HomeMy WebLinkAbout032-2092-95-000
STC - 104
AS BUILT SANITARY SYSTEM REPORT
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OWNER
ADDRESS
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SUBDIVISION / CSM# `LOT
SECTION_,- T N-R ,Lq W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
/T 7
yd sc~ f
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Al uFe
f3 /f. air,
GrfKi/C.e
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67
INDICATE NORTH ARROW
Provide setback nd elevation information on reverse of this form.
Provide 2 dim s'
~aT~..JIF
BENCHMARK: ~2~
ALTERNATE BM: SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer:- . S Liquid Capacity:
Setback from: Well House Other
Pump: Manufacturer, /o✓S Model#Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: Length Number of trenches
,Z _7
Distance & Direction to nearest prop. line: Ji77
Setback from: well :-2r_ Housefly Other
i
ELEVATIONS
Building Sewer ST Inlet. ST outlet q8
do')
PC inlet PC bottom y?~I// Pump Off
Header/Manifold Bottom of system
Existing Grade 98,35 Final grade DATE OF INSTALLATION: C7l
r
PLUMBER ON JOB:
LICENSE NUMBER:
INSPECTOR:-
3/9
c0nSin Department of Industry, PRIVATE SEWAGE SYSTEM County:
Labor and Human Relations
INSPECTION REPORT ST. CROIX
. • ` Safety aod"uildings Division
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI
VANASSE, MICHELLE X
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
rX
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmarks lJ
Dosing
Aeratio Bldg. Sewer
Holdin St/ICE' Inlet
NK SETBACK INFORMATION St/)tft Outlet 5.
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake J 7 /
Septic f y ~ 4 NA Dt Bottom
daal*
4k Dosing `r NA r/Man. s' 9
Aeration NA Dist. Pipe
Holdi Bot. System S./5- 99
PUMP/ S INFORMATION Final Grade
Manufacturer G < Demand
Model Number L,)G03 /(L -_2, GPM
TDH Lift Friction Head S TDH Ft
Ss I i
Forcemain Length Dia. 3 Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width > Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 9 DIMEN I N
-------S--
SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHIN Manufacturer:
SETBACK
INFORMATION Type of CHAMBER Mo um er:
System: ?.,,•__d fi OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s)/ , x Hole Size x Hole Spacing Vent To Air Intake
Length _A4_ Dia.' Length J~L Dia. a Spacing T
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over G~ xx Depth Of / xx Seeded/ Sodded- xx Mulched
Bed J?gKeenter Bed/Tdges Topsoil to ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)4/s I- 0 ~6tY X05;""q_
LOCATION: EAU-- .24.3 19W,NE SE LOT 1, BLO 2,80TH u ,
/ v z-? c am, ✓t' ul~ ~ ~ o
Plan revision required? ❑ Yes No
Use other side for additional information. /4:3~d FJ~A 9
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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SANITARY PERMIT APPLICATION COUNTY
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANIT Y PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than ~Qrp~~
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.
PROPER OWNER PROPERTY LOCATION
'/4 '/4, S T31 , N, R (Or
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM BER
II. TYPE OF BUILDING: (Check one) El State Owned 0 VILLLLAGE NEAREST ROAD
❑ Publlc ~ 1 or 2 Fam. Dwelling-## of bedrooms - PARCEL TAX NUMBER(S)
111. 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
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 in line A. Check line Bit applicable)
A) 1. ICI 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 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./i Ch) ELEVATION
Feet 3 Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installa 'on of the onsite sewage system shown on the attached plans.
Wbe s Nam Pri Plumbe 's S' nat e: ( Sta s MP/MPRSW No.: Business Phone Number:
9
PI ber's Address (Street, City, Stat , Zip OFT p/~
J L
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ss a Issuing Agent Signature
Surcharge Fee)
Approved ❑ Owner Given Initial
Adverse Determination 0
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. a
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
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WORKSHEET - MOUND SYSTEM DESIGN
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1'/~cr,zl1i PROBLEM; 594-41139
Design a mound system fora
The site characteristics are: Depth to groundwater or bedrock in.
l.andslope
S..
Percolation rate ~ '144, F miff f-fin•
Distance from dose chamber to distribution system ft.
Elevation difference between Dump and distribution systern 10_ ft. `
Step I. WASTEWATER LOAD = 16-03e111ieK 'X ?fie ~ gal.'
Step 2. SIZE THE ABSORPTION AREA
A) Area required ■ ~SDy,~/ J.~~~/,~f'- sq. ft.
B) Bed or trench length (B)
C) Bed or trench width (A) ft.
D) Trench spicing (C) _
Wastewater load .24 /day S ft.
• ~e~~c ies~'~' c3a1/ft 2
Step 3. MOUND HEIGHT.
A) Fill depth (D) _ ft.
B) Fil l dopth (E) ■ D + slope (AJ'~'~~ ,f1/ ft.
C) Bed or trench depth (F) _ rt.
D) Cap and topsoil depth (G) ft.
E Cap,and top oil depth•(H.) _ ft.
.o i gn :
Licenue
JFtte :
of !U.
S 9 4- 41 13 9 hall. f
Step 4. MOUND LENGTH
A) End slope (X) 0 + E + F + H x 3 • ft.
6) Total mound leng h (L) B + 2(K)
Step S. 'MOUND WIDTH .
Al) Upslope correction factor s.
A2) Upslope width (J) n (D + F + G)(3)(factor) . ft.
B1) Downslopa correction
factor ■ ,~.LL
B2) Downslope width (I) ■ (E + F + G)(3)(factor) , 9 ft.
C1) Total mound width (W) for bed a J + A + I . 2a ft.
C2) Total mound width (W) for trenches
J + i + (no. trenches -1) (c) + A + I ft.
I
Step 6. BASAL AREA -
A) Infiltrative capacity of natural soil 4;~r gal./ft2/44y
B) Basal area required • wastewater flow =
natural soil nfiltr tive-cdpacity sq. ft.
C1) Basal area available for bed for sloping sites R
Bx (A+I) •
. .dCc.., sq. ft.
C2) Bas are avail le for trench for sloping sites ■
6 W ~J + ql
~J-sq. ft.
93ys a3, y -~74~
C3) Basal area available for trench or bed;-for,level
to
Sign BxW~
. sq. ft.
Liconyo h -
Data:
594-41139 _
Step 7. DISTRIBUTION SYSTEM
7A) SIZE DISTRIBUTION SYSTEM
1) Hole size = in.
2) Hole spacing • in.
3) Distribution pipe length *.Fr,
4) Distribution pipe diameter in.
5) Spacing between distribution pipes in.
6) Distance from sidewall to distribution pipe • in.
7B) DISTRIBUTION PIPE DISCHARGE RATE _ ft.
1) Number of holes per pipe
2) Plow per pipe • -0!2 GPM.
7C) SIZE MANIFOLD
1) Manifold iscentral/ _ end
2) Manifold length ft.
3) Number of distribution lines =
4) Manifold diameter = in.
7D) SIZE FORCE MAIN
1) Minimum dosing rate GPM
2) Force main diameter / in.
3) Friction loss = •8~
jZ~ ft*
7E) TOTAL. DYNAMIC HEAD
1) Vertical lift = .GQ..Q ft.
2) Friction loss = t.
3) System head 2.5 ft. ft.
Total dynamic head = eft.
ai~;n•_
Licer ge:
Data
1 Pvt. ~ ot /a-
41
J39
7F) PUMP SELECTION
1) Pump selected will discharge ,`5 GPM at ft.
total dynamic head.
2) Pump model and manufacturer
7G) DOSE VOLUME
1) 1 XrS/, v 1 7lume of distribution lines gal./cycle
re(,
2) Daily wa tewater v lume : 4 doses/24 hrs. , l S- gal./cycle
3) Minimum dose volumes LPL.. gal./cycle
7H) DOSE CHAMBER
1) Minimum capacity required ■ S'ee- 7sdf .8Sz~. gal.
4~t~cJEA lN~.FiCS ~ q,~-l
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Licvnsc~ i;u: Date:- 9-s/
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Designer- 'S 9 4 - 411 39
pate' 9_i~`SLs~ Non-Woven Filter Fabric
4" Observation Pipe
~ Distribution Pipe
ASTM- C 33 Sand 1
H ~ Alter. Pos, of
" Topsoll \ _ ► Force Main
'ih
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% Slope
Bed Of 2 Force Main Plowe d
Droin Rock From Pump Layer
D 1
Cross Section Of A lAound System Using E - -
a A Std-For The Absorption Area F
Tx'K~cH G
A F t. li
Ft.
t~
A 1 Ft.
i Ft.
,!4(.~ Ft.
Alternate Position L hvI, Ft.
of
Force Main W Z/, Ft.
L.
7 A
e l4~Observotion Pipe
1 -JK
mA~fi - - ° ~Force Moin
W V) 0A From Pump
c -
3
o° Distribution Bed Of i2"- 2'z
Pipe Drain Rock
1
4 Observation Pipe permanent Marker
Pipe or Rods,
Plan View Of Mound Using A Bed For The Absorption Area
PAGE„ l-oFw-
.
PERFORATED PIPE DETAIL
and S94-41139
DISTRIBUTION PIPE LAYOUT
Perforated Schedule 40
PVC Pipe
End
Cap's
~.a`ole
ce
a~e~ Holes Located On
Bottom Are Equally
k Spaced
End
Cap 4
Schedule 40._ -:M "
PVC Force Main
n~
Last Hole
s .
Should Be' Next To ;Y 87i0NS
End Capp. „u.a .
Owner's Name:
P feet
:P1umber/d s nerla gnatures x _ inches
Y inches
Date$ License No. Hole Diameter /
----r-- ~ inch
Lateral Diameter 1 inch(es)
Force Main Diameter inches
Holes per Lateral.
feet. Invert Elevation
of Laterals
Page 7 of
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PAGE --L OF.,LQ
_,.PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
S94-41139
T CAP
VEW
40C.2. VENT PIPC
WEATHER PROOF APPROVED LOCKING
25' FR¢M DOOR, JUNCTION BOX M&WHOLE COVER
WINDOW OR FRESH 12'MIU.
AIR INTAKE
GRADE I
4 MIN,
19" Mild.
COWDUIT
18'NIAI.
11~ _
INLET. PROVIDE I -
AIRTIGHT SEAL
APPROVED JOINT A I II APPROVED JOINT:
W/ ca. PIPE - I I (I W/C.I. PIPE
EXTENDIN¢ 3' l I II ALARM EXTEIJDING 3'
ONTO SOLID SOIL ONTO SOLID SOIL
B - "pas
-A & - I GN
E 'I''~/ PUMP _1
Off
D G CONCRETE BLOCA
RISER EXIT PERMITTED OWL4 IF TANK MANUfACTURER HAS SUCH APPROVAL
SPECIFI•GATIOIJS
I:PtIC AND
USE TANKS MANUFACTURER: IJUMBER OF DOSES: PER DA:i
} TANK' t,IZE: A012 GALLOWS DOSE VOLUME: GALLONS
ALARM MAIJUFACTURER:
S. J, t~E. S ^L CAPACITIES. As_- ~ IWCHES OR as_7,--P~.Z GALLOWS
MODEL WUMBEK bss _IWCHES OF, .,-77~tLi. GALLONS
.SWITCH TyPC: IA E~.__, C.- INCWES OR .497 0ALLOWS
PUMP MANUFACTURCR: Ds,~IWCHES OR gUild• GALLOQ5
MODEL NOTE. PUMP AND ALARM ARE TO BE
bW11CN TYPE ,~pp~~ IUSTALLED ON SEPARATE CIRCUITS
: i,cy~, ,
PUMP DISLHARGE. RATE GPM
VERTICAL,DIIFEKENCE bETWEEN PUMP OFF ARID DISTRIBUTION PIPE..1f~fL FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . 2.5 FEET
+ _9LL FEET OF FORC£ MAIN X _4jmL_F/oo FLFRICTION FACTOR.. ,GS FEET
TOTAL OyWAMIC HEAD = FEET
IMTERNAL DIME SIONZ Of TAUK: LF-W'GTH ;WIDTH ;LIQUID DEPTH A17_
91GNE0: LICCUSE DUMBER, ,.,~5~ DATE:
J~yL~ I7 I
. Performance
Curves Pumps
METERS FEET S94-41139 9° 11a
MODEL 3885
25 so SIZE 3/4" Solids
!,EISLHI
70
20 WE10H
60
-WE07H
15 50
40 WEOSH
10 E
20 E03 ,
•
5
10
0 0
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
0 10 20 30 m3/h
CAPACITY
~GOULDS PUMPS, INC.
SB*CA FALLS NEW rock 1310
METERS FEET
120 MODEL 3885
SIZE 3/a" Solids
110 WE16HH
30 100
90
25
70
20-
WE 8p
05HH
50
15
40
10 30
20
5
10
0 0 FH r-t-t-+ H+H
0 10 20 30 40 50 60 70 80 90 100 110 120 GPM
LL,,,
0 10 20 30 W1h
CAPACITY
01906 Goulds Pumps, Inc. Effective July, 1985
C3885
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
September 23, 1994 2226 Rose Street
La Crosse WI 54603
K 0 CONSTRUCTION
KIM 0 CONNELL
308 MIDPINE CT
STAR PRAIRIE WI 54026
RE: PLAN S94-41139 FEE RECEIVED: 180.00
VANASSE, MICHELLE
NE,SE,24,31,19W
TOWN OF SOMERSET COUNTY OF ST CROIX
MOUND SYSTEM
The Department has reviewed the above-referenced submittal.
Conditional approval is hereby granted for the system plan submittal. All
noted items roust be corrected. The review and approval of the system is based
on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin
Administrative Code,'and is contingent upon compliance with any stipulations
shown on the plans. This system has not been reviewed for the code
requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin
Administrative Code.
This plan submittal approval will expire two years from the approval date, or
if a sanitary permit is obtained, plan approval will expire on the day the
initial sanitary permit expires. The licensed plumber responsible for this
installation shall keep one set of plans with the Department's stamp of
approval at the construction site. The installer shall notify the appropriate
inspector when inspections can be made.
All permits required by the city, village, township or county shall be
obtained prior to installation.
Inquiries should be directed to me at the number listed below. Please refer
to the plan number shown above.
Frard e ,
M. S m
Plan Reviewer
Section of Private Sewage
(608) 785-9348
6248R/ 1
SBD-6423 M. 01/81)
Wiscopsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pa e of
Labor it Human Relations g
Division of Safety 8 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
PROPERTY OWNER: PROPERTY LOCATION
GOVT. LOT 1/4 1/4 S T N,R ,r(or W
ROP TY OWNER':S MAILING ADDRESS LOT # LOCK # SUB . NAME OR CSM #
CIT~Y !TATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OWN NEARE T Rq~D /
s ( - _ ,L
6" X/
D4 New Construction Use b{J Residential / Number of bedrooms [ ] Addition to existing building
j J Replacement [ J Public or commercial describe
Code derived daily flow ~SD gpd Recommended design loading rate bed, gpd/ft2,2,'2 -trench, gpd/ft2
Absorption area required 31< bed, ft2 _ Zs trench, ft2 Maximum design loading rate gibed, gpd/ft2-f~trench, gpd/ft2
Recommended infiltration surface elevation(s) ~f l ft (as referred to site plan benchmark) ,
Additional design / site considerations
Parent material '/f Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE 7 SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem ❑S oU ®S ❑U ❑S ®U ❑S ELI []S ®U []S ®U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxtdary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer&
. U014
Ground
elev.
oG~B
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground 7s 8 '
/
elev. JA V
ft. AIP
l
sl+S~~/d>
Depth to
limiting
factor
Remarks:
CST Name:-Please Print Phone:
Address:
Signature: Date: CST Number:
PROPERTY OWNER I/ SOIL DESCRIPTION REPORT Page,-2-of
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft
in. Munsell Qu. Sz. nt. Color Gr. Sz. Sh. Bed Trench
13 A-ZILZMe- I OAII~t
Ground
elev. ys. 8
ft.
Depth to stPG✓8
limiting - -
factor
3
Remarks:
Boring #
Ground `
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
T-7
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
3 of 3
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Ga'
08/11/94 14:03 $ COUNTY CLERK Z 0u1 002
I
LINE 3E114,$EC.24
N£ C019Nl74 OF SE 1/4 OF SECT/ON 24,T3/N,Rt9
N87°570$"W.'-' 14 ./5....
tsao N eT•i7' 05^ w-.nf5f••, S IR E
F T
28.0
m~• %6 2 500 „
4a.
40
d
9
W
~ W
ng a$ _ aW
hA ~I A/ NQ
z r
X4
331 sq /t, 133, 951 sq. ft. 131,599 s4 ft.
133,8liJ •q. ft
J7 Q Q ~
285.00 9 280.00 90 6pSf.
t
Nd7.5705"W 570.00
S
8 $
6X
171,001 sq. ft.
N8T•s?'os"w
s 71100
,p
gym.
a
0
sy N . 7 ~
a
159,60o sq. ft.
N 87.67 05"w
ew o. 0
S"•
8 NN
UN,R.f9W. ey
apse,. a !59,600 sq, ft.
W ~
070.00
z Vii. -
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STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER F'rY1 ~~~C:
MAILING ADDRESS
PROPERTY ADDRESS
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE
PROPERTY LOCATION 1/4, 5E_ 1/4, Section 0 Ll T I N-R W
TOWN OF U , ST. CROIX COUNTY, WI
SUBDIVISION L J--tn~ LOT NUMBER pp c~
CERTIFIED SURVEY MAP , VOLUME j&~ PAGE 14q<, LOT NUMBER _UeJ 2
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 maint ne ust be completed and returned to the St. Croix
County Zoning Officer within 30 days of the three ye expr n date.
SIGNED:
DATE: q~~9
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, W1 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 a x.119 0,~r..~
Location of propertyVv- _1/4 Sc,, 1/4, Section '~)-L T 31 N-R
Township Mailing address
Address of site ,';Xv
Subdivision name,,,, Lot no.
Other homes on property? Yes'~ .__No
Previous owner of property - ~1 - _ -
Total size of property ~Q lj c. cnt~
Total size of parcel v~Iq.4 57 v
Date parcel was created
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? _><__Yes No
Volumejo q2) and Page Number L ,S~ 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 office of the County Register of
Deeds as Document No. j 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
- -
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
5092 STATE BAR OF WISCONSIN FORM 2 - 1982
VOL 1093PA,F
'
!~E( Ij t R'S OFFICE
ST. CROIX CO., WI
_...Ri.Chard-MI..Hansen.-and.-.Jane..A-Hansen ReC'dforRe:.ord
I ....~?ushand-.and..wife SEP ._..1 1994
_
9:50 AM
conveys and warrants to ..MiChE~J o-
interest.. and... Richard.. D.... Stout.. and..Janet-P.... Stollt,........... Regster of Deeds
husJx~nd..and..wife.,.-a..one-half
.....in ..C.ommn
RETURN TO
the following described real estate in St.r....QrO1X .......................County,
State of Wisconsin:
Tax Parcel No:
Lots 4, 5, 6, 7 and 8, Block 2, Hansen's Turtle Lake Hills First Addition
in the Town of Somerset, St. Croix County, Wisconsin.
This 15- not........... homestead property.
(is) (is not)
Exception to warranties: easements, restrictions and rights-of-way of
record, if any.
19..94...
Dated this .................4/.................... day of ~t. ..~{...a.47-
: ..(S Gl/,... (SEAL)
Richard M. Hansen J A. Hansen
.................................(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) .....R1ChdTd M.." Hansen, STATE OF WISCONSIN
Jane A. Hansen ss.
St. Croix
County.
authenticated this I. day Of ..J`j............... 1914 Personally came before me this ................day of
19 the above named
Richard M. Hansen, Jane A. Hansen
Kristina Ogland
.
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
to me known to be the person .5......... who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina Ogland
~£~o"rriey •
Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.) date: 19.........)
'Names of persons signing in any capacity should be typed or printed below their eignaturce.
WAnnANTY Dr•.r.D STATL: nAn PF WISCONSIN Wisconsin Legal plank (;o Inc