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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER,~l ~.✓~hv DfIYt ~C
ADDRESS
SUBDIVISION / CSM#_ e LOT
SECTION 6 T ci-T N-RAW, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN
T N VIEW
SHOW EVERY I G WITHIN 100 FEET OF SYSTEM
r
N N
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A& 60rn.tr
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lt~GUcr • 0
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LC)/ad
/~iSft.~KrP f rOwi fj.t uH. f ~
66
INDI_CA,rE NORTH ARPOtd
Provide setback and elevation information on reverse of this ford
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: /V£ ~D/itl✓ Or~~`,'. ~~d ut UGC.✓L/(//Gtr
v
ALTERNATE BM:
- ~/ew '7
PTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: i~o~er 6~ ax~~~
Liquid Capacity: /cam o
Setback from: Well bye //House Other
Pump: Manufacturer ~e~Irv Model# Size !
Float seperation ,f 77 Gallons/cycle: //7
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length -75 Number of trenches
Distance & Direction to nearest prop. line: ~,~ds/gee
Setback from: well: House 4'l Other
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:
,,e yay
LICENSE NUMBER: _ /jIN~$ 3~,2T
INSPEC'T'OR: -77o
3/93:jt
wisccnsin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations INSPECTION REPORT S7 ~Rb 1 X
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No.:
GENERAL INFORMATION al9ID
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
J~arJa4-e(~ ~~Rbm J652
CST BM Elev-: Insp. BM Elev-: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA l7
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV-
Septic - ~;v+_c - C.1 C+G1 i 4 Benchmark 5 31~
Dosing ~'e.Q.-~ Pt ~ ~ )_4 e 9106 ,w 2 Aerat Bldg. Sewer C~
Holding St/,Kt Inlet GEC.
TANK SETBACK INFORMATION St/, rd Outlet J~'2 p.3 35~
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake 3 7a
Septic NA Dt Bottom PM
Dosing ZS 77 7S / NA Hea4ler /Man. f r Q 2
Aeratio Dist. Pipe s i3 89, 7~ r
Bot. System 5 %O~L /
PUMP /POJA"FORMATION fi pw~ Final Grade
Manufacturer Ole, a and
Model Number xY 53 QPw.
air- I
TDH Li ft, Friction Syste TDH Ft
Forcemain I Lengths Dia. Dist. To well
SOIL ABSORPTION SYSTEM
BED / TRENCH width r Length No. Of jrenches PIT No. Of Pits Inside Dia.
't) I DIMEN I N 75 / DIMEN I
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING rer:
SETBACK
INFORMATION Type O CHAMB
a A OR IT Mo el Number:
System: stem:
DISTRIBUTION SYSTEM
Manifold Distribution Pipe(s) y x Hole Siz~el x Hole Spacing Vent To Air Intake
Length [i~! Length ~ Dia. Spacing/14-
SOIL 1
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 disc eles, perso esent, etc.)' -0 _ ,,e
'
a/ Z K d 171- zo ( (w
D
d<
Plan revision required? ❑ Yes P-44°
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspector's Signatu a Cert. No. ,
S?. Jose P4. b. Zvi -MW 1 '515, S15, Lo+ I I TeoLd lgrook-'C_"
1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER: '
i
_w
Bureau o of f B Building Water Systems
~•~ii..ii ; SANITARY PERMIT APPLICATION safety and Building Water Sn
201 E. Washington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madi#on, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Num er
~~o3 us
The information you provide may be used by other government agency programs ❑ Check it revision to previ application
(Privacy Law, s. 15.04 (1) (m)]. Sta P n I D. Numb r
RMATION
1. APPLICATION INFORMATION -PLEASE PRINT ALL INFO
PropeLty.Owner Name Propert Location cry
~/~e ro Att l 5L1 /4 ~ 1/4, S T 457 r N, R )6 ~t(orlo
ner's Mail= Addre Lot Number, Block Number
Property Ow
3E-3 -a -1
Cit Stat Zip odd /f Phone Number 3 Subdivision Nam orCSMNumber
Lf DIVA ( ) Z6~1 )0 / 94?
II. TYPE F BUILDING: (check one) ❑ State Owned ❑ city 2 Nearest RID d ,
❑ Public 1 or 2 Family Dwelling - No. of bedrooms 3 E] ToVillage
wn OF S ~C r~T
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Numbber(
1 ❑ Apartment/ Condo O.
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1.0 New 2.-K Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an
__System SystemTank OnlyExisting System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 Mound 30 ❑ Specify Type 410 Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation
? -r-- 75o 7 , 6,1 - ~ 2- Feet Z Feet
VII. TANK Capacity
gallons Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
New Existin strutted
Tanks Tanks
Septic Tank or Holding Tank -x /ew J ~`o~Qy CI ❑ ❑ ❑ ❑ ❑
Ej ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber Oil g~gr-
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
ss Phone Number:
- 7 Plum s Name: (Print) Plumber' ignature: (No St ps) rP/ME85W_hLo.: Bus~,,
7 ?.Z - 3 'z/
7' IiZ
!5 -
Plumber' Address (Street, City, State, Zip Code):
31 /-k I&t LcI / l
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved s itary Permit Fee (Includes Groundwater ate Issued Issuing Ag t S nature (N am
Approved ❑OwnerGivenInitial Surcharge Fee) /J~7/R
Adverse Determination / ~
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD-6398 (R. 015/94) DISTRIBUTION: Original to COUmy. One copy To: Safety & Buildings Division, Owner, Plumber
L
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years-
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
111. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
V1. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons; number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material Complete for all 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.
1X. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or vvith complete dimensions, location of holding tank(s), septic
tank(s) or other trej,.rnent tanks; building sewers; wells; water mains/water sei ire, stream,,; 1 lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system ar(a;; a,,cs the location cf the building served;
B) +-torizonLai and vertical elevation reference points; Q complete specifications for pumps and,-ontrols; dose volume;
elevation differences, friction loss, pump performance (-.urve; pump mode,' and pomp manu "a(t.irer, D) cross section
of the soil absorption system if required by the county, F) soil test data on a 1 15 norm; and F) al! sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (lees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
Jerome Donatell - Mound
594-20638
Location: SE 1/4, SE 1/4, Sec. 6, T 29 N, R 19 W
Town:.,,,St. Joseph
County: St. Croix
Date: August 1, 1994
Owner: Jerome Donatell
Address: 383 Trout Brook Trail
Hudson, WI 54016
Plumber: Roge Timm
Signature:
License # MPRS 224
Attachments: 6748-Plan Approval Application
115
page 1: cover
2: calculations
3: plot plan
4: system cross section
5: plan view, lateral detail
6: pump tank exit detail a'j.
7: pump curve "Y
~ iecLA114t~S
iosp
11 40~ 01 !i_eo 14 ~C
page 1 of 7
S94- 2063 8
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System Calculations
one family residence bedrooms
Loading rate gallons/sq ft per day
Depth to ground water in
Depth to bedrock > in
Cross slope 9 -fig %
Force main length ft of Z in
Manifold/header length N ft of in
Drainback 4••( gallons
Lateral length @ 3S•~5 ft of in
Lateral elevation $q•~ ft (bottom of pipe)
Lateral hole size YA- in @ in ( 4-••Y ft) spacing
S holes/lateral, holes total
Lateral volume 4-•S gallons
Total lateral discharge rate ~g•~ Z- gpm @ ft head
Elevation difference ~-bS ft
Friction loss ft @ , gpm
Total dynamic head Z ft
Pump/silhAon 3'~r gpm @ ft of head
Manufacturer ~oc lnv , Model # 3
Dose volume gallons
Lift/si'p~bon tank =°i » gallons
Septic tank gallons
Measurement pump on & off in
.y rt
Height alarm from tank bottom in y~ N5
4r'+c> But t GS
Reserve capacity gallon ,,,f' Ago
DE CE
ON
calcs Mpa of
S94-20638
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4 0~ ~
S104-20636
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S94- 2663 8
VEIJT CAP
`"C.I. VEMT PIPE
WEATHER PROOF APPROVED LOCKING
JUMCTION BOX MAMHOLE COVER
25' FROM DOOR, „ -A/
W q(LK1N V
WINDOW OR FRESH ~Z I t AQro L-
AIR INTAKE
GRADE
Q.\e,,, ...Gt l I 4u
COIJDUIT
~lll
1 PROVIDE
~2ry ~w, 1a cz. AIRTIGHT SEAL III
4ri,o Crra~ S , ~P.S I?2y ~T 2S•2' I I I i APPROVED JOIWTS
III W/C.I. PIPE
ALARM EXTEWDIWG 3'
El I OWTO SOLID SOIL
S•.~~~~ I I ow .
PUMP-~
y OFF
BLOCK
zo~
I AKII; Br~i1S11H65
U
S94--20638
v
HEAD/CAPACITY CURVE
TOTAL DYNAMIC HEADXMACITY PER MINUTE EFFLUENT and DEWATERING
EFFLUENT AND DEWATERING
WARNING: Model 185 should not be subjected to
less than 30 feet TDH.
34
11 '
1 TOTAL DYNAMIC NEAMCAPACITY PER MINUTE
37 EFFLUENTANDDEINATERING
100 5333
SERIES S7-39 W 137-130 161 161 165 187 _ _166_ -IM 160
95
R. M. " Las Gd. Lor4 Gal the Gal L0. Gd L64 Gd Ls. Od Lt. Gd U6 G.I Lt. Gd Lt.
90 S 1.82 43 163 72 273 104 394 106 401 61 231 61 231 56 220 155 5.F 155 507
26 10 3.03 34 121 61 231 79 300 100 376 61. 231 61 231 $6 220 148 560 151. 572
B5 NIL7I 15 4.57 It 72 45 170 64 242 91 S44 60 227 60 227 56 220 142 537 43 819
24 e0 20 0.10 25 95 x 136 62 110 59 223 60 217 _ _ _!8 220 136 !1S 140 S30
75 25 7.62 6 30 74 260 37 216 50 223 _ Ss 220 128 461 133 $03
22 'M1` 39 all w 266 55 208 58 220 90 310 55 220 121 436 127 461
70 10 1216 16 174 K 172 55 2% 77 28! 54 no 105 397 111 u1
z
u 20 5 w tat{ 21 60 33 125 51 191 54 210 SO 220 w 311 100 379
w u20 u v u 161 x lx >r 229 n 20 u u
b 1a 60
70 21.34 70 111 10 39 52 117 51 113 70 206
j 55 w 2439 14 !3 45 170 » IN S4 204
6
w .2713 u 111 2 1 77 140
SO
100 70.p t1 w 21 »
" s 110 8280
7 n 0 -
12 40 Ladl Wba 1023• 21' 21• 39' 66' 47 73 118' 111' I
,e
35
10-
a--
25
6- IN,
161 X\ 1
15 199
4 1° 9tl HEAD/CAPACITY CURVE
2 5 47 . 15, 139
° SEWAGE and DEWATERING
10 2G Jo_~ol sp_ E01_ 9o 10o 1110 170 130 140 50 160
a0 160 240 320 400 460 560 640 WARNING: Model 293 should not be subjected 10
0 FLOW PER INNUTE less than 15 feet TDH.
e
TOTAL DYNAMIC HEADXAPACITY PER MINUTE
SEWAGE AND DEWATERING
SERIES 262 206 267 260 282 m 282 203 201 296 108•
FT. M. Gal Lin Gal Ln Gal lore Gal Ln Gal In Gal Ln Gal Los Gal ltrs Gal Los Gal Los Gal LOB
5 1.62 90 341 120 484 128 484 128 181 130 492 180 681 140 530 196 742 ?25 852 400 1514
W 10 3.05 60 227 89 337 89 337 89 337 96 360 158 598 124 469 181 685 205 776 350 1325
15 -4,51 22.5 -_95. 50 189 SO 189 SO 189 63 238 135 611 106 401 130 492 165 626 185 700 300 1136
20 610 10 38 10 38 10 38 33 126 106 401 88 333 119 450 150 S68 168 636 250 946
22 25 7.62 76 288 68 257 106 401 136 515 153 560 200 751
70 30 9.14 43 163 47 178 90 340 121 468 140 530 150 $68
20 5 40 12.19 5 19 50 189 94 356 115 435
11150 1524 58 220 89 337
ss 60 1820 13 49 59 223
16- 70 2131 25 96
Y 14 .s LOckV&k 18' 21b' 21.5' 21.S' 26' 35' 42' 50 62 77 40'
12 40
0 35
j 10
0 70
29J _ - -
]5 0_
6 10
O
282
15
4 704
10
2 262 792
5 266. 67. 8 194 295
0
U.S. GALLONS 10 20 30 40 50 dd 70 80 90 10011 0 170 130 140 Iw 160 17018019 700 11 170 7J0 740 790 260 770 00 790 300 !10 3,20 3JO 34 350 36 370 360 390 400
41(
LITERS 0 00 160 740 320 400 4a0 960 NO 770 900 a90 1b 1040 1170 N 9]eg1~ /~//~`0 3 '3 ~'0~
iIOW PER 6YNlRE i/..NLF
.Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labtv and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
' COUNTY
St. Croix
Attach complete site plan on paper not less than 8 ~411 °in~h s ize. Plan must include, but
not limited to vertical and horizontal reference i , et tr3d of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and a z to nearest roach
APPLICANT INFORMATION-PLEAS NT As1FORMATN REVIEWED BY DATE
A t
OPERTY LOCATION
PROPERTY OWNER: a ft-9
Jerome Donatell k. -GPVT. LOT SE 1/4 SE 1/4,S6 T 29 N,R 19 >51%) W
PROPERTY OWNER':S MAILING ADDRESS OT # BLOCK # SUBD. NAME OR CSM #
383 Trout Brook Trail Ba....
CITY, STATE ZIP CODE ,PHONE NEl1n1BER ❑CITY ❑VILLAGE) TOWN NEAREST ROAD
Hudson, WI 54016 475) 386=3204' St. Joseph Trout Brook Trail
[ ] New Construction Use [ x ] Residential / Number of bedrooms 3 [ ] Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/ft2_trench, gpd/ft2
Absorption area required goo bed, ft2 750 trench, ft2 Maximum design loading rate ___5bed, gpd/ft2 -L trench, gpd/ft2
Recommended infiltration surface elevation(s) 89.2 It (as referred to site plan benchmark)
Additional design / site considerations install 5' x 75' rock bed on 88.2 as upslope edge w/ 1' sand fill
Parent material loess over till Flood plain elevation, if applicable NA ft
S = Suitable for system CONVENTIONAL MOUND 7IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem ❑S ®U US ❑U ❑S aU ❑S au ❑S Cx7U ❑S QU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trertdi
1 0-8 10YR 3/2 - sil 2 f sbk mvfr cs 1f/m .5 .6
2 8-22 10YR 4/3 - sil 2 m sbk mvfr cs 1m .5 .6
Ground 3 22-27 7.5YR 4/3 - sil 2 c abk mfr cs 1c .5 .6
elev. 4 27-39 7.5YR 4/4 f2d 7.5YR 6/2 sl 1 c abk mfi as - .4 .5
95.6 ft.
Depth to 5 39-59 5YR 4/4 - sl 0 m - - - 1.3 .4
limiting dense, poorly sorted till
factor
27"
L
Remarks:
Boring # 1 0-5 10YR 3/2 - sin 3 m cr mvfr cs 1f/m .5 .6
2 € 2 5-15 10YR 4/3 - sil 2 m sbk mvfr cs 1m .5 .6
3 15-26 10YR 4/4 - sil 3 m sbk mfi cs if .5 ::.6
Ground
elev. 4 26-48 5YR 4/4 c3d 2.5Y 7/4 sl 0 m - - - .3 .4
94.0 ft.
dense, poorly sorted till
Depth to
limiting
factor
26"
Remarks:
CST Name: Please Print Henry F. Grote Phone: 715-665-2681
Address: PO Box 57, Knapp, WI 54749-0057
Signature: vv:z'~' Date: 7/18/94 CST Number: 3065
PROPERTY OWNER Jerome Donatell SOIL DESCRIPTION REPORT Page Zof
_
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 Tre &
•''`'lM1t 1 0-6 10YR 2/2 - sil 2 m cr mvfr cs 2f/m .5 .6
3
2 6-21 7.5YR 4/3 - sl 1 m sbk dsh cs 1m .4 .5
Ground 3 21-50 5YR 4/4 - sl 0 m - - - .3 .4
elev. dense, poorly sorted till
98.3 ft.
Depth to
limiting
factor
21"
Remarks: above & outside system area
Boring #
1 0-6 7.5YR 3/2 - sil 2 m cr mvfr as 1f/m .5 .6
y`+..4. 2 6-19 10YR 4/3 - sil 2 f-m sbk mvfr cs 2f/m .5 .6
3 19-29 10YR 4/4 - sil 3 m sbk mfr cs 1m .5 .6
Ground
elev. 4 29-48 10YR 4/4 c2d 10YR 6/2 sl 2 c abk mfi as if .5 .6
91.0 ft.
5 48-54 5YR 4/4 - sl 0 m - - - .3 .4
Depth to
limiting dense, poorly sorted till
factor
29"
Remarks:
Boring #
1 0-5 7.5YR 3/2 - sil 2 m cr mvfr cs 1f/m .5 .6
2 5-11 10YR 3/2 - sl 2 f sbk mfr cs 1m .5 .6
5
3 11-22 10YR 3/4 - sl 2 m sbk mvfr cs 1m .5 .6
Ground
elev. 4 22-34 10YR 4/4 - sil 2 m sbk dsh cs 1m .5 .6
88.9 ft.
w/ common G si coats on peds
Depth to
limiting 5 34-49 10YR 4/4 f3d 10YR 6/2 sil 1 c sbk dh - 1f/c .2 .3
factor
3~n
Remarks:
Boring #
1 0-10 7.5YR 3/2 - sil 2 f sbk mvfr cs if
/m .5 .6
2 10-20 10YR 4/4 - sil 2 m sbk mvfr cs 1m .5 66
3 20-26 7.5YR 4/4 - sl 2 m sbk mfi cs 1m/c .5 .6
Ground
elev. 4 26-60 5YR 4/4 - sl 0 m - - - .3 4
86.3 ft.
dense, poor y sorted till w/ occasional weathered pockets 26-4
Depth to
limiting
factor
26"
Remarks:
SBD-8330(8.05/92)
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ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently
serving the J ercw~residence located at:
:54,--1/4, SC_ 1/4, Sec., T_c2LN, R_Zf W, Town of
Upon inspection, I certify that I have found the
tank and baffles to be in good condition, and it appears to be
functioning properly.
Last time serviced
Did flow back occur from absorption system? Yes No (if no, skip
next line)
Approximate volume or length of time: gallons minutes
Capacity: lUOG'
Construction: Prefab Concrete Steel Other
/Manufacurer ( if known)
,Age of Tank (if known):
(Signa ure) (Name) P ease Print
/t 'a 20z,_-~-
(Title)
Q (License Number)
(Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR-83, Wis. Adm. Code (except for
inspection opening over outlet baffle).
Name6 /~vtnw~ Signature av MP/M&S_
5/88
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ~J~'v m2 sin/~
~3 Tian Tir.~.0
MAILING ADDRESS
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE A / 'J ~/z
PROPERTY LOCATION JZf' 1/41 S2~ 1/4, Section T OF N-R_/y W
TOWN OF a ST. CROIX COUNTY, WI
SUBDIVISION LOT NUMBER I
CERTIFIED SURVEY MAP 336 VOLUME / I 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.
l/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 ust be completed an eturned to the St. Croix
County Zoning Officer within 30 days of the three ye xperation d e.
SIGNED:
' DATE. 11111"71
C
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 9 e,- 9 ),,1, /
Location of property_,~.C 1/4 .SE- 1/4, Section T~)_F N-R__LZW
Township 5'1 Mailing address
33-3
Address of site
Subdivision name sfil (JO Lot no.
Other homes on property? Yes X No
Previous owner of property go e~L
Total size of property
Total size of parcel
Date parcel was created , 9 - 7
Are all corners and lot lfnes 'identifiable? Yes No
Is this property being developed for (spec house) ? Yes ,10<- No
Volume .4,151"31, and Page Number ~56L as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the o fice 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.
Signature of Applicant Co-Applicant
/7 /Z~v
Date of S g ature Date of Signature
WARRANTY Rte
DOCUMENT NO. t _ $TATL Of WIScoNEQi41OIgUt s
r„ • ~OL 553 FA-M6 T= MAC U=V= M VATA
t .
339888 v
- REGSS::RS CHI CE
THIS INDENTURY, Made by Jan! a1 R.. Bauer and_ Jzrle* Me ST. CROIX CO., WIS.
Bauer,__husbana ana wife,- Recd. for Record tWs__9_th
A. D. 1977
day of M,
10110 --A M.
grantor A of _st_croix County Wisconsin, hereby conveys and warrants at a,
to jonatell_ emu Vicki E. Jonatell, ( i s
- - - - \
husband_ anat. wife,
- grantee a-- ANTNNN TO
of Coun Wisconsin, for the auto of i
U ZOO - e(0
.OQ)-- _
_---~even_ Tl.9uaard Fight _ Hunui ed_ 7, 800 '
the
following tract of land in - 3t•-_ Cr_ O Ix County, State of Wisconsin;
That certain parcel of land aescribed as Lot 1 on Certifies Surv-7
Map crated April 19, 19769 recorded in the St. Croix injVoluaetl,
j of Jeeds office on May 27, 1976 as jocument No.
Pa a 249 of Certified Survey Maps; said Lot 1 being located in the
SEj of the SE4 of Section 6, Township 29 Forth, Range 19 Went, St.
j Joseph Township, St. Croix County, Wisconsin, together
subject to a non-exclusive easement for roadway purposes over and
across the existing Z'_ the SE4 SEt, Section 6, T 29 N, R 19 airs from the TroutBro k Roa4 on Certifi the
East to the Town Road on the West, q
Survey Map.
I
77ANSFER
SIB
FEE
i
IN WITNESS WHEREOF, the.a:d nrantora`_. ha Te__.. here•lnW Set their_._ ",iand3 and Kcal 3 th:s et3th
-
day of AILr I_-- . A. D., 19 77-- ,
f. G <Lw..~^ (SEAL)
SIGNED AND SEALED IN PRESENCE OF
Daniel R. Eouer
I 2
2~~ ~ ~i(SEAL)
Janet M. Bauer
SE.%L)
I
LSEAL)
I
STATE OF WISCONSIN,
Pier-CQ.- ~1LYX~;?ci76YX -_--County.
28th day April A. D , 19 77.
' Personally came before me, this
F-auer ,nu J net M. Bauer, nusbana
- Daniel R.
the above named _
and wife,
to me known to be the person cho execute.l the forece nG .st um:nt a^d uknowlx?);0 Ohs same. John W. Davison
^Qiqq~~ART
Notary Public Pierce 'ounty, Wie.
This instrument drafted by
JO hn W Ja v i sore r' P ' iy Commission G+cQic+a~J 1.3) PermAnESIt
49
-alver.Fall a,
r (Section 94.51 (1) of the W Wnti~ tea provides that. all instrument, to be recorded shall has plaint, dated at typewritten cyareon the
tames of the grantors, Ar8 i.
a e. nuca co.. r..+uccr
'I WARRANTY DEED-STATE OF.IVISCONSIN, FORM \O. 9