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HomeMy WebLinkAbout022-1072-20-000 o N °o, p M y ' (U N 0. O w ~ tl I b °o I I ° I y ~ I ~ I v ~ I I I o a`~i 0) ° I z t° rn LL c MD o a~ U 0 CD Q U CO N U z a2 zz o v o z N z a m 0 0 2 v v I u 0 o (D Z II E o C" a) a) I •'v = g c O o Q Q z z o N z C\j c N E N N j ~ E R .L+ O 0 Q T) C) ai c in a -fl of N N I- U) F U) - Cv N li E d 0 O (v > 0 0 0 m a a a s N " U v v O N III 6) a W J U c rn rn ti E o o °o Q' _ O N > O U M 1 _ w m 0 a 00 co 0) a) 0) 1 cD 'C 0> Q Y Cn 05 C C 3 N c O ° Q~ Y o eu `n 0 0) o No a~ n °o °o 0) N Iq E Z= Q Y c 'a N N C14 : a) U) 06 1= c o a c Q C OCp• U C N y - a~+ -p N 00 O 00 N m c 70 00 0) L, o E cu co ~y c) N Y Q N O z N '7 mI Ea a Y Q L) E ` c c r A t . u a E 0 • 1 t STC - 104 AS BUILT SANITARY SYSTEM REPORT r OWNER U f ar p';~ ADDRESS J jTL 71 SUBDIVISION CSM# LOT SECTION T N-R_2ff W, Town of 1;1 ( 7d?r l ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM lptq0~ lug i 3U,X 7L~ ` 1D lo T&P INDICATE NORTH ARROW c< FS T Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. 1 S :HOZOSdSNI :HaGWnN aSNSOI'I ~J rp, :8Or NO HasHf1'Id •'foI;LVI'IVLSNI aO HIVG ape.zb Teu .a ape.zO buigsixa magsAS 3o moggog pTOJTUQW/.zapeaH 330 dmnd moggoq od 49TUT Od gaTgno IS 'gaTuI ZS aaMag buipTing SHOIZKA3'I3 xaug0 asnOH $ : TTaM :moaj xoaggaS : aui T • do.zd gsa.zeau 0-4 uoigoaaio aouegszo p / sagoua.zq 3o xagmnN 9 tggbuwi :ugpTM malsAs NOISdu0say 'IIOs UOTgeOOrj maeTy 17 :aT0kO su0TTeO uoTg2aades gpola b eziS I vy4rpow n a9angoejnuew :dmnd zagg0 `~~7 asnOH TTaM :mo-Tj xoeggas - J :A4Toedeo pinbT'I Sa :.zazngoe3nueW NoIlvmo3NI XNfis JNIMOH atalKyHO dW XNKS OISa33 ' ~ :xx~~NSs wIT Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST . CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: 2- 4 Permit Holder's Nam ❑ City ❑ Village nTown of: State Plan F ALDEN, JEFF & KELLY X VTWWTCXjNNjC Q2, -1072-1-0-000 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel ax o.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Atz c, `~j 0-" Benchmark S~3 Gf 7 y /Q D : 1~ Dosing Aeration Bldg. Sewer Holding St/Ht Inlet S qc~ TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet /gyp Air Intake ~i s ~~LtJO Septic /pa >S~ / y.?S, NA Dt Bottom ({S Dosing U' a >~S NA Header /Man. aG y g I , /!f Aeration NA Dist. Pipe o2~5-0 3 Holding Bot. System 3.38 0) , o7 PUMP/ SIPHON INFORMATION Final Grade .0/ /b 3.-7 De nand 6ja/K J Co-vc-~') (,,13 Oq, S Manufacturer #t" j Model Number 01/ 1) j 311 GPM V i Loss Head Friction System Ga TDHIS,I0t Ft TDH Lift jj,,01 Forcemain Length 1, Dia. r Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSION y /a DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: SETBACK CHAMBER Mode Number: INFORMATION Type O vGl 10 lb t S ~ lj f OR UNIT vi '4 System: DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia.~u Length Al~_' Dia. I~~~If 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.) ?L, yy 761 LOCATION: KINN~CKINNIC 26.28.18.401,NW,NE,EVERGREEN DR. fiel4 Plan revision required? ❑ Yes ❑ No FO ~ (1 QL ~ ~ Use other side for additional information. ICS 7 - SBD-6710 (R 05/91) Date Ise r sSignature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: ' SANITARY PERMIT APPLICATION v'~~AR In accord with ILHR 83.05, Wis. Adm. Code o STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ a g y ~J 8% X 11 inches in size. check if revision to p evious application -See reverse side for instructions for completing this application. sT ELAN I.D. ~Ny6Y5BLB 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. 5~ 7 7 PROPERTY OWNS p PROPERTY LOCATION r r l Y. Y., S go/ To E (Orrg) PROPERTY OWNER'S M IL NG ADD E LOT #.-lam BLOCK # ,11 4A,. I TY STA ZIP 9DE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER III. TYPE OF BUILDING: (Check one) CITY NEAREST WAD ❑ State Owned V TOWN ILLAGE l P7 r n U N 1 e Ptl Or. ❑ Public ®1 or 2 Fam. Dwelling of bedrooms3- PARCELTAXNUMBE (S) Ill. BUILDING USE: (If building type is public, check all that apply) ,o, 1~- 1 ❑ Apt/Condo l• < 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreaftional Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 90 Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.9 New 2.E] Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 511 Repair of an System System Tank Only Existing System Existing System. B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION no 3 ! 6 3 171 C~ ~eP: ~6 Feet eV0 Feet Vil. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete strCucted Steel glass Plastic App, Tanks Tanks Septic Tank or Holdin Tank Bl)(? e ' t, Ir Lift Pump Tank/Si hon Chamber o 1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu er's Name (Print): Plu be ' Signature: (No S s) M PRSW N Business Phone Number: lxata(~ 4 "_24~ 1 Plu er's jr7(S treet, Ci ~fgate,zip e):,` f11 er IVA IX. COUNTY/DEPARTM NT USE ONLY 1J Ct( ❑ Disapproved Sanit ry Permit Fee (inure es roue Water ate ssue Issuing A ent ature (N Stamp Approved El Owner Given Initial U&~ Zl~ Adverse Determination 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, 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. ll. 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 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) ~ RE TE5 r a~ "PA PC E _ ~ PRA FEleev t-ok&S/TE- t•5 00,e-R- 001'641-JA 50i4_ _rE-s T_ 13Y G • 5-F ~~FL Wisconsin De=Relations. e Industry, S_ " labor and HuSOIL AND IT E EVALUATION REPORT Page ~ Of - Division Division of Safety & Buildings in idh it f 5W is. Adm. Code PW.M , COUNTY sT. Gil'°O / • x Attach complete site plan on paper not less th 2 x 11 &hq n size. ust include, but not limited to vertical and horizontal referenc (B?ftand % e, scale or PARCEL I.D. # dimensioned, north arrow, and location and a to wrest road. APPLICANT INFORMATION-PLEASE T A ,p*lkOiifi~A ON W REVIEWED BY DATE PROPERTY OWNER: x; t 1114PERTY LOCATION 7TEFF ? 1< (V ALDE ,~,~thG F1C VT. LOTNa/ 1/4/VE1/4,S?GTLP N,R E(o~ PROPERTY OWNER':S MAILING ADDRESS G ff _ • LOT # BLOCK # SUBD. NAME OR CSM # 4t7 3 G RCEa h r 11 t,N . i= 0.4,v r F 30 4C-&-e- ?,W Fl CITY, STATE ZIP CODE PHONE N []CITY QVILLAGE OWN NEAREST ROAD HU05©a 401. Syoe(. (715) 3F4 ~la/8/ [r.J'New Construction Use [ r]' Residential / Number of bedrooms 3 [ J Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow yra gpd Recommended design loading rate bed, gpd/ft2 trench, gpdtft2 Absorption area required 37S' bed, ft2 375- trench, ft2 Maximum design,loading rate bed, gpd/ft2 trench, gpdm2 Recommended infiltration surface elevation(s) 5&E • 3 ft (as referred to site plan benchmark) h T' Additional design /site considerations A Re,* &C- 3- f3 4- B 5 so r•r h d3 I az fo& h- h a u v D Ci R~ DE . Parent materiL 7-0 Flood pl`nelevation,ifapplicable i ft 5Y!5TE re- ce r M ,.3 S =Suitable for system CONVENTIONAL MOUND rlN GROUND PgESSURE AT-GBA SYSTEM IN Flt,l. HOSING TANK , U = Unsuitable fors stem ❑ S C~'U L~J S ❑ U ❑ S 21.1 12 S ❑ U ❑ S L~ Q SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxiary Roots G DP /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed terldl ` O D-G /0 w 211 5 f, sbk of 5 3 f S 6 G - /.z /0 yR a /2- 1s Z.f, s6,e ti„ S l`F 7 Ground C " 3& /o yR '113 s Y G 15 " z f Sh/k nH,e- N x3 elev. 9G•9,0 ft. Depth to 7- limiting factor Sg.S. Remarks: 9rXe•y G-' VVC-W f6/ ` w fj~G Gf> j' D " . Boring # O -1 /d VA 2~l ( i*r- S f; 5`J~ n~, uf2i ~ S 3 f • 5 . ~ tA C3 7 13 /0YR is 2;f s he s • 7 • ~ 1 h C 3-3,P /6 Y/? 73 .5' y4 ~5 `~f ye N ~ Ground elev. ~G . o ft. Ii ie :....Depth t0 -%7-m 1UT1 14 M; I limiting factor Remarks: :%nee.v G- 5~o~~f!/ ~C6 w /r7Z~r 4~ f7- CST Name:-Please Print Ro t3E R T- 2,jL 13 R L C Lt T- Phone: 715-- 3 P(; , Address: & ©~,V~%G ,PD• u1?Soa Lo 1 Sybr 4 G CST. f J-YIPZ Signature: Date: CST Number: 4771 13 , ? /3 2 AP6" fvo 7 5_1171-13 /E- /CaK /IV y a~ rRe+rl'~' AAA-) T- .5 y S 7`4- . f PROPERTY OWNER A SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Ebjy* Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mr& 3. o- /a R 3 4L v-r c s 3 f • 8 'IM 13 3 /0 Yk Yl~e P Ground /p y to S N►► . S cl?,Je- C $ /a a ~L / yo /C9t'/2 S/G s D, s d C.5 sA-t 0Ri!'TFD S 01 !oo T N , S Depth to C3 D - 50 511 limiting ' factor Remarks: GrrVF /j~ ~4J to ev Boring # d -/O /lam yn 3 - S d,~►, ,e U-f C S 3-f r? • ~ 13 o 15 /o yl? ~/r,~vE6/ s o,,,,, ie ~s fl .s a2~ CS 7 •d C s-2- /p y)e y S AM Ground elev `.t /o t',2 f/Cv s o, c s Ga o.z-ft. Ok /d e S~ S ~l • d ~'F ,0 /ao N Depth to r limiting factor 1 r S,q NDS Sh'r u R hT O f ,ec~ a Y~ ' S Q Remarks: Boring # /0 yk 342, s 0""' t'2 /►n ufi2 c s 3 f • 7 50 y /VVJ CS 4016-1 CYR 516 5- 0, C, 91 dO-? c- .5 Ground C. 4F-7- elev. I2S / O/ ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: OWN 0130,,/o ACIA'" i. I J .gypa~ LA w N f n ~t1 C m s ~ ~ R ~ o P%~~a Gleeu C ~o w ~rn eo 0 a o r c P? r L c 0 o m~ ~ R r G ~ ~ V ~ ~ I 1 m r CA o M o } Z 51 tp ~ l ti Z 7p 0 P v, . .t CIO (1 O 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 S94-40592 FEE RECEIVED: 180.00 ALDEN, JEFF & KELLY NW,NE,26,28,18W 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, \ I #.rard Swim' Plan Reviewer Section of Private Sewage (608) 785-9348 SBD-6423 M. 01/91) 4 9 -40592 l~► r 11i cn . b ~4 ~I • ~I R W h ~ ( N o, ',3 6-12eu is • ~ ~ Ric ~ ° : • 1 C Y' O , ~ . 1 O Z M • G ~ o p p A o` ~ m } ~ 9 't`om Is P6 SFF A,yp yU,sq o' ~ 7 ~ ~ ~ ° slsP~ Fspa~r ~ ~ pz- ;o A. s ~1a U10- J Qo o o Page - Of - Li 2 Straw, Marsh Hay, Or '-.Synthetic': Covering • Distribution Pipe Medium Sand 6" Topsoil F E D 3 'Z % Slope Bed Of - 2 Force Main Plowed Aggregate Layer (6" Below Pipe) D Ft. E I . S Ft, I'' VA ik - Cross Section Of A Mound System Using A Bed For The Absorption Area F 179 Ft. G , 0 Ft. A Ft. H ~ Ft. MA, Signed: B 47 Ft. -"am License Number: 3~ 3 I K_ Ft. Date: 6 3 L Ft. J Ft. Alternate Position I Ft. ForcefMain. - W It. Observation Pipe ' FA K P F~brc~ain W .101, ~Oistribution Bed OfQ 2 ~~o~ A s • Pipe re b•1~e $0e I 9 g g Observation Pipe Permanent a' W 16 \%W o Q G Plan View Of Mound Using A Bed For The Absorpt a ~r J` a vc PIP", ~ N • .r ,s Q Q c ~V iF Las hole shoolA 6e, hexfi }o e.ndl CAP __..5 F+ S .---F } X _ ~nchc~ , y ~nel.es hole ~ `I ~ n e~ d~a• ~vi cl,Ccs~ ~0,niFo~ck J10.. rs (el r a'ca . ~ e\ hole per Pipe---- . bluer iV3 I' N ilo ~ ors 6 ~ qq Q ~0a 'a . SEPTIC•TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ni 4" CI VENT PIPE 12" MIN. ABOVE GRADE I; WEATHER PROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK & FINISHED GRADE 4" CI RISER WARNING LABEL 6" MIN. ABOVE GRADE ` 4" MIN. 18" IN. 6" MAX. •1 INLET I WATPT SEALS GAS- e t ~ TIGHT V _z A SEAL APPROVED CI4 PIPE ditl0 AFFLE I ALM JOINTS W/ CI 3' ONTO®~ B ON PIPE 3' ONTO SOLID I t~ONS ~r SOLID SOIL 4S"'~' C SOIL UMI~ ~p~. ~R S FT. A- I OFF RISER EXIT D PERMITTED ONLY ID `S,pN d~ IF TANK MANUFACTURER HAS APPROVAL P APPROVED BEDDING UNDER TANK SSE CONCRETE PAD SPECIFICATIONS 0. Q0 /",v SEPTIC / DOSE 'TANK MANUFACTURER: 1~ id~J~T ~'rft~s NUMBER DOSES PER DAY : TANK SIZES: SEPTIC loco GAL. DOSE VOLUME INCLUDING 15`" L/FZS, NAiN, DOSE (p 5(D GAL. F LOWBAC K : . ~ GAL. 3-~1 ALARM MANUFACTURER: SS Ejv&ro CAPACITIES: A = lfl.. INCHES = _ GAL. MODEL NUMBER: SDI -01 H SWITCH TYPE: Hy B = 2 INCHES = 3 ,2 GAL. Z ZZ A PU14P MANUFACTURER: ?5_~_J C INCHES GAL. MODEL NUMBER: 3G 13 _ch5 ,s SWITCH TYPE: D = INCHES = -)3-JL_GAL. . REQUIRED DISCHARGE RATE -31N GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP O '.:"F AND DISTRIBUTION PIPE . FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . 2.5 FEET i + _2S FEET FORCEMAIN X FT/100. FT. FRICTION FACTOR . 4,11 FEET, bti> TOTAL DYNAMIC HEAD = /6,y FEE'.r-----_--- INTERNAL DIMENSIONS OF PUMP TANK: LENGTH _ ro b ; WIDTH ~ C► ; DIAMETER LIQUID DEPTH SIGNED: a LICENSE NUMBER: 1~'`t DATE : or . 1/88 STC-105 SEPTIC TANK MAINTENANCE AGREEMENT Lj CCroix County OWNER/BUYER MAILING ADDRESS Mc d f i f Q Lt b PROPERTY ADDRESS 1360, if (location of septic system) Please o tain from the Planning Dept. CITY/STATE CLU etr , C _)l' ? ~L~✓ v PROPERTY LOCATION 1/4, 1/4, Section 9 , T N-R_Z~? W TOWN OF ST. CROIX COUNTY, WI LOT NUMBER SUBDIVISION CERTIFIED SURVEY MAP , VOLUME PAGE , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. 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 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. ---------------------------------1--------------------------------- Owner of property Location o roperty X 1/4 4, Section o7~ ,TJ~-N-R AA W Township 'I C. b Mailing address O/'7 3 S , a Address of site Subdivision name Lot no. Other homes on property? Yes X N Previous owner of property C /na-v A F't~ saA i, Total size of property Total size of parcel A Date parcel was created 91: Are all corners and lot lines Identifiable? Yes No Is this property being developed for (spec house) ? Yes -7 L_No Volume /07V and Page Number t3 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 it h office 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. ig ure of Applicant Co-Appl' nt 7- 94-f '7 - / - c?-/ Date of Signature Date of Signature i r I ~ DOCUMENT NO. WARRANTY DEED STATE,, OF WISCONSIN-DORM I 1 0 74PAGE 63 THIS SPACE RESERVED FOR RECORDING DATA 51541' THIS INDENTURE, Made this........ lS.t.......... day of ...SeptemberT. CROIX®+~ vi 9.2 between Richa.rd... Re.1. g.h. ...Smith a --.s..=rlg:l.e..... C:a..`d tix ;car A. D., 19_............... h . . person _ APR 14 1994 • 3:41; P ................................part..y......._ol the fast part and c c ;Rz~ Jeffrey.. T. Alden _.and..--Ke_1.1y.--~,.,..-.~~d-en.,._husb.and i r and wife . part..leS of the second part. - RETURN TO W i t n e s s e t h, That the said part y........ of the first part, for ,rn(I in consideration i of the sun, of...... one...D.oll.ar....and...o.then---- va.lua-ble..--co-nsider.at-io .......................to.....hl.m.............in hand paid by the said part..lE.qof the second part, the receipt whereof is hereby confessed and ackr,o\\,Icdged, ha..,S........given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do.eS..... give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part.10S.of the second parth.ei.kmrs and assigns forever, the following described real estate situated in the County of--- t.• CrOlX............... and State of Wisconsin, Lo-wit.: All that part of the N2 of the NE4 of Section 26, T28N, R18W, described as follows: Commencing at the NE corner of said Section 26; thence S88°08'1.8"W 979.72 feet along the north line of said NE4 to the point of beginning of this description; thence continuing S88°08'18"W 990.14 feet along said line; thence S00°54'30"E 1307.93 feet; thence N88°17'25"E 990.10 feet along the south line of said NZ of the NE4; thence N00°54'30"W 1310.56 feet to the point of beginning. Subject to right-of- way for the Town Road along the south line and all other easements of record. Containing 29.76 acres. (It,, NLCESSARY, CONTINUE DESCRIPTION ON RLVL•'RSL SIDE)" Together with all and singular the hcreditaments and appurtenances thcreunlo belonging or in any wise appertaining; and all the estate right, title, interest, clain, or demand whatsoever, of the said part....y......of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hcreditaments and appurtenances. To Have and To Hold the said premises as above described with thc hcreditaments and appurtenances, unto the said part.i.eSof the I second part, and totheir._heirs and assigns FOREVER. - And the said Richard...Rei.gh---- Smith for...rllmSe.lf.1..... 1S heirs, executors and administrators, do-es covenant, grant, bargain, and agree to and with the said partl.eS.of the second part th-eir .............heirs and assigns, that at the time of the ensealing and delivery of these presents .h-e...is well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever and that the above bargained premises in the quiet and peaceable possession of the said parc.iesof the second parttheilrcirs and assigns, against all and every person or persons lawfully claiming the whole or any part thereof ..he...... will forever WARRANT AND DEFEND. In Witness Whereof, the said part ---y....... of the first part ha...S...... hereunto set ---hl.s.... _ hand.......... _and seal........ this ...1 St day of..S.ep.tE!Mber........ A. D., 19.9.2....... SIGNED AND SEALED IN PRESENCE OF c~ (SEAL) x.:n.a....a~-~.~ gx~....s.►~ .ir.n.......... (SF,AI-) (SEAL) i STATE OF W{ kbi MINNESOTA Was -h....... pton ss. -.-......County. 1st da September 92 Personally came before me, this y of. • • - A. D., 19............ the above named........ Richard ...Rei.gh...Sm.i..th....... a....si,ng-l-e....person to me known to be the person ....who executed the foregoing instrument and Ccd the same. 1 NOTARY I ae.1.1X1.i.5.... YL.....E.~.d C.k9.Q.ri SEAL This instrument drafted by N tty(,I~~ b'tf~YV~~1Tntbn'.~'~...... .---...-..County, IxIhI. Dennis W Erickson, Lakeland, MN 1 W~`ly~ rUtl ~duNlr oilllti7i53io,U 'Ek ires ry Jaltiua 7 l..9.91.3... (Section 59.51 (1) of the Wisconsin Statutes provides that all instruments to be recorded shall have plainly printed or typewritten thereon the names of the grantors, grantees, witnesses and notary). WARRANTY DECD-STATE OF WISCONSIN, FORM NO. I n. c. u,i r. o, co.. Mnwauci l DEPARTl1lIENT OF REPORT ON SOIL BORINGS ANDCfA SAFETY & BUILDINGS DIVISION IW_CJ§TRY, P.O. BOX 76 LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ Y: LOT NO.:BLK. NO.: SUBDIVISION NAME: NW 1/4 NE 1/4 26 /T28 H/Rl8&(or) W Kinnickinnic n/a n/a n/a COUNTY: OWNER'S/NAME: MAILING ADDRE S: St. Croix Dennis W. Erickson Century Realty, Lakeland Minn. 55043 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence 3 n/a New ❑Replace 18_28_90 8-29-90 RATING: S= Site suitable for system U= Site unsuitable for system r ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYST?SZE] ILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) ❑ S HU EiS ❑U ❑ S HU U ®S ❑U m ound DESIGN RATE: If Percolation If any Portion of the tested area is in the Tests are NOT required under s. ILHR 83.09(5)(b), indicate: n/a Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS a e 92 PTiB BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH HICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH I LEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) 2.0 y B-1 15.08 100.45 none 3.08 1.00bl.l. 1.33bn.s.l. .75bn.l.s..75bn.mot.l.s.mot.f. B-2 5.75 100.45 none 3.17 1.25bl.1. 1.92bn.s.l. 1.33bn.mot.s.1. 1.25gy.mot. .s. B-3 5.67 100.95 none 4.67 .75bl.1. 3.92bn.l.s. 1.00gy.mot.f.s. 13- B- 13- decimal' PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATER INCHES NUMBER M4XES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER P_ 1 2.00 none 30 W-2 4 4 8 P_ 2 2.00 none 30 5 4-2 41-2 7 P_ none 3 52 5 5 6 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- zontal 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 10195' 3 r5I © P~ ~4-; 17 t 3; _i3,0 _S E i ~lyf p 51, V0 _ © . ~j F E , I 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: Gary L. Steel 8-29-90 ADDRESS: CERTIFICATIO NUMBER: [PHONE NUMBER (optional): 1554 200th. Ave., New Richmond, Wi. 54017 2298 715-246-6200 CST SIGN DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - 'L f t s O