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HomeMy WebLinkAbout022-1020-95-000 Z o a ~ o I N c c I M; a ~ I ~ I b N O N ~ w co L Q, C O I O (n n O 0) a O O i I ~ i O a) I ~ - m ( ' a) 0 a) N Z L W LL L m cu 0 _ o E ~ a) d 3 Q v M CD z 00 E z 0 0 0 d a) ►N- a m 00 o I 0 z d ~ ~ N w d Z a c o fn F- e- 'E z a Q) M C = p • ~i '0 C Q c6 O 0 a a w z z z v ~ I: d N O CV y }y~ o m M 41 m E ~l 0.. N O. M O G O O a d N ~ a o D D a -9 6 CD LO E c j co co H n 6 16 O O O z aaa M a) a 0 0 <n (n rn -j U rn m v ~aVI o o N m - C) 0) - O E CL o_ 'a ,D 0 m 2 N S (D "d d Q in cu I ' cn 0 I Lo U) O O b+ O U f- C j c0 h ~i rn N O a) a C C a 0 0) U O N ao c W t\ N N 4.r O Y - co C .C -S -0 izz '070 u -5 C, CD ao Cv " c c aoo 'n E c~a ro • O O CO 0 Y N O Z N cG cn r% d NIa 3 #t o l L a CL .2 (D E CII =w 'o r A c0)aF Ov~U 110 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER f I Ln P ADDRESS SUBDIVISION CSM# (e " A,, 116 4 ~ LOT ~ SECTIONT N-R_4~W, Town of /C ry~'l~ l C!. CC ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM /x'610P Y ' I I I I ~~Cb c' ~I I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions: to center of septic tank manhole cover. i ~ o q~:£6/£ " UOZOSdSNI :uas 1nN 3SN30I7 ( :90f NO UagNngd AOIIVggVISNI 3O RIVU apelb 1euT3, 9PRaD butgsTXa M04SAS 3o utoggog pT03TUQH/.z9peaH 330 dmnd moggoq Od 49TUT Od gaTgno IS .gaTul IS zaMaS buTpTTng SK011YAM aetig0 ( C asnoH :TTaM :utoaj xoeggaS : auTT • doad gsazmau og uoTgoa-ITo 13 aouegstQ ~X sayoua.zg go aagnmN / tggbugq tmPTM W3SSxs NOIZd2tOsEm 'IIOS uoTgeooZ uueTV : aTo a/suoTTeO uoTge.zadas geoTa j azTS y ~ Tap°W ~j~ I? 77 zaangoejnueyj :dmnd o ` zagg0 ,.S C: asnoH 0 T19M :moaj xoeggaS oQr : AgToedeO pTnbT'I : aeangoejnuvw XOjjVXUO3NI XXVJ DMia'IOR / *daU YHO clHnd / XHV;L OISdaS :Ka aivx ialgv T i~ Wisconsin Depdrtmentof Industry, PRIVATE SEWAGE SYSTEM County: Lacier and I$umanrRelations INSPECTION REPORT ST. CROIX Safety aRd Buildwogs Division (ATTACH TO PERMIT) Sanitary Permit No.: . GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State P DANIEL, EDDIE & GLENDA XQ KINNICKiNNic no CST BM Elev.: Insp. BM Elev.: BM Description: Parcel ax o.: TANK INFORMATION ELEVATION DATA f-1 w,A Inn TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /oo Dosing /430. Aeration Bldg. Sewer Holding St/ Ht Inlet 1a,6 ~oS,S S~ TANK SETBACK INFORMATION St/ Ht Outlet / ~5 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake l3./6 /D~/`~PS Septic ~5v ' a5 ~a5 NA Dt Bottom /12022r Dosing yas' j >aS" ~dC NA Header/Man. Aeration NA Dist. Pipe J45- 114_33 Holding Bot. System S,/7 PUMP/ SIPHON INFORMATION Final Grade Manufacturer 1 Demand lam. //U, / S Model Number lt/i GPM JJ%}~~..rz/ g /p 1-75 TDH Lift Friction System TDH Ft i Loss Head Forcemain Length Dia. Dist. To Well~S~ SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3, i~r DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manu acturer: SETBACK INFORMATION Type O /7QL> Mode Number: System: Y 7e1_1tsr-9 /$,S l owo y 5U' CHAMBER N~ OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) it x Hole Size x Hole Spacing Vent To Air Intake 1 ' , S acin 1/,/ I//g Length Dia. a Length - Dia. p g 7 56 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Q Depth Over ~11 Q xx Depth Of xx Seeded /_Sedde-6- xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil (0 - 1311yes ❑ No [/Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: KI/NNICKINNIC 8.28.18.120C,SW,NE,LOT 10, SLEEPY HOLLOW DR. Plan revision required? ❑ Yes ❑ No Use other side for additional information. 'y la~ t?y 3! SBD-6710 (R 05/91) Date t Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH • SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION COON l~'~'~Ifra Fi In accord with ILHR 83.05, Wis. Adm. Code C_o ti--A STATE SANITARY PERMIT # =Attach complete plans (to the county copy only) for the system, on paper not less than o2 l 8isQ~ 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. `741- 1-105 23 PROPERTY r.0 NER PROPERTY LOCATION E4 C Y., S TC/a, N, R E (o Kw PROPERTY OWNER'S MAILI AD ESS LOT # BLOCK J, ,7 7 CI SATE ' ZIP CODE PHONE NUMBER SUBDIVI ION NAME OR BER s~, tee r Z1 N ~e~ Y6 2Syr'' II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLLLAGE " 1 ( B ST ROAD ^f' GG~ ~J lhll► l Molf ❑ Public ®1 or 2 Fam. Dwelling-# of bedrooms PA ELTAXNUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo l( 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify I IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. f4 New 2.E] 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 RMound 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 /n REQUIRED (sq. ft.) PROPOSED/(sq. ft.) (Gals/day/sq. ft.) (Min.//inch) ✓ ELEVATION ~oq LI ~N~ v J Feet Feet (,E VII. TANK CAPACITY Site in alIons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 1_2b0 P(~QS Lift Pump Tank/Si hon Chamber 55) 1 r t` VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown o ched plans. Plumber's Name (Print : Plu er ignature: (No St$mps) MP PRSW Business Phone Number: Plumber's Address (Street, City tate, Zip Code): , F 20 Ca Avg IX. LINTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued suing Ag t Signatur tam ) y4,ot Surcharge Fee) y / Approved ❑ Owner Given initial r2A 5 j, Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08193) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber II INSTRUCTIONS E; 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),bo 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. 11. 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) fora 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. I I SBD-6398 (R.11/88) `Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations t',ivision of Safety Buildings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY ST G~or X, 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 I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION' REVIE DATE PROPERTY OWNER: PROPERTY L N v - ri` q FDD/E a 6:1,FVJ0+ GOVT. LOT ' 1/4 A/ 114,0 p ,R E (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # B ' SUBO. N R # h'D !3 ,4 v G~FN~s • /v _ 5!;? /7o Of~i 7-«.v CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑VI N ROAD / uDso,~ lv~s. 55~0~~ (115) aft -IV3 ~ , 411-0 4t; [ New Construction Use (Residential / Number of bedrooms y :Aditior>)t e i wilding j j Replacement Public or commercial describe Code derived daily flow (D o O god Recommended design loading rate • y bed, gpolft2 • S trench, gpd/ft2 Absorption area required 5"00 bed, ft2 d ° trench, 112 Maximum design loading rate • S bed, gpd/ft2 • & trench, gpd/ft2 Recommended infiltration surface elevation(s) • P A ..3 ft (as referred to site plan benchmark) Additional design/ site considerations SrT&=_ $017•y/31,F_ 4,v Y {aR lfo y vo T rA,G- S yS T-,-,, Parent material Scf 95' 5AAJT44 . 1fv1ACC1Jr rO Flood plain elevation, if applicable ti'p' • It 6rvo - 6,'L7- E-A0/-ffwr HOLDI TMK S = Suitable for system CONVENTIONAL M~OUyr~ IN-GROUND_PRE DIRE AT- S DE U ❑ SYSTEM ILL ❑ S ~ U = Unsuitable fors stem ❑ S DT I Crl'S ❑ U ❑ S Ldiy_ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell tOu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch ,<a w~ 4 O-5 /o yg 3/Z S. / 2,a+t , shK Mkt ufk c5 3-F s A z 3 o R y z,, sbk vf R C 5 3f .5 Co ;e ~a....... S - I y / Ground 6 13 - 4 7.5 Y R s 2~ s b k rm-f R, 15 2- f s ~ elev. ID'f, 6 ft. 7.S yR P3 =NA~D) S U, rw► , 9R GAy6t . 2- . 3 Depth to s vie 5/&' tv", Q ,t limiting Y R P G /1N v -F i et op N P factor S yR 5 g,55 Remarks: S.~e Rc, (ot,.~ Boring # 2 Z Q• /a yR 3/y St` 1 z.~► sbK ,t,,.f R e s 3 f . S . ~ ,<:.:xn<.:;, 11_1,(, '1•S ~,R `//Ce 51 1,n..,, '54K .w,f R S .2•F • S • C. Ground elev. C Zt'o-So -7•5YR 9R a Ayc~ a •G . ` • 3 /01710 ft. y. F It 24-SO 2.5 Y k s S P C_ I nM D'~ Depth to limiting factor „ RIZINAU] S JeA_ (3 e, I 04c) Remarks: CST Name: Please Print R 0 f3ER T t4 L-13 R i O Wr Phone: _71S-3e6- 819Q s Address: (e S 5 0 r -P- p. t 1- j q- 13 c S rM j- Y P2._. Signature: 0 S O A_~ "0 ( S , S Date: CST Number: N b rt t C f~D/C'~ 'Zd.t>,S w E'>i °E" This test site NOT APPROVED for a conventional septic system. See explanation. G /3 A,vp S OF vie y/ s.4,✓p . jklf, GG.s yliS• y 5~9.t.9l~ /fir/E7IP s stlt'A-s IIA!7- 11116-WV I,;1C y 7b ~SGvE/l 4, Gt>~ T covGY'/-iou S 17104 t' 204J ,~G G~~'7TE5 S~vt32~- ~~12~'cn'a,v ?d N~,P.~-~~ L polvv lv~~D PROPERTY OWNER ~LSOIL DESCRIPTION REPORT Page of' PARCEL I.D. # LO t /O - S/E&~y rl ucSCJ • Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoundlW Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 0.16 /oyk 3/Z - 5d 2.. row'. Sb,C 'PAUf0. CS 3 5 .G r x 42_ /0 -.16 toff- 31y sr l z.5h %4p- Os ~f . s .G Ground 26 -3G /0 vP 13, C, b k /w~'F 12 C S 3'F" . S elev. _ ft. (3z wy OYp- y 51 1,f, IFA -fA e s , . y .s Depth to , limiting factor A-7-5 Z SSS Remarks: Boring # >...,..:.I ~ z Ground elev. ft. Depth to limiting factor Remarks: Boring # '-x Ground elev. ft. Depth to limiting factor Remarks: Boring 4 Ground elev. ft. Depth to limiting factor Remarks: Con 0~7A/O ACMM L. o7 I C~ .1 c). A C4A J 6C ALE- : I = YO 8 z = /3/~~~NaE P~'rs 9,~goE FIEw►r~.~,s A ~ti,P .POaC 8670 /3E0 . ~ E ~~'vf no~3 - 11!. 70 j 110 - /3M SeT - T0 f of N&W r To LIf Lo V'N" 400047 s 167 3y- ~lEU~Tio,~ c This test site NOT APPROVED for a conventional septic system. 'e$ expl natt'on r ELEVATIDU S ~~v OvT srA 3 ~D g IfOMES rre- f $ y S TE ICI I E UAT1tW W td<. i 1 r i i ~avct E ~f~ • C'L. of Slev. it t;5 ~b a `75o~a~ fab.v g. do a.~ PUC. pkNYl P~Pc Heats l.ar,e v z ~.~t ditto!~ ; COT, oe st wu~ Or; e 0 C 1 jj K~I CTWk4p. ~0t.lee Pa. Page Or Straw Marsh Hay, Synthetic Covering Distribution Pipe Medium Sand Topsoil 3 ( E a D 3 ~ slopes 0/0 A%d Of - 2 %2 Force Main Plowed Aggregate Layer D i Ft. Cross Section Of A Mound System Using E Ft. F IS Ft. A Bed For The Absorption Area G I . o Ft. A Ft. H i.5-Ft. Signed: B Ft. License Number: ~a3 f K Ft. (U a 3 L- Ft. Date: _ Ft. Alternate Position Ft. of Force Main W Ft. L Observe-lion Pipe-,,., g K j I° --1-- W ~.Distributl 2 Pie ova p ,t ~J,BO4 No so~~fi►gse 9ate I 1N~S ~ s~PEtY ObservatilW- yob arm drs SEA C Plan View Of Mound Using A Bed For The Absorption Area I 1 1 Page _ Of Perforated Pipe Wall '2 ^ End View Per/orated End Cap PVC Pipe p\ee o Holes Located On Bottom, Are Equally Spaced • R Q m°''n PVC Manifold Pipe Alternate Position Of Distribution Force Main Pipe Last Hole Should Be Next To End Cop • End Cop..,) Distribution Pipe Layout P 3 ~ Ft. R S Xl Inches Y 0 Inches Signed: Hole Diameter Inch Lateral Inch(es) License Number: Manifold Inches Date : Ply. Force Main e7 Inches "It # of holes/pipe S Invert Elevation of Laterals "Ft. '51'a - of 110 0ti Sig" S~~ G PAGE OF PUMP CHAMBER CROSS SECTION ARID SPECIFICATIOAIS VENT CAP N°C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JULICTIOU BOX MAWHOLE COVER 2' 25' FROM DOOR, WINDOW OR FRESH 12"M111. AIR INTAKE I GRADE I I ti"MIN. 18" M I AI. CONDUIT INLET PROVIDE I ' AIRTIGHT SEAL t APPROVED JOIN W/C.I. PIPE T A' ~w I I W/C.IVP PEO►WTS A EXTENDING 3'-°"~s3~7 I III EXTENDING 3' ALARM ONTO SOLID SOIL OWTO SOLID SOIL h ~:A B t,. ~p30 1,'. fi~lORg i I IC,(-I. "LS gap u z5 I I ow 25 LLEV. 22--._ 1NaVS ~Y, pN I I ~IS►OH 8 _ _ 1 FT--O- OFF PUMP E CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TAWK MANUFACTURER HAS SUCH APPROVAL. SEPTIC f SPEC.IFI'CATIOAIS 005E M TANKS MAWUFACT URER. f• 1i~~Q~ 91'e~ u St I.WMBER OF DOSES: PER D" TANK SIZE: ZSO GALLONS DOSE VOLUME I12•Sty•) ALARM MANUFACTURER: ^f aAk (41-At INCLUDING BACKFLOW: I ~r L GALLONS GALLONS MODEL NUMBER: u A CAPACITIES: A= Z ` INCHES OR L L SWITCH TYPE: 14 ~ 5= Z- INCHES OR 3y 88 GALLONS ~~q~Z PUMP MANUFACTURER: I: n %.I ep C =8INCHES OR 139 5 GALLOWS MODEL NUMBER: - Li t 03 L D=-I1INCHES OR X209. GALLOWS SWITCH TYPE: 1-4 f) 1 NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE 3 _GP(A INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEELI PUMP OFF AND 013TRIBUTIOIJ PIPE.. o FEET 11•`I`~ + MINIMUM NETWORK SUPPLY PRESSURE . . 2.5 FEET ♦ 9"S FEET OF FORCE MAIN X 3A y 6 FYO nFRICTIOW FACTOR. .-L FEET TOTAL DYNAMIC. HEAD = I1. FEET • / I I I~ 1~ IIJTERNAL EIJSIOMS OF TANK: LENGTH 10 ? 11 ;WIDTH - I .;LIQUID DEPTH ~ 1 n 91GIJED: LtCE1JSE DUMBER: Y17? 1 DATE: " / r r joN 2 y X994 /V. SAFETY & BUILDINGS DIVISION . State of Wisconsin Department of Industry, Labor and Human Relations June 27, 1994 2226 Rose Street La Crosse WI 54603 WANG EXCAVATING THOMAS WANG W9672 770 AVE RIVER FALLS WI 54022 RE: PLAN S94-40593 FEE RECEIVED: 180.00 DANIEL, EDDIE & GLENDA SW,NE,8,28,18W TOWN OF KINNICKINNIC 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, .yard Swim Plan Reviewer Section of Private Sewage (608) 785-9348 4512R/ 1 sen-sail ~s. uireu STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. /Croix County OWNER/BUYER~ P CJ l ~i ICl l? f i"I ~ C' MAILING ADDRESS y/n l`f ~d & I PROPERTY ADDRESS 7 rP 9 L (location of septic system) Pleaseo tain from the Planning Dept. CITY/STATE a i 11 /l c A . PROPERTY LOCATION 5ZAJ 1/4, 1/4, Section a T N-R AF- W TOWN OF / 411nG~ /0 ST. CROIX COUNTY, WI SUBDIVISION Lo d A G LOT NUMBER IQ Lf CERTIFIED SURVEY MAP , VOLUME _8 , PAGE , LOT NUMBER lb Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 r, 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 T--41'r / ~ /e,0- ~4 1,6, Location of prop Kn' ty~1/4, SectionT~N-R~W Township , yi' Mailing address Address of site V s~FF c' O Subdivision name CS Lot no.I O Other homes on property? Yes No Previous owner of property e ~ ell Total size of property 2Z) 4 Total size of parcel ,W 4. Date parcel was created p'2'5 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house) ? Yes No Volume ln'~ and Page Number /a 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 th ffice of the County Register of Deeds as Document No., 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. -70 7 Signature of Applicant Co-Applicant '7z):A y Date ofdgnature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1988 TNIS Er,.Ce RraERVED FOR RECORDING DATA WARRANTY DEED 510487 , . 105✓ y. 'Pty Fast R'S OFFICE This Deed, made between Robert. .Richter,.-a/_k/.a........... OIX Co., WI Rabert.R.._Richter, for Record Grantor, 4 1993 ; and-.---Eddie--W -.Daniel--and-G.lenda-G.--Daniel,,--lwsband------------ :50 - F.M and.wi-fe......------•-•--- eti.,1 Q~ Grantee, rofon* IF, Witnesseth, That the said Grantor, for a valuable consideration ji conveys to Grantee the following described real estate in $t., crpi_X___..._.. - RETURN To tl County, State of Wisconsin: Tax Parcel No:................................... Part of SEl/4 of NW1/4 and part of SW1/4 of NEl/4 of Section 8-28-18, described as follows: Lot 10 of Certified Survey Map filed March 22, 1991, in Vol. 118", page 2338. TMMIE t with the right of ingress and egress over the road righ, of way as shown as Outlot "1" of Certified Survey Map filed March 22, 1991, in Vol. "811, page 2329. !eR FES I~, E i j This ..not------ homestead property. X145 is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And....... Robert.Richter- .a/V-a.Robert--K-.Richter warrants that the title is good, indefeasible in fee simple end free and clear of encumbrances except easements, restrictions and rights-of-way of record, if any; - ~ and will warrant and defend the same. I Dated this ---------•-•---•------•+-0---------------•-- day of _Becembier. 19-93--. I 1 ii (SEAL) - ~C (SEAL) I Robert Richter, a/k/a Robert K. - er--------------- . ~ticht -------•----•-•-----•--•-----•----__...•••-•-•-----••----•----•-•---.(SEAL) ........(SEAL) • I i I i) AUTHNNTICATION ACSNO W LBEIGMENT Signature (a) STATE OF WISCONSIN i nty St.---Croix------------ Con authentic If this --------day of-------------------------- 19------ Personally came before m• this 1_!!..... day of i December - 19•_•.)3. the above named lI Bobezt-Richte>, a/k/a Robert __K_ RichJ~ Connors------------ TITLE: MEMBER STATE BAR OF WISCONSIN NOW-7-PAMC (If not authorized by § 706.06. Wis. Stats.) '~y~e ~O to me known to be the perltl9'"..•..._ who executed the 1 f ing instru nd acknow ge the same. THIS INSTRUMENT WAS DRAFTED BY ~I _ - i~ yXlStina_ Qglalld-----•-------•---•-----------•• Alice Joy Co rs Attorney--at--TAN---------------------------------------- Notary Public County, ~t ~r Wis. (Signatures may be authenticated or acknowledged. Both My Commission is perm ent not, state expiration I~ are not necessary.) _ n date: 19.1.'-'1•) *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leal Blank Co. Inc FORM No. 1 - 1992 Milwaukee, Wis. MAR2 21,991.- 1 CERTIFIED SURVEY MAP t~ LOCATED IN THE SW1/4 OF THE NE1/4, THE NW1/4 OF THE NE.I 4,'TaE 4 OF THE NE1/4 AND THE SE1/4 OF THE NE1/4 OF SECTION 8,.,-k.28N, R18W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN NOTE: OUTLOT 1 IS A ROAD RIGHT-OF-WAY ra o 3 AND EXEMPT FROM THE REVIEW REQUIREMENTS H o V OF THE ST. CROIX COUNTY SUBDIVISION w w .D ORDINANCE. w ° W 00 W H UNPLATTED LANDS z ~ 8 p01E ¢ E-+ N1 ~ lO O 22462 w r+ Wa , SF ; U) H z 213'38' '22224' 6~~ 2i,` ` ' o0, ° w ~Ha S ~I y1~ 11 ~ 1 S30°54'E al ' 'EJ ' 221.47' wl ~ N30°54' HI UNPLATTED 221.47' 12 al 'o LANDS 9 z l :0I 66 , 3 o w , 3- _ 1 O , i M O i __4 o ' ° al M- ° 0 00~ 4 00 Ln z 8 13 00 rn o , rn W 1 z o0 8 '23 En 7 1 HI 24 16 \ d~ 7 ~ 15 w a H z z~ ox o w H o° ° UNPLATTED z w o - - - - - Ha ° ° ; LANDS to -4 3 m ° o o 3 LEGEND M o n m w o o ST. CROIX COUNTY SECTION CORNER w o 0 0 cn MONUMENT, FOUND. w - - - o cn un o UNPLATTED w 3 :D ° ° O 26 ~ - - - 1"X24" IRON PIPE WEIGHING 00 ~ 0 LANDS 1.68#/LINEAL FOOT, SET. w cn N ; o z x M CV ° ~o zr+ 4 H z o 000 2 7 w 00 z G)166; N87°51'00"E EAST-WEST 1/4 3 H ® 246.36' SECTION LINE 2 '66 2f,' 9 30 31 E1/4 CORNER SECTION 8 4ZIND 1 42nd 6Ave. ~O,-------`V 1887.53' T28N, R18W 3 I c719,238 S.F.±S88°16'01 W 4568.73' 00 00 Hz 0.442 AC. ± UNPLATTED LANDS O1 I E-z C.S.M. 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PaaaasTBag `g0supmS 'y saver `I k3.Ly0IdIZ1I30 S,*dOx3AN[1S I 199 14'. of L _W 467477 w r CERTIFIED SURVEY MAP LOCATED IN THE SE1/4 OF THE NW1/4 AND THE SW1/4 OF THE NE1/4 OF SECTION 8, T28N, R18W, f TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN C.S.M. LOT 1 4 OUTLOT 1 ' P6)-t- r _ - - 5 166' I 2 3 SO°17'00"W 51 .00' 6 --j _ - I S28°13100E 7 50.001 I I -41M S24053'0211 W 10041 F+Iv'+ 110.10' iii a0 ~ I zP11Iw C14 4 N82°34'30"W Nt UI~ I 95T. 5r, N0°23'56"E 705.04' 0 g3,3i I o WEST LINE OF THE SW1/4 OF THE NE1/4 I UNPLATTED LANDS 1 66' I NORTHERLY RIGHT-OF-WAY LINE LEGEND ST. CROIX COUNTY SECTION CORNER MONUMENT, FOUND. • 1" IRON PIPE, FOUND. aq 1"x24" IRON PIPE WEIGHING 1.681/LINEAL FOOT, SET. 01 `V 1.0 a I +1 N I ° 0 OWNER AND SUBDIVIDER Robert Richter vl No o °o ~ ~I 1152 Riverside Dr. N. W 3 -4 a o ~-i I Hudson, Wisconsin 54016 z 00 00 _ N r~ C all aI O z O 00 U O H ~ U 00 W p 3 W I rl W N Ln I zcnH Ln r ~I LO wl SCALE IN FEET 00 ° ° I 00 00 z 00 0' 200' 400' 3 z 3 N W ~ `r' 00 w 00 ASSUMED BEARINGS REFERENCED TO THE M ~ ° -4 U NORTH LINE OF THE NW1/4 OF SECTION 8 00 z Ln ow I-q WHICH BEARS S88°34'57"W 00 H rn z cn a Cl) H z H x ~ H C7 C4 a PQ o z N0003'50"W 409.80' NOTE: THIS MAP IS EXEMPT FROM N88°15'55"E TOWNSHIP AND COUNTY REVIEW S0°34'11"W 1832.76' 25.93' BECAUSE THIS LOT EXCEEDS 20 N WEST LINE OF THE NE1/4 OF THE NW1/4 ACRES IN SIZE. r, cv AND THE WEST LINE OF THE SE1/4 OF THE NW1/4 i° oo UNPLATTED LANDS NW CORNER SECTION 8 This instrument drafted by James T. Swanson. T28N, R18W Vol. 8 Page 2338