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Home My WebLink About008-1027-20-000 - AS BUILT SANSTC ITARY 104 SYSTEM REPORT OWNER ~1-yeq Lall'~50"Y) ADDRESS -66111/-e_ SUBDIVISION / CSM# LOT SECTION le T r N-R 16 W, Town of (!EO-u ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM IND1CATS NORTH ARROLq 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 ff I f I o~ r / 56,15) co t C+ 6 =r 2' ro ~Qi65 C4 Z f9 tA Q C9 Zl- 0-0 -A -OM Qy b1 'Tp~r A I03 r C ¢ ? P 3 tQt t'h kD R. e W, z n ru w 47 3 N p W Q L O C (Y) p s IA Ln Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations ST. CROIX Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 218896 Per 611' Na ftkRY/LYLA ❑ City ❑ Village [R Town of: State Plan ID No.: Eau Galle CST BM Elev.: , Insp. BM Elev.: BM Description: Parcel Tax No.: A9400180 S,Jrs TANK INFORMATION V' ELEVATION DA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r~✓GC1P5j°/I~~~>i Benchmark a /v v~ 50~ Dosing _ Aeration Bldg. Sewer Holding St/ Inlet TANK SETBACK INFORMATION St/jO Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I -fir a Septic 5,Iod NA Dt Boo tom a Dosing 3 NA 1 Man. ~~~5 Qa 7 Aeration A Dist. Pipe S.(~T ~•;°s /D~ Holding Bot. System PUMP / UPKOK4NFORMATION Final Grade Manufacturer Demand Model Number, GPM TDH Lift 5 rba" Friction System TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM _BED Width Length i No. Of Trenches PIT Of Pits Inside Dia. Liquid Depth DIM I N DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING turer: SETBACK INFORMATION Type O e CHA Model Number: System: /Y'cr~r, c! ~_/10 /7- UNIT DISTRIBUTION SYSTEM Manifold Distribution Pipe(s~ x Hole Size x Hole Spacing Vent To Air Intake Length Di j~~ I Length Dia. Spacing r r 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 g~/Trench Center 9_-/Trench Edges Topsoil ❑ Yes E] No Yes No COMMENTS: (Include code discrepancies, persons present, etc.)_/4s LOCATION: Eau Ga le,10.28.16W, NE, NE 9" ~r r Ito Plan revision required? ❑ Yes 0 ` Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: L►(~c~/-CA 7~~//2n~~J~ ~'1sl { ~C_c2v? Ot G C~ ~~t 'r oa SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY I'd IT Y ER IT # -Attach complete plans (to the county copy only) for the system, on paper not less than 'STATE Sr§§qt 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. - ~ PROPERTY OWNER PRO RTYLOCATION ev, 1, 1q, Lav' ' VF_% NE X., S , N, R (ore PROPERTY OWNER'S MAILIN ADDR LOT # BLOCK # Q7`'f'l ve"V e, CITY, STAIF ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER Vo,zrk S ('71 Y' II. TYPE OF BUILDING: (Check one) F1 State Owned ❑ VILLAGE i NEAR ST, OAD It- to L V ❑ Public 1 or 2 Fam. Dwelling-# of bedroorns - PAR EL TAX NUMBER(S) a smart, s~eer 1v F4 sr- III. BUILDING USE: (If building type is public, check all that apply) 00 q ~ 91 0(m 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 80 Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check o ly one in line A. Check line B if applicable) A) 1.E1 New 2. ~F eplacement 3. ❑ Replacement of 411 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 21ZMound 300 Specify Type 410 Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 140 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 REQUIREq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) n A!~ ATION S 37V S~ J ea Feet Fee t VII. TANK CAPACITY Site in allons Total of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New isting Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holdin Tank Lift Pump Tank r +f__M.. I '119kAh El I r_1 F-1 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: G. d Plum is A rdhi eet, City, S ate, Zip Co e I ►~v s S IX. COUNTY/DEPARTMENT USE ONLY Q~ ❑ Disapproved Sanit Fy Permit Fee (includes Groundwater Date Issued Issuing Agent {]SJ Approved I ❑ Owner Given Initial vvvU ` 0j) Surcharge Fee) + V Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety s 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 t 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. Ill. 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) SAFETY & BUILDINGS DIVISION M State of Wisconsin Department of Industry, Labor and Human Relations May 23, 1994 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 WEBSTER PLUMBING & ELECTRIC RT 3 BOX 231 ELLSWORTH WI 54011 RE: PLAN S94-01537 FEE RECEIVED: 180.00 LARSON, LILA / TERRY NE,NE,10,28,16W TOWN OF EAUGALLE 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 lan number shown above. Sinc Y, a Peter Page Plan Reviewe Section of Private Sewage (608) 266-2889 SRD.64221R.91/91) 7 Pot- flem U5 wov 4 f ~vl~ Se c N a~ C X055 Se C ho y y ~~o n ~ ~ N v ~ C c14 ~ d Pao °G 0 N~ 0 lip 6~- 3 7 r 0 l Sgt! -41537 4 t ~4 ~ , f ~ ~ ~ ~ , ~ 9r ~ t4 ~ 4' I x N ~ ~ d ray pq,,r L56 10.1-7160ac~ v I~I northeast corner of 50th avenue section 10 t28n r16w 124 foot by 27 foot mound 3,75 foot by 100 foot bed 18 inches sand beneath bed M74fe three bedroom home existing structure 94 si uses T nn~~ 1{ 4nC Ul V} opOcte as S / g3 0 qupt LO ClJ Terry and.. Lila Larson residence S94-01537 F-al/, Go Of Tewhskip Five # a I IS Tct-vle L ~.~q Leg o U' Sei✓ ion l 1 well house three bedroom home casing in center existing structure 34,064 ho~.Ze P-~ 1 .2588 I 51.0000 43,9595 lawn m$ Midwest hay f i e f cl precast din combo tank Uncopa c ~Pa 9 Ox e3 5 inr~ S94-015,97 -4t zygt- C L l7~' ~lv~Gtr'ays > o2D17 ~ fo /0~.. fi'br} Tevv% L'l q L"~sa~ cJ sec-l0 r.Z N R 1~ u~ l N ~ /~r JUG y ~ ~S4 00 11 P1~ NG 5 ,~°A° t ~a qo rip o R - Sfal rN?. r1~,s cv'' 6~ ~~°Lf ; P J `DES > D c. I goY~ ~ f o ~ 07.5 13s.~ 2 y 66" yip, 0* .2 8 ~o° UolP Boa 51,0000 .3705 69.9093 Lowy, WaY~d ~ pp g-s. ~0 - 21.7925 14,2769 B~ «y , op ~ , n o 13,6013 v e g 3 1' ~1------ S~ f~ o15.~ •.r S ~~4 i ~ e . w ~ 1 ~~1, ` 4~' its r ~ e3 Lrl~i n Page_ f~ (I~NAL WORKSFfi~1 NIV I& 00V 5ecio 1,24) R 16w Fw 6'--, Ile Of o~. P~~e MOUND SYS 1 EM If. IN•GROUND PRESSURE SYSTEM•Conitnued- 8rrx-L 1. Wastewater Lnad, total Daily Flow= .~u (2 gal, bilen 10. Force Main: Use s. ILHR 83.15 (3) (C) Cf~GSIe0- . Minimum Dosing Rate = --~/-y- Rpm. Adm. Code and PROVIDE A DETAILED t sr# IV zm Diameter = in. LIS I* Of SIZING ON PLANS. I P63 Q 11. Tntal Dynamic Head- "9 Depth to Limiting Factor It. t 63 7 7 System Head = S tl. 3. Landslope Vertical Lift = I g, ft. 4. 'Distance from Dose Chamber to q Friction Loss50 •x,7/12 . K~ It. Distribution System = /t. TDII = ft. S. Elevation Difference Between 12. Pump Selections Pump and Distribution System ■ ft. Pump will discharge at least Rpm i 6. Absorption Area Sizing: at &!d- _ ft, total dynamic head, Area Required = 7 sq. ft. Pu olet and manulitturerl _ Zee~leY' Bed or Trench Length (B) ■ ft, ~P K' Bed or Trench Width (A) ■ ft. 13. Dose Volume: Trench Spacing (C) ■ It. 10 Times Void Volume of f~ I 7. Mound Height: l Distribution Lines a f8'.joyl • gal. ' Fill Depth (D) _ ft. Dally Wastewater Volume i Fill Depth Downslope (E)' ft. 4 Doses In 24 h s ■ I-~ gal. Bed or Trench Depth (F) ■ - h. Backflow = ; IZ Q 'S :al. Cap and Topsoil Depth (G) a J--t--00- ft. Minimum Dose ■ ~2~ gal, Cap and Topsoil Depth (H) ■ I• S Q ft. 14. Dose Chamber: d. Mound Length: 2. f Volume ■ e r O End Slope (K) ■ fl. ra.+ gal. Total Mound Length (L) 111. CONVENTIONKL PRIVATE SEWAGE SYSTEM S0 ' 9. Mound Width: ■ e /b~ 1. Wastewater Load, Total Dally Flow a gal, Upslope Correction Factor b Use s. ILHR 83.15 (3) (c)Wis. Upslope Width (1) • 1t. Adm. Code and PROVIDE DETAILED Downslope Correction Factor ■ LIST OF SIZING ON PLANS. /~Q~ Downslope Width (1) a ~ It. 2. Required Septic Tank Capacity = L gal. Total Mound Width (W) ■ Z. ft. 3. Percolation Rate a min./t 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in ch. ILHR 83 Natural Soil = gal./sq.ft./day and PROVIDE A DETAILED LIST OF Basal Area Required a sq. ft. SIZING ON PLANS. Basal Area Available = DO p, It. Required Area = _ 11. If Standard Tables from Chapter 3 It. ILHR 8.3 Length _160 ft (l, are used, Indicate Table # Width = 3,, 7S' ft, 12. For the Distribution Network, Use Numbers 5.14 In Section 11. Number of Trenches ■ I Trench Spacing' ft, 11. IN-GROUND PRESSURE SYSTEM S. Distribution System: 1. Depth to Limiting Factor ■ ft. Lateral Length = ft. 2. Landslope ■ % -Number of Laterals ■ 3. Percolation Rate ■ ..,_y min./in. Lateral Spacing = 4. Proposed System Elevation ■ ft. Distance from Sidewall to Pips ■ '-1- `L In, S. Wastewater Load, Total Daily Flow: gal. System Elevation ■ ft. Use s. ILHR 83.15 (3) (c) , Wis. Adm. Code and PROVIDE A DETAILED ray IV. SYSTEM-IN-FILL LIST OF SIZING ON PLANS. n Fill in All Items from Section 111 Required Septic Tank Capacity a ill, 6. Absorption Area Sizing: V. SEPTIC TANK L« Percolation Rats st 1. Capacity = M Area Required ■ sq. ft. 2. Manufacturer. / r1~~~~5 ~Cf'~1 ~ Crl( ST-' gal. System Length ■ ft. 3. Show Site Constructed Tank Details on Plan System Width = ft'. 7. Distribution Pipe Sizing: '194 VI. DOSING TANK Hole Mie = In. 1. Capacity = D 6 . al. Hole Spacing = fl- .2. Manufactureri~L✓csfiP:YN L.rler.d Length • 11. J. Pump Manufacturer: 20 Ile i La14 rat Siic _L In. 4. Pump Mndel: .114.1.01 tipacireg " 11.. S. Operating Head= JL_ it. 6ki.loce Irnot sidrwall its 1'tlle 0-0- In. is. I low Rate= gpm, N. Di.uihulion Pipe DiscllAtgv Ratr: 7. Show Site Constructed Tank Details qn Plans Number of 11411r% Pet 1'Ipr 1 low Per filet = 0 gpm. VII. 110I.DING 1 ANK 11. Manifold SiAnit: 1. Capacity = gal. 1 Vile (cenlet or end) _ Cewt-elr 2. Manulaclurer: Length a It. 3. Show Site Constructed Tank Details on Plans Diameter in. -SHOW ALL INFORMATION ON PLANS- DILHR SOD-6761 IR.03/821 S C~. 0 1.53 7 Page Of Cross Section Of A Mound Using A Trench For The Absorption Area ro5 103.157 102.25 H Medium Sand Fill F 6" Topsoil Trench Of J" - 21j" Aggregate, Plowed Layer 6" Below Pipe, Covered With D Ft. Straw, Marsh Nay Or Synthetic Fabri E es Ft, r, 'dOFt. F O* 7.5r Ft. N S Ft. I coul► tvvv cq- dV / 3 Plan View Of Mound Using A Trench For The Absorption A W _ Force Main ~G a~ J Distribution Pipe t Permanent Markers Observation Pipe o p . ~ W W L r---, B K I Trench Of I? - 2V Aggregate -LL-L I- y Y A3 %zt. Y Ft. K Ft. W 2 Ft. B 10 Ft. J. Ft. L j2 Ft. s ' y Signed: 00 License Date //Z,/ Number: 3 pa,v 5 AA ~ f~ - p r.M 7 r , ~ ~ .j i ; ; . / rr i • / A ~ 1 ~I r a y U 1_ Distribution Pipe Detail For Two Lateral Network i Holes Located On Bottom Are Equally Spaced PVC Force Main End Cap H Y X X PVC Distribution Pipe P P X * Last Hole Should Be Next To End Cap r/ P - Ft. Hole Diameter Inch X Inches Lateral Diameter- Inch(es) w Y Inches Force Main Diameter Inches # Of Holes/Pipe g Invert Elevation Of Laterals f o - Ft. Signed: 4&- License Number: Date: Q n G _ M rf ~f J ~y ®oQ~ Qlv t J 4Q 7`j /4 O ~ V p y~Aj Q Q~ ~v S9.4-01537 ~3 Y'~ r ' i ti ` 1. 7 ~s r j q. t ~ y' Y_ , err. , ` ~ t~ '._a ~ : ~x. Page._L_Of~ COMBINATION SEPTIC TANK/PUMP'CHAMBER (No Scale) Cl Vent Pipe with .Approved Locking Manhole Cover Approved Cap, +259 With,Warning Label Attached From Buildings Warning Label weatherproof Approved _ Junction Box Vent Cap 12" Minimum Final: Grade ;6" Minimum 4" Minimum 6". Maximum, , 18" Mi.nimum 4 C.I. Quick Insp: Pipe Disconnect _ 1/4" Weep Hole Baffles [T 5 P *APPROVED JOINTS WIT APPROVED P SOLIDTSOIL~ QQS D Conc. Block O~ 3".of eddinq der Tank Note: Pump and Alarm Are On Separate Clrcui ' .--..'.,Number, of •Doses: 1 Per Day . Gallons Per Day/ Doses: Gallons Volume of Backflow:........ Tank Manufacturer: W _Gallons • Tank Size-Septic/Pump: Total Dose Yolume:........=~_Gallons Alarm Manufacturer: Gallons Model Number: to. Capacities: 2 ' Switch Type: + B inches o; 3 ~ 8 Gallons Pump Manufacturer: _ inches or 2 Gallons Model Number: o ev~ Ct Q + C inches orDGallons Minimum Discharge. ate: 2 p + D inches or Gallons - Total inches' or G ~ Gal-ions Vertical Difference Between Pump Off and Distribution Piper 8 Feet Minimum Required Supply Pressure:.....,••,;•,..,•..,....•..+ Feet Feet of Force Main x P'7 Friction. Factor/100 Feet: -.j ---Feet Inch Diameter Force. Main ~ Total Dynamic Head:.."."li t . Internal Tank Dimensions: Length r • Width~~ Liquid-Depth ' Signature Licen's'e' Numberr~~ Date S() 0 1..E 3 7% . kw i~ ti`p' o-~, {j ~t ' t' 1~• ~ f t, ~ • HEAD/CAPACITY CURV HEAD CAPACITY CUgVE EFFLUENT MODELS ' •11 S- t IfT- - TOTAL DYNAMIC HEAD/I 103 - EFFLUENT AND DE' 100 SERIES 67 es t' 97 FT !;a!= } 17199 ief . age. 0,0 9$- Oat I.~F~: QN QN 49 ;ice Sept; 723 104 toe to =yoi. Of so- is Jili, ;:.,off ~e Yt~: et ,fit} 70 too j= ww 3S ;i I: 48 go so 25 99 e7 I ' • 7S.._.. !1???? ~!?~!l~;; ;iii?",••:irt 2Jt~ ; 40 j 53 'ii~li;iji 46 70 so 40 ,:!•?i'E?~ _ i'21 yp/e~ Sao 165 70 ~1 16 f 60 55- 100 4•v ~'~y 'i : . t'?' ~,j 50- t 63 110 e`L•b0 y` ` ` - - - . r - 5- LookVWV•: _ 1825• 1 26' EFFLUENT & DE 35 - t~ 185 30 0 Warning: Model 185 - _ than 30 feet TDH. 25- 20 199 e ` - Note: For Head Cap; 4 I5- 161 ` - column-explosion pr' 10- 97 1 fee S - 1 9.9 s S .55,. 7,59 13 139 ✓ - 0 15 3 7 GALLONS 10 20 30 4U 50 60 70 Rif 44 n v' 80 s l 90 100 110 120 130 1 ~ 50 160 WARNING: Mod( • vol /U 5 5 pa.. 1l1JJf1;E 40 110, UMENT NO ST •rl: It.y~it., rnF WISCONSIN PH01 :1--1908 r..,. .w.~r. r.w. r, ..,n w.,., a.•. QUIT CLAIM DEED • S151045G - - j; REGISTER'S OFFICE ST. CROIX Co.. wi _Gaurgnce B Larson Pe FsOnal. Representative of II Reed forRecord - the Estate of Gregory M Larson DEC 14 1993 ~I i 1 mltelai s to E. Larson"and Nancy A I B' M 8:30 - A: „Larson.,, husband and vi.fet is' marital"propertX, I • the roll nx de-•rnreJ reel eclat In St r. C,roil{ County. State of Wiseonaln: f~ - , XVIE NORMAN S .C. P. O. Box 50 _NesL Richmond NL.. 5401 The North Hall of ate Northeast Tax Farrel exc ~ s Quarter of Section 10, Township ffi North Range 16 West sl exceptitt6 therefrom ■ strip of hind six rods wide running diagonally across said described Eighty acres heretofore deeded to E. S. i Austin for Pa lroad Right of Way as described in deed recorded In the office of the Register of Deeds for St. , Croix County, Wisconsin In Rook 18 of Deeds on page 463; also excepting a parcel or land In the Northwest corner of said Eighty described as follows: Commencing at the Northwest corner of said Eighty and running j thence East sixteen rods, thence Southeasterly to a point twenty rods South and twenty-four rods East or the Northwest corner or said Eighty; thence West twenty-four rods to the West line of said descrii ed Eighty, thence iI North twenty rods to the point of beginning; also exmpting an easement heretofore conveyed to Wisconsin Telephone Compmry and The American Telephone and Telegraph Company of Wisconsin recorded in Volume ji it 220 of Deeds on page 489 in said Register of Deeds office, and the South Half of the Southeast Darter of the Soulflear! ' Q Quarter of Section Three. Township ffi North Range 16 ii West. ~ This arneywnce 4 made to connection with and to support the Assignment of Land Contract dated October 19, - 1993. i This conveyance is also made in final distribution of Interest M the above described real estate from the Estate l ;I of Gregory M. Larson Gregory M. Larson died intestate on June 10, 1993, and the grantees In this deed are die legal heirs of Gregory M. Larson in atcordance with the intestate laws of the State of Wisconsin i Exempt No. 11. i This. ia_. not........... homestead property. !i (6) its not) Dated this . V.... day of December _ 19_. 93 r/y/J i ...(SEAL) ~ T._,(, ~....-(SEAL) j , • urence B. arson j Personal Representative ' _(SEAL) Estate of Gregory M. Lar3O#XEAI,, ~I AUTHNNTICATI ACKNOWLEDGMENT i Siaastp Lar STATE OF WISCONSIN ' as. ......................................County. .Uth is day _ eCe . Iv Peraonall came before me this ................day of _ 19 the above named Thomas R. 3chumacher TITLE: MEMBER STATE BAR OF WISCONSIN - - ' authorized by 1 7011.00, Wis. 3tats4 - - - to me kn to he the p who exwc rled the forexomx inArrmeot nnJ arknowlydxe the same. .rrs ,r+sTnur+eNT w......... ear Thomas R. Schumacher . .BARKE-NOfi MANr S.C......._. Baldwin, NI - 54002 Not. P bu C u l wra. (Sixnatij- may to authenticated or nckno.leterd. not% Mc C nu± Mrs h pr•mm-t If ot, o.te exp.ratrnn I ~ aR not neerna.ry1 date: 19__.....1 i I' OUR CL.IM DERD ar,le r ,p nl' N'lar 11~'.r~ u n INr.! r'- r., r•. wnpM I>n. tl........ • , r Y S94-01537 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER_ Tyr 1" _,A anC%t L--do La f 5 6 r1 ADDRESS : q 0r) 6;() N FIRE NO : ~y LOCATION: 1/41 AIE- 1/4, SEC. /_T~N-R_Z01 W, TOWN OF: C•4 6~ ST. CROIX COUNTY SUBDIVISION: LOT NO. 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 a 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 to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification from will be sent approximately 30 days prior to three year expiration. 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 form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE : vA' ' St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 e 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), thenia 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 4,_1110 I-) of property4LC- 1/4 AZE 1/4, Section T N-R /1 W Township Mailing address Lkj U`Z Address of site cis Subdivision name Lot no. Other homes on property? yes1 x No Previous owner of property LCLr~ ( f.,L1 r j~~ Total size of parcel <<C Y S Date parcel was created Poc: )1 0_3 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume nd Page Number,Lq3--. 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 & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty' deed recorded in the office of the County Register of Deeds as Document No. 7% , and that I (we) presently own the proposed site'for tie 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 County Register of deeds as Document No. Xzt Signature of applicant Co-applicant 66 Date of signature Date of Sign ture L E CUMENT NO. WARRANTY,DEED REC N& 1~".. - 7794 •-w,.t~,:,,,.T: a-,, ~ ~-U~~~. 0. APPAU393 STS CR-11aDK .s. yea RQea 1iX ftev~rd THIS DEED, made between Laurence E. Larson and Nancy A. Larson, husband and wife as marital property, Grantor, and Terry A. Larson and Lyla L. Larson, husband J U N 13 1994 and wife as survivorship marital property, Grantee, 12 , Q WITNESSETH, That the said Grantor, for a valuable consideration one dollar and other valuable consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: '0!flOtd41 . O RETURN TO: Bakke Norman, S.C. O Baldwin, WI ,may. Tax Parcel No: All that part of the North 1/2 of the Northeast 1/4 of Section 10, Township 28 North, Range 16 West, lying North and East of the E.S. Austin railroad right of way described in deed recorded in the Office of the Register of Deeds for St. Croix County, Wisconsin, in Book "18" of Deeds, page 463 excepting therefrom a strip of land six rods wide running diagonally across said described Eighty acres heretofore deeded to E.S. Austin for Railroad Right of Way as described in deed recorded in the office of the Register of Deeds for St. Croix County, Wisconsin in Book 18 of Deeds on page 463; also excepting an easement heretofore conveyed to Wisconsin Telephone Company and The American Telephone and Telegraph Company of Wisconsin recorded in Volume 220 of Deeds on page 489 in said Register of Deeds Office. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; and Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, highways, utility rights and reservations of record, and will warrant and defend the same. Dated this G day of June , 1994. (SEAL) a (SEAL) * !-Laure a E. Larson 17 / (SEAL) .(i1~1iL~~~~ (/mot/ (SEAL) * *Nancy A. Larson AUTHENTICATION ACKNOWLEDGEMENT Signature(s) of Laurence E. Larson and STATE OF WISCONSIN } Nancy A. Larson }ss. ST. CROIX COUNTY } authe s day ne 19 94 Personally came before me this day of 19 , the above named * Th-c%-as R. Schumacher TITLE MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY: BAKKE NORMAN, S.C. BALDWIN, WISCONSIN Notary Public, County, Wisconsin *Names of persons signing in any capacity should be typed or printed My Commission is permanent. (If not, state expiration date: 19~ below their signatures. 'Soil" Fvrdurt~c),, Ai,~ L~~sp41 PICIL, of P~ P~ y~ y o S.,/ s, ~1 e~~ ILIQN~L Rr~c a n v I -sal ~ ~ e ~4 ~ l pn ~u V,, to ti W O": ji.1/4f I r C ~ I / ~~-j OAkvc~ C', S I F&u C#tllt Twhs4.P mire °~~1R~ J~erv~ ~;~~t tot ov► 6,~Jo;L71600 northeast corner of 50th avenue section 10 t28n r16w 124 foot by 27 foot mound 3,75 foot by 100 foot bed 1760000 18 inches sand beneath bed three bedroom home existing structure 34A61E +i 2599 510000 tl.93% v I ~ Gnc opacY / qV 83 LO P~ Cu Terry and Lila Larson residence F-a- Cu Ilt Tewhskip Rve # • Tcp-vK e 1,I't2 l r2s'gOS well house three bedroom home casing in center existing structure 34,064 h O l e P-~ .2588 51.0000 43.9595 (awn dwest hay f i e l cal ecast p~ mbo tank UnOnr{ %0//Og 'Fay ~IIY ~i~W~ s~~p Fr~c ~ 2y~~ ~iV-e cF~d~ S > ao~ 'o laf %,'hP~ Tevv -t LC4 v sd 3 ~.1 ~,t~w ~ r~„S Cd►'"rte v~~ Gore 2 NI- rl y 6"5 C:x 8 .2 C 51,0000 oa %.3 705 69,9093 Cctw~, 21.7925 14,2769 ,.2 y z ~OUn /0/ 13.6013 0 63 l sI~ p ~ _ ~ ,ter' ~t"~ ` ~1°~` ~ .ei' ' ~ 3 e• s1 < j!„~ ~iy ~ r i ..Y : AE°? ~ ~1'a > sw• 4J/ ~ i ~ ~ ~f'r ~ ~~i.. ~ da P` 1 '1♦ yr LL 'j r`C + Y 1 °5E 1 _ i , } cz x U t , . • ~f _ ,.s,. s,~ 7 r . s m r+ , L .'rJ,, d Y' 1 1 s r ' N l: ''q44 U m N a .llL x lam' I •.x*r. N > rJd4 i' LL 1 ? V * . j` i k f t a,YY 0+raSY' i . ~s> z x• """Ike 1i:' Shy t ~ ' m x s } ,yF~ > fur ~ ~ ~ +r ' ,~'r' r S°f• °q ,~,~+.v " ~ ' -s , ' it ~j• ~r W ~ro• 1 +m Y~~f^ ~ j F!' ` ~~re a i 'n ! 'N 8Z •1 l3aeooootr r T jU I L N h in accord with ILHR 3.05. Wis. m. Code COUNTY a .wr.,ww nurtaw Z Aqy~ I Sr. CV0 r~ Attach complete site plan on paper not loss than a tit x 11 inches in size. Plan mu t include, but not limited to verlical and horizonta' reference point (BM), direction and % of slope, scale or PARCEL I.D. N dimensioned, north arrow, and location and distance to nearest road, 06~ 31 t9~ 7/ 00 0 6 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER PROPERTY LOCATION 6 r r L 110- 4((50 I) GOVT. LOT C, t/4 I/4,S' QT 9,,R o PROPERTY NER'S MAILIN ADDRESS LOT N BLOCK N SUBD. NAME OR CSM N N~11rv~~_C ~ ~ CITY ST E ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST RO D CI U rsco" a;- (7/0 - j [ J New Construction Use Kj Residential / Number of bedrooms 3 It~l Replacement ( j Public or commercial describe Code derived daily flow P gpd Recommended design loading rate bed, gpd/ft2 trench, gpde Absorption area required 5 757- bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd4t2 Recommended infiltration surface elevation(s) J.0 I . t-L ft (ask referred to site plan benchmark) Additional design / site considerations 19 n Parent material 1_1) SAS Flood plain elevation, if applicable ft S - Suitable for system CONVENTI L ND INGROU DPRESSURE AT"GRADE SYSTEM f1Ll HOl DING TANK U= Unsuitable Ions stem 11 S U S❑ U El S U El S U O S ❑ S U 10 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Roots GPD/ft in. Munsell C}u. Sz. Cont Color Gr. Sz. Sh. Consistence , Bed Trend <x o-s ~R 3Iz NU srl 2 m-r^ 3'' S o. J 0 -'_5 Ground 19-32 IO YR., ~ l3 C 5-16 c ~ f Q ~ 4 4- '1 I ~ O.S elev. eft. 3a-70 9,~ YR J 414 ~ Depth to limiting facto„ rl Remark's: Boring # / C r r>:~ N x • -04 1 n. S Y R 312 NO F: y? s l .L~ `yp IU o 1 2 r, V fr 3 v Ground 3 X1-32 lD YR 313 c w, J g~ 618 4 S v a-'f 6S 6,5- ate ft. y 3910 Y s C N o~ SYAP 41~ c r~ lr rvr {I - - 114' Depth to - - limiting factor I - i [ Remarks: CST Name:-Please Print Phone: [lh71s s9y Sofa Address. Signature Dale: CST NumboC em" a 1 ~I y ~Srr s sol9oz PROPERTY OWNER.-re vyT 4 L: j , 1'-„w5d4SOIL DESCRIPTION REPORT Page of '2' PARCEL I.D. ci3r c) 271 060 r-) VC 11 4 10 VT Boring # Horizon Depth Dominant Color Mottles Structure GPD1ft in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots Gr. Sz. Sh. Bed Twch Q'6 6o Y2 313 Alo vv,fr 3~r 05- 10-4/ Y S ~I k cv 3 v p, y as Ground IM to c ►v, S~Y.P6l~ G~ ~a~ p,y ,j- Rc I ft. 2226 613 n, LEA 61 ) 2 e, QG 4 ~vj/ ax Depth to~ 36 r+P G ' limiting S Y rh a ; - . faF~ ll Remarks: Boring # k k Ground elev. ft. Depth to limiting factor Remarks: Boring # } Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) vo1 /U 5:5 pa 41o , PASS ti VA E RL S[fiVE7 FOR RE NDIN DA'A ()OC UMENT NO ST: l E BAR 0 WIS '(~NSIN CORM 3-1982 ► QUIT CLAIM DEED 1 U0456 REGISTER'S ]rd" - ST. CROIX CLaurence.-E.-_ Larson-,. Personal. Representative of Rec'dforRetht_•-Estate_of Gregory M. Larson DEC 1 4 - - - - 8:30 quit-claims to rence ELarson and---Nancy A. . ~Larson, husband and wife, as marital property. - - - - . ' d De. II the followln~ described real estate in St.._Cr-91_X_- County, State of Wisconsin: j REUKE NORMAN, S .C. P. O. Box 50 N e I--_ichmo nd a_ _IdL-_.-5-4 0-L I Tax Parcel No:.--- The North Half of the Northeast Quarter of Section 10, Township 28 North Range 16 West excepting therefrom a strip of land six rods wide running diagonally across said described Eighty acres heretofore deeded to E. S. j Austin for Pailroad Right of Way as described in deed recorded in the office of the Register of Deeds for St. Croat County, Wisconsin in Rook 18 of Deeds on page 463; also excepting a parcel of land in the Northwest j corner of said Eighty described as follows: Commencing at the Northwest corner of said Eighty and running II thence East sixteen rods, thence Southeasterly to a point twenty rods South and twenty-four rods East of the Northwest corner of said Eighty, thence West twenty-four rods to the West line of said described Eighty, thence North twenty rods to the point of beginning; also excepting an easement heretofore conveyed to Wisconsin Telephone Company and The American Telephone and Telegraph Company of Wisconsin recorded in Volume l 220 of Deeds on page 489 in said Register of Deeds office, and the l 1 South Half of the Southeast Quarter of the Southeast Quarter of Section Three, Township 28 North. Range 16 I, West. This ct.aveyance is made in connection with and to support the Assignment of Land Contract dated October 19, M. This conveyance is also made in final distribution of interest in the above described real estate from the Estate of Gregory M. Larson. Gregory M. Larson died intestate on June 10, 1993, and the grantees in this deed are the legal heirs of Gregory M. Larson in a::ordance with the intestate laws of the State of Wisconsin. i i Exempt No. 11. ;I 'I ~I i This ..13-,.riot........... homestead property. (is) (is not) ,I Dated this day of December _ 19--93 I ! (SEAL) - - - urence E arson (SEAL) - - - - Ve Personal Representi ..(SEAL) Estate-..of .G.regory-.M._ La.r.501SEAL) I~ - - - I AUTHENTICATI ACKNOWLEDGMENT 75~ dare- Lar STATE OF WISCONSIN i Si ss. County. ece 93 ` auth is .-_-.---day 19..._.- Personally came before me this ----------------day of 7 19- the above named Thomas R. Schumacher . TITLE: MEMBER STATE BAR OF WISCONSIN (If not, - authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instn`ment and acknowledge the same. I) THIS INSTRUMEN-r WAS DRAFTFD BY - - - - Thomas R. Schumacher BARKS NORMAN, S.C•.------- - - . ! - Baldwin r-ICI-----54002------ Nota-y Public . ...County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is pe-manent.I If not, state expiration are not necessary.) date: - 19-- QUIT CLAFM DEED STATF. IlAR OF N'IS1'OXsIV A-•n- F.,¢.! n'.nk Co. Inc. FORM N.. 7 - 1982 `•L ...c. W m. Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page - of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPE OWNER: r fAu..r'enCe C-It PROPERTY LOCATION t YIN 06,_ GOVT. LOT n67 1/4 Y7C114,S1O T `a N.R /6 l PROPERTY OV&ER': MAILING ADD ESS LOT # BLOCK # SUED. NAME OR CSM # CITY, S TE ZIP CODE PHONE NUMBER []CITY []VILLAGE N NEAREST ROAD [ ] Ne nstruction Use [ residential / Number of bedrooms d [ ] Addition to existing building [ eplacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Ma)amum design loading rate bed, gpd/ft2 trench, gpd/9 Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK U = Unsuitable for system ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U [IS ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou Jary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft Depth to limiting factor ~ 5 v /3 3 7A I Initial: Date Y y~~ i 1 PROPERTY OWNER SOIL DESCRIPTION REPORT Page -of PARCEL I.D. 4 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boux~ry Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tench LID! Ground elev. ft Depth to limiting factor Remarks: Boring # Ground elev. ft Depth to limiting factor Soil pit locations N