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HomeMy WebLinkAbout032-1048-70-075 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS SUBDIVISION / CSM#_6p~ LOT # SECTION___L_~7 T_,_J/N-R~W, Town of ~r*i„~ asr T ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM SGGJA'~ h I sy INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. r BENCHMARK: ALTERNATE BM• SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: Setback from: Well_a~/._ House Other - Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: 42' Length Number of trenches i Distance & Direction to nearest prop. line: z i Setback from: well: House Other ELEVATIONS Building Sewer 9,22 ST Inlet. ST outlet 4PC 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 LI rt 10ty.17.31.19*,RIQATEUWAGt-SAfSTIWth Aven unty: -sLaborand Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) sanitar unit Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI X isle Insp. BM Elev.: BM Descriptio Parcel Tax No.: 117 b /D D. , d 5~ TANK INFORMATION ELEVATION DATA A9400113 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /t d> ` ) Benchmark r` 400 Dosing Aeration Bldg. Sewer [Holding St/ Ht Inlet 7. I S 9a 3~ TANK SETBACK INFORMATION St/ Ht Outlet y qa pq Vent TANK TO P / L WELL BLDG. AirIto ntake ROAD Dt Inlet Air Septic 20 1 7,)0 ' NA Dt Bottom Dosing NA Header/Man. go Aeration NA Dist. Pipe / ~,(a5 d,85 Holding Bot. System q` 0 PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand 0( Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. H Dist. To Well I SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 01 5- L/ I DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Moe Number: System: ~/0 yak N /4 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 4 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.) 8 a - a 17 LOCATION: Somerset.19.31.19W, SE, NE, Lot 8, 21~th Avenue f\ Plan revision required? ❑es ❑ No / Use other side for additional information. » ( ,C FT6 I a I SBD-6710 (R 05/91) Date lnspe is Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH r c SANITARY PERMIT NUMBER: a FZTDlt~IH9R SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY MEMO ::~z STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 0~o 0 )010 8% x 11 inches in size. [I Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER L APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION '/a, S T , N, R (Or 19110 Z1.1W PROPERTY OWNER'S MAILi ADDRESS LOT # BLOCK # yf/ CITY TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 11. TYPE OF BUILDING: (Check one) CITY - NEAREST ROAD ❑ St8te Owned O VILLAGE ❑ Public 0 1 or 2 Fam. Dwelling of bedrooms ~ AR AX NU ER( ) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 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. 14 New 2. ❑ Replacement 3.E] Replacement of 411 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existin System B) ® A Sanitary Permit was previously issued. Permit # 1222u- 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. ATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./' ch) ELEVATION V- A; 1 6/w~? 17 1,14 Feet Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed 7- 1 F-1 El F1 Se tic Tank or Holdin Tank L Lift Pump Tank/Si hon Chamber I El El El 1:1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installati of the onsite sewage system shown on the attached plans. Plumb 's Name (Pr t):, Plumber' Si a re: S ps MP/MPRSW No.: Business Phone Number: lum s Address (Street, City, State, Zip Code . IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sani ry Permit Fee (Includes Groundwater Date Issued Issuing Agent Signatu (No Stamps) Approved ❑ Owner Given Initial / Surcharge Fee) Adverse Determination d X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safetys Buildings Division, Owner, Plumber INSTRUCTIONS t 1. "`',tirmit is.valid for two (2) years. 2 pe>,,iit may be renewed before the expiration date, and at the time of renewal any new criteria it the Wisconsin Administrative Code will be applicable. 3. All , ev siw!s to this permit must be approved by the perrrcit issuing authority. 4. Change in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form ;SR?: 6199) to be suurrOte(; to the ~,ounty prior to installation. 5. Or se,w~oe:systems must be pvope,:y maintained. T F__ ~:iptic tank's) ri A be r _-ni )ed ir; e 'k c-. used pumper r tenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact you, local code fly ,T inistrator 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. Provice the legal description w id parcel tax n,,,rnber(s) of where the system is to be installed. Il. Type; Of building tieing served. Check only one and complete # of bedrooms if 1 or 2 Fancily i:lweliing. 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, econnection, or repair. V. Type of system. Check appropriate box depending en system type. VI. Absorpti,,.- system information. Provide all information requested in #1-7. VII. Tank i;,forn• ation. Fill in the capacity of every new and/or existing tank, list the total number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Compete 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 83% 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, ,veils; water mains/;eater service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systerns, re,-~i,,,, en# system areas; and the location of the building served; B) horizontal and vertical elevation reference Doints; C) complete specifications for pumps and controls; close volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorp?ion system if required by the-county; E) soil test data on a 115 form; and F) all sizing information. - - - - - - - - - - - - - - - - - GROUNDWATEt1-SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharces (fees) for a> num:)er of regulated practices which earl effect groundwater The monies collected through these si.~rcharges are used for monitorir g .;r ,idw ater c!,C n water contamination investigations and establishrricra of-standard. SBD-6398 (R.11/88) Wisco-isin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labo end Human Relations Divis. Hof Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code 4~Ir COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPS TY OWNER: PROPERTY LOCATION GOVT. LOT - 114 1/4,S/ 7 T ,N,R S (o(w PROPERTY OWNERS MAIL G DDRESS LOT BLOCK # SUBD. NAME OR CSM # CITY, STATE ) ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST Rey New Construction Use [jq Residential / Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe ~~bed, gpd/ft2& _ Code derived daily flow -s~4n gpd Recommended design loading rate trench, gpd/ft2 Absorption area required 4~ bed, ft2 . L trench, ft2 Maximum design loading rate ,gybed, gpd/ft2 R trench, gpd/ft2 Recommended infiltration surface elevation(s) yam, n ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem CAS ❑U PS ❑U f0S ❑U ®S ❑U ❑S ®U ❑S ou SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Copt. Color Gr. Sz. Sh. Bed Trench L... / J le ko, - .41Z Ground ele . Z ft. -~/v q? .1/ Z Depth to limiting factor Remarks: Boring # r Z Z Ground elev. Depth to limiting factor Remarks: CST Name:-Please Print Phone: Address: 1 . Signature: / ate: - - CST Number: PROPERTY OWNER - ^ SOIL DESCRIPTION REPORT Page~of PARCEL I.D. # i' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. nt Color Gr. Sz. Sh. Bed Trench M k E:; s Z4 AJ Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) l f 6E ~ or : ~eKJ :c,rr Li1~;JzzxJ'S'~c.~J,E.c'- ~C/OG~D Ikew r ~D /G~ PM, C 0 r C(`~S Af1of, Fft/A Ak Mitts A111 9b64tt4pM PIPt Yw.w 4 „it V060 Cy to, A40ve P 4' Coal it" v"I Pile ~J3 ; r of washo 16 Covefiftj • o../ pipe W. ol.au.ll~ . i4t Tee e ~eMel~ IIV* • • pwlw•1.• Vi p$ Ne• w • ~Cw11•t Twwl••Ib! AI 601194a of itele~l r • Pry pus to p 9 rA cat . _ Solt, rlt.t. - 4;4 . ®OaTRIBUT101.1 PIPE APPPL011Qp 5'(ur{cTlc tout 2" W hGORCGA1. --""~-r1ATZR1A,~ OR 9' of sTa~M h Olt MAft>,~. ►'Ay EL.EY, of .01,= AGGRC6^TC FEET ii OISTRIpUT10/J PIPS ~TV pC AT Ct►iT 4 AUtf AT l•CAiT;® IWCHC3 ISCLOW 0FtiVIuAl, •.a~oe . 10.9CNCL OUT MO MOF C THAW 4% IAICHCS OCI.OW ►INAI. C1tgOC !'Wcv`wM "PT110F EXCAVATIOP FhoM oK16W,%L 6, WIL, lucNes ruN,MUM ©EPnI of EXCav~trIoW 1 ~!1 ~ L. BE R OA ZllJgl, CeR,49L w1%.L 6C ~ INCHC S LIGCIJSC UUMBCIi: _ S ..;OqT C tic • 1G ~1 -nill ~~.JC'~/'/~~s~• .s./~o tilialr~nJ-JIJ co~.vez a~ ,f~as~;Y,~.J,7- .~/QJ, O i~ " ~ O~C'iv S /e 4,' ~~tw~~ t/~uSe It ~ 13iz, s a dCe t 40' 3 z I 01 LGZ4s' n~~partr 4w 31- i9-PRIi7~AtE dNR►G SST a Lake o y: R-A Labor and Human Relations INSPECTION REPORT Safety and Buildings Division P-OXX GENERAL INFORMATION (ATTACH TO PERMIT) sanitary ermit o.: Permit Holder's Name: ❑ City ❑ Village IR Town of: State PIA PD It? ST BM lev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9400030 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet Vent TANK TO P/ L WELL BLDG. A irIto ntake ROAD Dt Inlet Air Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction Syesatem TDH Ft Forcemain Length Dia. Hi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Model Number: 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 /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Somerset.18.31.19W, SE, NE, Lot 8, Rice Lake Road Plan revision required? ❑ Yes ❑ No Use other side for additional information. / SBD-6710 (R 05/91) Date Inspector's Signature Cert No. ~ R SANITARY PERMIT APPLICATION Y In accord with ILHR 83.05, Wis. Adm. Code COUNTY . :E:I1 ' -Attach complete plans (to the. county copy only) for the system, on paper not less than STATE jjqTfqMIT# 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 /",fy _Se PROPERTY LOCATION '/a Y4, S 17 T , N, R i (Or PROPERTY OWNER'S MAILING AD LOT # BLOCK # Cl A// kJ11 ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLLLAGE : NEAR T ROA Cc 40WW OF: 4- Z , O ❑ Public I~7t I~SJ 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUM E 444N Ill. BUILDING USE: (If building type is public, check all that apply) ry r, L 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 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 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit _ Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 300 Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min inch) ELEVATION Feet Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic A structed pp' Septic Tank or Holding Tank Tanks Tanks - &0,~ - / - -1 F] I Fj F1 Fr. Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installatio of the onsite sewage system shown on the attached plans. Plumber' Nam (Print): Plumber' Sig e: p MP/MPRSW No.: Business Phone Number: i lumbe 's Address (Street, City, State, Zi Code): IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved San ry Permit Fee (Includes Groundwater Date Issued Issuing Age Si 12 tamp W Approved El owner Given Initial surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS r 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 renews_,I any new criteria in the Wisconsin Administrative Code will he applicable. 3. All revisions to t'o'ss permit must be approved by the permit ::suing authority. 4. Changes in ownership or plumber requires a Sanil:ary per rwt Transfer% ^r Wai Form (SRI. 6399; to be submitted to !h, county prior to installation. 5 onsite s ; $ systems must be-propei:,y +v~aintaifiec. Thy, tank."_'. tie, . oensed pumper, wh ^ever necessary, usually every 2 to 3 years, 6. If you have questions concerning your onsite sewe.ge sysiF ra!, co,itact your local cod,: adr,n+ :rs<<etor or the- State of Wisconsin, Safety & Buildings Division, 603-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal descript on ar:d parcc,l tax nr:-nber(s) of where the system is to be installed. II. Type of t~vuilding being served. Check only one and complete of bedro:)rns i" 1 or 2 amity 'welling. III. Building use, It 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, r:connection, 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, 'ist the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Comp ete 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 appropria-l:e 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 rna nsAvater 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; fricti,:-n 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.si3rcharges are useJ for monitoriF!g gru-snwater, water contamination investicgationsafzKi establishment ol-standards. - SBD-6398 (R.11/88) 5028'2 CERTIRED S LEY Located in part of the Southeast one-quarter of the Northeast one- quarter of Section 17, Township 31 North, Range 19 West, Town of Somerset St. Croix.County,. Wisconsin... OWNER: River Hill Family -Trust LEGEND Gary Gifford, Trustee. FOUND ST. CROIX CO. MONUMENT 452 280th St. • FOUND I" IRON PIPE Osceola, Wi-'. 54020 0 S68 I" x 2 l" IRO RPIPE WEIGHING 1. LBS./INEA UNPLATTED LANDS_ SCALE 1" 200 NORTH LINE OF THE SEV4 OF THE NE 1/4 200 ZOO 0 200 ` N87° 34'02"•E 694.60' 294.93 399.67 D •i m ~v O F rr,sCO ti = m p ~ of o r D x e ~ t cn D ZAH ER J yN7 or A DOS 7 HUDSON m mm , z m 193,860 SO. FT. G36 SO. FT, WicJ. Q` z -Im 4.450 ACRES t53 ACRES =A -Yo Nm o SURN m m a 1 'n a o m I' E , Z BUILDING • 0. 5 a ,N Ir^ ,C ; N SETBACK----_..a,_, O N 6 .'1'JS• • (D07 _ ' it s ° 32'w 7 e.' 'Q '9°,'02;.; • r*i \ ;rn ,•"0~uT• EXISTINO 66' ROAD EASEMENT -70 BE_ I N OEOI16R7ED TO PUBLIC ,.p I DETAIL 0 i N _II c+ I i j I ID = m v Iz 1 5 0 ,cn 6 co 1 ~N87.49.39"E ( C!) 3 i' 0.42 I 1 234,729 SO. FT, (%j 225,063 SO.-FT. W 5.389 ACRES ~ 5.167 ACRES M NE CORNER N a - - - - - - SECTION 17 tp O to CD N 1 H A U V' w . I' v I~ "Co N 1 u' I EI/4 CORNERS v SECTION 17 m T31N, R19W N 284.62' 409,99' S 870.49'39" W 645.43' S87049 ° 39'W 694.61,'. SOUTH LINE OF THE NE 1/4 zz n N y p r 41 w z UNPI ATTED_ 1=ANDS_ >E O This instrument was drafted by Douglas J. Zahler _ H m SE CORNER e,,L,D o' -:-w STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER i4•Pv.,v x Tty~~ras.41J1.EveS/ MAILING ADDRESS _ /6 A/ ~ zir. i"Qve_ W" *rxik- 1591 PROPERTY ADDRESS _2s_~2 (location of septic system) Please obtain from the Planning Dept. CITY/STATE ~0 P,e sC., PROPERTY LOCATION .Te' 1/4, Nf 1/4, Section l7 T_ _N-R~W % TOWN OF _Som e4xer' ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER S CERTIFIEDSURVEY MAP ~,O;V7X , VOLUME_2, PAGE.265/ , LOT NUMBER 0? 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 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 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 Location of propertyS 1/4 /L'1/41 Section, l7 , T! N-R_Zj _W .Township - S~m~PP er- Mailing address _h_oO.Pr l --oo . Address of site Subdivision name tvC,e C~ftirs Lot no.~ Other homes on property? _yeS_ X No Previous owner of property Total size of parcel / /33 f/c,~~s /8d 436 W-T Date parcel was created 3 Are all corners and lot lines identifiable? _Yes No la thia property being developed for (spec house)? )e Yes No Volume `I and Page Number as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRMITY DEED which includes a DOCUMENT NUIWER, VOLUME AND PAGE. NUMBER & THE SEAL OF THE ItEGISTrlt 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 ny (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. Wy and that I (we) own the proposed site for the sewage disposal system orreI ewe) 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 County Register of deeds as Document No. 92 Si nature of ap 1 nt Co-applicant 1 PA 1 g Date f signature Date of gnature 1O55PAcE 346 ' volt DOCUMENT NO. STATE BAR OF WISCONSIN FORM 11-1988 TNia .1.1:1 q[5[RV [D OR RECORDING DATA LAND CONTRACT Individual and Corporate (TO BE USEC FOR ALL TRANSACTIONS WHERE OVER $26,000 I3 FINANCED AND OTHER NON CONSU3IER ACT TRANSACTIONS) REGISTER'S OFFICE (v ST. CROIX Co., W1 1tracR.l . an betwle,m River Hill Family Trust, Reed 1br R$aord C a/k/a aver i s at 1, y gus t ' DEC 1 6 1993 - ("Vendor", 8:30... A. whether one or more) and..... Marxi)7M,--Eien- and Theresa M. at M Eienry,_.husbansi._ansl.lai fe----------------- - - ('.Purchaser", whether one or more). ~r0f DNS Vendor sells and agrees to convey to Purchaser, upon the prompt and full per- formance of this contract by Purchaser, the following property, together with the rents, profits, fixtures snd other appurtenant interests (all called the "Property"), in Sty--Croix.................................. County, State of Wisconsin: RETURN TO River Hill FamilyTrus /o Gary Gifford, 452-280th S sceola, WI 54020 Tax Parcel No Part of SEl/4 of NE1/4 of Section 17-31-19, described as follows: Lot 8 of Certified Survey Map filed July 27, 1993, in Vol "9", page 2651. rRAMFEb This iS..l1Qt......... homestead property. = (is not; Purchaser agrees to purchase the. Property and to pay to Vendor at ~I SCE Vendor directs the sum of $_-22,54~).i?0 - • in the following manner s li at the execution of this Contract; and (b) the balance of together with interest from date hereof on the balance outstanding from time to time at the rate of 7t5...................... per cent per annum until paid in full, as follows: Commencing January 14, 1994, and on the 14th day of each and every month thereafter, equal monthly installments of principal and interest in the amount of $130.00. Provided, however, the entire outstanding balance shall be paid in full on or before the 14th day of DPr,L------------------- 19.--96_ the maturity date). Following any default- in payment, interest shall accrue at the rate of - 9-....•. % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligatiou3 when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any time tXXXXXXXXXXXXXXXXXXXXX#~c In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is leas than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in t} event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded heru.rom. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall i be retained by Vendor until the full purchase price is paid. Purchaser shall beentitled to take possession of the Property on-------- day..Q -siQ-s ng Kowa .Crow Out One LAND CONTRACT-Individual and STATE BAR OF *ISCONSl* Wisconsin Legal Blank Co. Corporate FORM No. It - 1987. . Inc. Milwaukee, Wis. vet Purchaser promisee to pay when due all 105 )PAGE347 taxes and assessments levied on the Property or upon Vendor's int_.est in it and to deliver to Vendor on demand receipts showing ^uch payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by Are, ex- tended coverage perils nd such oth hazards as Vendor may by Vendor, in the eum of NA than the balance owed under y require, without co-insurance, through insurers approved but Vendor shall not require coverage in an amount more this C Co ontract. P of 1111 premiums when due. The policies shall contain the standard clause in favor of the Vendor's urchaser interest shall and, pay unless the less Vendor insurance otherwise agrees in writing. the original Insurancelcompan es ndhVendor. Unless Pur hapsert and Vendor notherw Purchaser reatorsgive notice of loan to be applied to restoration or repair ofUU the Property damaged, provided the Vendor deems the promptly agreesnalwriting, Insura~ economically feasible. r - oil to shall be Purchaser covenants riot to commit waste nor allow waste to be committed on the Property in good tenantable condition and repair to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances anW regulations affecting the Property, . to keep the Property Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified, Vendor will on demand, execute and deliver to the Purchaser, a Warranty Deed, in fee simple, of the Property, free and clear of all liens a:,d encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: E7Sments.• .)iestr~ct4ns..and _ rights-of-wa•y_ of • record,~_ if _ any.................................................. Purchaser agrees that time of the essence and (a) in the event of a default in the payment of n interest which continues for a period of ..J&Q... days following the specified due date or (b) in the event of a default n performance of any other obligation of Purchaser which continues for a period of.... 6Q.- days followin written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance un or this contract shall become immediately due and payable in full, at Vendor's option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies addition to those provided by law or in equity: Vendor may, at his opp(sub to n t n,eterminatet h stContract and Purchas r s and the redemption to bet conditioned uponoPu cha er's fuller the payment P the entikretouts through balance, owith interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amountts previously paid by Purchaser shall be forefeited as liquidated damages for failure to fulfill this Contract and as rental for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific erformance of immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency- or ;iii) Vendor may sue at law for the entire unpaid portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract asacloud on price ide is a quiet-title action if the equitable interest oP Purchaser is insi any of the Property and have r receiver gnificant; and (v) Vendor may have Purchaser ejected from possession under (i), 00 appointed to collect any rents, issues or profits during the of the fore or (iv) above. Notwithstanding any oral or written statements or actions of Vendor can election of any going remedies shall only be binding upon Vendor if and when pursued in litigation and elf costa and expenses including reasonable attorneys fees of Vendor incurred to enforceany remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of forwlosurc of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, p the Property during the pendency of such action, and such rents, issues, and profits when so collected shall be held and applied as the court shall direct. equitable uq, sad roflta of of Purcchaser aerigh sl unnot der this fContract or by pt on, long-terlease orlrin any oin th ther Property y (by without aatheaienmrioteat owritten f any consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under tills Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under anv mortgage this Contract (except for an mort a e outstandl note against the Property the date ant Purch makes timely payment of the amounts t ern d"e u der th saCo nt act. Purchaser may make an h 3;~ pa deymente Firchaaer t the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered ymenta directly to this Contract. payments made on Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs legal t' repaentstives. gn successors and ass' s of Vendor and Purchaser. (If not an owner of the Property the spore OF Vendor for a valuable joine herein to release homestead rights in the subject property consideration and agrees to join is the execution of the deed to be made in fulfillment hereof.) Dated this " , L~_•'_• day of Dece lber.._..._._.. River Hill Family.Thist, a%k~a 1Riv r~ Hills Family St . i~ . (SEAL) By.;-• - = ruin M. Hen (SEAL) . Gary Gif£ordr..aa G E. Gifford Trustee 4n 41 ..----•-----..(SEAL) BY:( ptQ/11'4~~ (SEAL) • ..._Ttlexe _.M._.Heraxy- • lenoxa.G-i~ .ozd,...~'rustee AUTHENTICATION ACHNOWLZDnWRNT Si ature(s) Marvin M. Hen p_ M. enry, Gary Gifford, aJ a Gary E. STATE OF WISCONSIN .,Gifford; 1*mra-,Gifford---------------------- as. authenticated this - .County. M41.-day ot_._..Permbim..... 193 Personally came before me this . day of , it...---- the above named Kristina gland ( TITLE: MEMBER STATE BAR OF WISCONSIN " 1"""""-'-• I! not, _ authorized by § 706.06, Wis. Stats.) t - - to me known to be the a lift who executed the p foregoing instrument and cknowledge the same. --'--.--THIS INSTRUMENT WAS DRAFTED BY Kri sta.>la--Qgleld Attorney--at_.Law_........... - ...............1 Notary Public is. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state uexpirattiion ` are not necessary.) ~C date: 19._.-•••••) 'Names of persons signing in any capacity should b* type or printed belop their signatures. LAND CONTRACT - Individual and Cerperats - state Bar or wiaeenai{n. Ferae Ns. 11 - 19s2 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of Labor and Hpman Relations Divas[bn of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY,,) Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPEL OWNER PROPERTY LOCATION _ GOVT. LOT 1/4 1/4,S/ T N,Ror)R PROPERTY WNER':S MAILIAIG ADDRESS LOT # BLOCK # SUBD. ME OR CSM # CITY STATE 1 ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [ZTO IN NST R AD p(f New Construction Use [JI] Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate gibed, gpd/ft2_,_~trench, gpd/ft2 Absorption area required bed, ft2_ trench, ft2 Maximum design loading rate ed, gpd/ft2,trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site co siderations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem MS ❑ U ® S ❑ U ®S ❑ U MS ❑ U ❑ S OU ❑ S 8 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound; 3y Roots GPD/ft in. Munsell Qu. Sz. ont. Color Gr. Sz. Sh. Bed Trench Ground elev. &L' [ ft. Depth to limiting factor -7317 Remarks: Boring # :.t 9-29 7 Ground elev. ft• ~IT Depth to ! limiting factor L ~ A Remarks: CST Name:-Please Print Phone: 1 y - Address: «E ,,I ;5TttNV.?b ~Signature: Date: PROPERTY OWNER SOIL DESCRIPTION REPORT Page of _S PARCEL I.D. # ~ Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Trench }l6 nn• Ground 27- r r - elev. Depth to limiting factor Remarks: Boring # 1 ?R- 97 w Z, 4" Ground elev. &Z.0 ft. Depth to limiting factor J97 Remarks: Boring # ✓ - h .Ground.•... .sue s ~ ~ J - elev. eft. Depth to limiting factor q Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) i i I i ' -C ?1A J_ I I I , 1 I , I, ! _ i r- i ~ , I I I I I i I ' I I i ~ I I j , ~ i I I I r i ' I I i I I I ! - - I -T- i I I I r , I I I I I , I j i I ~ ~ ~ P I i ~ I I I I I i I ! 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Via • 0. w ►4~ .11 1~ Too • ►ala•1•• Pipe Y•1•v ' • 4••••11 no • ~CtiNI.1 irwb•1Mt AI 49196 01 416100 pus 1D fins.1 grolocl-c , solL rILL• 013TRIBUTIOI.1 PIPE • ~r►ROr~o S.10-pirTIC COVC 2"OF hGrj9EGA11E "'11ATERP%L OR 1.Oi S7RAM OR MARsti• ►!Ay EIAV• OF-lleFEXT • ~'•"o'~~'s-s'~ AGGRCGATC OISYRIOU'f10W FIPC.Tp pC AT 4CAI;11 IWCHC3 5CL.OW ORIVIWnI, '.K/►pE AWV AT LCAST&O IWCHLL OUT MO MORC THAN 42 1149CS CELOW /IWAL 4111100 MNcvYwlr► DEPTH OF EXCAVAT100 FROM OR14Wq>. 6RAoF. wIL~. ec IWGHEs rvxlnuM ©EPni OF EACAVAT1oN F1%OP\ 0~14114ge_ GRAPE wIL%. oc~_„- InIcHCs SIGLIC~D~ r • OAT C~ s tic 47 ay' Hof s /18 I air 5,~. ~