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HomeMy WebLinkAbout030-2090-50-000 3 ° 0 n 0. 0 N ~ O N N C .p GL I "C I N Z c L `a v I Q I', I M N v Z y > E (N U) 00 Z O W 1 d m N F- Z C O O Z a c d Z ~ I c co ~ { I' I ~ ~ I N J a N N •IV 0_ ~ t C,4 a -0 co 0 a) Q o z co z C E E I I' o m Y "=o0 IL < Fy- H H 3 U 003: 3: 0 a0 =aaa o (mil 7 O U) M y li M J U a OOi OOi N oo m LO a) N N N N r O E 0 C) 'p O 'p O N co f6 CO Y1 CA N O ca < U) m o ° 0 31 y O O O O C E N O co N_ it p O F- O Q> .S N U d O O O G O O O O t E a C -O N N N N V to C ( p Q. C C N 0O C V O N (O 4.a O N y O O C N t a~i 'O r N I N C) 0 IC M C ry~.+ j G L t=yam,! O Ul f6 O N fn "O O E ) O Z y Z (nU I U ~ ik Vii, E 3 L: a r`tii w E c t A U a ~ l0ait) STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ADDRESS j SUBDIVISION / CSM# LOT # SECTION T N-RAW, Town of___,",V at/ ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW ERYTHING WITHIN 100 FEET OF SYSTEM rd' 39 Ile a" INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:- Liquid Capacity: Setback from: Well House Other Pump: Manufacturer Model#Size Float seperation Gallons/cycle: /9~i,_ Alarm Location a , SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: Sr r~~~ Setback from: well: L, 7 HouseOther ELEVATIONS Building Sewer ST Inlet ST outlet ~~C6 PC inlet PC bottom Pump Off Header/Manifold 7 Bottom of system ~a Existing Grade Final grade 9~,1 DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt S t STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~~i7s) ADDRESS~yr'r SUBDIVISION / CSM# LOT # SECTION,2~/ T_~-2-_N-R ?~_W, Town of 1 s T. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 7S Busk a, ,e//INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. t s BENCHMARK: ~ z A X,'; I 4 2 Z4 2e ALTERNATE BM•9 SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: -Liquid Capacity: Setback from: Well House Other Pump: Manufacturer~~~ Model#, Size Float seperation h) ~Gallons/cycle: Alarm Location /,c1 ,A„c6 SOIL ABSORPTION SYSTEM Width: Length yi- Number of trenches Distance & Direction to nearest prop. line: 9~ Setback from: well: House Other ELEVATIONS Building Sewer ST Inlet. ST outlet 1Y PC inlet PC bottom Pump Off 7~~a Header/Manifold &S7 Bottom of system- _ Existing Grade Final grade DATE OF INSTALLATION: - I PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt LG$ $ ert e~'Ta QI 'yH• 24.30.20ANAT SEW.RGE SMEM County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division OTX (ATTACH TO PERMIT) Sanitary ermit o.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village [i Town of: State Plan ID No.: S E ev.. Insp. BM Elev.: BM Description: Parcel Tax No.: 11'__1d -nnn TANK INFORMATION ELEVATION DATA A93003725 9 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic' Benchmark Yc~ Dosing X W Aer on Bldg. Seer Holding St/Inlet e TANK SETBACK INFORMATION St/Outlet TANK TO P/ L WELL BLDG. vent to ROAD Dt Inlet Air Intake ILA_ NA Dt Bottom s, 79. 62 11 Septic ? 5O~ 8 Dosing > ~p ~NA Headers N~ ~S Aerat n Dist. Pipe , 7~i o.l Holding Bot. System PUMP/ fito"MI -INFORMATION ►a G age` 3,75 S $3 oyci O S.T• 6\3 ariufacturer Model Number GJLrD3//L L~51G PM L fo,(o5 0~, 3 4Z,q TDH Lift Friction Syestem A TDHpFt 14, oss 15 h Forcemain Length Dia. g) Dist. To Well 44 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7~E DIMENSIONS LEAC Manufact SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O /dtua 5c r CHAMBER Mode System: ZIA DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) / x Hole Size x Hole Spacing Vent To Air Intake Length ~ Dia. Length 7~ Dia. Spacing 6 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys Only Depth Over 2 „ Depth Over xx Depth Of x eeded/Sodded x rr Bed/+%NM enter - Bed/T $ dges 30 - Topsoil E] Yes No E] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: ST.JOSEPH.24.30.20W,NE,SE,LOT 9,CTH,V' 5, 60, Plan revision required? ❑ Yes 0- m-0-Use other side for additional infor ti 15 P Mp I/a3j ~;4lli z SBD-6710 (R 05/91) / /date inspector's Signatu a Cert . No. ~~S f ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION CIL:HR In accord with ILHR 83.05, Wis. Adm. Code COUNTY Y STAT SANITA Y P M # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ chleck 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. PROPE OWNER PROPERTY LOCATION '/a T , N, (or 'Al I 00,A PROPERTY O NE S AILING D _RE T # BLOCK # /T~ M° ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBE CITY, S AT JOE IL TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE ❑ Public 01 or 2 Fam. Dwelling-# of bedrooms AR L N III. BUILDING USE: (If building type is public, check all that apply) ?o 90 25 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) 1A Z New 2. ❑ 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 El Holding Tank 12 ri 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 69 5-,Zl Feet 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 Holdin Tank Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the and rsigned, assume responsibility for installati of the onsite sew system shown on the attached plans. Plumber' ame rint : Plumbs S' 7rhatur (No in-i-4- MP/MPRSW No.: Business Phone Number: (9K~L I ( -S Plumbs ' AcTdress Street, City, State, Zip Cod IX. C LINTY/DEPA TMENT USE ONLY Disapproved Sar)iSarY Permit Fee (Includes Groundwater a e ssue issuing A nt Sig to ) I 7140 ~~Pl u Approved ❑ Owner Given initial rcharge 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. r 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 applicab!e. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Per "n!! Transfe iRk rr,=wal Form (SP[) 6399) to be submitted to thi- co:anty prior to installation. 5. Onsite sewage systerims must be propet~y .rraintaiied. Th tank ) ry:..vt be pumped l>, a licensed pumper w never 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. ll. 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 request~c' in #1-7. VII. Tank information. Fill in the capacity of ev~ry new and/or exis - tk., list the total gp ,rn=, number of tanks and manufaCtUrer's name. Indicate prefab or site constf(1c .ti ar.d tank material, Corn.";ete fcr all septic, purrip/siphon and holding tanks lo, this system. Check, : < • imental approval only if :,an'Ks received experlmental praduct approval from Dlf_ii . Vlll. Responsibility statement. Installing piu!r~F--.r is to fill in name ~e nwribe, with appropriate prefix (e.g. MP, etc.). address and phone number. Plumber must sign F~ lass ,a;, form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and spec fi^ations riot smaller than T/2 11 inn _,hes must be >ubmittLd to the county. The plans mu -t include the f l c w ng: A) p! i -::3n, drawr to s Sri+h comple'n d r . r,• , .F; '(;c2ttion of holding tar<(s), sepil ?a or oche a'rnent tanks; b : Nr wef vw t;. ; eater service; streams a.nd lakes; P ~ urnf ~ (,r Si phon tanl,- •;istribotocn hoxes, rr,er- system areas, a'?(S t)e locauo•,i of p',e bui!din^ 8) ho' izont.,' >tlntS; C) complete specifications fot purr(ps and controls; dose !vat on tric',il- n loss; pump performance curve; pump model and pump manufacturer; D) cr, ss section of the soil ;;b ;orpiior1 system if required by the county; E) soil test data on a 115 form; and F) a0 s1 zing information. - - - - - - - - - - - - - - - - - - - - - - - GROUNDWATER- SURCHARGE 1983 Wisconsin Act 410, included the creation of surch .r9es (fees) for a number of regulated practices w`rich ;jar, i-ffect groundwater The monies collected throe g`, S,hese-st:rcharges slit' ed for monitoring gto :rldv ater waterc.ontarrrination invrrs'i.1at ens acid establishi,~2rrr it standards. SBD-6398 (R.11/88) N4(,'/ ~.v 30 ©,s,t-~<°r't y~ 9C t/OUSE -----14 ~J ~ ~awc~cr~z~r.N 4rlsconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page L of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code L°r 9 COUNTY - Attach complete site plan on paper not less than 8 112 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 INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT 1/4_5,,,- 1/4,S T N ,R E (o PROPERTY*WNER':S MAILING DDRESS LOT # BLb K # SUBO. NAME OR CSM # CITY TATE / ZIP CODE (PHONE NUMBER ❑CITY ❑VILLAGE [DTOWN NEAREST ROAD ~ r VS) New Construction Use jXJ Residential / Number of bedrooms [ J Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow -5 D gpd Recommended design loading rate , bed, gpd/ft2__,_~trench, gpd/ft2 Absorption area required _9/?n bed, ft2 XsA-_ trench, ft2~ Maximum design loading rate ,477 bed, gpd/ft2j~.trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material - - - - Flpod plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE ATGRAOE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ES ❑U I ES ❑U ❑S DU ®S ❑U 0S ErU C7S EU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft Boring # Horizon) in. Munsell Cu. Sz. nt Color Gr. Sz. Sh. Bed (Trench n'~ yam': •+k{.tilt-'. / ~ i Ground elev. 9ft - 5- - L Depth to limiting factor Remarks: Boring # 2. - Ground elegy 2/;J ft. I I Depth to limiting factor Remarks: / CST:`ase:-7!ease Print ;,caress. _ j / PROPERTY QWNER SOIL DESCRIPTION REPORT Page 2,of PARCEL I.D. # Boring# Horizon Depth Dominant Color Moores Texture Structure Consistence Boundary Roots GPDift in. Munsell Qu. Sz nt Color I Gr. Sz. Sh. I Bed ITrench 9V A1,211 14 Ground r elev. / Q ft. Depth to limiting factor , Remarks: Boring # _ 71 Ground elev. 1/ V r, 9~ft. Depth to liming factor Remarks: Boring # / i ?J 1 -41 f•'i 'ni:hvi:iti[ Ground elev. _ -57 ft S- 1/// A,/4 Depth to - limiting factor Remarks: Boring # E3 Ground elev. ft. Depth to limiting I I I factor I Remarks: sec-a-n 20 ;R.05.s2; r ; . ; 3`•Po I j ! ! 'I I _S.G~~~~ sc C `-~7/ ~ ~'D~~ ~~..~ac~C~W I I I I 1~ ! ; I ; , ! I j I i ; t ~ { i ! i I ~ 1 1 ~ ~ ~ ~ ~ I ! i IT- ! ! ' i I ! ! I j I I! I i i i►! 'i ~ I 1 1~ i I ! i i i 1 I 'I i I I i I I I ! , -i. ! I ; I l l i! I l{ I!!. _ I 1 I 'I I ~ I I! I I I~ ~I I I i! ~G..2 ! ! I i 1 I f j ~ • : „ems :r . _ ~ _ i T i ; ~ I PAC C 0 r too# FNNI Ak Wets AAA 0►4jtVgUq* PI►~ I 20.42` el6eee ►1~ 4' C••1 If" 1 1o flow ,60040 vM pope ' W! 4 last Of I r ; ir.~M~k CaaMr ; ; ' N~ieh • ~ is O"tw 2►qAi~ p•une11~ ' FI►~ Teo ` ►e••M IIp• • PN1M•1•• Pipe Ye1•v r ~w • ._C0*441 1«wbe1M! A/ ' buew 01 i1.1•~I 1 wt 1 1 t r so1L rnLL• • 013TR16UT101.1 PIFL A?PP O%►f G S' N iCTIC r COVC 2Y OF J%G6REGA?F I'1AT~R1^L OR V OF $TitA~. OR MAR•1• ►!Ay ELEY, oF20REL •d' '76i -L'~ AGGRC6AT C 1DISTRi*UTK0IJ ►IPC TO bC AT 4C4 iT . _ INCHES 5CLOW ORivlwAI. •~.iAOE I►WV AT. LcAST;O I"W" OUT 140 1AOP-C THAN yZ 1UC1{CS OCLOW ►INAL %,kAor. M~uclrwM OSPT•H,0F EXCAVATIOW FKoM oRi6wA.. 6gAv0 W1LI, bE -S~_ 11JCNEs 1'uKlr►VM ©EP TIi OF EXCAVATION f F O^ Q IiOWA tL GiRAD L W11.1. 6C l~ 1NCNC S t .c ~ D#ST r. • I n PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VEIJT CAP 4%.I. VENT PIPE WEATHER PROOF APPROVED LOCKIIQG JUQCTIOKI BOX MANHOLE COVER ~ 25' FRAM DOOR, WIIJDOW OR FRESH I2"MIU, I AIR IAITAKE GRADE I 4°M(IJ I Id. COIJDUIT-- \ \ X11 INLET PROVIDE I - - 7 AIRTIGHT SEAL I I i I V I APPROVED JOINT • A I I I ( APPROVED JOIWTS W/C.L PIPE I (I W/C.I. PIPE - EXTENDINfs 3- I II ALARM E%TENDIuG 3' ONTO SOLID SOIL I ' ( ONTO SOLID SOIL B I GN C 1 PUMP -9- D CONCRETE BLOC4t RISER OFF EXIT PERMITTED OIJL9 IF TAUK MAIJUVACTURER HAS SUCH APPROVAL SPECIFI.CATIOAIS EPTIC AND J l oSE TAWKS MAQUF'ACTURER: WMBER OF DOSES: PER DA-4 'TAMK :dzc: GALLOIJS DOSE VOLUME: 912 GALLOMS ALARM MAUUFACTURER: CAPACITIES: Aa _INC.MES OR CALLOUS MODEL ►JUMBER: 8=~.-INCHES OR 28 GALLOUS " SWITCH TYPE: C=-,L1INCHES OR 1910 GALLOUS PUMP MANUFACTURCR: D=~IMCNES OR CALLOUS MODEL NUMBER: 1~ ~a ,L1.4 NOTE. PUMP AND ALARM ARE TO BE IUSTALLED ON SEPARATE CIRCUITS ,WITCH TyPE:. 1 PUMP DISCHARGE. RATE - GPM VERTICAL, DIFYERENCE bETWEEU PUMP OFF AUD OISTRIBUTIOU PIPE..FEET + MINIMUM NETWORK SUPPLY PRESSURE FEET ♦ FEET OF FORCE MAIN X F/ioo FtFRICTIOU FACTOR.. ~sQS- FEET TOTAL DbMkMIC. HEAD = -49 FEET rye p IAITERIJAL DIME SIONS OF T : L.EIJ TH ;WIDTH ----;LIQUID DEPTH SIGIJED: VZ4z__-_LICE.U5E IJUMBER:S^~ DATE: Q) r CIL Y .Performance K Y ~ Curves Pumps METERS FEET 90 MODEL 3885 25 80 SIZE 3/4" Solids WE15H 70 2 20 WE10H 60 -WE07H 15 50 WE05H 40 10 30 WE03M 20 WE03L 5 tn- 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 1 1 t i 0 10 20 30 m'/h CAPACITY [qGOULDS PUMPS, INC. SEPECA FALLS NEW YOt71c 13148 METERS FEET 120 MODEL 3885 35 SIZE 3/4" Solids 110 WE15HH 100 30 90 25 70 20 60 O t- WE05HH 15 - 50 40 10 30 20 5 10 0 0 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM L i 1 1 0 10 20 30 mo/h CAPACITY 01985 Goulds Pumps, Inc. Effective July, 1985 C3885 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ADDRESS: ku .L FIRE N0: LOCATION: , 1/4 SEC.?= T-30 _ N-R,-2,1 Wo TOWN OF:~ ST.•CROIX COUNTY SUBDIVISION: LOT NO. 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 requirement 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. SIGNED:- r DATE: 12121 St. Croix County Zoning office 911 4th St. Hudson, WI 54016 STC-100 This application form is to be completed in furl and signed by the Uller(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 Douse), 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 propertykL-* 1/4 x_1/4, Seetion,~ T 1ZH-P .Township Hailing address /J-F Address of site /1-JC 1 4 Subdivision name Lot no. other homes on property? yes No Previous owner of property Total size of parcel Date parcel was created ' Are all corners and lot lines identifiable? Yes No Is thin property being developed for (spec house)? Yes ,.;h/--NO Volume and Page Number as recorded. with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARIWITY DEED wliich includes a DOCUMENT NUIIDER, VOLUHE AND PAGE NUME31'n It THE SEAL OF THE 11EGISTr.It 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 referencos3 to a certified survey map, the Certified Survey Nap shall also be required. PROPERTY OWNER CERTIFICATION I(%ec) 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 in th office of the County Register of Deeds as Document No. 1:p , 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 hae been duly recorded in the office of County Register of deeds as Document No. r Signature of aql cant Co-applicant Date f Si ature Date of Signature `j-~X• ~A C03b~ 2no)d_ $'O DOCUMENT NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING OAT^ STATE BAR OF WISCONSIN FORM 2-1982 I ; I I'.. - von 104$rACE z7508846 ~ - =`i Y - - - - - - - - - - REGISTER'S Off ICE .a ROBERT E. O'BRIEN and MARIANNE REPP-O'BRIEN, husband ST. C~(IX Co., w1 ii and wife,..-Grantors i Reed for Record I i+ I~ NOVI 21993 9:20 A. M I ! co.... s and warrants to .....ROHI',RT--~].,-JOHNSON--and--SANDRA-K+--------: C/~* R~LJL JO HNSON, husband -and --wife-•as survivorshipmarital . I ro ert Grantees ( R~Dr~ it RETURN TO • _ I - 1 the following described real estate in St........--Croix County, State of Wisconsin: • Tax Parcel No: i II i Lot 9, Arbor Hills in the Town of St. Joseph, St. Croix Countf, Wisconsin. i i f ITIXNSFE~ I i I E~ I , TOGETHER WITH and SUBJECT TO reservations, restrictions, easements and II rights of-way of record, if any. Ili i l ~I This i3 not homestead property. I~ (is) (is not) i Exception to warranties: l s 1993.... Dated this 5th day of - -Nov.ember (SEAL) --...-'!~1~!~•~ - (SEAL) I BERT E. O'BRIEN . . . . . . ~J i I/TL!?"'L"(SEAL► i ...........................•-----•-------------(SEAL) it ' MkaiNE REPP-oluu N it I ~i AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN as. ..S.T...._CRQLX---------•---•-- County it t authenticated this ________day of___________________________ 19 Personally came before me this -5th_........ day of i .November 19___93_ the above named 5 Robert E. 0 Brien and TITLE: MEMBER STATE BAR OF WISCONSIN Marianne Repp-0 Brien _ ;l ~ (If not- - authorized by 17(16.06, Wis. Stats.) to me k wn to be the per ns___._..___• who executed the forego' instrument and nowledge a same. i THIS INSTRUMENT WAS DRAFTED BY i Attorney Barry C. Lundeen MUDG$, PdR'IHR & LUNI)EEN; ' S : C:° '---wrAw-RUB 5M OF WTI------------- 11Q__S~csnd__ tireet~__Hudson,- WI.54016 Nota y blic ._St.-•-Croix--------------County. Wis. t (Signatures may be authenticated or acknowledged. Both My 0orn ssion is P ermanent. (If not, state expiration are not necessary.) date-------•.----- 19'ff Hamm of persona sicnina In any capacity should be typed or printed below their eiI WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. ~I FORM No. 2- 1982 Milwaukee. Wisconsin .~F u.r... a~... ~y.;.• ..,..b '.ri"i!°-. i-r' •.T N- ZC -2 ,151 O r.0 fn O 01 s0, N M N , M c7 {!l` O O N 1 1A V1 Vf O O O O O O O 0 O O O O 4 OI 10 f- 11 O to b 1 f- °D O N J' J M N f'f M N O 0 0 0 0 0 0 f"~ Ol O in M O O O O O O M M M O n M M M M 17 .r CO OI .0 40 M M M M N a a M N N N N M M M Y O o 0 0 0 0 0 O Qi Z to QI W to co~ t cn (n ' N .-r .r co N N N N N . 11 1 1 1 1 1 1 1 1 N I O N N N 0 N00°24'03 "W 00 / 136.64'':. of w p w LLA LL 'c 0 Lo <1 to - - o \ -11 0 a-1 0) h rh w z I o co f ° ~I Z Z / 0 1n°o. z a-1 r. a a <1 0) C u 01 ~I o c ti I u d v a NI d u ~ 0 k re 7 a d a d o ~I u 4 u 0 a ~ LL1 W I a a u cV >I CSI 03 ..4 0 r4) u au0w ::Dl Q-1 r o a a \ V F I u)l u a e a u U. O j 0)I co o to V a C C a !0 W V) ICI ~I WI 0: LL- 0 L. ad >,a O T L > L A u d d O rn 0) I~ I to c 00 G'~J N dU 0ji O O 0C0_ LYI JI a 4Mrn N OM L,J101 Q O L a d to \ k N.~ N H ...r((((ill` a' a V to > C a 4 d> u W A S N 7 C V a N O d o . 9 d d F N tk p• .-1 - 1 0 a 39 L. ..1 N wv u aw a Q 100; u O V cn z u O O C~ cJQE y a O v W u., 12°'~3 V) d y > cn o 9. 4, F- F- 1-4 Z 10-T ui ca w 31 co O w » 7 krn u.~ / W O J 03 A C r a N d N .r / ou N O k A a A Q (7 .4 4 O L. k O I W z ma O u .'7 0 C G. r / .i to cc W -A -H O N ~ a d- R u d d _1QQ.0 w a m o F~., c'a ° 4" 12°3354 F w ~ o. u ° rn o d > > 0-4 14 to 4) ~ O O k F 44 a 1. s F O a 0, 7-) O fn x 0 I T A (b 4 / 85.04' 750.00' NOO°27' 10"E / WEST LINE OF THE NE V4 OF UNPLATTED BEARINGS ARE REFERENCED TO THE EAST LINE OF THE SE 1/4 OF SECTION 24' ASSUMED TO BEAR S00°38'20"W. • ST. CROIX COUNTY WISCONSIN ZONING OFFICE M M a N ""`ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road r- - - Hudson, WI 54016-7710 (715) 386-4680 June 1, 1994 Mr. John Sias First Federal Savings Bank 201 South Second Street Hudson, Wisconsin 54016 RE: Septic Inspection for Bob Johnson Property Dear Mr. Sias: An inspection of the septic system for Bob Johnson's property was conducted on May 13, 1994. This property is located in the NE; of the SE; of Section 24, T30N-R20W, Lot 9, Arbor Hills, Town of St. Joseph, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three bedroom home. If you have any questions with regard to the above, please do not hesitate in contacting our office. in erely, me . Thompso'rfo Assistant Zoning Administrator mz cc: Becky Hartman Wiswnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page _ Of LAIwA tail Human Relations 'Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code t COUNTY ~ / 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. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: , PROPERTY LOCATION . ,12 GOVT. LOT 1/4s 1/4,S T N,R - E (o4f PROPERTYfWNER':S MAILING DDRESS L # B # SUBD. NAME OR CSM # A s- / ?rp S' CI TE I IP CODE PHONE NUMBER CITnY r-IVI1 j~jfOWN NEAREST ROAD FNew Construction Use [Xj Residential / Number of bedrooms r [ j Addition to existing building j j Replacement [ j Public or commercial describe Code derived daily flow s Q gpd Recommended design loading rate , -bed, gpd/ft2-,L-trench, gpd/ft2 Absorption area required bed, ft2 ~1Z trench, ft2 Maximum design loading rate __,`gibed, gpd/0_,_j~_trench, gpd/ft2 Recommended infiltration surface elevation(s), q ft (as referred to site plan benchmark) Additional design / site considerations Parent material FI plain elevation, if applicable ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem WS ❑ U 0 S ❑ U ❑ S ❑ U ®S ❑ U ❑ S ?U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. ont Color Gr. Sz. Sh. Bed Trench 4;;~i / :v:•: J. Z22 _4'Y "d tT-j L Ground , S elev. pft. - Depth to limiting factor >9 Remarks: Boring # •h7v~L ,(/7 1 - ye v 1/9- 54V Ground elev. 7~I~ ft. Depth to limiting fact Remarks: CST Name:-Please Print ' Phone: 0 Address: t Signature: . ' r/ Date: CST Nu r: PROPERTY OWNER SOIL DESCRIPTION REPORT Pagk.2.,,v ra~ PARCEL I.D. # ' t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 14 Ground V -4 elev. Depth to limiting factor~ Remarks: Boring # M. 7 le 1114 4 .)J- Al Z C j -S 12 J- C- J~ Ground el Depth to limiting fact y Remarks: Boring # ` g.- 14 Ground elev. - -1h Z2 27 ft. Depth to - J limiting factor ` Rema Boring # l Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) T-r- I - I i i II I p - _ ' _ --I - - i- - - ' ` -I w4 - - ~ mill I d i I o J } -_L.l? -r- • ^I --i i Via- I - i 1--- 7- ~ t 1 I 1 I T 1 ' ~ I I I I i 9L 41 LL I : , I I I I , +T j I i~1,g ! 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