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HomeMy WebLinkAbout010-1007-40-000 h 03 p« a 0. 0 1 ICI ~ y m et C: o co o o N ~ .r I `s I O CO CL c rC c O c C z c c y O Y O N y V CD Co oE E O O E (D O O N c Z U c O L m N LL c C C I C _ I O -0_ (0 O i E. ° - c -o E Q ~ m m U Co V a N ~ y E + O OL Z (D 0) ° W a m M H Z 'p C N O C C9 (D f0 O Z dt a v w p fA I- .N z y •O O L7 Co I, O N E 3 • ~l N O O c p m L 7 U O a a - z z - 0 .o z N E N N O I L = (6 C L D N M c`~i pv DT o a` ~D O LO E u) cu ~v o fq M fn F- F- ►i o O O O z •%Ail m Mi g ! E O N W Cl) rn O fA J U U) rn rn z M 7 (D n m '0 4 *V co OM O O O O r ` N N O o ~ O N M N N_ 2:1 c co o- N 7 a N O r ~i U o Q z m C, C? O O N IA 00 c 3 OU E CO r` O O N O W - O O O O O m N N U) U 0 :D d O O O O O r \ M I- O_ O. c ,[y T O O N (5 0 N N N V w 00 E p L L 6c7 O _M N N N! Tr' r O f0 Y W N H I- C N co cj O cy, • ° M E O rn E E U O O W ~ O .e-' UJ c CC r .«T+ ~ E m V~ 3 •Q a a. • a @ .0 N E 'c A ci a O co 0 L4"MIA)kfo%rtERERAI&ry;3.30.16.3+RIVATE SEWAGE SYSTEM t Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitar "nit GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State PI -CMlWETU. ---j1nsp-BME1ev. BM _t escriptio Parcel Tax No.: / / TANK INFORMATION ELEVATION DATA A9300224 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ZC-d Benchmark ~ ' / ~ ~ ~ Dosing r , / G , j1( Aeration Bldg. Sewer [Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom 5,D Dosing:`' NA Header trr. 3, / Z Aeratio NA Dist. Pipe Z. 9W Holding Bot. System PUMP/ S INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft oss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM OW/ TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIME055I' - ~ SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHI Manufa r. CHAMBER INFORMATION -Type O o e Num er: 9( System: OR UNIT -'.r 1 G DISTRIBUTION SYSTEM 9ti Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake r ~p Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EMERALD 3 30.16.37 Aze ~t~i~X ~ ;'fir ~ = I;f r ~ ti.:~~"~'`'- /yv~tc~ ca~~ ~ ~.`CU t~~r~ . - t ~rj /GY) G 4 Plan revision required? ❑ Yes ❑ No 711 Use other side for additional information. SBD-6710 (R 0 /91) ate Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: • e i DIL~.HR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 ~ 8% ' x 11 inches in size. neck r vision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 5 9. Gar 7 PROPERTY OWNER PROPERTY LOCATION B;// o t,t _eC 4-2 r. i(/C-'/4 1&)114, S T S6, N, R (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # /V/6 CITY, STATEr ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER III. TYPE OF BUILDING: Check one CITY NEAREST ROAD ( ) ❑ State Owned ❑ VILLAGES, ER <7 ❑ Public [Z 1 or 2 Fam. Dwelling-# of bedrooms PARCEL TAX NUMBER(s) o l 7 V0000 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 40 Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 5 ❑ Hotel/Motel g ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.E1 New 2. X Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 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 W 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 00 .9 SC%O ~oO /-Z 11 99' Feet /0/. Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank /2-0 0 L)C~ - ~-F1 F] - F-1 Lift Pump Tank/Siphon Chamber 1000 G CJ~ / VIII. 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: (No Stamps) MP/MPRSW No.: Business Phone Number: Z)C? lc- 4- j Plumber's Address (Street, City, State, Zip Code): IX. OUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa i ry Permit Feg,(Includes Groundwater Date Issue Issuing A ent Si toe (No mps Approved ❑ Owner Given Initial .`j~~'~ - 0v, urcharge Fee) -Adverse D rmination OU OO' X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a 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. Ill. 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, purnp/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 8/2 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, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) + $trow, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H 6" Topsoil F p 3 E 7~,ft • Slope R Bed Of 2~- 2 %2 (Force Main Plowed Aggr gate Layer oR b NVev (6" low Pipe) D AO Ft. ~p E Ft. ~,~GECross Section Of A Mound System Using -75 Ft. N~ A Bed For The Absorption Area F E ~Oa G A 0 Ft. Signed: A Ft. H S Ft. 1Y~.ca~~o v.- gned: B /,-,)o Ft. License Number: /VP 4~4Z9 K /o Ft. Date: •7-2,? -43 L /10 Ft. d Ft. Alternate Position I /0 Ft. of Force Main W Z Ft. L ~ Observation Pipe B K ----------------------.I Force Main G~ Distribution Bed Of i - 2 i~ Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Distribution Pipe Detail For A Four Lateral Network End Cap / Alternate Position Of - Force Main % P PVC Force Main s"ribution Pipe P - Holes Equally Spaced PVC Manifold Pipe On Bottom E`NP Rev . ~,®r Q S X t E X A F OH 0 GE Last Hole Should Be Next To End Cap ~ ~N O * pN S P Ft. S Ft. 1 X Inches 00i l~ Signed: Inches 3G Zn Hole Diameter Inch License Number: _ Lateral Diameter Inch(es) Date: ~-~S-93 Manifold Diameter, Z- Inches Force Main Diameter 3 Inches I Holes Per Pipe 13 Invert Elevation Of Laterals /oD"G t. PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VEUT CAP C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING 2 5' F R OM DOOR, JUKICTION BOX MANHOLE COVER ~ WINDOW OR FRESH 12"Mill. AIR INTAKE ( GRADE ( y" MIKJ. I~ I ~ 18" /rC11J. CO DUIT 18"MIN. IKILET vATE SEwA~`E T GHT SEAL i I PRI • n I APPROVED JOIKIT A j t'td~tiona I (i ( APPROVED JOIWTS W/C.I. PIPE® N I I I W/C.I. PIPE EXTENDIMCP 3' ~ I II ALARM E%TEKIDIWG 3' OUTO SOLID SOIL 11 I II ONTO SOLID SOIL D ~ ~R Te a NUS N I I Y `pS0 gU1L01 . OF 1NOUSTR gAFEt I i ow C 1S10N OF ELEV. FT. D E GpRRESPpNDENMP OFF SE COKICRETE BLOCK RISER EXIT PERMITTED OKJL9 IF TAWK MAULIFACTURE R, HAS SUCH APPROVAL SEPTIC E SPECIFI'CATIOKIS DOSE ,C TAKJKS MAMUFACTURER:-~ilweder-n NUMBER OF DOSES: 4 PER DA.4 TALJK SIZE: '16pQ GALLOUS DOSE VOLUME ALARM MAMUFACTURER: SJ eC~r'O IRICLUDIAIC, 6ACKFLOW: 22.5,0 GALLONS MODEL NUMBER: CAPACITIES: A= /21 1KICHES OK16 2' 8 GALLOWS SWITCH TYPE: ~e✓ CurY 8= Z-- IMCHES OR ZI L::~ GALLOWS PUMP MAMUFACTURER: 6a u / C= 7'~~,6 IKICHES OR2 zP t2 6ALLOUS MODEL MUMBER: D= 21" INCHES 0R k~ALL0MG SWITCH TYPE: fe'-curNOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE 60'8 GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEKI PUMP OFF AMD DISTRIBUTIOM PIPE.. 91:5 FEET RECEIVED + MIMIMUM NETWORK SUPPLY PRESSURTT,E~~.. . . . . . . . 2.5 FEET RECEIVED Q + Zoo FEET OF FORCE MAIN X 19 F/ooFtFRICTIOK! FACTOR. 2'16 FEET AUG Z 0 1`'i TOTAL DyWAMIC HEAD = ~lO FEET SAFETY 3 BLDGS. DIV. IIJTERIJAL DIMEWSIOAII; OF TAUK: LEKIGTH 8 Z ;WIDTH l° ;LIQUID DEPTH ~3 SIGI`lED: ~ - t - LICEMSE HUMBER: DATE: 17- 3,~/ tau ~a Performance Submersible Effluent . . -curves Pumps METERS FEET 90 MODEL 3885 25- 80 SIZE 3/4" Solids O WE15H a 70 = 20 WE10H J Fa- 60 -WE07H 15 50 WEOSH 40 10 30 WE03M 20 WE 03L 5 I 10 0 0 T.T. , - 0 10 20 30 40 50 70 80 90 100 110 120 GPM i I i 0 10 20 30 m'/h CAPACITY (Q GOULDS PUMPS, INC. SB•ECA FADS few r W BW8 METERS FEET 120 MODEL 3885 t 35 SIZE 3/4" Solids 1t 110 WE15HH 100 30 O 90 25 80 v' Q 70 `+l x 20 Fa- 60 0 50 WE05HH 15 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM i i i 0 10 20 30 m'm CAPACITY 01985 Goulds Pumps. Inc./ n ElfecGve my. 1985 7 2 C3885 Wis660111try5artment 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 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Bill Roukema. GOVT. LOTpTF, 1/4 N;,J 1/4,S 3 T 30 N,R 16 Xj(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 2439 Co. Rd. S n a n /a n /a CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ZrOWN NEAREST ROAD Emerald, WI. 54012 (715) 265-7441 Emerald Co. Rd. #S [ ] New Construction Use [x] Residential / Number of bedrooms 4 [ ] Addition to existing building jcj Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 5 bed, gpd/ft2 .6 trench, gpd/ft2 Absorption area required 500 bed, ft2 500 trench, ft2 Maximum design loading rate -5 ed, gpd/ft2-6_trench, gpd/ft2 Recommended infiltration surface elevation(s) 100.2 ft (as referred to site plan benchmark) Additional design / site considerations n/a Parent material outwash over glacial till Flood plain elevation, if applicable n/a ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE TSYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S fRU MS El U E] S fR U El S ~U ❑ S t2 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 Trench 1 -12 1 r3/2 none. I,. 2/m/gr mfr g/w 2/f- .5 .6 1 2 12-32 10yr4/4 none 1s. 0/sf; mvfr g/w 1/f .7 Ground 3 32-52 10yr4/4 c2d 7.5yr5/8 s1. 2/m/sbk mfr n/a n/r .5 .6 elev. 99.2 ft. Depth to limiting factor 32'1 Remarks: Boring # 1 0-12 10yr3/3 none L. 2/m/gr mfr g/w 2/f .5 .6 2 2 12-22 10yr4/4 none sl. 2/m/sbk mfr g/w 1/f .5 .6 3 22-32 7.5yr4/6 none S. 0/sg ml g/w 1/f .7 .8 Ground elev. 4 32-48 7.5yr4/4 c2d 5yr4/6 sl bk mfr na/ n/a .5 1.6 99.2 ft. % Depth to limiting factor 72 Remarks: CST Name:-Please Print r, P t►@ - Gary L. Steel 715-246 6200 Address: 1554 200th. A e . New ' Richmond, WI. 54017 } l i ~t'` Signature: - Date: CST Number: 2-24-93 2298 i PROPERTY OWNER Bill Roukema SOIL DESCRIPTION REPORT Pagd7'~6f3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Ba nidary Roots GP©/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-9 10yr3/3 none L. 2/m/gr mfr g/w 2/f .5 .6 3 2 9-15 7.5yr4/4 none sl. 2/m/sbk mvfr g/w 1/f .5 .6 Ground 3 15-30 7.5 4/6 none is. 0/sa mvfr /w 1/f .7 .8 elev. 98.60ft. 4 30-43 7.5yr4/4 c2d_ 5yr5/8 sl. 1/f/sbk mfr na/ n/a .4 .5 Depth to limiting factor 3011 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor. Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE 1554 20001. Ave Gary L. Steel C.S.T. 2298 Bill Roukema New Richmond, WI 54017 MPRSW-3254 rdE Tl"s S3-T30N-8161.1 (715) 246-6200 town of }r►erald r , v zo X33 Rio ~1P L f ..,Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labn'Y and Human Relatlons 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 x 11 inches in size. Plan must include, but _ St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Bill Roukema GOVT. LOTITF 1/4 nq 1/4,S 3 T 30 N,R I.6 x:R(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 2439 Co. Rd. S n /a CITY, STATE IP CODE PHONE NUMBER ❑CITY OVILLAGE 'OWN NEAREST ROAD Emerald, 111. 54012 (715) 265-7441 FNteral.cf Co. Rd.. #S [ [ New Construction Use [xj Residential / Number of bedrooms 4 [ j Addition to existing building jol Replacement [ j Public or commercial describe Code derived daily now 600 gpd Recommended design loading rate • 5 bed, gpd/ft2 - 6 trench, gpd/ft2 Absorption area required 500 bed, ft2 500 trench, ft2 Maximum design loading rate ___5-bed, gpd/ft2_trench, gpd/ft2 Recommended Infiltration surface elevation(s) 100.2 It (as referred to site plan benchmark) Additional design / site considerations n/a Parent material outwash over Placial till Flood plain elevation, if applicable n/a it S - Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U -Unsuitable fors stem ❑ S fRU bw O U O S fRU I3 S 9RU ❑ S j U EIS )MU 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 1 -12 1 3/2 none I,. 2/m/gr mfr /w 2/f. .5 .6 2 2-32 10yr4/4 none ls. 0/sp mvfr g/w 1/f .7 .17 Ground 3 32-52 10yr4/4 '62c 7.5yr5/8 sl. 2/m/shk mfr n/a n/r .5 .6 elev. 99.2 ft. Depth to limiting factor 32„ Remarks: Boring # 1 0-12 10yr3/3 none L. 2/m/gr mfr g/w 2/f .5 .6 2 2 112-22 10yr4/4 none sl. 2/m/sbk mfr g/w 1/f .5 1.6 3 122-32 7.5yr4/6 none S. 0/S8 m7. 8/w 1/f .7 .8 Ground elev. 4 132-48 -7.5yr4/4 c2d 5yr4/6 sl.-si.. 2/m/shk mfr na/ n/a .5 1.6 99.2 tt Depth to limiting factor 32 J Remarks: CST Name:-Please Print Phone: Gary L. Steel 715-246-6200 , Address: W cbmo- d. WI, 4017 Signature: Date: CST Number: 2-24-93 2293 { w ~ PROPERTY OWNER Bill Roukema SOIL DESCRIPTION REPORT Page 7 of3 PARCEL I.D: M Structure Roots GPD/it rD th Dominant Color Mottles Texture Consistence Bounday Bed Trends Boring # Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 10yr3/3 none 2/m/gr mf r g/w 2./f .5 .6 5 7.5yr4/4 none sl. 2./m/sbk mvfr g/w 1/f .5 .6 Ground 30 7.5 r4 6 none is. 0 sa mvfr /w J./f .7 .£t 9lev .6c>ft. 4 30-43 7.5yr[F/4 c2d. SyrS/R sl. J./f./st~k r~.ifr na/ n/a .4 5 Depth to limiting factor i Remarks: Boring # ' Ground elev. it. Deppth to Qmiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor . Remarks: r Boring # Ground elev. ft. Depth to limiting factor Remarks: , SBD-8330(R.05/92) STEEL'S SOIL SERVICE 1554 200bi. AVC Gary L. Steel X88 C.S.T. 2298 Bill Roukena New Richmond, WI 54017 MPRSW-3254 IIE-',MT', S3-T3011-R161d (715) 246-6200 town of Emerald I f q .IC~ .fir ~~,'1 G~ ) ~ rl l!U it STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER n-2 ROUTE/BOX NUMBER 2x'.39 S FIRE N0. 249? CITY/STATE L2/' ZIP 5~'Wz PROPERTY LOCATION: X114 IVIV 1/4, Section -3 , T 30 N, R 14 Vol Town of 7'frlala , St. Croix County, Subdivision /11 , Lot No. .4~4. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. SIGNED ` DATE 5 St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address I " APPLICATION FOR SANITARY PERMIT 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 131'11 z!~2 &_1 eel-1-17'a Location of property /V 1/4 AI 1/4, Section 3 , T 30 N-R Lea W Township /tee-r04 y _ Mailing address E s Address of site sc~rr~e Subdivision name /IX Lot number A1,4 Previous owner of property P. LCAIAILT-11 S/Z-MON SAC-LC-AI C, SAL.M19N Total size of parcel 192 Date parcel was created aA1KA(ow 1 I Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house)? Yes No Volume and Page Number ~5,~ 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. 4 9 R2G1 and that I (We) presently own the proposed site for the sewage disposal system. k._ -tom -purr--- w i-t tr-the-abe-ue -de s-s r gibed-- p rePe-rt 7 ; -f-or - t-he- ,---P the-sa-me_ has-been duly -reeerided In the Off-i-ce of t was DesUmant-No=- - Signature of Owner Signature of Co-Owner (If Applicable) 3 Op3e bat of ignature Da (e of Signature DOCUMENT NO. WARRANTY DEED THIS arAC9 assswvsD ,oa ascoaa 64 DATA STATE BAR OF WISCONSIN FORM Z-1982 488261 ~ REGISTER'S OFFICE Vol 1. SE OM Me " I I i ~ • ....Kenneth-Salmon._.also. known as Philip Kenneth Salmon, SEP091992 and Helen 3almon~ his wife d 8:30 A. M conveys and warrants to ..W lliitm_ E.. Roukema anal Donna M. Baukema,.. huaband..amd. ~ti~.a,..!tae.auklyo.XB~p..>?~rtal,-propert d Dew a[TURn TO I the following described real estate in .....St.--Croix ........................County, State of Wisconsin: Ts: Parcel No: . . Government Lots Three (3), Four (4), Five (S) and Six (6), and the East Half of the East Half of the Southwest Quarter (E} of E} of SW}), all located in Section Three (3), Township Thirty (30) North, of Range Sixteen (16) West. S Thu IN_.Aq1; homestead property. (is) (is not) Exception to warranties: ►!i8ust 18.92........ day of Dated this . ..(SEAL) •---~.(SEAL) h. $.4lmon • .R_.... elzn~t. ' .......(SEAL) --.v.•.... (SEAL) . Helen C...Salmon... AUTHENTICATION ACENOWLEDOMBNT Kenneth Salmon, a/k/a Philip STATE OF WISCONSIN Sisnstnre(s) P- • Kenneth Salmon, ,~d Helen C. Salmon County. ss. anthen lay ot.t.+y~~5W 3992 _ "Personally came before me this day ~ /kt1(,(/U^ , I%) the above named ` ' ` - •._$~nc~rik W....Van Dyk-----•---.----- TITLE: MEMBER STATE BAR OF WISCONSIN (u - - sathorised by 708.08. Wis. State.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY- AeinflKl §4, _ Ol;n_ Dyk b Needham. --S.C. 201 South Knowles Avenue, Box 127 ` Notary Public ..............County, Wis. (Signstnree RtChm may y b be • X40 authenticated o oedr acknowledged. Both My Commission is permanent. (If not, state expiration Sign ) ecessary.) a data: are not n 19--------- •Mam.e of persona siEninS is any capacity should bP typed or printed below their signatures. II Wisconsin Legal Blank Co.. Inc. OF CONSIM F0B![ Ir1~. Milwaukee. Wisconsin WARRANTY DiBD b. STATE BAS AL S W. - 19962 11 1 ~ '3 v--~~ , E, ~ 2, j r ; , _ `~-.3.~ .J - ? cry. - - 16 5 CL O g Z 7S• BM. /90' 1 90 20 20 a-3 o. .o /aoNSe z% ' a - /00,0 QI - 99-2*' 5cc. 3 133-98.60 NEB Nw~ W Acre s N°' ~y y 14k do rcp y~ ~ ~oyr~ dd 00 ' *7 M C) GIN ~p N 4~ n m . wne d a u ke Q 5 c a /e / G~e•v5 wood c. 5`-1°/-3 c5T`M 3AII 8-/7-FS