HomeMy WebLinkAbout040-1205-95-000
STC 104
AS BUILT SANITARY SYSTEM R CV-t
r f ~r• 4j'~i
OWNER ~ ~ ~ h. c.r • {
ADDRESS S~9
4
SUBDIVISION / CSM ~laUPr >ati LOT
y
SECTION /~T ae N-R_Zf_W, Town of Tr-.4
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
gM
i
-76 _
~a ~cyP ~6 55 ~ ! o
/ /haw ✓ Lina
r, '7 7,
s
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK:
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION
Manufacturer: &,42-e Es <f Liquid Capacity: lam
Setback from: Well T55 House S 3 Other
Pump: Manufacturer /14 Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
,7-1 57 Z
Width: S Length i z 63 Number of trenches
Distance & Direction to nearest prop. line: 7 Z
Setback from: well: ~House 7y Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION: 7- q41
PLUMBER ON JOB: .p t T^
LICENSE NUMBER:
INSPECTOR:
3/93:jt
T.WWPY?t rtTWMV.1niti6tL 28.19.964 /}IfflE 1iQTV"~ VP~OAD County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT) sanitar rmit
GENERAL INFORMATION
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI
X
R BM Elev.: BM Descriptio Parcel Tax No.:
/~D, D ` /off, cD 61eo4-?f' ~~cJ>!c4~ _
TANK INFORMATION ELEVATION DATA A9400121 4
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic S y~ 1' Benchmark /pd,
~
Bldg. Sewer
Holding St/~t Inlet 3 1,/ ~j/, 11
117
TANK SETBACK INFORMATION St/y0 Outlet
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic > SO 5 J O s NA Dt Bottom
Dosing NA Header /A&wF-
7, S j 99~ .b' :ZZ Aeration A Dist. Pipe Sia~'~`; •99a 97,7
Holdin Bot. System
PUMP / SIPHON INFORMATION Final Grade
Manu ac mand /f'~a ° d 7%C j/ Off,
Model Number GP
TDH Friction y , ` s ~1 !o ,
T
L Ht c. c~'~o f ~s 3
ead
Forcemain Length Dia. Dist. Towel
SOIL ABSORPTION SYSTEM
TRENCH Width / Length No. Of Trenches PI No. Of Pits Inside quid Depth
DIMENSIONS ~D DIMEN I N
SYSTEM TO P / L BLDG WELL LAKE /STREAM LEA Manufacturer:
SETBACK AMBER
INFORMATION Type Of ✓2e A-> i Moe Num e .
System:-~r<rd"6 &0 OR UNIT
DISTRIBUTION SYSTEM
Header/manifold Distribution Pipe(s) / x Hole Size x Hole 5 ng Vent To Ai take
Length 1L Dia. Length Dia. Spacing 1L__
SOIL COVER x Pressure Systems Only xx Mound Or At-.Grad s nl ~
Depth Over Depth Over i ! d xx Depth Of xx Seeded/ Sodded xx Mulched
BetTrenctrCenter~-~D /Trench Edges a0 - 7~ Topsoil E] Yes E] No p ❑ Yes E] No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: TROY 16.28.19.964,NW,NW,LOT 10,OMAH ROAD
/YIG ~P /L.fL-rte'
Plan revision required? ❑ Yes [yl"o e
Use other side for additional information.
SBD-6710 (R 05/91) Date Inspectors Signatur Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
SANITARY PERMIT APPLICATION -
C N
DILHR In accord with ILHR 83.05, Wis. Adm. Code co N
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 62 0 ~7 9 Q
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 PROPERTY LOCATION
r (A.) VlJlN, S ( ~ T 2j, N, R (or)
PROPERTY OWNER'S MAILING ADDRE LOT # BLOCK #
2 D I'('t A- 14 19
CITY, STATE ZIP CODE PHONE NUMB FR SUBDIVISION NAME OR CS NUMBER.
II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD
❑ State Owned VILLAGE ~ ' Y~
❑ Public ❑ 1 or 2 Fam. Dwelling~# of bedrooms -3 P R AX • NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) o /O •~6~ C
1 ❑ Apt/Condo 7 7
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 ❑ Off ice/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1 JRNew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] 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 TK Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
130 Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Tf y-79c~ ELEVATION
xy~ (o -"75 ?Z Feet /CO. Q Feet
VII. TANK CAPACITY Site
in allons Total of Prefab. Fiber- Exper.
INFORMATION New Misting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks strutted
Septic Tank or Holdin Tank k
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber' Name (Print): Plumbs 's Signature: (No mps) i WLSAP°r Z Business Phone Number:
vn ?i~Z / `77Z 144
Plumber's Ad ress (Street, City, State, Zip Code):
31 2_& 1210 Z4,,115 ~~A 2,7
IX. COUNTY/DEPARTMENT USE ONLY
issuing A ent Si ature (No mps
I J ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e issued ?4
Approved ED Owner Given Initial Surcharge Fee) 4-1 /Q/j S
Adverse Do rminati n / Q(!~l Wlz A
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 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 (SB2) 6399) to be
submitted to the county prior to installation.
5. Onsife 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 fine 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'/s 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)
Joe ~~Y~ Meinur/Co✓
TIMM EXCAVATING / OF L
Route 1 Box 192 SHEET NO.
WILSON, WISCONSIN 54027 CALCULATED BY DATE
(715) 772-3214 (715) 386-5443
MPRS 03224 WI MPCA #696 MN CHECKED BY DATE
SCALE
:Cy.
: i . .v..
° `
; .
%it 4
w~
n...~ `
AA '0
O y~.
F.
1, ty~
PRODUCT 205-1 ~p Inc., Groton, Mass, 01471, To Order PHONE TOLL FREE 1-800-22WBD
JOB P ~LIK~u✓~✓
TIMM EXCAVATING
Route 1 Box 192 SHEET NO. OF
WILSON, WISCONSIN 54027 CALCULATED BY DATE
(715) 772-3214 (715) 386-5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
. >lfl. j
i..... ...i. .
i_.
.
.
.
.~.D~. 7
r~
`
Qf J i
a
.
PRODUCT 205-1 ~Inc., Groton, Mass, 01471. To Order PHONE TOLL FREE 1-800-225-8380
WiscWsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Lai*, and Human Relations
Division 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 n h iz n must include, but St. Croix
not limited to vertical and horizontal reference poin ction an e, scale or PARCEL I.D. #
dimensioned, north arrow, and location and dista eare oa
REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE PR LLQF TION
PROPERTY OWNER: a► ``"PR LOCATION
Jeff Weinfurter RgR G . T NE 1/4 NW 1/4,S 16 T 28 1N,R19 W
PROPERTY OWNER':S MAILING ADDRESS BLOCK # SUBD. NAME OR CSM #
1260 Pine` Glover Station
TY []VILLAGE OWN NEAREST ROAD
CITY, STATE ZIP CODE PH NbWSr
Hudson, WI 54016 (715 - Troy Omaha
[X] New Construction Use [ X] Residential / Number of bedrooms 3 [ ] Addition to existing building
j ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/ft2 .6 trench, gpd1ft2
Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 97.9 ft (as referred to site plan benchmark)
Additional design / site considerations i nG ^1 1 5' x 75' tranrhac
Parent material outwash Flood plain elevation, if applicable NA ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ® S ❑ U Q S ❑ U S❑ U ®S ❑ U E3 S U ❑ S )MU
SOIL DESCRIPTION REPORT
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 0-5 10YR 2/1 - sl 2 m cr mvfr cs 2f/m .5 .6
22 5-20 10YR 2/2 - sl 2 m sbk mfr cs 1 f/m .5 .6
Ground 3 20-24 10YR 3/3 - is 1 m sbk mvfr gs 1m/c .7 .8
elev. 4 24-29 10YR 3/4 - is 1 m sbk mvfr gs 1m .7 .8
101.3 ft.
Depth to 5 29-68 10YR 4/6 - s 0 sg ml gs if .7 .8
limiting
factor 6 68-86 10YR 5/4,4/4 - s 0 sg ml - 1f/m .7 .8
*P8611
Remarks: occasional gr 29-86
Boring # 1 0-4 10YR 2/1 - sl 2 m cr mvfr as 2f/m .5 .6
2 4-13 10YR 2/2 - sl 2 m sbk mfr cw 1m .5 .6
3
3 13-29 10YR 3/3 - is 1 m sbk mvfr gs 1m .7 .8
Ground
elev. 4 29-34 10YR 3/4 - is 1 m sbk mvfr cs 1m .7 8
100.9 ft.
5 34-46 10YR 4/6 - s 0 sg ml cw 1m .7 .8
Depth t0 _ 0YR 5/4,4/4 - s 0 sg ml - - .7 .8
limiting w/ o casional strati ied mcs & inclusio s ls: i e ular, dis ontinuous .SYR 31is ba ds
ffacttor about 1" thic typically at 82 & 89
Remarks: occasional gr below 13
CST Name:-Please Print Henry F. Grote Phone: 715-665-2681
Address: PO Box 57, Knapp, WI 54749-0057
Signature: Date: 3/28/94 CST Number: 3065
PROPERTYOWNER Jeff Weinfurter SOIL DESCRIPTION REPORT Page .2 'of 3
4
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax Lary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-11 10YR 2/1 - sl 2 m cr mvfr cs 2f/m .5 .6
C4ti:
2 11-27 10YR 2/2 - sl 2 m sbk mfr cs 1f/m .5 .6
Ground 3 27-37 10YR 3/3 - is 1 m sbk mvfr gs if .7 .8
elev. 4 37-87 10YR 5/4,4/4 - s 0 sg ml - if .7 :.8
99.6 ft.
Depth to
limiting
factor
8711
Remarks:
Boring #
1 0-5 10YR 2/1 - sl 2 m cr mvfr cs 2f/m .5 .6
2 5-10 10YR 2/2 - sl 2 m sbk mfr cs 1m .5 .6
5
3 10-50 10YR 4/4 - sl 2 c-m abk mfr gs 1f/m .5 .6
Ground
elev. 3 50-53 10YR 4/4 - is 1 m sbk mvfr as if .7 E.8
100.9 ft.
4 53-90 10YR 5/4 - s 0 sg ml - 1f/m .7 s.8
Depth to
limiting w/ o casional mcs & cc gr
factor
~[)Il
Remarks:
Boring #
:::::::::.::::::1 0-12 10YR 2/1 - sl 2 f sbk mvfr cs 1f/m .5 6
:::s:
2 12-40 10YR 2/2 - is 1 m sbk mvfr gs if
3 40-57 10YR 3/4 - sl 1 m sbk mvfr cs if .4 .5
Ground
elev. 4 57-70 10YR 4/4 - scl 2 m sbk mfr cs lm .4 .5
98.4 ft. 2d 7.5YR 5/8
5 70-76 2.5Y 5/4 f1f 10YR 6 2 sil 3 m sbk mfr - - .5 .6
Depth to
limiting
factor
70"
Remarks:
Boring #
0-36 s & is similar to B-2; 35-about 60 dense in place, moderate stru ture scl; his pit outsid system
1 area
Ground
elev.
"98 ft.
Depth to
limiting
factor
> 60"
Remarks:
SBD-8330(8.05/92)
~wr Tew~.~ OJM• 1 ~eT ar► ~o~ ~b `
NF - M~• at
-TIV
I
aim nn J
dC, w.
4-4
•C~l H ~ 1e1 yt a iKTZ
'Cl
~o DS.IO 6mi b....~~ ~4J~ta+.{
SIDI
ELI`
• Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in a9iTft1HR,83.05, Wis. Adm. Code COUNTY
r } Y
i ' St. Croix
Attach complete site plan on paper not less th 8)I& x 11 inches in size. Plan must include, but
not limited to vertical and horizontal referent (BM,.i 4tfon and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and fance4o roa b
REVIEWED BY DATE
APPLICANT INFORMATION-PLEASE``PRINT A'LL`INpR~ATION
t a ,a
PROPERTY OWNER: - ti" ,FOPERTY LOCATION
Jeff Weinfurter `GOVT. LOT NE 1/4 NW 1/4,S 16 T 28 ,N,R19 W
r ~ -
PROPERTY OWNER':S MAILING ADDRESS 3YT,;OT1# BLOCK# SUBD.NAME
G1o~erCStation
1260 Pinewnnd Drive- Ant~~'~ CITY, STATE ZIP CODE PHO E ❑CITY ❑VILLAGE OWN NEAREST ROAD
Hudson, WI 54016 (715) 772-3214 Troy Omaha
[XI New Construction Use [ X] Residential / Number of bedrooms 3 [ ] Addition to existing building
[ I Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 5 bed, gpd/ft2 .6 trench, gpd/ft2
Absorption area required 900 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 97.9 ft (as referred to site plan benchmark)
Additional design / site considerations install 2 - 51 x 751 tranrhac
Parent material outwash Flood plain elevation, if applicable NA ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem ® S El U IDS ❑ U K IS ❑ U ®S ❑ U ❑ S O u ❑ S )I U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-5 10YR 2/1 - sl 2 m cr mvfr cs 2f/m .5 .6
<;w_F 2 5-20 10YR 2/2 - sl 2 m sbk mfr cs 1f/m .5 .6
Ground 3 20-24 10YR 3/3 - is 1 m sbk mvfr gs 1m/c .7 .8
elev. 4 24-29 1OYR 3/4 - is 1 m sbk mvfr gs 1m .7 ; .8
101.3 ft.
Depth to 5 29-68 1 OYR 4/6 - s 0 sg ml gs 1 f .7 .8
limiting
factor 6 68-86 10YR 5/4,4/4 - s 0 sg ml - 1f/m .7 .8
">8611
Remarks: occasional gr 29-86
Boring # 1 0-4 10YR 2/1 - sl 2 m cr mvfr as 2f/m .5 .6
3 2 4-13 10YR 2/2 - sl 2 m sbk mfr cw lm .5 .6
3 13-29 10YR 3/3 - is 1 m sbk mvfr gs lm .7 .8
Ground
elev. 4 29-34 10YR 3/4 - is 1 m sbk mvfr cs lm .7 .8
100.9 ft.
5 34-46 10YR 4/6 - s 0 sg ml cw 1m .7 .8
Depth t0 _ OYR 5/4,4/4 - s 0 sg ml - - .7 .8
limiting w/ o casional strati ied mcs & inclusio s is, i e ular dis ontinuous .5YR 3/ is ba ds
factor about 1" thic typically at 82 & 89
> 92"
Remarks: occasional gr below 13
CST Name:-Please Print Henry F. Grote Phone: 715-665-2681
Address: PO Box 57, Knapp, WI 54749-0057
Signature: Date: 3/28/94 CST Number: 3065
PROPERTY OWNER Jeff Weinfurter SOIL DESCRIPTION REPORT Page 2 of,-3--
PARCEL I.D. #f
R
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft
Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boundary Bed Trench
1 0-11 10YR 2/1 - sl 2 m cr mvfr cs 2f/m .5 .6
......4...`_. 2 11-27 10YR 2/2 - sl 2 m sbk mfr cs 1f/m .5 .6
3 27-37 10YR 3/3 - is 1 m sbk mvfr gs if .7 .8
Ground
elev. 4 37-87 10YR 5/4,4/4 - s 0 sg ml - if .7 :.8
99.6 ft.
Depth to
limiting
factor
871
Remarks:
Boring #
1 0-5 10YR.,2/1. - sl 2 m cr mvfr cs 2f/m 5 .6
5 2 5-10 lOYR 2/2 - sl 2 m sbk mfr cs lm .5 .6
3 10-50 10YR 4/4 - sl 2 c-m abk mfr gs if/m .5 ':.6
Ground
elev. 3 50-53 10YR 4/4 - is 1 m sbk mvfr as if .7 .8
100.9 ft.
4 53-90 10YR 5/4 - s 0 sg ml - 1f/m .7 .8
Depth to
limiting w/ o casional mcs & cc gr
factor
> 90„
Remarks:
Boring # li
1 0-12 10YR 2/1 - sl 2 f sbk mvfr cs 1f/m .5 .6
2 12-40 10YR 2/2 - is 1 m sbk mvfr gs if .7 .8
3 40-57 10YR 3/4 - sl 1 m sbk mvfr cs if .4 .5
Ground
elev. 4 57-70 10YR 4/4 - scl 2 m sbk mfr cs 1m 45
98.4 ft. 2d 7.5YR 5/8
5 70-76 2.5Y 5/4 f1f 10YR sil 3 m sbk mfr - - .5 .6
612
Depth to
limiting
factor
701
Remarks:
Boring #
0-36 s & is s milar to B-2; 35-about 60 dense i place, moderate stru ture scl; his pit outsid system
1 area
Ground
elev.
98 ft.
Depth to
limiting
factor
60"
Remarks:
SBD-8330(R.05/92)
l , ~ Z i' T Ow T ens. ~ QJM • 1 ) e ~ ~ d6.%%
L. ~,o \
C}A r~ vow. S t P o ~C e..
A OwN'' ~.0~ T l!
I
j
N
L
J w~ r A-0`
O
I I I ~o ate. d Z I ; i
I ~ I ~t~e~uatrt.~. f
Q
r Q' ~
terrna. <<~.~ ~9 :
+ ► e tC 1 e,.~: ~ off(. a,v
?ti ewe`
N.TS J
t4o %SAO %Q.L- O...L poo`~a..t
-LIL
C- to QC ,t
1-1 1 DWE:E T HFPk'F F I :E; HL 7154,151110 P. O
i
• ~ I
~ o n-, Jul .
Q LANDS ~
~
T 193.30 ' t .70
VA 4Qie rJf ! ~►o
N) W l T H N I 9'° ' `z
%
t I j V) if
y tv
CD_
~~3\ 4D I ! U4 o I
0 I
„Lb Q) i 0i i~77
i~
a w ! Q Ir -
~Tl 1>
tYi
m iQ
~
rn
N ~ i N
Ca I ~ ~
C7 i C~
U I iCjj .p_
E9~v Q~ ( O ii
iS 0 Cl)
222.00 b
).75 Z 225.02 i N 1035'06"E 155.00' ROAD N 193510 6 E ~ 380.02
t~ ! p
do z
± w c.a
PQ
F I~
1 ~ N ~ Gl
F .r D fTl
- I
F ~ :p ~ i sv
f
fTl
a) N
Q I p cn
l
1
- 3° 02
06
14 N 1 ° 3 5 06"E! 400.02 w°'Z ~~s►
66~ °
N b 1
n~
o
CD LA
0 .1 o Q
f i W
STC-105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER J e`'~F2e~Y 5 . .4- Ap Or A. W E-/d Ft 9, rV 'Z.
MAILING ADDRESS 532 oA-/_yt4A ROAQ I4DSD!✓ . 6VT 3'W (o
PROPERTY ADDRESS S32. O y A*tri ✓LvAcD
(location of septic system) Please obtain from the Planning Dept.
CITY/STATE "j)50-0 i w r 5'-i0 I
PROPERTY LOCATION NU) 1/4, N UQ 1/4, Section l~ T Z g N-R W
I
TOWN OF lRd ST. CROIX COUNTY, WI
SUBDIVISION Lo V r'7L STkll10-A.) LOT NUMBER ZO
CERTIFIED SURVEY MAP , VOLUME , PAGE , LOT NUMBER
Improper use and maintenance of your septic system could result in its premature failure to handle
wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed
by licensed septic tank pumper.- What you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
St. Croixr County residents may be eligible to receive a grant for a maximum of 60%_ of the cost.
of repllacement I f a failing system, which was in operation prior to July 1, 1978. St. Croix County
accepted t~iis 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: A
DATE: Z 141
St. Croix County Zoning Office
Government Center
1101 Carmichael Road
Hudson, WI 54016 11/93
B 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 _s 1 kE y ; • J o u - A • WE f,~ ~
Location of property N U) 1/4 N W 1/4, Section T _N-R /9 W
TownshipTienY Mailingaddress 532 pMA6fi* GAO
kuvs t -T '5-'L/01
Address of site 3Z d1v%4WA, na(1
Subdivision name -L.oclL-'V_ 5T-'A • o,,,v Lot no.
Other homes on property? Yes_)( _No
Previous owner of property__ I AAAL- k- h`4LZOL-01 4- Q05C-_)K ZW L • A)ZALCvc.-rte
Total size of property 2 . Z y Arc
Total size of parcel L415.04" k z 2 S, Z
Date parcel was created
Are all corners and lot lines identifiable? _ Yes No
Is this property being developed for (spec house) ? Yes No
Volume 07V and Page Number 3 _ as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOS NG
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 ;n tLhe o fice of the County Register of
Deeds as Document No. -5 l & 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.
WI e O of Appl' ant C 4Applicant W
19941
Da-Fe- or Signature Date 15✓f-Sig,
nature
DOCUMENT NO WARRANTY DEED THiS '-FA' E RESERVED FOR RECn RUNG DAT.
STATE BAR OF WISCONSIN FORM 2-1982
5155 ~5 1074FAGE3% -I C F.
ll. Cr",~ix CO., W!
Pbed lot Fwwd
Paul R. Malcolm and Rosemarie Louise Malcolm, _
husband and wife; . . . . . . APR 19 1994 ~
. . i3t 8,~30 A.
- -
Jeffre}~ S Weinfurter and Jodi A U► ti•R'"•.
conveys and warrants to
- . ' . Y
Weinfurter, husband- and- wife, . . dDlreor -
- -
-
the following described real estate in St CrOiX County, - - -
State of Wisconsin: - ~ - Tax Parcel No:(~Tv
Tot 10, Glover Station in the Town of Troy, St. Croix County,
Wisconsin.
F~
This ..---..-is-not--- homestead property.
(is not)
Exception to warranties: Easements, restrictions and rights-of-way of
record, if any.
I '
Dated this _ day of . is 94
77
(SEAL) GLId- (S~~ (SEAL)
Paul R.,Ma1c
_ (SEAL) /(SEAL)
Ros. r' uise Malcolm
I
j AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
St. Croix ss.
- --------County. i
authenticated this day of 19..-..- Personally came before me this day of
- April ---------------------1994..-- the above named
Paul R. Malcolm and Rosemarie Louise
ii
----Malcolm husband. and-- '
II TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, Afoory P11111C
authorized by § 706.06, Wis. Stats.) ?talc O WjSC~/~g
to me known to be the person U v execs e e
II egoing ins ment and knowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristin-a gjand-------
Alice Jo n s
Attorney at Law '
Votary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (I not state expirrtion
I~ are not necessary.) date: 19-•)
~I *Names of persons sirninz in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Go. Inc.
FORM No. 2- 1"2 Milwaukee Wisconsin