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S STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER-~,n1 jo C
ADDRESS
SUBDIVISION / CSM# LOT #
SECTION LPI(~ T 0,5 N-RW, Town of 0k-6c cay~e
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
0
rA 0L'L~ o
~ yam.
~ iaA' ova
L) i's ban C °v
A s ~ ~
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form-
Provide 2 dimensions to center of septic tank manhole cover.
r
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
Wisconsin Qepartmentof Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
PerDrTjjftr_SNarrteOHN ❑ City ❑ Village Town of: State Plan o.:
11 liVV ~ ~~J1 ~i
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No +e/
/C /O' . C e5a Q~S 7 ~~s -
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic FSG ,r Benchmark 3 SS JG`J. CG~~
Dosing u ~
Aerati Bldg. Sewer Id, X05
Holding St/ F r Inlet
TANK SETBACK INFORMATION St/y( Outlet
Vent
TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet
Air Ap
Septic 5~ NA Dt Bottom
Dosing >160 (,5-' a >Sb NA Man. 11
Aeration NA Dist. Pipe
Holding Bot. System 5• 9~ ~7~
PUMP/ S tI4NFORMATION Final Grade
Manufacturer Cc~cC✓ °61°/° r dj~ ;2 3' 93`1'S
Model Number o3L fGPM
TDH Lift a,✓ Friction I g' System ~50 TDHFt
Forcemain Length 1 Dia. F- " Dist. To Well J S
SOIL ABSORPTION SYSTEM
BED/TRENCH Width r Lengt No. Of Trenches No. Of Pits Inside"Dia. th
DIMENSIONS 7` 1 / DIMEN I
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH[N nu acturer:
SETBACK
INFORMATION Type Of CHA R Moe Number:
l
O NIT
System: l~?otLS+c~ /-no
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
I0 Length DiaLength Dia. -2 Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over ~r xx Depth Of xx Seeded Sodded xx Mulched
No E] No
Bed /Trench Center Bed /Trench Edges -C, Topsoil CO es E3
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: EAU GALLE 20.28.16 299 SW SW 222ND STREET
99a~
t
led -7~0/21,
Plan revision required? ❑ Yes ~o p
Use other side for additional information. jQ o`2 VIA
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
R
SANITARY PERMIT NUMBER: '
E
I
i
G~
e
Xtz
3
J ~
3
h HR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
ro
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% x 11 inches in size. c ec re son previous application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S9-y -OS~T
PROPERTY OWNER PROPERTY LOCATION
r-jok, = Nl0 I. W % _51,j) Y4, S Z(J T Z?, N, R 10 (Or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
.~oG 3 Z30- ' Ax XX
CITY, STATE =06 DE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
lC~u~ a1„-r ~.t~.~ . Z_ 715 ,N 2074 AIX
IZI VILLLLAGE ~GC4 60 NEAREST ROAD
II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑
❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL TAX UMB /O 00
III. BUILDING USE: (If building type is public, check all that apply)
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 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1..® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
s/ REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
7 > _37_5 _376 • Z /lif ~?O> ?3 Feet /l,~•'S7jFeet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank n9o - /000 e S YS
Lift Pump Tank/Si hon Chamber S 750,
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:
ale z~ AW50r" l`~ze, C<--. &G9 ~5' ~S`~-3378
Plumber's Address (Street, City, State, Zip Code
IX. COUNTY/DEPARTMENT USE ONLY
0 ❑ Disapproved Sanftry Permit Fee (includes Groundwater rate Issued Issuing Agen at 'Starn
Approved ❑ Owner Given initial iP,\ 0,3urcharge Fee)
Adverse Determination- ~r
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 prefat 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.
Vill. 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; triction loss; pump
performance curve; pump model and pump manufacturer; D) cross secti:;n 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
June 27, 1994 2226 Rose Street
La Crosse WI 54603
BOLDTS PLUMBING
820 MAIN ST
BALDWIN WI 54002
RE: PLAN S94-40544 FEE RECEIVED: 180.00
DITTMAN,JOHN
SW,SW,20,28,16W
TOWN OF EAU GALLE 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,
ti.
erard Swim
Plan Reviewer
Section of Private Sewage
(608) 785-9348
4501R/ 1
i
SBD-6429 (R. 61/91)
tl a ~m Q
/ * a;c [ A- ri~ r 4
e
Cross Section Of A Mound Using A Trench For The Absorption Area
I
- H
`tedium Sand- Fill -.J1 ° F 6" Topsoil
3 E D
Trench Of " - 2~" Aggregate, Plowed Layer
6" B4jojy?jjIK Covered With D /,o Ft.
pp9VgTE 594, arsh Hay Or Synthetic Fabric
ConditiOna iY C-~ IMP E Ft. G /,D Ft.
l F • 7-5' Ft. H Ft.
4
AR ~,ABOR & HU~+AN! ~ r
p~C• Of 11iR11STR~~';~Y BU1.499:i9.
pfVtS10N ~
SEE CO an View Of ;found Using A Trench For The Absorption Area
Force Main
F j Distribution Pipe
I Permanent Markers Observation Pipe
W A o -j-
B K
\ Trench Of " - 22" Aggregate
I
~ L- I
1~ x.44'
A `f Ft. I ' Ft. K 11-:5 Ft. W Ft.
B Ft. J 7, 5 Ft. L //7 Ft.
License
Signed: Plumber: ~ll~ Date: -5-
_ ;mil
Distribution Pipe Retail For Two Lateral Network
Holes Located On Bottom
Are Equally Spaced PVC Force Main End Cap ~
'Y X X PVC Distribution Pipe
P P
X
* Last Hole Should Be Next To End Cap 7
P Ft. Hole Diameter Inch
X Inches Lateral Diameter Z Inch(es)
Y Inches Force Main Diameter -2 Inches
# Of Holes/Pipe /Z
Invert Elevation Of Laterals 9 - 3 Ft.
Signed:
License Number: 4111z q
Date:
conditjona;u
?Pier
~ NNE
.My
Df,". OF 111011 A
OtVISION
S~ co
PAGI: -3 CF A_
PUMP CHAMBER CROSS SECTIOM AMD SPECIFICATIONS
5 4 4
VEUT CAP
4'C.I. VENT PIPE
WEATHER PROOF APPROVED LOCKING
25' FROM DOOR, JUAICTION BOX MAIJHOLE COVER
~
WINDOW OR FRESH - 12"MIU.
AIR IAITAKE I
GRADE
I `1" MIIJ.
I ~
18" /"CI IJ.
COMDUIT
18"MIN. ~~11 \
INLET itio~ OVIDE I li - -
j~.,,l,~CfIGHT SEAL I III
APPROVED JOINT A ~ k I I I APPROVED JOINTS
W/C.I. PIPE 60 , V.~S~~~ ' I (I I W/C.I. PIPE
EXTENDIUCY 3' IMG 3'
OkIT SOLO SOIL B ~ 065 s 5A A I I I ALARM ONTONSOL 0 SOIL
ELEV_ pp9779 9 FT. C Ga
PUMP -
OFF
D
COWCRETE BLOCK
L _j
RISER EXIT PERMITTED OIJLy IF TANK MAIJUFACTURER HAS SUCH APPROVAL
SEPTIC E 5PEC.IFI•CATI0kJS
DOSE-
TANKS MAMUFACTURER: L-t/~~SCrS (JLIMBER OF DOSES: PER DAy
10 x YOID I9D.18 ,C,AL.
TANK SIZE: DSO GALLONS DOSE VOLUME ALARM MANU FACTU RE R: INCLUDING BACKFLOW: GALLONS
MODEL NUMBER: CAPACITIES: A= ~ UCHES OR GALLONS
SWITCH TYPE: /~!`"Gury t
IIJCHES OR 3~~5pp'`__7z, GALLOAJS
PUMP MANUFACTURER: C = -INCHES OR GSLL O`S
MODEL NUMBER: ~'J~✓~3~~ D=!ZINCHES OR -Z)ALT
GALLOAIS
SWITCH TYPE: /l e C,_ 1,4f':;I MOTE: PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE Zy'n GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEAI PUMP OFF AND DISTRIBUTION PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . , , 2.5 FEET
+ 0 FEET OF FORCE MAIN X Z'GS FYo,FRICTIOIJ FACTOR_ /'8-' FEET
TOTAL DYNAMIC. HEAD ='33 FEET
p~Jy O
IAITERNAL DIMEWSIONC OF TANK: LENGTH a~;WIDTH 6 y -;LIQUID DEPTH YZ
/
SIGIJED:~ ~~r LICEOSE IJUMBER: 1~7P66Z-9 DATE:
.Performance Submersible Effluent
curves Pumps Ll of Z/
METERS FEET 9 c 4
90 .
MODEL 3885
25 80 SIZE 3/4" Solids
wE15H
° 70
= 20 WE,OH
Fa 60 '
0 -WE07H
15
WE05H
40
10 30 WE03M
WEOX
20
5
10
0 0
0 10 20 40 50 60 70 80 90 100 110 120 GPM
L I I I
0 10 20 30 m'/h
CAPACITY
[qGWLDS PUMPS. INC.
SENECA FA115 NEW YM 13148
METERS FEET
120 MODEL 3885
35 SIZE 3/4" Solids
110 WE15HH
100
30
90
25 80
i
Q 70-
x 20
J
Fa- 60
0
H
WEOSHH
15
40
10 30
20
5
10
0 O
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
I 1 I 1
0 10 20 30 m'/h
CAPACITY
01985 Goulds Pumps, Inc. ^ Effective July, 1985
J~V/ 7 C3885
c cvHLUN11UP4 titVUH 1
D I L H R 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 ~ro /rX
not limited to vertical and horizontal reference point (8M), direction and % of slope, scale or PARCEL I.O. /
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY ONNER: GTI PROPERTY LOCATION
30 k __l3i ~tMd h, GOVT. LOT 1.2 1/4 51,. 01'1/4.S , 20 T S AR & ( W
PROPERTYONNER:'S MAILING ADDR SS LOT Ir BLOCK SUED. NAME OR CSM ar
Z 3 3 22 Z'1 St, I
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN NEAREST ROAN
orw; n l l~: , sy0o (7151 &'g - 35 5 4`0 LA ,(1Q New Construction Use Residential / Number of bedrooms -3 0 Ile- j J Replacement ( J Public
or commercial describe
Code derived daily lbw ~50 gpd Recommended design loading rate bed, 9pd/ft2 • L bench, gpd/ft2
Absorption area required3715 bed, ff2 375 trench, 0., Maximum design loading rate _bed. gpd4t2 • 5 trench, gpde
Recommended infiltration surface elevation(s) 9l0 93 it (as referred to site plan benchmark)
Additional design / site considerations
Parent material Sig Seal" ma h Flood plain elevation, if applicable., ft
S = Suitable for system oONVENT"Ut. MOUND WGROUNDPRESSURE ATGFiAOE SYSTEM IN FlLL HOLDING TANK
U = Unsuitable fors stem El S IN U j S ❑ U ❑ S "N U ❑ S 1~ U El S _,~l U ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft
g Texture Consistence Baxrfary Roots
in. Munsell Ou. Sz. ConL Color Gr. Sz. Sh. Bed ITrend-
. 9 7.3'>'R y ti~ s; 1 r / m r C_ w 2 NP • 2
Ground 3 Z7--3q/0 R_:5 C o RS6 C-1 2.,-, r y l5
elev. •
'71 Oft.
Depth to
limiting
factor
Z7
I
Remark's:
Boring #
4> ?I5YR /"oY7 C SiA/ ~i» / rr~~r cw Z~ NP I 2
Z-g z g-zG 7, 5
yR C/ one- s~~ Zmsh~
Ground C/ 2, elev. fi ~I`
J~ r ft.
Depth to - - - - ~L r? r% i
i,
limiling
factor j
zG
vt
Remarks: & c"'.rllnr^1t*Pi
CST Name:-Please Print / Phone:
e uo,~so n- 33 7(fp
Address:
~zo Via,'. Sf. y 41:14
Signature
n J~ Date: CST Number:
Boring # Horizon Depth Dominant Color Mottles Structure CpD
Texture Consistence Baxidary Roots-
in. Munsell -
Qu. Sz. Cont. Color Gr. Sz. Sh.
Bed Trtrr)
l o -/O ,5 y No ?M />7 c w NP •L
3
z /0 -21- 7•s y y -No
✓!G ZmS~7C r Cud ~f :
Ground 3 Z(,-y0 /DYie 3 C Z 0 e e C~ Z r~ y- ~n '
elev.
'e ~ .
Depth to
limiting
factor
Remark's:
Boring #
Ground
elev.
fL
Depth to
limiting
factor
Remarks:
Boring #
"la
Ground
elev.
it
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
n.
Depth to
Gmiling
factor
Remarks-
• V I L ! 1 H in accord with ILHR 83.05• Ws. Adm. Code
"Y.~u:~.«~....,-«►, _ COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 fiches 1rt' ivFiA 14st4clude, but `-ro X
y not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL LO. S
dimensioned, north arrow, and location and distance to nearest road.
APPLICANTINFO RMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
FROPERTY~OWNER: PROPERTY LOCATION I
%~o ~Q ✓'SO Y~-~ ~o h .ti ~i t n. GOVT. LOT S GJ 1 /4 S/~/ 1/4.S,90 T g N.R A ( W
PROPER3 3NER'S MAI22Si L1OT # 114 BLOC SUBO. NAME OR CSM 2- 0
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN NEAREST ROAD
wP l,J; , s-yoo (7t 0 GS - 35 5 Q u z N~ s)k
..K New Construction Use Residential / Number of bedrooms .3
I J Replacement ( J Public or commercial describe
Code derived daily flow z}50 gpd Recommended design loading rate • L ench. gpd42
ybed, gpd/f2 tr
Absorption area required 3 75' bed, ft2 3 75 trench, 112, Maximum design loading rate - ` bed, gpd/ft2 • S trench, gpd/ft2
Recommended infiltration surface elevation(s) 9l0 93 It (as referred to site plan benchmark)
Additional design / site considerations
Parent material S//?`X e ' irJ h Flood plain elevation, if applicable It
S = Suitable for system DOWENTIONAL MOUND VJGROUNOPRESSURE AT~GRADE SYSTEM IN FlLL HOLOM TANK
U= Unsuitable I s Lem ❑ S 0 U ,m So U ❑ S~ U ❑ S JR U ❑ S ZU ❑ S U
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Elaxdary Roots GPD/fl
in. Munsell Op. Sz. Cont Color Gr. Sz. Sh. Bed ITrent
l 6-9 7.5X9 yY A4 nC Si tin .,7 r CGJ Z-P NP 1 2
..vc-.::.. 9-27 7.5 Y s /V in e sc 2"Is6 /V-fr C, L.) / •
q 5
•
Ground -3 27-3q IO R-:~% C D gS 6 Cl 2 --1 by, /)9 • y I.5
etev.
Depth to
limiting
factor
z7
Remark's:
Boring # '
~yR 10y CW Z-~
: Z 8-Lra 7,5 y` on>u sG~ Z'"51 Cw -y • 5
Ground -j 26-34 to Ye 5 y e Gal /o S C 1 Z.r ; •
eley.
VED
-RECE
Depth to - - - - j -
bmiling 0
factor
26 - -
SArr a - ow.
Remarks:
CST Name:-Please Print Phone:
-GBy- 33 7f
Address. -
Signature' Dale: CST Number
S- 7- ~y 34// 5
Boring # Norizo Depth Dominant Color MotUes Texture Structure Qp rl rl
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.~~ Roots -
0- w Nip
2 /D-Z6 7~5 s No G sc msb7~ I~7~r cw • y_ € •5
Ground 3 Z-yo AOYX s c z d o e-1 c/ Z m • y r5
elev.
Depth to
firniting
tailor
Remark's:
Boring #
Y III
I
Ground
elev.
fL
Depth to
limiting
(actor
Remarks:
Boring #
Ground
elev.
ft
Depth to
limiting
factor
Remarks:
Boring #
5 2'%
R
Ground
elev.
n.
Depth to
limiling j
factor I
Remarks:
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
MAILING ADDRESS /UG ,5' X30 l!~' c v ~n _ > Z'
PROPERTY ADDRESS Z/O 2zz 462~' I~a ~~v fir. /J" 51ywz,
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE 21?
~lXwc'Y`-
PROPERTY LOCATION Sz,J 1/4, 54,6) 1/4, Section ZO T Z Y ` N-R _1~6__W
TOWN OF a w 6a / le ST. CROIX COUNTY, WI
SUBDIVISION AIX LOT NUMBER
CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years oM sooner, if needed
by licensed septic tank pumper. What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost
of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that owners of all new systems agree to
keep their system properly maintained.
The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner
and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)
the, on-site wastewater disposal system is in proper operating condition and (2) after inspection and
pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum.
I/We,'the undersigned have read the above requirements and agree to maintain the private sewage
disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three year expiration date.
SIGNED:
DATE: c/
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 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.
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Owner of property c I n fy) Q -
Location of pproperty Ql 1/4.5-60 1/4, Section T_ LN-R W
Township Z ac/ 6a Mei Mailing address Z30
Address of site 2 S~ 2caI
Subdivision name Lot no.
Other homes on property? Yes__,~_No
Previous owner of property G~ a l 4rS0 Y~
Total size of property O c,, 14C
Total size of parcel s Acres
Date parcel was created
Are all corners and lot lines identifiable? _X _Yes No
Is this property being developed for (spec house) ? Yes _,-V No
Volume /n ? Z and Page Number 1 -?2- as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of' the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form,. by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. -5/76' l 7 , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Si ature of pMcant Co-App can
Z--a9 -qy 6- ~ y
Date of Signature Date of Signature
j j
THIS SPACE RESERVED FOR RECORDING DATA 'i
DOCUMENT NO. j WARRANTY DEED i,
STATE BAR OF WISCONSIN FORM 2-1982
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6
PIGE
VOL
13
l Robert P. Larson and Dorothy E. Larson, Rto-dftfR&Wrd
husband. .and wife
JUN 9 1994
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conveys and warrants to
Dittman, husbandnand..wifeman--and -Marfly n J.:
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RETURN TO
j'
it . . ~
.
i,he following described real estate in St.r.... EO. ......................County.
State of Wisconsin:
Tax Parcel No:
i IV
Southwest Quarter of the Southwest Quarter (SW; of SWk) of j
Section Twenty (20), Township Twenty-eight (28) North, Range
Sixteen (16) West.
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Reserving, however, to grantors, the right to remove crops
growing on the above-described premises on or before
Ortn''+Pr 20 , 1994, excepting from this reservation, however,
the right of grantees to place a residence and building upon a
l building site not to exceed ten acres, which site has been
identified by grantors and grantees and will not result in any
damage to said crops.
I.
This is--not homestead property.
(4* (is not)
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li Exception to warranties: Easements and restrictions of record.
I~ /G~- I,
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II Dated this - day of - V~!e - - . . . 19. 94
I'
I
I' - - --------------------•----------------(SEAL) .........._-.(SEAL)
Robert P. Larson {I,
ll. ----(SEAL)
I',!
II - --(SEAL) '
Dorot- h~E. Larson
-
I
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
I
II
_ 19:..... Personally came before me this day of
authenticated this ..____._day ol-------------------------- Count
1994--- the above named
1 '
Robert P. Larson and Dorothy E'
Larson
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not-
authorized by $ 706.06, Wis. Stats.) to me known to be the person s.__._.._~t e 'the
foregoing instr a and - -nowled ~ a (pmt y
THIS INSTRUMENT WAS DRAFTED BY
Thomas A. McCormack A
Baldwin, WI 54002 x
Notary Public . s~
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If nett' (state exra ictn
are not necessary.) date: - ---•-_-T X19:- )
*Names of persons signing in any capacity should be typed or printed below their signatures.
Wisconsin legal 3lank Co.. Inc.
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 - 1982 Milwaukee, Wisconsin
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