY MAP VOLUME 129 , 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 thr{ a ear expiration n SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 09/15/94 13:53 $ COUNTY CLERK 12002/002 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 /Ifo n- a 0 n eY"5'ar Location of property _S~4 1/4. 1/4, Section 2A , T Z ? N-R_ Township ~c w Mailing address ..32 5 I'l2o,v/e Z Address of site (n- subdivision name Lot no. other homes on property? Yes No Previous owner of property 14 1&--.1)-r _l,!°' Total size of property -/o X Total. size of parcel "/'o / ~ , Date parcel was created Q Are all corners and lot lines identifiable? Yes No ✓ is this property being developed for (spec house)? Yes No III Volume /09/_ and Page Number ` 3 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMEN'T' NUMBER, VOLUME AND PAGE NUMBER AND THE SEAS OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are). the owner (s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 52C>.3 , and that I (we) presently own the proposed site for the sewage disposal system or z (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 Doculuent No. Y ~ 1 Signature of Applicant Co-Applicant Date of Signature Date of Signature n Y ' A THIS SPACE RSSERVEO FOR RECORDING DATA II~ DOCUMENT NO. i,STATE,BAR OF WISCONSIN FORM 1-1982 ij WARRANTY DEED _ iil ;;.~TEr2'S Or -_520339 1091P ST. CROIX CO., W! li This Deed, made between .AlpryQ_k,---Inc,.. a Wiseon~ln. i! Rec'dforRe•:ord - ..car.para.tiQn----------------------------- AUG 18 1994 II 8:30 M ' at and.Ronald_..L._.Anderson _anct Grantor, A. .lanice_.J_._Anderson..------------------ ~~~*~+t-. h-usband-.and.-w.tfe-_as.-5.urvj.vor.shi.p_mania_l._.prQp.e_rty..._._...__ ' ( p~R9r ~t os~ds Grantee, II _ ~I Wi. . tnesseth, That the said Grantor, for a valuable consideration._.___ - - _ _ - II _ RETURN TO conveys to Grantee the following described real estate in ..--.St•---CrOiX. County, State of Wisconsin: Lot One (1) of Certified Survey Map dated April 19, 1994, recorded July 26, 1994, in Vol. 10 of Certified Tax Parcel No_ Survey Maps, page 2791, as Document #519472, being I i a part of th% SE} of the SEI of Section 26, Township i 29 North, Range 16 West. Is nOt homestead pro~:t ' This y. ;i (is) (is not) (I j~ Together with all and singular the hereditamente and appurtenances thereunto belonging; i~ And. - l warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances -except all easements, restrictions and rights of wdy of record. and will warrant and defend the same. 1 - 19.9---• j Dated this 2_----------------------------------- day of Au9-- t-------- lI II R Y ne ` (SEALS--- ` r16 ton, Pre aentl..rl .tSonALattori~ I TIC. Y D Y • Alb o0 5 A in-fact -----------(SEAL) - - (SEAL) Ii I " ° Douglas Ibrigtson, S retar • Albrookr--Inc.----------------- AUTHENTICATION ACKNOWLEDGMENT i tssan dec. STATE OF WISCONSIN Si S. gnture(. Rp__~91as.-1i for _.9f _ ea Albrook I)nc. and as o ney-rn-fact for Rub~C igtsQ Fr isle . o_f__AII?r_QQ_kA__I nc. --------------County. i -12. ay ---Ay9tlSt----------- 19__4 Personally came before me this day of 19-------- the above named -en - - --A Rl_h;Ardsoa-------•--•-------------"----- TIT E: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06. Wis. Stats.) to me known to be the person who executed the j foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY . J ne at -R) HARDSON ~ Attotorne at aw ' Wis. II Notary Public ------County, Spring ~/all.e-y,- wl---- (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary-) date: - - 19 •14a.ma Of persons signing in any caps ty nhotA4 be typed or printed below their signst're'. li STATE BAR OF WISCONSIN Wi-,,..,In T,..sl Blank Co. Inc. WARRANTY DEED FORM Pis. 1-1982 Mil.-auiee, Wis.