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HomeMy WebLinkAbout040-1215-50-000 i. STC - 104 AS BUILT SANITARY SYSTEM REPORT / ' la OWNER- 1 C I< /J L /y ADDRESS ~S /0/Z IIU6 W 000POMPf-Y SUBDIVISION / CSM# LOT # i SECTION T N-R W, Town of z ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ,J se L PC y ~dtp o 1 Gy ~J J 0 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form- Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK • C54 /00,0 ALTERNATE BM: 4V AUP5 Qa,n/PA-7p~/ Ilk1 SEPTIC TANK 'R/ PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: W rc-'<5 Liquid Capacity: 2 Setback from: Well A4 House Other 1 I l X/) 6f _57/ Pump: Manufacturer S Model# ✓ 7 Size If Float seperation 7 /z Gallons/cycle: Alarm Location 14y u5c~ R,4,~ en-W /~+-~S~6ofc SOIL ABSORPTION SYSTEM Width: Length ~J Number of trenches Distance & Direction to nearest prop. line: Setback from: well: /I- House .>zSt Other ELEVATIONS / Building Sewer 7 ST Inlet. Q Z f ~Z~ST outlet ~d Z , L S 4-o? 8ac% PC inlet LO ~ 4 Q Z PrC/ bottom_ 9, Pump Off Header/Manifold /y4(c gS Bottom of system lg Existing Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: OA 7e-7Z LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County 8T Labor and Human Rf-lations INSPECTION REPORT . CROIX Safety and aiuildings Division s (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 21 R9R1 P t1°*', N ❑ City Village R I Town o : State Plan ID No.: I ~/O 9s< - - zs , MK TI:Qy CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 16)A_;_t la, a - , A6e /'~X_ I A9400369 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic lam( . ZC Benchmark 7% If V Dosing 2, / l 0a - 4 ` , X. Aerati Bldg. Sewer 06, 73" Holdin St/ Inlet 5, Oo7,r TANK SETBACK INFORMATION St/ Outlet S r 6~.oS TANK TO P/ L WELL BLDG. Ae Intake ROAD Dt Inlet 5 02~ 7 -73" SN6lX ~81~ Septic , ((D NA Dt Bottom + 64 - Dosing > S07SV NA Man. o?./✓ , d5,0/~ 3,08 3, i Aeratio Dist. Pipe 3 3 r , Bot. System PUMP INFORMATION Final Grade Manufacturer Fr~s e'an ~ - Z c,/' d6 51 N r6 Model Number ~,j~D TDH Lift Friction lai Head p TDH (p9 Ft oss Forcemain Length 2/ Dia. 3 ' Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width r Length 3 r No. Of Drenches PIT No. Of Pits Inside Dia. Li uid Depth DIMENSIONS / DIM I SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING INFORMATION Type of Rwr i CHAM Mo a Num er: System: filccc 0( NIT DISTRIBUTION SYSTEM Ord Manifold Distribution Pi e(s) r~ rr x Hole ize x Hole Spacing Vent To Air Intake Length Dia Length 14-:i Dia. ~ Spacing r ~d SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx See!5 Sodded xx Mulched Bed/ enter Bed / dges Topsoil B-Fes No es El No f r - COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Troy.16.28.19W, SE, NW, Soo Line Road LeNS~C~oUe~l ~►l•Z"'"`~ f r-Lo J Plan revision required? ❑ Yes No Use other side for additional information. Q SBD-6710(R 05/)`I) Date Inspector's Signat re Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: . :C3: DlLHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code couNTY STATE S:jTAR IT # -Attach complete plans (to the county copy only) for the system, on paper not less than 11// application 8% x 11 inches in size. ❑ Check if reE?) to evious -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. V Too 7 7 PROP TY OWNER A / PROPERTY LOCATION C e V '/a V,&,S TZi ,N,R E or PRO RTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CS I NJJMBER GV A/ O 21,41, - II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ CITY i4GE /1 NEAREST ROAD G N IZ~ V 00 ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER( S) 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 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. IiNew 2. El Replacement 3. El Replacement of 4. ❑ Reconnection of 5. El 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 LN-Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22'Ll In-Ground 420 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./inch) /ELEVATION Feet Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New F-xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank Z~ ~~K s Lift Pump Tank/Siphon Chamber 0" Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PlumP s Name (Print): Plumber's Sig ture: (No Stam MP/MPR9W No.: Business Phone Number: 66r /V u 5, Plu b 's ddress (Street, City, State, Zip Code): 4 IX. LINTY /DEPARTMENT USE ONLY ❑ Disapproved Sa ' ry Permit Fee (Includes Groundwater ate Issued- Issuing A ent Si ature (No to s) Surcharge Fee) Approved ❑ Owner Given Initial Adverse t rminatio a X. CONDITIONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R.11/86) 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. Vill. 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) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations August 11, 1994 1053A East Green Bay Street Shawano WI 54166 £ A ka9. WEGERER SOIL TESTING r, i 421 N MAIN STREET PO 74 RIVER FALLS WI 54022 594-30779 FEE RECEIVED: 180.00 RE: PLAN NILSEN, RICK SE,NW,16,28,19W TOWN OF TROY 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 must 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 lumber responsible for this expires. The licensed plumber P 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. Sincerely, I,] JJ ~ Keith Wilkinson Plan Reviewer Section of Private Sewage (715) 524-3627 SBD•6423 (8.01/91) Page of 6 MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE LOCATED IN THE SE 1/4 OF THE MW 1/4 OF SECTION C6 TAN, R 19 W, TOWN OF T y-f , ST. C-CZOUC COUNTY, WISCONSIN. INDEX PAGE 1 *of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW-CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE SEW AGE gYS-VEM ~Ng1TE ~''V'/" PREPARED FOR69 = S t, t k i: ED -~~e_c lUtl_j v~,N REIA~ION bp N i ~r- v gRI~S-~~1~, ~y al _ 666-) SP2l~G 1t1 ~ p A g1~11Ai~'s DEpp~ piv ESP°NOSNcS. SEE PREPARED BY 894 30'779 WEGEE~ER SO I L TESTING AND . ov~e~®eten DES 2 (SM 51E=F;ZE1 I CE s c 0 1 v P.O. BOX 74 421 K. MIK ST, RIVER FALLS. YI 54022 w = wTHUR • WEGERER = 715-4254165 s D-915P GLLswrTH• - ~ t wrs. i .,a,~ s I GNP Z9, L49t/ JOB NO. g t/, l8 b PLOT PLAN • Page. Z• of Scale 1"= 4.p' ei" 1 V` 2- k~L . k 11.`1' O N 7 re !`F! 6 3lc(r' ofi), 'Lrt$71C O f" O IJ ,1i W~ O4 L, ~1,0I.. • S•1 l0 l/'~' JQ1 r~J i 77- EL to 7?- 2A CL=?~.YP1lC j / ~ ~ ~E ►'r<Atw ~,i 'DC) Y.111~'" L'Oh'~PItC"1' ~ /,J otZ DlsTv~R •4- ox 1 3 1u~q - / LIL V0 0 / • V3" 1 - eL VD0 d~ O/J 14'r 3/c/•' NW. P~., s~,c i~tP h N ~ r MST- ?..S' F12.W~1 Y1 pvhf 8, 9 4 / SYSTEM s o' ' e p,G GNSITE SEW I r ~ ~ EI,pS10NS ~DDDT ~ •~31y11.DINGS ' r--- DEPARSMEt~~ ` SRFE~ AN pG;~DENCE i 1 T sou '1-~ La1Z.,1 P a A C 5OO 1 .1le 'K~f i NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( required) 3. Install 4" observation pipe0 with approved caps. ( Z required) 4. Septic tank to `be. 1.zoo gallon capacity manufactured by \A "Izt-L4 W TLk$ - Y2~2 y 1i`Rik -to R e W eft S ~0 0 0 0kL- . T",.he . 5. Bench mark flc~ p 6. Divert surface water around mound to prevent ponding at the uphill side. A Page 3 Of 6 Approved Synthetic Covering Asia C33 Distribution Pipe Medium Sand Topsoil Elev. 1 c)14.0 3 E „ - b Z % Slope Bed Of 2~- 2 %2 (Force Mein Plowed Aggregate From Pump Layer D 1.o Ft. E Z.0 ~ Ft. ONSITE SEWAGE SyS'N-Wross Section Of A Mound System Using F o - Ft. A Bed For The Absorption Area n G I.o Ft. A 8 Ft. H l.5 Ft. Linear B 63 Ft. Desi ABI1/SQ FT 1 tg Ft. pEPARTME DtVt~;JP~ OF SArEf`I J 6,zFt. GNDENCE K `I Ft . SEE COR ee(Position L 85.3Ft. S94 Force Main W I-L-IFt• 4 30779 L Observation Pipe A I - - M N Distribution Bed Of 2 - 2 2 Pipe Aggregate Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page Of (2 Perforated Pipe Detail ! 0 End View Perforated End Cop. 1 PVC Pipe 'a, Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced S Q PVC Monifotd Pipe PVC Force Main Oistn ition, Pipe A Last Hole Should Be Next To End Cop End Cap P Zs S4 30 '7 t. 3 Distribution Pipe_ Layout ONSITE SEWAGE SYSI S L_ Ft. X -66 Inches em&~~4 Y 310 Inches F, t , Hole Diameter 11Y Inch Y H►U' RELATIONS Lateral l <<y Inch(es) OEPARTUILVy ► L e D DE' iS;'~1~1 GF SAFETY uD BUILDINGS Manifold 5- Inches Force Main 3 Inches SEEcZRESPON©ENGE # of holes/pipe 11 Invert Elevation of Laterals too-SoFt. Place lst hole 16y from center of manifold with succeeding holes at 36" intervals. Last hole to be next to the end cap. • PUMP CHAMBER CROSS SECTIOW AIJD SPECIFICATIOUS ' PAGE S OF !o VEWT CAP . `i' C. 1. VENT PIPC WEATHER PROOF APP lO ' ROVED LOCKING MANHOLE JUNCTtO1J DOX COVER WITH WARNING LABEL FROM DOOR, (Z•MIIJ. WIN0OW OR FRESH I AIR INTAKE GRADE I I '1" MIN. 000nUIT` 18"MIN.\ _ .l IAJLET ~~E SWAGES PROVIDE ( . QNS IGHT SEAL - I III ~ now 'n n s ~ coJn II v APPROVED JOINT A Tan, em I I I APPROVED JOINTS 1~~5 with approved wth, I I~1 LARM pipe extending A p1~GS 3 feet onto ~0~R'I • ~°~';t~U ~L I I I solid soil. 4001OF S~F0, N I I ON Both sides of \44 ~r~ tank. LLE1VI_~FT. 4!►j"' SOOgDEN PUMP OFF SEe c- 0 ~L °16.00 CONCRETE CLOCKA APPRaVEc RISER EXIT PER1411TED OUL4 IF TAWK MANUFACTURER HAS SUCH APPROVAL. 6EDflING SPECIFICATIONS DOSE TANK MANUFACTURER: vm),3~'Y NUMBER OF DOSES: .PER D" TANK 51ZE : 1u00 GALLOWS DOSE VOLUME ~J~ 3 (11 ALARM MANUFACTURER' S`~S'1~P~I,S INCLUDING DACK►LOW: GALLONS GALLOWS CAPACITIES: A ~'rt IWCHCS OR vV' 0 MODEL NUMBER: SWITCH TUFF.: k'1 -Z ~wf B = INCNES OR S GALLONS PUMP MANUFACTURER: M1 T~ C s ~ L12'• INCHES OR Z GALLONS MODEL IJUMBER: S - ~tA wsT 5 ~ =i is t~ s ~ b INCHES OR 30~Vl GALLONS MOTE: PUMP AND ALARM ARE bC S SWITCH TYPE: MINIMUM DISCNARGE RATE 6._6PM ' INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEN PUMP OFF AUD_DISTRIBUTIpN PIPE.. ~'yD FEET + MIAJItAUM- NETWORK SUPPLY PRE55UKE .2.50 FE:~94 + z'~ FEET OF FORCE MAIN! X d'SZF jOFxFRICTIou FACTOR. 0.10 3p9 y TOTAL Dy1JAMIC HEAD = q' 6~ FEET DIAMETER 90' k INTERNAL DIMLWSIOW~ OF TAWK: LEW&TH - ;WIDTH - ;LIQUID DEPTH ~1~ 'BOTTOM AREA 5 CJ 2:`7 231--_ t' l GAL/INCH AS PER MANUFACTURER GAL/INCH h TOTAL HEAD IN METERS _ co r- to Lo co N r O O O T Q co CD O co O co O CD N O CD - co N A, N O foe V N O W w Lo o°o 0 V I- r z Z ' 5 o E2 1. W O w o a. cn °v Z J 0 T o~ SS 33 J 1TY Q - ~POi~GpPP►G ° C3 0o U~ N 525 Q~ PQPG~-~~l G ~G CD co O NiG CD Q N O 00, cD C~ O Q - Q O O 4 CD - O N N N N C\j O O co NT T co ~ O h C\j K3 TOTAL HEAD IN FEET se Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of I Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY : s_-. c..hO IX 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. C) L) 0- ) Z [ so APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION f~ \`Z \ Cdr C N1 LS t` w 409 L9~ S E71/4 N W 1/4,S )~T L6 N,R ),9 E(009) PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 66'7 S~Z)~u ~1~tu y S - ` ~1 L41 *LL GLbvka~Z StkVr t At`RON CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [TOWN NEAREST ROAD W001_')Sv1Z,% M SS )L S (6/Z) 730_ 24~ 6 Z11 Soo Ltwt R,of4D [Kj New Construction Use [XJ Residential / Number of bedrooms L{ [ ] Additkn to existing building j ] Replacement [ J Public or commercial describe Code derived daily flow b 0 gpd Recommended design loading rate ° • Y bed, gpd/ft2 0, V trench, gpd/ft2 Absorption area required Sop bed, ft2 SOD trench, ft2 Maximum design loading rate o • S bed, gpd/ft2 0. 6 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ site considerations CZ ~c ow~M ~ V►°vk,p W IT-A 8 r 6 3 R ~0 • a SR+~D ~lLt Parent material S p C~~O S`lblki C~ Flood plain elevation, if applicable N • A ft S = Suitable for system CONVEN110NAL MOUND IWGROUND PRESSURE AT-GRADE SYSTEM IN RLL7 HOLDING TANK U = Unsuitable for stem ❑ S O u ®S ❑ U ❑ S [RU ❑ S [3U ❑ S IRU ❑ S [$U SOIL DESCRIPTION REPORT Depth Dominant Color . Mottles Structure GPD/ft Boring # Horizon in. Munsell Clu. Sz. Cont, Color Texture Gr. Sz. Sh. Cons~sbence eotrtdary Roots Bed tench a_8 1O`•t2 3/Z - 31~ Z►vt Sb1z >n~~ CS - o.S o•~ Z 8-tR ~0 `Z IZ 3/6 S 1 Z`F Sbk~~ r~ w - o• S 0.1, Ground 3 Iq-Za --)•S kR 3/ CSbk M L) CS o.q o•S elev. )o't ,o ft. zg- Z 0 7(~- I. y i s R S /a S ov,^ wl U Depth to y Rt tS 1~u t "rM7rin m&77 UA/ limiting factor wS'~ i _T_ Remarks: Boring # - 3 CH - 1~`f(2 3 ; `y ¢ ~>h S Yhv'F1- a.S 1 O.So.6 9 ~ Ground elev. f l r - -u Jl3 Y Cl '-12 /f3 1oZ•1 ft. Z9~ R Y -~-5 S S YA U Depth to 4 s lz S ia u Iw G] limiting factor Z 9 `r Remarks: TName:-Please Print Phone. Arthur L. We erer 715-425-0165 Address: Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: q_ q~ M00576 3 PROPERTY OWNER \2tCAr- AJEl. 'ON SOIL DESCRIPTION REPORT Page Of PARCEL I.D. # 0\40- 1 ZI S S O Depth Dominant Color Mottles Texture Structure Consistence Ekxgxlary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench tv~:J:'L!!23Ci:E S 3 1 o-S 10`-t,tz 31Z - st~1 Z~sb1T wt~ o. s o. L z 10 ~-t iV 3 bvt wr `f 4 e s o• s o 6 Ground 3 ZD 3 -7• S 4 ft 31y - S 1 0- 4 10 1-z Yn U C S 0 y o•S ~e1eV3 ft. 34-SY 1o`'tR /Z ~~sK2 sli3 `~s Owe vhv'~1. - - Depth to $ p S B o w 6 l limiting factor ' Remarks: Boring # _ - ' o - b v; Li 31Z s~1 Z~sl,k ~~f~ t:s - o.s o•6 X• y Z 6 - 31 do ~-t ~Z 31(. - S t~ Z '~J~k S o . S i 0. L 3 31-S2 tb~-IR b/y c ~.$~!R s/~, 'FS O ~+~►\Jiv~ - - Ground elev. 3 lo~S t 3 s l C~ Qk/ i)W vsd-o ft. Depth to limiting factor Remarks: Boring # :.s« ) 0_`I ~O`'L2 3l2 S1` z~sbk`F>. tX Z > 3 do ~-t ti 3l b s Z~~bli cs o 33_SL 1l 4m Ely Ground elev. 3 100.0 ft. S S~ 6 Depth to limiting factor ; j I Remarks: Boring # i. u~~............ Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05i92) - PLOT PLAN Page 3, of 3 • NL L 1 ~N . Z,tCh.. r' scr4~~ 1~t = U.0 ~ S~1D u0. 0~l0- LS►S_SO 3ly`~ 1J11~. 1~1.i't3'nC Pth~~ ' 1y w/coop LM'M,•~ ,vo-1 ° a fit, t,11 3 s. ~ ~ . y 4 Ott- bI3I%)Vte LL. eL 1,0 0 eL lot). ON !o" is H, ~ t s ~ / 3/V D)~A. pL~s77C PtP~ hN r m t.A 2 W 1/4 CORNER IZ SECTION 16 ~D ro T28N, R19W UNPLATTED LANDS to WEST LINE OF THE SE 1/4 OF THE NW N 01.35'06" E 800.89' ID _ 420.89' I Z - ISO. 0' o I U) ~I d II o t, CD u m cn . ° P, Ilu .0 D O N V I V O 4) m Ln D En w Z to C _n a) L" 0 0 \ Ww I ~ ,q A _ . d fn En ° <o m N I C-) H Z Ln I T r N V H py z v m I Z • 0E2 D m y ,6 Z m j Oe I by o ,E5 , pp5 6 ILI S~ n ~ L . p02 Ro OD \ O1 e6 so 0~ . 1 L O ~ o 6 19 .00. OA pLi Ul 0) I z SOO .p ~9 L N a m e 9 Z,~ I rr w S HIV I Z c,n "Se w I con f~ 0`9- 9 O UNPLATTED LANDS 41' \ \ 1' 68, f cn rn 3 ly°34, E 1/4 CORNER 1 x.6800" W SECTION 16 T28N, R19W rn S UNPLATTED LANDS So 9 ASSUMED BEARINGS REFERENCED TO THE EAST-WEST 1/4 SECTION LINE WHICH BEARS N 89°11'23° W ( I ~ I I I Z m N = ID n•~ ~ STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNEWBUYER C G ~r- lUl f~ 7~ 7 r\-) MAILING ADDRESS ~ S 7 '3d0&(N6 fFt CC ~D wEic~~~u2 y It C 55-11, - -199=9 04-uw PROPERTY ADDRESS L 004 rS 3 54 L iti E f?--O (location of septic system) Please obtain from the Planning Dept. CITY/STATE A gif 'J t"~w 5-~f d / PROPERTY LOCATION `5 1/4, -IU LO1/4, Section TN-R~W TOWN OF C~ ST. CROIX COUNTY, WI e5- SUBDIVISION ~2 rl 0 ® LOT NUMBER CERTIFIED SURVEY MAP , VOLUME /M4KGE-J7/, 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. 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 p' i date. SIGNED: DATE: 1 b' (0- q 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 Location of property_~1/4 /V X1/4, Section T N-R_-,Z W Township b~ Mailing address ~ e 'O/~ Address of site Subdivision name 2-qz°LoVNIo. Other homes on property? Yes 4 No Previous owner of property /yj d~ S 1 Total size of property Total size of parcel 2 4 c Date parcel was created Are all corners and lot lines identifiable? _ Yes No Is this property being developed f~o/r (spec house) ? Yes No Volume and Page Number '~7 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..52 Z 3 ~2 , 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 2 office of the County Register of Deeds as Document No. ~Z3 Z Signature of Applicant Co-Applicant Date of Signature Date of Signature e DOCUMENT NO. jSTATE BAR OF WISCONSIN FORM 1-198211 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED .ST. ~~®IX 196 This Deed, made between ~ C .Schultz,__eac_hJn--- thQiT__Q n_._rig]it----------- - - - - - , OCT 11' 1994 } Grantor, j~ 10:00 A. . and------- Ri-char_d-Nilsen --and__Valerie._Nilsen,_.as--marital 0.164,4 .suruiuorship--property- ftglaW of Dsaft Gra . ntee, - Witnesseth, That the said Grantor, for a valuable consideration--___. RETUR R I1J1L_ - ~R T-FfA~f~ B~aN K conveys to Grantee the following described real estate in .St,___Cro_ix--._._-___ County , State of Wisconsin: RIVIER FALLS, WISCONSIN 54027 1 Lot #45, Glover Station Second Addition Tax Parcel No- I~ 11, (This deed is given in fulfillment of that land contract dated December 2, 1993 in Vol. 1054, page 318, as Doc. No. 510297, II on December 10, 1993.) it I EXEMPT This i_S-.UQt........ homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And-__.__C_.__M,._Bye..and-Dennis-.R,--Schultz,--each- n_thei_r --own.ri_ght------- warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions of record. and will warrant and defend the same. 1 ,.'~o Dated this day of - - - October--------------- 19._94... ------(SEAL) -------..r- - (SEAL) M. Bye A - % -----------------------••-------•-----------------------------------(SEAL) - (SEAL) * Dennis R. Schultz AUTHENTICATION ACKNOWLEDGMENT Signature (s) STATE OF WISCONSIN ss. ST.__CROIX County. authenticated this ........day of___________________________ 19 Personally came before me this 41d day of _October____________________________ 19__04__ the above named * C,...M._-Dye and__Dexu>is__R._..Schultz TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person S.......... who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY - . C M. B e Attorne at Law y Y Sandra S. Lenzen .River.-Falls,..WI------ 54022................................. Notary Public St,-- l ro x............ County, Wis. j (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: Alzgust 10 19 97 ) j -Names of persons signing in any capacity should be typed or printed below their signatures. ~1 _WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Leval Blank Co. Inc.