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HomeMy WebLinkAbout016-1062-50-001 ti O Q> O 3 I O . Q M ~ C I p Y 0 d N E rn L U It °Or o ~n O :a O 0 ~ ~ a I Q_ T N N ~ I O c O Z a~ E 7 (S1 O U. N 0) _ .E X C p C V E Q U O L) ~ M v (D E N O z ~ ~ y I am N ~ Z I O 2 a a~i 2 d' c I ~ I a~ I c (D M~ -O 00 •FV L m N C Q w O O Q Q N O Z Z Z O m ~ m N O R 1~ N M M 0 0 a ° L L U N N N E' o F• F- H $ 3 3 a U S: 3000 a c9 I (y O N M N Oi > }~}i~~y Vl J U ~ rn O `l > T 7- (D y 0 1 Q O N O ~ E N O O 7 W ~ 0 m~ N N a N 7 w 0 O 0 c m N c °0 3 E o 0 c E cD rn r' o a c E c ti O L. O EO = o) N W O O N O . N L Cl (D cD (D Ln m O E cy O Y I\ .O e- • yr,~' O N J O N Z !A O cK E y I =#6 a as r~• ea a m '2 d `i1 y E m c c 2 C U n. 2 0 lA 0 - AS BUILT SANITARY SYSTEM REPORT OWNER A4 /f /y ~14, enna TOWNSHIP ~Le~v~omd SECTION,2 f T ?QN-R-/,-',5- W ADDRESS UD ST. CROIX COUNTY, WISCONSIN p/11 Gr~ d od G ZJ k/ , r .01 SUBDIVISION LOT LOT SIZE l1~L~ PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ;7'ga slope 3 ~RNI ~a use f°~ CbM~ DRiv'~ SAY INDICATE NORTH ARROW BENCHMARK: Elevation and description: ~~p07~~`6/Y1D/" s/cam/iYo Alternate benchmark / SEPTIC TANK: Manufacturer: / Liquid Cap. Rings used:'q Manhole cover elev:y6s' Final grade e'lev: !b / Tank inlet elev.: VI Z' _Tank outlet elev.: No. of feet from nearest road:Front__)L, Side , Rear Ft. l From nearest,prop. line:FrontX, Side , Rear Ft. / No. of feet from: Well ~d ~Building: (Include this information in the above plot plan) R~CE~VE (2 reference dimensions to septic tank) SEE REVERSE SIDE SEP 2 8 f132 N ST CrifJih AUNTY c-~ ZOI'` ING OFFICE 4~ r PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model:SVIAO Pump/Siphon Manufact. : dR~~~ pump Size A Elevation of inlet: -''"---;"Bottom of tank elevation Pump on elev.: &Pump off elev.:1742Gallons/cycle: 14 1a Alarm: Man.: s✓,Flc°tf-fRe Switch Type: /?WMekWyLocation,,64-6-"e/%/le4~ Distance from nearest prop. line: Front-, Side-, Rear_Ft.-.Zj~v Distance from: Well / Building g~ SOIL ABSORPTION SYSTEM Bed: Trench: ` Seepage Pit: Width: Length Number of Lines: Area Built Exist. Grade Elev. L2 S, Proposed Final Grade Elev. ) Fill depth to top of pipe: No. feet from nearest prop. line:Front_x_, Side , Rear Ft.l No. feet from well: No. feet from building HOLDING TANK Manufd~ r: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop ne:Front Rear -Ft. No. feet from: Wel building nearest road Alarm Manufacturer: INSPECTOR' TZ'2 lzf DATE : PLUMBER ON JOB: LICENSE NUMBER: 6/90:cj `WiConrrsi~BepartrreLfofinruOD 29.30.15.435 NW SW 135TH AVE. County: ry, Labor and Human Relations PRIVOE f EWAGE SYSTEM 'Safety arzA Buildings Division INSPECTION REPORT ST. CROIX (ATTACH TO PERMIT) Sanitary Permit No.: GJEWRAL INFORMATION 175670 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: LUEPKE SHERMAN & KATHLEEN GLENWOOD CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 016-1062-50-000 TANK INFORMATION ELEVATION DATA A9200330 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 57 Benchmark r r% Dosing Aeration Bldg. Sewer ( Holding St /inlet TANK SETBACK INFORMATION c+ 1`k Go4et - - - TANK TO P/ L WELL BLDG. Ventto ROAD nt4ff:eT Air Intake Septic >f J ?/d+ / NA Dt Bottom Z' , Dosing y1/10 ` NA /Man. D , 9 NA Dist. Pipe Aera-t-ion Holding Bot. System 3.31 r~7 PUMP/ SIPHON INFORMATION Final Grade - Manufacturer Demand 9~ S~ Model Number ZSA GPM TDH LiftT~. Friction System , TDH Ft oss Forcemain Length FS Dia. Hc~ Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM anifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length i A- Dia. _A~ Length 9c~ ! Dia. Spacing ~ f 1 cSd SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of , xx Seeded/ Seeded- xx Mulched 4W/ Trench Center if -Beds/Trench Edges Topsoil ~p es ❑ No E] No COMMENT (Include code discrepancies, persons present, etc.) C (C; tli~k~ r _ 4) C/ Ric, ~v4F 1E 1 cJ KN6 Plan revision required? ❑ ,YUse other side for additional information. I A A SBD-6710 (R 05/91) 6Dt~e~ Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i i } :.E[31LHR SANITARY PERMIT APPLICATION couNTY In accord with ILHR 83.05, Wis. Adm. Code , e,.,.. s.,...., STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ / 8'% z x 11 inches in size. c ec If vision prey ous application -See reverse side for instructions for completing this application. STATE PLAN I.D. N MBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. A- PROPERTY OWNER PROPERTY LOCATION 4i Y4 Y4, S v2 9 T , N, R / $Xor) W PROPERTY OWNER'S MAILING ADDRESS' LOT # BLOCK # .2 v . 7* V e-, CITY, STATE ZIP CODE PHONE:NUMBER SUBDIVISION NAME OR CSM NUMBER it o,-a/ C, G/ 5'G~~ b vl /a 1:3 ITY II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLAGE NEAREST ROAD 2 5d =W : eN ❑ Public ®1 or 2 Fam. Dwelling- # of bedrooms PARCEL AX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo b 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 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. [Z 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 0 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 Q 3 7 /i vZ k Z ©_!rFeet 8 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App -Tanks Tanks structed Septic Tank or Holdin Tank /OTiT A Lift Pump Tank/Si hon Chamber Q Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No amps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): C «,e A, o O of o IX. COUNTY/DEPART T USE ONLY ❑ Disapproved S--La iitary Permit Fee (Includes Groundwater a e ssue Issui Agent Signet Stamps) Approved El Owner Given Initial Surcharge Fee) 11.4 o 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 by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ll. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix. (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains.'water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if v required by the county; E) soil test data on a 115 form; and F) all sizing information. - - - - - - - - - - - - - - - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are.,used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) _ I i I I I ,I - 1 i r - - - Sr 7 j~- - I a - - ' 1 ' - - - - - ~ s-log - - -'4,e ' 1 I - i -I Yl► j- - - - _ G _ /Vt - - - - 1~- - - -i- F - w - - - - - - Ili. 0 -1 31- . - Z - a- - - ILP I I I ~ I I ~ I I ~ I I I~ I I i F I I I I. I r - _ -1- r L _ C - - - } I i I i r F T-- I I ~ I i l i 1 -I- - I- _ 1 , I , I I I - I I I I - - i - - - - - --I - _ - - - - l--I- --L-~-- - I I - ---I - - - I. - - -A- r r I. I , ~ I I I I I ov Lif - - - - -I- - - - - - -I i' I-- - tell i Rs - -I - - - - f r Page L Of 4O 7'.j Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand Topsoil _ F J p E % Slope Plowed Bed Of 2~- 2 %2 Force Main From Pump Layer Aggregate D • E ~ Cross Section of A Mound System Using , F A Bed For The Absorption Area G -h_ A~Ft. H L Signed: g Ft. License Number; q0 I Ft. Ft. 47 -7 W-WW K Ft. L//Ft. nditionally W;ZW~ Ft. IF tr, LABOR HUMA 70bservation Pipe-~ / ON F SAFETY N RELATIONS _ K SE C A --rce Main I. From Pump Distribution Bed Of 2 - 2 2 Pipe Aggregate 1 Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area ~ ~~>~ti~ ~~~~»~1t~a K~~ .,a ~r r i _*r• Page'Z Of y Perforated Pipe Detail 0 End Vievt )Perforated End Cop t PVC Pipe Holes Located On Bottom, Are Equally Spaced pv~. Q/ E djtwao Con 4 a goo P A . Distribution J Pipe Lass Hole Should Be" Next To End Cop End Cop Distribution Pipe Layout f 0-7 Ft. R S _ X Inches Y Inches Signed: Hole Diameter Inch 2- Lateral Inch(es) License Number: Manifold Inches Date: Force Main_ Inches # of holes/pipe Invert Elevation of Laterals/oZi7?Ft. -116- TA o:) (13087 aftftaft 9A ' + ww%• -waft : PAGE OF PUMP CHAMBER CROSS SECTION AUD SPECIFICATIONS ' VENT CAP 4"C.I. VENT PIPE " WEATHER PROOF APPROVED LOCKING 25' FROM DOOR, JUNCTION BOX MANHOLE COVER ~ WINDOW OR FRESH I2"MIU. AIR INTAKE I I GRADE 1 yu MIN. ~ _ 18" M I IJ. COI~fDUtT 18"MIAI. \ 'll INLET r-T rvA AIRTIGHTSEAL I III I I APPROVED JOINT A Cprti~.itlOnajjy I III APPROVED JOINT W/C.I. PIPE I III W/C.I. PIPE EXTENDING 3' I II ALARM EXTENDING 3'. ONTO SOLID SOIL V 1 Emm, 1) ONTO SOLID SOI1 I I I g pR O"S P R~~ t A UMAM H g pINO$ p~ptiE?R`l SAFm WD ow C I I . I I N OF CC~~ QQQQ I ELEV.L~t.tild FT. OIVtIS10 tr, P . w_?tiv PUMP-1 OFF D SEE CO CONCRETE bLOCK RISER EXIT PERMITTED GNL4 IF TANK MAMUFACTURER HAS SUCH APPROVAL SEPTIC e 5PEGIFICATI0KJ§ DOSE r TANKS MANUFACTURER: IkIUMBER OF DOSES: _PER DAy TANK 51ZE: GALLONS DOSE VOLUME ALARM MANUFACTURER: sT jFL egf;" o INCLUDIAIG BACKFLOW: GALL On1S MODEL NUMBER: Ge> COACITIES: A= ?_2'L INCRES OR ~ GALLOWS SWITCH TYPE: ~l C gi B= INCHES OR GALLONS PUMP MANUFACTURER: ZdeLL,eR C=INCHES OR GALLOUS MODEL NUMBER: 7 D=. INCHES OR -a1 r! GALLONS SWITCH TYPE: SJ ~L~G~fiYt~ ~J~~F~ Nq~YE: PUMP A►JD ALARM ARE TO BE MINIMUM DISCHARGE RATE ~P GpM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MI?NIIMUM NETWORK SUPPLY PRESSURE 2.5 FEET + __7ff_ FEET OF FORCE MAIN X Y--~F/opFT.FRICTION FAC'rGte._Zz_0_7 FEET TOTAL 09MAMIC. HEAD A_ZA_f_ZFEET INTERNAL DIMEMSIONS OF TANK: LENGTH *,WIDTH LIQUID DIrOT`H SIGNED: LICENSE IIJUMBER:` iMlzo fe DATE: o2 L ~ N w + r h spa . ~ v 4Y. 7% s'A W ~ F- W O TOTAL ETERS DYNAMIC HEAD FEET/ 0 4 LL HEAD CAPACITY CURVE M MODEL137-139 CAPACITYGALLONS/LITERS 0 0 30' CAPACITY HEAD UNITS/MIN 0 0 0 1',i•11'n FEET METERS ]GA LTRS NPT ET 8 S 5 °ha 25' 1 . 52 394 10 3.05 300 O - . 15 4.57 242 20' 20 6.10 136 1 46 25 7.62 7 92 0 30 Z 26 I 0 15' 0 H 4 to,- o' i 2 12% i Rod U.S. 10 20 30 40 50 60 70 80 90 100 J110 GALLONS 4 LITERSI 80 160 240 320 400 0 FLOW PER MINUTE' CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 200/208V or 230V. • Mercury float switches are available for controlling single • Electrical alternators, for duplex systems, are available and and three phase systems. supplied with an alarm. • Double piggyback mercury float switches are available for • Mechanical alternators, for duplex systems, are available variable level long cycle controls. with or without alarm switches. a Long cords are available in lengths of 15-25-35-50 feet. • Combination starters are available. • Over 130° F. (54°C.) special quotation required. Standard All Models - Weight 47 lbs. 1/2 H.P. SELECTION GUIDE SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. 137/139 Series Control Selection 2. Single piggyback mercury float switch or double piggyback mercury float Model Volts-Ph Mode Amps Simplex Duplex switch. Refer to FM0447. b - 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075. ' 10.4 1 m 1 & B M137/139 116 f 1 Auto N137/139 115 1 Non 10.4 2 or 2 & 7 3 or 5 & 6 4. Combination Starter. Refer to FM0514. 5. See FM0712 for Correct model of Electrical Alternator "E-Pak". 137139 230 1 Auto 5.2 1 or 1& 8 E1371139 230 1 Non 5.2 2 or 2 & 7 3 or 5 & 8 6. Mercury sensor float switch 10-0225 used as a control activator, specify H137/139 200-208 1 Auto 8.2 1&8 - duplex (3) Or (4) float system. '1137/139 200-208 1 Non 8.2 2&7 3 or 5 & 6 7. Four (4) hole "J-Pak", junction box, for water tight connection or wired-in 'J137/139 200-208 3 Non 2.2 2&4 3 & 4 or 5 & 6 simplex or 2 pump operation, 10-0002. •F137/139 230 3 Non 3.0 2&4 3 & 4 or 5&6 g. Two (2) hole "J-Pak", for Watertight connection or splice, 10-0003. .G137/139 460 3 Non 1.5 2& 4 3& 4 or 5& 6 No molded plug Three phase units require a control switch to operate an external magnetic or combination CAUTION starter. All Installation of controls, protection devices and wiring should be done by a qualified For information on additional Zoeller products refer to catalog on Combination starter, licensed electrician. All electrical and safety codes should be followed Including the FM0514; Piggyback Mercury Float Switches, FM0477; Electrical Alternator, FM0486; most recent National Electric Code (NEC) and the Occupational Safety and HeallhAct Mechanical Alternator, FM0495; Alarm Package, FM0513; and Sump/Sewage Basins, (OSHA). FMO487. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Manufacturers of . L. Louisville, KY 40256-0347 © O`1 ZA9, SHIP 10: 3280 Old Millers Lane Z` Louisville, KY 40216 `QUAL/TY 1444P6 ~NCE ~~,~,9 J (502) 778 2731 • FAX (502) 774-3624 - SOIL A l TION REPORT D I L H R i rd with I!,W 83. Adm. Code - ~ COUNTY Attach complete site plan on paper not less th n 1/2 x 1jir5kv. Irt/ Pla t include, but not limited to vertical and horizontal roforence poi t~dIrea oof s scale or PARCEL I.D. # dimensionod, north arrow, and location and di kp o C t ro v ~~6•---~Q ~ APPLICANT INFORMATION-PLEASE PR LL4t(iMAN REVIEWED BY DATE PROPERTY CWNER OPERTY LOCATION C° M'* Al a Q, GOVT. LOT k/ 1/4 S1,/ 1/4,S,19 T 3v+ N.R / ~r) W PROPERTY OWNER'S MAILING ADDRESS LOT >Y IBLOCK# ISUBD.NAMEORCSMS CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE CTOWN NEAREST ROAD e~vwood 1` lv 0/3 (71-02X_6-- ~11 N woo /~S 7`// ~tv~ (J New Construction Use ()(J Residential / Number of bedrooms Replacement ( ] Public or commercial describe Code derived daily flow ~D gpd Recommended design loading rate _,__2 bed, gpd/f12 . 3 trench, gpd/ft2 Absorption area required SO bed, 112 CEO trench, ft2 Maximum design loading rate _,_2~bed. gpd/tt2Ty trench, gpd/ft2 Recommended infiltration surface elevation(s) /D 7 e--3- 1t (as referred to site plan benchmark) Additional design / site considerations 2 d F 4 4'j "Ve 0e, Z 'W 41 Parent material 6tLA Q iA J, /_/L G Flood plain elevation, if applicable ft S =Suitable for system CONVENTIONAL MOUND WGROUNDPRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK T U = Unsuitable fors stem ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U C] S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourtary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trend Ground / O GI s Gr elev. - ' ' Depth to f limiting factor Remark's Boring # _ p i ~'%1vY!~N•i }?C e ;2 5,4t Al 1Y _V d ~iL Ground elev. Depth to - - limiting factor - I Remarks: CST Name:-Please Print 49 j if 7 Phone: 74 Address: 1 ;2 Signature: Date: CST Number: au~~, utJ~.~~~r~iVit tttt'Vt~t Boring # Horizon Depth Dominant Color Mottles Structure GPO/ in. Munsell Texture Consistence E3arrfary Roots Du. Sz. Cont. Color Gr. Sz. Sh. Trend / S~ ,L ,2 S6/s ~r ~w v Ground elev. Depth to limiting tact Remarks: Boring # Ground elev. h. Depth to limiting factor Remarks: Boring # Ground elev. fl. Depth to limiting factor Remarks: Boring # z Ground elev. ft. Depth to limiting 1 factor r- Remarks: I I ' - - i I ' i ' ~ 14 I- I I I tY. 49 I I I I l ~ I~ I~ i ~ I f i 1 4-1 I V I I I I I I ( I I I 1 i I ~ ~ ! I I i ~~-I-- ~ I 1 I I I I ~ I I I j ` I ~ I I I I I i I ~ ~ I I 11 I I~ I I I I! I I I 1 Ii I I 1-4 - - 1 , i , i j I i i i I _ I N SEPTIC TANK MAINTENANCE AGREEMENT rt St. Croix County ~ OWNSRAMPR N 4 n 0 ROUTE/BOX NUMBER~Z'F' Fire Number 0 d CITY/ STATE ` 'elv 4. 'c o" a/ 4ZIP O 13 rt M PROPERTY LOCATION:Section, 9 T;,?O-N, RAW, St. Croix County, Town of 0Z Subdivision Lot number. Improper use and maintenance of your septic system could result in its premature failure to handle wastes.- Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed 's'eptic tank pumper. What you put into the system can a ect t e .unct on o, the septic tank as a treat- ment-stage in the waste disposal system. St. Croix County residents-may be eligible to recieve 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 'sys~'ems agree to keep their system properly maintained. The property owner agrees to. submit to St. Croix County Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or..a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and •(2)•after inspection and pumping (if nec- essary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. y 0 I/WE, the undersigned have read the above requirements and agree 0 to maintain the private sewage disposal system in accordance with the standards set forth, herein, as.set by the Wisconsin Depart- a' ment of Natural Resources. Certification form must be completed a and returned to the St. Croix County Zoning Office within 3 days of the three year expiration date. R\ SIGNED DATE 0 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 386-4680 Sign, date and return to the above address. STC-100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the 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 6 (e,4/V p~ Location of property_y6v 1/4 54,) 1/4, Section a2 T, 0 N-R W Township ~~~N W®a o/ Mailing address Address of site Si4 M e subdivision name Lot no. Other homes on property? yes 2 No Previous owner of property Total size of parcel ~O /fede- Date parcel was created Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes -X_No Volume an of Deed,~ d Page Number as recorded. with the Register 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 cer addition tifi ed 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. 2 ye /S-- , and that I own the proposed site for'the sewage disposal (we) Presently s obtai system or I ned w a e an easement to ( ) the , run the above described property, for construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No . y/_,2Signature of applicant Co-appl cant Date of Signature Date of Signature . I, DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RgasRVSD IOR RSCOaDINO DATA i WARRANTY DEED 424015 BOOK 773 ~A E 588 This Deed, made between a l t e r J. Cas s e 11 i u s and REGISTERS OFFlCE Iti.1Ilan. -.C"S.eIli us.....husband_.aad.. wi fe I,_ aa.40i at ST. CROIX CO., WIS. Texan.ts...- 77n- --.-----.---.----.---_--.---.-----.---R«'d, .....1br Rsoord 06 2nd Grantor, day Of ril and.---She.rman.-L_.._Luepke._.an_d_.KathIee a.. M._ Luep.ke.,..__ __A2r-ilA.D. 1987 Husband. and_wi.fe__.as .suryivorship marital propE~rty. 11:00 A AL Grantee, Witnesseth, That the said Grantor, for a valuable consideration conveys to Grantee the following described real estate in S t , Cr0 i x R`T"R" TO Rivard Law Office County, State of Wisconsin : P.O. Box 9 West Half (W J) of the Southeast Quarter (SEI) Glenwood City, WI of the Northwest Quarter (NWJ) and the Northwest 54013 ,Quarter (NWJ) of the Southwest Quarter (SWJ) and Tax Parcel No: the West Half (W J) of the Southeast Quarter (SEE) of the Southwest Quarter (SWV of Section 29 Township 30 North, Range 15 West, subject to easements of record. A triangular pied in the Southwest corner of the Northeast Quarter (NEI) of the Southwest Quarter (SWJ) of Section 29, Township 30 North, Range 15 West, described as follows: Commencing at the Southwest corner of said North east Quarter (NEI) of Southwest Quarter (SWJ); thence North 18 feet; thence Southwesterly to a point on the South line of said Northeast Quarter (NEI; of Southwest Quarter (SWJ) 18 feet East of Southwest corner of said North east Quarter (NE}) of South West Quarter (SWI); thence 18 feet Westerly to point of beginning. This Deed is given in satisfaction of a land contract of April 29, 1974, Recorded May 14, 1974, in Volume 511, Page 57, as Document No. 321857. This 1s A)Q__ homestead property. {at►) (ia not) T ■ ,a •SFU Together with all and singular the hereditaments and appurtenances thereunto belonging; ( O And.. _ Mr warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except subject to easements and rights-of-way of record. and will warrant and defend the same. n^ Dated this day of J/ Y G ~7 (SEAL) (SEAL) Walter J. Cassellius J . ice'.`-. l✓._ `t.I~.QCf~~:: :.c v (SEAL) _ ..(SEAL) . Lillian Cassellius AUTHENTICATION ACKNOWLEDGMENT Signature(s) ..Walter -J. Cassellius STATE OF WISCONSIN 1,.~__ .Lillian -Cassellius sa - ..............y---- - County. auth Ica this~da o ___._C~ I 1 Personall came before me this ................day of . - - , 19 the above named antis X. Rivard - . TIT4$- MEMBER STATE BAP. Or WISCONSIN authorized by a 706.06, Wis. Stata.) to me :mown to be the person who executed the THIS INSTRUMENT WAS GRAFTED BY foregoing instrument and acknowledge the same. Francs-_-X-^R-i.vard .Glenwood City, WI 54013 ' Notary Public ittnatures may be authenticated or acknowledged. Both Mr Commission is County, Wis. are not necessary.) permanent. (if not, state expiration date: .Names of persons signing in any capacity should be typed or printed beb~w their signatures. IIC. udie,fo,ess„F1119 STATIC BAR OF WISCONSIN ~_L . FORM No. I bad Sswk No. 15001