HomeMy WebLinkAbout022-1005-10-100
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T~~~Tn 7~T~TrK NNIC 3.28 11 3 j(~~~N ''''~~jj AVE. County:
'-Vt/i3tbtrSi~Cl~irtrRBMb~tTdG3ff~, ~R~A~E' StWA~ S~~~t M
Labor and Human Relations INSPECTION REPORT ST. CROIX
Safety and Buildings Division
(ATTACH TO PERMIT) Sanitary Permit No-:
GENERAL INFORMATION 171461
Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.:
JOHNSON. CHARLES KINNICKINNIC Parcel Tax No.:
CST BM Elev.: Insp. BM Elev.: BM Description: / Z
02 -1005-10-0 0 .
TANK INFORMATION ELEVATION DATA A9200234 RZ
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic j1dE) Benchmark L8- ob
Dosing '$6,"'1- _20 Ol~.(PZ r
Aeration- Bldg. Sewer
r
Holding St/)ft Inlet ' 96,71
TANK SETBACK INFORMATION St/ yt Outlet G 23 r
Z
TANK TO P / L WELL BLDG. Ventto Air Intake ROAD Dt Inlet A),
Septic 7 !~f ' Z NA Dt Bottom ZS
Dosing /GfC~ BS NA UeaAet/ Man. /sl• g S~v
~~i
AeraUen' NA Dist. Pipe
Holding Bot. System 92,90
PUMP/ SHWM INFORMATION Final Manufacturer Dem d C
~~~3.~3
Model Number :OL of GPM
TDH Lift-U,V Friction Syste T D H l.', qFt
oss H
Forcemain Length r Dia. y~ Dist. To well
SOIL ABSORPTION SYSTEM
BED / TRENCH Width ry i Length 7 / No. Of Trenches PI DIME No. Of Pits inside Dia. Liquid Depth
DIMENSIONS jf Manufacturer:
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHI
SETBACK CHAMBER
INFORMATION Type O A-0 A Mo 91%m er:
System: 19,2 OR UNIT
DISTRIBUTION SYSTEM
/Manif old DistributionPipe(s)'x Hole Size,, x Hole Spacing VentToAirIntake
E~7 ~ Dia. 2 Length Dia. Spacing __~Z / ve
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over „ Depth Over , f xx Depth Of r t xx Seeded/ Sodded xx Mulched
/
AJAj Bed ii-~Center / Bed / Trench Edges J Topsoil G E] Yes El Yes q•k0___
N
Vii.: COMMENTS: (Include cod~crepanues, persons present, etc.)
~r
- G.i'Y lw" < F
Plan revision required? ❑ Yes No
Use other side for additional information. /,)I W All ~1
SBD-6710 (R 05/91) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
Y '
SANITARY PERMIT APPLICATION ZaILHR
In accord with ILHR 83.05, Wis. Adm. Code
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than ❑ '71 /(0
8% x 11 inches in size. Ch 1k if revision to prevao s application
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBS
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. - G (TG
PROPERTY OWNER PROPERTY LOCATION
)e A N r-,- '/4 xr a '/4, S 3 T , N, R l (or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
Q-A 6 vu r €'T1, ST . I iv 4-
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
L' Fu,1, s o TL- I/S 42,r-8706 N
El II. TYPE OF BUILDING: (Check one) ❑ State Owned VILLAGE : if ` -G NEA ST ROAD
vuw~e KaNw `
❑ Public 191 or 2 Fam. Dwelling-# of bedrooms --2- PAR LAX NU BE )
III. BUILDING USE: (If building type is public, check all that apply) a S _ l
1 ❑ Apt/Condo
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 90 Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. R New 2.E] Replacement 3.E] Replacement of 4. ❑ Reconnection of 5. ❑ 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 Ill Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 430 Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 12. 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
4.50 595 7 >v A- D Feet l ~G Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel glass Plastic App
Tanks Tanks structed
Se tic Tank or Holdin Tank /OCC )V14- /C'oO 1 1te
Lift Pum Tan i hon Chamber, 0 900 w N` CO Q,-El Ll El I El El
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 Stamps) MP R Business Phone Number:
Ov-
Plumbers Address (Street, City, State, Zip Code):
10 ' T ate- .5 o. , P` L.c,
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Faessued Issui Agent Signature (No Stamps)
Surcharge Fee)
~ppproved ❑ Owner Given Initial Ic- `1
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a 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.
11. 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; (Jose 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.
- -
GROUNDWATEIR 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)
SAFETY & BUILDINGS DIVISION
State of Wisconsin
Department of Industry, Labor and Human Relations
PRIVATE SEWAGE PLAN APPROVAL Northwest Regional Office
209 West First Street
Route 8, Box 8072
Hayward, Wisconsin 54843
CARL P HEISE Owner: CHARLES JOHNSON
1042 S MAIN 228 N FORTH ST
RIVER FALLS WI 54022 RIVER FALLS WI 54022
RE: Plan Number: S92-20461 Date Approved: June 4, 1992
Gallons Per Day: 450 Date Received: June 2, 1992
Project Name: JOHNSON, CHARLES Location: NW,NW,3,28,18W
Town of KINNICKINNIC '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
NOTE: Mound must be installed along the 96.80 foot contour line.
Inquiries concerning this approval may be made by calling (715) 634-4870.
i
u ~
SH D -6423 (R. 0"1)
v SAFETY & BUILDINGS DIVISION
.
State of Wisconsin
Department of Industry, Labor and Human Relations
CARL P HEISE
Page 2
Sincerely,
16y- 9M0~~
LEROY G. JANSKY
Section of Private Sewage
Division of Safety and Buildings
cc: CHARLES JOHNSON X Private Sewage Consultant
I
S R D 6423 IR. 0 1/811
MOVE THE EARTH
AILPORT EXCAVATING
1042 South Main -
RIVER FALLS, WI 54022
CARL P. HEISE (715) 425-2175
Owner
MOUND SYSTEM
FOR
A BEDROOM RESIDENCE
LOCATED IN THE !y€ !4 OF THE E OF SECTION T23 N, R W, -IV TOWN OF_pt~,y COUNTY, WISCONSIN.
INDEX
PAGE 1 of 6 TITLE SHEET
PAGE 2 of 6 PLOT PLAN I I t:'
PAGE 3 of 6 PLAN VIEW-CROSS SECTION
PAGE 4 of 6 DISTRIBUTION PIPE'LAYOUT
PAGE 5 of 6 PUMPING CHAMBER
PAGE 6 of 6 PUMP PERFORMANCE CURVE
PREPARED FOR
C~apvl6S ~ r, ,o~Kso'l)
228 N. FOrrh sT.
R%vcr &Q51 54027.
PREPARED BY
CARL P. HEISE
CST-3314 MPRS-3378
1042 SOUTH MAIN
RIVER FALLS, WI 54022
PIRWATE SEVIJAGE SYSTEM
0ncl Iionc.IYv
,1
l
IEPARTMENT OF IONS ND2 0 6
+ USlr ~A ~ ~ i~ v
DIVISION OF SAFET( Fji<:. GJIL.~INGS c !
SE'_ CORRE FEN-
P1oT P A~
a
I ~CR~~~/~6ZCEL
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slope a a
WooOED AttER J' 3
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8o~a Puc FORCE r,p~'w
BM TdQ o~ a,~~~P,p, a''obovyiol~ O 800 W WGEKSCOwC PKov
NRPL~QP
/4bSume IFl.lopq PUMP CHAMSER
ScA. 1.I ao'
" Ovc
o toao G.AL W EEks CowG
SEPTIC- 'rh*JK
QoPoy~.l O Pw~Qa5e44 11A to -W Pvt
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QNS
T OF INDUSTI; i t_RF%0~~~~,gU~LDINGS
DEPARWEN DIVISION OF SAFETY'
C ~ pCtvl~C-P ' E
E C
J
- °.w ~eop }f~y Z.• TO 130 Au
nt'~G~ 3 OF, 6
LO-m s~' or St-row,`,karsh Hay, Or
AppttovEa Synthetic Covering
Distribution Pipe
Medium Sand I ,
Topsoil -a..- -~c
F EL , 0
3 D % up5t.:. ~R
% Slope
Bed Of 1'0-212, Force Main Plowed
Aggregate From Pump Layer
D __FT-
'
Cross Section Of A Mound System Using E 11127.
PNiVATE SE\N.,,\QE AYI§~a~+br The Absorption Area F -iq -
G . 0 rr.
J
fb f2Ga d~ L ai G ~'r: ~ ~ L
A _.l Ft. H . _T-T. .
B 417 Ft.
I , Ft.
DEPARTMENT OF INDUSI RY P.ciA160NS J ~ Ft.
DIVISION OF SAffTY AND BUILDINIGS
K Ft.
IDENC L Ft.
scca oRReS~
2 ,'l putt MbiA7 4..
W Ft.
Observation Pipe--,\
g K
7 l
•I~
- --------------------I I l1yi 1
-W :T
Distribution Bed of z~- 2 %Z .
'Pipe Aggregate ,
Observation Pipes Permanent Markers
r
Plan View Of Mound• Using A -Bed For The Absorption Area
Forloroled Pipe Dololl
End Vio.
•Frrtorotto
Eno Cop PVC Frpt
°O,y office Lrr.~ l orolad or. Bottom,
O Cr( E ououy Spoced
I
p s.
PVC Fcrce'Moin
From Pump
PVC
MonilolG Pipt '
.
Il
DwI loutior•
rpipr
Lost Hole Should Br I
to End Cop
tors Car. Nctribution PIDt Lovout -
P 0~
S q
X 48
Y 4B~
Hole Diameter V4 Inch
Manifold " Inches
Force Main " ' Inches
Lateral " I Inch(es)
Holes Per Lateral y
~~~4 •~2 -i2o - /~B -z~G -~2 G4
PRIVATE SEWAGE SYSTEM
• ~2r~a ~E P~ L2 ~ :R tic •
G
DEPARTMENT OF ADUSTRY LAGO„ ~,P:D" l li ibi'AN RELA710NS
DIVISION OF SAFETI' ANI) LU!LDIlvGS
SEA OESP ENCE
' PAGE _L_ OFSrZ
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS'
VEIJ CAP
4*C.T.. VENT PIPC WEATHER PROOF APPROVED LOCKING
7 JUAICTION DOX MANHOLE COVER w~ Pt}p~o
25' FROM DOOR, IL•MIU.
WINDOW OR FRESH I
AIR IIJTAKE L`L tqpp,ox q,)
GRADE
`i• MIN.
COWDUIT
INLET PRi ATE SEVVA" F_ ~_;•yl~gn~S~E
_T AiRTIGHT SEAL I I i I
. ~ I v
~lFtG ~~`7.e.s rGf I I
APPROVED JOILIT A I I i ( APPROVED JOINTS
w/c.z. PIPE { I I I w/c.=. PIPE
CYTCNDIIJG 3 I II ALARM EXTENDILIG 3'
O►JYO 60610 601 L r I I I ONTO SOLID 6016
s
TM ENT Or INDUSTRY LABOH, Ai`;D HUMAN REIA-1IONS ( I ON
C DIVISION OF SAFETY AND BUILDINGS ( 1
I
LLCV. qQ,.Q. FT. n _ __j
EE COQ, . -SPO ENCE r, orF
0
EL 9 COUCRETE 9LOCK
RISER EXIT PERMITTED OWLtl IF TANK MANUFACTURER HAS SUCH APPROVAL S"pPPRoVi<t
SPEC.IFICATIOI~JS
SEPTIC
DOSE Wetk!, Cuh4 Jla/ NUMBER OF OOSCS:
TA~IK~ MANUFACTURER. 4 PER D/►y
. i z-s sue' .
TANK LIZE: 900 GALLOWS DOSE VOLUME , " 3Y
INCI.UDINCs OACKF60w: -46- GALLONS
ALARM MANUFAGTURGit: ,3, ( 4.;k-e .0
MODEL WUMBCR: 0LV CAPACITIES: A=.. I)jCI4E5 09 11 Z ALLONS
• SWITCH TUPC: W1 t yr wr 5= 2 IIJCHEZ OR ..Z~ 06LL01JS
PUMP MANUFACTURER: ZOtI(cv C, - , IIJCHES OR• `G d'eW5
MODEL NUMDCR: IJ' 22 0 s _ /2- INCHES OR - 219 0GALLON6
SWITCH TYPE: hAGrCwr~ ATE: PUMP AND ALARM ARE TO OC
MINIMUM DISCHARfiE RAPE ~8•~8 GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE DETWELIJ PUMP OFF AIJO..DISTRIBUTIOW PIPC.. 13.3 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . 2.5 FLET
+ -B 0 FEET OF FORCE MAIN X 1.3 FYofLFRICTIOU FACYOR.. Imo- FEET 1•24
TOTAL DIJWAMIC. HEAD FEET
ILITERLIAL DIMEIJSIOW~ OF TAWK: LEIJCPTH ;WIDTH ..._.;LIQUIO DEPTH 4.4
l g.2 c w
SIGNED: LICEIJSE IJUMBEFU 9 OATE:
Y
N F-
cr w
W W
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W
115
i 34
110
32 105
® 30 100 -
95
28
90
26 85
80
24
EF
FLUENT MODEL
and Q 75 MODEL 189
W 22 165
I
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DEWAT
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= v 20
~ --65'-
Z 18 --60-
55-
_j
16
Q MODEL
50
O 163 MODEL
1- 14 45 188
12 40-
35
10 MODEL
30 MODEL
137, 139
8 185
25,
6 20 MODEL
15 _.M DEL 161
4 4
10
MODEL
2
5 53, 55,
5T, 59
0
GALLONS 10 20 0 40 50 60 70 80. 1 90 100 110
LITERS 0 60 240 320 400
C52 e.o $
FLOW ER MINUTE
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STC - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER
ROUTE/BOX NUMBER ✓ 14 A;1vV/d_. /I~.y.YJCi }b FIRE NO.
CITY/STATE U6-A JE; Ile, 6U)14e ZIP ✓`1d-4- 'Z-
PROPERTY LOCATION: Aii~ 1/4 h,, F- 1/4, Section T,~Z 6 N, R f 9 W,
Town of k.-k n, St. Croix County,
Subdivision Lot No.
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
$3000 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
systems properly maintained.
The property owner agrees to submit to St. Croix County Zoning a certification
form, signed by the owner and by a master 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. Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and ag,ree to maintain
the private sewage disposal system in accordance with the standards set forth,
herei,n, as set by the Wisconsin Department of Natural Resources. Certification
form must be completed and returned to the St.Croix County Zoning Office within
30 days of the three year expiration date.
SIGNED E
DATE C 3 ' 9~
St. Croix County Zoning Office
St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
(715) 386-4680
Sign, Date, and Return to above address
S
APPLICATION FOR SANITARY PERMIT
STC - 100
:s application form is to be completed in full and signed by the owner(s) of the
)perty being developed. Any inadequacies will only result in delays of the permit
iuance. Should this development be intended for resale by owner/contractor, ("spec
ise"), then a second form should be retained and completed when the property is
!d and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ier of Property
ration of Property 14, Section fdd , T ~2eN-R_tk W
rnship ~r~vi.c h vh'K~.
cling Address
iress of Site
bdivision Name _ YV O~
t Number 11; ZL '
evious Owner of Property &t~ 6
tal Size of Parcel D
to Parcel Was Created
e all coxpers and lot lines identifiable? /X Yes No
this property being developed for resale (spec house) ? Yes --'7 No
lume and Page Number as recorded with the Register of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
Warranty Deed which includes a Document number, volume and page number, and the
al of the Register of Deeds. In. addition, a certified survey, if available, would be
lpful so as to avoid delays of the reviewingrocess-.- fif-the-deed description refer-
•~P
ces to a Certified Survey Map, the Certified' Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY.OWNER CERTIFICATION
(we) CVLU,6y that aQ,e d•tatementa on th"' oAm ane tltue to the but o6 my (om)
ow.tedge; that I (we) am (ane) the ownen(d o6 the phopenty ducAi•bed in th,i6
6ohmation 6oAm, by vi tue o6 a wak&anty deed heconded in the 066.ice o6 the
unty Regizteh o6 Veeddas Document No. h8AIA ; and that I We) pnesentty
n the pnoposed .6 to bon the sewage dupod dyd em (on 1 (we) have obtained an
cement, to nun with the above d6chi.bed pnopenty, bon the construct on o6 said
btem, and the same had been duty A corded in the 066.ice o6 the County Reg"ten o6
eds,. ad Vocument No.
GHA 7 OIL OWNEF~% SIGNATURE OF CO-OWNER (IF APPLICABLE)
.TR' SIGNED
DATE SIGNED
-Aim
5666 off No.
IN111p1ANTY a y:,~ ~,a~ 't
484' 41 "L 955 PA(pst
This D90C, m ads bslwwa .....isrl.and..R.... Walfgang..end ~
..a iic1. ..A„ ~Jabua mil . d x:30` P. .
. . . . . .
TW am .:M araNer.•im :.mumble so..~a.eatie T '
Gnaws re......................................... t5~ ~::Gx~ic.:
y
Guam C"Ift. State of Wiseasin.`i
h
sy Part of NEC of NEC of Section 3-28-18
described as follows: Lot 1 of Certified Tm Pared No: -
Sulrve Map filed June 29 1992 in Vol. 02991 , Paga
2489 (No. 17); also that part of NA of lit of
Section 3-28-18 lying Northerly of Interstate Hwy. "94".
i.
ti
TAM X. AAyet)..... bnmftmd promty
! Tocadwr -with an and darmlar ft beredihawob and apparwaaaest the mato belonging;
AM.....A.aland..RA..Iiolf&ang...and.. Gl.aria..1,...Asauasan
wassaaa chat do we bl Sped. ddtfee-01 M fat dmplt and free and char of tneambraactt accept
easements, restrictions, and rights-of-way of record, if any,
am will warI and 4~ * meas.
Dead this 5the der of ,Jp M.................................................... 1f.~2
p .(BEAL) )
• • land..R....Walfg s
{ .....................................................................(SEAL) o l7JIJl)LGdL.~i~./..........(alJtW
• • G1oria.. J....Asmussen...................
AOTIIUNTICATION AC=NOW LUDGUZUT
SipmAars(s) STATE OF WISCONSIN r.
mm.
St. Csoix
amlibmAkstmd fib .......Am et......................... 19...... .Pasonarir cams befera m fbM 1Sth .,&W at
aim ...................I 19..n ft S1*" am.d
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• .............~>.nl~~e~..,i ~..~1►um~u~aaa........
'PITi.Z:1[OMER STATZ SAIL OF WISCONSIN f
(aal~Umm ~id~~b1 i 706.Od.~~►ii. .
to me knowaM bo ft
foregoing ibns.
THIS 1NSTRI019M WAS ORAITW eT ~J w
rneX Marl!.. 7.~R1/f~..w W
54022
...F4.114 x..Wl..... Notarr Pablie L
(Signatures be autbrntieated or acknowledged. Both C°°°mi 11... 94
necessary.) 19.........)
•lfa~r of Maw desks is ass amm" dmm be er" or PH*" bow tlr4 dpaaaw.
WAU os
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Y. t
REPT131 . KINNICKINNIC ST. CROIX COUNTY ZONING PAGE 1
09/24/92 15:58 REQUESTS FOR INSPECTION WORK SHEETS FOR: 9/25/92 AREA: JT
Activity: A9200234 9/25/92 Type: MOUND Status: PENDING Constr:
Address: KINNICKINNIC 3.28.18.33, NE,NE, 130TH AVE.
Pardel: 022-1005-10-000 Occ: Use:
Description: 171461
Applicant: JOHNSON, CHARLES Phone:
Owner: JOHNSON, CHARLES Phone:
Contractor: HEISE, CARL P. Phone: (715)425-2175
Inspection Request Information.....
Phone:
Requestor: HEISE, CARL
Req Time: 10:09 Comments:
Items requested to be Inspected... Action Comments Time Exp
00012 FINAL INSPECTION
Inspection History.....
Item: 00012 FINAL INSPECTION
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
~t s ST. CROIX COUNTY COURTHOUSE
911 FOURTH STREET 0 HUDSON, WI 54016
(715) 386-4680
May 28, 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 Lee Wolfgang property, located in
the NE 1/4 of the NE 1/4 of Sec. 3, T28N-R18W, Town of
Kinnickinnic, St. Croix County has been conducted. This onsite
revealed suitable soils at a depth of 26" below which seasonally
saturated soil conditions were observed. This site will require
12" of sand fill beneath a mound for new construction.
Should you have any questions, please feel free to contact this
office.
in erely,
James K. Thompson
Zoning Administrator
cj