Loading...
HomeMy WebLinkAbout032-2071-90-300 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~'/~NO/'/DES 2 - C- ADDRESS ~G o S" iPE@ arJcs 17~: vim, Alf /o J~ J 1 SUBDIVISION / CSM# 1/0/ G- Q.-2.-- /SS9 LOT # SECTION /_T N-R ! ~ Town of Sa MIN ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Q BM,TP ~r Stma' rrv•rc P,,Tf/ /oa.ao 39. . id 'r S I, 'yo ~21er r d, o-) I P G b !a' -jl I W"e// I e 14- 14) 5.16 lv-y INDICATE NORTH ARROW Provide setback and elevation information on reverse of this-form. Provide 2 dimensions to center of septic tank manhole cover. } /o T laiq a~ .E~ = /U ° o o y 6 Sr BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: 1,P0, ,P,4141 Setback from: Well (.Z' House /7 OtherA/~,~af~/aws~ Z3 Pump: Manufacturer Model# Size Float seperation- Gallons/cycle: - Alarm Location .SOIL ABSORPTION SYSTEM Width: /8' Length Xe ' Number of trenches Distance & Direction to nearest prop. line: 3~F7`e Norys, leI /;yam Setback from: well: 5 House 2- Other /Z 74,,,e- ELEVATIONS /d- O.S3 Building Sewer ST Inlet; 3. &z ST outlet y,/9 PC inlet - PC bottom Pump Off Header/Manifold/af4 Bottom of system 7 Z Existing Grade /v.C/a Final grade Jy DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt j L(~*Ip~rt1t''y 13.30.20 VVXTE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT wafety and Buildings Division RWIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary r it Permit Holder's Name: ❑ City ❑ Village R Town of: State Plan o.: lev.: Insp. B ev.: BM Description: Parcel Tax No.: /&0, 601 l ~~cQS i/Z TANK INFORMATION ELEVATION DATA A9300262 /a 27/x'3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 7, S2 " Septic Gy `O G Benchmark ~9 l-U,~~s~ TC 6D ~ Dosing / B O. OG, to Aeration Bldg. Sewer Holding St/ K Inlet 6, G~1' bpd, 0? ~ TANK SETBACK INFORMATION St/ Outlet ~y' U~j,sl8" TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet j~ Air Intake Septic 7 i NA Dt Bottom / Dosing NA Headers 32 20 Aeration NA Dist. Pipe 3, Holding Bot. System - PUMP/SIPHON INFORMATION Grade M u a Demand TolO d'~rov 3 P~ gel 16~ Model Number GPM Sle OD, D~ TDH Lift Friction TDH Ft ength Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH width p y Length, ~.1 , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /0 DIMENSIONS SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACH--INCr- Manu act INFORMATION TypeO ~e.~ r , CHAMBER e System:( "0- de-CE1 DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) / i le Size x Hole Spacing Vent e Length ~ Dia Length 2 7 Dia. Spacing F~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Depth Over 3 Depth Over r/n r xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center ~'~r7 Bed/Trench Edges3/°~7 Tops ❑Yes o ❑Yes ❑No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: SOMERSET 13.30.20.777H , e tic -C lr a-~/ ✓ ~ ~ C G c~~ lp e, O lam".., i( `i~/ Y M ~ A /I~~Sy~♦ Plan revision required? ❑ es EJ-1 o p C~ Use other side for additional information. /~7 J~A :1 0 SBD-6710 (R 05/91) Date Inspector's Signatu a Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PER T # -Attach complete plans (to the county copy only) for the system, on paper not less than / 4evr 8% x 11 inches in size. ~n fffv,-. o 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 /QA%~0rL (~EVI5En P/,410 S %54o S/ T~O,N,R Z0 E(oKjj:) PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER v on 1(391 1 wZ Syol~ /Z C 5M G PQ e, /SS9 II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE: oIm cIS~-~ fa, fQ; ~ ~l;✓~ ❑ Public Lg 1 or 2 Fam. Dwelling- # of bedrooms ~ PARCEL TAX NUMBER( 3 Q p III. BUILDING USE: (If building type is public, check all that apply) 0-3 2- 2 d 7 / - ?(0 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 411 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 N Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION ~S'CS G y3 7Zo 41;,-. _ -7 9 / Feet 7I!• Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New isti Gallons Tanks Manufacturer's Name ncret Con- Steel glass Plastic App Tanks Tanks strutted Se tic Tank or Holdin Tank o00 / w e✓ 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): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: 7 z 3 (~cr 5 ta h6.,CN SEK~-~ ( 2- Plumber' Address (Street, City, State, Zip Code): o zz w~P,' ~o u/1 'o IX. COUNTY/DEPARTMENT USE ONLY m ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Eorylftl- e ssue Is;;~; t Sig a t a tNmm proved ❑ Owner Given Initial Surcharge Fee) r~- ~ Ap pp~ Adverse Determination 11 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. lll. 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. 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, 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) 1 ~o f L I~ i cp Q ~ Ff 39z _r ell LA f 1 I ~ P \ P ° v b A t~ P Z A W C H ~ N~ Q f l a0 ~ ~ V ~A 41- IN,i P ° y o Ul P Q ~ r r` q P P LA ':7 kA 0 m N ny ~ ~ ~ ~ ' P , sk lzlk c -y\ 7 .n v NJ Fs- - w p ~ o m I rf_ I Y i I z I < I I I I Ile 01 G7 I g~ ~ I I " I ~ n m I I I \ j < I I I m j ~ z I I ~ I rtt m I ~ ~ u I I I I W I v, I a, I CA C C I e N I I I I ~ ~'1 I I I I I W ~ 0 I I I e~ I I I I N Z n j ~ ~ I I I I m I j 'o n I I W o ; z I I I I I I ~m I I I ~ I I a j I I ~o I -b j I I I N W m O Z W co I ~ a i Z 'AY X 0 -PY j co x -i --1 °o o CA-1 0 o x Fn m~ m V M v ~ z b -o m Ti j0 o N r*' Z m 4- rn n z `o n I I o Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page - of Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY J Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but izL- 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 PROP TY OWNER: PROPERTY LOCATION GOVT. LOT 1/4 1/4,S/_3, T N,R V(or& PR PERTY N, ':S MAILING ADDRESS LOT # BLO K # SUBD. NAME OR CSM # CITY, ATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [SOWN NEAREST} OAD [xJ New Construction Use Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement Public or commercial describe Code derived daily flow gpd Recommended design loading rate gybed, gpd/ft2___2 _trench, gpd/ft2 Absorption area required bed, ft2 - :j-~ trench, ft2 Maximum design loading rate y bed, gpd/ft2_trench, gpd/ft2 Recommended infiltration surface elevation(s) z0=X / ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL F HOLDING TANK U=Unsuitable fors stem ®S ❑U COS ❑U MS ❑U MS ❑U ❑S OU ❑S MU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Pont Color Texture Gr. Sz. Sh. Consistence Baxxlary Roots Bed Trench X1,4 's Ground elev. ft. Depth to limiting factor Remarks: I Boring # 0~.*~1!Mg!~KH!1' 6z,27 A Z k 27116 viii Ground 7 elev. t. Depth to limiting factor Remarks: CST Name:-Please Print Phone: ;e112 11~z Address: Signature: I Date: CST Numb/ PROPERTYOWNER~ SOIL DESCRIPTION REPORT Page,-?.-af PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. 22nt Color Gr. Sz. Sh. Bed Trench k 4 ' Ground f - elev. Depth to limiting factor Remarks: Boring # MN ~i Ground elev. F ft. Depth to limiting factor Remarks: Boring # v~v:4Ground elev. `l ft. I Depth to limiting factor Remarks: Boring # III , IN Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) ~ 3O/ ,47 111-6 ,ell ~I a / ' oGO.T ~C /.J.C -SECTION 13 I UWIVCat CONY MONUMENT RANDY LIKES 701 AANROE ST. APT. N Z:, 1 NORM HUDSON, iii. o m r ungla~ted_lands_owned by_others 54016 zo 00 o NORTH LINE - SW 1/4 CENTER S88048148"W SECTION 13 455.89' 11/4" IRON ROD LOT 1 LEGEND N 249,008 sq.ft. , • REBAR FOUND 5.72 ac. EX. R/W s- c v r 1" x 24" IRON PIPE WEIGHING r 0 o 252,279 sq.ft. - ca 1.68 LBS/LIN. F1. SET. 5.79 ac. IN. R/W ; ~l~S'po~oo k . v o s- . V_ -4 U2 lm 0 1° = H -BEARINGS REFERENCED TO THE NORTH 1~ x - LOT 2 M ^ It! LINE Of THE SW 1/4 ASSUMED TO BE N 221.112 sq.ft.- 5.08 ac. N88°48'48"E. 228,772 sq.ft.- 5.25 ac. IN.R/ `c 1 ° SCALE IN, FEET 1471111 ta. r s 197.85' o r S88053147"W `•f 200 100 0 200 to >rc N o~~ OOo.OD °D 234.3 1 Y. x 168.28' 01. 0 ti N v N' s- 6 w o L t 201.31' i.+ %o fiJ 3 W ' v ic- N LO W o 66' _ L, 135,122 sq.ft. w C G, 3.10 ac. EX: R/W - - / - o o 156,309 sq.ft. tiry~~ m 3.59 ac. IN. R/W O O_ % ppoo ee~► 50.00 ~J,iu tib+%ti~• 579.25' ~ --4 WLA t j 7 203.986 a ft. 4.60 ac. EX. R/W N y 4 188.39 / O LOT q• oa 1 N8 7T5TI 2F11 238.97 9, i 237,705 sq.ft. 5.46 ac. IN. R/W ~c r r ~O - 238..-97' Q © 1268.79' 3 " 304.24' rec. as N88 38152"E 1304.62' r 5 ~ unQlatted_landa_nsOgd_by_ottierg EXISTING e 66' TOWN ROAD r CURVE DATA TABLE `t~ry19.7YaA!p'o J CURVE LOT RADIUS CENTRAL CHORD CURVE CHORD 'O ~GCl~¢~ N0. NO. LENGTH ANGLE LENGTH LENGTH BEARING ' It 1-2 149.69' 50 613-11" 127.04' 131.20' N62°50'47.5"E . 1 31°25'32" 81.08' 81.10' N53°26'5811E 2 18°47'39" 48.88' 49.10' N78°33'33.5"E ~J/j 3-4 116.69' 79°094 44" 148.70' 161.22' N48°21'31"E 1 60°:'1'0511 117.341 12?..95' NJ8°50'41.5"E 2 18047139" 38:101 30.271 1178033133.51E 5-6 83.691 75005'39.11 109.00' 109.60' N50024137"E S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER S ADDRESS ~G~ wao~ Q ya- A-P-t. ~U Z FIRE NUMBER_ CITY/STATE ZIP_ ~YDI~ PROPERTY LOCATION : Nr 1/4, -5 W 1/4, SECTION 13 , T_10 N-R_ 2 LP TOWN OF S6m~5 St. Croix County, i SUBDIVISIONC.S,M, Voh, P-ti 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 set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration date. SIGNED: DATE : / St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 STC-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 pormit issuance. ,Should this development be intended for resale by owner/contractor,(spec house), t:henia 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 _;q N D -Y I-T 5 Location of property,~1/4 1/4, Section T 30N-R 20 ff7 Township Mailing address s/( o _RjE~DujOc)D Dpjdr w~Gso W v . Address of site acrd' S`('ac~ Lo`~ Sp,ry,~ r,~ W; /s33 Subdivision name vl)a 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 this property being developed for (spec house)?,Yes No Volume,~and.Page Number 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 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. _31/1-/ Z f y , 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 duly recorded in the office of County Register of deeds as Document No._ 2> 4,912.Sy Signature of applicant Co-applicant Date of Signature Date of Signature W,~itll.~NTY nei:n D0CUMEt4r NO. 4 STATE OF WISCONSIN-FORM 9 E` ` 14 i/i,~ ~~3 THIS SPACE RESERVED FOR RCCORDIN:. DATA l J 7 vv i ll L. Kees and Mary A• Kees, REGISTF/2S OFFICE l'HlS iNC)EYCI,Rh, 0.1x.{e by......._..;....; . . ST. G":rJiX CO. WIS. nt tenants.....----..-_-.•.-....... ~lusbara wife, as -joint nt Rocl fcr Record this 31st g St Croix .....County, Wisconsin, dpy of Cct A. D. 19 77 grantor. of... , hereby .onc-)s Rarud Likest- a-slrrgle_person.......... at 9, ja A~,_1V1< old w.Itra.Its to.- -.-..Y - - Ra;b of C"d rr ----------grantee........ of - St. Croix County, Wisconsin for the sum of gne_pollar. ($1. 0 0I_ and Other ..Good.and..Valuable RETUl TO Consideration . - County, the following tr a of land in....-_ Wisconsin: - A parcel of land in th e Northeast Quarter of the Southwest Quarter of Section 13, T3 N, R20W, Town of Somerset, St. Croix County, Wisconsin described as follows: Sf 8 48"E thence at a St. Croix County Ni~nu meat at the W 1/4 corner of said Sep-trot 13, feet to the NW along the North line of the SW 1/4 of said Section 13, 1307.90intof beginning corner the NE 1/4 of the SW 1/4 of said Section 13, also being the po said NE 1/4 of the of 1/4 of the NE 1/4 description; thence SOi°02'37"E along the West line of the East Section 13, 1296.57 feet, thence N88°38'52"E, 1304.62 feet to the line of the SW 1/4 of section 13, thence NO0°53' 02"W along the East line of ct S88°3 4"W, Quarter of the Southwest Quarter of said Section 13, 195.85 feet, 579.25 feet, thence N01°28'23"E, 357.00 feet, thence S88°53'47"W, 234.34 feet, thence aboveede N04°58' 30"W, 743.49 feet to the North line of the SW 1/fof bbeg~~ing, 1t" S88048'48"W along said North line 455.89 feet to the Point scribed parcel containing 20.1.acres. Together with, and subject to, easements, restrictions, reservations e and ovenan ~f record. Together with a perpetual n°n-exclusive roadway er he Section 13, of the South 1338.5 feet of the East one-half of the Southwest Quart Township 30 North, Range 20 West and the East 2 cods of anthe d subject 1338.5afeet continued West one-half of said Southwest Quarter; together with, attached hereto and incorporated roadway easement as described in the °~~Y Easeuent" roadway easement for purposes of ingress, herein by reference, the total easement being a egress and regress and including the right to install and maintain telephone, electric and gas utility lines over such easement and future mant_enaanceand snow remvaltsh and pro-rata unless be the responsibility of adjoining land owners on a accepted as a town road, and seller shall not be obligated to blacktop surface said roadway. "R(3AI7i M EASEMENT" at the Wt-st Quarter corner of Centerline roadway described as follows: ncing St. Croix County, Section 13, Township 30 North, Range 20 West. Somerset Townsnip, of said Wisconsin; thence N88°48'48"E along the ,forth line of the Southwest Quarter Sec-ticn 13, 1307.90 feet to the Northwest corner of the Northeast Quarter of the South- west Quarter of said Section 13; thence S01'02'37 "E along the West line cf the Northeast Quarter of the Southwest Quarter, 1316.50 feet to the southwest corner of the Northeast Quarter of the Southwest Quarter of said Section 13, said corner being the (reverse side) In \ imess whereof t w s d ryrantor.S-- ha--.`fie. hereunto set..... ix. hands..- and seaL.S-- this -1S - day uf.._.~.C~ +FJ1_ A. D., 19 17 kND 3EAIAk11 IN PRESENCE OF LowellL• Kees Mar .9~ ~.p (SEAL ) ~Llat (SFAL) State of , Wisconsin, f. ~Ca A. D., 19 .77 St.- Croix_- - , County. Personally came before me, thus ,2.151-day o Ipwell-L.- and Mary A. Kees, husband and wife . the .,Lort: named - - to me known to be the perion-S.. wh(i-t'xen foret, irr t n; nowledge t c same. . ate- - TR19 INSTRUMENT WAS DRAFTED BY, • . _ Notary Public, St--. - (Yo1X I21CIIP . 15 WATT, i • My o,mmission (expires) P7o Jui y..20.'--1981 tSection 5951 (t) of tie Xi iscors:n 4ah,tn pc s :h xr!u i+1nr '+tro to trr^c< reIulres sthat a the Pname ofc'he+irer,on toner d vran- r,:anFns, F,rantccs atnesses ari naacy t..iur. 'KI or written thtresxs is • le>,ble e'anr.l the names -if the r menta. agency whu.h, !rafted such n;trument, shalt be •ted, P or,sln Le4'al nLtnk C,,n+pan7 Y VII-%.ke,. Will. ( Job 327111 ' WARRANTY uet:I, ST.aCF OF \V[S('ON HIV r r y 1 PI 561 • ~ - 163 t pOM OF BEGINNING of this centerline roadway description; said pr,- t also being the point of curvature of a curve concave to the Southeast having a central angle of \ 89°00'00" and a radius of 116.69 feet; thence Fasterly 181.26 feet along the arc of the curve, the long chord of which bears North 43027'23"East, 163.58 feet, to the point of tangency thereof, thence N8705723"E, 238.97 feet, said point also being the point of curvature of a curve concave to the Northwest having a central angle of 42°14'38" aril a radius of 181.20 feet, thence Easterly 133.60 feet along the arc of the curve, c: the long chord of which hears N66°50'04"E, 130.59 feet to the point of tangency thereof; thence N45°42'45"E, 166.47 feet; thence N26001'04"E, 239.49 feet; thence N01°28'23"E, 78.96 feet, said point beingon the South line, common to Lot 1 and Lot 4 of Certified Survey Map, St. Croix county, Wisconsin, Volume 1, page 285, 33 feet on both sides of said centerline description reserved for roadway easement. 1 l Wiscorpin Department of Industry, SOIL AND SITE EVALUATION REPORT Page - of Labsr and Human Relations Oivi`sion 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 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 I PROPE OWNER: PROPERTY LOCATION GOVT. LOT 1/4 1/4,S T,~ N,Ror)f j~r PROP TY MAILING ADDRESS LOT BLOC # SUBD. NAME OR CSM # CITY, TATE ZIP CODE PHONE NUMBER` ❑CITY ❑ ILLAGE f@TOWN NEAREST ROAD /A )T J4 New Construction Use Residential / Number of bedrooms 5 [ ] Addition to existing building ( ] Replacement [ ] Public or commercial describe Code derived daily flow _ gpd Recommended design loading rate -,bed, gpd/ft2 „S-" trench, gpd/ft2 Absorption area required bed, ft2 9,-,/) trench, ft2 Maximum design loading rate bed, gpd/1`1:2 /b5trench, gpd/ft2 Recommended infiltration surface elevation(s ft (as referred to site plan benchm rk) Additional design / site co siderations - Parent material ' Flood plain elevation, if applicable ,v ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U 14S ❑ U OS ❑ U [Z S ❑ U ❑ S ®U ❑ S ]Z U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourciary Roots GPD/ft in. Munsell Qu. Sz. ont. Color Gr. Sz. Sh. Bed Tw& Ground _ elev. /4;ZL ft. Depth to limiting factor ~ Remarks: Boring # Ground elev. ,&y ft. Depth to limiting factor > y~ g Remarks: CST Name:-Please Print Phone: a - Address: - o Signature: J Date: CST Number: f Pf 1S PROPERTY OWNER SOIL DESCRIPTION REPORT Page---) PARCEL I.D. # J G P D/ft Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz, 22nt. Color Gr. Sz. Sh. Bed Trench Ground , <5` - elev. Depth to limiting factor Remarks: Boring # Ground elev. ft. wwo Depth to limiting factor 15-9- Remarks: Boring # _ v: ~7 r 12 - Ground elev. ffr.1 ft. Depth to limiting factor Remarks: Boring # 9- Zy 7, T Ground elev. A170 A/,p ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) i I I II i I j I l !I 1 I i I ~ - I _ _ I I I I , ~T 1 I I I i - I I ; I i /i~,.tl~~t' 4-E:a~ ~ -s' ~ 6 /ds g7' ji✓~~YrCt~c~° I I ~ i I f ~ I~ I I I i I i II I ~ I ~ II I ' - I - I j i I I I i I I I I I i ~ I I I ~ I I ! i I~~ ~ -Tt ' I , I I r i ~ I I ~ I I ~y c I ~ 4, 1 is_ - --I - - - i I - - I ~ I I I r i I ~ 1 ' S~ ~ ~8 - i I I I I I I , I I I ~ i ~ I : I ' I i I I r - r I I , I T- I--i i I i i T I 7M 6UHfirl'i OWNER SECTION 13 • RANGY LIKES COUIITY MONUMENT iOI NONROE ST. co 'APT. N r NORTON HUDSON, iii. 0 co un la ted lands owned b others 54016 to co O n IT NORTH LINE - SW 1/4 CENTER S88048148"W SECTION 13 455.89' 11/4" IRON ROO LOT 1 LEGEND N 249,008 sq.ft. • REBAR FOUND 5.72 ac. EX. R/W . I" x 24" IRON PIPE WEIGHING 252,279 sq.fi. = • 1.68 LBS/LIN. FT. SET. 5.79 ac. IN. R/W wo .50 V. o 're "r rrnn ti IT r , N O IV ~ MI. LO.( 2 - -BEARINGS REFERENCED 10 THE NORTH w LINE OF THE SW 1/4 ASSUMED TO BE w 211,112 sq.ft.- 5.08 ac. c N86°48148"E. w N 228,772 sq.ft.- 5.25 ac. IN.R/ ``:sy SCALE IN FEET 42 N, 1 V 0 1 11 In. r r a 1 - 197.05' `.r.` 200 100 0 200 2 rA K o S882 54.31P 110 of 1, . v 0 166.28' al , „ `.%8~, n j.. W o f 201.31' w o. ` N - Co LDTJ 3 w a 661 L, 135,122 sq.ft. 0 3.10 ac. EX. R/W ~ a •"156,309 sq.ft. w - - 3.59 ac. IN. R/W J tiry e C)_ v, w ro0'~~ m1` S88036~1 r•+ >ti m 50.001~1,i .G ~bp% 579.25' Oil ~PPD' ~n s.x 4 188.391 LOT 4 203,986 sq.ft.'4.60 ac. EX. R/W co C m 1 Ni23''i 23 .97 9 , 237,705 sq.ft. 5.46 ac. IN. R/W - z 6 238.97' (D 1268.791 3 " 304.24' rec. as N88 38152"E 1304.62' 5 ~ unQlgttgd_landg_c~WBgd_~y_Qt~igrg EXISTING >c 66' TOWN ROAD CURVE DATA TABLE Lv,0;Pi j CURVE LOT RADIUS CENIRAL CHORD CURVE CHORD J NO. NO. LENGTH ANGL! LENGTH LENGTH BEARING ' ALLEN C. 1.0 1-2 149.691 5013' 1117 127.041 131.201 N62050147.5"E ti• * 1 31015132" 81.081 81.101 N5302615811E NYNA(3EN / 2 1804713911 48.881 49.101 N78033133.5'IE S-1 407 ))/'3 3-4 116.691 79"09'41,11 148.701 161.21' N4802213111E HUDS N, vy -F 1 600:1'05" 117.3/71 122.951 N38°50'41.5"E yq( v 0 z 2 16°47139" 30:10' 30.17' N78033133.5"E jt , 5-6 89.69' 75005'37" 102.001 1019.60' N,0020371E DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUN . ems" ° STATE ~N T-Attach complete plans (to the county copy only) for the system, on paper not less than IRMIT 8% x 11 inches in size. ❑ Check f 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 A D L -5 E% Sv S /A T ,?0, N, R Z e E (or)z PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 160S E DD Dpi va. Af+ /,Oz- CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ jig 4QWN OF: VILLAGE 5;0 1*wsm-~ ❑ Public 1,2 1 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL AX NUMBER (S) III. BUILDING USE: (If building type is public, check all that apply) 3Z . ;?-O~ ' 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursin Home Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/R airs 1 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 a plic ) A) 1. 5j New 2. ❑ Replacement 3. ❑ Replace of $ Reconnection of 5. ❑ Repair of an System System Tank Existing System Existing System B) ❑ A Sanitary Permit was previous) ssued. a ii~¢/ - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurize istributio 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 Press r 43 El 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 s REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min. inch) ELEVATION 41 0 CIO O 1~0 0 S 99. / Feet 3 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 Holding Tank 00 tt. ) S d _1+ . F-1 n El n Lift Pump Tank/Si hon Chamber Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Dom stfo►.1¢Qft o0 ~ fir- J'j 3 , 3Z3 3 Plumber' Address (Street, Ah, City, State, Zip Code): /RO -*I-- 2 Z- rJ le --e, k * o M IX. COUNTY/DEPARTMENT USE ONLY gn ❑ Disapproved Plwe,~e:po pjtary Permit Fee (inclu es Groundwater a e ssue issuing 701 Surcharge Approved ❑ Owner Given initial A versX. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11188) 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 maintaTined. 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. 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, 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. i , SBD-6398 (R.11/88) Fg57 [07 ~Z~'E 9S.?~ II ~ i i h T # I ~ o U ~y O i 10 >1 I N 'IV o ~ ~ M d ' al- a~ do~ j UN, a, ~ 'l tr _I k r Wiscenpin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of r Labor`and Human Relations . DWision of Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY I I Attach corriplete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but a:124 Z not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL .D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION : REVIEWED BY DATE PROPE OWNER: PROPERTY LOCATION GOVT. LOT 114 1/4,S T j N,R /(pr) PRO TY MAILING ADDRESS LOT BLOC # SUBD. NAME OR CSM # CITY, TATE ZIP CODE PHONE NUMBER'` ❑CITY ILLAGE OWN NEAREST ROAD s). r A )7 j4New Construction Use Residential / Number of bedrooms [ j Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived dairy flow f$,/ gpd Recommended design loading rate bed, gmW ,T- enhi, gpdtft2 Absorption area required bed, ft26 trench; ft2 Maximum design loading rate bed, gpd/ft2 , _S trench, gpolft2 Recommended infiltration surface elevations ft (as referred to site plan benchm k) Additional design ! Ye ce siderations Parent material Flood plain elevation, if applicable ,y.r ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S ❑ U WS ❑ U ®S ❑ U [M S ❑ U ❑ S ®U ❑ S J~ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boiund3y Roots GPD/ft in. Munsell QU. Sz. Pont Color Gr. Sz. Sh. Bed ranch k I}} 7>2 Z - Ground - elev. I,V-L ft. Depth to limiting ~ factor Remarks: Boring # rvr..; oqg x- i Ground " elev. lL a ft. Depth to G limiting factor l9!~' g Remarks: CST Name: Please Print 7_17 Phone: 2 9/ Address: Signature: Date: CST Number: PROPEMYOWNER SOIL DESCRIPTION REPORT Page ;2b! PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz, nt. Color Gr. Sz. Sh. Bed Trench - Ground 9-1 elev. Depth to limiting factor Remarks: Boring # f2 _,q S Ground elev. IAV ft. Depth to _ limiting factor Remarks: Boring # Y le YZ ~k Ground 3 elev. F,/ ft• Depth to limiting factor Remarks: Boring # J1 1V Ground elev. - - P -z 41Z Depth to limiting factor Remarks: . - I I ' I I j - - - I j I- 3 - i I j - - I I j ~ , I I j I ~ I ' I I i j / j - - i i I ~ rY 8 0 12 J war I I I ' ~ li Vi i I ~ I I I ' I ~ I~ I I I I ! I I I ' ( I ? I i i I I i ~ ~ ' i ~ I i i II I I i I i I I I I I I I I I t ' I I I I i ' I ' I I 1~-I I I I I I I I I I ~ r-,--I I II~ I I I ~ i 1 i ! I 'i I ~ I I i I I ' i I f i I I i ' j i ~ I I I i I ! i I I I I I I I I I ' ' ~ I I I I I I , I _ ' ~ ' i I I I I I I I I I I! i ~ I ~ i j I I ~ j I I i I I I I I j I ; I I I I I I ! I ~ I I ~ ' ~ ~ i I I I I I r"- I I ! I , ~ I 1 , ~ I I I I ~ I 1 I ' I i I ' i I I I I ' j I I~ I I I I j I 'i I I ~ I I j I I ~ ! I I i I I i' j I i ~ I ~ I ' I I ! j I i I ~ j I I I I~- I ' j j I I I F I I I - ~ I I i d IA Jf') io ! -T /t + I ~ oe i G I' Y N ~ ~ ~J P c s ~ i ~a w i ~ i 'mow I f`"" O I sp 6 n Y O O v p ~ I 'O ~o ~a~^ SO?r sy V~~~~