HomeMy WebLinkAbout030-2002-30-000
STC - 104 ~Grr r
AS BUILT SANITARY SYST,yyt~PORT
OWNER
4 `
ADDRESS
SUBDIVISION / CSM# LOT #
SECTION 33-T _N-R W, Town of. S f ,J 6 Sfl
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SfieW EVERYTHING WITHIN 100 FEET OF SYSTEM
8M k !
3
5ca f G ` =
ppb~p sR ~ ra-k
/ Cleld j
INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
BENCHMARK: /w Oc), C{,~~refa ®ne~ ~f ~~eC. ~ox
ALTERNATE BM:
SEPTIC TANK
Manufacturer: Liquid Capacity: Z600
Setback from: Well House Other
Pu Manufacturer Model Size
Float s eration G lons/cycle:
Alarm Locati
SOIL ABSORPTION SYSTEM
Width: ~.Z Length ~y Number of trenches /
Distance & Direction to nearest prop. line: W.Z S j
Setback from: well : 2j 0 House__~`50 Other
ELEVATIONS
Building Sewer ST Inlet. ST outlet
i
PC inlet PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: P~ cu~k
LICENSE NUMBER: /V` elf S AU A7 q
INSPECTOR:
3/93:jt
Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County. $3E*
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PER4T) Sanitar
GENERAL INFORMATION
o r m tty age Townvf: State Plan ID No.:
CST BM Elev.: / Insp. BM Elev.: BM`D~escription: Parcel 00242
Q~ , X45 0 t
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
~2
Septic Benchmark (PC JDv cJ
Dosing /''l., .,75f
Aerat Bldg. Sewer
Holding St/ Inlet 10 7,56,
TANK SETBACK INFORMATION St/ y+C Outlet a, /o' Z' d7
Vent
TANKTO P/L WELL BLDG. Airito ntake ROAD Dt Inlet
Ar
Septic > 5Zy 3S~ NA Dt Bottom
Dosing NA Header*fAa&__ d3 pS
Aerati NA Dist. Pipe ` 8. 75 /03, CQ r
Holding Bot. System 9,65
PUMP/ SYPHON INFORMATION Final Grade s, SS /OG~, 05
M a er Demand n Q(
. x.
Model Number G
TDH Lift Friction t
Forcemain gth Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT Of Pits Inside Dia. Liquid Depth
DIMENSIONS S DI I N
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING anufacturer:
SETBACK
~>tv Moe Nu r.
INFORMATION Type O 4, )C CHAMBER
System: '/.3e"d ti LSCJ-- OR UNIT
D TRIBUTION SYSTEM
Header / Manifold s° Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Lengt4b _K9 Dia. S~ Length I Dia. Spacing
_
SOIL'"COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only------.
Depth Over Depth Over „ xx Depth Of xx Seeded/ Sodded xx Mulched 11 Bed / nter Bed / TAU-€dges -_3tio Topsoil ❑ Yes ❑ Yes ❑ No
LOC4*MftNjW.•(IW&§Pygde3A9cAE$aAc%s,3A*n~P5 #EET
~j,~ 1:.l' ~-Cz`~ ~ .~~c;-s-, ,,t.,-,._ N,~~t"z~7 . ~c~,., Q~c/ ,v--~c!!`•-_ C~~
1)7
-7
0- ' !`''T
Plan revision required? ❑ Yes 0-14-0
9
Use other side for additional information. l0 11fe /
SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No.
4 AS O d x' -
ADDITIONAL COMMENTS ANDSKETCH
SANITARY PERMIT NUMBER:
ire® la "
I
DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
St. Croix
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 ~4 mo
8% x 11 inches in size. C if revision to previous 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
Richard L. Hill SW 1/4 NW 1/4,S 33 T30 N,R 19 )ao* yy
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
1060 Curve Crest Boulevard
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
Stillwater, MN 55082 1(612)430-118
II. TYPE OF BUILDING: (Check One) CITY NEAREST ROAD
❑ State Owned VILLAGE St . Joseph 52nd Street
❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL TAX NUM13E
Ill. BUILDING USE: (If building type is public, check all that apply) 636-a6ej,_-)-30-000
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 120 Service Station/Car Wash
5 ❑ Hotel/Motel 90 Office/Factory 130 Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. 1 New 2. El Replacement 3. ❑ Replacement of 4.0 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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 420 Pit Privy
130 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
450 643 900 0.05 Class 2 102.0 Feet 106.06Feet
VII. TANK CAPACITY Site
in allons 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 Holding Tank 1000 1 Henr Weeks 1-3 1 171 F1
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): PSignature: (bip Stamps) rMP/MPRSW No.: Business Phone Number:
Paul R. Cudd~~ PRSW2739 715 425-2049
Plumber's Address (Street, City, State, Zip Code):
1047 S. Wasson La., River Falls, WI 54022
IX. COUNTY/DEPARTMENT USE ONLY
roved n pmmol Sta s)
Disapp Sanitary Permit Fee (Includes Groundwater ate issued Issul
Surcharge Fee) „
❑ Approved ❑ Owner Given Initial 8- 12 - IF
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
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to ,3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
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.
l
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, draws 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)
~,1 c<1 ~'[ZD ~ l L~
Owmer's name San. Permit No.
H63.05 PLOT PLAN
Show:
" F Location of building*served u.A Dosing chamber
UT Septic tank Vertical/horizontal reference point
Building sewer System. elevation is `t~ Z-. O
Effluent system Well
Replacement system area r7~ Property lines w/in 50, of system
N R Distribution boxes Scale or dimensioned
Pump and controls:
Mfr. & Model No. Vertical Lift Size Force Main
Friction Loss T. D. H. Vol. Dist. Pipe Gal..per Min. Gal. per Cycle"
Place check mark in appropriate box, indicating item is shown on plot plan below:
e~ - tt. LO v. 0 • a.~ cony C-Ct.~TL~ p►~p 6 0 6, l S
of El-wc.laox
Tl=u~~~l~ih~~ pC~O~TST1?~
h
r sixlsr, coivrov1Z
4L. 0
0 Z0
`ZaY
,ten: w~eti` t~ a~ err
Amy If 7
y~pvc. PLMF0%--Y Lp Pile Leftyr 30' FtL" 9'cDS
/ A►~•O &T L-RST ZS
~ ~ ~ 3 'Fiz4~ 5 APT C TRIU{2,
N '
r Sy' 3
' sy~
lie SS
hiu BDRM
iL.
S O~ y,pV
C
S 10 of
~,0ot~ Q Db~
g I s Na1ZC 'T"k
By the granting or approving of the above plan, or upon the event of a subsequent
permit being issued, St.CroixCounty and theSt,CroixCounty Zoning Administrator, does
not assume or hold itself liable for any defects in plans or specifications, plan
omission, examination oversight, construction, or any damage that may result in or
after installation.
-17
t` - F - /Yl Pis ~l ~3 68//~/93
(,r c c, nnA tiro 1cens2 O. Date
~ v~ ev ~'t S !J A H C
CROSS SECTIOM OF A BED 5~3STUA
2*'OF AGGREGATE
.4- SOIL FILL
PVC
DISTRIBUTIO13 PIPE APPROVED S$WTHETIC COV"
o ova MATF-RIAL OR 9" OF 5TRA
° OR MARSH 1-1X`3
to" OF72-21 a * G®ATE
ELEV. OF FEET;
12p-(-TDm JF t~ .
Z 6 .INCHES BELOW ORIGIIJAL GRADE
DISTRIBUTIOIJ PIPE TU BE AT LEAST
ARID AT LEAST 20 I"CHFS BUT LJO MORE TRAM .42. IKIC14ES BELOW FILIAL GRADE
i
MAYIMUF% DEP-!-f{ DF EXCAVATIOI.1 FROM ORIGIQAL GRADE WILL BE I►JCHES
36
INCHES
MINIMUM DEPTH OF EXCAVATION FROM ORIGINAL GRADE WILL BE
SIGIJED: •
LIGENSC NUMBER= ~VIpPr.`St~✓ X739
Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page ` of
Labor and Human Relations
Divisio.-:,pf Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY sT. C.Z.p jK
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D.
dimensioned, north arrow, and location and distance to nearest road. ~ 3 1-,
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEW DB
PROPERTY OWNER: PROPERTY LOCATION
l Q." N1ZZD L. LL ~3 4 ~12> GOVT. LOT S kJ 1/4 N 1.l)1 /4,S 3 3 T 3 t3 N,R 19 E (or)Qa)
OPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD
Slll~wt~`(' FIN SSOaZ (wz) q30- 1!189 sr. S-oSe?pA sZ h ST-.
[?Q New Construction Use [JQ Residential / Number of bedrooms 3 [ ] AddibQn to existing building
j j Replacement [ ] Public or commercial describe
Code derived daily flow LlS~ gpd Recommended design loading rate o - S bed, gpd/ft2 trench, gpd/ft2
Absorption area required 6'13 bed, ft2 563 trench, ft2 Maximum design loading rate o ~ -7 bed, gpd/ft2 0• trench, gpd/ft2
Recommended infiltration surface elevation(s) S PfiG E ft (as referred to site plan benchmark)
Additional design / site considerations R.Ez1vt "El- lb 17," y- -is' 8tm - q oo S cp ~zr MSQWP1)u kQeA
Parent material STZ~1wt L wT by ell Shkufl 4 Ggh uet. Flood plain elevation, if applicable 1J R • ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U=Unsuitable fors stem QS ❑U 9S ❑U as ❑U WS ❑U IMS ❑U ❑S ~U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. consistence Roots Bed Tmnch
I o_ 9 ~o~tcZ 3t3 si I z`Fs U `ch `F - a.S o, s o.b
o,6
Z-!b 1~~R X16 Ghs~ Z S6k 1n~h cs k3.1&
Ground 3 ?6_q(6 7•S y(z VA S O S wl) a-S o.1 k1
elev. a. S o •7 o
Vbe•-I ft. y u3-y~3 -)•s `1fZ O-s v s5 ~
Depth to S yg_gb twitz- YA/ - S o sg ►-"i I 0.,-) o.a
limiting
factor ,
> 96'
Remarks:
Boring #
:<<:::;;:>::<:>::= I o- t o ~H Q 3 13 - S Z `F S b W~ `~h a s o• S u. L
L< Z ~F3 zy 1 o y 2 3/G - si 1 Z'F s bk tin 1^ s a S n.
-S ZL{-32 ~aSY¢ 3/y 6r 1S o s~ w►) o o.
Ground
elev. 4 3z -16 S y2 y/6 - S O 0-8
~OZ.Sft.
Depth to
limiting
factor y u ~x4
Remarks:
T Name:-Please Print Phone:
Arthur L. We erer 71 5 1
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WI 54022
Signature: Date: CST Number:
93 -`f5 5-3-93 M00576
PROPERTYGW*ER T}It-L SOIL DESCRIPTION REPORT Page :w 2- of 3
PARCEL I.D. #
Depth Dominant Color Mottles Structure GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tmrch
p_ 8 lo`l~Z 3! 3 s1 1 Z S~ M 1. a S o•S o•~
bh yn `FI~ @ S o. S o. 6
Ground 3 ►6-3y 7.S`1~, U/(, S u S~ y,1 cS o•7 O.4'y
elev.
1o3•oft. 3y-yn ~•S~-t tz~/y cs p s aS o• 7 n•$
Depth to S y u 8 1 O'1. 0 g 61 f n o
limiting
factor
- _?5<<
Remarks:
Boring #
0-10 10`d Q 313 S 1 Z`f'S bk m h a~S 0, S o, b
y.. > z 1o--tb to~-~ s/6 s j~ Z~ 3b~ y►~►~h cS o,S u- b
C r~ S O g !v►~ c S o• 0
3 Z6-3) S k-c R 31Y
Ground
elev. 3~_q1 t0 L12 y/fit S O S Yvl) 0.7 U
V06. ft.
Depth to
limiting
factor ,r
? °i7
Remarks:
Boring #
1 u -°I 1 i, •-t, Z 313 - S 1 z-'~`S b k rn `F1- CL- -S
O. S V
s.:.: •..Y :ti
S Y:; Z q -zy ~o Q 316 s i t Z is
bk wt `f~- c s o, s o,
3 -64-3k~ SyR VA - G►- 1 s o s9 wti ~ c S o-1 o, 8
Ground
elev. y 3u - S 2 - S `912 y/6 - S 4 s w~) a- S 6.1
0.6
10~ ft.
S SL_S~ 7•S ~t Q 3/ CS S 1ij Ct.S O C•
Depth to
limiting 6 13 1072 Vl _ S C~ g vy~ 0.1 0.
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
9u `i C'1Z. '
PROPERTY OWNER ~~UL SOIL DESCRIPTION REPORT Page?=of
PARCEL I.D. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer&
z s M a-s a• S o
Z g-t6 31io - sl Z`~~bk`FI~ ~S o.S 0.6
Ground 3 I b_ 3 y 7. S~ Q. ~l S S~ ln~ a S O.7 0.16
elev.
lo3•oft. 3`/-yo ~•S''t tz ~!y - cs Q g h1~ cg O--) o•$
Depth to S y 0 8 I O `1 IL y l - S O g 4n ( n U, 8
limiting
factor
7 B ~t
Remarks:
Boring #
o - t ~ lo~-tQ 313 s 1 Z~S bk yy , o'S o, S o• ~
S u- 6
:y:.. Z Lv-~ toH ~z 3/` - s j) Z~ Jb1~ Y~ h 0-S
3 1 y C r~ I S O a c S o• 4
Ground
elev. y 2 y/yt - S O S 1r)) 0 7 U
V06- tw ft.
Depth to
limiting
factor
Remarks:
Boring #
>n 1 -9 ioyt Z 313 - si 1 z~sbk Y,-, ~s o•S v•
s'' Z q -zy d o 316 _ S) t Z- S 6, S o, s a
3 V 3 - syR y/6 o sg w1 1 cS o-~ o, 8
Ground
elev. y 3u-S2 S `liz v/6 - S O S wl a- S 6-'1 Cl~
~o ft.
S SL_S6 7 S `i Q 3/ - GS d S wl ac.S 0•'7 O.
Depth to
limiting b 56.93 10 7IZ V/ S CU S vrf f~ .1 O.
factor
07
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
~Y
Remarks:
SBD-8330(8.05/92)
Wisconsin Department of Industry. SOIL AND SITE EVALUATION REPORT Page of
L rbor and Human Relations
Division of.Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
• COUNTY
ST• cZO lx
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATI0 N-P LEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
NClAk"rLt> L, 1.A 1\. _ Cau4q> GOVT. LOT St.v 1/4 NW1/4,S33T'B fJ N,R 19 E(or~J
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM #
Bobo c.hlzu~ GAT ~w~ . - -
CITY, STATE ZIP CODE PHONE NUMBER [:]CITY ❑VILLAGE MOWN NEAREST ROD
STll~wk'f R U'1N sso9Z (61L) X30- 1t89 sr• ~St;p~ Sz'= ST=
[lCJ New Construction Use (JQ Residential / Number of bedrooms 3 [ ] AddiitiiQn to existing building
j J Replacement Public or commercial describe
Code derived daily slow ~~SO gpd Recommended design loading rate o . S -bed, gpdd/9trench, gpd/h2
Absorption area required b L13 bed, ft2 563 trench, ft2 Maximum design loading rate o • 7 bed, gpd/ft2 0• S trench, gpd/ft2
Recommended infiltration surface elevation(s) SET>: ,PkG E It (as referred to site plan benchmark)
Additional design/ site wnsiderations RLTl 1~E1.~D 1Z r 7S t3~tj - q Do S ~T' t°f>3So R Prb KR~A
Parent material SEU twt iS QT DU(-* 3? ck3b 4 Gr-A utL. Flood plain elevation, if applicable tJ R ft
CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
S =Suitable for system
u=unsuitablefors stem ~S ❑u 49S 11U ~(S ❑u 19" ❑u 19S ❑u ❑S ~u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound; ry Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmrrh
Z`F'Sbk 1nJ' 0_5 v.S 6
Ground 3 ? b -43 7.S y y/6 S O S wt) a- -S o 1 I
elev.
fob 1 ft. y X13-(A •S `/2. ~l y 0-S u S5 o • $
Depth to S Il~_g~ lo'117- y/y - S o s9 ►'7 I o..~ o.a
limiting
fact b,r
Remarks:
Boring
S alt W~`F1, a s 0-3
o l•
nk,
It) -Ly 10 S 1 , Z S blt r1 T c S t~ S ' C~ .
-)-S YR 3/y _ 6>" 1 S o s~ w,) c s 07) 0.16
Ground
elev. 1 j 3Z S S`72 VA - S b S0) 1^~ ~ 0. ~ 0.8
1oz.Slt.
Depth to
limiting
factoS ,
Remarks:
CST 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:
93_-15 5-3-93 M00576
PLOT PLAN Page 15, of 3
a SCALE 130 '
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dh yam, 1`'101Z~ `~'7}ft~ S v' SST
1 IV S' OF Sy-Isy l
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~wZ s 8.1
L-LIQb6
~eTL~ TU T ~ S "Tier L~: ~2
+-►t t,~l-~~u MPKIV7kA toe oP cOutgZ 0VLR 'TykC- ~5° 21 vXio4 C-nibs.
sw _ 1 ► ,1 sff svtZi 7,(s PZN'UewT r-,aM AJ G of RgIluw ,
~3 -ls
(715 ) 42A-m69 M00576
CST #
CST Signature Date Signed Telephone No.
r
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ADDRESS -/oZ~' A,--n- <!5 7'~ FIRE NUMBER Z2_,. J
CITY/STATE zip
PROPERTY LOCATION:SW 1/4, x`' /4, SECTION- 33 T
N-R Z '51 w
TOWN OF~'f c~Q , St. Croix -County,
SUBDIVISION .Q~1G 4&- A S , LOT NUMBER_-'?,_.
Improper use and maintenance of your septic system could
result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three
years or sooner, if needed by 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 60% of the cost of replacement of a failing
system, which was in operation prior to July 1, 1978. St. Croix
County accepted this program in August of 1980, with the
requirement that owners of all new systems agree to keep their
system properly maintained.
The property owner agrees to submit to St. Croix Zoning a
certification 'form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or a licensed pumper
verifying that (1)• the on-site wastewater disposal system is in
proper operating condition and (2) after inspection and pumping (if
necessary), the septic tank is less than 1/3 full of sludge and
scum.
I/We, the undersigned have read the above requirements and
agree to maintain the private sewage disposal system in accordance
with the standards set forth, herein, as se y the Wisconsin DNR.
Certification stating that your septic has en maintained must be
completed and returned to the St. Croix Zinin
30 days of the three year expiration e.
SIGNED:
ATE• d
St. Croixco. Zoning Office
911 4th St.
Hudson, WI 54016
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 ~n delays of the pormit issuance. , Should this
development be intended for resale by owner/contractor,(spec
house), thenta second form should be retained and completed when
the property' is sold and submitted to this office with the
appropriate deed recording.
o
Owner of property
Location of, propertySL' 1/4 A~V)1/4, Section -33 , T , N-R /9 W
Township cJ 4 S S
Mailing address ,v6 5
A - v A).
Avfaz, Ak)S s
Address of site c7 2iV Ls T. S 11j1Uf,
Subdivision name GAS Lot no.
Other homes on property? yes No
Previous owner of property
Total size of parcel - oc)
Date parcel -was created o• Q oA, K.
'Are all corners and lot lines identifiable? V"_ Yes No
Is this property being developed for (spec house)? Yes ~o
Volume /0;? and. Page Number -'--y`- 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 & 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
.references to a Certified Survey Map, the Certified d Survey t 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. 50?~ , and that I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for
the construction of said system, and the same has
been
du
recorde in the office of County Register of deeds as Document
No.
g ature of applicant Co-applicant
v ~ d
Date of gnat a Date f S gnature
DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA j
~ -
STATE BAR OF WISCONSIN FORM 2-1982
STr CROIX Co.,
t Grantor C~ec*d folrRecord'
TOWER ASPHALT' INC.' a Minnesota corporation
- . -
- AUG 10 1993
. - - - -
conveys and warrants to _ RICHARD _L-.- HILL, and- BARBARA---
KUUNSKI_,--husband. -and __wife.-as.oint--tenants-,--Grantees-----
RETURN TO
the following described real estate in t._..Croix------_-----_--•_-County,
State of Wisconsin:
Tax Parcel No:
A parcel of land located in the SW4 of the NW-4 of Section 33, Town 30 North,
II Range 19 West, Town of St. Joseph, being further described as follows:
i
Commencing at the Southwest corner of Section 33; thence West along the South
line of Section 32 a distance of 57.61 feet; thence North 628.97 feet; thence
N87055'00" E 120.15 feet; thence N44048'00" E 444.26 feet; thence N1041'00" E
1091.23 feet; thence N10042'00" E 874.87 to the point of beginning;
ii
Thence continuing N10042'00" E 330.75 feet; thence East 639.73 feet; thence j!
ii SOo14145" E 325.00 feet; thence West 702.54 feet to the point of beginning,
I
subject to town road over the Westerly 33 feet.
I'
TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and
rights-of-way of record, if any.
I
This is not homestead property.
(is) (is not)
Exception to warranties:
ii
i
Dated this -----10th------ day of August-- , 19
TOWER ASPHALT, INC.
SEAL)
_ -
I
* BY c
-
--------------(SEAL) ~ -_---(SEAL) l
II
AUTTHENTIICATIO'N` ACKNOWLEDGMENT
A mw / I>r Z' STATE OF WISCONSIN I'
Signature(s) -
ss.
- Count
St. Croix
authenticated this1_~__day of__ 19..95 Personally came before me this 10th----day of
August------------------------------ 19---- 93the above named
- -
TITLE: MEMBE STATE BAR OF WISCONSIN
(If not-
authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Barry C. Lundeen
MUDGE, PORTER & LUND Iv C-
110 -Second__Street,-_Hudson_,__WI__54016 Notary Public __-__-_St,-_-Croix--___----_---_-County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration
are not necessary.)
date: 19--------•)
*Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
FORM No. 2 - 1982 Milwaukee, Wisconsin
W
W .
O O
'.208W 1320.07' N0°46'15"E 1179.03'
651 40' 373.42 707 58'
m m
N) N
1 NO L
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46-
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W o M >0
M A
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27
,29
3,00 _ rn U, 3p531-`/0042_,
Mo 001
W O w 30 2~
O n r -4 70
, O 330.75' ' (w_`~'
o o b 0
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I9 NO° 14'45' W cr i rn o :E Cn Ln
591.52 A O rrl o 0
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c~0 A ~N \ O O(n O N
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32 00' 268.28'
591.52 00~ 298.00 M
3526.00' w
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6127 738-01I~o
!0PERTY SURVEY REVlaa~s SCALE
DATE DESCRIPTION By WIN 54016 I DRAWN °r
Z DATE
s
1 i N wrt _ T}4. E
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print)- TESTS W E(OMPLE ED ON:
ae ate, a 8'
ADDRESS: C &F,,' ICA lO N ER: PHONE NUMBER( optional):
6o 3 Edson 1 fs~
6--q CST I A r
;UTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
3BD-6395 (R. 02/82) - OVER.-