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HomeMy WebLinkAbout008-1028-70-100 'D 0 ° N O~ ~ I 4N' 4 o w 0 ti ma N N Z c c p Ile Y c c m Y C N C w~i +L-. Z` f0 4 co G> d ro~ E CL h N ~ T pYa c O 'D ~ ~ c d I N Q w V ~ O X Z H a N L t0 C C LL 0O a = p v r j Q °c3-aiE Cl) Z E z a m o co z I N O Z 9 N ~ •7 d Z C N F- r N a> , N E ~w E ° _ d N ~ O O O • 'p L ty0 (C N O w N 0 z z o o zzo N OD N O 'IT d N ICI. > y i. a m v N CL D > O > o o a a N Z> p F' H F- d J m 0 0 0 • _ mama a c O O O p C) 0) :z to a) O N n N O O V W N O Eco eN~-- Lo O O 'D CD C d (0 N N O Z ) d rn v ~ Q (n m I N N ~►1 0 3 N N c o c E o 0 :3 to a) C14 Q CD H E m c 0 u a rn °o o f L ap N L N N tC N I~ OD r n p N N 40. F a) o Q 7 N; ? Cl '00 (D c N N O • O W co O Z U) F- cd co c a • a m d r`~l E 2 c r A 0 a I', 0 N U T~CAT.I~ EAU IgMp,~~LE 10.28.16.146 l SW, LOT 1 CO. RD. `Wisconsin Bepartment of lni3u ry, PRIVATE SWAGE SYSTEM County: Labor and Haman Relations INSPECTION REPORT Safety and Buildings Division ST CROIX Z_ (ATTACH TO PERMIT) Sanitary Permit No-: GEN'SRAL INFORMATION 175638 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: BOURN THOMAS ZS ~ EAU GALLE CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 008-1028-70-000 TANK INFORMATION ELEVATION DATA A9240297 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 6 Dosing Aeration Bldg. Sewer Holding St/W Inlet / TANK SETBACK INFORMATION St/ Outlet TANKTO P/L WELL BLJG. Ventto ROAD Dt Inlet / Air Intake NA Dt Bottom Septic 44 Dosing 9 > ?d" NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP f-4tFF111'II'l1-INFORMATION Final Grade Manufacturer Demand c?ae. 'lt~~ 4_1Z Model Number 71 a GPM I Loss Friction SysterryLJt~ TDH Ft TDH Lift Forcemain Length Dia. FFaii " Dist. To Well)./ SOIL ABSORPTION SYSTEM BED/TRENCH Width I Lengt ! No. Of Trenches PDI -E No. Of Pi Inside Dia. Liquid Depth DIMENSIONS 1` LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION TypeO 4# CHAMBER Mode Num er. System: /e >/O OR UNIT DISTRIBUTION SYSTEM 44tPoe1W/ M nifold /r Distribution Pipe(s) x Holel'Size,r x Hole Spaong Vent To Air Intake Length r~ Dia 2 Length 9L)c Dia. Spacing Y s ->/(:D ! SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over +r Depth Over ,I , xx Depth Of xx Seeded / Seddm- [xx Mulched Trench Center ~o Bed"1Trench Edges 1Z -I?Topsoil (~p Uj.*eS ❑ No C}-Vtrr ❑ No COMMENTS: (Include code discrepancies, persons present etc.) r? . 07~ _ C(V u" - Plan revision required? ❑ Yes 9_10 Use other side for additional information. Aan~, ~O SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: _ e e e . _ e N 0A / c7 .fe- cti'~n/ /CLt~ ~~6 t7 1 ~/-r?'1. 5 e4~ e4 iwZ~l &ye APPLICATION SANITARY PERMIT couN~ LHR In accord with ILHR 83.05, Wis. Adm. Code x S . Cro =:Z911 STATE SANITARY PERMIT # -Attach'complete plans (to the county copy only) for the system, on paper not less than / ~s 6 3 JP 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. 9A V06 Y 9 PROPERTY OWNER PROPERTY LOCATION 1-">Arn 130"RN f►'~oitY ~ kw % Sum %,S Ira T2$ , N, R 16 VC(or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # hoc_,w 13 ox 8 Z :1 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR GSM NUMBER MS14ro~%4%c. W ~ 1,54ris1 r115 235' 1116I4 1471-44{7 -0 CITY II. TYPE OF BUILDING: (Check One) ❑ State Owned ❑ VILLAGE : NEAREST ROAD : £A". tt QMN ❑ Publlc IS 1 or 2 Fam. Dwelling-#of bedrooms 3-- PARCEL TAX NUMBER (S) 1 ~b A 111. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo Voiu.Mc ~ iT„Ga zK ~G - / b.~ y~-- /O d 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 80 Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 1130 Other: Specify IV. TYPPEI OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.M 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 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 y , 5,0 RECQ/UIRED (sq. ft.) PROPOSED)(sq. ft.) (Gals/day/sq. ft.) (Min./inch) , ~7 ELEVATION 7 7 S, 6 -7 '2 raO l0 ! Feet / 63• s Feet i VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 1000 f~ T Lift Pump Tank/Si hon Chamber u ft.&CASa I ER _LOH E]_ D I El 1:1 VIII. RESPONSIBILITY STATEMENT 1, 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: ~fta L~ 93 X45 Plumber's Address (Street, City, State, Zip Code): a :L Ile. L j; 54 r! IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee ancludes Groundwater Date Issued Issuing Agent Signature (No Stamps) F%j Approved ❑ Owner Given Initial 4 w 0 gurcharge Fee) Adverse Determinatio Q ' X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety& Buildings Division, Owner, Plumber INSTRUCTIONS , r 1. A sanitary permit is valid for two (2) years. 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 sub"red 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-administrafor or the- State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ll. `Type of building being served.-Ctseck 6nry one and complete of bedrooms if 1 or2 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 investigation`s and establishment of standards. SBD-6398 (R.11/88) DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. sT 1.1)..NUTr~ q> I: APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. ` PROPERTY OWNER PROPERTY LOCATION FlA rn 130"qk-k r'loil't o sow Nw % sLa %4, S Id T'LS, N, R 16, 'X(or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Rou.-w 13ox 2 CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 1t'IEtJow►o.a►~ Lj" Is4n5l r1tS 235-46zy j-i~7Ly~{7 II. TYPE OF BUILDING: (Check one) 11 State Owned VIW4GE - NEAREST ROAD IQ OF: ❑ Public ®1 or 2 Fam. Dwelling of bedrooms 3 PARCEL TAX NUMBER(S) Ill. BUILDING USE: (If building type is public, check all that apply) i/ottir"6 `f i'AGQ Zit 10 Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 70 Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPPEI OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ITI 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 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 ~SD REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION u 7 , 3 / Feet 14 f' Feet VII. TANK CAPACITY Site in gallons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New P-xisting Gallons Tanks Concrete structed glass App' Tanks Tanks Septic Tank or Holdin Tank 000 Z- Lift Pump Tank/Si hon Chamber Vill. 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) r*W/MPIRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip,~//Code): O'w'TLc .i. c Lai .54 rl s. IX. COUNTY/DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater a e ssu Issuing Age ❑ Approved ED Owner Given initial surcharge Fee) Adverse Determin tion X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 WAYNE LORENZ Owner: PAM BOURN RR 1 RR 7 BOX 82 BOYCEVILLE WI 54725 MENOMONIE WI 54751 RE: Plan Number: S92-40689 Date Approved: August 7, 1992 Gallons Per Day: 450 Date Received: July 31, 1992 Project Name: BOURN, PAM Location: NW,SW,10,28,16W Town of EAU GALLE County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW MOUND Inquiries concerning this approval may be made by calling (608) 785-9348. Sincerely, ERARD M. SWIM Section of Private Sewage Division of Safety and Buildings PPP039/0009n/29 cc: PAM BOURN X Private Sewage Consultant sBD 6423, R. 111/911 PLc)T PLR R S B5 ~ 23 Y8" c i 351, Ya agoE GRASS Zc1d T~ I So j, PQe ~S ` m qbSOrArr~S, lP ~r. r/ e. ~I C57 0_r~ E►. = loo ~ drjj +Y~ v:aal~,r,. '1'ol D4 1x3' woo.A STAKE frj~j,7 ~nCl~P9 Of G ` St~~edo a a O Lor-fvt\ l of loon G.i~oa Fu. v TAB ~XIY(IUG 8• WE11 y. l..Jooded Els~ortiop 111.59 w ~ h ~7 ` 0PIZD PU SEA Lo CoTlw Dt IOOO Lnllou ScPT1 c. 'T RF1K 0~~ Jvl` To b. Le~wreo w\zN\.i So' ac ywcii,~o 3 Irl ~i r.H t1W pxiSnuG GaadL as ~iZr l ' rliav 1~f I, Z. ~C.Ra PR2al 14PLiEn of, 1 ~1 ~ TkKcSNola OC 6oawoe Sc¢:nc~ dm\L L u,).rc \.,u 119.94 So' x 30, GArt a ~ \A/AYE Lo~~~17 M~stS`~3y DaT> r. 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AIR IIJTAKE GRADE I ~ I `1" MIA]. 18' AIM. COU U1T I8"MIAs. `N ;=j~i~VIOE I 1 - - INLET cT--i1w D AIIGHT SEAL a. fit? I I A APPROVED JOINTS PPROVED JOINT JIr: Kerb I;x W/C.=. PIPE 0 I I I W/C.I. PIPE EXTEAJDIAJG 3' I III EXTEMD11JG 3' a M1\~~n~S ALARM OWTO SOLID SOIL .I~n~ OAITO SOLID SOIL ~~:4• q I I oN c of':r I: ' 1 ELEV.• ZO FT. 1? tZ PUMP ~ OFF D GOIJCRETE BLOCK lZ;O I f SPECIFI'CATIOUS SEPTIC DOSE TAWKS MAWLIFACTURER: MtaWesr 221 CAST QUMBER OF DOSES: ~ PER DAB TAMK SIZE: Iooco GALLOAJS DOSE VOLUME (17.47- ALARM MAAIUFACTURG.R: S. 7. cle-c-mo INCLUDING 6AGKFLOW 11,6 GALLONS MODEL IJUMBER: IOI Hw CAPACITIES: A= Z3 IAICAESOR ,5'1.-0 GALLOWS SWITCH TYPE: ~1EQG~Q`f 8=IIJCHES OR '410 GALLOWS PUMP MANUFACTURER: dV,, n,k-n C= 5..5 IUCHES OR 125-316 GALLOWS MODEL NUMBER: OS? 3.3 D=(L-IAICHESOR Ls3"L GALLONS SWITCH TYPE: MENCv. a-( IJOTE: PUMP AND ALARM ARE TO DE MINIMUM DISCHARGE RATE 23 GPM INSTALLED ON 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEAI PUMP OFF AMO DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE/. . . . . . . . . . . 2.5 FEET ~0FEET OF FORCE MAIN X F IOO FT_FRICTIOU FACTOR.. • 33 FEET TOTAL 0y3MA~MIC HEAD = IO•g.s FEET Q , ,E INTEFZNAL. DIMEIJSIONS OF TAIJK: LE`.jC~?H ~f _;WIuTFi 6 (1 ;LIQUID DEPTH 43 51GIJED:k°~.~~ G'7- LICEAJSF QUMBER: i3q DATE' 3d ~ EFFLUENT PUMPS 1 7 Features and Performance SP33 1/3 HP - MAX. SOLIDS S/8" SPHERE -1750 RPM 7iable in automatic or z' manual. • Completely submersible. 20 • Non-clog bronze impeller. • No suction screens to clean. 16 • Oil-filled, double ball bearing motor with built-in overload protection. = 1= Reliable diaphragm switch with j piggyback plug-in. • Rugged cast iron construction. 6 ' Completely field serviceable. AMPS AT K 11Sy • 1 1/2" NPT discharge. 4 6S AT 7]U/, S! LLI _ 0 F-T + 1 -1 1 1 H1 10 20 30 40 50 00 U.S. GALLONS PER MINUTE SPD50H/SPD 1 OOH 1/2 and 1 HP- MAX. SOLIDS 314" SPHERE-34s0 RPM SIN • Available in manual or automatic. • Dual seals standard. Seal 50 AT 1. failure sensor capability 2W. 7M FIAX available (to be wired to an Al alarm device) on manual pumps. • Open two-vane sewage type 30 &4, impeller. Pump shaft and all fasteners are stainless steel. • 1/2 HP (SPD50H) and 1 BP (SPD 100H) motors. Ball bearing construction and oil-filled. ° 0 x b W a 1W iM IN 140 2" NPT discharge (3" flange U.S. GALLONS FIER MINM optional). SKHD 150 144 HP-MAX. SOLIDS 3/4"SPHERE-3450 RPM "Semi-open thermoplastic ~ Impeller. W 120 1 1/2 HP, oll-filled motor. • Pump shaft and all fasteners are ,o M N~ stainless steel. 1-1 At 1 1 1/2" NPT discharge. Spring loaded mechanical seal 40 Arn rar. ~.u with carbon and ceramic faces. • Pump-out vanes on rear shroud 0O 10 m 30 TO of Impeller. • Dual seals. Seal failure sensor US. GALLONS PER MINUTE capability available (to be wired to an alarm device). ST. CROIX COUNTY ftWISCONSIN Y a . All ZONING OFFICE " y 4 S ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 - (715) 386-4680 it July 20, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Molly Olson property, located in the NW 1/4 of the SW 1/4, Sec. 10, T28N-R16W, Town of Eau Galle, St. Croix County. This onsite revealed suitable soils at a depth of 27" requiring 12" of sand fill beneath the mound. Should you have any questions, please feel free to contact this office. Sincerely, ~ aW ~w1V\ James K. Thompson Assistant Zoning Administrator js c .2 -D N A 40 0 0 o N o° O O z Z Z Lo " p1 ^ Jt, c en ~ Ln -I 0 co r- R ilJ 1 2 ` d C CL U16. O C :74 1 Q ~0 a 1D L >v c I > , ra 2 0. le z .64y g 2II 10 m.4 ~ X111 a CL q E ` C C 0 a~ CC a Y (n t l.n CL U. CL r a ~ N N~ o~ N Vi N ~ o d d z co d C N q c ° O H N S a .N c 3 Q co t c p f d O 6" 0 > G. 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C ro o m q w• v C4 O ~ Q) 4W w v 5~A c 40 s w -rn Z rtS o o !n 0 60 N 41 E E .1 O 3- £ ~o O N nq 7' d O o-I SFr 3 W ~ T° LLJ V) c o 0, vi N N v V, m O ~ a o a` ~ J >1 or IL 7 - end C, a) 0 1 a w to 0 3 I uii U) ej o O o 3 u :3 N O ~ ~ o tl' L>' .o I / rn 3 to p o u I I IV, ~v► Q J a ?J00 v a ~V 7 C~ V Q ~o 0 O v o M u. 111 C M ~~0 o v) cN 110 v~ x a cc r,() m a Z 01 O d a" C t` a _O y v r ar N m C u`0 z az`+ J d 7- A u- o o o 0 T~ TI ~ K r `v ~08'El7S MhEO~ND 5 v 41 a Zv~JZ4bd 'Z, g ~o a rvn 1v~ 1S!Z ah (nom a: 2 l`d N U 0 40 -0 d 7. NLn ~kd 0 2 Vl ~ a o goo UA- t / a a d J ~ ~ h a" a 1:2 of 4: 0 Ln L . _ T - P4 L iL ryi E-i N N tv 1S a ~ o a o a a . _41 0 .0 .0 .0 i ~P (44 9 S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER.. j9~ 4 d p7n 3a)-rn ADDRESS O T H 66 FIRE NUMBER CITY/STATE- (AhOA01' lie, zip PROPERTY LOCAThON : .~IW 1/4 , S W 1/4 , SECTION /O , T-4- N-RO_W TOWN OF LaAx t~sci,I I P- , St. Croix County, SUBDIVISION L{ !I (!4 9 7 , LOT NUMBER_,L_. 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: 't'(`~m DATE: 1 a7 96L 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 a second form should be retained and completed when the property` is sold and submitted to this office with the appropriate deed recording. Owner of property ~crv, 49,3 Location of property-&Ll/4 5kJ 1/4, Section /0 T,22LN-R_& W Township Fa,, 6al e, Mailing address I O 60-G 705 Address of site T_ (3~ j Subdivision name -Z-{ 1 "t"7 / Lot no. Other homes on property? yesV_No Previous owner of property O ~ 501'1 Total size of parcel q . ~;(oi CY.~eS Date parcel-was created __~__h (c Are all corners and lot lines identifiable? ✓ Yes No Is this property being developed for (spec house)? Yes ✓No Volume and Page Number o~J 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. Kyzno , 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. Signature of applicant Co-applica t /J7 _A7 Z 7 Al Date of Sig ature Date of Signature 'WIT v7 Y ~•t? y 54 a i:~ r N x,t qX)CVMEPFT NO. Wl Q'Aei _ 1b11X !D.............................. M ........oll Oiso>a. t/ic/a -d- Paaela Jean...--- DEC ~Itlt'elaian to T}t"as GeOr • eoulcnn an S~._... Bourn, husbaa and wife w. e ti- the folluwilW described real estate III -_....-.S s__ C S?,~X.. RcTu11m TO State of W isee"in : E Tax Parcel No: Part of the Northwest Quarter of the Southwest Rtuaeieht North (NWk of SW%) of section Ten (10), Township y- 9 (T29N), Range Sixteen West (R16W), Town of Eau Gallo, St. Croix County, Wisconsin, more particularly described as Lot On* (1) of Certified Survey !taps filed the 6th day of Decetwbe~ 1991, in Volume of Certified Survey maps, at Page office of the A0-91a-tor of.Deeds, St. Croix County, Wisconsin. E This is-. 0.9t_.. homestead property. r (1@ (is not) day of N[,;"- c 14..9i . Dated this • ~"1.1 ~1-// ~ - .(SEAL r3 (SEAL) * c~ - . ) . Molly 0 on ; (SEAL) (SEAL,) AUTHENTICATION ACKNOW LEDoMENT STATE OF WISCONSIN - ' Signature(s) - - - ss. - St. Croix f ount,• authenticated this - day of.:..---. - - . 19....- Persunally came before me this .day of 19,91 abm, ed Y l - a Mol,-..- %toll Olson, f/ ~u y TITLE: MEMBER STATE. BAR OF WISCONSIN t w ( If not. a ~ AAA :Ah V,t authorized by : 706.06, Wis. State.) to me known to be the Person t►n` forezuivir iruttrunlent and acknowledge • - 'r.;G INSTRUMENT WAS DRAFTED BY ` - _ _ Thomas A. McCormack ^ f~1tt !t~ 1`rr~tc~`. i 1 }i Baldwin, WI 54002 Nota! , ruhlic ~si'_ f~,n. t ,ti,c~►' Ni • G,Ill t~ssion is rermanent.4If not, state lit4! 1 ($tgnattires may tm aut'•entiE•ated or acknna•!t•dred, Roth - ? are not rune-nary-) date: 1 nee, ~'ad'-..'•---~.. Lsu .~~.s...*.~, _ ~s~:.._.. -r _ r ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 TTTTTT (715) 386-4680 July 20, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Molly Olson property, located in the NW 1/4 of the SW 1/4, Sec. 10, T28N-R16W, Town of Eau Galle, St. Croix County. This onsite revealed suitable soils at a depth of 27" requiring 12" of sand fill beneath the mound. Should you have any questions, please feel free to contact this office. Sincerely, James K. Thompson Assistant Zoning Administrator js ~N T c ,9 d 12 rN o 0 r- O N co - - v C> 0 CL C m p p co r~ - (D C: 4 A wci-o el- N V cc 0 cx: 2 ' D L ~0' a co V Co _ 4 0 0 a" n C t ~z 4-0 Ems' ~LL 3 ? c s~' d o~ CL ~O t/9 a U- m G r r~ N V/ LL o cu,lIl ~ VJJr to o m 2 m N a J 3 y : fa Vf d o 'O vJ O J Q Q E o x 2 W Q m 3 A (13 c oc a rnA E3 G q- ~ w j a Z rn a N rd W~ vo, f- N Ml N /I - to 0 o Vf c E 1J E 0 V ~C £ ~11 1~ d OBI"~ ~~-r 3 W T kA v a ~~51 O w v N V'1 ' U4 Z _ Q J O U/ v+17 r r L LA W o y 0 o r - ~ IL :3 oo on X C-4, 00 IL 0 ~ V r :t w a~ o - to O Z 0 r j 3 $ 41 N 2 r co ~~N ~ W aJ, J A 0 r A 01 1 tf) O W .1i U. 111 y - /r1 /n -0 -n M 4- 2 N N W +J 3 0 r r r 0 N ~r a Ew ('7 09 -~g c J L E O V' o y O 1 ? I~ 7 T ~a c LE N fY1 M E a~ O N7 d d n N- 7r ri K o N v O z E Y- N 0 N N r "o 0 z J a o c " cn -C 5: 7, a ° ° la = N a 0 11 13 r c J C ~ F J 0 co a Q ° 00- C31 o O q Z ~ I SoN3 m to m r- Z a2S O O c N N C t r a _ Yo c Q BOO 0 _m c v,d~ 1D eo r > R 0. 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V) p Y H o to -C ELE +1 W :3 4, tL C-0 '0 N~ O z J a o c rn c M 'n O to • O O O O r= l N 1"' V/ t Vic' c 41 r /1 N Q O I. r J c 4.1 TI I Jx ~o8'~hS M~~~o~hooo s a ~ Zc~z~bd ~~a E1 2 • t, ~o ~ cvr~ -lV1 1s~ZV~c~,~ ~ ~ a o 07 n 4 (D V v r 2 So Ul 0 N 4 Vl z ° o [J W / I- - Ln/Jf "moo Q U a, Pv- ~ J ~cn / p ~ N ~o C 4 3 g o U 41 is - N o Q cn LA a a V y o a, M H _ ar~ .21 ~ o a Q 41 " o~ X 44 w D ~ Q ~ d 41 to _ C t1J IV, .0 if J 9 '0 ~d I r 47619 7 CERTIFIED SURVEY MAP MOLLY OLSON Part of the Northwest 1/4 of the Southwest 1/4 of Section 10, Township ?8 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin. OIndicates 1" x 24" iron pipe weighing 1.13 lbs./lin. ft. set. -.E- Indicates fence. Dated: July ?1, 1991 Owner's Address: 474 C.T.H. "88" Revised: Sept. 1?, 1991 Woodville, WI 540?8 Phone- 1-715-684-3714 U _ N P L A _ T T E D _ . L A N D S . The wetlands shown on E L/NENW//4 sw//4 this map are protected ,p MOVED by the Wisconsin Oept. $ 00. 04' 03 "W 393, 90' A of Natural Resourses and St. F 1,991 Croix County 5 + Regulations. Any v I c r7i!FFi+1E?i~'~r'' alteration of the W 4 / / wetlands without prior approval w I Q will be a violation a k b v of the wetlands. a k ti U. es p d J/ I Q \ W h W 0 3 I 8 • N/ ~ m I V ~ N b Q „ 2 H b b b♦ M 0 ZI b 4 / O b N ~I W O -j W J o n t O °j ° Co Q O $ y m yl o y M ~I JI Z o R Q C N 2 N 00 • 34 03 "E 434.00' 2I O i This instrument drafted by w c o° Qj Laurence W. Murphy ^ p % to O b W O q ~I b Z 2 ALL BEARINGS REF. TO THE WEST L/NE OF THE o i., VI C SW 114 OF SEC. /0, T 29 N, R /6 W, A S SLIMED Z k3 b q b Z= N 00. 00' 00.1 E N O O m~ iu C 3 ~I N O W to b h t ~ ~ d W 3 a Q v x h h w = h • v h Q 0 0.0, 23' 00.00'00"W i 66.21' i 434.09 r - 2/29. e / r `LAUl1EN 62 ' " ~ : cc • _ m W UR N 00.00'00£ 2646.10- V1 7 3 W LINE SW I14 ~ N RFALLS 44 • i J • UNPLATTED LANDS isc. Q % 66 C. T. H. "BB " GANG 9 !Zac,,e I'll c9 3=rtified Survey Maps nn Laurence W. Murphy St. Croix County, Wisconsin s ~~~~,M O Registered Land Surveyor g1 DES ~ 60 9 pots 0 O1 Deals SHEET / OF2 w 476497 CERTIFIED SURVEY MAP MOLLY OLSON Part of the Northwest 1/4 of the Southwest 114 of Sect n 10, Township 78 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin OIndicates 1" x 24" iron pipe weighing 1.13 lbs./l in. t, :23L Indicates Fence. Dated: July ?1, 1991 Owner's Address: 47 C.T.H. "98" Revised: Sept. 12, 1991. Woxfvill~, WT 7/10"78 Ph e- 1-71.5-681-3714 UNPLA TIED LANDS LINE NW 114 SW 114 The wetlands shown on this map are protected by the Wisconsin Dept. f, S 00. 04' 03 "w 593, 80' of Natural Resourses and St. ° W Croix County Regulations. Any u / i I o+; alteration of the CC m a i' QI wetlands without a, °a a ~I prior approval r - i I Q w will be a violation N k of the wetlands. kL W 1 to v Wciya 3 H y, Q Q: Q) W y aI . 8 03 (1 0 U m o OI x LU ee QV a o O M 2 aC O / 4r b , to l a\ / 2 O O N" ^I O 7 in 0 Q 4 J w / o f a , 0 O •o ~ 2 vl a O W o - O Imo.. ^ Z o Q C ~ N o N 00 • 34 05 'E 434.00' ~ v 1 g n This instrume drafted by W 0 3 o° OI Laurence W. M -ii phy " b O ~ 3 o W o ~ v 2 2 ^ QI ALL SEA I GS REF. TC rHE WEST LINE Of 7NE O n, X ` vl C SW 114 0 EC. l0, 7 28 N, R 16 W, A S SLIMED i~ ~3 b 0 m b O 22: N 00. 00' "E N H ~O to 0 0 !u on 3 WI N 03 y to in W 7 c u t. W 3 N M Q u 2 • N ^ o ~ = h _ m ~ ~ ,,~11111111//I u ' J \gCONS . 23' M S 00.00'00"W h u `66.21' 3 ` 4 5 4 . 08 . c- - 2 12 5 . 8 / ' LAUREN 6 Z m W UR °C N 00.00' 00"E 2646.10' 17 3 y r • • WLINE SW 114 N RvFALLS,.' UNPL A T TED LANDS •Q 66 C. T. H. "BB " 0 LAND S~,•`~~ Vol. '44114 4 9 Page 2425 ~ Certified Survey Map: Laurence W. Murphy St. Croix County, Wisconsin Registered Land Surveyor f""O 6 ~gc,1► 10 D s 0'~~NN 9 FPM I SHEET / OF2 ti