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HomeMy WebLinkAbout026-1000-10-200 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER'Eiji ADDRESS )-/R_, - AL- rI , Imz) 11,7- 7 SUBDIVISION / CSM# LOT SECTION. T-30N-R l$ W, Town of i ST CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 94? i f ~,yGl4K He..su a .yQ 5~:9 iC INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. ~ I BENCHMARK:,' alJ Cz 1e91_1::, ALTERNATE BM: Z4 SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION Manufacturer: ~S Liquid Capacity: Setback from: Well House J Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location ';SOIL ABSORPTION SYSTEM Width:_IZ;2 Length Number of trenches Distance & Direction to nearest prop. line: Setback from: well: -1'-- House_,Zd_ Other ELEVATIONS Building Sewer - ST Inlet: !24S- I ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade DATE OF INSTALLATION: - - PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt r L9jATJrWr;,t j AjPy, 1.30.18 . PPI fl%fiEWAGRYS~Ed-OT 12 County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division r (ATTACH TO PERMIT) sanitary rmit GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan o.: C T BM E ev' 9 Insp. BM lev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9300266 /A - 9_ g3 g3a TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S ~Gr7e - G Benchmark Dosi f Ali Aeration Bldg. Sewer 97,1-5- Holding St! Inlet Fn f,71 9~- f/ TANK SETBACK INFORMATION St/ylf0utlet Vent TANK TO P/ L WELL BLDG. Air Ito ntake ROAD Dt Inlet Septic NA- Dt Bottom Dosi NA Headern. 8 5 9/~ Aeration A Dist. Pipe g, Z /,;~ri/, OS/ Hold i_ Bot. System M ~ PUMP/ SIPHON INFORMATION Final Grade -P os• r 35 ' 97 Ma Demand Model Number GPM TDH Lift Fric ' System TDH Ft orcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~7 DIMEN I N SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACH-IN-d- anuf INFORMATION TypeOf 35 Moe Number: System: z (A CHAMB 7~ /7l~ IT DISTRIBUTION SYSTEM Headers Distribution Pipes , x Hole Size x Hole Spacing Vent To Air Intake Length -4K- Dia. Length Dia. - Z~ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems On Depth Over Depth Over xx Depth Of xx Seeded/ S xx Mulc Bed /-Tier Center Bed hTj-j?*etrEdges - Topsoil ° - - v ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 1.30.18.P1,NE,NE,CO. RD. K, LOT #2 -Ile a;1(t Plan revision required? ❑ Yes No Use other side for additional information. f~ 0-7 933f c SBD-6710 (R 05191) Date Inspector's Signat a Cert. No. SANITARY PERMIT APPLICATION couNTY NLHR In accord with ILHR 83.05, Wis. Adm. Code STATE SAN IT RY PE MIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 1 / 8% x 11 inches in size. Ch if e o previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFO MATION - PLEASE PRINT ALL INFORMATION. PRO5VrY OWNER PROPERTY LOCATION '/a, S T , N, R (or '/4 Al,~~ Ye P OPERTY WNER'S M LING RE LOT # BLOCK # CI STA ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 'C"~ 111. TYPE OF BUILDING: (Check one) 11 State Owned ❑ VILLAGE : NEARE ROA N OF ❑ Public O 1 or 2 Fam. Dwelling4 of bedrooms- AX • ER( III. BUILDING USE: (If building type is public, check all that apply) 01_~c- 10I0 l 19 d 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. ❑ Replacement 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 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min inch) ELEVATION Feet Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New listing Gallons Tanks Manufacturer's Name Concret Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank llbn+ Ej I El 0 1 EL Fj F-1 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installati of the onsite sewage system shown on the attached plans. Plumber' Name PrIcM: Plumb s S' n r No ps) MP/MPRSW No.: Business Phone Number: -91 P ber' ddre Street, City, State, Zip de i / Z IX. C LINTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date ssue Issuing ent Signature (No J!~/Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS r 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. If. 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 aid/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'f 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 ;ponies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 R.11/88 7 4-4 < IJx .S'y017 3 ' S.cX°„ L /GMy, 30 yS' Q Cy? $T p,Co~'ao cJ~~! 0 WiAansin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of .3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 14 Attach complete site plan ,on paper not less than 81/2 x 11 inches in size. Plan must include, but 5t arc -nbt limited to vertical and-horizontal reference; point 10M), directipn and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to .nearest road. APPLICANT INFORMATION-PLEASE PRINT ALC INFORMATION REVI,EWEDRy DATE PROPERTY OWNER: PROPERTY LOCATION. OY1(~ 4 S e- 1'~ O GOVT. LOT j15 1/4 JVO '1/4,$ l T 3C3 N,R qr) W, PROP RTY OW R':S MAILING ADDRESS LOT If BLOCK # SUBD. NAME OR C9M if ''i' ~,•7 / I ?4/ N 5 CITY TATE ZIPCOD HONE UMBER OCITY OVI GE` OWN' • NEAREST ROAD r~ ew R~ o~ ciE.ct , =4- New Construction Use Residential / Number of bedrooms.3 Addition to existing building j ] Replacement • [ ] Public or commercial describe Code derived daily flows 0 gpd Recommended design loading rate . s bed, gpd/ft2__._trench, gpd/ft2 Absorption area requited bed, ft2 trench, ft2 Maximum design loading rate % bed, gpd/it? ~_'_irench, ~pd/ft2 Recommended infiltration surface elevation(s) 3 . ft (as referred to site plan benchmark) Additional des' n to considerations ; Parent materi u~ w► • _ Flood plain elevation, if applicable AJI& ft ' S =Vultable for system C NVWnONAL MOUND a •GROUND PRESSURE AT GRADE SYSTEM W FILL HOLDING TANK U= Unsuitable fors stem S O U 8. ❑ U " AS O u cis mu.-I_ .11 S [ 1 [IS XU S01'L DESCRIPTION REPORT a & .,C 6G., ' Depth Dominant Color Mottles Texture Structure Consistence Bwxk3y Roots GPbA Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. B C3 V IF -1 x /04 4/4( s o. s Al J14~- Cy w Ground elev Depth to limiting ,-o y o z c, factQr. Remarks: • . Boring # ~•~l /0 R 5 Cw r~ is, Is Sd/~ m~►- Cw •y i,S -01 byR L, C, 9d r4j~r Ground G u) . ~ I 6 elev. Fo, K fL mJ4r Imlungo 5a-7 7j. 4- _ OW yl r factor 1 ~5 Remarks: CSTName:-PleasflPrint Phone: ~yG _s~..3 r Address: CI a i . Signature: Date: CST N Umber: PROPERTY OWNER _aS 2 tr`d1~SOIL DESCRIPTION REPORT Pag :Lof 3' PARC EL IA # Depth Dominant Color Mottles Texture Structure Consistence Boundy Roots GPD/ft Boring # Horizon In.. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch P a-1- c W El 19 /1 --V /Ovif ;F/ a j fj 5 -by< Al _k,_ 0-0 y1\ y _5 Ground > 1 ;3 /S__ sb/~ t1 ~rr~ CW ' It 'Ji5vk "Me 'A Death to C v 5~ / S' Y1't i Q t~ lr .T' 1. JG 6J 7. limiting. for . ? ~ ^ . S . tl ,r •M ' - , s Remarks: - Boring # Ground s._ .4 ijjr Depth to Remarks: Boring # , _ CL4 i~ f l p °~o .Ground } 9,$ It rniOng factor Remarks: - < Bon # - i 6rou~ elev.. e * _.r . M.. . Depth to limiting .t. factor _ r, . _ . Remarks: ;SBD-8330(11.05192), , "s' ; PA& C O P rt-w fmil Ab wets Asd cu wlot* pipe .I C}w..~.w A~•NA Y•ol Cq w =0.4i• Mp• /lt 40 Coss IrM X91';. 1• /MN iaN VW III• r . • W,1 141 W Ir•II»II• C•.•,In• • O.w ►MiM'•1•a ' aall..ll~ dye T•• fr i• • AIII~Ia• I•Ilw•I•d pipe II.1•v • "C•rI1Ms 1«wl••llnt AI A•111. 01 i1N~w Pru c D i/,•.~ 9 r~ A4. 7 _ P ' • ' .1,16!3 c. i 10' ~ ~/~j~ • Sio, i01~ Fill.' OISTKto - T106:S PIlE • AP►RO`!f G Sv!'(l1ETIC COVC lit 2"ol` 1tGGRE4AI °'~/'1ATERIMt. OR t' OF S-rFi ELEV. OFD 1'~O'rt•&' AGGKCGATC '11 FELT, OISTRIAuYlou PIPe •-ru pC AT LICA><7 IWCHE3 5CLOW ORMIWA1, •CrlAOE AwJ~ AT. LCAiT AO IWCKLZ AUT WO MOF t THJ%W tit luo{Cs or.LOW flWAL. GItAOG • 1WcU1UM DE' H.."OF F.UAVATia!j rxo,.t OKIGwu 64w wlw. BE IIJCHEs tVNIMVM ©Ernt OF EXCAVATION r 'P\011\ a~IGINqL GRADE wlt.L. 6C -2 INCHC s LICCW3C MumbEIt: I l o . « I I ' I ' t I ~ ~ 1 ~ I f ~ I 'P I , I I ; 15~ 6 71 1 F I ~ I ~ I a t ~ I -_I I ~ ~ 1 I I I I ~ ~TI i I t I I I I I I ~ , { 1 r I -E 7 r t - r t f I - aA4 I I I t 1 C i I I , t--~- - i i t - t- 1 I- , r - _ I I I I I 1 1 I - I I ~ f i 4- 1 Y t ~ t 1 _ r a- I I I i t I I I _J IT - I I i 1 l ~ ~ { , i ~ I ~ , I : I I ~ I I 1- A _ ~I►- - ; ''rye a I ' I I ~ I I I I i ~ I ' I (K r fi-- f t ~ r 1 14 I I , I ~ I I I I ~ I I t t I I t I 7WI t - -Alto I. 1 /I o N-) t 4' I I i I -i I I t~ { I I I I I I I I I , I I , --r- I i d I I I I I I i I - i ' I i ! ! , ~ + Wisconsin Department of Indus ' t Laborand.HumanRelations `y ' SOIL AND SITE EVALUATION REPORT Division of safety & Buildings , in accord with ILHR.83.05, Wis. Adm. Code t COUNTY i Al8:10 psite plan on paper' riot loss4han 8.1/2 x 11'iriches In size: Pian must include, but S7: ~ra, nbt Umitoed to voilir al and-bodiontat ieferencg;go(nt ism), directiprt and % Of slopa, scale or dimeasiongd, north arrow, and location and distance to--nearest road. PARCEL L0, R'.. t APPLiCANTa10ORMATION-PLEASE PRiN•TALC"INFORINATION RE IE1AtEDQY • ti PROPERTY OWNER: , + • ^ PROPERTY LOCATION. • , " 0YY14 S., GOVT. LOT NL 1/4,$ , Pl~QP R':S MAILING /U~ 1/4 3C) N,f RTY OW ADDRESS . • ' T 9. . + LOT t1 BLOCK 'SUBD, NAME OR C9M 0 - CITY TATE • ` 'N ZIPC ' OD I PONE UMBER' ❑CI TY. ❑ • VI , . . GE' G~J R~ OWN _ NEAR .5 OJ. •(?fS'j• EST RC New Construction Use Residential / Number of bedrooms .3 (J Replacement [ J Addition to existing [ J Public or commercial describe building _ .Code derived daily flow ISO gpd Recommended design loading rate • ...bed , gpd/ft2 ` c Absorption area required-ti 2 _.trench, bed, it D : trench, 42 '',,Maximum design loading rate bed 2 t Recomrrie.dea Infiltrationpurface,eievalion(s~ 3 .-19pd .trench;. f ft (as referred to site plan benchmark) additional des to considerations " - Parent mater u+' LJ , • , . i Flood plain elevation, if app icabie• S:*9uitableTor system corwtxnoNAL } MO ND . : ~t N•GROUNDPRESSURE ATGRADt ~s U = Unsuitable for stem ❑ U S • ❑ U Effu . !H FU u •.~~...SOIL.DESCfI PTION AE'O.ORT Boring # Horizon Depth Dominant Color Mottles Structure' Texture . Consistence amndary Roo In. Munsetl ; 0u. Sz. ConL Color Gr. Sz. Sh' , 1 .".1z Al 16 YR- , J O ' s ~ y,~f7 Ground elev Deplh to limiting fact , a~ Remarks: ' Boring # R s ;a 1d , /s cw . a~+~ D Sdk mf►- C w jrn Ground r1 S if G C W elev. 7, § It. S k J'ti1 C! i .Ca~S D Depth to S th tl~ it (A) - I limiting C 5a -7 .R y .Y factor I ~~~44 I' c 7a-76 ~qfA VG P Remarks: • CST Name:-Pieasa Print Address: 96 Phone: Signature: c Date: , CScN, 'It 6, It! .r_ a,.+. ,....w....,.w ,,.,av.,.,..... w....•-'_ 'T•^w...++..a..w..sw•.w. ..,n~•..r:.... V:s.r:. ~ty~daQ , ; ww. ' ' , 1. • ".f'f 1 , t :'A~ • - ~ ' • ~ 4 ~ ! 1 ` ~ ~ . ' • ' i•`" ~ . c v t.-~~'~la 333//1...&"~ , noig _ _ • r+ r• I' r poe AM I* ` AGO ~'y~ • ~ • X19- 4. ~~J Rs- v lip q! La. oulio oupoe i. •:s)Puwab • . . . .,r.M w• .*~,w_•I ••rr.w,IT,w77V wa,M~ W1 •f . ••WM, Jam' : ~ Y •I . , ` i 10 ' i ' I, ;hy?,.. i ;7j;j•1(:~14 .i'.. .•t"',~,~ ,..,r,..,t, ~ :7I:1 IllW9, , M 1 ' ..rVM-~'T I~rwn j •:Jw nrw.• W4 t....aw.~U ...w,._..... w...~r.. ` of tAdao ..M. .r.~~ ~.f~. *iS~~ .{.1 (J►i .Liy;,,~,Z1i:11. ~ ~f•.y/, •'1~• .r;:~ .e_!:1N• y iti~rxr~:t► ~.A!" ,{•T.i •~•::.y.x\rr ,r•t•• •.•9„ -!7Y.•AraYlx Aw. :V•rYww+AM*,w/►a+adNl:IW..:.. awrs'tr fGt✓l.•N°;.tWx :Y N PUllo~~/ ~•':'if. art:}!.F' ! 1t{ ",`Y v t :f.: _ rt{~. r.\ r7$' \t t:rrtK,.rllli(jy):'1„ ~I,~;t'lirl~i,.} I I~je,•y" •r+'., a, tt'+c. Mai V ^ y ~ IvT . ~'•i!• ' 1~. t.~au j :'i j:~~: ; t r 08 .a?(i~uia~ Ttit G!`( :•:{ilYt':!3 . i 1l{fwj/ {v b.} 'ht~}Rrit l , WW.- " .l I r J •.'•""'r i ~...v . - J01091 •BuAlws t T f -7T ~a' '~r1~. t' .3 ~ ~ _ S` • :..-~:,t,~f .,.I , ~ ~-9~' . osyldaa ~~t,r.:. Imnojo rip W.-C! ~ tci,' 0. 77 r •WE , 2:Z:f K. { ± ' y' r let:( tlk wt•t3J.L';8~1T,<•,:fld G1, a:+~•rl..t~ .yS ZS j y.• - jolo.J'3uo'J 7S'no• Ilasunlry u~ ' s~oob Aqxrldg aoualsisuoo ejnlxal t • adzioH Bulbs emlonA seypolry Joloo J! Upoa yldaa ; . ; { a!.i• wtr.• fi'. •.tI S Tai r i, t , 1 i .+?S''4~ta'1'i3,ry.d~ r ' a6~d ltd O d 3» N O Ild I u o S 3 a d~NMO LM 8611d r - _ ► ~P r -f --I !PAO C> 1%11 D i' f nO'CONNNNELL 4 9 6 4 25 St cfolx CO. Wl CERTIFIED SURVEY MAP T j0MAS ANo JANET hEFF FKIN 'F-,rt of the Northeast 1/4 of the Northeast 114 of Section It Township 30 North, Asnge 8 West, Town of Richmond, St. Croix County, Wisconsin. N E 114 CO R. SEC• 1, r 30N, R/8 W, COR. SE C. T 3 ON, R 10 W, 10 OUN7Y SURVEYOR'S NON./ UNPLA TTED LANDS /COUNTY SURVEYOR'S MON./ h „ b b u u • 00'00" E ?612. 12' N LINE NE 114 pp 3//.00' 371.00' p 691.26' 1392.26' O - - Z64.00' h b b DOI N 90. 00' 00 "W 171.00' /001 O p 66' q p b b N _ - _ _ M ROAD SETBACK LINE 30'J"~ W p : o w / Xt., k. C I _ o LOT l b LOT 2 - N p ~ N N I Q W N M 2.316 ACRES ?.000 4CRCS 2 • 87, 118 SO. FT. N /02,628 S0. F7. p Q \ 0 /.606 4CRES pp 1.99Y ACRES h Q Z 69, 938 S0. FT. 82, 4 13 S0. FT. . W J N CL ?6 4. 00' 3 00' JI N 90.00'00W 371.00' J Owner's Address: UNPLA TTED LANDS Box 271 C.T.H. "K" New Richmond, WI 94017 AIL SE4R/NGs. REF. TO TH£ NORTH LINE Of THE NE 114 OF SEC. I , T 30N, R/8 W, 4SSUMEO N90. 00'00"f This instrument draFted by' Laurence W. Murp,111IIIlr1tiV-1 IM O Indicates 11, x 24" iron pipe weighing ^ %~~~cJG O'/~A 1.13 lbs./lin. Ft. set. • SCALE I - IOO' 'LAURE ES o 21' Jo' Ioo':, /10 zoo, 30j m W MU KY i % 0 ER FALLS,, J~ Gated: February 10, 1993 WlSC..,,.•' "Revised this 24TH day of March LAND 1993. " *8488S46116% Laurence W. Murphy Re istered Land Surveyor 12. o o wG o V1. El O 7 d ~D a a. ro 7 c, (Y1 1170 d S. 4 VOLUME 9 PACE 2602 SHEET / OF Z 0-40 Z 133HS 2092 Z0na 6 ZWnz0n AgdjrM •M eoua.anel Aq pe4je.ap 4uawnj4sUT STHI UolanUnS puel PGJ94ST a AgdjnW • M a0ua.anel i ~S p N b 7 03 Sim V A. ?p x Hd W M w rr• ON unyl , rs 4 v ~ w ~ 111111/1 • joa.aa44 uoT4e4ue9a,ad9,a zoa,a,aoo pue anj:~ e a.ae uoT4dT.aosep pue dew sT44 4m 4 pue A4uno0 xtojo •4S 4o saousutp.a0 a4:~ pue so4n4egS UTsuoosTM a44 Jo VE•SEE .a84deLo 'sp.aooaJ TeTOTJJO 04 6uTp.aoooe dew 8TH4 uo uMO4s Be spueT aso44 paptntp pue paAan.ans ane4 I 'u0-lJJGH. :~auef pue sewo4L 's,aauMO a4!z do UOT43aUTp Aq ge44 A.41gaao Rgeja;.4 op 'J0AGA.ang Pue1 peja4sT6aW 'Agd,anW •M aousinal 'I (aoJa T c dO A4unO3 (utsuoosTM Ao 04e4S •eatnpe Joj 8014AO 6UTUOZ l4uno0 XTOJO •4S a4:~ 4oe4uoo Tao.aed /Cue 6UTd0T8nap Jo 6utsegojnd ejo_499 C, 24a ' Tao.aed o4 ssa0oe ' azts 4oj wnwTutw 'spugl4em ' • a • t) suot4etnfia,a pue saTni 'sMeT A4unoO pue age:~S o4 4oafgns sT dew a44 uo uMogs jao.aed.40e3 E66T `uo.aeW jo AeP Hitia sTg4 PasTn24„ E661 'OT A•aen.aga3 : pa4e0 •p.aooa.a Ao s4uawases o,4 :~oafgns ouTaq os T e pue casod.lnd • M • 0 • d „~I„ .aod J00,a944 , 00' S9 AT,aa42.aON a4q Jano -4uawasea oq goafgns 6ui3g 'sa.a0e 9SE't 6UTUiequoo 'SNINNIS39 30 1NI06 9y4 Off. ,00.OCE N,:.L0,E2 00 N a0ua44 `•,OG'SLS M„00,.00006 N a0u944 •,00'OEE 3uL0,E2000 S aoua44 :auTT Pies uo ,00'SZS 3„00,00006 N anuTZU00 aoua44 !pagT.aosap UTa,aa4 aq 04 Tao,aed a44 4o 'ONINNIS39 30 1NIOd 844 04 ~93'E6ET dO aoue4stp a (T uoT4oaS Pees jo b/T 4sea42UON a44 Jo auTT 4q•ao~ eqq uo SuT.aeaq pownsse) 3„00,00006 N aoua4:~ 'T u0T:~09S pies jo .aauJoO b/T 44-ION ay4 4e 6uj3uawwo0 !sMo.Tjoj Be pagT.aosap Allnj a,aow 'UTsuoosTM 'fquno0 xto.a0 •4S 'pu0wyoTd,,._40 UMO.L l4seM el a6ued 'HtWON OF- dt4suM0l ,T u0T:~OaS jo 0/1 :~se8y4.aoN 844 dO b/T '4sea44JON 84~ uT pe2eooT pueT jo Taoied UTe4.a2o 4e41 uo T 4dT.aosaO •uTsuoasTM 'A4unoo xto.a0 •4S 'puowgOTH dO uMol 'q-saM el GEUea '44UON OE dL4sUM01 'T UOT40GS .40 b/,T 4sea44JON O44 -40 0/1 gsea44.aoN a44 .40 Zued t 1 LgNP4.r ONV SVKU-LL c:DM A3ALM Q3T 4LLLM SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER AW11 n1l"Al ADDRESS: Ilk" FIRE NO: LOCATION:_AZ.,~. 1/4, 1/4, SEC._=T_N-R~~W _ TOWN OF: , *st~ ST. • CROIX COUNTY SUBDIVISION:. a-400.-;~ LOT NO. az 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 to help with the cost of the 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 re uirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to the 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 from 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 DNR. Certification form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. }I ' SIGNED:~ /I AdIl 7>? ~Y ' DATE : Q St. Croix County Zoning office 911 4th St. Hudson, WI 54016 STC-100 This application form is to be completed in full and signed by the OViller(s) of the property being developed. hny inadequacies will only result in delays of the permit issuance. should this development be intended for resale by owner/contractor,(spec !louse), 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.~Y.,.1/4 XJt..114, Section" T_JN-R_ff_W .Township nAj Nailing address r:. O0 Qe-ve AZIAJ )&e1X n&o 10, 0 Address of site gS' 40, AkeV J~d, 7 Subdivision name_ Si~2 l o?6ap Lot no._ Other homes on property? ves A"-No Previous owner of property ne,)M._4_s P A"I 1166 y, Total size of parcel 4C0eES Date parcel was created a.5_MAe_e4 /ffT Are all corners and lot lines identifiable? _ X .yes __NO Is this property being developed for (spec house)? Yes ,r No Volume Oind Page Number as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A IIARIUJiTY DEED which includes a DOCUMENT NUIWER VOLUHE AND PAGE. IIUt in.'n & THE SEAL Or 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(%ee) certify that all statements of on this form are t best of ny (our) knowledge that I rue to the the property (we) am (are) the owner(s) of Y described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. e~p~f~? , 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, fo the construction of said system, and the same has eeduly recorded in the office of county Register of deeds as Document No. signatu a ap~licant Co-appl cant 0 C2 9l ua g n aU e- l -3 Date of 8 nature •OOCUMENT NO. STATE BAR. OF WISCONSIN FORM 2-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED A CO., V11 SO44`~ VOL 1000PAGEi72 LN" r Record 6 1993 M conveys and w ants to 11 till/ RETURN TO the following described real estate in ~tC County, State of Wisconsin: Tax Parcel No: ~ •f Eva This homestead property. (is) (is not) Exception to Warranties: Dated this 1:2 day of 1911. (SEAL) (SEAL) (SEAL) EAL) • ~arn~ S ~ N~ ~,~,eo.✓ AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN SS. 054- 0-l"0 t A County. authenticated this day of , 19 Personally came before me this day of n b 19jq]1--the above named ~ n yr, a s P e c~,~a`'~tcY,~; TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the persons authorized by § 706.06, Wis. Stalls.) U g. fore instrument d acknowledge t$~6 4> THIS INSTRUMENT WAS DRAFTED BY Notary Public Ujgo I k ~~Counly.,Wis. (Signa es may be 5e~nti or acknowledged. Both My Commission is permanent. (If not, state expiration are no necessary.) date: 19-• 1 $82 NTF 0021 Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Nelco Tax Forms, P.O. Box 10208, Green Bay, WI 54307-0208 Form No. 2 - 1982