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HomeMy WebLinkAbout040-1119-50-100 4 o CD ° M ~ a~ I o I a LO N I ~ ° I CL C14 ~ ~w m I 0 No0 t- = m I N > d 0 d Co -t Y 3 .O 1O Q Z N C L U' I c > y O O U (0 m0 w M .C O - v m o a~ Q N O co N m N C 3 z E z N y co d m N FN- z E 0 0 U O Z c o z r O c c Z 0 Eo N CL M N 0 N O EL U N O C C Y C U Z I- D y Z 04 c t^O y E Q N N ~ IL a .R r d' 'ct O O N r G r G r d U O N N Z > is ° a ° 3 3 3 o z°oo a a a N IL T .N 7 p fA m M M 0 LL rn rn U " O M .J Z Q > 7_ 7_ rn 0 ~ N I~MN ca CO O 'o E C pO N of N U~ d Q} fn N O O co O. N O N N co 00 N C CL 0 0 0 r F O N N - V 30 m O C: N N >1 C-4 w CO CC) 0) N O p y O O U O M 1- m° - O Z C z rd U) ~ w E Ea U A C.) a 2 0 U) U 5Y5 7Z-~41 STC - 104 AS BUILT SANITARY SYSTEM REPORT ODDrL OWNER 13013 / /r/ M '3 ADDRESS 7103 ~ ssey e / / 7 SVC 2- -2- ~j2,4 2 Wa c o F, P . SUBDIVISION / CSM# 50Y~/S 6p F -2-& 7 Z LOT SECTION, 3 T Z~ N-R ( W, Town of J ' 31. 28 , tit . '-tg g B ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i S NT INDICATE NORTH ARROW Provide setback and elevation information on reverse of this-form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: W OQ 'j~PM PO S 7 C 1Jr1 / l O/U ALTERNATE BM: 'V O V V,J - .vcJT _ 1y Co-vSfpvcT ~ Y&7-, Z SEPTIC TANK / Pump ER N rtQ 0 Gl, ftf' S ~ti lit,L 7~2 f 0, l ('00 Manufacturer: Liquid Capacity: O wE'(l uoi' 1A-7VM11 Setback from: Weller D47;~r- House Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM Width: s Length s t Number of trenches 3 Distance & Direction to nearest prop. line: 1> Setback from: well: House ~Z Other WO II4P le 7- ELEVATIONS Building Sewer ST Inlet: ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system ns, #Grade Final grade DATE OF INSTALLATION: PLUMBER ON JOB: ;P4d4Eo*'7-G'~+n ~G LICENSE NUMBER: lVo S 320 7 INSPECTOR: QOM /US /SD•v 5 13t~~PM . / fo~IE i 6-,jkA UE ~ I R LP s~,.4v Poc ~ISE~v ? T,4ivk fjoT*- ~i►>cJ;~s ( / R iSt~e ) ~Nfo T-q,v,~S goo i~fNK Ic~1= t K 5 Gaco . S ('ho R~Sf~) i Sc,¢!e . ! Zo 92 Aeop 13 ox ItJL~T ~ . S - r✓ f~M - Top of DRop Roy,? GS ' 0 Pi~D E" N4~')c 7 To WL r lvoo0 fe*tCe Dos GS F~, ~ if I e - 1AA)k E/EVrtTid.uS - J~'•V t GvlET oujItt M • l~, -fj?ENC !f SPEC s A 101. 20 i00.57P 103.6 9, ' 100.96 I /00 66 1-02-36 S('4- 2723..1 Puy ~csr p,• Pock Pkot&cjA~V '3 el-C_ HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT UFBRIGHT WITS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. INSTALLER & DESIGNER LIC. NO. 00663 T'R E.v c tf ~_GE vt Ti o ~v S F/IV* l TOP ' Togo 6 YsTF,1 evj&jp Cp Uf ~Q HE•1 DE',e I/Eti j E,uD D~Tjy E ND ~ i -7141 lKsconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page /of 3 Labor and Human Relations o0. rvrsionbl Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code P~~ T °F ST~ti G'~~vs~',✓ `,p,~,~,s- ` 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. # P--1,0 3Z' dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION 'REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 0 D D GOVT. LOT All 1/4 ! V 1/4,S 31 T -L. N,R E (or) W: 111 PROPERTY OWNER':S MAILING ADDRESS LOT If BLOCK # SUBD. NAME OR CSM # I 10 03 w ss~v r / CSC, pEti~~ v /2 faes CITY, STATE ZIP CODE PHONE NUMBER []CITY QVILLAGE )MOWN NEAREST ROAD f / )e P& di-1/• SfO 22_ (7151 yvZs'U17~ ?~Dy 2' &G /if-G0_ ( New Construction Use [ J Residential / Number of bedrooms [ J Addition to existing building j J Replacement a Code derived daily flow 75-0 gpd Recommended design loading rate _X-bed, gpd/ft' trench, gpd/It2 Absorption area required ~ bed, 11:2 9 trench, ft2 Maximum design loading rate X bed, gpd/ft2 ' d Irench, gpd/tt2 Recommended infiltration surface elevation(s) -S-,f4- ft (as referred to site plan benchmark) Additional design/ site con ' rations ;Kr c- 7~'tw S A'iA 90/0 190X'PI'ST , .0,0 /E tJ~/`ti0~ s Parent material $C$ o Y'~ .mot 9*,4 5 Flood plain elevation, ' applicable ft u i,v v v s t!a a, s S = Suitable for system cCQNVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem PUS O U ® S ❑ U O's ❑ U 2S O U 4S ❑ U ❑ S 4O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boutdery Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tmndh -7 Ground s"IO ~S y,~ y~ S S /lA,,/)-- / .-7 elev. 51 ft Depth to i limiting factor y Remarks: Boring # o - y soyiZ 31s~~ 4vi -e ~S 2f 17 100 - J o of y So ~o y e /10 o -60 io y%2 fs o,f ,y,,.~ GS / • s Ground elev. C b ~'y s - ©M+, s i ' l 5 6 ft. Depth to limiting factor Remarks: zL6Z120- v 13 z wh S 1-l 0 t'S 7 CST Name:-Please Print Phone:/s-_ 3 c~ - ~S Address: SITE SEPTIC PLUMBING CO. _ cl _ G 3 Csr"I 2 yPZ, Cos O'NEIL RD., HUDSON wi-s U016 l Signature: ROBERT ULBRIGHT Date: CST Number: T~~ MASTER PLUMBER LIC. NO. 3307 M.P.R.S. 1 , ",TALLER & DESIGNER LIC. NO. 00663 ORIGINAL RFc€~r~ED Al i'& 9 1 93 ~ u.. ~r,r,.:hX rle CU 9 PROPERTY OWNER Rot? ~~/'r'( 30D~ . SOIL DESCfa'TION REPORT ~ Page Z of 3 PARCEL I.D. # 20 A" W S L p I t Depth Dominant Color Mottles Structure GP rt2 Boring # Horizon Texture Consistence 8cuidary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz $h. Bed rench 3 O- /b 3/ S D, ter,, sb,~ ~v►.2 s Z f ~:5 /0 Y~e /5 4" Ile - Ground 132- YR /S otiv► y's.]_(Q ft. 14 677 ,►-r~ r s D, op Depth to C - O 4 11,1, 69,rwr, 7',o limiting , factor i Remarks: Borin g # -a /O //e 3~ ~S /,-F g 'jo fie "is- ?f rjp itiI- I U E3 top c - S i Ground y' s elev. hOv• ft . Depth to limiting factor Remarks: Boring # /0 f/,,2 311-11 ' /5 C f `1ie S 27f 'S 5 YQ /dl/~ yCO ~5 Dr4+1,S`J~ M~~ S lUf 7 'lJ Ground elev. ft Depth to limiting factor Remarks: Boring # Ground elev. ft Depth to limiting factor Remarks: con 0911^10 ^CQV11 JAM+1RO s o 0 ~I ih' IvLI ix~ 1r{ i USE Z ~ { I { { I T sF-,e/fs O f~S I I %6 ~ ~wI {w { ~g P Ga m , i ~ 1 j ~ j GlifjP/FiYi►Tic.v ~ y B3 ice{ ~-c { I 7- of EfFL vE'.uT- I L {`~~I 'Ni ICI paVi'OVS LAAsOf,~,,~se~ - wooo 1Ct-, tc p o s r . 70' S APPieox/EV•rr/av /0,0, o ' Yo0 To P v P -'4o . ARaposED .4 f3 0 os /~r~vE . wE5 T <oT Gi.'v~ F EL_EVATioZS 3 q,PPPoX - Yoo C3 y &AJ 3 Tr''5:06A6-5 0'lfa, 6 'x 4e8 ' ,fS 4&0xr-- S~ST~~'~t~V~T`►`o~5 ~•'Gf~EST " /0 'rif~E~ll G-l1~ t7 3. Z✓` , SG/a LE = 30 ~o w TAE' E,u 7/, -7' = ~AGl~hoE /'TS HOMESITE SEPTIC PLUMBING CO. W5 O'NEIL RD., HUDSON, WIS. 5+1016 ROBERT UWRIGHT i WIS. MASTER PLUMBER LIC. NO. 3307 MAR& k4NN. "STALLER 6 DESIGNER LIC. NO. DOW CS7-,41 1YP2- 9F 's 'f 3 W/1 e'o J C E R T I F I E D SURVEY, MAP LOCATED IN THE NEh OF THE SWk AND IN THE NWt OF THE SWh OF y4EC. 31, T28N, R19W, TOWNSHIP OF TROY, ST.CROIX COUNTY, WISCONSIN. PREPARED FOR: STANLEY CLAUSEN U N P L ATTED LANDS , S88*136'00"E 703.00 WEST LINE NE-SW NOTE:BEARINGS ARE REFER- ENCED TO THE SOUTH LINE OF THE SW I/4.f RECORD BEARING 50%~ Ia:l_ Z' y: a' o• LOT 1 Z• o a• 20.01 ACRES '-1• W E N _ j1811,720 So.FT.I e rD.48 AC. EX C. R.O.W. d G 1846.521 $0. FT.) N W- 0 ' a r: w . lV O J: N I_ J, QL- a N Q.. m, o en _ N 2 O y BUILDING SETBACK LINE O ........t ..................0 O O O M O NJ M - M r-S N ad• 36.00"W 703.00' JAW4Ci M N 88 36'00"W 703.00 ; SOUTH LINE NW-SW SOUTH LINE NE-SW UNPLATTE•D LANDS,, CERT1F1ffE) W MAP -:N va Y!, ' VOL. 6, Pu" 1790 NAM JAMES M. ' ' 3 ( - l • WEBER z S-1804 SOUTH LINE SW 1/4 SPRING VALLEY WI$. f~ . 1630.99'. I 863.37' iv. 0 % SB8•39'Oa"E N86•39''06"W sw con. SEC. a I. 1/4 Con. S EC. 01 3 I~ f*, SU UND). COUNTY MON. FOUND). SCOUNTY MON. FO JAMES SCALE 1"s 200' M. WEBER S-1804 DATED ""1.•24+%4%3 O* SET I"X 24" IRON PIPE WEIGHINA O' 100' 200' 400' 1. t 3 L BS. PER L INEA R FOOT. SHEET I OF 2 93- 107 THIS IN._STRUMENT DRAFTED BY J. W. tGL~/ y %///1 , r~////✓ v G~ /p s G1 7r7 7 j 49 g 4/ / 504456 CERTIFIED SURVEY MAP LOCATED IN THE NE4 OF THE SWk AND IN THE NW4 OF THE SW4 OF SEC. 31, T.28N,_R19W, TOWNSHIP OF TROY, ST-CROIX COUNTY, WISCONSIN. PREPARED FOR: STANLEY CLAUSEN U L,ATT,E.. LANDS way S88°:36'00"E 703. 00 y~OZ ;WEST LINE NE-SW NOTE:BEARINGS ARE REFER- ENCED TO THE SOUTH LINE OF THE SW 1/4.( RECORD BEARING 1. co Z.Imo: 2x199® A~G Ntr - Z• 3 Q' JAMES O'CON LOT I 00 0 20.01 ACRES -j . Z Register of Doeds )y xCo.•WI E a 18 74,7 20 SO,FT,1 0 StGroi N - 19.48 AC. EX C. R.O.W. It p 1 848, 32 1 SO. FT.) S p, o °o W• 1: W• N O F- PROVED Q. Iu 3 Q. Z' `l Z' a N j~oix COUNTY 0 ° y d."dmi1N Qlannov Z - f v) ~,~r>Isr4 and c4mv ittep •tvocorded BUILDING SETBACK 30 days of L I N E * ival date T e •Yeo ihaNIDS o p n E rod o o M o ro ro • N88-36'00"W 703.00' M N 880 36 00 W 703.00 SOUTH LINE NW-SW SOUTH LINE NE-SW UNPLA•TTE•D L•AND.S. Wo {{{{1f~m lfftty ( S U RV E Y M A P VOL. 6, PG. 1790 z • SOUTH LINE SW 1/4 1630.99 ' 863.37 N 88.39'06' W w OA,.o ~of; U Ft~~, T'S"W-'CO R. SEC. 3 1. I/4 COR.6SEC.301~ ( COUNTY MON. FOUND). SCOUNTY MON. FOUND). i,,i~~ S f~~o~eeo+ I , zoo JAMES M. WEBER 5-1804 S CA LE DATED x'1.•2 ~aq3 0= SET I"X 24" IRON PIPE WEIGHING 0' 100' 200' 400' 1. 13 L BS. PER L INEAR FOOT. SHEET I OF 2 93- 107 THIS INSTRUMENT DRAFTED BY J.W. Vol. 9 Page 2672 LCXiei ~iarfGi~iQYfar3Jls*r 8.19 LOTPAVWI AWA ATEM County: ,Labor and Human Relations INSPECTION REPORT Safety and Buildings Division sanita ~Yni GENERAL INFORMATION (ATTACH TO PERMIT) ❑ City ❑ Village ❑ Town of: State P Permit Holder's Name: I MID= le 11 Insp. BM Elev.: Description: Parcel Tax No.: BM 1 04-0-4419-630-100 TANK INFORMATION ELEVATION DATA A9300225 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER Model Number: INFORMATION TypeO System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.31.28.19 LOT 1 (ILWACO ROAD) Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: a.m SANITARY PERMIT APPLICATION 7DILHA In accord with ILHR 83.05, Wis. Adm. Code COU TY C440 I' X, -Attach complete plans (to the county copy only) for the system, on paper not less than 1:1 STATE fiRinngEwn R7pr, 8% x 11 inches in size. c o v ious application T # -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. /v PROPER OWN~j , PROPERTY LOCATION f7 1L JC /JAj 130 IPD Al,FYa •sW S 3 C T 2X, N, R ~ E (or) W PROPERTY OWNf~R's MAILING ADDRESS LOT # / BLOCK # " Y, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER `i - (~5.. ?-4 2 A51a f"Als W/ . _5 (02 -7 CS^ 5 d Ll q S 4 V01, II. TYPE OF BUILDING heck one) CITY NEAREST ROAD ( ❑ State Owned C~ VILLAG E : ZL Wf CV - / I OF: ❑ Public P1 or 2 Fam. Dwelling- # of bedrooms6L- PAR L TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) ©z /O v 1 El Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF P RMIT: (Check only one in line A. Check line B if applicable) A) 14 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.E] 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 eepage Bed 21 ❑ Mound 30 El Specify Type 41 El Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill yy use 3Lcy~ ~~'~f C b7 ~~p3 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 L., REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gallss/day/sq. ft.) (Min./inch) g3 ,LS' ELEVATION 7> v 73 ? R d /v 7 S Feet 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 s ructed Septic Tank or Holdin Tank &O Lift Pump Tank/Si hon Chamber ii~ 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 Si nature: (No Stamps) /MPRSW No.: Business Phone Number: &9&7 2VORiG47- 330 -7 -eel Plumber's Address (Street, City, State, Zip Code): 4 5 s 0 r ,vel Ii ~ . /{~pSo.✓ &&X Sy IX. COUNTY/DEPARTMENT USE ONLY j 7- ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue Issuing gent 7ure (No b)aMP!3y Approved El Owner Given Initial C40 Surcharge Fee) 10 1 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'Aisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved 19y the permit issuing authority. 4. Changes in ownership or plumber require-3 a Sanitary Permit Trarisfer/Renewal Form (SB0 63'IEI) to be sur~+itted to the county prior.to installation. 5. On,>iif, ssewage sy=stems must be properly rri intained. The r i. tank(s) rni:; t e pu npeJ by a licensed purripE+r whenever necessary, usually every 2 to ? 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 con,,,plete 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 wher > 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. 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. Abso,ption system information. Provide all inforrr+atian request-li in ~11-7 VII. Tank tion_ FIII in the rapacity of every :iew and/or ekrv' ',ist Vi to 3" number of tanks and < aoufacturer's nave. Indicate prefab or site cccs;?,: tank rna'.e6al. t "-r,.,te for all sepllc, pLi p/siphon and hoiding tanks for this system. Chec~ irrental approval cinl,; `lank; received expel i 'ai product appravRl from DILHR. Vlll. Resp w' it`iiify statement. instailinn plumper is to fill in nary :se rl 'rnC~er - rh appropt -_ie p-efix (e.g. MP, EJC.'/, add;"ess and phony; number. Plumber must 'aim p: iication form. IX. County/Department Use Only X. CcunYDepart.ment Use Only. Comf:~'-te pTars rnd saecificatio„:: riot smaller than . 11 inches ,:I be, subr'tted ~~~>1~inty The it,ans mi.d._1 t'io following. plot t. an draw scr,;._ r'u FF• t);f, r),,7!,iC,rl of tl'i dlf r la;~s psi, tank(s) or other tres3t'nent tar'As, buildings i s WC_f!<;, rv i r•+ ,ter service; streal s :ono I{lk.F::,; spur p of siphon tanks Clio: ihution box---,. in ski -1-, -iv rt system ai"a?r= the )Coat;Cli of the builuSng 3) hotizontal ail' ;s t' :3' 'IPtz+`.__'' ~.'-'E; p'~i,.f<•; C) cornp ete specifications for punips and controls; dose ve un u. J E:vatlon differ, r,e Iri,.iiDn Icss; 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 Wisc.)risin fact 410 included the creation of GLirchargi s (fees) for ",L irno `r c ` regulated p :.ctice~; f ich :an effect groundwafer. The r ic.,ni 's collected through these surcharges are used for ntcnitoring qr,-AidAate F s and water contamination investigations and establishment of standards, SBD-6398 (R.11/88) Wisconsin Departrnent of Industry, SOIL AND SITE EVALUATION REPORT P of 3 labor and Human. Relations - Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Core COUNTY P1f, f r 'OF ,J Tfti e4,1 f4V r16A-1 G•f AsPS Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but PARCEL LG. iy PE~Di~G- not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION &/3 ' ~c l.9 3 0.pv GOVT. LOT bC 19-S4) 114,S3/ T-2.9 N,R 17 E (or) l' PROPERTY OWNER'S MAULING ADDRESS LO i BLOCK ar SUED. NAME OR CSM 8 249 03 11, S.s~v e7 / csM E.ur~:,v G- 4c4c5 CIT_Y STATE ZIP CODE PHONE NUMBER []CITY []VILLAGEjiaYVN NEAREST ROAD t iE'~t~t7p ~~%S /u/. S*'o 2-2- ( 7iS) 1~$-G1 ?,Poy SL~iq c~~~ [A New Construction . Use (j Residential I Number of bedrooms Addition to e4sling bonding [ 1 Replacement Code derived daffy flow 75-0 gpd Recommended design loading rate _ _bed, gpolft2~~ -trench. gpolit2 Absorption area required bed, h2 9 trench, h2 Maximum design loading rate : bed, 9PdAt2 trench, Wl(t2 Recommended infiltralion surface elevation(s) it (as referred to site plan benchmark) Additional design / site oD atlons ZlfE 7`if'> 64 SOX _P I'ST , o v Dr fF. /EafTlo~ s Parent material SC- (M e,4 0 7y,.,4,-4 o 5 Flood plain elevation, ' applicable OW&, r A( AA h iN - M v v S t !p Lt~ S S - Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE 417 GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 00 S[] U EIS 0U_ as ❑ U IN'S O U as O U [Is Mu SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence fts tsly Roots GPOAt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tench 0 /O y~ 3r S sfak S z f , -7 Ground S: `jp 7S yid yG s S ~v~,Q. . elev. 5.~ • fL ' Depth to limiting factor I I Remarks: Boring # I 81 y= s~ /o Y/e y6 ~ ~ o - io yip ~ fs o,~; ti• ,y,,.C CS ~ • s = •G Ground elev. C / 9' S 6 fL - Depth to limiting fac~ Remarks: h,~e/ ~4N I~ wh S 110 ('S 7- TName:-Please Print Phone: bs Address: HOMESITE SEPTIC PLUMBING Co. 655 O'NEIL R - - l 3 "'01 2 ypL ` Signature: ROBERT ULBRIGHT Date: CST Number. u-(Jl^ I ;S. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. "'T`! !!!TALLER & DESIGNER LIC, NO. 00663 A 3 PROPERTY OWNER /3~ ' SOIL DESCF;.;ITION REPORT Page 2- 01 GD PARCEL'I.D.i. ZD 46I45 Boring # Horizon Depth Dominant Color Mottles Texture Structure Roots GP itt2 In. Munsell Ou. Sz. Cont. Color Gr. Sz Ph. Bed larch 7 0 Y" 01- /S 7 Ground 9)- 0,w, oil elev. -144 ? It. ~ew Depth to - 0 7siQ y S s, , 7"00 00 limiting _ [aft Remarks: Boring # E3 /o Y,e eio fe 0~1.s zf tip N~ g a-a /o F Ground C G 7•5ye s ,-M 5 7 i t~ ff]] L Depth to limiting faclDr Remarks: Boring # /a Y/2 3~ ~S d f r/ie S 2f • s" -~r Ground elev. Depth to limiting bft Remarks: 3onng ;rt t 1 .1-3 Ground elev. It. Depth to limiting facto Remarks: eon a-MA10 Acown N s a5~ ~ o 8, ~ ~ a~ j~'y ifs t~ l h' 1 ul I USE L ~ ix i Ir I ~ I Q 1 I ~b 1 1 w 1 w I fltA 5 1,V .sa,e fs S 10 E I I j ~I I, I 40le 14.4,(I;y a-i l/Q y "3 I K I i t'v~ /~,PE7RT•yF~ T of EfFL v~.u']-. I' I I~pl Iii 013L)I'OUS LslAJO"pFSeA-- - -f?A161- POST-. 2 b r ,0 i 'O I s ¢ ism, s. T ~,/EY~TiOV /00. O you I -To P n f p; ~k " ~o PRaposEO ,4 f3 o oc- 12AL7>E wE5 T <o T G~.v~ E LE:VATfOZ.S $ 9Z.9G i 'B 3 A~P~X boo 13y f3 S s Py ' ~sccr"►.r, ~oEo sysr~ D~siG-,c,~ ; 3 Tf CVC44-5 elf all- or I~ SYSTEM 61muA No.o5 1 ~id 7iPEN ~ ~J~. ZS S c,; LE 30 acv T,PE',u HOMESITE SEPTIC PLUMBING CO. 8550'NEIL RD., HUDSON. WIS. 5016 ROBERT WRIGHT i WIS. MAST£R PLUMBER LIC. NO. 3307 MAIM MINN. WALLER 6 DESIGNER LIC. NO. 00a93 ~sTtil zY~2- £ -S f 3 co led 13 ;%i Iri ICI vsE I 'C' I I f fA*5 1,V sE~PieS o -p S top 6s, y i M yc , n~P-CTi(' T.tiE~T of ff-t vFA-) -1-; ~4GC T'1`~i~ a-~ 3 iN~ ~ I i 114 21 OQV~'OVS L,4~uD~~tK rri WooD -Ftot' rc P os r , a you - I To P o f '~O bed wE5 T <oT Grv~' EL.EVATiOZ-S l 76, 4jOP,ox- yoo 3 y 5 ~sco,~►.~ nE-p sysr -0 05/ rcJ ; 3 T~~uc s E~ 'x 4 a " ~s -t&0 6YSTEAA 6l&-L)A -(oA3 , 00 I , ~id TiPEN ~ ~-9 . ZS SC /a LE 30 ~dW Ti E•V 10. 7 ' /3AG~hroE p~'TS HOME" SEPTIC PLUMBING CO. ON O'NEIL RD., HUM, WS. 5+40% ROBEW UtBRKWT WIS. MASH PLUMBER LIC. NO. 3307 MAR& MINN. IM,TALLER A DESIGNER LIC. NO. 00983 CsTtii 1yP2- 9-S-.93 ~~GwACo Rd- - ' Fresh Air Inlets And Observation Pipe Approved Vent Cap Jfl ( ~i~E'v~t Qom----- Minimum 12" .Above Final Grade ///rrr f~/' a • 4" Cast Iron Above Pipe Vent Pipe' i -to Final Grade ' Synthetic Covering min. 2" Aggregate Over Pipe Distribution - Tee Loo 0 0 0 Pipe (P ! Aggregate 0 Pertbrated Pipe Below Beneath Pipe 0 Couplinq Terminating At Bottom Of S.ystean . y . 77, :P Fresh Air Inlets And Observation Pipe Approved Vent Cap Minimum 12n Above - y~ 9ff~ Final Grade 1~- O 3 4" Cost Iron Above Pipe Vent Plpe' -to, Final Grade • Synthetic Covering ate b • Mina 2" AggL70 Over Pipe Distribution + Tee Pips ° 0 0 0 (Q " Aggregate v Perforated Pipe Below Beneath Pipe 0 Coupling Terminallag At / Bottom Of System i u Fresh Air Inlets And Observation Pipe Approved Vent Cop Minimum 12".Above • Final Grade _ 4" Ca=t Iron l~ Above Pipe Vent 4'Ipf 'to Final Grade Synthetic Covering min. 2" Aggregate Over Pipe Distribution Tee Pipe 0 0 0 0 0 Aggregate o Pertbrotod Pipe Below Son*ath Pipe o Coupling Taminoting At Bottom 01 System SysT~ , . i 7, / 504456 C E R T I FLED SURVEY MAP LOCATED IN THE NEq OF THE SW4 AND IN THE NW4 OF THE SWQ OF SEC. 31, T28N, R19W, TOWNSHIP OF TROY, ST.CROIX COUNTY, WISCONSIN. PREPARED FOR: STANLEY CLAUSEN U N. .P.L. AT.T. ..ED. LANDS.. . S88°;36'00"E 703.00 WEST LINE NE-SW IV OTE:BEARINGS ARE REFER- ENCED TO THE SOUTH LINEOF THE SW 1/4.f RECORD BEARING J. Q: .o Z: ~ 2 61993 9 o L O T o Q pAMES O'CONNELL O 2 0. 0 1 ACRES J Z Register 0100 s dw E N- (8 7 1, 7 20 SO. FT. ) O St C,(oix CO., V41 Q 19.48 AC. EXC. R.O.W. V O ( 848,52 1 SO. FT.) N j S 0' O o O W• N o W * PROVE lV F Q. cu - 3 Q. N -J• 0-- V N a.. Z' M c} Z. ^1 = ~toix COUNTY Z is r%hdasive Pua111Yl1s !,wimp and C r~r • frOlhnUttMs .t wecofdod BUILDING SETBACK 30 dovsof LINEI .•~'3val dvto t . 9 eve? sW be o O O is B void rn O M M M 88° 36'0w0"W 703.p130~, M N 88° 36 '00"w 703.00 S OUT 'I, NE NW - SW ~ SOUTH LINE NE-SW UNPLA.TTED LANDS, i CE Ri1FIE D teM~ W _ ~!s!l G~~ I S U. V E Y MAP cy v : ~V0L. 6, Pu 1790 N JAMES M. w WEBER z S•1804 • SOUTH LINE SW 1/4 SSS SPRING VALLEY r WIS. 1630.99' I 863.37' 0`•~ S88°3906" E N 88039'06"W O°,~ ` 404;1, + ,f G N SW COR. SEC. 31. SI/4 COR. SEC.31. 0 S~v ' ( COUNTY MON. FOUND). 1 COUNTY MON. FOUND). s~r~fo~e~o~Nti SCALE 1 200' JAMES M. WEBER S-1804 DATED O v SET I"X 24" IRON PIPE WEIGHING 0' IUD' 200' 400' 1. 13 LOS. PER LINEAR FOOT. SHEET I OF 2 93- J07 THIS INSTRUMENT DRAFTED BY J.W. Vol. 9 Page 2672 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER C", ADDRESS FIRE NUMBER CITY/STATE 1 l ZIP_ PROPERTY LOCATION :'Uz-- 1 4 SS O 1/4, SECTION T - - Z / , , N R W I TOWN OF 772--0k , St. Croix County, SUBDIVISION ("51411 0 `7 / ~1( •6O S , LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix county residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification *form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1)• the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/lle, 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: { r7 IV ]U (XQO . 1~`~ciu DATE: 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 fthe owner(s) of the property being developed. Any inadequacies will only result ~n delays of the permit issuance. ,should this development be intended for resale by owner/contractor,(spec house), thenta second form should be retained and completed when the property` is sold and submitted to this office with the appropriate deed recording. Owner of property Location of propertyALF:1/4 51/4, Section , 7_4 v N-R` l W Township Mailing address Address of site tt~~ 4 Subdivision name ~S S b~l~l S VQ1` r - Zr°~Lot no . Other homes on property? yes_ No Previous owner of property L• 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 3Lz volume la Uand.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. 5_6 - y S Lf / , 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. si nature of applicant Co-applicant Date of signature Date f signature I I ' 'DOCUMENT NO. THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED STATE BAR OF WISCONSIN FORM 2 - 1982 j 0 t f y_ i 4i :3 l(a,E r' 'X 504541 Co., 1 t 1030PAGE- .322 - - - , Recd for Record Stanley B. Clausen and NancyLClausen, husband and wife AUG 2 6 1993 . - - . - - 3.25 P # . . Robert W Bodd Jr. and Kimberlee R~glsta~ Dt a::ecs conveys and warrants to as survi ddy_, . hu-stand vorshiP. -m arital ..]30 A _..-and wife property..--- - _ RETURN TO Robert W. BOddy, Jr. _ _ 403 Wasson Ct. Apt. 1'7 . _ ~ 5402 the following described real estate in ..Bt...CrQix........ County, - River - a State of Wisconsin: Tax Parcel No: A parcel of land located in the NE 1/4 of the SW 1/4 and in the NW 1/4 of the SW 1/4 of Section 31, T28N, R19W, Township of Troy, St. Croix County, Wisconsin, more fully described as follows: Commencing at the S 1/4 corner of said Section 31; Thence North 88°39'06" West along the south line of the SW 1/4 a distance of 863.371; Thence North 1°23'42" East 1315.70,' to a point on the South line of the NE 1/4 of the SW 1/4 of said Section 31, said point also being the point of beginning; Thence North 88136100" West along the South line of the NE 1/4 of the SW 1/4 and extending along the South line of the NW 1/4 of the SW 1/4 703.00'; Thence North 1023142" East a distance of 1240.00'; Thence South 88136'00" East 703.001; Prf Thence South 1°23'42" West 1240.00' to the point of beginning. Contains 20.01 acres subject to Ilwaco Road right-of-way over the southerly 33' thereof. Also subject to any and all additional easements, right-of-ways or a 1 - conveyances of record. This .-_l5_-n.Ot._-......... homestead property. kx) (is not) Exception to warranties: Easements and restrictions of record. i. Dited this 19, ....6---------- day of 19-93 ------.--(SEAL) ao;ee (SEAL) - I St ley._B._,Clausen------ Nancy Clausen. - ---.(SEAL) - - - --..-..(SEAL) - AUTHENTICATION ACKNOWLEDGMENT I Signature(s) __Stanley__B_.__ClaUsen__atld------------- STATE OF WISCONSIN Nancy -L Claus-en--------------------------------------- SS. n/ pb~ -------------------------------County. au nticated this day of.-. 19.93_ Personally came before me this ________________day of 19- the above named - • WP S ~ TIT E: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY .....01t-inan- & -Webster-,_Ltd------------------------------ Box 490 Ell svxorth,WI - -54011._.... 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. 'I WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. S} ~ ~.3? ~ p Z ~~~5 3 ~ ~ Z ~ ~ a~ ~ ~ Z ~ ~0" ~ ti~ o. ~ o ~ Z ~ -