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Home My WebLink About014-1076-60-000 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESSJ~~3,0441 5-f-- G~ c; LJ1sL~~~3 SUBDIVISION / CSM9 LOT --4 N 5L _ SECTIONT _N-R ~J W, Town of I``0rr-4 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM c INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~~II o(M d J ~~~p S G f' cr y 17e4 dv"!, ALTERNATE BM: V%. O vx_c SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Mac[ q.)ejf f'2CVA Liquid Capacity: D Aos I Alutt1, Setback from: Well- 4 Other Pump: Manufacturer Model# Size_ Float seperation Gallons/cycle: Alarm Location e.- Y✓ Aj SOIL ABSORPTION SYSTEM Width: J 4- Length ( o Number of trenches Distance & Direction to nearest prop. line: Setback f rom: wel l : House y J Other ELEVATIONS Building Sewer r V ST Inlet. Q? 8 ST outlet 0,q3 PC inle~ PC bottom Pump Off Header/Manifold ,g Bottom of system Existing Grade :;k- Final grade kDS) ot 1 DATE OF INSTALLATION: - /(o ^ ~f 4'1 7 y 97 e ~ro ~2, i6 d ~ Hsl b`I PLUMBER ON JOB: CST. LICENSE NUMBER: S-7 5O lift- 3/93:jt ST. CROIX COUNTY WISCONSIN - - ZONING OFFICE A IN a ON I If r""'6 ST. CROIX COUNTY GOVERNMENT CENTER r.,. , _X 1 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 November 18, 1994 Mr. Clarence Glotfelty N4165 Highway 40 Bruce, Wisconsin 54819 RE: As Built for Clarence Jackelen Dear Mr. Glotfelty: Per your recent request, enclosed is a copy of the STC-104, as Built Sanitary System Report, for Clarence Jackelen. If there is anything else that you need, please do not hesitate in contacting me. Very sincerely, Mary J. Jenkins Assistant Zoning Administrator St. Croix County, Wisconsin mz Enclosure Wisconsin l5epartmentof Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION Pea% WWa16LARENCE ❑ City ❑ Village it Town of: State Plan o.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 420. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1, - Benchmark d _zJ Dosi ng Aeration Bldg. Sewer Holding St/ Ht Inlet I a,Olo D43 TANK SETBACK INFORMATION St/ Ht Outlet a, b , q 3 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 1,1"66 J3 Septic >La , O 2-0( } NA Dt Bottom IY, ('a3 _M 96 1~ q1 Dosing t 5 ~ r l b/ z > 1 NA Header / Man. ` 9 ",g 9 Aeration NA Dist. Pipe If qz• 5s Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Mo,-,ul Gyur Model Number 41- 1 GPM /q, DH Lift Friction System TDH Ft LF0 rcemain Length Dia. Fi i Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Len th No. Of Trenches PIT No. Of Pits Inside Liquid Depth DIMENSIONS _ 0 r DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Moe Number: System: > lOd /S OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Forest.35.31.15W, NE, SE, 310th Street Plan revision required? ❑ Yes 1L No L/ Use other side for additional information. o/ Iq I - SBD-6710(R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i SANITARY PERMIT APPLICATION Busafetyreau o off BuiuiildinWater Systems ng Water 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County i than 8 112 x 11 inches in size. at~ • See reverse side for instructions for completing this application State Sanitary Permit Num er qo3± The information you provide may be used by other government agency programs ❑ Check it revision to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Nu4Mer L APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Al. Property O e Name Proper Location &reMbL A 11a E 1/4, S 3:5 T3/ . N, R I.S 50off) W Property O er's Mailing Address Lot Number Block N~er c y State , Zip Code l 2 Phone Numb r -~o ubdivision Name or CSM Numb r ~ ! J ) s II. TYPE OF BUIL : (check one) ❑ State Owned El __9 Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms :3 Town OF Flo III. BUILDING USE: (If building type is public, check ~a~ll that apply) Parcel Tax Number(s) 1 F1 Apartment/ Condo / ~ ' at N -ID 7& 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 box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. X Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5- ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued- Permit Number Date Issued V (Check only one) on-Pressurized Distributio Pressurized Distribution Experimental Other 11 ❑ Seepage a 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank 12X Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage. Pit 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 Gjade ~Refired (sq. ft.) Proposed (;q. ft.) (Gals/day/sq. ft-) (Min-/inch) 1% 97d• e Feet z7eq 1&0 Feet d VII. TANK. Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank ink / / 9 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Sipuew{~ermber & SO p~t~i y/1 ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Pber's Name: (Print) Plumber's Signature: (N mps f&WPRSW No.: Business Phone Number: ZJ 'I 7 ~jrO X1.5 AAA /'0-31.44A, (Street, City, Sta e, Zi Code): _U Cf Lam.)/ SYI%~ - Sly g~3 t G IX. COUNTY /DEPARTME USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issue Iss ing Agent Signature (No Stamps Approved ❑ Surcharge fee) Owner Given Initial Adverse Determination U X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 5a~ I ~ SBD-6398 (R. 05/94) DISTRIBUTION: Original to county. One copy To: Safety & Buildings Dimsion, Owner, Plumber - j INSTRUCTIONS _ 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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 and 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 on 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 for numbers 1 through 7_ VII. Tank information. Fill in the capacity of every new/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 sepic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental r:- oduct approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate arefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. lX. County/ Department Use Only. X County/ Department Use Only. Complete plans anc? specifications not smaller than 8 1/2 x 11 incr1es ir,1 t :5e sub,Y,i tted t <i (-,,unty_ The plans must ii i~1 e ttl_) foilowincl. A) p:ot o,a(-,, prawn to scale or with corplete i, ",pit nlUrl`. ~acati-n ;)I :ic idi~nq tank(s), septic cr Went tan k;, 14 !ilgSe VV r5,; `A/ells; watt-. ij c•if1S-,, 41,(: '.,I akes; pump or siphon so l ~:~_arc>:ons~-oms; repiacernents,s;. a r,ebuildingserved, ~Jr'ZL .L 3i t; V fiCal cI: Vt i t)il +~rt:l r -r ~ COr ~~;~C ? rJct (t: . _I iUr p'.rli„),;;f t 11:r'Jls; d~Dse voIurne; eit-y-Oion c6 r=_ie" ~ friction Ic55; P- rp c.lJrvc, pumt. rni t'c.'I s-)p'r~ D' cross section O7 ^.2 moil abso, pt system if rt Cqu!r, C]'-, " t Q O3j :.j SOII tes_ a vli r11, at:1Ci Ili iIzjilg information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number or reg_,iated practice,, which can effect groundwater The monies collected through these surcharges are used for monitoring groundwater contarnination investigations and establishment of standards. f 3 ! j } 1 i •,~I ~ j ' , i i i _ r-i .......L............ ............j. ;j..... ..1 .....5.......... i -_.......i 10. ......Y.►.~`!~' .;.I!L?1A.1.4! .I i ! wig t f -q ; S~ IZA 7 s ~ • • , ' i..... j I i ! i ' i ! ~ i ` i .i 1. i .r-.. ...i...........:............ i i ! i i i i ..........o i...:..... ..C.... ...t ; ! 's ,Y It i /'L G { ' i A'f~ i s~ e [ [ i i i Si 7 I I j i~ S ; i i S 1 i ! , ! ! v~ j : i I i i : i i i f r r b 77 v [ i ! i I! i w t ! i i I i r '.C G mow. i i i i i I 1 i i S 1 I , t f i I [ I ! 1 7 i.i ~ i -1 d4* Q ; t 4 I ! i .i.... i i ! Y ..r......... ! i ! i 4 i i i i ! 1 t ! ~ 1J •t ........b........ , I . 3.. .I ! I ! i ate ` ! i i , j v ; j i I .y........... a« ou~ne~t's P "L a c ale o~d r'!A~ SeJ1 Wis. ! ~s ete,~a o K# _ . x......... i ! ! A pi i. _i ' / 9y19 f ........r.......... o. t I . ` i : ! y,x Y i i w BRUCE PUMP & TRENCHING, INC. N4165 Hwy. 40 d/3 - - BRUCE, WISCONSIN 54819 Yd 5--Q- Herman Glotfelty Clarence Glotfelty 868-5225 MP -4423 868-5831 CST -611 E ~S S"- l HEAD/CAPACITY CURVE x' EFFLUENT & DEWATERING TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE s- - 181 103 105 ISS lee In tee L~LIfl GAL 7q ML 4??_. aS"jn ML.-LTp. 8 1.62 43 IN 72 'Z73 J04 004 of 1 - 1 71 WO 100 '379": ~1__2J! 6e _230_mss 166_ Q_.. 10' a 34 129 - - - t . _201 61 221 6e 1b N 161 '00.. A. 1 46 71) 64 29- 91 11 04 BO X27... Ra 7J~ 1~2 fit7 t lS c.40 7~. z-_~u -129._,lH4...A.7__..GU1. 49..... M _12L.__<Ffl_' 12L_._..19!.. oo- - - JO 9~ 14 _M_ _2M_ 56 2M_ 58 90 NO, 491T 66 206. r6 2M 2O 106 V7_ 1 ai sa t ra z2i tao .,N too __21 801 w 12K-- 61 IVI 7 I t 70 ~I III~I~' VIII II II I,' Jo 1 1 10 Ja I.'. 62 '.IV sI 161 70 -xx6 4Z _12! 1M _6r '.724 Its 100 30.46 '0- -a5-- - - to BB _ 21 _7D_ 7 P1. a ;Yf t 65 1 'nod 60- lock Valve: m2s' 1' 26' se' 66' $7. 7J' IIS 91' 55- WARNING: Model 185 should not be subjected to loss 6 50-...__... 63 than 30 feet TDH. NOTE: For Head Capacity on Model 112, Industrial - - column-explosion proof pump, see FM0219. AO-- - - - - 85 35- t0' - d lea Z7 6 tS- _ 161 _ - - - - tee MAIL TO: P.O. BOX 16347 • Louisville, KY 40256 0347 9e SHIP TO: 3280 Old Millers Lane • Louisville, KY 40216 s . 'tJV sa - - " (502) 778-2731 • FAX (502) 774-3624 ~.j. s. Gn!.~O VS _,0 20~_ Ui 40 50 60 70 B0~90 t00 1110 1201,70 ,40 ~t50 t60~,,, 160- -240- 320 ,00 460 %0 610 0 SOIL AND SITE EVALUATION REPORT Page of L71; I~HR in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than /2 i . Ian must include, but s/ O / X not limited to vertical and horizontal reference int dir ction a lope, scale or PARCEL I.D. # / dimensioned, north arrow, and location and d' t~at~pb to eattt d. ;7 ' trd APPLICANT INFORMATION-PLEASE~IT A Lfik tfefF~OPRMATIO REVIEWED BY DATE ERTY LOCATION PROPERTY OWNER: A"" LOT _ 1/4 Ste- 1/4,S j T 3/ N,R /S~r) W PROPERTY OWNER: 'S MAILING ADDRESS' # BLOCK # I SUBD. NAME OR CSM # 3le C TY, STA E` ZIP CODE P1{ []CITY VILLAGE JUOWN NEAREST ROAD I I New Construction Use [ J Residential / Number of bedrooms (j Addition to existing building L4 Replacement [ j Public or commercial describe Code derived daily flow gpd Recommended design loading rate 1~bed, gpd/ft2 . trench, gpolft2 Absorption area required YJ_ bed, ft2, 5~~3 trench, 11:2 Maximum design loading rate -,-Z_bed, gpd/ft2 .FVench, gpol1112 Recommended infiltration surface elevation(s) . y7 Ydl Aol" ft (as referred to site plan benchmark) Additional design I site considerations Parent material _6146 Zj Z'2Z4 Flood plain elevation, if applicable AIX ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U OS ❑U E]S OU SOIL DESCRIPTION REPORT pth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft ED, Boring # in. Ground n Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch S/ V ,Y - elev. 3 A 1vc o A-, V P - ~ Depth ft. to -/,0/ 14f limiting factor j ~O Remarks: 9w h 9. i;&, o N- C e M e f` ed Boring # s _ need tv 8 Ground / 71'. y q 6 8 ' elev. 71'. _ $ C 3 ffB v e ef..S M -2 `ls ft. .ve Depth to limiting factor Remarks: CST Name: Please Print Phone: ~3~ ~,4,4•e S G~ Address: 3~ w d ~7~ e w 6~c✓ 641 Z' Z' Signature: / Q Date: CST Number: PROPERTY OWNER z- - Ltd. SOIL DESCRIPTION REPORT Page ;-2 of ..3 PARCEL I.D. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 / 0- o .3 5 .25-.6h A 5- M . 02 7- S /s F mvFe eld VF . 7 , Y /H e d Ground ,3 a9- p ,S' A !U elev. y,~-yR 1416, w ys ft. -78 S~ 2wilt va w rYP ' &W ~e Depth to ~~91 /a Y"q 6 6 S o S limiting factor Remarks: _y h aR/~o~Y CeMen/7`'ed Boring # i 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: i - .00 - - - I-t--- - - - - 3 M- _ L- 403 r, r,4A e e 86 - - - P6 I-A I 13 I I I I ' ~ -I --l---r-----}-li- -II I I j i. _ o I F I I I r- - I _ - ( F - ! ---I- - - - I I - L I - - I - -i-.- I L ! - r- - i - - , I - - I ! , f I I I I ! I I I I _ I I I I --1-- Imo- I - - I - - - - I- ! I - - i I - 1 - - - _ T -I _ Lt ; I - l - _ I - - : 1I j! I i ~ I ! i ~ E I I i i I I I I i I I I I - - 1- ! --I 1- I I I I ! I I ' STC- 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County O WNER/R C/A i'CA~ MAILING ADDRESS j~qOB PROPERTY ADDRESS~~ -s:;)~ (location of s is system Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 1/4, 1/4, Section T 3 N-R /,.-S; W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUM13ER 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 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. 11We, 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: DA-1-1-- St. - St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI S4016 11/93 8 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. _ ~_f owner of property 0JACCAU- re!.eiefeIrm Location of property N ! 1/4 5C-- 1/4, Section 36 ,T 3/ N-R is W Township -®R,LS r Mailing address /f - 310 -30% 4'. LAJ I -Syo1 3 Address of site 14- Subdivision name Lot no. Other homes on property? Yes X No Previous owner of II property 1" 4-, A- Total size of property $U ~C Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes k No Volume and Page Number 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. 39 (sv , 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. Signature of Appl ant Co-Applicant Date of Signature Date of Signature Pare 133 Yu. 700 WARRANTY DECD. To Husband and wife as Joint Tenants. .i..m.u M. MS ..uv... I 1i NUMBER i T4i,a Mpriturr. Made this 5th. day of..-.............. Eebrli-' .--....._.19....r i between Peter Jackelen and Cora- Jackelen,.husband and wife and each_'n_thci.r..ofyr_incl.iv.7G.ual...c.dp cit................. 239150 ...of the first part, - ° ..part. es `"1-^ence ; Jackelen and Genevieve I. Jackelen and...........:.. . . . husband and wife, as joint tenants, parties of the second part. Witnesseth, That the said part.. ] eS...of the first part, for and in consideration of the sum oC...i''il't.cert..hausand-nci.no/lAO . - _...--.--_.._............_......_.......................Dollars, to them ............._--...-..in hand paid by the said parties of the second part, the receipt whereof is hereby confessed and acknowledged, ha._ve. given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do............ give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said parties of the second part, as joint tenants, the following described real estate, situated in the County of .at_...craix .................................Wisconsin, to-wit: The Southwest quarter of the Southwest quarter (S""41 S';i the South Half of the i9orthwest quarter I (Sz Vti'4) of Sectinn hirty-six (36) ; the zast Half of the boutheast quarter (E SS ) of Section i Thirty-five (i7), all in ownship Thirty-one (31) :worth, of Range Fifteen (15) hest. j This convevance is (riven in pursuance of the terms of a land contract entered into between the parties in r.ovewber, 19Lt9. 015.50) ) ( R. S. ( Can. ) Together, with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part c:... of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and to Hold, the said premises as above described with the hereditaments and appurtenances, unto the said parties of the second part, as joint tenants. And the Said,..YC~cr.-Jackelen_ard..Cpra.Jackelen..._hus.band. and..wife . _ ...................part-ies.... of the first parr, for toemselves,,.-t. he ir,...................... heirs, executors and administrators, do...._... covenant, grant, bargain and agree to and with the said parties of the second part, and to and with the survivor of them, his or her heirs and assigns, that at the time of the ensealing and delivery of these presents they-- are ................well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever, I . - L . and that the above bargained premises, in the quiet and peaceable possession of the said parties of the second part, as joint tenants, against all and every person or persons lawfully claiming the whole or any part thereof they................... ........will forever WARRANT AND DEFEND. i In Witness Whereof, the said part-des.. of the first part ha.....ve.. hereunto set ...............their hand -..s. and seal_s.. this ( 51h, day of.------ ---..februarS 19.... 54 _i'eter Jackelen Signed, Sealed and Delivered in Presence of Peter Jackelen (SEAL) Cora...Jackelen.......--------------....-----..(SEAL) J....1: x-H.u hes.............. J. E. ill"hPa Onra darkel on (SEAL) .............................J.osP~h.:r"l:...3ut~hes...... i Joseph VJ. Hu=~hes -------------------°°--------...---------------......--------------------------...--...---------(SEAL) STATE OF WISCONSIN, ss. County. On this the.......... 5th............................. day of.............. ebruary.................... 19...arLl.., I officer, before me,-..-... Jose iih--u{..- uhhe.S.._ the undersigned personally appeared -_fjae iztr'_-Jackelen..2z1d:.0ora -.Jackelen.,...hushand..and..wi.fe...... known (or satisfactorily proven) to be the person.!L. whose name.. s subscribed to the within instrument and acknowledged that -...theyy... executed the same for the purposes therein contained. I In witness whereof I hereunto set my hand and official seal. Received for Record this...!Qthe..day of........... Febr.1la.1"'f.-........ Josenh YY. Hughes • Josenh Vi. Hughes A. D., 19-..511., at.-..9-012 'clock-A...M. Notary Public St....-4xo1x................ County, Wisconsin. David Mope (SEAL) . Register of Deeds. My Commission expires...... June 125 (To be filled in if signed by a Notary Public.) Deputy r .-JIM _00800N~ «;COWJN SOIL AND SITE EVALUATION REPORT PageLof 3' DILHR in accord with ILHR 83.05, Wis. Adm. Code W COUNTY tswe' -SmoiUM"FRAIM Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but .S~ /•X 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. - /0 7Z ~ b0 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION A GOVT. LOT N 1 /4 5~ 1/4,S j T N.R /f "R) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # C TY, MAC_? R ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE jgf TOWN NEE ROAD to oo d C 7" ~i/ 0/3 V/s)?-6.s'" a-s"~ e [ J New Construction Use [ J Residential I Number of bedrooms [ j Addition to existing building 0 Replacement [ j Public or commercial descxibe Code derived daily flow gpd Recommended design loading rate - -Z-bed, gpd/ft2 . S trench, gpd/ft2 Absorption area required . bed, ft2.-d3 trench, ft2 Maximum design loading rate -z-2 bed, gpd/ft2_, ?--trench, gpd/ft2 Recommended infiltration surface elevation(s) 9y. 4J 'f yd? ft (as referred to site plan benchmark) Additional design / site considerations Parent material GL,46i s 4 2'22,4 Flood plain elevation, if applicable &,4 ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. ,At Bed Trench _r-- Med 0 5 Ground 986 ft. p- "~yP 6/8 Sc 3, re of r w Vi" Depth to -/p~ ~ O S M • 6 limiting factor ~O Remarks: 9" hOP, i A v N 0M : ° ;7 Pd Boring # }.::<.r l O- /0 3 S S if F-r S , s €Med Ground y, s'y,Q 6 8 N e Z N'w P elev. 711 $ C NB vC vjS'A ft. Depth to limiting factor -t- Remarks: CST Name: Please Print Phone: 7~S 'a Address: o~ L/~ Q ui 60rc✓ ~i O~ Signature: Date: CST Number: PROPE'.'ryOWNER SOIL DESCRIPTION REPORT Page.,2_of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bw-dary Roots GPD/ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench s p4 c d Ground D S A W elev. %s ft. 7 :.,8 - 7 s-yR ye- C W 1 P 1YR ~IV e Depth to s' r'q/ /e YIq 6 6 limiting factor L I Remarks: d R/ o N C e M' e lv /-e o' Boring # Ground elev. ft. Depth to limiting factor I Remarks: Boring # Ground elev. it. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: e q Ayl- 1 I J fl i ' ~ I I i I I ~ I I I 1 ~ 'I iI I I i i I I I : I 3 eft ~ RE 6~- R 1 ~ , I/ I i t • 1~~~---- -f-- 1 0001, : I ~ a I i I I , I I I L7 i y ~I ' I o~'jt..~st 7~4e _c' ,R~dc'~~✓~ ~i I 13 I i 1 e- !Ndl 114 I f ~ I I 1. I i I r I { 1 - - _ - - - - I - - - : ! i / I I : I I I ~ I )h A e e-, Wisconsin ftpartment of Industry, SOIL AND SITE EVALUATION REPORT Page / of °3,\ 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 81/2 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 5/D REVIEWED BY DATE 0.C in PROPE OWNER: PROPERTY LOCATION 6.2WAU, ~~~e.Je,,,, GOVT. LOT /VE- 1/4 SE 1/4,S35T 31 N,R 15 W PROPERTY OWNER':S MAILING ADDRSS LOT # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑G4# ❑VIRAGE EPTOWN NEAREST ROAD I,j ~f 51/0/3 (715) -14:5 - 31 O -4'► S~ [ ] New Construction Use bKj Residential/ Number of bedrooms 3 [ ] Addition to existing building ~Q Replacement [ ] Public or commercial describe N • 19. Code derived daily flow 4450 gpd Recommended design loading rate - a bed, gpd/ft2 - -1 trench, gpd/ft2 Absorption area required c2;kRS bed, ft2 /SOD trench, ft2 Maximum design loading rate . of bed, gpd/ft2 •3 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Soil R • o CST G LE 5M Pvt ctr, 5 - /9941. Parent material 740 Flood plain elevation, if applicable 4. ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL7 HOLDING TANK U= Unsuitable fors stem ❑ S NU ®S ~aY ❑ S ®U ® S 011 ❑ S m U P q I NU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench / DY 3/y S i L o2 Cr r' C- S m 'X -S e D-B 13 8-340 / j 5&1 ~-~k m r w c. Z. 5 0 to Ground i3 o G s SyR`~~/ S►CL 1 s~ Ilv, >~-1 . a 3 93eV8 ft. Ci `>r~/D8 /DY 6 c3~ syR~/eds ~r►,~ 5 - e b Depth to limiting fact~or„_ Remarks: f Boring # f \ t t l Ground elev. ft. Depth to limiting factor I Remarks: CST Name:-Please Print / Phone: _ tr8 ~~53 Address: n/ v/ s, 5 C r y J Y 7 Signature: Date- /J CST Nu ber:M PROPERTY OWNER SOIL DESCRIPTION REPORT Pao-'- of PARCEL I.D. # f i Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munse►I Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor F-T Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) e- .0 - - I - I t I I i ~ y I I l i I ~ I I i I I 1~ I I I I I ~ ~I , , I ~ i ~ I II o I i I I I 1 I,, I j - ' I I t ► !vc WA I Af M. _ He 4+5'e. Se' _otR r*~ r : Ho e. ~_Pfs I B. M. /,00, M o w i to _S/o~iN~ FA 79 _LAwlty -Rees _ 17!o S,/oPe 8 p ; o,-- taest 7-weJvc4 I q gdc. Elev. y7ao Q i - I I i I J - I- - -I - - - -S - - 4: E-~LA, I AO I E xI_ ~i s t0 I I w 8' t' Avg ~ ~ -I---- ' I I I ' Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of Labor and Human Relations Division of Safety & Buildings A in accord with ILHR 83.05, Wis. Adm. Code COUNTY • -Attach complete site plan on paper not less than S 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 _ y0 PROPE 5TYOWNER: PROPERTY LOCATION GOVT. LOT /11 E 1/4 SE 1/4,S3ST 3 J N,R /5 L2~=) W PROPERTY OWNER':S MAILING ADDRSS LOT # BLOCK # SUBD. NAME OR CSM # / - _15/0 54- CITY, STATE ZIP CODE PHONE NUMBER ❑to}~ ❑VIL-b46E OWN NEAREST RQAD ~orc~ ~ 1 O -~-h S.-{ P Y ~f" JY013 (715) ~j - 4Wj _j l ] New Construction Use bc] Residential / Number of bedrooms 3 Addition to existing building K Replacement [ ] Public or commercial describe Code derived daily flow y5o gpd Recommended design loading rate • a bed, gpd/ft2 . 3 trench, gpd/ft2 Absorption area required .2 -'kRS bed, ft2 /500 trench, ft2 Maximum design loading rate . oL bed, gpd/ft2 .3 trench, gpd/ft2 Recommended infiltration surface elevation(s) /Vaq ft (as referred to site plan benchmark) Additional design / site considerations So.I R or-]- c5T G LE 5rn yl ad". 5 - /?,?Z/. _ Parent material Flood plain elevation, if applicable •4. ft S e for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK sable fors s tem ❑ S ®®S o u ❑ S N U ® S UU ❑ S Q S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles structure G P ;7f t7 Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bea D-E /OY 3/y SiL a C r cS m~ .j 13 y w C' Z, 5 4 Ground (o"~ 0 (0 5 Si~- ~ C 5~ rv~ r f- el C3 sy R 4./845 A; „e. Depth to limiting factor, Remarks: Boring # {1' iT? C i > Ground - elev. ft. Depth to - limiting factor Remarks: f ,a -Please Print l 'v / ce- F / Phone: _ _ J83 O Address: V V n5 S Kv, n lam' ~l J V 7 Ce P~ ~ Z5/ %J Signature: Date- / / j CST Nu b 1 r'//t'1 r I Q - -4 p qr 5p 7, _ L - - - Iv q - ~ ~ ~ ~ lax .9" - r--. - - - - ~ - I - - - - a na " v o d ~g i v `N- a N b .,C o I ' Y M 7 - _I i ~ j i ~ I i i ~ t i ;7 _ "All a~ ~ t - r-- I I- 1 ~ ~ a O O - - - - - - ~;~~-ate a- 17 F_T l