Loading...
HomeMy WebLinkAbout030-2009-90-003 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER U 2E~ /v~~sD'y ADDRESS ffvD.so-v lyis', S S~U~~ SUBDIVISION / CSM# LOT # 3 SECTION-!~/ T 3o N-R/y W, Town of ST TO ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM see s~~v-r- ORIGINAL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. C'sT S 3/~ 1~ o-~ `vESi LoT Li-rr.2 BENCHMARK: ,gyZ ALTERNATE BM: SEPTIC TANK / R / ION ~f ? p Manufacturer: Liquid Capacity- X200 Setback from: Well N House Ar Other 0 Pump: Manufacturer t~ Model# Size - Float seperation / Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: S' Length Number of trenches Distance & Direction to nearest prop. line: ~9 z GvEST to T L Setback from: well: House 3Z ' Other v ELEVATIONS Building Sewer ~G D'Sv ST Inlet. ff 00 ST outlet y ' PC inlet / PC bottom Pump Off Header/Manifold Bottom of system S6~ ~o[OT Existing Grade Final grade fA/ .f,4ee5 .y DATE OF INSTALLATION: yDU' 30 ~ .C~~ - ~ f PLUMBER ON JOB: 1i?O1SzE;0P7` LICENSE NUMBER: lf~OleS ,330 7 INSPECTOR: '#!!V1 J ~~~'/~!!f 3/93:jt d ~ o 1'1 y o ~A A L4 c o IkIl N I I 1 ~ 11 1 1 ~ N 6_ 1 ~I I ~ I I I I I 1 N I I 1 " V1 ~ 1 1 1 1 1 y ~ 1\N y N'~ ~e " f N 06 N Nk. ~ p n~ ~ wC,y ~ ~ y I M A xb • ~ oy I LIM d UN NIN N \ 4 w • o ■ 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.: Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State PI o.: NELSON, GREG & PAT X CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax O. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV- Septic l ad Benchmark ^Z COD , 16 Dosi ng &0b_ /66, Aeration Bldg. Sewer 100>S- Holding St/Ht Inlet 6-),7 9q,VZ TANK SETBACK INFORMATION St/ Ht Outlet 6,67 9q, or Vent TANKTO P/L WELL BLDG. A irito ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header / Man. q, 7y 7' 4 G. 6 Aeration NA Dist. Pipe 8.g 96 •9 y b Holding Bot. System 4 >5 q .`ice PUMP/ SIPHON INFORMATION Final Grade lP-a v q¢`s" Manufacturer Demand (c G~ie,j 3,15 /2 3 .5 9 Model Number GPM TDH Lift friction System TDH Ft oss I Forcemain Length Dia. I Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/ STREAM LEACHING Manufacturer: SETBACK CHAMBER f r+~~ 4 Model Number: INFORMATION Type O System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Tr nchCenter Bed / Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code Oiscrepanciest,,persorls present, etc.) ft e LOCATION: ST. JOSEPH 34.30:19.386E,SW,SE,LOT BEA'R'RICE CIRCLE off;, - ,a 7 r, 7 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I f ; SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 3Aq& W 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 1 / PROPERTY LOCATION 6-ke6- , PAT Alle!soi✓ W s 3 T30, N, R E (or W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~ p~ 7 1/7 pso~ s ycs~ 30 ~o f/ cs-m 11. TYPE OF BUILDING: (Check one) El State Owned ❑ CITY / . NEAREST ROAD V GE ❑ Public Lit or 2 Fam. Dwelling-#~ of bedrooms PARCEL TAX NUMBER(S) III. BUILDING USE: (if building type is public, check all that apply) d3O - 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10'❑ Outdoor Recreational Facility 30 Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 1120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OFBERMIT: (Check only one in line A. Check line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 eepage Trench 22 El in-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure / 43 ❑ Vault Privy 14 ❑ System-In-Fill Z 'til 4E A-16415 4CIf 64- 7 "(_7 S VI. ABSORPTION SYSTEM INFORMATION: 6 0 lam' 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.) P-R7OPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) CELEVATION ?,5'O / S0 Feet !tom Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks struct1 Septic Tank or Holding Tank ZOO Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) .A*/MPRSW No.: Business Phone Number: A 4 2T/hAIC4 3307 f h- Plumber's Address (Stree C, State, Zip Code): I UNTY/DEPARTMENT USE ONLY A I ❑ Disapproved SanitiAry Permit Fee (Includes Groundwater Eale ss a Issuing A lgn a s) ,.Surcharge Fee) pproved ❑ Owner Given Initial I UV ~xJ Adverse Determination if Ou 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. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring grounclrivater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) SAC N w r~T ca(~uER az SCALe. ► 3o tocw o 0 06 seWE~2 /pd, p • on, o sir Q y 4 \ cSr~y 3ly~ New ►zbo.. IO ~ Z./9 o,v GoT" sysr. 9G.p ? $ S~QTrc TqN k 9~IEvATiaa Sysr. 01\1 • a1 S8 e (E vhrro~s - g6 /00.70 f3 , (3 1`1~• 3 0 r m , SUC,C~~-ST'~O D o 5 y st~~ EIEV~r~a.os ~ cps ° o how ~-~~v~ 9yo " 15 y~ Pl 30-f 3~ + r I ~{/•Gfi~ 7-P,6,v C//- Fresh Air Inlets And Observation Pipe 4 Approved Vent Cop Minimum 12' Above Final Grade 3(0 "Above Pipe 4' Coil Iron 1o Final Grade- Vent flpe' Synthetic Covering Min. 2' Aggregate Over Pipe Otstributioe -Toe pipe 0 0 0 0 0 , Aggregate o Pertbroted PI a aglow 8eneoth Pipe p St✓$TE.~1 2-•~•- o •-Coupling Terminotinq At Bottom 01 System `ll~ • O Fresh Air Inlets And Observation Pipe Q+-- Approved Vent Cop Minimum 12' Above Final Grade 3(0 'Above Pipe _ 4' Cast Iron 'to Final Grade Vent Pipti Synthetic Covering Min. 2' Aggreqale over Pipe Distribution Tee Pipe 0 0 0 0 0 Aggregate 0 Perforated Pipe Below Beneath Plpe o - Coolnq Terminetlnq At 5''/ 57-E~ eY~- bottom Of System L o Tie ,v C f+ r Clr S~/ ` ~GL~I~V.y TO SD%/ ,,PE;op,/PT o~ y`/ Wisconsin Department Industry, Labor-and Human Relations SOIL AND SITE EVALUATION REPORT Page of 3 • Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Pv ppos~ : ~Iv~i v(r sysr~--ti !Aelf . COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST C/f'O/ x not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. flAt' ,V-, APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION x.9-2, REVIEWED BY DATE /3Eif- p"r'g' PROPERTY OWNER: PROPERTY LOCATION C'RE6 /t/E/SD,v GOVT. LOT $LU 1/4 S+6- 1/4,S 3,/T 30 N,R I E (or) W PROPERTY OWNER':S MAILING ADDRESS S~~'TE LOT # BLOCK # SUBD. NAME OR CSM # 9,370 vGSo.~ %a 3 S.y 39031 voi.S' 1yt5 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [AWN NEAREST ROAD Y50 21-2- (7/3) 3 ~lv 70JW S% • J OS~cp /f-- r,6- [9-]New Construction Use [ kf"Residenbal / Number of bedrooms Addition to existing building [ ) Replacement [ I Public or commercial describe Code derived daily flow (oob gpd Recommended design loading rate 7 bed, gpd/ft2 • trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate ' bed, gpd$ • S trench, gpd/ft2 Recommended infiltration surface elevation(s) See• P q . 3 ft (as referred to site plan benchmark) Additional design / site considerations g C o v S/o Gv p~pp i3o t piST~ii~v /'io-.J Parent material 5,Cyi - pv M 1 v, i " Flood plain elevation, if applicable Nff- ft T=Uunisuitabloerfor table system CONW~ U L MoLJ D IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK s stem 1''$$ ❑U LAS- 11 U 9-s~ 11 U US- 11 U ❑ S ~ SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell .,4 Qu. Sz. Cont Color Gr. Sz. Sh. d Be Trendt I /D yfP / /oqy 2 M+ 5/~ie S s,,., S 2- /o :,y~y3 Ground 3 75-YX 3151 z f S ijW vide ~S • 5 elev. 9v / 10o•*76 ft. G- y -7. y Depth to limiting factor 7 Remarks: Boring # YtIe V 4.: v. le*q 2- 441 54k w-l,'e i0 - 3 /oY/P X13 2 Ground G ~ zy %a y2 7/3 5i/. z G ~f,~ ~r ~iP C S / f S • G elev. - 3 7 S yX 31~s /,na iP d~ C S " y~ . (,,Oft. Depth to y~ -SAY S. S GQ~ . 7 limiting factor 7 yZ L Remarks: CST Name:-Please Print (Q0 QIFP-T - uLB R I• C-k7- Phone: 71f 3J0G _ F/eS Address: (0 5S r'te' ',v 1Z t'L p . V>7S o~ ~t • 5 4 o f Co )-I - f • e 57",Y 2~f Signature: Date: CST Number: ORIGINAL \ PROPERTY OWNER !s. I'eSOIL DESCRIPTION REPORT Page 2of 3 PARCEL I.D. # T 3 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench ~x /o /gyp y 3 s,/ ~ ~ sh,~ ~s ~ ~ • Y . s Ground ~o 36 7 S Yk Sly elev. ff yl, S~/ L' S. Cd S 3o ft. lD ~ ~ • ~ Depth to limiting factor y Remarks: Boring # MIMI, Ground elev. ft. Depth to limiting factor Remarks: Boring # \\4Y MM. Ground elev. ft. Depth to limiting factor Remarks: Boring # Mw i Ground elev. ft Depth to limiting factor I Remarks: eon GeIjwo nctn'" I i ¢ 1 ~II I I I Nw /-or caR~ER a SCALe : I"-3c)/ SoiL ~ TgsT ~ _ EM Ei" o O sEr Q y 4 ~ c ~ ray - 3~y y - io Z•~ °N LaT V5 r 9G•p ~ 8 GievATioa - - sysr. 9y av . d? g6 /oo•7p 13 7 ~tn • D C3 g y`9. 30' z 5v~~~-s T'~ p o 0 S 57'~M EIEU~T~p~S , ' y yi•6,1, Tit'£vGGI, • p Cos 0 0 . 3,T 3 ('3 T ED 3031 1 1984 , c eo~ G~Ix°f D••d~ h, ( OUTH 1/4 CORNER UNPLATTED LANDS - ] SECTION 34, T30N, R 19 W, _ COUNTY MONUMENT N2 00 04:3 I T WEST LINE SEI/4 A So 6" ` . N 000-22'-20" E 4W 585.25' SS•39,pp„ r .l a cn z -3,3- '0 rn - 6'~ 3 Q) m \ N Sp.Op Op "E m N 2S oe~~ 0 \ w/ -4 Ly , z w 0 33, 2~, (n 66. 001, 1 0)0 At is Q00 2So a~ 1 -00, - \ \q~cc` ~ W Cn r O 2~. o O C1 - 00 O ;U D N a \ p D OD 1 ((3171 -I O N Z C n Z ~ w o w W ~ vm O ~ 0 zrnO 2 y , ~4 ~p O I-' lJ - rn ~ 2 (p 0) O O Z O co 14 D O m rn O p OD N D A D 00 I do x Q z ` J x D ti _ p W 1a n 1 Z_ N ' c ED w o o m p so r°v o o°- c -1 z a 1 o M W N m o x 'n ci w O "I X (n _ x'v 0 1 0 N rn o -1 Z f x o -i N rn rn ~ O Lys M M ° -a X Z M0 °O2 S ~ //~~F = 0 z - o 7 -4 OZ (3' w p c- ft) n A N M A~ "10 ~cr.ovs o ao 0 C7 Z 00044snur O Z © 0 0 N M cC C, C 2 ~N ~ rn (n Ci~\ ~ I N -0 D 4~ ^ y O LO "O OD N 1- OD = CD (n 0- pa M -10 • 111 y 0 o O Z ao N- O rn w n RI to > z (J) 9D 0 (Z) -4 M ~a M co v or. I I~ \ S ~S' to (n w c . w- N g M o cV OD n O -4 L" x 07 cn w o A N Z~ 0 -71 4g 0 0 C z to M ^7 p m w I c O D D (n /4 O V COD - 0 v' I o m w N W N - w p 90 43, O n rn W IV l Us Ln CD CD CD CD h) ;0 c m O O O O O N (Nn N (a 0) ZZFn D M W 1 m O A 0 0 0 0 4 ~4 9) p A G5 C _ ~ A \ \ 1 A 0 Q 'v (n Z < - - A W \ ;a iD n W T 1'1 I z Q j1 N 0 (D W - N N N (a (a m r \ \ D 0 71 CO Ui 4 011 -t, 0) (n 0 0 N N N PD 0 0 W Z 0 n \ b ~ Z W(~ pp ~(pp 1 a1 al p U~ O kri rn N O - O (a -1 O C siS 10 Iz (n N (n N (n (n Lt) (n (n In cn W (n 0 < (n (A A N N (n w (n m 'v c° o a Wo 0 o O O° O O °0 \ \ \ %t~, ' z T~t .0 so ti -4 p a0o DAD N ((A N 0 W w m I~ V I I- I- (A Lj La A (n O N A N O 8 O O_ O O 00 • o Cv ID L, c- I I D r m c 00 0 x G) N o m N 4 -I -4 o 0 o m -1 ~ rn Z r N m -4 W 2 ca c o O f ~S o O o 0 1o r\) N N -4 D O p v m o JAN 1 61984 so so so W W O w N p p v :0 - w L CD 0 ' o `n 4 o C o_ o oo_ ~ r = o ? ~ Z ST. CROIX COu - 41 r _ " N Z n T M COMPREHENSIVE PARKS FLA, . wfs p O M AND ZONING COMMITTEE BEARING ARE ASSUMED AS O 0 N S W y t0 OD r c m N 000-22'- 20 E ALONG THE WEST O N P N -4 O o A m r~ LINE OF THE SE I/4, SEC. 34 (a N W p O 0 (n LR A N 0 m N -I Z O Volume 5 Page 1415 m STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER 1( ADDRESS ~3 CS.rYI. ~e4 ric( (;re le N-52- /`3e+~ :ct FIRE NUMBER Ce,4 2- CITY/STATE 65- Z~ cS76 PROPERTY LOCATION:S W 1/4 ,S F-1/4 , SECTION-3-q_; T = N-R l_q.„_W TOWN OF_~'~' St. Croix County, SUBDIVISION 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 a 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 C Zoning 0 ficer within 30 days of the three year expiration dat SIGNED: DATE : _ St. Croix co. Zoning Office rr 911 4th St. ( urr(n f aU~t~~sS Hudson, WI 54016 j'.7 /v~tp f~~~5dr► c STC-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 ,n delays of the permit issuance. Should this development be intended for resale by owner/contractor,(spec house), thenta 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 /y- 1 Qr Location of property~1/4 .5.0.1/4, Section , T_3_~)_N-R,_~`W Township D C /1 f Mailing address ri e-e- Cie_ Address of site (o' -z sotoice (r/'~~t Subdivision name-f. ss 3 Lot no. Other homes on property? yes----,K No Previous owner of property ldf-rev A. + D &b, e L. QJS e l l Total size of parcel _ 3 ~ZZ Acres Date parcel -was created _ l 7297 Are all corners and lot lines identifiable? _X-Yes _No Is this property being developed for (spec house)? Yes _.KNo . Volume and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid. delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map. shall also be required. PROPERTY OWNER. CERTIFICATION.. I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the 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, off ice* :of County Register of deeds as Document No. Signatur' o applicant.. Co-applicant Date of, Signature Date of Signature DOCUMENT NO. WARRANTY DEED TR'5 SPA'E RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORK 2-1982 51545 voi ~063~ $4 _.-;;SILK'S OFFICE ST. CROIX CO. WI ` ,.Jeffrey A,.Russell and Debbi,e.L,.Russell, Recd for P.ecoft~ FEB 1 1994 V8-30 A. M conveys and warrants to Greg..S . Nelson a)ld Patricia. J.. _ Nelson, husband. and wife. . LdDNdtt . . J RETURN TO Greg & Patricia Nelson 1505 S Ward Ave #8 the following described real estate in St. Croix County, Hudson WI 541716 State of Wisconsin : Tax Parcel No fay!- i R~^ I Part of the SASE:4, Sec. 34-T30N-R19W, described as follows: Lot J of Certified Survey Map recorded in Vol. 5 of Certified Survey Maps, page 1415, as Doc. No. 393031. Together with and subject to highway right of way and right to ingress and egress by the private road as contained on said Certified Survey Map. I Z-) ~iti'• <ti This _..-ig.-npt---- homestead property. (is not) Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this - - day of Ja--.- '19 94. ( SEAL) _ - ...(SEAL) ~ _ - R Je re ssel - - (SEAL) V1[/ ~~~-✓V (f~ (SEAL) Debbie L. Russell - .r AUTHENTICATION ACKNOWLEDGMENT Signaltuij~jtsJ:-,iIJ `f frey _A.__Russell_,____•________________ STATE OF WISCONSIN Z' "r '+r;+~- ~•5 Ruseh g e1lYhentic$flEd s ?day of.., . 19..9! Personally came before me this --........._-...day of County. • " 1 19 the above named e, - - - tlQ+lsti<na, and s - ' L}Nb1r R.$TA~'E BAR OF WISCONSIN [I1~.ua4"t - authorized by § 706.06, Wis. State.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY yXt' >1, Kristina Ogland - Attorney at LaW Notary Public .County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: 19._..._.) i' . *Names of persons signing in any capacity should be typed or printed below thair signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. .J FORM No. 2 - 1982 Milwaukee. Wisconsin ST. CROIX COUNTY WISCONSIN ZONING OFFICE 0 0 M U II N q ■ r~..6 ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 ' - (715) 386-4680 IAugust 28, 1995 Mr. Greg Nelson 652 Beatrice Circle Hudson, WI 54016 RE: Septic Inspection for Greg & Pat Nelson for Property Located at: 652 Beatrice Circle, Hudson WI Dear Mr. Nelson: An inspection of the septic system for the above referenced address was conducted on December 1, 1994. This property is located in the SW 1/4 of the SE 1/4 of Section 34, T30N-R19W, Lot 3, Town of St. Joseph, St. Croix County, Wisconsin. At the time of the inspection, this system was found to be code compliant for a four (4) bedroom home. If you have any questions with regard to the above, please do not hesitate in contacting our office. Sincerely, Mary J. enkins Assistant Zoning Administrator db t.i t~;=tn6spartmentofIndustry, SOIL AND SITE EVALUATION REPORT Page / of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05. Wis. Adm. Code COUNTY S-/ - All X Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCEL I.D. # _ not limited to vertical and horizontal reference point (BM), direction and % of slope, scald Qr 03v~~~ y ~jG ~U3 Cj ( I~ < / dimensioned, north arrow, and location and distance to nearest road. l V WE~' k ,,,,,DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION RE PROPERTY OW I I PROPERTY TION LG~ SSC 1 .1 GOVT. LOT 1/4 _S [-y 1/4,S3-f T _3C) N,R J q )for) W PROPERTY 0 R':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # SKIS X1.9 ~ r r 3 ! ~ c' Z t, VILLAGE ®fOWN E J CI , STATE yyk ZIP CODE PHONE U BER ❑CITY ❑ o - L Sso~-z~ h ~~ra~n~e = ~i e~- J:,4 New Construction Use Residential / Number of bedrooms ~3 [ ] Addition to existing building [ j Replacement [ ] Public or commercial describe Code derived daily flow 4So gpd Recommended design loading rate __.LZbed, gpd/ft2_trench, gpd/ft2 Absorption area required 6 ~3 bed, It" ~5(o3 trench, ft% Maximum design loading rate __L:7 bed., 91~/ft2-_trench, gpd/ft2 Recommended infiltration surface elevation(s) q / ft (as referred to site plan benchmark) Additional design / site considerations Parent material ®'A",j-A c h Flood plain elevation, if applicable i L-A ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM I FILL HOLDINc ~TANK U = Unsuitable for s stem i;YS C1 US ❑ U '0 S ❑ U 4S ❑ U ❑ S E3 S .f21 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed TwI h a 5 `w z s 6 M4_ r, C'o ROL S, J rn s 8~ /Y6 ~o Ground J-3-c3 /d a- 0-4 C_ Depth to o & 4/ S -9 A 1 limiting factor -7 (90 Remarks: D I Boring # y/~ z SQ/'f yYd W ~Y✓I Ground elev f2 L S / a Depth to limiting factor Remarks: ` CST Name:-Please Print Phone: Address: ZLCJ a 47. .r Rai t-11 Signature: Date: CST'Nixnber: -s s osim ZZ 9R PROPERTYOWNER„!644 7Wus_ci: LL SOIL DESCRIPTION REPORT Pale •9L aft PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture I Structure Consistence Bourxiery Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITw& o- o z Z /s akyq - i. REMO Z Z JO rz At-/y Iva c z. _ S Ground Z D /~f a)dzir s, I49 (~2 c,) t571 jr, i t. Q Depth to limiting 7 act Z.' Remarks: Boring - Ground elev. Z ,g ! 8 iz-w S E,3 ft. J21 Z eZ4k= 171W Y7 !:,A Depth to limiting factor Remarks: Boring # ROM 1 C Z rY1 S~ 1 5 Ground b S S elev. Depth to limiting Remarks: Boring # 41}C <tii~ Ground elev. ft. . Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE C Gary L. Steel e C.S.T. 2298 New Richmond, WI 54017 MPRSW-3254 W Y+ ~E Y,~ .53'~ - ~`30i(J - /2 J (715) 246-6200 ~ ~o ~ h ~ s ~o s cp h 4 s+4 V4, . 1~~E Cu\-!7~•-SAS y-~-Z So lie- 10 30' z,~5' ~za1o t~r'~ - - t ` (3 I z 0,x.•0 E ~ 0111 t 60, 3s~ 0 S °10 1p0~ cG