Loading...
HomeMy WebLinkAbout022-1029-40-000 c STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER_fi 'Ajr ~ l ADDRESS 3E~ _'3W S/ 0 I dR M( J SUBDIVISION / CSM# LOT # SECTION La T ) y N-R o W, Town of A IYi Yl f~ f 17 r~ t ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~aao 10 1,000 IQ, )6 6' INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. I I i BENCHMARK: ALTERNATE BM: SEPTIC TANK PUMP CHAMBER HOLDING TANK INFORMATION I Manufacturer: Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location I SOIL ABSORPTION SYSTEM I Width: Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House Other i ~I ELEVATIONS Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt f Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor apd Human Relations INSPECTION REPORT ST. CROIX Safbty and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Pla o.: CALL, MARVIN X , J 5~ CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: a,S TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. y Septic Benchmark rO / / C✓Ck. JZ cS ( s P CC~Cc/s, Dosing AeratioFI- Bldg. Sewer Holding St/ Inlet TANK SETBACK INFORMATION St/01 Outlet TANK TO P/ L WELL BLDG. Ae Intake ROAD Dt Inlet S. 5 Y7 Septic ~ NA Dt Bottom ?c 'a - Dosing NA Header / Man. Aeration Dist. Pipe Holding- Bot. System PUMP/ NFORMATION Final Grade Manufacturer Demand Model Number GPM ~a TDH Lift Friction System TDH Ft oss 1 H ead Forcemain Length Dia. Dist. To Well 1, j 62 y, SOIL ABSORPTION SYSTEM ? 4I BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth ~r DIMEN I N 99 SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: Type O CHAMBER Moe Number: System: OR UNIT DISTRIBUTION SYSTEM poffiow/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. c,,? 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: Kinnickinnic.10 28.18W, SE, SW, Highway 65 .rat 1,c !.Z l ^ ~4S ,Q/ ti D l / Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. i ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I i h I SANITARY PERMIT APPLICATION CO)JNXY t~~ILlnlllr„ In accord with ILHR 83.05, Wis. Adm. Code STATE SA T PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than cZ 19 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER / PROPERTY LOCATION %V1,10 i l F'/a S T o7 , N, R/F E (o _ PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK Sob S e1 'rte 17 CITY, ATE ZIP COD PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER FATE u Vin. 51d II. TYPE OF BUILDING: Check one) CITY NEAREST ROAD ( El State Owned U Pa TOWN VILLAGE : ~~M ❑ Public ®1 or 2 Fam. Dwelling-~#of bedrooms( PARCELTAXNUMBER(S)n l1 Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 100 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 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.E] 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 fA Mound 30 El Specify Type 41 El 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 REQUIR D (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION v tom` sV C I C 0 Feet k .5-0 Feet VII. TANK CAPACITY Site in allons 4Gallons of Prefab. Fiber- Exper. INFORMATION New xisting Tanks Manufacturer's Name oncretCon- Steel glass Plastic App Tanks Tanks structed Se tic Tank or Holdin Tank l F ' Y, Lift Pump Tank/Si hon Chamber t I VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum er's Name (Print): Plu s Signature: ( a s) W N ~ Business Phone Number: /u, 15 5 u Plumber's Address Street, Ci , S te, Zip de): t y L,) C/0 ~`Yo~~ IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanita Permit Fee (includes Groundwater ate Issued Issuing Agent urcharge Fee) pproved ❑ Owner Given Initial TTTTYYYY rr Adverse Determination [00 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A-sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 6013-266-3815. 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 arid/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 systern. 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. i 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) l lkJ~4 ~ L Lp a-% a G ► rb 6"* ~ ► ~ w ~ Q ~ l7~- . > rb (p z; Cf) y N FP` oP o 6 O ~'1WW- ~ fiS ~ / O ,"e a~.r l L ~ U'rl ~ Ri ~ Uj all o o 'a o m op cr r p ~ ~O Tl~ C ~1 a! j LV i C 55 SECTIOQ of Mou,-)D w~ r~ f3ED ~ S 94w41114 oEO~ *F ro y A jye c-jATE ~1 ST Ri(SuT~oa G rN~ cka FS s s ysrEM op Top sv► L EIEVhT-io~1 AS F M a Yi9 - C),3r L V).1 i FORM TO E7 C .33 u+ H R hj+ 0 SAID P • . plowst~ To P uu i FORM sl°pE rMA ~ E«VAroa u4~R - f3EV ~ ~ ©t~ 75 FT. - ELEvAT'10►J S t0.6 1 D~ , OF 2- I ATCRh ( s IG~~~~' , • g3 FT• -j-oP of R oc S ~~;,j~ o f I arE R l s i r F{ 13 E D -I- A N V t t Doll r't mares ~ ~N A W A ( FT. F r ~$c~t~lit'i,cN 1~ o------- - \ ~ i ~ V FT 'i w F T- W.., x 3/ CL. ~ T y ~~o of y. 30 3 Tc, ?I 01 eADncn v • _ ~~STf~ '3uTioA-) PIPE NtTwoRK L-Ayou'r S94®41114 OLP TO ~•*N 0 \ Est Al/ow IeOR \ 2 ' c~NDcJ~~/s 2, p fo Fr 3.0 Fr X ~o r y ~O 3S Fr 2 pvc VAR $*A TOTAL. V n t 0 U 0 1 ~ v7 CA ,,E`gNGE SY TE~t =+T,1n3 c:~ ~j Pi:k,il A Corti ~tiona y of f~ E 7 tic. H mSs MMIFOLD N t i G~ ES F once MAw Of HOIE5/.Pi P6 ~~3I 10 3 9 °F- LAlS / W3 6"7 -DE T^% - -6,0p 4At) PER FaR ~-~c t~ Pi P6 CD Rem ov ) \ Y All Tt2i11 Ruk)PS . PUMP CHAMBER CROSS SECTION AM SPECIFICATIONS p~<E ~ of s VENT CAP 594-41114. H"C.I. VENT P WE PROOF IPE APPROVED LOCKIIJG 25, FROM DOOR, JUNCTIOLI BOX MANHOLE COVER 12"MIU. w/ WINDOW OR FRESH IvtftNluCr IAIU I AIR INTAKE GRADE t I y" MIM. 18" MIW • ~~~ONDUIT - • PR OE I INLET MpN ~t3YYAA~ rHT SEAL APPROVED JOINT A t II APPROVED JOINTS 'w/C.-I. PIPE OF 10 W/C.I. PIPE EXTENDING 3' I ALARM EXTENDING s' Ell OINTO SOLID SOIL, ONTO SOLID o1J iI I ELEV. !kgFT-- PUMP J OFF r O I Z ~(AN bLOCK-- 3't ~PPl~ove~ RISER EXIT PERMITTED QNL4 IF TANK MANUFACTURC:K HAS SUCH APPROVAL SEPTIC E 5PF:CIFICAT IQM S i DOSE Mj~(L7SJ', TAWKS MANUFACTURER: flo rReelfsr kJUMBER OF DOSES: _ PER DA TAIJK SIZE: / 0-tro GALLOWS DOSE vo uL ME W x VOIU kOl > z Lr+ t'AL i-CIA (o ALARM MAIJUFACTUKER: LEy~~ A~t~'M ILICL.UDIIJG BACKFLOW: UG GALLONS MODEL NUMBER: CAPACITIES: A= 41CIIESOR BOO GALLONS SWITCH TYPE: MEG'LuRy F J OBIT- B z Z IL:CKES OK J ~ GALI Ohl PUMP MAIJUFACTUKCR: ?O-C= /A IAICNES OR !dFGicL OI~s' MODEL NUMBER: Y 1000 IWCFIES OR _ GALLONS SWITCH TYPE: P1 Gc.-y G'Y~k ~t e£'Cu ~y FIc Al- vin-m PWAP AWI) A11i;R11 ARC TO bE MINIMUM DISCHARGE RATE GPM 1141 TALLED ON 5L'PhRATC CIRCUITS VERTICAL DIFFERENCE BETWEEN PUM OFF AND DISTRIE,LITIOW PIPE.. FFrT &pl -i• MINIMUM NETWORK SUPPLY PRESSURE . . . . . 2.5 FLET 6A<<t ~i ~IfOf" J{ (j ``"t + 3S FEET OF FORCE MAIN X L=-[T.F'RICTIOIJ FACTOR../' FEET TOTAL Dy1JAMIC HEAD = FEET' i J D IIJTERIJAL DIMEWSIONS OF TAIJK: LE.WCGTH ;WIDTH / ; L.IAUID DCPTI4 3 Wisconsin Department of Industry, Industry, Labor and Human Re SOIL AND SITE EVALUATION REPORT Pap-of ' oivisiori ctsafety 8 Buildings ieaccd 05, Wis. Adm. Code 2 COUNTY Attach complete site plan on paper not less than s in siz ust include, but not limi ted to vertical and horizontal reference p~and % o scale or PARCEL I.D. # dimensioned, north arrow, and location and distAPPLICANT INFORMATION-PLEASE PR ~Jrt M~TJ~ REVIEWED BY DATE PROPERTY OWNER: PROPE LOCATION A1,401/N d, h1,47-~/ YV Cx,-UNT`~ GOVT- SE 1/4sW 1/4,S/0 T 2P N,R le E(oio PROPERTY OWNER':S MAILING ADDRESS ZONING OFF! r (QTR(' BLOCK# SUBD. NAME OR CSM # 13 ~o Sv j_. r G,}-,E_E . - yd ~ 0 CITY, STATE ZIP CODE PHONE NUMBER QCITY VILLAGE [gMWN NEAREST ROAD ~v~PNSvi//E 1"NIV- 55337 (6/1) S'SO' SC~~s K~:(/.vi'c~E'i;u•~i'~ - [ New Construction Use [vrResidential / Number of bedrooms Addition to existing building [ j Replacement [ [ Public or commercial describe Code derived daily flow (000 gpd Recommended design loading rate bed, gpolft2 ' trench, gPdtft2 Absorption area required -500 bed, 11:2 Slob trench, ft2 Maximum design loading rate bed, gpd/ft2 j ?....trench, gpd* Recommended infiltration surface elevation(s) S,ce P `a • 3 It (as referred to site plan benchmark) Additional design / site considerations Svc' -t81E- 0.- cy dip - TFS T Parent material SGS A, lo,c h l;u Flood plain elevation, if applicable r1~ It oug-T A V S - Suitable for system coNVENTIa MOUND ❑ U IN-GS UNO_Pf~ESSURE AT-GRADE SYYSTSEM IN ❑ H0L SNVG~ U = Unsuitable fors stem 0 S [B-fj [J $ O O C1J B-u 11 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BMIC13Y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed (nch A 0-? /bra 3/2- A& 105; s / f Ground R y 7 Yff 5100 5*- ,sfovE- S~,Po,~ / C~ir ,vr A/ lev. Depth to limiting - factor~ y, /3W. Remarks: Boring # ®y~ /o y,V 312- s z A" XAe ds f / f . '7 Z 13, 41 -1v /o 1111? 313 sl 1--"4 sd,~ M, fe es /?c y -5 Ground '3Z ' y0 /O y 5-11 2-,4, f,Jt A4, . elev v-,5 /0 ✓'7f7v ^TFt~ 51 Depth to IC D / b Sl S p, limiting factor SSS Remarks: /fb~Q~2o~ 02 COfi¢/C~~ CF~rFtir~y i,~ S~JDTS CST Name:-Please Print l06/3E;e 2(4/9 f 7 Phone: 3 PC f-5- Address: Co S G ' S'uo.~ / v -~t~ ~'ST-y S~~Z Signature: Date: CST Number: 'f'a7t AfO57- /t ~ST~'IcTiU~- ref O R I G I N A L 54,Vo 7///. 4 1 PROPERTY OWNER Cpl/ SOIL DESCRIPTION REPORT Page of 3 PARCEL LD. # yd AGHQ S Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed tench 3 0-/~ /o s/ v~,e S 3 -F -7 3 L 5~/. z s 2--f s io V"f Grounder 5 /d y S Z' elev. Depth to limiting Sr/ SSS' Remarks: Boring # Ground elev. ft. Depth to limiting factor i Remarks: Boring # GrounA elev. ft Depth to limiting Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: C011 009A/O ACMM O • wesr PRoP. o n 0 Nk Q tP tr, O 0q;zy °v i (A (A o c i , v m 0 t O JJ ti rn N ~ h C Cn Q\ ~ M n !r ~ W v W -v STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Marvin & Kathryn Call MAILING ADDRESS 1506 No. Snelling, St. Paul, MN 55108 PROPERTY ADDRESS 429 Hwy. 65, Roberts, WI 54023 (location of septic system) Please obtain from the Planning Dept. CITY/STATE Roberts, Wisconsin 54023 PROPERTY LOCATION SE 1/4, SW 1/4, Section 10 T 28 N-R 18 W TOWN OF Kinnickinnic ST. CROIX COUNTY, WI SUBDIVISION 40-acre parcel LOT NUMBER CERTIFIED SURVEY MAP h r~- , 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. *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 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 Marvin and Kathryn Call Location of property SE 1/4 SW 1/4, Section 10 T 28 N-R 18 W Township Kinnickinnic Mailing address (429 Hwy. 65, Roberts 54023-site) 1506 Snelling Ave. No., St. Paul, MN 55108 Address of site 429 Hwy. 65, Roberts, WI 54023 Subdivision name n/a Lot no. 40 acres Other homes on property? Yes XX No Previous owner of property Greg Bisel Total size of property 40 acres' Total size of parcel 40 acres Date parcel was created not new Are all corners and lot lines identifiable? x Yes No Is this property being developed for (spec house) ? Yes X No Volume and Page Number S'6o/ y 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 (we) certify that all statements on this form are true to the best of (our) knowledge that X (we) (are) the owner (s) of the property described in this information form, by virtue of a warranty deed recorded in~, he o fice of the County Register of Deeds as Document No. 5 l and that (we) pr ently own the proposed site for the sewage disposal system or (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. igna re of Applicant Co- pl cant Date of Signature Date of Signature 1-Rz~i nVV0VN %YJ GGG Il I DOCUMENT No. &4004TE BAR OF WISCONSIN FORM i _ 18. MC, SPACE RESERVED POR RECORDING DATA WARRANTY DEED 5175G3 YO! 10 8PA 564 TFR Q; ~3 LC I~ Cr•CI ! This Deed, made between ..Gregory-A....Bisel-and Reed f Roxanne D. Bise1 husband and wife . .a . JUN 7 1994 Grantor, and II=35 A and...._>~va.rl__R..._Oall. and. Kathryn J. Ca11,.. husband 1`~ wife..as...~ozr~tt_.tenants........... . Grantee, Witnesseth, That the said Grantor, for a valuable considerationNe I III ..da]J ar.. and. Atber_.good__ and.. valuable.. cotisideration....... - I ~ RRTURN YO conveys to Grantee the following described real estate in ...S.t Croix _ County, State of Wisconsin: I~ ll Tax Parcel No: ii Southeast Quarter of the Southwest Quarter (SFA of SAO, of Section Ten (10), Township Twenty-Eight (28) North, Range Eighteen (18) West. Together with an easement for ingress and egress described as follows; Commencing at a point located 33 feet South of the Northwest corner of the SW 1/4 of SW 1/4 of Section i 10--28-18; thence go North 66 feet; thence Southeasterly to the Northwest corner of the SE 1/4 of the SW 1/4 of Section 10-28-18; thence South 66 feet; thence Northwesterly to the point of beginning. i This easement may also be used for utilities by the grantees herein. ~j i i This 7.s_.nQt._.._.... homestead property. 99 (is not) Together with all and ainqu)ar the hereditaments and appurtenances thereunto belonging; j And..... grant.ClX I warrants that the title is flood, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, reservations and covenants, if any, of record, and higbway rights of way I and will warrant and defend the same. Dated thi .............27th ..ley. 94 I d (SEAL) (SEAL) ._Gr A. isel . (SEAL) (SEAL) Roxanne D..B gel. AUTHENTICATION ACRNOWLED MENT Signature(s) STATE OF WISCONSIN ss. .SG_..--Cra x ...................County. authenticated this day of 19 Personally carte before me this Nth day of May 1994.... the above named -------------•-•..............-•-•--••----...--•-•---------C------......... « f TITLE: MEMBER STATE BAIL OF WISCONSIN fpy -COW" • ,ju gji ry P---- - (If not . mNOit~'y..__..... - n - .~f E'E!IS.COILS({1l..._ uthorized by 706.06, Wis. State.) an W/ARg ort S.......... who executed the r ing instru and ackno dge the same. THIS INSTRUMENT WAS 0RAR7Eo EIY Edgard-F_.__ V1ack._.DAVISON. A. VLACK 200 East Elm Street n'tret"TSiis; WT •--~4fl2•Z Notary Public -----County, Wis. (Signatures; may be authenticated or. acknowledged. Both My Commission is permanent. (tf /not, state expiration are not necessary.) date: .111n..([1....,••,•,_, 19 *IQamm Of pcnMUS aiRninR 1n eny ¢apacitr Rhou)d be typed ur tlrintrd h0ow their E1g11atuYlc. Jdol L S% l~ L 6 i n S~ INDUSTRY, T~VIsOF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ' DIVISION P.O. BOX 796 LABOR AND PERCOLATION TESTS (115) MADISO N W1 5307 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOT NO.: BLK. NO.: SUBDIVISION NAME: %W r- A SECTION: TOWNSHIP/ /~,;vr. cr of i a t ~t ~-es sE io /T2?N/RIe E (or W k./ 0 COUNT 'S 6 YER'S NAME: MAILING ADDRESS: _5 .4o/ ~ C fipel f'Olv USE /Z- .f - DATES OBSERVATIONS MADE NO.B DR : r 0M R TA-17 D SCRIPT10N: PROFI E DESCRIPTIONS: PERCOLATION TESTS: NResidence 3 ) /t , XNew ❑ Replace Q_ - RATING: S- Site suitable for system U- Site unsuitable for system ONVENT NAL: MOUND: IN-GROUND-PRESSUR_ :SYSTEM-IN-FILOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑ S DU 0 S ❑U ❑ S CAU ❑ S NUT ❑ S MU ,~Yo0w0 00AIl If Percolation Tests are NOT required DESIGN RATE: I If an y portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GR UNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. GHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 7s/ S; • S• S' 4. SS Gv/ -r 1y01~.SJ /~3 , B- 3.3 / 2 ' C2Nn.2vl~~ JAS ~%AvLnS'fOA, _t- ~3ED A OC,E) . ~/0 s ' 13N sy. s/, . 7S o P s/ rl B-L / S' -p.olvS'E vv&0 cE,~ft~T~p SS -1y elv, 51 e-&V'VS_- foe B-3 i z S 2 S r o~- 'avk5E ~T s/ , c7 A-Z s/ w, M /"-/a~ 5 /,p'8tix. S` •G~'~/3v Si' / S ~O/F, S w/ -1'ff. rs -sy, 5 s -3 S ~~f •NE 1411 s L; MA-)y ff ok h wsr) , t. a s; r , 7 S ' Z,( (2a 'fl, / 2. o SI 44, S yo 3.75 w 5 I . M F~ ho 6- PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. --PERIOD 1 PERIOD2 PERIOD PER INCH P- P- P- $ V TEQ- TO U 4_~ S :"A,/ S' ~N 7- Z:g2 P-. i' P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe wTiai are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the directidr1. d rgercent of land slope. A; SYSTEM ELEVATION y j. x c0l 1 , PL 141 o > .v ~ i TN OT APPROVED 0a aI septila system. -8 qonvbn' S4e 6xpia6ation so%Z s -.5"&T 1414 7C 1 ~ ~"~~S-p,,J jrGG Orr, C/ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print : TESTS WERE COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. ADDRESS: 655O'NEIL CERTIFI TION NUMBER: PHONE NUMBS ( tiona1): ' ROBERT ULBRIGHT l ` ~ 2i 3Q 60 Flo Flo I CST SIGNATURE: MNN. INSTALLER & DESIGNER LIC: N0.00663 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - C~uLE6 ~ 7 S~ • ~/w~i (s' .lot h m vfE S~ffL ilP'/.v 4,15 ,gPP,eo~►• /oob HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGNT 'NIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. ± idld, INSTALLER 6 DESIGNER LIC. NO. 00663 f ~ ~ti ~AAW 5 uo 1 5 ~Q o CA t ,N ~a 2p tie 0~ 's ~ s~oiE c.cu'T6iP I ,s %o Sion , 10 i b 5 gy ~i'E v ,~v /P fz. r DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN RELATIONS 1 / MADISON, WI 53707 (H63.09(1) & Chapter 145.045) ' LOCATION: 5'141 SECTION: W TOWNSHIP/ LOT NO.: BLK. NO.: SUBDIVISION NAME: SE ~ /0 flI?N/I~Ip a E to ~1/.Vita/*C//ii' C UNT S A . MAILING ADDRESS: .~f •~01 ~i~~ ~~/So,v ~/~o E;c%c~~~,•~ ~'v,~v , ~/oor ~ ~,v i USE /Z- - DATES OBSERVATIONS MADE S NO. B DR : COMMER CIAL DESCRIPTION: PROFILE D ESC COLATION IPTIQNS: TESTS: PER Residence 3 9f / , TNew ❑Replace I Q ~r? RATING: S- Site suitable for system U- Site unsuitable for system ICONVENTIONAL: MOUND: IN-G S -I -FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) OS 0U OS ❑U OS CCU ❑S ©U ❑S DU ~OUAvG ~'~~G. If Percolation Tests are NOT required DESIGN RATE: I If any portion of the tested area is in the /J_ _ under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: / PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER OEM IN. ELEVATION OBSERVED ES HEST TO BEDROCK IF OBSERVED ISEE ABBRV.ON BACK.) 01 $N • -T . S •~P. S S r c^'S ~ 33 l 3.3 / 2 , 7 '757 '13,v-3,y 611 .7Y ae, S-1 Q ~r-vxe 2 s/ B-, /.rS' DR~^Sc 31V,0el) ~~`•~fr c~7 Q SS X, 4'Y /v. S .67 2 G/ • .3 S ~o'~ s ; GI~r~3v 'r dui-rff" g. ,y Jr/ 7"_2 MA J'I' Tf Ok N k.WZ') r 3, 7,5' ' 2.0 • .7S'~ r!C W 5 r rv f f &e PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WA fER LEVEL-INCHES RATE MINUI ES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P- P- P- 0 S" EC U X72 O.✓ Sc.V 7- 7-42 A' E P- P PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- tontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction And percent of land slope. - SYSTEM ELEVATION I P40 r' f 4-fAl - I I _J. - - - 0~-8,14-NOT APPROVED t H I eptiG system. a; nb t OGnal s - - - - ; S .e kpianavon. 4 7e 501 4v.~ , 7 orw _ , Irwl" 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. RAME print : TESTS WERE COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. 4 - 3 (?IF DR 6550'NEI CERTIF,I y PATIINUMBER: PHONE NUMBE (o tional): ROBERT ULBRIGHT S7 CST SIGNATURE: MINN. INSTALLER & DESIGNER LIC. N0.00663 C(jUL~i~ p ~C '4444, s~ . yy ~ s f, f~r,Pih ~vtE c 13,4eeHkE- 130.e4c, 6-..$' h 3~'AO WA/ 'A APP94 X • / oub 2 HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGNT NIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. wN, INSTALLER A DESIGNER LIC. NO. 00663 z jgAifJ . y 5;105 110 O il 6o 0 G ' INN 21 110 LCuTEIP 1 7$ %o I I S S9e ~ ; v ~y. 10 - T13 a -fry z PLD d G-AAJ