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HomeMy WebLinkAbout020-1104-20-000 Vtvisiriscon sin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 panel Human Relations on of Safety & Buildings in accord with ILHR 83.05,"VVIS Apdtlm Co te, COUNTY CAD X Attach complete site plan on paper not less than 8 1/2 x 11 inches in site .('tin muol . lude ~bu? . PARCEL I.D. # t not limited to vertical and horizontal reference point (BM), direction ar d='P/ bf sl a sgals Qr c dimensioned, north arrow, and location and distance to nearest roadt REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMjR ON PROPERTY OWNER: , - PROP8ATY OPATION ~ AW,f NAE$ Ey6K a . QQV~., ' ~•;W, 114, " 1/4S3 T N N,R I E W PROPERTY OWNER':S MAILING ADDRESS L # BLOCK # :.S NAME OR CSM # 694 uIH ne r C5M CI ZIP CODE PHONE NUMBER ❑OI Y-.- - VILLA E MOWN NEAREST ROAD AMDs L 5401 (115') S((o-3 72 -M wt-~\Tv QAK ztt vL pQ New Construction Use Residential / Number of bedrooms 3 [ J Addition to existing building j J Replacement [ J Public or commercial describe Code derived daily flow 50 gpd Recommended design loading rate W4 bed, gpd/ft2 O.S trench, gpd/ft2 Absorption area required 1125 bed, ft2 goo trench, ft2 Maximum design I grate 0.5 bed, gpd/ft2 0 . b trench, gpd/ft2 Recommended infiltration surface elevation(s)TO Dim EKMWED b. pt~( referred to site plan benchmark) Additional design / site considerations - Parent material sou t~.sTOmE Flood plain elevation, if applicable NAB ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem 5aS ❑U S ❑U S ❑U WS ❑U ❑S ~U ❑S NU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bwxl@jy Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tre & 0-S SY 240 5-1y to v+g 2-11 f I 2 r CS CZ o •S 0.6 Ground 3 I4-20 0 242- SJ 2- s 1 ry\ Fr CS G2 0.5- O.b elev. . g1.53 ft. ZO-2 10 3J3 S ( s mfr s C2 O.5 o. b Depth to S 21-149 10\4K 3I L4 S S on I 0.W C 2 0.7 . S limiting factor a tP 9-6 to V y y C S 0 m l - G 2 6.1 0.$ Remarks: W9tZ0M SR EHtS SAC- 6tA9r_L Boring # O- 10VK211 - 5~ Zm r J 0-5 C2_ 0•50-to ,,:.,.w...::.:. Z 10 'f K211 S\ Z C_ r I C 5 2 0.6 0. ko g -35 2.5 y ~s u - sl 1 m sbK rf% -Fr CS 0_2 O. q 0.5 Ground elev. 4 35-51 to ~2 - S 1 1 rnCS CZ 0.4 0 . 4,7j ft. r Depth to 5 51-1,2 to 3 S1 2 msb rA S . 0 • to limiting 62.7p 101 3/ - at\ 2msb K fi'r s cZ O. s 0. (o factor - Z o.7 O.f~ 7-72 7 '10-7z IbyC~lb _S 1) Y-Q Remarks: 4W 2PAJI S 1 U fits 0 CST Name:-Pllease Print t 7E~' Phone: b15 )x425-9 IQ Address: Aj 3103 (o50 n` ST: 2twvt✓ t=Au.S WL 5402-2- S' re: Date: CST Number: Sear, ICI %q96 / b5_70'7 PROPERTY OWNER HAE%xvrmeIe. \MWCE SOIL DESCRIPTION REPORT Page Zyof. 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 01 . 4 t -5 2.SYR2- 2 m rn el5 CZ s a,b 5-17 2.511QZ•5 p 1 M QV- rr\\ ' QS C2 .4 0.5 I.J Ground 3 1-7-2$ to re 31y r Si) 2msb M r C4>- CZ p . 0. (o elev. q6_~'7 ft• 7-1-34 l0 3110 SI Zrn M~ GS C2 0 5 - 0 . to Depth to S (,2 0 YK3) - S w►} - GZ O ~1 0.8 limiting factor 2,r Remarks: " Boring # 10 V P, 311 .3 6-5 Z - of l - Sl s S C_ C2 .S 0.10 Ground 1%-2q 0-j P, 2/2 C CZ . S D,~o elev. 24- 13 51 Q.39 ft. s S -.5- 0• f'o Depth to 5 Z'/-33 I -V51 2 msbK S C2 0.5- :0. io limiting 33-60 7.5`I 3t - S - C2 factor /r i Z~ Remarks:- 4b)6ZbM 2 hie S Zd4 3 R S eG EL Boring # 1 g 2sy 2 5 0 - I 3 m r ~r ~s c2 5 0. (0 5ti 2 S- )5 .5 2.5 0 - 7 nKsbK ►nVf 0. c2 o•s o. to 3 15-35 r® 3h& ed 3 vhSlQX Mfr' Cud C2 o.s o. b Ground elev. 4 35-41 IG Y 3/14 - s) £ S 2msbK ft fr- CV3 Z 0.S O. q j. O ft. 3 44-f,3 Ib 4 S Depth to rn I - C~ 6.1 0. limiting fac Q L Remarks: MKIZON 314IISMwy s~~c CO*rs; ftOZO/J LA i{ A--S5oAAC- . ak-IT:t 6f- OSq Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) Page_ of 3 PLOT PLAN Property Owner J4AIWaSeAtz-JeK, VAA)eF Legend:/ ~~-4/O/EXCt-P7 W+41~=Arc NOTED Legal Description OrLOCA'tEa \u' "E BM = (2k0UND SDK E pN EAST SISM OF FLAGeM-n AM n ^I W'14 OF -T H E nI W `N I See' 3, T2( A) .2 ►9 W TOWN OF Tvtoj ST,CK0\X CouNTy wsSCOAXSJJ _ fF~6l4iME~ ien.n! soil boring w/backhoe 2.19 Acros Au- wooz*Z C:7 81 r;L 9'x 33' ~In~( iX,~ ©aBM 140 - ~ S~,y 85 Lhtacot- D/STAKCO .S~ 0/ `S Do NOT o%s'TlaAB `o C153 s w 06a 4b,67 c~ RAPRUkiM 2J'~ e~96.11' 165' To -~j T WttrrE o~ p~uE 064 E1.44 U N ~VbOtJE w z 3 ~ous~-ro aE T 5' o~ Cof-C~Tt f FKoi& GWnC IANI, W 2,5 sac G KsA-r8 K FKow ZKAvAI F%ELp a 0 Q. W~LLTO SE 25' or- Co2F-A E12 FKOA \ zEI°`t e- TANK 5o' or- GCEATEK FKW DfA%A) F)W-1 2 D►C Gf-eAIEK Fr2AM I40uS;-: Signed CS Mo3707 Date SHPT, Lj 4q q6 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations iAsion of Safety & Buildings in accord with ILHR 83.05, ~fis-~, ACdfia, Code % COUNTY ST Cleo. x Attach complete site plan on paper not less than 8 1/2 x 11 inches in si a must-'include, but not limited to vertical and horizontal reference point (BM), direction an %,V sloes stela or ARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. _ : i ,i • VIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORM ,A N PROPERTY OWNER: PROPEWTY1'SMION VNk-E HAt`.5CAEYEt2 681 ktseh?/4, 1/4,S T 2,7 N,R 1`~ E W PROPERTY OWNER':S MAILING ADDRESS a# . BLOCK NAME OR CSM # 594 ulH 11F C5M CITY, STATE ZIP CODE PHONE NUMBER MOWN NEAREST ROAD j-lups L Sy()I (1IS) 'S((0-3 q"7-? 1-r'm vj"N u OAK QfC~VE pQ New Construction Use ()Cj Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow '550 gpd Recommended design loading rate 0.' bed, gpd/ft2 ! S trench, gpd/ft2 Absorption area required 112- S bed, ft2 4 oo trench, ft2 Maximum desigi~n~II adi, grate 0 • bed, gpd/ft2 o . trench, gpd/ft2 Recommended infiltration surface elevation(s) TO C3C- Din EKMINED $y SAS ttE(5referred to site plan benchmark) Additional design / site considerations - Parent material s~W osTo>JE -Flood plain elevation, if applicable NA ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ~0 S ❑ U S O U 91 S❑ U 10S ❑ U ❑ S 91U ❑ S l$I U 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 .:::1::: ' o-S 7•sv Flo - m Jr C s C 0. Z S-Iy IoYA"JI I ?rte rr\ r Cs C2 Ground 3 !q-20 0 242- - S[ 2 s 1 f,.~-r CS L2 D.S- 0•!' elev. q'1.33 ft. 7-0-2 to yr\ 'Js ' isrnFr 5 C2 O o. b Depth to S 2'?- I D 3I4 S S M 1 0-W G 2 0--7 X limiting factor fp 9-6 IoVKU L4 CS ~S m l - C2 J., 0 . Remarks: k(1'_iZ_ty,1 tp NAB -;WC &tA JLL Boring # 10VIZ`/1 - 1m r J~ CS t'Z ~•r C• Z Z. L,g YYN Z o.s o 1113 v;c21't - Sl 2 i Or O' Ground -35 ~.5 y1~ -1__-51C> _ 5) 1 m Sb K ~r C S C Z 0.4 o.51 ~elevv.. ft. y 35-51 tn• - 2 - l 1 rn 5b ' CS CZ 0, y 0.5 Depth to s SH f. 2 msb " rAf G S r- Z . S 0 . !a limiting to (r" -34' stl 2m5bK YY\~ r' S GZ O.S 0.1., factor 7 '1o-?s I>'Ifir S a Y- Remarks: _1LD) S E U ktS 0 CST Name:-Please Print Phone: mAy,N o bL IS7EP ~~15 ti25-~tsr~ Address: ~ T Aj 3h3 (050 ~ S Qvile c~~trS Ws 54021 11 Date: CST Number: (,T.~~ ' St_pT, IU tq9 M.05'707 PROPERTYOWNER HAESEAr--leK WC E 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 2 rn rn C5 c2 o 2 5.11 2.SYK--.5 b - I ~r~ r mV~r 45 CZ .4 o,S Ground 3 1-7-2$ 101C 314 S+i 2rr,SbK m Y- C6 C2 0 , 0'(0 elev. %x_411 ft. q 7-7 io rnr4 CS c2 0 5 0. Depth to s gtr2 1,0 YK3~ - 5 W11 GZ_ p 0 0.8 limiting factor Remarks: " Boring # IOV aft _ 51 3m 5 C,?_ a 5 0.1~ Ground t -2q I 0 212- - S _ M Y_. CjSI~ C GZ . 5-: 014 elev. - lev ft. h5 S1 2 S -s S 0.10 Depth to 5 Z?-33 1 -'1 S 2 m SbK S CZ 0.5 0. l~ limiting 5Y ? f ~p 7 - S factor CZ ~ 7 ~ 0• ~ Remarks: d htz S 1401C I Z U N 3 ~tS t KIZOAJ t~ 5 E GrAq iEL_ Boring # L/ J i ZSY 2-5/o - I 3 m r ~Y -s C2 b.5 p. to 2mSbK mV~ 4 c2 o•s o.t~ Ground 3 r5-3S IO 3~3 SI 3 w,fY, CU) C2 o.S 0.6 elev. 4 35--47 10Y 34 - s) £ 5 Zmstal~ ~.{r CvJ 2 O.S O. 47.0 ft. `Fg- f,3 la 4 S ( ,n 1 - c Z a.'7 ~J• Depth to limiting factor rr Remarks: oK►zoN 314RSmvwV s\\-T roars; t#D,nZOnl (1 Ai A"s SQMG 6fr Osca Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PLOT PLAN Page_,3_ of 3 Property Owner_14AgSeA6ygr,, \1AA)eE Legend : S/O~EXC~P7 W+} R~ /)OTEO Legal Description LOT LOCATED Nu -ENE PM (U,0vJD StAfF,kCE QN EAST T---3 , T2( /J R 19J S I JE OF FLAGGE-Z AN L) -I 1n1 'I4 OF 'T H;;-: N W Sr-C, STAKzo OAK -MeG TOWN OF T1201, ST,CKC)\X CouNTy wssCo),Xsi~j ~rSSLIMEZ 1000' soil boring w/backho 2. L9 ACIn--s) ALL WooatiD LINE. EL qz 331 FLhGX p/sT-4KrcD XJ. F, L. DO Nor O%STURB ^RPPRDRIM,~rt WA ITE ONE 1DKI V E 0Gq CLL44.Ml WMC) E C) Not,~s~-~o of (of-r-ATEK FKsaAr~ SIC SANK 25 "OTC GKF-ATE K rtbA1 QKfl1A1 FIE1,p WELt_ 1-0 ge= : ?5' OK- GkEAtF_R FKOM SEPtIC TAMK 50' Or- Gf-IF-;ATEIC F" DKAA) FIUC 2' or- (OK-E,A-rEK 1=12DM i4oLkiW Signed CST A~L Mo37o7 D ate -sEMT jq Iq qb 'b T. 2- A-At 5 ( eA F Wisconsin Department Industry, Labor and Human Relations SOIL AND SITE EVALUATION REPORT Page of 3 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 57" C1949 not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. A dimensioned, north arrow, and location and distance to nearest road. Q2 G -110V- Via- to D APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWE Y ATE~9~ PROPERTY GWNER:13 V yep,: PROPERTY LOCATION / NGE /1 5EX4e CS GOVT. LOT SW 1/454J 1/4,S3y T Lf N,R if E(oqDW PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # t:SUBD. NAME OR CS G G~1 viPEz- 4ME'•z CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE WN NEA IE RO D Huusoa co t. Syol ('715) 3r(0- 3y77 H 0DSo~ ~I~iiE o~#k :D :DR.. [ New Construction Use [ ✓j-Residential / Number of bedrooms 3 [ j Addition to existing building j ] Replacement [ J Public or commercial describe Code derived daily flow f5_0 gpd Recommended design loading rate bed, gpolft2 trench, gpdt' Absorption area required bed, ft? SG 3 trench, ft2 Maximum design loading rate gybed, gpd/ft2 • 00 trench, gpolFt2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations &4e TiPEu S o y S/D12~ Zvi D~D~ 1P•ar ntLaterial Se S (e - I I. a -F t i D S Flood plain elevation, if applicable W It S = `'uitabl' for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK J = Unsu;iable fors stem 93-S 1:1 U 0-5 [71 9'T El U 03' ❑ U B'S ❑ U ❑ S Em- SOIL'DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Bed Tiench 02- /0 Y,e :77/1 7 LI-17 4 ~-I(P-.zo Y4 31.1- 0"S"_ 'f/e 441 -7 Ground t~ 6 - 31. /D yR 31y . is l 4y • SDK d.e S 7 elev. Le /Oi V2_ ft. C .1- ty; 75 Y~2 y *o Depth to limiting factor Remarks: Boring # 02- L9 /0 yle 2 Y/f 311 Ground 13 3 15' C d S • e2 elev. C -efL -7.5 y(e' S o M1 /o/ ft. , s Depth to limiting fact pr ,1 > Remarks: CST Name:-Please Print 1208 P_ T- Z41 b A t • C A. T' Phone: 71.1,1-" 34c>(~- 9lo'r-.5-- Address: Ce S5 N e 1 L 1>-!7- H-~1 OSO~J 1. 5yo/6 3 esr-4r iVAl_ Signature:~~'tc" Date: CST Number: Ji Tits test site APPROVED ORIGINAL for a conventional seode systems. l 4v . • Y PROPERTY OWNER V• HAt-stMEY~ SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft consistence' Bour~y Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rerxh D o• 2~- S !2 twAt- a s z-F a 6- lo l(31a- ~5 Zfi S Ground r~ -Y L~ ie 3 /S , nM GC J~ • 7 -Jo elev. ~o~.,o ft. G 7s ,e y s , ~ s d,~ - Depth to limiting factor „ 17 Remarks: Boring # D L ? • S rQ,C S f /O yle 3 y ~s D , G~,Q s • 3S /o ,e Ground elev. C s- S 5 a2.~ S 0 ft. Depth to limiting factor Remarks: ~j Boring # D /O 2 S R f s 2~ • d e9, '15 00 Ground elev. d, nh . S . 7 !/4 . p ft Depth to limiting factor „ Remarks; Boring # :4}Yv i. ~n~• iS} Ground elev. ft. Depth to limiting factor Remarks: r Y8. O 2 L - J • ~ - cCICU~T"tO~S - 3 7•io 0 SO s //o• o 5CALE : l = yo s J Svg~ESTED SySTt~ TRt,~ ~G~. EI vt rt oN S - f3 - 13 3 ' 3 IOU) TAe, c~ /00. 0 pf0?0sev ffD~ES ~ T~ 13' loo ~S • ~ t267n 4 z by tpo- (4. :2-y AC~s 52- ~o ' 69 o U,.) D, '410V J f 4'44A I l',->E, iE'~ v ~3 r/ 410 AWS S ~,Puf YO 's M o.v uMiC•v T. r°Yo of M o-v a-4r6,v 7= io a, d' i RDAD nP P• S W 114 - SW l/4 j4g n-,' 412 D k=. 412 F 0 SW COR. S EC. 3 24 AC2E 5 23 mss. 38 F Two' 38 E 343.20` 3p 21. 22 N l/4 - N W l/4 r 3 8 C. ' I Co • ;i 38 D \ 662 598.32 25 \ 38 rn Z 0 ADDENDUM D - Legal Description for Offer to Purchase dated January 31, 1994, signed by Vance A. Haesemeyer A parcel of land known as Parcel #24 located in the Northwest Quarter of the Northwest Quarter of Section 3, Township 28 North, Range 19 West, Town of Troy, and in the Southwest Quarter of the Southwest Quarter of Section 34 Township 29 North, Range 19 West, Town of Hudson, described as follows: Beginning at the Northwest corner of said Section 3; thence North 0 degrees 28 feet 30 inches East (true bearing) 451.52 feet along the West line of said Section 34; thence East 248.05 feet; thence South 36 degrees 10 feet East 584.03 feet; thence South 57 degrees 50 feet West 169.22 feet along the Northwesterly line of a Town road; thence Southerly 353.6 feet along a 268 foot radius concave Easterly, chord bearing South 20 degrees 3 feet 40 inches West 328.32 feet along the Westerly line of said Town road; thence West 343.20 feet; thence North 0 degrees 21 feet 30 inches East 418.48 feet along the West line of said Section 3 to the Point of Beginning. BENCHMARK: 15 ~a` L-`si rt^S L~• c WI) b: " C4 n .r, ALTERNATE BM. /Yc r' y q/ 9d-l ?U4 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:11L1~~. ) ~`-E ,~-•,-ca i~ •'e-~Lr^n rreeasf Liquid Capacity: Setback from: Well House Other .yy Pump: Manufacturer4)y/,lam Model# )LF1)0 Size ~ ay Float seperatio(n/,,2" Gallons/cycle: A? CJ 'Lr Q'_' 2 l ' Alarm Location ~i SOIL ABSORPTION SYSTEM Width: Length 7~J,q- Number of trenches Distance & Direction to nearest prop. line: a,, f a4,4 Setback from: well: House Other ELEVATIONS /0217' /U2. Building Sewer N:f~. ST Inlet. - ST outlet /D~. PC inlet PC bottoms Pump Off 9Q Header/ Manifold Bottom of system j^?,~! `R Existing Grade Final grade c DATE OF INSTALLATION: a PLUMBER ON JOB: ;~x? ~3 LICENSE NUMBER: INSPECTOR: x~ iyl ~rL~r~~v ztl ~{75 3/93 : jt7is~ X35-tiny STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 1,',JAr1C t1~ ESE nl~a C:rt ADDRESS 59 k l.J~`~ T SUBDIVISION / CSM# SECTION T -1~ N-RAW, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM t1_1 rtic- - '0' -1 o- - -e-d A-.\, yy 21 'b 461 B 21~.~1tN ~r CL~S ' rZ 7-V (b 4~1 0-)'oX15 3~,. io' v K, < ho ` INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. .A-cl-t 5;( e-AAceZ 411:? Wisconsin Depart"*ntofIndustry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations ,Division of Safety a Wk*Vs in accord with II-HR 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 5T. G/ 10/•X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. 8 dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY GWNER: 13 V YeR : PROPERTY LOCATION NGE 11 9, Ma C/e GOVT. LOT SW 1/4 SLJ 1/4,S3y T Ly N.R I I E ( W PROPERTY OWNER'S MAILING ADDRESS LOT N BLOCK $ SUED. NAME OR CSM # AtRcsX. s /7/0 /l/fWEL 4P46'• 4t 2. F CITY, STATE ZIP CODE PHONE NUMBER CITY ]VILLAGE OWN NEAREST ROAD tjoosoa cot. 5yoj & ('715)3M-31/77 t~ vr,so~ ~~if~ ohk ~R ( New Construction Use -f-Residential /Number of bedrooms Addition to existing building (J Replacement ems' (J Public or commercial describe Code derived daily flowfgpd ;rte Recommended design loading rate f bed, gpolft2 trench, gpdnt2 Absorption area required / bed, ft2.-&•5-Uench, 112 Maximum design loading rate gybed, gpd/ftTlrench, gpdM2 Recommended infiltration surface elevation(s) it (as referred to site plan benchmark) Additional design / site considerations &SE T"y44C5 0,y S/ohe- Cv/ D,eop /.3 o :sT.P V e, ro a Tar nt material SC S G (e - ( i A3 f t J L D S Flood plain elevation applicable aal, plicable dl- . ft S'''Jftabl' ror System COPNEPr110MAt M UND IN•GROUNDPRESSURE 7 AT GRADE SYSTEM IN I'LL HMDING TAM L = Unsu;table fors stem L'S ❑ U ~ nu r~ ❑ U Cd3 O U ei~ ❑ U ❑ S (ftT SOIL DESCRIPTION REPORT tory~., u~rya^r, Depth Dominant Color Mottles TpYb;rp Structure C6ns~- -O„- R o GPD/ft in. Munsell Ou. Sz. Com Color Gr. Sz. 5.t. otg Bed ~ftartdi mw`g 0 Cv /0 yve 1 15 p 3 4, - ~G to Y4 31-11-. /s M, yie .wt .e '1 .8 round t~ G - 3.z /o yR 3/y is • s6k ~.t? s • 7 •8 elev. ~ . QL ft. ~9 ~5 YR V Lle S 0 nv4 s r- • ? )epth to miting 3clor i Remarks: Loring # 21 y /G /o y/c' 311 ,P 13 4~ )f /0 YR 3111 15 C- ~4 around r' ft. -Cf L. 7 ,s y(e, Mi. 5 GI?.~ • d i )-epth to ~mitirv act; Remarks: CST Name: Please Print 'Ro (3E RT ?-t' hi IQ t • C k r Phone: 71: ' 3f G e/e5--- Address: (e 55 '0" A? t i R D • t b.OS04 40L SYoi(v 3 -132- !~l G's*Pf -I- ~f Signature: Date: CST Number: a t 4 opqy Th 1* test 9th for It OOnventiona ~ROV se PROPERTYOWNER V• 14Ai5Cf1EYI` R SOIL DESCRIPTION REPORT Page 2,ol 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Qu• Sz• Cont. Color Texture Consistence BWXWy Roots GPD/ft f Gr. Sz. Sh. 3 ~ o• io R i. - 5 0 ~ Bed rer~l Ground r'~ "3~ Lo 3 s . 7 io rt. G 7,5 ,e y S Depth to t limiting ; factor „ 77" I i Remarks: Boring # D /O s • 3,~ /O - Ground 4t[S elev. 77.50 ft ~•s y y s , 4 Ab% s ~e.e Depth to limiting i factor Remarks: Boring (9L Ground 4 t 7S' iP y lv s D, c G~.L S • 7 ~•elev. Depth to limiting ' factor „ i Remarks: Blgi ~~ig # _ .~s> Ground ' elev. ft. Depth to limiting factor Remarks:... OWN O•IMAI D`^CMM r• • t. ,Z 2 y8, o U J1` V ~ICU~Tio~US - 3,°y ~z i 0 101. 65 3 3 107.1o -t 0 107-570 va 135 //o• o sCALE : i = yo v O r = /3.1C/E'~ f •Ts 5053 E STED Sy-STEM TRk,~~.G~ El~vtrio~S ~Nt~~ 13133 3 Cam. T C~~ ~G.~ /03. D 14 V", 'rPea Doz. o 104) TACK c4- /00-0 PIWOSE o ffDKES ATE y S 1 N I,v /.4(V -H , Bf 100 ~S o i2 ~Ja q z 30 AWAW mot/ L P~rR~Ei .3~ F o u u D, A/ov S `F ?.wa 1 E M sl ~P ~f'E V C -4, O AW5 o S v,Puf YON 's M o.u 0.4fev T. ~'oP OF M o,v a~~.v T = io o , O r *6Ws 4Wl3artT49 X}ustj0.29.19W ' `7'A fE AYS~fSTEM County: -aor and Human Relations Safety and Buildings Division INSPECTION REPORT _qT (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 208974 Permit Holder's Name: ❑ City Village 9 Town of: State Plan ID No.: RR, 31 Oyalnvv~,tF F on ev.: Insp. B Elev:' BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400097 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. SePticZ Benchmark Dosing 9J O Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet o Verit TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet Septic t7~ NA Dt Bottom ~IP Dosing NA Header/ Man. o 0 Aeration NA Dist. Pipe Holding Bot. System )ll r I ~ PUMP/ SIPHON INFORMATION Final Grade Manufacturer 7Gx Demand Model Number , GPM 1 (o TDH Lift F Loss riction System TDH Ft mead Forcemain Length Dia. f Dist. To well II~~ SOIL ABSORPTION SYSTEM "tom a. 3 ~ BED / TRENCH C Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: ape System: OR UNIT o s DISTRIBUTION SYSTEM / b v 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 led/Sodded xx Mulched Bed /Trench Centero Bed /Trench Edges Topsoil ❑ Yes El No El Yes El No COMMENTS: (Include code¢iscr ancies, persons present, etc.) l~ ~ Imo.. ` ~r' ~ ~ "'r - ~ ~ ; ~ (~.)~_~P,('✓v'..~,_.~ ' ~ o LOC & ION: Hudson.34.29.19W , Whfte Oak(--Drive I V I 1 T r~ 5 f f 7~1 J6A Plan revision required? ❑ Yes ❑ No Use other side for additional information. SLU BD-6710 (R 05/91) Date Inspector's Signature Cert No. f ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r " 0 cn Fi r Oz V' W M 1101 C) 9 2 z 7y 0 m TC~~) rr__ v CD M. co C \ W c W m 70 0 m\ r z l X O W U1 ~ c v~ m a) m Cl) z D cn < O m 11 n cD O Ln W 0 C W D N m x D m ` cn r 0 C/) x m y O D p in C C a D n z z (n N 3 z \ m Q G) ~h m (D z -C/) C L < { W C W m 7z N ( H m W W i~ C' W m o p "1 D = 0 7] z c Or < Z Ul m (D 0 7J O N C' m O m W co i 6 O O = z-0 z r: \ T m IITI 0 ~ OP m A Ut v v 2 m 0) l J C z O 0 D m A 0 U\ m m D m z m I Z Z A-IZ Ri o h llsO T m :3 k m 0 0 o D z z -1 ~ m z z m OW m O m W o for o z' ~N$~ NO D cn C ol~ ~T• ~r m 3 e ` 0 Q r r m 0 N ~D }J r J co co D m ~4 m CD z > W ~ C I x < C r cn cn ; D m i_ D z m ct H- { O z O ~O D 3 x n q Z O ~ r m G m m s m 7-1Z D 9 m H 70 z D C O O O O y~ cn T S N r~ O >I Z r o -o o l/ ( C) d O > m T v v A z o O D 0~ c O co n G) < z D N- -1 O l c° m 0 0 c fD T m m G << v W H m \ z 3 6 ~ m ~ D -1 0 # c o= r\ Lil O z c G Ul Ul O co p m ~ N m m W Z C,Q O b'Y _ F o I3t O : a~ CO c z m ~ m I .A ' Page 1 of 1 Al Bowman Plumbing, Inc. N Master Plumber No. 5875 2819 Knapp Street Menomonie, WI 54751 (715) 235-4634 FAX (715) 235-3650 C°I Vance Haesemeyer SW4SW4S34T29N/R19W Hudson township St. Croix county LEGEND top of BM: 100.' surveyor's monument Scale 111-40' except where indicated Proposed system meets all of ILHR 83.10 Jack A. Bowman MP 5875 System Elev. A-trench 100.' B-trench 102.' 0 4u"~~ 4ri _.1 too' ~ y'~~ q° ~J1~ nr' o ~I Z'~----} I I~~~NS343o3y $I.lo io k J~yyI k , ~ _ - Q ' z O r ` -7 S X -7 -5- V --b'?' I-- _l SANITA PERMIT ST. ~ ~ I X COUNTY (..I13ANSF DILH . R ER/ ENEWAL UNIFORM PERMI67-T) PERMIT RENEWAL DATE: PERMIT TRANSFER DATE: ORIGINAL PERMIT ISSUANCE DATE: STATE PLANN I.D. NUMBER: a-5 nl/ PROPERTY LOCATIQN:' SCI '/a S W %,S3 T ~ N,R 17 f (or) W TOWS ~ s~ LOT NUMBER: BLOCK NUMBER: SUBDIVISION NAME: NEAREST ROAD, LAKE OR LANDMARK: S9~ ~ urrF. opx (LI c PREVIOUS SANITARY PERMIT HOLDER (IF CHANGED): SANITARY PE IT TRANSFERRED TO: NAME: D SIG ATUR : NAME: I PHONE NUMBER: /Pb,c7/ 2l / Bowman Pl in Inc. 715)235-4634 ADDRESS: PHONE NUMBE : ADDRESS: I,~e~ 3X6 ~j~S 2819 app St. Menomonie, WI 54751 65.s d N2i l7so I, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this property. PLUMBER'S S ATURE: PREVIOUS PLUMBER'S NAME (IF CHANGED): a UL V. c r 4 -v-c,a s C- uc t3RI~T PL R'S ADDRESS--PREVIOUS PLUM ER'S ADDRESS: F' 2$19 Knapp St. , Menomonie, WI 54751 ~EIL ~Z~AA t NosoJ 1~ j , ~y o ~I, MP/NWIMW NUMBER: F715) HONE NUMBER: MP/MPRSW NUMBER: PHONE NUMBER: G _ MP 5875 235-4634 33o7 (7/`r) 3?4- O g`S SIGN TUBE OF ISSUING AGENT: DATE APPROVED: DISTRIBUTION: Original - County Copy - Bureau of Plumbing Copy - Owner DILHR-SBD-639 (R. 5/ ) Copy - Plumber Bowman Plumbing, Inc. Page 1 of 1 Ai N Master Plumber No. 5875 2819 Knapp Street Menomonie, WI 54751 (715) 235-4634 FAX (715) 235-3650 C~~1 RIOT Vance Haesemeyer SW4SW-4S34T29N/R19W Hudson township St. Croix county LEGEND top of BM: 100.' surveyor's monument Scale 111-40' except where indicated Proposed system meets all of ILHR 83.10 Jack A. Bowman MP 5875 System Elev. A-trench 100.' B-trench 102.' C) .4z, O 0 ~ A) AW 1 el, I rc-A- r SANITARY PERMIT APPLICATION ..i:: COUNTY V'~L■7■1 In accord with ILHR 83.05, Wis. Adm. Code 57-• r STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than M q-74 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. /V PROPERTY OWNER ~.,1 PROPERTY LOCATION r~ G a S 3 J T >T , N, R /7 E (or) W 111+A) C e Cu EVp y / / &5,E qe -Y -V 5 4) PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # /7/ v 1,4V AF L ye- . CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~fvli3'Zw ~i• S4r~<4 ~~5' 3 N CITY >L• NEAREST ROAD 13 11. TYPE OF BUILDING: (Check one ❑ State Owned / ❑ VILLAGE ~v~~~✓ Q-TOWN OF: ❑ Publlc ❑ 1 or 2 Fam. Dwellingf# of bedrooms _ PARCEL TAX NUMBER( S) 7 V III. BUILDING USE: (If building type is public, check all that apply) 0 .ZQ - /X0' 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. U New 2. ❑ Replacement 3.E1 Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 0-Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit 2w Pressure 43 El Vault Privy 14 El System-In-Fill Z 72 604415 6,146L S' )eZS VI. ABSORPTION SYSTEM INFORMATION: 166,0 l6yO 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 102.0 ELEVATION 750 1750 Feet Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank X20 Lift Pump Tank/Si hon Chamber 40,V 4d ?It Za-, El El I El I L1 I L] 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) k4WMPRSW No.: Business Phone Number: poj eer Z(L1312 f T 6S5 iuu-C< < 336 7 1(7/5 Plumber's Address (Street, City, State, Zip Code): 4,1557 D .c%~ i C 11 U 150-x/ ~J S S y6~ ~o IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui g Agent Signature (No Stamps) Approved El Owner Given Initial Surcharge Fee) Adverse Determination ~x 1 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber INSTRUCTIONS , 1: A sanitary permit is valid for two (2) years. ' 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of, tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water 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) Z y8 0 , w ~x ~ - ~ICV~Tro~S - - o C33 /o7.io 0 y 7. So 11 1/0 s //O • D 3 - 1344eloc PITS a Svgc~EST~~ SysTt~~ F- TRt,N CA- EI a V At ri oN S r3 - f3 - A3.3 3 to co T R e ,,j /00.0 1/Ety 11oa ~iE'FCifST 4~EEe-5 CONC,t~r Cp pRo~oos~D T ff0~'lE5 jTE oPRopoSerD 4041E-71/ yS H~Ni.Y v ~ B3 O 07o Ir f\ ~ 10 loo piheCE/ 20 f -f, o 4ws) F o uIu D , ,4/o,v S f -eN,cA 13Y ? SPEC/ Flevcjr ~605'7" - Cov.vTy 3 0,epeyoj2'S Mo.vv,4tjuT. F- , raP of MOw~•a~,vT = ioo.d a 'T~EUC tf Fresh Air Inlets And Observation Pipe Approved Venf Cap Minimum 12" Above Final Grade 9A+0E'- / a O 36 -Above Pipe _ 4' Cost Iron *to Final Grade vent pipe' r Synthetic Covering win. 2" Aggregate Over Pipe Oi:tributiat -Tee Pipe -'O 0 0 0 0 0 G Aggregate 0 Perforated Pipe Below Beneath Pipe _ SySj'E'rl ~ ° Coupling Terminating At Bottom Of System TReOctf a Fresh Air Inlets And Observation Pipe Approved Vent Cop MMmum 12' Above Final Grade )c4V /00.0 . 3(0 "V Above Pipe - 4' Cast Iron 1o Final Grade Vent Pipe' Synthetic Covering win. 2" Aggregate Over Pipe Distribution - Tee pipe 0 0 0 0 0 Aggregate . 0 Perforated Pipe Below Beneath PI PIP* 0 -Coupling Terminating At Bottom Of System 10 2 .0 , 6-2- +e4 t 5 C eA Ace X_ `f / Z F -t- 3 ~ F Wisconsin Dopartment Industry, "Labor and Human Relations SOIL AND SITE EVALUATION REPORT Page / of 3 Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 5T. c,PO 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 REVIEWED BY DATE PROPERTY GWNER: 130yeR : PROPERTY LOCATION /VCE 11,4,6 9, A(e CR GOVT. LOT SW 1/45LJ 1/4,S 3y T Lf N.R lq E(or63W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # P4^X1L -L 17i0 G/fv/P£L 4ME-- 12- F CITY, STATE ZIP CODE PHONE NUMBER ❑CITY OVILLAGE OWN NEAREST ROAD t-IuvS60 W j. Sgol & (715) 3M- 31/77 h 0DSoA-3 ~[nrfE ohk :DR . [ New Construction Use [•-rResidential / Number of bedrooms 3' [ J Addition to existing building (J Replacement [ ] Public or commercial describe Code derived daily flow DSO gpd Recommended design loading rate bed, gpd/ft2 trench, gpdM2 Absorption area required / bed, 1`12 SG 3 trench, 112 Maximum design loading rate gybed, gpd/ft2 • 00 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Z~SE TiPE-yg~4eS o y S/p7ye w~ D,U-O A0 A' ,17j STiPi~~ ne ~ Tar nt material SC S G (e - J I A3 f f E L0 15 Flood plain elevation, if applicable N• • C, 0D%QSAMmP-dr- ft r S = "uitabl- for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TAN i! = Unsu;iable fors stem [Q5 O U EK O U S O U C~ ❑ U f~S O U ❑ S C SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bounday Roots Bed Trertdi i£d ~a"a hf D Cv /0 1 0"t. v,Gie 5 2-n.. 7 • o 41 y 3/~ Ground 6 31 /0 YR 311/ M. 'aw d -,e S 7 elev. /ay ?2- ft C ~y ~5 YR y l{ s 0, s r • 7 Depth to limiting factoorrG Remarks: Boring # ye Is 0. 411 6 /,9 YX 3/x- 13 3 is D, c Ground elev. C -cJ2, 7. $ 1/(e S D, n*j, 5 ct?,Q 101.6's ft. Depth to limitirii . factor Remarks: CST Name:-Please Print Ro13E 12T Z41 b)Q ! •C k Phone. ?l~ 3~~'" /p.7 Address: 46 5 5 C) A) t i L R ff-t) OSOA..) W L 5yoi6 3 = y ~•s%`'/ -2-V AL--- Sgnature: c Date: CST Number: L PROPERTY OWNER V. ~AtKey~ SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. I Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bojxby Roots GPD/ft _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed T~u 0 S> 02- 0-6 10 A". 5 A /o der 31.;L- A'►'I t s z~ . . Ground /O pQ 3 ~S , nM • 7 - elev. Depth to limiting factor „ > 7 Remarks: Boring # - wq is o s 35/o ,e 3/y Ground s elev. C s- 7•.5 y y , ~ s aQ.~ r- • 7 /07.50 ft Depth to limiting factor > CytJQ_ Remarks: Boring # s z A41 sh,~ v~ s Z s F - ~P f ixn♦+.i~1tii: Ground 4 * 7S ~P y to 5 O, c yie dX S - • 7 elev. L 7 0-0 ft 7• L'i s ~i r~ ' Depth to limiting factor C!w. Remarks BW ~y~g # t:::.::.... Ground elev. ft Depth to limiting factor i Remarks: con ooonio ncrnm O 2-11 ?U I - ~CICU~T'fO~S - 3, log. ~i 0 13 3 107.1o 0 `i 107.5 0 ' lU //D 0 3 J Sug~ESTE~ SySTt~~ TRr,~ a v~ r~ oN s 13 J 3 3 Cam, T P eA.) O Gc~ T A C N a, /00. 0 pRo?osEo f~o~rES iT-C yS h~N~~v~ b b ~ L 83 1 67o ,2 1 CA z ~ a y 4zy AG~s ) ~o ~O PALE/ C41 0 14wsl o S ,put yo,p 's M o,u v~~"-u T. F- STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER yfi v CE- 3,P6 - 3 Y 77 MAILING ADDRESS Lrtv4'6'L ~fvD- Lyi• ~5 yidG PROPERTY ADDRESS ()AV- pal A- ' ] (location of septic system) Please obtain from the Planning Dept. CITY/STATE N Aaso hkl . y PROPERTY LOCATION S40 1/4, 5'(4) 1/4, Section T N-R ~i W TOWN OF ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIEDSURVEY 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 b a mater lumber, restricted lumber or a licensed verifying that 1 Y plumber, journeyman P P pumper mg 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:- St. Croix County Zoning Office I 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. Owner of property 9AA146- l/ ~1Z65,CRE' Location of propertysId 1/4 Sid 1/4, Section 3~ W Township I~VDSOA) Mailing address _ 1710 'eAwe'ec f fu~I~a-~ CP IS • 5 Yo` Cr Address of site OPIL NIVE- subdivision name * Lot no. Other homes on property? _AA yes,_, No Previous owner of property 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 'C No Volume 103 and Page Number 7-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 recorder? ; the office of the County Register of Deeds as Document No. r/ 2 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 County Register of deeds as Document No. Si~nature 7rf ap,licant Co-appl c t Date of Signature Date Si attire f _JON% - DOCUMENT NO WARRANTY DEED ~A E 1,[.benVED FOR RI--ING DATA STATE BAR OF WISCONSIN FORM 2- 1982 515127 MTV V I e( 37 ~P~CtE C!t'v Gi'tt'CE • A.. Kenneth Olson and Meta Thur Olson, husband and. STa CROix co., W , Rale'd fOr Rscurd wife a;}..:'jin..t.Tenants _ . . . - ' APR 7 1994 11:00 A. _ conveys and warrants to Vance A. Haesemeyer and Wendy R. at M Haesemeyer,.husbar)d.and. Wifes as survivorship - taratoeeas 1Marltal..p;roperty.... - I, - I II - . ....~RETURN To ~i Vance Haesemeyer i 1710 Laurel Ave. ;I - Hudson,. WI 54016 St.- Cro1X--- Count the following described real estate in - - Y. I~ a ' State of Wisconsin: ' Tax Parcel No:..---•---------------•-------- s, iI Part of NWl/4 of NW1/4 of Section 3-28-19 and part of SW1/4 of SW1/4 of Section 34-29-19 described as follows: Beginning at the Northwest corner of said Section 3; thence NO°28'30"E (true bearing) 45152 feet along the W line of said Section 34; thence E 248.05 feet; thence S36010 E 584.03 feet; thence S57050'W 169.22 feet along the Nally line of a Town Road; thence Sly 353.6 feet along a 268 foot radius concave Ely, chord bearing S20003'40"W 328.32 feet along the Wly line of i said Town Road; thence W 343.20 feet; thence N0021'30"E 418.48 feet along the W lin$1 °t of said Section 3 to the Point of Beginnitlg. This ._is_ not--.-, homestead property. tin) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Hated this 4th day of April / 19 94 i (SEAL) / IS EAi,) I' A. Kenneth ' (SEAL) ' C (SEAL) Meta Thur Olson j 1 ACKNOWLEDGMENT AUTHENTICATION A i 'n* Signature(s) STATE OF WISCONSIN ss. $C.-. CrQ1X-- . County. authenticated this day of 19._____ Personally came before me this .-..--_.4.--.day of April 19--94_ the above named A..-Kenneth..Olson. and Meta- Thor -Olson, ' ----husband.-and.-wife,... TITLE: MEMBER STATE BAR OF WISCONSIN li - (If not, - - - l authorized by § 706.06, Wis. Stats.) it to me known to be the person who executed the i! forego g instrument nd a kn¢wledge the sanic. THIS INSTRUMENT WAS DRAFTED BY L~~. ~~•'~/_j _ _ _ i O land L/ \ Attorney Jane ane Terkelsen I - at Law - - - - Nota P St. CrOiX County, Wis. i: (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) date: May. 15...- , 19- 94__.) 4 # *Names of persons signing in any capacity should be typed or printed below their signatures. ii r WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co Inc FORM No. 2- las2 Milwaukee Wisconsin I ` SITE INSPECTION MAP Drawn for: Jenny Olson c/o Cent. 21 Description of this property can be found in Vol. 479, Page 39 of the Register of Deeds in the St. Croix County Court House. There were, no encroachments readily apparent at the time of the field inspection (2/4/94). S 90'00'00"E 248.05' • - Indicates 1" iron pipe found, J.5'~ FENCE - i W 0. tP M (V cD 'n S00, N" yJ~ 6 to O v 0 0• z l SW cor. Sec. 34 ~ South line of the SW 1 /4 of Sec. 34 Hudson Tnsp. NWcor. Sec. 3 Tele. Ped.-- Troy Tnsp. North line of the NW 1 /4 of Sec. 3 9 `2Q QQr V~ OQ • ~ OMI w Curve information / M in Chord+ S20 03139"W 328.32' ° Delt= 75 32143" a (0 Radius= 268.00' / C) Length=353.36' z / Scale in feet / 1"=100' 343.20' N 90'00'00'W I 1" X 24" iron pipe \ weighing 1.68 lbs. / in. ft. set. March 16, 1994 494-2272