HomeMy WebLinkAbout032-1086-20-000
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STC - 104
AS BUILT SANITARY SYSTEM REPORT
OWNER R i~ C f f JE/V
ADDRESS ] 71
SUBDIVISION / CSM# IVA LOT #
Q/")L=
SECTION-_T N-R~ W, Town of
ST. CROIX COUNTY, WISCONSIN
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
ly,
67`
/Oad G-~ S. ! ~ R `vim
KEMtr~4c
INDI ATE NORTH ARROW
- -w- el-
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
L •
BENCHMARK: JP" 5neci &PF NEXT Tn &G /rEM~&r L
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION
Manufacturer: E E/~ S Liquid Capacity: /000 ~.L
Setback from: Well fQD7`' House q'7 Other
Pump: Manufacturer Model# Size N~
Float seperation N'A Gallons/cycle: A(,4
Alarm Location IM 4
SOIL ABSORPTION SYSTEM
Width: 5 Length 7 Number of trenches
Distance & Direction to nearest prop. line:
7p
i
Setback from: well: House 7' Other
ELEVATIONS
Building Sewer ST Inlet; b~ ST outlet
PC inlet VA PC bottom Pump Off &4
Header/Manifold ?yi 73 Bottom of system 3, 77
Existing Grade '7? Final grade p
DATE OF INSTALLATION: o5~- 23
PLUMBER ON JOB: 4a'dLi"-
LICENSE NUMBER: 3j?05
I
INSPECTOR:
3/93:jt
st~r`~si~i~ artrt~e~ rtt t~, 32.31.19Pawkrg?1 AGE NMM County:
Labor and Human Relations INSPECTION REPORT
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 193493
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
PATRICIA SOMERSET
CST BM Elev.: Insp. BM Elev.: B Description: Parcel Tax No.:
032-1086-20-000
71
TANK INFORMATION ELEVATION DATA A9300152
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic (124e_ Benchmark 3,Q5 ~60, CO
Dosi n
Aeration Bldg. Sewer
Holding St/ Inlet
TANK SETBACK INFORMATION St /tilt Outlet 7~
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic 7 NA Dt Bottom
Dosing NA Header M_V_~m
Aeration NA Dist. Pipe V7 , s'8r
Holding Bot. System 9;33 3. 7.:;~
PUMP/ SIPHON INFORMATION Final Grade
Man Demand JOB 3. ZZ~ . nModel Number GPM
TDH Lift Friction stem TDH Ft
oss
Forcemain Length Dia. Dist. ii
SOIL ABSORPTION SYSTEM
BED/TRENCH Widths i Length No. Off Trreenches PI N I N No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SYSTEM TO P/L BLDG WELL LAKE/STREAM LE G Manufacturer:
SETBACK CHAMBER tuber:
INFORMATION Type O OR UNIT
System:
DISTRIBUTION SYSTEM
Header / „ Distribution Pipe(s) i it x Hole Size x Hole Spacing Vent To Air Intake
i
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over .i Depth Over N xx Depth Of xx Seeded/ Sodded xx Mulched
01 1
Bed /Trench Center 3~ - Bed/ Trench Edges - SQ Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: SOMERSET 32.31.19.4178 (37TH STREET
el
Plan revision required? ❑ Yes
Use other side for additional information. Moll?]
SBD-6710 (R 05/91) Date Inspector's Signat re Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
I
BENCHMARK: j~ 576E .//-94 dfEXr TfJ 170& Ar~.ff L
ALTERNATE BM:
SEPTIC TANK / PUMP CHAMBER / HOLDING-TANK INFORMATION
Manufacturer: Liquid Capacity: /G1ppL
Setback from: Well f o ' House of Other
Pump: Manufacturer YA Model# Size
Float seperation ACA Gallons/cycle: A~4
Alarm Location A4
-:SOIL ABSORPTION SYSTEM
Width: Length 5'9 Number of trenches
Distance & Direction to nearest prop. line: 8-0
Setback from: well Housed Other
ELEVATIONS
Building Sewer ST Inlet: ST outlet.
PC inlet A(A PC bottom Pump Off
Header/Manifold 73 Bottom of systemr
Existing Grade Final grade
DATE OF INSTALLATION:- 23
PLUMBER ON JOB:
LICENSE NUMBER:
i~~ 5
INSPECTOR:
3/93: jt
17 DILHR sANIT FRY PERMIT APPLICATION ,
In accord with ILHR 83.05, Wis. Adm. Code Cot~NTIY`
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than /?3"/?-3
8% X 11 inches in size. ❑ Check 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
S~ E /a ES . T N,R 17 W
PROPERTY OWNE 'S MAILING ADDRESS LOT # IBLCK O#
Ir Si • VA_
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
/ a
11. TYPE OF BUILDING: Check one CITY NEAREST ROAD
( ) ❑ State Owned VILLAGE: :
i
❑ Public ~1 or 2 Fam. Dwelling- # of bedrooms R PARCEL NUMBER(S)
111. BUILDING USE: (If building type is public, check all that apply)
1 ❑ Apt/Condo v
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) 1.0 New 2. Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank
12 M 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
3 zz 116- ,J 3 r S Feet 5 Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
Tanks Tanks structed
Septic Tank or Holding TankL} C
Lift Pump Tank/Si hon Chamber F-1 1-1 [1 1 [1
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plu s Signature: (No Sta ps) P/MPR W Business Phone Number:
6-5 21 -r) Y31
(Street, City, State, Zip Code):
Plumber's Address
`A-
IX. COUNTY/DEPART ENT USE ONLY
X❑ Disapproved Sajtary Permit Fee (Includes Surcharge Fee) Groundwater ate Issued 1 g Agent Signat No Stamps)
!
Approved ❑ Owner Given Initial 5 .!i
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 bya I.icensed
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'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.
t
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.
SBD-6398 (R.11/88)
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Wiscoffisin Department of Industry, SOIL AND SITE EVALUATION REPORT Page l of 3
Labor'and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St . Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Carry & Patricia Casement GOVT. LOT NE 1/4NE 1/4,S32. T 31 N,R 19 f(or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BL9CK # SUBD NAME OR CSM #
1896 37th. St. n/a n a n~a
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE :WOWN NEAREST ROAD
Somer. set, WI. 5402.5 (715)2.47-5415 north part Somerset 37th. St.
[ ] New Construction Use [x_t Residential / Number of bedrooms 3 [ ] Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate ' 7 bed, gpd/ft2 ' 8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 93.75 ft (as referred to site plan benchmark)
Additional design / site considerations n/a
Parent material outwash Flood plain elevation, if applicable n/a. ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT•GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem 4N S ❑ U 4N S ❑ U ~ S ❑ U t2 S ❑ U ❑ S U ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
' 1 0-10 10yr3/3 none L. 2/m/sbl=. mfr g/w 2 m
2 10-36 10yr4//+ none sil. 1/f/sbk mfr g/w 1/f .2. .3
Ground 3 36-88 10yr3/4 none co. s. 0/sg ml n/a n/a .7 .8
elev.
97,8E ft.
Depth to
limiting
factor
>8(
Remarks:
Boring #
1. 0-12 10yr3/3 none L. 2/m/sblc mfr g/W 2/f .5 '':.6
2 2. 1?.-37 10 r4//+ none sil. 1/f/sbk mfr
3 37-84 10yr3/4 none co. s. 0/sg ml n/a n/a .7 .8
Ground
elev.
97.45 ft.
Depth to
limiting
factor
>84
Remarks:
CST Name: Please Print Phone:
_ ___Cary..L._..S_t~eL_ 715=246-h20(1--
dress 1554 200th. Av.e, JNew Richmond, Wi. 54017
t~.r,= ' , Late: ) ~ CST h;~;mtr-,r:
i 14-1.7-93 2298
r
,PROPER-'WOWNER Garry Fasemant SOIL DESCRIPTION REPORT Page2- of 3
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmrich
1 G-8 10 r_3/3 none L. 2/m/shk mvfr g/W 2/m .5 .6
. 2 B-31 10yr4/4 none sil. 2/m/shk mfr g/w 1/f .5 .6
Ground 3 31-84 10yr4/4 none Co. S. 0/sg ml. n/a n/a .7 .8
06. ~X. ft.
Depth to
limiting
factor
X',4
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
SPU SXV? M.05i'a2)
r. .
STEEL'S SOIL SERVICE
1 ) )4 Lill/LIl Ci.V
Gary L. Steele
C.S.T. 2298 Garry & Patricia Casement New Richmond, WI 54017
MPRSW-3254 rEINF% S32-T31N-81.941 (715) 2460200
tom of Somerset
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X~- ~44-
N CERTIFIED SURVEY MAP F r lED
BEARINGS ARE ASSUMED NE 1/4- NE I/4 - SEC. 32 , T31N, R19 W in 'IAAIES 1,619987 G
NORTH ALONG THE EAST 961* ftt h
LINE OF THE E 1/4 OF P AC TED C"'h eats
SECTION 32. uN. ~A49•
FD. 3/4 ON PIPE -13 NORTH LINE OF THE N 87 °-13'-21" W
R.L.S. MINN. 6267. N 87021" W NE I/~ 546. 56'
773.44- 35.23'
738.21' •x CO. MON.
47' pvpr„n,inll"Z - = NE. COR.
a .o o cu SEC. 32.
oo/ o
EXISTING ®w/ o%'v
0
HOUSE D8/ .4
~
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ni LOT - 1 :z* I ~
O
8.14 ACRES INC. R/W, z
7.72. ACRES EXC. RAW ~
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1 /rv' „
~r00 ru 'D
t ,n,ntniuuP,/ N =
cD O
~
34.00' I
w a !v
co
='S
1860- L609.30' 43'-23
NANO. m o 190106 386.12' / 133.12
cf)
r CPD ~ i ~ V ~ ANO
z ,op '3v
M m n36
O (D
LOT- 2 I
= w CO. MON.
M CT v 10.69 ACRES INC. R/ w
E I/4 COR.
Z 4 10.09 ACRES EXC. R/W I I SEC. 32. M 0 A
- I I P
z
z
s o -1rja0~$,AO~
0) 0
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M 7 J~\\1114/u/i O Z coo !1 f~
o LWHAGEN
0-41 rn m 33.00'
I E5 v sU R`i
54 2.7 3' tL ~
m
l Z, I go
CEO 18' 870-08'-29 5 75 . 74 '"E = I
ONlp 7 S 33.01' v :0
NANO. REVISED 2/ 05 / 81
SOUTH LINE OF THE NE 1/4- NE 1/4 CURVE DATA TAB LE
SEC. 32.
200' 100' 50' 0' 200' CURVE LOT RADIUS CHORD CHORD CENTRAL
C- N0. N0. LENGTH LENGTH BEARING ANGLE
SCALE = I"= 200' 1-2 - 1571. 35' 589.35' N 12°- 28'- 32.5 E 210- 37'-03
LEGEND
- I 1571.35' 411.96' N 15°-45'-08" E 150-03'-52"
o--I" X 24" IRON PIPE SET - 2 1571.3 5' 179.62' S 4 °-56'- 36.5'W 6°-33'-II "
WEIGHING 1.68 LBS. / LIN. FT.
uuunnnorn APPROXIMATE BLUFFLINE 3-4 - 1604.35' 601.7 3' S 12°-28'- 32.5° W 214 37 03"
APPROVED
_ 1 1604.35' 423.44' S 15°-42'-04.5" W 150-09'-59"
rco 1 ~y - 2 1604.35 180.24' S4°-53'- 33" W 6°-27'--04"
Volume 4 ff Page 1035
ST. CROIX CC?UNTY T H I S I N S T R U M E N T WAS DRAFTED BY B.R.P.
• • T
SURVEYORS CERTIFICATE
I, Allen C. N,yhagen, a registered Land Surveyor, hereby certify that by
the direction of Timothy Michaelson, I have surveyed, described and
mapped the land parcel which is represented by this Certified Survey Map;
that the exterior boundary of the land parcel surveyed and mapped is
described as follows:
A part of the NE 1/4 of the NE 1/4 of Section 32, T31N, R19W, Town of
Somerset, St. Croix County, Wisconsin, further described as follows:
Commencing at NE corner of said Section 32; thence N 87-13'-21" W along
the North line of the NE 1/4, 546.56 feet to the center of a Town RD.
and the point of beginning of this description; thence continuing
N 87-13'-21^ W along the North line of the NE 1/4, 773.44 feet; thence
S 00-001-14" E along the West line of the NE 1/4 of the NE 1/4, 1315.75
feet; thence S 87-081-29" E along the South line of the NE 1/4 of the
NE 1/4 of said Section 32, 575.7 feet to the centerline of a Town RD.;
thence N 1-401-01" E along the centerline of a Town RD. 610.15 to a point
of curvature of a curve concaved easterly and having a central angle of
21-37'-03" and a radius of 1571.35 feet; thence northeasterly 592.86 feet
along the arc of the curve, the long chord of which bears N 12-281-32.5" E,
589.35 feet to the point of tangency thereof, said arc also being the
aforesaid centerline of a Town RD; thence N 23-17'-04" E along the
centerline of said Town RD, 132.44 feet to the point of beginning.
Above described parcel contains 18.83 acres and is subject to a 33 foot
Town RD. easement along the easterly boundary line.
that this Certified Survey Map is a correct representation of the exterior
boundary surveyed and described;
that I have fully complied with the current provisions of Chapter 236.34
Wisconsin Revised Statutes, and the Land Subdivision Ordinance of~the
County of St. Croix in surveying and mapping same;
Certified this 7_-? + day of 1980, at Hudson, Wisconsin.
S i gn e d
Allen C. N,yhagen, Land Surveyor No. 1407
S & N Land Surveying
Hudson, Wisconsin 54016
CERTIFICATE OF THE TOWN OF SOMERSET ALLEN C.
NYHAGEN
I, do hereby certify that this S-1407
Certified Survey Map has been t
approved by the Town of Somerset HUDSON,
this day of 1980. WIS,...,oq-o,
'iC y ~D SU R
Town Clerk of Somerset
Volume 4 Page 1035
,1
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
r ~
OWNER/BUYER 1
ADDRESS 11?! 60 FIRE NUMBER 1996
CITY/STATE L /77 F 2 S E ZIP 5/0a 5-
PROPERTY LOCATION:, f 1/4 ,1/4, SECTION , T-2.LN-R_& W
TOWN OF O /YI e 2 SE f , St. Croix County,
SUBDIVISION , 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 beep maintained must be
completed and returned to the St. Croi Co. oning Of; cer within
30 days of the three year expiratio a e~,y /~/L
SIGNED: - Cy'
DATE : (G' ~1 T L
St. Croix co. 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 in delays of the permit issuance. ,Should this
development be intended for resale by owner/contractor,(spec
house), then Ia 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 2 I i S /
Location of'property N' 1/4 /_Vf1/4, Section 'T_31 N-R_Z2_W
Township
Mailing address 2~1 ~
Address of site /T ~_Ql 129 2S~
Subdivision name Lot no.
Other homes on property? yes-ZNo
Previous owner of property
Total size of parcel lS 3 /,5L e/2 S
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 03 as recorded with the Register
of Deeds. X78 607
i
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.-3,T99,71.6 , 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. .
Signs a of applicant Co-ap ant
1 .
Date of Signature Date of Signature
I
LOCUM[-"IT NO. T.I. 4PA~:C RESERVED 1011 RECORUINO DATA
WARRANTY DEED
STATE BAR OF WISCONSIN F 14M 2-1882
3899 i va►_ 5~ racE~i t
Timothy R. Michaelson and. Jacqueline K.. Michaelson..... RfiCvbT#RS OFFICE
husband and.wife,._as. joint .tenants...........__ 9T. GRC lX CjO.,'rW6.
Ret'd, for Raaord M 15th
day of nes_.._AD. 19-83
conveys and warrants to ..-.Garry. H.-Casement..and.Patricia'iE at 3.55 P
Casement, husband and wife- as joint -tenants j t Ak
.
- I mar ~t' de
.
RETURN TO
the! following described real estate in ...St-,..( OlX. .County, -
Ststte of Wisconsin:
Tax Parcel No:
Part of the NO-, of NF}g of Section 32-31-19 described
as follows: Lot 1 of Certified Survey Map filed in
volume 4, page 1035, St. Croix County, Wisconsin.
f
I
I
i
This . is homestead property.
(is) (is not)
Exreption to warranties:
Dated this 15th. day of December l9. 83
(SEAL) aco>~ (SEAL1
Timothy R. Michaelson
(SEAL) a(4fi"`crtQ K 4_- ...(SEAL)
K. Michaelson. .
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ss.
~ ♦
_.(./County.
authenticated this day of 19 Personally came before me this ..~5........ day of
~.C c ° t t 19.5.1-- the above named
.
TITLE: NIEMBER STATE BAR OF WISCONSIN
(If not- -
authorized b
y § 706.06, Wis. Stats.) to me known to.bd' a iNt~t}~ 5.,.:-._.. who executed the
foregoing inst~ %,r4,, a„4.;kC. 4~w! dge the same.
T4:3 INSTRUMENT WAS DRAFTED BY
.
Joseph- .D_--Boles,..Rodli-,..Beskar..&.Boles,..S.C. AR i
..River-.Falls-,.-Wisconsin... 54-022---------- \ntn-v PthfiM ff~~`j L~County, Wis.
(Signatures may he authenticated or acknowle(L:ed. Both SIC Cnmmissie$ S3 perm tnent.~(f not, state expiration
are not necessary.) J 19 a )
date:
F v. '
-Names of persons signing in any capacity sh-1-1 be tspc•I , -t,I Ih•ir ~i¢rn[..ras.
WARRANTT DEED STATE. BAR OF WISCONSIN Wi-)-;n I.v.1 ItL,• 4 1%, 1,,
WiscoAsin 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
` Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # p
dimensioned, north arrow, and location and distance to nearest road. 032'`Qd -00=-
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Carry & Patricia Casement GOVT. LOT DTE 1141TE 1/4,532 T 31 N,R 19 f(or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BL?CK # SUBD NAME OR CS
1896 37th. St. n a n a n/a
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE 9WOWN NEAREST ROAD
Somerset, WI. 54025 (715)247-5415 north art Somerset 37th. St.
[ ] New Construction Use [xj: Residential / Number of bedrooms 3 [ ] Addition to existing building
Replacement [ I Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 .8 trench, gpd/ft2
Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 93.75 ft (as referred to site plan benchmark)
Additional design / site considerations n/a
Parent material o utwa Flood plain elevation, if applicable n/a It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem )0 S ❑ U )0S ❑ U A2S ❑ U 12 S ❑ U ❑ S 0U ❑ S fRU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Texture Structure Consistence Banday Roots GPD/ft
Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-10 1 3 3 none L. 2/m/sbk mfr g/w 2 m
2 10-36 10yr4/4 none sil. 1/f/sbk mfr g/w 1/f .2 .3
Ground 3 36-88 10yr3/4 none co. S. 0/sg ml n/a n/a .7 .8
elev.
97.85 _ ft.
Depth to
limiting
factor
>88"
Remarks:
Boring # 1 10-12 10yr3/3 none L. 2/m/sbk mfr g/W 2/f .5 .6
2 'I< 2 12-37 10yr4/4 none 1/f/sbk mfr g/w 1/f .2 .3
3 37-84 10yr3/4 none c, ml n/a n/a .7 .8
Ground
elev.
97.45 ft.
to ~
Depth to A
limiting tD Z~G c, e
factor o
>84 , 1;K
Remarks:
CST Name:-Please Print one 6_6200
Address: 1554 00th. Ay,, w Richmond, Wi. 54017
Signature: 4-27_93 Date: 2298 CST Number:
PROPERTY OWNER Carry Fasemant SOIL DESCRIPTION REPORT Paget 6,f 3
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.
:~t~.~;; Bed Trench
PIN 1 Q- 1 3/3 none L. 2/m/sbk mvfr /w 2/m
g /w .6
2 8-31 10yr4/4 none sil. 2/m/sbk mfr /w 1/f .5 .6
Ground 3 31-84 10yr4/4 none Co. S. 0/sg ml n/a n/a .7 .3
96 e1e . ft.
Depth to
limiting
factor
>84
Remarks:
Boring #
vh.
vv:••v:;:`:;:::
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
y}4
~ti vin.........
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PROPERTY OWNER Garry Easemant SOIL DESCRIPTION REPORT Page 2' of 3
PARCEL La. #
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0-8 1 3/3 none L. 2/m/sbk mvfr g/w 2/m .5 .6
Nrv'I; 2 8-31 10yr4/4 none sil. 2/M/sbk mfr g/w 1/f .5 .6
Ground 3 31-84 10yr4/4 none co. S. 0/sg ml n/a n/a .7 .8
e1~y. ft. `
Depth to
limiting
factor
>84
Remarks:
Boring #
~~?i- vsi\
'•yr'.r vv~i
] •}K'N{vim..vCv,
x..v
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
gp-
iX
;.k
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
e . v
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
Y
STEEL'S SOIL SERVICE
t554 200th. "e.
Gary L. Steel pqTX8HbWqWAIW
C.S.T. 2298 Garry & Patricia Casement New Richmond, WI 54017
MPRSW-3254 NF%_NF;%,. S32-T31N-R19W (715) 246-6200
toim of Somerset
4 17
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r~f~►WKa,,-z- PPS
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