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HomeMy WebLinkAbout040-1276-10-000 eo p v~ I p `si I ~ I ~r ao m I a~ 4 ~ I I e c 0 N co 0 2 m c 0 m I is in W C (D o ago y c E a cc at cl- C O ° co a~ (D w ° N U O (D0) O O O'm C Z y C C Z L c N U) lL O N l~jL a N Co 3 W U N 3 - U C y O y C . O Q U CL) Q .t.. U Z II I co co v m I a3i ~ v~ I 111 Z Z E co E cn = O O O O E O c a E •O ~ •o Z - y N 3 a m a m ao H co L v I cc~ o I O Z c c m e y C o Z c c M 4) Z U) F- r a~ m rn t I E y E ° rn y a~ a~ Z Cl) S N N O N a w E ca (D y a H N C E.0 y y N y _N C N N N N c.= O o ~ N a s a rcT = c !i v O c c O c M.2 c Q Z m Z Z H Z z N I I d E m E c N t6 E ~ N E d co C. CC co 1 l~ « in C 0 0 IL a) a in IL 0) bap W.- _ O s a a m p a a a0 d co 000 0 •Ai C a y d N y oN=~i~i o =rnrn o cA J U O) a) Z 01 O) Z N N N N _ I m I m _ E O m as y E O O mI C E O O co y C Q. 0 Q Z cn O d Q cn m p U) 7 a~ U) U) M w ca y c ° c c m y c ° c c E LO o 4) cn Q (D IL CD V ^ co y c y E w a) 0 r- O N a? y C O C N c,j co N y t C7 O~ N C3) d N v v 00 d N v H C y CD N ` T O f' 7 O O O E U co H LL O Z Z Z tL O Z Z Y E € a#~ a a dad` dam E d y c o m 5 3° o o ~nc~ -1 A QIL ;Ov)v 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER GA4w,<~~ KeI S~i`J JF ' l ADDRESS SUBDIVISION / CSM# LOT # y T N-R ~ .4 W, Town of SECTION ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM A FFop V)~ ~ lol' 19 (8x4g ae~ 06- 0 a 0 L4 SenKoom t; Home j03 a - goo yu? V) e 17K~ve INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: wA)~c OUt Poor. lev = IGU• ALTERNATE BM: SEPTIC TANK pTT un, r D1-N_r q*N1t - ON Manufacturer: 1~Je f~S Liquid Capacity: 31) c f: ~oN Setback from: Well Nol 11J House 1 g Other NokSe' U rRt~ S ! p2 y3 - P_ u-re r Mme-l+ Size seperation ---Gallons/cycle: --Al-arm_...Locat_ion - SOIL ABSORPTION SYSTEM Width: Length 3 Number of trenches Distance & Direction to nearest prop. line: N qT Setback from: well: IN House ~g Other gouS~-Gl~e~- r~Q (03' I ELEVATIONS AN QQ Building Sewer ST Inlet ST outlet CO\) Q ~ 4 9•a ~l PC buttOM-- p Pump Header/Manifold Q Bottom of system y and rpN~ Existing Grade ig.r~a Final grade 1:;N~Q-t g(o.ss ouf ►efi - 9c~.aa f o~ y DATE OF INSTALLATION: G OY Q ° PLUMBER ON JOB: ~~?lY°r-- ~S'.•!/(~'_a.:?, ~ O~ LICENSE NUMBER: 3~ INSPECTOR: 3/93:jt L~~#rM3EparttYtp~fibf Irfdds • 19.126, PRIVA SEVi~►GEOiYSTM LEY RD. County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 199978 Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan ID No.: ev.: Insp. BM Elev.: BM De caption: Parcel Tax No.: /60, d) e ,?.g lvrl (rH- 040-1037-60-000 TANK INFORMATION ELEVATION DATA A9400006 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1,/ 1:2Z Dosi n Aeration Bldg. Sewer Holding St/ bg inlet 16,07 TANK SETBACK INFORMATION St/A Outlet ' q(6 6,- Vent ~ TANK TO P / L WELL BLDG. A irIto ntake ROAD Inlet Y, 3S-' 24, 5-7 Septic (2) /tR % NA 57. Dosing NA Header+_ i Aeration Dist. Pipe r Bot. System Hol PUMP / ra,~z 9~ SIPHON INFORMATION Final Grade 77 Manufa Demand ~r 6' 7 ,EV *e 5 7ly 9 ZZ Model Number GPM 9,7,. TDH Lift Friction e TDH Ft Forcemai Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Trenches PIT o. Of Pits Inside Dia. Liquid Depth DIMENSIONS If DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING anufacturer: SETBACK CHAM INFORMATION Type O Model Nu System: 3S~ 7/ NIT DISTRIBUTION SYSTEM Header / Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _.~1 Dia Length 54s) Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys my Depth Over Depth Over xx Depth Of ee ed / Sodded xx Mu c Bed / Uent'h Center Bed LT+e"eh Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 8.28.19.126,SW,SE,LOT 1, TOWNSV LLE D. 0- je, I y, Plan revision required? ❑ Yes ff-N-o q Use other side for additional information. ~ r SBD-6710 (R 05/91) p , Date i Inspector's Signature Cert No. ~~Z/~e SANITARY PERMIT APPLICATION COUNTY 701LHFR In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ f~9'~'~~ 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. PROP RTY OWNER PROPERTY LOCATION Q p, 1 fi e' S e %S~ '/s, S U Ta N, R I g E (or) W PR P RTY OWN R' MAILING AD°~ SS LOT # BLOCK # V bt,.) ' A i~t CI STATE ZIP COQO PHONE NUMBER SUBDIVISION NAME O NUMBER Teo „N s .S cw N N II. TYPE OF BUILDING: (Check one) ❑ State owned VILLAGE , 7 ROAD rooms 0 1A I Q ❑ Public 1..,~1 or 2 Fam. Dwellin9~of bed l~ PARCEL TAX 1 -J- 111. BUILDING USE: (If building type is public, check all that apply) 0 qO -10 37 Q 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 B if applicable) A) 1. Nlslew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) Jzy A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 IH Seepage Bed 21 ❑ Mound 3o ❑ 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 REQ~UyIRED (sq. ft.) PROPOSED (sq. ft.) (Gal ay/sq. ft.) (Min./inch) l~ ELEVATION Feet & 7 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 Septic Tank or Holdin Tank N00 1 F] I El Lift Pump Tank/Si hon Chamber F-1 F] I [1 [71 Vill. 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 Sign re: (No Sta ps) MP/MPRSW No.: Business Phone Number: u ,eQS W- 3 Y b Vf--W.o Jel -N BQ I Q~~ Plumber's Address (Street, Ci State, Zip Code 1169 M) IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sani ry Permit Fee (includes Groundwater Date Issued I suing Age ignature Approved El Owner Given Initial j~ Surcharge Fee) S Adverse Determination 102 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 ` 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 renew&I any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions tc this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBI_ 6399) to be submitted to the county prior to installation. 5. Onsite sewi ge systems must be property maintained. The +_:,ptic tank(s) must be Fur r ^cl ^y a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onstte sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. t 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. If. 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 ito oration. Fill in the capav^'ty of every new and/or exislir , tank, 'ist the total )umber of tanks and ;.anufacturer's name. Indicate prefab or site coast,uc:i:ed and tank material. Gorrtf.-:c~.,te for all septic, pump/siphon and holding tanks for this system. Check expp imentai approval only 1.1 am s received experimental product approval from D11 HR VIII. Responsibility statement. Installing plurr!bUr is to fill in name, license number with ap rooriE•-e prefix (e.g. MP, etc.), address and phone number. Plumber must sign application fo; m. IX. County/Departme - Use Only. X. County/Department Use Only. Com^ic>,te pans and specifications not sr-,,:oiler than 31.n 11 inch; sp ter -uhmitt`:r1 to th,, _cuity. The plans r-.sst include the fol!owirg: A) pi x:..,n drawn to scale with ,_o h~Oldln'y" ' `sn3;(S), septic iii K( Or other t! F tF r,1 tanks; bl i~ 1 t F ,e! `eYa-r +'1 "si `wall'„ service; streams and lakes; pump or siphon tank;, 0s;nbuticPn boxes. "-;r,: io., -ytitein`; system areas; and the iJCatlOri of the building . nr 'il v~ hOrlZUnta~ s, ~'~>s IPVntson 'eferenc@ ;.(1 1ty; ~ C) complete specifications for pumps and c:ontrois; close volume. -le;vat,on differences: fricti•,n toss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorplion system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER- SURCHARGE 1983 Wisconsin Act 419 included the creation of surcharges (fees) for ruumn,,r of regulated prac'ic.es -which car effect groundwater. The r~~on,eu c,o!:~.c:d three-,;a.: tt;cue surcharges are used or water contamination ;nvesligalions and establls~-w?enl of standards. SBD-6398 (R.11/88) LOT H : i_) O S S SECT .1 cwt X01. f? Q. 6 7 _ P A h LUM N A M E QW& oaf- RZI,ot,, ' ~?:t_S ~AAM E Q C A 10 nI _.-1~ L IC EN S E 3 F----' Al E A P - - - sa t iq BS U-, ° O o ba $y to 6"NI , - (p~,Y-s " `d V i. l W A 1 ~6t~} you /C j lo &o rW4 os SF ~j C~~Ne12 J l,JcIIS A~ F~Kf~t~ TIN~N 1 1 300 7~KoT- fRUTti S~S~P.. ~ = Q%~.p l,b)~ {~r~S ♦ S~sfi~w, a FRESH 1111'. I EC:TS AND OBSERVATION PIKE C110SS/ SECTION _ Appr.Dved Vent Cap Minimum 12" Above Final rrasie~__~._ 411 Cast Iron Above Pipe Vent Pipe To Final Grader Marsh Hay Or Synthetic Covering Min. 2" Aggr.eylot Over Pipe 1V Distribution Tee i Pipe Aggregate Per-f.orated Pipe Celow g ,ya 60 Beneath Pipe ---Coupling Terminating T . ' S f-~.._. Rot•tom of System Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pa e of - Labor and Human Relations g Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but 57/- 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 6;,q r e ' se An GOVT. LOT ,Sjl 1/4 ,5,0 1/4,S 4/T Z 1j(,N,R /,,5' o6 PROPERTY 0 ER':S LING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # /L/ S S~_ 611 1 CITY, TAE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD w,' t (745) 3 a~ , oltj6-j--- LAl 4-I 'New Construction Use j' Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow. kv gpd Recommended design loading rate ed, gpd/ft2_Ltrench, gpd/ft2 Absorption area required bed, ft2 7SO trench, ft2 Maximum design loading rate bed, gpd/ft2 , ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ?y yl ft (as referred to site plan benchmark) Additional design / site consideratio s Parent material,] Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND I GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ~R-S El U ,(S El U J:RS ❑ U a'S El U E:] S J54 U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxtdary Roots GPD/ft in. Munsell Qu. Sz. C nt. Color Gr. Sz. Sh. Bed Trench y§ : s 7 Ground eft Depth to limiting factor r L5 Remarks: Boring # i A ~J 1 1 ,y S! S ~i (L Y W Y c J i r, x> 3 rs y""~ r ^ 12 el" Ground tiirJ t -7 Depth to limiting factor 7 Remarks: CST Name:-Pleas int / Gre ;2 tlaoi Phone: G Address: C ✓ j IV e/x '74 a r S Signature: / Date: CST Number: d l 00 3 . PROPERTY OWNER SOIL DESCRIPTION REPORT Pages Of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Borxclary Roots GPD/ft in. Munsell Qu. Sz. Co Color Gr. Sz. Sh. Bed Tw& o" v " Zvi Ground elev. ft. Depth to limiting factor Remarks: Boring # le w a 1-1 IN :.t r ~S t,r l -so r1i C,4./ Ground S, ft. Depth to limiting faCt~ , Remarks: Boring # , . ; 6-7 ::ti;::A,' A ? /L IU 5' S~ t~ C ~61~ r Gq ZV E 3 - ~ ~ d Ground Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) e.~ T ® 3 69 ,fie ~d P;s Lne, HOo5~0, a- BL -31 063 F--~ l4 ~ ► B y~ S` r 498385 AIAY. 0 f? 1993. ~9~sterol NNELL Z CrftCD.,W1 / Bearings are referenced to the south line of the SE} of Section Q~ / 8, assumed to bear N88°32'41"E. (n N p Z 'CO N O N ~ O N N / / CO 0 t-1 °i m 0 o fi ya 0 © I I I oro 3 a r M W ° • - pS D 7 r• C 9 y rr +II~. Ud O~ W rv a T x M o [rJ f S 1 r r o c 0 0 -.h U3 M rt o o ft n 1 Q1 ° o (A '~Zrn7 CO ° a rf I C O v, .r f f ~Y' rn II-zv _rt M / O. 0 d 66' k Ir ~ OD 17A ~ C %0 n rr I t.tD•, s ~ i W I M 1J" G (~yD M CO Id rt En a O IZ c N 9i ccc0 O ~ CL _ n cn 00 = M 0 M L' t3 o rt rt r+ F o~ r• N ff• CL 0 H. rn ° ° O M (A > O ' CO -"i M O I C ko G = 00 a q CO 40 I w r- I~- c coi H 00 p CO N Cn CO I-~ `S19 0 P4 q rTF z IM tai ~ ` Id z0 Cr -n 4 ~gND r W I 4S S 6 z v r •43, CO CO N M D'^ N V M w ..w CO ° " ° olz frl o r o ~-v L CD Vn Ir- -I w i--~ O Z IM rt ~ Id N lr- Ln E C) BIZ It7 !D N IN F, CD O H. 437.181 L 1' Ki m m U W 5033 m N03017 15" 0- rt C- 00 17' 15"W UNPLATTEDLE~NUS t.. ° ° o -3 ° F 1.81' N > D w ° ,y N r O CO r F O o v m VOI.UML'. 9 PI1GF; 2613 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER Gl ' T SEA ADDRESS: 4~ d lb 1 1cLt~ ~~tL FIRE NO LOCATION: 'Al 1/4, S 1/4, SEC. _T 9-8 N-R~W, TOWN OF: t Yb~/' ST. CROIX COUNTY SUBDIVISION: VO[ • l a 3 LOT NO. 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 to help with the cost of the 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 the St. Croix County Zoning a certification form, signed by the owner and by a master 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. Certification from will be sent approximately 30 days prier *o three year expiration. 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 form must be completed and returned to the St. Croix Count, Zoning Officer within 30 days of the three year expir~;tiun date. SIGNED. vt~ DATE: St. Croix Co-t-pity 'Zoning Office 911 4:h St. Hudson, WI 54016 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 4' Location of property 1/4 1/4, Section T ~LN-R W Township ~T129V Mailing address ~i j 0 wit's Address of site 4-03 oW", ~z Subdivision name C,SWL X0-4 Vf /_3 -Lot no.-. Other homes on property? yes No Previous owner of property r f it -S Total size of parcel - 3,01 ae4S Date parcel was created Are all corners and lot lines identifiable? Yes No Is this 7operty being developed for (spec house)? Yes XNo /Aa volume and Page Number X as recorded. with the Register of Deeds. ~''6e~0~» 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 Re ester of Deeds as Document No. ''"'"~S~S3 g own the - - A;nd that I (we) presently 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 he office of County Register of deeds as Document No.~ s ' Si gnat 9nat of a ~1 ant Co-appl ca jqq3 Date f Signature Dade of S gnatut : DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED REEGIST"ETS UF;=ZCOZE r: Lam l" Arthur and Marilyn Feyereisen Pec'd for Rewind SEP 13 1993 at 9:15 A.C conveys and warrants to Gary and Rondi Feyereisen Register of Deeds RETURN TO the following described real estate in St. Croix County, State of Wisconsin: Tax Parcel No: A parcel of land identified as Lot 1 on the Certified Survey Map filed with the Register of Deeds, St. Croix County, Wisconsin, on may 3, 19931, No. 498385, Volume 9, Page 2613, and further described as follows: Located in Pte't of the SW-41 of the SE-41 of Section:,-8, T28N, R19W, Town of Troy, St. Croix County, Wisconsin. Commencing at the S1/4 of said Section 8; thence N88o32 41"E, along the south line of the SE1/4 of said sectlbn, 1242.53 feet; c thence continua ~ thence N03 17 15 W, .'1.81 feet to the oint of beginning; z'tg N03°17'15"W, 503.31 feet; thence S89'05 3 W, 214.18 feet; thence S19°20'44"W, 456.43 feet; thenceN89 38'59 W, 280,00 feet to the point of curvature of a 233.00 foot radius curve, concave southerly, whose central angle measures 28'23'39", whose chord bears S76009'11.5"W and measures114.29 feet; thence westerly, along the are of said curve, 115.47 feet to the easterly right-of-way ofthe town road (Townsvalley Road) being a point on a 610.62 foot radius curve, concave westerly, whose central angle measures 6 11 '50", chord bears S27005'31"E and measures whose 66.01 feet; thence southerly, along the are of said curve and said easterly right-of-way, 66.05 feet to the point of curvature of a 167.00 foot radius curve,concave southerly, whose central angle measures 28°46'14", whose chord bears N75°57'54"E and measures 82.98 feet; thence easterly, along the and of said curve, 83.86 feet to the point of tangency; thence S89°38'59"E, 674.62 feet to`the point of beginning. The right is also granted for use of Road Easement This is not homestead property. 0utlot 1 on the same map. (is) (is not) Exception to Warranties: EXEMPT Dated this day of 19_ 3 til/• ` (SEAL) 4zt2G,~~a (SEAL) Gary , Feyereisen Arthur Feyereisen (SEAL) (SEAL) Rondi A. Feyereisen Marilyn Feyere en AUTHENTICATION R ACKNOWLEDGMENT Signature(s) STATE OF°bdtSe01Q5M ss. U ZF County. / ~7 authenticated this day of , 19 Personally came before me this-day of 19-%3-_ the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person -r who executed the authorized by § 706.06, Wis. Slats.) foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Gary W. Feyereisen ary Public 11 .3-A "r4 ;t Z-rvi County, (Si natures ay be authe Icated or acknowledged. Both y Commission is permane . (If not, state ex iration are not nece sary.) date: (I ) -vsa. NOTARY PUBLIC-MINNESOTA Names of persons signing in any capacity should be typed or printed below their signatures. M Commission Expire r. 1&1 `'y WARRANTY DEED STATE BAR OF WISCONSIN Nell iq~x►t~2R Form No 2 - 1982 i . LQGiJ's p,,tW8(tQ* Ir uSt • 19.126 PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ' (ATTACH TO PERMIT) sanitar rmit GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village 9 Town of: State PI o.. ev.: nsp. BM Elev.: BM Description: X Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300252 TYPE MANUFACTURER CAPACITY STATION BS HI F ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto RO D Dt Inlet Air Intake Septic NA Dt Bottom Dosing NtINN Header/Ma . Aeration N Dist. Pi e Holding Bo . S tem PUMP/ SIPHON INFORMATI Fin Grade Manufacturer Demand Model Number P TDH Lift Friction System TDH t ' Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. f Tr nches 11 PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O CHAMBER Moe 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 T xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 8.28.19.126 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: SANITARY PERMIT APPLICATION 70ILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY -.„a ❑T _ 11P, IT-Attach complete plans (to the county copy only) for the system, on paper not less than 8'fi x 11 inches in size. cd .f ~aious application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. P ERTY OWNE PROPERTY LOCATION '/a ,4' % S TN, R /q E (or) W PROPER WNER' MAILING ADD SS LOT BLOCK # CITY STATE - ZIP ODE PHONE NU BE SUBDIVISION NAME OR CSM NUMBER &~O/ A l 0 II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD II ) ❑ State Owned 13 VILLAGE : ~d ~ El Public C& or 2 Fam. Dwelling-# of bedrooms ~ PARCEL TAX NU BER( ) 111. BUILDING USE: (If building type is public, check all that apply) ~Q 103 / _ 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 40 Church/School 80 Mobile Home Park 120 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. R New 2. ❑ Replacement 3. ❑ Replacement of 4.E1 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 FSeepage Trench 22 11 In-Ground 420 Pit Privy 13 Seepage Pit Pressure 43 ❑ Vault Privy 140 System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: '~f 3 sb 'y `T•Pj 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM LEA[. 7. FINAL GRADE REQUI ED (s . ft.) PROPOSED (sq. ft.) (Gals/ y/sq. ft.) (Min inch) Ml O 9 rJ.l INAErL~E ~4 (pQ 5-0 U w 94,1 Peet I La Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank o c I Q~ f H F] rT+++_ Lift Pump Tank/Si hon Chamber, Ej I El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plu er's Signatur • (No Stamps) MP/MPRSW No.: Business Phone Number: fim tSU ynk S R- 3 s Address (Street, City, State Zip Code): Plum q,05 M5 L,~ Pk) 5 6 -N IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved Sa ary Permit Fee (Includes Groundwater a e Issued issuing gent Sig e (No mps Approved ❑ Owner Given Initial 1K) i- Surcharge Fee) Qa/ Ad a D t rminat_ / X,~CO ITIONS OPPROVAL/REAS S FOR ISAPPROVAL: K:Zi~ - SBD-6398 (formerly Plb-67) (R. 11/88) 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 groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) 111 CROSS SECTION 67 _ PL. OT NAME ..N..A M JR e, ors ~e d' Dn PL D ID I • He~c~e Toe ~o W 130, I Set tsT 10 r • ,l~ 1 i S.., ti~.~rti..►a' yy ~ z 1hr4 r V6 Icy-fi Vo: 7 Y 2 Q - • w6D5.0~,, `w~ i 110 ~ X10 S t3 3 FRESH Ail'. INLETS AND OBSERVAnotj PIPE CROSS/ SECTION - Approved Vent Cap W b) Qo RAP? Minimum 12" Above Final Grade_-_,._ W0 n" Cast Iron Above--- Vend Pipe To Final Grade Marsh Hay Or ~Synthetic Coveri.ng Min. ,2" Aygr.c(j';il Over Pipe '•r-,~ Distribution .F-- Tee Pipe I B''~` ~ Tn£HCL' Aggregate Ver•f.oral:ed Pipe Celow b t1•~~~' ~"s ()eneath Pipe --Coupling Terminating' P 175 Bottom of System L.xbor and Human Relations SOIL AND SITE EVALUATION REPORT Page of 3 oiQision of Safety J Buildings in accord with I LH R 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 G'~` 1 c/'-~~SE~ GOVT. LOT SV 1/4 SE 1/4,S ? T J-,? N,R E (w; iGh1 4 PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME 0p CSM # iG/l. SvM.~rEk sT ? csM Pte'-~o.;J G- CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ErOWN NEAREST ROAD up So ti ~v/, , y oily 1715) 3 P6 - /al.$- -"R o ~.~v.~sv>4i~E y .PD New Construction Use [ j Residential / Number of bedrooms [ j Addition to existing building j j Replacement [ j Public or commercial describe Code derived daily flow gpd Recommended design loading rate 7 bed, gpd/0' 9 trench, gpd/ft2 Absorption area required ~S bed, ft2 '7570 trench, ft2 Maximum design loading rate bed, gpd/ft2 ' trench, gpolft2 Recommended infiltration surface elevation(s) -T-tk- 3 ft (as referred to site plan benchmark) / Additional design / ' considerations _ 5-L- rS • - ?SSE 7;&-4 .Lt S w/ Q"O~d 40XE S Parent material ayka'eh4_AP T 5/ - 6 X40/ Flood plain elevation, if applicable 4~ ft tUng Suie for Sy stem CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK able fors stem ® S 13 U 151 S ❑ U VS ❑ U ®S ❑ U [7S ❑ U ❑ S -F9 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou•d3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench /orw 312- S,y /,f, shy iw, -f-,e S /uf , 2- x<xs `LG /OVA 41~ /,f s 6~ iv►~~R Cs /v~ Z- 3 Ground ' 7 sce /S 1,401,Sh< I+~ 5 i 1.7 q elev. . 6 ft. C y- f0 /o re s~~r s O, e s .y►~ -e- 7 Depth to limiting factor Remarks: i Boring # ff D-~o', /oye 3/Z oY- 4 S~ / / f shr~ GS /v f Z ' 3 L ` C o / o Y,e y~ 5,'/ shy fie S /v f , Z 3 s Ground 13. /p 30 o Y4 fi/t- cs /.VF 14/ Ground elev. C' O - IP -7-50 1/y S n~ , S / • 7 yy, y/ ft. Depth to G ~0- fZ 7, SY/2 ve JFk limiting >fact Remarks: lloea ✓ "G " C' ayr*,:y S sal. ~A~v1~0-~r A9eeX r5 0,P S/ 449m 30 - y Z CST Name:-Please Print H0ME&TE SEPTIC PLUMBING CO. Phone: 715 Address: ROBERT ULBRIGHT Signature: Date: CST Number: x DES!GtJ[R UC. N0.00663 PROPERTY OWNER 6~- r~YLX ~i ~iSE~✓ SOIL DESCRIPTION REPORT Page 2of,. 3 PARCEL I.D. CSM ~~~V j~/'t~ (r ' t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 1 ......n. c o /o 3/2- 4.4 vex s y , S 7-16 -7, Sfie Ground s M► , a - • 7 eley. ft. Hoye S/ s DI C, 5 ~1ti'r~ r-- - • / Depth to limiting factor +i Remarks: Boring # 10-/o 10Y- / 'i•:~'itiii4ft$ti 1w 7~e Ground - itev ft. C Z "/OV /O ye C s /M y ' 'I Depth to limiting - factors L Remarks: Boring -/O /oy,E' 3~2- S~ Z,-F S6i~ ,y.,,, ✓{i2 S /Uf ` • S o -~y /o ye sh,( nMf~ 5 /u F Y .S AMA w.,.: f-~G Faye T 0& r,,,-rp, CS lof .K ,s Ground Slav. yS- 72-ft. Depth to limiting factor /do Remarks: Boring # Ground elev. R ft. Depth to - - - limiting factor - - - - Remarks: SBD-8330(8.05/92) s MC=Imm sw M M. m o ~ ro n mmcC ~ ~nw°v I~ Q m' ZS rC Z FA G) 70 ~VJ ~W O\ y ,A w r- rn o w~ o o 0 c 00 t 70 'At s o t . ~ w m ~W 00 P,~o~Oosev E~ s r L • G . h W