HomeMy WebLinkAbout008-1078-30-000 a �
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 353315
Permit Holder's Name: ❑ City ❑ Village ❑ Towg of: tate Plan ID No.:
Youri Bob I Eau Galle Townshi 29 ('9 q I = Ttu I D .
CST BM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.:
f1D ,D
me" 0" S rr ( t pvC 008 - 1078 -30 -000
TANK INFORMATION ELEVATION DATA a?7. Z8, N/z.9-
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic IZ Benchmark
Dosing V Alt. BM ,)O y "
Aeration Bldg. Sewer
8 rr D
Holding St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet —
TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet —
Air
Septic > jLV > /oa' 6 NA Dt Bottom
Dosing >ioo' bf0D — NA Header /Man. f - (00 /0
r
Aeration NA Dist. Pipe 5; ` �� 1,0
Holding Bot. System 30 w 3 �� o c(�
PUMP/ SIPHON INFORMATION 41 - Final Grade _ a6 )
Manufacturer C Uq S e . and St cover S 2
Model Number &D %L� GPM o / p 3 3y4 kcn , o
5 � TDH Lift ,Z Lriction �� System- TDH )e ,.ql Ft
Forcemai n Length Dia: z Dist. To Well ( tro
SOIL ABSORPTION SYSTEM
/ Width Len th r No. f renches PIT No. Of Pi Inside Dia. Liquid Depth
DIMENSIONS n l DIMENSION
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING ufactur
SETBACK CHAMBE
INFORMATION Type O ���� �n r r r Mod Nu r:
System: /� �/� ?� � �Zo OR
DISTRIBUTIO SYSTEM
Header /Man Id „ Distribution Pipe(s) u x Hole Size x Hole Spacing Vent To Air Intake
Length Dia- 2 Length � Dia. - - Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ ❑Yes EE] Yes
COMMENTS (Include code discrepancies, persons present, etc.) In et>.on 1: a * /e7S7CPD Inspection #2:0 7////00
Location: 2428 10th Avenue, Woodville, WI 54028 (SE l/4 SW 1 4 27 T28N R16W) - 8.
1.) Alt BM Description= f�g�+ti., t,, eQoe� -CK6 cow) = h - 5 _ o ' (� I �� = i t -A, 01 tit
2.) Bldg sewer length 51)
-am 71 0-5 t of cov r = > 4(, y
3.) contour , 0'
Plan revision required? ❑ Yes ONO
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
� SCO/1$ %/1 SANITARY PERMIT APPLICATION 201 B Washington Avenue
Department of Commerce In accord with ILHR 83.05, Wis. Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the sys paper not lesf,_ ounty
than 8112 x 11 inches in size. R /
• See reverse side for instructions for completing this appl'¢at n sr Sanitary Permit Number
Personal information you provide may be used for secondary purposes --1 - [J k if revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. : Sr CFA, 41 ", ; Stati Plan I.D. Number
I. APPLICATION INFORMATION -PLEASE PRINT AL f N e -
Property Owner Name �,' Pr Loc `n
1 - /4 L 7 T Z , N, R 1(0 k(or)
Property Owner's h Add ess b r�, Block Number
a 10 �h
City State Zip Code Phone Number Subdivision Name or CSM Number
I 1 t 112, LJ O Z 1 ( - 71$)778 0 Z (lo( 10 pq Z71
II. T P BUILDING: (check one) ❑ State Owned ❑ !t� Nearest Roa
Public to 1 or 2 Family Dwelling - No. of bedrooms 0 Town OF , /O'er lh�
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
1 ❑ Apartment/ Condo 006
2 Assembl Hall 6 Medical Facility/ Nursing Home 10 Outdoor Recreational Facilit
❑ Y ❑ Y 9 ❑ Y
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 box on line A. Check box on line B, if applicable)
A) 1. (X New 2 ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an
_____System -------- ------------- Only ___ ___ - ___ Existing System ________ Existin�System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 CaMound ( ZE] Specify Type 41 ❑ Holding Tank
12 171 Seepage Trench 22 [] In- Ground Pressure 42 C] Pit Privy
13 [] Seepage Pit 43 [] Vault Privy
14 E] System - In - Fill a ID
�
VI. ABSORPTION SYSTIEM 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
(ADO 140 7. 16Y Feet /0 3Feet
act
VII. TANK in Ca allo
g Total # of Prefab. Site Fiber- Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existing strutted
T nks Tanks
Septic Tank or Holding Tank 1%i5 n ❑ ❑ ❑ El El
Lift Pump Tank /Siphon Chamber '756 ❑ ❑ ❑ I ❑ ❑
Vlll. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Pl= er's ame : (Print) Plumber's Signature: (No amps) , MP P!M SSW NN o.: Business Phone Number:
r .k z6 z 7/5'- - 7 7 Z - 3 Ze
Plumb 's Address (Street, City, State, Zip Code):
IZR ?0 "? );L�_, �Jl /5 -1 LIJ 4t: ��Q - 17
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved nitary Permit Fee (Includes Groundwater ate ssue Is' n Agent Signature (No Stamps)
Approved ❑ Owner Given Initial
Surcharge Fee) �
2�� _
Adverse Determination c� �'� "HI k 11��
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: W =�
SBD- 6398 (R.11I97) - 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 a 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 and Buildings Division, 608- 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. 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 on 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 for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /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 1/2 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 contamination investigations
and establishment of standards.
I'
Safety and Buildings
10541 N RANCH ROAD
HAYWARD WI 54843
TDD #: (608) 264 -8777
1\ *isconsin www.commerce.statemims
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
February 23, 2000
CUST ID No.226524 ATTN.• POWTS INSPECTOR
ZONING OFFICE
ROGER L TIMM ST CROIX COUNTY SPIA
3128 20TH AVE 1101 CARMICHAEL RD
WILSON WI 54027 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 02/23/2002 Identification Numbers
Transaction ID No. 296891
Site ID No. 187401
SITE: Please refer to both identification numbers,
Site ID: 187401 L above, in all correspondence with the agency.
ST CROIX County, Town of EAU GALLS; TENTH AVE, EAU GALLE 54028
SE1/4, SWl/4, S27, T28N, R16W
Facility: ROBERT YOUNG TENTH AVE, EAU GALLE 54028 /� P.
FOR: MOUND, 600 GPD C o
Object Type: POWT System Regulated Object ID No.: 649668 APP
XMRTMI
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROV ED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
SEE COR
The following conditions shall be met during construction or installation and prior to occupancy or use:
1. This plan action is subject to designer comments on the plan.
2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular
to the direction of maximum slope.
3. Vehicular traffic is prohibited in the area 25' beyond the down slope edge of the mound.
4. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a).
5. Insulate building sewer per COMM 82.30(11)(c).
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /instal lation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
S' ely, DATE RECEIVED 02/16/2000
FEE REQUIRED $ 180.00
FEE RECEIVED $ 180.00
PATRICIA L SHANDORF , POWT L N REVIEWER BALANCE DUE $ 0.00
Integrated Services
(715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM
PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633
Robert Young - Mound
Transaction #
Location: Lot 1, CSM 509582, Vol. 10, p. 2711
SE 1/4, SW 1/4, Sec. 27, T 28 N, R 16 W
Town: Eau Galle
County: St. Croix Na
February 14, 2000 30 l
OF COMM E
Owner: Bob Young `FETY ING$
Address: 2692 Boston Road �Eg p --
Woodville, WI 54028 NCE
Plumber: Roger Timm = `� 6 J
Signature: -
License # MPRS 226524
Attachments: 6748 -Plan Review Application
SBD 8330
page 1: cover
2: calculations
3: plot plan
4: system cross section
5: plan view, lateral detail
6: pump tank exit detail
7: pump curve
page 1 of 7
System Calculations
One family residence bedrooms
Loading rate �'Z 8 gallons /sq ft per day
Depth to ground water �' Z in
Depth to bedrock ' 60 in
Cross slope ,Z " %
Force main length 2- 0 ft of in
Manifold /header length N C4 ft of -' in
Drainback I '�' e gallons
Lateral length @ CO �'` o ft of �' in
Lateral elevation � �' ft (bottom of pipe)
Lateral hole size \lam in @ � in ( S ' o ft) spacing
� holes /lateral, holes total
Lateral volume $ gallons
Total lateral discharge rate Zz'Z'3 gpm @ ft head
Elevation difference
4.�-� ft
Friction loss ` ft @ � gpm
Total dynamic head -+ ft
Pump/s, on gpm @ o ft of head
Manufacturer O "" - I Model #
Dose volume gallons
Lift /sighon tank �' °8�'`' �z }� }� gallons
septic tank g allons
Measurement pump on & off �'� in
Height alarm from tank bottom "� in
Reserve capacity g S gallons
calcs page 2- of
PLOT PLAN Page 3 of
SCALE 1 "= to O'
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_ � WEATIIERPQOOF
.3UNCTIaN
11JCKING + COVER Lot
pI11GK Dl��vICT -- �
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TO ND►yTuaBED
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E3€lalb MAN
A 30,1
pppapytp C.Y. P1r
SKET 3bjwr6 —� WFLES 1 AL 3' o.Ro
L. PIPS IS . V. pN – I sTU�la.
1{NECTIOMS � ,1 GRDUItO
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9 g. Ow PL"p
ColvCreErF .
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SEPTIC E SPECIFfCATIOUS
DOSE W ; �► nom„ ��
TAUKS MAWUFACTU0.ER: WUMEER OF DOSES: PER DAy
\ M 1»
TAA1K SIZE: 'L 1" GA1_LOUS ,DOSE VOLUME f
ALARM MALIUFACTUKLR: - IAtCLUDING 6ACKPLOW: � GALLONS
MODEL IJUMDEK: I CAPACITIES: A= 3a I IWC14E5 OR Z CA LLOUS
SWITCH TyPL: wo... B= 2' I NCHES OR 52.2 CALLOUS
PUMP MAMUFACTURER: &04 Ca lf � IULHES OR 1b CALLOU
MO E INCH GALLO►JS
D L IJUM�[R: 0 ES OR
SWITCH TYPE: ` °JrO ""� r ' O MOTE: PUMP AWD ALARM ARE TO OL
MIAIIMUM DISCHARGE RATE � GPM INSTALLED OW SEPAR CIRCUITS
VERTICAL DIFFEREIJCC 6ETWEEM PUMP OFF AIJD OISTRIRUTION PIPE.. �• }� FEET 1
+ MINIMUM METWORK SUPPLy PKItS6UR . . . .. . . . . 2. FLET
♦ zo FEET o f t•oacc MAIM ,� \ F /pprx FRItT10W FACTOR. ..._ FEET
= TOTAL Oyt,JAMIC, HEAD = FEET
1UTERWAL. DIMLW61OWS OF TAWK: LEW&TH `Z Z ;WIDTH � 9 ;LIQUID DEPTH
M ODEL 1 MO
Vertical Sump Pump Submersible Effluent Pump
0 EP0
ow n
M t.
GOULDS
}
i 11
1 �1
i n�
Pump Specifications I METERS FEET
' H P 10 MODEL: 3871
Up to 40 GPM
Discharge size 1 NPT ° 30
Solids: ��" maximum 5
u
Motor
Single phase: 115V 5 20
Materials of Construction 5
Brass/thermoplastic 4 15 EPOS
Features and Benefits
0
*Top suction eliminates 9
EPO4
impeller clogging. 5
• Corrosion resistant '
construction. 0 % 10 20 90 4T 50 US'GW
• Float actuated switch. 0 z . 6 B 10 12 W AW
C iPACITY
METERS FEET Pump Specifications Features and Benefits
7 MODEL DVP03 4 /10 and' /: HP • EPO4 impeller- semi -open design
m Up to 60 GPM with pump out vanes to protect
5 16 Maximum head to 32' mechanical seal.
4 Discharge size 1 NPT • EP05 impeller - enclosed design
3 To Solids: 3 /.' maximum for improved performance.
: Motor • Rugged glass - filled thermoplastic
0 T 5 All motors feature ball casing and base design provides
• bearing construction. superior strength and corrosion
o
0 5 1 0 1s 0 u 30 3s eo o.S.oPM resistance.
Single phase: 115V
° x CAPACITY 6 6 VO Materials of Construction • Cast iron motor housing for
Cast iron efficient heat transfer, strength,
Thermoplastic and durability.
Stainless steel • Corrosion resistant threaded
stainless steel shaft.
• Available for automatic and
manual operation.
• CSA listed models available.
All Models are designed for continuous o ration and feature stainless steel hardware. o
�d-�
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page I of 3
Lal!-w and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
s COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST. Cr-'3 1 x
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 E EWED BY DATE
PROPERTY OWNER: to PMj -t G ewR:1 a PROPERTY LOCATION
Se!t� L_PCCt. SON — GOVT. LOT S C 114 5 W 1/4,S 7-1 T 7 -- 8 N,R t 6 E (Ora)
PROPERTY OWNER-S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM #
187-5 QUmi t'tUt =. Souk I �1 �Vw\-oS`� C-S►�
CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE SrOWN NEAREST ROAD
sT CZf3Iy B U >tin► sso�1 (blt) v 6+"1l,L E �o 'rat Rv�•
{� New Construction Use Residential / Number of bedrooms f { ] Addih�rt to wdsting building
(] Replacement {) Public or commercial describe
Code derived daffy flow b o O gpd Recommended design loading rate c • - - b ad, gpolft c - 3 trench, gpol11
AbSox n area required S o o bed, ff2 S Q trench, ft Ma>amum design loading We o . S bed, gpd/ft 0 . 6 trench, gpoltt
Recommended infiltration surface elevation(s) t oy. O It (as referred to site plan benchmark)
Additional design / site considerations
Parent material Lu 11�3s . ovL� Tj% hL Floodlit elwa pce, if applicable N " . It
S = Suitable for sysikim CONVENTIONAL MOUND W -ffi"D PRESSURE AT -GRADE SYSTEM IN RLL HOLDING T
U= Unstattable for. ❑ S MU 0S ❑ U El INU [IS o U ❑ S ®U ❑ S ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Motties Texture Sere Consistence 8arxl3y Roots GPD
in. Munselt Qu. Sz Cont Color Gr. Sz. Sh. Bed Tmich
13 1 o -LO "b az-3i3 - s ib Z`�sbk `r`'�`�`^ cS - o- a�
Z ►o - Z(� �oH �S) Z'FSbk bv1 v�1,. eS _ o S o •�
Ground 7-6 !uti 3J6 4 �'S`�QSI� �S1 Z�S`1�2 YrtV`F eS
elev.
Ct S ft y 33 _3� l O`� �Z i�/ e Z "t `F S 4`^-� yn —
Depth tD
limiting
factor
�
r7
Remarks:
Boring # ;
1o`1 S
2 'L al .7-g b y Iz S i
S: o, 6
3 U -3 \oaf RV /y s ! 1 Z`FS bk ti►� `F1�
Ground
elev. l Oy R S1 o>Y\ y
q • 3 fL
1o�231b AH �
p��9 co ' t
factor v
1, h
v
Remarks:
CS T Name.--Please Print Arthur We e r e r one 715 ` , 2 5 016 5 :'
egerer Soil Testing& Design Service -P.O. Box 74 River Falis'Vl 54022
Signature: Date: CST Number:
X13 - Z tiff-- \`1 -a3 M00576
3U�t C1Z.
PROPERTY OWNER L t'CCZ Sl�r SOIL DESCRIPTION REPORT Page Z,of 3
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I Bed ITmnch
$4.... .::.:: �_�0 sv � 2`Fsbk v►r'f>^ �S o.S o. 6
. . ` s o • 6
byii:ii<::Li::.v.:•:.:
Ground 3 --r_ S K [Z SI C-)—
elev.
1,0 -I ft. c l Cp+v fV T3 $ 01= S v `'F z
Depth to
limiting
factor
Remarks:
Boring #
c•
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
9iii�<SL{:va:+i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground /
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
P ? of
0 3
PROPERTY OWNO 1 -• t'C -
1 SOIL DESCRIPTION REPORT
PARCEL I.D. #
. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
2�sbk vrr'�1� CS o•S o• 6
Z - S bk kPi `f f^ C.S _ o. 5 c, 6
,V-
Ground 3 Z.6_bo lv`lft- S/6 - �LS`fTZ 519 s —
elev.
ft. Ccyv w S o!= S Tlv&
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
Uniting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
w�
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(R.05/92)
aQ4 t��
PROPERTY OWNER l., NIX soNj SOIL DESCRIPTION REPORT Page?- of 3�
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boir>dary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr.. Sz. Sh. Bed Trends
E l \ p_�0 S�� 5 bk V" k eS o•s o• 6
Z �o - t�1"1 �!� S 1( Z'�sbk kn `Fr. cs _ o. S o• 6
Ground 3 zfQ b0 1 u`Z 1Z S/6 - �lS'm Sig 5 1 O
elev.
Tro w S po \j I
Depth to
limiting
factor
Z6"
F
Remarks:
Boring #
E3
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
t
EY
!A:
Ground y
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
PLOT PLAN Page 3 of 3
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CST Signature Date Signed Telephone No. CST #
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address '9 !/Zc? /
`� v
Property Address �a `�
(Verification required from Planning Department for new construction)
City /State G-)Qr)J 0 4< / P arcel Identification Number Iy 78 :Rd
LEGAL DESCRIPTION
Property Location % ' /4, S "k ) '/4, Sec. 7 7 T2S N -R loo W, Town of
Subdivision Lot #
Certified Survey Map # '5 - 094? Z , Volume / , Page # 7l /
Warranty Deed # _ h // j , Volume /x/75 , Page # Z
Spec house ❑ yes JX no Lot lines identifiable E] yes ❑ no
SYSTEM MAINTENANCE
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 pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department 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/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
daA ofe ee year expiration date.
�2/ .2//
SfdNATLMEA APfLICANT DA'L'E
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
AZ/
NATURE AM A DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
10
VOL 75 PAGE 232 614 789
KATHLEEN H. WALSH
REGISTER OF DE
Document Number
WARRANTY DEED ST. CROIX CO. W I
RELIVED FOR RECORD
Scott M. Ertle and Jean R. Larson, husband and wife, 1E -02 -1999 9:00 AN
conveys and warrants to Robert L. Young and Janet M. WARRANTY DEED
Young, husband and wife, the following described real EXEMPT I
estate in St. Croix County, State of Wisconsin: COPY fir
TRANSFER FEE: 111.60
RECORDING FEE: 10.00
PRIDES: 1
Recording Area
Name and Return Address
F f lr
008 - 1078 -30
(Parcel Identification Number)
That part of Southeast Quarter of Southwest Quarter (SE of SW % of Section Twenty -seven
(27), Township Twenty-eight (28) North, Range Sixteen (16) West, described as follows: Lot
One (1) of Certified Survey Map recorded in Volume 10 of Certified Survey Maps, page 2711,
as Document No. 509582. Together with and subject to a 66 foot wide common driveway
easement as shown on said Certified Survey Map, St. Croix County, Wisconsin.
Exception to warranties: all easements and restrictions of record.
This is not homestead property. Dated this 3_ day of A) ' , 1999.
0
• tt M Ertle
• ` 'Jean arson
AUTHENTICATION ACKNOWLEDGMENT
Signatures) STATE OF WISCONSIN
ST. CROIX COUNTY
Perso y me before me the _ ?- 0 day of 0 O f
19" he p¢ove named Scott M. Ertle and Jean R. Larson to
authenticated this _ day of kno o be the person(s) who executed the foregoing
� _ kd niture strumOt and acknoWed P the e.
Signature L
type or print name - . , " type or print name ✓4 lM rJF K • ✓ b`�l
TITLE: MEMBER STATE BAR OF WIS. SIN k Notary Public St. Croix County, Wisconsin.
(if not, ` My comR is permane If not, state expiration date:
authorized by §708.08, Wis.
TNN�E�sZ �
THIS INSTRUMENT WAS DRAFTED B) a,� •Names of persons signing In any capacity should be typed or
Thomas A. McCormack printed below their signatures.
Baldwin, Wl 54002
Inf-tim Piafa.sioMlc Company Fond du Lac, Wicmnain 6009152021
1 • f
0
FILED �
8 NOV 2 419 2
L JAMES O'CONNELI
Register 01 Deeds
509582 St . C Co.,w►
CERTIFIED SURVEY MAP v '
THE SE I/4 OF SWIM OF SECTION 27, T 28 N, R 16 W, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN.
PREPARED FOR:
NANCY GEHRIG NI 14 CORNER SEC. 27
(FOUND COUNTY MON.)
U . NPLATTED LANDS w
w
N.LINE SE-SW� 16'
o� w
N89 °36 "25 " "E 1327.64" °- rn
750.69' 576.95'
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�++ Z 20.81 ACRES a 19.34 ACRES m
m (906,275 SO. FT.) o (842,260 SO. FT.)
co
19.96 AC. EXC. EASEMENTS _ 18.41 AC. EXC. EASEMENTS of
.0 ro m (869,421 SO. FT.) Z (802,097 SO. FT.) v�
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ld
N89.33'57" - II•• / 678.92' _
132168'. — 580.62_
•33 6' ^ 609.25'
.... S89 °3 "5 "W 1 325.68 " S. LINE SE -SW
�SW CORNER SEC. 27 10TH AVE S1 14 CORNER SEC. 27
(FOUND COUNTY MON. ) - - - ........ (FOUND COUNTY MON.)
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