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HomeMy WebLinkAbout038-1170-20-000 4 0 oo ° w o O ~ vy g4 c M V O O N h O C ~ I y I m C O 13 C Z U2 co o M3 a 1 I a3i~ \ V I z y z I an d 1 Cl) f2 ~ v E Q CL CO o c C7 v c O Z c _ V T o d Z ~ c 6 I U) H z N 2 co 7 (D cu N N N )l) 1 (a CO ~ O O C C U Q O O w in Z z F- Z o N ^-~~l z O 41 l ~ N o o - c ooa` 0 3Nwrn x U 0 U) `"N = 7 16 z 4.; 0 IL alQra7 v o~ O O U) Nov 30) 0 Mo 'V Z (D o O O O E N M y m d O O N r p -C m Q Z U) N O O 3 N y C ►V n~ O O O N F- C C V a G 00 N N N C -O N N 'C R O ~ On o Q `.p C j r d N rn N n _ m M V co w .O. c O O N O t6 v • O O co . U) J O Z S Z ~L (A v r/~ `m A a 3 n ` a r`Iv •E r A 0 a 0 y U TRY, NT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, CC DIVISION LABOR P.O. BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON WI 53707 Sw 14- S--) a-Q (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: T NSHIP/M NICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: 1/ sw l/ 13 /TD N/W8 E (or) W S LINTY: OL-Q MAILING ADDRESS: 4083_ 9L U 6 a. ~o z USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: 0%,esidence N Q ®New ❑ Replace Z Z / 993 8 9~ RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING fil RECOMMENDED SYSTEM:(optio al) E❑U ZS ❑U ®S ❑U ❑ S ®U ❑ S e, If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. N BACK.) B l 8 ~Z-/2? 6d-s• ~V 043 8S 7• J ) o- / Z r1 tj( Z e- 39.- B- Z- 81) C. d 'tfiB,0~ -8/ S SIC'-3 B-.3 80 /d 7-a > Ra 1! ` c3~~/,r r~z s 4,e. on o,-lZ 5-- 39 r, B- 8 S 5«"~.Bn~s ~ aB,~ ( a-9'alb 9-ZO-9 BBS' 12d- B- Ilo,3 B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PER D PER INCH P_ / S'3 P_ Y_ I P- P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION /G GS ias a 9 i I . T 1Z~ ! _ - 33 F 1 dT~ ~l 92- Y r- -r I~ 10 v 1~ ~r all A- .0 07 r r2 1 197 Coo r_ I, 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 r(: TESTS WERE COMPLETED ON: Z9, 1,0,9 3 ~ 1a w i ADDRE : CERTIFICATION NUMBER: PHONE NUMBER (optional): C ltJ, .SY~s3 3) d4~ 9/ 5)-'l 7 z -6PY/4 CST NATURE: ZA-A I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use suction must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 8. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Sepsrates and Textures Other Symbols st - Stone (over 10") BR - Bedrock cob - Cobble (3 - 10") SS - Standstone gr - Gravel (under 3") LS - Limestone 's - Sand HGW - High Groundwater cs - Coarse Sand Perc - Precolation Rate med s - Medium Sand W - Well is Fine Sand Bldg - Building Is- Loamy Sand > - Greater Than 'sl - Loamy Sand < - Less Than '1 - Loam Bn - Brown 'sit - Silt Loam BI - Black si - Slit Gy - Gray cl - Clay Loam Y - Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc - Sandy Clay w/ - with sic - Silty Clay fff - few, fine, faint 'c - Clay cc - common, coarse pt - Peat mm - Many, Medium m - Muck d - distinct p - prominent HWL - High water level, surface water ' Six general soil textures BM - Bench Mark for liquid waste disposal VRP - Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER j ADDRESS S- JAW/ SUBDIVISION / CSM# LOT SECTION 3 T.3 1 N-R--S-W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM _ G SELL N~~ ~~,uSe G~~Pr. ey- T►USf►~~Lt~ 10CV 5,4L ! t i TRENCheS ~ r'~+~~ { u~ J ~ y 1 l•i3e v INDICATE NORTH ARROW] Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank mantlole cover. 1 BENCHMARK: "~rp o ~4961A S'7f*kr fi4ciV5 .4 -,yL-_ /CG ALTERNATE BM: i SEPTIC TAN / PUMP CHAMBER / BOLDING--TANK INFORMATION Manufacturer: 061VC Liquid Capacity: JOCCl ~RL Setback from: Well ~:r,*S-hle-I dHouse cZ Other Pump: Manufacturer A114 Modell Size Float seperation OV/4- Gallons/cycle: Alarm Location 41 SOIL ABSORPTION SYSTEM Width: Length O Number of trenches a Distance & Direction to nearest prop. line: iS u~r 5 Not ye r Setback from: well:-t7A'StA'-Li,1House 7a Other ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system 1011.6S- Existing Grade 10.7- S Final grade /G 7~-S DATE OF INSTALLATION: PLUMBER ON JOB: /l o v we/vd,~2 C K S©~~~ LICENSE NUMBER: M/) 3 LO 0 INSPECTOR: 3/93:jt LCJ(c~►ibo'kl part " $fI~ ~IE 13.31.M0A3%EWAGE SYSTEM County: Labor arrd Human Relations INSPECTION REPORT Safety and Buildings Division ST- rRQTX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑ City ❑ Village i" Town of: State Plan ID No.: lev.: Insp. BM Elev.: BM Description: Parcel Tax No.: , l 018-1055-30-000 TANK INFORMATION ELEVATION DATA A9300296 d/ k'3 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing--- Aeration Bldg. Sewer St/ Inlet l]9 79 TANK SETBACK INFORMATION St/ K Outlet 7 ' J6 9S1 TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic /ed~ NA Dt Bottom Dosing NA Header/Man. 65A-" 17 / Aeration NA Dist. Pipe '51, 'r / Holding Bot. System PUMP/ SIPHON INFORMATION Final Grades`"`' S'75,o/ D(,O~aB Manufa Demand ett~ Model Number GPM TDH LiftFriction e TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH Width r Length No. Of Trenches PIT Inside Dia. Liquid Depth DIMENSIONS S a C>? D MEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact SETBACK INFORMATION Type O t as CHAMBER umber: System: DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake i Length Dia Length lpd Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys s On Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched $ed'/Trench Center aed-/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 0~/i LOCATION: STAR PRARI E 13.31.18.238A ' C& p >Y1w i4 = /t/~~ r Z2 Plan revision required? ❑ Yes 2 -No / Use other side for additional information. ~Z 10A SBD-6710 (R 05/91) Date Inspe or'sSignatu a Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY St. Croix STATES IT R MIT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 8'r~ x 11 inches in size. h k if io t 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 Al T-11nde SW % SW %,S13 T 31 , N, R 18W E (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Box 686 5 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER St. Croix 154024 1(483-9265 Country Meadows II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE NEAREST ROAD •Star Prairi Cty Rd CC ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms 3 R EL AX NU B ) III. BUILDING USE: (If building type is public, check all that apply) Q j 0 -1G,5 s 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground N/A 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. ❑x 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 ❑ 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 450 585 600 .76 8 104.05 Feet 107 - E; Feet VII. TANK CAPACITY Site in allons Total of Prefab. Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New istin Gallons Tanks oncret structed glass App' Tanks Tanks Septic Tank or Holdin Tank 10001 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT ached plans. I, the undersigned, assume responsibility for install ion of the on ' e sewage system shown on the att Plumber's Name (Print): ( Plumber' i ature: m MP/MPRSW No.: Business Phone Number: Rodney Hendrickson \ 3470 (755-3)35 Plumber's Address (Street, City, State, Zip Code): Box 261, Dresser Wi. 54009 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa ary Permit Fee (Includes Groundwater Date Issued Issuing Agent Sign m Approved El Owner Given Initial Surcharge Fee) S l` ` Adverse Determin tion 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 r 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 tirne 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 De pumped by a licensed pumper whe lever 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 )r 2 Family Dwelling. 111. Building use. I" building type is Public, check all appropriate boxes that app9y. 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 ma.erial. 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 wi'h 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 3'% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete d mensions, "ocation 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 sys:e.ms; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; close 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 fonon; 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) Ln LL 0 w CD a. +.u 2 W J U.J ~C tij 7 rH~~ ` I CD w CY) (-n CD - U w cr 7' Z > ~ 'Ir In 0 CD CD ~a~ c~ LL U r- z_~ M ~Ae Q r ~ w z <E: cr V l o Z cym) 3- N o Lh =19 F- LLI CD = m LLJ X LLJ Z: Of w = r-i =¢wa¢ C_0 O r• ¢ LL CD m D ry Ln ~~w w > <E a- q: m W Ln D W :Z J w Cf) I- w U uaa-wc °n 0 ry LLJ w .Z cu of v L15 ° <E: C1~ CD (D~ Q EL EL CL CL 0_ ra U z U r .a cn pN ~ O Lf) C3 c ~ 4] ~ C y T? 93 LL C F- X O C 7 G7 L. CO E- CL Ln L. J x Z o o 0 ::W -3 ¢ co cn H J cn cn . ¢ o= U 0 0 LL J • o c I ~s En ❑ m cu pq I M (D a- v a- Q1 U O X O m c O C O L CD ~ C f~~ N C7 ~ O C) U m O L N N O aJ ❑ TJ aJ Q a3 u, j O S O C7 ® C a_mS Y cu a] C? 0 C4 Cu F- N 107 Slope °s `D ED ~Ln m a3 N C 07 J X ~ O L O J C- ~ Q` N + Q Q C L ® 'r ~I J PO J 4- O J _I n cu L Y U1 L J J d W SOS T~ hO l ~ O O U7 = U O 93 W d C3 C C7 a] al Lf'1 -;7- O F- L p O un O CO co O JCF) L 4.2 S ~f- ~ OO Q7 QM ncn U V aJ U C OOO~ w ~V m A a C CL C7 Q' Lf'1 ~p LL CD CD L ~7 O v- ❑ T llj~ Ln 0 m a~ rn d a_ 5'---x-- 6' -3~:, 5' - -ax 9" Vent U/approved cover -ct r-- Trenches CC Cl U W U7 n Cn a 9" 2729 perf , pipe (U a a v v il ==EM- II ~ L d y 03 3 T~ H 3 UJ O O O W C 7 a_ > j Ln i- 3 C L Cu J C'7 O W J Cn Cn Cn Cq Q] C:) n O Q CJ7 Ln w C- CD ° U ~ U Q] F- Cn W d F- Z U7 Q W O 0 - IL Q J r J a LL. N J U o w Z ci' w <z cn W Q ~ W u I- w 0 J U " z O O J Ln Li M M EEF- Z F- z ::!IK Ln w w c o w O R cv J m F-i w w d J O O m J J_ Z U. 3 En 3 3 CD C:) LLJ W ¢ L ¢ A Z:) N \ rr nn I Z.D V J Cr Ln N O CO F- LL. N = J J s rrVn~--~ J rr ON U Z ¢ Q Q s a\ Z Z Z r n N lD_- V lCD F- ' O ~ r LP W O LD Cu = L F- CD U CD ~ ~ CD o o w Z J Z Z F- F- O Q ~ F- ~ Q ~ Q W W Lr) w m w ¢ Q w O S X U d F- Z LLJ W O = W ~ w L.L. a_ O O O CJ7 CD - N Z W = O L1 Z F- f'- H ~ O cn d ° ¢ w w LLJ ::lK w w F- ca ca J OO Z- W F- = _ W Q Q = LL] LO Z = F- b\~d G1 X Z C 3 F- ~-r Z Q i--1 J cn to Q MQ 3 F- U7 M U7 O DEPARTMENT OF SAFETY & BUILDR INDUSTRY REPORT ON SOIL BORINGS AND HUMA HUMAN RELATIONS P.O. BOX 7E PERCOLATION TESTS (115) DIVt Ste' - .Sw ly,,~ (ILHR 83.09(1) & Chapter 145) MADISON, WI 53~ ;OC TION: -11 Ell : T NSHIP/MAICIPALITY: LOT NO.: BLK. NO.: SUBDIVIS ON NAME: 14 Sw / 13 /T 3► N/N 8 E (or) W TY: U0. MAILIN D S u //~~l 83- L G.~ USE ~o ~l/t ~o L NO.BEORMS,: JCDESCRIPTION: DATES OBSERVATIONS MADE esidence /V, G> New ❑Replaca ESTS z z i 993 8 9.~ RATING: S= Site suitable for system U- Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND PR URE: S STEM-IN-FILL HOLDING TANK: REC MMENDED SYSTII: :tp do ai) RTs ou ~0s au ®s ou F s ®u as emu. If Percolation Tests are NOT required DESIGN RATE: under s. IL HR 83.09(5)(b), indicate: If any portion of the tested area is in the Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL P H TO ROUNDWATER-INCHES CHARACTER SOIL WITH THICKN SS, COLOR, TEXTURE, AND DEPT NUMBER DEPTH IN, ELEVATION OBSERVED ES GHE TO BEDROCK IF OBSERVED (SEE ABBRV. N BACK.) B- /a8yr 8 0-1l° al/, iz-"~' x. "V - /8- 3 "Mee. QAS 8 d s I . U 8Z & oz/ 8L_ 11 'e, S. B Z S )8J o -lZ"of, Iz•-.~8"01673;/t e- 3 9 K. d .3 B- 3 80 /-j 7• C~ > - z s "e. etl J,*/, Z ,f-'- 39 B ( 08.8 ) 8~ 0~9' Q~ 9- Zo"~ Qn,s, l zd - $"d"re. B T 6?' d L.l ,e. d!i s,- i z/- Ye 'e. ens PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME NUMBER INCHES AFTER SWELLING INTERVAL-MIN. DROP I WATER L V L-IN HES RATE MINUTES P ~ S3 ~ (J PE 1G P PER INCH P- =9I / cP lel PP- P- P- LOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hot -ontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percer )f land slope. 'N'STEM ELEVATION /0 y oS ~ ~d S a 9 lee U ❑ 7 2c z A 6 f ,C1•-t-v~irc ~,~'l..-...~. i 7 IoQ ~ 1 ~~'I'.~~7_` I-_ _ _ ~ TN I - H3AO - (ES/OI 'M) S6~9 C~ASZ1 'jaisal I!oS pue )nunap Alaadojd 'Aliioglnv ;e3o-1 of Adoo auo pue ;eu!Bijo :NOIlflalalSl :3un.LvN 1SO Al 19 C :(;euo!ldo)a38WnN NOHd :u3eWf1N NOllV3ldllH3O y .'3HClG -C "6 z :NO 0313ldW00 3a3M S1S31 1 3wv ;Blloq pus 98pelmoull Aw jo lseq eq1 of loo.iaoa eje s1sal eq1 ;o uo!leool oql pue papjoaej elep oql legl pue'apoo an!lellsiululp u!SuoaS!M aq1 u! pa!;!gads spoglew pus S8lnpoooid eql 41!M pioooe ui ow Aq apew exam w1o; s!ql uo palUodal sisal pos aq1 legl A;!ljao AgOADII 'pauf3tsiapun eql i J.tlp - bt 1 1 t. w W Y \ a 2) \~291,Z~~ 9° A. P. N ov N '(3 1 1 Eo 12 13 T o w 54, 678 SQ. FT . ~ v 55,948 SQ. FT . 65, 485 SQ. FT . ' s S~ N O N N ' ° AC. 0 1.45 AC. a 1.26 D ~ 1.50 AC. A.P. ° Z Z c,J A.P. 50, 1 74.78' - 0 10 n~'o ----92.22'- \ N88 X51 '11'W 267.00' `26j - 0 30 c~~F Q r A.P _ \ (L 8 ~F~ ro QF 6 ~7) S88,51 111"E 267. 0' X81 _ r24\ e -_109.00 -82 (QI ~i S> 6 700 SQ . FT . GSL 100 02 0,~ i - 158.00' - oB , oo, o A.P. 9 .46 AC. \ ~ ovrGy, v ~~/009 / 70 30' W/DE QoW f- b ✓OINT DRIVEWAY ) `9 O\ 'oo 5 69 EASEMENT TO `Be 17 SFr LOTS 6 8 7 00, F~ A.P -y III • O ~ tiF t` . 00 10 \ b b66 7 o w 64,537 SQ. FT.o N~ o W a 4 5 1.94 AC.h P C v 90,393 SG . FT . 90,726 SQ. FT . 2.08 AC. 2.08 Nsa7 119, 032 SQ.FT. .N 0 Q C 2.73 AC. DRA 2 IDLING EAS, - - 'EA ro pN F (30' r ENT ON g1R UESJO SIOOa UM RE c eE~o WA -f E StORM N8B *34 ' 10 "W 336. 01 4 W N BENCH MARK TOP OF /RON j N m M I 304.60' .I I (D ELEV = 994.73 Ln - I r,Q _152.30__- 152.30 U, S.c 5 -_J n1 m )o o N881~44 ' 00 "W 4561. 90' p LOT 5 ~ I o i cn ~0! Z I C. S. M. ~I I V . 9, P. 246 0~1 1 , 2 3 COU TRY MEJDDWS VOL-'1. 5, PA E 9E ! OI co I I (._)1 i _ :3 4_ A . 3 X34 ' 10 "E 1654.04' - _ - _ - - - - - - - -C ~ R/W 1 InIPi A -T-T1= S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County, OWNER/BUYER L u,vC~ ADDRESS_ Sf,~e u_i 1)12 10* 4_5 PYRE NUMBER CITY/STATE., pad Cali ZIP_1f0/~f PROPERTY LOCATION :_51AA/4 ,._S A~1/4 , SECTION_,_-J TZN-R_10_W TOWN OF_ S~-.gP ~Pfl ~,`/p , St. Croix 'County, SUBDIVISION u ~2U /"I eEp1OC-45- , LOT NUMBER__:E7_ 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 maybe 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 da SIGNED: DATE: e7l- 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 yin delays of the permit issuance. , should this development be intended for resale by owner/contractor,(spec house), thenia 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 L u,vd-p Location of• property=2~r-l/4 =1/4, Section . I3., 'T_;ILN-R IF 11 Township J`--I92 A; kit Q Mailing address PO. Ox 68'~~ Address of site S,,PalusK ✓e. Subdivision name_ a Jti1 t i gaclo w s Lot no, other homes on property? yes__X_No Previous owner of property _ De°.N,v (s Zopjvi Total size of parcel o2, o $ ,q5;Re,5- Date parcel was created 'Are all corners and lot lines identifiable? --4-Yes No is this property being developed for (spec house)?,Yes No Volume_2nand.Page' Number -iEIL as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMT311T NUrMBriR, VOLUME AND PAGE NUMBER & THE SEAL Or THE REGISTER OF UIZDS, 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 t the (are) he owner(s) of property described in this information form, by virtue of a warranty deed recorded in tc.a office of tiie county Register°of Deeds as Document No.__~/ Q_, and that I own the proposed site for the sewage disposal system) orr I e(we) obtdined an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in t office of County Register of deeds as Document No. Q . Si ature o applicant Co-applicant Date of Signature liate of Signature. DOCUMENT No. WARRANTY DEED THIS SAGE RESERVED FOR RECORDING DATA STATE 13AR OF WISCONSIN FORM 2 - 1982 ~tiw Dennis- A. To .:...........o and Nancy C, Tornio husband and y* k wife conveys and warrants to LL, de„mod Tar O$Y'l~nC oks ~s tenants. in„common/bYaHoa;;estea"c~' ' pirierit RETURN TO the following described real estate in State of Wisconsin: .St....G 'O ,X... '""""""""'.County. Tax Parcel No:..... . ! Part of the. South one-half of the Southwest Quarter (S1/2 of SWl/4) of j Section 13, T31N, R18W, described as follows: Commencing at the Southwest i corner of said Section 13, also being the point of beginning; 00'13'37" West along the West line of the Southwest r ( thence North Section 13, 1289.05 feet; thence South 88'51'11" Easttalong the Northfli edof the said Southwest Quarter of Southwest Quarter Quarter of Southwest Quarter S « SWk) and Southeast West, 1299.80 feet; thence North 88-f34,101, West 2227.26 along feet; the thence South line hof the127" I Southwest Quarter (SW of said Section 13, 2216.18 feet to the point of • beginning; EXCEPT Certified Survey Map filed May 2, 197 in e "T', .795; and EXCEPT Certified Survey Map filed September 149 1579Volum in Volumm 3, Page 263; and EXCEPT Certified Survey Map filed September 029, and EXCEPT Certified Survey Map filed November 228 0, 1989,iinVVo ~7;8Page 11 page 2174; and EXCEPT Lots 4 and 5.6f Certified Survey Map filed March 26, 1 992 in Volume "gil, Page 2467; all in St. Croix County, Wisconsin. i *Grantees agree not to place a driveway closer than 135 feet from the westerly boun- dary of the above described property and oGrantors agree not to place a driveway on Lot 4 of Certified Survey Map, Vol. feet from the easterly boon 91 Page 2467, closer than 65 *their heirs, successors and ass get 4. This S not homestead property. ! (is) (is not) I Exception to warranties: easements, restrictions if any. and rights-of-way of record, i I Da this I day of NO v^c~ , 199.2 ii I (~Y1rJ....... (SEAL) .!f/ e~ Dennis A. Tornio .T (SEAL) ....~c....C'...'Ibrnio (SEAL) (SEAL) II .4`. • II AUTHENTICATION ACKNOWLEDGMENT s.: • Signature(s) is..A_..To' Nancy C. Tornio Q~......••••••••....... STATE OF WISCONSIN II . authenticated this ...~.daY of 2 ss. ~t.-- .h. 19..9.. Ceumy. ~j Personally came before me this . 19........ the above named j~ I~ ITLE ' : MEMBER STATE BAR 0 (If not F WISCONSIN authorized by § 706.06,-Wis.•Stats.j to me known to be the person THIS INSTRUMENT WAS DRAFTED BY foregoing instrument and acknowledge the samecuted the i~ y........... Kristina Ogland ~tt£orney""at'.Laia II Notary Public County, may be authenticated or acknowled ed. • - 'Af e not necessary.) g Both MY Commission is Wis. permanent. (If not, state expiration date: eN4ames of Persons siralne in any caPaclty should be t YDed or Printed below their signatures. I ~ ,!*:WA NTY DEED STATE BAR or WISCONSIN FORM No. 2 I ux2 Wisconsin Legal Blank Co., Inc. i J DOCUMENT No. WARRANTY DEED THIS SPACE RESERVED FOR RiCORDING DATA STATE BAR Or WISCONSIN FORM 2-198211 491208 _ y~L 979, A') E jj_ 1 REGISTERS OKiCE . Dennis-.A.-Tornio and -Nancy C.. Tornio, husband and sra max co., w, ~ Reed for Record wife 0 9 992 NOV- - 1 jo A. 11 conveys and warrants to ..Allen Lunde and nary Bove op R _ - . as .tenants in common . d b/A Homd:t ead Development W - - pc -TURN TO I . - . the following described real estate in _..St.... 0.j 1C County, - State of Wisconsin: Tax Parcel No: Part of the South one-half t. the Southwest Quarter (3112 of SW1/4) of i Section 13, T31N, R18W, described as follows: Commencing at the Southwest corner of said Section 13, also being the point of begirding; thence North 00'13'37" West along the West 'line of the Southwest Quarter (SWl/4) of said Section 13, 1289.05 feet; thence South 88'51111" Fast along the North line of the said Southwest Quarter of_ Southwest Quarter (.'tall: of SWN) and Southeast Quarter of Southwest Quarter (SEA of 2227.26 feet; thence South 00'16127" West, 1299.80 feet; thence North 88'34'10" West along the South line of the 1 Southwest Quarter (SWk) of said Section 13, 2216.18 feet to the point of j beginning; EXCEPT Certified Survey flap filed lay 2, 1979 in Volume "3", Page i 795; and EXCEPT Certified Survey Yap filed September 14, 1979 in Volume 3, Page 863; and EXCEPT Certified Survey Map filed September 28, 1988 in volume 7, Page 2029; and EXCEPT Certified Survey Map filed November 20, 1989, in Volume "8" 1 page 2174; and FXCEPT Lots 4 and 5 of Certified Survey Map filed March 26, 1992 in Volume 11911, Page 2467; all in St. Croix County, Wisconsin. *Grantees agree not to place a driveway closer than 135 feet from the westerly boun- dary of the above described property and"'Grantors agree not to place a driveway on Lot 4 of Certified Survey Map, Vol. 9, Page 2467, closer than 65 feet from the easterly boundary of said Lot 4. i *their heirs, successors and assigns. This is not homestead property. ~J•~ (is) (is not) easements, restrictions and rights-of-way of record, ~•EE Exception to warranties: if any. Ilk OA~e LEI No ~T~vvti4x~,. 199 2 Da this day of -.......(SEAL) !ltcxc (SEAL) 1 ....Dennis A. Tornio Tornio . (SEAL) (SEAL) . • it l AUTHENTICATION ACKNOWLEDGMENT Signature(s) Inn; s.-A.-.TQrniQ,._--.--• STATE OF WISCONSIN i Nancy C. Tornio as. oYrr ( ci 9 --------County. authenticcateed~ this ~.....day of 19...... Personally came before me this day of l 1 C9G4~e~l 19------- the above named Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not- - authorized by 706.06, Wis. Sta to me known to be the person who executed the li foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland --------•-------Attorney -at--I~.w - - - - - - Notary Public .........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- II82 Milwaukee. Wisconsin