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HomeMy WebLinkAbout008-1041-80-000 M N bq N M Q. 0 a N L O C I N 3 Ory N ° O -O Y N p w. N c i a N O'- C ..~.0 C h 00 °o N O_ U O C 3 N cO Q 7 Q O L C Q N uj O CL > r_ Q (0C) E co y N CL O O N _ co U' N = ~ N 3 0 0 01~ N00 0 .0 L s wCO o c ° ° 0 m o rZ ~M aci a~ o ~g ° o 5a Z 2 `y N C (D c aCo LL C E N - O N y U c `m 0 co N O c a E Q c 3 N U co -,t o. V N 1/1 O II, 0 0 Z d y 00 w a co `r~Z c O 0 z c 00 co - O m 2 C fo r Q1 N Z S CD E -o ~ M CL a N N c •N d t p c c O :o O z H Z N z N ° O Cy c ~ l0 E N N w U CL m N N d i ~5 U) O c o a E c U) U) z o = U w z - - al ~ II ° 3 3 3 ° 3 o o o z iQ Z (L IL CL N a co 7 O N X rn am N co -j U rn rn ° } O M (O 00 0 0 O O N N U E _ N > N M O 00 N m N _C3i CD O C O O N N W O c E N C O 'o E (0 N co 0) Q ~ Cl) F- J a) c f n- 00i 0 0 0 04 N N ,f"a N C N C C N-_ V f6 O N c O N c N M N O O 00 N fl O yC n'q co N 7 0') 6: :3 _r_ LU co c) z W V 0 a y a ' C y t7 N a • C S rr`i~~l E c c °1 `~1 A 0 a rL 1, 0 U) J STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER At U e eR~~ ~Sopt ADDRESS SUBDIVISION / CSM# /V A" LOT # SECTION___/1~4 T _N-R L 6 W, Town of LLe 14.2AS.1&-v~;;I3 ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM J ~ J 1 ~ 1 111 `~.a S G ,1 1 11 0. 1 1 F! bk3 o i= G►N \11\ r'r' S, puvG 1 ~ Gft^be 1 6 l 1A %'t"2+-1 Q f 000 GAG Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover- 4 HOSOSdSNI G! C)1 Q 1 2i 1~1Wf1N :I SN IJ I`I Y~ Cf :80 r NO URUWn`Id - : NOI,LV'I'IKZSNI AO SlVG J apPAb TPUTd %7 apPJE) buTgsTxg t-ttTCw;aqsAs 3o moggog r~ PT03TuPW/z9peaH 330 Lund✓4 / uioggoq Od gaTuT Od gaTgno ZS J ' gaTuI IS f .zaMaS buTpTTnS v' MOLIVARME .z911g0 ~~asnOH :-[-[;Dm :mojj xoeggaS >J : auT T • doad gsaxeau og uoTgoa.zTQ )3 aouegsTa satioueaq 3o .zagmnH 06;7 ggbuwI : tIgpTM z XHISAS AIOISdu0s8K 'IIOs uotgeooZ uuPTv :a13- oTTPO uoTge.zadas 1eoT3 azTS pOL1 IV A jazngoP3nuPy~ :dutnd zau40 ~asno}I~-T TDM : uto z3 NoPC{gaS :A-4ToPdPO p-FnbTZ :.za.zngz)PlnuPW XOIIVNUOdNI XXV1 Oxla'IOH / 'dHHW`dH0 dWnd / XNvs OIZdas : WII 3.I,1iN2i3,L`Itl . _ nJ - -v--tQ.~-,~~, - _V- _ ap~ :?i2ilfYiH~AI3II r part of ► 14.28.1WUTE SEWAGE SYSTEM County: Lahor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: 19 922 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: ev.: Insp BM Elev.: BM Description Parcel Tax No.: fr rr 41 611 f.. a,cal~,,;•~': 008-1041-80-000 TANK INFORMATION ELEVATION DATA A9300330 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /a/,8G /DO Dosing Aeration Bldg. Sewer Holding St/Ht Inlet 3,8' q5-, 21 TANK SETBACK INFORMATION St/ Ht Outlet 6,1? TANK TO P/ L WELL BLDG. Vent to ROAD Dt Inlet Air Intake Septic > 7 76 ' 3o yam} - NA Dt Bottom 9 a 3(1 Dosing NA Header/Man. a,s 43.36 S qL Aeration NA Dist. Pipe Sri A? Holding Bot. System 4•s s ka.3 . +o•s~ y 3a. o, 3 i PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft mead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH Width _ Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS j too' DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Model Number: System: !f /00 70 Aj/,I 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 ~-~D Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/ Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENT$: (I, a code discrepancies, persons present, etc.) j. ~,OCATION : GALL~14.28.16.2` t3 ~ E ! ! > ID. Plan revision required? ❑ Yes ❑ No I "se other side for additional information. BD-6710 (R 05/91) Date Inspector's Signature Cert No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i 713ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE AI~ITARYM -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ecCl/lE1J`/f1~JC(//~ 8% x 11 inches in size. Ch if a 'ion to previ us 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 Z- i/ eD4 /1 if --Q R Tt srn 1Y CJ'/a S6_%, S 1 y T 2,P, N, R /G E (or) PROPERTY OWNER'S MAILING AD RESS LOT # BLOCK # CITY, STATE P CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ROAD 11. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ [ZI VILLAGE NEAREST 7-AX 'W" ❑ Public 1 or 2 Fam. Dwellings 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 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. ❑ New 2. C5Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ©C? / 2 23 ® , gpy 9111 ety 13 q ,Beet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank ®t90 -~/l, Lift Pump Tank/Si hon Chamber F1 0 Vlll. 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 Signature: ( Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): c7 7 - d2 p 7-I -sr X5 A Zd cW irz rs. ~y~ G'~, IX. COUNTY/DEPARTMENT USE ONLY Disapproved itary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved El Owner Given initial Surcharge Fee) Adverse Determination & I 11--d 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 INSTRUCYIONS 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 63`x19) to be submitted to the ;runty prior to installation. 5. Onsite s(-wage 5; stms must be prr periy mairrtai ee. the septic-tank(s) must be pumped y licensed pumper whenever necessary, usually every 2 to 2 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. 11. 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 sy.%Aem. Check appropriate box depending on system type. VI Absort. on Fyste,., information,. Provide all information requested in f#1 7. Vil i.~?.l~ f=7it7rirai ECi~ is in We i.apaeity of every new and/or existing 'ist the total c'a1 or rwmber of tan/ s an t=nijfai,! ,=rer's narne. indicate prefab or site constructed arcs tank material C orrlr Ete or all se0c, pu; P,siphon and holding tanks for this system. Check experiri iital approval only if tanks received ~Uxpe product approval from DILHR. VIII FiocrznP„>it:iiity statement. Instailing plumber is to fill in name, license nornber with eppropri *e ;prefix (e.g. IvtP, etc.) address and phone riumber. Plumber must sign application form. IX. County hupartrnent Use Only. X. County/- Argpartment Use Only. and sper?+ : tior?. not smaller than 8Y2 x 11 inCt?8s t:`>± be Submlttst-' „ tt' ? ;-oltnty. The i ud plot plan, drawn t- scale C, 'with ~.o'i"i fete ditile'.",y ;`x; ation of t+C"-`bli j, Sc,. t ani ~i J^tlef treatRi6nt tanks ser SErEd3r'- sepNe ~i.,rop r, -~:;coh-n tanks, distribution bOxeS, Sig{r ai -~-_!!,tion SY tE•+'tl err i,, - ,~{trFf system and of the building served,- 3) horizontal ane_;, i=t... ,..,elreu,,ati.' C) corn pk-,le spr-ci icatioris for pumps and controls; dose volume;; elevation differencer:, it ct _.r, 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. g The n-ionies cc!lected through these sl:rchargvs are I 'rsFd for rnoiacrin ~ grcuridwater, water contarnination investlgations and estabhshrrwnr ct stai o4ards. SBD-6398 (R.11188) Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor 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 81/2 x 11 inches in size. Plan must include, but S T. C(2~0 C K 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. O O B - lO4 1- 80 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION L N V tl~-1U ( t9 E L I cc S 0 N GOVT. LOT N~ 1/4 SE 1/4,S I Y T ZZ N,R 1 6 E (04 PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # Z S~ Z C~~N`M N" - - CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®fOWN NEAREST ROAD Wbbt\jlt_LQ- W1 SVOZ8 (~IS)b98-ZS6S L:fSU GPV kL i C`r)i'N [ ] New Construction Use M Residential / Number of bedrooms 4/ [ ] Addkn to existing building PQ Replacement [ ] Public or commercial describe Code derived daily flow bum gpd Recommended design loading rate bed, gpdAt2 2 S trench, gpd/ft2 Absorption area required - bed, ft2 \z.oo trench, ft2 Ma)amum design loading rate u '4 bed, gVW a S trench, gpd/ft2 Recommended infiltration surface elevation(s) S Q:E &Ju~ 01,j llhge 3 ft (as referred to site plan benchmark) Additional design/ site considerations »c.\~-s'tCS W G 'T~T~jC)t* Le JGnt Fizam %v to t oz' 1,S R htit~u D , Parent material 5 (Mv vni~vT c ~ t*+z 1i ~u vtzk s 4 c Yo~n~ Rood PlAin elevation if applicable N It o t't'~O S = Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE TAT-GRADE SYSTEM W ,LL HOLDING TANK U=Unsuitable brsystem ~S ❑U LPfS ❑U ®S ❑U [~S ❑U OS ❑U ❑S J SOIL DESCRIPTION REPORT I Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Conn Color Gr. Sz. Sh. Bed rends ] .1 S u• 6 St Z F 112 wt F►.. S o. o-$ LO`-I,Q- 31 3 a 4 Ground 3 -3$ IQ) `1R YA - ~g tC~bk vnv~~, cg o s 6 eev. ct31 Qo ft. LO 11 R S/g - ~y owe Yrl v ~L. u , y o. S Depth to ems, rv Mui S N - S'1 R- y / ►n u 5 g S limiting factor > 76" Remarks: Boring # ~ Z 'F S 1~1~c t^t ~ a- S o • S ` ~ . ~ fa Z Z to zl= l~~tz g1S~ s i l Z~'sb►~ vn ~f►~ as S 3 Z6-41 ~`-1 ~ YIL ~ ~s ~ i~ sl~k y'►'I u~F~- CS Ground elev. 17 ti0 `l 2 S l ~S Owe Yn U - o • q l7. S 3.S ft. Depth to S ~ nro~ ~ S L( 1'ra OU E - limiting factor Remarks: T Name.-Please Print Phone: Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: 013_ Zy~ tio,ZS-°t3 M00576 PROPERTYOWNER B~-~LSW►v SOIL DESCRIPTION REPORT Page, Z.of 3_ - PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure COnsistience Boundary Roots GPD/ft in. Munsell Qu. Sz. Coat Color Gr. Sz. Sh. Bed Trends Ground 3-q Lo y 2 y/6 elev. gS.~ft. y 39=17 lOYR S - `~S - - - Depth to S )u o 1'L 81 limiting factor Remarks: Boring # 13 Ground elev. It Depth to limiting factor I Remarks: Boring # rv.. Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PLOT PLAN Page 3 of 3 SCALE 1"= 30 ' n2~U~Z `rp C~Jrt~ ST1~c~ cnUly . 8,t 0 o `was 3. \3?~ - ~TL 1OU .O O1J U-rmH 0 OF GftgN s% S~puv ~ x 6 6 prekae b' ~-1, 6 D2w~ 5 S ~s?SIpL~ S' lIrL `i3 0 x SE'P1ZC ~ Dt ~nn IJ C `Tl} t ~ a No `t-IF tNS~`t~-~ 3 "~1C!(~5C11 Sr►vtD~ B`1 ~n~rv~w,~n gor LoivG~ 32.E lJ~ ~T ~?+E k:~7LkEu"OivS ~)T I)ME OF coiuST,~-Ucl>bN. ~~pp %-24-7 d VQ) 'ZS_g3 (715 ) 425-0165 M00576 CST Signature Date Signed Telephone No. CST # PLOT PLAN SCALE 1"= 3D ' r' X935 B.2 r 5 ! 0 L'1.a5~ j ~ oi= 6~~aIt6E S~puvG 1 ~ wl x 11 ` 1 ~ ,e 1 C~R'¢~rGe 1 6 1 ~ ~1 6 . a.~ 12c~S14~N~GF lL`~3o fOD©GhL S• rAgk X 7 n C 21 \~vSTkti~ 3~1c~NS LAC\i S~wtD~ B`1 r'I~rvlr~vn go LurvG zl~ O~-EP ~T TL X01?E ~D -1ZM IhIL ~SI~C C\~ tzl-L~Jr~T7o~v S ~lT T~ ` OF CU- JST7-)JC7>'o,1 . C ROSS sue- c-r Fresh Air Watt And Observation Pipe Approved Vent Cap Mlnlmww 12' Above Final Grade I i _ 4' Cost Iron 20 • j Plpe Vent Pipe To e Mash troy Or Sying min gals OObvlbutlon Too 0 0 Pipe d Pope eolow d Perforate eu -Coupling Terminating At Bollom Of $Tslam goto5eJ 16 FL.~, t. /,arp, OI`~c or~,.r--- - 80 C,~ 6~ moo!, 12 41/1 r DIS'7-RIgUTI•JAl PIPE TU BF AT LEAST i_ INCHES BELOW ORIGIAJAL bftADE- AUU AT LCASTZO INCHES BUT 1.10 MORC THAW 42 INCNES BELOW FIAIAL GRADE I''tAXU'wM DEprq OF EXCAvATieo F'RoM OR16NAL 69ADF WILL BE --~_~IAJCNES MiN►MUM AEP" OF FACAVATIOM FROM 0~14IMAL F3RAPE WILL BE INCHES LIGEUSE AJUM13ER; DATE: S J N, SEPTIC TANK MAINTENANCE AGREEZIENT St. Croix County ~ OWNER/ BUYER Z-,~r !Uy`P 1e/ ~-e L s cs ,1 0 d ROUTE/BOX NUMBER Fire 'Humber S S z/ r QOu ; 'z CITY/STATE ZIP PROPERTY LOCATION Section=, • T?.N ► R_ + Town of~ u!~~ St. Croix County, Subdivision Lot number- Improper use and maintenance of your septPicosyystem could result in its premature failure to handle wastes. atyeyou arsput or-sooner* er. gists of pumping out the septic taanWWO k every t9ree if needed, by a glicget ns'ed se tic - the system- can a t e' unc on s eptic .tank as a treat ment'stage_in the waste disposal system. St. Croix:County residents m,,► be pllacementtofracfailinggsystem~, a maximum of 60% of the cost.o£ ree 1~ 1978. 5t.. Croix County wh c was in operation prior to-July accepted this program in August of 1980, with the requirement that. owners of all-hex s s e~ agree to keep their system properly maintained. Zoning a Croix County The property owner agrees to. submit to St• mater plumber, certification form, signed by the owner and by a er ears journeyman plumber,>triQSitecwastewaterrdior.a sposalcsystempispin proper f Eying that (1) the o if nec- operating condition and •(2)•after inspection and pumping ( , the septic%tank is less than 1/3 full ofdsludpriordtscum. essary), Certification form will be sent approximately 3 three year 'expiration. ► i/WE, the undersigned have read the above iin accordancegwith to maintain the private sewage disposal system the Wisconsin Depart- t s at ourcegherCertificationyform must be completed 3 b me nt of Natural Reso and returned to the 5t. Croix County Zoning Office,within`30:days of the three year expiration.date. ,r T=' SIGNED DATE ~ St. Croix County Zoning Office 911 4th:5ty Hudson, WI 54016 386-46.80 the above addres Sign, date and ,return to s.;; STC -loo This application form is to be completed in full and signed by the owlner(s) of t)te 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 _ C=,~v~~'s~ Location of property El/4' S% 1/4, Section' , j 4 , T ~LN-R 6 W .Township Mailing address s~ _ CT Address of site Subdivision name Lot no. other homes on property? _yes No Previous owner of property Total size of parcel, x Date parcel was created go 'doR c ' Are all corners and lot lines identifiable? =Yes No Is thin property being developed for (spec house)? Yes No Volume ~1 and page Number as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARIWITY DEED which includes a DOCUMENT NURDER, VOLUME AND PAGE. zium3i;n & THE SEAL OF THE REGISTLR 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 reCerencoa to a cortified survey Map, the certified survey Hap shall also be required. PROPERTY OWNER CERTIFICATION I(wc) certify that all statements on this form are true to the best.of• ny (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 iq the office of the county Register of Deeds ns Document Tlo. eS , and that I (we) own the proposed site for the sew ge disposal system orreI (we) obtained an easement, to run the above described the construction of said system, and the same h~pR been/dul recor,c~e n y t le office of county Register of deeds as Document yC No. 'Signature of apt)1 cant - _ Co-applicant 9 Vat-tea a Signature Date lAsrig nature No. 83. Warrmnty Deed-Common Form (STATQ Of W18CON81N) sm 266.16, W66 Statutes. Perm No .1 Published by Eau Claire lhak & Stationery Co. This Indenture. made this day of Now"!Awr A. D., 19 i between u1 1 Alice-!. i3erte 1_:,or;, iii , ~I.t :re part i :;,,of the first part, and • part i (,pf the second part MitilrO£tb: That the said part i , of the first part, for and in consideration of the sum of ; otli,~r :oo. an.f wjl.u,tble con: i,.er,j_f. i_on. to - in hand paid by the said part :i e,,3 of the second part, the receipt whereof is hereby confessed and acknowledged, have given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part ; of the second part, th i I. heirs and assigns forever, the following described real estate, situated in the county of P • i and State of Wisconsin, to-wit: li I 01, ~I 1. F1 _ i ~ .-711 1 -,...'ill, _ I~"- ~ ri•: t. I III I I III i I it I I I I it i I u VoQ£th£C with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim, or demand whatsoever, of the said part of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises and their hereditaments and appurtenances. ! Zo i'lab£'allb to 11alb, the said premises as above described with the hereditaments and appurtenances. I unto the said part ; of the second part, and to M h- 1 1 heirs and assigns FOREVER. I itL• ffj£ t1iD Y,cl son ru.-i ' ? rkt '_.;r,n for heirs, executors and administrators, do covenant, grant, bargain and agree to and with the said part l of the second part, i r heirs and assigns, that at the time of j the ensealing and delivery of these presents re well seized of the premises above described, it as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and II that the same are free and clear from all incumbrances whatever, and that the above bargained premises in the quiet and peaceable possession of the said part i of the 8001( PAtA i ! o "o } i } } ~ t17 i ` 1.> rD ~ M Co b ' ? {0 ° N o 0-3 } 5 ? E ra rn' ti ra Q4 ~ b s~ o ~ d I I (•6aniou pun xao-uv-'v:x.l'-va8 w(nunae aqj jo Ioulnu oql Uo Ja>n uauiieWa.q ao mulid ,itu!uld nnn4 iluga papaooaa oq aj w1w tunjigul rim 3ogl n'prnwa *K%ng •a!M e9 'qo-'u•x) .............................._.._...._................_....__...»...._...._....»...._.........._.........r------ tfl7 FJa~~Cl (1 ? soard2W uorssrrrruroo dYd rrrsuoosAl `Sjunoa ,orlgnd tae;oN n/ 'arue as q; pa2palmouyou pue ;rrarunz;sur:.,&uro,3azo; aq; papnoaxa ogAi. uoszad aqp aq o; u. iouy aru o) paurVu anogc orll ` 61 "Q 'T~ • {o rfep )-7 slip 'aui azo;aq aurco _ SS 11 'UJOU0301M 30 33tiarZ5 ~leaS~.:._..._.. _ _ _ _ _ zzd ,y ;i,•...+~.1 _ ~l eaS~.........._._ . _ _ _ _ . _ 1 - ;o aouasasd ur paleaS pus pau.7rs y161 "Q'ty` ~ao)\ do dep J-7 srq; leas Pue `-pueq .z r.ai;:a ;as o;unaaaq eg ;zed ;sag aq; ;o ? ;led pres ailp `)o3]J(}M ¢53ujjM ug: QN~d~Q PUe LNVUUVAJ aaeaaoI Ilrnt ';oazagp pied rfue zo aloge,, arl; Eur[urup Alln;Mel `suosaad ao uoszad dzaea pue Ile ;SUre2u 'su2rsse pue saraq J--: 'rzed puooas ~~93~ua 8Z~ ~ooa. L z4 ;a CL D zaz2 V CD 2433 2428 N 2447 Vt N I 2460 2465 2464 o, 2475 8 2474 • 2484 2 2 Ot6 5y~i a V ro 2509 N ~ 25,2 r 253, - 2530 2533 W 2548 ~ 2549 k%l ~ 2559 2555 C R mss, c - 2581 Z 2582 2581 ~ f N 1 ` ~ WW A VN V 2637 • iZS 65th St W 268, \ 267 0 / f \ 1-1-1 Visconsiq Department of Industry, SOIL AND SITE EVALUATION REPORT Page t of 3 Labor and Human Relations Divison of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY s T, Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or gO dimensioned, north arrow, and location and distance to nearest road. O 0'6 - l~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION L l CCZ: S L) N GOVT. LOT N 114 SE 1/4,S l T 2,15 N,R 16 E (a 11 L V e-N'e_Q E ftKA- PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # Z S 8 Z y q " N" CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE LWOWN NEAREST ROAD wbbOUt t_t_l r WI S VOZZ (~ISl~4~-ZS6S Lefty Gr e`ni N [ ] New Construction Use [JC] Residential / Number of bedrooms [ ] Addition to existing building Replacement [ ] Public or commercial describe Code derived daily flow bub gpd Recommended design loading rate ` bed, gpd/ft2 ° -S trench, gpd1ft2 Absorption area required bed, ft2 \z-oo trench, ft2 Maximum design loading rate '4 bed, gpd/ft2 ° -S trench, gpd/ft2 Recommended infiltration surface elevation(s) S kZZ ►~uR w- 7fts(z, 3 It (as referred to site plan benchmark) Additional design / site considerati ons Lrv o-\Z.~; kS LN G Le\) c,`Rt Ffza m %i~~! -p,, i ov' \ S hHvau t~ es> . Parent material S t pt r, (--v*r ov QTL'R LL ov L k S n-rot~ s 4ror~~ Flood plain elevation, if applicable N , P\ ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem (ff S ❑ U WS ❑ U Eg S❑ U as ❑ U 0S ❑ U ❑ S on SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boutdary Roots GPD/ft Boring # Horizon in. Munsell Chu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Z F ~l~h wt a S p• S u• 1, Z S ~~rr a, S Q. S U, 1, Ground 3 e-3'" to k~z VA - TS t C ~bVC vnu -JR, ~g ~ o• S ~•6 elev. q31 O ft. 3$-7(, l0 S!g - owe >M v u o. S Depth to e C~ iv S N. S `i R Y/ m u 5 e 5 limiting factor Remarks: Boring # c~ S - o . S u . Z`Fsbk wt`F~ Z Z to i~ Lu ~Z 31~ Sit s bk vn 'F1- a s L\ s € b. b 3 Z6-41 1 12L y1LS o_ S1~k ►►t V't~l~ S u. Ground elev. ZlS`'12 S 1~ ~t S o y►f U'~ - r q3.S ft. L.i 4 ...l S • . lUV l~ S ou I-. Depth to limiting factor r s yam:, Remarks: CST Name:-Please Print Arthur L. We erer Phone: 715-42565 Vegerer Soil Testing & Design Service-P.O. Box 74 River Fal1s,WI 54022 Signature: Date: CST Number: q~- 2-4-7 \o,ZS-1l3 M00576 L_ alz PROPERTYOWNER B'~TIEZLS6KJ SOIL DESCRIPTION REPORT Page. of. 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botrbary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer>ch Ground 3 -fig Loy2 YA - - elev. qs ,oft. y 39 ~-2 10 Y R S - ~s - _ - - Depth to S 1iw► N 0 YL ? T B 1 limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Cti>+ Ground elev. ft. Depth to limiting factor Remarks: Boring # vv} Ground elev. ft. Depth to limiting factor Remarks: SBD-833018.05/921 i PLOT PLAN Page - of 3 SCALE 1"= 3D ' vL1Z L ~`1 L.b ~~OIU 1'f~"~ ~~A`T~( t*L. 4 3 s 3. OF r-"j\ GF S~DUv x h GA6@ 6 yts~ PL'w e- S x S~RL ~ Ar Nn I/ C`11E" 13" 1,3 titi►SlL 3 C'SC\~ S` w~D~ B`1 w~~~\w,~n $o` Lu~vG 3Z.l` Dip ~T `1?F6 v~?SLp~F ~D~~. ~ t-\ZyylrvL mOveM ~zLwvr OhiS (~T MME pv= COi~S cl»N. ,p 83_24`7 d. ~0~2s_g3 (715 ) 425-0169 M00576 CST Signature Date Signed Telephone No. CST # • Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page t of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY sT, c(~► CSC. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or 8 - l1~ dimensioned, north arrow, and location and distance to nearest road. O O ` gC) APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION L IN U ftx-t) L I CC S3kas~_TIE S u N GOVT. LOT N 1/4 SE 114,S 1 V T 2,8 N,R l 6 E (00 PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # Z S 8 Z c ova.., Y`-( ' N° _ - CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE GOWN NEAREST ROAD Wbb N_') UI L.,LQ- ~vl S V62-8 Lz [ ] New Construction Use [JC] Residential / Number of bedrooms [ ] Addit n to existing building [aQ Replacement [ ] Public or commercial describe Code derived daily flow buo gpd Recommended design loading rate bed, gpolft2 0 • S trench, gVW Absorption area required - bed, ft2 \'-AWe trench, ft2 Maximum design loading rate a • `I bed, gpd/ft2 ° • S trench, gpddlft2 Recommended infiltration surface elevation(s) S k~-_Z NuR 3 It (as referred to site plan benchmark) s R hK~, t Additional design/ site considerations Uv c,\2.SrnS1N G 'T R.Cl~ FMM 80' TO V W3' Parent material st ►T ov tnL l-L ova k s two cYou~~ Flood plain elevation, if applicable N ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U_= Unsuitable for system ®'S ❑ U 19S ❑ U ®S ❑ U IRS ❑ U 0S ❑ U ❑ S ®"U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. ConL Color Gr. Sz. Sh. Bed rends Z 1~4r wL 1~ S o• S u• 6 - g l I f O- ~O -1 Q_ 31-1 Ground 3 1& 3 $ to 11 R- Y A - ~'g l C `j bh yn '~H G S O' S 6 elev. q3 , o ft. L/ 3 l0 `1 l2 S/8 - T o~,-, 1" u S Depth to ems, rv S-. S `1 R- Y/ m u 5 B S limiting factor > 76" Remarks: Boring # o-~o ~0~1~313 std 10 y►►t- as o.'o.ti Z Z 1ozL S 3 Z~-41 tin`I ylt. ~'s 1 Sl~k ~►1v,F~ CS Ground elev. do`-t2 S 1~ ~S Owe y►~ V~~ - o•~ d.S X13.5 ft. Depth to S NU y 1) $ 1'~ OUE limiting factor a 7 '7 8 Remarks: TName:-Please Print PhonB Arthur L. We erer 715-425-0165 Add egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: g3- 'W7 'o_ -S-°t3 M00576 PROPERTYOWNER B;-E'V-1.SU►v SOIL DESCRIPTION REPORT Page of . 3 PARCEL I.D. # - y : Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouclary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench Ground 3 ~{-fig t0 `12 Y/{ - ` - _ elev. °►S.oft. y 39 ~OY(Z S - ~s - _ - - Depth to S t~M )u 01'E limiting factor ? L Remarks: Boring # 13 Ground elev. It. Depth to Gmi6ng factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 13- Ground elev. ft Depth to limiting factor Remarks: SBD-8330(8.05/921 • PLOT PLAN Page 3 of 3 SCALE 130 ' LL `CQ_LC cKg L~ 1N 'TYM 8 1'V.EV), v L1Z L } L b '(101 rfN A*-) -D E,p 7N ~*i 4 3 s 'D' 2 l U1Z. `M CeirU ~3 TV-4j cP U N . 8, 2 k~,q s S. 3 - tel. Wu . o o►J 8o-rm ► cb d l= 6~2R 6E S tpljv ~ x b sae 6 IA 6 DQ ~'1 5 8.1 I 1Z5: S tp 3W ce a3 ° x r I Y 1 o•L ~1 ~ NS TA- L 3 `RZ.~►C*eS CV\ S'wtD%,E B`! wl~rvlr,ki $oLo~vc, 3Z4 ZN pr T1+E S Lo \ E Gt . "lZM IN (L T1Z~Chl ~-r-~--U"rjAJS (~T T►~ ~ of oow S`I1Z 0)k'N . Q3-2 ~y 41 C/~~ d.`~' ; Z S- q 3 (71 ) 425 - 1 6 5 M00576 CST Signature Date Signed Telephone No. CST #